Open Access Original Research Article

Reference Interval of Glycated Hemoglobin in Adults in Port Harcourt, Nigeria

Allison Frederick Igila, C. Ojule Aaron

Asian Journal of Medicine and Health, Page 1-6
DOI: 10.9734/ajmah/2019/v16i430148

Background: Measurement of glycated haemoglobin is accepted as the gold standard for the diagnosis and management of diabetes mellitus; but it is rarely used in this environment, a resource-poor setting, largely due to the high cost of the assay. There is need to determine its reference intervals in Port-Harcourt and encourage the use of this assay.

Aim:This study was designed to determine the reference interval of glycated haemoglobin of apparently healthy subjects between the ages of 20-80 years in Port Harcourt, Rivers State, Nigeria.

Methods: A total of 172 subjects who met the inclusion criteria were recruited for the study. A cross sectional sampling method was used to recruit subject. Subjects’ past medical history, demographic and anthropometric information were obtained with the help of a questionnaire. Blood was collected from subjects into an EDTA bottle and analysed for glycated haemoglobin using the boronate affinity chromatographic method.

Results: Results were analyzed using Statistical Package for Social Sciences version 20.0 (SPSS 20.0) and the reference interval was determined by the nonparametric method due to the skewness of the data. The mean age of subjects was 35.4 years and the minimum and maximum glycated haemoglobin value obtained were 3.5% and 6.0% after eliminating outliers. This gave a mean glycated haemoglobin value of 4.84% and a reference interval of 4.0-5.9%.

Conclusion: The reference interval so determined (4.0-5.9%) is different from that generated by the manufacturer of the diagnostic kit(4.0-6.5%). The introduction of this new local reference interval will enhance patient management in our local hospitals.

Open Access Original Research Article

Effects of Selected Antioxidants on Atherosclerosis in Hyperlipidemic Wistar Rats

K. S. Adedapo, S. Adepoju, T. O. Olusanya

Asian Journal of Medicine and Health, Page 1-8
DOI: 10.9734/ajmah/2019/v16i430150

The interplay of hyperlipidemia and oxidative stress in atherosclerosis has been fairly established by previous studies. There remains however, paucity of data in this environment on the direct effects of antioxidants on atherosclerosis. This study therefore aimed at determining the protective effects of EDTA, vitamin C and Vitamin E on atherosclerosis in diet induced heperlipidemic wister rats.

Thirty Wister rats were investigated in this study. The rats were randomly divided into five groups (n=6). The control group was fed with growers mash and water only while group II-V were induced with hyperlipidemic diet for ten weeks. In addition to the hyperlipidemic diet; group III received 1 g/kg body weight of EDTA, group IV received 1 g/kg body weight of vitamin C, group V received 1 g/kg body weight of vitamin E, and group VI received EDTA, vitamin C and E. The group’s treatments were orally for two weeks. C-reactive protein, Total cholesterol (TC), Triglyceride (TG), HDL-cholesterol, LDL-cholesterol, Total calcium and Total antioxidant status were analyzed using standard methods after the treatments.

The study showed significant effect in the use of EDTA, Vitamin C and Vitamin E in the treatment of atherosclerosis in rats which could be due to their antioxidant and anti-hyperlipidemic properties. Therefore the combinations EDTA, vitamin C and vitamin E appear greatly protective against atherosclerosis.

Open Access Original Research Article

Evaluation of Fluid Therapy by Point-of-Care Ultrasound in Hyperglycemic Emergencies

Serkan Dogan, Utku Murat Kalafat, Busra Bildik, Ramazan Guven, Dogac Niyazi Ozucelik, Melis Dorter, Basar Cander

Asian Journal of Medicine and Health, Page 1-10
DOI: 10.9734/ajmah/2019/v16i430151

Aim: Diabetic ketoacidosis (DKA) and Hyperosmolar hyperglycemic state (HHS) are among the cases where total body fluid deficit is high. Although it is known that dehydration is one of the main determinants of mortality and morbidity, it is difficult to determine and follow up fluid treatment in patients with multiple comorbidities. Measurement of the respiratory variability of the vena cava inferior diameter and vena cava inferior / aortic diameter measurement can be performed easily and quickly at the bedside and have a high objectivity compared to physical examination. In this study, we evaluated the follow-up of fluid therapy by POCUS with vena cava inferior diameter and vena cava inferior diameter / abdominal aortic diameter ratio in patients presenting with hyperglycemic emergencies (DKA, HHS, severe hyperglycemia).

Methodology: 56 patients diagnosed with severe hyperglycemia, DKA and HHS according to the American Diabetes Association (ADA) diagnostic criteria were included in the study. Vital signs, laboratory tests(venous blood gas analysis, complete urinalysis, osmolarity, fingertip blood glucose level), fluid volume and bedside ultrasonographic measurements [vena cava inferior inspiration and expiration (iVCI and eVCI) diameter,vena cava inferior colapsiability index (VCI index), abdominal aorta diameter and ratio of vena cava inferior to abdominal aorta diameter (VCI/Ao)] were recorded.

Results: Of the 56 patients, 21.4% were diagnosed with DKA 8.9%, HHS and 69.6% with severe hyperglycemia. There was a significant difference in osmolarity and although pH values ​​were not statistically significant, it tended to improve with the amount of fluid given. There was a significant difference in iVCI, VCI index and VCI/Ao.

Conclusion: We believe that planning and monitoring fluid treatment with bedside ultrasonographic VCI diameter and VCI/Ao ratio measurements will reduce the undesirable complications, the intensity of emergency services, long waiting time and follow-up periods and will contribute to patient benefit and emergency departments.

Open Access Original Research Article

Effect of Different Anti-Coagulants on the Accuracy of Glycated Haemoglobin Results

Frederick Igila Allison, Duru Ugochukwu Stephen

Asian Journal of Medicine and Health, Page 1-5
DOI: 10.9734/ajmah/2019/v16i430152

Background: Most manufacturers of glycated haemoglobin kits advocate for the use of EDTA bottles for sample collection. Other manufacturers even when using the same glycated haemoglobin assay method, advocate for the use of any of these anticoagulant: EDTA, heparin and fluoride oxalate as any of these anticoagulants for sample collection.

Aim: This study was therefore designed to evaluate the effect of different anticoagulants on the accuracy of glycated haemoglobin value using the same method.

Methods: Thirty subjects were selected by purposive sampling method and 2ml of blood was collected from each subject into sodium heparin, EDTA and fluoride oxalate bottles and stored for three days at 4ºC. Fifteen subjects’ samples were analysed daily for the next two days then all the samples were analysed on the third day. All samples were analysed using the boronate affinity chromatographic method by Clover.

Results: The mean of the values of glycated haemoglobin of samples for each anticoagulants were about the same for the first, second and third day. The differences in the mean values for each anticoagulant were not statistically significant, indicating fairly good stability.

Conclusion: From this study, it could be concluded that blood sample in EDTA, fluoride oxalate and heparin bottles can be used for glycated haemoglobin estimation without affecting the accuracy of the result. These samples in these containers were found to be stable for at least three days.

Open Access Case Study

Fracture of the Humeral Bone as the First Clinical Presentation of Metastatic Papillary Thyroid Carcinoma in Ibadan

Mustapha Akanji Ajani, Babatope Lanre Awosusi, Ebenezer O. Fatunla, Omolade O. Adegoke, Ayodeji A. Salami

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/ajmah/2019/v16i430149

Papillary thyroid carcinoma is the commonest type of thyroid cancer representing 75 to 85 per cent of all thyroid cancer cases. It is often well-differentiated, slow-growing, and localized, although it can metastasize. This is a case of a 49-year-old male who presented with a pathological fracture of the left humerus. A bone biopsy was done at the surgery which had a histological diagnosis of metastatic thyroid carcinoma. A total thyroidectomy was subsequently done and was histologically reported as a follicular variant of papillary thyroid carcinoma. The patient was clinically stable post-thyroidectomy and was discharged home on the 10th postoperative day and he is currently being followed-up in the surgical outpatient clinic. Pathological fracture as the initial clinical presentation is an unusual manifestation of metastatic thyroid carcinoma; therefore a high index of suspicion is needed to make this diagnosis. In any patient presenting with a pathologic fracture, the possibility of metastatic carcinoma from the thyroid gland should always be considered.