A Synopsis of Asthma Research in Nigeria between 1970 and 2010

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Ventiliatory Function in Nigerians with Type 2 Diabetes

Reduced ventilatory function in type 2 diabetes has been reported in other parts of the world. This study aimed to assess the ventilatory function in Nigerians with type 2 diabetes and its relationship to the duration of symptoms of diabetes, glycaemic control, age, and body mass index (BMI). One hundred and one (101)patients with type 2 diabetes were matched to 104 control subjects with normal glucose tolerance. Historical and clinical data were documented and venous blood sampled for HbA1c in the diabetes group. Peak expiratory flow rate (PEFR), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and the ratio of the FEV1 to the FVC as a percentage (FEV1/FVC%) were measured for both groups. Study subjects and controls were similarly matched. Mean PEFR (L/s), FEV1 (L), and FVC (L) were 5.6±2.24, 2.36±0.74,and 2.94±0.90, respectively, in the diabetes group and 6.31±1.62, 2.58±0.62, and 3.19±0.79, respectively, in the control group (p=0.006, 0.02, and 0.03, respectively).The FEV1/FVC% was 81.90±24.17 in the diabetes group and 81.26±5.99 in controls (p= 0.86). Compared with predicted values for Nigerians, 11 (11%) of diabetes subjects had restrictive lung disease and 6 (6%) had obstructive lung disease while 1 (1%) of controls had restrictive lung disease and 5 (5%) had obstructive lung disease (c2=9.46, p=0.009). In multivariate analysis, age was inversely related to the PEFR (p=0.04). BMI was inversely related to PEFR, FEV1, and FVC (p= 0.01, 0.001, 0.002, respectively). Duration of diabetes was also inversely related to FEV1 (p= 0.02). HbA1c was not significant for any ventilatory index. It was concluded that Nigerians with type 2 diabetes have significantly lower ventilatory function (with a restrictive pattern),compared with matched controls. Symptom duration,age, and BMI are independent determinants of ventilatory function

Eligibility of Nigerians with Type 2 Diabetes Mellitus for Inhaled Insulin

Parenteral delivery of insulin has been shown to reduce acceptance of insulin as a treatment option in type 2 diabetes mellitus (DM) patients.The advent of inhaled insulin is aimed at circumventing this problem; however inhaled insulin is a treatment option only for DM patients with normal lung function.The study set out to evaluate the forced expiratory volume in the first second in Liters (FEV1) of Nigerians with type 2 DM and thus determine the proportion potentially eligible for inhaled insulin.FEV1 was measured in 101 subjects with type 2 DM and 104 age; gender and body mass index matched controls without DM. All subjects were 'never smokers' without any physical condition that could compromise lung function. We then determined the proportion of subjects with FEV1; more than 70of normal; which defines eligibility for inhaled insulin.On the basis of the mean FEV1 in Liters of matched controls in this study being 2.58+ 0.62; the cot off for minimium FEV1 to qualify for inhaled insulin therapy was determined as 1.80 liters (i.e 70of 2.58). A total of 83 (84) of the 101 subjects with type 2 DM had FEV1 1.8 liters indicative of eligibility for inhaled insulin. Male sex; shorter duration of DM; normal body mass index (BMI) and younger age were associated with eligibility.A high proportion of Nigerians with type 2 DM attending tertiary care are eligible for inhaled insulin therapy making it a treatment option. The feasibility of this treatment option in terms of acceptability; affordability; side effect profile and efficacy in blood glucose control in Nigerians is an important research focus

Evaluation of Glutaraldehyde Test in the Diagnosis of Pulmonary Tuberculosis in Nigeria

In the developing world with scarcity of diagnostic facilities; the diagnosis of pulmonary tuberculosis (PTB) could often be difficult. Previous methods have proved inadequate; especially where TB is endemic. Serologic tests for the diagnosis of TB require advanced technology which is not readily available. The study therefore proposed to evaluate the usefulness (or otherwise) of the glutaraldehyde test (GT) in the diagnosis of PTB in this environment. Two hundred and ten consecutive consenting adults 18 years and above with newly diagnosed sputum smear positive PTB attending 4 government hospitals in the Lagos area were studied over one year. Age and sex matched controls from LUTH who had no symptoms or signs of TB were also studied. All cases had sputum smear examination (by the Ziehl-Neelsen method) and the glutaraldehyde test. Considering the normal gelification time of 215 seconds (at 1 SD); the glutaraldehyde test had a sensitivity; specificity; positive and negative predictive values of 92.40

Cockroach hypersensitivity in asthmatics in Lagos, Nigeria.

BACKGROUND: Cockroach allergy occurs frequently in asthmatics in urban areas, where the level of cockroach infestation is usually high. The prevalence of cockroach allergy, as well as the effect of associated factors on cockroach sensitisation in Nigeria is largely unknown. OBJECTIVE: To determine the prevalence of cockroach allergy in asthmatics in Lagos. DESIGN: A prospective case-control study. SETTING: Medical outpatient department of the Lagos University Teaching Hospital, Lagos, Nigeria. SUBJECTS: Two hundred and two patients with confirmed bronchial asthma and one hundred non-asthmatic control subjects took part in the study. INTERVENTION: The cockroach allergen was administered on all the subjects using skin prick technique. MAIN OUTCOME MEASURES: The provocation of a skin reaction (wcal) fifteen minutes after administering the cockroach antigen. RESULTS: Amongst the asthmatic patients 90 (44.6%) had positive skin tests to the cockroach allergen, compared to nine (9%) of the control subjects. There was a male preponderance of cockroach sensitivity amongst the asthmatic patients even though the difference between both sexes was not significant. Other highlights of the study included the fact that cockroach sensitivity was related to age, duration of asthma, nocturnal asthmatic attacks, frequency of attacks, and the levels of infestation. There was an insignificant relationship between cockroach sensitivity and the location of residences as well as the income status of the respondents. CONCLUSION: There is the need for more studies on cockroach allergy in asthmatics in our environment.

A ten-year review of asthma deaths at the Lagos University Teaching Hospital.

A retrospective study was made of forty-nine patients certified as dying from asthma in order to identify potentially avoidable factors. Forty-nine per cent of the deaths were due to delay in seeking medical help by patients or relations. Other factors identified as contributing to the asthma deaths included inadequate objective assessment of airway function, as well as inadequate administration of corticosteroids. Education of patients and general practitioners, as well as speedy referral to specialized units will help reduce the gap between diagnostic and therapeutic knowledge and its application in a developing country like Nigeria.

Primary pulmonary carcinoma in Lagos, Nigeria: a clinicopathological study.

A retrospective clinicopathological study of bronchogenic carcinoma in patients admitted to Lagos University Teaching Hospital (LUTH) during a 17-year period (1975-1991) is presented. Out of the 148 cases, 88 were confirmed histopathologically and in the remaining 66 cases, diagnosis was based on a combination of clinical and radiological features. Epidermoid carcinoma was the commonest histopathological variant and the male/female ratio was 2:1. Sixty five percent of the patients admitted to being heavy smokers. The majority of patients presented with weight loss, chronic cough with chest pain and haemoptysis in that order. With an average of nine cases yearly, this study shows that this disease is still uncommon in Nigerians.

Fungal chest infections at the Lagos University Teaching Hospital.

One hundred and ninety-six sputum specimens were collected from patients with suspected fungal chest infections between 1986 and 1989 at the Medical Out-patients Department of the Lagos University Teaching Hospital. Eighty-three fungal isolates were obtained representing 42.3 percent of specimens collected. Seventy per cent of the fungal isolates were due to species of either Candida or Aspergillus. Whilst the predisposing factors to Aspergillus infection were either due to tuberculosis or bronchial asthma, a high proportion of infection with Candida were due to patients with leukaemias and lymphomas. Diagnostic shortcomings in the cases studied are stressed. The widespread uncontrolled use of antibiotics and corticosteroids in Lagos, and the rising incidence of human immunodeficient virus infection makes it imperative to routinely investigate for fungal chest infections in Lagos.

An analysis of tetanus deaths in Lagos.

Between 1974 and 1984, 418 patients with tetanus, aged 10 years and older, represented 64.8% of all admissions to the intensive care unit of the Lagos University Teaching Hospital. Students accounted for the largest single group with tetanus, which mainly occurred during the dry season. There was a male preponderance (1.4 to 1), but no appreciable sex influence on mortality rates (46.1% for men; 44.6% for women). The mean mortality rate was 45.5%, with the highest mortality occurring in the elderly. Other high risk factors identified were neck and head injuries, post abortal or post partum states, hyperpyrexia, and tachycardia.

Cutaneous sarcoidosis in Nigeria.

The study is a retrospective analysis of the cutaneous manifestations of sarcoidosis in patients seen during a 10-year period at the skin and chest clinics of the Lagos University Teaching Hospital. Of the 43 patients with sarcoidosis 30% had skin lesions. The most common was sarcoidal infiltration of scarification marks. Facial macropapular lesions also were frequently present.

Identification of a German cockroach-specific allergen by human IgE and rabbit IgG.

To further study the immunology of insect hypersensitivity, we identified and partially characterized the principal allergens in whole body German cockroach (WBGCR) (Blattella germanica) and compared this extract to whole body antigens prepared from other insects. WBGCR extract was fractionated over a calibrated Sephadex G-200 column; peak allergenic activity was contained in fraction 3 (GCR3), containing components with apparent molecular weights ranging from 12,500 to 75,000 daltons. The antigenicity, allergenicity, and specificity of GCR3 components were tested by using rabbit antisera raised to GCR3 or true armyworm (Pseudaletia unipuncta). Radioimmunoassay, cross-inhibition and immunoblot studies revealed, particularly in the IgE system, that GCR3 contained an allergen with a pI of 6.7 and MW of 36,000 daltons that was unique to WBGCR extracts and not present in other insect species, including true armyworm, caddis fly, lakefly, yellow jacket, or honeybee. This GCR3 component may represent a specific marker for the diagnosis of cockroach hypersensitivity in an insect-sensitive population of individuals.

Plasma calcium in active pulmonary tuberculosis.

Fifty-two patients with active pulmonary tuberculosis were studied. Seventy percent of the patients were hypocalcemic at admission, but became normocalcemic after ten weeks of therapy. The improvement in hypocalcemia was thought to be due to either improved serum protein and albumin levels, which occurred after admission, or the reduced physical activity of the patients.Care should be taken in giving patients with pulmonary tuberculosis vitamin D supplements because of the possibility of hypersensitivity to vitamin D.The possible mechanisms of hypercalcemia in active pulmonary tuberculosis are discussed.

Attitudes and smoking habits of physicians at the Lagos University Teaching Hospital.

The attitudes and smoking habits of 333 doctors at the Lagos University Teaching Hospital were studied. Sixty eight percent were nonsmokers, while 24 percent were currently smoking, and 8 percent were ex-smokers. Surgeons (26 percent) and obstetricians and gynecologists (24 percent) accounted for most of the current smokers.The majority of doctors in Lagos were well informed on the health risks of smoking, but an insufficient number of them are currently giving advice on smoking cessation to their patients. There is a need to further educate doctors in Lagos on the important role physicians can play in smoking-cessation efforts.

An analysis of deaths due to tuberculosis at the Lagos University Teaching Hospital.

An analysis was made of deaths from tuberculosis in the Lagos University Teaching Hospital from 1976 to 1980. Of the 320 patients assessed, 240 were determined to have died from tuberculosis. Tuberculous meningitis was the main cause of death.Forty-two percent of the deaths occurred in the age group of 0 to 10 years old, and 47.5 percent of the patients died within one week of diagnosis. Potentially avoidable factors contributing to death include late reporting by patients to medical personnel, lack of bacillus of Calmette and Guerin (BCG) vaccine, irregular taking of medications by patients, and late referral of patients to specialized hospitals. There is a need for improved education of patients and medical personnel about the management of tuberculosis in Lagos.

Sarcoidosis in Lagos.

The clinical manifestations of sarcoidosis seen at the Lagos University Teaching Hospital are presented. The clinical features and management were in the main similar to those described in the temperate countries, but the patients tended to be older at presentation and were seen at a more advanced stage of the disease.Erythema nodosum and ocular lesions were relatively rare. The rarity of sarcoidosis in Lagos may be more apparent than real. Increased physician awareness of the disease is leading to the detection of more cases.

An analysis of skin prick test reactions on asthmatics in Lagos.

Skin tests were administered to 221 asthma patients at the Lagos University Teaching Hospital between 1977 and 1980. Of these, 168 patients (76 percent) had positive skin tests to one or more allergens and 53 (34 percent) had negative skin tests. Patients with positive tests tended to have a positive family history of asthma and an earlier age of onset of asthma.There was, however, no observed difference in the groups in the incidence of other allergies of urticaria, eczema, and allergic rhinitis. Results showed that 89 percent of asthmatics with positive skin tests were allergic either to house dust or to the house dust mite. Pollen allergy was comparatively rare. There is a need to prepare desensitizing antigens specific to this environment.

Case report. Acute intermittent porphyria present as quadriparesis in Nigerian female.

A case of intermittent porphyria is reported. The patient had quadriparesis, acute abdominal symptoms and abnormalities in the blood chemistry. Acute intermittent porphyria is not a common disease in Africans. The severe neurological signs in this patient may have been precipitated by medication.