Comparative performance of HbA1c 6.5% for FPG ≥7.0 vs 2hr PG≥11.1 criteria for diagnosis of type 2 diabetes

Background

International expert committee on the use of HbA1c to diagnose diabetes mellitus in 2009 and World Health Organization (WHO) in 2011 has advocated the use of HbA1c to diagnose diabetes mellitus.

Objective

To determine and compare the relationship between the new cut off value of HbA1c with established criteria.

Methods

Thirty-one hypertensive subjects attending Lagos University Teaching Hospital were recruited for HbA1c and standard oral glucose tolerance test. Fasting plasma glucose (FPG) and two-hour plasma glucose (2hrpp) value of e”126mg/ dl and ≥200mg/dl were used as standard respectively for diagnosis of diabetes. The HbA1c of e”6.5% was used to diagnose diabetes. The performance and correlation of HbA1c with FPG and 2hrpp were calculated and results were compared.

Results

Mean age of the subjects was 53.97±6.27years. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), efficiency and correlation of FPG is 50%, 68%, 27%, 85%, 64% and 0.5 respectively while the sensitivity, specificity, PPV, NPV, efficiency and correlation of 2hrpp is 73.91%, 62.5%,85%, 41.66%, 70.97% and 0.73% respectively. There was a significant difference between FPG and 2hrpp interms of sensitivity, PPV and NPV.

Conclusion

The results of HbA1c with 2hrpp has better correlation, sensitivity, and PPV compared to HbA1c with FPG.     

The epigastric heteropagus conjoined twins

Conjoined twins are rare and are classified as symmetrical or asymmetrical, in which a member, the host (autosite), is near normal and bears the parasite, which is incomplete, smaller, and fully dependent for growth on it. This form of conjoined twins is referred to as heteropagus and when attached to the epigastrium of the autosite is called epigastric heteropagus. Only 44 cases of epigastric heteropagus twins have been previously reported in the world literature. We hereby report the successful separation of a pair of heteropagus twins.     

Positron emission tomography shows that intrathecal leptin reaches the hypothalamus in baboons

Human obesity may be caused by a resistance to circulating leptin. Evidence from rodents and humans suggests that a major component of this resistance is an impairment in the ability of the blood-brain barrier (BBB) to transport leptin from the blood to the brain. One potential way to bypass the BBB is by administering leptin into the intrathecal (i.t.) space. To be effective, i.t. leptin would have to move caudally from the site of injection, enter the cranium, and reach the hypothalamic arcuate nucleus at the base of the pituitary fossa. However, many substances, especially small, lipid-soluble molecules, do not diffuse far from the site of i.t. injection but are resorbed back into blood. To determine whether i.t. leptin can move caudally, we injected leptin conjugated to diethylenetriaminepentaacetic acid (DTPA) and labeled with (68)Ga (G-Ob) into the lumbar space of three baboons. We also studied unconjugated DTPA labeled with (68)Ga, which did not move up the spinal cord but rapidly appeared in blood after i.t. injection. In contrast, G-Ob steadily moved toward the cranium and had reached the hypothalamus 91 and 139 min after i.t. injection in two baboons. We estimated the concentration of leptin in the hypothalamic region to be at least 8 ng/ml, which is about 40 times higher than cerebrospinal fluid levels in normal weight humans and about 4 times higher than the highest level ever recorded after the peripheral administration of leptin. In a third baboon, the leptin neither moved caudally nor appeared in the blood. We conclude that leptin administered i.t. can reach the hypothalamus in therapeutic concentrations, although there is considerable individual variation.     

The epidemiology of trachoma in Eastern Equatoria and Upper Nile States, southern Sudan

OBJECTIVE: Limited surveys and anecdotal data indicate that trachoma is endemic in the states of Eastern Equatoria and Upper Nile in southern Sudan. However, its magnitude and geographical distribution are largely unknown. We conducted surveys to ascertain the prevalence and geographical distribution of trachoma, and to identify targets for control interventions. METHODS: Population-based cross-sectional surveys were conducted in nine sites in southern Sudan between September 2001 and June 2004. Two-stage random cluster sampling with probability proportional to size was used to select the sample. Trachoma grading was done using the WHO simplified grading system. FINDINGS: A total of 17 016 persons were examined, a response rate of 86.1% of the enumerated population. Prevalence of signs of active trachoma in children aged 1-9 years was: TF=53.7% (95% confidence interval (CI)=52.1-55.3); TI=42.7% (95% CI=41.2-44.2); TF and/or TI=64.1% (95% CI=62.5-65.5). Prevalence of trichiasis (TT) in children aged less than 15 years was 1.2% (95% CI=0.9-1.4), while TT prevalence in persons aged 15 years and above was 9.2% (95% CI=8.6-9.9). Women were more likely to have trichiasis compared to men (odds ratio (OR)=1.57; 95% CI=1.34-1.84). Tentative extrapolation to the states of Eastern Equatoria and Upper Nile estimates that there is a backlog of 178,250 (lower and upper bounds=156,027-205,995) persons requiring surgery and the entire population, estimated to be over 3.9 million, is in need of the SAFE strategy to control blinding trachoma. CONCLUSION: Trachoma is a public health problem in all nine of the study sites surveyed. The unusually high prevalence of active trachoma and TT in children points to the severity of the problem. There is urgent need to implement trachoma control interventions in trachoma endemic regions of southern Sudan.     

Coagulation protein function: enhancement of the anticoagulant effect of acetaldehyde by sulfated glycosaminoglycans

In view of the increased anticoagulant effect of acetaldehyde-treated heparin, other glycosaminoglycans (GAGs) such as chondroitin sulfates A and C, dermatan sulfate (chondroitin sulfate B), heparan sulfate, and hyaluronic acid were tested for anticoagulant activity before and after exposure to acetaldehyde. Clotting times of human plasma Ci-Trol coagulation control, level I (Baxter Healthcare Corp.), were tested in the presence of 1.8, 3.0, 3.6, or 4.5 g heparin (0.32, 0.54, 0.64, 0.81 units heparin). Additionally, 9, 27, or 90 g of chondroitin sulfates A, B, or C was utilized in lieu of heparin. The effects of 2 g heparin (0.36 units), chondroitin sulfates A, B, and C, (20 g each), 2 g heparan sulfate, and 2 g hyaluronic acid, respectively, in the presence of 44.7 mM acetaldehyde on the clotting time of plasma were studied. It was observed that chondroitin sulfate B (dermatan sulfate) prolonged the clotting time of plasma, although to a lesser extent than heparin. Chondroitin sulfates A and C, heparan sulfate, and hyaluronic acid did not prolong clotting time. However, pretreatment of all the sulfated GAGs with acetaldehyde gave products that enhanced the anticoagulant effect of acetaldehyde, notwithstanding the lack of anticoagulant effect of the GAGs. In contrast, hyaluronic acid exhibited no effect upon clotting time nor did its acetaldehyde-treated product. Furthermore, ethanol exhibited no effect upon the clotting times of the GAG–plasma mixtures. These results suggest that sulfated GAGs may be modified by acetaldehyde, a component of plasma in chronic alcoholics, and that the resultant products may contribute to the prolonged clotting times.     

Accidentally discovered large metallic intra-orbital foreign body

A 6.2 cm long and 2.7 cm thick metallic foreign body was accidentally found and removed from a 62 years old man. He was sent to a minor operation theater for repair of left lower lid laceration secondary to trauma after a fight. Subsequent investigation, management, patient follow-up and outcome are discussed. Importance of careful history taking, thorough physical examination and proper investigations are stressed.     

A randomized clinical trial of the success rates of bilamellar tarsal rotation and tarsotomy for upper eyelid trachomatous trichiasis

A randomized clinical trial study was conducted to compare the success rates of two surgical methods: Bilamellar Tarsal Rotation (BTR) and Tarsotomy (Transverse Tarsotomy and lid margin Rotation = TTR) for trachomatous trichiasis of the upper lid; where success was defined as no lash/eyeball contact in all positions of gaze, complete lid closure, no under or over correction. The study was conducted at Minellik II Hospital, Addis Ababa. Two hundred fifty six upper eyelids of 153 patients with entropion/trichiasis related to trachoma were enrolled in the two groups. Patients were randomly allocated for the BTR (124) and TTR (132) procedures. Out of these, 237 (92.6%) came for the third month follow-up. One hundred fifteen (48.5%) lids underwent BTR and the remaining 122 (51.5%) underwent TTR. In total, from 141 patients who came for the last follow up, 109 (77.3%) were females. BTR procedure was found to be successful in 25 (86.2%) of the eyelids with minor trichiasis and 74 (86.0%) of those with major trichiasis; the difference between patients who had had minor and major trichiasis (X2 = 0.08, P = 0.772) was not statistically significant. TTR was successful in 39 (95.1%) of the eyelids with minor trichiasis and 68 (84.0%) of those with major trichiasis, again no statistically significant difference was observed for minor and major trichiasis (X2 = 3.15, P = 0.379). There was no statistically significant difference in recurrence between BTR and TTR (X2 = 0.14, P = 0.711). Complications such as lid-notching, pyogenic granuloma, etc. were observed more in BTR than in TTR and this was statistically significant (X2 = 9.54, P = 0.002). In conclusion, the results show that TTR is equally successful in minor and major trichiasis and has fewer complications than BTR at three months of follow-up.     

Uncomplicated malaria in children: The place of rapid diagnostic test

Background:

Malaria has remained a major cause of morbidity and mortality among the under-five children in Nigeria. Prompt and accurate diagnosis of malaria is necessary in controlling this high burden and preventing unnecessary use of anti-malarial drugs. Malaria rapid diagnostic test (MRDT) offers the hope of achieving this goal. However, the performance of these kits among the most vulnerable age group to malaria is inadequate.

Materials and Methods:

In this cross-sectional study, 433 out-patients, aged <5 years with fever or history of fever were enrolled. Each candidate was tested for malaria parasitaemia using ACON; malaria pf. Thick and thin films were also prepared from the same finger prick blood for each candidate.

Result:

Malaria rapid diagnostic test had sensitivity of 8.3%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 74%. The sensitivity of MRDT increased with increasing age. This effect of age on sensitivity was statistically significant (P = 0.007). Similarly parasite density had significant effect on the sensitivity of MRDT (P = <0.001).

Conclusion:

Histidine-rich protein-2 based MRDT is not a reliable mean of diagnosing malaria in the under-five age children with acute uncomplicated malaria.