Fetal glycated albumin levels in offspring of obese women.

OBJECTIVE: To determine the association between maternal obesity and fetal glycated albumin (GA) levels among pregnant women. METHODS: A comparative, cross-sectional study of 59 consenting, normoglycemic, pregnant women, who met the criteria for maternal obesity, attending the antenatal clinic of the University College Hospital, Nigeria, from June 2019 to December 2019. They were recruited at 36 weeks of gestation, followed up until delivery, and compared with 58 nonobese, normoglycemic pregnant controls. At delivery, blood samples were taken from the mothers and from the umbilical cords of their newborns for serum GA assay. Maternal and newborn variables were recorded, and comparisons were made using χ2 tests, independent t tests, odds ratios, analysis of variance, and Pearson correlates. Statistical significance was set at P < 0.05. RESULTS: The odds of elevated newborn GA were 3.21 times higher in obese women compared with nonobese women (P = 0.005) and 5-min APGAR scores were higher in the newborns of nonobese women (P = 0.039). There was a significant correlation between maternal and neonatal GA for all participants (r = 0.346, P = 0.000). CONCLUSION: These findings suggest that maternal obesity is associated with elevated fetal GA and low APGAR scores at 5 min in normoglycemic women.

Appropriate use of plasma glucose tests for diagnosis of diabetes mellitus in Ibadan, Nigeria.

Background: Diabetes mellitus is a growing epidemic in Africa. Its diagnosis relies exclusively on laboratory evidence, which differs based on clinical circumstances. Objective: The study described the appropriateness of plasma glucose test requests per the American Diabetes Association criteria. Methods: We reviewed the plasma glucose test requests received by the chemical pathology laboratory of the University College Hospital, Ibadan, Nigeria between June 2018 and November 2018. The American Diabetes Association diabetes diagnostic criteria were used to define the appropriateness of test requests and determine the potential for ill-informed clinical decisions. Results: Four hundred and twenty-three requisition forms were included, with the majority from the medical wards/clinics (72.3%); the most frequent reason for a plasma glucose test was systemic hypertension (28.6%). Fasting plasma glucose was most requested (254; 60.0%). One hundred and sixteen (27.4%) requests were potentially inappropriate, with the 2-h postprandial plasma glucose (2hPPG) test requests (83; 71.6%) being the most inappropriate. The difference in the proportion of inappropriate requests was not statistically significantly between medical or surgical wards/clinics (Odds ratio 1.131, 95% confidence interval 0.709-1.803, p = 0.605). Inappropriate requests in six cases may have triggered inappropriate action. Conclusion: A third of the glucose tests requested for querying diabetes mellitus may have been inappropriate. Results of such testing may trigger inappropriate clinical action. To improve the quality of care and for economic reasons, laboratories should have programmes to improve the appropriate use of their services.

Multicenter Survey of Physicians' Perception of Interpretative Commenting and Reflective Testing in Nigeria.

BACKGROUND: Interpretative commenting (IC) and reflective testing have recently generated interest because of their potential for adding value to Clinical laboratory testing. Physicians' perception to this post-testing service in Nigeria is unknown. This study examined the practices and physician's disposition regarding IC and reflective testing. METHODS: This cross-sectional study was conducted among 232 doctors working in public and private hospitals across eight purposively selected states in Nigeria. Doctors who have worked and/or currently working in a health facility within their state of residence and who consented to participating in this survey were given a structured questionnaire to fill and return. RESULTS: Paper-based reporting (213; 91.8%) was the most commonly practiced reporting method. One hundred and thirty-three (57.4%) doctors responded that interpretative comments were added to laboratory reports. "Free-handed text" (85/133; 63.9%) was the most commonly practiced form of IC; 184/232 (79.3%) and 166/232 (71.6%) doctors respectively considered comments on "potential implication of results" and "suggestions on further investigation" as the most "helpful" aspect of IC. Also, 192/232 (82.7%) doctors strongly agreed/agreed that IC influences patient's management. Only 125 (53.7%) doctors responded that they welcomed reflective testing. Concerns about cost implications (68/107;63.6%) and delays in release of result (48/107; 44.9%) were among reasons for not supporting reflective testing. CONCLUSION: Nigerian doctors generally have a positive disposition towards addition of interpretative comments but less so concerning reflective testing. However, challenges such as lack of LIS, EQA schemes for IC and gaps in physicians' education should be addressed to improve this aspect of laboratory services in Nigeria.

Serum testosterone in Nigerian men with type 2 diabetes mellitus and its relationship with insulin sensitivity and glycemic control.

BACKGROUND: There is increasing evidence that testosterone deficiency has key associations with insulin sensitivity and glycemic control. Its presence may therefore contribute to and/or exacerbate clinical disease in men with type 2 diabetes mellitus (T2DM). This study sought to determine the frequency of low free testosterone and explore its relationship with, insulin sensitivity and glycemic control among Nigerian men with T2DM. METHODS: One hundred and four men with type 2 DM and one hundred and one apparently healthy non-diabetic men matched for age, were recruited into the study Socio-demographic data, anthropometric measurements and blood samples were obtained for measurement of serum total testosterone (TT), sex hormone binding globulin (SHBG), fasting plasma insulin, fasting plasma glucose (FPG), glycated hemoglobin (HbA1c) and fasting lipid profile in all the subjects. Insulin sensitivity (%IS) and free testosterone (CFT) were then calculated. RESULTS: The median CFT for men with T2DM was significantly lower than that of non-diabetic controls (0.17 nmol/L vs 0.58 nmol/L respectively; P < 0.001). 52.9% of men with T2DM had low CFT, as compared with 21.4% amongst the non-diabetic controls; P < 0.001. Among men with T2DM, those with lower CFT had significantly lower median % S and higher mean HbA1c than those with normal CFT (37.0% versus 63.0%; P = 0.021 and 7.79 (2.03) % versus 7.02 (1.94) %; P = 0.038 respectively]. HbA1c had significant negative correlations with both CFT (correlation coefficient: -0.239 (P < 0.05) and TT (correlation coefficient: 0.354; P < 0.01. There was no significant difference in serum lipids when T2DM men with low serum CFT were compared with T2DM men with normal serum CFT levels. CONCLUSION: We conclude that low serum testosterone is common among men with T2DM and has a significant association with glycemic control (HbA1c) and insulin sensitivity.

The Top 25 Laboratory Tests by Volume and Revenue in Five Different Countries.

OBJECTIVES: To compare the most common diagnostic/laboratory tests across five different referral hospitals by volume and revenue. METHODS: The authors obtained data on volumes and reimbursement rates for the most common 25 tests at the five hospitals with which they are affiliated and organized them to be as comparable as possible. Simple descriptive statistics were used to make cross-country comparisons. RESULTS: There are strong similarities across all five hospitals in the top five tests by both volume and revenue. However, the top five by volume differ from the top five by revenue. Reimbursement rates also follow common patterns, being lowest for the most common biochemical test; intermediate for the most common hematology and microbiology tests, respectively; and highest for the most common pathology test. CONCLUSIONS: Most of the most common tests also appear in the new Essential Diagnostics List. This may inform plans for universal health coverage.

Tumor Necrosis Factor-Alpha and Interleukin-1 Alpha as Predictors of Survival in Peritonitis: A Pilot Study.

CONTEXT: Peritonitis induces an inflammatory response characterized by the elevation of various cytokine levels. Included in this cascade of cytokines are tumor necrosis factor-alpha (TNF-α) and interleukin-1 alpha (IL-1α). The outcome of patient care may be associated with the pattern of elaboration of these cytokines. AIM: The aim of this study was to describe the pattern of cytokine response (TNF-α and IL-1α) in the course of peritonitis and evaluate them as predictors of mortality in peritonitis. SETTING AND DESIGN: This was a prospective study conducted in the Division of Gastrointestinal Surgery, University College Hospital, Ibadan. METHODS: Consenting patients with clinical diagnosis of generalized peritonitis over a 6-month period (July to December 2015) were recruited. The serum samples of these patients were obtained at presentation, immediately after surgery, and 24 h and 48 h after surgery with a follow-up period of 30 days. RESULTS: Twenty-six samples out of thirty could be analyzed. Serum TNF-α and IL-1α levels were both elevated at presentation in all patients. However, the patterns of change after intervention varied between the survivors and nonsurvivors. CONCLUSION: Peritonitis triggers a simultaneous increase in serum levels of TNFα and IL-1α. Lower serum level of TNF-α is associated with survival, while on the contrary, higher level of IL-1α is associated with survival.

Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): a single-centre, randomised, double-blind, placebo-controlled trial.

Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. We evaluated the effect of TXA on fibrinolysis and coagulation in a sample of WOMAN trial participants. Methods: Adult women with a clinical diagnosis of PPH were randomised to receive 1 g TXA or matching placebo in the WOMAN trial. Participants in the WOMAN trial at University College Hospital (Ibadan, Nigeria) also had venous blood taken just before administration of the first dose of trial treatment and again 30 (±15) min after the first dose (the ETAC study).  We aimed to determine the effects of TXA on fibrinolysis (D-dimer and rotational thromboelastometry maximum clot lysis (ML)) and coagulation (international normalized ratio and clot amplitude at 5 min). We compared outcomes in women receiving TXA and placebo using linear regression, adjusting for baseline measurements. Results: Women (n=167) were randomised to receive TXA (n=83) or matching placebo (n=84). Due to missing data, seven women were excluded from analysis. The mean (SD) D-dimer concentration was 7.1 (7.0) mg/l in TXA-treated women and 9.6 (8.6) mg/l in placebo-treated women (p=0.09). After adjusting for baseline, the D-dimer concentration was 2.16 mg/l lower in TXA-treated women (-2.16, 95% CI -4.31 to 0.00, p=0.05). There was no significant difference in ML between TXA- and placebo-treated women (12.3% (18.4) and 10.7% (12.6), respectively; p=0.52) and no significant difference after adjusting for baseline ML (1.02, 95% CI -3.72 to 5.77, p=0.67).  There were no significant effects of TXA on any other parameters. Conclusion: TXA treatment was associated with reduced D-dimer levels but had no apparent effects on thromboelastometry parameters or coagulation tests. Registration: ISRCTN76912190 (initially registered 10/12/2008, WOMAN-ETAC included on 22/03/2012) and NCT00872469 (initially registered 31/03/2009, WOMAN-ETAC included on 22/03/2012).

Haematological and fibrinolytic status of Nigerian women with post-partum haemorrhage.

BACKGROUND: Early treatment with tranexamic acid reduces deaths due to bleeding after post-partum haemorrhage. We report the prevalence of haematological, coagulation and fibrinolytic abnormalities in Nigerian women with postpartum haemorrhage. METHODS: We performed a secondary analysis of the WOMAN trial to assess laboratory data and rotational thromboelastometry (ROTEM) parameters in 167 women with postpartum haemorrhage treated at University College Hospital, Ibadan, Nigeria. We defined hyper-fibrinolysis as EXTEM maximum lysis (ML) > 15% on ROTEM. We defined coagulopathy as EXTEM clot amplitude at 5 min (A5) < 40 mm or prothrombin ratio > 1.5. RESULTS: Among the study cohort, 53 (40%) women had severe anaemia (haemoglobin< 70 g/L) and 17 (13%) women had severe thrombocytopenia (platelet count < 50 × 109/L). Thirty-five women (23%) had ROTEM evidence of hyper-fibrinolysis. Based on prothrombin ratio criteria, 16 (12%) had coagulopathy. Based on EXTEM A5 criteria, 49 (34%) had coagulopathy. CONCLUSION: Our findings suggest that, based on a convenience sample of women from a large teaching hospital in Nigeria, hyper-fibrinolysis may commonly occur in postpartum haemorrhage. Further mechanistic studies are needed to examine hyper-fibrinolysis associated with postpartum haemorrhage. Findings from such studies may optimize treatment approaches for postpartum haemorrhage. TRIAL REGISTRATION: The Woman trial was registered: NCT00872469; ISRCTN76912190 (Registration date: 22/03/2012).

Access to pathology and laboratory medicine services: a crucial gap.

As global efforts accelerate to implement the Sustainable Development Goals and, in particular, universal health coverage, access to high-quality and timely pathology and laboratory medicine (PALM) services will be needed to support health-care systems that are tasked with achieving these goals. This access will be most challenging to achieve in low-income and middle-income countries (LMICs), which have a disproportionately large share of the global burden of disease but a disproportionately low share of global health-care resources, particularly PALM services. In this first in a Series of three papers on PALM in LMICs, we describe the crucial and central roles of PALM services in the accurate diagnosis and detection of disease, informing prognosis and guiding treatment, contributing to disease screening, public health surveillance and disease registries, and supporting medical-legal systems. We also describe how, even though data are sparse, these services are of both insufficient scope and inadequate quality to play their key role in health-care systems in LMICs. Lastly, we identify four key barriers to the provision of optimal PALM services in resource-limited settings: insufficient human resources or workforce capacity, inadequate education and training, inadequate infrastructure, and insufficient quality, standards, and accreditation.

Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action.

Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings.

Demographic and epidemiological characteristics of HIV opportunistic infections among older adults in Nigeria.

BACKGROUND: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them. OBJECTIVES: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria. METHODS: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan. RESULTS: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13). CONCLUSION: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa.

An Essential Pathology Package for Low- and Middle-Income Countries.

Objectives: We review the current status of pathology services in low- and middle-income countries and propose an "essential pathology package" along with estimated costs. The purpose is to provide guidance to policy makers as countries move toward universal health care systems. Methods: Five key themes were reviewed using existing literature (role of leadership; education, training, and continuing professional development; technology; accreditation, management, and quality standards; and reimbursement systems). A tiered system is described, building on existing proposals. The economic analysis draws on the very limited published studies, combined with expert opinion. Results: Countries have underinvested in pathology services, with detrimental effects on health care. The equipment needs for a tier 1 laboratory in a primary health facility are modest ($2-$5,000), compared with $150,000 to $200,000 in a district hospital, and higher in a referral hospital (depending on tests undertaken). Access to a national (or regional) specialized laboratory undertaking disease surveillance and registry is important. Recurrent costs of appropriate laboratories in district and referral hospitals are around 6% of the hospital budget in midsized hospitals and likely decline in the largest hospitals. Primary health facilities rely largely on single-use tests. Conclusions: Pathology is an essential component of good universal health care.

Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): protocol and statistical analysis plan for a randomized controlled trial.

Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. Tranexamic acid has the potential to reduce bleeding and a large randomized controlled trial of its effect on maternal health outcomes in women with PPH (The WOMAN trial) is ongoing. We will examine the effect of tranexamic acid on fibrinolysis and coagulation in a subset of WOMAN trial participants. Methods. Adult women with clinically diagnosed primary PPH after vaginal or caesarean delivery are eligible for inclusion in the WOMAN trial. In a sub-group of trial participants, blood samples will be collected at baseline and 30 minutes after the first dose of tranexamic acid or matching placebo.  Our primary objective is to evaluate the effect of tranexamic acid on fibrinolysis. Fibrinolysis will be assessed by measuring D-dimers and by rotational thromboelastometry (ROTEM). Secondary outcomes are international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, haemoglobin and platelets. We aim to include about 180 women from the University College Hospital, Ibadan in Nigeria. Discussion:  This sub-study of WOMAN trial participants should provide information on the mechanism of action of tranexamic acid in women with postpartum haemorrhage. We present the trial protocol and statistical analysis plan. The trial protocol was registered prior to the start of patient recruitment. The statistical analysis plan was completed before un-blinding. Trial registration: The trial was registered: ClinicalTrials.gov, Identifier NCT00872469 https://clinicaltrials.gov/ct2/show/NCT00872469; ISRCTN registry, Identifier ISRCTN76912190 http://www.isrctn.com/ISRCTN76912190 (Registration date: 22/03/2012).

Temporal distribution of baseline characteristics and association with early mortality among HIV-positive patients at University College Hospital, Ibadan, Nigeria.

The first six months of HIV care and treatment are very important for long-term outcome. Early mortality (within 6 months of care initiation) undermines care and treatment goals. This study assessed the temporal distribution in baseline characteristics and early mortality among HIV patients at the University College Hospital, Ibadan, Nigeria from 2006-2013. Factors associated with early mortality were also investigated. This was a retrospective analysis of data from 14 857 patients enrolled for care and treatment at the adult antiretroviral clinic of the University College Hospital, Ibadan, Nigeria. Effects of factors associated with early mortality were summarised using a hazard ratio with a 95% confidence interval obtained from Cox proportional hazard regression models. The mean age of the subjects was 36.4 (SD=10.2) years with females being in the majority (68.1%). While patients' demographic characteristics remained virtually the same over time, there was significant decline in the prevalence of baseline opportunistic infections (2006-2007=55.2%; 2011-2013=38.0%). Overall, 460 (3.1%) patients were known to have died within 6 months of enrollment in care/treatment. There was no significant trend in incidence of early mortality. Factors associated with early mortality include: male sex, HIV encephalopathy, low CD4 count (< 50 cells), and anaemia. To reduce early mortality, community education should be promoted, timely access to care and treatment should be facilitated and the health system further strengthened to care for high risk patients.

Dyslipidemia in ART-Naive HIV-Infected Persons in Nigeria--Implications for Care.

AIMS: This study aimed to describe the prevalence and pattern of lipid abnormalities among antiretroviral therapy (ART)-naive HIV patients, understand if there is any relationship to virologic and immunologic status, and discuss the implications for care. METHODS: This was a cross-sectional study in which baseline demographic, clinical, and laboratory data of all ART-naive HIV-infected individuals recruited into the adult ARV clinic, University College Hospital, Ibadan, between January and December 2006, were analyzed. RESULTS: In total, 1316 ART-naive HIV-infected persons were recruited in the period. Females subjects and participants aged ≦35 years accounted for 67.1% and 57.7% of all participants, respectively. At least 1 abnormal lipid fraction was seen in 73.3% of participants. It was observed that in 11.5% participants the total cholesterol (TC) was ≧5.2 mmol/L, in 2.7% the low-density lipoprotein cholesterol (LDL)-C was >4.1 mmol/L in 56.5% the high-density lipoprotein cholesterol (HDL)-C was <1.0 mmol/L, and in 27.6% the triglyceride (TG) was >1.7 mmol/L. The TC, LDL-C, and HDL-C were all significantly positively correlated with CD4 counts and negatively correlated with viral load. On the contrary, the TG levels were negatively correlated with CD4 counts and positively correlated with viral load. Multivariate linear analysis showed a significant relationship between all the lipid parameters and viral load. CD4 counts were only significantly associated with TC. CONCLUSIONS: A significant burden of dyslipidemia exists among ART-naive HIV-infected persons. Low HDL-C was the most frequently observed abnormality. The abnormalities related more with viral load levels than with CD4 counts. Dyslipidemia screening should be done in ART-naive HIV-infected persons. Simple healthy lifestyle changes should be emphasized, with other care given to those with the disorder.

Temporal distribution of baseline characteristics and association with early mortality among HIV-positive patients at University College Hospital, Ibadan, Nigeria

The first six months of HIV care and treatment are very important for long-term outcome. Early mortality (within 6 months of care initiation) undermines care and treatment goals. This study assessed the temporal distribution in baseline characteristics and early mortality among HIV patients at the University College Hospital; Ibadan; Nigeria from 2006-2013. Factors associated with early mortality were also investigated. This was a retrospective analysis of data from 14 857 patients enrolled for care and treatment at the adult antiretroviral clinic of the University College Hospital; Ibadan; Nigeria. Effects of factors associated with early mortality were summarised using a hazard ratio with a 95% confidence interval obtained from Cox proportional hazard regression models. The mean age of the subjects was 36.4 (SD=10.2) years with females being in the majority (68.1%). While patients' demographic characteristics remained virtually the same over time; there was significant decline in the prevalence of baseline opportunistic infections (2006-2007=55.2%; 2011-2013=38.0%). Overall; 460 (3.1%) patients were known to have died within 6 months of enrollment in care/treatment. There was no significant trend in incidence of early mortality. Factors associated with early mortality include: male sex; HIV encephalopathy; low CD4 count ( 50 cells); and anaemia. To reduce early mortality; community education should be promoted; timely access to care and treatment should be facilitated and the health system further strengthened to care for high risk patients

Oral glucose tolerance testing outcomes among women at high risk for gestational diabetes mellitus.

AIMS: This study aimed to determine the prevalence and relationships with known risk factors of gestational diabetes mellitus (GDM) at University College Hospital, Ibadan, Nigeria. METHODS: Records of all women referred for oral glucose tolerance testing at the metabolic research unit of the Hospital over a 2 year period were reviewed. Diagnosis of GDM was made in accordance with WHO criteria. GDM diagnosis was classified as early and late based on a gestational age <24 weeks and >24 weeks respectively. Body mass index (BMI) measurements were performed for women who presented in the first trimester. Various statistical tools including student t test and Pearson's coefficient of correlation were used. RESULTS: A total of 765 records were reviewed. The crude prevalence rate was 13.9%. The prevalence rate among women in the first trimester was highest at 17.4% although most of the diagnoses were made in the third trimester (55.7%). A positive family history and a family history of GDM were associated significantly with a higher fasting and 2 h post-load glucose values, irrespective of current GDM diagnosis. The most consistent associations with a diagnosis of GDM were a positive family history and a history of GDM. Age above 30 years at oral glucose testing also showed significant association. There was no BMI threshold associated with a significant risk of GDM for those women presenting in the first trimester. CONCLUSIONS: GDM is a common metabolic condition in Nigeria. Onset before the 24th week of pregnancy is not uncommon.

Retinopathy among type 2 diabetic patients seen at a tertiary hospital in Nigeria: a preliminary report.

OBJECTIVE: To determine the prevalence of diabetic retinopathy among patients attending the diabetic clinics of a tertiary hospital in Nigeria. METHODOLOGY: We examined the eyes of 76 patients with type 2 diabetes mellitus between July 2003 and January 2004 using dilated fundoscopy at the eye clinic of the University College Hospital, Ibadan. The results were compared with published figures. RESULTS: Mean age of patients was 57.5 +/- 10.4 years. Thirty-two patients (42.1%) had diabetic retinopathy. Of these, one patient had features of proliferative diabetic retinopathy while the other patients had non-proliferative diabetic retinopathy. Majority (53.1%) of those who had retinopathy had diabetes for more than 10 years, while 21.4% of patients without retinopathy had diabetes for more than 10 years (p = 0.005). The mean serial post-prandial plasma glucose of those who had retinopathy was higher when compared with the mean for those who did not have retinopathy (248.7 mg/dl vs 178.3 mg/dl; p = 0.003). CONCLUSION: The prevalence of diabetic retinopathy in our patients is higher than was previously reported in earlier studies. Patients with diabetes ought to be referred for ophthalmological evaluation and follow-up which they should be actively encouraged to attend.

Total antioxidants status and some hematological values in sickle cell disease patients in steady state.

Congenital hemoglobin mutations may alter the delicate balance of free-radical generation and antioxidant defense systems in the red cell. Oxidative stress may thus play a role in the pathophysiology of the clinical manifestations of the disease. We assessed the total antioxidant status in steady-state sickle cell anemia (SCA) patients and related it to certain hematological parameters and their recent clinical history. Forty (25 males/15 females) adult SCA patients and 30 age-matched controls were studied. All patients and control subjects had total antioxidant status (TAS), hematocrit, white blood cells, platelets and reticulocyte count done. The results showed that TAS levels were about 50% lower in the SCA patients compared with the controls. Among the SCA patients, 57.1% of those with TAS levels <1.00 mmol/L had bone pain crisis >3 times in the past year, compared with 16% in those with TAS levels >1.00 mmol/L. Total leukocyte count and platelets were also significantly higher in the SCA patients than controls. Our data support the growing evidence that oxidative stress has a role to play in the pathophysiology of SCA and intervention aimed at increasing the antioxidant capacity of these patients may be beneficial.

Low prevalence of hepatitis-C viral seropositivity among patients with type-2 diabetes mellitus in a tertiary hospital.

Recently, there have been increasing reports of high prevalence of hepatitis-C virus (HCV) in patients with type-2 diabetes, mostly in western nations. This suggests that type-2 diabetic patients could be considered to be at special risk of acquiring HCV and possibly that diabetes has an etiological relationship with HCV. Ninety patients with type-2 diabetes attending the medical outpatient clinic of the University College Hospital (UCH) and 90 nondiabetic controls with comparable age, sex and risk factors of exposure to HCV were recruited into the study. All subjects were screened for anti-HCV using a third-generation rapid enzyme immunoassay (Dialab anti-HCV cassette). Data were analyzed using Student's t test, Chi-squared test and Fisher's exact test. None of the diabetic patients tested positive for anti-HCV, while 1.1% of the control group tested positive for anti-HCV. There appears to be low prevalence of anti-HCV among type-2 diabetic patients in UCH Ibadan, and therefore no demonstrable risk of HCV in our patients.