Mathias Abiodun Emokpae

Proteinuria among adult sickle cell anemia patients in Nigeria

BACKGROUND/OBJECTIVE The life expectancy of patients with sickle cell anemia (SCA) has improved with modern medical care, and this has led to frequent observation of various chronic complications of the disease including abnormalities in renal function. Proteinuria is not only a marker of renal disease but is also a predictor of disease progression. This screening study was aimed at evaluating the prevalence of proteinuria among adult SCA patients in Kano, Nigeria, which has not been reported previously. MATERIAL AND METHODS A total of 200 adult SCA patients were studied. They consisted of 100 men and 100 women. Blood was collected for the assay of serum urea, sodium, potassium, chloride, bicarbonate, and creatinine and estimated glomerular filtration rate (eGFR) was determined using the Cockcroft-Gault formula. Urine dipstick test for the presence of proteinuria and other abnormalities was done, and 24-hour urine protein was measured in those with significant proteinuria. RESULTS Mean age of the male patients was 25.1 ± 1.0 years, whereas the mean age of the female patients was 22.8 ± 4.2 years. Twenty eight percent (32 males, 24 females) of the subjects were observed to have significant proteinuria. The mean estimated eGFR of the males was 88 ± 19.6 ml/min while that of the females was 92 ± 10.2 ml/min. The male SCA patients with proteinuria had a mean eGFR of 70 ± 6.9 ml/min, whereas the female SCA patients with proteinuria had mean eGFR of 101 ± 2.5 ml/min. Among the male patients with proteinuria, 50% had chronic kidney disease (CKD). CONCLUSION Proteinuria which is a marker of renal insufficiency is common among adult SCA patients, and routine screening for proteinuria may help detect those at increased risk of renal disease. CKD prevalence is high among SCA patients with significant proteinuria.

Neutrophil-to-lymphocyte, platelet-to-lymphocyte ratios and their association with atherogenic index of plasma in sickle cell nephropathy

Background/Objectives: Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios (NLR and PLR) were introduced as cheap and readily assessed biologic markers of subclinical inflammation. There are few studies that have evaluated NLR and PLR as prognostic markers of proteinuria in sickle cell anemia (SCA) patients. This study seeks to evaluate NLR and PLR in SCA patients with proteinuria, impaired kidney function and to ascertain whether there exist relationship between the leukocyte ratios and atherogenic index of plasma. Materials and Methods: The NLR, PLR, and atherogenic index were calculated from full blood count and lipid profile parameters determined from fasting blood specimens collected from 200 confirmed SCA patients and 100 control subjects with normal hemoglobin (Hb). Results: The NLR and PLR values were significantly higher (P < 0.001) in SCA patients compared with control subjects with normal Hb. Similarly, NLR and PLR values were significantly higher (P < 0.001) in SCA patients with proteinuria and those with impaired kidney function than without proteinuria and normal controls. A significantly positive association was observed between NLR and atherogenic index of plasma (AIP) in SCA patients with proteinuria (P < 0.05) and those with impaired kidney function (P < 0.02) while significant association was observed between PLR and AIP in SCA with impaired kidney function (P < 0.05). Conclusion: The leukocyte ratios may be useful as prognostic markers for the presence of proteinuria in SCA patients and impaired kidney function as well as cardiovascular risk event. The need to have reference cut-off values of NLR and PLR is hereby suggested to better identify those patients at risk in the management SCA patients.

Serum alpha-fetoprotein level is higher in hepatitis C than hepatitis B infected chronic liver disease patients

Background: The frequency of raised serum alpha-fetoprotein may vary in relation to hepatitis B or C infection in chronic liver disease (CLD). The study evaluated the frequency of hepatitis B and C in patients with chronic liver disease and correlated the levels of serum alpha-fetoprotein with hepatitis B and C infection in the patients. Materials and Methods: Eighty-six patients with CLD were recruited for the study. Fifty subjects, with no CLD were used as control. Hepatitis B surface Antigen (HBsAg) and hepatitis C antibody were determined using enzyme-linked immunosorbent assay (ELISA) technique (Human diagnostics, Germany and HCV Murex 40 Anhet laboratories, USA) while liver function tests were evaluated using express plus chemistry auto analyzer. Alpha-fetoprotein was assayed using ELECSYS 1010 auto analyser. Results: There were 60 males and 26 females, with a mean age of 46 + 6.5 years, while the controls were 25 males and 25 females with a mean age of 41 ± 2.5 years. Thirty-six subjects (41.7%) were seropositive for HBsAg while 24 (27.9%) were seropositive for Hepatitis C Virus (HCV) antibody. The mean alpha fetoprotein level was 359 ± 9.9 ng/mL while mean control value was 1.93 ± 0.24 ng/mL. Liver function test parameters were elevated compared with control subjects (P < 0.001). The increase in serum alpha-fetoprotein was higher (P < 0.001) in HCV than HBsAg positive patients. Conclusion: Serum alpha-fetoprotein level was highest in HCV compared to HBsAg positive and hepatitis negative patients with CLD.

Impact of fetal hemoglobin on micronutrients in sickle cell anemia

Background / Objective: The presence of persistent high fetal hemoglobin (HbF) in sickle cells disease (SCD) patients may be a modulator of clinical and biochemical features. This study seeks to test the hypothesis that high level of HbF may regulate the levels of calcium, magnesium, zinc, and copper in SCD patients in a steady clinical state. Materials and Methods: Serum calcium, magnesium, zinc, and copper were assayed in 100 SCD patients in steady clinical state and 50 control subjects using the colorimetric method while blood HbF was determined by alkaline denaturation method. Results: Twenty-five percent of the study group had high (>5%) HbF, while 75% had low (<4.9%) HbF levels. HbF (P < 0.001), serum copper (P < 0.001), and calcium (P = 0.002) were significantly higher in SCD patients compared with controls, while zinc and magnesium were significantly lower (P < 0.001) in SCD patient compared with controls. Serum calcium (P = 0.01) and copper (P = 0.118) were lower in SCD patients with high (≥5%) HbF while magnesium and zinc were significantly higher (P < 0.001) in SCD patients with high HbF compare with those with low (≤4.9). HbF correlated negatively with calcium (r = −0.25, P = 0.011) and copper (r = -0.11, P = 0.287) while magnesium (r = 0.60, P = 0.001) and zinc (r = 0.57, P < 0.001) correlated positively on HbF levels. Conclusion: HbF levels may have modulated the levels of these elements in SCD patients. It is suggested that HbF may be estimated along with hemoglobin electrophoresis in diagnosis, clinical management, and predicting clinical course of SCD patients. Nutritional studies may be routinely conducted in this group of patients for better management.

Thyroid disorders in adult Nigerians with palpitations

Background: Thyroid hormones elicit significant cardiovascular effects, and abnormalities of its concentration may lead to palpitations. This study seeks to evaluate the prevalence of thyroid hormone disorders in adult Nigerians with palpitations. Materials and Methods : A total of 62 patients (20 males, aged 36.8 ± 10.0 years and 42 females, aged 39.3 ± 9.9 years) with palpitations referred to the chemical pathology laboratory for biochemical analysis from June 2002 to May 2007 were retrospectively studied. All blood specimens were routinely collected in the morning in fasting state. The thyroid function parameters were analyzed using ELECSYS 1010 autoanalyzer supplied by Roche Diagnostics, Germany. The analyzer uses the principle of electrochemiluminescence immunoassay technique. Results : Out of the 62 patients, 10 (4 males and 6 females) had thyroid disorders representing a prevalence of 16.1%. Conclusions: Prevalence of 16.1% was observed in patients with palpitations. More women than men were observed to have palpitations and the ratio of proportion of thyroid disorders between male and female was 2:3.

The Association of Triiodothyronine-to-Thyroxine Ratio with Body Mass Index in Obese Nigerian Children and Adolescents

The interest in the relationship between thyroid dysfunction and obesity is on the increase. This study compares the triiodothyronine-to-thyroxine (T3/T4) ratio in obese and lean children and adolescents, and correlates thyroid hormones with body mass index (BMI) in obese Nigerian children. It is a retrospective study of records of 76 obese children and adolescents with a BMI of 31.7 ± 0.1 kg/m2 (26 males aged 10.9 ± 0.35 years, and 50 females aged 10.8 ± 0.4 years) that were referred to the laboratory for thyroid hormone evaluation because of their obese status. The controls were 20 age-matched non-obese apparently healthy subjects, with a mean age of 11.0 ± 0.47 years and a BMI of 20.2 ± 0.2 kg/m2. Serum T3, T4, and thyroid stimulating hormone (TSH) were determined using ELECSYS 1010 auto-analyzer (Roche Diagnostics, Penzberg, Germany). The BMI (p < 0.001), T3 (p < 0.01), TSH (p < 0.001) and T3/T4 ratio (p < 0.001) were significantly higher in obese than non-obese children and adolescents. Triiodothyronine (r = 0.230; p < 0.05), TSH (r = 0.272; p < 0.02), and T3/T4 ratio (r = 0.232; p < 0.05) correlated positively with BMI in obese children and adolescents. The T3/T4 ratio (p < 0.005) was significantly higher in obese boys than obese girls. Serum T3, TSH, and T3/T4 ratio correlated positive with BMI in obese Nigerian children and adolescents. Since thyroid dysfunction represents a continuum from asymptomatic to clinical symptomatic disease, it is suggested that obese children be counseled on the need to maintain ideal BMI in order to avoid the risks associated with obesity.

Serum Creatine Kinase-MB Isoenzyme Activity among Subjects with Uncomplicated Essential Hypertension: Any Sex Differences

Hypertension (high blood pressure) is a major health challenge and more women than men are affected by the condition. Complications as a result of this condition often lead to disabilities and premature death. The objective of this study was to evaluate creatine kinase-MB (CK-MB) activity in uncomplicated hypertension and to know whether sex differences exist in the activity of the enzyme. Serum creatine kinase-MB isoenzyme activity, troponin I, and lipid profile were evaluated in 140 male and 100 female Nigerians with hypertension. The control group was comprised of 100 (50 males and 50 females) normotensive subjects. Measured parameters were assayed using Selectra Pros chemistry analyzer. The means were compared between males and females using Students’t-test. The mean CK-MB activity of the female hypertensive subjects was significantly higher (p < 0.001) than the males. Similarly, the mean cardiac troponin I (cTnI) of the female hypertensive subjects was significantly higher (p < 0.001) than the males. Conversely, the mean CK-MB activity of the female normotensive subjects was significantly lower (p < 0.001) than the male counterparts. There was no difference in the levels of cTnI between male and female normotensive subjects. Serum CK-MB activity was higher in female than male hypertensive subjects. In the light of these results, cardiac markers should be routinely done in the evaluation of hypertensive subjects and sex-specific consideration may be recognized in the management of these patients.

Correlation of copper/zinc ratio with superoxide dismutase activity and neutrophil-to-lymphocyte ratio in human immunodeficiency virus type 1 (HIV-1) infected subjects

Introduction: The important role of nutrition in the pathogenesis of human immunodeficiency virus type-1 (HIV-1) infection has not been sufficiently addressed in sub-Sahara Africa, where the prevalence of HIV infection is high. This study correlates copper-to-zinc ratio with activities of superoxide dismutase and calculated neutrophil-to-lymphocyte ratio in HIV-1-infected subjects. Material and methods: In the study, there were 120 confirmed HIV-1 positive subjects and 100 HIV-1 negative ambulatory healthy controls. Complete blood count, clusters of differentiation (CD4+) lymphocyte count, serum superoxide dismutase (SOD), catalase, copper, and zinc were evaluated using hematology analyzer, FACS flow cytometer, enzyme-linked immunosorbent assay, and atomic absorption spectrophotometer, respectively. Correlation between the measured variables was completed using Pearson correlation coefficient. Results: Serum copper (p < 0.001), catalase (p < 0.05), and neutrophil-to-lymphocyte ratio (NLR) (p < 0.001) were significantly higher, while serum zinc (p < 0.001) was lower in HIV-1 positive than control subjects. Copper/zinc ratio correlated with SOD (r = –0.228; p < 0.02), CD4+ (–0.235; p < 0.02), and NLR (r = 0.198; p < 0.05) in HIV infected subjects. Conclusions: Copper/zinc ratio correlated with NLR, SOD, and CD4+ cell count. Because of the adverse effects associated with imbalance of copper and zinc levels, nutritional status, antioxidant defense mechanism, and inflammatory markers may be assessed periodically in HIV-1-infected patients. HIV AIDS Rev 2018; 17, 1: 18-23 DOI: https://doi.org/10.5114/hivar.2017.72278

Serum activities of oxidative burst enzymes in HIV infected subjects

Introduction: Human immunodeficiency virus (HIV) infected subjects are immuno-depressed because of decreased levels of circulating CD4+ lymphocytes. It was suggested that the qualitative defects in phagocytic functions in this infection may hinder chemotaxis, lower oxidative burst enzymes, alter phagocytosis and bacterial killing processes. The objective of this study was to evaluate the activities of oxidative burst enzymes in HIV infected subjects and to determine the effect of the use of highly active antiretroviral therapy on these enzymes. Material and methods: Serum catalase (CAT), superoxide dismutase (SOD) and myeloperoxidase (MPO) activities and CD4+ lymphocyte counts were evaluated in 176 HIV infected subjects (50 HIV naïve, 126 on antiretroviral therapy) and 40 HIV negative subjects which served as controls. The enzymes activities were assayed by the ELISA technique using reagents supplied by WKEA Med Supplies Corp (China). The CD4+ lymphocyte count was assayed using the FACScan flow cytometer technique (FACScan Becton Dickinson, USA). Results: There were statistically significant increases in the activities of CAT (p < 0.05) and MPO (p < 0.02) while SOD (p < 0.001) and CD4 cell count decreased significantly in HIV infected subjects than controls. The activities of CAT (p < 0.001), MPO (p < 0.01) and CD4 cell count (p < 0.001) were significantly higher while SOD (p < 0.001) was lower in HIV infected subjects on HAART than naïve. Conclusions: The observed increase in the activities of MPO and CAT in HIV positive subjects on HAART correlated with CD4 cell counts. Infected individuals may benefit from antioxidant supplementation in the treatment regimen. HIV AIDS Rev 2017; 16, 2: 84-88 DOI: https://doi.org/10.5114/hivar.2017.67988

Relationship between Neutrophil-to-Lymphocyte Ratio and Inflammatory Markers in Sickle Cell Anaemia Patients with Proteinuria

The renal functions and structure in sickle cell anaemia (SCA) patients may be affected by chronic haemodynamic changes and consequences of vaso-occlusive events in the renal medulla. Few reports on neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios in SCA patients in Africans exist in the literature. This study correlates the values of NLR and PLR with measured traditional inflammatory markers in SCA patients with and without proteinuria and impaired kidney function (defined in this study as estimated glomerular filtration rate (eGFR), less than 60 mL/min/1.73 m2. Full blood count, C-reactive protein (CRP), and fibrinogen were assayed in 150 SCA patients and 50 control subjects using Coulter Haematology analyser (CELL DYE 37000) and ELISA method, respectively. The NLR and PLR were calculated by dividing absolute neutrophil or platelet counts by absolute lymphocyte count. Fibrinogen, CRP, NLR, and PLR increased progressively (p < 0.001) in SCA patients with or without proteinuria, with the highest values seen in those with impaired renal function. NLR correlated positively with CRP and fibrinogen in SCA patients without proteinuria (p < 0.001), with proteinuria (p < 0.001), and impaired renal function (p < 0.05). A positive relationship was also observed between NLR and fibrinogen in the control subjects. The need to determine cut-off values for these leukocyte ratios to be used in identifying those patients at risk and in the general management of SCA patients is suggested.