Serum Levels of Micronutrients, Magnesium, and Markers of Immunity (CD4+ ) in Antiretroviral-naïve HIV-infected Individuals: Relationships and Predictors.

BACKGROUND: HIV/AIDS may lead to micronutrient deficiencies and low CD4+ count. OBJECTIVES: We assessed the correlation of CD4+ count in antiretroviral-naïve patients with the serum levels of micronutrients as measures of the relationship between immunity and nutrition/malnutrition. METHODS: A case-control study of ninety consecutive newly diagnosed HIV/AIDS patients and ninety blood donors. Blood collected from controls and patients before HAART treatment were assayed for serum zinc, selenium, copper, manganese, and magnesium. RESULTS: The participants had non-significantly lower zinc (14.25±2.93µmol/l versus 14.58±3.69µmol/l, p=0.493), significantly lower selenium (0.38±0.08µmol/l versus 0.78±0.22µmol/l, p<0.001), manganese (7.06±0.87µmol/l versus 11.23±3.27µmol/l, p<0.001), and magnesium (1.02±0.21mmol/l versus 1.21±0.28mmol/l, p<0.001) when compared with the controls. The mean copper level was similar in both groups (18.88±3.1µmol/l and 18.82±5.12µmol/l, p=0.921). There was no correlation between the micronutrients and CD4+ count; however, there were strong positive correlations between the levels of zinc and copper, selenium, magnesium; copper and magnesium (p<0.001 respectively). Multivariate regression showed that all micronutrients were independent predictors of one another (p<0.001). CONCLUSION: HIV/AIDS results in serum micronutrient depletion with strong positive correlations between their levels; all micronutrients were independent predictors of one another. This significant positive relationships between the micronutrients, and magnesium; and all other micronutrients being independent predictors of each other signifies a synergistic or supportive relationship between micronutrient deficiencies and HIV/AIDS disease morbidity and progression. Serum micronutrients may not be qualified as direct markers or surrogates for CD4+ count in antiretroviral-naïve HIV-infected patients.

Serum cartilage oligomeric matrix protein as a biomarker for predicting development and progression of knee osteoarthritis.

PURPOSE: Current modes of diagnosing and monitoring knee osteoarthritis (OA) are based on weight bearing radiographs usually made by the time joint destruction is already established. Cartilage oligomeric matrix protein (COMP) is a breakdown product of cartilage and its serum levels may be a potential indicator of early destruction in OA. This study aimed to ascertain the usefulness of serum COMP (sCOMP) in diagnosis and monitoring of knee joint OA within the study environment. METHODS: Ninety consenting adults were recruited. In the control group, 45 subjects having a diagnosis of knee OA had clinical and radiological grading done and blood samples taken for assay of sCOMP using the sandwich ELISA method. Forty-five volunteers with no features of osteoarthritis also had serum collected for sCOMP assay. Values obtained were then cross referenced with demographic indices, clinical and radiological severity grade to assess for relationships. RESULTS: Serum COMP was found to be significantly elevated (p = 0.0001) in the study group. The mean values and standard deviation of sCOMP were 3400 ± 1042.9 ng/ml and 2222 ± 605.6 ng/ml for the study and control groups, respectively. Higher values of sCOMP were found to be associated with higher clinical and radiological grades of OA. CONCLUSION: The study demonstrates that sCOMP is significantly higher in patients with knee OA than in those without the disease. Values of sCOMP were also found to increase with severity of knee OA, indicating the possibility of its use as a marker of diagnosis and severity.

The Inflammatory Response to Surgery in Sickle Cell Disease Patients Undergoing Cholecystectomy.

BACKGROUND AND OBJECTIVES: Patients with sickle cell anemia (SCA) may have elevated inflammatory markers in health, and this may be heightened after open operations. The inflammatory response of patients with SCA after minimally invasive surgeries has not been fully explored. PATIENTS AND METHODS: Consecutive patients with SCA and with hemoglobin AA (HbAA) undergoing laparoscopic cholecystectomy for acute cholecystitis were recruited into the study. Blood samples were taken before induction of anesthesia (0-h); at 4, 12, 24, and 48 h; and on postoperative day 7. Samples were analyzed for serum C-reactive protein and interleukin (IL)-1 through IL-18. RESULTS: Twenty-three patients, including 9 with SCA and 14 with HbAA, were recruited with 4 cases performed by open laparotomy. At 0-h, proinflammatory IL-1 levels (6.1 versus 4.8) and C-reactive protein levels (32.5 versus 26.6) were higher in patients with hemoglobin SS (HbSS) than in patients with HbAA, respectively. Over time, inflammatory markers were generally higher at each time-point for patients with HbSS compared with patients with HbAA for both proinflammatory and anti-inflammatory cytokines, rising immediately after surgery and up to 48 hours, then returning to baseline by postoperative day 7. There was a higher mean IL-1 level across all time-points in the HbSS group than in the HbAA group (P = .04). CONCLUSION: This exploratory study found an enhanced inflammatory response to cholecystectomy in patients with SCA compared with patients with HbAA. Minimally invasive surgical strategies for this patient group may help to mediate this response.