Epidemiology Trend of Chronic Kidney Disease in a Semi-Urban Tertiary Hospital in Sub-Saharan Africa.

Background The global burden of chronic kidney disease (CKD) has been on an alarming increase in the last two decades. The morbidity and mortality associated with CKD are even worse in Nigeria, like other developing countries, due to multiple socioeconomic and demographic factors in the country. CKD contributes to the increasing need for hospital admission. Hypertension and chronic glomerulonephritis have been the leading causes of CKD in Nigeria. However, diabetic nephropathy has recently gained more significance as a cause of CKD in developing countries. Aim and methods This study aimed to describe the current trend in the burden and population characteristics of CKD in Southern Nigeria. This is a cross-sectional, hospital-based study. The study recruited adult patients with prehemodialysis CKD seen in renal clinics over a two-year period (November 2014 to October 2016). Data were obtained using a questionnaire and from the clinic register. All participants were clinically assessed, including history, anthropometric measurements, and urinary albumin-creatinine ratio. Results A total of 1,549 patients were seen at the Medical Outpatient Clinic over the study period. CKD accounted for 9.7% of medical outpatient clinic attendance. The mean age of participants was 49±13 years. The leading causes of CKD were diabetes mellitus (32%), chronic glomerulonephritis (30%), and hypertension (22%). Among the participants, CKD stages 3, 4, and 5 were prevalent in 26.7%, 43.3%, and 14.7%, respectively. Conclusion and recommendation CKD is very prevalent among medical clinic patients. Diabetic nephropathy seems to be a more significant cause of CKD than was previously reported. Late presentation of patients to nephrologists remains an obstacle to improving CKD outcome in Nigeria. There is need for more intensive preventive measures and early intervention.

Acceptability of Newborn Screening for Sickle Cell Disease among Post-Partum Mothers in Abakaliki, South East Nigeria.

BACKGROUND: Newborn screening (NBS) for sickle cell disease (SCD) has been shown to reduce early childhood morbidity and mortality associated with sickle cell disease (SCD) but the programme is yet to gain universal coverage in Nigeria. The study assessed the awareness and acceptability of NBS for sickle cell disease for newly delivered mothers. MATERIALS AND METHODS: This was a cross-sectional study conducted to assess 780 mothers admitted into the postnatal ward 0-48 hours after delivery at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. Pre-validated questionnaires were employed for data collection and statistical analysis was performed using the United States' Center for Disease Prevention and Control (CDC) Epi Info 7.1.4 software. RESULTS: Only 172 (22%) and 96 (12.2%) of the mothers were aware of NBS and comprehensive care for babies with SCD respectively. The acceptance of NBS was high, 718 (92%) among the mothers. The reasons for acceptance of NBS were to know how to take care of the baby 416 (57.9%), know the genotype status 180 (25.1%) while the motivating factors for NBS were knowledge of benefits 455 (58%) and the cost is free 205 (26.1%). The majority of the mothers 561(71.6%) agree that SCD can be ameliorated by NBS while 80 (24.6%) do not know if it can. CONCLUSION: There was low awareness of NBS and comprehensive care for babies with SCD among mothers with newborns, however acceptability for NBS was high. There is a considerable need to bridge the communication gap between health workers and parents to increase their awareness.

CONTEXTE: Il a été démontré que le dépistage néonatal de la drépanocytose réduisait la morbidité et la mortalité infantiles associées à cette maladie, mais le programme n'a pas encore atteint une couverture universelle au Nigéria. L'étude a évalué la connaissance et l'acceptabilité du NBS pour la drépanocytose chez les mères qui viennent d'accoucher. MATÉRIEL ET MÉTHODES: Il s'agit d'une étude transversale menée auprès de 780 mères admises dans le service postnatal 0-48 heures après l'accouchement à l'hôpital universitaire fédéral Alex Ekwueme, à Abakaliki, au Nigeria. Des questionnaires pré-validés ont été utilisés pour la collecte des données et l'analyse statistique a été réalisée à l'aide du logiciel Epi Info 7.1.4 des Centres américains de prévention et de contrôle des maladies (CDC). RÉSULTATS: Seules 172 (22%) et 96 (12,2%) des mères connaissaient le NBS et les soins complets pour les bébés atteints de SCD, respectivement. Le taux d'acceptation du NBS était élevé, 718 (92%) parmi les mères. La raison de l'acceptation du NBS était de savoir comment s'occuper du bébé 416 (57,9%) et de connaître le statut du génotype 180 (25,1%) tandis que le facteur de motivation pour le NBS était la connaissance des avantages 455 (58%) et le coût est gratuit 205 (26,1%). La plupart des mères 561 (71,6%) sont d'accord pour dire que le NBS peut améliorer le SCD, tandis que 80 (24,6%) ne savent pas si c'est le cas. CONCLUSION: Les mères de nouveau-nés sont peu sensibilisées au NBS et aux soins complets pour les bébés atteints de DICS, mais l'acceptabilité du NBS est élevée. Il est nécessaire de rétablir la communication entre les professionnels de la santé et les parents afin de les sensibiliser davantage. Mots clés: Dépistage Néonatal, Drépanocytose, Acceptabilité, Sensibilisation, Mère.

Highlights from the Tenth International Workshop on HIV Persistence during Therapy, December 13-16, 2022, Miami, Florida-USA.

The International Workshop on HIV Persistence during Therapy provides a forum in which HIV/AIDS researchers gather to share the latest research findings related to viral reservoirs and cure. The Tenth Workshop, which was attended by over 400 delegates, extended over 4 days and comprised eight sessions covering topics from the basic science of viral persistence to therapeutic approaches to HIV cure. Furthermore, satellite sessions on the first day of the Conference featuring cure research endeavours being pursued by the Bill and Melinda Gates Foundation as well as those being coordinated under the National Institutes of Health Martin Delaney Collaboratory program, provided important updates on research advances being made in these initiatives. As with previous conferences, the International Workshop on HIV Persistence during Therapy is primarily abstract-driven with only one invited talk for each of the sessions. This format, therefore, increases the number of presentations from early-stage investigators. Furthermore, presentations by Community representatives illustrated approaches to creating cure research literacy with effective messaging for the Community. The following article offers a synopsis of the meeting sessions. Due to space constraints, some presentations may have only been briefly discussed. Nevertheless, the Workshop abstracts can be found online (https://www/sciencedirect.com/journal/journal-of-virus-eradication/vol/8/suppl/S).

Platelet Yield and Some Donor-Related Predictors in a Single Donor Apheresis: Report from a Nigerian Tertiary Hospital.

BACKGROUND: Single-donor platelet transfusion is the preferred therapeutic option for patients with platelet insufficiency and its effectiveness is partly dependent on the yield. AIM: To determine the platelet yield and predictors of platelet yield in single-donor apheresis. MATERIALS AND METHODS: This was a five-year review of the data on single-donor apheresis using the Haemonetics Apheresis machine MCS+ at Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi state. Platelet donor related variable of interest included the pre-donation platelet count, donor's blood group, number of apheresis cycles and yield volume. Analysis was done using Graphpad Prism version 9.1.1. RESULTS: A total of 153 platelet apheresis were studied. The mean (SD) values for pre-donation platelet count, number of cycles, platelet yield and volume of platelet concentrate were 279 ± 47 x 109/L, 6 ± 0.3, 4.5± 0.8 X 10 11/L, and 320 ± 78 mL respectively. In this study, volume of platelet concentrate predicted 61% of platelet yield while platelet count of donor predicted 41%. Neither ABO nor Rh blood groups was a determinant of platelet yield. CONCLUSION: Pre-donation platelet count and volume of platelet concentrate are important predictors of platelet yield. There is need for proper platelet donor selection.

CONTEXTE: La transfusion de plaquettes d'un seul donneur est l'option thérapeutique privilégiée pour les patients souffrant d'insuffisance plaquettaire et son efficacité dépend en partie du rendement. OBJECTIF: Déterminer le rendement plaquettaire et les prédicteurs du rendement plaquettaire dans l'aphérèse à donneur unique. MATÉRIEL ET MÉTHODES: Il s'agissait d'un examen quinquennal des données sur l'aphérèse à donneur unique utilisant l'appareil d'aphérèse Haemonetics MCS+ à l'hôpital universitaire fédéral Alex Ekwueme d'Abakaliki dans l'État d'Ebonyi. Les variables d'intérêt liées au donneur de plaquettes comprenaient la numération plaquettaire avant le don, le groupe sanguin du donneur, le nombre de cycles d'aphérèse et le volume de rendement. L'analyse a été effectuée à l'aide de Graphpad Prism version 9.1.1. RÉSULTATS: Au total, 153 aphérèses plaquettaires ont été étudiées. Les valeurs moyennes (écart-type) de la numération plaquettaire avant don, du nombre de cycles, du rendement plaquettaire et du volume du concentré plaquettaire étaient respectivement de 279 ± 47 x 109/L, 6 ± 0,3, 4,5 ± 0,8 x 1011/L et 320 ± 78mL. Dans cette étude, le volume du concentré plaquettaire prédisait 61 % du rendement plaquettaire, tandis que la numération plaquettaire du donneur prédisait 41 %. Ni le groupe sanguin ABO ni le groupe sanguin Rh n'ont été des facteurs déterminants du rendement plaquettaire. CONCLUSION: La numération plaquettaire pré-don et le volume de concentré plaquettaire sont des facteurs prédictifs importants du rendement plaquettaire. Il est nécessaire de sélectionner correctement les donneurs de plaquettes. Mots clés: Aphérèse plaquettaire, Numération plaquettaire, Volume plaquettaire, Rendement plaquettaire.

Chronic Myeloid Leukaemia with Sudden Bilateral Deafness and Leg Ulcer Associated with Hydroxyurea Therapy.

Deafness occurs rarely in patients with chronic myeloid leukaemia. Hydroxyurea-induced leg ulcer has been found in patients on long-term hydroxyurea therapy. We present a 53 year old man who developed spontaneous bilateral deafness shortly after he was diagnosed with chronic myeloid leukaemia and subsequently developed hydroxyurea induced leg ulcer in the course of treatment. A 53 year-old male presented to our clinic with six months history of left abdominal mass, associated with easy satiety, occasional fever, night sweats, loss of appetite, weight loss, easy fatiguability and bilateral leg swelling. Physical examination showed a middle-aged man in no obvious distress, afebrile, anicteric, pale, with no peripheral lympadenopathy but had bilateral pitting pedal edema to the lower third. There was no significant finding on the chest. Abdominal examination showed hepatosplenomagaly. Full blood count showed anaemia, hyperleucocytosis and thrombocytosis. Peripheral blood film and bone marrow aspiration examinations were in keeping with chronic myeloid leukaemia. The BCR/ABL-1 transcript was negative, thus he was started on hydroxyurea in addition to other supportive treatment. Before commencement of hydroxyurea therapy, he spontaneously developed bilateral sensorineural deafness. Subsequently, he also developed leg ulcers, having been on hydroxyurea therapy for seven years which healed within eight weeks on discontinuation of hydroxyurea. Spontaneous deafness can occur in patients with chronic myeloid leukaemia due to hyperleucocytosis and urgent cytoreduction may help to prevent this complication. In addition, leg ulcer due to long-term hydroxyurea therapy can occur and usually do not respond to the conventional treatment but discontinuation of hydroxyurea.

La surdité survient rarement chez les patients atteints de leucémie myéloïde chronique. Un ulcère de jambe induit par l'hydroxyurée a été trouvé chez des patients sous traitement à long terme par hydroxyurée. Nous présentons un homme de 53 ans qui a développé une surdité bilatérale spontanée peu de temps après avoir été diagnostiqué avec une leucémie myéloïde chronique et qui a ensuite développé un ulcère de jambe induit par l'hydroxyurée au cours du traitement. Un homme de 53 ans s'est présenté à notre clinique avec des antécédents de six mois de masse abdominale gauche, associée à une satiété facile, une fièvre occasionnelle, des sueurs nocturnes, une perte d'appétit, une perte de poids, une fatiguabilité facile et un gonflement bilatéral des jambes. L'examen physique a montré un homme d'âge moyen sans détresse évidente, apébrile, anictérique, pâle, sans lympadénopathie périphérique mais présentant un œdème bilatéral de la pédale par piqûres au tiers inférieur. Il n'y avait aucune découverte significative sur la poitrine. L'examen abdominal a montré une hépatosplénomagie. Une formule sanguine complète a montré une anémie, une hyperleucocytose et une thrombocytose. Les examens de frottis sanguin périphérique et d'aspiration de la moelle osseuse étaient conformes à la leucémie myéloïde chronique. Le transcrit BCR / ABL-1 était négatif, il a donc commencé à prendre de l'hydroxyurée en plus d'un autre traitement de soutien. Avant le début du traitement par hydroxyurée, il a développé spontanément une surdité neurosensorielle bilatérale. Par la suite, il a également développé des ulcères de jambe, après avoir été sous traitement à l'hydroxyurée pendant sept ans, qui ont guéri en huit semaines à l'arrêt de l'hydroxyurée. Une surdité spontanée peut survenir chez les patients atteints de leucémie myéloïde chronique due à une hyperleucocytose et une cytoréduction urgente peut aider à prévenir cette complication. De plus, un ulcère de jambe dû à un traitement à long terme par hydroxyurée peut survenir et ne répond généralement pas au traitement conventionnel mais l'arrêt de l'hydroxyurée.

An Audit of Orthodontic Retention Protocol in a Tertiary Health Institution: A 3-Year Retrospective Study.

BACKGROUND: The aim of this study was to determine the retention practices following orthodontic treatment in a tertiary health institution in Nigeria. METHODS: A retrospective study conducted in the Orthodontic Clinic of the Lagos University Teaching Hospital over a 3-year-period. Data on the type of retainers used and the retention practices in the upper and lower arches were obtained from case files of patients who had completed orthodontic treatment in the institution. Statistical analysis was performed using IBM SPSS software version 23. RESULTS: The demographic variables comprised of 136 subjects; 93 females (68.4%) and 43 males (31.6%). Their ages ranged from 9-44 years with a mean age of 18.96 ± 6.75. Class I malocclusion was the most common malocclusion pattern (84.6%), followed by Class II (10.3%) and Class III (5.1%). Removable retainers were more commonly used and accounted for retention carried out in 85.3% of the study population. There was a preference for the use of removable retainers in the upper arch; the Hawley retainer being the most used (79.4%). In the lower arch however, no form of retention was carried out for majority of the patients after orthodontic treatment (86.8%). However, when done, the fixed lingual retainer was the most frequently used (13.2%). CONCLUSION: The Hawley retainer was the predominant retainer in this study. The fixed lingual retainer was the most frequently used in the lower arch. Longitudinal studies are required to determine efficacy of different types of retention following orthodontic treatment.

CONTEXTE: Le but de cette étude était de déterminer les pratiques de rétention suite à un traitement orthodontique dans un établissement de santé tertiaire au Nigeria. MÉTHODES: Une étude rétrospective execute à la clinique d'orthodontie de l'hôpital universitaire de Lagos sur une période de 3 ans. Données sur le type de rétention utilisé et le les pratiques de rétention dans les arcades supérieures et inférieures ont été obtenues à partir des dossiers de patients ayant terminé un traitement orthodontique dans l'établissement. analyses statistiques a été réalisée à l'aide du logiciel IBM SPSS version 23. RÉSULTATS: Les variables démographiques comprenaient 136 sujets; 93 femmes (68,4%) et 43 hommes (31,6%). Leur âge variait de 9 à 44 ans avec un âge moyen de 18,96 ± 6,75 ans. La malocclusion de classe I était le modèle de malocclusion le plus courant (84,6%), suivie de la classe II (10,3%) et de la classe III (5,1%). Les dispositifs de retenue amovibles étaient plus couramment utilisés et représentaient la rétention effectuée dans 85,3% de la population étudiée. Il y avait une préférence pour l'utilisation de dispositifs de retenue amovibles dans l'arcade supérieure; le dispositif de retenue Hawley étant le plus utilisé (79,4%). Dans l'arcade inférieure cependant, aucune forme de rétention n'a été réalisée pour la majorité des patients après un traitement orthodontique (86,8%). Cependant, une fois terminé, le dispositif de retenue lingual fixe était le plus fréquemment utilisé (13,2%). CONCLUSION: Le dispositif de retenue Hawley était le dispositif de retenue prédominant dans cette étude. Le dispositif de retenue lingual fixe était le plus fréquemment utilisé dans l'arcade inférieure. Des études longitudinales sont nécessaires pour déterminer l'efficacité des différents types de rétention après un traitement orthodontique.

Prevalence and associations of symptomatic renal papillary necrosis in sickle cell anemia patients in South-Eastern Nigeria.

AIM: To assess the prevalence and associations of symptomatic renal papillary necrosis (RPN) in sickle cell anemia patients. PATIENTS AND METHODS: The case notes of homozygous hemoglobin (Hb) S patients diagnosed with RPN were retrospectively assessed. Diagnosis was based on microscopic hematuria and positive ultrasound findings. Their steady state diastolic blood pressure, Hb, leukocyte count, platelet count, serum direct bilirubin, and aspartate transaminase, were obtained by automated analyzers. These were evaluated for any relationship with the occurrence of RPN. RESULTS: Two hundred and twenty patients were assessed aged 6-55 years with a median age of 24 years. The prevalence of symptomatic RPN was found to be 2.3%. RPN was positively associated with the female gender (Chi-square P value 0.001), but not with any other clinical or laboratory variable. However, other predictors of disease severity were positively associated with RPN such as age, diastolic blood pressure 0.180 (P = 0.016), serum aspartate transaminase, serum bilirubin 0.145 (0.027), Hb, and leukocyte count - 0.155 (P = 0.003). CONCLUSION: The prevalence of symptomatic RPN is low in this group of homozygous S patients and occurs more commonly in females. Improvement in care for these patients will reduce these chronic complications.

Red cell alloimmunization in multi-transfused patients with sickle cell anemia in Benin City, Nigeria.

BACKGROUND: Sickle cell anemia (SCA) is an inherited hemoglobin disorder characterized by chronic anemia and occasional crises. Clinical features are variable. While some individuals are relatively stable and rarely require blood transfusion, others often require blood transfusion. Multiple blood transfusion is associated with complications including alloimmunization, infections, and iron overload. AIMS AND OBJECTIVES: The study aimed at determining the prevalence of red cell alloimmunization among multi-transfused patients with SCA. MATERIALS AND METHODS: A cross-sectional study of adult SCA patients who have received multiple blood transfusion and those who have never received blood was done. Antibody screening and identification were carried out using gel technology with commercially made panel of cells. RESULTS: A total of 145 SCA subjects were studied. They were made up of 86 test group (those that had received two or more units of blood) and 59 control group (those that had never received blood transfusion). Prevalence of red cell alloantibody among multi-transfused patients with SCA was found to be 9.3%. Alloantibodies identified were mainly against Rhesus antigens contributing 87.5% (anti-E 37.5%, anti-C 25%, anti-D 12.5%, anti-e 12.5%). A combination of Kell and Lutheran blood group antigens contributed 12.5%. No antibody was detected among the control group. CONCLUSION: Blood transfusion is associated with the development of alloantibodies. Routine blood grouping for multi-transfused patients with SCA should be extended to include other blood group antigens in addition to Rhesus D and ABO antigens.

Potential effects on the marine environment of dredging of the Bonny channel in the Niger Delta.

This study is an assessment of the possible effects of the dredging project on the water quality of the surrounding environment. Water quality data for the Bonny offshore river were collected. The parameters assessed were temperature, dissolved oxygen (DO), pH, biochemical oxygen demand (BOD), total dissolved solids (TDS), total suspended solids (TSS), nitrogen as nitrate, and phosphate. The concentrations of TDS, TSS, and nitrate far exceeded the permissible standard. There were significant differences between the dry and rainy season values of BOD5, TDS, TSS, nitrate, and phosphate. Also, the sediment physicochemical analysis indicated the presence of heavy metals such as Pb, Fe, Cd, Zn, Cr, and elements such as Ca, K, and Na. Following an assessment of the potential impact of the project using interaction matrix and checklist questionnaires, results showed that the major physicochemical parameters influenced by dredging are DO, TDS, TSS, heavy metals and calcium, potassium, and sodium. Mitigation measures for eliminating or reducing the negative impacts of dredging are presented.

Human papillomavirus 16 L2 inhibits the transcriptional activation function, but not the DNA replication function, of HPV-16 E2.

In this study we analysed the outcome of the interaction between HPV-16 L2 and E2 on the transactivation and DNA replication functions of E2. When E2 was expressed on its own, it transactivated a number of E2-responsive promoters but co-expression of L2 led to the down-regulation of the transcription transactivation activity of the E2 protein. This repression is not mediated by an increased degradation of the E2 protein. In contrast, the expression of L2 had no effect on the ability of E2 to activate DNA replication in association with the viral replication factor E1. Deletion mutagenesis identified L2 domains responsible for binding to E2 (first 50 N-terminus amino acid residues) and down-regulating its transactivation function (residues 301-400). The results demonstrate that L2 selectively inhibits the transcriptional activation property of E2 and that there is a direct interaction between the two proteins, although this is not sufficient to mediate the transcriptional repression. The consequences of the L2-E2 interaction for the viral life cycle are discussed.