Performance of the Androgen Deficiency in Aging Male questionnaire for the clinical detection of androgen deficiency in black sub-Saharan African men with Type-2 diabetes mellitus

Background: The Androgen Deficiency in Aging Male (ADAM) questionnaire is increasingly popular for evaluation of androgen deficiency (AD) in sub-Saharan African men with type 2 diabetes mellitus (DM). However, its reliability in this population is unknown.Methods: Total testosterone < 8 nmol/L was used as the gold standard for diagnosis of AD in this cross-sectional survey of 200 type 2 DM males aged 30–69 years. Participants also completed the Saint Louis University ADAM questionnaire whereby AD was diagnosed by a ‘yes’ answer to question 1 (reduced libido) or 7 (erectile dysfunction) or any other three questions. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of the ADAM tool were computed.Results: The mean age of the participants was 58.0 ± 8.8 years. A total of 142 subjects (71.0%) had AD based on the ADAM questionnaire. However, AD was biochemically confirmed in 59 subjects (29.5%). The ADAM questionnaire rendered a sensitivity of 88.1%, specificity of 44.7%, PPV of 50.0%, NPV of 85.7% and accuracy of 61.4%.Conclusion: Despite an impressive sensitivity, the low specificity and overall accuracy of the ADAM questionnaire makes it unreliable for the detection of AD in sub-Saharan African men with type 2 DM.Keywords: ADAM, Africa, androgen, Nigeria, testosterone, type 2 diabete

Pain management in medical wards: A single centre experience in Nigeria

Background: Pain is the commonest reason for hospital presentation worldwide. Its prevalence, distribution and severity are similar across different wards. However, the management of pain in medical wards is sub-optimal. The study was aimed at the determination of patients' perception of adequacy of pain management in medical wards.Methods: A cross sectional hospital based study of patients admitted into the medical wards of Federal Medical Centre, Makurdi over a two year period using a validated questionnaire purposively administered to consecutive patients who had diagnoses with pain as a major component (e.g. Sickle Cell Crisis, Painful Neuropathies) to capture socio - demographic and clinical parameters, diagnoses and analgesics (type, dose, escalation frequency).Results: There were 1,986 patients made up of 1,019 females and 967 males with mean age 53±18 years. Up to 31.1% were in their seventh decade with majority (59.3%) living in urban areas. Respondents were admitted with various painful conditions (e.g. neuropathies from diabetes and chronic kidney diseases constitute 42%). They were on appropriate analgesics at rather low doses or one off doses. Up to 62% had used bioceuticals. Majority (95.2%) of respondents felt that pain management in the medical wards was inadequate.Conclusion: Most (95.2%) patients felt pain management while they were on admission was not adequate. Analgesia was based on patient's complaint and the judgment of the physician. Key Words: Pain, analgesics, medical wards, bioceutical