Making sense of thyroid function tests

Background: Thyroid disorders are second only to diabetes mellitus among endocrine problems encountered in practice. Many patients with thyroid disorders tend to present with nonspecific symptoms to clinicians in different specialties, who are often quick to request for a thyroid function test. Although interpretation of the results of most thyroid function tests (TFTs) is straightforward, in a small number of situations the results seem to point in different directions, thereby producing clinical confusion. Knowledge of the different patterns of TFTs and their causes will help clinicians to properly manage their patients and avoid unnecessary, and often expensive further investigations.Objective: To highlight the causes of the different patterns of abnormal thyroid function tests seen in clinical practice and to provide a practical approach to the evaluation of patients with such results.Method: We searched PubMed, Google scholar and Medline for articles written in English on the interpretation and pattern of thyroid function tests.Result: Interpretation of the results of most TFTs is straightforward especially when combined measurements (TSH with T4 or T3 or both) are ordered. Careful clinical reassessment of thyroid status and consideration of possible confounding factors such as pregnancy, intercurrent (non-thyroidal) illness or drug therapy will readily identify the cause of such apparently discordant TFTs.Conclusion: A sound knowledge of the conditions that can be associated with different patterns of TFTs will go a long way in guiding the choice of additional investigations and allowing a correct diagnosis, thus avoiding inappropriate treatment.Keywords: Thyroid function tests (TFTs), patterns of abnormal TFTs, non-thyroidal illnes

Prevalence and risk factors for overweight and obesity among suburban semi-nomadic Fulani's of northwestern Nigeria

Background: Obesity is a major public health problem that is associated with increased cardiovascular morbidity and mortality. It is an important threat that is fast becoming an emerging epidemic globally, Nigeria inclusive. Although there are numerous studies on the prevalence of obesity in Nigeria, the semi-nomadic Fulani's have not been extensively studied. This study will, therefore, help to assist policymakers to plan effective strategies for combating the epidemic among neglected ethnic populations.Method: The study was a community-based cross-sectional study carried out in Kumbotso Local Government Area of Kano state, from June 2015 to December 2015. Anthropometric indices (Weight, height, waist and Hip circumferences) were measured for the subjects. Body mass index and waist hip ratio was also calculated. Serum blood glucose, lipid, and blood pressure were determined.Results:  The mean ±SD age of the subjects was 38.97±15/98 years, with a range of 18 – 90 years. There were 208 (39.1%) males and 324 (60.9%) females, p <0.001. Obesity was found in 9.21% of the subjects (4.32% of males, 13.58% of females). Overweight was found in 20.86% of the subjects, 15.38% of males and 13.58% of females respectively. Factors associated with overweight include advancing age and female gender. The odds ratio for developing obesity is higher in subjects > 50 years (2.319, 95% CI, 1.203-3.540).Conclusion: There is a relatively high prevalence of overweight and obesity among suburban semi-nomadic Fulani's. In view of this, there is the urgent need to initiate public health measures aimed at improving healthy lifestyle measures.Key words: Prevalence, overweight, obesity, risk factors and sub urban

Idiopathic scrotal calcinosis; a rare scrotal tumour: A Case Report and Review of Literature

Idiopathic scrotal calcinosis is a rare benign disease characterized by multiple, asymptomatic and painless nodules on the scrotum. We herein report this rare disease in a Nigerian adult male and briefly review the relevant literature.Key words: Calcinosis, scrotum, Nigerian adult male, painless nodules

Disseminated Cutaneous Leishmaniasis in HIV positive patient - A Case Report

Disseminated cutaneous leishmaniasis and HIV dual-infection is seldom reported. Leishmaniasis and HIV co-infection may intensify the immunedefect and is the chief reason for atypical presentation and widespread progression of cutaneous leishmaniasis and its defiance to conventional therapy. Here we report a 38-yearold HIV-positive ladywhopresented with a 6-month history of a progressive papule and nodular eruptions of leishmaniasis on face, trunk and extremities that was recalcitrant to treatment.Keywords: Co-infection, Diffuse cutaneous leishmaniasis, HIV infection

Mortality pattern among tuberculosis patients on treatment in Nigeria: A systematic review and meta-analysis

Background: Tuberculosis (TB) has continued to be associated with a substantial number of deaths, even in the era of effective antimicrobials. Nigeria is one of the countries with a high tuberculosis burden and has sub-optimal documentation of TB related deaths. Vital statistics/registration is not robust, and mortality surveys are rarely undertaken. In this study, we aimed to determine a precise estimate of TB related deaths on treatment and the trends in death rate while on TB treatment in Nigeria. Methods: We searched electronic databases for eligible studies from 1st January 2000 to 31st December 2017. We generated pooled death rate estimates using random-effects models and determined trends using meta-regression. Results: We identified 546 studies, of which 28 fulfilled the criteria for quantitative analysis. Overall, studies reported on 64,999 individuals. The pooled TB death rate during treatment was 6.6% (95% CI; 5.2-8.1%). There was a non-significant rise in TB related deaths on treatment of 0.2% per year (p-value = 0.454). Conclusion: We found a low TB related deaths on treatment, death rate and slight temporal rise over the study years. There is a need for continuous vital registration, including TB related death, and mortality survey among TB patients

Prevalence of _on-invasive risk factors of type 2 diabetes among higher education teachers in _orth-western _Igeria

Background: Teaching is associated with a number of stressful circumstances that promote unhealthy lifestyles capable of fuelling risk factors for metabolic and cardiovascular disorders. This study investigated the prevalence of selected non-invasive risk factors of Type 2 Diabetes (T2D) among higher education teachers. Methods: Higher education teachers numbering 876 from three tertiary institutions in Kano, North- Western Nigeria were assessed on selected non-invasive risk factors of T2D including Body Mass Index (BMI), Waist Circumference (WC), Waist-Hip-ratio (WHR), Percent Body Fat (PBF) and family history of diabetes. Lifestyle including smoking, alcoholism and physical inactivity were also assessed. Results: Female-male ratio of participants was 1:5 while the age range was 24-58 years. Female teachers had higher prevalence of poor adiposity markers represented by overweight (33.8%), obesity (12.7%), high PBF (21.7%) and WC in the high risk domain (53.5%). They also had higher prevalence of hypertension (22.5%) while men had higher prevalence of WHR (31.2%) in the high risk domain. Positive family history of diabetes was 6.5% (males), 7.5% (females); physical activity at walking level 46.0% (males), sedentary activity 85.9% (females); current smoking habit 42.8% (males), 4.3% (females) and current alcohol consumption was 11.9% for males and 0% for femaleteachers. Conclusion: There may be considerable chances of developing T2D among the higher education teachers based on prevalence of the selected risk factors and the risk may be higher among the female teachers. Measures to change the modifiable risk factors for the better in this population are urgently needed

Exercise Capacity in Type 2 Diabetes Patients: A Preliminary Investigation

To enhance glycaemic control and improve general well being, physical exercises, in addition to drugs and/or diet are usually prescribed to patients with Type 2 Diabetes mellitus (T2D). Assessment of the capacity of these patients to exercise based on the simple Six Minute Walk Test (6MWT) is however not sufficiently documented. We compared the exercise capacities of 58 T2D volunteers matched with 60 non-diabetic individuals using the 6MWT on a 50-meter corridor. The self paced Six Minutes Walk Distance (6MWD) was our outcome measure and it was taken as a display of the exercise capacity of the participants. The diabetic participants had significantly lower (t = 30.5046, P < 0.05) 6MWD (318.57 ± 43.7, 95% CI = 306.74-329.25 m) than the non-diabetic sample (596. 43 ± 54.78, 95% CI = 582.57-610.29 m) indicating lower exercise capacity. In the diabetic sample, we found significant differences in the 6MWD of the age groups (F = 9.4738, P < 0.05) and body mass index classifications (F = 3.3416, P < 0.05) but not for the duration of their diabetes. We found exercise capacity to be lower in patients with T2D than non-diabetic subjects and this was found to be lower in T2D patients who were older and overweight or obese. Exercise prescriptions for T2D patients should consider these factors to avoid exercise induced eventualities