Assessment of biochemical liver function tests in relation to age among steady state sickle cell anemia patients.

BACKGROUND AND OBJECTIVE: Multiorgan failure including liver dysfunction is a common finding in sickle cell anemia (SCA) patients, the cause of which is multifactorial with advancing age said to be a major determinant. There is a paucity of data on liver function among SCA patients in relation to age in northern Nigerian hospitals, including Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. This study was to assess the biochemical liver function tests (LFTs) as they relate to age among SCA patients in steady state, with a view to improving the overall monitoring of these patients. SUBJECTS AND METHODS: This study was carried out in ABUTH, Zaria, Northern Nigeria. LFTs were carried out in 100 SCA and 100 apparently healthy participants (controls). The SCA group was made up of fifty adults and fifty children diagnosed of SCA, whereas the control group was made up of fifty adults and fifty children who were apparently healthy and had hemoglobin AA. Paired two-tailed Student's t-test for matched samples and Pearson's linear correlation statistical methods were employed for the data analysis using Microsoft Office Excel 2007. A P ≤ 0.05 was considered as statistically significant. RESULTS: The serum concentrations of total bilirubin (TB), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and AST/ALT ratio were significantly higher in SCA patients compared to the controls (P = 0.001, P = 0.001, P = 0.05, P = 0.05 and P = 0.001, respectively). Serum total protein (TP) and ALB were significantly lower (P = 0.01 and P < 0.05, respectively) in SCA patients compared with the controls. The levels of TB, ALT, AST, ALP, and AST/ALT were significantly lower in SCA adults compared to SCA children, whereas TP and ALB were higher in SCA adults compared to the SCA children. There were significant negative correlations between age and each of TB, ALT, AST, ALP, and AST/ALT, and significant positive correlations between age and each of TP and ALB in SCA patients. CONCLUSION: There are mild LFTs derangements in SCA patients even in steady state with the extent of the abnormalities decreasing with advancing age of the patients.

First record of Phlebotomine sandflies (Diptera: Psychodidae) in the Comoros Archipelago with description of Sergentomyia (Vattieromyia) pessoni n. sp. and S. (Rondanomyia) goodmani comorensis n. ssp.

No Phlebotomine sandflies had ever been reported in the Comoros Archipelago, including the three islands of the Republic of the Union of Comoros (Grande Comore, Mohéli and Anjouan) and the French oversea department of Mayotte. During three field surveys carried out in 2003, 2007 and 2011, we provided the first record of Phlebotomine sandflies in this area. A total of 85 specimens belonging to three species were caught: a new species S. (Vattieromyia) pessoni n. sp. (two females from Grande Comore), a new subspecies of Sergentomyia (Rondanomyia) goodmani (80 specimens from Grande Comore and one from Anjouan) and Grassomyia sp. (two females from Mohéli). The individualisation of these taxa was inferred both from morphological criteria and sequencing of a part of the cytochrome b of the mitochondrial DNA. These taxa are closely related to Malagasy sandflies.

Biochemical features of hepatic dysfunction in Nigerians with sickle cell anaemia.

AIMS AND OBJECTIVES: This study seeks to document the biochemical manifestations of liver dysfunction in Nigerians with sickle cell anaemia with the aim of alerting physicians on the need to consider these changes in the overall management of the disease condition. PATIENTS AND METHODS: Serum total proteins, albumin, bilirubin, alkaline phosphatase (ALP), alanine aminotransferase(ALT) and aspartate aminotransferase(AST) levels were estimated in 150 patients with sickle cell anaemia (HbSS) and 100 control (HbAA) subjects. RESULTS: The serum total proteins and albumin levels were found to fall within the reference intervals in both the HbSSpatients and the controls. However, the mean bilirubin (total and conjugated) levels and the activities of alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase were significantly higher (P<0.05) in the HbSSpatients than the control subjects. CONCLUSION: This study demonstrated elevated levels of serum bilirubin, ALP, ALT and AST in patients with sickle cell anaemia.

Seroprevalence of hepatitis B surface antigen among patients attending Aminu Kano Teaching Hospital, Kano.

OBJECTIVE: To study the seroprevalence of Hepatitis B viral (HBV), infection among patients attending Aminu Kano Teaching Hospital in Kano metropolis. PATIENTS AND METHOD: This is a retrospective study in which patients tested for hepatitis B virus using hepatitis B surface antigen (HBsAg) as a marker were reviewed over 3 years. A total of 6,395 patients comprising of 4,040 males and 2,355 females including adults and children were tested for HBsAg from January 2004 to December 2006. Over this period, 1509 sera were tested in 2004, 2,322 in 2005 and 2,564 in 2006. RESULTS: Among the 6,395 patients, 703 (11.4%) comprising of 240 (10.2%) females and 490 (12.1%) males were positive for HBsAg. The highest prevalence was seen at the extremes of life in which 19.4% and 16.9% were seen among patients below 10 years and above 50 years respectively. The yearly trend of HBV surface antigenemia was 220 (14.6%) in 2004, 235 (10.1%) in 2005 and 275 (10.7%) in 2006. CONCLUSION: We conclude that the prevalence of HBsAg among patients attending Aminu Kano Teaching Hospital, Kano is high and highest prevalence is seen at the extremes of life.

Seroprevalence of hepatitis B surface antigen among patients attending Aminu Kano Teaching Hospital, Kano.

BACKGROUND: Hepatitis B virus infection has become a global public health problem. In Nigeria, several studies from different parts of the country have confirmed the endemicity of the infection. This study seeks examine the seroprevalence of Hepatitis B viral infection among patients attending Aminu Kano Teaching Hospital in Kano metropolis. METHOD: This is a retrospective study in which patients tested for hepatitis B virus using hepatitis B surface antigen (HBsAg) as a marker were reviewed over 3 years. A total of 6,395 patients comprising of 4,040 males and 2,355 females including adults and children were tested for HBsAg from January 2004 to December 2006. Over this period, 1,509 sera were tested in 2004, 2,322 in 2005 and 2,564 in 2006. RESULTS: Among the 6,395 patients, 703 (11.4%) comprising of 240 (10.2%) females and 490 (12.1%) males were positive for HBsAg. The highest prevalence was seen at the extremes of life in which 19.4% and 16.9% were seen among patients below 10 years and above 50 years respectively. The yearly trend of HBV surface antigenemia was 220 (14.6%) in 2004, 235 (10.1%) in 2005 and 275 (10.7%) in 2006. CONCLUSION: We conclude that the prevalence of HBsAg among patients attending Aminu Kano Teaching Hospital, Kano is high and highest prevalence is seen at the extremes of life.

Serum fructosamine in the assessment of glycaemic status in patients with sickle cell anaemia.

AIM: To assess the usefulness of fructosamine in evaluating the glycaemic status in patients with sickle cell anaemia. METHOD: Serum fructosamine, glucose, albumin and bilirubin were measured in one hundred and fifty patients with sickle cell anaemia (HbSS), fifty poorly controlled diabetics and one hundred healthy control subjects. Fructosamine was assayed using the method of Johnson et al. RESULTS: None of the HbSS patients had hyperglycaemia. Serum fructosamine was significantly higher in the poorly controlled Diabetics compared to the HbSS patients and the Controls. The mean serum albumin levels were within the laboratory's reference interval in the three groups of subjects studied. There was no significant correlation between fructosamine and normal serum albumin in the three groups of subjects. Moderately raised serum bilirubin concentrations in the HbSS patients did not cause any significant interference in the assay of fructosamine in the patients. CONCLUSION: Serum fructosamine could be reliably employed as a measure of glycaemic status of patients with sickle cell anaemia with moderate hyperbilirubinaemia.

Serum lipids in women on oral contraceptives in Zaria-Nigeria.

AIM: To compare the serum lipid levels of women on two different types of oral contraceptives, norethindrone 0.5 mg/ethinyl oestradiol 0.035 mg and norgesterol 0.5 mg/ethinyl oestradiol 0.03 mg. METHOD: Serum total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride levels were estimated in two groups (A&B) of women. Group A were 35 women who had been on norethindrone 0.5 mg/ethinyl oestradiol 0.035 mg for over one year, while the group B were 35 women on norgesterol 0.5 mg/ethinyl oestradiol 0.03 mg for three months. Thirty five healthy, age- matched women not on oral contraceptive agent were used as controls. RESULTS: Significantly higher levels of serum total cholesterol and triglycerides were found in the group A women compared to the group B women. The mean HDL-cholesterol level was significantly higher in the group B women in the 2nd and 3rd months of therapy than in the controls. The LDL-cholesterol levels were statistically similar in the two groups of contraceptive users and the controls. The results obtained were within the reference interval established in our laboratory. CONCLUSION: The oral contraceptive containing norgesterol 0.5 mg/ethinyl oestradiol 0.03 mg was found to be better as it increased the levels of HDL-cholesterol more than the other lipids. It is not known if this finding will persist on long-term use of the oral contraceptive.

Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis.

BACKGROUND: Smoking is harmful to health. On average, lifelong smokers lose 10 years of life, and about half of all lifelong smokers have their lives shortened by smoking. Stopping smoking reverses or prevents many of these harms. However, cessation services in the NHS achieve variable success rates with smokers who want to quit. Approaches to behaviour change can be supplemented with electronic aids, and this may significantly increase quit rates and prevent a proportion of cases that relapse. OBJECTIVE: The primary research question we sought to answer was: What is the effectiveness and cost-effectiveness of internet, pc and other electronic aids to help people stop smoking? We addressed the following three questions: (1) What is the effectiveness of internet sites, computer programs, mobile telephone text messages and other electronic aids for smoking cessation and/or reducing relapse? (2) What is the cost-effectiveness of incorporating internet sites, computer programs, mobile telephone text messages and other electronic aids into current nhs smoking cessation programmes? and (3) What are the current gaps in research into the effectiveness of internet sites, computer programs, mobile telephone text messages and other electronic aids to help people stop smoking? DATA SOURCES: For the effectiveness review, relevant primary studies were sought from The Cochrane Library [Cochrane Central Register of Controlled Trials (CENTRAL)] 2009, Issue 4, and MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Health Management Information Consortium (HMIC) (Ovid) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost) from 1980 to December 2009. In addition, NHS Economic Evaluation Database (NHS EED) and Database of Abstracts of Reviews of Effects (DARE) were searched for information on cost-effectiveness and modelling for the same period. Reference lists of included studies and of relevant systematic reviews were examined to identify further potentially relevant studies. Research registries of ongoing studies including National Institute for Health Research (NIHR) Clinical Research Network Portfolio Database, Current Controlled Trials and ClinicalTrials.gov were also searched, and further information was sought from contacts with experts. REVIEW METHODS: Randomised controlled trials (RCTs) and quasi-RCTs evaluating smoking cessation programmes that utilise computer, internet, mobile telephone or other electronic aids in adult smokers were included in the effectiveness review. Relevant studies of other design were included in the cost-effectiveness review and supplementary review. Pair-wise meta-analyses using both random- and fixed-effects models were carried out. Bayesian mixed-treatment comparisons (MTCs) were also performed. A de novo decision-analytical model was constructed for estimating the cost-effectiveness of interventions. Expected value of perfect information (EVPI) was calculated. Narrative synthesis of key themes and issues that may influence the acceptability and usability of electronic aids was provided in the supplementary review. RESULTS: This effectiveness review included 60 RCTs/quasi-RCTs reported in 77 publications. Pooled estimate for prolonged abstinence [relative risk (RR) = 1.32, 95% confidence interval (CI) 1.21 to 1.45] and point prevalence abstinence (RR = 1.14, 95% CI 1.07 to 1.22) suggested that computer and other electronic aids increase the likelihood of cessation compared with no intervention or generic self-help materials. There was no significant difference in effect sizes between aid to cessation studies (which provide support to smokers who are ready to quit) and cessation induction studies (which attempt to encourage a cessation attempt in smokers who are not yet ready to quit). Results from MTC also showed small but significant intervention effect (time to relapse, mean hazard ratio 0.87, 95% credible interval 0.83 to 0.92). Cost-threshold analyses indicated some form of electronic intervention is likely to be cost-effective when added to non-electronic behavioural support, but there is substantial uncertainty with regard to what the most effective (thus most cost-effective) type of electronic intervention is, which warrants further research. EVPI calculations suggested the upper limit for the benefit of this research is around £ 2000-3000 per person. LIMITATIONS: The review focuses on smoking cessation programmes in the adult population, but does not cover smoking cessation in adolescents. Most available evidence relates to interventions with a single tailored component, while evidence for different modes of delivery (e.g. e-mail, text messaging) is limited. Therefore, the findings of lack of sufficient evidence for proving or refuting effectiveness should not be regarded as evidence of ineffectiveness. We have examined only a small number of factors that could potentially influence the effectiveness of the interventions. A comprehensive evaluation of potential effect modifiers at study level in a systematic review of complex interventions remains challenging. Information presented in published papers is often insufficient to allow accurate coding of each intervention or comparator. A limitation of the cost-effectiveness analysis, shared with several previous cost-effectiveness analyses of smoking cessation interventions, is that intervention benefit is restricted to the first quit attempt. Exploring the impact of interventions on subsequent attempts requires more detailed information on patient event histories than is available from current evidence. CONCLUSIONS: Our effectiveness review concluded that computer and other electronic aids increase the likelihood of cessation compared with no intervention or generic self-help materials, but the effect is small. The effectiveness does not appear to vary with respect to mode of delivery and concurrent non-electronic co-interventions. Our cost-effectiveness review suggests that making some form of electronic support available to smokers actively seeking to quit is highly likely to be cost-effective. This is true whether the electronic intervention is delivered alongside brief advice or more intensive counselling. The key source of uncertainty is that around the comparative effectiveness of different types of electronic interventions. Our review suggests that further research is needed on the relative benefits of different forms of delivery for electronic aids, the content of delivery, and the acceptability of these technologies for smoking cessation with subpopulations of smokers, particularly disadvantaged groups. More evidence is also required on the relationship between involving users in the design of interventions and the impact this has on effectiveness, and finally on how electronic aids developed and tested in research settings are applied in routine practice and in the community.

Clinical effectiveness and cost-effectiveness of stem cell transplantation in the management of acute leukaemia: a systematic review.

BACKGROUND: Acute leukaemia is a group of rapidly progressing cancers of bone marrow and blood classified as either acute myeloid leukaemia (AML) or acute lymphoblastic leukaemia (ALL). Haemopoietic stem cell transplantation (SCT) has developed as an adjunct to or replacement for conventional chemotherapy with the aim of improving survival and quality of life. OBJECTIVES: A systematic overview of the best available evidence on the clinical effectiveness and cost-effectiveness of SCT in the treatment of acute leukaemia. DATA SOURCES: Clinical effectiveness: electronic databases, including MEDLINE, EMBASE and the Cochrane Library, were searched from inception to December 2008 to identify published systematic reviews and meta-analyses. Cochrane CENTRAL, MEDLINE, EMBASE and Science Citation Index (SCI) were searched from 1997 to March 2009 to identify primary studies. Cost-effectiveness: MEDLINE, EMBASE, Database of Abstracts of Reviews of Effects (DARE) and NHS Economic Evaluation Database (NHS EED) were searched from inception to January 2009. STUDY SELECTION: Potentially relevant papers were retrieved and independently checked against predefined criteria by two reviewers (one in the case of the cost-effectiveness review). STUDY APPRAISAL: Included reviews and meta-analyses were critically appraised and data extracted and narratively presented. Included randomised controlled trials (RCTs) and donor versus no donor (DvND) studies were mapped to the evidence covered in existing systematic reviews and meta-analyses according to a framework of 12 decision problems (DPs): DP1 related to SCT in adults with AML in first complete remission (CR1); DP2 to adults with AML in second or subsequent remission or with refractory disease (CR2+); DP3 to children with AML in CR1; DP4 to children with AML in CR2+; DP5 to adults with ALL in CR1; DP6 to adults with ALL in CR2+; DP7 to children with ALL in CR1; DP8 to children with ALL in CR2+; DP9 to comparison of different sources of stem cells in transplantation; DP10 to different conditioning regimens; DP11 to the use of purging in autologous SCT; and DP12 to the use of T-cell depletion in allogeneic SCT. RESULTS: Fifteen systematic reviews/meta-analyses met the inclusion criteria for the review of clinical effectiveness, thirteen of which were published from 2004 onwards. Taking into account the timing of their publications, most reviews appeared to have omitted an appreciable proportion of potentially available evidence. The best available evidence for effectiveness of allogeneic SCT using stem cells from matched sibling donors came from DvND studies: there was sufficient evidence to support the use of allogeneic SCT in DP1 (except in good-risk patients), DP3 (role of risk stratification unclear) and DP5 (role of risk stratification unclear). There was conflicting evidence in DP7 and a paucity of evidence from DvND studies for all decision problems concerning patient groups in CR2+. The best available evidence for effectiveness of autologous SCT came from RCTs: overall, evidence suggested that autologous SCT was either similar to or less effective than chemotherapy. There was a paucity of evidence from published reviews of RCTs for DPs 9-12. Nineteen studies met the inclusion criteria in the cost-effectiveness review, most reporting only cost information and only one incorporating an economic model. Although there is a wealth of information on costs and some information on cost-effectiveness of allogeneic SCT in adults with AML (DPs 1 and 2), there is very limited evidence on relative costs and cost-effectiveness for other DPs. LIMITATIONS: Time and resources did not permit critical appraisal of the primary studies on which the reviews/meta-analyses reviewed were based; there were substantial differences in methodologies, and consequently quantitative synthesis of data was neither planned in the protocol nor carried out; some of the studies were quite old and might not reflect current practice; and a number of the studies might not be applicable to the UK. CONCLUSIONS: Bearing in mind the limitations, existing evidence suggests that sibling donor allogeneic SCT may be more effective than chemotherapy in adult AML (except in good-risk patients) in CR1, childhood AML in CR1 and adult ALL in CR1, and that autologous SCT is equal to or less effective than chemotherapy. No firm conclusions could be drawn regarding the cost-effectiveness of SCT in the UK NHS owing to the limitations given above. Future research should include the impact of the treatments on patients' quality of life as well as information on health service use and costs associated with SCT from the perspective of the UK NHS.