Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a systematic review and meta-analysis.

BACKGROUND: Pregnancy in women with sickle-cell disease (SCD) is associated with increased adverse outcomes. Findings on the association between SCD and adverse pregnancy outcomes are conflicting, and the results do not address whether these associations are similar in both low- and high-income countries. OBJECTIVES: We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with SCD. SEARCH STRATEGY: The MEDLINE database was searched using medical subject headings (MeSH) and keywords for articles on pregnancy outcomes in women with SCD. SELECTION CRITERIA: We used full research articles published in English that compared women with SCD with women who did not have SCD, as controls. DATA COLLECTION AND ANALYSIS: Data were abstracted and analysed using comprehensive Meta-analysis 2.2. The primary outcomes were intrauterine growth restriction and perinatal mortality. Secondary outcomes were rates of caesarean sections, pre-eclampsia, eclampsia, postpartum haemorrhage, maternal mortality, prematurity, and low birthweight. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (95% CIs). MAIN RESULTS: Sixteen studies met all of the selection criteria and were included in the analysis. SCD was associated with intrauterine growth restriction (pooled OR 2.79, 95% CI 1.85-4.21), perinatal mortality (pooled OR 3.76, 95% CI 2.34-6.06), and low birthweight (pooled OR 2.00, 95% CI 1.42-2.83). SCD was also associated with an increased risk of pre-eclampsia (pooled OR 2.05, 95% CI 1.47-2.85), maternal mortality (pooled OR 10.91, 95% CI 1.83-65.11, P = 0.009), and eclampsia (pooled OR 3.02, 95% CI 1.20-7.58). CONCLUSION: Pregnancy in women with SCD is associated with increased risks of adverse perinatal and maternal outcomes in both low- and high-income countries. TWEETABLE ABSTRACT: This meta-analysis showed worse pregnancy outcomes in women with sickle-cell disease compared with controls.

Endomyocardial fibrosis associated with Schistosoma haematobium infection.

Endomyocardial fibrosis (EMF) is a form of restrictive cardiomyopathy common in the tropics and subtropics. The aetiology of EMF is unknown but helminth infestations such as schistosomiasis have been implicated. Two boys aged 8 and 10 years with EMF associated with Schistosoma haematobium, are described. The schistosomes in both cases may have been acquired from contact with contaminated water collected and stored in containers and subsequently used for bathing. Both patients were managed conservatively. Overall prognosis of EMF is poor and this report emphasizes the importance of public health interventions in the control of schistosomiasis.

Second Trimester Anaemia in Pregnant Ghanaians.

BACKGROUND: Anaemia is considered a severe public health problem by WHO and is seen as such in Ghana. Its prevalence in pregnancy has remained high despite improved antenatal care. The main purpose of this study was to determine the current anaemia prevalence and aetiology other than iron deficiency. METHODS: This was a cross-sectional study. A total of 214 pregnant women were studied. Women were administered a questionnaire related with the subject and blood samples were drawn. Full blood count was performed within four hours and serum iron, folate and vitamin B12 were studied. Other tests done included sickling and Hb electrophoresis , stool routine examination for hookworm infestation, thick and thin film for malaria parasitaemia. Dietary intake was also looked at to determine whether it contributed to anaemia seen in these subjects. RESULTS: Anaemia was detected in 150 (70%) of the 214 pregnant women studied. Using the World Health Organisation criteria for anaemia, 81 subjects had mild, 66 moderate and 3 had severe anaemia. Anaemia was more prevalent in young adults (82%) than in teenagers and subjects above 35years (p=0.018). Primigravidae (21%) and multigravidae (67%) were more likely to be anaemic than grandmultigravidae (12%). Anaemia was more prevalent in the low social class group (94%). Nutritional intake of both anaemic and non-anaemic subjects was found to be adequate and thus iron deficiency anaemia, which was found to be the commonest cause of anaemia, was probably due to intake of diet low in bioavailable iron. There was very little consumption of fruits and vegetables that facilitate iron absorption. Twenty seven anaemic subjects had low serum iron levels. Transferrin saturation was low in 39 subjects; 24 of these also had low serum iron, which was suggestive of iron deficiency. Folate and vitamin B12 deficiency did not play significant role in the aetiology of anaemia. Malaria and hookworm infestation were also not found to be significant in the causation of anaemia. CONCLUSIONS: The prevalence of anaemia (70%) in pregnant Ghanaians in their second trimester is unacceptably high. Twenty seven (18%) of the 70% anaemic subjects had low serum iron and six (4%) had low serum folate levels. None of the subjects had vitamin B12 deficiency. Generally dietary intake in pregnant women in this study was adequate, but significant proportion of their meals was of the type low in bioavailable iron as more cereals and tubers were consumed. The kind of diet, which most people can afford in Africa is low in proteins and vitamins, but high in carbohydrate with high phytate contents and this reduces iron absorption. Iron and folic acid prophylaxis for all women of child bearing age is recommended and emphasis on a more balanced nutritional intake at antenatal clinics should be encouraged.

CUTANEOUS INVOLVEMENT OF HODGKIN LYMPHOMA IN A CHILD--CASE REPORT.

Specific cutaneous involvement in Hodgkin Lymphoma is rare and has not been reported in the younger paediatric age group. We report a case of a ten year old girl who presented with specific cutaneous involvement, confirmed using immunohistochemical stains. Treatment with combination chemotherapy resulted in rapid disappearance of the lesions and contrary to the generally poor prognosis associated with most other such reported cases in adults, she has clinically remained disease free two and a half years post treatment. Obtaining an accurate pathological diagnosis is essential to ensure appropriate treatment even in resource limited settings as illustrated by this case.

Multicentric Castleman's disease in a Ghanaian adult.

Castleman's disease is a rare cause of lymphoid hyperplasia that may result in localized symptoms or an aggressive, multisystem disorder that can mimic other diseases like lymphoma or tuberculosis. We describe a case of a 55-year-old Ghanaian male who was successfully diagnosed and managed for multicentric Castleman's disease with combination chemotherapy.

Haemophagocytic lymphohistiocytosis in a Ghanaian child.

We report a case of a previously well nine-month-old infant who presented with prolonged fever, hepatosplenomegaly and pancytopenia. A diagnosis of haemophagocytic lymphohistiocytosis (HLH) was made during the course of hospital admission. There was good initial response to dexamethasone but the patient died less than two months after diagnosis. This is the first report of HLH from Ghana. The disease has a significant mortality rate if untreated and a high index of suspicion is required in all severely ill children.