Dr. Titilola S. AKINGBOLA

Basic Information

	Name: Dr. Titilola S. AKINGBOLA	Faculty: BASIC CLINICAL SCIENCES
	Email: This email address is being protected from spambots. You need JavaScript enabled to view it.	Department:Haematology
	Designation: Reader
Brief Biography:

Resume

I

• Name: Titilola Stella AKINGBOLA
• Date of Birth:                         7^th August 1962
• Department:                         Haematology
• Faculty: Basic Medical Sciences

II

• First Academic Appointment: Lecturer 1
• Present post (with date):             Senior Lecturer, 12 March, 2003
• Date of last promotion 01 October, 2003
• Date Last Considered for promotion Not Applicable

   III         University Education

a.    University of Ibadan, Ibadan                                      1981-1986

b.    National Postgraduate Medical College of               

       Nigeria (FMCPath)                                                    1991-1994

c.    West African College of Physicians                          1991-1998

d.     University of Ibadan  M.Sc                                       2001-2002

IV        Academic Qualifications

MB; BS (Medicine and Surgery)

University of Ibadan                                                   1986

M. Sc Epidemiology and Medical Statistics             2002

V         Professional Qualifications and Diplomas (with dates)

• Part I FMCPath 1994    National Postgraduate Medical College of Physicians
• FWACP (LAB MED) 1998 West African College of Physicians

VI        Scholarships, Fellowships and Prizes (with dates) in respect of Undergraduate and Postgraduate work only

• Global Health Fellowship Training as Medical Oncologist 2010

University of Chicago, Illinois, USA

• Cardiovascular Research Training (CaRT) Accra Ghana 2012
• Visiting Research Fellow in Stem Cell Transplant 2016

University of Chicago Illinois                                                                                                                      

VII      Honours, Distinctions & Membership of Learned Societies

• Nigerian Medical Association (NMA)             1986
• Nigerian Society for Haematology and Blood 1991

Transfusion (NSHBT)                                                                 

• Nigerian Society of Pathologists (NSP)             1993
• West African College of Physicians (WACP) 1998
• African Society for Blood Transfusion (ASBT) 2000
• International Aids Society 2006
• Member, Joanna Brigg’s International (JBI) 2007

Nigerian Team                                                                             

• Member, International Cancer Society 2008
• Member, Multidisciplinary Breast Tumor Group, Ibadan 2008
• Member, American Society of Haematology

(Membership Identity no. 1044139)                                            2010

VIII    Details of Teaching/ Work Experience

• Undergraduate
• Introductory courses - Blood groups in man, Transfusion reactions Erythropoiesis,

Blood film: Normal red cell, Red cell membrane abnormalities.

• Block I Posting: Burkitt’s Lymphoma, Multiple Myeloma, Acute lymphoblastic Leukaemia, Thromboembolic disorders, Acquired disorders of coagulation.
• Block II Posting: Acute myeloid leukaemias, chronic leukemia Laboratory investigation of bleeding disorders, laboratory diagnosis of multiple myeloma, inherited bleeding disorders and management.
• Block Posting Revision in Pathology and Pharmacology: Bone Marrow Transplantation, Acute Leukaemia, Transfusion Reactions.
• Block II Posting MBBS: Myeloproliferative Disorders (MPD), Megaloblastic Anaemia, Human Immunodeficiency Virus (HIV)
• Core lecture schedule for 400 Level MBBS/BDS students: Acquired bleeding disorders, Disseminated intravascular coagulopathies, Management of perioperative bleeding disorders

Broad Divisions of Topics taught at undergraduate level

• Coagulation: Inherited and acquired bleeding disorders, Haemostasis,
• Serology and blood transfusion: Blood safety, Blood groups in man, basic principles of cross match, Preparation of blood and blood products.
• Morphology in the normal individual and of basic haematological disorders all through the 3 postings: Leukaemias,

• Topics taught at post graduate level

HAE 705:       

Basic Haematology Practice, Biosafety Guidelines, Scope of Clinical Haematology,

Automation in Haematology, Stem Cell Transplantation, Principles of Cancer Chemotherapy I, Cytokines, Overview of Haemostasis, Quality Control in Haematology, Quality Control in Coagulation, Automation in Coagulation, Haematological Manifestations of HIV

• Administrative Duties
• Member, AIDS Surveillance Committee, Departmental Representative 1995
• Sub-Dean, Faculty of Basic Medical Sciences             2006 – 2010
• Consultant in charge of the Blood bank 2010
• Postgraduate Committee Representative (Postgraduate Coordinator) 2011 – till date

to the Department of Haematology

• Accreditation Representative to the West African College of Physicians 2011 – 2015
• Member, Ethics Committee UI/UCH Board (FBMS Representative) 2015 – till date

• Community Service

My contribution in this regard spans from interaction with professional groups, various religious bodies, non-governmental organizations (NGOs) and relief bodies over the old Western region.  I have formerly and informally interacted with my several generations of medical students as mentor, instructor or elder.

• Mentorship Programs
• Ladies Alert: I was a resource person for the Ladies Alert group which served as a mentorship platform for undergraduate young ladies in Queens Hall (2003)
• I have served and currently serve as mentor, instructor and elder for several generations of medical students and junior colleagues over the years.

• Health Awareness, Advocacy and Talks (Instructor Role)
• Universal Precautions: This was delivered to all ranks of workers in the University College Hospital between 1995 and 2005.
• Nutrition and HIV
• Knowing your Blood Groupsand Haemoglobin electrophoresis
• The power in the blood
• Menopause and its attending co-morbidities: Designed to give the women of the Gospel Group, Oritamefa, Ibadan some insight about their health, the attendant features and comorbidities associated with menopause.
• Educational Talk on Drug Abuse:Represented the Dean faculty of Basic Medical Sciences at a youth forum on the dangers of drug abuse.
• I also served severally as a resource person and facilitator for several health talks and health education programs over the years. Some of these previous activities include:

• Between 1990 – 2005 I gave several talks on HIV and AIDS to the following
• Oritamefa Baptist church
• Bodija Ashi Baptist Church
• Anglican Church @ Old Ife Road
• Toun Soetan Evangelical Ministry
• All Heads of Department at the instance of PEPFAR with emphasis on the right of the health professionals
• Management of sickle cell disease

Based on my research interest and works on sickle cell diseases, I was a resource person at the Doctors forum in the University Health Service and also the 2^nd CME for the National Association of Doctors in the University Health Services (NADUHS 2017)

• Community Health Outreaches
• Christian Medical Doctors Association: Free medical outreaches involving free consultation and free treatment are given periodically
• Bodija Ashi Baptist Church Medical Outreach Committee
• Under my leadership as Medical Chairperson (2013 - 2017), we organized on a quarterly basis medical outreaches to villages (Omilabu and Idia Ape preaching stations) and annually to foreign missions such as Togo, Lome
• Quarterly health talks to various churches on various topics such as: Know your figures, Drug misuse, Common skin disorders and hypertension

• Enhancing Donor Drive (Instructor Role)
• Annual Health Talks in various institutions, encouraging blood donation
• Chair, World Blood Day for the University College Hospital at least 5 years
• (1999, 2001, 2017, 2018)
• Chair Indigent committee of the welfare team: medical & Dental Association of Nigeria

Researches

a.         Completed Research

• Initial pain assessment in Sickle Cell Disease Patients with Pain crises
• CD4/CD8 Counts in Sickle Cell Disease patients in (a) Steady state (b) Pain Crises
• Microalbuminuria in Sickle cell disease subjects
• Haemoglobinopathy and Pregnancy
• Quality of life and assessment of disability in sickle cell disease patients in Ibadan.
• Knowledge, Attitude and Practice of Doctors, Nurses and Pharmacists to the use of hydroxyurea in sickle cell disease
• Knowledge, Attitude and Practice of health care workers towards Aphaeresis usage

• Research in progress
  • Differentiation between acute bone infarction and acute bone infection in sickle cell anaemia using serum monocyte chemo attractant protein – 1 (MCP-1) assay as a marker”.

Sponsorship:By the University Advancement Fund, awarded in 2011. My role is Co-Principal Investigator.  The aim of this study is to evaluate the effectiveness of serum monocyte chemoattractant protein – 1 (MCP-1) assay in predicting bone infection in Haemoglobin SS disease presenting with acute bone pain. This is an ELISA based study. A pilot study has been completed in January 2018. The results have been analyzed and awaiting publication. Sample collection for the main study is ongoing pending availability of funds.

• Quality of life in Sickle Cell Disease (2018), undergoing publication review.

• Expanded Coagulation Profile in Nigerian Children with Malaria versus Uncomplicated Malaria. Based on our findings in the previous study, Coagulation profile in children with cerebral malaria was completed in 1997 and published in 2006, Akingbola et al, there is need for scientific explanation to categorize and define the extent of coagulopathy in severe complicated malaria. Ethical approval is being processed. A pilot study is completed and a bigger study continues.

• The disease pattern and complications of the HbS+C cohort. The HbF distribution and its clinical correlates in Haemoglobin S+C in cohort will be estimated. Findings will be correlated with the phenotypes

• Dissertation and thesis
• The Coagulation Profile in Nigeria Children with Cerebral Malaria. Thesis FWACP (1998)
• Haematological Profile in Normal Pregnant Women in Nigeria. (M.Sc. Dissertation 2002)

Publications

• Books published: Nil
• Chapters in Books: Nil
• Conference Proceedings:
• Akingbola, T. S., Ezekekwu, C. A., Yaria, J., Saraf, S. L., Hsu, L. L., Cooper, R. S., Gordeuk, V. R., & Tayo, B. O. (2015). Assessment of Bone Marrow Function in Sickle Cell Anaemia Patients Using Corrected Reticulocyte Counts. 50% Contribution
• Patent: Nil

• Published Articles
• Kotila, T. R., Aken'ova, Y. A., Shokundi, W. A., Akingbola, T. S., & Fasola, F. A. (2001). Hodgkin's disease after treatment for Burkitt's lymphoma: case report. East African medical journal, 78(6), 334-336.(Kenya)25% Contribution

• Anetor J.I., Babalola O.O., Akingbola T.S., Adeniyi F.AA., (2002), “Observation on the Haemopoetic system in Tropical occupational plumbism and implication for our increasingly populated environment” Nigerian Journal of Physiological Science 17 (1-2), 9-15 (Nigeria) 35% Contribution

• Arowojolu, M. O., Dosumu, E. B., & Akingbola, T. S. (2002). The relationship between juvenile and non-juvenile periodontitis, ABO blood groups and haemoglobin types. African journal of medicine and medical sciences, 31(3), 249-252.(Nigeria) 35% Contribution

• Dosumu, E. B., Arowojolu, M. O., Akande, O. O., & Akingbola, T. S. (2002). Hematological values in juvienile periodontitis patients in Ibadan, Nigeria. African Journal of Biomedical Research, 5(3).(Nigeria) 35% Contribution

• Anetor, J. I., Ajose, F. I., & Akingbola, T. S. (2005). A Case of IgA Multiple Myeloma: nutritional perspective in diagnostic testing. Indian Journal of Clinical Biochemistry, 20(1), 193. (India) 40% Contribution

• Anetor, J. I., Akingbola, T. S., Adeniyi, F. A., & Taylor, G. O. (2005). Decreased total and ionized calcium levels and haematological indices in occupational lead exposure as evidence of the endocrine disruptive effect of lead. Indian journal of occupational and environmental medicine, 9(1), 15.(India) 40% Contribution

• Babalola, J. O., Babarinde, N. A., & Akingbola, T. S. (2005). Varying apparent rate constant: determination of uptake and release of protons during tetramer-dimer dissociation in human hemoglobin A. The Italian journal of biochemistry, 54(3-4), 240-247. (Italy) 30% Contribution

• Akingbola, T. S., Adewole, I. F., Adesina, O. A., Afolabi, K. A., Fehintola, F. A., Bamgboye, E. A., Aken'ova, Y. A., Shokunbi, W. A., Anwo J. A., & Nwegbu, M. M. (2006). Haematological profile of healthy pregnant women in Ibadan, south-western Nigeria. Journal of obstetrics and gynaecology, 26(8), 763-769.(United Kingdom) 60% Contribution

• Akingbola, T. S., Shokunbi, W. A., & Olumese, P. E. (2006). Coagulation profile in Nigerian children with cerebral malaria. The Nigerian postgraduate medical journal, 13(3), 195-199.(Nigeria) 60% Contribution

• Anetor, J. I., Ajose, O. A., Adebiyi, J. A., Akingbola, T. S., Iyanda, A. A., Ebesunu, M. O., Babalola, O. O., Aadeniyi, F. A. A. (2007). Decreased thiamine and magnesium levels in the potentiation of the neurotoxicity of lead in occupational lead exposure. Biological trace element research, 116(1), 43-51.(Mexico) 30% Contribution

• Anetor, J. I., Asiribo, O. A., Adedapo, K. S., Akingbola, T. S., Olorunnisola, O. S., & Adeniyi, F. A. A. (2007). Increased plasma manganese, partially reduced ascorbate, 1 and absence of mitochondrial oxidative stress in type 2 diabetes mellitus: implications for the superoxide uncoupling protein 2 (UCP-2) pathway. Biological trace element research, 120(1-3), 19-27. (Mexico) 25% Contribution

• Anetor, J. I., Ajose, F. O., Babalola, O. O., Akingbola, T. S., & Adeniyi, F. A. A. (2007). Altered calcium metabolism: The probable major biochemical lesion in many pathological and clinical states of lead toxicity. Journal of Biomedical Investigation, 5(1), 9-16.25% Contribution

• Anetor, J. I., Durojaiye, O. O., Iyanda, A., Adeniyi, F. A., Agbedana, E. O., &Akingbola, T. S. (2006). A basic investigation for inherited metabolic diseases: indication for genomic approach. Journal of Biomedical Investigation, 4(1), 23-27.(Nigeria) 20% Contribution

• Durosinmi M. A., Faluyi, J. O., Oyekunle, A. A., Salawu, L., Adediran, I. A., Akinola, N. O., Bamgbade, O. O., Okanny, C. C., Akanmu, S., Ogbe, O. P., Wakama, T. T., Nwauche, C. A., Enosolease, M. E., Halim, D. N. K., Bazuaye, G. N., Okocha, C. E., Olaniyi, J. A., Akingbola, T. S., Mabayoje, V. O., Raji, A. A., Mamman, A., Kuliya-Gwarzo, A., Ibegbulam, O. G., Ocheni, S., Tanko, Y., Arewa, O. P., Bolarinwa, R. A. A., Kassim, D. O., Ndakotsu, M. A., Amusu, O. A., Akinyanju, O. O., (2008). The use of Imatinib mesylate (Glivec) in Nigerian patients with chronicmyeloid leukemia. Cellular Therapy and Transplantation (USA) 35% Contribution

• Otegbayo, J. A., Taiwo, B. O., Akingbola, T. S., Odaibo, G. N., Adedapo, K. S., Penugonda, S., Adewole, I. F., Olaleye, D. O., Murphy, & R., Kanki, P. (2008). Prevalence of hepatitis B and C seropositivity in a Nigerian cohort of HIV-infected patients. Annals of hepatology, 7(2), 152-156. (Mexico) 30% Contribution

• Oladokun, R., Brown, B. J., Osinusi, K., Akingbola, T. S., Ajayi, S. O., & Omigbodun, O. O. (2008). A case of human bite by an 11-year old HIV positive girl in a paediatrics ward. African journal of medicine and medical sciences, 37(1), 81-85.Nigeria 25% Contribution

• Falade, C. O., Nash, O., Akingbola, T. S., Michael, O. S., Olojede, F., & Ademowo, O. G. (2009). Blood banking in a malaria-endemic area: evaluating the problem posed by malarial parasitaemias. Annals of Tropical Medicine & Parasitology, 103(5), 383-392. (United Kingdom) 40% Contribution

• Okunlola, M. A., Olutayo, A. A., Okonkwo, N. S., &Akingbola, T. S. (2010). Pattern of contraceptive use among women with sickle cell disease in Ibadan, South-west Nigeria. Journal of Obstetrics and Gynaecology, 30(2), 171-174.(United Kingdom) 25% Contribution

• Adesina, O., Oladokun, A., Akinyemi, O., Akingbola, T., Awolude, O., & Adewole, I. (2011). Risk of anaemia in HIV positive pregnant women in Ibadan, south west Nigeria. African journal of medicine and medical sciences, 40(1), 67-73.(Nigeria) 30% Contribution

• Akingbola, T. S., Kolude, B., Aneni, E. C., Raji, A. A., Iwara, K. U., Aken’Ova, Y. A., & Soyannwo, O. A. (2011). Abdominal pain in adult sickle cell disease patients: A Nigerian experience. Annals of Ibadan postgraduate medicine, 9(2), 100-104. (Nigeria) 50% Contribution

• Ayede, A. I., &Akingbola, T. S. (2011). Pattern, indications and review of complications of neonatal blood transfusion in Ibadan, southwest Nigeria. Annals of Ibadan postgraduate medicine, 9(1), 30-36. (Nigeria) 50% Contribution

• Oluwasola, A. O., Olaniyi, J. A., Otegbayo, J. A., Ogun, G. O., Akingbola, T. S., Ukah, C. O., Akang, E. E., & Aken'Ova, Y. A. (2011). A fifteen-year review of lymphomas in a Nigerian tertiary healthcare centre. Journal of health, population, and nutrition, 29(4), 310. 20% Contribution

• Otegbayo, J.A., Akingbola, T.S., Akinyemi, J.O., Adedapo, K.S., Odaibo, G.N., Aken Óva, Y.A., Olaleye, D.O., Adewole, I.F., Murphy, R., Kanki, P., (2011). Immunovirological and Biochemical Changes in Nigerian Patients with Hepatitis B Coinfection on Antiretroviral Therapy. World Journal of AIDS, 1, 31–36. (Italy) 35 % Contribution

• Akinlolu, A., Akingbola, T., & Salau, B. (2012). Lipid peroxidation in Nigerians affected with haematological malignancies. African journal of medicine and medical sciences, 41, 145-148.(Nigeria)35% Contribution

• Obajimi, M. O., Ajayi, I. O., Oluwasola, A. O., Adedokun, B. O., & Sofoluwe, A. T. & Olopade, OI (2013). Level of awareness of mammography among women attending outpatient clinics in a teaching hospital in Ibadan, South-West Nigeria. BMC Public Health, 13, 40.(United State of America) 20% Contribution

• Akingbola, T. S., Tayo, B. O., Salako, B., Layden, J. E., Hsu, L. L., Cooper, R. S., Gordeuk, V. R., & Saraf, S. L. (2014). Comparison of patients from Nigeria and the USA highlights modifiable risk factors for sickle cell anemia complications. Hemoglobin, 38(4), 236-243. Italy 50% Contribution

• Tayo, B. O., Akingbola, T. S., Salako, B. L., McKenzie, C. A., Reid, M., Layden, J., Osunkwo, I., Plange-Rhule, J., Luke, A., Durazo-Arvizu, R. & Cooper, R. S. (2014). Vitamin D levels are low in adult patients with sickle cell disease in Jamaica and West Africa. BMC hematology, 14(1), 12. (United Kingdom) 45% Contribution

• Odunukwe, N. N., Madu, J. A., Nnodu, O. E., Akingbola, T. S., Asuquo, I. M., Balogun, M. T., Olufela, K. O., Chinawaeze, A. J., Orkuma, J. A., Dalhat, G. G., & Otobo, U. I. (2015). Multiple myeloma in Nigeria: a multi-centre epidemiological and biomedical study. Pan African Medical Journal, 22(1).(Kenya) 35% Contribution

• Orimadegun, A. E., &Akingbola, T. S. (2015). Routine administration of intravenous calcium during exchange blood transfusion for treatment of severe neonatal hyperbilirubinaemia: a systematic review of quantitative evidence protocol. JBI database of systematic reviews and implementation reports, 13(1), 134-145. (Australia) 50% Contribution

• Akingbola, T. S., Yuguda, S., Akinyemi, O. O., & Olomu, S. (2016). Awareness and distribution of ABO, Rhesus blood groups and haemoglobin phenotypes among medical undergraduates in a Nigerian university. African journal of medicine and medical sciences, 45(3), 275-280.(Nigeria) 60% Contribution

• Akingbola, T.S., Bello, O.O., (2016). Obstetric Emergencies and Transfusion Needs in a Nigerian Hospital. Hematology & Transfusion International Journal 2(6). (United Kingdom) 60% Contribution

• Bassey, O.S., Soyemi, O., Adeniji-Sofoluwe, A., Adeoye, A.O., Mosuro, O., Akingbola, T.S., Osofundiya, O.O., Obajimi, G.O., Oluwasola, A.O., Obajimi, M.O., Olopade, O.I., (2016). Mammographic breast pattern in postmenopausal women in Ibadan, south-western Nigeria. British Journal of Medicine & Medical Research 17, 1–10. (United Kingdom) 20% Contribution

• Dedey, F., Wu, L., Ayettey, H., Sanuade, O. A., Akingbola, T. S., Hewlett, S. A., & Adanu, R. (2016). Factors associated with waiting time for breast cancer treatment in a teaching hospital in Ghana. Health Education & Behavior, 43(4), 420-427. (United States) 30% Contribution

• Oladele, F., Charles-Davies, M., Akingbola, T.S., Adeniyi, F., (2016). The interactive roles of some toxic metals, micronutrients, antioxidant vitamin and sex hormones in Nigerians with sickle cell disease. British Journal of Medicine and Medical Research 12, 1–10. (United Kingdom) 30% Contribution

• Anetor, J. I., Udah, D., Akingbola, T. S., Anetor, G. O., Babalola, O. O., Igharo, O. G., Uche, C. Z., Adeniyi, F. A. A. (2016). Upregulation of gamma-glutamyl-transpeptidase activity and uric acid level in mixed chemical exposure: implications for mutagenic and preneoplastic events. International Journal of Biological and Chemical Sciences, 10(6), 2655-2666. 30% Contribution

• Oluwayelu, D., Adebiyi, A., Abiola, J., Akingbola, T., & Cadmus, S. (2017). Serological evidence of hepatitis e virus activity among slaughtered pigs and in selected pig farms in Ibadan, Nigeria: Implications for zoonotic transmission Tropical Veterinarian, 35(3), 91-100.Nigeria20% Contribution

• Saraf, S. L., Akingbola, T. S., Shah, B. N., Ezekekwu, C. A., Sonubi, O., Zhang, X., Hsu, L. L., Gladwin, M. T., Machado, R. F., Cooper, R. S., Gordeuk, V. R., & Tayo, B. O. (2017). Associations of α-thalassemia and BCL11A with stroke in Nigerian, United States, and United Kingdom sickle cell anemia cohorts. Blood advances, 1(11), 693-698.(United State of America) 35% Contribution

• Akingbola, T. S., Fasola, F., Khadijat, A., T, A., Anyanwu C. (2018). Red Cell Exchange Transfusion in Sickle Cell Anaemia Patients at the. Journal of Blood Disorders & Transfusion 9(1) 1-5Accepted March 08, 2018, Published March 15, 2018. 55% Contribution

• Ezekekwu, C. A., Kotila, T. R., Akingbola, T. S., Lettre, G., Gordeuk, V. R., Cooper, R. S., & Tayo, B. O. (2018). Sickle Cell Disease Clinical Trials and Phenotypes. Journal of tropical diseases & public health, 6(2). Accepted March 31, 2018 published April 08, 2018. 40% Contribution. I was acting in mentoring capacity to the first 2 authors here.
• Tayo, B. O., Akingbola, T. S., Saraf, S. L., Shah, B. N., Ezekekwu, C. A., Sonubi, O., Hsu, L. L., Cooper, S. R., & Gordeuk, V. R. (2018). Fixed Low‐Dose Hydroxyurea for the Treatment of Adults with Sickle Cell Anemia in Nigeria. American journal of hematology. (Accepted May, 2018) (United State of America) 50% Equal Contribution by 1^st and 2^nd authors, also corresponding author

• Akingbola T.S., Akinyemi O.O., Amodu O.O., and Tayo B.O., (2018). Sickle Cell Disease Management in Nigeria: Understanding the challenges from the Physicians Perspectives. African Journal of Medicine and Medical Sciences Vol 93(8), (Accepted 26 September, 2017) (Nigeria) 60% Contribution

• Busari, O. E., Ojo. O.T., &Akingbola, T. S. (2018) Bacteria Contamination of Blood and Blood Components: Reducing the risks in Nigeria. International Blood Research and Reviews 8 (2), 1-7, (Accepted 2^nd July 2018) 30% Contribution

• Aisabokhale F. A., Akingbola T. S., Kolude B., (2018), D-dimer as a Predictor of Thromboembolic Disorder in HIV/AIDS Patients in Nigeria. Nigerian Journal of Physiological Sciences (Accepted July 2018) Corresponding author, did most of the workContribution, Corresponding author (Nigeria) 60% Contribution

• Akingbola, T. S., Adeoye, A. O., Akinwunmi, A. O., (2018). Management of essential thrombocythemia in a resource - limited country; A Nigerian Case study. Annals of tropical pathology. Vol9(2), 167-171(July – December Edition) (Nigeria) 60% Contribution

* Papers published after last promotion

XI.      Major Conferences Attended and Papers Presented (In the past 5 years)

• 59^thAmerican Society for Hematology 2017 in Atlanta Georgia Dec1 - 4.

Paper presented “Low Fixed Dose Hydroxyurea in Resource Limited Region”

• 58^th American Society for Hematology 2016 in San Diego Dec. 5- 8.

Paper presented “Hydroxyurea in Adult Sickle Cell Disease in South West Nigeria”

• 57^th ASH Annual meeting and Exposition @San Diego, CA, December 3-6, 2016
• 5^th University of Ibadan Conference of Biomedical Research, Faculty of Basic Medical Sciences College of Medicine, Ibadan. In Collaboration with Archives of Basic and Applied Medicine. Theme: Biotechnology for Health July 12 – 15, 2016. Sustainable Development Training of Reviewers and Ethics Committee Members, June 28-30, 2016.

Oral Presentations:

i.        ObstetricEmergencies and Transfusion Needs in a Nigerian Hospital

ii.       Red Cell Exchange Transfusion in Sickle Cell Anemia Patient at The University College Hospital, Ibadan: A Preliminary Report

• 9^th annual Sickle Cell and Thalassaemia Advanced Conference @ Hilton London Tower Bridge Hotel 7^th-9^th October, 2015. Poster Presentation: Quality of life in Sickle Cell Disease
• 57^th ASH Annual meeting and Exposition @ Orlando, Florida, December 5-8, 2015
• H3Africa Sickle Cell Disease Meeting, 7^th November, 2014. Dar-Es Salaam, Tanzania. Poster Presentation: Microalbuminuria in Sickle Cell Disease
• 9^th International African Organization for Research & Training in Cancer Conference (AORTIC) 20 – 24^th November, 2013. Durban South Africa
• 39^th Scientific Conference of the Nigerian Society for Haematology & Blood Transfusion Sheraton Lagos, Nigeria. Participated in Pre-Conference Educational Programme held @ LUTH, 17-18^TH September, 2012.
• 39^th Scientific Conference of the Nigerian Society for Haematology & Blood Transfusion Sheraton Lagos, Nigeria. Participated in the main Conference Educational Programme held @ LUTH, 19-20^TH September, 2012.
• National Association of Medical Educators Ibadan 2012: Facilitator @ the 1^st National Medical Education Conference 20 -21^st September, 2012 @ the University College Hospital, Ibadan.

Ten Publications That Best Reflect My Contribution to Scholarship in Haematology

• Akingbola T.S., Adewole I.F., Adesina O.A., Afolabi K.A., Fehintola F.A., Bamgboye E.A., Aken’Ova Y.A., Shokunbi W.A., Anwo J.A., Nwegbu M.M., (2006), Haematological profile of healthy pregnant women in Ibadan, South-western Nigeria. The Journal of Obstetrics and Gynaecology, Vol. 26(8), 763-769 (United Kingdom) 60% Contribution

• Akingbola T.S., Shokunbi W.A., Olumese P.E.,(2006), Coagulation Profile in Nigerian Children with Cerebral Malaria Nigerian, Postgraduate Medical Journal, 13 (3) (Nigeria) 70% Contribution

• Akingbola T. S., Kolude B., Aneni E.C., Raji A.A., Iwara K.U., Aken’ Ova Y.A., and O.A., Soyanwo (2011). Abdominal Pain in Adult Sickle Cell Disease Patients: A Nigerian experience. Annals of Postgraduate Medicine Vol 9 (2), 100-105 (Nigeria) 50% Contribution

• Ayede A. I., & Akingbola T. S., (2011). Pattern, complications and review of Neonatal Blood transfusion in Ibadan, southwest Nigeria. Annals of Ibadan Postgraduate Medicine, vol. 9 (1), 30-36. (Nigeria) 45% Contribution.

• Akingbola, T.S., Tayo, B.O., Salako, B., Layden, J.E., Hsu, L.L., Cooper, R.S., Gordeuk, V.R., Saraf, S.L., (2014). Comparison of patients from Nigeria and the USA highlights modifiable risk factors for sickle cell anemia complications. Hemoglobin 38 (4), 236–243. Italy50% Contribution

• Akingbola, T.S., Yuguda, S., Akinyemi, O.O., Olomu, S., (2016). Awareness and distribution of ABO, Rhesus blood groups and haemoglobin phenotypes among medical undergraduates in a Nigerian university. African Journal of Medicine and Medical Sciences 45, 275–280. (Nigeria) 60% Contribution

• Akingbola, T.S., Saraf, S.L., Shah, B.N., Ezekekwu, C.A., Sonubi, O., Hsu, L.L., Cooper, R.S., Gordeuk, V.R., Tayo, B.O., (2016). Hydroxyurea for Treatment of Sickle Cell Disease in Adults in Africa. Blood 1305 (Washington DC) 60% Contribution

• Akingbola T.S., Akinyemi O.O., Amodu O.O., and Tayo B.O., (2018). Sickle Cell Disease Management in Nigeria: Understanding the challenges from the Physicians Perspectives. African Journal of Medicine and Medical Sciences (Accepted 2017) (Nigeria) 60% Contribution

• Aisabokhle, F. A., Akingbola, T. S., Kolude, B., D-Dimer as a Predictor of Thromboembolic Disorder in HIV/AIDS Patients in Nigeria, Nigerian Journal of Physiological Sciences (Accepted July 2018) Corresponding author Nigeria 60% Contribution

• Tayo B.O., Akingbola T.S., Saraf S.L., Shah B.N., Ezekekwu C.A., Sonubi O., Hsu LL, Cooper RS, Gordeuk VR (2018). Fixed Low-Dose Hydroxyurea for the Treatment of Adults with Sickle Cell Anemia in Nigeria. American Journal of Haematology (Accepted, in press) (United State of America) 50% Equal Contribution by 1^st and 2^nd authors, also corresponding author.

Grouping of Articles

I have contributed in publications to five major areas of haematology, namely: Haemoglobinopathy, Haemopoiesis, Blood banking and Transfusion (Transfusion Transmissible Infections), Oncology and Coagulation.

• Haemoglobinopathy (Sickle cell disease) (19, 21, 27,28, 35, 38, 39, 40, 41, 42 constitutes 24.44 % of the publications)

Sickle cell anaemia (SCA), the most deleterious form of SCD constitutes a quarter (25%) of my Articles.  Our findings (in article 27) showed  that higher values for BMI and BP in Chicago SCA patients may contribute to an increased risk of stroke and highlights the need for measures to reduce these risk factors. Lower pneumococcal vaccination and HU therapy rates in Ibadan SCA patients supports  the need for more improved vaccination coverage and for studies to define the role of HU therapy in Africa.  The first clinical trial on HU in  adults sickle cell patients in sub Saharan Africa, (article 41) by the end of 24 weeks of hydroxyurea therapy revealed  median increases in the hemoglobin concentration of 5 g/L, hematocrit of 1.1% and MCV of 8.4 fl (P < 0.001) and body weight of 1.3 kg (P = 0.061). There were median decreases in the white blood cell count of 1200/μL (P = 0.013), in neutrophils of 900/μL (P = 0.086) and in platelets of 56 000/μL (P = 0.001). Our  median (IQ range) hemoglobin F was 4.0% (2.6-6.6%) at baseline which increased to 9.8% (6.9–13.0%) during therapy (P < 0.001). One patient experienced an increase in hemoglobin F from 8.0% to 26.4%. During the observation period off hydroxyurea, there were trends to decrease rather than increase  hematocrit and MCV and hemoglobin F, and the other parameters did not change significantly. Hydroxyurea therapy for SCA increases hemoglobin F, reduces pain crises, acute chest syndrome and blood transfusions, and possibly increases survival.  Neutropenia and thrombocytopenia are limitations to achieving the maximal doses are prescribed; frequent blood count monitoring is required.  Our findings in the HU trial compared favourably with the MSH study (escalated dosing), we concluded that the low fixed Hydroxyurea 500mg/day is efficient and cost effective. Hydroxyurea has however just been licensed for children with SCA in the US so a similar study should be projected in children. 

Awareness of contraception (Article 19) is demonstrated in our evaluation of SCD patients, uptake remains low with a prevalence of 15.3% which is comparable to 11.1% in the general populace. Two thirds of the SCA population studied are singles and many of the respondents married late because they are perceived  to be unhealthy. We proposed the need for continuous health education to dispel fears associated with contraception, need for child spacing and encouragement to limit the family size in sickle cell disease.

In our retrospective study (Article 21) of abdominal pain there was no significant difference between the steady state PCV and the PCV during the acute abdominal pain episodes. Final diagnosis showed that only 38.8% of the patients had vasoocclusive crises and the reliability index between the provisional diagnosis and the final diagnosis was 67%. Abdominal pain in SCD is heterogeneous with diverse differential diagnoses.  We concluded that not all abdominal pains in SCD are due to vasoocclusive crises hence early diagnosis and prompt treatment can be lifesaving. 

The bone marrow function in 92 steady state SCA patients, 40 (43.5%) who had corrected reticulocyte count <2.5% were older (p: 0.013), taller (p: 0.041) with  higher Aspartate transaminase (AST) levels (p:0.006) than those with corrected counts >2.5%  (52 (56.5%).  CBC parameters were not different between both groups.   Reticulocytosis a feature of poor prognosis in SCA was not a remarkable feature in the cohort of SCA studied. Reticulocyte counts using the coulter counter shall be repeated in SCD.

A qualitative cross-sectional study (Article 42) on SCD  management in Nigeria: understanding the challenges from the physicians’ perspectives, respondents (physicians) were of the opinion that SCD patients and their families face myriads of challenges in Nigeria ranging from medical (frequent illnesses and crises and slow growth. i.e. bone pains, recurrent anaemia, malaria, chronic leg ulcer and even risk of HIV and Hepatitis B from frequent blood transfusion), Psychological (lack of confidence, marital stigmatization and drug dependency and addiction depression), social (school or work absenteeism due to frequent illnesses, employability and hence income and ability to pay for healthcare, challenges with relationships etc.) and even that of poor health systems (lack of infrastructures, and poor management of already existing ones) to address their needs. The knowledge gap in the community about the disease (SCD) should be bridged. Effective workplace policy to protect persons living with SCD from discrimination is recommended.

Our  work on micronutrients (35)showed low levels of zinc, copper, selenium and vitamin E in sickle cell disease, this in addition to the findings of low levels of testosterone, oestradiol may suggest that the oxidative stress showed by the low levels of micronutrients could be the link to the subfertility found in sickle cell disease. We suggested supplementation with micronutrients in the management of this disorder. Analysis of serum samples of steady state SCD (Article 28),  20 Jamaicans and 50 West Africans with sickle cell disease mean values of 25(OH)D were 37% and 39% lower than controls, respectively. Metabolic abnormalities in the absorption and conversion pathways are possible causes for the consistent relative deficiency of 25(OH)D in sickle cell disease. Deficiencies of zinc and vitamin E malabsorption have been reported in SCD. The study also reported the antisickling effectiveness of Cu, Zn and antioxidant Vitamin E, which may be important in the management of SCD. Zn, Cu and Vitamin E levels in this study were significantly lower, while She was higher in both male and female cases compared with controls (P<.006). Cu, Se, Zn and Vitamin E, which have been found to effectively relieve the oxidative stress that prevails in SCD, are deficient in these patients. Growth failure is the most frequent endocrine abnormality observed in patients with SCD.

Children with SCD have significantly decreased height, weight, and BMI when compared with healthy, control subjects of comparable age, sex, and ethnicity. In this present study, the mean body weight and BMI were significantly reduced in both male and female cases compared with their respective values in the control group. Body weight correlated positively with testosterone in male cases while estrogen at the luteal phase correlated significantly with height in FSCD. Reduced levels of testosterone in MSCD were observed in this study. Our observations confirm androgen deficiency consistent with the primary. In conclusion low levels of circulating zinc, copper, vitamin E, testosterone and estradiol are present in SCD patients.

A high-risk genetic profile is associated with increased hemolysis and stroke history in 3 independent cohorts. In Article 39,investigation of a high-risk genetic profile, defined as SCA patients who did not inherit either a-thalassemia or the BCL11A rs1427407 T allele, had stronger associations with clinical and laboratory variables(increased markers of hemolysis-high reticulocytes and stroke history,  but no association with frequent vasoocclusive crises >3 per year) than the individual genetic components in the University of Ibadan cohort when compared with two other cohorts Chicago and Walk- Treatment of Pulmonary Hypertension and Sickle Cell Disease with Sildenafil Therapystudy (Walk-PHaSST). This profile may help identify patients to prioritize for HU and for closer monitoring strategies for stroke.

Similarly, SCD patients may experience psychological challenges, according to the respondents, due to the frequent illnesses, discrimination suffered as well as stigmatization. Some respondents submitted that there is still The knowledge gap in the community about sickle cell disease should be bridged through constant health education in order to alleviate stigma. There is also a need for an effective policy to protect persons living with SCD from discrimination in the labor market as well as the workplace.

Knowledge of blood group and haemoglobin phenotypes among medical students was found to be poor. Only 43.9% of the participants knew their blood groups while less than a third (29.7%) knew their haemoglobin phenotypes. knowledge of both their blood groups and haemoglobin phenotypes was documented in as low as 20.6% of the respondents. The frequency of haemoglobin AA, AS, AC and CC were 78.0%, 16.8%, 3.9% and 1.3% respectively. Similarly, the distribution of blood groups were: O Rh D positive – 47.8%; O Rh D negative – 1.9%; A RhD positive – 21.9%; A Rh D negative – 1.3%; B Rh D positive – 23.2%; B Rh D negative -1.3% and AB Rh D positive – 2.6%.   Participants who had previously donated blood and those who were females were more likely to know their blood groups and haemoglobin phenotypes respectively (p<0.05).

In line with the furtherance of research work, emphasis on other aspects haemoglobinopathies such as quality of life in sickle cell disease, sickle cell disease and pregnancy have been completed. More ongoing research on second commonest type of haemoglobinopathy.

• Serology (Blood banking and Transfusion and Transfusion Transmissible Infections and HIV related disorders: Articles 4,16,17,18,20,22,24,30,37,43 constitutes 24.44% of my research work)

The emergence and wide dissemination of drug-resistant malarial parasites as captured in article 18, underscores the need to prevent post-transfusion malaria. In Nigeria, as in most of sub-Saharan Africa, however, blood donors are not routinely screened for malarial infection. Recently, 391 consecutive potential blood donors in a malaria-endemic area of south–western Nigeria were each checked for malarial parasitaemia using three methods: microscopy (all samples), OptiMAL (315 samples) and/or the Clinotech Malaria Cassette (142 samples). OptiMAL detects parasite-specific lactate dehydrogenase whereas the Clinotech test detects the surface proteins of merozoites and sporozoites. Microscopy revealed parasitaemias in 79 (20.2%) of the potential donors, the levels of parasitaemia varying from 34 to 6289 asexual parasites/ml (mean5445/ml). The prevalence of malarial parasitaemia, as detected by microscopy, was significantly higher during the rainy season than in the dry season (27.3% v. 5.5%; P,0.0001).

Therefore, with no significant association between patients’ parasitaemia and fever (i.e. an axillary temperature >37.5uC), blood group, gender or anaemia, the corresponding prevalences of malarial parasitaemia detected using the rapid diagnostic tests were 3.8% (12/315) for OptiMAL and 57.8% (82/142) for the Clinotech. With the results of the microscopy used as the ‘gold standard’, OptiMAL gave a sensitivity of only 16.0% but a specificity of 98.5%. The corresponding values for the Clinotech tests were 69.2% and 50.0%, respectively. Screening for malaria parasitaemia in the routine investigation of potential blood donors in Nigeria, especially during the rainy season, when the risk of transfusion-transmitted malaria appears relatively high.

The relationship between juvenile and non-juvenile periodontitis (JP, non-JP), ABO blood groups and haemoglobin type (Article 4). Forty Nigerian adolescent individuals were investigated, twenty of which were diagnosed as having JP while the remaining 20 were diagnosed a having plaque-induced chronic periodontitis (nonJP).  All the JP patients were either of blood group B/AB, rhesus positive while the non-JP subjects had B rhesus positive/negative, O rhesus positive/negative or AB rhesus positive. The differences between the results of the test and the control groups were statistically significant P < 0.05. All the forty subjects (JP and non-JP) had the haemoglobin type A and none of them exhibited the S and C haemoglobin types. Further molecular studies is required.

Furthermore, our study in Article 22 reveals there is a huge need for blood transfusion in the new born particularly due to the reduced marrow activity in the neonatal period. Despite widely use of blood products in the neonatal period, there is paucity of local data. The study evaluated the blood transfusion indications and patterns in special care baby unit and C12nd of University College Hospital, Ibadan, Nigeria. Our results from 100 neonates recruited for the study, with a male: female ratio of (M: F= 1:1), age range 2–34 days and weight range between 0.8kg to 3.6 kg with a mean weight of 1.64kg. The main indications for transfusion were anaemia from prematurity & neonatal sepsis (NNS) 46%; (red cell replacement), NNS, Disseminated intravascular coagulation (DIC) & anaemia 24%; (partial exchange + top up + Fresh frozen plasma), neonatal jaundice (NNJ) & anaemia 14%; (whole blood), NNJ, NNS + anaemia 6% (Blood transfusion + Fresh frozen plasma), NNS + anaemia 10% (whole blood).

With reference to article 30, Neonatal hyperbilirubinemia is an abnormally high level of bilirubin in the circulating blood, resulting in clinically visible icterus or jaundice. A serum bilirubin level above 5 mg per dL (86 μmol per L) is a frequently encountered problem worldwide and is a common reason for neonates to present to the emergency department.Blood transfusion is still frequent in the study area and prematurity, neonatal sepsis and jaundice rank high in the indications (Articles 22 and 30). Transfusion reactions are rare in the evaluated neonates.

Finally, in our study on Obstetric Emergencies and Transfusion Needs in a Nigerian Hospital, (article 32 ) the majority of patients receiving transfusion are given to otherwise healthy women in response to undiagnosed obstetric haemorrhage. The study explored the needs and blood transfusion rate among obstetrics patients at the University College Hospital (UCH), Ibadan to provide insights into the rationale behind such practices.

Though the overall obstetric transfusion rate was lower than that of comparable facilities, the transfusion rate among patients receiving CS was markedly high. The majority of transfused obstetric patients had complications resulting in anaemia, while haemorrhage propagated the second highest number of cases requiring transfusion.

Transfusion transmissible infections i.e. malaria, hepatitis B, were evaluated. (Articles 16, 17, 18, 20, 24, 37) The use of post exposure prophylaxis in HIV was reported in the case of human bite by an advanced AIDS case in article 17. We reported that HIV and AIDS is feminized in our setting and similarly  a relatively high prevalence of HBV and HCV co-infection in general, and a higher rate of HBV co-infection among males than females. Pre-treatment CD4 count was significantly lower among those with HCV co-infection, while ALT was slightly higher among those with HBV co-infection.

Virological responses were not different in the treatment naïve HIV HBV negative versus HBV positive (Article 24). The median CD4 count for the HBsAg negative was 104 cells/(mm3 IQR 34-171) and it was significantly higher than those of the positive (91 cells/mm3) (p <0.05). ALT and AST were higher among HBsAg positives, while urea and creatinine levels were similar. The median change in CD4 count from baseline and during the course of therapy were similar in the two groups. In conclusion no significant difference in the rate of CD4 recovery and HIV-RNA decline in among coinfected and monoin-fected HIV patients at different stages of therapy.

• Haematopoesis (3,4,5,7,8,9,11,13 constitutes 17.7% of my publications)

 

The haemopoietic systemwas one of the earliest principal targets of lead (Pb) to be  studied but largely from temperate developed countries. This study reports investigations, into the haemotobiochemical variations associated with occupational Pb poisoning in a tropical developing country.The lead workers classified according to exposure categories based on the prevailing air lead level (PbA) at the occupational environment were  studied  (Article 3);  revealed that Blood lead (PbB) was significantly higher in lead workers than in controls (P<0.001). The PbB of controls (occupationally unexposed) was also significantly higher than in communities that have either reduced or eliminated lead from petrol. Erythrocyte protoporphyrin (EPP) and porphobilinogen (PBG) were similar in lead workers and controls. The haem degradative product bilirubin was unlike EPP and PBG higher in controls (P<0.05). Indices of iron (Fe) homeostasis, serum Fe, total iron binding capacity (TIBC), transferrin, and percentage Fe saturation did not differ between lead workers and control (P>0.05) in all cases. There was also no alteration in RNA metabolism as indicated by the absence of basophilic stippling in the erythrocytes of lead workers, compared with control (P<0.001) in all cases. In contrast, the haem cofactor metals, copper (Cu) and Zinc (Zn) levels were significantly elevated in lead workers compared with controls (P<0.01; P<0.001) respectively. There was no variation with exposure category.These observations imply that the combination of well-known Zn deficiency in many tropical countries and the substantial environmental lead pollution may predispose the general population to a significantly depressed haemopoietic system. This may in turn increase the prevalence of subclinical or overt anaemia of uncertain aetiology in the presence of other haem pathway stressors such as malnutrition.

Furthermore, in relation to article 3, article 7 and 11 (Decreased total and ionized calcium levels and haematological indices in occupational lead exposure as evidence of the endocrine disruptive effect of lead) revealed that the multisystem and prime environmental and occupational toxin, lead (Pb) is seldom included in the list of endocrine disruptors group like bisphenols A, B and F, nonylphenol, benzoquine, equiline etc.   Dietary intake including dairy products andmicronutrients as assessed by 24-hour dietary recall was similar between lead workers and controls. Calcium homeostasis and haematological indices were evaluated in all subjects. Blood lead level was significantly higher in the lead workers than in controls (P<0.001). Total and ionized calcium levels were in contrast significantly decreased in lead workers compared with controls (P<0.01, P<0.001 respectively). Inorganic phosphate level though slightly raised compared to controls did not reach statistical significance (P>0.05). The haematological indices, haemoglobin, haematocrit, and mean cell haemoglobin concentration like calcium levels were all significantly reduced (P<0.001) in all cases. Semi-quantitative assessment of erythrocyte protoporphyrin was trace (±) in both lead workers and controls (i.e. similar). Serum copper level was significantly higher in Pb workers than in controls (P<0.005). These decreases are consistent with a repression of the endocrine systems regulating both erythropoiesis and calcium homeostasis resident in the proximal convoluted tubule (PCT) of the kidney; the most vulnerable site to Pb damage. This study has shown that relatively low BPb levels can enhance Pb absorption and also potentiate Pb neurotoxicity in the presence of decreased serum thiamine and Mg levels.

Moving into our study on Haematological Values in Juvienile Periodontitis Patients in Ibadan, Nigeria (article 5), clinical and haematological examinations of forty adolescent patients in the group (15-22) years with established clinical features of chronic periodontitis but without any diagnosable medical disease were done. Patients were divided into two Groups (A &B), group A were diagnosed as having juvenile periodontitis (JP) while group B had the plaque-induced chronic periodontitis i.e. non- JP and were used as control. Comparing the following hematological features between these two groups and the expected normal values here in the tropics; White Blood Cell (WBC)-total and differential, Packed Cell Volume (PCV) and the blood film appearance. According to the general blood examination of both groups, almost all the numerical values were within the normal range as compared to the documental normal value in Nigeria. we therefore concluded that low lymphocyte responsiveness, lymphocyte dysfunction and a deficiency of neutrophil chemotaxis as earlier reported may be involved in the pathogenesis of JP rather than the numerical value of these cells. And that the relationship of periodontal disease to other neutrophil functions such as phagocytosis and bactericidal activity requires further investigation.

In the study of Coagulation profile in Nigerian children with cerebral malaria (article 10), the study was to determine the screening coagulation tests - PT, PTT(k), TCT, fibrinogen and absolute platelet counts. There were 97 children with 35 cerebral malaria (CM) and two control groups 30 acute malaria (AM) and 32 healthy controls aged 6 months--11 years. This is the first documented report of coagulation profile in Nigerian children above 6 months. Our study revealed the means of the PT in the three groups were normal. There was no significant difference between the means of PTT(k) and fibrinogen, p values 0.51 and 0.20 respectively. Nine of the CM group had deranged PT while eleven had elevated PTT(k). Four of the thrombocytopaenic CM patients were hypercoagulable. Three CM patients had bleeding episodes without laboratory evidences of DIC. Thrombocytopaenia occurred in 46% of the CM group compared with 23% of the AM. The role of hypercoagulable state observed amongst the thrombocytopaenic CM group could not be determined. In conclusion, we suggest close monitoring of platelet count and coagulation profile in those with haemorrhagic complications.

Haematological profile of healthy pregnant women in Ibadan, South-western Nigeria), the study revealed a dearth of information on the reference values for haematological indices particularly according to trimesters   in Nigerian women.  A descriptive study   over a period of 8 months on apparently healthy pregnant women with an objective of to provide reference values in Nigerian.  The mean values (and 95% confidence intervals, CI) of haematological indices were as follows:

First trimester: Haemoglobin (Hb) 112.44 (101.64 – 123.25) g/l, haematocrit (hct) 35 (32 – 38) %, WBC 5.488 (4.025 – 6.950)6109/l and platelet counts 227.56 (165.21 – 289.90)6109/l;

Second trimester: Hb 100.39 (97.85 – 102.92) g/l, hct 29.3 (28.5 – 30.1) %, WBC 6.57 (6.19 – 6.95)6109/l, platelet count 229.56 (211.86 – 247.26); and the

Third trimester: Hb 98.06 (96.12 – 100.00) g/l, hct 29.4 (28.7 – 29.9) %, WBC 6.92 (6.53 – 7.30), platelet count 186.52 (177.67 – 195.38)6109/l.

We compared results in the 3 semesters with   52 non-pregnant age matched women volunteers as controls whose mean haematological indices and 95% CI were: Hb 120.51 (116.61 – 124.41) g/l, hct 36 (25 – 48) %, WBC 5.28 (2.9 – 8.7)6109, platelet count 330.87 (176 – 538)6109 /l. The following haematological indices: WBC, platelet counts, RBC, PCT, and PDW, of women between the trimesters showed statistical significance (p value  <0.001 in each case). The WBC is inversely proportional to the PCT and the MCV in the pregnant women was slightly raised. In this study, pregnancy is characterised by lowest values of haemoglobin parameters in trimester three and there are statistically significant differences between the WBC, platelet counts, RBC, PCT, and PDW of women between the three trimesters.

• Oncology (2, 6, 15,23,25,26,29,33,34,36,45 constitute 24.44%of my publications and 60% of them are on Haematooncology+14.6% of my Haem-Onc articles )

Haematooncology: I have  Articles in the field of haematooncology addressing multiple myeloma (articles2,6 and 29), hodgkin lymphoma (article 2,25), chronic myeloid leukaemia (article 11,25) and malignant lymphoma articles (articles 23 and 25). We reported the development of nodular sclerosing Hodgkin ‘s disease (HD) on a patient 2 decades after successful treatment for Burkitts lymphoma with cyclophosphamide following abdominal recession. The recurrent and solitary nature of the lymphadenopathy and the fact that it was reported as reactive hyperplasia typical of nodular lymphocyte predominant HD. We believe there was a transitory period of the malignancy as nodular lymphocyte predominant. Our first case of multiple myeloma (article 6) Unlike previous reports from Caucasians there was normocalcaemia, normal protein level, microcytic hypochromia, low MCHC, cholesterol level at the lower limit of the reference range and normal urea level (in the face of markedly raised creatinine level). Nutritional modulation of the classical laboratory features of this disease may account for the fairly atypical laboratory picture unlike previous reports from Caucasians were there was normocalcaemia, normal protein level, microcytic hypochromia, low MCHC, cholesterol level at the lower limit of the reference range and normal urea level (in the face of markedly raised creatinine level). Nutritional modulation of the classical laboratory features of this disease may account for the fairly atypical laboratory picture. This study portrayed the importance of detail investigation on the causes of bone pain and anaemia in person's aged 40 years and above. There is a high prevalence of nephropathy in this cohort of patients which needs to be further investigated. Majority of the patients, though < 65 years of age were placed on melphalan-containing combinations, which foreclosed chances of future autologous bone marrow transplantation. Compared to treatment outcome with conventional chemotherapy and alpha interferon, as previously used in Nigeria, the results obtained with this regimen has established Imatinib as the first-line treatment strategy in patients with CML, as it is in other populations, with minimal morbidity (Article 15). Our fifteen year review of lymphomas (article 23)presenting to the University of Ibadan showed that the prevalence of lymphomas declined from 1.4% to 0.7%  after reviewing  surgical biopsies during 1991-2005. There was adecline in the proportion of high-grade non-Hodgkin lymphoma and Burkitt’s lymphoma from 79.1% and45.8% respectively to 21.1% and 13.6% respectively. There is a suggestion that the HIV/AIDS epidemic inthe country may not have influenced the pattern of occurrence of both major histomorphological typesof lymphoma in Ibadan.

In the field of medical oncology Following my short term fellowship in  medical oncology, with breast pathology I collaborated with the breast tumour boards in the University College Hospital, University of Ibadan and the University of Korlebu and we have couple of research work.  (Articles 26, 33, 34 which show that waiting time and level of awareness affect disease outcome. The observed up-regulation of Gamma-Glutamine-Transpeptidase in a team exposed to mixed chemicals,   its positivecorrelation with uric acid levels may be a protective response against oxidative stress arising from or related tothe depletion of thiol group; thus enhancing maintenance of GSH levels; and may serve as an inexpensive earlybiomarker of mutagenicity in mixed chemical exposure.

Haemostasis (Coagulation (10, 44 constitutes 4.4%of my publication and was mostly on thrombosis )

 My dissertation was Coagulation profile in Nigerian children with  Cerebral malaria (Article 10 discovered moderately severe thrombocytopenia and slightly deranged Prothrombin and activated partial Thromboplastin Time in Kaolin. Thrombocytopenia occurred in 46% of the cerebral malaria group compared to 20% of those with Acute Malaria. The role of the hypercoagulable state observed in the thrombocytopenic CM group could not be determined.  We suggested  close monitoring of platelet and coagulation profile in those with haemorrhagic complications. An ongoing work expanding the coagulation parameters now including D-Dimer. We further studied coagulation parameters, D dimer in HIV and AIDS following cases or incidental findings of thromboses.  The D-dimer level in the cases (193.60+ 177.00ng/ml was significantly higher than the controls (118.10± 140.58ng/ml) while a significantly lower aPTT was reported in the cases 36.22±4.05 seconds) compared to the controls (41.14±8.87 seconds). There was also a proportionately higher prevalence of D-dimer above the normal range in the cases. In our study there was a higher predisposition to a hypercoagulable state and thrombotic risk was observed in the cases. The evaluation of this biomarker remains an important predictor of thromboembolic event risk. 

Genomics  and others ( 4.4%)

A study of chronic diabetes mellitus, a recognized non communicable disease, which presents with aneamia a considerable number of times, showed that Ascorbic acid was not significantly different (p>0.05), but was 50% lower than the level in non-diabetics. Potassium like Mn and glucose was significantly higher in diabetes mellitus (DM) than in controls (p<0.001). Creatinine was not significantly different between diabetics and controls (p>0.05). Correlations among all

parameters were not significantly different. These findings suggest absence of significant

oxidative stress in the mitochondria. Apeep into genomics (Article 14) revealed that testing handicapped subjects with basic investigations i.e. FeCl₃ and ninhydrin reaction was largely negative in subjects showed that Inherited Metabolic Diseases (IMD) may not be excluded despite marked neurological dysfunction in majority of the residents studied. We suggested more sensitive techniques of genomics and a well-equipped National centre.

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