Investigating the level of glaucoma awareness and perception of its risk factors in Anambra State, Nigeria.

OBJECTIVES: The purpose of this study was to investigate the level of awareness of glaucoma and perception of its risk factors in Anambra State, and to examine and evaluate the health seeking behaviour of this target population and its relationship with the development glaucoma. STUDY DESIGN: This is a qualitative study that utilised face-to-face semi-structured interviews to investigate the level of glaucoma awareness in the state. METHODS: Purposive, non-random sampling technique was used to recruit the participants, and data were collected from 28 participants [aged 21-73 years] using semi-structured interview. The resulting data were analysed using Nvivo 10 software and Interpretative phenomenological analysis framework. RESULTS: Of the 28 interviewees, 15 (53.6%) live in urban areas, and 13 (46.4%) live in the rural areas; 11 (39.3%) of the participants were male and 17 (60.7%) were females. In this study, people with more education, and people that live in the urban areas tend to have heard about glaucoma compared with people with less education, and who live in the rural areas; although this sample was too small to make substantive claims. Glaucoma was perceived as 'a dangerous eye disease that can cause blindness if not treated early; serious eye problem; an incurable eye problem that can eventually result to blindness, and a dangerous eye problem that can easily render a person blind'. Four a priori themes and ten emergent themes were identified. CONCLUSIONS: There is low awareness of glaucoma in this population, and this encourages people to indulge in certain risk behaviours that could predispose them to glaucoma. Therefore, providing sustained health promotion programmes and improved eye care services could help this population immensely in the current struggle against glaucoma blindness.

Sclerostin antibody treatment enhances bone strength but does not prevent growth retardation in young mice treated with dexamethasone.

OBJECTIVE: Exposure to supraphysiologic levels of glucocorticoid drugs is known to have detrimental effects on bone formation and linear growth. Patients with sclerosteosis lack the bone regulatory protein sclerostin, have excessive bone formation, and are typically above average in height. This study was undertaken to characterize the effects of a monoclonal antibody to sclerostin (Scl-AbI) in mice exposed to dexamethasone (DEX). METHODS: Young mice were concomitantly treated with DEX (or vehicle control) and Scl-AbI antibody (or isotype-matched control antibody [Ctrl-Ab]) in 2 independent studies. Linear growth, the volume and strength of the bones, and the levels of bone turnover markers were analyzed. RESULTS: In DEX-treated mice, Scl-AbI had no significant effect on linear growth when compared to control treatment (Ctrl-Ab). However, in mice treated with DEX and Scl-ABI, a significant increase in trabecular bone at the femoral metaphysis (bone volume/total volume +117% versus Ctrl-Ab-treated mice) and in the width and volume of the cortical bone at the femoral diaphysis (+24% and +20%, respectively, versus Ctrl-Ab-treated mice) was noted. Scl-AbI treatment also improved mechanical strength (as assessed by 4-point bending studies) at the femoral diaphysis in DEX-treated mice (maximum load +60% and ultimate strength +47% in Scl-AbI-treated mice versus Ctrl-Ab-treated mice). Elevated osteocalcin levels were not detected in DEX-treated mice that received Scl-AbI, although levels of type 5b tartrate-resistant acid phosphatase were significantly lower than those observed in mice receiving DEX and Ctrl-Ab. CONCLUSION: Scl-AbI treatment does not prevent the detrimental effects of DEX on linear growth, but the antibody does increase both cortical and trabecular bone and improves bone mechanical properties in DEX-treated mice.

Comparison of Dynabeads and Capcellia methods with FACScount for the estimation of CD4 T-lymphocyte levels in HIV/AIDS patients in Lagos, Nigeria.

OBJECTIVE: To compare the efficacy of the Capcellia assay and the Dynabeads technique against the FACScount technique in the estimation of CD4 T-lymphocytes within a Nigerian setting. DESIGN: Prospective study. SETTING: Urban area in Nigeria. SUBJECTS: Ninety seven subjects (51 HIV seronegative and 46 HIV seropositive adults) seen in the blood banks and two out patient clinics in Lagos within the study period. MAIN OUTCOME MEASURES: Dynadeads technique with a higher correlation coefficient is a feasible alternative to the FACScount method. RESULTS: There was an overall correlation coefficient of r = 0.75 for CD4 cell counts as determined by the Dynabeads technique in comparison with the FACScount method. Also, an overall correlation coefficient of r = 0.17 for CD4 cell counts as determined by the Capcellia technique against the FACScount method. CONCLUSION: Dynabeads technique is simple to carry out and cheaper in terms of demand for human expertise and infrastructural requirements than the FACScounts. Therefore, it was recommended for use in the laboratory for monitoring of ARV therapy in Nigeria and any other resource poor

Seminal fluid indices of men attending infertility clinic at St. Charles Borromeo Hospital, Onitsha, Nigeria (1994-1998).

The result of seminal fluid analysis of 628 men attending an infertility clinic in Onitsha, between 1994-1998; were collated and analysed. The result showed that 62.7% (n = 3394) had normal sperm density, while 37% (n = 234) of the men, had sperm density less than 20 million per ml ejaculate. 6.2% (n = 39) of these patients were azoospermic. 44% (n = 270) of these patients had sperm motility that was less than 50% while 20.5% (n = 129) of the samples contained pathogens, with commonest pathogen being staphylococus aureus in 46% (n = 60) of the sampled patients with pathogens. This high rate of oligospermia and azoospermia calls for proper education of the populace as regards, prevention and treatment of sexually transmitted diseases and urinary tract infections. Also, there is the urgent need to establish centres for assisted reproduction, which will help in solving the already overwhelming problem of infertility in our community.

Prevalence of human immunodeficiency virus (HIV) antibodies in tuberculosis patients in Lagos, Nigeria.

To establish the prevalence of HIV antibodies in patients with pulmonary tuberculosis, 536 new cases presenting with symptoms of bronchopulmonary disorders were randomly selected from the six referral chest clinics in Lagos and screened for tuberculosis and HIV infections. Sputum and serum samples were obtained from all the patients. The sputum samples were examined for acid-fast bacilli (AFB) by both microscopy and culture. The sera were screened for HIV-1 and HIV-2 antibodies by ELISA and confirmed by Western blot (WB). Of the 536 cases studied, 188 (35%) were positive for AFB while 13 (2.4%) were seropositive for HIV. Correlation between the AFB and HIV results revealed that 10 (5.3%) of the 188 AFB positives were also seropositive for HIV as compared to 3 (0.9%) in the 348 AFB negative cases. The difference in the HIV seroprevalence rates in the two groups was statistically significant (P < 0.001). The recorded higher frequency of HIV infections in the AFB positives strongly suggested some level of interaction between TB and HIV infections in Lagos. Infections with HIV-2 were more prevalent than HIV-1 in the patients with HIV and TB. No case of dual infection with HIV-1 and HIV-2 was recorded in this group of patients. However, in the 3 HIV-seropositive patients within the control group (non-tuberculosis patients), 2 (67%) were positive for both HIV-1 and HIV-2 while 1 (33%) was positive for HIV-2 only. Mycobacterium tuberculosis (70%), M. avium (20%) and M. kansasii (10%) were the mycobacteria strains isolated from the HIV/TB infected patients.(ABSTRACT TRUNCATED AT 250 WORDS)

HLA-D region heterogeneity in a Nigerian population.

HLA class II antigens were studied in a panel of 130 Nigerians. Complex patterns of associations were seen between HLA-Dw, -DR and -DQ specificities, differing widely from those reported for other populations. A number of Dw types were associated with the same DR antigen: Dw'1N' and Dw'BERN' with DR1, Dw2 and Dw'2N' with DR2, Dw5 and Dw'5N' (Dw5 + Dw'F5') with DRw11. It was also observed that a Dw type associated with more than one DR antigen: HLA-Dw3 was assigned to individuals who were DR3 negative and similarly Dw10, Dw13 and Dw14 to individuals negative for DR4. HLA-DRw8 and Dw8 were completely dissociated in Nigerians, and Dw8 did not show a preferential DR association. These results demonstrate that DR and DQ identity between HTC stimulator and responder cell is not necessarily a prerequisite for Dw to be assigned. Preliminary studies show that subtypes of HLA-Dw1 and Dw8 detected by HTC typing correlate with restriction fragment length polymorphisms (RFLPs) detected with a combination of Bgl II enzyme and DRA/DRB cDNA probes. HLA-DP antigen frequencies differed between Nigerians and British Caucasoids. The most common DP antigen in Nigerians was DPw1, compared with DPw4 in Caucasoids. HLA-DPw6 appeared to be absent or rare in both Nigerians and British Caucasoids. Only five out of 68 Nigerians tested were assigned two DP specificities. The association between HLA-DR3 and DPw1 reported in Caucasoid panels was absent in Nigerians.

HLA-DR4 associated Dw types in rheumatoid arthritis.

Frequencies of HLA-DR4 and its related Dw types were compared between randomly selected normal controls and the index cases of multiplex rheumatoid arthritis (RA) families. A DR4 frequency of 68.3% was observed in index cases (n = 57) compared to 31.2% in normal controls (n = 96). Cellular typing with homozygous typing cells (HTCs) revealed significant increases of Dw4 (49.1% vs 22.9% RR = 3.2 p less than 0.001) and Dw14 (22.8% vs 2.1% RR = 13.9 p less than 0.001) in the index cases. A non-significant increase was seen for Dw13 (8.8% vs 4.1%). When DR4 positive patients and controls were compared, a significant increase was seen only for Dw14 (34.2% vs 6.6% RR = 7.3 p less than 0.01). Data from HLA genotyped RA and normal families allowed an examination of haplotype combinations of HLA-B antigens and DR4/Dw types to be made. HLA-Dw4 was predominantly found with B44 and Bw62 with nearly all DR4/Bw62 haplotypes being Dw4 positive. HLA-Dw13 was associated with B44 and Dw14 with Bw60, B44 and B27. Based on HTC and normal family data. Dw10 was found to be strongly associated with B38 containing haplotypes. Analysis of 69 C4A, C4B complement typed DR4 haplotypes failed to show any statistically significant association between Dw type and "complotype". However, there was a suggestion of C4A3. BQO being associated with Dw4 (34.2% vs 16.1% X2 = 2.9 p = ns) and C4A3, B1 with Dw14 (45.5% vs 27.6% X2 = 2.1 p = ns).(ABSTRACT TRUNCATED AT 250 WORDS)

HLA associations with multiple sclerosis in Sicily and Malta.

The islands of Sicily and Malta have very different prevalence rates for multiple sclerosis (MS): at least 44 per 100,000 in Sicily and only 4 per 100,000 in Malta. In Northern Europe, MS is associated with HLA-DR2/Dw2. The other components of the commonest DR2-containing haplotype of this region, HLA-A3-B7-DR2-Dw2, also tend to be present at higher frequency in MS patients. HLA Class I and II antigen frequencies and associations in controls and MS patients from Sicily and Malta were studied to discover whether they might account for the difference in MS prevalence. In Sicilian MS patients, DR2 is increased in frequency compared with controls and four out of five DR2-positive patients also type as Dw2. In the Maltese population, DR2 is present at high frequency but approximately half of the DR2 positive individuals do not type as Dw2 so that DR2 is probably most commonly present as part of Class II haplotypes other than those commonly associated with MS. Additional differences in HLA profile of the Sicilian and Maltese populations were found when HLA-A, -B, and B-DR antigen associations were examined. Therefore, some of the difference in MS prevalence might be explained by genetic factors.

Serological biochemical and functional characterisation of three different HLA-DR monoclonal antibodies derived from C57BL6 mice.

C57BL6 mice which do not express I-E gene products were immunised with EBV transformed human B cell lines to generate MoAbs. Three hybridoma supernatants which initially reacted with the immunising donor cell but not a T cell line lacking Class II antigens were further investigated. I-D SDS-PAGE patterns of molecules precipitated by the three supernatants from a cell membrane lysate were characteristic of HLA-Class II alpha and beta chains. Two-dimensional analysis established the specificity of the supernatants as HLA-DR specific. This was confirmed by the reaction patterns with Class II mutant deletant cell lines. In both ELISA and cytotoxicity one reacted with all lymphoblastoid cell lines tested, one reacted with all except two that were DR7 homozygous and the third reacted strongly only with cells that were DR3. All three antibodies were cytotoxic to both peripheral blood lymphocytes and EBV transformed B cell lines. The DR3 specific MoAb (IgG2a) was suitable as a typing reagent. The DR3 reactive MoAb specifically inhibited stimulation by a Dw3 HTC and the other two MoAbs inhibited all HTCs tested. These findings are consistent with the view that certain determinants responsible for the Dw specificities are carried on the DR molecules.

HLA-Dw specificity assignments are independent of HLA-DQ, HLA-DR, and other class II specificities and define a biologically important segregant series which strongly activates a functionally distinct T cell subset.

Several lines of evidence indicate that HLA-Dw, as defined by HTC typing, is not the result of the combined stimulatory effect of HLA-DR and DQ. Therefore, responder cells do not have to share HLA-DQ antigens with the stimulator HTCs to give a typing response. The common HLA-DR-DQ associations observed in HTCs correspond to different patterns of linkage disequilibrium in different populations. HLA-DQ and HLA-Dw are functionally heterogeneous. Although HLA-DQ molecules may play a role in primary stimulation, this role is distinct from that of Dw determinants which have strong lymphocyte activating properties. The role of the HLA-DQ determinants on the other hand, is one of modulating the total T cell response by controlling the proliferation of suppressor and cytotoxic cells. The primary MLC response is the result of the proliferative effect of HLA-Dw, DR, DP, and other associated determinants, in conjunction with a modulatory effect of DQ molecules. However, HLA-Dw (as detected by HTC typing) are DR associated determinants which are immunodominant in primary MLR. The genes of the HLA-DR subregion have been named DR by the WHO nomenclature committee. This subregion encodes the HLA-DR specificities and the DRw52 and DRw53 determinants. Unfortunately this nomenclature does not take into account the need to define the genetic basis of the HLA-Dw determinants--whether they are encoded by separate genes within the HLA-DR subregion or whether they are encoded by as yet unspecified genes in the HLA class II region in linkage disequilibrium with HLA-DR DRw52/53. There are at least three and possibly four beta chain genes in the HLA-DR subregion, all in strong linkage disequilibrium with each other. Some of these are expressed in most haplotypes while others are not; some behave as pseudogenes in some haplotypes and in others, all the genes are expressed. All the genes of the class II region have not been fully characterized. HLA-Dw determinants may be specified by one or more of these genes. When more information becomes available, the genetic and molecular basis of the HLA-Dw series as well as the functional heterogeneity and antigenic strength of the various class II determinants will be better understood.

A new HLA Bw16 subtype defined in both Negroid and Saudi Arabian populations.

Serological identification of a new HLA-Bw16 subtype, B39B, was made by the analysis of reaction patterns of many alloantisera and one monoclonal antibody. The B39B pattern of reactivity was shown to be distinct from HLA-Bw38, Bw39, and 8w57. Cytotoxicity testing before and after absorption suggests that the B39B specificity belongs to the HLA-B7 cross-reactive group. The B39B was clearly demonstrated in two families. This antigen was detected in Negroids and Saudi Arabian Caucasoids but not in a large panel of British Caucasoids.

Different functions and associations of HLA-DR and HLA-DQ(DC) antigens shown by serological, cellular and DNA assays.

Two consanguineous Caucasoid HTCs, DHI and FPA, were investigated, the latter having an unusual HLA-DR/DQ(DC) association. Both these HTCs typed clearly as HLA-DRw11. However, while DHI typed as DRw11/DQw3(DC4) as expected, FPA typed as DRw11/DQw1(DC1) instead. Although extremely rare in Caucasoids, DRw11/DQw1 is a common pattern of association in Nigerian Negroids. Southern blots of DNA extracted from EBV cell line derived from FPA, hybridized with HLA-DC alpha and HLA-DC beta probes, confirmed this unusual DRw11/DQw1(DC1) association. In addition the DC alpha probe showed a unique additional restriction fragment length polymorphism (8 kb) attributable to the DX gene in the FPA DNA. When DHI and FPA were used as stimulators in MLC, the patterns to typing responses obtained were not completely concordant although they overlap to some extent. For this reason FPA has been locally designated Dw'F5', distinct from Dw5. Furthermore, the HLA-DQ antigens of the responder cells were not necessarily the same as those of the HTCS to which they gave typing responses (FPA and DHI). Functional studies using these two HTCs showed that the DQ(DC) antigens probably have no direct lymphocyte activating properties but rather have a regulatory role in controlling responses to allodeterminants in MLC.

HLA polymorphisms in Nigerians.

The HLA class I and class II phenotypes of a panel of 114 unrelated Nigerians have been determined. The panel was tested for all the known class I antigens and comparisons of the HLA-A and -B frequencies with those of other African Negroid populations revealed some differences. Only limited comparisons could be made for the HLA-DR and -D frequencies as these are not available for any well-defined African Negroid population. The data concerning the class II antigens of this panel are the most interesting. Half of the DRw11-positive panel members are DQw3 negative and DQw1 positive. In addition, there is dissociation of some HLA-D and -DR specificities, a number of panel members are positive for an HLA-D specificity and are negative for the corresponding HLA-DR specificity. Our results show the value of population studies in the investigation of the relationship between the different HLA class II antigens.

HLA polymorphisms in a Shanghai Chinese population.

The frequencies of the HLA-A, B, C, D, DR and MB antigens have been determined in a homogeneous Shanghai Chinese population. Comparisons with the HLA-A and -B frequencies in other subsets of the Chinese population revealed some marked differences. No comparisons were possible for the D, DR and MB antigens since there were no previous studies of the antigens in those loci. We suggest that studies of the Chinese population should be confined to clearly defined homogeneous subsets. In this manner, the confounding effect of population heterogeneity may be avoided, and it is this heterogeneity which calls for extensive surveys of the huge Chinese population.

HLA-DB3: population distribution and family studies of a new HLA-D antigen associated with HLA-D antigen associated with HLA-DR4 in Caucasoids.

On the basis of studies with 6 HTCs in four different families the new cluster DB3 identified in the 8th Workshop can be considered an established specificity of the HLA-D series. In 112 healthy Caucasoids resident in South East England the frequency of this antigen was 2.6% similar to the frequency found in 142 Caucasoid patients with rheumatoid arthritis. The frequency in 54 unrelated Chinese individuals from Shanghai and of 120 Nigerians was 7.5% and 3%, respectively. All Caucasoid individuals who were DB3 were also DR4 whereas no such association was found in the two other population groups.