Prevalence and trends of adult overweight and obesity in Nigeria - A systematic review and meta-analysis.

Background: The prevalence of obesity and its attendant complications are on the increase globally-sub-Saharan Africa inclusive. Obesity confers an increased risk of coronary artery disease, type 2 diabetes, ischemic stroke, and some cancers. In Nigeria, several individual reports estimate an exponential increase in the prevalence of overweight and obesity. Aim: In this study, we aimed to estimate the current prevalence of overweight and obesity in Nigeria through a systematic review and meta-analyses. Materials and Methods: A systematic review and meta-analysis were conducted on the prevalence of obesity in Nigeria using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format following searches on major search engines, performed in PubMed, Science Direct, Google Scholar, Africa Journals Online (AJOL), and the WHO African Index Medicus database. Studies on the subject area conducted from the year 2000 to 2018 were included. The forest plot was used to graphically present the results, while confidence interval at 95% was used to display the rates. Results: A total of 77 articles on the prevalence of obesity involving 107, 781 individuals were used in the study. We found a pooled estimate of overweight of 26.0% (95% CI: 23.0-29.0) and that of obesity as 15.0% (95% CI: 13.0-16.0). There was an increasing trend in the prevalence of obesity in Nigeria from the study especially among urban dwellers. Conclusion: The prevalence of obesity and overweight in Nigeria is high with a rising trend over the years. A Nigerian national health survey of non-communicable diseases especially the burden of overweight/obesity is recommended to through more light on the subject. There is need for concerted effort to tame the tide of rising obesity rates in Nigeria.

Comparison of the Efficacy, Tolerability and Side Effect Profile of Vildagliptin-Metformin with Metformin-GlibenclamideMamong Nigerian.

BACKGROUND: The use of fixed dose combination oral antidiabetic drugs (OADs) in the therapeutic management of type 2 diabetes mellitus (DM) patients is becoming popular among clinicians. Reduced pill burden with fixed combination OADs is generally perceived to improve adherence and efficacy. The aim of this study was to compare the efficacy, tolerability and side effects (SEs) profile of vildagliptin-metformin (VM) combination with metformin-glibenclamide (MG) combination in type 2 DM patients at the Aminu Kano Teaching Hospital (AKTH). METHODS: A descriptive prospective open-labeled comparative out-patient study of type 2 DM patients spanning over three months with 60 Patients assigned to two treatment groups - VM (Group 1) and MG (Group 2) of 30 patients each. Parameters measured at baseline, 6 weeks and 12 weeks of study included demographic and anthropometric data; fasting plasma glucose (FPG) level; 2-hour post-prandial (2-hrPPG) glucose; liver function tests (LFTs); Electrolyte, Urea and Creatinine (EUCr); and fasting plasma lipids. Glycated haemoglobin (HbA1c) was measured at baseline and at 12 weeks of the study. A p-value of <0.05 was considered to be significant. RESULTS: There was improvement in FPG, 2hr PPG, HbA1c in all subjects in both groups at the end of the study (6.44±0.79mmol/ l, 8.80±1.16mmol/l and 7.22±1.20% respectively in group 1(VM); and 6.40±0.83mmol/l, 9.29±1.39 and 7.25±0.96% respectively for group 2(MG). There was a significant improvement in body mass index (BMI) of subjects in group 1 (30.02±4.16 at baseline, 29.71±4.12 at study end) compared to those in group 2 (31.98±6.32 at baseline, 32.62±6.30 at study end), p=0.04. At the end of the study, the efficacy of VM (HbA1C-7.22±1.20%) was comparable to that of MG (HbA1c-7.25±0.96), P=0.92. The tolerability of MG (attrition rate 6.7%) was better than that of VM (attrition rate 13%), although this difference was not statistically significant P=0.16. The subjects on VM experienced more gastrointestinal (GIT) side effects compared to those on MG. The major SEs experienced by those on MG were hypoglycaemia and weight gain. VM was less tolerated and had more GIT side effects than MG. CONCLUSION: The use of single pill combination oral antidiabetic medications is associated with improved efficacy.

CONTEXTE: L'utilisation d'associations fixes d'antidiabétiques oraux (ADO) dans la prise en charge thérapeutique des patients atteints de diabète sucré (DM) de type 2 est en train de devenir populaire parmi les cliniciens. La réduction du fardeau de la pilule avec des ADO à combinaison fixe est généralement perçue comme améliorant l'observance et l'efficacité. Le but de cette étude était de comparer l'efficacité, la tolérabilité et le profil d'effets secondaires (ES) de l'association vildagliptine - metformine (VM) avec l'association metformine - glibenclamide (MG) chez des patients atteints de DM de type 2 à l'hôpital universitaire Aminu Kano (AKTH). MÉTHODES: Une étude descriptive prospective ouverte comparative ambulatoire de patients atteints de diabète de type 2 s'étalant sur trois mois avec 60 patients répartis en deux groupes de traitement - VM (groupe 1) et MG (groupe 2) de 30 patients chacun. Les paramètres mesurés au départ, 6 semaines et 12 semaines d'étude comprenaient des données démographiques et anthropométriques ; taux de glucose plasmatique à jeun (FPG); Glycémie post-prandiale 2 heures (2-hrPPG) ; tests de la fonction hépatique (LFT); électrolyte, urée et créatinine (EUCr); et les lipides plasmatiques à jeun. L'hémoglobine glyquée (HbA1c) a été mesurée au départ et à 12 semaines de l'étude. Une valeur p < 0,05 a été considérée comme significative. RÉSULTATS: Il y avait une amélioration de la FPG, 2h PPG, HbA1c chez tous les sujets dans les deux groupes à la fin de l'étude (6,44 ± 0,79 mmol/l, 8,80 ± 1,16 mmol/l et 7,22 ± 1,20 % respectivement dans le groupe 1 (VM) et 6,40 ± 0,83 mmol/l, 9,29 ± 1,39 et 7,25 ± 0,96 % respectivement pour le groupe 2 (MG). Il y avait une amélioration significative de l'indice de masse corporelle (IMC) des sujets du groupe 1 (30,02 ± 4,16 au départ, 29,71 ± 4,12 à la fin de l'étude) par rapport à ceux du groupe 2 (31,98 ± 6,32 à l'inclusion, 32,62 ± 6,30 à la fin de l'étude), p = 0,04. À la fin de l'étude, l'efficacité de la VM (HbA1C-7,22 ± 1,20 %) était comparable à celle de MG (HbA1c-7,25 ± 0,96), P= 0,92. La tolérance de MG (taux d'attrition 6,7 %) était meilleure que celle de VM (taux d'attrition 13 %), bien que cette différence n'ait pas été statistiquement significative P= 0,16. Les sujets sous VM ont présenté plus d'effets secondaires gastro-intestinaux (GIT) que ceux sous MG. Les principaux effets secondaires ressentis par ceux sous MG étaient l'hypoglycémie et la prise de poids. La VM était moins tolérée et avait plus d'effets secondaires GIT que MG. CONCLUSION: L'utilisation de médicaments antidiabétiques oraux combinés à une seule pilule est associée à une efficacité améliorée. Mots clés: Diabète, Efficacité, Metformine-Glibenclamide, Tolérabilité, Vildagliptine-Metformine.

Favourable Outcome of Severe Lassa Fever Following Early Diagnosis and Treatment: A Case Report.

BACKGROUND: Nigeria has experienced several outbreaks of Lassa fever with a high fatality rate mostly from delayed presentation and treatment. We report a case of severe Lassa fever with complete recovery following prompt treatment to draw the attention of clinicians to the importance of early diagnosis and prompt treatment. CASE SUMMARY: A 30 year old male Nigerian presented with acute fever, haematuria and haematemesis. He was immediately commenced on ribavirin in addition to supportive care. He improved clinically and was discharged after full recovery. CONCLUSION: We recommend strengthening of health institutions towards early identification of suspected cases and prompt treatment.

L'ARRIERE PLAN: Le Nigéria a connu plusieurs flambées de fièvre de Lassa avec un taux de mortalité élevé principalement dû à un retard de présentation et de traitement. Nous rapportons un cas de fièvre de Lassa sévère avec guérison complète après un traitement rapide afin d'attirer l'attention des cliniciens sur l'importance d'un diagnostic précoce et d'un traitement rapide. RÉSUMÉ DU CAS: Un Nigérian de 30 ans a présenté une fièvre aiguë, une hématurie et une hématémèse. Il a immédiatement commencé à prendre de la ribavirine en plus des soins de soutien. Il s'est amélioré cliniquement et a été libéré après un rétablissement complet. CONCLUSION: Nous recommandons de renforcer les établissements de santé pour une identification précoce des cas suspects et un traitement rapide. MOTS CLÉS: Fièvre de Lassa, issue favorable, ribavirine, diagnostic et traitement précoces, Nigéria.

Atypical Diabetes Presentations in Sub-Saharan Africa Classification Puzzle and Possible Role of Precision Medicine.

Precision in the diagnosis and classification of diabetes mellitus, a complex heterogeneous disease is increasingly required to achieve treatment goals and prevent complications. Several reviews over decades have not completely solved the diabetes classification puzzle. African clinicians are sometimes confronted with the difficulty of classifying a newly diagnosed diabetes patient presenting atypically. These unusual presentations fall into those with diagnosis of either clinical type 1 or 2 diabetes but having some diagnostic and/or therapeutic features at variance with what are seen in the Western nations, those with tropical diabetes and those known as ketosis-prone type 2 diabetes (KPD). Reports from many African countries indicate that patients do not fit the classic pattern seen in the Western nations. In recent times, there has been groundswell of pressures and proposed models to evolve a more accurate classification of diabetes and the recent 2019 WHO diabetes classification seems to have acknowledged and accommodated these concerns. Perhaps advances in genomic knowledge could help with precision in diabetes classification, especially in Africa. This review seeks to highlight the challenges often encountered with classifying diabetes patients in Africa, and proffer suggestions on the way forward including possible benefit from advances in molecular genomics.

PREVALENCE OF METABOLIC SYNDROME AMONG APPARENTLY HEALTHY ADULTS IN A RURAL COMMUNITY, IN NORTH-WESTERN NIGERIA.

BACKGROUND: Metabolic syndrome (MetS) is a cluster of multiple metabolic abnormalities that increases the risk of cardiovascular morbidity and mortality, and a resultant severe economic implication. This study assessed the burden of MetS in a Nigerian rural community setting. METHOD: This was a cross-sectional, community based study on apparently healthy subjects. A multi stage cluster sampling technique was employed to recruit the study subjects. A standardized pre-tested questionnaire was used to obtain data, and blood samples from subjects were analysed using standard laboratory techniques. MetS was defined using the NCEP-ATP3 criteria. Data were analysed using STATA version II, and a p value of < 0.05 was considered statistically significant. RESULTS: A total of 450 subjects completed the study, with 38% being males, and a mean age of 40.27 ± 16.41 years. MetS was found in 116 (25.78%) of the subjects. Of these, systemic hypertension was found in 91(78.45%), while all (116) had elevated cholesterol and triglycerides. Abdominal adiposity was found in 45 (38.79%) subjects and 44 (37.93%) had Type 2 diabetes mellitus. CONCLUSION: The prevalence of MetS and its components in our studied population was high; hence the need for further large population based studies to determine its predictors in our environment.

Dyslipidemia: Prevalence and associated risk factors among patients with Lichen Planus in Kano, North-West Nigeria.

BACKGROUND: Lichen planus (LP) is a chronic inflammatory disorder. Recently, there are suggestions that LP is associated with dyslipidemia in a large series of patients independent of other causes. OBJECTIVE: The objective of this study was to investigate the prevalence and associated risk factors for dyslipidaemia among patients with LP. METHODS: This case-control study included 180.subjects, 90 with lichen planus (39 men and 51 Women) and 90 (44 men and 46 women) controls consecutively recruited from the outpatient Dermatology clinic of Amnihu Kano Teaching Hospital Kano-Nigeria. RESULTS: The prevalence of dyslipidemia was found to be higher among LP patients (32%) than the corol group (24%), p=0.208. Our study showed that male patients with LP have higher tendencies to develop dyslipidemia (OR 5.66, CI 1.73-19.59). Equally the duration of illness t 2 months was found to be a strong predictor of developing dyslipidemia (OR 5.65, CI 1.12-38.3). No significant differences were observed in glucose levels, body mass index, or blood pressure between the two study groups. CONCLUSION: The prevalence of dyslipidaemia among patients with LP in this study was high with male gender and increased-duration of illness being strong predictors. There is need for further studies on a larger scale to establish the prevalence and independent predictors of dyslipidaemia in patients with LP in our setting.

Prevalence of overweight and obesity in Maiduguri, North-Eastern Nigeria.

BACKGROUND: The prevalence of obesity is on the increase worldwide including in many developing countries. There is no report on the magnitude of obesity among adults in Maiduguri, a major city in northeastern Nigeria. MATERIALS AND METHODS: We selected a sample of 1650 men and women aged 15 years and above resident in Gwange ward in Maiduguri metropolitan council using a multistage sampling technique. Height, weight, waist (WC) and hip circumferences w measured. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Data were analyzed using SPSS version13. The ethics committee of the University of Maiduguri Teaching Hospital approved the study and consent was sought individually from the participants before being enlisted. RESULTS: The mean (SD) age of the respondents was 36.2 (14.4) years, with a range of 15 to 70 years. The mean (SD) ages of the males and females were 34.9 4.3) and 38.9 (14.0) years, respectively, (p < 0.001). The overall crude prevalence rates of overweight and obesity were 27.1% and 17.1%, respectively. In men, 40.6% were either overweight or obese, while in women 51.9% were either overweight or obese. We observed the highest prevalence rates of overweight and obesity in the middle age group. There were more obese females than males (14.05 vs. 4.3%) among both young and elderly (12.1% vs. 10.5%) subjects. CONCLUSION: The prevalence of overweight and obesity is high in Maiduguri metropolis particularly among women. Concerted efforts should be made to curb the menace of increasing rate of obesity in the metropolis through public enlightenment on the risks associated with obesity and the benefits of adopting a healthy lifestyle.

Time course of improvement of metabolic parameters after a 12 week physical exercise programme in patients with type 2 diabetes: the influence of gender in a Nigerian population.

Gender is a major determinant of the outcomes of many health interventions. This study documents the order of significant improvements in metabolic parameters of patients with type 2 diabetes mellitus (T2DM) having metabolic syndrome within 12 weeks of physical exercise programmes. Twenty-nine patients, mean age 49.6 ± 3.7 years, presenting with high fasting plasma glucose, high triglycerides, hypertension, and high waist circumference undertook a thrice weekly aerobic and endurance exercise programme in addition to their drugs and diet. Variables were assessed at baseline and end of every two weeks for twelve weeks. Compared with baseline, significant improvement (P < 0.05) in the metabolic parameters occurred in this order for the male participants: fasting glucose (2nd week), triglycerides and waist circumference (4th week), and systolic blood pressure (12th week). For the female participants, it was fasting glucose (4th week), triglycerides (6th week), and waist circumference (10th week). Regardless of the gender, fasting glucose was the first to improve significantly, followed by triglycerides. Hypertension did not improve significantly at all in the female participants as they may require more than twelve weeks of therapeutic exercise for any significant improvement in hypertension.

New-onset diabetes after renal transplantation: a case series as seen in a Nigerian kidney transplant population.

New-onset diabetes after transplantation (NODAT) is an important metabolic complication of transplantation because of its associated morbidity and mortality. Risk factors for NODAT include those known to cause diabetes mellitus in non-transplant patients as well as transplant-specific factors. This study was aimed at illustrating the presentation and management of NODAT in three kidney transplant recipients in our center and reviewing the literature. To our knowledge, this is the first report from Nigeria. Two of the patients were males of ages 60 and 36 years, respectively, while the third was a female aged 25 years. They were all receiving prednisolone, two were on tacrolimus, and one was on cyclosporine as part of their immunosuppressive regimens. They developed NODAT at varying times post transplant, ranging from 3 months to 6 years. Two patients were managed with oral hypoglycemic agents and one with insulin. One patient died of hemorrhagic stroke. We conclude that NODAT occurred in our kidney transplant recipients and recommend that physicians should have a high index of suspicion in order to make an early diagnosis and institute appropriate management to reduce morbidity and mortality.

Histoplasmosis: an elusive re-emerging chest infection.

An immunocompetent patient presenting with disseminated histoplasmosis and superior vena cava obstruction. Features at presentation were in keeping with tuberculosis. Histology of bronchoalveolar lavage specimen clinches the diagnosis of histoplasmosis.

Verrucous (hypertrophic) cutaneous lupus erythematosus: a case report.

Verrucous (Hypertrophic) lupus erythematosus (LE) represents a rare but distinct, variant of chronic discoid lupus erythematosus. We report a case of LE with verrucous lesions for its rarity and peculiar location posing a diagnostic dilemma.

Disseminated cutaneous leishmaniasis in HIV positive patient--a case report.

Disseminated cutaneous leishmaniasis and HIV dual-infection is seldom reported. Leishmaniasis and HIV co-infection may intensify the immune defect and is the chief reason for atypical presentation and widespread progression of cutaneous leishmaniasis and its defiance to conventional therapy. Here we report a 38-year-old HIV-positive lady who presented with a 6-month history of a progressive papule and nodular eruptions of leishmaniasis on face, trunk and extremities that was recalcitrant to treatment.

Physical activity levels of type 2 diabetes patients seen at the outpatient diabetes clinics of two tertiary health institutions in Nigeria.

BACKGROUND: It is uncertain whether physical activity is sufficiently utilized as a complementary therapy in diabetes management by the patients visiting Nigerian hospitals. OBJECTIVES: This study assessed the level of physical activity of Type 2 Diabetes (T2D) patients attending tertiary hospital clinics, and investigates the factors that may expose them to sedentariness. METHODS: Physical activity survey was carried out on 248 T2D patients randomly selected from the University College Hospital, Ibadan, and Aminu Kano Teaching Hospital, Kano, Nigeria; and 248 matched non-diabetic participants. Physical activity level was assessed using the International Physical Activity Questionnaire. Socio-demographic information in addition to any previous expert advice on physical activity was recorded. Chi-Squared tests and regression analysis were conducted at p < 0.05. RESULTS: Significant difference existed between the physical activity levels of the T2D patients and the nondiabetic participants (c2 = 57.1, p = 0.0001). Most of the T2D patients were moderately active (62.1%) and less sedentary (27.4%) compared to the non-diabetic participants who were less moderately active (30.6%) and more sedentary (37.5%). Being female doubles the odds of being sedentary (OR = 2.02; 95% CI = 1.52-3.18) likewise increasing age, paid employment and fewer sessions of expert advice on physical activities encourage sedentariness. CONCLUSION: The T2D patients were more physically active at moderate levels than the non-diabetic participants, although, a substantial proportion of the T2D patients were sedentary. Lack of, or infrequent expert advice on physical activity, older age, being female and in paid employment may contribute to sedentariness among the participants.

Idiopathic scrotal calcinosis; a rare scrotal tumour: a case report and review of literature.

Idiopathic scrotal calcinosis is a rare benign disease characterized by multiple, asymptomatic and painless nodules on the scrotum. We herein report this rare disease in a Nigerian adult male and briefly review the relevant literature.

Relationship between duration of diagnosis and neuromusculoskeletal complications of middle-aged type 2 diabetes patients.

BACKGROUND: Patients with Type 2 Diabetes (T2D) often present with complications involving the neuromusculoskeletal system which creep in as the condition advances in years. Hence there is a need to further understand how the duration of diagnosis of diabetes (DD) relates to the neuromusculoskeletal complications in order to design timely preventive programmes. OBJECTIVE: To investigate the relationship between the duration of diabetes and neuromusculoskeletal complications in type 2 diabetes. METHODS: This was a cross-sectional survey involving 139 consenting T2D patients and 139 age and sex-matched nondiabetic individuals. The participants were assessed for the DD and selected neuromusculoskeletal complications including muscle weakness, ranges of motion (ROM), pain and foot ulceration. RESULTS: The mean DD was 7.82 ± 2.41 years. There were significant differences (p < 0.01) between the clinical variables of both groups. In the diabetic participants, significant inverse relationships (P<0.05) were obtained between the DDD and each of muscle strength {{lbow flexors (r =-0.57), knee extensors (r=-0.63), handgrip (r=-0.82)}; ROM {wrist extension (r=-0.64) and ankle planterflexion (r=-0.63)}. Significant and direct relationships were obtained between the DDD and each of pain (r=0.62) and ulcerative grading (r= 0.81). CONCLUSIONS: Type 2 Diabetes patients have poorer neuromusculoskeletal variables and longer duration of diabetes is associated with reduced muscle strength, diminished ROM, gradual ulceration of skin of the feet and higher level of foot pain. Immediate therapeutic exercises against these complications soon after diagnosis of diabetes may help to decelerate their progression.

Prevalence of Non-Invasive Risk Factors of Type 2 Diabetes among Higher Education Teachers in North-Western Nigeria

Background: Teaching is associated with a number of stressful circumstances that promote unhealthy lifestyles capable of fuelling risk factors for metabolic and cardiovascular disorders. This study investigated the prevalence of selected non-invasive risk factors of Type 2 Diabetes (T2D) among higher education teachers. Methods: Higher education teachers numbering 876 from three tertiary institutions in Kano; North- Western Nigeria were assessed on selected non-invasive risk factors of T2D including Body Mass Index (BMI); Waist Circumference (WC); Waist-Hip-ratio (WHR); Percent Body Fat (PBF) and family history of diabetes. Lifestyle including smoking; alcoholism and physical inactivity were also assessed. Results: Female-male ratio of participants was 1:5 while the age range was 24-58 years. Female teachers had higher prevalence of poor adiposity markers represented by overweight (33.8); obesity (12.7); high PBF (21.7) and WC in the high risk domain (53.5). They also had higher prevalence of hypertension (22.5) while men had higher prevalence of WHR (31.2) in the high risk domain. Positive family history of diabetes was 6.5(males); 7.5(females); physical activity at walking level 46.0(males); sedentary activity 85.9(females); current smoking habit 42.8(males); 4.3(females) and current alcohol consumption was 11.9for males and 0for female teachers. Conclusion: There may be considerable chances of developing T2D among the higher education teachers based on prevalence of the selected risk factors and the risk may be higher among the female teachers. Measures to change the modifiable risk factors for the better in this population are urgently needed

Relationship between duration of diagnosis and neuromusculoskeletal complications of middle-aged type 2 diabetes patients

Abstract. BACKGROUND: Patients with Type 2 Diabetes (T2D) often present with complications involving the neuromusculoskeletal system which creep in as the condition advances in years. Hence there is a need to further understand how the duration of diagnosis of diabetes (DD) relates to the neuromusculoskeletal complications in order to design timely preventive programmes. OBJECTIVE: To investigate the relationship between the duration of diabetes and neuromusculoskeletal complications in type 2 diabetes. METHODS: This was a cross-sectional survey involving 139 consenting T2D patients and 139 age and sex-matched nondiabetic individuals. The participants were assessed for the DD and selected neuromusculoskeletal complications including muscle weakness, ranges of motion (ROM), pain and foot ulceration. RESULTS: The mean DD was 7.82 ± 2.41 years. There were significant differences (p < 0.01) between the clinical variables of both groups. In the diabetic participants, significant inverse relationships (P<0.05) were obtained between the DDD and each of muscle strength {elbow flexors (r = -0.57), knee extensors (r = -0.63), handgrip (r = ­0.82)}; ROM {wrist extension (r = -0.64) and ankle planterflexion (r = -0.63)}. Significant and direct relationships were obtained between the DDD and each of pain (r = 0.62) and ulcerative grading (r = 0.81). CONCLUSIONS: Type 2 Diabetes patients have poorer neuromusculoskeletal variables and longer duration of diabetes is associated with reduced muscle strength, diminished ROM, gradual ulceration of skin of the feet and higher level of foot pain. Immediate therapeutic exercises against these complications soon after diagnosis of diabetes may help to decelerate their progression

Type 2 segmental Darier's disease in a twelve-year-old Nigerian male--a case report.

Darier's disease is an autosomal dominant disorder characterized clinically by presence of keratotic papules in a seborrheic distribution, nail involvement and mucosal lesions. There are several clinical variants of Darier's disease, but few cases of segmental Darier's disease have been described in the literature. We describe a 12-year-old boy with type 2 mosaic phenotype. This unique clinical variant of Darier's disease has been described very rarely.

Rhinocerebral Mucormycosis in a Patient with Type 1 Diabetes Mellitus: Case Report

Background: Rhinocerebral mucormycosis is one of the severe forms of infections in persons with diabetes mellitus. Its occurrence is rare and is reported little in our environ- ment. We report a case of rhinocerebral mucormycosis in a patient with type 1 diabetes mellitus (DM) with the aim of drawing the attention of physicians to its existence in our nvironment and the need for aggressive management. Method: The case notes of a patient with type 1 DM presenting with features of rhinocerebral mucormycosis and the rele- vant literature of the subject was reviewed. Result: An eighteen-year old senior secondary school man with a one-year history of type 1 DM was admitted to the male medical ard of Aminu Kano Teaching Hospital (AKTH) with features of diabetic ketoacidosis (DKA); facial rashes involving the medial canthus of the right eye extending to the right para- nasal area and right nostril. The facial rashes which started initially as blisters later progressed to form ulcers with necroses. There was progressive deterioration in level of consciousness with a right hemiparesis. Magnetic resonance imaging (MRI) revealed multiple brain abscesses with dilatation and engorgement of the sphenoidal and maxillary sinuses. He was managed with broad-spectrum antibiotics; antifungals and wound debridement. He continued to deteriorate and died seven weeks later. Conlusion: Rhinocere- bral mucormycosis though rare; does occur especially in the setting of DM and requires an aggressive and a multidisciplinary approach to management

Dupuytren's contracture in a patient with type 2 diabetes mellitus--a case report.

BACKGROUND: Dupuytren's contracture is one of the manifestations of the hand syndrome in diabetes mellitus (DM). Its occurrence in diabetes mellitus is not commonly reported in this environment. This report aims to highlight the occurrence of Dupuytren's contracture as a rare manifestation of diabetic hand syndrome in a patient with type 2 DM. METHOD: The case note of a patient with type 2 DM who developed Dupuytren's contracture in both hands and the available literature on the subject were reviewed. RESULT: A 62-year-old Nigerian male Islamic Cleric with type 2 DM for sixteen years on follow-up at the Diabetes clinic of the Jos University Teaching Hospital (JUTH), Jos, developed flexion deformity involving both palms. His symptoms had progressed gradually over the preceding nine months before presentation. Physical examination revealed bilateral Dupuytren's contracture of the palms with hyperkeratosis and flexion deformities of the fingers. He was admitted to the surgical ward of JUTH and had surgery in the right hand. He is to have surgery in the left hand on a later date. CONCLUSION: Dupuytren's contracture is a rare presentation of diabetic hand syndrome. A careful hand examination by physicians in all DM patients for early diagnosis and treatment is recommended.