Treatment to targets in type 2 diabetics: analysis of out-patients practice at a remote Western Nigerian hospital

Diabetes mellitus (DM) is a leading cause of morbidity and mortality allover the world. Tight control of diabetes in the outpatients will reduce complications and hospitalizations. This study of Nigerian patients with diabetes examined the adequacy of glycemic and BP control in line with current guidelines. A 4 month retrospective analysis of type 2 diabetics attending Medical Outpatients Department (MOPD) of Federal Medical Centre, Ido Ekiti, Ekiti State, Nigeria between June and September 2008 was carried out using medical records of the patients. SPSS 13 software was used to analyze data. Data are expressed as mean ± Standard Deviation (SD) and frequency expressed as a percentage where necessary. A total of 308 type 2 diabetes mellitus patients, aged between 35 and 85years were analyzed. Their mean age was 60.90 ± 11.60years. There were 125 males (40.6%) and 183 females (59.4%) giving an M: F ratio of 1:1.46. Mean duration of clinic attendance was 26.18 ± 24.46 months. Glycemic control was achieved in only about a third of the patients (29.3% and 32.5% using IDF-Europe and ADA criteria respectively). Blood pressure control was achieved in 24.5% and 48.7% had BMI ≥ 25kg/m2. No correlation between mean fasting plasma glucose (FPG) and body mass index (BMI). Frequencies of insulin and low dose aspirin use were low (5.3% and 37% respectively). The results from this study showed poor control of blood glucose, BP and weight in the patients. We are of the opinion that current practices are not aggressive enough to manage a substantial proportion of type 2 diabetes patients.KEY WORDS: Diabetes mellitus; Glycemic control; BP contro

Baseline CD4+ T lymphocyte cell counts, hepatitis B and C viruses seropositivity in adults with Human Immunodeficiency Virus infection at a tertiary hospital in Nigeria

Background: Ekiti State of Nigeria is known to have the lowest prevalence of HIV in Nigeria. University Teaching Hospital (UTH), Ado Ekiti was recently upgraded to serve as one of the three centres for HIV/AIDS referral, diagnosis and treatment in Ekiti State. We evaluated the baseline immunologic and biochemical parameters of patients presenting at the ART clinic of University Teaching Hospital, Ado Ekiti, Ekiti State. Methods: All HIV seropositive patients not yet on antiretroviral therapy, who presented at the ART Clinic within the study period had at the first visit to the clinic, their blood sample taken for CD4 cell counts estimation, HBsAg and anti- HCV screening, ALT, AST as well as hemoglobin estimation as part of the routine workup to assess their disease health status and need for antiretroviral therapy. Statistical significance was taken as p< 0.05. Results: A total of 273 patients comprising 79 (28.9%) males and 194 (71.1%) females were included in the study (F:M = 2.46: 1). The mean age of the study population was 36.21± 10.20 years with mean age of males (39.52 ± 9.95years) significantly higher than females (34.88 ± 10.02; p=0.001). The overall prevalence of HBsAg in the study population was 6.6% with a sex specific prevalence of 8.1% and 6% for males and females, respectively. No statistically significance difference in the mean serum alanine transaminase, serum aspartate transaminase, hemoglobin and CD4+ T- Lymphocytes cell count of those who had HBsAg negative status compared to those who had HBsAg positive status. Two (0.7%) of the patients had positive serum anti HCV antibodies. The CD4+ T- Lymphocytes cell count ranged between 5 – 1050 cells/Hl with a mean of 286.19 ± 233.31 cells/Hl. The majority of patients (71.8%) had a CD4+ T- Lymphocytes cell count < 350 cells/Hl. Conclusion: At the time of presentation, majority of our patients had a CD4+ T- Lymphocytes cell count less than 350 cells/Hl consistent with significant immune-suppression. More sustained and vigorous awareness campaigns still need to be done in Ekiti State to diagnose this disease early. There is also a need to accelerate the integration of hepatitis B virus screening and treatment programme into HIV/AIDS programme because of the morbidity and mortality implication of HBV and HIV co-infection.Key words: HIV AIDS infection, CD4+ T-lymphocyte cell counts, Hepatitis B virus infectio

Effects of feeding adult snails Stylosanthes guianensis or Lablab purpureus as substitute for pawpaw leaf

The feeding trial assessed the performance, carcass and sensory evaluation of adult snails fed solely on leaves of Stylosanthes guianensis or Lablab purpureus as substitute for pawpaw leaf. Ninety-six (96) adult snails were used for the trial, and they were shared into three groups. Each group was replicated four times with 8 snails per replicate in a completely randomized design. Parameters measured include weight gain, feed intake and feed conversion ratio, while dressing percent were calculated. The sensory evaluation was also carried out. The results show that snails fed S. guianensis performed better in terms of weight gain and feed intake and compared competitively with snail fed pawpaw leaf (P>0.05).The dressing percent, shell thickness, length and width, taste and general acceptability were not affected by the dietary treatments. Snail farmers are encouraged to cultivate S. guianensis to feed snails which can be used to substitute pawpaw leaf

Cardiovascular responses to treadmill exercise in Nigerian hypertensives with left ventricular hypertrophy

Background: Left ventricular hypertrophy (LVH) is an independent risk factor for adverse cardiac outcomes in hypertensive patients.Objective: This study is designed to assess the cardiovascular responses to treadmill exercise among Nigerian hypertensives with echocardiographically proven LVH.Materials and Methods: Fifty hypertensive patients with LVH (27 males and 23 females) between 30 and 65 years of age were studied in Nigeria. 50 hypertensive patients without LVH and 50 normal subjects who were age and sex matched served as controls. All patients and control subjects underwent M-mode, 2-D and Doppler ECHO-studies and the Bruce protocol treadmill exercise test.Results: The study showed that the estimated maximal oxygen consumption (MVO2) in MET reduced progressively from 8.39 ± 1.26 (normotensive control) to 7.62 ± 1.33 (hypertensive without LVH), 6.27 ± 0.99 (hypertensive with LVH) (P<0.0001ANOVA). The duration of exercise (s) was also reduced in that order from 455.4 ± 79.1 to 411.6 ±8 2.3, 315.8 ± 75.6 respectively (P<0.0001). The systolic blood pressure (SBP) and pressure rate product (PRP) during maximal exercise were also increased in hypertensives with LVH and hypertensive without LVH when compared to normotensive controls. The hypertensives with LVH and hypertensives without LVH also showed significant limitation to heart rate increase with exercise compared to normotensive controls (P<0.003).Conclusion: This study demonstrated significant impairment of exercise capacity in hypertensives with or without LVH compared to normotensive subjects. Both earlier recognition and improved understanding of LVH may lead to more effective therapeutic strategies for this cardiovascular risk factor

Risk factors for delayed presentation and referral of symptomatic cancer: Evidence for common cancers

Background:It has been suggested that the known poorer survival from cancer in the United Kingdom, compared with other European countries, can be attributed to more advanced cancer stage at presentation. There is, therefore, a need to understand the diagnostic process, and to ascertain the risk factors for increased time to presentation.Methods:We report the results from two worldwide systematic reviews of the literature on patient-mediated and practitioner-mediated delays, identifying the factors that may influence these.Results:Across cancer sites, non-recognition of symptom seriousness is the main patient-mediated factor resulting in increased time to presentation. There is strong evidence of an association between older age and patient delay for breast cancer, between lower socio-economic status and delay for upper gastrointestinal and urological cancers and between lower education level and delay for breast and colorectal cancers. Fear of cancer is a contributor to delayed presentation, while sanctioning of help seeking by others can be a powerful mediator of reduced time to presentation. For practitioner delay, ‘misdiagnosis’ occurring either through treating patients symptomatically or relating symptoms to a health problem other than cancer, was an important theme across cancer sites. For some cancers, this could also be linked to inadequate patient examination, use of inappropriate tests or failing to follow-up negative or inconclusive test results.Conclusion:Having sought help for potential cancer symptoms, it is therefore important that practitioners recognise these symptoms, and examine, investigate and refer appropriately. © 2009 Cancer Research UK All rights reserved

Reduced paediatric hospitalizations for malaria and febrile illness patterns following implementation of community-based malaria control programme in rural Rwanda

<p>Abstract</p> <p>Background</p> <p>Malaria control is currently receiving significant international commitment. As part of this commitment, Rwanda has undertaken a two-pronged approach to combating malaria via mass distribution of long-lasting insecticidal-treated nets and distribution of antimalarial medications by community health workers. This study attempted to measure the impact of these interventions on paediatric hospitalizations for malaria and on laboratory markers of disease severity.</p> <p>Methods</p> <p>A retrospective analysis of hospital records pre- and post-community-based malaria control interventions at a district hospital in rural Rwanda was performed. The interventions took place in August 2006 in the region served by the hospital and consisted of mass insecticide treated net distribution and community health workers antimalarial medication disbursement. The study periods consisted of the December–February high transmission seasons pre- and post-rollout. The record review examined a total of 551 paediatric admissions to identify 1) laboratory-confirmed malaria, defined by thick smear examination, 2) suspected malaria, defined as fever and symptoms consistent with malaria in the absence of an alternate cause, and 3) all-cause admissions. To define the impact of the intervention on clinical markers of malaria disease, trends in admission peripheral parasitaemia and haemoglobin were analyzed. To define accuracy of clinical diagnoses, trends in proportions of malaria admissions which were microscopy-confirmed before and after the intervention were examined. Finally, to assess overall management of febrile illnesses antibiotic use was described.</p> <p>Results</p> <p>Of the 551 total admissions, 268 (48.6%) and 437 (79.3%) were attributable to laboratory-confirmed and suspected malaria, respectively. The absolute number of admissions due to suspected malaria was smaller during the post-intervention period (N = 150) relative to the pre-intervention period (N = 287), in spite of an increase in the absolute number of hospitalizations due to other causes during the post-intervention period. The percentage of suspected malaria admissions that were laboratory-confirmed was greater during the pre-intervention period (80.4%) relative to the post-intervention period (48.1%, prevalence ratio [PR]: 1.67; 95% CI: 1.39 – 2.02; chi-squared p-value < 0.0001). Among children admitted with laboratory-confirmed malaria, the risk of high parasitaemia was higher during the pre-intervention period relative to the post-intervention period (age-adjusted PR: 1.62; 95% CI: 1.11 – 2.38; chi-squared p-value = 0.004), and the risk of severe anaemia was more than twofold greater during the pre-intervention period (age-adjusted PR: 2.47; 95% CI: 0.84 – 7.24; chi-squared p-value = 0.08). Antibiotic use was common, with 70.7% of all children with clinical malaria and 86.4% of children with slide-negative malaria receiving antibacterial therapy.</p> <p>Conclusion</p> <p>This study suggests that both admissions for malaria and laboratory markers of clinical disease among children may be rapidly reduced following community-based malaria control efforts. Additionally, this study highlights the problem of over-diagnosis and over-treatment of malaria in malaria-endemic regions, especially as malaria prevalence falls. More accurate diagnosis and management of febrile illnesses is critically needed both now and as fever aetiologies change with further reductions in malaria.</p

Tumours and tumour-like lesions of the lower face at Korle Bu Teaching Hospital, Ghana – an eight year study

<p>Abstract</p> <p>Background</p> <p>The oro-facial region including the jawbones, the maxilla and mandible and related tissues can be the site of a multitude of neoplastic conditions. These tumours have a predilection for the entire facial region; however, odontogenic tumours tend to affect the mandible more than the maxilla, especially, in West African children. We report results from a retrospective study spanning eight years on the frequency, clinical presentation, sites and character of lower face tumours seen in the main referral hospital in Ghana.</p> <p>Patients and methods</p> <p>Records of consecutive patients of all age and sex seen by the first author's team at the Department of Oral and Maxillofacial Surgery, Korle-Bu Teaching Hospital with tumours affecting the lower part of the face from January 1996 to December 2003 were retrieved, coded and entered into a database. The data were then analyzed by age, sex, presenting signs and symptoms, site of lesion, and their histology.</p> <p>Results</p> <p>A total of 394 patients with oro-facial swellings were retrieved from the registry out of which 210 had lower face tumour and tumour-like lesions. The complete data set was obtained for 171 patients, comprising 99 (58%) males and 72 (42%) females. The most common clinical presenting features were mandibular facial swelling (63%), intra-oral swelling (55%), pain (41%) and ulceration (29%). The tumours were predominantly found in the right (43%), anterior (19%) and left (18%) aspects of the lower face. The remainder making up 20% were found in the floor of the mouth, tongue and lips. Seventy eight (45.6%) of the patients presented with lesions that were classified as malignant of which 54 (62%) were diagnosed as squamous cell carcinoma (SCC). Sixty-two (36.3%) had benign odontogenic tumours and thirty-one (18.1%) had non-odontogenic tumour-like lesions. Fifty-four (62%) of malignant tumours were squamous cell carcinoma; 58 (93.6%) of the benign odontogenic tumours were classified as ameloblastoma. The mean age at presentation of all lesions was 40.4 years with over 50% of benign lesions in patients aged between 11 and 30 years. Malignant tumours were more commonly detected in patients between 41 and 70 years (63%).</p> <p>Conclusion</p> <p>Tumours and tumour-like lesions of the lower face comprising the mandible, tongue and adjacent structures are a diverse group of neoplasm and are seen commonly in practice of Maxillofacial surgery. Both malignant and benign tumours are seen in the Ghanaian population. In the present study, SCC and ameloblastoma were the commonest malignant and benign odontogenic tumours seen respectively; the two representing more than 65% of all tumours.</p

Aptamer-based field-effect biosensor for tenofovir detection

During medical treatment it is critical to maintain the circulatory concentration of drugs within their therapeutic range. A novel biosensor is presented in this work to address the lack of a reliable point-of-care drug monitoring system in the market. The biosensor incorporates high selectivity and sensitivity by integrating aptamers as the recognition element and field-effect transistors as the signal transducer. The drug tenofovir was used as a model small molecule. The biointerface of the sensor is a binary self-assembled monolayer of specific thiolated aptamer and 6-mercapto-1-hexanol (MCH), whose ratio was optimized by electrochemical impedance spectroscopy measurements to enhance the sensitivity towards the specific target. Surface plasmon resonance, performed under different buffer conditions, shows optimum specific and little non-specific binding in phosphate buffered saline. The dose-response behavior of the field-effect biosensor presents a linear range between 1 nM and 100 nM of tenofovir and a limit of detection of 1.2 nM. Two non-specific drugs and one non-specific aptamer, tested as stringent control candidates, caused negligible responses. The applications were successfully extended to the detection of the drug in human serum. As demonstrated by impedance measurements, the aptamer-based sensors can be used for real-time drug monitoring