Amos Dangana

Randomized Clinical Trials on Breast Cancer in Nigeria and Other Developing Countries: Challenges and Constraints

Worldwide, breast cancer is the commonest cancer among women, and its incidence is rising exponentially particularly in developing countries. Compared with Caucasian women, women in developing countries experience a disproportionate burden of aggressive Triple Negative Breast Cancer for reasons that remain unknown and understudied. There is a high incidence of late stage presentation, low level of public awareness of the disease, suboptimal health infrastructure, lack of universal access to affordable interventions and poor prognosis.

Phenotypic profile of pulmonary aspergillosis and associated cellular immunity among people living with human immunodeficiency virus in Maiduguri, Nigeria

Objective: Aspergillus causes many forms of pulmonary infectious diseases ranging from colonization (noninvasive) to invasive aspergillosis. This largely depends on the underlying hosts lung health and immune status. Pulmonary aspergillosis (PA), especially the invasive form, occurs as opportunistic to human immunodeficiency virus (HIV) as a result of cluster of differentiation (CD)4+ lymphopenia. The majority of patients with comorbid HIV and aspergillosis go undiagnosed. This study aimed to isolate, identify the etiologies, and determine the prevalence of PA among HIV-infected persons with a productive cough (at least <2 weeks) at the HIV Clinics of the University of Maiduguri Teaching Hospital, Nigeria. Materials and Methods: After ethical approval, three consecutive early morning sputum samples were collected from patients with negative tuberculosis results. The samples were individually inoculated onto Sabouraud dextrose agar supplemented with chloramphenicol and cycloheximide in duplicate for 7 days at 37°C and 25°C, respectively. The fungal isolates were examined morphologically and microscopically and identified using the standard biochemical reagents. CD4+ cell counts were performed using flow cytometry. Self-administered questionnaires were used to assess the patients data. All patients were antiretroviral naïve. Results: The prevalence of PA was 12.7% in these 150 patients. Of the 19 fungal culture-positive individuals, Aspergillus fumigatus accounted for the highest proportion of the isolates (8, 42.1%) followed by Aspergillus niger (5, 26.3%), Aspergillus flavus (4, 21.1%), and Aspergillus terreus (2, 10.5%). Based on the assessment of functionality of cellular immunity, HIV participants who were negative for PA (131/150) had significantly higher mean ± standard deviation CD4 T-cell counts (245.65 ± 178.32 cells/mL) than those with aspergillosis (126.13 ± 105.27 cells/mL) (P = 0.0051). PA was relatively highest among patients with CD4+ cell counts <200 cells/mL (12. 34.3%) followed by those with CD4+ cell counts between 200 and 350 cells/mL (5, 9.6%) and least among those with CD4+ cell counts >350 cells/mL (2, 3.2%). The Chi-square test showed a significant association between the prevalence of PA and the CD4+ cell count, age, and gender (P < 0.05) but not with occupation or education level (P > 0.05). Conclusion: The findings from this study indicate that Aspergillus spp. is a significant etiology of acute productive cough in people living with HIV and this is related to the CD4+ cell count of coinfected persons.

Seroprevalence of acute hepatitis C virus infection among mortuary workers and ambulance drivers in Plateau State, Nigeria

Nigeria is one of the countries highly endemic for viral hepatitis. However, data on the prevalence of hepatitis C virus (HCV) infection among mortuary workers and ambulance drivers has not been documented. Hence, this study sought to determine the seroprevalence of HCV among mortuary workers and ambulance drivers in Plateau State, North Central Nigeria. Between December 2015 and February 2016, a total of 80 blood samples were collected from mortuary workers and ambulance drivers with the view to test for HCV antibody using rapid immunochromatographic test (ICT) and enzyme-linked immunosorbent assay for anti-HCV immunoglobulin M. Three milliliter of blood was collected from each patient and the serum was separated out and used for the screening. A self-administered questionnaire was used to access the patients’ sociodemographic variables. Of the 80 samples analyzed, five (6.3%) were positive for HCV using the rapid immunochromatographic assay, while two (2.5%) were positive for anti-HCV immunoglobulin M. There was no statistical association between seroprevalence of HCV with age and sex of patients. However, the seroprevalence of HCV was significantly associated with contact with blood, number of sexual partners, use of gloves, and history of sexually transmitted infections (P<0.05). The HCV seroprevalence of 2.5% among mortuary workers and ambulance drivers was relatively low; however, this suggests that the patients are at-risk group for occupational infection due to HCV.

Fetal hemoglobin gene expression in patients with sickle cell disease in North Central Nigeria

BACKGROUND: Fetal hemoglobin (HbF) plays a dominant role in ameliorating morbidity and mortality associated with sickle cell disease (SCD). OBJECTIVE: This study evaluated the distribution pattern of HbF and total Hb concentration among 75 participants with homozygous sickle cell trait (HbSHbS) as test cases and 71 with homozygous normal trait (HbAHbA) as controls. MATERIALS AND METHODS: Ethylenediaminetetraacetic acid-anticoagulated blood samples were collected from all participants. They were tested for HbF and HbA fractions using high-performance liquid chromatography, while total Hb concentration was determined by cynomethemoglobin technique. RESULTS: Participants with HbSHbS genotype showed mean ± standard error of mean (SEM) of HbF levels of 6.5 ± 0.8%, HbA1 showed mean ± SEM of 2.6 ± 0.3%, and HbA2 showed mean ± SEM of 4.9 ± 0.1%. Those with HbAHbA (control participants) genotype showed mean ± SEM of HbF levels of 0.5 ± 0.04%, HbA1 showed mean ± SEM of 87.3 ± 0.4%, and HbA2 showed mean ± SEM of 3.2 ± 0.1%, while the mean ± SEM Hb concentration of test cases was 6.5 ± 0.16 g/dl and that of controls was 12.32 ± 0.13 g/dl. The total Hb concentration of sickle cell patients was significantly lower than that of nonsickle cell patients. There was a positive correlation of Hb concentration (g/dl) with HbSHbS gene expression. CONCLUSION: Findings from this study revealed that the lesser episodes of sickle cell crisis, the lower the HbF expression and higher the total Hb concentration. Hence, it is recommended that the determination of HbF, HbA1, and HbA2 levels be considered in conjunction with other routine complete blood count and hematology tests in the diagnosis and clinical management of SCD.

Dengue virus non-structural Protein-1 expression and associated risk factors among febrile Patients attending University of Abuja Teaching Hospital, Nigeria

BACKGROUND Dengue is a mosquito-borne and neglected tropical viral disease that has been reported to be hyper-endemic in Nigeria. However, this is the first dengue study in Abuja. OBJECTIVE This hospital-based cross-sectional study investigated the prevalence of Dengue virus (DENV) non-structural protein-1 (NS1) antigenaemia, anti-Dengue virus IgG and their associated risk factors among febrile patients attending the University of Abuja Teaching Hospital (UATH), Nigeria. MATERIALS AND METHODS From May to August 2016, blood samples were individually collected from 171 consented participants. These samples were analyzed using DENV NS1 and anti-DENV IgG Enzyme Linked Immunosorbent Assay (ELISA) kits. Well-structured questionnaires was used to collect sociodemographic variables of participants. RESULTS Out of the 171 participants, the prevalence of Dengue virus NS1 antigenaemia and IgG seropositivity were 8.8% and 43.3%, respectively. Three (1.8%) of the patients were NS1 (+) IgG (-), 12 (7.0%) had NS1 (+) IgG (+), 62 (36.3%) were NS1 (-) IgG (+), while 97 (56.7%) of the remaining patients were NS1 (-) IgG (-). There was statistical association between DENV NS1 antigenaemia with age of patients (p=0.034), residence in proximity to waste dumpsites (p<0.0001) but not with occupation of patients (p=0.166), use of indoor insecticide sprays (p=0.4910) and presence of household artificial water containers (p=0.3650). There was statistical association between the prevalence of anti-Dengue virus IgG with occupation (p=0.0034) and education level of patients (p<0.001). However, there was no statistical association between the prevalence of anti-Dengue virus IgG with gender (p=0.4060) and residential area of patients (p=0.3896). CONCLUSION Findings from this study revealed that DENV infection is one of the etiological agents of acute febrile illnesses in Abuja. Its recommended that Dengue testing be considered during differential diagnosis of febrile patients.

Hematological Changes Associated with Illicit Drug Abuse in A City of Northern Nigeria: Dangana A et al. Haematological effects of illicit drug abuse

BACKGROUND AND OBJECTIVE: Several illicit drugs have been linked to derangement of many hematological indices which can lead to host tissues and / or organs dysfunctions.The purpose of this study was to determine the effects of different psychoactive substances on hematological parameters of study subjects. METHOD: The study included 200 substance abusers and 50 non-substance abusers comprising of 235 males and 15 females. All subjects were investigated routinely using hematological tests and urine toxicology parameters to assess the effects of psychoactive substance use. These subjects were grouped according to type of drug, and duration of substances they abuse. An association between urine toxicology results and changes in hematological parameters was evaluated for statistical significance. RESULTS: There was statistical association between the number of substances abused with gender (p = 0.0169) but not with age of subjects (p = 0.9639). Findings from this study showed significant difference between certain hematological parameters of non-substance users (NSU) and specific groups of substance abusers. The packed cell volume and eosinophil counts were significantly higher in substance abusers with increase in number of drug abuse compared to NSU (p = 0.02 and p = 0.0008 respectively). There was no statistically significant correlation between duration of substance abuse and hematological parameters studied. CONCLUSION: Illicit substance abuse predisposes individuals to eosinophilia and relative increase in PCV. There is a need to promote awareness on the health related effects associated with illicit substance abuse.

Effects of adopting preventive measures on malaria parasitemia among pregnant women in Kaduna state, Nigeria

Background There are several malaria preventive measures. The availability of a particular method does not guarantee its adherence and effective usage. This eventually may not provide the desired results for the fight against malaria. Pregnant women are at higher risk of contracting malaria, and therefore it is necessary that they should be protected against the infection. Objective of the study This cross-sectional study investigated the significant roles of various preventive measures against malaria infection among pregnant women attending four selected secondary health facilities in Kaduna state, Nigeria. Materials and methods Blood samples were collected from 353 pregnant women attending selected hospitals. Malaria parasite microscopy was conducted on the basis of standard protocols. Structured questionnaires were used to obtain data with regard to subject knowledge and practice of preventive measures against malaria. Results Out of the 353 subjects tested, 79 (22.4%) had malaria parasitaemia. One hundred and fifteen (32.6%) subjects used no preventive measure, 45 (12.7%) used sulfadoxine-pyrimethamine prophylaxis, 53 (15.0%) used insecticide treated nets (ITNs), 72 (20.4%) used indoor insecticide house spray, while 68 (19.3%) used > 1 preventive measures. Out of the 79 subjects infected with malaria, 57 (72.2%) do not know how to prevent malaria, while 22 (27.8%) had prior knowledge of malaria prevention. Highest cases (41 [51.9%]) of malaria parasitaemia were recorded in women with no knowledge of preventive measures during pregnancy, while women who used > 1 measures have the least cases (5 [6.3%]) of malaria parasitaemia. There was statistical association between the use of preventive measures and decreased malaria parasitaemia (P < 0.0001). Conclusion Findings from this study revealed that there is need for more sensitization campaigns on available malaria preventive measures. Also, the combination of preventive methods should be considered by pregnant women in order to minimize their chances of acquiring malaria.