Hepatic transaminase and alkaline phosphatase enzyme levels in HIV/HBV co-infected and HIV mono-infected patients in Maiduguri, Nigeria.

BACKGROUND: Studies have shown that HIV-HBV co-infected patients have an increased risk of liver-related morbidity and mortality compared to their HIV-mono-infected counterparts. Furthermore, it has been reported that HIV-HBV co-infected patients have a significantly high incidence of drug-induced hepatotoxicity following commencement of HAART than HIV-mono-infected patients. OBJECTIVES: To compare the levels of aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALKPO 4 ) enzyme levels between HAART naïve HIV-HBV co-infected patients and their HIV-mono-infected counterparts. MATERIALS AND METHODS: A cross-sectional descriptive study in which 142 newly diagnosed HIV/HBV co-infected and HIV mono-infected adults were investigated for alkaline aminotransferase, aspartate aminotransferase and alkaline phosphatase enzyme levels. RESULTS: The study subjects comprised of 80 (56.3%) females and 62 (46.7%) males. The age range of the study population was 15-65 years. The mean ages of male and female subjects were 45.5 ± 10.5 years and 39.1 ± 7.5 years respectively ( P < 0.05). Sixty-three (44.4%) study subjects were HIV/HBV co-infected while 79 (55.6%) were HIV mono-infected. The mean ALT enzyme level of HIV/HBV co-infected subjects was significantly higher than that of HIV mono-infected ones i.e., 42.12 IU/l vs. 27.86 IU/l, ( P = 0.038). However, there was no statistically significant difference in the mean AST (30.14 IU/l vs. 29.09 IU/l, P = 0.893) and ALKPO 4 (55.86 IU/l vs. 60.97 IU/l, P = 0.205) enzyme levels between HIV-HBV co-infected and HIV mono-infected subjects albeit the two enzymes were moderately elevated in both categories of subjects. CONCLUSION: The significantly elevated ALT enzyme levels amongst HIV-HBV co-infected subjects suggest that HIV-HBV co-infected patients may have an increased risk of liver-related morbidity and mortality than their HIV mono-infected counterparts. Screening for serological markers of chronic HBV infection, as well as hepatic transaminase enzyme levels in all newly diagnosed HIV-positive patients is therefore recommended before commencement of HAART.

Serum C-reactive protein in Nigerians with type II diabetes mellitus.

BACKGROUND: C-reactive protein is an acute-phase proteins, produce in the liver, its release is stimulated by cytokines (interleukin 6 and tumour necrosis factor alpha). Elevated level of it is a risk factor for coronary heart disease. Baseline levels of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. Diabetics are at increased risk for coronary heart disease, data from the Framingham Study showed a two-to three-fold elevation in the risk of clinically evident atherosclerotic disease in patients with type II diabetes compared to those without diabetes. However, but data regarding CRP in Nigerian diabetic is lacking. OBJECTIVES: The study was to determine serum C-reactive protein in Nigerian with Type II diabetes mellitus. METHODS: The study design was cross-sectional conducted among patients attending out patient clinic of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State south western Nigeria. Measurement of C-reactive protein was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA). RESULTS: A total of 125 consecutive subjects were recruited comprising 75 patients with type II diabetes mellitus with or without hypertension and 50 apparently healthy age-and-sex comparable controls. There was a significant difference between the mean systolic and diastolic blood pressures of the patients and controls. The fasting blood glucose and C-reactive protein were significantly higher in diabetics compared to controls. There was a positive and significant correlation between FBG and CRP in both patients and controls. CONCLUSION: This study showed that diabetics have significantly higher serum C-reactive protein compared to the apparently controls. Also there was a positive and significant correlation between C-reactive protein and fasting blood glucose among both patients and controls.

Malaria vaccine: the pros and cons.

BACKGROUND: Malaria is an important parasitic disease of humans caused by infection with a parasite of the genus Polasmodium and transmitted by female anopheles. Infection caused by P. falciparum is the most serious of all the other species (P. ovale, P. vivax and P. malariae) especially in terms of morbidity and mortality hence the reason why most of the research has been focussed on this species. The disease affects up to about 40 per cent of the world's population with around 300-500 million people currently infected and mainly in the tropics. It has a high morbidity and mortality especially in resource-poor tropical and subtropical regions with an economic fall of about US$ 12 billion annually in Africa alone. METHOD: relevant literatures were reviewed from medical journals, library search and internet source. Other relevant websites like PATH, Malaria Vaccine Initiative and Global Fund were also visited to source for information. The key words employed were: malaria, vaccine, anopheles mosquito, insecticide treated bed-nets, pyrethroids and Plasmodium. RESULTS: several studies have underscored the need to develop an effective human malaria vaccine for the control and possible eradication of malaria across the globe with the view to reduce the morbidity and mortality associated with the disease, improve on the social and economic losses and also protect those at risk. CONCLUSION: It is very obvious that the need for effective human malaria vaccine is not only to serve those living in malaria endemic regions but also the non-immune travellers especially those travelling to malaria endemic areas; this would offer cost effective means of preventing the disease, reducing the morbidity and mortality associated with it in addition to closing the gap left by other control measures. It is very obvious that there is no single control measure known to be effective in the control of malaria, hence the need for combination of more than one method with the aim of achieving synergy in the total control and possible eradication of the disease. It suffices to say that despite the use of combination of more than one method (e.g., drugs treating patients, breaking the life cycle of the vector mosquito using larvicides, clearing swamps and other mosquito breeding sites), no much progress was made towards achieving this goal, hence the renewed interest especially with regards to vaccine development.

Serum C-reactive protein in Nigerians with type 2 diabetes mellitus.

BACKGROUND: C-reactive protein is an acute-phase proteins, produce in the liver, its release is stimulated by cytokines (interleukin 6 and tumour necrosis factor alpha). Elevated level of it is a risk factor for coronary heart disease. Baseline levels of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. Diabetics are at increased risk for coronary heart disease, data from the Framingham Study showed a two- to three-fold elevation in the risk of clinically evident atherosclerotic disease in patients with type II diabetes compared to those without diabetes. However, but data regarding CRP in Nigerian diabetic is lacking. METHOD: A cross-sectional study conducted among patients attending out patient clinic of the Obafemi Awolowo University Teaching Hospitals complex OAUTHC) Ile Ife, Osun State south western Nigeria. Measurement of C-reactive protein was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA). RESULTS: A total of 125 consecutive subjects were recruited comprising 75 patients with type II diabetes mellitus with or without hypertension and 50 apparently healthy age-and-sex comparable controls. There was a significant difference between the mean systolic and diastolic blood pressures of the patients and controls. The fasting blood glucose and C-reactive protein were significantly higher in diabetics compared to controls. there was a positive and significant correlation between FBG and CRP in both patients and controls. CONCLUSION: This study showed that diabetics have significantly higher serum C-reactive protein compared to the apparently controls. Also there was a positive and significant correlation between C-reactive protein and fasting blood glucose among both patients and controls.

Pharmacotherapy for chronic heart failure.

BACKGROUND: Heart failure is a chronic and progressive disorder which results due to inability of the heart to pump adequate blood to meet up the metabolic demands of the body. Detecting patients with heart failure could be simple but rather complex of clinical decisions as presentation could be classical or non-specific with minimal symptoms and orsigns. Management is aimed at relieving symptoms, improving quality of life, preventing hospitalisation and arresting disease progression thus prolonging survival. In addition to pharmacologic measures, non-pharmacologic ones are also employed. METHOD: Relevant literature was reviewed using medical journals and also via internet. The key words employed were: Heart failure, Chronic heart failure, Diuretics, Vasodilators, Angiotensin receptor blockers (ARBS) and Angiotensin converting enzyme inhibitors (ACEI). The National Heart, Lung and Blood Institute, Canadian Cardiovascular Society, American College of Cardiology websites were also used in the course of this review. RESULTS: This review was able to support the use of betablockers, ACEI, ARBS, digitalis, diuretics, vasodilators and aldosterone antagonists in the management of chronic heart failure. CONCLUSION: The objectives of drug therapy in heart failure includes the short-term goals of stabilising the patient, improving haemodynamic function and conferring symptomatic improvement, as well as the long-term goal of limiting disease progression, decreasing hospital re-admission rates and improving survival. The cause needs to be established and aggravating factors identified (and where possible treated). Most of the drugs, if not all, are used in combination with one another to achieve maximal therapeutic goal. Use of some drugs could be entertained as an add-on therapy depending on any co-existing medical condition.

Radiograghic evaluation of lymphadenopathy in pulmonary tuberculosis in Northeastern, Nigeria.

BACKGROUND: There is changing pattern of presentation of tuberculosis in the era of HIV Lymphadenopathy is one of the most important manifestations of tuberculosis, hence the need for the evaluation of its radiologic patterns. METHODS: A multi-centre retrospective study of chest radiographs of 116 adult patients diagnosed bacteriologically (positive sputum smear) as pulmonary tuberculosis was conducted in the University of Maiduguri Teaching Hospital, Maiduguri, and Federal Medical Centre Nguru, in Bomo and Yobe States, Nigeria, respectively between April 2003 and March 2004. Lymphadenopathy was assessed in all the radiographs. RESULTS: Of the one hundred and sixteen radiographs of patients analyzed, there were 83 (71.6%) males and 33 (28.4%) females with mean age of 37.99 +/- 14.11 years. A total of thirty eight patients (32.7%) presented with lymphadenopathy with the highest frequency in the left hilar region (12.9%). Bilateral hilar and paratracheal lymphadenopathy were the lowest with equal percentages (4.3%). Left, right and bilateral hilar enlargement were more common in males than females (p < 0.000) and more patients had left hilar (15) than right hilar (13) enlargement (p = 0.030). Only 3 (2.6%) out of all the patients presented with lymph node calcification. CONCLUSION: In conclusion, there is a rise in the prevalence of lymphadenopathy among pulmonary tuberculosis patients when compared to a previous study done in the pre-HIV era in Nigeria.

Should absolute lymphocyte count be used as a surrogate marker for CD4+ count in patients with HIV/AIDS?

The World Health Organization (WHO) has recommended the use of absolute lymphocyte count (ALC) as a potential marker for immunosuppression where CD4+ count is unavailable. However, there are conflicting reports on the usefulness of ALC as a surrogate marker for CD4+ counts in patients with HIV/AIDS, more so, in patients with HIV-associated tuberculosis (TB). To evaluate the usefulness of ALC as an alternative to CD4+ counts and to see whether TB affects the correlation of ALC with CD4+ counts in patients with HIV-associated TB. A total of 66 consecutive patients (33 with and 33 without TB) with a diagnosis of HIV infection were recruited into the study as cases. Another group of 66 subjects (33 subjects each) age- and sex-matched HIV-negative controls were recruited as controls and stratified in to two: a) HIV-negative PTB patients. b) apparently healthy HIV and PTB negative individuals. The age range was from 15-60 years (median: 32 years). The highest percentage (39%) of subjects fell in the age range of 25-29 years. The mean ALC for HIV-associated PTB was 3906 +/- 1092 cells/microl and for patients with HIV infection only. 4755 +/- 1049 cells/microl. There was no significant difference in mean ALC between males and females in both groups (P > 0.05). Patients with dual infection by M. tuberculosis and HIV had the lowest mean ALC (3906 +/- 1092 cells/microl). Healthy controls had mean ALC (+/- SD) of 5249 +/- 101 cells/microl. There was significant difference between the healthy controls and the other three groups. The observed difference was more in patients with HIV/ TB co-infection (P < 0.005) compared with patients with HIV alone (P < 0.05). No significant correlation was observed between CD4+ cell counts and ALC in all the age groups of the study population. When the CD4+ counts were divided into < 200 and > or = 200 cells/microl and the ALC into < 2000 and > or = 2000 cells/microl, the sensitivity, specificity and positive predictive values of the diagnostic usefulness of ALC in HIV-associated PTB were 52%. 56.3% and 78.8% while for HIV only patients the same values were 56.3%. 55.9% and 54.5%, respectively. We cannot recommend the use of ALC as a surrogate for CD4+ count in our environment as this study has clearly shown that the correlation between the two is weak. Patients with dual infection by HIV and M. tuberculosis are more likely to have lower CD4+ cell and AL counts than those with HIV infection occurring alone.

Mantoux reaction in patients with HIV-related pulmonary tuberculosis in Maiduguri, Nigeria.

Tuberculin skin testing is used for the identification of individuals with infection by Mycobacterium tuberculosis and other non-tuberculous mycobacteria. However, its value in immunosuppressed individuals due to human immunodeficiency virus (HIV) infection is controversial. This study was aimed at determining the relationship between Mantoux reaction and CD4+ cell counts; and whether the test can be used to predict CD4+ counts in patients dually infected with Human Immunodeficiency Virus and M. tuberculosis. Eighty patients, comprising 42 males (52.5%) and 38 females (47.5%) confirmed to be having antibodies to HIV who also had sputum smear positive pulmonary tuberculosis were recruited over a period of 16 months. They were Mantoux-tested with 0.1 ml of 5TU of PPD which was interpreted thus: <5 mm = negative, =5 mm = positive. CD4+ counts were determined using Dynabeads technique. The ages of all the patients ranged between 18 and 55 years (mean +/- SD: 33.9+/-8.42 years). The males had a mean age of 35.4 +/- 7.7 years while that of the females was 29.6+/-53 years (P<0.05). The CD4+ counts ranged between 73 and 512 cells/microl with a mean of 235.05 +/- 112.8 cells/microl. Fifty seven (71%) patients had negative PPD tests while 23 (29%) tested positive. Of the 37 with CD4+ counts <200 cells/microl, 32 (86.48%) had negative reaction (<5 mm) and 5 (13.51%) were positive (=5 mm) as compared to those with CD4 counts =200 cells/microl, among whom 25 (58.13%) were negative and 18 (41.86%) were positive (P<0.05). The positive predictive value was low at 56.14%. The difference in mean indurations between those with CD4+ count <200 cells/microl versus those with CD4+ count =200 cells/microl was statistically significant (P<0.05). On the whole, Mantoux indurations were noted to weakly correlate positively with CD4+ counts (Pearson's correlation, r=+0.36, P=0.001. It was concluded that there is a weak positive correlation between Mantoux reaction and CD4+ cell counts and that the Mantoux test is a poor predictor of CD4+ cell count.

Anthropometric evaluation of cachexia in chronic congestive heart failure: the role of tricuspid regurgitation.

Cardiac cachexia has recently been identified as an independent risk factor for mortality in chronic congestive heart failure. The aims of our study were to further identify the clinical or biochemical predictors or correlates of the cachexia, and to quantitate the magnitude of wasting. We undertook an anthropometric comparison of 30 patients with congestive heart failure, aged 56 (13) years, with ten age- and sex-matched healthy volunteers and 16 patients with essential hypertension. In comparison to the healthy volunteers, the heart failure patients exhibited a trend towards a lower body mass index, 21 (2.7) versus 23 (3.8) kg/m2, the 95% confidence interval for the difference being -0.54 to 5.4. However, the mid-upper arm circumference, of 24 (3.8) cm in the heart failure patients, was significantly (P<0.02) lower than the 27 (2.0) cm in the healthy volunteer group, with a 95% confidence interval for the difference being 1.18 to 4.82 cm. The triceps, mid-thigh, scapula and abdominal skinfold thicknesses were separately and significantly (P<0.05) diminished in the heart failure patients compared to the healthy controls. The sum of the four skin fold thicknesses, with a value of 68 (13) mm in the healthy volunteers, was highly significantly greater (P<0.001) than the value of 35.6 (9) mm in the heart failure patients. The 95% confidence interval for this difference was 22.7 to 41.3 mm. The patients with essential hypertension differed significantly from the heart failure patients in all of these parameters (P<0.01), but were not statistically different from the healthy controls in the anthropometric parameters. Among the heart failure patients, those with tricuspid regurgitation (n = 12) had a worse clinical, biochemical and cachexia profile compared to patients without the tricuspid regurgitation (n = 18). The values (tricuspid regurgitation versus no regurgitation) were New York Heart Association Class, 3.5 (0.65) versus 2.7 (0.75), P<0.01; ejection fraction of 34 (9) versus 43 (13)%, not significant; greater hepatomegaly of 159 (31) versus 135 (29) mm, P<0.05; more severe hypoalbuminemia, 24.5 (2.7) versus 28.5 (6.8) g/l, P<0.05; and worse hyponatremia, 128 (4) versus 133 (5) mmol/l, P<0.05. The tricuspid regurgitation group had a significantly more severe reduction in abdominal and scapula skin fold thickness (P<0.01) than that found in patients without tricuspid regurgitation. The sum of the four skin fold thicknesses was significantly lower (P<0.05) in tricuspid regurgitation, 30.9 (8) mm, than in heart failure without associated regurgitation, 38.0 (9.6). The 95% confidence interval for the difference was 0.8 to 13.4 mm. It is concluded that significant diminution of muscle bulk and subcutaneous fat occurs in chronic heart failure. Tricuspid regurgitation may be an accentuating and accelerating risk factor for cardiac cachexia, on account of a greater hypoalbuminemia and hyponatremia, which, presumably, results from the associated protein-losing enteropathy.