Appraisal of timing for oral glucose tolerance testing in relation to risk factors for gestational diabetes mellitus in pregnant women in a Nigerian Teaching Hospital.

OBJECTIVE: We investigated the pattern of common risk factors present in women undergoing oral glucose tolerance test (OGTT) in our center and to determine their relationship with time of presentation for the test. MATERIALS AND METHODS: The records of women referred to the metabolic clinic for OGTT over a 1-year period were reviewed. Data available for retrieval included age, gravidity and gestational age, weight, and risk factors for gestational diabetes mellitus (GDM). RESULTS: Two hundred and fifty-three (253) pregnant women form the subject of this study. Thirty-five (13.8%) of the study population had GDM by WHO criteria. Approximately, 10% of the women were tested before 24 weeks and 87.6% of the women had at least one of the common risk factors as indication for testing. The most frequent indications were a history of previous macrosomic baby 77 (30.4%) and maternal obesity 61 (24.1%). Among the indications for OGTT, only a history of previous intrauterine fetal death was significantly associated with testing before 24 weeks of gestation. CONCLUSION: Early screening for GDM is not common in our environment. The presence of risk factors for GDM did not prompt early screening. Public enlightenment on the risk factors for GDM and the need for early screening should be vigorously pursued particularly for women at risk for GDM.

Serum cholinesterase activity in the diagnosis of nonalcoholic fatty liver disease in type 2 diabetic patients.

The aim of the study was to compare the serum cholinesterase activities of a group of type 2 diabetic patients showing clinical evidence of nonalcoholic fatty liver disease to those of age and sex-matched type 2 diabetics who showed no evidence of liver disease, and healthy control subjects to determine, if serum cholinesterase can be used to diagnose nonalcoholic fatty liver disease in type 2 diabetic patients. Mean serum cholinesterase activity in diabetics with nonalcoholic fatty liver disease was found to be statistically significantly lower than in diabetics without liver disease and in healthy subjects. There was no statistically significant difference between the mean values of serum cholinesterase activities of non-liver disease diabetics and healthy control subjects. It was found that serum cholinesterase activity of 1640IU/L or less differentiated type 2 diabetic subjects with nonalcoholic fatty liver disease from diabetic subjects who were free of liver disease with a diagnostic sensitivity of 87.5% and specificity of 75%. It is suggested that routine monitoring of serum cholinesterase activities from the time of diagnosis of type 2 diabetes mellitus may reveal the earliest time for the change in serum cholinesterase activities in diabetics that signals the onset of nonalcoholic fatty liver disease.

Thyroid hormone: a "prime suspect" in human immunodeficiency virus (HIV/AIDS) patients?

Acquired Immunodeficiency Syndrome (AIDS) is the final and most serious stage of the disease caused by human immunodeficiency virus. The Immune system is the target of AIDS. We investigate presently any possible involvement of thyroid hormone, the deficiency of which gives rise to oedema and susceptibility to nonspecific infections; with a view to finding the primary factor seeding the disease. It has been reported that circumcision reduced the incidence of HIV/AIDS infection. Beyond circumcision however there might be some constitutional factor that comprises HIV infection to clinical AIDS. It is against this background that our research team turned to possible dyshormonopoisis and to thyroid hormone as a prime suspect among other possible factors that cause clinical AIDS. Moreover the hormone has been reported to be crucial for optimum immune function. A population of 200 seropositive AIDS patients were investigated against a control of 50 subjects made up of 25 healthy circumcised males and 25 healthy females; all of who were seronegative for the disease. The parameters investigated include thyrotropin (TSH), Thyroxine (T4), Total protein (TP), Albumin (Alb), Globulin (Glob), Immune complex (IC3) and Bence Jones proteins (BJP) levels in serum or urine. All seropositive clinically HIV/AIDS patients were hypothyroid. Seronegatives had significantly higher T4, TP, and Alb levels at P < 0.001 and P < 0.05 for Glob than seropositives. Seropositive females exhibited significant (P < 0.001) higher levels of IC3 than seronegative males. The globulin levels of all HIV patients were significantly (P < 0.05) higher than control. BJP was also isolated in the urine of patients. The findings suggest that thyroid hormone deficiency is a primary culprit for the other inert or dormant factors to be activated.

Resetting the detection level of cord blood thyroid stimulating hormone (TSH) for the diagnosis of congenital hypothyroidism.

An appraisal of a 17-year primary thyroid stimulating hormone (TSH) screening programme for the detection of congenital hypothyroidism was carried out to establish the reference interval of cord blood TSH in unaffected infants; the mean cord blood TSH concentration of affected infants and the incidence of congenital hypothyroidism in the Najran province of Saudi Arabia. Our findings show a reference interval of cord blood TSH of 2.0-16.8 mU/l in unaffected infants; a mean cord blood TSH concentration of 399 mU/l in affected infants; a false positive rate for the diagnosis of at-risk infants of 1.02% and a congenital hypothyroidism incidence rate of 34/100 000 (1 : 2931) live births. These findings suggest that there is a need to reset the cord blood TSH concentration for the detection of at-risk infants. We suggest that the detection level of cord blood TSH for the recognition of at-risk infants can be set at 90 mU/l rather than the recommended level of 30 mU/l. This should reduce the false positive rate for detection of infants at risk of congenital hypothyroidism.

Serum cholinesterase activity helps to distinguish between liver disease and non-liver disease aberration in liver function tests.

The diagnostic usefulness of a single determination of serum cholinesterase activity to distinguish between overt liver disease and non-liver disease clinical problems in which a few of the traditional liver function tests are abnormal was assessed. Using three groups of subjects comprising liver disease, non-liver disease, and healthy controls, we have shown that serum cholinesterase activity helped to distinguish between liver disease and non-liver disease in subjects who had abnormality of a few liver function tests. Serum cholinesterase activity helped also to distinguish between the liver disease subjects and healthy controls. There was no statistically significant difference between the mean serum cholinesterase activities of non-liver disease subjects and healthy controls. We suggest that determination of serum cholinesterase activity is a cost-effective diagnostic means of differentiating between overt liver disease and non-liver diseases where there may be aberration of some liver function tests.

Preliminary clinical investigation of the contraceptive efficacy and chemical pathological effects of RICOM-1013-J of Ricinus communis var minor on women volunteers.

The seeds of Ricinus communis Linn, RICOM-1013-J, administered as a single oral dose of 2.3-2.5 g once per 12 months protected against pregnancy in 50 women volunteers for a period of one year. The antifertility and contraceptive efficacy of the seed was demonstrated in this study. Clinical observation revealed very minimal side effects. Some of the side effects investigated included headache, nausea, vomiting, weight gain, loss of appetite, raised blood pressure and dysmenorrhoea. Furthermore, both the renal and liver functions were not affected as revealed by urea, electrolyte and creatinine values as well as total bilirubin, conjugated bilirubin, serum albumin, total protein and transaminases values when compared with control values. In addition cholesterol and phospholipids were not significantly altered. When all these results are considered together, it seems unlikely that the antifertility and contraceptive efficacy of RICOM-1013-J is due to hormonal mechanisms alone since side effects, renal and liver function, and cholesterol effects attributable to oestrogen and/or progesterone were minimal in the volunteers.

Does serum albumin/phospholipid index better reflect overall protein status in man?

Serum albumin concentration is a commonly used, but inadequate index of protein status in man. A study of serum lipid changes in malnourished children reported a progressive increase in serum phospholipid concentration with deterioration of protein status in the children. This led us to assess the usefulness of serum albumin/phospholipid index (API) in groups of healthy young adults, malnourished children, and their age-and-sex-matched well-nourished controls. We found that API discriminated between malnourished and well-nourished children. There was no difference between the index for well-nourished children and adults in spite of differences in body sizes. However, since serum albumin showed a similar discrimination between malnourished and well-nourished children, API may possibly not be superior to serum albumin in the assessment of protein status in man.

Influence of the thyroid state on the intrinsic contractile properties of the bladder muscle.

The role of thyroid hormones on the contractile responses of the isolated rat urinary bladder strips to acetilcholine and potassium chloride (in depolarising Tyrode solution) was examined. Chronic administration of thyroxine (6-8 micrograms/100 g body wt/day) for 15 days caused stimulation of acetylcholine and potassium chloride-induced contractile responses of the rat urinary bladder strip. Thyroidectomy caused inhibition of acetylcholine and potassium chloride-induced contractile responses of the rat urinary bladder strip. These findings suggest that the thyroid state affects the intrinsic contractile state of bladder muscle.

Effects of Norplant contraceptive subdermal implants on serum lipids and lipoproteins.

A longitudinal, short-term study of women using NORPLANT (levonorgestrel implants) was conducted. Cholesterol content of the major lipoproteins along with total cholesterol and triglycerides were measured in fasting blood samples from 32 women volunteers. Results for lipids and lipoproteins determined 6 and 12 months post-NORPLANT insertion were compared with values obtained for samples taken just before implantation. Total serum triglycerides was significantly reduced (p < 0.01) from 1.14 +/- 0.44mmol/l (mean +/- SD) to 0.89 +/- 0.25mmol/l at six and to 0.89 +/- 0.34mmol/l at twelve months post-insertion. Serum total cholesterol was 3.97 +/- 0.53mmol/l at the time of insertion while at six and twelve months post-insertion, they were 3.65 +/- 0.49mmol/l and 3.56 +/- 0.71mmol/l, respectively. These changes in values from the time of insertion to twelve months, were statistically significant (P < 0.02). As regards lipoprotein fractions, high density lipoprotein-cholesterol (HDL-chol) exhibited statistically significant reduction (P < 0.001) from 1.38 +/- 0.34 mmol/l to 0.71 +/- 0.30 mmol/l (mean +/- SD) six months post-insertion. Although the value had improved to 1.14 +/- 0.38mmol/l by twelve months, the value was still significantly different from the pre-insertion value. The low density lipoprotein-cholesterol (LDL-chol) had a mean value (+/- SD) of 2.08 +/- 0.45 mmol/l at the time of insertion. This was significantly elevated (P < 0.001) at six months to 2.54 +/- 0.48mmol/l (mean +/- SD). The twelve-month post-insertion value of LDL-chol (2.02 +/- 0.79) was similar to the pre-insertion value. The shift in HDL-cholesterol and LDL-cholesterol within six months followed by a virtual return to the pre-insertion values may represent only a transient change in metabolism of lipids and lipoproteins consequent upon NORPLANT contraception.

Thyroidectomy and thyroxine administration alter serum calcium levels in rat.

The effects of thyroidectomy and thyroxine on serum calcium concentration were studied in adult albino Wistar strain rats using the technique described by Baginski et al. (1973) as used by Lorentz [10]. Thyroidectomy decreased serum calcium concentration from 2.28 +/- 0.02 mmol/l to 1.61 +/- 0.01 mmol/l. Chronic administration of thyroxine (6-8 micrograms/100 g body wt/day) for 35 days caused an increased serum calcium concentrations from 2.28 +/- 0.02 mmol/l to 2.98 +/- 0.05 mmol/l. These findings suggest that thyroidectomy and the dose of thyroxine used affected calcium metabolism in rats.

The effect of thyroidectomy and thyroxine on the reactivity of rat diaphragm muscle to electrical stimulation in vitro.

The effect of thyroidectomy and thyroxine on the reactivity of diaphragm muscle to electrical stimulation was studied in adult albino Wistar rats. Thyroidectomy significantly affected the contractility of the diaphragm muscle. The result shows that thyroidectomy predisposes the muscle of the diaphragm to fatigue.

Increase in total serum triglyceride and phospholipid in kwashiorkor.

Fasting serum lipids in children presenting with protein-energy malnutrition were studied in comparison with those of sex- and age-matched well nourished controls. There was no difference in serum total cholesterol between malnourished and well nourished children. However, serum triglyceride and phospholipid concentrations were significantly higher in children with kwashiorkor or marasmic kwashiorkor than in well nourished controls. It appears that serum concentrations of triglycerides and phospholipids increase with increasing severity of malnutrition, and that fasting serum triglyceride and phospholipid concentrations above 3 mmol/l are jointly predictive of a poor prognosis in malnourished children.

Total phospholipid choline concentration of amniotic fluid in the assessment of foetal gestational and lung maturity. I. Establishment of a direct enzymic method.

An enzymic assay of the choline-containing phospholipids of amniotic fluid which does not require lipid solvent extraction has been developed. Lecithin and sphingomyelin are the dominant phospholipids in mature lung surfactant. The total phospholipid choline content of amniotic fluid, which represents the molar sum of lecithin and sphingomyelin, may be expected to correlate with foetal lung maturity. The merits of our new analytical method of determination of total phospholipid choline concentration in amniotic fluid are discussed.

Total phospholipid choline concentration of amniotic fluid in the assessment of foetal gestational and lung maturity. II. Correlation study.

Analysis of total phospholipid choline concentration was carried out on amniotic fluid samples obtained from 20 pregnant Nigerian women in established labour to determine the correlation of amniotic fluid phospholipid choline concentration with the gestational ages and maturity of the infants. There was a positive correlation between phospholipid choline concentration and gestational age. All infants whose gestational ages were estimated to be over 36 weeks had a total phospholipid concentration greater than 50 mumols/l. Four infants whose gestational ages were less than 36 weeks had total phospholipid choline concentration less than 30 mumols/l. None of these infants showed any evidence of Respiratory Distress Syndrome.