Cerebral atrophy and dementia in type 2 diabetes mellitus: report of two cases and review of literature.

A report of two cases of cerebral atrophy and dementia possibly arising as a result of poor control of type 2 Diabetes Mellitus are presented The two elderly patients presented to the old age Psychiatric clinic with history of impairment in memory and changes in personality. They had a history of long standing poorly controlled diabetes mellitus. They were assessed using psychometric instruments, laboratory investigation and neuro-imaging. A diagnosis of dementia was made in each of two the patients. The aim of this case report is to draw the attention of the medical community and policy makers to the relationship between type 2 diabetes mellitus and dementia with a view to evolving policy change on the care for the elderly in Nigeria.

Smoking prevention and cessation in the Africa and Middle East region: a consensus draft guideline for healthcare providers--executive summary.

Despite the abundance of scientific evidence confirming the health consequences of smoking and other forms of tobacco use, the tobacco epidemic remains an important public health problem and by 2030 it is predicted that more than 80% of tobacco deaths will be in developing countries. In Africa and the Middle East, many local factors contribute to the initiation and maintenance of tobacco use. Although efforts to reduce the mortality and morbidity associated with smoking and tobacco dependence are underway, there is a need for guidance on how to utilize appropriate tobacco control policies and psychology- and pharmacology-based therapies to counter tobacco dependence as recommended by the Framework Convention on Tobacco Control (FCTC). A group of tobacco cessation experts from public health services and/or academic institutions in Africa and the Middle East participated in a series of four meetings held in Cairo, Cape Town, and Dubai between May 2008 and February 2011 to develop a draft guideline tailored to their region. This article provides the background to the development of this draft smoking cessation guideline and discusses how the recommendations can be implemented and progress monitored to promote both primary prevention and cessation of tobacco use within our countries. The draft guideline for Africa and the Middle East provides an important resource in combating the devastating effects of tobacco use in these regions which can be further localized through engagement with local stakeholders in the countries of the region.

Leptin Concentrations in Non-Obese and Obese Non-Diabetes Nigerian-Africans.

BACKGROUND: Controversial findings exist on the role of leptin in obesity and its correlation with metabolic variables, with few data emanating from Nigerian-Africans. Plasma leptin was therefore determined in obese and non-obese. Its relationship with obesity indices and metabolic variables were further envisaged. MATERIALS AND METHODS: A cross-sectional comparative study on 87 randomly-selected non-diabetes Nigerians distributed into 3 groups (24 normal, 23 pre-obese and 40 obese). Obesity indices, fasting Insulin (FI) and homeostasis model assessment-insulin resistance (HOMA-IR) were determined. Plasma leptin was determined by sandwich enzyme-linked immunosorbent assay. Mann-Whitney U-test, Independent Kruskal-Wallis test, Spearman correlation and Step-wise Multivariate Logistic Regression analysis determined outcomes. RESULTS: Median+IQR leptin concentrations were higher in obese {61.8(40.8, 91.4) ng/mL, p<0.001} than pre-obese {42.7(28.0, 51.7) ng/mL, p=0.003} and normal {28.6(20.7, 39.8) ng/mL, p=0.03} BMI categories. Leptin was higher (p<0.001) in females than males {Median+IQR, 52.0 (35.0, 80.0) ng/mL versus 34.0(24, 65.0 ng/mL)}. Leptin was positively correlated with body fat percentage (BFP), r=0.57; waist circumference (WC), r=0.46 and body mass index (BMI), r=0.50, p<0.001, respectively in all subjects, with higher correlation coefficient in males than females. Leptin showed sex-specific correlations to age, FI and HOMA-IR. In the unadjusted models, central obesity/generalized obesity, WC, BMI, BFP, combined pre-obesity/obesity, younger age and female sex were significantly (p<0.001) associated with log-transformed leptin. WC (OR: 1.2, 95% CI, 1.05-1.38, p=0.009), BFP (OR: 1.41, 95% CI, 1.07-1.84, p=0.013) and BMI (OR: 1.6, 95% CI, 1.13-2.31, p=0.008) in men and all subjects, were independently associated with hyperleptinaemia following adjustments. CONCLUSION: Plasma leptin concentrations, fasting insulin and insulin resistance are higher in obese and pre-obese than normal controls, with females showing higher leptin concentrations than males. Leptin is independently related to BMI, BFP, WC, female sex and generalized/central obesity in Nigerian-Africans especially males. It showed sex-specific relations to age, fasting insulin and HOMA-IR.

Leptin concentrations in type 2 diabetes and non-diabetes Nigerian-Africans.

Most studies on leptin in diabetes mellitus (DM) compared to healthy controls were done in Caucasians, with conflicting findings. Paucity of data on this exists in Nigerian-Africans. Therefore, the study determined plasma leptin concentrations in newly diagnosed type-2 diabetes versus controls and its relation to obesity/demographic-metabolic indices. A cross-sectional comparative study on 154 subjects: 67 diabetes and 87 healthy controls at the Ahmadu Bello University Teaching Hospital, Nigeria. Leptin was determined by the sandwich enzyme-linked immunosorbent assay. Mann-Whitney U test, Spearman's Correlation and Step-wise Multiple Logistic Regression analysis of Log-transformed variables determined outcomes. Leptin trended towards lower levels in DM subjects than controls when both sexes were combined, though insignificant (P=0.12). Leptin was significantly (P<0.001) positively correlated with waist circumference (WC) and body mass index (BMI) in DM (WC, r=0.71; BMI, r=0.84) as well as controls (WC, r=0.46, BMI, r=0.51), respectively. Leptin was significantly (P<0.001) higher in females than males, with approximately 2 times Odds of female sex association with log-transformed (Ln10) hyperleptinaemia {Odds Ratio (OR): 1.9, 95% CI, 0.97-3.92, P<0.001}. Age was positively (r=0.21, P=0.05) correlated to leptin in controls, while fasting blood glucose (FBG) negatively correlated to uncontrolled DM (r=-0.26). Leptin showed no significant (P>0.05) correlation to fasting insulin (FI) and HOMA-IR. WC was an independent predictor of Ln10hyperleptinaemia in DM subjects (OR: 1.12, 95% CI, 1.03-1.23, P=0.01). BMI showed significant (P<0.001) association with Ln10hyperleptinaemia in both subjects. Conclusively, leptin trends towards lower levels but are not different in newly diagnosed DM than controls. The association of leptin with obesity is similar but stronger in diabetes than controls, with no relations to FI and HOMA-IR. WC and BMI are independent predictors of hyperleptinaemia.

Cardiovascular risk factors in adult general out-patient clinics in Nigeria: a country analysis of the Africa and Middle East Cardiovascular Epidemiological (ACE) study.

BACKGROUND: With globalization and rapid urbanization, demographic and epidemiologic transitions have become important determinants for the emergence of cardiovascular disease (CVD). OBJECTIVE: To estimate the prevalence of CVD risk factors in adult out-patients attending general practice and non-specialist clinics in urban and rural Nigeria. METHODS: As part of the Africa and Middle East Cardiovascular Epidemiological (ACE) study, a cross-sectional epidemiologic study was undertaken for the presence of hypertension, diabetes mellitus, dyslipidemia, obesity, smoking and abdominal obesity in Nigeria. RESULTS: In total, 303 subjects from 8 out-patient general practice clinics were studied, 184 (60.7%) were female and 119 (39.3%) were male. Mean age was 42.7±13.1 years; 51.8% were aged <45 years; 4% ≥65 years. Over 90% of subjects had ≥1 of 6 selected modifiable cardiovascular risk factors: 138 (45.6%) had 1-2; 65 (21.5%) had 3; 60 (19.8%) had 4; and 11 (3.6%) had 5 concurrent risk factors. Screening identified 206 subjects (68.0%) with dyslipidemia who did not have a prior diagnosis. CONCLUSION: Cardiovascular risk factors are highly prevalent in Nigerian subjects attending out-patient clinics. Moreover, many subjects were undiagnosed and therefore unaware of their cardiovascular risk status. Opportunistic screening alongside intensive national, multisectoral education or risk factor education is needed, should be scaled up nationwide and rolled out in both urban and rural communities in Nigeria.

Left ventricular function in type 2 diabetes patients without cardiac symptoms in Zaria, Nigeria.

Fifty type 2 diabetes patients (25 of them being hypertensive) who had no cardiac symptoms had their left ventricular function assessed. There were 24 female and 26 male diabetes patients evaluated, along with a control group of 50 healthy subjects. The patients and controls underwent full clinical evaluation, which included physical examination, blood biochemistry (urea and electrolyte; creatinine, creatinine clearance; fasting blood and two-hour postprandial glucose levels, lipid profile), electrocardiograph, chest radiograph, and echocardiograph. The hypertensive diabetes patients had higher cholesterol levels, and 50% had levels >5.0 mmol/L. Sixteen patients had cataracts, 14 had background retinopathy, 12 had peripheral neuropathy, and 7 had peripheral vascular disease. The subjects had significantly lower ejection fraction than controls, and fractional shortening showed a similar pattern. Eight patients had ejection fraction <50% compared to none of the controls. Sixty-six percent of the subjects and 30% of the controls had diastolic dysfunction (reverse E/A ratio, prolonged deceleration time, and lower deceleration rate), respectively, but the diabetes patients did not show any difference. Diastolic dysfunction correlated significantly with age, fasting blood glucose, and two-hour postprandial glucose. The subjects had higher left ventricular mass (LVM) than controls. The LVM correlated significantly positively with diastolic blood pressure, systolic blood pressure, and pulse pressure. Subclinical diabetic cardiomyopathy exists in our patients; in addition, other risk factors for cardiomyopathy and coronary artery disease exist, including hypertension, hypercholesterolemia, and obesity.

Clinical presentation and outcome of toxoplasma encephalitis in HIV-infected patients from Zaria, Northern Nigeria: a case series of 9 patients.

Toxoplasma encephalitis (TE) is the most common cause of focal deficits in patients living with HIV/AIDS. Among 257 HIV-infected adult patients seen between January 2006 and December 2010 in a tertiary hospital in Zaria, northern Nigeria, 9 (3.5%) patients had clinical, serological, and brain imaging evidence of TE. All 9 patients had CD4 count of less than 50 cells/mm(3). Of the 9 patients, 7 were antiretroviral therapy (ART)-naive, while 2 were cases of ART-induced TE-immune reconstitution inflammatory syndrome. After administering intravenous dexamethasone for cerebral decompression and specific antitoxoplasma therapy, symptoms and signs resolved in 8 patients within 4 to 14 days, but 1 patient died. Our data suggest that even in the ART era in Nigeria, TE remains a fairly common cause of morbidity among HIV-infected patients due to late HIV diagnosis and significant immunosuppression at diagnosis. Early HIV diagnosis, early initiation of highly active ART, and routine prophylaxis against TE are imperative in combating the challenge of HIV/AIDS-related TE in Nigeria.

Seroprevalence of IgM and IgG antibodies to Toxoplasma infection in healthy and HIV-positive adults from Northern Nigeria.

INTRODUCTION: We examined the seroprevalence of toxoplasma infection in HIV-negative and -positive adults from Zaria, Northern Nigeria, and assessed its relationship with demographic, clinical, and immunological findings. METHODOLOGY: In a six-month cross-sectional study undertaken in 2008, sera of 219 adults, including 111 consecutive HIV-infected adults and 108 healthy HIV-negative adult volunteers from Zaria, Northern Nigeria, were examined for IgG and IgM antibodies to toxoplasma by ELISA. Clinical characteristics of the HIV-infected patients were documented. Differences in toxoplasma seropositivity between HIV-positive and negative adults were sought. The relationship between toxoplasma seropositivity and variables such as age, sex and antiretroviral (ART) status, as well as HIV clinical staging and CD4 cell counts were also determined. P < 0.05 was considered significant. RESULTS: The seroprevalence of toxoplasma infection (IgG positive and or IgM positive) was 32.4% in HIV-negative healthy adults and 38.7% in HIV-infected adults (P > 0.05). The rate of IgM seropositivity was 4.6% in healthy adults and 1.8% in HIV-infected patients, while the rate of IgG seropositivity (without IgM seropositivity) was 28.7% in healthy adults and 37.8% in HIV-infected patients (p > 0.05). Toxoplasma seropositivity was not associated with age, sex, ART status, CD4 cell count or HIV clinical staging. Seventy-four percent of the toxoplasma seropositive HIV-infected patients were asymptomatic and no cases of toxoplasma encephalitis were identified. CONCLUSION: Toxoplasmosis is equally prevalent in HIV-infected patients and healthy adults from similar environments in Northern Nigeria. It is imperative to develop public health policies to prevent toxoplasmosis in Nigeria, especially in HIV-infected patients.

Human Herpesvirus 8 Infections and AIDS-Associated Kaposi Sarcoma in Zaria, Northern Nigeria.

BACKGROUND/OBJECTIVES: Studies on human herpesvirus 8 (HHV8) infection in patients with AIDS-associated Kaposi sarcoma (AIDS-KS), from Nigeria are lacking. We examined the seroprevalence of HHV8 infection in patients with AIDS-KS presenting to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria, and also described their clinical presentation. METHODS: A total of 20 (11 males and 9 females) histologically confirmed adults with AIDS-KS were recruited consecutively in 2007. The clinical types of lesions, associated diseases, and the AIDS clinical trial group staging of AIDS-KS were noted. Anti-lytic HHV8 antibodies were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: Kaposi sarcoma skin lesions were diverse but mostly nodules (19 cases) and papules (16). Majority (18 cases) had poor risk AIDS-KS, with 10 (50%) patients having concomitant opportunistic infections and 3 (15%) patients having generalized skin lesions. Females had a more severe disease. Seventeen patients (85%) were HHV8-seropositive. CONCLUSION: AIDS-KS is associated with high HHV8 infection and presents with a variety of skin manifestations that are often aggressive, advanced, and worse in females.

Pattern of serum cytokine expression and T-cell subsets in sickle cell disease patients in vaso-occlusive crisis.

The pathogenesis of sickle vaso-occlusive crisis (VOC) in sickle cell disease (SCD) patients involves the accumulation of rigid sickle cells and the stimulation of an ongoing inflammatory response, as well as the stress of infections. The immune response, via cytokine imbalances and deregulated T-cell subsets, also has been proposed to contribute to the development of VOC. In this study, a panel of high-sensitivity cytokine kits was used to investigate cytokines in the sera of SCD patients in VOC. The results were compared primarily with those for stable SCD patients and secondarily with those for normal healthy people who served as controls. The cytokines studied included interleukin-2 (IL-2), IL-4, and IL-10. Lymphocyte subsets of patients with VOC were also studied and were compared with those of both control groups (20 stable patients without crisis [SCD group] and 20 normal healthy controls [NHC]). The VOC group was notable for remarkably elevated levels of IL-4, among the three cytokines tested, compared with those for the SCD and NHC groups. Patients with VOC also differed from stable SCD patients and NHC by having notably lower IL-10 levels, as well as the lowest ratio of CD4(+) to CD8(+) T cells (0.7). The patterns of the proinflammatory cytokine IL-2 did not differ between VOC and stable SCD patients, but NHC had significantly lower IL-2 levels than both the VOC and SCD groups. Our results demonstrate coexisting levels, both high and low, of TH1- and TH2-type cytokines, as well as diminished levels of T-cell subsets in VOC. These results are discussed in an effort to better understand the importance of the immune system profile in the pathogenesis of sickle cell VOC. Since the possibility that a cytokine imbalance is implicated in the pathogenesis of sickle cell crisis has been raised, our results should prompt further investigation of the host immune response in terms of TH1 and TH2 balance in sickle cell crisis.

Genital tuberculosis presenting as pyrexia of undetermined origin.

A case of Genital tuberculosis in a female patient is presented. The key presenting features in this lady were chronic weight loss, colicky lower abdominal pains, fever, and amenorrhea. The fact that tuberculosis is still very much around and could present in unpredictable ways is emphasised.