Blood donation practices, processing and utilisation of blood components in government tertiary hospitals in Nigeria: a multicentre cooperative study.

BACKGROUND: Timely access to safe blood and blood components is still a challenge in Nigeria. This study aimed to determine blood donation practices, processing and utilization of blood components across government tertiary hospitals (THs) in Nigeria. METHODS: This was a descriptive cross-sectional study done in Nigeria in June-July 2020. Data were analysed with SPSS version 21.0. RESULTS: Data were collected from 50 THs. The majority (68%) of the THs lack facilities for blood component preparation and only 18% and 32% provide cryoprecipitate and platelet concentrate, respectively. Whole blood was most commonly requested (57.04%). All facilities tested blood for HIV, HBV and HCV, but the majority (23 [46%]) employed rapid screening tests alone and nucleic acid testing was not available in any hospitals. The manual method was the most common method of compatibility testing in 90% (45/50) and none of the THs routinely perform extended red cell typing. The average time to process routine, emergency and uncross-matched requests were a mean of 109.58±79.76 min (range 45.00-360.00), 41.62±25.23 (10.00-240.00) and 11.09±4.92 (2.00-20.00), respectively. CONCLUSION: Facilities for blood component preparation were not widely available. Concerned government authorities should provide facilities for blood component preparation.

Antimicrobial analysis of honey against Staphylococcus aureus isolates from wound, ADMET properties of its bioactive compounds and in-silico evaluation against dihydropteroate synthase.

BACKGROUND: One of the main challenges of wound healing is infection with multi-drug resistant (MDR) bacteria such as Staphylococcus aureus. The spectrum of antibiotics used to treat them is declining; thus, there is a need for alternatives. Our study was designed to evaluate the antimicrobial properties of honey, its pharmacokinetics (ADMET) properties and in-silico analysis of its bioactive compounds against dihydropteroate synthase of S. aureus using trimethoprim as control. METHODS: Standard protocols were employed in collection and preparation of samples, generation of canonical strings, and conduction of microbiological analyses. Bioactive compounds' ADMET properties were evaluated using the SWISSADME and the MCULE toxicity checker tools. The MCULE one-click docking tool was used in carrying out the dockings. RESULTS: The gas chromatography-mass spectrophotometry revealed twenty (20) bioactive compounds and was dominated by sugars (> 60%). We isolated a total of 47 S. aureus isolates from the wound samples. At lower concentrations, resistance to trimethoprim (95.74 to 100.00%) was higher than honey (70.21 to 96.36%). Only seven (7) isolates meet Lipinski's rule of five and ADMET properties. The docking scores of the bioactive compounds ranged from -3.3 to -4.6 while that of trimethoprim was -6.1, indicating better binding or interaction with the dihydropteroate synthase. The bioactive compounds were not substrates to P450 cytochrome enzymes (CYP1A2, CYP2CI9 and CYP2D6) and p-glycoprotein, indicating better gastrointestinal tract (GIT) absorption. CONCLUSION: The favourable docking properties shown by the bioactive compounds suggest they could be lead compounds for newer antimetabolites for management of MDR S. aureus.

Evaluation of Annona muricata extract against Staphylococcus aureus isolate and in-silico activity of bioactive compounds against Capsular protein (Cap5O).

BACKGROUND: Staphylococcus aureus has prevailed against the majority of antibiotics currently in clinical use, making it a significant global public health problem. As a safer alternative, bioactive compounds have been explored. Annona muricata has been shown to possess antimicrobial activity. However, there are few reports on the molecular activity of A. muricata bioactive compounds against S. aureus. Thus, this study was aimed at evaluating the antimicrobial activity of its crude extract as well as investigating the potential of its bioactive compounds against the Cap5O capsular polysaccharides (CPS) of S. aureus via molecular docking. METHODS: Collection of plant leaves, preparation of extracts, anti-nutrient analysis, phytochemical screening via crude method and gas chromatography-mass spectrophotometer (GC-MS), isolation and characterization of S. aureus and the antimicrobial activity test were all done using standard protocols. Molecular docking was done using the MCULE online tool with emphasis on docking scores, toxicity, and other properties. RESULTS: Crude screening of the extracts showed the presence of polyphenols, hydroxyanthraquinones, reducing compounds, flavonoids, saponins, glycosides, alkaloids, anthraquinones, phlobatannins and tannins in different concentrations. Anti-nutrient analysis showed the presence of allowable levels of evaluated anti-nutrients. GC-MS revealed a total of twenty-nine (29) bioactive compounds, out of which only 4 (13.80%) docked without toxicity and these were bicyclo[4.1.0]heptan-2-one 6-methyl, trichloromethane, carbonic acid 2-dimethylaminoethyl propyl ester, and 1-methyl-4-phenyl-5-thioxo-1,2,4-triazolidin-3-one on either the NAD-binding or C-terminal substrate binding domain of Cap5O. CONCLUSION: Results obtained show that Cap5O could be a potential drug target for multi-drug resistant S. aureus, however, further studies aimed at evaluating these bioactive compounds individually and in combination are highly needed.

Invasive Pulmonary Cryptococcal Infection Masquerading as Lung Cancer with Brain Metastases: A Case Report.

Cryptococcosis, a global disease problem, seen frequently in the immuno-suppressed, also affects patients without apparent immuno-suppression. Pulmonary cryptococcosis patients often present as cryptococcal pneumonia, whereas intracranial cryptococcosis presents with meningitis. We present a 33-year-old immunocompetent man, diagnosed with invasive pulmonary cryptococcal disease with spread to the brain. This case is unique because the patient was previously treated for tuberculosis and presented with typical bronchopulmonary thoracic, extra-thoracic as well as computed tomography (CT) scan features suggestive of lung cancer. Cryptococcosis was diagnosed by identification of oval thick-walled yeast on histology of lung biopsy specimen. The patient was treated with flucytosine and fluconazole initially and subsequently with Amphotericin B and fluconazole. He made clinical improvement with the resolution of symptoms but had residual radiological features. Invasive cryptococcosis affecting the lung and brain may present with a clinical picture similar to metastatic lung cancer. We recommend routine fungal stains and fungal culture in suspected cases.

La cryptococcose, une maladie mondiale, fréquemment observée chez les sujets immunodéprimés, affecte également les patients sans immunodépression apparente. Les patients atteints de cryptococcose pulmonaire se présentent souvent comme une pneumonie cryptococcique tandis que la cryptococcose intracrânienne se présente avec une méningite. Nous présentons un homme immunocompétent de 33 ans, diagnostiqué avec une maladie pulmonaire invasive cryptococcique avec propagation au cerveau. Ce cas est unique car le patient a déjà été traité pour tuberculose et s'est présenté avec des caractéristiques bronchopulmonaires thoraciques, extra-thoraciques ainsi qu'une tomodensitométrie (TDM) typiques suggérant un cancer du poumon. La cryptococcose a été diagnostiquée par l'identification d'une levure ovale à paroi épaisse sur l'histologie d'un échantillon de biopsie pulmonaire. Le patient a été traité initialement par Flucytosine et Fluconazole, puis par Amphotéricine B et Fluconazole. Il a fait une amélioration clinique avec la résolution des symptômes mais avait des caractéristiques radiologiques résiduelles. La cryptococcose invasive affectant le poumon et le cerveau peut présenter un tableau clinique similaire au cancer du poumon métastatique. Nous recommandons des colorations fongiques de routine et une culture fongique dans les cas suspects.

Neurofibromas as bilateral cystic chest wall swellings.

A 35 year old male farmer presented with soft bilateral posterior chest wall swellings. He had no similar swellings elsewhere. There were no associated symptoms, except cosmetic deformity and discomfort when he lies on his back. A clinical diagnosis of posterior chest wall lipomata was made. However at surgery, the two tumours were completely cystic. Following total excision, histology of the two tumours revealed cystic degeneration of neurofibromas. His postoperative recovery was uneventful. The importance of this report is to emphasize the need for histological examination of all excised human tissues, which is not always the case in most of our rural areas and to document the discovery of such a rare clinical entity in our centre. This rare entity should be borne in mind when considering the differential diagnosis of benign cystic chest wall tumours.

A Prospective Study of Blunt Abdominal Trauma at the University of Calabar Teaching Hospital, Nigeria.

BACKGROUND: Blunt abdominal trauma (BAT) usually results from motor vehicle accidents, assaults, and recreational accidents or falls. This communication is a 3-year report of an ongoing study aimed at providing the current BAT prevalence in our center. It is hoped that this would assist in a better design of prevention and emergency trauma response systems to cope with this epidemic. METHODS: All of the patients admitted to the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria, from February 2005 to January 2008 were prospectively studied based on a questionnaire. Hemodynamic stability and sonography formed the basis for selecting patients for non-operative management (NOM); others were offered laparotomy. RESULTS: In total, 4,391 emergencies were seen during the study period, of which 1,654 (38%) were due to trauma. Seventy-nine patients with abdominal trauma accounted for 4.8% of trauma cases. Forty-two (53%) patients suffered BAT and their ages ranged from 14 and 56 years (mean 28.4 years), with a male:female ratio of 2.5:1. Road traffic accidents accounted for 13 (87%) and 26 (96%) patients in the NOM and laparotomy groups, respectively. The most commonly injured organ was the spleen in both groups: 8 (50%) and 15 (56%) in the NOM and laparotomy groups, respectively. Fifteen (36%) patients were managed successfully in the NOM group. CONCLUSION: Trauma was mainly due to road traffic injuries. Hemodynamic stability and ultrasonography effectively selected patients for NOM. The establishment of trauma systems, provision of ancillary diagnostic and monitoring facilities, well-designed roads and traffic infrastructure, and health education on road safety would reduce injury, morbidity, and mortality.

A Prospective Study of Penetrating Abdominal Trauma at the University of Calabar Teaching Hospital, Calabar, Southern Nigeria.

BACKGROUND: Abdominal injuries are on the increase in both developed and developing countries. The frequency of penetrating abdominal trauma (PAT) varies across the globe because it relates to industrialization, the weapons available, and the presence of military conflicts. This study sought to evaluate the current pattern and outcome of managementof PAT in Calabar, which is undergoing rapid urbanization, and with a focus on tourism. METHOD: Patients admitted to the University of Calabar Teaching Hospital, Calabar with PAT from February 2005 to January 2008 were prospectively studied. RESULTS: Seventy-nine patients presented with abdominal trauma, among which 39 (49%) were PAT. There were 37 males and two females, whose ages ranged from 5 to 54 years (mean 27.8 years). Stab wound (18; 46.1%) was the commonest injury, while gunshot wound (15; 38.5%) ranked second. Others were road traffic accident (two patients), fall, cow horn injury, shrapnel, and criminal abortion (a patient each). The commonest injury was evisceration of the omentum and small intestine, which occurred in 13 (36%) patients. Five (14%) patients suffered small intestinal perforations, while three (8%) had liver, splenic and colonic injuries, respectively. Others were rectal injury (four patients), mesenteric injury and perforated stomach (two patients each), and a patient with diaphragmatic injury. The outcome was fatal in two (5%) patients. CONCLUSION: Penetrating abdominal trauma is on the increase in Calabar. The pattern of injury revealed areas which, when effectively contained, will lead to an improvement in the safety of our environment.