Microalbuminuria and hypertensive retinopathy among newly diagnosed nondiabetic hypertensive adult Nigerians

Objective: Microalbuminuria (MA) is a marker of vascular damage and has prognostic implications in hypertension. The objective of this study was to determine if the presence of MA increases the risk of hypertensive retinal damage in nondiabetic adult Nigerians with hypertension.Materials and Methods: A total of 96 consecutive newly diagnosed hypertensive patients attending the outpatient clinic and who consented and met the criteria for the study were recruited. There was also the same number of age- and sex-matched normotensive controls.Results: MA was present in 31 (32.3%) of the patients and 6 (6.3%) of the controls. The mean (±SD) ages of patients with and without MA were 52.5 ± 11.9 years and 48.3 ± 13.0 years, respectively. The diastolic blood pressure (P = 0.03) and mean arterial pressure (P = 0.01) were statistically higher in hypertensive patients with MA than in their counterparts without it. Patients with MA were more likely to have hypertensive retinopathy (HRP) than patients without it (71% vs 37%, P = 0.001). Advanced HRP, i.e., Grades III - IV, was more common in patients with MA than in those without it (22.6% vs 1.5%).Conclusion: This study shows a high prevalence of HRP in Nigerian hypertensives with MA

Left ventricular structure and function in black normotensive type 2 diabetes mellitus patients

Background: Relationship between type 2 DM and cardiovascular disease (CVD) is well known, with CVD being the most common cause of mortality in diabetics. Significant myocardial injury before overt CVD in DM can be identified early using echocardiography. This study therefore aimed at evaluating left ventricular structure and function of patients with type 2 DM.Materials and Methods: One hundred and fifty adult type 2 DM patients were recruited with 150 age- and sexmatched controls. Patients and subjects with systemic hypertension, pregnancy, sickle cell disease and structural heart disease were excluded from the study. Participants were evaluated clinically; had anthropometric parameters and electrocardiogram taken. Echocardiograms were obtained according to the American Society of Echocardiography (ASE) recommendations.Results: Mean age of the patients (55.4±11.6 years) was similar to that of the control (54.2±9.6 years) (P=0.348) and the duration of DM was 4.53 years. Left ventricular (LV) systolic function was normal in both groups but was higher in patients than controls (ejection fraction=70.3±10.7% and 64.4 ± 9.4%, P =0.001 respectively). The prevalence of LV diastolic dysfunction (LVDD) was 72% in the patients compared with 6% in controls (P=0.001). Patients’ age, body weight, duration of DM, LV mass index and left atrial dimension were positive correlates of LVDD while patients’ age, weight and left atrial dimension were independent predictors of LVDD.Conclusion: There is high prevalence of alterations in LV structure and function in normotensive type 2 DM; and there is a need for early intervention to prevent overt LV dysfunction

Cardiac Arrhythmias in Children with Sickle Cell Anaemia

Background : Sickle cell anaemia (SCA) is an important cause of morbidity and mortality in tropical Africa. Recurrent episodes of vaso-occlusive crisis often lead to organ ischaemia and/or infarction. Arrythmias are common and reliable manifestations of myocardial ischaemia and often follow infarction. The prevalence and pattern of cardiac arrhythmias among SCA patients has not been studied extensively, particularly in children. Objective: To determine whether or not, patients with SCA are more prone than others to cardiac arrhythmias. Patients and Methods: The standard 12-lead ECGs of 35 patients with SCA presenting during 40 episodes of vaso-occlusive crisis (Group A) were compared with those of 40 age- and sex-matched sicklers in the steady state (Group B) and with 40 age- and sex-matched patients with anaemia due to causes other than haemoglobinopathy (Group C). Results: Cardiac arrhythmias were detected in four (10 percent) of the crisis episodes in Group A patients compared to three (7.5 percent) of patients in Group B and only one (2.5 percent) of the patients in Group C (p>0.3). In Groups A and B, the arrhythmias were all of atrial origin. The mean haematocrit level of Group A subjects with arrhythmias was significantly lower than those without (p= 0.037). Conclusions: Although differences did not reach statistical significance, the results suggest that patients with SCA appear to be more prone to cardiac arrhythmias than others, whether or not they are in crisis. Further studies involving larger populations are indicated. Nigerian Journal of Paediatrics2003;30:13-1

Correlation of Admission Blood Pressures with 30-Day Outcome in Acute Ischaemic Stroke in Nigerians.

Background: There is a lot of controversy on the prognostic value of admission blood pressures in acute ischaemic stroke, but in Nigeria, there is no information on this. Objective: The objective of this study was to correlate the effect of blood pressures measured on admission with 30-day mortality and neurological handicap in Nigerians with acute ischaemic stroke. Methods: This was a prospective observational study carried out between February, 2003 and May, 2004 at the Lagos University Teaching Hospital, Lagos, Nigeria. All eligible consecutively consenting ischaemic stroke patients were recruited. Systolic (SBP) and diastolic blood pressures (DBP) were measured on admission while pulse pressure (PP) and mean arterial pressure (MAP) were derived. Patients were periodically evaluated for progress and/or development of complications. Primary outcome was mortality within 30 days while secondary outcome was level of handicap on the modified Rankin Scale. Results: 100 patients were studied (mean age 58.56±14.12 years); 53% were males. Overall 30-day case fatality rate was 28%. There was no significant correlation between admission blood pressures and 30-day mortality (SBP: r = -0.05, p= 0.62; DBP: r = -0.12, p= 0.23; PP: r = 0.01, p= 0.90; MAP: r = -0.09, p= 0.36) or modified Rankin Score (SBP: r = -0.11, p= 0.29; DBP: r = -0.13, p= 0.21; PP: r= -0.06, p= 0.54; MAP: r = -0.13, p= 0.21). Conclusion: Admission blood pressures do not have significant influence on 30-day mortality and level of handicap in Nigerians with ischaemic stroke. Keywords: correlation, ischaemic stroke, blood pressure, outcome, Nigerians Nigerian Medical Journal Vol. 48 (3) 2007: pp. 58-6

Basal and squamous cell carcinomata on the same patients: report of two cases in Aibinos

Background: Skin cancer is the most common cancer among the lightly pigmented individuals in Europe, North America and Australia. It occurs infrequently in darkly pigmented individuals because they have more melanin. Melanin and albinism are a known risk factors for skin cancers in Africans. Those already treated for skin cancer run a risk of developing another skin cancer. Method: Two case reports of albinos who developed basal cell carcinoma (BCC) and squamous cell carcinomata (SCC) later are presented. The two female albinos aged 61 and 21years had BCC and SCC involving the left arm and the dorsum of the left hand in case1 and involving the face and the medial side of the right elbow in case 2. Both patients had numerous actinic keratoses that indicated chronic exposure to sunlight. Results: The outcome was good for the BCC\'s as the wounds healed post excision. There was no evidence of recurrence when the patients represented with SCC at 12 and 18 months respectively. Conclusion: Albinos run a risk of developing both BCC and SCC with chronic exposure to sunlight. Health education strategies on the need for early institution of preventive measures and follow up are emphasised as they run a risk of developing another cancer. Keywords: Albinos, Basal cell carcinoma, Squamous cell carcinoma, Same individualsPort Harcourt Medical Journal Vol. 3 (1) 2008: pp. 111-11

Pattern of Left Ventricular Diastolic Dysfunction and QTc Prolongation in Adult Nigerians with Chronic Heart Failure

Abnormalities of left ventricular diastolic function are known in patients with chronic heart failure but their relationship with QT interval has not been well studied, particularly in Nigeria. This study is therefore aimed at determining the relationship between pattern of diastolic dysfunction and QT interval. Ninety-six consecutive patients with heart failure were recruited with 90 age and sex-matched controls. All the subjects had a 12-lead electrocardiogram at a paper speed of 25mm/sec and a rhythm strip (lead II) at 50mm/sec. The latter was used to calculate the QTc using the Bazett\'s formula. Left ventricular systolic and diastolic functions were assessed using 2D guided M-mode and Doppler echocardiogram respectively. They were followed-up for six months for clinical outcome. Ninety-one patients and 90 controls completed the study. Five patients were lost to follow-up. The mean age (51.9±16 years) of the patients was similar to that of the controls (50.3±15) (P = 0.475). Twenty eight (30.8%) patients died during the study period. When patients with mild to moderate diastolic dysfunction (impaired relaxation and pseudo-normalization) were compared with severe form (restrictive pattern), the mean QTc was significantly longer in the latter group (0.493±0.029) than in the former (0.468±0.037) P=0.0001. Significant positive correlation was observed between QTc and stage of diastolic dysfunction (r = 0.318, P = 0.002). The data suggest that QTc may predict severity of diastolic dysfunction and by extension death in this group of patients. Keywords: Diastolic dysfunction, QTc, mortality, chronic heart failureNigerian Medical Practitioner Vol. 53 (4) 2008: pp. 57-6

May measurement month 2018: an analysis of blood pressure screening results from Nigeria.

Hypertension remains the dominant cardiovascular risk factor worldwide. May Measurement Month (MMM) is an annual global programme of the International Society of Hypertension aimed at screening for undetected hypertension in the general population. We report the outcome of MMM 2018 in Nigeria. An opportunistic screening of adults aged at least 18 years was conducted in the six geopolitical zones of Nigeria in the month of May, 2018. Screening for hypertension was done by trained volunteers with the use of validated digital and mercury sphygmomanometers following the MMM protocol. Hypertension was defined as blood pressure (BP) ≥140/90 mmHg or the use of BP-lowering medication. There were 6398 participants (53.0% female) with a mean (SD) age of 41.7 (15.0) years. Hypertension was present in 36.4% of the participants with 51.1% of the hypertensives aware of their status, 41.8% on medication, of whom 43.1% were controlled. Overall, only 18.0% of all hypertensive participants had their BP under control. The proportion with hypertension is high, and awareness, treatment, and control rates are low. Concerted efforts are needed to improve awareness and treatment of hypertension in Nigeria in order to reduce the high rate of complications associated with uncontrolled BP

May Measurement Month 2019: an analysis of blood pressure screening results from Nigeria

The aim of this study is to estimate the frequency of undetected hypertension across the six geopolitical zones of Nigeria. We conducted an opportunistic screening of adults aged at least 18 years in the month of May 2019. Participants were recruited by trained volunteers using the May Measurement Month protocol. Blood pressure (BP) was measured using validated digital and mercury sphygmomanometers. We defined hypertension as BP ≥140/90 mmHg or the use of BP-lowering medication. A total of 3646 participants (52.8% females) with a mean age of 44.5 ± 15.7 years were screened. Hypertension was present in 39.2% of the participants but only 55. 4% of these were on antihypertensive medications. Only 46.8% hypertensives who were on medications had their BP controlled (<140/90 mmHg). Previous history of hypertension in pregnancy, alcohol intake and smoking were associated with increased mean systolic and diastolic BPs. The frequency of Nigerians with hypertension is high while only about half of those on antihypertensive medications are controlled. A multi-pronged approach to reduce the burden of hypertension is needed

May Measurement Month 2017: screening for hypertension in Nigeria-Sub-Saharan Africa.

Hypertension and its complications are now responsible for about a quarter of emergency medical admissions in urban hospitals in Nigeria. It is the commonest risk factor for stroke, heart failure, chronic kidney disease, and dementia. Furthermore, high blood pressure is the commonest cause of sudden unexpected natural death in the country. Regrettably, the rate of awareness, treatment, and control is abysmally low in the country and in many parts of the world. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high blood pressure (BP) and to act as a temporary solution to the lack of screening programs worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. A total of 19 904 individuals with a mean age of 40.9 years, were screened during MMM17. After multiple imputation, 6709 (36.2%) had hypertension. Of individuals not receiving anti-hypertensive medication, 4140 (25.9%) were found to have hypertension. Of individuals receiving anti-hypertensive medication, 1449 (58.8%) had uncontrolled BP. MMM17 was one of the largest BP screening campaigns undertaken in Nigeria. A significant number of the participants were identified with hypertension (but not on any treatment) and uncontrolled BP despite being treated. These results suggest that opportunistic screening can identify significant numbers with raised BP