Aetiological Spectrum of Pancreaticobiliary Diseases in Adult Nigerians on Magnetic Resonance Cholangiopancreatography.

BACKGROUND: Imaging is vital for assessing pancreaticobiliary diseases. AIM: The aim of the study was to investigate the spectrum and pattern of pancreaticobiliary diseases in adult Nigerians using magnetic resonance cholangiopancreatography (MRCP). METHODS: This was a retrospective, descriptive cross-sectional study. The electronic radiological records of 110 adult Nigerians who had undergone MRCP were reviewed. The MRCP images were evaluated for bile duct dilatation, intraluminal filling defects, strictures, calculi, and other abnormalities. RESULTS: There were 45 males (40.9%) and 65 females (59.1%) aged 18-83 years, with a mean age of 51.93 ± 15.22 years. Jaundice (59.1%) and right hypochondrial pain (31.8%) were the most common presenting complaints. Gallstones (32.7%), common bile duct strictures (15.5%), choledocholithiasis (11.8%), pancreatic head carcinoma (10.9%), and gallbladder carcinoma (2.7%) were the most frequent abnormalities. There was biliary obstruction in 56.4% of participants, mostly at the distal and proximal common bile duct. Other findings include hepatomegaly (23.6%), hepatic cysts (6.4%), hepatic steatosis (0.9%), duodenal wall thickening (1.8%), and ascites (5.5%). MRCP was normal in 25 (22.7%) participants. CONCLUSION: Gallstones were the predominant pathology of the various pancreaticobiliary diseases, while Pancreatic head and gallbladder carcinoma were the most common malignant diseases.

A case report of T cell prolymphocytic leukemia and Kaposi sarcoma and a review of T cell prolymphocytic leukemia.

T cell prolymphocytic leukemia (T-PLL) is a rare mature T cell lymphoproliferative disease. It has been associated with an aggressive course, a poor response to conventional chemotherapy and a short median survival. Here we present a rare case of concurrent T-PLL and Kaposi sarcoma who achieved a complete hematologic and cytogenetic remission after a very short course of treatment with alemtuzumab. A review of T-PLL was done. In this review, clinical features, laboratory features and current therapeutic strategies of T-PLL are presented.

Evaluation of in ovo feeding of low or high mixtures of cysteine and lysine on performance, intestinal morphology and physiological responses of thermal-challenged broiler embryos.

The objective of this study was to evaluate the effect of in ovo feeding cysteine, lysine or their combinations on the perinatal and post-hatch physiological responses of broiler embryos exposed to heat stress during incubation. A total of two thousand fertile eggs of broiler breeders (Ross 308) flock (at 38 weeks of age) were used for this study. In the first 10 days, the eggs were incubated using the conventional protocol of relative humidity and temperature of 55% and 37.8°C respectively. From day ten onward, the temperature was increased to 39.6°C for 6 h per day. On day 17.5, 1,500 eggs with the evidence of living embryos were randomly selected and assigned to 6 treatments having five replicates of 50 eggs each. The treatments were: un-injected eggs (UI), eggs injected with only 0.5 ml distilled water (DW), 3.5 mg/egg cysteine (CY), 2mg/egg lysine (LY), 3.4 mg cysteine+2 mg lysine (CLH) and 1.7 mg cysteine+1 mg lysine (CLL). On day 21, the hatchability, anatomical characteristics, chick quality and the antioxidant status of the chicks were evaluated. During the post-hatch phase, data were collected on the haematology, biochemical parameters, growth performance and intestinal morphology of the birds. The results revealed that the hatchability of CY chicks was higher (p < 0.05) than in the other treatments, while the lowest values were recorded in CLH. The hatching muscle of the chicks of CLL was similar to those of CY but higher (p < 0.05) than the others. The MDA of DW and UI chickens was similar and higher than birds in the other treatment groups. The serum SOD of CLL birds was comparable to that of CY but higher than the values recorded in the other treatments. The final weights of CLL chickens were similar to those of LY but significantly higher (p < 0.05) than those of the other treatments. The duodenal villus heights of the birds of CLL were higher than those of the other treatment groups, whereas the villus height of the birds of CLH was higher than those of UI, DW and CY. Overall, in ovo feeding of cysteine alone improved the hatchability of thermally-challenged broiler embryos. In contrast, a low-dose mixture of cysteine plus lysine improved the post-hatch growth performance.

Using serial haemorheological parameters to assess clinical status in sickle cell anaemia patients in vaso-occlussive crisis.

In a prospective study using standard methods, haemorheological parameters were assessed in 10 sickle cell anaemia patients in pain crises. Patients were investigated for possible changes in determinants of rheology in the course of painful episodes: blood samples were taken for plasma fibrinogen concentration (PFC); plasma viscosity (PV); haematocrit (Hct), whole blood viscosity (WBV) and the erythrocyte sedimentation rate (ESR) using standard methods. Samples were collected on presentation to the emergency unit and daily for 4 consecutive days. Whole blood viscosity and plasma fibrinogen concentration were significantly higher at onset of crises when compared with baseline values (p<0.01 and p<0.0001), respectively. Plasma fibrinogen and blood viscosity peaked within 24 h of onset of crisis and started declining 48-72 h later. These parameters approached baseline values by the 4th day of painful crisis.There was no significant change in the haematocrit and the erythrocyte sedimentation rate during the period of painful crisis despite change in whole blood viscosity and fibrinogen. In conclusion, this study showed elevated haemorheological parameters in sickle cell anaemia patients in VOC, it also demonstrated an acute rise in these parameters at onset of crisis and a return to almost baseline levels within 96 h of onset of painful episodes.

Haematological influences of potassium adaptation in normotensive and renally-hypertensive Wistar rats.

Dietary potassium is known to cause reduction in blood pressure in several models of hypertension in human and animal studies but its haematological effects are not known. Here, experiments are designed to study the haematological effects of potassium adaptation (achieved by administering 0.75% KCl solution in drinking water for five weeks) in Wistar rats. The animals are divided into four groups comprising controls, potassium-adapted, renal hypertensive, and renal hypertensive with later adaptation to potassium. Packed cell volume (PCV) and platelet count (PC), whole blood and plasma viscosities, and platelet aggregation in the presence of sodium nitroprusside, levcromakalim, and glibenclamide, are studied. Results showed comparable PCV and PC in all groups. While relative whole blood viscosity was significantly higher (P<0.05) in the hypertensive group, relative plasma viscosity was similar in all groups. Adaptation significantly reduced (P<0.05) the tendency of platelets to aggregate to collagen. Sodium nitroprusside significantly reduced (P<0.05) the pro-aggregatory effects of collagen only in the control group. Neither of the potassium-channel modulators (levcromakalim, glibenclamide) caused any significant alteration in platelet response to collagen at the concentrations studied. Although these results suggest that potassium adaptation may not affect haemorheology, the reduced ability of platelets to aggregate--by mechanisms not clearly understood--has implications for reduced thromboembolism and the attendant cardiovascular sequelae.

Risk factors and seroprevalence of hepatitis C antibody in blood donors in Nigeria.

OBJECTIVE: To determine risk factors and sero-prevalence of hepatitis C virus antibody (anti-HCV) in blood donors in Nigeria. DESIGN: A descriptive study was performed on 260 healthy blood donors. Sera were screened for anti-HCV, using enzyme linked immuno-absorbent assay. Personal information and risk factors associated with positive anti-HCV was volunteered by the study subjects using a questionnaire. SETTING: Blood Bank of the University of Benin Teaching Hospital, Benin, Nigeria. SUBJECTS: Two hundred and sixty healthy volunteer male donors aged 20-54 years. RESULTS: Anti-HCV prevalence rate was 12.3%. Fifty six point six per cent of the anti-HCV positives were in the 41-50 year age group. There was an association between anti-HCV positive and history of exposure to heterosexual partners at risk, history of sexually transmitted disease; low socio-economic status and hepatitis B surface antigen positivity. CONCLUSION: The prevalence rate was 12.3%; this was the highest reported among volunteer blood donors in Nigeria. In order to reduce the spread of hepatitis C virus, we recommend elimination of donors with risk factors identified as being associated with anti-HCV. The introduction of cost effective screening and public education on the epidemiology of anti-HCV, is also recommended.

Cobalamin status in sickle cell disease.

INTRODUCTION: Some studies comparing serum cobalamin in individuals with and without sickle cell disease (SCD) have suggested a higher prevalence of cobalamin deficiency in SCD but others have not. Our aim was to prospectively compare cobalamin status in African-Americans with and without SCD. METHODS: We analyzed blood samples from 86 subjects in two groups: SCD (n = 29) and non-SCD (n = 57). Serum cobalamin, folate, homocysteine, methylmalonic acid (MMA), anti-intrinsic factor antibody, Helicobacter pylori antibody, and gastrin were measured and compared. RESULTS: The median cobalamin was 235 pM in the SCD group vs. 292 pM in the non-SCD group (P-value = 0.014). No significant differences in MMA or homocysteine were seen. Using the criteria of a low cobalamin and an elevated MMA or an elevated MMA alone, cobalamin deficiency was suggested in 4 (13.8%) in the SCD group and 6 (10.5%) in the non-SCD group. Two of these SCD patients and four of these control subjects had chronic renal disease, which may lead to elevated MMA in the absence of cobalamin deficiency. The remaining four met criteria for cobalamin deficiency, 2 (6.9%) in the SCD group and 2 (3.5%) in the non-SCD group (P = 0.6). CONCLUSION: A lower cobalamin was observed in SCD patients without a higher prevalence of cobalamin deficiency. The inclusion of haptocorrin and holotranscobalamin measurement in future studies may provide a better assessment of cobalamin status in this patient group.

Thirst perception and drinking in euhydrate and dehydrate human subjects.

Studies on how the body senses the need to correct extracellular and intracellular volumes and ionic concentration changes is relatively scanty. The present studies were designed to determine the effect of oral distilled water (DW) and saline loads, gargling with DW and DW preload on thirst perception (TP) and drinking in euhydrate and dehydrated subjects. The subjects were healthy male volunteers between the ages of 17 and 35 years. Group A subjects were given DW or various concentrations of sodium chloride [NaCl] orally. Subjects in groups B, C and D were dehydrated for 18 hours before the experiment. Group B gargled 500 ml of DW in divided volume of 50 ml at five minutes interval over a period of 50 minutes. Group C gargled with DW and different concentrations of NaCl. Group D were preloaded with four volumes of DW before ad libitum DW intake. TP was rated using the Visual Analogue Scale. Results showed that in Group A, drinking DW reduced TP, suggesting that baseline TP in normal euhydrate subjects is slightly elevated. Drinking DW reduced TP more than drinking NaCl solutions. Gargling resulted in a gradual fall in TP. The decrease in TP was statistically significant after 30 minutes of gargling. Gargling with different concentrations of NaCl solutions resulted in significant reductions in TP in all the groups. There was a significant decrease in TP in the group preloaded with 1000 ml of distilled water at 5 minutes of rehydration. At 20 minutes TP was abolished suggesting that approximately 1000 ml of water was needed for the rehydration. These results show that baseline TP in euhydrates is elevated and that TP increases in dehydrated subjects. Gargling reduces TP, but did not abolish thirst. It is suggested that a fall in plasma osmolality due to drinking may be responsible for abolishing thirst.

Thirst perception in dehydrated sickle cell disease patients in steady state.

Liberal fluid intake is one of the key management strategies in sickle cell anaemia [SCA] patients in steady state, but less work has been done on the desire of patients to drink water. Using the Visual Analogue Scale we studied thirst perception [TP] in 20 euhydrated SCA patients and 28 control [HbA] subjects, as well as during dehydration in 13 SCA patients and 9 HbA subjects. Serum and urine samples were collected and analyzed for Na, K ions, creatinine concentrations and haematocrit and specific gravity of urine were determined. During euhydration, TP was significantly [P<0.05] higher in male SCA patients compared to the HbA subjects. In females, TP in SCA patient was not statistically significant compared with HbA subjects. After 13 hours of dehydration, TP was significantly [P<0.05] reduced in female. While dehydration increased TP in HbA subjects, it reduced TP in SCA patients. Fluid intakes after dehydration in SCA patients were not significantly different from the control HbA subjects in both male and female. It can be concluded that female SCA patients do not have normal response to dehydration with regards to TP after a period of dehydration. Since dehydration stimulates the release of vasoactive hormones like vasopressin, this may explain why female patients are less prone to crisis than their male counterparts.

Vascular effect of ketamine in isolated rabbit aortic smooth muscle.

The precise mechanism by which ketamine induces relaxation of vascular smooth muscle is not clear. The goal of this study was to further characterize the vascular actions of ketamine in rabbit aortic smooth muscles. Ring segments (2mm) of rabbit aortae were suspended in 20ml organ baths containing physiological salt solution (PSS) and isometric contractions were recorded at 37 degrees C and pH 7.4. The medium was bubbled with O(2) 95 % and CO(2) 5 % mixture and rings were given an initial load of 2g. An equilibration period of 90 minutes was allowed. Three protocols were examined: (a) Effect of ketamine on baseline tension (b) relaxation-responses to ketamine following precontractions induced by 10(-7)M phenylephrine or high K(+) (40mM) PSS and (c) influence of presence or absence of endothelium on the relaxation response to ketamine. Ketamine produced relaxation of contractile responses induced by both phenylephrine and high K(+). The respective maximum relaxation responses induced by ketamine following precontractions by phenylephrine and high-K(+) were 76.8 +/- 2.3 and 71.2 +/- 8.0 (p > 0.05). Ach-induced relaxation was observed only in rings with intact endothelium whereas ketamine-induced relaxation was observed in intact as well as endothelium-denuded rings; this suggests that ketamine-induced relaxation of rabbit aortic smooth muscle is independent of vascular endothelium.

Rheological variations among Nigerians with different hemoglobin genotypes

A total of one hundred and Forty-five (145) subjects comprising of 50 homozygous Hemoglobin A subjects (HbAA); 50 heterozygous hemoglobin AS (HbAS) subjects and 45 homozygous hemoglobin S (HbSS) subjects were recruited for this study with a view to ascertain variations in the Hemorheological values possibly associated with the inherited hemoglobin genotype. Some Hemorheological determinants such as whole blood viscosity (WBV) and plasma viscosity (PV) and Plasma Fibrinogen Concentration (PFC) were measured with standard methods. We recorded a relatively unchanged whole blood viscosities in subjects with various hemoglobin genotypes (AA; AS and SS; P0.05; respectively). Also; there were no significant differences in PV values of HbAA and HbAS while there were significant increases in PV and PFC of HbSS compared with others (P0.05; respectively). However; relative erythrocyte viscosity (REV) of HbSS became significantly reduced when repeated with saline after replacing plasma with saline (P0.05; respectively); to ascertain the erythrocytic cellular viscosity. We conclude that increased plasma viscosity coupled with that of PFC in HBSS could be due to plasmatic components and that cellular rheologic properties of the erythrocytes may be dependent on its content of hemoglobin while whole blood viscosities are stable in native blood irrespective of haemoglobin genotypes