Autoimmune diseases in a Nigerian woman--a case report

Autoimmune diseases (AD) are conditions in which there is the development of antibodies against self cells/ organs. AD could either be organ-specific or non-organ specific (systemic) in clinical presentation. Commonly reported ADs includes: Myasthenia gravis, Hashimoto thyroiditis, Guillian-Barre syndrome, vitiligo, type 1 diabetes mellitus, Graves diseases, Goodpastures syndrome, pemphigus, rheumatoid arthritis, systemic lupus erythematosis, Addisons disease, multiple sclerosis, pernicious anaemia, autoimmune haemolytic anaemia, chronic active hepatitis, idiopathic thrombocytopenic purpura. There is paucity of locally documented information on the occurrence of AD in same patient in our environment. We therefore report the case of a 66 year old woman who presented at the University College Hospital (UCH), Ibadan, with a spectrum of the AD, Vitiligo, rheumatoid arthritis, myasthenia gravis, impaired glucose tolerance.

Microalbuminuria in controlled type 2 diabetes mellitus patients

Microalbuminuria assessment using albumin: creatinine ratio (ACR) by ELISA in early morning urine sample was studied in 83 (43 males, 40 females) normotensive type 2 diabetic patients and 40 (20 males; 15 females) age matched apparently healthy control subjects attending the medical outpatient clinic of the University College Hospital, Ibadan. The prevalence of microalbuminuria among the diabetic patients was found to be 60% and 30% among the controls. The level of microalbuminuria was found to correlate with age, duration of diabetes, blood pressure and waist:hip ratio. In both the patients and the controls, microalbuminuria was uncommon below the age of 50 years. The study highlights the contribution of a background renal insult as the probable reason for the high prevalence of microalbuminuria.

Prostate specific antigen in the Nigerian African

The biological characteristics of prostate-specific antigen were studied in the Nigerian African. Two hundred and fourteen persons were selected for the study. The group was made up of 59 apparently healthy men (age range 22-76 years), 58 men (age range 40-91 years) who had biopsy proven diagnosis of cancer of the prostate gland, 81 men (age range 46-87 years) who had biopsy proven benign prostatic hypertrophy (BPH) and 16 women (age range 23-47 years). Their median ages were 53 years, 66 years, 66 years and 27 years, respectively. The median PSA value among the control population was 0.7 ug/L (range 0.1-4.3 ug/L) and 98.3% of them had PSA of less than 4 ug/L. No person below 50 years of age had PSA value greater than 2 ug/L. There was a significant correlation between age and serum PSA value over the entire age range (r = 0.523; P = 0.001). In the female study group, 4(25%) had detectable values the cause of which could not be determined. The median PSA value among the BPH patients was 8.5 ug/L (range 0.2-350 ug/L). In this group 37% of them had values below 4 ug/L and 54.3% of them had values less than 10 ug/L. Among the patients who had cancer of the prostate gland the median PSA value was 92.6 ug/L and the mode was greater than 350 ug/L (32% of the patients); 10% and 20% of them had values below 4 ug/L and 10 ug/L respectively. It is concluded that the trend is the same as in the studies and there is the need for prostate gland volume studies and evaluation of women who have detectable PSA values.

Abdominal adiposity in six populations of West African descent: prevalence and population attributable fraction of hypertension

OBJECTIVES

The objective of this investigation was to examine the prevalence of abdominal adiposity and its association with the prevalence of hypertension among African descent populations in Nigeria, Cameroon, Jamaica, St. Lucia, Barbados, and the United States (US).

RESEARCH METHOD

The data for this investigation were obtained from the International Collaborative Study on Hypertension in Blacks. Hypertension was defined as mean diastolic blood pressure > or =90 mmHg, systolic blood pressure > or = 140 mmHg or current treatment with prescribed anti-hypertension medication. Abdominal overweight was defined as waist circumference (WC) > or =94 and > or =80 cm for men and women, respectively. Abdominal obesity was defined as WC > or =102 and > or =88 cm for men and women, respectively. We estimated the site-specific prevalence of abdominal overweight and obesity across age and body mass index cut-points. We also calculated the population attributable fraction (AF) of hypertension due to abdominal adiposity.

RESULTS

The prevalence of hypertension in these populations was tightly linked to abdominal adiposity. Increases in abdominal overweight accompanied an increasing degree of Westernization, rising from 6.4% and 26.3% in Nigeria, 16.5% and 62.8% in Cameroon, 15.8% and 58.6% in Jamaica, 14.3% and 62.1% in St. Lucia, 21.4% and 70.3% in Barbados to 38.9%, and 76.4% in the US for men and women, respectively. The corresponding values for abdominal obesity were 1.6% and 12.3% in Nigeria, 5.1% and 38.9% in Cameroon, 5.5% and 34.0% in Jamaica, 2.7% and 40.7% in St. Lucia, 7.8% and 44.7% in Barbados to 21.7% and 54.1% in the US for men and women, respectively. Body mass index-adjusted estimates of AF suggest that in most of these populations, especially in females, avoidance of abdominal overweight or obesity would help to curb the development of hypertension.

DISCUSSION

An important public health challenge is to clarify how lifestyle factors influence risks of abdominal adiposity and ultimately the increased risk of cardiovascular diseases.

Anterior pituitary gland assessment in sickle cell anaemia patients with delayed menarche

Pituitary gland dysfunction and its contribution to menarcheal delay in sickle cell anaemia patients was investigated. Ten SS patients mean age 17.5 years who had not achieved menarche were recruited and 10 each of AS and AA controls, mean ages 17.4 and 17.7 years were used as controls to study the effect of the heterozygous state. Dynamic studies with LHRH and TRH were performed for 60 minutes and LH, FSH, PRL and TSH assays were done. Median basal values were significantly lower in the SS patients compared with the AS and AA controls for LH, FSH and PRL. LH: 3.0; 7.1; 7.7 U/L, FSH: 2.1: 4.3: 5.1 U/L. PRL: 94.5; 590; 390 U/L, respectively. The median basal TSH values did not show any significant difference between the SS subjects (7.3 U/L) and the AS and AA controls (5.4 U/L) and 5.6 U/L, respectively. The readily releasable pool also showed the same pattern for LH, FSH and PRL as the basal values while the SS subjects had higher median TSH releasable pool values that were significantly different from those of the AA controls. From the prolactin responses three subjects demonstrated maturational delay in menarcheal achievement while seven demonstrated isolated gonadotrophin deficiency. It is concluded that SS patients with delayed menarche have a hypothalamopituitary axis dysfunction that gives rise to delay in menarcheal achievement and metabolic adaptations to stress of illness. The heterozygous state did not delay menarcheal onset.

Endemic goitre prevalence in Ifedapo Local Government Area of Oyo State, Nigeria

As part of efforts aimed at providing an adequate data base for the control of iodine deficiency disorders (IDD) in Nigeria, we undertook an extensive goitre survey of Ifedapo Local Government Area (LGA) of Oyo State, which lies within the goitre-belt of South-western Nigeria. Primary school pupils aged between six and twelve years were the subjects of the survey. From each of ten health districts of the LGA, one primary school was included in the survey. For each school, the entire school population was assessed for goitre by palpation and goitre graded according to WHO/ICCIDD criteria. The survey included 3599 pupils (1889 males and 1710 females). The total goitre rate (TGR) for the LGA was 23.4% while the visible goitre rate (VGR) was 6.4%. The highest goitre rate was recorded in District I (Sango, Saki) TGR = 39.5%; VGR = 17.3%), while the lowest rate was seen in District 4 (Wasengare) TGR = 5.2%; VGR = 0.7%). Females had higher goitre rates than males (TGR: 25.7% vs 21.3%; VGR: 7.5% vs 5.5%). Most of the goitres were Grades IA (36.7%) or IB (35.7%). Goitre grades 2 and 3 accounted for only 27.3% and 0.2%, respectively. These results show that there is a mild to moderate IDD problem in Ifedapo LGA. The implications of this finding, in view of the known deleterious consequences of IDD, are discussed and the need for correction highlighted.

The influence of iodine deficiency on the cognitive performance of school children in Saki, south-west Nigeria

The influence of inadequate iodine intake on the thyroid status and cognitive performance of school children in Saki, a town within the goitre belt of South-western Nigeria with known environmental iodine deficiency, was assessed. One hundred and ninety-seven (197) study subjects from Saki and seventy (70) appropriately matched control subjects from Moniya, near Ibadan, the Oyo State capital were recruited into the study. The subjects were apparently healthy primary school pupils between the ages of 10 and 14 years and had been resident in the respective locality for at least two (2) years. After establishing the presence of goitre, blood was collected for thyroid function tests by venepuncture from each pupil. The cognitive function tests, Draw-A-Person (DAP) test and the Standard Progressive Matrices (SPM) were administered simultaneously to all the pupils in the class. Urine samples were collected for urinary iodine estimation. The mean urinary iodine concentration was significantly lower in Saki than in Moniya (134.81 +/- 69.86 vs 220.00 +/- 69.00 ug/L, P < 0.01). The total goitre rates (TGR) and the visible goitre rates (VGR) were 15.2% and 1.5% for Saki, and 8.6% and 4.3% for Moniya, respectively. The mean plasma total T4 was significantly lower in Saki pupils (97.55 +/- 26.64 nmol/L vs 122.52 +/- 26.51 nmol/L P < 0.05). The TSH level was higher in Saki pupils than in Moniya pupils (4.72 +/- 1.38 mU/L vs 4.26 +/- 1.28 mU/L), but the difference was not statistically significant. Scores on intelligence function tests (DAP and SPM) were lower for Saki pupils when compared with Moniya pupils, though the differences were not statistically significant. These results show that there is a mild but significant iodine deficiency disorder problem in Saki. However, the children in Saki still maintained euthyroidism and the mild degree of iodine deficiency did not seem to have adversely affected their cognitive performance.

Maternal and neonatal thyroid status in Saki, Nigeria

The influence of inadequate iodine intake on maternal and neonatal thyroid status in Saki, a locality known to have environmental iodine deficiency and located within the goitre belt of Southwestern Nigeria was investigated. One hundred and five (105) subjects and ninety (90) controls from Ibadan were recruited into the study. All subjects were apparently healthy with at least thirty-seven (37) completed weeks of gestation. Each subject was assessed for goitre and blood sample obtained by venepuncture for thyroid function tests before onset of labour. Spot urine samples were also obtained from the mothers at the time of examination for urinary iodine estimation. At delivery, cord blood samples were obtained from the babies for thyroid function tests. The mean maternal urinary iodine excretion was significantly less in Saki when compared with Ibadan (144.76 +/- 14.68 vs 213.36 +/- 9.89 ug/L P < 0.01). Maternal total goitre rates (TGR) were 46.8% and 2.2%, while maternal visible goitre rates (VGR) were 26.6% and 1.1% in Saki and Ibadan, respectively. Maternal mean plasma total T3 and total T4 were relatively lower in Saki as compared to Ibadan, though the differences were not statistically significant. Mean maternal plasma TSH in Saki was slightly above our laboratory reference interval (0.3-5.0 mU/L) and higher than the level seen in Ibadan mothers (6.54 +/- 1.58 vs 4.18 +/- 1.37 mU/L,), though the difference was also not statistically significant. Mean neonatal total T3 and T4 were lower in Saki when compared to Ibadan, but the differences were not statistically significant. The mean neonatal plasma TSH in Saki was above the adult reference interval and significantly higher than the level seen in Ibadan (9.82 +/- 1.64 vs 4.18 +/- 1.17 mU/L, P < 0.05). The incidence of neonatal chemical hypothyroidism (NCH) in Saki was 14.7 per 1000 babies. No case of NCH was seen in Ibadan. These results suggest environmental iodine deficiency and relative chemical hypothyroidism of mothers and neonates in Saki when compared to mothers and noenates from non-iodine deficient areas.

The mortality risk associated with hypertension: preliminary results of a prospective study in rural Nigeria

The contribution of hypertension to adult mortality in Africa has not been well studied. Although cross-sectional surveys have provided data on the prevalence of this condition, the relative risk of death associated with hypertension has not been defined. In the face of high levels of competing mortality from infectious disease among the general population, and the virtual absence of atherosclerotic precursors, estimates of risk derived from industrialised countries may not be generalisable to this setting. We conducted a 2-year prospective study among 1344 mean and women in a rural community in south-western Nigeria. The prevalence of hypertension (140/90 mm Hg) at baseline was 9.3%. In the observational phase, 3.0% of the survey participants died each year. Among the 74 decedents, hypertension was nearly twice as common as among those who survived (14.9% vs 8.4%). In multivariate analysis the risk of death increased over 60% for a 20 mm Hg increase in diastolic blood pressure. The population attributable risk, or the reduction in mortality that would have been observed if hypertension were not present in this community, was estimated as 7%. These findings document an identifiable impact of hypertension on all-cause mortality in rural Africa and demonstrate that programs to evaluate potential treatment options are needed.

Maternal and cord blood lactate and 3-hydroxybutyrate levels during labour in Nigerian women

In this preliminary study, maternal and fetal blood lactate and 3-hydroxybutyrate (3-OHB) levels were assayed by specific enzymatic spectrophotometric methods in two groups of parturient Nigerian women during the three labour stages and their newborn: (i) thirty two women with babies' Apgar score > or = 6, and, (ii) eighteen women with babies' Apgar scores á 5. Cord blood was collected within 1 min. of cord clamping. In all the patients there was a lactate gradient between the foetus and mother. Neonates with Apgar score < 5 had greater cord blood 3-OHB levels. This could indicate reduced utilisation and/or increased production of this metabolite. Since in states of glucose deprivation as could be found in placenta insufficiency, 3-OHB is utilised by the foetus for the synthesis of essential cerebral lipids. It is speculated that the immediate poor clinical condition of babies with low Apgar scores may be a consequence of reduced synthesis of these cerebral lipids as they were unable to utilise circulating 3-OHB. The rapid response to routine resuscitative measures in these newborn babies could also indicate improved 3-OHB utilisation secondary to an improved tissue oxygenation status. These hypotheses from the basis for further studies.

Comparison of single serum progesterone and endometrial biopsy for confirmation of ovulation in infertile Nigerian women

Infertility remains a medico-social problem in Nigeria and it accounts for a large percentage of outpatient gynecological consultations. The evaluation of the infertile couple remains a continuing challenge to the practising doctor in this part of the world. The need to evaluate the two methods commonly used for determining ovulation in these patients is indicated. Endometrial biopsy specimen and a single sample for serum progesterone estimation were obtained simultaneously in the luteal phase from 50 normally menstruating infertile Nigerian women. Subsequent analysis showed that a serum progesterone value of 6.6 nmol/l (2.2 ng/ml) or above was always associated with a secretory endometrium. Forty-six cycles yielded sufficient information to compare the two methods for confirmation of ovulation. Patients who ovulated with a progesterone value of 6.6 nmol/l (2.2 ng/ml) were 91.3% (42/46) or above, while 89% (41/46) showed secretory endometrium. Forty-six of the cases 86.9% (40/46) were judged to have ovulated by both parameters while 6.5% demonstrated anovulatory cycle using both criteria. From the study, a significant correlation was obtained between endometrial biopsy and progesterone assay methods in confirming ovulation.

Norplant use by women with sickle cell disease

OBJECTIVE

To assess the safety of Norplant contraceptive implant use by women with mild-moderate homozygous sickle cell disease (HbSS).

METHOD

Prospective observation of women pre- and post-insertion of Norplant, with each woman serving as her own control.

PARTICIPANTS

25 women 18-40 years of age who attended a hospital sickle cell clinic; post-insertion data were available for 23 women.

OUTCOME MEASURES

Changes in hematologic parameters including PCV, MCV, reticulocytes, ISCs, HbF and bilirubin; changes in biochemical parameters including HDL cholesterol, aspartate transaminase, alkaline phosphate, serum creatinine and serum albumin.

RESULT

With a mean follow-up of 12.4 months (range 1-29 months), there were no clinically or statistically significant group or individual changes in the hematologic or biochemical parameters after Norplant insertion.

CONCLUSION

Norplant appears to be a safe and appropriate contraceptive for women with mild-moderate HbSS disease.

Plasma glucose and insulin responses to oral glucose loading in nonobese Nigerian subjects with essential hypertension

In assessing the relationship between insulin levels and blood pressure, we analyzed glucose and insulin data after standard 75 g oral glucose tolerance tests in 16 nonobese male Nigerian subjects with essential hypertension and compared their results with those obtained from 16 age- and sex-matched healthy normotensive subjects. The fasting plasma glucose and insulin as well as 2-hour postload insulin values were similar in both groups. The hypertensive subjects had significantly greater 2-hour glucose levels, larger incremental areas under the glucose/time curves, and smaller ratios of incremental insulin to incremental glucose areas (P < .05). These parameters suggest some impairment of glucose tolerance in the hypertensive subjects related to an inadequate insulin response to the oral glucose load. Model analysis of the glucose and insulin data confirmed these observations in that the estimated rate of glucose uptake into peripheral tissues (M value) was lower in the hypertensive subjects (P = .02). There was no correlation at any time point between insulin values and blood pressure in either group of subjects. These results suggest that essential hypertension in Nigerian diabetic subjects is associated with a reduced insulin response to glucose loading, which is at variance with reports in whites, and deserve further investigation.

Effect of saline and glucose infusions of oxytocin on neonatal bilirubin levels

OBJECTIVE

To ascertain the effect of isotonic saline and glucose infusions of oxytocin on neonatal bilirubin levels.

METHOD

Eighty-two parturient Nigerian women requiring oxytocin infusion in labor were randomized into two groups receiving 0.9% saline or 5% glucose, respectively. A group of 82 women not requiring oxytocin were recruited for comparison. All had sodium and bilirubin estimations in cord plasma and neonatal bilirubin assay on Day 3.

RESULT

Analysis of variance revealed higher mean cord and neonatal bilirubin levels in the glucose group compared with the other two (P < 0.05). Significant inverse correlation was observed between cord plasma sodium and neonatal bilirubin levels in all groups. Hyperbilirubinemia occurred in 55% of babies in the glucose group compared with 21% and 22% in the saline and control groups, respectively (P < 0.001).

CONCLUSION

The use of isotonic saline rather than 5% glucose solution as vehicle for oxytocin infusion in labor appears to be associated with lower neonatal bilirubin levels.

Insulinoma in pregnancy presenting as a seizure disorder: a case report

We present the clinical course and problems in the management of a 30 year old Nigerian lady who was admitted with fasting hypoglycaemia due to a pancreatic islet cell tumour (insulinoma) during the first trimester of pregnancy. Her case was initially misdiagnosed as idiopathic epilepsy. The outcome was fatal mainly because the poor clinical state of the patient limited our treatment options. This condition though uncommon, is potentially easily recognisable and treatable, as long as there is a high index of suspicion.

Plasma and salivary concentrations of glucose and cortisol during insulin-induced hypoglycaemic stress in healthy Nigerians

We measured cortisol levels in plasma and saliva samples obtained simultaneously from 10 fasting adult Nigerians at 0900 h and at 60 and 90 min of hypoglycaemia induced by intravenous insulin. Salivary glucose levels (fasting and after i.v. insulin) were unaffected by hypoglycaemia and did not correlate with plasma glucose at any time point. Cortisol levels in plasma and saliva increased by 50% and 120%, respectively, from fasting to 90 min values (both P less than 0.05) after i.v. insulin. This increase was evident by 60 min (plasma 33% and saliva 40%, both P less than 0.05 compared to fasting values). There was a significant positive correlation between the percentage increases in plasma and salivary cortisol (r = 0.65, P less than 0.05). Salivary cortisol was always (0900 h and during hypoglycaemic stress) 15-20% of total plasma cortisol, a percentage similar to the reported values on the contribution of free plasma cortisol to total plasma cortisol. We conclude that increases in plasma cortisol are reflected in saliva, and salivary cortisol could be estimated as an alternative to free plasma cortisol in the dynamic assessment of adrenocortical function in humans.

Plasma glucose and thiocyanate responses to different mixed cassava meals in non-diabetic Nigerians

We measured plasma glucose and thiocyanate levels before and up to 4 h after feeding 11 overnight fasted healthy non-diabetic volunteers randomly on three occasions each with three locally consumed cassava meals: (i) gari as eba 50 g; (ii) lafun 50 g and (iii) parboiled cassava flakes 76 g. Each of these meals contained 175 kcal (0.7 MJ) and was consumed with a sauce to a total caloric value of 300 kcal (1.26 MJ). On the fourth visit, each volunteer consumed 75 g glucose. While the peak and 2-h glucose values were greatest with oral glucose (P less than 0.01), they were similar with the three cassava meals, although tended to be lowest with lafun. Similarly, areas (incremental and total) under the glucose/time curves were highest with oral glucose (P less than 0.05), but while eba and cassava flakes were similar, lafun had the lowest values (P less than 0.05). Plasma thiocyanate levels were unchanged after ingestion of oral glucose and eba, but increased to peak values (P less than 0.05) by 14 per cent on cassava flakes and by 23 per cent on lafun. We conclude that post-prandial glycaemia and plasma thiocyanate levels after cassava meals depend on the mode of preparation of the meal and that lafun showed the least glycaemic response of the three cassava meals tested although it caused the greatest increase in plasma thiocyanate levels. These findings suggest that a cyanogenetic potential does not always reflect a tendency to hyperglycaemia.

Cheiroarthropathy and long term diabetic complications in Nigerians

Two hundred and fifty six consecutively ambulant diabetic patients attending a Nigerian diabetic clinic for the presence of cheiroarthropathy were examined using standard criteria. Forty eight (19%) had limited joint mobility of the hand, a prevalence higher than the 4% (2/56) observed in a non-diabetic population matched for age and sex. Limited joint mobility was twice as prevalent in the insulin treated (16/50, 32%) than in the non-insulin dependent (32/206, 16%) diabetics. Indices such as age, duration of diabetes, and glycaemic control (as assessed by integrated blood glucose concentration over the previous 12 months and glycated haemoglobin (HbA1c concentrations) were the same in the diabetics with and without limited joint mobility. The prevalence of cataracts (18/48, 38%) and background retinopathy (8/48, 17%) was higher in diabetics with limited joint mobility than in those without (respectively 6-9% and 5-6%); hypertension, peripheral neuropathy, and foot ulcers, however, were about equally common in the two groups of diabetics (with and without limited joint mobility). Nephropathy appeared commoner in diabetic subjects without limited joint mobility. Our results confirm previous observations in Caucasians of an increased prevalence of limited joint mobility in diabetes, especially those receiving insulin treatment, and also showed that limited joint mobility could predict the presence of retinopathy and cataracts in those diabetics. Neuropathy and hypertension were not commoner in our diabetics with limited joint mobility (unlike in the Caucasian population), suggesting that racial factors may underlie the predictive value of limited joint mobility in diabetic microangiopathy.

Clinical, hormonal and biochemical features of menopausal women in Ibadan, Nigeria

As a result of the general lack of information about the menopause in Nigeria this study was conducted to determine the prevalence of climacteric symptoms in a cohort of healthy perimenopausal women and also to evaluate the hormonal and biochemical profile of the subjects. Seventeen menopausal and 19 premenopausal women aged 40 years or more were interviewed and had venepuncture and collection of 24-h urine samples. Plasma from the blood samples was used for the assay of LH, FSH, progesterone, 17 beta-oestradiol, calcium and cholesterol while urinary calcium was determined from the 24-h urine samples. The data revealed a significant difference in the prevalence of the symptoms of vasomotor instability (hot flushes, palpitations and excessive sweating) among the menopausal group when compared with the premenopausal group. Furthermore, plasma gonadotrophin levels (LH and FSH) were significantly elevated while plasma oestradiol and progesterone levels were lower in the menopausal women than in the premenopausal group. With regards to the biochemical indices evaluated, only 24-h urinary calcium levels were found to be significantly different for the two groups, with higher levels in the menopausal women. The significance of these findings and the need for adequate screening and treatment of selected menopausal women are discussed.

Dietary salt and the glycaemic response to meals of different fibre content

In attempting to resolve the existing controversy on the effect of dietary salt intake on glycaemic responses, we investigated post-prandial plasma glucose levels in 10 healthy normal weight non-diabetic Nigerian subjects (aged 23.1 years +/- 1.3 (s.e.m.) with body mass index, BMI 19.9 +/- 0.6 kg/m2) consuming equal amounts of carbohydrate from glucose, boiled yam (low fibre content of 0.9 per cent raw tuber weight) and boiled black-eyed peas (high fibre content of 4.8 per cent dry weight) with and without added table salt (4.25 g). The results indicated no significant differences in fasting, peak and 2-h plasma glucose concentrations and total and incremental areas under the 3-h glucose/time curves in the subjects consuming each meal with and without added salt. Added salt had no influence on the glycaemic index of each meal. We conclude that salt has no effect on the glycaemic response to plain glucose or meals with varying fibre content even in a population known to demonstrate defects in salt handling.

Haemolytic anaemia associated with Nigerian barbecued meat (red suya)

Five cases of haemolytic anaemia occurring in male Nigerians following the ingestion of spiced barbecued meat (suya) are described. Although suya is a popular food item in various parts of Nigeria, all five patients described in this report had consumed a special brand, called red suya, purchased from vendors at a popular road junction between the cities of Lagos and Ibadan. Ingestion of the culprit suya sample was followed within 24 h by malaise and fever, while passage of dark-coloured urine and jaundice followed 1-3 days thereafter. Glucose-6-phosphate dehydrogenase (G6PD) deficiency was demonstrated by a fluorescent screening test in all cases, while the enzyme phenotype was shown to be GdA- in all four cases studied by starch-gel electrophoresis, thus suggesting that G6PD deficiency was a predisposing factor in the cases reported in this series. The haemolytic disease was self-limiting and full recovery followed in all cases. In view of the markedly circumscribed range from where the patients originated, the culprit agent responsible for the haemolytic disease is believed to be a recently introduced food additive that is probably accessible only to a limited number of suya vendors.

Mild hypertension in patients with suspected dilated cardiomyopathy: cause or consequence?

This study was undertaken to clarify the relationship between mild transient hypertension and dilated cardiomyopathy. Fifty-five patients were studied: group 1--controls (12 patients), group 2--hypertensives without clinical evidence of heart failure (14 patients), group 3--patients with hypertensive heart failure and diastolic blood pressure above 100 mmHg (10 patients), group 4--patients with possible dilated cardiomyopathy with mild hypertension, i.e. diastolic blood pressure of 90-100 mmHg (8 patients), group 5--patients with dilated cardiomyopathy and normal blood pressure (11 patients). The haemodynamic status and cardiac contractility indices were measured in each patient on admission, using M-mode echocardiography. Serum sodium and potassium as well as the urinary sodium, potassium and vanillyl mandelic acid excretions were also measured. The stroke volume, cardiac output and cardiac index fell with heart failure, but much more remarkably in group 4. The peripheral vascular resistance was higher in groups 2, 3 and 4 than in groups 1 and 5; so also were the aortic diameter, left posterior wall thickness and left ventricular mass. The plasma volume, aldosterone and cortisol levels were higher and the urinary sodium and potassium excretion lower in patients with heart failure (groups 3, 4 and 5). It is concluded that the raised blood pressure found in some patients suspected to have dilated cardiomyopathy is not due to the haemodynamic and biochemical changes that occur in heart failure. Such patients are 'chronic' hypertensives with hypertensive heart failure. Their presenting blood pressure is low because of their markedly reduced cardiac output.

Human protein requirements: obligatory urinary and faecal nitrogen losses and the factorial estimation of protein needs of Nigerian male adults

1. The present study was designed to use the factorial approach to estimate protein requirements of Nigerian male adults by measuring obligatory nitrogen losses via urine, faeces and sweat when N intake was very low and energy intake adequate. 2. Eight adult men from Osegere village near Ibadan and seven medical students from the University of Ibadan, who volunteered to participate as subjects in the study, were given a low-protein diet (based on staple foods habitually consumed by subjects) for 10 d. Mean daily total protein intake was 4.68 g while that of energy was 0.2 MJ/kg body-weight. After an initial 5 d adaptation period, 24 h urine and faces were collected in marked containers for five consecutive days for N determination. N losses from the skin were also determined in the village adults. 3. Mean daily urinary, faecal and sweat N losses (mg N/kg body-weight) were 45.88 (SD4.84), 21.79 (SD4.19), and 7.46 (SD1.71) from the village adults. The corresponding urinary and faecal N losses from the university students were 43.45 (SD2.28) and 18.32 (SD4.66) (sweat N loss not measured). Thus the total daily obligatory N losses (per kg body-weight) from the village adults and university students were 75.13 and 69.23 mg N respectively (assuming a sweat N loss of 7.46 mg for the university students). After adjusting for requirement and making a 30% allowance for individual variability, the safe level of protein intake was calculated to be 0.78 and 0.73 g protein/kg body-weight for the village men and university students respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Non-invasive cardiac study in diabetic Nigerians using systolic time intervals

Non-invasive cardiac studies using systolic time intervals were performed on 89 diabetic Nigerians and 45 non-diabetic controls, to investigate possible preclinical abnormality of left ventricular function. There was no significant difference in the pre-ejection period to left ventricular ejection time ratio (PEP/LVET) between the patients and controls: 0.373 +/- 0.011 vs 0.365 +/- 0.013 (P = 0.688). Patients at higher risk for developing significant vascular disease i.e. those with peripheral vascular insufficiency, those in higher socio-economic class and those with disease duration of 10 or more years had the highest mean values of PEP/LVET (0.403, 0.403 and 0.412 respectively). However, these values did not reach a level of significance. There was no correlation between PEP/LVET and age, body mass index, duration of diabetes, total or HDL cholesterol and the HDL to total cholesterol ratio. Because recent reports have related diabetic cardiomyopathy to angiopathic disease in diabetes, these results suggest that Nigerian patients, who like most other black African diabetics show little susceptibility to severe vascular complications of diabetes may enjoy some protection from a preclinical abnormality of left ventricular function as well.

17 Beta-estradiol, progesterone and testosterone in the normal menstrual cycle of Nigerians

Circulating blood levels of estradiol, progesterone and testosterone are reported in 17 normally menstruating Nigerian women. The pattern of secretion and the range of levels of estradiol and progesterone are similar to those reported in other ethnic groups. Testosterone levels were, in general, higher than corresponding values in Caucasian or Asian women, but were of the same order of magnitude as previously reported in Zambian African women.

Biochemical hypothyroidism in Nigerian children with nephrotic syndrome

The nephrotic syndrome in Nigerian children is known to be largely associated with the endemicity of quartan malaria. Routine thyroid function studies were carried out on 24 children with clinical and biochemical evidence of the nephrotic syndrome. The children, aged four to 14 years, were all in the active phase of their disease, presenting with facial and pedal oedema and ascites. There was severe hypoalbuninaemia [mean (S.E.); 19.2 (1.1) g/l], hypercholesterolaemia; 10.5 (1.0) mmol/l and severe albuminuria ranging from 1 to 10 g/l. There was no clinical evidence of thyroid disease. The results of thyroid function tests in these children were compared with those of 181 apparently healthy children of the same age range. The mean total serum thyroxine levels (S.E.) were 118.3 (2.6) and 50.0 (6.4) nmol/l in controls and patients, respectively; T3 resin uptake values were 29.8 (0.2)% and 33.1 (1.2)%; the free thyroxine index (FTI) was 34.7 (0.8) and 16.7 (1.9) while thyrotropin (TSH) levels were 4.8 (0.2) and 10.6 (1.0) mU/l (IRP. MRC 68/38), respectively. The findings of low levels of thyroxine and FTI in association with high levels of TSH suggest that a state of primary hypothyroidism exists in these nephrotic children.

Haemoglobin A1 (HbA1) determination in Nigerian diabetics

Haemoglobin A1 (HbA1) levels were measured in diabetic Nigerians using the cation exchange micro-column chromatographic technique. The HbA1 values confirmed the potential usefulness of this method as a tool for assessing the degree of metabolic control in diabetics. It was found to be both simple to perform and potentially cost-effective. However, the low accuracy and poor reproducibility of the results obtained led to the conclusion that this method would appear not to be suitable for use in most tropical developing countries. The factors responsible for this finding were examined and discussed.

Pituitary and placental hormone levels in pseudocyesis

Twelve patients with clinical features of pseudocyesis were divided into two groups according to the presence or absence of galactorrhea. The mean serum prolactin level of patients with galactorrhea was significantly higher than the normal values of the patients without galactorrhea. The mean serum levels of luteinizing hormone and follicle-stimulating hormone were markedly elevated in patients without galactorrhea. This was especially true of luteinizing hormone. Serum levels of human chorionic gonadotropin were undetectable in all patients. The significance of these observations is discussed.