Protein C and antithrombin levels in patients with sickle cell anemia in Ahmadu Bello University Teaching Hospital Zaria, Nigeria

BACKGROUND

Alterations in the components of hemostasis, namely platelet function, the procoagulant, anticoagulant, and the fibrinolytic systems, are observed in sickle cell anemia (SCA) and are in favor of a procoagulant phenotype. Therefore, study of protein C and antithrombin (AT) levels in patients with SCA in steady state may be used in the treatment and/or prevention of SCA-related thrombotic complications. We studied the changes of these naturally occurring anticoagulants in patients with SCA attending the sickle cell clinic in Ahmadu Bello University Teaching Hospital, Zaria.

METHODS

We conducted a case-control study involving 50 SCA (HbSS) patients in the steady state as cases and 25 healthy volunteers with normal hemoglobin (HbAA) as controls. Protein C and AT levels were estimated by semi-automation using Diagnostica Stago hematology coagulation analyzer. Frequencies, proportions, and independent t test were performed using SPSS version 20.

RESULTS

The mean ages of both the patients and controls were 23.80 ± 7.46 and 24.28 ± 3.48 years, respectively, and study participants comprised 40 (53.0%) women between the ages of 15-50 years and 15-34 years (P = 0.76). The mean values of protein C and AT levels in patients with SCA in the steady state and the control group were 60.26 ± 20.58% versus 81.30 ± 19.74%, 95% CI 11.13-30.96, and 42.11 ± 5.01% versus 61.88 ± 11.27%, 95% CI 16.03-23.51 with P values (P < 0.001), respectively.

CONCLUSIONS

This study showed that there was a significant decrease in the levels of protein C and AT between the SCA patients in the steady state and the controls. We recommend baseline investigations of these naturally occurring anticoagulants in patients with SCA, especially in those with frequent vaso-occlusive crises. This will give us an insight into the additional pathophysiologic mechanism in SCA-related thrombotic complications for better patient management and outcome.

The effect of preoperative oral administration of prednisolone on postoperative pain in patients with symptomatic irreversible pulpitis: a single-centre randomized controlled trial

AIM

This single-centre randomized, double-blind, placebo-controlled clinical trial assessed the effect of a preoperative, single, oral dose of prednisolone on postoperative pain and postoperative analgesic intake in patients with symptomatic, irreversible pulpitis in mandibular molars.

METHODOLOGY

Four hundred participants, randomly assigned to two equal groups, received either 40 mg prednisolone or placebo tablets 30 min before single-visit root canal treatment. Patients recorded their pain level 6, 12 and 24 h after treatment on a 100-mm visual analogue scale. All patients received a sham capsule to take if needed as a postoperative analgesic, and, if the pain persisted, an analgesic was prescribed. The relative risk reduction and 95% confidence intervals (CI) were estimated for binary data. Mann-Whitney U-test was used to compare postoperative pain intensity between groups.

RESULTS

The relative risk reduction in pain incidence was 20.31% (95% CI: 12.03%, 27.82%) at 6 h, 23.39% (95% CI: 14.75%, 31.16%) at 12 h and 28.85% (95% CI: 18.08%, 38.20%) at 24 h. Prednisolone had significantly less post-obturation pain intensity compared to placebo at 6, 12 and 24 h (P < 0.001). The relative risk reduction in sham-capsule intake was 54% (95% CI: 38%, 66%) and of analgesic intake was 55% (95% CI: 3%, 79%). No adverse effects were recorded.

CONCLUSION

Preoperative oral administration of a single dose of 40 mg prednisolone was beneficial to control short-term post-obturation pain after single-visit root canal treatment in patients with symptomatic irreversible pulpitis reducing pain incidence after 24 h by approximately 30% and postoperative analgesic intake by approximately 55%.

Variations in the β-globin genes of sickle cell anaemia patients in Zaria, Northwestern, Nigeria

CONTEXT

Sickle Cell Anaemia (SCA) is a genetic disorder with a life-long disability, which is of public health importance. The diversity in its clinico-pathologic and laboratory presentations may be due to the interplay between additional genetic differences and environmental factors. The genetic factors may be within the β-globin gene itself, the β-globin gene cluster or elsewhere in the genome.

AIM

To characterize the β-globin gene for variations associated with the Sickle Cell mutation.

SETTINGS AND DESIGN

A cross-sectional descriptive study involving 51 adult SCA patients attending Sickle Cell Clinic of Haematology Department Ahmadu Bello University (ABUTH) Zaria, Kaduna State, Nigeria.

METHODS AND MATERIAL

The buccal swab specimens were collected and β-globin gene DNA sequencing was done. The sequences obtained were compared with a Genbank Reference β-globin gene (NC_000011.9) using Basic Local Alignment Search Tool (BLAST), and variations noted. Data generated were analyzed using SPSS Version 20.0.

STATISTICAL ANALYSIS USED

Data generated was summarized by using charts, means±2SD, and 95% confidence intervals.

RESULTS

There were 40 (78.43%) females and 11 (21.57%) males. The mean age of the participants was 25.35 ± 7.67 years, 95% CI (23.20, 27.51). The classic sickle cell mutation A T was present in all participants. The mean number of β-Globin gene variations was 8.61±11.30, 95% CI (5.43, 11.78). The number of Substitutions were 122 (27.79%), insertions 184 (41.91%), and deletions 133 (30.30%). These occurred in various combinations. The mean number of substitutions, insertions, and deletions were 2.39±3.23, 3.61±7.66, and 2.60±2.46 with 95% CIs of (1.48, 3.30), (1.45, 5.76), and (1.92, 3.30) respectively.

CONCLUSIONS

There are β-globin gene variations in SCA patients in Zaria, and locally relevant genetic database of the SCA population will be the cornerstone in understanding genotype-phenotype interactions in this disorder.

Catching up with wonderful women: The women-are-wonderful effect is smaller in more gender egalitarian societies

Inequalities between men and women are common and well-documented. Objective indexes show that men are better positioned than women in societal hierarchies-there is no single country in the world without a gender gap. In contrast, researchers have found that the women-are-wonderful effect-that women are evaluated more positively than men overall-is also common. Cross-cultural studies on gender equality reveal that the more gender egalitarian the society is, the less prevalent explicit gender stereotypes are. Yet, because self-reported gender stereotypes may differ from implicit attitudes towards each gender, we reanalysed data collected across 44 cultures, and (a) confirmed that societal gender egalitarianism reduces the women-are-wonderful effect when it is measured more implicitly (i.e. rating the personality of men and women presented in images) and (b) documented that the social perception of men benefits more from gender egalitarianism than that of women.

Follicular output rate can predict clinical pregnancy in women with unexplained infertility undergoing IVF/ICSI: a prospective cohort study

This study aimed to determine whether follicular output rate (FORT) can predict the clinical pregnancy rate in women with unexplained infertility undergoing IVF/ICSI. This was a prospective study conducted at Dar El Teb subfertility centre in Cairo between June 2014 and July 2016. A total of 303 women with unexplained infertility, who were undergoing IVF/ICSI, were divided into three groups according to FORT tertile values. FORT was calculated as pre-ovulatory follicle count/antral follicle count × 100. There was a progressive and significant increase from the low to the high FORT groups in the clinical pregnancy rate (29.9%, 43.3% and 57.8%; P < 0.001), number of retrieved oocytes (5.4 ± 1.5, versus 6.8 ± 2.8, and 7.4 ± 2.1; P < 0.001), and fertilization rate (48.4 ± 21.8 versus 55.3 ± 20.3 and 57.4 ± 19.2; P = 0.006). Multivariate logistic regression analysis revealed that the correlation between FORT and pregnancy was independent of potential confounding factors (P = 0.008). We concluded that FORT is an independent variable affecting the clinical pregnancy rate in IVF/ICSI cycles. Higher FORT values had better oocyte yield and clinical pregnancy rates in women with unexplained infertility undergoing IVF/ICSI with potentially normal ovarian response.

The potential protective effect of α-lipoic acid against nanocopper particle-induced hepatotoxicity in male rats

The present research task is aimed to evaluate the role of exogenous α-lipoic acid (ALA) (100 mg/kg body weight) as hepatoprotective and potent antioxidant in amelioration of copper nanoparticle (CNP)-induced hepatotoxicity. Forty male rats were randomly assigned into four equal groups: group I (control), group II received CNPs, group III received CNPs + ALA, and finally group IV received ALA for 2 months. At the end of the experimental period, the rats were decapitated, and blood and liver tissue samples were collected for measurement of liver function tests, antioxidant status, lipid peroxidation (LPO), copper content, expression of some apoptotic genes, and histopathological analysis. CNPs induced marked hepatic damages as evident by severe alteration in hepatic biomarkers. This was accompanied by a significant elevation in hepatic LPO and induced nitric oxide, copper content, and expression level of apoptotic genes (C-myc and C-jun). In contrast, marked depletion for antioxidant parameters was detected. These findings were confirmed with severe pathological alterations. Coadministration of ALA as a powerful antioxidant attenuates the hepatotoxic effects of CNPs through improvement of liver parameters, oxidative status, genetic changes, and preservation of liver integrity through histopathological analysis. These results suggest that consumed ALA could be used as an applicable hepatoprotective agent against oxidative damage mediated by nanoparticles intoxication.

ID: 16: INAPPROPRIATE DEFIBRILLATION DUE TO ELCTRO-MAGNETIC INTERFERENCE FROM NEARBY ALTERNATING CURRENT

Introduction

Implantable cardioverter-defibrillator (ICD) to monitor and promptly treat life-threatening arrhythmia has been a very successful approach. However, inappropriate defibrillation could increase morbidity and mortality. Most common causes of inappropriate defibrillation are: supra-ventricular arrhythmia and device malfunctions.

Case Description

A 31-year-old female with arrythmogenic right ventricular cardiomyopathy (ARVC) status post dual chamber ICD presented after her ICD had fired. Patient was sitting near a public swimming pool and suddenly felt a jolt, “getting hit at the back of the head”. On further ICD Interrogation revealed a high frequency artifact on the intra-cardiac electrogram which was sensed by the device as ventricular fibrillation, and subsequently it was defibrillated. Other parameters including sensing and pacing thresholds, lead impedances were all within normal limits.

Discussion

Alternating current from a nearby electric generator created Electro-magnetic interference (EMI) which led to inappropriate defibrillation. High frequency oscillating artifact is the hallmark of EMI from alternating current. We should be aware of all possible causes that can interfere with cardiac devices. .

ID: 66: HENOCH-SCHONLEIN PURPURA (HSP) PRESENTING AS A LARGE PERICARDIAL EFFUSION IN AN ADULT

Introduction

Henoch-Schonlein Purpura (HSP) is the most common form of systemic vasculitis in children. It is characterized by a tetrad of palpable purpura, arthralgia, abdominal pain and renal disease. It rarely presents with significant pericardial disease, especially in adults, and is a rare entity with only a few reported cases.

Case Description

A 49 year old Male presented with a two month history of progressive dyspnea, polyarthralgia, fatigue, and skin rash. Physical exam showed cardiac dullness beyond the apical point of maximal impulse, elbow joints with limited range of motion and swelling, periungal erythema and palpable purpura over his extremities. He was found to have a large pericardial effusion on an echocardiogram with respiratory variation requiring drainage. Laboratory evaluation revealed markedly elevated C-Reactive Protein of 225. Biopsy of the skin purpura was consistent with IgA leukocytoclastic vasculitis with intense deposition of IgA within the superficial dermal blood vessel walls. Pericardial fluid was consistent with acute inflammation with several neutrophils but no growth on culture. The patient was started on high dose steroids with marked improvement in his symptoms including a decreased pericardial effusion. A repeat echocardiogram was obtained which showed only trivial pericardial effusion with no signs of tamponande.

Discussion

HSP is a rather common disease in children with systemic hypersensitivity vasculitis in the skin and other organs including the kidneys. It rarely involves the myocardium or pericardium and is even rarer to present as a large pericardial effusion, especially in an adult. HSP presenting as pericardial disease has only been reported in a few cases. Although the pericardial involvement of Henoch-Schonlein Purpura seen in this patient is rare, any collagen vascular disease can present with pericardial effusion and might respond to appropriate anti-inflammatory therapies including steroids if recognized promptly.