Metabolic Syndrome Disorders In Urban Black Zimbabweans With Type 2 Diabetes Mellitus

A CAJM field study.Objective: The main aim of the study was to determine the prevalence of metabolic syndrome disorders and their interrelations in black Zimbabwean type 2 diabetic patients. Study Design: Prospective cross sectional study. Setting: Outpatient diabetic clinics at Harare and Parirenyatwa tertiary hospitals. Main Outcome Measures: We recruited 109 adult diabetic subjects attending a tertiary hospital Diabetic Clinic. Anthropometric and metabolic parameters were measured by standard methods. Eighty percent of the patients were hypertensive, 32% dyslipidaemic, 32% obese, 50% hyperinsulinaemic, 61% had poor • glycaemic control and 43% of the participants had the metabolic syndrome. The means of BMI and triglycerides were significantly different in hyperinsulinaemic versus non-hyperinsulinaemic patients (p<0.001 and 0.041 respectively), and diastolic blood pressure was significantly raised in the obese group (p=0.043). The following significant associations were observed, hyperinsulinaemia with the metabolic syndrome (odds ratio=3.9, p<0.001) as well with obesity (odds ratio=4.8, p<0.001), however, only a weak association was observed between hypertension and hyperinsulinaemia (odds ratio=2.5, p=0.064). Patients exhibiting three metabolic disorders (dyslipidaemia, hypertension and obesity) were five times more likely to be hyperinsulinaemic (p=0.025) and hypertensive patients were almost three times more likely to, be hyperinsulinaemic. Conclusion: In comparison to their counterparts from certain ethnic groups, this urban diabetic population is also burdened with a variety of metabolic disorders which are risk factors for coronary artery disease. In this population, hyperinsulinaemia has a relatively weak association with hypertension and the relationship between obesity versus diastolic blood pressure as well as hypertriglyceridaemia versus serum insulin levels requires further investigation

Asymptomatic bacteriuria in sickle cell disease: a cross-sectional study

BACKGROUND: It is known that there is significant morbidity associated with urinary tract infection and with renal dysfunction in sickle cell disease (SCD). However, it is not known if there are potential adverse outcomes associated with asymptomatic bacteriuria (ASB) infections in sickle cell disease if left untreated. This study was undertaken to determine the prevalence of ASB, in a cohort of patients with SCD. METHODS: This is a cross-sectional study of patients in the Jamaican Sickle Cell Cohort. Aseptically collected mid-stream urine (MSU) samples were obtained from 266 patients for urinalysis, culture and sensitivity analysis. Proteinuria was measured by urine dipsticks. Individuals with abnormal urine culture results had repeat urine culture. Serum creatinine was measured and steady state haematology and uric acid concentrations were obtained from clinical records. This was completed at a primary care health clinic dedicated to sickle cell diseases in Kingston, Jamaica. There were 133 males and 133 females in the sample studied. The mean age (mean ± sd) of participants was 26.6 ± 2.5 years. The main outcome measures were the culture of ≥ 10(5 )colony forming units of a urinary tract pathogen per milliliter of urine from a MSU specimen on a single occasion (probable ASB) or on consecutive occasions (confirmed ASB). RESULTS: Of the 266 urines collected, 234 were sterile and 29 had significant bacteriuria yielding a prevalence of probable ASB of 10.9% (29/266). Fourteen patients had confirmed ASB (prevalence 5.3%) of which 13 had pyuria. Controlling for genotype, females were 14.7 times more likely to have confirmed ASB compared to males (95%CI 1.8 to 121.0). The number of recorded visits for symptomatic UTI was increased by a factor of 2.5 (95% CI 1.4 to 4.5, p < 0.005) but serum creatinine, uric acid and haematology values were not different in patients with confirmed ASB compared with those with sterile urine. There was no association with history of gram negative sepsis. CONCLUSION: ASB is a significant problem in individuals with SCD and may be the source of pathogens in UTI. However, further research is needed to determine the clinical significance of ASB in SCD

Malnutrition enteropathy in Zambian and Zimbabwean children with severe acute malnutrition: A multi-arm randomized phase II trial.

Malnutrition underlies almost half of all child deaths globally. Severe Acute Malnutrition (SAM) carries unacceptable mortality, particularly if accompanied by infection or medical complications, including enteropathy. We evaluated four interventions for malnutrition enteropathy in a multi-centre phase II multi-arm trial in Zambia and Zimbabwe and completed in 2021. The purpose of this trial was to identify therapies which could be taken forward into phase III trials. Children of either sex were eligible for inclusion if aged 6-59 months and hospitalised with SAM (using WHO definitions: WLZ <-3, and/or MUAC <11.5 cm, and/or bilateral pedal oedema), with written, informed consent from the primary caregiver. We randomised 125 children hospitalised with complicated SAM to 14 days treatment with (i) bovine colostrum (n = 25), (ii) N-acetyl glucosamine (n = 24), (iii) subcutaneous teduglutide (n = 26), (iv) budesonide (n = 25) or (v) standard care only (n = 25). The primary endpoint was a composite of faecal biomarkers (myeloperoxidase, neopterin, α1-antitrypsin). Laboratory assessments, but not treatments, were blinded. Per-protocol analysis used ANCOVA, adjusted for baseline biomarker value, sex, oedema, HIV status, diarrhoea, weight-for-length Z-score, and study site, with pre-specified significance of P < 0.10. Of 143 children screened, 125 were randomised. Teduglutide reduced the primary endpoint of biomarkers of mucosal damage (effect size -0.89 (90% CI: -1.69,-0.10) P = 0.07), while colostrum (-0.58 (-1.4, 0.23) P = 0.24), N-acetyl glucosamine (-0.20 (-1.01, 0.60) P = 0.67), and budesonide (-0.50 (-1.33, 0.33) P = 0.32) had no significant effect. All interventions proved safe. This work suggests that treatment of enteropathy may be beneficial in children with complicated malnutrition. The trial was registered at ClinicalTrials.gov with the identifier NCT03716115

Liver and kidney function tests in normal and pre-eclamptic gestation: A comparison with non-gestational reference values

Objective: To compare liver and kidney function tests in pre-eclampsia and in uncomplicated pregnancy and to relate the results to physiological reference values. Design: Prospective cross sectional study. Setting: Antenatal clinic and antenatal labour wards. Harare Hospital, Zimbabwe. Subjects: 38 pre-eclamptic and 72 normal women of similar parity, gravida and gestational age. Main Outcome Measures: Serum albumin, total bil irubin, alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT) and gamma-glutamyl transaminase (GGT) were used as indices of hepatic function. Serum creatinine, urea and uric acid were used to assess renal function. Results: Albumin, bilirubin and ALT did not show any differences between the pre-eclamptic and normotensive pregnant women. The activities of the following enzymes, ALP (p<0.001), AST (p=0.001) and GGT (p<0.01) were significantly elevated in pre-eclamptic women. The renal indices, creatinine, urea and uric acid were significantly raised in pre-eclampsia (p<().()() 1). No significant differences were observed in the haematological parameters, haemoglobin (Hb), white blood cell count (WBC), red blood cell count (RBC), mean corpuscular volume (MCV) and platelet count. Almost all the biochemical and haematological parameters were lower in normal pregnancy compared to the physiological reference values used in our maternity unit. Conclusion: Liver and kidney function is modified by normal pregnancy. However, the majority of the liver and kidney function tests between pre-eclamptic and normal pregnancy exhibited significant differences. The physiological reference values that are currently in use are different from those of women with uncomplicated pregnancies and may not be entirely suitable for management of pre-eclampsia which has hepatic and renal involvement

Metabolic Syndrome Disorders In Urban Black Zimbabweans With Type 2 Diabetes Mellitus

Objective: The main aim of the study was to determine the prevalence of metabolic syndrome disorders and their interrelations in black Zimbabwean type 2 diabetic patients. Study Design: Prospective cross sectional study. Setting: Outpatient diabetic clinics at Harare and Parirenyatwa tertiary hospitals. Main Outcome Measures: We recruited 109 adult diabetic subjects attending a tertiary hospital Diabetic Clinic. Anthropometric and metabolic parameters were measured by standard methods. Eighty percent of the patients were hypertensive, 32% dyslipidaemic, 32% obese, 50% hyperinsulinaemic, 61% had poor • glycaemic control and 43% of the participants had the metabolic syndrome. The means of BMI and triglycerides were significantly different in hyperinsulinaemic versus non-hyperinsulinaemic patients (p<0.001 and 0.041 respectively), and diastolic blood pressure was significantly raised in the obese group (p=0.043). The following significant associations were observed, hyperinsulinaemia with the metabolic syndrome (odds ratio=3.9, p<0.001) as well with obesity (odds ratio=4.8, p<0.001), however, only a weak association was observed between hypertension and hyperinsulinaemia (odds ratio=2.5, p=0.064). Patients exhibiting three metabolic disorders (dyslipidaemia, hypertension and obesity) were five times more likely to be hyperinsulinaemic (p=0.025) and hypertensive patients were almost three times more likely to, be hyperinsulinaemic. Conclusion: In comparison to their counterparts from certain ethnic groups, this urban diabetic population is also burdened with a variety of metabolic disorders which are risk factors for coronary artery disease. In this population, hyperinsulinaemia has a relatively weak association with hypertension and the relationship between obesity versus diastolic blood pressure as well as hypertriglyceridaemia versus serum insulin levels requires further investigation

Occurrence of diabetogenic changes in pregnancy among black women in an urban setting

Objective: To find out if pregnancy in black Zimbabwean women is a diabetogenic state using basal blood levels of cortisol, insulin, C-peptide and glucose. Methods: 111 women (28 non-pregnant, 29 first trimester, 26 second trimester and 28 third trimester) aged between 18 and 35 years were recruited for the study. Fasting plasma cortisol, insulin, C-peptide and glucose were determined by standard methods. The glucose/insulin ratio was used as an index of insulin sensitivity and the C-peptide/glucose ratio as well as the homeostasis assessment model (HOMA) as an index of insulin resistance. Results: The means of fasting plasma cortisol levels were significantly elevated, p <0.0001 among the four groups (non-pregnant, first, second and third trimester women). Fasting plasma insulin levels peaked during the third trimester and significant differences were noted among all women, p <0.05. Similar data was obtained for C-peptide levels (a better indicator of beta-cell insulin secretory activity) among the groups, p <0.01. The means of fasting plasma glucose levels were significantly decreased with advancing gestation, p <0.0001. Significantly lower glucose/insulin ratios, a measure of insulin sensitivity and elevated C-peptide/glucose ratios, an index of insulin resistance, were demonstrated among the women, (p <0.05 and <0.01 respectively). Conclusion: The basal data presented in this paper clearly demonstrates that the diabetogenic effects of pregnancy are also expressed by Zimbabwean black women, especially in late gestatio

Insulin secretion, clearance and sensitivity in Black pregnant and non-pregnant women in Harare, Zimbabwe

No Abstract. Central African Journal of Medicine Vol. 45 (1) 1999: pp. 11-1