Comparative study of C-reactive protein and other biochemical parameters in patients with hepatitis B and malaria in Calabar, Nigeria.

Serum levels of C-reactive proteins (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein, albumin and globulins were investigated using high sensitivity immunoturbidometric and colorimetric techniques in individuals with hepatitis (n=50), malaria (n=50) and 40 control subjects in age range of 30 to 65 years. The hepatitis patients had a significantly higher (P < 0.01) level of aminotransferases when compared to malaria patients and control subjects. The mean value of ALT was 103.50 ± 71.4 IU/L and 46.72 ±17.48 IU/L for hepatitis and malaria respectively. The values for AST were 116.76 ± 63.27 IU/L and 57.74 IU/L ± 15.18 IU/L for hepatitis and malaria respectively while the values for control were 34.75 ± 14.64 and 35.25 ± 15.56 IU/L for AST and ALT respectively. The malaria patients showed a significantly higher level (P < 0.01) of aminotransferases when compared to the control. The mean serum CRP levels were 0.71 ± 0.11 mg/dL and 0.78 ± 0.13 mg/dL for hepatitis and malaria respectively. These values were significantly higher (P < 0.01) than those of the controls which was 0.32 ± 0.12 mg/dL. The values of CRP in malaria were significantly higher (P< 0.05) when compared with hepatitis. In malaria, AST correlated with CRP (r = 0.58). The mean serum proteins of hepatitis patients were significantly lower (P < 0.05) than those of the control and malaria while there were no significant differences between the total protein in malaria when compared with control. Albumin levels in both patients were significantly lower (P > 0.05) than those of the controls. The mean values were 33.40 ± 3.40g/L and 34.47 ± 3.56g/L for hepatitis and malaria respectively and 37.00 ± 3.43 g/L for the control. C-reactive protein correlated negatively with albumin in malaria (r = -0.26) while albumin had a negative correlation with globulin(r = -0.36). Also albumin-globulin ratio were significantly (P < 0.05) decreased in both patients when compared with controls. This result suggests that a systemic acute phase response is present in hepatitis and malaria patients hence measurement of C-reactive proteins may be helpful in the diagnosis and management of hepatitis and malaria; especially in the malaria endemic region such as Nigeria.

Evaluation of syphilis in patients with HIV infection in Nigeria.

OBJECTIVE: To document the manifestations of syphilis among patients with concurrent HIV infection over a 12-month period. METHOD: Descriptive, cross-sectional, hospital-based study of all adult patients with syphilis and HIV infection who attended the skin clinic of the University of Nigeria, Teaching Hospital, Enugu, between July 2000 and June 2001. A standardized questionnaire was used to record age, sex, marital status, occupation and risk factor for HIV infection; initial site of onset of rash/ulcers, duration of the illness, any concomitant affection of mucosa, hair and nails as well as treatments received by each patient prior to presentation. Morphological distribution of lesions, mucosal surface (conjuctival, vulval and rectal) examinations and documentation of concomitant disorders with HIV were noted by the examining dermatologist. Lesional biopsy and dark-field microscopy were undertaken to confirm diagnosis where serologic (non-treponemal and treponemal specific) tests for syphilis were inconsistent with clinical suspicion. Each patient had a routine chest x-ray, mantoux and purified protein derivative (PPD) status taken. RESULTS: Thirty-one patients (21 males) with concurrent syphilis and HIV were seen during the study period. Primary syphilis was diagnosed in nine (29%), secondary syphilis in 20 (64.5%) and latent syphilis in two (6.5%). Neurosyphilis was not observed. Prevalence of syphilis for these patients with concurrent HIV was 2.1%. Mean duration of syphilis was 3.9 months +/- 1.4 and lesions of greatest concern occurred mainly on the genitalia. The glans penis was affected in 10 (32.3%) cases, the penile shaft in seven (22.6%), the oral cavity in five (16.1%), the rectum in six (19.4%) and the vulva in three (0.9%) cases. Nine (29.1%) patients had a history of primary syphilitic chancre, 19 (61.3%) had a past history of sexually transmitted disease (STD)--particularly genital ulcers--while three (9.7%) could not recall any past history of STD. Eighteen (59.3%) had a history of unprotected sex, 16 (51.7%) had multiple sexual partners, four (13.3%) had had oral sex, and one anal sex (3.3%); none admitted to being bisexual. Other relevant risk factors for HIV transmission were blood transfusion within 5 years for three (9.7%) and intravenous drug use in two (6.5%). Some patients had more than one condition as a potential source of exposure. Serological tests were weakly reactive in 17 (48.4%), strongly reactive in nine (29%) and non-reactive in five (16.1%) patients. Three patients exhibited prozone phenomenon. Treatment comprised the syndromic approach, which currently is advocated for use in primary healthcare centres without facilities for aetiological diagnosis of sexually transmitted infections. CONCLUSION: Our cases with concurrent syphilis and HIV/AIDS had unusual manifestations, responded to treatment more slowly and died sooner than cases described in Western literature due to generally lower levels of health.

Serum heat-stable alkaline phosphatase activity in normal pregnancy.

OBJECTIVE: To determine the reference values for heat-stable alkaline phosphatase in apparently healthy non-pregnant and in normal pregnant females and to assess the suitability of this parameter as a measure of placental function and indirectly as a measure of foetal survival. DESIGN: A prospective study. SETTING: Ante-natal clinic, University of Nigeria Teaching Hospital, Enugu, Nigeria. PARTICIPANTS: Ninety eight apparently normal pregnant females in various gestational ages and 47 apparently healthy non-pregnant females. MAIN OUTCOME MEASURES: The serum heat-stable alkaline phosphatase activity. RESULTS: Variability in values exists between individuals in the same gestational age. The mean and standard deviation of serum heat-stable alkaline phosphatase was found to be 0.79 +/- 1.54 iu/L in the control group. No significant difference was found (p < 0.05) between this and the mean and standard deviation of serum alkaline phosphatase of 0.98 +/- 1.28 iu/L found in the first eight weeks of gestation. However the means and standard deviations of first trimester, second and third trimester were significantly higher than the controls. CONCLUSION: In the face of worsening economic situation in third world countries this simple method could be used in urban and some rural hospitals in assessing placenta insufficiency.

Use of a portable glucose meter in a Nigerian diabetic clinic.

We assessed the performance of a portable glucose meter in a tropical environment. This was undertaken in an effort to reduce the costs of regular blood glucose measurements for our diabetic patients, many of whom were finding regular laboratory tests financially burdensome. The glucose meter was as accurate as the laboratory up to glucose concentrations of 250 mg/dl (14 mmol/l) but slightly overestimated results above that level. Nevertheless, it gave results comparable to those obtained with similar instruments in temperate countries, with a correlation coefficient of 0.91. Its cheapness, alternative power source from dry battery, use of finger prick capillary rather than venous blood, ease of operation, and quick production of results make it almost ideal for use in developing countries.

Selective IgA deficiency (SIgAD) in Eastern Nigeria.

Fifteen cases of selective IgA deficiency were found among 3772 children. Six had IgA levels of 0.01 g/l both in their serum and saliva, and had associated allergic disorders. The other nine, who did not have atopic disease, had measurable amounts of IgA in their saliva. This finding supports the belief that the early development of secretory IgA may reduce the chances of the development of allergic disease.

Hypersensitivity to paw-paw (Cerica papaya): report of a case.

A 23-year-old female presented with classical features of immediate hypersensitivity reaction after contact with paw-paw (Cerica papaya). She had a total serum IgE of 2500 i.u./ml. Prick tests with paw-paw extracts were positive. Her serum gave a positive P-K test on her siblings.

Biochemical studies of apparently 'healthy' blood donors with reference to liver function tests and immunoglobulins.

Liver function tests and immunoglobulin features of apparently 'healthy' blood donors were studied. Twenty-one (9.5%) subjects with HBsAg were observed. These subjects were found to have significantly higher mean and standard deviation of total serum bilirubin, alanine and aspartate aminotransferase levels than those of a randomly selected HBsAg-negative group. Serum urea was significantly lower (p less than 0.01) in the HBsAg-positive cases. Total serum IgE (IU/ml) was significantly higher in the HBsAg-positive cases (p less than 0.01). Comparison of laboratory findings of these cases and active hepatitis HBsAg-positive subjects showed that there were more elevated abnormalities in the latter.

Intestinal helminthic infections and some haematological parameters in pregnant women attended at the University Teaching Hospital in Calabar, Nigeria

Muestras de deposiciones y de sangre fueron obtenidas de 728 mujeres embarazadas de Calabar entre Febrero 1981 y Marzo 1983. El examen de deposiciones para helmintos reveló: Uncinarias (6,5%), Ascaris lumbricoides (16,3%), Trichuris trichiura (3,4%) y Strongyloides stercoralis (1,2%). Sólo 14 de las 728 embarazadas presentaron infecciones por dos especies de helmintos, mientras que en únicamente tres se encontraron poliinfecciones. Se observó que la edad de las pacientes infectadas con uncinarias era significativamente menor que la de las infectadas con A. lumbricoides. No se encontraron diferencias significativas entre los valores medios de hemoglobina de las mujeres infectadas y las mujeres no infectadas. Sin embargo, el recuento de glóbulos blancos reveló una discreta a moderada eosinofilia en las mujeres con infecciones por helmintos. También se encontró un aumento de la velocidad de sedimentación globular en dichas mujeres. Los resultados de este estudio sugieren que además de la infección por helmintos, otras causas pueden contribuir a la disminución de los valores de hemoglobina en las mujeres embarazadas de nuestra comunidad

Observations of Trichomonas vaginalis infections at the University Teaching Hospital in Calabar, Nigeria.

The pattern of Trichomonas vaginalis infections at the Outpatient Clinic of the University Teaching Hospital in Calabar, Nigeria was determined for the two-year period (January 1981 - December 1982). Of the 5520 patients examined in 1981, T. vaginalis was found in 10 males (0.11%) and 57 females (1.03%). Of the 2511 patients examined in 1982, the parasite was found in 27 males (1.07%) and 31 females (1.20%). A few prepubertal cases were observed. The increasing significance of T. vaginalis as a public health problem in this area is discussed.

A two-year analysis of giardiasis at the University Teaching Hospital in Calabar, Nigeria.

La prevalencia de la giardiasis en el Hospital Docente Universitario de Calabar (HDUC) en Nigeria fue estudiada para el periodo Enero 1981 - Diciembre 1982. De las 5.211 muestras fecales examinadas en 1981, Giardia lamblia fue encontrada en 18 hombres (0,34%) y en 22 mujeres (0,42%).De las 2.325 muestras fecales correspondientes a 1982, el parasito fue visto solamente en las correspondientes a 3 hombres (0,13%) y a 3 mujeres (0,13%). Se discute y se enfatiza la necesidad de programas preventivos mas que de programas curativos en el HDUC, como medidas de salud publica para el control de la giardiasis