Osaro Erhabor

Evaluation of coagulation parameters and liver enzymes among alcohol drinkers in Port Harcourt, Nigeria

Alcohol is a major contributor to the global burden of disease, disability, and death in high, middle, and low-income countries. Harmful use of alcohol is one of the main factors contributing to premature deaths and avoidable disease burden worldwide and has a major impact on public health. The aim of this present cross-sectional study was to investigate the effect of alcohol consumption on coagulation parameters and liver enzymes of subjects in Port Harcourt, Nigeria. Two hundred adults consisting of 120 alcohol dependent subjects and 80 age, gender-matched nondrinkers aged 25–65 years (mean age 45.25 ± 11.50 years) were enrolled in this study. Of the 120 chronic alcohol drinkers, 37 were dependent on local dry gin, while 83 were dependent on other alcoholic beverages. The mean values of the liver enzymes, aspartate aminotransferase and gamma glutamyl transferase, were significantly higher (P = 0.002 and P = 0.02 respectively) among the chronic alcohol consumers compared with their nondrinker counterparts. Although the value of alanine aminotransferase was higher in the chronic drinkers, it did not reveal any significant difference (P = 0.11). The coagulation parameters, prothrombin time and activated partial thromboplastin time were investigated among chronic drinkers and nondrinkers. The mean value of prothrombin time and activated partial thromboplastin time was significantly higher in the chronic alcohol drinkers compared to the nondrinkers (P = 0.04 and P = 0.02 respectively). We observed a positive and significant correlation between values of liver enzymes, serum gamma glutamyl transferase and aspartate aminotransferase, and values of prothrombin time among alcohol consumers (r = 0.72 and r = 0.68 respectively). The implementation of policies to target harm reduction strategies among alcoholics is urgently needed, alongside the building of a strong base of public awareness and community support required for the continuity and sustainability of alcohol policies. There is also the need for the Nigerian government to enforce tighter regulations and restrictions on the production and distribution of alcoholic beverages to reduce harmful use, and protect young people and other vulnerable groups.

Some hemostatic parameters in women with obstetric hemorrhage in Sokoto, Nigeria.

Obstetric hemorrhage is the leading cause of maternal mortality and morbidity worldwide. This study was carried out to investigate the effect of obstetric hemorrhage on the prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet count (PLC). Women with obstetric hemorrhage were divided into two categories, women with antepartum hemorrhage (APH) and those with postpartum hemorrhage (PPH). Pregnant women without hemorrhage were included as controls. Eighty-six pregnant women aged 18–45 years (mean age 36.25 ± 10.50 years) were presented to the Obstetrics and Gynaecology Department of Maryam Abacha Women and Children Hospital in Sokoto Metropolis, Sokoto State, Nigeria with history of obstetric hemorrhage. Forty-three age-matched nonhemorrhaging parturient women were included as controls. The determination of PT and APTT was done by manual methods using commercially prepared Diagen reagent kits, whereas PLC was done by manual methods using a hemocytometer. The results of PT and APTT were significantly higher among women with APH (20.7 ± 4.226 seconds and 46.04 ± 8.689 seconds, respectively) and among women with PPH (23.17 ± 2.708 seconds and 53.78 ± 4.089 seconds, respectively) compared to normal pregnant women (15.85 ± 0.8930 seconds and 36.225 ± 5.010 seconds, respectively) (P = 0.0001). Similarly, the PLC was significantly higher among normal pregnant women compared to those with APH and PPH (291.425 ± 75.980 × 109 compared to 154.83 ± 47.019 × 109 and 136.43 ± 43.894 × 109, respectively) (P = 0.0001). The PT and APTT of women who presented with PPH were significantly higher compared to those who presented with APH (23.17 ± 2.708 seconds and 53.78 ± 4.089 seconds versus 20.7 ± 4.226 seconds and 46.04 ± 8.689 seconds, respectively) (P = 0.02 and P = 0.04, respectively). The PLC was significantly higher among women who presented with APH compared to those who presented with PPH (P = 0.01). The PT and APTT values were higher in the third trimester among women with APH (24.38 ± 2.33 seconds and 52.25 ± 6.71 seconds, respectively), PPH (24.75 ± 2.63 seconds and 58.25 ± 2.53 seconds, respectively), and control women (16.00 ± 0.82 seconds and 34.42 ± 5.59 seconds, respectively) compared to those in first and second trimester. The PLC was significantly lower in the third trimester among APH, PPH, and normal pregnant women (131 ± 23.02 × 109, 99 ± 21.46 × 109, and 192.86 ± 25.44 × 109, respectively). PT and APTT values correlated positively and significantly with trimester (r = 0.52 and 0.65, respectively; P = 0.01). The PLC of women with APH, PPH, and normal control women correlated negatively with trimester (r = −0.36, −0.54, and −0.28, respectively; P = 0.05). Obstetrics hemorrhage compounded the hemostatic status of pregnant women in Sokoto, Nigeria. There is need for the provision of rapid diagnosis of coagulopathy to guide the provision of best therapeutic management options.

Randomized Clinical Trials on Breast Cancer in Nigeria and Other Developing Countries: Challenges and Constraints

Worldwide, breast cancer is the commonest cancer among women, and its incidence is rising exponentially particularly in developing countries. Compared with Caucasian women, women in developing countries experience a disproportionate burden of aggressive Triple Negative Breast Cancer for reasons that remain unknown and understudied. There is a high incidence of late stage presentation, low level of public awareness of the disease, suboptimal health infrastructure, lack of universal access to affordable interventions and poor prognosis.

Glucose-6-phosphate dehydrogenase deficiency among children attending the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common human enzyme deficiencies in the world. It is particularly common in populations living in malaria-endemic areas, affecting more than 400 million people worldwide. This present study was conducted with the aim of determining the prevalence of G6PD deficiency among children visiting the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital for pediatric-related care. The study included 118 children, made up of 77 (65.3%) males and 41 (34.7%) females aged ≤5 years with mean age of 3.26 ± 1.90 years. Randox G6PD quantitative in vitro test screening was used for the diagnosis of G6PD deficiency. Of the 118 children tested, 17 (14.4%) were G6PD-deficient. Prevalence of G6PD deficiency was concentrated predominantly among male children (22.1%). Male sex was significantly correlated with G6PD deficiency among the children studied (r = 7.85, P = 0.01). The highest prevalence occurred among children in the 2- to 5-year age-group. Of the 17 G6PD-deficient children, twelve (70.2%) were moderately deficient, while five (29.4%) were severely deficient. Blood film from G6PD-deficient children indicated the following morphological changes; Heinz bodies, schistocytes, target cells, nucleated red cells, spherocytes, and polychromasia. This present study has shown a high prevalence of G6PD deficiency among children residing in Sokoto in the northwestern geopolitical zone of Nigeria. The study indicated a male sex bias in the prevalence of G6PD deficiency among the children studied. There is a need for the routine screening of children for G6PD deficiency in our environment, to allow for evidence-based management of these children and to ensure the avoidance of food, drugs, and infective agents that can potentially predispose these children to oxidative stress as well as diseases that deplete micronutrients that protect against oxidative stress. There is need to build capacity in our setting among pediatricians to ensure the effective management of children with G6PD deficiency.

Prostate Specific Antigen (PSA) Screening among Apparently Healthy Men of African Descent in Sokoto, North Western, Nigeria

Background: Globally prostate cancer is the sixth leading cause of cancer-related death in men. Prostate Specific Antigen (PSA) is present in small amount in the serum of men with healthy prostates, but is often elevated in the presence of prostate cancer and other prostate-related disorders. The aim of this present study was to determine the PSA levels among healthy men of African descent resident in Sokoto, North Western Nigeria. Methods: Testing was carried out using the CTK Biotech PSA kit (CTK Biotech Inc, San Diego, USA). The Onsite PSA Rapid Test is a lateral flow chromatographic immunoassay for the qualitative detection of prostate specific antigen (PSA) in human serum or plasma at a cut-off level of 4.0 ng/mL. Original Research article

Absolute lymphocyte count as a marker for CD4 lymphocyte count: criterion for initiating antiretroviral therapy in HIV-infected Nigerians

BACKGROUND Few laboratories in resource-constrained countries can afford to perform laboratory-monitoring tests required for the implementation of HIV therapy. In this case control study, we have investigated the relevance of absolute lymphocyte count as a surrogate marker for CD4 lymphocyte count as a criterion for initiating HAARTin HIV-infected Nigerians. METHODS A total of 100 consecutive recruited HIV-infected, previously antiretroviral naive persons and 30 HIV-negative individuals blood samples were run for absolute lymphocyte and CD4 lymphocyte counts and results were compared by a model of linear regression analysis. RESULTS An overall modest correlation was observed between absolute lymphocyte count and CD4 lymphocyte (r = 0.51) and at CD4 lymphocyte threshold relevant for clinical management of HIV-infected; <200, 200-350 and >350 cells/microL (r = 0.41, 0.30 and 0.21) respectively. Mean absolute lymphocyte count of 1.60 +/- 0.77 x 10(9)/L, 1.88 +/- 1.11 x 10(9)/L and 2.04 +/- 0.54 x 10(9)/L was equivalent respectively to CD4 of <200, 200-350 and >350 cells/microL. CONCLUSIONS This study indicates a modest correlation between absolute and CD4 lymphocyte counts of HIV-infected Nigerians and at CD4 lymphocyte count threshold significant for clinical management of HIV-infected. Absolute lymphocyte count can become a minimal inexpensive alternative to CD4 lymphocyte count in conjunction with WHO staging and clinical status of patient in determining the optimal time to initiate therapy particularly in resource limited settings where other expensive methods of CD4 enumeration are unavailable.

Frequency of anti-glycoprotein Ia/IIa (anti-HPA-5b,-5a) and anti-glycoprotein IIb/IIIa (anti-HPA-1a,-3a,-4a) alloantibodies in multiparous women of African descent

®qualitative solid phase ELISA reagent. Platelet count was done using the ICSH approved procedure using 1% ammonium oxalate reagent. Study design: A cross-section of apparently healthy adult Nigerian multiparous non-pregnant women, who were staff of a tertiary health facility in the Niger Delta, Nigeria, were screened for alloantibodies to human platelet antigens. Results: Of the one hundred (100) women screened, the prevalence of anti-glycoprotein IIb/ IIIa (anti-HPA-Ia,-3a,-4a) was zero percent (0%), anti-glycoprotein Ia/IIa (anti-HPA-5b) accounted for 30% of results, while anti-glycoprotein Ia/IIa (anti-HPA-5a) was 18%. Parity was found to exert significant influence on the development to HPA antibodies (Fisher’s Exact Test = 11.683, P , 0.05; 13.577, P , 0.01). The platelet count of the women did not appear to exert any influence on the development of the antibodies (P . 0.05). Conclusion: This study has observed a high prevalence of anti-HPA-5b in our sample population. The prevalence of alloantibodies to HPA antigens was found to associate strongly with parity. These results indicate that there is a need to initiate platelet serology in our tertiary health institutions, as well as educate our women on the risk associated with frequent pregnancies, and ensure that adequate caution is taken when recruiting multiparous women

The effects of highly active antiretroviral therapy (HAART) of stavudine, lamivudine and nevirapine on the CD4 lymphocyte count of HIV-infected Africans: the Nigerian experience

OBJECTIVES The objective of this study was to investigate the short-term effect of highly active antiretroviral therapy on the CD4 lymphocyte count of HIV-infected Nigerians. DESIGN A case control study of 70 HIV-infected subjects placed on highly active antiretroviral therapy. Thirty HIV-infected yet to start therapy due to unaffordability were observed as controls. SETTING This study was carried out at the Hematology Department of the University of Port Harcourt Teaching Hospital a 500 bed tertiary hospital and one of the designated antiretroviral therapy pilot centers. METHODS CD4 lymphocyte count was determined at baseline for subjects and controls. Subjects were placed on HAART for 12 weeks while controls that were yet to start therapy were monitored as controls. CD4 lymphocyte count was repeated after 12 weeks and the differences compared statistically. RESULTS We observed that subjects and control patients did not differ significantly in their CD4 lymphocyte count at baseline (p>0.05), but after 12 weeks HAART in subjects and untreated control there was a mean increase in CD4 count of (39 cells/microL) in subjects, while untreated controls showed a mean decline of (12 cells/microL) p< 0.05. There was a statistically significant variation in the therapy dependent increases in CD4 count of HAART treated subjects based on pre-therapeutic baseline CD4 count (divide2 = 180.39, p<0.05). The HAART dependent increase in CD4 counts was higher in younger subjects 19-28 years (31 cells/microL) compared to older subjects 49-58 years (21 cells/microL) (p = 0.01). Similarly CD4 response was found higher in females compared to males (p = 0.01). CONCLUSION This study indicates the importance of accessing the CD4 lymphocyte count of HIV infected patients before the initiation of HAART, its use as a prognostic maker in predicting the initial response to HAART and in determining the optimal time to initiate therapy.