Changes in mediators of inflammation and pro-thrombosis after 12 months of dietary modification in adults with metabolic syndrome.

OBJECTIVE: This study evaluated the effects of a 12-month dietary modification on indices of inflammation and pro-thrombosis in adults with metabolic syndrome (MS). MATERIALS AND METHODS: This longitudinal study involved 252 adults with MS recruited from the Bodija market, Ibadan and its environs. Participants were placed on 20%, 30% and 50% calories obtained from protein, total fat and carbohydrate respectively and were followed up monthly for 12 months. Anthropometry and blood pressure were measured using standard methods. Fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), fibrinogen, plasminogen activator inhibitor-1 (PAI-1)], interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured using spectrophotometric methods and ELISA as appropriate. Data was analysed using ANCOVA, Student's t-test, Mann-Whitney U and Wilcoxon signed-rank tests. P-values less than 0.05 were considered significant. RESULTS: After 6 months of dietary modification, there was a significant reduction in waist circumference (WC), while the levels of HDL-C, fibrinogen and PAI-1 were significantly increased when compared with the corresponding baseline values. However, WC and fibrinogen reduced significantly, while HDL-C and IL-10 significantly increased after 12 months of dietary modification as compared with the respective baseline values. CONCLUSION: Long-term regular dietary modification may be beneficial in ameliorating inflammation and pro-thrombosis in metabolic syndrome.

Insulin sensitivity and mortality risk estimation in patients with type 2 diabetes mellitus.

BACKGROUND: There is at present the dearth of information on the possible contribution of insulin resistance to scores obtained from mortality risk estimation in patients with type 2 diabetes mellitus (T2DM). AIM: This study determined the mortality risk scores in patients with T2DM and its relationship with insulin resistance. METHODS: Fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol (HDL), triglycerides, serum and urinary creatinine, glycated hemoglobin (HbA1c), serum insulin, and urinary albumin were determined in 111 T2DM patients. Thereafter, low-density lipoprotein cholesterol (LDL), quantitative insulin sensitivity check index (QUICKI), urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR) were calculated using the standard formula. Mortality risk was estimated using the validated Gargano mortality risk calculator with scores ≤0.67, 0.68-0.79, and ≥0.80 considered as low, intermediate, and high risks, respectively. RESULTS: Of the total patients, 5 (4.5%), 28 (25.2%), and 78 (70.3%) patients had high, intermediate, and low mortality risk, respectively. There was no difference in the median QUICKI values when the three groups were compared. However, there was a significant elevation in the median eGFR in patients with high mortality risk compared with patients with low and intermediate mortality risks. Also, the median mortality risk score of patients with low insulin sensitivity (QUICKI ≤0.3) was similar to that obtained in patients with normal insulin sensitivity (QUICKI ≥0.31). No significant correlation was found between QUICKI and mortality risk scores. CONCLUSION: Insulin sensitivity status does not have a direct effect on scores obtained from the Gargano mortality risk prediction model.

VITAMIN B12 LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS ON METFORMIN.

BACKGROUND: Due to the clinical benefits of metformin, its associated side effects such as vitamin B12 deficiency are usually overlooked and rarely investigated. OBJECTIVE: This study was carried out to determine the serum level of vitamin B12 in Nigerian patients with type 2 diabetes mellitus (T2DM) on metformin. METHODS: Serum vitamin B12 level was determined using high performance liquid chromatography (HPLC) in 81 T2DM patients who have been on metformin for 5 years or more. Vitamin B12 deficiency was defined as serum concentration of <200 pg/dl, borderline deficiency as 200 - 300 pg/dl and >300 pg/dl as normal. Differences in vitamin B12 levels between different groups were assessed using Mann Whitney U test and P<0.05 was considered as statistically significant. RESULTS: Vitamin B12 deficiency and borderline deficiency were recorded in 8.6% and 26.0% of the patients respectively. Vitamin B12 level was significantly lower in patients who have been on metformin for ≥10 years compared with patients with <10 years history of metformin use. Similarly, patients who were on metformin at a dose of >1000 mg/day had significantly lower vitamin B12 level when compared with patients on ≤1000 mg/day. CONCLUSION: Low serum vitamin B12 level is associated with longer duration and higher dose of metformin use. Therefore, routine determination of vitamin B12 level in patients with T2DM on high dose of metformin and those with prolonged use of metformin might help in identifying patients that would benefit from vitamin B12 supplements.

Metabolic alterations in different stages of hypertension in an apparently healthy nigerian population.

Metabolic syndrome (MS) amplifies hypertension (HTN) associated with increased risk of cardiovascular disease (CVD). MS components and other CVD risk measures were investigated in different stages of hypertension. 534 apparently healthy Nigerian traders aged 18-105 years were participants of a cohort study. The International Diabetes Federation (2005) and the National High Blood Pressure Education Program Coordinating Committee criteria were used for MS and HTN classifications, respectively. Anthropometric indices were obtained by standard methods. Levels of fasting plasma glucose (FPG), total cholesterol (TC), triglyceride (TG), and high-density lipoprotein cholesterol (HDLC) were determined by enzymatic methods, while low-density lipoprotein cholesterol (LDLC) was calculated. Data analysed statistically were significant at P < 0.05. 143 (26.8%), 197 (36.9%), and 194 (36.3%) of the traders had normotension, pre-HTN and HTN (stages 1 and 2), respectively. All indices tested except HDLC were significantly different among BP groups (P < 0.05). Waist to hip (WHR) and waist to height (WHT) ratios were significantly different between HTN groups (P < 0.05). HTN was associated with MS and female gender (P < 0.05). Metabolic alterations and significant HTN were observed. Treatment of the individual components of the syndrome and improvement of modifiable metabolic factors may be necessary to reduce MS and high BP.

Serum levels of copeptin, C-reactive protein and cortisol in different severity groups of sickle cell anaemia.

It is well known that individuals with SCA undergo constant physiological stress even, in steady state. However, there is little information on the relationship between the severity of sickle cell anaemia (SCA) and serum levels of biomarkers of stress. This study therefore determined the serum levels of copeptin, cortisol and CRP in adults with SCA in different severity groups. Sixty adults with sickle cell anaemia in steady state (27.1±6.3 years) and in vaso-occlusive crisis (24.9±4.9 years) were recruited into this cross-sectional study. Degree of severity (mild, moderate or severe) was determined using a scoring system incorporating annual number of blood transfusions, crisis and presence of anaemia, vaso-occlusive pain and organ complications. Standard methods were used for the determination of packed cell volume (PCV), total white blood cell count (WBC), blood pressure measurements and anthropometric indices. Serum levels of copeptin, cortisol and CRP were determined using ELISA with the ratios calculated accordingly. Data obtained were statistically analyzed using the Student's t-test, Mann Whitney U and Chi-square test as appropriate. P<0.05 was considered significant. The mean systolic blood pressure (SBP) and copeptin level were significantly higher in subjects with moderate SCA compared with those with mild SCA. Similarly SBP, pulse, WBC, copeptin and cortisol were significantly higher while body weight was significantly lower in subjects with severe SCA compared with subjects with mild SCA. However, WBC and cortisol-to-copeptin ratio were significantly higher in subjects with severe SCA compared with subjects with moderate SCA. There was progressive rise in serum levels of CRP from mild SCA through severe SCA but the differences were not statistically significant. Also, proportions of subjects with elevated SBP and WBC were higher than the proportion of subjects with lower SBP and WBC in the severe SCA group. Serum levels of cortisol, copeptin, and their ratio could differentiate severe SCA from mild or moderate SCA. Also, elevated systolic blood pressure and total white blood cell count are associated with severe sickle cell anaemia.

Complement factors in newly diagnosed Nigerian schizoprenic patients and those on antipsychotic therapy.

The role of Complement factors in the pathogenesis of psychiatric disorders is enormous, but the data on levels and functions of complement factors in patients with schizophrenia are scanty and conflicting. To address this issue, levels of Complement regulators (C1 inhibitor and C3 activator) and complement factors (C1q, C3c, C4 and C5) were determined in the serum of newly diagnosed drug free schizophrenic patients, schizophrenic patients on medication and healthy subjects using immune-plates. C1q was significantly reduced in newly diagnosed schizophrenic patients or schizophrenic patients on medication compared with the controls. C3c was significantly reduced in newly diagnosed schizophrenic patients compared with controls or schizophrenic patients on medication. The levels of C3 activators, C1 inhibitors and C4 were similar in the two groups of schizophrenic patients compared with the controls. It may be concluded from this study that C1q is deficient in schizophrenic patients; and that C3c may differentiate newly diagnosed schizophrenia from schizophrenic patients on medication.

Renal disease in adult Nigerians with sickle cell anemia: a report of prevalence, clinical features and risk factors.

Renal abnormalities in adult Nigerians with sickle cell anemia (SCA) have not been extensively studied. To determine the prevalence, pattern and the associated risk factors of renal disease, 72 subjects with SCA from two centers in the southwestern Nigeria were investigated. Socio-demographic data, body mass index and clinical findings were documented. The urine analysis, serum bio-chemistry, hemogram and renal factors attributable to SCA were determined. Presence of albuminuria of at least 1+ or microalbuminuria in those negative with dipstick; and the estimated glomerular filtration rate (eGFR) using the Cockcroft-Gault formula categorized subjects to various stages of chronic kidney disease (CKD). Subjects with and without albuminuria were compared to determine the relative risk associated with renal disease. Four (5.6%) subjects had macro-albuminuria, while 32 (44.4%) had micro-albuminuria and 30 (41.7%) had hemoglobinuria. In the subjects with albuminuria, age, hematocrit, systolic blood pressure, serum creatinine, urea and creatinine clearance were numerically higher while the eGFR was numerically lower. There was no significant difference in the clinical parameters studied in the two groups of subjects. The diastolic blood pressure was significantly higher in the albuminuric group. Based on eGFR, 22 (30.6%) subjects had hyperfiltration (GFR > 140 mL/min/1.73 m2), of whom 36.4% had albuminuria, 18 (25.0%) had stage 1 CKD, 30 (41.7%) had stage 2 CKD and two (2.7%) subjects had stage 3 CKD with albuminuria. None had stage 4 and 5 CKD. We conclude that renal abnormalities, importantly albuminuria, is common in adult Nigerians with SCA and the pattern and incidence are similar to those reported from other parts of the world. Regular blood pressure monitoring, early diagnosis and active intervention are advocated to delay progression to end-stage kidney disease in view of poor outcomes of renal replacement therapy in SCA patients with nephropathy.

Acetylation pharmacogenetics and renal function in diabetes mellitus patients.

Activities of human hepatic drug metabolizing enzymes N-acetyl transferase (NATS) had earlier been recognized as a cause of inter-individual variation in the metabolism of drugs. Therefore acetylation of many drugs in human exhibit genetic polymorphism. The aim of the study was to investigate if acetylator status predispose diabetic mellitus patients more to the complications of renal disease, One hundred and twenty (120) diabetics consisting of (50) Type 1 (T(1)) and 70 Type 2 (T(2)) diabetes mellitus patients and 100 healthy individuals as controls were classified as slow or rapid acetylator using sulphamethazine (SMZ) as an in vivo probe. The percentage acetylation, recovery of SMZ, creatinine clearance and presence of urinary albumin were determined. A significant difference (P < 0.05) was observed in the percentage of SMZ acetylated between slow and rapid acetylators in control, T(1) and T(2) subjects. The ratios of slow to rapid acetylators for T(1), T(2) and control subjects were 1:4, 3:2 and 2:3 respectively. No significant differences were observed in the percentage of SMZ recovered in the urine of slow and rapid acetylators that are diabetics. The difference in creatinine clearance of slow and rapid acetylators in T(1) and T(2) were significant (P < 0.05). 29% out of 120 (24.2%) diabetics (T(1) and T(2)) exhibited albuminuria out of which 25 (86.2%) had slow acetylator status. These findings suggest that slow acetylator status in diabetes mellitus could be a predisposing factor in the development of renal complications. This underscores the need for a rapid pharmacogenetic testing and therapeutic drug monitoring in such patients. However this inference could be further validated with a larger sample size.

Frequent occurrence of high gamma-glutamyl transferase and alanine amino transferase among Nigerian patients with type 2 diabetes.

Liver function tests (LFTs) are commonly deranged in diabetic patients. There is, however, paucity of local data on actual prevalence and pattern of LFTs abnormality among diabetic patients. A case-control study was carried out to study the pattern of LFTs abnormality among patients with type 2 diabetes (DM). Ninety consecutive patients with type 2 diabetes attending Medical Outpatient Clinic of the University College Hospital, Ibadan, and 90 nondiabetic controls with comparable age and sex were recruited into the study. Serum albumin, alanine amino transferase (ALT) and Gamma glutamyl transpeptidase (GGT) were tested in all subjects. Data were analyzed using Student's t-test, chi-square test and Mann-Whitney U. Among the diabetic patients, 70% had at least one deranged LFTs. The ALT and GGT values were significantly higher (52.9 IU/L and 24.3 U/L respectively) in the diabetic group compared to the controls (34.4 IU/L and 9.2 U/L respectively). Also, the most predominant LFT abnormality in diabetic group was isolated elevation of GGT. This study has confirmed the reported common derangement of LFTs in patients with type 2 DM. In addition, isolated elevation of GGT and ALT are common in Nigerian type 2 diabetic patients. There is need for further study to determine the significance of high GGT and ALT in Nigerian type 2 diabetic population.

Circulating immune complexes, immunoglobulin classes (IgG, IgA and IgM) and complement components (C3c, C4 and Factor B) in diabetic Nigerians.

OBJECTIVE: To evaluate serum levels of circulating immune complexes (CICs), immunoglobulin classes (IgG, IgA and IgM) and Complement Components (C3c, C4 and Factor B) in Nigerians with Type 1 or Type 2 diabetes mellitus. DESIGN: Case control study. SETTING: University College Hospital, Ibadan, Oyo State, Nigeria. SUBJECTS: Forty-two subjects with diabetic mellitus (17 Type 1 D. M. and 25 Type 2 D. M.) and 21 apparently healthy control subjects. INTERVENTION: Serum level of CICs was measured by polyethylene glycol precipitation method while single radial immunodiffusion method was used to measure serum levels of immunoglobulins and complement components. RESULTS: Only CICs were significantly higher in Type 1 diabetic subjects compared with the controls whereas CICs C3c, C4 and IgM were significantly increased in Type 2 diabetic subjects compared with the controls. The levels of CICs, C3c and IgM were significantly elevated in Type 2 diabetics compared with Type 1 diabetics. CONCLUSION: CIC concentrations may serve as a useful index of depressed host defences usually associated with diabetics mellitus and that humoral immunity is deranged more in Type 2 diabetics compared with Type 1 diabetics. Probably as a result of hyperinsulinaemia associated with insulin resistance.

Erythrocyte membrane protein alteration in diabetics.

OBJECTIVES: To study the protein components of the erythrocyte membranes of diabetic Nigerians and to compare the results with the erythrocyte membrane protein components of normal healthy Nigerians. DESIGN: Laboratory based cross-sectional study. SETTING: Department of Medicine, University College Hospital (UCH), Ibadan and Biomembrane Research Laboratory, Department of Biochemistry, College of Medicine, University of Ibadan, Ibadan, Nigeria. SUBJECTS AND METHODS: The study was carried out in patients with insulin-dependent diabetes mellitus--IDDM (Type 1 diabetes), non-insulin dependent diabetes mellitus--NIDDM (Type 2 diabetes) and healthy human volunteers (HHm), which served as controls. The subjects were aged 30-65 years. There were 12 subjects in each of the IDDM and NIDDM) and 18 subjects in the HHm group. Blood samples (20 ml per subject) were obtained from each subject and erythrocyte ghost membranes were isolated separately from each sample. Total erythrocyte membrane protein concentration of each sample was determined using bovine serum albumin (BSA) as standard. The protein components of the erythrocyte ghost membranes were determined using sodium dodecyl sulphate polyacrylamide gel electrophoresis. STATISTICAL METHOD: All values given are the mean +/- standard deviation (+/- SD) of the parameters measured. Significance was assessed using Student's t-test and P values of 0.05 or less were taken as statistically significant. RESULTS: The total protein concentration of HHm was 5.5 +/- 0.01 micrograms/ml, total protein concentration of IDDM was 4.5 +/- 0.01 micrograms/ml while NIDDM was 5.1 +/- 0.02 micrograms/ml. The spectrin alpha and beta-chain bands are heavily present in the healthy human erythrocyte membranes and are absent in the insulin dependent diabetic membranes. The ankyrin band, band six and below are more pronounced in IDDM and NIDDM but are relatively absent in the healthy humans. CONCLUSIONS: The results obtained provide evidence of profound quantitative and qualitative alteration of the erythrocyte membrane proteins in diabetic Nigerians. This may likely have serious functional implications of the diabetic patients.

The effect of oral hypoglycaemic agents on dyslipidaemia in Nigerian patients with newly diagnosed non-insulin dependent diabetes mellitus--a prospective study.

Thirty-five patients with non-insulin dependent diabetes (NIDDM) were treated and followed up for 24 weeks. Six of whom were managed with diet and/or metformin, nine received glibenclamide, twelve had a combination of metformin and glibenclamide, while the remaining eight patients received metformin and/or some other type of sulphonylurea (chlorpropamide or glipizide). By an analysis of variance, the different drug regimes showed equivalent glycaemic controlling effects, but the influence on dyslipidaemia was variable within the treatment groups, while these changes were insignificant between the groups. It is thus concluded that commonly used oral hypoglycaemic agents do not adversely affect plasma lipid levels in Nigerian patients with NIDDM.

The effect of glycaemic control on the prevalence and pattern of dyslipidaemia in Nigerian patients with newly diagnosed non insulin dependent diabetes mellitus.

Dyslipidaemia (DL) is a common condition in patients with NIDDM, but its prevalence and the effect of glycaemic control on the disorder have only been scantily reported in Nigerians. The present study is therefore aimed at determining the effect of diabetic control on prevalence and pattern of DL in Nigerian patients with NIDDM. Thirty six diabetics were followed up for 24 weeks. Indices determined included anthropometric measurements, fasting (FBG) and two hour post prandial blood glucose (2 hours PPBG), together with glycated haemoglobin (GHb) levels, and fasting lipids at presentation, 12 and after 24 weeks of treatment. The prevalence rates of raised total cholesterol/high density lipoprotein cholesterol (TC/HDL) ratio reduced HDL-cholesterol and mixed DL decreased significantly between 0-week and 24 weeks of treatment (57.1% vs 14.3% 50% vs 11.4% and 44% vs 22.2% respectively, P < 0.001 for each). The proportion of patient with elevated low-density lipoprotein-cholesterol also decreased significantly from 21.4% at 0-week to 8.8 after 24 weeks (P < 0.025). On the other hand, the prevalence of hypercholesterolaemia and hypertriglycerilaemia were not significantly changed between 0 and 24 weeks (P > 0.05). Patients with DL despite treatment were characterised by higher FBG at 24 weeks of treatment compared with normolipidaemic patients (P < 0.001). It is concluded from this study that improved glycaemic control reduced some dyslipidaemia, and may therefore suffice to correct them in some Nigerian patients with NIDDM.

Biophysical and biochemical analysis of semen in infertile Nigerian males.

Biophysical analysis of semen was performed in fifty-eight Nigerian male partners of infertile marriages. Sperm count concentration was significantly higher (P < 0.001) in oligospermics compared to normospermics as expected. However, there was no significant difference in sperm volume or motility percentage between the normospermics and the oligospermics; of course, no sperms were seen in the azoospermics. Biochemical analyses of serum zinc, copper, magnesium, and manganese by atomic absorption spectrophotometry [8] were further correlated in fifty-two patients. There were no statistically significant differences observed in the serum levels of zinc, magnesium, and copper among the normospermics, oligospermics, and azoospermics. The normospermic infertile patients, however, exhibited higher serum manganese when compared with oligospermics and azoospermics (P < 0.001). This finding suggests a potential role for manganese in the evaluation of infertile males.

Urinary iodine excretion in mothers and their breast-fed children in relation to other childhood nutritional parameters.

OBJECTIVE: There is currently no coordinated policy on the epidemiology and control of iodine deficiency disorders (IDD) in many parts of Africa even where these disorders are endemic. Assessment of the urinary iodine excretion is believed to give the best index of the prevalence of IDD in the community. This study aimed to establish whether: (i) the breast-fed child of an iodine replete mother was protected from IDD and, (ii) infants at risk of IDD and in need of immediate iodine supplementation could easily be identified through simple screening methods. DESIGN: Randomized, cross-sectional study. SETTING: A tertiary care infant welfare clinic in Ibadan, South-western Nigeria, a geographical area recognised to be outside Nigeria's endemic goitre belt (goitre prevalence < 5.0%). SUBJECTS: 68 healthy mother-child pairs. The children were all aged 9-18 months and breast-fed almost exclusively. INTERVENTIONS: Nil. METHODS: The relationships of anthropometric, iodine status (casual urinary iodine (I) and iodine/creatinine ratio (I/Cr)) and nutritional indices (weights, haematocrits) of the mothers with those of their breast-fed children were assessed, as well as how these parameters differed between the children classified on the basis of their mid-upper arm circumference, MUAC, as: (A) borderline malnourished, MUAC < 13.5 cm and, (B) well nourished, MUAC > 13.5 cm. RESULTS: The maternal values for I and I/Cr were significantly (p < 0.001) greater than those of their breast-fed infants, although the respective mother-child pair values correlated positively (I, r 0.47; I/Cr, 0.21; both p < 0.05). There was thus a gradient in iodine status between the mother and her breast-fed infant that is unfavourable to the growing child; the latter may thus require iodine supplementation in spite of the fact that the mother is iodine replete. Among the children, those considered well nourished (Group B) had similar iodine status parameters as those considered poorly nourished (Group A) suggesting that malnutrition alone should not be the determinant of the prioritization (or otherwise) of iodine supplementation in a population with coexistent iodine deficiency and malnutrition. Mean values for (I) in all the children (9.9 micrograms/dl) fell in the iodine deficiency range ( < 10 micrograms/dL), although all the mothers were iodine replete (mean urinary (I) 14.5 micrograms/dL), despite the fact that all resided in a non iodine deficient area. CONCLUSION: The study suggests that: (i) the breast-fed child of an iodine replete mother resident in a non-iodine deficient area may be iodine deficient and in need of iodine supplementation; (ii) malnutrition, as defined by the simple community screening method of measuring the MUAC, will not accurately identify those infants in immediate need of iodine supplementation. These observations have important implications for planning IDD control programmes in Africa.

The psychological condition of a cohort of Nigerian diabetic subjects.

The emotional condition and cognitive function of 37 insulin requiring (IDD) and 46 non-insulin requiring (NIDD) diabetics (in stable conditions) were compared, using the Hospital Anxiety and Depressive Scale (HAD) and the Mini-Mental State Examination (MMSE). About 5% of IDD and 4% of NIDD had threshold score for clinical anxiety; while 37.8% of IDD and 15.2% of NIDD had depression. The prevalence rate of depression for the entire cohort was 25.3%, while the rate for anxiety was 4.8%. Only the illiterates among IDD had up to threshold score for depression. The most common reported symptoms were, the feelings of not being able to enjoy things as usual, and not looking forward with enjoyment to things. Cognitive function was predominantly normal, not being significantly associated with HAD scale scores, age, duration of illness and level of education. Compared with previous reports in the same hospital, diabetics experienced significantly less depressive symptoms than cancer patients. The findings are similar to reports from developed countries in showing that IDD subjects are more emotionally disturbed than NIDD subjects; and that depression is a commonly feature of chronic debilitating illness. Clinicians need to be sensitive to the emotional condition of their patients, because depression impairs the ability to comply with treatment and therefore mars prognosis.

The psychosocial problems of sickle cell disease sufferers and their methods of coping.

We interviewed 170 sickle cell disease (SCD) patients (mean age 25 years) with a modified version of the Frankfurter Befindlichkeitskala (FBS, 33-item) and the 12-item General Health Questionnaire (GHQ-12), with a view to highlighting the psychosocial issues which worry them, the way they cope with these problems, and the factors associated with these issues. The mean FBS score of SCD patients was comparable with those of insulin dependent diabetics, but significantly higher than that of non-insulin dependent diabetics. The FBS scores were significantly correlated with GHQ-12 scores. Feelings of inadequacy of social contact were significantly associated with high FBS and GHQ scores. Some common complaints were: the limitations illness placed on social life; depressive feelings; abnormal habitus; suicidal ideation during crises; and the burden of illness on the family. They frequently resorted to prayers as a method of coping, as most had no clear ideas on how to deal with these issues. Worries over psychosocial consequences of SCD, seem to add considerably to the burden of illness, and clinicians will offer better care to patients if they routinely enquire into some of these issues and offer health education and counselling in a group setting.

The problems of peritoneal dialysis in the management of chronic uraemia in Nigeria.

The problems encountered in the use of peritoneal dialysis (PD) in the initial management of patients with chronic renal failure in Nigeria were highlighted, studying 23 patients (13 males and 10 females) aged between 15 and 68 years (mean age 36.4 years). Peritonitis was the most common complication, occurring in 16 (70%) of patients; effluent drainage obstruction in 11 patients (48%); haemorrhagic effluent in 10 patients (44%); fluid leak from catheter site infection in 7 patients (30%); accidental disconnection of line/catheter joint in 5 patients (22%); and catheter site infection in 2 patients (9%). A positive effluent culture was found in only 4 out of 18 cultured samples, with Klebsiella and Staphylococcus aureus being the organisms isolated. Dialysis was terminated in patients for the following reasons: financial constraints (8 patients), unresolving peritonitis (7 patients), drainage problems (3 patients), and clinical improvement (5 patients). The study concludes that PD in the management of chronic uraemia in developing countries, while producing clinical benefits in the majority of patients, is still not generally acceptable as a long-term treatment modality in view of the number of problems.

Insulin responses following glucose administration in menstruating women.

OBJECTIVE: The aim of the study was to investigate changes in insulin sensitivity during the menstrual cycle, in a group of regularly menstruating black African women. METHOD: Insulin responses to intravenous glucose (300 mg/kg) were assessed, for up to 3 h, in 3 groups of age- and body mass-matched non-obese sedentary Nigerian women: Group A, 7 women in the menstrual follicular phase; Group B, 7 women in the menstrual luteal phase; C, 7 men. RESULT: Women in the menstrual luteal phase had the greatest integrated first-phase insulin response and insulin/glucose ratios, much higher than the similar values for these variables obtained in other groups. This suggests that the menstrual luteal phase is associated with relative insulin resistance. CONCLUSION: Black African women in the menstrual luteal phase demonstrate an exaggerated insulin response to an acute glucose load and are thus relatively insulin-insensitive. This confirms previous observations in Caucasians.

Glucose and insulin responses to intravenous glucose challenge in relatives of Nigerian patients with non-insulin-dependent diabetes mellitus.

We analysed blood insulin and glucose concentrations before and during frequently sampled intravenous glucose tolerance tests (FSIGT) in 2 groups of Nigerian subjects: (A) Control group (n = 18), without a positive family history of diabetes mellitus, and (B) Experimental group (n = 16), comprising age-, sex- and body mass-matched first-degree relatives of patients with non-insulin-dependent diabetes mellitus (NIDDM). In comparison with Group A subjects, those in Group B had: (i) higher fasting plasma glucose level (mean +/- S.E.M. 4.1 +/- 0.1 vs. 3.8 +/- 0.11 mmol/l, P < 0.05); (ii) similar fasting serum insulin levels (6.7 +/- 5.0 vs. 5.8 +/- 5.6 mU/l, P = NS); (iii) lower mean incremental area under the first-phase (t = 0-10 min) post-glucose challenge insulin curve (376.9 +/- 8.8 vs. 435.6 +/- 5.6 mU/min l-1, P < 0.05); (iv) increased incremental area under the second-phase (t = 10-182 min) post-glucose challenge insulin curve (432.9 +/- 11.5 vs. 161.3 +/- 8.7 mU/min l-1, P < 0.05); (v) reduced KG rate constant of glucose elimination (0.97 +/- 0.12 vs. 1.41 +/- 0.12%/min, P < 0.05). These results suggest that the subjects with a positive family history of NIDDM have a reduced beta-cell insulin secretory reserve (from reduced first-phase insulin response), tendency to rebound hyperinsulinemia during the latter phase of the insulin secretory response, a degree of tissue insulin insensitivity (as evident from high fasting plasma glucose despite similar insulin levels) and a diminished glucose disposal rate, in comparison with subjects without a family history of NIDDM. These features predict subsequent development of diabetes and suggest that as in Caucasians, first-degree relatives of Nigerian patients with NIDDM are at greater risk for future development of the disease.