Control of risk factors for nephropathy among Nigerian outpatients with Type 2 diabetes mellitus

Background and Objectives: To determine the proportion of type 2 diabetic  outpatients with adequate control of risk factors for nephropathy in a Nigerian teaching hospital.Methods: Between April and July 2005, 160 type 2 diabetic outpatients were  assessed for control of average fasting blood glucose and blood pressure over 3 visits, and current use of ACE inhibitors. All patients were over 30 years of age and had been followed up for at least one year with at least 6 prior clinic visits.Results: We studied 58 male and 102 female subjects with a mean (±SD) age of 54±10 years. The majority (54.7%) had diabetes between 1 and 5 years, and 95% were on antidiabetic drugs, most commonly both a sulphonylurea and metformin (64.5%). 114 (71.2%) were being treated for hypertension. The mean fasting blood glucose (FBS) was 7.6±2.9mmol/L, and 73 (45.6%) had good glycaemic control  (mean FBS≤ 5.6mmol/L). A total of 51 (31.9%) had good blood pressure control (<140/90mmHg in non-hypertensives and <130/80mmHg in hypertensives), and 73 (45.6%) were currently receiving ACE inhibitors. Only five (3.1%) had the combination of good glycaemic control, good blood pressure control and received ACE inhibitors. Conversely, 23 (14.4%) had a combination of poor glycaemic control, poor blood pressure control, and were not receiving ACE inhibitors. Duration of diabetes (p<0.01), elevated creatinine (p<0.01), and elevated systolic blood  pressure (p<0.01) were independently associated with proteinuria.Conclusion: Despite the availability of measures to prevent the progression of diabetic nephropathy, control of risk factors was poor. Physicians and diabetic patients in Nigeria must work together to improve their management of risk factors for nephropathy.Key words: Diabetes mellitus, chronic kidney disease, renoprotectio

Rickets: An Overview and Future Directions, with Special Reference to Bangladesh: A Summary of the Rickets Convergence Group Meeting, Dhaka, 26–27 January 2006

Rickets has emerged as a public-health problem in Bangladesh during the past two decades, with up to 8% of children clinically affected in some areas. Insufficiency of dietary calcium is thought to be the underlying cause, and treatment with calcium (350–1,000 mg elemental calcium daily) is curative. Despite this apparently simple treatment, little is known about the most appropriate management of bone deformities of affected children, and further studies are needed to determine the details of dosing and duration of calcium therapy, the role of bracing, and specific indications for surgical intervention. Effective preventive measures that can feasibly reach entire communities are needed, and these may differ between various affected regions

Adaptation of calcium absorption during treatment of nutritional rickets in Nigerian children

Nutritional rickets in Nigerian children has been effectively treated with Ca supplementation. High values of Ca absorption efficiency have been observed in untreated children, but whether Ca absorption efficiency changes during treatment with Ca is unknown. Our objective in conducting this study wits to identify the effect of Ca therapy on Ca absorptive efficiency in children with primary Ca-deficient nutritional rickets. Twelve children with radiographically active tickets, 2 to 14 years of age (median 39 months) participated in the study. We assessed dietary Ca intake via dietary recalls, and measured biochemical markers of Ca and vitamin D homeostasis. Fractional Ca absorption was measured using a dual tracer stable isotope method, before and after 2 weeks of treatment with 15.0 mmol elemental Ca daily. Ten children had adequate urine collection for inclusion in the analysis. Usual dietary Ca intake was 4.2 (SD 1.0) mmol/d. The median Ca absorption prior to treatment was 72% (range 52-97%) and decreased significantly to 57% (31-84%) (P=0.004) after 2 weeks Of Supplementation. We conclude that Nigerian children with rickets adapt to Ca Supplementation with a small decrease in Ca absorptive capacity, but retain very high absorptive levels during supplementation. Overall Ca absorption efficiency was comparable with that identified in other populations with low Ca intakes. These data demonstrate that although absorptive capacity is regulated by supplementation, recovery from rickets likely occurs through efficient use of both dietary and supplemental Ca

Rickets: An Overview and Future Directions, with Special Reference to Bangladesh: A Summary of the Rickets Convergence Group Meeting, Dhaka, 26-27 January 2006

Rickets has emerged as a public-health problem in Bangladesh during the past two decades, with up to 8% of children clinically affected in some areas. Insufficiency of dietary calcium is thought to be the underlying cause, and treatment with calcium (350-1,000 mg elemental calcium daily) is curative. Despite this apparently simple treatment, little is known about the most appropriate management of bone deformities of affected children, and further studies are needed to determine the details of dosing and duration of calcium therapy, the role of bracing, and specific indications for surgical intervention. Effective preventive measures that can feasibly reach entire communities are needed, and these may differ between various affected regions

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries.

Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D 1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations

Evaluating the Evidence in Clinical Studies of Vitamin D in COVID-19

Laboratory evidence provides a biological rationale for the benefits of vitamin D in COVID-19, and vitamin D supplementation is associated with reduced risk of respiratory infections. Most of the clinical studies of vitamin D in COVID-19 have been observational, and the most serious problem with observational study design is that of confounding. Observational studies typically assess the relationship of 25(OH)D values with COVID-19 outcomes. Many conditions associated with low vitamin D status are also associated with worse COVID-19 outcomes. Randomized controlled trials (RCTs) overcome the problem of confounding, typically comparing outcomes between groups receiving vitamin D supplementation or placebo. However, any benefit of vitamin D in COVID-19 may be related to the dose, duration, daily vs. bolus administration, interaction with other treatments, and timing of administration prior to or during the illness. Serum 25(OH)D values >50 nmol/L have been associated with reduced infection rates, severity of COVID-19, and mortality in observational studies. Few RCTs of vitamin D supplementation have been completed, and they have shown no benefit of vitamin D in hospitalized patients. Vitamin D may benefit those with mild or asymptomatic COVID-19, and those with greater 25(OH)D values may have lower risk of acquiring infection. Because those at greatest risk of COVID-19 are also at greatest risk of vitamin D deficiency, it is reasonable to recommend vitamin D supplementation 15–20 mcg (600–800 IU) daily for the general population during the COVID-19 pandemic. Vitamin D doses greater than 100 mcg (4000 IU) daily should not be used without monitoring serum 25(OH)D and calcium

Biomass fuel use and the risk of asthma in Nigerian children

Background: Biomass fuel smoke exposure contributes to respiratory infections in childhood, but its association with asthma has not been established. We studied the relationship of biomass fuel use with asthma symptoms and lung function in Nigerian children. Methods: A cross-sectional study was performed in 299 village children aged 5-11 years in North Central Nigeria. Data were collected regarding the cooking fuels used and duration of daily smoke exposure in the cooking area. Asthma symptoms were assessed with a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and lung function was assessed with spirometry. Results: The prevalence of a lifetime history of wheeze was 9.4% (95% CI: 6.3%-13.2%). Fourteen children (4.7%) had airway obstruction (FEV1/FEV6 <85%). Female subjects had lower FEV1 and FEV6 (110% and 120% percent predicted, respectively) than males (121% and 130%, respectively, P<0.001 for both differences). Advancing age was associated with a relative decline in the predicted value of FEV1 of 7.8% per year (r = -0.61; P < 0.001). Children in families that used firewood daily did not have a significantly increased likelihood of asthma-related symptoms (OR = 2.36, 95% Cl: 0.66-8.44). Similarly, airway obstruction did not differ significantly between children in households that did and did not use firewood daily (mean FEV1/FEV6 of 0.95 and 0.97, respectively; P = 0.41). Conclusion: Reported smoke exposure was not associated with an increased risk of asthma symptoms or airway obstruction. However, lifetime smoke exposure may explain the reduction in spirometric values in female subjects and with advancing age. (C) 2013 Elsevier Ltd. All rights reserved