Prevalence and pattern of skin diseases in patients with diabetes mellitus at a tertiary hospital in Northern Nigeria.

BACKGROUND: Diabetes mellitus is one of the most common metabolic disorders with a rising prevalence. It cuts across all ages and socioeconomic status. Various skin lesions are frequently observed in diabetic patients. AIMS: This study was carried out to determine the prevalence, pattern, and determinants of skin diseases in diabetic patients at the Barau Dikko Teaching Hospital, Kaduna, North West Nigeria. MATERIALS AND METHODS: One hundred consecutive diabetic patients attending the clinic were included in the study. RESULTS: Many of the patients had more than one skin condition at a time. The most prevalent skin diseases were idiopathic guttate hypomelanosis which was seen in 61% of patients, infections from fungal, bacterial, and viral causes occurred in 30% of patients, other skin disorders were diabetic dermopathy seen in 17% of patients, palmoplantar hyperpigmentation was seen in 13% of patients, while pruritus occurred in 12% of patients and xerosis was seen in 10% of patients. CONCLUSION: Skin disorders are common among diabetic patients at Barau Dikko Teaching Hospital, Kaduna, North West Nigeria.

Prevalence of Pre-Diabetes, Diabetes and Associated Cardiovascular Risk Amongst Healthcare Workers in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria using Glycated Haemoglobin.

BACKGROUND: There is a global rise in the prevalence of diabetes mellitus and pre-diabetes is a fore-runner to type-2 diabetes. Pre-diabetes is reversible, therefore, measures should be taken to halt or slow down its progression to frank diabetes. AIM: The study aimed to evaluate the prevalence of pre-diabetes and diabetes amongst staff of ABUTH, Zaria and identify some cardiovascular risks associated with them. METHODS: A cross-sectional analytical study carried out on 377 healthcare workers who presented at the Medical out-patient department of ABUTH, Zaria in response to an invitation for the 2017 World Diabetes Day free medical screening. HbA1c was assessed via Immunofluorescence method. The difference in HbA1c amongst healthcare workers was determined by One-way Analysis of Variance with Post-hoc Bonferroni test. Cardiovascular risk associations were assessed via Multiple Binary Logistic Regression. RESULTS: Pre-diabetes and diabetes prevalence were 19.4% and 6.5% respectively. There were 28.6% undiagnosed diabetic healthcare workers. There was no significant (p=0.35) difference in HbA1c between different categories of healthcare workers, however, random blood glucose was significantly (p=0.042) higher in other healthcare workers than doctors. There was a significant (p<0.01) association between systolic hypertension and risk of developing pre-diabetes and diabetes (OR, 4.11, CI 0.98-17.30). CONCLUSION: There is a high prevalence of pre-diabetes and diabetes amongst healthcare workers in Zaria. The odds of hypertensive healthcare workers developing pre-diabetes and diabetes is high. Efforts should be geared at intensifying health education, increased work physical activity and proper diet.

Waist-height ratio: How well does it predict glucose intolerance and systemic hypertension?

AIM: The aim of this study is to assess whether WHtR is a better predictor of glucose intolerance and systemic hypertension than some other obesity indices. METHODS: This is a cross-sectional observational study among four hundred (4 0 0) participants in a Northern Nigerian population. Four (4) participants were eventually excluded due to incomplete data, therefore data from three hundred and ninety six (3 9 6) participants were used in the final analysis. The study assessed whether WHtR is a better predictor of glucose intolerance and systemic hypertension compared to some other obesity indices. Participants were recruited after due consent, then bio-data, blood pressure levels, and some anthropometric measurements were obtained. Subsequently, plasma glucose levels (fasting [FPG] and 2-hour post 75 g glucose load [2HrPPG]) were measured. Data was entered into Microsoft Excel, then analyzed using IBM SPSS version 23. RESULTS: Data from three hundred and ninety six (3 9 6) participants (4 excluded due to incomplete details) were analyzed. Logistic regression of obesity indices showed that WHtR was the best predictor of glucose intolerance with odds ratio (OD) of 20.74 (CI 2.80-155, p < 0.001), followed by WC with OD of 1.89 (CI 1.83-3.94, p < 0.001), then WHR with OD of 1.69 (CI 1.06-8.22, p = 0.009). The least but significant predictor of glucose intolerance was BMI with odds ratio of 1.12 (CI 1.06-3.18, p < 0.001). Furthermore, logistic regression of obesity indices showed that WHtR was the strongest predictor of systemic hypertension with OD of 2.32 (CI 4.85-14.96, p < 0.001), followed by BMI (OD 1.99, CI 1.96-2.05, p = 0.031), then WC (OD 1.95, CI 1.90-1.99, p = 0.020). The weakest predictor of systemic hypertension was WHR (OD 1.26, CI 0.04-1.88, p = 0.181). CONCLUSION: WHtR had the highest predictive power for both glucose intolerance and systemic hypertension compared to BMI, WC, and WHR.

Haematological and Immunological Parameters in Patients with Chronic Hepatitis B Infection in Zaria, Nigeria.

Hepatitis B virus (HBV) is one of the major causes of morbidity and mortality worldwide. The aim of this study was to determine the haematological and immunological parameters in patients with chronic HBV infection in Zaria, Nigeria. Twenty individuals with confirmed chronic HBV (CHB) infection constituted the subjects while 20 non-HBV-infected individuals were monitored as controls. The subjects were enrolled purposively from the Gastroenterology Clinic of the Ahmadu Bello University Teaching Hospital Shika, Zaria Nigeria. Four millilitres of blood samples were collected from each study participants. Full blood count was conducted using the Swelab Alfa Haematology Analyzer, while CD4+ T-Cell enumeration was performed using the Sysmex Partec CyFlow® Counter IVD flow cytometer according to the manufacturers' instruction. The mean (and standard deviation) age of the 20 participants with CHB was 32.7 (±10.1) years while that of the 20 HBV negative control participants was 30.0 (±7.8) years. Mann-Whitney test showed no significant difference between the two groups in their total WBC (p=0.6634) and granulocytes (p=0.2386). There was a significant increase in the monocytes count (p=0.0151) and a significant decrease in the lymphocytes count (p=0.0006) of patients with CHB compared to the healthy control. There was no significant difference in the mean CD4+ T-lymphocytes count between subjects and controls (p=0.0633). Unpaired Student t-test showed no significant difference between the two groups in the other haematological parameters. This study showed a significant increase in monocytes and decrease in lymphocytes, a phenomenon that characterize the sustenance of infection by immune evasion mechanism.

Incidence of dog bite injuries and clinical rabies in a tertiary health care institution: a 10-year retrospective study.

BACKGROUND: It is widely recognized that rabies is grossly under-reported even though it is a notifiable disease and a lack of accurate figures has rendered rabies a low public health and veterinary priority. This study aimed at determining the incidence of dog bite injuries and clinical rabies in a tertiary health care centre. MATERIALS AND METHODS: Case records of patients managed at the accident and emergency unit of Ahmadu Bello University Teaching Hospital, Zaria, between June 2000 and May 2010 with diagnosis of dog bite and rabies were retrieved. Relevant clinical data were extracted using a structured questionnaire designed for the study. RESULTS: Eighty-one persons out of 24,683 consultations in the accident and emergency unit presented with dog bite injuries with two clinical cases of human rabies. Mean age of victims of dog bite injuries was 21.1 ± 14.3 years and the majority (55.6%) were children. Males were more affected than females with a male:female ratio of 4.8:1, lower limb/buttock injuries were significantly higher in children than adults, but the adults sustained significantly more severe (type III) injury. The majority of dog bite injuries were washed with soap and irrigated with water or saline and 87.7% of the victim of dog bite received postexposure anti-rabies vaccine. CONCLUSION: Hospital incidence of dog bite injuries was low, but the use of postexposure prophylaxis was high.

Incidence of dog bite injuries and clinical rabies in a tertiary health care institution: A 10-year retrospective study

Background: It is widely recognized that rabies is grossly under-reported even though it is a notifiable disease and a lack of accurate figures has rendered rabies a low public health and veterinary priority. This study aimed at determining the incidence of dog bite injuries and clinical rabies in a tertiary health care centre.Materials and Methods: Case records of patients managed at the accident and emergency unit of Ahmadu Bello University Teaching Hospital, Zaria, between June 2000 and May 2010 with diagnosis of dog bite and rabies were retrieved. Relevant clinical data were extracted using a structured questionnaire designed for the study.Results: Eighty-one persons out of 24,683 consultations in the accident and emergency unit presented with dog bite injuries with two clinical cases of human rabies. Mean age of victims of dog bite injuries was 21.1 ± 14.3 years and the majority (55.6%) were children. Males were more affected than females with a male:female ratio of 4.8:1, lower limb/buttock injuries were significantly higher in children than adults, but the adults sustained significantly more severe (type III) injury. The majority of dog bite injuries were washed with soap and irrigated with water or saline and 87.7% of the victim of dog bite received postexposure anti-rabies vaccine.Conclusion: Hospital incidence of dog bite injuries was low, but the use of postexposure prophylaxis was high

Reactive airway and anaesthesia: challenge to the anaesthetist and the way forward.

BACKGROUND: Patients with concurrent medical conditions such as Reactive airway disease presenting for anaesthesia, and surgery have potentially increased risk of perioperative morbidity and mortality if not well managed. OBJECTIVE: To highlight the need for adequate perioperative care and review the evidence for selection of techniques in the anesthesia for such cases" MATERIALS AND METHODS: An illustrative case is presented. CONCLUSION: The main goal of the anaesthetist is to administer safe and sufficient anaestheia without precipitating bronchospasm.

Myasthenia gravis associated with autoimmune thyroid disease: a report of two patients.

Myasthenia gravis (MG) is an acquired autoimmune disorder causing skeletal muscle fatigue and weakness. This is a report of one woman and her daughter presenting with myasthenia and gravis and Grave's disease. It highlights possible hereditary component of this condition which has not been commonly reported in our setting.

Relationship between casual blood sugar and body mass index in a suburban northern Nigerian population: a short communication.

BACKGROUND: Obesity is the most important modifiable risk factor in the pathogenesis of type-2 diabetes reported in most cross sectional studies. However, racial factors seem to be important in the relationship between body mass index (BMI) and glucose intolerance. This study aims at defining the relationship between these variables in two suburban populations in Nigeria. METHOD: A prospective survey of Adults aged 55 years or younger who gave informed consent, in two communities (Makarfi and Giwa) near Zaria, northern Nigeria was done. The BMI and casual blood sugar using capillary blood assessed with the Ames glucometer were determined for all the subjects. Students t-test was used to compare continuous variables while Pearson's correlation coefficient was used for continuous variables; the level of significance was p < 0.05 in each case. RESULT: Three-hundred and seventeen subjects participated in the study Mean age of subjects was 35.03 +/- 9.79 years (33.0 +/- 9.64 among females and 36.18 +/- 9.59 among males p = 0.1007). CONCLUSION: Female subjects had significantly higher BMI than their male counter parts, (26.61 +/- 7.19 KgM2 versus 24.01 +/- 5.39, KgM2 p = 0.0341.) Casual blood sugar levels were however similar between males and females 85.21 +/-27.04 mg/dl versus 85.88 +/- 14.74 mg/dl, p = 0.8868. There was a positive but non-significant correlation between casual blood sugar and BMI among female subjects (r = +0.1520, p > 0.05) in the males however, the correlation between these variables was not significant (r = -0.0395, p > 0.5).

Anti-Retroviral Therapy Induced Diabetes in a Nigerian

Background:Anti-retroviral therapy (ART) using Highly Active Anti-retroviral Therapy (HAART) has led to considerable reduction in morbidity and mortality associated with human Immune deficiency virus (HIV) infection.This has led to increased life expectancy in HIV infected individuals on one hand; and side effects of chronic administration of these drugs on the other. One of such untoward effects is the association of anti-retroviral drugs especially the protease inhibitors (PI's) with metabolic derangements such as dyslipi- daemia; lipodystrophy; insulin resistance and rarely Diabetes mellitus. Although there is extensive literature on this dysmetabolic syndrome in the Western World; there is to our knowledge no previous report from Nigeria. Objective: to report a case of diabetes mellitus following the initiation of anti-retroviral therapy. Methods: a case report of diabetes mellitus induced by anti-retroviral therapy in a 48 year old Nigerian male. Conclusion: Awareness and high index of suspicion is required to identify the metabolic complications of ART

Severe diarrhoea complicating metformin therapy: an unusual presentation.

BACKGROUND: Gastro-intestinal symptoms especially diarrhoea could complicate metformin therapy. METHODS: A 57-year old Nigerian man who had severe diarrhoea as a result of metformin therapy is presented. CONCLUSION: Clinicians should be wary of this complication and be on the watch out for it.

Plasma insulin response to oral glucose tolerance test in type-2 Nigerian diabetics.

OBJECTIVE: To study the plasma insulin pattern in type 2 diabetic Nigerians both in the fasting state and in response to a standard oral glucose tolerance test. DESIGN: A cross sectional study. SETTING: Diabetic clinic, Ahmadu Bello University Teaching Hospital, Zaria Nigeria. SUBJECTS: Forty type 2 diabetic patients and thirty six healthy age and sex matched control subjects was undertaken. INTERVENTIONS: Eligible patients and control subjects underwent a standard oral glucose tolerance test (OGTT). Plasma levels of glucose and insulin levels determined by a glucose oxidase method and ELISA techniques respectively. Student's t-test was used to compare continuous variables, Chi-square test for categorical variable and Pearson's correlation coefficient to define correlation between variables. The level of statistical significance in each case was taken as P < 0.05. RESULTS: Type 2 diabetic patients demonstrated significantly lower fasting plasma insulin levels, when compared to control subjects (4.20+/-1.78 micro- units/ml vs 5.72+/-2.16 micro - units/ml respectively p<0.05). Similarly, plasma insulin levels following oral glucose challenge were significantly lower in the type 2 diabetic population. CONCLUSION: Type 2 diabetic patients in this study demonstrate both fasting post OGTT hypoinsulinaemia. These findings are discussed in the light of the available knowledge on the aetiopathogenesis of type-2 diabetes mellitus in Africans.