Anticoagulation in Sub‑Saharan Africa with the Advent of Non‑Vitamin K Antagonist Oral Anticoagulants

Background: Since the approval of warfarin, a Vitamin K antagonist anticoagulant (VKA), no other oral anticoagulant existed for patients who needed long‑term anticoagulation therapy until the recent introduction of non‑VKA oral anticoagulants (NOACs). NOACs came to fill in therapeutic gaps associated with VKA. Dedicated anticoagulation clinics has improved the outcome of using VKA. However, with the arrival of NOACs, it is not clear how they will fit into these clinics. Methods: We searched PubMed, Google Scholar, Medline, and African Journals OnLine for articles on anticoagulation management and NOACs. Results: There were very few dedicated anticoagulation management centers in Sub‑Saharan Africa, notably in Nigeria, South Africa, Kenya, Uganda, Namibia, Ghana, Botswana, Namibia, and Cameroun and warfarin was the anticoagulant used. NOACs were not used regularly. None of these anticoagulation clinics had incorporated NOACs management into their routine service as was done for VKA. Conclusion: Anticoagulation clinics in Sub‑Saharan Africa must include NOACs as part of their area of service in addition to warfarin. The use of NOACs in Africa will leap frog if proper anticoagulation management policy and structure are laid out, the cost of NOACs are reduced, and emphasis is given to retraining of staff. Keywords: Anticoagulation management, NOACs, Sub‑Saharan Africa, warfari

Sonographic assessment of petroleum-induced hepatotoxicity in Nigerians: does biochemical assessment underestimate liver damage?

Background: Exposure to petroleum products has been shown to have significant adverse effects on the liver which can manifest either as morphological or physiological changes.Objectives: The aim of the study was to assess the effects of chronic exposure to some petroleum products on the liver of exposed workers using sonography and to determine whether biochemical assessments underestimated hepatotoxicity.Methods: Abdominal ultrasound was performed on 415 exposed workers in order to evaluate liver echogenicity and size. Also, biochemical assessment of the liver was done to evaluate its functionResults: Statistically significant increase in the liver parenchymal echogenicity and the liver size was seen in the exposed workers compared with control (p ≤ 0.05). These increased as the exposure duration increased. It was also noted that out of 16.87% (N=70) exposed workers with abnormal liver echopattern, only 2.65% (N=11) had alanine aminotransferase above the reference range.Conclusion: The study revealed evidence of ultrasound detectable hepatotoxicity among the exposed subjects. Sonography appeared to detect petroleum products-induced hepatic toxicity more than biochemical assays suggesting that biochemical assessment may have underestimated toxicity.Keywords: Petroleum Products, Exposure, Hepatotoxicity, Sonography, Biochemical assessment, Nigeri

Sonographic assessment of petroleum-induced hepatotoxicity in Nigerians: does biochemical assessment underestimate liver damage?

Background: Exposure to petroleum products has been shown to have significant adverse effects on the liver which can manifest either as morphological or physiological changes. Objectives: The aim of the study was to assess the effects of chronic exposure to some petroleum products on the liver of exposed workers using sonography and to determine whether biochemical assessments underestimated hepatotoxicity. Methods: Abdominal ultrasound was performed on 415 exposed workers in order to evaluate liver echogenicity and size. Also, biochemical assessment of the liver was done to evaluate its function Results: Statistically significant increase in the liver parenchymal echogenicity and the liver size was seen in the exposed workers compared with control (p 64 0.05). These increased as the exposure duration increased. It was also noted that out of 16.87% (N=70) exposed workers with abnormal liver echopattern, only 2.65% (N=11) had alanine aminotransferase above the reference range. Conclusion: The study revealed evidence of ultrasound detectable hepatotoxicity among the exposed subjects. Sonography appeared to detect petroleum products-induced hepatic toxicity more than biochemical assays suggesting that biochemical assessment may have underestimated toxicity

Awareness, Treatment, and Control of Hypertension in Primary Health Care and Secondary Referral Medical Outpatient Clinic Settings at Enugu, Southeast Nigeria

Essential hypertension is the most common noncommunicable disease (NCD), affecting more than half the adult population in many countries and being the major NCD contributor to the double burden of disease in developing countries. We undertook a survey of the hypertension awareness, treatment, and control in primary and secondary referral health care clinics in Enugu, Nigeria, and compared these data with those obtained in local community surveys. The prevalence of hypertension in the primary care clinic (9.2%) was lower than in a previously reported community survey (42.2%), while, in the referral clinic, 70.3% of patients attending were hypertensive. Hypertension awareness rates were 91.9%, 29.4%, and 93.2% in these respective health care settings. Treatment and control rates (89.9% and 72.9%) were better in the secondary care clinic than in the primary care centre (87.7% and 46.0%). (Chi-square analysis confirmed statistically significant differences between these rates (p<0.05).) These data may form a useful index of health care system effectiveness in Nigeria. Possible reasons for the differences observed and effective strategies to address the waxing pandemic of hypertension are discussed