Pub Date : 2020-09-01DOI: 10.1080/16089677.2020.1817283
Oppah Kuguyo, Chengeto Muhaso, Simbarashe Nyandoro, J. Chirenda, V. Chikwasha, A. Mageza, L. Gwanzura, D. Mukona, A. Matimba
Background: Poor management of diabetes mellitus gives rise to complications such as diabetic foot (DF), which pose a host of medical and socioeconomic problems, especially in low-income countries where resources, capacity and awareness are limited. Aim: This study purposed to identify local factors influencing poor management of diabetes and, therefore, increasing risk of DF in Zimbabwe. Method: This study utilised a descriptive qualitative design with a purposive sample of 30 nurses from 14 polyclinics and 2 major referral hospitals in Harare, Zimbabwe. Four focus-group discussions were conducted following a semi-structured interview guide with sections addressing commonly encountered socio-economic, cultural and behavioural factors, which potentially increase the risk of DF complications among diagnosed and undiagnosed diabetic individuals. Thematic analysis was used to analyse the data. Results: Four major themes were identified including poor socioeconomic status, poor self-care, religious and cultural factors, and health-system-related factors. Lack of awareness results in poor health-seeking behaviour, and use of unconventional treatment methods, which may increase DF risk among people living with diabetes, both diagnosed and undiagnosed. Conclusion: Appropriately tailored education and awareness interventions taking into account local socio-economic and cultural factors are key to the prevention of DF and promotion of self-management activities.
{"title":"Perspectives of healthcare workers on factors influencing diabetes management and diabetic foot problems in Zimbabwe","authors":"Oppah Kuguyo, Chengeto Muhaso, Simbarashe Nyandoro, J. Chirenda, V. Chikwasha, A. Mageza, L. Gwanzura, D. Mukona, A. Matimba","doi":"10.1080/16089677.2020.1817283","DOIUrl":"https://doi.org/10.1080/16089677.2020.1817283","url":null,"abstract":"Background: Poor management of diabetes mellitus gives rise to complications such as diabetic foot (DF), which pose a host of medical and socioeconomic problems, especially in low-income countries where resources, capacity and awareness are limited. Aim: This study purposed to identify local factors influencing poor management of diabetes and, therefore, increasing risk of DF in Zimbabwe. Method: This study utilised a descriptive qualitative design with a purposive sample of 30 nurses from 14 polyclinics and 2 major referral hospitals in Harare, Zimbabwe. Four focus-group discussions were conducted following a semi-structured interview guide with sections addressing commonly encountered socio-economic, cultural and behavioural factors, which potentially increase the risk of DF complications among diagnosed and undiagnosed diabetic individuals. Thematic analysis was used to analyse the data. Results: Four major themes were identified including poor socioeconomic status, poor self-care, religious and cultural factors, and health-system-related factors. Lack of awareness results in poor health-seeking behaviour, and use of unconventional treatment methods, which may increase DF risk among people living with diabetes, both diagnosed and undiagnosed. Conclusion: Appropriately tailored education and awareness interventions taking into account local socio-economic and cultural factors are key to the prevention of DF and promotion of self-management activities.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"76 1","pages":"57 - 62"},"PeriodicalIF":0.5,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81400837","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 : 2020-08-11DOI: 10.1080/16089677.2020.1793488
S. Pillay
Background: The diabetes pandemic continues to cause both patient and economic burden. Globally, strategies to improve glycaemic control in patients with diabetes are highly sought after. One such strategy involves the use of point-of-care glycated haemoglobin (POCT HbA1c) testing, which provides clinicians with rapid information on glycaemic control and also may assist with a diagnosis of diabetes in others. Methods: This pilot study was conducted over three months (December 2019–February 2020) at 21 KwaZulu-Natal (KZN) public healthcare facilities. All patients presenting to the triage units of these facilities had their diabetic history taken and POCT HbA1c, together with their random blood glucose, tested and recorded by nursing staff. These data were forwarded to the Department of Health. Results: A total of 3 541 patients were included in study, 1 306 with diabetes and 2 235 with no prior diabetes history. The median (+IQR) HbA1c% achieved in the diabetes cohort was 6.0 (5.2–8.1) with 32.39% of these patients not achieving target glycaemic control (HbA1c < 7%). This study revealed that a significant proportion of the patients with no history of diabetes mellitus (DM) had evidence of diabetes (HbA1c > 6.5%) and pre-diabetes (HbA1c 5.7–6.4%) (45.59% vs. 19.5%, respectively). A total of 361 (16.51%) of these asymptomatic patients with no history of DM had random blood glucose levels of ≥ 11.1 mmol/l. There were significant inter-facility differences noted with regard to the number of patients with diabetes achieving target glycaemic control. Conclusion: This study found that at least one-third of diabetes patients attending these KZN healthcare facilities had sub-optimal control. There was a significant percentage of patients without prior history of DM who had glycaemic levels suggesting dysglycaemia (pre-diabetes and overt diabetes). The Government needs to heed the results of such studies to develop strategies targeting this group of previously undiagnosed diabetes patients. HbA1c point-of-care testing provides one avenue of intervention for both groups of patients.
{"title":"Pilot study involving the use of point-of-care glycated haemoglobin (HbA1c) testing for screening and monitoring of diabetes mellitus in the public healthcare sector in KwaZulu-Natal","authors":"S. Pillay","doi":"10.1080/16089677.2020.1793488","DOIUrl":"https://doi.org/10.1080/16089677.2020.1793488","url":null,"abstract":"Background: The diabetes pandemic continues to cause both patient and economic burden. Globally, strategies to improve glycaemic control in patients with diabetes are highly sought after. One such strategy involves the use of point-of-care glycated haemoglobin (POCT HbA1c) testing, which provides clinicians with rapid information on glycaemic control and also may assist with a diagnosis of diabetes in others. Methods: This pilot study was conducted over three months (December 2019–February 2020) at 21 KwaZulu-Natal (KZN) public healthcare facilities. All patients presenting to the triage units of these facilities had their diabetic history taken and POCT HbA1c, together with their random blood glucose, tested and recorded by nursing staff. These data were forwarded to the Department of Health. Results: A total of 3 541 patients were included in study, 1 306 with diabetes and 2 235 with no prior diabetes history. The median (+IQR) HbA1c% achieved in the diabetes cohort was 6.0 (5.2–8.1) with 32.39% of these patients not achieving target glycaemic control (HbA1c < 7%). This study revealed that a significant proportion of the patients with no history of diabetes mellitus (DM) had evidence of diabetes (HbA1c > 6.5%) and pre-diabetes (HbA1c 5.7–6.4%) (45.59% vs. 19.5%, respectively). A total of 361 (16.51%) of these asymptomatic patients with no history of DM had random blood glucose levels of ≥ 11.1 mmol/l. There were significant inter-facility differences noted with regard to the number of patients with diabetes achieving target glycaemic control. Conclusion: This study found that at least one-third of diabetes patients attending these KZN healthcare facilities had sub-optimal control. There was a significant percentage of patients without prior history of DM who had glycaemic levels suggesting dysglycaemia (pre-diabetes and overt diabetes). The Government needs to heed the results of such studies to develop strategies targeting this group of previously undiagnosed diabetes patients. HbA1c point-of-care testing provides one avenue of intervention for both groups of patients.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"17 1","pages":"63 - 69"},"PeriodicalIF":0.5,"publicationDate":"2020-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87712299","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 : 2020-08-05DOI: 10.1080/16089677.2020.1793487
R. Makan, C. V. Vuuren
A case of necrotising migratory erythema (NME), which is one of the distinctive paraneoplastic skin manifestations associated with the glucagonoma syndrome, is described and discussed. In 80% of all patients with glucagonoma, NME is the first clinical sign. The glucagonoma syndrome is a constellation of clinical features: NME, weight loss, anaemia, diabetes, diarrhoea, thromboembolism and neuropsychiatric symptoms. The global incidence of glucagonoma is one in 20 million people per year. The male to female ratio is 0.8:1 with the mean age of diagnosis being 52.2 years. The median time in relation to the initial onset of symptoms and the correct diagnosis is 3.5 years. The 10-year survival rate in patients with metastatic disease is 51.6% and without metastatic disease 64.3%. SPECT scan has a sensitivity range of 67–100% for detecting neuroendocrine tumours. Differential diagnoses of other skin conditions that mimic NME are: bullous pemphigoid, vasculitis, acrodermatitis enteropathica, chronic mucocutaneous candidiasis, seborrhoeic dermatitis, contact dermatitis, pellagra, inflammatory bowel disease, liver cirrhosis, coeliac disease, chemical burns, eczema, herpes etc. A satisfactory response to somatostatin as medical therapy in a case-study patient with metastatic disease is reported.
{"title":"Necrotising migratory erythema leading to the diagnosis of a metastatic glucagonoma without diabetes","authors":"R. Makan, C. V. Vuuren","doi":"10.1080/16089677.2020.1793487","DOIUrl":"https://doi.org/10.1080/16089677.2020.1793487","url":null,"abstract":"A case of necrotising migratory erythema (NME), which is one of the distinctive paraneoplastic skin manifestations associated with the glucagonoma syndrome, is described and discussed. In 80% of all patients with glucagonoma, NME is the first clinical sign. The glucagonoma syndrome is a constellation of clinical features: NME, weight loss, anaemia, diabetes, diarrhoea, thromboembolism and neuropsychiatric symptoms. The global incidence of glucagonoma is one in 20 million people per year. The male to female ratio is 0.8:1 with the mean age of diagnosis being 52.2 years. The median time in relation to the initial onset of symptoms and the correct diagnosis is 3.5 years. The 10-year survival rate in patients with metastatic disease is 51.6% and without metastatic disease 64.3%. SPECT scan has a sensitivity range of 67–100% for detecting neuroendocrine tumours. Differential diagnoses of other skin conditions that mimic NME are: bullous pemphigoid, vasculitis, acrodermatitis enteropathica, chronic mucocutaneous candidiasis, seborrhoeic dermatitis, contact dermatitis, pellagra, inflammatory bowel disease, liver cirrhosis, coeliac disease, chemical burns, eczema, herpes etc. A satisfactory response to somatostatin as medical therapy in a case-study patient with metastatic disease is reported.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"74 1","pages":"80 - 81"},"PeriodicalIF":0.5,"publicationDate":"2020-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86351317","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 : 2020-05-03DOI: 10.1080/16089677.2020.1782007
AT Thompson, J. Bruce, V. Kong, D. Clarke, C. Aldous
Background: Healthcare policy decisions are driven by many factors, including cost, hence the need to show costs of diabetes mellitus-related lower limb amputations (DMLLA) to inform amendments to health care. Substantial decreases in amputation rates are associated with specialised podiatry foot clinics and ongoing foot education, as per national guidelines on the multidisciplinary team approach (MDTA) to diabetes health care. There are only two podiatry posts in KwaZulu-Natal (KZN) state health department (DoH). Objectives: Aims were to draft the medical costs for 660 DMLLA at Greys Hospital for the period 2013–2017; to extrapolate costs on annual DMLLA in KZN; to outline socio-economic costs for future investigation; to present evidence that podiatry in the MDTA can decrease numbers of DMLLA. Methods: A retrospective review on clinical data captured in real time and maintained by the Pietermaritzburg Metropolitan Trauma Service (PMTS) and Surgical Service (PMSS) was performed. Costs were analysed on data for 660 patients’ DMLLA at Greys Hospital between 2013 and 2017, and psychological and socio-economic costs via literature review. Results: Medical care at Greys Hospital for 660 DMLLA in the five years cost in excess of ZAR 213 million. Extrapolated to the 1 231 diabetic amputations (2014) equals an annual cost to KZN DoH in excess of ZAR 398 million. Personal, family loss and socio-economic costs are estimated in excess of ZAR five million per amputee, resulting in further cost of ZAR 6.155 billion per annum to KZN. Extrapolation across 11 provinces signifies a national cost of at least ZAR 68 billion. Conclusions: We present a gauge of the cost of DMLLA to KZN and national health. Substantial possible socio-economic losses compound these. The role of podiatrists within MDTA teams has an evidence base to prevent DMLLA.
{"title":"Counting the cost of preventable diabetes-related lower limb amputations at a single district hospital in KwaZulu-Natal: what does this mean, what can be done?","authors":"AT Thompson, J. Bruce, V. Kong, D. Clarke, C. Aldous","doi":"10.1080/16089677.2020.1782007","DOIUrl":"https://doi.org/10.1080/16089677.2020.1782007","url":null,"abstract":"Background: Healthcare policy decisions are driven by many factors, including cost, hence the need to show costs of diabetes mellitus-related lower limb amputations (DMLLA) to inform amendments to health care. Substantial decreases in amputation rates are associated with specialised podiatry foot clinics and ongoing foot education, as per national guidelines on the multidisciplinary team approach (MDTA) to diabetes health care. There are only two podiatry posts in KwaZulu-Natal (KZN) state health department (DoH). Objectives: Aims were to draft the medical costs for 660 DMLLA at Greys Hospital for the period 2013–2017; to extrapolate costs on annual DMLLA in KZN; to outline socio-economic costs for future investigation; to present evidence that podiatry in the MDTA can decrease numbers of DMLLA. Methods: A retrospective review on clinical data captured in real time and maintained by the Pietermaritzburg Metropolitan Trauma Service (PMTS) and Surgical Service (PMSS) was performed. Costs were analysed on data for 660 patients’ DMLLA at Greys Hospital between 2013 and 2017, and psychological and socio-economic costs via literature review. Results: Medical care at Greys Hospital for 660 DMLLA in the five years cost in excess of ZAR 213 million. Extrapolated to the 1 231 diabetic amputations (2014) equals an annual cost to KZN DoH in excess of ZAR 398 million. Personal, family loss and socio-economic costs are estimated in excess of ZAR five million per amputee, resulting in further cost of ZAR 6.155 billion per annum to KZN. Extrapolation across 11 provinces signifies a national cost of at least ZAR 68 billion. Conclusions: We present a gauge of the cost of DMLLA to KZN and national health. Substantial possible socio-economic losses compound these. The role of podiatrists within MDTA teams has an evidence base to prevent DMLLA.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"71 1","pages":"44 - 50"},"PeriodicalIF":0.5,"publicationDate":"2020-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85186918","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 : 2020-05-03DOI: 10.1080/16089677.2020.1748321
M. Z. Hoosen, I. Paruk, F. Pirie, A. Motala
Aim: To assess control and morbidity in patients with type 1 diabetes mellitus (T1 attending a tertiary adult diabetes clinic in Durban, South Africa. Methods: A retrospective chart review of all patients with T1D who attended clinic in the years 2006, 2012 and 2015. Clinical and laboratory changes were assessed at an individual patient-level follow-up (IPLF) and whole clinic level (n = 231). Results: In the IPLF study arm (n = 58; 45% Black patients; 62% female; median age 18 years), mean HbA1c [% (mmol/mol)] decreased from 9.9 ± 2.6% (85 ± 28) in 2006 to 8.7 ± 1.5% (72 ± 16) in 2012 (p < 0.001) and to 9.1 ± 1.7% (76 ± 19) in 2015 (p = 0.03); target HbA1c < 7.0% (< 53 mmol/mol) was achieved in 7.1%, 5.3% and 8.3%, respectively. Compared with 2006, in 2015 there was a higher prevalence of retinopathy (10.3% vs. 29.3%, p = 0.004), abnormal glomerular filtration rate (0% vs. 6.9%, p = 0.04) and abnormal serum creatinine (0% vs. 8.6%, p = 0.02). Predictive risk factors for new retinopathy included diabetes duration (OR 1.4; 95% CI 1.0–1.3; p = 0.03) and diastolic blood pressure (OR 1.15; 95% CI 1.0–1.3; p = 0.04). Conclusion: Glycaemic control improved over 10 years, but fell short of recommended targets. Intensive efforts are required to achieve current targets for glycaemic and non-glycaemic control.
目的:评估在南非德班三级成人糖尿病诊所就诊的1型糖尿病(T1)患者的控制和发病率。方法:回顾性分析2006年、2012年和2015年就诊的所有T1D患者。临床和实验室变化在个体患者水平随访(IPLF)和整个临床水平(n = 231)进行评估。结果:在IPLF研究组(n = 58;黑人占45%;62%的女性;平均HbA1c [% (mmol/mol)]由2006年的9.9±2.6%(85±28)降至2012年的8.7±1.5%(72±16)(p < 0.001)， 2015年降至9.1±1.7%(76±19)(p = 0.03);HbA1c < 7.0% (< 53 mmol/mol)的达标比例分别为7.1%、5.3%和8.3%。与2006年相比，2015年视网膜病变(10.3% vs. 29.3%， p = 0.004)、肾小球滤过率异常(0% vs. 6.9%， p = 0.04)和血清肌酐异常(0% vs. 8.6%， p = 0.02)的患病率较高。新发视网膜病变的预测危险因素包括糖尿病病程(OR 1.4;95% ci 1.0-1.3;p = 0.03)和舒张压(OR 1.15;95% ci 1.0-1.3;P = 0.04)。结论:血糖控制在10年内有所改善，但仍未达到推荐目标。要达到血糖控制和非血糖控制的当前目标，需要进行大量的努力。
{"title":"Trends in glycaemic control and morbidity over 10 years in patients with type 1 diabetes mellitus at Inkosi Albert Luthuli Central Hospital","authors":"M. Z. Hoosen, I. Paruk, F. Pirie, A. Motala","doi":"10.1080/16089677.2020.1748321","DOIUrl":"https://doi.org/10.1080/16089677.2020.1748321","url":null,"abstract":"Aim: To assess control and morbidity in patients with type 1 diabetes mellitus (T1 attending a tertiary adult diabetes clinic in Durban, South Africa. Methods: A retrospective chart review of all patients with T1D who attended clinic in the years 2006, 2012 and 2015. Clinical and laboratory changes were assessed at an individual patient-level follow-up (IPLF) and whole clinic level (n = 231). Results: In the IPLF study arm (n = 58; 45% Black patients; 62% female; median age 18 years), mean HbA1c [% (mmol/mol)] decreased from 9.9 ± 2.6% (85 ± 28) in 2006 to 8.7 ± 1.5% (72 ± 16) in 2012 (p < 0.001) and to 9.1 ± 1.7% (76 ± 19) in 2015 (p = 0.03); target HbA1c < 7.0% (< 53 mmol/mol) was achieved in 7.1%, 5.3% and 8.3%, respectively. Compared with 2006, in 2015 there was a higher prevalence of retinopathy (10.3% vs. 29.3%, p = 0.004), abnormal glomerular filtration rate (0% vs. 6.9%, p = 0.04) and abnormal serum creatinine (0% vs. 8.6%, p = 0.02). Predictive risk factors for new retinopathy included diabetes duration (OR 1.4; 95% CI 1.0–1.3; p = 0.03) and diastolic blood pressure (OR 1.15; 95% CI 1.0–1.3; p = 0.04). Conclusion: Glycaemic control improved over 10 years, but fell short of recommended targets. Intensive efforts are required to achieve current targets for glycaemic and non-glycaemic control.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"1 1","pages":"36 - 43"},"PeriodicalIF":0.5,"publicationDate":"2020-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76394729","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 : 2020-04-16DOI: 10.1080/16089677.2020.1732690
Z. Dire, F. Raal
Insulinomas are rare functional neuroendocrine tumours. These tumours present with symptoms of hypoglycaemia, adrenergic and neuroglycopenic symptoms. Insulinomas are usually small in size, making them difficult to locate. Diagnosis is often delayed in these cases resulting in lasting neurological complications, often not reversible after surgical removal of the insulinoma. We report a case of a 33-year-old HIV-positive female with delayed presentation of an insulinoma. She presented with a long history of neurological symptoms with lasting neurological sequelae and poor functional status, during which time the diagnosis of insulinoma was repeatedly missed.
{"title":"An unusual presentation of insulinoma and the serious consequences of delayed diagnosis","authors":"Z. Dire, F. Raal","doi":"10.1080/16089677.2020.1732690","DOIUrl":"https://doi.org/10.1080/16089677.2020.1732690","url":null,"abstract":"Insulinomas are rare functional neuroendocrine tumours. These tumours present with symptoms of hypoglycaemia, adrenergic and neuroglycopenic symptoms. Insulinomas are usually small in size, making them difficult to locate. Diagnosis is often delayed in these cases resulting in lasting neurological complications, often not reversible after surgical removal of the insulinoma. We report a case of a 33-year-old HIV-positive female with delayed presentation of an insulinoma. She presented with a long history of neurological symptoms with lasting neurological sequelae and poor functional status, during which time the diagnosis of insulinoma was repeatedly missed.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"10 1","pages":"28 - 30"},"PeriodicalIF":0.5,"publicationDate":"2020-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84450094","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 : 2020-03-23DOI: 10.1080/16089677.2020.1732691
Zareena Angamia, F. Raal
Although rare, the presentation of the genetic disease spectrum associated with lysosomal acid lipase (LAL) deficiency, a disorder named cholesteryl ester storage disease (CESD) or the more severe form of Wolman's disease, is an important condition to recognise. LAL plays an essential role in lipid catabolism and a deficiency in this enzyme results in accumulation of cholesterol esters in multiple tissues. The first clinical manifestation is often hepatomegaly, despite the multi-system nature of the disorder. Other associated features include splenomegaly, adrenal calcification, malabsorption, hypercholesterolaemia or mixed hyperlipidaemia predisposing to premature atherosclerosis, as well as liver dysfunction, which can lead to cirrhosis and liver failure. Diagnosis can be made through genetic screening, LAL activity measurement or on liver biopsy. Recent advances in treatment of LAL deficiency have been made with development of a recombinant human LAL (sebelipase alpha). Adjunctive treatment with lipid-lowering therapy continues to be standard management.
{"title":"An unusual case of hypercholesterolaemia with liver dysfunction","authors":"Zareena Angamia, F. Raal","doi":"10.1080/16089677.2020.1732691","DOIUrl":"https://doi.org/10.1080/16089677.2020.1732691","url":null,"abstract":"Although rare, the presentation of the genetic disease spectrum associated with lysosomal acid lipase (LAL) deficiency, a disorder named cholesteryl ester storage disease (CESD) or the more severe form of Wolman's disease, is an important condition to recognise. LAL plays an essential role in lipid catabolism and a deficiency in this enzyme results in accumulation of cholesterol esters in multiple tissues. The first clinical manifestation is often hepatomegaly, despite the multi-system nature of the disorder. Other associated features include splenomegaly, adrenal calcification, malabsorption, hypercholesterolaemia or mixed hyperlipidaemia predisposing to premature atherosclerosis, as well as liver dysfunction, which can lead to cirrhosis and liver failure. Diagnosis can be made through genetic screening, LAL activity measurement or on liver biopsy. Recent advances in treatment of LAL deficiency have been made with development of a recombinant human LAL (sebelipase alpha). Adjunctive treatment with lipid-lowering therapy continues to be standard management.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"23 1","pages":"31 - 35"},"PeriodicalIF":0.5,"publicationDate":"2020-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/16089677.2020.1732691","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72526910","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 : 2020-02-10DOI: 10.1080/16089677.2020.1722402
Helen Hoenck, W. Conradie, M. Conradie, A. Coetzee
Metastasis of a neuroendocrine tumour (NET) to the orbit is a rare occurrence, with published data limited to a few case reports. Orbital involvement usually presents with proptosis and decreased ocular mobility. Timing, in relation to the presentation of the primary tumour (PT), varies. The authors report a case of a 58-year-old female whose clinical presentation of orbital metastases preceded clinical suspicion of a midgut NET. Her presentation was with severe headaches and bilateral ptosis, histologically proven to be due to orbital muscle infiltration. The PT location was determined from the histopathological markers on orbital muscle biopsy, which suggested a gastrointestinal origin. Abdominal computed tomography (CT) was in keeping with a midgut NET with features characteristic of a desmoplastic reaction. Additional CT findings were widespread metastases, corroborated by nuclear imaging. The patient developed carcinoid syndrome and subsequently underwent surgical resection of the PT due to acute bowel obstruction. Her carcinoid symptoms and ocular findings improved on continued somatostatin receptor analogue therapy, but she sadly died within one month following surgery.
{"title":"Midgut neuroendocrine tumour presenting as orbital metastases","authors":"Helen Hoenck, W. Conradie, M. Conradie, A. Coetzee","doi":"10.1080/16089677.2020.1722402","DOIUrl":"https://doi.org/10.1080/16089677.2020.1722402","url":null,"abstract":"Metastasis of a neuroendocrine tumour (NET) to the orbit is a rare occurrence, with published data limited to a few case reports. Orbital involvement usually presents with proptosis and decreased ocular mobility. Timing, in relation to the presentation of the primary tumour (PT), varies. The authors report a case of a 58-year-old female whose clinical presentation of orbital metastases preceded clinical suspicion of a midgut NET. Her presentation was with severe headaches and bilateral ptosis, histologically proven to be due to orbital muscle infiltration. The PT location was determined from the histopathological markers on orbital muscle biopsy, which suggested a gastrointestinal origin. Abdominal computed tomography (CT) was in keeping with a midgut NET with features characteristic of a desmoplastic reaction. Additional CT findings were widespread metastases, corroborated by nuclear imaging. The patient developed carcinoid syndrome and subsequently underwent surgical resection of the PT due to acute bowel obstruction. Her carcinoid symptoms and ocular findings improved on continued somatostatin receptor analogue therapy, but she sadly died within one month following surgery.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"32 1","pages":"24 - 27"},"PeriodicalIF":0.5,"publicationDate":"2020-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82952538","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 : 2020-01-02DOI: 10.1080/16089677.2019.1692478
Simbarashe B Mhishi, D. V. van Zyl
Background: A patient-centred approach with self-monitoring of blood glucose (SMBG) has emerged as the preferred approach in monitoring and managing blood glucose. The success of SMBG in diabetes treatment and management relies heavily on the accurate and reproducible measurement of blood glucose values. Aim: To evaluate whether patients and healthcare professionals can accurately estimate blood glucose using photometric strips, by visually matching them to colorimetric charts. Methods: A cross-sectional study design was used with participants enrolled from patients and healthcare providers attending and working at the Diabetes Clinic of Kalafong Provincial Tertiary Hospital (KPTH). A convenience sample of 144 patients and 10 healthcare professionals was enrolled. Results: Limits of agreement of patient and healthcare professional visual estimates were 11.1 to 10.4 mmol/l and 6.7 to 5.7 mmol/l, respectively. The mean difference for estimates by healthcare professionals was 0.8 mmol/l (95% CI 1.30–0.31 mmol/l) while patient estimates had a mean difference of 0.4 mmol/l (95% CI 1.2−0.5 mmol/l). Conclusions: The study noted that visual colour matching was inexact and generally would overestimate blood glucose. Healthcare professionals gave visual estimates that were more accurate in comparison with patients.
背景:以患者为中心的自我血糖监测(SMBG)已成为监测和管理血糖的首选方法。SMBG在糖尿病治疗和管理中的成功在很大程度上依赖于准确和可重复的血糖值测量。目的:评估患者和医疗保健专业人员是否可以准确地估计血糖使用光度条，通过视觉匹配他们比色图。方法:采用横断面研究设计，参与者来自卡拉丰省三级医院(KPTH)糖尿病诊所的患者和医疗保健提供者。纳入了144名患者和10名医疗保健专业人员的方便样本。结果:患者和卫生保健专业人员的视觉估计值的一致限分别为11.1 ~ 10.4 mmol/l和6.7 ~ 5.7 mmol/l。卫生保健专业人员估计的平均差异为0.8 mmol/l (95% CI 1.30-0.31 mmol/l)，而患者估计的平均差异为0.4 mmol/l (95% CI 1.2 - 0.5 mmol/l)。结论:该研究指出，视觉颜色匹配是不准确的，通常会高估血糖。与患者相比，医疗保健专业人员给出的视觉估计更准确。
{"title":"Evaluation of the accuracy of visual glucose estimates by healthcare providers and patients at Kalafong Hospital, City of Tshwane, South Africa","authors":"Simbarashe B Mhishi, D. V. van Zyl","doi":"10.1080/16089677.2019.1692478","DOIUrl":"https://doi.org/10.1080/16089677.2019.1692478","url":null,"abstract":"Background: A patient-centred approach with self-monitoring of blood glucose (SMBG) has emerged as the preferred approach in monitoring and managing blood glucose. The success of SMBG in diabetes treatment and management relies heavily on the accurate and reproducible measurement of blood glucose values. Aim: To evaluate whether patients and healthcare professionals can accurately estimate blood glucose using photometric strips, by visually matching them to colorimetric charts. Methods: A cross-sectional study design was used with participants enrolled from patients and healthcare providers attending and working at the Diabetes Clinic of Kalafong Provincial Tertiary Hospital (KPTH). A convenience sample of 144 patients and 10 healthcare professionals was enrolled. Results: Limits of agreement of patient and healthcare professional visual estimates were 11.1 to 10.4 mmol/l and 6.7 to 5.7 mmol/l, respectively. The mean difference for estimates by healthcare professionals was 0.8 mmol/l (95% CI 1.30–0.31 mmol/l) while patient estimates had a mean difference of 0.4 mmol/l (95% CI 1.2−0.5 mmol/l). Conclusions: The study noted that visual colour matching was inexact and generally would overestimate blood glucose. Healthcare professionals gave visual estimates that were more accurate in comparison with patients.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"73 1","pages":"18 - 23"},"PeriodicalIF":0.5,"publicationDate":"2020-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90964401","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 : 2020-01-02DOI: 10.1080/16089677.2019.1680008
A. Coetzee, Jocelynn Ann Hellig, Candice Sher-Lockitz, Annelize Barnard, V. Thomas, M. Conradie
Ovarian neoplasms are rare tumours of steroid cell origin. These tumours present clinically due to the associated excess production of either androgenic or oestrogenic gonadal steroid hormones. The clinical picture is dictated by the specific hormone(s) produced and influenced by the age of the patient. The case is a 59-year-old woman who presented with a five-year history suggestive of androgen excess. She underwent a hysterectomy and right-sided oophorectomy at age 28 years for dysfunctional uterine bleeding. Virilisation was confirmed on clinical examination and the testosterone excess biochemically localised to the ovaries. A left-sided oophorectomy was performed. The clinical picture and testosterone excess persisted after surgery. Follow-up radiological investigations identified adnexal material that on resection proved to be remnant ovarian tissue. Histopathology confirmed the presence of a steroid cell tumour within the remnant tissue. The biochemical androgen excess resolved and the clinical features improved dramatically.
{"title":"Virilising ovarian tumour in a postmenopausal woman after bilateral oophorectomy","authors":"A. Coetzee, Jocelynn Ann Hellig, Candice Sher-Lockitz, Annelize Barnard, V. Thomas, M. Conradie","doi":"10.1080/16089677.2019.1680008","DOIUrl":"https://doi.org/10.1080/16089677.2019.1680008","url":null,"abstract":"Ovarian neoplasms are rare tumours of steroid cell origin. These tumours present clinically due to the associated excess production of either androgenic or oestrogenic gonadal steroid hormones. The clinical picture is dictated by the specific hormone(s) produced and influenced by the age of the patient. The case is a 59-year-old woman who presented with a five-year history suggestive of androgen excess. She underwent a hysterectomy and right-sided oophorectomy at age 28 years for dysfunctional uterine bleeding. Virilisation was confirmed on clinical examination and the testosterone excess biochemically localised to the ovaries. A left-sided oophorectomy was performed. The clinical picture and testosterone excess persisted after surgery. Follow-up radiological investigations identified adnexal material that on resection proved to be remnant ovarian tissue. Histopathology confirmed the presence of a steroid cell tumour within the remnant tissue. The biochemical androgen excess resolved and the clinical features improved dramatically.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"205 1","pages":"1 - 5"},"PeriodicalIF":0.5,"publicationDate":"2020-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72952492","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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