High sensitive C-reactive protein (HsCRP) as a cardiovascular risk factor in hypertensive Nigerians.

AIMS AND OBJECTIVES: The objective of this study is to determine the effect of plasma high sensitivity C-reactive protein (HsCRP) levels on hypertensive and apparently healthy normotensive Nigerians in the management of hypertension. This is a preliminary study; a study involving larger numbers of normotensives and hypertensives is in progress. SUBJECTS AND METHODS: Plasma C-reactive protein level was determined in 150 hypertensive patients mean age 46.8±8.2 years and 30 apparently healthy normotensive individuals mean age 38.8 ±13.2years using the enzyme linked immunosorbent assay (ELISA) technique. RESULTS: The hypertensive subjects had significantly higher body mass index (BMI) (p-value < 0.05) than the normotensive subjects (BMI=28.34 ±4.40kg/m2 Vs. 25.79±2.91kg/m2). The hypertensive subjects also had significantly higher C- reactive protein values (0.18 ± 0.1mg/dL Vs 0.08±0.04 mg/dL) (p-value < 0.0001). Among the hypertensive subjects, there was no significant difference in the level of C-reactive protein between the males and the females (0.17±0.10 mg/dL Vs 0.20±0.09 mg/dL). In the hypertensive patients, CRP positively correlated with atherogenic index (r = 0.551, p < 0.05) and coronary heart disease (CHD) risk (r= 0.589, p < 0.05). However, in normotensive patients, CRP was positively correlated with atherogenic index (r = 0.492, p < 0.01) but negatively correlated with CHD risk (r = -0.475, p < 0.01). CONCLUSION: These results show that the plasma concentrations of HsCRP in hypertensive subjects were significantly higher than those of the normotensive subjects and HsCRP positively correlated with atherogenic index and CHD risk in hypertensive Nigerians.

Plasma vitamin C levels and risk of preterm prelabour rupture of membranes.

PURPOSE: Preterm prelabour rupture of membranes (PPROM) is a leading cause of preterm births. Its attendant contribution to maternal and perinatal morbidity and mortality makes it imperative to identify factors that may help prevent this condition. This study examined the association between plasma vitamin C concentration and the risk of (PPROM) amongst pregnant women in a tertiary hospital setting. METHODS: This was a prospective cross sectional study conducted at the Obstetric and Gynaecology Department of University of Benin Teaching Hospital (UBTH), Benin City. The study was in two phases, first a pilot study to determine baseline plasma vitamin C concentration amongst pregnant women in UBTH was conducted. In the main study 80 pregnant women were recruited into two groups of those with PPROM (40 cases) and those without PPROM (40 controls) matched for gestational age. Plasma vitamin C concentration was determined for all study participants and their sociodemographic characters were used to generate a database for analysis. RESULTS: In the pilot study, plasma vitamin C concentration decreased with increasing gestational age of pregnancy. In the main study plasma vitamin C concentration was significantly lower in women with PPROM than controls without PPROM, 0.53 ± 0.05 vs. 0.58 ± 0.05 mg/dl; P = 0.0001. Both groups (case and control) were comparably matched in age, parity and social class. There was a significant association between low vitamin C levels and the occurrence of PPROM (95% CI 1.53-11.88; P = 0.008). CONCLUSION: Plasma vitamin C was found to be lower in women with PPROM. Low plasma vitamin C concentration may thus be an associated risk factor for PPROM. Hence improved dietary or drug supplements may be a useful adjunctive strategy to reducing the incidence of PPROM and its attendant adverse sequelae. While this intervention is advocated, further multicentre investigation of the effects of vitamin C on risk of preterm PROM is suggested.

The assessment of plasma ascorbic acid, alpha tocopherol and albumin creatinine ratio in patients with chronic renal failure.

BACKGROUND: Albumin: creatinine ratio is used to assess chronic renal damage while the status of Antioxidant vitamins could be compromised in chronic renal failure patients. OBJECTIVE: To assess the levels of Antioxidant vitamins and Albumin creatinine ratio, in patients with chronic renal failure. (CRF) METHODS. Thirty patients (15 males, 15 females), aged 17-80 years old diagnosed as having chronic renal failure but clinically stable were recruited from the University of Benin Teaching Hospital. The control subjects were apparently healthy individuals. Blood and urine samples were collected for antioxidant Vitamin C and E, albumin and creatinine assays respectively. RESULTS: Plasma vitamin E level significantly decreased ( p < 0.05) while Plasma vitamin C showed no significant difference (p > 0.05), in chronic renal failure patients when compared to the control subjects. Albumin creatinine ratio was significantly increased ( p < 0.05) compared to the control groups CONCLUSION: There are reduced levels of plasma antioxidant vitamins C and E in patients with chronic renal failure. These findings suggest that supplementation with antioxidant vitamins C and E could be beneficial to slow down the process of progressive renal damage in CRF. However we advice that more interventional studies be carried out on a larger scale to truly establish the beneficial effects of antioxidant supplementation in CRF patients.

Plasma lipid peroxidation and totalantioxidant status among dyslipidaemic and hypertensive Nigerians with high risk of coronary heart disease.

BACKGROUND: The oxidative modification hypothesis of atherosclerosis predicts that low density lipoprotein-cholesterol (LDL-C) oxidation is an early event in atherosclerosis and that oxidized LDL-C contributes to atherogenesis OBJECTIVE: To determine a link, if any, between the plasma lipid peroxidation and total antioxidant status (TAS) among dyslipidemic and hypertensive Nigerian patients with high risk of coronary heart disease. METHODS: The study groups comprised 58 hypertensive adult Nigerians whose fasting plasma total cholesterol (TC) levels were > 5.5 mmol/L and with high risk coronary heart disease (CHD) lipid fraction i.e. 'the ratio of high density lipoprotein cholesterol to total cholesterol' (HDL-C/TC) < 0.13 were selected for the study. The control groups comprised 58 non hypertensive adult Nigerians with (HDL-C/TC) > 0.30. RESULTS: The mean +/- SD TAS level (1.02 +/- 0.15 mmol/L trolox) for males and (0.99 +/- 0.17 mmol/L) for females were significantly reduced (p < 0.05) compared to the controls; however (MDA) level (5.15 +/- 0.82 mmol/ml) for males and (5.06 +/- 0.73 mmol/ml) for females were significantly increased (p < 0.01) compared to the controls. The mean +/- SD plasma TC and LDL-C malonyl level (5.87 +/- 0.23 mmol/L and 4.65 +/- 0.34 mmol/L) were significantly increased (p < 0.01) in males hypertensive compared to the control. An inverse correlation between the TAS/TC(r = -0.53, p < 0.001) and TAS/LDL-C (r = -0.50, p < 0.001), however a direct correlation between the MDA/TC(r = 0.51, p < 0.001) and MDA/LDL-C (r = 0.48, p < 0.01) for males hypertensive were found. In female subjects the mean +/- SD plasma TC (5.95 +/- 0.13 mmol/L) and LDL-C (4.45 +/- 1.04 mmol/L) were significantly increased (p < 0.05) and (p < 0.01) respectively compared to the controls. Also in hypertensive females inverse correlation between the TAS/TC (r = -0.59, p < 0.001) and TAS/LDL-C (r = -.41, p < 0.01), and a direct correlation between the MDA/TC ( r= .48, p < 0.01) and MDA/LDL-C (r = 0.31, p < 0.05) were found. CONCLUSION: Since dyslipidaemia, hypertension and lipid peroxidation were directly relate to the severity of atherosclerosis, elimination of free radicals in the plasma before the peripheral tissues can take them up might reduce atherosclerosis. In view of our present findings, a management strategy aimed at simultaneously reducing lipid peroxidation and increasing total antioxidant status in dyslipidemic patients may be of benefit.

Serum concentration of acute phase protein and lipid profile in HIV-1 seropositive patients and its relationship to the progression of the disease.

AIMS AND OBJECTIVES: To evaluate the effect of HIV-1 infection and its progression on lipid profiles, acute-phase proteins and to determine which of the parameters may serve as an early indicator of the progression of HIV infection. MATERIALS AND METHODS: A cross-sectional study was conducted on sixty-two HIV-1 infected subjects attending HIV clinic, the patients consisted of 29 males and 33 females aged between 20-60 years (mean age 31+/- 7 years) who were screened for HIV-1 by ELISA test. Absolute CD4+ T lymphocyte was counted and HIV infected individuals were classified according to the Centre for Disease Control and Prevention (CDC) Criteria; CD4+ counts e"500/mm3 (asymptomatic), CD4+ counts 200-499/mm3 (symptomatic) and CD4+ counts d"199/mm3 (symptomatic) with full blown AIDS. Serum concentrations of total protein, albumin, gamma globulin, acute-phase protein, and lipid profile were determined. RESULTS: There was significantly increased gamma globulin fraction of the serum protein in HIV patients with CD4+ counts of e"500/mm3, 200-499/mm3 and d"199/mm3 when compared with the controls. Serum triglyceride was significantly increased in HIV patients with CD4+ counts of d"199/mm3 only, whereas a significantly decreased serum HDL-cholesterol in HIV patients with CD4+ counts of 200-499/mm3 and d"199/mm3 was found when compared with the controls. Haptoglobin, C-reactive protein and a1-acid glycoprotein were significantly increased in HIV patients with CD4+ counts of 200-499/mm3 and d"199/mm3 when compared with the controls. However, albumin was significantly reduced in HIV patients with CD4+ counts of d"199/mm3 when compared with the controls. There was direct correlation between HDL-cholesterol and the CD4+ counts, on the other hand, an inverse correlation between C-reactive protein, haptoglobin and a1-acid glycoprotein against CD4+ counts was found. CONCLUSION: A decreased HDL-cholesterol had direct correlation with the CD4+ counts in all the stages of HIV infection; however, increased haptoglobin and C-reactive protein had inverse correlation with the CD4+ counts in all the stages of HIV infection. Therefore HDL-cholesterol, C-reactive protein and haptoglobin may serve as indicators of disease progression in HIV infection.

Prevalence of Poor Glycaemic Control in Diabetics seen in a Tertiary Medical Centre.

OBJECTIVE: The objective of the study was to determine the prevalence of poor glycaemic control in otherwise clinically stable diabetic patients seen in a tertiary hospital. STUDY DESIGN: It was a cross-sectional study of 64 type 2 diabetic patients and 32 healthy controls. Patients were randomly selected from registered diabetic patients of the hospital who came to the pathology phlebotomy room for routine fasting plasma glucose investigation; (prior to their regular diabetic clinic attendance). The controls were selected from amongst hospital workers and clients of the hospital on routine medical investigations. The fasting plasma glucose and glycated haemoglobin were estimated, so also was urinalysis. The mean, standard deviation and standard error of mean (SEM) were calculated, so also were the frequency and percentages. Student ' t ' test method was applied as test of statistical significance. RESULTS: 53.2% of the patients had good glycaemic control, 31.2% fair and 15.6% poor glycaemic control. 46.9% glycosuria, 34.4% proteinuria and 9.4% ketonuria. 31.8% had no formal education and 46.9% had no knowledge of the type of drugs they were taking for the disease. CONCLUSION: The prevalence of poor glycaemic control is high in type 2 DM patients seen in our hospital. More regular monitoring of FPG and glycated haemoglobin is recommended.

Extracellular calcium and magnesium in preeclampsia and eclampsia.

The cause of preeclampsia remains unknown and calcium and magnesium supplement are being suggested as means of prevention. The objective of this study was to assess magnesium and calcium in the plasma and cerebrospinal fluid of Nigerian women with preeclampsia and eclampsia. Setting was University of Benin Teaching Hospital, in Nigeria. It was a cross-sectional study comprising of eleven patients and twenty-three controls. The mean, standard deviation and Standard Error of Mean (SEM) were calculated. Student 't' test method was applied. Plasma calcium was significantly lower in patients than controls (9.2 +/- 1.02 Vs 9.98 +/- 0.87mg/dl, P 0.043) "t" test. The CSF calcium and magnesium levels were lower in patients than controls, (5.66 +/- 1.22 vs 6.67 +/- 1.15 mg/ dl, P 0.043 and 1.75 +/- 0.56 vs 1.91 +/- 0.19 mg/dl, P 0. < 0.0001) respectively. There is extracellular calcium and magnesium reduction in patients with preeclampsia and eclampsia. This reduction may have a cause and effect relationship with these disorders.

Body mass index in type 2 diabetes mellitus complications: hypertensive diabetics and diabetic nephropathy.

BACKGROUND: It is widely reported that obesity is one of the major risk factors for developing type 2 Diabetes Mellitus, and also carries with it a higher risk of diabetic complications. OBJECTIVE: Body Mass Index was examined in type 2 diabetes mellitus complications and the prevalence of overweight and obesity were determined. PATIENTS AND METHODS: fifty-two type 2 diabetic patients were studied. 13 patients with diabetic nephropathy, 16 were hypertensive diabetics while 23 were normotensive diabetics. The weight, height and blood pressure of the patients were measured and the BMI were calculated. RESULTS: The mean BMI was highest in the diabetic nephropathy patients (27.9+/-1.0) and lowest in the hypertensive diabetics (25.5+/-5.2) P=0.0001. The prevalence of overweight and obesity were 31 and 46 respectively in diabetic nephropathy compared with 19 and 12.5 respectively in diabetics with hypertension. CONCLUSION: Overweight and obesity are more common in diabetics with nephropathy compared with normotensive and hypertensive diabetic patients.

Pathology services delivery: policy analysis using a Nigerian tertiary institution as a prototype.

BACKGROUND: Laboratory services delivery face criticisms on daily basis by the patients (the beneficiary), the clinicians (the user), and the hospital management (the policy maker). The service provider (the laboratory) is faced with the task of trying to explain her problems. OBJECTIVE OF THE STUDY: Was to critically do a policy analysis of the problems of laboratory service delivery, with the aim of identifying the causes of these problems and making recommendations to the policy makers. SETTING: The University of Benin Teaching Hospital, a foremost tertiary institution in Nigeria. METHOD: George Kent's normative policy analysis model was used to analyse the laboratory guidelines and procedures of sample collection, transportation, analysis and eventual generation of laboratory results. All the steps in the guidelines are analysed using the fifteen steps in Kent's normative model of policy analysis. RESULTS: The policy analysis shows that problems of laboratory services delivery are triangular with the patient at the center of the triangle. The most important finding of this analysis is that there is no formal laboratory service policy to guide all the actors i.e. the hospital management, laboratory staff and the clinicians. Problems arising from the laboratory are solved through the use of circular letters, likened to administrative incremental model of decision-making. CONCLUSION: There is a need to have a formal policy. A formal policy on laboratory service delivery will guide the provider, the user and the policy makers in solving the problems that originate from the laboratory service on a permanent basis. It will also establish a regular method of evaluating the services that are provided by the laboratory.