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   2019| July-December  | Volume 10 | Issue 2  
    Online since December 6, 2019

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Hematological parameters of children with sickle cell anemia in steady and crisis states in Zaria, Nigeria
Yakubu Abubakar, Hafsat Rufa'i Ahmad, Jamilu Abdullahi Faruk
July-December 2019, 10(2):122-125
Background: Sickle cell anemia (SCA) is the most common and severest form of sickle cell disease. It affects about 3% of the Nigerian population with a high mortality in children. Hematological parameters are routinely used in the monitoring of SCA patients and might vary in crisis and steady states. Aims and Objectives: This study was aimed at comparing the hematological parameters of SCA patients in steady state with those in hemolytic and vaso-occlusive crisis states. Methodology: It was a cross-sectional study carried out at the pediatric outpatient clinic of a tertiary hospital in North West Nigeria. We recruited 170 SCA patients in steady state or in crisis state. Five milliliters of blood sample was collected for full blood count analysis using the Sysmex Xt 2000i automated hematology analyzer. Results: Hemoglobin (Hb) and hematocrit (HCT) levels for SCA patients in steady state were 8.28 ± 1.64 g/dl and 21.8 ± 4.04% while in vaso-occlusive crisis (VOC) state were 7.81 ± 1.37 g/dl and 22.05 ± 1.37% and those with hemolytic crisis were 4.45 ± 0.12 and 13.35 ± 0.67, respectively. Total white blood cell (WBC) count in steady and VOC states was 14.51 ± 5.21 × 109/l and 17.46 ± 5.26 × 109/l, respectively, while those in hemolytic crisis had WBC of 14.92 ± 5.82 × 106/l. ANOVA test was 0.0001, 0.0001, and 0.03, respectively, which indicates a statistically significant difference between the groups. The mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) in steady state were 76.67 fl ± 9.02, 27.18 pg ± 4.36, and 35.17 g/dl ± 4.25, while in VOC state, they were 74.88 fl ± 11.60, 27.24 pg ± 3.70, and 35.49 g/dl ± 1.42 and, in anemic crisis state, they were 76.63 ± 11.74, 26.71 ± 3.78 and 35.03 ± 1.20, respectively. Conclusion: Hematological parameters were lower during crisis states, although most of these were not significantly different from those in steady state apart from the WBC count, Hb, and HCT. Therefore, routine monitoring of hematological parameters should remain an important component in the management of SCA children.
  3,937 356 -
Age-related complications among individuals with sickle cell anemia attending a tertiary health facility in Northwestern Nigeria
Halima Bello-Manga, Sani Awwalu, Ifeoma P Ijei, Livingstone G Dogara
July-December 2019, 10(2):109-113
Background: Sickle cell disease (SCD) is the most common monogenetic disorder worldwide. With an annual birthrate of approximately 150,000 in Nigeria, the burden is expected to increase by 75% in 2050. With improved care, patients live longer but may have more complications. This study seeks to determine the prevalence of some complications of sickle cell anemia (SCA) and how age relates to these complications. Methods: This was a 2-year retrospective review of clinic records of patients with SCA attending the hematology clinic of Barau Dikko Teaching Hospital, Kaduna State, Nigeria. Data on sex, age at last birthday, age at diagnosis of SCA, number of crises in past 6 months, proteinuria, steady-state hemoglobin concentration, chest infections, stroke, and oxygen saturation (SPO2) were collated. Statistical Analysis: Data were analyzed using SPSS version 21 (IBM Corp., 2012, Armonk NY, USA). Continuous and categorical variables were assessed using the Shapiro–Wilk test and percentages. Differences in presenting ages between variables were determined using Mann–Whitney U-tests. Level of statistical significance was set at P ≤ 0.05. Results: A total of 109 patients were retrieved, 68.8% (75/109) were females with a median (interquartile range [IQR]) age of 22(18, 29) years. The median (IQR) number of crises in the preceding 6 months was 0 (0, 3). The prevalence of proteinuria, chest infections in the preceding 6 months, severe anemia, low oxygenation, and stroke were 9.5% (4/42), 6.5% (5/77), 7.0% (5/71), 58.9% (33/56), and 1.3% (1/77), respectively. A positive correlation existed between number of crises and presenting age (r = 0.317; P = 0.005). Patients with proteinuria, severe anemia, chest infections, and low SPO2had higher mean rank presenting age while patients with stroke had lower mean rank presenting age. Conclusion: Older age is significantly associated with severity of SCD. Age-targeted interventions guided by evidence-based practices are important in slowing down disease progression and severity.
  3,945 317 -
Antimicrobial resistance pattern of enterococci isolated from stool samples in a tertiary hospital in Nigeria
Shuwaram Amina Shettima, Kenneth Chukwuemeka Iregbu
July-December 2019, 10(2):126-131
Background: Enterococci cause infections both in and out of the hospital setting and have demonstrated resistance to almost all classes of drugs. A combination of cell wall acting agents and high-level aminoglycosides is a commonly used regimen for serious infections, but resistance to either renders the synergism ineffective. Vancomycin is the drug of choice for life-threatening infections, but there have been increasing reports of resistance to the drug. Vancomycin-resistant enterococci (VRE) infection is usually preceded by gastrointestinal colonization. Aim: This study was carried out to determine the antimicrobial resistance profile of Enterococcus species isolated from stool and the prevalence of VRE. Materials and Methods: Enterococci were identified from stool samples based on characteristic growth patterns on Bile Esculin Agar and MacConkey agar and growth in 6.5% sodium chloride broth. Speciation was by conventional biochemical identification. Antibiotic susceptibility testing and screening for high-level aminoglycoside resistance (HLAR) were done by modified Kirby–Bauer disk diffusion technique. Susceptibility of isolates to linezolid, penicillin, nitrofurantoin, high-level gentamicin and streptomycin, tetracycline, ciprofloxacin, vancomycin, and teicoplanin was tested. VRE screening was done using a chromogenic agar. The polymerase chain reaction was used for confirmation. Results: Nine species of Enterococcus were identified from 561 isolates. The most common species were Enterococcus faecium (46.0%), Enterococcus faecalis (21.6%), Enterococcus gallinarum (18.5%), and Enterococcus casseliflavus (5.2%). Resistance was highest to ciprofloxacin, tetracycline, and nitrofurantoin. Lowest resistance was to vancomycin, teicoplanin, gentamicin, and linezolid. VRE prevalence rate was 1.1% and that of HLAR was 20.7%. All VRE had vanA gene. Conclusion: Overall, E. faecium was the predominant species. Highest resistance was to ciprofloxacin and tetracycline.
  3,692 281 -
Histopathologic spectrum of lymph node disease in a lagos facility
Olubanji Ajibola Oguntunde, Nzechukwu Zimudo Ikeri, Uche Igbokwe, Fatimah Biade Abdulkareem, Adekunbiola Fehintola Banjo
July-December 2019, 10(2):114-118
Background and Objective: Hematopathology is often a technical and challenging aspect of pathology, requiring robust ancillary testing and second specialist opinion, both of which are not readily available and affordable to the Nigerian population. The aim of this study, therefore, was to determine the histological spectrum of lymph node diseases and highlight the diagnostic challenges. Methodology: A retrospective review of lymph node biopsies submitted to The Specialist Laboratories, Lagos, Nigeria, over an 8-year period was carried out. A proportion of these had a specialist's second opinion and ancillary immunohistochemistry testing where necessary. Results: Two hundred and ten lymph node biopsies were studied. Majority of the cases were diagnosed as nonspecific reactive changes (31.0%). This was followed by metastases to the lymph nodes (22.9%) and lymphomas (18.6%). Non-Hodgkin's lymphoma accounted for 79.5% of lymphomas, of which small cell lymphoma (35.5%) and diffuse large B-cell lymphoma (29.0%) were the most predominant subtypes. There was a 62.1% concordance between the preliminary and final diagnoses. Conclusion: These morphologic findings are in keeping with those in published literature. A significant number of discordant cases highlight the need for specialist training in hematopathology as well as the establishment of well-equipped facilities for accurate and cost-effective diagnosis.
  3,495 263 -
The total antioxidant status and antioxidant vitamins in Gombe, Nigeria
S Adamu, OM Akinosun, FM Abbiyesuku, Jibril M El-Bashir, JD Abubakar
July-December 2019, 10(2):119-121
Background: Measuring individual oxidants and antioxidants as markers of oxidative stress may be expensive, time-consuming, and open to a great deal of errors. In addition to freedom from the above, total antioxidant status (TAS) combines the synergistic effects of all the antioxidants in the system including those yet to be discovered. Aims and Objectives: The aim of this study was to evaluate the correlation between plasma levels of antioxidant vitamins (Vitamins A, C, and E) and TAS in Gombe, Nigeria. Materials and Methods: Pearson's correlation was used to correlate between plasma levels of antioxidant vitamins (Vitamins A, C, and E) and TAS among 180 people. Antioxidant vitamins (Vitamins A, C, and E) were analyzed using high-performance liquid chromatography and TAS was analyzed using standard colorimetric methods. Results: The mean age of the participants is 29.14 ± 3.6 years, and the mean body mass index is 23.26 ± 3.1. There was a significant strong (P < 0.001) positive correlation between TAS and Vitamin A (r = 0.59), Vitamin E (r = 0.52), and Vitamin C (r = 0.62). Conclusion: This study has demonstrated a high level of correlation between plasma levels of antioxidant vitamins (Vitamins A, C, and E) and TAS. This is an indication that TAS may assume a clinical status as a marker of oxidative stress. It may reduce the number of analytes, cost, time, and errors involved in assessing individual oxidants and antioxidants as markers of oxidative stress.
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Indications and patterns of blood transfusion in neonatal intensive care unit of a tertiary hospital in North West Nigeria
Ibrahim Usman Kusfa, Aisha Indo Mamman, Ismaila Nda Ibrahim, Augustine Benjamin, Garba Yahaya, Sani Musa, Aisha Ahmed Abubakar, Sirajo Mohammed Aminu, Abdulaziz Hassan, Muhammad Shakir Balogun
July-December 2019, 10(2):132-135
Background: Neonates requiring intensive care are among the most frequently transfused group of patients. Indications for blood transfusion in neonates could be physiological or pathological. However, despite frequent blood transfusions in neonates in Zaria, there is a paucity of studies on its indications and patterns among neonates in our setting. Objectives: The objective of this study is to determine the indications and patterns of blood transfusions among neonates in the neonatal intensive care unit (NICU) of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. Methods: This was a cross-sectional study on neonates in the NICU of ABUTH, Zaria. A pro forma was used to collect information from the mothers and neonates' case notes. Charts and table were used to show frequencies and proportions on the indications and types of blood transfusion given. Results: A total number of 172 neonates were admitted during the study period among whom 60 had blood transfusion. The median age (interquartile range) of the neonates was 2.5 (27) days, and the mean (± standard deviation) birth weight and hematocrit of the neonates were 2432.5 ± 722.9 g and 37.19 ± 8.76%, respectively, with 32 (53.3%) being males. Neonatal anemia (30, 50%), neonatal jaundice (25, 41.7%), neonatal sepsis (3, 5%), and preparation for surgery (2, 3.3%) were the indications for blood transfusion. Thirty-nine (65.0%) and 21 (35.0%) of the neonates had top-up and exchange blood transfusion, respectively. Conclusions: Neonatal anemia and jaundice were the major indications for blood transfusion while simple top-up was the main type of blood transfusions among the neonates in this study.
  1,539 125 -
Prevalence and associated risk factors of Chlamydia trachomatis among gynecology clinic attendees in a tertiary institution in Ogun State, Nigeria
Tinuade Adesola Ajani, Charles John Elikwu, Chinenye Gloria Anaedobe, Timothy A Olusesan Oluwasola, Mustapha Akanji Ajani
July-December 2019, 10(2):136-140
Background: Chlamydia trachomatis is one of the most prevalent bacterial-causing urogenital infections in men and women worldwide. There have been increasing reports of the prevalence of C. trachomatis in Nigeria. Aims: This study aimed to detect the prevalence of C. trachomatis seromarkers immunoglobulin G (IgG) and immunoglobulin A (IgA) and also to determine their associated risk factors among gynecology clinic attendees in the Babcock University Teaching Hospital, Ilishan-Remo, Ogun State of Nigeria. Materials and Methods: This was a cross-sectional study involving 145 consenting attendees of gynecology clinic of the hospital. Blood samples were collected and tested for C. trachomatis IgG and IgA using the enzyme-linked immunosorbent assay technique. Sociodemographic and sex behavioral factors were obtained by the interviewer-based questionnaires, whereas statistical analysis was done using SPSS version 23. Results: Overall prevalence of combined IgG and IgA was 46 (31.7%). Among the infected, 30 (65.2%) were young women aged 15–25 years and majority, 109 (75%), had never used condom while 83 (57.2%) had only one sex partner in the preceding 3 months. Twenty-three (15.9%) had a positive history of sexually transmitted infection (STIs), whereas 75 (51.7%) had ≥2 lifetime sex partners. Factors associated with the occurrence of both seromarkers on bivariate analysis included the previous history of STI and number of lifetime sex partners (P < 0.05), but with further analysis, only lifetime sex partners remained statistically significant (odds ratio = 5.63, confidence interval = 1.09–29.05, P = 0.007). Conclusion: There was a high prevalence of active, chronic, and persistent C. trachomatis infection with number of lifetime sex partner being a significant risk factor among our clinic attendees in Ogun State. Appropriate sex education should be encouraged among young people to reduce the burden of the infection and its attendant sequelae in our community.
  1,348 124 -
Histopathological pattern of prostatic lesions in Kano, Northwestern Nigeria: A 14-year review
Abdulkadir Abubakar, Sule Alfa Alhaji, Haruna Muhammad Sanusi, Salihu Aliyu, Muhammad Ujudud Musa, Abubakar Sarki Abdullahi
July-December 2019, 10(2):150-154
Background: Prostatic lesions are major afflictions of the aging men worldwide. High prevalence of prostatic neoplasm among the aged, their high incidence in the instances of obstructive uropathy, and many other complications with ensuing morbidity and mortality earn them a unique urologic placement. The epidemiological appraisals on the histology of prostatic lesions among men in Kano are not conclusive. The aim of this study was to review the spectrum of prostate lesions diagnosed with histopathology in Kano. Methodology: This was a retrospective review of histologically diagnosed prostatic lesions at Aminu Kano Teaching Hospital, Northwestern Nigeria, from 2005 to 2018. The data collated and analyzed were the age of patients and histological diagnoses. Summaries of these results were shown as mean of patients' age, patients' age range, frequency distribution tables, and some photomicrographs of the lesions. Results: A total of 4292 prostatic specimens were histologically diagnosed in the study. Nodular hyperplasia was the most common histological conclusion (75.9%), followed by invasive prostate cancer (23.5%). Many prostate cancer specimens have Gleason's scores of the poorly differentiated tumor (48.0%). The patient's age in both peaked at the age group of 60–69 years. Few specimens had prostatic intraepithelial neoplasia and inflammatory process. Conclusion: Nodular hyperplasia specimens had the highest of histological conclusions. The age profiles of prostate cancer patients were lower than those of the Western world. High-grade tumors weigh heavy among malignancies and hence the need for better biomarkers which may enhance early diagnosis and better treatment outcome.
  1,241 166 -
Utility of sunflower agar for laboratory detection of Cryptococcus neoformans
Sabitu Muhammad Zainu, M Ayanbimpe Grace, Yahya Mohammed, BA Sani, Aliyu Maryam Kangiwa
July-December 2019, 10(2):145-149
Background: Early diagnosis and management of cryptococcal meningitis is associated with good prognosis and long-term survival. Culture methods have been found to be promising and definitive in the diagnosis of many infectious diseases. We look at the sunflower agar (SFA) cultural method for detection Cryptococcus neoformans, the causative agent of cryptococcal meningitis. Materials and Methods: This is a descriptive cross-sectional study carried out at Jos University Teaching Hospital, Jos Nigeria, to find out the performance of SFA for the detection of C. neoformans. Cerebrospinal fluids (CSFs) of the study subjects were collected, subjected to Indian ink microscopy, inoculated on Sabouraud dextrose agar (SDA) and SFA for identification of C. neoformans. Results: A total of 90 CSF samples were analyzed for the identification of C. neoformans. SFA and SDA were able to confirm 8 (50%) and 7 (43%) of the 16 capsulated yeast cells detected by Indian ink microscopy as C. neoformans. Both media were found to have similar sensitivity (100%), specificity (91.3%), positive predictive value (80%), and negative predictive value (100%) in comparison with Indian ink microscopy. In terms of turnaround time, 6 isolates were identified within an average of 48 h (P = 0.017) by SFA, while SDA detects 2 isolates (P = 0.111) at the stipulated period. Conclusion: SFA can be a good routine conventional culture media for laboratory detection of C. neoformans.
  1,271 110 -
Intraoperative surgical pathology consultation (frozen section) in resource-limited setting
Saddik Malam Sahabi, Umar Mohammed, Kabiru Abdullahi, Abdulkadir Aminu, Kiran O Ekochin, Adedeji Bankole Kofi, Lawal Taofeek Olayinka, Ajayi Ayooye Samuel
July-December 2019, 10(2):141-144
Background: Intraoperative consultation aims at guiding decision during surgeries. Frozen section (FS) technique is a valuable tool used to rapidly prepare slides from tissues for microscopic interpretation. Over the past 100 years, FS diagnosis of surgically resected tumors and tissue has become a well-established practice in developed countries. On the other hand, developing countries only relatively recently got introduced to this technique. However, it remains unpopular due to a number of factors. This study strives to show that an alternative means in terms of reagents can easily be sought when the challenge of resource limitation is encountered. To the best of our knowledge, such a study has not been conducted in Nigeria. Methods: This was a prospective study over 12 weeks in which a comparison was made from surgical biopsy specimens received for intraoperative consultation. Using commercially available cryocompound, optimal cutting temperature (OCT) and readily available, less expensive, easy to handle alternative to embedding media: water and office glue. Staining was by conventional hematoxylin and eosin. Both groups were then viewed with the light microscope and findings were reported and compared. Results: Fifty-seven cases were studied, of which 24 were positive for tumor. Thirty cases were negative for tumor, and three cases had features consistent with metastatic tumor. Freezing time was 1–2 min for OCT and the glue alternative, while a third group was in frozen water for 2–3 min. The slides' quality was satisfactory for tissues processed in the OCT and glue; however, those processed in water had the worst outcome in terms of artifacts. Freeze and staining artifact were minimal in tissues processed using OCT and glue, whereas tissues processed using water was worst. Conclusion: Office glue is a readily obtainable alternative medium for FS and can provide satisfactorily comparable results to the conventional OCT in a resource-limited setting and is in the opinion of the authors, a good alternative.
  1,055 98 -
A case of dicephalus parapagus dibrachius dipedis twins with review of literature
Michael Chukwugoziem Nweke, Olubukola Adeponle Adesina, Ayomide Akinola, Oluwadamilare Iyapo, Gabriel Olabiyi Ogun
July-December 2019, 10(2):166-171
Conjoined twins are embryologic abnormalities which occur due to incomplete division of monozygotic twins. They are classified based on the most prominent site of union. Our aim was to use a postmortem examination to allow for proper classification and description of various coexisting pathologies present within the conjoined twins. We report an occurrence of a dicephalus parapagus dibrachius dipedis conjoined twin delivered to a 28-year-old female at our hospital. An autopsy was performed on the twin following an early demise. The detailed morphological examination findings with emphasis on the unique cardiovascular anatomical finding are reported along with a review of relevant literature. This report illustrates the occurrence of this variant of conjoined twins and the need to establish detailed institutional/national registries for birth defects and congenital anomalies in developing countries.
  1,029 90 -
Primary plasma cell leukemia in a 55-year-old Nigerian woman
Theresa Ukamaka Nwagha, Alozie Uchenna Eze, Richard Chidubem Okebaram, Helen Chioma Okoye
July-December 2019, 10(2):155-158
Plasma cell leukemia (PCL) is a rare and an aggressive disease, accounting for only 2%–3% of all plasma cell dyscrasias. Diagnosis is made by the presence of more than 2 × 109/L plasma cells in the peripheral blood or monoclonal plasmacytosis more than 20% of the plasma cells in the peripheral blood. PCL has limited treatment options comprising of the conventional multiple myeloma (MM) treatment drugs and a very poor prognosis. We report a case of a 55-year-old woman who presented with a history of high-grade fever, generalized weakness, petechial rashes, and transfusion-dependent anemia of about 3 months' duration. Peripheral blood film revealed moderate leukocytosis with 30% plasma cells. Bone marrow aspirate also showed significant plasmacytosis. Immunophenotyping confirmed peripheral blood plasmacytosis. The patient initially responded to chemotherapy but succumbed to the disease.
  956 99 -
Epstein–Barr virus-positive diffuse large B-cell lymphoma, not otherwise specified: A diagnostic challenge
Pallavi Sinha, Sarika Singh, Lity Dhar, Kirti Balhara
July-December 2019, 10(2):172-174
Epstein–Barr virus-positive diffuse large B-cell lymphoma, not otherwise specified (EBV + DLBCL) is a new separate entity included in 2016 WHO classification with dismal prognosis. Hence, awareness is needed for prompt diagnosis and swift treatment. Here, we present a case of a 48-year-old male with multiple cervical lymphadenopathy for 5 months. On examination, the patient had severe pallor and multiple firm to hard nontender cervical lymph nodes. Bone marrow aspiration was a dry tap. Bone marrow biopsy revealed nodular collection of atypical monomorphic lymphoid cells admixed with lymphocytes, eosinophils, and plasma cells in the background. Lymph node biopsy demonstrated total effacement of normal lymph node architecture with atypical lymphoid cells. These cells were positive for CD20, CD30, and CD38, LMP1, myc, IRF4/MUM1, and FOXP1 and were negative for anaplastic lymphoma kinase, CD3, CD10, bcl2, bcl6, and CD15. Diagnosis of EBV-positive DLBCL was rendered.
  930 110 -
Myeloid sarcoma presenting with proptosis, ruptured globe, and facial swelling
Jamilu Abdullahi Faruk, Mustapha Niyi Adebiyi, Samaha Mustapha, Garba D Waziri, Dauda E Suleiman, Aliyu D Waziri, Hafsat Ahmad Rufa’i
July-December 2019, 10(2):159-162
Myeloid sarcoma (MS) is a rare malignancy of immature myeloid cells and/or monocytes that occur in an extramedullary site. It is frequently mistaken for small-round-blue cell tumors, in the absence of immunohistochemistry. A case report of an unusual presentation of MS with a ruptured globe at a tertiary setting of North-western Nigeria is presented. The patient was a 12-year-old girl with progressive bilateral proptosis and spontaneous rupture of the left eye. A histologic diagnosis of embryonal rhabdomyosarcoma was made, but she had a minimal improvement in her clinical condition following chemotherapy. Further review showed bone marrow myeloblasts >98%. The previous tissue biopsy was subjected to immunohistochemistry and found to be CD117 – strongly positive and CD34 – patchy positive. The conclusion was that of myeloid leukemic infiltration of orbital tissue MS. The patient abandoned the treatment due to caregiver fatigue and financial exhaustion.
  917 93 -
Mesenteric cyst in a 6-years old: A case report and review of literature
Felix Emeka Menkiti, Corelius Ozobia Ukah, Jideofor Okechukwu Ugwu
July-December 2019, 10(2):163-165
Mesenteric cysts (MCs) are a group of rare benign intra-abdominal lesions that are usually asymptomatic but with chances of recurrence and malignant transformation if incompletely excised. Its asymptomatic or nonspecific symptomatic nature makes preoperative diagnosis difficult. We report a case of huge congenital MC in a 6 years old. He was brought to our center following a history of recurrent abdominal pain since birth. The diagnosis was suggested following computed tomography scan but only confirmed postlaparotomy through histopathologic evaluation. No recurrence on follow-up has been reported.
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