Malaria Infection in Patients with Sickle Cell Disease in Nigeria: Association with Markers of Hyposplenism

Malaria is considered an important cause of morbidity and mortality among people living with sickle cell disease (SCD). This has partly been attributed to the loss of splenic function that occurs early in the disease process. We conducted a cross-sectional study and determined the frequency of malaria infection among SCD patients and explored the association with spleen's presence on ultrasonography and spleen function assessed using the frequency of Howell-Jolly bodies (HJBs). A total of 395 participants consisting of 119 acutely-ill SCD patients, 168 steady-state SCD controls, and 108 healthy non-SCD controls were studied. The prevalence of Plasmodium falciparum parasitemia was 51.3% in acutely-ill SCD patients, 31.7% in steady-state SCD controls, and 11.0% in the healthy non-SCD controls; however, the mean parasite density was significantly higher in the non-SCD controls compared to both SCD groups (p = 0.0001). Among the acutely-ill SCD patients, the prevalence of clinical malaria and severe malaria anemia were highest in children <5 years of age. The prevalence of parasitemia (p = 0.540) and parasite density (p = 0.975) showed no association with spleen presence or absence on ultrasonography. Similarly, the frequency of HJB red cells was not associated with the presence of parasitemia (p = 0.183). Our study highlights the frequency and role of malaria infection in acutely-ill SCD patients, especially in those younger than five years. Although we have found no evidence of an increased risk of malaria parasitemia or parasite density with markers of hyposplenism, the role played by an underlying immunity to malaria among SCD patients in malaria-endemic region is not clear and needs further studies.

Determinants of splenic preservation among patients with sickle cell disease in North-Eastern Nigeria

OBJECTIVE

In patients with sickle cell disease (SCD), the spleen commonly enlarges during early childhood, but undergoes reduction in size and fibrosis from repeated episodes of vaso-occlusion and infarction. The rate of progression of this process varies markedly among these patients. The aim of current study was to explore clinical and laboratory factors associated with the preservation of the spleen among these patients.

METHODS

Two hundred four patients with SCD (103 females; age 1-45 years) underwent abdominal ultrasonography at the University of Maiduguri Teaching Hospital, Nigeria between October 2020 and November 2021 to assess for splenic visualisation and echotexture. Steady-state clinical parameters and blood samples for full blood count, serum chemistry, high-performance liquid chromatography and malaria parasitemia were obtained from all the patients.

RESULTS

The spleen was visualised in 107 (52.4%; 95% confidence interval [CI], 46%-59%) patients with SCD on ultrasonography. While the spleen was visualised in all children less than 5 years of age, it was visualised in only 23.5% of those aged 15 years and older. Visualisation of the spleen was significantly associated with low mean corpuscular haemoglobin concentration and high haemoglobin F (HbF) in those younger than 10 years. The odds of visualisation of the spleen on ultrasonography increased by a factor of 1.17% for every 1% increase in HbF level. Only 32 (15%) patients were on regular hydroxyurea therapy. The HbF level was significantly higher among patients on hydroxyurea (median 12.7 vs. 7.4; p < 0.0001).

CONCLUSION

In patients with SCD, failure to visualise the spleen was not found in children less than 5 years old. Patients with visualised spleens had a higher level of HbF than those with non-visualised spleens. HbF was significantly associated with visualisation of the spleen before 10 years of age. Since early administration of hydroxyurea will increase HbF level, we expect that it would help to preserve the spleen.

Cardiovascular disturbances in COVID-19: an updated review of the pathophysiology and clinical evidence of cardiovascular damage induced by SARS-CoV-2

Severe acute respiratory coronavirus-2 (SARS-Co-2) is the causative agent of coronavirus disease-2019 (COVID-19). COVID-19 is a disease with highly variable phenotypes, being asymptomatic in most patients. In symptomatic patients, disease manifestation is variable, ranging from mild disease to severe and critical illness requiring treatment in the intensive care unit. The presence of underlying cardiovascular morbidities was identified early in the evolution of the disease to be a critical determinant of the severe disease phenotype. SARS-CoV-2, though a primarily respiratory virus, also causes severe damage to the cardiovascular system, contributing significantly to morbidity and mortality seen in COVID-19. Evidence on the impact of cardiovascular disorders in disease manifestation and outcome of treatment is rapidly emerging. The cardiovascular system expresses the angiotensin-converting enzyme-2, the receptor used by SARS-CoV-2 for binding, making it vulnerable to infection by the virus. Systemic perturbations including the so-called cytokine storm also impact on the normal functioning of the cardiovascular system. Imaging plays a prominent role not only in the detection of cardiovascular damage induced by SARS-CoV-2 infection but in the follow-up of patients' clinical progress while on treatment and in identifying long-term sequelae of the disease.

Advanced-stage Wilms tumor arising in a horseshoe kidney of a 9-year-old child: a case report

BACKGROUND

Horseshoe kidney (HK) is one of the most common renal fusion abnormalities, with an incidence of 1:400 in the normal population. However, Wilms tumor (WT) arising in an HK is a rare occurrence. We report the case of a 9-year-old boy who presented with an advanced WT in an HK and also highlight the management challenges in a resource-poor setting such as ours.

CASE PRESENTATION

The patient was a 9-year-old Nigerian boy presented to the Pediatrics Outpatient Clinic of the University of Maiduguri Teaching Hospital (UMTH) with a history of progressive abdominal swelling, weight loss, abdominal pain, and cough. Abdominal examination revealed an irregular, firm, and non-tender mass in the right lumbar region. A computed tomography (CT) scan of the abdomen showed a heterogeneously dense mass that was predominantly to the right side of the abdomen and crossed the midline to the left side, where it continued with the relatively normal renal tissue. Chest CT revealed pulmonary metastases. A diagnosis of WT in an HK was made. The patient had a 6-week course of neoadjuvant chemotherapy, and a right nephrectomy and left partial nephrectomy was performed. The final histologic diagnosis of WT was made. Radiotherapy was intended but was not available in our facility, and the parents could not afford referral to another center.

CONCLUSIONS

Children with a clinically suspected HK with WT should undergo a careful imaging evaluation such as CT before any surgical intervention. Neoadjuvant chemotherapy to reduce tumor bulk might be a good treatment method to reduce surgical morbidity and aid in complete excision and potential for preserving renal function.

Encephalocraniocutaneous Lipomatosis Associated with Orbital Cyst: A Variant or New Entity?

Encephalocraniocutaneous lipomatosis (ECCL), also known as Haberland or Fishman syndrome, is an extremely rare congenital neurocutaneous disorder that characteristically involves ectomesodermal tissues such as the central nervous system, eyes, and skin. The etiology of the disease remains unknown. Here we present a rare case of ECCL associated with bilateral eye involvement and orbital cyst from Sub-Saharan Africa. A 3-year-old boy presented with cystic right eye swelling since birth. Physical examination showed alopecia on right side of the scalp, ipsilateral ocular cyst, and microphthalmia with a contralateral limbal dermoid. Computed tomography of the brain revealed severe atrophy of the right cerebral hemisphere with an expansion of the cerebrospinal fluid space and dilatation of the lateral ventricle suggesting ex-vacuo hydrocephalus. Right orbital cyst continuous with the globe and calcification of the posterior aspect of both globes were also present. Histopathologic findings of the excised orbital cyst revealed an eyeball covered by fatty tissue, calcification of the cyst wall, and corneal opacity. Microscopy showed cornea-sclera wall composed of normal cartilage communicating with sandwich bony trabeculae with a focus of marrow cells, consistent with choristoma. The constellation of these findings conforms to Moog’s revised diagnostic criteria for ECCL proposed in 2009. Although the disorder is easily recognizable at birth, neuroimaging is essential for appropriate diagnosis and management and to exclude or confirm other unusual associated abnormalities.

Abstract PO-088: Low levels of PSA in diabetic Nigerians: A call for a separate reference range for prostate cancer screening among type-2 diabetics?

INTRODUCTION Diabetic patients are at higher risk of developing malignancies. Studies have however suggested a contrasting data, indicating lower risk of prostate cancer in type 2 diabetics. Studies in some parts of the world showed lower PSA levels in diabetic patients, but yet to be verified in African living in Africa. AIM The aim was to determine the levels of PSA in Diabetic and Non-diabetic men in Maiduguri-Nigeria and to ascertain similar lower values in African living in Africa.

MATERIALS AND METHODS This was a hospital based case-control study that included a total of 132 participants whose ages were from 40 years and above and voluntarily consented to be part of this study. Ethical clearance was obtained from Ethics and Research Committee of the University of Maiduguri Teaching Hospital, structured questionnaire was self-administered. One hundred and four (104) were confirmed type 2 DM male attending Metabolic Clinic University of Maiduguri Teaching Hospital and twenty eight (28) non-diabetic men, who had no history of hypertension, not using antihypertensives or steroid drugs, no history of cardiovascular diseases, not using anti-lipid drugs; not having cancer; non-smokers and non-alcoholic consented and served as control. Data on family history of DM, duration of the disease, hypertension and social lifestyle recorded for diabetic patients. Weight, height and BMI were calculated, Blood pressure, fasting glucose and serum for PSA were determined. RESULTS The mean ages of diabetic and non- diabetic men were 53.3 ± 11.8 and 53.9 ± 6.1 years, respectively. The mean total serum PSA was significantly lower in diabetic compared to non-diabetic (0.72 ± 0.09 ng/ml vs. 2.50 ± 0.44 ng/ml, respectively, p = 0.000). The mean fasting glucose was significantly higher among diabetic compared to non-diabetic p = 0.006). Diabetics were grouped into 5 according to their age (40 -49, 50-59, 60-69,70-79, ≥ 80). The age 70-79 years has the highest mean PSA level than all other groups (1.19 ± 0.45ng/ml), while age group ≥ 80 years has the least PSA value of (0.15 ± 0.05ng/ml). The mean fasting glucose is lowest in age group of ≥ 80years and highest in age groups of 50-59 and 40-49years (7.78 ± 0.68 and 7.56 ± 0.63mmol/L) respectively.

The treatment modality was grouped into five; insulin 5(4.8%), oral 73(70.2%), oral and insulin 8(7.7%) and diet 18 (13.6%). Oral and insulin treatment has higher level of PSA (1.29 ±1.03 ng/ml) compared to all the other groups. The PSA levels were grouped based on the duration of diagnosis of DM (0-5, 6-10, 11-15, 16-20 and ≥ 21years) and 11-15 years duration have high levels of PSA than the other group.

There was significant Pearson’s Correlation between PSA and age, systolic and diastolic (p=0.000, p=0.002 and p=0.006) respectively. CONCLUSION serum PSA level is significantly lower in type 2 diabetics than in non-diabetics in this study. This study and other findings recommend establishment of separate reference interval for Type 2 diabetic men for appropriate evaluation of their prostatic diseases using the PSA

Citation Format: Rebecca Mtaku Gali, Dahiru Saleh Mshelia, Jessy Thomas Medugu, Musa Dungus, Hassan Dogo, Haruna Asura Nggada, Bata Mtaku Gali, Mwajim Bukar, Ahmad Gadam Ibrahim, Galadima Gadzama, Abubakar Farate. Low levels of PSA in diabetic Nigerians: A call for a separate reference range for prostate cancer screening among type-2 diabetics? [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-088.

Evaluation of hypofunctioning thyroid nodules with technetium-99m MIBI and ultrasonography

Background: Fine needle aspiration cytology (FNAC) cannot reliably differentiate follicular adenoma from follicular carcinoma (FC), which requires histological evidence of capsular or vascular invasion. FC is the most predominant thyroid cancer in our loco-regional environment, indicating the need for improvement in preoperative diagnostic accuracy of thyroid nodules to ensure appropriate and timely interventions.Objective: The purpose of this study was to assess the role of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy and ultrasonography (USG) in the differential diagnosis of thyroid nodules.Methods: Forty-two patients with hypofunctioning thyroid nodules were prospectively studied with 99mTc-MIBI scintigraphy and USG to differentiate benign from malignant nodules. An injection of 740 MBq of 99mTc-MIBI was intravenously administered, followed by semiquantitative analysis of dual-phase scans using a 4-point (0 to 3) scoring system. USG was subsequently performed and interpretation was based on some sonographic criteria for malignancy. In the following days and weeks, patients underwent FNAC followed by surgery and histopathologic examination.Results: All malignant nodules were positive on 99mTc-MIBI and all but two malignant nodules were positive on USG. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy are, respectively, 100%, 70%, 65%, 100%, and 81% for 99mTc-MIBI scintigraphy; 87%, 78%, 68%, 91% and 81% for USG; and 83%, 100%, 100%, 96% and 64% for FNAC. There was no statistically significant difference between 99mTc-MIBI scintigraphy and USG performance for both benign (p = 0.317) and malignant (p = 0.573) nodules.Conclusion: 99mTc-MIBI scintigraphy and USG are important imaging modalities in the evaluation of thyroid nodules, particularly follicular neoplasms which are frequently associated with non-diagnostic cytology.