Metabolic syndrome in subjects with type-2 diabetes mellitus.

BACKGROUND: Each component of metabolic syndrome (MS) conveys increased cardiovascular disease risk, but as a combination they become much more powerful. Vigorous early management of the syndrome may have a significant impact on the prevention of both diabetes and cardiovascular disease. AIM: This study aims to determine the frequency of occurrence of MS and its relation to cardiovascular events among patients with type-2 diabetic mellitus. METHODS: The study group consisted of 218 type-2 diabetic patients. These were screened for hypertension, hyperlipidemia, obesity, microalbuminuria, and cardiovascular events. RESULTS: There were 128 (58.7%) males and 90 (41.3%) females. The mean age was 53.4 +/- 6.3 years and a mean body mass index (BMI) of 25.5 +/- 5.4 (males-23.4 +/- 4.2; females-26.2 +/- 5.7). MS was present in 55 (25.2%) of the study population. Systemic hypertension was the most common component of MS seen in 84 (38.5%) patients. The mean serum total cholesterol was 168.6 +/- 25.8 mg% (men 153 +/- 23; women 169 +/- 19; p > 0.05). Eight female and 12 male patients had serum total cholesterol > or = 200 mg%. Dyslipidemia occurs more commonly in males than females. Obesity was more common in female patients than in males. Out of 128 male type-2 patients with diabetes seen, 111 (86.7%) were without microalbuminuria. The corresponding figure among the females was 90% (81 out of 90 patients). CONCLUSIONS: The study demonstrated that MS was present in 25.2% of the study population. The syndrome and its different components were positively associated with a higher risk of stroke, peripheral vascular disease, and occurrence of microalbuminuria, p < 0.001. Ischemic heart disease occurs rarely in the population. A long-term, targeted, intensive intervention involving multiple cardiovascular risk factors is recommended to reduce the risk of both cardiovascular and microvascular events among patients with type-2 diabetic mellitus.

Pattern of occurrence of microalbuminuria among dippers and non-dippers (essential hypertensives) in a Nigerian university teaching hospital.

OBJECTIVES: Hypertensives who fail to manifest the normal circadian nocturnal fall in blood pressure have a higher incidence of cardiovascular complications, early glomerular injury and microalbuminuria. This study aims to quantify the proportion of dippers and non-dippers among the essential hypertensive population, and determine the frequency of occurrence of micro-albuminuria among them. MATERIALS AND METHODS: Early morning urine specimens were taken from 50 patients with essential hypertension and 20 healthy, normotensive subjects. Combined negative results from albustic strip testing and sulfosalicylic acid tests were taken as excluding microalbuminuria. While collecting urine for 24-hour urinary protein and creatinine clearance, hourly blood pressure readings were recorded. Readings obtained between 07:00 and 23:00 were taken as daytime blood pressure readings, whereas readings obtained between 23:00 and 07:00 were considered night-time blood pressure. Dippers were considered to be those patients in whom the difference between mean daytime systolic/diastolic blood pressure and mean night-time systolic/diastolic blood pressure was 10/5mm Hg or more. RESULTS: Thirty-six (72%) and 14 (28%) patients with essential hypertension fulfilled the criteria for dippers and non-dippers, respectively. The night-time systolic and diastolic blood pressures were significantly higher in non-dippers than in dippers (P < 0.05). The mean daytime systolic and diastolic blood pressures were not different between these two groups. Twenty-nine out of 36 (80.6%) urinary specimens from dippers were without microalbuminuria, against six out of 14 (42.9%) specimens from non-dippers, p < 0.05. Eighteen out of 20 controls (90%) were without microalbuminuria. CONCLUSION: This study demonstrated that about 28% of the local essential hypertensive population was non-dippers and 57.1% of these had microalbuminuria with the attendant cardiovascular and renal risks.

Spectrum and outcome of clinical diseases in adults living with AIDS at the Ogun State University Teaching Hospital.

OBJECTIVES: To evaluate the changing frequency of HIV/AIDS amongst medical admissions as well as the spectrum and outcome of clinical diseases among these patients. DESIGN: Retrospective study. SETTING: Tertiary hospital in Nigeria. PARTICIPANTS: Two hundred and six People Living With AIDS (PLWA) admitted at the medical wards during the period 1992 to 2002. INTERVENTION: Treatment was symptomatic in all patients and where appropriate, specific treatment was administered for indicator diseases. Highly Active Anti-retroviral Therapy (HAART) was not used. MAIN OUTCOME MEASURES: Mortality within six months of diagnosis. RESULTS: PLWA constituted 4.2% of all medical admissions. The frequency increased from 0% in 1992 to 7.6% in 2001, and dropped to 5% by the year 2002. Seventy patients (34%) died within six months of diagnosis. RESULTS: This study has demonstrated an increasing frequency of HIV/AIDS amongst our medical in-patients from none in 1992 to 7.6% in 2001, and thereafter, a decline in 2002. We suspect that this decline could be a reflection of the health education on HIV, its increasing awareness and the widespread utilisation of effective control measures. Furthermore, the administration of highly active anti retroviral therapy (HAART) to a segment of PLWA in Sagamu by the community medicine department could be contributory. CONCLUSION: A community based study would be needed to assess the efficacy or otherwise of these current control measures. The advent of saliva and urine tests for HIV detection would ease specimen collection and increase compliance and participation at the community level.