Genetic heterogeneity of "normal" human erythrocyte glucose-6-phosphate dehydrogenase: an isoelectrophoretic polymorphism.

Quantitative determination of glucose-6-phosphate dehydrogenase (G6PD; D-glucose-6-phosphate: NADP+ 1-oxidoreductase, EC 1.1.1.49) activity was carried out in 214 male Nigerian children of 84 mothers with known Gd genotype. The relative intrasibship difference in G6PD activity (normalized to the lowest value within the sibship) was below 0.18 in all cases but one when the children were known to have the same Gd+ allele (identical by descent); whereas it was higher than 0.18 in 18 out of 33 sibships in which children might have had either of the two maternal (electrophoretically identical) Gd+ alleles. G6PD from 10 (8 G6PD B and 2 G6PD A) children belonging to four of the sibships possessing high quantitative variation in G6PD activity was partially purified and extensively characterized. The 8 G6PD type B samples fell unambiguously into two classes on the basis of Km values for glucose 6-phosphate (determined at variuos pH values), and KCl gradient elution from DEAE-Sephadex columns. The two types of G6PD B were resolved from an artificial mixture on a DEAE-Sephacel column. The two G6PD type A samples were also different from each other by the same criteria. We conclude that "normal" G6PD is genetically heterogeneous and that the structural Gd alleles concerned are all polymorphic in the Nigerian population. In this instance, a human enzyme polymorphism, not associated with enzyme deficiency, is revealed by an approach other than electrophoresis.     

Salmonella enterica Serovar Enteritidis,England and Wales, 1945–2011

In England and Wales, the emergence of Salmonella enterica serovar Enteritidis resulted in the largest and most persistent epidemic of foodborne infection attributable to a single subtype of any pathogen since systematic national microbiological surveillance was established. We reviewed 67 years of surveillance data to examine the features, underlying causes, and overall effects of S. enterica ser. Enteritidis. The epidemic was associated with the consumption of contaminated chicken meat and eggs, and a decline in the number of infections began after the adoption of vaccination and other measures in production and distribution of chicken meat and eggs. We estimate that >525,000 persons became ill during the course of the epidemic, which caused a total of 6,750,000 days of illness, 27,000 hospitalizations, and 2,000 deaths. Measures undertaken to control the epidemic have resulted in a major reduction in foodborne disease in England and Wales.     

Pattern of dental extraction in children in a Nigerian tertiary hospital

Changes that occurred in the pattern of tooth extraction in the last 13 years among a population of children in Nigerian were studied. The result of this study was then compared to that of a past study done in the same institution 13 years earlier. Information on age, gender, and indication of tooth extraction was collected prospectively from 379 consecutive patients who visited the outpatient Pediatric Dental Clinic for the first time during the year 2002. Results showed tooth extraction due to caries decreased, while there was an increase in tooth extraction from an apparent increase in orthodontic treatment needs. Acute necrotizing ulcerative gingivitis (ANUG), a significant cause of tooth loss in the last decade, decreased significantly. The pattern of deciduous tooth loss also changed as more anterior teeth were lost for orthodontic reasons in this present study. The pattern of tooth loss in the permanent dentition remains very similar to that of the past study, though more premolars were lost in the present study. There appears to be an increasing need for tooth extractions in orthodontic treatment for this population of children. The focus of planned dental health care provisions, treatment policies, and training emphasis in child dental care may need to shift to addressing orthodontic needs.     

HIV seroprevalence in emergency department patients: Lagos University Teaching Hospital, Lagos, 1999

The emergency department patients represent a cross-section of the entire population and values of HIV seroprevalence in them have been used to assess the general trends of HIV surveillance in other countries. The objectives of this study is to determine 1. Whether seroprevalence of HIV antibodies in patients attending emergency departments could serve as a marker of prevalence of HIV antibody in the general population. 2. The degree of clinical suspicion or knowledge of the medical personnel to the status o the HIV seropositive patients is also evaluated. A total of 312 emergency department patients of Lagos University Teaching Hospital (LUTH) had their blood samples screened for antibodies against Human Immunodeficiency Virus (HIV) types I and II by ELISA based techniques: Immunocomb II HIV I & II Bispot Kits. Repeatedly reactive samples were confirmed by another ELISA based technique using Immunocomb I & II Combfirm kits. The attending medical doctor was asked whether there was any suspicion or knowledge that the patient being attended to, was HIV seropositive. The seroprevalence of HIV antibodies was 5.77% with no significant difference in sex incidence. The age groups 20-29 and 30-39 years were most affected. The seropositive nature of affected patients was unsuspected by medical personnel in 55.56% of the HIV antibodies seropositive patients. The Federal Ministry of Health in 2000, estimated the National prevalence rate of HIV to have been 5.4% in 1998. This figure is comparable to that obtained in this study and revalidates the fact that emergency department patients may be used for disease surveillance in the population. The seropositive status of majority of the HIV positive patients was unsuspected by the attending medical personnel. Thus, strict adherence to universal safety precautions is essential for all medical personnel. Post exposure prophylaxis should be made readily accessible to all medical personnel.     

Diagnosis of iron deficiency anaemia among Nigerian pregnant women by serum iron/T.I.B.C. determination.

Fifty-five patients have been investigated for anaemia in pregnancy. Using the serum iron/T.I.B.C. ratio as a diagnostic index it has been found that iron deficiency exists in 60% of our expectant mothers with mild anaemia. This type of anaemia was more common in multiparous women and more frequent in the first and second trimesters of pregnancy, There is, therefore, a strong indication for the routine administration of iron supplements to our women during pregnancy and the puerperium.     

Diminished synthesis of an alpha chain mutant, hemoglobin I (α16 lys → glu)

In patients heterozygous for abnormal hemoglobins there is usually less than 50% of the mutant hemoglobin present in peripheral blood. The synthetic rates of alpha-chain mutants compared to alpha(A) have not been reported to date. In this study the production of alpha(A)- and alpha(I)-chains has been measured in peripheral blood and bone marrow of two patients with approximately 30% hemoglobin I, an alpha-chain abnormality (alpha(16 lys --> glu)). The results suggest that the decreased amount of alpha(I) compared to alpha(A) is due solely to diminished biosynthesis of the alpha(I)-chains. The relative rates of synthesis of alpha(I)- and alpha(A)-chains are similar in both nucleated red cells and reticulocytes indicating that no change occurs during erythroid cell maturation which preferentially affects either alpha(I) or alpha(A) production.     

Transthyretin as a marker to predict outcome in critically ill patients

BackgroundA determination of serum Transthyretin (TTR, Prealbumin) level is an objective method of assessing protein catabolic loss of severely ill patients and numerous studies have shown that TTR levels correlate with patient outcomes of non-critically ill patients. We evaluated whether TTR level correlates with the prevalence of PEM in the ICU and evaluated serum TTR level as an indicator of the effectiveness of nutrition support and the prognosis in critically ill patients.MethodsWe studied PEM prevalence in 118 patients admitted to a community hospital's medical intensive care unit and the association between TTR, low albumin (ALB) concentration and high-risk disease (HRD), i.e., sepsis, inability to take in oral nutrients, etc. Serum TTR was measured on the day of admission, day 3 and day 7 of their ICU stay. APACHE II and SOFA score was assessed on the day of admission and the nutritional status and nutritional requirement was assessed for their entire ICU stay. Patients were divided into three groups based on initial TTR level and the outcome analysis was performed for APACHE II score, SOFA score, ICU length of stay, hospital length of stay, and mortality.ResultsTTR showed excellent concordance with patients classified with PEM or at high malnutrition risk, and followed for 7 days, it is a measure of the metabolic burden. TTR levels decline from day 1 to day 7 in spite of providing nutritional support. Patients were classified in 3 categories with respect to the level of TTR: more than 170 mg/L, twenty-five patients (group 3); 100–170 mg/L, forty-eight patients (group 2); less than 100 mg/L, forty-five patients (group 1). TTR level correlated with ICU length of stay, hospital length of stay, and APACHE II score, and predicts mortality.ConclusionsTTR identified patients at highest risk for metabolic losses associated with stress hypermetabolism as serum TTR levels did not respond early to nutrition support because of the delayed return to anabolic status. It is particularly helpful in removing interpretation bias, and it is an excellent measure of the systemic inflammatory response concurrent with a preexisting state of chronic inanition.     

Prevalence and correlates of suicidal behaviour among adolescents in southwest Nigeria

BACKGROUND: Despite being recognized by the World Health Organization as a significant social and health concern, information on suicidal behaviours in Nigerian adolescents is unknown. AIMS: To establish the prevalence and associated psychosocial correlates of suicidal ideation and attempts in Nigerian youth. METHODS: Stratified sampling was used to identify youth aged 10-17 years who completed the Nigeria version of the Global School Health Questionnaire (GSHQ) and the Diagnostic Predictive Scale (DPS) for youths (suicidal behaviour questions) in a classroom setting. RESULTS: A total of 1429 youth completed the instruments. Over 20% reported suicidal ideation and approximately 12% reported that they had attempted suicide in the last year. Adolescents living in urban areas, from polygamous or disrupted families, had higher rates of suicidal behaviour. Multiple psychosocial factors such as sexual abuse, physical attack and involvement in physical fights were significant predictors of suicidal behaviour. CONCLUSION: Factors associated with suicidal ideation and behaviours are similar to those found in other studies but the rates of both suicidal ideation and attempts are towards the upper limit of rates for youth. This study suggests that there is an urgent need for Nigerian policymakers and health providers to review and address this issue.