Speed of capillary blood flow and d-dimer levels in sickle cell anaemia patients in Calabar, cross river state

Background: The experience of painful episodes of ill health caused by sequelae of erythrocytes sickling, impaired blood flow, hypercoagulation and vaso-occlusion is one of the hallmarks of sickle cell disease. Preventing painful episodes and promoting the physical wellbeing of persons with sickle cell disease is usually a major objective in the management of the condition. The purpose of this study is to investigate capillary blood flow and D-Dimer activities in people with sickle cell anaemia.Methods: A total of 90 subjects (27 males and 63 females) participated in the study, the study comprised of 34 HbSS patients, three were in crisis and thirty-one in steady state, 9 sickle cell carriers (HbAS) and 47 HbAA were control subjects. The haemoglobin phenotype was determined using haemoglobin electrophoresis at alkaline pH (8.6), speed of capillary blood flow was estimated using vascular Doppler ultrasonographic technique and D-Dimer was determined using ELISA method.Results: Results obtained showed that there was a significant variation (p=0.042) in the mean levels D-Dimer among the groups. There was however no significant variations (p>0.05) in the other parameters among the groups. A post hoc analysis of mean D-Dimer in sickle cell patients, sickle cell carriers and controls showed that the sickle cell patients had significantly higher D-Dimer levels compared with controls.Conclusions: Sickle cells patients in steady state had higher D-Dimer levels compared with controls and sickle cell patients in crisis had lower speed of capillary blood flow when compared to sickle cell patients in steady state and controls

Blood pressure indices and disease severity in patients with sickle cell anaemia

Background: Individuals with sickle cell anaemia (SCA) have lower systemic blood pressures compared to individuals with haemoglobin Hb AA phenotype.Objective: To evaluate blood pressure indices of individuals with SCA in steady state, in comparison with haematological and clinical markers of disease severity.Methodology: Seventy-nine (79) individuals with SCA (subjects) in steady state and 50 age-matched individuals with Hb AA (controls) were prospectively studied. Height, blood pressure (BP), weight, creatinine clearance (by 24-hour urine collection), full blood count (FBC) and reticulocyte count were obtained from all subjects and controls. Body mass index (BMI), corrected reticulocyte count, mean arterial pressure (MAP) and pulse pressure (PP) were calculated using standard protocols.The frequency of vaso-occlusive crises in the last one year and number of blood transfusions in the last two years were obtained from subjects.Data was analyzed using descriptive and inferential statistics and p ≤0.05 was used to define the level of statistical significance.Results: The systolic (105.52±11.75mmHg and 113.20±7.94mmHg respectively; P = 0.01), diastolic (62.59±9.33mmHg and 75.40±5.70mmHg respectively; P=0.03) and mean arterial pressures (76.90±8.81mmHg and 88.00±5.51mmHg respectively;P =0.04) were significantly lower in subjects when compared with controls. ; pulse pressure (PP) was however significantly higher in subjects than controls (42.92±10.91mmHg and 37.80±7.43mmHg respectively (P = 0.03). In female subjects, the white cell count was negatively correlated with systolic BP (r = -0.39;P = 0.01) and PP (r = -0.33; P = 0.03).Conclusion: Lower systolic and pulse pressures may predict worsening disease severity in individuals with sickle cell anaemia.Keywords: Sickle cell anaemia,disease severity,blood pressure indice

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Sickle cell disease genetic counseling and testing: A review

The huge burden of sickle cell disease (SCD) coupled with a correspondingly high morbidity and mortality, particularly in Sub-Saharan Africa, has made it really imperative to invest more in ways of reducing the prevalence of this disorder. The SCD genetic counseling and testing have been shown to educate individuals on SCD and also offer those at risk the opportunity of making informed decisions on marriage and pregnancy. We reviewed available data on genetic counseling and testing for SCD, using the PubMed, PubMed Central, Google Scholar, and African Index Medicus search engines, through a combination of words and phrases relevant to the subject and attempted to highlight how this can be better applied in a resource-poor setting such as Nigeria, with a huge disease burden. More advanced countries with significant population of patients with SCD and other hemoglobinopathies have evolved functional genetic and counseling protocols, with remarkable impacts on disease epidemiology; this feat however does not appear to be replicated in a number of African countries. This paper reviewed genetic counseling and testing for SCD in countries with high disease burden, with particular emphasis on Nigeria, which has a disease prevalence and carrier rate of 2-3% and 20-30%, respectively

The assessment of systemic inflammatory response in apparently healthy adult smokers in Nnewi, South East Nigeria

Background: Induction of systemic inflammation is thought to underlie major organ dysfunction in cigarette smokers. Objective: The objective of the study is to estimate the levels of inflammatory markers (the leukocyte count and C-reactive protein [CRP]) in adult smokers in Nnewi metropolis, South East Nigeria. Subjects and Methods: A total of 120 adults, comprising of 60 smokers and age-matched nonsmokers, respectively were recruited. Five millilitre of venous blood was collected from each participant, of which 2 ml was used for full blood count estimation, using the Sysmex NX® hematology analyzer, while 3 ml was dispensed into plain tube and serum was extracted for CRP measurement, using the ELISA technique. Statistical analysis was done using SPSS (version 20), the students t-test was used for the comparison of means, and level of statistical significance set at (P < 0.05). Results: The serum CRP level was significantly higher in smokers compared with controls (P 5 years, compared with those whose smoking history was 5 sticks of cigarettes in 1 month (P = 0.023, 0.004, and <0.001, respectively). Conclusion: Cigarette smoking is associated with a significant acute inflammatory response which becomes exaggerated with increasing duration and frequency of exposure

Seroprevalence of transfusion transmissible viral markers in sickle cell disease patients and healthy controls in Ile-Ife, South-Western Nigeria: A case–control study

Background: The risk of acquiring transfusion transmissible viral infections is said to be higher in patients requiring regular blood transfusions such as those with sickle cell disease (SCD). Aim: We determined the seroprevalence of blood transfusion viral markers among our patients with SCD. Subjects and Methods: This a case–control analytical study consisting of 82 confirmed SCD patients on routine follow-up at our facility in steady state and 90 age-matched controls. Demographic and transfusion history were recorded while 5 ml of blood was drawn for hematocrit levels, and serum tested for transfusion transmissible viral markers for hepatitis B, (hepatitis B surface antigen [HBsAg], hepatitis B surface antibody [HBsAb], hepatitis B e antigen [HBeAg], hepatitis B e antibody [HBeAb], hepatitis B core antibody [HBcAb]), hepatitis C virus (HCV) and human immunodeficiency viruses (HIVs) using the rapid test kits. Ethical approval for the study was obtained from the Institutional Review Board and each participant gave informed consent. Data were analyzed using descriptive and inferential statistics. Results: The seroprevalence of HBsAg, HBsAb, and HBeAg in cases was 2 (2.4%), 7 (8.5%), and 0 (0.0%), respectively, whereas it was 7 (8.5%), 11 (13.4%), 6 (7.3%), and 2 (2.4%) for HBeAb, HBcAb, HCV, and HIV antibodies. Compared to the controls, cases had higher prevalence rate of HBeAb (P = 0.005). No significant difference was observed in those with or without low hematocrit (≤18%) or those that received blood transfusion and those that did not (P > 0.05). Conclusion: We conclude that blood transfusion did not significantly increase the seroprevalence of markers of transfusion transmissible viral infection in SCD patients

Adverse reactions to blood donation: A descriptive study of 3520 blood donors in a Nigerian tertiary hospital

Background: The occurrence of adverse reactions to blood donation significantly hampers donor retention and negatively impacts on the universal availability of adequate numbers of blood donor units. Objective: To analyze the spectrum and prevalence of adverse reactions in blood donors in a tertiary hospital-based blood bank in Nigeria. Subjects and Methods: The details of 3520 blood donors who presented for donation over a 12 months period were retrieved from the departmental archives for analysis. These included sociodemographic information, type of donor, type and frequency of adverse reactions to blood donation. Data were analyzed using the Statistical Package for Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA) computer software. Descriptive and inferential statistics were employed to represent the distribution of donor characteristics (as percentages) and compare reaction rates by gender and severity, respectively. Results: The prevalence of adverse reactions to blood donation was (56/3520) 1.60%; this occurred more frequently in male and family replacement donors (55.35% and 100.0%, respectively). The spectrum of donor adverse reactions included anxiety 25 (44.64%), generalized body weakness 11 (19.64%), hematoma 10 (17.86%), fainting 5 (8.93%), and vomiting 5 (8.93%). Vasovagal reactions were the most frequent adverse reaction encountered among the donors (46/56; 82.14%). Conclusion: Vasovagal reactions are common adverse phenomena in our blood donor set; this has implications on transfusion safety and blood donor retention

Adverse reactions to blood donation: A descriptive study of 3520 blood donors in a Nigerian tertiary hospital

Background: The occurrence of adverse reactions to blood donation significantly hampers donor retention and negatively impacts on the universal availability of adequate numbers of blood donor units. Objective: To analyze the spectrum and prevalence of adverse reactions in blood donors in a tertiary hospital-based blood bank in Nigeria. Subjects and Methods: The details of 3520 blood donors who presented for donation over a 12 months period were retrieved from the departmental archives for analysis. These included sociodemographic information, type of donor, type and frequency of adverse reactions to blood donation. Data were analyzed using the Statistical Package for Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA) computer software. Descriptive and inferential statistics were employed to represent the distribution of donor characteristics (as percentages) and compare reaction rates by gender and severity, respectively. Results: The prevalence of adverse reactions to blood donation was (56/3520) 1.60%; this occurred more frequently in male and family replacement donors (55.35% and 100.0%, respectively). The spectrum of donor adverse reactions included anxiety 25 (44.64%), generalized body weakness 11 (19.64%), hematoma 10 (17.86%), fainting 5 (8.93%), and vomiting 5 (8.93%). Vasovagal reactions were the most frequent adverse reaction encountered among the donors (46/56; 82.14%). Conclusion: Vasovagal reactions are common adverse phenomena in our blood donor set; this has implications on transfusion safety and blood donor retention