APOLIPOPROTEIN E GENE POLYMORPHISMS AND PLASMA LIPIDS IN PERSONS LIVING WITH HIV: A CROSS SECTIONAL STUDY.

Background and Objective: A major modifiable risk factor for atherosclerotic cardiovascular disease is abnormalities in lipid and lipoprotein metabolism which are frequently seen in HIV as well as its treatment. Apo-E is a protein that is important in plasma lipid homeostasis and its genetic alleles have been shown to contribute to lipid abnormalities. We examined for the effect of Apo-E gene polymorphisms on plasma lipid levels in PLHIV on protease inhibitor therapy. Methods: This was a cross-sectional study conducted among adult persons living with HIV. Lipid profile, Apo-B and Apo-A were measured in fasting plasma. Amplification and analysis of Apo-E genotypes were determined using the Seeplex Apo-E ACE genotyping kit. Differences in quantitative values were compared with non-parametric analysis methods. Results: Eighty-four persons were recruited into the study, 75% of whom were virally suppressed. The 3 homozygous genotypes had significantly different levels of low-density lipoprotein cholesterol (LDL-C), Apolipoprotein B (Apo-B) and Apolipoprotein A1 (Apo-A1). Persons with apo ε2/ε2 had higher LDL-C compared to those with apo ε3/ε3 (3.26 (3.61) mmol/L vs. 2.76 (1.28) mmol/L, p = 0.010). Those with apo ε4/ε4 had lower Apo-A1 compared to those with apo ε3/ε3 (0.84 (0.48) g/dL vs. 1.27 (0.70) g/dL, p =0.009). Compared with the same group, the heterozygous genotype, apo ε2/ε3 had lower triglyceride levels :1.33 (0.65) mmol/ L vs. 1.86 (1.11) mmol/L, p = 0.045. Conclusion: Polymorphisms in the Apo-E gene may have significant influences on plasma lipid and apolipoprotein levels in PLHIV on PI therapy. This may have implications for the assessment of risk for cardiovascular disease.

Association of SARS-CoV-2 viral load with biochemical profile of COVID-19 patients: A nigerian experience.

Background: Kidney involvement in coronavirus disease 2019 (COVID-19) pathology has been supported by high frequency of angiotensin-converting enzyme 2 (ACE2) expression on renal cells and reports of acute kidney injury. However, the association between host viral load and kidney function is not clear. Aim: In this study, plasma levels of renal markers (urea nitrogen, creatinine, and estimated glomerular filtration rate (eGFR)) and electrolytes (sodium, potassium, chlorine, and bicarbonate) were assessed in relation to SARS-CoV-2 viral load of COVID-19 patients. Patients and Methods: This cross-sectional study involved 144 consenting COVID-19 patients admitted to the Ogun state COVID-19 isolation center between May and December 2020. All participants presented with mild respiratory symptoms and did not require ICU admission or ventilation support. Data included reverse transcriptase polymerase chain reaction (RT-PCR) cycle threshold (CT) value, blood urea nitrogen (BUN), creatinine, sodium, potassium, chlorine, bicarbonate measurements, and glomerular filtration rate. Reference intervals were used as comparators, and multiple linear regression model was fitted. Statistical significance was set at P < 0.05. Results: BUN level and creatinine were elevated in 4 (2.8%) and 42 (29.2%) patients, respectively, with lowered eGFR observed in 37 (25.7%) patients. Hyponatremia and hypokalemia were observed in 35 (24.3%) and 21 (14.6%) patients, respectively, while hypochloremia was observed in 21 (14.6%) patients. Lowered bicarbonate was observed in 29 (20.1%) patients. Linear regression showed statistically significant association (R2 = 0.340, P = 0.032) between RT-PCR CT value and eGFR (ß = 0.006, P = 0.017) as well as HCO3 (ß = -0.262, P = 0.036). Conclusion: COVID-19 patients with mild respiratory symptoms exhibited renal abnormalities, electrolytes, and acid-base imbalances which were partly associated with SARS-CoV-2 viral load.

Obstetric analgesia for vaginal birth in contemporary obstetrics: a survey of the practice of obstetricians in Nigeria.

BACKGROUND: Contemporary obstetrics in sub-Saharan Africa is yet to meet the analgesic needs of most women during child birth for a satisfactory birth experience and expectedly, obstetricians have a major role to play in achieving this. METHODS: This was a questionnaire-based, cross-sectional study of 151 obstetricians and gynecologists that attended the 46th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abakaliki, southeast Nigeria in November, 2012. SOGON is the umbrella body that oversees the obstetric and gynecological practice in Nigeria. Data was collated and analyzed with Epi-info statistical software, and conclusions were drawn by means of simple percentages and inferential statistics using Odds Ratio, with P-value < 0.05 at 95% Confidence Interval (CI) taken to be statistically significant. RESULTS: Of the 151 participants, males predominated; 110 (72.9%) practiced in government-owned tertiary hospitals in urban locations. Only 74 (49%) offered obstetric analgesia. Among users, only 20 (13.3%) offered obstetric analgesia routinely to parturients, 44 (29.1%) sometimes and 10 (6.6%) on patients' requests. The commonest analgesia was opioids (41.1%). Among non-users, the commonest reasons adduced were fear of respiratory distress (31.1%), cost (24.7%) and late presentation in labour (15.6%). CONCLUSION: The routine prescription and utilization of obstetric analgesia by obstetricians in Nigeria is still low. Obstetricians are encouraged to step up its use to make childbirth a more fulfilling experience for parturients.

Variation in serum electrolytes and enzyme concentrations in patients with sickle cell disease.

AIM: To assess levels of some biochemical variables in sickle cell disease patients from eastern Saudi Arabia during steady state and in crises states, with a view to comparing biochemical and clinical manifestations of the disease with those in other geographical locations. METHODS: Serum calcium, uric acid, total bilirubin, lactate dehydrogenase, hydroxybutyrate dehydrogenase, and haemoglobin were measured in 110 sickle cell patients when in steady state. The same variables were measured on 30 of the patients when they went into crisis. RESULTS: Serum calcium tended to be lower in sickle cell patients than in healthy controls, while uric acid tended to be in the high normal range. Crises did not make any difference to serum calcium but they increased the uric acid level significantly. All the other variables measured were significantly abnormal and more so during crises. CONCLUSIONS: Although the abnormal levels obtained for these biochemical variables in patients with sickle cell disease from eastern Saudi Arabia were similar to those from other geographical locations, there were noticeable differences in the severity of the abnormalities, which probably explains the differences in the clinical manifestations of the disease between geographical locations. Values of some of these variables could be adapted for use to monitor crises.

Current observations on sickle cell genotype in Nigeria.

The haematological indices and clinical manifestations of sickle cell disease (SCD) patients were investigated in a combined group of male and female Nigerians, and the results were matched against those from non-SCD individuals. Haemoglobin concentrations (Hb), red blood cell count (RBC) and packed cell volume (PCV) were significantly lower in the haemoglobin SS (HbSS) individuals than in the haemoglobin AS (HbAS) and haemoglobin AA (HbAA) individuals. White cell count (WBC) was of course higher in the HbSS patients as was the foetal haemoglobin (HbF) also. The clinical investigations show a 16% incidence of leg ulceration amongst the SCD patients and a 25% incidence of 'crisis state' requiring blood transfusion. Comparison of these findings with those obtained for Jamaicans and Saudi Arabian sickle cell patients show several differences indicating a milder disease in the Nigerian than the Jamaicans.

Comparison of some haematological indices of Africans and Caucasians resident in the same Nigerian environment.

Haemoglobin levels, total with blood cell counts and differential white blood cell counts were estimated for 512 Africans and 196 Caucasians who had been living in the same cosmopolitan Nigerian town for at least a year. Haemoglobin levels for African females differed significantly from those of Caucasians and many of the African females had values which indicated anaemia. Total white blood cell counts were similar, but an increased lymphocyte count was found in Africans and a higher neutrophil count in Caucasians. Eosinophil count was higher in Africans than in the Caucasians.

Detection of adenosine diphosphate-ribosyl transferase activity in the filarial worm, Onchocerca volvulus.

The existence of the nuclear enzyme ADP-ribosyl transferase in the filarial worm Onchocerca volvulus was demonstrated. The enzyme activity was observed in the nuclear preparation from the parasitic organism. Poly(ADP-ribose) was identified as the reaction product by the isolation of phosphoribosyl-AMP and 5'AMP as the major products of snake-venom phosphodiesterase digestion. The temperature and pH optima for the enzyme were 25 degrees C and 8.5, respectively. The apparent Km value exhibited by the substrate NAD+, is 750 microM and the activity of the enzyme is inhibited by four chemical classes of inhibitors, nicotinamides, methylxanthines, thymidine and aromatic amides.

The antisickling role of uric acid in sickle cell disease.

Based on the antisickling properties of structurally similar compounds, uric acid (urate) was investigated and found to possess antisickling activity on sickle cell erythrocytes, in particular at higher urate concentrations. Serum urate levels were subsequently determined for 60 sickle cell patients of both sexes within the age limit of 1-27 years. The mean serum urate values were computed at discrete age groups, and the values obtained were compared with the mean serum urate concentration for 15 normal subjects of both sexes and similar age range. Although a definite age-dependent trend did exist in the mean serum urate concentration in sickle cell disease (SCD), this elevation could not be truly referred to as "hyperuricaemia'. Hence, any possible contribution by elevated serum urate to a gouty trait and SCD bone crisis remains unclear. However, these observed serum urate values corresponded well with those concentrations which inhibited the sickling of sickle cell erythrocytes in vitro, permitting the speculation that the elevated serum urate might well be beneficial to sickle cell patients in a compensatory way.

Plasma urea in pregnant urban African and Caucasian women.

Plasma urea concentrations were determined for 109 pregnant Caucasian women and 117 pregnant urban African women covering the last two trimesters of pregnancy. Elevation of the urea level was observed in both populations. The elevation was progressive in both cases. The urea levels for Caucasians were apparently normal until about the thirteenth week of gestation when it rose to above normal level and increased progressively in the third trimester. For the Africans, the progressive rise was similar but the values did not exceed the normal range until after the thirty-second week of gestation. Thus, a general pattern of variation which is similar in both Caucasians and Africans exists for the plasma urea level during pregnancy. However, the levels for Caucasians over the gestational periods are consistently higher than the level for Africans. The increase in the level of this non-protein nitrogen compound was attributed to increased intake of proteinous foods and is probably a result of diminished excretion of urea arising from pre-renal causes such as volume depletion.

Ultrasonography of the prostate: a preliminary report from Nigeria.

Suprapubic transabdominal prostatic sonography was performed at two Nigerian centers over the past year. All abnormal glands were found enlarged. Capsular, periprostatic and extra-organ features helped to segregate carcinomas from benign diseases. Gland shape and internal texture were less useful criteria. Prostatic sonography has great promise in developing and fragile economies, where other efficacious and contemporary imaging modalities are unaffordable.

Serum creatinine and uric acid levels in pregnant urban African and Caucasian women.

Serum creatinine and uric acid concentrations were determined for 117 pregnant urban African women and 109 pregnant Caucasian women covering the three trimesters of pregnancy. The creatinine levels for Caucasians rose as pregnancy progressed, exceeding the normal adult level, while that for Africans rose only slightly and only during the last trimester of pregnancy. A similar observation was made for uric acid levels except that the rise in Africans commenced earlier than it did for creatinine, commencing from about the second trimester. Also, the levels in both groups of people remained within the normal adult range. The increased levels of these non-protein nitrogen compounds during pregnancy was attributable to increased metabolism associated with the condition. The difference observed between the Caucasians and Africans was attributed to the better protein nutritional status of the former. It is suggested that the creatinine "curve" especially for the Caucasians could be utilized in the monitoring of foetal well-being.

Serum calcium and protein levels in pregnant African and Caucasian women.

Serum calcium and protein concentrations were determined for 243 pregnant urban African and 150 Caucasian women covering the three trimesters of pregnancy. It was shown that the serum protein content of the pregnant African was consistently lower than that of her Caucasian counterpart, probably as a result of environmental and nutritional factors. On the other hand, there appeared to be little difference in the serum calcium concentration of both groups up to the end of the second trimester; thereafter, the serum calcium of the pregnant African began to increase significantly above that of the Caucasian up to term (without hypercalcaemia), whereas the Caucasian calcium concentration remained virtually unchanged. It is therefore concluded that this phenomenon is a compensatory mechanism through which the increasing need of the foetus for calcium was adequately satisfied by mobilization of calcium from its depot.

Serum aspartate and alanine aminotransferase in filariasis.

Serum aspartate aminotransferase level in filarial patients was estimated. The level was compared against the level of the same enzyme in non-filarial patients. Similarly estimated and compared was the level of serum alanine aminotransferase in the same groups of subjects. It was found that there was a mild but significant elevation of aspartate aminotransferase level above the normal level, in filarial patients in Nigeria. However, no concomitant elevation of alanine aminotransferase level was observed.

Comparison of normal values of sodium and potassium in plasma of adult Nigerians with those of adult Europeans.

Although it has been suggested that there may be adrenocortical hypofunction in Africans as compared to Europeans, very few studies have been carried out to measure whether there is an associated difference in plasma and cellular cation composition. To test this, blood was collected from Nigerians and from European expatriates living in Port Harcourt, and serum sodium and potassium were measured. No differences in serum cation composition were found between the two races.

The enhancement of cytotoxicity of N-methyl-N-nitrosourea and of gamma-radiation by inhibitors of poly(ADP-ribose) polymerase.

Inhibitors of poly(ADP-ribose) polymerase show a synergistic potentiation of cytotoxicity with certain DNA-damaging agents. Non-toxic concentrations of 5-methylnicotinamide dramatically potentiate the cytotoxicity of N-methyl-N-nitrosourea as tested by the cloning ability of mouse leukaemia (L1210) cells. A dose-enhancement factor of about 10 is observed. This potentiation is dependent on the concentration of 5-methylnicotinamide. The methylxanthines theobromine, theophylline and caffeine also increase the cytotoxicity of methylnitrosourea. Thymidine, in the presence of sufficient deoxycytidine to overcome the perturbation of deoxynucleotide metabolism, also potentiates the cytotoxicity of methylnitrosourea. Nicotinate, which is not an inhibitor of poly-(ADP-ribose) polymerase, has no effect on methylnitrosourea toxicity. A very small, but consistent, enhancement of the toxicity of gamma-radiation by the same inhibitors has been observed. We suggest that this potentiation of cytotoxicity is mediated by inhibition of (ADP-ribose)n biosynthesis; and that the biosynthesis is stimulated by DNA damage. We therefore propose that (ADP-ribose)n takes part in cellular repair mechanisms, either by modifying chromatin structure or by a specific participation in DNA repair.