Recent advances in the pathophysiology and management of sepsis: a review

Sepsis is a syndrome consisting of physiological, pathological and biochemical anomalies caused by infectious agents. It causes clinical organ dysfunction, which is identified by an acute increase in the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score of two or more points. SOFA score is a score of three components that can be easily used at the bedside to track the clinical status of a patient while on admission, and these are altered respiratory rate of ≥ 22 breaths/minute, altered mental status, and systolic blood pressure of ≤ 100 mmHg. A patient with SOFA score of ≥ 2 has an attributable 2 - 25-fold increased risk of mortality compared to a patient with SOFA score of ˂ 2. This present review provides information on the new definition of sepsis and septic shock, aetiology, pathophysiology, biochemical, pathological and haematological changes, morbidity and mortality parameters, management, andprognostic factors in patients with sepsis. Key words: Sepsis, septic shock, SOFA score, pathophysiology, management bundle

Traumatic Brain Injury and Metabolic Dysfunction Among Head Injured Patients in a Tertiary Hospital in North-Central Nigeria

Traumatic Brain Injury (TBI) is a common health problem which is one of the main causes of chronic disability and it is associated with hormonal and metabolic disorders. This work was carried out to investigate the relationship between some stress hormones (i.e. prolactin and cortisol) and plasma glucose level in TBI patients. Twenty-five TBI patients were included in the study consecutively. All patients underwent basal hormonal and plasma glucose evaluation within 24 hours of admission. One of the patients died during the acute phase. The results of the study show that prolactin and glucose levels were positively correlated with the Glasgow Coma Scale (GSC). Cortisol levels were observed to be highest in the moderate TBI group with GSC score of 9-13. The results also showed that 80% (20 patients) of the patients were age 40 years and below and 84% (21 patients) were males. In conclusion, present data show that prolactin, cortisol and plasma glucose are disturbed in TBI. The disturbances in the levels of prolactin and glucose are related to the severity of TBI. However, there is no direct relationship between cortisol and severity of TBI. Our results also show that TBI is more common in males and young people

Atherogenic risk pattern among Nigerian hypertensive and diabetic patients undergoing follow-up visit in a tertiary hospital

Objectives: Cardiovascular risk can be predicted using lipid ratios such as the atherogenic index which is defined as the base 10 logarithm of the ratio of plasma triglyceride (TG) to high density lipoprotein cholesterol (HDL-C) – it is a useful prognostic parameter for guiding timely interventions and has also been employed as a predictor of cardiovascular risk. However, this is rarely used in the clinical practice in developing countries including Nigeria.Methods: This study was a hospital-based cross-sectional study of 382 hypertensive and diabetic patients attending outpatient clinics of a tertiary hospital in Nigeria. Atherogenic risk profile, was categorized as low risk (<0.1), intermediate risk (0.1–0.24), and high risk (>0.24). Predictors were established using regression analysis. Level of significance was set at p-value of <0.05 and 95% confidence interval.Results: The mean age of participants was 56±12 years, 31.4% of participants had high atherogenic risk. This was higher among female patients (60.0%). Participants with high TC, high LDL, uncontrolled blood pressure had odds of 1.64, 1.43 and 1.17 times of developing high atherogenic risk respectively.Conclusion: A significant proportion of participants in this study population were at risk of developing atherosclerosis. Key identified populations at risk of CVD should be considered for routine artherogenic assessment.Keywords: Atherogenic, indices, hypertension, diabete

Resting serum concentration of high-sensitivity C-reactive protein (hs-CRP) in sportsmen and untrained male adults

There is an inverse relationship between regular physical activity and concentration of serum inflammatory markers, with variations in resting CRP in trained and  untrained subjects. The effect of acute and prolonged exercises has been studied on inflammatory markers with dearth of information and controversies on the resting serum values of high sensitivity CRP (hs-CRP). Therefore, this study sought to  identify and compare variations that occur in serum levels of high sensitivity CRP in groups of sportsmen (6) and physically active untrained subjects. Eighty-one healthy male participants made up of 21 untrained (control), 10 footballers, 10 athletes, 10 karates, 10 volleyballers, 10 basketballers, and 10 baseballers  voluntarily participated in the study. Participants rested while in sitting position for about 30 minutes during which blood pressures and heart rates were taken. 5 mls of venous blood was withdrawn from the antecubital vein of the participants  (aseptically) between 7:00 and 10:00 am into lithium heparin bottles following an overnight fast. The supernatant was decanted and centrifuged at 3000 rpm, serum was collected and stored at -20ºC prior to biochemical assay which was done with the use of enzyme linked immunosorbent assay (ELISA) kits for hs-CRP. Differences in the means within the sporting groups were analysed using one-way ANOVA while the difference between the trained sportsmen and untrained young adults was analysed using the independent T-test. Statistical significance was set at p < 0.05. The Mean ±SEM age, weight, height, and BMI of the participants were 22.0±0.8 years, 64.1±2.2 kg, 1.74±0.3 m, and 20.6±0.2 kg/m2 respectively. The resting concentration of hs-CRP (μg/ml) was 1.0±0.2 in the untrained, 2.6±0.7 in footballers, 3.6±2.1 in track athletes, 2.4±0.5 in basketballers, 2.2±0.5 in volleyballers, 2.4±1.3 in baseballers, and 1.7±0.5 in karate respectively. There was no significant difference in the resting hs-CRP amongst the sporting groups, and in the sportsmen and untrained group. Resting serum levels of hs-CRP falls within normal range, and varies insignificantly in groups of sports, and in sportsmen and untrained young male adults. This may suggest that the types of sporting activities or participation in sports has no impact on the resting serum hs-CRP.Keywords: Resting hs-CRP, Sportsmen, Young male adult

Serum Malondialdehyde and antioxidant enzymes as bioindicator of oxidative stress in women with PCOS at UITH, Ilorin

Several studies showed circulating oxidative markers being significantly high in Polycystic Ovary Syndrome (PCOS) women when compared with women without PCOS thus oxidative markers may be considered as potential inducer of PCOS pathogenesis. However some previous studies show inconsistent findings among PCOS patients hence, more studies are necessary to further investigate such relationships involving antioxidants and PCOS, especially in our clime where there is paucity of data relating PCOS and oxidative stress marker. Our aim therefore, was to determine the activities of oxidative stress markers in patients with PCOS. This prospective study was carried out on 45 female clients with PCOS aged between 27 and 50 years and their results were compared with 45 healthy age matched controls. The serum was used to estimate the levels of Malondialdehide (MDA), Superoxide dismutase (SOD), and Glutathione S-reductase (GSH), activities in both patients and controls. The data was analyzed using the Statistical Package for Social Sciences (SPSS). The mean serum levels of SOD, MDA and GSH were statistically significantly higher in women with PCOS than in control. There was statistically significant positive correlation between Folicle Stimulating Hormone (FSH), Leutenizing Hormone (LH), SOD, MDA and Age. Higher serum MDA, SOD and GSH levels in PCOS patients compared with the controls in this study, similar to previous studies may be attributed to a compensatory response by the body's defense mechanisms to higher circulating levels of oxidants. No statistical significance difference in the mean catalase activity when PCOS patients were compared with controls. In conclusion, serum MDA and antioxidant enzymes are higher in PCOS patients, pointing to the fact that oxidative stress is more prevalent among these patients with PCOS, therefore it will not be out of place to evaluate with PCOS for oxidative stress, irrespective of their reproductive disorders

Lipid Profile in Subfertile Clients with Premature Ovarian Failure: University of Ilorin Teaching Hospital Experience

Background: Premature Ovarian Failure (POF) is associated with a higher incidence of cardiovascular events later in life. Concurrent with the ages of menopausal transition, a shift in lipid profile takes place. The increased burden may be mediated by a worsening of cardiovascular risk factors, such as lipids, corresponding with the loss of ovarian function. Aim and Objectives: To investigate serum lipid and hormonal levels in women with premature ovarian failure and compare with those of apparently healthy women of similar age. Material and Methods: The study was a cross-sectional one in which serum fasting Total Cholesterol (TC), Triglycerides (TG), High Density Lipoprotein Cholesterol (HDL-C) and Low Density Lipoprotein Cholesterol (LDL-C) levels were measured in 50 women with POF and compared with 40 age matched control. Serum hormonal profiles were compared with lipid profiles and biomarkers of atherogenic index were assessed. Results:Women with POF present with statistically significant elevations in the mean values of serum FSH and LH, when compared with those of controls (p<0.001), while there were significant decrease in mean levels of serum prolactin, progesterone, testosterone and oestradiol when subjects were compared with controls (p<0.001). There were statistically significant elevations in serum total cholesterol, triglycerides, HDL-C and LDL-C, in premature ovarian failure subjects when compared with controls (p<0.001). There was statistically significantly difference when mean values of artherogenic index and Castelli ratio II of subjects were compared with those of controls. Conclusion: Loss of ovarian function at a very young age (POF) was characterized with subtle changes in the serum lipid profile (higher TC, TG, HDL-C, and LDL-C levels). It also shows that atherogenic index and Castelli ratio II are better tools for assessment of atherogenicity than CHD risk ratio and Castelli ratio I in patients with POF

Anti-Kell allo-immunization in a Tertiary Care Hospital in North central Nigeria

Objective: Although ABO and Rh are the most clinically important blood group systems, other systems are also immunogenically significant. After ABO and Rh systems, anti-K, anti-k, anti-Kpa, anti-Kpb, anti-Jsa, anti-Jsb, and anti-U1a, were the next to cause acute and delayed haemolytic transfusion reactions and Haemolytic Disease of Fetus and Newborn. Design: A prospective cross-sectional study. Subjects: 300 adult patients who had one or more units of packed cells or whole blood for correction of anaemia. Interventions: antibody screening, identification and titration was performed using commercially prepared panel of cells on the serum obtained by centrifuging 2ml of venous blood aspirated from every blood transfusion recipient 48 hours after transfusion. Result: Anti-K allo-immunization in this study was 1.6%. Anaemia and bleeding associated with pregnancy and other obstetrics and gynaecology disorders, Diabetes Mellitus and cancer of the bladder were indications for transfusions in 60%, 20% and 20% respectively of the 5 anti-K allo-immunized recipients. Female sex and previous blood transfusions correlated significantly with anti-K&nbsp; alloimmunization while age, types of unit transfused, and types of transfusion did not. All the anti-K allo-antibodies were of the IgG while 2 were of IgG + IgM type. Conclusion: Because of the high prevalence of anti-K in this study, antibodies screening and identification is recommended to improve&nbsp; blood transfusion safety

Risperidone-Induced hyperprolactinemia in a Pre-menopausal Woman: A case report

A common side effect of antipsychotic medications used to treat psychotic patients is hyperprolactinemia. Its occurrence leads to dysfunction of the reproductive, endocrine and metabolic systems. This side effect which may be symptomatic or asymptomatic, is commonly under reported and under treated and may result in poor compliance. We present the case of a 35year old patienttreated for psychotic depression with atypical antipsychotics, Risperidone and Amitrypiline, who presented with galactorrhea and amenorrhea which led her to stop her medications and consequently, a resurgence of the primary illness. Hormonal assay showed elevated Prolactin level which reduced significantly with institution of dopamine agonist Bromocriptine and a switch in medicationto Aripripazole. These are examples of treatment strategies suggested in literatures reviewed. We recommended that clinicians pay more attention to hyperproclactenimia as an important side effect seen in patients taking antipsychotics which may reduce compliance. Key words: Hyperprolactinemia, Antipsychotic, Risperidone&nbsp

Non-galactorrhoeic hyperprolactinaemia in subfertile female patients: A Nigerian tertiary hospital's experience

Non-galactorrhoeic hyperprolactinaemia is one of the major causes of infertility, usually overlooked worldwide. Observed increasing incidence and prevalence, result in high medical cost and poor outcome of infertility treatment.  The high possibility of missing this clinical entity which is usually a biochemical diagnosis need to be critically looked into as there is paucity of data in this aspect thus necessitating this study.A cross sectional study of eighty-seven (87) sub-fertile females with age range of 31 and 42 years attending the Assisted Reproductive Unit of the University of Ilorin Teaching Hospital (U.I.T.H) Ilorin, Nigeria were recruited for the study. Their descriptive parameters and information were extracted from their hospital folders.Forty-eight (55.2%) of the 87 of the subfertile females had hyperprolactinaemia without galactorrhoea while thirty-nine (44.8%) had galactorrhoeic hyperprolactinaemia. Mean ages of galactorrhoeic and non-galactorrhoeic hyperprolactinaemia patients were 39.2±6.1 and 37.3±6.9 respectively, and when they were compared there was no statistically significant difference with p-value of 0.194. There was significant positive correlation between age, duration and serum level of prolactin in both galactorrhoeic and non-galactorrhoeic hyperprolactinaemia.We concluded that non-galactorrhoeic hyperprolactinaemia is an hidden common cause of infertility and an appraisal of this clinical entity is important more so that it is the major presentation of hyperprolactinaemia in our study. The import of the study therefore is that person with suspected case of infertility should be investigated for hyperprolactinaemia even in the absence of galactorrhea as well as holistic interpretation of hormonal profile as prompt and proper treatment will yield a fruitful result. Keywords: Non-galactorrhoeic Hyperprolactinaemia, Subfertile females, Assisted Reproductive Uni

Seeds and seedlings vigour in tropical maize inbred lines

Seed and seedling vigour is an aspect of seed quality which affects field establishment and performance. Low maize yields have been reported  to be affected by several factors in which poor quality seed with low seed and seedling vigour. Information is scarce on seed and seedling vigour in maize inbred lines developed for tropical environments. Fifteen genotypes of tropical maize (Zea mays L.) inbred lines were evaluated to determine the level of differences in seed and seedling vigour traits, and extent of relationships among traits and their heritability. A substantial amount of genetic variability was found, which suggested that most of the traits under study could be improved through selection and utilized in breeding programs. Positive and signifi- cant interrelationship  among  seed germination  and seedling  traits  and  a positive  correlation  between  seed germination and seed vigour and field emergence showed that these could be given due consideration in crop improvement for seed and seedling vigour. High genotypic coefficient of variation, heritability and genetic advance were obtained for seed germination, seed emergence, shoot length and seedling vigour index I and II, revealing the possibility of improvement in these characters through direct selection. The principal component analysis (PCA) identified seed emergence, shoot length, seedling vigour index I and II and tetrazolium vigour as characters that contributed greatly to variation in seed vigour in the maize inbred lines. Cluster analysis partitioned the genotypes into two groups, with group I consisting of seven genotypes and group II comprised the other eight genotypes, which suggested that hybridization between the two groups could lead to high level of heterosis. Genotype V5  had superior seedling vigour traits compared to other genotypes. Seedling emer- gence, shoot length, seedling vigour index I, seedling vigour index II and tetrazolium vigour are effective characters for good seedling vigour traits in maize inbred lines investigated