Evaluation of microalbuminuria in relation to asymptomatic bacteruria in Nigerian patients with sickle cell anemia.

Studies have identified microalbuminuria (MA) and asymptomatic bacteruria (ASB) as co-morbid factors in sickle cell anemia (SCA). However, the relationship between these comorbid factors remains unclear and data are lacking for Nigerian patients. This study determined the prevalence of MA and ASB in a cohort of patients with SCA in a steady state, in Lagos, Nigeria. Early morning mid-stream urine samples were collected in sterile bottles from 103 patients comprising 48 males and 55 females with a mean age of 10.4 years. Aerobic culture and colony count of organisms was done using conventional methods. Serum creatinine and hematological indices, including irreversibly sickled cells (ISC), were also assayed. Of the 103 urine samples screened, 23 (22.3%) had albuminuria (ALB), and consisted of nine males and 14 females (P > 0.05); 16.5% of the cases had MA (P <0.05). Age at onset of MA was seven years, and children accounted for 23.5% of all cases with ALB (P >0.05). The prevalence of confirmed ASB was 14.6%, with females accounting for 14 of 19 probable ASB cases (P <0.05). Univariate regression analysis demonstrated a significant (P <0.05) association between age at onset of MA, hemoglobin level, reticulocyte count, ISC and occurrence of ASB, but with only ISC evolving as an independent predictor. Twenty-eight bacterial isolates predominated by Escherichia coli (39.3%; P <0.05), of whom 89.3% were multi-drug resistant, were recovered from the ASB urine samples. In conclusion, both MA and ASB are common in Nigerian SCA patients, with the former occurring from the first decade of life.

Hypoglycemic and hypocholesterolemic potential of Persea americana leaf extracts.

The effect of aqueous and methanolic leaf extracts of Persea americana on plasma glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-CHOL), and high-density lipoprotein cholesterol (HDL-CHOL) in rats was investigated. Albino rats were fed a diet containing 20% groundnut oil, 0.5% cholesterol, and 0.25% cholic acid to induce hypercholesterolemia. They were then treated daily with aqueous or methanolic extract of P. americana leaf (10 mg/kg of body weight) for 8 weeks. There were no significant (P > .05) differences in the overall body weight gain of the hypercholesterolemic rats compared to normal control. Liver to body weight ratio, plasma glucose, total cholesterol (T-CHOL), and LDL-CHOL levels were significantly (P < .05) elevated in rats fed hypercholesterolemic diet compared to normal controls. The administration of aqueous and methanolic leaf extracts of P. americana induced reductions in plasma glucose (16% and 11%,respectively), T-CHOL (8% and 5%, respectively), and LDL-CHOL (19% and 20%, respectively) in the treated rats compared to the hypercholesterolemic controls. Also, plasma HDL-CHOL concentrations increased by 85% and 68%, respectively, in the aqueous and methanolic extract-treated rats compared to the hypercholesterolemic controls. These results suggest that aqueous and methanolic leaf extracts of P. americana lower plasma glucose and influence lipid metabolism in hypercholesterolemic rats with consequent lowering of T-CHOL and LDL-CHOL and a restoration of HDL-CHOL levels. This could represent a protective mechanism against the development of atherosclerosis.

Willingness to seek HIV testing and counseling among pregnant women attending antenatal clinics in Ogun State, Nigeria.

HIV counseling and testing (CT) is slowly being introduced as one of several key components of the comprehensive package of HIV/AIDS prevention and care in Nigeria, particularly in the prevention of mother-to-child transmission of HIV (PMTCT). A cross-sectional survey of 804 women attending antenatal clinics (ANC) in Ogun State, Nigeria was done using questionnaires to assess their willingness to seek and undergo CT and know the determinants. Focus group discussions were also held in the general community: 84.3% of respondents believed in AIDS reality, while 24.3% thought they were at risk of HIV infection. Only 27% knew about MTCT, while 69.7% of 723 who had heard of HIV/AIDS did not know about CT. Only 71 (8.8%) had thought about CT and 33 (4.5%) mentioned HIV testing as one of antenatal tests. After health education on CT, 89% of the women expressed willingness to be tested. Their willingness for CT was positively associated with education (p < 0.05), ranging from 77% (no education) to 93% (post-secondary). More of those with self-perceived risk expressed willingness to test for HIV (p < 0.05). Those willing to be tested had a higher knowledge score on how HIV spreads than those not willing. Multiple regressions identified four key factors that were associated with willingness for CT: increasing educational level; not fearing a blood test; perception that the clinic offered privacy; and perceptions of higher levels of social support from relatives and peers. Those unwilling or undecided about CT expressed strong fear of social stigma/rejection if tested positive. The results provided insights for planning promotional programs and showed that not only are IEC efforts needed to boost knowledge about HIV/AIDS, but that change in clinic setting and community are imperative in creating supportive environment to encourage uptake of CT services.

Comparative efficacy of dihydroartemisinin, chloroquine and combination of dihydroartemisinin and chloroquine or mefloquine in mice infected with Plasmodium berghei

Comparative efficacy of dihydroartemisinin alone, chloroquine alone, combination of dihydroartemisinin plus mefloquine and combination of dihydroartemisinin plus chloroquine was evaluated in mice. Parasite clearance time was very short in mice treated with dihydroartemisinin alone mean ± SD PCT was (1.64- ± 0.50 days). This was followed by combination of dihydroartemisinin with mefloquine (2.73 ± 0.47), Then combination of dihydroartemisinin with chloroquine (2.84 ± 0.50). The mice that were treated with chloroquine alone had PCT of 4.0 ± 2.32. There was significant difference between the dihydroartemisinin group and the chloroquine group (P<0.0002). There was also significant difference between the dihydroartemisinin group and combination of dihydroartemisinin plus mefloquine and also combination of dihydroartemisinin plus chloroquine (P<0.005). The combination therapy was more effective than when chloroquine was administered alone

Treatment of childhood fevers and other illnesses in three rural Nigerian communities.

The seeking of healthcare for childhood illnesses was studied in three rural Nigerian communities of approximately 10,000 population each. The aim was to provide a baseline understanding of illness behaviour on which to build a programme for the promotion of prepackaged chloroquine and cotrimoxazole for early and appropriate treatment of childhood fevers at the community level. A total of 3117 parents of children who had been ill during the 2 weeks prior to interview responded to questions about the nature of the illness and the actions taken. Local illness terms were elicited, and the most prevalent recent illness and the actions taken. Local illness terms were elicited, and the most prevalent recent illnesses were 'hot body' (43.9 per cent), malaria, known as iba (17.7 per cent), and cough (7.4 per cent). The most common form of first-line treatment was drugs from a patent medicine vendor or drug hawker (49.6 per cent). Only 3.6 per cent did nothing. Most who sought care (77.5 per cent) were satisfied with their first line of action, and did not seek further treatment. The average cost of an illness episode was less than US$2.00 with a median of US$1.00. Specifically, chloroquine tablets cost an average of US 29 cents per course. Analysis found a configuration of signs and symptoms associated with chloroquine use, to include perception of the child having malaria, high temperature and loss of appetite. The configuration positively associated with antibiotic use consisted of cough and difficult breathing. The ability of the child's care-givers, both parental and professional, to make these distinctions in medication use will provide the foundation for health education in the promotion of appropriate early treatment of childhood fevers in the three study sites.

Analysis of human antibodies to erythrocyte binding antigen 175 of Plasmodium falciparum.

Invasion of human erythrocytes by Plasmodium falciparum merozoites is a multistep process. For many strains of the parasite, part of this process requires that the erythrocyte binding antigen 175 (EBA-175) of the merozoite binds to sialic acid residues of glycophorin A on the erythrocyte surface, a receptor-ligand interaction which represents a potential target for inhibition by antibodies. This study characterizes the reactivity of naturally acquired human antibodies with four recombinant proteins representing parts of EBA-175 (region II, regions III to V, and the dimorphic C and F segment region) in populations in which the organism is endemic. Serum immunoglobulin G (IgG) recognizing the recombinant proteins is predominantly of the IgG1 and IgG3 subclasses, and its prevalence increases with age. In a large population study in The Gambia, serum positivity for IgG or IgG1 and IgG3 subclass antibodies to each of the EBA-175 recombinant antigens was not significantly associated with subsequent protection from clinical malaria. However, there was a trend indicating that individuals with high levels of IgG to region II may have some protection.

Effect of chlorpheniramine on the pharmacokinetics of and response to chloroquine of Nigerian children with falciparum malaria.

Chlorpheniramine (CP), a histamine H1-receptor antagonist, enhances the efficacy of chloroquine (CQ) in acute uncomplicated falciparum malaria. The effects of this combination therapy on the pharmacokinetic disposition of CQ is, however, unpredictable. A standard treatment with 25 mg CQ base per kg bodyweight was orally administered over 3 days, alone or in combination with CP, to 17 semi-immune Nigerian children with Plasmodium falciparum parasitaemia attending hospital in Lagos, Nigeria, and observed for 28 days. Whole-blood CQ concentrations were monitored 14 times during the follow-up by high-performance liquid chromatography analysis of blood dried on filter paper. Parasitaemia was determined on thick blood films stained with Giemsa, and treatment failures were established following the WHO classification for CQ resistance. Our pharmacokinetic data showed that the peak whole-blood CQ concentration was significantly increased (P < 0.05) by CP administration, and the time to achieve the peak was reduced in the presence of CP. The area under the first-moment drug-concentration-time curve was also significantly increased (P < 0.05) by CP administration. Treatment with CQ-CP combination resulted in a shorter parasite clearance time (2.0 +/- 0.5 days) and a higher cure rate (87.5%) compared to treatment with CQ alone (3.5 +/- 0.5 days; 66.7%). Our data suggest that CP enhanced the efficacy of CQ against resistant P. falciparum in acute uncomplicated malaria by increasing the uptake/concentration of CQ in resistant parasites.

The prevalence of ABO blood group antigens and antibodies in Lagos State, Nigeria.

A total of 1239 normal donors from the Lagos University Teaching Hospital (LUTH) and 111 staff of the National Institute for Medical Research (NIMR) Yaba were screened for ABO antibodies. Of the number from LUTH, 220 (17.8%) were found to be in group A, 282 (22.8%) in group B, 85 (6.9%) in group AB and 652 (52.6%) in group O. The number from NIMR consisted of 20 (18.0%) in group A, 25 (22.5%) in group B 8(7.2%) in group AB and 58 (52.3%) in group O. The mean tile avidity time of sera from 789 (62.66%) potent LUTH donors was less than 35 seconds. Only 97 (6.91%) of this reacted within 10 seconds. On the other hand, only 11(9.9%) of the NIMR sera reacted within 35 seconds and none reacted within 10 seconds. Group O individuals from LUTH and NIMR did not always have anti-A and anti-B components of their sera with equal avidity or potency. It was also observed that high avidity of antibody did not necessarily correspond with high potency. The commonest titre for group B (anti-A) sera was 256 and that for group A (anti-B) was 512. In general, anti-B titres tended to be consistently higher than anti-A. There was a bimodal peak at titres 32 and 256 in group B (anti-A) sera. This repeated itself in the anti-A component of group O sera (i.e., anti-A+B), but here the peaks occurred at 32 and 128.(ABSTRACT TRUNCATED AT 250 WORDS)

"Antimalarial" medicinal plants and their impact on cell populations in various organs of mice.

We have investigated the effects of leaf and bark decoctions of Ocimum gratissimum, Azadirachta indica, Morinda lucida and Enantia chlorantha on (a) the course of Plasmodium yoelii nigeriensis malaria (b) reticulocyte and haematocrit values and (c) nucleated cell numbers in the spleen, bone marrow, peritoneum, liver and peripheral blood of Swiss albino mice. Results obtained showed that normal mice infected with the parasite (10(4)/mouse) suffered fulminant parasitaemia which resulted in death, 7-10 days later. All infected mice treated with chloroquine survived. On the other hand all infected mice treated with the medicinal plants exhibited varying percentages of chemosuppression of early parasitaemia which did not lead to their survival. The total number of nucleated cells in the liver, spleen and peripheral blood of malaria-infected mice increased enormously before the animals died. Such increases were maintained in other groups of mice treated with the medicinal plants. In the non-infected mice, O.gratissimum and E. chlorantha administration increased the number of nucleated cells in the spleen, liver and peripheral blood. Chloroquine on the other hand decreased the number of nucleated cells in both the malaria-infected and un-infected mice. There was also a decrease in reticulocyte numbers in the blood of normal mice injected with chloroquine. Conversely reticulocyte numbers increased in normal mice administered with some medicinal plants. Acute and chronic toxicity tests revealed that some of the medicinal plants were much more toxic than others.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell-mediated immunity in the liver of mice vaccinated against malaria.

Mice can be protected against several species of lethal malaria infection by vaccination, and their recovery correlates well with increased anti-malarial antibody levels, particularly IgG (ref.2). However, there is also a good correlation between protection by vaccines and priming for delayed-type hypersensitivity in the skin, although there is no obvious explanation for this effect. We now report an apparent relationship between protection and a cell-mediated immune response involving the migration of various types of cell capable of killing malaria parasites in vitro to the liver. We suggest that the effect of vaccination is to bring together parasites, specific antibody and nonspecific cytotoxic cells, and that the liver may be a major site for their interaction.

Development and suppression of a population of late-adhering macrophages in mouse malaria.

Changes in phagocytic and adherent cell numbers were compared during the course of infections of mice with Plasmodium yoelii (Py) and P. berghei (Pb) and in vaccinated mice challenged with homologous parasites. Nucleated cells in the spleen increased in number in Py-infected mice and were maximal at the time of recovery. The number of phagocytic cells increased in parallel, as did the number of blood leucocytes. Rates of increase were accelerated in vaccinated mice. Changes in Pb-infected mice resembled controls and blood leucocytes showed no consistent increase. In infected mice, the number of spleen and bone marrow cells which adhered to plastic rose above normal. At some stages of infection, cells which did not adhere in 24 h did so in 72 h. Such late-adhering cells, which resembled macrophages in morphology, were most numerous at the time of recovery. They appeared to be derived from monocyte precursors which matured in culture. Sometimes cells adherent at 24 h suppressed the development of the late-adhering population. Silica invactivated these suppressive macrophages but did not affect the precursors which developed into late-adhering cells. It is concluded that malarial infection stimulates the production of precursors of the macrophage-monocyte series and that their development is regulated by the presence of mature macrophages.