Making sense of thyroid function tests

Background: Thyroid disorders are second only to diabetes mellitus among endocrine problems encountered in practice. Many patients with thyroid disorders tend to present with nonspecific symptoms to clinicians in different specialties, who are often quick to request for a thyroid function test. Although interpretation of the results of most thyroid function tests (TFTs) is straightforward, in a small number of situations the results seem to point in different directions, thereby producing clinical confusion. Knowledge of the different patterns of TFTs and their causes will help clinicians to properly manage their patients and avoid unnecessary, and often expensive further investigations.Objective: To highlight the causes of the different patterns of abnormal thyroid function tests seen in clinical practice and to provide a practical approach to the evaluation of patients with such results.Method: We searched PubMed, Google scholar and Medline for articles written in English on the interpretation and pattern of thyroid function tests.Result: Interpretation of the results of most TFTs is straightforward especially when combined measurements (TSH with T4 or T3 or both) are ordered. Careful clinical reassessment of thyroid status and consideration of possible confounding factors such as pregnancy, intercurrent (non-thyroidal) illness or drug therapy will readily identify the cause of such apparently discordant TFTs.Conclusion: A sound knowledge of the conditions that can be associated with different patterns of TFTs will go a long way in guiding the choice of additional investigations and allowing a correct diagnosis, thus avoiding inappropriate treatment.Keywords: Thyroid function tests (TFTs), patterns of abnormal TFTs, non-thyroidal illnes

Prevalence and risk factors for overweight and obesity among suburban semi-nomadic Fulani's of northwestern Nigeria

Background: Obesity is a major public health problem that is associated with increased cardiovascular morbidity and mortality. It is an important threat that is fast becoming an emerging epidemic globally, Nigeria inclusive. Although there are numerous studies on the prevalence of obesity in Nigeria, the semi-nomadic Fulani's have not been extensively studied. This study will, therefore, help to assist policymakers to plan effective strategies for combating the epidemic among neglected ethnic populations.Method: The study was a community-based cross-sectional study carried out in Kumbotso Local Government Area of Kano state, from June 2015 to December 2015. Anthropometric indices (Weight, height, waist and Hip circumferences) were measured for the subjects. Body mass index and waist hip ratio was also calculated. Serum blood glucose, lipid, and blood pressure were determined.Results:  The mean ±SD age of the subjects was 38.97±15/98 years, with a range of 18 – 90 years. There were 208 (39.1%) males and 324 (60.9%) females, p <0.001. Obesity was found in 9.21% of the subjects (4.32% of males, 13.58% of females). Overweight was found in 20.86% of the subjects, 15.38% of males and 13.58% of females respectively. Factors associated with overweight include advancing age and female gender. The odds ratio for developing obesity is higher in subjects > 50 years (2.319, 95% CI, 1.203-3.540).Conclusion: There is a relatively high prevalence of overweight and obesity among suburban semi-nomadic Fulani's. In view of this, there is the urgent need to initiate public health measures aimed at improving healthy lifestyle measures.Key words: Prevalence, overweight, obesity, risk factors and sub urban

Predictive value of spot urine albumin-to-creatinine ratio for echocardiography-based left ventricular hypertrophy among newly diagnosed hypertensive patients

Objective: Studies have reported high prevalence of left ventricular hypertrophy (LVH) among patients with microalbuminuria. Both left ventricular hypertrophy and microalbuminuria (MA) are associated with increased risk of cardiovascular morbidity and mortality. The study aimed to determine the predictive value of spot urine albumin-to-creatinine ratio (ACR) for echocardiography-based LVH in newly diagnosed hypertensive patients.Methods: LVH was defined as left ventricular mass index (LVMI) of >115g/m2 in males and >95g/m2 in females. Microalbuminuria was defined as ACR >30 mg/g and diagnostic value of MA for LVH assessed using X2 2by2 table and the Receiver Operating Characteristics (ROC) curve plot.Results: Sixty six (48.5%) males and 70(51.5%) females with a mean age of 44.8(10.5 %) years were studied. Left ventricular hypertrophy was observed in 36.8% while 42.7% had MA. The prevalence of MA in those with LVH was 66%. Microalbuminuria showed a sensitivity of 64% and specificity of 70% for echocardiography (echo) detected LVH, while the positive predictive value (PPV) and negative predictive value (NPV) were 55% and 77% respectively. Diagnostic accuracy of MA for echo LVH was 68% with an odd ratio of 4.1. ROC curve plot revealed an area under the curve of 0.73 at ACR of 36mg/g, improving the sensitivity and NPV to 85.7% and 83.8% respectively.Conclusion: Microalbuminuria predicts LVH in treatment naïve Nigerian hypertensive patients. This can be used as a surrogate for LVH in outpatient settings, providing vital information for comprehensive management of patients.Keywords: Hypertension, microalbuminuria, albumin-to-creatinine ratio, left ventricular hypertroph

Knowledge, attitude, and practice of diabetic retinopathy among Physicians in northwestern Nigeria

Background: Diabetic retinopathy (DR) is the leading cause of preventable blindness in the productive population that poses a considerable global public health burden. Objective: The objective of this study is to assess the knowledge, attitude, and practice of DR screening among physicians in Northwestern Nigeria.Materials and Methods: Survey responses were obtained from 105 physicians in 4 tertiary hospitals using a Likert scale questionnaire. The internal consistency of the questionnaire was calculated using Cronbach’s alpha coefficient. Principal  component analysis was used for data reduction and grouping with the varimax rotation method, and the factors were extracted based on an Eigenvalue >1. Results: Most of the respondents (78.8%) were aware of the most effective method of delaying the onset of DR and frequency of eye examination (94.1%). Lack of ophthalmoscopes (70.6%) and dilating eye drops (50.6%) form important barriers to performing a good eye examination. Conclusion: DR screening among physicians practicing in Northwestern Nigeria was suboptimal, which prompts the need for improved training of physicians managing persons with diabetes on eye examination in a bid to strengthen DR screening and reduce the burden of visual impairment in our environment.Keywords: Attitude, diabetic retinopathy, knowledge, ophthalmologist, practic

Serum C-reactive protein in Nigerians with type II diabetes mellitus

Background: C-reactive protein  is  an  acute-phase proteins, produce in the liver, its release is stimulated by cytokines (interleukin 6 and tumour necrosis factor alpha). Elevated level of it is a risk factor for coronary heart disease. Baseline levels of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. Diabetics are at increased risk for coronary heart disease, data from the Framingham Study showed a two-to three-fold elevation in the risk of clinically evident atherosclerotic disease in patients with type II diabetes compared to those without diabetes. However, but data regarding CRP in Nigerian diabetic is lacking.Objectives: The study was to determine serum C-reactive protein in Nigerian with Type II diabetes mellitusMethods: The study design was cross-sectional conducted among patients attending out patient clinic of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State south western Nigeria. Measurement of C- reactive protein was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA).Results: A total of 125 consecutive subjects were recruited comprising 75 patients with type II diabetes mellitus with or without hypertension and 50 apparently healthy age-and-sex comparable controls. There was a significant difference between the mean systolic and diastolic blood pressures of the patients and controls. The fasting blood glucose and C-reactive protein  were  significantly higher  in  diabetics  compared  to  controls. There was a positive and significant correlation between FBG and CRP in both patients and controls.Conclusion: This study showed that diabetics have significantly higher serum C-reactive protein compared to the apparently controls. Also there was a positive and significant correlation between C-reactive protein and fasting blood glucose among both patients and controls.Keywords: Diabetes mellitus, C-reactive protein, Coronary heart diseas