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   2014| September-October  | Volume 55 | Issue 5  
    Online since September 9, 2014

 
 
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ORIGINAL ARTICLES
Hypertensive disorders in pregnancy among pregnant women in a Nigerian Teaching Hospital
Swati Singh, Ekele Bissallah Ahmed, Shehu Constance Egondu, Nwobodo Emmanuel Ikechukwu
September-October 2014, 55(5):384-388
DOI:10.4103/0300-1652.140377  PMID:25298602
Background: Hypertensive disorders in pregnancy (HDP) represent a group of conditions associated with high blood pressure during pregnancy. It is an important cause of feto-maternal morbidity and mortality, particularly in developing countries. The aims of the study were to find the prevalence of hypertensive disorders and its associated risk factors among women attending the antenatal clinic of Usmanu Danfodiyo University Teaching Hospital,(UDUTH) Sokoto. Materials and Methods: A longitudinal study of 216 consecutively recruited women that were less than 20 weeks pregnant at booking was carried out. Blood pressure was measured for each woman at booking and at subsequent visits. Urinalysis was done at booking and whenever blood pressure was elevated. Patients were followed-up to delivery and 6 weeks postpartum. Data entry and analysis was done using Statistical Analysis System (SAS) statistical package. Results: The prevalence of HDP in the study was 17% while preeclampsia was 6%. Previous history of preeclampsia (P < 0.001; Relative risk (RR) 4.2; conficence interval (CI) 2.144-6.812), multiple gestation (P < 0.03; RR 3.8; CI 1.037-6.235), gestational diabetes (P < 0.02; RR 4.8; CI 1.910-6.751) and obesity (P < 0.002; RR 2.7; CI 1.373-5.511) were the significant risk factors in the development of HDP among the study population. Conclusion: The prevalence of HDP in the study group is high. Therefore, paying attention to the risk factors will ensure early detection and prevention of the progression of the disease and its sequelae.
  32 17,344 239
REVIEW ARTICLE
The effect of light-activation sources on tooth bleaching
Kusai Baroudi, Nadia Aly Hassan
September-October 2014, 55(5):363-368
DOI:10.4103/0300-1652.140316  PMID:25298598
Vital bleaching is one of the most requested cosmetic dental procedures asked by patients who seek a more pleasing smile. This procedure consists of carbamide or hydrogen peroxide gel applications that can be applied in-office or by the patient (at-home/overnight bleaching system). Some in-office treatments utilise whitening light with the objective of speeding up the whitening process. The objective of this article is to review and summarise the current literature with regard to the effect of light-activation sources on in-office tooth bleaching. A literature search was conducted using Medline, accessed via the National Library of Medicine Pub Med from 2003 to 2013 searching for articles relating to effectiveness of light activation sources on in-office tooth bleaching. This study found conflicting evidence on whether light truly improve tooth whitening. Other factors such as, type of stain, initial tooth colour and subject age which can influence tooth bleaching outcome were discussed. Conclusions: The use of light activator sources with in-office bleaching treatment of vital teeth did not increase the efficacy of bleaching or accelerate the bleaching.
  21 8,666 362
CASE REPORTS
Sclerosing stromal tumour of the ovary: A case report and the review of literature
Özhan Özdemir, Mustafa Erkan Sari, Ertugrul Sen, Aslihan Kurt, Ayse Burcu Ileri, Cemal Resat Atalay
September-October 2014, 55(5):432-437
DOI:10.4103/0300-1652.140391  PMID:25298611
Sclerosing stromal tumours are rare benign ovarian neoplasms of the sex cord stromal that occur predominantly in the second and third decades of life. To date, 208 cases have been recorded in the literature. Most patients have menstrual irregularities and pelvic pain. Infertility and virilisation have also been described. In this article, histopathological features and differential diagnosis of the benign sclerosing stromal tumour were described together with the literature data. It is imperative to consider the differential diagnosis of a sclerozing stromal tumour of the ovary in a young woman with an ovarian tumour. A combination of morphological, immunohistochemical, radiological and clinical findings is needed in differentiating the tumour from thecoma, fibroma/fibrosarcoma, lipoid tumours and Krukenberg tumour.
  19 2,186 94
ORIGINAL ARTICLES
Serum lipid profile and uric acid levels in preeclampsia in University of Benin Teaching Hospital
Nosakhare O Enaruna, Joseph O Idemudia, Paul I Aikoriogie
September-October 2014, 55(5):423-427
DOI:10.4103/0300-1652.140387  PMID:25298609
Background: Preeclampsia is a pregnancy-specific disease associated with significant maternal and perinatal mortality and morbidity. Lipid abnormality and elevated serum uric acid have been reported as early features of the disease. We aimed to detect the level of serum lipid profile and uric acid abnormalities in severe preeclamptics in Benin City and to measure their clinical significance. Materials and Methods: A prospective case-control study was conducted with subjects presenting with severe preeclampsia to the Obstetric Unit of the UBTH, Benin City. Fasting serum lipid profile and uric acid levels of 40 severe preeclamptic subjects and 80 gestation-matched normotensive controls were done at recruitment. The preeclamptic subjects were managed according to our departmental protocol which included stabilisation and delivery. Their sociodemographic and clinical characteristics were used to generate a database for analysis. Results: The mean serum uric acid level was 28% higher in severe preeclamptics than normotensive women (5.96 ± 2.54 mg/dl versus 4.30 ± 0.85; P = 0.005). There were statistically significant differences in levels of triglycerides (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) between the preeclamptics and their normotensive controls (P = 0.006, P = 0.000, P = 0.000, respectively). Abnormal serum uric acid was associated with advanced maternal age (P = 0.000), early-onset preeclampsia (P = 0.000) and abnormal body mass index (BMI; P = 0.000). Low birth weight was more likely in preeclamptics with elevated serum uric acid levels (P = 0.041). Conclusion: Abnormality of serum uric acid in preeclampsia was significantly associated with increased frequency of complications but lipid profile abnormalities were not shown in the subjects studied. We recommend a larger scale study to determine lipid profile in normal and complicated pregnancies in our environment.
  12 6,239 183
Defective lipid metabolism in sickle cell anaemia subjects in vaso-occlusive crisis
Kehinde Sola Akinlade, Christiana Odunayo Adewale, Sheu Kadiri Rahamon, Foluke Atinuke Fasola, John Ayodele Olaniyi, Adedeji David Atere
September-October 2014, 55(5):428-431
DOI:10.4103/0300-1652.140388  PMID:25298610
Background: Abnormal lipid homeostasis has been reported in sickle cell anaemia (SCA) as well as in other haematological disorders. However, there is little information on the lipid profile of SCA subjects in vaso-occlusive crisis (VOC). This study determined the lipid profile of adult SCA subjects in VOC and in steady state (SSCA). Materials and Methods: Fifty-eight (58) adults with HbSS (30 in steady state and 28 in vaso-occlusive crisis) and 24 age-matched healthy individuals with HbAA genotype were recruited into this study. Standard methods were used for the determination of blood pressure (BP), packed cell volume (PCV), total white blood cell count (WBC) and haemoglobin phenotype. After an overnight fast, 5 ml of venous blood was obtained from each SSCA and the controls while samples were collected upon admission in the VOC group. Plasma lipid profile was determined using enzymatic method. Differences between two groups were determined using independent Student's t-test or Man-Whitney U as appropriate. P-values less than 0.05 were considered significant. Results: Plasma total cholesterol (TC) and high density lipoprotein (HDL) were significantly lower while the ratio of triglyceride (TG) to HDL (TG/HDL) was significantly higher in SSCA compared with the controls. Low density lipoprotein (LDL) and TC were significantly lower in SCA subjects in VOC compared with controls. However, TC, TG, LDL and TG/HDL were significantly lower while HDL was significantly higher in VOC compared with SSCA. Conclusion: Sickle cell anaemia subjects have defective fasting lipid metabolism which becomes pronounced with VOC.
  12 4,675 99
Preterm delivery and low maternal serum cholesterol level: Any correlation?
Ayodeji A Oluwole, Maymunah A Adegbesan-Omilabu, Kehinde S Okunade
September-October 2014, 55(5):406-410
DOI:10.4103/0300-1652.140381  PMID:25298606
Background: The study assessed whether low maternal serum cholesterol during early pregnancy is associated with preterm delivery. Patients and Methods: It was a prospective observational cohort study involving pregnant women at gestational age of 14-20 weeks over a period of 12 months. Blood samples were obtained to measure total serum cholesterol concentrations and the sera were then analysed enzymatically by the cholesterol oxidase: p-aminophenazone (CHOD PAP) method. Results: The study showed an incidence of 5.0% for preterm delivery in the low risk study patients. Preterm birth was 4.83-times more common with low total maternal cholesterol than with midrange total cholesterol (11.8% versus 2.2%, P = 0.024). Conclusion: Low maternal serum cholesterol (hypocholesterolaemia) is associated with preterm delivery. Optimal maternal serum cholesterol during pregnancy may have merit, therefore pregnant women should be encouraged to follow a healthy, balanced diet.
  9 4,165 90
Communicating tobacco health risks: How effective are the warning labels on tobacco products?
Amandeep Chopra, Nanak Chand Rao, Nidhi Gupta, Shelja Vashisth
September-October 2014, 55(5):411-416
DOI:10.4103/0300-1652.140383  PMID:25298607
Background: Health hazards of tobacco are well known but only small numbers of tobacco users are fully aware of the harmful effects of tobacco. Warning labels on tobacco products are an effective way of communicating the consequences of tobacco use and bring about behavioural changes like quitting and reducing the tobacco consumption. So the present study was conducted to investigate the awareness and effectiveness of warning labels on tobacco products among health and non-healthcare professional of Barwala, Panchkula. Materials and Methods: A descriptive cross-sectional survey was carried out among 408 subjects who were randomly selected from different professional colleges of Barwala, Panchkula. Data obtained were anlysed using descriptive statistics and Chi-square test using SPSS 20.0. Results: Most of study participants has noticed the warnings on tobacco products and most of them believe that they could understand warning labels. More that 70% believe that warnings create awareness about health hazards of tobacco and help in reducing or quitting tobacco. Pictorial warning was found to be better as compared to text warning. Health professionals were able to assess pictorial warnings more correctly as compared to non-healthcare professionals. Conclusion: Warning labels on tobacco packs effectively inform people about adverse health effects of tobacco but the mandated warnings do not serve the desired purpose since they are not properly understood.
  9 5,417 110
A randomised controlled trial of opioid only versus combined opioid and non-steroidal anti inflammatory analgesics for pain relief in the first 48 hours after Caesarean section
Natalia Adamou, Jamilu Tukur, Zakari Muhammad, Hadiza Galadanci
September-October 2014, 55(5):369-373
DOI:10.4103/0300-1652.140319  PMID:25298599
Background: Post-Caesarean section pain is complex in nature, requiring a combination of pharmacological and non-pharmacological methods. Effective management of postoperative pain will reduce postoperative morbidity, hospital stay and cost. The objective of this study was to compare the clinical effectiveness and adverse effects of a combination of non-selective cyclooxygenase (COX) inhibitor (Diclofenac sodium 50 mg) and opioid (Pentazocine 60 mg) to opiod only (Pentazocine 60 mg) for pain management after Caesarean section (CS) at Aminu Kano Teaching Hospital (AKTH). Materials and Methods: This was a randomised double-blind controlled study conducted at AKTH, Kano, Nigeria. A total of 166 patients scheduled to undergo either emergency or elective Caesarean section were studied. Group I received a combination of COX inhibitor and opiod while Group II received opiod only for pain management after CS. Results: The average age of the patients was 28.35 years (SD ± 6.426) in the group I and 26.9(SD ± 6.133) in group II. The mean parity was 3.27(SD ± 2.67) and 2.75(SD ± 2.14) while the mean gestational age at admission was 37.68(SD ± 2.69) and 38.18(SD ± 2.63) weeks in the first and second groups, respectively. Comparison of the level of pain experienced and patients satisfaction during the first 48 hours postoperatively revealed that the level of pain was statistically significantly less and patient's satisfaction significantly better in group I compared to group II (P-value 0.00001). Conclusion: The use of combined compared to single agent analgesia is safe, significantly reduced pain and improved patient satisfaction after a caesarian section (CS).
  6 6,794 215
A cohort study to evaluate cardiovascular risk of selective and nonselective cyclooxygenase inhibitors (COX-Is) in arthritic patients attending orthopedic department of a tertiary care hospital
Uma A Bhosale, Nilofar Quraishi, Radha Yegnanarayan, Dileep Devasthale
September-October 2014, 55(5):417-422
DOI:10.4103/0300-1652.140386  PMID:25298608
Background: Cyclooxygenase-2 inhibitors (COX-2-Is) have recently been concerned in the occurrence of adverse cardiovascular (CV) events. Rofecoxib and valdecoxib has been withdrawn from the market, but celecoxib, etoricoxib and parecoxib continues to be used. Other nonsteroidal anti-inflammatory drugs (NSAIDs) may also increase the risk of CV events. However, clinical trial databases for COX-2-Is had created lots of controversies regarding cardiovascular safety of selective and nonselective cyclooxygenase inhibitors (COX-Is). This study was, conducted to assess and compare the CV risk of COX-Is in arthritic patients over a period of time. Materials and Methods: In this prospective cohort study adult arthritics of either sex those were freshly diagnosed or taking COX-Is for < 3 months; were included. Patients were grouped into nonselective and selective COX-2-I groups with reference to treatment they received. The CV risk factors like blood pressure (BP), blood sugar level (BSL), lipid profile, body mass index (BMI) were assessed and compared; demography of CV risk factors was also studied. Data obtained was analysed using Student's 't'-test of OpenEpi statistical software. Results: Study clearly revealed that all NSAIDs exhibit variable CV risk; however, selective COX-2-Is found to exhibit more CV risk. BMI, BP and lipid profile; the potential CV risk factors, showed significant impairment in selective COX-2-Is group; P < 0.01, P < 0.001 and P < 0.05, respectively, compared to baseline and P < 0.05 vs. nonselective COX-Is for BMI. Conclusions: This study portrays the potential CV risk of selective COX-2-Is; confirms and re-evaluate the results of earlier studies in this regard.
  4 4,908 173
CASE REPORTS
Incidental detection of microfilariae in a lymph node aspirate: A case report
Donatus Sabageh, Adetunji S Oguntola, Adebanke M Oguntola, Olanrewaju O Bajowa
September-October 2014, 55(5):438-440
DOI:10.4103/0300-1652.140392  PMID:25298612
Lymphatic filariasis is a global health problem endemic in Nigeria. Peripheral blood smears are frequently negative for microfilariae in a significant number of infected patients in whom conventional diagnostic methods may also fail to identify the disease. In such cases, fine needle aspiration cytology may play an important role in disease identification. A 49-year-old South-western male Nigerian farmer, presented with a one-year history of a right groin swelling, which became painful 2 weeks before coming to the hospital. A clinical assessment of lymphogranuloma venereum was made to rule out a non-Hodgkin lymphoma. Initial laboratory investigations only showed mild eosinophilia and haematuria. However, fine needle aspiration cytology performed on the swelling showed microfilariae of Wuchereria bancrofti for which appropriate treatment was instituted with excellent outcome. This case demonstrates that lymphatic filariasis should be considered in the differential diagnosis of lymph node swellings in the groin and that aspiration cytology may play an important role in its diagnosis, especially in an endemic resource poor country.
  3 4,071 84
ORIGINAL ARTICLES
The effect of preoperative intravenous paracetamol administration on postoperative fever in pediatrics cardiac surgery
Mohammad-Hasan Abdollahi, Khalil Foruzan-nia, Mostafa Behjati, Babak Bagheri, Mehdi Khanbabayi-Gol, Shahla Dareshiri, Alireza Pishgahi, Rafie Zarezadeh, Nazgol Lotfi -Naghsh, Ainaz Lotfi -Naghsh, Mohammad Naghavi-Behzad
September-October 2014, 55(5):379-383
DOI:10.4103/0300-1652.140376  PMID:25298601
Background: Post-operative fever is a common complication of cardiac operations, which is known to be correlated with a greater degree of cognitive dysfunction 6 weeks after cardiac surgery. The aim of the present study was to examine efficacy and safety of single dose intravenous Paracetamol in treatment of post-operative fever in children undergoing cardiac surgery. Materials and Methods: In this randomised, double-blind, placebo-controlled clinical trial, 80 children, aged 1-12 years, presenting for open heart surgery were entered in the trial and randomly allocated into two groups: Placebo and Paracetamol. After induction of anaesthesia, 15 mg/kg intravenous Paracetamol solution was infused during 1 h in the Paracetamol group. Patients in placebo group received 15 mg/kg normal saline infusion during the same time. Since the end of operation until next 24 h in intensive care unit, axillary temperature of the two group patients was recorded in 4-h intervals. Any fever that occurred during this period had been treated with Paracetamol suppository (125 mg) and the amount of antipyretic drug consumption for each patient had been recorded. In order to examine the safety of Paracetamol, patients were evaluated for drug complication at the same time. Results: Mean axillary temperature during first 24 h after operation was significantly lower in Paracetamol group compared with placebo group (P = 0.001). Overall fever incidence during 24 h after operation was higher in placebo group compared with Paracetamol group (P = 0.012). Of Paracetamol group patients, 42.5% compared with 15% of placebo group participants had no consumption of antipyretic agent (Paracetamol suppository) during 24 h after operation (P = 0.001). Conclusion: This study suggests that single dose administration of intravenous Paracetamol before paediatric cardiac surgeries using cardiopulmonary bypass; reduce mean body temperature in the first 24 h after operation.
  3 5,870 181
Contributing death factors in very low-birth-weight infants by path method analysis
Morteza Ghojazadeh, Atefeh Velayati, Fatemeh Mallah, Saber Azami-Aghdash, Keyvan Mirnia, Reza Piri, Mohammad Naghavi-Behzad
September-October 2014, 55(5):389-393
DOI:10.4103/0300-1652.140378  PMID:25298603
Background: Neonatal deaths account for 40% of deaths under the age of 5 years worldwide. Therefore, efforts to achieve the UN Millennium Development Goal 4 of reducing childhood mortality by two-thirds by 2015 are focused on reducing neonatal deaths in high-mortality countries. The aim of present study was to determine death factors among very low-birth-weight infants by path method analysis. Materials and Methods: In this study, medical records of 2,135 infants admitted between years 2008 and 2010 in neonatal intense care unit of Alzahra Educational-Medical centre (Tabriz, Iran) were analysed by path method using statistical software SPSS 18. Results: Variables such as duration of hospitalisation, birth weight, gestational age have negative effect on infant mortality, and gestational blood pressure has positive direct effect on infant mortality that at whole represented 66.5% of infant mortality variance (F = 1018, P < 0.001). Gestational age termination in the positive form through birth weight, and also gestational blood pressure in negative form through hospitalisation period had indirect effect on infant mortality. Conclusion: The results of the study indicated that the duration of low-birth-weight infant's hospitalisation is also associated with infant's mortality (coefficient -0.7; P < 0.001). This study revealed that among the maternal factors only gestational blood pressure was in relationship with infants' mortality.
  3 4,554 83
Experience with percutaneous closure of ductus arteriosus using the Amplatzer duct occluder in 243 consecutive patients and long-term results-A single centre study
Mostafa Behjati-Ardakani, Mohammad Amin Behjati-Ardakani, Mehdi Hadadzadeh, Seyed Hossein Moshtaghion, Mohammadtaghi Sarebanhassanabadi
September-October 2014, 55(5):394-398
DOI:10.4103/0300-1652.140379  PMID:25298604
Background: Percutaneous closure of patent ductus arteriosus (PDA) with Amplatzer duct occluder (ADO) has become increasingly popular in many cardiovascular centres. This study analysed the long-term results of percutaneous closure of PDA with ADO in a single centre. Materials and Methods: Between May 2004 and January 2013, 243 patients with median age of 2.5 years (range = 30 months to 38 years) and median weight of 10 Kg (range 4.5-80.5 Kg) underwent percutaneous closure of PDA using the ADO. The devices were implanted under fluoroscopic guidance. Patients were followed-up for any complications. Results: The mean diameter of narrow part of PDA was 6.4 ± 2.2 mm. The mean diameter of devices was 7.8 ± 2.3 mm. The devices were successfully implanted in 239 (98.3%) cases. At immediate, 1 day, 1, 6, 12 months and late follow-up, the complete occlusion rate was 33% (79 case), 97.1% (236 case), 97.5% (237 case), 98.3% (238 case), 98.3% (238 case) and 98.3% (238 case), respectively. Residual shunt remained in one case at late follow-up. The device embolisation occurred in five patients. The devices were successful retrieved in three patient and second larger devices were inserted. Two other devices were surgically retrieved and PDAs were ligated. Moderate left pulmonary artery stenosis (LPA) in one child and mild LPA stenosis in one infant were detected. Mild aortic obstruction occurred in one infant. Conclusions: Long-term follow-up of patients indicate that percutaneous closure of PDA using ADO is a safe and effective procedure. However, some complications, including device embolisation, left pulmonary stenosis and aortic obstruction may be observed in some cases.
  2 4,154 100
LETTERS TO EDITOR
Assessment of attitude in KAP study: A comment on: A survey on doctors' knowledge and attitude of treating chronic pain in three tertiary hospitals in Nigeria
Kanica Kaushal
September-October 2014, 55(5):441-441
DOI:10.4103/0300-1652.140393  PMID:25298613
  - 3,669 73
Percutaneous closure of atrial septal defect and persistent fossa ovalis: Nuances with implications
Kelechi E Okonta, Emmanuel O Ocheli, Francis U Iregbu
September-October 2014, 55(5):441-442
DOI:10.4103/0300-1652.140395  PMID:25298614
  - 2,888 45
ORIGINAL ARTICLES
Risk management assessment of Health Maintenance Organisations participating in the National Health Insurance Scheme
Princess Christina Campbell, Patrick Chukwuemeka Korie, Feziechukwu Collins Nnaji
September-October 2014, 55(5):399-405
DOI:10.4103/0300-1652.140380  PMID:25298605
Background: The National Health Insurance Scheme (NHIS), operated majorly in Nigeria by health maintenance organisations (HMOs), took off formally in June 2005. In view of the inherent risks in the operation of any social health insurance, it is necessary to efficiently manage these risks for sustainability of the scheme. Consequently the risk-management strategies deployed by HMOs need regular assessment. This study assessed the risk management in the Nigeria social health insurance scheme among HMOs. Materials and Methods: Cross-sectional survey of 33 HMOs participating in the NHIS. Results: Utilisation of standard risk-management strategies by the HMOs was 11 (52.6%). The other risk-management strategies not utilised in the NHIS 10 (47.4%) were risk equalisation and reinsurance. As high as 11 (52.4%) of participating HMOs had a weak enrollee base (less than 30,000 and poor monthly premium and these impacted negatively on the HMOs such that a large percentage 12 (54.1%) were unable to meet up with their financial obligations. Most of the HMOs 15 (71.4%) participated in the Millennium development goal (MDG) maternal and child health insurance programme. Conclusions: Weak enrollee base and poor monthly premium predisposed the HMOs to financial risk which impacted negatively on the overall performance in service delivery in the NHIS, further worsened by the non-utilisation of risk equalisation and reinsurance as risk-management strategies in the NHIS. There is need to make the scheme compulsory and introduce risk equalisation and reinsurance.
  - 7,068 129
Value of the use of absolute lymphocyte as surrogate for CD4 count in resource poor situations
Oluwafemi Johnson Adegbamigbe, James Olabanji Adewuyi, Philip O Olatunji
September-October 2014, 55(5):374-378
DOI:10.4103/0300-1652.140324  PMID:25298600
Background: The initiation of antiretroviral (ARV) drugs and monitoring of human immunodeficiency virus (HIV) treatment in developing nations such as sub-Sahara Africa is based on the clinical stage and level of CD4 count. Clinical stages can easily be determined using the World Health Organisation (WHO) criteria, this is not so with CD4 count where the right equipment and expertise are not easily available. This lead to various studies being carried out in search of surrogates for CD4 count with use of total lymphocyte count (TLC) being suggested by some studies. Objective: In situation where determination of CD4 cell count is not available or feasible, lymphocyte count is believed to be one alternative method for immunological classification of Acquired Immunodeficiency Syndrome (AIDS). Such assumption may not be true of every population. The objective is, therefore, to examine the correlation between the absolute lymphocyte count and the CD4+ lymphocyte count in HIV positive patients. Materials and Methods: One hundred and sixty-five consecutive HIV positive patients were recruited for the study before the commencement of ARV drugs over a period of 13 months. The haemotological parameters such as the CD4 count was done by flow cytometry using Partec cyflow counter machine made in Germany, with strict adherence to the manufacturer's standard operating procedure. TLC were also determined using Sysmex haematology blood analyser, following the manufacturer's standard operating procedure. Patients were then grouped into CD4 and Total lymphocyte (TLC) categories. These were then compared to determine if there is any correlation as shown in previous studies. Statistical analysis of data was done using Statistical Package for Social Sciences (SPSS) and statistical significance of data was based on P value of less than 0.05. There was significant positive correlation (P value 0.000) between TLC and CD4 count. Results: Majority of the patients with TLC less than 1000/mm [3] had CD4 count <200 cells/μl. Using TLC <1000/mm [3] threshold, there was high sensitivity of 81.8% but low specificity and positive predictive value of 47.5% and 19.4%, respectively, for CD4 count <200 cells/μl. Further assessment using TLC of <1,200/mm [3] for the currently accepted CD4 count cut-off of <350 cells/μl for initiation of antiretroviral drugs, the sensitivity, specificity, positive predictive value were found to be 76.5%, 26.7%, 21.3%, respectively. Conclusions: Considering the low specificity and positive predictive value, it was concluded that the use of TLC of as a surrogate for CD4 count is unreliable. However, where there is no alternative, it could be used with caution bearing in mind its limitations.
  - 5,146 148
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