Serum Levels of Inflammatory Cytokines in Helminth Infested Pregnant Women and Cord Blood of their Babies in Relation to Pregnancy Outcome.

Pregnancy places a very high demand on physical, physiological and immunological responses of females,especially when aggravated by parasitic infestation. There is strong evidence that maternal infestations with helminth haveprofound effects on immunity to helminths and other pathogens. This case-control study involved 245 pregnant women aged18-40 years (>30 weeks of gestation) recruited from three secondary level hospitals in Ibadan, Nigeria. Morning stoolsamples collected from pregnant women were examine for intestinal helminths using formol-ether concentration method. Atotal of 38 participants comprising 17 Helminth Positive (HP) and 21 Helminth Negative (HN) pregnant women werepurposely selected for the study. Sera from these women (38) and their babies' cord (38) were analysed for immune factors[interleukins 6 and 8 (IL-6, IL-8), tumor necrosis factor-alpha (TNF-α) and immunoglobulin E (IgE)] were analyzed usingELISA. Anthropometric indices [weight and height in mothers and babies and Chest Circumference (CC) in babies] weremeasured using standard methods. Data were subjected to descriptive statistics and analysed using Student t-test and Pearsoncorrelation at α0.05. Only Ascaris lumbricoides was found in the 17 (6.9%) infested pregnant women. The mean levels of IL-6 (57.8 ± 32.8 vs 52.8±39.6 pg/mL), IL-8 (24.3±3.5 vs 22.0±7.1 pg/mL) and IgE (333.3±96.6 vs 242.3±96.8 IU/mL) weresimilar in HP when compared with HN. In cord sera, IL-8 level was significantly higher in babies of HP (23.7±3.9 pg/mL)compared with babies of HN (20.1±5.9 pg/mL). The levels of IL-6, TNF-α and nutritional indices in HP had significantpositive correlation with corresponding levels in babies of HP mothers. Only CC was significantly lowered in babies of HPcompared with HN mothers. Other anthropometric indices were not significantly different. Therefore, this present studysuggests that helminth infestation may lead to strong Th2 immune responses as is reflected by the cytokine levels of mothersand babies as well as anthropometric measurements of babies of infested mothers. The outcomes of this study provide basisto deworm pregnant women during pregnancy.

Changes in mediators of inflammation and pro-thrombosis after 12 months of dietary modification in adults with metabolic syndrome.

OBJECTIVE: This study evaluated the effects of a 12-month dietary modification on indices of inflammation and pro-thrombosis in adults with metabolic syndrome (MS). MATERIALS AND METHODS: This longitudinal study involved 252 adults with MS recruited from the Bodija market, Ibadan and its environs. Participants were placed on 20%, 30% and 50% calories obtained from protein, total fat and carbohydrate respectively and were followed up monthly for 12 months. Anthropometry and blood pressure were measured using standard methods. Fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), fibrinogen, plasminogen activator inhibitor-1 (PAI-1)], interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured using spectrophotometric methods and ELISA as appropriate. Data was analysed using ANCOVA, Student's t-test, Mann-Whitney U and Wilcoxon signed-rank tests. P-values less than 0.05 were considered significant. RESULTS: After 6 months of dietary modification, there was a significant reduction in waist circumference (WC), while the levels of HDL-C, fibrinogen and PAI-1 were significantly increased when compared with the corresponding baseline values. However, WC and fibrinogen reduced significantly, while HDL-C and IL-10 significantly increased after 12 months of dietary modification as compared with the respective baseline values. CONCLUSION: Long-term regular dietary modification may be beneficial in ameliorating inflammation and pro-thrombosis in metabolic syndrome.

Anthropometric Indices and Serum Micronutrient Status of Helminth - Infected School Children from Semi-Urban Communities in Southwestern Nigeria.

Adequate nutrition is essential for normal growth of children but helminth infection is proposed to cause nutritional deficiencies. This study was carried out to assess the nutritional status of helminth infected school aged children in semi-urban communities of South-West Nigeria. Two hundred children from primary schools in Akinyele Local Government of Oyo State, Nigeria participated in the study. Anthropometric measurements were analyzed using the WHO AnthroPlus software. Kato Katz method was used to detect ova of helminths in the stool while serum levels of iron, zinc, selenium, ferritin, transferrin, vitamin A, vitamin C and haptoglobin were measured using High Performance Liquid Chromatography and Atomic Absorption Spectophotometry as appropriate. 60 (30%) of the children had intestinal helminth infection with Ascaris lumbricoides (23.0%) as most prevalent, followed by hookworm (2.5%) and Trichuris trichuria (0.5%).  Stunting was more prevalent than thinness or underweight among the study population especially the female children. There were significantly reduced serum levels of zinc and vitamin A and significantly increased serum levels of transferrin and selenium in helminth-infected children compared with helminth-uninfected children. This study established the need for regular deworming of school age children and supplementing diets of school children in rural communities with vitamin A and zinc.

Plasma Adenosine Deaminase Enzyme Reduces with Treatment of Pulmonary Tuberculosis in Nigerian Patients: Indication for Diagnosis and Treatment Monitoring.

Tuberculosis(TB)-specific host biomarkers for diagnosis and monitoring of treatment response have been identified as priorities for TB research. Macrophage and T cell lymphocytes play vital roles in Mycobacterium tuberculosis immune response and their associated biomarkers could form good candidates for diagnosis and treatment monitoring. The enzyme adenosine deaminase (ADA) is produced mainly by monocytes and macrophages and increase in biological fluids in the course of infection with microorganisms infecting macrophages. This study comprised sixty-eight (68) participants; twenty-four (24) multi-drug-resistant TB(MDR-TB) patients, twenty-four (24) drug-sensitive TB patients(DS-TB) and twenty (20) non-TB apparently healthy individuals. Five (5) milliliters of blood was drawn before commencement of chemotherapy and 6 anti-TB therapy. In DSTB and MDR-TB patients before commencement of chemotherapy and 6 months of anti-TB treatment, the mean plasma levels of ADA were significantly increased compared with control. At 6 months of anti-TB chemotherapy of DSTB or MDR TB patients, ADA level was significantly decreased compared with before chemotherapy. Plasma ADA in DSTB patients before and 6 months of chemotherapy were not significantly different compared MDR TB patients. Plasma ADA level is a promising biomarker for the screening and treatment monitoring of pulmonary tuberculosis but not to differentiate MDR TB from DSTB patients.

Serum Levels of Selected Vitamins and Trace Elements in Nigerian Consumers of Alcoholic Beverage: A Suggestion for DNA Hypomethylation.

Folic acid, vitamins and Zinc play essential role in DNA methylation but alcohol consumption is known to affectthe levels of these micronutrients leading to risk of developing various illnesses and certain cancers. This study determinedthe levels of DNA methylation dependent-micronutrients (folate, vitamin B12, vitamin B6, zinc and selenium) andhomocysteine as a suggestion for DNA methylation status in Nigerian alcohol consumers compared with non-consumers ofalcohol. Venous blood (5ml) was obtained from thirty-four males that consume alcoholic beverages for at least 10 years andthirty-two male controls that did not consume alcoholic beverages at least 10 years. Serum concentrations of folate, vitaminB12, vitamin B6, homocysteine (Hcy), selenium (Se) and zinc (Zn) were determined using High Performance LiquidChromatography (HPLC) and Atomic Absorption Spectrophotometry (AAS) as appropriate. Independent Student t-test wasused to compare the mean values between alcohol consumers and control. Mean differences were considered significant atp<0.05. The mean serum levels of Zn and Se were significantly raised in alcohol consumers when compared with nonalcohol consumers while the mean levels of Vitamin B6 and Hcy were significantly reduced in alcohol consumers whencompared with non-alcohol consumers. There were no statistically significant differences in the mean serum levels ofVitamin B12 and folate in alcohol consumers when compared with non-alcohol consumers. Since vitamin B6 and Hcy arerequired for DNA methylation, reduced vitamin B6 and Hcy levels in consumers of alcoholic beverages might suggest DNAhypomethylation in alcohol consumers.

Pneumococcal-specific IgG levels after 13-valent pneumococcal conjugate vaccination in Nigerian children with sickle cell disease.

BACKGROUND: Children with sickle cell disease (SCD) are particularly susceptible to pneumococcal infection. Administration of the 13-valent conjugate pneumococcal vaccine which is now available in Nigeria may help to reduce the incidence. OBJECTIVES: To determine the serum level of pneumococcal-specific IgG (PIgG) in a cohort of patients with SCD after administration of a single-dose of a 13-valent pneumococcal conjugate vaccine. METHODS: The study was conducted between December 2011 and March 2012 among children with SCD aged 5 months to 5 years attending the sickle cell clinic in five public hospitals in Lagos. Altogether, 151 children with SCD and 52 without it (controls) were recruited by convenience sampling from the sickle cell clinics and well-child clinics. Blood samples were collected for PIgG concentrations before and 2 months after a single dose of the Prevenar 13 vaccine. Seroconversion was defined as a fourfold or greater increase in antibody concentration after vaccination while those with PIgG concentrations ≥200 µU/ml were considered to have protective levels. RESULTS: The age range of the total study group was 5-60 months with a mean (SD) of 39.04 (15.44) months and a median of 39 months. The mean (SD) ages of subjects with and without SCD were 38.91 (15.75) months and 16.39 (15.45) months, respectively. The PIgG concentration 2 months post-vaccination was significantly greater than the pre-vaccination levels in all age categories in both groups and almost all subjects had protective PIgG concentrations 2 months after vaccination. A four-fold increase in PIgG concentration was detected more commonly in the controls than in SCD patients. CONCLUSION: Prevenar 13 provided protective immunity in all vaccinated children but those under 2 years of age who had non-protective levels pre-vaccination benefited the most.

Metabolic alterations in different stages of hypertension in an apparently healthy nigerian population.

Metabolic syndrome (MS) amplifies hypertension (HTN) associated with increased risk of cardiovascular disease (CVD). MS components and other CVD risk measures were investigated in different stages of hypertension. 534 apparently healthy Nigerian traders aged 18-105 years were participants of a cohort study. The International Diabetes Federation (2005) and the National High Blood Pressure Education Program Coordinating Committee criteria were used for MS and HTN classifications, respectively. Anthropometric indices were obtained by standard methods. Levels of fasting plasma glucose (FPG), total cholesterol (TC), triglyceride (TG), and high-density lipoprotein cholesterol (HDLC) were determined by enzymatic methods, while low-density lipoprotein cholesterol (LDLC) was calculated. Data analysed statistically were significant at P < 0.05. 143 (26.8%), 197 (36.9%), and 194 (36.3%) of the traders had normotension, pre-HTN and HTN (stages 1 and 2), respectively. All indices tested except HDLC were significantly different among BP groups (P < 0.05). Waist to hip (WHR) and waist to height (WHT) ratios were significantly different between HTN groups (P < 0.05). HTN was associated with MS and female gender (P < 0.05). Metabolic alterations and significant HTN were observed. Treatment of the individual components of the syndrome and improvement of modifiable metabolic factors may be necessary to reduce MS and high BP.

Allergy sensitization and asthma among 13-14 year old school children in Nigeria.

BACKGROUND: The prevalence of asthma and role of atopy in asthma among children has not been clearly defined in Nigeria. OBJECTIVE: To determine the prevalence of asthma and investigate risk factors related to allergy sensitization among urban and rural school children in southwest Nigeria. METHODS: Validated ISAAC questionnaire was administered to 1736 high school children in randomly selected schools in rural and urban communities. Identified asthma cases were matched to controls. Allergy skin tests, blood eosinophil count, serum IgE and stool examination for parasites were performed. Dust samples from homes were also collected and analyzed for allergens. RESULTS: The prevalence of asthma was 7.5% (95% CI 6.0 to 9.2%) and 8% (95% CI 6.0-10.4%) in the rural and urban communities respectively . Risk factors for asthma included cigarette-smoking, cats in the home and family size. Eosinophil count (109/L) was elevated in asthmatics [0.70 (95% CI 0.48-1.11) vs. 0.32 (95% CI 0.19-0.69); p<0.01], but IgE levels were similar between the two groups (298±229 IU/mL vs. 288±257; p=0.97). Positive skin tests to cat hair, cockroach, mango blossom and mouse epithelium were more frequent in asthmatics than in healthy controls, especially in the rural communities. There was no correlation between allergens in dust collected from homes and skin test reactivity. CONCLUSION: Asthma prevalence is similar in rural and urban children in Southwest Nigeria and atopy with elevated IgE was not observed to be a major factor for asthma in our cohort of children in both communities.

Complement factors in newly diagnosed Nigerian schizoprenic patients and those on antipsychotic therapy.

The role of Complement factors in the pathogenesis of psychiatric disorders is enormous, but the data on levels and functions of complement factors in patients with schizophrenia are scanty and conflicting. To address this issue, levels of Complement regulators (C1 inhibitor and C3 activator) and complement factors (C1q, C3c, C4 and C5) were determined in the serum of newly diagnosed drug free schizophrenic patients, schizophrenic patients on medication and healthy subjects using immune-plates. C1q was significantly reduced in newly diagnosed schizophrenic patients or schizophrenic patients on medication compared with the controls. C3c was significantly reduced in newly diagnosed schizophrenic patients compared with controls or schizophrenic patients on medication. The levels of C3 activators, C1 inhibitors and C4 were similar in the two groups of schizophrenic patients compared with the controls. It may be concluded from this study that C1q is deficient in schizophrenic patients; and that C3c may differentiate newly diagnosed schizophrenia from schizophrenic patients on medication.

Progesterone, selected heavy metals and micronutrients in pregnant Nigerian women with a history of recurrent spontaneous abortion.

BACKGROUND: Environmental and endocrine factors have been implicated in the aetiology of recurrent abortion, with poorly understood roles. Luteal phase insufficiency marked with insufficient progesterone secretion has been reported. OBJECTIVE: To define the involvement of progesterone, trace metals, and Vitamin E in pregnant women with history of recurrent spontaneous abortion. METHODS: Convenience sampling method was used to recruit 69 pregnant women aged 21-41 years with gestational age of 0-20 weeks in this case-control study. Thirty five (cases) and thirty four (controls) had previous and no history of recurrent spontaneous abortion respectively. Demographic characteristics and 10 mls of blood samples were obtained from each subject. Serum obtained was used for the determination of progesterone, zinc, copper, selenium, iron, magnesium, manganese, chromium, lead, cadmium, and serum vitamin E by standard methods. RESULTS: Results showed statistically significant decreases (p<0.05) in the serum zinc, copper, and vitamin E and a significant elevation (p<0.05) in the serum selenium, lead, and cadmium in cases compared with controls. Insignificant decrease (p=0.07) was observed in the serum progesterone when cases were compared with controls. CONCLUSION: Results suggest that elevated serum heavy metals (cadmium and lead) and reduction of essential micronutrients (zinc, copper and vitamin E) may contribute to recurrent spontaneous abortion.

Diagnostic value of lipids, total antioxidants, and trace metals in benign prostate hyperplasia and prostate cancer.

BACKGROUND: Considerable overlap exists in the value of total prostate specific antigen (tPSA) in both prostate cancer (Pca) and benign prostate hyperplasia (BPH). Developing an effective biochemical screening test that will complement PSA assay could reduce the associated cost of care and give timely attention to prostate cancer patients even when they are still asymptomatic is therefore desirable. This work was therefore an attempt to evaluate the possible roles of lipids, antioxidants, and trace metals in breaking the diagnostic tie between Pca and BPH. MATERIALS AND METHODS: Anthropometric characteristics, total prostate specific antigen (tPSA), serum lipids (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides), Vit. E, total antioxidant status (TAS), and trace metals (Se, Cu, Fe, Zn, and Mn) were determined in 40 patients with histopathological diagnosis of BPH and Pca. Forty age matched control subjects were also recruited from the same community. Informed consent was obtained from all the participants in the study. A P-value < 0.05 was considered significant. RESULTS: There were significant variations in the weight, hip circumference, and body mass index (BMI) across the group but the post hoc test did not show any difference between patients with prostate cancer and BPH. Among the biochemical parameters studied, only the total cholesterol and triglyceride differed significantly between patients with BPH and prostate cancer patients. Cut-offs from ROC for BPH and prostate cancer at 88.9 sensitivity and 66.7% specificity (95% CI) were 88.5 mg and 161 mg/dl for triglycerides and cholesterol respectively. Furthermore there were no significant variations in the mean levels of copper and tPSA, Vit E, and LDL cholesterol among the study subjects and the controls. CONCLUSION: Prior to prostate biopsy, serum lipid (especially, fasting triglycerides, total cholesterol) could help in early discrimination of patients with BPH from prostate cancer in adjunct to total PSA and other management protocol for diagnosis of prostate cancer. The use of trace metal or antioxidants may have limited advantages. Further studies in this regard will be very desirable to see if this pattern of triglyceride and total cholesterol values in BPH and Pca are sustainable.

Salivary immunoglobulin classes in Nigerians with periodontitis.

AIM: To provide information on the usefulness of salivary immunoglobulin classes in the diagnosis of periodontitis. MATERIALS AND METHODS: About 5 ml of unstimulated saliva was collected from 25 newly diagnosed subjects with periodontitis and 21 sex/age-matched apparently healthy individuals into plain sample bottles. The samples were collected between 9 am and 11 am at least, 1 hour after eating or washing of mouth and levels of salivary immunoglobulin classes (IgA, IgG, IgE and IgM) were determined using enzyme-linked immunosorbent assay (ELISA). RESULTS: Only the mean level of IgA was significantly raised (p = 0.05) in the saliva of periodontitis patients compared with controls. The mean levels of IgG, IgM and IgE were not significantly elevated in patients with periodontitis, when compared with controls (p > 0.05). CONCLUSION: This study showed that elevated salivary levels of IgA could be used as a screening tool for periodontitis. CLINICAL SIGNIFICANCE: Identification of patients at risk and the diagnosis of active phases of periodontal disease remains a challenge due to lack of laboratory test routinely employed in the diagnosis and monitoring of patients with periodontal disease. This study showed that elevated salivary levels of immunoglobulin classes especially, IgA could be used as a screening tool for periodontitis.

Atopy is a risk factor for adult asthma in urban community of Southwestern Nigeria.

RATIONALE: Factors affecting asthma course are not clearly elucidated in urban communities in developing countries. Furthermore, the interaction between factors such as atopy, environmental exposure, urbanization, and helminthic infections in modulating asthma have not been well investigated. OBJECTIVES: To determine factors, which affect asthma in adults being evaluated at urban tertiary health center of Southwestern part of Nigeria. MATERIALS AND METHODS: A random sample of 24 (12 males, 12 females) consecutive asthmatics seen in the Outpatient Pulmonary Clinic of University College Hospital of Ibadan and 27 (13 males, 14 females) age and gender-matched controls underwent evaluation, which included blood tests for eosinophils, serum IgE, allergy skin tests to eight common environmental allergens, and spirometry. The modified version of the questionnaire of the International study of Asthma and Allergies in Children (ISAAC) Phase III used by the same study group of researchers in Nigeria was used to assess the asthma symptoms. Wilcoxon sign-rank tests were used to compare eosinophil counts, percentage eosinophils, and allergic skin test between the two groups, while paired t test was used to compare spirometry variables. RESULTS: Asthmatics had significantly more positive skin reaction to house dust mite and mould than controls (P<0.05). Total serum IgE was also significantly higher in asthmatics than in controls (mean 210 vs 60 IU/mL; P=0.003). However, no significant differences were observed in total eosinophil counts. No significant difference in the degree of intestinal helminthes infection in the two groups, which means stool parasitism was similar. FEV(1) % was significantly lower in asthmatics (P=0.02) but FEV(1) was similar between the two groups (P=0.02). CONCLUSION: The elevated levels of IgE and positive skin reactions to some of the common environmental allergens suggests an important role of atopy in the expression of asthma in this developing country's urban setting. Intestinal parasites were seen in both, control and asthma subjects, but appear not to play any role in the course of asthma, so also is the blood group, genotype and G6PD status.

Effects of low protein diet and pregnancy on course of Plasmodium berghei infection in mice.

Pregnancy and malnutrition influence the severity or trend of malaria especially in sub-Saharan Africa where parasitic infections are highly predominant. This study was used to evaluate the combined effects of low protein diet and pregnancy on the course of Plasmodium berghei infection in mice. Thirty female BALB/c mice were divided into six groups viz: Non-infected mice fed on normal diet (NIND), Infected mice fed on normal diet (IND), Noninfected mice fed on low protein diet (NILP), Infected mice fed on low protein diet (ILP), Non-infected gravid mice fed on low protein diet (NIGLP) and Gravid infected mice fed on low protein diet (GILP). Malaria parasite count, packed cell volume, body weight and plasma nitric oxide (NO) production were determined. Data were compared statistically across the groups using Student t-test and ANOVA. Parasite detection in peripheral blood was delayed in ILP (day 7) and GILP (day 11) relative to IND (day 3). The peak parasitaemia and mean survival time were significantly lower (p < 0.05) in GILP relative to other infected groups. GILP could not carry the pregnancy to term. Nitric oxide production was observed to increase more rapidly in IND relative to ILP after parasite detection with a peak production by day 15. Mortality commenced in both groups afterwards. Low protein diet delayed the peak production of NO supporting its protective influence on malaria infection. However, the combined effects of low protein diet and pregnancy resulted in early mortality and inability of mice to carry pregnancy to term.

Atopy is associated with asthma in adults living in rural and urban southwestern Nigeria.

RATIONALE: Factors affecting the course of asthma are not clearly understood in rural and urban communities within low-resource countries. Furthermore, the interactions between atopy, environmental exposure, and helminthic infections in modulating asthma have not been well investigated. OBJECTIVES: To conduct a feasibility study to examine the relationship between atopy and asthma in adults at two rural Health Centers and urban university college hospital in southwestern Nigeria. METHODS: A convenient sample of 55 consecutive patients with stable physician-diagnosed asthma and 55 age-matched nonasthmatic controls seen at the outpatient clinics in two rural Health Centers and an urban university hospital were enrolled. All subjects underwent blood test, allergy skin test, and stool examination for ova and parasites. Wilcoxon sign-rank tests were used to compare serum eosinophilia and allergy skin test between the two groups. RESULTS: Asthmatics in both urban and rural settings had significantly more positive skin reactions to house dust mite, cockroach, mold, and mouse epithelium than nonasthmatic controls (p < .05). Mean total serum IgE was also significantly higher in asthmatics than in nonasthmatic controls (360 vs. 90 IU/L, p <.001). Stool parasitemia was infrequent in both groups and not statistically significant. CONCLUSION: Atopy is associated with adult asthma in southwest Nigeria. Larger studies to confirm the nature of this association and to examine the role of helminthic infection and other environmental factors on the expression of asthma are needed.

FOETAL HAEMOGLOBIN (HbF) STATUS IN ADULT SICKLE CELL ANAEMIA PATIENTS IN IBADAN, NIGERIA.

AIM: Elevated HbF, among other biological and environmental factors, is responsible for decrease in mortality in sickle cell anaemia (SCA). This study determined the levels of HbF in adult SCA patients in steady state compared with HbAA controls. HbF was discussed in line with the clinical course of the disease so as to emphasize the relevance of hydroxyurea in the management of adult SCA patients. MATERIALS AND METHODS: The HbF levels of 66 confirmed SCA patients and 31 HbAA controls were estimated using Betke method and HbF percentage was calculated using formula: %HbF percentage = A413 filtrate x 100A413 standard x 20. RESULT: A statistical significant difference in the mean of the levels of HbF in patients (5.16±4.04) compared to controls (1.04±0.44) (p = 0.000) was observed. The mean levels of HbF for males (4.71±3.49) compared to that of females (4.99) were statistically similar (p =0.773). It was also observed that the mean HbF level appears to be declining as age advances. SCA patients were classified to three categories viz: HbF <2% (21.2% SCA patients); HbF of 2.1% -10%, (68.2% SCA patients); and HbF of 10.1% -16%, (10.6% SCA patients). CONCLUSION: Substantial proportion of our patients actually will require treatment with hydroxylurea to stimulate HbF production especially those with HbF percentage of <2 and some with HbF percentage of 2.1 - 10%. HPFH may be considered rare since only 10. 6% had HbF at the range of 10.1-16%. This study showed that in treating our SCA patients in Nigeria we need to adopt and encourage the use of HbF activating agents like hydroxyurea or any other safe agent that will be found to stimulate HbF production in SCD patients.

Interferon-gamma in suppurative otitis media: significance of otorrhoea type and disease outcome.

BACKGROUND: Interferon-gamma has been reported to have an immunoregulatory role in otitis media with effusion. However, such a role remains to be determined in acute suppurative otitis media. AIM: To determine the levels of interferon-gamma in middle-ear secretion in children with acute suppurative otitis media, and to determine the significance of interferon-gamma to the nature of otorrhoea and the outcome of otitis media. SETTINGS AND DESIGN: Prospective, longitudinal follow up of patients selected from community and tertiary health centres. METHODS: We selected children with acute suppurative otitis media, diagnosed as otorrhoea of less than three months' duration. Middle-ear secretions were collected by pipetting and stored at -80 degrees C. Interferon-gamma was assayed using enzyme-linked immunosorbent assay. The patients were treated and followed up for nine to 12 months, to separate those with resolved acute suppurative otitis media from those with chronic suppurative otitis media. RESULT: The study initially included 358 cases of acute suppurative otitis media. Nine-month follow up was achieved in 304 patients (85 percent). Of these patients, acute suppurative otitis media resolved in 187 (61 percent), while chronic suppurative otitis media was evident in 117 (39 percent). The children with completed follow up comprised 173 boys and 131 girls, aged between four months and nine years (mean age 6.6 years; standard deviation 1.32). These children had purulent otorrhoea in 171 cases (56 percent) and mucoid otorrhoea in 133 cases (44 percent). The children's middle-ear secretion interferon-gamma concentrations ranged from 12 to 126 pg/ml. The mean middle-ear secretion interferon-gamma concentration was 27.2 pg/ml (standard deviation 8.8) in patients whose acute suppurative otitis media resolved, and 73.1 pg/ml (standard deviation 9.5) in those progressing to chronic suppurative otitis media. In children with purulent otitis media, the mean middle-ear secretion interferon-gamma concentration was 43.5 pg/ml (standard deviation 15.6); in those with mucoid otitis media, it was 74.3 pg/ml (standard deviation 19.1). Univariate analysis revealed significant differences in middle-ear secretion interferon-gamma concentration, comparing resolved acute suppurative otitis media and chronic suppurative otitis media cases (p = 0.00), and comparing purulent and mucoid otitis media cases (p = 0.00). Pearson correlation testing revealed significant inverse correlation between interferon-gamma concentration and middle-ear secretion immunoglobulin G concentration (p = 0.01), immunoglobulin E concentration (p = 0.03) and immunoglobulin A concentration (p = 0.00). CONCLUSION: A high concentration of interferon-gamma in middle-ear secretions promotes chronicity of suppurative otitis media. Further research in this area may lead to the development of agents which assist the control of suppurative otitis media chronicity.

Essential trace elements and antioxidant status in relation to severity of HIV in Nigerian patients.

OBJECTIVES: This study was designed to determine the plasma levels of some antioxidants and trace elements in three severity groups of HIV patients compared with non-HIV-infected controls. METHODS: The plasma levels of antioxidants (total antioxidant, albumin, bilirubin and uric acid) and trace elements (Mg, Fe, Zn, Mn, Cu, Cr, Cd and Se) were estimated spectrophotometrically in controls and patients with CD4 counts of <200; 200-499 and > or =500 cells/microl. RESULTS: Uric acid and Zn were significantly higher, while vitamin E and all the trace elements (except Zn) were significantly lower in HIV-infected patients compared to healthy controls. The highest level of uric acid was observed in those with CD4 counts of <200 cells/microl. All the trace elements (except Zn) were higher in HIV subjects with a CD4 count of 200-499 cells/microl compared to >500 cells/microl. Only uric acid and Zn showed significant correlation with CD4 count. CONCLUSION: Based on the results of this study, we recommend routine assessment and appropriate supplementation of antioxidants/trace elements in HIV subjects. This supplementation is hoped to strengthen the immune system and reduce the adverse consequences of HIV- related oxidative stress.

Usefulness of acute phase proteins for monitoring development of hepatocellular carcinoma in hepatitis B virus carriers.

BACKGROUND: Serum levels of acute phase proteins (APP) have been used to diagnose and follow up treatment of liver diseases. This study was carried out to determine the usefulness of APP to predict development of hepatocellular carcinoma (HCC) among Hepatitis B virus (HBV) carriers. STUDY DESIGN: In a prospective study, serum haptoglobin, transferrin and alpha 2 macroglobulin levels of 55 subjects consisting of 20 HBV carriers, 18 HBV-positive HCC patients and 17 controls were determined using single radial immunodiffusion. RESULT: The mean levels of haptoglobin were 141.75mg/dl+/-133.76, 97.11mg/dl+/-92.62,161.59mg/dl+/-146.86 for HBV carriers, HBV-positive HCC and controls respectively. The mean transferrin levels for HBV carriers, HBV-positive HCC and controls were 166.4mg/ dl+/-88.31, 140.0mg/dl+/-68.73 and 270.35mg/dl+/-122.79 respectively while similar values for alpha 2 macroglobulin were 195.4mg/dl+/-93.86, 189.83mg/dl+/-77.19 and 127.53mg/dl+/-43.29. No significant difference in the mean serum haptoglobin levels of HBV carriers and HBV-positive HCC (p=0.526), HBV carriers and controls (p= 0.883) and HBV-positive HCC and controls (p=0.295). The difference between the mean serum transferrin levels was insignificant between HBV carriers and HBV-positive HCC, p= 0.671, but was significant between HBV carriers, and HBV-positive HCC compared with controls, (p=0.005 and 0.000 respectively). No significant difference in alpha 2 macroglobulin between HBV carriers and HBV-positive HCC, (p=0.972), but the differences were significant between HBV carriers, and HBV-positive HCC and controls, (p=0.024 and 0.048 respectively). CONCLUSION: Haptoglobin, alpha 2 macroglobulin and transferrin lack predictive value for development of HCC in HBV carriers. Reduced transferrin and increased alpha 2 macroglobulin in HBV carriers might suggest active liver disease.

Complement factors and circulating immune complexes in children with urinary schistosomiasis and asymptomatic malaria.

Serum concentrations of circulating immune complexes (CIC), complement factors (Factor B, C4, C8) and complement activities (CH50 and AH50) were determined in Nigerian school children having urinary schistosomiasis with or without symptomatic malaria by polyethylene glycol precipitation method, single radial immunodiffusion and total haemolytic activities respectively. One hundred and forty-seven children were recruited from St. John's Primary School, Mokola, Ibadan, Nigeria.RP ovale only, mixed infection of P. ovale with P. falciparum or mixed infection of P. malariae with P. falciparum were found in subjects with asymptomatic malaria without urinary schistosomiasis (M-USS) but P. malariae or P. falciparum was found in subjects with co-infection of urinary schistosomiasis and asymptomatic malaria (M + USS). Mean value of C4 concentration was significantly reduced in M - USS subjects or subjects having both USS and asymptomatic malaria (M + USS) compared with non-infected controls. Serum concentration of Factor B(FB) was significantly reduced while AH50 was significantly increased in urinary schisosomiasis subjects without malaria (USS-M) compared with M-USS subjects or the controls. These observations implied that complement system in USS-M subjects is activated predominantly via alternative pathway (APW) while complement system is activated via classical pathway (CPW) in M-USS or M+USS subjects. The switch of complement activation pathway from alternative type in USS-M subjects to classical type in M-USS subjects may explain the lower malaria parasite densities often found in children harbouring Schistosoma haematobium parasites.