Outcomes of asymptomatic malaria parasitaemia in neonates in a tertiary hospital,southeast Nigeria

Background:

Malaria infestation during pregnancy is mostly asymptomatic and untreated especially in unbooked pregnancies. It presents with almost all the fetal complications of overt malaria in pregnancy. The aim of this study was to determine the effect of asymptomatic malaria parasitaemia on the neonates of unbooked parturients delivered at term at the Federal Teaching Hospital, Abakaliki.

Materials and Methods:

This study was conducted in the labour ward complex of the Federal Teaching Hospital, Abakaliki from March to May 2012. Unbooked pregnant women who fulfilled the inclusion criteria and gave consent were consecutively recruited. Cord blood and placenta tissue were collected for haemoglobin concentration determination and histology, respectively. Birth weights were determined with an electronic weighing machine. Statistical Analysis was done with 2008 Epi Info™ software and level of significant was set at P-value <0.05.

Results:

A total of 250 unbooked parturients were recruited, of which 194 (77.6%) had asymptomatic malaria parasitaemia while 227 (90.8%) had placental parasitisation. The prevalence of low birth weight in the study was 16.4%. There was significant relationship between asymptomatic malaria parasitemia and birth weight (X² = 43.70, P-value < 0.001). There were no low-birth-weight deliveries among paturients without placental parasitemia. No neonate, however, had anaemia in the study.

Conclusion:

Asymptomatic malaria parasitemia and placental parasitisation by malaria parasites contribute to the outcome of the foetal birth weight. Asymptomatic malaria parasitaemia and placental parasitaemia did not result in a corresponding foetal anaemia on babies delivered.     

Hepatitis C Virus Screening and Management of Seroconversions in Hemodialysis Facilities

Over the past two decades, healthcare‐associated exposure has increasingly been proved to be a means of hepatitis C virus (HCV) transmission, especially in hemodialysis facilities. The prevalence of HCV among hemodialysis patients is known to be several times greater than that of the general population of the United States, and chronic HCV infection is associated with significant morbidity and mortality among these patients. During 2008–2011, HCV infection outbreaks were identified in multiple US hemodialysis facilities, resulting in at least 46 new HCV infections among hemodialysis patients. These outbreaks, linked to infection control breaches, also highlight the failure of some facilities to follow established guidelines for routine HCV antibody (anti‐HCV) screening and response to new HCV infection among hemodialysis patients. Current national guidelines recommend screening of hemodialysis patients for anti‐HCV on facility admission and, for susceptible patients, on a semiannual basis. Here, we seek to underscore the importance of compliance with national recommendations for anti‐HCV screening of hemodialysis patients and actions to be taken in the event of possible HCV transmission within a hemodialysis facility. These include general steps to ensure that: hemodialysis patients are routinely screened for anti‐HCV to facilitate early detection of new infections; newly infected patients are informed of the change in their HCV status and undergo clinical evaluation; and public health officials are notified of new HCV infections in a timely manner. We then focus on the need to assess infection control practices at the facility, with particular attention given to safe handling of injectable medications, hand hygiene and disinfection practices. In the absence of a vaccine, routine screening and adherence to standard infection control practices will remain the key strategies for preventing HCV transmission in hemodialysis units.     

Black soot exposure induced hypothalamic and testicular oxidative stress and apoptosis in male rats

Air pollution constitutes the largest cause of environmental risks today. At present, no scientific publication linking environmental black soot and derangement in the hypothalamus and testis of rats exists. This study investigated the effect of black soot exposure on hypothalamic and testicular functions of male rats exposed to black soot for 4, 8 and 12 weeks respectively. The hypothalamus and testis were processed for biochemical analysis. Results show that black soot exposure for 4, 8 and 12 weeks significantly (p < .05) increased oxidative stress markers both in the testis and in the hypothalamus of rats. Also, black soot exposure significantly (p < .05) decreased the alkaline phosphatase, acid phosphatase as well as lactate dehydrogenase activities in the testis. Furthermore, the result demonstrated an upregulation of the protein expression of caspase-3, an indication of increased apoptosis which led to the disruption of the histological architecture of the hypothalamus and testis. Taken together, black soot exposure induced hypothalamic and testicular oxidative stress and apoptosis in male rats.     

Latent Cytomegalovirus Infection Exacerbates Experimental Colitis

Inflammatory bowel disease (IBD) severity is positively correlated with cytomegalovirus (CMV) infection. This may reflect CMV triggering and/or exacerbating flares of IBD and/or IBD or immunosuppressive drugs administered to patients with IBD increasing susceptibility to CMV infection. Herein, we performed studies in mice to investigate these possibilities. Mice administered murine CMV (MCMV) developed signs of acute viral infection (malaise and weight loss) and had MCMV loads that were readily detected in numerous organs including the intestine. By 4 weeks, these mice manifested a “latent” infection in which MCMV levels were low but detectable by PCR. Such MCMV infection did not induce acute colitis in either wild-type mice or IL-10^−/− mice, which are highly prone to developing colitis. However, underlying MCMV infection in an acute or latent state exacerbated the severity of colitis induced by dextran sodium sulfate (DSS). Such potentiation of DSS colitis by latent MCMV infection seemed to occur without viral reactivation. Whereas initial MCMV infection induced acute alterations in serum and intestinal cytokines, such cytokine levels returned to baseline before administration of DSS. However, the initial infection resulted in lasting elevation of antibodies to commensal bacterial antigens, suggesting that MCMV infection may have potentiated colitis via priming of the intestinal immune response to gut microbiota. Thus, underlying CMV infection can alter mucosal immunity, potentially increasing the tendency of CMV-infected hosts to develop colitis.Inflammatory bowel disease (IBD) is the collective term for the idiopathic inflammatory diseases of the intestine, whose main forms include Crohn’s disease and ulcerative colitis. Ulcerative colitis tends to affect the bowel in a continuous fashion from the rectum, extending a certain distance in the colon and then abruptly stopping. It affects the mucosa and submucosa with ulceration and crypt abscesses. Crohn’s disease is a nonspecific granulomatous disease that affects all layers of the bowel wall in a skip-like fashion. Whereas IBD is not generally thought to be caused by a specific pathogen, several lines of evidence indicate an essential role for commensal intestinal bacteria. Specifically, IBD has long been associated with an elevated immune response to the commensal gut microbiota, suggesting that the disease may result from immune dysregulation.¹ More recently, it has been observed that persons with IBD have alterations in both the composition and location of their gut microbiota, suggesting that inability to control the normal commensal microbiota might underlie IBD. However, it is not clear whether these changes play a causative role or, rather, are a consequence of IBD. Analogously, although lack of an association between a specific viral pathogen and IBD argue against a specific viral cause of this disorder, common viruses have been suggested as either modulators or triggers of IBD.² However, because patients with IBD are frequently in an immunocompromised state because of poor nutrition and immunosuppressive agents, it has been difficult to decipher the extent to which such common viruses might promote and/or exacerbate IBD.Human cytomegalovirus (CMV) is a member of the herpes family of viruses. CMV infection is quite common with approximately 40 to 70% of adults being infected in the latent state.³ Infection is bimodal, occurring through vertical and horizontal transmission in early childhood and again mainly through sexual transmission, in young adults.⁴ Latent CMV infection, defined by carriage of the CMV genome without active replication, is commonly asymptomatic in immunocompetent individuals whereas active CMV infection is associated with clinical disease such as fever, sore throat and leukopenia. CMV commonly infects fibroblasts, endothelial cells, and myeloid cells.⁵ CMV has developed methods for evading host immune system, such as latency and inhibition of apoptosis, and this ability enables reactivation of virus in the immunosuppressed hosts.⁶ The prevalence of active CMV infection in the colon is considerably higher in patients with IBD relative to control populations.⁷ The majority of such infections are thought to represent reactivation of latent CMV, although there is little formal proof to rule out new infections in this population. In any case, CMV is clearly associated with more severe IBD and thought to be a general detriment to the health of patients with IBD with active CMV infections although the extent to which CMV may activate and/or exacerbate flares of gut inflammation in IBD is not well defined.⁸ Moreover, little is known regarding whether latent CMV infection affects either development of IBD and/or may alter severity of disease absentia reactivation. Thus, we used a mouse model of CMV infection to investigate the hypotheses that i) CMV might trigger gut inflammation in a susceptible host and/or ii) that the presence of CMV might alter gut inflammation in response to a well defined trigger of acute colitis, namely the chemical dextran sodium sulfate (DSS). We observed that although murine CMV (MCMV) did not trigger acute inflammation, it promoted mucosal immune responses and increased severity of colitis induced by DSS. Thus, latent CMV infection may alter one’s risk for developing intestinal inflammation.     

Erythritol reduces small intestinal glucose absorption,increases muscle glucose uptake,improves glucose metabolic enzymes activities and increases expression of Glut-4 and IRS-1 in type 2 diabetic rats

Purpose

Studies have reported that erythritol, a low or non-glycemic sugar alcohol possesses anti-hyperglycemic and anti-diabetic potentials but the underlying mode of actions is not clear. This study investigated the underlying mode of actions behind the anti-hyperglycemic and anti-diabetic potentials of erythritol using different experimental models (experiment 1, 2 and 3).

Methods

Experiment 1 examined the effects of increasing concentrations (2.5–20%) of erythritol on glucose absorption and uptake in isolated rat jejunum and psoas muscle, respectively. Experiments 2 and 3 examined the effects of a single oral dose of erythritol (1 g/kg bw) on intestinal glucose absorption, gastric emptying and postprandial blood glucose increase, glucose tolerance, serum insulin level, muscle/liver hexokinase and liver glucose-6 phosphatase activities, liver and muscle glycogen contents and mRNA and protein expression of muscle Glut-4 and IRS-1 in normal and type 2 diabetic animals.

Results

Experiment 1 revealed that erythritol dose dependently enhanced muscle glucose ex vivo. Experiment 2 demonstrated that erythritol feeding delayed gastric emptying and reduced small intestinal glucose absorption as well as postprandial blood glucose rise, especially in diabetic animals. Experiment 3 showed that erythritol feeding improved glucose tolerance, muscle/liver hexokinase and liver glucose-6 phosphatase activities, glycogen storage and also modulated expression of muscle Glut-4 and IRS-1 in diabetic animals.

Conclusion

Data suggest that erythritol may exert anti-hyperglycemic effects not only via reducing small intestinal glucose absorption, but also by increasing muscle glucose uptake, improving glucose metabolic enzymes activity and modulating muscle Glut-4 and IRS-1 mRNA and protein expression. Hence, erythritol may be a useful dietary supplement for managing hyperglycemia, particularly for T2D.

     

Comments on the environmental health implications of Acanthamoeba

Acanthamoeba has been designated an emerging environmental, public health and clinical problem. It is an uncommon, but increasingly prevalent infection liable to cause perturbative ocular damage, particularly in frequent contact lens wearers. The clinical course, specificities in ophthalmologic and parasitologic diagnosis, drug and surgical treatment of Acanthamoebakeratitis pose a difficulty to both clinicians and researchers. New insights have been provided with respect to the risk factors, incidence, and pathogenesis of contact lens‐associated infectious keratitis. Acanthamoebakeratitis may be associated with poor outcome, even with intensive treatment, especially in the later clinical course of the disease with its distinct characteristic features which are perturbative in our environment.     

Mechanical bowel obstruction: Review of 316 cases in benin city

A retrospective study of 316 patients with a diagnosis of intestinal obstruction admitted to the University of Benin Teaching Hospital over a 5 year period is presented. The overall mortality was 10.6 percent. Attention is called to the unacceptably high morbidity and mortality associated with volvulus in this and other series. Because the most common cause of intestinal obstruction in Africa is strangulation, a preventable complication of inguinal hernia, the clinician has a unique opportunity to significantly decrease the incidence of intestinal obstruction in Africa. Finally, our study confirms that the single most important antecedent of a grave prognosis in intestinal obstruction is late presentation of the patient.     

Feto-maternal outcomes of caesarean delivery in Federal Medical Centre,Asaba: a two year review

BackgroundThe upward trend of caesarean section and its associated morbidity/mortality especially in low and middle income areas makes regular appraisal of the procedure necessary.ObjectiveTo evaluate caesarean section; its rate, indications, and maternal and fetal outcomes in Asaba.MethodsA retrospective study of all caesarean sections carried out at the obstetrics unit of the Federal Medical Centre, Asaba, between July 1, 2018 and June 31, 2020. Data was analyzed using SPSS version 20.ResultsThere were 2778 deliveries during the period, out of which 705 had caesarean sections, giving an overall caesarean section rate of 25.4%.There were 456 (64.7%) emergency caesarean sections. The commonest indication for caesarean section was repeat caesarean section 196 (27.8%), while cephalo-pelvic disproportion 87 (12.3%) was the commonest indication for emergency caesarean section. Majority of the babies had low APGAR score at 1min and 5mins, 126 (27.6%) and 50 (11.0%) from emergency than elective caesarean section 16 (6.4%) and 5 (2.0%) at 1min and 5mins respectively (x2=17.963, P<0.001). There were 31 (4.2%) perinatal deaths out of which majority 28 (6.1%) were from emergency caesarean sections (x2=9.412 P=0.002). The commonest post-operative complication was postpartum anaemia (140 (19.9%) while caesarean section case fatality was 0.6%.ConclusionThis study showed a caesarean section rate of 25.4% with repeat caesarean section and Cephalopelvic disproportion being the most common indication for elective and emergency caesarean section respectively. Emergency caesarean section accounted for most of the cases and is associated with a higher risk of maternal and perinatal morbidity and mortality.