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Objective: To determine the prevalence of mcroalbuminuria in type 2 diabetes from Papua new Guinea and examine its association with glycaemic control, blood pressure and duration of diabetes., Design: Prospective, type 2 Melanesian diabetics attending a diabetic clinic., Setting: 800 bed teaching hospital in Port Moresby, Papua New Guinea., Main Outcome Measures: Microalbuminuria, glycaemic control, systolic and diastolic blood pressure, serum creatinine, duration of diabetes., Results: Microalbuminuria was detected in 42% (34 males and 37 females of mean age 41 years) with significantly (p = 0.007) higher values being observed in males. Hypertension was present in 16.9% of diabetics. Both systolic and diastolic blood pressure measurements were significantly higher in diabetics with microalbuminuria. There were no significant differences in age, Body Mass Index (BMI), and glycaemic control in patients with or without microalbuminuria. On regression analysis, the presence of microalbuminuria was found to be independent of glycaemic control, duration of disease, (BMI), but influenced strongly by diastolic blood pressure (p = 0.002) and to a lesser degree by age (p = 0.043)., Conclusion: There was a high prevalence of mcroalbuminuria, which was independent of glycaemic control, BMI and duration of disease. The presence of microalbuminuria was influenced by diastolic blood pressure and age. Patients with elevated creatinine levels were also found to be at risk.

Objective: To study the frequency, outcome and association with neurological signs and symptoms of severe hyponatraemia (< 120 mmol/l) in adult hospitalised patients., Design: Retrospective study of severe hyponatraemia using laboratory data to identify patients., Setting: 800 bed peri-urban hospital in the former homeland of Transkei., Subjects: All adult inpatients from the medical and surgical wards with severe hyponatraemia during a 10 month period of which 18 cases records could not be traced and one was antefactual., Main Outcome Measures: Incidence of severe hyponatraemia, mortality, admission hyponatraemia, hospital acquired hyponatraemia, neurological symptoms and outcome., Results: The overall incidence of severe hyponatraemia was 1.1%. Among the 58 patients (mean age 49.3 years), pulmonary tuberculosis (24%), Diabetes mellitus (19%) and renal failure (17.2%) were the principal aetiological conditions occurring in approximately 60% of hyponatraemic patients. A high mortality rate of 44.8% was observed which was probably associated with the severity of the underlying disease. 36.2% of patients had serum sodium levels of less than 115 mmol/l with a significantly (p < 0.05) higher mortality (62%) than those with values greater than 115 mmol/l (32%). Admission hyponatraemia (63.8%) was more frequent (p < 0.05) than hospital acquired hyponatraemia (36.2%); in the latter, hyponatraemia was more likely to normalise (p < 0.05). Neurological signs and symptoms developed in 17.2%, this being associated with a high mortality and lower mean serum sodium levels of 112 mmol/l respectively. Following therapy, serum sodium levels normalised in nearly half the patients. In three (5.2%) patients, the hyponatraemia worsened whilst another three became hypernatraemic., Conclusion: The incidence of severe hyponatraemia was lower than that observed in developed countries. It was associated with severe underlying disease and had a high mortality rate. Patients whose hyponatraemia did not normalise were more likely to have higher mortality.

Different data have been reported with respect to the distribution of plasma and tissue fatty acids in patients with Diabetes mellitus and some studies have suggested that severe diabetes is required to produce the fatty acid abnormalities observed in the diabetic rat. We studied the plasma fatty acid profile with particular attention to the omega three and six fatty acids in 14 non insulin dependent (NIDDM) Melanesian diabetics the majority of whom were poorly controlled (mean glycosylated haemoglobin levels of 12.89pc), their mean ages were 43.0 + 6.3 with a duration of 5.2 + 4.8 years. Plasma fatty acids were estimated by gas chromatography (GC) using a flame ionization detector (FID). Each diabetic was age and sex matched with a non diabetic healthy control. Through the plasma concentrations of arachidonic (20:4, w-6), eicosapentanoic (20:5, w-3) and docosahaxaenoic (22:6, w-3) acids were lower than in control subjects, these values were of no significant difference. Similarly, no significant differences were observed between the total plasma saturated fatty acids (palmitic and stearic acids) of diabetic and control subjects. The results of this pilot study suggest that poor metabolic control may not be associated with plasma fatty acids abnormalities in NIDDM patients.

Plasma cholesterol was measured in 417 healthy rural Nigerians consisting of 230 males (mean age 36.60 +/- 1.29 years) and 187 (mean age 34.60 +/- 1.38 years). Mean plasma cholesterol concentrations were found to be 2.91 +/- 0.22 mmol/l and 3.26 +/- 0.25 mmol/l in males and females respectively. These differences were highly significant (p < 0.025). The lowest plasma cholesterol levels were observed in the 11 to 20 year age group and the highest in the > 61 years age group. A strong correlation, which was higher in males than females was observed between plasma cholesterol and age (r = 0.48; p < 0.01). No significant correlation was observed between body mass index (BMI) and plasma cholesterol in both male female subjects. These results suggest that plasma cholesterol concentrations observed in rural Nigerians may be related to their physical activity and the consumption of a low fat diet.

Plasma lipids and lipoprotein-cholesterol profiles were studies in 11 consecutive patients (eight females and three males) with the nephrotic syndrome (NS) during a short term treatment with high dose prednisolone. A significant fall from the high mean pre-treatment levels of total cholesterol and LDL-cholesterol was demonstrated at four, eight and 12 weeks of treatment (p < 0.005) while the fall in the mean triglyceride level only became significant at eight weeks (p < 0.01). The mean HDL-cholesterol level did not change significantly throughout, although there was a significant rise in the mean HDL-cholesterol total cholesterol ratio at four weeks (p = 0.01) and at both eight and 12 weeks (p < 0.005). The study has demonstrated a significant improvement in the lipids and lipoprotein-cholesterol profile of patients with the nephrotic syndrome during a shortterm high dose steroid treatment.

Detection of measles specific IgG in serum was done on 618 samples obtained from Nigerians (aged 11 years or more) resident in Ilorin (urban) and Shao (a suburban outlay of Ilorin). An enzyme-linked immunosorbent assay (ELISA) method was used. Eighty-six percent of the sampled population had detectable antibody levels. Significant differences were found between positivity rates in the two locations studied and between the sexes in the urban samples.

Plasma lipids and lipoproteins were measured in 24 Nigerians with the nephrotic syndrome and 29 healthy subjects. None of the patients had been commenced on treatment. Plasma total cholesterol, low density lipoprotein (LDL) cholesterol group (P less than 0.005). By contrast, the HDL-cholesterol to total cholesterol ratio as well as the HDL-cholesterol concentrations were found to be significantly lowered in the nephrotics than the controls (P less than 0.005). A strong correlation was observed between plasma total cholesterol and LDL cholesterol values but not between the other biochemical parameters (r = 0.98.P less than 0.01). These results, though not definitive, suggest that Nigerians with the nephrotic syndrome may represent a risk group for the development of ischaemic heart disease. Long term prospective studies in such patients are desirable to define the effect of these lipid and lipoprotein abnormalities.