Comparative Evaluation of Creatinine and Cystatin C Derived Glomerular Filtration Rate Methods in Hiv Patients on Therapy and Healthy Controls.

BACKGROUND: Antiretroviral drugs are associated with adverse effects including chronic kidney disease. The onset of chronic kidney disease manifests with mild reduction in GFR. Early detection of chronic kidney disease is integral component of clinical medicine with major effect on disease labeling, intervention and drug dosing. METHODS: We determined the serum creatinine and cystatin-c levels of 55 HIV patients on one year ART, 55 HIV patients on three years ART and 54 apparently healthy controls using colorimetric and immunoturbidimetric methods respectively. Glomerular filtration rates (GFRs) were calculated from serum creatinine and cystatin-c levels with Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. RESULTS: The mean±SD GFR derived from serum creatinine (ml/min/1.73m2) were 110.55±14.34, 106.35±19.25 and 121.63±13.88 for HIV patients on one year, three years ART and healthy controls respectively. GFR derived from cystatin-c (ml/min/1.73m2) were 90.96±13.53, 87.27±14.16 and 108.61±12.07 for HIV patients on one year, three years ART and healthy subjects respectively. GFRcreat was higher when compared with GFRcyst in each group (p=0.01). No significant association was seen between body mass index (BMI) and GFRcyst in patients (p= 0.720) and controls (p=0.760). Binary logistic regression analysis for sensitivity between patients and controls showed odd ratios (0.95 and 1.03) for GFRcreat and (1.04 and 0.99) for GFRcyst in group 1 and 2 respectively. CONCLUSION: Rather than creatinine, GFR derived from serum cystatin-c might be an ideal renal function estimate for this population of Nigerians for sensitivity and non dependence on age and BMI.

CONTEXTE: Les médicaments antirétroviraux sont associés à des effets indésirables dont la maladie rénale chronique. L'apparition de la maladie rénale chronique se manifeste par une légère réduction du DFG. La détection précoce de la maladie rénale chronique fait partie intégrante de la médecine clinique et a un effet majeur sur l'étiquetage de la maladie, l'intervention et le dosage des médicaments. MÉTHODES: Nous avons déterminé les taux de créatinine et de cystatine-c sériques de 55 patients VIH sous traitement antirétroviral pendant un an, 55 patients VIH sous traitement antirétroviral pendant trois ans et 54 témoins apparemment sains, en utilisant respectivement les méthodes colorimétrique et méthodes colorimétriques et immunoturbidimétriques respectivement. Les taux de filtration glomérulaire (GFR) ont été calculés à partir des taux de créatinine sérique et de cystatine-c avec les équations de la Collaboration pour l'épidémiologie de la maladie rénale chronique (CKD-EPI). RÉSULTATS: Le DFG moyen±SD dérivé de la créatinine sérique (ml/min/1,73m2) étaient de 110,55±14,34, 106,35±19,25 et 121,63±13,88 pour les patients séropositifs sous TAR d'un an, de trois ans et les contrôles sains respectivement. Le DFG dérivé de la cystatine-c (ml/min/1,73m2) étaient de 90,96±13,53, 87,27±14,16 et 108,61±12,07 pour les patients séropositifs sous TAR d'un an, de trois ans et les sujets sains respectivement. Le DFGcreat était plus élevé que le DFGcyst dans chaque groupe (p=0,01). Aucune association significative n'a été observée entre l'indice de masse corporelle (IMC) et le DFGcyst chez les patients (p=0,720) et les contrôles (p=0,760). L'analyse de régression logistique binaire pour la sensibilité entre les patients et les contrôles a montré des rapports impairs (0,95 et 1,03) pour le GFRcreat et (1,04 et 0,99) pour GFRcyst dans les groupes 1 et 2, respectivement. CONCLUSION: Le DFG dérivé de la cystatine-c sérique, plutôt que de la créatinine, pourrait être une mesure idéale du DFG. cystatine-c sérique pourrait être une estimation idéale de la fonction rénale pour cette population de Nigérians en termes de sensibilité et de non dépendance à l'âge et à l'IMC. MOTS CLÉS: ART, Créatinine, Cystatine-c, DFG, VIH.

EVALUATION OF MALE SEX HORMONES AND TRACE ELEMENTS IN MALE TYPE 2 DIABETIC PATIENTS ATTENDING NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL DIABETIC CLINICS.

BACKGROUND: There is accumulating evidence that the metabolism of male sex hormones and several trace elements are altered in type 2 diabetic mellitus and may have specific role in the pathogenesis and progression of the disease. AIM: To assess the levels of male sex hormones and trace elements in type 2 diabetic patients and to ascertain an association between male sex hormones and trace elements among diabetic subjects. METHODS: A descriptive cross sectional study was conducted among 125 diabetic and 50 non diabetic subjects. Venous blood samples were collected from all respondents and estimated for fasting blood glucose, male sex hormones and trace elements. The results were subjected to statistical analysis and comparison using Students' test and Pearson correlation analysis. RESULTS: The mean testosterone level was significantly lower in diabetics than in controls (3.9 ± 1.9ng/ml) in comparison with (5.1 ± 1.7ng/ml; P < 0.05). The mean value of Zinc, Manganese, Selenium and Chromium were significantly lower among the diabetics when compared with the controls (Zn;898.7 ± 131.0 µg/l; Mn:0.30 ± 0.06 µg/l;Se:51.3 ± 11.1 µg/l; Cr: 0.04 ± 0.03 µg/I) in comparison with (Zn: 1007.3 ± 85.2 µg/l; Mn: 0.05 ± 0.07µg/l; Se: 62.1 ± 11.1 µg/l; Cr: 0.06 ± 0.01 µg/l; P < 0.05).The mean Fasting Blood Glucose in diabetic subjects was significantly higher when compared with the controls (7.9 ± 3.7 mmol/l) in comparison with (4.6 ± 0.4 mmol/l; P < 0.05).The trace elements showed a positive correlation with testosterone in diabetic subjects (Zn r = 0.359, Ser = 0.443, Mn r = 0.350, P < 0.05). CONCLUSION: This study observed decreased levels of testosterone and trace elements in type 2 diabetics and a positive correlation between low testosterone and low trace elements levels in diabetic subjects. These trace elements are antioxidants and their low levels in diabetic patients may further increase the severity of the disease.

Iron status of some pregnant women in Orlu town--eastern Nigeria.

BACKGROUND: High prevalence of anaemia has been reported among pregnant women especially in developing nations. This paper considers maternal haemoglobin (Hb) level, serum total iron, iron binding capacity, and serum ferritn iin antenatal women in Orlu-Imo State Nigeria. PATIENTS AND METHODS: Haemoglobin level, serum iron, serum ferritin, and total iron binding capacity (TIBC) were measured in different trimesters among 90 pregnant women aged 20-45 years, on iron supplements attending antenatal clinic of Imo State University Teaching Hospital Orlu. First trimester comprised of 16.7% (n = 15), second trimester comprised of 50% (n = 45) while as third trimester comprised of 33.3% (n = 30). 30 non-pregnant women aged 26-40 years were used as controls. RESULT: The mean Hb level was 11.28 +/- 1.4 g/dl in first trimester, 9.51 +/- 1.9 g/dl in second trimester, 10.4 +/- 1.2 g/dl in third trimester, and 10.9 +/- 1.5 g/dl in controls. Mean serum iron level was 142 +/- 23 microg/ml in first trimester, 235 +/- 118 microg/ml in second trimester, 251 +/- 118 microg/ml in third trimester, and 99.7 +/- 19.4 microg/ml in controls. Mean serum ferritin was 57.7 +/- 30 ng/ml in first trimester, 37.6 +/- 17 ng/ml in second trimester, 37.3 +/- 20 ng/ml in third trimester, and 86.7 +/- 16.9 ng/ml in controls TIBC was 337 +/- 90 microg/dl in first trimester, 441 +/- 19 microg/dl in second trimester, 482 +/- 149 microg/dl in third trimester and 271.8 +/- 89.0 microg/ml in controls. Hb level was relatively stable in pregnancy, but was significantly (p < 0.05) lowest in the second trimester compared with controls Serum iron and TIBC progressively increased from first trimester to third trimester. Conversely, serum ferritin declined progressively from first trimester to third trimester. The increments in serum iron was statistically significant (p < 0.05) between first and second trimester, but not significant between second and third trimester. TIBC was significantly higher in third trimester compared with first trimester. Serum ferritin was significantly lower in second and third trimesters compared with controls. This implies a progressive mineral transfer from mother to fetus. TIBC and serum iron were significantly (p 0.05) lowest in non-pregnant controls compared with the three trimesters of pregnancy. Conversely ferritin was significantly (p < 0.05) higher among the non-pregnant controls compared with the three trimesters of pregnancy. This implies that the nonpregnant women had more iron store and had less iron need than their pregnant counterpart. The higher iron need in pregnancy necessitated its mobilization from its stores. CONCLUSION: This study encourages more critical antenatal care especially at second trimester of pregnancy with much emphasis on dietary supplementation of iron and minerals through adequate consumption of local vegetables and other food diets rich in iron. There was poorest antenatal attendance in the first trimester. Pregnant women in this environment should be encouraged to register early for antenatal care.

Selenium, zinc and magnesium status of HIV positive adults presenting at a university teaching hospital in Orlu-Eastern Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV) infection is associated with increased nutrient requirement. Information on micro-mineral status in HIV infected in Nigerians is lacking. We evaluated the impact of HIV infection on selenium, zinc and magnesium status of HIV infected adults presenting at Imo State University Teaching Hospital. METHODOLOGY: Fifty one (51) consecutive adult HIV patients (aged 18-56 years), presenting at the HIV treatment unit of the hospital over a period of 3-months who gave informed written consent participated. Also 48 HIV sero-negative adults (aged 19-59 years) were recruited as controls. Blood samples were collected from all subjects for mineral estimation by atomic absorption spectrophotometry. Results were presented as means (+/- SD) and variables compared using unpaired t-test. RESULT: Selenium, zinc and magnesium levels in HIV patients were 0.23 +/- 0.08 mmol/L, 9.04 +/- 1.26 mmol/L and 104.61 +/- 24 mmol/L respectively. Minerals in controls were 0.29 +/- 0.09 mmol/L, 9.73 +/- 1.15 mmol/L and 125.57 +/- 29.55 mmol/L respectively. All minerals were significantly lower in HIV patients (P < 0.05). In male controls, mineral levels were 0.32 +/- 0.08 mmol/L, 9.97 +/- 2.96 mmol/L and 94.93 +/- 28.63 mmol/L respectively. In male HIV patients minerals were 0.02 +/- 0.06 mmol/L, 8.74 +/- 1.23 mmol/L and 93.42 +/- 19.79 mmol/L respectively. All minerals were significantly lower in male HIV patients than male controls. In female controls selenium, zinc and magnesium levels were 0.28 +/- 0.09 mml/L, 9.57 +/- 1.17 mmol/L and 121.39 +/- 29.89 mmol respectively. Minerals in female HIV patients were 0.25 +/- 0.08 mmol/L, 9.17 +/- 1.29 mmol/L and 110.77 +/- 24.42 mmol/L respectively. There were no significant differences in respective micro-mineral level between female controls and female HIV patients. CONCLUSION: Selenium, zinc and magnesium were depleted in HIV infected suburban Nigerian subjects. Depletion was predominant in males possibly due to better health seeking behavior of females than males causing early presentation in females.

Non Protease Inhibitor-Based Highly Active Antiretroviral Therapy (HAART) improves micromineral status in HIV positive Nigerians.

Introduction of highly active antiretroviral therapy (HAART) has improved the prognosis of human immunodeficiency virus (HIV) infection. The social burden of HIV infection in Nigeria is well appreciated, but the consequences of this infection and HAART on micro mineral status are unknown in Nigeria. We evaluated these effects in Orlu, Imo State, Nigeria. This prospective study involved 51 adult HIV positive patients (18-56 years). Serum selenium, magnesium and zinc were measured using atomic absorption spectrophotometry before and after 6 months on HAART. Results are presented as means while comparison of variables was done using paired t-tests. P-value < 0.05 was considered significant. Selenium, magnesium and zinc levels in the participants before HAART were 0.23±0.08 mmol/L, 104.61±24.16 mmol/L and 9.04±1.26 mmol/L respectively. Mineral levels 6 months after HAART were 0.25±0.08 mmol/L, 115.57±27.98 mmol/L and 9.41±1.23 mmol/L respectively. Selenium and magnesium levels significantly increased after 6 months on HAART (p < 0.05) while zinc level did not increase significantly (p> 0.05). HAART improved selenium and magnesium status of HIV patients but their zinc status remained the same.

Comparative study of C-reactive protein and other biochemical parameters in patients with hepatitis B and malaria in Calabar, Nigeria.

Serum levels of C-reactive proteins (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein, albumin and globulins were investigated using high sensitivity immunoturbidometric and colorimetric techniques in individuals with hepatitis (n=50), malaria (n=50) and 40 control subjects in age range of 30 to 65 years. The hepatitis patients had a significantly higher (P < 0.01) level of aminotransferases when compared to malaria patients and control subjects. The mean value of ALT was 103.50 ± 71.4 IU/L and 46.72 ±17.48 IU/L for hepatitis and malaria respectively. The values for AST were 116.76 ± 63.27 IU/L and 57.74 IU/L ± 15.18 IU/L for hepatitis and malaria respectively while the values for control were 34.75 ± 14.64 and 35.25 ± 15.56 IU/L for AST and ALT respectively. The malaria patients showed a significantly higher level (P < 0.01) of aminotransferases when compared to the control. The mean serum CRP levels were 0.71 ± 0.11 mg/dL and 0.78 ± 0.13 mg/dL for hepatitis and malaria respectively. These values were significantly higher (P < 0.01) than those of the controls which was 0.32 ± 0.12 mg/dL. The values of CRP in malaria were significantly higher (P< 0.05) when compared with hepatitis. In malaria, AST correlated with CRP (r = 0.58). The mean serum proteins of hepatitis patients were significantly lower (P < 0.05) than those of the control and malaria while there were no significant differences between the total protein in malaria when compared with control. Albumin levels in both patients were significantly lower (P > 0.05) than those of the controls. The mean values were 33.40 ± 3.40g/L and 34.47 ± 3.56g/L for hepatitis and malaria respectively and 37.00 ± 3.43 g/L for the control. C-reactive protein correlated negatively with albumin in malaria (r = -0.26) while albumin had a negative correlation with globulin(r = -0.36). Also albumin-globulin ratio were significantly (P < 0.05) decreased in both patients when compared with controls. This result suggests that a systemic acute phase response is present in hepatitis and malaria patients hence measurement of C-reactive proteins may be helpful in the diagnosis and management of hepatitis and malaria; especially in the malaria endemic region such as Nigeria.