Evaluation of the diagnostic utility of leucocyte in comparison to other biomarkers in the management of patients with pulmonary tuberculosis

Background: Pulmonary tuberculosis (PTB) is an infectious and debilitating disease that affects millions of people each year. Simple, reliable and cost effective biomarkers are vital to fore-stall the morbidity and mortality that is hallmark of the infection especially in resource poor economy.Methods: This comparative study enlisted 140 subjects: 80 had PTB and 60 do not. Blood of 8mls was collected; 3mls in K2-EDTA for FBC testing with XE-2100 Sysmex and ESR by Westergreen method. The remainder was used for serum CRP assay by ELISA. The radiological extent was determined from Chest X ray report and disease severity using modified Bandim TB scoring was extracted from the case note. The aim of the study is to investigate the relationship and diagnostic utility between leucocyte with CRP, ESR, radiological extent of disease and disease severity in PTB.Results: Mean Lymphocyte count was lower while TWBC, Neutrophil and Monocyte counts were higher in subjects compared to control (p<0.05). Median CRP, ESR, NLR, NMR and MLR were higher in subjects compared to control (p<0.05), NLR and MLR showed strong positive significant correlation with ESR, disease severity, and radiological extend of disease. NMR (p= 0.00) had a negative correlation with ESR (p<0.05) and inverse correlation with disease severity and radiological extent.Conclusions: This study found NLR, MLR and NMR as a readily, easily available and inexpensive indices that are as efficient and comparable to known biomarkers in PTB infection, therefore could serve as valuable predictive biomarker in areas of high disease burden with weak economy

Haematologic Indices in Pulmonary Tuberculosis with or without HIV Co-Infection in South Eastern Nigeria

To evaluate the changes in haematologic indices in patients with pulmonary tuberculosis (PTB) with or without Human Immune Deficiency Virus (HIV) co-infection in South Eastern Nigeria. The study population included 116 subjects (60 = males; 56 = females), recruited from 2 study centers: mile 4 Hospital Abakaliki Ebonyi State and Nnamdi Azikiwe University, Teaching  Hospital Nnewi, Anambra State, both in Nigeria. PTB + HIV (n = 20); PTB infection ( n = 27) and HIV sereopositive (n = 28). The PTB and HIV negative; control subjects were 41 (n = 41). Blood samples collected from subjects in Ethylene diamine tetra acetic acid (EDTA) container were used for the analysis of the Haemtological cells count,  packed cell volume (PCV) and Haemoglobin estimation using routine methods as described (Dacie and Lewis, 1984). HIV screening was done with Stat pak kit and confirmatory test by Western blot method. Erythrocyte sedimentation rate (ESR) was by Westergren method. Haemoglobin estimation (Hb), packed cell volume (PCV) values were significantly lower in patients with PTB (11.27±1.62 g/dl, 0.35±0.04 l/l) compared with control values (13.67±1.46 g/dl 0.41 ± 0.05 l/l) (p &lt; 0.05). Patients with HIV seropositive showed significantly low PCV values of (0.36 ± 0.04 l/l) compared with the control subjects (0.41 ± 0.05 l/l) (p &lt; 0.05). PTB patients showed higher TWBC counts (6062.5 ± 1481.83109/l) when compared those with HIV infection (3841.38±735.58 x 109/l) as well as normal control value (4363.64±551.66 x 109/l) (p &lt; 0.05). Male and female values compared in this work showed no significant difference (p &gt; 0.05). The results showed that the effect of PTB and HIV infection have caused some haematological deregulation. It also showed that sex has little or no effect on the studied parameters. Keywords: Pulmonary tuberculosis (PTB); Human ImmunoDeficiency Virus (HIV) and Hematologic Indice

Fibrinogen Concentration and Thrombin Levels in Pregnant Women in Nnewi, Anambra State, South, Eastern Nigeria.

This study was aimed at looking at the influence of pregnancy on fibrinogen concentration and thrombin time (TT) levels. A total of 195 pregnant women between 18 and 35 years were recruited, 59 were in their first trimester (group A), 61 second trimester (group B) and 75 the third trimester (group C). A total of 150 apparently healthy non pregnant women were used as normal control (group D). Blood samples which was collected from each of the participants after obtaining informed consent was tested for the fibrinogen concentration using Clauss method and thrombin time using two stage method. The study was approved by Nnamdi Azikiwe University Teaching Hospital Ethical Committee Nnewi. ANOVA and students t-test were used for statistical analysis. The results showed that fibrinogen concentration (mg/dL) were significantly higher (p&lt;0.05) in group A, B and C as compared with the control group. TT (s) were significantly higher (p&lt;0.05) in group A, B and C compared with the control group. This study therefore suggests that the increase in these coagulation factors observed are due to increased thrombin generation, inflammatory state of pregnancy and fibrinogen being an acute-phase protein. It is important to obtain a baseline of these parameters for all pregnant women during antenatal visits, in order to detect any abnormality early. Key words: Fibrinogen concentration, thrombin time and pregnancy

Modulation of the immune response to Mycobacterium tuberculosis during malaria/M. tuberculosis co-infection

Tuberculosis (TB) causes significant morbidity and mortality on a global scale. The African region has 24% of the world's TB cases. TB overlaps with other infectious diseases such as malaria and HIV, which are also highly prevalent in the African region. TB is a leading cause of death among HIV-positive patients and co-infection with HIV and TB has been described as a syndemic. In view of the overlapping epidemiology of these diseases, it is important to understand the dynamics of the immune response to TB in the context of co-infection. We investigated the cytokine response to purified protein derivative (PPD) in peripheral blood mononuclear cells from TB patients co-infected with HIV or malaria and compared it to that of malaria- and HIV-free TB patients. A total of 231 subjects were recruited for this study and classified into six groups; untreated TB-positive, TB positive subjects on TB drugs, TB- and HIV-positive, TB- and malaria-positive, latent TB and apparently healthy control subjects. Our results demonstrate maintenance of interferon (IFN)-γ production in HIV and malaria co-infected TB patients in spite of lower CD4 counts in the HIV-infected cohort. Malaria co-infection caused an increase in the production of the T helper type 2 (Th2)-associated cytokine interleukin (IL)-4 and the anti-inflammatory cytokine IL-10 in PPD-stimulated cultures. These results suggest that malaria co-infection diverts immune response against M. tuberculosis towards a Th-2/anti-inflammatory response which might have important consequences for disease progression

Influence of Antenatal Care on the Haematocrit Value of Pregnant Nigerian Igbo Women

Context: Antenatal care is generally believed to influence the outcome of any pregnancy. Haematocrit values are important in the assessment of anaemia in pregnancy. A good antenatal care is expected to be associated with good haematocrit values, prevent anaemia in pregnancy, and result in an overall good pregnancy outcome. Objective: To determine the prevalence of anaemia in pregnancy and the effect of antenatal care, especially iron and folate supplementation on the blood build-up in pregnancy. Study Design, Setting and Subjects: Single arm clinical study of 186 consecutive booked pregnant women with singleton fetuses attending antenatal clinic at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. The biosocial characteristics (age, parity and social class); gestational age at booking; and compliance with antenatal medication were obtained and analysed. Results: At booking, 66(35.5%) of the women were anaemic, with haematocrit value being less than 30%. At the onset of labour, the number dropped to 32(17.2%) [p < 0.05] representing a 50% improvement in the proportion of anaemic women. Conclusion: The results suggests that antenatal iron and folate supplementation and antenatal care in general promote blood build-up in the pregnant women, thereby reducing the incidence of anaemia before parturition. Key Words: Antenatal Care, Haematinics, Iron, Folate, Anaemia. [Trop J Obstet Gynaecol, 2002, 19: 68-70

The prevalence of overweight/obesity and dyslipidemia amongst a group of women attending "August" meeting

Background: Obesity and dyslipidemia are major risk factors for cardiovascular disease while obesity is a leading determinant for hypertension and diabetes mellitus. The objective of this study was to assess the prevalence of overweight/obesity and dyslipidemia amongst a group of women attending "August" meeting. Methods: A total of 186 women attending the 2006 "August" meeting at Naze, Owerri North Local Government Area, Imo State, were recruited into the study but only 183 had complete data. The Blood Pressure (BP) was measured using a Standard Mercury Sphygmomanometer with appropriate cuff size. BMI was calculated as weight (in kilograms) divided by height (in meters) squared. Based on the WHO classification overweight was defined as BMI between 25 and 29.9kg/m 2 , and obesity was defined as BMI ≥ 30kg/m 2 . Total serum cholesterol was determined by the method of Trinder 1969, triglycerides by the method of Jacobs and van Demark 1960 while LDL-C and HDL-C were determined by the method of Assmann, Jabs Kohnert et al 1984. Hypercholesterolemia was defined as total cholesterol 6.20mmol/L (240mg/dl), reduced HDL less than 1.29mmol/L (50mg/ dl), Hypertriglyceridemia as triglycerides greater than 1.7mmol/ L (150mg/dl). Result:The mean age is 54.84yrs ± 10.76, the mean BMI 26.47 ± 4.50, mean SBP 132.38mmHg ± 21.94, mean DBP 77.07mmHg ± 12.25, mean TC 5.29 mmol/L ± 1.76, mean HDL 1.14mmol/L ± 0.83, mean LDL 1.39mmol/L ± 0.63, mean TG 1.49mmol/L ± 0.63. The prevalence of overweight was 38.5%, obesity 20.7%, hypertriglyceridemia 34.1%, hypercholesterolemia 31.4%, low HDL 37.6%, hypertension 44.3% and dyslipidemia 60.5%. BMI correlated with DBP r =.290, P < .000; TC r = .246, P < .001; LDL r = .172, P = .024 but did not correlate with age SBP, TG and HDL. Age correlated with SBP r =.321, P < .000 and LDL r =.163, P =.031. TC correlated with SBP r =.370, P < .000, DBP r = .274, P < .000, TG r = .441, P < .000 LDL r = .757, P < .000 but did not correlate with HDL. Conclusion: In conclusion this study has shown a high prevalence of Obesity/Overweight, Hypercholesterolemia, Hyperglyceridemia as well as low HDL amongst a group of women attending "August" meeting