Journal of Endocrinology, Metabolism and Diabetes of South Africa

Editorial

Jeff Wing, Nasrin Goolam Mahyoodeen — Thu, 19 Oct 2023 00:00:00 +0000

No Abstract.

Incidence and predictors of diabetes mellitus among severe COVID-19 patients in western Ethiopia: A retrospective cohort study

Thu, 19 Oct 2023 00:00:00 +0000

Background: Evidence reported a high occurrence of diabetes mellitus (DM) during the time of COVID-19. This study aimed to assess the incidence of DM and its predictors among severe COVID-19 patients admitted to the treatment centre of Wollega University Referral Hospital (WURH), western Ethiopia.

Methods: A facility-based retrospective cohort study was conducted among severe COVID-19 patients diagnosed using the rRT-PCR from September 30, 2020, to June 10, 2021. EpiData version 3.2 was used for data entry, and STATA version 14 for analysis. A Cox proportional hazard regression analysis was used to determine factors associated with DM. A multivariable Cox regression model with 95% CI and adjusted hazard ratio (AHR) was used to identify a significant predictor of the incidence of DM at p-value < 0.05.

Results: A total of 304 patient cards with complete data were included in the final analysis. The mean age of the participants was 43.3 (SD ± 16.9) years. Of the total 304 patients admitted with severe COVID-19, 14.5% were newly diagnosed with DM with an overall incidence rate of 13.7 per 1 000 person days’ observation (PDO). The median time to occurrence of DM was 11 days (95% CI 7, 13) days. Age > 41 years (AHR = 2.54, 95% CI 1.15, 5.57), living in urban (AHR = 2.49, 95% CI 1.12, 5.52) and loss of appetite (AHR = 2.24, 95% CI 1.16, 4.34) increased the hazard of DM incidence, while presenting to the health facility after two days of clinical manifestation (AHR = 0.49, 95% CI 0.23, 0.96) decreased the risk of developing DM.

Conclusions: The incidence rate of DM among patients admitted with severe COVID-19 in the study area was found to be 13.7 per 1 000 person days’ observation. Higher age, urban residence, early presentation to a health facility and loss of appetite were independent predictors of DM incidence. Therefore, we recommend early detection of DM and frequent monitoring of blood glucose for patients diagnosed with COVID-19.

Comparison of formulae for calculating the corrected QT (QTc) interval in an adult population attending a diabetes clinic at a rural hospital in South Africa

B.N. Mkhwanazi, L. Govender, S. Pillay — Thu, 19 Oct 2023 00:00:00 +0000

Background: A prolonged corrected QT (QTc) interval on the electrocardiograph is an important marker of cardiac autonomic neuropathy and increased risk of developing arrhythmias. Various formulae exist for the calculation of QTc, the most common being Bazett’s, which is also the default formula utilised by the Edan SE® ECG machine to automatically calculate QTc. Little or no literature exists on the comparisons of the various formulae in patients living with diabetes, more especially in those diabetes patients with HIV infection.

Methods: Retrospective (n = 631) electrocardiographs were collected and analysed. QT and RR were measured for QTc calculation. QTc was calculated using three formulae, namely Bazett (QTcB), Fridericia (QTcFri) and Framingham (QTcFram). Additionally, the automated QTc (QTcM), which used Bazett’s formula, was recorded for comparison purposes. To determine the optimal formula for QTc calculation, slopes and r² using a QTc/RR regression analysis were calculated. The formula with the r 2 closest to zero was deemed superior when compared with its counterparts.

Results: The QTc Bazett was the worst-performing formula for QTc calculation, with the QTcFri performing best across both type 2 and type 1 diabetes patients with or without HIV infection. To validate which formula was employed in the automated QTc result, a mean difference comparison was performed, which indicated a non-significant difference between the machine-calculated QTcM and QTcB (p = 0.572, 0.384, 0.980) in all groups except for the type 1 diabetic group without HIV (p = 0.009). These findings indicated that the automated QTc employed Bazett’s formula.

Conclusion: Evidence from this study has shown that the best formula to calculate QTc in patients with DM, with and without HIV infection, is the Fridericia formula. The authors advise that careful consideration should be taken when selecting a formula for QTc calculation. This will improve precision diagnosis and patient care.

Lipid profiles of HIV-infected diabetic patients

Thu, 19 Oct 2023 00:00:00 +0000

Background: Despite highly active antiretroviral therapy (HAART) leading to a decline in human immunodeficiency virus (HIV)-induced morbidity and mortality, in recent years HAART has been implicated in abnormal lipid profiles, diabetes mellitus (DM) and predisposition of patients to cardiovascular disease (CVD).

Objectives: In this comparative study, the side effects of HAART as well as other lifestyle factors such as diet, exercise, alcohol and/or smoking were assessed, as well as family history of diabetes between HIV-infected and HIV- uninfected patients of African ancestry with DM.

Methods: The study population consisted of 80 Black African diabetic patients (18–65 years old) stratified by HIV status (HIVinfected n = 40; HIV-uninfected n = 40). Anthropometric measurements (weight, height and BMI) and blood pressure (BP), as well as biochemical tests for glucose, cholesterol, high-density lipoproteins (HDL), low-density lipoproteins (LDL) and triglycerides were performed.

Results: The median BMI indicated overweight in the HIV-infected compared with the HIV- uninfected, which was congruent with obesity. Systolic BP was higher in the HIV-infected compared with the HIV-uninfected groups, at 138.15 and 134.75 mmHg (p = 0.1651), respectively. Glucose was high in both groups, confirming diabetes (p = 0.3900). Cholesterol was high (4.85 mmol/l) in the HIV-infected group while HDL was lower (0.95 mmol/l) in the HIV-uninfected group. Triglycerides were elevated in the HIV-uninfected (1.90 mmol/l) compared with the HIV-infected (1.61 mmol/l) (p = 0.7500) group.

Conclusion: Despite HAART being documented as a contributor to DM and abnormal lipid profiles in the HIV-infected group, lifestyle factors such as diet also affect obesity phenotype in the uninfected group. Thus, irrespective of DM and/or HIV status, a lack of exercise, behavioural and lifestyle risk factors exacerbate abnormal lipid profiles. Notably, a family history of DM showed a strong susceptibility to its development.

Clinical and ultrasound characteristics distinguishing benign and malignant thyroid nodules in Johannesburg, South Africa

Kershlin Naidu, Victoria Saksenberg, Nasrin Goolam Mahyoodeen — Thu, 19 Oct 2023 00:00:00 +0000

Background: The detection of thyroid nodules is increasingly common in clinical practice owing to the widespread use of ultrasonography.
Objectives: The aims of this study were to describe the clinical and biochemical characteristics of patients undergoing fineneedle aspiration (FNA) of thyroid nodules and to assess the ultrasound, cytologic and, where relevant, histologic features of thyroid nodules in this cohort.
Methods: A retrospective study was conducted of 313 patients undergoing FNA at a private hospital in Johannesburg from October 2015 to July 2019. Demographic, clinical and biochemical data were recorded. Ultrasound features were graded according to the American Thyroid Association (ATA) guidelines and cytology was reported according to the Bethesda System for Reporting Thyroid Cytopathology.
Results: The mean (SD) age of patients in this study was 48.0 (12.7) years and 250 (80.1%) were female. White and Asian/Indian patients made up 79% of the cohort. Cytology results showed the following (n [%]): benign, 272 (86.9); indeterminate, 15 (4.79); suspicious/malignant, 25 (7.99). Sonographic characteristics associated with malignancy were microcalcifications and hypoechogenicity (OR [95% CI], p-value: 3.93 (1.62, 9.53), p = 0.001and 2.34 (1.01, 5.41), p = 0.04, respectively). There was an association with the composite ATA score and malignancy (3.59 [2.06, 6.25], p < 0.0005).
Conclusion: Thyroid ultrasound and FNA are important diagnostic modalities in identifying clinically relevant thyroid nodules. Concordance was shown with the ATA guidelines, Bethesda System for Reporting Thyroid Cytopathology and malignant histology, which validates their accuracy in the local population.

Thyroid paraganglioma – a rare entity

K. Naidu, V. Saksenberg, M.F. Sulimana, B Bhana — Thu, 19 Oct 2023 00:00:00 +0000

No Abstract.

Thyrotoxic periodic paralysis: A presentation of hyperthyroidism increasing in frequency around the world

A.M.M. Ollivry, Z.J. Joubert — Thu, 19 Oct 2023 00:00:00 +0000

Thyrotoxic periodic paralysis (TPP) is a complication of hyperthyroidism commonly seen in Asian populations. It presents as sudden-onset muscle paralysis and hypokalaemia. Diagnosis is often delayed due to the rarity of the disease, the subtlety of the hyperthyroidism and the fleeting nature of the clinical presentation. With global expansion, physicians outside Asia should be aware of this disease for early recognition and treatment as severe cardiac arrhythmias, which may prove fatal, can occur. Several breakthroughs have been made in identifying the pathophysiological mechanism resulting in the severe hypokalaemia, including mutations in the Kir2.6 channel, an inwardly rectifying potassium channel, which results in a massive intracellular potassium shift. Treating the underlying hyperthyroidism is the definitive treatment; however, beta blockers and potassium supplementation are vital in acute management of this condition. This is a report of a case seen in Cape Town, South Africa with a review of the literature regarding the clinical features, pathophysiology and treatment.