Assessment of gender differences in some inflammatory cytokines of tuberculosis patients before and during treatment.

Background: Gender variation is a feature of many physiological parameters including inflammatory cytokines. Inflammation is an obvious feature of Tuberculosis (TB) infection with changes in pro and anti-inflammatory cytokines. Objective: To compare the levels of inflammatory cytokines between male and female TB patients before treatment, after 2-months and after 6-months anti-tuberculosis treatment. Materials and methods: A total of 35 males and 25 females TB subjects were enlisted before initiation of therapy and followed up after 2-months and 6 months treatment and samples collected and analysed. Tumour necrosis factor-alpha (TNF-α), Interleukin 10 (IL-10, Interleukin -6 (IL-6), Interleukin-2 (IL-2), transforming growth factor-beta (TGF-ß) were assayed by ELISA method. Results: Before treatment, the median level of IL-6 (pg/ml) was significantly higher in males compared to female TB patients (P=0.046). While after 2-months treatment, TNF-α (pg/ml) and IL-10 (pg/ml) was significantly higher in males compared with females (P=0.008 and 0.045 respectively). Conversely, the median IL-6 (pg/ml) was significantly higher in female TB patients compared to the males (P=0.042). No significant differences were observed after 6-months treatment. Conclusion: Gender differences exist in IL-6 before treatment and in IL-6, TNF-α and IL-10 at two months treatment. Thus, TB treatment contributes differentially to levels of inflammatory cytokines in male and female TB patients.

Evaluation of the utility value of three diagnostic methods in the detection of malaria parasites in endemic area.

BACKGROUND: Malaria is a debilitating disease with high morbidity and mortality in Africa, commonly caused by different species of the genus Plasmodium in humans. Misdiagnosis is a major challenge in endemic areas because of other disease complications and technical expertise of the medical laboratory staff. Microscopic method using Giemsa-stained blood film has been the mainstay of diagnosis of malaria. However, since 1993 when rapid diagnostic test (RDT) kits were introduced, they have proved to be effective in the diagnosis of malaria. This study was aimed at comparing the accuracy of microscopy and RDTs in the diagnosis of malaria using nested PCR as the reference standard. Four hundred and twenty (420) venous blood specimens were collected from patients attending different General Hospitals in Ebonyi State with clinical symptoms of malaria. The samples were tested with Giemsa-stained microscopy and three RDTs. Fifty specimens were randomly selected for molecular analysis. RESULTS: Using different diagnostic methods, the prevalence of malaria among the subjects studied was 25.95% as detected by microscopy, prevalence found among the RDTs was 22.90, 15.20 and 54.80% for Carestart, SD Bioline PF and SD Bioline PF/PV, respectively. Molecular assay yielded a prevalence of 32%. The major specie identified was Plasmodium falciparum; there was co-infection of P. falciparum with Plasmodium malariae and Plasmodium ovale. The sensitivity and specificity of microscopy was 50.00 and 70.59% while that of the RDTs were (25.00 and 85.29%), (25.00 and 94.12%) and (68.75 and 52.94%) for Carestart, SD Bioline PF and SD Bioline PF/PV, respectively. Cohen's kappa coefficient was used to measure the level of agreement of the methods with nested PCR. Microscopy showed a moderate measure of agreement (k = 0.491), Carestart showed a good measure of agreement (k = 0.611), SD Bioline PF showed a fair measure of agreement (k = 0.226) while SD Bioline PF/PV showed a poor measure of agreement (k = 0.172). CONCLUSIONS: This study recommends that the policy of malaria diagnosis be changed such that the routine diagnosis of malaria is done by a combination of both microscopy and a RDT kit of high sensitivity and specificity so as to complement the errors associated with either of the methods. The finding of P. ovale in the study area necessitates an expanded molecular epidemiology of malaria within the study area.

Normal pregnancy and coagulation profile: from the first through the third trimester.

BACKGROUND: Normal pregnancy is a hypercoagulable state; a physiological safety valve aimed at preventing excessive maternal blood loss at delivery. OBJECTIVE: To evaluate the influence of normal pregnancy on blood coagulation and to explore changes in activity from the first through the third trimester. SUBJECT AND METHODS: Sixty (60) apparently healthy pregnant women (20 from each trimester) and 20 healthy non-pregnant age-matched controls were recruited. Each participant had Prothrombin time (PT). Activated partial thromboplastin time (APTT) and platelet count done. Multiple comparisons were made between control values and coagulation profile at different stages of pregnancy using the Bonferroni statistics. Results were expressed as means and standard deviations, p < 0.01 was significant at 95 % CI. Ethical approval for the study was obtained from the Institutional review board. RESULTS: The means of the APTT were significantly lower in the first, second and third trimesters compared with controls (35.59 ± 4.95 seconds, 32.22 ± 5.79 seconds and 29.60 ± 3.66 seconds, respectively, vs. 40.55 ± 5.95 seconds; p = 0.01). Correspondingly, the platelet count was significantly lower in the 3 trimester of pregnancy compared with controls (178.35 ± 41.52 x 10(9)/L vs. 233.86 ± 55.34 x 10(9)/L; p < 0.01) and equally with level in the 2nd trimester (178.35 ± 41.52 x 10(9)/L vs. 232.10 ± 48.67 x 10(9)/L; p < 0.01). CONCLUSION: The APTT and platelet counts are significantly lower in the 3 trimester of normal pregnancy.

Evaluation of serum ferritin levels and blood counts in apparently normal individuals in Nnewi, South-east Nigeria.

INTRODUCTION: Serum ferritin levels as well as blood counts are variously affected in diverse disease conditions, particularly those characterized by inflammation. OBJECTIVE: To evaluate the relationship between serum ferritin levels and blood counts in apparently healthy Nigerian subjects. SUBJECTS AND METHODS: Five (5ml) of venous blood was collected for full blood count, malaria parasite, serum ferritin and C- reactive protein (CRP) estimation from 88 apparently healthy subjects. Those positive for malaria parasite (on blood film examination) or had elevated serum CRP were excluded. Statistical analysis was performed with SPSS version 16; (SPSS Inc., Chicago IL). Associations were tested between parameters using Pearson's correlation, set at a coefficient of p < 0.05. Ethical approval was obtained from the Institutional Review Board and all participants gave informed consent. RESULTS: The median, mean and modal ages of subjects were 23.50 years, 25.25 years and 16.00 years, respectively while the mean packed cell volume (PCV), total white blood cell (TWBC), platelet count and serum ferritin level were 0.37L/L, 7.10 x 10(9)/L, 246.39 x 10(9)/L and 18.35 ng/ml, respectively. Age of subjects varied significantly with serum ferritin, platelet count and TWBC (p > 0.05). The PCV, platelet count and TWBC varied significantly across the different age groups of the study population (p < 0.05), likewise the PCV in males, compared to females (p < 0.05). CONCLUSION: Serum ferritin level in our apparently healthy subjects is lower than previously reported but did not vary significantly with blood counts.

HEMATOLOGICAL INDICES IN AUTOMOTIVE TECHNICIANS IN NNEWI, SOUTH-EAST NIGERIA.

BACKGROUND: Occupational exposure to petroleum products is known to be associated with a number of health risks as well as adverse effects on haematological indices. OBJECTIVE: To evaluate the effect of exposure to petroleum products on haematological parameters in automobile mechanics in Nnewi, south-east Nigeria. SUBJECTS AND METHODS: Fifty (50) automobile technicians and 50 healthy controls participated in the study. Full blood count was performed for each participant using the automated Sysmex haemocytometer (Model PCE 210) while data analysis was done using the SPSS (statistical package for social sciences) version 16 computer soft ware (Chicago, IL, Inc.). Results were expressed as frequencies, means and standard deviations; comparison of haematological parameters was made between subjects and controls and at different durations of exposure using the students' t-test and analysis of variance (ANOVA), respectively. The level of statistical significance was p < 0.05 (at 95% CI). Ethical approval was obtained from the Institutional review board and all participants gave informed consent. RESULTS: There red blood cell count (RBC) and haematocrit were significantly lower while the platelet count was significantly higher in test subjects compared with controls (p values; 0.04, 0.03 and 0.01, respectively). Correspondingly, the mean cell volume (MCV) and mean cell haemoglobin (MCH) were significantly lower in test subjects compared with controls (p = 0.62 and 0.03, respectively). The red cell count, MCV and platelet count significantly decreased with increasing duration of work exposure (p = 0.001, respectively). CONCLUSION: Occupational exposure to petroleum products adversely affects blood counts, with a significant decrease in RBC, MCV and platelet count as duration of exposure increases.

Degrees of kidney disease in nigerian adults with sickle-cell disease.

OBJECTIVE: To study degrees of chronic kidney disease (CKD) using creatinine clearance in adult Nigerian patients with sickle-cell disease (SCD). METHODS: One hundred SCD patients, made up of 79 HbSS (homozygous haemoglobin S) patients and 21 HbSC (heterozygous haemoglobins S and C) patients, were investigated prospectively, along with 50 normal controls. Their sociodemographic data, weight and drug history were documented. Each participant underwent dipstick urinalysis, and creatinine clearance was calculated following a 24-hour urine collection and serum creatinine measurement. They were categorized into stages of CKD based on the creatinine clearance. RESULTS: Of the 79 HbSS patients, 14 (18%), 28 (35%), 33 (42%) and 4 (5%) had stage 1, 2, 3 and 4 CKD, respectively. In the HbSC group, 3 (14%), 9 (43%) and 9 (43%) patients had stage 1, 2 and 3 CKD, respectively. Proteinuria was noted in 16 (20%) HbSS patients but not in any of the HbSC patients. Of the subjects aged ≤24 years (n = 49), 9 (18%), 18 (37%), 21 (43%) and 1 (2%) had stage 1, 2, 3 and 4 CKD, respectively. Of those aged >24 years (n = 51), 8 (16%), 19 (37%), 21 (41%) and 3 (6%) had stage 1, 2, 3 and 4 CKD, respectively. None of the subjects had stage 5 CKD. CONCLUSION: In this study, the adult subjects with SCD had various degrees of CKD. Adequate follow-up and active intervention are advocated to delay the onset of end-stage nephropathy.