Cg Orluwene

Urinary interleukin (Il)-18 as an early predictive biomarker of subclinical proximal tubular dysfunction in HIV-infected patients exposed to tenofovir.

Proximal tubular dysfunction (PTD) is a frequent complication of HIV-infected patients and lack of early biomarkers for PTD has impaired our ability to intervene in a timely manner. In this present study, we tested if interleukin- 18 (IL-18) is a predictive biomarker for PTD in HIV-infected patients on tenofovir (TDF) and Non-tenofovir (N-TDF) antiretroviral therapy and taking as control HIV treatment naive patients. Exclusion criteria included pre-existing renal insufficiency and nephrotoxin used. Serial urine samples were analyzed by enzyme-linked immunosorbent assay for IL-18 in 254 HIV- infected patients at three different points (at baseline, at 4 weeks and at 12 weeks of fellow-up). Using eGFR values, marked decreased in kidney function was detected only at 12 weeks in the TDF regimen group (p=0.003) as compared to other study groups. In contrast, urine IL-18 increased at a much early time (at 4 weeks) particularly in the TDF regimen group (p=0.000) follow by the naive group (p=0.02) and continued to increase up to 12 weeks of follow up. This marked elevation is believed to be progressive. Our results indicate that IL-18 is an early, predictive biomarker of PTD and that this biomarker may allow for the reliable early diagnosis of PTD at all times in HIV-infected patients on TDF at risk of proximal tubular dysfunction, much before the rise in serum creatinine

DISPARITY IN DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS USING 75g AND 100g GLUCOSE LOAD TESTS AMONG ANTE-NATAL ATTENDEES AT MADONNA UNIVERSITY TEACHING HOSPITAL, ELELE, RIVERS STATE

Several cases of Gestational diabetes mellitus (GDM) are seen in our working environment and this condition can have substantial impact on fetal growth, birth weight and morbidity. Standard recommendations for GDM testing prescribe the use of either a 3-hour, 100g glucose load (100g) or a 2-hour 75g glucose load (75g). We investigated the comparability of the 75g and the 100g tests in the diagnosis of GDM in our environment. From February, 2007 to January 2010, we performed the GDM testing using a 75g glucose load on 956 consecutive Nigerian non-obese and non-diabetic pregnant women who attended the antenatal clinic of the Madonna University Teaching Hospital, Elele, Rivers State. This testing was carried out during two periods of pregnancy: early (16-24weeks) and late (26-34weeks). All women with 1-hour plasma glucose above 7.2mmol/L in the 75g test were retested using the 100-g glucose load within a week. Gestational diabetes mellitus (GDM) was diagnosed (during the 16-24weeks) in 46 out of 269 women with the 100g and 18 out of 269 with the 75g load (12 concordant); the k index was 0.22. At 26-34 weeks of pregnancy, 388 out of 950 women (40.8%) underwent both tests. GDM was diagnosed in 65 of 388 women with 100g load and in 29 of 388 women with the 75g load (14 concordant); the k index was 0.19.Among women with positive GDM in both early and late periods of pregnancy, there was only weak diagnostic agreement between results determined with 75g and 100g glucose loads.

Comparison of mean prostate-specific antigen (PSA) values between sexually active males and age-matched celibate males

Prostate-specific antigen is currently quite useful in the clinical screening and early detection of prostate cancer. Sexual activity has been thought to be associated with increased PSA values. This poses a serious question as to the application of this useful screening tool in evaluation of prostate pathology in celibate males in terms of the possibility of creating a different “cut-off” for them. This study looks at the difference in the Prostate-Specific Antigen (PSA) values between sexually-active males and age-matched celibate males with a view to identifying any significant difference that may be of clinical importance. In this prospective study, 99 subjects were recruited, comprising 49 celibate males and 50 sexually-active males. All subjects were non-obese, had no prostatic symptoms and were not masturbating. Standard technique of specimen collection, processing and analysis of PSA values using Immunoassay technique were applied. The celibate group had a mean PSA value of 2.6±0.2ng/ml, while the sexually-active group had a mean PSA value of 2.7±0.1ng/ml. This difference was found not to be statistically significant (P>0.05). Provided individuals abstain from ejaculation. 72 hours to specimen collection, there is no need to create a different “cut-off” or criteria for interpretation of PSA values for celibate males. The same criteria for PSA value interpretation could be used for evaluation of prostate pathology in both groups. Key Words: Prostate-specific antigen, celibate, sexually-active, screening

Screening for microalbuminuria in newly diagnosed type 2 diabetics at a staff clinic in Port Harcourt

Background: Most individuals working in the Nigerian National Petroleum Company (NNPC) Port Harcourt are obese (with BMI> 29 kg/m2). This has been attributed to change in diet and life style. Most of these individuals present with type 2 diabetes. Individuals with diabetes are at higher risk of suffering renal damage. It is observed that in spite of the medical facilities made available to these company workers, they do not present early for management but rather present when diabetic complications have set in to worsen outcome of management. nAim: To study the prevalence of microalbuminuria (as an evidence of onset of renal complication of diabetes) in newly diagnosed type 2 diabetics and its possible relationship with other diabetic complications in this group of patients.nMethods: In this prospective study, 60 newly diagnosed type 2 diabetics were tested for microalbuminuria using micral test strips. Subjects and controls were also assessed for retinopathy, hypertension and glycated haemoglobin levels. nResults: Microalbuminuria was present in 38 (63.3%) patients and was found to be significantly associated with mean arterial pressure, systemic hypertension, glycated haemoglobin levels and diabetic retinopathy (p Keywords : Screening, Microalbuminuria, Type 2 diabetics, Glycated haemoglobin, Diabetic retinopathy, Systemic hypertension, Port Harcourt Port Harcourt Medical Journal Vol. 3 (1) 2008: pp. 10-14