Allogeneic Transplant and Gene Therapy: Evolving Toward a Cure

Curative therapies for sickle cell disease (SCD) include allogeneic human leukocyte antigen (HLA)- matched sibling and haploidentical hematopoietic cell transplant (HCT), gene therapy, and gene editing. However, comparative trial data that might facilitate selecting one curative therapy over another are unavailable. New strategies to decrease graft rejection and graft-versus-host disease (GVHD) risks are needed to expand haploidentical HCT. Myeloablative gene therapy and gene editing also has limitations. Herein, we review recent studies on curative therapies for SCD in the past 5 years.

Domestic chicken diversity: Origin, distribution, and adaptation

Chicken is the most numerous among the domesticated livestock species. Across cultures, religions, and societies, chicken is widely accepted with little or no taboo compared to other domestic animals. Its adaptability to diverse environmental conditions and demonstrated potential for breeding improvement provide a unique genetic resource for addressing the challenges of food security in a world impacted by climatic change and human population growth. Recent studies, shedding new knowledge on the chicken genomes, have helped reconstruct its past evolutionary history. Here, we review the literature concerning the origin, dispersion, and adaptation of domestic chicken. We highlight the role of human and natural selection in shaping the diversity of the species and provide a few examples of knowledge gaps that may be the focus of future research.

Long stay patients in a psychiatric hospital in Lagos, Nigeria

OBJECTIVE

In the face of recently introduced government health reform and the dwindling number of available beds for acutely ill patients, a cross sectional study was carried out on long-stay patients at the 100 years old psychiatric hospital Yaba, Lagos, Nigeria with a view to discharging most of them.

METHOD

Necessary consent was obtained from the Hospital Research and Ethical Committee. All the long-stay patients were evaluated with a specially designed proforma to elicit socio-demographic, clinical and long-stay variables. Further more, each of them had clinical assessment to make diagnosis in accordance with ICD - 10 and finally, the subjects were also assessed with the Brief Psychiatric Rating Scale (BPRS).

RESULTS

Fifty-one (51) subjects; that is, occupying 10.7% of the hospital functional beds fulfilled the criteria of long-stay. They included 36 (70.6%) males and 15(24.4%) females. The mean age was 47.3 inverted exclamation markA16.5 years with age range of 18-92 years. The average length of stay was 11.4 inverted exclamation markA15.0 years and range of 0.5 to 57 years; with significant gender difference (males higher than females) (t =3.51, p<0.02). The vast majority of the subjects were diagnosed with schizophrenia (84.3%), followed by mental retardation with seizure disorder (5.9%). One-third (33.3%) of the subjects had co-morbid physical pathologies most especially epilepsies, hypertension, Koch inverted exclamation mark s disease, HIV/AIDS. Despite being on high doses of antipsychotics (conventional and/or atypical) the majority of the subjects (86.3%) exhibited poor mental state with BPRS scores of inverted exclamation markY10. The mean BPRS score was 23.6 inverted exclamation markA22.0 and range of 4-56 with a significant gender difference (t = 3.66, p< 0.02).

CONCLUSION

These patients would continue to require long-stay hospitalization despite been a burden to the study center; or, in the alternative provision of mid Cway facilities for their rehabilitation.

Effects of ethanolic extract of Tetrapleura tetraptera fruit on serum lipid profile and kidney function in male Dutch-white rabbits

BACKGROUND

Tetrapleura tetraptera fruit is widely used in Nigeria as a spice and for treatment of various medical ailments. Reports indicate that feeding of extracts to animals produced some toxic effects and pathological lesions in some organs.

OBJECTIVE

This study was designed to investigate the effects of 10 days oral administration of the ethanolic extract of Tetrapleura tetraptera (TTE) on the lipid profile and kidney function in male rabbits.

METHODS

Twenty healthy, acclimatized male rabbits weighing 1.4 - 1.6 kg were randomly divided into four groups. Group 1 served as control and received only water while groups 2, 3 and 4 were administered 50, 100 and 150 mg/kg bodyweight of TTE respectively. Fasting serum from all groups were analyzed for lipid profile and kidney function parameters using standard protocols. Data were analyzed using student's t-test and ANOVA.

RESULTS

Tetrapleura tetraptera extract elicited reduction in serum triacylglycerols, elevation of LDL-cholesterol and alteration of kidney function parameters in male rabbits.

CONCLUSION

Ethanolic extract of Tetrapleura tetraptera may predispose to hypertension and cardiovascular diseases.

Physico-chemical studies on adulteration of honey in Nigeria

The extent of adulteration of honey samples from various geographical locations in Nigeria was evaluated. In order to ascertain the quality and extent of adulteration of the honey samples, the total titrable acidity, brix content, pH, colour, viscosity, moisture content, total solids, ash content, hydroxymethyl furfural and microbiological analysis were carried out. Honey samples from Akwa-Ibom, Ondo and Ogun had a high hydroxymethyl furfural with coliforms and total bacteria counts being absent, while honey samples from Shaki, Yola and Ibadan had a low hydroxymethyl furfural and some total viable counts were present in them. These results indicate that honey samples from Akwa-Ibom, Ondo and Ogun were completely free of adulteration. However, honey samples obtained from Shaki, Yola and Ibadan were discovered to have undergone some form of adulteration.

A rapid situation assessment of sexual risk behaviour of alcohol users in Lagos, Nigeria

BACKGROUND

National sentinel surveys of HIV/AIDS among pregnant women in Nigeria have shown steady rise in prevalence from 1991 (1.8%) to 2001 (5.8%), which may reflect the pattern in the adult population in the country. The roles of known potential risk factors of the HIV/AIDS scourge in Nigeria deserve elucidation. This work aims to study the relationship between alcohol use and sexual risk behaviour.

PATIENTS AND METHODS

Rapid assessment technique involving qualitative and quantitative methods was employed. A multi-site design which made it possible to compare samples recruited in high and low density settings was used.

RESULTS

One hundred and nine of the alcohol users were recruited in the Low Density Area (LDA), while 130 were recruited in the High Density Area (HDA). In the HDA, 49 (53%) of the beer users used alcohol before sex either most or all of the time 21 (22.6%), or occasionally 28 (29.1%). Unlike the beer users less than half, 8 (42.1%), of Palm wine drinkers drank alcohol before sex. Beer users in the HDA used beer after sex with casual partners significantly more than the Palm wine drinkers (P = 0.036). Alcohol users in the LDA were more inclined to casual sex and they (54, 56.8%) believed that it had some or major role in their desire as well as performance of sex compared with users in the HDA (P = 0.005).

CONCLUSION

Irrespective of their socioeconomic class, ethnicity, religion and educational attainment alcohol users in the country indulge in high risk sexual behaviours that predispose them to infection with HIV and other sexually transmitted diseases.

Relapse precipitants in Nigerian drug abusers

OBJECTIVE

To determine the precipitants of relapse among patients admitted to a Psychiatric Hospital in Nigeria for substance abuse.

PATIENTS AND METHODS

A cross-sectional survey of consecutive admitted drug abuse patients was carried out at the Psychiatric Hospital, Yaba, Lagos, using Marlatt's categories to measure high risk situations for relapse.

RESULTS

Eighty-two subjects who were mostly male (87.9%), never married (53.7%), privately employed (58.5%), professionals (32%) with mean age 31.2 (+/- 6.56) years were evaluated. Most had used two or three different drugs. Coping with negative emotional states or enhancement of positive emotions were the main reasons for relapse determinants given by the subjects. Substance abuse management in Nigeria should embrace inquiries into these emotional states during both the admission and the post-discharge periods.

CONCLUSION

Routine use of Marlatt' relapse precipitant categories may be helpful in designing intervention strategies to sustain abstinence in Nigerian drug abuser.

Emotional reactions of relatives to schizophrenic patients in Lagos, Nigeria

Unlike what obtains in the developed countries, not much is known about the expressed emotions (EE) of the family to mental illness in developing nations, including Nigeria. Therefore, the objective of this study is to investigate the EE among family members to schizophrenics in Lagos, Nigeria. The Camberwell Family Interview was conducted with Nigerian family members of 19 schizophrenics whose symptoms were further ascertained using the Present State Examination. Sixty-three percent of the family sample showed high expressed emotions (HEE). The proportion of HEE families increased progressively with the number of previous hospitalization (r = 1, p = 0.000). The mean ratings of Critical Comment, Warmth and Positive Remarks were, respectively, 6.1 (+/- 3.8), 2.6 (+/- 0.9) and 2.2 (+/- 0.9) and 2.2 (+/- 1.3). The proportions of relatives showing Emotional Over-Involvement and Hostility were, respectively, 26.3% and 31.6%. The correlation between Warmth and Critical Comment was -0.39. The findings were compared with those of a key cross-cultural study of EE and the implications highlighted.

Specific psychiatric morbidity among diabetics at a Nigerian General Hospital

BACKGROUND

In Nigeria, with a rising incidence of diabetes mellitus (DM), there are no controlled studies of specific psychiatric morbidity among sufferers.

OBJECTIVE

To assess the prevalence of specific psychiatric disorders and general cognitive impairment in patients with diabetes mellitus.

METHOD

Using Wing's Present State Examination and the Mini-Mental State Examination, we assessed the prevalence of specific psychiatric disorders and cognitive impairment among 100 DM patients attending an out-patient clinic, in comparison with a matched non-clinic sample; and examined the relationship between psychiatric morbidity and clinical variables.

RESULTS

They were predominantly males (66%), mean age 43.0 years, mean duration of illness, 7.7 years and in low level occupations. Only 11 of the patients had sexual dysfunction (11%) and psychiatric symptoms (31%). Psychiatric diagnosis (ICD-10) were, generalised anxiety (6%) and mild depressive disorder (4%). Two had subjective memory disturbance. Insulin-dependent patients had significantly more widespread psychiatric symptoms than the non-insulin dependent. Psychiatric symptomatology was significantly associated with low occupational status, duration of illness and sexual dysfunction.

CONCLUSION

Health education, subsidizing the cost of treatment, and physicians' sensitivity to the emotional condition of patients, will help to relieve psychic distress and make for more adequate management.

Rehabilitation of heroin and cocaine abusers managed in a Nigerian psychiatric hospital

Eighty patients, managed primarily for heroin and cocaine dependence at the Drug Rehabilitation Unit of Psychiatric Hospital, Yaba, Lagos, were followed up monthly for a period of 12 months post-discharge and assessed with regard to continued substance use, employment status and illegal activities. The management package included full assessment, detoxification, treatment of associated physical conditions, group therapy sessions, occupational and vocational rehabilitation. The sample was predominantly male (91%), young adults (mean age 29.1 years; SD 5.99) and single (58%). Although 95% had some formal education, many were school drop-outs, and only 31.3% were gainfully employed. The majority (84%), used a combination of heroin and cocaine, almost all on a daily basis, mainly by smoking and "chasing the dragon" (95%). Other substances reportedly used preadmission were alcohol (22.5%), cannabis (76.3%) and tobacco (97.5%). Less than one half (43.8%) completed the minimum one month required for inpatient treatment. Only seven (8.7%) attended the follow-up clinic regularly, but all defaulters were assessed in their homes. The level of heroin, cocaine and cannabis use, as well as report of illegal activities, dropped sharply from the first month post-discharge, but started to rise again (albeit slowly) by the second half of the follow-up period. There was only a slight insignificant gain in employment status of patients during the follow-up period. The community-based management approach is strongly advocated as a way of addressing the several factors identified in this study as militating against the successful management of substance abusers.

Kleine-Levin syndrome: case report

A case of Kleine-Levin syndrome in a fourteen year old junior high school female student is described. The episodic disorder was characterised by excessive sleep, voracious appetite, irritability, confusion and electro-encephalographic changes. Remission was spontaneous. Prospects for organic aetiology, differential diagnosis, and the importance of early detection are discussed.

Comparative study of psychiatric morbidity among workers at a paint factory in Nigeria

Inspite of numerous reports on the neurobehavioural effects of paints, there have been no such studies from Nigeria, where there are now many paint factories. The general aim of this study was, to assess the prevalence of specific psychiatric morbidity among workers in a large paint manufacturing factory. Using the Psychiatric Assessment Schedule (PAS), 60 workers (mean age, 38.1) directly involved in paint manufacture, 60 administrative staff (mean age 41.1) in the factory, and 60 postal workers (mean age 37.7) were assessed. Although higher proportions of factory workers (80%), and postal workers (73.3%) had positive PAS scores compared with administrators (36.7%), there were no significant differences in mean PAS scores across the groups. Two subjects each of factory workers (agoraphobia and dysthymia) and postal workers (dysthymia and generalised anxiety) fulfilled DSM-IIIR criteria for specific diagnosis. However, the paint workers had a wider spread of PAS symptoms, were significantly more likely to experience the symptoms constituting neurasthenia, had many more psychological complaints, experienced a wider variety of spontaneously reported symptoms, and constituted the most frequent users of health services. They had no knowledge of the possible mental health effects of exposure to paint. This level of distress is comparable to many reported findings.

Financial cost of treating out-patients with schizophrenia in Nigeria

BACKGROUND

An assessment of the monetary costs of treating a group of Nigerian out-patients with schizophrenia, in comparison with insulin-dependent diabetics, was made.

METHOD

Fifty out-patients with schizophrenia (mean age 42.9) and 40 with diabetes (mean age 41.9), attending government hospitals in Lagos, were assessed at six-monthly intervals, for direct and indirect costs (US$ = 82 naira; minimum monthly wage = 500 naira).

RESULTS

Twenty (40%) of those with schizophrenia and eight (20%) of the diabetics had no income at all. The mean total cost of schizophrenia in six months (2941.4 naira) or US$ 35.9) was significantly less than that of diabetes (11,791 naira or US $143). The cost of antipsychotic drugs accounts for 52.8% of the cost of schizophrenia; insulin injections accounted for 92.8% of the total cost of diabetes. Patients with schizophrenia and their relatives suffered significantly more loss of working days. Cost of illness was not significantly correlated with age and duration of illness.

CONCLUSIONS

Because of drastic currency devaluation, and lack of disability benefits and nursing homes, the findings contrast with Western reports where cost of drugs constitutes 2-5%, and indirect costs constitute over 50% of the total cost of schizophrenia.

Folie-a-deux: report of two incidents

Two incidents of shared delusions are presented, one between two brothers and the other between an elderly couple. Their presentation and management are discussed. The possible role of projection and overvalued ideas as aetiological factors in Nigerians with shared delusions are highlighted.