Recent advances in childhood diabetes mellitus

Diabetes mellitus (DM) is a syndrome characterized by disturbed metabolism of carbohydrate, protein, and fat. It is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin. It presents with very different medical and psychosocial issues in children.Epidemiological studies indicate that there is gradual but steady increase in the incidence of both type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in both developed and developing countries. The manifestations, therapy goals, clinical course, susceptibility to complications of diabetes differ among childhood cases. T1DM accounts for the majority of cases of diabetes in children. Diabetic ketoacidosis may be the initial presentation of T1DM in many children particularly in Africa probably due to low level ofawareness.The focus of this review on T1DM is to provide an overview of the major advances in the aetiology, pathogenesis, and clinical management of newly diagnosed children and their subsequent management with the aim of ensuring optimal growth and development as well as preventing acute and chronic complications. The advances in insulin therapy and regimens and the presentation and management of diabetic ketoacidosis are discussed. The prospects for the cure of the disease are also highlighted in this review.Key words : Childhood diabetes, glucose monitoring, insulin therapy, DKA, advance

Paediatric Endocrine Disorders at the University College Hospital, Ibadan: 2002 – 2009

Background: Until recently, most published research focus more on infectious diseases and malnutrition giving the impression that endocrine disorders are uncommon. Reports on endocrine disorders in children in developing countries are few compared to developed countries reflecting the different level of prevalence in the different geographical locations and or level of awareness and availability of facilities for proper diagnosis.Objective: This study aims at defining the burden of paediatric endocrine disorders in Ibadan.Subjects/Methods: A review of records of children who presented at University College Hospital, Ibadan with paediatric endocrine disorders from 2002 to 2009 was carried out.Results: During the eight-year period, a total of 110 children presented with various endocrine disorders but only 94 had complete data for this study. There were 47(50%) males and 37(39.4%) females, and in 10(10.6%) of them, had genital ambiguity at presentation. Patients’ ages ranged from 2 weeks to 15 years with a median of 3 years. Many (35%) patients were malnourished with weight less than 80% of the expected weight for age and only 9% were overweight. Yearly distribution of cases showed a steady increase in number of cases from 2005. Rickets and metabolic disorders constituted 56.4% of patients; Diabetes mellitus was diagnosed in 12.8%, adrenal disoders in 10.6%, pubertal disorders in 5.3% and growth disorders in 4.3% of the patients. Thyroid disorders werepresent in 6.4%, obesity in 3.2% while the least common disorder was Diabetes insipidus (1%). About 58% of the children had parents in the low socioeconomic status and the management of the cases were severely hampered by lack of funds. About 60.6% of these patients were lost to follow up, during the period.Conclusions: Paediatric endocrine disorders are associated with a high incidence of malnutrition. Most patients presented with rickets which is a preventable condition.Keywords: Endocrine disorders, Awareness, Rickets, Malnutrition, Financial constraints

Evaluation of Nutritional Quality and Haematological Parameters of Moringa (Moringa oleifera) Lam Leaves in the Diet of African Catfish (Clarias gariepinus).

This study was carried out to evaluate the effects of dietary levels of Moringa oleifera leaves on the growth performance and haematological parameters of Clarias gariepinus juveniles. Five treatments were used and 10 Clarias gariepinus juveniles with mean weight (19.00±0.50g) per tank each in triplicate. The five treatment tanks were fed with five isonitrogenous diets containing 40% crude protein with varying inclusion of Moringa oleifera (control diet with 0% Moringa oleifera, 4.1g Moringa oleifera inclusion, 8.2g Moringa oleifera inclusion, 12.3g Moringa oleifera inclusion and 16.39g Moringa oleifera inclusion). The fishes were fed twice daily for an experimental period of 12 weeks. The fish in tank T (4.1g inclusion of Moringa oleifera) had the best weight gain with 2 range 27.67±0.60. The specific growth rate was highest in fish in tank T (0.96±0.01). The fish fed 2 4.1g M.oleifera inclusion had the best feed conversion ratio (1.36±0.03). The highest feed intake (15.11±0.00) was found in fish fed with 4.1g M.oleifera inclusion. The protein efficiency ratio was higher in fish fed with 4.1g M. oleifera with range 1.83±0.04. Percentage weight gain was higher in fish fed 4.1g M. oleifera with range 142.00±3.06.There was no significant difference in the growth performance of all the treatment. No mortality was recorded in all experimental tanks. The Fish fed with M. oleifera showed increase in the haematological values of Packed Cell Volume (PCV), (27.38±3.06), Haemoglobin, (HGB), (8.33 ±1.01), Red blood cell, (RBC), (2.48±0.21) and white blood cell, (WBC), (220.56±9.75) compared to the values of fish fed control diet with PCV (13.87±9.40), HGB (5.03±2.70), RBC (1.25±0.85) and WBC (149.60±64.28). The white blood cell (WBC) shows no significant difference (P>0.05) among the fish in tanks T , T , T , and T (25%, 1 2 3 4 50%, 75% and 100% inclusion of M. oleifera respectively) but they were significantly different(P<0.05) from the fish in the tank T (control tank).There was reduction in the haematological 0 values of the fish fed M.oleifera diet with Mean cell haemoglobin concentration, (MCHC), (28.90±6.62) and the Mean Corpuscular Haemoglobin, (MCH) (32.64±7.32) compared to the values of fish fed the control diet with MCHC (39.24±13.98) and MCH (44.00±17.12). It was concluded that using M.oleifera leaves as feed for Clarias gariepinus enhances the growth of the fish and has no negative impact on the health status of the fish. Therefore partial replacement of feed with M.oleifera should be encouraged.Keywords: Bio indicator, Heamatology, Moringa oleifera, Clarias gariepinu

Analysis of some selected toxic metals in registered herbal products manufactured in Nigeria

The use of herbal medicine has been on the increase in many developing and industrialized countries and Nigerians in particular has been using herbal medicine for many centuries. The approval of these herbal remedies by regulatory bodies has further encouraged the use of herbal remedies. The safety of these herbal remedies is however poorly understood. This study investigated the concentration of arsenic, cadmium, lead and mercury in twenty registered ready to use herbal products. Twenty brands of herbal remedies were purchased randomly from the Pharmacy shops in Lagos, digested with aquaregia (3:1 HCl: HNO3) and were analysed using atomic absorption spectroscopy (Buck 205 Atomic Absorption Spectrophotometer). There was no detectable lead in any of the 20 herbal samples; however, all the samples contained a detectable amount of one or more of the other metals of interest. The Oral Component Limit (OCL) for arsenic, cadmium and mercury as stated by USP are 1.5, 0.5 and 1.5 μg/g, respectively. All the samples contained arsenic and mercury below the USP OCL, while sixtyfive percent contained cadmium out of which fifty-five percent were above USP OCL. The results obtained from this study suggest a significant risk to consumers’ health considering the toxicity of these heavy metals.Key words: Herbal remedies, toxic heavy metals, atomic absorption spectrophotometry

Multiple pituitary hormone deficiency caused by Pit-I mutation and the challenges of management in a developing country

Background: In most developing countries, childhood endocrine disorders are not as common as infections but they do occur. Multiple pituitary hormone deficiency (MPHD) is a known cause of familial short stature. This is very rarely diagnosed in Nigerian children. We describe the challenges of diagnosis and management of childhood endocrine conditions in a developing economy using a ten year old Nigerian girl with MPHD as an illustration.Methods: Patient had auxological data suggestive of short stature. In order to make a definitive diagnosis, pituitary function tests were carried out in the United Kingdom.Results: Biochemical tests revealed growth hormone (GH) deficiency, Thyroid Stimulating Hormone (TSH) deficiency, decreased prolactin (PRL) level, normal cortisol and gonadotrophins. Her DNA analysis identified PIT-1 mutation in exon-6. She was placed on recombinant GH and thyroxine with evidence of catch up in height.Conclusions: There were challenges to management such as, inadequate facility for diagnosis, huge cost of treatment and little awareness about childhood endocrine conditions amongst health workers in a developing economy.Keywords: Multiple pituitary hormone deficiency (MPHD), PIT-1 mutation, short stature, management, developing country

Antioxidant activities of Parquetina nigrescens

The antioxidant activities of different extracts (aqueous, methanol and flavonoid) of Parquetina nigrescens and butylated hydroxyl anisole, as reference compound, were evaluated in terms of scavenging effect, reducing power and inhibition of Fe2+/ascorbate-induced mitochondrial lipid peroxidation in rat liver. Extracts of P. nigrescens scavenged 2,2-diphenyl-1-picrylhydrazyl (DPPH) generated radicals in the increasing order of flavonoid > methanol > aqueous > BHA at 1000 g/ml. The reducing power followed a similar trend as observed with scavenging activities. Extracts of P. nigrescens, at 50 mg/ml, exhibited significant (P < 0.05) inhibitory effects on  Fe2+/ascorbate-induced lipid peroxidation in rat liver mitochondria. These results showed that P. nigrescens contains antioxidants that could be useful in attenuating reactions which generate free radicals in the body.Key words: Parquetina nigrescens, antioxidant activities, lipid peroxidation

Evaluation of renal volume by ultrasonography in patients with essential hypertension in Ile-Ife, south western Nigeria

Background and aims: To determine renal volume in adult patients with essential hypertension and correlate it with age, sex, body mass index (BMI), body surface area (BSA) and duration of hypertension. Patients and methods: A total of 150 patients (75 males, 75 females) with essential hypertension and normal renal status were evaluated sonographically in this prospective study. Fifty healthy individuals (25 males, 25 females) without hypertension were also evaluated as control. Renal volume was then calculated from the kidney’s length, width and anterio-posterior diameter using the formula L*W*AP*0.523. Results: The range of renal volume obtained was 51.65-205.02 cm3, with a mean of 114.06±29.78 cm3 for the left kidney and 47.37-177.50 cm3 with a mean of 106.14±25.42 cm3 for the right kidney. The mean volumes of the right and left kidneys in males (112.98±25.56 cm3 and 123.11±32.49 cm3, respectively), were significantly higher than in females (99.31±23.07 cm3 and 105.01±23.77 cm3, respectively). Renal volume correlated significantly with BSA and BMI, but decreased with age. The renal volume showed no correlation with duration of hypertension. Conclusion: Renal volume is higher in the left than the right kidney in hypertensive patients of both sexes and female hypertensive patients have smaller kidney size compared to males. The study also shows that volume of both kidneys decreases with age and positive correlation between renal volume, BSA and BMI. However, there is no correlation between renal size and duration of hypertension.Keywords: essential hypertension; renal volume; ultrasonograph

Combined mitral and tricuspid stenosis in 47-year old rheumatic valvular heart disease patient: a case report

Rheumatic valvular heart disease is a common complication of rheumatic fever; however combined mitral and tricuspid stenosis is an extremely rare form of multi-valve disease presentation. Case Presentation: We report a case of combined mitral and tricuspid stenosis from rheumatic heart disease (RHD) in a 47-year-old woman who was being managed for hypertensive heart disease (HHDx) on anti-hypertensives for 2yrs prior to presentation. However, on further review with transthoracic echocardiography (TTE), she was found to have thickened mitral valve and hockey stick appearance with dilated left atrium (dimension of 60mm) and reduced left ventricular ejection fraction (LVEF) of 45%. A repeat TTE done 8 years after the first one showed a severely dilated left atrium (LAD 71mm) with estimated area of 55.4cm2; moderate mitral stenosis and severe tricuspid stenosis with moderate TR. The LVEF was 29% with a severe right ventricular (RV) systolic dysfunction (TAPSE of 9mm). Patient is being managed conservatively due to economic constraints and the likelihood of very poor surgical outcome due to severe biventricular dysfunction. Conclusion: The case is reported for its rarity as well as the importance of interval evaluation of unaffected valves in a setting of single valve disease for early detection and possible prompt treatment and intervention

Evaluation of the chemical constituents and the antimicrobial activity of the volatile oil of Citrus reticulata fruit(Tangerine fruit peel) from South West Nigeria

The volatile oil of tangerine fruit (Citrus reticulata) was extracted by steam distillation and assessed for antibacterial and antioxidant activity. The volatile oil was tested against some Gram-negative organisms (Escherichia coli ATCC 35218, E. coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Salmonella paratyphi, Proteus mirabilis and Citrobacter spp); Gram-positive organisms such as Staphylococcus aureus ATCC 25923, S. aureus, Enterococcus faecalis and a fungus (Candida albicans). The minimum inhibitory concentration (MIC) was determined with concentrations of oil extract ranging from 0.87 to 445 mg/ml. Result of the study showed that the oil has a broad spectrum antibacterial activity. MIC recorded were S. aureus (0.74 mg/ml), S. aureus ATTC 25923 (2.46 mg/ml), E. faecalis (1.26 mg/ml), S. typhi (2.07 mg/ml), K. pneumoniae (0.56 mg/ml), E. coli ATTC 35218 (0.19 mg/ml), E. coli (1.95 mg/ml), P. aeruginosa (0.97 mg/ml), C. albicans (0.68 mg/ml). Antioxidant screening with 2,2-diphenyl-1-picrylhydrazyl (DPPH) was negative. Analysis of the chemical constituent by GC-MS showed the presence of D-limonene as the major constituent. Other constituents found were a-pinene and β-pinene