Yalusa C; Habibu M
Dept. of Library and Information Sci. Faculty of Education, Ahmadu Bello University Zaria.
Akpulu S.P
Dept. of Human Anatomy, Faculty of Medicine, Ahmadu Bello University Zaria, Nigeria

All correspondence to: Phone +1237060975262

ABSTRACT
Digitalization of information has made access to medical science records and information easy and fast. Therefore, the need for developing skills, knowledge and understanding in the use of electronic information devices cannot be over emphasized. However, the reverse is what is commonly seen in most of our institutions of learning. This study was aim at studying the utilization of digital information resources (DIR) for academic development in School of Health Information Management ABUTH, Zaria. Two hundred and thirty six (236) structured questionnaires were administered using the stratified random sampling technique. The data collected was analyzed using frequency and simple percentage statistics. The study revealed that while e-Text books (53.6%) and Internet facilities (38.0%) top the most frequently used digital resource materials, Irregular power supply (31.8 %) and poor network services (24.8 %) top the challenges faced in accessing DIR by the respondents. 52.6% of the respondents accessed DIR materials by subscription. 26.0% is by loan while 20.7% is by purchase. This finding suggests that there is under-utilization of DIR because of infrastructural changes. It is therefore recommended that all relevant stake holders should invest heavily in ensure ring adequate provision of digital resource materials in the Libraries.

Key words: Digitalization, utilization, Information Management, Resources.

INTRODUCTION

The library or information center is the heart of the academic community since learning and research is the core academic program (Bashir, 2013). The digitalization of information and communication has no doubt brought about changes and rapid development in all human endeavours especially in medical science education. Thus, the ability for timely acquisition, retrieval and utilization of relevant and accurate information has become an important attribute in teaching and learning process especially among medical students.
Digital or electronic information resources are those information resources that contain information other than in written format. According to Bandele (2006), digital information resources are tools that comprise electronic devices which are utilized for information and communication needs of institutions, organization, students and individuals. Such electronic devices include computers (desktop/laptops), internet networking, telephone (handsets/mobile phones), video and multimedia devices. Adegun (2007) revealed that presently in Nigeria, the use of E-learning in the educational sector is still at the rudimentary stage.
In this age of information explosion, no student is expected to be left behind, especially students that study information science related courses such as the Health Information
Management Students. Digitalization of information has made access to records and information easy and fast. It gives room for unrestricted access to students for relevant information and development in various subject areas. Access to latest text books, journals, books published by reputable scholars in various disciplines is guaranteed for students. The internet provides e-mail services generally utilized for correspondences and dissemination of information. Student read comments from daily mails (newspaper), use chat room where activities take place lively and the use of World Wide Web (WWW) for necessary information (Adebayo, 2007). Digital information or what may be referred to as ICT has increased importance within the school curriculum, support student-teachers in teaching and learning process, enables students to access, share, analyses and present information gained from a variety of sources and in many different ways and encourages active participation in classroom interaction as knowledge is shared (Emenilse, 2003).

However, the reverse is what is commonly seen in our institutions of learning. Most students are faced with challenges of sourcing and utilization of digital information resources ranging due to several reasons, which may include inadequate digital facilities. Most of our schools do not have enough functional electronic  information resource equipment that can meet the need the need of the rapidly growing student population. Another reason is that the majority of the students are not well trained or skilled with the knowledge of information technology particularly the practical aspect of it. Poor quality service delivery is another reason that poses challenges to our students. This is locally referred to as “No Network”. The evident of poor services develop lack of confidence in the system. Lack of maintenance and regular services or replacement of spare parts when faulty is also a challenge to students. Poor power (electricity) supply has greatly disrupted the smooth running of electronic services so much that most students have resulted to fate, while become nonchalant towards anything digital or electronic. What impact has these on the students and how can some of these reasons be corrected? According to Missen et al (2005), the Internet poses African Universities to gain equal footing with their sister institutions in the more developed countries. It is imperative that Institution of learning be connected if they are not to be rendered irrelevant in the modern academic world.

Harold (1998) supported this by saying the weakness of the present situation lies in the absence of a nationally coordinated programme of bibliographical activity, and in the lack of coordination between organisation and institutions with related interest. It is against this background that this study was carried out.

Materials and Methods
This study was conducted in the School of Health Information Management (SHIM) A.B.U.T.H Zaria. The school is located in the old Ahmadu Bello University Teaching Hospital Tudun Wada Zaria and has a population of approximately 600 students. Stratified proportionate random sampling was adopted using the open and close ended structured questionnaire. The questionnaire was designed after the pattern of Aina (2004). The questionnaire was divided into sections. Section A was on personal data. Section B was as on knowledge and availability of library information resources (LIR) and section C was on the use of LIR, while Section D was on Challenges encountered in the access and use of DIR. The data generated from the questionnaires was analysed by using frequency and simple percentage statistics.

Results and Discussion
Out of the two hundred and thirty-six (236) questionnaires administered, only two hundred and twelve (212) was eturned correctly completed.

Discussion
The finding in this study is similar to most studies carried out on utilization of digital resources. The results show that female respondents 136 (64.2%) were more than that of the male 76 (35.8%). The age range of the respondents with the highest percentage (48.1%), was 21-30 year. The respondents 138 (65.1%) with National Diploma Certificate are more than those with other educational qualifications. Text books 158 (40.1%) and Internet facilities 152 (38.6%) constituted the highest percentage of digital resource materials available in the institution. The most frequent channel of accessing Digital Information Resources by the students was by subscription 142 (52.6%). Text books and internet facilities also top the most frequently used DIR with 72 (34.6%) and 46 (22.1%) respectively. The most frequent reasons for using DIR was for academic resources 106 (35.3%) and for information 104 (34.7%). This study also shows that the respondents use the DIR more daily 102 (45.5%) than weekly usage of frequency 54 (24.1%). Eighty two (48.5%) of the respondents were very satisfactory with use of Internet facilities while, 20 (22.2) of the respondents were not satisfied with the use of Audio Visual. The most frequent challenges of accessing DIR reported the students was irregular power supply 100 (31.8 %) followed by Net Work problems 78 (24.8 %).

In a recent study conducted by the Global information technology (2005), the report used the Networked Readiness index (NRI) covering a total of 115 economies in 2005-2006, to measure the degree of preparation of a nation or community to participate in and benefit from ICT developments. Nigeria was ranked 90th out of the 115 countries surveyed, united states of America toped the list, followed by Singapore, Denmark, Iceland, Finland, Canada, Taiwan, Sweden, Switzerland and the United Kingdom and so on. Also, Nigeria was ranked 86th out of 104 countries surveyed in 2004 (Global information Technology, 2004).
This study recorded a general low usage and patronage of digital information resources when compared to results from other part of the world. This, according to Tiefel (2004) may be due to the fact that most library users are unaware of the quality and variety of information available.. Internet is the most frequently used DIR, which is similar to this finding. Falak (2003) reported the rapid growth and use of e-books in school’s colleges and universities in developing countries, which is not the case with finding of this study where text books seem to be the highest. Most of these studies reported high usage of internet resources (De Vicente et al 2004; Falk, 2003). High usage was `attributed to a number of factors including the freely available access, the ease of use and its currency. Gakibayo (2001) and Agaba (2003) carried out a study on e-resources usage at Makerere University of Science and Technology; the results of this study indicated low usage. Zaki (1991), pointed out that the poor library use background by students in using library facilities, had led them to carry this problem with them to Universities and higher institutions.

Conclusion
The finding from this study suggests that though, the DIR has provided a wider access to global information resources, these resources are not effectively utilized due to varying factors.

Recommendation
There is need to equip end-users with skills such as information literacy skills, information retrieval skills, computer skills among others as a strategy to promote e-resource usage among medical students.

Acknowledgment
We are grateful to the management of ABUTH Zaria, especially the Coordinator and students of School of Health Information Management ABUTH Zaria, for the support and cooperation.

REFERENCES
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3. Bates, A.W. (1997) “Restructuring the university for technological change http:bates.c.studies.ube. ca/carnegie.htm (December 13, 2001)

4. Bashir J M (2013)Provision and utilization of electronic information resources in Federal college of education libraries: a case study of federal college of education library Zaria.

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8. Imo, N. T. & Igbo H.U. (2011). Challenge of digitalizing information resources in Nigeria university libraries. A paper presented at the 49th NLA National Conference/ AGM 10th- 15th July. Awka

9. Jensen, M. (2007), Information communication (ICTs) in Africa: a status report, Paper presented at the Third Task Force meeting of the UN ICT Task Force; New York.

10. Okello-Obura, C & Magara,E. (2008),”Electronic information access and Utilization by Makerere students in Uganda “Evidence Based library and information practice, vol.3 No.3, available at://ejournals.library.ualberta.ca/index.php/EBLIP/article/view/935/3328 (accessed June 12 2010)

11. Adeyinka, T, Adedeji, T , Ayen, C.O. & Omoba, R.O. (2008). Self-Efficacyand Use of Electronic Information as Predictors of Academic Performance. Online Electronic Journal of Academic and Special
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12. Afolabi, M.O. (2007), Paper presented at Electronic Information for libraries Network (elFL.net) workshop Obafemi Awolo University, lle-Ife, Nigeria.

13. Fatoki, O. C. ( 2007). Digitalization of library materials in Nigeria: Issues and heritage of University of Nigeria, Nsukka: Issues and current status. A paper presented at the Nigeria library Association (NLA) 4th Annual National Conference and AGM 26-31 July 2009 Ibadan.

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15. Jensen, M. (2007), Information communication (ICTs) in Africa: a status report, Paper presented at the Third Task Force meeting of the UN ICT Task Force; New York

16. Okello-Obura, C & Magara,E. (2008),”Electronic information access and Utilization by Makerere students in Uganda “Evidence Based library and information practice, vol.3 No.3, available at://ejournals .library. ualberta .ca/index.php/EBLIP/article/view/935/3328 (accessed June 12 2010)

17. Adeyinka, T, Adedeji, T. , Ayen, C.O. & Omoba, R.O. (2008). Self-Efficacyand Use of Electronic Information as Predictors of Academic Performance. Online Electronic Journal of Academic and Special Librarianship, 8(2), 1-17.

The post Utilization Of Digital Information Resources For Academic Development In School Of Health Information Management Zaria appeared first on Nigerian Biomedical Science Journal.

Akpulu S.P
Department of Human Anatomy, Faculty of Medicine, Ahmadu Bello University Zaria. Nigeria
Yahaha Adamu
Elite International School of Health Academy, Zaria. Nigeria
Iduh M.U
Dept of microbiology Faculty of Med.Lab.Sciences Usmanu Danfodio University Sokoto Nigeria
Ankuma S J., Ojih M.A
Department, of Medical Microbiology Ahmadu Bello University Teaching Hospital Shika- Zaria.

Correspondences to: E-mail: petosw2000@yahoo.com

ABSTRACT
Intestinal protozoa and faeco-oral transmitted helminths (STH) constitute major health problems, especially in the tropical and sub-tropical regions. They can be the cause of a wide spectrum of clinical problems ranging from apparently symptomless infections to life-threatening conditions such as intestinal obstruction as in Ascaris infestation, failure to thrive as well as anaemia if not properly treated. In this study, results of 100 stool samples of children 1 to 10 year that visited GSGH between January 2014 and January 2015, were collected from the laboratory record book, and analyzed using simple percentages. The results showed that male patient (54.4%) ware more than the female patient (46.0 %). It also showed that the total age range of 1-5 year is 22 (40.74%), while that of age 6-10 years is 32 (59.25%), This study also shows that the highest parasitic infection in this study is Ascaris lumbricoid (66.67%), followed by E.vermicularis (16.67%). The percentage infection of the Ascaris lumbricoid, is more in female children (66.67%) between 6-10 years, than the male children (33.33%) of the same age range. It is suggested that children with intestinal parasites should be treated periodically treated and ensure personal hygiene and clean environment.

Key Word: Intestinal protozoa, faeco-oral, parasites and infections

INTRODUCTION

Intestinal parasitic infections are globally endemic and have been described as constituting the greatest single worldwide cause of illness and disease Mehraj et al, (2008). IPIs are linked to lack of sanitation, lack of access to safe water and improper hygiene; therefore, they occur wherever there is poverty. Intestinal parasitic infections deprive the poorest of the poor of health, contributing to economic instability and social marginalization. The poor people of under developed nations experience a cycle where under nutrition and repeated infections lead to excess morbidity that can continue from generation to generation. People of all ages are affected by this cycle of prevalent parasitic infections; however, children are the worst affected Mehraj et al, (2008). Intestinal protozoa and faeco-oral transmitted helminths (STH) constitute major health problems, especially in the tropical and sub-tropical regions (Savioli et al;1992)
They can be the cause of a wide spectrum of clinical problems ranging from apparently symptomless infections to life-threatening conditions such as intestinal obstruction as in Ascaris infestation, failure to thrive as well as anaemia if not properly treated. Feaces are the solid, semi-solid formed or unformed waste product of the animal’s digestives system including Bacteria and parasites excreted out of the body.Feases vary significantly in appearances i.e size, color and texture, according to the state of digestive system, diet and general health. Normally stool is semi-solid, with a mucus coating. Stool examinations helps in easy detection and identification of parasite example; the larvae, ciliate, flagellates and trophozoite of amoeba. Ova and cyst may also be detected by using wet saline preparation method. For a number of years, the centers for disease control (D C) has recommended that the routine parasite logical examination of a fecal specimen should consist of a direct microscopic examination in both saline and iodine, a concentration examination and a permanently stained smear. However, timely processing within 1 hour of passage of a fresh specimen will give better result.

MATERIALS AND METHODS
The area of study is Zaria local government. There is high commercial activity in the local Government, this is evidence by the presence of large central markets and Government academic institutions and several health Institution both federal and state owned, including the Hajia Gambo Sawaba General Hospital, Zaria City. The population of the study covered 100 children under ages of 1-10year who attended Hajiya Gambo Sawaba General Hospital between 20014 and 20015 respectively. Data was collected from the available laboratory record book of parasitology and micro biology laboratories from January 2014 to January.2015. The data collected was analyzed and presented using frequency distribution table and result express in percentage.
from January 2014 to January.2015. The data collected was analyzed and presented using frequency distribution table and result express in percentage.

Results and discussion

Table 3 above showed the result both males and females that were infected with parasites. The tables generally suggest that, the children between 6-10year are more frequently infected with high number of parasite [83.33%], when compared to that of children between the ages of 1-5years, which showed low paracetaemia of only (1) [16.66%] of infections.

Discussion
In this study of 100 stool samples of children age one to ten that visited GSGH between January 2014 and January 2015, the male patient (54.4%) ware more than the female patient (46.0 %). The result also showed that the age range of 1-5 is 22 (40.74%), while that of age 6-10 years is 32 (59.25%), implying that children between the age of 6-10 frequent the hospital more that the children of age 1 to 5 year. This study also shows that the highest parasitic infection in this study is Ascaris lumbricoid (66.67%), followed by E.vermicularis (16.67%). The percentage infection of the Ascaris lumbricoid, is more in female children (66.67%) between 6-10 years, than the male children (33.33%) of the same age range.

The tables generally suggest that, the children between 6-10year are more frequently infected with high number of parasite [83.33%], when compared to that of children between the ages of 1-5years, which showed low paracetaemia of only (1) [16.66%] of infections. A similar trend was reported by Jombo et al;2007, in which the bulk of parasitic infestation occurred in the 8-15 years age group. High prevalence of intestinal parasitic infestation is apt to occur in low socio-economic condition, characterised by inadequate water supply and poor sanitary disposal of faeces (Meremikwu et al1995; Al-Agha and Teodorescu 2000). The higher prevalence rate of intestinal parasitism in this study might be attributed to the poor hygienic practice and sanitary environment. The indiscriminate disposal of human wastes and unhygienic way of life might have been predisposing factors. The predominance of Ascaris lumbricoides in this study is in consonance with other reports (Eneanya and Anikwue, 2005). This observation is similar to the finning of Damen et al 2007 on the study of Prevalence of Intestinal Parasites among Pupils in Rural North Eastern, Nigeria, where the age group of 6-8 years had the highest prevalence (85.7%). Thy also observed that the distribution of intestinal parasites showed Ascaris lumbricoides to have the highest prevalence of (19.1%). Similarly, a study by Uwaezuoke et al;2006, on the prevalence of intestinal parasites was conducted among school children in Owerri Municipality of Imo State, Nigeria, between February and September 2003 reported that of the 1511 children examined, 721 (47.7%) were infected with intestinal parasites. The parasites encountered showed Ascaris lumbricoides (18.5%) to be the highest, followed by Trichuris truchiura (10.7%), Entamoeba histolytica (7.3%), Strongyloides stercoralis (6.0%), and Hookworm (5.3%). Uwaezuoke et al;2006 observed that although the prevalence of intestinal parasites was higher among males (50.3%) than in the females (45.7%), it was not significant (p<0.05), this observation is in contrast to our finding in this study.

Conclusion
This study showed a high prevalence of intestinal parasitic (Ascaris lumbricoides) infection in the stool
samples of femae children (age 6-10 year) attending Gambo Sawaba General Hospital kofan Gaya Zaria.

Recommendation
It is suggested that children with intestinal parasites should be treated periodically using broad spectrum or multi-agent drug combinations because of the multiple parasitism susceptibility in children. Public enlightenment and emphasis on personal hygiene and clean environment may be necessary in the prevention and control of parasitic infections among children in rural areas.

Acknowledgment
I appreciate the management and laboratory staff of GSGH, Zaria for the support and permission to carry out this study.

REFERENCE
1. Cheesbrough M. Medical Parasitology. Medical Laboratory Mannual or Tropical Countries Sheck Wah Tong Printing press ltd Hong Kong low price edition. 1991

2. Salako A.A. Effects of portable water availability on intestinal parasitism among rural school children with sewage disposal facilities in the Mjidum and Owutu sub- urban community of Lagos state. Nigeria Medical practioner. 2001;39:3–4.

3. Agwu N. A. Incidence of intestinal helminthiasis in school children in Aba urban city, Abia state, Nigeria, International Journal. Environmental Health and Human Development. 2001;1:47–51.

4. Meremikwu M.M., Antia-Obong O.E., Asindi A.A., Ejezie G.C. Prevalence and Intensity of intestinal Helminthiasis in Pre-School children of peasant farmers in Calabar, Nigeria. Nigerian Journal of medicine. 1995;2:40–44.

5. Al-Agha R, Teodorescu I. Intestinal parasites infections and anaemia in primary schools children in G29 Gonernorates Palestine. Roum- Arch- Microbiol- Immunol. 2000;59(1-2):131–143. [PubMed]

6. Luka S.A., Ajogi I., Umoh J.U. Helminthosis among primary schools in Lere local Government Area Kaduna state, Nigeria. The Nigerian Journal of parasitology. 2000;21:109–116.

7. Eneanya C.I., Anikwue C. A school based intestinal helminthiasis programme in Nigeria: Perceptions, attitude and acceptability to community members. Nigerian Journal of parasitology. 2005;26:55–60.

8. Jombo G.T.A., Egah D.Z., Akuson J.T., Mbaawuga E.M. Human intestinal parasitism in a rural settlement of Northern Nigeria, A Survey. Nigeria Medical practioner. 2007;1/2:11–15.
9. Uwaezuoke JC., Udujih OS., Onyeka PIK (2006). Prevalence of intestinal parasites among school children in Owerri municipality, Imo state, Nigeria International Journal of Natural and Applied Sciences Vol 2, No 3 (2006)

10. Savioli L., Bundy DAP and Tomkins A (1992).
Intestinal parasitic infections: a soluble. public health problem. Trans R Soc Trop Med Hyg. ;86:353–354

11. Mehraj V, Hatcher J, Akhtar S, Rafique G, Beg MA (2008) Prevalence and Factors Associated with Intestinal Parasitic Infection among Children in an Urban Slum of Karachi. PLoS ONE 3(11): e3680. doi:10.1371/journal.pone.0003680

The post Feacal Examination of Children Attending Hajiyya Gambo Sawaba General Hospital, Zaria. appeared first on Nigerian Biomedical Science Journal.

Akpulu S.P
Department of Human Anatomy,Ahmadu Bello University, Zaria, Kaduna State, Nigeria..
Adamu M
Elite International Academy of Health Technology, MTD Zaria, Kaduna State, Nigeria
Oledinma S
Dept. of Hematology, Sch of Med. Lab. Sciences, A.B.U Teaching Hospital Zaria
Yaro E.G
Department of Human Anatomy, Ahmadu Bello University, Zaria, Nigeria
Ajayi I.T
Laboratory Department, Federal Medical Centre,Birnin kudu Jigawa State Nigeria

All Correspondent to: petosw2000@yahoo.com

ABSTRACT
Background: Transfusion transmitted infections threatened the safety of patients requiring blood transfusion, which in turn imposes serious challenges for the availability of safe blood products. The aim of the study is to determine the prevalence of transfusion transmitted infections in blood donors and to evaluate the demographic characteristics of reactive and non-reactive blood donors. Materials and Methods: A retrospective study of transfusion screening tests done in Hajiya Gambo Sawaba General Hospital Zaria between January and December 2016. Data retrieved from the laboratory record books, were analyzed using simple percentages. Results: A total of 1875 blood donors with mean age of 28 was recorded. 1850(98.6%) were males and 25(1.4%) females. Three hundred and fifty nine (19.1%) donations were reactive to all screening assay. The prevalence of Hepatitis B, Hepatitis C, Human Immuno Deficiency Virus and Syphillis was found to be 127(6.8%), 190 (10.1%), 33(1.8%) and 9(0.4%) respectively. Conclusion: This study revealed that there is a substantial percentage of the blood donors harbored transfusion transmitted infections. There is a need for stringent selection of blood donors with the emphasis on comprehensive screening of donors blood using standard methods to ensure the safety of blood recipient.

Key words: Blood, donors, Screening, Transfusion Transmissible Infection.

INTRODUCTION

Transfusion-transmitted infections are increasingly becoming major mode of transmission of various diseases, in the high prevalence areas in sub-sahara Africa. This is because of high level of occurrence of blood demanding health conditions. Transfusion transmitted infections are major concern among health workers (WHO, 2008). Patients on transfusion therapy are at increased risk of transfusion transmitted infections and every year more than 90million units of blood are collected worldwide. Each transfusion carries a risk of transmitting blood-borne pathogens including mainly HIV, HBV, HCV and syphilis (Bihl et al, 2007). To improved blood transfusion safety WHO recommends an integrated strategy including establishment of well-organized blood transfusion services, prioritization of blood donation from non-remunerated donors, screening of donated blood for at least the four-major transfusion-transmissible infections (TTIs) with quality-assured assay, rational use of blood implementation of effective quality control system (WHO 2008).
Selection of donors with low TTIs risk followed by effective laboratory screening has been part of a critical process of reducing the risk of transmission to a very low level in the past 20 years (WHO, 2002). Nevertheless, particularly in low resource countries, a significant proportion of donated blood remains unsafe as it is either not screened for all major TTIs or not in a quality controlled manner, according Dodd 2007.  Most blood banks in Africa are small hospital based and relying on an important proportion of replacement donors in contrast with western transfusion unit organized with large pools of voluntary donors Dodd (2007). In addition, recommended screening tests like immunoassays (EIA) or nucleic acid testing (NAT) are technically, logically and financially still far beyond reach of many resources constrained blood banks. Every blood banks follows screening procedures to prevent such infections but infective agents escape detection due to window period, a period where in the infective agent presence cannot be detected, though it is present in donors blood (Moor 1999). Blood bank in developed countries are doing Nucleic Acid Amplification Testing (NAT) since 1999 to screened donated blood (Pathaks 2010). The window period for for testing for HIV, HBV, HCV has been significantly reduced with NAT.
The infections of HBV and human immune deficiency virus (HIV) are a rapidly growing issue of public health concern, it has been observed that HBV and HIV co infection interferes with the natural history of HBV infection and as associated with higher HBV DNA levels (Gibson 1997, colin1999). Human immune deficiency virus(HIV) infection causes a broad spectrum disease and has a varied clinical cause, from mild, flulike symptoms to AIDs, which is life threatening and the end stage of infection (MOH Mozambique 2007). Factors that can contribute to HIV transmission through blood transfusion include the window period.
Hepatitis B surface antigen testing was introduced 1970s and its transmission was consistently reduced since then (WHO 2004). Still, 300 million are infected worldwide. HBV Surface antigen is routinely included in donor screening but it fails to detect presence of HBV during window period. Chronic carriers of HBV may have low level viremia and may not have detectable HBsAg level, so some centers have started testing antibodies against HBV core protein (Diarra, 2009). Hepatitis C virus currently affect over four million peoples in USA and therefore it is the commonest transfusion transmitted infection and main indication for liver transplantation. High risk group is constituted by those who received transfusion prior to 1991 or the ones who are drug abusers using shared needles (Laperche, 2009). Incubation period can be as long as decades and this contributes to high rates of infection. Approximately 90% of individuals infected with HCV are either asymptomatic or have only mild symptoms (Matee, 2006). Syphilis is caused by infection with treponemapallidium. It is spread primarily through sexual contact. T.pallidium can also be transmitted by vertical transmission by mother to fetus or through blood if donor is already infected (Peeling2004). Approximately 57% 0f all transfusion transmissible infections and 16% of transfusion related deaths have been associated with bacterial contamination (Wagner 2004). Blood components may be contaminated with bacteria at many stages of preparation, including blood collection, processing, probing and transfusion. Bacteria may enter into blood components from many sources; exposure to donor skin bacteria by vein puncture, contaminated bags and infected environment of blood banks or hospitals, (Wagner 2004). Parasites are common infectious agents worldwide and several protozoans have shown to be transmitted via blood transfusion (Kitchen, 2006).
Malaria is endemic in tropical and subtropical regions of Africa with up to 300 million infections and one million deaths annually (Kinde et al,2000). It can also be transmitted from an infected to her fetus or from an infected blood to the recipient. WHO accepts the use of rapid and simple serological assays for TTIs and quality controlled (WHO, 2009) and Rapid test-based screening protocols still tends to be used increasingly in African blood banks. Therefore, the need to investigate the prevalence of transfusion transmissible infections among blood donors at Hajiya Gambo Sawaba General Hospital, Zaria Nigeria.

Materials And Methods
This retrospective study was conducted at blood transfusion unit of Hajiya Gambo Sawaba General Hospital Zaria, Kaduna state. Three hundred and ninety blood donors were prospectively recruited in the study from 1 January 2016 up to December 2016. Only Physically fit 18-55years old were included in the study, donors were excluded if they were below 18 years old, weigh less than <50kg, anemic, had a history of jaundice, malaria, asthma, engage in high risk behavior (i.e unsafe intercourse, drug abuse) had a past history of HBV, HCV, HIV-1 and HIV-2 or syphilis or were apparently unhealthy or malnourished. After the prospective donor has passed the hemoglobin check. Determine and uni-gold rapid test kits were used to test for HIV. The single rapid kit used for testing Hepatitis B surface Antigen (HBsAg) is ACON while Dialspot is used for testing Hepatitis C virus (HCV) and also syphilis. Blood donation process is stopped when any of the donors is reactive for any of the TTI markers. Data on blood donor’s age, sex, blood group, serological result of HCV, HBsAg, HIV and syphilis were collected at the time of blood collection, by using a structured questionnaire. Summary of statistics such as frequencies and percentages were computed. The results were presented using tables, charts and graphs.

The findings of this study showed that male is more than female. This is expected because traditionally, female is not encouraged to donate blood as the male. The study also shows hepatitis B and C virus, HIV and syphilis antibodies to be 10.1%, 6.8%, 1.8% and 0.4% respectively. The result of HBsAg in this study varied from that of Olaleye, et al (2007) which shows a very high prevalence (30.8%) of HBsAg in Ibadan. Other studies in Nigeria have also reported higher prevalence of 15.8% in University of Maiduguri Teaching Hospital Borno State, and 13.4% in Abakaliki by Idiona (2014), while Alikor and Erhabor (2007) reported a 12.4% prevalence among children in tertiary hospitals Niger Delta, Nigeria. However, the prevalence reported in this study is higher than the 8.3% prevalence reported in previous study conducted by Luka et al., at Ahmadu Bello University Teaching Hospital Zaria Kaunda state. It also higher than the 7.6%, 9.3% and 3.9% prevalence reported by Ugwuja et al(2009) in Nnewi, Awka and Abakalikl, Nigeria respectively.
The sero prevalence of HCV antibody found among blood donors in this study is lower when compared to the same study carried out in other locations, A study carried out in South Eastern state of Nigeria by Chukwurah, et al., (2005) found that 7.6% of blood donors had HCV revalence. In similar study carried out in Lagos, Nigeria, Afolabi, et al., (2012) reported that 8.4% of blood donors were positive for HCV antibody. This study agrees with the 6% HCV prevalence report by Egah et al.(2007), in Jos, Plateau state Nigeria.
Marked variation of HIV antibody has been reported in different part of Nigeria. Some workers reported the prevalence of HIV antibody to be lower than 1.8% as found in this study, while others reported higher prevalence of HIV antibody in other studies. Elele, et al., (2013) reported 4% prevalence of HIV antibody among blood donors in Port Harcourt, South Southern Nigeria had. Over all, the prevalence of HBsAg, HCV, HIV and syphilis antibodies found in this study is among the lowest reported in Nigeria. This observation may portably be due to the positive impact of HIV education and public enlightenment which have been in place in Zaria for many years. This might have helped in the reduction of the spread of HIV, HBsAg, HCV and syphilis since they have similar modes of transmission. Another factor that may account for the low prevalence of transfusion Transmissible infections in this study may be due to the fact that most of the donors were not commercial donors.

Conclusion
Results of the study which showed that the prevalence of HBsAg, HCV, HIV and syphilis antibody were 10.1%, 6.8%, 1.8% and 0.4% which suggest that HBV and HCV infections is still a health challenge that must be given more attention.

Acknowledgment
We are grateful to the Management of Gambo Sawaba General Hospital Zaria especially the Head and staff of the Laoratory for permission and cooperation during the work. We are also grateful to the staff of Elite International Health Academy Zaria for support and assistant.

REFERENCE

1. Kleinman S, Busch mp, korelitz jj, Schriber GB. (1997), The incidence/window period model and its used to asses the risk of transfusion transmitted Human immunodeficiency virus and Hepatitis c Virus infection. Transfuse Med Rev. 11:155-172.

2. Wor ld health organization (WHO) (2002) “Blood safety strategy for African region,” Tech. Rep. WHO AFR/RC51/9 REV.1, World health organization Regional office for Africa Brazzaville, Congo,.view at google scholar.

3. Amiwero, C.E., R.J. Prescott, O.A. George, N.I. Joy and M. Aisha (2013). Seroprevalence of transfusion transmissible infections among blood donors attending the federal medical centre, Bida. Int. j. modern Bio,. Res., 1:1-7.

4. Chikwem, J.O,I.Mohammed, G.C.Okara, N.C.Ukwandu and T.O. Ola, (1994) prevalence of transmissible blood infections among blood donors at the university of Maiduguri, Nigeria. East Afr. Med. J., 74:213-216.

5. Matee MIN, Magesa PM, LyamuyaEF. (2006); Sero-prevalence of human immune deficiency virus, hepatitis B and C virus and syphilis infections among blood donors at the muslim bili National hospital in darul Es Salam, Tanzania. BMC Public health (6:21. Doi: 10:1186/1471-2458-6-21 [PMC free article] [pub Med] [cross Ref].

6. Australian Red Cross Blood Service, author. Medlink. (2006) Updated estimates of residual risks of transmitted infections [serial on the internet] [cited 2007 April 1-DEC].

7. Uneke, C.J., O. Ogbu, P.U. Inyama, G.I.Ayanwu, M.O. Njoku and J.H Idoko, (2005). Prevalence of hepatitis-B surface antigen among blood donors and human immunodeficiency virus-infected patients in Jos, Nigeria. Mem. Inst. Oswaldo cruz, 100: 13-16.

8. Olatunji, P.O and H.O. Olawumi, (2006). HIV/AIDs in Illorin changing trend, emerging risk factors. Nig. Post-grad Med.j., 13:107-110.

9. Leena, M.S and S.Mohd, (2012). Trend and prevalence of transfusion transmitted infection among blood donors in Rural Teaching Institute south India. J. pathd. Nepodr., 2:203-206.

10. Kaur, G., S. Basu,R. kaur, p. kaur and S. Garg( 2010).pattern of infections among blood donors in a tertiary care centre: A retrospective study. Med. J. India, 23:147-149.

11. Jeremiah, Z.A., B. Koate, F.Buseri and F. Emelike, (2008). Prevalence of antibodies to Hepatitis C virus in apparently Healthy port Harcourt blood donors and association with blood group and other risk factors. Blood transfusion, 6:150-155.

12. Kafi Abad,S.A., H. Rezvan. H. Aboghasemi and A. Talebian, (2009). Prevalence and trends and immunodeficiency virus, hepatitis B virus and hepatitis C virus among blood donors in iran, 2004 through 2007. Transfusion, 49:2214-2220.

13. Federal ministry of health, (2004. 2003) National HIV sero-prevalence sentinel survey. Department of public health, National AIDs/STDs control programme, Technical Report. pp: 94 http://www.nigeria-aids.org/pdf/ 2003sentinel Survey.pdf

14. Fessehaye, N., D,Naik and T.fessehaye,(2011). Transfusion Transmitted infections A retrospective analysis from the National Blood transfusion Service in Eritrea. Pan Afr. Med. J., Vol.9.

15. El-Hazmi, M.M., (2004). Prevalence of HBV, HCV, HIV-1, 2 and HTLV-I/II infections among blood donors in a teaching hospitalin the central region of Saudi Arabia. Saudi Med. J.,25:26-33.

16. Widman FK (ed) (1985) Technical manual. American Association of Blood Banks, Arlington, pp325-344.

17. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the united states. Recommendation of the advisory committee on immunization practices (ACIP). Part II immunization of adults. MMWR Morb Mortal Wkly Rep (2006); 55(RR-16).

18. Recommendation for prevention and control of hepatitis C virus (HCV) infection and HCV related chronic diseases. MMWR Morb Wkly Rep (1998);47 (RR-19).

19. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIVand recommendations for postexposure prophylaxis. MMWR Morb Mortal Wkly Rep(2001);50(RR-11)

20. Ampoto W., N. Nii-Trebi, J.Ansah, K.Abe and H.Naito et al., (2002). Prevalence of blood borne infectious diseases in blood donors in Ghana. Clin. Microbial, 40:3523-3525.

21. Diro, E.,S, Alemu and A.G/yohonnes (2008). Blood safety and prevalence of transfusion transmissible viral infections among donors at the Redcross blood bank in Gondar University Hospital. Ethiop, Med. J., 46:7-13.

22. Nwakwo E, Momodu I, Umar I, Musa B, Adeleke s, (2012) Sero prevalence of the mator blood
borne infections among donors in Kano, Nigeria. Jurk I Med. Sic. 2012, 42 (2): 337-41.

23. Federal Ministry of Health, Nigeria Sentinel Survey among pregnant women (2008).

24. Isa A.H; Hassan A. and Mamar A. I (2009) Sero prevalence of Hepatitis Cuirus antibodies among blood donors Kaduna Afr, I Cln Escper. Micro Biol. 2009; 11: 75-78

25. Egah, D. Zi, Mandong B. Mandong B.M Iya D, Gom Walk N.E., Audu E.S, Ban Wat E.B and Onile B. A (2004) Hepatitis C Virus Anitbodies among Blood Donors in Jos, Nigeria Annals of African Medicine, 2004 3 (1)

The post Prevalence of Transfussion Transmissible Infection among Blood Donors Attending Hajiya Gambo Sawaba General Hospital Zaria appeared first on Nigerian Biomedical Science Journal.

Adejo, D S. & Randawa, A J.

Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
Aguoru, C U. & Ega R A I.

Department of Biological Sciences, Federal University of Agriculture, Makurdi, Nigeria
Maryam M, & Adeyanju D.

Department of Medical Microbiology, Ahmadu Bello University Teaching Hospital Zaria

All correspondence to: adedansteve@gmail.com

ABSTRACT
Vaginal infections in pregnancy are associated with considerable discomfort and adverse pregnancy outcomes including preterm delivery, low birth weight and increased infant mortality. This study evaluated the prevalence of vulvovaginal candidiasis and the effects of the infection on pregnancy outcome among women attending antenatal clinic in Ahmadu Bello University Teaching Hospital Zaria. A semi-structured questionnaire was administered and high vaginal swab samples were obtained from consenting pregnant women. The samples were processed following standard protocols. The prevalence of vulvovaginal candidiasis was 20.2%. Infections were higher in the third trimester and many women admitted to practices that increase risk of these infections. There was no statistically significant relationship vaginal candidiasis and pregnancy outcome or foetal complications at P=0.05. However, over 50% of the population had abnormal vaginal discharge with more than 30% of them suffering from various degrees of vaginal itching and erythema. Adequate investigation and prompt treatment will improve the quality of life and health of mother and feotus.

Key words: Vulvovaginal candidiasis, Pregnancy, Preterm, Candida albicans.

INTRODUCTION

Pregnancy is a physiological state, which produces several normal and expected changes in all the maternal organ systems. It is believed that higher estrogen levels and higher glycogen content in vaginal secretions during pregnancy increase a woman’s risk of developing vulvovaginal candidiasis (Pratibha et al., 2013). Vaginal candidiasis is one of the most common forms of fungal diseases, that are usually reported in pregnant women which may cause systemic infections in neonate particularly with low birth weight and prematurity after delivery (Mendling, and Brasch, 2010). Although colonization of the maternal genital tract by specific organisms has been inconsistently associated with spontaneous preterm birth and/or preterm premature rupture of the membranes, some infections have been consistently associated with preterm delivery (Gibbs et al., 1992).

It has been hypothesized that screening for and treatment of common vaginal infections would reduce the rate of preterm birth among affected women (Hollier, 2005). There is a possible link between the presence of vaginal Candida and premature birth. Researchers are currently investigating whether treating women with asymptomatic vaginal thrush is effective in reducing spontaneous preterm birth. Hopefully, these studies will show if eradicating Candida in pregnancy helps to reduce the rate of preterm
birth and late miscarriage.

In a related study in Oyo, 33.3% of the 135 women had candidiasis in pregnancy according to Adeyeba et al., (2003). Akinbami et al., 2015 and Anorlu et al., 2004 reported a prevalence of vulvocandidiasis in pregnancy to be 25% and 26% in their respective studies conducted at Ogbomosho and Lagos, Nigeria. Rasti et al. (2014) found that the prevalence of vaginal candidiasis in pregnant women in Iran was 49 (32.7 %). 35% of the patients with preterm labour and 31.8 % with term labour were infected with C. albicans. Out of 12 pregnant women with premature rupture of membrane (PROM), four women (33.3%) were showed positive results of C. albicans infection, while in 138 of the mothers without PROM , C. albicans was found in 45 (32.6%) (Rasti et al., 2014). Candida is an important risk factor of systemic infections in low birth weights infants and the related mortalities (Kaufman, et al., 2006). Neonatal septicemia produced by Candida in the premature infants with low birth weight has been reported to be successfully treated with amphotericin B (Baradkar, et al., 2008). Most fungal infections in preterm neonates are due to Candida species; a much smaller number of infections may be attributed Malassezia, Zygomycetes, or Aspergillus pathogens. Candida species are commensal organisms that colonize the skin and mucosal surfaces and adhere to catheter surfaces. Candida albicans and parapsilosis account for 80-90% of infections. Candida can invade the bloodstream and disseminate in these infants because of their immature immune systems, complicated by the inevitable need to compromise their developing skin and mucosal membrane barrier defenses. For these reasons, fungal infections are often difficult to eradicate in the preterm infant (Kaufman et al., 2006).

The risk for invasive fungal infections is high in very low birth weight (VLBW) infants (< 1500 g) and highest for infants born at the youngest gestational ages who survive past the immediate postnatal period (Kaufman, 2014). There was a tendency towards spontaneous preterm birth reduction among women with asymptomatic candidiasis treated with clotrimazole (Rasti et al., 2014). Screening for eradication of infection during pregnancy may reduce the risk of preterm delivery (Kufman et al., 2006). The objectives of this study were to determine the prevalence of C. albicans in pregnant women referred to obstetrics clinics at Ahmadu Bello University Teaching Hospital Zaria and also to find the effects of infection on the pregnancy including birth weight the children delivered by the women.

MATERIALS AND METHODS

Study Area: This study was carried out on 238 pregnant women in all. 121women presenting with symptoms of vaginal discharge, itching and erythema were recruited as cases. The controls were 117 pregnant women who are asymptomatic. All the women had pregnancies with single fetus of gestational age of > 16weeks with term or preterm delivery referred to Ahmadu Bello University Teaching
Hospital Zaria, from September 2015 to January 2016.
Sampling Technique: Convenience sampling techniques was used in which women who consented, and met the inclusion criteria were recruited consecutively during the period of the study. A questionnaire was provided based on a secure database including demographic data, medical history, symptoms of disease, pregnancy complications and postnatal data.
Sample collection: High Vaginal Swabs were collected with the assistance of health professionals. Cusco vaginal speculum was inserted into the vagina for the visualization of the vaginal wall. A swab stick was inserted through the speculum into the vaginal canal and rotated. This permitted acquisition of vaginal fluid, columnar and or cuboidal epithelial cells which are the main reservoir of pathogenic organisms. The swabs were transported promptly to the laboratory and processed within 30 minutes of collection. The swabs were cultured on Sabaroud agar for isolation of Candida Sp, and vaginal smears were Gram-stained and microscopically evaluated.
Data analysis: The data were analyzed by SPSS version 20 using chi square and Fischer exact tests.

RESULTS
Table 1 shows that Forty eight, 48 (20.2%) pregnant women had Candida infection, of which 33(68.7%) and 15 (31.3%) were isolates from cases and control groups respectively. The prevalence of vaginal candidiasis in pregnant women was 20.2%. There were 18 (7.6%) preterm deliveries among patients who participated in the study, 15 (83.3%) were among women who had vaginal

discharge while 3 (1.3%) had no symptoms. Out of the women who had preterm births, five (5) had Candida albicans infection.
There was no growth in 63 (54%) swabs out of the 117 control samples while 33 (28.2%) had normal vaginal flora isolated. Only 17 of the controls had pathogenic isolates and 15 were Candida albicans as indicated on Table 2. Table 3 shows the distribution of various complications observed during the study. In all, 39 women had babies with complications. Eleven 11 (28.2%) of these complications were Jaundice, 6 (15.3%) early neonate death, 4 (0.1%) fresh still birth and 18 (46.2%) had conjunctivitis respectively. Among the 121 cases who had vaginal discharge, 3 (2.5%) had early neonatal death 2 (1.7%) had fresh still birth and 1 (0.8%) had miscarriage. Other complications observed in the two weeks old infants delivered of women who had abnormal vaginal discharge during post natal clinics include jaundice 4 (3.3%) and Conjunctivitis 11 (9.1%). In the control group, 7 (6.0%) babies born had conjunctivitis, 2 (1.7%) babies had jaundice and 2(1.7) women had fresh still births. There was no record of miscarriages among them. A significant higher frequency of preterm delivery was found in the cases group than in the controls however; only 5 of the women had candidiasis.
In Table 4, 136 (56%) of the study population had abnormal vaginal discharge at various degree and more than 30% suffered vaginal itching and discomfort during pregnancy. The table revealed that women who complained of abnormal discharge consist of 84 from the cases category and 53 from the controls. 52 of the cases group had vaginal itching and discomfort while among the controls, they were 20.
The study also showed that 17.1% of the pregnant women who enrolled for the study had adequate knowledge of vulvocandidiasis in pregnancy and 29.6% has a history of the infection in the past.

DISCUSSIONS
The result of the study showed that vaginal yeast infections are a common problem during pregnancy and the prevalence of vulvocandidiasis in pregnancy is 20.2% in Zaria. This is similar to studies conducted in Nigeria by Akinbami et al., 2015 at Ladoke Akintola University of Technology (LAUTECH) in Ogbomoso who reported the prevalence of vulvovaginal candidiasis to be 25%. Anorlu et al. 2004, in another studies documented a prevalence rate of 26% in Ibadan (Anorlu et al., 2004).
Vaginal secretions during pregnancy fall from a pH of greater than 7 (an alkaline pH) to 4 or 5 (an acid pH). This change in pH also unfortunately, favors the growth of Candida albicans. Vaginal infection during pregnancy may be caused by high estrogen levels (Pratibha et al., 2013). These infections are not risky to the pregnancy, but they can cause uncomfortable symptoms and severe fatigue among pregnant women.
This study revealed that 27.7% of the patients with preterm labour and 34.3 % of mothers with appropriate gestational age were infected with C. albicans. Out of 121 pregnant women with abnormal vaginal discharge, 16 (13.2%) mothers had preterm births but only 5 of them had Candida infection. The remaining eleven swabs from the pregnant women consist of 1 normal flora, 6 bacterial isolates and 4 sterile swabs. Our findings did not show any statistical significance effect of vaginal C. albicans infection on pregnancy outcome at P < 0.05 as shown in Table 2

The difference between cases and controls was clinically significant. The study suggests increased risk of vaginal infection during pregnancy among the study population. However, no statistically significant relation was found between C. albicans infections and preterm birth. The prevalence of vaginal candidiasis in the study was 20.2 %. Five 5 (10.4%) of the patients infected with Candida had preterm births and forty three 43 (89.5%) had term deliveries.

The prevalence of vulvovaginal candidiasis in this study is significantly lower than a similar study among pregnant women in Gboko, Nigeria which gave of 47.7% higher than that of the control (20.3%). The rate of symptomatic candidiasis among the pregnant women was significantly high compared to those without symptoms (Jombo et al., 2011). Olugbenga et al., (2014) found that at least one in every three women is infected. This is similar to many reports including 30% by Okonkwo and Umeanaeto (2010) and 37.4% by Guzel et al.,(2011). In Iran prevalence of vaginal candidiasis in 150 pregnant women was 32.7 %. The study showed that the patients with preterm labour were 35% compared to those with term labour (31.8%) were infected with C. albicans (Rasti et al., 2014).
The incidence of yeast infections has greatly increased in recent times especially with the widespread use of broad-spectrum antibiotics and immunosuppressive treatment. Candidiasis is an important yeast infection that is especially common in pregnancy with the risk of the woman harboring Candida spp. and infecting their babies during the perinatal period. Pregnancy, diabetes mellitus, and antibiotic treatment are the most common predisposing factors (Cohen et al., 2012). Some studies have shown that vulvovaginitis has increased in the past three decades due to antifungal resistance to Candida species and a change in women’s health quality (Olugbenga et al., 2014).
Vulvovaginal candidiasis had been noted to be more common in pregnancy, and pregnant women have been reported to have higher rates of recurrent infections. According to the results of Kaufman (2006), Candida is a risk factor for both systemic infections in low birth weight infants and mortality which was not in consistence with the results of this study. Among 48 mothers who had C. albicans infection, 5 (10.4%) were delivered of preterm babies while of 120 mothers with appropriate gestational age newborns, 33 (68.7 %) were shown to have C. albicans infections and this was not statistically significant (P>0.05).

The study also exposed the urgency and need of educating the study population on vaginal infection and its risk on the fetus despite the fact that most of the participants reside in urban and semi urban area. Only 17% of the pregnant women who took part in the study had previous knowledge of the infection as most women claim it is a toilet infection with little or no information of the cause of infection. This is in agreement with the study Jombol et al, (2011) who found that 94.1% of the pregnant women were ignorant of the disease. About 54% of the pregnant women complained of abnormal vaginal discharge with many of them presenting with various degree of itching and erythema.

CONCLUSIONS
In this study, the prevalence of Candida infection in pregnancy among the study population was 20.2%. More
than 20% of women had culture-positive Candida albicans vaginal infection during pregnancy, which represents a very high rate of infection of the lower genital tract of pregnant women. However, there was no significant relationship between vulvovaginal candidiasis with pregnancy outcome and foetal or neonatal complications. The rate of symptomatic and asymptomatic vulvovaginal candidiasis among pregnant women in Zaria is high with a corresponding low level of awareness and care about the disease.

RECOMMENDATIONS
Health education should be instituted at ante-natal clinics so as to raise the knowledge and level of awareness of pregnant women towards seeking prompt and appropriate treatment. Routine screening and consequent treatment for vaginal candidiasis could improve pregnancy outcomes. In women with persistent discharge, screening for lower genital tract infections (vaginal and cervical) is recommended. If vulvovaginal candidiasis is diagnosed in a symptomatic pregnant woman, treatment is indicated.

Pregnant women are at high risk of vaginal infections, thus adequate investigations and prompt treatment will improve the quality of lives and prevent adverse effects on mother and fetus. Adequate laboratory facilities should be provided and laboratory personnel should be trained in the diagnosis of vulvovaginal candidiasis.

REFERENCES

1. Adeyeba,O.A. Adeoye,M.O. and Adesiji, Y.O.(2003). Bacteriological and Parasitological Assessment of Vaginitis in Pregnant Women in Iseyin, Oyo State, Nigeria. African Journal of Clinical Experimental Microbiology, 4 (2):112-125.

2. Akinbami NA, Babalola OG, Shittu OM, Tijani MA and Adekola AS (2015). Detection and Epidemiology of Vulvovaginal Candidiasis among Asymptomatic Pregnant Women Attending a Tertiary Hospital in Ogbomoso, Nigeria International Journal of Biomedical Resources. 6(07): 18-23.

3. Anorlu R, Imosemi D , Odunukwe N , Abudu O , and Otuonye M (2004). Prevalence of HIV among women with vaginal discharge in a gynecological clinic. National Medical Association. 96(3): 367–371.

4. Baradkar, V.P. Mathur, M. and Kumar, S. (2008). Neonatal septicaemia in a premature infant due to Candida du bliniensis. Indian Journal of Medical Microbiology. 26(4):382.’Retrieved from’: 10.4103/0255-0857.43574.

5. Cohen, C.R. Lingappa, J.R. Baeten, J.M. Ngayo, M.O. Spiegel,.CA. Hong, T. Donnell, D. Celum, C. Kapiga, S. Delany, S. and Bukusi, E.A. (2012). Bacterial Vaginosis Associated with increased risk of Female-to-Male HIV-1 Transmission: a prospective Cohort Analysis among African couples. PLoS Med 9: e1001251.

6. Gibbs, R.S. Romero, R. Hillier, S.L. Eschenbach, D.A. and Sweet, R.L. (1992). A review of premature birth and Subclinical Infection. American Journal Obstetrics & Gynaecology. 166:1515–1528.

7. Hollier, L.M. (2005).Preventing preterm birth: what works, what doesn’t. Obstetrics and Gynecology Survey. 60:124–131.

8. Jombo, G.T. Akpera, M.T. Hemba, S.H. and Eyong, K.I. (2011). Symptomatic Vulvovaginal Candidiasis: Knowledge, Perceptions and Treatment modalities among Pregnant women of an Urban Settlement in West Africa. African Journal of Clinical and Experimental Microbiology 12 (1) 32-37.

9. Kaufman, D.A. Gurka, M.J. Hazen, K.C. Boyle, R. Robinson, M. and Grossman, L.B.(2006). Patterns of Fungal Colonization in Preterm Infants weighing Less Than 1000 Grams at Birth. Pediatrics Infectious Disease Journal 25(8):733–7.

10. Kaufman, D.A (2014). Clinical microbiology of Bacterial and Fungal Sepsis in very-low-birth-weight infants. Clinical Microbioliology Reviews Jul. 17(3):638-80

11. Mendling, W. and Brasch, J.(2010). Guideline Vulvovaginal Candidosis. Mycoses. 55:1–13.

12. Ogbonna, C.I. Ogbonna, I.B. Ogbonna, A.A. and Anosike, J.C. (1991). Studies on the incidence of Trichomonas Vaginalis Amongst Pregnant Women in Jos area of Plateau State, Nigeria. Angew Parasitology. 32(4):198–204.

13. Okonkwo, N. J and Umeanaeto, P.U (2010). Prevalence of Vaginal Candidiasis among Pregnant Women in Nnewi Town of Anambra State, Nigeria. African Research Review, 4(4) Pp. 539-548.

14. Olugbenga, A. O. Olufunmilola, B. M. Olowe, R. and Adekanle, D. (2014). Prevalence of Vulvovaginal Candidiasis, Trichomoniasis and Bacterial Vaginosis Among Pregnant Women Receiving Antenatal Care in Southwestern Nigeria. European Journal of Microbiology and Immunology 4(4): 193–197.

15. Pratibha Kamath , Maria Pais and Malathi.G.Nayak (2013) Risk of vaginal candidiasis among pregnant women. International Journal of Current Microbiology and Applied Science 2(9): 141-146.

16. Rasti, S. Asadi, M. A. Taghriri, A. Mitra, B. M. and Mousavie, G. (2014). Vaginal Candidiasis Complications on Pregnant Women. Jundishapur Journal of Microbiology. 7(2): e10078

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Kudi A.A., Saminu C.M., Hassan M.D., Manga M.M:

Department of Medical Microbiology & Immunology Federal Teaching Hospital, Gombe
Deborah B., Madina E.K.,

Centre for Integrated Health Programme (CIHP), Gombe Regional Office.
Sa’idu A.

Department of Medicine, Federal Teaching Hospital, Gombe

All correspondence to: kudiayuba@gmail.com

ABSTRACT
A success story at the Federal Teaching Hospital, Gombe (FTHG) a 500-bed capacity tertiary institution situated at the heart of the North-eastern Nigeria. A manually operated PCR facility was first installed by a supporting partner – the Institute of Human Virology-Nigeria (IHVN) in 2009. The FTHG in collaboration with Centre for Integrated Health Programme (CIHP) and Centre for Disease Control (CDC) – Nigeria up-graded the facility to an Automated PCR machine (COBAS TAQMANN96) in 2015. It was a good response to partnership that demonstrates programme commitment and sustainability. In that spirit, human and material resources were committed towards the actualization of space and infrastructure with quality finishing/furnishing of the PCR Laboratory. Staff were highly motivated and the dearth in Laboratory infrastructure was greatly addressed. Timely Supply of reagents and consumables was also sustained. The resultant benefit of this partnership was quality improvement to services with increased in patients’ access to HIV and Hepatitis B and C diagnosis and treatment monitoring. Our Centre remains ever grateful to the PEPFAR HIV programme, our supporting partners and the Federal Ministry of Health, Nigeria.

Key Words: PCR, PEPFAR HIV and AIDS Programme, Partnership.

INTRODUCTION

Gombe, a State located in the Northeast region of Nigeria within the expansive savannah. It shares border with Yobe, Taraba, Bauchi, Borno and Adamawa States. The State has an area of about 20, 265 square kilometres and a population of around 2,353,000 people as at 2006 census.1 Gombe has 2 distinct climatic conditions, the dry season (November to March) and the raining season (April to October) with an average rain fall of 850mm.1

The Federal Teaching Hospital Gombe (FTHG) is located in Gombe, a tertiary 500-bed capacity health institution situated in the heart of the North-eastern Nigeria, relatively equipped with states of the arts facilities in Diagnostic Laboratory, addresses wide range of investigations. Before the coming of the Centre for International Health Programme (CIHP) as a supporting partner in the field of HIV investigations and treatment monitoring, the Laboratory could only boast of a manually operated PCR equipment installed by the Institute of Human Virology, Nigeria (IHVN)] in 2009, under the Presidential Emergency Plan for AIDS Relief (PEPFAR), a programme of the United States of America launched in 2003 to combat
global HIV/AIDS.2,3 For us at the Federal Teaching Hospital Gombe (FTHG), Nigeria, the up-grading of the PCR Laboratory to automation by the CIHP/CDC (Centre for Disease Control) – Nigeria in partnership with FTHG management was a success story. The Hospital Management, staff and people of Gombe State will ever be grateful to PEPFAR.

Team work and Positive Response to Partnership
The News to install an automated PCR Machine (COBAS TAQMANN96) came to us (Laboratory Management) as an institution, and was observed that our supporting partner, CIHP were serious, as ever; they placed the card on the table that; PCR automated equipment could be installed in our facility to boost the Centre’s capacity in HIV and AIDS investigations. What was required then of the FTHG Management to put in place were space (infrastructure) and few other logistics. The laboratory Team saw the possibility because of the close working relationship, support and co-operation being received at all times from the Hospital management.

In high Spirit, the Laboratory leadership Team led by the Director Laboratory Services, approached the Hospital management with a proposal to that effect, and sooner than expected, discussion with the management for theconstruction of a brand new PCR Laboratory was concluded and approved. The Chief Medical Director (CMD), Dr. Abubakar Sa’idu assured the leadership of CIHP that construction of the PCR Laboratory, furnishing and any other necessary item(s) needed according to specification to enable the centre have the automated PCR equipment installed will be put in place. He equally made a strong commitment towards the deadline given by CIHP/NCDC- Nigeria for the space to be ready. To his words, within 3 months (April to July, 2015), all were set for PCR equipment installation. On 1st October, 2015, PCR equipment with all the necessary accessories for Early Infant Diagnosis (EID) and Viral quantification (viral load) reagents arrived the FTHG. PCR Equipment (COBAS TAQMANN96) and all the accompanied accessories were received by the Director Laboratory services in good deadline given by CIHP/NCDC- Nigeria for the space to be ready. To his words, within 3 months (April to July, 2015), all were set for PCR equipment installation. On 1st October, 2015, PCR equipment with all the necessary accessories for Early Infant Diagnosis (EID) and Viral quantification (viral load) reagents arrived the FTHG. PCR Equipment (COBAS TAQMANN96) and all the accompanied accessories were received by the Director Laboratory services in good condition and according to the specifications earlier given.

On 13th October, 2015, installation and on-site training of staff were completed by a Team of Roche Engineers with the support of the CIHP Gombe Laboratory Team, led by the Senior Laboratory Supervisor, Mrs. Deborah Bulus. The arrival of -20oC and -80oC deep freezers from the CIHP supporting partners, and the installation of 20Kva inverter by same (CIHP) later, climaxed the infrastructural up-grading of the PCR Laboratory at the FTHG Centre. The now fully equipped PCR Laboratory was commissioned by the Hon. Minister of Health, Prof. Isaac F. Adewole on 11th January 2016. This has greatly addressed the dearth in Laboratory infrastructure, improves the quality of services in the Centre and increased access; staff were also highly motivated to quality issues.

To further galvanized its commitment to quality and demonstrate a kind of strong partnership, aside from EID and HIV (viral load) investigations fully supported by the CIHP/CDC-Nigeria, the FTHG management added Hepatitis B and Hepatitis C viral quantification to the menu of investigations using the installed PCR machine. So far, from the date the PCR machine was installed to the time of writing this report, more than 36,840 samples were received from Kaduna, Benue and Gombe States for HIV viral load, 5,157 for EID, while 242 for Hepatitis B virus
and 85 for Hepatitis C virus were analysed. The addition of these tests to the HIV investigations have greatly enhanced quality of patient care and reduced the hardship hitherto been experienced by the patients.
CONCLUSION
The FTHG Management and staff have not only demonstrated good response and sensitivity to partnership, but also understood the principle and importance of programme sustainability. This was clearly seen in the resources being committed, both human and material towards the actualization of space and infrastructure with quality finishing/furnishing of the PCR Laboratory. This is our success story. We remain ever grateful to our programme partners and the Federal Ministry of Health. We look forward to more of supports and such types of collaboration from well-meaning groups and organisations in and outside Nigeria.

REFERENCES

1. Gombe State action plan of His Excellency, 29th May, 2011 to 29th May, 2015. An official document of the Gombe State Government.

2. Partnering to Achieve Epidemic Control in Nigeria. www.pepfar.gov

3. PEPFAR HIV and AIDS programme on the Nigeria

The post In the Spirit of Partnership, an Automated PCR Machine Installed under the PEPFAR HIV and AIDS Programme: The Federal Teaching Hospital, Gombe/CIHP Success Story appeared first on Nigerian Biomedical Science Journal.

Ojih M.A
Department, of Medical Microbiology Ahmadu Bello University Teaching Hospital Zaria.
Amadi Y.H
Department of Parasitology and Entomology Ahmadu Bello University Zaria.
Akpulu S.P
Department of Human Anatomy Ahmadu Bello University Zaria.
Yaro E.G
Department of Human Anatomy, Ahmadu Bello University, Zaria, Nigeria

All correspondence to: E-mail: maryarichayakubu@gmail.com

ABSTRACT
Background: Intestinal parasites and helminthic infection has posed medical changes to the developing word. There is therefore need to source and develop local drugs or herbs to combat this menace. Aims and Objectives: This study therefore examined the anthelminthic activity of ethanolic leaf extract of combretum molle in vitro on the ova of Hookworm and Haemonchus contortus. Materials and Methods: One drop of the extract mixed 5 drops of distilled water was added to 6 drops of faecal samples on a microtiter well and incubated for 14 days at 260C, using water as control. The activity was assessed by comparing the number of ova present after a period of 2 weeks for both the extract and water. The result showed that there was only one egg (non -embryonated) of hookworm observed in the well with the extract. For the Haemonchus contortus in the well with extract, there as one egg,12 unembryonated eggs, 13 dead larvae. For the control(water), there was no positive effect on the hookworm and the Haemonchus contortus. Conclusion: Result from this study shows that ethanolic leaf extract of combretum molle was effective against the ova of the hookworm and the Haemonchus contortus and can be a possible anthelmentic agent.

Keywords: helminthic, Haemonchus contortus. combretum molle, Hookorm

Introduction

Intestinal parasites and helminthic infection has posed medical changes to the developing word. Resistance to antibiotics is becoming a serious problem worldwide. The discovery of new and effective antimicrobials and/or resistance modulators is necessary to tackle the activity of spread of helminths. Infections with helminths are among the most widespread diseases worldwide and the reason for considerable morbidity, mainly in populations from less developed countries of Sub-Saharan Africa, the Americas, and Southeast Asia (Hotez et al.,2008). Recent investigations estimated the number of people infected with the most common parasitic nematodes Ascaris lumbricoides, Trichuris trichiura, and hookworms (Ancylostoma duodenale and Necator americanus) to be more than 1.7 billion worldwide, including 100 million infections in West Africa (Pullan et al., 2010). Extensive measures have been undertaken by the WHO to provide effective and low-cost treatments for the inhabitants in endemic areas, which have successively led to a decrease in the morbidity and prevalence of intestinal helminthiases (Humphries et al.,2012). In most cases, albendazole is the deworming drug of choice, however, mebendazole, pyrantel, and levamisole are also classified as essential medicines (WHO,2013). Nevertheless, the number of approved anthelmintic drugs the societies are relying on is very limited and especially large-scale preventive applications bear the risk of resistances to emerge (Vercruysse et al.,2011). In veterinary medicine, this is already the case where worldwide resistances of parasites of livestock have increased to a dramatic degree within the last years (Kaplan and Vidyashankar,2012). Despite the availability of conventional drugs, traditional medicine, often based on medicinal plants, plays a crucial role in the treatment of helminthic infections. As indicated by a recent field study, many African patients prefer to consult traditional healers or herbal practitioners for this indication (Agyare et al.,2009). More than 300 species of plants have been reportedly used in traditional control of human and animal helminthosis in Africa (Nwude et al.,1998). Combretum molle of the combretacae family is used to treat human ailments including abdominal discomfort, body pains, respiratory discomfort, cods and fevers, ear and eye ailments, schistosomiasis, hookworms, dysmenorrhea and infertility in women, leprosy, syphilis, microbial infections and general body weakness (Ademola and Eloff, 2010). Helminthiasis is a major limitation to the livestock industry in Africa. Haemonchus contortus is the singular most important helminth responsible for major economic losses in small ruminants. The high cost of anthelmintics to small farmers, resistance to available anthelmintics and residue problems in meat and milk consumed by humans further complicates matters.

Haemonchus contortus is the single most important constraint to sheep production in South Africa (Vatta et al.,2001) with estimated direct and indirect economic losses of US $45 million (I.G. Horak personal communication quoted by Waller, (2006). The cost of controlling helminth infestation is also very high globally with chemotherapy remaining the most widely used method of treatment. Unfortunately, the excessive use of these drugs when not necessary, in addition to their use at incorrect doses, has resulted in the wide scale emergence of resistance in this parasite. The use of plants and plant extracts as a possible source of new anthelmintic has received more interest in the last decade. This study therefore aim to study the anthelminthic activity of Combretum molle (velvet bush willow) against ova of hookworm and Haemonchus contortus.

Materials and methods
This study was conducted in the department of parasitology and entomology, faculty of veterinary medicine Ahmad Bello University, Zaria. Positive stool sample was collected from Ahmad Bello University Teaching Hosital Zaria. Plant collection. Five-kilogram leaves of Combretum molle was collected in Zaria and identified in the biological science department of Ahmad Bello University, plant extraction. The leaves were air dried (290C) under shade and grinded sing pestle and mortar into fine powder as described by Onyeyili et al.,2001. 150g of the powdered sample was extracted with 2.5L of 96% ethanol using cold maceration (percolation) method. The filtrate was evaporated and the extract obtained used. One part of Acacia was mixed with 5 parts of the extract.one drop of the mixture as introduced into microtiter well for culture and left for two weeks using water as control. 0.1ml distilled water was added to 1.2ml positive faecal sample and 0.2ml extract. Culture was observed for ova microscopically on day 7, 10 and 14 post incubation respectively.

Discussion
The results from this study shows that at the end of 14 days, the extract at 0.2ml had an adverse effect on the ova of Hookworm and the egg, and larvae of Haemonchus contortuus. This was observed by the absence and dead of the ova and larva. which implies that the extract has anthelminthic effect. While in day 7 and 10, the extract did not reduce the number of the ova and larvae significantly the control only with water did not show any anthelminthic effect rather, the ova hatched to larvae.

These findings are similar with previous investigations on lethal anthelmintic effects against a variety of nematode species, including adult C. elegans Mohamed et al (2000) and L3 larvae of Toxocara canis Kiuchi et al (2000). Also, the activity against C. elegans (L4 larvae/ young adults) of a plant extract from Combretum mucronatum by Schum. & Thonn. (Combretaceae) leaves has been confirmed in vitro (adult worms) and in vivo against Trichuris muris and against adult stages of A. ceylanicum, Spiegler et al., (2015) while the same extract was inactive against third stage larvae of the hookworm Kone et al., (2012). This inactivity is probably caused by the sheath protecting the free-living L3 larva persevering in soil, which is unlikely to be penetrated by large polar molecules such as proanthocyanidins. T. et al., (2012). Similarly, Adamu et al (2013) reported that the plants extract generally had better inhibition activity on the eggs than on the larva of H. contortus based on the EC50 values recorded. This is contrary to report by Ademola where they had better activity for the larval inhibition compared to the egg hatch assay.

In comparison to work undertaken using extracts of other plant species, the activity shown by the three plants with the best activity were in the same order of activities found by Bizimenyera et al., (2006) using Peltophorum africanum leaf, bark and roots as well as extracts of Coriandum sativum on eggs and larval development of H. contortus Eguale et al.,(2007). Bizimenyera et al., (2006) recorded an EC50 of 0.62 mg/ml and 0.72 mg/ml for the leaf acetone extract for the EHA and LDT assays respectively. This is in the same order with values of 0.62 and 0.64 mg/ml recorded in the EHA and LDT for H. trifoliata in the current study. The EC50 of H. trifoliata was lower than the acetone leaf extracts of Combretum molle 0.87 mg/ml and 0.60 mg/ml for the EHA and LDT respectively (Eloff McGaw and Eloff, 2008). The weak activity recorded by M. azedarach (EC50 = 10.96 mg/ml) agrees with Maciel et al., (2006) in Brazil where they reported an LC50 of 9.18 mg/ml with the leaf ethanol extract of the plant. It is encouraging that despite the difference in geographical location and organic extractants used, similar bioactivity was obtained for related species.

Conclusion
This finding shows that Combretum Molle has an Anthelminthic activity on the Ova of Hookworm and Haemonchus 

Acknowledgment
We are grateful to the Management and Laboratory staff Ahmadu Bello University Teaching Hospital Zaria, and Department of Parasitology and Entomology, Faculty of Veterinary Medicine Ahmadu Bello University for permission, support and cooperation during the work.

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Akande T,

            Dept. of Chemical Pathology, Bingham University, Jos Campus

Olusanya T, Mamza Y.

            Dept. of Medical Laboratory Science, University of Maiduguri

All correspondence to: Akande T. Dept. of Chemical Pathology, Bingham University, Jos Campus

ABSTRACT

INTRODUCTION

Uric acid is the metabolic acid product of Purine metabolism. Previous studies have demonstrated a strong relationship between serum uric acid level and coronary heart disease (CHD) and some studies suggested that uric acid may be an independent risk factor for cardiovascular disease [1-9]. Recently, a meta-analysis showed that hyperuricemia may increase the risk of CHD events, independently of traditional CHD risk factors [10]. However, the nature of relationship between uric acid and cardiovascular disease remain a subject of debate [11-13].

Epidemiological studies have reported relationship between serum uric acid level and a wide variety of cardiovascular conditions, including hypertension metabolic syndrome [14] Coronary artery disease [15]. Cardiovascular disease is the number one global cause of death. An estimated 17.3 million people died from cardiovascular disease CVDs in 2008; representing 30% of all global death [16] CVDs are projected to remain the single leading cause of death [17]. Presently there is paucity of epidemiological data on serum uric acid level in cardiovascular disease in this environment and even with long standing awareness of this association, little attention has been paid to its potential significance, hence the need for this study.

Materials and Method

The study group comprised 100 consecutive cardiovascular disease patients attending the medical clinic at the university of Maiduguri teaching hospital, a referral center for North-eastern states of Nigeria and neighbouring countries e.g. Chad and Cameroon.

The patient recruited were seen in the medical clinics, reviewed by the physicians and provisionally diagnosed of cardiovascular disease. Control subjects, 50 apparently healthy individuals without signs of cardiovascular disorder were recruited. Patients with associated cases of kidney dysfunction and gout were excluded.

Data Collection

A standard questionnaire was used to collect information such as age, sex, medications, education level. The history of chronic disease and current use of medication were recorded.

In all study patents, a complete clinical work was done including height, weight and body mass index. The body mass index was calculated and expressed as Kg/m2. The blood pressure was recorded in the right upper arm in the sitting posture after a five-minute rest. Patient were categorized as being hypertensive if they were on antihypertensive treatment or if they had a systolic blood pressure >140mmHgand /or diastolic blood pressure >90mmHg [18].

Biochemical Measurements

Peripheral various blood samples were collected after an overnight fast and the following investigations were done: plasma glucose, serum cholesterol, and serum triglyceride high density lipoprotein-cholesterol and serum uric acid. Biochemical analyses were done spectrophotometrically using reagents supplied by Randox UK). Serum uric acid using Uricase enzymatic method, were estimated in all samples.

Statistical analysis

Statistical analysis was performed with the SPSS statistical package (version 11.0). Student’t’ test was used to compare the means of variables. The level of significance was set at p-value of <0.05.

Results

The study included a total population of 150 subjects, 100 of which were patients with confirmed cases of cardiovascular disease and 50 control individuals. Among the test individual’s females represented 66% of the total population while males represented a portion of 34%.

Table 1. Shows the mean distribution of the age, blood pressure, and body mass index of test and control individuals by sex. There was a significant difference (P<0.05) between the test and control for all characteristics. The total mean age for test individuals was 45.9±15.4 with the males (mean=54.7±14.3) averagely older than the female patients (mean=41.5±14.2). Table 2 shows a mean distribution of biochemical parameters.

Table 3: represent the percentage distribution of serum uric acid levels stratified by age group and sex. The total percentage incidence of hyperuricemia in the CVD patients was 57% among all the age groups and gender. There was a significant level of occurrence of hyperuricemia among all the age and sex. Few of the patients fell between the age group 0 – 19 (4%) and highest was 40 – 59 (54%) having an incidence of 56%.

Table 4: shows the relationship that exists between serum uric acid levels and cardiovascular disease in the presence and absence of individual CVD risk factors. The result revealed that hyperuricemia still persisted even in the absence of individual CVD risk factors. It shows that 54.5% of patients with normal BMI were hyperuricemic as well as 58% of non diabetic patients, 62% of patients with normal serum cholesterol levels and 63% of patients with normal blood pressure all of which were significantly higher than those of patients with one or more CVD risk factors.Table 5: shows the association of serum uric acid level and CVD after categorizing the test individually into diuretic users. The result shows a frequency of 39% diabetics as against 61% of those whose indication does not include diuretic. The incidence of hyperuricemic was substantially higher among persons on diuretic use (64%). However, the association of hyperuricemia with CVD was still maintained as a significant 52.5% of the non-diuretic

DISCUSSION

In this representative general population, hyperuricemia bore a continuous, independent, specific, and significant positive relationship to cardiovascular disease. This association was true for both men and women. The impact of hyperuricemia on cardiovascular disease was positive at all age groups but this influence was strongly observed from those aged 20-59 and above 80.

These data are consistent with a variety of other studies suggesting that an elevated serum uric acid level is an independent risk factor for cardiovascular disease [19, 20, 21, 22].

Furthermore, after controlling for potential risk factors, it was observed that the presence or absence of individual CVD risk factors did not generally alter the positive relation of hyperuricemia to cardiovascular disease as the association of increased serum uric acid level still persisted even among subjects with low cardiovascular risk (i.e. those without an increased cholesterol level, hypertension, diabetes, or obesity). On other hand, hyperuricemia was not strongly associated with CVD in diabetic and patients with elevated cholesterol. In adult, serum uric acid levels vary with height, body weight, blood pressure, alcohol intake and diuretic use [23, 24, 25]. The influence of diuretic therapy on serum uric acid is of particular note and potential importance [26, 27]. To check this influence on the study subjects, patients were stratified based on diuretic and non-diuretic users. In this group, diuretic therapy did appear to modestly increase serum uric acid level. However, the serum uric acid to CVD relation was independently of the effect of diuretics as a higher percentage of the non-diuretic users still had a hyperuricemic state.

The results of this study are not in agreement with that of Culleton etal [11]which reported that an elevated serum uric acid level at baseline was not independently associated with increased risk of cardiovascular mortality. They concluded that the apparent association of serum uric acid to cardiovascular events was probably due to the effect of other cardiovascular risk factors, particularly by diuretic use. The different results seen in these two studies may be due to difference in the population studied (i.e. population from their study was almost exclusively white while those in this study were all black). But considering the vast reports that favor the results of this study, it suggested that theirs may however be an exception, rather than the rule.

The vital question is whether increased serum uric acid is a casual factor for cardiovascular disease. Observational data alone cannot answer that question. It is not possible to determine here whether hyperuricemia is a marker, a co- morbid or intervening factor, or a direct cause of CVD.

In any event, however, hyperuricemia has been shown to meet conventional criteria for a cardiovascular risk factor. The association of increased serum uric acid to cardiovascular disease events is significant, is independent of other known CVD risk factors, is specific and has substantial effect size.

Conclusion

Hyperuricemia was associated with cardiovascular disease independently of conventional cardiovascular disease risk factors and may be considered a risk factor for cardiovascular disease.

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The post Hyperuricemia as a risk factor for cardiovascular Disease: A Prospectivestudy of patients attending A tertiary hospital in North- Eastern Nigeria. appeared first on Nigerian Biomedical Science Journal.

Omosigho O.P., Odedina E.O. EmumwenE.G.

Medical Microbiology Department, Federal Medical Centre Bida. Niger State, Nigeria.

Emumwen E.F

Department of Biological Sciences, The Federal Polytechnic Bida. Niger State, Nigeria.

All correspondence to: Omosigho Omoruyi Pius Medical Microbiology Department,

Federal Medical Centre Bida. Niger State .Nigeria Email –omosighoop@gmail.com.

ABSTRACT

Cytomegalovirus (CMV) is a common opportunistic infection in immunocompromised individuals particularly HIV/AIDS. Avidity is the strength with which the IgG attached to antigen; it measures the length of time after primary infection. CMV IgG avidity assay seems to be one of the most accessible tools to differentiate between primary and non-primary CMV infection.  This study was conducted to evaluate the significance of the utility of the relationship of IgG Avidity Index and IgM levels for differential diagnosis of primary Cytomegalovirus infection from non-primary infection in HIV/AIDS patients in Federal Medical Centre Bida. Blood samples were collected from HIV positive patients on Highly Active Anti-Retroviral Therapy for IgM Enzyme Linked Immonosorbent Assay, all positive IgM samples were tested for IgG Avidity. Out of the three hundred and eighty five (385) HIV positive subjects, an overall prevalence of 19.8% IgM was found among patients with HIV in Bida. Out of the 77 IgM positive samples tested for IgG Avidity index, 12(15.6%) had high avidity while 65(84.4%) had low avidity.  Low avidity indices indicate low maturation of IgG antibodies in blood caused by recent or acute primary CMV infection There was a significant difference (P=0.001) between the utility of IgG avidity index and IgM in the differential diagnosis of primary Cytomegalovirus infection. Primary CMV infections by IgM ELISA alone was significantly overestimated as only 65(84.4%) out of the 77 CMV IgM positive are actually primary infection while the rest 12 (15.6%) are non-primary infections. The utility of IgG avidity ELISA significantly reduced the reported prevalence of primary CMV infection with IgM ELISA method in this study. IgG avidity index is a sensitive, specific and less expensive method for identification of recent CMV infection in HIV positive patients compared to more sophisticated and expensive molecular methods.

Keywords: IgG Avidity, Cytomegalovirus, HIV/AIDS, Primary infection, Bida, Nigeria.

INTRODUCTION

Cytomegalovirus  a member of the human Herpes family of viruses, transmissible through blood component, transfusion is an important cause for concern worldwide this is because the majority of adults have serological evidence of previous infection . (Zhang et al., 1995). The prevalence of seropositivity of CMV  in the adult population over 40 years of age worldwide are reported to be 60-100%, due to transmission through sexual contact, spread from   children and breastfeeding (Helkeret al., 2004).

Like most other Heperviruses, CMV is latent in their host after primary infection and persists for life (Drobyskinet al., 1993). Nevertheless, reactivation in

immunosuppressive individuals leads to end organ disease such as retinitis, encephalitis and interstitial pneumonitis (Manezet al., 1993). Acute infection of CMV leads to serious morbidity and mortality (Hillyeret al., 1990). CMV co- infection is a major cause of morbidity and mortality in individuals with depressed cell mediated immunity associated with Acquired Immunodeficiency Syndrome AIDS (Macheret al., 1983).

CMV is one of the most successful of human pathogens, since it can be transmitted both vertically and horizontally, usually with little effect on the host. CMV is shed in body fluids (e.g., saliva, urine, semen, breast milk). Transmission usually occurs from person to person, including through the intrauterine route, but it can also be spread during transfusion or organ transplantation.

Globally, between 60 and 90% of the general population is infected with CMV, with generally higher rates in developing countries (Rowshaniet al., 2005).

The functional binding affinity of anti-CMV IgG antibodies increases progressively over time after immunity by infection; it is otherwise referred to as maturation of the humoral immune response Low IgG  avidity indices may indicate primary infection whereas high avidity indices indicate non-primary infection (Bonalumiet al.,2011).

The CMV-IgG avidity ELISA has also been successfully used to diagnose CMV in children. Vilibic-Cavleket al in 2011 evaluated the value of IgG avidity in diagnosis of CMV infection in newborns and infants. Their analysis of 40 serum samples from under 1 year old infants with suspected CMV infection. 13 (32.5%) of the subjects were seropositive to anti-CMV IgM, 3 (7.5%) had equivocal IgM antibodies result, and 24 (60.0%) patients had IgG antibodies only. With IgGavidity ELISA, CMV infections (with low avidity indices) were reported in 61.5% IgM positive and 54.2% IgM negative infants. IgG avidity distribution across age of infants demonstrated recent primary CMV infection in 58.8% patients younger than 3 months compared with 91.7% and 81.8% in 3–6 and 6–12 months old infants respectively. The study showed that IgG avidity ELISA results in children older than 3 months of age was significantly useful for CMV diagnosis regardless of their IgM result.(Vilibic-Cavleket al.,2011).

Primary CMV infection is likely to occur when there is seroconversion from IgM negativity to IgM positivity in combination with low IgG avidityindex. The anti-cytomegalovirus IgG avidity ELISA is presently the most reliable investigation used to identify primary CMV infection in pregnant women. The IgG avidity test is highly specific (100%) and sensitive (94.3%). The degree of antibody avidity slowly and progressively increases reflecting the maturation of humoral immuneresponse over time (Lazzarottoet al.,2002, Egger et al.,2000 ). Low avidity indices indicate low maturation of IgG antibodies in blood caused by recent or acute primary CMV infection (Lazzarottoet al.,1997). Low avidity indices are encountered 18–20 weeks after the onset of symptoms in apparently healthy individuals (Egger et al.,2000).

The aim of this work was to establish the significance of IgG Avidity Index in the differential diagnosis of primary Cytomegalovirus infection from non-primary infection in patients attending Anti-Retroviral Therapy Clinic in FMC Bida Niger State.

Materials and Methods

This study was a cross sectional study of patients with HIV infection attending the Anti-Retroviral Therapy (ART) Clinic of Federal Medical Centre Bida, Niger State. The study was carried out in the Anti-Retroviral Therapy (ART) Clinic of Federal Medical Centre Bida, located in Bida Local Government Area of Niger State, North Central Nigeria.

Approval for this study was obtained from the Ethical Review Committee of FMC, Bida. The sample collection was explained to the subjects using the information sheet

prepared by the researcher. Each subject was required to give a written informed consent before being eligible to participate in the study. The minimum sample size for this study was determined using the Fischer formula. (Fisheret al., 1998)

Subjects:

Five milliliters of whole blood was drawn from the median cubital vein of every volunteer into a plain tube, allowed to clot; specimen was processed into serum by room temperature centrifugation at 3000 revolution per minutes for 10 minutes and stored at -200c. The frozen serum were thawed at room temperatures for 45 mins. Enzyme Linked Immonosorbent Assay (ELISA) IgM DIA Source (KAPRCVG01) CMV IgM kit was used following manufacturer instruction. All samples that were IgM positive were tested for IgG Avidity to differentiate primary from non-primary CVM infection.

IgG Avidity ELISA

Principle of the Test

Measurement of CMV –specific IgG avidity has proved to be a powerful tool for distinguishing primary from non-primary CMV infection. Defined as the strength with which the IgG attaches to antigen .IgG avidity measures the length of time following primary infection. Thus IgG produced within the first few months following primary infection exhibits low avidity, whereas IgG produced several months or years exhibits high avidity. However detection of CMV –specific IgG of high avidity is actually more informative from clinical standpoint as the presence of high avidity IgG essentially excludes the possibility that infection occurred within the previous four months.

Description of Methods

Cytomegalovirus IgG avidity ELISA utilizes urea, an agent that disrupts hydrogen bonds, to differentiate low avidity from high avidity antibodies. Following attachment to immobilized antigen, low avidity IgG readily dissociates from the antigen in the presence of urea whereas high avidity IgG does not. Thus, avidity was assessed by performing duplicate sets of the routine ELISA for CMV-specific IgG. The only difference was that after the initial incubation, one set was washed with buffer containing urea and the other set was washed with buffer lacking urea.

The CMV –specific IgG signal (optical density) of the set washed with urea buffer was divided by the CMV-specific IgG signal of the set washed with non- urea buffer providing the avidity index (AI). Avidity Index values lesser or equal to 0.50 indicates low avidity, values of 0.51-0.59 indicate intermediate avidity and values equal or greater than 0.60 indicate high avidity.

Assay Procedure IgG ELISA

1. The required number of cavities was placed in the frame and a protocol sheet was prepared.
2. Samples were diluted 1:101, distributing ten microliter of sample into one milliliter of sample diluents.
3. One hundred microliters of each diluted sample and calibrators (0, 1, 2 and 3) were pipetted to the appropriate wells. One well was left for the substrate blank.
4. The micro plate was incubated for 45 mins at 370C.
5. The micro plate was aspirated and each well was washed four times for 30 seconds with washing solution manually using a dispenser. Blotted and dried by inverting plate on absorbent material.
6. One hundred microliters of each Enzyme –Labeled 2nd Antibody was added into each well.
7. The micro plate was incubated for 45 mins at 370C.
8. Each well was aspirated and washed four times for 30 seconds with washing solution manually using a dispenser. Blotted and dried by inverting plate on absorbent material.
9. One hundred microliters of TMB Chromatogen solution was added to each of the well using a dispenser.
10. Incubated for 15 mins at room temperature. Exposure to direct sunlight was avoided.
11. One hundred microliters of stop solution was added to each well using a dispenser.
12. The absorbance of the solution in the wells was read using a microplate reader set to 450 nm. If wavelength correction was necessary, the instrument was set to dual wavelength measurement at 450nm with background wavelength correction set at 600 or 620nm.

Note:

(i)  Avidity was assessed by performing duplicate sets of      the routine ELISA for CMV-specific IgG.

(ii) One set was washed with buffer containing urea and     the other set was washed with buffer lacking urea

Statistical Analysis

Generated data from the study was entered into and analysed with SPSS version 20.0. Data was summarized in frequency tables. Relationships and interactions among variables were determined using Chi-square crosstabs. Statistical significance tests were based on the 95 % Confidence Interval (CI), P value of less than 0.05.

RESULTS

Three hundred and eighty five (385) blood samples were collected among patients with HIV/AIDS on Highly Active Anti-Retroviral Therapy attending Anti-Retroviral Therapy clinic in Federal Medical Centre Bida.

The prevalence of CMV IgM study report among HIV subjects in Bida is presented in Table 1. Out of the total three hundred and eighty five (385) HIV seropositive subjects, 77(19.8%) were positive for anti-CMV IgM antibodies.

IgG Avidity Index and IgM relationship in the differential diagnosis of primary Cytomegalovirus infection from non-primary infection in HIV/AIDS subjects is presented in Table 2 .Out of the 77 IgM positive samples tested for IgG Avidity index, 12(15.6%) were high avid while 65(84.4%) were low avid . There was a significant difference (p= 0.001) between the prevalence of primary infection from non-primary infection with the use of IgG avidity index ELISA.

Discussion

The specific CMV IgM antibodies prevalence was found to be 77(19.8%), this prevalence reported in Bida was one of the highest reported among HIV patients in recent times compared to other reports in other developing countries. The prevalence of  9.52% was reported by Basawarajuet al., (2011) from HIV seropositive patients in Khammam  India, while Ojide et al., (2013) in Benin City reported 7.0%,  Musa et al., (2003) in  Kano reported 13.0% and Akinbami et al.,(2010) in Lagos reported 6.6%.  All reported a lower prevalence compared to our findings in Bida.

Out of the 77 IgM positive sample this study reported 65(84.4%) low avidity and 12(15.6%) high avidity among the subjects,  this agreed well with the report among pregnant women in Kenya (Mainngi and Nyamache, 2014) who reported 11 (20.37%) high avidity and 44(79.63) low avidity out of the 54 IgM positive women.

This study found a statistical difference (P=0.001) between IgG Avidity index and IgM levels for differential diagnosis of CMV primary from non-primary infection among HIV subjects in Bida. However, Chakravaritet al., (2009) observed that CMV active infection might be a marker of extremely severe immunosuppression, which may ultimately lead to fatal outcome in HIV patients and the presence of IgM antibodies may be due to primary infection, reactivation or re-infection by CMV.

Our study have convincingly demonstrates that measurement of CMV IgG avidity is both sensitive and specific method for identifying patients with recent primary CMV infection which is also a less expensive techniques compared to polymerase chain reaction (PCR) for confirmation. Low CMV IgG avidity is an accurate indicator of primary infection of CMV within the preceding 3-4 months while high avidity excludes primary infection (Prince and Nixon, 2014).

The utility of IgM avidity ELISA significantly reduced the prevalence of primary CMV infection with IgM ELISA in this study, in other words primary CMV infections by IgM

ELISA alone was significantly overestimated as only 84.4% CMV IgM are actually primary infection while the rest 15.4%  are non-primary infections.

In conclusion, CMV IgG avidity assay is an accessible method in the differential diagnosis of primary Cytomegalovirus from non-primary CMV infection in HIV patients , this technique is not expensive compared to the highly sophiscated Polymerase Chain Reaction it is highly recommended for use in the confirmation of primary CMV infection.

REFERENCES:

1. Akinbami, A.A, Akamu A.S., Adeyemo T.A., Wright K.O., Dada M.O and Dosunmu A.O. (2010).Cytomegalovirus antibodies Amongst Immunocompromised (HIV) patients at Lagos University Teaching Hospital (LUTH) Idi- Araba, Lagos. Journal of Medicine 11:151-154.
2. Basawaraju, A., Mane, P. M. and Vijayadurga, S. (2011). The reactivation of Cytomegalovirus infection in HIV infected patients. Journal of Clinical Diagnostic Research. 5(4): 749-751.
3. Bonalumi, S.; Trapanese, A.; Santamaria, A.; D’Emidio, L.; Mobili, L.(2011)
4. Cytomegalovirus infection in pregnancy: Review of the literature. J. Prenat. Med. 5, 1–8.
5. Charravarti, A., Kashyap, B. and Matlani, M. (2009). Cytomegalovirus infections; An Indian Perspective. Indian Journal of Medical Microbiology 27: 3-11.
6. Drobyski, W., Dume, W., Burd, E., Knox, K., Ash, R. and Horowitz, M. (1993). Human herpes virus 6 (HHV) Infection in allogeneic bone marrow suppressive role for HHV 6. Infectious Disease 167: 735-739.
7. Egger, S.M. Bade, R.U. (2000)Ender, S.G. Combination of microneutralization and avidity    assays: Improved diagnosis of recent primary human cytomegalovirus infection in single serum sample of second trimester pregnancy. J. Med. Virol.  60, 324–330.
8. Fisher, A. A., Lang J. E., Stoeekel, J. E. and Townsend, J. W. (1998). Handbook for family planning operations research design. Population council.Pp 117-118.
9. Helker, M., Qiu D., Martin M., Linder P., Irish W., Torre –Cisneros J.(2004). Continuous Cytomegalovirus sero-conversion in a large group of healthy blood donors. Voxsanguinis86: 41-44.
10. Hillyer, C. D., Snydman D. R. and Berkman E. M. (1990). The risk of Cytomegalovirus infection in Solid organ and bone marrow recipients. Transfusion.30:659-660.
11. Lazzarotto, T., Spezzacatena, P., Pradelli, P., Abate, D.A., Varani, S.,Landini, M.P (1997).
12. Avidity of immunoglobulin G directed against human cytomegalovirus during primary and secondary infections in immunocompetent and immunocompromised subjects. Clin. Diagn. Lab. Immunol. 4, 469–473.
13. Lazzarotto, T., Gabrielli, L., Lanari, M.; Guerra, B., Bellucci, T., Sassi, M.,Landini, M.P.(2004) Congenital cytomegalovirus infection: recent  advances in the diagnosis of maternal infection. Hum. Immunol.  65:  410–415.
14. Macher, A. M., Reichert C. M., Straus, S. E., Longo D. L., Parrilo J. and Lane H.C. (1983).Death in the AIDS patients: Role of  Cytomegalovirus. New England Journal of Medicine 309:14-54.
15. Manez, R., Kusne, S., Martin, M., Linden, P., Irish, W., Torre-Cisneros, J. (1993).The impact of blood transfusion on the occurrence of Pneumonitis in primary Cytomegalovirus infection after liver transplant. Transplantation 30: 594-597.
16. Maingi Z. and Nyamachi A.K. (2014). Seroprevalence of Cytomegalovirus (CMV) among pregnant women in Thuka, Kenya. BMC Research Notes 7:794- 798.
17. Musa, A.M., Taura D. W., Mukhtar M. D., Koki Y. A. and Adamu S. (2014). Studies on cytomegalovirus among HIV Positive Patients attending Infectious Disease Hospital, Kano State Nigeria. Greener Journal of Epidemiology and Public Health.2(1): 32-36.
18. Ojide, C. K., Kalu, E. I., Nwadike, V. U., Ogbaini-Emovon E. I. and Omoti, C. (2013). Seroprevalence of Cytomegalovirus among HIV– Infected Adult Patients on HAART. International Journal of Tropical Disease and Health 3 (3): 233-241.
19. Prince H.E and Nixon M.L (2014). Role of CMV IgG Avidity testing in diagnosing primary CMV infection during pregnancy .Clinical Vaccine Immunology .22(10); 1377- 1384.
20. Rowshani, AT., Bemelman F.J., Van-Leeuwen E.M., Van-Lier R.A. and TenBerge I.J. (2005). Clinical and immunologic aspects of Cytomegalovirus infection in solid organ transplant recipients. Transplantation79(4):381-386.
21. Vilibic-Cavlek, T.; Ljubin-Sternak, S.; Vojnovic, G.; Sviben, M.; Mlinar-Galinovic, G. The Role of IgG Avidity in Diagnosis of Cytomegalovirus Infection in Newborns and Infants. Coll. Antropol. 2012, 36, 297–300.
22. Zhang, L., Hanff, P., Rutherford, C., Chinchull, C. and Crumpacker, L.(1996). Detection of human Cytomegalovirus DNA, RNA and Antibodies in normal blood donors. Journal of Infectious Disease 171:1002-1006.

The post IgG Avidity Index in the Differential Diagnosis of Primary Cytomegalovirus Infection from Non- Primary Infection in HIV/AIDS Patients in Bida, Nigeria. appeared first on Nigerian Biomedical Science Journal.

Abdullahi Umar

Dermatology Unit, Department of Medicine, Ahmadu Bello University and Teaching Hospital, Zaria.

Adeiza Mukhtar Abdulmajid.

Infectious Disease Unit, Department of Medicine, Ahmadu Bello University and Teaching Hospital, Zaria.

Correspondences to: Dr. Abdullahi Umar, Department of Medicine P.M.B 06, Ahmadu Bello University Teaching Hospital, Shika-Zaria. Email: drumarabdallah@gmail.com

Abstract:

Key-words: *Neurofibromatosis type 1 *malignant peripheral nerve sheath tumours (MPNST) *Autosomal dominant disorder *Paraparesis

Introduction

Neurofibromatosis type 1 was first described by Frederic von Recklinghausen in 1882. It is a relatively common inherited disorder that affects about 1 in 2500 to 1 in 3000 people worldwide with no sex or ethnic variation (1).

Even though it is a benign tumour but malignant peripheral nerve sheath tumours (MPNST) may occur with an incidence of 0.16% in patients with neurofibromatosis type 1, compared to incidence of 0.001% in the general population (2,3). Patients are also at risk of developing other associated tumours such as; optic pathway glioma, glioblastoma, gastrointestinal stromal tumour, breast cancer, leukaemia, phaeochromocytoma etc.1.

Both the peripheral and central nervous system are affected in NF-1. Plexiform neurofibromas affects large nerves, plexi, spinal roots, sympathetic nerves, or small peripheral nerve fibres. This may results in pain and erosion of the neural foramen or cord compression at multiple levels (4).

In NF-1, the thorax and lungs can be affected in several ways such as cutaneous and subcutaneous neurofibromas on the chest wall, kyphoscoliosis, ribbon deformity of the ribs, Intrathoracic neoplasms and interstitial lung disease (5).

This case is reported because of the rarity of MPNST in

association with NF-1 presenting with Intrathoracic tumour and cord compression syndrome.

Case History:

A 33 year old woman with NF-1 on follow up at the neurology and plastic surgery clinic presented with a four months history of progressive paraparesis, associated numbness, paraesthesia and low back pain with no history of trauma to the back. She had associated history of both faecal and urinary incontinence but no history of headache, convulsions or loss of consciousness. There was no visual or hearing abnormalities and there was no family history of neurofibromatosis.

A month prior to presentation, she developed insidious onset of cough, productive of whitish mucoid, non-bloody sputum with associated right sided dull aching chest pain and progressive breathlessness with reduced exercise tolerance. There was no orthopnoea or Paroxysmal nocturnal dyspnoea, no leg swellings and no palpitations. No history of contact with a known open pulmonary tuberculosis case and was never treated for pulmonary tuberculosis before. She had history of high grade intermittent fever with chills and rigors noticed two weeks before presentation. There was no drenching night sweat but she had significant weight loss. No history of cigarette smoking or exposure to organic and inorganic dust. Review of gastrointestinal tract system essentially unremarkable. No family history of neurofibromatosis.

She was not diabetic or hypertensive and there was no risk factor for HIV infection and no previous exposure to ionizing radiation.

Physical examination revealed an acute on chronically ill-looking young woman in respiratory distress (tachypnoeic, oxygen saturation of 88% on room air). She was pale, not cyanosed and had no significant peripheral lymphadenopathy.Multiple cutaneous neurofibromas, cafe´-au-lait macules, and skinfold freckling with plexiform neurofibromas were seen. [Figure 1]

Her pulse rate was 120 per minute regular, full volume, blood pressure was 100/70mmHg supine with distended external jugular veins. Apex beat was displaced at 6th LICS lateral to mid-clavicular line, non-heaving and heart sounds were normal first and second with no murmurs. Respiratory rate was 32 cycles per minute with reduced chest movement on the right hemi thorax and trachea deviated to the left. Percussion note was stony dull over the right hemi thorax where breath sound was vesicular with reduced intensity. Coarse crepitations were heard over the left infra-clavicular and infra-axillary areas.

On examining the central nervous system she had spastic paraparesis with hypereflexia and ankle clonus. There was loss of sensation to both fine and crude touch and a sensory level at T4/T5. She has non tender hepatomegaly with no ascites.

Laboratory results showed normal blood sugar and electrolytes. HIV antibodies were negative and full blood count was normal. Pulmonary tuberculosis screen were negative (sputum AFB, gene xpert/RIF). Chest x-ray showed right sided pleural effusion with a mass on the right hemi thorax. Chest CT scan could not be done for financial reasons. Abdominal/chest ultrasound scan done showed hepatomegaly of 16.2cm with a well-defined right lower lung mass, right sided pleural effusion and anterior abdominal wall subcutaneous nodules. [Figure 2]

Diagnostic pleural fluid tap showed a haemorrhagic and exudative pleural effusion. A biopsy of the Intrathoracic mass was taken and histology report showed a cellular tumour growing in sheets with vague fascicular pattern, it was composed of markedly pleomorphic round to spindle cells including giant forms with oval to wavy nuclei, prominent nucleoli, coarse chromatin pattern and scanty to moderate cytoplasm. Mitoses (9p10hpf) and foci of necrosis were noted. The stroma was scanty to moderate and fibromyxoid. These findings were suggestive of malignant peripheral nerve sheath tumour (MPNST). [Figure 3] With these findings, a diagnosis of neurofibromatosis type 1 associated with malignant peripheral nerve sheath tumour of the thoracic spinal nerves was made complicated by a malignant pleural effusion and superior vena caval obstruction.

She had supplemental oxygen therapy and intercostal tube drainage of the effusion but died of progressive respiratory failure while awaiting the histology report.

Comment

Format of referencing 

Havard or APHA style?

Discussion:

Neurofibromatosis type 1 or von Recklinghausen?s disease is an autosomal dominant disorder of the ectoderm and mesoderm characterized mainly by the presence of neurofibromas, cafe-au-lait spots, and pigmented hamartomas in the iris (Lisch nodules) (6). According to national institute of health (NIH) consensus criteria for diagnosis of neurofibromatosis type 1 , Two or more of the following clinical features are sufficient toestablish a diagnosis of neurofibromatosis type 1:? Six or more cafe-au-lait macules (>0.5 cm at largestDiameter in a prepubertal child or >1.5 cm in post-pubertalIndividuals), ? Axillary freckling or freckling in inguinal regions, ? Two or more neurofibromas of any type or one or more plexiform neurofibromas, ? Two or more Lisch nodules (iris hamartomas), ? A distinctive osseous lesion (sphenoid wing dysplasia, long-bone dysplasia), ? an optic pathway glioma, ? A first-degree relative with neurofibromatosis type 1 diagnosed by the above criteria (1).

The NF-1 gene is located on chromosome 17q11 which functions as tumour suppressor gene and encodes for the protein Neurofibrin (6), which is predominantly expressed in neurons, Schwann cells and astrocytes.

Oncogenic mutations in Ras genes or inactivation of NF-1 gene leads to a permanentstimulation of a cascade of signals and excessive cell division, leading to the formation of tumours (7). The mutation of tumour suppressor NF-1 gene increases the risk for the development of other malignancies mainly derived from the neural crest such as malignant schwannoma, neurofibrosarcoma, intracranial glioma, and phaeochromocytoma in patients with NF-1 (6).

Malignant peripheral nerve sheath tumour (MPNST) as seen is this case is a rare and aggressive sarcoma that arises from the nerve sheath or shows features of nerve sheath differentiation, with an incidence of 0.001% in the general population as against incidence of 0.16% in patients with neurofibromatosis type 1 (2, 3).These tumours represent about 3?10% of all soft-tissue sarcomas, with majority of cases seen in individuals with neurofibromatosis type 1 (1). MPNST can arise anywhere within the body but more commonly seen in the extremities, head, and neck (2, 3). The index case had Intrathoracic and spinal involvement though in the literature, Intrathoracic MPNST is uncommon (8).

The cumulative lifetime risk of developing MPNST in a patient with NF-1 is about 8?13%9. The risk of developing this severe form of sarcoma is increased 20-fold in the area of an existing internal plexiform neurofibroma (1), which was noticed in this case.

Other risk factors for development of MPNST include previous radiation therapy which our patient has never had, and large germline mutations encompassing the entire NF1 gene (micro deletions) (1).

The index case met 4 of the 6 major diagnostic criteria for NF-1 though only 2 are needed namely; >6 cafe´ -au-lait macules, skinfold freckling, 1 plexiform neurofibromas and >2 cutaneous neurofibromas. She didn?t have osseous dysplasia, iris hamartomas and optic glioma. On the other hand, neurofibromatosis type 2 (NF-2) is characterized by bilateral vestibular schwannoma. Both conditions have high de novo mutation rates and carry a high risk of tumour formation, though NF-1 carries a higher risk of high-grade malignancy (10).

The median age for sporadic MPNST is between 30 and 60 years, and that for NF-1-associated MPNST is seen in much younger age group between 20 and 40 years (11), as seen in this case at 33 years.Patients with MPNST presents

with a rapidly enlarging mass that may be painful or cause local neurological symptoms such as weakness or paraesthesia. This case presented with progressive bilateral lower limb weakness that may be related to spinal cord compression by MPNST, but a dumb bell neurofibroma may also compress on the spinal nerves.

Exertional dyspnoea, cough and chest pain that may be related to the rapidly enlarging Intrathoracic tumour with pleural effusion, mediastinal shift and superior vena cava obstruction as shown in the above index case are obvious manifestations of Intrathoracic MPNST associated with NF-1.

Magnetic resonance imaging is considered the most useful imaging modality which helps to characterize the anatomical extent of the tumour for subsequent surgical intervention. Flourodeoxyglucose-positron emission tomography (FDG-PET) has been employed to differentiate between benign neurofibromas from MPNST in patients with NF-1, with relatively high specificity (12). However these advanced imaging modalities were not available or affordable in our centre.

Histology remains the most readily available diagnostic tool for MPNST, even though the histologic features may rather be non-specific (13). Histological features of MPNST may composed of monotonous spindle cells arranged in intersecting fascicles. Pleomorphic variants also exist as seen in the index case. Compared to benign neurofibromas, MPNST usually shows a marked increase in tumour cellularity, pleomorphism, and mitotic activity and have a more organized cellular growth pattern, with less extracellular matrix material (13).

The most effective treatment for MPNST requires complete surgical excision. Even with surgical excision, 5-year overall survival rates are poor and MPNST represents a substantial cause of mortality in individuals with NF-1 (1). Radiotherapy may delay recurrence but has little effect on long-term survival (14). Doxorubicin can be used as single-agent standard chemotherapy for soft tissue sarcoma in adults, but has a poor response rate of 12% (15). Furthermore, the presence of NF-1 is one of the most significant poor prognostic factors with use of chemotherapy against MPNST (16).

The late presentation of this case and the extensive nature of the disease at presentation contributed to the poor outcome.

References:

1. Angela C H, David H G. Neurofibromatosis type 1: a multidisciplinary approach to care. Lancet Neurol2014; 13: 83443.

2. Yamaguchi, U., Hasegawa, T., Hirose, T., Chuman, H., Kawai, A.et al. Low grade malignant peripheral nerve sheath tumour: varied cytological and histological patterns. J ClinPathol 2003; 56: 826?830.

3. Rekhi B, Abhijeet I, Rajiv K, Maria AD, Rajesh D, Nirmala A. J. Malignant peripheral nerve sheath tumors: Clinicopathological profile of 63 cases diagnosed at a tertiary cancer referral center in Mumbai, India. Indian J PatholMicrobiol. 2010; 53: 611-618.

The post Intrathoracic and spinal malignant peripheral Nerve sheath tumour in a Nigerian woman With Neurofibromatosis Type 1: a case report And review of literature. appeared first on Nigerian Biomedical Science Journal.

Daniel, L.A.

Principal Education Officer, Department of Biology, Government Science Secondary School, Kaltungo,Gombe State Nigeria

Kahya, S.S.

Department of Molecular Biology Root Crop Research Institute Vom, Plateau State Nigeria.

Lasekum, E.P.

Assistant Chief Medical Laboratory Scientist, School of Medical LaboratoryScience, Gombe State College of Health Sciences and Technology,Kaltungo.

Yaro, M.B.

Department of Biology, School of Sciences, College of Education Hong Adamawa State Nigeria

All correspondence to: elasekum@gmail.com

Abstracts

KEY WORDS: Prevalence, Urinary Schistosomiasis, Community, Shonge,Shongom, Gombe-Nigeria.

INTRODUCTION

Urinary Schistosomiasis is caused by Schistosoma haematobium whose intermediate host is the freshwater snail of the genus Bulinus(WHO, 2013).Usually called bilharzia which rank second to malaria in terms of socio-economic and public health significance in tropical and sub-tropical areas. It is the most prevalent of the water-borne diseases, with a very great risk on the health of rural populations (Biu et al., 2000). Previous studies on the incidence and surveys of Schistosomiasis in Nigeria, described the prevalence in some towns and communities varies between 32% to 98% according to Adewumiet al., (1990); Emejulu et al., (1994); Edungbola et al., (1998); Adeyeba and Ojeaga, (2002).The geographical distribution of the infection and of severe morbidity is restricted to specific areas. Several studies indicate that a lot of research work need to be carried out to determine new endemic areas and to harness the predictive potential of schistosomiasis to enhance cheaper community diagnosis and preventive measures(Mbata et. al., 2009). The disease transmission occurs where freshwater snail intermediate host, the genus Bulinus is present and where there is contact between the human population and infested water (Uwaezuoke, 2005). Subjects who lived close to bodies of water are more exposed and therefore, more vulnerable to Schistosoma haematobium infection than those who lived further from the water (Ugbomoiko, et al., 2010). A study conducted in Ebonyi state revealed that 235(26.8%) people were infected with Schistosoma haematobium (Chigozie, et al., 2007). A study conducted in Zuru, Kebbi State, Nigeria (Daniel 2001) reported that prevalence rate was highest in males (67.5%) and (52.2%) in females. Nale et al (2002) reported a prevalence rate 19.4% in males, which was significantly higher than prevalence observed in females 3.11%. A study of prevalence and intensity of urinary Schistosomiasis conducted in Bauchi, showed that infection rate were higher among children under 15 years than adult, and males (25.2%) had higher infection rate than females (21.2%) (Elekeh, 2006). In another study Biu et al., (2000) reported on the incidence of the disease in north-eastern Nigeria but there was little data available in Shonge area, Shongom Local Government Area.

This study was to investigate the prevalence of urinary tract Schistosomiasis in Shonge, Shongom Local Government Area, Nigeria, and to determine the predisposing factors of the disease, thus to identify methods of preventing and controlling the disease.

MATERIALS AND METHODS

The study was conducted in Shonge, Shongom Local Government Area, Gombe State -Nigeria, which comprises of three (3) communities-Burak, Bangunji and Kushi. The relief of the area provides uplands, hills and mountains that give rise to streams and vegetation of the savannah. It occupies a fertile land, which has much rainfall and used for agricultural purposes, several streams, ponds, and few earth dams mostly used for dry season farming. However, the streams overflow their banks during the rainy season and dries up during the dry season. The populace make use of streams, ponds and dams as their source of water for domestic purposes which as a result become infected and re-infected.

The General Hospital Kaltungo, Kaltungo LGA Gombe State, Nigeria approved the procedures for sample collection. The information on age, sex, community, occupation, and source of water supplies was obtained from the subjects.

A total of 300 urine samples comprising samples from adult males and adult femaleseach were collected randomly and examined from January to June 2015. The urine samples were collected in 50ml universal sample bottles between 10am and 2pm (WHO, 2003) and taken to General Hospital Kaltungo laboratory in a box of Ice pack for analysis within 1 hour. Each urine sample was observed for evidence of turbidity. Urinalysis was carried out with reagent strip meditest combi-9 manufactured by Machery-Nagel according to themanufacturer’s instructions to detect haematuria and proteinuria in the urine samplesand subsequent color change compared with the standard color scale provided by the manufacturer (Nnoruka, 2000).

The samples were analyzed by centrifugation and sedimentation techniques (WHO, 1991).Twenty milliliters (20ml)of urine samples were centrifuged for 2 minutes at 2000rpm and the deposit of each sample bottle collected while the other samples were allow to sediment for about 1hour. The deposit were separately examined microscopically with x10 and x40 objectives to identify Schistosoma haematobium ova or egg(s) which appears as golden yellowish and elliptical in shape with a terminal spine. The urine samples containing ova or egg(s) of Schistosoma haematobium and without eggs were recorded. The data obtained were analyzed using Chi-Square statistic.

Water reservoirs, streams and rivers were visited in all the three communities to search for intermediate host snails in these areas. Snails found were handpicked and put in small plastic bucket, transportedimmediately to the laboratory

anddissectedfor sporocystafter exposure to sunlight for about 3hours (Emejuluet al., 1994).

Results

The result of this study shows that out of the 300 urine samples examined from three wards in Shonge, Shongom LGA, Gombe State, the overall number of people infected with Schistosoma haematobiumeggs was 84 (28.0%)

The prevalence of Schistosoma haematobium in the urine samples among the communities, 100 urine samples were examined in each community. Table 1 indicates that Bangunji had the highest infection rate of 37 (12.3%) followed by Burak with rate of 30(10.0%) while Kushi 17 (6.0%) was found to be the least infected. Chi square analysis indicated that there was significant differencein infection betweenthe communities (p< 0.05).

Table 2 shows the prevalence of infections in relation to gender, which indicated that 58(19.3%) were males while 26(8.7%) were females and there was a significant difference in infection between sexes (p<0.05).

The highest prevalence rate of infection was recorded among subjects belonged to age group 30-35, 36(12.0%) years old, while the least rate of infection was observed in those within age bracket 40-above, 2(0.6%) years old. Others were 18-23 years old with prevalence rate 14 (4.7%), 24-29 years old had the prevalence infection rate

Table 1: Incidence of Schistosoma haematobium among Communities in the Study Area

Table 2: Prevalence of Urinary Schistosomiasis in relation to Gender

(66.7%) in age group 30-35 years old in males and females respectively (Table 3).

Table 4 showed the distribution of urinary schistosomiasis in relation to occupation which revealed that farmers 57(19.0%) were mostly infected by Housewives 18(6.0%).Civil servants 5(1.7%) and others 4(1.3%) who did not specified their occupations had the least incidence rate of infection due to Schistosoma haematobium. There wassignificant difference in infection between the inhabitant occupation (p<0.05).

The prevalence of infection in relation to sources of water supply (Table 5) indicated those that used Dam 42(14.0%)

Table 3: Distribution of Urinary Schistosomiasis among study subjects in relation to Age group

21(7.0%), 36-41 years old with 11(3.7%)years old (Table 3). Statistical analysis shows that there was significant difference in infection between age group (p <0.05).

The distribution of age group and gender among inhabitants of the study area shows that high infection rate (47.4%) was found in age group 36-41 years old and had the highest infection rate followed by those that used stream 40(13.3%) and Borehole 2(0.6%); those that used pipe borne had no infection. There was a significant difference in infection between sources of water supply (p<0.05).

Table 4: Urinary schistosomiasis among inhabitant in the study area in relation to occupation

Table 5: Urinary Schistosomiasis in relation to sources of Water Supply

Bangunji had (12.3%) infection rate this could be due to their closeness to streams and other water bodies that came from the highlands in the area. Subjects who lived close to bodies of water or irrigation canals were more exposed and therefore, more vulnerable to urinary schistosomiasis than those who lived further from the water (Ugbomoikoet al., 2010).

Infection rates in the area varied with their ages; age group 30-35 years had the highest incidence rate (12.3%). This age group formed part of the workforce in the study area which was farming. This might be associated with frequent water contact since ages engaged in activities that involve

Discussion and conclusion

The results of this research indicated Schistosomahaematobiuminfection was prevalent in the study area with an overall incidence rate(28.0%), males(19.3%) were more infected than females(8.7%), this result agrees with Naleet al., (2001) who reported a prevalence of 19.4% in males which was significantly higher than prevalence observed  in females (3.11%). The study supports a number of previous reports that have consistently shown Schistosoma heamatobium infection endemicity in Nigeria is on the increase particularly in rural areas (Okoli, et al., 2006).

Bangunji had (12.3%) infection rate this could be due to their closeness to streams and other water bodies that came from the highlands in the area. Subjects who lived close to bodies of water or irrigation canals were more exposed and therefore, more vulnerable to urinary schistosomiasis than those who lived further from the water (Ugbomoikoet al., 2010).

Infection rates in the area varied with their ages; age group 30-35 years had the highest incidence rate (12.3%). This age group formed part of the workforce in the study area which was farming. This might be associated with frequent water contact since ages engaged in activities that involve contact with water. Prevalence rate in age group 42-above (0.6%) was low in the study area this could be likely that they were ageing and would venture going near such water bodies to get infected with Schistosoma haematobium. The low prevalence in age people may be due to progressive increase in the level of natural acquired immunity against Schistosoma haematobiumless water contact (Dawetet al,.2012).The high incidence (47.4%) in age group 36-41 years (66.7%) in 30-35yeares were found in males and females respectively, this does not agree with (Ombugadu, 2012).

The occupation of the inhabitants of the three communities showed greater influence on the prevalence of infection, farmers and housewives had (19.0%) and (6.0%) respectively. This could partly be due to the constant exposure to contaminatedwater bodies on their farmlands at work or on their ways to farm as they cross the streams .Also housewives go out to fetch water and wash household utensils in the slow moving stream which might expose birth to infection withSchistosoma haematobium.This does not agree with Olusegunetal., (2011) who reported the heights prevalence of 0.7% in artisan which there was noinfections among household in HIV positive patient attending university of Benin teaching hospital Benin City Edo state, Nigeria.

The incident rate of e infection in civil servant study area was low (1.7%), The low infection rate among civil servant could associated with fact that neither go to farms nor streams because they have alternative means of livelihood. This contradicts (Pukumaet al., 2006) who reported a high prevalence 38.9% among civil servants or shelleng town Adamawa state, Nigeria.

Those that used stream (13.3%) were more infected, followed by those that used dam (14.0%) astheir sources of water supply, this could be that the inhabitant of the community used stream water and dam for domestic activities such as drinking and washing of pots and dishes or engaged in agricultural and recreational activities, thereby had contact with infested water bodies (Chigozieet al., 2007).

Conclusion

In conclusion, the study has indicated high prevalence of Schistosoma haematobium infection among the inhabitant in the study area. The high infection recorded could probably be due to reasons like unhealthy environment, socio-cultural practices, poverty, that the inhabitants in study area were ignorant of the mode of transmission of this disease and improper sanitation increase contamination of area and so infecting the available snail host.

The overall number of people infected with schistosomahaematobium ova was (28.0%) in the study area. Infection may be possibly higher because it was only a single sample obtained from each person and very light infections might have been missed. In a study (Engels, 1997) suggested duplicate samples on three or more days increase the chances of finding ova.

Prevention of Schistosoma haematobuimincludes basically the destruction of intermediate host snail; infective stage with molluscicides and larvicides respectively (Nwagu, 1998). The control of snail intermediate host would reduce the rate of transmission, thereby reduction in prevalence of infection in the study area. Subjects in the study area should be educated by the Local government health care workers on proper means of waste disposal, and construction of sanitary latrines in their homes so as to reduce the act of urinating or defecating in the open surroundings. The communities in the study area should embark on routine environmental sanitation.

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