Comparison of blood, bone marrow aspirate, stool and urine cultures in the diagnosis of enteric fever.

A total of 288 specimens made up of 84 specimens each of blood, stool, urine and 36 specimens of bone marrow aspirates were collected from enteric fever patients. The blood specimen was used for cultural diagnosis and malaria parasite (MP) test, while serum from the blood was screened by Widal test. The remaining specimens (bone marrow aspirate, stool and urine) were only used for cultural diagnosis, but their cultural diagnostic sensitivity were only calculated from the patients whose Widal tests were positive. The widal test showed that 21(25%) had significant reciprocal titre levels of > 80 and > 160 for O and H antigens respectively. Malaria parasites test also had 23(37.4%) cases positive with 1(4.4%) and 22(95.7%) of them positive and negative by widal test respectively. Stool, blood and bone marrow aspirate were 33%, 28.6% and 38.1% sensitive respectively, while the diagnostic sensitivity of urine was zero. In the diagnosis of enteric fever, it is suggested that the presumptive serology test (Widal) be carried out along with cultures from bone marrow aspirate and stool where the former is affordable and available. Malaria parasite microscopy should also be done because majority of the suspected enteric fevers may actually only be malaria fever in an environment like Nigeria which is endemic for the two diseases (malaria and typhoid fever).

Interferon alfa-2a (Roferon-A) monotherapy in chronic myelogenous leukemia: a pilot study in Nigerian patients in early chronic phase.

The efficacy and safety of interferon alfa-2a monotherapy was evaluated in seventeen Nigeria patients with chronic myelogenous leukaemia (CML). Male and female patients with a mean age of 34.5 +/- 10.6 years were recruited into the study. Interferon therapy was administered at a maintenance dose of 9 MIU daily for 12 months. Efficacy was evaluated by assessing both haematologic and cytogenetic response, tolerability by incidence of adverse events and safety by laboratory haematological and biochemical indices. At the end of 12 months of therapy 6 patients (54.4%) had complete haematologic remission whilst 3 patients (100% of those evaluated) showed partial cytogenetic remission. The incidence of adverse event was 70% and the monitored haematologic and biochemical indices were not adversely affected by treatment. In conclusion, the study clearly demonstrated a significant benefit of interferon alpha-2a in the management of Nigerian patients with CML. The changes in the haematological and cytogenetic profiles between baseline and term were significant (p < 0.05). However, it is imperative and important to encourage and continue monitoring of the responding and stabilized patients beyond 12 months in order to demonstrate sustained response. The drug was reasonably well tolerated, however life threatening pancytopenia may pose a major problem in certain cases.

Acceptability of prenatal diagnosis of sickle cell anaemia by a sample of the Nigerian population.

The acceptability of prenatal diagnosis (PND) as a means of controlling sickle cell anaemia (SCA) in Nigeria was examined using a semi-structured questionnaire. The aim of the study was to examine the attitudes of well-informed, educated Nigerians to the use of PND and abortion of confirmed HbSS pregnancies in the control of SCA. There were 433 respondents comprising 204 males and 210 females (gender was not recorded for 19 respondents). They were aged 15-50 (31 +/- 18) years. Forty percent had HbAA, 15% HbAS, 1.6% HbAC, 2% HbSS, and 0.2% HbSC; 153 (35%) had no knowledge of their haemoglobin electrophoretic patterns "genotypes". The majority of the respondents (69.5%) appreciated the role of both parents in the transmission of the disease. Only 45 (18%) of the respondents heard of SCA for the first time through sickle cell counsellors, 23% through newsmedia, 29% through friends and relations, 21% obtained the information through health workers, while 5% had never heard of sickle cell disease before the interview. As many as 192 (44%) of the respondents were aware that SCA could be diagnosed in pregnancy; 45% would opt for termination of the affected pregnancies. Avoidance of the problems associated with managing SCA children was the most important reason for approving pregnancy termination, whereas 73% of those rejecting pregnancy termination did so for religious and moral reasons. Seventy-eight percent of those interviewed would want PND started in Nigeria. The two approved control measure for SCA by most of the respondents were genetic counselling and PND; both should, therefore, be considered in implementing control measures for SCA in this country.

Single oral dose of azithromycin for therapy of susceptible sexually transmitted diseases: a multicenter open evaluation.

In three randomised, multicentre studies, azithromycin treatment (1g) as a single dose was administered to patients with uncomplicated gonococcal and non-gonococcal urethritis attending STD Research Laboratories in Lagos, Jos and Ibadan; between January 1989 and December, 1990. One hundred and eighty three patients, comprising 106 males and 77 females who had infections were evaluable at the end of the treatment. Of these 71% of the N. gonorrhoeae isolates were penicillinase producers (PPNG), while 39% were non-PPNG. One hundred and fourteen (95%) of 120 patients with gonococcal urethritis including 104 cases due to penicillinase producing Neiserria gonorrhoeae (PPNG) were clinically and bacteriologically cured with a single 1g dose of azithromycin. Fifty-four (90%) out of 60 patients with non-gonococcal urethritis were cured whilst administered the same dose of azithromycin. The side effects reported for azithromycin were mainly mild and moderate gastro-intestinal complaints and there were no major abnormalities in laboratory parameters. It is concluded that azithromycin was efficacious and safe for the treatment of uncomplicated gonococcal and non-gonococcal infections and may improve patient compliance.

Rapid control of chronic granulocytic leukaemia.

Sixty patients with chronic granulocytic leukaemia (CGL), anaemia, hyperleucocytosis and hepatosplenomegaly were randomized into 3 treatment schedule consisting of: (i) cyclophosphamide 600 mg/m2 intravenously (i.v.) on day 1. (ii) cytosine arabinoside 100 mg/m2 subcutaneously (sc) 12 hourly for days 1-5. (iii) combination of i.v. cyclophosphamide 600 mg/m2 one day 1 and cytosine arabinoside 100 mg/m2 12 hourly sc for days 1-5. Each cycle of treatment lasted 7 days. Patients on combined chemotherapy achieved laboratory and clinical remission within 28 days of treatment, while patients on single agent chemotherapy of cytosine arabinoside or cyclophosphamide still had hyperleucocytosis and hepatosplenomegaly after 28 days of treatment. Six patients treated with cyclophosphamide only had thrombocytopenic bleeding, but no patient treated with either cytosine arabinoside only or a combination of cytosine arabinoside and cyclophosphamide bled. It is suggested that patients with CGL, anaemia, hyperleucocytosis, and hepatosplenomegaly can be rapidly controlled with a combination of cytosine arabinoside and cyclophosphamide.

Haematological indices of Nigerians with sickle cell anaemia

Sickle cell anaemia patients in steady state have haematological values different from the normal population. Sickle cell patients are in a steady state when they are not in crisis and have no bacterial infection. The haemoglobin level is low and reticulocyte count high. There is also peripheral leucotosis and thrombocytosis

Haematological indices and serum lead level in welders working in automobile industry in a Nigerian city

Forty-four welders working in car maintenance industry in Jos; Nigeria had their haemoglobin; haematocrit; leucocyte; platelet and serum lead level determined; while their urine were screened for haem synthetic products. The serum lead level in welders was 28.5 plus 11.2/ng/dl which was significantly higher than the value of 20.8 plus 9/ng/dl recorded for the control group. Though 24 welders who had worked over 10 years had higher serum levels than 20 welders who had worked for less than 10 years this was not statistically significant; also urine examination did not reveal the presence of porphyrinogen or porphyrin in the welders

Puerperal haematological indices in the Nigerian.

Haematological indices were studied longitudinally in 84 healthy pregnant women at term and on days 1, 3, 5, 7 and 42 in the puerperium. Haemoglobin and haematocrit increased on day 1 after delivery, reduced on days 3 and 5 then started rising such that by day 42, the normal haemoglobin in African non-pregnant women was achieved. Leucocyte and neutrophil count increased significantly on day 1 but started falling thereafter and by day 5 the value had returned to normal. The lymphocyte, eosinophil and monocyte count did not show significant variation within the period of study. The platelet count in the primipara showed significant change on days 3 and 5. The variations in haemoglobin, haematocrit, leucocyte and platelet count in the puerperium were more marked in the primipara than the multipara and grandmultipara.

Influence of denervation on smooth muscle response to repeated administration of cyclophosphamide, cytosine arabinoside, or their combination.

Cyclophosphamide, 40 mg.kg-1, cytosine arabinoside, 2 mg.kg-1 or their combination, were all given once weekly to chicks for 5 weeks. The expansor secundariorum muscle of the left wing of each chick was then surgically denervated leaving that of the right wing to serve as the control. Drug administrations continued for a further 5 weeks before the responses of normal and denervated expansor muscles were determined pharmacologically. Cyclophosphamide depressed the response of the expansor muscle to noradrenergic nerve stimulation but enhanced the response to noradrenaline and potassium chloride. Cytosine arabinoside enhanced responses of expansor muscles to noradrenergic nerve stimulation and noradrenaline, but depressed responses evoked by potassium chloride. The combination enhanced responses to nerve stimulation, noradrenaline, and potassium chloride. Expansor muscles were unresponsive to acetylcholine and anticancer drugs failed to restore the responsiveness to acetylcholine except the combination. Denervation depressed responses to noradrenergic nerve stimulation but caused supersensitivity to noradrenaline; this was more marked in the combination and cyclophosphamide groups, with no change in sensitivity seen in the cytosine arabinoside group. The denervated expansor muscle responded to acetylcholine in the order, combination much greater than cyclophosphamide greater than control greater than cytosine group. Denervated expansor muscles from anticancer groups were supersensitive to potassium chloride, with the combination group having the most pronounced effect. It is suggested that denervation influences smooth muscle sensitivity to agonist drugs which can modify the effects of anticancer drugs on smooth muscle.

Anticonceptive and estrogenic effects of a seed extract of Ricinus communis var. minor.

An ether-soluble fraction of a methanol extract of Ricinus communis var. minor seeds administered subcutaneously to adult female rats and rabbits at doses up to 1.2 g/kg and 600 mg/kg, respectively, in divided doses showed anti-implantation and anticonceptive activities. Laparotomy performed on Day 10 and Day 15 of pregnancy on mated female rats and rabbits treated with the extract did not reveal any uterine implantation sites. The animals were protected against pregnancy for over three gestation periods and among those that later delivered, there was no evidence of abnormality in the pups. In ovariectomized young female rats as well as in immature mice, the extract dose-dependently increased uterine wet weight. Furthermore, the extract induced premature opening of the vagina, increased the number of epithelial cells and cornified cells and decreased the leucocyte number in the vaginal smear. The estrogen-like activities exhibited by the extract were dose-dependent and the anticonceptive effect may be due at least in part to such estrogenic action.

Intraocular coenurosis: a case report.

A case of intraocular coenurosis was clinically diagnosed and treated with praziquantel. The drug destroyed the coenurus, but vision was lost through toxic endophthalmitis and retinal detachment. There were no systemic side effects.

A comparison of the effects of repeated administration of cyclophosphamide, cytosine arabinoside or their combination on smooth and skeletal muscle.

The pharmacological effects of repeated administration of 2 mg Kg-1 cytosine arabinoside, 40 mg Kg-1 cyclophosphamide or their combination, all given once weekly for 5 weeks, have been investigated in chicks. Cyclophosphamide did not affect responses to noradrenergic nerve stimulation or phenylephrine, depressed responses of the expansor secundariorum muscle to acetylcholine but sensitised the muscle to direct stimulation. Cytosine arabinoside depressed noradrenergic transmission and enhanced responses of the expansor muscle to phenylephrine and acetylcholine. The combination of both drugs enhanced responses to noradrenergic nerve stimulation due to increased alpha-adrenergic receptor mediated contraction and direct muscle sensitisation. Cyclophosphamide, cytosine arabinoside or their combination produced a non-specific depression of the upper oesophagus and ileum. The exception was the marked increase in response of the ileum from the combination group to agonist drugs, indicating synergism. The non-specific skeletal muscle depressant actions of cyclophosphamide and the combination groups were more pronounced than that of the cytosine arabinoside group.

Haematologic indices in African children.

A full blood count was performed on 380 children (186 preschool and 194 school children). It was found that the school children had significantly higher haemoglobin, haematocrit, neutrophil and platelet counts than the preschool children. The preschool children had higher total leucocyte and lymphocyte counts.

Ocular findings in homozygous sickle cell disease in Jos, Nigeria.

Ophthalmological examinations were performed in 78 homozygous sickle cell (Hb SS) patients, aged 4-42 years attending the sickle cell clinic of the Jos University Teaching Hospital, and the University Clinic, Jos, in Nigeria. Conjunctival signs present in about 77% of cases were observed in all ages and sexes. White without pressure present in 62.8% of the cases was the commonest retinal sign and in 56.3% of the cases was associated with peripheral retinal vessel disease. Salmon patches (6.4%), iridescent spots (10.3%), mottled brown areas (16.7%) and black sunbursts (7.7%) were seen as early as 10 years of age but showed an upward trend with age. Peripheral retinal vessel disease present in 52.5% of the cases was the second commonest retinal sign and with the exception of arteriolar occlusion showed no sex predilection, but an upward trend with age. Arterio-venous anastomosis (7.7%), vitreous haemorrhages and veils (3.8%) were the only severe proliferative signs noted. There were no cases of retinal neovascularization, retinal detachment or of angoid streaks, and the posterior poles were normal. Retinal signs were present as early as 8 years of age and showed an upward trend with age.

Haematological values in pregnancy in Jos.

Blood samples taken from 270 women, 30 in first trimester of pregnancy, 90 in second trimester and 150 in third trimester, were analysed for haemoglobin (Hb) packed cell volume (pcv), white blood cell count (wbc) and differentials and platelet count. The values for 95%, range for first trimester was Hb 122 +/- 19.8, pcv .37 +/- .0568L/L, wbc 6.189 +/- 2.484 x 10(9)/L and platelet 200.428 +/- 101.828 x 10(9)/L, for the second trimester, Hb 117.5 +/- 25.2 g/L pcv .36 +/- .0706L/L, wbc 6.414 +/- 2.884 x 10(9)/L and platelet 189.168 +/- 101.828 x 10(9)/L, and for third trimester Hb 119.6 +/- 24 pcv .36 +/- .072L/L, wbc 7.119 +/- 2.356 x 10(9)/L and platelet 193.786 +/- 103.016 x 10(9)/L. These results were compared with those of 150 non-pregnant women whose haematological indices were Hb. 130.5 +/- 17.89g/L, pcv .3994 +/- .0716L/L, wbc 5.255 +/- 2.900 x 10(9)/L and platelet 242.600 +/- 105.416. These results show that there is a significant fall in Hb, pcv, and platelet in pregnancy, while wbc count shows a significant rise in pregnancy due to neutrophilia.

Chronic lymphocytic leukaemia with raised serum IgM levels.

Eight patients diagnosed as having chronic lymphocytic leukaemia (CLL) from clinical and haematological data were also observed to possess immunological characteristics similar to tropical splenomegaly syndrome (TSS). We suggest that the raised IgM level in these cases may be the effect of chronic exposure to malaria in patients who later developed CLL. Consequently, raised serum IgM, which is a feature of TSS, may also be found in some cases of CLL in Nigeria.

Sensori-neural hearing impairment in chronic granulocytic leukaemia.

Sudden sensori-neural hearing impairment as a complication of chronic granulocytic leukaemia (CGL) occurred in five of the ten patients seen in Jos University Teaching Hospital over a period of two years. This complication occurred more frequently in younger patients especially females with excessive hepatosplenomegaly, higher leucocyte count and lower platelet count. Leucostasis in internal auditory artery may be acting as a thrombus to cause infarction in the cochlea resulting in the sudden hearing loss.