Relationship between Serum Uric Acid and Hypertension among Secondary School Adolescents in Ekiti State, Nigeria.

BACKGROUND: With the seemingly increasing trend of childhood hypertension, high serum uric acid (SUA) levels might be an indicator of essential hypertension among adolescents. OBJECTIVE: To determine the SUA levels of hypertensive students and randomly selected controls and find the association, if any, between SUA level and blood pressure (BP) among secondary school students in Ido-Osi Local Government Area (LGA). METHODOLOGY: The study was a nested case-control study conducted among selected secondary school students in IdoOsi LGA from June 2017 to March 2018. Of the 573 students screened for hypertension, SUA was assayed from 31 hypertensive students and an equal number of age- and sexmatched controls. Serum uric acid greater than 5.5 mg/ dL was taken as high. Statistical analysis included chi-square and Pearson correlation. RESULTS: There was a positive correlation between SUA level and both systolic BP (p < 0.013) and diastolic BP (p < 0.017). The mean (SD) serum uric acid level of the hypertensive students [5.39 (2.08) mg/ dL] was higher than that of the controls [4.24 (1.81) mg/ dL] (p = 0.023). Hypertensive students with hyperuricaemia had a higher mean (SD) systolic BP than those with low uric acid: 138.67 (14.81) versus 128.68 (10.04); p =0.037. CONCLUSION: The mean serum uric acid level of students with hypertension was higher than that of the non-hypertensive students and high SUA levels appear to more prominently affect systolic than diastolic blood pressures among the cohort of hypertensive students.

CONTEXTE: Compte tenu de la tendance apparemment croissante de l'hypertension chez les enfants, des taux élevés d'acide urique sérique (AUS) pourraient être un indicateur d'hypertension essentielle chez les adolescents. OBJECTIF: Déterminer les niveaux d'acide urique sérique des élèves hypertendus et des témoins choisis au hasard et trouver l'association, le cas échéant, entre le niveau d'acide urique sérique et la tension artérielle chez les élèves du secondaire dans la zone de gouvernement local (LGA) d'Ido-Osi. MÉTHODOLOGIE: L'étude était une étude cas-témoins imbriquée menée auprès d'élèves du secondaire sélectionnés dans la zone de gouvernement local d'Ido-Osi de juin 2017 à mars 2018. Sur les 573 élèves dépistés pour l'hypertension, le SUA a été dosé chez 31 élèves hypertendus et un nombre égal de témoins appariés selon l'âge et le sexe. Un taux d'acide urique sérique supérieur à 5,5 mg/ dL a été considéré comme élevé. L'analyse statistique a porté sur le chi-carré et la corrélation de Pearson. RÉSULTATS: Il y avait une corrélation positive entre le niveau de SUA et la tension systolique (p < 0,013) et la tension diastolique (p< 0,017). Le niveau moyen (SD) d'acide urique sérique des étudiants hypertendus [5,39 (2,08) mg/ dL] était plus élevé que celui des témoins [4,24 (1,81) mg/ dL] (p = 0,023). Les étudiants hypertendus présentant une hyperuricémie avaient une TA systolique moyenne (SD) plus élevée que ceux ayant un faible taux d'acide urique : 138,67 (14,81) contre 128,68 (10,04); p =0,037. CONCLUSION: Le taux moyen d'acide urique sérique des étudiants hypertendus était plus élevé que celui des étudiants non hypertendus et les taux élevés d'acide urique sérique semblent affecter davantage la pression artérielle systolique que la pression artérielle diastolique dans la cohorte d'étudiants hypertendus. Mots-clés: Adolescents, hypertension, relation, acide urique sérique.

Evaluation of Primary School Health Environment in Ido/Osi Local Government Area, Ekiti State, Nigeria.

BACKGROUND: School environment entails the sum total of the physical, biological, social, and emotional environment within which members of the school community operate. It is essential to make the school environment healthy to promote and protect the health of school pupils as well as their safety. This study aimed at finding the level of implementation of a Healthy School Environment (HSE) in Ido/Osi Local Government Area (LGA) of Ekiti State. METHODOLOGY: A cross-sectional descriptive study carried out among 48 private and 19 public primary schools using a standardised checklist and direct observation. RESULTS: The teacher-to-pupil ratio was 1:16 in public schools and 1:10 in private schools. The leading source of water in 47.8% of the schools was well water. Most, 97%, of the schools practiced open dumping of refuse. Private schools had more school buildings with strong walls and good roofs with doors and windows which provided adequate ventilation compared to the public schools (p- 0.001). No school was located close to an industrial area, however, none had a safety patrol team. Only 34.3% of schools had a fence and 31.3% had terrains prone to flooding. Only 3% of the schools, all private schools, attained the minimum acceptable score on the school environment. CONCLUSION: The status of school environment was poor in the study location and school ownership did not make any much impact as there was no difference in the situations of school environment between public and private schools.

CONTEXTE: L'environnement scolaire est l'ensemble des conditions physiques, biologiques, sociales et émotionnelles dans lesquelles évoluent les membres de la communauté scolaire. Il est essentiel de rendre l'environnement scolaire sain afin de promouvoir et de protéger la santé des élèves ainsi que leur sécurité. Cette étude visait à déterminer le niveau de mise en œuvre de l'environnement scolaire sain (HSE) dans la zone de gouvernement local (LGA) d'Ido/Osi de l'État d'Ekiti. MÉTHODOLOGIE: Une étude descriptive transversale a été menée dans 48 écoles primaires privées et 19 écoles primaires publiques à l'aide d'une liste de contrôle standardisée et d'une observation directe. RÉSULTATS: Le ratio enseignant/élèves était de 1:16 dans les écoles publiques et de 1:10 dans les écoles privées. La principale source d'eau dans 47,8 % des écoles était l'eau de puits. La plupart des écoles (97%) pratiquaient le dépôt d'ordures à l'air libre. Les écoles privées avaient plus de bâtiments scolaires avec des murs solides et de bons toits avec des portes et des fenêtres qui fournissaient une ventilation adéquate par rapport aux écoles publiques (p- 0.001). Aucune école n'était située à proximité d'une zone industrielle, mais aucune ne disposait d'une équipe de patrouille de sécurité. Seules 34,3 % des écoles disposaient d'une clôture et 31,3 % étaient situées sur des terrains inondables. Seules 3 % des écoles, toutes privées, ont atteint le score minimum acceptable en matière d'environnement scolaire. CONCLUSION: L'état de l'environnement scolaire était médiocre dans la région étudiée et la propriété de l'école n'avait pas beaucoup d'impact car il n'y avait pas de différence dans la situation de l'environnement scolaire entre les écoles publiques et les écoles privées. Mots-clés: État d'Ekiti, Environnement sain, Gouvernement Local, Nigeria, École Primaire, Environnement Scolaire.

An assessment of school-based health instruction among primary schools in Ido/Osi local government area Southwest, Nigeria.

Background: School Health Instruction (SHI) comprises of series of formal, well-planned, and organized learning whereby information concerning knowledge, habits, attitudes, practices, and conducts are given pertaining to the health of an individual or members of the school community. A well-structured and implemented SHI forms the basis for a healthy health promotion. Aim: The study aimed at assessing the implementation of SHI among primary schools in a Local Government Area, Southwest, Nigeria. Subjects and Methods: A cross-sectional descriptive study was carried out among 67 private and public schools in a Local Government Area of Ekiti State using a standardized checklist and direct observation. Data were analyzed using SPSS version 25. Results: The ratio of teachers to pupils was 1:16 in public schools and 1:10 in private schools. More public-school teachers (93.8%) compared to private school teachers (28.9) had education-related qualifications (P < 0.0001). All public schools adhered to the recommended three periods per week on health education while the frequency of adherence varied in private schools. About half of the private school teachers and 60.4% of the public school teachers have had in-service training on general health and health promotion. Direct teaching by a subject teacher was carried out by 11.9% of the schools while 49.3% had supplemental teaching aids. The scope of health education was uniform among all the schools. Only 46.3% of the schools attained the recommended minimum acceptable score on SHI. Conclusion: School health instruction was poorly implemented in the study location. There is a need to scale up SHI and monitor its implementation in the study location. These efforts should be supported by all stakeholders and backed with adequate oversight function by regulatory authorities, provision of in-service training, and teaching aids for teachers.

Challenges in the logistics management of vaccine cold chain system in Ile-Ife, Osun State, Nigeria

Background: The success of national immunization programmes depends largely on effective logistics management of the vaccine cold chain system. This study assessed cold chain equipment functionality, healthcare workers' knowledge and practice of the logistics management of vaccine cold chain system in Ile-Ife, Nigeria. Methods: A descriptive study was conducted in immunization clinics of 35 health facilities in Ife East and Central Local Government Areas (LGA) in Ile-Ife. There were 100 immunization service providers in the (LGAs) and they were all recruited into the study. Information was obtained with the aid of an interviewer-administered, structured questionnaire. Cold chain equipment functionality was assessed using a checklist. Data were analyzed using SPSS version 20.0. Results: Eleven (31.4%) of the facilities had functional refrigerators for storing vaccines, 16 (45.7%) had cold boxes while 13 (37.1%) had thermometers for vaccine temperature monitoring. Fifty-four (54.0%) of the healthcare workers were aware of the "shake test" and 19 (19.0%) could correctly interpret colour changes on a vaccine vial monitor. Consumption record was considered by 69 (69.0%) of healthcare workers when making vaccine requisitions while the required lead time was considered by 24 (24.0%) of them. Only 29 (29.0%) of healthcare workers kept records of vaccines stock-on-hand.Conclusion: Adequate training and supportive supervision is essential to improve healthcare workers' knowledge and cold chain practices. Relevant cold chain equipment should be provided to boost storage capacity across health facilities

Hepatoprotective activity of purified fractions from Garcinia kola seeds in mice intoxicated with carbon tetrachloride.

The hepatoprotective activity of kolaviron (KV), a biflavonoid complex from Garcinia kola seeds, and its purified fractions was investigated in mice intoxicated with carbon tetrachloride (CCl(4)). The ability of vitamin E to attenuate the toxicity was also examined. KV was extracted from powdered seeds of G. kola and then separated by thin-layer chromatography into three fractions--Fraction I (FI), Fraction II (FII), and Fraction III (FIII), with ratio of fronts values of 0.48, 0.71, and 0.76, respectively. Pretreatment with KV, FI, and FII at a dose of 100 mg/kg of body weight for 2 weeks and then challenge with CCl(4) at a dose of 1.2 g/kg of body weight, three times a week for 2 consecutive weeks, decreased the CCl(4)-induced increase in activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) by 31%, 30%, and 31% and 41%, 55%, and 42%, respectively. CCl(4) intoxication also caused a significant (P < .05) accumulation of lipid peroxidation (LPO) products as revealed by the formation of the thiobarbituric acid-reactive substances: CCl(4) induced LPO levels in serum and microsomes by 112% and 89%, respectively. However, pretreatment with KV, FI, and FII decreased LPO levels in serum by 31%, 41%, and 40% and in microsomes by 48%, 39%, and 35%, respectively. Vitamin E was protective in reducing the CCl(4)-induced increase in levels of AST, ALT, and gamma-glutamyl transferase as well as LPO. Furthermore, CCl(4) intoxication significantly (P < .05) decreased the activities of microsomal glucose-6-phosphatase, aniline hydroxylase, and cytosolic glutathione-S-transferase (GST). While pretreatments with KV, FI, and FII were able to ameliorate the levels of glucose-6-phosphatase and GST, there were no significant (P > .05) effects on the levels of aniline hydroxylase and DT-diaphorase. This study confirms that FI and FII from KV enhanced recovery from CCl(4)-induced hepatotoxicity by decreasing the extent of LPO and also inducing the levels of phase II enzyme (GST). These fractions are responsible for the observed antihepatotoxic effect of KV.

Hypoglycaemic and hypolipidaemic effects of fractions from kolaviron, a biflavonoid complex from Garcinia Kola in streptozotocin-induced diabetes mellitus rats.

In the search for natural hypoglycaemic agents as alternatives to synthetic ones that are expensive and not easily accessible, and to justify the use of Garcinia kola seeds in traditional African medicine to treat diabetes, the hypoglycaemic and hypolipidaemic effects of fractions from kolaviron (KV) (a Garcinia kola seed extract) were investigated in normal and streptozotocin (STZ)-diabetic rats. KV, a biflavonoid complex from Garcinia kola seed, was separated by thin-layer chromatography into three fractions; Fraction I (FI), Fraction II (FII) and Fraction III (FIII) with RF values of 0.48, 0.71 and 0.76, respectively. In normoglycaemic rats, KV, FI and FII administered at a dose of 100 mg kg(-1) body weight elicited significant (P < 0.05) hypoglycaemic activity within 4 h of oral administration. Precisely, KV, FI and FII decreased blood glucose levels of normoglycaemic rats by 66%, 50% and 61%, respectively, when compared with controls 30 min after oral administration of the extracts. In hyperglycaemic rats, KV, FI and FII significantly (P < 0.05) reduced blood sugar levels in STZ-diabetic rats within 4 h of oral administration. Furthermore, KV alone produced a significant (P < 0.05) anti-diabetic effect from day 3 to day 7 of oral intubation of STZ-diabetic rats. In addition, the extracts showed favourable effect on the plasma lipid profile of STZ-diabetic rats, and also decreased significantly (P < 0.05) the STZ-induced increase in the activity of microsomal glucose-6-phosphatase and lipid peroxidation (LPO) products. This study confirms the anti-diabetic and hypolipidaemic effects of KV in STZ-diabetic rats. These observed effects of KV are attributed to two of its fractions, FI and FII, with RF values of 0.48 and 0.71, respectively.

The performance profile of medical students in the mock objective structured clinical examination.

OBJECTIVE: Acquisition of clinical skills, after completing a course in the basic sciences, is an essential aspect of undergraduate training in any medical school. These skills are usually divided into 3 broad categories: namely, history taking, physical examination and selection of the appropriate laboratory investigations. At the end of the clerkship, the students' clinical skills have to be assessed. The main objective was to describe the performance profile of a group of medical students while examing a distended abdomen in the United Arab Emirates. METHODS: This paper describes the performance profile of 24 randomly selected medical students in a mock objective structured clinical examination of a patient with distended abdomen in the hospital environment. Marks were allotted according to the checklist of the performance expectations. For the assessment used in this paper, ability to perform a step of the clinical examination was rated positive and documented. RESULTS: The performance profile of the students was very good to excellent, corresponding to 9 out of 10 marks. All students identified or excluded the common signs of clinical ascites. The signs uncommonly seen in this area, such as Dupytren's contractures, were excluded by 20 of 24 (83%) students. CONCLUSION: The excellent performance is attributed to a greater exposure to patients with mainly gastrointestinal disorders during the clerkship. The main advantage of an objective structured clinical abdominal examination, which is set up in a hospital environment, is that it reflects the real life situation of a practising physician, as opposed to using simulated patients. Although, a structured clinical examination is labor-intensive and costly, the advantages outweigh the work and cost of setting it up.

Evaluation of Plasma Beta-2-microglobulin in Patients with the Nephrotic Syndrome.

In patients with the nephrotic syndrome, it is often desirable to assess the disease process, not only by proteinuria but also by indices of glomerular inflammatory process. We investigated the importance of beta-microglobulin (betaM) as a means of assessing renal function in patients with the nephrotic syndrome with normal or abnormal values of creatinine clearance. There were 46 patients (mean age, 42.2 + 10.4 years; male/female (M/F) ratio = 31/15) and 35 healthy controls (mean age 39 + 4.5 years, M/F ratio 25/10). We subdivided the study patients into group A (n = 18, mean age 39.6 + 10.6 years, M/F ratio 8/10) and group B patients (n = 28, mean age 45.6 + 8.9 years, M/F ratio 23/5) who had normal and abnormal values of creatinine clearance respectively. An enzyme-linked-immunosorbent assay (ELISA) was used to quantitate plasma beta2M in the study patients and controls. The median 132M levels of the study patients and controls were 44.0 and 1.7 mg/l respectively (p < 0.0001). Beta-2-M levels correlated significantly with serum creatinine (r = 0.56, p < 0.0001), and creatinine clearance (r = -0.6, p < 0.0001). In group A patients, the median beta2M level was significantly higher than normal (4.1 vs. 1.7 mg/1, p < 0.01). Plasma beta2M levels did not correlate well with any other parameter measured in group A patients. When groups A and B were compared, the median plasma beta2M level in group B was significantly higher than group A (20.3 vs. 4.1 mg/1, p < 0.0001). The urinary beta2M (expressed per mg urine creatinine) was also higher in group B than group A patients (6.8 vs. 0.7 p < 0.05). We conclude that elevation of beta2M-microglobulin in patients with the nephrotic syndrome who have normal creatinine clearance suggests early abnormal renal function in these patients. It may be used to assess the rate of normalisation of renal function or progression to chronic renal failure.

The outcome of a 2-week treatment of Helicobacter pylori-positive duodenal ulcer with omeprazole-based antibiotic regimen in a region with high metronidazole resistance rate.

BACKGROUND/OBJECTIVE: Metronidazole resistance is a major problem in many developing countries. Our main objective was to study the outcome of a non-metronidazole and omeprazole-based antibiotic regimen in eradicating Helicobacter pylori in patients with duodenal ulcer. DESIGN: A prospective study of 50 consecutive patients with proven peptic ulcer (mean age 36.6 +/- 10.5 years, range 17-60, male:female = 2), referred from the primary health centres. MAIN OUTCOME MEASURE: The primary outcome of the study was H. pylori eradication, at least 4 weeks after stopping antibiotic treatment. METHODS: Patients were considered eligible for the study if they had endoscopic evidence or a past medical history of peptic ulcer and had not received any antibiotics for at least 4 weeks prior to admission into the study. H. pylori infection was confirmed by serology, histology, a rapid urease test (RUT) and culture. After an initial oesophago-gastroduodenoscopy (OGD), each patient received a 2-week course of omeprazole (20 mg twice daily), and each of amoxycillin capsules (500 mg) and clarithromycin tablets (250 mg) thrice daily after food. The follow-up OGDs were performed after a mean period of 10.04 weeks (range 4-48) and at 10.4 +/- 2.5 months (range 6-14 months) after stopping treatment. RESULTS: All 50 patients completed the study. The sensitivity values for serology, RUT and histopathology were 98, 96 and 100%, respectively. H. pylori culture was positive in only 15 of 50 patients (30% sensitivity). H. pylori was eradicated in 47 (94%) patients. There was no evidence of H. pylori infection in the 27 of 35 (77%) patients, who returned for a third OGD. At the time of the second OGD, there was a significant reduction of pain-days (from 5.47 to 1.16), and antral (from 1.95 to 0.78) and corpus (from 1.8 to 0.6) mucosal cellular infiltrate scores, when compared with the first OGD (P < 0.001 in each case). CONCLUSION: Exclusion of metronidazole from the treatment regimen of patients with H. pylori-positive duodenal ulcer in a region with metronidazole resistance yielded an excellent H. pylori eradication rate of 94%, when omeprazole, amoxicillin and clarithromycin were used.

Characterization of autonomic dysfunction in patients with irritable bowel syndrome by means of heart rate variability studies.

OBJECTIVE: Our aim was to characterize autonomic dysfunction in patients with irritable bowel syndrome (IBS) using heart rate variability (HRV) studies. METHODS: EKG signals were obtained from 35 patients (mean age, 39.1 +/- 9.5 yr, M:F ratio = 2.9:1) and 18 healthy controls (mean age, 38.2 +/- 6.5 yr, M:F ratio = 2:1) in supine, standing, and deep-breathing modes. Fast Fourier transformation and autoregressive techniques were used to analyze the HRV power spectra in very low (VLF, 0.0078-0.04 Hz), low (LF, 0.04-0.14 Hz), and high (HF, 0.14-0.4 Hz) frequency bands. RESULTS: In the supine position, the VLF power spectral density (PSD) in IBS was significantly higher than normal (3 vs 1.3 beats per minute [bpm]2/Hz, p < 0.01). On changing from the supine to standing position, the normals (NC) had raised median PSDs in the VLF (1.3 vs 12.8 bpm2/Hz, p < 0.01) and LF (1.6 vs 6.1 bpm2/Hz, p < 0.01) bands, as a sign of increased sympathetic tone, whereas the median HF PSDs (parasympathetic tone) remained unchanged (1.8 bpm2/Hz each, p = 0.8). Similarly, the IBS patients had increased VLF (3.04 vs 14.93 bpm2/Hz, p < 0.01) and LF (2.8 vs 8.7 bpm2/Hz, p < 0.01) PSDs on standing up, but the HF PSD was also raised (from 2.4 to 5.7 bpm2/Hz, p = 0.04). On changing from standing to the deep-breathing mode, the normals had a significant increase in the HF (from 1.8 to 10.3 bpm2/Hz, p < 0.001) and a significant reduction of the VLF (from 12.8 to 2.2 bpm2/Hz, p < 0.01) PSDs. The reduction of the LF PSD was not significant (from 6.1 to 5.6 bpm2/Hz, p = 0.6). In IBS, HF PSD remained constant (5.7 bpm2/Hz each, p = 0.6), whereas the LF PSD increased from 8.7 to 24.2 bpm2/Hz (p < 0.0001). The VLF PSD was reduced (from 14.9 to 4.1 bpm2/Hz, p < 0.0001). In IBS, the median sympathovagal outflow ratio was significantly lower in the standing position (1.4 vs 2.8, p < 0.02) and higher in the deep-breathing mode (7.33 vs 0.42, p < 0.0001) than normal. CONCLUSIONS: IBS patients have reduced sympathetic influence on the heart period in response to orthostatic stress and diminished parasympathetic modulation during deep breathing.

Grading Helicobacter pylori gastritis in dyspeptic patients.

Helicobacter pylori-like organisms (Hp) and polymorphonuclear leucocytes (PMNs) in 2614 gastroduodenal biopsies from 602 patients with dyspepsia, in Al Ain, United Arab Emirates, between October 1990 and October 1992, were histologically graded to determine the prevalence of Hp gastritis and their utilization in the evaluation of treatment efficacy in these patients. Symptoms of functional dyspepsia included, in order of frequency, abdominal pain or discomfort, flatulence, burning sensation, regurgitation, fullness, nausea, vomiting, bloating and belching. The biopsies were paraffin embedded, sectioned and stained with hematoxylin and eosin (H and E) to grade the inflammation. In addition to H and E, several special stains including modified Giemsa (MG), Wharthin-Starry silver and cold Ziehl-Neelsen stains were utilized to clearly identify Hp organisms. Giemsa method was found to be superior to other special stains in visualizing the Hp organisms in paraffin sections, and was utilized in every case. Two immunohistochemical markers for B cells (CD20) and T cells (CD45RO) were utilized for labeling lymphocytes infiltrating the lamina propria of the gastroduodenal biopsies in formalin-fixed paraffin-embedded sections. H and E and MG stained sections were utilized to count PMNs and Hp, and were graded 0, 1, 2, and 3, corresponding to none, mild, moderate, and severe grades of the Sydney system for classification of gastritis, respectively. Of the total initial 2318 endoscopic biopsies, 98.8% of the patients had suitable biopsies for histologic evaluation. Unsuitable biopsies were recovered from patients with gastric carcinoma. Inflammation was seen in 98.5% of 595 patients with suitable biopsies. In 74.5% of these patients the inflammation was active; 37.5, 32.5 and 4.5% had mild, moderate and severe active inflammation, respectively. In the remaining 24% of the 595 patients, the gastritis was chronic without activity or atrophic changes. As many as 73.6% of the patients with suitable biopsies were Hp positive; 39.8, 29.1 and 4.7% had grades 1, 2 and 3 Hp, respectively. Intestinal metaplasia was found in 28.9% of the 602 patients, and was seen more often in Hp positive than Hp negative patients (34.5 vs 14%, P < 0.005, for d.f. = 1; chi 2 = 10.35). Of the Hp positive patients, 172 and 46 patients attended the first and second follow-up endoscopy visits, respectively. The triple treatment was composed of one dose of tinidazole (2gm), doxycycline, 200 mg initial dose and 100 mg daily for two weeks, and bismuth subcitrate (Gist-Brocades nv, Delft, The Netherlands), 2 tablets twice daily for 4 weeks. After triple drug treatment, eradication of Hp was accomplished, histologically, in 38.4 and 45.7% of the patients on first and second follow-up visits, respectively. Thus, the Sydney system-based grading scale provides an objective histological evaluation of Hp gastritis for accurate prevalence studies, and may prove to be of value in estimating treatment efficacy.

Antibody binding to alpha 2-macroglobulin facilitates direct quantitation of elastase-alpha 2-macroglobulin complexes by a simple ELISA technique.

In order to investigate the effect which the binding of anti-alpha 2-macroglobulin (anti-A2M) antibody has on subsequent antigen-antibody reaction between the complexed elastase and the solid phase anti-elastase antibody, elastase alpha 2-macroglobulin complex (EMC) was incubated with anti-A2M antibody and then extracted by a solid-phase bound rabbit anti-elastase antibody. A doubling dilution series of EMC generated dose related absorbance values. The critical factor permitting the immunological detection of A2M-bound elastase is the pre-incubation of anti-A2M antibody with EMC in solution. The assay exhibited a lower detection limit of 0.5 ng bound elastase per ml and EMC levels in serum samples from ten volunteers were significantly higher than in plasma (28 vs. 21 ng/ml, p < 0.05, Student's t test for paired samples). The EMC levels measured with this assay were essentially identical to those obtained when phenyl methyl sulfonyl fluoride (PMSF) was added to the assay buffer solution.

Clinicopathological assessment of gastric biopsy samples of patients with Helicobacter pylori infection--metronidazole resistance and compliance problems in the United Arab Emirates.

The significance of Helicobacter pylori (HP) infection was assessed prospectively in forty-two patients with dyspepsia using histological, bacteriological and biopsy urease techniques. Thirty-eight patients (90.5%) were positive for HP infection and were treated with bismuth subcitrate (De Nol), tinidazole and doxycycline. HP was present in the antrum, corpus, fundus, duodenum and gastric juice in 36, 26, 23, 2 and 2 patients respectively (p < 0.01, X2 test). Histological assessment yielded more positive identifications of HP than the urease test (36 vs 28 positive cases, p < 0.01, McNemar's X2 test), while histology and bacteriology were virtually identical (38 vs 37 of 41 pairs, p > 0.5, X2 test). There was a good correlation between bacterial and polymorphonuclear leucocyte (PMNL) counts per high power field (r = 0.8; p < 0.001; n = 34 pairs). There was resistance to metronidazole in 10 out of 16 isolates, but no resistance was recorded against tetracycline (p < 0.001, X2 test). Among the sixteen patients who attended follow-up endoscopy, there was clinical improvement and no evidence of HP in 5 individuals (31.25%). One patient had amelioration of his symptoms, 5 experienced no change and in 5 their symptoms became worse. Metronidazole resistance may be one of the important factors in the United Arab Emirates and elsewhere.

Plasma lactoferrin as a marker of infection in elderly individuals.

To assess lactoferrin as a marker of infection, plasma lactoferrin (LF) levels were determined in elderly in patients with infection and compared with age- and sex-matched healthy and hospital controls and young healthy blood donors. The median LF level in infection (800 ng/mL) was significantly higher than in healthy elderly living in old people's home (300 ng/mL) or elderly hospital controls (298 ng/mL) (p less than 0.01 in each case). Plasma LF correlated significantly with elastase alpha-1-proteinase inhibitor complex (EPIC) (Rs = 0.8, p less than 0.01) and C-reactive protein (CRP) (Rs = 0.45, p less than 0.02), but not with erythrocyte sedimentation rate (ESR) or white blood cell counts. We conclude that plasma LF, like CRP and EPIC, is a marker of infection in elderly individuals.

Faecal elastase reflects disease activity in active ulcerative colitis.

Alpha-1-proteinase inhibitor-bound elastase (EPIC) was measured in plasma and fresh stool samples from 20 patients with Crohn's disease (CD), 16 patients with ulcerative colitis (UC), and 10 controls. Median EPIC values were significantly higher than normal in active CD and UC. EPIC was virtually undetectable in the stool samples of control subjects. Median faecal EPIC in 14 patients with active CD (478 ng/ml) or 10 patients with active UC (1159 ng/ml) was significantly higher than in quiescent disease (p less than 0.05) and in control subjects (p less than 0.001 in each case). The difference in the median values between active CD and UC was not significant (p = 0.065). The median faecal EPIC levels were identical in active UC (1159 ng/ml) and patients with large-bowel CD (LBCD) (1015 ng/ml) (p = 0.9), and each was significantly higher than the value of 168 ng/ml in small-bowel CD (SBCD) (p less than 0.01 in each case). In active LBCD but not in SBCD, faecal EPIC correlated significantly with Crohn's disease activity index (R = 0.78, p less than 0.05), plasma C-reactive protein (CRP) (R = 0.9, p less than 0.01), and erythrocyte sedimentation rate (ESR) (R = 0.74, p less than 0.05). In active UC, faecal EPIC correlated significantly with a numerical disease activity index (R = 0.9, p less than 0.01) but not with plasma EPIC and CRP, ESR, and leucocyte counts. Faecal EPIC values may be a better reflection of disease activity in active UC than plasma levels of markers of inflammation.

Somatostatin inhibits neutrophil elastase release in vitro.

The influence of the long-acting somatostatin analogue, SMS 201-995, on FMLP-induced neutrophil elastase release in vitro has been investigated. Doses from 150 ng/ml upwards inhibited elastase release, with 100% inhibition by 2500 ng/ml. Inhibition was demonstrated both by an assay measuring elastase immunometrically and by an assay based on its enzyme activity. The demonstration that SMS 201-995 inhibits protease release from polymorphonuclear leukocytes may have implications for the long-term clinical use of this somatostatin analogue.

The effect of some anti-inflammatory agents on elastase release from neutrophils in-vitro.

In view of the potential role of released polymorphonuclear leucocyte elastase in causing tissue damage, the effect of commonly used anti-inflammatory drugs on elastase release from neutrophils has been studied in-vitro. Elastase release from neutrophils exposed to the synthetic bacterial cell wall peptide N-formyl-L-methionyl-L-leucyl-L-phenylalanine (10(-6) M) was quantitated using a radiometric immunoassay and a functional assay of elastase. Prednisolone and non-steroidal anti-inflammatory drugs inhibited elastase release at concentrations from 0.1 mM-0.1 nM. No inhibition by sulphosalicylic acid, D-penicillamine or chloroquine sulphate was observed. The clinical relevance of these findings is discussed.

Molecular distribution of elastase between its two main inhibitors: direct quantitation of elastase-alpha 2-macroglobulin complex with a novel ELISA technique.

A novel enzyme-linked immunosorbent assay for the quantitation of elastase linked to alpha 2-macroglobulin (alpha 2M) (elastase-alpha 2M complex, EMC) in body fluids is presented. The assay has a lower detection limit of 1.5 ng bound elastase per ml. The critical factor allowing immunological detection of alpha 2M-bound elastase is the addition of phenyl methyl sulphonyl fluoride (PMSF) to the assay buffer. The assay has been used to quantitate EMC in plasma and serum of healthy volunteers, and assess the distribution of elastase between its two main inhibitors, alpha 2M and alpha 1-proteinase inhibitor (API). EMC levels in serum samples from volunteers were significantly higher than in plasma (26.9 vs 21.9 ng/ml, p = 0.05, Student's t-test for paired samples). The API-bound elastase levels were 70.2 and 170.1 ng/ml in plasma and serum respectively (statistically significantly higher in serum, p less than 0.0001). The ratio of macroglobulin to alpha 1-proteinase-bound elastase levels was 0.333 in plasma and 0.168 in serum (p less than 0.0001). As alpha 2M bound elastase retains some proteolytic activity, direct measurement of circulating levels in inflammatory conditions should be of interest.

Plasma lactoferrin and neutrophil elastase in rheumatoid arthritis and systemic lupus erythematosus.

In order to assess lactoferrin (LF), stored in specific granules of neutrophils, as a marker of inflammation, LF was measured in plasma and serum samples of patients with active rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). In active RA, the median plasma LF level (800 ng/ml) was significantly higher than in normal individuals (220 ng/ml) (P less than 0.00001) and patients with active SLE (235 ng/ml) (P less than 0.00001). Median plasma elastase-proteinase inhibitor complex (EPIC) and C-reactive protein (CRP) levels were also significantly higher in patients with RA than in normal individuals (P less than 0.00001) and active SLE (P less than 0.00001 for both EPIC and CRP). Elevations of LF, EPIC and CRP in RA were independent of rheumatoid factor titres. Plasma lactoferrin in RA correlated significantly with EPIC (Rs = 0.7, P less than 0.0001), CRP (Rx = 0.72, P less than 0.0001) and absolute neutrophil counts (Rs = 0.483, P less than 0.02), but surprisingly not with the Ritchie index, with which CRP showed a weak but significant correlation (Rs = 0.27, P less than 0.05 greater than 0.025). Thus plasma LF and EPIC are markers of inflammation in RA and their levels may reflect release of mediators of inflammation into the joint space and periarticular tissue.