Faculty of Clinical Sciences

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Open Access
Assessment of diabetic control:an African perspective
(FSG communications, 1994-04) Ohwovoriole, A.E; Fasanmade, O.A; Johnson, T.O
Diabetes mellitus, especially non-insulin dependent diabetes (NIDDM) is being increasingly recognised particularly in Africa and other parts of the developing world. The complications taking a great toll of life among African diabetics include: hyperglycaemic emergencies, hypoglycaemia, limb gangrene, strokes and infections. Recent observations indicate an increase in these complications. If this trend is halted, the management of diabetes in the region needs to be reappraised.
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Dysphagia due to Diabetic Autonomic Neuropathy
(Nigerian Medical Association, 1994-09) Fasanmade, O.A; Ohwovoriole, A.E; Johnson, T.O
Diabetes autonomic neuropathy (DAN), affects several systems with varying manifestations. The gastrointestinal system is one of the major targets for damage in long standing diabetes. Clinical manifestation of autonomic neuropathy involving the gastrointestinal system may be obvious or pose diagnostic problems when the diagnosis is not suspected. Here we present a case of autonomic neuropathy involving the oesophagus with the presentation of progressive dysphagia mimicking a neoplasm.
Open Access
A Study of insulin sensitivity in selected Nigerian subjects
(1996-10) Fasanmade, O.A
ABSTRACT: Insulin Sensitivity A study of insulin sensitivity was carried out on selected Nigerian subjects to measure insulin sensitivity in a group of diabetic subjects and non-diabetic controls. The relationship between insulin sensitivity and the clinical characteristics of the studied subjects were also to be determined. Patients with diabetes mellitus (DM) were studied as DM is the commonest endocrine disease known to be associated with insulin resistance (IR). The DM patients were recruited from the diabetes out-patients’ clinic of the Lagos University Teaching Hospital (LUTH). The control subjects were recruited from amongst the medical students and the workers of the LUTH. Both groups of the subjects were examined physically and their anthropometric indices measured and subsequently compared. The individuals in the study and control groups then had their insulin sensitivity estimated. This was done by calculating the glucose disappearance rates from the short insulin tolerance test (SITT). The SITT was performed on each subject in both groups and the results analysed. Different methods of calculating the Glucose disposal rate (GDR) during the tests were also analysed to identify the most accurate when compared with the analytical (the gold standard). Results of the clinical characteristics of the study and control group demonstrated differences mainly in the age, waist hip ratio and the fasting plasma glucose. For each of these parameters the diabetics had significantly higher values than the control subjects in both male and female subgroups. The body mass index (BMI), waist circumference and blood pressures were also higher in the diabetics than in the control group but these differences were not significantly higher. The GDR for the control subjects was 3.00mg/dL/min while for the diabetes it was 1.76mg/dL/min. Using values derived from the control subjects as reference points 31 and 141 of the male and female diabetics respectively were classified insulin sensitive. The observed difference in GDR values could not be attributed to differences in the anthropometric indices between the control and diabetic subject. There was strong correlation between the different methods of calculating the GDR from the SITT. The GDR was found to be higher in females than males. The GDR also was noted to decline with the age, BMI, WHR and waist circumference in both sexes. The correlations were however not significant except in the case of the females (with respect to age only). In conclusion the SITT has here been shown to be a practicable way of measuring insulin sensitivity. By the calculation of the GDR it has been found that IR is common in the diabetics studied. IR is also commoner in males and those with obesity, especially those with abdominal adiposity. It is however recommended that more studies need to be done in diabetics and non-diabetics to make far reaching conclusions on insulin sensitivity patterns in Nigerians
Open Access
Acute bacterial meningitis in a developing country: diagnosis related mortality among paediatric patients
(University of Zimbabwe Publications, 1998-01) Imananagha, K.K.; Peters, E.J.; Philip-Ephraim, E.E.; Ekott, J.U.; Imananagha, L.N.; Ekure, E.N.; Esin, R.A.
OBJECTIVES: To evaluate the effect of late diagnosis and other factors on outcome of paediatric bacterial meningitis (BM) and recommend appropriate intervention. DESIGN: Case series. SETTING: University of Calabar Teaching Hospital, Calabar, Nigeria. SUBJECTS: 62 consecutive BM patients aged two months to 16 years admitted between 1991 and 1994. MAIN OUTCOME MEASURES: Mortality rate. RESULTS: Diagnostic difficulties experienced in 58% of cases and other factors resulted in delayed diagnosis and high mortality (20 to 47%). CONCLUSION: Only elimination of the identified inadequacies in management can significantly reduce the BM-related high mortality in developing countries.
Open Access
Genital Injuries in Civil Urban Population
(Lagos Journal of Surgery- Department of Surgery, College of Medicine, University of Lagos, 1999) Osegbe, D.N; Ekeke, O.N; Ukpong, A.E; Kanu, O.O; Ogunbamise, O.O; Adegbola, O.
To assess the pattern of genital injuries in an urban Nigeria population, 34 evaluable patients managed in our service in the past 5 years were studied. The patients were young and there was a strong male preponderance (1 6: l). The injury mechanism was penetrating and gunshot by armed robbers inflicted complex and severe iniuries. Iniuryto hospital time and injury to intervention fime in hospital were prolonged in many. Circumcision related penile iniury followed by armed robbery gunshot topped the chart of aet1010gy. Infection at 63% was a maior source of high morbidity and prolonged hospital stay. Gunshot wounds were managed by extensive debridement and delayed primary suturing. The testes were explored in all violent injuries to the scrotum. Fractured penis was treated by immediate penile degloving and suturing of the breach in tunica albuginea with restoration of erection. Penile amputations, managed by naked eye re-apposition failed. Orchidectomy was performed for shattered testis. Only one patient required blood transfusion. Associated iniuries were common and urethral damage ranked highest. One death occurred but this was not owing to genital iniury per se. Genital iniury is uncommon but will rise with increasing violence in civil society. Early, and expert intervention hold the key to satisfactory outcome
Open Access
Hypoglycaemic action of medicinal plants with tolbutamide in the albino rats
(DIABETES INTERNATIONAL, 1999-11) Odeigah, P.G.C; Taiwo, I.A; Akomolafe, E.O; Durojaiye, O.O
Full texts attached
Open Access
Localised Tetanus In Lagos, Nigeria.
(Lagos University Medical Society (LUMS), 1999-12) Okubadejo, N.U.; Danesi, M.A.
Localized tetanus is rare in Nigerians, with an incidence of 1.8% in a previous report. We report six cases of localized tetanus out of total of 95 cases of tetanus seen at the Lagos University Teaching Hospital over a period of 3 years. All cases were seen and managed by one or both of the authors, the policy in the hospital being that all cases of tetanus in adolescents and adults are referred to and managed by the Neurology unit. The frequency of localized tetanus was 6.3% of all cases of tetanus. Two of the cases had partial immunization. The contribution of partial immunization to causation needs further study. The commonest site of involvement was the lower limb (in five of the cases). No case of cephalic tetanus was seen. Recognition of the existence of localized tetanus is important to ensure correct diagnosis and treatment.
Open Access
Plasma lipid levels and glucose concentrations in previously tablet controlled NIDDM patients and their relationship to cardiovascular morbidity
(Nigerian Medical Association, 2000) Jarikre, A.E; Fasanmade, O.A; Okosieme, O.E
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Open Access
Paediatric HIV/AIDS Infection in three of four children from consecutive twins deliveries
(Paediatric Association of Nigeria, 2000) Ekanem, E.E.; Uniga, A.J.; Ekure, E.N.
Vertical infection the Human Immunodeficiency Virus (HIV) among two consecutive pair of twins from a well-to-do family is presented. While the first twin of the first pair must have been infected in-utero, the second may have been infected at parturition or through breast milk. Severe protein-energy malnutrition was the main mode of presentation. A recommendation is made for routine screening of pregnant women during ante-natal care with family planning counselling of positive cases. Zidovudine therapy for infected pregnant women is also recommended. In addition, it is suggested that infected mothers from high socio-economic classes in our environment should not breast-feed their infants. HIV/AIDS should please be suspected when PEM manifests in children from high socio-economic families.
Open Access
In Search of Susceptibility Genes for Type 2 Diabetes in West Africa: The Design and Results of the First Phase of the AADM Study
(Elsevier, 2001-01) Rotimi, C.N; Dunston, G.M; Berg, K; Akinsete, O; Johnson, T; Fasanmade, O
PURPOSE: The purpose of this study is to map type 2 diabetes susceptibility genes in West African ancestral populations of African-Americans, through an international collaboration between West African and US investigators. DESIGN AND METHODS: Affected sib-pairs (ASP) along with unaffected spouse controls are being enrolled and examined in West Africa, with two sites established in Ghana (Accra and Kumasi) and three in Nigeria (Enugu, Ibadan, and Lagos). Eligible participants are invited to study clinics to obtain detailed epidemiologic, family, and medical history information. Blood samples are drawn from each participant to measure glucose, insulin, C-peptide, total cholesterol, LDL, HDL, triglycerides, albumin, creatinine, urea, uric acid, total calcium and to detect autoantibodies to glutamic acid decarboxylase (GAD). DNA is isolated from frozen white blood cells obtained from 20 ml of EDTA whole blood samples. RESULTS: With full informed consent, 162 individuals from 78 families have been enrolled and examined since the Africa America Diabetes Mellitus (AADM) study began in June of 1997. Logistics of field examinations and specimen shipping have been successfully established. At the end of the third year of field activity (September 2000) the AADM study will have enrolled and performed comprehensive examination on 400 ASP with type 2 diabetes, for a minimum of 800 cases and 200 controls from Ghana and Nigeria. At the current participation rate, the goal of 400 sib-pairs and 200 controls will be met before the scheduled closing date. CONCLUSIONS: The AADM study will create a comprehensive epidemiologic and genetic resource that will facilitate a powerful genome-wide search for West African susceptibility genes to type 2 diabetes.
Open Access
Instrumental deliveries and outcome in a British district general hospital
(Nigerian Quarterly Journal of Hospital Medicine, 2002) Afolabi, B.B.
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Open Access
Africa can solve its own health problems. Africa needs less globalisation and more real assistance
(BMJ, 2002) Afolabi, B.B.
The article by Holmes and the accompanying commentaries essentially aim to explore the evidence for the efficacy and effectiveness of the psychotherapies and how this should be applied in everyday clini≠cal practice.1It is ironic that the arguments against cognitive therapy include numerous instances of idiosyncratic use of research evidence.Firstly, for example, in his commentary Bolsover selects three studies to support hisview that the evidence base for cognitive therapy is weak. We would challenge him to apply his arguments to the seven systematic reviews of cognitive therapy in the Cochrane Database and the Database of Abstracts of Reviews of Effectiveness.2Holmes and also Bolsover cite a single paper to suggest that cognitive therapy isless effective in the real world of clinical practice than in university based clinicaltrials. This caricature may have applied tosome trials conducted 30 years ago but isirrelevant now. To give just two examples,recent trials of cognitive therapy for chronic depression specifically recruited individualswho were depressed despite adequate trialsof pharmacotherapy and psychotherapy.3Also, the Cochrane review of cognitivetherapy for schizophrenia includes exam≠ples of “real world” interventions.
Open Access
Perinatal Mortality Among Twins In Lagos University Teaching Hospital : Associated Risk Factors
(Lagos University Medical Society, 2002) Ekure, E.N.; Iroha, E.O.
Background: Perinatal mortality rate is reported to be higher in twins than in singletons. More than two decades ago, Abudu and Agarin reported a twinning rate of 21.1/1000 maternities and perinatal mortality rate of 142.6/1000 among twins in Lagos. Objective: To determine the current perinatal mortality rate and risk factors that influence perinatal mortality among twins in Lagos University Teaching Hospital, Nigeria. Materials and Methods: Babies weighing >1000grammes delivered by twin pregnancy between January 1996 and December 2000 in Lagos University Teaching Hospital were retrospectively studied. Routinely collected data from nurses and doctors registers in the departments of Obstetrics and Paediatrics on all twin deliveries was analysed. Results: Out of 5,947 deliveries, there were158 set of twins' giving a twinning rate of 26.6/1000 for the institution. Fifteen of the babies weighed <1000g and so were excluded leaving 301 babies. Twenty-seven babies weighing >1000g died perinatally giving a perinatal mortality rate of 89.7/1000. The significant risk factors for perinatal mortality identified in twins were lack of antenatal care (P=0.005), low gestational age and premature delivery (P<0.005), low birth weight especially <2000g (<0.001), like-sex pair (P=0.01) and breech presentation (P=0.05). Conclusion: All multiple pregnancies should be supervised in institutions with facilities for premature care and babies who weigh <2000g, belong to like-sex pair or have breech presentation should be specially cared for by personnel trained in neonatal care because of a significant risk of perinatal mortality.
Open Access
Admission blood pressure of stroke patients and its relationship to one-week case fatality-a preliminary study.
(Lagos University Medical Society (LUMS), 2002-01) Ojini, F.I.; Okubadejo, N.U.; Ogun, S.A.; Akokhia, S.I.; Danesi, M.A.
Background: High blood pressure is often said to be associated with poor outcome in stroke. However, there remains some uncertainly about the relationship of blood pressure to mortality in stroke. Objective: This study seeks to determine the influence of admission blood pressure on early mortality of stroke patients at the Lagos University Teaching Hospital (LUTH). Methods: Clinical and laboratory data were collected prospectively according to a standardized protocol, from stroke patients admitted to LUTH in 1999 and 2000, and information obtained about the time of onset of stroke, history of hypertension, level of consciousness, admission blood pressure, ECG findings of left ventricular hypertrophy, and one-week outcome. Results: hypertension was present in 87.3% of strokes on presentation. Strokes with mild to moderate hypertension had the lowest case fatality of 5.6%, while those with isolated systolic hypertension had the highest fatality of 40%. There was a u-shaped relationship between admission blood pressure and one-week case fatality, with strokes that had mild to moderate hypertension having a significantly lower one-week case fatality than strokes with normal blood pressure and severe hypertension Conclusion: Most patients with stroke have hypertension on presentation. It appears that mild to moderate hypertension on presentation is associated with a significantly better one-week outcome for stroke patients than other categories of blood pressure.
Open Access
Risk of seizures in first degree relatives of probands with epilepsy
(Lagos University Medical Society (LUMS), 2002-01) Okubadejo, N.U.; Danesi, M.A.
Objective: To determine the risk of seizures in first degree relatives of epileptic patients. To relate the risk to several clinical characteristics in the probands. Such information is useful for genetic counselling. Methods: A prospective case-control study of 648 FDR of 88 probands attending the neurology out-patient clinic of a tertiary hospital in Lagos, Nigeria, and 308 FDR of 44 age and sex-matched controls was carried out. History of seizures in all FDR was sought using a survey questionnaire either directly filled by the FDR, probands or both. The risk of seizures in FDR was related to some clinical variables in the probands. Results: Overall risk of seizures was slightly but insignificantly higher (3.6%) in FDR of probands with epilepsy compared to controls (2.3%) (chitest; p > 0.05). Risk of seizures was highest in offspring of probands (4.3%), and FDR of female probands (4.0% compared to 3.1% in males), probands with seizure onset below 10 years (5.1% compared to 3.1% >10years) and probands with complex partial seizures (4.9% compared to 3.9% for generalized tonic-clonic seizures). The differences did not however reach statistical significance in comparison to the control group (chitest; p > 0.05). Conclusion: The risk of seizures in FDR of Nigerian probands with epilepsy has a similar profile with that in other environments such as Europe and North America in that it is marginally higher but not significantly different from the risk in the normal population.
Open Access
Does diagnosis of hypertension prevent stroke? A preliminary investigation of relative frequency of undiagnosed and previously diagnosed hypertension before first stroke in a Lagos hospital.
(Lagos University Medical Society (LUMS), 2002-01) Okubadejo, N.U.; Ojini, F.I.; Dawodu, C.O.; Danesi, M.A.
Introduction: The present study was designed to determine the relative frequency of previously diagnosed and undiagnosed hypertension in first stroke in order to evaluate if previous diagnosis of hypertension can prevent stroke. Patients and Methods: One hundred and twenty nine first stroke patients presenting at the emergency unit of a tertiary hospital in Lagos, Nigeria, were prospectively studied. Presence of hypertension and other modifiable risk factors was documented. History of diagnosis of hypertension before onset of focal neurological features was sought to categorize patients as having either known (previously diagnosed) or unknown (previously undiagnosed) hypertension. Results: Significantly higher percentage of the 102 first stroke patients with hypertension were known hypertensives (77.4% versus 22.6% unknown). This was so irrespective of whether the patients had other modifiable risk factors. Conclusion: Majority of our patients presenting with stroke were previously diagnosed hypertensives. Thus, diagnosing hypertension alone does not prevent stroke. Further studies are required to clearly define the impact of inadequate blood pressure control after diagnosis of hypertension (including poor drug compliance) and other risk factors.
Open Access
The impact of an intervention to change health workers' HIV/AIDS attitudes and knowledge in Nigeria: a controlled trial
(Elsevier, 2002-03) Ezedinachi, E.N.U.; Ross, M.W.; Meremiku, M.; Essien, E.J.; Edem, C.B.; Ekure, E.N.; Ita, O.
The aim of the study was to improve health workers' skills and confidence in dealing with patients with HIV disease and increase attention to patients' human rights. A longitudinal controlled trial was carried out in which one Nigerian state served as the intervention site and the adjacent state served as the control site for an intervention and dissemination of training in clinical management, health education, and attitudinal change toward patients with HIV disease. The intervention group n=1072, control group n=480. Following initial questionnaire-defining focus groups, nurses, laboratory technologists and physicians in all base hospitals in the intervention state were trained by influential role models who attended the initial training. Data were collected in all sites pre-training and 1 y later. Hierarchical multiple regression analysis controlling for baseline data, and orthogonal factor analysis to define scales were used. Data showed significant positive changes after 1 y in the intervention group on perception of population risk assessment, attitudes and beliefs about people with HIV disease, less fear and more sympathy for and responsibility toward HIV patients, and an increase in self-perceived clinical skills. There was increased willingness to treat and teach colleagues about people with HIV. Clinician fear and discrimination were significantly reduced, and the climate of fear that was associated with HIV was replaced with a professional concern. There was increased understanding of appropriate psychosocial, clinical and human rights issues associated with HIV treatment and prevention. This intervention, targeting health workers in an entire state and using HIV/AIDS information, role modeling, diffusion of training and discussions of discrimination and human rights, significantly affected the perception of risk groups and behaviors, perceived skills in treatment and counseling, reduced fears and increased concern for people with HIV disease, and improved the climate of treatment and prevention of HIV disease compared with a control state.
Open Access
Fasting plasma glucose levels in normal pregnant Nigerians
(J Obstet Gynaecol, 2003) Afolabi, B.B.; Abudu, O.O.; Oyeyinka, O.
Summary A study was undertaken to determine a reference value for fasting plasma glucose in a group of apparently normal pregnant Nigerian women. Three hundred and twenty women were tested; 260 pregnant and 60 non-pregnant. There were 60, 100 and 100 subjects in the first, second and third trimesters, respectively. Fasting plasma glucose was measured in each of the women using the glucose oxidase method. The mean fasting plasma glucose level was 4.64+0.79 mmol/l in the control group and 3.72+0.58, 3.78+0.81 and 3.81+0.85 mmol/l in the first, second and third trimesters of pregnancy, respectively. Mean fasting plasma glucose+ 2 standard deviations (SD) of all the pregnant women was 5.3 mmol/l, which is much lower than the World Health Organisation value for the diagnosis of diabetes mellitus.
Open Access
Prevalence and determinants of diabetic retinopathy and cataracts in West African type 2 diabetes patients
(2003) Rotimi, C; Daniel, H; Zhou, J; Obisesan, A; Chen, G; Chen, Y; Amoah, A; Opoku, V; Acheampong, J; Agyenim-Boateng, K; Eghan, B.A Jr; Oli, J; Okafor, G; Ofoegbu, E; Osotimehin, B; Abbiyesuku, F; Johnson, T; Fasanmade, O; Doumatey, A; Aje, T; Collins, F; Dunston, G
Objective: To quantify the prevalence of, and risk factors for, diabetic retinopathy and cata- racts in patients with type 2 diabetes, and their spouse controls, enrolled from 5 centers in 2 West African countries (Ghana and Nigeria). Method: The analysis cohort was made up of 840 subjects with type 2 diabetes, and their 191 unaffected spouse controls, who were en- rolled and examined in Lagos, Enugu, and Iba- dan, in Nigeria, and in Accra and Kumasi, in Ghana. A diagnosis of diabetic retinopathy was made only where a participant had a mini- mum of one microaneurysm in any field, as well as exhibiting hemorrhages (dot, blot, or flame shaped), and maculopathy (with or with- out clinically significant edema). Results: Average duration of diabetes was 7.0 years, and mean age at diagnosis was 46.5 years. Prevalence of diabetic retinopathy was 17.9%. Cataracts were present in 44.9% of the patients with type 2 diabetes, and in 18.3% of spouse controls. The risk of developing reti- nopathy increased more than 3-fold for pa- tients at the highest fasting plasma glucose (FPG) level (OR􏰃3.4; 95% CI, 1.8–6.3), com- pared to patients at the lowest FPG level. The odds ratios for persons with diabetes for 10 years or more, compared to persons with di- abetes for less than 5 years, was 7.3 (95% CI, 4.3–12.3) for retinopathy, and 2.6 (95% CI, 1.5–4.5) for cataracts. Conclusions: Cataracts were a more impor- tant cause of vision impairment than was dia- betic retinopathy in this cohort. The preva- lence of cataracts in patients with diabetes was more than twice that of their spouse controls, indicating that type 2 diabetes is an important risk factor for cataract formation. Individuals who developed type 2 diabetes at an earlier age were more likely to develop both diabetic retinopathy and cataracts. A strong positive as- sociation was observed between FPG level, duration of diabetes, and risk of retinopathy and cataracts. The low prevalence of retinop- athy and cataracts observed within the first 5 years of diagnosis of diabetes in this cohort, suggests that intensive blood glucose control may reduce the risk of the development and progression of retinopathy and cataracts. In this regard, early eye examination, preferably at first presentation of elevated blood glucose, is highly recommended
Open Access
Factors influencing HIV seroprevalence rate among pregnant women in Calabar, Nigeria
(Bachudo Science Company Limited, 2003) Ekure, E.N.; Etuk, S.J.
Human immune deficiency virus (HIV) seroprevalence among pregnant women in Calabar was studied. The aims were to establish HIV seroprevalence rate and to identify factors which influence this rate in our pregnant women. HIV seroprevalence rate of 2.7% among antenatal women in Calabar was recorded with a vertical transmission rate of 20%. Husband and wife not living together, history of induced abortion and blood transfusion significantly increase HIV seroprevalence rate among antenatal women in our community (P = 0.02 - 0.04). Marital status and age seemed to increase while social class and previous pregnancy outcome did not influence the HIV seroprevalence rate in these women. The importance of screening as a necessary step towards prevention of vertical transmission should be emphasised during our antenatal health talks. Pregnant women with history of induced abortion, those who are not living together with their husbands and those with history of blood transfusion should have a one-to-one person education on this issue. Any cause that would separate wives from their husbands should be discouraged. Family planning as a means of preventing unwanted pregnancy should be encouraged and transfusion of unscreened blood should be banned in all health facilities in Nigeria.

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