10-Year Risk of Developing Type 2 Diabetes Mellitus: A Survey of Rural Communities in Southern Nigeria

BACKGROUND

The exponential rise in the prevalence of Type 2 Diabetes (T2DM) necessitates the introduction of strategies for early diagnosis to reduce the burden of the disease. This study assessed the prevalence of prediabetes and also determined the 10-year risk of developing T2DM in Southern Nigerian rural communities by adopting the validated Finnish Diabetes Risk Score (FINDRISC) tool.

METHODS

273 participants from 3 Southern rural communities aged 18 years and older were recruited in this cross-sectional study. Data in the FINDRISC stratification tool and Random Blood Glucose (RBG) variables were obtained for the participants. IBM SPSS version 21 was used to analyze the data with a level of significance put at p < 0.05.

RESULTS

The participants' mean age was 54.20±16.61 years. The prevalence of prediabetes among the study participants based on RBG was 4.8% (3.8% of males and 6.6% of females, respectively). Most of the study participants (41%) had a low risk of developing T2DM which meant that 1 in 100 participants would become diabetic in a 10-year period, based on the FINDRISC scale. Amongst the male participants, the Total Diabetes Risk Score (TDRS) showed significant positive correlation with the RBG (r=0.315, p=0.001); similarly, a weak positive correlation between TDRS and RBG was noted among female participants.

CONCLUSION

The propensity of developing T2DM in 10 years was indisputably low amongst rural dwellers in the Southern Nigerian rural communities studied. Further studies to compare the risk of developing T2DM between rural and urban communities would be required.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Predictors and Barriers to Condom Use in the African Cohort Study

Consistent condom use is an inexpensive and efficacious HIV prevention strategy. Understanding factors associated with condom use and barriers to use can inform strategies to increase condom uptake. The ongoing African Cohort Study prospectively enrolls adults at 12 clinical sites in Uganda, Kenya, Tanzania, and Nigeria. At enrollment, participants are asked about condom use at last sex with a regular partner. Robust Poisson regression models were used to evaluate predictors of self-reported condom use. Participants who reported not using condoms were asked to provide reasons. From January 2013 to September 2019, 2482 participants reported having at least one regular sexual partner in the preceding 6 months. Of those, 1577 (63.5%) reported using a condom at last sex. Condom use was more common among older participants, males, HIV-infected participants, and those with an HIV-infected partner. Married participants, those with a partner of unknown HIV status, and those reporting alcohol use were less likely to report condom use at last sex. Condom use at last sex also varied significantly by clinical site. Partner disapproval or refusal to use a condom was a consistent driver of disparities in condom use among participants who were HIV infected, female, and aged 18-24 years. Effective HIV prevention programs should integrate condom education with the tools necessary to negotiate condom use with regular partners.

Molecular screening for Neisseria gonorrhoeae antimicrobial resistance markers in Nigerian men who have sex with men and transgender women

Antimicrobial-resistant Neisseria gonorrhoeae (NG) is a global public health issue that threatens effectiveness of current treatments of NG. Increased use of nucleic acid amplification tests (NAATs) in lieu of cultures makes obtaining clinical isolates for susceptibility testing difficult and samples collected in commercial transport buffer for NAATs do not preserve viable organism, while molecular methods of assessing antibiotic susceptibility do not require viable organism. We evaluated 243 NG-positive samples in Aptima transport media including urine, oral, and rectal swabs from Nigerian men who have sex with men for markers to penicillinase-producing NG, ciprofloxacin ( GyrA and ParC mutations), and extended spectrum cephalosporins (ESCs, PenA mosaic [allele X], PonA, mtrR, PorB mutations) by real-time PCR. NG DNA was recovered in 75% (183/243) of samples. Of these, 93% (171/183) were positive for at least one resistance marker. We observed a prevalence of dual resistance markers to penicillin and ciprofloxacin at 46.2% (79/171). Six percent of samples (10/171) tested positive for the PenA mosaic (allele X) ESC marker. These data indicate that antibiotic-resistant NG is common in Nigeria. Laboratory and clinical capacity building in Nigeria should include development of methods to culture NG and determine antimicrobial susceptibility.

Significant contribution of subtype G to HIV-1 genetic complexity in Nigeria identified by a newly developed subtyping assay specific for subtype G and CRF02_AG

While abundant sequence information is available from human immunodeficiency virus type 1 (HIV-1) subtypes A, B, C and CRF01_AE for HIV-1 vaccine design, sequences from West Africa are less represented. We sought to augment our understanding of HIV-1 variants circulating in 6 Nigerian cities as a step to subsequent HIV-1 vaccine development.The G/CRF02_AG multi-region hybridization assay (MHA) was developed to differentiate subtype G, CRF02_AG and their recombinants from other subtypes based on 7 HIV-1 segments. Plasma from 224 HIV-1 infected volunteers enrolled in a cohort examining HIV-1 prevalence, risk factor, and subtype from Makurdi (30), Abuja (18), Enugu (11), Kaduna (12), Tafa (95), and Ojo/Lagos (58) was analyzed using MHA. HIV-1 genomes from 42 samples were sequenced to validate the MHA and fully explore the recombinant structure of G and CRF02_AG variants.The sensitivity and specificity of MHA varied between 73-100% and 90-100%, respectively. The subtype distribution as identified by MHA among 224 samples revealed 38% CRF02_AG, 28% G, and 26% G/CRF02_AG recombinants while 8% remained nontypeable strains. In envelope (env) gp120, 38.84% of the samples reacted to a G probe while 31.25% reacted to a CRF02 (subtype A) probe. Full genome characterization of 42 sequences revealed the complexity of Nigerian HIV-1 variants.CRF02_AG, subtype G, and their recombinants were the major circulating HIV-1 variants in 6 Nigerian cities. High proportions of samples reacted to a G probe in env gp120 confirms that subtype G infections are abundant and should be considered in strategies for global HIV-1 vaccine development.

External cuneocerebellar projection and Purkinje cell zebrin II bands: a direct comparison of parasagittal banding in the mouse cerebellum

The parasagittal parcellation of the mammalian cerebellar cortex has been revealed using anatomical, electrophysiological, histological and immunological techniques. Correlation studies have been carried out to determine whether a common organizational plan encompassing the various afferent, efferent and intrinsic maps may exist in the mammalian cerebellum. Many of these studies utilized the parasagittal Purkinje cell antigenic banding pattern as revealed by the monoclonal antibody against zebrin antigens as a standard reference. In this study, the pattern of labelled mossy fiber terminals originating from the external cuneate nucleus was determined and compared with the Purkinje cell antigenic zebrin bands in the same sections. External cuneocerebellar fibers in the mouse were observed to project in well-delineated parasagittal terminal distribution zones, primarily to the ipsilateral vermal cerebellar cortex. However, there was a very minor, but consistent contralateral component. The external cuneocerebellar fiber termination pattern in the mouse differed from that seen in other rodents such as the rat. Comparison of the external cuneucerebellar terminal zones in sections immunohistochemically stained for the zebrin II antigen revealed that the boundaries of the terminal fields of the external cuneocerebellar projection do not always align with those of the zebrin II antigenic bands. These results strongly suggest that mossy fibers have a complicated relationship to zebrin defined compartments. Therefore, the designation 'functional unit' of the cerebellum or 'cerebellar module' remains uncertain at this time.

Quadruple labeling of brain-stem neurons: a multiple retrograde fluorescent tracer study of axonal collateralization

Four different fluorochromes were injected into adjacent cervical spinal cord segments, 1 unique tracer per segment. Each tracer, Fluoro-Gold, Fast Blue, Diamidino Yellow dihydrochloride and Propidium Iodide, was taken up by axonal terminals and transported intra-axonally in a retrograde direction to the cell bodies. Some, though by no means all, of these axons were stem axons with terminals in 2, 3 or 4 of the injected spinal segments. Hence as many as 4 different fluorescent tracers could be discerned simultaneously within individual neuronal somata of origin using fluorescent microscopy. These results extend the possibilities for multiple interconnection determinations within the central nervous system. Specifically, the potential for individual neurons of a nucleus to project collateral branches of a stem axon to as many as 4 different central nervous system nuclei now can be studied simultaneously using these 4 fluorescent tracers.

Origins and collateralization of corticospinal, corticopontine, corticorubral and corticostriatal tracts: a multiple retrograde fluorescent tracing study

Cerebral cells of origin for the corticospinal (CST), corticopontine (CP), corticorubral (CR) and corticostriatal (CS) fibers in the rat were identified following the simultaneous retrograde transport of propidium iodide (PI), fast blue (FB), fluorogold (FG) and diamidino yellow (DY). PI was injected into the contralateral C4 spinal cord segment while FB, FG and DY were injected into the ipsilateral medial pontine nuclei, red nucleus and striatum, respectively. Labeled pyramidal neurons projecting corticospinal axons were contralateral to injection in lamina V and ranged in size from small to large. These CST neurons occupied two distinct cortical areas. The cortical neurons of origin for the corticopontine, corticorubral and corticostriatal fibers were ipsilateral to injections. Labeled neurons were localized in cortical lamina V for the corticopontine and corticorubral fibers while corticostriate neurons were located in laminae III, V and VI. The CP, CR and CS labeled cells occupied one large cortical area which topographically included parts of the medial (AGm) and lateral (AGl) agranular cortices and the primary (SI) somatosensory cortex. Considerable overlapping of the cortical neurons of origin for the four motor fiber systems was apparent. More than 98% of the labeled cells were single labeled while less than 2% were double labeled. No triple or quadruple labeled neurons were observed. Hence, morphological evidence is presented that cortical motor neurons project mainly individual, rather than collateral, axons to each of the four motor associated nuclei investigated in this study. However, only a few cortical neurons projected axons simultaneously to a maximum of two nuclei involved in the motor pathways.

Differential sites of origin and collateralization of corticospinal neurons in the rat: a multiple fluorescent retrograde tracer study

Cells of origin for corticospinal fibers in the rat were identified following retrograde transport of Fluoro-Gold (FG), Propidium iodide (PI), Fast blue (FB), and Diamidino yellow (DY) injected unilaterally into lumbar (FG), mid-thoracic (PI), cervical enlargement (FB), and cranial cervical (DY) spinal gray matter. Most labeled neurons were contralateral to injection in lamina V and ranged from small to very large. These cells occupied two distinct cortical regions: one rostral and the other larger and more caudal. Neurons of the rostral region projected axons solely to cervical spinal segments whereas neurons of the caudal region projected fibers to all spinal segments. Somatotopically, most neurons projecting to lumbar segments were most medial. More than 98% of all labeled cortical neurons contained only a single fluorescent tracer; however, within a single tissue section each of the 4 tracers could be found in these single labeled neurons. The few double labeled neurons contained only cervical (DY + FB) or thoracolumbar (PI + FG) tracers. No triple or quadruple labeled cells were seen. Hence morphological evidence is presented that corticospinal axons branch to terminate in more than one spinal region, but these collateral terminations are restricted to only a few adjacent spinal segments.

Lack of efficacy of pyrimethamine prophylaxis in pregnant Nigerian women

To evaluate the efficacy of pyrimethamine on the blood stage (suppressive prophylaxis) and liver stage (causal prophylaxis) of Plasmodium falciparum in pregnant women, in vivo and in vitro field studies were conducted in Ilorin, Nigeria, from Jan 1 to June 30, 1988. For pregnant women with P falciparum infections who received 25 mg of pyrimethamine weekly for suppressive prophylaxis, 67% (59/88) of in vivo and 60% (6/10) of in vitro tests showed pyrimethamine resistance. A second group of parasitaemic and parasite-free pregnant women was enrolled to evaluate the efficacy of pyrimethamine as a primary tissue schizonticide; after receiving a curative dose of chloroquine (25 mg/kg), half the women were given 25 mg of pyrimethamine weekly and half received no prophylaxis. Parasitologic failure rates did not differ between the pyrimethamine-treated (8/34) and the control (11/37) groups during the 16-week follow-up. Thus, pyrimethamine is not effective for suppressive or causal prophylaxis in pregnant women in Ilorin.

Malaria chemoprophylaxis with chloroquine in young Nigerian children. IV. Its effect on haematological measurements

Haematological measurements were made in 198 Nigerian children aged three months to two years who received weekly malaria chemoprophylaxis with chloroquine from shortly after birth until the age of one or two years and in 185 age-matched control children. Children protected against malaria had a higher mean haemoglobin level and a higher packed cell volume than control children, and they showed fewer abnormalities of their red cells. Total and differential white blood cell counts, mean plasma folate and mean serum ferritin concentrations were similar in both groups of children. However, the geometric mean red cell folate level of children exposed to malaria was significantly higher than the mean level of control children; and it may be that malaria raises the red cell folate through intracellular synthesis by malaria parasites. Children with malaria parasitaemia had a significantly lower haemoglobin and packed cell volume and a significantly higher geometric mean red cell folate and ferritin level than children without parasitaemia. Serum ferritin is probably an unreliable index of iron status in children with malaria.

Malaria and haemoglobin genotype in young northern Nigerian children

Plasmodium falciparum and P. malariae were found less frequently in blood obtained from Nigerian children under the age of two years who had the haemoglobin genotype AS than in blood films obtained from those who had the genotype AA. However, differences between the two groups were statistically significant only for P. falciparum asexual forms. The prevalence of malaria antibodies, as measured by an ELISA, did not differ significantly between the two groups.

A comparison of chloroquine and pyrimethamine as malaria chemoprophylactics in young Nigerian children

The efficacy of chloroquine and pyrimethamine as malaria chemoprophylactics was investigated in young Nigerian children. Chloroquine resistance had not been documented in the study area; pyrimethamine resistance was probably present but uncommon. Children who received weekly chemoprophylaxis with pyrimethamine had a lower prevalence of malaria parasitaemia and malaria antibodies than children who received weekly chemoprophylaxis with chloroquine. Pyrimethamine given monthly gave a comparable degree of protection to chloroquine given weekly. Chloroquine frequently induced vomiting in young children and this may have impaired its efficacy as a prophylactic. We conclude that, in an area where neither chloroquine nor pyrimethamine resistance is prevalent, pyrimethamine is a better chemoprophylactic for young children than chloroquine.