Community based diabetes risk assessment in Ogun state, Nigeria (World Diabetes Foundation project 08-321).

OBJECTIVE: The study assessed the risk of developing type 2 diabetes Mellitus in Ogun State, Nigeria. MATERIALS AND METHODS: Finnish Medical Association diabetes risk score was administered across 25 communities facilitated by non-communicable disease clinics established under a World Diabetes Foundation project. Subjects in the high risk group had blood glucose estimated. RESULTS: 58,567 respondents included 34,990 (59.6%) females and 23,667 (40.3%) males. Majority (61.2%) were between 25 years and 54 years. Considering waist circumference, 34,990 (38.1%) females and 23,667 (5.3%) males had values above 88 cm and 102 cm respectively. Overall, 11,266 (19.2%) were obese and 28.9% overweight using body mass index (BMI). More females had elevated BMI than males. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of all subjects were 129.54 mm Hg ± 23.5 mm Hg and 76.21 mm Hg ± 15.5 mm Hg respectively. Prevalence of hypertension (Joint National Committee VII classification) was 27.7%. More subjects had normal DBP than SBP (68.2% vs. 42.5% P < 0.05). Mean fasting blood glucose (FBG) of all subjects was 5.5 mmol/L ± 0.67 mmol/L. Using a casual blood glucose >11.1 mmol/L and/or FBG >7 mmol/L, the total yield of subjects adjudged as having diabetes was 2,956 (5.05%). Mean total risk score was 5.60 ± 3.90; this was significantly higher in females (6.34 ± 4.16 vs. 4.24 ± 3.71, P < 0.05). A total of 2,956 (5.05%) had high risk of developing DM within 10 years. CONCLUSION: The risk of developing DM is high in the community studied with females having a higher risk score. There is urgent need to implement diabetes prevention strategies.

Common mental disorders among subjects with T2DM in Sagamu, Nigeria.

BACKGROUND: Psychological disorders are common in diabetes mellitus with associated increased adverse disease outcome, economic burden on patient and family and poor quality of life. Psychological well being among T2DM patients has been poorly evaluated in Nigeria. OBJECTIVE: The study set out to determine the prevalence and pattern of psychological disorders of Anxiety and Depression as well as evaluate the relationship between psychological well being and diabetes related factors in our diabetic population. MATERIALS AND METHODS: This was a prospective study carried out among T2DM patients attending the Endocrine Clinic of OOUTH between September and November 2009 using the GHQ-12 and HADS questionnaires, and patients' medical records. RESULTS: One hundred and two patients were evaluated (56 females, 46 males) with mean age of 60.4 +/- 9.2 years. Females generally scored significantly higher on the GHQ-12 (29.6 vs. 9.1 p < 0.05), HADS for anxiety (18.5 vs. 4.5 p < .05), as well as HADS for depression (25.9 vs. 4.5 p < 0.05). The commonest comorbidity of diabetes mellitus in the study was hypertension 56.9%, with 68.6% being overweight and obese (BMI > 25). Complications commonly observed were retinopathy (19.6%), neuropathy (15.7%), diabetic foot syndrome (11.8%), stroke (9.8%), erectile dysfunction and nephropathy (5.9%). The presence of these (except BMI) increased the prevalence and scores on all the parameters. CONCLUSION: The prevalence of psychopathologies of depression and anxiety was high in this study. The presence of complications and co-morbidities contributed positively to the high prevalence. It is recommended that early identification of these conditions and prompt referral for treatment is imperative for improved overall disease outcome.

Correlates of cardiac autonomic neuropathy in Nigerian patients with type 2 diabetes mellitus.

Cardiac Autonomic Neuropathy (CAN) contributes significantly to increased cardiovascular morbidity and mortality in type2 diabetic patients. This manuscript aims to study the prevalence of CAN in T2DM patients in our environment and identify factors that correlate with and predict development of CAN. This is with the intention to prevent and intervene in these factors. One hundred and eight (108) T2DM patients were screened and investigated by the standard six non-invasive tests including heart rate variability, QTc and Valsalva manouvre. Patients who had abnormality in more than 2 of the tests were adjudged to have CAN. They were statistically compared with those without CAN. Thirty- seven (34.2%) patients had CAN. The commonest abnormality was in heart rate response to standing (76.9%) There was no significant difference in the mean age and sex of those with CAN and those without. Though significantly more males had CAN, when sex was entered into the logistic regression it did not correlate with CAN. Poor short-term glycaemic control as demonstrated by fasting blood glucose (130.87 + 56.1 vs 94.24 + 48.9 mg%, p < 0.05); serum creatinine (1.23 + 0.52 vs 0.86 + 0.39 mg%, p<0.05), presence of hypertension and first degree family history were significantly more in patients with CAN. There was more than 2-fold increased risk of developing CAN when serum creatinine was greater than 1.5 mg% (OR 2.013, 95% CI 0.543-2.657) and when FBG was more than 120 mg% (OR 2.106, 95% CI 0.834-2.897). CAN is common in our patients with T2DM. It is more prevalent in those with hypertension, first degree family history and renal damage. Poor short-time glycaemic control was also a contributory factor.

Reiter's syndrome--a case report and review of literature.

The occurrence of Reiter's Syndrome is rare and not commonly reported in Nigeria. This paper reports a case of a 35 yr old male Nigerian with Reiter's Syndrome, occurring 1-2 weeks after a bout of a dysenteric illness. The patient presented with fever, conjunctivitis, dysentery, urethritis and arthralgia. The joint pains involved the left wrist (which was swollen), the right knee and ankle joints. The patient was managed conservatively. The case is presented with a view to documenting the occurrence of Reiter's Syndrome in an African Nigerian.

Cardiovascular risk factors in type 2 diabetic Nigerians with clinical diabetic nephropathy.

This study aimed to assess the distribution of cardiovascular risk factors among subjects with type 2 clinical diabetic nephropathy, since in diabetic subjects, the excess mortality in cardiovascular events is primarily related to nephropathy. The study group consisted of 162 subjects with type 2 diabetes mellitus and persistent proteinuria, and the control group was 80 type 2 diabetic subjects without nephropathy. In the study group there were 81 male and 81 female subjects whose mean age was 53.4 +/- 6.3 years. There was no significant consumption of alcohol and cigarette use in the population. The mean waist-hip ratio (WHR) was 0.97 and 0.96 in male and female subjects, respectively. The mean body mass index (BMI) of the subjects was 25.5 +/- 5.2 (males: 24.4 +/- 4.3, females: 27.2 +/- 5.5). A total of 106 subjects, made up of 45 male (27.8%) and 61 female (37.7%) subjects, were hypertensive as compared with 16 controls (20%). There was a significant difference in systolic blood pressure (p < 0.05) between the obese and non-obese subjects. One hundred and thirty three subjects (82.1%) had serum total cholesterol below 200 mg% as compared with 74 (92.5% ) in the control. Seventy-eight subjects (48.1%) had left ventricular hypertrophy. Males had a higher tendency of developing left ventricular hypertrophy (p = 0.04). Stroke and peripheral vascular disease respectively occurred more commonly in type 2 diabetes mellitus subjects with nephropathy [7 (4%) and 44 (27.2%)] compared to type 2 diabetic subjects without nephropathy [0 (0% ) and 9 (11.3% )] (p < 0.05). We found that there is a high prevalence of cardiovascular risk factors among Nigerian subjects with clinical diabetic nephropathy.

Erythrocyte membrane digoxin-sensitive (Na(+)-K+)-ATPase of non-insulin dependent diabetic humans.

Erythrocyte plasma membranes of non-insulin dependent diabetic humans (NIDDM) and healthy humans were prepared by hypotonic lysis. The specific activity of (Na(+)-K+)-ATPase of NIDDM membranes, both in the absence and presence of digoxin were lower than the specific activity of normal enzymes (83.6 percent and 74.0 percent of the normal enzyme respectively). Addition of digoxin decreased the activity of this enzyme (38.0 percent in NIDDM and 30.0 percent in normal enzyme). Although the affinity of the pump for ATP was similar in both membranes of NIDDM and normal humans (K(m) for ATP = 19.9 +/- 0.24 microM ATP and 20.0 +/- 0.21 microM ATP respectively), the Vmax of NIDDM membranes was more than 20 percent lower than that of the normal enzyme. The specific activity of Mg(2+)-dependent Ca(2+)-pumping ATPase (Ca(2+)-Mg(2+)-ATPase) of NIDDM membrane was lower than 80 percent of the specific activity of the normal enzymes. While the affinity of the pump for ATP was lower in the membranes of NIDDM (Km for ATP = 50.0 +/- 4.3 microM ATP) in comparison to normal membranes (Km for ATP = 63.1 +/- 38 microM ATP), the Vmax of NIDDM membranes was similar to the normal enzyme. Altogether, these findings suggest that both the (Na(+)-K+)-ATPase and Ca(2+)-pumping ATPase of NIDDM membranes are less functional than the enzymes in normal erythrocytes.

Soft tissue rheumatism among Nigerians.

Sixty-eight Nigerians were seen, investigated and treated for soft tissue rheumatism. Most of the subjects had capsulitis of the shoulder, commonly associated with Diabetes mellitus and Hypertension. Other diagnostic groups were however seen. The treatment modalities were basically intra articular steroids, analgesics and physiotherapy.

Galanin receptors in human basal forebrain differ from receptors in the hypothalamus: characterization using [125I]galanin (porcine) and [125I]galantide.

Galanin, a 29-amino acid peptide, is uniquely distributed in human basal forebrain and may play a role in cholinergic cell dysfunction in Alzheimer's disease. We report a detailed evaluation of galanin receptors in human basal forebrain (67 +/- 12 years) and hypothalamus (67 +/- 15 years) with radioligand binding techniques. The binding of [125I]galanin (porcine) (agonist) or [125I]galantide [GAL (1-3)-substance P (5-11)-NH2] (putative antagonist) saturated in 2 hr, and only 15% to 30% of either radioligand was removed in the presence of unlabeled peptide. [125I]Galanin or [125I]galantide binding in basal forebrain revealed similar Bmax values, with [125I]galanin having a higher affinity for the galanin receptor. In contrast, [125I]galanin showed a lower affinity and labeled 42% more receptors than [125I]galantide in the hypothalamus. Differences were noted in competition studies of galanin and galanin chimeric peptides (M15, M35, M40 and C7) between [125I]galanin and [125I]galantide binding and in both regions. M35, M40 and C7 showed high affinity for galanin receptors in the hypothalamus with Hill coefficients close to unity, whereas in the basal forebrain these peptides competed differently. 5'-Guanylylimidodiphosphate reduced the specific binding of either radioligand in both regions. Based on the derived data, both radioligands irreversibly bind with high affinity and act as agonists at galanin receptors in human basal forebrain and hypothalamus. Galanin and galanin chimeric peptides compete differently for galanin receptors depending on the radioligand and region tested, suggesting subtype differences.

Clinical, biochemical and morphologic features of acne keloidalis in a black population.

BACKGROUND: Acne keloidalis (AK) is an important cause of morbidity in Nigeria and accounts for 1.3% of patients with skin conditions in a Nigerian dermatology clinic. Treatment is usually unsatisfactory because the etiopathogenesis is unclear. METHODS: A prospective clinico-pathological study was carried out to identify predisposing factors, viable treatment modalities, and prognostic indicators. RESULTS: The study suggested that AK is associated with the male gender seborrheic constitution, early reproductive years, and increased fasting blood testosterone concentration. Features that may predispose to the vastly predominant occipital location of the lesions include increased mast cell density and dilatation of dermal capillaries. MANAGEMENT: The main aims are diagnosis of early papules and avoidance of physical and chemical traumatizing agents. Retinoic acid analogs and antiandrogens may be helpful. CONCLUSIONS: The widespread use of irritating physical and chemical traditional treatment remedies and delay in seeking medical attention--AK is typically asymptomatic--contribute to the relatively advanced nature of the disease at the time of presentation to the specialist.