Surgical androgen deprivation therapy in advanced prostate cancer in patients of African descent: comparison of biochemical efficacy of bilateral total and subcapsular orchidectomy.

Background: Surgical androgen deprivation therapy (ADT) to treat advanced prostate cancer can be achieved either by bilateral total orchidectomy (BTO) or bilateral subcapsular orchidectomy (BSCO). However, biochemical and clinical equivalence between BTO and BSCO among native Africans is undocumented. Objective: To compare the biochemical response (testosterone and prostate specific antigen) in patients who had BTO and BSCO for advanced prostate cancer. Methods: A randomized single- blind study of 64 consenting patients that underwent either BTO or BSCO. Pre- and post-operative PSA and testosterone assays were done serially at intervals and compared between each treatment group. Results: Each treatment group were similar with no statistically significant difference in terms of age (p= 0.449) or degree of tumor differentiation (p =0.714). Neither median testosterone (p= 0.515) nor the mean pre-operative PSA differ between the two groups (p = 0.482). Also, similar trends were noticed post operatively except at the 2nd month when a statistically significant difference was recorded (p = 0.003). Conclusion: The two techniques of orchidectomy were effective in accomplishing androgen deprivation. They produced similar biochemical (testosterone and PSA) response.

Functional iron status of chronic kidney disease patients at the University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Background: Functional iron deficiency has been found to be a common cause of poor response to erythropoiesis stimulating agents in anaemic patients with chronic kidney disease (CKD). Objectives: Assess the functional iron status of patients with chronic kidney disease. Methods: This was a hospital based cross sectional study. The study subjects were chronic kidney disease patients with age and sex matched healthy controls. Full blood count, serum ferritin, soluble transferring receptor, C-reactive protein, serum iron and total iron binding capacity were measured in the patients and healthy controls.Data was analyzed with statistical package for the social sciences software version 22.0. And the level of statistical significance was set at p. value < 0.05. Results: The mean ± SD of the age of patient with CKD was 55.0 + 15.4 years, while that of controls was 52.7 + 13.6 years. The mean serum ferritin, serum iron, TIBC and CRP were significantly higher in patients compared with controls (p<0.001, 0.023, <0.001 and 0.001) respectively. Functional iron deficiency was seen in 19.5% of patients with CKD. Conclusion: The predominant form of iron deficiency in our study was functional iron deficiency.

Functional iron status of chronic kidney disease patients at the University of Ilorin Teaching Hospital, Ilorin, Nigeria

Background: Functional iron deficiency has been found to be a common cause of poor response to erythropoiesis stimulating agents in anaemic patients with chronic kidney disease (CKD). Objectives: Assess the functional iron status of patients with chronic kidney disease. Methods: This was a hospital based cross sectional study. The study subjects were chronic kidney disease patients with age and sex matched healthy controls. Full blood count, serum ferritin, soluble transferring receptor, C-reactive protein, serum iron and total iron binding capacity were measured in the patients and healthy controls. Data was analyzed with statistical package for the social sciences software version 22.0. And the level of statistical significance was set at p. value < 0.05. Results: The mean ± SD of the age of patient with CKD was 55.0 + 15.4 years, while that of controls was 52.7 + 13.6 years. The mean serum ferritin, serum iron, TIBC and CRP were significantly higher in patients compared with controls (p<0.001, 0.023, <0.001 and 0.001) respectively. Functional iron deficiency was seen in 19.5% of patients with CKD. Conclusion: The predominant form of iron deficiency in our study was functional iron deficiency

Acute Kidney Injuries in Children with Severe Malaria: A comparative study of diagnostic criteria based on serum cystatin C and creatinine levels.

OBJECTIVES: Serum creatinine levels are often used to diagnose acute kidney injury (AKI), but may not necessarily accurately reflect changes in glomerular filtration rate (GFR). This study aimed to compare the prevalence of AKI in children with severe malaria using diagnostic criteria based on creatinine values in contrast to cystatin C. METHODS: This prospective cross-sectional study was performed between June 2016 and May 2017 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 170 children aged 0.5-14 years old with severe malaria were included. Serum cystatin C levels were determined using a particle-enhanced immunoturbidmetric assay method, while creatinine levels were measured using the Jaffe reaction. Renal function assessed using cystatin C-derived estimated GFR (eGFR) was compared to that measured using three sets of criteria based on creatinine values including the Kidney Disease: Improved Global Outcomes (KDIGO) and World Health Organization (WHO) criteria as well as an absolute creatinine cut-off value of >1.5 mg/dL. RESULTS: Mean serum cystatin C and creatinine levels were 1.77 ± 1.37 mg/L and 1.23 ± 1.80 mg/dL, respectively (P = 0.002). According to the KDIGO, WHO and absolute creatinine criteria, the frequency of AKI was 32.4%, 7.6% and 16.5%, respectively. In contrast, the incidence of AKI based on cystatin C-derived eGFR was 51.8%. Overall, the rate of detection of AKI was significantly higher using cystatin C compared to the KDIGO, WHO and absolute creatinine criteria (P = 0.003, <0.001 and <0.001, respectively). CONCLUSION: Diagnostic criteria for AKI based on creatinine values may not indicate the actual burden of disease in children with severe malaria.

Triglyceride/HDL-cholesterol ratio and plasminogen activator inhibitor-1 independently predict high pulse pressure in sickle cell trait and disease.

We hypothesised that TG/HDL-C ratio and PAI-1 would be associated with high pulse pressure (PP) in young adults with sickle cell trait (SCT) and sickle cell disease (SCD). We compared the clinical, biochemical, and cardiometabolic parameters among individuals with normal genotype (HbAA; n = 60), SCT (HbAS; n = 60), and SCD (HbSS; n = 60), all in steady state. Using multivariate linear regression analysis, high PP was positively related to TG/HDL-C ratio in SCT (ß = 0.307; p = .014) and PAI-1 (ß = 0.499; p = .001) in SCD. The curve of receiver operating characteristic also showed that TG/HDL-C ratio and PAI-1 are efficient predictors of high PP in SCT carriers and SCD patients, respectively. This study suggests that increased levels of TG/HDL-C ratio and PAI-1 may be salient risk factors that would promote the development of arterial stiffness and other CVD in SCT carriers and SCD patients.

Serum zinc levels of hospitalized children with acute diarrhea differ by the isolated viruses.

BACKGROUND: Acute diarrhea constitutes a major global burden to morbidity and mortality in under-five children. Research has shown that micronutrient zinc plays a pivotal role in childhood diarrhea; however, there are contradictory reports of its therapeutic benefit across the various causative enteropathogens. OBJECTIVES: The aim of the study was to determine the prevalence of viral etiology (rotavirus, adenovirus, and norovirus) and compare the serum zinc levels of children with acute diarrhea. METHODS: A comparative cross-sectional study in which 100 hospitalized children with acute diarrhea aged one-59 months and 100 controls were recruited. Viruses were investigated from stool specimens using the immunochromatographic technique, while serum zinc was determined through the colorimetric method. Data analysis was with SPSS 20 software package. RESULTS: The prevalence of viruses in the subjects was 62.0% with rotavirus isolated in 30 (30.0%) of the patients, while adenovirus and norovirus were detected in 21 (21.0%) and 11 (11.0%) patients, respectively. Rotavirus was the only virus detected in 2 (2.0%) of the controls. The mean serum zinc level of 65.3 ± 7.4 µg/dl in the subjects was significantly lower than 69.0 ± 6.5µg/dl in the controls (P < 0.001). The prevalence of zinc deficiency in the subjects (47.0%) was significantly higher than 32.0% in the controls (P = 0.030). The mean serum zinc levels differed significantly among the viruses isolated in the subjects (P < 0.001). CONCLUSIONS: Viruses contribute largely to etiology of acute diarrhea in Nigerian under-five children. Zinc deficiency was also highly prevalent in the study population. The serum zinc levels varied significantly across the different viruses isolated.

Effects of Highly Active Antiretroviral Therapy on Renal Function and Renal Phosphate Handling in African Adults with Advanced HIV and CKD.

BACKGROUND: Highly Active Antiretroviral Therapy (HAART) has been implicated in renal dysfunction with hypophosphataemia. OBJECTIVE: We prospectively evaluated renal phosphate excretion during HAART use. METHOD: Newly diagnosed human immunodeficiency virus (HIV)-infected individuals were treated with Tenofovir disoproxil fumarate/Emtricitabine/Efavirenz (TDF/FTC/EFV), n=33; Zidovudine/Lamivudine/Nevirapine (ZDV/3TC/NVP), n=53; and Zidovudine/Lamivudine/Efavirenz (ZDV/3TC/EFV), n=16. Creatinine and phosphate were assayed in blood and urine simultaneously at baseline, 1, 3, 6 and 9 months. Glomerular filtration rate (eGFR), fractional phosphate excretion and reabsorption (FEPi % and TRP), and the ratio of tubular maximum reabsorption of phosphate (TmP) to GFR (TmP/GFR) were estimated. RESULTS: At baseline, eGFR showed moderate chronic kidney disease (mean: 35.50 ± 2.02, 33.14 ± 1.63, and 39.97±1.84 ml/min/1.73m2 in the 3 groups respectively); 54 (52.9%) patients had hyperphosphataemia (>1.4mmo/L); 43 (42.2%) had normophosphataemia (0.6-1.4mmol/L); 5 (4.9%) had hypophosphataemia (<0.6mmol/L). eGFR improved significantly from 1 month (≥60, 58.65 ± 1.11, and 51.76 ±1.59 ml/min/1.73m2; p=0.04, <0.001, 0.67 respectively), with a relapse at 9 months in TDFtreated subjects (50.10 ± 1.89 ml/min/1.73m2). TDF/FTC/EFV resulted in significantly greater reduction in plasma phosphate than ZDV/3TC/NVP (p=0.031), but not significantly different from ZDV/3TC/EFV (p=0.968). Similarly, ZDV/3TC/EFV resulted in significantly greater reduction in plasma phosphate than ZDV/3TC/NVP (p=0.036). FEP% progressively increased with HAART duration, more in TDF-treated and ZDV/3TC/EFV-treated groups than ZDV/3TC/NVP (p=0.014); TRP was elevated (>0.86), implying non-maximal phosphate reabsorption. TmP/GFR values were elevated, (>1.35mmol/l). CONCLUSION: HIV causes kidney dysfunction with reduced phosphate excretion resulting in hyperphosphataemia but HAART improves renal function. Prolonged use of TDF can cause renal toxicity with hypophosphataemia as fractional excretion progressively increased with duration of therapy unlike ZDV/3TC/NVP. The use of different third agents (either NVP or EFV) in zidovudine-based therapy results in significantly different plasma phosphate levels; ZDV/3TC/EFV, like TDF/FTC/EFV, resulted in significantly greater decline in plasma phosphate than ZDV/3TC/NVP. Thus, Evafirenz (EVF) may have similar or synergistic adverse effects with tenofovir disoproxil fumarate (TDF).

Prevalence of antibody to hepatitis B core antigen among hepatitis B surface antigen-negative blood donors in Ilorin, Nigeria: A cross-sectional study.

BACKGROUND: Post-transfusion hepatitis occurs even with stringent donor selection criteria and screening for hepatitis B surface antigen (HBsAg). The objective of this study was to determine the prevalence of antibody to hepatitis B core antigen (anti-HBc) in HBsAg-negative blood donors. METHODS: This was a cross-sectional study in which 200 HBsAg-negative blood donors were recruited. Screening for viral markers was done using both a rapid test kit and enzyme-linked immunosorbent assay (ELISA) for anti-HBc IgM. Quantitative and qualitative analysis of anti-HBc IgM was done by "capture" enzyme immunoassay using DIA.PRO HBc IgM test kits. The other viral markers were investigated using one step cassette style HBV tests. SPSS version 16 was used for data analysis. A P-value of 0.05 or less was considered significant. RESULTS: There were 190 male (95%) and 10 female (5%) blood donors, with a mean age of 31.7 ± 7.9 years. The prevalence of anti-HBc IgM was 4%. The other viral markers (HBeAg, anti-HBeAg, anti-HBs and total anti-HBc) had a prevalence of 1.5%, 23%, 2.5%, and 32.5%, respectively. CONCLUSIONS: The prevalence of anti-HBc IgM in this study was high, and this supports the fact that screening blood donors for HBsAg alone is not sufficient to prevent transmission of HBV.

High salt intake does not aggravate glucose dysregulation and dyslipidemia induced by estrogen-progestin oral contraceptive.

BACKGROUND: Estrogen-progestogen combined oral contraceptive (OC) use has been associated with increased cardiometabolic risk factors, including glucose dysregulation, dyslipidemia, hypertension, and pro-inflammatory state. However, the effect of a high-salt diet on these risk factors during OC use is not yet investigated. We therefore hypothesized that a high-salt diet would increase cardiometabolic risk factors in female rats treated with a combination of OC steroids, levonorgestrel (L) and ethinylestradiol (EE), and that elevated plasma levels of pro-inflammatory markers are associated with the cardiometabolic effects. METHODS: Female Wistar rats were given (p.o.) vehicle, high-dose (1.0µg EE plus 5.0µgL) or low-dose (0.1µg EE plus 0.5µgL) OC with or without a high-salt diet (8%) daily for 8 weeks. Insulin resistance (IR) was estimated using the homeostatic model of assessment (HOMA). RESULTS: Results showed that OC treatment or high salt diet led to significant increases in insulin resistance, plasma insulin, total cholesterol (TC), triglyceride (TG), TC/HDL-cholesterol, uric acid levels, and decreased glucose tolerance. OC treatment but not a high-salt diet resulted in increased plasma C-reactive protein and TG/HDL-cholesterol. However, a high-salt diet did not aggravate the effects of OC treatment. CONCLUSION: The results from the present study indicate that glucose dysfunction and dyslipidemia induced by OC use, but not those induced by increased dietary salt are associated with elevated plasma C-reactive protein. Besides, increased dietary salt does not worsen abnormal cardiometabolic impact of OC use.

Mullerian Agenesis with Primary Amenorrhea: A Case Report of a Normal Phenotypic Female.

Meyer-Rokitansky-Kuster-Hauser syndrome is a rare congenital abnormality occurring sporadically in females. It is the most common cause of primary amenorrhea. Affected persons usually appear normal on physical examination. This is a case of a 25-year-old woman who presented with primary amenorrhea and, subsequently, had diagnostic laparoscopy to confirm the diagnosis of Mullerian agenesis.

Characterization of prefrontal cortex microstructure and antioxidant status in a rat model of neurodegeneration induced by aluminium chloride and multiple low-dose streptozotocin.

Diabetes mellitus (DM) is a risk factor for Alzheimer's disease (AD), and several individuals with AD are diabetic. Most non-transgenic animal models of AD make use of oral treatment with aluminium chloride (AlCl(3)) to induce brain lesions pathognomonic of the disease. Moreover, streptozotocin (STZ) can induce pathological features of either AD or DM depending on the mode of treatment. In the present study, we characterised prefrontal microanatomy and antioxidant defence system in a rat model of AD confounded by DM, with the objective of assessing the suitability of this model in the study of sporadic AD with DM co-morbidity. Adult Wistar rats were randomly assigned to receive either intraperitoneal STZ (30 mg/kg/day for 3 days; to induce DM), oral AlCl(3) (500 mg/kg/day for 4 weeks; to induce some brain lesions characteristic of AD); or both STZ and AlCl(3) (to induce AD with DM co-morbidity). Untreated rats served as controls. During treatment, blood glucose levels and body weights were evaluated repeatedly in all rats. At euthanasia, prefrontal cortex was homogenized in phosphate buffer solution and the supernatants assayed for some antioxidant enzymes (catalase, CAT; superoxide dismutase, SOD; and reduced glutathione, GSH). Moreover, following perfusion-fixation of the brain, frontal lobes were processed by the haematoxylin and eosin (H&E) or Congo red technique. Our findings showed that in rats co-administered AlCl(3) and STZ (AD + DM rats), prefrontal levels of GSH reduced significantly (p < 0.05), while reductions in SOD and CAT were not significant (p > 0.05) compared with the controls. Moreover, in this model of AD with DM co-morbidity, extensive neuronal cell loss was observed in the prefrontal cortex, but Congophilic deposits were not present. The neurodegenerative lesions and antioxidant deficits characteristic of this AlCl(3) + STZ (AD + DM) rat model were more pronounced than similar lesions associated with mono-treatment with either STZ (DM) or AlCl(3) (AD) alone; and this makes the AlCl(3) + STZ model a suitable option for the study of neurodegenerative diseases (such as AD) with DM co-morbidity.

Testicular histomorphometry and semen quality of adult Wistar rats following juvenile oral lead intoxication

Empirical evidence has shown that childhood lead (Pb) intoxication impairs cognitive function and heightens the risk of dementia in young adult humans. However, the effects of juvenile Pb toxicity on testicular morphometry and semen quality in young adulthood require further studies. Using a rodent model, juvenile (4 weeks old) Wistar rats were randomized to receive either normal saline or lead acetate in their drinking water at 0.5% (5000 ppm), 1.5% (15000 ppm) and 2.5% (25000 ppm) for 7 weeks. At 11 weeks postnatal, young adult rats were anaesthetized and their cauda epididymides excised for sperm analysis. The left testicles were homogenized in phosphate buffer and the supernatants assayed for testosterone by the enzyme immunoassay technique. The right testicles were processed for photomicroscopy by the haematoxylin and eosin technique. Using ImageJ software, testicular sections were subjected to morphometric analysis. Our findings showed that juvenile Pb intoxication alters testicular histomorphometry in young adulthood as indicated by significant (P<0.05) reductions in seminiferous tubule diameters and lumen, and marked attenuation of the germinal epithelium in the Pb-exposed rats compared with the non-exposed age-matched controls. Furthermore, findings from sperm analysis showed significantly low sperm density and motility following oral Pb exposure, while the percentage of deformed and dead sperm cells had increased significantly (P<0.05). Meanwhile, testicular interstitial compartment and the associated Leydig cells were unperturbed, and testicular testosterone levels were not significantly different between the control and Pb-treated groups (P>0.05). These findings show that Pb intoxication initiated prior to pubescence alters testicular histomorphometry and lowers semen quality in young adult Wistar rats, and these changes were unconnected with testicular testosterone levels

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Serum zinc levels in hospitalized children with acute lower respiratory infections in the north-central region of Nigeria.

BACKGROUND: Macronutrient deficiency has continued to attract significant research interest, where as the import of micronutrients like zinc has only recently become the focus of interest. Thus against the background of a dearth of data on zinc levels in Nigerian children with Acute Lower Respiratory Infection (ALRI), this study was carried out in Ilorin, Nigeria to determine the serum zinc levels in hospitalized children with ALRI. METHODOLOGY: A comparative cross-sectional hospital based study involving 120 children aged two months to five years with ALRI recruited as subjects, and 120 age-appropriate controls without ALRI was carried out. Socio-demographic, clinical and laboratory data were obtained. The serum zinc was analyzed with a Jenway™ spectrophotometer after an initial preparation with the QuantiChrom™ zinc assay kit. RESULTS: The male/ female ratio was 1.6:1. The mean (SD) serum zinc level in subjects with ALRI of 18.7(11.8)µg/dl was significantly lower than the corresponding value of 53.1(18.5)µg/dl recorded in the controls, p=0.001. The prevalence of 98.3% for low serum zinc levels recorded in children with ALRI was significantly higher than that recorded in controls of 64.2%, p=0.001. CONCLUSION: Low serum zinc levels are significantly associated with ALRI. There is a need to determine whether hospitalized children managed for ALRI might benefit from post discharge zinc supplementation.