Outcome of surgery for toxic goitres in Maiduguri: a single teaching hospital's perspective.

BACKGROUND: Thyrotoxicosis a common endocrine disorder of the thyroid gland in Nigeria is commonly treated surgically. The outcome of thyroidectomy for toxic goiters in Maiduguri Nigeria is evaluated. MATERIALS AND METHODS: Over the last 5 years (Jan 2005-July 2010) , in a prospective review, the demographic, and clinical data of patients operated for toxic goiters in our department was entered, into a predesigned proforma and analyzed. The objective of the study is to review our experience with subtotal and near-total thyroidectomy as treatment for benign toxic goiters. RESULTS: Seventy-eight patients, 11 males (14.1%) and 67 females (85.9%), with male: female ratio of 1:6.1 and the mean age of 30 ± 10.9 (range, 17-65 years), underwent thyroidectomy for toxic goiters. The mean duration of symptoms was 41.9 (range 3-126 months). There were 53 patients with toxic diffuse goiters (Grave's disease) with their mean age of 27.6 ± 6.93 (range 17-38 years), 23 with toxic multinodular goiters, the mean age of 43.7 ± 15.68 (range 17-65 years) and two with toxic nodule. There was no case of permanent recurrent laryngeal nerve palsy or permanent hypocalcemia. Transient hypocalcemia occurred in 9 (11.5%) patients and hemorrhage with hematoma, requiring exploration in 4 (5.1%). There were two cases of wound infection and no postoperative mortality. The mean hospital stay was 7.6 ± 2.34 (range 5-15 days). There was no disease recurrence over a mean follow-up of 20.7 (range 2-48) months. CONCLUSION: Subtotal thyroidectomy is an effective procedure for the treatment of thyrotoxicosis with few postoperative complications and majority of patients being euthyroid after long follow-up.

Correlation of oxidative stress and inflammatory markers with the severity of sickle cell nephropathy.

BACKGROUND: Reactive oxygen species have been shown to mediate inflammatory process and may be involved in lipid peroxidation. METHODS: This study evaluates superoxide dismutase, glutathione peroxidase, catalase, malondialdehyde, C- reactive protein and fibrinogen in the serum of patients with sickle cell disease and their correlation with renal insufficiency. Superoxide dismutase, glutathione peroxides and C - reactive protein were assayed using sandwich ELISA technique while malondialdehyde and fibrinogen were determined using thiobarbituric reactive substance and turbidometric technique, respectively. RESULTS: The study group consisted of 40 patients with sickle cell disease along with macroalbuminuria, 16 with chronic kidney disease and 144 sickle cell disease controls. Superoxide dismutase, glutathione peroxidase and catalase were decreased while malondialdehyde, C-reactive protein and fibrinogen were increased in patients with sickle cell disease along with renal insufficiency. These parameters correlated with the severity of renal disease. CONCLUSION: Oxidative stress and inflammatory parameters correlate with sickle cell disease nephropathy.

Antiphospholipids Antibodies and Migraine

Background: Antiphospholipids antibodies has been associated with non-thrombotic neurological conditions such as migraine. We set out to estimate the concentration of antiphospholipids antibody among patients with migraine and normal population. Methods: This is prospective case-control study of 158 subjects including 82 migraine patients who fulfilled the International Headache Society criteria for the diagnosis of migraine headache and 76 age and sex-matched controls who were mostly hospital staff and medical students. Blood samples were taken for quantification of antiphospholipids antibodies. Results: There were 28 males and 54 females among the migraine patients and 30 males and 46 females among the controls. Their mean ages were 28.8 + 8.4 years and 26.4 + 3.9 years; respectively. Migraine patients had increased level of aPL (lgG anti Beta2GP1) 27.76 + 14.47IU/ml compared to the normal healthy adults (21.43 + 9.4IU/ml) (p0.05). Similarly; antiphospholipid antibodies was significantly elevated in migraine patients with aura compared to those without aura; (?2

Role of a diagnostic laboratory in the management of diabetes mellitus.

OBJECTIVE: To elucidate the role of a modern diagnostic laboratory in the management of diabetes mellitus. SOURCES OF DATA: Available literature on local and international studies on the role of the laboratory in the management of diabetes mellitus. RESULTS: Preclinical diagnosis of diabetes mellitus, good monitoring of short, medium and long-term glycaemic control necessary to avoid diabetic complications in poor resource settings are now possible with modern diagnostic laboratories. CONCLUSION: Creating the required awareness on the roles of a diagnostic laboratory in the management of diabetes mellitus is needed now more than ever before in resource poor nations otherwise the success achieved by the developed world where diabetic patients become insulin independent after islet cell transplant with glucocorticoid free immunosuppression cannot be attained in the near future.

Serum antiphospholipid antibodies among healthy adults in northeastern Nigeria.

BACKGROUND: Antiphospholipid antibodies have been associated with variety of conditions. There is no standard health associated reference values required for the interpretation of antiphospholipid antibodies result available among adults in North- eastern Nigeria and Nigeria in general. The aim of this study is to determine the normal serum level (cutoffpoint) in healthy adult Nigerians. The need or otherwise for stratification of the reference values by sex would also be determined. METHODS: Seventy-six healthy adults' medical students and health workers were enrolled in the study over the period of twelve consecutive months. Blood samples were taken for quantification of antiphopholipid antibodies using Enzyme Linked Immunosorbent Assay (ELISA) technique. Apparently healthy adults age between 16-50 years who are neither human immunodeficiency virus positive nor VDRL positive were included in the study. Reference values were calculated by parametric method. RESULTS: The mean serum concentration of IgG Antiâ2GP1 for the sample population was 21.43 +/- 9.43 U/ml. The mean serum concentration of IgG Antiâ2GP1 for males was 18.6 +/- 7.6 U/ml while for the female sample population was 22.7+/-10.2 U/ml. There is no gender variation (P > 0.05). CONCLUSION: The reference value for serum antiphospholipid antibodies in healthy adults in Northeastern Nigeria was 21.43 +/- 9.43 U/ml. The reference values should be used in this environment for both sexes. Extension of the scope of the study to cover the entire homogenous society of Northern Nigeria is recommended.

Pattern of biochemistry laboratory requests and results in north eastern Nigeria.

OBJECTIVES: Deficient action of insulin is associated with derangement of carbohydrate, fat and protein metabolism. Determination of the extent of such derangement in steady state type 2 diabetic patients enhances management planning and prevents diabetic complications. This is necessary in a poor resource setting where functional national health insurance scheme is not available. The study aimed at assessing the level of plasma glucose and lipids, renal function, total calcium, inorganic phosphates and albumin and their relevance in steady state type 2 diabetic patients in north-eastern Nigeria in order to minimize the cost of laboratory investigations while preventing diabetic complications. METHOD: Two hundred and eighteen steady state type 2-diabetic patients were recruited at the Chemical pathology laboratory of the University of Maiduguri Teaching Hospital over a period of one year. Tests requested by the Clinicians for steady state diabetics were collated, the pattern of biochemistry laboratory requests and results were determined. The mean and standard deviation of the results were calculated. RESULTS: Out of the 218 steady state diabetics, only 48 (22.2 % ) had good short-term glycaemic control (fasting blood glucose < 7mmol/l). No test for long-term glycaemic control was requested during the study period. Lipid profile and protein assessment were carried out in 30% and 52.3 % of the patients respectively. Biochemical tests were not optimally utilised and this resulted in poor glycaemic control. CONCLUSION: Proper utilisation of laboratory tests for adequate long-term glycaemic control through team work approach with laboratory physicians are recommended.