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Papers by Taiwo Kotila

Research paper thumbnail of Therapeutic Plasma Exchange in the Management of Myasthenia Crisis in a Resource Poor Setting

International journal of healthcare and medical sciences, May 20, 2019

BACKGROUND: Therapeutic Plasma Exchange (TPE) is an apheresis treatment in which the plasma compo... more BACKGROUND: Therapeutic Plasma Exchange (TPE) is an apheresis treatment in which the plasma component of blood is removed and replaced with supplemental fluids. It is an immunomodulatory treatment that has been reported to be a successful therapeutic procedure for the treatment of severely compromised patients with myasthenia gravis when given at short intervals. TPE is known to have a comparable efficacy to intravenous immunoglobulin (IVIG) in the treatments of patients with moderate to severe myasthenia crisis. METHODOLOGY: We report a case of a 47year old male patient with severe myasthenia crisis. He was managed using cobe spectra version 6.1 to carry out an automated TPE, with a suboptimal response and subsequent use of IVIG resulting in full recovery. This report highlights the possible factors that may hinder optimal response of a patient with Myasthenia crisis to TPE procedure in a poor resource setting. CONCLUSION: TPE is an essential immunomodulatory therapy in the management of acute myasthenia crisis whether given alone or in combination with immunosuppressive drugs. There can be a rebound overproduction of the offending autoantibodies in MG following TPE which can be cleared from circulation using immunosuppressive therapy.

Research paper thumbnail of Phenotypic and genotypic expression of alpha thalassaemia in Ibadan, Nigeria

PubMed, Sep 1, 2012

Background: Alpha thalassaemia is a common monogenic disorder found in most parts of the world bu... more Background: Alpha thalassaemia is a common monogenic disorder found in most parts of the world but the severe form is restricted in its distribution while the mild deletional form of alpha- thalassaemia has a wider geographical distribution. Methods: One hundred and fifty one Nigerians which included 29 patients with unexplained recurrent haemolytic anaemia had their a-thalassaemia status determined by gap PCR after being screened using red cell indices. Results: Only the -alpha(3.7) deletion occurs among Nigerians with a gene frequency of 0.21. Forty-two per cent of the study population are heterozygotes, 9% are homozygotes while 49% are normal for this deletion. The mean haematocrit for the study population is 37.5%: homozygote, heterozygotes and normal subjects had a mean haematocrit of 37.3%, 37.5% and 37.7% respectively. The mean mean corpuscular haemoglobin (MCH) and haematocrit are significantly lower for patients than controls (24 +/- 2.9 pg vs. 26.6 +/- 2.5 pg (p = .000), 29% vs. 40% (p = .000) respectively). Forty three percent of both patients and controls had MCH of less than 27 pg but only 10% of patients had MCH that is greater than 27pg. Homozygote patients had a higher mean haematocrit than patients who are normal for the deletion (34.7% vs. 25.4%, p = 0.06) but homozygote patients had a lower mean haematocrit than homozygote controls (34.7% vs. 38.5%, p = 0.4). Conclusion: This would suggest that alpha-thalassaemia is not responsible for the recurrent haemolytic anaemia observed in these patients and that the high prevalence of microcytosis among the normal populace needs further exploration.

Research paper thumbnail of Assessment Of Immunoglobulin Levels In The Cause Of False Pass Rate In The Use Of Copper Sulphate (CuSO ) 4 As Pre-donation Screening Test

Tropical Journal of Health Sciences, 2013

Click on the link to view the abstract. The Tropical Journal of Health Sciences Vol 20 No 2 (July... more Click on the link to view the abstract. The Tropical Journal of Health Sciences Vol 20 No 2 (July 2013)

Research paper thumbnail of Automated techniques in haematology

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, Sep 15, 2006

Research paper thumbnail of When the inheritance of two heterozygote state become a diagnostic problem: Misdiagnosis of the sickle cell trait

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, Aug 23, 2007

Research paper thumbnail of Guidelines for teh diagnosis of the haemoglobinopathies in Nigeria

Annals of Ibadan postgraduate medicine, Feb 28, 2011

Research paper thumbnail of The pregnant Rhesus negative Nigerian woman

Nigerian Postgraduate Medical Journal

Alloimmunisation to Rhesus D (RhD) is a major factor in perinatal morbidity and may result in the... more Alloimmunisation to Rhesus D (RhD) is a major factor in perinatal morbidity and may result in the compromise of the woman's obstetric career. In Nigeria accurate population based studies to determine the prevalence of Rhesus negative women and the incidence of alloimmunisation are lacking, hence we undertook to study pregnancy outcome in Rhesus negative women. We studied retrospectively sixty-seven RhD negative women over a two year period; information was obtained from the case-file of all pregnant women who presented to the ante-natal clinic and were identified as Rhesus negative. This was corroborated with the blood bank record over the same period. Forty per cent of these were nulliparae with an average of 0.5 abortions. Only 20% had the blood groups of their husbands documented, and only four babies born to these women had their Rhesus group recorded. Six of the babies appeared to have been severely affected by Rhesus isoimmunisation. Three of these had an exchange blood transfusion (EBT); all who had an EBT had a satisfactory outcome. Out of the other three, there were two neonatal deaths and one fresh stillbirth. Fourteen babies had neonatal jaundice with a mean bilirubin level of 6 mg/dl, all of which were mainly unconjugated. Evidence for the administration of anti D was obtained in only three patients; all had one ampoule (dose in i.u and/or _g not stated) administered within 72 hr. This preliminary study has shown that isoimmunisation due to Rhesus incompatibility is poorly studied among Nigerian women with many questions unanswered; therefore there is an urgent need for a management protocol for this condition, which will include both the clinicians and the laboratory physicians.

Research paper thumbnail of Hypereosinophilic syndrome with severe hypokalaemia in a Nigerian woman: A case report

Nigerian Journal of Medicine

Introduction Hypereosinophilic syndrome (HES) is a rare disorder. It is defined as eosinophilia o... more Introduction Hypereosinophilic syndrome (HES) is a rare disorder. It is defined as eosinophilia of greater than1.5x109 /L persisting for at least 6 months or death before 6 months without an identifiable cause and with eosinophil-mediated organ dysfunction. We present a rare case of hypereosinophilic syndrome with severe hypokalaemia in a Nigerian female patient. Case Presentation A 43year old food vendor referred to the Haematology Department, University College Hospital, Ibadan on account of a 6-week history of cough productive of mucoid, brownish, foul smelling sputum with associated breathlessness, high grade intermittent fever, and intense pruritus. She had accompanying non-projectile,non-bloody vomiting of recently ingested meals. There was absolute eosinophilia of 83x109/L and bone marrow cytology revealed marked eosinophilia with blasts of less than 5%. She also had asymptomatic severe hypokalaemia (1.9mmol/l) likely due to vomiting and reduced dietary intake. The aetiology of the hypereosinophilia could not be ascertained.She was admitted and commenced on intranasal oxygen, Tabs Loratidine, intravenous hydration.The severe hypokalaemia was corrected with IV KCL over 48hours followed with the administration of slow K tablets 600mg tds. She also had tabs Hydroxyurea for cytoreduction and Allopurinol to prevent hyperuricaemia. She improved with the above line of management. Conclusion This appears to be the first reported case of HES with asymptomatic severe hypokalaemia in the literature. Being a rare disorder it could easily have been missed without a review of the peripheral blood film and marrow aspirate. This finding suggests a possible relationship between hypereosinophilia and hypokalemia which needs to be explored.

Research paper thumbnail of Pattern of Haemoglobin Phenotypes and the Clinical Identity of Clients Tested at a Private Diagnostic Center in South-West Nigeria

West Africa Journal of Medicine

Background: Haemoglobinopathies are diseases of global importance and the countries with high dis... more Background: Haemoglobinopathies are diseases of global importance and the countries with high disease burdens have inaccurate national data on the incidence of the various haemoglobin (Hb) phenotypes. Objective: To review the Hb phenotype distribution, the referral identity of patients, and the clinical reasons for phenotyping. Methods: A retrospective descriptive study conducted at a private diagnostic laboratory in Lagos, South-West, Nigeria. The anonymous results of Hb phenotypes of the patients determined using gel electrophoresis were retrieved from the laboratory information system (LIS). Results: There were 942 patients: 519(55.1%) males and 423(44.9%) females with median ages 30yrs (11months-89yrs) vs 27yrs (9months-89yrs), p=0.0018. The phenotypes were HbAA, 592(63.2%); HbAS(26.4%); HbSS(7.1%); HbAC(2.1%), HbSC(0.7%) and HbCC(0.4%). Of the total, 757(80.4%) were referred by health care providers and 185(19.6%) were selfreferred, and there was no association between gender a...

Research paper thumbnail of Good practice statements for antithrombotic therapy in the management of COVID‐19: Guidance from the SSC of the ISTH

Journal of Thrombosis and Haemostasis

Research paper thumbnail of Pain management in sickle cell disease: What remedy to reduce the risk of opioid abuse?

African Journal of Anaesthesia and Intensive Care, 2015

Sickle cell disease is an inherited disorder, the hallmark of which is recurrent acute painful cr... more Sickle cell disease is an inherited disorder, the hallmark of which is recurrent acute painful crises requiring opioid therapy. These acute painful episodes when superimposed on chronic pain could last for years especially in association with comorbidities like osteonecrosis, chronic leg ulcers, cholelithiasis or stuttering priapism. The need for adequate pain control in such patients should therefore be balanced to avoid opioid dependence. The treatment of superimposed acute pain with opioid in a patient with background chronic pain makes pain control a challenge. This is because the comorbidities responsible for the chronic pain are often associated with a depressive state because of limited treatment options for some of these comorbidities. Abuse of opioid by a patient with chronic pain raises the possibility of pseudoaddiction. However, abuse of opioid is not limited to patients with chronic pain or acute on chronic pain, it has also being observed in patients without chronic pain. It is necessary to decide on drugs that may adequately control chronic pain on a long term with minimal side effects; the newer drugs on the horizon which are targeted towards sickle cell disease are therefore possible viable options. Keywords: Opioid, addiction, sickle cell pain, chronic pain, psychosocial, targeted therapy

Research paper thumbnail of C0301: Antithrombin Activity in Patients with Venous Thrombo-Embolism in an African Population

Thrombosis Research, 2014

Research paper thumbnail of A revisit of venous thromboembolism

African journal of medicine and medical sciences, 2013

To determine the effect of the introduction of Doppler ultrasonography to the management of venou... more To determine the effect of the introduction of Doppler ultrasonography to the management of venous thromboembolism in a health care facility in Nigeria. A descriptive study of cases of venous thromboembolism (VTE) over a five year period (March 2007-February 2012) was compared with a five year review done two decades ago before the introduction of Doppler ultrasonography. This review showed an increase of VTE cases from 60 to 178 with a median age of 53 yrs, median age of female patients was 5 yrs younger than male patients with Male/female ratio of 1:1.2. There was an even distribution of patients seen over the five year period with a mean prevalence of 35.6 patients per year. Patients with distal deep vein thrombosis (DVT) were in the majority (76%) compared with proximal DVT and PE which were 21% Vs 3%. About 4% of the patients had a recurrence of the VTE with male patients having twice the likelihood of a re-thrombosis. Common comorbid states observed are cerebrovascular disease...

Research paper thumbnail of Betke's and elution methods in estimation of haemoglobin F in sickle cell anaemia

East African medical journal, 2000

To compare the effect of the type of spectrophotometer and method used in the estimation of HbF. ... more To compare the effect of the type of spectrophotometer and method used in the estimation of HbF. Two sets of experiments were done. In the first set, paired blood samples were obtained from 28 adult sickle cell anaemia subjects. One of each pair of samples was analysed for HbF by Betke's method and the other by the elution method and the values obtained were compared. In the second set of experiments, ten other paired samples were analysed for HbF, one using an analogue spectrophotometer and the other using a digital spectrophotometer and the results compared. Adult sickle cell clinic, University College Hospital, Ibadan, Nigeria. Thirty eight sickle cell anaemia patients. HbF levels estimated by the two methods showed good agreement as estimated by the Bland-Altman plot. HbF levels obtained by Betke's method correlated well with those obtained by the elution method (r = 0.59, p = 0.0015) and the mean values were similar (14.9% versus 13.5%, p=0.215). The values obtained by ...

Research paper thumbnail of Earliest presenting sign and morbidity profile of sickle cell disease patients attending the adult SCD clinic at the UCH Ibadan, Nigeria

The Central African journal of medicine, 2001

Research paper thumbnail of Venous thromboembolism in Ibadan: A five year experience (1986-1990)

Nigerian Quarterly Journal of Hospital Medicine, 2008

Research paper thumbnail of Hodgkin's disease after treatment for Burkitt's lymphoma: case report

East African Medical Journal, 2001

Hodgkin's disease and non-Hodgkin's lymphomas are interrelated disorders which have been reported... more Hodgkin's disease and non-Hodgkin's lymphomas are interrelated disorders which have been reported to occur either simultaneously or sequentially in the same patient. We report here the development of nodular sclerosing type Hodgkin's disease in a patient two decades after successful treatment for Burkitt's lymphoma with cyclophosphomide and abdominal resection (AR). White the onset of symptoms after treatment for Burkitt's lymphoma was seven years definitive diagnosis of Hodgkin's disease was only made 22 years after the initial diagnosisof Burkitt's lymphoma. The recurrentandsolitarynatureof thelymphadenopathy and the fact that it was initially reported as reactive hyperplasia is typical of nodular lymphocyte predominant Hodgkin's disease. We believe that there was a transitor"'-period of the malignancy as nodular lymphocyte predominant Hodgkin's disease.

Research paper thumbnail of Survival advantage in female patients with sickle cell anaemia

East African Medical Journal, 2001

Research paper thumbnail of Audit of the red cell units supply of a busy hospital blood bank in Nigeria

Nigerian Journal of Clinical Practice, Jun 1, 2009

Background/objective: Blood bank audit embraces all procedures from blood procurement to the long... more Background/objective: Blood bank audit embraces all procedures from blood procurement to the long -term consequences of transfusion which helps to identify opportunities for improvement. We have therefore looked at red cell transfusion in our hospital to identify areas that will require improvement. Method: Data was collected retrospectively from the hard copy record of the blood bank for a period of one month. Results: Request was made for 1210 red cell units; crossmatch was made for 64% of the request. All units crossmatched were issued, of these 4.15% were returned unutilized. 5.1% were issued as uncrossmatched. The Obstetrics/Gynaecology unit recorded the highest blood usage and the medical unit the least. The use of blood by the emergency and paediatric were the same. The crossmatch:transfusion ratio for the hospital was 0.9:1. This study has shown that the crossmatch and transfusion rates are almost equal and only a small percentage was returned unused. Conclusion: This showed that there is inadequate supply of blood. There is a need to assess the reason for transfusion and establishing a blood transfusion advisory committee by the hospital. This will ensure interaction and collaboration between blood suppliers and users to improve the quality of transfusion practice. The new policy establishing a national transfusion service will also improve the transfusion service but emphasis has to be put on donor recruitment and donor care.

Research paper thumbnail of Haemoglobin F and clinical severity of sickle cell anaemia among Nigerian adults

PubMed, Nov 21, 2001

Haemoglobin F (HbF) has been a useful criterion in predicting the clinical severity of sickle cel... more Haemoglobin F (HbF) has been a useful criterion in predicting the clinical severity of sickle cell disease (SCD). Thus different treatment modalities are geared towards raising its level. This study estimated HbF levels in sickle cell anaemia patients. HbF levels were then compared with clinical parameters such as the average number of bone pain crisis per year, transfusion requirement, enlargement of both the spleen and liver and the haematocrit level. The mean HbF value was 7.4 +/- 3.6%. Males recorded a higher mean level than females 7.6 +/- 3.9%, and 6.7 +/- 3.6% respectively, (P > 0.05). HbF of 7.4% was used to divide the patients into two broad groups. Patients with HbF of more than 7.4% were older compared to those with less than 7.4% (P > 0.5), the former group was also less transfusion dependent (P > 0.05) even though their haematocrit was not significantly different (P > 0.05) from those with HbF of < 7.4%. The patients with higher HbF levels are also more likely to retain their spleen longer than their counterpart with lower values. It appears that clinical severity has a relationship with HbF values even though most were not statistically significant. There is a need for larger studies to study this relationship more closely.

Research paper thumbnail of Therapeutic Plasma Exchange in the Management of Myasthenia Crisis in a Resource Poor Setting

International journal of healthcare and medical sciences, May 20, 2019

BACKGROUND: Therapeutic Plasma Exchange (TPE) is an apheresis treatment in which the plasma compo... more BACKGROUND: Therapeutic Plasma Exchange (TPE) is an apheresis treatment in which the plasma component of blood is removed and replaced with supplemental fluids. It is an immunomodulatory treatment that has been reported to be a successful therapeutic procedure for the treatment of severely compromised patients with myasthenia gravis when given at short intervals. TPE is known to have a comparable efficacy to intravenous immunoglobulin (IVIG) in the treatments of patients with moderate to severe myasthenia crisis. METHODOLOGY: We report a case of a 47year old male patient with severe myasthenia crisis. He was managed using cobe spectra version 6.1 to carry out an automated TPE, with a suboptimal response and subsequent use of IVIG resulting in full recovery. This report highlights the possible factors that may hinder optimal response of a patient with Myasthenia crisis to TPE procedure in a poor resource setting. CONCLUSION: TPE is an essential immunomodulatory therapy in the management of acute myasthenia crisis whether given alone or in combination with immunosuppressive drugs. There can be a rebound overproduction of the offending autoantibodies in MG following TPE which can be cleared from circulation using immunosuppressive therapy.

Research paper thumbnail of Phenotypic and genotypic expression of alpha thalassaemia in Ibadan, Nigeria

PubMed, Sep 1, 2012

Background: Alpha thalassaemia is a common monogenic disorder found in most parts of the world bu... more Background: Alpha thalassaemia is a common monogenic disorder found in most parts of the world but the severe form is restricted in its distribution while the mild deletional form of alpha- thalassaemia has a wider geographical distribution. Methods: One hundred and fifty one Nigerians which included 29 patients with unexplained recurrent haemolytic anaemia had their a-thalassaemia status determined by gap PCR after being screened using red cell indices. Results: Only the -alpha(3.7) deletion occurs among Nigerians with a gene frequency of 0.21. Forty-two per cent of the study population are heterozygotes, 9% are homozygotes while 49% are normal for this deletion. The mean haematocrit for the study population is 37.5%: homozygote, heterozygotes and normal subjects had a mean haematocrit of 37.3%, 37.5% and 37.7% respectively. The mean mean corpuscular haemoglobin (MCH) and haematocrit are significantly lower for patients than controls (24 +/- 2.9 pg vs. 26.6 +/- 2.5 pg (p = .000), 29% vs. 40% (p = .000) respectively). Forty three percent of both patients and controls had MCH of less than 27 pg but only 10% of patients had MCH that is greater than 27pg. Homozygote patients had a higher mean haematocrit than patients who are normal for the deletion (34.7% vs. 25.4%, p = 0.06) but homozygote patients had a lower mean haematocrit than homozygote controls (34.7% vs. 38.5%, p = 0.4). Conclusion: This would suggest that alpha-thalassaemia is not responsible for the recurrent haemolytic anaemia observed in these patients and that the high prevalence of microcytosis among the normal populace needs further exploration.

Research paper thumbnail of Assessment Of Immunoglobulin Levels In The Cause Of False Pass Rate In The Use Of Copper Sulphate (CuSO ) 4 As Pre-donation Screening Test

Tropical Journal of Health Sciences, 2013

Click on the link to view the abstract. The Tropical Journal of Health Sciences Vol 20 No 2 (July... more Click on the link to view the abstract. The Tropical Journal of Health Sciences Vol 20 No 2 (July 2013)

Research paper thumbnail of Automated techniques in haematology

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, Sep 15, 2006

Research paper thumbnail of When the inheritance of two heterozygote state become a diagnostic problem: Misdiagnosis of the sickle cell trait

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, Aug 23, 2007

Research paper thumbnail of Guidelines for teh diagnosis of the haemoglobinopathies in Nigeria

Annals of Ibadan postgraduate medicine, Feb 28, 2011

Research paper thumbnail of The pregnant Rhesus negative Nigerian woman

Nigerian Postgraduate Medical Journal

Alloimmunisation to Rhesus D (RhD) is a major factor in perinatal morbidity and may result in the... more Alloimmunisation to Rhesus D (RhD) is a major factor in perinatal morbidity and may result in the compromise of the woman&#39;s obstetric career. In Nigeria accurate population based studies to determine the prevalence of Rhesus negative women and the incidence of alloimmunisation are lacking, hence we undertook to study pregnancy outcome in Rhesus negative women. We studied retrospectively sixty-seven RhD negative women over a two year period; information was obtained from the case-file of all pregnant women who presented to the ante-natal clinic and were identified as Rhesus negative. This was corroborated with the blood bank record over the same period. Forty per cent of these were nulliparae with an average of 0.5 abortions. Only 20% had the blood groups of their husbands documented, and only four babies born to these women had their Rhesus group recorded. Six of the babies appeared to have been severely affected by Rhesus isoimmunisation. Three of these had an exchange blood transfusion (EBT); all who had an EBT had a satisfactory outcome. Out of the other three, there were two neonatal deaths and one fresh stillbirth. Fourteen babies had neonatal jaundice with a mean bilirubin level of 6 mg/dl, all of which were mainly unconjugated. Evidence for the administration of anti D was obtained in only three patients; all had one ampoule (dose in i.u and/or _g not stated) administered within 72 hr. This preliminary study has shown that isoimmunisation due to Rhesus incompatibility is poorly studied among Nigerian women with many questions unanswered; therefore there is an urgent need for a management protocol for this condition, which will include both the clinicians and the laboratory physicians.

Research paper thumbnail of Hypereosinophilic syndrome with severe hypokalaemia in a Nigerian woman: A case report

Nigerian Journal of Medicine

Introduction Hypereosinophilic syndrome (HES) is a rare disorder. It is defined as eosinophilia o... more Introduction Hypereosinophilic syndrome (HES) is a rare disorder. It is defined as eosinophilia of greater than1.5x109 /L persisting for at least 6 months or death before 6 months without an identifiable cause and with eosinophil-mediated organ dysfunction. We present a rare case of hypereosinophilic syndrome with severe hypokalaemia in a Nigerian female patient. Case Presentation A 43year old food vendor referred to the Haematology Department, University College Hospital, Ibadan on account of a 6-week history of cough productive of mucoid, brownish, foul smelling sputum with associated breathlessness, high grade intermittent fever, and intense pruritus. She had accompanying non-projectile,non-bloody vomiting of recently ingested meals. There was absolute eosinophilia of 83x109/L and bone marrow cytology revealed marked eosinophilia with blasts of less than 5%. She also had asymptomatic severe hypokalaemia (1.9mmol/l) likely due to vomiting and reduced dietary intake. The aetiology of the hypereosinophilia could not be ascertained.She was admitted and commenced on intranasal oxygen, Tabs Loratidine, intravenous hydration.The severe hypokalaemia was corrected with IV KCL over 48hours followed with the administration of slow K tablets 600mg tds. She also had tabs Hydroxyurea for cytoreduction and Allopurinol to prevent hyperuricaemia. She improved with the above line of management. Conclusion This appears to be the first reported case of HES with asymptomatic severe hypokalaemia in the literature. Being a rare disorder it could easily have been missed without a review of the peripheral blood film and marrow aspirate. This finding suggests a possible relationship between hypereosinophilia and hypokalemia which needs to be explored.

Research paper thumbnail of Pattern of Haemoglobin Phenotypes and the Clinical Identity of Clients Tested at a Private Diagnostic Center in South-West Nigeria

West Africa Journal of Medicine

Background: Haemoglobinopathies are diseases of global importance and the countries with high dis... more Background: Haemoglobinopathies are diseases of global importance and the countries with high disease burdens have inaccurate national data on the incidence of the various haemoglobin (Hb) phenotypes. Objective: To review the Hb phenotype distribution, the referral identity of patients, and the clinical reasons for phenotyping. Methods: A retrospective descriptive study conducted at a private diagnostic laboratory in Lagos, South-West, Nigeria. The anonymous results of Hb phenotypes of the patients determined using gel electrophoresis were retrieved from the laboratory information system (LIS). Results: There were 942 patients: 519(55.1%) males and 423(44.9%) females with median ages 30yrs (11months-89yrs) vs 27yrs (9months-89yrs), p=0.0018. The phenotypes were HbAA, 592(63.2%); HbAS(26.4%); HbSS(7.1%); HbAC(2.1%), HbSC(0.7%) and HbCC(0.4%). Of the total, 757(80.4%) were referred by health care providers and 185(19.6%) were selfreferred, and there was no association between gender a...

Research paper thumbnail of Good practice statements for antithrombotic therapy in the management of COVID‐19: Guidance from the SSC of the ISTH

Journal of Thrombosis and Haemostasis

Research paper thumbnail of Pain management in sickle cell disease: What remedy to reduce the risk of opioid abuse?

African Journal of Anaesthesia and Intensive Care, 2015

Sickle cell disease is an inherited disorder, the hallmark of which is recurrent acute painful cr... more Sickle cell disease is an inherited disorder, the hallmark of which is recurrent acute painful crises requiring opioid therapy. These acute painful episodes when superimposed on chronic pain could last for years especially in association with comorbidities like osteonecrosis, chronic leg ulcers, cholelithiasis or stuttering priapism. The need for adequate pain control in such patients should therefore be balanced to avoid opioid dependence. The treatment of superimposed acute pain with opioid in a patient with background chronic pain makes pain control a challenge. This is because the comorbidities responsible for the chronic pain are often associated with a depressive state because of limited treatment options for some of these comorbidities. Abuse of opioid by a patient with chronic pain raises the possibility of pseudoaddiction. However, abuse of opioid is not limited to patients with chronic pain or acute on chronic pain, it has also being observed in patients without chronic pain. It is necessary to decide on drugs that may adequately control chronic pain on a long term with minimal side effects; the newer drugs on the horizon which are targeted towards sickle cell disease are therefore possible viable options. Keywords: Opioid, addiction, sickle cell pain, chronic pain, psychosocial, targeted therapy

Research paper thumbnail of C0301: Antithrombin Activity in Patients with Venous Thrombo-Embolism in an African Population

Thrombosis Research, 2014

Research paper thumbnail of A revisit of venous thromboembolism

African journal of medicine and medical sciences, 2013

To determine the effect of the introduction of Doppler ultrasonography to the management of venou... more To determine the effect of the introduction of Doppler ultrasonography to the management of venous thromboembolism in a health care facility in Nigeria. A descriptive study of cases of venous thromboembolism (VTE) over a five year period (March 2007-February 2012) was compared with a five year review done two decades ago before the introduction of Doppler ultrasonography. This review showed an increase of VTE cases from 60 to 178 with a median age of 53 yrs, median age of female patients was 5 yrs younger than male patients with Male/female ratio of 1:1.2. There was an even distribution of patients seen over the five year period with a mean prevalence of 35.6 patients per year. Patients with distal deep vein thrombosis (DVT) were in the majority (76%) compared with proximal DVT and PE which were 21% Vs 3%. About 4% of the patients had a recurrence of the VTE with male patients having twice the likelihood of a re-thrombosis. Common comorbid states observed are cerebrovascular disease...

Research paper thumbnail of Betke's and elution methods in estimation of haemoglobin F in sickle cell anaemia

East African medical journal, 2000

To compare the effect of the type of spectrophotometer and method used in the estimation of HbF. ... more To compare the effect of the type of spectrophotometer and method used in the estimation of HbF. Two sets of experiments were done. In the first set, paired blood samples were obtained from 28 adult sickle cell anaemia subjects. One of each pair of samples was analysed for HbF by Betke's method and the other by the elution method and the values obtained were compared. In the second set of experiments, ten other paired samples were analysed for HbF, one using an analogue spectrophotometer and the other using a digital spectrophotometer and the results compared. Adult sickle cell clinic, University College Hospital, Ibadan, Nigeria. Thirty eight sickle cell anaemia patients. HbF levels estimated by the two methods showed good agreement as estimated by the Bland-Altman plot. HbF levels obtained by Betke's method correlated well with those obtained by the elution method (r = 0.59, p = 0.0015) and the mean values were similar (14.9% versus 13.5%, p=0.215). The values obtained by ...

Research paper thumbnail of Earliest presenting sign and morbidity profile of sickle cell disease patients attending the adult SCD clinic at the UCH Ibadan, Nigeria

The Central African journal of medicine, 2001

Research paper thumbnail of Venous thromboembolism in Ibadan: A five year experience (1986-1990)

Nigerian Quarterly Journal of Hospital Medicine, 2008

Research paper thumbnail of Hodgkin's disease after treatment for Burkitt's lymphoma: case report

East African Medical Journal, 2001

Hodgkin's disease and non-Hodgkin's lymphomas are interrelated disorders which have been reported... more Hodgkin's disease and non-Hodgkin's lymphomas are interrelated disorders which have been reported to occur either simultaneously or sequentially in the same patient. We report here the development of nodular sclerosing type Hodgkin's disease in a patient two decades after successful treatment for Burkitt's lymphoma with cyclophosphomide and abdominal resection (AR). White the onset of symptoms after treatment for Burkitt's lymphoma was seven years definitive diagnosis of Hodgkin's disease was only made 22 years after the initial diagnosisof Burkitt's lymphoma. The recurrentandsolitarynatureof thelymphadenopathy and the fact that it was initially reported as reactive hyperplasia is typical of nodular lymphocyte predominant Hodgkin's disease. We believe that there was a transitor"'-period of the malignancy as nodular lymphocyte predominant Hodgkin's disease.

Research paper thumbnail of Survival advantage in female patients with sickle cell anaemia

East African Medical Journal, 2001

Research paper thumbnail of Audit of the red cell units supply of a busy hospital blood bank in Nigeria

Nigerian Journal of Clinical Practice, Jun 1, 2009

Background/objective: Blood bank audit embraces all procedures from blood procurement to the long... more Background/objective: Blood bank audit embraces all procedures from blood procurement to the long -term consequences of transfusion which helps to identify opportunities for improvement. We have therefore looked at red cell transfusion in our hospital to identify areas that will require improvement. Method: Data was collected retrospectively from the hard copy record of the blood bank for a period of one month. Results: Request was made for 1210 red cell units; crossmatch was made for 64% of the request. All units crossmatched were issued, of these 4.15% were returned unutilized. 5.1% were issued as uncrossmatched. The Obstetrics/Gynaecology unit recorded the highest blood usage and the medical unit the least. The use of blood by the emergency and paediatric were the same. The crossmatch:transfusion ratio for the hospital was 0.9:1. This study has shown that the crossmatch and transfusion rates are almost equal and only a small percentage was returned unused. Conclusion: This showed that there is inadequate supply of blood. There is a need to assess the reason for transfusion and establishing a blood transfusion advisory committee by the hospital. This will ensure interaction and collaboration between blood suppliers and users to improve the quality of transfusion practice. The new policy establishing a national transfusion service will also improve the transfusion service but emphasis has to be put on donor recruitment and donor care.

Research paper thumbnail of Haemoglobin F and clinical severity of sickle cell anaemia among Nigerian adults

PubMed, Nov 21, 2001

Haemoglobin F (HbF) has been a useful criterion in predicting the clinical severity of sickle cel... more Haemoglobin F (HbF) has been a useful criterion in predicting the clinical severity of sickle cell disease (SCD). Thus different treatment modalities are geared towards raising its level. This study estimated HbF levels in sickle cell anaemia patients. HbF levels were then compared with clinical parameters such as the average number of bone pain crisis per year, transfusion requirement, enlargement of both the spleen and liver and the haematocrit level. The mean HbF value was 7.4 +/- 3.6%. Males recorded a higher mean level than females 7.6 +/- 3.9%, and 6.7 +/- 3.6% respectively, (P > 0.05). HbF of 7.4% was used to divide the patients into two broad groups. Patients with HbF of more than 7.4% were older compared to those with less than 7.4% (P > 0.5), the former group was also less transfusion dependent (P > 0.05) even though their haematocrit was not significantly different (P > 0.05) from those with HbF of < 7.4%. The patients with higher HbF levels are also more likely to retain their spleen longer than their counterpart with lower values. It appears that clinical severity has a relationship with HbF values even though most were not statistically significant. There is a need for larger studies to study this relationship more closely.