Effect of automated red cell exchanges on oxygen saturation on-air, blood parameters and length of hospitalization in sickle cell disease patients with acute chest syndrome

BACKGROUND: Red cell exchanges (RCEs) lead to improvement in tissue oxygenation and reduction in inflammatory markers in sickle cell disease (SCD) patients who present with acute chest syndrome (ACS). The aim of this study is to evaluate the effects of automated-RCE (auto-RCE) on oxygen saturation (SpO2) on-air, blood counts, the time to correct the parameters and length of hospitalization after the exchange in SCD patients presenting with ACS. SUBJECTS AND METHODS: This was 2 years study involving five SCD patients; the time for SpO2 on air to increase to ≥95% and chest symptoms to resolve, postprocedure, as well as the length of in-patient hospitalization was recorded. All data were entered into Statistical Package for Social Sciences Version 20.0 (SPSS Inc., Chicago, IL, USA) computer software for analyses. RESULTS: The study involved 4 (80%) hemoglobin (Hb) SS and 1 (20%) HbSC patients. The median time of SpO2 recovery was 24 h, ranging from 6 to 96 h. About 60% (3/5) of patients achieved optimal SpO2 within 24 h post-RCE, while discharge from intensive care unit was 24 h after auto-RCE in one patient. The Hb concentration was significantly higher, while the total white cell and absolute neutrophil counts were significantly lower at the time of resolution of symptoms, compared to before auto-RCE (P < 0.05). The average post auto-red cell transfusion symptoms duration was 105.6 (24-240) h while mean inpatient stay was 244.8 (144-456) h. CONCLUSION: Auto-RCE could reverse hypoxia in ACS within 24 h

Serum Levels of Pro-inflammatory Cytokines in relationship to outcomes in Children with P. falciparum malaria, in Nnewi-South east Nigeria

Background and Objective: In P. falciparum malaria (PFM) infestation there are marked changes in cytokine production as the body mounts an immune response to it. Hence we set out to study these changes.Methods: A total of 158 cases of PFM among children attending the paediatric unit of our hospital and 56 healthy controls were studied. Children with febrile illness were screened for malaria using 10% Giemsa stained blood smear. Patients with positive smears were recruited; co-infected patients – those infected by another organism in addition to plasmodium specie.- were excluded. Whole blood was collected, some into plain tubes for serum cytokine testing and some into EDTA bottles for complete blood count and parasite density (PD) determination. Controls with asymptomatic parasitaemia were excluded.Results: Using the World Health Organization criteria for defining severe malaria; we identified 15 cases of severe and 143 cases of uncomplicated PFM. Significantly elevated levels of interleukin-1 (IL-1), interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α) were seen in the uncomplicated and severe forms of PFM. It was observed that the elevated cytokine values correlated with PD (in uncomplicated PFM but not in the severe forms). The difference between PD/absolute monocyte count (AMC) ratio was not significant (p=0.13); while PD/platelet count (PC) and PC/ AMC ratios were significant (p=0.01, and 0.03 respectively) when compared between uncomplicated and severe disease.Conclusion: Our data seems to suggest that subjects with an adequate immune response to the parasite density, in terms of pro-inflammatory cytokine levels, presented with uncomplicated disease; while those who have an inadequate response presented with severe disease. The ratios of (PD/PC) and (PC/AMC), in the positive and negative directions respectively, may be predictors of increased disease severity. These observations may have implications for predicting disease outcome and PFM therapy.Key Words: plasmodium falciparum malaria, pro-inflammatory cytokines, Parasite density/Platelet count ratio, Platelet count/Absolute monocyt

Unusual presentations of childhood acute lymphoblastic leukaemia: A case report

Childhood acute lymphoblastic leukaemia, (ALL) is increasingly reported to present in an atypical fashion which may have significant implications for treatment outcomes and survival. This case report presents a Nigerian child who’s clinical and radiological features together with effusion cytological findings were suggestive of metastatic neuroblastoma. However, a definitive diagnosis of ALL was established following a bone marrow  aspiration study that revealed abnormal cellularity consistent with L1 morphological subtype. Unfortunately, the child was discharged against medical advice before definitive therapy could be commenced.Key words: Atypical presentations, metastatic neuroblastoma, childhood acute lymphoblastic leukaemia

Pattern of childhood and adolescent malignancies at a tertiary health institution in South-east Nigeria : A ten year study

Background: Cancer remains a major cause of death in children and adolescents, and differs in adults in nature, distribution and prognosis1. A culture of case documentation is lacking in our environment and many cases go unreported.Study objectives: To document the pattern of childhood and adolescent malignancies at a tertiary health institution in south-east Nigeria over a ten year period (January 2004 to December 2013)Methodology: Details of all children and adolescents aged 18 years and below treated for malignancy were extracted from the cancer registry and the records unit of the histopathology department for the period beginning at January 2004 to December 2013 at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. Information retrieved was verified against the hospital admission register, as well as the medical and histopathology records for all cancer patients over the period of interest.Results: Eighty-five cases of childhood and adolescent malignancy were treated at NAUTH, Nnewi between January 2004 and December 2013. Median age of the study population was 9years, with a range of 0.1– 18years, more males (56.50%) than females (43.50%). Commonest tumours were the Lymphomas (11.76%) comprising Non- Hodgkin’s lymphoma (80%), Hodgkin’s lymphoma (10%) and Large-cell lymphoma (10%), the Leukaemias (11.76%) comprising Acute myeloblastic leukaemia (80%) and Acute lymphoblastic leukaemia (20%). Others were Rhabdomyosarcoma (11.76%), Nephroblastoma (11.76%), Retinoblastoma (5.88%), Ovarian tumours (4.71%), the Soft tissue sarcomas-excluding rhabdomyosarcoma (3.53%) and Osteogenic sarcoma (3.35%)’.Conclusion: Study findings suggest that lymphoma, leukaemia, rhabdomyosarcoma and nephroblastoma are the commonest childhood and adolescent malignancies in south-east Nigeria.Keywords: Childhood, Adolescent, Malignanc

Prevalence of haemolysins in blood donors in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

Background: The presence of high titres of haemolysins (lytic antibodies) in the sera of donors could predispose to adverse blood transfusion reactions.Objective: To evaluate the prevalence of haemolysins among blood donors at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.Methodology: A total of 1,370 donors were randomly selected for the study between April and September 2014. Each donor had 3mls of blood collected; 2mls was dispensed into plain bottles and serum extracted for haemolysin testing, while 1ml was dispensed into ethylene diaminetetracetic acid (EDTA) bottle for blood grouping. Haemolysin testing was done by reacting freshly prepared standard A, B, AB and O red cell suspensions with sera from each participant while blood grouping was done using commercial anti-sera kits. Ethical approval was obtained from the institution’s Review Committee, and all participants gave informed consent.Results: The general prevalence of haemolysins was 220/1370 (16.06%), while alpha, beta and alpha plus beta haemolysins were detected in 70 (5.11%), 90 (6.5%) and 60 (4.38%) of donors, respectively. The number of donors with blood groups A, B and O were 265, 165 and 940, while the distribution of haemolysins was 18.87%, 18.18% and 14.89%, respectively. Of the 220 donors in whom haemolysins were detected, 18.2% (40/220), 27.3% (60/220), 40.9% (90/220) and 13.6% (30/220) were aged 18-27years, 28-37years, 38-47years and 48-57years, respectively.Conclusion: There is a high prevalence of haemolysins in our donors, particularly in those with blood group A and in the age range of 38-47years.Keywords: Blood groups, lytic antibodies, South-East Nigeria, transfusio

Structural and Economic Viability of 2D/3D Finite Element Analysis of Conical Arched Roof Truss

Arch and conical roof trusses are employed when dealing with large span roof trusses. But a combination of the two geometrical shapes may lead to a better economical sections and a means of dealing with larger spans of roof truss that are not suitable for an arch or conical roof truss. Consequently, this paper examines the structural and economic viability of arched conical roof truss system based on 2D/3D finite element method analysis. Analysis of the results showed that truss members were subjected to higher axial forces in 2D analysis than 3D analysis, which will result to overdesign of the structural members and the attendant high construction cost. There are some variations observed in the axial forces for trusses located at edges of polygon when compared with the trusses located mid-point between two polygonal edges. This observation is quite significant in the sizes of the steel section properties of the members as well as in the fabrication and installation cost

Allopurinol induced Stevens - Johnson syndrome in a Nigerian woman with chronic lymphocytic leukaemia

Stevens-Johnson syndrome is an adverse muco-cutaneous complication arising from a number of conditions which include the administration of some drugs. A female Nigerian with chronic lymphocytic leukaemia, (Binet stage C) who developed Stevens-Johnson syndrome following commencement of allopurinol is presented. She was treated with intravenous fluids, steroid, antihistamine, antibiotics, skin emollient along with oral care, while allopurinol was discontinued. She attained full recovery and was re-commenced on cyclophosphamide (without allopurinol), with no further sequelae.Conclusion: Stevens-Johnson syndrome could occur in patients on allopurinol, this is the first of such report (to the author’s best knowledge) from South-East Nigeria. Drug withdrawal and supportive management are associated with clinical recovery.Keywords: Adverse skin reactions, lymphoid malignancy, steroid

Haematological and clinical profile in Nigerian sickle cell disease patients with and without chronic kidney disease

Background: Sickle cell disease (SCD) has adverse effects on the kidneys which impact on clinical outcome.Objectives: To study and compare some clinical and haematological profiles in SCD patients, with and without chronic kidney disease (CKD).Methods: Prospectively, 92 SCD patients were investigated and stratified into those with CKD (creatinine clearance ≤60ml/min) and those without (creatinine clearance≥60ml/min). Socio-demographic data, clinical and haematological parameters were documented and compared in the two groups as well as with gender stratification, using the student’s t-test.Results: The crises frequency and transfusion history (in males) together with the corrected reticulocyte count (in females) were significantly different in SCD patients with CKD, compared to those without (p values&lt;0.05).Conclusion: Kidney disease significantly influences some clinical and haematological parameters in patients with SCD, which could impact on survival.Keywords: Corrected reticulocyte count, transfusion history, vaso-occlusive crise