Open Access Case Study

Topic- Euglycemic Diabetic Ketoacidosis in a Patient of Type 2 DM on Alternative Medicine Precipitated by Dengue Infection

Chandan Kumar, Mohit Gupta, Ujjwal Kumar, Anil Kumar Kem

Asian Journal of Research and Reports in Endocrinology, Page 1-4

Aim: Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus (DM) that can become life-threatening. DKA is recognized by hyperglycemia, metabolic acidosis and presence of serum and/or urine ketones. DKA can occur in the setting of normal glucose concentrations. This uncommon form of DKA is known as euglycemic DKA. The aim of this case report is to alert the physician to include euglycemic DKA in differential diagnosis for a patient presenting with dengue fever and metabolic ketoacidosis with a past history of diabetes on alternative medicine therapy.

Presentation of Case: A 70-year-old female presented to us with high grade (102 deg F), intermittent type fever for 3 days. She also reported nausea, vomiting and bilateral knee joint pain. She reported having diabetes for the last 10 years for treatment of which she was on alternative therapy medication. Laboratory workup showed dengue fever, severe metabolic acidosis and 3+ ketonuria. RBS was 186 mg/dl. She was treated with IV fluids for hydration, paracetamol (antipyretics), regular insulin and dextrose drip. Her health improved with the above-mentioned treatment.

Discussion: Euglycemic DKA is defined as DKA with BG concentration of <200 mg/d. DKA can go undiagnosed if the patient has blood sugar levels of <200 mg/dl at the time of initial presentation. Moreover, DKA occurs rarely in a patient presenting with dengue fever.

Conclusion: Euglycemic DKA is a rare presntation of DKA and thus can go undiagnosed at initial presentation. It may be seen in patients with diabetes (on alternative therapy medications) presenting with dengue fever.

Open Access Original Research Article

Evaluation of Acute and Chronic Toxicity of Tartrazine (E102) on Steriod Reproductive Hormones of Albino Rats

Ibioku Elekima, Ogechi Edna Nwachuku

Asian Journal of Research and Reports in Endocrinology, Page 1-15

Aim: To determine the acute and chronic effect of tartrazine on reproductive steroid hormones of albino rats.

Study Design: The design involved acute and chronic study. The acute study investigated intraperitoneal and oral route of administration while the chronic study used oral route only. The rats used for the study weighed 150 gm approximately. In the acute study, 48 rats (24 female and 24 male) were used for intraperitoneal treatment and were randomly selected into six groups treated with 0.0 g/kg, 1.67 g/kg, 3.33 g/kg, 5.0 g/kg, 6.67 g/kg and 8.33 g/kg of tartrazine. In orally treated rats, 48 rats (24 female and 24 male) were also used and were treated with 0.0 g/kg, 2.5 g/kg, 5.0 g/kg, 10.0 g/kg, 15.0 g/kg and 20.0 g/kg of tartrazine. In the chronic study, the experiment was divided into phase 1, 2 and 3 which lasted for 30, 60 and 90 days respectively. In each phase, 80 rats were used and were divided into treatment and control groups. The treatment groups were given 7.5 mg/kg of tartrazine orally on daily basis over a period of 30, 60 and 90 days while the control groups were not treated with tartrazine.

Place and Duration of Study: The study was carried out in the Department of Medical Laboratory Science, Rivers State University, Port Harcourt, Nigeria over a period of 12 months (December, 2017 – December, 2018).

Methodology: At the end of the acute and chronic study, 5 mls of whole blood specimens was collected by means of cardiac puncture into plain bottles. The specimens were spun at 4500 rpm for 10 minutes to obtain serum. The laboratory analysis of the hormonal parameters was based on Enzyme Linked Immunosorbent Assay (ELISA) Technique. Statistical analysis was performed using GraphPad Prism version 5.03. More so, ovarian and testicular tissues were also collected for histological examinations. These tissues were fixed in 10% formol-saline prior to tissue processing. Staining was done using Haematoxylin and Eosin stain.

Results: In acute study, female treated rats (intraperitoneally and orally) showed significantly higher values in Progesterone (PROG) and Estradiol (E2) concentrations while male treated rats (intraperitoneally and orally) indicated significantly lower values in testosterone (TESTO) concentration compared with control rats. Histopathologic examination showed flagella distortion in the seminiferous lumen, vacuolation, pycnosis, distortion of basement membrane and loss of leydig cells of the testis. More so, mild vacuolation of follicular ovarian cells were also seen. In chronic treatments, hormonal parameters after 30 days, 60 days and 90 days showed no significant differences in testosterone (TESTO), Progesterone (PROG) and Estradiol (E2) concentrations in tartrazine treated rats compared with their respective control rats. When the comparative analyses of treated groups after 30, 60 and 90 days using One-Way ANOVA were considered, testosterone (TESTO) concentration indicated significantly lower levels in treated male rats while Progesterone (PROG) showed significantly higher values over 30, 60 and 90 days in treated female rats. Histopathologic examination indicated mild changes such as flagella distortion, pycnosis and vacuolation in testicular tissues especially after 90 days of chronic treatment likewise mild vacuolation of ovarian cells.

Conclusion: In the acute study, reduction in testosterone (TESTO) concentration while increase in PROG and E2 concentrations were seen. However, in the chronic study, significant differences were not seen in testosterone (TESTO), Progesterone (PROG) and Estradiol (E2) concentrations. Finally, when the influence on duration of exposure at ADI doses (7.5 mg/kg) were considered after 30, 60 and 90 days, reduction in testosterone (TESTO) and increase in Progesterone (PROG) concentrations were seen.

Open Access Original Research Article

Utilization of Diabetes Knowledge and Glycemic Control, a Case of Butere Subcounty Hospital, Kakamega County, Kenya

Faustina L. Sakari, Kemei. K. William

Asian Journal of Research and Reports in Endocrinology, Page 1-10

Background: Lack of knowledge on diabetes and self care practices among diabetics are some of the important factors influencing the progression of diabetes and its complications.

Objective: To assess patients knowledge on diabetes and self care practices and relate this to achievement of satisfactory glycemic control.

Methodology: This was a cross sectional study at the outpatient clinic of Butere subcounty Hospital involving all diabetic patients. Data was collected using pretested structured questionnaires. Blood was drawn for random blood sugar testing. Data was analyzed for descriptive and inferential statistics using Microsoft excel 2007 and Statistical Package for Social Scientists version 22.

Results: A total of 71 patients participated in this study, 47.8% were males. Majority (29.6%) were aged between 46-55 years. Seventy three percent were married, 86.5% had secondary education and below with only 4.2% having university education. Majority (46.5%) were self employed while11.3% were retired. Forty eight percent of the patients had diabetes for more than 5 years and majorities (80%) were on oral medication. Diabetes patients had poor glycemic control with 87.3% having random blood sugar more than 8mmol/l with the mean random blood sugar of12.2 ±3.7 mmol/l. Majority of the patients (64.8%) had poor knowledge. The mean total knowledge score was 32 ± 4.3; diabetes knowledge score was 16 ± 4.2 and self care knowledge score was 15.6 ±3.9. Patients scored poorly on self care practices with more than 71% scoring less than 50% of the score. There was a negative correlation between random blood sugar and knowledge score(r = -0.340, p = 0.004).Patients with good glycemic control had knowledge mean of 37.3 ± 0.9 while those with poor glycemic control had mean of 31.2 ± 0.7. The difference was statistically significant (t = 2.999, p = 0.004).

Discussion: It is evident from this study that diabetics at Butere Subcounty Hospital do not have adequate knowledge of the diabetes especially on the self care practices aspect as more than 80% of them scored poorly. Poor knowledge in these patients was associated with unsatisfactory glycemic control. There was a negative correlation between level of knowledge and glycemic control among these patients and the correlation was statistically significant

Conclusion: Diabetic patients at Butere subcounty Hospital had low knowledge on diabetes and self care practices and this was associated with unsatisfactory glycemic control.

Recommendation: There is need to find out if knowledge deficit in these patients is the cause of unsatisfactory glycemic control.

Open Access Original Research Article

Effects of Methanolic Root Extract of Holarrhena floribunda on Liver Enzymes and Histopathology of the Ovaries and testes Tissues in Wistar Rats

Dennis Amaechi, I. P. Ekpe, B. N. Yisa

Asian Journal of Research and Reports in Endocrinology, Page 1-7

Aim: This study was conducted with the aim of investigating the effects of methanolic root extract of Holarrehna floribunda on serum activities of some liver enzymes and histopathology of the ovaries and testes tissues of the rats.

Methods: Twenty- four male and female Wistar rats (150-250 g body weight) were randomly assigned into four groups of 6 rats each. Group 1 (Control male) had taken normal rat chow and drinking water. Group 2 (Control female) had taken normal rat chow and drinking water, Group 3 (Male test group), was administered with 200 mg/kg of Holarrehna floribunda extract, Group 4 (Female test group), was administered with 200 mg/kg of Holarrehna floribunda, Group The feeding had regimens lasted for 5 weeks.

Results: The effects of administrating the extract on the serum enzymes, revealed the activity of ALT in Group 1 is 28.60±2.71U/L and Group 3 is 29.20±1.43U/L while for Groups 2 and 4 were 34.00±0.00U/L and 32.86±2.87U/L, There was significant decrease (p<0.05) in ALT between group 2 and 4 and no significant increase (p<0.05) between Group 1 and Group 3. The values of AST obtained in Group 1 is 53.00±1.87U/L and Group 3 is 33.40±2.60U/L, Group 2 and 4 were 38.00±2.50U/L and 35.43±1.91U/L. There was significant decrease (p<0.05) between Group 2 and Group 4 and a increase between Group 1and Group 3.

The histological integrity of the testes and ovary had been examined. Results revealed that for the tissues of the testes, there was no evidence of histological distortion; the oocytes and the follicles were normal. While in the extract administered group, there were large number of Leydig cells present in between the seminiferous tubules.

Conclusion: This present study exhibited that the extract has no toxic effect on the liver. The histologic results showed no disorganization and degeneration in the ovary and testes. These results can help to explain why Holarrehna floribunda might be used in improving sterility/fertility disorders of women.

Open Access Original Research Article

Explanatory Factors for Compliance to Self-Care Therapy among Type II Diabetics in Bandundu-Ville, Democratic Republic of the Congo

Désiré Lukelo Nsobani, Oscar Kolnziam Nsutier, Tshiama Claudine, Etswaka Etswaka, Nsamongo Mokoko, Kwetepey Kwete, Ndombi Suale, Chandelier Shungu Luhata, Gédéon Ngiala Bongo

Asian Journal of Research and Reports in Endocrinology, Page 1-9

Diabetes is a real public health problem and a global economic burden that affects every country. Although its management is codified, most people with diabetes are unable to keep follow-up appointments. Thus, compliance with self-care, a concordance between therapeutic prescription and patient compliance, is therefore not limited to strict drug treatment. The purpose of this study was to identify the factors that explain compliance to self-care in patients with type II diabetes in order to reduce the incidence of complications related to this century's pandemic. The survey was carried out at the General Reference Hospital of Bandundu-Ville in the Urban-Rural Health Zone of Bandundu-Ville, Kwilu province, DRC. This cross-sectional study conducted from March to April 2018, involved Type II diabetics. The sample size was determined based on the Fischer formula. So, 138 subjects were selected. The semi-structured interview was used with closed and/or open-ended questions designed on a Likert-type scale with seven choices of answers in the design of the items.

The findings show that the age varies between 46 and 76 years with an average age of 50 ±13.7 years.  However, 71.0% of respondents were married, 49.3% had a secondary education while 61.6% were in the private sector. The probability of compliance to self-care in self-care (diabetic patients) influences the perception of threats caused by the onset of the disease (p>0.000, χ2 =20.1, α = 0.05).

In conclusion, the main determinants of compliance to self-care by diabetics to meet the time required by caregivers to take diabetes mellitus medications are in the following order of importance namely the perception of threats caused by the onset of the disease and expected outcomes. On the other hand, the sense of personal effectiveness is not significantly related to the compliance to self-care.