Functional Haplotypes in the ADIPOQ Gene are Associated with Underweight, Immunosuppression and Viral Suppression in Kenyan HIV-1 Infected Antiretroviral Treatment Naive and Experienced Injection Substance Users

BACKGROUND: Human immunodeficiency virus and injection substance use have an influence on genes and gene expression. These effects could be beneficial or detrimental in defining disease outcomes. Adiponectin gene is key in modulating metabolic and immunoregulatory functions. Understanding the effects of human immunodeficiency virus and injection substance use on the gene in the context of antiretroviral therapy is important for predicting disease outcomes.METHODS: This cross-sectional genetic study determined polymorphisms in the promoter region of adiponectin gene. Two variants were analyzed: rs2241766 and rs266729. Polymorphisms were associated with clinical markers of disease outcome; underweight, immunosuppression and viral suppression. The variants were genotyped via random fragment length polymorphism.RESULTS: GC haplotype was associated with higher odds of having underweight (OR, 2.21; 95% CI, 1.83-4.60; P=0.008 vs. OR, 2.30; 95% CI, 1.89-4.71; P=0.006) in antiretroviral treatment -naive and experienced injection substance users andimmunosuppression (OR, 1.90; 95% CI 1.67-3.98, P=0.041) in naive. Bonferroni correction revealed GC haplotype carriers only to have low body mass index in both naive (median, 14.8; IQR, 3.2kg/m2; P<0.002) and experienced (median, 15.2; IQR, 3.2 kg/m2; P<0.002) injection substance users. Circulating total adiponectin levels were higher in naive (median, 19.5; IQR, 7.9 μg/ml) than - experienced (median, 12.0; IQR, 4.4 μg/ml) injection substance users (P<0.0001). GC carriers presented with low serum adiponectin levels in both study groups.CONCLUSION: The study revealed haplotypes of adiponectin gene at loci rs2241766 and rs266729 that could determine disease outcomes in human immunodeficiency virus -1 antiretroviral treatment- naive and experienced injection substance users

Reproductive and Lifestyle Characteristics of Kenyan Women Presenting With Precancerous Cervical Lesions: A Hospital-Based Case–Control Study

Background: Cervical cancer is a leading cause of cancer in women, accounting for 68% of cancer-related deaths among women in developing countries. Several reproductive, lifestyle and demographic risk factors are associated with increased risk for cervical cancer. This study examined the association of risk factors with precancerous cervical lesion grade in women attending Nakuru County Referral Hospital.   Methods: This hospital-based, case-control study was conducted among women aged 20 to 70 years from January to December, 2017. A total of 142 women were recruited into the study and stratified based on precancerous cervical lesion grades based on the Bethesda System as: atypical glandular cells or adenocarcinoma in situ (AGC/AIS, n=8), high-grade squamous intraepithelial lesions (HSIL, n=59), low-grade squamous intraepithelial lesions (LSIL, n=35), and controls (n=40). Structured questionnaires were used to collect information on demographic, reproductive health, and lifestyle characteristics; anthropometric assessments were conducted. Endocervical swabs and scrapings were obtained from the study participants and used for human papillomavirus (HPV)-16/18, and Pap smear screening.   Results: Age differed significantly among the study groups, with age rising with higher grade of precancerous lesion. Higher rates of HPV 16/18 infection was associated with presenting with AGC/AIS (n=8, 100.0%), HSIL (n=47, 79.7%), and (n= 29, 82.9%), compared to controls (n=4, 10.0%; P<.001). History of concomitant lower abdominal pain, vaginal bleeding and discharge was associated with higher risk of precancerous lesion in the HSIL group (odds ratio [OR] 8.9; 95% confidence interval [CI], 2.6 to 30.6) and the LSIL group (OR 5.8; 95% CI, 1.8 to 18.8). Bust circumference <99 cm was associated with higher risk of having AGC/AIS (OR 17.4; 95% CI, 1.1 to 276.0), HSIL (OR 5.9; 95% CI, 2.0 to 17.1), and LSIL (OR 2.7; 95% CI, 0.9 to 7.8). Waist circumference <86 cm was associated with higher risk of HSIL (OR, 5.4; 95% CI, 1.9 to 15.4) and LSIL (OR 2.9; 95% CI, 0.9 to 8.2). Having a healthy diet was associated with higher odds of LSIL (OR, 4.2; 95% CI, 1.4 to 12.9), but was not associated with HSIL or AGC/AIS.   Conclusion: This study suggests that high-risk HPV 16/18 infection, chronic lower abdominal pain with vaginal bleeding, and decreased upper and lower trunk body mass, are associated with higher risk of precancerous cervical lesions. Integrating targeted cervical cancer screening in routine reproductive health-care services may reduce the risk of developing cervical cancer

Interactions Between Mushroom Powder, Sodium Chloride, and Bovine Proteins and Their Effects on Lipid Oxidation Products and Consumer Acceptability

The antioxidant capacity of dried Agaricus bisporus mushrooms (DAB) in beef has previously been assessed. However, interactions between lipid oxidation products, mushroom polyphenols, and bovine proteins present in beef to explain the mushroom\u27s antioxidative effect, has not been determined. Oven-dried or lyophilized DAB with and without 15 g NaCl/kg beef (1.5%) or 20 g NaCl/kg beef (2%) were added to sarcoplasmic protein homogenates from top round beef. Malondialdehyde and volatile aldehyde binding to sarcoplasmic protein (SP) were monitored. Oven dried had 64% higher total phenolic compared to lyophilized DAB, leading to ∼50% lower malondialdehyde content in beef with oven dried DAB compared to lyophilized DAB. The addition of 20 g NaCl/kg beef (2%) acted as a pro-oxidant, while addition of 15 g NaCl/kg beef (1.5%) increased binding of lipid oxidation (LOX) products to SP. The results suggest that addition of mushrooms to beef can enhance the binding of sarcoplasmic protein to lipid oxidation products, thereby decreasing lipid oxidation compounds

Knowledge, Perception and Level of Male Partner Involvement in Choice of Delivery Site among Couples at Coast Level Five Hospital, Mombasa County, Kenya

Involvement of males in reproductive health is an important step in reducing maternal and newborn deaths. A number of pregnant women attending Coast Level Five Hospital report waiting for their male partner to discuss and choose the delivery site. Although some do this when already in labour , there are no records on how many practice this and the influence of the couple knowledge and perception on male partner involvement in choice of delivery site. This descriptive cross-sectional study aimed at establishing the level of male partner involvement and influence of couple knowledge and perception on male involvement in choice of delivery site among women who delivered at this facility. Systematic sampling was used to select the participants. A semi-structured questionnaire and focus group discussion guide were used to collect data. Chi-square and binary logistic regression were used for statistical analysis. 40.6% of male partners were involved in choice of delivery site, women knowledge (χ2-19.256; df-1; p<0.001), women (χ2-11.347; df-1; p=0.001) and male partners’ perception (χ2-10.909; df-1; p=0.001) influenced male partner involvement. However, women knowledge was the only predictor of male involvement (OR-3.843; 95% CI, 2.082-7.092; P<0.001). Male partner involvement was low, empowering women and encouraging positive perception among women and male partners will enhance male partner involvement in choice of delivery site. The health workers in Mombasa should come up with health education and communication strategies to improve public knowledge and perception towards male involvement and ultimately improve the level of male partner involvement in choice of delivery site. Keywords: Coast Level Five Hospital, Male involvement, Choice of delivery site, Mombasa Kenya, Male partner, Knowledge and perception

Birth Preparedness and Complication Readiness among Women with Pregnancy and Childbirth related Complications at Kenyatta National Teaching and Referral Hospital, Kenya

Background: In developing countries, particularly those in Sub-Saharan Africa, women and newborns continue to face increased risks of mortality and morbidity during the time of pregnancy, birth and postpartum. Preparing for childbirth and being ready for complications is a key strategy in reducing maternal mortality and morbidity as this would reduce delay in obtaining skilled maternal care especially during childbirth. This survey was evaluating birth preparedness and complication readiness (BPCR) among womenseeking services at Kenyatta National Teaching and Referral Hospital.Methods: A cross-sectional hospital-based study was conducted among women admitted in the antenatal and postnatal ward. Data was collected using a standardised questionnaire. A respondent was considered to have satisfactory BPCR if she reported that she had identified the place of delivery, made prior financial arrangements and organised for means of transport to place of childbirth and/or for the time of obstetric emergencies ahead of childbirth.Results: The survey recruited 353 women aged between 15 and 44 years. Majority were married (n=288, 81.6%) and unemployed (n=232, 65.7%). Additionally, most of the participants were multiparous (n=345,97.7%) and had made at least 1 visit at the Antenatal Clinic during their current pregnancy (n=331, 93.8%). The proportion of women whose BPCR was rated as satisfactory was 56.7% (95% confidence interval, (CI) 49.7% - 63.6%). Factors associated with satisfactory BPCR included: being married (OR10.66, 95%CI5.21-21.83), having post-secondary education (OR 11.52, 95% CI 6.62-20.05), being in formal employment (OR 4.14, 95%CI2.51-6.82), gestation >28 weeks (OR=1.83,95%CI1.08-3.09), multiparity (OR=1.87,95%CI1.21-2.88), visiting Antenatal Care Clinic (OR=9.31, 95% CI 2.70-32.09)and particularly visiting the clinic more than 2 times (OR=4.43, 95% CI 2.75-7.13).Conclusions: The study documented sub-optimal BPCR. This highlights the need to review the current strategies and approaches being utilised to promote BPCR

Cytokine profiles in highly active antiretroviral treatment non-adherent, adherent and naive HIV-1 infected patients in Western Kenya

Background: Cytokines play an important role in signaling the immune system to build an adequate immune responseagainst HIV. HIV distorts the balance between pro and anti-inflammatory cytokines causing viral replication. Highly active antiretroviral treatment (HAART) acts by trying to restore pro and anti-inflammatory cytokine balance. It is not clear how HAART non-adherence influences circulating cytokine levels. This study therefore determined cytokine levels in HAART non-adherent individuals. Methods: This cross-sectional study recruited 163 participants (51 controls, 23 HIV-1+ HAART naive, 28 HAART-adherent6 months, 19 HAART-adherent 12 months and 42 HAART non-adherent). Cytokines were analyzed by ELISA while CD4 T cells determined in 3.0 μl of whole blood using BD FACSCaliburTM and viral load in 0.2ml plasma sample using Abbott Molecular m2000sp sample preparation and m2000rt real-time amplification and detection systems (Abbott MolecularInc., Illinois, USA) according to the manufacturer’s methods. Results: IL-4, IL-6, IL-10, TNF-α and TGF-β were significantly elevated in HIV-1 HAART non-adherent compared withHIV-1 HAART adherent and healthy controls P<0.01. IFN- γ was significantly decreased in HIV-1 HAART non-adherentcompared with HIV-1 HAART adherent and healthy controls P<0.01. TNF-α and TGF-β were significantly reduced in HIV-1 HAART adherent patients at 12 months compared to those at 6 months P<0.01. IL-4 and IL-10 correlated positively withviral load. IL-4, IL-6, IL-10, TNF-α and TGF- β associated inversely with CD4 T cell counts and body mass index (BMI). Conclusion: This study established that HAART adherence is immunologically beneficial to the pro and anti-inflammatory cytokine balance milieu while non-adherence appears to cause alterations in pro and anti-inflammatory cytokines warping the balance in this dichotomy. Keywords: Cytokines; non-adherence; HAART