Clinical and biochemical manifestations of severe sickle cell anemia in adult patients in steady state in Ile-Ife, Nigeria

Background: There are documented established markers (indices) of disease severity in patients with sickle cell anemia (SCA) and they determine the course of the disease. This study investigated the pattern and prevalence of some of these markers of disease severity in adult patients with SCA in steady state attending the hematology clinic of a federal tertiary teaching hospital in Ile-Ife, Nigeria.Materials and Methods: This was a descriptive study. Basic demographic data and relevant clinical information was obtained using a well-structured questionnaire and the case files (hospital records) of 50 consecutive SCA (HbSS) patients.Results: The study group comprised of 21(42%) males and 29(58%) females. The age range was 18–45years with a mean(±SD) of 27.6±7.607. Hepatomegaly (64%), frequent episodes of vaso-occlusive crisis, that is, ≥ 3 episodes per year(30%) and Dactylitis in infanthood(26%) were the most common clinical parameters identified in these patients while a high serum total bilirubin of > 51μmol/L(26%) was the most common laboratory parameter seen in these patients.Conclusion: Markers of disease severity were identified in the patients with SCA inthis study. The presence of these markers in an SCA patient connotes severe disease and they determine the course of the disease. Therefore, there is a need to pay more attention to these patients by following them up more closely.Keywords: disease severity, markers, sickle cell anemia, steady state, adults, patient

Clinical and Biochemical Manifestations of Severe Sickle Cell Anemia in Adult Patients in Steady State in Ile-Ife, Nigeria

Background: There are documented established markers (indices) of disease severity in patients with sickle cell anemia (SCA) and they determine the course of the disease. This study investigated the pattern and prevalence of some of these markers of disease severity in adult patients with SCA in steady state attending the hematology clinic of a federal tertiary teaching hospital in Ile-Ife, Nigeria. Materials and Methods: This was a descriptive study. Basic demographic data and relevant clinical information was obtained using a well-structured questionnaire and the case files (hospital records) of 50 consecutive SCA (HbSS) patients. Results: The study group comprised of 21(42%) males and 29(58%) females. The age range was 18–45years with a mean(±SD) of 27.6±7.607. Hepatomegaly(64%), frequent episodes of vaso-occlusive crisis, that is, ≥ 3 episodes per year(30%) and Dactylitis in infanthood(26%) were the most common clinical parameters identified in these patients while a high serum total bilirubin of > 51µmol/L(26%) was the most common laboratory parameter seen in these patients. Conclusion: Markers of disease severity were identified in the patients with SCA in this study. The presence of these markers in an SCA patient connotes severe disease and they determine the course of the disease. Therefore, there is a need to pay more attention to these patients by following them up more closely

Clinical versus Sonographic Estimation of Foetal Weight in Southwest Nigeria

A prospective study was conducted at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, between 3 January and 31May 2004, to compare the accuracy of clinical and ultrasonographic estimation of foetal weight at term. One hundred pregnant women who fulfilled the inclusion criteria had their foetal weight estimated independently using clinical and ultrasonographic methods. Accuracy was determined by percentage error, absolute percentage error, and proportion of estimates within 10% of actual birthweight (birthweight of +10%). Statistical analysis was done using the paired t-test, the Wilcoxon signed-rank test, and the chi-square test. The study sample had an actual average birthweight of 3,255+622 (range 2,150–4,950) g. Overall, the clinical method overestimated birthweight, while ultrasound underestimated it. The mean absolute percentage error of the clinical method was smaller than that of the sonographic method, and the number of estimates within 10% of actual birthweight for the clinical method (70%) was greater than for the sonographic method (68%); the difference was not statistically significant. In the low birthweight (<2,500 g) group, the mean errors of sonographic estimates were significantly smaller, and significantly more sonographic estimates (66.7%) were within 10% of actual birthweight than those of the clinical method (41.7%). No statistically significant difference was observed in all the measures of accuracy for the normal birthweight range of 2,500-<4,000 g and in the macrosonic group (≥4,000 g), except that, while the ultrasonographic method underestimated birthweight, the clinical method overestimated it. Clinical estimation of birthweight is as accurate as routine ultrasonographic estimation, except in low-birthweight babies. Therefore, when the clinical method suggests weight smaller than 2,500 g, subsequent sonographic estimation is recommended to yield a better prediction and to further evaluate foetal well-being

Clinical Versus Sonographic Estimation of Foetal Weight in Southwest Nigeria

A prospective study was conducted at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, between 3 January and 31May 2004, to compare the accuracy of clinical and ultrasonographic estimation of foetal weight at term. One hundred pregnant women who fulfilled the inclusion criteria had their foetal weight estimated in dependently using clinical and ultrasonographic methods.Accuracy was determined by percentage error, absolute percentage error,and proportion of estimates within 10% of actual birth-weight (birth-weight of +10%). Statistical analysis was done using the paired t-test, the Wilcoxon signed-rank test, and the chi-square test. The study sample had an actual average birthweight of 3,255+622 (range 2,150-4,950) g. Overall, the clinical method overestimated birth-weight, while ultrasound underestimated it. The mean absolute percentage error of the clinical method was smaller than that of the sonographic method, and the number of estimates within 10% of actual birthweight for the clinical method (70%) was greater than for the sonographic method (68%); the difference was not statistically significant. In thelow birth-weight(&lt;&lt;2,500g)group, the mean errors of sonographic estimates were significantly smaller, and significantly more sonographic estimates (66.7%) were within 10% of actual birth-weight than those of the clinical method (41.7%). No statistically significant difference was observed in all the measures of accuracy for the normal birth-weight range of 2,500-&lt;4,000 g and in the macrosonic group ( 654,000 g), except that, while the ultrasonographic method underestimated birth-weight, the clinical method overestimated it. Clinical estimation of birth-weight is as accurate as routineultrasonographic estimation, except in low-birth-weight babies. Therefore, when the clinical method suggests weight smaller than 2,500 g, subsequent sonographic estimation is recommended to yield a better prediction and to further evaluate foetal well-being

Differences in COVID-19 Preventive Behavior and Food Insecurity by HIV Status in Nigeria

The aim of the study was to assess if there were signifcant diferences in the adoption of COVID-19 risk preventive behaviors and experience of food insecurity by people living with and without HIV in Nigeria. This was a cross-sectional study that recruited a convenience sample of 4471 (20.5% HIV positive) adults in Nigeria. Binary logistic regression analysis was conducted to test the associations between the explanatory variable (HIV positive and non-positive status) and the outcome variables—COVID-19 related behavior changes (physical distancing, isolation/quarantine, working remotely) and food insecurity (hungry but did not eat, cut the size of meals/skip meals) controlling for age, sex at birth, COVID-19 status, and medical status of respondents. Signifcantly fewer people living with HIV (PLWH) reported a positive COVID-19 test result; and had lower odds of practicing COVID-19 risk preventive behaviors. In comparison with those living without HIV, PLWH had higher odds of cutting meal sizes as a food security measure (AOR: 3.18; 95% CI 2.60–3.88) and lower odds of being hungry and not eating (AOR: 0.24; 95% CI 0.20–0.30). In conclusion, associations between HIV status, COVID-19 preventive behaviors and food security are highly complex and warrant further in-depth to unravel the incongruities identifed

Hepatobiliary ultrasonographic abnormalities in adult patients with sickle cell anaemia in steady state in Ile-Ife, Nigeria

BACKGROUND: Sickle cell anaemia (SCA) is associated with structural manifestations in the hepatobiliary axis. This study aimed to investigate the hepatobiliary ultrasonographic abnormalities in adult patients with sickle cell anaemia in steady state attending the Haematology clinic of a federal tertiary health institution in Ile-Ife, Nigeria. MATERIAL AND METHODS: Basic demographic data as well as right upper abdominal quadrant ultrasonography of 50 consecutive sickle cell anaemia patients were compared with those of 50 age- and sex-matched subjects with HbAA as controls. RESULTS: Each of the study groups (patients and controls) comprised of 21 (42%) males and 29 (58%) females. The age range of the patients was 18-45 years with a mean (±SD) of 27.6±7.607 years, while that of the controls was 21-43 years with a mean (±SD) of 28.0±5.079 years (p=0.746). Amongst the patients, 32 (64%) had hepatomegaly, 15 (30%) cholelithiasis and 3 (6%) biliary sludge. Fourteen (28%) of the patients had normal hepatobiliary ultrasound findings. In the control group, one (2%) person had cholelithiasis, one (2%) biliary sludge, one (2%) fatty liver and none hepatomegaly. Forty-seven (94%) of the controls had normal hepatobiliary ultrasound findings. There was a statistically significant difference in the prevalence of hepatomegaly and cholelithiasis between the patients and controls (p value <0.001 for both comparisons). CONCLUSIONS: In this study, hepatomegaly, cholelithiasis and biliary sludge were the most common hepatobiliary ultrasound findings in patients with sickle cell anaemia. Ultrasonography is a useful tool for assessing hepatobiliary abnormalities in patients with sickle cell anaemia

Zastosowanie badania ultrasonograficznego w diagnostyce dolnego podwichnięcia stawu ramiennego u pacjentów poudarowych z porażeniem połowiczym

Aim of the study: To evaluate the usefulness of ultrasonographic acromion-greater tuberosity distance measurement and Shoulder ratio in detecting post-stroke inferior shoulder subluxation. Material and methods: Forty-five hemiplegic stroke patients and 45 controls underwent shoulder sonography to measure their acromion-greater tuberosity distance. Side-to-side acromion-greater tuberosity distance differences and Shoulder ratios were derived from the acromion-greater tuberosity distance values. The long head of biceps tendon, subscapularis tendon, supraspinatus tendon, and the infraspinatus tendon were also evaluated to exclude full thickness tendon tears. Data were analyzed using the Statistical Package for Social Sciences version 20.0 for windows. Normality of data distribution was checked using the Kolmogorov–Smirnov test. Mann–Whitney U test and Chi-square tests were utilized. Results: Hemiplegic and control shoulders’ acromion-greater tuberosity distance values were 2.8 ± 0.6 cm and 2.4 ± 0.4 cm, respectively (p = 0.001). Hemiplegic and control shoulder ratios were 1.3 ± 0.3 and 1.1 ± 0.1, respectively; p < 0.001. Point biserial correlation showed that the presence of subluxation correlated moderately with higher shoulder ratios in all the hemiplegics (rpb = 0.520; p < 0.001). Conclusion: Our results suggest that acromion-greater tuberosity distance measurement is useful for detecting inferior shoulder subluxation. Shoulder ratio may be of complementary or supplemental value to acromion-greater tuberosity distance difference.Cel badania: Ocena przydatności ultrasonograficznego pomiaru odległości między wyrostkiem barkowym łopatki a guzkiem większym kości ramiennej oraz wskaźnika barkowego w diagnostyce poudarowego podwichnięcia barku w kierunku dolnym. Materiały i metody: Czterdziestu pięciu pacjentów z porażeniem połowiczym w przebiegu udaru mózgu oraz 45 osób z grupy kontrolnej poddano badaniu ultrasonograficznemu w celu zmierzenia odległości między wyrostkiem barkowym a guzkiem większym kości ramiennej. Na podstawie wartości odległości między wyrostkiem barkowym a guzkiem większym kości ramiennej obliczono różnice między stronami ciała w odniesieniu do odległości między wyrostkiem barkowym a guzkiem większym kości ramiennej oraz wskaźnik barkowy. Dokonano również oceny ścięgna głowy długiej mięśnia dwugłowego ramienia, ścięgna podłopatkowego, ścięgna mięśnia nadgrzebieniowego i ścięgna mięśnia podgrzebieniowego w celu wykluczenia zerwania ścięgna na całej jego grubości. Dane analizowano z zastosowaniem Statistical Package for Social Sciences wersja 20.0 dla systemu Windows. Normalność rozkładu danych weryfikowano z zastosowaniem testu Kołmogorowa–Smirnowa. Wykorzystano testy U Manna–Whitneya i χ2. Wyniki: Odległość między wyrostkiem barkowym a guzkiem większym kości ramiennej u pacjentów z porażeniem połowiczym i w grupie kontrolnej wyniosła odpowiednio 2,8 ± 0,6 cm i 2,4 ± 0,4 cm (p = 0,001). Wskaźnik barkowy u pacjentów z porażeniem połowiczym i w grupie kontrolnej wynosił odpowiednio 1,3 ± 0,3 i 1,1 ± 0,1 (p < 0,001). Korelacja dwuszeregowa punktowa wykazała, że obecność podwichnięcia umiarkowanie korelowała z wyższym wskaźnikiem barkowym u wszystkich pacjentów z porażeniem połowiczym (rpb = 0,520; p < 0,001). Wniosek: Uzyskane przez nas wyniki sugerują, że pomiar odległości między wyrostkiem barkowym a guzkiem większym kości ramiennej jest przydatny w wykrywaniu podwichnięcia barku w kierunku dolnym. Wskaźnik barkowy może mieć dodatkową lub uzupełniającą wartość w pomiarze różnicy w odległości między wyrostkiem barkowym a guzkiem większym kości ramiennej. Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/wydawnictwa/volume-17-no-6

Badanie dopplerowskie przepływu przez tętnice maciczne w nadciśnieniu tętniczym u ciężarnych w Nigerii

Aim of the study: To evaluate the value of uterine artery Doppler indices and waveform pattern in predicting fetuses at risk for intrauterine growth restriction in hypertensive disorders of pregnancy. Materials and methods: This was a prospective cross-sectional study including 80 pregnant subjects with hypertensive disorders of pregnancy and two control groups. Uterine artery Doppler sonography was performed in all study participants. Uterine artery Doppler indices across the groups were compared using the analysis of variance (ANOVA) while the presence of prediastolic notch was analyzed with the Chi Square test. Results: For the hypertensive disorders of pregnancy group, resistivity index > 0.66 had a sensitivity of 50.0%, specificity of 69.1% and a positive predictive value of 22.2% for predicting intrauterine growth restriction. The odds ratio was 2.2 with a 95% confidence interval of 0.6–7.8. The presence of prediastolic notching had a sensitivity of 100.0%, specificity of 96.0% and a positive predictive value of 80.0% for predicting intrauterine growth restriction. The odds ratio was 22.7 with a 95% confidence interval of 7.5–68.5. Conclusion: Uterine artery Doppler sonography is useful for predicting fetuses at risk for intrauterine growth restriction in hypertensive disorder of pregnancy. Prediastolic notching is more sensitive and more specific than uterine artery resistivity index in predicting fetuses at risk of intrauterine growth restriction in established hypertensive disorder of pregnancy.Cel badania: Ocena wartości wskaźników dopplerowskich w tętnicach macicznych oraz kształtu fali przepływu w przewidywaniu wystąpienia wewnątrzmacicznego zahamowania wzrostu płodu w przebiegu nadciśnienia tętniczego u kobiet w ciąży. Materiał i metody: Było to prospektywne badanie przekrojowe obejmujące 80 ciężarnych pacjentek z nadciśnieniem tętniczym oraz 2 grupy kontrolne. U wszystkich uczestniczek wykonano badanie przepływu przez tętnice maciczne z użyciem opcji dopplerowskich. W celu porównania wskaźników dopplerowskich tętnic macicznych we wszystkich grupach zastosowano analizę wariancji (ANOVA), natomiast obecność wcięcia wczesnorozkurczowego analizowano z wykorzystaniem testu chi-kwadrat. Wyniki: W grupie ciężarnych z nadciśnieniem tętniczym wrażliwość wskaźnika oporu naczyniowego >0,66 wynosiła 50%, specyficzność – 69,1%, natomiast dodatnia wartość predykcyjna dla wewnątrzmacicznego zahamowania wzrostu płodu – 22,2%. Iloraz szans wynosił 2,2 przy 95-procentowym przedziale ufności wynoszącym 0,6–7,8. Obecność wcięcia wczesnorozkurczowego wykazywała wrażliwość na poziomie 100%, specyficzność – 96% i dodatnią wartość predykcyjną dla wewnątrzmacicznego zahamowania wzrostu płodu wynoszącą 80%. Iloraz szans wynosił 22,7 przy 95-procentowym przedziale ufności wynoszącym 7,5–68,5. Wnioski: Badanie przepływów w tętnicach macicznych z zastosowaniem opcji dopplerowskich jest użytecznym narzędziem do przewidywania ryzyka wystąpienia wewnątrzmacicznego zahamowania wzrostu płodu w przebiegu nadciśnienia tętniczego w ciąży. Obecność wcięcia wczesnorozkurczowego charakteryzuje się większą wrażliwością i specyficznością w przewidywaniu ryzyka wystąpienia wewnątrzmacicznego zahamowania wzrostu płodu w przebiegu rozpoznanego nadciśnienia tętniczego w ciąży niż wskaźnik oporu naczyniowego w tętnicach macicznych. Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/wydawnictwa/volume-17-no-7

Uterine artery Doppler velocimetry in hypertensive disorder of pregnancy in Nigeria

Aim of the study: To evaluate the value of uterine artery Doppler indices and waveform pattern in predicting fetuses at risk for intrauterine growth restriction in hypertensive disorders of pregnancy. Materials and methods: This was a prospective cross-sectional study including 80 pregnant subjects with hypertensive disorders of pregnancy and two control groups. Uterine artery Doppler sonography was performed in all study participants. Uterine artery Doppler indices across the groups were compared using the analysis of variance (ANOVA) while the presence of prediastolic notch was analyzed with the Chi Square test. Results: For the hypertensive disorders of pregnancy group, resistivity index > 0.66 had a sensitivity of 50.0%, specificity of 69.1% and a positive predictive value of 22.2% for predicting intrauterine growth restriction. The odds ratio was 2.2 with a 95% confidence interval of 0.6–7.8. The presence of prediastolic notching had a sensitivity of 100.0%, specificity of 96.0% and a positive predictive value of 80.0% for predicting intrauterine growth restriction. The odds ratio was 22.7 with a 95% confidence interval of 7.5–68.5. Conclusion: Uterine artery Doppler sonography is useful for predicting fetuses at risk for intrauterine growth restriction in hypertensive disorder of pregnancy. Prediastolic notching is more sensitive and more specific than uterine artery resistivity index in predicting fetuses at risk of intrauterine growth restriction in established hypertensive disorder of pregnancy