African Journal of Endocrinology and Metabolism

Effect of normal and pre-eclamptic pregnancies on plasma cholinesterase in Nigerian women

AA Osinubi

Background: Pre-eclampsia can be devastating and life-threatening for both mother and baby, particularly in developing countries. It is a major cause of maternal and foetal mortality and morbidity. Early diagnosis and management are very important to the reduction of mortality and morbidity. A sensitive diagnostic and prognostic marker will therefore be of great value. There is paucity of data on the effect of pre-eclamptic pregnancy on plasma cholinesterase activity especially in Nigerians. Objective: Our aim was to determine the changes in plasma cholinesterase concentration in normal and pre-eclamptic pregnancies in Nigerians. Setting: Antenatal Clinic and Prenatal Diagnostic and Therapy Centre in a Tertiary University Teaching Hospital in Lagos. Patients and Methods: Plasma cholinesterase concentration was determined using a colorimetric method in 30 healthy non-pregnant, 30 healthy pregnant, 30 and 27 pregnant women with mild and severe pre-eclampsia, respectively, between 28 and 41 weeks of gestation. Cholinesterase activity was re-assessed 6 weeks postpartum. Results: The mean plasma cholinesterase levels in healthy non-pregnant women, women with normal pregnancy, pregnant women with mild pre-eclampsia and those with severe pre-eclampsia were 3594±1042, 2135±422, 1781±330 and 1630±326 (m/L), respectively. Six weeks postpartum, the mean cholinesterase levels in the normal pregnant, mild eclamptic and severe eclamptic groups were 3212±346, 3157±750 and 2864±700 (/L), respectively. Conclusions: Our study suggests that normal pregnancy, mild and severe pre-eclampsia cause a significant (p< 0.01) reduction in plasma cholinesterase activity compared to non-pregnant state, with the greatest decrease in severe pre-eclamptic pregnancy. This decline does not return to normal non-pregnant state in subjects with severe pre-clampsia within six weeks postpartum. The place of plasma cholinesterase concentration as a diagnostic and prognostic marker in pre-eclamptic and eclamptic pregnancies should be further explored. Keywords: Cholinesterase, Eclampsia, Pre-eclampsia, Pregnancy, Succinylcholine.

Medium-term carbohydrate tolerance improves and then deteriorates with advancing pregnancy in urban Nigerian women

J Olorondu

Background: It has been reported that carbohydrate metabolism does not deteriorate in pregnancy in the African, an observation at variance with general teaching. Objective: To determine the effect of pregnancy on medium term carbohydrate metabolism Methods: Medium term carbohydrate metabolism was evaluated in pregnant and non-pregnant Nigerian women using changes in Glycoted Plasma Proteins (GPP) as a surrogate for medium-term carbohydrate metabolism. Study subjects included women in all three trimesters of pregnancy, a group of non-pregnant women with normal carbohydrate metabolism and another group of women with confirmed diabetes already on treatment but not pregnant. Fasting plasma glucose was determined by the glucose oxidase method while GPP was determined using a modification of the thiobarbituric method with correction for levels of total plasma proteins (TPP). Average values are presented as mean (SD) while relationship between variables were determined using Pearson product moment correlation coefficients. Significance of p values of determinations is set at p <0.05. Results: Women in the various pregnancy trimesters were similar in age and without family or personal history of diabetes mellitus. Fasting plasma glucose (FPG) levels of pregnant women in all trimesters were lower than those of non-pregnant women of similar age. GPP values in the first and second trimesters were lower than non-pregnant women and third trimester pregnant women. GPP was highest in the third trimester of pregnancy even being significantly higher than in the non-pregnant women. Correlation between FPG and GPP was highest and significant in the third semester. Conclusion: FPG levels are poor reflections of the carbohydrate tolerance in pregnancy. Carbohydrate metabolism is enhanced in the first trimester and thereafter deteriorates throughout pregnancy. When using GPP to assess carbohydrate metabolism in pregnancy, correction should be made for the level of total plasma proteins. Carbohydrate metabolism in the African deteriorates with advancing pregnancy. Keywords: Pregnancy, Carbohydrate intolerance, Glycated plasma proteins, Fructosamine, Fasting plasma glucose, Nigeria.

Prevalence of the metabolic syndrome among patients with type 2 diabetes mellitus in Uyo, Nigeria

BC Unadike

Background: The metabolic syndrome is a cluster of risk factors that is responsible for most of the excess cardiovascular morbidity amongst persons with type 2 Diabetes Mellitus (DM). The metabolic syndrome increases the risk for coronary heart disease and stroke by three-fold with a marked increase in cardiovascular mortality. Objectives: This study set out to find the prevalence of the metabolic syndrome amongst type 2 diabetes mellitus patients and the commonest metabolic abnormalities in them in Uyo, South-South Nigeria. Subjects and Methods: A prospective cross sectional study carried out at the diabetes clinic of the University of Uyo Teaching Hospital, between January and August, 2008. Data obtained included anthropometric indices, blood pressure and fasting serum lipids. Data was analyzed using SPSS version 10. Results: Two hundred and forty subjects (106 males, 134 females) were enrolled for the study. The prevalence of metabolic syndrome was 62.5%. . Majority of the subjects with metabolic syndrome were aged between 41-70 years with a mean age of. 53±7years. Hypertension was the most common metabolic abnormality present in 130 (86.6%) of the subjects with metabolic syndrome, while low high density lipoprotein (HDL) was the least common abnormality present in 26 (17.3%) of the subjects with metabolic syndrome. Two metabolic abnormalities were present in 114 (76%) of the subjects, while four abnormalities were present in 4 (2.6%) of the subjects with metabolic syndrome. Conclusion: The prevalence of metabolic syndrome in type 2 DM patients in Uyo, South-South of Nigeria is high. With the cardiovascular risk associated with this syndrome, efforts must be geared towards addressing these abnormalities through lifestyle modification, health awareness and medications in order to reduce this complication in type 2 DM patients. Keywords: Metabolic syndrome, Type 2 DM, Uyo.

Prevalence of the metabolic syndrome among patients with type 2 diabetes mellitus in urban North-Central Nigeria.

FH Puepet

Background: In most people with glucose intolerance or type 2 diabetes mellitus (DM), there is a multiple set of risk factors that commonly appear together forming what is now known as the ‘Metabolic Syndrome’ (MS). This ‘clustering’ of metabolic abnormalities that occur in the same individual appear to confer substantial additional cardiovascular risk. There has been no report on the MS among patients with type 2 DM in urban North-central Nigeria. Objective: The objective of this study was to determine the prevalence of the MS among urban North-central Nigerians with type 2 DM and to describe the frequency of the syndrome’s components. Methods: Six hundred and thirty four (634) patients with type 2 diabetes attending the out-patient clinic of the Diabetes Screening and Care Centre, Jos, Nigeria were screened for the MS. A brief history was obtained and their anthropometric indices and blood pressure were measured. Fasting venous plasma samples were analyzed for lipids. Early morning spot urine samples were obtained for estimation of microalbuminuria using the Bayer DCA 2000® machine. The diagnosis of MS was made based on the new International Diabetes Federation (IDF) definition. Results: Of the 634 patients enrolled with mean (standard deviation/SD) age 54.2(9.1) years, 56% were females. The prevalence of MS was 63.6% (74.5% in males and 54.9% in females, p<0.05). The mean (SD) age of patients with MS was 54.7(9.5) years. About 80% of the patients were centrally obese, 63% had hypertension, 62% had high triglycerides and 70% with low HDL-Chol. Among patients with MS, 79% had dyslipidaemia, 41% had BMI e”30, and 36% had microalbuminuria. Conclusion: The prevalence of the MS in this group of upland Nigerian patients with type 2 diabetes is moderately high. This probably reflects the adoption of Western lifestyles and diets that require intervention. Keywords: Prevalence, Metabolic syndrome, Diabetes

Review: Environmental endocrine disruptors of testicular function

LC Saalu

In the last 50 years the incidence of infertility, testicular and prostate cancers and associated maladies has increased significantly. Infertility now affects 15-20% of couples as opposed to 7-8% fifty years ago. Average sperm counts among adult men have decreased by 50% since 1938, with a decline of 2% every year from 1973. This decline in male reproductive health has been linked to an increased presence in the environment of chemical contaminants in the form of pesticides and plastics. Rapid and unplanned industrialization caused large amounts of these synthetic compounds and their by-products to be released in the environment (air, soil, water and food). studies have shown that occupational exposure to pesticides caused neonatal deaths, congenital defects, testicular dysfunction and male infertility. Many of these chemicals found in our environment and households have oestrogenic properties (“xenoestrogens”) and are toxic because they affect the endocrine system (“endocrine disruptors”). Evidence of the health hazards of endocrine disrupting chemicals continues to mount. In terms of male fertility, it now seems that these ubiquitous chemicals are a significant threat at various stages, from testicular development to sperm production to the functionality of healthy sperm. This class of chemicals appears to be threatening male fertility on several fronts. That endocrine disruptors abound in our environment is not in doubt. Clinicians and other health practitioners confronted with the challenges of managing male infertility should attempt to identify the aetiology of a possible exposure to endocrine disruptors, and initiate a plan to control and prevent exposure to others. In addition, concerted efforts should be made by both government and non-governmental agencies to institute local studies that will assess local endocrine disruptors, degree of contamination, level of exposure and proffer control and preventive measures. Emphasis should be placed on establishment of chemical screening and testing program, research into dose and vulnerable periods, institution of surveillance of disease incidence, improvement of exposure monitoring, and educating community leaders and the public in general. Keywords: Endocrine disrupt ors, testis, testosterone, environment, infertility, peticides.