Clinical usefulness of a timed overnight (8 hours) Urine Albumin (microalbumin) excretion in monitor-ing treatment in benign essential hypertension.

AIMS AND OBJECTIVES: This research aims to establish the usefulness of timed over- night (8 hours) Urine Albumin(microalbumin) Excretion (UAE), in monitoring therapy in Nigerian patients with benign essential hypertension. SUBJECTS AND METHODS: The study population comprised 40 normotensives/controls, (23 males and 17 females) aged between 20-70 years, with a mean blood pressure 116/75mmHg, 30 well-controlled hypertensive patients, diastolic BP <100mmHg or MAP (mean arterial pressure) = 110mmHg and 30 poorly controlled hypertensive patients, diastolic blood pressure > 100mmHg or MAP >110mmHg.Urine albumin(microalbumin) was determined on the 8 hours overnight urine samples by ELISA method using kit from Randox Laboratories Limited, N.Ireland Cat No. MA 1410. UAE was calculated from the urine albumin concentration, urine volume and collection time. The intra assay precision was determined by running 20 replicates of two kit controls in a single batch. The coefficient of variation was 6.6% at 10.70mg/L and 4.3% at 51.20mg/L. RESULTS: The average UAE in the three groups were as follows: 12:22 +/-4.65ug/ min, 21.50 +/- 10.5ug/min and 30.10 +/- 24.25 ug/min in the control, well controlled and poorly controlled groups respectively, 12.5% of normotensive subjects, 40% of well controlled and 56.7% of poorly controlled patients were found to have microalbuminuria.The UAE increased significantly with the severity of hypertension (r = 0.32, p<0.001 for control) r = 0.38, p<00.05 for controlled and r = 0.49 p<0.05 for poorly controlled. CONCLUSION: A timed overnight (8 hours) Urinary UAE is a preferred alternative to cumbersome 24 hours urine collection for monitoring response to treatment in Nigerian patients with benign essential hypertension.

Reference interval of serum heat-stable alkaline phosphatase activity in pregnant women in Zaria.

UNLABELLED: The study was designed to establish a reference interval for serum heat-stable ALP activity in pregnancy, which is not available in this environment. MATERIALS AND METHODS: One hundred (100) apparently healthy pregnant women in their third (3rd) trimester who were attending the antenatal clinic (ANC) of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria were recruited for the study. The serum heat-stable ALP activity was measured using the 4-nitrophenyl phosphate (4-NPP) method introduced in 1946 by Bessey, Lowry and Brock. RESULTS: The reference interval for the serum heat-stable ALP activity was found to be 24-161 IU/L. This was similar to some earlier reports elsewhere. CONCLUSION: The finding will help in the evaluation/diagnosis of patients with placental insufficiency.

Serum lipids in women on oral contraceptives in Zaria-Nigeria.

AIM: To compare the serum lipid levels of women on two different types of oral contraceptives, norethindrone 0.5 mg/ethinyl oestradiol 0.035 mg and norgesterol 0.5 mg/ethinyl oestradiol 0.03 mg. METHOD: Serum total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride levels were estimated in two groups (A&B) of women. Group A were 35 women who had been on norethindrone 0.5 mg/ethinyl oestradiol 0.035 mg for over one year, while the group B were 35 women on norgesterol 0.5 mg/ethinyl oestradiol 0.03 mg for three months. Thirty five healthy, age- matched women not on oral contraceptive agent were used as controls. RESULTS: Significantly higher levels of serum total cholesterol and triglycerides were found in the group A women compared to the group B women. The mean HDL-cholesterol level was significantly higher in the group B women in the 2nd and 3rd months of therapy than in the controls. The LDL-cholesterol levels were statistically similar in the two groups of contraceptive users and the controls. The results obtained were within the reference interval established in our laboratory. CONCLUSION: The oral contraceptive containing norgesterol 0.5 mg/ethinyl oestradiol 0.03 mg was found to be better as it increased the levels of HDL-cholesterol more than the other lipids. It is not known if this finding will persist on long-term use of the oral contraceptive.

Fractional excretion of magnesium of chronic renal failure patients in Lagos, Nigeria.

The objective of this study was to explore the usefulness of the fractional excretion of magnesium (FEMg2+) in Nigerian chronic renal failure patients (mild to moderate) in determining the severity of renal insufficiency. Plasma and twenty-four hour urine samples were analysed for magnesium and creatinine in thirty-five chronic renal failure patients and twenty-five healthy controls. The mean fractional excretion of magnesium (FEMg2+) was 15.3%(13.6) in the patients and 6.1%(2.3) in the controls and this correlated negatively with the creatinine clearance in both groups (r = -0.343, p < 0.05) in patients and (r = -0.665, p < 0.001) in controls. There was a positive correlation between plasma creatinine and fractional excretion of magnesium in the patients (r = 0.463, p < 0.05) and controls (0.455, p < 0.05). FEMg2+ may therefore be a more sensitive indicator of renal insufficiency and may also be a better indicator of the progression of renal failure.

Plasma magnesium in adult asthmatics at the Lagos University Teaching Hospital, Nigeria.

OBJECTIVE: To determine the plasma magnesium levels in adult asthmatics. DESIGN: Case control study. SETTING: Lagos University Teaching Hospital, Lagos, Nigeria. SUBJECTS: Forty stable asthmatics and thirty five apparently healthy controls. METHODS: Detailed history including drug history was obtained from patients and controls. Fasting venous blood was collected into heparinized tubes from both patients and controls. Plasma magnesium, albumin, calcium and phosphorus were measured using spectrophotometric end point methods. RESULTS: Mean (SD) plasma magnesium concentration of 0.93(0.24) mmol/L in the asthmatics was significantly lower compared to the controls which was 1.15(0.28) mmol/L, p<0.001. There was no significant difference in the plasma albumin, calcium and phosphorus levels between the patients and controls. Plasma magnesium levels correlated with the plasma albumin level (r=0.62) but did not correlate with the duration of disease, peak flow rate and age of patients. There was no gender difference in plasma magnesium levels in the asthmatics. CONCLUSION: Adult Nigerian asthmatics have lower plasma magnesium concentrations compared to healthy controls. This may be of use in future therapeutic management of asthma. A large scale multi-centre study needs to be carried out since this study was done in one hospital.

Plasma magnesium in adult Nigerian patients with epilepsy.

UNLABELLED: The objective of this study was to determine the relationship between plasma magnesium levels and epilepsy. The study was carried out at the Lagos University Teaching Hospital. Plasma magnesium was estimated using the calmigite dye colorimetric method in 45 adults with epilepsy and 35 healthy controls. Plasma concentrations of calcium, phosphorus and albumin were also estimated. The mean plasma magnesium in the patients was 0.98 mm0l/L (0.05) while that in the controls was 1.15 mmol/L (0.28). The mean plasma magnesium in the epileptics was significantly lower than that obtained in the controls (p < 0.001). Age of onset of seizures, seizure frequency and duration of treatment did not influence the plasma magnesium levels. Low plasma magnesium is associated with epilepsy, further studies may determine the influence of anti-epileptic drug therapy on plasma magnesium levels. KEYWORDS: magnesium, seizures, Nigeria.

The lactate dehydrogenases in malignant and non-malignant diseases.

The objective of this paper was to determine different patterns of Lactate Dehydrogenase(LD) isoenzymes in serum, pleural effusions and ascitic fluid collections and their usefulness in the differential diagnosis of malignant and non-malignant diseases. It was a case control study carried out at the Lagos University Teaching Hospital. Forty- six patients with pleural or ascitic fluid collection (male and female, age range between 18 and 65 years) made up of Twenty-two patients with malignant diseases and twenty-four with non- malignant diseases were recruited. Control group comprised 50 apparently healthy subjects of both sexes with age ranging between 18 and 65 years. Serum, pleural and ascitic fluid collections were assayed for total lactate dehydrogenase(LD) and it s isoenzymes. Total LD was estimated using the pyruvate to lactate reaction. LD isoenzyme analysis was estimated by cellulose acetate electrophoresis and stained with formazan. The mean total serum LD activity in the disease groups (malignant and non-malignant) was significantly higher than the mean total serum LD activity in the control group. The pleural fluid LD was highest in patients with empyema thoracis. Five isoenzymes of LD (LD1 - LD5) were present in both control and patient sera. The serum LD1 and LD2 isoenzymes were predominant in the controls. The serum LD4 and LD5 isoenzymes were predominant in the disease groups (malignant and non-malignant). LD4 and LD5 were the predominant isoenzymes in both pleural and ascitic fluids obtained in malignant and non-malignant diseases. Serum LD4 was significantly higher than serum LD5 in non-malignant disease while serum LD5 was significantly higher than serum LD4 in malignant disease. The types of malignancies could not be differentiated by serum and effusion fluid LD isoenzyme pattern. Pleural fluid total LD estimation is useful in monitoring patients on chest tubes and may be used to determine when to insert them. Serum LD4 and LD5 differentiates malignant from non-malignant disease but the effusion LD isoenzyme pattern does not.

Evaluation of a locally-made urease test for detecting Helicobacter pylori infection.

We studied the efficacy of a home-made urease test (HUT) in the detection of Helicobacter pylori (HP) infection in patients undergoing upper gastrointestinal endoscopy. In the first phase of the study, two antral biopsies each were obtained from 43 patients for urease tests using the CLOtest and a home-made buffered 2% urea solution with phenol red as indicator at pH 6.8 (2% HUT). Twenty-six patients (60.5%) were HP positive, both by the 2% HUT and CLOtest with 100% concordance. In the second phase of the study three antral biopsies each and blood were obtained from 42 patients for the determination of HP status using a 10% HUT and a combination of culture and serology. Twenty-three patients (54.8%) were HP positive using the 10% HUT, while 32 patients (76.2%) were positive using the combination of 2 tests. Compared to this the sensitivity and specificity of the 10% HUT were 72% and 100% respectively. The CLOtest produced a colour change in a shorter time than the 2% and 10% HUT (median 1 hour versus 10 hours versus 16 hours p < 0.0001). In the third phase of the study, we observed that by doubling the biopsy size, the time required to obtain a colour change was significantly reduced (median 4.5 hours versus 10 hours p < 0.05). The HUT is easy to prepare, cheap, sufficiently sensitive and it is reliable enough to start treatment when positive. With 100% concordance and 1% the cost per test when compared to the commercially available CLOtest; the 10% HUT is hereby recommended for the detection of UP infection in our region.

Gastric antral juxtamucosal pH in helicobacter pylori positive and negative dyspeptic patients.

Maintenance of gastric juxtamucosal pH at a stable near neutral value may be the cumulative effect of the various components of the mucosal defense system. In order to assess the effect of helicobacter pylori (HP) infection on mucosal defense, we measured the gastric antral juxtamucosal pH in 40 dyspeptic patients by using a flexible glass pH microelectrode which can be passed down the instrument channel of standard gastroscopes. HP status was determined using serology, culture, histology and urease test. We also investigated the relationship between juxtamucosal pH and the severity of antral HP infection. The mean antral juxtamucosal pH in 26 (65%) HP positive patients was 6.49 +/- 0.20 compared to 6.19 +/- 0.21 in 14 (35%) HP negative patients (p < 0.00001). Other factors like age, sex, duodenogastric reflux or presence of chronic duodenal ulcer did not significantly affect juxtamucosal pH (p > 0.05). Subset analysis of data on HP positive patients (n = 26) revealed no significant correlations between antral chronic gastritis anti-HP IgG titre and antral juxtamucosal pH (p > 0.05). This study shows that HP increases gastric antral juxtamucosal pH. This finding supports the suggested role of HP in producing hypergastrinaemia and gastric acid hypersecretion.

Hypothalamic neuropeptide Y mRNA in pregnant, lactating and suckling rats.

Blood glucose, plasma insulin and luteinizing hormone levels were studied in pregnant wistra rats and those in early and late stages of lactation. NPY mRNA was also measured in whole hypothalamic tissue of these rats which were either fed ad libitum or food deprived to 80% of the relative controls. When fed ad libitum, hypothalamic NPY mRNA was not significantly elevated in the pregnant rats (111 +/- 2.1%). By the 5th and 4th days of lactation the mRNA had increased progressively (141 +/- 4.7% of control, p<0.01; 186 +/- 9%, p<0.001) respectively. Blood glucose levels were unchanged in pregnancy and lactation, however, insulin levels dropped significantly by the ]4th day of lactation (control 322.3 +/- 3.2; lactating 298.6 +/- 4.8 pmol/l; p<0.05). Luteinizing hormone was significantly reduced in the lactating rats (control 2.2 +/- 0.21, lactating 0.81 +/- 0.2 ng/ml;p<0.05). In food restriction, NPY mRNA was increased moderately in the non-pregnant state and enormously in late lactation (non-pregnant 157 +/- 21%, lactating 333 +/- 35%, p<0.001). In a lactation, blood glucose was unchanged while plasma insulin and LH were reduced to 20% and 50% of controls respectively (insulin: control 110.3 +/- 2.0; lactating 18.3 pmol/l; LH. control 1.3 +/- 0.1; lactating 0.59 +/- 0.4 ng/ml p<0.01). Orexigenic effect of hypothalamic NPY is possibly responsible for the hyperphagia in lactating. Food restriction and lactation had additive lowering effect on plasma insulin but an additive increase on hypothalamic NPYmRNA. NPY message may be partially responsible for the anovulatory effect of lactation.

Gastric acid secretion in Helicobacter pylori positive and negative dyspeptic Nigerians.

The pathological role of Helicobacter pylori is largely unproven in our region of high incidence of infection but very low incidence of serious gastroduodenal lesions. The aim of this study was to investigate the effect of H. pylori infection on gastric acid secretion. One week after gastroduodenoscopy, basal and pentagastrin (8 micrograms/kg) stimulated gastric acid secretion were measured in 39 dyspeptic Nigerians. H. pylori status was determined using urease test, culture, histology and serology, while gastritis was assessed using the Sydney system criteria. The median maximal acid output (MAO) and peak acid output (PAO) in mmol/h were significantly higher in H. pylori positive (29.3, range 7.4-81.6 and 34.4, range 7.6-144.0) than in H. pylori negative (16.6, range 4.2-44.1 and 22.4, range 5.6-48.6) patients, p = 0.019 and p = 0.029, respectively. Stimulated gastric acid secretion was significantly higher in patients with duodenal ulcer (n = 8) than in H. pylori negative (n = 11) patients, but was similar in non-ulcer dyspeptics (n = 20) and H. pylori negative patients. The median basal acid output was not significantly different between the groups of patients. Our patients (median age 32 years) had normal mucosa (12.1%), pangastritis with corpus predominance (12.1%), antrum-only gastritis (24.3%) and pangastritis with antral predominance (51.5%). In the subset of H. pylori positive patients (n = 28, 71.8%), there were no significant correlations between grade of antral chronic inflammation, gastritis index score, anti-H. pylori IgG titre and gastric acid secretion, p > 0.05. H. pylori infection increases MAO and PAO in our relatively young patients with antral predominant chronic gastritis.

Application of polymerase chain reaction to the prenatal diagnosis of sickle cell anaemia in Nigeria.

Although sickle-cell disease is very common in Nigeria, control by prenatal testing is lacking. The polymerase chain reaction-based technology combined with chorionic villi sampling has enabled us to offer prenatal diagnosis of sickle cell disease to 50 pregnant women who were at risk of bearing children with sickle cell anaemia. DNA was extracted from the villus and subjected to either PCR and restriction enzyme (Dde I) analysis (36 samples) or to PCR-ARMS procedure (12 samples) or to both procedures when the results by the first procedure were equivocal (2 samples). The genotypic distribution was 13AA, 25AS and 11SS. In one case, it was not possible to determine the genotype of the villi by both methods. A post delivery genotype analysis confirms the correctness of prenatal diagnosis in all the 42 subjects that has so far reported. The results clearly demonstrate the usefulness of the PCR method in the prenatal diagnosis of sickle-cell anaemia in this environment.

Plasma calcium in active pulmonary tuberculosis.

Fifty-two patients with active pulmonary tuberculosis were studied. Seventy percent of the patients were hypocalcemic at admission, but became normocalcemic after ten weeks of therapy. The improvement in hypocalcemia was thought to be due to either improved serum protein and albumin levels, which occurred after admission, or the reduced physical activity of the patients.Care should be taken in giving patients with pulmonary tuberculosis vitamin D supplements because of the possibility of hypersensitivity to vitamin D.The possible mechanisms of hypercalcemia in active pulmonary tuberculosis are discussed.

The effect of long term anticonvulsant therapy on serum calcium, phosphate and alkaline phosphatase in Nigerian epileptic patients.

A survey of calcium metabolism in fifty-two epileptic patients on long term therapy with anti-convulsant drugs, showed that their total serum calcium levels were within normal limits. There was neither clinical nor radiological evidence of osteomalacia in any of them. It is postulated therefore that the osteomalacic effect of antivonculsant drugs reported among Caucasians does not appear to occur in African patients in a tropical environment most probably due to the abundance of vitamin D derived from the sun's ultra-violet light.