Vertical transmission of HIV in New York State: a basis for statewide testing of newborns.

Infants (n = 313) of HIV-infected mothers were enrolled (mean age 1.9 weeks, range 0-8 weeks) in a 3-year prospective study of vertical transmission. Fifty-six infants (17.9%) had laboratory and clinical evidence of HIV infection. Polymerase chain reaction (PCR) provided early and reliable identification of infected infants. Thirty-one of the 56 infected infants had specimens submitted when the infants were 4 weeks of age or less and 30 (97%) tested PCR positive. This percentage increased to 100% by 8 weeks of age when 51 of the 56 infected infants had specimens tested for that time period. Immune complex dissociation (ICD) antigen testing was a sensitive method for diagnosis of infection but only in infants older than 1 month. p24 antigen testing, although free of false positives, is less sensitive than either of the other methods. Among surrogate markers of HIV infection, elevation of soluble CD8 levels precedes an increase in immunoglobulin levels or a decline in CD4 T lymphocytes. Vertical transmission is significantly lower in Central and Western New York State than other regions. Transmission is significantly higher in low birthweight babies and in infants whose mothers have CD4 counts < 500. This study provided the basis for establishing a Pediatric HIV PCR Testing Service for the early diagnosis of HIV infection in neonates.

Serum beta-carotene deficiency in HIV-infected children.

Representative levels of serum micronutrients specifically, beta-carotene and vitamins A and E, were studied in symptomatic human immunodeficiency virus (HIV)-infected children. The nutritional status of 23 symptomatic African-American and Hispanic HIV-infected children were compared with an appropriate control group comprised of 36 uninfected children matched for age and sex, using body mass index. Serum beta-carotene and vitamin A and E levels were randomly determined on 15 of the infected children. Beta-carotene concentration was 4.9-fold reduced in symptomatic HIV-infected children when compared with the control group. There was a 6.5-fold decrease in the serum level for children without acquired immunodeficiency syndrome (AIDS) and a 13-fold reduction in children with AIDS. No differences in the mean values for serum vitamins A and E were observed in the groups studied. Although the nutritional status of the symptomatic HIV-infected children was not different from that of the control population, their serum beta-carotene levels were profoundly deficient. This finding may have immunologic and clinical implications for children with rapidly progressing HIV disease.

Clinical significance of resolution of chest X-ray findings in HIV-infected children with lymphocytic interstitial pneumonitis (LIP).

Lymphocytic interstitial pneumonitis (LIP) in HIV-infected children is generally associated with better prognosis as compared with children with Pneumocystis carinii pneumonia (PCP). We prospectively studied 12 cases of HIV-infected children with LIP over a 4-year period in an effort to document one aspect of the natural history of this clinical entity. Severe CD4 lymphocytopenia was associated with complete resolution of the chest X-ray findings in five patients, one of whom died of disseminated Mycobacterium avium complex. A second patient developed rapid-onset subacute HIV encephalopathy at the time when the CD4-lymphocyte count declined from 589 to 39, and the lung findings resolved spontaneously. The resolution of the lung pathology may be the first indication of severe immune suppression and a warning of the increased risk for opportunistic infections. Therefore, in those settings where diagnostic laboratory facilities are not easily available, the resolution of the reticulonodular changes on chest radiographs is a poor prognostic sign in HIV-infected children with LIP.

Factors associated with hypertension in Nigerian civil servants.

BACKGROUND: Study of hypertension in segments of West African populations in transition toward Westernization may lead to better understanding of the high risk for hypertension among Westernized blacks. METHODS: Five hundred fifty-nine urban civil servants, ages 25-54, were recruited from six ministries of Bendel State, Nigeria. Blood pressure, physical measurements, urinary protein and glucose, fasting blood glucose, and demographic data were collected at the workplace. Subjects were classified as senior staff (professionals or administrators) or junior staff (non-administrators). RESULTS: Among 172 male senior staff, the age-adjusted rate of hypertension (diastolic blood pressure > or = 90 mm Hg, systolic blood pressure > or = 140 mm Hg, or on an antihypertensive medication) was 43% and occurrence rose dramatically from 21 to 63% across age groups 25-34 to 45-54, respectively. Among 266 male junior staff, the age-adjusted rate of hypertension was 23%, and occurrence did not rise with age. Logistic regression showed that body mass index (kg/m2), age, alcohol drinking, and being senior staff were all independently related to hypertension in men. On the other hand, the age-adjusted rate of hypertension in 121 women was 20% and was significantly related only to body mass index. CONCLUSION: Male urban civil servants appeared to have a risk for hypertension similar to that of U.S. black males. Age, body mass index, alcohol drinking, and other unidentified factors related to higher socioeconomic status were strong determinants of hypertension in this population.

Tracking of blood pressure and anthropometric measures in Nigerian children.

Persistence in ranks (tracking) for blood pressure and anthropometric measures over a one year period was examined in 208 Nigerian children (age 6-17 years). Systolic blood pressure tracked better than diastolic blood pressure (r = 0.52 to 0.72) and r = 0.25 to 0.55, respectively). For systolic blood pressure, 56.5%-70.6% of the Nigerian children remained in the top tertile after one year compared with 45.5%-69.2% for diastolic blood pressure. Weight showed the strongest correlation over the one year period (r = 0.88 to 0.97), whereas skinfolds demonstrated the weakest association (r = 0.54 to 0.82). The association between anthropometric measures at baseline and blood pressure one year later revealed for both males and females that height and weight were positively and significantly correlated with blood pressure.

Body fat distribution patterns and blood pressure in black and white women.

The prevalence of obesity and being overweight and the distribution of body fat in relation to blood pressure were assessed in a college population of 181 black and white US women and 124 black Nigerian women. The mean ages ranged from 18.6 to 22.4 years. Twenty-nine percent of black US women were overweight and 12.9% were obese; whereas 13.6% of white US women were overweight and 2.3% were obese. Only 18.6% of Nigerians were overweight and 1.6% were obese. More upper body fat was found among the black US women and Nigerians than among white US women. There was no significant correlation between body fat distribution and blood pressure among Nigerians. In general, among US blacks and whites, there were positive associations among body mass index, waist-hip girth measurements, and blood pressure, particularly for systolic blood pressure.

Factors related to blood pressure among urban Nigerian workers.

This cross-sectional study of urban, Nigerian civil servants found that age, body mass index, alcohol drinking and high socioeconomic status were all positively and independently related to blood pressure among 438 males. Among 121 females, only body mass index was significantly related to blood pressure.

Blood pressure and other cardiovascular disease risk factors in black adults with sickle cell trait or glucose-6-phosphate dehydrogenase deficiency.

In this study, we examined the relationship of two common genetic markers in black populations, sickle cell trait and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, to cardiovascular risk factors. The subjects were Nigerian civil servants in Benin City, Nigeria. We measured blood pressure, height, weight, sickle cell hemoglobin, G-6-PD, proteinuria, microalbuminuria and fasting serum cholesterol, high-density lipoprotein cholesterol (HDL), triglycerides, apoprotein (APO) AI, and APO B. Data were collected on age, alcohol consumption, cigarette smoking, job status, and years lived in an urban area. There were 257 males (3 SS hemoglobin, 73 AS, 181 AA) and 69 females (23 AS, 46 AA). In comparing cardiovascular risk factors, males differed only in percent of smokers (31.5 in AS vs. 17.8 in AA, P less than 0.01). Among females, only high-density lipoprotein (HDL) cholesterol differed (61.5 mg/dl in AS vs. 52.4 in AA, P less than 0.01). We hypothesize that females with sickle cell trait are more likely to use oral contraceptives than nontrait females. If so, the high-estrogen oral contraceptives available in Nigeria could elevate HDL. G-6-PD deficiency status among males (52 deficient, 207 nondeficient) and females (1 deficient, 5 carriers, 65 nondeficient) was not related to any of the cardiovascular risk factors. We conclude that sickle cell hemoglobin trait and G-6-PD deficiency are not useful genetic markers for risk factors for cardiovascular disease.

Assessment of cardiovascular risk factors in Nigerian students.

The present study assessed the prevalence of cardiovascular risk factors in 65 Nigerian medical students attending the University of Benin, Benin City, Nigeria. Their ages ranged from 17 to 28 years with a mean age for men of 20.9 years and for women of 18.8 years. Approximately 8% of the men and 0% of the women were current cigarette smokers, whereas alcohol use was observed in 14.6% of the men and in 0% of the women. The Nigerian men had significantly higher diastolic blood pressures than did American black and white men. Compared to American black men, the Nigerian men had considerably lower total cholesterol and triglyceride concentrations. The Nigerian women did not differ from American black women with respect to total cholesterol, but had significantly lower triglyceride concentrations.

Seasonal variation in respiratory syncytial virus infections in children in Benin-City, Nigeria.

The seasonal variation in respiratory syncytial virus (RSV) infections in children was examined in Benin City. Nasopharyngeal washes were obtained from children under 3 years hospitalised for acute lower respiratory infections during two seasons - rainy season (June-August) and dry season (December-February). RSV surface antigen was identified by ELISA. 54% of patients in the rainy season were ELISA positive for RSV compared to 8.8% during the dry season. Clinical features in the RSV infected patients were not different between the two seasons and were similar to that reported from temperate climates. It is concluded that RSV infections occur all year round with a peak during the rainy season.

The diagnostic value of leukocyte indices and micro-erythrocyte sedimentation rate in neonatal infections.

In an attempt to compare sensitivity, specificity and predictive values of newborn screening tests for sepsis, leukocyte indices derived from healthy African neonates, Manroe's published indices, micro-erythrocyte sedimentation rates (Mini-ESR) and a combination of the Mini-ESR and leukocyte indices of African neonates were applied to 32 infected infants and 20 uninfected neonates studied prospectively. The sensitivity, specificity and predictive values derived from Manroe's indices were 93%, 35% and 69.8% respectively. The corresponding values derived from the indices of African neonates were 84.4%, 95% and 96.4%. Local reference values were thus more specific and predictive. Values obtained by combining Mini-ESR with indices of the African Neonates were 100%, 85% and 94%. The Mini-ESR alone yielded a sensitivity of 96.9%, specificity of 90% and a predictive value of 94%. The mini-ESR alone may therefore be a more valuable test in the sepsis screening of the African neonate.

Bacterial growth in expressed breast-milk.

We determined the degree of bacterial contamination and the rate of bacterial growth in expressed breast-milk stored in a tropical environment with high ambient temperatures and humidity. Colostrum or mature milk obtained from mothers who were delivered preterm or at term was stored at room temperature (27-32 degrees C) and in a refrigerator (4 degrees C) over a 24-h period. Bacterial isolates represented normal skin flora. Our study showed that colostrum was more inhibitory than mature milk, and term colostrum more so than preterm colostrum. At room temperature, mature milk from term mothers could be stored for 6 h without a significant increase in bacterial counts. Term colostrum could be stored for 12 h without significant bacterial growth. Preterm milk could be stored for 4 hr. Our findings should be of practical value to lactating mothers without access to refrigerators.

Pepsin and its multiple forms in early life.

Pepsin and its multiple molecular forms have been studied in pre-term and post-term Nigerian infants. The levels of total enzyme activity and acidity were lower in the pre-term infants when compared to term and post-term infants. Resolutions of the various species by ion-exchange chromatography and electrophoresis revealed that the development of specific isoenzymes in term infants occurred towards the end of the neonatal period. Differential development of the enzyme and the isoenzyme in the neonatal period may have important clinical bearing on the subsequent pancreatic protease hydrolysis which may provide a basis for evaluating gastric capacity for nutritional management of these infants.

Physiologic jaundice in the Nigerian neonate.

In the course of a systemic study of physiologic hyperbilirubinaemia, 200 Nigerian newborn infants were evaluated daily over a 12-day period. The pre-term and post-term neonates exhibited a distinct biphasic pattern of hyperbilirubinaemia. Mean peak bilirubin levels of 8.20 mg/dl for the pre-term, 7.15 mg/dl for the post-term and 8.34 for the term were attained on the fourth, third and fifth days, respectively. Term small for gestational age neonates experienced mean peak bilirubin levels of 7.02 mg/dl at the age of 4 days and maintained a sustained elevation for as long as the last day of the study. Higher values of physiologic hyperbilirubinaemia are observed in this study than has been reported for American neonates.

Decreased serum alpha-amylase levels in infected Nigerian newborn infants.

Serum alpha-amylase activity was determined in 41 newborn infants with proven bacterial infections and compared to values obtained in 18 healthy control neonates. In the infected neonates serum alpha-amylase value, as determined by the blue starch method, was only 40% that of healthy controls; the mean value of 175.1 +/- 64.9 IU/l for healthy neonates was significantly higher (p less than 0.0010) than the value of 82.8 +/- 44.4 IU/l for the infected neonates. Alpha-amylase levels did not correlate with severity of infections or mortality. The sensitivity and specificity of serum alpha-amylase level of 100 IU/l were 75.6 and 94.7%; the positive and negative predictive values were 91.2 and 84.4%, respectively.

An epidemiological assessment of blood pressure determinants in an adolescent population of Nigerians.

An epidemiological assessment of blood pressure determinants in a random sample of 254 Nigerian adolescents aged 6-17 years in Benin City, Nigeria, was conducted. None of the adolescents reported cigarette smoking. Only 2.6% of the males and 0% of the females were alcohol users. Socio-economic status of the children according to parental education revealed that approximately 23% of the mothers and 9.8% of the fathers received less than a secondary (high school) education. At the other end of the education spectrum, a college education was received by 64.1% and 30.8% of the fathers and mothers, respectively. Two percent of the females and 1.3% of the males either had systolic blood pressures of greater than or equal to 140 mmHg or diastolic blood pressures of greater than or equal to 90 mmHg. No significant blood pressure differences existed between the two sexes. Among the males, it was demonstrated that age, body mass index, and heart rate were significant independent predictors of systolic blood pressure, explaining 49% of the variance. Forty-seven per cent of systolic blood pressure variance was explained by age and heart rate, for females. It was interesting to note that age was the only independent predictor of diastolic blood pressure for both males and females after control for heart rate and body mass index.

Cardiothoracic ratio in Nigerian newborn infants.

Cardiothoracic ratio was calculated from measurements made on the frontal radiographs of 172 normal (appropriate for gestational age) Nigerian newborn infants. The normal ratio was compared with those of 30, 32 and 42 neonates with respiratory distress syndrome, birth asphyxia and parenchymal lung disease respectively. The ratio for normal neonates was 49.12%. It was however significantly increased in respiratory distress syndrome (51.18%) and asphyxia (50.81%). The cardiothoracic ratio values obtained in this study are lower than those in Caucasian newborn infants.