Ab Olokoba

Type 2 Diabetes Mellitus: A Review of Current Trends

Type 2 diabetes mellitus (DM) is a chronic metabolic disorder in which prevalence has been increasing steadily all over the world. As a result of this trend, it is fast becoming an epidemic in some countries of the world with the number of people affected expected to double in the next decade due to increase in ageing population, thereby adding to the already existing burden for healthcare providers, especially in poorly developed countries. This review is based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. Subject heading and key words used include type 2 diabetes mellitus, prevalence, current diagnosis, and current treatment. Only articles in English were included. Screening and diagnosis is still based on World Health Organization (WHO) and American Diabetes Association (ADA) criteria which include both clinical and laboratory parameters. No cure has yet been found for the disease; however, treatment modalities include lifestyle modifications, treatment of obesity, oral hypoglycemic agents, and insulin sensitizers like metformin, a biguanide that reduces insulin resistance, is still the recommended first line medication especially for obese patients. Other effective medications include non-sulfonylurea secretagogues, thiazolidinediones, alpha glucosidase inhibitors, and insulin. Recent research into the pathophysiology of type 2 DM has led to the introduction of new medications like glucagon-like peptide 1 analogoues: dipeptidyl peptidase-IV inhibitors, inhibitors of the sodium-glucose cotransporter 2 and 11ß-hydroxysteroid dehydrogenase 1, insulin-releasing glucokinase activators and pancreatic-G-protein-coupled fatty-acid-receptor agonists, glucagon-receptor antagonists, metabolic inhibitors of hepatic glucose output and quick-release bromocriptine. Inhaled insulin was licensed for use in 2006 but has been withdrawn from the market because of low patronage.

Hepatitis B virus infection amongst pregnant women in North-Eastern Nigeria- A call for action

BACKGROUND It is well known that Hepatitis B virus infection is endemic in Nigeria. Even though studies have been carried out on Hepatitis B virus infection in different parts of Nigeria, and in different sub-groups of individuals, information regarding the prevalence of Hepatitis B virus infection in pregnant women is scanty especially from the North-eastern region of Nigeria. We therefore determined the seroprevalence of Hepatitis B surface antigen (HBsAg) amongst pregnant women in North Eastern Nigeria. MATERIALS AND METHODS A hospital-based cross-sectional study was carried out. The setting was the ante-natal clinic of the Federal Medical Centre, Yola, Nigeria. The duration of the study was from July 2008 to December 2008. Two hundred and thirty-one consecutively recruited pregnant women were screened for Hepatitis B surface antigen. Positive samples were re-tested using ELISA to eliminate false positives. Their biodata were obtained using a questionnaire to establish the presence of possible risk factors such as blood transfusion, surgery, etc. Written informed consent was obtained from each woman. RESULTS Out of the 231 pregnant women tested, nineteen of them were seropositive for Hepatitis B virus infection giving an infection rate of 8.2%. Women in the age group 25-29 years had the highest HBV infection rate. CONCLUSION This study confirms a high seroprevalence of Hepatitis B virus infect ion amongst pregnant women. It is recommended that pregnant women should be routinely screened for Hepatitis B virus infection as part of antenatal care services.

Alzheimer's disease: A review of recent developments

Alzheimers disease (AD) is the most common type of dementia in aging adults, and a substantial burden to patients, caregivers, and the healthcare system. It is an increasingly significant public health issue; with the number of people living with AD projected to increase dramatically over the next few decades, making the search for treatments and tools to measure disease progression increasingly urgent. This review is based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. The subject headings and keywords used were Alzheimers disease, dementia, primary neuronal degeneration and senile plagues. Only the articles written in English were included. The diagnosis is still primarily made based on history and physical and neurologic examinations. Approved treatments are few and of limited efficacy, serving mostly to slow or delay progression and not to cure the disease, despite significant research by pharmaceutical industries. Cholinesterase inhibitors offer some help in treating cognitive and global functioning, as well as behavioral abnormalities in patients with mild-, moderate-, or severe-stage disease. The N-methyl-d-aspartate (NMDA) antagonist, memantine, is similarly effective alone or in combination with cholinesterase inhibitors in moderate to severe stages of the disease. Recent insights into the pathophysiology of AD have led to promising investigational therapies, including the development of γ- and β-secretase inhibitors as well as active and passive immunization against the amyloid β-protein.

Current management of Parkinson's disease

Although Parkinsons disease (PD) is still incurable, a large number of different treatments have become available to improve the quality of life and physical and psychological morbidity, and its early treatment is of prime importance. This article reviews the current situation of PD. This review was based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. The subject headings and keywords used were Parkinsons disease and therapeutic advances. Only articles written in English were included.The management of PD has evolved rapidly over the last 10 years with the advent of new drugs and new classes of drugs, but the currently available treatment methods are all symptomatic ones. However, some of these may have marginal disease-modifying effects. Progress in manufacture of newer drugs has markedly improved the treatment of early PD; however, the management of advanced Parkinsons symptoms remains a challenge. Currently no treatment has been proven to slow the progression of PD. Although symptomatic therapy can provide benefit for many years, PD will eventually result in significant morbidity.

Helicobacter pylori eradication therapy: A review of current trends

Helicobacter pylori has been implicated in the formation of chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma and gastric cancer. Eradication of H. Pylori has been recommended as treatment and prevention for these complications. This review is based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. Subject heading and key words used include H. Pylori, current treatment and emerging therapy. Only articles in English were included. There has been a substantial decline in the H. pylori eradication rates over the years, despite the use of proton pump inhibitor and bismuth salts for triple and quadruple therapies respectively. The reasons for eradication failure are diverse, among them, antibiotic resistance is an important factor in the treatment failure. Primary resistance to clarithromycin or metronidazole significantly affects the efficacy of eradication therapy. This has led to the introduction of second line, third line “rescue,” and sequential therapies for resistant cases. Subsequently, new antibiotic combinations with proton-pump inhibitors and bismuth salts are being studied in the last decade, to find out the antibiotics that are capable of increasing the eradication rates. Some of these antibiotics include Levofloxacin, Doxycycline, Rifaximin, Rifampicin, Furazolidone based therapies. Studies are ongoing to determine the efficacy of Lactoferrin based therapy.

A survey of neonatal tetanus at a district general hospital in north-east Nigeria

Neonatal tetanus (NNT) remains among the leading causes of morbidity and mortality in Nigeria and a huge challenge in achieving the fourth goal of the Millennium Development Goals. We reviewed the morbidity and mortality pattern among neonates with NNT admitted to the District General Hospital in north-east Nigeria from 2006 to 2009. Half of the patients were from rural areas and were delivered at home by untrained traditional birth attendants with no prior antenatal health care. Razor blades and scissors were the instruments used to cut the cord in nonhygienic conditions. Spasticity, lack of sucking, trismus, fever, omphalitis, risus sardonicus and opisthotonus were the most common presenting signs and symptoms. Overall, mortality was 56%. Health education of mothers and traditional birth attendants, the promotion of hospital delivery and antenatal tetanus immunization of all pregnant women, particularly in rural areas, are recommended if NNT is to be prevented.

Excessive Daytime Sleepiness and Unintended Sleep Episodes Associated with Parkinson's Disease

This article looks at the issues of excessive daytime sleepiness and unintended sleep episodes in patients with Parkinsons disease (PD) and explores the reasons why patients might suffer from these symptoms, and what steps could be taken to manage them. During the last decade, understanding of sleep/wake regulation has increased. Several brainstem nuclei and their communication pathways in the ascending arousing system through the hypothalamus and thalamus to the cortex play key roles in sleep disorders. Insomnia is the most common sleep disorder in PD patients, and excessive daytime sleepiness is also common. Excessive daytime sleepiness affects up to 50% of PD patients and a growing body of research has established this sleep disturbance as a marker of preclinical and premotor PD. It is a frequent and highly persistent feature in PD, with multifactorial underlying pathophysiology. Both age and disease-related disturbances of sleep-wake regulation contribute to hypersomnia in PD. Treatment with dopamine agonists also contribute to excessive daytime sleepiness. Effective management of sleep disturbances and excessive daytime sleepiness can greatly improve the quality of life for patients with PD.

Risk factors and clinical presentation of hepatitis C virus infection in Nigerians with chronic liver disease.

Chronic liver disease is becoming a major public health problem in Nigeria and hepatitis C virus is becoming a significant causative factor in its aetiology worldwide and in Nigeria. We determined the risk factors and clinical presentation of hepatitis C virus infection in Nigerians with chronic liver disease. A structured interviewer-administered questionnaire was administered in order to determine the risk factors for hepatitis C virus infection and a physical examination was carried out in order to determine the clinical presentation. Ninety patients with clinical, biochemical and sonographic evidence of chronic liver disease and 85 controls without liver disease were studied. Anti-HCV antibodies were detected in 14.4% and 2.4% of patients and controls, respectively (P < 0.05). The main risk factors were scarification, traditional surgery and blood transfusion. Ascites, jaundice, pedal swelling, abdominal distension, hepatomegaly, abdominal pain and splenomegaly were the main presentations.

Fatores associados à tosse seca, tosse produtiva e tosse noturna em adultos jovens na Nigéria

OBJETIVO: Determinar os fatores associados a tosse seca, tosse produtiva e tosse noturna entre jovens adultos na Nigeria. METODOS: Foram avaliados 498 individuos com 20-44 anos de idade em Ilorin, Nigeria, utilizando-se o questionario European Community Respiratory Health Survey (ECRHS), administrado por entrevistadores treinados. RESULTADOS: A tosse noturna apresentou associacoes com asma (OR = 10,87; p 0,05). CONCLUSOES: A prevencao precoce e o tratamento de condicoes associadas a tosse, assim como a modificacao de fatores sociais comumente associados a tosse, sao necessarios a fim de reduzir a morbidade respiratoria.

Prevalence of intestinal parasites in newly diagnosed HIV/AIDS patients in Ilorin, Nigeria

Abstract Background Human immune-deficiency virus/acquired immune-deficiency syndrome predisposes to opportunistic parasitic infestations of the gastrointestinal tract. This study aimed to determine the prevalence of intestinal parasites in newly diagnosed treatment naïve HIV/AIDS patients. Methods This hospital-based cross-sectional study was carried out from December 2010 to June 2011. Questionnaires were administered to 238 HIV/AIDS subjects, and 238 age and sex-matched controls. CD4+ T cell count was carried out on HIV-positive subjects. Stool samples were examined using direct microscopic and modified Ziehl-Neelsen methods. Positivity of intestinal parasites was taken as the presence of worms, oocyst, cyst, ova or larvae in the stool samples. Results Ninety males and 148 females were studied for the HIV-positive and HIV-negative controls respectively. Intestinal parasitic infestation in HIV-positive subjects was 68.5%, and was significantly higher than in the HIV-negative controls 49.2% (P < 0.05). In HIV-positive subjects, Cryptosporidium spp. was the commonest (55.0%) parasite isolated. Others were Cyclospora cayetanensis (41.2%), Isospora belli (3.0%), Entamoeba histolytica (8.4%), Giardia lamblia (3.7%), Ascaris lumbricoides (2.5%), Strongyloides stercoralis (1.7%), Trichuris trichiura (0.8%) and Schistosoma mansoni (0.4%). HIV-positive patients with CD4+ T cell count of less than 200 cells/ul were more at risk of opportunistic parasites compared to the HIV-negative controls. Conclusion The prevalence of intestinal parasites in newly diagnosed HIV/AIDS individuals was high, and its association with CD4+ T cell count was demonstrated. Routine screening for parasitic infestations at diagnosis is indicated to reduce the burden of the disease.