Effect of Dried Lake Salt (Kanwa) on Lipid profile and Heart Histology of Female Albino Rats

Peripatum cardiomyopathy is a devastating form of cardiac failure affecting women mainly in their last month of pregnancy or early postpartum with high incidence in Northern Nigeria where the consumption of dried lake salt postpartum is high. The current work was designed to study the effect of dried lake salt on lipid profile and histology of heart in female albino rats. The rats were administered graded doses of the salt for 4 weeks. The group administered 300mg/kg body weight of the dried lake salt has significantly (P<0.05) lower high density lipoprotein-cholesterol as compared with the control. There was no significant (P>0.05) increase in low density lipoprotein-cholesterol but total cholesterol, triglyceride and very low density lipoprotein- cholesterol levels were lower compared to the control. Atherogenic index of the group administered 300mg/kg body weight was significantly (P<0.05) higher compared to the control. The histological examinations of section of the heart reveal chamber dilation, hypertrophy and focal atrophy. The study suggests that consumption of dried lake salt for 4 weeks caused alteration to heart tissue and may cause heart related diseases in rats.Keywords: Peripartum cardiomyopathy, Dried lake salt, Postpartum, Pregnanc

Prescription Pattern of Anti-Hypertensive Drugs in a Tertiary Health Institution in Nigeria

Objective: This study examined the pattern of physicians\u2019 prescription of antihypertensive drugs and its possible effects on blood pressure control as well as physicians\u2019 compliance with recommended guidelines. Methods: Records of 145 patients aged 17-91 (mean: 52.6\ub114.6) years, with male to female ratio of 1:1.2 were randomly selected. Information on antihypertensive prescriptions was recorded. Blood pressure control was defined as systolic and diastolic blood pressure less than 140 mm Hg and 90mmHg, respectively. Results: Of the 145 patients studied, 20% (29) were on monotherapy and 80% (116) on combination therapy. Of the patients on combination therapy, 61.2% (71), 33.6% (39) and 5.2% (6) were on 2, 3 and 4 drugs, respectively. Diuretic was the most frequently prescribed drug either as a single agent (44.8%) or as combination therapy (88.8%). Mean reductions in both systolic and diastolic blood pressures were more in patients on calcium channel blocker than those on diuretic monotherapy (t=2.5 and 3.6 for reductions in systolic and diastolic BP, respectively; P<.05 for both), and, in patients on combination therapy than those on monotherapy (t=3.64 and 3.27 for reductions in systolic and diastolic BP, respectively; P<.01 for both). Blood pressure control rate was 30.5%. Conclusion: Our results are consistent with the previously observed benefits of antihypertensive combination therapy, and demonstrate an apparent higher efficacy of calcium channel blocker monotherapy than diuretic monotherapy in blood pressure lowering in the study population. Major limitations of this work include its retrospective nature and the inability to determine the actual patients\u2019 adherence to therapy.Objectif: Cette \ue9tude a examin\ue9 le sch\ue9ma de l\u2019ordonance m\ue9dicale (prescription m\ue9dicamenteuse) des antihypertenseurs et son effet possible dans le contr\uf4le de l\u2019hypertension art\ue9rielle ainsi que sa comformit\ue9 aux indications recommend\ue9es. Methode: Les donn\ue9es de 145 patients \ue2g\ue9s de 17 \ue0 91 ans, (moyenne: 52, 6+ 14, 6) avec un rapport d\u2019un homme pour 1, 2 femmes, ont \ue9t\ue9 recueillis au hazard. Des informations sur les ordonnances des antihypertenseurs ont \ue9t\ue9 enregistr\ue9es. Moins de 140mm/hg pour systolique et 90mm/hg pour diastolique ont \ue9t\ue9 retenus comme le contr\uf4le. Resultats: De 145 partients \ue9tudes, 20% soit patients \ue9taient sur le r\ue9gime monoth\ue9rapie (combin\ue9e). Pour les patient en r\ue9gime multith\ue9rapie, 61, 2% soit 71, 33, 6% soit 39 et 5, 2% soit 6 \ue9taient sur 2, 3, et 4 m\ue9dicaments respectivement. Les diur\ue9tiques \ue9taient plus fr\ue9quemment prescript, soit seuls (44, 8%) ou en combinaison avec d\u2019autres agents antihypertenseurs. La r\ue9duction moyenne dans les deux cas de systolique et diastolique \ue9tait plus \ue9lev\ue9e chez les patients prenant les diur\ue9tiques tout court. (= 2.5 et, 3.6 pour la r\ue9duction en systolique et diastolique respectirement; p<0.05 pour les deux cas), et chez les patients en th\ue9rapie combin\ue9e que chez ceux en monoth\ue9rapie (t = 3,64 et 3, 27 pour la r\ue9duction en systolique et diastolique respectivement; p< 0.01) pour les deux cas_. Le taux de contr\uf4le \ue9tait 30, 5%. Conclusion: Nos r\ue9sultats correspondent aux b\ue9n\ue9fices d\ue9j\ue0 observ\ue9s dans le r\ue9gime de la th\ue9rapie antihypertensive combin\ue9e, et montre une efficacit\ue9 clairement \ue9lev\ue9e de beta-bloquants de calcium (la chaine de bloquants de calcium) utilis\ue9s en monoth\ue9rapie que les diur\ue9tiques utilis\ue9s en monoth\ue9rapie dans l\u2019abaissement de la tension art\ue9rielle au sein de l\u2019\ue9chantillon de l\u2019\ue9tude

Characterisation of heart failure with normal ejection fraction in a tertiary hospital in Nigeria

<p>Abstract</p> <p>Background</p> <p>The study aimed to determine the frequency and characteristics of heart failure with normal EF in a native African population with heart failure.</p> <p>Methods</p> <p>It was a hospital cohort study. Subjects were 177 consecutive individuals with heart failure and ninety apparently normal control subjects. All the subjects underwent transthoracic echocardiography. The group with heart failure was further subdivided into heart failure with normal EF (EF ≥ 50) (HFNEF) and heart failure with low EF(EF <50)(HFLEF).</p> <p>Results</p> <p>The subjects with heart failure have a mean age of 52.3 ± 16.64 years vs 52.1 ± 11.84 years in the control subjects; p = 0.914. Other baseline characteristics except blood pressure parameters and height were comparable between the group with heart failure and the control subjects. The frequency of HFNEF was 39.5%. Compared with the HFLEF group, the HFNEF group have a smaller left ventricular diameter (in diastole and systole): (5.2 ± 1.22 cm vs 6.2 ± 1.39 cm; p < 0.0001 and 3.6 ± 1.24 cm vs 5.4 ± 1.35 cm;p < 0.0001) respectively, a higher relative wall thickness and deceleration time of the early mitral inflow velocity: (0.4 ± 0.12 vs 0.3 ± 0.14 p < 0.0001 and 149.6 ± 72.35 vs 110.9 ± 63.40 p = 0.001) respectively.</p> <p>The two groups with heart failure differed significantly from the control subjects in virtually all echocardiographic measurements except aortic root diameter, LV posterior wall thickness(HFLEF), and late mitral inflow velocity(HFNEF). HFNEF accounted for 70(39.5%) of cases of heart failure in this study.</p> <p>Hypertension is the underlying cardiovascular disease in 134(75.7%) of the combined heart failure population, 58 (82.9%) of the subjects with HFNEF group and 76(71%) of the HFLEF group. Females accounted for 44 (62.9%) of the subjects with HFNEF against 42(39.3%) in the HFLEF group (p = 0.002).</p> <p>Conclusion</p> <p>The frequency of heart failure with normal EF in this native African cohort with heart failure is comparable with the frequency in other populations. These groups of patients are more likely female, hypertensive with concentric pattern of left ventricular hypertrophy.</p

The risk of metabolic syndrome as a result of lifestyle among Ellisras rural young adults

The study aimed to investigate the association between metabolic syndrome (MetS) and lifestyle risk factors among Ellisras adults. A cross-sectional study was conducted on 624 adults (306 males and 318 females). MetS was defined according to the criteria of the International Diabetes Federation. The prevalence of MetS was 23.1% (8.6% males and 36.8 % females). Females appeared to have higher mean values for waist circumference (WC), fasting blood glucose (FBG), total cholesterol (TCHOL) and low-density lipoprotein cholesterol (LDL-C), while males had high mean values for high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), systolic blood pressure (SBP) and diastolic blood pressure (DBP). No significant age and gender differences were observed for dietary intake. Significantly more females (51.9%) presented with increased WC than males (4.6%). Participants who had a high dietary energy intake were significantly less likely to present with larger WC (OR: 0.250 95% CI [0.161; 0.389]), low HDL-C (OR: 0.306 95% CI [0.220; 0.425]) and high LDL-C (OR: 0.583 95% CI [0.418; 0.812]) but more likely to present with elevated FBG (OR: 1.01 95% CI [0.735; 1.386]), high TCHOL (OR: 1.039 95% CI [0.575; 1.337]), high TG (OR: 1.186 95% CI [0.695; 2.023]) and hypertension (OR: 5.205 95% CI [3.156; 8.585]). After adjusting for age, gender, smoking, and alcohol status, high energy intake was more than two times likely to predict MetS in adults with a large WC (OR: 2.766 95% CI [0.863; 3.477] and elevated FBG (OR: 2.227 95% CI [1.051; 3.328]). Therefore, identifying groups that are at an increased risk and those that are in their early stages of MetS will help improve and prevent the increase of the MetS in the future

Estimating the burden of selected non-communicable diseases in Africa: a systematic review of the evidence

Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa

Predictors of 30 days outcome of patients with acute stroke in Sokoto

Background: Though the epidemiologic profile of patients with acute stroke has been described in the sub Sahara African region, little is known about predictors of mortality in patients with acute stroke. This study aimed to determine the predictors of 30-day mortality of acute stroke so that early therapeutic measures could be instituted to improve functional outcome. Methods: Case records of patients admitted from January 2007 to December 2009 with clinical diagnosis of stroke were retrieved. Relevant clinical data were extracted using structured questionnaire. Results: A total of 370 case files with clinical diagnosis of stroke were traced but only 260 had complete information. The mean age of patients was 55.7±14.3 years; Hypertension was the most common modifiable risk factor for stroke followed by diabetes mellitus. The 24-hour and 30-day case fatalities were 11.9% and 38.4%, respectively. Predictors of 30-day mortality were admission blood glucose, level of consciousness and age at stroke. Conclusion: The 30-day case fatality of acute stroke was high and predictors of outcome included old age reduced level of consciousness and elevated blood glucose at presentation

The impact of training on malaria treatment practices: a study of patent medicine vendors in Birnin-kebbi.

Background: Patent medicine vendors are major providers antimalaria treatment in Nigeria. The management of malaria by this informal sector of healthcare delivery is however dominated by negative practices. This study determines the influence of training on antimalaria treatment practices of patent medicine vendors. Methods: Fifty-five patent medicine vendors selected through a multistage sampling technique inBirnin-Kebbi were recruited into the study. Their baseline treatment practices were determined and the negative ones identified. Intervention training was instituted and its impact assessed using ainterviewer-administered questionnaire. Simulated visit mystery client survey which involved direct observation of patent medicine vendors practice was conducted after the intervention and the resultscompared with self reported post intervention practices. Results: The negative practices identified included inappropriate dosage regimen, frequent unnecessary use of injectables and alteration of physicians’ prescriptions. Following the intervention training of the patent medicine vendors, the overall appropriate treatment practice score rose from baseline value of 3.6% to 45.5% (p0.05) and significantly lower than the post training values (p0.05) and was significantly lower than the post intervention values (

Relationship Between Epistaxis And Hypertension: A Study Of Patients Seen In The Emergency Units Of Two Tertiary Health Institutions In Nigeria

Both epistaxis and hypertension are common in the general population. This study aimed at determining the prevalence of hypertension among epistaxics, and the relationship between epistaxis and hypertension. Retrospective analysis of 62 adults comprising 31 each of males and females with a mean age of 41.4 ± 16.6 years (range: 18-90 years) that presented in the emergency units of two tertiary health institutions seen over 11 years was done.Main outcome measure was the prevalence of hypertension amongst epistaxics. Seventy-six age and sex-matched patients with bleeding from sites other than the nostrils with no record of epistaxiswere selected by simple random sampling as controls. Peak prevalence of epistaxis occurred during the months of January and March. Compared to the controls, the epistaxics had significantly higher blood pressures: (146.1 ± 40.7 mmHg versus 123.2 ± 16.3 mmHg systolic, P =0.001), and (91.3 ± 24.8 mmHg versus 78.2 ± 12.8 mmHg diastolic, P=0.001), and higher proportions of patientswith previous history of hypertension (32.3% versus 7.9%;

Comparative Analysis of Salt Taste Perception among Diabetics, Hypertensives and Diabetic Hypertensives

Impaired salt taste perception has been described in patients with essential hypertension. Hypertension occurs more frequently in diabetics than the general population. We compared salt taste perception among patients with type 2 diabetes (n=59), hypertension (n=57) and concurrent hypertension and diabetes (n=56) using graded NaCl solution (0 - 400 mmol/L). Sixty age, sex and body mass index-matched healthy individuals served as controls. Main outcome measures included taste threshold for NaCl recognition, and salt taste insensitivity defined as taste threshold for NaCl recognition > 100 mmol/L. Diabetic hypertensives had insignificantly higher duration of diabetes than the diabetic normotensives (5.0 ± 4.1 versus 3.5 ± 2.6, P= 0.07). The prevalence of NaCl taste insensitivity did not differ significantly among hypertensives, diabetic hypertensives and diabetics normotensives (52.6% versus 46.4% versus 40.7%; P=0.3). Compared to the controls, normotensive diabetics were at higher risk of salt taste insensitivity (40.7% versus 18.3%, P=0.01; OR=3.1, 95% CI =1.2-7.7). In the diabetic normotensive group, NaCl taste recognition threshold correlated positively with systolic blood pressure (r=0.501, P=0.001), diastolic blood pressure (r=0.411, P=0.04) and duration of diagnosis of diabetes (r=0.402, P=0.02). These results suggest that salt taste acuity is impaired in type 2 diabetics and could be a contributory factor to the high prevalence of hypertension in the diabetic population. Keywords: Salt taste perception, type 2 diabetes, hypertensionNigerian Medical Practitioner Vol. 53 (1&2) 2008: pp. 7-1