Prevalence of activated protein C resistance (Factor V Leiden) in Lagos, Nigeria

Objectives: Hereditary resistance to activated Protein C (Factor V Leiden) is the commonest genetic defect known to confer a predisposition to thrombosis. This study aims to determine the prevalence of activated protein C resistance (APCr) in Lagos, and to determine if any association exists between APCr and ABO, Rhesus blood types, and hemoglobin phenotypes.Materials and Methods: A functional APCr test was conducted on healthy adult volunteers to get a Factor-V-related activated protein C ratio (APC-V ratio). APCr due to Factor V mutation was indicated when the APC-V ratio is below a cut-off value that was determined by calibration. Subjects’ hemoglobin, red cell ABO, and Rhesus phenotypes were determined by standard methods.Results: Six (2%) of 297 participants with normal baseline coagulation screening tests had functional resistance to activated protein C (APC-V ratio < 2). None of the six subjects with APCr had history of venous thromboembolism. One of the six subjects was a female but the male sex did not demonstrate a risk of inheritance of APCr (P = 0.39). Four (67%) of the six subjects with APCr were non-O blood group. Whereas only two (0.9%) of 226 non-A subjects (blood groups 0 and B) had APCr, 4 (6%) of 71 subjects with A gene (blood groups A and AB) had APCr. The inheritance of A gene appears to constitute a risk to inheritance of APCr (P = 0.03). No association was demonstrable between APCr and hemoglobin phenotypes.Conclusion: Only 2% of the studied population had resistance to APC. The inheritance of blood group A may be a predisposition to APCr

Homocysteine Levels in Nigerian Women with Pre-eclampsis/Eclampsia

Hyperhomocysteinaemia has been linked in various studies worldwide to the occurrence of cardiovascular disorders and endothelial cell injury. In Nigeria with one of the highest maternal/neonatal mortality and morbidity, it is significant to explore means of predicting pregnancy-induced hypertension. This study was carried out at the Lagos University Teaching Hospital which is a major referral center in the South-western part of Nigeria. It was set to determine the mean plasma homocysteine levels and corpuscular haemoglobin in pre-eclamptic/eclamptic Nigerian women. A total of 150 subjects consisting of 100 primigravidae and 25 diagnosed cases of pre-eclampsia/eclampsia and 25 non-pregnant females were enrolled in the study. 60 primigravidae were lost to follow up or had incomplete data. The mean value of homocysteine in the control group, and eclamptic group was 7.5±3.4 μmol/L and 16.1±6.5 μmol/L respectively. There is positive and significant correlation between plasma homocysteine in the eclamptic group and the mean MCV (r=0.97, p=0.01), and between plasma homocysteine, systolic and diastolic blood pressure of the eclamptic group (r=0.944, p=0.0001; r=0.98, p=0.0001). The study further supports earlier findings of increased homocysteine levels in the occurrence of pre-eclampsia/eclampsia. Keywords: Hyperhomocysteinaemia, Pre-eclampsia/eclampsia, Primigravidae, Cardiovascular disorde

Cytomegalovirus antibodies among healthy blood donors at Lagos University Teaching Hospital

Objectives. Cytomegalovirus (CMV) is found worldwide in all geographical locations and socio-economic groups and is the virus most frequently transmitted to a developing child before birth. This study aimed to determine the prevalence and risk factors for CMV antibodies among healthy blood donors at Lagos University Teaching Hospital (LUTH).Methods. A cross-sectional study was carried out among consecutively recruited replacement blood donors attending the blood donor clinic at LUTH. A 5 ml blood sample was collected from each consenting participant and serum-assayed for CMV IgG/IgM using an enzyme-linked immunosorbent assay (ELISA)-based kit.Results. A total of 122 healthy donors were recruited; 96% of the donors were IgG anti-CMV positive while 19.5% were IgM anti-CMV positive. Previous history of blood transfusion was not significantly related to CMV positivity.Conclusion. The seroprevalence of CMV appears to be very high in this environment among healthy blood donors. Based on previous studies that showed a decrease in the incidence of CMV disease when blood is screened for CMV (IgM), the incidence of the disease can be decreased in Lagos if blood is screened for CMV

Pharmacoepidemiology of antiretroviral drugs in a teaching hospital in Lagos, Nigeria

Objective: Prescribing, adherence, and adverse drug events to HAART in a large antiretroviral programme in Lagos was evaluated.Design: A retrospective 5 year open cohort studySetting: The AIDS Prevention Initiative in Nigeria (APIN) clinic at LUTH is one of the United States Presidential Emergency Plan for AIDS Relief (PEPFAR) funded centers for HIV relief program in Nigeria Participants The case files of 390 patients on HAART and attending the APIN clinic were reviewed sequel to random selection.Main outcome measures: Demographics of the patients and pattern of antiretroviral (ARV) combination drugs prescribed were extracted from their case files. The details of the adverse drug events (ADEs) were extracted from drug toxicity forms regularly filled for each patient. A Chi-square test with Yates correction was used to determine the association between  adherence and therapeutic outcomeResults: A total of 2944 prescriptions were assessed. Zidovudine + lamivudine + nevirapine (35.87%) and stavudine + lamivudine + nevirapine (35.63%) were the most frequently prescribed combinations. Over 2000 ADEs were reported with cough (13.3%), fever (8.75%) and skin rashes (8.01%) being the most frequently reported. Drug adherence was associated with good therapeutic outcome (÷2 = 115.60, p<0.0001).Conclusions: Zidovudine + lamivudine + nevirapine was the most  frequently prescribed ARV combination. Cough was the most frequently reported ADE. Interventions aimed at rational prescribing of ARV drugsand improving adherence to antiretroviral drugs is essential for good therapeutic outcome in the treatment of HIV infection.Keywords: Pharmacoepidemiology, antiretroviral drugs, drug adherence, adverse event

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Differential Cell Count of Bone Marrow Aspirates in Steady-state Sickle Cell Anaemia Patients

Background: Megaloblastic arrest of the bone marrow is one of the causes of anaemic crises in patients with sickle cell anaemia. The diagnosis of this condition will require that the reference level of megaloblastosis during steady state be properly documented. Objectives:To document a reference differential cell count in the bone marrow aspirates of patients with sickle cell anaemia and determine the level of megaloblastosis that can be regarded as indicating megaloblastic crisis in such patients. Design: Systematic counting of haematopoietic cells in the bone marrow of children with confirmed Hb phenotype SS who are in steady state. Subjects and Methods: The subjects were 11 of 68 children with sickle cell anaemia attending the paediatric outpatient clinic at the Lagos University Teaching Hospital, Lagos, in respect of whom parental consent for bone marrow aspiration was obtained. About 4.5 ml of blood was obtained from the antecubital vein of each child, for full blood count. Bone marrow was aspirated from the posterior superior iliac spine. Slides were stained with MayGrünwald-Giemsa stain. Proportions of erythroid, myeloid, lymphoid and megakaryocytic cells out of 250 nucleated bone marrow cells were determined. Results: Steady state mean packed cell volume (PCV) was 0.2 ± 0.017 L/L. The mean reticulocyte count was 5.9 percent (95% CI, 5.3 – 7.0%) and the mean cell volume was 91.8 ± 2.7 fl. Erythroid precursors constituted 34.5 percent of the total nucleated bone marrow cells (NBMC). Of these, polychromatic and orthochromatic erythroid blasts predominated, constituting 49 and 36percent respectively, of total erythroid precursors. Polychromatic and orthochromatic megaloblasts constituted 16.5percent (95% CI, 7-25%) of total NBMC or 47.8 percent of erythroid precursors. The myeloid erythroid ratio was 1:1. The reference range of megaloblasts was 8-26 percent of the NBMC. Conclusion: Patients with sickle cell anaemia in steady-state may show megaloblastic bone marrow changes even with routine folate supplements. Megaloblastic crisis should not be diagnosed until megaloblasts are in excess of 26 percent of the total NBMC. Nigerian Journal of Paediatrics2003;30:54-5

Sero-Prevalence of Human Parvo-Virus B19 Antibody in Paediatric Sickle Cell Disease Patients seen at the Lagos University Teaching Hospital (LUTH)

Introduction: Human parvovirus B19 (PVB19) is a DNA virus implicated in the pathogenesis of aplastic crisis. Aplastic crisis is one of the medical emergencies complicating sickle cell anaemia (SCA). Objective: This study aims to determine the seroprevalence of PVB19 in paediatric SCA patients. Methods: This is a cross sectional study conducted at the Lagos University Teaching Hospital, Lagos Nigeria. A total of 98 participants were studied comprising 67 sickle cell anaemia subjects and 31 controls (Hb AA) aged between 5 – 17years. Seroprevalence of parvovirus was determined using ELISA kits for IgG and IgM anti-PVB19 antibodies by Immuno-Biological Laboratories, (IBL) Inc. Minneapolis, USA. Results were analyzed using Winpepi statistical software. Fishers’ Exact test, Chi-square and student T-test were used as appropriate to compare variables between both groups. P-values <0.05 were considered significant. Results: Thirty eight (56.72%) SCA subjects were positive for anti-PVB19 IgG antibody while 18 (58.06%) controls were positive. Six (8.96%) SCA subjects were positive anti-PVB19 IgM antibodies while 2 (6.45%) controls were positive for anti-PVB19 IgM antibodies. There was no significant difference in the seroprevalence of IgG and IgM antiPVB19 in both groups.Conclusion: The study has shown a high seroprevalence of IgG anti-PVB19 antibodies in both SCA subjects and controls. Thus SCA does not confer a higher risk of Parvovirus infection however because of their lower stable haemoglobin state, PVB infection may result in a more symptomatic anaemia compared to the general populace. Key words: Seroprevalence, parvovirus B19, blood donors, sickle cell anaemi

Gender and CD4 Values as Correlates for Iron Status in Anaemic HIV Infected Individuals

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Prevalence of anti‑A and anti‑B hemolysis among blood group O donors in Lagos

Background: Group O donor blood is more readily available and is frequently used as universal red cell donor in our environment. The presence of hemolysins in the donors may however lead to hemolysis in the recipients. Attempts have been made to study the prevalence of hemolysins in various populations with results from our environment showing wide variation (20–80%).Aims: To determine the prevalence and titer of anti‑A and anti B hemolysins among blood donors at the Lagos University Teaching Hospital and compare results with that obtained elsewhere. Determine if the practice of transfusion of group O blood to nongroup O recipients is permissible in this environment.Materials and Methods: Test for hemolysis was done using the standard tube method. Samples positive for hemolysis were then scored and titrated with the titers read visually and photometrically at 540 nm.Results: Three hundred and fifty blood group O donors with age range 18–58 years and median age of 28 ± 8.4 years were enrolled in the study. The overall prevalence of anti‑A and/or anti‑B hemolysins obtained was 30.3%. Prevalence of anti‑A and anti‑B hemolysins only was 15.4% and 5.1% respectively whereas both anti‑A and anti‑B hemolysins were present in 9.7% donor samples. Though anti‑A hemolysins were more prevalent than anti‑B hemolysins, anti‑B hemolysins had higher mean visual (6:7) and spectrophotometric titers (81:101). A visual titer of 8 and above which is considered significant was seen in 18.6% of donor samples.Conclusion: Anti‑A and anti‑B hemolysins exist in significant frequencies and titers among blood group O donors in Lagos. It is recommended that the use of group O donor blood for recipients who are non‑O be discouraged. Clinical studies to determine the frequency and severity of hemolysis in non‑group O recipients of blood group O are required.Key words: Anti‑A and anti‑B hemolysins, blood donors, blood group O, prevalenc

Anaemia in HIV Infection: Relating Red Cell Indices And Iron Profile

Anaemia -a frequent complication of HIV infection- is multi-factorial, and its incidence is associated with progression of HIV disease. Recognition of iron related anaemia in HIV infection remains a challenge. Exploring red cell indices and iron profile may provide easier and more efficient diagnostic option. This study aims to evaluate iron status of anaemic HIV infected individuals in relation to apparently healthy, non-HIV infected persons, and determine indices that best indicate iron deficiency anaemia in HIV infection. A total of 100 Adults with serologic diagnosis of HIV, and Packed Cell Volume (PCV) <30% (or Hb<10g/dl), were recruited with 50 HIV negative adults, non anaemic apparently healthy subjects as controls. Five mililiters of blood placed in sodium ethylene-diamine tetra-acetate (EDTA) specimen bottle was used for the estimation of Haemoglobin concentration (Hb), Packed Cell volume (PCV), Reticulocyte count, along with red cell indices: Mean cell Volume (MCV), Mean Cell Haemoglobin (MCH) and Mean Cell Haemoglobin Concentration (MCHC). Serum extract was then used for serum iron, serum ferritin and serum transferrin analyses. Of the total 100 HIV positive subjects, 51 of 63(81%) subjects with Hb between 7-10g/dl were in CDC stages B and C while only 12 of 63 (19%), were in stage A. The Hb levels fell with progression of HIV disease. MCV, MCH and MCHC of the control population, were significantly higher than the study population ( 86.3fl vs 82.9fl; 27.8pg vs 26.3pg and 32.2g vs 31.1g; p<0.05respectively). However, Reticulocyte count was significantly higher in the HIV infected study group (1.6% vs 1.3%; p<0.05).Mean serum iron, and mean serum transferrin levels were significantly higher among the HIV negative controls compared with the HIV-positive study population(280.2 μg/dl vs 195.16 μg/dl and 2.3g/l vs 1.47g/l; p< 0.05 respectively). However, mean serum ferritin was significantly higher among the HIV positive study population ( 540.3ng/ml vs 141.6ng/ml; p<0.05). Anaemia in HIV infection is essentially anaemia of chronic disorders. Decreasing serum transferrin level and rising values of serum ferritin associate best with severity of anaemia in HIV infection.Keywords: HIV; Anaemia; Ferritin, Transferrin; Serum Iro