Outcome of hyperglycemic emergencies in a tertiary hospital, South East, Nigeria

Background: Hyperglycemic emergency (HE) is typically represented by diabetic ketoacidosis, (DKA) and hyperosmolar hyperglycemic state (HHS). It is a common cause of hospitalization due to diabetes mellitus (DM) and is associated with considerable mortality. In South East Nigeria, there is a paucity of studies on the treatment outcome of HE, hence the need for this study. Objective: The aim and objective of the study were to determine the outcome of treatment of adult persons living with diabetes managed for HE at Federal Medical Centre (FMC), Umuahia. Materials and Methods: This was a prospective study in which 110 consecutive adult patients managed for HE at FMC, Umuahia, were recruited. Data obtained included a total number of medical and diabetic admissions within the study period. For participants that met the inclusion criteria for the study, their bio­data, blood pressures, level of consciousness at presentation or while being treated, random plasma glucose, plasma electrolytes, urea, creatinine, and plasma 3­beta­hydroxybutyrate were noted and/or measured. Similarly, urine sample was collected from each participant for analysis (glucose, protein, and ketone). The outcome measures were patient's survival, hospitalization duration, and death. Analysis of data was done using SPSS 20.0 and the level of statistical significance was set at P < 0.05. Results: Of the 110 participants recruited, there were 46 (41.8%) males and 64 (58.2%) females. HE constituted 15.6% of the total medical admissions within the study period with a mortality of 10%. DKA and mixed form of HE were the predominant patterns in the study. While hospitalization duration was variable, no female participant was discharged against medical advice. Conclusion: The study showed that HE is a frequent acute complication of DM in this region ofNigeria and that HE typically presents as DKA and mixed form. Hospitalization for HE had a variable duration with a significant mortality

Haemoptysis in a female with diabetes mellitus: a unique presentation of chronic pulmonary aspergillosis, pulmonary tuberculosis, and Klebsiella peumoniae co-infection.

While chronic pulmonary aspergillosis (CPA), pulmonary tuberculosis (PTB), and Klebsiella pneumoniae pneumonia co-infection is rare, we present a 50-year-old woman with uncontrolled diabetes who presented with these three diseases. There is considerable overlap in symptoms of PTB and CPA. Treatment with antifungals, anti-tuberculosis therapy, and antibiotics is beneficial.

Disclosure amongst adult HIV patients on antiretroviral therapy in Port Harcourt, Nigeria.

HIV transmission is still a public health concern in sub-Saharan Africa; disclosure is an effective tool for its prevention, contact tracing and treatment. We aimed to evaluate the disclosure behaviours of adult HIV-positive patients receiving antiretroviral therapy (ART) in University of Port Harcourt Teaching Hospital, and identify major challenges to disclosure in a bid to develop ways to improve this practice in the environment. Patients receiving ART in this centre were interviewed using an interviewer-administered questionnaire. A total of 250 clients were interviewed over three months. A majority of the patients were tested on account of ill health 143 (57.2%). They commenced ART within 8 ± 15.4 SD months of presentation. The mean period before disclosure was 4.75 ± 12.8 SD months of diagnosis. Thirty-six (14.4%) of the respondents had not disclosed their HIV status; the major barrier to disclosure was stigmatisation in 19 (36%).

Diabetes conversation map in Nigeria: A new socioeducational tool in diabetes care.

The importance of diabetes education in the management of patients is very crucial. One-on-one education, didactic group lectures are traditional methods employed in Diabetes Education. In our environment, group interaction using the Diabetes Conversation Map tools may prove to be effective especially during regular meetings of the Diabetes Association.

Prognostic indices of diabetes mortality.

INTRODUCTION: Diabetes mellitus is an important cause of morbidity and mortality worldwide and the burden associated with it is felt more in developing countries. Communicable diseases, as opposed to non-communicable diseases, remain a top priority in developing countries like Nigeria. This report sets out to highlight the current status of diabetes-related hospitalizations in Nigeria and also to make comparisons with past reports. This goal will be achieved primarily by determining the prognostic factors associated with diabetes mortality and also noting the duration of hospital stay for the major causes of diabetes deaths. METHOD: From January through December 2006, subjects with diabetes mellitus (DM) in a tertiary hospital in Nigeria were prospectively studied after admission to assess their shortterm outcome which was defined as death. The total mortality, causes of death, associated complications and duration of hospital stay were noted. The predictive factors for DM morbidity were evaluated using chi test, logistic regression. Students t test was computed for quantitative data. RESULTS: A total of 1,327 subjects were admitted to the Medical wards for the duration of the study and the crude death rate was 11%. DM related admissions made up 206 (15%) of all the medical admissions and the case fatality rate was 33 (16%). The most common reasons for DM admission were hyperglycaemic emergencies (HE), 88 (40%) and hypertension, 44 (21%). The most common causes of deaths were HE, 15 (46%) and DM foot ulcers (DFU), 10 (30%) while DFU and cerebrovascular accident (CVA) had the highest case fatality rates of 28% and 25% respectively. DFU had the most prolonged duration of admission ranging from 15-122 days. DFU, CVD and having type 2 DM were highly predictive of fatal outcomes. The odds ratio and 95% CI for these factors were 4.5 (1.5-12.7), 3.0 (0.9-9.92 and 3.1 (0.7-14) respectively. CONCLUSION: DFU and HE are potentially remediable causes of mortality in DM. DFU as seen by the prolonged hospital stay imposes a huge burden on health resources. Better and early intervention of DFU is necessary to reduce the resultant disease burden.