Changes in mediators of inflammation and pro-thrombosis after 12 months of dietary modification in adults with metabolic syndrome.

OBJECTIVE: This study evaluated the effects of a 12-month dietary modification on indices of inflammation and pro-thrombosis in adults with metabolic syndrome (MS). MATERIALS AND METHODS: This longitudinal study involved 252 adults with MS recruited from the Bodija market, Ibadan and its environs. Participants were placed on 20%, 30% and 50% calories obtained from protein, total fat and carbohydrate respectively and were followed up monthly for 12 months. Anthropometry and blood pressure were measured using standard methods. Fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), fibrinogen, plasminogen activator inhibitor-1 (PAI-1)], interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured using spectrophotometric methods and ELISA as appropriate. Data was analysed using ANCOVA, Student's t-test, Mann-Whitney U and Wilcoxon signed-rank tests. P-values less than 0.05 were considered significant. RESULTS: After 6 months of dietary modification, there was a significant reduction in waist circumference (WC), while the levels of HDL-C, fibrinogen and PAI-1 were significantly increased when compared with the corresponding baseline values. However, WC and fibrinogen reduced significantly, while HDL-C and IL-10 significantly increased after 12 months of dietary modification as compared with the respective baseline values. CONCLUSION: Long-term regular dietary modification may be beneficial in ameliorating inflammation and pro-thrombosis in metabolic syndrome.

Insulin sensitivity and mortality risk estimation in patients with type 2 diabetes mellitus.

BACKGROUND: There is at present the dearth of information on the possible contribution of insulin resistance to scores obtained from mortality risk estimation in patients with type 2 diabetes mellitus (T2DM). AIM: This study determined the mortality risk scores in patients with T2DM and its relationship with insulin resistance. METHODS: Fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol (HDL), triglycerides, serum and urinary creatinine, glycated hemoglobin (HbA1c), serum insulin, and urinary albumin were determined in 111 T2DM patients. Thereafter, low-density lipoprotein cholesterol (LDL), quantitative insulin sensitivity check index (QUICKI), urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR) were calculated using the standard formula. Mortality risk was estimated using the validated Gargano mortality risk calculator with scores ≤0.67, 0.68-0.79, and ≥0.80 considered as low, intermediate, and high risks, respectively. RESULTS: Of the total patients, 5 (4.5%), 28 (25.2%), and 78 (70.3%) patients had high, intermediate, and low mortality risk, respectively. There was no difference in the median QUICKI values when the three groups were compared. However, there was a significant elevation in the median eGFR in patients with high mortality risk compared with patients with low and intermediate mortality risks. Also, the median mortality risk score of patients with low insulin sensitivity (QUICKI ≤0.3) was similar to that obtained in patients with normal insulin sensitivity (QUICKI ≥0.31). No significant correlation was found between QUICKI and mortality risk scores. CONCLUSION: Insulin sensitivity status does not have a direct effect on scores obtained from the Gargano mortality risk prediction model.

VITAMIN B12 LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS ON METFORMIN.

BACKGROUND: Due to the clinical benefits of metformin, its associated side effects such as vitamin B12 deficiency are usually overlooked and rarely investigated. OBJECTIVE: This study was carried out to determine the serum level of vitamin B12 in Nigerian patients with type 2 diabetes mellitus (T2DM) on metformin. METHODS: Serum vitamin B12 level was determined using high performance liquid chromatography (HPLC) in 81 T2DM patients who have been on metformin for 5 years or more. Vitamin B12 deficiency was defined as serum concentration of <200 pg/dl, borderline deficiency as 200 - 300 pg/dl and >300 pg/dl as normal. Differences in vitamin B12 levels between different groups were assessed using Mann Whitney U test and P<0.05 was considered as statistically significant. RESULTS: Vitamin B12 deficiency and borderline deficiency were recorded in 8.6% and 26.0% of the patients respectively. Vitamin B12 level was significantly lower in patients who have been on metformin for ≥10 years compared with patients with <10 years history of metformin use. Similarly, patients who were on metformin at a dose of >1000 mg/day had significantly lower vitamin B12 level when compared with patients on ≤1000 mg/day. CONCLUSION: Low serum vitamin B12 level is associated with longer duration and higher dose of metformin use. Therefore, routine determination of vitamin B12 level in patients with T2DM on high dose of metformin and those with prolonged use of metformin might help in identifying patients that would benefit from vitamin B12 supplements.

Serum copeptin and its diagnostic performance in schizophrenia.

BACKGROUND: Inappropriate arginine vasopressin (AVP) secretion has been reported in schizophrenic patients. However, there is lack of information on serum level of copeptin and its diagnostic performance in schizophrenia. This study therefore, evaluated serum copeptin and its diagnostic performance in schizophrenic patients. METHODS: Sixty subjects (30.02 ± 7.17 years) with schizophrenia (19 drug naïve [DNS] and 41 schizophrenics on treatment [SOT]) and 30 healthy individuals (33.62 ± 9.05 years) with no history of schizophrenia were enrolled into this study. Schizophrenia was diagnosed using the Tenth edition of the International Classification of Diseases and Related Health Problems (ICD-10). Estimation of serum copeptin, plasma electrolytes (potassium, sodium and chloride) and uric acid was done using ELISA, Ion-Selective electrode (ISE) and enzymatic method respectively. RESULTS: Copeptin was significantly higher while uric acid, potassium and sodium levels were significantly lower in patients with schizophrenia compared with controls. Similarly, copeptin was significantly higher while sodium, potassium and uric acid levels were significantly lower in DNS and SOT compared with controls. However, insignificant elevation in copeptin level and insignificant reduction in sodium, potassium, chloride and uric acid levels were observed in DNS compared with SOT. The Area under the curve (AUROC) for copeptin was 0.686 (P = 0.004). CONCLUSION: There is elevated copeptin level in patients with schizophrenia and that copeptin levels might be a valuable tool in the diagnosis of schizophrenia.

Metabolic alterations in different stages of hypertension in an apparently healthy nigerian population.

Metabolic syndrome (MS) amplifies hypertension (HTN) associated with increased risk of cardiovascular disease (CVD). MS components and other CVD risk measures were investigated in different stages of hypertension. 534 apparently healthy Nigerian traders aged 18-105 years were participants of a cohort study. The International Diabetes Federation (2005) and the National High Blood Pressure Education Program Coordinating Committee criteria were used for MS and HTN classifications, respectively. Anthropometric indices were obtained by standard methods. Levels of fasting plasma glucose (FPG), total cholesterol (TC), triglyceride (TG), and high-density lipoprotein cholesterol (HDLC) were determined by enzymatic methods, while low-density lipoprotein cholesterol (LDLC) was calculated. Data analysed statistically were significant at P < 0.05. 143 (26.8%), 197 (36.9%), and 194 (36.3%) of the traders had normotension, pre-HTN and HTN (stages 1 and 2), respectively. All indices tested except HDLC were significantly different among BP groups (P < 0.05). Waist to hip (WHR) and waist to height (WHT) ratios were significantly different between HTN groups (P < 0.05). HTN was associated with MS and female gender (P < 0.05). Metabolic alterations and significant HTN were observed. Treatment of the individual components of the syndrome and improvement of modifiable metabolic factors may be necessary to reduce MS and high BP.

Attitude of HIV patients to herbal remedy for HIV infection in Nigeria.

World Health Organisation estimated that about 80% of Africans use herbal remedies for illness. Human immunodeficiency virus (HIV) infection which was believed to have no cure led many HIV patients to source for alternative or complementary therapy. A structured questionnaire was administered to 640 HIV patients in selected Nigerian HIV/AIDS clinics from 2009 to 2011 to assess their attitudes to the use of herbal remedy. Six hundred and ten (610) of the respondents were diagnosed by medical doctor and 6.3% (40) had lived with HIV for 4 years and above. Twenty (20) respondents had sought for medical therapy after diagnosis, 310 applied herbal remedy and 180 of the respondents opted for spiritual solutions. Although, majority (73.4%) would denied the use of herbal remedy when asked by a medical practitioner, 100 respondents combines herbal remedy with HAART and 67.2% of the entire respondents are of the opinion that herbal therapy is effective in HIV infection management. 64.1% of the respondents wanted herbal remedy as complementary therapy and 54.7% concluded that non availability of herbs could stop them from using herbal remedy. This study concluded that the use of herbal remedy for HIV infection is high despite advice by medical doctors thus there is a need for caution when prescribing orthodox medicines that could interfere with hepatic metabolism.

Serum levels of copeptin, C-reactive protein and cortisol in different severity groups of sickle cell anaemia.

It is well known that individuals with SCA undergo constant physiological stress even, in steady state. However, there is little information on the relationship between the severity of sickle cell anaemia (SCA) and serum levels of biomarkers of stress. This study therefore determined the serum levels of copeptin, cortisol and CRP in adults with SCA in different severity groups. Sixty adults with sickle cell anaemia in steady state (27.1±6.3 years) and in vaso-occlusive crisis (24.9±4.9 years) were recruited into this cross-sectional study. Degree of severity (mild, moderate or severe) was determined using a scoring system incorporating annual number of blood transfusions, crisis and presence of anaemia, vaso-occlusive pain and organ complications. Standard methods were used for the determination of packed cell volume (PCV), total white blood cell count (WBC), blood pressure measurements and anthropometric indices. Serum levels of copeptin, cortisol and CRP were determined using ELISA with the ratios calculated accordingly. Data obtained were statistically analyzed using the Student's t-test, Mann Whitney U and Chi-square test as appropriate. P<0.05 was considered significant. The mean systolic blood pressure (SBP) and copeptin level were significantly higher in subjects with moderate SCA compared with those with mild SCA. Similarly SBP, pulse, WBC, copeptin and cortisol were significantly higher while body weight was significantly lower in subjects with severe SCA compared with subjects with mild SCA. However, WBC and cortisol-to-copeptin ratio were significantly higher in subjects with severe SCA compared with subjects with moderate SCA. There was progressive rise in serum levels of CRP from mild SCA through severe SCA but the differences were not statistically significant. Also, proportions of subjects with elevated SBP and WBC were higher than the proportion of subjects with lower SBP and WBC in the severe SCA group. Serum levels of cortisol, copeptin, and their ratio could differentiate severe SCA from mild or moderate SCA. Also, elevated systolic blood pressure and total white blood cell count are associated with severe sickle cell anaemia.

Salivary immunoglobulin classes in Nigerians with periodontitis.

AIM: To provide information on the usefulness of salivary immunoglobulin classes in the diagnosis of periodontitis. MATERIALS AND METHODS: About 5 ml of unstimulated saliva was collected from 25 newly diagnosed subjects with periodontitis and 21 sex/age-matched apparently healthy individuals into plain sample bottles. The samples were collected between 9 am and 11 am at least, 1 hour after eating or washing of mouth and levels of salivary immunoglobulin classes (IgA, IgG, IgE and IgM) were determined using enzyme-linked immunosorbent assay (ELISA). RESULTS: Only the mean level of IgA was significantly raised (p = 0.05) in the saliva of periodontitis patients compared with controls. The mean levels of IgG, IgM and IgE were not significantly elevated in patients with periodontitis, when compared with controls (p > 0.05). CONCLUSION: This study showed that elevated salivary levels of IgA could be used as a screening tool for periodontitis. CLINICAL SIGNIFICANCE: Identification of patients at risk and the diagnosis of active phases of periodontal disease remains a challenge due to lack of laboratory test routinely employed in the diagnosis and monitoring of patients with periodontal disease. This study showed that elevated salivary levels of immunoglobulin classes especially, IgA could be used as a screening tool for periodontitis.

Biochemical Nutritional Parameters in Breast-Milk and Plasma of HIV Infected Lactating Nigerian Mothers on Anti-Retroviral Therapy

Undernourishment in HIV infected individuals exacerbates immunosuppression; acceleration of HIV replication and CD4 + T cell depletion. The production of human milk (lactogenesis) is dependent on factors in the blood therefore deranged blood parameters in HIV patients are expected to reflect in the components of breast milk. Study on effects of HIV infection on nutritional components of breast milk and plasma is scarce. This study assessed the impact which HIV infection might have on the nutritional quality of human breast milk and plasma by determining the levels of biochemical nutritional factors such as albumin; pre-albumin; transferrin and retinol binding in HIV infected lactating mothers (n=20) and HIV-negative lactating mothers (n=30) using immunoplates. The mean plasma level of albumin was significantly reduced in HIV infected lactating mothers (HIM) compared with HIV-negative lactating mothers (control). Breast milk transferrin was significantly increased in HIM compared with the control. It is concluded from this study that hypoalbuminaemia is a common feature in HIV-infected lactating mothers

Antioxidant Levels of Acute Leukaemia Patients in Nigeria

The incorporation of nutritional screening and comprehensive assessments of oxidative stress is increasingly recognised as imperative in the development of standards for quality care in oncology. This study evaluated the levels of nitric oxide (NO); some essential trace metals (Zn; Cu; Fe; and Se); superoxide dismutase (SOD) activity and malondialdehyde (MDA) in twenty five (25) patients with acute leukaemia and 25 apparently healthy controls. The mean levels of plasma Zinc (Zn); Iron (Fe) and Selenium (Se) were not significantly elevated (p 0.05) in leukaemia patients compared with controls. Also; slightly lower level of plasma Cu was observed in leukaemia patients compared with the controls. However; nitric oxide was significantly increased (p 0.05) in leukaemia patients compared with controls. The implication of the present finding is that intervention to increase antioxidant status in patients with Acute Lymphoblastic Leukaemia (ALL) should be considered