APOLIPOPROTEIN E GENE POLYMORPHISMS AND PLASMA LIPIDS IN PERSONS LIVING WITH HIV: A CROSS SECTIONAL STUDY.

Background and Objective: A major modifiable risk factor for atherosclerotic cardiovascular disease is abnormalities in lipid and lipoprotein metabolism which are frequently seen in HIV as well as its treatment. Apo-E is a protein that is important in plasma lipid homeostasis and its genetic alleles have been shown to contribute to lipid abnormalities. We examined for the effect of Apo-E gene polymorphisms on plasma lipid levels in PLHIV on protease inhibitor therapy. Methods: This was a cross-sectional study conducted among adult persons living with HIV. Lipid profile, Apo-B and Apo-A were measured in fasting plasma. Amplification and analysis of Apo-E genotypes were determined using the Seeplex Apo-E ACE genotyping kit. Differences in quantitative values were compared with non-parametric analysis methods. Results: Eighty-four persons were recruited into the study, 75% of whom were virally suppressed. The 3 homozygous genotypes had significantly different levels of low-density lipoprotein cholesterol (LDL-C), Apolipoprotein B (Apo-B) and Apolipoprotein A1 (Apo-A1). Persons with apo ε2/ε2 had higher LDL-C compared to those with apo ε3/ε3 (3.26 (3.61) mmol/L vs. 2.76 (1.28) mmol/L, p = 0.010). Those with apo ε4/ε4 had lower Apo-A1 compared to those with apo ε3/ε3 (0.84 (0.48) g/dL vs. 1.27 (0.70) g/dL, p =0.009). Compared with the same group, the heterozygous genotype, apo ε2/ε3 had lower triglyceride levels :1.33 (0.65) mmol/ L vs. 1.86 (1.11) mmol/L, p = 0.045. Conclusion: Polymorphisms in the Apo-E gene may have significant influences on plasma lipid and apolipoprotein levels in PLHIV on PI therapy. This may have implications for the assessment of risk for cardiovascular disease.

The Assessment of Copeptin and Brain Natriuretic Peptide Levels as Biomarkers in Hypertensive Disorders of Pregnancy.

BACKGROUND: Hypertensive disorders of pregnancy associated with potentially fatal outcomes are common obstetrics occurrences. Early diagnosis, management and prediction of outcomes are challenges to be surmounted especially in developing countries. Biomarkers are emerging as useful tools for diagnosis and prognostication in varying health conditions. Elevated levels of serum copeptin and Brain Natriuretic Peptide (BNP) are associated with adverse perinatal outcomes and may serve as potential biomarkers utilized during routine antenatal care. OBJECTIVE: To determine the level and clinical value of copeptin and BNP as biomarkers of hypertensive disorders of pregnancy among Nigerian pregnant women. METHODS: This case-control study comprised 156 consenting pregnant women equally grouped into those with chronic hypertension (CH), gestational hypertension (GH), and preeclampsia (PE) as cases and normotensives as controls. Pregnant women were recruited from the antenatal clinic, University College Hospital, Nigeria. Blood pressures were measured and blood (10ml) was drawn from patients, serum and plasma obtained accordingly while other data were collected using interviewer administered questionnaire and medical records. Serum copeptin and plasma BNP levels were measured using enzyme-linked immunosorbent assay. Data was analysed with SPSS version 20.0 and statistical significance was set at p < 0.05. RESULTS: The mean levels of SBP and DBP were significantly higher in CH (155.41±2.14; 102.36±2.0 mmHg), GH (150.49±0.82; 98.67±0.56 mmHg), and PE (153.92±1.47; 98.92±0.61 mmHg), compared to controls (101.85±1.9; 66.77±1.24 mmHg). Mean serum copeptin and plasma BNP were significantly higher in women with GH (21.25±1.31pmol/L; 223.05±14.95pg/mL) and PE (22.47±1.01pmol/L; 253.99±17.69pg/mL) compared with controls (9.05±1.01pmol/L; 48.63±2.50pg/mL) (p<0.05). There was no significant difference in the mean levels of copeptin and BNP in CH compared with controls (p>0.05). The ROC curve for copeptin gave an AUC of 0.829 (p= 0.000) with a cut off value of 10.15pmol/ L while the AUC for BNP was 0.902 (p= 0.000) with a cut off value of 50.81pg/mL. CONCLUSION: Serum copeptin and plasma BNP levels were significantly higher in GH and PE and may be used as markers of hypertensive disorders of pregnancy among Nigerian pregnant women.

Bone Scintigraphy in Breast Cancer Patients in Ibadan, Nigeria.

BACKGROUND: The bone is the commonest site of metastases from breast carcinoma. Radionuclide isotope scanning is a sensitive scanning procedure for the demonstration of bone pathology. In May 2006, a gamma camera was introduced into clinical use for skeletal scintigraphy at the University College Hospital, Ibadan, Nigeria. OBJECTIVE: To review the first five years findings of skeletal scintigraphy in our breast cancer patients. METHODS: We retrospectively reviewed the clinical data and scintigraphic bone studies of patients with histology proven breast carcinoma managed in the Surgical Oncology Division, University College Hospital, Ibadan, Nigeria between May 2006 and April 2011. RESULTS: Within the period, a total of 597 breast cancer patients had skeletal scintigraphy (SS). Of the 594 (99.5%) SS reports available for review, scintigraphic evidence of bone metastases was found in 232 (39.1%) patients. Correlation of bone involvement and clinical stage showed that a large majority of the patients had stage IV (83.3%) and III (15.7%) disease. Most patients (71.6%) had multiple bone lesions. The bone lesions were osteoblastic in 88.9% of the patients; only 1.8% had purely osteolytic lesions with the remainder being a mix of both. CONCLUSION: There was scintigraphic evidence of bone metastasis in most of our patients with stage four breast cancer and in some with locally advanced disease. Multiple bone lesions were found in many of them and almost all the lesions were osteoblastic. Moreover, both the truncal and axial skeletal bones were involved in similar proportions.

Stitch abscess masquerading as recurrent thyroid cancer.

Recurrent thyroid cancer after remnant ablation is a known entity in follow up of differentiated thyroid cancer. It is however unusual for a stitch abscess to present as a recurrent thyroid cancer. We highlight the diagnostic dilemma of a stitch abscess masquerading as a recurrent thyroid cancer in a young female adult in the setting of financial constraint.

Diagnostic value of lipids, total antioxidants, and trace metals in benign prostate hyperplasia and prostate cancer.

BACKGROUND: Considerable overlap exists in the value of total prostate specific antigen (tPSA) in both prostate cancer (Pca) and benign prostate hyperplasia (BPH). Developing an effective biochemical screening test that will complement PSA assay could reduce the associated cost of care and give timely attention to prostate cancer patients even when they are still asymptomatic is therefore desirable. This work was therefore an attempt to evaluate the possible roles of lipids, antioxidants, and trace metals in breaking the diagnostic tie between Pca and BPH. MATERIALS AND METHODS: Anthropometric characteristics, total prostate specific antigen (tPSA), serum lipids (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides), Vit. E, total antioxidant status (TAS), and trace metals (Se, Cu, Fe, Zn, and Mn) were determined in 40 patients with histopathological diagnosis of BPH and Pca. Forty age matched control subjects were also recruited from the same community. Informed consent was obtained from all the participants in the study. A P-value < 0.05 was considered significant. RESULTS: There were significant variations in the weight, hip circumference, and body mass index (BMI) across the group but the post hoc test did not show any difference between patients with prostate cancer and BPH. Among the biochemical parameters studied, only the total cholesterol and triglyceride differed significantly between patients with BPH and prostate cancer patients. Cut-offs from ROC for BPH and prostate cancer at 88.9 sensitivity and 66.7% specificity (95% CI) were 88.5 mg and 161 mg/dl for triglycerides and cholesterol respectively. Furthermore there were no significant variations in the mean levels of copper and tPSA, Vit E, and LDL cholesterol among the study subjects and the controls. CONCLUSION: Prior to prostate biopsy, serum lipid (especially, fasting triglycerides, total cholesterol) could help in early discrimination of patients with BPH from prostate cancer in adjunct to total PSA and other management protocol for diagnosis of prostate cancer. The use of trace metal or antioxidants may have limited advantages. Further studies in this regard will be very desirable to see if this pattern of triglyceride and total cholesterol values in BPH and Pca are sustainable.

High default rate in thyroid cancer management in Ibadan, Nigeria: a need for health insurance.

BACKGROUND: Differentiated thyroid cancer is a potentially curable disease provided there is early diagnosis and full compliance with management modalities. This however becomes a problem in a resource poor environment where most patients pay out of pocket resulting in poor compliance and inability to access standard care due to poverty. This retrospective study was carried out to evaluate the percentage of patients that could afford the cost of care in a premier nuclear medicine facility of a tertiary centre. PATIENTS, MATERIAL AND METHOD: A total 56 patients with differentiated thyroid cancer managed since the inception of the Nuclear Medicine Department, University College Hospital from June 2006 to March 2010 were included in the study. Socioeconomic status of the patients and the affordability of the nuclear medicine procedure for differentiated thyroid cancer post thyroidectomy were evaluated. RESULT: A total of 20 out of 56 (35.7%) patients had total thyroidectomy at presentation, while, 36 had subtotal thyroidectomy. The commonest type of thyroid malignancy was papillary thyroid cancer (51.8%), while follicular cancer accounted for 41.1%. Medullary and Anaplastic thyroid cancers were the least common. Majority of the patients evaluated were within the income bracket of 10,000-30,000 naira ($67- $200) per month). The average cost of management of thyroid cancer post total thyroidectomy was $2500 (N375 000.00) at this centre. Twenty one out of 56 patients (37.5%) could afford the $300 cost of diagnostic whole body iodine scan while only 16 patients out 21 (28.6%) could afford the ($1200) cost of radioactive iodine treatment. CONCLUSION: With average cost of management of management of thyroid cancer beyond the yearly income of majority of the patients studied, there is need for a comprehensive health insurance policy to make accessibility of care of this potentially curable disease available to most Nigerians.

Radioactive iodine ablation therapy: a viable option in the management of Graves' disease in Nigeria.

BACKGROUND: Graves' disease is an autoimmune disorder characterized by hyperthyroidism and associated features. Management of this disease condition for many decades has been largely by surgical and medical intervention. Usage of anti thyroid medication ameliorates the symptoms and effects of excessive production of thyroid hormones. Recently in Nigeria, Nuclear medicine facility became available with the option radioiodine ablative therapy for the management of Graves disease. This study highlights the benefits of radioiodine therapy against the background of equally viable medical and surgical practice. PATIENTS MATERIAL AND METHOD: All the 36 patients seen from the inception of Nuclear Medicine facility at the University College Hospital from June 2006 to May 2010 were included in this study. Sources of referral were compiled. All the patients were on anti thyroid medication at presentation. Thyroid scan was performed by Siemens E- cam gamma camera 20 minutes after intravenous injection of 3-5 mCi of Tc-99m-Pertechnetate. The patients with "diffuse toxic goiter" on thyroid scan were given 10 mCi of Iodine-131 orally and discharged home with radiosafety precautions. Most of the patients were treated 5 days post discontinuation of antithyroid medication. The patients were followed-up monthly with thyroid function tests to determine commencement of replacement therapy. RESULT: Peak incidence of Graves' disease was at 6th decade (38.9%) of all patients studied. This disease was commoner in women with a ratio of 8 to 1. Ten (27.8%) patients became hypothyroid at the 3rd month post radioactive iodine-131 treatment, while the remaining 20 (55.6%) patients became hypothyroid at the 5th month. Six patients were lost to follow up. There was no recurrence of hyperthyroidism in all patients treated. Twenty eight (93.3%) patients were maintained on 100 mcg of levo-thyroxine daily, while 2 (6.7%) patients had more than 100 mcg of levo- thyroxine daily as maintenance dose. CONCLUSION: Radioactive iodine therapy presents a safe and effective alternative to the older conventional mode of management of Graves' disease

Potential toxicity of chlorpheniramine plus chloroquine for the treatment of childhood malaria.

OBJECTIVES: To compare the adverse effects of two regimens of chlorpheniramine plus chloroquine (CP+CQ) in children who live in a country where chloroquine resistant malaria is endemic. METHODS: 99 children with acute uncomplicated malaria were randomised into two treatment groups. Group I received high dose chlorpheniramine (6 mg +12 mg/day for 7 days in children = 5 years; 8 mg + 18 mg/day for 7 days in those >5 years) plus chloroquine 10 mg/kg daily for 3 days. Group II received a 50% higher dose of chlorpheniramine plus chloroquine 10 mg/kg daily for 3 days. Outcome measures were vital signs, clinical response and parasite clearance on days 0-7 and day 14. RESULTS: Parasite clearance, fever clearance and cure rate were comparable for the two groups. Drowsiness occurred in 66.7% of high dose and 86.3% of higher dose CP+CQ subjects (p = 0.05). Compared to children treated with high dose, those treated with higher dose CP+CQ had significantly lower respiratory rates on day 2 (p = 0.001), day 6 (p = 0.015), and on day 14 (p = 0.003). CONCLUSION: The higher rates of drowsiness and lower respiratory rates in children treated with higher dose CP+CQ calls for caution in the clinical application of the higher dose combination. The higher dose has no additional benefit and may in fact be dangerous.

Frequent occurrence of high gamma-glutamyl transferase and alanine amino transferase among Nigerian patients with type 2 diabetes.

Liver function tests (LFTs) are commonly deranged in diabetic patients. There is, however, paucity of local data on actual prevalence and pattern of LFTs abnormality among diabetic patients. A case-control study was carried out to study the pattern of LFTs abnormality among patients with type 2 diabetes (DM). Ninety consecutive patients with type 2 diabetes attending Medical Outpatient Clinic of the University College Hospital, Ibadan, and 90 nondiabetic controls with comparable age and sex were recruited into the study. Serum albumin, alanine amino transferase (ALT) and Gamma glutamyl transpeptidase (GGT) were tested in all subjects. Data were analyzed using Student's t-test, chi-square test and Mann-Whitney U. Among the diabetic patients, 70% had at least one deranged LFTs. The ALT and GGT values were significantly higher (52.9 IU/L and 24.3 U/L respectively) in the diabetic group compared to the controls (34.4 IU/L and 9.2 U/L respectively). Also, the most predominant LFT abnormality in diabetic group was isolated elevation of GGT. This study has confirmed the reported common derangement of LFTs in patients with type 2 DM. In addition, isolated elevation of GGT and ALT are common in Nigerian type 2 diabetic patients. There is need for further study to determine the significance of high GGT and ALT in Nigerian type 2 diabetic population.

Increased plasma manganese, partially reduced ascorbate, 1 and absence of mitochondrial oxidative stress in type 2 diabetes mellitus: implications for the superoxide uncoupling protein 2 (UCP-2) pathway.

Oxidative stress is an important component of diabetes and its complications. Manganese (Mn), the key component of the Mitochondrial antioxidant (MnSOD), plays a key role in the superoxide uncoupling protein 2 (UCP-2) pathway in inhibiting of glucose-stimulated insulin secretion (GSIS). The interactions of Mn with ascorbate and other components of this pathway have not been defined in type-2 diabetes. Fifty established type 2 diabetics (30 males, 20 females) and 30 non-diabetics (controls; 18 males, 12 females) matched for age and sex were investigated. Dietary intake, particularly of micronutrients as assessed by 24-h dietary recall was similar between diabetics and controls. Weight and height of all subjects were determined and body mass index (BMI) computed after clinical assessment. Fasting plasma glucose, manganese, ascorbic acid, creatinine and K+ levels were determined; K+ was to assess the K+ channels, whereas creatinine was to assess probability of oxidative stress nephropathy. Body mass index was greater in DM than in controls (p < 0.001). Fasting plasma glucose and Mn levels (p < 0.00 and p < 0.01, respectively) were higher in diabetes than in the controls. Manganese level was greater than twice the levels in controls. Ascorbic acid was not significantly different (p > 0.05), but was 50% lower than the level in non-diabetics. Potassium like Mn and glucose was significantly higher in diabetes mellitus (DM) than in controls (p < 0.001). Creatinine was not significantly different between diabetics and controls (p > 0.05). Correlations among all parameters were not significantly different. These findings suggest absence of significant oxidative stress in the mitochondria, probably excluding a role for UCP-2-superoxide pathway in the inhibition of glucose-stimulated insulin secretion (GSIS), calling for caution in the precocious conclusion that interruption of UCP-2 activity may provide a viable strategy to improve beta-cell dysfunction in type 2 diabetes mellitus.

Unexpectedly high prevalence of target-organ damage in newly diagnosed Nigerians with hypertension.

INTRODUCTION: Hypertension remains a formidable cardiovascular problem in the entire world. Untreated or poorly controlled hypertension predisposes to target-organ damage and is often followed by serious cardiovascular events. Knowledge of the type and distribution of endorgan damage in newly diagnosed hypertensive patients would help to determine the interventions or preventative measures needed in such patients. OBJECTIVE: To assess target-organ involvement in newly diagnosed, untreated hypertensive patients presenting at the University College Hospital, Ibadan, Nigeria. METHODS: Newly diagnosed hypertensive men and women were recruited consecutively into the study. Target-organ damage was assessed using electroctrocardiography, echocardiography, renal function assessment (including tests for albuminuria) and fundoscopy. RESULTS: A total of 68 subjects were recruited, but only 54 (79.4%), with a mean age of 59.1 ( +/- 12.4) years, completed the study. There were 29 ( +/- 53.7%) men, mean age 63.5 ( +/- 12.6) years, and 25 (46.3%) women, mean age 54.1 ( +/- 10.4) years. Fifty per cent of the subjects had no symptoms. Some form of albuminuria was found in about 40.7%. Seventy-one per cent (71%) had between grade 1 and 2 hypertensive retinopathy. Only six (11.1%) had glomerular filtration rate greater than 90 ml/min. Systolic function was impaired in three (5.6%) of the subjects. Diastolic dysfunction was present in 36 (66.7%) subjects. CONCLUSION: Target-organ damage already exists in newly diagnosed hypertensive subjects before presentation. We suggest early screening for cardiovascular risk factors and possibly a reduction in the criteria for the definition of hypertension in black Africans.

Scintimammography screening for recurrent breast cancer in women.

Scintimammography (SM) is a nuclear medicine technique in which a tumour seeking radionuclide is used to localize or trace an active or residual tumour in breast tissue. It involves the injection ofa radiopharmaceutical into circulation and obtaining a scan of the breast tissue l0-15 min later. This procedure has been shown to be an accurate diagnostic tool in patients with symptomatic breast lesion with a non-diagnostic mammogram and for whom characterizing the lesion becomes important. This retrospective study was done using the case records of all 72 patients who had presented for scintimammography on follow -up for breast conservation surgery from January to August 2005. The result of scintimammography done using 99mTc tetrofosmin method was compared with mammograms and cytology reports when available. A total number of 52 patients, mean age 49.4 +/- 8.71 years (range 35-67) were analyzed. The commonest presentation was induration at site of surgery. In 43 patients without recurrent disease, scintimammography correctly characterized 42 while 8 out of the 10 patients with recurrent disease confirmed by histology reports were correctly identified The sensitivity of this study was 88.8%, while specificity was 95.4%. The positive predictive value was 80%, while the negative predictive value was 95.3%. Given the non-invasiveness of scintimammography and the high diagnostic index, it is a very useful tool in breast cancer diagnosis and followup. Furthermore, the radiation dose to the patient is lower than a chest radiograph and as such the fear of radiation comparatively is milder.

A review of hypertensive disorders of pregnancy.

The detection and clinical management of hypertension in pregnant women are complicated by the concern for fetal development and survival as well as for the health of the mother. Preeclampsia describes a common syndrome that occurs in the second half of pregnancy and often manifesting with hypertension and proteinuria. It occurs in up to 10% of all pregnancies. The factors that initiate preeclampsia are unknown and still a subject of intense clinical research by both Obstetricians and Physicians. The blue print for the development of preeclampsia is probably laid down early in pregnancy, and delivery of the fetus and placenta remains the only effective treatment. Severaclinical, biophysical and biochemical tests have been reported in the world literature to predict the development of preeclampsia. Also, numerous reports have described the predictive value of every possible substance that can be measured in maternal blood or urine. However, the presence of microalbuminuria is an important clinical finding in pregnant women. Indeed, urinary albumin excretion when used as a single test has shown that albumin excretion was higher at booking in those that later developed hypertensive disorders of pregnancy than those that did not have the condition. It had a higher sensitivity and poor predictive value. In conclusion, the factors that are responsible for hypertensive disorders of pregnancy remain unknown and treatment is still difficult. The search for an ideal predictive test or tests should therefore be a continuous exercise.

Acute phase proteins, trace elements in asymptomatic human immunodeficiency virus infection in Nigerians.

The natural history of Human Immunodeficiency Virus (HIV) infection is incompletely understood. Factors other than HIV infection alone may be required for the development of the profound immunosuppression that characterizes advanced HIV disease. Nutritional status plays an important role in maintaining normal immunity and thus may be one of these factors. The plasma concentrations of C-reactive protein, transferrin, selected trace elements (Mg, Zn, Fe, Cu, Cd, Se and Cr,), total protein and albumin were determined in 25 asymptomatic HIV-infected Nigerian subjects and 30 age matched HIV-seronegative controls using single radial immunodiffusion and spectrophotometric methods. The mean values of Cu (73.2 + 23.9 microg/dl), Mg (9.83 + 5.5 mg/dl), Fe (126 + 21 microg/L), Cd (24.6 + 7.2 microg/L), Se (22.0 + 12.2 microg/dl) and Cr (19.0 + 5.2 microg/L) were low in asymptomatic HIV-positive subjects when compared with the controls (Cu = 119.3 + 30.8 microg/dl; Mg = 14.5 + 4.6 mg/L; Fe = 155 + 8.8 microg/ dl; Cd = 33. 1 + 8.3 microg/L; Se = 30.9 + 8.3 microg/dl; Cr = 32.1 + 7.8 microg/ L). The level of Zn was similar in asymptomatic HIV-positive subjects (5.1 + 1.9 mg/dl) and the controls (4.6 + 1.7mg/dl). The value of albumin in asymptomatic HIV-positive subjects (3.43 + 0.7 g/dl) was significantly low when compared with the controls (4.04 + 0.52 g/dl). Significant correlation existed between albumin and Mg in asymptomatic HIV subjects (r = + 0.758, p < 0.001). The mean value of C-reactive protein was significantly higher in HIV-infected subjects compared with the controls while the level of transferrin in HIV-infected subjects (92.86 + 26.3 mg/dl) did not show any significant difference when compared with the controls (84.36 + 16.9 mg/dl). This study revealed the deficiencies of trace elements in asymptomatic HIV infection and therefore suggests dietary supplementation of these trace elements in the infected subjects.

Serum albumin, creatinine, uric acid and hypertensive disorders of pregnancy.

BACKGROUND: Pre-eclampsia is a form of hypertensive disorder of pregnancy. It is a common cause of both maternal and perinatal morbidity and mortality in both developed and developing countries. OBJECTIVE: To evaluate the possibility of early prediction of hypertensive disorders of pregnancy using single estimation of serum protein, creatinine and uric in serum samples of healthy primigravidae with singleton pregnancy. SETTING: University College Hospital, Ibadan. SUBJECTS: Fifty nine normortensive primigravidae. METHODS: Fifty nine healthy normotensive primigravidae with singleton pregnancy who booked for antenal care and delivered at the University College Hospital, Ibadan had single estimations of their serum albumin, creatinine and uric acid levels at booking before the 20th week of pregnancy. The women were followed up longitudinally throughout pregnancy. RESULTS: Pre-eclampsia occurred in five of the patients (21.7%), two had pregnancy induced hypertension only (8.7%) while 16 remained normotensive (69.6%). The difference in the mean serum concentration of uric acid (0.162 +/- 0.02 mmol/L) and creatinine (93.70 +/- 10.08 micromol/L) respectively were not statistically significant (p>0.05). However, the difference in the mean serum albumin levels (4.06 +/- 0.06 versus 3.71 +/- 0.33 gm/dl) was significantly higher in the pre-eclampsia group (p<0.05). The predictive performance of these tests was generally low whether alone or in combination. CONCLUSION: Single estimation of serum uric acid and creatinine levels early in pregnancy are of little value in the prediction of pre-eclampsia. A large study is recommended to properly define the value of serum albumin levels in pregnancy in the prediction of pre-eclampsia in the light of the findings of this study.

Microalbuminuria in controlled type 2 diabetes mellitus patients.

Microalbuminuria assessment using albumin: creatinine ratio (ACR) by ELISA in early morning urine sample was studied in 83 (43 males, 40 females) normotensive type 2 diabetic patients and 40 (20 males; 15 females) age matched apparently healthy control subjects attending the medical outpatient clinic of the University College Hospital, Ibadan. The prevalence of microalbuminuria among the diabetic patients was found to be 60% and 30% among the controls. The level of microalbuminuria was found to correlate with age, duration of diabetes, blood pressure and waist:hip ratio. In both the patients and the controls, microalbuminuria was uncommon below the age of 50 years. The study highlights the contribution of a background renal insult as the probable reason for the high prevalence of microalbuminuria.