Serum leptin levels and relationship with maternal weight gain at term among obese and non-obese pregnant women in Enugu, Nigeria: a comparative cross-sectional study.

OBJECTIVE: To determine and compare the mean maternal serum leptin levels, the prevalence of high serum leptin levels and mean gestational weight gain at term among obese and non-obese pregnant women in Enugu, Nigeria. METHODS: This cross-sectional comparative study enrolled obese and non-obese pregnant women. The serum leptin levels of the women were determined using an enzyme-linked immunosorbent assay kit. Anthropometric and sociodemographic data were obtained and compared. Mean weight gain during pregnancy was determined. RESULTS: A total of 170 pregnant women were included in the study. The mean ± SD serum leptin level (99.39 ± 50.2 ng/ml) and the prevalence of hyperleptinaemia (81 of 85 patients; 95.3%) among the obese pregnant women at term were significantly higher than those of the non-obese pregnant women (48.98 ± 30.35 ng/ml/65 of 85 patients; 76.5%). The mean percentage weight gain was significantly higher in the non-obese women compared with the obese women at term. The predictors of high maternal serum leptin level at term among the participants were the employment status and levels of education of the participants. CONCLUSION: Maternal serum leptin level, maternal weight gain and prevalence of hyperleptinaemia at term were significantly higher in the obese compared with the non-obese pregnant women.

COVID-19 in hematological malignancies: Case series and literature review.

Earlier reports suggest that cancer patients were twice more likely to contract severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this report, we describe two patients with hematological malignancies seen at the peak of the first wave of the coronavirus disease 2019 pandemic. A 61-year-old man was referred to our urology unit he was diagnosed with nodular hyperplasia and multiple myeloma and commenced on bortezomib, thalidomide, and dexamethasone combination chemotherapy. He developed a cough and fever, with SPO2 86%, He was positive for SARS-CoV-2 and died a few days later. A 42-year-old man with Hodgkin lymphoma on treatment with Adriamycin, bleomycin, vincristine, and dacarbazine with positive SARS-CoV-2 exposure was diagnosed with pleural effusion at A/E. Three days postadmission, his condition worsened with low SPO2 despite intranasal oxygen. He died after testing positive for SARS-CoV-2. Patients with hematological malignancies tend to have a greater risk of SARS-COV-2 infection and severe disease due to immunosuppression from cancer and its treatment.

Résumé Des rapports antérieurs suggèrent que les patients atteints de cancer étaient deux fois plus susceptibles de contracter le coronavirus 2 du syndrome respiratoire aigu sévère (SARS-CoV-2) infection. Dans ce rapport, nous décrivons deux patients atteints d'hémopathies malignes vus au plus fort de la première vague de la maladie à coronavirus pandémie de 2019. Un homme de 61 ans a été référé à notre unité d'urologie. On lui a diagnostiqué une hyperplasie nodulaire et un myélome multiple. commencé une chimiothérapie combinée bortézomib, thalidomide et dexaméthasone. Il a développé une toux et de la fièvre, avec SPO2 86%, Il était positif pour le SRAS-CoV-2 et est décédé quelques jours plus tard. Un homme de 42 ans atteint d'un lymphome hodgkinien sous traitement par adriamycine, bléomycine, la vincristine et la dacarbazine avec une exposition positive au SRAS-CoV-2 ont reçu un diagnostic d'épanchement pleural à l'A/E. Trois jours après l'admission, son l'état s'est aggravé avec une faible SPO2 malgré l'oxygène intranasal. Il est décédé après avoir été testé positif au SRAS-CoV-2. Les patients atteints d'hématologie les tumeurs malignes ont tendance à avoir un risque plus élevé d'infection par le SRAS-COV-2 et de maladie grave en raison de l'immunosuppression du cancer et de son traitement. Mots-clés: Traitement du cancer, tumeurs malignes hématologiques, immunosuppression, syndrome respiratoire aigu sévère coronavirus 2.

Adherence to prophylaxis and bleeding outcome: A multicenter Nigerian study.

In Nigeria, low-dose prophylaxis is the standard of care as it reduces bleeding, development of target joints, arthropathy, and improvement of quality of life. Non-adherence or poor adherence can prevent the achievement of these outcomes. The levels and determinants of (non-)adherence among persons with haaemophilia (PWH) in Sub-Saharan Africa have not been evidenced. We aimed to evaluate self-reported adherence among PWH, provide evidence of determinants/predictors of adherence, and establish the associations between nonadherence and presence of target joints and annualized bleed rate. A cross-sectional survey of 42 participants on low-dose prophylaxis recruited during outpatient appointments in 5 haemophilia treatment centers in Nigeria. We used the validated Haemophilia Regimen Treatment Adherence Scale- Prophylaxis (VERITAS -Pro), 24 questions on six subscales (time, dose, plan, remember, skip, and communicate) questionnaire. The options of VERITAS -Pro were represented in a 5 Likert scale and the possible subscale ranged from 4 points (most adherent) to 20 points (least adherent) and the possible total score ranged from 24 (most adherent) to 120 (least adherent) the cutoff for overall adherence put at > 61 to indicate nonadherence. Information on the presence of target joints, the number of target joints, and annualized bleeding rates were collected from medical files. The mean age of the participants was 9.79 (6.29) years, with 96.6% having hemophilia A and 79.3% having target joints. Overall adherence to the prophylaxis regimen was 81.0%. The mean total VERITAS-Pro for the adherent group and the non-adherent group was 37.35 ±9.08 and 63.0± 6.37, respectively. The mean subscale scores for the adherent group ranged from 0.67 (communication) to 8.68 (planning), while the mean subscale scores range from 1.0 communication to 13.88 (planning) for the nonadherent group. The mean difference of all except the dosing subscale was statistically significant with p<0.05. Only the skipping subscale showed a statistically significant positive correlation with ABR in the non-adherent group p = 0.02. The findings indicate that adherence was very good, and most were in communication with their treatment centers. The skipping subscale was significantly associated with ABR for the nonadherent group. Interventions aimed at improving adherence are the key to better treatment outcomes. A multicenter study was needed to assess the reason for poor adherence.

Iron supplementation and blood donation in Nigeria: Effect on Hemoglobin, red cell indices, and iron stores - The ranferon™ study.

Background: Iron-deficiency anemia is an important limiting factor to a sustainable supply of blood units, especially in low- and middle-income countries. Blood transfusion practice in Nigeria is poorly developed and structured with paucity of voluntary nonremunerated blood donors and high rate of donor deferrals resulting from low hemoglobin (Hb) levels. Aims: This study aimed to assess the effect of daily supplementation of iron using Ranferon-12 on Hb level, red blood cell (RBC) indices, iron level, ferritin level, and Hb recovery in blood donors in Nigeria. Methodology: This longitudinal study was conducted at a tertiary hospital blood transfusion center from March to July 2020. Blood samples of regular donors were collected at three points in the study for the measurement of Hb and hematocrit (HCT); RBC indices including mean cell volume (MCV), mean cell hemoglobin (MCH), and Mean cell haemoglobin concentration (MCHC); and iron stores including serum iron, serum ferritin, and serum transferrin. The first point was at recruitment before donation of one unit of blood; the second point after the blood donation; and the third point at 6 weeks post blood donation. Following donation, participants were placed on Ranferon capsules (iron fumarate - 100 mg elemental iron) and 100 mg of tablet Vitamin C, for 6 weeks. Results: There was a moderate significant positive correlation between administration of Ranferon and change in the values of HCT, MCV, MCH, red cell distribution width, ferritin, and transferring (P < 0.05). Percentage recovery of Hb, red cell indices, and iron stores parameters after 6 weeks of daily Ranferon ranged between 89% and 100%. Conclusion: Iron supplementation using Ranferon capsule daily for 6 weeks enhances recovery of Hb, red cell indices, and iron stores with attainment of benchmark Hb levels for donation.

Résumé Contexte: L'anémie ferriprive est un facteur limitant important pour un approvisionnement durable en unités de sang, en particulier dans les pays à revenu faible et intermédiaire (PRFI). La pratique de la transfusion sanguine au Nigéria est peu développée et structurée avec une pénurie de donneurs de sang volontaires non rémunérés (VNRD) et un taux élevé d'exclusion des donneurs résultant de faibles taux d'hémoglobine (Hb). Objectifs: Cette étude visait à évaluer l'effet de la supplémentation quotidienne en fer à l'aide de Ranferon-12 sur le taux d'hémoglobine (Hb), les indices de globules rouges (RBC), le taux de fer, le taux de ferritine et la récupération de l'Hb chez les donneurs de sang au Nigeria. Méthodes: Cette étude longitudinale a été menée dans un centre de transfusion sanguine d'un hôpital tertiaire de mars à juillet 2020. Des échantillons de sang de donneurs réguliers ont été prélevés à trois points de l'étude pour mesurer l'Hb, l'hématocrite (HCT) ; Les indices RBC, y compris le volume cellulaire moyen (MCV), l'hémoglobine cellulaire moyenne (MCH) et la concentration moyenne d'hémoglobine cellulaire (MCHC) ; et les réserves de fer, y compris le fer sérique, la ferritine sérique et la transferrine sérique. Le premier point concernait le recrutement avant le don d'une unité de sang ; deuxième point ­ après le don de sang ; et troisième point ­ six semaines après le don de sang. Après le don, les participants ont reçu des gélules de Ranferon (fumarate de fer --100 mg de fer élémentaire) et 100 mg de vitamine C en comprimé, pendant 6 semaines. Résultats: Il y avait une corrélation positive significative modérée entre l'administration de Ranferon et le changement des valeurs de HCT, MCV, MCH, la largeur de distribution des globules rouges, la ferritine et le transfert (p < 0,05). Le pourcentage de récupération de l'Hb, des indices de globules rouges et des paramètres des réserves de fer après 6 semaines de Ranferon quotidien variait entre 89 % et 100 %. Conclusion: La supplémentation en fer à l'aide de la capsule de Ranferon quotidiennement pendant 6 semaines améliore la récupération de l'Hb, des indices de globules rouges et des réserves de fer avec l'atteinte des niveaux d'hémoglobine de référence pour le don. Mots-clés: Transfusion sanguine, donneurs de sang, ferritine, hémoglobine, anémie ferriprive.

Determinants of Obstetricians' Pattern of Care for Sickle Cell Disease in Pregnancy.

Background: Pregnancy in sickle cell disease (SCD) is high risk. With improved comprehensive obstetric care, pregnant females with SCD can achieve successful pregnancy outcomes, especially in resource-poor settings. Objectives: To determine the predictors of Obstetricians' pattern of care for SCD in pregnancy in Nigeria. Materials and Methods: Self-administered, pre-tested, pre-validated questionnaires containing 18 questions on demographic details of obstetricians, and their pattern of practice towards antenatal care for pregnant SCD patients were distributed to attendees of the 2018 conference of the Society of Obstetrics and Gynaecology of Nigeria (SOGON). Regression analysis was done to determine the possible predictors, and a significant level was <0.05. Result: Almost all the respondents (98.4%) considered pregnancy in SCD as high risk, and 96.2% proposed for preconception care in a tertiary hospital. The majority, (62%) agreed that antenatal visits in the first and second trimesters should be more frequent. The majority (96.2%) reported they would routinely order urine tests among other investigations. Majority of respondents,74.9% and 98.4% knew that foetal medicine specialists and haematologists should be part of preconception care team, respectively. Respondents' practice centre and designation, significantly contributed to their "willingness to consult a haematologist" (P = 0.004)," and willingness to consult a foetal specialist" (P = 0.047), while practice centre and practice population significantly contributed to their response to "ideal centre for management of SCD pregnancy": (P = 0.049), (P = 0.024) respectively. Conclusion: Obstetricians' level of training, practice centre, and practice population of pregnant women with SCD are significant contributors to their pattern of care towards antenatal care for pregnancy in SCD.

Prevalence of venous thromboembolism risk factors in hospitalized patients at the University of Nigeria Teaching Hospital, Enugu Nigeria.

Background: Venous thromboembolism (VTE) is a common and lethal disease. Assessing the risk factors will help to modify exposures. Aim: This study, assessed VTE risk factors in hospitalized patients at the University of Nigeria Teaching Hospital, Enugu. Patients and Methods: This was an observational, case-control study. Three hundred and fifty (350) patients were recruited for the study: This comprised 150 medical patients, 140 surgical patients and a population of 60 healthy control group. Subjects were evaluated once using the Caprini risk assessment model (RAM). Results: Over 50% of all hospitalized patients, were at risk for VTE. Surgical patients were at a higher risk than medical patients. Hemoglobin concentration was associated with the risk of VTE in surgical patients, while d-dimer was associated with VTE risk in medical patients. Conclusion: This study shows a high prevalence of VTE risk factors among hospitalized patients at the University of Nigeria Teaching Hospital.

Does Sickle Cell Disease Protect against HIV Infection: A Systematic Review.

OBJECTIVE: The aim of this systematic review was to investigate whether sickle cell disease (SCD) protects against human immunodeficiency virus (HIV) infection by determining the association between SCD and the incidence and virulence of HIV infection. METHODS: This is a systematic review that used MEDLINE, PubMed, CINAHL, and Academic Search Complete as data sources. Articles describing the relationship of SCD with HIV infection were included in this review. The effect measures were converted to correlation coefficients and synthesized accordingly to examine the putative protective role of SCD against HIV infection. Independent full-text screening and data extraction were conducted on all eligible studies. The risk of bias was assessed using the mixed methods appraisal tool. We employed a random-effects model of meta-analysis to estimate the pooled prevalence. We computed Cochrane's Q statistics, I2, and prediction interval to quantify effect size heterogeneity. RESULTS: SCD reduces the risk of HIV infection by 75% (odds ratio [OR] = 0.25; r = -0.36, p < 0.001; I2 = 71.65). There was no publication bias (Egger's t value = 0.411; p = 0.721). Similarly, risk of HIV virulence was reduced by 77% (OR = 0.23; r = -0.38; p < 0.001; I2 = 63.07). The mechanisms implicated in the protective influence of SCD include autosplenectomy, reduced CCR5 expression, and increased expression of heme and iron-regulated genes. CONCLUSIONS: SCD appears to protect against HIV infection and slows HIV progression.

Prevalence of venous thromboembolism and its associations in a large racially homogenous population of sickle cell disease patients.

To determine the prevalence of venous thromboembolism (VTE) among adult sickle cell disease (SCD) patients in Nigeria. METHODS: This was a multicentre retrospective study in which the medical records of adult SCD patients were reviewed. Information on demographics, steady-state haemogram, clinical phenotypes, duration of follow-up, history of VTE including risk factors and management was collected. RESULTS: Of the 509 SCD patients with a median (IQR) duration of follow-up of 2 years, 10 (2.0%) had VTE (9 DVT and 1 PE). Their median (IQR) age was 27 (22.8-30.3) years. Identifiable risk factors for VTE included positive family history (2, 20%) surgery, splenectomy, paraplegia and cancer (1, 10% each). No risk factor was identifiable in four persons. VTE had no significant association with age and gender. VTE was significantly associated with the following events: acute chest syndrome [p = .002, odds ratio (OR) 8, 95% CI 2.2-28.9], osteonecrosis [p = .012, OR 5.24, 95% CI, 1.45-18.91] and vaso-occlusive crisis [p = .035]. Also significantly associated with VTE were pulmonary hypertension [p = .001, OR 23.3, 95%CI 5.18-105.06] and stroke [p = .032, OR 9.35, 95%CI 0.87-53.25]. CONCLUSION: The prevalence of VTE among SCD patients in Nigeria is low. It is significantly associated with vaso-occlusive crisis, pulmonary hypertension and stroke.

Clinical screening for menorrhagia and other bleeding symptoms in Nigerian women.

Objective: The objective of the study was to evaluate the prevalence of perceived bleeding symptoms in Nigerian women and the usefulness of a simple clinical screening tool for bleeding symptoms. Materials and Methods: A population-based cross-sectional survey of 1524 women of 16-50 years in Southeast Nigeria using a structured, prevalidated, pretested questionnaire was conducted. Results: A total of 1524 (85%) women responded with the mean age of 26 (10.6) years. Prevalence of bleeding symptoms was 24.6% and 11% of the women reported a positive family history of bleeding symptoms. There was a significant association between having a positive family history of bleeding disorder and experiencing bleeding symptoms (adjusted odds ratio: 0.12, 95% confidence interval: 0.06-0.22 P < 0.0001). Two hundred and six women experienced at least one bleeding symptom, 125 (8.2%) experienced at least two, whereas 43 (2.8%) experienced >3 bleeding symptoms. The most common perceived bleeding symptom was heavy menstrual bleeding (HMB) present in 83 women (22.2%), 141 (9.3%) reported a past history of HMB, 202 (13.3%) had heavy bleeds during most of their monthly cycle, and 351 (23%) requiring resuscitation with blood support. Conclusion: The prevalence of perceived bleeding symptoms among women is high, and HMB is the most common bleeding symptom. This clinical screening tool is easy and cost-effective in routinely identifying women with bleeding symptoms needing further hemostatic and obstetrics evaluation.

RésuméObjectif: L'objectif de l'étude était d'évaluer la prévalence des symptômes hémorragiques perçus chez les femmes nigérianes et l'utilité d'un outil de dépistage clinique simple des symptômes hémorragiques. Matériel et méthodes: enquête transversale auprès de la population auprès de 1 524 femmes de 16 à 50 ans dans le sud-est du Nigéria à l'aide d'un questionnaire structuré, prévalidé et prétesté. Résultats: Un total de 1524 (85%) les femmes ont répondu avec l'âge moyen de 26 (10,6) ans. La prévalence des symptômes hémorragiques était de 24,6% et 11% des femmes ont signalé un antécédents familiaux positifs de symptômes hémorragiques. Il y avait une association significative entre avoir des antécédents familiaux de saignement positifs trouble et présentant des symptômes hémorragiques (rapport de cotes ajusté: 0,12, intervalle de confiance à 95%: 0,06­0,22 P <0,0001). Deux cent et six femmes ont présenté au moins un symptôme de saignement, 125 (8,2%) en ont eu au moins deux, tandis que 43 (2,8%) ont eu> 3 saignements symptômes. Le symptôme de saignement perçu le plus courant était le saignement menstruel abondant (HMB) présent chez 83 femmes (22,2%), 141 (9,3%) ont signalé des antécédents de HMB, 202 (13,3%) ont eu des saignements abondants pendant la majeure partie de leur cycle mensuel et 351 (23%) ont dû être réanimés avec support sanguin. Conclusion: la prévalence des symptômes hémorragiques perçus chez les femmes est élevée et le HMB est le plus courant symptôme de saignement. Cet outil de dépistage clinique est simple et économique pour identifier systématiquement les femmes présentant des symptômes hémorragiques nécessitant évaluation hémostatique et obstétrique plus poussée.

Clinical and Laboratory Predictors of Frequency of Painful Crises among Sickle Cell Anaemia Patients in Nigeria.

INTRODUCTION: The severity of Sickle Cell Anaemia (SCA) in terms of frequency of painful Vaso-Occlusive Crises (VOC) may be affected by clinical and haematological parameters amongst others. Elucidation of these factors in a given disease prevalent environment is necessary for prompt and effective management of patients with frequent painful VOC. AIM: This study aimed at determining the clinical and laboratory predictors of frequency of painful VOC among SCA patients in Enugu, Southeastern Nigeria. MATERIALS AND METHODS: It was a cross-sectional study of 100 consecutive SCA patients receiving care at the University of Nigeria Teaching Hospital, Enugu, Nigeria between May 2012 and February 2014. The eligible patients were categorized into two groups namely; Group A and Group B. Group A/study group (severe disease) comprised SCA patients who had experienced three or more painful crises (≥3 crises) in the last one year preceding the study but, currently in steady state, while Group B/control group (mild-moderate disease), comprised SCA patients matched for age, sex, highest educational status, and occupation but who have had no painful crisis or had only one or two painful crises (0-2 crises) in the last one year preceding the study and currently in steady state. RESULTS: The overall mean age of the patients was 18.4±12.2 (range=2-52) years. The mean values of the haematological parameters including haemoglobin concentration, white cell count, platelet count, and neutrophil count were significantly higher in those with severe crises than mild-moderate crises (p<0.05). Sickle cell related complications including Avascular Necrosis (AVN) and leg ulcers were significantly higher in the study group than the control group (p<0.05). CONCLUSION: There was significant association between the frequency of crises and haemogblobin level, platelet and neutrophil counts and some clinical parameters: AVN, nephropathy and stroke. Future preventive interventions for reduction in frequency of crisis amongst patients with SCA could be targeted at controlling the blood levels of the identified haematological parameters.

Asymptomatic malaria parasitemia does not induce additional oxidative stress in pregnant women of South East Nigeria.

OBJECTIVE: To determine the relationship between asymptomatic malaria parasitemia and some oxidative stress parameters in pregnant Nigerian women. METHODS: This is a cross-sectional study involving 130 normal pregnant women at various trimesters, who were attending antenatal clinic at the University of Nigeria Teaching Hospital (UNTH) and Kenechukwu Specialist Hospital in Enugu. A comparable group (control), made of 30 non pregnant women was also recruited. After a 24 hour dietary recall, serum levels of vitamin A, C and malondialdehyde (MDA) were determined by colorimetric method, while vitamin E was determined by absorptiometric method. RESULTS: There were no statistically significant differences in age, parity, estimated calorie, vitamins A, C and E intake between the pregnant and non pregnant groups (P> 0.05). The serum level of the vitamins (umol/L) and MDA (umol/L) in control, 1st, 2nd and 3rd trimesters respectively were: (1)Vitamin A: 1.6±0.36 vs 0.6±0.26 vs 0.62± 0.33 vs 0.46± 0.21 (P < 0.0001); (2) Vitamin C: 75.65±14.15 vs 62.97±24.4 vs 37.85±15.19 vs 28.94±8.52 (P<0.0001); (3) Vitamin E: 3.01± 1.32 vs 3.45±2.01 vs 9.36±2.75 vs 9.82±2.97 (P<0.0001); (4) MDA: 1.42± 0.02 vs 1.61±0.02 vs 1.79±0.02 vs 2.03±0.05 (P<0.0001). However, there were no significant changes in the serum level of the vitamins and MDA between the positive and the negative parasitemia subjects (P>0.05). CONCLUSIONS: Asymptomatic malaria parasitemia does not induce additional oxidative stress on pregnant women in Nigeria. The enormity of acute and complicated attack should be further investigated.

Asymptomatic Plasmodium parasitaemia in pregnant Nigerian women: almost a decade after Roll Back Malaria.

Malaria during pregnancy is a major cause of fetal and maternal morbidity and mortality. In malaria-endemic areas, the condition may remain asymptomatic but is still associated with complications. The objective of this study was to determine the prevalence of asymptomatic malaria parasitaemia and its relationship with various sociodemographic characteristics. The study was performed at three hospitals in Enugu, the centre of southeast Nigeria, during the rainy season between March 2006 and October 2007. Pregnant women attending the antenatal clinic at the index pregnancy were randomly selected and counseled, and peripheral blood samples were collected for malaria parasite and packed cell volume estimation. Age, parity, gestational age at booking, degree of anaemia and parasite density were recorded. Of 125 pregnant women tested, 73 had microscopic Plasmodium parasitaemia, giving a prevalence of 58.4%. Asymptomatic malaria parasitaemia was more common in primigravidae, in the second trimester and in the younger age group. Anaemia in pregnancy was prevalent (55.2%) and there was no significant difference in the density of parasitaemia in those with mild, moderate and severe anaemia. The prevalence of Plasmodium parasitaemia in pregnant Nigerian women is still very high nearly a decade after Roll Back Malaria. It is therefore pertinent to reappraise Roll Back Malaria strategies or to design a more effective programme for the prevention and treatment of malaria in pregnancy.