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Sickle cell disease (SCD) remains prevalent in Nigeria and can be complicated by cholelithiasis even in children. There is still a dearth of knowledge about the occurrence of cholelithiasis in these children. The present study is aimed to determine the prevalence of cholelithiasis in pediatric SCD in Lagos and documents relevant socio-demographic and clinical correlates.This was a cross-sectional study of children and adolescents aged 1-19 years with SCD attending the Paediatric Haematology Clinic of the Lagos University Teaching Hospital. One hundred and forty-seven children were consecutively recruited into the study over 3 months and they all had sonographic examination of the gall bladder. The association between cholelithiasis, sociodemographic data, clinical symptoms, laboratory parameters, and the use of hydroxyurea was also documented.The median age (range) of the study participants was 9.0 (1-19) years and majority were males (59.9%). The prevalence of cholelithiasis was 13.6% and the condition was most prevalent in adolescents (21.4%) compared to the younger children (6.5%). All the children with cholelithiasis were asymptomatic. Age and the frequency of crisis were significantly associated with cholelithiasis on multivariate analysis (P = 0.03, 0.045, respectively). The use of hydroxyurea was not significantly related to the occurrence of cholelithiasis.The prevalence of cholelithiasis observed in this study is high. Routine screening of older children and adolescents with SCD, especially with the frequent crisis is suggested. Longitudinal studies to establish the relationship between hydroxyurea and cholelithiasis is also advocated.

PURPOSE: Omega-3 fatty acids have been shown to reduce the incidence and slow the growth of mammary gland cancer in rodent models. Since exposure to dietary components during the critical developmental times of gestation and lactation may alter risk for mammary gland cancer in females, we tested whether exposure to increased levels of long-chain omega-3 fatty acids from fish oils would be preventive or promotional to mammary gland cancer in the offspring. METHODS: Normal SV129 female mice were fed AIN 76 diets containing either 10% corn oil (control, 50% omega 6, n-6) or 5% of an omega-3 (n-3) fatty acid concentrate (fish oil 60% n-3) + 5% canola oil (10% n-3 + 20% n-6). Females were then mated with C(3)1 TAg transgenic mice. At weaning (3 weeks), pups were randomized to either the corn (C) or fish oil (F) diet, 15–17 mice per group. Four experimental groups were generated: FF, FC, CF and CC. Tumor incidence and multiplicity were assessed at the following time points 120, 130 and 140 days of age. A panel of genes encoding signal transduction proteins were analyzed in mammary glands at 130 days. RESULTS: Mice never exposed to fish oil (CC group) had a significantly higher incidence and multiplicity of mammary gland tumors than mice exposed to fish oil throughout life (FF group). Mice exposed to fish oil during a portion of life (CF or FC) had intermediate tumor incidences and multiplicities. Results also indicate that maternal consumption of fish oil increased the expression of genes associated with immune system activation (Ccl20, Cd5, Il2, Lef1, Lta). CONCLUSIONS: Adequate omega-3 fatty acids in the maternal diet may reduce the risk for mammary gland cancer in the offspring. If humans make dietary change by consuming more omega-3 fat instead of corn oil with 0% omega 3 fat, breast cancer may be reduced in the next generation.

Introduction there is a paucity of data on the financial implications of sickle cell disease on households of affected children and their use of health insurance in Nigeria. This study assessed the awareness of health insurance, patterns of health service utilization and financial implications of sickle cell disease among children seeking care at a tertiary facility in Nigeria. Methods a structured questionnaire was administered to parents of 314 children with sickle cell disease attending the pediatric hematology unit of the Lagos University Teaching Hospital between May and December 2019. Results mean age of the children was 91.5 ± 43.1 months. M: F was 1.17: 1. 45.5% of households earned above NGN 150,000 (USD 417) monthly. 71.3% of the parents had heard of health insurance but only 20.7% were enrolled in a health insurance scheme. Awareness of health insurance was significantly associated with social class (p=0.000) and monthly household income (p=0.000). 60.8% of the parents preferred pre-facility treatment. Social class (p=0.01) and monthly household income (p=0.001) were significantly associated with home treatment. Time on admission ranged from 2-18 days with an average of 4.31 days. Average cost of hospitalization was USD 148 ± USD 14.2 and total cost of care incurred was USD 20,787. Neither age of child (p=0.857), estimated household income (p=0.863) nor social class (p=0.397) was associated with cost of care. Conclusion a high cost of care was observed in our study population underscoring the need for increased awareness and access to health insurance for households of children with sickle cell disease.

Background: Over the last two decades, there has been significant improvement in the outcomes of children with Wilms' tumour (WT) in high income countries (HICs) with approximately 85% survival rate globally. This is partly attributable to a multi-disciplinary team approach to care and the evolution of more robust treatment measures. A previous review in our centre prior to multi-disciplinary team shows a survival rate of 31.48%, However, the survival rates from low- and middle-income countries are still low when compared to HICs due to delays in access to care at all levels, poor to non-existent health insurance coverage, limited workforce resources, weak health-care systems and infrastructure. The aim of this study is to determine the impact of a multi-disciplinary team approach on the treatment outcomes of children with WT. Methodology: This is a 5-year retrospective review of all patients managed with WT at the Lagos University Teaching Hospital, Lagos, Nigeria. Information was extracted from the patients' case notes, operation notes and ward admission records. The data were analysed with SPSS 25, and P < 0.05 was considered to be statistically significant. Results: Forty patients were included in the study; male to female ratio was 1.6:1. The disease occurred in the right kidney in 23 patients (57.5%) and on the left in 17 patients (42.5%). The average duration of symptoms before presentation was 3.6 months (range 1–7 months), majority of patients presented with abdominal masses and were assessed as per unit protocol with abdominal Computerized tomography scan, chest X-ray and abdominal ultrasound scan to assign the patient International Society of Paediatric oncology regimen. The predominant stage at surgery was Stage III 26 (65%), while Stage IV was 9 (22.5%). Morbidity after chemotherapy was 10 (25%). Twenty-five patients (63%) completed chemotherapy while 15 patients (37%) started chemotherapy but defaulted midway. The 5-year survival rate was 75%. Increasing age and male sex were associated with reduced odds of mortality; however, this was not statistically significant. Increased duration of treatment, being treated with chemotherapy alone, as well as advanced tumour stage and histology were associated with increased odds of mortality, however, this was not statistically significant. Conclusion: The development of an institutional WT treatment pathway involving a multidisciplinary team has resulted in improved outcomes. There is need for increased community awareness to improve the time to presentation.

Hematopoietic cell transplant (HCT) can cure both children and adults with sickle cell disease. Outcomes have historically been poor for the vast majority of patients who lack a matched sibling donor. However, the development of haploidentical HCT (haplo-HCT) with high doses of posttransplant cyclophosphamide (PTCy) has allowed for curative long-term potential with favorable transplant-related outcomes, though this has not obviated the potential for graft rejection from human leukocyte antigen mismatch and repeated red blood cell transfusions. Accordingly, multiple strategies have been developed to improve outcomes, the majority of which are based on the Johns Hopkins platform from 2012. Presently, we aim to discuss results from pertinent studies and compare outcomes with the two most recent approaches involving either thiotepa plus 200-cGy total body irradiation or 400-cGy total body irradiation. Direct comparisons are required to determine the optimized curative potential. Transplant-eligible patients must be referred to tertiary medical centers for consideration of haplo-HCT.

Introduction HIV/AIDS has gradually become a chronic disorder following the success of combination chemotherapy. As a result of the persisting immune deficiency, certain risk factors predispose affected individuals to infections. The aim of the study was to determine the prevalence and identify risk factors of asymptomatic bacteriuria among HIV infected children. Methods this was a case control study conducted at the Lagos University Teaching Hospital from July 2010 to June 2011.Eighty-five children living with HIV were consecutively selected from the HIV clinic of the Lagos University Teaching Hospital and compared with 85 age and sex matched HIV negative controls for the occurrence of asymptomatic bacteriuria. Mid-stream urine samples were obtained from the participants and the samples were analyzed for microscopy, culture and sensitivity. Demographic and clinical data was obtained from the caregivers and clinical notes respectively. Data were analyzed utilizing SPSS version 17. Results the prevalence of asymptomatic bacteriuria was 24.7% among children living with HIV and 8.2% among un-infected children (p value 0.004). The stage of the disease, CD4 count, sex as well as age were risk factors for asymptomatic bacteriuria among children living with HIV. Conclusion asymptomatic bacteriuria is a prevalent problem among children living with HIV infection and urinary screening should be routine in the work up of febrile children living with HIV.

Prostate cancer incidence and mortality are high in the Western world and high ω-6/ω-3 PUFA in the Western diet may be a contributing factor. We investigated whether changing from a diet that approximates ω-6 fat content of the Western diet to a high ω-3 fat diet at adulthood might reduce prostate cancer risk. Female SV 129 mice that had consumed a high ω-6 diet containing corn oil for 2 weeks were bred with homozygous C3(1)Tag transgenic male mice. All male offspring were weaned to the corn oil diet (CO) until postpuberty when half of the male offspring were transferred to a high ω-3 diet containing canola oil and fish oil concentrate (FS). High ω-3 diet increased ω-3 and decreased ω-6 fat content of mice tissues. Average weights of prostate and genitourinary bloc were significantly lower in mice consuming high ω-3 diet at adulthood (CO-FS) than mice fed a lifetime high ω-6 diet (CO-CO). There was slower progression of tumorigenesis in dorsalateral prostate of CO-FS than in CO-CO mice. CO-FS mice had slightly lower plasma testosterone level at 24 and 40 weeks, significantly lower estradiol level at 40 weeks and significantly less expressed androgen receptor (AR) in the dorsalateral prostate at 40 weeks than CO-CO mice. Consumption of high ω-3 diet lowered the expression of genes expected to increase proliferation and decrease apoptosis in dorsalateral prostate. Our results suggest that consumption of high ω-3 diet slows down prostate tumorigenesis by lowering estradiol, testosterone and AR levels, promoting apoptosis and suppressing cell proliferation in C3(1)Tag mice.

Walnuts contain multiple ingredients that, individually, have been shown to slow cancer growth, including omega-3 fatty acids, antioxidants, and phytosterols. In previous research, consumption of walnuts has slowed the growth of implanted breast cancers. We wanted to determine whether regular walnut consumption might reduce the risk for developing cancer. Homozygous male C(3)1 TAg mice were bred with female SV129 mice consuming either the control AIN-76 diet or the walnut-containing diet. At weaning, the female hemizygous pups were randomized to control or walnut-containing diets and followed for tumor development. Compared to a diet without walnuts, consumption of walnuts significantly reduced tumor incidence (fraction of mice with at least one tumor), multiplicity (number of glands with tumor/mouse), and size. Gene expression analyses indicated that consumption of the walnut diet altered expression of multiple genes associated with proliferation and differentiation of mammary epithelial cells. A comparison with another dietary intervention indicated that the omega 3 content alone did not account for the extent of tumor suppression due to the walnut. The results of this study indicate that walnut consumption could contribute to a healthy diet to reduce risk for breast cancer.

Minnesota is currently home to the tenth largest African population and the second largest East African population in the United States. HIV is increasingly being diagnosed in African-born persons in Minnesota. A retrospective survey was conducted on all African-born patients in our HIV clinic between January 1994 and June 2005. We identified 237 patients who were African-born and HIV-positive. They constituted 12% of patients attending the clinic within the study timeframe. There was no significant difference in the ages of the African-born and non-African patients in the HIV clinic. African-born patients were more likely to be women compared with non-African patients (p < 0.001). Forty-three percent of the African-born patients presented with AIDS as defined by CD4(+) T cell counts less than 200 cells per milliliter compared to 33% of antiretroviral naive non-African HIV patients in the clinic (p < 0.001). Most patients were infected through heterosexual contact and only 4% were diagnosed as a result of routine testing. Seven known HIV subtypes and four unique recombinant forms were identified. The most common opportunistic infection was pulmonary tuberculosis. African immigrants with HIV appear to: (1) access care at later stages of HIV disease than other patients in our clinic; (2) are often infected with non-B subtypes; (3) do not routinely get tested for HIV. Increased awareness to this growing trend is needed for health care providers and public health officials to tailor educational programs and prevention efforts for African immigrants in the United States.

Most of the information about genetic sequencing and drug susceptibility of human immunodeficiency virus type 1 (HIV-1) is derived from the study of HIV-1 subtype B. Worldwide, most people infected with HIV-1 are infected with non-subtype B viruses and live in developing countries. We report 3 cases of antiretroviral-naive African immigrants infected with HIV-1 strains possessing the K103N mutation in the reverse transcriptase gene, which confers high-level resistance to all nonnucleoside reverse transcriptase inhibitors.

The purpose of this study was to generate data on the relative prevalences of the HIV-1 subtypes circulating in Nigeria. A total of 252 HIV-1 positive samples collected during an epidemiologic survey conducted in April 1996 were genetically characterized by HMA (heteroduplex mobility assay) and/or sequencing. Samples were collected in Lagos, Calabar, Kano, and Maiduguri. Overall, the predominant env subtypes were A (61.3%) and G (37.5%). Subtype A is more prevalent in the south (p is less than 0.001), about 70% in Lagos and Calabar, whereas a quarter of the samples was classified as subtype G in these states. In contrast, subtype G is predominant in the north (p is less than 0.001), representing 58% of the samples in Kano. In the northeastern region, Maiduguri, almost similar proportions of subtype A and G were seen, 49 and 47.4%, respectively. A total of 37 samples was also sequenced in the p24 region from the gag gene ; 13 (35%) had discordant subtype designations between env and gag. The majority of the gag (12 of 17) and env (14 of 22) subtype A sequences clustered with the A/G-IBNG strain. Whithin subtype G, three different subclusters were seen among the envelope sequences. These different subclusters are observed among samples obtained from asymptomatic individuals and AIDS patients from the four Nigerian states studied. In conclusion, we observed a limited number of HIV-1 subtypes circulating in Nigeria, with subtypes A and G being the major env subtypes responsible for the HIV-1 epidemic. Nevertheless, the high rate of recombinant viruses (A/G) and the different A/G recombinant structures indicate a complex pattern of HIV-1 viruses circulating in this country. (Résumé d'auteur)

This study was undertaken (i) to determine the seroprevalence of antibodies to Hepatitis C virus (anti -HCV) among blood donors (ii) to document the incidence of known risk factors for HCV infection among blood donors.This is a cross sectional prospective study among apparently normal blood donors. Subjects were recruited from three different hospitals in Lagos metropolis. All recruited donors were evaluated for HCV infection- associated risk factors by questionnaire interviews. Sera samples from recruited donors were tested for anti-HCV using third generation Murex (Murex Biotech, South Africa) and fourth generation Dialab Enzyme Linked Immunosorbent Assay (ELISA) kits (Dialab. Austria).A total of three hundred and thirty four blood donors were screened, of which seven (2.1 %) were positive for anti-HCV. The blood donors comprised 15 (4.5 %) females and 319 (95.5 %) males. There was an association between anti-HCV positivity and history of multiple sex partners and previous sexually transmitted infections (X2-15.9; p0.05) Majority of blood donors were family replacement 317 (94.9 %) with anti-HCV prevalence of 2.2 % (7/317) while 5.1 % (17/334) were voluntary non remunerated with anti-HCV prevalence of 0% (p0.05) CONCLUSION: Prevalence of anti-HCV among blood donors in Lagos (2.1%) is low as in most previous reports from Nigeria and some other parts of Africa.

Sorethroat is a common reason for presentation in primary paediatric care. Because only a minority of cases of pharyngitis is caused by bacteria, physicians have been guided by various recommendations on the judicious use of antibiotics to avoid overprescription. In the absence of guidelines, the treatment approaches between physicians may differ. The management of children with sorethroat by physicians in Benin City, Mid-Western Nigeria was evaluated.The experience and practice of 25 paediatricians and 30 non paediatricians who routinely attend to children with sorethroat in Benin metropolis, Nigeria were evaluated with the aid of a self administered questionnaire. Information sought for included biodata, empirical antibiotic prescription. The choice of antibiotic and complications ofpharyngitis encountered in practice.Majority of respondents 31(56.4 %) considered viruses as the commonest cause of pharyngitis. Despite this an equal proportion 31(56.4 %) treated children with sorethroat empirically with antibiotics. Of these, significantly more paediatricians 19(61.3 %) than non paediatricians 12(38.7 %) considered viruses the commonest cause of pharyngitis, P = 0.013. CI (0.10 0.63). Almost three quarter (72.7 %) of respondents examine the throat of the children while only 18.2 % obtained throat swab for microbiological analysis. The 24 doctors who did not treat empirically would prescribe antibiotic if the patient has purulent pharyngeal exudates, fever and adenitis. Augmentin and cefuroxime were the most prescribed antibiotics.A lot of children served by these doctors receive antibiotic needlessly from empirical antibiotic treatment ofpharyngitis. National guidelines on appropriate antibiotic use is needed to promote rational use of antibiotics and reduce antibiotic overuse.

The objective was to determine the efficacy and safety of Enoxaparin as an antithrombotic agent in orthopaedic patients at risk for thromboembolism. 49 patients who had lower limb orthopaedic surgery were studied. They received subcutaneous Enoxaparin 40mg 12 hours before surgery and subsequently, daily for one week. Blood specimens were drawn at 2 and 12 hours after the first injection, and 24 hours after the fourth injection for anti Factor Xa assay. Specimens were also taken preoperatively, 1st, 5th and 7th post operative days (POD) for determination of Packed Cell Volume (PCV), Haemoglobin level, White Blood Cell (WBC) and Platelet Counts. The mean pre-treatment, 2, 12 and 24 hours anti Factor Xa clotting times were 14.5 +/- 0.8, 36.2 +/- 5.6, 30.6 +/- 9.8 and 25.8 +/- 9.3 seconds respectively. The changes were significant, P = 8.2 x 10(-12). The 2 and 24 hours clotting times corresponded to plasma heparin concentration level of 0.12 - 0.22U/ml read off from prepared Enoxaparin standardisation curve. Significant changes were observed in haemoglobin level, PCV, WBC and Platelet Counts when preoperative, 1st, 5th and 7th POD mean values were compared by Analysis of Variance--P0.01 in all cases. The study showed that Enoxaparin 40 mg daily caused hypocoagulation within prophylactic range of 0.12 - 0.22U/ml of heparin in the plasma. Changes in blood counts were within the limits expected post surgery.

Background. Genetic variation in human immunodeficiency virus (HIV)-1 poses significant public-health and clinical challenges. In North America, subtype B is most prevalent. HIV-1 subtyping is not integrated into routine HIV/acquired immunodeficiency syndrome surveillance in the United States. In 2003, the Minnesota Department of Health piloted HIV-1 subtyping with routine surveillance to describe the existence and variety of non-subtype B strains. Methods. Targeted HIV-1 subtype surveillance was conducted on 98 African-born HIV-infected patients. Sentinel subtype surveillance was conducted in a Minneapolis sexually transmitted disease clinic on 28 newly diagnosed non-African HIV-positive patients. Subtype determination was based on a partial sequence of the gp41 region of the HIV-1 env gene. Results. Subtyping was successful for 87 of 98 samples from African-born HIV-infected patients; 95% were non-B subtypes. The 7 subtypes observed were consistent with strains endemic in patients' birth regions. Subtyping was also completed for samples from 25 of 28 non-African-born patients; all were subtype B. Conclusions. Multiple HIV-1 subtypes are present in Minnesota. Our data suggest that most of the HIV cases in Minnesota among African-born patients are non-B subtypes. Population-based surveillance inclusive of groups at high risk for variant strains is needed to monitor the prevalence and variety of HIV subtypes in the United States.

The emergency department patients represent a cross-section of the entire population and values of HIV seroprevalence in them have been used to assess the general trends of HIV surveillance in other countries. The objectives of this study is to determine 1. Whether seroprevalence of HIV antibodies in patients attending emergency departments could serve as a marker of prevalence of HIV antibody in the general population. 2. The degree of clinical suspicion or knowledge of the medical personnel to the status o the HIV seropositive patients is also evaluated. A total of 312 emergency department patients of Lagos University Teaching Hospital (LUTH) had their blood samples screened for antibodies against Human Immunodeficiency Virus (HIV) types I and II by ELISA based techniques: Immunocomb II HIV III Bispot Kits. Repeatedly reactive samples were confirmed by another ELISA based technique using Immunocomb III Combfirm kits. The attending medical doctor was asked whether there was any suspicion or knowledge that the patient being attended to, was HIV seropositive. The seroprevalence of HIV antibodies was 5.77% with no significant difference in sex incidence. The age groups 20-29 and 30-39 years were most affected. The seropositive nature of affected patients was unsuspected by medical personnel in 55.56% of the HIV antibodies seropositive patients. The Federal Ministry of Health in 2000, estimated the National prevalence rate of HIV to have been 5.4% in 1998. This figure is comparable to that obtained in this study and revalidates the fact that emergency department patients may be used for disease surveillance in the population. The seropositive status of majority of the HIV positive patients was unsuspected by the attending medical personnel. Thus, strict adherence to universal safety precautions is essential for all medical personnel. Post exposure prophylaxis should be made readily accessible to all medical personnel.

The HIV/AIDS epidemic appears to have stabilized in the world's developed countries while it is still worsening in many areas of the resource-poor world. HIV/AIDS patients in countries such as the United States are living longer primarily due to the availability of potent antiretroviral drug combinations and tests to monitor the risk of progression of disease. Management of HIV is very complicated. General guidelines for treatment are available. Published guidelines, however, are often too simplistic and do not reflect new or controversial information. Most patients will develop resistant virus during their treatment. Several antiretroviral medications are on the horizon that will afford better options for treatment, and studies are underway to evaluate treatment strategies that would be potent, less toxic, and convenient for patients. Because the field of HIV care continues to evolve rapidly and there is increasing diversity among infected patients, treatment and prevention are optimized when provided by a dedicated care team supervised by an HIV specialist.

Summary Forty (40) HIV positive patients with CD4 cell counts between 100 - 500 cellh/mm3 were recruited from 8 different centres in Nigeria including a research centre and specialist and teaching hospitaLs They were enrolled into an open, non-comparative study of a triple combination regimen containing the Protease Inhibitor (PI), Nelfinavir and two Reverse Transcriptase Inhibitors (RTIs), Zakitabine (Hivid) and Zidovudine for a period of 24 weeks. Thirty-one (31) patients completed the study. Nine (9) patients withdrew from the study. Two of these because of Adverse Events (AE), 2 others because they developed tuberculosis and had to withdraw because of rifampicin therapy. The remaining five (5), withdrew voluntarily. Efficacy of the PI containing triple regimen was evaluated using viral load and absolute CD4 changes, weight gain and clinical response during the course of the triaL Twenty-two (22) patients had plasma viral loads measured at the beginning and at the end of the trial (24 weeks). Seventeen (17) out of the 22 patients (77%), experienced a significant reduction in their plasma viral loads (p0.05 There was 1 log reduction in plasma viral load in 6 patients (25%), 2 log in 4 patients (17%). In 2 patients (8%), plasma viral load was reduced below the level of detection. The viral load increased over the treatment period in five patients (21%). Similarly 22 out of the 26 patients (85%) experienced increase in the level of their CD4 lymphocyte counts at the end of the study. The average CD4 counts of all 26 patients rose from 272.94 +/- 137.71/dl to 414 +/- 243.71/ul over 24 weeks (p0.05). There was monthly rise of 27 CD4 cells/microl. Four (4) patients (15%) had a fall in their CD4 lymphocyte counts. Twenty (20) out of the 26 patients (77%), who completed the study were observed to have weight gains ranging from 1.5 to 31 kilograms over the 24 week study period. In 4 patients, there was no weight gain during the study period. Two patients (5%) were withdrawn due to adverse events from the viracept combination. One of these was because of life threatening diarrhoea while the other patient had severe peripheral neuropathy and severe weakness in the lower limbs. Eight (8) other patients had diarrhoea but not severe enough to stop them from continuing with the triaL Other adverse events seen include anaemia (1 patient), pancytopenia (1 patient), and transient elevation of serum urea and creatinine (1 patient). None of these adverse events was severe enough to warrant withdrawal from therapy. The study has therefore demonstrated the significant efficacy and tolerability of (Nelfinavir/Zalcitabine/ Zidovudine combination in suppressing viral replication, increasing the CD4 cell counts and improving the quality of life in Nigeria patients with HIV.

A prospective study was carried out at the Lagos University Teaching Hospital in Lagos. The aims were to determine the prevalence of otorhinolaryngological disease among patients who were HIV+ and or had clinical AIDS and to correlate the presence of ORL disease with the clinical state of HIV infection. The study was done between October 1998 and September 1999. A total of ninety-eight patients were studied. The age range of the patients was between 15 and 69 years with 83% of them being in the age group of 20-49 years. The results showed that while only 17% of the patients were referred because of ORL diseases, 80% of them actually had O.R.L./head and neck conditions. This difference of proportion is highly significant P = 0.000037. 160.20% of the patients had oral/pharyngeal lesions and 24.5% had identifiable otological disease. Hearing impairment was noted in 30.6% of the patients on pure tone audiometric assessment of which 26.5% were sensorineural. The correlation between O.R.L./head and neck manifestation and the CDC classification of HIV/AIDS infection did not reveal a definite pattern.

The objective of the study is to determine whether Absolute Lymphocyte Count (ALC) can serve as a surrogate for CD4 T-lymphocyte Cell Count (CCC) in HIV infected Nigerians on Lamivudine/Zidovudine anti-retroviral therapy. 32 adult Nigerians infected with HIV were recruited into the study. They were assessed clinically and categorised into three clinical stages A, B and C according to CDC criteria. They all received lamivudine 150 mg b.d and Zidovodine 300 mg b.d for six months. Blood specimens were taken on enrollment and at four weekly intervals for paired ALC and CCC determination. ANOVA statistics was used to determine whether ALC and CCC (separately) change significantly with increasing duration of therapy. Paired ALC and CCC values were tested for correlation. Sensitivity and specificity of low ALC values in predicting low CCC values were also calculated. The 32 patients comprised 18 males and 14 females aged between 16 and 49 years. The mean age (SD) was 36.1 (+/-7.85) years. The mean ALC value rose from 2485/l and 2352/microl before commencement of therapy to 3026/microl and 3151/microl four weeks after for males and females respectively. These changes were not significant, P0.05. No further changes were noted over the next 24 weeks. However, the mean CCC values increased from 233/microl before therapy through 339/microl at four weeks, 362/microl at eight weeks to 398/micro1 at 12 weeks. It then fluctuated between 372/microl and 310/microl for the remaining part of the study. These changes were not significant: F: ratio = 1.28 (df = 6,181), P0.05. A weak but significant positive correlation was established between ALC and CCC. Correlation coefficient was 0.25, P0.05. The sensitivity and specificity of ALC 2000/microl as a predictor of CCC 200/microl were 57% and 72% respectively. ALC correlates weakly with CCC in patients undergoing antiretroviral therapy and it may not serve as a perfect surrogate for CCC as a monitor of immunological response to therapy.

The efficacy and safety of interferon alfa-2a monotherapy was evaluated in seventeen Nigeria patients with chronic myelogenous leukaemia (CML). Male and female patients with a mean age of 34.5 +/- 10.6 years were recruited into the study. Interferon therapy was administered at a maintenance dose of 9 MIU daily for 12 months. Efficacy was evaluated by assessing both haematologic and cytogenetic response, tolerability by incidence of adverse events and safety by laboratory haematological and biochemical indices. At the end of 12 months of therapy 6 patients (54.4%) had complete haematologic remission whilst 3 patients (100% of those evaluated) showed partial cytogenetic remission. The incidence of adverse event was 70% and the monitored haematologic and biochemical indices were not adversely affected by treatment. In conclusion, the study clearly demonstrated a significant benefit of interferon alpha-2a in the management of Nigerian patients with CML. The changes in the haematological and cytogenetic profiles between baseline and term were significant (p0.05). However, it is imperative and important to encourage and continue monitoring of the responding and stabilized patients beyond 12 months in order to demonstrate sustained response. The drug was reasonably well tolerated, however life threatening pancytopenia may pose a major problem in certain cases.

The study was conducted to document the spectrum of clinical diseases in HIV infected patients at the Lagos University Teaching Hospital (LUTH) over a period of five years: 1992-1996. Patients with symptoms suggestive of HIV infection in both in and out-patients at LUTH were studied. Their blood specimens were screened for HIV infection using enzyme immunosorbent assay (EIA) technique and positive results were confirmed by western blotting techniques. The following were documented: risk factors, clinical history and physical findings. Of the 5,010 patients screened in a five-year period, 759 (15.15%) were found to be HIV positive. Of these 759 patients, 406 (53.5%) were young adults in their third decade (20-30 years). Heterosexual intercourse was the major risk factor in these patients (76%). Progressive loss of weight occurred in 77.8%, prolonged fever in 73%, chronic cough in 50%, painless lymphadenopathy in 40%, chronic diarrhoea in 35%, Kaposi's sarcoma in 0.52% and non-Hodgkin's lymphoma in 0.65%. It appears the scourge of AIDS has eventually hit Nigeria. There is the need for reinvigoration of preventive efforts but some energy has to be channeled towards patient care.

To document the seroprevalence of HTLV-1 and HIV in blood donors and in patients with lymphoma and leukaemia in Lagos metropolis.Cross sectional.The Lagos University Teaching Hospital (LUTH) and General Hospital, Lagos (GH).406 apparently healthy voluntary blood donors from the LUTH and GH and 30 patients [20 patients with histological diagnosis of Non-Hodgkin's Lymphoma (NHL) and 10 patients with diagnosis of Chronic Lymphocytic Leukaemia (CLL)] were recruited at LUTH.HTLV-1 and HIV-1 seroprevalence.Out of 406 donors, three (0.7%) were positive for HTLV-1 and 20 (4.9%) were positive for HIV-1. None of the 30 patients with NHL or CLL were positive for HTLV-1. Five of NHL patients were positive for HIV-1.HTLV-1 seroprevalence is low among Lagos donors. Routine screening of donors for this virus will not be cost effective. NHL is one of the AIDS related malignancies which has been documented in this study.

To determine current data on HIV infection and to further confirm the presence of HIV-1 group O infection in Nigeria, 2300 samples from five states were tested for the presence of HIV antibody. A convenience sampling was obtained from pregnant women, tuberculosis (TB) patients, commercial sex workers (CSWs), blood donors, patients with sexually transmitted diseases (STDs), patients with skin diseases, male clients of CSWs, outpatients suspected to have AIDS, truck drivers, and community dwellers. With the exception of pregnant women, the HIV prevalences in all these groups were high: 60.6% in CSWs, 16.2% in TB patients, 7.7% in blood donors in some states, and 16% in the rural area of Kano State. Male clients of CSWs, truck drivers, and STD patients had prevalences of 7.8%, 8.6%, and 21.2%, respectively. Regional differences in relation to HIV prevalences were observed; HIV-2 and most of the HIV-1/2 infections were found in the southern states of Nigeria. Higher HIV prevalences were observed in the north-northeast in pregnant women, TB patients, and CSWs, but for blood donors, higher rates were seen in the southeast-southwest. One asymptomatic 50-year-old woman, a community dweller in Kano, was identified to be HIV-1 group O-positive. Compared with data from national surveillance studies in 1991/1992 and 1993/1994, a substantial increase in HIV infection was observed. Our results show a growing incidence of HIV infection in Nigeria and suggest the presence of a rural HIV epidemic. The identification of HIV-1 group O in Kano shows that this virus strain is geographically widespread in Nigeria.To obtain current data on HIV infection in Nigeria by population group, a seroanalysis of 2300 samples from 5 states (Lagos, Cross River, Borno, Kano, and Jugawa) was conducted during March-May 1996. The sample included commercial sex workers, pregnant women, tuberculosis patients, blood donors, patients with sexually transmitted diseases (STDs), patients with skin diseases, male clients of commercial sex workers, outpatients suspected to have AIDS, truck drivers, and community residents. Overall HIV prevalence was 40.7%. With the exception of pregnant women (1.7%), HIV prevalence was high in all subgroups: 60.6% in commercial sex workers, 21.2% in STD patients, 16.2% in tuberculosis patients, and 16.0% in rural areas of Kano state. The majority of HIV-positive women were 21-30 years of age, while HIV-infected men were primarily over 40 years of age. Compared with data from national seroprevalence studies conducted during 1991-92 and 1993-94, this study confirms a substantial recent increase in HIV infection in Nigeria. Of the 330 antibody-positive specimens, HIV-1 was the predominant infection in 315; there were 3 cases of HIV-2 and 12 cases involving dual HIV-1/2 infection. Only 1 serum sample was positive for HIV-1 group O antibodies. The high HIV prevalence detected among commercial sex workers indicates the potential for rapid diffusion of HIV to the general population.

Background Maternal consumption of a diet high in omega 6 polyunsaturated fats (n-6 PUFA) has been shown to increase risk whereas a diet high in omega 3 polyunsaturated fats (n-3 PUFA) from fish oil has been shown to decrease risk for mammary gland cancer in female offspring of rats. The aim of this study was to determine whether increasing n-3 PUFA and reducing n-6 PUFA by using canola oil instead of corn oil in the maternal diet might reduce the risk for breast cancer in female offspring. Methods Female SV 129 mice were divided into two groups and placed on diets containing either 10% w/w corn oil (which is 50% n-6 PUFA, control diet) or 10% w/w canola oil (which is 20% n-6 PUFA, 10% n-3 PUFA, test diet). After two weeks on the diets the females were bred with homozygous C3(1) TAg transgenic mice. Mother mice consumed the assigned diet throughout gestation and nursing of the offspring. After weaning, all female offspring were maintained on the control diet. Results Compared to offspring of mothers fed the corn oil diet (CO/CO group), offspring of mothers fed the canola oil diet (CA/CO group) had significantly fewer mammary glands with tumors throughout the experiment. At 130 days of age, the CA/CO group had significantly fewer tumors per mouse (multiplicity); the tumor incidence (fraction of mice with any tumor) and the total tumor weight (per mouse that developed tumor) was less than one half that of the CO/CO group. At 170 days of age, the total tumor weight per mouse was significantly less in the CA/CO group and if a tumor developed the rate of tumor growth rate was half that of CO/CO group. These results indicate that maternal consumption of canola oil was associated with delayed appearance of mammary gland tumors and slowed growth of the tumors that developed. Conclusions Substituting canola oil for corn oil is an easy dietary change for people to make; such a change to the maternal diet may decrease risk for breast cancer in the daughter.

One hundred-and-sixty-seven cases of malignant lymphomas (ML) diagnosed in the Jos University Teaching Hospital, Jos, Nigeria, over a ten-year period (1979-88) were reviewed. The overall incidence rate is 13.4 per 100,000 with a median age of 29 years and a male:female ratio of 3:1. Non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) represent 67.7 pc and 32.3 pc cases respectively. Low, intermediate and high grade NHLs account for 51.4 pc, 17.7 pc and 30.0 pc of cases respectively; the collective median age at presentation is 31 years and the male:female ratio is 2:1 (Follicular: 13.3 pc; diffuse 86.7 pc). The small lymphocytic lymphoma is the commonest NHL (38.1 pc); the small non-cleaved cell type (African Burkitt's lymphoma type) accounts for 24.7 pc with an incidence rate of 2.2 per 100,000 within the general population and a median age of 10 years. Hodgkin's disease (median age: 28 years) is the commonest form of ML exhibiting only a single peak in the 21-30 years range. The male:female ratio is 8:1 and histological types associated with poor prognosis predominate. The prevalent clinical presentations is with a painless peripheral lymphadenopathy, the cervical group of lymph nodes is often involved representing 55 pc and 67 pc of NHL and HD cases respectively. Burkitt's lymphoma present primarily as an abdomino-pelvic tumour (67.8 pc of cases). Primary extradonal presentation is seen in 90 pc of MLs, all of which are the NHL group with Burkitt's lymphoma accounting for 80 pc of all cases.

Bacteraemia is a relatively common event in HIV-infected patients, especially in late infection. Studies in Africa have shown that more than 23% of AIDS patients have bacteraemia but there is paucity of data from Nigeria.Blood samples from 67 consecutive patients with AIDS attending the Lagos University Teaching Hospital between April and August 2000 were cultured. Temperature, ESR, Full blood count, and where possible CD4 counts were obtained. Socio-demographic details were also recorded. Thirty apparently healthy people were randomly selected from a low-risk population to act as non-AIDS controls. The Oxoid Signal Blood Culture System was used to investigate bacteraemia. Antibiotic sensitivity tests were carried out on all isolates.Twenty-two (33%) of the 67 AIDS patients were culture positive. Non-typhoidal Salmonella spp (45.5%), coagulase-negative staphylococci (22.7%) and Staphylococcus aureus (18.2%) were most commonly isolated. One isolate each of Klebsiella pneumoniae, Pseudomonas aeruginosa and Bacillus spp were identified. All bacteraemic patients had temperatures above 38 degrees C and white blood cell counts ranged between 2,700-13,500/mm(3). There was a high rate of antibiotic resistance particularly to chloramphenicol, tetracyclines, cotrimoxazole and beta-lactam antibiotics. However, most isolates were still susceptible to gentamicin and the fluoroquinolones. There was no significant difference in the socio-demographics of the bacteraemic AIDS and non-bacteraemic AIDS patients.Salmonella spp. were the most common aetiological agent of bacteraemia among AIDS patients seen at the Lagos University Teaching Hospital (LUTH), Nigeria. A high temperature was a pointer to the presence of bactaeraemia while total white blood cell counts were not useful. It is recommended that blood culture should be done for AIDS patients with elevated temperature irrespective of the total white blood cell count.

The ventilatory response to carbon dioxide was measured by a rebreathing technique in 21 Nigerians who had homozygous sickle-cell disease. The slope of the carbon dioxide response curve was obtained by plotting the ventilation at successive half-minute intervals against the corresponding mean end-tidal PCO2. Our results showed that sickle-cell patients are as sensitive to carbon dioxide as are normal subjects.

Pituitary ablation by yttrium-90 implant was performed in four patients with a leucoerythroblastic blood picture due to marrow involvement by carcinoma of the breast. In three, symptoms were relieved, transfusion requirements ceased, and several months of normal life resulted.

Leg ulceration was found in only 14 of 834 (1.7%) sickle cell patients seen in a Lagos Hospital. Ulcers were seen only in patients above the age of 12 years in whom the prevalence was 5.4%. Affected males outnumbered females 6 to 1. The aetiology was traumatic in 12 patients, spontaneous in three and due to furuncle in one. The commonest sites were around the ankles. Ulceration was not commoner in patients with low socioeconomic status. The simplest forms of aseptic treatment resulted in as variable a healing time as more complex forms of treatment, but a high recurrence rate of ulceration (71.4%) was the major problem. There remains no acceptable reason for the lower prevalence of leg ulceration in Africans with sickle cell disease, but the role of zinc in susceptibility to the ulcers deserves further investigation.

Results of a detailed study of the fibrinolytic enzyme system in pregnant and non-pregnant Nigerians are reported. It was observed that plasma plasminogen, alpha 1-antitrypsin, and alpha 2-macroglobulin were significantly increased in pregnancy (P less than 0.001) in comparison with the non-pregnant state. Fibrinogen was also increased but at a level of P less than 0.01. A prolonged euglobulin clot lysis time was also observed (P less than 0.001). There was no significant difference in the mean values of platelet count in the two groups. These findings indicate that Nigerian women in pregnancy show physiological changes in haemostasis identical to those reported in Caucasians.

Using enzyme-linked immunosorbent assay (ELISA) and confirmatory immunoprecipitation tests, sera from 640 Nigerians from Lagos and Cross River States were examined for antibodies against HIV. These comprised 570 blood donors and their family members, 56 patients with various haematological conditions and 14 patients with acute Plasmodium falciparum infection. None of the sera was positive for HTLV-III/LAV antibodies by immunoprecipitation, although 12 (1.9%) sera were positive by ELISA.

Antibodies to HTLV-I have been detected in sera from 15 (2.0%) of 736 adult blood-donors in Nigeria, in 4 (20.0%) of 20 patients with chronic lymphatic leukaemia, 3 (10.0%) of 30 with non-Hodgkin's lymphoma, one of 12 with Burkitt's lymphoma and one of 7 with acute lymphoblastic leukaemia. The frequency of positivily was higher (3.6%) in the blood-donors from the guinea and wooded savanna of northern Nigeria than in those from the rain-forest and mangrove swamps of southern Nigeria (1.8% in Lagos and 0.7% in Calabar). Two of the 3 seropositive patients with lymphoma had clinical presentation and courses similar to those of Japanese and Caribbean patients with adult T-cell leukaemia/lymphoma.