Background: The magnitude of sickle cell nephropathy is high. Creatinine clearance is perhaps the best means to determine the severity of renal impairment in resource limited economies. With the various sources of errors inherent in the process of collecting timed urine for clearance studies, it is imperative to find alternative means of assessing the status of renal function. Predictive formulae have not been studied in Nigerians with sickle cell disease (SCD). Objective: To evaluate five commonly used predictive formulae to estimate glomerular filtration rate (GFR) in patients with sickle cell disease in the out-patient setting. Also to determine if any predictive formulae can be used in place of the measured value. Methods: Consecutive SCD patients, who attended the haematology outpatient clinic of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), were recruited into the study over a seven-month period. Those on medications that can interfere with renal function were excluded. Demographic details were collected and recorded. Blood and 24-hour urine samples were analyzed for serum and urinary creatinine, and creatinine clearance. The latter was compared with glomerular filtration rates estimated from five predictive formulae. Results: One hundred SCD patients (including 79 HbSS and 21 HbSC patients) were studied. The mean age was 26.2 ± 7.4 years and 54% were females. The highest agreement was between measured GFR and Cockcroft-Gault (CG) estimates (k = 0.50), followed by Mawer (k = 0.49), Hull (k = 0.26), Gates (k = 0.21) and MDRD (k = 0.02). Using the Bland-Altman technique, the Hull (mean = -15 ± 55) and MDRD (mean = -48 ± 61) formulae significantly underestimated GFR while the Mawer (mean = 8 ± 39) and CG (mean = -10 ± 39) formulae overestimated GFR. The Gates formula (mean = 0.6 ± 54) showed no difference with measured GFR. Conclusion: If we rely on the serum creatinine and the predictive formulae that are commonly in use, the status of renal function many patients with sickle cell disease will be inappropriately classified. However the CG formula may be used with the understanding of its limitation.

Background: Metabolic syndrome and hypothyroidism are independent risk factors for cardiovascular disease. The prevalence of each is rising exponentially. It is possible that patients with both disease entities may have a compounded risk especially considering the association of metabolic syndrome with plasma glucose levels and the intricate relationship between plasma glucose and thyroid function. Objective: The objective of this study is to examine the possible association between metabolic syndrome and thyroid function in industrial workers. Patients and Methods: A total of 93 subjects were recruited for this study. 48 had metabolic syndrome (using NCEP ATP III criteria) and formed the study group while 45 age- matched subjects were recruited into the control group. Basic demographic data, components of the metabolic syndrome, thyrotropin and free thyroxine were estimated for all subjects using standard methods. Appropriate statistics were used to analyze data. Results: Components of the metabolic syndrome and thyrotropin were significantly higher in the study group (P<0.05) while high density lipoprotein cholesterol and free thyroxine were significantly lower in the study group (P<0.05). 42 (87.5%) of the study group and 8 (18%) of the control group had sub-clinical hypothyroidism (high thyrotropin with normal free thyroxine (P<0.05). Women with metabolic syndrome are more associated with sub-clinical hypothyroidism (P=0.025) CI: 1.950-13.212). Conclusion: Sub-clinical hypothyroidism is significantly associated with metabolic syndrome in industrial workers. Females have an increased risk of this association. There may be an increased risk for cardiovascular disease and need for thyroid replacement therapy for this group of patients.

Background: For a country like Nigeria where conventional Pap smear is still the mainstay of screening for preneoplastic lesions of cervical cancer there is need to determine the diagnostic value of this technique for detecting HPV, the most important aetiological agent of this cancer. Materials and Methods: 300 women were subjected to conventional Pap smear with simultaneous sampling for E6 gene of HPV 16 and 18 by PCR, and the sensitivity, specificity and positive predictive value of Pap smear for detecting HPV infection (Low Grade Intraepithelial Lesions) determined. Results: Conventional Pap smear showed a sensitivity of 34.3%, specificity of 99.3% and positive predictive value of 85.7% (p <0.05). Conclusion: This study concludes that there is need for adoption of more sensitive methods such as liquid-based cytology and HPV testing for detecting early changes such as HPV infection in cervical epithelium in view of the low sensitivity of conventional Pap smear. This will help in better triaging of patients for follow-up.

Background: Human immunodeficiency virus (HIV) has become a worldwide pandemic with over sixty percent of those infected in sub Saharan Africa. African women are disproportionately affected compared to their counterpart in other parts of the world. Cervical cancer is one of the leading causes of death in sub Saharan Africa including Nigeria. This study was carried out to determine the prevalence of cervical abnormalities, to determine the frequencies of various types of cervical abnormalities and the relationship between types of abnormal smears and CD4 count in HIV positive women, in Lagos, Nigeria, Methods: This is a cross sectional case control study of HIV positive patients attending the Lagos University Teaching Hospital HIV/AIDS clinic. The control group comprises patients undergoing routine Pap smear in LUTH and St. Kizito's clinic, a missionary hospital in Lekki, Lagos. In all five hundred and ninety two women were included comprising 292 HIV positive women as case and 300 HIV negative women as control. Pap smear test and CD4 count were performed on the case group and HIV confirmation test on the control group. Results: The study found that there is a higher prevalence of squamous intraepithelial lesion among the HIV positive women compared with their HIV negative counterpart (20.2% vs 9.4%); also there is higher rate of human papillomavirus cytopathic effect among the HIV positive women (6.8% vs 3.7%). It was also observed that there is a decrease in abnormal smear pattern with high CD4 count (p<0.05). Conclusions: The study showed that there is a higher prevalence of abnormal cervical smears among the HIV positive women (HPW ) compared to the HIV negative women (HNW) and there is relationship between the CD4 count and abnormal cervical smear among the HPW. Pap smear should be incorporated into the management of HIV positive.

Aim: To report and analyze the results of a Pap Smear screening outreach programme organized in the Niger Delta region of Nigeria and compare these with other parts of the world. Methods: A one-day cervical cancer screening programme was organized in the Niger Delta region of Nigeria. Cervical smears were collected from voluntary participants after a short interview and sent to the Niger Delta University Teaching Hospital for analysis. Statistical analysis was performed for differences in proportion using the Chi square by SPSS version 16. Results: A total of 75 smears were collected and analyzed. The mean age of the participants was 35.99 years while the age range was 21-62 years. Three smears (4.0%) were unsatisfactory. Cervical smears were normal in 65 cases (86.7%) while 7 participants (9.4%) showed cervical squamous abnormalities with 2 cases (2.7%) diagnosed as ASCUS and 5 cases (6.7%) as LGSIL. Three (60.0%) participants with LGSIL were younger than 30 years old with the youngest being 21 years old. All cases of LGSIL showed evidence of the cytopathic effects of HPV. Conclusion: Pre-invasive cervical lesions and HPV infections occur very early and at high frequencies in some Nigerian populations. Therefore, well-organised cervical cancer screening programmes need to be established in order to reduce cervical cancer incidence and mortality.

A high burden of Hepatitis B and C (HBV and HCV) and Human Immunodeficiency Virus (HIV) infections exists in developing countries including Nigeria with wide variability in the prevalence of co-infection and clinical syndromes in various regions. The aim of this study is to determine the prevalence rate of these infections and coinfections among the blood donors at the Federal Medical Centre, Ido-Ekiti and to determine the more vulnerable age-group in this region. From July 2007 to July 2009, 662 donors were studied. Blood samples taken from the donors were screened for HIV and HCV antibodies by double ELISA technique, and for HbsAg by ELISA technique. Data entry and processing were done using EPI-INFO version 6 and SPSS version 15. Data were compared using 2-tailed chi-square test and Yates correction or Fisher exact test when applicable. Probability value less than 0.05 was considered significant. Overall, 7.9% of the donors were sero-positive for HbsAg, 7.3% for HCV antibody and 5% for HIV antibody. Co-infection rate of HIV/HCV was 1.1%, HIV/HBV was 1.2%, HBV/HCV was 2.1% and HIV/HBV/HCV was 0.6%. The age-group 20-30 years had the highest prevalence for HCV (17.9%), HBV/HCV co-infection (2.4%) and HIV/HBV/HCV infection (1.2%). Up to 57.6% of HIV infected blood donors have co-infection with either HBV or HCV or both. This study detected a high prevalence rate of HBV, HCV and HIV infections among blood donors in Ido Ekiti. All co-infections were detected at lower rates compared to single infections. The age-group 20-30 years were the most vulnerable group to these infections. A high percentage of HIV sero-positive donors had other co-infections. Adequate screening of blood donors and widespread awareness programmes on these infections especially among the youth as well as immunization against HBV are important in curtailing these infections. Follow-up incidence study in this field is recommended.

Objectives: Several studies have related deficient plasma levels of fat-soluble vitamins to increased prevalence of metabolic syndrome and suggested that optimal levels may reduce the risk and progression of metabolic syndrome. This study was designed to assess the plasma concentrations of vitamins A, D and E in Nigerians with metabolic syndrome. Materials and Methods: One hundred metabolic syndrome subjects were recruited into the study; 55% of them had type 2 diabetes. One hundred controls were ageand sex-matched. Blood pressure, body mass index, waist circumference, concentrations of plasma glucose, lipid profile, vitamins A, D and E were estimated. Results: The mean plasma vitamin E of metabolic syndrome subjects was significantly lower than that of controls (P=0.0001) and also lower in subjects with diabetes than in those without diabetes (P=0.006). The mean plasma vitamins A and D of subjects were similar to that of controls (P=0.231 and 0.391 respectively) and also similar in subjects with and without diabetes (P=0.134 and 0.061 respectively). Mean values of vitamins A, D and E in subjects and vitamins A and D in controls were suboptimal. Conclusion: Plasma vitamin E was lower in subjects with metabolic syndrome than in controls, and vitamins A and D were similar but suboptimal in both groups. This may be due to inadequate vitamin intake, increased oxidative stress and inflammation among other factors.

Malignant fibrous histiocytoma or undifferentiated high grade pleomorphic sarcoma is a rare tumour of the spermatic cord. It presents as a painless swelling in the inguinal canal which is usually difficult to diagnose. The prognosis is poor if not detected early and treated promptly, therefore physicians need to be on the lookout for this tumour in any inguinal swelling in adults in the fifty years and above age group. We hereby present a case of a 53 year old man that was never diagnosed to have this tumour until autopsy.