Prevalence of end-digit preference in recorded blood pressure by nurses: a comparison of measurements taken by mercury and electronic blood pressure-measuring devices

Objectives: When compared with the use of a mercury  sphygmomanometer, the use of a validated digital blood pressure (BP) measuring device eliminates the risk of exposure to mercury. Digital devices are also associated with a lesser degree of end-digit preference (EDP). EDP refers to the occurrence of a particular end digit more frequently than would be expected through chance alone. There have been only a few reports from Africa on the occurrence of EDP in BP measurement. This study examined EDP in BP taken by nurses before and after the introduction of a digital BP-measuring device. Design: The design was a retrospective study. Settings and subjects: We reviewed the BP readings of 58 patients who presented at the dedicated clinic for people living with human immunodeficiency virus/acquired immune deficiency syndrome of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, before and after the introduction of the digital BP-measuring device. Outcome measures: The prevalence of end-digit zero of systolic and diastolic BP readings before and after the introduction of the digital device was compared using McNemar’s test. Results: There was a large and significant fall in end-digit zero when BP readings that were taken using the mercury and digital devices were compared (systolic 98.1% vs. 10.9%, p-value < 0.001; diastolic 97.1% vs. 14.9%, p-value < 0.001 (McNemar’s test). Conclusion: There was a significant reduction in the frequency of end-digit zero when BP was taken with the digital devicerather than the mercury device. Regular training and certification of healthcare workers in BP measurement is recommended to ensure a high quality BP measurement standard.Keywords: blood pressure measurement, mercury sphygmomanometer, digital blood pressure-measuring devices, end-digit preferenc

The impacts of first line highly active antiretroviral therapy on serum selenium, cd4 count and body mass index: a cross sectional and short prospective study

Introduction: The relationship that exists between body weights, serum selenium and immunological markers of HIV/AIDS continue to provoke more researches in the recent times. The objectives of this study were to examine baseline body mass index, CD4 count and serum selenium and to prospectively assess the impacts of HAART on same parameters 48 weeks post HAART among HIV patients. Methods: A cohort comprising 140 newly diagnosed HIV positive were prospectively studied. Anthropometric measurements, serum selenium and CD4 count were assessed at diagnosis and 48 weeks post HAART. Results: The mean age for patients was 35±8.8 years; 68% was female. Patients' mean weight was 56.79±10.22kg, BMI; 21.59±3.53, serum selenium; 0.55 ± 0.45μmol/L and CD4 count; 288.36 ± 232.23 at the baseline. At diagnosis, 47 (33.6%) were in stage 1, 49 (35.0%) in stage 2, 26 (18.6%) and 18 (12.9%) were in stage 3 and 4 respectively. Similarly, most patients had normal body mass index, 94 (67.14%), 26 (18.57%) were underweight, (12.86%) were overweight and two (1.43%) were obese at diagnosis. At 48 weeks post HAART, the mean weight, BMI, serum selenium and CD4 count were significantly increased. Conclusion: HAART repleted CD4 count and serum selenium, Post HAART overweight was associated with lesser CD4 count reconstitution and selenium repletion. A renew call for weight monitoring in HAART era.Key words: HIV/AIDS, Selenium, CD4 count, BMI, HAAR

Cigarette Smoking Practices and Its Determinants Among University Students in Southwest, Nigeria

Background: Tobacco smoking is one of the largest causes of preventable morbidity and mortality globally, and is responsible for many causes of premature deaths. This study seeks to find out cigarette-smoking practices among University Students in Ekiti State, Nigeria and identify its determinants. Methodology: This study was a descriptive cross-sectional study of young adults in tertiary institutions. The sample size was 300 while multi stage sampling technique was adopted to select the students that were interviewed. The pre-tested questionnaire was semi structured and it was self administered. Data analysis was done using Epi-Info version 3.4.1. Frequency tables and cross-tabulations were generated with a statistical significance p-value pre-determined at less than 0.05. Results: The prevalence of students that ever smoked was 66 (22.0%) while those that currently smoke are 41 (13.7%). Of the students that smoked, largest proportion (53.0%) smoked for pleasure. The mean age at onset of smoking was 15.14 + 4.34 while the mean number of sticks smoked per day was 4.46 + 4.59. Introduction to smoking was mainly by friends at home (48.6%), colleagues in school (33.3%) and siblings (18.1%) The factors that were positively associated with smoking habits were male sex, alcohol consumption, having a friend/relative that smokes, having no prior education on the dangers of smoking. They were all statistically significant. Conclusion: Peer influence is a very important source of cigarette smoking among the youths. Previous education on dangers of smoking and the perception that smoking is risky to health significantly reduced the prevalence of smoking. It is therefore recommended that health education on the risks associated with smoking be introduced to young adults early

Prevalence of metabolic syndrome among HIV-positive and HIV-negative populations in sub-Saharan Africa-a systematic review and meta-analysis

BACKGROUND: Metabolic syndrome (MetS) is a constellation of conditions that increase the risk of cardiovascular diseases. It is an emerging concern in sub-Saharan African (SSA) countries, particularly because of an increasingly aging population and lifestyle changes. There is an increased risk of MetS and its components among people living with Human immune deficiency syndrome (HIV) individuals; however, the prevalence of metabolic syndrome in the SSA population and its differential contribution by HIV status is not yet established. This systematic review and meta-analysis were conducted to estimate the pooled prevalence of metabolic syndrome in people living with HIV and uninfected populations, its variation by sub-components. METHODS: We performed a comprehensive search on major databases-MEDLINE (PubMed), EBSCOhost, and Cochrane Database of Systematic Reviews and Web of sciences for original epidemiological research articles that compared proportions of the MetS and its subcomponents between people living with HIV and uninfected patients and published between January 1990-December 2017. The inclusion criteria were adults aged ≥ 18 years, with confirmed HIV status. We assessed the risk of bias using a prevalence studies tool, and random effect meta-analyses were used to compute the pooled overall prevalence. RESULTS: A total of four cross-sectional studies comprising 496 HIV uninfected and 731 infected participants were included in the meta-analysis. The overall prevalence of MetS among people living with HIV was 21.5% (95% CI 15.09-26.86) versus uninfected 12.0% (95% CI 5.00-21.00%), with substantial heterogeneity. The reported relative risk estimate for MetS among the two groups was twofold (RR 1.83, 95% CI 0.98-3.41), with an estimated predictive interval of 0.15 to 22.43 and P = 0.055 higher for the infected population. Hypertension was the most prevalent MetS sub-components, with diverse proportions of people living with HIV (5.2-50.0%) and uninfected (10.0-59.0%) populations. CONCLUSIONS: The high range of MetS prevalence in the HIV-infected population compared to the uninfected population highlights the possible presence of HIV related drivers of MetS. Also, the reported high rate of MetS, irrespective of HIV status, indicates a major metabolic disorder epidemic that requires urgent prevention and management programs in SSA. Similarly, in the era of universal test and treat strategy among people living with HIV cohorts, routine check-up of MetS sub-components is required in HIV management as biomarkers. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016045727

Quercetin and Allopurinol Ameliorate Kidney Injury in STZ-Treated Rats with Regulation of Renal NLRP3 Inflammasome Activation and Lipid Accumulation

Hyperuricemia, hyperlipidemia and inflammation are associated with diabetic nephropathy. The NLRP3 inflammasome-mediated inflammation is recently recognized in the development of kidney injury. Urate and lipid are considered as danger signals in the NLRP3 inflammasome activation. Although dietary flavonoid quercetin and allopurinol alleviate hyperuricemia, dyslipidmia and inflammation, their nephroprotective effects are currently unknown. In this study, we used streptozotocin (STZ)-induced diabetic nephropathy model with hyperuricemia and dyslipidemia in rats, and found over-expression of renal inflammasome components NLRP3, apoptosis-associated speck-like protein and Caspase-1, resulting in elevation of IL-1β and IL-18, with subsequently deteriorated renal injury. These findings demonstrated the possible association between renal NLRP3 inflammasome activation and lipid accumulation to superimpose causes of nephrotoxicity in STZ-treated rats. The treatment of quercetin and allopurinol regulated renal urate transport-related proteins to reduce hyperuricemia, and lipid metabolism-related genes to alleviate kidney lipid accumulation in STZ-treated rats. Furthermore, quercetin and allopurinol were found to suppress renal NLRP3 inflammasome activation, at least partly, via their anti-hyperuricemic and anti-dyslipidemic effects, resulting in the amelioration of STZ-induced the superimposed nephrotoxicity in rats. These results may provide a basis for the prevention of diabetes-associated nephrotoxicity with urate-lowering agents such as quercetin and allopurinol

Diagnosis, staging and control of hypertension – the paradigm shift to systolic blood pressure

Hypertension is an important medical and public health issue affecting one billion people worldwide and accounting for approximately 7.1 million deaths per year. The relative importance of systolic blood pressure (SBP) and diastolic blood pressure (DBP) has been a subject of much debate since the introduction of sphygmomanometry into clinical practice. Earlier reports and guidelines had chosen DBP as the primary parameter for diagnosing, staging and control of hypertension. However, studies have shown that SBP is an important cardiovascular and renal risk factor than DBP particularly in the middle aged and elderly individuals. Also, grading and eligibility for drug therapy were better assessed using SBP than DBP. In addition, poor SBP control is largely responsible for the unacceptably low rates of overall blood pressure control. Thus, evidence abounds to show that SBP is more important than DBP in the diagnosis, staging (classification), risk stratification and management of hypertension. This informed the paradigm shift to SBP as the primary parameter for diagnosing, staging and control of hypertension. Nigerian Medical Practitioner Vol. 50(1) 2006: 3-

Awareness, knowledge and perception of chronic kidney disease in a rural community of South‑West Nigeria

Background: Awareness and education on kidney disease impact on its effective management and will reduce the significant economic and public health burden. Knowledge of CKD and risk factors increases the perception of being at high risk and increasing health seeking behavior. We conducted a cross‑sectional descriptive study to assess the level of awareness, knowledge and conventional risk factors of CKD in the community to strategize on preventive modalities using the information gathered from this population.Methods: We used a pretested structured questionnaire to draw information on sociodemography, knowledge and risk factors of CKD from 563 residents aged >18 years.Results: A total of 454 residents completed this study, mainly farmers, with a mean age of 45.8 ± 19.0 years and male: female ratio of 0.8:1. Only 33.7% had heard of kidney disease with 59.3% from the media and 35.3% from health workers; the level of knowledge of CKD was good in 27.1%. The majority (67.0%) do not know the correct location of the kidneys. Only 10.6% could mention at least one function of the kidneys with only 24.5% agreeing that NSAIDs can cause kidney disease. A laboratory test for kidney function was known by 4.4%; 45.9% and 47.8% believe that CKD can be cured by spiritual means and herbal concoctions respectively. Only 11.1% agreed that CKD can be hereditary. Abdominal obesity and cigarette smoking were seen in 14.6% and 16.6% respectively. Hypertension was seen in 26.5% while 17.8% actually knew they were hypertensive. Diabetes mellitus was found in 3.4%. None of the patients with CKD who had diabetes or hypertension was aware of kidney disease.Conclusion: There are a misconception and low level of awareness and knowledge of CKD, including those with risk factors, in the community. Efforts should be made to create awareness and educate people on CKD and prevention of its risk factors.Key words: Awareness, chronic kidney disease, knowledge, perceptio

The impact of acne and facial post-inflammatory hyperpigmentation on quality of life and self-esteem of newly admitted Nigerian undergraduates

Adeolu Oladayo Akinboro,1 Ogochukwu Ifeanyi Ezejiofor,2 Fatai Olatunde Olanrewaju,3 Mufutau Muphy Oripelaye,3 Olatunde Peter Olabode,4 Olugbenga Edward Ayodele,4 Emmanuel Olaniyi Onayemi3 1Dermatology Unit, Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso and LAUTECH Teaching Hospital, Ogbomoso, Nigeria; 2Dermatology Unit, Department of Medicine, Nnamdi Azikiwe University, Nnewi, Nigeria; 3Department of Dermatology and Venereology, Obafemi Awolowo University and OAUTHC, Ile-Ife, Nigeria; 4Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso and LAUTECH Teaching Hospital, Ogbomoso, Nigeria Background: Acne and facial post-inflammatory hyperpigmentation are relatively common clinical conditions among adolescents and young adults, and inflict psychosocial injuries on sufferers.Objective: To document the psychosocial and self-esteem implications of acne and facial hyperpigmentation on newly admitted undergraduates.Materials and methods: A cross-sectional survey was conducted among 200 undergraduates. Demographics and clinical characteristics were obtained and acne was graded using the US Food and Drug Administration 5-category global system of acne classification. Participants completed the Cardiff Acne Disability Index (CADI) and the Rosenberg self-esteem scale (RSES), and data were analyzed using SPSS 20.Results: Mean age of acne onset was 16.24 ± 3.32 years. There were 168 (84.0%) cases categorized as almost clear, 24 (12.0%) as mild acne, 4 (2.0%) as moderate acne and 4 (2.0%) as severe acne. Acne with facial hyperpigmentation, compared to acne without hyperpigmentation, was associated with significant level of anxiety in 30 participants (26.5% vs 10.3%, p=0.004) and emotional distress in 40 (35.4% vs 10.3%, p<0.001). Acne severity correlated with total CADI score but not with total RSES score. Quality of life (QoL) was significantly reduced among acne patients with facial hyperpigmentation (1.77±1.62, vs 1.07±1.02, p<0.001) compared to those without hyperpigmentation. Acne and facial hyperpigmentation was associated with social life interference, avoidance of public facilities, poor body image and self-esteem and perception of worse disease. There was no association between gender and QoL but acne was related to a reduction of self-worth. Low self-esteem was present in 1.5%, and severe acne was associated with an occasional feeling of uselessness in the male gender. Conclusion: Acne with facial hyperpigmentation induces poorer QoL and self-esteem is impaired only in severe acne. Beyond the medical treatment of acne, dermatologists should routinely assess the QoL and give attention to treatment of facial post-inflammatory hyperpigmentation among people of color. Keywords: acne, quality of life, self-esteem, facial hyperpigmentation, undergraduate

Pulmonary stenosis in pregnancy: A case report

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