Acute chest syndrome in sickle cell anaemia: higher serum levels of interleukin-8 and highly sensitive C-reactive proteins are associated with impaired lung function.

BACKGROUND: Sickle cell anaemia (SCA) is a chronic inflammatory disorder with multiple organ manifestations including acute and long-term pulmonary dysfunction. AIMS/OBJECTIVES: To assess lung function of children with SCA and determine the possible role of acute chest syndrome (ACS), serum inflammatory cytokines, highly sensitive C-reactive protein (hs-CRP), leucocytes and 25-hydroxyvitamin D on the development of impaired lung function. SUBJECTS AND METHODS: Lung function of 76 children with SCA was determined by spirometer and classified into normal or impaired. Sociodemographic, clinical, haematological, biochemical and immunological data of the two groups were compared by univariate and multivariate analyses. RESULTS: Fifty (65.8%) patients had impaired lung function, comprising of 30.3%, 3.9% and 31.6% with restrictive, obstructive and mixed disease patterns, respectively. Children with previous ACS were 3.6 times more likely to have impaired lung function than those without ACS (82.1% vs 56.3%, p = 0.02, OR 3.6, 95% CI 1.2-10.8). Interleukin (IL)-8 and hs-CRP were significantly higher in patients with impaired lung function (p = 0.02 and <0.001, respectively). Using logistic regression, previous ACS (OR 5.8, 95% CI 1.1-5.8, p = 0.03) and higher serum IL-8 levels (OR 3.0, 95% CI 1.0-8.0, p = 0.02) independently predicted the presence of abnormal lung function. CONCLUSIONS: Lung dysfunction, predominantly restrictive pattern, is common in SCA and is associated with previous ACS and alterations in immunological markers, especially serum IL-8 and hs-CRP. ABBREVIATIONS: ACS: acute chest syndrome; CBT: chronic blood transfusion; ELISA: enzyme-linked immunosorbent assay; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; HPLC: high-density liquid chromatography; hs-CRP: highly sensitive C-reactive proteins; HU: hydroxyurea; IL: Interleukin; PEFR: peak expiratory flow rate; SEM: standard error of the mean; TLC: total lung capacity; 25-OHD: 25-hydroxyvitamin D; VOC: vaso-occlusive crisis; WGH: Wesley Guild Hospital.

Cerebrospinal fluid and plasma ß-endorphin levels in children with cerebral malaria.

OBJECTIVES: Cerebral malaria (CM) is the most lethal form of malaria, yet its pathogenesis is not fully understood. Cytoadherence, sequestration, alterations in cytokine expression, inflammation, and microvascular obstruction are all hypothesized to be important in the aetio-pathogenesis of coma which characterizes cerebral malaria and the death which sometimes result. Beta (ß)-endorphin has been postulated to be involved in the pathogenetic processes of inflammation and cytokine expression, although the exact role is unknown. The aim of this study was to determine the levels of ß-endorphin in cerebrospinal fluid (CSF) and plasma of children with CM and compare the levels of ß-endorphin in the plasma of children with CM with that of apparently healthy age- and sex-matched controls at Ile-Ife, Nigeria. MATERIALS AND METHODS: Additional to the standard investigation for CM, CSF and venous blood samples were obtained from the subjects for the determination of ß-endorphin levels. RESULTS: Forty children with CM were studied along with forty age- and sex-matched controls. The mean CSF ß-endorphin (± SD) level for the children with CM was 1.8 ± 0.9 pmol/L. The mean plasma ß-endorphin levels at admission (3.1 ± 2.0 pmol/L) and discharge (4.1 ± 3.3 pmol/L) were higher in children with CM than in the control subjects (2.7 ± 0.7 pmol/L). However, only the mean plasma ß-endorphin levels at discharge was significantly higher than that of controls (p = .012). CONCLUSION: Children with CM had higher mean plasma ß-endorphin levels compared to the controls and there was increased production of ß-endorphins in children with CM during the course of the illness.

Relationship between foetal haemoglobin and haematological indices in children with sickle cell anaemia from South Western Nigeria.

BACKGROUND: Foetal haemoglobin (HbF, α2γ2) retards polymerisation of haemoglobin (Hb) in sickle cell anaemia (SCA). In Nigeria, studies on the levels of HbF and its relationship with haematological indices are scanty. This study evaluated HbF concentrations of children with SCA from Southwestern Nigeria and correlated the levels with various haematological indices. MATERIALS AND METHODS: HbF levels were quantified by high-performance liquid chromatography and haematological parameters determined with automated haemoanalyser. The relationship between steady-state HbF levels and blood parameters were assessed by statistical analyses. RESULTS: The mean HbF of the 91 children with SCA (9.6% ± 5.9%) was significantly higher than 0.5 ± 0.7% for the 91 age- and sex-matched controls, P < 0.001. About two-third of children with SCA, sixty (65.9%) had low HbF levels (HbF of < 10%) whereas about one-third, 31 (34.1%) had high HbF level (HbF of ≥ 10%). The mean Hb concentration, haematocrit (Hct) and total red blood cell count were significantly lower amongst children with SCA, whereas the total white blood cell (WBC) counts, neutrophils, monocyte and lymphocyte percent, platelet counts, mean corpuscular Hb (MCH) and MCH concentration were significantly higher. HbF had a positive but weak correlation with Hct (r = 0.24, P = 0.014), Hb concentration (r = 0.21, P = 0.047) and red cell distribution width (r = 0.25, P = 0.015) and an inverse correlation with WBC count (r = -0.23, P = 0.038). CONCLUSION: Children with SCA had higher levels of HbF than matched controls. HbF had an inverse correlation with the WBC count and direct relationship with Hct and Hb concentration. It is recommended that routine determination of HbF and its induction are essential to maintain optimal haematological state of patients with SCD.

Undernutrition and anaemia among HAART-naïve HIV infected children in Ile-Ife, Nigeria: a case-controlled, hospital based study.

INTRODUCTION: Case control studies that assess the burden and factors associated with undernutrition and anaemia among HAART naïve HIV infected children in Nigeria is very sparse. This will help to formulate nutritional programs among these children. METHODS: Seventy HAART naive HIV infected children aged 18 months and above were as well as seventy age and sex matched HIV negative children were recruited from August 2007 to January 2009 at Paediatric Clinic of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Their bio data, WHO clinical stage, anthropometric measurements, haematocrit, serum albumin and CD4 counts were taken with other parameters according to a study proforma. RESULTS: The prevalence of stunting, underweight and wasting among the HIV infected subjects were 48. 6%,58. 6% and 31. 4% respectively which as significantly higher than 28. 1%, 7. 1% and 28. 1% among the HIV negative controls. 20. 1% of the HIV infected children were marasmic compared to 2. 3% of the controls. Triple anthropometric failure was found in 7. 1% of the subjects as compared to none among the controls. Anaemia is significantly more prevalent among the subjects than the controls (70. 0% vs 31. 4%; p<0. 001). The prevalence of anaemia was higher in the HIV infected subjects with undernutrition. Low socioeconomic status, hypoalbuminemia and severe immunosuppression are significantly associated with higher undernutrition prevalence. CONCLUSION: Several years after availability of HAART, undernutrition and anaemia remain widely prevalent among newly presenting HAART naïve HIV infected Nigerian children. Nutritional supplementation and evaluation for anaemia still need close attention in the management of these children.