Comparative effectiveness of low-level laser therapy versus muscle energy technique among diabetic patients with frozen shoulder: a study protocol for a parallel group randomised controlled trial.

BACKGROUND: Diabetes mellitus is one of the fastest-growing health challenges of the twenty-first century with multifactorial impact including high rates of morbidity and mortality as well as increased healthcare costs. It is associated with musculoskeletal complications, with frozen shoulder being commonly reported. While low-level laser therapy (LLLT) and muscle energy technique (MET) are commonly used to manage  this condition, there remains a lack of agreement on the most effective approach, with limited research available on their comparative efficacy. OBJECTIVES: To evaluate the comparative effectiveness of LLLT versus MET among diabetic patients with frozen shoulder. METHODS: This is a single-centre, prospective, single-blind, randomised controlled trial with three parallel groups to be conducted at Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria. Sixty diabetic patients with frozen shoulder will be randomly assigned into LLLT group, MET group, or control group in a 1:1:1 ratio. All the groups will receive treatment three times weekly for 8 weeks. The primary outcome will be shoulder function and the secondary outcomes will include pain intensity, shoulder ROM, interleukin-6 (IL-6), depression, anxiety, and quality of life (QoL). All outcomes will be assessed at baseline, at post 8-week intervention, and at 3 months follow-up. DISCUSSION: This will be the first randomised controlled trial to evaluate the comparative effectiveness of LLLT versus MET on both clinical and psychological parameters among diabetic patients with frozen shoulder. The findings of the study may provide evidence on the efficacy of these interventions and most likely, the optimal treatment approach for frozen shoulder related to diabetes, which may guide clinical practice. TRIAL REGISTRATION: Pan African Clinical Trials Registry (PACTR202208562111554). Registered on August 10, 2022.

Phenotypic profile and antibiogram of biofilm-producing bacteria isolates from diabetic foot ulcers in Zaria, Nigeria.

BACKGROUND: Diabetic foot ulcers (DFUs) present with high morbidity and reduce patient's quality of life. There is a gross paucity of data on biofilm-producing bacteria in DFU Infection in North-Western Nigeria. The study sought to determine the biofilm-forming ability of bacteria isolates from DFUs and determine their antimicrobial susceptibility pattern in Zaria, North-Western Nigeria. MATERIALS AND METHODS: This hospital-based cross-sectional study of patients with DFUs was conducted from June 2018 to February 2020. Consecutive biopsies were aseptically collected. Bacteria were isolated and identified using a Microgen kit. Biofilm forming ability and antibiogram of isolates were determined using microtitre plate and disk diffusion methods, respectively. RESULTS: Of the 225 participants enrolled, males constituted the majority, 144 (64.0%) with 88 (36.0%) females, the median age of participants was 54 (48-60) years, and the age range was 36-77 years. A total of 172 bacteria were isolated, and 123 (71.5%) were biofilm producers. Staphylococcus aureus (26.7%) was the highest biofilm producer, while Citrobacter freundii and Stenotrophomonas maltophilia were the least biofilm producers, 1 (0.6%) each. A disproportionate resistance pattern was demonstrated among the biofilm and non-biofilm producers against the cephalosporins tested, ceftazidime (68% vs. 18%), ceftriaxone (50% vs. 8.0%) and cefotaxime (21% vs. 0.0%). About 46% and 68% of the biofilm producers were resistant to gentamycin and ciprofloxacin, respectively. While only 2% of the non-biofilm producers were resistant to imipenem, 11% of the biofilm producers were resistant to it. CONCLUSION: These findings revealed a high proportion of biofilm-producing bacteria and were more resistant than non-biofilm producers.

Clinical and biochemical correlates of hypogonadism in men with type 2 diabetes mellitus.

INTRODUCTION: there is an association between hypogonadism and obesity, chronic hyperglycaemia, and ageing in men with type 2 diabetes mellitus (T2DM). T2DM is known to be associated with low testosterone. There is a paucity of data on the risk factors of hypogonadism in Nigerian men with T2DM. The objective of this study was to determine the clinical and biochemical correlates of hypogonadism and clinical predictors of low total testosterone levels in men with T2DM. METHODS: this was a cross-sectional study consisting of 358 men with T2DM and 179 non-diabetic men (controls). Structured Androgen Deficiency in the Ageing Male questionnaire was administered. Clinical and biochemical parameters were measured. Free testosterone was calculated from albumin, SHBG and total testosterone using Vermeulen´s method. Hypogonadism was defined as fasting TT as < 8 nmol/L with or without symptoms or TT of 8-12 nmol/L with symptoms of androgen deficiency. Low testosterone was defined as serum total testosterone levels ≤ 12 nmol/L. RESULTS: the mean (±SD) total testosterone of men with T2DM and controls were 8.79±3.35 nmol/L and 15.41±3.79 nmol/L respectively (p < 0.001). The risk of hypogonadism was associated with central obesity (Odds ratio [OR] 2.24, 95% confidence interval [CI] 0.38-13.07), systolic hypertension (OR 3.93, 95% CI 0.67-23.10), hyperglycaemia (OR 2.48, 95% CI 0.37-16.46) and hypercholesterolaemia (OR 2.50, 95% CI 0.43-14.61). In a multivariable regression analysis, there was a significant negative correlation between total testosterone and triglycerides (r -1.85, 95% CI -3.58 - 0.12, P = 0.04) and HDL cholesterol (r -1.25, 95% CI -5.95-3.45, P = 0.02). CONCLUSION: this study shows that in men with T2DM, triglycerides and HDL cholesterol are independent correlates of hypogonadism but not central adiposity, systolic blood pressure and glycaemia. Further large prospective studies are recommended.

Prediabetes Deserves More Attention: A Review.

Evidence increasingly demonstrates that prediabetes is a toxic state, as well as a risk factor for diabetes, and is associated with pathophysiological changes in several tissues and organs. Unfortunately, use of available evidence-based treatments for prediabetes is low. This review seeks to explain why prediabetes must be viewed and treated as a serious pathological entity in its own right. It offers an overview of the pathophysiology and complications of prediabetes and describes how this condition can be reversed if all treatment avenues are deployed early in its course.

Patients' Experiences About Exercise Prescription and Education in the Physiotherapy Management of Nonspecific Low-Back Pain.

Low-back pain (LBP) is highly prevalent in the society, and its socioeconomic consequences are quite evident. Physiotherapists play a prominent role in the management of individuals with this condition, and it is, therefore, of utmost importance that physiotherapists engage in the most efficient and effective management practices available. For perceptions of good performance and quality health care, patient experience is an important indicator of effective care and management. A mixed-methods research design-a cross-sectional survey (quantitative research) and a focus group discussion (FGD; qualitative research)-was employed in this study, investigating patients' experience in physiotherapy management of nonspecific LBP. An adapted questionnaire was used for data collection from purposively selected participants recruited from 3 hospitals in Kubwa, Abuja, from April to August 2018. The FGD involved 6 patients recruited by simple random sampling using the fishbowl technique. Descriptive and thematic analyses were done on data collected. A total of 126 patients (male = 41, female = 85) were included, with a mean age of 51.0 ± 14.6 years, while the modal age-group was 60 to 69 years. Of these, 41 (32.5%) had nonspecific LBP for less than a year, and the 2 most applied interventions were exercise and heat therapy, followed by education/advice. In all, 110 (87.3%) reported positive experience about education, while 119 (94.4%) reported positive experience about exercise prescription. The result from the qualitative research is in conformity with that of the quantitative analysis. Patients with nonspecific LBP received adequate education regarding their condition and had good experience in the course of their physiotherapy management.

Waist-height ratio: How well does it predict glucose intolerance and systemic hypertension?

AIM: The aim of this study is to assess whether WHtR is a better predictor of glucose intolerance and systemic hypertension than some other obesity indices. METHODS: This is a cross-sectional observational study among four hundred (4 0 0) participants in a Northern Nigerian population. Four (4) participants were eventually excluded due to incomplete data, therefore data from three hundred and ninety six (3 9 6) participants were used in the final analysis. The study assessed whether WHtR is a better predictor of glucose intolerance and systemic hypertension compared to some other obesity indices. Participants were recruited after due consent, then bio-data, blood pressure levels, and some anthropometric measurements were obtained. Subsequently, plasma glucose levels (fasting [FPG] and 2-hour post 75 g glucose load [2HrPPG]) were measured. Data was entered into Microsoft Excel, then analyzed using IBM SPSS version 23. RESULTS: Data from three hundred and ninety six (3 9 6) participants (4 excluded due to incomplete details) were analyzed. Logistic regression of obesity indices showed that WHtR was the best predictor of glucose intolerance with odds ratio (OD) of 20.74 (CI 2.80-155, p < 0.001), followed by WC with OD of 1.89 (CI 1.83-3.94, p < 0.001), then WHR with OD of 1.69 (CI 1.06-8.22, p = 0.009). The least but significant predictor of glucose intolerance was BMI with odds ratio of 1.12 (CI 1.06-3.18, p < 0.001). Furthermore, logistic regression of obesity indices showed that WHtR was the strongest predictor of systemic hypertension with OD of 2.32 (CI 4.85-14.96, p < 0.001), followed by BMI (OD 1.99, CI 1.96-2.05, p = 0.031), then WC (OD 1.95, CI 1.90-1.99, p = 0.020). The weakest predictor of systemic hypertension was WHR (OD 1.26, CI 0.04-1.88, p = 0.181). CONCLUSION: WHtR had the highest predictive power for both glucose intolerance and systemic hypertension compared to BMI, WC, and WHR.

The effect of methanol rhizome extract of Nymphaea lotus Linn. (Nymphaeaceae) in animal models of diarrhoea.

ETHNOPHARMACOLOGICAL RELEVANCE: Nymphaea lotus, which is widely distributed throughout tropical Africa, enjoys a number of ethnomedical uses in Nigeria. Traditionally, the rhizomes of N. lotus are used to cure diarrhoea. AIM OF STUDY: This study aims to evaluate the antidiarrhoeal activity of the methanol rhizome extract of N. lotus plant in laboratory animals. MATERIALS AND METHODS: The extract was screened for activity against castor oil-induced diarrhoea and magnesium sulphate-induced diarrhoea as well as effect on gastric transit time in mice. The effect of methanol rhizome extract of Nymphaea lotus on the perfused isolated tissue preparation was also determined. RESULTS: For castor oil-induced diarrhoea, the extract at doses of 200, 400 and 800mg/kg produced significant reduction in the frequency of diarrhoea (at p<0.001, p<0.001 and p<0.01 respectively). The extract at 800mg/kg produced a significant delay in onset of diarrhoea (p<0.05) comparable to loperamide (3mg/kg). The frequency of magnesium sulphate-induced diarrhoea was also significantly reduced in the groups treated with 200, 400 and 800mg/kg of the extract at p<0.001, p<0.001 and p<0.01 respectively. At doses of 200mg/kg and 400mg/kg, the protection produced was comparable to loperamide, 3mg/kg. All treated groups produced significant reduction in the transit of charcoal meal along the intestinal tract at p<0.001. The extract at low concentration (4×10(-4)-6.4×10(-2)mg/ml) had contractile effect on the tone of contraction of the rabbit jejunum while at higher concentrations (8×10(-2)-512×10(-2)mg/ml) produced significant reduction in the tone and rate of spontaneous contraction of rabbit jejunum. The extract at lower concentrations (4×10(-4)-2×10(-2)mg/ml) has no effect on contraction of the guinea pig ileum while higher concentrations (4×10(-2)-512×10(-2)mg/ml) produced significant relaxant activity on guinea pig ileum. CONCLUSION: This study has shown that the methanol rhizome extract of N. lotus has antidiarrhoeal properties thus justifying its use by the local population for this purpose.

Age-dependent alteration of antioxidant defense system in hypertensive and type-2 diabetes patients.

BACKGROUND: The association between hypertension and diabetes has been linked to increased oxidative stress with age. This study was to examine the level of age-dependent alterations in antioxidant defense system between patients having hypertension and/or type-2 diabetes. METHODS: The study was conducted at the Ahmadu Bello University Teaching Hospital, Zaria-Nigeria, using 200 Subjects recruited from the cardiology, endocrinology and outpatient clinics. They were divided into four groups of 50 subjects each, namely: Diabetic group (DG), hypertensive (HG) and hypertensive-diabetic group (HDG) as cases. The control group (CG) was non-diabetic normotensive subjects. They were all stratified into six age-ranges namely 20-29, 30-39, 40-49, 50-59, 60-69, 70-79 years. Oxidative stress markers (lipid peroxidation, antioxidant vitamins and elements, enzymatic and non-enzymatic antioxidant) were measured in the blood sample collected from all subjects in each age group within the study groups. RESULTS: The results in the DG, HG and HDG, showed that the percentage decrease in enzymatic antioxidants and antioxidant vitamins with age were significantly (P < 0.05) higher than 10.8% and 20.0% respectively when compared to the CG, whereas, the level of decrease in serum Selenium at same age range was significantly higher than 52.8%. The level of lipid peroxidation in the cases was observed to be significantly (P < 0.05) higher than 89.9% when compared to the mean reference values (2.94 ± 0.05 nmol/ml) of the CG at same age range. Also, the decrease levels of endogenous antioxidants were observed to be directly related to aging. CONCLUSION: The result obtained demonstrates the percentage age-dependent alteration in oxidative stress markers. The percentage decrease in the antioxidant levels during aging could be an explanation to the possible link, underlying the complication of type-2 diabetes and hypertension in this locale. Hence, antioxidants supplements may be useful in the management of the diseases during aging.

Socio-economic status of patients with type 2 diabetes and hypertension attending the Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria.

Hypertension (HTN) and Type 2 diabetes (T2D) are lifestyle interrelated diseases of global significance. Interestingly, the prevalence of these diseases in Africa and indeed Nigeria seems to be on the increase. This study, therefore, investigated the socioeconomic status (based on income, education and occupational activity) of 400 subjects (52% female and 48% male) aged 20 years and above who were sampled randomly among the newly diagnosed HTN and/or T2D cases at the Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria. A semi-structured questionnaire was used to collect information from the subjects. From the result obtained, most of the respondents who live in towns or city suffer from either HTN or T2D while more town dwellers (28%) suffer from a combination of both diseases. It was also discovered that most respondents who suffer from HTN and from a combination of HTN and T2D belong to the old generation (60-79 years). There is higher prevalence rate of diabetes among the respondents who had no formal education or attended only basic Arabic schools. Most respondents who earn good income (NGN50,000-NGN100,000 and above NGN100,000) suffer HTN, T2D and a combination of both diseases. Those engaged in heavy occupational activities had the lowest prevalence of the disease compared with those of light or moderate occupational activities. These data will be found useful in planning intervention healthcare preventive programs especially on public enlightenment workshops and seminars to educate the populace on the importance of lifestyle modification, healthy diet and regular exercises.

2 Cases of Bullosis Diabeticorum following Long-Distance Journeys by Road: A Report of 2 Cases.

Background. Bullosis diabeticorum is a distinct, spontaneous, noninflammatory, and blistering condition of acral skin that is unique to diabetics. It is rare. Exact aetiopathogenesis is not known, but many attributed peripheral neuropathy as a potent risk factor, others hypothesized the role of trauma, UV light, and nephropathy. Aim. To present cases of bullosis diabeticorum following long-distance journeys by road. Methods. History and physical examinations were done on 2 diabetics who presented with bilateral feet bullae following a long journey. Biopsy of a circumferential area of the bullae including adjoining apparently normal skin was done. Results. Features of peripheral neuropathy were noted. One developed digital gangrene without features of peripheral vascular disease. Culture of aspirate from a bullae yielded Staphylococcus aureus. Tissue biopsy showed hyperkeratotic focally acanthotic pigmented epidermis with subcorneal separation of the granular layer of the epidermis by aggregates of viable and nonviable polymorphs and lymphocytes. There is mild acantholysis of the epidermis, and a fibrocollagenous dermis which is moderately infiltrated by lymphocytes. Conclusion. Long journeys by road is a strong factor in the aetiopathogenesis of bullosis diabeticorum on a background of peripheral neuropathy. Diabetics especially those with peripheral neuropathy should be cautious while traveling long journeys by road.

Anti-retroviral therapy induced diabetes in a Nigerian.

BACKGROUND: Anti-retroviral therapy (ART) using Highly Active Anti-retroviral Therapy (HAART) has led to considerable reduction in morbidity and mortality associated with human Immune deficiency virus (HIV) infection. This has led to increased life expectancy in HIV infected individuals on one hand, and side effects of chronic administration of these drugs on the other. One of such untoward effects is the association of anti-retroviral drugs especially the protease inhibitors (PI's) with metabolic derangements such as dyslipidaemia, lipodystrophy, insulin resistance and rarely Diabetes mellitus. Although there is extensive literature on this dysmetabolic syndrome in the Western World; there is to our knowledge no previous report from Nigeria. OBJECTIVE: to report a case of diabetes mellitus following the initiation of anti-retroviral therapy. METHODS: a case report of diabetes mellitus induced by anti-retroviral therapy in a 48 year old Nigerian male. CONCLUSION: Awareness and high index of suspicion is required to identify the metabolic complications of ART.