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Background: In cancer microenvironment, there is increased production of inflammatory cytokines, including tumour necrosis factor (TNF)-α, interleukin (IL)-1a, and IL-6. These cytokines are capable of causing thrombus formation through the activation of tissue factors. Then, the Khorana risk score can be Utilised to stratify the risk of venous thromboembolism in cancer patients. AIM: The objective of this study was to determine the relationship between levels of IL 6, TNF-α, and Khorana scores of chemotherapy-naïve ambulatory cancer patients (CNACPs). MATERIALS AND METHODS: This was a cross-sectional study. The case group (n = 100) consisted of newly diagnosed CNACP recruited from adult oncology clinics of University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria, whereas the control group (n = 100) consisted of healthy individuals. The participants’ blood samples were assayed by enzyme-linked immunosorbent assay (ELISA) technique for IL-6 and TNF-α. Demographic variables were analysed using descriptive statistics in the form of frequencies and percentages and P < 0.05 was considered statistically significant. Results: There were significant differences between the mean levels of IL-6 (P = 0.036) and TNF-α (P = 0.001) in three Khorana score groups of the case group. Further, comparisons of mean IL-6 levels between three Khorana score groups showed that differences were between high-risk versus low-risk groups (P = 0.026) and between intermediate-risk versus low-risk groups (P = 0.014). Comparison of mean TNF-α levels in three Khorana score groups of CNACP showed that differences were between high-risk versus low-risk groups (P = 0.026) and between intermediate-risk versus low-risk groups (P = 0.014). Furthermore, there was a significant positive correlation between the Khorana scores and IL-6 (r = 0.28, P = 0.031) and TNF-α (r = 0.254, P = 0.011). The mean serum levels of IL-6 and TNF-α were significantly higher in CNACP than in healthy control (8.98 [8–12] pg/ml vs. 8.43 [2–10] pg/ml, P < 0.001) and (P < 0.001 and < 0.01), respectively. Conclusion: Inflammatory biomarkers are elevated in ambulatory CNACP and their values are significantly related with Khorana scores. There is a need for more studies on the possible benefit of prophylactic anticoagulation for newly diagnosed CNACP.

Abstract Background There is currently insufficient data regarding immune parameters and relationship with severity of malaria infection in Enugu, Nigeria where the economic and social costs of the disease and its management are extremely high. This study was conducted to determine the relationship between malaria severity and some immune-inflammatory markers among malaria-infected children in Enugu, Nigeria. Methods The study adopted a case control design. Eligible children were categorized into three groups — complicated, uncomplicated and healthy children. Pro-inflammatory cytokines –interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α); and anti-inflammatory cytokine — interleukin-10 (IL-10) were assayed using enzyme-linked immunosorbent assay (ELISA) technique, while immune cell ratios — neutrophil lymphocyte ratio (NLR) and monocyte lymphocyte ratio (MLR) were calculated from full blood count results. Results The overall mean age of the participants was 7.3 ± 3.4 (range: 6 months − 12 years) and the male-female ratio was 1:1. There was no significant difference between the ages of the three groups (P = 0.44). The Mean levels of IFN-γ, TNF-α, and NLR were higher in complicated than uncomplicated malaria (266.9 ± 66.3pg/ml vs. 62.5 ± 6.4pg/ml, p

Background: Hydroxyurea (HU) is the first disease-modifying drug used in the treatment of sickle cell disease (SCD). Despite its well-documented benefits, adoption and drug adherence have remained difficult. Aim: This study focused on determining the uptake rate of HU among SCD patients and the effects of HU on the disease outcome. Methodology: This was a retrospective hospital-based study conducted in four Nigerian tertiary institutions from October 2016 to September 2021. Data on their basic demographics, steady-state hematologic parameters, acute and chronic SCD-related events, and the use of HU were retrieved and analysed using the Statistical Package for the Social Sciences (SPSS) version 21. Statistics were both descriptive and inferential. Results: Of 509 SCD patients’ data analysed, 251 were male (49.3%), while 258 were female (50.7%). Their mean age was 26.9 (standard deviation ± 8.11) years; range: 18–63 years. Only 28 (5.5%) of the 509 patients were receiving or had ever received HU therapy. The steady-state hematological variables between individuals who are on hydroxyurea and those who are not hydroxyurea showed a statistically significant difference. Individuals who experience priapism (21.4%) and stroke (10.7%) were considerably more likely to be on HU (P = 0.001, 0.043), whereas patients not on HU were more likely to experience pulmonary hypertension (2.5%) (P = 0.001). Conclusion: The uptake of HU among SCD patients was low. Further prospective studies are encouraged to ascertain the factors responsible for this. There is a need for improved patients’ education and counselling to increase the level of awareness of HU and its benefits among patients.

Background: Most of the predictive tools put up to prognosticate treatment outcomes in patients with chronic lymphocytic leukaemia (CLL) are not easily available and affordable in our resource-constrained environment. Aim: The aim of this study was to evaluate the impact of staging and some tumour bulk on treatment outcomes of persons with CLL, Enugu, Nigeria. Patients and Methods: This is a 10-year review of the CLL data from the haemato-oncology unit of a Nigerian tertiary hospital to evaluate the impact of staging and tumour bulk indicators. Data were retrieved from the case notes of 102 patients with CLL receiving care at the facility. Data of interest include basic demographic variables, clinical features including spleen size and disease staging and blood counts. Statistical analysis was done using SPSS version 22. Results: The median absolute lymphocyte count (ALC) was 108.05 (confidence interval [CI] = 50.8–201.3, interquartile range [IQR] = 124.4) ×109/L, and duration of survival for the study cohort was 5.5 (CI = 3.5–31.9, IQR = 27) months. Majority (69, 79.3%) were in Stage C. The Binet stage showed a significant association with the ALC (r = 0.338; P = 0.002) but not with spleen size (r = 0.198; P = 0.056). The duration of survival only showed a significant inverse relationship with the ALC (r = 0.35, P = 0.006) but with neither the Binet stage (r = 0.103, P = 0.431) nor spleen size (r = 0.184, P = 0.116). Conclusion: In CLL patients, ALC at presentation correlates with the duration of survival. We recommend that the ALC at presentation be used as a prognostic marker in our clime.

Background: The overall quality of care may be hampered by poorly written referrals. Referral letters should be detailed to elicit prompt response by the invited unit. This will enhance ideal management of cases that are referred. Aim: The aim of the study is to determine the quality (content and usefulness) of referral letters received from inpatient clinical wards of University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla by hematology department of the hospital. Materials and Methods: This was a retrospective study of all referral letters received in hematology department of the hospital over a 1-year period (January to December, 2019) using a validated questionnaire. Results: A total of 231 referral letters were received and evaluated. The median age of the patients was 35 (range: 20–59) years with male-to-female ratio of 1:1.3. Initial statement identifying the reason for the referral was observed in 88.7% (n = 205). Majority (176/213, 82.5%) of the referrals did not include the results of investigations the patients did before the referral. Less than a quarter of the referrals (41/231, 19.3%) contained information on the treatment given to the patient. More than one-tenth (24/231), 11.3%) of the referrals were unhelpful while 13.6% (n = 29) were helpful. Conclusion: The referrals sent to the hematology department were deficient in quality. These deficiencies could be ameliorated by tutoring the younger doctors on the content of an ideal referral letter. Furthermore, a well-structured “referral form” with prompts for easy filling could be designed by hospitals as a guide to physicians for writing appropriate referral letter.

Background: Vaso-occlusive crisis (VOC) is a feature of sickle cell disease (SCD), an inherited medical condition which is more common in Sub-Saharan Africa especially Nigeria and is saddled with multi-systemic complications. Knowledge and practice of preventive measures of VOC by patients may reduce the risk of morbidity and mortality. Aim: The purpose of this manuscript is to determine the knowledge, attitude, and practice of the various preventive measures of VOC by patients and their relationship with their frequency of painful crisis. Materials and Methods: A cross-sectional descriptive survey was used. This study was conducted between August, 2018, and February, 2019. Participants were selected consecutively as they came for clinic consultations. Demographic characteristics and the knowledge, attitude, and practice of various preventive measures of VOC were obtained using a structured interviewer-administered questionnaire. The analysis was performed using Statistical Package for the Social Sciences software version 23.0. Descriptive and inferential statistics were used with P < 0.05 which was considered statistically significant. Ethical clearance and informed consent were obtained before the commencement of the study. Results: A total of 154 SCD patients participated in the study and were made up of 73 (47.4%) males and 81 (52.6%) females, with a male-to-female ratio of 1: 1.1. Majority of the respondents (76.6%) had good knowledge of preventive measures toward VOC in SCD. This study also found that 59 (38.3%) participants had good practice of preventive measures toward VOC while 95 (61.7%) had fair practice. Majority (68% [40/59]) of those who had good practice of preventive measures were less likely to have more than three crises in a year compared to those who do not practice good preventive measures, though not statistically significant (OR = 2.489, P = 0558) (confidence interval = 0.480 – 0.637). Conclusion: Majority of the patients have good knowledge and practice of preventive measures of VOC and this appears to have reduced the frequency of their crisis in a year. Health education for sickle cell patients is an important tool that may reduce morbidity and mortality by reducing the frequency of crisis.

Background: Multiple myeloma (MM) is a very common hematological malignancy and constitutes about 10% of hematological malignancies. Laboratory investigations including haematological, biochemical, and molecular studies play an important role in the diagnosis, monitoring of response, and relapse in patients with MM. Objectives: The objectives of this article were to assess the initial clinical features, hematological profile, and biochemical parameters of newly diagnosed patients with MM. Materials and Methods: This was a retrospective study of MM patients seen from February 2010 to January 2020 at a tertiary hospital in Nigeria. A total of 51 patients’ case notes were retrieved from the Medical Records Department of the hospital. The socio-demographic data were collected using a Microsoft Excel Sheet. Data on age, sex, hematological parameters, presence of bone lesions (fractures, and osteolytic findings from radiographs), and biochemical parameters were extracted and analyzed. Results: The median age was 60.5 years, and the mean age was 59.6 ± 9.3 with a range of 35–89 years and a male-to-female ratio of 1.7:1. Only 1 (2.0%) patient was aged below 40 years, and the rest 50 (98.0%) were above 40 years of age. The 61–70 age group had the highest number of cases, 31 (60.8%). The mean hemoglobin, white cell count, and platelet count were 7.96 ± 2.2; 6.76 ± 0.6; and 213.50 ± 98 respectively. Serum protein was >80 g/L in 33 (64.7%) and

BackgroundTo our knowledge, there is no prior randomized trial on the efficacy of Mojeaga remedy (a special blend of Alchornea cordifolia, Pennisetum glaucum and Sorghum bicolor extracts) when co-administered with standard-of-care for correction of anemia in obstetrics practice. This study determined the efficacy, safety and tolerability of Mojeaga as adjunct to conventional oral iron therapy for correction of anemia in obstetric population.MethodsA pilot open-label randomized clinical trial. Participants with confirmed diagnosis of anemia in three tertiary hospitals in Nigeria were studied. Eligible participants were randomized 1:1 to either Mojeaga syrups 50 mls (200mg/50mls) administered three times daily in conjunction with conventional iron therapy (Mojeaga group) for 2 weeks or conventional iron therapy alone without Mojeaga (standard-of-care group) for 2 weeks. Repeat hematocrit level were done 2 weeks post-initial therapy. Primary outcome measures were changes in hematocrit level and median hematocrit level at two weeks post therapy. Maternal adverse events and neonatal outcomes (birth anomalies, low birthweight, preterm rupture of membranes and preterm labor) were considered the safety outcome measures. Analysis was by intention-to-treat.ResultsNinety five participants were enrolled and randomly assigned to the Mojeaga group (n = 48) or standard-of-care group (n = 47). The baseline socio-demographic and clinical characteristics of the study participants were similar. At two weeks follow-up the median rise in hematocrit values from baseline (10.00±7.00% vs 6.00±4.00%;p0.05).ConclusionMojeaga represents a new adjuvants for standard-of-care option for patients with anemia. Mojeaga remedy is safe for treating anemia during pregnancy and puerperium without increasing the incidence of congenital anomalies, or adverse neonatal outcomes.Clinical trial registrationwww.pactr.samrc.ac.za: PACTR201901852059636 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5822).

Objective. We systematically identified the prevalence of triplex infections (combined human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)) in pregnancy. Methods. To gather information on the frequency of triplex infections, we searched the databases of PubMed, CINAHL, and Google Scholar. Without regard to language, we utilized search terms that covered HIV, HBV, HCV, and pregnancy. Pregnant women with triplex infections of HIV, HBV, and HCV were included in studies that also examined the prevalence of triplex infections. Review Manager 5.4.1 was employed to conduct the meta-analysis. Critical appraisal and bias tool risk data were provided as percentages with 95% confidence intervals (95% CIs), and I2 was used as the statistical measure of heterogeneity. The checklist was created by Hoy and colleagues. The study protocol was registered on PROSPERO, under the registration number CRD42020202583. Results. Eight studies involving 5314 women were included. We identified one ongoing study. Pooled prevalence of triplex infections was 0.03% (95% CI: 0.02–0.04%) according to meta-analysis. Subgroup analysis demonstrated a significantly high prevalence of 0.08% (95% CI: 0.06–0.10%; 3863 women) in HIV-positive population than 0.00% (95% CI:−0.00-0.00; 1451 women; P

Introduction: With increasing evidence of thromboembolic events among pregnant Nigerian women and associated high maternal mortality rates, there is a need to document the plasma levels of some markers of thrombosis in this population to aid prompt management of thromboembolic events. Objectives: To determine the plasma levels of free protein S (fPS), protein C (PC) antigen (PCAg), and PC activity (PCAc) in normal pregnancy, and any correlations with maternal age, gestational age (GA), and blood group. Materials and Methods: A cross-sectional study of eligible pregnant women receiving antenatal care in a tertiary hospital in south-south Nigeria. The plasma concentrations of fPS, PCAg, and PCAc were measured using enzyme-linked immunosorbent assay and Protac methods. Statistical analysis was both descriptive and inferential and done using SPSS, version 21, for windows. A P-value of

Objectives: The objective of the study was to assess how the current COVID-19 pandemic has affected cesarean section (C-section) rates, indications, and peripartum outcomes. Methods: This was a retrospective cross-sectional study that compared a 3-month rates of and indications for C-sections at three tertiary health care institutions in Nigeria before (October 2019–December 2019) and during the first wave of COVID-19 pandemic (March 2020–May 2020). Primary outcomes were C-section rate and indications between the two periods. Data were analyzed using SPSS 26.0 IBM Corporation. Rates and odds ratios with 95% confidence intervals were used to quantify indications and peripartum outcomes and statistical significance was accepted when p value was

The Corornavirus Disease (COVID-19) virus infection has a wide range of presentation- asymptomatic, mild, severe and critical forms that often lead to death from respiratory failure. There is a strong relationship between the severity of COVID-19 infection and some haematological parameters. Patients often present with lymphocytopenia at diagnosis despite having a normal total white cell count. The degree of lymphocytopenia could predict the progression to pneumonia and subsequent need for ventilator support due to respiratory failure. Apart from lymphocytopenia, thrombocytopenia has been linked with increased severity of COVID-19 symptoms. The lymphocyte-platelet ratio has been found to a better marker for disease severity than isolated lymphocytopenia or thrombocytopenia. COVID-19 patients have been found to be at increased risk of Venous Thromboembolism (VTE). There is elevation of D-dimers, abnormalities of the Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) among hospitalised COVID-19 patients. This has necessitated the use of prophylactic anticoagulation even in the early phases of the infection.

INTRODUCTION: Problem-based learning (PBL) method which was introduced about 50 years ago in Canada is beginning to gain acceptance over conventional teaching method (CTM) worldwide in medical education but still remains unpopular in Nigeria. This study aims to determine the perception of clinical medical students to the use of both learning methods in pathology courses. METHODS: a cross-sectional quantitative survey was conducted in four Nigerian Universities drawn from four regions of the country. Data were collected using pretested semi-structured self-administered questionnaires. RESULTS: the study included 310 respondents, 182(58.7%) males and 128(41.3%) females. Of all the participants, 257(82.9%) had heard of PBL prior to the study and 260(83.9%) thought it suitable for teaching and learning Pathology. Majority of participants, 221(71.3%) preferred a combination of both PBL and CTM while 238(76.8%) thought PBL suitable for all medical students. Some identified factors capable of enhancing adaptation of PBL into medical curriculum include conducive quiet spaces for learning and availability of computers with internet facilities for students' use. CONCLUSION: participants demonstrated high level of awareness of PBL and thought it suitable for all medical students. Availability of computers and up-to-date libraries with internet and audio-visual facilities could enhance adaptation of PBL into medical curriculum in Nigeria.

Introduction: The severity of Sickle Cell Anaemia (SCA) in terms of frequency of painful Vaso-Occlusive Crises (VOC) may be affected by clinical and haematological parameters amongst others. Elucidation of these factors in a given disease prevalent environment is necessary for prompt and effective management of patients with frequent painful VOC. Aim: This study aimed at determining the clinical and laboratory predictors of frequency of painful VOC among SCA patients in Enugu, Southeastern Nigeria. Materials and Methods: It was a cross-sectional study of 100 consecutive SCA patients receiving care at the University of Nigeria Teaching Hospital, Enugu, Nigeria between May 2012 and February 2014. The eligible patients were categorized into two groups namely; Group A and Group B. Group A/study group (severe disease) comprised SCA patients who had experienced three or more painful crises (≥3 crises) in the last one year preceding the study but, currently in steady state, while Group B/control group (mild–moderate disease), comprised SCA patients matched for age, sex, highest educational status, and occupation but who have had no painful crisis or had only one or two painful crises (0–2 crises) in the last one year preceding the study and currently in steady state. Results: The overall mean age of the patients was 18.4±12.2 (range=2-52) years. The mean values of the haematological parameters including haemoglobin concentration, white cell count, platelet count, and neutrophil count were significantly higher in those with severe crises than mild-moderate crises (p