Ocular morbidity from sickle cell disease in a Nigerian cohort.

UNLABELLED: Sickle cell Retinopathy is increasingly being recognised as a cause of significant ocular morbidity and blindness in Africa south of the Sahara. This study looked for retinopathy in a cohort of 90 Nigerians with Sickle Cell Disease (SCD). METHOD: The cohort consisted of black Nigerians from the Hausa-Fulani, Ibo and Yoruba, as well as other minority ethnic groups resident in the Federal Capital Territory aged between 5-36 yr. 88 patients were SS and only 2 SC. RESULTS: SCD related posterior lesions were seen in 22 patients (24%). Of these, 19 cases (21%) had Non Proliferative Sickle Retinopathy (NPSR) while 5 (5.6%) had Proliferative Sickle Retinopathy (PSR) in various stages of development, and 2 had both PSR and NPSR. Patients with PSR are at risk of blindness from vitreous haemorrhage and tractional retinal detachment. A 14-year-old male with arterio-venous anastomosis was the youngest with PSR while the most advanced PSR lesion was a sea fan in a 25-year-old female. CONCLUSIONS: standard treatment consisting of photocoagulation and/or vitrectomy is not available in many eye centres in sub-Saharan Africa and steps need to be taken to improve this situation. The role of anti-sickling remedies, if any, is the subject of ongoing investigations. Our findings with NIPRISAN, a phytomedicinal preparation currently undergoing trials, will be reported subsequently.

A multicentre study to determine the efficacy and tolerability of a combination of nelfinavir (VIRACEPT), zalcitabine (HIVID) and zidovudine in the treatment of HIV infected Nigerian patients.

Summary Forty (40) HIV positive patients with CD4 cell counts between 100 - 500 cellh/mm3 were recruited from 8 different centres in Nigeria including a research centre and specialist and teaching hospitaLs They were enrolled into an open, non-comparative study of a triple combination regimen containing the Protease Inhibitor (PI), Nelfinavir and two Reverse Transcriptase Inhibitors (RTIs), Zakitabine (Hivid) and Zidovudine for a period of 24 weeks. Thirty-one (31) patients completed the study. Nine (9) patients withdrew from the study. Two of these because of Adverse Events (AE), 2 others because they developed tuberculosis and had to withdraw because of rifampicin therapy. The remaining five (5), withdrew voluntarily. Efficacy of the PI containing triple regimen was evaluated using viral load and absolute CD4 changes, weight gain and clinical response during the course of the triaL Twenty-two (22) patients had plasma viral loads measured at the beginning and at the end of the trial (24 weeks). Seventeen (17) out of the 22 patients (77%), experienced a significant reduction in their plasma viral loads (p<0.05 There was 1 log reduction in plasma viral load in 6 patients (25%), 2 log in 4 patients (17%). In 2 patients (8%), plasma viral load was reduced below the level of detection. The viral load increased over the treatment period in five patients (21%). Similarly 22 out of the 26 patients (85%) experienced increase in the level of their CD4 lymphocyte counts at the end of the study. The average CD4 counts of all 26 patients rose from 272.94 +/- 137.71/dl to 414 +/- 243.71/ul over 24 weeks (p<0.05). There was monthly rise of 27 CD4 cells/microl. Four (4) patients (15%) had a fall in their CD4 lymphocyte counts. Twenty (20) out of the 26 patients (77%), who completed the study were observed to have weight gains ranging from 1.5 to 31 kilograms over the 24 week study period. In 4 patients, there was no weight gain during the study period. Two patients (5%) were withdrawn due to adverse events from the viracept combination. One of these was because of life threatening diarrhoea while the other patient had severe peripheral neuropathy and severe weakness in the lower limbs. Eight (8) other patients had diarrhoea but not severe enough to stop them from continuing with the triaL Other adverse events seen include anaemia (1 patient), pancytopenia (1 patient), and transient elevation of serum urea and creatinine (1 patient). None of these adverse events was severe enough to warrant withdrawal from therapy. The study has therefore demonstrated the significant efficacy and tolerability of (Nelfinavir/Zalcitabine/ Zidovudine combination in suppressing viral replication, increasing the CD4 cell counts and improving the quality of life in Nigeria patients with HIV.

Anthelmintic activity of the stem bark extracts of Berlina grandiflora and one of its active principles, Betulinic acid.

This study examines the anthelmintic activity of a methanol, hexane and ethylacetate extracts of Berlina grandiflora and purified betulinic acid, the major triterpenoid found in the extract. Caenorhabditis elegans, a free living soil nematode was used as in vitro model in the study. A suspension of worms was treated with the extracts. After seven days of incubation activity was assessed in terms of number of worms exhibiting motiliy. The results showed that methanol, hexane and ethylacetate fractions at 500 ppm showed anthelmintic activities in the order ethylacetate > methanol > hexane from the alcoholic crude extract. The isolated betulinic acid from the ethylacetate fraction at 100 and 500 ppm showed strong anthelmintic activities comparable to piperazine. These results confirm the traditional use of Berlina grandiflora as an anthelmintic and indicate that betulinic acid is the active component.

When should children and young adults with sickle cell disease be referred for eye assessment?

Children and young adults who suffer from sickle cell disease (SCD) are at risk of blindness from retinopathy and other complications. The incidence of proliferative retinopathy in SCD patients varies from 5 to 10% depending on the genotype, being commoner in SC than SS and S-thal. 'Sudden' blinding sequelae such as vitreous haemmorrhage and tractional retinal detachment can eventuate from vasculo-proliferative retinal lesions, known as sea fans, in otherwise 'quiet' eyes. This risk can be minimised considerably if the lesions are detected in a timely fashion and treated, usually with laser photocoagulation and possibly with cryotherapy. This communication aims, by a review of relevant literature and through our original data, to highlight a time frame for the development of proliferative sickle retinopathy to enable paediatricians decide on an appropriate time of referral for ophthalmic assessment. Ninety patients with SCD (88 SS, 2 SC) aged 5-36 years were examined for anterior and posterior ocular signs of SCD using dilated binocular indirect ophthalmoscopy. Other relevant literature was reviewed. Twenty-four percent of these patients had some form of SCD related posterior pathology, 5.6% of which was pre-proliferative or proliferative. This included a 14-year-old SS patient with arterio-venous anastomosis. The literature reveals that patients begin to exhibit evidence of proliferative retinopathy from about the age of 10 and the frequency tends to increase with age. However, though rare, vitreous haemmorhage has been known to occur below the age of 20. Children with SCD should, from about the age of ten, be referred for at least biennial dilated binocular indirect ophthalmoscopy preferably with fluorescein angiography if such facilities are available, so that neovascular lesions can be treated before blinding sequelae occur. From the age of 20, the frequency of eye examination should increase to yearly. Antisickling remedies, such as NIPRISAN may be beneficial in prophylaxis.

Evaluation of Nigerian traditional medicine: effects of Gakani, a herbal anti-asthmatic drug.

The anti-asthmatic potential of Gakani, a popular herbal drug in Nigeria was investigated. The LD50 values of the freeze-dried aqueous extract in mice and rats were 20.9 +/- 2.4 mg/kg and 18.6 +/- 4 mg/kg, respectively. The extract unsurmountably blocked the effects of histamine and isoprenaline on the guinea pig tracheaL chain. It produced initial dose-related contractions of the isolated guinea pig ileum and rat stomach strip, which was followed by persistent autoinhibition and inhibition of histamine- and 5-hydroxytryptamine (5-HT)-induced responses of the two preparations, respectively. The extract had good anti-inflammatory effect in rats, causing a dose-related inhibition of the increase in the paw circumference (acute inflammation) induced by subplantar injection of fresh egg albumin. These results highlight the anti-asthmatic and toxic potential of this preparation and the need for a systemic approach in the study of traditional medicines.

Chemotherapy of AIDS

The epidemic of AIDS took the world unawares. However; scientists and drug manufacturers have responded promptly to this dreadful challenge. It has now become possible to consider vaccine against AIDS by 2000 ADS