Axillary fibroadenoma mimicking lymphadenopathy

No Abstract. Keywords: breast; fibroadenoma; axilla Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.73-7

Blood Pressure and Obesity Index Assessment in a Typical Urban Slum in Enugu, Nigeria

Background: Rapid transition from rural to urban lifestyle in Africa has been associated with increasing cardiovascular disease burden and thus, the need for continuous reevaluation of cardiovascular risk factors in African slums which have been shown to harbor 40 to 80% of urban residents cannot be over emphasized.Objectives: To evaluate hypertension and obesity in a typical urban slum in South East, Nigeria.Design: Cross-sectional community based study.Setting: A typical urban slum in Enugu State, Eastern Nigeria.Subjects: One hundred and ninety one volunteers from the slum.Results: The mean age of the entire participants in this study was 44.1 ± 16.2 years while their mean BMI was 25.1 ± 5.2 Kg/m2. Their mean systolic BP was 128.8 mmHg ± 22.2 and 79.0mmHg ± 12.9 for mean diastolic BP. Both systolic and diastolic blood pressure (BP) increased as age group increased peaking at the age group 55- 74 years and then dropping after 75 years. Mean BMI peaked at 35- 54 years and then started dropping as age increased. In the entire community, 29.3% of the participants had hypertension (males: 42.1 %, females: 23.9%), 25.1% had isolated systolic HBP (ISH) while 22.0% had isolated diastolic HBP (IDH). In the general population, the general prevalence of HBP and ISH increased as age group increased. IDH increased as age increased peaking at 55- 74 year age group (34.1%) and then dropped thereafter (≥75; ISH=10.0%). Among the females, HBP prevalence increased across board as age increased but among the males, it increased with age and peaked at 55-74 year age group (61.1%) and then dropped (≥75; HBP= 57.1%). The prevalence of obesity in the community was 13.1% (males; 5.3%, females; 16.4%). None of those ≥75 years had obesity. Obesity prevalence was highest in those 35-54 years old (17.6%) and least in those 15- 34 years old (9.1%). Generally and within all age groups, females had higher obesity prevalence than the males. For the males, Obesity was highest in those 55-74 years (11.1%) while for the females, it was highest in those 35-54 years (23.0%). Prevalence of HBP increased with BMI getting to more than double fold in those found to be obese. 26% of the participants (20.8% of males and 31.3% of females) who were found to have hypertension had prior knowledge of it.Conclusion: Hypertension and obesity are on the increase in Nigeria and degree of ignorance about these major cardiovascular risk factors has remained very high

Screening For Peripheral Neuropathy In Diabetic Patients: The benefits of the United Kingdom Screening Test – UKST- (a clinical scoring system).

Background: Peripheral nerve damage is a common complication of diabetes mellitus and often presents with a gamut of unpleasant sensations difficult to assess accurately clinically. Objective: To describe the United Kingdom Screening Test (UKST), a simple, accurate and reproducible clinical method for assessing the symptoms and signs of peripheral neuropathy (PN) in diabetes mellitus. The aim is to stimulate interest in the use of this tool for clinical research to detect subjective and objective PN in diabetic subjects, especially in resource poor developing countries limited by non-availability of more sophisticated quantitative diagnostic facilities. Methodology: The UKST is a two part diagnostic test consisting of scores for symptoms and signs and was used by Young et al to determine the prevalence of PN in the United Kingdom. The details of the scores for symptoms and signs are shown in Tables 1 and 2 and the diagnostic criteria for PN/benefits of this clinical scoring method are highlighted. Conclusion: PN is the commonest risk factor for foot ulceration, gangrene and loss of limb in diabetes and the importance of detecting it as early as possible in diabetic subjects cannot be overemphasized. Simple, reproducible clinical tools like the UKST facilitate this, especially in resource poor nations limited by non-availability of sophisticated diagnostic instruments. Keywords: Peripheral neuropathy, Diabetes mellitus, United Kingdom Screening Test.Tropical Journal of Medical Research Vol. 12 (1) 2008: pp. 45-4

Evaluation of age and peripheral vascular disease as risk factors for diabetic foot ulceration among Nigerian patients without foot ulcers.

Background and Objectives: Risk factors predisposing to foot ulceration in diabetic subjects are multiple. Age and peripheral vascular disease arerecognized risk factors for foot ulceration among diabetes mellitus subjects.Objectives: To evaluate the effect of age and peripheral vascular disease as risk factors for foot ulceration in Nigerian diabetic subjects withoutcurrent or previous foot ulceration.Subjects and methods: One hundred and twenty (120) diabetic mellitus (DM) subjects receiving care at the medical outpatient department (MOPD)and the diabetic clinic of the Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria, were recruited consecutively as they presented. Datacollected included subjects age (years), gender, age at first diagnosis of DM, duration of DM (years) and baseline fasting venous plasma glucose. The subjects were evaluated for peripheral vascular disease using clinical criteria (absence of distal pedal arterial pulsations) and by the hand-heldDoppler ultrasound device to determine the Ankle Brachial Index (ABI) and the Quality of Doppler Signal (QDS).Results: Among the 120 diabetic participants, peripheral vascular disease (PVD) was detected only in those aged 50 years and above and all the three diagnostic methods detected PVD increasingly with advancing age. Clinical criteria detected PVD in 4.7% of those aged 50-59 years and 26.3% of those aged .70years. For the same age groups ABI detected PVD in 9.3% and 26.3% and QDS 0.0% and 26.3% respectively.Conclusion: Age and peripheral vascular disease are risk factors for foot complication in Nigerians with diabetes mellitus. Elderly diabetic subjectsshould be recognized as a special group at high risk for foot disease from DM and specific preventive programs should target this group to reducemorbidity and mortality from avoidable loss of limbs to diabetes

Prevalence of metabolic syndrome in healthy professionals in Asaba, South South Nigeria

No Abstract

Assessment Of Kidney Sizes [Using Ultrasonography] In Chronic Renal Failure

Objectives: To assess the effects of severity of renal failure on kidney size. Subjects and Method: Ninety adult subjects [56 male 34 female] were recruited from the renal clinic of University of Nigeria Teaching Hospital, Enugu, over a period of 13 consecutive months. History and physical examination were carried out on initial visit. Their GFR was determined by urine creatinine clearance. The subjects were grouped into 3 – Group 1 GFR 11 – 20mls/min, Group 2 GFR 6 – 10mls/min, Group 3 GFR ≤5mls/min. Their kidney sizes were measured using ultrasonography. Results In both male and female subjects, mean kidney size reduced progressively as GFR deteriorated. Mean kidney size in male subjects in group 1 was 9.2cm±0.2. Group 2 was 8.4cm±0.5, Group 3 was 7.9cm±0.5. Mean kidney size in female subjects was as follows – Group 1-8.9cm±0.1, Group 2 – 8.2cm±0.1, Group 3 -8.0cm±0.5. Conclusion Mean kidney sizes were reduced as GFR worsened progressively Keywords: Ultrasonography, Kidney sizes, Enugu, NigeriaTropical Journal of Medical Research Vol. 12 (1) 2008: pp. 6-

Incidence Of Discharge Against Medical Advice (Dama) In Adult Medical Wards Of The Federal Medical Centre Asaba

Background: A retrospective study aimed at evaluating the causes, incidence and pattern of the phenomenon of discharge against medical advice (DAMA) in the medical wards of the Federal Medical Centre (FMC) Asaba, Delta State, Nigeria. Methodology: The case files of patients admitted in the medical wards between November 2005 and October 2007 were retrieved and reviewed. Relevant data were extracted and simple statistics derived. Results: A total of 1860 patients were admitted within this period. Eighty four (4.52%) left against medical advice. Male /female ratio was 1:1.33. The ages ranged between 15 and 90 years (mean 51.56years±18.35). The commonest cause of DAMA in male subjects was to seek alternative treatments while in females, it was financial constraints. Conclusion: Patients DAMA for various reasons and measures to reduce it must tackle the fundamental causes. Keywords: Incidence, Discharge Against Medical Advice, Asaba. Tropical Journal of Medical Research Vol. 12 (1) 2008: pp. 41-4

The Prevalence of Chronic Kidney Disease in Apparently Healthy Retired Subjects in Asaba, Nigeria

Background: The prevalence of chronic kidney disease (CKD) is increasing globally. Studies on this subject, especially in the older age groups are difficult to come by in developing countries like Nigeria. Aim: The aim of this study, therefore, is to estimate the prevalence of CKD in retired and elderly Nigerian subjects. Subjects and Methods: A total of 170 retired subjects were recruited for the study. Anthropometric measurements were carried out and blood samples taken for serum urea and creatinine estimation. Estimated glomerular filtration rate (eGFR) was determined using software by Kidney Health Australia. The figures obtained thereafter were multiplied by 1.21 to accommodate for the black race. Differences between subjects were tested, using Chi‑squared test for categorical data, while two tailed unpaired t‑test was used for comparison of means. A significant difference was defined as (P < 0.05) Results: A total of 170 subjects with age ranged between 50 and 86 years, with a mean age of 68.1 (7.7) years (95% confidence interval [CI = 66.9‑69.3]) completed this study. Male: Female ratio was 2:1 and 66.5% (113/170) of subjects were elderly (above 65 years). eGFR of subjects ranged from 31 to 114 ml/min/1.73 m2, with a mean of 64.5 (16.5) ml/min/1.73 m2 (95% CI = 62.0‑67.0). The prevalence of CKD in the general population studied was 43.5% (74/170), whereas that in the elderly sub‑population was 40.7% (46/113). In the non‑elderly subjects, CKD was observed in 49.1% (28/57) of subjects. There was no statistically significant difference between the prevalence of CKD in both groups (P = 0.53). The prevalence of CKD was significantly higher in the female subjects than their male counterparts. Subjects with CKD had 33.33% (38/74) males and 64.3% (36/74) females. Conclusion: Prevalence of CKD in this studied population is quitehigh. More aggressive public health measures are required to stem the tide.Keywords: Chronic kidney disease, Estimated glomerular filtration rate, Retired subject

CD4 Cell Count in HIV positive subjects in Asaba, South South Nigeria –

Objective: A two year retrospective evaluation of the CD4 cell count in HIV/AIDS subjects attending the adult HIV Clinic of the Federal MedicalCentre, Asaba, Delta State, Nigeria.Methodology: The case notes of all confirmed HIV subjects, who visited the HIV Clinics of the Federal Medical Centre, Asaba between December2005 to November 2007 were retrieved from the medical records. Those with incomplete records were excluded. Biodata [including sex, age,educational status and occupation] and CD4 cell count on initial hospital visit were recorded and reviewed. The mean, standard deviation andpercentages of relevant data were calculated and data presented in simple descriptive statistics.Results: Three hundred and four (304) subjects with complete medical records were evaluated within the study period. One hundred and sixty eight (168; 55.3%) were males while one hundred and thirty six (136; 44.7%) were females, with female/male ratio being 1: 1.2.Their ages ranged from 21 years to 70 years, with a mean age of 38.3 ± 10.56 years. Most of the subjects (61.8%) were aged 40 years and below and most had a low literacy level [92.1% attained a maximum educational status of secondary education or less]. Their CD4 cell count ranged from 8 to 566 cells/mm3, with a mean of 98.1 ± 106.22. Most of the subjects [86.9%] had CD4 cell count of 200 or less.Conclusion: Most subjects with HIV/AIDS present initially to hospital with very low CD4 cell counts. Most also are young with low literacy levels

Eating Habits of the Elderly in Asaba, Delta State, Nigeria

Objectives: The study was undertaken to describe the eating habits of literate elderly in Asaba, urban city in Delta State of Nigeria. Methods: A total of 176 elderly male (62.5%) and female (37.5%) aged 50years and above who attended Medical Lectures of the Ebreme foundation for the elderly were enrolled in this study. Dietary information was collected by means of an interviewer-administered food frequency questionnaire. The SPSS (Statistic Package for Social Science) version 13.0 was used for data analysis. Results: More than half (52.3%) of the population studied had tertiary education, 73.9% were married and lived with their family members. Their main source of income was retirement pension (71%). This income significantly influenced the amount of money spent on daily meals (Chi square =28.660; P-value 0.018). Their meals were mainly prepared by spouse (56.3%) and however, these meals were reported consumed without salt at table (72.7%). The meal preparation was significantly correlated with their marital status (