Vitamin D supplementation improves insulin resistance in type 2 diabetes subjects in Lagos, Nigeria

Type 2 diabetes is a disease caused by both insulin resistance and an insulin secretory defect. Reports suggest that vitamin D3 supplementation improves insulin resistance and pancreatic beta-cell function, but there is paucity of data on vitamin D and glycaemia in type 2 diabetes in Nigeria. We have therefore performed a single blind prospective randomised placebo-controlled trial, involving type 2 diabetes participants in Lagos, Nigeria. The participants consisted of 42 type 2 diabetes patients with vitamin D deficiency. These participants were randomised into two equal groups of treatment and a placebo arm. Vitamin D3(3000 IU daily) was given to the participants in the treatment arm. Insulin resistance (HOMA-IR) and pancreatic beta-cell (HOMA-B) function were determined at baseline and after 12 weeks of vitamin D3 supplementation, or placebo treatment. There was a reduction from baseline in the mean insulin resistance level in both the treatment and placebo groups. How-ever, this reduction was only statistically significant in the treatment group (p <0.01). The proportion of subjects with improvement in insulin resistance status (homeostatic model assessment insulin resistance score (HOMA-IR)<2.0) was significantly higher in the treatment arm (p<0.05). There was a reduction in the mean insulin secretory capacity in the treatment group while it increased in the placebo group, though this difference was not statistically significant. We conclude that vitamin D3 supplementation results in a reduction in insulin resistance, but has no effect on pancreatic beta-cell function in type 2 diabetes

Body mass index and its effect on serum cortisol level.

INTRODUCTION: Cortisol measurement is indicated in suspected over or under production of cortisol by the adrenal cortex. The finding of low cortisol can create concern and initiate further investigations for the exclusion of adrenal insufficiency. Cushing's syndrome is frequently included in the differential diagnosis of obesity. Some literature describes reduced serum cortisol levels in obesity, however, this is not a well-recognized phenomenon. AIM: The aim of this study was to determine the relationship between body mass index (BMI) and serum cortisol levels. SUBJECTS, MATERIALS AND METHODS: Seventy healthy participants agreed to take part in the study. The anthropometric measurements (weight, height, and waist and hip circumferences) were done. Exclusion criteria include those with a history of adrenal/pituitary disease or medications altering cortisol level. The basal cortisol (BC) sample was taken at 8 a.m. immediately before administration of an intravenous bolus injection of 250 µg adrenocorticotropic hormone (ACTH). BMI categories were defined as normal and high if BMI was 18.5-24.99 kg/m² and ≥ 25 kg/m², respectively. RESULTS: Forty (57.1%) participants had normal BMI while 30 (42.9%) participants had BMI ≥ 25 kg/m² (P0 = 0.053). The mean BC level was lower in participants with BMI ≥ 25 kg/m² but not significant. There was a negative correlation between BMI and BC level ( r = -0.205, P = 0.88) while a positive correlation existed between stimulated cortisol level and BMI (r = 0.009, P = 0.944). CONCLUSION: Persons with BMI above 25 kg/m² had lower BC level though not statistically significant, the trend was noticed. Subjecting people whose BMI is above 25 kg/m² to further stimulation with ACTH because of low BC is not advised because their response to ACTH stimulation was similar to those who have normal BMI.

Prevalence of dysglycemia in Calabar: a cross-sectional observational study among residents of Calabar, Nigeria.

OBJECTIVE: Population data on dysglycemia are scarce in West Africa. This study aimed to determine the pattern of dysglycemia in Calabar city in South East Nigeria. DESIGN: This was a cross-sectional observational study. METHODS: 1134 adults in Calabar were recruited. A multistage sampling method randomly selected 4 out of 22 wards, and 50 households from each ward. All adults within each household were recruited and an oral glucose tolerance test was performed. Dysglycemia was defined as any form of glucose intolerance, including: impaired fasting glucose (blood glucose level 110-125 mg/dL), impaired glucose tolerance (blood glucose level ≥140 mg/dL 2 h after consuming 75 g of glucose), or diabetes mellitus (DM), as defined by fasting glucose level ≥126 mg/dL, or a blood glucose level ≥200 mg/dL, 2 h after a 75 g glucose load. RESULTS: Mean values of fasting plasma glucose were 95 mg/dL (95% CI 92.1 to 97.5) for men and 96 mg/dL (95% CI 93.2 to 98.6) for women. The overall prevalence of dysglycemia was 24%. The prevalence of impaired fasting glucose was 9%, the prevalence of impaired glucose tolerance 20%, and the prevalence of undiagnosed DM 7%. All values were a few percentage points higher for men than women. CONCLUSIONS: The prevalence of undiagnosed DM among residents of Calabar is similar to studies elsewhere in Nigeria but much higher than the previous national prevalence survey, with close to a quarter of the adults having dysglycemia and 7% having undiagnosed DM. This is a serious public health problem requiring a programme of mass education and case identification and management in all health facilities. TRIAL REGISTRATION NUMBER: CRS/MH/CR-HREC/020/Vol.8/43.

Assessment of anthropometric indices among residents of Calabar, South-East Nigeria.

BACKGROUND: Obesity is a risk factor for type 2 diabetes mellitus which may be addressed by application of intensive lifestyle interventions. Thus, establishing normative values of anthropometric indices in our environment is crucial. This study aimed to determine normative values of anthropometric indices of nutrition among residents of Calabar. MATERIALS AND METHODS: This cross sectional observational study recruited residents of Calabar aged between 15-79 years using a multistage sampling method. Trained research assistants collected socio-demographic data and did anthropometric measurements. RESULTS: There were 645 (56.5%) males and 489 (43.1%) females. Males had significantly lower general adiposity and hip circumference (HC) than females while females had significantly lower waist circumference (WC) and waist hip ratio (WHR) than males. The WHR increased with age particularly among males. Body mass index (BMI) also increased with age in both males and females with a peak in the middle age bracket, followed by a decline among the elderly. The mean (SD) BMI was 27.7 (5.0) kg/m(2). Males had a mean (SD) BMI of 27.0 (4.4) kg/m(2), while females had a mean (SD) BMI of 28.5 (5.5) kg/m(2) respectively. WC correlated positively and significantly with BMI and WHR in males and females. WHR correlated positively and significantly with BMI in males and females. CONCLUSION: There are positive linear inter relationships between the indices of nutrition which is strongest between WC and BMI. In view of the strong independent association of DM with indices of nutrition, it is appropriate to derive normal cut-off values for WC, WHR and BMI nationally.

Endocrine-related diseases in the emergency unit of a Tertiary Health Care Center in Lagos: A study of the admission and mortality patterns.

INTRODUCTION: Non-communicable diseases are emerging as an important component of the burden of diseases in developing countries. Knowledge on admission and mortality patterns of endocrine-related diseases will give insight into the magnitude of these conditions and provide effective tools for planning, delivery, and evaluation of health-care needs relating to endocrinology. MATERIALS AND METHODS: We retrieved medical records of patients that visited the emergency unit of the Lagos University Teaching hospital, over a period of 1 year (March 2011 to February 2012) from the hospital admissions and death registers. Information obtained included: Age, gender, diagnosis at admission and death, co-morbidities. Diagnoses were classified as endocrine-related and non-endocrine related diseases. Records with incomplete data were excluded from the study. RESULTS: A total of 1703 adult medical cases were seen; of these, 174 were endocrine-related, accounting for 10.2% of the total emergency room admission in the hospital. The most common cause of endocrine-related admission was hyperglycaemic crises, 75 (43.1%) of cases; followed by diabetes mellitus foot syndrome, 33 (19.0%); hypoglycaemia 23 (13.2%) and diabetes mellitus related co-morbidities 33 (19.0%). There were 39 endocrine-related deaths recorded. The result revealed that 46.1% of the total mortality was related to hyperglycaemic emergencies. Most of the mortalities were sepsis-related (35.8%), with hyperglycaemic crises worst affected (71.42%). However, the case fatalities were highest in subjects with thyrotoxic crisis and hypoglycaemic coma. CONCLUSION: Diabetic complications were the leading causes of endocrine-related admissions and mortality in this health facility. The co-morbidity of sepsis and hyperglycaemia may worsen mortality in patients who present with hyperglycaemic crises. Hence, evidence of infection should be sought early in such patients and appropriate therapy instituted.

Rural-urban difference in plasma lipid levels and prevalence of dyslipidemia in Hausa-Fulani of north-western Nigeria.

OBJECTIVES: To compare the serum lipids levels, prevalence of dyslipidaemia, and adiposity of rural versus urban dwellers in Sokoto, Nigeria. METHODS: A cross-sectional study was conducted in both rural and urban areas of Sokoto, Nigeria. One hundred participants were recruited using a multi-stage sampling method. Demographic data and anthropometric measurements were obtained. Fasting blood was drawn for assessment of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol. The classification of dyslipidemia was based on the National Cholesterol Education Program-Adult Treatment Panel guidelines. RESULTS: The (mean [SD]) waist circumference of the urban participants (83.8 [9.5] cm) was significantly higher than the rural participants (79.2 [11.2] cm) (P = .030). The mean BMI of the urban participants (23.9 [3.9] kg/m2) was higher than the rural participants (22.2 [3.7] kg/m2) (P = .09). The mean TC was significantly higher in urban (175.9 [49.6] mg/dL) than rural participants (148.3 [24.3] mg/dL) P < .001. Mean serum LDL-C, and TG concentrations were higher in the urban than rural participants but the difference was not statistically significant. Mean serum HDL-C was also insignificantly higher in the rural (51.1 [7.9] mg/dL) than in urban participants (50.2 [11.7] mg/dL) (P = .64). The most frequent dyslipidemia was abnormally low HDL-C (13%) and this was more common in the urban participants (16%) than in rural participants (10%). CONCLUSION: This study demonstrated that compared to the rural dwellers, the urban dweller were more likely to be obese and had higher frequency of adverse plasma lipid profile. This may have implications for rural-urban patterns of lipid related cardiovascular disease.

Adrenocortical function in Nigerians with human immunodeficiency virus infection.

OBJECTIVE: This study sets out to determine the prevalence of adrenocortical insufficiency in persons with HIV infection by determining the response to low-dose (1 µg) ACTH stimulation. DESIGN: An experimental study involving people with HIV infection and healthy people. SETTING: The study group and the controls were recruited from the Lagos University Teaching Hospital (LUTH). PARTICIPANTS: forty-three newly diagnosed and treatment naïve persons with HIV (23 males and 20 females) and 70 (35 males and 35 females) HIV negative subjects completed the study. INTERVENTION: One µg Synacthen was given intravenously to stimulate the adrenal glands. MAIN OUTCOME MEASURES: Blood was collected for basal cortisol levels and 30 minutes after the injection of ACTH. Cortisol was assayed using ELISA. RESULTS: The mean basal cortisol was 154.9 ± 27.2 nmol/L and 239.9 ± 31.6 nmol/L (p<0.001); while the 30-minute post ACTH test cortisol level was 354.8 ± 19.9 nmol/L and 870.9 ± 163.5 nmol/L (p<0.001) and the increment was 100.0 ± 17.2 nmol/L and 588.8 ± 143.4 nmol/L (p<0.001) in HIV and healthy subject group respectively. Using the diagnostic criteria derived for the diagnosis of adrenocortical insufficiency in this study (30 minute cortisol level <380.2 nmol/L and increment from basal to stimulated cortisol level <158.5 nmol/L); fifteen (34.8%) persons with HIV had adrenal insufficiency. CONCLUSION: Adrenocortical insufficiency is common in persons with HIV infection, occurring in about 34.8% of patients studied. Clinically evident adrenocortical insufficiency is uncommon in persons with HIV.

Prevalence of hypertension amongst persons with diabetes mellitus in Benin City, Nigeria.

OBJECTIVE: To determine the prevalence of hypertension amongst persons with diabetes mellitus (DM) in Benin city. MATERIALS AND METHODS: Four hundred and fifty diabetic subjects were evaluated for hypertension by measuring their blood pressure using a sphygmomanometer at the diabetes clinics of the University of Benin Teaching Hospital and Central Hospital, both in Benin City, Nigeria. Other data obtained included age, sex, type of DM, weight, height, body mass index and waist hip ratio. RESULTS: Two hundred and forty-four out of 450 subjects had hypertension, thus giving a prevalence rate of 54.2%. 124 males (50.8%) were hypertensive compared with 120 (49.2%) females, but this difference was not significant (χ2 = 0.1, df = 1, P > 0.05). Thirteen (22.4%) of the 58 Type 1 subjects had hypertension, while 231 (58.9%) of the Type 2 subjects had hypertension, and this difference was statistically significant (χ2 = 27, df = 1, P < 0.05). CONCLUSIONS: Hypertension is prevalent in persons with DM. Studies have shown that adequate control of the blood pressure reduces the microvascular and macrovascular complications of DM. DM care providers must prescribe appropriate antihypertensive therapy to control hypertension in persons with DM.

Writing biomedical manuscripts part I: fundamentals and general rules.

It is a professional obligation for health researchers to investigate and communicate their findings to the medical community. The writing of a publishable scientific manuscript can be a daunting task for the beginner and to even some established researchers. Many manuscripts fail to get off the ground and/or are rejected. The writing task can be made easier and the quality improved by using and following simple rules and leads that apply to general scientific writing .The manuscript should follow a standard structure:(e.g. (Abstract) plus Introduction, Methods, Results, and Discussion/Conclusion, the IMRAD model. The authors must also follow well established fundamentals of good communication in science and be systematic in approach. The manuscript must move from what is currently known to what was unknown that was investigated using a hypothesis, research question or problem statement. Each section has its own style of structure and language of presentation. The beginning of writing a good manuscript is to do a good study design and to pay attention to details at every stage. Many manuscripts are rejected because of errors that can be avoided if the authors follow simple guidelines and rules. One good way to avoid potential disappointment in manuscript writing is to follow the established general rules along with those of the journal in which the paper is to be published. An important injunction is to make the writing precise, clear, parsimonious, and comprehensible to the intended audience. The purpose of this article is to arm and encourage potential biomedical authors with tools and rules that will enable them to write contemporary manuscripts, which can stand the rigorous peer review process. The expectations of standard journals, and common pitfalls the major elements of a manuscript are covered.

Glycaemic response to some commonly eaten fruits in type 2 diabetes mellitus.

BACKGROUND: It is not known which of the commonly consumed fruits in Nigeria are suitable for persons with diabetes mellitus especially with regards to the attendant plasma glucose response (PGR) to consumption of such fruits. OBJECTIVES: To determine and compare the PGR to commonly eaten fruits in patients with diabetes mellitus. METHODS: Ten persons with type 2 diabetes mellitus were studied. Fifty-gram portions of five fruits containing 50 g carbohydrate [ banana, Musa paradisiaca; orange, Citrus sinensis; pineapple, Ananus comosus; mango, Magnifera indica; pawpaw, Carica papaya], and glucose were randomly fed to the study subjects at one-week intervals. Blood samples were collected in the fasting state and half-hourly over a 2- hour period post-ingestion of the fruits or glucose for plasma glucose determination. Plasma glucose responses were assessed by the peak plasma glucose concentration (PPPG), maximum increase in postprandial plasma glucose (MIPG), two-hour postprandial plasma glucose level (2hPG) and incremental area under the glucose curve (IAUGC). RESULTS: The mean ± SEM PPPG in mmol/L were: banana, 9.0± 1.6; orange, 8.1± 0.8; pineapple, 9.2±1.1; mango, 8.0 ± 1.1; and pawpaw, 7.8±0.9. The mean ±SEM IAUGC in mmol.min/L were: banana, 131.7±53.4; orange, 108.7±29.8; pineapple, 115.3±33.2; mango, 101.6 ± 28.7; and pawpaw, 124.1± 46.1. However, mango showed the least MIPG (1.8 ± 0.5 mmol/l) followed by orange and pawpaw. The IAUGC also followed this pattern. There were no significant differences among the glycaemic indices of the fruits. Glucose load produced a significantly higher IAUGC than the fruits (orange, pineapple, mango, pawpaw, p<0.005; banana, p<0.025). CONCLUSION: The plasma glucose response to consumption of Nigeria fruits are similar. The PGR indices to all fruits were less than the PGR after an equivalent carbohydrate load of glucose. It appears safe to recommend these Nigerian fruits to persons with diabetes within the prescribed daily total calorie intake.

Adrenocortical function in Nigerian patients with pulmonary tuberculosis (PTB).

Addison's disease was frequently consequent upon affectation of the glands by tuberculosis. Pulmonary Tuberculosis (PTB) is still very common in Nigeria but no report on the functional status of the adrenal cortex in patients with PTB in Nigeria exists. It is very important to note that subclinical adrenocortical failure in tuberculosis is an entity that should be considered as cortisol deficiency could be responsible for unexpected sudden death in this category of patients. This study sets out to determine the prevalence of subclinical adrenocortical failure in persons with PTB by determining the response to low-dose (1 ìg) ACTH stimulation. Forty four persons with newly diagnosed sputum-positive PTB and treatment naive, (23 males and 21 females, mean age 34.4 +/- 11.3 years, and mean body mass index (BMI) of 18.9 +/- 2.9 kg/m2) completed the study. Of the one hundred healthy volunteers recruited as control subjects, 70 persons (35 males and 35 females, mean age 38.1 +/- 12.5 years, BMI 24.1 +/- 3.7 kg/m2) completed the exercise. There was no statistically significant difference in the basal cortisol of healthy subjects and persons with PTB (239.9 vs. 229.1 nmol/L, p = 0.661). The thirty minute response to ACTH stimulation test and increment were significantly lower in persons with PTB than in healthy subjects. Adrenocortical insufficiency, mostly at the subclinical level, is common in persons with PTB infection, occurring in about 23% of patients. We therefore recommend that basal cortisol levels should not be used to detect adrenocortical insufficiency; rather stimulation tests should be used to exclude or confirm suspected adrenocortical insufficiency in patients with PTB.

Dysglycaemia and its risk factors in an urban Fulani population of northern Nigeria.

BACKGROUND: The Fulani are a normally nomadic people known for covering great distances on foot with a resulting lean physique and presumably low incidence of diabetes mellitus (DM). The occurrence of glucose intolerance among the urban Nigerian Fulani has not been reported. OBJECTIVE: To determine the prevalence of dysglycaemia and its correlates among urban Fulani. METHODS: Three hundred and eighty-nine Fulani were recruited from urban areas of Sokoto state using a multi-stage sampling technique. Using a modification of the WHO STEPS instrument, information on socio-demographic and anthropometric data was gathered. Either casual or fasting plasma glucose was obtained in all subjects while oral glucose tolerance test (OGTT) was performed in a randomly selected subset of 48 subjects. Glucose intolerance or dysglycaemia was defined using WHO criteria as the presence of diabetes mellitus, impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT). Classifications of adiposity as body mass index (BMI) and waist circumference (WC) and blood pressure were made using standard criteria. RESULTS: Of the 389 subjects studied, 190 (48.8%) were females while 199 (51.2%) subjects were males (c2=5.43, p> 0.05). The overall mean (SD) age of the sample population was 39.3 (14.2) years with the males [42.0 (13.8) years] being significantly older than the females [36.4 (14.1) years], p< 0.05. Eighteen (4.6%) subjects had previously undiagnosed type 2 diabetes mellitus while 37(16.9%) of the subjects had IFG and seven (14.6%) subjects had impaired glucose tolerance. The mean FPG was higher in the males [5.49 (1.7) mmol/l] than in the females [5.25 (1.9) mmol/l],p=0.33. The overall mean two-hour plasma post glucose-load was 6.5 (1.6) mmol/l; higher in the males [6.9 (2)] mmol/l than in the females [6.2 (1) mmol/l] , p=0.55.The mean age, BMI, waist circumference and blood pressure of subjects with dysglycaemia were significantly higher than those in subjects with normoglycaemia (p<0.05). CONCLUSION: Prevalence of dysglycaemia in the urban Fulani population of Northern Nigeria is high and much higher in the male than female Fulani. Occurrence of obesity and hypertension appears lower than in other Nigerian reports. Occurrence of dysglycaemia in the urban Fulani increases with age, weight and waist circumference. There is need to conduct a similar study among rural Fulani to better appreciate the environmental influence on these variables.

Writing biomedical manuscripts part II: standard elements and common errors.

It is incumbent on, satisfying to, and rewarding for, researchers to have their work published. Many workers are denied this satisfaction because of their inability to secure acceptance after what they consider a good research. Several reasons account for rejection or delay of manuscripts submitted to biomedical journals. A research poorly conceptualised and/or conducted will fail to fly but poor writing up of the completed work accounts for a greater majority of manuscripts that get rejected. The chances of manuscript acceptance can be increased by paying attention to the standard elements and avoiding correcting the common errors that make for the rejection of manuscripts. Cultivating the habit of structuring every department of the manuscript greatly improves chances of acceptance. The final paper should follow the universally accepted pattern of aim , introduction , methods, results, and discussion. The sequence of putting the paper together is different from the order in the final form. Follow a pattern that starts with the Tables and figures for the results section , followed by final version of the methods section. The title and abstract should be about the last to be written in the final version of the manuscript. You need to have results sorted out early as the rest of what you will write is largely dictated by your results. Revise the work several times and get co - authors and third parties to help read it over. To succeed follow the universal rules of writing and those of the target journal rules while avoiding those errors that are easily amenable to correction before you submit your manuscript.

Comparison of low dose and standard dose adrenocorticotropin stimulation tests in healthy Nigerians.

Hypothalamo-pituitary-adrenal (HPA) axis dysfunction is a potentially life-threatening condition. It is of paramount importance that safe, reliable diagnostic tests be available to identify patients at risk for adrenal insufficiency. The 250 microg Adrenocorticotropic hormone (ACTH) stimulation test is commonly used to assess adrenocortical function. The 250 microg dose is supraphysiological, therefore several investigators, over the years, have used 1 microg ACTH stimulation test to assess adrenocortical function. The aim of the study was to compare the response of healthy adult Nigerian subjects to the 250 microg and 1 microg ACTH tests. Ten healthy subjects, five males and five females, aged between 20-60 years, (mean, 38.7 years) participated in this study. They all had normal medical histories and physical examinations, were nonsmokers, and had never received any type of glucocorticoid therapy. Serum chemistries, full blood counts, erythrocyte sedimentation rate, were all within normal limits. Both low dose ACTH test and standard dose ACTH test were performed on the 10 subjects in a randomized order on different days.There was no statistically significant difference in mean serum cortisol levels between the two test doses at 30 minutes (928.4 vs 929.8 nmol/L). There was a strong correlation between 30-minute cortisol responses to 1 microg and 250 microg ACTH stimulation tests, r = 0.999; p < 0.001. In agreement with other published data, our study confirms that 1 microg ACTH stimulates adrenocortical secretion in normal subjects in the period 30 minutes post injection comparable to 250 microg ACTH testing.

Comparison of low dose and standard dose adrenocorticotropin stimulation tests in healthy Nigerians

Hypothalamo-pituitary-adrenal (HPA) axis dysfunction is a potentially life-threatening condition. It is of paramount importance that safe; reliable diagnostic tests be available to identify patients at risk for adrenal insufficiency. The 250?g Adrenocorticotropic hormone (ACTH) stimulation test is commonly used to assess adrenocortical function. The 250?g dose is supraphysiological; therefore several investigators; over the years; have used 1?g ACTH stimulation test to assess adrenocortical function.The aim of the study was to compare the response of healthy adult Nigerian subjects to the 250?g and 1?g ACTH tests.Ten healthy subjects; five males and five females; aged between 20-60 years; (mean; 38.7 years) participated in this study. They all had normal medical histories and physical examinations; were nonsmokers; and had never received any type of glucocorticoid therapy. Serum chemistries; full blood counts; erythrocyte sedimentation rate; were all within normal limits. Both low dose ACTH test and standard dose ACTH test were performed on the 10 subjects in a randomized order on different days.There was no statistically significant difference in mean serum cortisol levels between the two test doses at 30 minutes (928.4 vs 929.8nmol/L). There was a strong correlation between 30-minute cortisol responses to 1?g and 250?g ACTH stimulation tests; r=0.999; p0.001.In agreement with other published data; our study confirms that 1?g ACTH stimulates adrenocortical secretion in normal subjects in the period 30 minutes post injection comparable to 250?g ACTH testing

Adrenocortical function in Nigerian patients with pulmonary tuberculosis (PTB)

Addison's disease was frequently consequent upon affectation of the glands by tuberculosis. Pulmonary Tuberculosis (PTB) is still very common in Nigeria but no report on the functional status of the adrenal cortex in patients with PTB in Nigeria exists. It is very important to note that subclinical adrenocortical failure in tuberculosis is an entity that should be considered as cortisol deficiency could be responsible for unexpected sudden death in this category of patients. This study sets out to determine the prevalence of subclinical adrenocortical failure in persons with PTB by determining the response to low-dose (1 ìg) ACTH stimulation. Forty four persons with newly diagnosed sputum-positive PTB and treatment naive, (23 males and 21 females, mean age 34.4 +/- 11.3 years, and mean body mass index (BMI) of 18.9 +/- 2.9 kg/m2) completed the study. Of the one hundred healthy volunteers recruited as control subjects, 70 persons (35 males and 35 females, mean age 38.1 +/- 12.5 years, BMI 24.1 +/- 3.7 kg/m2) completed the exercise. There was no statistically significant difference in the basal cortisol of healthy subjects and persons with PTB (239.9 vs. 229.1 nmol/L, p = 0.661). The thirty minute response to ACTH stimulation test and increment were significantly lower in persons with PTB than in healthy subjects. Adrenocortical insufficiency, mostly at the subclinical level, is common in persons with PTB infection, occurring in about 23% of patients. We therefore recommend that basal cortisol levels should not be used to detect adrenocortical insufficiency; rather stimulation tests should be used to exclude or confirm suspected adrenocortical insufficiency in patients with PTB

Prevalence of risk factors for diabetes mellitus in a non-diabetic population in Jos, Nigeria.

BACKGROUND: Diabetes mellitus (DM) is assuming epidemic proportions worldwide, but probably more so in the developing world. Identification of risk factors for the development of type 2 diabetes mellitus is a necessary step in planning prevention programmes for diabetes mellitus. The objective of this study was to determine the frequency of risk factors for type 2 DM among inhabitants of Jos, a northern city on the Nigerian Plateau. METHOD: A district in central Jos was randomly picked. Census of the district was carried out to record the names of all eligible residents from 250 households selected systematically. A questionnaire was administered by trained interviewers. Socio-demographic data, family history of diabetes, and data on work related physical activity were recorded. Height, weight and waist and hip circumferences were also measured. BMI (kg/m2) and waist-hip ration were calculated. RESULTS: Of 902 subjects (= 15years of age), 825 (91.5%) responded. The mean (SD) age of 400 males and 422 females were respectively 36.4 (15.2) and 39.9 (17.3) years. About 50% of the respondents were inactive. 435 (52.7%) were currently taking alcohol. Twenty nine (3.5%) of the subjects admitted to parental history of DM. 177 (21.4%) were either overweight or obese. 32% of males and 86% of females had abnormal waist circumferences (WCE). 96 (23.8%) males and 316(74.9%) females had abnormal WHR. BMI correlated strongly and significantly with WHR (r = 0.64, p < 0.001) and WCE (r = 0.72, p < 0.001). CONCLUSION: Inactivity alcohol usage and excess weight appear to be dominant risk factors for development of type 2 DM in this group of upland Nigerians.

Steroid responsive hypertension secondary to 11-beta hydroxylase deficiency--a case report.

BACKGROUND: Congenital adrenal hyperplasia (CAH), due to deficiency in 11â hydroxylase enzyme is rare a cause of virilization associated with glucocorticoid responsive hypertension. OBJECTIVE: To present a rare cause of CAH and secondary hypertension responsive to glucocorticoid therapy. METHODS: Clinical and laboratory evaluation of a young woman with a "phallus" and hypertension. Investigations carried out included serum biochemistry, bone age determination, sex chromatin evaluation and serum levels of androgens and 17-OH progesterone, as well as pelvic ultrasonography. RESULTS: There was a history of cliteromegaly, first noticed at age 14 years, but menstrual periods were said to be regular. Physical findings included male type hairline and musculature with a blood pressure of 160/110mmHg. Breast development was Tanner Grade 3 while the public hair was male in pattern. The clitoris was 5cm long. Serum electrolytes were normal but levels of testosterone, dehydroepiandosterone sulphate and 17-OH progesterone were elevated. Features were compatible with a diagnosis of congenital adrenal hyperplasia (CAH) due to Il-beta-hydroxylase defficiency. Hypertension responded to glucocorticoid therapy, recurred on default and was corrected again on re-starting hydrocortisone. CONCLUSION: Congenital adrenal hyperplasia due to 11â-hydroxylase deficiency though rare, should be considered in the differential diagnosis of hypertension with virilization in young females.

Autosomal Dominant Pattern of Inheritance in Type 2 Diabetes in Nigeria

We investigated 212 patients attending 3 diabetic clinics centres in Lagos; Nigeria; and recorded family history; age of onset of diabetes; and body mass index. Analysis of family pedigrees showed that 3of sibships followed an autosomal dominant pattern of inheritance. The mean age of diabetes onset among the dominant group was 25 years and obesity was uncommon. This suggests that these patients may have Maturity Onset Diabetes of the Young (MODY)