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- ItemOpen AccessAssessment of diabetic control:an African perspective(FSG communications, 1994-04) Ohwovoriole, A.E; Fasanmade, O.A; Johnson, T.ODiabetes 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.
- ItemRestrictedDysphagia due to Diabetic Autonomic Neuropathy(Nigerian Medical Association, 1994-09) Fasanmade, O.A; Ohwovoriole, A.E; Johnson, T.ODiabetes 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.
- ItemOpen AccessA Study of insulin sensitivity in selected Nigerian subjects(1996-10) Fasanmade, O.AABSTRACT: 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
- ItemOpen AccessLocalised 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.
- ItemOpen AccessPlasma 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.EFull texts attached
- ItemOpen AccessIn 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, OPURPOSE: 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.
- ItemOpen AccessRisk 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.
- ItemOpen AccessAdmission 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.
- ItemOpen AccessDoes 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.
- ItemOpen AccessPrevalence 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, GObjective: 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 (OR3.4; 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
- ItemOpen AccessSevere Acute Respiratory Syndrome (SARS): An Overview(Lagos University Medical Society (LUMS), 2003-07) Okubadejo, N.U.; Bandele, E.O.Background: Severe acute respiratory syndrome (SARS) is an emerging infectious disease recognized in March 2003. From its original location, the disease has rapidly spread globally, leaving in its wake considerable anxiety, morbidity and mortality. Objective: To review existing literature on SARS, and provide an overview of what is currently known of the epidemiology, clinical features, diagnosis, treatment and prognosis of SARS. Findings: Much information has become available on SARS, and this is largely credited to international collaboration, expedition of information flow via the world wide web and global press, and the leading roles of the World Health Organization (WHO), Centres for Disease Control and Prevention (CDC), governmental health authorities, and non-governmental organizations. The causative agent has been sequenced, preliminary short-term clinical features described, and interim prevention measures identified. The probability of resurgence, the gold standard for diagnosis, and specific treatment regimes, are actively being investigated.
- ItemOpen AccessPlasma magnesium in adult Nigerian patients with epilepsy(National Postgraduate Medical College of Nigeria, 2003-12) Oladipo, O.O.; Ajala, M.O.; Okubadejo, N.U.; Danesi, M.A.; Afonja, O.A.The objective of this study was to determine the relationship between plasma magnesium levels and epilepsy. The study was carried out at the Lagos University Teaching Hospital. Plasma magnesium was estimated using the calmigite dye colorimetric method in 45 adults with epilepsy and 35 healthy controls. Plasma concentrations of calcium, phosphorus and albumin were also estimated. The mean plasma magnesium in the patients was 0.98 mm0l/L (0.05) while that in the controls was 1.15 mmol/L (0.28). The mean plasma magnesium in the epileptics was significantly lower than that obtained in the controls (p < 0.001). Age of onset of seizures, seizure frequency and duration of treatment did not influence the plasma magnesium levels. Low plasma magnesium is associated with epilepsy, further studies may determine the influence of anti-epileptic drug therapy on plasma magnesium levels.
- ItemOpen AccessPseudohermaphroditism due to congenital adrenal hyperplasia - a case report(Endocrine and Metabolism Society of Nigeria, 2004) Fasanmade, O.A; Ohwovoriole, A.E; Isiavwe, A.R.Background: Congenital adrenal hyperplasia [CAH] due to 21-hydroxylase deficiency is the most common cause of ambiguous genitalia. The hypertensive form is due to 11B – hydroxylase deficiency. The purpose of this report is to apprise clinicians of the presentation of this form of CAH. CASE REPORT: A 17- year old female Nigerian presented with the history of a ‘male’ phallus that was first noticed 3 years prior to presentation. Menarche was at age 14. There was no menstrual irregularity. She was apparently female at birth and was circumcised in early childhood. Her development milestones were normal. Her height was 1.60m and weight was 46.2kg. BMI was 18kg/m2. Virilising features accompanied the presence of the phallus. Her breasts were small. Genital examination revealed clitoromegaly. The labia minora were hypo plastic. The vestibule with vaginal orifice and well – formed hymen were present. She was hypertensive with clinical features of hypertensive heart disease. Hormone profile showed elevated testosterone to 3.9ng/ml [0.2-0.8 = females]. Elevated Dhea-sulphate [17 ketosteroids]-6, 400 ng/ml [700-3900,F]. The 17 OH progesterone was 3.71nmol/L [F-0.45 -3.3]. Cortisol was 192.0 nmol/L [a.m -171 -536, p.m – 64- 340]. Serum electrolytes were normal. Pelvic USS was normal. She was placed on glucocorticoids and lisinopril. Conclusion: CAH is an uncommon but recognized cause of hypertension and should be considered in the differential diagnosis of young patients with hypertension and virilisation.
- ItemOpen AccessFine needle aspiration cytology of thyroid gland swellings: a 2 year follow up(Endocrine and Metabolism Society of Nigeria, 2004) Fasanmade, O.A; Nnodu, O.Eabstracts attached
- ItemOpen AccessPlasma leptin in Graves' disease(Endocrine and Metabolism Society of Nigeria, 2004) Ajala, M.O; Alalade, T.O; Oshodi, T.O; Fasanmade, O; Kazeem, A.AAbstracts attached
- ItemOpen AccessA Genome-Wide Search for Type 2 Diabetes Susceptibility Genes in West Africans: The Africa America Diabetes Mellitus (AADM) Study(American Diabetes Association, 2004) Rotimi, C.N.; Chen, G.; Adeyemo, A.A.; Furbert-Harris, P.; Parish-Gause, D.; Zhou, J.; Berg, K.; Adegoke, O.; Amoah, A.; Owusu, S.; Acheampong, J.; Agyenim-Boateng, K.; Eghan, B.A. Jr; Oli, J.; Okafor, G.; Ofoegbu, E.; Osotimehin, B.; Abbiyesuku, F.; Johnson, T.; Rufus, T.; Fasanmade, O.; Kittles, R.; Daniel, H.; Chen, Y.; Dunston, G.; Collins, F.S.The incidence of type 2 diabetes is growing rapidly, not only in developed countries but also worldwide. We chose to study type 2 diabetes in West Africa, where diabetes is less common than in the U.S., reasoning that in an environment where calories are less abundant, incident cases of type 2 diabetes might carry a proportionately greater genetic component. Through the Africa America Diabetes Mellitus (AADM) study, we carried out a genome-wide linkage analysis of type 2 diabetes in a cohort of 343 affected sibling pairs (691 individuals) enrolled from five West African centers in two countries (Ghana: Accra and Kumasi; Nigeria: Enugu, Ibadan, and Lagos). A total of 390 polymorphic markers were genotyped, and multipoint linkage analysis was conducted using the GENEHUNTER-PLUS and ASM programs. Suggestive evidence of linkage was observed in four regions on three chromosomes (12, 19, and 20). The two largest logarithm of odds scores of 2.63 and 1.92 for chromosomes 20q13.3 and 12q24, respectively, are particularly interesting because these regions have been reported to harbor diabetes susceptibility genes in several other populations and ethnic groups. Given the history of forced migration of West African populations during the slave trade, these results should have considerable relevance to the study of type 2 diabetes in African Americans.
- ItemOpen AccessClinical profile of 1267 Nigerians with diabetes mellitus(Endocrine and Metabolism society of Nigeria, 2004) Fasanmade, O.A; Okubadejo, N.U.Abstracts attached
- ItemOpen AccessA Genome-Wide Search for Type 2 Diabetes Susceptibility Genes in West Africans. The Africa America Diabetes Mellitus (AADM) Study(American Diabetes Association, 2004-03) Rotimi, C.N; Chen, G; Adeyemo, A.A; Fubert-Harris, P; Osotimehin, B; Fasanmade, OThe incidence of type 2 diabetes is growing rapidly, not only in developed countries but also worldwide. We chose to study type 2 diabetes in West Africa, where diabetes is less common than in the U.S., reasoning that in an environment where calories are less abundant, incident cases of type 2 diabetes might carry a propor- tionately greater genetic component. Through the Af- rica America Diabetes Mellitus (AADM) study, we carried out a genome-wide linkage analysis of type 2 diabetes in a cohort of 343 affected sibling pairs (691 individuals) enrolled from five West African centers in two countries (Ghana: Accra and Kumasi; Nigeria: Enugu, Ibadan, and Lagos). A total of 390 polymorphic markers were genotyped, and multipoint linkage analy- sis was conducted using the GENEHUNTER-PLUS and ASM programs. Suggestive evidence of linkage was ob- served in four regions on three chromosomes (12, 19, and 20). The two largest logarithm of odds scores of 2.63 and 1.92 for chromosomes 20q13.3 and 12q24, respectively, are particularly interesting because these regions have been reported to harbor diabetes suscep- tibility genes in several other populations and ethnic groups. Given the history of forced migration of West African populations during the slave trade, these re- sults should have considerable relevance to the study of type 2 diabetes in African Americans.
- ItemOpen AccessDiagnostic issues in cerebral malaria: a study of 112 adolescents and adults in Lagos, Nigeria(National Postgraduate Medical College of Nigeria, 2004-03) Okubadejo, N.U.; Danesi, M.A.OBJECTIVE: To determine the accuracy of initial diagnosis of cerebral malaria in adolescents and adults presenting at our tertiary centre and identify the clinical and laboratory parameters helpful in distinguishing cerebral malaria from other differential diagnosis. METHODS: A retrospective review of 112 adolescents and adults initially diagnosed as having cerebral malaria was carried out. Clinical features (risk factors, mode of presentation, clinical course and final diagnosis) and laboratory parameters (level of parasitaemia, haematologic and biochemical values) were documented. RESULTS: A correct diagnosis was made in 52 patients (46.4%), with septicaemia (20.5%) and meningitis (15.2%) accounting for most misdiagnosis. The majority of correctly diagnosed were aged 11-25 years (92.3%), and a predisposing factor was identifiable in 46.2%. Parasitaemia was predominantly moderate to heavy in correctly diagnosed cases, compared to those misdiagnosed in whom it was mild to moderate. Case fatality was higher for misdiagnosed cases (18.6%). CONCLUSION: The probability of an alternate diagnosis amenable to other treatment regimes should always be explored. This is particularly important in patients of middle age and those with either absent predisposing factors or mild parasitaemia, in order to reduce case fatality.
- ItemOpen AccessFrequency and predictors of autonomic dysfunction in Parkinson's disease: a study of African patients in Lagos, Nigeria(National Postgraduate Medical College of Nigeria, 2004-03) Okubadejo, N.U.; Danesi, M.A.The degenerative changes in PD also affect the autonomic nervous system. The frequency and predictors of such involvement in Africans with PD has not been reported. OBJECTIVE: i) To determine the frequency and type of autonomic dysfunction in Nigerians with idiopathic Parkinson's disease (PD). ii) To determine the predictors of autonomic dysfunction in PD. METHODS: Cardiovascular autonomic function assessed in 33 study subjects with PD and 33 age-matched controls, utilising heart rate variability to deep breathing, standing and the Valsalva manoeuvre, and the blood pressure (BP) response to standing. The results were compared based on treatment category, grade of severity on the Columbia scale of Hoehn and Yahr, duration of PD, age at onset of PD, present age and occurrence of autonomic symptoms. RESULTS: Parasympathetic function was abnormal in 51.5% of PD subjects, significantly higher than controls (P<0.001). Of these, 76.5% had early parasympathetic involvement and 23.5% definite parasympathetic involvement. Age above 65 years (at time of study or onset of PD) was the only clinical variable associated with parasympathetic autonomic dysfunction (p<0.05). Symptoms dysfunction occurred in 60.6% of PD patients and only 6.1% of controls (p<0. 001). There was however no demonstrable relationship between the occurrence of symptoms and objective evidence of autonomic dysfunction: 41.2% of PD patients with parasympathetic dysfunction had no symptoms. CONCLUSION: Autonomic dysfunction was found to be common in Africans with PD, particularly those above 65 years and tends to affect the parasympathetic system. However, the abnormality may be detectable even before symptoms appear. As such, we recommend that cardiovascular tests of autonomic function be a routine aspect of the evaluation of PD patients, especially with advancing age.