Virologic and immunologic outcome of treatment of HIV infection with a herbal concoction, α-Zam, among clients seeking herbal remedy in Nigeria.

This study was to determine the effectiveness (CD4 count and viral load) of a safe herbal concoction, α-Zam used by clients seeking herbal remedy for treatment of HIV infection in Nigeria. 51 patients taking α-Zam as complementary and alternative therapy through the herbal therapist were studied for a period of 16 months. Preliminary medical and laboratory examinations using WHO and CDC criteria were done after confirmation of HIV infection by Western blotting in the nearest teaching hospitals to the residence of the patients. Regular visits were paid to the patients after commencement of the α-Zam to assess the side-effects, drug interactions, toxicity and effectiveness of the herbal remedy. There was a statistical significance (P<0.05) between pre-treatment and post-treatment CD4 count. 4 (7.8%) of the patients had average increase in CD4 count of 262±16 cell/µL, 23 (45.1%) patients with average increase 310±16 cell/µL, 16 (31.4%) patients with average increase 456±25 cell/µL and 8 (15.7%) patients with average increase 510±36 cell/µL( %) were at WHO staging I , II, III and IV respectively within 4 months on herbal therapy. There was very marked reduction in viral (HIV-RNA) load with 41 (80.4%) and10 (19.6%) HIV infected patients had undetectable viral load and <1000 copies/ml respectively after the therapy. All symptoms and signs associated with HIV infection in all patients fully subsided within 4 weeks of commencement of α-Zam therapy and there was no evidence of negative drug interaction in those HIV patients using both the herbal and highly active anti-retroviral therapy (HAART). The study is in progress to determine periodic immunological outcomes of post therapy in all patients.

Virologic and immunologic outcome of treatment of HIV infection with a herbal concoction, A-Zam, among clients seeking herbal remedy in Nigeria

Abstract: This study was to determine the effectiveness (CD4 count and viral load) of a safe herbal concoction, α-Zam used by clients seeking herbal remedy for treatment of HIV infection in Nigeria. 51 patients taking α-Zam as complementary and alternative therapy through the herbal therapist were studied for a period of 16 months. Preliminary medical and laboratory examinations using WHO and CDC criteria were done after confirmation of HIV infection by Western blotting in the nearest teaching hospitals to the residence of the patients. Regular visits were paid to the patients after commencement of the α-Zam to assess the side-effects, drug interactions, toxicity and effectiveness of the herbal remedy. There was a statistical significance (P<0.05) between pre-treatment and post-treatment CD4 count. 4 (7.8%) of the patients had average increase in CD4 count of 262±16 cell/µL, 23 (45.1%) patients with average increase 310±16 cell/µL, 16 (31.4%) patients with average increase 456±25 cell/µL and 8 (15.7%) patients with average increase 510±36 cell/µL( %) were at WHO staging I , II, III and IV respectively within 4 months on herbal therapy. There was very marked reduction in viral (HIV-RNA) load with 41 (80.4%) and 10 (19.6%) HIV infected patients had undetectable viral load and <1000 copies/ml respectively after the therapy. All symptoms and signs associated with HIV infection in all patients fully subsided within 4 weeks of commencement of α-zam therapy and there was no evidence of negative drug interaction in those HIV patients using both the herbal and highly active anti-retroviral therapy (HAART). The study is in progress to determine periodic immunological outcomes of post therapy in all patients

Prevalence of hypertension and associated variables in paid workers in Ilorin, Nigeria.

BACKGROUND: The enormous burden of hypertension worldwide and in Africa, informed the decision to measure the blood pressure pattern in salaried workers in Ilorin, Nigeria. These were selected, as they resemble closely those that are likely to be affected by western style living. METHODS: It was a cross-sectional study that involved staff of both government and a private organisation in Ilorin, Nigeria. Two hundred and eighty one subjects, comprising of 211 males and 70 females were recruited into the study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) and fasting plasma glucose (FPG) were determined. RESULTS: The prevalence of hypertension was 27.1% in the population, being 28.4% in males and 22.9% in females. Mean SBP and DBP were significantly higher in females (SBP; 139.59 mmHg +/- 20.84, DBP; 86.92 mmHg +/- 10.96) than in males (SBP; 127.39 mmHg +/- 19.55, DBP; 82.16 mmHg). P < 0.05. The prevalence of hypertension increased with age and BMI. Age was correlated to SBP, (r = 0.355, P < 0.01) DBP, (r = 0.322, P < 0.01) and BMI (r = 0.143, P < 0.05). Obesity prevalence was 13.2% consisting of males (5.3%) and females (7.8%). Prevalence of diabetes mellitus was similar in both sexes at 1.5%. CONCLUSION: There is a high prevalence of hypertension among salary earners in Ilorin, Nigeria and this is commoner among males. The degree of increase in BP is worse in female workers. Obesity is on the upward climb in our society and should be addressed early in order to curtail its associated morbidities.

Glycaemic Response to Different Preparations of Yam in Diabetic and Non-Diabetic Nigerians

Post-pandial glycaemic responses to food can be affected by the method involved in the preparation of the food. Dietary intervention with food modification forms the corner- stone of management of type 2 diabetes worldwide. The effect of processing on yam; a staple food in Nigeria; was studied among diabetic and non-diabetic Nigerians. Despite undergoing more processing; amala prepared from yam flour had a better post-pandial glycaemic response index (PGRI) compared to other yam preparations; and this was also significantly higher among the diabetic subjects. Yam-based products; particularly amala; should be encouraged among diabetic Nigerians

Clinical laboratory in the biochemical evaluation of hypertension in Nigeria.

Hypertension is a worldwide problem. It is associated with severe complications that are worse in blacks! Effective management of hypertension requires that the pathophysiologic mechanism, underlining the condition be identified. The clinical laboratory can help in this regard by separating primary hypertension cases (high plasma rennin activity and low plasma rennin activity types) from those of secondary and mendelian types of hypertension. However most clinical laboratories in Nigeria do not provide some of the needed specialized tests-plasma renin activity level, urinary coritsol, plasma aldosterone and metanephrines, plasma natriuretic peptide and oral captopril tests, on routine bases. Importantly, clinicians in Nigeria should consider seriously, the role of the clinical laboratory in the management of hypertension, a condition that affects about 20% of the adult population. They should look beyond "basic or routine tests" in the management of patients with hypertension. Specific tests that will assist in the proper diagnoses of the type of hypertension in a patient should be carried out routinely on every case of hypertension. This will assist in justifying the addition of such investigations in laboratory tests repertoire, when laboratory budgets are prepared.

Pattern of some risk factors for cardiovascular disease in untreated Nigerian hypertensive patients.

OBJECTIVE: Coronary heart disease risk factors tend to cluster in patients with hypertension. In works done in Nigeria, the hypertensive subjects studied were those receiving treatment. Our aim was to evaluate the pattern of these risk factors in untreated hypertensive patients. STUDY DESIGN: Fifty untreated hypertensives and fifty normotensives were recruited among salary earners in Horin, Nigeria, after excluding conditions that can cause dyslipidaemia. Plasma total cholesterol (TC), Triglycerides (TG), HDL Cholesterol (HDL-C), LDL Cholesterol (LDL-C), Fasting Plasma Glucose (FBG) and Body moras Index (BMI) were determined in the subjects. RESULT: Prevalence of hypertension increased with age. Plasma TC, HDL-C, LDL-C and BMI were higher in hypertensives (TC; 4.54 mmol/L +/- 1.56, HDL-C; 1.28 mmol/ L +/- 0.45, LDL-C; 3.21 mmol/L +/- 1.34, BMI; 26.42 kg/m2 +/- 4.75) than in normotensive controls (TC; 3.20 mmol/L +/- 1.28, HDL-C; 0.93 mmol/L +/- 0.41, LDL-C; 2.28 mmol/L +/- 1.01, BMI; 23.37 kg/m2 +/- 4.75). Overweight was more common in hypertensives (70%) than in normotensives, and females constituted 53% of the overweight hypertensives. CONCLUSION: The dyslipidaemia associated with hypertension, is here noted to be present before commencement of antihypertensive therapy. This observation should influence drug prescription for treatment of hypertension. Overweight hypertensives are likely to benefit from a concurrent control of blood pressure and body weight

Role of hepatic enzymes in the biochemical assessment of the severity of sickle cell anemia.

BACKGROUND AND OBJECTIVES: Various clinical and hematological indices have been used to assess the severity of Sickle Cell Anemia (SCA), however biochemical indices are lacking. Hepatomegaly has been a frequent finding in SCA and its persistence has been associated with increased disease severity. The association between hepatic enzymes and disease severity in SCA is undefined. This study was therefore designed to look at the association between clinical severity and hepatic enzymes in SCA subjects with persistent hepatomegaly (that is, lasting more than six months) in order to determine a possible role for hepatic enzymes as a biochemical index of severity. MATERIALS AND METHODS: Serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (SAP) and gamma-glutamyl-transferase (GGT) were determined in two groups of SCA subjects and in hemoglobin genotype AA (HbAA) controls. SCA group comprised of 37 subjects with persistent hepatomegaly equal to or greater than 10 cm (below right coastal margin) while the second group comprised another 38 SCA subjects without palpable hepatomegaly. 40 individuals with hemoglobin genotype AA served as control for both groups. Clinical and hematological parameters of severity which included steady state haematocrit, number of transfusions per year, number of crises per year and percentage HbF level were determined and scored in a manner similar to the Glasgow coma scale. Results obtained were analyzed with the aid of statistical package on EPI-INFO version 6.02. RESULTS: There was a significant increase in serum ALT, ALP and GGT levels in SCA with persistent hepatomegaly over those without hepatomegaly (p < 0.05, p < 0.05 and p < 0.01 respectively). All the index scores and the final aggregate severity scores were also significantly higher in SCA subjects with persistent hepatomegaly. Only GGT demonstrated a fairly positive and significant correlation (r = 0.46, P < 0.05) with increased clinical severity among the hepatic enzymes. CONCLUSION: Elevated serum level of GGT in SCA during steady state is suggestive of increased disease severity.

High Risk Coronary Heart Disease, Lipid Fractions and Transferrin Saturation among Hypertensive Nigerians.

BACKGROUND AND OBJECTIVES: Hypertension and hypercholesterolemia are well established independent risk factors of coronary heart disease. Moreover, drug treatment of hypertension also affects lipid metabolism. Recently, body iron status has also been implicated as a risk factor of coronary heart disease. It is not however clear whether hypertension or hypercholesterolaemia directly or indirectly influences body iron status. This study was therefore decided to look at the association between transferrin saturation and hypercholesterolaemia in adult hypertensive Nigerians with high risk Coronary Heart Disease (CHD) lipid fraction. MATERIALS AND METHODS: The study group comprises eighty two adult Nigerians who are known hypertensives with high risk coronary heart disease lipid fraction: that is the ratio of high density lipoprotein cholesterol to total cholesterol (HDL-C/TC) <= 0.13 while the control subjects comprises eighty adult Nigerians who are also known hypertensives with normal HDL-C/TC ratio (>=0.30). RESULTS: The total iron binding capacity is not significantly different between the two groups. Also, serum iron and transferrin saturation were not significantly different in the two groups. Transferrin saturation does not show appreciable correlation with total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels in any of the two groups. CONCLUSION: The association between transferrin saturation and hypercholesterolaemia in hypertensive is not strong enough to possibly suggest that one influences the other. However, the influence of antihypertensive drugs on lipid metabolism cannot be ruled out in this study because subjects and controls were not selected based on type or class of medication. KEYWORDS: transferrin saturation, high risk CHD lipid fraction, hypertensives.

Awareness of atherosclerosis risk factors in Nigeria.

Non-communicable diseases, which include hypertension and diabetes mellitus, have become an important cause of morbidity and mortality in Nigeria. The determination of serum lipid levels is used routinely to assess the risk of atherosclerosis. This study was performed in order to determine the frequency of serum lipid requests in the community. Information on both lipid and total chemical pathology requests for the study period (May 1998 to April 2000) was obtained from the Department of Chemical Pathology, University of Ilorin Teaching Hospital, whilst data on the total hospital attendance was obtained from the hospital's Record Department. The number of serum lipid requests increased from year to year (May 1998 to April 1999 = 780; May 1999 to April 2000 = 1,357; May 2000 to April 2001 = 1,382). The percentages of total requests for serum Lipids when compared with the total laboratory requests for the period of study were 12.0%, 13.3% and 14.0% for the first, second and third year respectively. More men than women had their serum lipid levels determined; 31.3% of the patients had hyper-cholesterolaemia (> 5.2 mmol/L), while 9.9% had values > or = 6.2 mmol/L. Industrial disputes (strikes) affected our results. For the three-year period there was no remarkable increase in the use of the lipid profile facilities available in the centre. This reflects the inadequate awareness of lipid disorders as a risk factor for atherosclerosis.

Prevalence of diabetes mellitus and impaired glucose tolerance in factory workers from Transkei, South Africa.

OBJECTIVE: To determine the prevalence of diabetes mellitus and impaired glucose tolerance (IGT) in a group of peri-urban black South Africans. DESIGN: Cross-sectional study in which an oral glucose tolerance test (OGTT) was performed on each subject. SETTING: Two of the largest factories in the surroundings of Umtata, the capital of the former homeland of Transkei, South Africa. SUBJECTS: A total of 374 Xhosa-speaking factory workers. MAIN OUTCOME MEASURES: Frequency of diabetes mellitus and IGT according to age group and gender using the current World Health Organisation (WHO) criteria for the diagnosis of abnormal glucose tolerance and its relationship to obesity. RESULTS: The crude prevalences for diabetes mellitus and IGT were 2.45% and 2.7% respectively. The age-adjusted prevalences using a standard world population were 4.5% (confidence interval (CI) 1.54-7.42) and 5.1% (CI 2.45-5.51) for diabetes and IGT respectively. The prevalence of diabetes was similar in male and female workers (P = 0.31), with the highest incidence observed in the age group from 40 to 59 years. No subject below the age of 40 years was found to be diabetic, and the prevalence of the disease was found to increase with age. Obesity was present in 22.2% of all subjects. Prevalence of obesity was similar in subjects with diabetes and in those with impaired and normal glucose tolerance (P = 0.71). However, overweight, identified in 26.8% of subjects, was more frequently observed in the IGT group than in the other two groups (P = 0.01). IGT was observed in 3.4% of male and 1.5% of female workers respectively (P = 0.13), with peak prevalences occurring between the ages of 30 and 49 years. CONCLUSION: In conclusion, this study found a prevalence of diabetes and IGT comparable to prevalence results reported in other black South African communities. The implications with regard to this community merit further study.

Importance of family history in type 2 black South African diabetic patients.

OBJECTIVE: To assess the family history of diabetes in type 2 black South African diabetics with emphasis on the parental phenotype. DESIGN: Prospective case-control study in which family histories were obtained from patients. SETTING: Diabetic clinic of a provincial teaching hospital in the Transkei region of South Africa. SUBJECTS: A total of 1111 type 2 diabetics attending the diabetic clinic and 687 controls. MAIN OUTCOME MEASURES: History of diabetes in parents, siblings, maternal and paternal grandparents, aunts, and uncles. RESULTS: Altogether 27.3% of diabetic subjects had a family history of diabetes compared with 8.4% in the control group (p<0.01). Among the group with positive family history 82.6% reported only one diabetic family member, while 17.4% reported at least two relatives; 6.6% had a diabetic relative from both maternal and paternal sides, and 87.8% had first degree relative with diabetes. Among them there was a significant maternal aggregation with 64.7% of patients having a diabetic mother compared with 27% who had a diabetic father (p<0.01). No maternal effect was observed among the second and third degree relatives. Patients with positive family history had an earlier onset of diabetes than those without family history (p<0.01). CONCLUSION: These data suggest that type 2 diabetes is heritable in black South African diabetics. It is also likely that maternal influences may play an important part.

Serum electrolyte, urea and creatinine in clinically stable Nigerian newborn.

Serum electrolytes urea and creatinine of 80 clinically stable normal newborn comprising 60 preterm and 20 term appropriate for gestational age babies were prospectively studied. A negative correlation between the serum sodium, potassium, urea, creatinine and the gestational age was found. A statistical significant difference in the mean values of serum urea and creatinine in both preterm and term babies was obtained but there was no statistical significant difference in the mean value of serum sodium and potassium.

Blood sugar control among fasting Muslims with type 2 diabetes mellitus in Ilorin.

Fasting in the month of Ramadan represents a recurring annual event in the life of a Muslim. It also represents one of the five pillars around which the Islamic faith revolves making it desirable to even diabetic Muslims if only to live a spiritually fulfilling life. We therefore embarked upon the study of 33 patients with Type 2 Diabetes Mellitus who fasted in the month of Ramadan of 1417 Hijra year (1997 Gregorian) with a view to establishing the effect of fasting on their blood sugar control. This is meant to serve as a framework for establishing a scientific basis for advice to Muslim diabetic patients who may wish to fast in subsequent years. Eight point three percent of patients considered for enrollment signified their non-willingness to fast even after health-education. In the month preceding fasting the mean +/- SD for fasting blood sugar (FBS) was 6.71 +/- 2.81 mmol/L, 6.50 +/- 2.34 mmol/L for the month of Ramadan and 6.93 +/- 2.53 mmol/L for the month after. There was no statistically significant difference between the means for the three months. However, larger percentage of patients (76%) had their fasting blood sugar improved upon during fasting than either before or after. In addition, there was no reported case of acute complication from diabetic emergencies all through the period of the study. Based on these findings, it was concluded that most Type 2 diabetic patients actually do as well, like their normal counterparts during fasting and could be encouraged to do so provided they are clinically stable.

Effect of drug-induced hyperuricaemia on renal function in Nigerians with pulmonary tuberculosis.

Some anti-tuberculosis chemotherapeutic agents have been established as causing hyperuricaemia. Hyperuricaemia in turn causes renal damage. This study therefore aims at establishing the effect of anti-tuberculosis drugs-induced hyperuricaemia on renal function of the patients. Fifty patients with newly diagnosed pulmonary tuberculosis with mean age of 36.8 years (SD 13.69) consisting of 14 females and 17 males were longitudinally studied each for 6 months to determine the effect of drug-induced hyperuricaemia on their renal function. The Biochemical indices determined included serum urate level, serum creatinine level, and creatinine clearance of newly diagnosed patient with tuberculosis, before and during treatment with anti-tuberculosis therapy. Serum urate level revealed that 16 (51.6%) and 15 (48.4%) of the patients were hyperuricaemic at the end of the first and second months of anti-tuberculosis therapy. There was no significant difference in the mean serum creatinine level of the control group 96 micromol/L when compared with both the pre-treat value 89 micromol/L (P > 0.25) as well as the value at the end of the sixth month of treatment 91 micromol/L (P > 0.40). However, there was a statistically significant difference in the mean creatinine clearance of the control group 102 ml/min/1.73 m2 when compared with the patient's mean pre-treatment value (89 ml/min/1.73 m2) P < 0.05. Also the mean creatinine clearance increased to (103 ml/min/1.73 m2) by the end of the 6th month of treatment, a value that is statistically significant when compared with the pretreatment value of (89 ml/min/1.73 m2) P < 0.05. We submit as follows: that pulmonary tuberculosis as a disease with significant impairment of renal function; despite the associated drug-induced hyperuricaemia recorded during the treatment, renal function steadily improved with the treatment of pulmonary tuberculosis to the extent that comparable values with control was obtained at the end of treatment. We conclude therefore that drug-induced hyperuricaemia associated with treatment of pulmonary tuberculosis has no detectable negative effect on renal function of the patient.

Prevalence of some risk factors of coronary heart disease in a rural Nigerian population.

OBJECTIVE: To determine the prevalence of some risk factors of coronary heart disease (CHD) in a rural Nigerian population. DESIGN: Prospective cross-sectional study. SETTING: Three villages around Maiduguri in the north eastern part of Nigeria. SUBJECTS: Five hundred randomly selected subjects, consisting of 278 males and 222 females. INTERVENTION: Anthropometric parameters such as weight, height, body mass index and blood pressure were measured. Also fasting blood concentration of glucose, total cholesterol (Tc) and high density cholesterol (HDL-c) were measured. MAIN OUTCOME MEASURES: The various parameters were compared between males and females. RESULTS: Prevalence of hypercholesterolaemia was zero because no subjects had values greater than 5.2 mmol/1. Overall prevalence of obesity was 2%, with 1.2% in males and 3.2% in females. High blood pressure was observed in 15.2% of the subjects, with it being more among males (19.1%) than females (10.3%). Mean fasting blood glucose was significantly higher (p < 0.01) in females (6.2 mmol/1) than males (4.2 mmol/1). Prevalence of diabetes mellitus was 2.6% and being higher among females. CONCLUSION: Our results demonstrated lower prevalence of obesity and hypertension when compared with earlier results from the southern part of Nigeria, but showed an increase in the prevalence of diabetes mellitus. We therefore recommend that a survey of CHD risk factors should be carried out in different ethnic groups.

Assessment of glycaemic control in stable type 2 black South African diabetics attending a peri-urban clinic.

Glycaemic control was assessed in type 2 black diabetics attending the diabetic clinic at a peri-urban hospital. Baseline glycosylated haemoglobin levels were measured and a subsequent estimation was carried out in those patients who attended a follow-up consultation to see whether current recommended targets for glycosylated haemoglobin levels were being attained. Out of 708 patients, mean age 56.3 years, 14.7% were insulin treated and 85.3% were non-insulin-treated. Target values of HbA1c < 7% were achieved in only 20.1% (142) of patients. Although mean glycosylated haemoglobin levels were significantly higher in females (p = 0.03), the proportion of poorly controlled diabetics was similar in the two sexes. Patients whose HbA1c levels fell within the target values had diabetes of significantly shorter duration than those exhibiting poor control (5.0 + 0.2 vs 7.03 + 0.5 years). Obesity was present in 562 patients (79.4%). Target values were only achieved in 16.4% of non-obese and 21% of obese diabetics, with mean glycosylated haemoglobin levels being significantly higher (p < 0.05) in the former group (10.3 + 0.4% vs 9.5 + 0.2%). Similar results were observed with respect to type of treatment, with only 14.4% of insulin-treated and 21% of non-insulin-treated diabetics achieving target values. The follow-up HbA1c estimation did not show any difference in the glycaemic control status of patients, with only 19.9% of them achieving the target values. Dietary advice (though minimal) seemed to have no impact on the metabolic control of our patients. These results suggest that glycaemic control was poor irrespective of sex, duration, BMI, educational status, dietary advice and type of treatment with recommended target values not being achieved in the majority of patients. Behavioural changes through health educational programmes need to be instituted with both patient and medical personnel being motivated to take this process forward.

Effect of gestational age on levels of serum alkaline phosphatase isoenzymes in healthy pregnant women.

OBJECTIVES: To confirm that the bone isoenzyme of alkaline phosphatase (ALP) contributes significantly to the increased ALP in normal pregnancy, and to determine the gestational age at which the increase occurs. METHODS: Cross-sectional determinations of serum total, bone and placental ALP were carried out in 67 normal pregnant women. The results were compared with those of 18 normal age-matched non-pregnant controls using Student's t-test. RESULTS: At both 31-32 weeks and 38 weeks of gestation, serum activities of bone ALP were increased significantly (P < 0.05 and P < 0.001, respectively) when compared with controls. The percentage contribution of bone ALP to the total was higher at 31-32 weeks and lower at 38 weeks when compared with the contribution from placental ALP. CONCLUSION: Knowledge of time of elevation of serum bone ALP activity in normal pregnancy will be helpful in the interpretation of elevated serum total ALP activity during pregnancy.

Plasma urate in diabetes: relationship to glycaemia, glucose disposal, microvascular complications and the variations following oral glucose.

In order to provide further insights into the conflicting reports of associations between diabetes and uric acid metabolism, we studied 175 adult diabetic patients (56 IDDM, 119 NIDDM) and 114 matched control subjects. Plasma uric acid (PUA) concentrations were not significantly different between diabetic and control subjects, despite increased urinary urate in diabetic patients. There were no significant associations, in diabetic patients, between PUA and (i) type of diabetes, (ii) glycaemic control, (iii) retinopathy and (iv) proteinuria. Plasma urate did not correlate with the KG constant for glucose disposal rate during IVGTT, thus indicating that PUA may not be related to insulin action. In a separate study, PUA rose sharply, peaking at 30 min, and fell subsequently in both newly diagnosed NIDDM patients (n = 20) and subjects with impaired glucose tolerance (n = 15) in response to standard OGTT, in contrast to normal controls (n = 35) in whom PUA rose gradually to a peak at 120 min. Mean rise in PUA from baseline to peak was significant (P less than 0.05) in the diabetic group only. These differences in PUA response during an OGTT between subjects with abnormal glucose metabolism and normal controls may be a feature in the metabolic evolution of diabetes and need further investigation.

Isoenzymes of alkaline phosphatase in epileptic patients receiving carbamazepine monotherapy.

The effects of carbamazepine monotherapy were investigated in 20 female and 21 male epileptic patients to determine whether treatment would induce an increase in serum alkaline phosphatase (ALP) activity, a known effect of many anticonvulsant drugs. Serum total ALP activity was increased in nine out of the 41 patients (22%), serum bone ALP activity was increased in 10 (24%), and serum non-bone ALP activity was increased in three (7%). There was no significant difference when the mean of the patients' serum total ALP was compared with that of the controls. Twenty per cent of the patients with increased serum bone ALP had normal serum total ALP, indicating that increased serum bone isoenzyme activity may precede an increase in the total enzyme activity. This should be considered when interpreting results of increased total ALP in epileptic patients.