Carotid doppler ultrasonography in patients with co-existing type 2 diabetes mellitus and hypertension in Nigeria

Background:The co-existence of diabetes mellitus (DM) and hypertension (HTN) has been rising globally with subclinical atherosclerotic complications. These vascular changes can be detected using carotid ultrasonography. Objectives: To determine and compare the carotid arterial structural wall changes and blood flow velocities of adults with co-existing DM and HTN with age-and sex-matched non-diabetic, non-hypertensive controls. Methods: A cross-sectional comparative study of 300 participants comprising 200 adults with co-existing DM and HTN and 100 age-and sex-matched controls was done. Their carotid arteries were examined bilaterally for plaques, carotid intima media thickness (CIMT) and flow velocities ­peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistive index (RI) using 4­12MHz linear array transducer. Visceral obesity and serum lipids were also assessed. Results: The mean age of the subjects was 56.13 ± 6.93 years; they comprised 38% males and 62% females. The subjects' CIMT was statistically significantly higher (p = 0.001) with a three-fold mean increase (45.5%) compared to the controls (13.7%). Lower flow velocities but higher indices were also observed in the subjects. Strong and significant correlations were observed between EDV and PI r =-0.663, p=>0.001), EDV and RI (r = -0.661, p=>0.001) and PI and RI (r =0.988, p= >0.001)among the subjects. Conclusion: Significant reduction in flow velocities with increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, carotid ultrasonography should be mandatory in individuals at risk for early detection and possible prevention of atherosclerotic complications.

Screening of newly-diagnosed adults with tuberculosis for diabetes mellitus and Impaired Glucose Tolerance in a Local Government Area in Ogun State, Nigeria

Background: Emerging patterns in epidemiological transitions have led to increased risk for Non-Communicable Diseases and infectious conditions globally. Diabetes mellitus (DM) in a population is one such risk factor that could lead to the development of Tuberculosis (TB) due to weakened immune functions in affected persons, with implications for mortality. If not diagnosed early, DM also leads to poor treatment outcomes in TB. Objective: To assess the prevalence of DM and impaired glucose tolerance (pre-diabetes) among newly diagnosed tuberculosis cases in Ijebu-Ode Local Government Area of Ogun State, Nigeria. Methods: This cross-sectional study was conducted among 100 newly diagnosed Pulmonary TB patients in ljebu-Ode LGA. The patients were selected from four health facilities and were screened for elevated Fasting Blood Glucose levels using a laboratory spectrophotometer (glucose oxidase method). Results: The mean age of the 100 study participants was 33 years (± 9.82), with ages within 19 -62 years. Eleven (11.0%) had elevated blood glucose levels suggestive of DM, while 20 (20.0%) had impaired fasting blood glucose levels. Among these 31 patients, 18 (58.0%) were males while 13 (42.0%) were females. The modal ages were within 20-39 years. Conclusion: Screening for DM by healthcare providers should be routinely conducted before commencing TB patients on treatment. This will aid early detection, improve treatment outcomes of TB and prevent mortality among patients with these co-morbidities

Pattern of serum electrolytes and cortisol levels in Nigerians with uncomplicated type 2 diabetes mellitus

Diabetes mellitus (DM) is a metabolic disorder, the commonest endocrine disease with increasing prevalence worldwide. Studies on electrolytes derangement in complicated diabetes abound but there are few in uncomplicated diabetes. To determine, compare and correlate serum electrolytes and Cortisol levels in a cohort of uncomplicated type 2 diabetics. A cross sectional study of sixty (60) type 2 diabetes patients of 5-10 years duration without complications and 50 healthy non-diabetic controls that were recruited from the diabetes and general out-patient clinics of a tertiary care facility over 3 months. Using a study questionnaire, information on age, anthropometry, fasting blood Glucose, serum electrolytes and Cortisol were obtained and analyzed following standard procedures. The mean 2 age (years) of diabetics was 49.58 ( ± 11.2) and controls 47.00 ( ± 12.1) and their BMI (Kg/m )[26.47 ( ± 3.97) vs 25.77 ( ± 4.85) respectively were not significantly different (p=0.524; p=0.407). The Waist-hipratio (WHR) was significantly higher in diabetics [0.933 ± 0.004 vs 0.905 ± 0.83) p=0.024]. The mean values of studied parameters among the diabetics and controls respectively are as follows: fasting blood glucose (FBG) [138.4 ± 78.7 vs 82.5 ± 73.7 mg/dl]; serum electrolytes: Sodium 139.0 ± 8.4 vs 142 ± 4.2mg/dl], Potassium [5.2 ± 1.4 vs 4.1 ± 0.53mg/dl] and Chloride [99.3 ± 6.8 vs 104.5 ± 5.0 mg/dl] with significant differences in each (p=0.000, 0.011, 0.000, 0.000 respectively). The mean serum Cortisol was not statistically different [125.5 ± 43.2 vs 121.5 ± 61.3 ng/mL (p=0.693)]. There was no correlation between the various serum electrolytes and Cortisol levels. Electrolytes imbalance in uncomplicated diabetes are present, with higher potassium and lower sodium than in controls with no accompanying change in Hypothalamus-Pituitary-Adrenal activity as measured by serum Cortisol level. This derangement in electrolyte level may be attributed to hyperglycaemia, osmotic diuresis and dietary habit

Plasma Micronutrients (magnesium, zinc, selenium) Status and Lipid Profile in Type II Diabetes Mellitus Patients in Sagamu, Southwestern Nigeria

Background: Diabetes mellitus (DM) is a group of metabolic disorders characterised by hyperglycemia with secondary derangements in micronutrient status. Various studies had given conflicting reports of increased or decreased levels of micronutrients in Type II DM.Objective: To measure the plasma micronutrient levels and lipid profile in adults with Type II DM.Method: Plasma magnesium, zinc and selenium levels were measured among 100 subjects comprising 50 people with DM (age range 36-70 years) and 50 control subjects without DM (age range 29-70 years). The anthropometric parameters were measured; fasting blood glucose, plasma cholesterol, triglycerides, and high-density lipoprotein cholesterol, micronutrients (magnesium, zinc and selenium) levels were also measured using standard methods.Result: There were statistically significant (p < 0.05) higher plasma glucose, blood pressure (systolic and diastolic), LDLC, and lower levels of plasma magnesium, zinc, selenium, HDLC levels among the patients with DM (cases) compared with the normal control subjects. No significant difference was observed in the plasma total cholesterol and triglyceride between the two groups. A significant negative correlation was found between the plasma levels of the trace metals (magnesium, zinc and selenium) and triglycerides (r = - 0.36, r = - 0.43, r = - 0.51 respectively).Conclusion: Plasma levels of magnesium, zinc and selenium are reduced in Type II DM with associated hyperglycaemia-driven dyslipidaemia

Pattern of Doppler Ultrasonographic Scan Requests and Findings: A 3-Year Study

Introduction: Doppler ultrasonography is a radiological investigative tool which is relatively new in developing countries, Nigeria inclusive.Objective: To describe the clinical indications, the pattern of requests and findings of Doppler ultrasonographic studies in a tertiary health facility in Sagamu, Nigeria. This is a preliminary report of a spanning June 2007 to July 2010 and highlighting the Methods: This initial report covered the period between June 2007 and July 2010. The subjects consisted of patients who were referred for Doppler Ultrasonography from public and private health facilities in Sagamu. The ultrasound scan was carried out using a Siemens's Sonoline G-40® Ultrasound Machine. The features recorded included the waveforms, peak velocities, pathologic features such as plaques, irregular pools of blood and the relative absence of flow as well as the lack of Doppler signals.Results: There were 42 patients comprising 29 (69%) males and 13 (31%) females, aged 16-78 years, with a mean age of 53 ± 15.5 years. The subjects were matched for age (p = 0.9). The clinical indications for Doppler ultrasound studies included Diabetes Foot Syndrome (DFS), Deep Venous Thrombosis (DVT), peripheral arterial disease, and leg swellings. Minor indications included oedema, gunshot wound, nephritic syndrome, supraclavicular tumour and varicose veins. The Doppler ultrasound findings were confirmatory of the clinical diagnosis of DVT in 5/8 (62.5%) and 5/23 (21.7%) in DFS patients.Conclusion: Doppler ultrasound confirmed a higher proportion of DVT compared to DFS

The impact of religion and culture on diabetes care in Nigeria

This study aimed to relate the psychosocial effects of religion and culture with the awareness; knowledge and attitude of Nigerians regarding diabetes preven-tion and care. Data was collected from a sample of 1500 individuals in communities where secondary and tertiary health care centres are situated from 12/02/2012 to 25/03/2012. The study population in-cluded a higher proportion of females (65%); with the majority between 19 and 29 years old (56%). Most were unemployed (67%) or in the teaching profession (24%). Over half (58%) respondents were Christian; while 41% were Muslim; and 1% were traditional worshippers. Over 25% believed that diabetes was due to witchcraft or a punishment from God. Also; 28% believed that diabetes was caused by an infection; and 16% and 10% believed diabetes could be caused by witchcraft or by God; respectively. Nearly all (90%) believed that diabetes was potentially fatal. We conclude that many diabetic patients have inadequate knowledge about the causes of diabetes and its complications

Respiratory symptoms and pattern of lung functions among commercial motorcyclists in Sagamu, Nigeria

Background: The relationship between occupational exposure to air pollutants and poor respiratory health is known. The motorcyclists commonly seek medical care for respiratory diseases in Nigeria.Objective: To determine the prevalence of respiratory symptoms and the pattern of lung functions among commercial motorcyclists compared to control subjects.Method: The controlled cross-sectional study was conducted in Sagamu, an urban town in south-western, Nigeria. The commercial motorcyclists and the controls with similar age, non-smokers and same male sex were included in the study. The riders and controls recruited were non-smokers. A structured questionnaire approved by the British Medical Research Council/ATS (American Thoracic Society) was used. The pulmonary function tests were performed according to ATS recommendation.Results: A total of 200 subjects were studied: 100 were commercial motorcyclists and 100 were non-motorcyclist controls. Compared with the controls, the prevalence of cough (71% vs 21%) and sputum (67% vs 20%) was higher among the commercial motorcyclists. Twenty-one percent of the commercial motorcyclists had an obstructive ventilatory pattern compared to 13% of the control group.Conclusion: This study provides further evidence that commercial motorcyclists are exposed to occupational hazards which predisposed them to increased frequency of respiratory symptoms and impaired lung functions. Health education strategy may assist this group of workers and reduce the burden of respiratory disorders among them