L-Arginine supplementation enhanced expression of glucose transporter (GLUT 1) in sickle cell anaemia subjects in the steady state.

L-Arginine may have therapeutic value in the management of sickle cell disease and diabetes mellitus. There is very little information on the interaction of GLUT 1 and L-Arginine in sickle cell disease subjects. This study compared the blood levels of Glut 1, fasting blood glucose (FBG) and fasting insulin (FIns) in non-sickle cell anaemia (HbAA) and sickle cell anaemia (HbSS) subjects in the steady state before and following L-Arginine supplementation (1 g/day for 6 weeks). Nitric oxide metabolites, (NOX), catalase, superoxide dismutase and glutathione peroxidase were also measured in each group of subjects. Correlation coefficients between change (Δ) in Glut 1 and change (Δ) in FBG, Fins, NOX and antioxidant enzymes respectively were calculated. Before supplementation, Glut 1, NOX, GPX and CAT were significantly higher in HbAA subjects while FIns, FBG and MDA were higher in HbSS subjects. In both groups, supplementation significantly increased NOX, Glut 1 and antioxidant enzymes but decreased MDA. Supplementation increased FIns in HbAA but decreased FBG and FIns in HbSS subjects. In both groups of subjects, ΔGLUT 1 correlated positively with ΔNOX, antioxidant enzymes and Δ[R] but negatively with ΔMDA. ΔGLUT 1 correlated negatively with ΔFBG and ΔFins in HbSS but positively in HbAA. Study thus showed that in the steady state HbSS subjects had lower GLUT 1 but elevated FBG and Fins levels than HbAA subjects. Additionally, L-Arginine increased GLUT I and antioxidant enzymes but decreased Fins, FBG and MDA in HbSS subjects.

Land tenure and property rights, and household food security among rice farmers in Northern Nigeria.

There are growing campaigns to promote land titling to secure Land Tenure and Property Rights (LTPRs) in African agriculture. Theoretically, deed registration should reduce land disputes, facilitate land use as collateral for loans, and stimulate investment in land improvement for increased productivity, income and food security. Empirical evidence in these regards, however, remains anecdotal, and sometimes conflicting. This paper reports a study that examined LTPRs' among smallholder rice farmers in Northern Nigeria and the influence on household food security (HFS). It used cross-section data obtained from 549 rice farmers, selected by multistage sampling across 84 rice-growing communities, seven (7) States and the three (3) geopolitical zones in northern Nigeria. Data collection was by personal interviews of adult members of the farmers' households, focusing on the households' socio-economics, livelihoods, and LTPRs on farmland cultivated during the 2016/17 farming season. HFS was assessed within the framework of the United States Department of Agriculture' HFS Survey Module. LTPRs assessment was in terms of the type (source) and registration of titles to farmlands. HFS modelling was within the framework of Poisson, Instrumental Variable Poisson (IVP) and Zero-inflated Poisson (ZIP) regression methods, with endogeneity concerns and choice of specification addressed within Hausman specification tests. The results show that land titling is not endogenous in the estimated models; and that HFS is significantly (p < 0.01) enhanced with an increase in shares of freehold and leasehold in the households' farmlands, as against reliance on communal holdings. Holding de jure secure title to farmlands, however, had no significant influence on HFS. The evidence supports the need to develop land markets to enhance the ease of land transfer, as part of measures to enhance HFS in northern Nigeria.

Supplementation with l-arginine stabilizes plasma arginine and nitric oxide metabolites, suppresses elevated liver enzymes and peroxidation in sickle cell anaemia.

The effect of l-arginine on liver function in SCD has received little or no attention. The effect of a chronic, oral, low-dose supplementation with l-arginine (1gm/day for 6 weeks) on some liver enzymes, lipid peroxidation and nitric oxide metabolites was studied in 20 normal (non-sickle cell anaemia; NSCA) subjects and 20 sickle cell anaemia (SCA) subjects. Ten milliliters of blood was withdrawn from an ante-cubital vein for the estimation of plasma arginine concentration ([R]), alanine aminotransaminase (ALT), aspartate aminotransaminase (AST) and alkaline phosphatase (ALP), plasma total bilirubin concentration [TB], malondialdehyde concentration [MDA] and nitric oxide metabolites concentration [NOx]. Before supplementation, ALT, AST, ALP (p<0.05 respectively) and TB (p<0.001) were higher in SCA subjects than in NSCA subjects. [R] and [NOx] were higher in NSCA subjects (p<0.001 and p<0.05 respectively). Supplementation caused greater percent increases in [R], and [NOX] in SCA than in NSCA subjects (p<0.001 in each case). l-Arginine caused greater percent reductions in ALT and AST in SCA subjects but greater percent reduction in ALP in NSCA subjects (p<0.001 in each case). Changes in [MDA] and [TB] in the two groups were similar. Study shows that chronic, oral, low-dose supplementation with l-arginine improved liver function, oxidative stress, plasma arginine concentration and nitric oxide metabolites levels in NSCA and SCA subjects. Responses in SCA subjects to l-arginine were more sensitive than in NSCA subjects.

l-Arginine supplementation enhances antioxidant activity and erythrocyte integrity in sickle cell anaemia subjects.

The effect of oral, low-dose l-arginine supplementation (1g/day for 6 weeks) on antioxidant activity, haematological parameters and osmotic fragility of red blood cells was investigated in sickle cell disease sufferers. Twenty eight sickle cell anaemia subjects were recruited for the study. Five millilitres of blood was withdrawn from an ante-cubital vein for the estimation of plasma arginine concentration ([R]), total antioxidant enzymes (TAE) activity, malondialdehyde concentration ([MDA]), RBC count, [Hb], PCV, MCHC, MCV, MCH, percent irreversibly sickled cells (%ISC)) and osmotic fragility of red blood cells in the subjects. l-arginine supplementation increased [R] (p<0.001), TAE activity (p<0.05) and MCV (<0.05) but reduced plasma [MDA], MCHC, MCH and %ISC (p<0.001, respectively). Δ[R] correlated positively with ΔTAE (r=0.8) and negatively with Δ[MDA] (r=-0.7) and Δ%ISC (r=-0.5). Also ΔTAE activity correlated negatively with Δ[MDA] (r=-0.7) and Δ%ISC (r=-0.6). Supplementation shifted the osmotic fragiligram to the right and reduced the concentrations of NaCl at which initial and complete lyses of erythrocytes occurred. Study showed that low-dose, oral l-arginine increased antioxidant activity, red blood cell resistance to osmotic lysis but reduced red cell density in SCD.

Current sickle cell disease management practices in Nigeria.

BACKGROUND: Although Nigeria has the highest burden of sickle cell disease (SCD) worldwide, there is still variable and poor utilisation of standard-of-care practices for SCD patients in the country. METHODS: This was a questionnaire survey of doctors in some dedicated SCD clinics in Nigeria in order to document the facilities available and common management practices. RESULTS: There were responses from 18 clinics based in 11 institutions. The number of patients being followed in each centre ranged from 15 to approximately 11 000. All clinics provided malaria prophylaxis and folic acid routinely to their patients. Only eight clinics prescribe penicillin prophylaxis. Eight prescribe hydroxyurea to patients who can afford it when indicated. All of the centres except three have electronic cell counters, but all had access to haemoglobin electrophoresis. Three had high-performance liquid chromatography machines installed but none was being routinely used. One institution had a functioning molecular biology laboratory. There is no official newborn screening programme in the country. All had access to microbiology and chemistry laboratories. Nine institutions had CT, six had MRI and three had transcranial Doppler facilities. CONCLUSION: The care available for SCD in Nigeria is still suboptimal and there is an urgent need for concerted effort to tackle the problem, but to make a significant impact on the burden of the disease would require more focus at the primary care level. Some steps to achieving this are outlined.

L-arginine increases nitric oxide and attenuates pressor and heart rate responses to change in posture in sickle cell anemia subjects.

Pressor and heart rate changes following change in posture without or with L-arginine supplementation (1g/day for 6 weeks) were studied in 28 sickle cell anemia (SCA) and 32 non-sickle cell anemia (NSCA) subjects. Change in posture increased HR (p<0.01), RPP (p<0.05) in both groups of subjects, MABP (p<0.05) in SCAS but reduced MABP (p<0.01) in NSCAS and PP (p<0.01) in SCAS. L-Arginine supplementation increased plasma L-Arginine concentration ([R]) in both groups of subjects (p<0.001 in each group) and serum nitric oxide metabolites concentration ([NOx]) (p<0.01 in each group). Change (Δ) [R] correlated positively with Δ [NOx] in both groups (+ 0.7 in each group). L-Arginine supplementation caused greater reduction of MABP (p<0.001) in NSCAS than in SCAS. However, reduction in HR was greater (p<0.001) in SCAS than in NSCAS. After supplementation, MABP and PP responses to change in posture were attenuated in the two groups. However, while HR and RPP responses in SCAS were attenuated, the same responses were enhanced in NSCAS by change in posture after supplementation. In conclusion, study shows that oral, low dose, chronic supplementation with L-arginine increased NO availability and attenuated pressor and heart rate responses to change in posture in sickle cell anemia subjects.

A prospective diary study of stuttering priapism in adolescents and young men with sickle cell anemia: report of an international randomized control trial--the priapism in sickle cell study.

Priapism is defined as a prolonged, persistent, and purposeless penile erection. It is a common (35%) but frequently understated complication in young men and adults with sickle cell disease. We had previously demonstrated an association between stuttering attacks (<4 hours) and an acute catastrophic event with its consequent problems of erectile dysfunction and impotence. We describe a randomized, placebo-controlled, clinical study looking at medical prophylaxis with 2 oral α-adrenergic agonists, etilefrine and ephedrine, in preventing stuttering attacks of priapism. One hundred thirty-one patients were registered into a 2-phase (observational and intervention phase) study, and 86 patients (66%) completed Phase A diary charts. Forty-six patients (59%) completed a 6-month treatment phase (Phase B), and the remaining patients were lost to follow-up despite persistent efforts to contact them. Various reasons are postulated for the high attrition rates. The drugs were well tolerated, and no serious adverse events were reported. There was no significant difference among the 4 treatment groups in the weekly total number of attacks in Phase B (analysis of covariance P = .99) nor among the average pain score per attack after adjusting for attack rates and pain scores in Phase A (analysis of covariance P = .33). None of the patients who completed the study required penile aspiration at study sites while on medical prophylaxis. Young men with sickle cell disease are not comfortable engaging with health care providers about issues relating to their sexual health. The full impact of an improved awareness campaign and early presentation to hospital merits further standardized study. Priapism still contributes seriously to the comorbidity experienced by this previously inaccessible group of patients and medical prophylaxis with oral α-adrenergic agonists is feasible. Future international collaborative efforts using some of the lessons learnt in this study should be undertaken.

Liver enzymes and trace elements in the acute phase of sickle cell anaemia.

BACKGROUND: Trace elements are required for the performance of numerous functions of immune cells. It is not clear whether levels of trace elements are elevated and whether there is a relationship between the levels of liver enzymes and trace elements in patients with sickle cell anaemia in crisis. OBJECTIVE: To compare the plasma levels of liver enzymes and trace elements in non sickle cell anaemia (NSCA), sickle cell anaemia subjects in the steady state (SCASS) and sickle cell anaemia patients in crisis (SCAC). METHODS: Haematological parameters, liver enzymes and trace elements were determined in 20 NSCA subjects, 20 SCASS subjects and 18 SCAC subjects. Variables studied included aspartate aminotransferase (AST) , alanine aminotransaminase (ALT), alkaline phosphatase (ALP), and the trace elements copper, zinc, and manganese. RESULTS: Levels of liver enzymes were higher in the SCAC subjects than in the NSCA or SCASS subjects (p<0.001). Plasma Cu++, Zn++ and Mn++ were also higher in the SCAC subjects than in the NSCA or SCASS subjects (p<0.001). Correlationships were high and strong between AST and ALT (r=+0.7; p=0.03), AST and ALP (r=+0.9; p=0.001), Zn++ and Fe++ (r=+0.9; p=0.001) in SCAC. CONCLUSION: During crisis in sickle cell anaemia, liver enzymes, as well as the trace elements of Cu++, Zn++ and Mn++ are increased; levels of aspartate aminotransaminase are strongly correlated with those of ALT and ALP. Levels of liver enzymes do not appear to be related to those of the trace elements in painful sickle cell crisis.

Liver Enzymes and Trace Elements in the Acute Phase of Sickle Cell Anaemia

BACKGROUND: Trace elements are required for the performance of numerous functions of immune cells. It is not clear whether levels of trace elements are elevated and whether there is a relationship between the levels of liver enzymes and trace elements in patients with sickle cell anaemia in crisis. OBJECTIVE: To compare the plasma levels of liver enzymes and trace elements in non sickle cell anaemia (NSCA); sickle cell anaemia subjects in the steady state (SCASS) and sickle cell anaemia patients in crisis (SCAC). METHODS: Haematological parameters; liver enzymes and trace elements were determined in 20 NSCA subjects; 20 SCASS subjects and 18 SCAC subjects. Variables studied included aspartate aminotransferase (AST) alanine aminotransaminase (ALT); alkaline phosphatase (ALP); and the trace elements copper; zinc; and manganese. RESULTS: Levels of liver enzymes were higher in the SCAC subjects than in the NSCA or SCASS subjects (p

Electrocardiographic and blood pressure changes in apparently healthy male subjects following oral, chronic, low-dose vitamin C supplementation and/or change in posture.

INTRODUCTION: Studies have shown that oral, chronic, low dose vitamin C reduces blood pressure and forearm blood flow in normal young adults or hypertensive patients. It is not clear how vitamin C affects cardiac function or autonomic control of blood pressure in young apparently healthy adults. AIM: This study was undertaken to examine the effects of a chronic, low dose (300 mg/day for 6 weeks) vitamin C supplementation on the electrocardiogram and autonomic control of blood pressure in apparently healthy male subjects. METHODOLOGY: Electrocardiographic (ECG) and arterial blood pressure (BP) changes were assessed following change in posture with or without oral, chronic low dose vitamin C supplementation in twenty (20) apparently healthy male subjects (mean age 28.2 +/- 2.0 yrs). Blood pressure (BP, mm Hg) and ECG measurements (amplitude, mV; duration or interval, ms) were recorded in the supine position and immediately on assumption of the upright position. Heart rate (HR; beats/min) was calculated from the ECG while rate pressure product (RPP; arbitrary units) was calculated and used as a measure of myocardial oxygen demand. Each subject was then placed on oral vitamin C at a dose of 300 mg/day for 6 weeks. Measurements were made again after the period. RESULTS: Change in posture caused significant reductions in P-wave amplitude, QRS amplitude and duration, T-wave amplitude and systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MABP) (p < 0.01 respectively). PR and RR intervals also fell (p < 0.05 and p < 0.001 respectively) while HR and RPP increased (p < 0.001) Vitamin C decreased T-wave amplitude (p < 0.01) and QRS duration (p < 0.01). Also, SBP, DBP, MABP and RPP fell (p < 0.01 in each case). After vitamin C supplement ation, change in posture decreased P-wave amplitude, T-wave duration, P-wave duration, QT interval and RR interval (p < 0.05 respectively). BP and HR responses to postural change were attenuated by vitamin C supplementation. SBP fell by 7.4 +/- 1.0 mm Hg (Vs 12.2 +/-0.1 mm Hg pre-supplementation), DBP by 5.4 +/- 0.6 mm Hg (Vs 10.4 +/- 0.1 mm Hg pre-supplementation) and MABP by 6.1 +/- 1.4 mm Hg (Vs 11.0 +/- 0.1 mm Hg pre-supplementation). HR increased by 18.6 +/- 1.0 beats/min (Vs 29.6 +/- 2.5 beats/min pre-supplementation) and RPP by 1385.6 +/- 126.4 units (Vs 2370.0 +/- 105.6 units pre-supplementation). CONCLUSION: Chronic, low dose vitamin C supplementation enhanced cardiovascular autonomic activity in apparently healthy young subjects. It minimized the fluctuations in BP and HR and also reduced myocardial oxygen demand following postural change.

Cardiac and autonomic responses to change in posture or vitamin C supplementation in sickle cell anemia subjects.

Autonomic function following change in posture with or without vitamin C supplementation was studied in ten (10) sickle cell anemia (SCA) and twelve (12) non-sickle cell anemia (NSCA) subjects. Arterial blood pressure and electrocardiographic measurements were taken in the supine position on a couch 80cm high and immediately on assumption of the upright position. Vitamin C was then administered orally (300mg/day for 6 weeks). At the end of the period, blood pressure and ECG measurements were again made in the supine position and in response to change in posture. Change in posture significantly decreased QRS amplitude, QRS duration, PR interval, RR interval and MABP but increased HR and rate pressure product (RPP) in both groups of subjects. The HR and RPP responses were significantly higher in NSCA than in SCA subjects (p<0.001, respectively). Vitamin C caused greater reductions in QRS duration (p<0.01), PR duration p<0.001) in the NSCA subjects than in SCA subjects. It caused, however, greater reduction in RR duration (p<0.001) and MABP in SCA subjects than in NSCA subjects. It also caused significantly greater increases in HR and RPP (p<0.001, respectively) in the SCA subjects than in NSCA subjects. After vitamin C supplementation, change in posture decreased RR interval (p<0.001), QT interval (p<0.01) and MABP (p<0.05) but increased RPP (p<0.01) in NSCA subjects. In SCA subjects, there was a fall in RR interval (p<0.001) and MABP (p<0.01), but elevated RPP (p<0.001). Changes (Delta) in MABP, HR and RPP were similar between NSCA and SCA subjects. In conclusion, these findings indicate a blunted cardiovascular autonomic response to change in posture in sickle cell anemia subjects. Chronic, oral, low-dose vitamin C supplementation equilibrates this response with those of non-sickle cell anemia subjects.

Hepatitis B and C virus infection in Nigerian patients with HIV/AIDS.

OBJECTIVES: This study was designed to assess the prevalence of HBV and HCV infection in HIV patients and evaluate the risk of infection compared with HIV negative control subjects. METHOD: This is a prospective case control study in which 240 HIV/AIDS patients and age and sex matched controls were evaluated. The diagnosis of HIV infection was based on a positive HIV screening test using Capillus test kits (Trinity Biotech PLC, Ireland) and confirmed using Western blot assay. HBsAg and anti-HCV were assayed by commercially available chromatographic immunoassay (SD BIOLINE). RESULTS: Eleven (9.2%) of the 120 HIV/AIDS patients and 8 (7%) of the 120 control subjects were positive for the HBsAg (OR=1, p=0.27). HBeAg was detected in 3 of the 11 (27.3%) subjects with HIV/HBV co infections. HIV positive patients were 7 times more likely to have HCV infection than control patients (5.8% compared with 0.8%, OR=7.3, p= 0.03). CONCLUSION: The lack of a strong association between HBV and HIV infection may be related to different exposure routes in this population where HBV infection is highly endemic and childhood infection almost universal. In this African population, HIV infection may be a super-infection of HBV infections contracted in childhood. This high HCV/HIV co-infection rate is consistent with the shared parenteral and sexual routes of transmission.

Effect of sodium salicylate iontophoresis in the management of hip pain in patients with sickle cell disease.

BACKGROUND: Iotophoresis is a means of delivering drugs across the skin for the management of a variety of conditions, most often for localized inflammation and pain. It is becoming popular as an alternative to oral and injection delivery system because it is non-invasive, non-traumatic, and painless and also because of its specific delivery system. OBJECTIVE: The objective of this study was to determine the effectiveness of sodium salicylate iontophoresis in the management of hip pain in patient with sickle cell disorders (SCD). METHOD: The participants for this study were 20 patients with SCD, their ages ranged from 15-30 years. They were randomly assigned into two groups of 10 (study and control groups. All the participants were given conventional physiotherapy and their regular medications. In addition sodium salicylate iontophoresis was giving to the affected hip of the participants in the study group using a galvanic current machine. Pain intensity and range of motion at the hip joint were assessed at the beginning and after 10 treatment sessions. Data were analyzed using Mann Whitney U test and paired t-test for the visual analogue scale and goniometric values respectively. RESULT: The results showed that there was a statistically significant reduction in pain intensity only in the participants in the study group (p<0.05), there was also a statistically significant improvement in the hip range of motion of the participants in the study group (p<0.05). CONCLUSION: It was concluded that sodium salicylate iontophoresis was effective in the management of hip pain in patients with SCD. It is therefore recommended for routine use for patients with SCD on admission with severe pain.

Effect of changes in plasma vitamin E level of vascular responses and lipid peroxidation in sickle cell anaemia subjects.

The effect of vitamin E supplementation (300 mg/day for 6 weeks) on blood pressure, forearm blood flow, forearm vascular resistance, plasma vitamin E level and lipid peroxidation status was investigated in adult sickle cell anaemia subjects. Ten adults whose ages ranged from 19.0 to 25.0 years (mean 22.8+/-0.8 years) were studied. Vitamin E supplementation had little or no effect on arterial blood pressure but significantly increased forearm blood flow (p<0.001) and plasma vitamin E level (p<0.001). However it significantly decreased lipid peroxidation status (p<0.001) and forearm vascular resistance (p<0.001). The change in plasma vitamin E concentration correlated negatively with change in lipid peroxidation status (r=-0.8; p=0.003). However, change in plasma vitamin E concentration correlated positively with change in forearm blood flow (r=0.8; p=0.006). There was an inverse correlation between change in plasma lipid peroxidation and change in forearm blood flow (r=-0.7; p=0.03). The study therefore shows that in sickle cell anaemia subjects, vitamin E supplementation increases forearm blood flow and reduces forearm vascular resistance and lipid peroxidation. The increase in forearm blood flow correlates inversely with the reduction in lipid peroxidation. This suggests that in sickle cell anaemia subjects, vitamin E supplementation could cause an increase in forearm blood flow by decreasing plasma lipid peroxidation level.

Occlusal features of sickle cell anaemia patients in Lagos, Nigeria.

One hundred and four sickle cell anaemia patients aged 10-45 years and attending the out patients' clinic of the Lagos University Teaching Hospital as part of a routine check-up were seen. They were in a steady state of health. By means of a structured questionnaire the Biodata of each consecutive eligible patient was obtained and physical examination was carried out. Oral examination was done with emphasis on occlusal variables including Angle's Classification of occlusion, overjet, overbite, tooth: bone ratio, lip competence and skeletal pattern. Results showed that the majority of the patients 92 (88.5%) seen presented with Angle's Class 1 malocclusion. Increased overjet was observed in 50 (48.2%) of the sample population while an overbite depth of 2 was most frequently seen in these patients. Spacing in the anterior segment of the upper and lower arches was a fairly common occurrence, occurring in 51 (49.0%) and 39 (30.8%) of the patients seen respectively. Normal dental base relationship (Skeletal 1) was observed in 72 (69.2%) while lip incompetence was seen in 41 (39.4%) of the patients examined. Occlusal anomalies vary from mild to severe and may be attributable to hyperplastic maxillary bone and the resultant skeletal discrepancy.

Effect of acute uncomplicated malaria on platelet counts.

OBJECTIVE: To determine the effect of uncomplicated malaria on platelet count. PATIENTS AND METHODS: Adult Nigerians (residing in the Lagos metropolis) who were diagnosed as having uncomplicated malaria were treated with a standard regime of chloroquine. Platelet counts were obtained before treatment, Day 0, and again on day 14 when parasitaemia had been cleared in the patients. There were 40 (21 males, 19 females) patients enrolled for the study. Their ages ranged from 15 years to 56 years with a mean +/- SEM of 27. 4 +/- 1.8 years. 28 (14 males, 14 females) patients had both day 0 and 14 platelet counts. RESULTS: The malaria parasite counts ranged from 1020 /mm(3) to 72,000 /mm(3) at day 0 with a mean +/-SEM of 15,638.0 +/- 3,727.0/mm(3) and zero on day 14. The mean platelet count on day 0 was 137.0 +/- 58.4x 10(9)/L while the day 14 mean platelet count was 234.0 +/- 96.9 x 10(9)/L. Comparison of mean platelet counts on day 0 with those on day 14 showed a highly statistically significant difference (p < 0.001). The degree of malaria parasitaemia was not significantly related to the level of platelet count. Transient thrombocytopenia is very common in uncomplicated malaria in semi -immune adults. The mechanism, aetiology, and clinical relevance of the phenomenon deserve further studies.

Ocular findings in sickle cell disease patients in Lagos.

Sickle cell disease has varied manifestations in all systems of the body, ocular manifestations can be severe and sudden blindness may result amidst other complications. The study aims at determining the ocular findings in patients with sickle cell anaemia (HbSS) and sickle cell haemoglobin C disease (HbSC). 99 subjects were recruited into the study carried out at the Lagos University Teaching Hospital over a 2 year period. A structured interview questionnaire was administered and physical examination was carried out at the Medical Out Patients' Sickle Cell Clinics. Subsequently in the (Guinness) Eye centre, examination for ocular manifestations was carried out using Snellen's chart, Slit light microscopy, direct and indirect ophthalmoscopy under mydriasis (with Gutt Tropicamide 1% , epinephrine 10% ) as well as tonometry and gonioscopy. The age of the 99 (51 males, 48 females) patients ranged from 13 to 43 years with a mean +/-SD of 20.42 +/- 6.13. There were 88 (88.9% ) SS and 11 (11.1% ) SC patients. The male to female ratio was 1.1: 1. Normal vision was present in 95 (96% ) of the patients [86 (97.8% ) SS and 9 (81.8% ) SC] while 4 (4.0% ) of the patients [2 (2.2% ) SS and 2 (18.2% ) SC] had impaired vision. Of the complaints, blurred vision was found in 12 (13.6% ) SS and one (9.0% ) SC patients. Itching of the eyes was found in 15 (17.0% ) SS and 3 (27.3% ) SC patients. Icterus was found in 50 (50.5% ), conjunctival signs were found in 49 (49.5% ), retinal vascular tortuosity was in 12 (12 .10% ), peripheral retinal degeneration was in 5 (5% ), iridescent spots was in 3 (3% ) and optic atrophy in 2 (2% ) patients. The tortuosity of major fundus vessels were graded into 4 according to Hook and Cooper's criteria 87 (87.9% ) of the patients were in grade 0. The conjunctival vessels anomalies were classified into 5 grades (criteria of Sergeant). 37 (37.5% ) were in grade 0, 35 (35.3% ) in grade 1, 8 (8.1% ) in grade 2, 7 (7.1% ) in grade 3 and 12 (12.1% ) in grade 4. Conjunctival abnormalities occur commonly while proliferative retinopathy and optic atrophy were uncommon in sickle cell disease patients in Lagos. Further studies are required with a larger number of subjects to investigate the low incidence of proliferative retinopathy and optic atrophy in Lagos.

Chronic liver disease in Lagos: a clinicopathological study.

OBJECTIVE: To evaluate the clinical features and stage of chronic liver disease at presentation in Lagos. METHODS: Clinical features, hepatic functional reserve (Child-Pugh classification) and liver histopathology were evaluated in 74 patients with chronic liver disease (CLD). RESULTS: The average age of the patients was 44.1 +/- 14yr and most (57, 67% ) were male. Ascites, hepatomegaly and jaundice were noted in 66%, 51%, 47% respectively. Hepatocellular carcinoma, liver cirrhosis and chronic hepatitis were seen in 35, 29, and 10 patients respectively. Significant impairment of hepatic functional reserve was noted in most of the patients with liver cirrhosis (76% ) and carcinoma (68% ). Hepatitis B and C infections were identified in 58% and 12% of the patients respectively. CONCLUSION: The majority of clinically identified patients with CLD had severe impairment of hepatic function with underlying advanced liver cirrhosis or hepatocellular carcinoma at presentation. Viral hepatitis was associated with most CLD and thus is potentially preventable and treatable when detected early. Public enlightenment programmes on hepatitis, widespread implementation of HBV vaccination, and surveillance of individual at-risk are essential for the control of hepatitis infection and the early detection of compensated CLD.

Low genetic diversity despite hyperendemicity of hepatitis B virus genotype E throughout West Africa.

Sub-Saharan Africa suffers from an excessively high endemicity of hepatitis B virus (HBV), but little is known about the prevalent genotypes. In this study, we investigated the PreS1/PreS2/S genes of 127 viruses obtained from 12 locations in Mali, Burkina Faso, Togo, Benin, Nigeria, Cameroon, and the Democratic Republic of Congo. Except for those obtained from the Cameroon HIV cohort (18/22 HBV genotype A), 96 of 105 sequences belonged to HBV genotype E (HBV/E), and viral DNA was very similar (1.67% diversity) throughout this vast HBV/E crescent, which spans 6000 km across Africa. The low diversity suggests that HBV/E may have a short evolutionary history. Considering a typical mutation rate of DNA viruses, it would take only 200 years for the strain diversity of HBV/E viruses to develop from a single introductory event. The relatively recent introduction of HBV/E into humans would also explain its conspicuous absence in the Americas, despite the forced immigration of slaves from west Africa, until the early 19th century. Infection during infancy is mostly associated with chronic carrier status, and this combination can account for the explosive spread of virtually identical viruses within a community, but whether other routes of long-range transmissions must be considered becomes an important question.

Hepatitis C virus infection in patients with sickle cell anaemia at the Lagos University Hospital.

The objective of this studies is to determine the frequency of antibodies to Hepatitis C virus (anti-HCV), (2) assess the role of blood transfusion in transmission of infection, and (3) evaluate the clinical implication of anti-HCV sero-positivity in patients with Sickle cell anaemia (SCA). Two hundred and seventy-eight (278) patients with SCA were evaluated by questionnaire interviews for risk factors, clinical examination and serum testing for anti-HCV using a third generation ELISA kit. The overall anti-HCV prevalence was 5.0% (14/278). Anti-HCV was positive in 7% (5/76) of never transfused compared with 5% (9/202) of previously transfused sicklers. (p = 0.5). Clinically, splenomegaly alone or in combination with hepatomegaly was associated with a positive anti-HCV (p = 0.04 and 0.01 respectively). Anti-HCV was detected in 5% of adult patients with Sickle cell anaemia, especially in patients with persistent splenomegaly alone or in combination with hepatomegaly. Blood transfusion did not appear to be the major route of HCV transmission.