Low rate of proteinuria in hypertensives resident in a rural area of Plateau State, Nigeria.

BACKGROUND: Hypertensives are screened for proteinuria largely to detect kidney involvement. In most reports from urban areas, the burden is considerable. We decided to see the scenario in a rural setting with the opportunity presented by our cardiovascular disease (CVD) survey of a rural area in North Central Nigeria. METHODOLOGY: In 2008 we surveyed a rural population in Mangu Local Government area of Plateau State for CVD risk factors using the protocol of the National survey of 1991; slightly modified. One in three subjects was sequentially randomized to have blood and urine examination. Blood tests included glucose, creatinine, uric acid, total and high density lipoprotein cholesterol. Blood pressures were also taken. RESULTS: Blood and urine tests were done on 282 subjects. Eight of them (2.84%) had proteinuria. Ninety-nine of the 282 (35.11%) were hypertensive. Seven out of the 99 hypertensives (7.07%) had proteinuria. Between those hypertensives (positive or negative for proteinuria), the following indices: glucose, HDL cholesterol, SBP and DBP differed significantly (p = 0.000, p = 0.015, p = 0.000, p = 0.000 respectively). CONCLUSION: Compared with rates in urban centres of Nigeria, our population recorded low proteinuria rates both for the whole population and the hypertensive segment. It therefore appears that proteinuria in hypertension is not only a reflection of severity and burden of hypertension, but has some relation with residence. Rural areas have lower constellation of CVD risk factor (due to different life style) and lower incidence of hypertension. Consequently, their proteinuria rates are low.

Cardiovascular epidemiological transition in a rural habitat of Nigeria: the case of mangu local government area.

BACKGROUND: Epidemiological transition is at various stages in different places. The true situation in sub-Saharan Africa (SSA) is largely unknown. Having studied this rural habitat 17 years ago, we returned there to study several cardiovascular disease (CVD) risk factors to see if any change had occurred. METHODS: The communities studied in 1991 as part of the national CVD survey were returned to in 2008 and re-studied descriptively in a cross-sectional manner. All adults 15 years and above, apart from demographic and personal data had blood pressure (BP) and some blood indices determined. RESULTS: Over the period, some changes occurred. The mean (SD) age increased from 34.1(16.9) to 45.5(18.2) years suggesting an ageing population. More people in 2008 than 1991 lived most of their last 5 years in the urban areas suggesting some influence of urbanisation. Significantly fewer people smoked and drank after 17 years. However mean (SD) of Body Mass Index rose [20.7(2.8) to 23.7(4.5) kg/m²], as well as SBP and DBP. Prevalence of hypertension rose from 7.4% to 20.9%. Both total and HDL cholesterol rose, although atherogenic index dropped. Mean (SD) blood sugar interestingly dropped from 5.0(2.9) to 4.6(1.0) mmol/l. CONCLUSION: Epidemiological transition is evident in this rural SSA habitat, and proactive steps to stem the tide and curb the consequences of CVD should be instituted.

Serum cholinesterase activity in the diagnosis of nonalcoholic fatty liver disease in type 2 diabetic patients.

The aim of the study was to compare the serum cholinesterase activities of a group of type 2 diabetic patients showing clinical evidence of nonalcoholic fatty liver disease to those of age and sex-matched type 2 diabetics who showed no evidence of liver disease, and healthy control subjects to determine, if serum cholinesterase can be used to diagnose nonalcoholic fatty liver disease in type 2 diabetic patients. Mean serum cholinesterase activity in diabetics with nonalcoholic fatty liver disease was found to be statistically significantly lower than in diabetics without liver disease and in healthy subjects. There was no statistically significant difference between the mean values of serum cholinesterase activities of non-liver disease diabetics and healthy control subjects. It was found that serum cholinesterase activity of 1640IU/L or less differentiated type 2 diabetic subjects with nonalcoholic fatty liver disease from diabetic subjects who were free of liver disease with a diagnostic sensitivity of 87.5% and specificity of 75%. It is suggested that routine monitoring of serum cholinesterase activities from the time of diagnosis of type 2 diabetes mellitus may reveal the earliest time for the change in serum cholinesterase activities in diabetics that signals the onset of nonalcoholic fatty liver disease.

Kartagener syndrome in a Nigerian African--a case report and literature review.

BACKGROUND: Kartagener syndrome is a type of primary ciliary dyskinesia. It is a rare autonomic recessive disorder with an estimated incidence of about 1 in 32,000 live births. In Nigeria, because of lack of availability of facilities for investigations in order to make a diagnosis, it has hardly been reported. OBJECTIVES: This report is intended to remind clinicians of the condition of Kartagener syndrome as the patients might be missed in the presentation as our patient's diagnosis was missed and he was diagnosed to have tuberculosis. CASE SUMMARY: This case is that of a 43-year-old male Nigerian African, who has had an on and off productive cough, since he was 33 years of age. Eight months prior to presentation, the cough worsened and was associated with haemolysis that was followed by swelling of the feet. This swelling of the feet started two months before presentation. He had subfertility. He was found to have partial situs inversus viscerum (dextrocardia which is the hallmark of the diagnosis of Kartagener syndrome). He had lung collapse in the right lower zone, also supporting the diagnosis of Kartagener syndrome. This patient had cor pulmonale from repeated chest infection and died after 30 days of admission.

Primary hyperparathyroidism presenting with severe hypertension in a middle aged Nigerian--a case report.

OBJECTIVE: To draw attention to primary hyperparathyroidism as a cause of severe hypertension. RESULTS: A 47 year old Nigerian male presented with headache, occasional blurring of vision and dyspnoea on mild exertion of 2/12 duration. He had been troubled by painful osteoarthritis of the knees for 2 years for which he was taking NSAIDs. He was found to be severely hypertensive, BP 210/130mmHg and had bilateral knee crepitus. BP was resistant to control on Nifedipine R and Moduretic. Serum urea, creatinine, uric acid were normal but there was hyperacalcaemia and hyperchloraemia. Haematological indices, urinalysis, microscopy and culture of urine were normal. Parathyroid hormone level was raised. A parathyroid MIBI scan study showed an extensive area of significance towards the inferior pole of the right lobe of thyroid medially with a second area of very low significance medial to the left pole. These findings indicated the presence of a right inferior parathyroid adenoma. He had parathyroid surgery and a large adenoma in the right inferior gland and a smaller left inferior gland were removed and confirmed histologically. Corrected calcium and parathyroid hormone levels dropped to normal, and the BP was easily controlled with Lisinopril 5mg daily subsequently. He is not currently on antihypertensive medication two years post surgery. CONCLUSION: This case highlights the need for thorough investigation of cases of hypertension to exclude specifically secondary causes, which in some cases may be endocrine in origin and may easily be corrected.

Reduced thyrotropin in euthyroid goitrous patients suggesting subclinical hyperthyroidism.

BACKGROUND: Subclinical hyperthyroidism, a biochemical finding of low serum thyrotropin (TSH) with the serum levels of thyroxine (T4) and triiodothyronine (T3) within the reference range, could easily be ignored by clinicians, as it, usually, does not manifest with any thyroid specific symptoms. It is of two types: endogenous and exogenous. However, patients with the findings of low TSH, normal T4 and T3 develop some abnormalities in the cardiovascular system, such as atrial fibrillation, increase in left ventricular mass and diastolic dysfunction. It is believed that treatment intervention may reduce or halt the progression of the cardiac abnormalities. The main objective of the study was to determine how frequent subclinical hyperthyroidism was occurs and to serve as a reminder to the existence of the disorder. METHODS: It was a hospital-based study carried out at the Jos University Teaching Hospital (JUTH). Consecutive clinically euthyroid goitre patients attending the outpatient department of JUTH, were studied for various parameters including TSH, T4 and T3 The serum concentrations of T4 and T3 were determined by enzyme-linked immunosorbent assay (ELISA) technique. The serum TSH concentration was estimated using a 2nd generation ELISA technique. RESULTS: 98 patients participated in the study. Nine patients had non-specific symptoms not referable to the thyroid and found to have high levels of thyroid hormone concentration with depressed TSH and were excluded from further analysis, while 7 had subclinical hyperthyroidism giving a prevalence rate of 7.9% among these clinical euthyroid goitre patients. The subjects with this condition were mainly above 60 years of age and mainly had long-standing goitre. CONCLUSION: Endogenous subclinical hyperthyroidism was present in 7.9% of these clinically euthyroid goitre patients mainly 60 years and above, with long-standing goitre. This high prevalence rate calls for high index of suspicion as this condition is associated with morbidities that can raise mortality.

Diabetes co-existing with chronic liver disease: clinical features and response to therapy.

BACKGROUND AND OBJECTIVES: Diabetes mellitus (DM) and chronic liver disease (cirrhosis) may co-exist in the same individual. Diabetes may cause non-alcoholic steatohepatitis with necroinflammatory changes and granuloma formation leading to hepatic fibrosis. Cirrhosis of the liver from alcohol and hepatitis C infection, on the other hand, may give rise to insulin resistance or may result in progressive impairment of insulin secretion leading to DM. We studied the clinical features and response to therapy of diabetic patients with the two conditions to determine if there are differences in the clinical features and effects of the chronic liver disease (CLD) on the management of DM. METHODS: This was a prospective study conducted at the Diabetes Clinic at the Jos University Teaching Hospital (JUTH) over a period of two years. Newly diagnosed diabetics with features of CLD (cirrhosis) were enrolled into the study after obtaining a consent. Age, sex, body mass index (BMI), family history of diabetes were recorded, as well as symptoms and signs of DM or CLD. Serum fasting blood glucose (FBS), prothrombin time ratio (PTR), and serum fasting lipids (serum lipoproteins and serum triglycerides) were measured. Urinalysis was done. The responses to therapy were classified as very rapid, rapid and gradual based on our previous unpublished observations that diabetic patients with CLD responded briskly to antidiabetes therapy. RESULTS: 26 patients(19 men, and 7 women) were seen with both diseases agreed to participate in the study This accounted for 8.6% of the diabetic population attending the diabetes clinic. The mean age of the patients was 54.6 (9.2) years spanning a range of 34-75 years. Mean BMI was 21.6 (6.0) kg/m2. The mean serum albumin concentration was 25.5 (8.5) g/l, mean FBS was 15.5 ( 3.4) mmol/l and PTR was 1.6 (0.43). Urinalysis showed glycosuriain all patients with only one patient showing trace of ketonuria. Clinical features of DM and CLD were few each. There was a brisk response to insulin therapy so that one needs to be cautious with insulin administration. CONCLUSION: Diabetes in patients with CLD has similar but fewer features compared to patients with type2 DM. CLD affects the response to therapy, particularly insulin therapy and calls for caution, as these patients may be sensitive to therapy.

Reduced Thyrotropin in Euthyroid Goitrous Patients Suggesting Subclinical Hyperthyroidism

B a c k g r o u n d : Subclinical hypertyhroidism; a biochemical finding of low serum thyrotropin (TSH) with the serum levels of thyroxine (T4 ) and triiodothyronine (T3) within the reference range; could easily be ignored by clinicians; as it; usually; does not manifest with any thyroid specific symptoms. It is of two types : endogenous and exogenous. However; patients with the findings of low TSH; normal T4 and T3 develop some abnormalities in the cardiovascular system; such as atrial fibrillation; increasein left ventricular mass and diastolic dysfunction. It is believed that treatment intervention may reduce or halt the progression of the cardiac abnormalities. The main objective of the study was to determine how frequent subclinical hyperthyroidism was occurs and to serve as a reminder to the existence of the disorder. Methods : It was a hospital-based study carried out at the Jos University Teaching Hospital (JUTH). Consecutive clinically euthyroid goitre patients attending the outpatient department of JUTH; were studied for various parameters including TSH; T4 and T3. The serum concentrations of T4 and T3 were determined by enzyme-linked immunosorbent assay (ELISA) technique. The serum TSH concentration was estimated using a 2nd generation ELISA technique. Results : 98 patients participated in the study. Nine patients had non-specific symptoms not referable to the thyroid and found to have high levels of thyroid hormone concentration with depressed TSH and were excluded from further analysis; while 7 had subclinical hyperthyroidism giving a prevalence rate of 7.9among these clinical euthyroid goitre patients. The subjects with this condition were mainly above 60 years of age and mainly had long-standing goitre. Conclusion: Endogenous subclinical hyperthyroidism was present in 7.9of these clinically euthyroid goitre patients mainly 60 years and above; with long - standing goitre. This high prevalence rate calls for high index of suspicion as this condition is associated with morbidities that can raise mortality

Diabetes Co-existing with Chronic Liver Disease : Clinical Features and Reponse to Therapy

Background and objectives : Diabetes mellitus (DM) and chronic liver disease (cirrhosis) may co-exist in the same individual. Diabetes may cause non-alcoholic steatohepatitis with necroinflammatory changes and granuloma formation leading to hepatic fibrosis. Cirrhosis of the liver from alcohol and hepatitis C infection; on the other hand; may give rise to insulin resistance or may result in progressive impairment of insulin secretion leading to DM. We studied the clinical features and response to therapy of diabetic patients with the two conditions to determine if there are differences in the clinical features and effects of the chronic liver disease (CLD) on the management of DM. Methods: This was a prospective study conducted at the Diabetes Clinic at the Jos University Teaching Hospital (JUTH) over a period of two years. Newly diagnosed diabetics with features of CLD (cirrhosis) were enrolled into the study after obtaining a consent. Age; sex; body mass index (BMI); family history of diabetes were recorded; as well as symptoms and signs of DM or CLD. Serum fasting blood glucose (FBS); prothrombin time ratio (PTR); and serum fasting lipids (serum lipoproteins and serum triglycerides) were measured. Urinalysis was done. The responses to therapy were classified as very rapid; rapid and gradual based on our previous unpublished observations that diabetic patients with CLD responded briskly to antidiabetes therapy. Result : 26 patients (19 men; and 7 women) were seen with both diseases agreed to participate in the study. This accounted for 8.6of the diabetic population attending the diabetes clinic. The mean age of the patients was 54.6 (9.2 ) years spanning a range of 34-75 years. Mean BMI was 21.6 (6) kg/m2. The mean serum albumin concentration was 25.5 (8.5) g/l; mean FBS was 15.5 (3.4) mmol/l and PTR was 1.6 (0.43). Urinalysis showed glycosuriain all patients with only one patient showing trace of ketonuria. Clinical features of DM and CLD were few each. There was a brisk response to insulin therapy so that one needs to be cautious with insulin administration.Conclusion : Diabetes in patients with CLD has similar but fewer features compared to patients with type 2 DM. CLD affects the response to therapy; particularly insulintherapy and calls for caution; as these patients may be sensitive to therapy

Some metabolic abnormalities in type 2 diabetic patients in Jos, north central Nigeria.

BACKGROUND: Diabetes mellitus is associated with derangements in the serum levels of several biochemical parameters. This study was conducted in an attempt to obtain the biochemical profiles and their abnormalities in Nigerian type 2 diabetic patients in Jos, North Central Nigeria. METHODS: Seventy-five (75) Nigerians with type 2 diabetes mellitus and 69 age and sex-matched non-diabetic controls were investigated. Each participant had fasting plasma glucose, plasma lipids, liver, renal function profiles as well as their clinical characteristics assessed. RESULTS: The clinical characteristics body mass index, waist hip ratio and blood pressures were significantly higher in diabetics than controls (p < 0.05). Renal and lipid profiles were also significantly higher in diabetics. There was no significant difference in the liver profile between diabetics and controls. Diabetics with good glycaemic control had lower frequencies of biochemical abnormalities compared to diabetics with poor control. CONCLUSION: Metabolic abnormalities are common in Nigerians with type 2 diabetes. Our findings support the fact that controlling hyperglycaemic state would be beneficial in preventing the major metabolic abnormalities and hence the complications of diabetes mellitus.