Eclampsia: 134 consecutive cases

OBJECTIVE

A retrospective analysis of all cases of eclampsia (134) at Korle Bu Teaching Hospital, Accra, Ghana, in 1991, was undertaken to determine future directions in prevention and management.

METHODS

One hundred and thirty-four consecutive cases of eclampsia were reviewed to assess possible risk factors, associated medical impact, and the usefulness of prenatal care.

RESULTS

Risk factors for the development of eclampsia include: young age, delivery in the rainy season, nulliparity, multiple pregnancy, prolonged labor, and lack of prenatal care. Eclampsia is associated with high maternal and perinatal mortality.

CONCLUSIONS

Future emphasis on prenatal clinics, and earlier detection and management of pre-eclampsia should lessen the incidence of this severe obstetric emergency.

Generating colour and texture verniers

This paper describes computer graphics techniques for presenting visual stimuli in a vernier format composed out of coloured texture patterns. Such stimuli can be used to investigate the performance at the task of localising boundaries mediated by changes in colour and/or texture. We summarise the contents as follows: (1) Techniques for presenting visual stimuli are reviewed with a view to how they might be used to present colour and texture verniers. (2) The design of the vernier stimuli for the localisation task is considered. (3) Significant elements of this design are: (a) the use of non-isoplanatic textures to avoid interference effects at boundaries, (b) the modulation of the texture patterns along axes in MacLeod-Boynton colour space so that relative retinal cone contributions are controlled, and (c) the use of double-buffering, colour map manipulation, and contrast randomisation techniques to avoid problems commonly encountered when presenting computer graphics stimuli on colour monitors. (4) Results of a psychophysical experiment that presents colour and texture verniers are reported elsewhere.

Diagnosing unruptured ectopic pregnancy

OBJECTIVE

A retrospective analysis of the management of ectopic pregnancy at Korle Bu Teaching Hospital in Accra, Ghana, to assess the impact of the introduction of ultrasonography as a diagnostic tool.

METHODS

All charts of patients with ectopic pregnancies from 1 January 1986 to 31 December 1990 were analyzed. The management of those patients who had transabdominal ultrasonography was compared with those who had not.

RESULTS

The use of ultrasonography increased the number of unruptured ectopic pregnancies from 0.3% to 8.5% (P < 0.001). This also reflected a reduction in misdiagnoses, blood transfusions, and maternal deaths.

CONCLUSIONS

The reasonable use of modern technology can be of great assistance even in developing countries, as shown by the positive impact of the use of ultrasonography to aid in the diagnosis of ectopic pregnancy in Ghana, West Africa.

A novel deletion of approximately 27 kb including the beta-globin gene and the locus control region 3'HS-1 regulatory sequence: beta zero-thalassemia or hereditary persistence of fetal hemoglobin?

A novel deletion of approximately 27 kb with the 5' breakpoint 1.5 to 2.2 kb upstream of the beta-globin gene, and the 3' breakpoint approximately 24 kb downstream of the beta-globin gene, has been found in five members of two families from Southeast Asia (Vietnam and Cambodia). Six members of another family from China, previously reported from our laboratory, have also been shown to carry this deletion. The patients presented with mild hypochromia and microcytosis, a hemoglobin (Hb) A2 level of approximately 4.0%, and a markedly increased, heterocellularly distributed, Hb F level (14.0 to 26.0%). In vitro globin-chain synthesis showed a mild imbalance with appreciable gamma-chain compensation (alpha/beta + gamma ratio of 1.46). The 3' end of this deletion includes the 3'HS-1, and we hypothesize that removal of this region results in the loss of its gamma-globin gene-silencing effect, which causes a markedly elevated Hb F level with a modest increase in Hb A2 levels, unlike the situation in other deletional beta zero-thalassemias. The possible influence of particular sequence variations in the locus control region 5'HS-2 and the G gamma promoter, present on the chromosome with this deletion, on the overall gamma-globin gene should also be considered.

Quantities of alpha Q chain variants in heterozygotes with and without a concomitant beta-thalassemia trait

We have analyzed the quantities of alpha x chain-containing hemoglobins (alpha 2 x beta 2 and alpha 2 x delta 2) in 14 heterozygotes for Hb Q-India [alpha 64(E13)Asp-->His] or Hb Q-Thailand [alpha 74(EF3)Asp-->His]; both amino acid replacements are the result of mutations in the alpha 1-globin gene. Five of these persons (three with Hb Q-India and two with Hb Q-Thailand) had an additional beta(0)-thalassemia heterozygosity. The average quantities for Hb Q + Hb Q2 in the four groups were 17.2% (alpha alpha Q/alpha alpha; beta A/beta A), 9.5% (alpha alpha Q/alpha alpha; beta A/beta(0) Th), 26.8% (-alpha Q/alpha alpha; beta A/beta A), and 16.95% (-alpha Q/alpha alpha; beta A/beta(0) Th). These variations can best be explained by a posttranslational control mechanism; an imbalance in the alpha A, alpha Q, and beta A chain ratio will favor the alpha 2 Q beta 2 formation when an alpha-thalassemia is present and will reduce its formation in the presence of a beta-thalassemia heterozygosity.

Hb Sinai-Baltimore or alpha 2 beta (2)18(A15)Val->Gly, a silent, mildly unstable beta chain variant detected by isoelectrofocusing and high performance liquid chromatography

Isoelectrofocusing and high performance liquid chromatographic methods were used to study an abnormal hemoglobin present in a Black male infant and his mother. The variant, named Hb Sinai-Baltimore, focused slightly behind Hb A and separated incompletely from Hb A by cation exchange high performance liquid chromatography, while the separation of the beta A and beta X chains by reversed phase high performance liquid chromatography was complete. The variant was identified through an analysis of peptides in a tryptic digest of the isolated beta X chain and by sequencing of amplified DNA which included the beta-globin gene. The Val->Gly replacement at position beta 18 (codon 18; GTG->GGG) or at the last position of the A helix decreases the stability of the variant without affecting the hematological parameters of its carrier. The propositus was a compound heterozygote for Hb Sinai-Baltimore and Hb S; the relative quantities of the two variant chains were somewhat different from those of the beta X and beta A chains in the mother with the simple Hb Sinai-Baltimore heterozygosity. An uncertainty about the alpha-globin gene status in the child prevented a further evaluation of these differences.

Three sickle cell anemia patients each with a different alpha chain variant. Diagnostic complications

We have studied three sickle cell anemia patients who also carried a heterozygosity for one of the following alpha chain abnormalities: Hb G-Philadelphia [alpha 68(E17)Asn-->Lys], Hb Montgomery [alpha 48 (CE6)Leu-->Arg], and Hb Chicago [alpha 136(H19)Leu-->Met]. Electrophoretic analyses alone may result in incomplete and incorrect information. Confirmation of the diagnosis of Hb SS or Hb SC disease by one of the fast high performance liquid chromatographic procedures is recommended.

Schistosomiasis and cervical cancer in Ghana

OBJECTIVE

To discover a possible association between schistosomiasis and cervical dysplasia and/or cervical cancer in Ghana, West Africa.

METHOD

Two groups of 24 subjects each were identified, one group from a schistosomiasis-endemic area and a control group from a non-endemic area. Random cervical biopsies, cervical cytology and human papilloma virus (HPV) DNA testing were performed on all subjects. Demographic data were analyzed using Student's t-test. Histologic and DNA findings were analyzed using Fisher's exact test.

RESULTS

From the endemic area, 46% of subjects had histologic evidence of schistosomiasis infection of the cervix. No evidence of dysplasia or cancer on cervical cytology was noted in this group. Mild dysplasia was noted in random cervix biopsies in one patient, and 8 patients had evidence of HPV infection of the cervix. No patient from the non-endemic area had cytologic or histologic evidence of cervical dysplasia or cancer. Eleven subjects in this group had evidence of HPV infection.

CONCLUSION

This study does not reveal an association between cervical schistosomiasis and cervical dysplasia or cervical cancer on cytology or histology. Both study groups demonstrated a high degree of infection with HPV, however. It may be the HPV and not the schistosomiasis which is responsible for the development of uterine cervix cancer.

The M gamma chain of human fetal hemoglobin is an A gamma chain with an in vitro modification of gamma 141 leucine to hydroxyleucine

We have reanalyzed the structure of the gamma T-15 peptide from the minor M gamma chain of human hemoglobin (Hb) F. Amino acid analysis confirmed that the Leu 141 residue was missing from position 9 of this peptide, and liquid secondary ion mass spectrometry indicated that it was replaced, not by methionine (residue mass 131) as previously believed, but by an amino acid of mass 129. By analogy with the recently reported oxidation of the corresponding leucine at position gamma 141 of the unstable Hb Atlanta, it appears that the M gamma chain also results from the oxidation of gamma 141 to hydroxyleucine (residue mass 129). The finding that the proportion of the M gamma chain increased when red cell lysates were prepared with carbon tetrachloride prompted us to reinvestigate the oxidation mechanism involved in the formation of beta 141 hydroxyleucine in Hb Atlanta. Oxidation of the beta 141 residue could be detected when carbon tetrachloride was used in the lysis protocol, while conversion of oxyhemoglobin to carbon monoxyhemoglobin prior to carbon tetrachloride treatment prevented oxidation. It therefore appears that the hydroxylation of Leu 141 is not an in vivo process in the circulating red cell. Perhaps leucine at position 141 of the beta, gamma, and delta chains (and at position 136 of the alpha chain), which forms a contact with heme and is located directly across the heme plate from the E helix, is oxidized to hydroxyleucine at a very low rate forming minute amounts of modified chains; this process is accelerated by treatment with agents such as carbon tetrachloride and prolonged exposure to air.

Maternal height as a predictor of vaginal delivery

OBJECTIVE

The purpose of the study was to establish a relationship between maternal height and vaginal delivery.

METHOD

A prospective study of 900 primigravidas in labor in the Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital was conducted. A questionnaire was developed and administered by research assistants. The results were analyzed using the X2-test.

RESULTS

Of the 900 patients who delivered, 538 were studied. The remaining patients were excluded from the study because of factors described under exclusion criteria. A critical height of 154 cm was chosen as the screening height for 'at risk' of cephalopelvic disproportion (CPD). This height would identify 71.1% of women who would develop CPD.

CONCLUSION

Short women with heights up to 150 cm are at risk of failing spontaneous vaginal delivery and should be referred to hospitals where labor could be closely monitored and cesarean section performed if necessary.

Transgenic mouse model of X-linked cleft palate

A transgenic mouse line, PyLMP.5, exhibited a sex-linked lethality not observed in any other lines expressing the transgene. In this unique line, the transgene integrated into the X chromosome, yielding a simple tandem duplication of the insert sequences with minimal, if any, additional rearrangement of the cellular sequences. The predominant phenotype was a cleft secondary palate and neonatal lethality in males. Survival of females was dependent on the mouse strain background. The disrupted cellular sequences have been mapped to the proximal region of the mouse X chromosome. The disrupted locus may represent the mouse counterpart to a human locus mutated in an X-linked cleft secondary palate syndrome.

Menopausal age of Ghanaian women

OBJECTIVE

The purpose of the study was to determine the age of menopause among Ghanaian women.

METHOD

A prospective survey involving 152 women in Akosombo District in Ghana was conducted. A questionnaire was developed including: age at menopause, symptoms of hot flushes or flashes, palpitations, anxiety, sleeplessness, headaches, frequency of urine, depression, irritability, tiredness, weight gain, poor memory and attitudes to coitus.

RESULT

Of 152 women interviewed, 29 were excluded because they were not sure of their birth dates and 123 women were analyzed. The mean and median ages at menopause were 48.05 years +/- 3.62 S.D. and 48 years respectively. The major symptoms at menopause were tiredness 79.9%, sleeplessness 71.0%, palpitations 63.7%, weight gain 61.8%, hot flushes 56.5%, and irritability 56.5%. However, 85.6% of the women who experienced hot flushes reported this to be the most unpleasant.

CONCLUSION

1. The age at menopause in Ghanaian population was 48.05 +/- 3.62. 2. Tiredness, sleeplessness, palpitations, weight gain, hot flushes, irritability, anxiety and headache were the major symptoms at menopause. 3. Hot flushes or flashes was the most disturbing symptom at menopause.

Heterozygosity for the IVS-I-5 (G-->C) mutation with a G-->A change at codon 18 (Val-->Met; Hb Baden) in cis and a T-->G mutation at codon 126 (Val-->Gly; Hb Dhonburi) in trans resulting in a thalassemia intermedia

We have analyzed the hemoglobins of a young German patient with beta-thalassemia intermedia and of his immediate family and included in these studies an evaluation of possible nucleotide changes in the beta-globin genes through sequencing of amplified DNA. One chromosome of the propositus and one of his father's carried the GTG-->GGG mutation at codon 126 leading to the synthesis of Hb Dhonburi or alpha 2 beta (2)126(H4)Val-->Gly; this variant is slightly unstable and is associated with mild thalassemic features. His second chromosome and one of his mother's had the common IVS-I-5 (G-->C) mutation that leads to a rather severe beta(+)-thalassemia and the GTG-->ATG mutation at codon 18, resulting in the replacement of a valine residue by a methionine residue. This newly discovered beta-chain variant, named Hb Baden, was present for only 2-3% in both the patient and his mother. This low amount results from a decreased splicing of RNA at the donor splice-site of the first intron that is nearly completely deactivated by the IVS-I-5 (G-->C) thalassemic mutation. The chromosome with the codon 18 (GTG-->ATG) and the IVS-I-5 (G-->C) mutations has thus far been found only in this German family; analysis of 51 chromosomes from patients with the IVS-I-5 (G-->C) mutation living in different countries failed to detect the codon 18 (GTG-->ATG) change.

Comparative studies of live neonates in maternal sickle cell haemoglobinopathy in Ghana

This study assessed the current status of live neonates born to sickle cell mothers when compared with those of normal (control) women. Birth weight, placental weight, fetoplacental ratio, and gestational age for live neonates in singleton births by twenty-nine haemoglobin SS (HbSS), fifty-two haemoglobin SC (HbSC), and fifty-one (normal) haemoglobin AA (HbAA) mothers were statistically compared. Neonates of HbSS mothers had a statistically lower than normal mean birth weight and gestational age, but only a shorter mean gestation significantly distinguished those of the HbSC and HbAA mothers. Inferentially, neonates delivered by HbSS women were both underweight and preterm, whereas those of HbSC women were preterm but not underweight, and apparently large for gestational age (LGA). No statistical differences were found between neonates in terms of placental weights or fetoplacental ratios.

Etiological factors of male infertility in Africa

Of the 595 infertile African males studied, 192 (30.8%) were azoospermic and 413 (69.40%) had oligospermia. Azoospermia was caused by obstruction to the vas and/or epididymis in 44% of cases and testicular lesions in the remaining 56% of cases, whilst the oligospermia was probably caused by obstruction in 4.7% of cases and testicular lesions in 85.3%. Bilateral testicular biopsies were performed on 302 patients. A variety of pathological conditions were observed; the most prevalent was hypospermatogenesis, in 12% of cases. A significant portion (37.2%) of patients without testicular biopsies had clinically detectable testicular or epididymal abnormalities. There was a higher incidence (12%) of inflammatory testicular or prostatic conditions in this study as compared with those found in Europeans, suggesting that inflammatory conditions contribute more to male infertility in Africa. Only a single case of chromosomal abnormality was detected.

Heterogeneity of the hemoglobin of the Ohrid trout (Salmo L. typicus)

We have analyzed the hemoglobins of five individual trout from the Ohrid Lake (Salmo L. typicus) by electrophoretic methods, by reversed-phase high-performance liquid chromatography, and by limited structural analyses. The two major classes of hemoglobin are type I (35% of total) and type IV (65%). Type IV is the major oxygen-transporting hemoglobin; it consists of three types of beta chain (in about equal quantities) and three types of alpha chain (one major and two minor types). Several structural differences have been observed between these three beta (IV) chains and between the three alpha (IV) chains, suggesting a complex genetic system governing the synthesis of these proteins. Moreover, a few amino acid substitutions occur at positions involved in contacts between chains, which suggests that differences in oxygen affinity may exist between these various type IV hemoglobins. Type I hemoglobin is less complex because it contains one type of beta chain and two alpha chains; the latter two differ in numerous positions, suggesting duplications of the alpha (I)-globin gene. The alpha and beta chains of type I hemoglobin differ considerably from the alpha and beta chains of type IV hemoglobin, indicating the existence of alpha (I)- and beta (I)-globin genes separate from the alpha (IV)- and beta (IV)-globin genes.

A case-control study of selected pathogens including verocytotoxigenic Escherichia coli in calf diarrhea on an Ontario veal farm

A case-control study of diarrheal disease in veal calves was conducted over a three month period on a single large veal farm in southern Ontario. One hundred diarrheic calves (cases) were identified by visual examination of their feces. Each case was matched to two nondiarrhetic controls from the same room on the same day, and a fecal sample was obtained from each animal. Fecal consistency of cases and controls was observed daily for one week following sample collection. Control calves which developed diarrhea during that period were excluded from the study. Breed, sex and the date and nature of antimicrobial drugs administered to each calf were recorded. Moisture content of fecal samples was measured by weighing samples before and after oven drying. Samples were screened for verocytotoxigenic Escherichia coli (VTEC) using a Vero cell assay, for enterotoxigenic E. coli (ETEC) using an immunoblot procedure with anti-K99 monoclonal antibodies, and for Salmonella species using modified semi-solid Rappaport-Vassiliadis medium. A latex agglutination test was used to detect rotaviruses, and samples were examined for cryptosporidia using sucrose wet mounts. No VTEC were identified in cases or controls. One calf was positive for Salmonella and three were positive for ETEC. Rotaviruses were detected in four cases and four controls. A significant positive association was found between diarrhea and infection with Cryptosporidium. This study thus provided no evidence of an association between diarrhea and infection with either VTEC, ETEC, Salmonella spp. or rotaviruses in the population examined. On the other hand our results do suggest that Cryptosporidium infection may promote transient diarrheal disease in veal calves in Ontario.

Distribution and characteristics of verocytotoxigenic Escherichia coli isolated from Ontario dairy cattle

Faecal swabs obtained from a random sample of 1131 cows and 659 calves on 100 southern Ontario dairy farms were examined for verocytotoxigenic Escherichia coli (VTEC) using a Vero cell assay. Five isolates from each positive culture were tested similarly. Positive colonies were examined with DNA probes for Shiga-like toxin I (SLT-I) and SLT-II sequences. Probe-negative colonies were tested for neutralization of verocytotoxicity using anti-SLT-I and anti-SLT-IIv antisera. Colonies showing no neutralization response were examined in a polymerase chain reaction procedure. Colonies positive by any test were confirmed to be E. coli biochemically, serotyped, biotyped and tested for antimicrobial resistance. Faecal culture supernatants which were positive in the Vero cell assay, but culture negative, were examined using the neutralization assay. Animals were classified positive by faecal culture supernatant or by positive VTEC isolate. The prevalence rates of VTEC infection in cows and calves were estimated to be 9.5 and 24.7%, respectively. The proportion of animals infected on each farm ranged from 0 to 60% for cows and 0 to 100% for calves. Of 206 VTEC isolates identified, few were of serotypes which have been isolated from humans and none were E. coli O 157.H7.