Relationship between Glycaemic Control and Oral Immunologic Proteins.

BACKGROUND: Attaining a good glycaemic control is usually the target for therapy in diabetic patients as this is expected to prevent both acute and chronic complications. Oral infections are however very common among diabetic patients despite the presence of many immunologic proteins in the saliva. This study was designed to determine the impact of glycaemic control on levels of these proteins in diabetic patients. METHODS: Salivary lysozyme, histatins, immunoglobulin A and immunoglobulin G were measured in diabetic patients. The levels of these immunologic proteins were compared between patients whose HbA1c were less than 7% and those whose values were greater than or equal to 7%. RESULTS: A total of 95 participants were recruited for this study with 37 (38.9%) of them having a median HbA1c of 6.3% (IQR 5.3- 6.6) and the remaining 58 (61.1%) having a median HbA 1c of 9.1% (IQR 8.1-10.5). There was no significant difference in salivary lysozyme (31.24 vs 33.77 ng/ml; p = 0.69), histatins (9.65 vs 9.17 ng/ml; p = 0.27), IgA (12.79 vs 12.19 µg/ml; p = 0.16) and IgG (31.29 vs 32.49 µg/ml; p = 0.85) between the group with good and those with poor glycaemic control. CONCLUSION: This study showed that glycaemic control does not impact the levels of salivary immunologic proteins in diabetic patients, so quality attention should be given to oral care to avoid the development of oral complications.

CONTEXTE: L'obtention d'un bon contrôle glycémique est généralement l'objectif du traitement des patients diabétiques, car il est censé prévenir les complications aiguës et chroniques. Les infections buccales sont cependant très fréquentes chez les patients diabétiques malgré la présence de nombreuses protéines immunologiques dans la salive. Cette étude a été conçue pour déterminer l'impact du contrôle glycémique sur les niveaux de ces protéines chez les patients diabétiques. MÉTHODES: Le lysozyme, les histatines, l'immunoglobuline A et l'immunoglobuline G salivaires ont été mesurés chez les patients diabétiques. Les niveaux de ces protéines immunologiques ont été comparés entre les patients dont le HbA1c était inférieur à 7 % et ceux dont les valeurs étaient supérieures ou égales à 7 %. RÉSULTATS: Au total, 95 participants ont été recrutés pour cette étude, 37 (38,9 %) d'entre eux ayant une HbA1c médiane de 6,3 % (IQR 5,3- 6,6) et les 58 autres (61,1 %) ayant une HbA1c médiane de 9,1 % (IQR 8,1- 10,5). Il n'y avait pas de différence significative dans le lysozyme salivaire (31,24 vs 33,77 ng/ml ; p= 0,69), les histatines(9,65 vs 9,17 ng/ml ; p= 0,27), les IgA (12,79 vs 12,19 ?g/ml ; p= 0,16) et les IgG (31,29 vs 32,49 ?g/ml ; p= 0,85) entre le groupe avec un bon et celui avec un mauvais contrôle glycémique. CONCLUSION: Cette étude a montré que le contrôle glycémique n'a pas d'impact sur les niveaux de protéines immunologiques salivaires chez les patients diabétiques, une attention de qualité devrait donc être accordée aux soins bucco-dentaires pour éviter le développement de complications orales. Mots clés: Diabète, Contrôle glycémique, Protéines salivaires, Cavité orale, Protéines immunologiques.

Are roadside petrol dispensers at risk of oxidative stress? a study from gombe, North East Nigeria.

BACKGROUND: Gasoline is one of the most frequently utilized chemicals whose use is on the increase. Exposure to the volatile constituents of gasoline generates free radicals leading to oxidative stress. This is associated with nucleic acid, lipids, and protein damages leading to chronic diseases including cancers. Occupational exposure to this product is of public health concern, especially in the developing countries where the awareness and enforcement of safety measures are not adequate. MATERIALS AND METHODS: Plasma level of total antioxidant status (TAS) was compared between 90 roadside dispensers of gasoline and 90 age- and sex-matched controls. TAS was measured using standard colorimetric method. RESULTS: The mean age of the exposed and control groups is 29.03 ± 3.7 and 29.24 ± 3.5 years, respectively. The mean plasma TAS level of the exposed (0.60 ± 0.33 mmol/L) was significantly (P < 0.001) lower than that of the controls (1.29 ± 0.25 mmol/L). CONCLUSION: Our data have demonstrated higher level of oxidative stress in roadside dispensers of gasoline compared to the controls. This is an indication that roadside gasoline dispensers are probably at greater risk of developing chronic diseases associated with increased oxidative stress. Antioxidant supplementation may be of benefit to the roadside gasoline dispensers. Legislation on roadside gasoline dispensing should be enforced to reduce the incidence of long-term complications from repeated exposures.

Vitamin D Levels and Insulin Resistance among Nigerian men with Type-2 Diabetes mellitus

Background: A number of studies have shown a high prevalence of insufficient vitamin D levels in humans in the North American, European and Asian regions. Various research works have also shown that low serum vitamin D levels play a major role in the pathogenesis of chronic, non-infective illnesses such as diabetes mellitus and cancer.Objective: This study was aimed at assessing the serum vitamin D status in relation to glucose homeostasis among men with Type-2 Diabetes mellitus and normal controls.Methods: This comparative cross-sectional study included 80 men with confirmed diagnosis of Type-2 diabetes mellitus and 49 normal adult male controls. Serum 25-hydroxy vitamin D, fasting serum C-peptide and fasting plasma glucose levels were measured in both study groups.Results: There was a significant difference between the mean serum 25-OH vitamin D levels among the cases (36.55ng/mL) and the controls (42.96ng/mL) (p = 0.001). All the four 25-OH vitamin D-deficient subjects had diabetes. In the diabetes group, 43.8% had a normal insulin resistance compared to 61.8% of the control group (p = 0.054). In the diabetes group, 73.8% had sufficient vitamin D, 21.2% had insufficient vitamin D and 5% had vitamin D deficiency. In the control group, there was a significant negative correlation between serum 25-OH vitamin D and BMI and fasting plasma glucose. The mean HOMA2IR value for the diabetes group (3.09) was higher than the value for the controls (2.40).Conclusion: The mean serum 25-OH vitamin D level in the diabetes group was lower than that of the control group hence, hypovitaminosis D may be a contributor to the onset of diabetes mellitus among Nigerian men

Malondialdehyde and antioxidant enzymes in second and third trimesters of pre-eclamptic Nigerian women.

AIM AND OBJECTIVE: To determine changes in malondialdehyde (product of lipid peroxidation) and antioxidant enzymes (Superoxide Dismutase, Glutathione Per-oxidase) levels in pre-eclamptic Nigerian women PATIENTS AND METHODS: A Total of 100 subjects each for pre-eclamptic,apparently normal and non pregnant women were recruited into the study.Venous blood samples were taken from the participants during second and third trimesters of pregnancy and at the point of contact for non pregnant women. Malondialdehyde, glutathione peroxidase and superoxide dismutase were measured accordingly from plasma and haemolysate prepared from whole blood.Variables were analysed using SPSS version 16, taking level of significance to be 0.05 RESULTS: Plasma malondialdehyde in the third trimester (3.13±0.61umol/l) of pre-eclamptic subjects was higher than in the second trimester (3.00±1.21umol/l).Plasma malondialdehyde in the third trimester of normal pregnancy (2.03±0.71umol/l) was also found to be significantly higher than in the second trimester (1.65±0.62umol/ l)(p<0.0001). Glutathione peroxidase in pre-eclamptic subjects was significantly higher in the third trimester (2804.11±1573.00U/L) as compared to the second trimester (2655.00±1751.30U/L), p= 0.0001.Glutathione peroxidase activity in the third trimester of normal pregnancy(3339.50±1733.80U/L) was also found to be higher than in the second trimester(3023.50±1115.90U/L)(p=0.131). Superoxide dismutase activity was significantly lower in the third trimester of pre-eclamptic pregnancy when compared to second trimester (110.40±59.47 Vs 118.01±64.41 U/ ml)(p<0.039) .Similarly,superoxide dismutase activity was significantly lower in the third trimester of normal pregnancy (110.40±59.47U/ml) than in the second trimester(153.01±71.85U/ml)(p<0.0001). CONCLUSION: There was an increased level of lipid peroxidation products,malondialdehyde in subjects with pre-eclampsia. This was more in the third trimester. There was an increased oxidative stress in pre-eclampsia as evidenced also by low serum level of superoxide dismutase in the third trimester.Diet rich in antioxidant enzyme might be beneficial.

Excess renal insufficiency among type 2 diabetic patients with dip-stick positive proteinuria in a tertiary hospital.

BACKGROUND: Most patients with Diabetic Nephropathy (DN) in developing countries are detected at the rather late stage of clinical nephropathy by routine semi-quantitative dip-stick urinalysis. Some patients with DN have been reported to have renal insufficiency at the time of diagnosis. Little is known about the GFR status of such macroalbuminuric Nigerian diabetic patients. The aim of this study was to assess levels of creatinine and GFR in dip-stick positive type 2 diabetic patients at the University College Hospital (UCH), Ibadan, Nigeria. METHODOLOGY: A cross-sectional study was carried out. Forty dip-stick positive out of 79 randomly screened patients with T2DM attending the Diabetes Clinic of UCH, Ibadan who met selection criteria were recruited. Data were obtained on demography, diabetes history, and blood pressure. Samples were collected and analysed for 24-hour urinary protein, creatinine, and blood glucose. Creatinine clearance was estimated by Cockroft-Gault formula. RESULTS: There were 25 (62.5%) females and 15 (37.5%) males. The mean age of subjects was 59.4 years (SD 11.25). Twenty-seven (67.5%) had elevated serum creatinine, 33 (82.5%) were macroalbuminuric, while 36 (90%) had creatinine clearance indicating renal insufficiency. Also 18 (45%) patients and 19 (47.5%) had suboptimal blood pressure control and glycaemic control. CONCLUSION: We concluded that there appears to be excess renal insufficiency among type 2 diabetic patients with overt proteinuria in UCH, Ibadan. Diabetic patients with overt proteinuria should immediately be assessed for renal insufficiency and appropriate measures instituted to prevent or delay progression to ESRD.

Thyroid dysfunction in type 2 diabetics seen at the University College Hospital, Ibadan, Nigeria.

Thyroid dysfunction complicates the metabolic derangement observed in Diabetes Mellitus (DM). It is necessary to recognize and treat it when present in order to achieve stability of metabolic control in these patients. The prevalence of thyroid dysfunction in type-2 diabetics in our environment is not known. This study was therefore designed to determine the prevalence of thyroid dysfunction in Type 2 diabetics seen at the Metabolic Research Unit of University College Hospital, Ibadan, Nigeria. Serum TSH, Free T3 and Free T4 assays were performed using Automated Enzyme Immunoassay platform on fresh sera from volunteers comprising 64 adult type 2 diabetics and 36, age matched, non diabetic controls; weight, height and blood pressures were measured in all subjects. In addition, past lipid profile results of type 2 diabetics were retrieved from medical records. Thyroid dysfunction was present in 19 (29.7%) of 64 type 2 diabetics and 1 (2.8%) of 36 non diabetic controls.The prevalence of thyroid dysfunction is 32.4% in females and 25.9% in males. Secondary hypothyroidism was seen in 78.9%, sub-clinical hypothyroidism in 15.8%, and sub-clinical hyperthyroidism 5.2% of subjects with thyroid dysfunction. Abnormal lipid profiles were seen in 35.4% of euthyroid type 2 diabetics and 100% of hypothyroid type 2 diabetics. 87.5% of type 2 diabetics and 38.8% of controls were hypertensive. 7.8% of type 2 diabetics and 50% of controls were obese. The prevalence of thyroid dysfunction in type 2 is higher in type 2 diabetics than in controls. More of Type 2 diabetics were obese and more of them were hypertensive compared to controls. The approach of using TSH first in screening for thyroid dysfunction is not sufficient in type 2 diabetics. Routine screening for thyroid dysfunction should be carried out in type 2 diabetics.

Liver enzymes in Nigerians with lichen planus.

INTRODUCTION: Lichen planus has been reported in association with liver diseases. Clinical signs such as jaundice may not be reliable indicator of ongoing inflammation or the presence of an ongoing liver disease. Liver function test in spite of its variability may serve as a more reliable indicator of liver disease. The objective of this study is to assess the discriminant power of liver enzymes with lichen planus and control. METHODS: Sixty Nigerians with lichen planus (LP group) and 30 patients with other dermatoses control group A) and 30 apparently normal individual (control group B) had their liver enzymes assayed using the automated Hitachi 70 auto-analyzer. RESULT: There was no a statistically significant difference in the level of liver enzymes between the LP group and controls. CONCLUSION: Liver enzymes in Nigerian with lichenplanus are generally within normal limits and are comparable to individuals without lichen planus.

Effect of increased patient-physician contact time and health education in achieving diabetes mellitus management objectives in a resource-poor environment.

INTRODUCTION: Diabetes mellitus remains a significant universal health problem. Globally, the prevalence of diabetes mellitus is projected to grow from 135 million in 1995 to 300 million in 2025. Due to inadequate healthcare facilities and providers, poverty, and illiteracy coupled with increasing prevalence of diabetes mellitus, there is limited patient-physician contact time. As a result, patients with diabetes mellitus develop complications and die early in life due to poor management. This has grave economic implications as diabetes mellitus principally affects people in their most productive years of life. A cross-sectional and longitudinal study on patients with type 2 diabetes mellitus was carried out to demonstrate how diabetic management objectives can be achieved in a resource-poor environment by increasing patient-physician contact time and with health education. METHODS: One group of 105 consecutive patients with type 2 diabetes mellitus were recruited and managed in the metabolic research unit (MRU), where health education was emphasised for five years, served as the intensively-treated cohort (ITC). Another group of 115 patients with type 2 diabetes mellitus were also recruited and managed over the same five-year period in the medical outpatient department (MOPD) of the same hospital, where there was patient congestion at the clinic, served as the control cohort (CC). The CC also reported to the MRU during their follow-up for measurement of their blood pressure and urinalysis. Other measurements for the CC were obtained from the MOPD on the same day of their visit to the MRU. Morbidities were recorded on recruitment, at each visit, and at the end of the study in each cohort. RESULTS: There was a marked reduction of morbidity at the end of the study in the ITC (222 versus 106, p-value is 0.0013), compared to the CC (138 versus 130, p-value is greater than 0.05). There was also a significant reduction in the number of patients with individual morbidities in the ITC, while significant reduction was only noticed in hypertension, eye problems, neuropathies, infections/boils, and ulcer/blisters in the CC. In 85 percent of the ITC, plasma glucose clustered around the target of the study as compared to only 58 percent of the CC. CONCLUSION: Diabetes mellitus management objectives can be achieved by increasing both patient-physician contact time and health education in addition to other conventional forms of treatment, especially in a resource-poor environment.

Agouti-related protein promoter variant associated with leanness and decreased risk for diabetes in West Africans.

OBJECTIVE: The role of the central melanocortin system in the development of obesity has been extensively studied. Single-nucleotide polymorphisms (SNPs) within several candidate genes have been associated with food intake and obesity-related phenotypes; however, few of these associations have been replicated. SNPs in the agouti-related protein (AGRP) gene coding (Ala67Thr, 199G/A) and promoter (-38C/T) have been reported to be associated with body mass index (BMI), fat mass (FM) and percent body fat, in populations of European and African descent. In this study, we evaluated the association between the functional AGRP -38C/T promoter SNP and weight-related traits, namely BMI, FM and fat-free mass (FFM), as well as diabetes status. DESIGN: An association study of the AGRP -38C/T SNP and indices of obesity and diabetes status. SUBJECTS: A well-characterized population of 538 West Africans from Ghana and Nigeria recruited in the AADM (Africa America Diabetes Mellitus) study (mean age 52 years, 41.3% males, 71% diabetic). MEASUREMENTS: Genotyping of the AGRP -38C/T SNP, BMI, FM, FFM and fasting plasma glucose. RESULTS: Women carrying two copies of the variant T allele had significantly lower BMI (OR=0.47; 95% CI, 0.25-0.87). Also, men with at least one copy of the variant T allele were over two times less likely to be diabetic than other men (OR=0.44; 95% CI, 0.22-0.89). CONCLUSION: Our results replicate previous findings and implicate the AGRP -38C/T SNP in the regulation of body weight in West Africans.

Serum and seminal plasma hormonal profiles of infertile Nigerian male.

Male infertility constitutes a worldwide problem, especially in Nigeria where most men do not readily accept that they may contribute to the couple's infertility. In order to assess hormonal disturbances in the male infertility we compared male reproductive hormonal levels in human serum and seminal plasma and evaluated the hypothalamic-pituitary-testicular-axis in infertile Nigerian males. The biophysical semen parameters were assessed by W.H.O. standard manual method. Serum and seminal plasma male reproductive hormones (Leutinizing hormones, Follicular stimulating hormone, Prolactin and Testosterone) were measured by Enzyme Immunoassay (EIA) technique of W.H.O. in sixty (60) infertile adult male Nigerians (Oligospermic; n = 40 and azoopermic; n = 20) and forty controls of proven fertility (Normospermic subjects; n = 40). The results show that the serum concentrations of gonadotropins (LH and FSH) were significantly higher (P<0.05) in infertile subjects than controls. Patterns of serum prolactin levels were similar. The values of gonadotropins in serum were significantly higher (P<0.05) than those of seminal plasma. Seminal plasma testosterone in infertile subjects was significantly higher (P<0.005) than that of controls but the serum levels of testosterone were significantly higher (P<0.05) in azoospermic than oligospermic subjects and controls. There was no significant correlation between serum hormonal level and seminal plasma hormonal level in all the groups (P<0.05). We concluded that male infertility in Nigerians is characterized by hyperprolactinaemia, raised serum gonadotropins (LH, FSH), and raised seminal plasma testosterone. Hormonal profiles in serum and seminal plasma were not significantly correlated, and hence cannot be used as exclusive alternative in male infertility investigations. The observed spermogram in spite of significant elevation of seminal plasma testosterone in infertile males investigated suggests Sertoli cells malfunction.

A genome-wide scan for quantitative trait loci linked to obesity phenotypes among West Africans.

OBJECTIVE: To identify quantitative trait loci (QTL) for three obesity phenotypes: body mass index (BMI), fat mass (FM) and percent body fat (PBF) in West Africans with type 2 diabetes (T2DM). DESIGN: An affected sibling pair (ASP) design, in which both siblings had T2DM. Obesity was analyzed as a quantitative trait using a variance components approach. SUBJECTS: Sib-pairs affected with T2DM from the Africa America Diabetes Mellitus (AADM) study, comprising 321 sibling pairs and 36 half-sibling pairs. MEASUREMENTS: Weight was measured on an electronic scale to the nearest 0.1 kg, and height was measured with a stadiometer to the nearest 0.1 cm. Body composition was estimated using bioelectric impedance analysis (BIA). Genotyping was carried out at the Center for Inherited Disease Research (CIDR) with a panel of 390 trinucleotide and tetranucleotide repeats. RESULTS: The obesity-related phenotype showing the strongest linkage evidence was PBF on chromosome 2 (LOD 3.30 at 72.6 cM, marker D2S739). Suggestive linkage to FM was found on chromosomes 2 (LOD 2.56 at 80.4 cM) and 5 (LOD 2.25 at 98 cM, marker D5S1725). The highest LOD score for BMI was 1.68 (chromosome 4, 113.8 cM). The areas of linkage for the three phenotypes showed some clustering as all three phenotypes were linked to the same regions of 2p13 and 5q14, and our study replicated linkage evidence for several regions previously reported in other studies. CONCLUSION: We obtained evidence for several QTLs on chromosome 2, 4 and 5 to three obesity phenotypes. This study provides data on the genetics of obesity in populations that are currently under represented in the global effort directed at understanding the pathophysiology of excess adiposity in free living individuals.

The significance of autonomic symptoms in Nigerian diabetics.

Diabetes mellitus is the most common endocrine disorder worldwide and disturbance of autonomic function is a frequent complication. Symptoms of autonomic neuropathy are however non-specific and the aetiology is multifactorial in diabetics. This study was carried out to determine the relationship between symptoms of autonomic neuropathy and pathology of the autonomic nervous system in diabetic patients. A hundred diabetics were studied, 50 with, and 50 without symptoms of autonomic neuropathy. Objective test of autonomic function used were the heart rate responses to deep breathing, to standing and to the Valsava manoeuvre; and the blood pressure responses to standing and to sustained handgrip. There was no significant difference between diabetics with symptoms suggestive of autonomic neuropathy, and those without, with regard to findings on autonomic function testing. While the symptoms were unreliable in determining the presence of autonomic neuropathy, they were significantly related to poor glycaemic control and to peripheral neuropathy (P < 0.01). The symptoms of autonomic neuropathy are non-specific in Nigerian diabetics and may reflect poor glycaemic control rather than autonomic neuropathy. Autonomic function tests should be carried out in diabetics suspected of having autonomic neuropathy.

Glucose and insulin responses in offspring of Nigerian Type 2 diabetics.

Type 2 diabetes mellitus has a strong genetic basis by a concordance rate ranging between 60 and 90% in monozygotic twins. Glucose and insulin responses to an oral glucose load were measured in 52 offspring of Nigerian Type 2 diabetics and 50 control subjects selected to achieve a similar distribution of age and gender. All subject studied were glucose tolerant. In comparison with control subjects, offspring of Type 2 diabetics had a significantly higher mean (SD) (i) fasting plasma glucose level [69.2 (13.0) mg/dl vs. 62.2 (7.6) mg/dl; P = 0.0012] (ii) fasting plasma insulin level [26.6 (15.4) microIU/ml vs 14.8 (6.8) microIU/ml; P < 0.0001] (iii) 2 hours post glucose load plasma insulin level [59.8 (33.9) microIU/ml vs. 40.9 (24.2) microIU/ml; P = 0.0028]. The mean (SD) 2-hour post glucose load plasma glucose level did not differ significantly between both groups of subjects [92.8 (23.8) mg/dl vs. 85.5 (21.3) mg/dl; P = 0.11]. Further multiple regressional analysis showed that the differences in fasting plasma insulin and 2-hour post glucose load insulin observed were only accounted for by the presence of a parental history of diabetes and were not influenced significantly by BMI, waist and hip circumferences. This study shows that offspring of Nigerian Type 2 diabetics have hyperinsulinaemia, despite being glucose tolerant and this supports the insulin-resistance hypothesis for Type 2 DM. This implies that they are at a greater risk for developing diabetes mellitus and are therefore an important group for the primary prevention of Type 2 DM.

In search of susceptibility genes for type 2 diabetes in West Africa: the design and results of the first phase of the AADM study.

PURPOSE: The purpose of this study is to map type 2 diabetes susceptibility genes in West African ancestral populations of African-Americans, through an international collaboration between West African and US investigators. DESIGN AND METHODS: Affected sib-pairs (ASP) along with unaffected spouse controls are being enrolled and examined in West Africa, with two sites established in Ghana (Accra and Kumasi) and three in Nigeria (Enugu, Ibadan, and Lagos). Eligible participants are invited to study clinics to obtain detailed epidemiologic, family, and medical history information. Blood samples are drawn from each participant to measure glucose, insulin, C-peptide, total cholesterol, LDL, HDL, triglycerides, albumin, creatinine, urea, uric acid, total calcium and to detect autoantibodies to glutamic acid decarboxylase (GAD). DNA is isolated from frozen white blood cells obtained from 20 ml of EDTA whole blood samples. RESULTS: With full informed consent, 162 individuals from 78 families have been enrolled and examined since the Africa America Diabetes Mellitus (AADM) study began in June of 1997. Logistics of field examinations and specimen shipping have been successfully established. At the end of the third year of field activity (September 2000) the AADM study will have enrolled and performed comprehensive examination on 400 ASP with type 2 diabetes, for a minimum of 800 cases and 200 controls from Ghana and Nigeria. At the current participation rate, the goal of 400 sib-pairs and 200 controls will be met before the scheduled closing date. CONCLUSIONS: The AADM study will create a comprehensive epidemiologic and genetic resource that will facilitate a powerful genome-wide search for West African susceptibility genes to type 2 diabetes.

Microalbuminuria in controlled type 2 diabetes mellitus patients.

Microalbuminuria assessment using albumin: creatinine ratio (ACR) by ELISA in early morning urine sample was studied in 83 (43 males, 40 females) normotensive type 2 diabetic patients and 40 (20 males; 15 females) age matched apparently healthy control subjects attending the medical outpatient clinic of the University College Hospital, Ibadan. The prevalence of microalbuminuria among the diabetic patients was found to be 60% and 30% among the controls. The level of microalbuminuria was found to correlate with age, duration of diabetes, blood pressure and waist:hip ratio. In both the patients and the controls, microalbuminuria was uncommon below the age of 50 years. The study highlights the contribution of a background renal insult as the probable reason for the high prevalence of microalbuminuria.

Betke's and elution methods in estimation of haemoglobin F in sickle cell anaemia.

OBJECTIVE: To compare the effect of the type of spectrophotometer and method used in the estimation of HbF. DESIGN: Two sets of experiments were done. In the first set, paired blood samples were obtained from 28 adult sickle cell anaemia subjects. One of each pair of samples was analysed for HbF by Betke's method and the other by the elution method and the values obtained were compared. In the second set of experiments, ten other paired samples were analysed for HbF, one using an analogue spectrophotometer and the other using a digital spectrophotometer and the results compared. SETTING: Adult sickle cell clinic, University College Hospital, Ibadan, Nigeria. SUBJECTS: Thirty eight sickle cell anaemia patients. RESULTS: HbF levels estimated by the two methods showed good agreement as estimated by the Bland-Altman plot. HbF levels obtained by Betke's method correlated well with those obtained by the elution method (r = 0.59, p = 0.0015) and the mean values were similar (14.9% versus 13.5%, p=0.215). The values obtained by the analogue spectrophotometer showed poor agreement with those obtained by the digital instrument, with the mean value of the former being much lower than that of the latter. CONCLUSION: Both Betke's method and the elution method give similar results in the estimation of HbF so that for practical purposes, the two methods are interchangeable. The type of spectrophotometer used may have a major influence on HbF values obtained. Therefore, such information should be stated in any study reporting HbF values to facilitate interpretation.

Prostate specific antigen in the Nigerian African.

The biological characteristics of prostate-specific antigen were studied in the Nigerian African. Two hundred and fourteen persons were selected for the study. The group was made up of 59 apparently healthy men (age range 22-76 years), 58 men (age range 40-91 years) who had biopsy proven diagnosis of cancer of the prostate gland, 81 men (age range 46-87 years) who had biopsy proven benign prostatic hypertrophy (BPH) and 16 women (age range 23-47 years). Their median ages were 53 years, 66 years, 66 years and 27 years, respectively. The median PSA value among the control population was 0.7 ug/L (range 0.1-4.3 ug/L) and 98.3% of them had PSA of less than 4 ug/L. No person below 50 years of age had PSA value greater than 2 ug/L. There was a significant correlation between age and serum PSA value over the entire age range (r = 0.523; P = 0.001). In the female study group, 4(25%) had detectable values the cause of which could not be determined. The median PSA value among the BPH patients was 8.5 ug/L (range 0.2-350 ug/L). In this group 37% of them had values below 4 ug/L and 54.3% of them had values less than 10 ug/L. Among the patients who had cancer of the prostate gland the median PSA value was 92.6 ug/L and the mode was greater than 350 ug/L (32% of the patients); 10% and 20% of them had values below 4 ug/L and 10 ug/L respectively. It is concluded that the trend is the same as in the studies and there is the need for prostate gland volume studies and evaluation of women who have detectable PSA values.

Anterior pituitary gland assessment in sickle cell anaemia patients with delayed menarche.

Pituitary gland dysfunction and its contribution to menarcheal delay in sickle cell anaemia patients was investigated. Ten SS patients mean age 17.5 years who had not achieved menarche were recruited and 10 each of AS and AA controls, mean ages 17.4 and 17.7 years were used as controls to study the effect of the heterozygous state. Dynamic studies with LHRH and TRH were performed for 60 minutes and LH, FSH, PRL and TSH assays were done. Median basal values were significantly lower in the SS patients compared with the AS and AA controls for LH, FSH and PRL. LH: 3.0; 7.1; 7.7 U/L, FSH: 2.1: 4.3: 5.1 U/L. PRL: 94.5; 590; 390 U/L, respectively. The median basal TSH values did not show any significant difference between the SS subjects (7.3 U/L) and the AS and AA controls (5.4 U/L) and 5.6 U/L, respectively. The readily releasable pool also showed the same pattern for LH, FSH and PRL as the basal values while the SS subjects had higher median TSH releasable pool values that were significantly different from those of the AA controls. From the prolactin responses three subjects demonstrated maturational delay in menarcheal achievement while seven demonstrated isolated gonadotrophin deficiency. It is concluded that SS patients with delayed menarche have a hypothalamopituitary axis dysfunction that gives rise to delay in menarcheal achievement and metabolic adaptations to stress of illness. The heterozygous state did not delay menarcheal onset.

Endemic goitre prevalence in Ifedapo Local Government Area of Oyo State, Nigeria.

As part of efforts aimed at providing an adequate data base for the control of iodine deficiency disorders (IDD) in Nigeria, we undertook an extensive goitre survey of Ifedapo Local Government Area (LGA) of Oyo State, which lies within the goitre-belt of South-western Nigeria. Primary school pupils aged between six and twelve years were the subjects of the survey. From each of ten health districts of the LGA, one primary school was included in the survey. For each school, the entire school population was assessed for goitre by palpation and goitre graded according to WHO/ICCIDD criteria. The survey included 3599 pupils (1889 males and 1710 females). The total goitre rate (TGR) for the LGA was 23.4% while the visible goitre rate (VGR) was 6.4%. The highest goitre rate was recorded in District I (Sango, Saki) TGR = 39.5%; VGR = 17.3%), while the lowest rate was seen in District 4 (Wasengare) TGR = 5.2%; VGR = 0.7%). Females had higher goitre rates than males (TGR: 25.7% vs 21.3%; VGR: 7.5% vs 5.5%). Most of the goitres were Grades IA (36.7%) or IB (35.7%). Goitre grades 2 and 3 accounted for only 27.3% and 0.2%, respectively. These results show that there is a mild to moderate IDD problem in Ifedapo LGA. The implications of this finding, in view of the known deleterious consequences of IDD, are discussed and the need for correction highlighted.

Insulin responses following glucose administration in menstruating women.

OBJECTIVE: The aim of the study was to investigate changes in insulin sensitivity during the menstrual cycle, in a group of regularly menstruating black African women. METHOD: Insulin responses to intravenous glucose (300 mg/kg) were assessed, for up to 3 h, in 3 groups of age- and body mass-matched non-obese sedentary Nigerian women: Group A, 7 women in the menstrual follicular phase; Group B, 7 women in the menstrual luteal phase; C, 7 men. RESULT: Women in the menstrual luteal phase had the greatest integrated first-phase insulin response and insulin/glucose ratios, much higher than the similar values for these variables obtained in other groups. This suggests that the menstrual luteal phase is associated with relative insulin resistance. CONCLUSION: Black African women in the menstrual luteal phase demonstrate an exaggerated insulin response to an acute glucose load and are thus relatively insulin-insensitive. This confirms previous observations in Caucasians.