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Nutritional and Metabolic Diseases - Top 30 Publications

Metformin for Prediabetes.

Hyperphosphatemia and hs-CRP Initiate the Coronary Artery Calcification in Peritoneal Dialysis Patients.

Background. Coronary artery calcification (CAC) contributes to high risk of cardiocerebrovascular diseases in dialysis patients. However, the risk factors for CAC initiation in peritoneal dialysis (PD) patients are not known clearly. Methods. Adult patients with baseline CaCS = 0 and who were followed up for at least 3 years or until the conversion from absent to any measurable CAC detected were included in this observational cohort study. Binary logistic regression was performed to identify the risk factors for CAC initiation in PD patients. Results. 70 patients recruited to our study were split into a noninitiation group (n = 37) and an initiation group (n = 33) according to the conversion of any measurable CAC during their follow-up or not. In univariate analysis, systolic blood pressure, serum phosphorus, fibrinogen, hs-CRP, serum creatinine, and triglycerides were positively associated with the initiation of CAC, while the high density lipoprotein and nPCR did the opposite function. Multivariate analysis revealed that hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation after adjustments. Conclusions. Hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation in PD patients. These results suggested potential clinical strategies to prevent the initiation of CAC in PD patients.

Myocardial susceptibility to ischaemia/reperfusion in obesity: a re-evaluation of the effects of age.

Reports on the effect of age and obesity on myocardial ischaemia/reperfusion (I/R) injury and ischaemic preconditioning are contradictory. The aim of this study was to re-evaluate the effects of age and diet-induced obesity (DIO) on myocardial I/R injury and preconditioning potential.

Insights for Oxidative Stress and mTOR Signaling in Myocardial Ischemia/Reperfusion Injury under Diabetes.

Diabetes mellitus (DM) displays a high morbidity. The diabetic heart is susceptible to myocardial ischemia/reperfusion (MI/R) injury. Impaired activation of prosurvival pathways, endoplasmic reticulum (ER) stress, increased basal oxidative state, and decreased antioxidant defense and autophagy may render diabetic hearts more vulnerable to MI/R injury. Oxidative stress and mTOR signaling crucially regulate cardiometabolism, affecting MI/R injury under diabetes. Producing reactive oxygen species (ROS) and reactive nitrogen species (RNS), uncoupling nitric oxide synthase (NOS), and disturbing the mitochondrial quality control may be three major mechanisms of oxidative stress. mTOR signaling presents both cardioprotective and cardiotoxic effects on the diabetic heart, which interplays with oxidative stress directly or indirectly. Antihyperglycemic agent metformin and newly found free radicals scavengers, Sirt1 and CTRP9, may serve as promising pharmacological therapeutic targets. In this review, we will focus on the role of oxidative stress and mTOR signaling in the pathophysiology of MI/R injury in diabetes and discuss potential mechanisms and their interactions in an effort to provide some evidence for cardiometabolic targeted therapies for ischemic heart disease (IHD).

Herbal medicines for diabetes control among Indian and Pakistani migrants with diabetes.

Drawing on data collected during a 16-month ethnographic investigation, this paper explores practices around Indians' and Pakistanis' use of herbal medications for diabetes control. The ethnographic study was conducted among Indian and Pakistani migrants in Edinburgh, Scotland and included extended participant observation, six group discussions and 21 semi-structured interviews. Respondents showed great resistance in adhering to medication prescriptions for diabetes control due to their various side effects, especially within the stomach. In order to avoid such side effects, respondents decreased medication dosage and turned to non-allopathic remedies that usually consisted of herbal medications that, according to Indians and Pakistanis, did not cause side effects as medications did and tackled the cause of the disease rather than its symptoms. Such remedies however, were not only combined with allopathic ones but also eventually replaced without the doctor's consultation.

Not 'Taking the Easy Way Out': Reframing Bariatric Surgery from Low-effort Weight Loss to Hard Work.

Cultural notions equating greater morality and virtue with hard work and productive output are deeply embedded in American value systems. This is exemplified in how people understand and execute personal body projects, including efforts to become slim. Bariatric surgery is commonly viewed as a 'low-effort' means of losing weight, and individuals who opt for this surgery are often perceived to be 'cheating.' This extended ethnographic study within one bariatric program in the Southwestern United States shows how patients conscientiously perform this productivity. By prioritizing discourses that focus on their own hard work and the inherent value and necessity of their surgery, patients and practitioners alike contest the dominant public views of surgically-induced weight loss.

Presentation of calcinosis cutis universalis in mixed connective tissue disorder: an encounter during hip arthroplasty.

A woman aged 23 years with a diagnosis of mixed connective tissue disorder presented with left groin pain extending over 6 months. Workup revealed avascular necrosis of the femoral head (Grade 3) secondary to systemic lupus erythematosus and chronic steroid intake. An uncemented total hip arthroplasty was considered as the patient was only in the third decade of life. During the preop workup, careful clinical assessment had revealed multiple subcutaneous nodules affecting the extensor musculature limited to the gluteal region, anterior and posterior aspects of the thigh. The diagnosis of calcinosis cutis universalis was made after a CT revealed calcified nodules in the subcutaneous, subfascial and muscular planes. A total hip arthroplasty using the posterior approach was performed with minimal trauma to the calcified nodules and thereby preventing a source of persistent drainage and reducing morbidity due to infection.

Severe hypophosphataemia after intravenous iron administration.

Iron deficiency is common and can be effectively treated with parenteral iron infusion. We report a case of an iron-deficient and vitamin D-deficient woman who developed severe symptomatic hypophosphataemia following intravenous ferric carboxymaltose administration. We stress the need of increased awareness of this potential complication among physicians. Patients should be informed of this complication and instructed to report for follow-up if they experience new musculoskeletal symptoms or worsening of tiredness. As severe hypophosphataemia is usually symptomatic, we recommend screening symptomatic patients for this complication. Recognising and treating the possible exacerbating factors, especially vitamin D deficiency, might be a simple measure to mitigate this complication.

All-Cause and Cardiovascular Mortality following Treatment with Metformin or Glyburide in Patients with Type 2 Diabetes Mellitus.

Both metformin and sulfonylurea (SU) drugs are among the most widely-used anti-hyperglycemic medications in patients with type 2 diabetes mellitus (T2DM). Previous studies have shown that treatment with SUs might be associated with decreased survival compared with metformin. This study aimed to evaluate all-cause and cardiovascular mortality rates between glyburide and metformin in patients diagnosed with T2DM.

The quest for new drugs to prevent osteoporosis-related fractures.

There is a need for the development of new drugs to prevent osteoporosis-related fractures. Fractures are projected to increase and the present drugs have modest efficacy, significant side-effects and poor compliance. To illustrate the difficulties in the development of new drugs, the author reviews the fate of several drugs that have failed to gain regulatory approval. These drugs include arzoxifene, lasofoxifene, MK-5442, roncalceret and odanacatib. Romosozumab and abaloparatide are the only new drugs presently in phase-3 development. It is anticipated that ongoing studies of the mechanisms and signaling pathways involved in the regulation of bone remodeling will open up new opportunities for targeted pharmacological interventions to increase bone strength. However, the perfect drug is still a long way off and will face many obstacles before approval.

Age-related prevalence of osteoporosis and fragility fractures: real-world data from an Austrian Menopause and Osteoporosis Clinic.

Age and bone mineral density (BMD) are the most relevant determinants for public health authorities to govern the management of osteoporosis. The objectives of this study were to determine the age-related prevalence of osteopenia and osteoporosis according to WHO criteria and fragility fractures in middle-aged and older women.

The Strategy to Prevent and Regress the Vascular Calcification in Dialysis Patients.

The high prevalence of arterial calcification in end-stage renal disease (ESRD) is far beyond the explanation by common cardiovascular risk factors such as aging, diabetes, hypertension, and dyslipidemia. The finding relies on the fact that vascular and valvular calcifications are predictors of cardiovascular diseases and mortality in persons with chronic renal failure. In addition to traditional cardiovascular risk factors such as diabetes mellitus and blood pressure control, other ESRD-related risks such as phosphate retention, excess calcium, and prolonged dialysis time also contribute to the development of vascular calcification. The strategies are to reverse "calcium paradox" and lower vascular calcification by decreasing procalcific factors including minimization of inflammation (through adequate dialysis and by avoiding malnutrition, intravenous labile iron, and positive calcium and phosphate balance), correction of high and low bone turnover, and restoration of anticalcification factor balance such as correction of vitamin D and K deficiency; parathyroid intervention is reserved for severe hyperparathyroidism. The role of bone antiresorption therapy such as bisphosphonates and denosumab in vascular calcification in high-bone-turnover disease remains unclear. The limited data on sodium thiosulfate are promising. However, if calcification is to be targeted, ensure that bone health is not compromised by the treatments.

Role of Vitamin D in Uremic Vascular Calcification.

The risk of cardiovascular death is 10 times higher in patients with CKD (chronic kidney disease) than in those without CKD. Vascular calcification, common in patients with CKD, is a predictor of cardiovascular mortality. Vitamin D deficiency, another complication of CKD, is associated with vascular calcification in patients with CKD. GFR decline, proteinuria, tubulointerstitial injury, and the therapeutic dose of active form vitamin D aggravate vitamin D deficiency and reduce its pleiotropic effect on the cardiovascular system. Vitamin D supplement for CKD patients provides a protective role in vascular calcification on the endothelium by (1) renin-angiotensin-aldosterone system inactivation, (2) alleviating insulin resistance, (3) reduction of cholesterol and inhibition of foam cell and cholesterol efflux in macrophages, and (4) modulating vascular regeneration. For the arterial calcification, vitamin D supplement provides adjunctive role in regressing proteinuria, reverse renal osteodystrophy, and restoring calcification inhibitors. Recently, adventitial progenitor cell has been linked to be involved in the vascular calcification. Vitamin D may provide a role in modulating adventitial progenitor cells. In summary, vitamin D supplement may provide an ancillary role for ameliorating uremic vascular calcification.

The Neutrophil-Lymphocyte Ratio Is Associated with Coronary Artery Calcification in Asymptomatic Korean Males: A Cross-Sectional Study.

Introduction. The neutrophil-lymphocyte ratio (NLR) is a significant systemic predictor of cardiovascular disease (CVD). The coronary artery calcium score (CACS) reflects coronary artery calcification and is an independent risk factor for coronary artery stenosis. In the present study, we explored the relationship between the NLR and CACS in terms of subclinical inflammation and coronary artery calcification. Materials and Methods. We evaluated males and females who did not have CVD, diabetes, high blood pressure, or high fasting blood sugar levels. We measured white blood cell, neutrophil, lymphocyte counts, fasting blood sugar, total cholesterol, high-density lipoprotein cholesterol, triglycerides (TG), and high-sensitivity C-reactive protein levels in blood samples. We also obtained CACSs using coronary multidetector computed tomography. Results. Multivariate logistic regression showed that older age was significantly associated with a higher CACS (P < 0.001); males had higher CACSs than females (P < 0.001); and the higher the TG level, the higher the CACS (P = 0.019). The NLR of males, but not females, was significantly associated with the CACS. Conclusion. An independent association between the NLR and CACS was thus evident in healthy adult males after adjusting for other CVD risk factors. Therefore, the NLR is a significant predictor of potential CVD in male subjects with subclinical atherosclerosis.

Phentermine induced acute interstitial nephritis.

Acute interstitial nephritis (AIN) has a number of medication-related aetiologies. Antibiotics, proton pump inhibitors and non-steroidal anti-inflammatory drugs are common causes; however, any medication has the potential to cause drug-induced AIN. We report the first case of phentermine-induced AIN. A Caucasian woman aged 43 years presented with a 5-week history of lethargy, left-sided lower abdominal pain, nausea and vomiting. She had been taking phentermine for weight loss for 9 months and had recently ceased the medication. The patient underwent a renal biopsy that showed a predominantly lymphohistiocytic interstitial infiltrate with a moderate number of eosinophils consistent with AIN. Phentermine is increasingly used for weight loss in obese patients. This is the first case implicating phentermine as the causative agent for drug-induced AIN. While rare, phentermine-induced AIN is a possible adverse reaction of phentermine. Physicians and patients need to be aware of this risk.

Discriminatory Ability of Visceral Adiposity Index (VAI) in Diagnosis of Metabolic Syndrome: A Population Based Study.

Background Visceral adiposity index (VAI) has been suggested as an index of visceral adiposity. This study was conducted to determine the discriminatory ability of VAI in diagnosis of metabolic syndrome (MetS). Methods and materials We used the data of 5 312 subjects aged 18-74 years of a cohort study conducted among 6 140 individuals aged 10-90 years in Amol, northern Iran. The city population was divided into 16 strata based on gender and age groups in 10-year intervals. The subjects were randomly selected from each stratum. MetS was defined based on National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII), American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) update of Adult Treatment Panel III (ATPIII), International Diabetes Federation (IDF) and joint interim statement (JIS) definitions. The discriminatory ability of VAI and other obesity measures were evaluated using receiver operating characteristic (ROC) curves. Results While waist circumference (WC) showed the highest discriminatory ability for MetS in IDF definition in men (AUC=0.899 [CI=0.888-0.910]), VAI had the greatest discriminatory ability according to other definitions in men and women. The related AUCs of VAI were 0.866 (95%CI: 0.850-0.881), 0.829 (95%CI: 0.813-0.846), 0.859 (95%CI: 0.844-0.873) and 0.876 (95%CI: 0.863-0.889) based on NCEP/ATPIII, AHA/NHLBI update of ATPIII, IDF and JIS definition in men, and also 0.888 (95%CI: 0.875-0.902), 0.894 (95%CI: 0.881-0.907), 0.883 (95%CI: 0.869-0.897) and 0.879 (95%CI: 0.864-0.894) in women, respectively. Conclusion VAI showed an excellent discriminatory ability in diagnosis of MetS. Considering its relatively simple calculation, this index could be suggested as a reliable tool in medical practice.

Reversal of isolated 20q deletion with vitamin B12 replacement in a patient with pernicious anaemia.

Severe vitamin B12 deficiency is well known to cause morphological alterations in bone marrow. In rare instances, these myelodysplastic and megaloblastic changes can coexist with cytogenetic abnormalities. Here, we report a case of a 38-year-old African-American woman with pernicious anaemia, who was found to have an isolated 20q deletion and which resolved after vitamin B12 replacement. We also discuss various mechanisms in which vitamin B12 deficiency can lead to chromosomal abnormalities. A literature review is also performed to evaluate various other chromosomal aberrations associated with B12 deficiency.

Differential representation of liver proteins in obese human subjects suggests novel biomarkers and promising targets for drug development in obesity.

The proteome of liver biopsies from human obese (O) subjects has been compared to those of nonobese (NO) subjects using two-dimensional gel electrophoresis (2-DE). Differentially represented proteins were identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS)-based peptide mass fingerprinting (PMF) and nanoflow-liquid chromatography coupled to electrospray-tandem mass spectrometry (nLC-ESI-MS/MS). Overall, 61 gene products common to all of the liver biopsies were identified within 65 spots, among which 25 ones were differently represented between O and NO subjects. In particular, over-representation of short-chain acyl-CoA dehydrogenase, Δ(3,5)-Δ(2,4)dienoyl-CoA isomerase, acetyl-CoA acetyltransferase, glyoxylate reductase/hydroxypyruvate reductase, fructose-biphosphate aldolase B, peroxiredoxin I, protein DJ-1, catalase, α- and β-hemoglobin subunits, 3-mercaptopyruvate S-transferase, calreticulin, aminoacylase 1, phenazine biosynthesis-like domain-containing protein and a form of fatty acid-binding protein, together with downrepresentation of glutamate dehydrogenase, glutathione S-transferase A1, S-adenosylmethionine synthase 1A and a form of apolipoprotein A-I, was associated with the obesity condition. Some of these metabolic enzymes and antioxidant proteins have already been identified as putative diagnostic markers of liver dysfunction in animal models of steatosis or obesity, suggesting additional investigations on their role in these syndromes. Their differential representation in human liver was suggestive of their consideration as obesity human biomarkers and for the development of novel antiobesity drugs.

Effect of Spirulina platensis ingestion on the abnormal biochemical and oxidative stress parameters in the pancreas and liver of alloxan-induced diabetic rats.

Previous studies have shown that Spirulina platensis Gomont (Phormidiaceae) (SP) extract has beneficial effects on many disease conditions. The putative protective effects of SP were investigated in diabetic rats.

Hypofibrinolytic State in Subjects with Type 2 Diabetes Mellitus Aggravated by the Metabolic Syndrome before Clinical Manifestations of Atherothrombotic Disease.

Background. Metabolic and genetic factors induce plasminogen activator inhibitor type-1 (PAI-1) overexpression; higher PAI-1 levels decrease fibrinolysis and promote atherothrombosis. Aim. To assess PAI-1 antigen levels among subjects with type 2 diabetes mellitus (T2DM) plus Metabolic Syndrome (MetS) before clinical manifestations of atherothrombosis and the contribution of metabolic factors and 4G/5G polymorphism of PAI-1 gene on the variability of PAI-1. Methods. We conducted an observational, cross-sectional assay in a hospital in Mexico City from May 2010 to September 2011. MetS was defined by the International Diabetes Federation criteria. PAI-1 levels and 4G/5G polymorphism were determined by ELISA and PCR-RFLP analysis. Results. We enrolled 215 subjects with T2DM plus MetS and 307 controls. Subjects with T2DM plus MetS had higher PAI-1 levels than the reference group (58.4 ± 21 versus 49.9 ± 16 ng/mL, p = 0.026). A model with components of MetS explained only 12% of variability on PAI-1 levels (R(2) = 0.12; p = 0.001), with β = 0.18 (p = 0.03) for hypertension, β = -0.16 (p = 0.05) for NL HDL-c, and β = 0.15 (p = 0.05) for NL triglycerides. Conclusion. Subjects with T2DM plus MetS have elevated PAI-1 levels before clinical manifestations of atherothrombotic disease. Metabolic factors have a more important contribution than 4G/5G polymorphism on PAI-1 plasma variability.

Cœliac disease: a rare cause of recurrent miscarriages.

Cœliac disease is an autoimmune disorder associated with Gluten intolerance resulting in progressive destruction of the villi of the small intestine. Symptoms are very diverse and can occur at any age. Abortive illness is a rare symptom leading to the detection of cœliac disease. We report the case of a patient with a history of 12 consecutive miscarriages whose etiology was finally related to cœliac disease.

Influences of osteoarthritis and osteoporosis on the electrical properties of human bones as in vivo electrets produced due to Wolff's law.

We characterized the electrical properties of living bone obtained from patients who had undergone total hip arthroplasty (THA) or hemiarthroplasty by means of analysis of the electrically polarized and nonpolarized bone specimens, and we discussed the role of an organic and inorganic matrix of human bone in bone piezoelectricity.We used human femoral neck bone that was harvested during THA for advanced osteoarthritis of the hip joint (OA group) and hemiarthroplasty for femoral neck fracture (FNF group). The specimens were scanned to evaluate the cancellous bone structures using micro-computed tomography, and we quantified the carbonic acid by attenuated total reflection (ATR) spectra to estimate carbonate apatite. The stored electrical charge in the electrically polarized and nonpolarized bone specimens were calculated using thermally stimulated depolarized current (TSDC) measurements.Each TSDC curve in the groups had peaks at 100°C, 300°C and 500°C, which may be attributed to collagen, carbonate apatite and hydroxyapatite, respectively. It is suggested that organic substances are more effectively electrically polarized than apatite minerals by the polarization at room temperature and that the stored charge in living bone may be affected not only by total bone mass but also by bone quality, including 3-dimensional structure and structural component.

Diabetes Increases Morbidities of Colonic Diverticular Disease and Colonic Diverticular Hemorrhage: A Systematic Review and Meta-Analysis.

Colonic diverticular disease (CDD) and colonic diverticular hemorrhage (CDH) are the most common disorders in hospital admissions and outpatient health clinic visits. However, risk factors of CDD and CDH are complicated and need to be discussed. Diabetes mellitus (DM) has been related with CDD and CDH, but the associations remain ambiguous. Therefore, we performed a literature search for studies involving the associations among DM, morbidity of CDD, and incidence of CDH. Relative risks or odds ratios with their corresponding 95% confidence intervals (CIs) were combined and weighted to produce summary effect size. Sensitivity analysis and subgroup analysis were further performed. We selected 17 studies that involved a total of 8212 patients with diabetes, 381,579 controls without diabetes. We found that patients with DM had approximately 1.201 times higher CDD morbidity in prospective studies (95% CI, 1.135-1.270) with no significant heterogeneity (Q = 0.42, P = 0.519, I = 0%). DM was associated with a 52.8% increase in risk of CDH (95% CI, 14%-104%); we did not find significant heterogeneity among these studies (Q = 12.94, P = 0.114, I = 38.2%). This meta-analysis confirms that DM is an important risk factor for morbidities of CDD and CDH.

Vorapaxar and Amyotrophic Lateral Sclerosis: Coincidence or Adverse Association?

Vorapaxar, a novel antiplatelet thrombin PAR-1 inhibitor, is currently approved for post myocardial infarction and peripheral artery disease indications with concomitant use of clopidogrel and/or aspirin. The vorapaxar safety profile was acceptable. However, aside from heightened bleeding risks, excesses of solid cancers and diplopia, there were more amyotrophic lateral sclerosis (ALS) diagnoses after vorapaxar.

Life-threatening emphysematous liver abscess associated with poorly controlled diabetes mellitus: a case report.

Emphysematous liver abscesses are defined as liver abscesses accompanied by gas formation. The fatality rate is extremely high at 27%, necessitating prompt intensive care.

Iron-deficient erythropoiesis in blood donors and red blood cell recovery after transfusion: initial studies with a mouse model.

Most frequent red cell (RBC) donors and many first-time donors are iron deficient, but meet haemoglobin standards. However, the effects of donation-induced iron deficiency on RBC storage quality are unknown. Thus, we used a mouse model to determine if donor iron deficiency reduced post-transfusion RBC recovery.

Glutamine dipeptide and cortisol change the liver glucose metabolism and reduce the severity of insulin-induced hypoglycaemia in untreated T1DM Swiss mice.

Glutamine is conditionally essential in type 1 diabetes mellitus, and might be useful to counteract hypoglycaemia.

Effects of Selenium Yeast on Blood Glucose and Antioxidant Biomarkers in Cholesterol Fed Diet Induced Type 2 Diabetes Mellitus in Wistar Rats.

Selenium is an antioxidant that prevents oxygen radical from damaging cells from chronic diseases that can develop from cell injury and inflammation such as diabetes mellitus. The aim of the study is to investigate the possible protective effect of selenium yeast on cholesterol diet induced type-2 diabetes mellitus and oxidative stress in rats. Twenty male wistar rats were divided in to four groups of five animals each: Group 1: (Negative control) received standard animal feed only, Group 2:  received cholesterol diet (CD) only, Group 3: received CD and 0.1 mg/kg selenium yeast orally, Group 4: Received CD and 0.2 mg/kg selenium yeast orally for six weeks. At the end of the study period, the animals were sacrificed and the serum samples were collected and evaluated for estimation of antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx). The results showed a significant decrease in blood glucose level in the groups  co-administered CD and selenium yeast when compared to CD group only. Antioxidant enzymes status recorded significant decrease in SOD, CAT and GPx activities in CD and selenium yeast administered when compared to CD group only. In Conclusion, Selenium yeast administrations prevent free radical formations which are potent inducer of diabetes mellitus.

Iron Status of Pregnant Women in Rural and Urban Communities of Cross River State, South-South Nigeria.

Anaemia in pregnancy is a major public health problem in Nigeria. Iron deficiency is one of the major causes of anaemia in pregnancy.  Inadequate iron intake during pregnancy can be dangerous to both baby and mother. Iron status of pregnant women was assessed in two rural and one urban communities in Cross River State Nigeria. Packed cell volume, haemoglobin, mean cell haemoglobin, mean cell haemoglobin concentration, red cell count, serum iron, total iron binding capacity, transferrin saturation, serum ferritin, soluble transferrin receptor and soluble transferrin receptor/ferritin ratio were measured in plasma/serum of 170 pregnant women within the age range of 15-45 years. Seventy participants were from antenatal clinic of University of Calabar Teaching Hospital Calabar (urban community), 50 from St Joseph Hospital Ikot Ene (rural community) in Akpabuyo Local Government Area and the remaining 50 from University of Calabar Teaching Hospital   extension clinic in Okoyong (rural community), Odukpani Local Government Area of Cross River state. The prevalence of   anaemia, iron deficiency, iron depletion and iron deficiency anaemia were found to be significantly higher among pregnant women from the two rural communities when compared to the urban community. it was also observed that  the prevalence of  anaemia, iron deficiency, iron depletion and iron deficiency anaemia   were significantly higher (p<0.05) among pregnant women from Akpabuyo   38(76.00%),   20(40.00%),   23(46.0%)   ,   16(32.00%)   respectively followed   by  Okoyong 24(48.0%),  20(40.0%),  16(32.0%),  6(12.0)     and  then  those  from     Calabar  14(20%), 12(17.90%) , 14(20.0%).  The mean haemoglobin and haematocrit were significantly reduced in pregnant women from the two rural communities. Serum iron, serum ferritin and transferrin saturation showed no significant difference while total iron binding capacity and soluble transferrin receptor significantly increased among pregnant women from Okoyong when compared to those from Calabar. It was also shown that pregnant women in their third trimesters and multigravidae had the highest prevalence of iron depletion and iron deficiency anaemia while prevalence of iron deficiency and anaemia were higher in primigravidae and the pregnant women in their second trimester. In conclusion, this study has shown that the prevalence of anaemia and iron deficiency anaemia are higher among pregnant women in the rural communities when compared to those in the urban areas.

Schizophrenia-like symptoms in a patient with Leigh syndrome.

Leigh syndrome is a mitochondrial disease characterized by subacute necrotizing encephalomyelopathy. Almost all cases of Leigh syndrome develop at infancy or early childhood and die within several years due to rapidly progressive muscle weakness and respiratory failure. Here, we present a rare case of a patient who developed Leigh syndrome associated with thiamine-responsive pyruvate dehydrogenase-complex deficiency at 2 years of age and has survived to adolescence through effective high dose thiamin therapy. At 15 years of age, the patient presented persecutory delusions and auditory hallucinations, suggesting an association between mitochondrial dysfunction and schizophrenia-like psychotic symptoms.