Low rate of proteinuria in hypertensives resident in a rural area of Plateau State, Nigeria.

BACKGROUND: Hypertensives are screened for proteinuria largely to detect kidney involvement. In most reports from urban areas, the burden is considerable. We decided to see the scenario in a rural setting with the opportunity presented by our cardiovascular disease (CVD) survey of a rural area in North Central Nigeria. METHODOLOGY: In 2008 we surveyed a rural population in Mangu Local Government area of Plateau State for CVD risk factors using the protocol of the National survey of 1991; slightly modified. One in three subjects was sequentially randomized to have blood and urine examination. Blood tests included glucose, creatinine, uric acid, total and high density lipoprotein cholesterol. Blood pressures were also taken. RESULTS: Blood and urine tests were done on 282 subjects. Eight of them (2.84%) had proteinuria. Ninety-nine of the 282 (35.11%) were hypertensive. Seven out of the 99 hypertensives (7.07%) had proteinuria. Between those hypertensives (positive or negative for proteinuria), the following indices: glucose, HDL cholesterol, SBP and DBP differed significantly (p = 0.000, p = 0.015, p = 0.000, p = 0.000 respectively). CONCLUSION: Compared with rates in urban centres of Nigeria, our population recorded low proteinuria rates both for the whole population and the hypertensive segment. It therefore appears that proteinuria in hypertension is not only a reflection of severity and burden of hypertension, but has some relation with residence. Rural areas have lower constellation of CVD risk factor (due to different life style) and lower incidence of hypertension. Consequently, their proteinuria rates are low.

Cardiovascular epidemiological transition in a rural habitat of Nigeria: the case of mangu local government area.

BACKGROUND: Epidemiological transition is at various stages in different places. The true situation in sub-Saharan Africa (SSA) is largely unknown. Having studied this rural habitat 17 years ago, we returned there to study several cardiovascular disease (CVD) risk factors to see if any change had occurred. METHODS: The communities studied in 1991 as part of the national CVD survey were returned to in 2008 and re-studied descriptively in a cross-sectional manner. All adults 15 years and above, apart from demographic and personal data had blood pressure (BP) and some blood indices determined. RESULTS: Over the period, some changes occurred. The mean (SD) age increased from 34.1(16.9) to 45.5(18.2) years suggesting an ageing population. More people in 2008 than 1991 lived most of their last 5 years in the urban areas suggesting some influence of urbanisation. Significantly fewer people smoked and drank after 17 years. However mean (SD) of Body Mass Index rose [20.7(2.8) to 23.7(4.5) kg/m²], as well as SBP and DBP. Prevalence of hypertension rose from 7.4% to 20.9%. Both total and HDL cholesterol rose, although atherogenic index dropped. Mean (SD) blood sugar interestingly dropped from 5.0(2.9) to 4.6(1.0) mmol/l. CONCLUSION: Epidemiological transition is evident in this rural SSA habitat, and proactive steps to stem the tide and curb the consequences of CVD should be instituted.

The seroprevalence of cytomegalovirus antibodies among prospective blood donors in Jos.

BACKGROUND: Human cytomegalovirus, otherwise called human herpes virus type 5, is a significant cause of morbidity and mortality in pregnancy, and among immunocompromised patients like recipients of organ transplants. Cytomegalovirus is transmissible via blood transfusion, among other parenteral routes. This study therefore aims at establishing the seroprevalence of CMV antibodies among prospective blood donors in Jos. This is with a view to making recommendations on donor screening and transfusion protocols among susceptible patients. METHODS: A total of 200 prospective blood donors were recruited into the study. Screening for CMV antibodies was done using ELISA kit, manufactured by "DIALAB", Austria (www.dialb.at). RESULTS: Of the 200 prospective blood donors analysed, 184 donors were found to be positive for cytomegalovirus antibodies, representing a prevalence rate of 92%. The peak age prevalence was in the 25-29 years age range, representing 30.4%. Cytomegalovirus prevalence was lowest in the 15-19 years age range and above 50 years (1.6% each). CONCLUSION: A cytomegalovirus antibody prevalence rate of 92% indicates that screening for CMV should be included in screening algorithm for potentially susceptible recipients of blood and its products. Non infected susceptible persons should be transfused CMV negative orleucocyte depleted blood and blood products.

Glucose-6-phosphate dehydrogenase (G6PD) activity and deficiency in a population of Nigerian males resident in Jos.

The activity of red blood cell Glucose 6-phosphate dehydrogenase (G6PD) in one hundred and twenty six healthy male individuals who are Nigerians residing in Jos was evaluated. The enzyme activity was determined quantitatively by spectrophotometer assay method. The activity of red cell G6PD enzyme was subnormal in 20 % of the population studied. This agrees with previous report of the prevalence of G6PD deficiency in Nigerian males from the Western region of the country which is between 20 and 26 %of the population. The proportion of Nigerian males with subnormal G6PD activity is relatively constant irrespective of their geographical location.

Neurological complications of chronic myeloid leukaemia: any cure?

OBJECTIVE: To attempt to explain the non-reversal, contrary to the widely held view, of the neurological deficits complicating chronic myeloid leukaemia. METHOD: Using patients' case folders and haematological malignancy register all cases of chronic myeloid leukaemia seen in Jos University Teaching Hospital between July 1995 and June 2005 were retrospectively studied. All the available literature on the subject was also reviewed. RESULTS: Thirty-three cases of chronic myeloid leukaemia were seen within the study period. Five (15.15%) of them had one or more sensori-neural defects. Of the five, two (40%) patients presented with bilateral hearing impairment, each beginning with the left ear; one (20%) presented with left ear hearing loss; one (20%) came with severe left ear tinnitus; one (20%) presented with complete bilateral hearing and bilateral visual losses. Fundoscopy showed leukaemic deposits on the retina. Other causes of blindness and deafness, e.g. trauma and foreign body in the ear respectively, were excluded. CONCLUSION: While the complications due to hyperleucocytosis-induced stasis recover following the conventional treatment, those due to other pathogenetic mechanisms such as leukaemic deposits do not return to their pre-morbid states following disease control despite the use of the currently available treatment protocols. For future research, more still needs to be done to elicit other uncommon pathogenetic mechanisms underlying these complications with a view to finding specific treatment measures for worrisome chronic myeloid leukaemia-related sensori-neural deficits.

Paediatric malignancies

This study aims to describe the pattern of paediatric malignancies in a tertiary hospital in North Eastern Nigeria. This was a retrospective study of all paediatric malignancies diagnosed between June 2000 and May 2006 at the Federal Medical Centre; Gombe; Nigeria. Data were collected from the histopathology and haematology registers; as well as patients' case files and were analyzed. A total of 3;313 children were admitted within the study period. Out of this; 68(2.05) children aged less than 15 years (M:F=1:1) had histologically confirmed malignancies. Malignant lymphomas were the most common (42.65) of all the childhood malignancies; with Burkitt's lymphoma ranking highest (68.97). Burkitt's lymphoma also accounted for 29.41of all the malignancies. Other common malignancies included sarcomas 10(14.71); neurofibromatosis 9(13.24); nephroblastoma 8(11.77); acute lymphoblastic leukaemia 5(7.35) and retinoblastoma 4(5.88). The less common paediatric malignancies were melanoma; invasive lobular breast carcinoma and squamous cell carcinoma of the breast; which together accounted for 4.41. Burkitt's lymphoma is the most frequently diagnosed malignant neoplasm in children at the Federal Medical Centre; Gombe

Osteonecrosis complicating chronic myeloid leukaemia.

BACKGROUND: There are previous reports of osteonecrosis among Nigerians with sickle cell diseases and some other medical conditions. To the best of the authors' knowledge there is, however, no known such report attributed to chronic myeloid leukaemia, especially in Nigeria. Apart from presenting this as the first report, it is also to emphasize the need for early full blood count in persons presenting with otherwise non-haematological condition. METHOD: The case note of the patient and the available literature on the subject were used. RESULT: The 15-year-old girl who presented with a fifteen-month history of right hip joint pain and progressive abdominal swelling with weight loss for five months was found to have chronic myeloid leukaemia and avascular necrosis of the right femoral head. Her gait and walk improved remarkably within two weeks of commencing cytoreductive therapy. However, she still uses crutches due to the extensive bone damage from the prolonged impaired blood supply caused by chronic myeloid leukaemia before presentation. CONCLUSION: Osteonecrosis of the femoral head can complicate chronic myeloid leukaemia from hyperviscosity-induced leucostasis. Early simple peripheral blood examination in diseases presenting with otherwise non-haematological symptoms will reduce, if not prevent, severe complications of diseases.

Which babies get blood in Jos, Nigeria?

Documentation of the transfusion needs of neonatal units is required to guide blood banks in meeting demands. A prospective observational study of newborn transfusions over 35 weeks was conducted. Eighty-four transfusions were conducted in 62 of 377 (16.45%) admitted infants in 35 weeks. Neonatal jaundice (57.2%) and anemia (38.1%) were main indications. In 85.7% cases, blood transfused was < 3 days old. Weight of infants at transfusion was < 2500 g in 51.6% cases. Infants were first transfused at < 7 days in 59.7% cases. Whole blood was used in 64.3% of all cases. Overall transfusion rate was 2.4/week. Neonatal jaundice is the commonest indication for transfusion and whole blood is in greater demand.

S6 kinase p90rsk in granulocyte-macrophage colony-stimulating factor-stimulated proliferative and mature hematopoietic cells.

The ribosomal S6 kinase p90(rsk) was studied in mature and proliferating hemopoietic cells in response to the human cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF). In neutrophils, GM-CSF induced time-dependent electrophoretic mobility shifts in immunoreactive p90(rsk). Although these shifts suggested changes in the phosphorylation status of the molecule, a kinase assay with whole cell lysates detected minimal (1.5-fold) increments in enzymatic activity. Only immunoprecipitation followed by immune complex kinase assay or in-gel kinase assay performed against the RSK substrate RRLSSLRA evidenced an increase in p90(rsk) activity (3.4-fold). p90(rsk) was also detected in the GM-CSF-dependent erythroleukemia cell line TF-1. Normally cultured, cytokine-supplemented cells did not respond to further GM-CSF stimulation. However, the activity of p90(rsk) in cytokine-starved cells increased dramatically in response to short term GM-CSF challenge. This effect was readily observable in total cell lysates (6.6-fold increase over controls) and was paralleled by changes in mitogen-activated protein kinase activity (a substrate of p90(rsk)). Thus, p90(rsk) is present in mature hemopoietic cells, but the extent of the enzymatic response to GM-CSF is significantly lower than that seen in proliferative cells.