A first trimester prediction model and nomogram for gestational diabetes mellitus based on maternal clinical risk factors in a resource-poor setting

BACKGROUND

The implementation of universal screening for Gestational Diabetes Mellitus (GDM) is challenged by several factors key amongst which is limited resources, hence the continued reliance on risk factor-based screening. Effective identification of high-risk women early in pregnancy may enable preventive intervention. This study aimed at developing a GDM prediction model based on maternal clinical risk factors that are easily assessable in the first trimester of pregnancy in a population of Nigerian women.

METHODS

This was a multi-hospital prospective observational cohort study of 253 consecutively selected pregnant women from which maternal clinical data was collected at 8-12 weeks gestational age. Diagnosis of GDM was made via a one-step 75-gram Oral Glucose Tolerance Test (OGTT) at 24-28 weeks of gestation. A GDM prediction model and nomogram based on selected maternal clinical risk factors was developed using multiple logistic regression analysis, and its performance was assessed by Receiver Operator Curve (ROC) analysis. Data analysis was carried out using Statistical Package for Social Sciences (SPSS) version 25 and Python programming language (version 3.0).

RESULTS

Increasing maternal age, higher body mass index (BMI), a family history of diabetes mellitus in first-degree relative and previous history of foetal macrosomia were the major predictors of GDM. The model equation was: LogitP = 6.358 - 0.066 × Age - 0.075 × First trimester BMI - 1.879 × First-degree relative with diabetes mellitus - 0.522 × History of foetal macrosomia. It had an area under the receiver operator characteristic (ROC) curve (AUC) of 0.814 (95% CI: 0.751-0.877; p-value < 0.001), and at a predicted probability threshold of 0.745, it had a sensitivity of 79.2% and specificity of 74.5%.

CONCLUSION

This first trimester prediction model reliably identifies women at high risk for GDM development in the first trimester, and the nomogram enhances its practical applicability, contributing to improved clinical outcomes in the study population.

Sex Hormone-Binding Globulin Level Enhances Prediction of Gestational Diabetes Mellitus in a Sub-Saharan African Population

BACKGROUND

The burden of Gestational Diabetes Mellitus (GDM) in the Sub-Saharan African region has been on the rise despite increased diagnosis and treatment. Current risk factor-based prediction approaches in the region lack strong predictive value, hence the need for effective early prediction and preventive interventions.

AIM

The aim of this study was to assess the diagnostic improvement in prediction of GDM by the addition of Sex Hormone-Binding Globulin (SHBG) assay to current approaches which assess early pregnancy maternal clinical risk factors in the study population.

METHODS

This was a multi-centre hospital-based prospective observational study carried out over a period of 18 months in which serum SHBG levels were assayed and maternal clinical risk factors for GDM evaluated in a cohort of 271 pregnant women at 9 to 16 weeks gestational age. These participants were subsequently tested for GDM using a diagnostic 75g oral glucose tolerance test (OGTT) at 24 to 28 weeks of gestation.

RESULTS

Clinical risk factor-based prediction approach had a diagnostic sensitivity of 59.6%, specificity of 69.4% and an area under the ROC curve of 0.758 (95% CI = 0.686, 0.830; p < 0.001). Following addition of SHBG assay to the maternal risk factors as predictors of GDM, the diagnostic sensitivity increased to 70.2%, specificity to 76.3% and there was a significant increase in the area under the ROC curve of 0.061 (95% CI = 0.006, 0.117; p = 0.030).

CONCLUSION

Current maternal clinical risk factor-based GDM prediction approach in early pregnancy lacks strong predictive value in the study population. Thus, addition of biochemical predictors like SHBG may improve early prediction of GDM and enable timely intervention.

Mitigating the Risk of COVID-19 Deaths in Cardiovascular Disease Patients in Africa Resource Poor Communities

The novel coronavirus disease 2019 (Covid-19) pandemic has affected millions of patients in almost all countries with over one million cases recorded in Africa where it is a major health challenge. Covid-19 is known to have significant implications for those with pre-existing cardiovascular disease (CVD) and their cardiologists. Patients with pre-existing CVD are at increased risk of morbidity and mortality from Covid-19 due to associated direct and indirect life threatening cardiovascular (CV) complications. Mitigating the risk of such Covid-19 deaths in resource poor communities requires the institution of preventive measures at the primary, secondary and tertiary levels of preventive phenomenon with emphasis at the first two levels. General preventive measures, screening and monitoring of CVD patients for complications and modification of drug treatment and other treatment methods will need to be implemented. Health policy makers and manager should provide required training and retraining of CV health care workers managing Covid-19 patients with CVD, provision of health education, personal protective equipment (PPE), and diagnostic kits.

Short height and poor education increase the risk of dementia in Nigerian type 2 diabetic women

Introduction

There is urgent need to investigate type 2 diabetes and dementia crosstalk in sub-Saharan African countries with special attention to women who have higher vulnerability. Nigeria which has the highest number of diabetics on the African continent is a good location for the investigation.

Methods

Biophysical parameters, occupation, education, burden of diabetes mellitus, cardiovascular health, and cognition were evaluated in 102 type 2 diabetics and 99 controls.

Results

Short physical stature and lower level of education were hallmarks of diabetes in females. Two dementia scales (Mini–Mental State Examination and six-item Cognitive Impairment Test) showed cognitive impairment status, with the six-item Cognitive Impairment Test scale being more specific and sensitive. Both scales showed correlations with age, education, weight, height, and disease onset, whereas fasten blood glucose was negatively correlated with height and their blood pressure was normal.

Discussion

Height, an easy-to-measure parameter in Nigeria, may reveal increased risk of dementia in poorly educated female Nigerian diabetics, thus helping to improve preventive and therapeutic interventions.

Increased central adiposity may not underlie the marked elevation of IL-6 in diabetes mellitus patients in South-West, Nigeria

BACKGROUND

Chronic inflammation is linked to disorders of obesity, insulin resistance and DM2. This reflects as increase in proinflammatory cytokines including IL-6. In Nigeria, there is no study that has measured IL-6 in diabetics, in spite of having the highest number of diabetics in Africa.

METHODS

The twenty-eight DM2 patients and 13 controls recruited for this study had their BP, BMI, waist circumference (WC) and waist-hip-ratio (WHR) measured. They also had fasting plasma IL-6, fasting plasma glucose, total cholesterol (TC), Triglyceride (Tg), high density lipoprotein cholesterol (HDL-C), urea, creatinine, aspartate transaminases (AST), alanine transferases (ALT), total protein (TP) and albumin determined.

RESULTS

Mean age was 51.83 years ± 13.28, with diabetics significantly older than controls (56.61 yrs. ± 9.62 vs. 41.54 years ± 14.53) P < 0.05. The mean IL-6 in diabetics (194.77 pg/ml ± 166.16) was significantly higher than controls' (26.29 pg/ml ± 6.65) at p ≤ 0.01. No significant difference in mean BMI in diabetics and controls. But WC and WHR of diabetics (100.75 cm ± 18.47; 1.01 ± 0.14) were significant higher than in controls (88.77 cm ± 13.36; 0.88 ± 0.07) at p ≤ 0.05 (WC; p value 0.043) and p ≤ 0.01(WHR; p value 0.002). Among diabetics, there were significant correlations between IL-6 and Tg (p<0.01, r = 0.007**),IL-6 and LDL-C (p<0.05, r = 0.02*), IL-6 and AST (p<0.05, r = 0.041*r4) and IL-6 and ALT (p<0.01, r = 0.004**)

CONCLUSION

Elevated IL-6 in DM2 patients in South West Nigeria correlates with liver transaminases and not increased markers of central adiposity.

Students' perceptions of their learning environment at the College of Medicine, University of Ilorin, Southwest, Nigeria

BACKGROUND

Quality of medical school graduates is influenced by cumulative effect of their learning environment. Measurement of such environment at the University of Ilorin, Nigeria was done by evaluating Students' perception using the DREEM questionnaires, with a view to improving the quality of medical education.

METHODS

DREEM questionnaire was applied to second, third, fourth and fifth year medical students, for assessment of the various aspects of effective educational environment. Responses were analyzed using SPSS software version 19.

RESULTS

One hundred and eighty students (66.2%) were males and 92 (33.8%) females. The mean age was 21.2 years ± 2.5 with 83 (30.5%) students in second year of study, 68 (25.0%) in third year, 80 (29.4%) in fourth year and 41 (15.1%) in fifth year. Mean global perception score was 108.4 / 200 points (54.2%) and this was not affected by sex, age and year of study. Scores for "Students' Perception of Learning" (SPL) and "Students' Academic Self Perceptions" (SASP) were 28.0/48 (58.8%) and 21.8/32 (68.1%) respectively. Three key areas are in need of attention; "Students' Perception of Course Organizers" (SPCO) (22.0/44, 50.0%), "Students' Perception of Atmosphere" (SPA) (23.8/48, 49.6%) and "Students' Social Self Perceptions" (SSSP) (12.8/28, 45.7%). The SSSP score was significantly higher in males (13.18) than in females (12.06) (p=0.02; p < 0.05), and in second (13.38) and third year (13.55) students compared to fourth year (12.16) and fifth year (11.76) (p=0.003).

CONCLUSION

Improvement in some aspect of teaching, atmosphere and social factors could be of further benefit to the students.

Diagnosis and treatment of giant cell granuloma of the temporal bone: Report of eight cases

Abstract Conclusions: It is impossible to make a diagnosis of temporal giant cell granuloma (GCG) before operation because of nonspecific clinical and imaging feature. Surgery is the first-line choice of treatment.

OBJECTIVE

To evaluate the diagnosis and treatment of temporal GCG.

METHODS

Eight patients with GCG receiving treatment in the Chinese PLA General Hospital between 2001 and 2010 were recruited for the study. These patients' clinical features, imaging and histopathological findings, types of surgery, and results of follow-up evaluations were noted.

RESULTS

The group was made up of four males and four females, with a median age of 37 years (range 21-50 years). Four patients had a granuloma on the left side and four on the right of the head. The median duration of the disease was 21 months (range 5-60 months). All patients, except one referred to us for recurring disease, were managed in our hospital. The main symptoms were: hearing loss (n = 5), tinnitus (n = 4), otalgia (n = 3), dizziness (n = 2), and local masses (n = 2). Radiological examination of the masses revealed erosion of the temporal bone and base of the skull. There was no definitive diagnosis in any of the patients before surgery. All patients had surgical treatment, six of them by middle cranial fossa approach and two by combined cranio-auricular approach. Surgical complications included partial facial paralysis (three cases) and cerebral edema (one case) but they resolved soon after surgery. One patient was lost to follow-up, but the other seven were followed up over a mean period of 24 months; none has reported a recurrence.

Glycated haemoglobin and glycaemic control of diabetics in Ilorin

OBJECTIVES

With increasing adoption of Western Lifestyle in Nigeria, the incidence of Diabetes Mellitus is on the increase in the country with its attendant complications. The objective of this study was to determine the prevalence of patients at risk of developing diabetic complications in Ilorin, Nigeria, among our patients with diabetes mellitus.

METHODS

A cross-sectional study of diabetic patients attending the University of Ilorin Teaching Hospital ted haemoglobin as an index of medium term glucose control was assayed in established diabetics. The result obtained was evaluated against the bench mark HbA1c value of 7.2% for the development of complication.

RESULTS

Fifty-six percent of the subjects were females and all of them were forty years and above in age. Only four percent of the patients were below the age of forty years. Seventy-two percent of the subjects had diabetes for less than 10 years. Only female patients had BMI values greater than 30 kg/m2. About 64% of the patients had HbA1c value > 7.2%. More males (73.7%) had HbA1c 7.2% than females (64.5%) (P < 0.05). The patients had a mean HbA1c value of 8.0%, while the mean HbA1c in the control was 5.2%. These two mean HbA1c values gave a P-value of 0.0001 on Student t-test. The female diabetic patients had a mean HbA1c value of 7.8% (SD = 1.96) against the value of 5.1% (SD = 1.13) for the female control patients (P-value of 0.0001). Similarly, the male patients and male control subjects had mean HbA1c values of 8.1% (SD = 1.96) and 5.6% (SD = 1.00) respectively with P-value of 0.0001. The control subjects had a mean fasting blood glucose level of (+/- SD) 4.93 +/- 1.09 mmol/L and the corresponding value for the diabetics was 8.5 +/- 4.2 mmol/L. when these two values were compared we got a P-Value < 0.05.

CONCLUSIONS

The mean HbA1c values between the patients and the control subjects were significantly different. Diabetics in our environment with mean HbA1c value of 8.0% are prone to developing complications because of poor glycaemic control. We therefore advise that, periodic estimation ofglycated haemoglobin be carried out along side fasting blood glucose, in our diabetics.

Prevalence of hypertension and associated variables in paid workers in Ilorin, Nigeria

BACKGROUND

The enormous burden of hypertension worldwide and in Africa, informed the decision to measure the blood pressure pattern in salaried workers in Ilorin, Nigeria. These were selected, as they resemble closely those that are likely to be affected by western style living.

METHODS

It was a cross-sectional study that involved staff of both government and a private organisation in Ilorin, Nigeria. Two hundred and eighty one subjects, comprising of 211 males and 70 females were recruited into the study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) and fasting plasma glucose (FPG) were determined.

RESULTS

The prevalence of hypertension was 27.1% in the population, being 28.4% in males and 22.9% in females. Mean SBP and DBP were significantly higher in females (SBP; 139.59 mmHg +/- 20.84, DBP; 86.92 mmHg +/- 10.96) than in males (SBP; 127.39 mmHg +/- 19.55, DBP; 82.16 mmHg). P < 0.05. The prevalence of hypertension increased with age and BMI. Age was correlated to SBP, (r = 0.355, P < 0.01) DBP, (r = 0.322, P < 0.01) and BMI (r = 0.143, P < 0.05). Obesity prevalence was 13.2% consisting of males (5.3%) and females (7.8%). Prevalence of diabetes mellitus was similar in both sexes at 1.5%.

CONCLUSION

There is a high prevalence of hypertension among salary earners in Ilorin, Nigeria and this is commoner among males. The degree of increase in BP is worse in female workers. Obesity is on the upward climb in our society and should be addressed early in order to curtail its associated morbidities.

Clinical laboratory in the biochemical evaluation of hypertension in Nigeria

Hypertension is a worldwide problem. It is associated with severe complications that are worse in blacks! Effective management of hypertension requires that the pathophysiologic mechanism, underlining the condition be identified. The clinical laboratory can help in this regard by separating primary hypertension cases (high plasma rennin activity and low plasma rennin activity types) from those of secondary and mendelian types of hypertension. However most clinical laboratories in Nigeria do not provide some of the needed specialized tests-plasma renin activity level, urinary coritsol, plasma aldosterone and metanephrines, plasma natriuretic peptide and oral captopril tests, on routine bases. Importantly, clinicians in Nigeria should consider seriously, the role of the clinical laboratory in the management of hypertension, a condition that affects about 20% of the adult population. They should look beyond "basic or routine tests" in the management of patients with hypertension. Specific tests that will assist in the proper diagnoses of the type of hypertension in a patient should be carried out routinely on every case of hypertension. This will assist in justifying the addition of such investigations in laboratory tests repertoire, when laboratory budgets are prepared.

Pattern of some risk factors for cardiovascular disease in untreated Nigerian hypertensive patients

OBJECTIVE

Coronary heart disease risk factors tend to cluster in patients with hypertension. In works done in Nigeria, the hypertensive subjects studied were those receiving treatment. Our aim was to evaluate the pattern of these risk factors in untreated hypertensive patients.

STUDY DESIGN

Fifty untreated hypertensives and fifty normotensives were recruited among salary earners in Horin, Nigeria, after excluding conditions that can cause dyslipidaemia. Plasma total cholesterol (TC), Triglycerides (TG), HDL Cholesterol (HDL-C), LDL Cholesterol (LDL-C), Fasting Plasma Glucose (FBG) and Body moras Index (BMI) were determined in the subjects.

RESULT

Prevalence of hypertension increased with age. Plasma TC, HDL-C, LDL-C and BMI were higher in hypertensives (TC; 4.54 mmol/L +/- 1.56, HDL-C; 1.28 mmol/ L +/- 0.45, LDL-C; 3.21 mmol/L +/- 1.34, BMI; 26.42 kg/m2 +/- 4.75) than in normotensive controls (TC; 3.20 mmol/L +/- 1.28, HDL-C; 0.93 mmol/L +/- 0.41, LDL-C; 2.28 mmol/L +/- 1.01, BMI; 23.37 kg/m2 +/- 4.75). Overweight was more common in hypertensives (70%) than in normotensives, and females constituted 53% of the overweight hypertensives.

CONCLUSION

The dyslipidaemia associated with hypertension, is here noted to be present before commencement of antihypertensive therapy. This observation should influence drug prescription for treatment of hypertension. Overweight hypertensives are likely to benefit from a concurrent control of blood pressure and body weight

Role of hepatic enzymes in the biochemical assessment of the severity of sickle cell anemia

BACKGROUND AND OBJECTIVES

Various clinical and hematological indices have been used to assess the severity of Sickle Cell Anemia (SCA), however biochemical indices are lacking. Hepatomegaly has been a frequent finding in SCA and its persistence has been associated with increased disease severity. The association between hepatic enzymes and disease severity in SCA is undefined. This study was therefore designed to look at the association between clinical severity and hepatic enzymes in SCA subjects with persistent hepatomegaly (that is, lasting more than six months) in order to determine a possible role for hepatic enzymes as a biochemical index of severity.

MATERIALS AND METHODS

Serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (SAP) and gamma-glutamyl-transferase (GGT) were determined in two groups of SCA subjects and in hemoglobin genotype AA (HbAA) controls. SCA group comprised of 37 subjects with persistent hepatomegaly equal to or greater than 10 cm (below right coastal margin) while the second group comprised another 38 SCA subjects without palpable hepatomegaly. 40 individuals with hemoglobin genotype AA served as control for both groups. Clinical and hematological parameters of severity which included steady state haematocrit, number of transfusions per year, number of crises per year and percentage HbF level were determined and scored in a manner similar to the Glasgow coma scale. Results obtained were analyzed with the aid of statistical package on EPI-INFO version 6.02.

RESULTS

There was a significant increase in serum ALT, ALP and GGT levels in SCA with persistent hepatomegaly over those without hepatomegaly (p < 0.05, p < 0.05 and p < 0.01 respectively). All the index scores and the final aggregate severity scores were also significantly higher in SCA subjects with persistent hepatomegaly. Only GGT demonstrated a fairly positive and significant correlation (r = 0.46, P < 0.05) with increased clinical severity among the hepatic enzymes.

CONCLUSION

Elevated serum level of GGT in SCA during steady state is suggestive of increased disease severity.

Awareness of atherosclerosis risk factors in Nigeria

Non-communicable diseases, which include hypertension and diabetes mellitus, have become an important cause of morbidity and mortality in Nigeria. The determination of serum lipid levels is used routinely to assess the risk of atherosclerosis. This study was performed in order to determine the frequency of serum lipid requests in the community. Information on both lipid and total chemical pathology requests for the study period (May 1998 to April 2000) was obtained from the Department of Chemical Pathology, University of Ilorin Teaching Hospital, whilst data on the total hospital attendance was obtained from the hospital's Record Department. The number of serum lipid requests increased from year to year (May 1998 to April 1999 = 780; May 1999 to April 2000 = 1,357; May 2000 to April 2001 = 1,382). The percentages of total requests for serum Lipids when compared with the total laboratory requests for the period of study were 12.0%, 13.3% and 14.0% for the first, second and third year respectively. More men than women had their serum lipid levels determined; 31.3% of the patients had hyper-cholesterolaemia (> 5.2 mmol/L), while 9.9% had values > or = 6.2 mmol/L. Industrial disputes (strikes) affected our results. For the three-year period there was no remarkable increase in the use of the lipid profile facilities available in the centre. This reflects the inadequate awareness of lipid disorders as a risk factor for atherosclerosis.

Glycated haemoglobin and associated variables in diabetics: Ilorin experience

One hundred and fifty type 2 diabetes mellitus patients were investigated to determine extent of haemoglobin glycation and factors that might influence it. Factors so considered were age, sex, disease duration, and body mass index. The mean HbA(1c) was 8.0%. Ninety-six (about 64%) of the subjects had HbA(1c) > 7.2%. Seventy-one of these were males. Sex and age did not have significant effect on HbA(1c) and so was disease duration in our center. Almost 70% of the female diabetics were overweight. Correlation was very poor between BMI and haemoglobin glycation. However, assessment of the individual group results tended to suggest that glycation decrease with increasing BMI.