Clinical profile of patients with diabetes mellitus in gusau, Northwestern, Nigeria.

Background: There are variable reports of glycemic control and complications among patients living with diabetes mellitus (DM). Aim: The aim of this study was to determine the glycemic control and complications among patients with DM seen at the medical outpatient department of a tertiary health institution in Northwestern Nigeria. Methodology: This was a descriptive cross-sectional study of 236 patients attending DM Clinic at Federal Medical Centre Gusau. A questionnaire was administered that contains sociodemographic characteristics of the patients, duration of DM, adherence to management, and complications. Anthropometry, blood pressures, and fasting plasma glucose (FPG) were recorded. Data were analyzed using SPSS version 20.0. Results: Eighty-six (36%) males and 150 (64%) females patients with DM were evaluated. Their mean (standard deviation [SD]) age was 53.5 ± 12.3 years with mean (SD) duration of DM of 7.9 ± 6.2 years. The mean FPG was 8.85 ± 3.8 mmol/L (males 8.21 ± 3.6, females 9.49 ± 3.8). Forty-seven (20%), 75 (32%), 113 (48%) of the patients had good, fair, and poor glycemic control, respectively. The major complications observed were peripheral neuropathy (61%) and visual impairment (51%). Glycemic control was significantly better among males and those with good adherence to medications. There was a positive association between the longer duration of DM with complications. Conclusion: Only 20% of our patients achieved good glycemic control and many have complications. Majority of the patients adhered more with medications as compared to dietary management and exercise. There is a need for clinicians to educate patients more on the need for lifestyle modifications.

RésuméConcernant les origines de la situation: Il y a des variables rapports glycémie de contrôle et des complications parmi les patients qui vie avec le diabète mellitus(DM). BUT: Le but de cet étude était pour déterminer le contrôle et les complications glycémie parmi les patients avec le DM vue dans le service de consultation tertiaire dans l'établissement de santé au Nord-ouest du Nigéria. Méthodologie: C'était une description transversale d'étude de 236 patients qui ont assistait à l'événement clinique de la DM au centre médical fédérale à Gusau.Un questionnaire était gérer à contenu de socio démographe de trait de caractère des patients, durée de la DM, hypertension, et le FPG qui se lit "Fasting plasma glucose" en anglais ont été enregistré. Les données ont été analysé avec l'utilisation de la SPSS version 20.0. Résultat: Quatre-vingt huit(36%) mâles et 150(64%) femelles des patients avec la DM ont été évalué. Leurs âges (écart-type) [ET]) moyenne était 53.5±12.3 ans avec une moyenne (ET) et avec une durée de DM de 7.9±6.2 ans. La moyenne et pauvre contrôle du glycémie respectivement. Les complications majeur observé était les périphériques neuropathie(61%) et malvoyants(51%). Le contrôle glycémie était sensiblement mieux parmi les mâles et avec ceux de bonnes médications. Il y avait une association positive entre une longue durée de la DM avec complication. Conclusion: Seul 20% de nos patients ont obtenu un bon contrôle de glycémie et d'autre avec beaucoup de complications. La majorité des patients se sont adhérent plus avec la médication comparer à la gestion diététique et exercice. Il y a la nécessité des clinicien d'instruire ou éduquer les patients plus suis la mode de vie de modification.

Oxidative stress among subjects with metabolic syndrome in Sokoto, North-Western Nigeria.

BACKGROUND: Oxidative stress is known to play a role in the pathophysiology of metabolic syndrome and its components. Racial differences may exist in the level of markers of oxidative stress and antioxidants in patients with metabolic syndrome. AIM: The aim of this study was to determine the oxidative stress and antioxidants status in subjects with metabolic syndrome in Sokoto, North-Western Nigeria. METHODS: A cross-sectional community-based study was carried out. Two hundred subjects (96 males and 104 females) were recruited for the study using a multi-stage sampling technique. Demographic data were obtained from the participants. Evaluation of anthropometric variables, blood pressure, blood glucose levels, lipid profiles, plasma insulin levels, total antioxidant status, and oxidative stress markers was performed. RESULTS: The subjects with metabolic syndrome had significantly higher malondialdehyde as compared to those without metabolic syndrome (236.4 [92.2] vs. 184 [63.2] nmol/l). The antioxidant enzymes (superoxide dismutase, glutathione peroxidase and catalase) were significantly lower in subjects with metabolic syndrome than in those without metabolic syndrome (11.3 [4.2] vs. 13.9 [4.1] U/ml, 160[42] vs. 220[32] U/ml, and 2.12 [0.2] vs. 2.42 [0.2] U/ml, respectively). Similarly, the antioxidant Vitamins (A, C, and E) levels were significantly lower in subjects with metabolic syndrome than in those without metabolic syndrome (7.1 [4.1] vs. 7.7 [4.2] µmol/L, 225 [55.3] vs. 227.6 [62.3] µmol/L, and 75.9 [13.9] vs. 82.8 [18.6] mg/dl, respectively). There was a positive correlation between components of metabolic syndrome and free radicals. CONCLUSION: Significantly increased oxidative stress and diminished antioxidant defenses were found among Nigerians with metabolic syndrome.

Self-reported physical activity among health care professionals in South-West Nigeria.

INTRODUCTION: Physical activity (PA) is a key requirement for maintaining good health. There is growing evidence of declining PA worldwide. Physical inactivity is linked with the global obesity pandemic and increasing burden of noncommunicable diseases (NCDs) in developing countries. A barrier to PA counseling by health care providers (HCPs) is personal PA habits. Information regarding PA among HCPs in Nigeria is limited. We aimed to determine the adequacy and predictors of PA among HCPs of a tertiary health care facility in Lagos, Nigeria. METHODS: A cross-sectional study was carried out with the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Using the World Health Organization (WHO) guideline, PA was categorized as adequate or inadequate. Predictors of PA were explored with multivariate logistic regression. RESULTS: A total of 300 HCPs were recruited, comprising 47.7% doctors and dentists, 43.3% nurses and 9.0% other HCPs. Mean age was 39.9 (9.0 years), 79.2%, 9.7% and 11.1% of the HCPs had low, moderate or high PA levels respectively. Thus, only 20.8% had adequate PA. 71.3% had body mass index (BMI) above the recommended value. BMI of ≥25 kg/m2 was associated with inadequate PA (Adjusted Odds Ratio-2.1,P=0.018). CONCLUSION: Majority of the HCPs had inadequate PA levels according to WHO guidelines. BMI≥25 kg/m2 was associated with inadequate physical inactivity. The low level of PA implies that these HCPs are at risk for NCDs. This will have a negative impact on availability of human resource for health. There is an urgent need to establish programs to increase PA among HCPs.

Lipoatrophy among patients on antiretroviral therapy in Lagos, Nigeria: Prevalence, pattern and association with cardiovascular risk factors.

CONTEXT: Antiretroviral therapy (ART) is linked with morphologic abnormalities such as lipoatrophy (LA), which may accompany metabolic alterations (dysglycemias, dyslipidemia and insulin resistance) that increase cardiovascular disease risk. LA and its association with metabolic alterations have been infrequently studied amongst Nigerians on ART. AIMS: To determine the prevalence, pattern and association of LA with metabolic abnormalities and hypertension among patients on ART attending an ambulatory human immunodeficiency virus clinic in Lagos, Nigeria. SUBJECTS AND METHODS: A cross-sectional study was carried out among patients on ART using a structured interviewer administered questionnaire. Data obtained included patients and physician's assessment of body fat changes, drug history, blood pressure, body composition assessment using bioelectrical impedance analysis and biochemical evaluation (glucose, lipids). LA was defined clinically. Data were analyzed using IBM SPSS statistical software version 21. RESULTS: A total of 48 (33.1%) of the 145 patients had LA. The face was the most frequently affected body region. Patients with LA with lower body circumferences, skin-fold thickness and body fat (P < 0.05). The frequencies of lipid abnormalities were: Reduced high density lipoprotein-cholesterol (47.1%), elevated total cholesterol (35.6%), reduced low density lipoprotein-cholesterol (19.2%), elevated triglycerides (14.4%). Fasting plasma glucose (FPG)≥6.1 mmol/l and hypertension were present among 9.6% and 40.7% respectively. LA was not significantly associated with the presence of glucose intolerance, dyslipidemia or hypertension (P > 0.05). CONCLUSIONS: Lipoatrophy, though commonly encountered in patients on ART in Nigeria was not associated with the presence of dyslipidemia, abnormal FPG or hypertension. Regular monitoring by the physician and increased patients awareness are necessary to reduce its prevalence and impact.

Obesity; overweight; and underweight among urban Nigerians

Background: Disease burden from communicable and noncommunicable diseases is a significant health challenge facing many developing nations. Among the noncommunicable diseases; is obesity; which has become a global epidemic associated with urbanization. Objective: The aim was to evaluate the prevalence of weight abnormalities; their pattern of distribution and regional differences among apparently healthy urban dwelling Nigerians. Methods: A cross-sectional community-based descriptive survey was carried out in five urban cities; each from one geo-political zone of Nigeria. Multistage sampling procedures were used to select participants using the World Health Organization STEPS instrument. Ethical approval and consents were duly and respectively obtained from the Ethics Committee in the tertiary centers and participants in each of these cities. Analysis was performed using SPSS version 20 (IBM Corp.; Amonk; NY; released 2011) with P value set at 0.05. Results: A total of 5392 participants were recruited; of which; 54.5 and 45.5 were males and females respectively. Mean (standard deviation) age and body mass index (BMI) were 40.6 (14.3) years and 25.3 (5.1) kg/m 2 . Obesity; overweight; and underweight were found in 17; 31; and 5 of participants respectively. Significantly; while underweight declined with increasing age; overweight; and obesity increased to peak in the middle age brackets. Age of ? 40 years was found to confer about twice the risk of becoming overweight. The prevalence of obesity and mean BMI were significantly higher both among the females and the participants from southern zones. Conclusion: Obesity and overweight are common in our urban dwellers with accompanying regional differences. Attainment of middle age increases the likelihood of urban dwelling Nigerians to become overweight/obese. There is therefore the need to institute measures that will check development of overweight/obesity early enough; while improving the nutritional status of the few who may still be undernourished

Obesity, overweight, and underweight among urban Nigerians.

BACKGROUND: Disease burden from communicable and noncommunicable diseases is a significant health challenge facing many developing nations. Among the noncommunicable diseases, is obesity, which has become a global epidemic associated with urbanization. OBJECTIVE: The aim was to evaluate the prevalence of weight abnormalities, their pattern of distribution and regional differences among apparently healthy urban dwelling Nigerians. METHODS: A cross-sectional community-based descriptive survey was carried out in five urban cities, each from one geo-political zone of Nigeria. Multistage sampling procedures were used to select participants using the World Health Organization STEPS instrument. Ethical approval and consents were duly and respectively obtained from the Ethics Committee in the tertiary centers and participants in each of these cities. Analysis was performed using SPSS version 20 (IBM Corp., Amonk, NY; released 2011) with P value set at < 0.05. RESULTS: A total of 5392 participants were recruited; of which, 54.5% and 45.5% were males and females respectively. Mean (standard deviation) age and body mass index (BMI) were 40.6 (14.3) years and 25.3 (5.1) kg/m 2 . Obesity, overweight, and underweight were found in 17%, 31%, and 5% of participants respectively. Significantly, while underweight declined with increasing age, overweight, and obesity increased to peak in the middle age brackets. Age of ≥ 40 years was found to confer about twice the risk of becoming overweight. The prevalence of obesity and mean BMI were significantly higher both among the females and the participants from southern zones. CONCLUSION: Obesity and overweight are common in our urban dwellers with accompanying regional differences. Attainment of middle age increases the likelihood of urban dwelling Nigerians to become overweight/obese. There is therefore the need to institute measures that will check development of overweight/obesity early enough, while improving the nutritional status of the few who may still be undernourished.

Rural-urban difference in plasma lipid levels and prevalence of dyslipidemia in Hausa-Fulani of north-western Nigeria.

OBJECTIVES: To compare the serum lipids levels, prevalence of dyslipidaemia, and adiposity of rural versus urban dwellers in Sokoto, Nigeria. METHODS: A cross-sectional study was conducted in both rural and urban areas of Sokoto, Nigeria. One hundred participants were recruited using a multi-stage sampling method. Demographic data and anthropometric measurements were obtained. Fasting blood was drawn for assessment of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol. The classification of dyslipidemia was based on the National Cholesterol Education Program-Adult Treatment Panel guidelines. RESULTS: The (mean [SD]) waist circumference of the urban participants (83.8 [9.5] cm) was significantly higher than the rural participants (79.2 [11.2] cm) (P = .030). The mean BMI of the urban participants (23.9 [3.9] kg/m2) was higher than the rural participants (22.2 [3.7] kg/m2) (P = .09). The mean TC was significantly higher in urban (175.9 [49.6] mg/dL) than rural participants (148.3 [24.3] mg/dL) P < .001. Mean serum LDL-C, and TG concentrations were higher in the urban than rural participants but the difference was not statistically significant. Mean serum HDL-C was also insignificantly higher in the rural (51.1 [7.9] mg/dL) than in urban participants (50.2 [11.7] mg/dL) (P = .64). The most frequent dyslipidemia was abnormally low HDL-C (13%) and this was more common in the urban participants (16%) than in rural participants (10%). CONCLUSION: This study demonstrated that compared to the rural dwellers, the urban dweller were more likely to be obese and had higher frequency of adverse plasma lipid profile. This may have implications for rural-urban patterns of lipid related cardiovascular disease.

Prevalence, associated factors and relationship between prehypertension and hypertension: a study of two ethnic African populations in Northern Nigeria.

To determine the prevalence and relationship between prehypertension and hypertension, we studied 782 ethnic Hausa and Fulanis (men, 409; women, 373) aged 38.9±13.9 years recruited by multistage cluster sampling. Demographic, anthropometry, metabolic and JNC VII-based blood pressure categories were obtained and analysed using univariate and multivariate models. The prevalence rates of prehypertension and hypertension were 58.7% (men 59.2%, women 58.2%) and 24.8% (men 25.9%, women 23.6%), respectively. Only 16.5% of the population had JNC VII defined optimum blood pressure. Compared to hypertension, prehypertension had earlier onset (second versus third decade) and peak (fourth versus fifth decade) of life. The peak and trough prevalence of hypertension and prehypertension, respectively were observed in the 5th decade of life. Obesity, abnormalities of glucose metabolism and insulin resistance were the major factors associated with prehypertension and hypertension. Multivariate analysis identified obesity and impaired glucose tolerance as independent predictors of hypertension. Of those with hypertension, 13.9% were aware of their high blood pressure status of which 85.7% were commenced on treatment and 12.5% achieved blood pressure control. Overall, 1.5% of the study population had blood pressure <140/90 mm Hg. It is concluded that less than 20% of people of Hausa and Fulani ethnicities had optimum blood pressure. These are predominantly in their second decade of life suggesting that rise in blood pressure begins early in this population. The fifth decade of life may represent a period of transition from prehypertension to hypertension.

Dysglycaemia and its risk factors in an urban Fulani population of northern Nigeria.

BACKGROUND: The Fulani are a normally nomadic people known for covering great distances on foot with a resulting lean physique and presumably low incidence of diabetes mellitus (DM). The occurrence of glucose intolerance among the urban Nigerian Fulani has not been reported. OBJECTIVE: To determine the prevalence of dysglycaemia and its correlates among urban Fulani. METHODS: Three hundred and eighty-nine Fulani were recruited from urban areas of Sokoto state using a multi-stage sampling technique. Using a modification of the WHO STEPS instrument, information on socio-demographic and anthropometric data was gathered. Either casual or fasting plasma glucose was obtained in all subjects while oral glucose tolerance test (OGTT) was performed in a randomly selected subset of 48 subjects. Glucose intolerance or dysglycaemia was defined using WHO criteria as the presence of diabetes mellitus, impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT). Classifications of adiposity as body mass index (BMI) and waist circumference (WC) and blood pressure were made using standard criteria. RESULTS: Of the 389 subjects studied, 190 (48.8%) were females while 199 (51.2%) subjects were males (c2=5.43, p> 0.05). The overall mean (SD) age of the sample population was 39.3 (14.2) years with the males [42.0 (13.8) years] being significantly older than the females [36.4 (14.1) years], p< 0.05. Eighteen (4.6%) subjects had previously undiagnosed type 2 diabetes mellitus while 37(16.9%) of the subjects had IFG and seven (14.6%) subjects had impaired glucose tolerance. The mean FPG was higher in the males [5.49 (1.7) mmol/l] than in the females [5.25 (1.9) mmol/l],p=0.33. The overall mean two-hour plasma post glucose-load was 6.5 (1.6) mmol/l; higher in the males [6.9 (2)] mmol/l than in the females [6.2 (1) mmol/l] , p=0.55.The mean age, BMI, waist circumference and blood pressure of subjects with dysglycaemia were significantly higher than those in subjects with normoglycaemia (p<0.05). CONCLUSION: Prevalence of dysglycaemia in the urban Fulani population of Northern Nigeria is high and much higher in the male than female Fulani. Occurrence of obesity and hypertension appears lower than in other Nigerian reports. Occurrence of dysglycaemia in the urban Fulani increases with age, weight and waist circumference. There is need to conduct a similar study among rural Fulani to better appreciate the environmental influence on these variables.

Causes of childhood deaths in Bangladesh: an update.

UNLABELLED: Knowledge of the causes of child death is important for health-sector planning since they relate to available interventions. Little is known about causes of child death in Bangladesh from the conventional sources since there is no vital registration system and very few deaths are attended by a qualified physician. To determine the cause structure of child deaths, verbal autopsy interviews were conducted in the Bangladesh Demographic and Health Survey (BDHS) 1993/94 national sample. Verbal autopsy is a method of finding out the causes of death based on an interview with the next of kin or other caregivers. Between BDHS 1993/94 and BDHS 1996/97, 1-4-y-old child mortality in Bangladesh declined by about 27.0%. This impressive decline prompted a verbal autopsy study using the BDHS 1996/97 national sample to determine whether the cause structure had changed. The same verbal autopsy instrument and methods to collect the data and the same computer algorithm to assign causes of death were used in both surveys. Comparison of BDHS 1993/94 and 1996/97 cause-specific mortality rates revealed that deaths due to almost all causes had declined, although significantly so only for acute respiratory infections (ARI), persistent diarrhoea and drowning. Deaths due to neonatal tetanus, acute watery diarrhoea and undernutrition had not decreased at all. CONCLUSION: Despite an impressive decline in deaths due to ARI, this condition remains the most important known cause of death in Bangladeshi children. Neonatal tetanus and measles together account for about 10% of deaths in children under 5 y. Further improvements in child survival are possible by improving access to and quality of available child survival interventions.

Protein kinase C-induced changes in the stoichiometry of ATP binding activate cardiac ATP-sensitive K+ channels. A possible mechanistic link to ischemic preconditioning.

Activation of both ATP-sensitive K+ (KATP) channels and the enzyme protein kinase C (PKC) has been associated with the cardioprotective response of ischemic preconditioning. We recently showed that at low cytoplasmic ATP (< or = 50 mumol/L), PKC inhibits KATP channel activity. This finding is surprising, as both KATP channels and PKC are activated during preconditioning. However, PKC also altered ATP binding to the channel, changing the Hill coefficient from approximately 2 to approximately 1. This apparent change in stoichiometry would lead to a PKC-induced activation of KATP channels at more physiological (millimolar) levels of ATP. The aim of the present study was to determine whether PKC activates cardiac KATP channels at millimolar levels of ATP. The effects of PKC on single KATP channels were studied at millimolar internal ATP levels using excised inside-out membrane patches from rabbit ventricular myocytes. Application of purified constitutively active PKC (20 nmol/L) to the intracellular surface of the patches produced an approximately threefold increase in the channel open probability. The specific PKC inhibitor peptide PKC(19-31) prevented this increase. Heat-inactivated PKC had no effect on KATP channel properties. KATP channel activity spontaneously returned to control levels after washout of PKC. This spontaneous reversal did not occur in the presence of 5 nmol/L okadaic acid, suggesting that the reversal of PKC's action is dependent on activity of a membrane-associated type 2A protein phosphatase (PP2A). In the presence of exogenous PP2A (7.5 nmol/L), PKC had no effect. We conclude that the PKC-induced increase in KATP channel activity at millimolar ATP results from a crossing of the ATP concentration-response curves for inhibition of the phosphorylated and nonphosphorylated forms of the channel. This identifies a mechanism by which PKC activates KATP channels at near physiological levels of ATP and thus could link these two components in a signaling pathway that induces ischemic preconditioning.

Treatment of recurrent and metastatic carcinoma of cervix: a comparison of low dose methotrexate with adriamycin plus methotrexate.

Sixty-six patients with recurrent or metastatic cervical cancer were treated with two different chemotherapy regimens in the last 11 years. Thirty-three patients received weekly low-dose methotrexate (MTX) regimen A and the other 33 patients were treated with a combination of adriamycin and MTX, regimen B. Response rates were 15.2% and 42.4% with regimens A and B respectively (P = 0.014). Symptomatic relief, duration of response and median survival were similar in both groups. General and haematological toxicities were higher including one toxic death with regimen B. Considering the quality of remaining life of the patient low dose MTX is preferred for the treatment of symptomatic recurrent and metastatic cervical cancer.