Prescription and cost consideration at a diabetic clinic in Ibadan, Nigeria: a report

Diabetes mellitus is associated with high morbidity and mortality. The high cost of treatment is a major concern to both physicians and patients. This study assessed pattern and cost of drugs prescribed at a diabetic clinic, and identified the commonest reasons militatingagainst adherence to therapy.The study was a cross-sectional survey. Data was obtained from all prescriptions issued following each daysconsultation. Patients were also interviewed using a self-administered questionnaire. Means were compared using t-test and chi2 was used totest associations. P-value < 0.05 was considered significant statistically. Three hundred and fortynine (349) diabetic patients were seen. There were more females than males (61.9% & 38.1%). About 36% (125) of the patients had no formal education and 12% (42) had only primary education, while 80% were from the low socioeconomicclass. The average number of drugs prescribed/day was 4 with an average cost of medications/day being N183.5 ±150.4 (Nigeriannaira) approx $1.40 (USD). The commonest reasons that militate against adherence to prescribed drugs were the high cost of the drugs(52.2%) and the large number of drugs to be taken (43.5%). Biguanides (66%) are the commonest oral hypoglycemic agents prescribed,while ACEIs (53%) were the commonest antihypertensive prescribed. Only 5.4% of patients received statins. The cost of medicationsprescribed to diabetic patients in Ibadan, Nigeria is quite high. Every effort at cost reduction through improved prescription of drugs asgenerics and rational prescribing is necessary so as to encourage adherence to drug therapy.Key words: Cost of drugs, diabetes mellitus, drug use indicators, Nigeria, factor

A non-functioning left kidney from renal tuberculosis: a case report

This is a 25-year old petty trader with 2-year history of recurrent left flank pains, an uneventful pregnancy, a ballotable tender, irregular left kidney and a renal sonogram suggestive of chronic pyelonephritis with intra-renal abscesses. Intravenous urogram showed a non-functioning left kidney. She had a left nephrectomy with histology showing focal segmental glomerulosclerosis with extensive areas of necrosis, acute on chronic inflammation with formation of foreign body and Langerhans type giant cells suggestive of renal tuberculosis. She made an uneventful recovery with stable renal function

Assessment of measures of adiposity that correlate with blood pressure among hypertensive Africans

Background: Studies differ on which anthropometric measure of adiposity shows good correlation with cardiovascular diseases. In this study, we evaluated the effects of common epidemiological measures of adiposity as a correlate of elevated blood pressure in an African population.Methodology: The study was carried out between June 2009 and December 2011 at the medical out-patient department of a tertiary healthcare center in Nigeria. Correlation analysis was used to assess the relationship between blood pressure and body mass index (BMI), waist to height ratio (WHtR), and waist circumference (WC).Results: A total of 1,416 Hypertensives comprising 1090 (77%) adult females recruited over two and half years. Women were significantly older (49.2±8.1 vs. 48.0±10.0 years, p=0.039) and shorter (1.6±6.3 vs 1.7±6.8 meters, p<0.0001) when compared with men. Blood pressure parameters were comparable between women and men. Approximately 1 out of 5 participants had good blood pressure control with no gender difference. Anthropometric measurements showed that 446(32%) were overweight, 404(29%) obese and 40(3%) were morbidly obese. Compared with their male counterparts, females were significantly more likely to be obese (P<0.0001). Similarly, 51.6% of the subjects had abdominal obesity, with female preponderance (P<0.0001). Likewise, a greater proportion of women had substantially higher measured waist circumference risk. Compared with other measures of adiposity, body mass index correlated best with diastolic blood pressure in both gender (P< 0.05).Conclusion: This study adds to the evidence that obesity is a major cardiovascular risk factor. BMI, as a measure of adiposity, was found to correlate best with blood pressure. These findings support other observations in other populations that BMI rather than waist to height ratio (WHtR), and waist circumference (WC) is a better correlate of hypertension

A multi-ancestry genome-wide study incorporating gene-smoking interactions identifies multiple new loci for pulse pressure and mean arterial pressure

Elevated blood pressure (BP), a leading cause of global morbidity and mortality, is influenced by both genetic and lifestyle factors. Cigarette smoking is one such lifestyle factor. Across five ancestries, we performed a genome-wide gene–smoking interaction study of mean arterial pressure (MAP) and pulse pressure (PP) in 129 913 individuals in stage 1 and follow-up analysis in 480 178 additional individuals in stage 2. We report here 136 loci significantly associated with MAP and/or PP. Of these, 61 were previously published through main-effect analysis of BP traits, 37 were recently reported by us for systolic BP and/or diastolic BP through gene–smoking interaction analysis and 38 were newly identified (P < 5 × 10−8, false discovery rate < 0.05). We also identified nine new signals near known loci. Of the 136 loci, 8 showed significant interaction with smoking status. They include CSMD1 previously reported for insulin resistance and BP in the spontaneously hypertensive rats. Many of the 38 new loci show biologic plausibility for a role in BP regulation. SLC26A7 encodes a chloride/bicarbonate exchanger expressed in the renal outer medullary collecting duct. AVPR1A is widely expressed, including in vascular smooth muscle cells, kidney, myocardium and brain. FHAD1 is a long non-coding RNA overexpressed in heart failure. TMEM51 was associated with contractile function in cardiomyocytes. CASP9 plays a central role in cardiomyocyte apoptosis. Identified only in African ancestry were 30 novel loci. Our findings highlight the value of multi-ancestry investigations, particularly in studies of interaction with lifestyle factors, where genomic and lifestyle differences may contribute to novel findings

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BLOOD PRESSURE CONTROL IN A POPULATION WHERE ANTIHYPERTENSIVES ARE GIVEN FREE

ABSTRACTBackground: Analysis of blood pressure control has shown that optimal blood pressurecontrol is generally low in many studies. Poor adherence to therapeutic plans and noncomplianceare perhaps the most important factors responsible for poor control. In mostcases poverty has been adduced to be responsible for non-compliance especially in thesub-Saharan Africa. Assessment of blood pressure control in situations whereantihypertensives are given free is necessary.Objectives: To assess blood pressure control in a population where antihypertensivesare given free.Setting: International institute for tropical Agriculture (IITA).Design: Cross-sectional study.Subjects: One hundred and forty three consecutive hypertensive subjects (106 males and37 females) being followed-up in the medical clinic of the International Institute forTropical Agriculture (IITA) for variable numbers of years were studied. Blood pressurewas considered to be well controlled if it was less than 140/90 mmHg and uncontrolledif higher than 140/90mmHg.Results: About 51(36%) of the subjects may be described as being fully controlled onthe treatment instituted while 54(38%) of the subjects were not controlled at all. Inabout 18% of the patients, the systolic blood pressure alone was controlled while in8% the diastolic blood pressure alone was controlled.Main Outcome measures: Level of blood pressure control in this study is poor suggestingthat availability of free drug alone is not enough to improve adherence to antihypertensives.Conclusion: The percentage of hypertensive patients with optimal blood pressure controlin this population is low, although this was higher when compared to a report froma similar study where drugs were not given free to patients. Physicians managinghypertension in such establishments should pay attention to adequate dosing andappropriate combination of drugs

SERUM ALBUMIN, CREATININE, URIC ACID AND HYPERTENSIVE DISORDERS OF PREGNANCY

ABSTRACTBackground: Pre-eclampsia is a form of hypertensive disorder of pregnancy. It is a commoncause of both maternal and perinatal morbidity and mortality in both developed anddeveloping countries.Objective: To evaluate the possibility of early prediction of hypertensive disorders ofpregnancy using single estimation of serum protein, creatinine and uric in serum samples ofhealthy primigravidae with singleton pregnancy.Setting: University College Hospital, Ibadan.Subjects: Fifty nine normortensive primigravidae.Methods: Fifty nine healthy normotensive primigravidae with singleton pregnancy whobooked for antenal care and delivered at the University College Hospital, Ibadan had singleestimations of their serum albumin, creatinine and uric acid levels at booking before the 20thweek of pregnancy. The women were followed up longitudinally throughout pregnancy.Results: Pre-eclampsia occurred in five of the patients (21.7%), two had pregnancy inducedhypertension only (8.7%) while 16 remained normotensive (69.6%). The difference in themean serum concentration of uric acid (0.162± 0.02 mmol/L) and creatinine (93.70± 10.08μmol/L) respectively were not statistically significant (p&gt;0.05). However, the difference in themean serum albumin levels (4.06± 0.06 versus 3.71±0.33 gm/dl) was significantly higher inthe pre-eclampsia group (p&lt;0.05). The predictive performance of these tests was generallylow whether alone or in combination.Conclusion: Single estimation of serum uric acid and creatinine levels early in pregnancy areof little value in the prediction of pre-eclampsia. A large study is recommended to properlydefine the value of serum albumin levels in pregnancy in the prediction of pre-eclampsia inthe light of the findings of this study