A comparative laboratory diagnosis of malaria: microscopy versus rapid diagnostic test kits.

OBJECTIVE: To compare the two methods of rapid diagnostic tests (RDTs) and microscopy in the diagnosis of malaria. METHODS: RDTs and microscopy were carried out to diagnose malaria. Percentage malaria parasitaemia was calculated on thin films and all non-acute cases of plasmodiasis with less than 0.001% malaria parasitaemia were regarded as negative. Results were simply presented as percentage positive of the total number of patients under study. The results of RDTs were compared to those of microscopy while those of RDTs based on antigen were compared to those of RDTs based on antibody. Patients' follow-up was made for all cases. RESULTS: All the 200 patients under present study tested positive to RDTs based on malaria antibodies (serum) method (100%). 128 out of 200 tested positive to RDTs based on malaria antigen (whole blood) method (64%), while 118 out of 200 patients under present study tested positive to visual microscopy of Lieshman and diluted Giemsa (59%). All patients that tested positive to microscopy also tested positive to RDTs based on antigen. All patients on the second day of follow-up were non-febrile and had antimalaria drugs. CONCLUSIONS: We conclude based on the present study that the RDTs based on malaria antigen (whole blood) method is as specific as the traditional microscopy and even appears more sensitive than microscopy. The RDTs based on antibody (serum) method is unspecific thus it should not be encouraged. It is most likely that Africa being an endemic region, formation of certain levels of malaria antibody may not be uncommon. The present study also supports the opinion that a good number of febrile cases is not due to malaria. We support WHO's report on cost effectiveness of RDTs but, recommend that only the antigen based method should possibly, be adopted in Africa and other malaria endemic regions of the world.

Prevalence of chronic kidney disease in adults with metabolic syndrome.

The burden of chronic kidney disease (CKD) and other non- communicable diseases continues to rise globally, and recent studies suggest that metabolic syndrome (MS) may add to this burden by contributing to the development of CKD. Given that reports on the prevalence of CKD in patients with MS in this environment are scanty, this study was undertaken with the sole aim of determining the prevalence of CKD in subjects with MS as defined by the International Diabetes Federation (IDF) and the National Cholesterol Education Project Adult Treatment Panel III (NCEP ATP III). A total of 240 consenting adults (18-70 years) attending the general out- patient clinic of the General Hospital Okrika for various ailments were studied. Subjects were screened for MS as per the above- mentioned criteria. Estimated GFR (eGFR) was determined with Modification of Diet for Renal Disease (MDRD) formula and CKD was defined as eGFR less than 60 mL/min/1.73 m2 . Data was analyzed using SPSS version 12.0 and Epi info version 4.06d; P <0.05 was considered as significant. A total of 88 males and 152 females were screened for MS by both criteria. Eighty- four (35.0%) of 240 subjects had MS as defined by NCEP ATP III, while 85 (35.4%) had MS as defined by the IDF. The subjects were predominantly females, and mean age was between 54.74 ± 15.30 and 55.60 ± 14.81 years. Four of the 84 (4.8%) subjects with MS by NCEP ATP III definition had CKD while three of the 85 (3.5%) subjects with MS by IDF definition had CKD. Among subjects without MS by either definition, the prevalence of CKD was four of 140 (2.9%). Although the prevalence of CKD was higher among subjects with MS by ATP III compared with those with MS as defined by IDF and subjects without MS, the differences were not statistically significant (X2 = 0.14; P = 0.710). A comparison of MS subjects without CKD and those with CKD did not show any significant difference in age, waist circumference, body mass index, blood pressure, fasting blood glucose and lipid profile (P > 0.05). CKD was more common in subjects with MS compared with those without, although the difference was not statistically significant. The prevalence of CKD in subjects with MS in our study population did not differ significantly when the different MS definitions were employed.

Prevalence of metabolic syndrome in urban and suburban Rivers State, Nigeria: International Diabetes Federation and Adult Treatment Panel III definitions.

BACKGROUND: It was not clear for a while, which of the definitions of metabolic syndrome best predicted those at risk of cardiovascular disease and diabetes but recent studies have confirmed the predictive ability of various definitions of metabolic syndrome and have reported that the International Diabetes Federation definition, although more sensitive is associated with a higher false positive predictive rate. OBJECTIVES: To determine the prevalence of metabolic syndrome, using the International Diabetes Federation and Adult Treatment Panel III definitions among adult Nigerians attending Family Medicine Clinics at two hospitals in Rivers State Nigeria. METHODS: Adult subjects attending family medicine clinics at an urban and a sub-urban hospital in Rivers State, Nigeria were bled after an overnight fast, and venous blood obtained for lipid studies and fasting plasma glucose estimations. Measurements were made to determine height, weight, waist circumference and blood pressure. The data obtained was analysed using SPSS for Windows software version 12 and Epi info version 6.04D RESULTS: The prevalence of metabolic syndrome was 19.81% (ATP III) and 23.19% (IDF) at one centre and 34.17% (ATP III) and 35.42% (IDF) at the other centre. CONCLUSION: The prevalence of metabolic syndrome by the two definitions was significantly higher at the second centre. The difference in the prevalence rates by the two definitions was also much smaller in the second centre perhaps because the second centre had more women and the mean age of the subjects was significantly higher.

Some haematological reference values for pre-primary and primary school aged children in Port Harcourt, Nigeria.

BACKGROUND: Published reports of haematological reference values for pre-primary and primary school aged residents of Port Harcourt, Nigeria are relatively scanty. AIM: To determine the reference ranges of some haematological parameters for pre-primary and primary school aged children resident in Port Harcourt, Nigeria. METHODS: A total of 250 pre-primary school subjects consisting of 124 males and 126 females aged between 1 to 5 years and 536 primary school children consisting of 262 males and 274 females aged between 6 and 13 years resident in Port Harcourt, Nigeria were randomly recruited into the study. 3-5 ml of venous blood was collected with minimum stasis and the values of the following haematological parameters determined by the indicated methods: Haematocrit was determined using Hawksley micro-capillary tubes centrifuged at 3000 rpm for 10 minutes. Red blood cells, white blood cells [including a differential count] and platelet cells were counted manually using the improved Neubauer counting chamber. Erythrocyte Sedimentation Rate (ESR) was determined using the Westergren method. Haemoglobin concentration was determined by the cyanmethaemoglobin method. RESULTS: The reference ranges for haematocrit, total white blood cell, differential neutrophils and lymphocyte counts, platelet cell counts and erythrocyte sedimentation rates; haemoglobin concentration and red cell counts are presented for male and female pre-primary and primary school children in Port Harcourt. There were no significant gender variations in the values of these parameters in both pre-primary and primary school children. However, primary school subjects, irrespective of sex, were found to have significantly higher values of lymphocyte differential counts and erythrocyte sedimentation rates and significantly lower platelet counts and total white cell counts and differential neutrophils counts compared to their pre-primary school counterparts [p<0.05]. There were no significant differences in the values of haematocrit between the two subject groups; though the values in primary school subjects were marginally higher. CONCLUSIONS: The present study reports values and reference ranges of some haematological parameters for pre-primary and primary school aged children in Port Harcourt, Nigeria; no significant gender variations were observed in these parameters. The results indicate that significant differences exist in the values of some of the haematological parameters under investigation between pre-primary and primary school subjects. This suggests a distinction in the haematological parameters of both populations.

Relative Risk of Metabolic Syndrome Components in Nigerians: the Adult Treatment Panel III Definition

Background: The prevalence of metabolic syndrome is increasing in all populations worldwide and is associated with a substantially elevated risk of type 2 diabetes (5-fold) and of cardiovascular disease (2-3 fold). Metabolic syndrome is now established as a simple means of identifying individuals at increased risk of future cardio vascular disease and type 2 diabetes mellitus. Aim: To determine the prevalence of metabolic syndrome among adult Nigerians attending Family Medicine Clinics at two health facilities in Rivers State; Nigeria and to determine how much each diagnostic criterion contributed to the diagnosis of metabolic syndrome. Methods: Subjects were bled after an overnight fast; and venous blood obtained for lipid studies and fasting blood glucose estimation. Measurements were made to determine height; weight; waist circumference and blood pressure. The diagnosis of metabolic syndrome was based on the National Cholesterol Education Project: Adult Treatment Panel III (ATP III) definition. Results: The unadjusted and age-adjusted prevalence rates of metabolic syndrome at one centre were 19.8and 20.9respectively while they were 34.2and 31.6respectively at the other centre. The prevalence of low HDL-cholesterol was very high at both centres (78.3at one centre and 92.1at the other). Metabolic syndrome is most prevalent in females and older subjects. Conclusion: The prevalence of metabolic syndrome (19.8and 20.9; unadjusted and age-adjusted; respectively) were lower at one centre than the other (34.2and 31.6; unadjusted and age-adjusted; respectively). Despite the very high prevalence of low HDL- cholesterol; the relative risk for metabolic syndrome was not statistical significant (RR=6.73; 95CI: 0.99-45.55)

Medical Waste Management at the University of Port Harcourt Teaching Hospital

Background: The generation and handling of wastes from medically related procedures poses a potential health hazard to health workers and non health workers alike; and this has far reaching consequences for the public in areas where such wastes are disposed of carelessly. Aim: To investigate the medical waste management procedure at the University of Port Harcourt Teaching Hospital (UPTH) and assess the knowledge of; attitudes to and practice of waste management by staff of the Hospital. Methods: A stratified random sampling method was used for this descriptive cross sectional study; using a structured questionnaire that was pre-tested; as the instrument of data collection. The respondents were directly involved with medical waste generation; handling and disposal. Data collected was analysed using Statistical Package for Social Sciences for windows software; version 12.0. Results: There was a high level of awareness among UPTH health workers of the different waste types and their hazardous nature. A majority of the respondents showed favourable attitudes towards the importance of guidelines on medical waste management and training in; and use of personal protective equipment. Also the staff avoided certain aspects of their jobs they considered risky. The study also showed that the procedure of medical wastes management i.e. generation; segregation; storage; treatment; and final disposal at the UPTH was inadequate. Conclusion: The knowledge; attitude; and practice of the UPTH members of staff regarding management of medical wastes appeared satisfactory. The procedure of wastes management at the hospital appeared inadequate. We recommend that health education on medical wastes management be aggressively pursued as a policy

The prevalence of obesity as indicated by BMI and waist circumference among Nigerian adults attending family medicine clinics as outpatients in Rivers State.

BACKGROUND: The prevalence of overweight and obesity in most developed countries and in urban areas of many less developed countries has been increasing markedly over the past twenty years. This study's aims were to determine the prevalence of obesity using BMI and waist circumference among Nigerian adults attending Family Medicine Clinics as outpatients and to assess the relative associations with CVD risk factors. METHODS: Subjects, who all volunteered for this study reported at the study centres after an overnight fast, to be weighed (in kg), for their heights (in metres), blood pressure and waist circumference (in cm) measured, and their venous blood samples taken for lipid studies and fasting blood glucose estimation. Results were analysed using SPSS for windows software (version 11) and Epi Info (version 6. 04d). RESULTS: The prevalence of obesity as determined by large waist circumference was 31.7% at the Okrika (rural) centre and 16.9% at the Port Harcourt centre. It was 16.3% at the Okrika centre and 14% at the Port Harcourt centre, as determined by BMI > or = 30 kgm(-2). Obesity as determined by BMI > or = 30 kgm(-2) is more prevalent among young adults (< 40 years) in Port Harcourt than at Okrika. Obesity by both definitions is more prevalent among females than among males (p < 0.01) and more among subjects older than 40 years. Both indices of obesity appear to be significantly associated with CVD risk factors. CONCLUSION: Obesity in our environment is strongly associated with a family history of obesity and a sedentary lifestyle. It is therefore not surprisingly more prevalent among females and older members of society. Healthier eating and social habits, and increased physical activity need to be strongly encouraged.

The prevalence of obesity as indicated by BMI and waist circumference among Nigerian adults attending family medicine clinics as outpatients in Rivers State

Background: The prevalence of overweight and obesity in most developed countries and in urban areas of many less developed countries has been increasing markedly over the past twenty years. This study's aims were to determine the prevalence of obesity using BMI and waist circumference among Nigerian adults attending Family Medicine Clinics as outpatients and to assess the relative associations with CVD risk factors. Methods: Subjects, who all volunteered for this study reported at the study centres after an overnight fast, to be weighed (in kg), for their heights (in metres), blood pressure and waist circumference (in cm) measured, and their venous blood samples taken for lipid studies and fasting blood glucose estimation. Results were analysed using SPSS for windows software (version 11) and Epi Info (version 6. 04d). Results: The prevalence of obesity as determined by large waist circumference was 31.7% at the Okrika (rural) centre and 16.9% at the Port Harcourt centre. It was 16.3% at the Okrika centre and 14% at the Port Harcourt centre, as determined by BMI > or = 30 kgm(-2). Obesity as determined by BMI > or = 30 kgm(-2) is more prevalent among young adults (< 40 years) in Port Harcourt than at Okrika. Obesity by both definitions is more prevalent among females than among males (p < 0.01) and more among subjects older than 40 years. Both indices of obesity appear to be significantly associated with CVD risk factors. Conclusion: Obesity in our environment is strongly associated with a family history of obesity and a sedentary lifestyle. It is therefore not surprisingly more prevalent among females and older members of society. Healthier eating and social habits, and increased physical activity need to be strongly encouraged

Type 2 diabetes mellitus: a review of pharmacological treatment.

BACKGROUND: Type 2 diabetes mellitus, is a disease with a rising prevalence worldwide. It is currently estimated that 190 million people around the world suffer from diabetes mellitus, with over 330 million predicted to have the condition by 2025 and 366 million by the year 2030. It is predicted that the developing countries will contribute 77.6% of the total number of diabetic patients in the world by the year 2030. This rapidly growing prevalence among developing countries is attributed to the effects of urbanization, industrialization and globalization on these countries. There has been substantial progress over the last decade in the development of new agents for the treatment of type 2 diabetes especially focusing on the underlying pathophysiology. Despite this and the numerous guidelines from diabetes organisations only less than 40% of patients achieve recommended glycaemic targets. We therefore decided to do a review of the pharmacological treatment of type 2 diabetes mellitus to highlight the pharmacology and effectiveness of these agents and their roles in the management of type 2 diabetes. METHODS: We reviewed the literature on the subject using materials from library search, articles in journals, internet search and conference abstracts. RESULTS: The global burden of type 2 diabetes mellitus, the various pharmacological agents available for the treatment of type 2 diabetes mellitus, including novel agents were discussed. CONCLUSION: The prevalence of type 2 diabetes mellitus is increasing worldwide and the predicted increase is much higher in developing countries compared to the developed countries. There are obviously an enormous number of therapies available for the treatment of type 2 diabetes mellitus and if effectively deployed it will be possible to achieve target diabetic control in most of our patients. This however, should not detract us from adopting measures that will reduce the prevalence of type 2 diabetes mellitus in our population bearing in mind that prevention is more cost effective especially given our low socioeconomic development and the very high predicted rise in the burden of type 2 diabetes mellitus in our developing world.

Glucocorticoids and the insulin resistance syndrome.

BACKGROUND: Insulin regulates the uptake, utilization and storage of cellular nutrients. An attenuated responsiveness of tissues to insulin (insulin resistance), results in the metabolic or insulin resistance syndrome, polycystic ovary disease, lipodystrophic states and leprechaunism. Type 2 diabetes mellitus, a consequence of insulin resistance and a major component of the insulin resistance syndrome, currently affects 177 million people worldwide and is predicted to rise to over 300 million by 2025 (the majority of cases in Africa). METHODS: We reviewed currently available literature on the role of glucocorticoids in the pathogenesis and clinical management of the insulin resistance syndrome. RESULTS: The epidemiology of insulin resistance, the components of insulin resistance syndrome, factors responsible for insulin resistance, the role of glucocorticoids, and the treatment of gluocorticoid induced insulin resistance have been discussed. CONCLUSION: Chronically elevated serum glucocorticoid levels contribute to diabetes and removal of glucocorticoid excess improves insulin sensitivity. Because insulin regulates 11beta-hydroxysteroid dehydrogenase enzyme type-1 (11betaHSD-1) activity, it has been suggested that dysregulation of (11betaHSD-1) may underlie the pathogenesis of glucocorticoid-dependent insulin-resistance. Indeed, 11beta-HSD1 has been proposed as a new target for type 2 diabetes drugs.