Some emerging issues in medical admission pattern in the tropics

Background: There is a changing pattern in terms of medical admissions worldwide with an alarming increase in the prevalence of noncommunicable diseases, especially in the tropics over the last decade. The aim of this study was to describe the pattern of medical admission and highlight emerging issues of noncommunicable diseases in a Nigerian University Teaching Hospital. Materials and Methods: A retrospective review of medical admission at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, South Western Nigeria, over a 3 years period (January 2005 to December 2007). Data were retrieved from the medical records of all medical admission over the study period. Results: During the study period, 1786 patients were admitted into the medical wards. This consisted of 1089 males (61.0%) and 697 females (39.0%). Their ages ranged from 14 to 96 years with mean ages of 51 ± 16.89 years. Subjects ≥60 years of age accounted for 27.3% and 29.8% of total males and female admissions which were the largest age group. Noncommunicable diseases were responsible for 47.99% of total medical admissions. The indications for admission in order of frequency include cerebrovascular accidents 239 (13.4%), diabetes mellitus 194 (10.9%), tuberculosis 151 (8.5%), and chronic kidney disease 116 (6.5%). Hypertension was the underlying risk factor in majority of patients with CVD and CKD. Conclusion: Noncommunicable disease accounted for a significant number of admissions over 3 year duration. The elderly accounted for a major age group admitted for medical diseases. Therefore, preventive strategies against noncommunicable disease and effective geriatric care are advocated.Keywords: Cardiovascular disease, noncommunicable disease, tropicsNigerian Journal of Clinical Practice • Jan-Mar 2012 • Vol 15 • Issue

Electrocardiographic changes during oesophagogastroscopy

Background: Oesophagogastroduodenoscopy (EGD) should be very safe, but there are many potential hazards, although the rate of serious complications is small. There are so many complications that can arise during this procedure. Most of these complications involve the respiratory or cardiovascular systems, especially in sick or sedated patients. The aim of this study was to determine the various electrocardiographic changes that can occur at different stages of diagnostic EGD and to determine their severity.Materials and Methods: The study is a descriptive one which was carried out at the endoscopy unit of Ladoke Akintola University of Technology Teaching Hospital, (LAUTECH), Osogbo, Osun State. Consecutive patients who were referred for oesophagogastroduodenoscopy (EGD) over a 3-month period and who consented to take part in the study were recruited. The electrodes of a portable electrocardiographic (ECG) machine (model Cardiovit AT_1ECG Machine) were attached to the patients accordingly and remained fixed till the end of the procedure. ECG recordings were done at baseline, postpremedication, during intubation and 5 minutes postprocedure. The results of the study were analyzedusing simple descriptive statistical methods such as range, mean and standard deviation for continuous variables, and numbers and percentages for discreet variables.Results: Twenty-six (26) patients were studied, comprising 14 (53.8%) males and 12 (46.2%) females. The mean age of the patients was 47.19 ± 14.42 years. Three (11.5%) patients had tachycardia at the beginning of the procedure, while 13 (50%) patients developed tachycardia  postpremedication and during the procedure, whereas 17 (65.4%) patientshad tachycardia at the end of the procedure. Only one patient had bradycardia. Various ST-T wave abnormalities were observed at each stage of the procedure. Conduction abnormality was observed in 8 (30.8%), 9 (34.6%), 7 (26.9%) and 5 (19.2%) patients at rest, post-premedication, during the procedure and postprocedure respectively. Premature ventricular complexes (PVC) were observed in 4 (15.4%), 5 (19.2%), 4 (15.4%), and 4 (15.4%) patients at rest, postpremedication, during the procedure and post procedure respectively.Conclusion: This study has shown that, although ECG abnormalities do occur during EGD, these abnormalities are not severe enough to warrant specific interventions or discontinuation of the procedure.Key words: Changes, electrocardiography, oesophagogastroduodenoscop

Left ventricular hypertrophy, geometric patterns and clinical correlates among treated hypertensive Nigerians

Background: Left ventricular hypertrophy can be due to various reasons including hypertension. It constitutes an increased cardiovascular risk. Various left ventricular geometric patterns occur in hypertension and may affect the cardiovascular risk profile of hypertensive subjects. Methods: One hundred and eighty eight hypertensive subjects were used for this study. Left ventricular hypertrophy was diagnosed by echocardiography. Relative wall thickness was derived by 2 x PWT/LVIDd. Subjects were arbitrarily categorized according to the duration of hypertension. Statistical analysis was done using SPSS 15.0. Results: The mean age of the study population was 55.95±10.71 years. Subjects who had hypertension for >5 years were more likely to be older and had a lower ejection fraction , larger left ventricular diastolic internal dimension than those with duration of hypertensio

EXAMINING THE LEVEL OF STADIUM SECURITY AND SAFETY DURING NIGERIA PROFESSIONAL FOOTBALL LEAGUE MATCHES

The purpose of this study was to examine the level of stadium security and safety employed during Nigeria Professional Football League Matches; this is due to the fact that security during the NPFL seems to be ineffective with reports of violence, assaults and pandemonium springing up indiscriminately. A descriptive survey research design was utilized with ten (10) stadia that participated in the NPFL 2018/2019 football league season and their managers being the respondents. Seven (7) security parameters were identified including entry and exit systems, Venue Operations Centre (VOC), Closed Circuit Television (CCTV), Protection of the field of play, public announcer room, stewards’ management and police attendance. Results indicated that majority of the security measures to ensure spectator safety are not followed as recommended by FIFA and the green guide; with CCTV and VOC non-existent in almost all the stadia in the study. Results are discussed in relation to previous studies.  Article visualizations

Willingness To Seek Human Immunodeficiency Virus (HIV) Voluntary Counselling And Testing (VCT) Among Urban Residents in Osogbo, South-West Nigeria

Background/Objective: Sub-Saharan Africa is home to two-thirds of all people living with HIV/AIDS. Nigeria has the third highest population of People Living with HIV/AIDS (PLWHAs). Voluntary counselling and testing (VCT) is rapidly becoming an important component of HIV/AIDS prevention and care strategy. The objective of this study was to assess the knowledge and perception of HIV/AIDS and the factors that may affect willingness to seek VCT among residents of an urban community in Nigeria. Methodology:  A cross-sectional descriptive study was conducted in Osogbo, Nigeria. Structured questionnaires were used to gather information from 332 residents. A multistage sampling technique was used for the selection of respondents. A total of 350 houses were selected from the 26 wards. Results: A high proportion (97.6%) of the respondents confirmed that they have heard of HIV/AIDS, 91.1% believed that AIDS is real. Knowledge of HIV/AIDS by the respondents was related to their level of educational attainment and their professions. Only 28.4% of the respondents are aware of VCT, but (66.9%) were willing to seek VCT services if the services are available; 66.7% confirmed that they would go ahead even if a fee is attached. However, 47.2% of those that think otherwise are scare of confidentiality, stigmatization and lack of fund. Willingness was also related to level of educational attainment, professionalism and age group. Conclusion: Programme managers should ensure that councillors have good knowledge on how to alleviate the fear of clients. Counselling should be the first step and if necessary test should follow.Journal of Community Medicine & Primary Health vol 23 (1-2) 201

Burden of obesity in essential hypertension: Pattern and prevalence

Obesity continues to be an epidemic worldwide. There also continues to be a relationship between obesity and hypertension both causal and consequentially. The study aims at determining the prevalence and pattern of overweight and obesity among our patients being managed for essential hypertension. The study was a cross sectional study. Consecutive patients diagnosed with essential hypertension were recruited from two university teaching hospitals in the SouthWest of Nigeria. Demographicdata such as age, gender, weight and height were obtained from patients at recruitment. Patients with congestive heart failure, secondary hypertension, chronic kidney disease, and other chronic diseases wereexcluded. Pregnant women were also excluded. Obesity was defined according toWHOclassification. Statistical analysis was done by the Statistical Package for Social Sciences version 11.0. One thousand one hundred and two (1102) consecutive hypertensive patients were recruited. Two hundred and eighty six (286) were dropped due to evidence of overt heart failure (98) and chronic kidney disease and others (188).There were (420) males (51.5%) and 396 females (48.5%), mean age 54.97 (±13.14) years. (Range 10-91). 7.6% (62) were underweight (36 males, 26 Females): 260 (31.9%) were overweight, consisting of 148 males and 112 females: 135 (16.5%) had mild obesity consisting of 48 males and 87 females: 43(5.3%) had moderate obesity with 15 males and 28 females while 30 (3.7%) had severe obesity (consisting of 22 females).About two thirds of the hypertensive patients seen in two teaching hospitals in the SouthWest of Nigeria in this study were either overweight or obese. Therefore lifestyle modification geared toward weightreduction should be emphasized in these patients

Prevalence of hepatitis B surface antigen, hepatitis C and Human Immunodeficiency Virus antibodies in a population of students of tertiary institution in Nigeria

Objective: Human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C viruses (HCV) are major causes of mortality and morbidity worldwide. They are also among the commonest transfusiontransmissible infectious agents. Students of higher institutions are often used as voluntary unpaid donors by many hospitals in Nigeria. In this study, the prevalence of HIV and HCV and HBsAg is determined in a population of students attending Ladoke Akintola University of Technology in south west Nigeria, to provide background information on the burden of these infections in this population. Materials and Methods: Serum samples were obtained from students of the Pre-degree Science programme of Ladoke Akintola University of Technology, Ogbomosho and tested for antibodies to HIV, HCV and HBsAg using the ELISA procedure. Results: The prevalence rates of antibodies to HIV and HCV in the student population were 0% and 4.8%, respectively and that of HBsAg was 9.5%. Conclusion: The findings of this study which showed that the prevalence of antibodies to HIV and of HBsAg in this group of students is somewhat similar to those carried out in similar populations. This strongly suggests that the viral burden amongst this population of students is similar and that probably similar factors (demographic) are responsible for maintaining this level of viral load. Further studies would be needed to elucidate the reasons why this is the case. Also it would be necessary to reemphasize the methods of prevention of transmission of these viruses, and to ensure their implementation in order to reduce the viral levels and therefore avoid the long term sequalae.Key words: Transfusion, Infection, Blood Donatio

Haemodialysis practice in a resource–limited setting in the tropics

Background: Objective: To provide information on the challenges of haemodialysis in a resource limited setting in South-Western Nigeria.Methods: This is a 5 year audit of all haemodialysis sessions carried out at the renal unit of the Ladoke Akintola University Teaching Hospital  (LAUTECH), Osogbo, Nigeria.Results: A total of 225 patients were offered haemodialysis (HD) during this period with age range of 10 to 85 years (mean age of 49  years±16.25). There were 155 males and 70 females (male to female  ratio of 2.2:1). Chronic kidney failure accounted for 180 (80%) of the cases while acute kidney injury (AKI) constituted 45 (20%) of the cases offered haemodialysis. The sessions of HD in both cases ranged from 1 to 27 with an average of 3 sessions. Hypotension is still the commonest intradialytic complication at our setting while diabetic nephropathy is rapidly emerging as a major cause of end stage renal disease at our setting  requiring HD. As seen in other parts of the tropics sepsis, nephrotoxinsand pregnancy related cases still accounted for a large percentage of AKI cases requiring haemodialysis. Only three patients were able to afford haemodialysis support for more than three months.Conclusion: Haemodialysis still remains a veritable option in renal  replacement therapy. Problems encountered were similar to many other settings in the tropics. Intensive efforts should still be geared at preventing the risk factors for both acute kidney injury and chronickidney disease in our environment.Keywords: Haemodialysis, practice, tropics, Resource limite

Prediction of functional capacity during six – minute walk among patients with chronic heart failure

Formulae for predicting functional capacity during 6-minue walk are lacking and the accuracy of the existing formulae has been challenged in deferent populations. The purpose of this study was to develop an equation that would be useful in predicting functional capacity in form of maximum oxygen consumption) (V0 ) in Chronic Heart Failure Patients (CHF) during exercise.Sixty-five subjects were recruited for the study. The procedure required the subjects to walk on a self paced speed on a 20 meter marked level ground for 6 minutes. The distance covered in 6 minutes was measured and the speed calculated.The result showed that the distance covered was highly correlated with the VO2 (0.65, p< 0.01). The regression analysis revealed that a linear equation model developed was a good predictor ofV0 for the group.The study concluded that in situation where sophisticated equipments are lacking, this equation might be useful during exercise supervision for patients withCHF. [VO2 (ml kg-1 min-1) = 0.0105 x distance (m) + 0.0238 age (yr) - 0.03085 weight (kg) + 5.598]

Cardiovascular responses to treadmill exercise in Nigerian hypertensives with left ventricular hypertrophy

Background: Left ventricular hypertrophy (LVH) is an independent risk factor for adverse cardiac outcomes in hypertensive patients.Objective: This study is designed to assess the cardiovascular responses to treadmill exercise among Nigerian hypertensives with echocardiographically proven LVH.Materials and Methods: Fifty hypertensive patients with LVH (27 males and 23 females) between 30 and 65 years of age were studied in Nigeria. 50 hypertensive patients without LVH and 50 normal subjects who were age and sex matched served as controls. All patients and control subjects underwent M-mode, 2-D and Doppler ECHO-studies and the Bruce protocol treadmill exercise test.Results: The study showed that the estimated maximal oxygen consumption (MVO2) in MET reduced progressively from 8.39 &#177; 1.26 (normotensive control) to 7.62 &#177; 1.33 (hypertensive without LVH), 6.27 &#177; 0.99 (hypertensive with LVH) (P&lt;0.0001ANOVA). The duration of exercise (s) was also reduced in that order from 455.4 &#177; 79.1 to 411.6 &#177;8 2.3, 315.8 &#177; 75.6 respectively (P&lt;0.0001). The systolic blood pressure (SBP) and pressure rate product (PRP) during maximal exercise were also increased in hypertensives with LVH and hypertensive without LVH when compared to normotensive controls. The hypertensives with LVH and hypertensives without LVH also showed significant limitation to heart rate increase with exercise compared to normotensive controls (P&lt;0.003).Conclusion: This study demonstrated significant impairment of exercise capacity in hypertensives with or without LVH compared to normotensive subjects. Both earlier recognition and improved understanding of LVH may lead to more effective therapeutic strategies for this cardiovascular risk factor