Impact of structured education on glucose control and hypoglycaemia in Type-2 diabetes: a systematic review of randomized controlled trials

Evidence for the use of structured education in diabetes management is accumulating and has shown positive influence in the management of Type-2 diabetes.Objective: To assess the impact of structured education on glucose control and hypoglycaemia in the management of Type-2 diabetes.Methods: A systematic review was done using Medline via Ovid and EMBASE databases of published English literature between 1980 and 2014. Included studies were randomized control trials that assessed the impact of structured education on glucose control and hypoglycaemia.Results: Out of the 12,086 full text articles were identified, 36 full text articles were finally considered for this review after applying both inclusion and exclusion criteria, of which 34 were exclusively on the effect of structured diabetes education on glucose control whilst 2 were studies on the effects of structured diabetes education on glucose control and hypoglycaemia. Majority of the studies included a predominant Caucasian population. There was heterogeneity in the included studies such as intervention methods and intensity as well as follow up periods. Group based education was preferred over individual education by most studies. Overall, most of the studies showed a significant positive effect on glycaemic control compared with control groups. One study showed a significant impact of structured education on hypoglycaemia.Conclusion: Structured education has positive impact on glucose control and hypoglycaemia in Type-2 diabetes and must be incorporated in routine care.Funding: The study was funded by the authorsKeywords: Structured education, Type-2 diabetes, glucose control, hypoglycaemia, effectivenes

A case of Cushing Syndrome due to accidental intake of dexamethasone: a call for enforcement of regulatory laws

Cushing syndrome could be a complication of long-term steroid use, resulting in a wide range of clinical presentations. Whereas some patients take medically prescribed doses of conventional medicines, including steroids for various ailments, others inadvertently consume unspecified doses by adulterating traditional medicines with these orthodox medications to increase their therapeutic appeal. Furthermore, some individuals with access to conventional medications may sell them in unlabelled packages as traditional medicines (TMs) to unsuspecting customers. This may lead to undesirable side effects and safety concerns. The case report highlights the problem of poorly regulated access to medications and makes suggestions to protect patrons' health of traditional medicines

Challenges in the Management of a Patient with Myxoedema Coma in Ghana: A Case Report

Myxoedema coma is a rare life-threatening disease, and it is essential that it is managed appropriately to reduce the associated high mortality. However, in the setting where efficient healthcare delivery is hampered by inadequacies, the management of such cases may pose a significant challenge. We present the case of a middle-aged woman diagnosed with myxoedema coma and severe hyponatremia. The case report highlights some of the challenges that may be encountered during the management of myxoedema coma in similar settings and outlines the management strategies undertaken to overcome them in the absence of national guidelines. It also brings to the fore the need for clinicians to look out for clinical features suggestive of hypothyroidism particularly among high risk individuals for early diagnosis and treatment.Funding: None declaredKeywords: myxoedema coma, management, challenges, Ghan

Health-related quality of life and its demographic, clinical and psychosocial determinants among male patients with hypertension in a Ghanaian tertiary hospital

Objectives: This study aimed to evaluate Health-related quality of life (HRQoL) among male patients with hyperten-sion and its associated demographic, clinical and psychosocial factors.Design: This was a facility-based cross-sectional studySetting: This study was carried out at the outpatient department in Korle-Bu Teaching HospitalParticipants: Three hundred and fifty-eight hypertensive patients were recruited for this studyData collection: Information on socio-demographic characteristics, clinical features, insomnia, medication adherence, psychological distress, sexual dysfunction and HRQoL were obtained through patient-reported measures using struc-tured questionnaires and standardised instruments. Statistical analysis/Main outcome measure: The study assessed HRQoL among male hypertensive patients. One-way ANOVA was used to compare the average scores of the various domains of HRQL across the independent vari-ables. Multivariate linear regression models with robust standard errors were used to determine factors associated with quality of life.Results: Participants with poor perceived overall HRQoL was 14.0%. Comparatively, HRQoL (mean ± SD) was the least in the physical health domain (56.77±14.33) but the highest in the psychological domain (58.7 ± 16.0). Multi-variate linear regression showed that income level, educational level, insomnia, overall satisfaction, sexual desire and medication adherence were significant predictors of HRQoL. Average scores of HRQoL domains reduced with a higher level of sexual desire dysfunction.Conclusion: HRQoL among male hypertensive patients was negatively affected by insomnia, sexual desire dysfunc-tion, educational level and adherence to antihypertensive medications but positively affected by income level. Clinical practice and policy processes should be directed at these factors to improve HRQoL

Screening for Cushing Syndrome at the Primary Care Level: What Every General Practitioner Must Know

Cushing’s syndrome is a rare entity, and a high index of suspicion is needed for screening in a primary care setting. The clinical awareness of the primary care physician (PCP) to the highly indicative signs and symptoms such as facial plethora, proximal myopathy, reddish purple striae, and easy bruisability should alert him to look for biochemical evidence of Cushing’s syndrome through any of the first-line screening tests, namely, 24-hour urinary free cortisol, overnight dexamethasone suppression test, or late-night salivary cortisol. Commonly used random cortisol measurements are unreliable; hence, general practitioners are encouraged to understand the use of these more reliable tests with increased sensitivity and specificity for screening Cushing’s syndrome. In this write-up, we set out to increase awareness about the presentation of Cushing’s syndrome and current recommended screening methods as well as their strengths and weaknesses. We relied mainly on the recommendations by the Endocrine Society Guidelines

Psychological changes in Africans with kidney disease in Ghana: a comparison of haemodialysis patients and patients with chronic kidney disease not on dialysis

Background: The prevalence of chronic kidney disease (CKD) is high in sub-Saharan Africa and affects the productive workforce. CKD has been associated with psychological problems such as anxiety and depression; however, there is little published information on the burden of psychological problems among the CKD population in African countries. Our study assessed psychological changes in two groups of patients, one group with end-stage renal disease receiving chronic haemodialysis, and a second with CKD not on dialysis.Methods: A cross-sectional study involving patients on chronic haemodialysis and patients with CKD stages 3–5 (the “CKD” patients) was conducted at the Renal Unit of the Korle-Bu Teaching Hospital in Accra, Ghana. One hundred and sixty-eight participants (82 CKD and 86 haemodialysis patients) were recruited. Demographic, clinical and laboratory information was captured, the Revised Quick Cognitive Screening Test (RQCST) was used to assess cognitive function and the Brief Symptoms Inventory-18 (BSI-18) was used to screen for anxiety, somatization and depression.Results: CKD patients were older than those on haemodialysis, with mean ages of 53.3 and 46.6 years, respectively. Two-thirds (113/167) were male. The median glomerular filtration rate (GFR) of the CKD patients was 21 mL/min/1.73 m2 (interquartile range 9–34). Most of the haemodialysis patients (78.6%) were receiving two sessions of haemodialysis per week and their mean kT/V was 1.16 ± 0.23. The RQCST global scores in the two groups of patients were similar, with almost 90% of haemodialysis patients and 85% of CKD patients obtaining scores above 50. Haemodialysis patients had better scores for immediate recall memory. The haemodialysis patients also had higher BSI-18 global scores than the CKD patients (mean of 0.83 vs 0.70, p = 0.033). Mean anxiety and somatization scores were also higher in the haemodialysis patients.Conclusions: Haemodialysis patients demonstrated higher anxiety and somatization scores than the CKD patients. Clinical psychological support should therefore be included in the treatment of our patients, and especially for those on chronic haemodialysis

A typical presentation of COVID-19 in a patient with type 2 diabetes at an urban primary care facility in Accra, Ghana

This is a case report of a 55-year-old man with Type 2 Diabetes Mellitus who presented with progressive breathlessness, chest pain and hyperglycaemia. An initial impression of a chest infection was made. Management was initiated with antibiotics, but this was unsuccessful, and he continued to desaturate. A screen for Coronavirus Disease of 2019 (COVID-19) returned positive. There was no prodrome of fever or flu-like illness or known contact with a patient known to have COVID-19. This case is instructive as he didn’t fit the typical case definition for suspected COVID-19. There is significant community spread in Ghana, therefore COVID-19 should be a differential diagnosis in patients who present with hyperglycaemia and respiratory symptoms in the absence of a febrile illness. Primary care doctors must have a high index of suspicion in cases of significant hyperglycaemia and inability to maintain oxygen saturation.Patients known to have diabetes and those not known to have diabetes may develop hyperglycaemia subsequent to COVID-19. A high index of suspicion is crucial for early identification, notification for testing, isolation, treatment, contact tracing and possible referral or coordination of care with other specialists. Early identification will protect healthcare workers and patients alike from cross-infection

Co-Morbid Hypothyroidism and Liver Dysfunction: A Review

The liver and thyroid hormones interact at multiple levels to maintain homoeostasis. The liver requires large adequate amounts of thyroid hormones to execute its metabolic functions optimally, and deficiency of thyroid hormones may lead to liver dysfunction. Hypothyroidism has been associated with abnormal lipid metabolism, non-alcoholic fatty liver disease (NAFLD), hypothyroidism-induced myopathy, hypothyroidism-associated gallstones and occasionally, interferon-induced thyroid dysfunction. NAFLD remain an important association with hypothyroidism and further studies are needed that specifically compare the natural course of NAFLD secondary to hypothyroidism and primary NAFLD. Hepatic dysfunction associated with hypothyroidism is usually reverted by normalizing thyroid status. Large scale studies geared towards finding new and effective therapies, especially for NAFLD are needed. The clinician must be aware that there exists overlapping symptomatology between liver dysfunction and severe hypothyroidism which may make delay the diagnosis and treatment of hypothyroidism; this requires a high index of suspicion