Pub Date : 2021-02-15DOI: 10.1080/16089677.2021.1877444
Wissam S Hamid, H. Ahmed, Mona A Osman, Rasha Babiker
Background: Diabetic neuropathy is one of the most common microvascular complications associated with diabetes mellitus. Diabetic peripheral neuropathy (DPN) has been linked to hyperglycaemia and long duration of uncontrolled type 2 diabetes mellitus (T2DM) as measured by glycosylated haemoglobin (HbA1c). To our knowledge the estimated duration between diagnosis and developing DPN and the level of HbA1c have not yet been investigated in Sudanese patients with type 2 DM. Therefore, this study aims to investigate the relationship between the duration of diabetes and HbA1c with nerve conduction velocity (NCV) in patients with type 2 DM. Methods: This cross-sectional study recruited 63 male and female patients with T2DM who attended the diabetic outpatient clinic of Academy Charity Teaching Hospital (ACTH) and Alzaytouna Private Hospital for Nerve Conduction Velocity (NCV) and electromyography (EMG) tests. Nerve conduction was done by using ADInstruments PowerLab series 26. SPSS was used to analyse the data and p-value < 0.05 was considered significant. Results: The mean duration of DM was 14.7 (± SD 9.24) years and the mean age of participants was 57.71 (± SD 12.2) years. The most common symptom was numbness (50%). Pearson's correlation test revealed a significant negative correlation between HbA1c and nerve conduction velocity (r = 0.4, p < 0.05) and negative significant correlation between the duration and the amplitude (r = 0.35, p < 0.05). Conclusion: There is a slowing of nerve conduction velocity in type 2 diabetic patients, which is accelerated by the poor glycaemic control (HbA1c). These findings support the need for tight glycaemic control to avoid drastic neuropathic complications of diabetes.
{"title":"Nerve conduction and its correlations with duration of diabetes mellitus and glycosylated haemoglobin in type 2 diabetes mellitus (T2DM)","authors":"Wissam S Hamid, H. Ahmed, Mona A Osman, Rasha Babiker","doi":"10.1080/16089677.2021.1877444","DOIUrl":"https://doi.org/10.1080/16089677.2021.1877444","url":null,"abstract":"Background: Diabetic neuropathy is one of the most common microvascular complications associated with diabetes mellitus. Diabetic peripheral neuropathy (DPN) has been linked to hyperglycaemia and long duration of uncontrolled type 2 diabetes mellitus (T2DM) as measured by glycosylated haemoglobin (HbA1c). To our knowledge the estimated duration between diagnosis and developing DPN and the level of HbA1c have not yet been investigated in Sudanese patients with type 2 DM. Therefore, this study aims to investigate the relationship between the duration of diabetes and HbA1c with nerve conduction velocity (NCV) in patients with type 2 DM. Methods: This cross-sectional study recruited 63 male and female patients with T2DM who attended the diabetic outpatient clinic of Academy Charity Teaching Hospital (ACTH) and Alzaytouna Private Hospital for Nerve Conduction Velocity (NCV) and electromyography (EMG) tests. Nerve conduction was done by using ADInstruments PowerLab series 26. SPSS was used to analyse the data and p-value < 0.05 was considered significant. Results: The mean duration of DM was 14.7 (± SD 9.24) years and the mean age of participants was 57.71 (± SD 12.2) years. The most common symptom was numbness (50%). Pearson's correlation test revealed a significant negative correlation between HbA1c and nerve conduction velocity (r = 0.4, p < 0.05) and negative significant correlation between the duration and the amplitude (r = 0.35, p < 0.05). Conclusion: There is a slowing of nerve conduction velocity in type 2 diabetic patients, which is accelerated by the poor glycaemic control (HbA1c). These findings support the need for tight glycaemic control to avoid drastic neuropathic complications of diabetes.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"15 1","pages":"46 - 51"},"PeriodicalIF":0.5,"publicationDate":"2021-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84286628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-02DOI: 10.1080/16089677.2021.1877443
M. Pienaar, Marianne Reid, M. Nel
Objective: To establish the impact of a face-to-face peer-support intervention on adults with type 2 diabetes in South Africa. Methods: A cluster randomised controlled trial was conducted involving 288 adults with type 2 diabetes from six communities in the Free State province. Individuals (n = 141) in three communities were randomly allocated to the intervention group, and individuals (n = 147) in another three communities were randomly allocated to the control group. Trained community health workers led monthly group sessions and home visits. The control group received the usual care. The primary outcome of the study was glycated haemoglobin (HbA1c), measured at baseline and endpoint after four months. Secondary outcomes included blood pressure, body mass index and waist circumference, measured at baseline and endpoint. Descriptive statistics were calculated per group. Results: No significant changes from baseline were found between groups regarding HbA1c (p = 0.87), body mass index (p = 0.21), waist circumference (p = 0.24) and systolic blood pressure (p = 0.13). Compared with the control group, the intervention group had a significant improvement in diastolic blood pressure (p = 0.02). Conclusions: The face-to-face peer-support intervention delivered by trained community health workers in a semi-urban rural area resulted in a significant improvement in diastolic blood pressure of adults with type 2 diabetes.
{"title":"The impact of a face-to-face peer-support intervention on adults with type 2 diabetes: a cluster-randomised trial","authors":"M. Pienaar, Marianne Reid, M. Nel","doi":"10.1080/16089677.2021.1877443","DOIUrl":"https://doi.org/10.1080/16089677.2021.1877443","url":null,"abstract":"Objective: To establish the impact of a face-to-face peer-support intervention on adults with type 2 diabetes in South Africa. Methods: A cluster randomised controlled trial was conducted involving 288 adults with type 2 diabetes from six communities in the Free State province. Individuals (n = 141) in three communities were randomly allocated to the intervention group, and individuals (n = 147) in another three communities were randomly allocated to the control group. Trained community health workers led monthly group sessions and home visits. The control group received the usual care. The primary outcome of the study was glycated haemoglobin (HbA1c), measured at baseline and endpoint after four months. Secondary outcomes included blood pressure, body mass index and waist circumference, measured at baseline and endpoint. Descriptive statistics were calculated per group. Results: No significant changes from baseline were found between groups regarding HbA1c (p = 0.87), body mass index (p = 0.21), waist circumference (p = 0.24) and systolic blood pressure (p = 0.13). Compared with the control group, the intervention group had a significant improvement in diastolic blood pressure (p = 0.02). Conclusions: The face-to-face peer-support intervention delivered by trained community health workers in a semi-urban rural area resulted in a significant improvement in diastolic blood pressure of adults with type 2 diabetes.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"104 1","pages":"34 - 39"},"PeriodicalIF":0.5,"publicationDate":"2021-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85862713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-02DOI: 10.1080/16089677.2021.1877445
M. Esaadi, F. Paruk, B. Cassim
Objectives: There are limited data on vertebral fractures (VFs) in South Africa (SA). Therefore a study was undertaken to compare the demographic profile, clinical risk factors and bone mineral density (BMD) in subjects aged 60 years and over with and without morphometric VFs. Patients and methods: In a descriptive case-controlled study, demographic data, clinical risk factors (CRF) and BMD were collected. Morphometric VFs were identified using the semi-quantitative Genant method. Descriptive analysis was undertaken using Student’s t-test, the Mann–Whitney U-test and the chi-square test. Results: In the 197 subjects enrolled, the median age was 72.0 years (IQR 67.0–78.5 years) and morphometric VFs were identified in 41 subjects (20.8%). The prevalence of VFs increased with age, and while more common in women compared with men (23.8% vs. 13.0%), this was not significant (p 0.095). There was no difference in the prevalence of VFs between African and Indian subjects (23.4% vs. 17.4%; p 0.240), nor CRFs between subjects with and without VFs. Subjects with a VF had a significantly lower BMD at the spine (p = 0.020), but not at the neck of femur and total hip. Conclusion: This study highlights the need for adequate screening and management protocols for osteoporosis in all ethnic groups in SA.
{"title":"Prevalence and clinical risk factors for morphometric vertebral fractures in older subjects in KwaZulu-Natal","authors":"M. Esaadi, F. Paruk, B. Cassim","doi":"10.1080/16089677.2021.1877445","DOIUrl":"https://doi.org/10.1080/16089677.2021.1877445","url":null,"abstract":"Objectives: There are limited data on vertebral fractures (VFs) in South Africa (SA). Therefore a study was undertaken to compare the demographic profile, clinical risk factors and bone mineral density (BMD) in subjects aged 60 years and over with and without morphometric VFs. Patients and methods: In a descriptive case-controlled study, demographic data, clinical risk factors (CRF) and BMD were collected. Morphometric VFs were identified using the semi-quantitative Genant method. Descriptive analysis was undertaken using Student’s t-test, the Mann–Whitney U-test and the chi-square test. Results: In the 197 subjects enrolled, the median age was 72.0 years (IQR 67.0–78.5 years) and morphometric VFs were identified in 41 subjects (20.8%). The prevalence of VFs increased with age, and while more common in women compared with men (23.8% vs. 13.0%), this was not significant (p 0.095). There was no difference in the prevalence of VFs between African and Indian subjects (23.4% vs. 17.4%; p 0.240), nor CRFs between subjects with and without VFs. Subjects with a VF had a significantly lower BMD at the spine (p = 0.020), but not at the neck of femur and total hip. Conclusion: This study highlights the need for adequate screening and management protocols for osteoporosis in all ethnic groups in SA.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"1 1","pages":"29 - 33"},"PeriodicalIF":0.5,"publicationDate":"2021-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89744662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-30DOI: 10.1080/16089677.2020.1850033
Dominic Hicks, R. Hickner, Usha Govinden, T. Sookan
Background: Exercise interventions improve type 2 diabetes (T2D). Published randomised control trials and crossover control trials were systematically examined to establish the differences in the effect of single-bout exercise on glucose control and insulin sensitivity in individuals with type 2 diabetes. Methods: Using PRISMA guidelines on three electronic databases, studies that tested the effects of a single bout of exercise on glucose control and insulin sensitivity in T2D were identified. To be included, studies had to meet the PRISMA criteria and contain data on the effects of a single bout of exercise on blood glucose and/or insulin resistance in individuals with T2D. Results: Three of the 205 articles met the inclusion criteria. All of the studies prescribed a single bout of continuous aerobic exercise at 40–60% heart rate reserve (HRR), 60% HRR, or 73% VO2 peak. Aerobic exercise was associated with improved glucose control when compared with resistance exercise. Continuous aerobic exercise significantly lowered average glucose during the first 24 hours post-exercise. Interval walking decreased mean and maximal blood glucose when compared with that in control. Conclusions: In conclusion, the findings of this review suggest high-intensity interval training to be the most effective form of exercise.
{"title":"Acute effects of single-bout exercise in adults with type 2 diabetes: a systematic review of randomised controlled trials and controlled crossover trials","authors":"Dominic Hicks, R. Hickner, Usha Govinden, T. Sookan","doi":"10.1080/16089677.2020.1850033","DOIUrl":"https://doi.org/10.1080/16089677.2020.1850033","url":null,"abstract":"Background: Exercise interventions improve type 2 diabetes (T2D). Published randomised control trials and crossover control trials were systematically examined to establish the differences in the effect of single-bout exercise on glucose control and insulin sensitivity in individuals with type 2 diabetes. Methods: Using PRISMA guidelines on three electronic databases, studies that tested the effects of a single bout of exercise on glucose control and insulin sensitivity in T2D were identified. To be included, studies had to meet the PRISMA criteria and contain data on the effects of a single bout of exercise on blood glucose and/or insulin resistance in individuals with T2D. Results: Three of the 205 articles met the inclusion criteria. All of the studies prescribed a single bout of continuous aerobic exercise at 40–60% heart rate reserve (HRR), 60% HRR, or 73% VO2 peak. Aerobic exercise was associated with improved glucose control when compared with resistance exercise. Continuous aerobic exercise significantly lowered average glucose during the first 24 hours post-exercise. Interval walking decreased mean and maximal blood glucose when compared with that in control. Conclusions: In conclusion, the findings of this review suggest high-intensity interval training to be the most effective form of exercise.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"30 1","pages":"24 - 28"},"PeriodicalIF":0.5,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77202365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-30DOI: 10.1080/16089677.2020.1843841
M. Budge, W. Conradie, K. Beviss-Challinor, L. Martin, M. Conradie, A. Coetzee
Background: Increased bone resorption is a well-described consequence of primary hyperparathyroidism (PHPT). In South Africa, little is known about the impact of PHPT on skeletal health. Objective: To determine the prevalence of decreased bone mineral density (BMD), vertebral fractures and osteitis fibrosa cystica in patients with PHPT who underwent parathyroidectomy. Methods: Retrospective study of patients who underwent parathyroidectomy for PHPT at Tygerberg Hospital in Cape Town, from January 2010 to December 2019. Clinical, biochemical and BMD parameters are described. Results: Final analysis included 56 patients (median age 63.5 years; 80.4% female). Initial calcium, parathyroid hormone (PTH) and 25-hydroxyvitamin D (25[OH]D) levels were 2.93 mmol/l, 19.4 pmol/l and 34.0 nmol/l, respectively. Of the total cohort, 71.4% had decreased BMD. The prevalence of osteoporosis and osteopenia in postmenopausal women and men ≥ 50 years was 50.0% and 39.1% respectively; low bone mass for age in premenopausal women and men < 50 years was 20.0%. Vertebral fractures were seen in 21.2% of patients on radiography. Osteitis fibrosa cystica was present in five patients (9.6%). PTH levels were significantly elevated in patients with osteoporosis compared with those with normal BMD (36.4 vs. 16.1 pmol/l; p = 0.02). Conclusion: Two-thirds of patients who underwent parathyroidectomy for PHPT had decreased BMD, with osteoporosis present in 50% of postmenopausal women and older men. One in five had vertebral fractures. These findings underscore the importance of skeletal assessment in the management of PHPT.
{"title":"Bone health in patients undergoing surgery for primary hyperparathyroidism at Tygerberg Hospital, Cape Town, South Africa","authors":"M. Budge, W. Conradie, K. Beviss-Challinor, L. Martin, M. Conradie, A. Coetzee","doi":"10.1080/16089677.2020.1843841","DOIUrl":"https://doi.org/10.1080/16089677.2020.1843841","url":null,"abstract":"Background: Increased bone resorption is a well-described consequence of primary hyperparathyroidism (PHPT). In South Africa, little is known about the impact of PHPT on skeletal health. Objective: To determine the prevalence of decreased bone mineral density (BMD), vertebral fractures and osteitis fibrosa cystica in patients with PHPT who underwent parathyroidectomy. Methods: Retrospective study of patients who underwent parathyroidectomy for PHPT at Tygerberg Hospital in Cape Town, from January 2010 to December 2019. Clinical, biochemical and BMD parameters are described. Results: Final analysis included 56 patients (median age 63.5 years; 80.4% female). Initial calcium, parathyroid hormone (PTH) and 25-hydroxyvitamin D (25[OH]D) levels were 2.93 mmol/l, 19.4 pmol/l and 34.0 nmol/l, respectively. Of the total cohort, 71.4% had decreased BMD. The prevalence of osteoporosis and osteopenia in postmenopausal women and men ≥ 50 years was 50.0% and 39.1% respectively; low bone mass for age in premenopausal women and men < 50 years was 20.0%. Vertebral fractures were seen in 21.2% of patients on radiography. Osteitis fibrosa cystica was present in five patients (9.6%). PTH levels were significantly elevated in patients with osteoporosis compared with those with normal BMD (36.4 vs. 16.1 pmol/l; p = 0.02). Conclusion: Two-thirds of patients who underwent parathyroidectomy for PHPT had decreased BMD, with osteoporosis present in 50% of postmenopausal women and older men. One in five had vertebral fractures. These findings underscore the importance of skeletal assessment in the management of PHPT.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"41 1","pages":"16 - 23"},"PeriodicalIF":0.5,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78828830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-26DOI: 10.1080/16089677.2020.1838161
C. Bruce-Brand, A. C. van Wyk
Introduction: A substantial proportion of phaeochromocytomas and paragangliomas are associated with underlying germline mutations, of which the majority are due to mutations in one of the genes in the succinate dehydrogenase (SDH) complex. A commercially available immunohistochemical stain for SDHB has excellent correlation with SDH gene mutation status when staining is lost. This abnormal loss of staining can identify potential familial tumours and tumours with a higher risk of malignant behaviour. The prevalence of SDH deficiency in the South African setting has not been published previously. Methods: A retrospective laboratory-based study at Tygerberg Hospital in Cape Town used immunohistochemistry on archived tumour tissue to assess loss of SDHB staining in phaeochromocytomas and paragangliomas submitted to the histopathology laboratory (National Health Laboratory Service) between 2005 and 2015. Results: Tumour tissue from 52 patients was tested. In total, 36% showed loss of staining. Loss of staining was significantly correlated with a younger age at presentation (z = −3.59, p < 0.001). The median age of those who showed loss of staining was 26 years (IQR 21–41), compared with 50.5 years (IQR 36–61) for those who showed retained staining. The inter-observer agreement in the interpretation of the immunohistochemical stain was excellent (Cohen’s kappa = 0.917; 95% confidence interval, 0.81–1, p < 0.001). Conclusion: Approximately one-third of phaeochromocytomas and paragangliomas in our setting are likely to be associated with germline mutations in one of the SDH genes. Immunohistochemical testing of tumour tissue can identify this group to allow better prognostication and appropriate genetic testing and counselling.
{"title":"Prevalence of succinate dehydrogenase deficiency in paragangliomas and phaeochromocytomas at a tertiary hospital in Cape Town: a retrospective review","authors":"C. Bruce-Brand, A. C. van Wyk","doi":"10.1080/16089677.2020.1838161","DOIUrl":"https://doi.org/10.1080/16089677.2020.1838161","url":null,"abstract":"Introduction: A substantial proportion of phaeochromocytomas and paragangliomas are associated with underlying germline mutations, of which the majority are due to mutations in one of the genes in the succinate dehydrogenase (SDH) complex. A commercially available immunohistochemical stain for SDHB has excellent correlation with SDH gene mutation status when staining is lost. This abnormal loss of staining can identify potential familial tumours and tumours with a higher risk of malignant behaviour. The prevalence of SDH deficiency in the South African setting has not been published previously. Methods: A retrospective laboratory-based study at Tygerberg Hospital in Cape Town used immunohistochemistry on archived tumour tissue to assess loss of SDHB staining in phaeochromocytomas and paragangliomas submitted to the histopathology laboratory (National Health Laboratory Service) between 2005 and 2015. Results: Tumour tissue from 52 patients was tested. In total, 36% showed loss of staining. Loss of staining was significantly correlated with a younger age at presentation (z = −3.59, p < 0.001). The median age of those who showed loss of staining was 26 years (IQR 21–41), compared with 50.5 years (IQR 36–61) for those who showed retained staining. The inter-observer agreement in the interpretation of the immunohistochemical stain was excellent (Cohen’s kappa = 0.917; 95% confidence interval, 0.81–1, p < 0.001). Conclusion: Approximately one-third of phaeochromocytomas and paragangliomas in our setting are likely to be associated with germline mutations in one of the SDH genes. Immunohistochemical testing of tumour tissue can identify this group to allow better prognostication and appropriate genetic testing and counselling.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"4 1","pages":"9 - 15"},"PeriodicalIF":0.5,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84849595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-18DOI: 10.1080/16089677.2020.1831740
T. van der Made, M. van de Vyver, M. Conradie-Smit, M. Conradie
Background: The association between hyperemesis gravidarum (HG) and abnormal thyroid function is well known. Aims: The prevalence, aetiology and course of thyrotoxicosis in women with hyperemesis gravidarum (HG) were studied. Methods: Women admitted for HG, who underwent thyroid function evaluation between 1 August 2016 and 30 April 2019, were studied. Laboratory data included baseline human chorionic gonadotropin (hCG) and baseline (t1), discharge (t2) and follow-up (t3) thyroid function tests (thyroid stimulating hormone [TSH] and free thyroxin [fT4]). Available TSH receptor antibody status was assessed. Results: Eighty-two patients were included. The incidence of thyrotoxicosis was 49% based on local laboratory TSH range and 48% if trimester-specific ranges used. In the majority of normal pregnancies, thyrotoxicosis was hCG-mediated (72.5%), 15% were confirmed to have Graves’ disease and 12% had a molar pregnancy. Very high fT4 levels (> 40 pmol/l) at baseline [t1] were documented in 24% of women with hCG-mediated thyrotoxicosis. Clinical features were absent in a third of women with Graves’ disease and the diagnosis was reliant on positive antibody status. Free T4 values declined from (t1) to later in gestation (t3) (p < 0.001). Conclusion: The incidence of thyrotoxicosis in women with HG is high. Free-T4 values decrease with clinical stabilisation of HG, suggesting a contribution of dehydration to the large variation in baseline fT4 measurements. Testing for TSH-receptor antibodies should be considered in women with TSH < 0.01 pmol/l and persistent fT4 elevation on follow-up. Final review of thyroid function should be performed after 15 weeks’ gestation.
{"title":"Prevalence and aetiology of thyrotoxicosis in patients with hyperemesis gravidarum presenting to a tertiary hospital in Cape Town, South Africa","authors":"T. van der Made, M. van de Vyver, M. Conradie-Smit, M. Conradie","doi":"10.1080/16089677.2020.1831740","DOIUrl":"https://doi.org/10.1080/16089677.2020.1831740","url":null,"abstract":"Background: The association between hyperemesis gravidarum (HG) and abnormal thyroid function is well known. Aims: The prevalence, aetiology and course of thyrotoxicosis in women with hyperemesis gravidarum (HG) were studied. Methods: Women admitted for HG, who underwent thyroid function evaluation between 1 August 2016 and 30 April 2019, were studied. Laboratory data included baseline human chorionic gonadotropin (hCG) and baseline (t1), discharge (t2) and follow-up (t3) thyroid function tests (thyroid stimulating hormone [TSH] and free thyroxin [fT4]). Available TSH receptor antibody status was assessed. Results: Eighty-two patients were included. The incidence of thyrotoxicosis was 49% based on local laboratory TSH range and 48% if trimester-specific ranges used. In the majority of normal pregnancies, thyrotoxicosis was hCG-mediated (72.5%), 15% were confirmed to have Graves’ disease and 12% had a molar pregnancy. Very high fT4 levels (> 40 pmol/l) at baseline [t1] were documented in 24% of women with hCG-mediated thyrotoxicosis. Clinical features were absent in a third of women with Graves’ disease and the diagnosis was reliant on positive antibody status. Free T4 values declined from (t1) to later in gestation (t3) (p < 0.001). Conclusion: The incidence of thyrotoxicosis in women with HG is high. Free-T4 values decrease with clinical stabilisation of HG, suggesting a contribution of dehydration to the large variation in baseline fT4 measurements. Testing for TSH-receptor antibodies should be considered in women with TSH < 0.01 pmol/l and persistent fT4 elevation on follow-up. Final review of thyroid function should be performed after 15 weeks’ gestation.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"61 1","pages":"1 - 8"},"PeriodicalIF":0.5,"publicationDate":"2020-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83063346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1080/16089677.2020.1823678
S. Pillay
Background: Ideal control of diabetes mellitus (DM) remains elusive globally. Identifying defaulting reasons in diabetes clinics can provide potential interventional areas. Methods: Data of patients booked for the Edendale Hospital diabetes clinic (attendees and defaulters) between August 2019 and February 2020 were used to determine whether control in defaulters differed from attendees and to analyse defaulting reasons. Results: A total of 581 patients living with diabetes (PLWD) attended; 213 defaulted (defaulting rate 26.79%). Defaulters (1) had poorer glycaemic and lipid control; (2) with HIV infection and type 2 DM (T2DM) had inferior glycaemic control; (3) performed more self-monitoring of blood glucose (SMBG). Substantially more females defaulted across all categories. They had poorer glycaemia and lipid control with higher body mass index. The commonest defaulting reasons were forgetting appointments, too many clinics (TMC), patient sick and work commitments (44.3% vs. 24.5% vs. 13.1% vs. 10.8%). Within HIV-infected defaulters, reasons ranged from TMC, work commitments and other reasons to forgot appointment (57.7% vs. 26.1% vs. 23.8% vs. 13.8%). A significant number of HIV-infected and patients on antiretroviral therapy, of both sexes, with T2DM, defaulted secondary to TMC. Patients with hypertension and chronic kidney disease (CKD) defaulted due to TMC. Bivariate analysis revealed that being a pensioner, increased age, employment and presence of T2DM were significantly associated with being sick. Older patients defaulted in poor weather while younger patients specified school/work commitments. Patients who complained of TMC had higher creatinine levels. Conclusions: The defaulting rate in PLWD remains high. Defaulters had sub-optimal glycaemic and lipid control. TMC proved to be significant for patients with chronic diseases (HIV infection, hypertension and CKD) highlighting the need for combined communicable and non-communicable diseases clinics. Defaulting females and HIV-infected PLWD had high prevalence of cardiovascular risk factors. Afternoon clinics might assist with work/school commitments. Wireless uploading of SMBG results and teleconsultation is an option.
背景:糖尿病(DM)的理想控制在全球范围内仍然难以捉摸。在糖尿病诊所中识别不合格的原因可以提供潜在的干预领域。方法:使用2019年8月至2020年2月期间在Edendale医院糖尿病诊所预约的患者(出席者和违约者)的数据，确定违约者的控制是否与出席者不同，并分析违约原因。结果:共纳入581例糖尿病患者(PLWD);213个违约(违约率26.79%)。违约者(1)血糖和血脂控制较差;(2) HIV感染合并2型糖尿病(T2DM)患者血糖控制较差;(3)更多的自我监测血糖(SMBG)。更多的女性在所有类别中都默认。他们的血糖和血脂控制较差，体重指数较高。最常见的违约原因是忘记预约、诊所太多、病人生病和工作承诺(44.3% vs. 24.5% vs. 13.1% vs. 10.8%)。在感染艾滋病毒的违约者中，原因从TMC、工作承诺和其他原因到忘记预约(57.7% vs. 26.1% vs. 23.8% vs. 13.8%)不等。相当数量的艾滋病毒感染者和接受抗逆转录病毒治疗的患者，无论男女，患有2型糖尿病，默认继发于TMC。高血压和慢性肾脏疾病(CKD)患者因TMC而违约。双变量分析显示，领取养老金、年龄增加、就业和患有2型糖尿病与患病显著相关。年龄较大的患者在恶劣天气中违约，而年龄较小的患者则指定学校/工作义务。主诉TMC的患者肌酐水平较高。结论:PLWD的违约率仍然很高。违约者血糖和血脂控制欠佳。事实证明，TMC对慢性病患者(艾滋病毒感染、高血压和慢性肾病)非常重要，这突出表明需要建立传染病和非传染性疾病联合诊所。女性和hiv感染的PLWD有较高的心血管危险因素。下午的诊所可能有助于工作/学校的安排。无线上传SMBG结果和远程咨询是一种选择。
{"title":"Defaulters. Are they worse off? Analysing reasons for this phenomenon amongst patients with diabetes with and without HIV infection","authors":"S. Pillay","doi":"10.1080/16089677.2020.1823678","DOIUrl":"https://doi.org/10.1080/16089677.2020.1823678","url":null,"abstract":"Background: Ideal control of diabetes mellitus (DM) remains elusive globally. Identifying defaulting reasons in diabetes clinics can provide potential interventional areas. Methods: Data of patients booked for the Edendale Hospital diabetes clinic (attendees and defaulters) between August 2019 and February 2020 were used to determine whether control in defaulters differed from attendees and to analyse defaulting reasons. Results: A total of 581 patients living with diabetes (PLWD) attended; 213 defaulted (defaulting rate 26.79%). Defaulters (1) had poorer glycaemic and lipid control; (2) with HIV infection and type 2 DM (T2DM) had inferior glycaemic control; (3) performed more self-monitoring of blood glucose (SMBG). Substantially more females defaulted across all categories. They had poorer glycaemia and lipid control with higher body mass index. The commonest defaulting reasons were forgetting appointments, too many clinics (TMC), patient sick and work commitments (44.3% vs. 24.5% vs. 13.1% vs. 10.8%). Within HIV-infected defaulters, reasons ranged from TMC, work commitments and other reasons to forgot appointment (57.7% vs. 26.1% vs. 23.8% vs. 13.8%). A significant number of HIV-infected and patients on antiretroviral therapy, of both sexes, with T2DM, defaulted secondary to TMC. Patients with hypertension and chronic kidney disease (CKD) defaulted due to TMC. Bivariate analysis revealed that being a pensioner, increased age, employment and presence of T2DM were significantly associated with being sick. Older patients defaulted in poor weather while younger patients specified school/work commitments. Patients who complained of TMC had higher creatinine levels. Conclusions: The defaulting rate in PLWD remains high. Defaulters had sub-optimal glycaemic and lipid control. TMC proved to be significant for patients with chronic diseases (HIV infection, hypertension and CKD) highlighting the need for combined communicable and non-communicable diseases clinics. Defaulting females and HIV-infected PLWD had high prevalence of cardiovascular risk factors. Afternoon clinics might assist with work/school commitments. Wireless uploading of SMBG results and teleconsultation is an option.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"68 6 1","pages":"70 - 79"},"PeriodicalIF":0.5,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88015602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1080/16089677.2020.1817281
Jkd Jacobs, Wd Basson, MJ Basson
Introduction: Diabetes mellitus (DM) is a chronic metabolic disease defined by elevated blood glucose levels over a long period of time. One in 10 people are living with DM. Objective: The main purpose of this investigative study was to gain knowledge regarding the perceptions of students’ self-management living with diabetes mellitus at a tertiary institute. Methods: The Interactive Qualitative Analysis (IQA) was used to construct and describe a cognitive mind map of students’ perceptions of their self-management living with DM. Results: An analysis of the participants’ mind map representing students living with DM revealed eight main components (affinities), namely: Social awareness and acceptance, Food available on campus, Keeping insulin cool, Independent lifestyle, Adjusting by cooking, Hurdles in the academic environment, Causes of changing blood sugar and Adapting to effects of changing blood sugar. Conclusion: The final perceptual system was an informative representation of the self-management of students living with DM. The system reflects barriers to compliance with self-management facing students living with DM. The system produced four recognisable loops or cycles, namely the Ignorance loop, the Revision loop, the Developing loop and the Self-management loop. These loops created pathways through the system for the students living with DM to find a way to better self-management.
{"title":"Perceptual systems of the self-management of students living with diabetes mellitus: an IQA approach","authors":"Jkd Jacobs, Wd Basson, MJ Basson","doi":"10.1080/16089677.2020.1817281","DOIUrl":"https://doi.org/10.1080/16089677.2020.1817281","url":null,"abstract":"Introduction: Diabetes mellitus (DM) is a chronic metabolic disease defined by elevated blood glucose levels over a long period of time. One in 10 people are living with DM. Objective: The main purpose of this investigative study was to gain knowledge regarding the perceptions of students’ self-management living with diabetes mellitus at a tertiary institute. Methods: The Interactive Qualitative Analysis (IQA) was used to construct and describe a cognitive mind map of students’ perceptions of their self-management living with DM. Results: An analysis of the participants’ mind map representing students living with DM revealed eight main components (affinities), namely: Social awareness and acceptance, Food available on campus, Keeping insulin cool, Independent lifestyle, Adjusting by cooking, Hurdles in the academic environment, Causes of changing blood sugar and Adapting to effects of changing blood sugar. Conclusion: The final perceptual system was an informative representation of the self-management of students living with DM. The system reflects barriers to compliance with self-management facing students living with DM. The system produced four recognisable loops or cycles, namely the Ignorance loop, the Revision loop, the Developing loop and the Self-management loop. These loops created pathways through the system for the students living with DM to find a way to better self-management.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"25 1","pages":"51 - 56"},"PeriodicalIF":0.5,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79650768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1080/16089677.2020.1817282
N. Madi, F. Moosa, K. Parbhoo, J. Pettifor, K. Thandrayen
Pseudohypoparathyroidism (PHP) represents a group of disorders due to end organ resistance to the actions of parathyroid hormone (PTH) and abnormalities in the PTH signalling pathway. PHP is characterised by hypocalcaemia and hyperphosphataemia, with or without a variable expression of physical features. The constellation of these physical features together are termed Albright hereditary osteodystrophy (AHO). PHP and related disorders are primarily clinical diagnoses in our setting as confirmatory laboratory testing is not widely available. Molecular genetics is the gold standard for confirmation and categorisation of PHP into the different subtypes, but with recent advances in molecular diagnostics a pathophysiological approach appears to be more practical in the clinical setting. The aim of our report is to describe the diverse clinical features, clinical course and genetic testing of nine patients who have been followed up at our paediatric Metabolic Bone Clinic at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa.
{"title":"Pseudohypoparathyroidism presenting in children at a tertiary hospital in Johannesburg, South Africa","authors":"N. Madi, F. Moosa, K. Parbhoo, J. Pettifor, K. Thandrayen","doi":"10.1080/16089677.2020.1817282","DOIUrl":"https://doi.org/10.1080/16089677.2020.1817282","url":null,"abstract":"Pseudohypoparathyroidism (PHP) represents a group of disorders due to end organ resistance to the actions of parathyroid hormone (PTH) and abnormalities in the PTH signalling pathway. PHP is characterised by hypocalcaemia and hyperphosphataemia, with or without a variable expression of physical features. The constellation of these physical features together are termed Albright hereditary osteodystrophy (AHO). PHP and related disorders are primarily clinical diagnoses in our setting as confirmatory laboratory testing is not widely available. Molecular genetics is the gold standard for confirmation and categorisation of PHP into the different subtypes, but with recent advances in molecular diagnostics a pathophysiological approach appears to be more practical in the clinical setting. The aim of our report is to describe the diverse clinical features, clinical course and genetic testing of nine patients who have been followed up at our paediatric Metabolic Bone Clinic at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"37 1","pages":"82 - 89"},"PeriodicalIF":0.5,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77459980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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