The relationship between measures of obesity and atherogenic lipids among Nigerians with hypertension

AimThis study aimed to determine the relationship between measures of obesity and serum lipid levels among hypertensive patients.MethodsThis was a cross-sectional study in which participants newly diagnosed with hypertension formed the study population. A range of demographic and anthropometric data was obtained, including weight, height, and waist and hip circumference. Fasting serum lipids were also measured, including total cholesterol, high density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Low density lipoprotein cholesterol (LDL-C) was calculated using Friedewald formula. Statistical analysis was then carried out to determine the relationship between anthropometric indices and lipid profile levels. ResultsThe study population consisted of 124 male and 290 female subjects with a mean age of 66±16.95 years (range, 30–100 years).The female subjects were older than the male subjects (p=0.020). Our analysis showed that 85%, 58.5% and 30.7% of the study population had abnormal waist circumference (WC), abnormal waist-hip ratio (WHR) and a body mass index (BMI) >25 kg/m2, respectively. Decreased HDL-C (70.1%) was the commonest lipid abnormality detected, followed by elevated LDL (6.0%). None of the anthropometric indices were independent predictors of abnormal lipid levels. However, advanced age and female sex were independent predictors for at least one serum lipid abnormality.ConclusionNone of the measures of obesity could independently predict abnormal lipid levels in individuals newly diagnosed with hypertension. However, female sex, advanced age and systolic blood pressure were independently associated with abnormal serum lipids. Encouraging regular exercise, and the possible addition of statins, may be beneficial in addressing both obesity and dyslipidaemia

Audit of insulin prescription patterns and associated burden among diabetics in a tertiary health institution in Nigeria

Background: Insulin is one of the most important anti-diabetic agents in the management of diabetes even among type 2 diabetic. Objective: There was need to assess insulin adherence, mode of insulin delivery and burden of insulin usage among diabetics.Methods: A cross-sectional, prospective questionnaire, orally administered at a Diabetes Clinic of a University Teaching Hospital, SouthWest, Nigeria. Participants were consecutive patients with diabetes who were 18 years or older presently on insulin either alone or in combination with other anti-diabetic agents for at least 3 months. Baseline demographic and insulin treatment information were obtained.Results: Two hundred and thirteen (213) participants were studied. Of these, 21 (9.9%) had T1DM and 192 (90.1%) had T2DM, (means age, 58.6 ± 13.1 years, mean duration of diabetes, 7.0 ± 6.9 years). Insulin adherence was noted in 72.8% with better adherence among those who self-injected insulin compared to those who were injected by health care professionals (HCPs) or relations. Among the respondents, 80.8% were on human insulin and pre-mixed insulin was the most commonly used form of insulin (52.6%). Most participants (52.6%) were taking 10-20 units per day, only 22 (10.3%) were on >40units/day. Reuse of insulin needle was found in 74.6% of the participants.  Major reasons for insulin omission were non-availability of insulin and patients being tired of insulin injection.Conclusion: The insulin adherence among diabetics in this study was high. Non-availability of insulin, insulin injection pain and being tired of continual insulin usage were some of the reasons for non-adherent to insulin usage.Keywords: Adherence, diabetes, burden, insulin injection, omission

Audit of insulin prescription patterns and associated burden among diabetics in a tertiary health institution in Nigeria

Background: Insulin is one of the most important anti-diabetic agents in the management of diabetes even among type 2 diabetic. Objective: There was need to assess insulin adherence, mode of insulin delivery and burden of insulin usage among diabetics. Methods: A cross-sectional, prospective questionnaire, orally administered at a Diabetes Clinic of a University Teaching Hospital, SouthWest, Nigeria. Participants were consecutive patients with diabetes who were 18 years or older presently on insulin either alone or in combination with other anti-diabetic agents for at least 3 months. Baseline demographic and insulin treatment information were obtained. Results: Two hundred and thirteen (213) participants were studied. Of these, 21 (9.9%) had T1DM and 192 (90.1%) had T2DM, (means age, 58.6 \ub1 13.1 years, mean duration of diabetes, 7.0 \ub1 6.9 years). Insulin adherence was noted in 72.8% with better adherence among those who self-injected insulin compared to those who were injected by health care professionals (HCPs) or relations. Among the respondents, 80.8% were on human insulin and pre-mixed insulin was the most commonly used form of insulin (52.6%). Most participants (52.6%) were taking 10-20 units per day, only 22 (10.3%) were on >40units/day. Reuse of insulin needle was found in 74.6% of the participants. Major reasons for insulin omission were non-availability of insulin and patients being tired of insulin injection. Conclusion: The insulin adherence among diabetics in this study was high. Non-availability of insulin, insulin injection pain and being tired of continual insulin usage were some of the reasons for non-adherent to insulin usage

Patterns and outcomes of medical admissions in the accident and emergency department of a tertiary health center in a rural community of Ekiti, Nigeria

Background: Low and middle-income countries like Nigeria face many challenges in emergency medical care owing to poor treatment facilities and inadequately trained personnel. Most Nigerians live in rural areas. The disease and death burdens in accident and emergency departments in this setting have not been closely studied. Aim: To determine the basic demographics, disease burden, and outcomes for accident and emergency admissions. Settings and Design: This retrospective study was carried out on patients admitted to an accident and emergency department. Materials and Methods: A retrospective review of medical admissions to the accident and emergency wards of the Federal Medical Centre, Ido-Ekiti, Ekiti State, southwest Nigeria, between January 2010 and December 2012. Statistical analysis used: The data were analyzed using SPSS Version 16 software. The results were presented in descriptive and tabular forms. Result: In all, 2922 patients were admitted during the study period (age range, 11-100 years; mean, 51.89 ± 20.11 years). There were 1679 (57.5%) males and 1243 (42.5%) females, with a ratio of 1.4:1. Young adults (aged 40 years and under) formed the highest age group (46.8%). The number of patients admitted for non-communicable diseases were high (1989 patients: 68.07%). Among non-communicable diseases, cardiovascular disorders were the most frequent (797; 27.28%). The most common cause of deaths was cardiovascular disease (33.5%). Conclusion: Young adults and males were the groups most commonly admitted. Non-communicable diseases were more frequent than communicable diseases. The proportion of patients discharged against medical advice and fatalities requires urgent attention

Cardiovascular risk factors in semi-urban communities in southwest Nigeria: Patterns and prevalence

Introduction: Over 80% of cardiovascular deaths take place in low- and middle-income countries; most of these deaths are due to modifiable risk factors. The study aimed at estimating the prevalence and pattern of major cardiovascular risk factors in both men and women older than 18 years. Methods: This is a cross-sectional study of cardiovascular risk factors among semi-urban dwellers in Ekiti State, south-western, Nigeria. 750 participants were drawn from 10 communities. The instrument used was the standard WHO STEPS (II) questionnaire, while blood samples were obtained for analysis. Results: There were 750 participants with 529 (70.53%) females. The mean age of participants was 61.7 ± 18.50 years and participants’ ⩾65 years comprised 38.3%. There were 0.8%, 24.9% and 12.4%, who at the time of this study smoked cigarettes, consumed alcohol, and ate a high salt diet, respectively. The prevalence of hypertension, diabetes, generalized and abdominal obesity was 47.2%, 6.8%, 8.5% and 32.0%, respectively, with only 48.9% receiving hypertension treatment. Elevated total cholesterol, LDL-cholesterol, and low HDL was seen in 4.4%, 16.7% and 56.3% respectively. Conclusion: High prevalence of cardiovascular risk factors call for an urgent need for more public health attention and reinforcement of primary preventive strategies to curb its menace

In-patient morbidity and mortality patterns among patients with diabetes in Southwest Nigeria: A multicenter prospective study

Background: Diabetes is a disease of public concern with increasing hospital admissions and mortality in developing countries. Hence, we aimed to determine the patterns of in-hospital morbidity and mortality in patients admitted for diabetes. Methods: A prospective multicenter analysis of the causes of hospital admission and death among patients with type 2 diabetes who were admitted from diabetic clinic and emergency units over a 3-month period in selected tertiary hospitals in southwest, Nigeria was conducted. Data analysis was performed using the SPSS version 21.0. Results: A total of 341 patients with diabetes were admitted with a mean age of 59.6 ± 15.6 years and overall mortality of 14 deaths (4.4%). Almost three-fifths (59.5%) were previously known patients with diabetes with a mean duration of 52.44 ± 30.02 months. Two hundred and thirty-one (70.9%) patients were admitted through the emergency units and others through outpatient clinics. The duration of hospital stay ranged from 1 to 135 days, with a mean duration of 24.5 ± 14.7 days. The diabetes-related indications for admission were hyperglycemic crisis (diabetes ketoacidosis [DKA] and hyperglycemic hyperosmolar state [HHS]) (59.8%), diabetic foot ulcer [DFU], (11.7%), hypoglycemia (7.6%), and infections (7.3%). Among the diabetes-related diagnoses, 100%, 77.8%, 50.0%, 41.7%, and 28.3% of patients with chronic kidney disease, stroke, DFU, DKA, and HHS respectively stayed longer than 10 days on admission. Conclusion: Diabetes still contributes high cause of morbidity in our hospitals but with a reduced mortality compared to previously reported figure. Hence, continued emphasis on early diagnosis with improvements in diabetes care will help to improve diabetes outcomes