Haematology Parameters of Apparently Healthy Prospective Whole Blood Donors in a Nigerian Hospital Setting

Background: Adequate selection of a prospective whole blood donor protects his health and safety of the recipient. Objectives: The main objective of this study was to determine the haematology parameters of apparently healthy prospective whole blood donors. Participants and Methods: This was a hospital based prospective study carried out from August to October 2020 at the blood transfusion unit of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria. A structured pretested questionnaire was used for data collection. The socio demographic status and the haematology parameters of apparently healthy prospective whole blood donors who tested negative for HIV, hepatitis B and C markers were captured. Obtained data were analysed with the statistical package for the social scientist software version 20. Results: One hundred male (97.1%) and three female (2.9%) apparently healthy prospective whole blood donors were studied. The median age of study subjects was 30 years. Obtained median haematology parameter values were 13 g/dl, 40%, 4.9/nl and 203.9/nl for haemoglobin concentration, haematocrit, total white cell and platelet counts respectively. The median values for the mean corpuscular haemoglobin concentration (MCHC), mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) of participants were 32.6 g/dl, 27.7 pg and 85.7 fl respectively. Observed prevalence of subnormal haematology parameters for haemoglobin concentration, total white cells, platelets were 12.6%, 25.2%, and 13.6% respectively. Also subnormal values for MCHC, MCH, MCV were 11.7%, 26.2%, and 16.5% respectively among prospective whole blood donors in this study. No higher than normal haematology parameter values were observed. Median values for erythrocyte sedimentation rate was 8.4 mm/hr. Conclusion: A significant percentage of apparently healthy prospective whole blood donors had subnormal haematology parameters values. Obtained normal values in our study are comparable with local reference range reports from previous studies in Nigeria and other parts of Africa. 124947 .

Primary unifocal penile follicular center non-Hodgkin lymphoma:Report of a rare case and review of the literature

Dear Editor,We present a rare case of a primary penile follicular center non-Hodgkin lymphoma and a review of the available literature on this condition.A BCL2 gene transposition which was identified with fluorescent in situ hybridization(FISH)molecular analysis is a unique manifestation not previously reported to the best of our knowledge.A 67-year-old man presented with a 3-month history of a small nodule on the left side of the corona of glans penis.The patient had no significant medical or family history.The patient underwent excision and biopsy of the penile lesion with a 0.5 cm macroscopic margin under local anesthesia and sedation.He was discharged on the day of surgery,and there were no postoperative complications or adverse events.The informed consent was obtained from thepatient.

Seven-years post allogeneic hematopoietic stem cell transplantation pure red cell aplastic anemia cured with daratumumab:A case report and review of literature

BACKGROUND Allogeneic hematopoietic stem cell transplantation(Allo-HSCT)is currently the only viable method of curing patients with acute myeloid leukaemia.In 30%to 50%of patients,donors and recipients have some level of ABO blood group incompatibility.ABO blood group incompatibility can cause antibodies against the donor's red blood cells to persist in the recipient's body,resulting in a delay of several months in the recovery of red blood cells.A number of different treatments have been reported for post-transplant pure red cell aplastic anaemia(PRCA),such as plasmapheresis,donor lymphocyte infusions,anti-thymocyte globulin,rituximab and steroids.CASE SUMMARY A 41-year-old female diagnosed with acute myeloid leukaemia underwent peripheral blood allogeneic haematopoietic stem cell transplantation in November 2013 from an HLA matched unrelated donor.The donor was AB-positive and the recipient was O-positive.The patient was diagnosed with PRCA three months after receiving the donor stem cell transplant.After failing multiple lines of therapy,the patient applied for daratumumab.After receiving three doses of daratumumab,the patient developed a reticulocyte response and no longer required CONCLUSION The use of daratumumab anti-CD38 for the remove of plasma cells is safe and effective and may be tried for refractory patients with PRCA after undergoing allo-HSCT for ABO incompatibility.

Antimicrobial Activities of Plant Extracts against Streptococcus pneumoniae Isolated from Pediatric Patients at Federal Teaching Hospital Abakaliki, Ebonyi State

Antibiotic-resistant genes have become a threat to synthetic or conventional medications and because of this much work has been done on using plants and plants part to treat disease caused by bacteria, Herbal medicine has served as effective treatment against various diseases caused by pathogenic bacteria and multi drug-resistant strains of bacteria which made it advantageous over synthetic medications. This study aimed to reveal the sensitivity of Streptococcus pneumoniae from clinical isolate and perform antibacterial assay on the organism using plants leaf extracts of Ocimum gratissimum, Sida acuta, Newbouldia laevia and Mimosa pudica. Gram staining and various biochemical test were used for the identification of Streptococcus pneumoniae. The plants leaves were aseptically washed, dried and ground into fine powder and diluted in varying concentration and agar well diffusion method was used to test for the antimicrobial properties of this plants on Streptococcus pneumoniae at various concentrations as follows 0.1 g/ml, 0.4 g/ml, 0.6 g/ml and 1 g/ml. The plants extract of Ocimum gratissimum showed a greater antibacterial effects on Streptococcus pneumoniae in high concentration more than other plant extracts while Sida acuta and Newbouldia laevia plant extract showed weak antibacterial properties to the organism. This proves that Ocimum gratissimum and Mimosa pudica leaves have good and strong antibacterial properties against Streptococcus pneumoniae than Sida acuta and Newbouldia laevia and can be used as antibacterial agent at adequate concentrations.

Clinical profile and outcomes in very elderly patients with atrial fibrillation anticoagulated with rivaroxaban: data from the EMIR study

Objectives To analyze the clinical profile,adequacy of treatment with rivaroxaban and outcomes in octogenarians with atrial fibrillation(AF),taking rivaroxaban in clinical practice.Methods Observational and non-interventional study that included AF adults recruited from 79 Spanish centers,anticoagulated with rivaroxaban ≥ 6 months before being included.Data were analyzed according to age(≥ 80 vs.< 80 years) at baseline.Results Out of 1433 patients,453(31.6%) were octogenarians at baseline.Compared to younger patients,octogenarians had more comorbidities,higher CHA2DS2-VASc(4.5 ± 1.3 vs.3.0 ± 1.4;P < 0.001) and HAS-BLED scores(2.0 ± 1.0 vs.1.4 ± 1.0;P < 0.001).Overall,the dose of rivaroxaban was adequately prescribed in 83.4% of patients,but more frequently in the younger population(71.1% vs.89.1%;P = 0.039).After a mean follow-up of 2.2 ± 0.6 years,annual rates of stroke + systemic embolism + transient ischemic attack,MACE,cardiovascular death and major bleeding were 1.03%,1.24%,1.03% and 1.75%,respectively,in octogenarian patients.Except for progressive heart failure death and major bleeding,rates of outcomes in octogenarians were similar compared to younger patients.In octogenarians,the concomitant use of antiplatelet agents and non-severe dementia were independently associated with the development of ischemic stroke,whereas previous coronary revascularization and heart failure with MACE,and higher HAS-BLED score with major bleeding.Conclusions In clinical practice,around one third of patients taking rivaroxaban are octogenarians.These patients have many comorbidities and a high thromboembolic risk.Despite that,rates of adverse events remain low.Rivaroxaban is adequately prescribed in the majority of octogenarians.

Antibiogram of Bacteria Isolated from Tuberculosis Patients Attending Hospital within Izzi-Abakaliki in Ebonyi State

The Antibiogram of the bacterial isolates from Tuberculosis (TB) patients attending hospitals within Izzi-Abakaliki was evaluated. The bacterial isolates were isolated and identified from the sputum samples according to microbiological principles while the antibiotics susceptibility test was done by disc diffusion method using Ofloxacin, Pefloxacin, Ciprofloxacin, amoxicillin/clavulanate, Gentamycin, Streptomycin, Cephalosporin, Cotrimoxazole, Nalidixic acid and Ampicillin. Bacteria isolated include 5 E. coli (25%), 3 Streptococcus pyogenes (15%), 2 Streptococcus pneumoniae (10%), 1 Klebsiella spp. (5%), 3 Haemophilus influenza (15%), 2 Pseudomonas (10%), 3 Proteus spp. (15%), 1 Staphylococcus aureus (10%). The result of Antibiogram shows that E. coli was 100% resistant to Amoxicillin/clavulanate and cotrimoxazole, followed by Streptomycin (80%) and 100% susceptible to Pefloxacin with inhibition zone diameter of 18 mm and 18 mm for Ofloxacin (60%). S. pneumoniae and Klebsiella spp. were highly resistant to Amoxicillin/clavulanate (100%), Gentamycin (100%) and Ampicillin (100%) and 100% susceptible to Pefloxacin with inhibition zone 18 mm, Ciprofloxacin (17 mm). S. pyogenes was resistant to streptomycin and Ceporex, with 100% sensitivity to Ofloxacin, Ciprofloxacin and Pefloxacin. Pseudomonas spp. and S. aureus were both 100% resistant to all antibiotics except Ofloxacin, Ciprofloxacin, and Pefloxacin respectively. Proteus spp. was susceptible to Pefloxacin (100%), Ofloxacin (66.7%) and Ciprofloxacin (66.7%) but highly resistant to Streptomycin (100%) and Ampicillin (100%). Haemophilus influenzae were susceptible to Ofloxacin (100%) and Pefloxacin (100%), with high resistance to Amoxicillin/clavulanate (100%) and Ceporex (100%). From the study, Ofloxacin and Pefloxacin are susceptible to all bacteria isolated and are recommended for treatment of the bacterial infection with TB patient.

Evaluation of the Completeness in the Filling of Laboratory Request Forms Submitted to the Haematology Laboratory at a Tertiary Hospital in Kenya

Background information: The laboratory request form is a communication link between the clinicians and the laboratory staff. It contains demographic details of the patient including full names, age and gender;the test required;location of the patient;date and time of request among other details. Incomplete and inaccurate filling of the request forms may cause errors which can impact on the quality of the patient care. Methodology: The study was a descriptive cross sectional where 289 laboratory request forms submitted consecutively to the haematology laboratory during the month of January 2018 were evaluated. Data was collected using a data collection form and analyzed by use of frequency table. Ethical clearance was sought from Institutional Research and Ethical Committee of Moi University and Moi Teaching and Referral Hospital. Results: Of all the 289 forms evaluated, only 1% (3/289) had all the required information. The parameters with the most information were patient’s name (100%), hospital number (100%), sex (99.7%), age (98.3%), investigation requested (97.6%), the location of the patient (96.9%), clinician’s name (96.9%) and signature (96.5%). The least information was recorded for clinical history (14.7%) and address of the patient (4.8%). Conclusion: The study showed that there were inadequacies in the recording of the required information in the laboratory request form. The parameters which were completely filled were the patient’s name and the hospital number, whereas the address and the clinical history had the least completion rates.

Prevalence and Viral Load Determination of Hepatitis B Virus among Hiv Seropositive Patients Attending Kogi State Specialist Hospital Lokoja, Kogi State

Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) share common risk factors and HBV occurs in people with HIV resulting in an increased risk for HIV/HBV co-infection. Globally, hepatitis B virus infection is of serious public health causing morbidity and mortality. The increasing incidence of liver diseases caused by HBV is emerging as a significant cause of morbidity and mortality among HIV-infected individuals. A clearer knowledge of HBV prevalence in Kogi State is important in order to educate, inform the population and control epidemics through extensive vaccination and treatment programme. The aim of this study was to determine the seroprevalence of Hepatitis B infection and to evaluate molecularly HBV infection among HIV seropositive individuals. Sera samples were obtained from 218 consented HIV participants and screened for HBsAg using the commercial membrane based rapid qualitative test kit and real-time PCR was performed using Tianlong to assay the virus quantitatively. A structured questionnaire was used to collect information on patient’s demographic variables and risk factors for HBV transmission. Overall, 17 of the participants were seropositive to HBsAg. There was a significant difference between the age distribution with (P-value = 0.006) and marital status with (P-value = 0.044). Type of marriage, occupation, place of residence and risk factors associated with HIV and HBV co-infection do not show significant differences. A total of 17 HBsAg positive samples were subjected to viral load analysis, out of which 7 were highly unsuppressed, 5 were suppressed while the remaining 5 were undetectable. This study confirmed a moderately high HIV/HBV co-infection rate (7.8%). The highly unsuppressed viral load obtained from the study is a potential risk for Hepatocellular carcinoma among the study population. Enlightenment programme on routes of virus acquisition with a view to reducing the morbidity and mortality of HIV/HBV co-infection should be intensified.

The impact of COVID-19 on the birth rate in Nigeria:a report from population-based registries

Background and objectives:Coronavirus disease 2019(COVID-19)is a pandemic that has become a major source of morbidity and mortality worldwide,affecting the physical and mental health of individuals influencing reproduction.Despite the threat,it poses to maternal health in sub-Saharan Africa and Nigeria,there is little or no data on the impact it has on fertility,conception,gestation and birth.To compare the birth rate between pre-COVID and COVID times using selected months of the year.Materials and methods:This was a secondary analysis of cross-sectional analytical study data from the birth registries of three tertiary hospitals,comparing two years[2019(Pre-COVID)]versus[2020(COVID era)]using three months of the year(October to December).The data relied upon was obtained from birth registries in three busy maternity clinics all within tertiary hospitals in South-East Nigeria and we aimed at discussing the potential impacts of COVID-19 on fertility in Nigeria.The secondary outcome measures were;mode of delivery,booking status of the participants,maternal age and occupation.Results:There was a significant decrease in tertiary-hospital based birth rate by 92 births(P=0.0009;95%CI:-16.0519 to-4.1481)among mothers in all the three hospitals in 2020 during the COVID period(post lockdown months)of October to December.There was a significant difference in the mode of delivery for mothers(P=0.0096)with a 95%confidence interval of 1.0664 to 1.5916,as more gave birth through vaginal delivery during the 2020 COVID-19 period than pre-COVID-19.Conclusion:Tertiary-hospital based birth rates were reduced during the pandemic.Our multi-centre study extrapolated on possible factors that may have played a role in this decline in their birth rate,which includes but is not limited to;decreased access to hospital care due to the total lockdowns/curfews and worsening inflation and economic recession in the country.

Activated Protein C Resistance in Patients with Pre-Eclampsia in Lagos, Nigeria

Background: Preeclampsia is reported to complicate 2% - 8% of pregnancies globally and is an important cause of maternal and perinatal morbidity and mortality. The aetiology and pathogenesis are still poorly understood and substantial improvement has not been made in the prediction, prevention and treatment of the disease. Objective: To compare the frequency of activated protein C resistance (APC-R) in patients with pre-eclampsia to that of normotensive pregnant women and to determine the correlation between activated protein ratio (APC-ratio) and the severity of pre-eclampsia. Methodology: A cross-sectional study was carried out in 100 pre-eclamptic patients and 100 normotensive pregnant controls. The APC-ratio was determined using the modified activated partial thromboplastin time. Study participants with APC-ratio of less than 2.0 were defined as having APC-R. Data was analyzed using SPSS version 22.0. Results: Mean APC-ratio was significantly lower in pre-eclamptics (2.89 ± 1.70) compared to normotensive pregnant women (3.57 ± 1.06) (p = 0.0008) and the levels were also higher in mild (2.95 ± 1.15) compared to severe pre-eclamptics (2.62 ± 1.14). The frequency of APC-R was 26% among women with pre-eclampsia compared to 4% among normotensive controls (p = 0.000). Among 100 pre-eclamptic women 7 (21.2%) out of 33 with mild pre–eclampsia had APC-R, while 19 (28.4%) out of 67 with severe pre-eclampsia had APC-R. APC-ratio had a significant negative correlation with mean arterial blood pressure (r = −0.324;p = 0.000) and proteinuria (r = −0.379;p = 0.000) among study participants. Conclusion: The frequency of activated protein c resistance is significantly higher in pre-eclamptics compared to normotensive pregnant women and this is more pronounced in those with severe pre-eclampsia compared with those with mild disease. APC-R may therefore be used as a marker of severity in the disease.

UGT1A1 gene polymorphism: Impact on toxicity and efficacy of irinotecan-based regimens in metastatic colorectal cancer

AIM: To investigate the correlation between uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1) gene polymorphisms and irinotecan-associated side effects and parameters of drug efficacy in patients with metastatic colorectal cancer (mCRC) receiving a low-dose weekly irinotecan chemotherapeutic regimen. METHODS: Genotypes were retrospectively evaluated by gene scan analysis on the ABI 310 sequencer of the TATAA box in the promoter region of the UGT1A1 gene in blood samples from 105 patients who had received 1st line irinotecan-based chemotherapy for mCRC. RESULTS: The distribution of the genotypes was as follows: wild type genotype (WT) (6/6 ) 39.0%, heterozygous genotype (6/7) 49.5%, and homozygous genotype (7/7) 9.5%. The overall response rate (OR) was similar between patients carrying the (6/7, 7/7) or the WT genotype (6/6) (44.3% vs 43.2%, P = 0.75). Neither time to progression [(TTP) 8.1 vs 8.2 mo, P = 0.97] nor overall survival [(OS) 21.2 vs 18.9 mo, P = 0.73] differed significantly in patients who carried the(6/6) when compared to the (6/7, 7/7) genotype. No significant differences in toxicity were observed: Grade 3 and 4 delayed diarrhoea [(6/7, 7/7) vs (6/6); 13.0% vs 6.2%, P =0.08], treatment delays [(6/7, 7/7) vs (6/6); 25.1% vs 19.3%, P = 0.24] or dose reductions [(6/7, 7/7) vs (6/6); 21.5% vs 27.2%, P = 0.07].CONCLUSION: This analysis demonstrates the non-significant influence of the UGT1A1 gene polymorphism on efficacy and rate of irinotecan-associated toxicity in mCRC patients receiving low-dose irinotecan based chemotherapy.

Frequency of primary iron overload and HFE gene mutations (C282Y,H63D and S65C) in chronic liver disease patients in north India

AIM:To identify the frequency of iron overload and study the three mutations in the HFE gene (C282Y,H63D,and S65C) in patients with chronic liver disorders (CLD) and controls. METHODS:To identify patients with iron overload (transferrin saturation > 45% in females and > 50% in males and serum ferritin > 1000 ng/mL) we evaluated 236 patients with CLD,including 59 with non-alcoholic steatohepatitis (NASH),22 with alcoholic liver disease (ALD),19 of cirrhosis due to viruses (HBV,HCV),and 136 with cryptogenic cirrhosis. Mutations of the HFE gene were analyzed by PCR-RE. hundred controls were screened for iron status and the mutations. RESULTS:Seventeen patients with CLD showed evidence of iron overload. Fifteen cases of iron overload had cryptogenic cirrhosis and two had ALD. None of the controls showed iron overload. We did not find any individual with 282Y or 65C either in the cases or in the controls. The prevalence of H63D heterozygosity was 12% in normal individuals,14.8% in 236 patients (16.9% in NASH,13.6% in ALD,26.3% in viral and 12.5% in cryptogenic cirrhosis) and the overall prevalence was 13.98%. Only two of the 17 patients with primary iron overload were heterozygous for H63D. One patient with NASH and one normal individual who were homozygous for H63D showed no iron overload.CONCLUSION:Primary iron overload in Indians is nonHFE type,which is different from that in Europeans and further molecular studies are required to determine the defect in various iron regulatory genes.

Effect of iron overload on electrophysiology of slow reaction autorhythmic cells of left ventricular outflow tract in guinea pigs

Objective: To investigate the electrophysiology effects and mechanism of iron overload on the slow response autorhythmic cells in the left ventricular outflow tract of guinea pigs.Methods: Standard microelectrode cell recording techniques were adopted to observe the electrophysiological effects of different concentrations of Fe^(2+)(100 μmol/L, 200 μmol/L) on the left ventricular outflow tract autorhythmic cells.Heart tissues were perfused with FeSO_4(200 μmol/L) combing with CaCl_2(4.2 mmol/L), Verapamil,(1 μmol/L), and nickel chloride(200μmol/L) respectively to observe the influences of these contents on electrophysiology of FeSO_4(200μmol/L) on the left ventricular outflow tract autorhythmic cells.Results: Fe^(2+)at both 100 μmol/L and 200 μmol/L could change the electrophysiological parameters of the slow response autorhythmic cells of the left ventricular outflow tract in a concentrationdependent manner resulting into decrease in Vmax, APA and MDP, slower RPF and VDD, and prolonged APD_(50) and APD_(90)(P all <0.05).Besides, perfusion of increased Ca^(2+) concentration could partially offset the electrophysiological effects of Fe^(2+)(200 μmol/L).The L-type calcium channel(LTCC) blocker Verapamil(1 μmol/L) could block the electrophysiological effects of Fe^(2+)(200 μmol/L).But the T-type calcium channel(TTCC) blocker nickel chloride(NiCl_2, 200 μmol/L) could not block the electrophysiological effects of Fe^(2+)(200 μmol/L).Conclusions: Fe^(2+) can directly change the electrophysiological characteristics of the slow response autorhythmic cells of the left ventricular outflow tract probably through the L-type calcium channel.

Burden of venous thromboembolism in patients with pancreatic cancer

Pancreatic cancer(PC)is a devastating malignancy with fewer than 10%of patients being alive at 5 years after diagnosis.Venous thromboembolism(VTE)occurs in approximatively 20%of patients with PC,resulting in increased morbidity,mortality and significant health care costs.The management of VTE is particularly challenging in these frail patients.Adequate selection of the most appropriate anticoagulant for each individual patient according to the current international guidelines is warranted for overcoming treatment challenges.The International Initiative on Thrombosis and Cancer multi-language web-based mobile application(downloadable for free at www.itaccme.com)has been developed to help clinicians in decision making in the most complex situations.In this narrative review,we will discuss the contemporary epidemiology and burden of VTE in PC patients,the performances and limitations of current risk assessment models to predict the risk of VTE,as well as evidence from recent clinical trials for the primary prophylaxis and treatment of cancer-associated VTE that support updated clinical practice guidelines.

Prevalence of asymptomatic malaria parasitaemia

Objective:To evaluate factors associated with prevalence of malaria parasitaemia at first antenatal care visit.Methods:The study was conducted at the University of Calabar Teaching Hospital from 1st June,2007 to 31st July,2007.A structured questionnaire was administered to a total of 545 pregnant women that were recruited in this study after obtaining informed consent and two slides of thin and thick films were prepared for each participant.Results:Five hundred and twenty(95.4%) out of the 545 participants suffered from malaria parasitaemia,the rest 4.6%of those who had no parasitaemia had experienced symptomatic malaria before and were treated in private hospitals prior to their recruitment into the study.All participants(100%) who did not have antimalarials had parasitaemia compared with 91.1%among those that had antimalarials.The proportion of moderate to severe parasitaemia was also significantly higher among the former.Besides,the difference in parasitaemia between primigravidae and multigravidae was statistically significant(P=0.000) too. Among the methods used for vector control,only insecticide treated nets(ITNS) was associated with significant reduction in the level of parasitaemia(RR=0.83).Conclusion:Malaria parasitaemia at first booking is significandy higher in primigravidae and women who have no anti-malaria treatment. The use of safe and effective antimalarial treatment along with ITNs will significandy reduce the level of parasitaemia in pregnant women.

Treatment of hepatitis C virus genotype 4 with peginterferon alfa-2a: Impact of bilharziasis and fibrosis stage

AIM： To evaluate pegylated interferon alpha2a （PegIFN-α2a） in Egyptian patients with HCV genotype 4, and the impact of pretreatment viral load, co-existent bilharziasis and histological liver changes on response rate. METHODS： A total of 73 nafve patients （61 with history of bilharziasis） with compensated chronic HCV genotype 4 were enrolled into： group A （38 patients） who received 180 mg PegIFN-alpha2a subcutaneously once weekly for a year and group B （35 patients） received IFN alpha-2a 3 MU 3 times weekly. Ribavirin was added to each regimen at a dose of 1200 mg. Patients were followed for 72 wk and sustained response was assessed. RESULTS： Significant improvement in both end of treatment response （ETR） （P 〈 0.002） and sustained response （SR） （P 〈 0.05） was noted with pegylated interferon, where ETR was achieved in 29 （76.3%） and 14 patients （40%） in both groups respectively, and 25 patients in group A （65.8%） and 9 （25.7%） in group B could retain negative viraemia by the end of follow up period. Sustained virological response （SVR） showed a significant negative correlation with age and positive correlation with pretreatment inflammation in patients receiving PegIFN. Viral clearance after 3 mo of therapy was associated with high incidence of ETR and SR （P 〈 0.001）, but without significant difference between both forms of interferon. Significant improvement in response was achieved in patients with high grade fibrosis （grade 3 and 4） with PegIFN-α2a, where SR was seen in 5 out of 13 patients in group A, but none in group B. There was no significant difference in response between bilharzial and non-bilharzial patients in both groups. In terms of safety and tolerability, neutropenia was the predominant side effect, both drugs were comparable. CONCLUSION： PegIFN-~2a combined with ribavirin results in improvement in sustained response in HCV genotype 4, irrespective of history of bilharzial infestation.

Clinical utility of viscoelastic testing in chronic liver disease: A systematic review

BACKGROUND Conventional coagulation tests are widely used in chronic liver disease to assess haemostasis and to guide blood product transfusion.This is despite the fact that conventional tests do not reliably separate those with a clinically significant coagulopathy from those who do not.Viscoelastic testing such as thromboelastography(TEG)correlate with bleeding risk and are more accurate in identifying those who will benefit from blood product transfusion.Despite this,viscoelastic tests have not been widely used in patients with chronic liver disease outside the transplant setting.AIM To assess the utility of Viscoelastic Testing guided transfusion in chronic liver disease patients presenting with bleeding or who require an invasive procedure.METHODS PubMed and Google Scholar searches were performed using the key words“thromboelastography”,“TEG”or“viscoelastic”and“liver transplantation”,“cirrhosis”or“liver disease”and“transfusion”,“haemostasis”,“blood management”or“haemorrhage”.A full text review was undertaken and data was extracted from randomised control trials that evaluated the outcomes of viscoelastic test guided transfusion in those with liver disease.The study subjects,inclusion and exclusion criteria,methods,outcomes and length of follow up were examined.Data was extracted by two independent individuals using a standardized collection form.The risk of bias was assessed in the included studies.RESULTS A total of five randomised control trials included in the analysis examined the use of TEG guided blood product transfusion in cirrhosis prior to invasive procedures(n=118),non-variceal haemorrhage(n=96),variceal haemorrhage(n=60)and liver transplantation(n=28).TEG guided transfusion was effective in all five studies with a statistically significant reduction in overall blood product transfusion compared to standard of care.Four of the five studies reported a significant reduction in transfusion of fresh frozen plasma and platelets.Two studies showed a significant reduction in cryoprecipitate transfusion.No increased risk of bleeding was reported in the three trials where TEG was used perioperatively or prior to an invasive procedure.Two trials in the setting of cirrhotic variceal and non-variceal bleeding showed no difference in control of initial bleeding.In those with variceal bleeding,there was a statistically significant reduction in rate of re-bleeding at 42 d in the TEG arm 10%(vs 26.7%in the standard of care arm P=0.012).Mortality data reported at various time points for all five trials from 6 wk up to 3 years was not statistically different between each arm.One trial in the setting of non-variceal bleeding demonstrated a significant reduction in adverse transfusion events in the TEG arm 30.6%(vs 74.5%in the control arm P<0.01).In this study there was no significant difference in total hospital stay although length of stay in intensive care unit was reduced by an average of 2 d in the TEG arm(P=0.012).CONCLUSION Viscoelastic testing has been shown to reduce blood product usage in chronic liver disease without compromising safety and may enable guidelines to be developed to ensure patients with liver disease are optimally managed.

Antiinflammatory activity of the methanolic extract of the seeds of Carica papaya in experimental animals

Objective:To scientifically verify the claims of our traditional healers on the anti-inflammatory activity of Carica papaya(C.papaya) and possibly deduce its activities.Methods:0.1 mL of fresh egg albumin was injected into the right hind-paw of adult white Wistar rats to induce inflammation an hour post intraperitoneal(IP) administration of 50-200 mg/kg doses of the extract to 3 groups of 5 rats per group.The 4th group of 5 rats was used as negative control and received 2 mL/kg(IP) of physiological saline,while the 5th group of 5 rats was used as positive-comparative control and received(IP) 150 mg/kg of aspirin.Increases in diameter of the paw were measured with the aid of Veneer Calipers before extract administration and at interval of 30 minutes post administration for further 2 hours.Percentage inhibition of oedema was calculated for each dose group and results were subjected to statistical analysis using student /-test and analysis of variance(ANOVA).Results:All doses of extract showed a dose and time dependent inhibition effects of oedema(P【0.05).Conclusions:This work is at present though limited to animals,the anti-inflammatory activity of the seeds of C.papaya is perhaps proven.

Isolated myeloid sarcoma in the pancreas and orbit:A case report and review of literature

Myeloid sarcoma(MS) is a type of extramedullary solid haematological tumour. Myeloid sarcoma is classified into two types based on whether onset of the disease is complicated by haematologic diseases: extramedullary infiltration of leukaemia(leukaemic MS) and isolated myeloid sarcoma. The incidence of isolated myeloid sarcoma is low. In particular, isolated myeloid sarcoma involving the pancreas is extremely rare and prone to misdiagnosis. This case report describes the long and eventful diagnostic process of a case of myeloid sarcoma involving the pancreas and orbit. Due to a lack of typical clinical manifestations and imaging characteristics, the patient underwent several rounds of treatment without a confirmed diagnosis. Eventually, the final diagnosis was pathologically confirmed using several types of biopsies and immunohistochemical detection. To date, this type of disease has not been reported in the literature. This case report describes the detailed diagnostic process and discusses the strategies used for diagnosis, which will facilitate the diagnosis of such diseases in the future.

Haematological and lipid profile assays in Nigerian asthmatics

Objective:To assess the haematological and lipid profile assays in asthmatics.Methods: Eighty asthmatic subjects were prospectively studied in a major referral centre serving the Niger Delta region of Nigeria for 12 months(2006-2007).Clinico-haematological and serum lipid total cholesterol(TC),triglyceride(TG),and lipoproteins concentration were analyzed after adjusting for age,cigarette smoking,alcohol ingestion,hypertension and diabetes mellitus.Results: Eighty patients(34 males and 46 females) were seen with female predominating in the various age groups(M∶F ratio,0.7∶1).Total cholesterol and low density lipoproteins-cholesterol for the asthmatics was significantly higher than the controls(P<0.000 1),while the ratio of TC∶HDL-C(high density lipoprotein-cholesterol) in asthmatics was 3.67 compared to the control value of 3.01.TC and low density lipoprotein-cholesterole(LDL-C) were significantly higher in females than the males(P<0.05).There was a combined hypertriglyceridemia(HT,>2.3mmol/L) and a significant hypercholesterolemia(HC,>5.2mmol/L) according to the Adult Treatment Panel III definition in asthmatics thereby putting them at increased risk for the development of cardiovascular disease as well as other disorders related to excess lipids.There was a significant thrombocytopenia(P<0.000 1) which may accompany allergen exposure and this persists for 24 h;that asthmatics of African descent showed a significantly increased total leucocyte count(P=0.001) similar to other studies in the Western countries.Conclusion: Hyperlipidaemia is a prevalent medical problem among asthmatics;hence screening for fasting serum lipid levels to identify those who need early intervention is recommended.