FACULTY OF BASIC MEDICAL SCIENCES
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Item Features and outcome of surgical management of spinal tumors in a cohort of nigerian patients(Elsevier Inc, 2014) Adeolu, A. A.; Oyemolade, T. A.; Salami, A. A.; Adigun, T. A.; Malomo, A. O.; Akang, E. A.; Shokunbi, M. T.OBJECTIVE: There is a dearth of information on operated cases of spinal tumors in patients in sub-Saharan Africa. The objective of this study was to evaluate the histologic pattern, anatomic distribution, and extent and outcome of surgery of Nigerian patients with spinal tumors. METHODS: This retrospective study comprised a cohort of Nigerians who underwent surgery for spinal tumors. Data obtained included patient demographics, duration of symptoms, anatomic location, imaging findings, Frankel grading before and after surgery, and type and outcome of surgery. Univariate analysis was performed, and results were compared with results from other parts of the world. RESULTS: There were 59 patients (male-to-female ratio 1:1.1) with a bimodal age distribution. The highest (20.34%) incidence was seen in the 20e29 age group. More than half (58.06%) of the patients presented with a duration of symptoms of at least 6 months (duration of symptoms was >12 months in 35.48%). Motor deficit was present in 97.73% of patients at presentation. Functional grading was Frankel A in 38.10% of patients, Frankel C in 26.19%, Frankel B in 16.67%, Frankel D in 16.67%, and Frankel E in 2.38%. The tumors were mostly in the thoracic region (65.45%), and 58% were extradural in location. Gross total tumor excision was performed in 50.88% of the cases, and subtotal resection was performed in 24.56%. Spinal stabilization was performed in 17.86% with spinous process wiring and vertical strut being the most common method of stabilization (80%) among this group. Metastasis was the most common histologic tumor type (23.21%). Meningioma accounted for 12.50% of tumors, and ependymoma, astrocytoma, and hemangioma each accounted for 7.14%. The most common source of metastasis was the prostate (38.46%). Postoperatively, 45% of patients improved neurologically, 52.5% remained the same, and 2.5% deteriorated. There was no perioperative mortality. CONCLUSIONS: Metastasis was the most common histologic type of spinal tumor in this study, and the most common location was extradural. The outcome was satisfactory in most cases with neurologic function remaining the same or improving after surgery in most patients.Item Correlation of intraoperative cytological and final histological diagnoses(Wiley, 2014) Salami, A.; Adeleye, A.; Ogun, G.; Adeoye, A.; Adeolu, A.; Okolo, C.; Eze, U.; Abdullahi, Y.; Lawan, A.; Ogunbiyi, J.; Akang, E.; Shokunbi, M.; Azeez, A.; Malomo, A.Objective: Intraoperative cytology is a cost-effective, rapid, and easy technique, and studies have shown good correlation between intraoperative cytology and histology. We undertook this study to compare the intraoperative cytology diagnoses of brain lesions made in our unit over a 10-year period with the definitive histological diagnoses. The aim was to determine the degree of accuracy of this procedure. Study design: This is a retrospective study of intraoperative neuropathology consultation cytology smears or imprints and histology of 69 cases obtained over a 10-year period. Cytology smears were stained using both Papanicolaou and Giemsa. Histology sections were prepared from routine formalin-fixed paraffin- embedded tissue and stained using H and E method. Each of the smears and histology samples were assessed by at least two pathologists. Cytological diagnosis was correlated with final histological diagnosis. The sensitivity and specificity of cytological diagnosis was evaluated using final histological diagnosis as gold standard. Results: Correlation was strongest with inflammatory lesions followed by low-grade neoplasms. High-grade neoplasms also showed good concordance, but the degree of correlation was lower than in the other categories. Misdiagnosis was commonest with benign tumors. Conclusion: Intraoperative cytology is a relatively simple, reliable, and accurate diagnostic technique and should be more commonly used, particularly in low-resource settings. Diagn. Cytopathol.Item Enhanced wound contraction in fresh wounds dressed with honey in wistar rats (rattus novergicus)(West African College of Physicians and the West African College of Surgeons, 2004) Osuagwu, F. C.; Oladejo, O. W.; Imosemi, I. O.; Aiku, A.; Ekpo, O. E.; Salami, A. A.; Oyedele, O. O; Akang E. U.Background: Due to reports that honey accelerates wound healing, an investigation on its role in wound con- traction in fresh wounds inflicted on wistar rats was car- ried out. Method: Twenty adult male wistar rats had 2cm by 2cm square wound inflicted on their right dorsolateral trunk. They were divided into two groups. The experimental group had their wounds dressed with honey while the control group had normal saline dressing. Wound dress- ing was done every five days and measurements taken at each dressing. Wound morphology was also assessed. Results: Dressing with honey significantly enhanced percentage wound contraction on day 10 with value of 79.20±2.94 compared to control value of 53.50 ±4.32. p=0.0. The mean wound measurement on day 10 reduced significantly in honey group, 1.15±0.18 compared to con- trol group 2.38±0.28. p=0.002. However, there was no significant difference in fibroblast count per high power field in honey group 68.0 ±2.59 compared to control 90.2 17.40, p=0.242. Honey dressing increased mean blood vessel count per high power field, 18.8±3.77 albeit non significantly when compared to control value of 13.4±2.44, p=0.264. Also honey dressing caused increased granulation tissue for- mation in wounds dressed with honey compared to con- trol group. Conclusion: Our study suggests that honey dressing enhances wound contraction in fresh wounds which is one of the key features of wound healing.Item A randomized, open-label trial of combined nitazoxanide and atazanavir/ritonavir for mild to moderate COVID-19(Frontiers Media, 2022-09) Fowotade, A.; Bamidele, F.; Egbetola, B.; Fagbamigbe, A. F.; Adeagbo, B. A.; Adefuye, B. O.; Olagunoye, A.; Ojo, T. O.; Adebiyi, A. O.; Olagunju, O. I.; Ladipo, O. T.; Akinloye, A.; Onayade, A.; Bolaji, O. O.; Rannard, S.; Happi, C.; Owen, A.; Olagunju, A.Background: The nitazoxanide plus atazanavir/ritonavir for COVID-19 (NACOVID) trial investigated the efficacy and safety of repurposed nitazoxanide combined with atazanavir/ritonavir for COVID-19. Methods: This is a pilot, randomized, open-label multicenter trial conducted in Nigeria. Mild to moderate COVID-19 patients were randomly assigned to receive standard of care (SoC) or SoC plus a 14-day course of nitazoxanide (1,000 mg b.i.d.) and atazanavir/ritonavir (300/100 mg od) and followed through day 28. Study endpoints included time to clinical improvement, SARS-CoV-2 viral load change, and time to complete symptom resolution. Safety and pharmacokinetics were also evaluated (ClinicalTrials.gov ID: NCT04459286). Results: There was no difference in time to clinical improvement between the SoC (n = 26) and SoC plus intervention arms (n = 31; Cox proportional hazards regression analysis adjusted hazard ratio, aHR = 0.898, 95% CI: 0.492–1.638, p = 0.725). No difference was observed in the pattern of saliva SARS-CoV- 2 viral load changes from days 2–28 in the 35% of patients with detectable virus at baseline (20/57) (aHR = 0.948, 95% CI: 0.341–2.636, p = 0.919). There was no significant difference in time to complete symptom resolution (aHR = 0.535, 95% CI: 0.251–1.140, p = 0.105). Atazanavir/ritonavir increased tizoxanide plasma exposure by 68% and median trough plasma concentration was 1,546 ng/ml (95% CI: 797–2,557), above its putative EC90 in 54% of patients. Tizoxanide was undetectable in saliva. Conclusion: Nitazoxanide co-administered with atazanavir/ritonavir was safe but not better than standard of care in treating COVID-19. These findings should be interpreted in the context of incomplete enrollment (64%) and the limited number of patients with detectable SARS-CoV-2 in saliva at baseline in this trial.Item Seroprevalence of anti-SARS-CoV-2 specific antibodies in vaccinated and vaccine naïve adult Nigerians(Plos One, 2023-01) Onifade, A. A.; Fowotade, A.; Rahamon, S. K.; Edem, V. F.; Yaqub, S. A.; Akande, O. K.; Arinola, O. G.Background Reports on the evaluation of immune responses to different COVID-19 vaccines are limited. Similarly, effects of age and gender have not been well explored as variables that could impact on the vaccine-induced antibody response. Therefore, seroprevalence of anti-SARS-CoV-2 specific antibodies in vaccinated and vaccine naïve adult Nigerians was determined in this study. Methodology A total of 141 adults were enrolled into this study. Presence or absence of SARS-CoV-2 infection was confirmed by real-time reverse-transcriptase polymerase-chain reaction (RT-PCR) assay on nasopharyngeal and oropharyngeal swab specimens. Anti-SARS-CoV-2 Specific IgG and IgM antibodies were qualitatively detected using a Rapid Diagnostic Test kit. Results Pre-vaccination, 77% of the study participants had never had PCR-confirmed COVID-19 test yet 66.7% of them were seropositive for SARS-CoV-2 antibodies. Of 111 COVID-19 vaccinated participants, 69.2% and 73.8% of them had SARS-CoV-2 specific IgG post-first and second doses of COVID-19 vaccine respectively. However, 23.1% and 21.4% of the participants who have had first and second doses respectively ha no detectable anti- SARS-CoV-2 antibodies. The proportion of participants with SARS-CoV-2 specific IgG was insignificantly higher in those between the ages of 18–40 years and 41–59 years compared with individuals aged �60 years. No significant association was observed between gender and seropositivity for SARS-CoV-2 antibodies. Conclusion There is high SARS-CoV-2 antibody seroprevalence among Nigerian adults who never had PCR-confirmed COVID-19. Also, there is the need for anti-SARS-CoV-2 antibodies screening post vaccination as this could be essential in achieving herd immunity. Age and gender do not seem to have significant association with seropositivity.Item A multi-country phase 2 study to evaluate the suitcase lab for rapid detection of SARS CoV-2 in seven Sub-Saharan African countries: Lessons from the field(Elsevier B.V., 2023) Ceruti, A.; Dia, N.; Bakarey, A. S.; Ssekitoleko, J.; Andriamandimby, S. F.; Malwengo-Kasongo, P.; Ahmed, R. H. A.; Kobialka, R. M.; Heraud, J. M.; Diagne, M. M.; Fowotade, A.Background: The COVID-19 pandemic led to severe health systems collapse, as well as logistics and supply delivery shortages across sectors. Delivery of PCR related healthcare supplies continue to be hindered. There is the need for a rapid and accessible SARS-CoV-2 molecular detection method in low resource settings. Objectives: To validate a novel isothermal amplification method for rapid detection of SARS-CoV-2 across seven sub-Sharan African countries. Study design: In this multi-country phase 2 diagnostic study, 3,231 clinical samples in seven African sites were tested with two reverse transcription Recombinase-Aided Amplification (RT-RAA) assays (based on SARS-CoV-2 Nucleocapsid (N) gene and RNA-dependent RNA polymerase (RdRP) gene). The test was performed in a mobile suitcase laboratory within 15 min. All results were compared to a real-time RT-PCR assay. Extraction kits based on silica gel or magnetic beads were applied. Results: Four sites demonstrated good to excellent agreement, while three sites showed fair to moderate results. The RdRP gene assay exhibited an overall PPV of 0.92 and a NPV of 0.88. The N gene assay exhibited an overall PPV of 0.93 and a NPV 0.88. The sensitivity of both RT-RAA assays varied depending on the sample Ct values. When comparing sensitivity between sites, values differed considerably. For high viral load samples, the RT-RAA assay sensitivity ranges were between 60.5 and 100% (RdRP assay) and 25 and 98.6 (N assay). Conclusion: Overall, the RdRP based RT-RAA test showed the best assay accuracy. This study highlights the challenges of implementing rapid molecular assays in field conditions. Factors that are important for successful deployment across countries include the implementation of standardized operation procedures, in-person continuous training for staff, and enhanced quality control measures.Item Comparative analysis of Cervical Human Papillomavirus DNA testing and cytological findings among women presenting for “Pap” smear in a Tertiary Health Centre in Northern Nigeria(SCIENCE DOMAIN International, 2016) Manga, M. M.; Fowotade, A.; Abdullahi, Y. M.; El-Nafaty, A. U.; Adamu, S.; Bojude, A. D.; Pindiga, H. U.; Bakare, R. A.; Osoba, A. O.Aim: This study was conducted to compare different cytological findings with cervical HPV infection among women presenting for cervical cancer screening in Gombe north-eastern Nigeria. Study Design: It is a hospital based cross-sectional study. Place and Duration of Study: Departments of Obstetrics/Gynaecology and Histopathology Federal Teaching Hospital Gombe (FTHG) Nigeria, between August 2013 and May 2014. Methodology: Two hundred and nine (209) women were subjected to liquid-based cervical cytology and HPV DNA testing. Results: Of the 209 participants, cytological findings were normal in 126 (61.6%) women while 80 (39.0%) had abnormal features. Three (1.4%) respondents had unsatisfactory smears. The observed abnormal cytological features include HPV changes 30 (14.4%), HPV changes with inflammation 2 (1.0%), inflammatory changes alone 36 (17.3%), Low Squamous Intraepithelial Lesion; LSIL 3 (1.4%), High Squamous Intraepithelial Lesion; HSIL 5 (2.4%) and malignant changes 3 (1.4%). Positive HPV DNA testing was detected among 100 (48.1%) of the participants. Almost half 60 (47.6%) of the women with normal cytology were positive for HPV. Among women with cytologically detected HPV changes, only 16 (50%) were also HPV DNA positive. The sensitivity and specificity of cervical cytology in detecting HPV infection was 16.2% and 85.0% respectively. Conclusion: This study reports a very low sensitivity but relatively high specificity of cytology in detecting cervical HPV infection. It further justifies the need for introduction of HPV DNA testing to improve efficiency and maximise the sensitivity of cytology based cervical cancer screening for women above 30 years.Item Emergence and spread of two SARS-CoV-2 variants of interest in Nigeria(Nature Portfolio, 2023-02) Olawoye, I. B.; Oluniyi, P. E.; Oguzie, J. U.; Uwanibe, J. N.; Kayode, T. A.; Olumade, T. J.; Ajogbasile, F. V.; Parker, E.; Eromon, P. E.; Abechi, P.; Fowotade, A.Identifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study,we integrated genomic and travel data to investigate the emergence and spread of the SARS-CoV-2 B.1.1.318 and B.1.525 (Eta) variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave in Nigeria emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Data from this study show how regional connectivity of Nigeria drove the spread of these variants of interest to surrounding countries and those connected by air-traffic. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission, as bidirectional transmission within and between African nations are grossly underestimated as seen in our import risk index estimates.Item A 4-Year cross-sectional study of Hepatitis B virus infection among pregnant women: need for policy decision(Ecronicon, 2022-03) Fowotade, A.; Omoruyi, E. C.; Adesina, O.; Adekanmbi, O.; Adetunji, S.; Akande, K. O.; Adepoju, A.Background: The elimination of hepatitis B virus (HBV) in Nigeria, especially among pregnant women requires commitment from the government and health policy makers. This is predicated on comprehensive surveillance and epidemiological data. The objective of the current study is to provide the epidemiological data and unique perspectives that will inform accurate advocacy and influence policy decisions. Materials and Methods: A 4-year cross-sectional study was conducted among 2,428 consecutively recruited consenting pregnant women attending antenatal care at the University College Hospital, Ibadan, Oyo State, Nigeria. Venous blood was screened for HBsAg using Enzyme Linked Immunosorbent Assay (ELISA). HBsAg sero-negative samples were further tested for other HBV serological markers (anti-HBc, HBeAg and anti-HBe by ELISA. Socio-demographic and clinical details were obtained using a semi-structured questionnaire. Results: Overall HBsAg prevalence was 5.1% (2,305/2,482). Twenty three (1%) of the HBsAg sero-negative women tested positive to both anti-HBc and anti-HBe while 5.3% and 0.8% tested positive to only anti-HBc and anti-HBe, respectively. Additionally, 6.4% (38/594) of the HBV fully vaccinated pregnant women tested positive to HBsAg. Conclusion: Hepatitis B is endemic among Nigerian pregnant women. Serological patterns indicated possible occult hepatitis B infection. More political commitment from government and policy makers is urgently required.Item Prevalence of hepatitis B virus core antibodies among blood donors in Nigeria: implications for blood safety(AOSIS, 2022-09) Fasola, F. A.; Fowotade, A. A.|; Faneye, A. O.; Adeleke, A.Background: Anti-hepatitis B core antibody (anti-HBc) testing improves transfusion safety by detecting past and current hepatitis B virus (HBV) infection while detecting hepatitis B surface antigen (HBsAg) in serology-negative HBV infection. However, occult HBV infection (OBI) (serum or liver HBV DNA-positive but HBsAg-negative) remains unaddressed among replacement blood donors – family members or friends who donate to replace blood transfused to a relative. Objective: This study assessed risk factors for a positive anti-HBc test among donors with OBI and determined the anti-HBc-positive status of replacement donors. Methods: The study was conducted at the University College Hospital Blood Bank, Ibadan, Nigeria, using blood samples collected from blood donors between April 2019 and May 2019. Donors were screened for HBsAg by rapid diagnostic test (RDT) and enzyme-linked immunosorbent assay (ELISA) and anti-HBc by ELISA, while HBV DNA was detected using a semi-nested polymerase chain reaction. Results: Of the 274 participants, 15 (5.5%) were HBsAg-positive by RDT and 36 (13.1%) by ELISA, while 133 (48.5%) were anti-HBc positive. Out of 232 HBsAg-negative donors, 107 (46.1%) were anti-HBc positive. Of the 107 HBsAg-negative but anti-HBc-positive samples, only one (0.93%) was HBV DNA-positive. The HBV DNA-positive donor was HBsAg-negative by both RDT and ELISA tests. Conclusion: This study establishes a potential risk for HBV transmission from isolated anti-HBc-positive donors to blood recipients. HBc immunoglobulin (antibody) M testing to identify blood units requiring further screening with polymerase chain reaction to detect OBI can prevent HBV transmission through blood transfusion.