Plasma Micronutrients (magnesium, zinc, selenium) Status and Lipid Profile in Type II Diabetes Mellitus Patients in Sagamu, Southwestern Nigeria

Background: Diabetes mellitus (DM) is a group of metabolic disorders characterised by hyperglycemia with secondary derangements in micronutrient status. Various studies had given conflicting reports of increased or decreased levels of micronutrients in Type II DM. Objective: To measure the plasma micronutrient levels and lipid profile in adults with Type II DM. Method: Plasma magnesium, zinc and selenium levels were measured among 100 subjects comprising 50 people with DM (age range 36-70 years) and 50 control subjects without DM (age range 29-70 years). The anthropometric parameters were measured; fasting blood glucose, plasma cholesterol, triglycerides, and high-density lipoprotein cholesterol, micronutrients (magnesium, zinc and selenium) levels were also measured using standard methods. Result: There were statistically significant (p < 0.05) higher plasma glucose, blood pressure (systolic and diastolic), LDLC, and lower levels of plasma magnesium, zinc, selenium, HDLC levels among the patients with DM (cases) compared with the normal control subjects. No significant difference was observed in the plasma total cholesterol and triglyceride between the two groups. A significant negative correlation was found between the plasma levels of the trace metals (magnesium, zinc and selenium) and triglycerides (r = - 0.36, r = - 0.43, r = - 0.51 respectively). Conclusion: Plasma levels of magnesium, zinc and selenium are reduced in Type II DM with associated hyperglycaemia-driven dyslipidaemia

Churg-Strauss's Syndrome; Review of literature

Churg – Strauss Syndrome (CSS) is a rare idiopathic, multisystemic, autoimmune disease, characterized by diffuse eosinophilic infiltration and necrotizing vasculitis of small to medium sized vessels. Late onset asthma and/or allergic rhinitis are frequent clinical manifestations with fever and loss of weight as systemic symptoms at presentation. Mononeuritis multiplex, myalgia, skin involvement (purpura, skin nodules, urticarial rash, livedo reticularis), arthralgia, gastro intestinal tract (GIT) involvement, pericardial, myocardial, central nervous system (CNS) and renal involvements are other manifestations of CSS. Diagnostic hallmarks include Blood and tissue eosinophilia, histology revealing eosinophilic granulomas and/or necrotizing vasculitides in tissue biopsy. Although not a criterion of CSS diagnosis, presence of Antineutrophil Cytoplasmic Antibodies (ANCA), especially antimyeloperoxidase (ANCA MPO), is associated with CSS. This is present in more than 40% (40 - 66 - 73%) of CSS patients. Pathogenesis varies from ANCA activation of neutrophils and resultant systemic endothetial damage (in ANCA positive CSS), on one hand, and tissue infiltration by eosinophils with resultant tissue damage by toxic products of eosinophils (in ANCA negative CSS), on the other hand. There are also the varying B and T cell dysfunctions. Diffuse organ involvement, especially cardiovascular (CVS), GIT, rare involvement of CNS and renal system suggest poorer prognosis and possible fatal outcome. Patients with these poor prognostic outlooks, especially cardiac, receive aggressive treatment using corticosteroids combined with immunosuppresants (chiefly cyclophosphamide). Patients with refractory CSS have been successfully treated, adding TNF – alpha blockers to a combination of glucocorticoids and cyclophosphamide. Antithymocyte globulin or pooled intravenous globulin have been found effective alternative therapy in resistant cases and most especially in pregnant patients. Keywords: Churg-Strauss syndrome, Eosinophilia, Antineutrophil Cytoplasmic Antibodies, Immunosuppressant

Rheumatologic Disorders in Diabetes Mellitus: Case Reports and Review of Literature

Various rheumatologic disorders are associated with diabetes mellitus. These include osteoarthritis, shoulder pain syndrome, flexor tendon synovitis and Diffuse Idiopathic Skeletal Hyperostosis (DISH). Although Diabetes Mellitus has been frequently reported among Nigerians, there are few reports on rheumatologic disorders among them. This is a case report of four rheumatologic conditions commonly seen among Nigerian diabetics. Three (3) of the four diabetic patients were females, (ages 67-87yrs) and had limited joint mobility (LJM), Shoulder Pain syndrome with Sudecks Atrophy and neurogenic bladder in the 82yr old. The fourth patient, 61 yr old male had LJM only. Diabetes duration ranged from 10-20 years. They were managed conservatively with NSAID, intra-articular steroid injection into the shoulder joint and intra-lesional injection in the patient with trigger finger. Response to therapy was effective with little or no pain after. Long disease duration and old age are essentials to the onset of rheumatological disorders in diabetes. There may be multiple manifestations in any one patient and multidisciplinary approach in management of patients to improve outcome and overall quality of life is advocated.Keywords: Diabetes mellitus, duration, rheumatologic manifestation

Reiters syndrome – a case report and review of literature

The occurrence of Reiter's Syndrome is rare and not commonly reported in Nigeria. This paper reports a case of a 35yr old male Nigerian with Reiter's Syndrome, occurring 1-2 weeks after a bout of a dysenteric illness. The patient presented with fever, conjunctivitis, dysentery, urethritis and arthralgia. The joint pains involved the left wrist (which was swollen), the right knee and ankle joints. The patient was managed conservatively. The case is presented with a view to documenting the occurrence of Reiter's Syndrome in an African Nigerian. Key Words: Reiters syndrome; Nigerian African Health Sciences Vol.4(2) 2004: 136-13