Clinical Significance of Elevated Levels of Cardiac Troponin T in Patients with Chronic Kidney Disease at Lagos University Teaching Hospital, Lagos.

BACKGROUND: This is an observational study of pre-dialysis patients with Chronic Kidney Disease (CKD) attending nephrology clinic at Lagos University Teaching Hospital to determine the clinical significance of elevated levels of Cardiac Troponin T (CTT) and possible associated factors. METHODS: One hundred and forty-three (143) patients with CKD and no prior history of myocardial infarction were recruited and their serum levels of CTT were determined within 3 months of sample collection and storage at -80° C. ECG findings and clinical variables were compared. The 99 percentile cut-off value was derived using healthy individuals that met the inclusion criteria. RESULTS: Mean blood CTT level was significantly higher in CKD patients compared to the general population. The 99th percentile value derived in the reference sample population was 48.02pg/ml. Statistical analysis showed significant association of CTT elevation with left ventricular hypertrophy, decreased renal function and age. CONCLUSION: CTT is generally elevated in pre-dialysis patients with CKD and a single elevated blood level of CTT above the 99th percentile may suggest asymptomatic Acute Coronary Syndrome. Serial rising levels of CTT and other clinical features will be of diagnostic significance in the diagnosis and management of asymptomatic acute coronary syndrome in patients with CKD.

CONTEXTE: Étude observationnelle de patients prédialysés atteints d'une maladie rénale chronique (MRC) fréquentant une clinique de néphrologie de l'hôpital universitaire de Lagos afin de déterminer la signification clinique des niveaux élevés de troponine cardiaque T (TTC) et des facteurs associés possibles. METHODESS: Cent quarante-trois (143) patients atteints de MRC et aucun antécédent d'infarctus du myocarde ont été recrutés et leurs taux sériques de TTC ont été déterminés dans les 3 mois suivant le prélèvement et le stockage de l'échantillon à -80 °C. Les résultats de l'ECG et les variables cliniques ont été comparés. La valeur seuil du 99e centile a été calculée à partir de personnes en bonne santé qui répondaient aux critères d'inclusion. RESULTATSS: Le taux moyen de TTC dans le sang était significativement plus élevé chez les patients atteints de MRC que dans la population générale. La valeur du 99e centile calculée dans la population de l'échantillon de référence était de 48,02pg/ml. L'analyse statistique a montré l'association significative de l'altitude de TTC avec l'hypertrophie ventriculaire gauche, la fonction rénale diminuée et l'âge. CONCLUSION: Le CTT est généralement élevé dans les patients de pré-dialyse atteints de MRC et un taux sanguin élevé simple de CTT au-dessus du 99ème centile peut suggérer ACS qui n'a pas été remarqué. Les niveaux ascendants périodiques de CTT et d'autres dispositifs cliniques seront d'importance diagnostique dans le diagnostic et la gestion de ces patients atteints de MRC mais asymptomatique pour le syndrome coronaire aigu. MOTS-CLÉS: Troponine cardiaque T, Syndrome coronarien aigu, Maladie rénale chronique, hypertrophie ventriculaire gauche.

L-arginine supplementation lowers blood pressure, protein excretion and plasma lipid profile in experimental salt-induced hypertension in pregnancy: Relevance to preeclampsia.

This study aimed to investigate the effects of L-arginine supplementation on blood pressure, protein excretion, lipid profile in salt-induced hypertensive pregnant rats. Female Sprague-Dawley rats were divided into 4 groups. Control Preg (normal rat chow). Control Preg + L-ARG (normal rat chow and daily oral L-Arginine from 16th - 20th week). Salt Preg (high salt diet, 8%). Salt Preg + L-ARG (high salt diet, 8% and daily oral L-Arginine from 16th - 20th week. Non-invasive BP was recorded using a tail-cuff machine at 1 st and 2nd trimesters. On day 19 of pregnancy, invasive BP was obtained by carotid artery cannulation connected to LabChart-7 pro software. This was followed by blood samples collection for lipid profile analysis. L-arginine significantly reduced (P < 0.05) systolic, diastolic, MAP at 1 st, 2nd trimesters, day 19 of pregnancy, LDL, plasma and urinary creatinine and protein levels in Control Preg + L-ARG and Salt Preg + L-ARG groups compared to other groups. Urinary Na + and K + were significantly higher (P < 0.05) in Salt Preg + L-ARG group compared to other groups. Total cholesterol level was significantly higher (P < 0.05) in salt groups compared to control groups. Triglyceride level and urine volume were significantly higher (P < 0.05) in Salt Preg group compared to other groups. It also significantly increased (P < 0.05) HDL in Control Preg + L-ARG and Salt Preg + L-ARG groups compared to other groups. L-arginine supplementation ameliorates some deleterious effects in salt- induced hypertensive pregnant rats possibly through its known NO vasodilatory effect and might also mediate a diuretic like action.

L-Arginine Co-Administration with Carbamazepine Improves Cognition in Male Sprague-Dawley Rats.

Cognitive impairment is a common adverse effect associated with carbamazepine use. One of the proposedmechanisms for cognitive impairment may be attributed to the pro-oxidant properties of carbamazepine. This studyinvestigated the effects of L-Arginine supplementation with carbamazepine on cognition in adult male non-epileptic rats.Adult male Sprague-Dawley rats with average weight 200g to 220g were divided into 4 groups; (1) Control group treatedwith distilled water, (2) L-Arginine group treated with L-Arginine (100mg/kg BW) in distilled water, (3) Carbamazepinegroup treated with carbamazepine (25mg/kg BW twice daily) in distilled water, and (4) Carbamazepine + L-Arginine grouptreated with Carbamazepine and L-Arginine as above for two weeks to assess the acute changes in cognition and oxidativestress markers. Following two weeks of treatment, cognition was assessed using the Y-maze, after which the rats werehumanely sacrificed with the hippocampus and frontal lobes isolated from the brain and subsequently homogenized forassessment of oxidative stress markers [(Catalase, superoxide dismutase (SOD), malondialdehyde (MDA), and reducedGlutathione (GSH)]. Arm entry and correct alternation were significantly higher (p < 0.05) in the L-Arginine and L-Arginine+ Carbamazepine groups compared to carbamazepine group. In the frontal lobe, L-Arginine significantly increased (p < 0.05)catalase and GSH levels compared to other groups while in the hippocampus, it significantly (p < 0.05) reduced MDA withno change in other parameters. Likewise, SOD and MDA levels were significantly lower (p < 0.05) in the L-Arginine +Carbamazepine group compared to other groups. Oral L-Arginine supplementation with carbamazepine improved cognitiveperformance on Y maze.

A prospective cohort study on the clinical utility of second trimester mean arterial blood pressure in the prediction of late-onset preeclampsia among Nigerian women.

BACKGROUND: Early detection of preeclampsia will help reduce the morbidities and mortalities associated with the disorder. Late-onset preeclampsia was the predominant presentation in this cohort. The search for biomarkers for predicting preeclampsia is still ongoing. Mean arterial blood pressure (MABP), which has the advantage of presenting a single cutoff value compared with the use of systolic and diastolic blood pressure measurements, merits evaluation. AIM: The study aims to evaluate the clinical utility of second trimester MABP in the prediction of preeclampsia. METHODS: This was a prospective cohort study of 155 normotensive, nonproteinuric pregnant women without prior history of gestational hypertension. The women were booked patients attending the antenatal clinic at the Lagos University Teaching Hospital and were all in their second trimesters of pregnancy. The outcome measures were systolic blood pressure, diastolic blood pressure, and MABP. The end point of the study was the development of preeclampsia. The diagnosis of preeclampsia was made by the attending obstetrician. The data were analyzed using the IBM SPSS statistical software. Statistical significance was set at P < 0.05. RESULTS: One hundred and fifty-five pregnant women participated in the study. Eleven (7.1%) of the women developed preeclampsia after 34 weeks gestation and 144 (92.9%) had normal pregnancy. The mean gestational age at the time of assessment was 18.88 ± 3.15 weeks with a range of 14 weeks to 27 completed weeks. There was a statistically significant increase in the systolic blood pressure, diastolic blood pressure, and MABP values in the group of women who later developed preeclampsia, P = 0.005, 0.001, and <0.001, respectively. At a false-positive rate of 10%, MABP value of 88.33 mmHg predicted preeclampsia with a specificity of 90% and a sensitivity of 45.5%, P <0.05. The area under the receiver-operative characteristics curve (AUC) was 0.732 (95% confidence interval, 0.544-0.919, P = 0.011). The negative predictive value (NPV) was 88.88% and the positive predictive value (PPV) was 45.45%, P < 0.05. At an MABP cutoff of 88.33 mmHg, preeclampsia was predicted with a relative risk of 4.44 and a positive likelihood ratio of 6.46, P < 0.05. CONCLUSIONS: With an AUC of 0.732, MABP performed moderately (considering that excellent performance has an AUC of 1.0) in the prediction of late-onset preeclampsia in Nigerian women. Its high NPV suggests a strong ability to rule out preeclampsia and help to appropriate management.

Early pregnancy plasminogen activator inhibitor-1 levels in Nigerian women and its relationship with preeclampsia.

AIM: This study compared early plasma levels of plasminogen activator inhibitor-1 (PAI-1) in normal pregnancy and preeclampsia and determined its relationship with disease severity. SUBJECTS AND METHODS: This was a prospective cohort study of 195 normotensive, aproteinuric pregnant women without prior history of gestational hypertension. The women were attending the Antenatal Clinic at The Lagos University Teaching Hospital and were within 24 weeks gestation at recruitment. The outcome measures were PAI-1, systolic blood pressure (SBP), diastolic blood pressure (DBP), and significant proteinuria. The endpoint of the study was the development of preeclampsia. The diagnosis of preeclampsia was made by the attending Obstetrician. The data were analyzed using the IBM SPSS statistical software. Statistical significance was set at P < 0.05. RESULTS: First trimester PAI-1 levels were significantly higher in the women who later developed preeclampsia compared to those who had a normal pregnancy (P < 0.0001). In these group of women who later developed preeclampsia, PAI-1 had an inverse relationship with gestational age (r = 0.878) whereas in normal pregnancy, PAI-1 and gestational age had a direct relationship (r = 0.017). Second trimester systolic and DBP values were also significantly higher in the women who later developed preeclampsia compared to normal pregnancy, P = 0.007 and 0.004, respectively. There was, however, no correlation between PAI-1 values and SBP, DBP and proteinuria in the women who developed preeclampsia. CONCLUSION: Plasma levels of PAI-1 are increased early in pregnancies complicated by preeclampsia, but the lack of correlation of this marker with disease severity may limit its clinical utility.

Early pregnancy plasminogen activator inhibitor-1 levels in Nigerian women and its relationship with preeclampsia

Aim: This study compared early plasma levels of plasminogen activator inhibitor-1 (PAI-1) in normal pregnancy and preeclampsia and determined its relationship with disease severity. Subjects and Methods: This was a prospective cohort study of 195 normotensive, aproteinuric pregnant women without prior history of gestational hypertension. The women were attending the Antenatal Clinic at The Lagos University Teaching Hospital and were within 24 weeks gestation at recruitment. The outcome measures were PAI-1, systolic blood pressure (SBP), diastolic blood pressure (DBP), and significant proteinuria. The endpoint of the study was the development of preeclampsia. The diagnosis of preeclampsia was made by the attending Obstetrician. The data were analyzed using the IBM SPSS statistical software. Statistical significance was set at P < 0.05. Results: First trimester PAI-1 levels were significantly higher in the women who later developed preeclampsia compared to those who had a normal pregnancy (P < 0.0001). In these group of women who later developed preeclampsia, PAI-1 had an inverse relationship with gestational age (r = 0.878) whereas in normal pregnancy, PAI-1 and gestational age had a direct relationship (r = 0.017). Second trimester systolic and DBP values were also significantly higher in the women who later developed preeclampsia compared to normal pregnancy, P = 0.007 and 0.004, respectively. There was, however, no correlation between PAI-1 values and SBP, DBP and proteinuria in the women who developed preeclampsia. Conclusion: Plasma levels of PAI-1 are increased early in pregnancies complicated by preeclampsia, but the lack of correlation of this marker with disease severity may limit its clinical utility

Association of pre-eclampsia with metabolic syndrome and increased risk of cardiovascular disease in women: A systemic review.

BACKGROUND AND OBJECTIVES: Cardiovascular disease (CVD) is the leading cause of death in women globally. Preeclampsia has been linked to increased risk of developing heart disease later in life. The best approach for the prevention of CVD after preeclampsia is yet unclear. Studies assessing CVD risk post preeclampsia have included metabolic risk factors that define the metabolic syndrome (MS). This review quantifies the association between preeclampsia and CVD in the context of metabolic risk factors that define the MS. MATERIALS AND METHODS: PubMed database was searched for relevant articles from 1999 to March 2015. The search phrase was "preeclampsia and MS." After two levels of screening by title and abstract, case-control, cohort, and cross-sectional studies that included at least 50 subjects were selected. RESULTS: Twenty-four articles that reported the prevalence or odds for MS and its components following a history of preeclampsia and the prevalence of preeclampsia in women with prepregnancy MS were selected. A total of 9 case-control, 11 cohort, and four cross-sectional studies were included. The prevalence of MS ranged from 10.9% to 27.3% after a preeclamptic pregnancy. About 88% of the case-control studies showed a statistically significant difference in prevalence of MS post preeclampsia whereas 75% of the cohort studies reported prevalence values >10% for the prevalence of MS post preeclampsia. The odds for developing MS post preeclampsia ranged from 1.23 to 3.60 and 83% of the studies reported an odds ratio >2. The prevalence of developing preeclampsia in women with prepregnancy MS ranged from 26.7% to 45% compared to 4.7% to 17% among controls. CONCLUSION: The prevalence and odds for developing MS after a preeclamptic pregnancy are high suggesting that MS may be involved in the pathogenesis of CVD following preeclampsia. This will provide evidence on the potential health benefits of a modifiable CVD risk screening program for women with a history of preeclampsia.

Calcium and Magnesium Metabolism in Pre-Eclampsia.

BACKGROUND: Preeclampsia is a multisystem disorder associated with high maternal and perinatal mortality and morbidity. The cause of the disorder is largely unknown and its pathogenesis is complex and poorly understood. Calcium and magnesium are divalent ions which may have roles to play in the manifestations of the disease. An understanding of their metabolism in preeclampsia may aid our management of pregnant women who develop the disease. OBJECTIVE: To determine the plasma and urinary concentrations of calcium, magnesium and parathyroid hormone in women with mild, severe preeclampsia and in normal pregnancy. METHODS: This is was a case control study of fifty women with mild preeclampsia, fifty women with severe preeclampsia and fifty women with normal pregnancy as controls, drawn from The Antenatal Clinic at the Lagos University Teaching Hospital, Lagos, Nigeria. The women were consecutively recruited after signing an informed consent form. Ethical approval was obtained from the medical ethics committee of the hospital. RESULTS: The three groups of women were similar in their socio demographic characteristics. Plasma calcium was low in mild and severe preeclampsia compared to normal pregnancy controls (p=0.021). Urine calcium/creatinine ratio was lower in mild and severe preeclampsia compared to normal pregnancy controls (p= 0.030). Fractional excretion of calcium and levels of parathyroid hormone were similar across all three subgroups of women. Plasma magnesium was higher in mild and severe preeclampsia compared to normal pregnancy controls (p=0.011) and showed a positive correlation with plasma creatinine (r=0.48, p=0.045). Parathyroid hormone levels were similar across the study groups. CONCLUSION: Preeclampsia is associated with significant changes in calcium and magnesium metabolism. This study noted significant hypocalcaemia in mild and severe preeclampsia with significantly low urine calcium/creatinine levels. Calcium supplementation may have a place in patient's management. Hypermagnesemia was observed in mild and severe preeclampsia and appeared related to renal function.

The prevalence of metabolic syndrome in persons with type 2 diabetes at the Lagos University Tteaching Hospital, Lagos, Nigeria.

BACKGROUND: Over the past decade, Lagos state has witnessed greater industrialization and increased economic prosperity. Lifestyle has become increasingly westernized, characterised by intake of excesscalories and physical inactivity. It is possible that these changes would lead to increases in the prevalence of metabolic syndrome and type 2 diabetes which are known cardiovascular risk factors. It became important therefore to study the prevalence of metabolic syndrome in type 2 diabetes in Lagos, Nigeria as at the present time and compare it with previous prevalence rates as well as rates from other centres as a way of assessing current cardiovascular risk burden in this population. OBJECTIVES: This study is to determine the prevalence of metabolic syndrome in type 2 diabetes and to correlate the presence of microalbuminuria with glycaemic control. METHODS: One hundred subjects with type 2 diabetes were selected by simple random sampling from patients attending The Diabetic Clinic at the Lagos University Teaching Hospital, Lagos, Nigeria.Age and sex matched controls were recruited from members of staff of the hospital.Clinical data was obtained by interviewing the participants. Anthropometric measurements were made and blood and urine specimens were collected for analysis. The World Health Organisation (WHO) criteria which is specified for the diagnosis of metabolic syndrome in the setting of type 2 diabetes was used to determine the prevalence of metabolic syndrome in this population. RESULTS: Central obesity had the highest prevalence (79%) among persons with diabetes,followed by hypertension (69%), low HDL (50%), general obesity (40%), microalbuminuria (24%) and hypertriglyceridemia (10%). The prevalence of metabolic syndrome was 86%in this group. The commonest occurring metabolic syndrome component among patients with type 2 diabetes and metabolic syndrome was obesity (91.9%). There was a moderate positive correlation(r=0.52; p=0.01) between HbA1c values and microalbuminuria in persons with diabetes and the metabolic syndrome. CONCLUSION: The prevalence of metabolic syndrome is very high among patients with type 2 diabetes in The Lagos University Teaching Hospital, Lagos, Nigeria.

The agreement of point-of-care and standard laboratory electrolyte and glucose analysis in critically ill patients in a sub-Saharan tertiary teaching hospital.

BACKGROUND: The critically ill patient undergoes rapid changes in the internal milieu requiring quick intervention. Point of care testing has been shown to be valuable in the early diagnosis and management of such patients. OBJECTIVE: This study determined the agreement between I-STAT Abbot point of care testing with standard laboratory testing in the analysis of electrolytes and glucose concentrations in critically ill patients. METHODS: The study was performed in a Sub-Saharan Tertiary Teaching Hospital in critically ill patients. Electrolyte and glucose analysis were measured with I-STAT Abbot Analyzer unit with parallel blood specimens (n = 30) tested in the laboratory on an ion-selective electrode, SFRI analyzer ISE 6000. RESULTS: There was no significant difference in mean sodium, potassium, chloride and glucose between I-STAT POCT and standard laboratory measurements. The agreement between POCT and laboratory glucose was good p(c) = 0.967, mean difference of 0.79 and 95% limit of agreement from -3.83 to +5.107 mmol/L, p = 0.733. Bicarbonate was moderate (p) = 0.637, mean difference of 1.95 and 95% limit of agreement from -4.294 to +0.394 mmol/L, p = 0.101. There was moderate agreement for sodium (p(c)) = 0.32, mean difference of 5.8 and 95% limit of agreement from -0.378 to +11.98 mmol/L, p = 0.064. Agreement for potassium was moderate (p(c)) = 0.439, mean difference of 0.15 and limit of agreement from -0.401 to +0.701 mmol/L, p = 0.588. There was, however, a significant difference in mean chloride, and BUN values; chloride (p(c)) = 0.0796, mean difference of 13.8 and 95% limit of agreement from -7.55 to + 20.015 mmol/L. Blood urea nitrogen (p(c)) = 0.064, mean difference of 18.55 and 95% limit of agreement from -30.126 to +6.974 mmol/L. CONCLUSION: The mean sodium, potassium, glucose and bicarbonate were comparable with moderate to good agreement between I-STAT POCT and ISE 6000 Analyzer. Though, the mean BUN and chloride levels between the analytical methods differ significantly.

The relationship between microalbuminuria, cardiovascular risk factors and disease management in type 2 diabetes.

BACKGROUND: In patients with type 2 diabetes, microalbuminuria is an early clinical sign suggestive of vascular damage to the glomerulus. Microalbuminuria has also been currently reported as an important risk factor for cardiovascular disease and becomes relevant in the management of type 2 diabetes. OBJECTIVES: This study is to determine the prevalence of microalbuminuria, identify the risk factors associated with microalbuminuria in type 2 diabetes, and to asses the achievement of treatment goals for cardiovascular risk reduction in type 2 diabetics. SUBJECTS AND METHODS: Seventy- two subjects with microalbuminuria were recruited from three hundred consecutively screened type 2 diabetics attending the Diabetic Clinic at the Lagos University Teaching Hospital. Clinical data were obtained by interviewing the participants. Anthropometric measurements were made and blood specimens were collected for analysis. RESULTS: The prevalence of microalbuminuria was twenty-four percent (24%) in type 2 diabetes. Multiple logistic regression identified duration of diabetes (odds ratio 1.3 (95% CI; 0.03-1.58), hypertension(odds ratio 5.2 (95% Cl; 1.24-18.62), Body mass index (BMI) (odds ratio 1.27 (95% CI; 1.0-1.6), waist/hip ratio (WHR) (odds ratio 1.9 (95% Cl; 1.3-3.5), andHbA,c (odds ratio 6.6 (95% Cl; 1.02-27) as independent risk factors associated with microalbuminuria in type 2 diabetics. Optimum blood pressure, glycemic and weight control were achieved in eighty five percent (85%), fifty eight percent (58%) and nineteen percent (19%) of the type 2 diabetes respectively. CONCLUSION: This study showed that microalbuminuria is common among patients with type 2 diabetes. It also showed improvement in glycemic control and modifiable cardiovascular risk factor control when compared with previous studies.

Effects of streptozotocin, fructose and sucrose-induced insulin resistance on plasma and urinary electrolytes in male Sprague-Dawley rats.

BACKGROUND: Several groups in recent times have related the pathogenesis of renal haemodynamic changes in diabetes and most of the experimental diabetic conditions studied so far were carried out using streptozotocin injection only. OBJECTIVE: The aim of the present study was to examine the effects of streptozotocin, fructose and sucrose induced insulin resistance on plasma and urinary electrolytes. Closely related to this aim, was the view to suggest which profoundly potentiate insulin resistance more between fructose and sucrose. METHODS: Thirty-six male Sprague-Dawley rats were randomly divided into 6 groups Group 1 > control group. Group 2 > served as streptozotocin group, rendered diabetic by a single dose IP injection of Streptozotocin 45 mg/kg in 0.1 M freshly dissolved in Na+ citrate buffer pH 4.5. Hyperglycaemia confirmed after 48 hours. Groups 3 and 4 > served as 25% fructose and 50% fructose groups respectively; fed on a diet containing 25% and 50% fructose (W/W) for 12 weeks. Groups 5 and 6 > served as 25% sucrose and 50% sucrose groups respectively; fed on a diet containing 25% and 50% sucrose (W/W) for 12 weeks. Hyperglycaemia confirmed at the 12th week. RESULTS: Plasma and urinary sodium and potassium were significantly higher (P < 0.05) in the 25% and 50% sucrose groups compared to the other groups. Plasma and urinary chloride was significantly higher (P < 0.05) in the 25% and 50% fructose groups compared to the other groups. Plasma creatinine and urea was significantly higher (P < 0.05) in the streptozotocin, 25% and 50% Sucrose groups compared to all the other groups. Urinary creatinine and urea was significantly higher (P < 0.05) in the streptozotocin, and 25% Fructose groups compared to all the other groups. CONCLUSION: The elevated levels of plasma and urinary electrolytes are presumptive markers of diabetes associated lesions in the kidneys of rats. Fructose potentiated insulin resistance effect more than sucrose though sucrose might have more effect on renal sodium handling.