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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 16 | Issue 2
Page Nos. 43-73

Online since Monday, May 20, 2019

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REVIEW ARTICLE  

Insulin therapy in patients with type 2 diabetes mellitus p. 43
Ifedayo Adeola Odeniyi, Oluwarotimi Bolaji Olopade, Olufemi Adetola Fasanmade
DOI:10.4103/jcls.jcls_5_18  
Diabetes mellitus is a disease of metabolic dysregulation, most notably abnormal glucose metabolism, accompanied by characteristic long-term complications. The complications that are specific to diabetes include retinopathy, nephropathy, and neuropathy. To achieve glycemic goals in patients with Type 2 diabetes when multiple pharmacologic agents are failing, the early introduction of insulin is key. Our objective is to assist clinicians in designing individualized management plans for insulin therapy in patients with Type 2 diabetes mellitus. We searched Medline, PubMed, journal articles, WHO publications, and reputable textbooks relating to diabetes mellitus and insulin therapy using publications from 1992 to 2016. With the progression of Type 2 diabetes, there is ultimately progressive loss of pancreatic beta-cell function and endogenous insulin secretion. At this stage, most patients require exogenous insulin therapy to achieve optimal glucose control. Choosing from the wide variety of glucose-lowering interventions currently available could be a challenge for the health-care provider and the patients in terms of effectiveness, tolerability, and cost of the various diabetes treatments. However, these should not be the case as risk reductions in long-term complications were related to the levels of glycemic control achieved, rather than to a specific glucose-lowering agent. The challenges of initiating and intensifying insulin therapy are quite enormous and could be daunting to health-care givers. Glycemic treatment should be stepwise with swift introduction of successive interventions after treatment failure (i.e., A1C ≥7.0%). Insulin should be initiated when A1C is ≥7.0% after 2–3 months of dual oral therapy.
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ORIGINAL RESEARCH REPORTS Top

Depression-related knowledge, attitude, and help-seeking behavior among residents of Surulere Local Government Area, Lagos State, Nigeria p. 49
Chinenye C Egwuonwu, Oluchi J Kanma-Okafor, Adedoyin O Ogunyemi, Hammed O Yusuf, Joseph D Adeyemi
DOI:10.4103/jcls.jcls_90_18  
Context: Worldwide, depression leads among the causes of ill-health and disability. Therefore, it is a major public health concern. Aim: This study was carried out to determine depression-related knowledge, attitude, and help-seeking behavior among residents of Surulere Local Government Area, Lagos state, Nigeria. Settings and Design: This was a descriptive cross-sectional study. A total of 422 respondents were recruited using the multistage sampling technique. Subjects and Methods: An adapted, pretested, semi-structured, and interviewer-administered questionnaire was used to collect data. Statistical Analysis Used: Data were analyzed using EPI Info Version 7 statistical software. Results: The proportion of respondents with depressive symptoms such as loss of interest in usual activities was 30.6%. Majority of the respondents had good knowledge of depression (90.0%), positive attitude (93.2%), and good help-seeking behavior (87.9%) toward depression. Marital status was not significantly associated with the presence of depressive symptoms. However, there was a statistically significant association between employment status and the presence of depressive symptoms (P = 0.001) and the help-seeking behavior toward depression (P = 0.013); the level of education on the other hand showed a statistically significant association with both knowledge and attitude (P = 0.003, P ≤ 0.001, respectively). Conclusion: Most of the respondents had good knowledge, positive attitude, and good help-seeking behavior toward depression; however, mental health services may not be readily available. There is therefore a need to ensure the availability of good mental health services as well as public enlightenment on where and how to access these services. These can prove very useful in tackling the rising prevalence of mental health disorders.
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“Hidden fluid” in the critically ill patient: A wake-up call p. 57
Babatunde Babasola Osinaike, Arinola A Sanusi, Shete Kunle Phillips
DOI:10.4103/jcls.jcls_70_18  
Background and Aim: Fluid overload and unfavorable outcomes in critically ill patients have been demonstrated in many clinical settings, such as acute lung injury/acute respiratory distress syndrome, septic patients, and those with acute kidney injury. Fluid overload has been reported in up to 70% of patients admitted to the intensive care unit (ICU). Fluid optimization strategies are often used to prevent fluid overload. Less obvious sources of fluid intake are often overlooked. The aim of this study was to determine the contribution of intravenous medications to daily fluid intake and balance in our ICU. Methodology: We conducted a retrospective study on adult patients admitted to the ICU of the University College Hospital, Ibadan, from January to December 2015. Daily ICU record charts were reviewed to determine the sources and volumes of various fluids for the study patients. Fluid other than intravenous fluid, enteral feeds, and blood/blood products were categorized as hidden fluid. These were mainly intravenous medications. Data were analyzed using the Statistical Package for the Scientific Solutions Version 20. Results: A total of 286 patients were admitted during the study year. There were 26 nonadults (≤16 years) excluded, and the records of 74 patients were not available. The mean daily volume of drug solutions (473.4 ml) was about 16% of the mean daily intake (2846.1 ml). The percentage of hidden fluid was highest in the neurology group (26.7%). No group had <10%. The use of vasopressor was significantly associated with higher volume of hidden fluid (P = 0.001). Hidden fluid constituted 13% of the total fluid administered during the study period. Conclusion: Intravenous drug solutions were important contributions to fluid intake and balance in our review. ICU clinician should always consider this when calculating daily fluid maintenance. Further study is needed to determine their contribution to the development of fluid overload and ICU mortality.
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Awareness and practice of testicular self-examination among regular undergraduate male health sciences university students, Debre Tabor, Northwest Ethiopia p. 61
Biresaw Wassihun Alemu, Shegaw Zeleke Baih
DOI:10.4103/jcls.jcls_54_18  
Background: Testicular cancer (TC) is the most common cancer among 15–35-year-old males and the incidence is increasing. This form of cancer is easily diagnosable by testicular self-examination (TSE) and is 96% curable if detected early. Objective: To assess awareness and practice of testicular self-examination among regular undergraduate Male Health Sciences University students, Debre Tabor, North West Ethiopia. Patients and Methods: An institution-based cross-sectional study design was conducted. The study participants were stratified based on their year of study and selected by simple random sampling method. Pretested and structured self-administered questionnaire were used. The data were entered to EpiData version 3.1 statistical software and exported to Statistical Package for the Social Sciences version 22.0 for analysis. Both bivariate and multivariate logistic regression analysis were performed to identify associated factors. P <0.05 with 95% confidence level was used to declare statistical significance. Results: A total of 225 respondents were participated with a response rate of 97.3%. Of the respondents, 53% had poor knowledge toward TC and 78% had poor practice toward TSE. The major reason 64.0% for poor practice of TSEs was inability to carry out the examination. Students in clinical year were more knowledgeable toward TSE with adjusted odds ratio (AOR = 5.27 [95% confidence interval (CI); 2.04, 13.66]) as compared to preclinical year and students in clinical year had good practice toward TSE with (AOR = 2.71 [95% CI; 1.10, 6.68]) than preclinical year of study. Conclusion: knowledge and practice of TSE among respondents were poor. The reason not to perform TSE, as revealed in the study was not caring the examination and lack of knowledge toward TSE. They are unaware of their risk for TC, which is the most common neoplasm in this age group. Providing regular health education toward TSE is important to improve the knowledge of.
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Management of Wilm's tumor at the Lagos University Teaching Hospital (a 10-year retrospective study) p. 68
Adetutu B Mabadeje-Isowo, Anthonia C Sowunmi, Abdulrasaq R Oyesegun, Adeniyi Adenipekun, Kingsley K Ketiku, Uchenna Samuel Okoro
DOI:10.4103/jcls.jcls_80_18  
Background: Wilms' tumor (WT), also known as nephroblastoma, is the most frequently diagnosed renal tumor in children, accounting for 6% of all childhood tumors. It is relatively more common in blacks and majority of cases are diagnosed within the first 3 years of life. Aim: The study aimed to review the prevalence, pattern of presentation, and management outcome of WT at the Lagos University Teaching Hospital (LUTH). Methodology: This is a retrospective study of patients diagnosed with WT at LUTH between January 2004 and December 2013. Results: A total of 108 patients were retrieved for this study. Sixty (55.56%) patients were male and 48 (44.44%) were female with a male-to-female ratio of 1.25:1. The age range was from 9 months to 11 years with a mean age of 4 (standard deviation: ±2.37) years. The most common mode of presentation was an abdominal mass, and 66.67% of the patients presented with Stages III–V. Fifty percent of the patients had complete response following treatment (chemotherapy [CHT]) and 33 (30.6%) patients had partial response (i.e., 30% reduction in tumor size). Twenty-one (19.4%) patients had a progression of disease despite the treatment. Eleven (20.37%) had recurrence after 5 years of completing their treatment. Disease-free survival rate at 5-year posttreatment was 31.48%. Conclusion: Most of the patients presented with advanced disease at diagnosis resulting in poor response and survival. Early presentation and diagnosis will improve the results. Combination treatment with surgery and CHT gives the best results.
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