Impact of serum uric acid concentration on ultrasound scanned pregnant women in Calabar, Nigeria

Objectives: To evaluate the effect of serum uric acid elevation on the fetus and to determine the existence of a connection between hyperuricemia and gestational hyperten sion (pre-eclampsia).Materials and method: A prospective cross-sectional case-controlled ultrasound scan study was done on 200 singleton pregnant women between 20 to 40 weeks gestational age in a 12-month period. The age range for the cases and control were from 15 to 39 years. Uric acid concentration in the serum obtained from all the women was analyzed utilizing manual colorimetric method. Pearson’s correlation and the student t-tests were used to analyze the data obtained.Results: Maternal serum uric acid had negative correlation with fetal heart rate (FHR) (p = 0.025) and a positive correlation with estimated gestational age (EGA) (p = 0.040) including estimated fetal weight EFW (p = 0.046). A significant positive correlation between uric acid and proteinuria (p = 0.009) was observed. Uric acid was higher in pre-eclamptics than gestational hypertensives (8.528±2.679 mg/dl versus 6.542±1.746 mg/dl, p = 0.016). Also, uric acid in pregnancy induced hypertension (PIH) was higher than the normotensives (7.535±2.165 mg/dl versus 5.437±1.636 mg/dl).Conclusion: Maternal hyperuricemia predisposes to fetal bradycardia which may have possibly led to the two fetal demise recorded in the present study. Increased EFW with hyperuricemia may be due to higher body mass index (BMI) of the subjects. Therefore, high serum uric acid has a significant role in foretelling the appearance of preeclampsia but not gestational hypertension

Risk factors and assessment for cardiovascular disease among HIV-positive patients attending a Nigerian tertiary hospital

Introduction: cardiovascular risk factors are prevalent in HIV-positive patients which places them at increased risk for cardiovascular disease (CVD). We aimed to determine the risk factors and risk assessment for CVD in HIV-positive patients with and without antiretroviral therapy. Methods: this was a cross-sectional study of HIV-positive patients attending the Lagos University Teaching Hospital, Nigeria. Anthropometric and blood pressure measurements were performed; fasting lipid profile, plasma glucose, homocysteine and hsCRP were determined, as well as prevalences and risk assessments. Statistical tests were used to compare the groups and p-value <0.05 was considered to be significant. Results: 283 subjects were recruited for this study (100 HIV-positive treatment-naive, 100 HIV-positive treated and 83 HIV negative controls). Compared to the controls, mean (sd) values were significantly higher among HIV-treated subjects: waist circumference=88.7 (10.4), p=0.035; systolic bp= 124.9 (20.7), p=0.014; glucose= 5.54 (1.7), p=0.015; triglyceride= 2.0 (1.2), p<0.001; homocysteine= 10.9 (8.9-16.2), p=0.0003; while hsCRP= 2.9 (1.4-11.6), p=0.002 and HDL-C=0.9 (0.4), p=<0.0001 were higher among the HIV-naïve subjects. Likewise, higher prevalences of the risk factors were noted among the HIV-treated subjects except low HDL-C (p<0.001) and hsCRP (p=0.03) which were higher in the HIVnaïve group. Risk assessment using ratios showed high risk for CVD especially in the HIV-naïve group. The median range for Framingham risk assessment was 1.0 - 7.5%. Conclusion: Risk factors and risk assessment for CVD are increased in HIV-positive patients with and without antiretroviral therapy.Routine evaluation and risk assessment for CVD irrespective of therapy status is necessary to prevent future cardiovascular events.Pan African Medical Journal 2016; 2

Hypocalcemia and Vaso‐Occlusive Painful Crises in Pediatric Sickle Cell Anaemia

Background: Low serum calcium (hypocalcemia) occurs in sickle cell anaemic (SCA) children. Concomitant presence of prolonged corrected QT (QTc) interval on electrocardiogram can ascertain hypocalcemia, especially during vaso-occlusive painful crises (VOC). Aim: The aim of the study was to determine the relationship between hypocalcemia and VOC. Methods: It was a prospective cohort study of 38 SCA children aged 4–17 years during VOC and when the same children were in steady state. Information regarding bone pain and clinical examination were obtained, following which electrocardiography was done during both clinical states. Blood was drawn for total calcium and serum albumin estimation. Results: The mean (standard deviation [SD]) of total calcium was significantly lower during VOC (1.90 [0.19] mmol/l) than during follow-up steady state (2.24 [0.22] mmol/l), P < 0.001. The mean rank of QTc interval was significantly higher during VOC (19.93) than in follow-up steady state (14.50), P < 0.001. Total calcium negatively correlated with QTc intervals during VOC (rs[36] = −0.36, P = 0.029) and follow-up steady state (rs[36] = −0.49, P = 0.002), while QTc interval was highly predictive of hypocalcemia (area under the curve [AUC] = 0.82, P < 0.001). Similarly, total calcium was highly predictive of VOC (AUC = 0.89, P < 0.001) at cutoff point of 2.13 mmol/l with 89.5% sensitivity and 81.6% specificity. Hypocalcemia was significantly observed during VOC than follow‐up steady state (89.5% vs. 21.1%, P < 0.001) with odds ratio of 21.28 (95% confidence interval: 0.012–0.189; P < 0.001). Conclusion: Total calcium <2.13 mmol/l is associated with VOC. Regular total calcium tests should be done. SCA children may benefit from routine oral calcium to reduce frequency of VOC

Antenatal Deworming and Materno-Perinatal Outcomes in Calabar, Nigeria

BACKGROUND: Studies have shown that administration of anthelmintic drugs in pregnancy can reduce the incidence of maternal anaemia; however, data on other maternal and perinatal outcomes are limited.AIM: This study was therefore conducted to evaluate the direct impact of mass deworming on delivery and perinatal outcome.MATERIAL AND METHODS: A total of 560 healthy pregnant women in their second trimester were randomised to receive a single dose of oral mebendazole (500 mg) and placebo. Each participant received the standard dose of iron supplement and malaria prophylaxis. They were followed up to delivery and immediate postpartum period to document the possible impact on maternal and perinatal outcomes.RESULTS: The prevalence of anaemia at term, 37 weeks gestation and above, among the treatment arm was 12.6% compared with 29.9% in the placebo arm (p < 0.001). Caesarean section rates was higher in the treated group and the placebo (p = 0.047).There were no statistically significant differences in incidences of postpartum haemorrhage (p = 0.119), Puerperal, pyrexia (p = 0.943), low birth weight (p = 0.556) asphyxia (p = 0.706) and perinatal death (p = 0.621).CONCLUSION: Presumptive deworming during the antenatal period can significantly reduce the incidence of peripartum anaemia. However, more studies may be needed to prove any positive perinatal outcome

Seroprevalence, Associated Factors, and Fetomaternal Outcome in Pregnant Women That Tested Positive to Hepatitis E Antibodies in Nigeria

Background. Hepatitis E virus infection is an emerging disease with varied courses in pregnancy. There is a dearth of statistics among pregnant women. Aim. To evaluate the prevalence, associated factors, and pregnancy outcome in women that tested positive for hepatitis E virus (HEV) antibodies in pregnancy. Research Methods. This was a cross-sectional study conducted among pregnant women at a teaching hospital in Nigeria. Relevant information was collected using a structured questionnaire. Blood was collected from each of the participants, and the serum was used to determine the presence of hepatitis E immunoglobulin M (IgM) and G (IgG). The data were analysed using SPSS version 23. Associations between variables were determined at a p value of <0.05. Results. A total of 200 pregnant women participated in this study. The prevalence of HEV infection among pregnant women was 28.00% (56/200). The mean age was 30.11 ± 5.88. Hepatitis E infection was significantly associated with age (p value = 0.028), method of faecal disposal (p value = 0.043), and source of drinking water (p value = 0.039). A total of 9/200 (4.50%) stillbirths were recorded with 3/9 (33.33%) in women that tested positive for HEV antibodies. About 4/200(2.00%) miscarriages were recorded, and 2/4 (50.00%) were in women that tested positive for HEV antibodies. Hepatitis E infection was not significantly associated with perinatal outcome (p value = 0.45). Only 1/56 (0.50%) maternal death was recorded among women that tested positive to hepatitis E, and none was recorded among those that tested negative to hepatitis E antibodies. Conclusion. There was a significant statistical association between HEV infection and age, method of faecal disposal, and source of drinking water. This underscores the importance of the provision of clean water and safe faecal disposal. Hepatitis E virus infection did not significantly affect the foetal and maternal outcomes