Addison's disease: a case report

Addison's disease is a rare endocrine disease. This is a report of a case of Addison's disease as seen in a Nigerian female patient to highlight the occurrence in this environment as well as sensitize practitioners as to its possible aetiology, particularly in this era of tuberculosis and the pandemic of HIV/AIDS. Keywords: Addison's disease, tuberculosis Annals of African Medicine Vol.2(2) 2003: 85-8

Global disability burden and its predictors among adult Nigerians living with Type- 2 diabetes

Background: Type 2 diabetes mellitus (T2DM) is a public health issue associated with a high prevalence of disability.Studies on disability profile in terms of reduction in body structure and function, personal activities and societal participation, defined as ‘global disability’, are scarce among people living with T2DM in Nigeria.Objectives: To assess the prevalence of global disability and its predictors among Nigerian living with T2DM.Methods: A cross-sectional analysis of 162 patients diagnosed with T2DM and attending a tertiary health facility was performed for global disability measure and function. Their clinical and socio-demographic data were obtained. Poisson regression analysis was applied to assess the predicting factors of disability.Results: A mean global disability score of 22.1 was reported among the participants, varying from moderate to high in each item. About 25.0% had mild disability, while 60.5% reported moderate to severe disability. Elevated glycosylated haemoglobin, fasting blood glucose, systolic blood pressure, age, disease duration and marital status predicteddisability. A unit increase in HbA1c, systolic blood pressure and 1 month increase in DM duration had more disability reported estimates [1.062 (CI=1.050-1.075), 1.005 (CI=1.002-1.007) and 1.001 (CI=1.000-1.002) times, respectively].Married participants were 1.13 (CI=1.02-1.23) times more likely to be disabled than unmarried.Conclusions: There is mild to moderate burden and risk of global disability among Nigerian living with T2DM. Age, DM duration, marital status, fasting blood glucose, glycosylated haemoglobin and systolic hypertension significantly predicted disability.Keywords: global disability; type 2 diabetes; predicting factors; NigeriaFunding: None declare

Pattern of Doppler Ultrasonographic Scan Requests and Findings: A 3-Year Study

Introduction: Doppler ultrasonography is a radiological investigative tool which is relatively new in developing countries, Nigeria inclusive. Objective: To describe the clinical indications, the pattern of requests and findings of Doppler ultrasonographic studies in a tertiary health facility in Sagamu, Nigeria. This is a preliminary report of a spanning June 2007 to July 2010 and highlighting the Methods: This initial report covered the period between June 2007 and July 2010. The subjects consisted of patients who were referred for Doppler Ultrasonography from public and private health facilities in Sagamu. The ultrasound scan was carried out using a Siemens's Sonoline G-40® Ultrasound Machine. The features recorded included the waveforms, peak velocities, pathologic features such as plaques, irregular pools of blood and the relative absence of flow as well as the lack of Doppler signals. Results: There were 42 patients comprising 29 (69%) males and 13 (31%) females, aged 16-78 years, with a mean age of 53 ± 15.5 years. The subjects were matched for age (p = 0.9). The clinical indications for Doppler ultrasound studies included Diabetes Foot Syndrome (DFS), Deep Venous Thrombosis (DVT), peripheral arterial disease, and leg swellings. Minor indications included oedema, gunshot wound, nephritic syndrome, supraclavicular tumour and varicose veins. The Doppler ultrasound findings were confirmatory of the clinical diagnosis of DVT in 5/8 (62.5%) and 5/23 (21.7%) in DFS patients. Conclusion: Doppler ultrasound confirmed a higher proportion of DVT compared to DFS

Addison's Disease

Addison's disease is a rare endocrine disease. This is a report of a case of Addison's disease as seen in a Nigerian female patient to highlight the occurrence in this environment as well as sensitize practitioners as to its possible aetiology, particularly in this era of tuberculosis and the pandemic of HIV/AIDS

The Attitude of Older Patients to Deprescribing Polypharmacy in Ogun State, Nigeria

Background: Deprescribing has been suggested as a beneficial intervention to reduce polypharmacy among older patients. However, little is known about the willingness to accept this intervention among patients in resource-limited settings. Objective: To evaluate the attitudes of older patients to deprescribing polypharmacy. Methods: A quantitative, cross-sectional survey was carried out among consecutively selected ambulatory patients aged ≥65 years who were on ≥5 chronic medications in two secondary healthcare facilities in Ogun State, southwest Nigeria. The 22-item revised Patients Attitude Towards Deprescribing questionnaire was used to evaluate the participants' attitudes toward deprescribing, while another ten-question tool explored participants' sociodemographic and clinical data. Logistic regression was used to determine factors associated with willingness to deprescribe among the participants using the global question, "If my doctor said it was possible, I would be willing to stop one or more of my regular medicines”. Results: Out of the 341 participants, the majority were females (60.7%), and 90.0% were on 5-7 medications. About three-quarters (71.8%) strongly agreed or agreed that they would be willing “to stop one or more of their medicines if the doctor said it was possible”. Female gender and caregivers’ involvement in medication management were significantly associated with participants' willingness to accept deprescribing (p = 0.07 and p = 0.01). Conclusions: Most participants were willing to accept the deprescribing of their medications. Female gender and caregivers’ involvement in medication management were predictive factors for the participants' willingness to accept deprescribing

Diagnosis, prescription drug use and potentially inappropriate medications among adults aged ≥50 years in a Nigerian Hospital

Older adults are peculiar in diagnosis, medicine use and medication related problems. To categorize diagnosis, evaluate drug use and determine potentially inappropriate medications among ≥50 year olds, a 12 months retrospective audit was conducted using 300 medical files of adults aged 50 years and above attending outpatient clinics of Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun State, Nigeria. Information on sex, age, occupation, diagnosis and medicines prescribed was retrieved consecutively. Statistical Package for Social Science Version 20 was used for frequencies. Diagnosis was categorized using the International Statistical Classification of Diseases Tenth Revision Clinical Modification (ICD-10-CM). Potentially inappropriate medications (PIMs) were evaluated using the 2012 American Geriatric Society Beers Criteria. A majority of encounters were females, 173 (57.6%); traders by occupation, 144 (48.2%) and 60-69 years old, 107 (35.6%). Based on ICD-10-CM, hypertension (I10) 53 (17.7%) and osteoarthritis (M17), 47 (15.7%), were the most prevalent. Diseases of the musculoskeletal system and connective tissue (M00-M99), 85 (28.3%), was the most occurring title. The average number of medicines was 1.99. Antihypertensives (65.3%) were the most prescribed medicines. Diazepam, 35 (11.5%), and naproxen, 15 (5%), were the most prescribed Potentially Inappropriate Medications. Although numerous diagnoses and co-morbidities were encountered, medicine use was adjudged optimal. It is recommended that benefits be weighed against risk before use of such medicines.Keywords: Categorize, Diagnosis, ICD-10-M, Olabisi Onabanjo University Teaching Hospital, OOUTH, Sagam

Awareness of Ocular Complications of Diabetes Among Diabetic Patients In A Tertiary Hospital In Western, Nigeria

Background:- Diabetes is no longer a disease of affluent and industrialized countries. It affects virtually all ocular structures and can lead to blindness. Routine eye examination is necessary for early detection of ocular involvement and prevention of blindness. Only few diabetics have regular eye examination. Aim:- To study the awareness of ocular complications of diabetes among diabetic patients Methodology:- A cross-sectional prospective study of 148 randomly selected diabetic patients was done. A semi structured questionnaire was administered to these patients by an interviewer who is medical personnel, not below the level of a house-officer. Informed consent was obtained from the patients before filling the questionnaires. The information obtained include the biodata, educational level, duration of diabetes, whether they were aware that diabetes can affect other parts of the body, if yes which parts, which parts of the eye can it affect, how can it affect the eye, whether or not routine eye examination is necessary in diabetics, if yes how often, how did they learn about diabetes and how they think awareness of diabetic complications can be improved. The results were collated and analyzed using SPSS version 13, with chi square done where necessary. Results:- A total of 148 patients were studied. Their ages range between 21years and 82years, with a mean of 58.53 +10.4years. Majority were between 36-60yearrs of age. Eighty-three (56.1%) had educational level within secondary level 40(27 %) tertiary education while 25(16.9 %)) do not have formal education. Most common co morbid factor was hypertension, found in 44.6%. One hundred and twenty three (83.1%) were aware that diabetes could affect other parts of the body, 41% were aware of brain affectation, 54% were aware that it can affect the kidneys, 77.7% were aware that it can affect the eyes, 39.2% blood vessels, 66.2% the legs, 40.5% the skin and 41.9% were aware that it can affect the genitals. Of the 77.7% who were aware that it can affect the eyes, more than half (58.8%) did not know the part of the eye that can be affected. 20.3% knew that it can affect the crystalline lens,4.1% external eye, 13.5% the retina and 3.4% thought it can affect the combination of external eye, lens and the retina. Forty nine respondents (33.1%) did not know that routine eye examination is necessary in diabetics, 16.2% says eye examination should be once, 18.2% twice, 18.9% thrice and 26.4% none. Only 18 (12.2%) respondents got their information of eye complication from eye specialists. Sixty- one respondents (41.2%) do not know how diabetes can affect the eye, 29.7% knew that poor control is the problem, 8.8% think it is due to long duration, 7.4% believe it was a combination of poor control and long duration, 2% claim it is due to infection, 8.8% combination of infection, poor control and long duration and 0.7% erroneously believe thinking too much of DM can result in eye complication. Patients who have been diabetic for more than 10years are more aware that diabetes can affect the eye than those below 5years (92.3% vs. 7.2%, p=0.001). Awareness of diabetic complication is better in those with tertiary education than others (p=0.001). Conclusion:- We conclude that though awareness of ocular complication of diabetes mellitus is high, the level of knowledge is low. Health Practitioners especially eye care specialist need to intensify health education through media, regular health talks in clinics to increase knowledge and increase health seeking behaviours of diabetics in the

A study of disease pattern in a tertiary level Gastroenterology and Hepatology Out-Patient Unit

Background: Diseases affecting the gastrointestinal tract and its accessory organs like the liver, gall bladder and the pancreas have become a global concern as they are characterized by morbidities with high burden to both the individual and the economy. Objective: To describe the pattern of various gastrointestinal and hepatic diseases at a tertiary institution. Methods: A retrospective study of consecutive new referrals for ambulatory clinic visits to a Gastroenterology and Hepatology Clinic between May 2014 and May 2016 was conducted. Results: There were 259 new cases comprising 148 (57.1%) males and 111 (42.9%) females, aged 16-89 years with a mean age of 42.0 ±15.5 years. The commonest reasons for referral included asymptomatic chronic Hepatitis B Virus (HBV) infection (35.9%), chronic liver disease (CLD) (12.4%), hepatocellular carcinoma (HCC) (11.6%) and dyspepsia (10%). Asymptomatic HBV infection, CLD and HCC were more frequent among the males, whereas dyspeptic complains were more prevalent among the females (p = 0.008). Conclusion: Asymptomatic chronic hepatitis B virus infection, which is the leading cause of chronic liver disease and hepatocellular carcinoma, was the most common reason for ambulatory gastroenterology and hepatology consultation in this study. Therefore, more effective measures for the eradication of the hepatitis B virus are desired

Stigmatising attitude of medical students towards a psychiatry label

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Addisonès Disease: A case report

Addison's disease is a rare endocrine disease. This is a report of a case of Addison's disease as seen in a Nigerian female patient to highlight the occurrence in this environment as well as sensitize practitioners as to its possible aetiology, particularly in this era of tuberculosis and the pandemic of HIV/AIDS