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   Table of Contents - Current issue
January-June 2022
Volume 12 | Issue 1
Page Nos. 1-59

Online since Friday, September 2, 2022

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Metabolic syndrome: a review p. 1
Chidiebube Jeremiah Ugwu, Maryann K Oham, Chioma S Eyisi, Beatrice Nelson-Ogbonna, Chidimma Brenda Nwatu, Christian I Okafor
Metabolic Syndrome (MetS) is a clinical construct that has continued to gain increasing global relevance due to the rising levels of obesity. It represents a cluster of metabolic abnormalities that include hypertension, central obesity, insulin resistance, and atherogenic dyslipidemia, and is strongly associated with an increased risk of developing diabetes and atherosclerotic and non-atherosclerotic cardiovascular disease. Regrettably, little consensus has been reached on the application of MetS despite several discoveries. This has limited its usefulness as a clinical tool. MetS as a clinical entity can be faulted as it lacks a scale to measure exactly how much each of its components contributes. Therefore, whether the syndrome as a whole counts more than the sum of its components is still uncertain. Even now, a clear pathophysiologic link between the components of MetS has not been identified, although many theories have been propoundedHowever, some progress has also been made on the link between Metabolic Syndrome and autoimmunity, rheumatic diseases, hyperuricaemia, cancer, dementias, infertility, and most recently non-alcoholic fatty liver disease. In these conditions, the metabolic dysfunction in MetS is believed to cause dysfunction in the immune system and also an elevation in inflammatory markers. There is an increased incidence of MetS in patients with autoimmune and autoinflammatory conditions which may account for the increased incidence of cardiovascular disease in these patients. In this review, the advances in the understanding and management of MetS are discussed including the conditions associated with MetS.
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Diabetes as it affects the oral cavity p. 10
Olufemi A Fasanmade, Adekunmi A Fasanmade, Anthonia O Ogbera, Patricia O Ayanbadejo, Richard A Adewole
Background: Diabetes is one of the commonest noncommunicable diseases and often affects various organs. The oral cavity is a commonly affected area, which is not given due attention. Objective: The objective of this review article was to highlight often overlooked dental, oral, and maxillofacial comorbidities in patients with diabetes mellitus (DM). Design: Review article. Setting: Clinical. Materials and Methods: Articles on the oral manifestations of DM were collated through studies done by other clinical researchers over the past three decades to highlight different oral conditions that complicate or are associated with DM. The databases of PubMed and Google Scholar were searched, and the key words used were oral manifestations, DM, and oral health. Results: About 100 articles on the subject were identified, several of which were perused and used for this review. Many oral comorbidities exist in patients with DM including periodontal diseases, caries, tongue lesions, buccal lesions, abnormalities of taste, and orodental infections. These conditions affected glycemic control, and poor glycemic control led to several of these manifestations. Conclusion: Comprehensive oral and dental screening should be incorporated into medical examination of patients with DM. Also, we recommend that patients visiting dental surgeries for rapidly advancing periodontal disease and orodental infections should be screened for DM among other immunosuppressive states.
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Vitamin D status and bone health in healthy adult Nigerians p. 15
Ayotunde Oladunni Ale, Sanya Bamidele Osalusi, Olusola L Adeyemo
Background: With the emergence of osteoporosis as a major public health concern among economically developed nations, more research is needed on the prevalence and etiology of this and related diseases in resource-limited countries. This study evaluated vitamin D status and its relationship with skeletal health in healthy adult Nigerians. Materials and Methods: Forty apparently healthy subjects between the ages of 21 and 50 were recruited in this prospective study. A variety of physiological parameters were assessed including markers of bone health, thyroid function, and renal function, as well as parathyroid hormone levels, calcium excretion rates, and serum 25-hydroxyvitamin-D levels. Bone mineral density (BMD) was evaluated via dual-energy X-ray absorptiometry. Results: Mean serum 25-hydroxyvitamin-D level was 53 (15.66) nmol/L and 70% of the subjects had vitamin D insufficiency. Osteopenia was observed in 25% of the subjects, and none of the subjects presented with osteoporosis. The BMD T-score of subjects with osteopenia was significantly lower when compared with non-osteopenic subjects. Serum osteocalcin was significantly higher in osteopenic subjects when compared with non-osteopenic subjects, but 24-h calcium excretion was comparable between the two groups. Mean serum 25-hydroxyvitamin-D in subjects with osteopenia was lower when compared with non-osteopenic subjects, whereas thyroid, renal, and calcium-phosphorus parameters were not significantly different between the groups. Conclusion: There is a high rate of vitamin D insufficiency and bone loss among apparently healthy Nigerians, and we propose vitamin D status and bone health as targets for intervention.
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Evaluation of the effects of the extract of dried roots of Jatropha curcas in the female Wistar rats p. 21
Ayotunde O Ale, Omolola S Odesanmi, Olubunmi A Magbagbeola
Background: Jatropha curcas is a multipurpose plant with medicinal properties along with the capability to produce cheap, commercially lucrative biofuel. Literature search reveals well-known medicinal uses of different parts of J. curcas, especially in traditional medicine; also, some studies have established the medicinal role of different parts of the plant in in-vitro and in-vivo models. Objectives: The objective is to evaluate the effects of oral administration of ethanolic and aqueous extracts of dried roots of J. curcas on the liver function in adult female rats. Materials and Methods: Rats were procured from the Animal House of the University of Ibadan. They were allowed a period of acclimatization (for 15 days) and divided into five groups (n = 4): four groups (groups A to C) were treated with aqueous extracts of dried roots of J. curcas, one group (group D) was treated with ethanolic extract of the same, and Group E did not receive any treatment (control group). After oral administration of the preparation for 15 days, the rats were sacrificed under anesthesia and blood samples were sent for biochemical analysis. Measurement of liver enzymes such as serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), alkaline phosphatase (ALP), albumin, total protein, bilirubin, and urea levels was carried out. Results: SGOT, SGPT, and urea levels were significantly lower in the alcoholic extract-treated group (group D) when compared with other aqueous extract-treated groups; also the total protein level was significantly lower in the rats in group D. ALP and bilirubin levels were significantly lower in some of the aqueous extract-treated groups (groups A and C, respectively). Conclusion: None of the extracts (aqueous and ethanolic) was found to be totally safe in adult female rats with regard to liver function. However, further study is required with larger sample size with prolonged period of administration and measurement of other biochemical and hematological parameters.
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Pre-obesity/obesity in relation to blood pressure among tertiary healthcare workers in an African setting p. 28
Obiageli U Onyemelukwe, Yazid S Kaoje, Bansi K Isa, Ahydiru A Mamza, Mathew A Iyanda, Beatrice Bello-Ovosi, Ademola O Adeleye, Habibu Balarabe, Maryam Ahmed, Lilian O Okonkwo, Innocent O Okpe, Emediong N Idung, Fatima Bello, Adamu G Bakari
Background: The study aimed to determine the predictive power of pre-obesity/obesity indices in pre-hypertension/hypertension among Northern Nigerian tertiary healthcare workers (HCWs). Materials and Methods: A cross-sectional analytical study was done on 348 HCWs. Blood pressure (BP) was defined via the 7th Joint National Committee and the American Heart Association/American College of Cardiology 2017 guidelines. Obesity was defined by body mass index (BMI)/waist circumference (WC). Pearson’s correlation, one-way analysis of variance, and binary logistic regression determined relationships. MedCalc explored the area under the curve (AUC) of obesity indices in hypertension/prehypertension prediction. Results: There were 129 (37.1%) hypertensives out of 348 HCWs. A total of 156 (44.8%) and 114 (32.8%) had systolic and diastolic pre-hypertension, respectively, whereas 241 (60.9%) were pre-obese/obese, of which nurses constituted the majority (82.8%). The anthropometric indices increased from normotension through pre-hypertension to hypertension in females. Pre-obesity [odds ratio (OR): 2.2 (95% confidence interval (CI): 1.1–4.2; P = 0.02)] and generalized obesity [OR: 2.2 (95% CI: 1.2–4.2; P = 0.02)] were associated with hypertension. Central obesity by the International Diabetes Federation (OR: 3.3; 95% CI: 1–11.2; P = 0.005) and World Health Organization (OR: 4.3; 95% CI: 1.1–16.3; P = 0.03) criteria was related to systolic hypertension in males and both systolic/diastolic in females. The optimal WC cut-off values were 87 cm [men: AUC: 0.70 (95% CI: 0.62–0.78); sensitivity (SS): 75%; specificity (SP): 63%; Youden index (YI): 0.36; P = 0.0001] and 101 cm [women: AUC: 0.65 (95% CI: 0.58–0.71); P = 0.0005] for hypertension prediction. The BMI cut-off values for hypertension were 28 kg/m2 [men: AUC: 0.72 (95% CI: 0.64–0.79); YI: 0.36; P = 0.0001] and 31 kg/m2 [women: AUC: 0.63 (95% CI: 0.56–0.69); YI: 0.21; P = 0.0014]. The WC and BMI cut-off values for pre-hypertension prediction were 86 cm (men: AUC: 0.65; SS: 65%; SP: 61%; YI: 0.26; P = 0.0013) and 82 cm (women: AUC: 0.65; SS: 86%; SP: 39%; YI: 0.25; P = 0.0001) and 23 kg/m2(men: AUC: 0.65; P = 0.0001) and 24 kg/m2 (women: AUC: 0.63; P <0.0001). Conclusion: BMI and WC can predict pre-hypertension, with WC being a more reliable predictor of hypertension in Nigerian-African male HCWs. Anthropometric indicators of overall obesity and central obesity can, therefore, be used for screening hypertension/pre-hypertension among Northern-Nigerian HCWs.
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Sporadic primary hyperparathyroidism mimicking rickets in a child: A diagnostic challenge p. 41
MA Mujeeb Afzal, Vivek Kyatham, P Srinivas Rao, Vijay Sheker R Danda
Primary hyperparathyroidism (PHPT) is very rare in children and adolescents. Here, we report a case of a 9-year-old boy with PHPT who presented with skeletal manifestations of rickets. Biochemical investigations initially revealed vitamin D deficiency. Re-evaluation due to the lack of clinical improvement following vitamin D supplementation revealed hypercalcemia and elevated parathyroid hormone. 99mTc-sestamibi scan found a right inferior parathyroid adenoma, and genetic analysis did not find any pathogenic variant. The excision of parathyroid adenoma led to the resolution of all clinical features. In a child with rickets, the absence of resolution of clinical features after vitamin D supplementation and hypercalcemia at presentation, or after vitamin D supplementation, needs further evaluation to rule out PHPT.
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Remission of diabetes mellitus or honey moon phenomenon in a newly diagnosed young Nigerian. A case report p. 45
Henry Chijioke Onyegbutulem, Ambrose U Awogu, Jibril Y Abdulahi, Peace Ijeoma Henry-Onyegbutulem
Background: Diabetes Mellitus has since been recognised as a chronic metabolic syndrome referred variously as relentless and lifelong, requiring drugs for its control. However, studies are suggesting possible reversibility following appropriate and early interventions. Objective: To sensitize clinicians on the need for early and appropriate treatment intensification. This may not only help prevent long term complications but also offers an opportunity for remission. Materials and Methods: We report the case of an obese female teenager, who presented for the first time in coma with hyperglycaemia, and subsequent remission. Results and Interpretation: Early and intensive initiation of diabetes Treatment resulting in disease remission. Conclusions: Prompt initiation and Intensification of diabetes care including diet, lifestyle interventions and drugs is bound to ensure good outcomes including prevention of diabetes-related complications. In the course of this, remission may occur, especially in newly diagnosed young patients who don’t have organ damage yet.
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Profile of patients with fibrocalculous pancreatopathy seen in Benin City, Nigeria p. 49
Andrew E Edo, Sylvester E Idogun, Gloria O Edo, Aihanuwa Eregie
Fibrocalculous pancreatopathy is a rare cause of diabetes mellitus in the young. We report two cases of fibrocalculous pancreatopathy in two young female Nigerians. The first patient was a 21-year-old student who presented with polyuria, weight loss, and itching of the vulva. Random blood sugar was 272 mg/dL. Abdominal X-ray showed pancreatic calcification. The second patient was a 20-year-old student who presented with complaints of polyuria, weight loss, and amenorrhea. Her fasting blood sugar was 336 mg/dL. Urinalysis confirmed the presence of proteinuria++, glucosuria+, ketonuria++; urine βHCG was found to be negative, and HbA1c was 12.7%. Plain abdominal X-ray showed pancreatic calcifications. Their clinical diagnosis was fibrocalculous pancreatopathy. Hyperglycemia was controlled with insulin in both the patients.
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Steroid-induced diabetes mellitus in children: A case series from Nigeria p. 53
Ibironke J Akinola, Gbenga Akinyosoye, Adaobi U Solarin, Motunrayo O Adekunle
Steroid-induced diabetes mellitus is rarely reported in the pediatric population. In children, high doses of corticosteroids are often used in the treatment of acute leukemias, lymphomas, connective tissue disorders, and rheumatological disorders. One of the many complications of corticosteroid toxicity is transient hyperglycemia and by extension diabetes mellitus. We describe three cases involving Nigerian children managed in a tertiary center for systemic juvenile idiopathic arthritis, acute leukemia, and nephrotic syndrome. Management necessitated the use of high dose steroids, and the development of diabetes mellitus ensued. One child died from complications of the primary disease. Steroid-induced diabetes can be easily diagnosed in the presence of a high index of suspicion and just as easily missed if the focus is only on the primary condition.
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Cushing’s syndrome in a 17-year-old female teenager secondary to a unilateral right adrenal adenoma: A case report p. 56
Andrew E Edo, Osariemen A Osunbor
Cushing’s syndrome is a rare endocrine disorder in the pediatric population. We report a case of a 17-year-old female Nigerian who presented with a 10 months history of progressive weight gain, amenorrhea, facial hair, and striae. She had not used oral contraceptive or steroids. Physical examination revealed an obese teenager with moon-like facies. Blood pressure was 150/90 mmHg. There were widespread striae over the back, upper arms, and thighs. The clinical diagnosis was Cushing’s syndrome. Urine free cortisol was 274.37 µg/24 h (4.3-56 µg/24 h). Plasma cortisol levels before and after dexamethasone suppression were 609.63 mmol/L and 578.71 mmol/L (normal value: <240.61 mmol/L), respectively. Plasma ACTH was 7.8 pg/mL (2.8-64.6 pg/mL). Abdominal magnetic resonance imaging (MRI) scan revealed a right adrenal mass showing mild enhancement on post-contrast. Brain MRI was normal. A right laparoscopic adrenalectomy was done. By 16 weeks post-surgery, patient’s menstrual cycle had resumed. The moon-like facies and striae were largely resolved.
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