Clinical usefulness of a timed overnight (8 hours) Urine Albumin (microalbumin) excretion in monitor-ing treatment in benign essential hypertension.

AIMS AND OBJECTIVES: This research aims to establish the usefulness of timed over- night (8 hours) Urine Albumin(microalbumin) Excretion (UAE), in monitoring therapy in Nigerian patients with benign essential hypertension. SUBJECTS AND METHODS: The study population comprised 40 normotensives/controls, (23 males and 17 females) aged between 20-70 years, with a mean blood pressure 116/75mmHg, 30 well-controlled hypertensive patients, diastolic BP <100mmHg or MAP (mean arterial pressure) = 110mmHg and 30 poorly controlled hypertensive patients, diastolic blood pressure > 100mmHg or MAP >110mmHg.Urine albumin(microalbumin) was determined on the 8 hours overnight urine samples by ELISA method using kit from Randox Laboratories Limited, N.Ireland Cat No. MA 1410. UAE was calculated from the urine albumin concentration, urine volume and collection time. The intra assay precision was determined by running 20 replicates of two kit controls in a single batch. The coefficient of variation was 6.6% at 10.70mg/L and 4.3% at 51.20mg/L. RESULTS: The average UAE in the three groups were as follows: 12:22 +/-4.65ug/ min, 21.50 +/- 10.5ug/min and 30.10 +/- 24.25 ug/min in the control, well controlled and poorly controlled groups respectively, 12.5% of normotensive subjects, 40% of well controlled and 56.7% of poorly controlled patients were found to have microalbuminuria.The UAE increased significantly with the severity of hypertension (r = 0.32, p<0.001 for control) r = 0.38, p<00.05 for controlled and r = 0.49 p<0.05 for poorly controlled. CONCLUSION: A timed overnight (8 hours) Urinary UAE is a preferred alternative to cumbersome 24 hours urine collection for monitoring response to treatment in Nigerian patients with benign essential hypertension.

Abdominal pain and a raised amylase? It's not always pancreatitis. . .

We report the case of a 72 year old man with a history of COPD and heavy alcohol consumption who was initially diagnosed with acute pancreatitis based on a presentation with epigastric pain and elevated serum amylase. Review of his notes revealed several previous similar admissions and extensive normal investigations apart from persistently elevated amylase. Further analysis showed evidence of macroamylasaemia which accounted for the apparently high serum amylase level.

Evaluation of a locally-made urease test for detecting Helicobacter pylori infection.

We studied the efficacy of a home-made urease test (HUT) in the detection of Helicobacter pylori (HP) infection in patients undergoing upper gastrointestinal endoscopy. In the first phase of the study, two antral biopsies each were obtained from 43 patients for urease tests using the CLOtest and a home-made buffered 2% urea solution with phenol red as indicator at pH 6.8 (2% HUT). Twenty-six patients (60.5%) were HP positive, both by the 2% HUT and CLOtest with 100% concordance. In the second phase of the study three antral biopsies each and blood were obtained from 42 patients for the determination of HP status using a 10% HUT and a combination of culture and serology. Twenty-three patients (54.8%) were HP positive using the 10% HUT, while 32 patients (76.2%) were positive using the combination of 2 tests. Compared to this the sensitivity and specificity of the 10% HUT were 72% and 100% respectively. The CLOtest produced a colour change in a shorter time than the 2% and 10% HUT (median 1 hour versus 10 hours versus 16 hours p < 0.0001). In the third phase of the study, we observed that by doubling the biopsy size, the time required to obtain a colour change was significantly reduced (median 4.5 hours versus 10 hours p < 0.05). The HUT is easy to prepare, cheap, sufficiently sensitive and it is reliable enough to start treatment when positive. With 100% concordance and 1% the cost per test when compared to the commercially available CLOtest; the 10% HUT is hereby recommended for the detection of UP infection in our region.

Gastric antral juxtamucosal pH in helicobacter pylori positive and negative dyspeptic patients.

Maintenance of gastric juxtamucosal pH at a stable near neutral value may be the cumulative effect of the various components of the mucosal defense system. In order to assess the effect of helicobacter pylori (HP) infection on mucosal defense, we measured the gastric antral juxtamucosal pH in 40 dyspeptic patients by using a flexible glass pH microelectrode which can be passed down the instrument channel of standard gastroscopes. HP status was determined using serology, culture, histology and urease test. We also investigated the relationship between juxtamucosal pH and the severity of antral HP infection. The mean antral juxtamucosal pH in 26 (65%) HP positive patients was 6.49 +/- 0.20 compared to 6.19 +/- 0.21 in 14 (35%) HP negative patients (p < 0.00001). Other factors like age, sex, duodenogastric reflux or presence of chronic duodenal ulcer did not significantly affect juxtamucosal pH (p > 0.05). Subset analysis of data on HP positive patients (n = 26) revealed no significant correlations between antral chronic gastritis anti-HP IgG titre and antral juxtamucosal pH (p > 0.05). This study shows that HP increases gastric antral juxtamucosal pH. This finding supports the suggested role of HP in producing hypergastrinaemia and gastric acid hypersecretion.