Should we assume accuracy of point of care glucose meters? An observation from a tertiary health care centre

Background: Self-monitoring of blood glucose is important in the management of patients with diabetes mellitus in the community as well as in the hospital. It has been used for calculation of insulin doses of individuals with dysglycaemia and monitoring of glucose control. Errors in the measurement of the blood glucose can lead poor management of a patient. There is therefore the need to ensure standardization of these meters in order to achieve accuracy and precision.Objectives: To evaluate the precision and accuracy of four glucose meters commonly used for self-monitoring of blood glucose (SMBG) in a tertiary health care Centre compared to the reference laboratory method.Materials and Methods: We analyzed blood glucose samples of 55 diabetic patients who came to diabetes clinic using 4 different glucose meters (Accucheck active, Novo max extra, One touch Ultra 2 and On call plus (accoson)). Capillary and Venous blood samples were taken simultaneously from each patient for analysis using four blood glucose meters and laboratory reference method respectively. The laboratory value was used as a tool for comparison. The accuracy and precision were evaluated by the ISO and ADA criteria. The results obtained were analysed using Bland Altman graphs, correlation coefficients, scatter plots and Clarke's error grid analysis.Results: We observed good correlation between two glucose meters (AccucheckTM and NovomaxTM) and laboratory analyzed values. Among the glucose meters AccucheckTM, NovomaxTM, One touch UltraTM and On call plusTM, the correlation coefficient was 0.97, 0.96, 0.88 and 0.69 respectively. The degree of agreement of the laboratory method and the AccucheckTM, NovomaxTM, One touch ultraTM and On call plusTM glucose meters was 89.09, 80.00, 76.20 and 71.32% respectively. Accucheck and NovomaxTM were within ±20% accuracy (14.5% and 16.1%).Conclusion: There is a need for adequate and appropriate evaluation of all glucose meters in our setting before that we deploy them for use. None of glucose meters met the ISO target. Only one glucose meter (AccucheckTM) met the ADA guideline for accuracy.Keywords: Accuracy; glucose meters; diabetes mellitus; self-monitoring of blood glucos

Prevalence and Determinants of Endothelial Dysfunction among Adults Living with HIV in Northwest Nigeria

Background: Endothelial dysfunction constitutes an early pathophysiological event in atherogenesis and cardiovascular disease. This study aimed to assess the prevalence, determinants, and degree of endothelial dysfunction in antiretroviral therapy (ART)–treated people living with HIV (PLWH) in northwestern Nigeria using brachial flow-mediated dilatation (FMD). Methods: This was a comparative, cross-sectional study. A total of 200 ART-treated adults living with HIV with no evidence of kidney disease were compared with 200 HIV-negative participants attending a tertiary hospital in Kano, Nigeria, between September 2020 and May 2021. Endothelial function was evaluated by measuring FMD with a high-resolution vascular ultrasound transducer. FMD was calculated as the ratio of the brachial artery diameter after reactive hyperemia to baseline diameter and expressed as a percentage of change. Blood and urine samples were obtained from participants in both arms. Urine albumin-to-creatinine ratio (uACR) was calculated using the 2021 CKD-EPI estimated glomerular filtration rate (eGFR) creatinine-cystatin C equation without the race variable, and low-density lipoprotein (LDL) cholesterol was measured using enzymatic method. Results: The overall mean age (± standard deviation) of the study participants was 42 ± 11 years. Participants in the comparison arm were younger than PLWH (38 ± 11 versus 46 ± 10 years, respectively). The median (interquartile range) uACR was 41.6 (23.2–162.9) mg/g for the ART-treated PLWH versus 14.5 (7.4–27.0) mg/g for healthy controls. PLWH had a significantly lower mean percent FMD when compared to HIV-negative participants (9.8% ± 5.4 versus 12.1% ± 9.2, respectively). Reduced FMD was independently associated with HIV infection (β = –2.83%, 95% CI, –4.44% to –1.21%, p = 0.001), estimated glomerular filtration rate (β = –0.04%, 95% CI, –0.07% to –0.01%, p = 0.004) and LDL cholesterol (β = –1.12%, 95% CI, –2.13% to –0.11%, p = 0.029). Conclusion: HIV-positive status, lower estimated GFR, and higher LDL cholesterol levels were independently associated with endothelial dysfunction. Future prospective studies with larger cohorts of persons living with HIV (and age- and sex-matched HIV-negative controls) are needed to gain further insight into these important findings. In the interim, aggressive management of modifiable risk factors is warranted

Challenges and Implications of the COVID-19 Pandemic on Mental Health: A Systematic Review

The measures put in place to contain the rapid spread of COVID-19 infection, such as quarantine, self-isolation, and lockdown, were supportive but have significantly affected the mental wellbeing of individuals. The primary goal of this study was to review the impact of COVID-19 on mental health. An intensive literature search was conducted using PsycINFO, PsyciatryOnline, PubMed, and the China National Knowledge Infrastructure (CNKI) databases. Articles published between January 2020 and June 2022 were retrieved and appraised. Reviews and retrospective studies were excluded. One hundred and twenty-two (122) relevant articles that fulfilled the inclusion criteria were finally selected. A high prevalence of anxiety, depression, insomnia, and post-traumatic stress disorders was reported. Alcohol and substance abuse, domestic violence, stigmatization, and suicidal tendencies have all been identified as direct consequences of lockdown. The eminent risk factors for mental health disorders identified during COVID-19 include fear of infection, history of mental illness, poor financial status, female gender, and alcohol drinking. The protective factors for mental health include higher income levels, public awareness, psychological counseling, social and government support. Overall, the COVID-19 pandemic has caused a number of mental disorders in addition to economic hardship. This strongly suggests the need to monitor the long-term impact of the COVID-19 pandemic on mental health