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

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

Effect of Envenomation on Serum Hepatic Biomarkers in Snake (Echis Ocellatus) Bitten Individuals in Zamko Comprehensive Health Centre of the Jos University Teaching Hospital, North Central Nigeria.

Background: Snake bite is a neglected public health issue in many tropical and subtropical countries of the world. About 5.4 million snakebites occur each year, resulting in 1.8 to 2.7 million cases of envenomation yearly. Hepatic markers have been reported to rise 3-6 hours after injection of venom in experimental animals. This study aims to biochemically assess ALT, AST and GGT levels as biomarkers of Echis ocellatus envenomation in victims of snake bite presenting at JUTH Comprehensive Health Centre Zamko 6hours post-bite and compare with values in those bitten by non-venomous snakes. Methodology: The study was a comparative cross-sectional study where serum levels of AST, ALT and GGT were compared between the study group and the control group. Results: Of the 150 respondents, 75 from each study group, 90(60.0%) were Male while 60(40.0%) were Female, with a Male to Female ratio of 1.5:1. The most predominant age group was 20-29 years 57(38.0%), the mean age was 39 years. The most predominant occupation was farming 82(54.7%). The majority 82(54.7%) had a secondary level of education. 91(60.7%) were married. A large majority of 123(82.0) had Christianity as their religion. We found a significant increase in the levels of AST (47.45IU/L) and GGT (61.62 IU/L) in the study group compared to AST (25.88IU/L), GGT (29.61IU/L) in the control group at p<0.05, while the level of ALT was similar in both groups at p>0.05. Conclusion: This implies that serum levels of AST and GGT can be used to diagnose envenomation in snakebite patients.

Serum reference intervals of micronutrients, vitamins, and interleukins among healthy adults in South-Western Nigeria.

Objectives: Clinical decision making depends mostly on appropriate application of numerical pathology reports from laboratory results, interpreted by comparison with reference intervals. We determined serum reference intervals of micronutrients, vitamins, and detectable interleukins among healthy adults in South-Western Nigeria. Design and methods: This prospective study used a priori selection approach in blood-donors. They were screened for conditions that could elicit cytokine production.Serum micronutrients were assayed using Atomic Absorption Spectrophotometry; interleukins and vitamins by high Performance Liquid Chromatography. The reference intervals (RIs) were estimated at 2.5th percentile and 97.5th percentile. Results: One hundred and eighteen (118) apparently healthy subjects, aged 18-56 years; 113 (95.8%) being 18-44years, and 5 (4.2%): 45-56 years; mostly males, 13 (11.02%) females, all Africans of Yoruba ethnicity.Estimated reference limits were: Zinc: 9.49-20.54 µmol/L, Selenium: 0.50-1.11 µmol/L, Copper: 13.86-27.97 µmol/L, Iron: 14.19-32.07 µmol/L, Manganese: 6.24-16.37 nmol/L; Magnesium: 0.78-1.62 mmol/L.Vitamins: A-1.08-2.39 µmol/L; D: 59.89-164.42 µmol/L; E: 7.13-19.45 µmol/L; K: 0.16-0.42 nmol/L; B1: 74.09-201.56 nmol/L; B6: 0.12-0.29 nmol/L; B12: 155.55-407.96 pmol/L; C: 47.74-112.99 µmol/L.Detected interleukins (IL-1 to IL-18): IL-1: 0.58-1.24 ng/L, IL-2: 0.09-0.18 ng/L, IL-3: 0.39-0.89 ng/L, IL-4: 0.27-0.58 ng/L, ….to IL-18: 0.74-1.56 ng/L. Conclusions: The RI derived from this study for serum micronutrient, vitamin and interleukin concentrations are the first published for our population. They are in general agreement with those published from other geographical climes but there are differences at the lower and upper limits of the RI. The study reinforces the importance of deriving RI for the population that a clinical laboratory will serve.

Rising prevalence of gestational diabetes mellitus and its associated risk factors in Makurdi, North-Central Region of Nigeria.

Background: The disease burden of gestational diabetes mellitus (GDM) in sub-Saharan African region have been on the rise. Proper assessment of current prevalence of GDM may inform policy changes and management approach for improved care delivery. Objective: To determine the current prevalence of Gestational Diabetes Mellitus (GDM) and evaluate its major risk factors amongst pregnant women in Makurdi, North-Central Nigeria. Method: This was a multi-center hospital-based prospective observational study. Maternal characteristics and clinical risk factors for GDM in a cohort of 281 pregnant women at 9 to 16 weeks gestational age was evaluated. The one-step 75g oral glucose tolerance test (OGTT) was carried out at 24 to 28 weeks of gestation. Result: Of the 356 women recruited, 281 (79.8%) completed the study. The GDM prevalence in the cohort was 16.7%. Increased early pregnancy BMI (adjusted OR = 1.154, 95% CI = 1.080 - 1.233, p<0.001) and presence of family history of diabetes mellitus (adjusted OR = 0.482, 95% CI = 0.233 - 0.997, P<0.05) were independent risk factors for GDM in the cohort. Conclusion: Increasing maternal age and early pregnancy BMI amongst other possible reasons, may account for the rising prevalence of GDM in the region.