Biomedical subjects

N O Akinola

Publications and source records attributed to N O Akinola.

17 recordsLinked to original sources

PubMed2006

Clinical and prognostic features of Nigerians with chronic myeloid leukemia.

AIMS AND OBJECTIVES: Chronic myeloid leukemia (CML). PATIENTS AND METHODS: CML patients confirmed at the OAUTHC, Ile-Ife between June 1986 and December 1999 were studied prospectively until death or the last visit to the clinic. Stages of the disease at diagnosis, presenting clinical features and laboratory parameters, as well as the drug history were noted for each patient. Survival of each patient was computed from the date of diagnosis until the date of death. Kaplan-Meier statistical technique was used for analysis of survival. Factors were compared with log rank test. Student's t-test was used for comparing means of presenting clinical and laboratory parameters between groups. P-value of <0.05 was considered significant. SPSS for windows Release 10 (Real Stats, Real Easy, 1989-1999) was used for all calculations. RESULTS AND CONCLUSION: There were 42 patients (27 males and 15 females, ratio of 1.8:1) with ages ranging from 12-74 (median=38.0) years. Philadelphia chromosome was positive in the five patients (12.0%) that underwent cytogenetic analysis. Thirty-three of the patients (78.6%) presented in treatable chronic phase and the other 9 (21.4%) were seen in advanced stages (7 in accelerated & 2 in blastic phase). The median survival of patients that presented in chronic phase was 31.7 months compared to 0.16 months in patients presenting in advanced stages, the difference was statistically significant (log rank=7.8, p-value=0.005). Significant positive correlation was obtained between spleen size and total white cell count at diagnosis (r=0.36, p=0.02). Univariate regression analysis showed negative relationship between survival and ages of patients at diagnosis, haematocrit value, spleen and liver sizes, and blast count. The relationships were statistically significant for only liver and spleen (b=-0.63, p=0.004 and b=-0.51, p=0.026, respectively). Regression of both the liver and spleen with survival, still confirms the significant negative relationship between hepatomegaly and survival.

Adolescent↗

PubMed2004

The search for a predictor of CD4 cell count continues: total lymphocyte count is not a substitute for CD4 cell count in the management of HIV-infected individuals in a resource-limited setting.

Total lymphocyte count (TLC) has been recommended as a substitute for CD4 cell count for the management of HIV-infected individuals living in resource-limited settings. To confirm this, 151 TLCs and CD4 cell counts were obtained from 109 patients who had not yet started treatment and analyzed. CD4 cell counts of <200 cells/mm3 were found in 42 cases (37.8%) with TLCs of > or =1200 cells/mm3. Thus, 1 in 3 individuals would have been deprived of needed treatment. Therefore, in this setting, TLC is not a reliable predictor of CD4 cell count in HIV-infected individuals.

Adult↗

PubMed2004

Determinants of survival in Nigerians with Burkitt's lymphoma.

There is paucity of information on the factors influencing survival of patients with Burkitt's lymphoma (BL) in Nigeria. This work was undertaken to examine the roles of presenting clinical and laboratory features in the survival of a number of Nigerian patients with BL. Confirmed cases of BL diagnosed in the hospital between January 1986 and December 1999 were studied. Diagnosis of the tumour was based on fine needle aspiration cytology of easily accessible mass in a large majority of patients. Median survival was calculated for all the dead patients using Kaplan-Meier technique. SPSS 10 statistical software and EPI 6.04b were used for all statistical calculations. A total of 213 patients were recruited over the 13-year period; with ages ranging from 3-45 years (median = 9) at diagnosis. The male-female ratio was 1.8:1. At the time of analysis in December 2001, 166 (77.9%) of patients had defaulted, 44 were known to have died and 3 were still alive. Only 81 (38%) of the patients had adequate chemotherapy (4-6 cycles). Fifty one (23.9%) patients had an initial complete remission. The mean survival of the 44 patients that died was 10.5 weeks (95% Cl = 3.9-17.1). It is concluded that survival in Burkitt's lymphoma was significantly better in patients who had adequate therapy, mean 40.8 +/- 12.2 (SE) weeks compared to those who had less than adequate cycles of chemotherapy, mean 3.7 +/- 1.0 (SE) weeks (p = 0.0000). Inadequate therapy and high default rate were partly responsible for the poor survival results obtained in this study.

Adolescent↗

PubMed2003

A retrospective study of prevalence of antibody to HIV in blood donors at Ile-Ife, Nigeria.

Records of voluntary and remunerative blood donors bled at the OAUTHC, Ile-Ife, Nigeria between January 1993 and December 2000 were reviewed for HIV sero-positivity. With a structured questionnaire, and over a period of 2 months, the attitudes and awareness of some of the donors of HIV/AIDS epidemic in the country were also assessed. Of the 16,080 units of blood collected in the period under review, only 1073(6.7%) were obtained from voluntary donors. The cumulative HIV seroprevalence rate was 2.1% in the paid donors as against 0.3% in the voluntary donors (c2 = 16.3, df = 1, p = 0.00003). Sixty-five (805) of the donors interviewed confirmed previous knowledge of HIV/AIDS before the interview. All the respondents appreciated the roles of blood transfusion in the transmission of AIDS viruses. The majority (74%) of the respondents were unemployed. Poverty was the reason given by 61(75%) of the commercial donors for selling their blood. We conclude that there is a greater risk of transmitting AIDS viruses (and possibly other blood transmissible diseases) through remunerated blood donors.

Adult↗

PubMed2000

The haematological profile of Nigerians with chronic renal failure.

In an attempt to add to existing sparse literature on the haematological profile in chronic renal failure (CFR) in Nigeria, we have undertaken a comprehensive haematological sturdy of 39 patients (male 27, female 12) age range 11-56 yr., (mean 28.8 +/- 11.8) who had established pre-dialytic CFR. The mean haematocrit was 24.1 +/- 6.7% (range 12-40%). Severe anaemia was found in seven (18%), mild to moderate anaemia in 27 (69%) whilst five patients were not anaemic. Haematocrit correlated inversely with the degree of renal failure as assessed by serum creatinine (r = -0.35, P < 0.05). Red cell morphology was variable but the majority of patients showed a normocytic, normochromic blood film. The reticulocyte counts/indices were low. The mean total white cell count was generally within normal limits, ranging from (2 to 10.5 x 10(9)/l), with a mean of 5.3 +/- 2.1 x 10(9)/l and striking eosinophilia in 5 patients. Platelet count ranged between 82 and 350 x 10(9)/l (mean 156.5 +/- 65.7 x 10(9)/l) with only 3 patients having a relatively low count of < 100 x 10/l. Prolonged bleeding time (BT) > 9 minutes occurred in 13 (25.6%). There was no significant correlation between platelet count and bleeding time r = 0.21, P = 0.34. No significant correlation was observed between serum creatinine and bleeding time r = 0.09, P > 05. The bone marrow showed predominantly normocellular marrow but 7 patients had hypocellularity. Myeloid: Erythroid ratio ranged between 1:1 and 10:1, (mean 3:6:1) and correlated positively with serum creatinine values. (r = 0.37, P = 0.048). Bone marrow storage iron was absent in two and reduced in six patients. Severe anaemia is a common feature in Nigeria patients with CRF and it strongly associated with the severity of the renal failure. The low reticulocyte count and the tendency for erythroid hpoplasia to occur with increasing severity of renal failure would necessitate the use of erythropietin in our patients. The increased bleeding tendency in some of the patients calls for caution in surgical procedures in these patient.

Adolescent↗

PubMed1995

Acceptability of prenatal diagnosis of sickle cell anaemia (SCA) by female patients and parents of SCA patients in Nigeria.

The acceptability of prenatal diagnosis (PND) of sickle cell anaemia (SCA) as a means of controlling sickle cell disorder in Nigeria was examined using a structured questionnaire. The respondents were comprised of 92 adult female patients with SCA, aged 15-20 (23 +/- 6) years; 53 HbAS mothers, aged 20-61 (37 +/- 11) years and 48 HbAS fathers, aged 33-65 (46 +/- 8) years. More than 85% of the respondents would like PND to be offered in Nigeria and 92% of the HbAS mothers as well as 86% of the fathers would like to have the investigation or allow their wives to go through the procedure, respectively. Only 35% of the patients as compared to 63% of the mothers and 51% of the fathers would opt for termination of an affected pregnancy. Fear of the complications of abortion and religious convictions were the two most frequently cited reasons for opposing pregnancy termination. The high percentage of parents who would opt for termination of an affected pregnancy was associated with the societal emphasis on perfection and on previous experience in management of SCA patients. It is interesting that most of the respondents still favoured effective genetic counselling as the best means of controlling SCA.

Adolescent↗

PubMed1995

Malignant solid tumours in Nigerian children.

The subject of neoplasia in African children has received little or no attention within the past two decades. The current study retrospectively reviews malignant solid tumours in children from birth up to the age of 15 years over an 11 year period in Ile-Ife, Nigeria. During this period, 71 pc of solid tumours seen in children were malignant and boys were more often affected than girls. The peak incidence was between the ages of six and 13 years. Lymphoma was the commonest type of tumour, accounting for 72.6 pc of all malignant solid tumours and males predominated. All the rhabdomyosarcomas were seen in boys and the alveolar variant predominated. Osteogenic sarcoma and nephroblastoma were more often seen in girls. No primary brain tumour was seen.

Adolescent↗

PubMed1994

Monitoring the acute phase response to vaso-occlusive crisis in sickle cell disease.

AIMS: To identify suitable acute phase proteins as objective markers of tissue ischaemia during painful vaso-occlusive crises in sickle cell disease. METHODS: The prodromal and established phases of 14 vaso-occlusive crises were studied longitudinally in 10 patients with sickle cell anaemia. Automated solid phase enzyme immunoassays were used to measure the fast responding acute phase proteins C-reactive protein and serum amyloid A protein. Slower responding glycoproteins (fibrinogen, orosomucoid, sialic acid and concanavalin-A binding) were measured in parallel. RESULTS: C-reactive protein and serum amyloid A protein increased early in crisis, sometimes within the early (prodromal) phase. Crises that resolved within 24 hours in hospital showed a minor and transient rise compared with crises that required treatment for four days or more. In eight crises treated by patients at home the acute phase response ranged from minor to a level consistent with extensive tissue ischaemia. CONCLUSIONS: Sensitive enzyme immunoassays for C-reactive protein and serum amyloid A protein are of potential value for monitoring the onset of tissue ischaemia in sickle cell crisis and for confirming subsequent resolution.

Acute-Phase Proteins↗

PubMed1992

Rheological changes in the prodromal and established phases of sickle cell vaso-occlusive crisis.

A rheological study has been made in 20 patients with sickle cell anaemia in the steady state and in the prodromal and established phases of 12 vaso-occlusive crises. Rheology of sickle cells was studied by discontinuous density gradient fractionation and by filtration through pores of 5 microns diameter. The prodromal phase of crisis (day 1), when compared with mean steady state values, was associated with the development of a sub-population of poorly deformable dense cells. This sub-population appeared 1 or more days before the acute-phase rise in C-reactive protein, orosomucoid, fibrinogen, plasma viscosity and leucocytes, and before the rise in serum lactate dehydrogenase. As crisis evolved, the sub-population decreased to steady-state values, or below, by days 6-7. Identification of the prodromal phase of sickle cell crisis has allowed the detection of rheological changes of potential aetiological significance.

Acute-Phase Reaction↗

PubMed1992

Subclinical ischaemic episodes during the steady state of sickle cell anaemia.

AIMS: To determine the clinical, haematological, biochemical and rheological changes that occur in the asymptomatic steady state of sickle cell anaemia. METHODS: Patient self-assessment visual analogue scores (for wellbeing and tiredness), the blood concentration of acute phase proteins (C-reactive protein, orosomucoid, and fibrinogen), and blood rheology (percentage of dense cells and the number of sickled cells that occluded pores 5 microns in diameter) were studied longitudinally on 10 occasions in each of 20 outpatients with sickle cell anaemia. RESULTS: Patients in the steady state showed fluctuation in visual analogue scores, in concentration of acute phase proteins, and in rheological parameters consistent with minor episodes of tissue injury. Significantly more variation in acute phase proteins occurred in the steady state of 14 of the 20 patients who developed one or more vaso-occlusive crises during the 16 month study period. Rheological fluctuation in the steady state simulated rheological change during crisis, namely a transient rise and then fall in the number of dense and poorly filterable cells. CONCLUSIONS: The term "steady state" is a misnomer, being characterised by biochemical and rheological fluctuation consistent with minor episodes of microvascular occlusion that are insufficient to cause the overt tissue infarction of painful crisis.

Acute-Phase Proteins↗

PubMed1985

Blood pressure distribution of Nigerians in the first two decades of life.

The systolic and diastolic blood pressures of 2301 Nigerian boys and 2017 Nigerian girls were measured. Their ages, which were in the range 1-20 years, heights and weights were also recorded. The relationship between these variables are discussed. Selected percentiles of systolic and diastolic pressures for different ages and weights are given.

Adolescent↗

PubMedDate not supplied

Acceptability of prenatal diagnosis of sickle cell anaemia by a sample of the Nigerian population.

The acceptability of prenatal diagnosis (PND) as a means of controlling sickle cell anaemia (SCA) in Nigeria was examined using a semi-structured questionnaire. The aim of the study was to examine the attitudes of well-informed, educated Nigerians to the use of PND and abortion of confirmed HbSS pregnancies in the control of SCA. There were 433 respondents comprising 204 males and 210 females (gender was not recorded for 19 respondents). They were aged 15-50 (31 +/- 18) years. Forty percent had HbAA, 15% HbAS, 1.6% HbAC, 2% HbSS, and 0.2% HbSC; 153 (35%) had no knowledge of their haemoglobin electrophoretic patterns "genotypes". The majority of the respondents (69.5%) appreciated the role of both parents in the transmission of the disease. Only 45 (18%) of the respondents heard of SCA for the first time through sickle cell counsellors, 23% through newsmedia, 29% through friends and relations, 21% obtained the information through health workers, while 5% had never heard of sickle cell disease before the interview. As many as 192 (44%) of the respondents were aware that SCA could be diagnosed in pregnancy; 45% would opt for termination of the affected pregnancies. Avoidance of the problems associated with managing SCA children was the most important reason for approving pregnancy termination, whereas 73% of those rejecting pregnancy termination did so for religious and moral reasons. Seventy-eight percent of those interviewed would want PND started in Nigeria. The two approved control measure for SCA by most of the respondents were genetic counselling and PND; both should, therefore, be considered in implementing control measures for SCA in this country.

Abortion, Induced↗

PubMedDate not supplied

Interferon alfa-2a (Roferon-A) monotherapy in chronic myelogenous leukemia: a pilot study in Nigerian patients in early chronic phase.

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 (p < 0.05). 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.

Adult↗

PubMedDate not supplied

What does the presence of hypertension portend in the Nigerian with non insulin dependent diabetes mellitus.

132 Nigerians with Non Insulin -dependent diabetes mellitus (NIDDM) were divided into two groups (NIDDM) patients with hypertension and those without) and their clinico-laboratory parameters were studied and analyzed. Their mean age (SD) was 59.5+/-9 years. Body mass index (BMI) was 25.2+/-3.5 kg/m2 and the duration of DM was 6.9+/-6 years. The prevalence of hypertension was 55(41.6%) No significant difference were observed in the age, sex ratio and BMI of both groups but the duration of DM showed a statistical difference between the two groups. However, laboratory parameters such as fasting blood glucose, serum urea, creatinine clearance and degree of proteinuria all showed statistically significant difference between the hypertensive and normotensive groups. Also the hypertensive diabetic group were observed to have more end organ damage i.e peripheral neuropathy, diabetic retinopathy and diabetic nephropathy than the normotensive diabetics. We conclude that, hypertension in NIDDM patients has prognostic implications and so more aggressive efforts be made in detecting and controlling hypertension in DM patients.

Age Distribution↗

PubMedDate not supplied

Cardiovascular changes in sickle cell anaemia.

Sickle cell anaemia (SCA) is the commonest inherited haemoglobinopathy in Nigeria and is associated with high morbidity and mortality, particularly in early childhood in most of the affected population. The cardiac manifestations of SCA are a significant feature of the disease but there is a paucity of information on the cardiovascular involvement in SCA in Nigeria and Africa. The size of the sickle cell problem in the country is growing rapidly and there should therefore be a greater awareness of the cardiac problems associated with SCA. This review highlights the clinical features, changes in cardiac structure and function at rest and on exercise, cardiac pathology and associated heart diseases in SCA as well as the recent global progress made in the understanding of the cardiovascular changes in the disease. Emphasis is laid on data derived from Nigerian studies.

Anemia, Sickle Cell↗

PubMedDate not supplied

The clinical, electrocardiographic and self-paced walking exercise features of Nigerians with sickle cell anaemia presenting at OAUTHC, Ile-Ife.

Most patients with sickle cell anaemia (SCA) show evidence of cardiac dysfunction. This study aimed at clinically and electrocardiographically assessing the exercise capacity of steady state SCA patients using self-paced walking exercise. Forty one (17 males and 24 females) steady state SCA patients between the ages of 15 and 37 years were prospectively studied with 41 age and sex-matched (17 males and 24 females) normal AA controls. All subjects had clinical evaluation, resting 12-lead electrocardiography (ECG), 12 minutes self-paced walking exercise, and were tested for haematological and biochemical abnormalities. The clinical features of the patients reflected a hyperdynamic circulation which was evidenced by faster heart rates, wide pulse pressure, cardiomegaly, loud heart sounds and cardiac murmurs. Non-specific ECG findings were observed in this study. The mean QRS voltage (Sokolow-Lyon criteria) was significantly higher in patients compared to controls (P < 0.05). The mean rate, P wave duration and corrected QT interval of SS patients were significantly higher than the controls. The patients also had a significantly lower mean QRS frontal axis than the controls (P < 0.05) but there was no difference between the two groups in the mean QRS duration and PR interval. There was no abnormal QRS axis in the two groups. The self-paced walking exercise test showed significant limitation of exercise capacity in SCA patients, as evidenced by the significant reduction in speed and distance covered by the patients compared with the controls. While both groups achieved similar post exercise heart rate and systolic BP, the change in heart rate was significantly less in the patients. This study concluded that SCA patients have larger hearts and non-specific ECG changes. They showed significant limitation of exercise capacity with self-paced walking exercise, which was a safe and reproducible measure of cardiac reserve in them.

Adolescent↗

PubMedDate not supplied

A review of histology of bone marrow trephine in malignant lymphomas.

BACKGROUND: To investigate the prevalence and pattern of bone marrow involvement and its effects on the peripheral blood counts of malignant lymphoma patients. METHODS: A prospective study of patients with histologically confirmed malignant lymphomas that presented from January 1994 to December, 1999 at the Department of Haematology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife. Patients underwent routine investigations such as packed cell volume (PCV); white blood cell counts (total and differentials), and platelet counts. Bone marrow aspirates and trephine biopsies were carried out on admission. Histological classification was based on the working formulation, while clinical staging was based on the Ann Arbor classification. The data collected was analysed using simple statistical methods and Epi info 6. (World Health Organisation), Geneva, Center for disease control (CDC), Atlanta, USA (1994) statistical software was used for all statistical analysis. RESULTS: Out of the thirty cases (19 males and 11 females) of lymphoma that were studied, twenty-four (80%) were Non Hodgkins lymphoma (NHL) and 6 (20%) were Hodgkins disease (HD). In the NHLs, age range was 18-75 years with a median of 50 years with sixteen males and eight females, male:female ratio 2:1. Twelve of the patients had marrow involvement and were low-grade indolent disease. The most common pattern of marrow involvement in NHL was diffuse type. In HD, the age range was 18-65 years with a median of 45.5 years. There were three females and three males with M:F of 1:1. The most common pattern of marrow involvement was mixed cellularity in four patients, while one patient had lymphocyte predominant and the other lymphocyte depleted. In all cases with marrow involvement there were varying degrees of marrow suppression as reflected by anaemia and thrombocytopaenia, and in one pancytopaenia. CONCLUSION: Bone marrow examination is an important aspect in the diagnosis of patients with malignant lymphoma and there is superiority of trephine biopsy over the aspiration biopsy.

Adolescent↗