Anaemia and its response to treatment with recombinant human erythropoietin in chronic kidney disease patients

BACKGROUND

The introduction of erythropoietin has transformed the management of anaemia in CKD, with considerable benefits which includes enhanced quality of life, increased exercise capacity and improved cardiac function. There is paucity of data on the beneficial effects of this treatment from this environment.

OBJECTIVE

The aim of this work was to study the pattern and response of anaemia and its response to treatment with recombinant human erythropoietin(r-HuEpo) in CKD patients in Nigeria.

METHODS

This was a prospective study in which 20 CKD patients who satisfied the inclusion criteria were recruited consecutively. Subcutaneous r-HuEpo was administered to each of the study patients, starting with a weekly dose of 50 iu per kg and titrated according to haemoglobin (Hb) response, which was monitored fortnightly throughout the study period with the aim of achieving a target Hb of 11g per dl.

RESULTS

The patients studied were anaemic with mean Hb of 7.36(1.05) g/dl. The anemia was normocytic normochromic in 85% of the patients. All the patients responded to treatment with r-HuEpo with the mean Hb rising from 6.74(0.70)g per dl to 11.64(0.37) g/dl and 7.64(1.19) to 11.98(0.45) g/dl in those on maintenance haemodialysis and pre-dialysis patients respectively. The patients reached the target Hb of 11g/dl within 8 weeks in predialytic CKD patients and within 10 weeks in those on maintenance haemodialysis.

CONCLUSION

Anaemia is mostly normocytic normochromic in CKD patients in our environment and r-HuEpo therapy is effective in correcting the anaemia.

Ichthyosis hystrix Curth-Macklin type in an African girl

Ichthyosis hystrix Curth-Macklin type is a rare autosomal dominant skin disorder characterized by extensive hyperkeratosis and palmo-plantar keratoderma. It results from heterozygous frameshift mutation in keratin 1 gene (KRT1). Histological features, showing perinuclear vacuolization and binucleated cells, are similar to those of epidermolytic hyperkeratosis except for the absence of epidermolysis. The present report describes the condition in a 16-year-old African girl where available treatment was disappointing.

Krukenberg's tumour

BACKGROUND

Krukenburg's tumour, a metastatic cancer to the ovary can pose difficulties in early diagnosis. The paucity of reports from our environment coupled with the difficulties we encountered makes it imperative that we report this case.

METHODS

We present a 32-year-old lady who presented with mucoid and bloody diarrhoea associated with menstrual irregularity, weight loss and lower abdominal pains 2 years after surgical treatment for gastric cancer. Literature on Krukenburg's tumour was also reviewed.

RESULTS

While serum level of CEA was found to be elevated and colonoscopy showed an ulcerated mass obliterating the lumen of the sigmoid colon, abdominal CT scan revealed bilateral adnexal masses. The histology of the colonic lesion showed signet ring carcinoma while the enlarged ovaries turned out to have evidence of metastatic adenocarcinoma.

CONCLUSION

Early diagnosis of KT can be difficult. Periodic surveillance is, therefore, essential especially in those who have had a gastrointestinal malignancy.

Dyschromatosis universalis hereditaria in a young Nigerian female

Dyschromatosis universalis hereditaria (DUH) is a clinically heterogeneous disorder that shows generalized mottled pigmentation. It occurs most commonly in Japanese persons, with sporadic reports from South Africa, India, and Iraq. Histopathology reveals a variable degree of pigmentary incontinence. Although the precise etiology of this disorder is not yet known, the clinicopathological findings implicate an inherent abnormality of melanosomes or melanin processing. We describe a case in a young Nigerian girl.

Blood pressure control among treated hypertensives in a tertiary health institution

BACKGROUND

Goal blood pressure (BP) was defined by the JNC VI and the World Health Organization-International Society of Hypertension (WHO/ISH) as <140 mm Hg systolic and <90 mm Hg diastolic for the general and <130 mm Hg systolic and <85 mm Hg diastolic for special high-risk populations. It is well established that adequate BP control characterizes only a fraction of treated hypertensive patients. The importance of tight BP control has been established in preventing cardiovascular morbidity and mortality

METHODS

We performed cross-sectional studies on the current status of BP control among treated hypertensive in our center. One hundred consecutive patients with essential hypertension who have been attending the out patient hypertension clinic and have been on treatment for at least 6 months were recruited. The pre treatment BP and BP records in the previous 2 visits were noted. Patients were said to have good BP control if their BPs are < 140/90 mmHg (<130/80 mmHg for high risk patients) at the time of the study and in the last visit.

RESULTS

There were 49 males and 51 female (M: F; 1:1), aged 26 to 85 (mean 52.33 +/- 12.29) years. The duration of hypertension ranged 6 months to 30 (mean 7.37 +/- 7.1) years. The duration of treatment in our centre was 6 months to 10 (mean 3.22 +/- 2.23) years. Blood pressure was controlled in 33 (33%) of the patients. Pre-treatment mean blood pressure was significantly higher than the BP value at the time of the study (155.87 +/- 26.02/97.81 +/- 11.89 mmHg versus 143.40 +/- 24.14/86.53 +/- 12.71 mmHg) (p<0.05). Diuretics were the commonest antihypertensive prescribed either alone or in combination (69%), followed by a calcium antagonist (56%) and centrally acting drugs (38%). Twenty seven were on single antihypertensive, 43 (43%) on 2, 25(25%) on 3 and 5 (5%) on 4 classes of antihypertensive. Blood pressure control was associated with taking more than one antihypertensive medication and compliance.

CONCLUSION

Control of BP in patients receiving antihypertensive drugs is still far from optimal in the study population in Nigeria just as in other countries. Many patients had multiple cardiovascular risk factors. Adherence to medication should be encouraged.

Ischaemic heart disease in Aminu Kano Teaching Hospital, Kano, Nigeria: a 5 year review

BACKGROUND

Socio-economic changes and rural urban migration have led to emergence of non-communicable disease including ischaemic heart disease (IHD) and many others. The actual prevalence of IHD in Nigeria is not known. The non communicable disease (NCD) survey sought to determine the prevalence of major risk factors, rather than the prevalence of the disease itself. The prevalence is generally considered low in Nigeria but the current impression about its importance stems mostly from anecdotal reports. We therefore set out to describe the prevalence as well as the spectrum of IHD at Aminu Kano Teaching Hospital, Kano.

METHOD

Between July 2000 and June 2005, we reviewed the prevalence as well as the spectrum of presentation of IHD in Aminu Kano Teaching Hospital. Information was obtained from the medical records of patients in the medical unit of the hospital. Age, sex, diagnosis, risk factors for IHD, other relevant clinical and laboratory data and outcome of patients for myocardial infarction (MI) were extracted from the records. Data was analyzed using SPSS version 10.0 software.

RESULTS

There were 5124 medical patients admitted over the period under review, out of which 1347 had cardiovascular diseases. Forty six patients were diagnosed to have IHD giving it a prevalence of 0.9% of medical conditions and 3.4% of all cardiovascular cases. There were 33 males and 13 females (M : F = 2.5:1). Twenty two patients (47.8%) had myocardial infarction, 14 (30.4%) had ischemic cardiomyopathy and 10 (21.7%) had angina. The patients consist of 41 (89.1%) Nigerians, 3 (6.5%) Lebanese, 1 (2.2%) Indian and 1 (2.2%) Pakistani. The risk factors found were Hypertension in 37 (80.4%) of patients, diabetes in 16 (34.8%), and Dyslipidaemia in 20 (43.5%). Others were cigarette smoking and obesity.

CONCLUSION

IHD is an important cause of morbidity and mortality in our population. There is need for us to be on the alert and prepare ourselves to manage these cases. Focus should be on preventive cardiology.

Preliminary characterisation of extracellular serine proteases of Dermatophilus congolensis isolates from cattle, sheep and horses

Dermatophilus congolensis is a filamentous branching actinomycete that causes dermatophilosis, an exudative dermatitis in ruminants. The pathogenesis of this disease is poorly understood and virulence factors of D. congolensis have not been characterised. Culture filtrate (CF) of 14 D. congolensis isolates from cattle, 15 from sheep and four from horses were examined for proteolytic activity using azocasein as a non-specific substrate. The isolates were from a variety of geographical locations. All the isolates examined produced extracellular proteolytic activity. CF from 24 and 48 h cultures and from first and third passages contained proteases. Proteolytic activity was greatest in neutral to alkaline pH (pH 7-10). CF of bovine isolates contained more proteolytic activity than that of ovine isolates. Furthermore, in substrate SDS-PAGE gels containing azocasein the number of proteolytic bands and their molecular weights in CF of bovine, ovine and equine isolates were different, giving distinctive band patterns for isolates from each host species. Three out of four bovine isolates from Antigua gave a fourth band pattern. Bands of equivalent molecular weights to the proteases could not be identified in silver stained SDS-PAGE gels of CF. Serine protease inhibitors had a concentration-dependent inhibitory effect on proteolytic activity in CF and inhibited activity of all proteolytic bands in substrate gels. With the exception of EDTA which had a variable-enhancing effect on activity, inhibitors of other classes of protease had no effect on activity. We conclude that D. congolensis produces a number of extracellular alkaline serine proteases, our results suggest the presence of host-specific variation between isolates and to a lesser extent between isolates from the same host species.