A first trimester prediction model and nomogram for gestational diabetes mellitus based on maternal clinical risk factors in a resource-poor setting.

BACKGROUND: The implementation of universal screening for Gestational Diabetes Mellitus (GDM) is challenged by several factors key amongst which is limited resources, hence the continued reliance on risk factor-based screening. Effective identification of high-risk women early in pregnancy may enable preventive intervention. This study aimed at developing a GDM prediction model based on maternal clinical risk factors that are easily assessable in the first trimester of pregnancy in a population of Nigerian women. METHODS: This was a multi-hospital prospective observational cohort study of 253 consecutively selected pregnant women from which maternal clinical data was collected at 8-12 weeks gestational age. Diagnosis of GDM was made via a one-step 75-gram Oral Glucose Tolerance Test (OGTT) at 24-28 weeks of gestation. A GDM prediction model and nomogram based on selected maternal clinical risk factors was developed using multiple logistic regression analysis, and its performance was assessed by Receiver Operator Curve (ROC) analysis. Data analysis was carried out using Statistical Package for Social Sciences (SPSS) version 25 and Python programming language (version 3.0). RESULTS: Increasing maternal age, higher body mass index (BMI), a family history of diabetes mellitus in first-degree relative and previous history of foetal macrosomia were the major predictors of GDM. The model equation was: LogitP = 6.358 - 0.066 × Age - 0.075 × First trimester BMI - 1.879 × First-degree relative with diabetes mellitus - 0.522 × History of foetal macrosomia. It had an area under the receiver operator characteristic (ROC) curve (AUC) of 0.814 (95% CI: 0.751-0.877; p-value < 0.001), and at a predicted probability threshold of 0.745, it had a sensitivity of 79.2% and specificity of 74.5%. CONCLUSION: This first trimester prediction model reliably identifies women at high risk for GDM development in the first trimester, and the nomogram enhances its practical applicability, contributing to improved clinical outcomes in the study population.

Mitigating the Risk of COVID-19 Deaths in Cardiovascular Disease Patients in Africa Resource Poor Communities.

The novel coronavirus disease 2019 (Covid-19) pandemic has affected millions of patients in almost all countries with over one million cases recorded in Africa where it is a major health challenge. Covid-19 is known to have significant implications for those with pre-existing cardiovascular disease (CVD) and their cardiologists. Patients with pre-existing CVD are at increased risk of morbidity and mortality from Covid-19 due to associated direct and indirect life threatening cardiovascular (CV) complications. Mitigating the risk of such Covid-19 deaths in resource poor communities requires the institution of preventive measures at the primary, secondary and tertiary levels of preventive phenomenon with emphasis at the first two levels. General preventive measures, screening and monitoring of CVD patients for complications and modification of drug treatment and other treatment methods will need to be implemented. Health policy makers and manager should provide required training and retraining of CV health care workers managing Covid-19 patients with CVD, provision of health education, personal protective equipment (PPE), and diagnostic kits.

Short height and poor education increase the risk of dementia in Nigerian type 2 diabetic women.

INTRODUCTION: There is urgent need to investigate type 2 diabetes and dementia crosstalk in sub-Saharan African countries with special attention to women who have higher vulnerability. Nigeria which has the highest number of diabetics on the African continent is a good location for the investigation. METHODS: Biophysical parameters, occupation, education, burden of diabetes mellitus, cardiovascular health, and cognition were evaluated in 102 type 2 diabetics and 99 controls. RESULTS: Short physical stature and lower level of education were hallmarks of diabetes in females. Two dementia scales (Mini-Mental State Examination and six-item Cognitive Impairment Test) showed cognitive impairment status, with the six-item Cognitive Impairment Test scale being more specific and sensitive. Both scales showed correlations with age, education, weight, height, and disease onset, whereas fasten blood glucose was negatively correlated with height and their blood pressure was normal. DISCUSSION: Height, an easy-to-measure parameter in Nigeria, may reveal increased risk of dementia in poorly educated female Nigerian diabetics, thus helping to improve preventive and therapeutic interventions.

Diagnosis and treatment of giant cell granuloma of the temporal bone: Report of eight cases.

UNLABELLED: Abstract Conclusions: It is impossible to make a diagnosis of temporal giant cell granuloma (GCG) before operation because of nonspecific clinical and imaging feature. Surgery is the first-line choice of treatment. OBJECTIVE: To evaluate the diagnosis and treatment of temporal GCG. METHODS: Eight patients with GCG receiving treatment in the Chinese PLA General Hospital between 2001 and 2010 were recruited for the study. These patients' clinical features, imaging and histopathological findings, types of surgery, and results of follow-up evaluations were noted. RESULTS: The group was made up of four males and four females, with a median age of 37 years (range 21-50 years). Four patients had a granuloma on the left side and four on the right of the head. The median duration of the disease was 21 months (range 5-60 months). All patients, except one referred to us for recurring disease, were managed in our hospital. The main symptoms were: hearing loss (n = 5), tinnitus (n = 4), otalgia (n = 3), dizziness (n = 2), and local masses (n = 2). Radiological examination of the masses revealed erosion of the temporal bone and base of the skull. There was no definitive diagnosis in any of the patients before surgery. All patients had surgical treatment, six of them by middle cranial fossa approach and two by combined cranio-auricular approach. Surgical complications included partial facial paralysis (three cases) and cerebral edema (one case) but they resolved soon after surgery. One patient was lost to follow-up, but the other seven were followed up over a mean period of 24 months; none has reported a recurrence.