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  • Author: Alphonsus N. Onyiriuka x
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Alphonsus N. Onyiriuka and Francisca N. Enyi

Abstract

Background and Aims: In very low birthweight (VLBW) infants, birthweight < 1,500g, hyperglycaemia is associated with increased rates of mortality and morbidity. Our study aimed at determining the prevalence of hyperglycaemia among VLBW infants and describing their clinical characteristics. Methods: A retrospective chart review of all inborn VLBW infants was performed. Information obtained included birthweight, gestational age (best obstetric record), gender, and history of chorioamnionitis/maternal medical disorders, type and rates of intravenous fluid administration. Blood glucose level ≥ 7 mmol/L on at least two occasions defined hyperglycaemia. Results: Of the 279 blood glucose values, obtained from 93 infants, 91 (32.6%; 95% CI = 27.1% -38.1%) were in the hyperglycaemic range, with the majority (61.5%) occurring in the first 48 hours of life. The frequency of hyperglycaemia was significantly associated with a rate of infusion greater than 0.4g/kg/hour (Odds Ratio, OR = 3.76; 95% CI=1.58-8.94) and a positive history of maternal chorioamnionitis (OR = 3.04; 95%CI= 1.15-8.01). Conclusion: In the first 48 hours of life, hyperglycaemia co-existing with or complicating primary illnesses was common in VLBW infants who had dextrose infusion and a positive history of maternal chorioamnionitis

Open access

Alphonsus N. Onyiriuka and Sandra O. Edorhe

Abstract

This paper reports a case of a male infant born to a 32-year-old multiparous mother with overweight (BMI 28.5kg/m2) and gestational diabetes mellitus (GDM). The mother had fasting hyperglycaemia (range 5.7- 6.0mmol/L) noted at 24 weeks of pregnancy and was managed with diet alone. There is no family history of diabetes mellitus and the mother did not have pre-eclampsia. Physical examination of the infant revealed macrosomia (birthweight, 4600g) and bilateral congenital cryptorchidism. The baby suffered severe hypoglycaemia (blood glucose 1.7mmol/L) and hypocalcaemia (total serum calcium 1.03mmol/L), manifesting with seizures. He was successfully managed with 10% dextrose water and calcium gluconate infusion, using standard protocol. His karyotype is 46 XY. The patient was discharged from admission at the age of 10 days and was referred to the paediatric endocrinologist at the tertiary hospital. By 8 weeks of age, the right testis was noticed to have descended into the right scrotum. At the age of 3 months, the left testis was still not palpable either in the inguinal canal or the scrotal sac. The patient was lost to follow up. Conclusion: Diet-treated maternal overweight in association with GDM could potentially increase the risk for hypocalcaemia, hypoglycaemia, macrosomia and congenital cryptorchidism in the offspring, highlighting the need for physicians to assess for the presence of these morbidities in such infants.

Open access

Alphonsus N. Onyiriuka, Jackson I. Ikuren and Rita C. Onyiriuka

Abstract

Background and Aims: Body mass index (BMI) is an inexpensive and easy-to-perform method of screening for weight status, which may have detrimental health consequences. The aim of our study was to assess the pattern of BMI among Nigerian adolescent secondary school girls and determine the prevalence of underweight, overweight and obesity among them.

Materials and Methods: In this school-based cross-sectional study, weight was measured, using the spring bathroom scale which was supported at all times on a rigid base. Height was measured without footwear with the heels together. The BMI was computed, using the formula weight/height2 (kg/m2). The BMI-for-age percentile chart was used in classifying the weight status of the subjects.

Results: A total of 2,159 girls from two public urban day secondary schools participated in the study. Seven students declined to participate, giving a response rate of 99.7%. The overall mean weight, height and body mass index (BMI) of the participants were 43.16±6.07 kg (95% confidence interval, CI= 42.90-43.42), 151.53±6.20 cm (95% CI=151.27-151.79) and 19.76±3.07 kg/m2 (95% CI= 19.63-19.89). The BMI values increased directly with age. Participants in the early adolescent stage demonstrated a significantly lower mean BMI value than either the middle or late adolescent stages. Based on WHO criteria, the prevalence rates of underweight, overweight and obesity were 7.1% (95% CI= 3.0-11.2), 8.3% (95% CI= 4.3-12.3) and 2.1% (95% CI= 2.0-6.2), respectively. The overall prevalence of healthy weight status was 82.5% (95% CI= 80.7-84.3). Conclusion: Nigerian adolescent secondary school girls are at increased risk of the double burden of nutrition as both underweight and overweight show a relatively similar prevalence rates.

Open access

Amarabia N.E. Ibeawuchi, Alphonsus N. Onyiriuka and Philip O. Abiodun

Abstract

Background and Aims: In Nigeria, community-based epidemiological data related to the prevalence of zinc deficiency in preschool children are scarce. We assessed the prevalence of zinc deficiency and the associated socio-demographic variables in children aged between 6 and 60 months, living in a Nigerian rural community.

Materials and Methods: In this cross-sectional study, the serum zinc concentrations of 252 children aged between 6 and 60 months in a rural community in Nigeria were assessed, using atomic absorption spectrophotometry. The study population was selected by multistage random sampling and at least two children were selected from every household which had children in the study age group. The socio-demographic characteristics of the subjects were obtained, using an interviewer-administered questionnaire.

Results: A total of 252 children were studied, 134 (53.2%) males and 118 (46.8%) females. The mean age was 32.7±17.0 months, similar for both sexes. Overall, 220 (87.3%) had low serum zinc concentrations (less than 7.65µmol/L). According to age, the highest mean serum zinc concentration was 5.43±3.52µmol/L in children aged between 6 and 12 months. Correlation between serum zinc concentration and family size or socio-economic status (SES) showed that the smaller the family size and the higher the SES, the higher the serum zinc concentration.

Conclusions: The high prevalence of low serum zinc concentration indicates that zinc deficiency is a public health problem in our rural communities, requiring public health intervention.

Open access

Alphonsus N. Onyiriuka, Chinwe A. Oguejiofor and Wilson E. Sadoh

Abstract

A 16-year-old boy whose diabetes mellitus was diagnosed 3 months previously in a private hospital but was not placed on medication. The presenting complaints were fast breathing for 24 hours, weakness for 2 hours, and unresponsiveness to calls for 0.5 hours. His father was obese with type 2 diabetes mellitus and died 8 months earlier from cardiac arrest. His birthweight was low, 2.2kg. At first presentation, his weight, BMI and blood pressure were 60kg (25th-50th percentile), 19.4kg/m2 (25thpercentile) and 110/70mmHg (systolic BP 50th percentile, diastolic BP 50th-90th percentile), respectively. He was managed for diabetic ketoacidosis and was discharged on subcutaneous premixed insulin, 1 Unit/kg/day. At point of discharge, weight and BP were 60.5 kg and 120/70 mmHg, respectively. The patient defaulted but presented again 6 months later at the age of 17 years. At second presentation, his weight, BMI and BP were 89 kg (95th percentile), 27.5 kg/m2 (90th-95th percentile) and 180/80 mmHg (systolic 99th percentile; diastolic 90th percentile), respectively. His waist circumference was 98.7cm (> 90th percentile). We had no record of previous waist circumference. His lipid profile showed low HDL-cholesterol 0.7252 mmol/L [(28mg/dl); <5thpercentile]. His fasting blood glucose and HbA1C were 6.5 mmol/L (117mg/dl) and 34 mol/mol (5.3%), respectively. A diagnosis of metabolic syndrome in a patient with ketosis-prone type 2 diabetes was made. He was referred to the pediatric cardiologist for management of his hypertension. He defaulted again and was lost to follow up. Conclusion: This report illustrates the association of low birth weight and rapid weight gain with metabolic syndrome in adolescence.

Open access

Alphonsus N. Onyiriuka, Abiola O. Oduwole, Elizabeth E. Oyenusi, Isaac O. Oluwayemi, Moustafa Kouyate, Olubunmi Fakaye, Chiedozie J. Achonwa and Mohammad Abdullahi

Abstract

We report a common diabetes management problem illustrated by an adolescent female university student with recurrent episodes of hypoglycaemia on Tuesdays when she has intensive academic activity lasting most of the day. Steps taken to reduce the risk of hypoglycaemia were patient education and empowerment, frequent self monitoring of blood glucose, reduction in insulin dose on Tuesdays and emphasizing availability of ongoing professional guidance and support anytime she may need it. One of the challenges encountered in the management of this patient was her family’s inability to afford the cost of basal-bolus regimen or continuous subcutaneous insulin infusion via insulin pump; the two insulin regimens that best fit into university lifestyle. Conclusion: Adolescents with diabetes mellitus attending tertiary educational institutions may be at increased risk of hypoglycaemia, particularly on days when they have intensive academic activities.