Musculoskeletal pain, disability and health-seeking behavior in adult Kuwaitis using a validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire.

OBJECTIVE: The WHO-ILAR Community Oriented Program for Control of Rheumatic Diseases (COPCORD) primarily aims to estimate the burden of musculoskeletal symptoms/disorders. We investigated data on musculoskeletal pain, disability and health-seeking behavior in the first community-based COPCORD study in Kuwait. METHODS: The validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire was used in 2,500 randomly selected Kuwaiti households. The target population comprised Kuwaiti nationals aged 15 years and older. Twenty-four trained field workers completed the survey in 8 weeks. Those subjects reporting musculoskeletal pain were identified (Phase 1), and were asked to complete a self-evaluation questionnaire (Phase 2) prior to rheumatological examination (Phase 3). Phase 2 included questions on the site and severity of pain, traumatic events, functional disability, and treatment. Patients marked their pain sites on a mannequin during their interviews. "Sufferers" were defined as those with musculoskeletal pain and no history of trauma. RESULTS: A total of 7,670 adults were interviewed (response rate 88%), of whom 2,057 had musculoskeletal pain not related to trauma. Knees, back, and shoulders were the common sites of pain. Most of the sufferers reported the severity of pain as being moderate to severe. Functional disability was reported in 39.1% of the sufferers. The age-sex population adjusted prevalence rate for musculoskeletal pain was 35.7% in females and 20.2% in males. The most common sources for advice on treatment were physicians in hospitals (68.8%) and general practitioners (30.4%). 82% had prescriptions for their medications, while 19.4% had self prescribed tablets. CONCLUSION: Musculoskeletal pain is a major health problem among Kuwaitis and deserves intense government attention.

Relations of serum interleukin 18 levels to serum lipid and glucose concentrations in an apparently healthy adult population.

AIM: To investigate the associations between serum interleukin (IL) 18 concentrations and indices of lipid and carbohydrate metabolism in healthy adults. METHODS: Fasting serum concentrations of IL-18, glucose, total cholesterol, triglyceride, and high- and low-density lipoprotein cholesterols were measured in 570 apparently healthy adults. RESULTS: Univariate linear and partial regression analyses showed that the serum IL-18 concentration was positively correlated with serum triglyceride and glucose concentrations in both obese and diabetic subjects after controlling for the confounding effects of age, sex, and body mass index. CONCLUSION: IL-18 may be associated with obesity and glucose intolerance.

Obesity is an independent risk factor for plasma lipid peroxidation and depletion of erythrocyte cytoprotectic enzymes in humans.

OBJECTIVE: Obesity, defined as a body mass index (BMI) greater than 30 kg/m(2), is now recognised as a risk factor for diabetes mellitus, hyperlipidaemia, colon cancer, sudden death and other cardiovascular diseases. In this study, it is hypothesized that obesity is an independent risk factor for lipid peroxidation and decreased activities of cytoprotective enzymes in humans. SUBJECTS: Fifty normal healthy subjects with healthy BMI (19-25 kg/m(2)) and 250 subjects with different grades of obesity (30-50 kg/m(2)) with no history of smoking or biochemical evidence of diabetes mellitus, hypertension, hyperlipidaemia, renal or liver disease or cancer. MEASUREMENTS: To test this hypothesis, we assessed lipid peroxidation and cytoprotection by measuring the concentrations of plasma malondialdehyde (P-MDA) and the activities of erythrocyte copper zinc-superoxide dismutase (CuZn-SOD) and glutathione peroxidase (GPX). RESULTS: The concentration of P-MDA was significantly lower (P<0.001) in subjects with healthy BMI (2.53+/-0.04 micro mol/l) than in those with BMI above 40 kg/m(2) (4.75+0.05 micro mol/l). Furthermore, there was a significantly positive association (r=0.342, P=0.013) between BMI and P-MDA. On the other hand, subjects with healthy BMI had significantly higher (P<0.001) erythrocyte CUZn-SOD (1464+/-23 units/g Hb) and GPX (98.4+/-3.3 units/g Hb) than those with BMI above 40 kg/m(2) (1005+/-26 units/g Hb) and (84.3+/-6.7 units/g Hb) respectively. Furthermore, erythrocyte CuZn-SOD and GPX activities were negatively associated with BMI (r=-0.566, P=0.005 and r=-0.436, P=0.018) respectively. CONCLUSION: It is concluded from these results that obesity in the absence of smoking, diabetes mellitus, hyperlipidaemia, renal or liver disease causes lipid peroxidation and decreased activities of cytoprotective enzymes, and should therefore receive the same attention as obesity with complications.

Interleukins in preeclampsia.

BACKGROUND: Preeclampsia is a multisystemic disorder of unknown etiology. Recently, endothelial damage has been implicated in its cause. The objective of this study was to determine the role of interleukins in the etiology of preeclampsia. PATIENTS AND METHODS: Thirty-two primigravidas with preeclampsia but without any clinical evidence of infection and 32 age-matched primigravidas with uncomplicated normal pregnancies were investigated. Phlebotomy was performed at 32 weeks of gestation and blood collected for immunoassays of interleukin-2 (IL2), interleukin-2 receptor (IL-2R), interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-10 (IL-10), using commercially available immunoassay kits. RESULTS: Although the maternal plasma concentrations of IL-2 and IL-2R were slightly higher in normal pregnant women (76.3+/-13.7 pg/mL and 526.3+/-47.1 pg/mL, respectively) than in women with preeclampsia (57.8+/-10.8 pg/mL and 476.9+/-33.9 pg/mL, respectively), the differences were not statistically significant (P>0.05). However, maternal plasma IL-6 and IL-8 concentrations were significantly higher (P<0.05) in normal pregnancy (158.0+/-35.4 pg/mL and 5163.6+/-800 pg/mL, respectively) than in pregnancy complicated with preeclampsia (60.0+/-13.7 pg/mL and 2495.8+/-729.4 pg/mL, respectively). On the other hand, maternal plasma concentration of IL-10 was significantly higher (P<0.05) in preeclampsia (93.2+/-24.1 pg/mL) than in normal pregnancy (31.07+/-7.0 pg/mL). CONCLUSION: It is concluded that the elevated maternal plasma IL-10 concentration in preeclampsia may be a protective response to maternal immunorejection.

Spot urine concentrations of type I collagen cross-linked N-telopeptides and deoxypyridinoline in psoriatic arthritis.

The main objectives of this study were to investigate whether the spot urine concentrations of type I collagen cross-linked N-telopeptides (NTx) and deoxypyridinoline (Dpd) can be used to distinguish between active and suppressed disease in psoriatic arthritis (PsA) and to study the relationship between these markers of bone resorption and disease activity indices. Using enzyme-linked immunosorbent assays, concentrations of NTx and Dpd were estimated in spot urine samples from 25 patients with active disease, 10 patients with suppressed disease and 35 age- and sex-matched healthy control subjects. In patients with active disease, urine concentrations of NTx and Dpd were significantly elevated (p<0.001) compared with healthy controls and there were no significant differences (p>0.05) when compared with those with suppressed disease. In active disease, there was no significant positive correlation between urinary NTx and erythrocyte sedimentation rate (ESR) (r = 0.025, p>0.05) nor between Dpd and ESR (r = -0.208, p>0.05). In conclusion, NTx and Dpd concentrations in spot urine have no association with disease activity in patients with PsA.

Urine levels of type 1 collagen cross-linked N-telopeptides and deoxypyridinoline correlate with disease activity in rheumatoid arthritis.

OBJECTIVES: The aim of this study was to find out whether spot urinary concentrations of type 1 collagen cross-linked N-telopeptides (NTx) and deoxypyridinoline (Pyrilinks-D) can differentiate between active and inactive disease in rheumatoid arthritis (RA) and to investigate the extent to which they correlate with indices of disease activity. METHODS: Using enzyme-linked immunosorbent assays, the concentrations of NTx and Pyrilinks-D were estimated in spot urine samples from 25 females with active disease, 25 females with inactive disease, and in 25 controls. RESULTS: In Patients with active disease, urinary concentrations of NTx and Pyrilinks-D were significantly higher (p < 0.01) than in those with inactive disease or in healthy controls. In active disease there were significant positive correlation between urinary NTx and ESR, the swollen joint count, the tender joint count, and the patient's global assessment.

Serum B2-microglobulin concentration correlates with urinary concentrations of type 1 collagen cross-linked N-telopeptides and deoxypyridinoline in rheumatoid arthritis.

BACKGROUND: Determination of serum ss2-microglobulin concentration, an invasive procedure, has been advocated for monitoring patientsA centAA response to treatment in rheumatoid arthritis. The object of this study was to find out if serum ss2-microglobulin concentration correlated with urinary excretions of type 1 collagen crosslinked N-telopeptides (NTx) and deoxypyridinoline (Pyrilinks-D) in rheumatoid arthritis (RA). SUBJECTS AND METHODS: Using chemiluminiscent assay, serum ss2-microglobulin concentrations were estimated in 25 female patients with active RA, 25 female with inactive disease, and 25 age-matched healthy female controls. Concentrations of NTx and Pyrilinks-D were also determined by immunoabsorbent assays in spot urine samples from these subject groups. RESULTS: The serum concentration of ss2-microglobulin in patients with RA (7.45+/-2.10 mg/L) was significantly higher (P<0.001) than the concentrations in patients with inactive disease (3.33+/-0.76 mg/L), or than in normal healthy controls (2.747plusmn;0.52 mg/L). Similarly, in patients with active RA, the spot urinary concentrations of NTx (123.08+/-25.53 nmol BCE/mmol creatinine) and Pyrilinks-D (15.087plusmn;3.29 nmol/mmol creatinine) were significantly higher (P<0.01) than those in patients with inactive disease (58.42AA+/-12.65 nmol BCE/mmol creatinine and 10.10+/-2.43 nmol/mmol creatinine, respectively). In patients with active RA, serum concentration of ss2-microglobulin correlated positively with spot urinary NTx concentrations (r=0.9910, P=0.0001), and Pyrilinks-D concentration (r=0.6177, P=0.001). CONCLUSION: In patients with active RA, the spot urinary concentrations of NTx and Pyrilinks-D correlated positively with serum AA2-microglobulin. Therefore, the estimations of these urinary markers may take the place of serum ss2-microglobulin estimation in monitoring the patientA centAAs response to treatment in rheumatoid arthritis.

Traditional fertility regulation among the Yoruba of southwestern Nigeria. I. A study of prevalence, attitudes, practice and methods.

This study was conducted among Yoruba women and traditional healers with the aim of identifying and describing the practice, preparation, and administration of traditional contraceptives. The data were obtained in 1990 from a random sample of 1,400 women of childbearing age and 42 traditional healers in Nigeria's Oranmiyan area, using questionnaires and in-depth interviews. Findings revealed that knowledge of the traditional contraceptives is nearly universal among the Yoruba population, and the traditional contraceptive prevalence rate is 7.1 percent. The use of traditional contraceptives was significantly more common among uneducated women and among women aged 20 to 29 years old. Findings also revealed the existence of four main varieties of traditional contraceptive devices, the methods of preparation of the traditional contraceptives, varieties of herbal and animal products used, methods of administration, and taboos against usage. The easy accessibility of traditional medical practitioners and the belief that traditional contraceptive devices are devoid of complications, especially among those experienced with modern contraceptive devices, were the main reasons women cited for patronizing the traditional practitioners. The paper concludes with policy implications for family planning programmers in Nigeria.

Serum lipid concentrations in patients with major depressive disorder.

This study compared the serum lipid concentrations in 100 patients with major depressive disorder (MDD) with those from 100 matched healthy controls. It was found that the serum total cholesterol concentration in patients with MDD (5.27 +/- 1.18 mmol/L) was significantly lower than the value (6.63 +/- 1.32 mmol/L) in sex-, age-, and weight-matched healthy controls. This significant decrease in serum cholesterol in patients with MDD was noted in both sexes and in all age groups. Patients with MDD, however, had significantly higher HDL cholesterol than matched controls. There were no statistically significant differences in serum concentrations of triglycerides, apolipoprotein (Apo) A1, Apo B, transferrin, and albumin between patients and controls. Clinical recovery of patients with MDD was accompanied by a significant increase in serum total cholesterol from 5.27 +/- 1.18 mmol/L to 6.12 +/- 1.2 mmol/L. These results suggest an association between low serum total cholesterol and depression in both sexes and at all age groups.

Reference intervals for some serum biochemical markers of bone metabolism in Kuwait.

Using the Hitachi 717 Selective Multichannel analyser, we established reference intervals for serum albumin (37-9 g/l); measured serum calcium (2.14-2.54 mmol/l); corrected serum calcium (2.25-2.60 mmol/l); serum phosphate (0.74-1.60 mmol/l); and alkaline phosphatase (47.0-289.6 U/l) in the Kuwaiti population. The mean concentrations of calcium and phosphate decreased with increasing age in both sexes except for a sudden increase in women at about menopause. Although there was a skewed distribution of alkaline phosphatase in both sexes there was a significant increase in enzyme activity in women after the age of 50 years. Using corrected serum calcium we found that 15% of women in the reproductive age group in Kuwait had hypocalcaemia.

Purification and catalytic properties of liver alcohol dehydrogenase isoenzymes in patients with hepatoma in Nigeria.

Alcohol dehydrogenase isoenzymes were isolated from the liver of patients with hepatoma and healthy control individuals. Whereas only a single form of the enzyme was obtained in healthy control liver, two distinct forms of the enzyme were found in hepatoma liver. These two forms were named AD-I and AD-II according to their elution pattern in CM-cellulose chromatography and mobility towards the anode in polyacrylamide gel electrophoresis. Both isoenzymes resembled normal liver enzyme with respect to their molecular properties. However, the two forms had distinct kinetic properties, although AD-I had some properties similar to the normal liver enzyme. The Km values of AD-I for ethanol, n-butanol and m-nitrobenzyl alcohol were 61 microM, 90 microM and 292 microM, respectively, as against the values for AD-II which were 473 microM, 100 microM and 60 microM for the respective substrates. Pyrazole inhibited the activity of AD-II but not that of AD-I. These kinetic properties of alcohol dehydrogenase in patients with hepatoma could be of clinical importance particularly in the tropics where the disease is prevalent.

Childhood diarrhoea in rural Nigeria. I. Studies on prevalence, mortality and socio-environmental factors.

This population-based study was conducted to determine the prevalence, mortality, and socio-environmental determinants of diarrhoeal diseases in children less than 5-years of age in a rural area of Akoko North, Ondo State, Nigeria. A total of 856 households with children less than 5-years old were randomly selected for the questionnaire and observational investigations. A two-week prevalence rate of the diseases among the children was 8.1%. The rate was highest among children 0-11 months old and slightly higher among the boys than girls. The infant mortality rate was 102/1000 and the mortality rate in less than 5-year old children was 62.1/1000 in the area. The majority of these deaths took place in the homes and health centres and were never reported. Social and environmental factors including dirty feeding bottles and utensils, inadequate disposal of faeces and household refuse, and poor storage of drinking water were found to be significantly related to the high incidence of the diseases. Educational interventions recommended for the control of the disease focused on these factors.

A comparative study of oral glucose tolerance tests in Nigerian women on three types of steroidal contraceptives.

Oral glucose tolerance tests (OGTT) were performed on 146 Nigerian women volunteers using one of three types of steroidal contraceptives: high-dose combined pills; low-dose combined pills and injectable progesterone. Twenty-six appropriately matched nonusers served as controls. The OGTT curves were analysed using the H-index (HI). Women on injectable progesterone and high-dose combined pills, respectively, had significantly higher (P less than 0.05) mean HI than the controls. The low-dose combined pills had the least effect on carbohydrate metabolism.

Properties of serum alcohol dehydrogenase in Nigerians with primary hepatoma.

The serum activity of alcohol dehydrogenase was determined in healthy controls and in patients with liver diseases. The mean activity in hepatoma (6.4 +/- 1.0U/L) was significantly higher (P less than 0.05) than the mean values in liver cirrhosis (2.7 +/- 0.5U/L); hepatitis (4.3 +/- 1.0U/L), obstructive jaundice (2.9 +/- 0.5U/L) and healthy controls (0.7 +/- 0.1U/L). Alcohol dehydrogenase purified by CM-cellulose chromatography from the sera of patients with hepatoma had a higher affinity for butanol long chain saturated and unsaturated alcohols than the purified enzyme from healthy controls. Similarly, hepatoma alcohol dehydrogenase oxidized ethanol very poorly (KM = 154 microM) when compared with that from healthy controls (KM = 40.2 microM). Hepatoma alcohol dehydrogenase was inhibited by pyrazole while those of other liver diseases and the healthy controls were not. These properties of serum alcohol dehydrogenase may prove useful in the early diagnosis of hepatoma since biochemical changes occur before morphological changes in the development of cancer.

Serum thyroglobulin autoantibody titres and immunoglobulin concentrations in Nigerians with goitre.

Using the tanned turkey red blood cell haemaglutination test, blood samples from 327 Nigerians with goitre were screened for the presence of thyroglobulin autoantibody. 15 (4.6%) were found to have significantly positive autoantibody titres while none of the 50 age and sex-matched normal controls and autoantibody. Of the 15 with significantly positive thyroglobulin autoantibody titres, only 2 were males, giving a male:female ratio of 1 to 6.5. The mean serum concentration of IgG in the positive cases (4,163 +/- 53.5 mg/100 ml) was significantly higher than either that of normal controls (3,044 +/- 147.6 mg/100 ml) of goiterous subjects with no thyroglobulin autoantibody (2,196 +/- 116.5mg/100ml). It was found that thyroglobulin autoantibody is an IgG immunoglobulin. It is concluded that autoimmune thyroid disease occurs in Nigerians with goitre and that females are affected more than males.

Steroidal contraceptives and changes in individual plasma phospholipids: possible role in thrombosis.

The changes in the levels of individual phospholipids were studies in women during prolonged use of three types of steroidal contraceptive preparation: high-dose combined pills (Noriday 1 + 50 Fe); low-dose combined pills (Nominest Fe) and progestin-only injectables (Depo-Provera). Women on high-dose combined pills had significantly higher (p less than 0.05) mean lysophosphatidylcholine (LPC), sphingomyelin (SPH), phosphatidylserine (PS) and phosphatidylethanolamine (PE) levels, respectively, than the women on low-dose combined pills, progestin-only injectables and the controls, respectively. Women on low-dose combined pills had significantly lower (p less than 0.01) mean LPC and PS levels, respectively, than the controls, while women on progestin-only injectables had significantly lower (p less than 0.01) mean PS and PE levels, respectively, than the controls. Based on the reported high activities of PS and PE in hemostasis, the PE/total plasma phospholipids, PS/total plasma phospholipids and the sum of PE and PS/total plasma phospholipids ratios were calculated to assess the possible overall effect of the changes in plasma phospholipids in steroidal contraceptive users. The results obtained using these indices agree with some earlier reports of an estrogen dose-dependent risk/incidence of thrombosis in steroidal contraceptive users. It is concluded that the observed dose-dependent estrogen-induced alterations in phospholipids, and, most especially, the PE and PS fractions may bear a relationship with thrombotic conditions.