Platelet Indices and Erythrocyte Sedimentation Rate are useful Parameters in the Assessment of a Cohort of Nigerian Women with Preeclampsia

BACKGROUND

The study compared some haematological parameters in normotensive pregnant women with those of women with pre-eclampsia (PE) to identify those parameters that may reinforce the occurrence and severity of PE.

METHODS

The study was a case-control study involving 40 pre-eclamptic women as subjects and 40 normotensive pregnant women as controls. The subjects were classified into mild and severe based on their blood pressure of >140/90 mmHg and >169/100 mmHg, respectively. Full blood count (FBC) was done using a haematology autoanalyzer, D-dimer and fibrinogen were assessed by enzyme-linked immunosorbent assay (ELISA) method, while Prothrombin Time (PT) and activated plasma thromboplastin time (aPTT) were done manually.

RESULTS

The mean PCV was higher while the mean WBC was lower in PE but the differences were not statistically significant. The ESR was significantly higher (50.48 ± 2.90mm/hr vs 41.05 ± 3.74mm/hr, p < 0.049). The mean neutrophil (59.38 ± 7.77% vs 64.95 ± 6.68%; p < 0.001) and lymphocyte (31.35±7.67% vs 7.63±7.47%, p = 0.031) counts were significantly lower and higher, respectively, in PE. Although the mean platelet count in PE was lower, the plateletcrit, mean platelet volume (MPV), and platelet distribution width (PDW) were significantly higher in PE (p = 0.01, 0.04, 0.001, respectively). The D-dimer was significantly higher in the women with PE (p < 0.001), while the PT, aPTT and fibrinogen concentrations were not statistically different between the two groups.

CONCLUSION

It may be concluded that low platelet count, high MPV, PDW, PCT and ESR in PE women may reinforce the diagnosis while a high MPV may, in addition, discriminate between severe and mild Pre-eclampsia.

Design and methods of the prevalence and pharmacogenomics of tenofovir nephrotoxicity in HIV-positive adults in south-western Nigeria study

BACKGROUND

Individuals of African descent are at higher risk of developing kidney disease than their European counterparts, and HIV infection is associated with increased risk of nephropathy. Despite a safe renal profile in the clinical trials, long-term use of tenofovir disoproxil fumarate (TDF) has been associated with proximal renal tubulopathy although the underlying mechanisms remain undetermined. We aim to establish the prevalence of and risk factors for TDF-induced kidney tubular dysfunction (KTD) among HIV-I and II individuals treated with TDF in south-west Nigeria. Association between TDF-induced KTD and genetic polymorphisms in renal drug transporter genes and the APOL1 (Apolipoprotein L1) gene will be examined.

METHODS

This study has two phases. An initial cross-sectional study will screen 3000 individuals attending the HIV clinics in south-west Nigeria for KTD to determine the prevalence and risk factors. This will be followed by a case-control study of 400 KTD cases and 400 matched controls to evaluate single nucleotide polymorphism (SNP) associations. Data on socio-demographics, risk factors for kidney dysfunction and HIV history will be collected by questionnaire. Blood and urine samples for measurements of severity of HIV disease (CD4 count, viral load) and renal function (creatinine, eGFR, phosphate, uric acid, glucose) will also be collected. Utility of urinary retinol binding protein (RBP) and N-acetyl-beta-D-glucosaminidase (NAG) levels as surrogate markers of KTD will be evaluated. Genomic DNA will be extracted from whole blood and SNP analyses performed using the rhAMP SNP genotyping assays. Statistical analysis including univariate and multivariate logistic regression analyses will be performed to identify factors associated with KTD.

DISCUSSION

In spite of TDF being the most commonly used antiretroviral agent and a key component of many HIV treatment regimens, it has potential detrimental effects on the kidneys. This study will establish the burden and risk factors for TDF-induced KTD in Nigerians, and explore associations between KTD and polymorphisms in renal transporter genes as well as APOL1 risk variants. This study may potentially engender an approach for prevention as well as stemming the burden of CKD in sub-Saharan Africa where GDP per capita is low and budgetary allocation for health is inadequate.

Detection of bacteriuria among human immunodeficiency virus seropositive individuals in Osogbo, south-western Nigeria

Human immunodeficiency virus-positive individuals are at increased risk of both asymptomatic and symptomatic urinary tract infections. The aim of this study was to determine the prevalence of asymptomatic bacteriuria (ASB) in HIV-positive individuals, its associated factors including any correlation with the CD4 count of the patient, and the antibiotic susceptibility pattern of the isolated organisms. Midstream urine and blood samples were collected from 242 consenting HIV-positive patients who were attending routine follow-up clinic during the six-month period of the study. Microscopy, culture, and antibiotic susceptibility testing of the samples were carried out following standard protocols, and CD4 counts were also determined. Fifty one (21.1%) of the 242 individuals had significant bacteriuria. The predominant organism was Klebsiella spp. (35%) followed by Escherichia coli (31%). Prevalence of bacteriuria was higher in the women. Low CD4 counts and young age were significantly associated with the presence of bacteriuria. ASB prevalence is high in this population and related to the CD4 count level.

Genotypes and phenotypes of Shiga toxin-producing Escherichia coli (STEC) in Abeokuta, Southwestern Nigeria

Purpose

To characterize the prevalence of hemolytic Shiga toxin-producing Escherichia coli (STEC) with a multidrug-resistant pattern in different age groups in Abeokuta, Nigeria.

Methods

Nonrepetitive E. coli isolates were collected from 202 subjects with or without evidence of diarrhea. Each isolate was biochemically identified and antimicrobial susceptibility testing was performed using the disk diffusion method. A sorbitol fermentation test of all the E. coli isolates was done and the minimum inhibitory concentration of suspected STEC was measured by the standard broth microdilution method to determine antibiotic resistance. The genotypes of stx1, stx2, and hlyA were determined by polymerase chain reaction assay.

Results

The majority of subjects were aged ≥40 years (41.6%) and were female (61.9%). Of the 202 subjects, 86.1% had STEC isolates (P<0.05). A high rate of STEC isolates resistant to amoxicillin (90.6%), cefotaxime (77.7%), and cefuroxime (75.7%) was observed. Resistance to amoxicillin, gentamicin, and cefotaxime was demonstrated with a minimum inhibitory concentration >16 μg/mL in 13.9%, 11.4%, and 10.4% of the isolates, respectively. The prevalence of stx1, stx2, and hlyA was 13.9%, 6.9%, and 2.0%, respectively; 5.5% of stx1 were in the 0–10-year-old age group, 3.5% of stx2 were aged ≥40 and above, and 1.0% of the hlyA isolates were in the 0–10-year-old age group.

Conclusion

The prevalence of virulent STEC is a public health concern. The use of polymerase chain reaction assay should aid quick detection of this virulent serotype and help curb the severe epidemic of human diseases associated with STEC infections.

Ovarian non-Hodgkin's lymphoma presenting as obstructive jaundice - a case report

OBJECTIVE

To highlight the importance of considering abdominal Lymphoma as a differential diagnosis in the management of obstructive jaundice.

PATIENT

A 51 year old female who presented with abdominal swelling associated with features of obstructive jaundice. Significant findings included jaundice on examination, with abdominal ascites. Laparotomy revealed three litres of icteric fluid. There was a huge left ovarian tumour measuring 14 cm x 12 cm. Massive peritoneal seedling involved the whole abdomen and pelvis was noted. Following surgery allowing for adequate wound healing, the patient was placed on appropriate chemotherapy. INVESTIGATION/DIAGNOSIS: Histology of excision biopsy revealed high grade Non-Hodgkins's Lymphoma. Screening for human deficiency virus (HIV) was negative. However the erythrocyte sedimentation rate (ESR) was raised at 92 mm Westergren in the first hour. The liver function tests were deranged with total bilirubin of 274 micromol/l and conjugated bilirubin of 204 micromol. serum Ast and Alt were also significantly raised. Total proteins, urea and electrolytes remained essentially within normal limits. The patient was placed on CHOP combination therapy. She attained remission after four cycles of chemotherapy and was discharged home.

CONCLUSION

Abdominal Non-Hodgkin's Lymphoma should be a strong consideration in the management of obstructive jaundice.

Ovarian Non-Hodgkin's Lymphoma presenting as obstructive jaundice - a case report

OBJECTIVE

To highlight the importance of considering abdominal Lymphoma as a differential diagnosis in the management of obstructive jaundice.

PATIENT

A 51 year old female who presented with abdominal swelling associated with features of obstructive jaundice. Significant findings included jaundice on examination, with abdominal ascites. Laparotomy revealed three litres of icteric fluid. There was a huge left ovarian tumour measuring 14cm x 12cm. Massive peritoneal seedling involved the whole abdomen and pelvis was noted. Following surgery allowing for adequate wound healing, the patient was placed on appropriate chemotherapy. INVESTIGATION/DIAGNOSIS: Histology of excision biopsy revealed high grade Non-Hodgkins's Lymphoma. Screening for human deficiency virus (HIV) was negative. However the erythrocyte sedimentation rate (ESR) was raised at 92 mm Westergren in the first hour. The liver function tests were deranged with total bilirubin of 274 mmol/l and conjugated bilirubin of 204 mmol. serum Ast and Alt were also significantly raised. Total proteins, urea and electrolytes remained essentially within normal limits. The patient was placed on CHOP combination therapy. She attained remission after four cycles of chemotherapy and was discharged home.

CONCLUSION

Abdominal Non-Hodgkin's Lymphoma should be a strong consideration in the management of obstructive jaundice.

Feto - maternal haemorrhage in parturients: Incidence and its determinants

This prospective study of parturients at a tertiary health institution in south-western Nigeria aims to identify the incidence, severity and obstetric factors predisposing to feto - maternal haemorrhage (FMH) in our population. The exclusion criteria were haemoglobinopathy and patient's refusal of consent to participate in the study. The prepared slide was processed as in the acid elution test described by Kleihauer - Betke. The FMH was calculated using Mollison formula (Mollison 1972). Baseline data included maternal biodata, blood group, RhD and haemoglobin electrophoresis, route/mode of delivery, duration of labour, obstetric interventions, fetal blood group and birth weight. Data generated were analysed with Statistical Package for Social Scientists (SPSS) version 11 software. Frequency tables, cross-tabulations and correlations were performed. Pearson's correlation was applied to continuous variables, while Spearman's correlation was utilised for discrete variables. Level of statistical significance was set at p < 0.05. A total of 163 parturients were studied, of which eight were multifetal gestations. There were no significant differences in maternal age, parity, estimated gestational age at delivery and birth weight, in both groups of parturients with and without FMH. A total of 17 parturients (10.43%), four of which were multifetal gestations (2.45%), had demonstrable FMH. Large FMH (>15 ml fetal cells) were noted in 10 (6.14%) parturients, of which, four were RhD-negative mothers. A total of 9.8% and 11.5% parturients in the vaginal and caesarean delivery groups, respectively, had significant FMH (p = 0.736). Incidence of large FMH was similar with each of the routes of delivery. Antepartum complications of pregnancy, delivery manoeuvres and episiotomy were not significant determinants of FMH. Multiple gestations, fetal birth weight and complications in labour were significantly associated with risk of FMH. Risk-based approach to management, in RhD negative pregnant women, might lead to under-treatment, with attendant increased incidence of isoimmunisation. At least in all RhD-negative women, the cord blood should be tested to determine the baby's blood group and if RhD-positive, Kleihauer - Betke test should be done to determine the degree of FMH and anti-D immunoglobulin dose administered appropriately. Further studies are necessary to establish the determinants/risk factors for FMH.

Sexual risk behaviour among young people in Osogbo, Osun state Nigeria

By analysing data randomly collected via administration of questionnaire by interview of individuals on sexual risk behaviour to 628 young people living in Osogbo, Nigeria, the results of the questionnaire revealed that the mean age of first sexual encounter was 17.4 years for men and 16.5 years for women. Men tended to have multiple sexual partners more than the women (74.4% and 25.1%, respectively), while there was a highly significant relationship between sexually transmitted disease and multiple sexual partners among singles with P<0.001 and P= 0.000. We concluded that parents and government alike should teach sex education at home, and in schools involving intensive counselling.

Absence of HIV-1 and HIV-2 seroconversions in a cohort medical students in a Nigerian medical school

A cohort of 70, HIV-1 and HIV-2 seronegative medical students were followed up for 30 months, after which 65 were retested for HIV antibody. None of the students was infected by HIV during the period of study. A questionnaire survey carried out showed that all the students had a very good knowledge of HIV, its mode of transmission, control and prevention. Most of the students have never had sex or had a single sex partner and used condoms always or most of the time during sexual intercourse.

Generalised Burkitt's lymphoma involving both breasts--a case report

BACKGROUND

Burkitt's lymphoma is a disease of children age ranging 8-10 years. Lymphoma involving the breast is an unusual clinical entity, which is rarely distinguished preoperatively from other more common forms of breast cancer. The Management differs from the more typical adenocarcinoma of the breast in that the emphasis is on systemic therapy.

CASE

We report a 27-year-old pregnant Nigerian civil servant at 28 weeks gestation, who presented with multiple organ swellings including both breasts. She was diagnosed histologically as primary breast Burkitt's lymphoma. She was treated with systemic chemotherapy after spontaneous abortion. She had a recurrence of the lesion in the right breast a month later that was excised. Presently there is no evidence of any mass.

CONCLUSION

Compared with breast carcinoma, primary breast lymphoma is a rare disease but should be considered in the differential diagnosis of breast masses.

A retrospective study of prevalence of antibody to HIV in blood donors at Ile-Ife, Nigeria

Records of voluntary and remunerative blood donors bled at the OAUTHC, Ile-Ife, Nigeria between January 1993 and December 2000 were reviewed for HIV sero-positivity. With a structured questionnaire, and over a period of 2 months, the attitudes and awareness of some of the donors of HIV/AIDS epidemic in the country were also assessed. Of the 16,080 units of blood collected in the period under review, only 1073(6.7%) were obtained from voluntary donors. The cumulative HIV seroprevalence rate was 2.1% in the paid donors as against 0.3% in the voluntary donors (c2 = 16.3, df = 1, p = 0.00003). Sixty-five (805) of the donors interviewed confirmed previous knowledge of HIV/AIDS before the interview. All the respondents appreciated the roles of blood transfusion in the transmission of AIDS viruses. The majority (74%) of the respondents were unemployed. Poverty was the reason given by 61(75%) of the commercial donors for selling their blood. We conclude that there is a greater risk of transmitting AIDS viruses (and possibly other blood transmissible diseases) through remunerated blood donors.

A review of histology of bone marrow trephine in malignant lymphomas

BACKGROUND

To investigate the prevalence and pattern of bone marrow involvement and its effects on the peripheral blood counts of malignant lymphoma patients.

METHODS

A prospective study of patients with histologically confirmed malignant lymphomas that presented from January 1994 to December, 1999 at the Department of Haematology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife. Patients underwent routine investigations such as packed cell volume (PCV); white blood cell counts (total and differentials), and platelet counts. Bone marrow aspirates and trephine biopsies were carried out on admission. Histological classification was based on the working formulation, while clinical staging was based on the Ann Arbor classification. The data collected was analysed using simple statistical methods and Epi info 6. (World Health Organisation), Geneva, Center for disease control (CDC), Atlanta, USA (1994) statistical software was used for all statistical analysis.

RESULTS

Out of the thirty cases (19 males and 11 females) of lymphoma that were studied, twenty-four (80%) were Non Hodgkins lymphoma (NHL) and 6 (20%) were Hodgkins disease (HD). In the NHLs, age range was 18-75 years with a median of 50 years with sixteen males and eight females, male:female ratio 2:1. Twelve of the patients had marrow involvement and were low-grade indolent disease. The most common pattern of marrow involvement in NHL was diffuse type. In HD, the age range was 18-65 years with a median of 45.5 years. There were three females and three males with M:F of 1:1. The most common pattern of marrow involvement was mixed cellularity in four patients, while one patient had lymphocyte predominant and the other lymphocyte depleted. In all cases with marrow involvement there were varying degrees of marrow suppression as reflected by anaemia and thrombocytopaenia, and in one pancytopaenia.

CONCLUSION

Bone marrow examination is an important aspect in the diagnosis of patients with malignant lymphoma and there is superiority of trephine biopsy over the aspiration biopsy.