Patterns of left ventricular geometry in hypertensive patients in University of Benin teaching hospital, Benin city

Systemic hypertension is associated with different left ventricular geometric adaptations, which are matched to systemic hemodynamics and ventricular load. Four geometric patterns have been described. The prevalence of these left ventricular geometric patterns in hypertension has been reported in other places but, the prevalence in university of Benin teaching hospital is not known. The aim of the study was to determine the prevalence of the different left ventricular geometric patterns in hypertensive patients in university of Benin teaching hospital Benin City. Two hundred and seventy-four (247) recently diagnosed hypertensive subjects had trans thoracic echocardiography done to determine the left ventricular mass (LVM) and relative wall thickness (RWT). The geometric pattern was then derived from the LVM and RWT. The prevalence of each geometric pattern was determined as a percentage of the total number of subjects. Concentric hypertrophy was the most prevalent geometric pattern (30.8%), concentric remodeling was however the least prevalent (19.4%). The prevalence of eccentric hypertrophy was 27.9% while, that of normal geometry was 21.9%. The prevalence of left ventricular geometric patterns in hypertension is as follows; concentric hypertrophy 30.8%, eccentric hypertrophy 27.9%, normal geometry 21.9% and concentric remodeling 19.4%. Keywords: Prevalence, left ventricular geometry, hypertension

Comparative analysis of different modalities of assessment of lower extremity peripheral artery disease and its prevalence amongst diabetic patients

Background: Diabetes mellitus is an important risk factor for development of atherosclerosis and by extension, lower extremity peripheral artery disease (LEAD). The prevalence of LEAD may vary depending on the diagnostic tool applied. Objective: To determine the effect of applied diagnostic tool on the prevalence of LEAD in type 2 diabetes mellitus patients in a tertiary hospital in Nigeria. Materials and Methods: Three hundred and eighty eight diabetic patients aged between 35 and 88 years were consecutively enrolled in the study. Fifty age and sex matched controls were also recruited for the study. LEAD was assessed in all the patients using:1. History of intermittent claudication using the Edinburgh Claudication Questionnaire.2. Palpation of pedal pulses for diminished or absent dorsalis pedis and/or posterior tibial artery pulsations.3. Ankle Brachial Index <0.9 in either leg, using hand-held Doppler ultrasonographyResults: The study showed that the prevalence of LEAD was 35.6% with Doppler ABI <0.9 in either leg. The prevalence of LEAD using history of intermittent claudication and diminished or absent pedal pulses determined by palpation were 5.4% and 13.9%, respectively. Determination of LEAD by history of intermittent claudication and physical examination of pedal pulses both had low sensitivity but high specificity. The ratio of symptomatic to asymptomatic disease was found to be 2: 15. Conclusion: LEAD is common among type 2 diabetes patients in Nigeria and majority of the patients had asymptomatic disease. We recommend that patients with type 2 diabetes mellitus be screened for LEAD using ABI <0.9.Key Words: Diabetes Mellitus, Ankle Brachial Index (ABI

The Challenges Of Managing Quintuplets In A Developing Country (Nigeria)

High order multiple deliveries have been reported from a number of developed countries previously but not from a developing country. This report highlights the challenges posed by the management of the second surviving quintuplet delivery in Nigeria at the University of Benin Teaching Hospital Benin, and the subsequent management of the babies. The first was at UNTH in 1988 but the mother took fertility drugs. The challenges encountered during the antenatal care of the mother included the long stay in the hospital of the mother for bed rest, accurate diagnosis of the number of the babies prenatally, management of the weight of the mother and acceleration of the maturation of the babies' lungs. During delivery, resuscitation of the babies with the available health professionals, materials and equipment also posed some problems. Continuous ambubagging with oxygen was performed when some of them went apnoeic. Continuous positive airway pressure (CPAP) ventilation with a respirator (i.e. Mechanical ventilation), which was not available during resuscitation or early in their lives, could not be offered. Management consisted of using hot water bottles; perplex glass shied to maintain body temperature instead of incubators and respirators; which also were not available. It is recommended that adequate manpower, equipment and diagnostic procedures be made readily available to cope with such circumstances. This case is highlighted because this is the first known surviving quintuplet delivery in Nigeria by a mother without having taken fertility drugs and to evaluate the management of these babies and their mother in difficult circumstances. Nigerian Journal of Clinical Practice Vol.6(1) 2003: 71-7