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1.  The metabolic syndrome in thyroid disease: A report from Nigeria 
Background:
The objective of this study was to determine the prevalence of the metabolic syndrome and its components in people with thyroid disorders.
Materials and Methods:
112 subjects with a history of thyroid disorders were consecutively enrolled for the study. Clinical data were obtained by interviewing the patients and referring to their case folders and prescriptions. The subjects were categorized into three: thyrotoxic, those with hypothyroidism and those with nontoxic goiters, based on clinical parameters and or thyroid function tests. The study subjects were weighed and their anthropometric indices were documented. The laboratory parameters that were analyzed included total cholesterol, high-density and low-density cholesterol and triglyceride. Statistical analysis was performed using Student's t test, one-way analysis of variance (ANOVA) test and chi-square test.
Results:
The study subjects were aged between 14 and 76 years, with a mean age of 44.5 years, and the female:male ratio was 97:15. The mean age and anthropometric indices were comparable in subjects with thyrotoxicosis, hypothyroidism and euthyroidism. The overall prevalence of the metabolic syndrome was 28% and the frequency of occurrence of the metabolic syndrome in subjects with thyrotoxicosis, hypothyroidism and nontoxic goiter was 24%, 40% and 42%, respectively. The commonest occurring metabolic syndrome defining criterion was dysglycemia, while hypertension and elevated triglyceride were the least documented of the criteria.
Conclusion:
Metabolic syndrome occurs in 1 in every 4 persons with thyroid disorders, and as such, routine screening for this cardiovascular risk factor may be of benefit in this group of people, especially in those with hypothyroidism.
doi:10.4103/2230-8210.95688
PMCID: PMC3354852  PMID: 22629511
Metabolic syndrome; Nigeria; thyroid
2.  Insulin use, prescription patterns, regimens and costs.-a narrative from a developing country 
Background
Achieving good glycemic control is of paramount importance in the reduction of diabetes mellitus (DM) associated morbidity and mortality. Insulin plays a key role in the management of DM but unfortunately whilst some healthcare providers present insulin as a treatment of last resort , patients on insulin often have insulin related issues such as needle phobias, fear of hypoglycaemia, weight gain and in developing countries, costs. This Report aims at assessing insulin prescription pattern, insulin costs and issues associated with adherence.
Methods
This was a Cross-sectional observation Study whereby 160 patients with DM who were on insulin solely or in combination with oral hypoglycaemic agents were recruited over a 6 month period. Information obtained from the Study subjects pertained to their histories of DM, types of insulin, insulin costs, adherence issues and insulin delivery devices. Long and short term glycaemic control were determined and evaluated for possible relation to insulin adherence. Test statistics used were chi square, t test and binary regression.
Results
Insulin adherence was noted in 123-77% of the Study subjects and this was comparable between persons with type 1 DM and those with type 2 DM. The mean glycosylated haemoglobin values were significantly higher in those who admitted to non insulin adherence compared to those who adhered to their insulin regimen (9.7% (2.3) Vs 8.6% (2.1), p = 0.01). Reasons proffered by Respondents for non insulin adherence included high costs-15(41%), inconvenience −15 (41%) and needle pain-79)18%. A greater proportion of persons who self injected insulin adhered to insulin prescriptions compared to those who did not self inject and thus had better glycaemic control. Shorter duration of DM and older age were found to be predictors of adherence to insulin prescription.
The monthly mean costs of insulin for those who earned an income was 5212.8 Nigerian naira which is equivalent to 33.1 US dollars and we estimated that persons on a minimum wage would spend 29% of their monthly income on the procurement of insulin.
Conclusions
Health related costs, age, duration of DM and insulin associated side effects are some of the factors implicated in adherence to insulin prescription.
doi:10.1186/1758-5996-4-50
PMCID: PMC3538575  PMID: 23199230
3.  Latent Autoimmune Diabetes Mellitus in Adults (LADA) and it’s characteristics in a subset of Nigerians initially managed for type 2 diabetes 
Introduction
Latent autoimmune diabetes in adults (LADA) is an entity characterized by the presence of GAD autoantibodies. LADA is largely understudied and underreported amongst Nigerians with Diabetes Mellitus (DM). We undertook to document the Prevalence, clinical and biochemical characteristics of LADA in a subset of Nigerians who hitherto had been treated for type 2 DM.
Methods
This is a cross-sectional study conducted on 235 patients being managed for type 2 DM. The diagnosis of LADA was made in the presence of Glutamic Acid Decarboxylase autoantibody (GADA) positivity in the study subjects. Thereafter persons with LADA were compared with those without LADA. Clinical parameters such as demographic data, history of diabetes mellitus (DM) and its complications were obtained, biochemical parameters including Fasting blood glucose (FBG), C-peptide, glycated haemoglobin (HbA1c) and lipid parameters were compared in both groups of Study subject. Test statistics used were Student t- test and χ 2. SPSS was used for data analysis.
Results
Thirty three out of 235 of the Study subjects were GADA positive, giving a prevalence of 14%. The mean age (SD) of the subjects with LADA is 53.24(7.22) with an age range of 30–63 years. Majority (48%) of LADA subjects were in the 50–59 age category. There was no significant difference in the proportion of males and females with LADA (p = 0.3). 37% of patients with LADA were on insulin for glycaemic control. Three (3) LADA subjects had history/clinical evidence of autoimmune thyroid disease. 66% of LADA were in the overweight/obese category. LADA subjects had significant poor long term glycaemic control compared with anti-GAD negative subjects (p = 0.026). About half of LADA subjects were insulinopaenic. LADA subjects had lower levels of total cholesterol than GADA-ve subjects (p = 0.03). A higher proportion of LADA had evidence of microvascular complications of DM compared with antiGAD negative individuals.
Conclusion
The diagnosis of LADA should be entertained in overweight/obese persons from the fourth decade of life presenting with DM. Pharmacotherapy with insulin is a potential means of managing hyperglycaemia in this group of patients especially since a significant proportion are insulinopaenic. The Prevalence of LADA in our patients is comparable to what obtains in Ghanaian and Caucasian populations.
doi:10.1186/1755-7682-5-23
PMCID: PMC3464687  PMID: 22894705
LADA; Prevalence; Complications; Nigerians
4.  Understanding asthma and the metabolic syndrome - a Nigerian report 
Introduction
Nigeria is a developing country that is currently witnessing an upsurge in diabetes mellitus and obesity with its antecedent consequences. There is also a fairly high prevalence of asthma affecting an estimated 10.7% of the population. There is no data presently on the possible presence of metabolic syndrome in Nigerian living with asthma. The study was conceived to determine the prevalence of metabolic syndrome among a population of asthmatics seen in our practice. We also attempt to compare asthma severity, control and pulmonary function tests in asthmatics with metabolic syndrome and those without.
Methodology
This cross-sectional study was carried out at the asthma clinic of a tertiary teaching hospital. Ethical clearance was obtained from the research and ethics committee of the hospital. Written consent was obtained from the participants. Interviewer based questionnaire was used to obtain required information, anthropometric indices were recorded and clinical examinations done. Pulmonary function tests were carried out using desktop Alpha Spirometer model 6000 made by Vitalograph UK (2007). Blood pressure was measured using sphygmomanometer in mmHg. Fasting venous blood was taken for blood sugar and lipid profile. Metabolic syndrome was defined by the international diabetes Federation (IDF) criteria.
Result
One hundred and fifty eight (158) asthmatics participated in the study comprising of 63 (39.9%) males and 95(60.1%) females. The age range was 14-78 years with a mean of 46.48+/-17.00 years. The mean duration of asthma diagnosis was 13.95+/-12.14 years. The prevalence of hypertension was 29.1%. 17 (10.8%) had fasting blood sugar above 100 mg/dl. Abdominal obesity was present in 78 (49.5%). The mean total cholesterol was 192.63+/-40.7 mg/dl. HDL was low in 21(22%) of female and 3 (4.8%) male. The prevalence of metabolic syndrome was 17.7%, affecting 28 asthma patients. Asthma control was affected by the presence of metabolic syndrome. P < 0.05. The pulmonary function test was not significantly affected by presence of metabolic syndrome.
Conclusion
Metabolic syndrome prevalence is high in the population of asthma patients studied. It is therefore important to screen patient with asthma for this condition and treat to improve outcome.
doi:10.1186/1755-7682-5-20
PMCID: PMC3499319  PMID: 22726248

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