Global challenges in health: effect of westernization on the prevalence of diabetes mellitus in Nigeria

Diabetes mellitus is a common non communicable disease which appears to be assuming epidemic proportions worldwide with 382 million people affected worldwide. Current estimates describe Nigeria as having about 4 million affected people a large proportion of which are undiagnosed. The factors driving the diabetes epidemic worldwide include obesity, physical inactivity, smoking, alcohol intake all of which are associated with globalization/ westernization. The role of these factors in Nigeria and the possible measures to reduce the trend in the country are highlighted in this review. Simple inexpensive lifestyle measures have been outlined to curb the looming diabetes epidemic in the country.Keywords: Diabetes mellitus, prevalence, challenges, westernization, Nigeri

Comparative Analysis of Salivary Glucose and Electrolytes in Diabetic Individuals with Periodontitis

Background : A high incidence of periodontal disease has been reported among diabetics, however the role of saliva in the occurrence of this oral disease in these patients is yet to be understood.Objective: To determine the effects of type-2 diabetes and periodontal disease on salivary flow rate and biochemical composition.Design: A prospective study involving 40 adult human subjects divided equally into four groups of diabetics with periodontitis (group 1), diabetics without periodontitis (group 2), non diabetics with periodontitis (group 3) and non diabetics without periodontitis (group 4).Methodology: Saliva samples were collected and analyzed for salivary glucose, total protein, calcium, sodium, potassium, chloride and bicarbonate. Salivary flow rates were also determined. Results: Salivary glucose and potassium levels were significantly higher (P = 0.002 and 0.04 respectively) in diabetic patients regardless of periodontal disease (mean = 100.7 ± 9.33 mg/dl; 111.5 ± 32.85 mg/dl and 23.79 ± 5.19 mg/dl; 22.9 ± 6.25 mg/dl respectively) compared with non diabetic participants (mean = 80.5 ± 30.85 mg/dl; 62.5 ± 31.89 mg/dl and 19.23 ± 5.04 mg/dl; 17.74 ± 4.68 mg/dl respectively). In contrast, there was no significant difference in saliva flow rates and levels of total protein, Na+, Ca++, Cl- and HCO3- between the groups.Conclusion: Salivary glucose and potassium levels were significantly higher among diabetics with or without periodontitis compared with non-diabetics with or without periodontitis. However, biochemical composition of saliva in diabetic individuals has probably little role in their susceptibility to periodontitis.Keywords: periodontitis, type 2 diabetes mellitus, salivary electrolytes, salivary glucos

Evaluation of prescription pattern and glycaemic control among diabetes patients in an ambulatory tertiary care setting in southwestern Nigeria

Background: Drug prescription in diabetes is complex, thereby making diabetes patients a high-risk group. Thus, treating the patient with diabetes remains a practice that entails constant re-evaluation and assessment of patient’s therapy and response.Objective: To evaluate pattern of antidiabetes and adjunctive medications prescribed for patients as well as extent of glycaemic control.Method: A cross-sectional concurrent review of case-notes of diabetes patients attending the endocrinology out-patient clinic of the University College Hospital, Ibadan, for 4-consecutive weeks. In-patient case-notes, newly diagnosed, and those with incomplete data were excluded. Data were summarised using descriptive statistics. Chi-square was used to investigate categorical variables at p<0.05.Results: Mean age and duration of diagnosis were 60.6±13.0 and 10.2±7.9 years, respectively. Type-1-diabetes accounted for 4 (6.9%) and type-2-diabetes (54; 93.1%). Co-administered combination of metformin and glimepiride (15; 25.9%) was most commonly prescribed. Mean glycosilated haemoglobin was 6.9±1.8%. Nineteen (59.4%) were adjudged to have good glycaemic control (HbA1c<7%). Calcium-channel-blockers (23; 19.5%), statins (23; 19.5%), angiotension-converting-enzyme inhibitors (22; 18.6%) and low-dose aspirin (20; 17.0%) were the commonly prescribed adjuncts. Of the 16 (27.6%) patients whose adherence status was documented, 8 (50.0%) who were regular on medication were subjectively adjudged adherent.Conclusion: Metformin-based regimen, specifically, the co-administered combination of metformin and glimepiride is mostly prescribed. Overall blood glucose profile indicates fair glycaemic control. There is a greater likelihood of evidence-based prescriptions for the patients. However, there is a need for concerted efforts by providers in ensuring improved medication adherence, in order to ensure better therapeutic outcomes.Keywords: Antidiabetes medication, glycaemic control, diabetes patients, ambulator

Evaluation of Dimethylformamide (DMF) as an Organic Modifier in Hydrophobicity Index (Rm) Determination.

Purpose: Ideal behaviour of mixtures of organic modifier and water is reflected by a linear relationship between refractive index and fraction of organic modifier in the mixture. This study was carried out to investigate dimethylformamide (DMF) as an organic modifier in hydrophobicity index (Rm) determination. Method: We quantitatively evaluated the problem of partial miscibility of phases associated with the reversed phase thin layer chromatographic (RPTLC) system, using liquid paraffin as stationary phase and acetone/water mixtures as mobile phase. Ideality of behaviour of acetone /water mixtures was investigated by refractive index measurements. Rm values of compounds were determined using mixtures of acetone and water as mobile phase. Results: DMF/water mixture behaved ideally across the whole concentration range investigated (0-100%) while acetone/water mixture deviated from ideal behaviour when the concentration of acetone in the mixture was 80%. DMF also gave a better extrapolation of Rm value from linear regression of partition data than acetone for bezafibrate used as a test-drug molecule. Conclusion: DMF is a better organic modifier than acetone in this RPTLC system. These findings could be extended to drug-receptor and drug design studies. The use of dimethylformamide (DMF) in preference to acetone as organic modifier is proposed in this study. Keywords: Drug design, dimethylformamide, hydrophobicity index, organic modifiers Tropical Journal of Pharmaceutical Research 2002; 1(2): 83-9

Effects of Hypothyroidism and Exogenous Thyroxine on Gastrointestinal Organs of Rat

Summary: Thyroxine (T4) is important in gut development and maturation, and its use in treating hypothyroidism is becoming more popular. This study was conducted to evaluate the effect of thyroidectomy and thyroxine replacement on some gastrointestinal organs. Ten out of 20 thyroidectomised rats received 100pg/kgbw of T4 for five weeks to become euthyroid while the rest were left to become hypothyroid. Ten sham operated rats were made hyperthyroid by giving 100pg/kg.bw of T4 for five weeks, while the other ten sham operated rats served as control. 10mg/kg.bw intraperitoneal injection of ketamine was given as anesthesia for thyroidectomy and sham operation. At the end of the fifth week, the animals were sacrificed. Liver, stomach and small intestine were harvested and their morphological dimensions measured. Everted sacs were made from the small intestine for glucose transfer studies and slides for histomorphometry. There was no significant difference in the weights of the liver and stomach of the groups when compared with the control group. There was significant (p<0.05) increase in length and diameter but reduced wall thickness in the hyperthyroid small intestine; unlike that of hypothyroid which had significant (p<0.05) shorter length, decreased diameter but increased wall thickness. Villi length and crypt depth was higher in hyperthyroid (p<0.01) but smallest in the hypothyroid (p<0.05). Glucose transfer was lesser in the hypothyroid but greater in the hyperthyroid intestine. These findings show that hypothyroidism diminishes the morphological variables of absorption in the small intestine as a mechanism to reducing its transfer capacity, while thyroxine replacement increases these variables as mechanism to increasing intestinal transfer capacity.Keywords: Thyroidectomy, Thyroxine, Gastrointestinal organs, Everted sac, Glucose transfer

Effects of Hypothyroidism and Exogenous Thyroxine on Gastrointestinal Organs of Rat

Thyroxine (T4) is important in gut development and maturation, and its use in treating hypothyroidism is becoming more popular. This study was conducted to evaluate the effect of thyroidectomy and thyroxine replacement on some gastrointestinal organs. Ten out of 20 thyroidectomised rats received 100pg/kgbw of T4 for five weeks to become euthyroid while the rest were left to become hypothyroid. Ten sham operated rats were made hyperthyroid by giving 100pg/kg.bw of T4 for five weeks, while the other ten sham operated rats served as control. 10mg/kg.bw intraperitoneal injection of ketamine was given as anesthesia for thyroidectomy and sham operation. At the end of the fifth week, the animals were sacrificed. Liver, stomach and small intestine were harvested and their morphological dimensions measured. Everted sacs were made from the small intestine for glucose transfer studies and slides for histomorphometry. There was no significant difference in the weights of the liver and stomach of the groups when compared with the control group. There was significant (p<0.05) increase in length and diameter but reduced wall thickness in the hyperthyroid small intestine; unlike that of hypothyroid which had significant (p<0.05) shorter length, decreased diameter but increased wall thickness. Villi length and crypt depth was higher in hyperthyroid (p<0.01) but smallest in the hypothyroid (p<0.05). Glucose transfer was lesser in the hypothyroid but greater in the hyperthyroid intestine. These findings show that hypothyroidism diminishes the morphological variables of absorption in the small intestine as a mechanism to reducing its transfer capacity, while thyroxine replacement increases these variables as mechanism to increasing intestinal transfer capacity

A Fuzzy-Logic Approach to Dynamic Bayesian Severity Level Classification of Driver Distraction Using Image Recognition

open access articleDetecting and classifying driver distractions is crucial in the prevention of road accidents. These distractions impact both driver behavior and vehicle dynamics. Knowing the degree of driver distraction can aid in accident prevention techniques, including transitioning of control to a level 4 semi- autonomous vehicle, when a high distraction severity level is reached. Thus, enhancement of Advanced Driving Assistance Systems (ADAS) is a critical component in the safety of vehicle drivers and other road users. In this paper, a new methodology is introduced, using an expert knowledge rule system to predict the severity of distraction in a contiguous set of video frames using the Naturalistic Driving American University of Cairo (AUC) Distraction Dataset. A multi-class distraction system comprises the face orientation, drivers’ activities, hands and previous driver distraction, a severity classification model is developed as a discrete dynamic Bayesian (DDB). Furthermore, a Mamdani-based fuzzy system was implemented to detect multi- class of distractions into a severity level of safe, careless or dangerous driving. Thus, if a high level of severity is reached the semi-autonomous vehicle will take control. The result further shows that some instances of driver’s distraction may quickly transition from a careless to dangerous driving in a multi-class distraction context

A Context Aware Classification System for Monitoring Driver’s Distraction Levels

Understanding the safety measures regarding developing self-driving futuristic cars is a concern for decision-makers, civil society, consumer groups, and manufacturers. The researchers are trying to thoroughly test and simulate various driving contexts to make these cars fully secure for road users. Including the vehicle’ surroundings offer an ideal way to monitor context-aware situations and incorporate the various hazards. In this regard, different studies have analysed drivers’ behaviour under different case scenarios and scrutinised the external environment to obtain a holistic view of vehicles and the environment. Studies showed that the primary cause of road accidents is driver distraction, and there is a thin line that separates the transition from careless to dangerous. While there has been a significant improvement in advanced driver assistance systems, the current measures neither detect the severity of the distraction levels nor the context-aware, which can aid in preventing accidents. Also, no compact study provides a complete model for transitioning control from the driver to the vehicle when a high degree of distraction is detected. The current study proposes a context-aware severity model to detect safety issues related to driver’s distractions, considering the physiological attributes, the activities, and context-aware situations such as environment and vehicle. Thereby, a novel three-phase Fast Recurrent Convolutional Neural Network (Fast-RCNN) architecture addresses the physiological attributes. Secondly, a novel two-tier FRCNN-LSTM framework is devised to classify the severity of driver distraction. Thirdly, a Dynamic Bayesian Network (DBN) for the prediction of driver distraction. The study further proposes the Multiclass Driver Distraction Risk Assessment (MDDRA) model, which can be adopted in a context-aware driving distraction scenario. Finally, a 3-way hybrid CNN-DBN-LSTM multiclass degree of driver distraction according to severity level is developed. In addition, a Hidden Markov Driver Distraction Severity Model (HMDDSM) for the transitioning of control from the driver to the vehicle when a high degree of distraction is detected. This work tests and evaluates the proposed models using the multi-view TeleFOT naturalistic driving study data and the American University of Cairo dataset (AUCD). The evaluation of the developed models was performed using cross-correlation, hybrid cross-correlations, K-Folds validation. The results show that the technique effectively learns and adopts safety measures related to the severity of driver distraction. In addition, the results also show that while a driver is in a dangerous distraction state, the control can be shifted from driver to vehicle in a systematic manner

Assessment and predictors of blood glucose levels in hypertensives attending a secondary health centre: relationship with physical activity and diet quality

The aim: this study aims to assess the prevalence of hyperglycaemia, the association between diet quality, physical exercise and blood glucose levels among hypertensives attending a secondary health centre in Nigeria. There is a paucity of data concerning these issues and the study would contribute positively to future management of the patients. Methods: the study was a cross-sectional study of 354 hypertensives that was conducted at the State Hospital, Oyo, Nigeria. The systematic sampling technique was used to recruit patients, and the data were analysed using SPSS software version 23. Linear regression was done to determine the predictors of hyperglycaemia, and logistic regression was done to determine the predictors of diet quality. Results: the mean age of the respondents was 52.60(SD±8.26) years. The prevalence of undiagnosed diabetes in this cohort was 19.60 %. The association of glycated haemoglobin (HbAic) with High Density Lipoprotein (HDL) was negative, weak in strength and statistically significant (p-value=0.034). For every 1 unit decrease in High Density Lipoprotein (HDL), there was a statistically significant increase in HbAic by about 0.383 units (95 % C.I equals -0.737 to -0.029, p-value=0.034). For every 1 unit increase in total Cholesterol, there was a significant increase in HbAic by about 0.158 units (95 % CI equals 0.007 to 0.308, p-value=0.04). Age group &lt;45 years were about 2 times less likely to have good diet quality than those of 55 years and above (OR=0.502; 95 % CI=0.270 – 0.932, p-value=0.029). Conclusions: the study has assisted to characterise this population of hypertensives in terms of serum glucose levels. The prevalence of hyperglycaemia was high among these hypertensives. The predictors of hyperglycaemia were HDL and Cholesterol. Also, the predictor of good diet quality was the age of the respondent

Neuromusculoskeletal disorders in patients with Type 2 diabetes mellitus: Outcome of a twelve-week Therapeutic exercise programme

Usual line of management of diabetes patients is drug and diet with theirphysical needs usually receiving minimal attention. Among the physical needs, requiring attention is their neuromusculoskeletal disorders. This study was designed to investigate the effect of a twelve-week therapeuticexercise on neuromusculoskeletal disorders ofType 2 Diabetes (T2D) patients. Forty-three participants from the Diabetes Specialty Clinic ofAminu KanoTeaching Hospital, Kano completed the study. Selected neuromusculoskeletal disorders including pain, dermatological foot grades,disorders of ranges of motion and strength of selected joints and muscles were assessed before and after a period of twelve weeks of therapeutic exercises. Participants were followed up for another twelve weekswithout therapeutic exercises. Baseline assessment revealed poor neuromusculoskeletal status. Significant improvements (P0.05). T2D patients presented with neuromusculoskeletal disorders at baseline. Therapeutic exercises however assisted in the improvement of these disorders but relapsed when exercises were suspended. Engagement in therapeutic exercises enhanced neuromusculoskeletal health, while withdrawal from the exercise contributed to a decline. T2D patients should be encouraged to participate in therapeutic exercises in order to promote their health and function