Evaluating the effect of antidiabetic treatment on haemostatic and fibrinolytic parameters among type 2 diabetics in Ilorin, Nigeria

Background:Type 2 Diabetes Mellitus is a disease of epidemic proportions and many patients are at a great risk of premature mortality and complication of atherothrombotic disorders affecting coronary, cerebral and peripheral arterial trees. Increased Plasminogen Activator Inhibitor Type 1 inhibits fibrinolysis and predicts cardiovascular risk in those living with Type 2 Diabetes. This study aimed to determine the effect of antidiabetic treatment on haemostatic and fibrinolytic parameters among Type 2 Diabetic subjects in Ilorin.Methods:This was a comparative cross-sectional study involving 78 Type 2 diabetic patients, (39 treatment naïve, 39 treatment experienced). Full blood count was performed using Sysmex XP300 while Prothrombin time was determined using one stage test of Owren. Activated partial thromboplastin time was determined by method of Proctor and Rapaport. Fibrinogen and Plasminogen Activator Inhibitor type-1 were assayed using AssayMax Human Fibrinogen ELISAand AssayMax Human PAI-1 ELISAkit. Data Analysis was done using SPSS version 25.0.Results:Mean PAI-1 levels were significantly higher in treatment naïve diabetics when compared to treatment experienced diabetics (2.44 ±2.57 vs 2.51±1.47 ng/ml p=0.002) as were fibrinogen levels (434.65±366.15 vs 482.24± 299.64mg /dl; p = 0.048). PAI -1 levels were lowest among diabetics treated with Metformin + DPP4 inhibitors, while fibrinogen levels were lowest among those treated with Metformin + sulfonylurea combination.Conclusion:Oral hypoglycaemic treatment, combination therapy in particular, improves fibrinolysis in type 2 diabetics thereby reducing the risk of cardiovascular disease in type 2 diabetes mellitus patients

Normal CD4 Count Range among Healthy Nigerian Population in Ilorin.

BACKGROUND: For the establishment and monitoring of the immune status, CD4 count is critical. OBJECTIVES: To determine the CD4 count range of apparently healthy Nigerians resident in Ilorin and compare with the national value. METHODS: An automated blood analyzer was used to determine the full blood count and CD4 count. The percentage of CD4 count was derived by using other variables. RESULTS: Of the 1205 participants, the reference CD4 count (percentage of CD4) range for adult was 400 to 1288 cells/mm3 (19%-48%) and for children was 582 to 3652 cells/mm3 (17%-50%). CD4 count and percentage of CD4 were significantly ( P = .001) higher in females than in males, and the CD4 count declined significantly with increasing age ( r = -.174, P ≤ .0001). The percentage of CD4 count shows less variation with age ( r = -.051, P = .076). Adult residents of Ilorin had significantly lower absolute mean CD4 count (808 ± 260) than that of the national reference values of 847.0 ± 307.0 cells/mm3 ( P = .001). CONCLUSION: We therefore advocate the use of CD4 count range derived in this study is lower than that of the national reference values.

Effect of Hepatitis B Virus Co-Infection on CD4 Cell Count and Liver Function of HIV Infected Patients.

BACKGROUND: Human immunodeficiency virus (HIV) and Hepatitis B virus (HBV) share similar routes of transmission, making it possible for an individual to have a co-infection. HBV infection is well known to be a major cause of chronic liver diseases worldwide. The aim of this study was to determine the prevalence of HBV infection among HIV infected HAART naïve patients and investigate the effect of co-infection on CD4 count and liver function. STUDY DESIGN: This was a hospital based descriptive cross sectional study of one hundred consecutive therapy-naive HIV-infected individuals. The CD4 count, Hepatitis B surface antigen, Serum albumin, total Protein, and liver enzymes were determined using standard techniques. RESULTS: The prevalence of HIV and HBV co-infection was 37%. The mean serum ALT and ALP were significantly higher in the co- infected patients (P-values <0.05). The mean CD4 count of the mono infected patients was significantly higher (p-value of 0.014). The mean serum ALT, AST and ALP of mono and co-infected patients with CD4 count<200/µl were significantly higher than those with count ≥ 200 cells/µl. (p-value of <0.01). The mean ALT and AST of the co-infected patients and all patients with CD4 count <200 cells/µl were higher than the normal reference range. CONCLUSION: Approximately one third of HIV positive patients had hepatitis B virus co-infection. Co-infection and CD4 count <200 cells/µl are likely to result in abnormal ALT and AST. We recommend that co-infected patients and those with CD4 count <200 cells/µl should be given non-hepatotoxic antiretroviral drug.

Coagulation profile in severe pre-eclampsia and eclampsia in Ilorin, Nigeria: implications for anaesthetic management in operative obstetrics.

BACKGROUND: Severe preeclampsia and eclampsia are associated with coagulopathy which may be a contraindication to central neural axial blockade for caesarean section. Many investigations of bleeding tendencies are not done in our environment because of logistic reasons and emergency presentations of these patients.The study was designed to determine the coagulation profile of severe preeclamptic and eclamptic women in labour and possibly arrive at affordable and readily available investigation(s) that can be used in excluding bleeding tendencies in these patients. STUDY DESIGN: In a prospective study, 50 severely preeclamptic/eclamptic patients in labour and, 50 parturients with normal pregnancies, and, in labour were recruited. Full blood count including platelet count, prothrombin time (PT) using the International Normalized Ratio (INR) and partial thromboplastin time with kaolin (PTTK) were done in all the patients. RESULTS: Mean platelet count was significantly lower in study patients than in controls, 158.1 × 10(9)/l versus 216.9 × 10(9)/l, p = 0.0001. Mean INR and PTTK were within the reference values for the reagents used but mean INR was significantly greater in cases than in controls, 1.06 ± 0.01 versus 0.92 ± 0.01 (p = 0.001) while PTTK was also significantly longer in cases than in controls, 38.4 ± 0.21 versus 34.3 ± 0.44 seconds (p = 0.002). CONCLUSION: As platelet count can be readily obtained and it is affordable in our environment, it can be used in assessing bleeding tendencies in these patients for their effective management.

Pre-donation screening of blood for transfusion transmissible infections: the gains and the pains - experience at a resource limited blood bank.

OBJECTIVE: To determine whether or not pre-donation testing of blood donors affords substantial cost savings without compromise to blood transfusion safety. Pre-donation testing of blood donors for Transfusion Transmissible Infections (TTIs) is done in most developing countries because substantial cost savings are made from resources, materials and man-hours which would have been spent to procure infected blood units. Simple rapid test kits used in pre-donation testing is not as sensitive as the Enzyme Linked Immuno-sorbent Assay (ELISA) method used in post-donation screening in a quality assured manner. DESIGN: It is a retrospective study where records of pre- and post-donation tests done in donor clinic of University of Ilorin Teaching Hospital, between January and December 2010 were retrieved. All processes and inputs were evaluated and costs calculated for pre-donation testing by simple rapid techniques and post donation screening by ELISA. RESULTS: 5000 prospective donors were tested in the study period. The cost of single rapid Pre-donation testing was less than that of single ELISA Post-donation screen. The cost of double rapid Pre-donation and Post donation ELISA screen exceeded the cost of single post donation ELISA screen. Substantial cost savings were made when single rapid Pre-donation testing is relied on. More blood units were found reactive for the TTIs with the more expensive Post-donation ELISA. CONCLUSION: Pre-donation testing of blood donors was not cost effective. Although, there is an apparent savings if pre-donation testing is not followed by post-donation ELISA testing, it is done at a compromise to blood transfusion safety.

Effect of hepatitis-B virus co-infection on CD4 cell count and liver function of HIV infected patients.

BACKGROUND: Human immunodeficiency virus (HIV) and Hepatitis B virus (HBV) share similar routes of transmission making it possible for an individual to have a co-infection. HBV infection is well known to be a major cause of chronic liver diseases worldwide. The aim of this study was to determine the prevalence of HBV infection among HIV infected HAART naïve patients and investigate the effect of co-infection on CD4 count and liver function. STUDY DESIGN: This was a hospital based descriptive cross sectional study of one hundred consecutive therapy-naive HIV-infected individuals. The CD4 count, Hepatitis B surface antigen. Serum albumin, total Protein, and liver enzymes were determined using standard techniques. RESULTS: The prevalence of HIV and HBV co-infection was 37%. The mean serum ALT and ALP were significantly higher in the co-infected patients (P-values <0.05). The mean CD4 count of the mono infected patients was significantly higher (p-value of 0.014). The mean serum ALT, AST and ALP of mono and coinfected patients with CD4 count<200/µl were significantly higher than those with count ≥ 200 cells/µl. (p-value of <0.01). The mean ALT and AST of the co infected patients and all patients with CD4 count <200 cells/µl were higher than the normal reference range. CONCLUSION: Approximately one third of HIV positive patients had hepatitis B virus co-infection. Co-infection and CD4 count <200 cells/µl are likely to result in abnormal ALT and AST. We recommend those co-infected patients and those with CD4 count <200 cells/µl should be given non-hepatotoxic antiretroviral drug.

RISK FACTORS AND SERO-PREVALENCE OF HEPATITIS B SURFACE ANTIGEN AMONG BLOOD DONORS IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN, NIGERIA.

BACKGROUND: Availability of safe blood and blood products for transfusion is increasingly difficult globally, especially in developing countries because of high prevalence of Transfusion Transmissible Infections. OBJECTIVES: To determine the prevalence of HBsAg among blood donors and to evaluate the socio-economic, demographic and medical factors associated with its infection. DESIGN: A prospective study. SUBJECTS: Three hundred and fifty consecutive blood donors were recruited. 2 ml of venous blood was collected aseptically from the ante-cubital vein and subjected to serological test for HBsAg. RESULTS: High prevalence rate 10.9% was recorded. All the donors reactive to HBsAg were males (38,100%) with a mean age of 30.7 ± 8.02 years, while 55.3%, 44.7%, 5.3%, 42%, 47.4%, 5.3% of them were single, married, primary school graduate, secondary school graduate, tertiary school graduate and illiterate respectively with 36.8%, 23.7%, 39.5% and 0% been unemployed, civil servants/professionals, skilled artisans and business/petty traders. The most common risk factor was multiple sexual partners 55.3%, followed by extra marital affairs 13.2%, tattooing 10.5%, previous blood transfusion 5.2%, previous surgery 2.6% and sex trading 2.6%. CONCLUSION: Active public enlightenment programmes and strict blood donation selection criteria need to be put in place in order to provide safe blood and blood products for transfusion.

Pre-Donation Screening of Blood for Transfusion Transmissible Infections: The Gains and the Pains - Experience at a Resource Limited Blood Bank

Objective: To determine whether or not pre-donation testing of blood donors affords substantial cost savings without compromise to blood transfusion safety. Predonation testing of blood donors for Transfusion Transmissible Infections (TTIs) is done in most developing countries because substantial cost savings are made from resources; materials and man-hours which would have been spent to procure infected blood units. Simple rapid test kits used in pre-donation testing is not as sensitive as the Enzyme Linked Immuno-sorbent Assay (ELISA) method used in post-donation screening in a quality assured manner. Design: It is a retrospective study where records of pre- and post-donation tests done in donor clinic of University of Ilorin Teaching Hospital; between January and December 2010 were retrieved. All processes and inputs were evaluated and costs calculated for predonation testing by simple rapid techniques and post donation screening by ELISA. Results: 5000 prospective donors were tested in the study period. The cost of single rapid Pre-donation testing was less than that of single ELISA Postdonation screen. The cost of double rapid Pre-donation and Post donation ELISA screen exceeded the cost of single post donation ELISA screen. Substantial cost savings were made when single rapid Pre-donation testing is relied on. More blood units were found reactive for the TTIs with the more expensive Postdonation ELISA. Conclusion: Pre-donation testing of blood donors was not cost effective. Although; there is an apparent savings if pre-donation testing is not followed by postdonation ELISA testing; it is done at a compromise to blood transfusion safety

Effect of Hepatitis B Virus Co-Infection on CD4 Cell Count and Liver Function of HIV Infected Patients

Background: Human immunodeficiency virus (HIV)and Hepatitis B virus (HBV) share similar routes of transmission; making it possible for an individual to have a co-infection. HBV infection is well known to be a major cause of chronic liver diseases worldwide. The aim of this study was to determine the prevalence of HBV infection among HIV infected HAART naive patients and investigate the effect of co-infection on CD4 count and liver function. Study design: This was a hospital based descriptive cross sectional study of one hundred consecutive therapy-naive HIV-infected individuals. The CD4 count; Hepatitis B surface antigen; Serum albumin; total Protein; and liver enzymes were determined using standard techniques. Results:The prevalence of HIV and HBV co-infection was 37. The mean serum ALT and ALP were significantly higher in the co- infected patients (Pvalues 0.05). The mean CD4 count of the mono infected patients was significantly higher (p-value of 0.014). The mean serum ALT; AST and ALP of mono and co-infected patients with CD4 count200/?l were significantly higher than those with count ? 200 cells/?l. (p-value of 0.01). The mean ALT and AST of the co -infected patients and all patients with CD4 count 200 cells/?l were higher than the normal reference range. Conclusion : Approximately one third of HIV positive patients had hepatitis B virus co-infection. Coinfection and CD4 count 200 cells/?l are likely to result in abnormal ALT and AST. We recommend that co-infected patients and those with CD4 count 200 cells/?l should be given non-hepatotoxic antiretroviral drug

Sero-prevalence of syphilis among patients with mental illness: comparison with blood donors.

BACKGROUND: Mentally ill individuals (MII) are at risk of acquiring syphilis and other sexually transmitted infections. This study aimed at determining sero-prevalence of syphilis among MII and compare them with voluntary blood donors (VBD) at University of Ilorin Teaching Hospital (UITH), Nigeria. METHODS: A cross-sectional study done between June, 2010 and June 2011, and involving 350 each of VBDs and MII in and out-patients of UITH. Serological test was done using venereal disease research laboratory (VDRL) and the Treponema Pallidum Haemagglutination (TPHA) kit. RESULTS: Of the 700 subjects, 324 (92.6%) MII, and 349 (99.7%) VBDs were <55 years; 71 (21.4%) MII were Civil Servants compared with 96 (27.4%) VBDs. Significantly more VBDs had higher education than MII (185 or 52.9%, and 140 or 40% respectively). Christians constituted the majority (176 or 50.3%) among MII, and Muslims (210 or 60%) among VBDs. Significantly more married VBDs (204/206 or 99.0%) live with spouses; more VBDs consumed alcohol (37 or 10.6%), smoked (19 or 5.4%), and engaged in extramarital sex (105 or 30.0%). Significantly more MII had blood transfusion (40 or 11.4); engaged in sex trade (12 or 3.4%); and more syphilis prevalence (5.4%). In addition, more syphilitic MII smoked (18 or 94.7%); and all syphilitic MII had psychotic disorders. CONCLUSION: The prevalence of syphilis in MII is significantly higher than among VBDs. Routine screening of MII is advocated to stem this problem.

Otologic and audiological evaluation among HIV patients in Ilorin, Nigeria.

BACKGROUND: HIV infection is the highest cause of death worldwide and presenting eventually with ENT regions. OBJECTIVE: This study is to determine the prevalence of hearing loss and hearing patterns among adults Nigerians with HIV and causal relationships between CD4+ counts with the degree of hearing impairments. METHODS: This prospective study was carried out among all consecutive HIV positive patients attending the clinic at the University of Ilorin teaching hospital (U.I.T.H.), Ilorin, Nigeria between January and July, 2008. They all had audiological assessments with a pure tone audiometer within the frequency range 250 to 8,000 Hz to determine their hearing thresholds together with their CD+ counts estimations. RESULTS: 89 were evaluated in the age range of 18 to 56 years (Mean 36.4 years, SD of 8.82) and the modal age group was 21-39 years (59.6%), 40-56 years (38.2%).There were 51 males (57.3%) and 38 females (42.7%) with a male/female ratio of 1.3:1.0. Otological symptoms included tinnitus (15.7%), vertigo (15.7%), otalgia (14.6%) and hard of hearing (10%). Examinations showed bilateral serous Otitis media (glue ear) in 58 patients (65.1%) with no affectation of the facial nerves. PTA showed mixed, conductive and SNHL in 32 patients (36%), 20 patients (22.5%), 9 patients (10.1%) respectively and only 15(16.9%) had normal hearing thresholds. The CD4+ counts ranged between 12 to 616. CD4 counts with hearing loss mostly < 300mm3. CONCLUSION: The prevalence of hearing loss is 87% among HIV infected patients, mostly mixed HLwith causal relationships between reduced CD4+ counts of less than 300/mm3 with severity of hearing loss. The hearing loss can interfere with the communication and specific knowledge vital to the development of best practices towards ensuring the inclusion of hearing impaired in HIV/AIDS prevention and treatment programmes.

Effect of highly active antiretroviral therapy on CD4 count and weight in AIDS patients seen at the UITH, Ilorin.

OBJECTIVE: To determine the response on treatment-naïve HIV/AIDS patients to the Highly Active Antiretroviral Therapy (HAART) in terms of CD4 Count and Weight gain over a period of 2 1/2 years. METHODS: Patients with Acquired Immunodeficiency Syndrome (AIDS) were recruited under the Federal Government Highly Active Antiretroviral Therapy (HAART) programme at the University of Ilorin Teaching Hospital. The treatment regimen included Lamivudine, Starvudine and Nevirapine. The patients' responses were evaluated with respect to CD4 count and weight over the period of treatment. The diagnosis of HIV/AIDS was made on the basis of reactivity with two different ELISA reagents, and CD4 count was done with Dynal T4 Quant method. The weights (kg.) of the patients were taken at monthly visit. RESULTS: The duration of treatment for the patients analysed ranged from 1 month to 14 months. Analysis of CD4 count was possible in 105 patients. The mean post treatment CD4 count and weight were significantly higher than the pre-treatment values (p < 0.001 and p < 1.01) respectively. There were significant positive correlations (p < 0.05 and p < 0.001) between increases in CD4 count and weight respectively, and duration of treatment. In eight (8) patients, CD4 Count reduced or remained the same in spite of treatment. CONCLUSION: The HAART regime is associated with increase in CD4 Count and weight gain. While increases in CD4 Count and weight correlated with duration of therapy, there was no correlation between CD4 Count increase and weight gain.

HIV seropositivity and related eye diseases in Uith, Ilorin.

INTRODUCTION: HIV is assuming an alarming pandemic worldwide and presently in Nigeria it is a source of concern to all and sundry. AIM: To review the demography of cases positive for HIV in the eye clinic over a 5-year period and to identify ocular diseases that have high predictive value for HIV. METHODS: A retrospective study of all the patients that were screened for HIV in the eye clinic over a 5-year period was done. Screening was by ELISA method with confirmation by Western blot test. RESULTS: A total of 60 patients were screened and 26 (43.3%) of them were HIV positive. The male to female ratio of HIV positive patients was 1:1. All the seropositive patients were between the ages of 20-49 years and about a third were students from the higher institutions. Half of the patients were single. Diagnoses with high predictive values were Herpes Zoster Ophthalmicus (62%), Steven Johnson syndrome (50%), HIV retinopathy (75%), Bilateral Unresolving Toxoplasmosis (42%). The common presentations however are Herpes Zoster Ophthalmicus (HZO) and unresolving bilateral Uveitis. CONCLUSION: HIV and ocular involvement is increasing in Ilorin. The high-risk groups among patients presenting to the hospital are students of higher institutions and Soldiers. Diseases of high predictive indices are Herpes zoster Ophthalmicus, Steven Johnson's syndrome, HIV retinopathy.

The value of serum albumin in pretreatment assessment and monitoring of therapy in HIV/AIDS patients.

OBJECTIVES: We sought to examine the utility of serum albumin measurement in staging AIDS and monitoring patients' response to therapy. METHODS: The possible importance of serum albumin measurement in assessing AIDS stage and in monitoring the response to highly active antiretroviral therapy using CD4 cell count and body weight as parameters was examined in 185 consecutive HIV-infected, therapy-naïve individuals who were recruited for antiretroviral therapy at the university of Ilorin Teaching Hospital. The regimen included lamivudine, stavudine and nevirapine. The diagnosis of AIDS was established through a combination of clinical features and HIV seropositivity using two different enzyme-linked immunosorbent assay techniques. Serum albumin level was determined by the Bromocresol green method, while the CD4 lymphocyte count was obtained using the Dynal T4 count method. Body weight was measured in kilograms with light clothes on. RESULTS: There were significant positive correlations between pretreatment albumin and both pretreatment CD4 cell count and pretreatment weight, and between post-treatment albumin and both post-treatment weight and post-treatment CD4 cell count up to a count of 700 cells/microL. There were also significant positive correlations between increase in serum albumin and both increase in body weight and duration of treatment. CONCLUSIONS: We conclude that, in developing countries where many patients may not be able to afford to pay for CD4 cell counts and viral load tests, which are the traditional markers for HIV disease, serum albumin would be a very useful surrogate test for predicting severity of HIV infection and for clinical monitoring of response to antiretroviral therapy.

HIV/AIDS in Ilorin: changing trend, emerging risk factors.

OBJECTIVE: We examined HIV seropositivity rates among blood donors, subjects screened for certificate purposes, and four sentinel surveys. Demographic and clinical features were analysed over periods to determine changes in risk factors and groups at risks. METHODOLOGY: Questionnaires and protocols were completed for patients screening or clinically assessed, while HIV positivity was determined on the basis of reactivity with two different ELIZA techniques. RESULTS: The positivity rates were below 2% in blood donors, maximum of 4.3% for sentinel surveys, and 11% among subjects screened for certificate purposes. Results showed decreasing male:female ratio, younger female patients, and preponderance of traders and artisans. Weight loss, fever, and diarrhoea were the commonest presenting features. 41% live away from their spouses. CONCLUSION: The 11% positivity rate among subjects requiring certificates raises questions on the reliability of sentinel survey figures. Campaigns should be targeted at artisans, traders and those living away from their spouses.

Prevalence and titre of alpha and beta haemolysins in blood group 'O' donors in Ilorin.

Sera from 250 selected group 'O' donors were screened for anti A and anti B haemolysins. Those that were positive were titrated for haemolytic antibodies and the result read both visually and spectrophotometrically. The visual and spectrophotometric titres were then compared. The prevalence of alpha and beta haemolysin was 23.2%. Haemolytic anti B occurred twice as frequent as haemolytic anti A but the titre of haemolytic anti-A was higher than haemolytic anti-B. There was no relationship between sex and age and the prevalence of haemolysins. Significant visual titre of 8 and above was found in 18.5% of lytic anti-A and 13.2% of lytic anti-B, but the proportion of the whole study population with significant visual titre of 8 and above was low, i.e., 2.0% for anti-A and 2.8% for anti-B. On the average the spectrophotometric titres were consistently one fold higher than the visual titres.