Evaluation of convalescent whole blood for treating Ebola Virus Disease in Freetown, Sierra Leone.

BACKGROUND: Convalescent blood therapy has been a promising form of treatment for Ebola Virus Disease (EVD), but less attention has been focused on it for treatment. METHOD: We assessed the effectiveness of convalescent whole blood (CWB) in the treatment of consented EVD patients. We recruited 69 subjects in December 2014 up to April 2015, at the 34 Military Hospital in Wilberforce and the PTS 1 Ebola Treatment Unit in Hastings, Freetown. Forty-four were given CWB, and 25 who consented but preferred to be exempted from the CWB treatment were used to compare clinical outcomes. All were given routine treatment used at the Ebola Treatment Unit. RESULTS: One of 44 subjects treated with CWB dropped out of the study and 31 recovered while 12 succumbed to the disease with a case fatality rate of 27.9%. For the group that was given routine treatment without CWB, 11 died with a case fatality rate of 44%. There was a significant difference between admission viral load and viral load after the first 24 h of treatment with convalescent whole blood (P < 0.01). The odds ratio for survival with CWB was 2.3 (95% CI, 0.8-6.5). CONCLUSION: CWB is promising for treating EVD in resource-poor settings, especially in the early phases of outbreaks when resource-mobilization is done. Even though our sample size was small and the evaluation was not randomised, our results contribute to existing evidence that convalescent whole blood could be considered as a useful candidate for treating EVD. Further studies that are randomised will be required to further assess the efficacy of CWB as treatment option during any EVD outbreak.

Human energy expenditure in lowland rice cultivation in Malaysia.

A study was undertaken to evaluate the human energy consumption of various field operations involved in lowland rice cultivation in Malaysia. Based on recorded average heart rates, fertilizing was found to be the most strenuous operation, with an average heart rate of 138 beats min(-1). There were no significant differences in the average heart rates of the subjects among the individual tasks within the first plowing, second plowing, and harvesting operations, with the average heart rates for these three tasks being 116, 106, and 106 beats min(-1), respectively. The corresponding energy expenditures were 3.90, 3.43, and 3.35 kcal min(-1). Loading the seed into the blower tank and broadcasting the seed were the most critical tasks for the seed broadcasting operation, with average heart rates of 124 and 136 beats min(-1), respectively. The highest energy expenditure of 418.38 kcal ha(-1) was observed for seed broadcasting, and the lowest energy expenditure of 127.96 kcal ha(-1) was for second plowing. The total seasonal human energy expenditure for rice cultivation was estimated to be 5810.71 kcal ha(-1), 55.7% of which was spent on pesticide spraying. Although the sample size in this study was relatively small, the results indicated that human energy expenditure per unit area (kcal ha(-1)) was positively linked to the average heart rate of the subjects and negatively linked to the field capacity. Thus, mechanization of certain tasks could decrease worker physical effort and fatigue and increase production.

Sero-prevalence of hepatitis B virus among middle to high socio-economic antenatal population in Sierra Leone.

This study was designed in order to find out the prevalence of HBV markers amongst pregnant women of middle and high socio-economic class in Sierra Leone. The aim was to determine the necessity and likely benefits of a scheme aimed at the vaccination of children of seropositive mothers who can afford the cost until mass immunisation is possible. A total of 302 women were studied. The seroprevalence rate formed in this study population was 6.2%. The proposed intervention would markedly reduce the HBV status in Sierra Leone, taking into account the high prevalent rate amongst this group. The low anti-HBs found in this population was suprisingly (5.1%); considering the high degree of antigenemia, this should be a subject for future research.

Normal haematological values in adult Sierra Leonean males in Freetown.

In this study, we determined normal values for some haematological parameters in male Sierra Leoneans--Haemaglobin concentration (HB), Packed Cell Volume (PCV), White Blood Cell Count (WBC), Red Blood Cell Count (RCC) and Erythrocyte Sedimentation rate (ESR). The result obtained differ significantly from those found in European text books as normal values for these parameters. We recommend that results obtained from this study replace European reference values for male Sierra Leoneans.

Effects of mutations in the human uncoupling protein 3 gene on the respiratory quotient and fat oxidation in severe obesity and type 2 diabetes.

Human uncoupling protein 3 (UCP3) is a mitochondrial transmembrane carrier that uncouples oxidative ATP phosphorylation. With the capacity to participate in thermogenesis and energy balance, UCP3 is an important obesity candidate gene. A missense polymorphism in exon 3 (V102I) was identified in an obese and diabetic proband. A mutation introducing a stop codon in exon 4 (R143X) and a terminal polymorphism in the splice donor junction of exon 6 were also identified in a compound heterozygote that was morbidly obese and diabetic. Allele frequencies of the exon 3 and exon 6 splice junction polymorphisms were determined and found to be similar in Gullah-speaking African Americans and the Mende tribe of Sierra Leone, but absent in Caucasians. Moreover, in exon 6-splice donor heterozygotes, basal fat oxidation rates were reduced by 50%, and the respiratory quotient was markedly increased compared with wild-type individuals, implicating a role for UCP3 in metabolic fuel partitioning.

The prevalence of sickle cell trait in Sierra Leone. A laboratory profile.

Three thousand five hundred and twenty four (1527 male and 1997 female) samples were screened for the presence of the abnormal haemoglobin--Sickle Cell (HbS) between 1990-1993. 780 (22%) of these show sickle erythrocytes in a reduced oxygen environment. Electrophoretic differentiation of 344 samples positive from the metabisulphite screening test, revealed that 76 are of the homozygous form with 3 being HbSC. Noting the adverse consequences on the health status of those affected and the expense involved in the management of such patients, there is an urgent need for intervention.

Platelet counts in healthy adult Sierra Leoneans.

The platelet counts of 100 healthy Sierra Leoneans were determined. Fifty six (56) Males and Forty four (44) Females were included in the study. The mean platelet count was 197 x 10(9)/L(SD = 25 x 10(9)/L Range = 115-335 x 10(9)/L The results of this study compare favourably with those obtained from previous studies in other African Countries and confirms that the normal platelet count in the African is lower than in Caucasians.

Chronic leg ulcers in sickle cell disease: experience in Ibadan, Nigeria.

The prevalence of chronic leg ulcers was investigated in 872 adults with sickle cell disease (SCD) (630 HbSS and 242 HbSC) at Ibadan, Nigeria. The incidence was 7.5% in HbSS and 1.7% in HbSC patients. The sex ratio in HbSS was 2:1 in favour of males, and three of the four HbSC were females. Ulcers were sited around the ankles in more than 70% of the patients. The duration of the ulcers varied from less than 1 year to more than 20 years. There was no bias for social class. Response to therapy, including autologous skin graft, was poor.

Changing patterns of acute lymphoblastic leukaemia in Nigeria.

An increase in the number of Nigerian patients with acute lymphoblastic leukaemia (ALL), relative to those having acute myelogenous leukaemia, was predicted some years ago. This was expected to result from an enhanced socio-economic status of most members of the general population and improved nutrition. A review of the features of ALL patients seen in University College Hospital, Ibadan, during different periods over the past three decades revealed not only the predicted changes but also an increasing proportion of pediatric and female patients. Except for an unusual number of patients with the rare L3 morphological variant seen within the last 2 years, little else changed in the clinical and laboratory features of the disease. Atrophy of the thymus resulting from malnutrition is thought to inhibit the occurrence of common-ALL in the first decade of life. This inhibition is removed by improved nutrition, thus allowing more cases of common-ALL to develop in children. The trend in Nigeria has been observed earlier among Arabs in the Gaza Strip in the Sinai Peninsula. If the hypothesis is correct, undernutrition occurring for a long enough time in a previously well-nourished population should lead to changes opposite to those observed. The increasing percentage of patients who are either young, female or of high socio-economic class imply better prognosis for more Nigerian ALL patients.