Prevalence and risk factors of hypocalcemia among pregnant and non-pregnant women in Maiduguri, Nigeria: A cross-sectional study.

BACKGROUND: Pregnancy is a period of heightened calcium demand necessary for the optimum growth and development of the fetus and placenta. Women with low calcium intake may manifest with hypocalcemia in pregnancy. OBJECTIVE: The aim of this study was to determine the prevalence and risk factors of hypocalcemia among pregnant and non-pregnant women in Maiduguri, Nigeria. SUBJECTS AND METHODS: A comparative cross-sectional study was conducted at the University of Maiduguri Teaching Hospital, Maiduguri from 1st January 2017 to 31st December 2018. For each patient, sociodemographic and clinical characteristics were noted. Serum calcium, phosphate, total protein, and albumin were determined using spectrophometric methods with their specific reagents. The data obtained was analyzed using the SPSS statistical software for windows version 20. Chi-square test, Student t-test and ANOVA were used as appropriate. Odd ratio with multiple logistic regression was used to determine risk factors for hypocalcemia. P value < 0.05 was considered statistically significant. RESULTS: A total of 1,500 (1,000 pregnant and 500 non-pregnant) women were analyzed. The mean age, total protein, and albumin were similar in the pregnant and non-pregnant women. However, the non-pregnant women were of higher parity than the pregnant women (3.75 ± 2.79 versus 2.45 ± 2.24, P < 0.001). The staple food of both group were mainly high carbohydrate diets. The prevalence of hypocalcemia was 29.20% among the pregnant women and 14.20% among the non-pregnant women (X2 = 64.34, P < 0.001). The mean serum calcium was lower among the pregnant compared to the non-pregnant women (2.08 ± 0.22 mmol/L versus 2.2 ± 0.19 mmol/L, F = 5.73, P = 0.02). There were no statistically significant differences in the mean serum calcium across the trimesters of pregnancy (F = 1.58, P = 0.21). CONCLUSION: Hypocalcemia in pregnancy is common in our environment and it is associated with anemia in pregnancy, anorexia, and primigravidity while attainment of at least basic education is protective. We recommend routine calcium supplementation in pregnancy and preconception period.

Correlation between serum calcium levels and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy in primary hyperparathyroidism.

AIM: The goal of the study is to correlate serum calcium levels with the results of dual-phase (99m)Tc-sestamibi parathyroid scintigraphy to find the best cut-off level of the serum calcium that correlates with a positive presurgery. METHODS: In 111 patients, serum calcium and plasma parathormone (PTH) levels were compared with the results of the (99m)Tc-MIBI scintigraphy and with this data determined the level of calcium above which the (99m)Tc-MIBI scintigraphy was likely to be positive and below which the study was likely to be negative. RESULTS: In total, 11 men (18%) and 50 women (82%) had a positive (99m)Tc-MIBI study. Overall 67% of those patients with a positive (99m)Tc-MIBI study had a PTH >200 ng l(-1) compared to only 9% of those with a negative (99m)Tc-MIBI scintigraphy; however, for those with a positive study on an early (99m)Tc-MIBI scintigraphy, this rose to 85%. Overall a serum calcium of >2·70 mmol l(-1) was found in 82% of patients with a positive (99m)Tc-MIBI study but only 14% of those with a negative (99m)Tc-MIBI study, this is rose to 97% of patients with a parathyroid adenoma identified on early images. It is also shown that patients whose serum total calcium <2·51 mmol l(-1) rarely have positive (99m)Tc-MIBI scintigraphy. CONCLUSION: (99m)Tc-MIBI parathyroid scintigraphy is most likely to yield identification and localization of a parathyroid adenoma when both PTH and calcium are elevated; however, although there is no lower limit of PTH which can predict a negative study, we cannot recommend (99m)Tc-MIBI parathyroid scintigraphy if the serum calcium is <2·51 mmol l(-1).

The use of plasma lipid and lipoprotein ratios in interpreting the hyperlipidaemia of pregnancy.

The aim of this study was to determine the lipid and lipoproteins ratio in pregnant mothers and to evaluate their role in the interpretation of hyperlipidaemias. A total of 222 pregnant women who registered for ANC and 222 non-pregnant healthy women of the sameage and parity as control were recruited for the study. A sample of venous blood after an overnight fast was collected for analysis and interpretation. The mean ± SD age (years) of pregnant women, 27.317 ± 7.283 years and that of the non-pregnant women, 26.234 ± 6.234 years are not significantly different, p = 0.429. Total cholesterol, HDL-c and TGs were significantly higher in pregnant women (5.29 ± 1.04 mmol/l, 1.64 ± 0.42 mmol/l and 1.74 ± 0.42 mmol/l) compared with that of non-pregnant women (4.64 ± 0.92 mmol/l, 1.25 ± 0.35 mmol/l and 1.37 ± 0.45 mmol/l, respectively) All showed p < 0.000. The frequencies of hypercholesterolaemia, 96(43.2%) and hypertriglyceridaemia, 82 (36.9%), are significantly higher in the pregnant women than in the non-pregnant women, 58 (26.1%) and 26 (11.7%), respectively. TC/HDL-C ratio, 3.33 ± 1.01 and LDL/HDL-C ratio, 1.91 ± 0.85 are significantly lower in pregnant women compared with non-pregnant women counterparts, 3.89 ± 0.97 and 2.35 ± 0.84, respectively. Similarly the frequencies of increased TC/HDL-C ratio, 22 (9.9%) and LDL/HDL-C ratio, 16 (7.2%) are significantly less in the pregnant compared with the non-pregnant women, 54 (24.3%) and 28 (12.6%), respectively.

Lipid profile in pre-dialysis chronic kidney disease patients attending University of Maiduguri Teaching Hospital, Maiduguri-Nigeria.

BACKGROUND/OBJECTIVES: Cardiovascular disease is a major cause of morbidity and mortality among patients with chronic kidney disease, and accounts for 50% of all deaths in them. Dyslipidaemia does not only accelerate atherosclerosis in these patients but also progresses the renal disease. This study therefore set to investigate the pattern of lipid profile in pre-dialysis chronic kidney disease patients. METHODS: This was case control study of 63 pre-dialysis chronic kidney disease patients attending University of Maiduguri teaching Hospital and 60 control subjects. All factors that may lead to dyslipidaemia were excluded in all subjects except hypertension. Lipid profiles were measured by standard methods. Data were analyzed using a statistical software SPSS version 11.0. Their observed differences in mean-SEM values were analyzed for statistical significance using Student's t-test andp-value <0.05 was considered significant. RESULTS: the mean+SEM of total cholesterol 4.50+0.14 mmol/L and triglycerides 2.18+0.10 mmol/L in patients were significantly higher than that of the controls 3.79+0.11 mmol/L and 1.19+0.06 mmol/L respectively, p<0.05. Similarly the mean+SEM of LDL 2.62+0.16 mmol/L and LDL/HDL ratio 3.53+0.12 in patients were significantly higher when compared to that of the controls 2.04+0.16 mmol/L and 2.04+0.08 respectively, p<0.05. However, although the mean+SEM HDL in patient 1.07+0.07 mmol/L, was lower than that of the controls 1.21+0.06 mmol/L, the difference was not statistically significant, p>0.05. The pattern of lipid profile did not change with severity of disease and dyslipidaemia in patients were more in triglycerides, 68.3% and HDL, 63.5% than in TC, 22.2% and LDL, 17.5%. CONCLUSION: Dyslipidaemia is common in pre-dialysis chronic kidney disease patients. It is pertinent to investigate and treat dyslipidaemia early in the course of the disease as it may prevent further progression of the renal damage.

The usefulness of total cholesterol and high density lipoprotein--cholesterol ratio in interpreting lipid profile results of diabetes mellitus patients.

OBJECTIVE: To determine the usefulness of total cholesterol/high-density lipoprotein cholesterol and/or high-density lipoprotein cholesterol/total cholesterol ratios in the interpretation of lipid profile result in clinical practice. METHODS: This is a prospective case-control study involving 109 diabetics, 98 diabetic hypertensives, 102 hypertensives and 120 control subjects. Serum lipid profile and plasma glucose were determined using appropriate methods. RESULTS: The mean ages of the different study groups were similar. Body mass indices of diabetics with or without hypertension were significantly higher than that of the controls. The difference in the mean total cholesterol of each group was not statistically significant when compared with the controls. A significant difference existed in the mean LDL when the different study groups were compared with the controls. There was a significant difference in the mean TG of DM and DM/hypertension patients compared with that of controls. However, the mean TG of hypertensive patients was not statistically different with that of the controls. The mean HDL was lower in each group of patients compared to that of the controls however the difference was not statistically significant. The mean TC/HDL ratios were significantly higher in all groups of patients when compared to that of the controls while HDL/TC ratios were significantly lower in all categories of patients when compared to that of the controls. CONCLUSION: The ratios identified more dyslipidaemia than either of the lipid profile components. Therefore, the use of TC/HDL and or HDL/ TC ratios should be encouraged in screening for dyslipidaemia in diabetic patients with or without hypertension in clinical practice.

Role of a diagnostic laboratory in the management of diabetes mellitus.

OBJECTIVE: To elucidate the role of a modern diagnostic laboratory in the management of diabetes mellitus. SOURCES OF DATA: Available literature on local and international studies on the role of the laboratory in the management of diabetes mellitus. RESULTS: Preclinical diagnosis of diabetes mellitus, good monitoring of short, medium and long-term glycaemic control necessary to avoid diabetic complications in poor resource settings are now possible with modern diagnostic laboratories. CONCLUSION: Creating the required awareness on the roles of a diagnostic laboratory in the management of diabetes mellitus is needed now more than ever before in resource poor nations otherwise the success achieved by the developed world where diabetic patients become insulin independent after islet cell transplant with glucocorticoid free immunosuppression cannot be attained in the near future.

Effect of increased patient-physician contact time and health education in achieving diabetes mellitus management objectives in a resource-poor environment.

INTRODUCTION: Diabetes mellitus remains a significant universal health problem. Globally, the prevalence of diabetes mellitus is projected to grow from 135 million in 1995 to 300 million in 2025. Due to inadequate healthcare facilities and providers, poverty, and illiteracy coupled with increasing prevalence of diabetes mellitus, there is limited patient-physician contact time. As a result, patients with diabetes mellitus develop complications and die early in life due to poor management. This has grave economic implications as diabetes mellitus principally affects people in their most productive years of life. A cross-sectional and longitudinal study on patients with type 2 diabetes mellitus was carried out to demonstrate how diabetic management objectives can be achieved in a resource-poor environment by increasing patient-physician contact time and with health education. METHODS: One group of 105 consecutive patients with type 2 diabetes mellitus were recruited and managed in the metabolic research unit (MRU), where health education was emphasised for five years, served as the intensively-treated cohort (ITC). Another group of 115 patients with type 2 diabetes mellitus were also recruited and managed over the same five-year period in the medical outpatient department (MOPD) of the same hospital, where there was patient congestion at the clinic, served as the control cohort (CC). The CC also reported to the MRU during their follow-up for measurement of their blood pressure and urinalysis. Other measurements for the CC were obtained from the MOPD on the same day of their visit to the MRU. Morbidities were recorded on recruitment, at each visit, and at the end of the study in each cohort. RESULTS: There was a marked reduction of morbidity at the end of the study in the ITC (222 versus 106, p-value is 0.0013), compared to the CC (138 versus 130, p-value is greater than 0.05). There was also a significant reduction in the number of patients with individual morbidities in the ITC, while significant reduction was only noticed in hypertension, eye problems, neuropathies, infections/boils, and ulcer/blisters in the CC. In 85 percent of the ITC, plasma glucose clustered around the target of the study as compared to only 58 percent of the CC. CONCLUSION: Diabetes mellitus management objectives can be achieved by increasing both patient-physician contact time and health education in addition to other conventional forms of treatment, especially in a resource-poor environment.

Pattern of biochemistry laboratory requests and results in north eastern Nigeria.

OBJECTIVES: Deficient action of insulin is associated with derangement of carbohydrate, fat and protein metabolism. Determination of the extent of such derangement in steady state type 2 diabetic patients enhances management planning and prevents diabetic complications. This is necessary in a poor resource setting where functional national health insurance scheme is not available. The study aimed at assessing the level of plasma glucose and lipids, renal function, total calcium, inorganic phosphates and albumin and their relevance in steady state type 2 diabetic patients in north-eastern Nigeria in order to minimize the cost of laboratory investigations while preventing diabetic complications. METHOD: Two hundred and eighteen steady state type 2-diabetic patients were recruited at the Chemical pathology laboratory of the University of Maiduguri Teaching Hospital over a period of one year. Tests requested by the Clinicians for steady state diabetics were collated, the pattern of biochemistry laboratory requests and results were determined. The mean and standard deviation of the results were calculated. RESULTS: Out of the 218 steady state diabetics, only 48 (22.2 % ) had good short-term glycaemic control (fasting blood glucose < 7mmol/l). No test for long-term glycaemic control was requested during the study period. Lipid profile and protein assessment were carried out in 30% and 52.3 % of the patients respectively. Biochemical tests were not optimally utilised and this resulted in poor glycaemic control. CONCLUSION: Proper utilisation of laboratory tests for adequate long-term glycaemic control through team work approach with laboratory physicians are recommended.

Point of care testing: a delight or a dilemma in the developing world?: an overview.

OBJECTIVES: This is to highlight the use of POCT especially by the untrained laboratorians, and its disadvantages and advantages. PATIENTS AND METHODS: The results of urinalysis carried out in Antenatal Clinic and Central Chemical Pathology laboratory for a two-year period were analysed to determine how the results were interpreted, whether there were further request(s) and how relevant they were. The results of 56 out of 303 oral glucose tolerance tests carried out because of positive glucose in urine (glycosuria) were reviewed. Similarly the results of 176 pregnant women who had proteinuria on urinalysis in Antenatal Clinic and 92 patients who had positive bilirubin-diglucuronide in their urine (bilirubinuria) were also reviewed. RESULTS: The result shows that only 18 out of the 56 patients who had OGTT based on positive glucose in their urine had glycosuria on fasting urine sample on the OGTT day. 4 of them had gestational diabetes mellitus, 2 were diabetic before conception 5 had impaired glucose tolerance, while 7 had renal glycosuria. Thirty-eight results were false positives with repeat urinalysis and OGTT. Also out of the 176 pregnant women who had proteinuria on urinalysis only 57(32.4%) were confirmed on repeat urinalysis and/or 24 hr urinary protein quantification, 51 became negative after successful treatment of their UTI, while 68(38.6%) were false positives. Similarly out of 92 patients who had bilirubinuria only 23 showed abnormalities suggestive of some degree of liver disease. CONCLUSION: Results obtained on POCT must be validated in the central laboratory.

Chemical composition of urinary calculi in Maiduguri, Nigeria.

Urolithiasis is a common disorder in Maiduguri and constitutes a significant proportion of surgical diseases in Nigerian Hospitals today. Although, the analysis of the stones is an integral part of the assessment of stone formers, earlier report in Maiduguri did not dwell well on it. We therefore, carry out this study to report on the composition of urinary tract calculi removed during surgery at the University of Maiduguri Teaching Hospital and to find out if stone composition in the area changes with time. Fourty-nine urinary tract calculi removed in the surgery unit of the Hospital in 2003 were chemically analyzed in the Department of Chemical Pathology of the same Hospital. We also retrieved results of stones analyzed in 1989 (41) and 1999 (21) and compared the results with the 49 analyzed in 2003. The results showed a male preponderance with male: female ratio 12:1, and the calculi occurred more in the upper part of the tract (70.9%) than the lower part of the tract (29.1%). Calcium containing stones constituted the majority; 76.9%, uric acid/urate was associated with 16.3% of the stones while struvite constitutes 4.3%, xanthine 1.7% and cystine 0.9%. There was subsequent reduction of struvite stones with time. Urinary tract stone is common in Maiduguri. There is need for identification of risk factors of calculi formation in the environment to enable the health care providers plan preventive measures in order to reduce the high incidence in the area.