Etiology and Clinical Evaluation of Patients with Bronchiectasis in a Tertiary Hospital in Nigeria.

BACKGROUND: Bronchiectasis is often considered an orphan disease in developed societies. This may not be the case with low-income countries. Currently there is a paucity of data on the pattern and presentation of this condition in Nigeria. OBJECTIVE: This study was undertaken to determine the frequency and pattern of presentation of bronchiectasis in a tertiary healthcare facility in Uyo, South-South, Nigeria. METHODS: We carried out a three-year prospective study of adult patients aged between 15-85 years diagnosed with bronchiectasis in the University of Uyo Teaching Hospital in Uyo, Nigeria between 2016 and 2019. RESULTS: Eighty-two patients were identified from the clinic register. Out of these, 76 were recruited into the study; made up of 44(57.9%) males and 32 (42.1%) females. The average age of the patients was 49.7 ± 14.1 years. Sixteen (21.1%) of the patients were HIV positive. Forty-four (57.9%) patients had previously been treated for pulmonary tuberculosis. Majority of the patients; 72 (94.7%) had chronic productive cough. Sixty-four (84.2%) had at least one episode of exacerbation within the last 12 months while 36(47.4%) had a severe exacerbation requiring hospitalisation. Hospitalisation was associated with several factors with the strongest contributor being the presence of respiratory distress on physical examination (OR 15.4 p= 0.002). CONCLUSION: Bronchiectasis is not an uncommon disease amongst our patients. A previous history of pulmonary tuberculosis is the commonest associated predisposing medical condition. There is a high rate of exacerbation among these patients with respiratory distress as the strongest predictor of hospitalisation.

CONTEXTE: La bronchectasie est souvent considérée comme une maladie orpheline dans les sociétés développées.Ce n'est peut-être pas le cas dans pays à faible revenu. Actuellement, il y a une pénurie de données sur les caractéristiques et la présentation de cette maladie au Nigeria. OBJECTIF: Cette étude a été entreprise pour déterminer la fréquence et le mode de présentation de la bronchectasie dans un établissement de soins tertiaires à Uyo, dans le sud-sud du Nigeria. MÉTHODES: Nous avons mené une étude prospective sur trois ans auprès de patients adultes âgés de 15 à 85 ans chez qui on a diagnostiqué une bronchectasie dans l'hôpital universitaire d'Uyo, à Uyo, entre 2016 et 2019. Uyo, au Nigeria, entre 2016 et 2019. RÉSULTATS: Quatre-vingt-deux patients ont été identifiés à partir du registre de la clinique registre. Parmi ceux-ci, 76 ont été recrutés dans l'étude ; composés de 44 (57,9 %) hommes et 32 (42,1 %) femmes. L'âge moyen des patients était de 49,7 ± 14,1 ans. Seize (21,1 %) des patients étaient séropositifs. Quarante-quatre (57,9 %) patients avaient déjà été traités pour une tuberculose pulmonaire.La majorité des patients ; 72 (94,7%) avaient une toux productive chronique. Soixante-quatre (84,2 %) ont eu au moins un épisode d'exacerbation au cours des 12 derniers mois, tandis que 36 (47,4 %) ont eu une exacerbation sévère nécessitant une hospitalisation. L'hospitalisation était associée à plusieurs facteurs, le facteur le plus important étant la présence d'une présence d'une détresse respiratoire à l'examen physique (OR 15.4 p= 0.002). CONCLUSION: La bronchectasie n'est pas une maladie rare parmi nos patients. Un antécédent de tuberculose pulmonaire est l'état médical prédisposant le plus fréquent.ll existe un taux élevé d'exacerbation chez ces patients, la détresse respiratoire étant le facteur prédictif le plus fort d'hospitalisation. MOTS CLÉS: Étiologie, Caractéristiques cliniques, Bronchiectasie, Exacerbation, Hospitalisation.

Psychological distress and health-related quality of life among stable patients with bronchiectasis.

BACKGROUND: Bronchiectasis is characterized by chronic symptoms and impaired physical activity. Anxiety and depression usually complicate chronic illness. Thus, underdiagnosis of psychological distress in bronchiectasis may lead to increased morbidity and mortality. AIMS: The aim of this study is to evaluate the impact of physical illness on psychological distress and its association with health-related quality of life (HRQOL). SUBJECTS AND METHODS: This is a cross-sectional study of adults with bronchiectasis. Patients completed a study questionnaire, the hospital anxiety and depression scale and the World Health Organization quality of life brief (WHOQOL-BREF) questionnaire. Physical examination was conducted on all participants. RESULTS: 103 patients were recruited for this study: 54 males (52.4%) and 49 females (47.6%). The average age of the patients was 49.12 ± 14.37 years. The most common predisposing factor for bronchiectasis amongst the patients was previous pulmonary tuberculosis (51 patients, 49.5%). Chronic productive cough, which was reported by 98 of the subjects (95.15%), was the most common symptom. 89 subjects (86.41%) reported episodes of shortness of breath, 82 (79.61%) reported at least one episode of exacerbation, while 52 subjects (50.49%) were hospitalized for bronchiectasis in the previous 12 months. 23 subjects (22.3%) had anxiety and 32 (31.1%) had depression. Anxiety and depression were significantly associated with indicators of severe disease. The subjects recorded low HRQOL scores across all domains. Psychological distress displayed a significant negative association with all the quality-of-life domains except between anxiety and social interaction. CONCLUSION: Symptoms of depression and anxiety are common among patients with bronchiectasis and these symptoms have a negative impact on HRQOL.

Association of lead exposure, serum uric acid and parameters of renal function in Nigerian lead-exposed workers.

BACKGROUND: The presence of hyperuricemia and renal function impairment, especially in the absence of urate stone formation is strongly suggestive of lead nephropathy. The evaluation of this association is essential in areas where lead exposure is still prevalent and uncontrolled. OBJECTIVE: To determine the relationship between serum uric acid and renal function indices in lead-exposed workers. METHODS: A cross-sectional study of 190 adults with occupational lead exposure and 80 adults (comparison group), matched for age and sex was performed in Port Harcourt, South-south Nigeria. Blood lead was used as the biomarker of lead exposure while serum urea, serum creatinine, urine albumin (using urine albumin:creatinine ratio), estimated glomerular filtration rate (GFR) and serum uric acid were the renal function indices measured. RESULTS: Occupationally lead-exposed subjects had a significantly (p = 0.008) higher mean±SD blood lead levels (50.37±24.58 µg/dL) than the comparison group (41.40±26.85). The mean±SD serum urea (8.6±2.3 mg/dL), creatinine (1.0±0.2 mg/dL) and serum uric acid (4.6±1.2 mg/dL) were significantly (p < 0.01) higher in the study subjects than the comparison group (7.6±2.4, 0.9±0.2, and 3.9±1.1 mg/dL, respectively). The mean±SD creatinine clearance was significantly (p = 0.002) lower in the study subjects than the comparison group (98.9±21.3 vs. 108.2±25.2 mL/min/1.72 m2). Serum uric acid level correlated positively with serum creatinine (r = 0.134) and negatively with GFR (r = -0.151). CONCLUSION: People with occupational lead exposure are at risk of developing hyperuricemia and renal impairment.

Occupational and environmental lead exposure in Port Harcourt, Nigeria: analysis of its association with renal function indices.

BACKGROUND: In spite of the high risk of lead exposure in Nigeria, there is a paucity of data on the occupational and environmental burden of lead exposure and its impact on human health especially its nephrotoxic effects. This study aims to assess the degree of occupational and environmental lead exposure in Port Harcourt Nigeria and the relationship between lead exposure and indices of renal function. METHODS: A cross sectional comparative study of 190 aduIt subjects with occupational lead exposure and 80 matched controls. Blood lead was used as the biomarker of lead exposure. Serum urea, creatinine, uric acid, urine albumin and glomerular filtration rate were the renal function indices measured. RESULTS: Occupationally lead exposed subjects had higher mean blood lead 50.37 +/- 24.58 ug/dI, than controls 41.40 +/- 26.85 ug/dl (p = 0.008). The mean values of serum urea, creatinine and uric acid were significantly higher in study subjects compared to controls 3.06 +/- 0.81 mmol/L vs. 2.7 +/- 0.84 mmol/L (p = 0.002), 87.2 +/- 14.30 umol/L vs. 80.68 +/- 14.70 umol/L (p = 0.001) and 271.93 +/- 71.18 umol/L vs. 231.1 +/- 62.70 umol/L (p = 0.000) respectively. Creatinine clearance was significantly lower in subjects compared to controls 98.86 +/- 21.26 mI/min/1.72m2 vs. 108.18 +/- 25.16 mI/min/1.72m2 (p = 0.002). Blood lead correlated positively only with blood urea [r = .031, r2 = .017, p = .031] and negatively [r = -.144, r2 = .02 1, p = .018] with serum phosphate. CONCLUSION: The level of environmental and occupational lead exposure in Port Harcourt, Nigeria is high, with occupational lead exposure increasing the risk of lead toxicity and renal function impairment.

Pattern of non-communicable diseases among medical admissions in Port Harcourt, Nigeria.

OBJECTIVE: To determine the pattern of non-communicable diseases in the medical wards of the University of Port Harcourt Teaching Hospital (UPTH), over four consecutive years (June 2000 to June 2004). METHODS: The study was retrospective and data were obtained from the medical registers in the medical wards and the records department of the UPTH. Medical admissions due to non-communicable diseases were carefully selected and analyzed. RESULTS: There were 1853 cases of various non-communicable diseases out of a total medical admission of 3294 constituting 56.2% of total medical admissions. Diseases of the cardiovascular, endocrine and renal systems were the most prevalent constituting 35.7%, 18.5% and 16.8% respectively. Hypertension, diabetes mellitus, and chronic renal failure were the most common cardiovascular, endocrine and renal disorders respectively CONCLUSION: Non-communicable diseases are a major cause of morbidity in Port Harcourt. There is need for adequate health education and lifestyle modification to reduce the burden of non-communicable diseases in Nigeria.

Acute pulmonary embolism: a review.

BACKGROUND: Pulmonary embolism (PE) is a common clinical disorder which is associated with high morbidity and mortality if untreated. Due to the high morbidity and mortality associated with undiagnosed and poorly treated PE, there is a need for protocols based on risk factor assessment to facilitate early diagnosis of PE and protocols to ensure early and adequate treatment. The aim of this review is to highlight the risk factors associated with PE and discuss the modalities for optimal management of PE. METHOD: Literature was reviewed using available medical journals, Science direct, Medline and Embase databases. Key words employed were: pulmonary embolism, deep venous thrombosis (DVT), venous thromboembolism (VTE) and thrombophilia. Information was also sourced from the British Thoracic Society and The National Heart, Lung and Blood Institute websites. RESULTS: Studies have shown that hypercoagulability state, stasis and local trauma to the vessel wall predisposes to PE. These studies further underscored that heparin is the cornerstone of therapy hence optimal diagnostic approach should be observed to avoid unnecessary anticoagulant therapy considering the fact that it carries a risk forb leeding. CONCLUSION: This review was able to highlight the risk factors and management of pulmonary embolism. Patients with one or more predisposing factors and having high index of suspicion based on clinical assessment should be managed according to an agreed hospital protocol.

Socio-demographic variables and family health: A prospective study of a Katcha in north-central Nigeria.

BACKGROUND: Healthy families are vital prerequisites for a stable society and economic development of the community. The health status of families and communities is influenced by several socio-demographic variables such as educational status, marital pattern and gender relationships. The objective of this study is to examine the effect of certain socio-demographic variables on the health status of a rural community in Northern Nigeria. METHOD: A prospective survey over a six month period, which commenced in May 2005, was done in rural primary health care centre in Katcha local Government area of Niger state. All consecutive parents either male or female of children seeking care in the health center who gave consent to participate in the survey were recruited. A structured researcher administered questionnaire was used in sourcing data. Data was analyzed using Microsoft Excel version 2003. RESULTS: A total of 608 parents comprising 302 (49.67%) male and 306 (50.33%) females (M: F = 1:1.01) were surveyed. Of these 78.48% females were uneducated compared to only 41.83% males. While most males were gainfully employed, 20.86% of females were full time housewives. Polygamy was the predominant marital pattern. The findings indicate that women in the community were socially disadvantaged compared to males. CONCLUSION: There is a significant socio-economic gap which puts females at a disadvantage in the rural community surveyed. Bridging this Socio-economic gap between men and women in rural communities will help improve the health status in our rural communities.

Culture and health: the effect of Nupe cultural practice on the health of Nupe people.

BACKGROUND: The Cultural practices of communities are known to influence the Health status of the community both positively and negatively. To achieve set out health goals positive cultural practices should be enhanced and incorporated into community based health programmes. This commentary aims to highlight the positive and negative effects of cultural practices on health using the Nupes a tribe in North central Nigeria as a reference point. METHOD: Information on the cultural practice of Nupe people and the related health effects were obtained through observation, group discussion and interviews among Katcha people, a Nupe community in Nigerstate of Nigeria. Literature of the effects of cultural practices on health was reviewed using MEDLINE and manual library search. RESULTS: Cultural practices with positive health effects such a "Tamako" a system of community based assistance to the sick was found among the Nupes in Katcha. This system is useful in defraying hospital bills of indigent members of the community. Another positive practice is the culture of food assistance and gifts to nursing mothers which helps to improve their nutritional status. However Negative cultural practices such as child marriage, "Sadakiar" (wife gifts), "Egikpa" (child fostering) and "Efidan" (body scarifications) are also practiced. CONCLUSION: Cultural practices have significant effects on health. Most of these effects are detrimental and should be discouraged. Cultural practices with positive effects should be encouraged and integrated into community based health policies and programmes in order to enhance the attainment of the millennium development goals especially in rural communities of the developing world.

Parkinsonism induced by sepsis: a case report.

BACKGROUND: Parkinson's disease (PD) is a slowly progressive neurodegenerative disease that appears essentially as a sporadic condition with no identifiable cause. Parkinsonism is used for syndromes where the aetiolobgy is known such as Parkinsonism due to stroke, infection, neuroleptic drugs and toxic agents. Parkinson's disease and Parkinsonism present with the tetrad of tremor at rest, slowness of voluntary movement (bradykinesia), rigidity and a characteristic disturbance of gait and posture. A report of Parkinsonism induced by sepsis is rare. This report aims to create awareness of Parkinsonism as a manifestation of sepsis. METHOD: The case note of a patient with Parkinsonism induced by sepsis managed in the medical unit of the University of Port Harcourt Teaching Hospital and a review of the literature on the subject with Medline search was used. RESULT: A 71-year-old Nigerian male presented with Parkinsonism on a background of Gram negative sepsis which resolved with antibiotic therapy. Antiparkinoinian drugs were not used. CONCLUSION: Parkinsonism is a rarely reported neurological complication of sepsis. There is a need for physicians to be aware of this clinical manifestation.

Echocardiography in the University of Port Harcourt Teaching Hospital: April 2000 to March 2003.

BACKGROUND: Echocardiography is a cheap and non-invasive technique for the investigation of cardiac diseases with reliable levels of accuracy. Echocardiography services commenced in the Cardiac unit of the University of Port Harcourt Teaching Hospital (UPTH) in April 2000. There is a need to establish an accurate pattern of cardiac diseases seen in the centre based on echocardiography assessment. The aim of the study was to review the pattern of cardiac diseases diagnosed by echocardiography in the cardiology unit of the University of Port Harcourt Teaching hospital. METHOD: A prospective descriptive study of patients referred to the cardiology unit of UPTH for echocardiography for a variety of cardiac complain was done. Subjects had two dimensional and M-mode echocardiography assessment using a Siemens Sonoline SL 1 machine with a 3.5 MHz sector probe. RESULTS: One hundred and forty one subjects aged between 16-84 years with a mean age of 44.2 +/- 11.5 years had echocardiography assessment over the three year period. Eighty two (58.2%) of the subjects were males while 59 (41.8%) were females. Fourty eight (34.0%) of subjects had hypertensive heart disease, 28 (19.9%) had Cardiomyopathies, 13 (9.2%) had rheumatic heart disease. Pericardial disease, congenital heart disease and cor pulmonale was found in 6 (4.3%), 2 (1.4%) and 1 (0.7%) respectively. Fourty three (30.5%) of subjects had normal findings on echocardiography. CONCLUSION: Hypertensive heart disease was found to be the most prevalent cardiac condition followed by the cardiomyopathies and rheumatic heart disease in that order. This trend is very similar to what obtains in sub Saharan Africa as documented by similar studies.

Lipid profile of healthy adult Nigerians in Port Harcourt, Nigeria.

BACKGROUND: Hyperlipidaemia is a major cardiovascular risk factor for coronary artery disease, atherosclerosis, hypertension and stroke. It is thought that serum cholesterol levels are low in Nigerians as shown by results of a population survey done over twenty years ago. In addition the last national non communicable disease survey recorded a low prevalence of Hyperlipidaemia (4.0%) in Nigeria. With increasing urbanisation and socioeconomic improvement, changing population dynamics is expected to influence disease pattern and noncommunicable diseases are expected to rise. Thus there is a need to screen healthy adults for their lipid pattern in Port Harcourt a city with high population dynamics where such studies have not been previously reported. METHOD: A prospective descriptive population survey was carried out among healthy adults residing in Port Harcourt. A total of ninety two adults were screened after obtaining informed consent. Weight, height, blood pressure, fasting blood sugar and fasting lipid profile were measured. Results were analysed using simple statistical methods. RESULTS: A total of ninety two subjects were recruited into the study. Fourty seven (51.1%) of the subjects were males while fourty five (48.9%) were females. The age range of subjects was 24-59 years with mean of 38.84 +/- 8.36 years. The mean BMI was 28.76 +/- 5.91 Kg/m2. There was no significant statistical difference between the mean BMI for males and females. The mean fasting blood sugar, mean total cholesterol and mean LDL cholesterol were 4.45 +/- 0.89 mmol/L, 4.76 +/- 1.06 mmol/L and 3.65 +/- 0.89 mmol/L. The mean total triglyceride was 1.02 +/- 0.30 mmol/L while the mean HDL was 0.90 +/- 0.25 mmol/L. There was an increase in total cholesterol with increasing age and an increase in total cholesterol and LDL cholesterol with increasing social class. Subjects with total cholesterol above 6.5 mmol/L constituted 31.52% of study subjects. Subjects with BMI between 25-29 Kg/m2 made up 43.48% of subjects while 33.69% of subjects had BMI above 30 Kg/m2. CONCLUSION: A high mean total and LDL cholesterol values were observed among healthy adults in Port Harcourt. The prevalence of obesity was also found to be high. There is a need for public health action to address these findings especially as high serum cholesterol levels have a direct correlation with coronary artery disease. Further large scale urban survey of non communicable diseases in the country is therefore necessary at this time.