Establishing Reference Intervals for Serum and Salivary Cortisol in a Selected Population in Kano, Nigeria.

OBJECTIVE: Serum cortisol has long been used in the assessment of disorders of the hypothalamic-pituitary-adrenal axis. The reference interval for cortisol in both serum and saliva depends on the analytical methodology and the population studied; hence, a locally derived population-based reference interval is recommended. To our knowledge, there are no studies on reference interval determination in the study area, raising concerns about the use of reference intervals established in European and North American populations. This work aimed to establish reference intervals for baseline serum and salivary cortisol levels among healthy adults in Kano, Nigeria, using methods available in our laboratory. METHODS: A cross-section of 148 apparently healthy reference individuals aged 16 to 67 years were recruited from a local community in Kano, Nigeria, using a systematic sampling technique. Baseline serum cortisol was analyzed using highly sensitive and specific electrochemiluminescence quantitative measurements on an automated immunology analyzer. Salivary cortisol levels were measured using Salimetrics' competitive enzyme-linked immunosorbent assay test kits. Parametric methods with a 95% confidence interval were used to calculate reference intervals. RESULTS: The reference intervals for cortisol in serum and saliva were 72.0 nmo/L to 554.0 nmol/L and 0.40 nmol/L to 18.0 nmol/L, respectively. There was a weak positive correlation between serum and salivary cortisol values, but this association was not statistically significant. CONCLUSION: The development of locally derived adult reference intervals can improve the diagnostic utility of serum and salivary cortisol assessment and strengthen the reliability of adrenal insufficiency diagnoses in our population.

Factors associated with hypertension among adults in high burden kidney disease areas of Jigawa State, Nigeria: A cross-sectional survey.

Background: Hypertension is the leading risk factor for preventable cardiovascular-related complications and mortalities worldwide. Materials and Methods: A cross-sectional survey was conducted to assess the prevalence and factors associated with hypertension among 361 adults from four local government areas (LGAs) of Jigawa state identified to have high burden of kidney diseases. The Modified WHO STEPS questionnaire and multi-stage sampling technique were employed and data were analysed using IBM SPSS version 22.0. Results: The age of the respondents ranged from 18 to 102 years with a median of 45 (interquartile range = 30-80) years. More than a quarter (34.9%) of the respondents were unemployed. Few reported history of alcohol ingestion (0.8%) and cigarette smoking (1.1%). The prevalence of systolic hypertension was 116 (32.1%), while that of diastolic hypertension was 133 (36.8%). Jahun LGA had higher cases (36.7%) of systolic hypertension, whereas Dutse LGA had higher cases (47.8%) of diastolic hypertension. Systolic hypertension was significantly higher (P < 0.001) among those >35 years of age. The odds of developing systolic hypertension were significantly lower among those between the ages of 18 and 35 years, and those between the ages of 18 and 35 years were less likely to have systolic hypertension than those above the age of 35 years (adjusted odds ratio = 9.0; 95% confidence interval = 4.6-17.6). Similarly, those who reported family history of diabetes and hypertension (P < 0.001) had a significantly higher proportion of systolic hypertension. Conclusions: The prevalence of hypertension was alarming in the high burden kidney disease areas. The government should develop a sustainable model for the mass community screening of risk factors and community-based health insurance for the effective management of all identified cases.

Burden, socio-demographic and other risk factors associated with haemodialysis in North-west Nigeria: A retrospective multicentre analysis.

Background: Kidney diseases requiring haemodialysis are becoming an emerging public health problem. This study aimed to determine the burden, socio-demographic and other risk factors associated with haemodialysis in Northwest Nigeria. Methodology: The study was a retrospective multicentre review of secondary data from the dialysis centres of public hospitals in northwestern Nigeria. Risk factors for renal failure were examined in 1329 patients who were enrolled for haemodialysis between 2019 and 2022 in the four public dialysis centres in Kano and Jigawa state. Data were analysed using IBM SPSS Statistics for Windows, version 22.0, with statistical significance set at P ≤ 0.05. Results: The minimum age of the patients was 2 years and the maximum was 100 years with a median of 48 (interquartile range = 31, 60) years. Chronic kidney disease (CKD) was found amongst more than two-thirds 998 (75.1%) of the patients. Up to 51 (3.8%), 62 (4.7%) and 10 (0.8%) were seropositive for HIV, hepatitis B and hepatitis C, respectively. Acute kidney injury (AKI) was significantly higher (67.9%, P < 0.001) amongst patients with post-partum haemorrhage (PPH), and were 24 times more likely to develop AKI when compared with those with no PPH (adjusted odds ratio [aOR] =24, 95% confidence interval [CI] = [13.5-44.5]). CKD was significantly higher amongst patients with hypertension (HTN) (84.9%, P < 0.001), and were 3.2 times more likely to develop CKD compared with non-hypertensives (aOR = 3.2, 95% CI = [2.4-4.1]). Acute on CKD (AOCCKD) was significantly higher amongst patients with chronic glomerulonephritis (CGN) (28.1%, P < 0.001), and were three times more likely to develop AOCCKD than those without CGN (aOR = 3, 95% CI = [2.1-4.2]). Conclusion: PPH was the major reason for AKI related haemodialysis while diabetes and HTN were the major causes of CKD-requiring haemodialysis. CGN was more amongst patients who had dialysis due to acute exacerbation of CKD. The government and relevant stakeholders should ensure a favourable policy for the screening and management of patients.

CA125 levels in pregnancy: A case-control study amongst pregnant women in Aminu Kano teaching hospital, North-West Nigeria.

BACKGROUND: Induction of inflammatory response within the placenta in patients with pre-eclampsia triggers the expression of CA125, thus making CA125 a potential marker reflecting the severity of preeclampsia. OBJECTIVE: The study was aimed to assess and compare CA125 levels in pre-eclamptics and normotensives. SUBJECTS AND METHODS: A case-control design was used to study 83 each of the selected pre-eclamptics and normotensives women using a systematic sampling technique. Data were collected using interviewer-administered questionnaire; blood and urine samples were also collected and analysed in the laboratory. Data were summarised using frequencies, percentages, mean ± standard deviation (SD) or median, and range as appropriate. Inferential statistical measures were used to determine the relationship between the outcome and independent variables with a P value set to be statistically significant at ≤0.05. RESULTS: The ages of the pre-eclamptics and normotensives women were found to have a mean ± SD of 29.46 ± 6.92 and 29.70 ± 6.90 years, respectively. More than half 58 (69.9%) of the cases had proteinuria of 3+ (300 mg/dL). Significant difference was statistically (P < 0.01) found in mean serum CA125 levels between women with mild and severe pre-eclampsia with CA125 being more likely to be higher (>50 IU/mL) in severe pre-eclampsia than in mild pre-eclampsia. CONCLUSION: The study has shown that serum CA125 is elevated in pre-eclamptic pregnancies compared to normotensive pregnancies and the possibility of CA125 being a biomarker of severity and hence may provide information to make an informed choice in early-onset pre-eclampsia to consider conservative management and thus improve perinatal outcome.