Serum Levels of Pro-inflammatory Cytokines in relationship to outcomes in Children with P. falciparum malaria, in Nnewi-South east Nigeria

Background and Objective: In P. falciparum malaria (PFM) infestation there are marked changes in cytokine production as the body mounts an immune response to it. Hence we set out to study these changes.Methods: A total of 158 cases of PFM among children attending the paediatric unit of our hospital and 56 healthy controls were studied. Children with febrile illness were screened for malaria using 10% Giemsa stained blood smear. Patients with positive smears were recruited; co-infected patients – those infected by another organism in addition to plasmodium specie.- were excluded. Whole blood was collected, some into plain tubes for serum cytokine testing and some into EDTA bottles for complete blood count and parasite density (PD) determination. Controls with asymptomatic parasitaemia were excluded.Results: Using the World Health Organization criteria for defining severe malaria; we identified 15 cases of severe and 143 cases of uncomplicated PFM. Significantly elevated levels of interleukin-1 (IL-1), interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α) were seen in the uncomplicated and severe forms of PFM. It was observed that the elevated cytokine values correlated with PD (in uncomplicated PFM but not in the severe forms). The difference between PD/absolute monocyte count (AMC) ratio was not significant (p=0.13); while PD/platelet count (PC) and PC/ AMC ratios were significant (p=0.01, and 0.03 respectively) when compared between uncomplicated and severe disease.Conclusion: Our data seems to suggest that subjects with an adequate immune response to the parasite density, in terms of pro-inflammatory cytokine levels, presented with uncomplicated disease; while those who have an inadequate response presented with severe disease. The ratios of (PD/PC) and (PC/AMC), in the positive and negative directions respectively, may be predictors of increased disease severity. These observations may have implications for predicting disease outcome and PFM therapy.Key Words: plasmodium falciparum malaria, pro-inflammatory cytokines, Parasite density/Platelet count ratio, Platelet count/Absolute monocyt

Prevalence of haemolysins in blood donors in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

Background: The presence of high titres of haemolysins (lytic antibodies) in the sera of donors could predispose to adverse blood transfusion reactions.Objective: To evaluate the prevalence of haemolysins among blood donors at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.Methodology: A total of 1,370 donors were randomly selected for the study between April and September 2014. Each donor had 3mls of blood collected; 2mls was dispensed into plain bottles and serum extracted for haemolysin testing, while 1ml was dispensed into ethylene diaminetetracetic acid (EDTA) bottle for blood grouping. Haemolysin testing was done by reacting freshly prepared standard A, B, AB and O red cell suspensions with sera from each participant while blood grouping was done using commercial anti-sera kits. Ethical approval was obtained from the institution’s Review Committee, and all participants gave informed consent.Results: The general prevalence of haemolysins was 220/1370 (16.06%), while alpha, beta and alpha plus beta haemolysins were detected in 70 (5.11%), 90 (6.5%) and 60 (4.38%) of donors, respectively. The number of donors with blood groups A, B and O were 265, 165 and 940, while the distribution of haemolysins was 18.87%, 18.18% and 14.89%, respectively. Of the 220 donors in whom haemolysins were detected, 18.2% (40/220), 27.3% (60/220), 40.9% (90/220) and 13.6% (30/220) were aged 18-27years, 28-37years, 38-47years and 48-57years, respectively.Conclusion: There is a high prevalence of haemolysins in our donors, particularly in those with blood group A and in the age range of 38-47years.Keywords: Blood groups, lytic antibodies, South-East Nigeria, transfusio

Allopurinol induced Stevens - Johnson syndrome in a Nigerian woman with chronic lymphocytic leukaemia

Stevens-Johnson syndrome is an adverse muco-cutaneous complication arising from a number of conditions which include the administration of some drugs. A female Nigerian with chronic lymphocytic leukaemia, (Binet stage C) who developed Stevens-Johnson syndrome following commencement of allopurinol is presented. She was treated with intravenous fluids, steroid, antihistamine, antibiotics, skin emollient along with oral care, while allopurinol was discontinued. She attained full recovery and was re-commenced on cyclophosphamide (without allopurinol), with no further sequelae.Conclusion: Stevens-Johnson syndrome could occur in patients on allopurinol, this is the first of such report (to the author’s best knowledge) from South-East Nigeria. Drug withdrawal and supportive management are associated with clinical recovery.Keywords: Adverse skin reactions, lymphoid malignancy, steroid

Haematological and clinical profile in Nigerian sickle cell disease patients with and without chronic kidney disease

Background: Sickle cell disease (SCD) has adverse effects on the kidneys which impact on clinical outcome.Objectives: To study and compare some clinical and haematological profiles in SCD patients, with and without chronic kidney disease (CKD).Methods: Prospectively, 92 SCD patients were investigated and stratified into those with CKD (creatinine clearance ≤60ml/min) and those without (creatinine clearance≥60ml/min). Socio-demographic data, clinical and haematological parameters were documented and compared in the two groups as well as with gender stratification, using the student’s t-test.Results: The crises frequency and transfusion history (in males) together with the corrected reticulocyte count (in females) were significantly different in SCD patients with CKD, compared to those without (p values<0.05).Conclusion: Kidney disease significantly influences some clinical and haematological parameters in patients with SCD, which could impact on survival.Keywords: Corrected reticulocyte count, transfusion history, vaso-occlusive crise

Assessment of Lipid Profile in HIV Seropositive Pregnant Women attending Ante-Natal Clinic in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

Background: Undesirable changes in lipid metabolism have been reported among HIV-infected individuals undergoing anti-retroviral therapy. Considering the peculiarity of pregnant women who are also faced with similar metabolic changes, it becomes necessary to ascertain lipid changes that occur in them, and assess the effect of anti-retroviral therapy (ART), diet and physical exercise on their lipid profile.Methods: The study was conducted in Nnamdi Azikiwe University Teaching Hospital, Nnewi in Anambra State, Nigeria. One hundred subjects were recruited for this study. This comprised of 50 HIV sero-positive pregnant women (test) and 50matched HIV sero-negative, pregnant women (controls) attending ante-natal clinic. Questionnaires and patient records were used to obtain data and information on the subjects. They were categorized into three groups based on dietary intake (carbohydrate-rich, protein-rich and cholesterol-rich) and into two groups based on exposure to physical activity, at least one hour daily exercising and non-exercising. After an overnight fast, 5mls of blood was collected from all subjects into plain tubes and sera analyzed for total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol(LDL-C) and high density lipoprotein cholesterol (HDL-C) using the VITROS 350 automatic chemistry analyzer.Result: The lipid profile of HIV sero-positive pregnant women were significantly lower than in sero-negative pregnant women (p=0.028).There was no statistically significant difference in lipid profile between those on ART and those not on ART. With physical exercise decreased levels of lipids were observed in both test and control groups (p<0.05). There was significant difference in the TC and LDL-C with respect to the diets for carbohydrate-rich, protein-rich and cholesterol-rich diets (p<0.05) in the control group.Conclusion: Findings from this study suggest that HIV does alter the lipid profile of HIV-infected pregnant women. This, however, causes a deranged lipid profile. Physical activity and diet also play important roles in the regulation of lipid levels