Annals of African Medicine
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   Table of Contents - Current issue
Coverpage
October-December 2016
Volume 15 | Issue 4
Page Nos. 157-211

Online since Thursday, November 17, 2016

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ORIGINAL ARTICLES  

Ultrasound assessment of thyroid gland volume in diabetic patients without overt thyroid disease p. 157
Christopher C Nduka, Ademola A Adeyekun
DOI:10.4103/1596-3519.194276  PMID:27853029
Background: Diabetes mellitus and thyroid disease are known to mutually influence each other. Thyroid disease can worsen glycaemic control in diabetes, and patients with diabetes mellitus have increased incidence of thyroid disorders such as increase in size, compared to the normal population. Aims/Objectives: The aim of the study was to sonographically assess thyroid gland volume in Nigerian adult diabetic patients and compare with apparently healthy adults (controls). Subjects and Methods: The study setting was the Department of Radiology, University of Benin Teaching Hospital (UBTH) Nigeria. The thyroid gland in 120 diabetic subjects and equal number of apparently healthy controls was scanned with a 5-12 MHz linear transducer of a SONOACE X4 Machine. Thyroid gland volume was assessed. Statistical analysis was done with Statistical Package for the Social Sciences (SPSS) version 17 (SPSS Inc, Chicago, IL, USA). Results: Diabetics had significantly increased thyroid volume compared to age matched male and female control subjects (11.5 ± 5.2 cm3 vs 7.4 ± 1.9 cm3; P< 0.001 for males) and (9.9 ± 6.2 cm3 vs 7.1 ± 3.4 cm3; P< 0.001 for females) respectively. Gender did not significantly influence thyroid volume among diabetics. Conclusion: Diabetics have higher thyroid gland dimensions, compared to apparently healthy subjects. Gland proliferation from circulating insulin may play a role. This is not influenced by gender.
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The prevalence and characteristics of latent autoimmune diabetes in adults subset among type two diabetes mellitus patients in Northern Nigeria p. 163
Salisu Babura Muazu, Innocent Okpe, Felicia Anumah
DOI:10.4103/1596-3519.194277  PMID:27853030
Introduction: Latent autoimmune diabetes in adult (LADA) is a form of Type 1 diabetes mellitus (T1DM) that occurs in adult or with advancing age. It commonly occurs in people aged ≥30 years and is characterized by initial response to oral hypoglycemic agents, lean body mass, and presence of glutamic acid decarboxylase autoantibody (GAD-Ab). It exhibits rapid deterioration of the pancreatic β-cells secretory function due to the destructive action of the autoantibodies. The prevalence of LADA among T2DM patients varies among population due to different diagnostic criteria, patients' characteristics, the assay used, and genetic predisposition. In this study, we intend to document prevalence and clinical characteristics of LADA subset patients in Northern Nigeria. Methods: Two-hundred noninsulin-requiring T2DM patients were recruited from the diabetes clinic based on the selection criteria. Their clinical characteristics were documented, and we measured their serum GAD-Ab, glycated hemoglobin (HbA1c), fasting C-peptide, fasting plasma glucose, and fasting serum lipids. The mean (standard deviation) of these clinical and biochemical parameters was compared between GAD-Ab+ and GAD-Ab groups. The data were analyzed using SPSS version 20 with P< 0.05 as statistically significant. Results: The prevalence of LADA among the T2DM patients studied was found to be 10.5% (21/200); there were more males than females (15 [71%]:6 [29%], χ2 = 4.2, P< 0.05). The mean age of the GAD-Ab+ was 52.0 (11.0), and there was no statistical difference with GAD-Ab group. GAD-Ab+ was found more common in the age group of 40–49 years 10/21 (48%). The body mass index, waist circumference, and serum C-peptide were found to be significantly lower in GAD-Ab+ than in GAD-Ab group (22.1 [51], 80.1 [12.4], 0.84 [0.05] vs. 27.3 [4.9], 93.2 [10.9], 1.72 [0.43]), P< 0.05. The HbA1c was found to be significantly higher in GAD-Ab+ than in GAD-Ab (8.3 [1.4] vs. 7.0 [2.1]). Other clinical and metabolic parameters were found not to be significantly different between the two groups. Conclusion: We conclude that the prevalence of LADA among T2DM patients in Northern Nigeria is 10.5%. It is more common among males aged 40–49 years and lean subjects. The male sex and decreasing central adiposity are predictors of GAD-Ab+ among T2DM subjects.
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The post-Ebola virus disease scourge in Nigeria: Individual levels of preparedness among physicians in the Federal Capital Territory Abuja p. 171
Adewale L Alli, Maxwell M Nwegbu, Perpetua U Ibekwe, Titus S Ibekwe
DOI:10.4103/1596-3519.194278  PMID:27853031
Background: Ebola virus disease (EVD) is a viral hemorrhagic illness with great propensity for spread across international borders. The latest outbreak in the West African region, which involved Nigeria, was the worst among previously documented 25 outbreaks since discovery in 1976. The Nigerian response toward attaining Ebola free status was phenomenal and a case study for most nations. However, the persistence of EVD in West Africa is still a risk to recurrence, hence, the need to assess the level of consciousness of Nigerian physicians towards this. Methodology: A cross-sectional study utilizing the instrument of a pretested semi-structured questionnaire was conducted among physicians practicing within the federal capital city of Nigeria. General knowledge, treatment, prevention, and reporting of EVD were assessed and appropriate statistical analyses done using SPSS 20. Results: Of the 101 respondents, 45% and 87% showed excellent level (>80% score) of “general knowledge” and “reporting” on EVD, respectively. However, only 51% respondents had good (60–80%) knowledge on EVD treatment. Three percent correctly identified the “EVD helpline” phone-numbers for reporting suspected cases. Furthermore, 43.6% admitted the availability of personal protective equipment (PPE) in their hospitals while 35.6% had witnessed a demonstration of the use. The distribution of the PPEs appeared skewed - 74.4% (teaching-hospitals), 16% (private-hospitals), and the primary health care centers (9.6%). Conclusion: A majority of the physicians showed good level of preparedness as it relates to general knowledge on EVD, knowledge on good clinical practice, use of protocols and standard precautions and PPE. The identification of deficits in knowledge on treatment of EVD and flow path for the notification of suspected cases requires urgent redress given the risk of re-occurrence in the country.
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Depression in patients with epilepsy in Northwestern Nigeria: Prevalence and clinical correlates p. 179
Shakirah Desola Owolabi, Lukman Femi Owolabi, Owoidoho Udofia, Shehu Sale
DOI:10.4103/1596-3519.194279  PMID:27853032
Background: The impact of seizure disorder on people living with epilepsy (PWE) is worsened by the occurrence of comorbid psychiatric disorders, such as depression, which have been found commonly in PWE. Despite the dire consequences comorbid depression has on PWE, it still remains underdiagnosed and undertreated. Objective: To determine the prevalence of depression and associated clinical factors in PWE in Northwestern Nigeria. Materials and Methods: A total of 255 consecutive patients with epilepsy aged 18 years and above, from two health facilities, were recruited in this cross-sectional study. Following completion of a structured proforma detailing sociodemographic and seizure characteristics, Mini International Neuropsychiatric Interview was administered to diagnose depression in the patients. Results: A total of 255 patients, with a mean age of 32 years (standard deviation = 1.31), comprising 147 (57.6%) males and 108 (42.4%) females were studied. Majority (79.2%) of the patients had primarily generalized seizure type. Overall, depressive disorder was present in 52 (20.4%) patients. A significant association was found between previous hospitalization for epilepsy (P = 0.009), increased frequency of seizures, (P = 0.004), and prolonged duration of epilepsy, (P = 0.006). The independent predictors of depression included duration of epilepsy (P = 0.0001), previous hospitalization for epilepsy (P = 0.011), and frequency of seizures (P = 0.028). Conclusion: Depression was common in PWE. Female gender, previous hospitalization for epilepsy, increased frequency of seizures and prolonged duration of epilepsy were associated with depression in PWE. Previous hospitalization for epilepsy, increased frequency of seizures, and prolonged duration of epilepsy were independent predictors of depression.
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Performance of waist circumference and proposed cutoff levels for defining overweight and obesity in Nigerians p. 185
Christian I Okafor, Taiwo H Raimi, Ibrahim D Gezawa, Anas A Sabir, Ofem Enang, Fabian Puepet, Olufemi A Fasanmade, Esther N Ofoegbu, Olatunde Odusan
DOI:10.4103/1596-3519.194275  PMID:27853033
Background: Waist circumference (WC) is a simple tool for measuring central obesity in routine clinic settings. Gender- and ethnic-specific optimal cutoff points for WC are encouraged for populations lacking such data. Objectives: To derive WC cutoff values, predictive of overweight and obesity in Nigerians and to evaluate the performance of currently recommended values. Subjects and Methods: Apparently, healthy urban dwellers from six cities spread across Nigeria were selected for this cross-sectional study. Biophysical profiles such as blood pressure and anthropometric indices were measured according to the World Health Organization's STEPs instrument protocol. Receiver operating characteristics curve analysis was used to determine the optimal cutoff levels using the decision rule of maximum (sensitivity + specificity). The level of significance was set at P< 0.05. Results: A total of 6089 subjects (3234 males and 2855 females) were recruited for the study. WC demonstrated a high area under the curve in both genders. Selected cutoff points ranged from 83 to 96 cm with high sensitivities and specificities. Conclusions: The currently recommended gender-specific WC cutoff values proved inappropriate in this study group, but WC remains a reliable tool for measuring obesity.
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Evaluation of dyslipidemia, lipid ratios, and atherogenic index as cardiovascular risk factors among semi-urban dwellers in Nigeria p. 194
Michael Adeyemi Olamoyegun, Rotimi Oluyombo, Stephen Olabode Asaolu
DOI:10.4103/1596-3519.194280  PMID:27853034
Background and Objectives: The increasing frequency of cardiovascular disease (CVD) rests on the presence of major cardiovascular risk factors including dyslipidemia. This dyslipidemia is also a target for the prevention and treatment of many cardiovascular diseases. Hence, identification of individuals at risk of CVD is needed for early identification and prevention. The study was carried out to evaluate dyslipidemia using the lipid ratios and indices instead of just the conventional lipid profile. Methodology: It was a cross-sectional study with 699 participants recruited from semi-urban communities in Nigeria. Anthropometric indices, blood pressure, and fasting lipid profiles were determined. Abnormalities in lipid indices and lipid ratios with atherogenic index were also determined. SPSS software version 17.0 were used for analysis, P< 0.05 was considered statistically significant. Results: There were 699 participants with a mean age of 64.45 ± 15.53 years. Elevated total cholesterol, high low-density lipoprotein-cholesterol, elevated triglyceride, and low high-density lipoprotein were seen in 5.3%, 19.3%, 4.4%, and 76.3% of the participants, respectively. The Castelli's risk index-I (CRI-I) predicted the highest prevalence of predisposition to cardiovascular risk (47.8%) with females being at significantly higher risk (55.2% vs. 29.3%, P< 0.001). Atherogenic coefficient, CRI-II, CHOLIndex, atherogenic index of plasma (AIP) predicted a cardiovascular risk prevalence of 22.5%, 15.9%, 11.2%, and 11.0%, respectively, with no significant difference in between the sexes. Conclusions: Serum lipid ratios and AIP may be used in addition to lipid parameters in clinical practice to assess cardiovascular risks even when lipid profiles are apparently normal. AIP was more gender specific amidst the lipid ratios.
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CASE REPORTS Top

Dystonia, myoclonus, and encephalopathy in a single patient: A rare association of moyamoya p. 200
Ujjawal Roy, Urmila Das, Ajay Panwar, Prabhat Kumar Lal
DOI:10.4103/1596-3519.194284  PMID:27853035
Moyamoya disease (MMD) is a rare neurovascular disorder which pathologically, is a chronic cerebrovasculopathy. It is characterized by stenosis of the internal carotid artery (ICA) and the main branches within the circle of Willis with consecutive development of collateral vessels. There are a few cases in the literature which have described movement disorders as a manifestation of MMD; however these have been uncommonly reported in cases of moyamoya syndrome (MMS). We present a 10-year-old boy with dystonia, myoclonus and encephalopathy like features. These features in association with moyamoya, are rarely described.
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Idiopathic pulmonary fibrosis misdiagnosed as sputum-negative pulmonary tuberculosis p. 204
Muhammad Danasabe Isah, Aminu Abbas, Abdullahi A Abba, Mohammed Umar
DOI:10.4103/1596-3519.194282  PMID:27853036
Idiopathic pulmonary fibrosis (IPF), also known as cryptogenic fibrosing alveolitis, is one of a spectrum of idiopathic interstitial pneumonia. IPF is an increasingly common condition which poses many diagnostic and therapeutic challenges leading to misdiagnosis and mismanagement. We presented a 55-year-old male textile trader who was initially managed as sputum-negative pulmonary tuberculosis before histology report. He presented to our clinic with Breathlessness and cough of 3 years and 2.5 years, respectively. He had commenced anti-tuberculosis two months before presentation without significant relief. General Physical examination and vital signs were essentially normal. SPO2 was 96% on room air. Chest Examination revealed end-inspiratory bi-basal velcro-like crackles. Other systemic examinations were normal. Radiological examination by way of chest X- ray and chest CT showed features suggestive of IPF. The patient also had open Lung biopsy for histology and spirometry which demonstrated restrictive ventilatory function pattern. A diagnosis of Interstitial lung disease probably Idiopathic Pulmonary Fibrosis was entertained. He was commenced on Tab prednisolone, Tab Rabeprazole, with minimal improvement. IPF have often been misdiagnosed and treated as pulmonary tuberculosis with unfavorable outcome.
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LETTERS TO THE EDITOR Top

Acute methemoglobinemia due to ingestion of MAHIA wine brandy p. 207
Mohamed Adnane Beradai, Smael Labib, Saïd Boujraf, Mustapha Harandou
DOI:10.4103/1596-3519.194283  PMID:27853037
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Primary polydipsia in a 15-month-old male at paediatric endocrinology clinic University of Nigeria Teaching Hospital p. 210
Ugo Nnenna Chikani, Beckie Nnenna Tagbo, Maryann Ugochi Ibekwe, Gilbert Nwadiakanma Adimorah, Herbert Obu, Christopher Bismarck Eke, Modupe Omoshalewa Ugege, Adaobi Ijeoma Bisi Onyemaechi, Ikechukwu Frank Ogbonna
DOI:10.4103/1596-3519.194281  PMID:27853038
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