The mechanisms involved in the pathogenesis of osteonecrosis of the femoral head in sickle cell disease are not fully known. The aim of this study was to identify risk factors for osteonecrosis of the femoral head among sickle cell disease patients. Clinical (frequency of painful crises and hospitalisation) and laboratory parameters (euglobulin clot lysis time, haematocrit, platelet count, and leucocyte count) of 25 consecutive patients with avascular necrosis of the femoral head from sickle cell disease were compared with those of 26 age-and sex-matched sickle cell disease patients without avascular necrosis. The group with avascular necrosis of the femoral head (mean age 23.7± 4.9 years) had a significantly higher rate of painful crises (p=0.03) and hospitalisations per year (p=0.002) than the group without avascular necrosis (mean age 21.6± 5.2 years). The group with avascular necrosis also had a significantly higher euglobulin clot lysis time than the group without avascular necrosis (p=0.001). In conclusion, it appears that not all patients with sickle cell disease have impaired fibrinolytic activity. The aetiology of avascular necrosis in sickle cell disease is multifactorial.Résumé Les mécanismes de la nécrose de la tête fémorale dans la drépanocytose sont encore relativement obscures. Le but de cette étude est de mettre en évidence les facteurs de risque de la tête fémorale chez les patients présentant une drépanocytose. Matériel et méthode : l'évaluation des paramètres cliniques (fréquence des crises, nombre d'hospitalisations) et biologique (lyse du caillot, euglobuline, hématrocrite, plaquettes et numération leucocytaire) de 25 patients consécutifs présentant une nécrose avasculaire de la tête fémorale dans le cadre d'une drépanocytose ont été comparés aux données d'une série de patients âgés en moyenne de 26 ans et présentant une drépanocytose sans nécrose aseptique. Résultats : le groupe des nécroses aseptiques de tête fémorale était âgé en moyenne de 23,7± 4,9 avec un nombre de crises douloureuses significativement plus élevé (p=0,03) et un nombre d'hospitalisation également plus élevé (p=0,002) que dans le groupe des nécroses avasculaires simples, moyenne d'âge 21,6±5,2 ans. Le groupe présentant une nécrose avasculaire présent-ant également un taux de lyse du caillot et d'euglobuline plus élevé que dans le groupe sans nécrose (p=0,001). Conclusion : il semble que les patients porteurs d'une drépanocytose comportent sur le plan biologique une activité fribrinolytique plus importante. L'étiologie de la nécrose avasculaire dans le cadre de la drépanocytose est multifactorielle.

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Total lymphocyte count (TLC) has been recommended as a substitute for CD4 cell count for the management of HIV-infected individuals living in resource-limited settings. To confirm this, 151 TLCs and CD4 cell counts were obtained from 109 patients who had not yet started treatment and analyzed. CD4 cell counts of <200 cells/mm3 were found in 42 cases (37.8%) with TLCs of > or =1200 cells/mm3. Thus, 1 in 3 individuals would have been deprived of needed treatment. Therefore, in this setting, TLC is not a reliable predictor of CD4 cell count in HIV-infected individuals.

Objectives: To determine the aetiology, pattern of presentation, treatment regimen and outcome of management of priapism in our environment and to compare our findings with previous studies in this country and elsewhere.

Although variable clinicopathological entities have been documented in sickle cell trait in pregnancy, such information is absent in this environment. This study therefore was aimed at examining the outcome of pregnancy in a population of Nigerian women with sickle cell trait. A prospective analytical study was carried at Ile-Ife, Nigeria comparing morbidities and mortalities between 210 pregnant women with sickle cell trait and 210 women with HbAA. Data were processed using SPSS 11.0 and PEPI packages, and the p value was set at =0.05. There were no significant differences between mothers with sickle cell trait and HbAA in terms of sociodemographic characteristics, the course of labour, deliveries and morbidity patterns. However, mothers with sickle cell trait had significantly fewer attacks of malaria in pregnancy (25.7% compared with 34.8%) and faster recovery of their newborn from birth asphyxia at 1 min (0.9% compared with 4.9%). Sickle cell trait may confer greater resistance to malaria in pregnancy and carries no extra risk to the outcome of pregnancy.