Prevalence of gastroesophageal reflux disease among patients with bronchial asthma.

Bronchial asthma (BA) is a chronic inflammatory condition of the airways characterised by bronchial hyper-responsiveness and narrowing of the airways, which is reversible either spontaneously or with treatment. It affects about 300 million people worldwide including 10% of the Nigerian population.1 Gastroesophageal reflux disease (GERD) however is a chronic gastrointestinal condition characterised by abnormal exposure of the mucosa of the lower oesophagus to acid due to dysfunction of the lower oesophageal sphincter. About 10-30% of adult population in the Western world are affected.2 GERD can aggravate asthma in several ways; and these include vagally mediated reflex triggered by acid in oesophagus as well as micro aspiration of gastric acid resulting in bronchoconstriction.3 Also some asthma drugs cause lower esophageal sphincter relaxation making acid escape easy. Hyperinflation of the chest in asthma with flattening of the diaphragm is thought to contribute to weakness of the crura muscles and dysfunction of the lower esophageal sphincter and amplification of the thoraco-abdominal pressure gradient during an attack helps to promote GERD.4 Reflux symptoms are reported in up to 77% of asthmatics while 32-82% of asthmatics have abnormal pH studies. Silent reflux may be as common as symptomatic reflux with reports suggesting that 25-50% asthmatics have no reflux symptoms but abnormal pH studies5. On the other hand, GERD has been known to have extra-oesophageal manifestation including hoarseness of voice, cough and wheezing.6 Endoscopic studies equally could be normal in up to 50% (non-erosive GERD). 7 There appears to be a diagnostic dilemma, which is further intrigued by cases of silent GERD. 24-hour oesophageal pH measurement and sometimes manometry has remained the cornerstone of GERD diagnosis, however, this is often not widely available in daily practice because of their cost and invasive nature. Hence, guidelines for their use8 have been published. Symptom analysis however has been documented as a practical and inexpensive method of diagnosing GERD, but this obviously may not detect cases of silent GERD or with atypical symptoms. A number of validated questionnaires including QUEST, REQUESTTM and FSSG9 exist with differing sensitivity and predictability. Reports of relationship between BA and GERD exist in Western literature with sometimes conflicting findings to improper definition of BA and/or GERD.10-12 There is limited information about this association among asthma sufferers in Nigeria. We aim to study this relationship among our patients to bridge the existing gap with objectives as: to determine the frequency of symptomatic GERD among previously diagnosed asthmatics attending an Asthma clinic by means of a validated questionnaire (frequency scale for symptoms of GERD (FSSG or Fscale) 9 as well as 24 hour nasopharyngeal DX PH detector, to compare GERD prevalence between the asthmatics and a control population matched for age and sex and to document the upper gastrointestinal tract endoscopic findings in the subgroup of subjects found to have GERD.

A Two-Year Audit of Thyroid Disorders in an Urban Hospital in Nigeria

Thyroid disorders are the second commonly encountered disorders in endocrine clinics and are significant causes of medical morbidity and mortality. It is pertinent to note that in the Nigerian setting; there are challenges of sub-optimal investigative and therapeutic facilities especially as concerning thyroid disorders hence there is underreporting of this important group of endocrine disorders from our part of the world.The objective of this audit is to describe the pattern of presentation; investigation; management and outcome of thyroid disorders in patients attending the Lagos State University Teaching Hospital (LASUTH) Endocrine Center.This was a retrospective medical record review of patients with thyroid disorders who presented to the out patient department; the Medical and Emergency wards of LASUTH between June 2007-June 2009. The clinical; biochemical; serological and histological parameters were used to characterize the patients. Investigations done; treatment type; complications of thyroid disorders; hospitalization records and outcome of management were all documented.One hundred and seventy patients with thyroid disorders aged between 11 and 70 years were seen during the period under review. The male: female ratio was 1:7. Patients presenting with thyrotoxicosis were 128 in number thus giving an incidence rate per year of 64. Therapeutic options were essentially thionamides; betablockers; steroids; surgery; radioactive iodine (RAI) and thyroxine. The mean (SEM) duration of medication usage was 24.5 and the median medication duration was 24 months. RAI usage was low as its use was documented in 7of the subjects with thyroid dysfunction. The rate of occurrence of variable glucose intolerance was 28with frank diabetes mellitus diagnosed in 9of the cases of hyperthyroidism. Thyroid storm; psychiatric manifestations; thyrocardiac disease and cerebrovascular diseases were indications for hospitalizations. Two deaths were documented and these were due to thyrocardiac disease and thyroid storm.RAI usage is underutilized and the thionamides are the main stay of treatment for people presenting with thyrotoxicosis. Given the peculiarities of presentation of thyroid disorders in our practice and the challenges of poor accessibility to diagnostic and therapeutic facilities; it is imperative that management guidelines that take into consideration our resource poor background be set up

Complementary and Alternative Medicine Use in Diabetes Mellitus

"BACKGROUND: Complementary and alternative medicine (CAM); an emerging aspect of the management of chronic diseases worldwide is not widely studied in Nigerian patients with diabetes mellitus (DM). OBJECTIVE: To assess the frequency and pattern of CAM utilization in people with DM . METHODS: This was a cross-sectional question-naire survey involving 263 patients with DM. Biodata; duration of DM; type and pattern of CAM utilization and adherence to prescribed medications were documented. The prevalence and possible determinants of CAM utilization were evaluated by determining the odds ratio for independent variables. RESULTS: There were 263 respondents with a mean age of 60 (10.7) years and with ages ranging from 28-80 years. The prevalence of CAM usage was 46and the female: male ratio was 2:1. Generally; CAM users were older than non-CAM users; (p= 0.006). The main forms of CAM used were biological based therapies and these included bitter leaf (Vernonia amygdalina); aloe vera; garlic; ginger; and ""local herbs"". Adherence to prescribed medications was observed by 94of respondents. CONCLUSION: We found that CAM usage is an important facet of management of DM among our patients with biological based therapies being the prevalent forms of CAM utilized. Despite CAM usage; adherence to prescribed medications was high. Further evaluation of the impact of CAM on glycaemia is needed."

Foot Ulceration in Nigerian Diabetic Patients: a Study of Risk Factors

Diabetic foot ulceration is an important cause of morbidity and mortality in Nigerian diabetic patients. Identification of the risk factors for ulceration is; therefore; of paramount significance. This study aimed to determine these risk factors. Forty-seven (47) diabetic patients with past or present foot ulceration were studied together with an equal number of controls which were diabetic subjects with no past/present history of ulceration. Risk factors strongly associated with foot ulceration included peripheral vascular disease; male sex; nephropathy; retinopathy; foot deformities; history of previous foot ulceration or amputation; cataract formation; poor glycaemic control; neuropathy; and tinea pedis. Weakly associated risk factors were walking unshod; being of low socio-educational status; and smoking. We concluded that many risk factors for foot ulceration are potentially preventable. As part of a comprehensive footcare programme; education on footcare should be directed at patients; family members; and healthcare providers