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Background: Anaemia is a public health problem affecting millions of people globally, especially in low and middle-income countries. It leads to complications that affect patients' daily activities due to fatigue and impaired cognitive function. Objectives: To determine the prevalence and patterns of anaemia amongst patients attending tertiary health institutions. Materials and Methods: This was a retrospective study which used previous records obtained from the registers available at the Haematology Section of the Laboratory Complex, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Amaku, Awka, Nigeria. These were records from 1st January 2016 to 31st December 2017. A proforma was used to collect data from the registers in the Haematology Department. Variables extracted were year, month, age, sex and patient's Department. Data were analysed using SPSS (Statistical Package for Social Science) version 20.0. Results were presented in tables. Results: A total of 4950 haemoglobin concentration test results were analysed. 2846 (57.5%) were females. The overall prevalence of anaemia regardless of the degree of severity was found to be 62.9%. Severe anaemia was highest in males 15 years and above (15%). Children below the age of 5 had the lowest prevalence of anaemia. (62.5%). Mild anaemia was highest in Children aged 12 to 14 (35.1%). Patients older than 15 years constituted over half of the data collected. Conclusion: The prevalence of anaemia based on available laboratory results is alarmingly high in Awka, Nigeria, when compared to other related studies within Nigeria and beyond.

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

Sickle cell disease (SCD) presents with a dynamic background of haemolysis and deepening anaemia. This increases the demand for transfusion if any additional strain on haemopoiesis is encountered due to any other physiological or pathological causes. Patients with cerebrovascular accidents are placed on chronic blood transfusion; those with acute sequestration and acute chest syndrome are likewise managed with blood transfusion. These patients are prone to develop complications of blood transfusion including alloimmunization and hyperhaemolytic syndrome (HHS). This term is used to describe haemolysis of both transfused and “own” red cells occurring during or post-transfusion in sickle cell patients. Hyperhaemolysis results in worsening post-transfusion haemoglobin due attendant haemolysis of both transfused and autologous red cells. The mechanism underlying this rare and usually fatal complication of SCD has been thought to be secondary to changes in the red cell membrane with associated immunological reactions against exposed cell membrane phospholipids. The predisposition to HHS in sickle cell is also varied and the search for a prediction pattern or value has been evasive. This review discusses the pathogenesis, risk factors and treatment of HHS, elaborating on what is known of this rare condition.

Introduction: Sickle Cell Disease (SCD) is an inherited haemolytic disorder that affects virtually all body systems including the eye. Ocular complications of SCD could have dire consequences if not detected early. Objectives: We aimed at determining the prevalence of ocular complications of SCD in our patients. Methods: This study was carried out on patients attending both the adult and Paediatric Sickle cell disease clinic at Chukwuemeka Odumegwu Ojukwu Teaching Hospital, Akwa, Anambra State, Nigeria, over an 8 month period. A structured questionnaire was administered to consenting patients to determine their sociodemographic variables and other characteristics. Visual acuity was determined with multiple optotype Snellen’s chart at 6 metres in natural daylight. Using pen-torch, the face, external eye examination, anterior segment examination and pupillary reaction to light were assessed. Magnified anterior segment examination was performed with slit-lamp biomicroscope. All subjects underwent dilated fundoscopy (after instillation of tropicamide 0.5% eye drop) using Welch Allyn indirect ophthalmoscope. Results were analysed using SPSS version 22.0 Inc Chicago Illinois and represented in tables. Statistically significant P value was set at < 0.05. Results: A total of 28 patients with age range of 6-42 years were seen. 17 (60.7%) were males, while 11 (39.3%) were females. 8 (28.6%) had at least one ocular anomaly comprising of refractory errors 3 (10.8%), sickle cell retinopathy 4 (14.3%) and glaucoma 2 (7.1%). Only 2 (7.1%) routinely visit eye clinic. SCD retinopathy was found to increase with age (P value= 0.005). Conclusion: SCD retinopathy was found more in the older age group despite the small sample size at a prevalence rate of 14.3%. Early initiation of routine ocular examination for SCD patients will be beneficial to avert these complications. More efforts should be made at educating the patients. Larger studies will be required to determine the actual prevalence of ocular anomaly in SCD patients in Anambra State.

Aim: Granulocyte differentiation factor 15 (GDF15) is a growth factor and biomarker for many disorders where Ischaemia Reperfusion Injury (IRI) is pathophysiologically relevant. Hence the need to evaluate GDF-15 as a biomarker in Sickle Cell Disease (SCD). Study Design: This is a cross sectional study. Place and Duration of Study: Department of Haematology, Nnamdi University Teaching Hospital, Nnewi, Anambra state, Nigeria, between January and December 2018. Methods: Ninety subjects were randomly recruited with haemoglobin (Hb) phenotypes SS (test), AS and AA (controls); numbering 30, 28 and 32 respectively. Disease severity was determined by calculating an objective score. 5 mls of blood was collected and used to determine Full Blood Count (FBC), haemoglobin Phenotype and GDF-15 levels (by Enzyme Linked Immunosorbent assay). Data collected was analysed using Statistical Package for Social Sciences software version 20 (SPSS Inc., IL, Chicago, USA). P< 0.05 was considered as significant. Results: GDF-15 level was found to be significantly different in the different HB phenotypes p= 0.005 and correlated negatively with sickle cell disease severity (r= -0.307, p= 0.098). The difference between median GDF-15 levels of HBSS subjects with mild and moderate disease was statistically significant at p= 0.01. Conclusion: We hypothesize that GDF-15 may be a potential therapeutic target for intervention against ischaemia/reperfusion induced micro- vascular injury. Natural GDF-15 mimetics may be useful in taking advantage of this potential therapeutic target.

Objective The purpose of this pilot study was to explore the effect of omega-3 fatty acids and potassium thiocyanate on conditional peak systolic cerebral artery blood velocity in children with sickle cell anemia (SCA). Methods Transcranial doppler ultrasonography (TCD) was done on 232 SCA children, and 21 found with conditional peak systolic blood velocity (PSV) of 200–249 cm/s in internal carotid, middle or anterior cerebral arteries. These were randomized to receive omega-3 fatty acids and potassium thiocyanate with standard treatment of SCA (test group, N = 14), or standard treatment only (control group, N = 7). After 3 months of treatment, PSV was measured again. Results Right middle cerebral artery PSV was significantly reduced in the test relative to the control groups (p = 0.04). PSV returned to normal in 79% of the test versus 43% of the control group; and increased to abnormal in one member of the control group, but none of the test group. Conclusions The pilot data suggest that in SCA, omega-3 fatty acids and potassium thiocyanate might reduce conditional blood velocity to normal, or prevent progression to abnormal values. A larger, randomized, clinical trial is required to further address the current gap in management of conditional TCD blood velocity.

Studies have indicated neutrophil/lymphocyte ratio (NLR), Platelet/Lymphocyte ratio (PLR), and platelet/neutrophils ratio (PNR) to be inflammatory markers. The correlation of these values in infants of hypertensive mothers has not been investigated.To investigate the relationship between NLR, PLR, and PNR of neonates of women with hypertensive disease of pregnancy and neonatal APGAR scores and birth weight.Cord blood samples of 200 neonates collected and the blood counts and ratios obtained.NLR in the babies of the hypertensive mothers was 0.865 and 1.42 in the control group (p = 0.0001). PLR was 34.7 in the neonates of the hypertensive mothers and 62.4 in the control group (p = 0.0001). PNR did not differ significantly between the two groups,p = 0.418. Degree of hypertension had a direct relationship with NLR; SBP had a p value of 0.001 while the DBP had p = 0.002. The PLR had an inverse relationship with the degree of hypertension; SBP p value of 0.0001, while DBP was p = 0.0001. No significant association was observed between the ratios and neonatal birth weight (p ≥ 0.05); however, PNR and PLR were found to be significantly associated with the 1st (p = 0.045 and 0.030) and 5th (0.049 and 0.037) minute APGAR scores in the newborns.PLR and NLR in neonates of hypertensive mothers are found to be markedly lower than those of controls, the degree of which is affected by the severity of hypertension. Also, lower PLR is associated with lower APGAR scores. Therefore, severity of high blood pressure and lower PLR may be determinants of poor birth outcome.

Background: Multiply transfused patients (MTPs) are often at risk of alloimmunization and other transfusion-associated complications. These complications could be ameliorated through extended blood typing prior to transfusion of blood and blood products. Objective: The aim of this study was to assess the knowledge and practice of safe blood transfusion in MTPs by physicians. Materials and Methods: This was a cross-sectional questionnaire-based study of physicians who attended a scientific conference of the West Africa College of Physicians in Asaba, Delta State. Result: Most of the respondents (68%) managed patients requiring multiple blood transfusions. Forty-seven respondents (68.1%) had a blood transfusion policy for MTPs in their respective centers, and 43 (68.1%) had no transfusion trigger hemoglobin level in their respective health facilities. Respondents who had a blood transfusion policy in their centers had a better knowledge of safe blood transfusion than those that did not, P = 0.008. None of the respondents reported carrying out antibody screening before and after multiply transfusing the patients. Although 100% performed initial screening for transfusion transmissible infections (TTIs), only 11.6% repeated screening for TTIs annually. Conclusion: Practice of safe blood transfusion in MTPs was found to be poor among physicians in Nigeria. Hospitals and training institutions should design ways to update knowledge of physicians on safe blood transfusion especially in MTPs and by so doing optimize safe blood transfusion practices, so as to improve the quality of life of patients.

Background: High-risk sexual practices are an important driver for the spread of HIV; little is known about the sexual practices of persons living with HIV/AIDS (PLWH) in Nigeria. Aim: The aim of this study was to evaluate the sexual behaviors of PLWH and determinants of the practice of multiple sexual partners. Materials and Methods: This was a cross-sectional descriptive study. Information on sexual practices before and after diagnosis of HIV/AIDS was sought from PLWH on antiretroviral therapy. Data were analyzed using the Statistical Package for the Statistical Package for the Social Sciences (SPSS) software, version 22 (IBM Chicago Illinois, USA). Results: A total of 250 PLWH participated in the study with the interquartile age range of 31–42 years. 72% were females and 43.6% had multiple sexual partners before diagnosis, whereas only 6.0% had multiple sexual partners after diagnosis (P 0.05). Conclusion: This study identifies gender as a determinant of high-risk sexual practices; males were more likely to have multiple sexual partners than their female counterparts before diagnosis. However, diagnosis or knowledge of HIV status is associated with a decline in risky sexual behaviors.

Background: The prevention and control of human immunodeficiency virus (HIV) infection depend on the prevention of new infections as well as treating currently infected individuals. Adequate knowledge of HIV infection among person living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA) may be an important tool in reducing spread of the virus. Objective: The objective of the study was to evaluate knowledge and attitude of PLWHA on HIV infection. Methodology: This was a cross-sectional study conducted at the Chukwuemeka Odumegwu Ojukwu Teaching Hospital. Knowledge of infection, spread, control, and effect was sought from HIV-positive respondents using a structured questionnaire. Information about their attitude and beliefs was also obtained. Collected data were analyzed using the Statistical Package for Social Sciences for Windows, Version 21.0. Results: A total of 70 HIV-positive patients, including 23 (32.9%) males and 47 (67.1%) females with a mean age of 37.7 years were participated. The overall knowledge on HIV transmission, clinical effects, complications, and controls was good in 15.7%, average in 72.9%, and poor in 11.4%. Knowledge of means of transmission was appropriate in majority of them. Majority of 66 (94.3%) patients showed a positive attitude to life. Conclusion: Most of the HIV-positive patients had average knowledge on HIV, and majority had a positive attitude to life.

HIV transmission is still a public health concern in sub-Saharan Africa; disclosure is an effective tool for its prevention, contact tracing and treatment. We aimed to evaluate the disclosure behaviours of adult HIV-positive patients receiving antiretroviral therapy (ART) in University of Port Harcourt Teaching Hospital, and identify major challenges to disclosure in a bid to develop ways to improve this practice in the environment. Patients receiving ART in this centre were interviewed using an interviewer-administered questionnaire. A total of 250 clients were interviewed over three months. A majority of the patients were tested on account of ill health 143 (57.2%). They commenced ART within 8 ± 15.4 SD months of presentation. The mean period before disclosure was 4.75 ± 12.8 SD months of diagnosis. Thirty-six (14.4%) of the respondents had not disclosed their HIV status; the major barrier to disclosure was stigmatisation in 19 (36%).

Background: Cancer of the prostate is the commonest cancer and the most frequent cause of cancer deaths in Nigerian males. In Nigeria, prostate cancer patients frequently present in the late stage of the disease with consequent poor prognosis. The outcome of the disease in our setting is also worsened by diagnostic errors; this fact has been underappreciated. In this study, we have assessed the accuracy of clinical diagnosis of prostate tumors by clinicians working in Anambra State, Nigeria. Materials and Methods: Retrospective data were retrieved for all histopathology requests for prostatectomy specimens submitted to three pathology laboratories in Anambra State, Nigeria. The working clinical diagnoses were compared with the corresponding histopathology diagnoses, and the diagnostic accuracy of the medical doctors was calculated statistically. Results: Our results showed that the clinicians studied have a low overall sensitivity (37,500 per 100,000 patients) in diagnosing prostate cancer. Furthermore, doctors working in public hospitals have a slightly lower sensitivity but higher specificity than doctors serving in private hospitals when it comes to diagnosing prostrate tumors. Conclusion: This study revealed a high specificity but low sensitivity in clinicians' ability to accurately diagnose prostatic cancer. Reliance on PSA needs to be reviewed. More so the serving laboratories in the index State may need to apply internal and external quality assurance systems to their PSA analysis. It will be instructive to search for other diagnostic tools with appreciably higher predictive value. Generally, more education, research and development is needed for improvement.

Modern medicine brought with it “evidence-based practice”, which demands that a diagnostic test or treatment method or drug to be used on humans must be proven to be at least safe and efficacious; and the result from the use of such must be reliable and repeatable. These days, the need for evidence-based practice has become even more imperative. Evidence-based practice extends to veterinary practice and also to non-medical practices, for instance in oil exploration. To satisfy these demands in drug testing, robust statistical methods of assessment and ethical procedure must be employed. We here develop and present a probability model for the approval of a new drug intended for use in man or animal. The model showed that there should be more than one evaluation committee working on the approval of one drug at a time. This approach would help in minimizing the error of approving wrongly drugs that should never have been approved. The proposed method has proven the workability and value of using at least three independent evaluation committees, working with the same sets of criteria, in assessing the basis for the use of a new drug and its approval.

This paper proposes false-rates-based relative risk-type measure of the strength of association between state of nature or condition in a population and test results in diagnostic screening tests. The adopted method provides an estimate for the proposed relative risk that depends only on the estimated sensitivity and specificity of the test in the event that the prevalence rate is not known. The proposed method unlike the traditional odds ratio provides estimates of not only the proposed false rates based relative risk-type measure of association, but also alternative sample estimates of its associated standard deviation and test statistic for significance that intrinsically and structurally partials out, that is, does not include in its formulation the number of subjects in the sample known or believed to actually have the condition in nature but test negative or actually do not have the condition in nature but test positive to the condition in the screening test. The proposed method given that the prevalence rate of the condition in the population is known, provides sample estimates of the false positive rate, false negative rate and their odds as well as the proportion of the population expected to test positive to the condition in the screening test which are additional useful information to guide policy formulation and implementation over and above the traditional odds ratio method. Modified estimates of the standard deviation and test statistic for the proposed measure that adjust for the fact that some sample observations in a screening test are not known and cannot therefore validly be used in traditional relative risk estimation method are provided. The proposed method which is shown to provide more information and to be at least as efficient as the traditional relative risk method is illustrated with some sample data.

Background: Maternal factors are determinants of birth outcome which includes birth weight, haematological indices and mode of delivery of their babies.Objectives: To determine the impact of parity and gestational age of hypertensive mothers on some neonatal variables.Methods: A hospital based cross-sectional study of measurement of neonatal variables (birth weight, red blood cells and mode of delivery) among hypertensive mothers and their controls was conducted over a period of six months. Data were analyzed using the Statistical Package for Social Sciences program (SPSS), version 20.Results: There were statistically significant differences in means between the neonates of the hypertensive group and non-hypertensive group for maternal age (t =1.61, p = 0.002), baby weight (t =2.87, p < 0.001), haemoglobin (Hb) (t =4.65, p = 0.010) and packed cell volume (PCV) (t =4.75, p = 0.009), but none for gravidity (t =1.95, p = 0.927)For all subjects, there was poor correlation between gestational age and variables; birth weight , haemoglobin (Hb), packed cell volume (PCV), nucleated red blood cell (nRBC) and parity. Likewise, parity poorly correlated with variables; age, birth weight, Hb, PCV, and nRBC. There was a statistically significant association between mode of delivery and hypertension (χ2 =53.082, p