Rasheed Yusuf

Lipid abnormalities: A case study of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Background : Abnormal lipid levels, especially elevated total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) and decreased high density lipoprotein cholesterol (HDL-C), contribute additional risk to patients with diabetes mellitus (DM) and coronary heart disease (CHD). Reports on the pattern of lipid profile abnormality in blacks are scanty and inconsistent. The aim of the present study has been to carry out a retrospective analysis of lipid profile investigation in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Materials and Methods : A total of 448 patients with different disease conditions, such as type II DM, CHD, renal disorders, liver diseases and other abnormalities, who were referred to the chemical pathology laboratory from various clinics and hospitals for lipid profile analysis were assessed. The subjects were made up of 312 (69.67%) males and 136 (30.33%) females. The mean age for the total (combined males and females) was 58 (ranged 45-72) years and the mean age values for males and females were 62 (ranged 51-73) and 53 (ranged 35-65) years respectively. Results : The results show that abnormal lipid profile was found in 51 (11.38%) patients who were consisted of 33 (67.71%) males and 18 (35.29%) females. These also consisted of 35 (68.63%) patients with cardiovascular diseases (CVD), 5 (9.80%) patients with type II diabetes mellitus (DM) and 11 (21.57%) patients with other clinical conditions such as liver and renal diseases. Hypercholesterolemia and hypertriglyceridemia alone were observed in 8 and 15 patients respectively. Low density lipoprotein cholesterol (LDL-C) levels were elevated in 11 patients. Thirty six (36) patients had reduced levels of HDL-C only, with concomitant high levels of TC/HDL-C ratio. Combined hyperlipidemia was observed in only five patients. The results revealed that abnormal lipid profile pattern was higher in patients with CVD (68.60%) than in other cases. Conclusion : The results of the present study demonstrate that low HDL-C levels seemed to be more prevalent in this population. This report could contribute to the ongoing work on lipid research in Nigeria and the world at large.

Cardiac Troponin T and creatine kinase MB fraction levels among patients with acute ischemic stroke in Nigeria

Background: Stroke has been a global burden, with increasing morbidity and mortality. Serum cardiac troponin t (cTnT) and creatine kinase (CK-MB) fraction are reported to be elevated in patients admitted with acute ischaemic stroke and high level of these biomarkers indicated more severe stroke and neurologic deficit in some of the patients. Objective: To evaluate the serum levels cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in patients with acute ischaemic stroke and relate the analytes to severity of stroke. Method: Patients with clinical diagnosis of ischaemic stroke diagnosed, confirmed by brain Computerized Tomography scan and equal number of apparently healthy age and sex-matched were recruited. Serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) were analysed using ELISA method and Stroke severity was determined using National Institute of Health Stroke Score (NIHSS). Results: Mean serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in stroke patients were found to be higher than age sex matched control (p<0.05). NIHS Score of 12.2 ± 5.43 and 9.78 ± 3.97 were observed in Patients with elevated and normal cTnT respectively (p=0.009) while NIHS Score were similar in patients with elevated and normal CK-MB (p = 0.772). Conclusion: The mean values of serum cTnT and CK-MB were higher in acute ischaemic stroke patients compared to controls. Serum cardiac Troponin t level may be a significant biomarker of the severity of stroke.

Lipid profile of HIV/AIDS patients attending antiretroviral clinic in Zaria, North-Western Nigeria

Introduction: Nigeria, the tenth most populous country in the world and the most populous country in sub-Saharan Africa, has the second highest population of people living with HIV, after South Africa. A variety of endocrinologic, metabolic and nutritional disturbances are common during the course of HIV infection. Most HIV/AIDS patients develop multiple metabolic abnormalities including insulin resistance, lipodystrophy and dyslipidemia leading to increased risk of cardiovascular disease (CVD). Objective: To assess the lipid profile of HIV/AIDS patients attending antiretroviral (ARV) clinic in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. Materials and Methods: Fifty HIV-seropositive patients on ARV therapy, 50 ARV-naοve HIV patients and also 50 HIV-negative controls were assessed for lipid profile status and CD4 count. BMI of all participants was calculated. Data obtained were analysed using SPSS 15.0. A P- value ≤ 0.05 was considered as statistically significant. Results: The mean values of lipid profile showed a significantly higher total cholesterol (P < 0.01) and HDL-cholesterol (P < 0.001) in HIV-positive patients on ARV therapy compared with ARV-naive patients and controls. There was a positive significant correlation between CD4 count and total cholesterol as well as between CD4 count and LDL-cholesterol in patients on ARV therapy. A negative significant correlation was found between CD4 count and triglyceride in ARV-naive patients. Atherogenic index was significantly lower (P < 0.01) in HIV-positive patients on ARV therapy. Conclusion: HIV infection leads to dyslipidemia which is probably worsened by ARV therapy; however, these dyslipidemia did not constitute CVD risk.

Assessment of biochemical liver function tests in relation to age among steady state sickle cell anemia patients

Background and Objective: Multiorgan failure including liver dysfunction is a common finding in sickle cell anemia (SCA) patients, the cause of which is multifactorial with advancing age said to be a major determinant. There is a paucity of data on liver function among SCA patients in relation to age in northern Nigerian hospitals, including Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. This study was to assess the biochemical liver function tests (LFTs) as they relate to age among SCA patients in steady state, with a view to improving the overall monitoring of these patients. Subjects and Methods: This study was carried out in ABUTH, Zaria, Northern Nigeria. LFTs were carried out in 100 SCA and 100 apparently healthy participants (controls). The SCA group was made up of fifty adults and fifty children diagnosed of SCA, whereas the control group was made up of fifty adults and fifty children who were apparently healthy and had hemoglobin AA. Paired two-tailed Students t-test for matched samples and Pearsons linear correlation statistical methods were employed for the data analysis using Microsoft Office Excel 2007. A P ≤ 0.05 was considered as statistically significant. Results: The serum concentrations of total bilirubin (TB), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and AST/ALT ratio were significantly higher in SCA patients compared to the controls (P = 0.001, P = 0.001, P = 0.05, P = 0.05 and P = 0.001, respectively). Serum total protein (TP) and ALB were significantly lower (P = 0.01 and P < 0.05, respectively) in SCA patients compared with the controls. The levels of TB, ALT, AST, ALP, and AST/ALT were significantly lower in SCA adults compared to SCA children, whereas TP and ALB were higher in SCA adults compared to the SCA children. There were significant negative correlations between age and each of TB, ALT, AST, ALP, and AST/ALT, and significant positive correlations between age and each of TP and ALB in SCA patients. Conclusion: There are mild LFTs derangements in SCA patients even in steady state with the extent of the abnormalities decreasing with advancing age of the patients.

Nutritional iodine status of pregnant women in Zaria, North-Western Nigeria

Background: Iodine deficiency is a major public health problem worldwide, especially in pregnant women and young children. It is the most common cause of preventable mental retardation all over the world. Few among the devastating outcomes of iodine deficiency in pregnancy are increased perinatal mortality, abortions, stillbirths, neonatal hypothyroidism, goiter, and congenital anomalies. Objective: To assess the nutritional iodine status of pregnant women in Zaria. Methods: Four hundred subjects were recruited for this study consisting of three hundred apparently healthy pregnant women and one hundred apparently healthy nonpregnant age-matched controls. Random urine samples were collected and analyzed for iodine by modified Sandell-Kolthoff reaction. Data were analyzed using Epi-Info 3.5.3 to obtain the mean ages and median urinary iodine concentration (UIC) for pregnant women, controls and then for each trimester of pregnancy. P ≤ 0.05 was considered statistically significant. Results: Mean ages ± standard deviation for pregnant women and controls were 25.41 ± 5.98 and 26.70 ± 5.83 years, respectively (P > 0.05). Median UIC for pregnant women and controls were 193 μg/L and 205 μg/L, respectively. Trimester-specific UICs were 250 μg/L, 154 μg/L, and 150 μg/L for the first, second, and third trimesters, respectively. The percentage of women with iodine deficiency increased with advancing gestational age. Conclusion: Pregnant women in Zaria were iodine sufficient. There was a progressive decline in median UIC from the first through the third trimester.

Determination of Normal Portal Vein Parameters on Triplex Ultrasound Scan Among Adults in Zaria, Nigeria

Background: There are many causes of the portal vein (PV) disease and these include portal hypertension (PHT), PV thrombosis, PV gas and PV stenosis/obstruction. PHT is a common clinical presentation of portal venous disease with multiple causes and several sequelae. There is a need for an imaging parameter that will aid early diagnosis of PHT since portal pressure monitoring devices are not available in most tertiary hospitals in Nigeria. Aims and Objectives: To determine the normal values of PV parameters using triplex ultrasound (US) among adults in Zaria, Nigeria. Settings and Design: This prospective study was conducted over a period of 6 months between November 2011 and May 2012 at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: Following an overnight fast, US scan was performed on 186 eligible participants. The diameter, cross-sectional area (CSA) and flow velocity of the PV were obtained. Results: The PV parameters obtained were as follows (mean ± standard deviation): PV diameter, 1.09 ± 0.22 cm (range: 0.87-1.31); CSA, 1.10 ± 0.203 cm 2 (range: 0.89-1.30) and mean flow velocity, 15.44 ± 2.63 cm/s (range: 12.80-18.10). All the measurements in males were significantly higher than those in females (P < 0.001). Conclusion: The normal values of PV parameters have been established in adult subjects in Zaria. These values will serve as a reference to detect abnormalities of dimensions and flow velocities in the PV, thus enabling quantitative evaluation of patients with suspected PV disease.

An evaluation of the gallbladder in adult sickle cell anemia patients in Zaria North-West Nigeria

Background: Sickle cell anemia (SCA) is characterized by a constant state of hemolysis which leads to hyperbilirubinemia. Hyperbilirubinemia may predispose to development of pigment gallstones in these patients. Gallstones in SCA patients increase morbidity and mortality and poses diagnostic dilemma as most patients are asymptomatic. The objective of this study was to evaluate the gallbladder using ultrasonography, biochemical, and hematological parameters among adult SCA patients in steady state at the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Patients and Method: We conducted a case-control cross-sectional study of adult SCA patients attending the hematology clinic of ABUTH, Zaria, Nigeria and HbAA controls. Sixty-seven consenting adult SCA patients in steady state and twenty HbAA controls had abdominal ultrasonography, biochemical, and hematological tests on blood samples. Information obtained was entered and analyzed using Statistical Package for the Social Sciences (SPSS) 17.0. Statistical evaluation consisted of descriptive analysis and comparison of means using student′s t-test. Level of significance was set at P < 0.05. Results: Of the 67 SCA patients, 19 (28.4%) had gallstones, and the prevalence increased with increasing age of the patients. There were significant differences in all laboratory parameters between SCA patients and the HbAA controls except alkaline phosphatase levels. While there were no significant differences in these parameters between SCA patients with gallstone and those without gallstone except the gallbladder volume. All the SCA patients with gallbladder stones were asymptomatic. Conclusion: There is a high prevalence of gallbladder stone in SCA patients, especially after the age of 20 years. Thus, abdominal ultrasonography should be part of the routine care of SCA patients, especially after the second decade of life.

Prevalence of gestational thyroid disorders in Zaria, north-western Nigeria

Background: Thyroid disorders are the second most common endocrine disorders found during pregnancy. Normal maternal thyroid function is critical for normal fetal development. Gestational thyroid dysfunctions complicate pregnancy with a significant increase in maternal and perinatal morbidity and mortality. Objective: To assess the prevalence of thyroid disorders among pregnant women in Zaria. Materials and Methods: Study population consisted of 300 apparently healthy pregnant women and 100 apparently healthy age-matched nonpregnant controls. Participants were not on any drug that can affect thyroid function. Serum thyroid hormones [thyroid stimulating hormone, free triiodothyronine (T 3 ), free thyroxine (T 4 ), and thyroid peroxidase (TPO) antibody] were assayed using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using Epi Info 3.5.3 and P-values ≤0.05 were considered statistically significant. Results: Ages (mean ± SD) were 25.41 ± 5.98 and 26.70 ± 5.83 years for pregnant women and controls, respectively. Parity mean ± SD were 2.32 ± 2.24 and 2.63 ± 2.75 for pregnant women and controls, respectively. The mean gestational age ± SD was 21.68 ± 10.38 weeks. Three percent (3%) were hypothyroid, while 2.3% were hyperthyroid. Nine percent (9%) were TPO antibody positive. Conclusion: Prevalence of thyroid disorders among pregnant women in Zaria was high therefore routine screening of all pregnant women for thyroid disorders during antenatal care visits may be of benefit.

Microalbuminuria in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Patients on Antiretroviral Therapy in Zaria, Nigeria

Introduction: Microalbuminuria (MA) an early marker of glomerular dysfunction is also associated with increased risk of cardiovascular disease (CVD) in the general population, and is frequently seen among patients with human immunodeficiency virus (HIV) infection. Measurement of MA is not routinely done in many HIV/acquired immunodeficiency syndrome (AIDS) patients in our environment, especially those on antiretroviral therapy (ART). This study was to determine the prevalence of MA among HIV/AIDS patients in Zaria. Subjects and Methods: Screening for MA was carried out in this cross-sectional study involving 101 HIV/AIDS patients on ART. Patients with hypertension, diabetes, renal disease, pregnancy, and with features suggestive of malignancy were excluded from the study. Urinary albumin and creatinine, serum creatinine, glucose, cholesterol, and CD4 count were assayed. The data obtained were analyzed using the statistical software package for the social sciences version 16.0 (SPSS 16.0). Result: The mean values for urine albumin, urine creatinine, and albumin creatinine ratio (ACR) were 9.35 mg/L ± 1.32 mg/L, 6.50 mmol/L ± 0.35 mmol/L and 1.77 mg/mmol ± 0.34 mg/mmol, respectively. Twenty-one (20.8%) patients were found to have MA (ACR 3-30 mg/mmol) with remaining 80 (79.2%) having normoalbuminuria (ACR <3 mg/mmol). Among patients with MA, 6 (5.9%) had estimated creatinine clearance of <60 ml/min. There was a statistically significant association (P < 0.001) between ACR and age in microalbuminuric patients. Conclusion: Prevalence of MA is high among HIV/AIDS patients on ART in Zaria. Routine measurement of microalbumin in urine is suggested for early identification of renal disease and CVD and possibly reduces morbidity and mortality among patients with HIV/AIDS infection.

Determination of normal portal vein congestive index on ultrasound scan among adults in Zaria, Nigeria

Background: Portal hypertension is a major abnormality of the portal venous system and it is a commonly encountered clinical condition with multiple causes and several sequelae. The need for an imaging parameter that will aid its early diagnosis cannot be overemphasized, bearing in mind that portal pressure monitoring devices are not available in most tertiary hospitals in Nigeria. This prospective study was aimed at using ultrasound to determine the normal Portal Vein Congestive Index among adults in Zaria, Nigeria. Patients and Methods: The study was conducted over a period of 6 months spanning 15 th November 2011 to 14 th May 2012 at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria. Following an overnight fast by the 186 eligible participants, the portal vein diameter, cross sectional area and flow velocity were obtained using ultrasound Doppler equipment (Mindray diagnostic ultrasound system, Model DC-3, 2010-2012, Nanshan, Shenzen, PR China). B-Mode gray-scale for the assessment of dimensions, and Duplex Doppler Ultrasound Scan techniques for interrogation of the flow pattern and velocity. These parameters were then used to obtain the congestive index of the subjects. Results: The portal vein hemodynamic parameters were as follows mean (SD): Cross sectional area, 1.097 cm 2 (0.203) (ranged 0.89-1.30); mean flow velocity, 15.44 cm/s (2.628) (ranged 12.80-18.10); and congestive index, 0.0722 cmS (0.0135) (ranged 0.0587-0.0857). All measurements in males were significantly higher than those in females (P < 0.001); and the portal vein congestive index increased significantly with age (P = 0.006). Conclusion: Reference values of normal congestive index of the portal vein have been established and may be used for the assessment of patients with liver diseases or portal hypertension in this environment.