Vitamin D Levels and Insulin Resistance among Nigerian men with Type-2 Diabetes mellitus

Background: A number of studies have shown a high prevalence of insufficient vitamin D levels in humans in the North American, European and Asian regions. Various research works have also shown that low serum vitamin D levels play a major role in the pathogenesis of chronic, non-infective illnesses such as diabetes mellitus and cancer.Objective: This study was aimed at assessing the serum vitamin D status in relation to glucose homeostasis among men with Type-2 Diabetes mellitus and normal controls.Methods: This comparative cross-sectional study included 80 men with confirmed diagnosis of Type-2 diabetes mellitus and 49 normal adult male controls. Serum 25-hydroxy vitamin D, fasting serum C-peptide and fasting plasma glucose levels were measured in both study groups.Results: There was a significant difference between the mean serum 25-OH vitamin D levels among the cases (36.55ng/mL) and the controls (42.96ng/mL) (p = 0.001). All the four 25-OH vitamin D-deficient subjects had diabetes. In the diabetes group, 43.8% had a normal insulin resistance compared to 61.8% of the control group (p = 0.054). In the diabetes group, 73.8% had sufficient vitamin D, 21.2% had insufficient vitamin D and 5% had vitamin D deficiency. In the control group, there was a significant negative correlation between serum 25-OH vitamin D and BMI and fasting plasma glucose. The mean HOMA2IR value for the diabetes group (3.09) was higher than the value for the controls (2.40).Conclusion: The mean serum 25-OH vitamin D level in the diabetes group was lower than that of the control group hence, hypovitaminosis D may be a contributor to the onset of diabetes mellitus among Nigerian men

Polyp prevalence at colonoscopy among Nigerians: A prospective observational study.

BACKGROUND: This study was aimed at identifying the prevalence, distribution, and clinicopathologic characteristic of colonic polyps among Nigerians undergoing colonoscopy at the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Nigeria. We also determined the polyp detection rate (PDR), polyps per colonoscopy (PPC) and adenoma detection rate (ADR). MATERIALS AND METHODS: This is a prospective study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2013. The patient demographics, indications for colonoscopy, colonoscopic findings, number of the polyps, their sizes, possible risk factors in the individual case histories, and histopathological characteristics of the polyps. RESULTS: During the study period, a total of 415 patients met the inclusion criteria and only 67 out of these had colonic polyps. The overall PDR was 16.1%. The age ranged was 2-87 years with a median of 57 years. Forty-three (64.2%) patients were 50 years or above and there were 40 (59.7%) males. Thirty-three (49.3%) patients were referred as a result of lower gastrointestinal bleeding, 14 (20.9%) for colorectal cancer (CRC) and 13 (19.4%) for routine screening. Thirty-nine (58.2%) patients had the polyps at the rectosigmoid region of the colon, 17 (25.4%) had the polyps located proximal to sigmoid colon and 11 (16.4%) patients had multiple polyps involving both segments. Adenomatous polyps was the most common (28 [47.5%]) histopathological finding of which two patients had adenomatous polyposis. Other findings include inflammatory polyps in 17 (18.8%) patients, 5 (8.5%) patients each had hyperplastic and malignant polyps, while 4 (6.8%) patients had juvenile polyps. The ADR was 6.8 and the PPC was 0.2. Statistically, patients 50 years and older were more likely to have adenomatous and hyperplastic polyps than those younger than this age (P = 0.010). CONCLUSION: We conclude that polyps are probably not as rare among black Africans especially when they are above 50 years. Our histopathological finding of adenomatous change in a good proportion of the detected polyps show that they are likely to be associated with CRCs in our compatriots and as such we would recommend a routine screening colonoscopy for Nigerians aged 50 and above.

Experience with colonoscopy in the riverine southwestern Nigeria.

BACKGROUND: Colonoscopy is useful for diagnosis, treatment and surveillance of anal and colorectal lesions. It affords a good, less invasive and tolerable way to see and access the large intestine. AIM AND OBJECTIVE: To determine the indications, finding and diagnosis at colonoscopy in a riverine setting in Southwestern Nigeria. TYPE OF STUDY: Descriptive cross sectional study. PATIENTS AND METHODS: Patients who presented in the State Specialist Hospital, Okitipupa and requiring colonoscopy in their management between January 2011 to April 2013 were included in this study. They were reviewed and their demographic and clinical data, indications for colonoscopy, the findings and the pathological diagnosis were entered in a proforma. RESULTS: Colonoscopy was done in 100 patients out of which seventy seven (77%) were males and 23 (23%) were females. The indications were frank lower gastrointestinal bleeding 55 (55%) chronic diarrhea (11%), chronic constipation10(10%), occult gastrointestinal bleeding (7.0%), lower abdominal and anal pain 4 (4.0%), queried anorectal cancer 3 (3.0%) and enterocutaneous fistula 1(1%). Colonoscopic findings, include, normal finding 24(24%) colitis 24 (24.0%), hemorrhoid 20(20.0%), Anal fissure 16 (16.0%) colonic cancer 5 (5.0%), anorectal cancer 4 (4.0%), caecal cancer 2 (2.0%) faecal impaction 2 (2.0%), anal wart 2 (2.0%) , polyps 1 (1.0%) and anal fistula 1 (1.0%). The diagnostic yield was 76%. CONCLUSION: Bleeding from the lower gastrointestinal tract was the commonest indication for colonoscopy and the most frequent pathology was amoebic in the riverine Southwestern Nigeria.

Complete recovery of renal allograft function after sixty days of delay following living related transplantation.

Delayed graft function (DGF), a term employed when a newly transplanted organ does not function efficiently is commonly observed following cadaveric renal transplantation but is very rare after living related transplants. We present a 31-year-old female recipient of a related donor kidney (mother) who had DGF following trans-plantation due to acute tubular necrosis, probably caused by partial allograft arterial thrombosis, which recovered function after 60 days. Appropriate use of allograft biopsy should be encouraged even in resource-limited settings lest the allograft be assumed to have failed irreversibly.

Antibiotic resistance of helicobacter pylori from patients in Ile-Ife, South-west, Nigeria

Background: Helicobacter pylori has become recognized as a major cause of gastroduodenal diseases in man. Evidence indicates that once acquired; H. pylori persists; usually for life unless eradicated by antimicrobial therapy. Over the past few years; we have accumulated some knowledge of the epidemiology of H. pylori in Ile-Ife; South-West Nigeria. In one collaborative study; we detected H. pylori in 195 (73) patients referred for endoscopy at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). Furthermore we have observed a variegated gastric inflammatory response and atrophy including atrophic pangastritis but are yet to demonstrate MALToma in any of our patients. In addition we have demonstrated that dental plaque is a possible source of gastric H. pylori infection and such an endogenous source could account for difficulty in eradication leading to re-infection. Presently; infected patients are treated with standard combination therapy made up of amoxycilin and ciprofloxacin with a proton pump inhibitor /bismuth. Reports however have shown that the incidence of antimicrobial resistance in Helicobacter pylori is a growing problem and which has been linked with failures in treatment and eradication. Given this situation it has become necessary to have information about the susceptibility of isolates to particular antimicrobial agents before the selection of an appropriate treatment regimen. Objectives: More recently; we sought to study antimicrobial susceptibility of locally isolated H. pylori strains. Methods: We subjected 32 isolates to antimicrobial susceptibility testing against seven agents. Results: All the isolates showed multiple acquired antimicrobial resistance as they were all resistant to amoxicillin; clarithromycin; metronidazole; while 29/31; 27/31 showed resistance to rifampicin and tetracycline respectively. Five (15.6) of these isolates showed resistance to ciprofloxacin. Conclusions: Our findings suggest that H. pylori strains isolated within our study environment have acquired resistance to all the commonly pres-cribed antibiotics. On the basis of the findings it would be necessary to re-evaluate the eradication treatment regime in our setting

Kidney transplantation in a developing economy: challenges and initial report of three cases at Ile Ife.

BACKGROUND: Kidney transplantation (KT) is globally adjudged the best alternative treatment for end stage renal disease (ESRD) in preference to life-long dialysis. This form of therapy was hitherto unavailable in Nigeria until our hospital and a private hospital embarked on a KT programme despite our depressed economy, and inadequate facilities. We present the initial report of KT performed in our hospital and the challenges of KT in our developing society. CASE REPORTS: Three patients with ESRD had living related KT between June 2002 and April 2003. The first patient died with functioning graft six and a half months post transplantation from complications of Diabetes mellitus and sepsis, while the remaining two still enjoy a good quality of life 35 months post transplantation. There were problems with procurement and monitoring of immunosuppressive drugs in the three patients. This report also illustrates the common causes of ESRD in Nigeria and some of the complications of KT. To our knowledge, these are the first reported cases of KT in Nigeria. CONCLUSION: Kidney transplantation is cost effective and offers a good quality of life for ESRD patients. Poverty, inadequate facilities and lack of donors are major problems facing KT in our society. Although KT requires high technical and material resources, with proper training, commitment and adequate funding, it is feasible, safe and cheaper on a long term basis for the management of patients with ESRD in a developing economy like ours. There is a need for government funding of KT programmes in developing countries.

Primary hepatocellular carcinoma in Ile-Ife, Nigeria: a prospective study of 154 cases.

Primary hepatocellular carcinoma is a tumour with a dismal prognosis. In recent times, however, great advances have been made in its management. This 13-year prospective study done at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, was an attempt to appraise the outlook of the disease in Nigeria at the turn of the 21st century. Primary hepatocellular carcinoma affected mainly middle-aged Nigerians (peak age-group = 40-59 years), predominantly males (M:F = 2:1) and, in a sizeable proportion (78%), it co-existed with cirrhosis. Significant risk factors found were scarification marks (87%), anicteric hepatitis (71.3%), abuse of medicinal herbs and analgesics (68.6%) and injection from quack doctors (51%). Blood test for HBsAg was positive in 61% of patients. The mean duration of symptoms. before diagnosis was 12.64 weeks (SD 13.77) while, on the average, patients died within 14.0 weeks (SD 13.0) of illness, usually of liver failure (67.7%). Only symptomatic treatment could be offered in 148 patients (96.1%) while chemotherapy was merely attempted in 5 (3.25%). Majority of the patients (59.8%) were either discharged against medical advice or lost to follow-up. This study shows that Nigerian patients presenting with primary hepatocellular carcinoma already have advanced disease and this makes treatment and survival hopeless. Universal immunisation with HB vaccine should be implemented in Nigeria without further delay and health education should be directed against socio-cultural practices which are aetiological risk factors for primary hepatocellular carcinoma.

Thyroid malignancy in endemic nodular goitres: prevalence, pattern and treatment.

AIMS: The epidemiology of thyroid cancers in goitre endemic zones has not been recently reviewed, and changes being currently reported have been from studies in non-endemic areas. The aims of this study were to present the clinical pattern of thyroid malignancy in a goitre endemic area and identify recent changes, if any. METHODS: The study was conducted at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between January 1983 and December 1993. Records of patients with nodular goitres treated with thyroidectomy were reviewed, and the clinical features, laboratory parameters, treatment, outcome and follow-up of histologically-proven malignant cases were studied. RESULTS: Thirty-six of 279 (12.9%) patients, aged 13-85 years (mean)=43.7+/-14.7 years), carried malignant goitres, and most (80%) were young or middle-aged women. Of the well-differentiated cancers, follicular type was the most prevalent, being six- and 12-fold as frequent as papillary and medullary cancers (69%vs 11% and 5.6%), respectively. Lymphoma accounted for 5.6%, fibrosarcoma, 5.6% and anaplastic, 2.8%. No relationship was demonstrable between cancer type, duration of goitre and age at diagnosis (r=0.06 and 0.17, respectively). CONCLUSIONS: Thyroid cancers afflict comparatively young women in our environment, and follicular cancer remains the predominant type, partly as a result of persisting dietary iodine deficiency.

Upper gastrointestinal findings and incidence of Helicobacter pylori infection among Nigerian patients with dyspepsia.

Gastroscopy is the preferred method of diagnosis of upper gastrointestinal (UGI) disorders which often present with dyspepsia. Since the discovery of helicobacter pylori (H. pylori) as an important aetiological agent in gastroduodenal disease, investigation for this organism during UGI endoscopy has become a standard clinical practice. We have studied a large number of Nigerian patients with dyspeptic symptoms referred for endoscopy for the spectrum of gastroduodenal diseases and the incidence of H. pylori infection. Detection of H. pylori was done on gastric muscosal biopsies either by the Campylobacter-Like Organism (CLO)-urease test or by histropathology. A total of 834 patients were studied out of which 268 were investigated for H. pylori. A hundred and ninety-five patients (73%) were positive for H. pylori and the peak age was in the fourth decade. Duodenal ulcer (DU) was the most common endoscopic finding (38.7%). The incidence of H. pylori infection was 76% among patients with DU, gastritis, gastroduodenitis and gastric outlet obstruction. However, all the anterior and pyloric channel Duus tested for H. pylori were positive gastric ulcer (GU) was diagnosed in only 4.7% of patients but 82% of them tested for H. pylori were positive. H. pylori was significantly associated with GU occurring with gastritis. Gastric carcinoma was diagnosed in 52 patients (6.2%) and 50% of those tested for H. pylori were positive. This study shows that H. pylori plays an important role in the aetiopathogenesis of peptic ulcer disease among Nigerian patients and that the diagnosis of anterior and pyloric channel Duus or gastroesophageal polyp disease may be an indicator of massive H. pylori infection.