Open heart surgery: preliminary report of blood transfusion practice and haematological changes. Experience from a Nigerian tertiary teaching hospital.

AIMS AND OBJECTIVES: The study aimed at reviewing the utilisation of blood / blood products and haematological profile changes, with a view to developing a hospital transfusion guideline in open heart surgery in Nigeria. MATERIALS AND METHODS: The surgeries were performed at the intensive care unit theatre of Lagos State University Teaching Hospital. Eligibility for surgery was determined by the Cardiologist and the cardiovascular Surgeon based on clinical presentation, electro- and echocardiography assessments among other tests. Fourteen open-heart surgeries were conducted. Blood products demand for different procedures and several peri-operative laboratory parameters such as full blood count, and coagulation profile were determined. RESULTS: The greatest demand for blood products was found in valvular surgery and atrial septal defect (ASD) where a mean of four units of red cell concentrate, fresh frozen plasma and cryoprecipitate were transfused. Other surgeries such as, patent ductus arteriosus, Tetralogy of Fallot did not require much transfusion of blood products. Overall, the pre-operative and post-operative haematocrit, white cell count, platelet count, and international normalized ratio (INR) mean were 37% /25%,4.9 X 10 9/L / 11.4 X 10 9/L, 182 X 10 9/L/ 97 X 10 9/L, and 1.15/ 2.2 respectively. CONCLUSION: It appears that transfusion requirement in most open heart surgeries aside from valvular surgery and atrial septal defect (ASD) repair, is minimal. Patients for valvular heart surgeries and ASD repair should be evaluated for possible autologous blood transfusion.

Chest X- ray findings in HIV patients in relation to the CD4 count.

BACKGROUND: CD4 count measures the degree of immunosupression in HIV-infected patients. Immunosupression results in lack of ability of the body to fight infections thus predisposing the individual to infection; lung is one of the most susceptible organs. An important diagnostic tool in assessing the respiratory complications as well as the manifestations of HIV infection is the chest radiograph. OBJECTIVE: This study is aimed at determining the radiological features seen on chest radiographs of HIV/AIDS patients in relation to their corresponding CD4 count which is a measure of immunosupression. METHODS: This study was conducted at Lagos State University Teaching Hospital (LASUTH) HIV clinic between September 2009 and August 2010 amongst all consenting registered HIV/AIDS patients. A total of one hundred and six consenting participants were recruited consecutively into the study, their blood samples were collected for CD4 count assay, and all the participants were sent for chest xray in the radiology department. They were asked to fill the structured questionnaire to obtain demographic data. RESULTS: More than three-quarters, 87(82.1%) had a normal chest radiographs. The abnormal findings included 13 cases of (12.3%) pulmonary tuberculosis, 3(2.8%) having bronchopneumonia, and 3(2.8%) lobar pneumonia. Majority, 32 of 87 of those with normal chest-x ray had CD4 count <100 cells/il while about half of the patients with pulmonary tuberculosis (5 of 13) had CD4 count >350 cells/il. All the three patients who had lobar pneumonia had CD4 count between 200-350 cells/il, while 2 of 3 patients with bronchopneumonia had CD4 counts between 200-350 cells/il, only 1 of them had CD4 of 100-200 cells/il CONCLUSION: About three-quarters of HIV-infected patients had normal chest radiographs, majority of those with normal chest x-ray were severely immunocompromised. While almost half of those with pulmonary tuberculosis had CD4 count >350 cells/il. The CD4 count level may not be an indicator of pulmonary infection.

A preliminary study of the frequency of focal neurological deficits in HIV/AIDS patients seropositive for Toxoplasma gondii IgG in Lagos, Nigeria.

BACKGROUND: Cerebral toxoplasmosis is a common cause of focal neurologic deficits in HIV/AIDS. Financial constraints and access to neuroradiological facilities limit definitive diagnosis and first-line treatments are largely expensive and cumbersome. OBJECTIVE: This study examined the frequency of focal neurological signs in HIV/AIDS patients with positive Toxoplasma gondii IgG antibodies (and thus at high risk of reactivation), and the relationship to CD4 count. METHODS: Using a case-control design, T. gondii IgG serology was determined in 83 HIV/AIDS patients on HAART and 42 HIV seronegative controls. Neurological evaluation and CD4 count (mm3) was conducted in all subjects. RESULTS: A total of 71 (85.5%) HIV/AIDS patients were seropositive for T. gondii IgG. The IgG seroprevalence was 84.8% for cases with CD4 count < 200 and 86.0% with CD4 < or = 200 (P = 0.46). Of the cases with positive Toxoplasma antibodies, the frequency of neurological lateralizing signs was higher in those with CD4 count < 200 (32.6%) compared to persons with CD4 count > or = 200 (7.1%) (chi2 = 4.90, Fisher exact P <0.01). The mean CD4 count of cases with lateralizing signs was 113.7 +/- 113.9 in contrast to 254.0 +/- 218.9 in those without lateralizing signs (P < 0.01). CONCLUSION: In our study, a higher frequency of focal neurological signs was found in the T. gondii seropositive HIV/AIDS patients with a higher degree of immune compromise (CD4 count < 200). We suggest the adoption of routine prophylactic anti-toxoplasma therapy in this subgroup given that cerebral toxoplasmosis is a leading cause of intracranial space occupying lesions in HIV/AIDS.

Seroprevalence of hepatitis C infection in HIV patients using a rapid one-step test strip kit.

BACKGROUND: Hepatitis C virus (HCV) and HIV are transmitted via similar routes making co-infection with these viruses a common event. In addition, HIV infection and related immunosupression in patients with hepatitis C may be associated with more rapid progression of liver disease to cirrhosis, end-stage liver disease and death. OBJECTIVE: The study is to determine the seroprevalence of HIV/HCV co-infection rate. METHODS: A cross -sectional study was carried out from January to March 2010 at the HIV clinic of the Lagos State University Teaching Hospital. About 5 mls of blood sample was collected from each consenting participant. Sera were subjected to HCV rapid kit as recommended by the manufacturer (Dia Spot HCV one step test strip). The descriptive data was given as means +/- standard deviation (SD). The chi-squared test was used for analytical assessment. The differences were considered statistically significant when P value obtained was < 0.05. RESULTS: The overall seroprevalence rate of HIV/HCV coinfection was 3.3%. Only 6 of 194 female HIV subjects screened tested positive for HCV (3.1%), while 3 of 73 male subjects tested positive for HCV (4.1%) (P value 0.001). None of the 9 co-infected HIV/HCV participants (both male and female) had CD4 count of 350 and above, 3 had a count of 1-100 cells/il., 4 had 100-200, while 2 had 201-350. CONCLUSION: There is the need to include hepatitis C screening routinely in all HIV-infected patients undergoing pre-HAART evaluation in HIV clinics in order to lower liver-related morbidity and mortality associated with them.