Impact of Psychoanalysis in Nigeria: A Case Study

The authors set out to examine the impact of Psychoanalysis in Nigeria. In doing this they selected a significant stakeholder, who trained in Germany and returned to Nigeria as a case study. Examining the activities as he set out to indigenize psychotherapy in Nigeria, it was found that psychoanalytic thinking helped in the psychodynamic observations on the frequent somatic complaints of psychological origin which helped to make treatment possible. Family therapy based on psychoanalysis was modeled to treat patients classified as traditional, mixed and westernized. Dream analysis and hypnosis were also used for treatment in Nigeria with good results. Finally the harmony restoration theory was put forward whereby the African is healthy when he is at peace with his world of relationship (cosmos) comprising endocosmos – mind body relationship, mesocosmos relationship with significant others and exocosmos relationship with spirits, ancestors, deities, gods, God. He/she is sick when there is a distortion in the person’s world of relationship. Treatment is restoration of harmony. In every one there is a yearning to reach out to others (cosmic expansion drive) and an inclination to be interested in the self (cosmic reduction drive) at the various levels of the cosmos. Eight personality types were worked out of the combination of expansion and reduction drives. The conclusion was that psychoanalysis has come to stay in Nigeria

A randomised comparison of deferasirox versus deferoxamine for the treatment of transfusional iron overload in sickle cell disease

Deferasirox is a once-daily, oral iron chelator developed for treating transfusional iron overload. Preclinical studies indicated that the kidney was a potential target organ of toxicity. As patients with sickle cell disease often have abnormal baseline renal function, the primary objective of this randomised, open-label, phase II trial was to evaluate the safety and tolerability of deferasirox in comparison with deferoxamine in this population. Assessment of efficacy, as measured by change in liver iron concentration (LIC) using biosusceptometry, was a secondary objective. A total of 195 adult and paediatric patients received deferasirox (n = 132) or deferoxamine (n = 63). Adverse events most commonly associated with deferasirox were mild, including transient nausea, vomiting, diarrhoea, abdominal pain and skin rash. Abnormal laboratory studies with deferasirox were occasionally associated with mild non-progressive increases in serum creatinine and reversible elevations in liver function tests. Discontinuation rates from deferasirox (11·4%) and deferoxamine (11·1%) were similar. Over 1 year, similar dose-dependent LIC reductions were observed with deferasirox and deferoxamine. Once-daily oral deferasirox has acceptable tolerability and appears to have similar efficacy to deferoxamine in reducing iron burden in transfused patients with sickle cell disease

Refining the value of secretory phospholipase A2 as a predictor of acute chest syndrome in sickle cell disease: results of a feasibility study (PROACTIVE)

Acute chest syndrome (ACS) is defined as fever, respiratory symptoms and a new pulmonary infiltrate in an individual with sickle cell disease (SCD). Nearly half of ACS episodes occur in SCD patients already hospitalized, potentially permitting pre-emptive therapy in high-risk patients. Simple transfusion of red blood cells may abort ACS if given to patients hospitalized for pain who develop fever and elevated levels of secretory phospholipase A2 (sPLA2). In a feasibility study (PROACTIVE; ClinicalTrials.gov NCT00951808), patients hospitalized for pain who developed fever and elevated sPLA2 were eligible for randomization to transfusion or observation; all others were enrolled in an observational arm. Of 237 enrolled, only 10 were randomized; one of the four to receive transfusion had delayed treatment. Of 233 subjects receiving standard care, 22 developed ACS. A threshold level of sPLA2 ≥ 48 ng/ml gave optimal sensitivity (73%), specificity (71%) and accuracy (71%), but a positive predictive value of only 24%. The predictive value of sPLA2 was improved in adults and patients with chest or back pain, lower haemoglobin concentration and higher white blood cell counts; and those receiving less than two-thirds maintenance fluids. The hurdles identified in PROACTIVE should facilitate design of a larger, definitive, phase 3 randomized controlled trial

Pulmonary hypertension in sickle cell disease: Relevance to children

Pulmonary arterial hypertension (PAH), once considered a rare complication of sickle cell disease (SCD) and thalassemia, appears to be more common in adults with hemoglobinopathy than previously appreciated. On prospective screening of adults with SCD, approximately one-third of adults are found on echocardiography to have a tricuspid regurgitant jet velocity (TRV) of 2.5 m/s or higher, many of whom are asymptomatic. Dyspnea on exertion is the most common presenting symptom. This TRV abnormality is a marker for approximately 40% 3-year mortality in adults, and it is associated with laboratory values suggestive of more severe intravascular hemolysis. Release of hemoglobin and arginase from lysed red cells causes scavenging of nitric oxide (NO) and catabolism of L-arginine, the obligate substrate for NO synthase. The resulting impairment in NO bioavailability is associated with pulmonary vasoconstriction, endothelial dysfunction, thrombosis, and eventual development of plexogenic arterial lesions, the histological hallmark of all forms of PAH. Undoubtedly, additional pathophysiological mechanisms will also play a role in its multifactorial pathogenesis. Early data from children with SCD indicate a similar prevalence of elevated TRV, but the prognostic implications of this remain to be established. Individual patient diagnosis of PAH requires confirmation by right heart catheterization studies and individualized management. Hemolysis-associated PAH with impairments in NO bioavailability is being identified in thalassemia and other hemolytic disorders, and may be a general consequence of long-standing, severe intravascular hemolytic anemia

Impact of Psychoanalysis in Nigeria: A Case Study

The authors set out to examine the impact of Psychoanalysis in Nigeria. In doing this they selected a significant stakeholder, who trained in Germany and returned to Nigeria as a case study. Examining the activities as he set out to indigenize psychotherapy in Nigeria, it was found that psychoanalytic thinking helped in the psychodynamic observations on the frequent somatic complaints of psychological origin which helped to make treatment possible. Family therapy based on psychoanalysis was modeled to treat patients classified as traditional, mixed and westernized. Dream analysis and hypnosis were also used for treatment in Nigeria with good results. Finally the harmony restoration theory was put forward whereby the African is healthy when he is at peace with his world of relationship (cosmos) comprising endocosmos – mind body relationship, mesocosmos relationship with significant others and exocosmos relationship with spirits, ancestors, deities, gods, God. He/she is sick when there is a distortion in the person’s world of relationship. Treatment is restoration of harmony. In every one there is a yearning to reach out to others (cosmic expansion drive) and an inclination to be interested in the self (cosmic reduction drive) at the various levels of the cosmos. Eight personality types were worked out of the combination of expansion and reduction drives. The conclusion was that psychoanalysis has come to stay in Nigeria

Self-perceived loss of control and untreated dental decay in African American adults with and without sickle cell disease

The aim of this cross-sectional study was to investigate the association between self-perceived loss of control as measured by dental external locus of control summary scores, with the amount of untreated dental decay in African American adults with sickle cell disease (SCD) and African Americans adults without SCD. The sample included 102 subjects with SCD and 103 subjects without SCD matched on age, sex, and recruitment location (mean age of all subjects 35.4 years, 55.6% female). Subjects with SCD in the highest quartile for dental external locus of control summary scores had 2.58-fold (CI 1.05, 6.34) as much untreated decay as those in the lowest quartile (p\u3c.05) in multivariable analysis using the negative binomial regression model. For subjects without SCD, those in the highest quartile for dental external locus of control summary scores had 3.00-fold (CI 1.38, 6.49) as much untreated decay as those in the lowest quartile (p\u3c.05) using similar analysis. This study showed that higher dental external locus of control is associated with increased untreated tooth decay, both for African Americans with and without SCD and that the magnitude of the association did not differ across groups

High-density SNP genotyping to define β-globin locus haplotypes

Five major β-globin locus haplotypes have been established in individuals with sickle cell disease (SCD) from the Benin, Bantu, Senegal, Cameroon, and Arab-Indian populations. Historically, β-haplotypes were established using restriction fragment length polymorphism (RFLP) analysis across the β-locus, which consists of five functional β-like globin genes located on chromosome 11. Previous attempts to correlate these haplotypes as robust predictors of clinical phenotypes observed in SCD have not been successful. We speculate that the coverage and distribution of the RFLP sites located proximal to or within the globin genes are not sufficiently dense to accurately reflect the complexity of this region. To test our hypothesis, we performed RFLP analysis and high-density single nucleotide polymorphism (SNP) genotyping across the β-locus using DNA samples from healthy African Americans with either normal hemoglobin A (HbAA) or individuals with homozygous SS (HbSS) disease. Using the genotyping data from 88 SNPs and Haploview analysis, we generated a greater number of haplotypes than that observed with RFLP analysis alone. Furthermore, a unique pattern of long-range linkage disequilibrium between the locus control region and the β-like globin genes was observed in the HbSS group. Interestingly, we observed multiple SNPs within the HindIII restriction site located in the Gγ-globin intervening sequence II which produced the same RFLP pattern. These findings illustrated the inability of RFLP analysis to decipher the complexity of sequence variations that impacts genomic structure in this region. Our data suggest that high-density SNP mapping may be required to accurately define β-haplotypes that correlate with the different clinical phenotypes observed in SCD. © 2008 Elsevier Inc. All rights reserved

Clinical correlates of acute pulmonary events in children and adolescents with sickle cell disease

Objectives We aimed to identify risk factors for acute pulmonary events in children and adolescents in the Pulmonary Hypertension and the Hypoxic Response in SCD ( PUSH ) study. Methods Patients with hemoglobin SS ( n  = 376) and other sickle cell genotypes ( n  = 127) aged 3–20 yrs were studied at four centers in a cross‐sectional manner. A subgroup ( n  = 293) was followed for a median of 21 months (range 9–35). Results A patient‐reported history of one or more acute pulmonary events, either acute chest syndrome ( ACS ) or pneumonia, was obtained in 195 hemoglobin SS patients (52%) and 51 patients with other genotypes (40%). By logistic regression, history of acute pulmonary events was independently associated with patient‐reported history of asthma ( P  3 severe pain episodes in the preceding 12 months ( P  = 0.002), higher tricuspid regurgitation velocity ( TRV ) ( P  = 0.028), and higher white blood cell ( WBC ) count ( P  = 0.043) among hemoglobin SS patients. History of acute pulmonary events was associated with >3 severe pain episodes ( P  = 0.009) among patients with other genotypes. During follow‐up, 43 patients (15%) had at least one new ACS episode including 11 without a baseline history of acute pulmonary events. History of acute pulmonary events (odds ratio 5.0; P  < 0.0001) and younger age (odds ratio 0.9; P  = 0.007) were independently associated with developing a new episode during follow‐up. Conclusions Asthma history, frequent pain, and higher values for TRV and WBC count were independently associated with history of acute pulmonary events in hemoglobin SS patients and frequent pain was associated in those with other genotypes. Measures to reduce pain episodes and control asthma may help to decrease the incidence of acute pulmonary events in SCD .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98784/1/ejh12118.pd

Elevated tricuspid regurgitant jet velocity in children and adolescents with sickle cell disease: association with hemolysis and hemoglobin oxygen desaturation

An elevated echocardiography-determined tricuspid regurgitant jet velocity predicts high systolic pulmonary artery pressure and early mortality in adults with sickle cell disease. The study provides evidence for independent associations of elevated jet velocity with hemolysis and oxygen desaturation in children and adolescents with sickle cell disease