Establishing Reference Intervals for Serum and Salivary Cortisol in a Selected Population in Kano, Nigeria.

OBJECTIVE: Serum cortisol has long been used in the assessment of disorders of the hypothalamic-pituitary-adrenal axis. The reference interval for cortisol in both serum and saliva depends on the analytical methodology and the population studied; hence, a locally derived population-based reference interval is recommended. To our knowledge, there are no studies on reference interval determination in the study area, raising concerns about the use of reference intervals established in European and North American populations. This work aimed to establish reference intervals for baseline serum and salivary cortisol levels among healthy adults in Kano, Nigeria, using methods available in our laboratory. METHODS: A cross-section of 148 apparently healthy reference individuals aged 16 to 67 years were recruited from a local community in Kano, Nigeria, using a systematic sampling technique. Baseline serum cortisol was analyzed using highly sensitive and specific electrochemiluminescence quantitative measurements on an automated immunology analyzer. Salivary cortisol levels were measured using Salimetrics' competitive enzyme-linked immunosorbent assay test kits. Parametric methods with a 95% confidence interval were used to calculate reference intervals. RESULTS: The reference intervals for cortisol in serum and saliva were 72.0 nmo/L to 554.0 nmol/L and 0.40 nmol/L to 18.0 nmol/L, respectively. There was a weak positive correlation between serum and salivary cortisol values, but this association was not statistically significant. CONCLUSION: The development of locally derived adult reference intervals can improve the diagnostic utility of serum and salivary cortisol assessment and strengthen the reliability of adrenal insufficiency diagnoses in our population.

Doppler Sonographic Characteristics and Clinical Outcomes of Diabetic Foot Syndrome: A 5-Year Audit from a Tertiary Hospital in Northern Nigeria.

Background: Diabetes foot syndrome is one of the common complications of diabetes. Detailed information on the clinical and vascular characteristics of patients with diabetic foot disease in relation to the outcome of the care provided to these patients will be useful to policymakers and clinicians in early detection and timely interventions for the prevention of disabling complications. Materials and Methods: This is a review of patients with diabetic foot managed in Aminu Kano Teaching Hospital over 5 years (January 2017-May 2022). The sociodemographic characteristics, Wagner classification of the foot, Doppler sonographic characteristics and clinical outcomes, etc., were reviewed. Results: A total of 51 patients were reviewed. Males and females accounted for 56.8% and 43.1%, respectively. Twenty-five patients had Wagner grade 4 ulcers, and fewer patients had Wagner grade 1 and 5-foot ulcers. The mean ± standard deviation Doppler arterial intimal media thickness was 1.53 ± 0.33 (range 0.90-2.40 mm). The majority of DFS patients had Doppler sonographic lesions on the right lower limb 28 (54.9%) only, and 11 (21.6%) of the lesions were bilateral. The posterior tibial artery 11 (21.6%) was the most involved arterial segment with plaques, followed by a combination of popliteal and tibial arterial 10 (19.6%) segments. At 6 months, 45.2% had limb amputation, 17.6% healed ulcers, 17.6% delayed wound healing, and 9.8% died. Conclusion: There is an unacceptably high prevalence of poor treatment outcomes, thus, contributing to a huge burden of care to patients living with diabetes. There is a strong association between severe arterial stenosis detected by Doppler ultrasound and higher rates of amputations.

The role of medical-grade maggots in facilitating healing of diabetic foot ulcers in Kano, northern Nigeria: a case series.

OBJECTIVE: Approximately 13% of people living with diabetes develop one or more ulcers during the course of the disease, and diabetic foot ulcer (DFU) is responsible for >60% of lower limb amputations worldwide. This case series aimed to demonstrate the effectiveness of medical-grade maggots on DFUs in promoting wound healing and reducing related hospital stays in northern Nigeria. METHOD: Maggot debridement therapy (MDT) was applied to the DFUs of patients who consented to this treatment between January-August 2021 at the Orthopaedic Unit of the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Sterile first instar larvae of Lucilia sericata were obtained indigenously and applied using the confinement (free-range) method under aseptic procedure. RESULTS: A total of 15 patients with DFUs of Wagner classification grades III (33.3%) and IV (66.7%), were seen and documented. The patients included 10 (66.7%) females and five (33.3%) males, giving a female:male ratio of 2:1. The mean age (±standard deviation) of the respondents was 51.6±10.8 years. The surface area of the wounds ranged from 24-140cm2, with a median value of 75cm2. Among the patients, 60% had two cycles of MDT, with a median duration of five days. Most of the wounds (53.3%) were debrided within five days; 13.3% (two wounds) took seven days to be fully debrided. A paired sample t-test showed a statistically significant association between wound surface area and therapy duration (t=8.0; p=0.000) and between wound surface area and cycles of therapy (t=8.3; p=0.000). Before maggot application, 14 (93.3%) DFUs were completely (100%) covered with slough and only one (6.7%) was 95% covered with slough. After maggot application, 10 (66.7%) wounds were completely debrided while five (33.3%) wounds required bedside surgical debridement to achieve complete debridement. A paired sample t-test showed statistically significant difference between the pre- and post-MDT slough covering the wounds (t=45.1; p=0.000). CONCLUSION: In this case series, MDT was successfully used in the debridement of DFUs, which facilitated the healing process with an encouraging clinical outcome.

Prevalence and risk factors of diabetes foot ulcers in Kano, northwestern Nigeria.

BACKGROUND: Foot complications account for more hospital admissions than any other diabetes mellitus (DM) complications with adverse outcomes being foot ulcers and amputation. OBJECTIVE: To determine the prevalence and risk factors of diabetic foot ulcers in Kano, Northwestern Nigeria. METHODS: A descriptive cross-sectional study was conducted in the diabetes outpatient clinics and medical and surgical wards of two hospitals in Kano, Nigeria. Data were collected on socio-demographic characteristics, type, and duration of DM. The study subjects were assessed for the presence of and risk factors for foot ulcers. RESULTS: We recruited 394 patients with DM (163 males and 231 females) with a mean (SD) age and duration of DM of 50.8 ± 12.5 years and 7.72 ± 6.65 years respectively. Type 2 DM was present in 95% of the study subjects. Diabetic foot ulcer (DFU) was present in 57 (14.5%) of the patients. Risk factors associated with DFU assessed using univariate analysis were older age, longer duration of DM, presence of peripheral neuropathy (PN), peripheral arterial disease (PAD), diabetic retinopathy, nephropathy, foot deformities, previous DFU, and poor glycemic control. The independent determinants of DFU were previous DFU, foot deformities, retinopathy, PN, PAD, and poor glycemic control. CONCLUSION: DFU can be found in our setting and the predominant risk factors for DFU are common and remain unchanged in our environment. This study, therefore, buttresses the effect of early detection and treatment of DM in preventing the complications that arise from the disease.

Prevalence and Determinants of Endothelial Dysfunction among Adults Living with HIV in Northwest Nigeria.

Background: Endothelial dysfunction constitutes an early pathophysiological event in atherogenesis and cardiovascular disease. This study aimed to assess the prevalence, determinants, and degree of endothelial dysfunction in antiretroviral therapy (ART)-treated people living with HIV (PLWH) in northwestern Nigeria using brachial flow-mediated dilatation (FMD). Methods: This was a comparative, cross-sectional study. A total of 200 ART-treated adults living with HIV with no evidence of kidney disease were compared with 200 HIV-negative participants attending a tertiary hospital in Kano, Nigeria, between September 2020 and May 2021. Endothelial function was evaluated by measuring FMD with a high-resolution vascular ultrasound transducer. FMD was calculated as the ratio of the brachial artery diameter after reactive hyperemia to baseline diameter and expressed as a percentage of change. Blood and urine samples were obtained from participants in both arms. Urine albumin-to-creatinine ratio (uACR) was calculated using the 2021 CKD-EPI estimated glomerular filtration rate (eGFR) creatinine-cystatin C equation without the race variable, and low-density lipoprotein (LDL) cholesterol was measured using enzymatic method. Results: The overall mean age (± standard deviation) of the study participants was 42 ± 11 years. Participants in the comparison arm were younger than PLWH (38 ± 11 versus 46 ± 10 years, respectively). The median (interquartile range) uACR was 41.6 (23.2-162.9) mg/g for the ART-treated PLWH versus 14.5 (7.4-27.0) mg/g for healthy controls. PLWH had a significantly lower mean percent FMD when compared to HIV-negative participants (9.8% ± 5.4 versus 12.1% ± 9.2, respectively). Reduced FMD was independently associated with HIV infection (ß = -2.83%, 95% CI, -4.44% to -1.21%, p = 0.001), estimated glomerular filtration rate (ß = -0.04%, 95% CI, -0.07% to -0.01%, p = 0.004) and LDL cholesterol (ß = -1.12%, 95% CI, -2.13% to -0.11%, p = 0.029). Conclusion: HIV-positive status, lower estimated GFR, and higher LDL cholesterol levels were independently associated with endothelial dysfunction. Future prospective studies with larger cohorts of persons living with HIV (and age- and sex-matched HIV-negative controls) are needed to gain further insight into these important findings. In the interim, aggressive management of modifiable risk factors is warranted.

Health-related quality of life of persons with diabetic foot ulcers in a cosmopolitan city in northwestern Nigeria.

Background: Diabetic foot ulcer is one of the most serious and disabling complications of diabetes mellitus (DM). It is a major source of morbidity, mortality, and a leading cause of hospitalization. It constitutes a major burden to the patient, family, and health-care system as well as impairs quality of life (QoL). The aim of this study was to determine the QoL of persons with diabetic foot ulcers attending two major hospitals in a cosmopolitan city in northwestern Nigeria. Materials and Methods: We conducted a descriptive cross-sectional study at the diabetes outpatient clinics and wards of two major hospitals in Kano, Northwestern Nigeria. Sociodemographic characteristics, type of DM, duration of DM, and the presence of risk factors for foot ulcers were assessed. The QoL of patients with and without foot ulcer was determined a well-validated questionnaire for chronic diseases, short form 36 (SF 36) health-related QoL questionnaire. Results: We recruited 394 patients with DM (163 males and 231 females) with mean age and duration of DM of 50.8 ± 12.5 years and 7.72 ± 6.65 years, respectively. Ninety-five percent of the study participants had type 2 DM. Foot ulcers were present in 57 (14.5%) study participants. The QoL was generally poor (P < 0.001) in patients with DFU, compared with those without DFU in all domains of the SF 36, that indicated poor QoL in the physical, mental, and emotional well-being of the patients. Conclusion: Diabetic foot ulcers are quite common and impart significantly on the QoL of persons with DM affecting their physical, mental, and emotional well-being. Early detection and management of foot ulcers will reduce the burden of the disease and improve the QoL of affected individuals.

Résumé Contexte: L'ulcère du pied diabétique est l'une des complications les plus graves et les plus invalidantes du diabète sucré (DM). C'est une source majeure de 14 morbidité, mortalité, et l'une des principales causes d'hospitalisation. Il constitue un fardeau majeur pour le patient, la famille et le système de soins de santé, car 15 ans et nuit à la qualité de vie (QoL). Le but de cette étude était de déterminer la qualité de vie des personnes atteintes d'ulcères de pied diabétique fréquentant deux 16 hôpitaux principaux dans une ville cosmopolite du nord-ouest du Nigéria. Matériaux et Méthodes: Nous avons mené une étude transversale descriptive 17 dans les cliniques externes de diabète et les salles de deux grands hôpitaux à Kano, nord-ouest du Nigeria. Des caractéristiques sociodémographiques, le type 18 de DM, la durée de DM, et la présence des facteurs de risque pour des ulcères de pied ont été évalués. La qualité de vie des patients avec et sans ulcère de pied était 19 déterminé un questionnaire bien-validé pour les maladies chroniques, questionnaire court-connexe de qol de la forme 36 (SF 36). Résultats: Nous avons recruté 394 patient avec le DM (163 mâles et 231 femelles) avec l'âge moyen et la durée du DM de 50,8 ± 12,5 ans et 7,72 ± 6,65 ans, respectivement. 20 Quatre-vingt-quinze pour cent des participants à l'étude présentaient un DM de type 2. Des ulcères du pied étaient présents dans 57 (14,5 %) participants à l'étude. Le QoL était généralement pauvre (P < 0,001) dans les patients avec DFU, comparé à ceux sans DFU dans tous les domaines du SF 36, qui a indiqué le QoL pauvre dans le bien-être physique, mental, 22, et émotionnel des patients. Conclusion: Les ulcères diabétiques de pied sont tout à fait communs et transmettent de manière significative sur la QoL de 23 personnes avec le DM affectant leur bien-être physique, mental, et émotionnel. La détection et la prise en charge précoces des ulcères du pied réduiront le fardeau de la maladie et amélioreront la qualité de vie des personnes touchées. Mots-clés: Ulcère du pied diabétique, Qualité de vie liée à la santé, Nord-Ouest du Nigéria, questionnaire abrégé.

Diabetes Mellitus and its Risk Factors Among a Suburban Population of Northwestern Nigerians: A Community-Based Survey.

Background: Diabetes mellitus is a serious public health problem, and its prevalence is increasing globally. However, there are scanty reports of the scope and burden of the disease among suburban populations of Nigeria. This study aims to determine the prevalence of diabetes mellitus and to determine the associated risk factors of the disease among the suburban population of Northern Nigeria. Methodology: A community-based descriptive cross-sectional study was conducted in which 1100 subjects were recruited using a multistage random cluster sampling technique. They were screened for diabetes by fasting plasma glucose (FPG) or casual plasma glucose (CPG) estimation. Individuals with FOG >7mmol//l or CPG >7.8mmol/l abnormal glucose levels had a 75 g oral glucose tolerance test (OGTT) and HbA1c done. The prevalence of diabetes was computed with a 95% confidence interval. Result: The crude prevalence of diabetes from this study is 4.1% (95% CI = 3.3 - 4.9%) and standardized rate of 6.4%. Male gender OR 0.74, (95% CI = 0.569 - 1.982), age >40yrs OR 1.12 (95% CI = 0.851 - 1.463), physical inactivity OR 3.78 (95% CI = 2.881 - 12.726), Hypertension (SBP OR 10.28 (95% CI = 6.319- 29.369), (DBP OR 7.52 (95% CI = 3.928 - 36.914), and family history of DM OR 9.34 (95% CI = 3.890 - 23.481), showed significant independent association with diabetes. Conclusion: The prevalence of diabetes in the suburban population of Northwestern Nigeria is high and the associated risk factors include overweight and obesity, physical inactivity, family history of diabetes and age.

Audit of carotid doppler sonography: Spectrum of findings at a tertiary hospital in Northwestern Nigeria.

Introduction: Doppler sonography of the cervical segment of the carotid arteries is becoming a popular tool for evaluating atherosclerosis of the carotid artery. We present the audit of findings on carotid ultrasound examination among patients with clinical suspicion and risks for cerebrovascular disease and possible correlates in Northern Nigeria. Materials and Methods: We performed carotid ultrasound examination on all patients referred for screening and clinical suspicion of cerebrovascular disease within the year 2017. The patients' characteristics, risk factors, presence of atheroma and characteristic of the atheroma, degree of stenotic disease as well as the presence of incidental ultrasound findings were reviewed and documented. Results: Out of the 62 patients, 55 (88.7%) of them had various degrees and types of atheromatous plaques in different segments of the cervical carotid arteries, whereas 7 (11.3%) were normal. The predominant risk factor was smoking followed by diabetes mellitus, whereas the highest indication for the scan was transient ischemic attack. Incidental thyroid lesions such as nodules and cysts were encountered in 14 (22.6%) of the patients. There is a statistically significant difference between sex and age with the side of lesion, degree of stenosis, segment involved, and type of atheromatous plaque. Conclusion: There is a statistically significant difference between sex and age with the side of lesion, degree of stenosis, segment involved, and type of atheromatous plaque. About one-fifth of our patients had incidental thyroid lesions. Therefore, routine screening of population at risk is highly recommended.

RésuméIntroduction: l'échographie Doppler du segment cervical des artères carotides devient un outil populaire pour évaluer l'athérosclérose de l'artère carotide. Nous présentons l'audit des résultats de l'examen échographique carotidien chez les patients avec suspicion clinique et risques de maladie cérébrovasculaire et corrélats possibles dans le nord du Nigéria. Matériaux et méthodes: Nous avons effectué un examen échographique carotidiensur tous les patients référés pour dépistage et suspicion clinique de maladie vasculaire cérébrale au cours de l'année 2017. Les caractéristiques des patients, le risqué facteurs, présence d'athérome et caractéristique de l'athérome, degré de maladie sténotique ainsi que la présence d'une échographie accidentelle les résultats ont été examinés et documentés. Résultats: Sur les 62 patients, 55 (88, 7%) d'entre eux avaient différents degrés et types d'athéromes plaques dans différents segments des artères carotides cervicales, alors que 7 (11,3%) étaient normales. Le facteur de risque prédominant était le tabagisme suivipar le diabète sucré, alors que l'indication la plus élevée pour l'examen était une attaque ischémique transitoire. Lésions thyroïdiennes accidentelles telles que nodules etdes kystes ont été rencontrés chez 14 (22,6%) des patients. Il y a une différence statistiquement significative entre le sexe et l'âge avec le côté de la lésion, degré de sténose, segment impliqué et type de plaque athéromateuse. Conclusion: il existe une différence statistiquement significative entre les sexes et l'âge avec le côté de la lésion, le degré de sténose, le segment impliqué et le type de plaque athéromateuse. Environ un cinquième de nos patients avaientlésions thyroïdiennes accidentelles. Par conséquent, le dépistage systématique de la population à risque est fortement recommandé.

Prevalence and Risk Factors for Diabetes Mellitus in Nigeria: A Systematic Review and Meta-Analysis.

INTRODUCTION: There has been no nationwide health (diabetes) survey in Nigeria since 1992, when a diabetes mellitus (DM) prevalence of 2.2% was reported. We aimed to determine the prevalence of and risk factors for DM in Nigeria by performing a systematic review and meta-analysis. METHODS: We searched Medline, EMBASE, PubMed, PapersFirst, the Cochrane Library, Scopus, Bioline, African Journals Online, Institute of Scientific Information, and Google Scholar from the year 1990 to 2017. Using MeSH headings, the terms "diabetes mellitus," "risk factors," "prevalence," and "Nigeria" as well as variations thereof were searched for. The last search was performed on 26 November 2017. We only included studies that utilized the random plasma glucose test, the fasting plasma glucose test, the oral glucose tolerance test (OGTT), or HbA1c to diagnose DM. A total of 23 studies (n = 14,650 persons) were evaluated. A random effects model was used to estimate the pooled prevalence of DM. We estimated the overall pooled prevalence of DM and subgroup-specific DM prevalences while accounting for inter-study and intra-study variability/heterogeneity. RESULTS: The overall pooled prevalence of DM was 5.77% (95% CI 4.3-7.1). The pooled prevalences of DM in the six geopolitical zones of Nigeria were 3.0% (95% CI 1.7-4.3) in the north-west, 5.9% (95% CI 2.4-9.4) in the north-east, 3.8% (95% CI 2.9-4.7) in the north-central zone, 5.5% (95% CI 4.0-7.1) in the south-west, 4.6% (95% CI 3.4-5.9) in the south-east, and 9.8% (95% CI 7.2-12.4) in the south-south zone. Risk factors for the pooled prevalence of DM were a family history of DM (4.6%; 95% CI 3.5-5.6); urban dwelling (6.0%; 95% CI 4.3-7.8); unhealthy dietary habits (8.0%; 95% CI 5.4-10.5); cigarette smoking (4.4%; 95% CI 1.3-10.2); older age (6.6%; 95% CI 4.5-8.7); physical inactivity (4.8%; 95% CI 3.2-6.4); and obesity (5.3%; 95% CI 3.8-6.9). CONCLUSION: There has been an increase in the prevalence of DM in Nigeria. All regions of the country have been affected, with the highest prevalence seen in the south-south geopolitical zone. Urban dwelling, physical inactivity, advanced age, and unhealthy diet are important risk factors for DM among Nigerians. A national diabetes care and prevention policy is highly recommended.

Cost of Illness of Diabetic Foot Ulcer in a Resource Limited Setting: A Study from Northwestern Nigeria.

INTRODUCTION: Diabetic foot ulcer is a major complication of diabetes with a high economic cost of managing. Data from resource limited setting will bring to light how patients in these localities suffer financially in addition to poverty and lack of health insurance. This study estimated cost of illness among patients with diabetic foot ulcer in northwestern Nigeria. METHODS: It was a hospital based cross-sectional study. Questionnaire was used to take the bio data and medical history. Direct medical, direct non-medical and indirect cost were estimated. RESULT: Majority of the patients were males with the mean age of 59.3 ± 15.1 yrs. About 60% of the patients earn less than $100 monthly. The total cost of illness of diabetic foot ulcer was estimated at $140,735.56 (median = $1381.55[IQR 1002.42-]). Direct cost of illness was $107,797.06 (median = $1023.27[IQR 773.93-1568]), while the indirect cost was $32,938.49 (median = $209.90[IQR 128.74-357.08]). Out of pocket payment accounted for 90% of the payment. CONCLUSION: The cost of diabetic foot ulcer is very exorbitant and the patients affected are mostly poor, unemployed and the breadwinners of their families.