Plasmodium falciparum Infection Modulates Platelet Count than Leucocyte Parameters in Carriage of Different Haemoglobin Beta Subunit (HBB) Genotypes

Background: Sickle cell disease is a prime genetic disorder due to a single nucleotide mutation resulting in haemoglobin gene (HbS) occurring in the regions where malaria is endemic. Though it primarily a disease of erythrocytes, non-erythrocytic cells are equally affected just like in malaria infection. Furthermore, leucocytes and thrombocytes have equally been hypothesized to be the driving force for sickle cell crisis. However, the modulatory trends and magnitude of Plasmodium falciparum infection on platelet and leucocyte parameters in sickle cell disease is not entirely explored. Objectives: The current study therefore determined the modulatory effects of P. falciparum infection on platelet and leucocyte parameters in carriage of different haemoglobin beta subunit (HBB) genotypes. Methodology: This cross-sectional study evaluated leucocytes and thrombocytes parameters in P. falciparum-infected and non-infected children (n=217, aged 1-192 months) with different HBB genotypes.  Children with acute febrile conditions were randomly selected and enrolled at Jaramogi Oginga Odinga Teaching and Referral Hospital for a period of ten months at outpatient clinic.  Haematological parameters were determined using Beckman Coulter counter ACTdiff2TM while HBB genotyping was done using TaqMan® SNP genotyping assay.  Chi-square (χ2) analysis was used to determine differences between proportions.  Mann-Whitney U test and Kruskal Wallis test were used for comparisons of demographic and laboratory characteristics wherever applicable.  Partial correlation test was used to determine relationship between leucocytes and thrombocyte parameters in carriage of different HBB genotypes while adjusting for age and sex as covariates. Results: Generally, there were no differences in WBC (p=0.746), lymphocytes (p=0.103), monocyte (p=0.084) and granulocytes (p=0.354) between the infected and non-infected children. Platelet count [median (IQR); 236 (129.5), p=0.001] and PCT, [median (IQR); 0.13 (0.1), p=0.001] were markedly reduced in infected children. Specifically, monocytes had a positive correlation with platelet count (r= 0.742, p=0.002) in non-infected children with HbSS genotype. WBC revealed a positive correlation with platelet count in both infected and non-infected children (r =0.358, r2 =0.128, p =0.047 and r = -0.638, r2 =0.407, p= 0.047) in carriage of HbSS respectively WBC and RDW in children infected with falciparum in carriage of HbSS genotypes (r =0.818, r2 =0.669, p =0.004). Monocyte count revealed a positive correlation with platelet count in non-infected children and no correlation in children infected with malaria (r= -0.742, P=0.022 and r= -0.245, P=0.525, respectively). Conclusion: P. falciparum infection is responsible for a decrease the platelet count as WBC count increases in children with HbSS. Therefore, a decrease in platelet count against leukocytosis in carriage of HbSS should warrant a test for P. falciparum infection. Keywords: Correlation, Haemoglobin, Haemoglobin beta sub-unit, genotype, Leucocyte, Thrombocyte. DOI: 10.7176/JNSR/14-10-05 Publication date:August 31st 202

Variation in Termination of Brachial Artery Among Black African Population

Background:As the main arterial supply of the upper limb, brachial artery (BA) terminates by dividing into ulnar and radial artery about 1cm at the neck of radius as documented in standard anatomy text books. However, due to variations in results from different studies, BA may terminate at the level of neck of radius, radial tuberosity, mid arm and proximal arm. Based on its clinical utility such as blood pressure monitoring and surgical procedures, few reported disparities in certain populations and paucity data especially in black African population, exploration of variations in termination of BA is warranted.Objective:The purpose of this study was to evaluate variation in termination of brachial artery among black African population.Methodology:This was a cross sectional descriptive study carried out in human anatomy laboratories in Maseno, Uzima and Masinde muliro universities in Western Kenya. In this study, 77 cadavers constituting (n=154) upper limb specimens of back African population were sampled using stratified sampling technique. Data on termination of BA, laterality of the upper limb and sex of the cadaver were recorded in data entry form. Brachium region was exposed to access the brachial artery where its course to termination was assessed. Descriptive statistics was used to assess frequency distribution of variant termination while Chi-square was used to determine difference in proportion of normal termination and cumulative variation of termination of BA with regards to laterality of the upper limb. Results:Out of 154 upper limbs studied, the majority (89.0%) had a normal termination at the radial neck, while 7.8% terminated at the radial tuberosity. A small percentage of the upper limbs (1.3% and 1.9%) had termination at midarm and proximal arm, respectively. There was no statistically significant difference in variation in the left and right limbs (p=0.333 and p= 0.564) respectively relative to the normal termination.Conclusion and recommendations: There are variations in termination of brachial artery among the black African population, however, the variation from the normal morphology is not statistically significant, though clinically significant. Termination at radial tuberosity is the most common variant and more common in men than women. Understanding variant termination of BA among black African population is key to all health care professionals especially surgeons, radiologists, anatomists and medical students as such variants may lead to misdiagnosis and post operative related complications. Thus, further population and race specific studies need to be undertaken on such variants. Keywords:Brachial artey, Ulnar artery, Radial artery, Radial tuberosity, Radial neck, Midarm. DOI:10.7176/JNSR/14-12-03 Publication date:September 30th 202