Prevalence and associations of symptomatic renal papillary necrosis in sickle cell anemia patients in South‑Eastern Nigeria

Aim: To assess the prevalence and associations of symptomatic renal papillary necrosis (RPN) in sickle cell anemia patients.Patients and Methods: The case notes of homozygous hemoglobin (Hb) S patients diagnosed with RPN were retrospectively assessed. Diagnosis was based on microscopic hematuria and positive ultrasound findings. Their steady state diastolic blood pressure, Hb, leukocyte count, platelet count, serum direct bilirubin, and aspartate transaminase, were obtained by automated analyzers. These were evaluated for any relationship with the occurrence of RPN.Results: Two hundred and twenty patients were assessed aged 6–55 years with a median age of 24 years. The prevalence of symptomatic RPN was found to be 2.3%. RPN was positively associated with the female gender (Chi‑square P value 0.001), but not with any other clinical or laboratory variable. However, other predictors of disease severity were positively associated with RPN such as age, diastolic blood pressure 0.180 (P = 0.016), serum aspartate transaminase, serum bilirubin 0.145 (0.027), Hb, and leukocyte count − 0.155 (P = 0.003).Conclusion: The prevalence of symptomatic RPN is low in this group of homozygous S patients and occurs more commonly in females. Improvement in care for these patients will reduce these chronic complications.Keywords: Female gender, microscopic hematuria, renal papillary necrosis, sickle cell anemi

Improved functionalization of oleic acid-coated iron oxide nanoparticles for biomedical applications

Superparamagnetic iron oxide nanoparticles can providemultiple benefits for biomedical applications in aqueous environments such asmagnetic separation or magnetic resonance imaging. To increase the colloidal stability and allow subsequent reactions, the introduction of hydrophilic functional groups onto the particles’ surface is essential. During this process, the original coating is exchanged by preferably covalently bonded ligands such as trialkoxysilanes. The duration of the silane exchange reaction, which commonly takes more than 24 h, is an important drawback for this approach. In this paper, we present a novel method, which introduces ultrasonication as an energy source to dramatically accelerate this process, resulting in high-quality waterdispersible nanoparticles around 10 nmin size. To prove the generic character, different functional groups were introduced on the surface including polyethylene glycol chains, carboxylic acid, amine, and thiol groups. Their colloidal stability in various aqueous buffer solutions as well as human plasma and serum was investigated to allow implementation in biomedical and sensing applications.status: publishe

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Surgical site infection following primary joint replacement at the National Orthopaedic Hospital, Enugu

Background: Total joint replacement is increasingly in use for treatment of orthopaedic ailments. Infection following joint replacement surgery can be devastating. Infection rates of 1-2.3% are reported in developed countries. In Nigeria proper theatre facilities, like controlled airflow systems and the use of body exhaust suits, for joint replacement surgeries are not commonplace. Aim: To determine the surgical site infection rates for total joint replacements done in the National Orthopaedic Hospital Enugu and to compare this to what is obtainable in developed countries where proper laminar airflow theatre facilities exist. Materials and Methods: At the National Orthopaedic Hospital Enugu, 33 total joint replacement surgeries were done in 5 years giving an average of 6.6 surgeries per year and the number is increasing. One patient had revision hip arthroplasty and was excluded from the study. Thirty two patients met the inclusion criteria and were recruited into the study. Results: Twenty-three patients had total hip replacement while nine patients had total knee replacement. There were 19 males and 13 females enrolled in the study with a ratio of 1.5:1. The mean age was 57.4years. One patient had superficial incisional surgical site infection giving a surgical site infection rate of 3.1% reported in this study with pseudomonas as the causative organism. Conclusion: It is concluded that these surgeries can be done in the conventional theatres available in Nigeria as the infection rate reported in this study is comparable to what is obtainable in developed countries

Implant Associated Surgical Site Infection in Orthopaedics: A Regional Hospital Experience

No Abstrac

Important clinical and laboratory correlates of glomerular filtration rate in sickle cell anemia

Background: Renal impairment is routinely assessed using the estimated glomerular filtration rate (eGFR) and it may be helpful to obtain certain clinical or laboratory markers, which show relationship with glomerular filtration rate (GFR) in sickle cell disease (SCD).Aim: To assess the relationship between important clinical and laboratory parameters in SCD, and the eGFR.Patients and Methods: Steady state clinical and laboratory data were obtained from 228 homozygous SCD patients seen over a 7‑year period. The GFR was estimated using (isotope dilution mass spectrometry) traceable modification of diet in renal disease (MDRD) and Cockroft–Gault methods. The correlation coefficient and independent t‑test were done to assess the level of significance between the eGFR_MDRD and the known indicators of disease severity.Results: The serum alkaline phosphatase (ALP) and serum direct bilirubin levels both showed significant inverse relationship with eGFR_MDRD P = 0.012 and P = 0.24, respectively. The patients’ age, Hb, leukocyte count, platelet count, serum direct bilirubin and aspartate transaminase did not show a significant correlation. The eGFR_MDRD was more discriminatory revealing that 20.3% of the patients had suboptimal GFR. Proteinuria in steady state was observed in 20.3% of the patients.Conclusion: High serum direct bilirubin and ALP are associated with a deteriorating eGFR_MDRD. Other clinical and laboratory indicators of disease severity in SCD do not show the relationship with the GFR. MDRD_GFR estimation seemed to be a more appropriate method of estimating GFR in SCD.Key words: Cockroft–Gault, glomerular filtration rate, modification of diet in renal disease sickle cel

Traumatic hip dislocation; a South East Nigeria hospital experience

Background: Hip dislocation is a relatively common orthopaedic emergency. The hip is an inherently stable joint and substantial force is required for dislocation to occur. Thus hip dislocation is said to follow motor vehicle accidents with more than 90% of hip dislocations being posterior. Thompson and Epstein grade I and II are acknowledged to be the commonest grades of posterior hip dislocation. Method: This is a retrospective study involving all cases of traumatic hip dislocation seen at The National Orthopaedic Hospital, Enugu between 1st January 2004 and 31st December 2009.The records of the patients were obtained and the relevant data extracted. The data was analyzed to determine the pattern and management of hip dislocations. Results: A total of 67 patients were seen and treated within the study period. There were 48(69.6%) males and 21(30.4%) females giving a male to female ratio of 2.3:1. The mean age was 36.4 &plusmn; 14.6 years. Posterior hip dislocation was seen in 92.9% of cases. Thompson and Epstein grade I and II were seen in 63% of cases. Interval to presentation was variable and ranged from &lt;6 hours (39.1%), within 12 hours (44.9%), to &gt;13 weeks (7.2%). Associated neurological injury was present in 5.7% of patients. The commonest form of treatment was closed reduction in 76.8% of patients. Associated injuries occurred in 53.6% of patients with fractures of other bones in 23.2%. Most (88.4%) traumatic hip dislocations followed motor vehicular accident. Conclusion: Traumatic hip dislocation occurs in our environment and posterior dislocations are the commonest form. Thompson and Epstein I and II are common. Late presentation is common in our environment but closed reduction is the form of treatment in most cases. Associated injuries are frequently seen