Evaluation of interleukin 8 and interleukin 10 cytokines in liquid based cervical cytology samples.

INTRODUCTION: inflammatory cytokines have been associated with various cancers, including cervical cancers. Interpreting cytokine expression in liquid based cervical samples is quite challenging. This study is aimed at evaluating the levels of interleukin 8 and 10 in liquid based cervical samples. METHODS: this is a descriptive analytical study carried out on eighty five (85) subjects aged between 23 and 68 years. Cervical samples were collected in liquid based medium and smears later examined after staining with Papanicolaou technique. These were categorized into low grade intra-epithelial lesion/malignancy, high grade intraepithelial lesion/malignancy according to the degree of dyskaryosis. Concentrations of interleukin 8 and interleukin 10 in the samples were determined by enzyme linked immunosorbent assay. RESULTS: the mean age, standard deviation (SD) of the study subjects were 40.6 (7.8) years. A total number of 79 females (92.9%) were negative for intra-epithelial lesion/malignancy (NILM), while 4 (4.71%) and 2 (2.35%) were positive for low grade intra-epithelial lesion/malignancy (LILM) and high grade intra-epithelial lesion (HILM) respectively. While mean levels of interleukin 8 increased with the degree of malignancy, (107.27 ± 11.88pg/ml) in LILM, (114.80 ± 2.12pg/ml) in HILM when compared with NILM (88.39 ± 18.06pg/ml), (f = 0.700, p = 0.018); the mean levels of interleukin 10 was comparable between these groups (p ≥ 0.05). Pearson correlation coefficient analysis showed a negative association between interleukin 8 and interleukin 10 (r = -1.999, p = 0.000) in LILM. CONCLUSION: interleukin 8 cytokines in cervical cancer is associated with the degree of malignancy. Possible anti-inflammatory effect of interleukin 10 was not observed.

Leptin: Adiponectin ratio discriminated the risk of metabolic syndrome better than adiponectin and leptin in Southwest Nigeria.

AIM: To assess the ability of leptin, adiponectin and leptin: adiponectin ratio (LAR) to discriminate apparently healthy subjects with metabolic syndrome in Southwest Nigeria. METHODS: One hundred and twenty three subjects with metabolic syndrome (cases) were age matched with 123 subjects without metabolic syndrome. The serum adiponectin and leptin levels were measured using standard procedures. The ability of serum adiponectin, leptin and LAR to discriminate metabolic syndrome and its components were determined using the receiver operating curve and linear regression. RESULTS: The median age of the cases (49 IQR 42, 56 years) was not significantly different from the controls (48 IQR 39, 56 years) p = 0.252. The adiponectin levels was reduced with increasing number of the components of metabolic syndrome from 11.6 (IQR 9.6, 13.5) among subjects without any component of metabolic syndrome to 6.5 (IQR 5.7, 7.7) in subjects with more than three components of metabolic syndrome. For leptin and LAR, the values increased with increasing components (p < 0.001). LAR (AUC 0.960) discriminated metabolic syndrome better than adiponectin (AUC 0.865) and leptin (AUC = 0.918) in males and females (LAR AUC = 0.966, adiponectin AUC = 0.888, leptin AUC = 0.929). CONCLUSION: LAR had better ability to discriminate the risk of metabolic syndrome than adiponectin and leptin alone in males and females among apparently healthy subjects from Southwest Nigeria.

Xanthine oxidase activity in type 2 diabetic Nigerians.

AIM: This study evaluated the activity of xanthine oxidase in Nigerians with type 2 diabetic mellitus as well as its relationship with lipid peroxidation, inflammatory bio markers and glycemic control indices. METHODS: Two hundred and thirty seven (237) subjects, comprising of one hundred and fifty seven (157) DM subjects and eighty (80) aged matched controls participated in this study. Blood samples were collected from the participants for the estimations of xanthine oxidase activity, uric acid, malon diadehyde (MDA), erythrocyte sedimentation rate (ESR), high sensitive c - reactive protein (hs CRP), glucose, fructosamine and glycosylated hemoglobin by standard methods. RESULTS: The results of this study showed a significantly increased activity of xanthine oxidase in DM (0.044 ±â€¯0.05µ/mg) compared with apparently healthy controls (0.028 ±â€¯0.00 µ/mg). The mean plasma levels of MDA (42.40 ±â€¯2.50µmol/l) and uric acid (7.22 ±â€¯0.20 mg/dl) in DM were significantly higher (p ≤ 0.05) than healthy non DM group. The mean levels of hs CRP in DM (4.09 ±â€¯0.91µg/ml) was significantly higher than controls (1.30 ±â€¯0.50µg/ml, p = 0.009). While no association of xanthine oxidase was observed with glycemic control indices and hs CRP, a negative association of xanthine oxidase was observed with MDA (r = -0.514, p = 0.000). CONCLUSION: Increased activity of xanthine oxidase in DM was associated with increased lipid peroxidation and could be a salient entity towards the onset on complications.

Anthropometric parameter that best predict metabolic syndrome in South west Nigeria.

AIM: This study compared the ability of anthropometric parameters to predict Metabolic Syndrome (MetS). METHODS: Eleven anthropometric parameters: waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), a body shape index (ABSI), body roundness index (BRI), visceral adiposity index (VAI), abdominal volume index (AVI), Conicity Index (CI), body adiposity index (BAI), lipid accumulation product (LAP) and waist circumference-triglyceride index (WTI) were measured and calculated in apparently healthy subjects with and without MetS. A receiver operating characteristic (ROC) curve was applied to assess their ability to predict MetS. RESULTS: Of the 535 subjects recruited 23% had MetS. WC had the largest area under the curve (AUC) in both men (0.814 95% CI 0.721-0.907) and women (0.819 95%CI 0.771-0.867). This did not differ from the AUC of BMI, WHtR, BRI, CI, BAI, LAP in men and BMI, WHtR, BAI, LAP, VAI and WTI in women (P > 0.05). The cutoff point for WC was 89.5 cm and 91.8 cm in men and women respectively. The AUC of WC was the largest in the 40-49 and 60 years and above age groups while the AUC of LAP was the largest for age groups 30-39 and 50-59 years. CONCLUSION: Of the 11 anthropometric parameters assessed, the WC was the best at predicting MetS in both men and women. There is need to ascertain the cutoff point and establish landmark for measuring WC especially for the sub Saharan region.

Screening for peripheral neuropathy and peripheral arterial disease in persons with diabetes mellitus in a Nigerian University Teaching Hospital.

BACKGROUND: Identifying the risk factors for diabetes mellitus related foot ulceration would save more limbs from amputation. This report focuses on the determining the burden of peripheral arterial disease and neuropathy in persons with diabetes mellitus (DM). METHODS: This is a descriptive study carried out in the Diabetic Clinic of the Lagos State University Teaching Hospital in patients with DM who had no past/present history of foot ulceration. Biothesiometry was employed and ankle brachial pressure indices were measured to evaluate for neuropathy and peripheral arterial disease (PAD) respectively. RESULTS: A total of 225 persons living with DM who met inclusion criteria were recruited consecutively over a 3 months period. Age range was 28-87 years with the mean [61.4 (10.8)] and median (63) years respectively. Patients symptomatic for neuropathy and PAD were 37 and 40 % respectively of the study population. An older age of >60 years and poor glycaemic control were potential predictors of neuropathy. Neuropathy and PAD occurred commonly in the seventh decade of life. CONCLUSION: Given the fairly high proportions of neuropathy and PAD in our patients with DM, we recommend that they be routinely examined in persons with DM.

Effect of sub-clinical hypothyroidism on clinical severity in first-ever acute ischemic stroke.

BACKGROUND: Subclinical hypothyroidism has been documented to have a positive effect on the clinical presentation and outcome in acute ischemic stroke. OBJECTIVE: To determine the prevalence of subclinical hypothyroidism in first ever ischemic strokes and to evaluate its effect on the clinical presentation. METHODS: Using a cross-sectional study design, 138 patients diagnosed with first ever ischemic stroke within 7 days of onset were included in the study. Each participant had documentation of demographic data, followed by a detailed neurological examination. Stroke severity on admission was recorded using the National Institute of Health Stroke Scale (NIHSS) and blood samples for free thyroxine (T4) and thyroid stimulating hormone (TSH) were taken within 24h of onset of symptoms. For analysis, the patients were divided into two groups: those who had elevated TSH level (> 2.5 mlU/L) with normal FT4 level were assigned to the sub-clinical hypothyroidism group whilst those with normal thyroid function were assigned to the control group. All values were compared between the two groups. RESULTS: The study population comprised of a total number of 138 participants with mean age of 63.4 +/- 12.9 years. The females were 56 (40.6%) and the males were 82 (59.4%). A total number of 11 (7.9%) had subclinical hypothyroidism whilst 127 participants (92%) had normal thyroid functions. The mean NIHSS score of cases with SCH on admission was significantly lower than that of those with normal thyroid functions (6.73 +/- 3.6 vs. 11.1 +/- 6.3, p=0.025). A significantly higher proportion of patients in the SCH group had mild neurologic deficits on admission compared with the group with normal thyroid functions (81.8% vs 24.4%, p < 0.001). CONCLUSION: Our study has suggested that subclinical hypothyroidism appears to confer a neuroprotective effect in acute ischemic stroke.

Impact of Inflammation on Male Reproductive Tract.

Fertility in the male is dependent on the proper production of sperm cells. This process, called spermatogenesis is very complex and involves the synchronization of numerous factors. The presence of pro-inflammatory cytokines, tumor necrosis factor-alpha (TNF-α), interleukin-1 alpha (IL-1 α) and interleukin 1 beta (IL-1 ß) cytokines in the male reproductive tract (testis, epididymis and sperm) may have certain physiological functions. However, when the levels of these cytokines are higher than normal, as seen in conditions of inflammation, they become very harmful to sperm production. Moreover, inflammation is also associated with oxidative stress and the latter is well known to impair sperm function. Epidemiological studies regarding male infertility have revealed that more and more infertile men suffer from acute or chronic inflammation of the genitourinary tract, which often occurs without any symptoms. The inflammatory reactions within the male genital tract are inevitably connected with oxidative stress. Oxidative stress, especially in sperm, is harmful because it damages sperm DNA and causes apoptosis in sperm. This article reviewed the suggested mechanisms and contribution of inflammation to male infertility. In addition, the review was further strengthened by discussing how inflammation affects both fertility and assisted reproductive technologies (ART).

Cytokines, Type 2 DM and the Metabolic Syndrome.

BACKGROUND: Inflammatory markers have been widely implicated in Diabetes Mellitus (DM) and the metabolic syndrome (Mets). Data on the association of cytokines (pro inflammatory mediators) and components of the Mets are sparse in sub Saharan Africa. OBJECTIVE: We sought to document the pattern of distribution of cytokines in Nigerian subjects with type 2 DM and compare cytokine levels between DM subjects with and without the Mets. METHODS: 200 subjects with type 2 DM and 100 healthy sex and aged matched Controls were studied. Anthropometric indices, lipid parameters and cytokine levels, which included interleukin 10 (IL-10), tumour necrosis factor-alpha (TNF-α), interferon gamma (IFN-γ) and C reactive protein (CRP) were determined. Continuous variables were compared between subjects with type 2 DM and the controls and also between DM subjects with and without the Mets. RESULTS: The mean levels of all studied cytokines were significantly higher in the subjects with type 2 DM than the Control subjects, save for IFN-γ which was significantly lower in type 2 DM. The mean cytokine levels were comparable in the DM subjects with and without the Mets and also comparable in obese DM and non obese DM subjects. Of the Mets defining criteria, waist circumference (WC) and Triglyceride (TG) were found to be significantly associated with only two of the studied cytokines. The correlation coefficient and p values of these findings are as follows: WC vs TNF-α (r = 0.16, p = 0.001) and TG vs CRP (r = 0.15, p = 0.03). Multiple regression analyses showed that the cytokines were linearly associated with each other but not with other clinical and biochemical variables. The cytokines were found to be interrelated. IL-10 with a beta value of 0.14 predicted the presence of INF-γ with a 95% confidence interval of 0.000 - 0.109 and a p value of 0.05. TNF-α with a beta value of 0.17 predicted the presence of IL-10 with a 95% confidence interval of 0.004 - 0.034 and a p value of 0.01. IL-10 with a beta value of 0.17 predicted the presence of TNF-α with a 95% confidence interval of 0.3-0.590 and a p value of 0.01. CONCLUSION: Cytokine levels are higher in DM than non DM subjects; however, the cytokine levels are not strongly associated with the Mets. Limited correlations were found between each of the cytokines and the parameters of the Mets. Further studies on this entity amongst Africans should be carried out to ascertain if these results are peculiar to DM subjects in sub- Saharan Africa.

Glycaemic indices and non-traditional biochemical cardiovascular disease markers in a diabetic population in Nigeria.

OBJECTIVE: To determine the frequency of hyperfibrinogenaemia, elevated C-reactive protein, hyperuricaemia and elevated lipoprotein A in a clinic population of patients with type 2 Diabetes mellitus (DM) compared with healthy controls; and determine the interrelationship between fasting plasma glucose levels and indices of long-term glycaemic control (fructosamine and glycosylated haemoglobin) in DM. STUDY DESIGN: Cross-sectional, analytical study. PLACE AND DURATION OF STUDY: The study was conducted at the Lagos State University Teaching Hospital, Ikeja, from April to June 2009. METHODOLOGY: A total of 200 patients with type 2 DM and 100 age and gender matched healthy controls were recruited for the study. Glycaemic control was assessed using fasting blood glucose, fructosamine and glycosylated haemoglobin levels. The non-traditional risk factors studied included C-reactive protein (CRP), Lipoprotein a (Lpa), serum uric acid (SUA), microalbuminuria and fibrinogen. Mann-whitney, chi-square and Pearson's correlation tests were used for analysis as applicable. RESULTS: Hyperfibrinoginaemia, elevated CRP, LPa, microalbuminuria and hyperuricaemia were present in 3.5%, 65%, 12%, 6% and 57% respectively in type 2 DM. The mean levels of these CV risk factors were significantly higher in subjects with type 2 DM than that of the control subject. There was a positive and significant correlation between HbA1c and FBS (r=0.46, p=0.0001) and HbA1c and fructosamine (r=0.49, p=0.0001). All studied CVS risk factors were related to indices of glycaemic control which were found to be interrelated. Fasting blood glucose significantly correlated with both HbA1c and fructosamine but HbA1c showed better correlation to FPG than fructosamine (r=0.51 vs. 0.32). CONCLUSION: Glycosylated haemoglobin and fasting plasma glucose but not fructosamine are significantly associated with microalbuminuria, fibrinogen SUA and CRP in type 2 DM. HbA1c was found to be better than fructosamine in monitoring overall long-term glycaemic control.

Acute phase reactant dynamics and incidence of microvascular dysfunctions in type 2 diabetes mellitus.

BACKGROUND: Acute Phase Reactants (APRs) have a wide range of activities that contribute to host defense. The aim of this report was to evaluate the dynamics and magnitude of these proteins in various microvascular complications in diabetes mellitus (DM). We also sought to assess the predictive values of APRs and other clinical variables for microvascular complications in DM. METHODS: This was a case control study carried out in 200 Nigerian subjects with type 2 DM and 100 sex and age matched healthy controls. The studied APRs included C-reactive protein, beta 2 microglobulin, fibrinogen and lipoprotein (a). RESULTS: The mean values of the APRs were significantly higher in type 2 DM compared with the controls and were observed in higher concentrations in those with microvascular complications, except beta 2 microglobulin. Presence of microvascular complications was observed in those with dilated fundus examination (retinopathy), symptom score of 3.0 (neuropathy), urea and creatinine levels above 50mg% and 1.5mg%, respectively, with significant proteinuria (nephropathy). Significant increase in mean ± SEM values of lipoprotein (a) was observed in diabetic retinopathy in comparison with those without complications (25.76 ± 1.13 mg/dl vs. 22.37 ± 0.73 mg/dl, p = 0.005). Elevated C-reactive protein was observed in diabetic neuropathy in comparison with those without complications (11.43 ± 2.33 u/ml vs. 8.30 ± 1.15 u/ml, p = 0.048). Increased beta 2 microglobulin levels were observed in patients with diabetic foot ulcers in comparison with those without complications (3.04 ± 0.51 mg/dl vs. 2.54 ± 0.14 mg/dl, p = 0.049). Circulating levels of Lipoprotein (a) predicted retinopathy in DM with both good and poor long-term glycemic control while duration of DM predicted the occurrence of foot ulcers.. CONCLUSIONS: Increased level of APRs was associated with a number of microvascular complications and may play a role in the pathogenesis.

Lipoprotein (a), C-reactive protein and some metabolic cardiovascular risk factors in type 2 DM.

BACKGROUND: Lipoprotein (a) (LP (a) is an independent cardiovascular risk factor that is not widely studied in people of sub-Saharan African origin. The aim of this report is to determine the frequency of occurrence of elevated Lp (a) and possible relationship with total cholesterol (TCHOL), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), C reactive protein (CRP) and serum uric acid (SUA). METHODS: This is a cross sectional study carried out in 200 Nigerian patients with type 2 DM and 100 sex and age matched healthy Controls aged between 32-86 years. We determined the frequency of occurrence of elevated Lp (a) levels in the study subjects and compared clinical and biochemical variables between type 2 diabetic patients and non-diabetic patients. Clinical and biochemical parameters were also compared between subjects with type 2 DM who had elevated LP (a) and normal LP (a) levels. Long term glycaemic control using glycosylated haemoglobin was determined and compared in the study subjects. Test statistics used include chi square, correlation coefficient analysis and Student's t test. RESULTS: The mean Lp(a) concentration differed significantly between type 2 diabetic patients and the Control subjects (18.7 (5.8) mg/dl vs 23 (6.8) mg/dl, 0.00001). Similarly, the prevalence of high LP (a) levels in type 2 DM patients was significantly higher than that of the Control subjects (12.5% vs 4%, p-0.019). The mean levels of the lipid profile parameters (TCHOL, LDL-C, TG, LDL/HDL) and CRP were significantly higher in DM patients than in the Control subjects. The mean LP (a) levels were comparable in both sexes and in DM subjects with and without hypertension. TG was the only parameter that differed significantly between subjects with elevated Lp (a) levels and those with normal Lp (a) levels. There was a significant positive correlation (r) between Lp(a) levels and TG, LDL-C. TCHOL, LDL/HDL and uric acid. No association was found between Lp(a) and clinical parameters such as age and anthropometric indices. CONCLUSION: We have showed that Lp (a), CRP and other CVS risk factors cluster more in patients with DM than non DM patients. Serum Lp (a) levels are not associated with anthropometric and glycaemic indices.

Hyperuricaemia and the metabolic syndrome in type 2 DM.

BACKGROUND: Elevated serum uric acid levels (SUA) have been associated with an increased risk of cardiovascular diseases and the metabolic syndrome (MetS) and are often reported to be higher in females than in males. The aim of this report is to determine the prevalence and clinical correlates of hyperuricaemia and also to evaluate associations with the MetS in people with type 2 diabetes mellitus (DM). METHODS: This was a cross-sectional study conducted in people with type 2 DM in Lagos, Nigeria. Hyperuricaemia was defined by cut-off values of > 7 mg/dl for men and > 6 mg/dl for women. The diagnosis of MetS was made using the new definition by the American Heart Association and other related bodies. Clinical and biochemical parameters were compared between subjects with hyperuricaemia and normouricaemia. Statistical analysis included usage of Student's t test, Pearson correlation coefficients, multivariate regression analysis and chi square. RESULTS: 601 patients with type 2 DM aged between 34-91 years were recruited for the study. The prevalence rates of hyperuricaemia and the MetS were 25% and 60% respectively. The frequency of occurrence of hyperuricaemia was comparable in both genders (59% vs 41%, p = 0.3). Although, the prevalence of the MetS in subjects with hyperuricaemia and normouricaemia was comparable (61 vs 56%, p = 0.1), a higher proportion of hyperuricaemic subjects had 3 or more components of the Mets compared with normouricaemic subjects. Possible predictors of hyperuricaemia include central obesity, smoking and elevated serum triglycerides (TG). SUA levels were found to be positively and significantly associated with serum TG (r = 0.2, p = 0.0001) and total cholesterol (r = 13, p = 0.001). CONCLUSION: The prevalence of hyperuricaemia in subjects with type 2 DM is comparable in both genders and possible predictors of hyperuricaemia are potentially modifiable. SUA is positively and significantly associated with serum TG and total cholesterol.