Ofem Enang

Prevalence of dysglycemia in Calabar: a cross-sectional observational study among residents of Calabar, Nigeria

Objective Population data on dysglycemia are scarce in West Africa. This study aimed to determine the pattern of dysglycemia in Calabar city in South East Nigeria. Design This was a cross-sectional observational study. Methods 1134 adults in Calabar were recruited. A multistage sampling method randomly selected 4 out of 22 wards, and 50 households from each ward. All adults within each household were recruited and an oral glucose tolerance test was performed. Dysglycemia was defined as any form of glucose intolerance, including: impaired fasting glucose (blood glucose level 110–125 mg/dL), impaired glucose tolerance (blood glucose level ≥140 mg/dL 2 h after consuming 75 g of glucose), or diabetes mellitus (DM), as defined by fasting glucose level ≥126 mg/dL, or a blood glucose level ≥200 mg/dL, 2 h after a 75 g glucose load. Results Mean values of fasting plasma glucose were 95 mg/dL (95% CI 92.1 to 97.5) for men and 96 mg/dL (95% CI 93.2 to 98.6) for women. The overall prevalence of dysglycemia was 24%. The prevalence of impaired fasting glucose was 9%, the prevalence of impaired glucose tolerance 20%, and the prevalence of undiagnosed DM 7%. All values were a few percentage points higher for men than women. Conclusions The prevalence of undiagnosed DM among residents of Calabar is similar to studies elsewhere in Nigeria but much higher than the previous national prevalence survey, with close to a quarter of the adults having dysglycemia and 7% having undiagnosed DM. This is a serious public health problem requiring a programme of mass education and case identification and management in all health facilities. Trial registration number CRS/MH/CR-HREC/020/Vol.8/43

Profile, Bacteriology, and Risk Factors for Foot Ulcers among Diabetics in a Tertiary Hospital in Calabar, Nigeria

Diabetic foot disease is a major medical, social, and economic problem. This retrospective study assessed the profile of diabetes mellitus patients with foot ulcers in the University of Calabar Teaching Hospital (UCTH), Nigeria. Admission records of all patients admitted unto the medical wards of UCTH over a 5 year period were analysed. The records of diabetic patients were retrieved. Data on patient characteristics and possible risk factors for diabetes mellitus foot ulcers was extracted. Of the 3,882 patients admitted, 297 (7%) were on account of complications of diabetes mellitus. Foot ulcers accounted for 63 (21.2%) of all diabetic admissions. The elderly constituted the majority of patients admitted with foot ulcers. The average duration of stay of diabetics with foot ulcers was 38.5 days. Diabetics admitted for other conditions had average duration of admission of 15.8 days. Staphylococcus aureus was the commonest organism isolated from swabs of foot ulcers. Most of the organisms identified from ulcer swab cultures were sensitive to quinolones and resistant to penicillins. These diabetic foot ulcers were significantly associated with peripheral sensory neuropathy, peripheral vascular disease, intermittent claudication, and walking barefoot. An effective diabetes foot programme is required to address these risk factors and reverse the current trend.

Haemoptysis in a female with diabetes mellitus: a unique presentation of chronic pulmonary aspergillosis, pulmonary tuberculosis, and Klebsiella peumoniae co‐infection

While chronic pulmonary aspergillosis (CPA), pulmonary tuberculosis (PTB), and Klebsiella pneumoniae pneumonia co‐infection is rare, we present a 50‐year‐old woman with uncontrolled diabetes who presented with these three diseases. There is considerable overlap in symptoms of PTB and CPA. Treatment with antifungals, anti‐tuberculosis therapy, and antibiotics is beneficial.

Performance of waist circumference and proposed cutoff levels for defining overweight and obesity in Nigerians

Background: Waist circumference (WC) is a simple tool for measuring central obesity in routine clinic settings. Gender- and ethnic-specific optimal cutoff points for WC are encouraged for populations lacking such data. Objectives: To derive WC cutoff values, predictive of overweight and obesity in Nigerians and to evaluate the performance of currently recommended values. Subjects and Methods: Apparently, healthy urban dwellers from six cities spread across Nigeria were selected for this cross-sectional study. Biophysical profiles such as blood pressure and anthropometric indices were measured according to the World Health Organizations STEPs instrument protocol. Receiver operating characteristics curve analysis was used to determine the optimal cutoff levels using the decision rule of maximum (sensitivity + specificity). The level of significance was set at P < 0.05. Results: A total of 6089 subjects (3234 males and 2855 females) were recruited for the study. WC demonstrated a high area under the curve in both genders. Selected cutoff points ranged from 83 to 96 cm with high sensitivities and specificities. Conclusions: The currently recommended gender-specific WC cutoff values proved inappropriate in this study group, but WC remains a reliable tool for measuring obesity.