Aetiological considerations in 96 consecutive cases of ascites

Background: Ascites is always a feature of an underlying disease, whose cause is unknown at presentation most of the time. Its initial treatment therefore will be empirical and dependent on the most frequent and common causes in the environment. Aim: To evaluate a cohort of patients with ascites to determine the common causes in in the University of Port Harcourt Teaching Hospital (UPTH). Methods: We undertook a clinical evaluation of 96 consecutive cases seen at the UPTH, over a three-year period, using a combination of diagnostic modalities which included biochemical, serological and cytological examination of the ascitic fluid, as well as radiology and ultrasonography, and histological examinations of liver biopsy specimens in cases suggestive of liver disease. Results: The three most common causes of ascites in this series were liver diseases-36.5% (chronic liver disease 27.1%, hepatocellular carcinoma 9.4%), renal diseases 30.2% (chronic renal failure 23.9%, nephrotic syndrome 6.3%), and cardiac diseases 23.9% (congestive cardiac failure 22.9%, Endomyocardial fibrosis 1%). The clinical conditions associated with portal hypertension (liver and cardiac diseases) accounted for 60% of cases. Localized intra-abdominal disease, such as tuberculosis was rare (3.1%), and chronic alcohol consumption was very common amongst all aetiological groups. Peripheral oedema was a frequent accompaniment of the renal and cardiac cases more than the liver diseases, whereas pleural effusion was very rare. Conclusion: Patients presenting with ascites can be commenced on diuretics and salt restriction pending the establishment of a definitive diagnosis. Port Harcourt Medical Journal Vol. 1(1) September 2006: 29-3

Prevalence and risk factors for diabetes and diabetic retinopathy: results from the Nigeria national blindness and visual impairment survey.

BACKGROUND: In Nigeria, urbanisation and increasing life expectancy are likely to increase the incidence of non-communicable diseases. As the epidemic of diabetes matures, visual loss from diabetic retinopathy (DR) will increase unless mechanisms for early detection and treatment improve, and health systems respond to the growing burden of non-communicable diseases. METHODS: A nationally-representative population-based sample of 13,591 participants aged ≥40 years selected by multistage-stratified-cluster-random-sampling with probability-proportional-to-size procedures were examined in 305 clusters in Nigeria between January 2005 to June 2007. All were asked about history of diabetes and underwent basic eye examination. Visual acuity (VA) was measured using logMAR E-chart. Participants with VA11.1mmol/l or had DR. Data in the subsample were used to estimate the prevalence and to analyse risk factors for diabetes and DR using multivariable logistic regression. Additional information on the types of DR was obtained from participants not in the subsample. RESULTS: In the subsample, 164 participants were excluded due to missing data; and 1,595 analysed. 52/1,595 had diabetes, a prevalence of 3.3% (95%CI 2.5-4.3%); and 25/52(48%) did not know. Media opacity in 8/52 precluded retinal examination. 9/44(20.5%) had DR. Higher prevalence of diabetes was associated with urban residence (Odds ratio [OR]1.87) and overweight/obesity (OR3.02/4.43 respectively). Although not statistically significant, DR was associated with hypertension (OR3.49) and RBG>15.0mmol/L (OR8.10). Persons with diabetes had 3 times greater odds of blindness. Of 11,832 other participants in the study sample, 175(1.5%) had history of diabetes; 28 had DR. Types of DR (total=37) included 10.8% proliferative, 51.4% macular oedema. CONCLUSION: The age-adjusted prevalence of diabetes in Nigeria was 3.25% (95%CI 2.50-4.30) and over 10% of people with diabetes aged ≥40 years had sight-threatening-DR. These data will enable the development of better public health strategies for the control of diabetes and planning services for DR to prevent vision loss