Obstetric outcomes of human herpes virus-2 infection among pregnant women in Benin, Nigeria.

OBJECTIVE: This study investigated the obstetric outcomes of herpes simplex virus (HSV-2) infection among pregnant women. MATERIALS AND METHODS: In this prospective cohort study, a total of 674 consenting pregnant women attending ante-natal clinic in the University of Benin Teaching Hospital and Central Hospital Benin were recruited between November 2011 and December, 2012. The women were screened for HSV-1, and HSV-2 using glycoprotein-G-based type-specific Enzyme Linked Immunosorbent Assay on archived blood samples; and were followed up to the delivery period and postnatal clinic. The HSV-2-seronegative participants underwent second blood sampling for HSV-2 IgG and IgM assay during the delivery period. The patients were thus categorized into "HSV-2 seropositive", "HSV-2-seronegative," and "incident HSV-2 infection" cohorts. The pregnancy outcomes were assessed by review of hospital records. Data analysis was with SPSS version 16 software. RESULTS: Of 674 pregnant women surveyed, 312 (46.3%) were HSV-2 seropositive; while 362 (56.7%) were HSV-2 seronegative. Comparing the "HSV-2 seropositive" and "HSV-seronegative" groups, there were no significant differences in occurrence of low birth weight (LBW), prematurity, spontaneous abortions, and stillbirth events (P=0.96; 0.95; 1.0; and 0.77, respectively). Comparing the "incident HSV-2 infection" with the "HSV-2 seronegative" groups, the relative risks of occurrence of LBW deliveries, preterm deliveries, and stillbirths were 12.6, 25.1, and 4.5, respectively. CONCLUSION: First episode HSV-2 infection among pregnant women in Benin, Nigeria is associated with an increased risk of occurrence of spontaneous abortion, LBW delivery, stillbirths, and preterm delivery.

Basal insulin resistance and secretion in Nigerians with type 2 diabetes mellitus.

AIM: The objective of this study was to estimate basal insulin resistance (IR) and insulin secretion (IS) in Nigerians with type 2 diabetes mellitus (T2DM). METHODS: The homeostasis model assessment (HOMA) method was used to estimate basal IR and IS in 146 Nigerians with T2DM and in 33 controls at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Correlations and multiple regression analysis between Box-Cox-transformed IR and log-transformed IS and anthropometric indices were carried out. RESULTS: IR and reduced IS were present, respectively, in 139 (95.5%) and 109 (74.7%) of the diabetic subjects and in 25 (75.8%) and 4 (12.1%) of the controls. In the diabetic subjects, age at diagnosis, duration of diabetes, waist circumference (WC), and body mass index (BMI) correlated significantly with IR (r = -0.2399, P = 0.0035; r = 0.1993, P = 0.0166; r = 0.2267, P = 0.0059; r = 0.2082, P = 0.0120; respectively), whereas duration of diabetes, WC, and BMI correlated significantly with IS (r = -0.2166, P = 0.0091; r = 0.3062, P = 0.0002; r = 0.2746, P = 0.0008; respectively). Age at diagnosis, WC, and duration of diabetes were significant predictors of IR (beta = -0.0161, P < 0.001; beta = 0.0121, P = 0.002; beta = 0.0138, P = 0.042; respectively), whereas duration of diabetes and WC significantly predicted IS (beta = -0.0159, P = 0.025; beta = 0.0155, P < 0.001). CONCLUSIONS: This study shows that both IR and reduced IS are major features of T2DM in Nigerians and that WC consistently correlated and predicted IR. WC measurement is simple and ideal in resource-poor settings for the detection of IR and abdominal obesity. The apparent rarity of coronary heart disease (CHD) in black Africans with T2DM despite a high prevalence of IR warrants further investigation.

Establishment of reference values of CD4 and CD8 lymphocyte subsets in healthy Nigerian adults.

A total of 2,570 apparently healthy human immunodeficiency virus-negative adults from the six geopolitical zones in the country were enrolled in our study in 2006. The samples were assayed using the Cyflow technique. Data were analyzed using the Statistical Package for Social Scientists (SPSS). The majority (64%) of the participants had CD4 counts within the range of 501 to 1,000 cells/microl. The reference range for CD4 was 365 to 1,571 cells/microl, while the reference range for CD8 was 145 to 884 cells/microl.

Beta cell function and response to treatment in Nigerians with Type 2 diabetes mellitus.

There are scant data from African populations on the association between beta-cell function and response to treatment with oral hypoglycaemic agents in Type 2 diabetes mellitus (T2DM). Fasting plasma C-peptide (FCP) and glucagon-stimulated C-peptide (GSCP) levels were measured in 116 Nigerians with T2DM at a university teaching hospital. After 9 months of follow-up and treatment, they were categorized into three groups based on response to treatment: (A) good control but not on maximum sulphonylurea (SU) therapy, (B) inadequate control but not on maximum SU therapy and (C) on maximum SU therapy+/-insulin or biguanide. Logistic regression models were used to investigate how well C-peptide levels predicted the subjects belonging to Group C who are likely to require insulin. The mean FCP and mean GSCP levels of Group C were significantly lower than in the other groups (p=0.024; p= <0.001 respectively). A GSCP cut-off value of < or =1.3 ng/mL predicted membership of Group C with 85% sensitivity and 89% specificity while a cut-off of < or =1.8 ng/mL was associated with 91% sensitivity and 66% specificity. In resource-poor settings where inadequate treatment are common, estimation of GSCP may be useful in predicting treatment response and should be weighed against the cost of inadequate therapy with higher morbidity and mortality.

Clinical manifestations of HIV infection in children at Enugu, Nigeria.

Three-hundred-and-fifty-eight (358) pediatric patients below 16 years of age were screened for suspected human immunodeficiency virus (HIV) infection between October 1989 and September 1996. Eighty-three (23 per cent) were confirmed positive. However, adequate clinical data were obtained retrospectively in only 63 patients. Twenty-three (37 per cent) of the patients presented with features corresponding to WHO case definition of Paediatric Acquired Immunodeficiency syndrome (AIDS) in Africa. Vertical mode of infection was documented in 13 (30 per cent) of them while 30 (68 per cent) were infected through blood transfusion. The main clinical features at presentation were generalised lymphadenopathy (59 per cent), persistent or recurrent fever (51 per cent), progressive weight loss or poor weight gain (51 per cent), chronic diarrhoea (38 per cent), various skin manifestations (37 per cent), persistent cough (32 per cent), and oral candidiasis (19 per cent). Six patients died during the initial admission, while majority were lost to follow-up.

Tetanus antibodies at booking in a Nigerian obstetric population.

Eighty-four consenting ante-natal patients at the University of Nigeria Teaching Hospital, Enugu, were examined for tetanus antibodies at booking. Only 28.6% had detectable serum antibodies. Although 73.8% were immunized within three years prior to investigation, only 37.1% had measurable antibodies. It was found that the longer the interval from previous immunization, the fewer the number with detectable antibodies and the lower the titres. Possible explanations for these findings are discussed and recommendations made.

PIP: Vaccinating pregnant women against tetanus can passively protect offspring against the disease. The earlier in the pregnancy this occurs, the greater the chances of neonate protection. In some countries pregnant women do not seek health support until well into their pregnancy, which may not allow sufficient time for a tetanus vaccine to provide full protection. Reported here are findings on 84 pregnant Nigerian women at the time of their initial medical appointment. Blood was analyzed for tetanus antibodies using the hemagglutination method. 24 women (28.6%) had measurable antibody to tetanus. 62 women (73.8%) had received a tetanus vaccine within the last 3 years. The data suggest that the longer the time interval since previous immunization, the smaller the number of patients with detectable antibodies; generally, titer levels became lower as time passed. A complete immunization series is needed for each pregnancy and is strongly recommended. A more intensive health education program is also needed and should stress the importance of early prenatal care and the tetanus immunization program.

The response to varied timing and spacing of tetanus toxoid administration in pregnancy.

One hundred and sixty-eight pregnant women at the University of Nigeria Teaching Hospital, Enugu, Nigeria, were studied for their response to varied timing and spacing of tetanus toxoid administration. In patients who started immunization before the third trimester of pregnancy, the longer the interval between the two doses, the better the response. In contrast, when immunization was started in the third trimester, the longer the interval between the two injections, the poorer the response. In all cases, the presence of antitetanus antibodies at booking conferred better response. In addition, the titres of antibodies in all patients who responded continued to rise till delivery. The significance of these findings is discussed and recommendations made.

Immediate skin sensitivity test reactivity in Nigerians with allergic rhinitis.

A report of skin tests on 62 patients with allergic rhinitis is presented. Detailed allergy history was obtained using Bencard case history chart. Skin test using Bencard skin testing kit was done on each patient. Results showed house dust was most common agent with 74.19% and house dust mite next with 70.38%. Most of the patients fall within the age group 21-30 years. The need to obtain extracts for the skin test locally is stressed as that will make the result more meaningful.

The prevalence of hepatitis B surface antigen in Nigerian diabetics.

The prevalence of hepatitis B surface antigen (HBS Ag) was determined in 210 Nigerian diabetics and in 210 non-diabetic controls matched for age and sex. Nineteen diabetics (9.0%) were found to have HBS Ag in their sera compared to six (2.9%) of the non-diabetic controls. The difference is statistically significant and may be attributable to the common practice of injudicious administration of insulin injections among Nigerian diabetics. There was no correlation between the prevalence of HBS Ag and the degree of control of diabetes. The prevalence of HBS Ag among new diabetics was found to be low. It is unlikely that diabetics have impaired ability to remove the hepatitis B virus once they are infected or that serum hepatitis plays any role in the causation of diabetes.

The incidence of hepatitis B surface antigen in Nigeria.

We have determined the incidence of hepatitis B surface antigen (HBsAg) in an urban (Enugu) and a rural (Okpatu) population groups in Nigeria. There were no statistically significant differences between the incidence in the two populations. Contrary to earlier reports we did not observe any significant age-related differences in the incidence rates within either population group. In general our results are similar to those reported for the urban inhabitants of Ibadan (several hundred miles west of Enugu) and its surrounding rural population. The low carrier rate recorded for schoolchildren drawn from a mainly high socio-economic group in our population has led us to suggest that socio-economic status alone or together with exposure to mosquito and other insect bites are probably the most relevant factors in the transmission of HBsAg in Nigerians.

Immunoglobulin levels in Nigerian cord blood sera.

We have quantified the levels of IgG, IgA and IgM in Nigerian cord blood samples during the dry and the wet seasons. Almost all the samples collected during both seasons had detectable levels of IgG and IgM, while IgA was detected in 71% of those collected in the rainy season and in only 45% of those collected during the dry season. We observed seasonal variations in the levels of each of these immunoglobulins but the variations were not consistent for all three immunoglobulin classes. This suggests that the levels of each immunoglobulin class in the cord blood is probably controlled by different antigenic factors in our environment. The mean values for all three immunoglobulin classes were raised in all our samples above those of UK cord blood samples. This is consistent with earlier reports for samples collected in the tropics. In the paired cord/maternal immunoglobulin estimations, 75% of cord sera had higher levels of IgG than their corresponding maternal samples, suggesting either active transfer of the immunoglobulin across the placenta or increased rate of synthesis or decreased rate of catabolism in utero.

Antiglobulins in Nigerians with rheumatoid disease.

The levels of IgG and IgM antiglobulins in the sera of Nigerian patients with seropositive rheumatoid arthritis, seronegative arthritis, and Reiter's syndrome have been studied using an immunosorbent of glutaraldehyde insolubilized human IgG. No conclusion could be reached in the case of IgM antiglobulins because of the relatively high threshold of detectability in the quantitation procedure, but all groups of patients had significantly higher levels of IgG antiglobulins than did a group of healthy Nigerians.