Erythropoietic Response to Anaemia of Dialysis Naïve Patients with Chronic Kidney Disease in Zaria, North-West Nigeria.

INTRODUCTION: Chronic kidney disease (CKD) is a global health problem with an increasing prevalence worldwide. Anemia is one of its consistent and severe hematological complications although its mechanism is not fully elucidated. The primary defect could manifest as serum erythropoietin (sEPO) deficiency or EPO resistance. We set out to determine the erythropoietic response to anemia of patients with CKD and its relationship with their iron status in a cross-sectional descriptive study of 91 patients in various stages of CKD. Materials and Methods: Soluble transferrin receptor (sTfR), sEpo, and serum ferritin levels were determined using ELISA method (Diagnostic Automation Inc and WKEA med supplies corp.). Data generated were analyzed using Epi Info version 3.5.3 and level of statistical significance was set at ≤0.05. Results: Participants comprised of 50 females (54.9%) and 41 (45.1%) males with an overall mean age of 47 ± 15 years. The major causes of CKD were hypertension (HTN) (50.54%), diabetes mellitus (DM) (6.59%), and HTN + DM (19.78%). The mean hemoglobin (Hb) concentration of the participants was 10.97 ± 2.28 g/dl; the red cell indices were within normal ranges except for Red cell distribution width-Coefficient of variation (%) which was elevated (16.29%). The mean serum ferritin, sTfR, and sEpo were 70.58 ± 46.44 ng/ml (interquartile range [IQR] 82.00), 22.9 ± 49.7 ng/ml (IQR 15.00), and 12.49 ± 33.47 IU/L (IQR 6.00), respectively, with a high variance. Serum ferritin and sTfR are consistently low across the stages of CKD (range between 54.54 ng/ml and 88.64 ng/ml), but sEPO for stage 3 and 4 showed a 2-fold increase when compared to normal level at Hb 10.97 g/dl (29.54 IU/L and 38.83 IU/L, respectively). Correlation between sTfR and sEpo (r2 = 0.96, P = 0.001), while between sEpo and serum ferritin (r2 = 0.02, P = 0.185), and between Hb and stage of CKD undulating (r2 = 0.41, P = 0.001). CONCLUSION: In contrast to some existing literature, this study has demonstrated that EPO resistance and iron deficiency contributes to anemia in CKD and serum ferritin can be used to assess the iron level of dialysis naïve CKD patients at every stage of the disease.

Protein C and antithrombin levels in patients with sickle cell anemia in Ahmadu Bello University Teaching Hospital Zaria, Nigeria.

BACKGROUND: Alterations in the components of hemostasis, namely platelet function, the procoagulant, anticoagulant, and the fibrinolytic systems, are observed in sickle cell anemia (SCA) and are in favor of a procoagulant phenotype. Therefore, study of protein C and antithrombin (AT) levels in patients with SCA in steady state may be used in the treatment and/or prevention of SCA-related thrombotic complications. We studied the changes of these naturally occurring anticoagulants in patients with SCA attending the sickle cell clinic in Ahmadu Bello University Teaching Hospital, Zaria. METHODS: We conducted a case-control study involving 50 SCA (HbSS) patients in the steady state as cases and 25 healthy volunteers with normal hemoglobin (HbAA) as controls. Protein C and AT levels were estimated by semi-automation using Diagnostica Stago hematology coagulation analyzer. Frequencies, proportions, and independent t test were performed using SPSS version 20. RESULTS: The mean ages of both the patients and controls were 23.80 ± 7.46 and 24.28 ± 3.48 years, respectively, and study participants comprised 40 (53.0%) women between the ages of 15-50 years and 15-34 years (P = 0.76). The mean values of protein C and AT levels in patients with SCA in the steady state and the control group were 60.26 ± 20.58% versus 81.30 ± 19.74%, 95% CI 11.13-30.96, and 42.11 ± 5.01% versus 61.88 ± 11.27%, 95% CI 16.03-23.51 with P values (P < 0.001), respectively. CONCLUSIONS: This study showed that there was a significant decrease in the levels of protein C and AT between the SCA patients in the steady state and the controls. We recommend baseline investigations of these naturally occurring anticoagulants in patients with SCA, especially in those with frequent vaso-occlusive crises. This will give us an insight into the additional pathophysiologic mechanism in SCA-related thrombotic complications for better patient management and outcome.

The frequency and outcome of neuropathies among HIV/AIDS adults treated at a tertiary hospital in Kaduna State, Nigeria.

AIMS AND OBJECTIVES: Highly active antiretroviral therapy (HAART) has been shown to reduce AIDS- defining illnesses, including neuropathies. However, it has been postulated that an increase in age -, HIV- and HAART- related neurological complications will occur as HIV-infected persons live longer. This study investigated the frequency and outcome of neuropathies in relation to CD4+ cell count and HAART status of hospitalised HIV/AIDS patients in Shika. PATIENTS AND METHODS: Consecutive adult (e"15 years) non pregnant HIV- infected patients treated at Ahmadu Bello University Teaching Hospital Shika-Zaria from January 2006 to May 2013 with neuropathies were studied. Non HIV-infected patients with neurological disorders and HIV-infected patients without neuropathies were excluded. RESULTS: Of 5240 HIV/AIDS patients seen , 11% (566) presented with neuropathy at median CD4+ cell counts of 200 cells / ul, with yearly reduction of the frequency of patients with neuropathy from 3.9% in 2006 to 0.06% in 2013. Male: female ratio was 2:1 and respective mean years were 41.9±10.1: 45.3±17.4 (p<0.00). 253 (45%) were on HAART at presentation. 40 patients died and the mortality was associated with recurrent seizures, CD4+ cell counts d" 100 / ul, male sex, HAART-naivety and presence of co-morbidity and complications. CONCLUSIONS: The progressive reduction in the yearly frequency of neuropathy among HIV/AIDS patients suggests a beneficial effect of HAART on neuropathies. However, late presentation, low CD4+ cell counts and failure of patients to start HAART early were responsible for AIDS-related mortality thus highlighting the importance of early HIV screening and treatment.

Challenges of HIV treatment in resource-poor countries: a review.

BACKGROUND: The human immunodeficiency virus/acquired immunodeficiency syndrome pandemic have posed a significant public health challenge to the global community. Massive therapeutic interventions with antiretroviral drugs are being undertaken, yet problems and challenges exist. This review examines these problems and challenges as they affect the treatment of HIV infection in resource-poor countries such as Nigeria. METHODS: The information was sourced from relevant literature using human immunodeficiency virus/acquired immunodeficiency syndrome journals, textbooks and Websites on human immunodeficiency virus/acquired immunodeficiency syndrome, highly active antiretroviral therapy, resource-poor countries as key words. RESULTS: Several studies have shown that the advent of highly active antiretroviral therapy in 1996 has significantly reduced morbidity and mortality among people living with HIV/AIDS (PLWHA). But in resource-poor countries, initiation and maintenance of highly active antiretroviral therapy has been associated with many challenges and problems such as: poor infrastructural base for the control programs; irregular or non availability of drugs; poor drug adherence; co-morbidities and opportunistic infections/malignancies; drug toxicities; drug/food and drug/drug interactions; laboratory monitoring of viral load; CD4 cell counts; full blood counts; electrolytes, kidney and liver functions. CONCLUSION: The review has shown that the solution to the pandemic lies in a multi-sectoral and holistic approach involving International and local agencies, and communities.

Seroprevalence of hepatitis C virus antibodies amongst blood donors in Ahmadu Bello University Teaching Hospital (ABUTH) Kaduna

Background: Hepatitis C virus (HCV) is one of the most common transfusion transmissible infections hence the introduction of routine screening for its antibodies in blood donors in most blood banks. Methods: This was a retrospective study in which the blood donor screening register for all intending donors were reviewed and analyzed. Results: There were 4;731 potential donors with age range 20-41years. Eighty six (1.8) were sero-positive to HCV antibodies with a decreasing incidence over the period under review. The highest incidence was recorded the age group 31-40 years. Aim: To determine the sero-prevalence of HCV among blood donors in ABUTH Kaduna. Conclusion: HCV infection is not uncommon in our environment hence the need to emphasize it's routine screening among all potential donors