Heavy metal content of rice meals sold in a Nigerian market population with a high prevalence of hypertension.

Context: Some market populations in Nigeria have been shown to have high prevalence of hypertension. Current evidence includes environmental pollutants such as heavy metals as risk factors for hypertension. Aim: To study the heavy metal content of rice meals sold in a market population with a high prevalence of hypertension. Settings and Design: This was a descriptive, cross-sectional study conducted in Ogbete market in Enugu, Southeast Nigeria. Subjects and Methods: Five different cooked rice meals were obtained from 25 locations of the market. The rice meals included jollof rice, white rice and tomato stew, fried rice, white rice and vegetable sauce, and white rice and palm oil stew (ofeakwu). Accompanying protein (meat, fish, and egg) and vegetable salad were excluded. Similar rice meals were homogenized and analyzed in triplicates using spectrophotometric methods for mercury, copper, cadmium, lead, and arsenic determination. Statistical Analysis Used: The mean concentrations of the heavy metals were compared using analysis of variance, and P < 0.05 was considered statistically significant. Results: Twenty-five rice dishes were evaluated, five of each kind. Arsenic content ranged from 503 to 550 mg/kg and was comparable across the five rice dishes (P = 0.148). Copper was significantly highest (16767 mg/kg) in the white rice and tomato stew dish (P < 0.001), while mercury was significantly highest (33 mg/kg) in white rice and ofeakwu (P < 0.001). Jollof rice had the highest cadmium content (23 mg/kg), which was statistically significant (P = 0.021). Lead was not found in any of the rice dishes. Conclusions: Risk factors such as heavy metals may play a role in the high prevalence of hypertension observed in market populations, and rice meals may be a major source of these heavy metals.

RésuméContexte: Il a été démontré que certaines populations du marché au Nigéria présentent une prévalence élevée d'hypertension. Les preuves actuelles incluent l'environnement des polluants tels que les métaux lourds comme facteurs de risque d'hypertension. Objectif: étudier la teneur en métaux lourds des farines de riz vendues dans une population de marché avec une prévalence élevée d'hypertension. Paramètres et conception: il s'agit d'une étude descriptive et transversale menée sur le marché d'Ogbete en Enugu, sud-est du Nigéria. Sujets et méthodes: Cinq plats de riz cuit différents ont été obtenus dans 25 emplacements du marché. Le riz les repas comprenaient du riz jollof, du riz blanc et du ragoût de tomates, du riz frit, du riz blanc et de la sauce aux légumes, et du riz blanc et du ragoût d'huile de palme (ofeakwu). Les protéines d'accompagnement (viande, poisson et œuf) et la salade de légumes ont été exclues. Des farines de riz similaires ont été homogénéisées et analysées triplicats utilisant des méthodes spectrophotométriques pour la détermination du mercure, du cuivre, du cadmium, du plomb et de l'arsenic. Analyse statistique utilisée: le les concentrations moyennes des métaux lourds ont été comparées à l'aide d'une analyse de variance, et P <0.05 a été considéré comme statistiquement significatif. Résultats: Vingt-cinq plats de riz ont été évalués, cinq de chaque type. La teneur en arsenic variait de 503 à 550 mg / kg et était comparable dans les cinq plats de riz (P = 0,148). Le cuivre était significativement plus élevé (16767 mg / kg) dans le plat de ragoût de riz blanc et de tomate (P <0.001), tandis que le mercure était significativement plus élevé (33 mg / kg) dans le riz blanc et l'ofeakwu (P <0.001). Le riz Jollof avait la plus forte teneur en cadmium (23 mg / kg), qui était statistiquement significatif (P = 0.021). Le plomb n'a été trouvé dans aucun des plats de riz. Conclusions: Des facteurs de risque tels que les métaux lourds peuvent jouent un rôle dans la prévalence élevée de l'hypertension observée dans les populations du marché, et les farines de riz peuvent être une source majeure de ces métaux lourds.

Metformin: A Possible Option in Cancer Chemotherapy.

Metformin has been used for a long time as an antidiabetic medication for type 2 diabetes. It is used either as a monotherapy or in combination with other antidiabetic medications. The drug came into prominence in diabetes and other conditions with cardiovascular risk after the landmark study of 1995 by the United Kingdom Prospective Diabetes Study which emphasized its importance. However, the drug has been used in experimental trials in various aspects of medicine and pharmacology such as in reproductive medicine, cancer chemotherapy, metabolic diseases, and neurodegenerative diseases. It has been in use in the treatment of polycystic ovarian disease and obesity and is being considered in type 1 diabetes. This study seeks to evaluate the relevance of metformin in cancer management. Different mechanisms have been proposed for its antitumor action which involves the following: (a) the activation of adenosine monophosphate kinase, (b) modulation of adenosine A1 receptor (ADORA), (c) reduction in insulin/insulin growth factors, and (d) the role of metformin in the inhibition of endogenous reactive oxygen species (ROS); and its resultant damage to deoxyribonucleic acid (DNA) molecule is another paramount antitumor mechanism.

Self Monitoring of Blood Glucose Among Patients with Type 2 Diabetes Mellitus in Eastern Nigeria: Need for Multi-strategic Interventions.

BACKGROUND: Self Monitoring of Blood Glucose (SMBG) is a useful adjunct to lifestyle modification and medications for optimal management of type 2 Diabetes Mellitus (DM). This study was aimed at evaluating the practice, cost and associations of SMBG in subjects with type 2 DM in Enugu, Nigeria. METHODS: In a cross-sectional survey conducted at the diabetes clinic in three hospitals, 366 type 2 diabetic subjects aged 18-65 years were consecutively interviewed. Socio-demographic and clinical information were documented and glycated hemoglobin was performed for all the participants. RESULTS: A total of 318 subjects with mean age of 49.0 ± 9.4 years completed the study. 304 subjects (95.6%) reported that they were aware of SMBG and 60.7% practiced SMBG at frequencies ranging from ≥ 1/day (7.9%), ≥ 1/week (26.1%) or < 1/week (26.7%). 39.3% of the respondents did not perform any SMBG. Lack of finance was the predominant reason for not performing any SMBG. The median monthly cost of performing SMBG excluding the cost of meters was N2,000 (USD 6.7) per patient, amounting to annual societal cost of N37.8 billion (USD 126 million). Significant associates of performing any SMBG were longer DM duration, previous participation in diabetes education, insulin treatment and infrequent hospitalization. CONCLUSION: Despite high awareness, SMBG practice is grossly inadequate and is associated with a huge economic burden that may be unsustainable in a resource-poor country like Nigeria. Measures aimed at reducing the cost of glucometers and strips, and improving diabetes education are recommended.

Predictors of in-hospital mortality and length of stay in community-acquired pneumonia: a 5-year multi-centre case control study of adults in a developing country.

BACKGROUND: We investigated predictors of in-hospital mortality and length of hospital stay among adults with community-acquired pneumonia (CAP) in Nigeria in order to provide recommendations to improve CAP outcomes in developing countries. METHODS: This was a multi-centre case control study of patients ≥18 years who were admitted with CAP between 2008 and 2012. Case notes of 100 consecutive patients who died (cases) and random sample of 300 patients discharged (controls) were selected. RESULTS: Mean ages were 55.4±19.6 (cases) and 49.3±19.2 (controls). Independent predictors of mortality were CURB-65 score ≥3: adjusted odds ratio (aOR) 24.3, late presentation: aOR 8.6, co-morbidity: aOR 3.9, delayed first dose antibiotics (>4 hours): aOR 3.5, need for supplemental oxygen: aOR 4.9, multilobar pneumonia: aOR 4.0, non-pneumococcal aetiology: aOR 6.5, anaemia: aOR 3.8 and hyperglycemia: aOR 8.6. CURB-65 ≥3 predicted mortality with a high specificity (96.1%) but low sensitivity (75%); positive predictive value of 88.2% and negative predictive value of 90.8%. Care in hospital A and B: aOR 3.3 and 2.2 respectively, male gender aOR 2.1, co-morbidity aOR 3.0, anaemia aOR 2.1 and elevated serum creatinine aOR 6.3 independently predicted length of hospital stay >10 days among survivors. CONCLUSIONS: Several modifiable patient-related and process-of-care factors predicted in-hospital mortality, and length of hospital stay among survivors. Our findings should be used to improve CAP outcomes in developing countries.

Atherogenic index of plasma in highly active antiretroviral therapy-naïve patients with human immunodeficiency virus infection in Southeast Nigeria.

INTRODUCTION: Metabolic abnormalities are often common among human immunodeficiency virus (HIV) patients. The atherogenic index of plasma (AIP) is increasingly being used as a screening tool for dyslipidemia as it predicts the presence of small, dense, and highly atherogenic low density lipoprotein (LDL) and high density lipoprotein (HDL) particles. The aim of this study was to identify the pattern and predictors of an abnormal atherogenic index in highly active antiretroviral therapy (HAART)-naïve HIV patients. MATERIALS AND METHODS: HAART-naïve patients with HIV infection were recruited for this cross-sectional study. Anthropometric indices, blood pressure, CD4 count, viral load, fasting blood glucose, and lipid profiles were determined. Total cholesterol (TCH)/HDL, triglyceride (TG)/HDL, and LDL/HDL ratios were calculated. The AIP was calculated as log (TG/HDL). The correlations between AIP and the other lipoprotein ratios and predictors of AIP were determined using stepwise multiple linear regression. P < 0.05 was considered as significant. RESULTS: A total of 353 patients with a mean age of 37.3 (9.6) years were recruited for this study. Low HDL level was the most common abnormality in 222 (62.9%) patients while elevated TCH was seen in 54 (15.3%) patients. Those with medium risk (AIP 0.1-0.24) and high risk category (AIP > 0.24) constituted up to 226 (64%) of the patients. There were significant correlations between AIP and CD4 count, body mass index, LDL, TCH/HDL, and LDL/HDL. Predictors of AIP were CD4 count, TCH/HDL, and LDL/HDL. CONCLUSION: Abnormal AIP is frequent in HAART-naïve HIV patients and is inversely related to their level of immunity. We recommend that AIP estimation should be part of baseline assessment of HIV patients before the commencement of therapy.

Profile of HIV-infected patients receiving second-line antiretroviral therapy in a resource-limited setting in Nigeria.

BACKGROUND: Second-line antiretroviral therapy (ART) accounts for less than 5% of total ART in resource-limited settings. We described the baseline characteristics, reasons for switch and treatment outcomes of Nigerian patients receiving second-line ART. METHODS: In this retrospective cohort study we recorded the baseline characteristics of HIV-infected adults whose treatment regimen was switched from a non-nucleoside reverse transcriptase inhibitor, a first-line agent, to a protease inhibitor-based second-line regimen. The duration of follow-up was 12 months. RESULTS: Of 4229 patients who started first-line therapy, 186 (4.4%) were switched to second-line therapy after a mean duration of 16.6 ± 7.6 months. Their mean age was 41.8 ± 9.6 years and 59.1% were women. The median (range) viral load and CD4 cell counts at switch were 4.7 (4.1-6.3) log10 copies/ml and 71 (6-610) cells/µl, respectively. The predominant reason for switch was virological failure (79.0%). Only 55.4% and 36.6% of patients had CD4 cell count and viral load at 12 months. About 82%, 79% and 82% of patients with available data achieved virological suppression at 3 months, 6 months and 12 months respectively (p = 0.81). The proportion of patients who achieved ≥50% rise in CD4 cell count increased from 55.8% at 3 months to 78.6% at 12 months (p = 0.0002). CONCLUSION: The rate of switch to second-line therapy was low but there were good treatment outcomes among patients with available data. Attrition rate was high. Regular viral load monitoring, improved availability/affordability of second-line regimens and retention in care should become priorities in resource-limited settings.

Prevalence and predictors of impaired fasting glucose among Nigerian patients with hepatitis B virus infection.

AIM: Previous studies on the relationship between hepatitis B virus (HBV) infection and type 2 diabetes mellitus (DM) are conflicting. We aimed to elucidate the relationship by investigating the prevalence and predictors of impaired fasting glucose (IFG) in HBV-infected patients. METHODS: A total of 204 consecutive patients with hepatitis B surface antigen (HBsAg) seropositivity for ≥ 6 months were recruited in a cross-sectional study. Patients with DM were excluded. Information regarding age, gender, ethnicity, residence, family history of DM, alcohol use, and cigarette smoking were obtained using a structured questionnaire. Fasting plasma glucose, lipid profile, liver enzymes and hepatitis Be antigen (HBeAg) were tested. RESULTS: The participants had a mean age of 33.6 ± 8.4 years and included 123 (60.3%) females, 40 (19.6%) with HBeAg seropositivity, and 29 (14.2%) with family history of DM. The prevalence of IFG was 52 (25.5%). On multivariate analysis, the independent predictors of IFG were family history of DM (OR = 8.23, 95% CI = 2.78-24.31), male gender (OR = 2.83, 95% CI = 1.17-6.64), HBeAg seropositivity (OR = 4.97, 95% CI = 1.87-13.18) and elevated GGT (OR = 7.27, 95% C.I = 2.88-18.35). CONCLUSION: The prevalence of IFG among HBV-infected patients is high. Targeted screening and follow-up of HBV-infected patients for abnormalities of glucose metabolism is recommended.

Beta cell response to a mixed meal in nigerian patients with type 2 diabetes.

BACKGROUND: The pathophysiology of type2 diabetes involves both insulin resistance and poor beta cell function. Studies have been done in several populations to assess the relative importance of these mechanisms in individual patients. In our environment studies to assess beta cell function have been done with glucagon stimulation or an oral glucose tolerance test. This study was done to assess the response of the beta cell to a standardized mixed meal and its relationship with glycaemic control in patients with type2 diabetes. METHODS: Ninety patients with type 2 diabetes were recruited into the study. Weight, height, body mass index and waist circumference were measured. Blood samples were analysed for fasting plasma glucose (FPG) and fasting C peptide (FCP) and glycated haemoglobin (HbA1c). Patients were given their usual drugs for management of their diabetes and then served with a standard meal calculated to contain 50 g of carbohydrate, made up of 53 % carbohydrate, 17 % of protein and 30 % of lipids, providing 500 kcal. Blood samples 2 hours after the start of the meal were analysed for postprandial glucose (PPG) and postprandial C peptide (PCP). Fasting (M0) and postprandial beta cell responsiveness (M1) were calculated. RESULTS: The mean FPG and PPG were 7.51+/- 3.39 mmol/l and 11.02+/-4.03 mmol/l respectively while the mean glycated haemoglobin (HbA1c) was 9.0+/-2.5 %. The mean fasting C peptide was 1.44+/-1.80ug/ml. Many of the patients (56.7 %) had low FCP levels. The mean postprandial C peptide was 4.0+/-2.8 ng/ml. There were significant correlations between M1, HbA1c and PPG (p = 0.015, 0.024, 0.001 respectively) and also between M0, HbA1c, PPG and FPG (p = 0.001, 0.002, 0.001). HbA1c decreased across increasing tertiles of M0 (p < 0.001) and also M1 (p = 0.002). In step-wise linear regression analysis, M0 and M1 significantly predicted HbA1c. CONCLUSIONS: Many of the patients had low C peptide levels with poor beta cell response to the meal. The patients had poor glycaemic control and poor beta cell function. Both fasting and postprandial beta cell responsiveness were significant determinants of blood glucose and glycated haemoglobin levels. It is likely that putting these patients on insulin may have led to better glycaemic control in them.