Immunohematological characteristics of Nigerian sickle cell disease patients with osteomyelitis

Objective: We aimed in this paper to investigate some immunohematological characteristics of Nigerian sickle cell anemia (SCA) patients with osteomyelitis.Material and Methods: Thirty SCA patients with osteomyelitis (SO) and 30 SCA patients without osteomyelitis (S) were investigated. The PCV, WBC and platelet count were done on automated counter, while the erytorocyte sedimentation rate (ESR) was determined by Westergren’s technique. C3 activator, C1-INH, IgA, IgG and IgM were estimated by the single radial immunodiffusion method. Results: The SO patients weighed less (z =1.943, p<0.055) and were shorter (z = -2.064, p<0.039). High serum levels of IgG, IgM, C1-INH and C3 activator were also found in the SO group. ESR correlated positively with hematocrit (r=0.371, p<0.04) and C3 activator (r=0.468, p<0.03) in SO. Similarly, WBC correlated positively with C1-INH (r=0.806, p<0.01), while we also noted positive correlation between C1-INH and C3 activator (r=0.525, p<0.02). In SO, ESR correlated positively with both IgM (r=0.531, p<0.02) and C3 activator (r=0.449, p<0.05).Conclusion: This study suggests some derangement in immune status in Nigerian SCA patients with osteomyelitis and that C1-INH and C3 activator may be useful markers of immune status in SCA patients

Review of Classical Methods in Supersaturated Designs (SSD) for factor Screening

Supersaturated designs are fractional factorial designs that have too few runs to allow the estimation of the main effects of all the factors in the experiment. There has been a great deal of interest in the development of these designs for factor screening in recent years. A review of supersaturated design is presented, including criteria for design selection, with reference to the popular E(s2) criterion and classical methods for constructing supersaturated designs. Classical methods have been suggested for the analysis of data from supersaturated designs and these are critically reviewed and illustrated. Keywords: Supersaturated, Classical method, Screening, fractional factorial and E(S2

Assessment of iron Parameters and Transient Elastography (FibroScan) Pattern amongPatients with Chronic Viral Hepatitis Infection in Jos, Nigeria

Background:The long-termeffect of excess iron deposition in the liver include fibrosis and cirrhosis which may progress to hepatocellular carcinoma. We assessed iron parameters among patients with chronic viral hepatitis B and C infection (CVHBI; CVHCI) to determineif any correlation existed with the degree of fibrosis in the liver. Methods: A cross-sectional descriptive study was carried out on 186 patients, made up of 132 patients withCVHBI and 54 patients with CVHCI. Serum ferritin and C-reactive protein were done by ELISA, serum iron and total iron binding capacity (TIBC) by colorimetric technique while transferrin saturation (Tsat) was calculated using serum iron and TIBC values. Liver fibrosis was assessed using fibroscan.Obtained data wereanalysed using SPSS version 20 and p values &lt; 0.05 were considered statistically significant.&nbsp; Results: The mean values for serum ferritin, iron, TIBC and Tsat were 218.1±325.6µg/L, 25.1±22.8µmol/L, 71.13 ± 35.92µmol/L and 45.2 ± 49.9% respectively. There were no significant differences in iron parameters between patients with CVHBI and CVHCI. Elevated serum ferritin was found in 15.2% and 20.4% of CHBVI and CHCVI patients respectively; while an elevated Tsat was seen in 22.7% and 24.1% of CHBVI and CHCVI patients respectively. Using a combination of elevated serum ferritin and Tsat, the prevalence of iron overload was found to be1.6%. Fibroscan scores did not differ significantly between patients with orwithout elevated iron parameters. Conclusion:Chronic viral hepatitis infection is associated elevated iron parameters though withminimal effect on liver fibrosis. Conflict of interest: Ni

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Clinicopathological Features Of Nigerians With Myelodysplastic Syndromes

Aim: Myelodysplastic syndromes are a group of haematologic disorders characterized by varying degrees of cytopenias and a propensity to leukaemic transformation. The aim of this study is to determine the prevalence, clinical and laboratory characteristics and the outcome of management in Nigerians with this disorder. Methods: Ten patients who have full clinical and laboratory information were retrospectively studied. Data extracted included demographic parameters, clinical features at presentation, haematological parameters, including bone marrow cytology (and cytogenetic findings, where available), management instituted and outcome of such therapy. Results: Ten patients with de novo MDS were managed and followed-up for a median period of 3 months. The majority (90.0%) were aged 50 years or above with a median age of 65 years. All presented with symptoms of cytopenias such as anaemia (100%), neutropenia (50.0%), and thrombocytopenia (10.0%). Patients had mainly supportive management such as blood product supports. One patient, however, in addition received growth factor and cytotoxic chemotherapy, while one received cytotoxic drugs alone. These were however not adequate due to financial constraints. Eight deaths were recorded (88.9%), either cytopenia related (five) or renal failure (three). Cause of death in one was not known as he died at home. The mean survival was 50.5 ± 96.1 weeks (range=2.1-308.4 weeks) Conclusion: It could be concluded that though clinical and laboratory features of Nigerians with MDS are similar to what is obtained from other parts of the world, non-availability of both specific and supportive drugs, and poor socio-economic status of most patients contributed significantly to the poor outcome recorded in this report

Immunoglobulins (Classes IgG, IgA and IgM) in Pregnant Women With Urinary Schistosomiasis in Ilie, Southwestern Nigeria

Context: The occurrence of schistosome eggs or worms in the female genital tract has been reported in several clinical conditions including ectopic pregnancy and infertility. The presence of schistosome eggs in urine has been reported to correlate with female genital schistosomiasis (FGS), but the impact of schistosome eggs or adult worms on host\'s immune responses during pregnancy is however yet to be determined. Aims: In view of the possible occurrence of female genital schistosomiasis without the eggs being detected in the urine except surgical biopsy. Moreso, surgical procedure may have adverse effects on both the mother and foetus. The diagnostic relevance of three immunoglobulin classes (IgG, IgA & IgM) was investigated in pregnant women with urinary schistosomiasis. Design & Setting: Case-control study in Ilie village in Olorunda Local Government Area of Osun State, Nigeria. Subjects: They were made up of thirty pregnant women with urinary schistosomiasis (P+USS), thirty-six pregnant women without USS (P-USS), eighteen non-pregnant women with USS (NP+USS), and twenty-four non-pregnant healthy women without urinary schistosomiasis (NP-USS). Main Outcome Measures: Serum levels of three immunoglobulin classes (IgG, IgA, IgM) were determined using single radial immuno-diffusion technique in one hundred and eight Nigerian women. Results: All the three classes of immunoglobulin were higher in P+USS compared with other groups. Both IgA and IgG were significantly different when P+USS and other groups were compared. No significant difference existed when IgM was compared in P+USS and P-USS or NP+USS and NP-USS or P-USS and NP-USS. Conclusions: The results shows that raised IgM during pregnancy may indicate FGS among other causes. Key Words: Immunoglobulins, Pregnancy, Schistosomiasis [Trop J Obstet Gynaecol, 2004;21:125-127

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

Determinants of Overall and Progression-Free Survival of Nigerian Patients with Philadelphia-Positive Chronic Myeloid Leukemia

Objective. The tyrosine kinase inhibitors have markedly changed the disease course for patients with Ph+ and/or BCR-ABL1+ chronic myeloid leukemia (CML). This study was embarked upon to assess the long-term effects of imatinib therapy on survival in adult Nigerian patients with CML. Methods. All adult patients on imatinib (400–600 mg) seen from July 2003 to December 2010 were assessed. Male/female distribution was 171/101, with a median age of 38 (range, 20–75) years. Overall survival (OS) and progression-free survival (PFS) were determined using the Kaplan-Meier techniques. Results. Of all the 272 patients, 205 were in chronic phase, 54 in accelerated phase, and five in blastic phase, at commencement of imatinib. As at December 2010, 222 were alive. OS at 1 and 5 years was 94% and 63%, while PFS was 89% and 54%, respectively. Similarly, amongst the 205 patients in chronic phase, OS at 1 and 5 years was 97% and 68%, while PFS was 92% and 57%. Conclusion. Imatinib’s place as first-line therapy in the treatment of CML has further been reinforced in our patients, with improved survival and reduced morbidity, comparable with outcomes in other populations

Chronic Myeloid Leukemia in Nigerian Patients: Anemia is an Independent Predictor of Overall Survival

Objectives The advent of the tyrosine kinase inhibitors has markedly changed the prognostic outlook for patients with Ph + and/or BCR-ABL1 + chronic myeloid leukemia (CML). This study was designed to assess the overall survival (OS) of Nigerian patients with CML receiving imatinib therapy and to identify the significant predictors of OS. Methods All patients with CML receiving imatinib from July 2003 to June 2013 were studied. The clinical and hematological parameters were studied. The Kaplan-Meier technique was used to estimate the OS and median survival. P -value of <0.05 was considered as statistically significant. Results The median age of all 527 patients (male/female = 320/207) was 37 (range 10-87) years. There were 472, 47, and 7 in chronic phase (CP), accelerated phase, and blastic phase, respectively. As at June 2013, 442 patients are alive. The median survival was 105.7 months (95% confidence interval [CI], 91.5-119.9); while OS at one, two, and five years were 95%, 90%, and 75%, respectively. Multivariate Cox regression analysis revealed that OS was significantly better in patients diagnosed with CP ( P = 0.001, odds ratio = 1.576, 95% CI = 1.205-2.061) or not in patients with anemia ( P = 0.031, odds ratio = 1.666, 95% CI = 1.047-2.649). Combining these variables yielded three prognostic groups: CP without anemia, CP with anemia, and non-CP, with significantly different median OS of 123.3, 92.0, and 74.7 months, respectively (χ 2 = 22.042, P = 0.000016). Conclusion This study has clearly shown that for Nigerian patients with CML, the clinical phase of the disease at diagnosis and the hematocrit can be used to stratify patients into low, intermediate, and high risk groups

Effects of mucuna seed extract on sperm functional integrities and seminal oxidative stress indices of vitrified goat semen

Effects of mucuna seed extract (MSE) in tris-extenders on sperm functional integrities and seminal oxidative stress indices of vitrified sperm of West African Dwarf (WAD) goat bucks were investigated. Varying levels (0, 0.25, 0.5, 0.75, 1 g/100 mL of diluent) of MSE in tris-extenders were diluted with semen specimens. Diluted semen specimens were vitrified and preserved in liquid nitrogen. The results showed that sperm functional integrities (acrosome and membrane integrities) in MSE extenders were comparable. However, seminal oxidative stress indices (malondialdehyde [MDA] and acrosin activity) differed (P<0.05) among the various treatments and the control. The results revealed that semen vitrified with MSE had reduced (P<0.05) MDA concentrations compared to the control. Higher (P<0.05) acrosin activities were recorded in semen vitrified with MSE compared to the control except at 0.25g MSE and optimal values were recorded at 1g MSE. The findings indicated that MSE in the tris-extenders reduced MDA concentration with congruent elevated acrosin activity and consequently maintained sperm functional integrities of vitrified spermatozoa of the WAD goat