Reference values in laboratory medicine.
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Africa↗
Biomedical subjects
A A Amayo
Publications and source records attributed to A A Amayo.
Diabetic ketoacidosis: clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi.
OBJECTIVE: To determine the clinico-laboratory features and precipitating factors of diabetic ketoacidosis (DKA) at Kenyatta National Hospital (KNH). DESIGN: Prospective cross-sectional study. SETTING: Inpatient medical and surgical wards of KNH. SUBJECTS: Adult patients aged 12 years and above with known or previously unknown diabetes hospitalised with a diagnosis of diabetic ketoacidosis. RESULTS: Over a nine month period, 48 patients had DKA out of 648 diabetic patients hospitalised within the period, one died before full evaluation. Mean (SD) age was 37 (18.12) years for males, 29.9 (14.3) for females, range of 12 to 77 years. Half of the patients were newly diagnosed. More than 90% had HbA1c > 8%, only three patients had HbA1c of 7-8.0%. More than 90% had altered level of consciousness, with almost quarter in coma, 36% had systolic hypotension, almost 75% had moderate to severe dehydration. Blunted level of consciousness was significantly associated with severe dehydration and metabolic acidosis. Over 65% patients had leucocytosis but most (55%) of them did not have overt infection. Amongst the precipitating factors, 34% had missed insulin, 23.4% had overt infection and only 6.4% had both infection and missed insulin injections. Infection sites included respiratory, genito-urinary and septicaemia. Almost thirty (29.8%) percent of the study subjects died within 48 hours of hospitalisation. CONCLUSION: Diabetic ketoacidosis occurred in about 8% of the hospitalised diabetic patients. It was a major cause of morbidity and mortality. The main precipitant factors of DKA were infections and missed insulin injections. These factors are preventable in order to improve outcomes in the diabetic patients who complicate to DKA.
Adolescent↗
Comparison of calculated and direct low density lipoprotein cholesterol determinations in a routine laboratory.
BACKGROUND: Low density lipoprotein cholesterol (LDL-C) concentrations form the basis for treatment guidelines established for hyperlipidaemic patients. LDL-C concentrations are commonly calculated using the Friedwald formula (FF) which has several limitations. Recently, direct methods for LDL-C estimation have been developed which are suitable for routine laboratories. OBJECTIVE: To compare serum LDL-C concentrations determined by a direct assay and the Friedwald formula. DESIGN: Cross-sectional study. SETTING: Mater Hospital Laboratory, Nairobi, Kenya. METHODS: The clinical performance of the two methods was evaluated by analysing 211 fresh plasma samples from fasting adult patients. The samples were divided into four groups-normolipidaemic; and Types IIa, IIb and IV hyperlipidaemias. RESULTS: The Friedwald formula (FF) correlated best with the direct assay in the normolipidaemic samples (r = 0.879; y= 0.468 + 0.852x). Direct LDL-C values were significantly lower than the FF in the Type IIa hyperlipidaemia samples (paired differences 0.38 +/- 0.62). There was only 65% agreement between the two methods in the borderline high LDL-C group of the National Cholesterol Education Program (NCEP) classification (LDL-C 3.36-4.14 mmol/L). CONCLUSION: There is lack of agreement between the FF and the Abbott direct LDL-C assay. If the two methods are used interchangeably, there may be confusion in the classification and control of lipid lowering medication for patients with hyperlipidaemia.
Adult↗
Transient focal neurological deficits in patients with hypoglycaemia and hyperglycaemia: report of four cases.
A case of hypoglycaemia and three cases of hyperglycaemia presenting with focal neurological deficits are presented. The focal presentations were hemiparesis and focal convulsion that returned to normal upon correction of the blood sugar. Elderly patients not uncommonly present with transient focal neurologic deficits related to abnormalities in blood sugar levels. In these patients correction of blood sugar levels per se may ameliorate symptoms and signs making it unnecessary to investigate for cerebrovascular disease. In diabetic patients on insulin or oral hypoglycaemic agents focal neurologic deficit should alert the clinician on the possibility of hypoglycaemia.
Aged↗