Impact of Parity on Cardiac Structure and Function in Apparently Healthy Pregnant Nigerian Women.

BACKGROUND: There are few and conflicting reports in the literature about the relationship between parity and maternal cardiac function. The study aimed to assess the impact of parity on cardiac structure and function in apparently healthy pregnant women in Nigeria. METHODS: This was a cross-sectional study carried out in 3 tertiary centers in Kano, and 1 in Ile-Ife, Nigeria. 112 apparently healthy pregnant women were consecutively recruited between the 28th and 38th weeks of gestation, and their cardiac structure and function assessed using echocardiography. Left ventricular (LV) systolic dysfunction was defined as LV ejection fraction of below 50%, and diastolic dysfunction was graded using mitral filling and tissue Doppler velocities. RESULTS: LV systolic dysfunction and diastolic dysfunction were found in 6 (5.4%) subjects and 20 (17.9%) subjects, respectively. Age (p= <0.0001), left atrial (LA) size (P<0.0001), interventricular septal thickness at end diastole (IVSD) (p= 0.005), posterior wall thickness at end diastole (PWTD) (p=0.004) and QRS duration (p= <0.0001) all increased progressively with higher parity, while tricuspid annular systolic excursion (p=0.320) decreased with higher parity. There was significant positive correlation between parity and age (r= 0.475, p= <0.0001), LA size (r=0.332, p= <0.0001), IVSD (r=0.264, p= 0.005) and PWTD (r= 0.343, p= <0.0001). LV systolic function was not significantly associated with parity. CONCLUSION: Our findings suggested that parity was significantly associated with myocardial remodeling in apparently healthy pregnant women.

CONTEXTE: Il existe peu de données contradictoires dans la littérature sur la relation entre la parité et la fonction cardiaque maternelle. L'étude visait à évaluer l'impact de la parité sur la structure et la fonction cardiaques chez des femmes enceintes apparemment en bonne santé au Nigeria. METHODES: Il s'agissait d'une étude transversale menée dans 3 centres tertiaires à Kano et 1 à Ile-Ife, au Nigeria. 112 femmes enceintes apparemment en bonne santé ont été recrutées consécutivement entre la 28* et la 38* semaine de gestation, et leur structure et fonction cardiaques ont été évaluées par échocardiographie. La dysfonction systolique du ventricule gauche (VG) a été définie comme une fraction d'éjection du VG inférieure à 50 %, et la dysfonction diastolique a été graduée en utilisant le remplissage mitral et les vitesses Doppler tissulaires. RESULTATS: Un dysfonctionnement systolique VG et un dysfonctionnement diastolique ont été trouvés chez 6 (5,4 %) sujets et 20 (17,9 %) sujets respectivement. Âge (p=<0,0001), taille de l'oreillette gauche (LA) (P<0,0001), épaisseur du septum interventriculaire en fin de diastole (IVSD) (p=0,005), épaisseur de la paroi postérieure en fin de diastole (PWTD)(p=0,004) et La durée du QRS (p = <0,0001) a augmenté progressivement avec une parité plus élevée, tandis que l'excursion systolique annulaire tricuspide (p = 0,320) a diminué avec une parité plus élevée. Il y avait une corrélation positive significative entre la parité et l'âge (r = 0,475, p = <0,0001), la taille LA (r = 0,332, p = <0,0001), IVSD (r = 0,264, p = 0,005) et PWTD (r = 0,343, p=<0,0001). La fonction systolique VG était associée à la parité. CONCLUSION: Nos résultats suggèrent que la parité est significativement associée au remodelage du myocarde chez les femmes enceintes apparemment en bonne santé. n'était pas significatif. Mots clés: Grossesse, Parité, Structure Cardiaque, Registre peace.

Influence of systolic blood pressure on outcomes in Nigerians with peripartum cardiomyopathy.

Background: The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP). Patients and Methods: PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90-99, 100-109, 110-119, 120-129, 130-139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling. Results: Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90-99 mmHg, 24.7% had 100-109 mmHg, 24.7% had 110-119 mmHg, 18.5% had 120-129 mmHg, 7.5% had 130-139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90-99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49-10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91-0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or ß-receptor blockers had an HR of 1.71 (95% CI 0.93-3.16, P = 0.085). However, SBP was not associated with LV function recovery. Conclusion: In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months.

Correlation between Echocardiographic Left Ventricular Hypertrophy and various Electrocardiographic Criteria of Left Ventricular Hypertrophy among Black Hypertensives.

BACKGROUND: Systemic hypertension remains an important risk factor for cardiovascular diseases and a major global public health problem. Left ventricular hypertrophy (LVH) is a recognized complication of systemic hypertension and strongly predicts cardiovascular morbidity and mortality. In Nigeria, few studies have evaluated the correlation of ECG criteria in the diagnosis of left ventricular hypertrophy among hypertensives and almost all the previous studies on ECG LVH used only one or two criteria. This study sets out to determine the correlations between various ECG criteria of LVH and echocardiographic LVH among patients with hypertension using six ECG LVH criteria. METHODS: One hundred and seventy-eight hypertensives and eighty- nine age and sex matched controls were recruited consecutively into the study. All participants including hypertensives and control subjects had echocardiography whereas only hypertensive subjects had both echocardiography and ECG. ECG LVH was determined using Sokolow-Lyon, Cornell voltage, Goldberger, Massoleini, Romhilt-Estes and Cornell duration product ECG criteria. RESULTS: Sokolow-Lyon and Cornell voltage criteria had significant positive correlation with echocardiographic LVH (p=0.001 and 0.003, respectively). Although Goldberger and Massoleini criteria had positive correlation coefficients, these were not statistically significant. CONCLUSION: There are significant correlations between echocardiographic LVH and ECG LVH determined by Cornell voltage and Sokolow-Lyon criteria.

CONTEXTE: L'hypertension systémique reste un facteur de risque important pour les maladies cardiovasculaires et un problème majeur de santé publique mondiale. L'hypertrophie ventriculaire gauche (HVG) est une complication reconnue de l'hypertension systémique et prédit fortement la morbidité et la mortalité cardiovasculaires. Au Nigeria, peu d'études ont évalué la corrélation des critères ECG dans le diagnostic de l'hypertrophie ventriculaire gauche chez les hypertendus et presque toutes les études précédentes sur l'ECG HVG n'utilisaient qu'un ou deux critères. Cette étude vise à déterminer les corrélations entre divers critères ECG de l'HVG et l'HVG échocardiographique chez les patients hypertendus à l'aide de six critères ECG LVH. MÉTHODES: Cent soixante-dix-huit hypertendus et quatre-vingtneuf témoins appariés selon l'âge et le sexe ont été recrutés consécutivement dans l'étude. Tous les participants, y compris les hypertendus et les sujets témoins, ont eu une échocardiographie alors que seuls les sujets hypertendus ont eu à la fois une échocardiographie et un ECG. ECG L'HVG a été déterminée en utilisant les critères ECG de produit de durée de Sokolow-Lyon, de tension de Cornell, de Goldberger, de Massoleini, de Romhilt-Estes et de Cornell. RÉSULTATS: Les critères de tension de Sokolow-Lyon et de Cornell avaient une corrélation positive significative avec l'HVG échocardiographique (p=0,001 et 0,003, respectivement). Bien que les critères de Goldberger et Massoleini aient des coefficients de corrélation positifs, ceux-ci n'étaient pas statistiquement significatifs. CONCLUSION: Il existe des corrélations significatives entre l'HVG échocardiographique et l'HVG ECG déterminées par le voltage de Cornell et les critères de Sokolow-Lyon. MOTS-CLÉS: Corrélation; échocardiographie; électrocardiographie; Hypertrophie ventriculaire gauche; Hypertendus noirs.

Oxidative stress among subjects with metabolic syndrome in Sokoto, North-Western Nigeria.

BACKGROUND: Oxidative stress is known to play a role in the pathophysiology of metabolic syndrome and its components. Racial differences may exist in the level of markers of oxidative stress and antioxidants in patients with metabolic syndrome. AIM: The aim of this study was to determine the oxidative stress and antioxidants status in subjects with metabolic syndrome in Sokoto, North-Western Nigeria. METHODS: A cross-sectional community-based study was carried out. Two hundred subjects (96 males and 104 females) were recruited for the study using a multi-stage sampling technique. Demographic data were obtained from the participants. Evaluation of anthropometric variables, blood pressure, blood glucose levels, lipid profiles, plasma insulin levels, total antioxidant status, and oxidative stress markers was performed. RESULTS: The subjects with metabolic syndrome had significantly higher malondialdehyde as compared to those without metabolic syndrome (236.4 [92.2] vs. 184 [63.2] nmol/l). The antioxidant enzymes (superoxide dismutase, glutathione peroxidase and catalase) were significantly lower in subjects with metabolic syndrome than in those without metabolic syndrome (11.3 [4.2] vs. 13.9 [4.1] U/ml, 160[42] vs. 220[32] U/ml, and 2.12 [0.2] vs. 2.42 [0.2] U/ml, respectively). Similarly, the antioxidant Vitamins (A, C, and E) levels were significantly lower in subjects with metabolic syndrome than in those without metabolic syndrome (7.1 [4.1] vs. 7.7 [4.2] µmol/L, 225 [55.3] vs. 227.6 [62.3] µmol/L, and 75.9 [13.9] vs. 82.8 [18.6] mg/dl, respectively). There was a positive correlation between components of metabolic syndrome and free radicals. CONCLUSION: Significantly increased oxidative stress and diminished antioxidant defenses were found among Nigerians with metabolic syndrome.

Rural-urban difference in plasma lipid levels and prevalence of dyslipidemia in Hausa-Fulani of north-western Nigeria.

OBJECTIVES: To compare the serum lipids levels, prevalence of dyslipidaemia, and adiposity of rural versus urban dwellers in Sokoto, Nigeria. METHODS: A cross-sectional study was conducted in both rural and urban areas of Sokoto, Nigeria. One hundred participants were recruited using a multi-stage sampling method. Demographic data and anthropometric measurements were obtained. Fasting blood was drawn for assessment of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol. The classification of dyslipidemia was based on the National Cholesterol Education Program-Adult Treatment Panel guidelines. RESULTS: The (mean [SD]) waist circumference of the urban participants (83.8 [9.5] cm) was significantly higher than the rural participants (79.2 [11.2] cm) (P = .030). The mean BMI of the urban participants (23.9 [3.9] kg/m2) was higher than the rural participants (22.2 [3.7] kg/m2) (P = .09). The mean TC was significantly higher in urban (175.9 [49.6] mg/dL) than rural participants (148.3 [24.3] mg/dL) P < .001. Mean serum LDL-C, and TG concentrations were higher in the urban than rural participants but the difference was not statistically significant. Mean serum HDL-C was also insignificantly higher in the rural (51.1 [7.9] mg/dL) than in urban participants (50.2 [11.7] mg/dL) (P = .64). The most frequent dyslipidemia was abnormally low HDL-C (13%) and this was more common in the urban participants (16%) than in rural participants (10%). CONCLUSION: This study demonstrated that compared to the rural dwellers, the urban dweller were more likely to be obese and had higher frequency of adverse plasma lipid profile. This may have implications for rural-urban patterns of lipid related cardiovascular disease.

Pregnancy outcome in women with eclampsia at a tertiary centre in northern Nigeria.

BACKGROUND: Eclampsia is a major cause of maternal and perinatal morbidity and mortality. The objectives of this study were to determine pregnancy outcome in women with eclampsia especially the maternal and perinatal deaths and the various contributory factors. MATERIALS AND METHOD: A retrospective analysis of demographic and clinical data of patients with eclampsia over a ten-year period (2000-2009) with particular reference to fetal and maternal outcome. Statistical analysis was by Epi- info computer package while test of significance between proportions was done using chi square. Ap value less than 0.05 was considered significant. RESULTS: 23,266 deliveries were conducted and 1027 cases of eclampsia were managed within the 10-yr period giving an incidence of 4.4%. The patients were mainly primigravidae (76%, N=778) with no antenatal care (93.4%, N=959); mean age was 21 years. Intrapartum eclampsia accounted for 62.6%, (N=643). About 45% (N=643) delivered spontaneously, 28.7% (N=277) had instrumental delivery while 19.6% (N=189) had caesarean section. Of the 621 maternal deaths for the period, eclampsia contributed to 29.4% (184) with a case fatality rate of 17.9%. Case fatality in the two years (2006/2007) when magnesium sulphate was used only on eclamptics with repeat fits (because of limited supply) was 18.2% which was not significantly different from the 20.0% fatality recorded in the two years (2008/2009) the drug was used routinely as the sole anticonvulsant agent P > 0.05. Maternal deaths were significantly more amongst the multiparous women with eclampsia (23.3%) than the primigravidae (16%); mortality was also more in eclamptics who had no antenatal care (18.7%) than those with care (5.9%), p <0.05. Major maternal complications were aspiration pneumonitis (23.9%) and pulmonary oedema (16.3%), hyperpyrexia (17.9%), acute renal failure (11.4%), and cerebrovascular accidents 9.8%. Total perinatal deaths were 392 with 81.1% (318/392) still births and 18.9% (74/392) early neonatal deaths mainly from severe birth asphyxia. Perinatal mortality ratio was 406/1000. CONCLUSION: The incidence of eclampsia in the study group was high. It was a major direct cause of maternal and perinatal deaths. Maternal outcome was also poor even with the introduction of magnesium sulphate. Interventions for reduction of maternal and perinatal mortality must emphasize on strategies that prevent the occurrence of eclampsia since outcome in some settings is still not very favorable when it does occur.

Dysglycaemia and its risk factors in an urban Fulani population of northern Nigeria.

BACKGROUND: The Fulani are a normally nomadic people known for covering great distances on foot with a resulting lean physique and presumably low incidence of diabetes mellitus (DM). The occurrence of glucose intolerance among the urban Nigerian Fulani has not been reported. OBJECTIVE: To determine the prevalence of dysglycaemia and its correlates among urban Fulani. METHODS: Three hundred and eighty-nine Fulani were recruited from urban areas of Sokoto state using a multi-stage sampling technique. Using a modification of the WHO STEPS instrument, information on socio-demographic and anthropometric data was gathered. Either casual or fasting plasma glucose was obtained in all subjects while oral glucose tolerance test (OGTT) was performed in a randomly selected subset of 48 subjects. Glucose intolerance or dysglycaemia was defined using WHO criteria as the presence of diabetes mellitus, impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT). Classifications of adiposity as body mass index (BMI) and waist circumference (WC) and blood pressure were made using standard criteria. RESULTS: Of the 389 subjects studied, 190 (48.8%) were females while 199 (51.2%) subjects were males (c2=5.43, p> 0.05). The overall mean (SD) age of the sample population was 39.3 (14.2) years with the males [42.0 (13.8) years] being significantly older than the females [36.4 (14.1) years], p< 0.05. Eighteen (4.6%) subjects had previously undiagnosed type 2 diabetes mellitus while 37(16.9%) of the subjects had IFG and seven (14.6%) subjects had impaired glucose tolerance. The mean FPG was higher in the males [5.49 (1.7) mmol/l] than in the females [5.25 (1.9) mmol/l],p=0.33. The overall mean two-hour plasma post glucose-load was 6.5 (1.6) mmol/l; higher in the males [6.9 (2)] mmol/l than in the females [6.2 (1) mmol/l] , p=0.55.The mean age, BMI, waist circumference and blood pressure of subjects with dysglycaemia were significantly higher than those in subjects with normoglycaemia (p<0.05). CONCLUSION: Prevalence of dysglycaemia in the urban Fulani population of Northern Nigeria is high and much higher in the male than female Fulani. Occurrence of obesity and hypertension appears lower than in other Nigerian reports. Occurrence of dysglycaemia in the urban Fulani increases with age, weight and waist circumference. There is need to conduct a similar study among rural Fulani to better appreciate the environmental influence on these variables.

Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry.

AIMS: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. METHODS AND RESULTS: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. CONCLUSIONS: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria.

Clinical neuropathy in HIV/AIDS: an eight-year review of hospitalized patients in Sokoto, northwestern Nigeria.

HIV/AIDS is a multi-systemic disease that targets mainly the immune and nervous systems. Although about 4.4% of Nigerians are infected with HIV, data on the spectrum of HIV-related nervous disease in this population is rare. This study describes the neurological manifestations of HIV/AIDS in northern Nigeria. We undertook retrospective and descriptive analyses of the demographic, clinical, neurologic and laboratory data of all hospitalized HIV/AIDS adults in a referral hospital in northwestern Nigeria. The study period covered 2000 to 2007. We studied 322 HIV/AIDS patients (218 men, 104 women) aged 33.4 +/- 11.4 years (range: 18-65 years) who constituted 3.5% of the total medical admissions. HIV transmission was exclusively by heterosexual intercourse involving multiple partners. The majority (70.2%) was married and 78.9% were in stage III/IV HIV/AIDS disease. Fifty-two (16.2%) had CD4+ T-cell count determination, the mean value being 220 +/- 147.2 cells/m(3), and 58 (18.0%) were on highly active antiretroviral therapy. Fifty-one (15.8%) had neurological complications dominated by central nervous diseases including encephalitis (17.6%), dementia (16.2%) and stroke (14.9%). Peripheral nerve involvements were relatively infrequent. Compared with HIV/AIDS patients without neurological complications, a significantly higher proportion of those with HIV-associated neuropathy had a stage IV disease (30% versus 9.4%, chi(2) = 19.5, P < 0.001). Neurological complications, particularly central nervous diseases, are an important cause of morbidity in the HIV/AIDS population.

Multiple embolisations in rheumatic heart disease: a case report.

BACKGROUND: Though systemic thromboembolism is not an infrequent complication of rheumatic valvular disease, multiple embolic phenomena are rare. OBJECTIVE: To present a patient with rheumatic heart disease associated with multiple embolic complications. CASE REPORT: A 44-year-old lady with rheumatic valvular disease and atrial fibrillation defaulted anticoagulant medication, and subsequently presented with acute chest pain, acute left ventricular failure, focal neurological deficit and gangrenous lower limb extremities. Electrocardiography showed atrial fibrillation and an old anteroseptal myocardial infarction. Echocardiography showed multiple valvular lesions and multiple thrombi in the left atrium. Computed tomogram scan demonstrated a large infarct involving the region supplied by the right middle cerebral artery. Bilateral above knee amputation was performed. Recovery from neurological deficit was complete. She had, during a 4-year follow-up and anticoagulation remained free of new clinically evident embolic complications. Serial echocardiography however showed that the atrial clots had persisted and presumably fibrosed. CONCLUSION: Multiple systemic thromboembolisms are serious complication of atrial fibrillation of valvular aetiology, and their prevention requires continuous anticoagulation.

Metabolic dysfunctions in non-antiretroviral treated HIV/AIDS patients.

BACKGROUND: AIDS related metabolic and morphologic disorders have been attributed to protease inhibitor based antiretroviral therapy. HIV/AIDS is however a multi-systemic disease with potential for alteration of metabolic and endocrine functions. OBJECTIVE: To determine if metabolic disorders occur in non-antiretroviral treated HIV/AIDS patients. METHODS: Case control study of prospectively recruited 48 HIV seropositive patients, and randomly selected age and sex-matched controls. Main outcome measures included plasma lipid concentrations and intravenous glucose tolerance measured using glucose assimilation coefficient, K. A K-value less than 1.2 constituted an impaired glucose tolerance. RESULTS: Compared to the controls, HIV/AIDS patients had significantly lower glucose assimilation coefficient (1.5 +/- 0.5 versus 2.7 +/- 0.9; p < 0.001); higher proportion of individuals with impaired glucose tolerance (35.4% versus 7.5%; P = 0.01); and higher plasma triglyceride concentration (166.5 +/-20.7 mg/dL versus 148.9 +/- 13.5 mg/dL; p = 0.04). The proportion of patients with hypertriglyceridaemia was also significantly higher among patients than controls (56.3% versus 17.5%; p = 0.04). CONCLUSIONS: Metabolic dysfunctions occur in HIV/AIDS independent of antiretroviral therapy. Routine monitor of plasma lipids and glucose is therefore advocated in HIV/AIDS patients.

Salt taste perception and relationship with blood pressure in type 2 diabetics.

Patients with type 2 diabetes (normotensives, n=59; hypertensives, n=56) and matched controls (n=60) had salt taste perception determined using graded NaCl solutions ( 0-400 mmol 1(-1)). Diabetic hypertensives, diabetic normotensives and controls differed significantly in taste threshold to NaCl recognition (F=4.4, P=0.01) and prevalence of NaCl taste insensitivity (P=0.003). Taste threshold to NaCl recognition correlated positively with duration of diabetes (r=0.402, P=0.04) and was associated with mean arterial pressure (P<0.001), the association being significant after adjustment for age (P<0.001), gender (P< 0.001), family history of hypertension ( P< 001), body mass index (P<0.01), antihypertensive medication ( P<0.01) and proteinuria ( P<0.04).

An audit of snake bite injuries seen at the Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria.

BACKGROUND AND OBJECTIVES: Snakebite is an important but often overlooked medical problem worldwide. This work is an audit of snakebite injuries in Sokoto, North West Nigeria using hospital-based data. METHODOLOGY: A retrospective analysis of the records of all adult patients with snakebite managed at Usmanu Danfodiyo University Teaching Hospital Sokoto, North West Nigeria from January 2000 to December 2004 was carried out. Information retrieved included demographic and clinical data. RESULTS: Seventy three patients made up of 55 males (75.3%) and 18 females (24.7%) were involved. Male to female ratio was 3:1. Snakebite constituted 1.7 per 1000 hospital admissions and 12.7 per 1000 medical admissions. 82.2% of the patients were between 15 and 40 years of age. 89% of the bites were between the months of March and October. 54.8% of the patients were bitten in the home environment while 39.7% were bitten in the bush. The lower limbs were the most common sites of bite (58.9%). Most( 63%) of the bites occurred during the daytime. 50.7% of the patients showed signs of envenomation while 64.4% received antivenom. Majority of the patients survived and 2.7% of the patients died. The outcome was unknown in 26.0% of patients. CONCLUSION: Snakebite constitutes an important cause of hospital admission and occurs mainly during the rainy season which coincides with the period of intense farming activities in the study population. The build up commences during the period of intense heat. Envenomation status of patients need to be accurately determined to avoid excessive use of antivenoms with the attendant risk to patients.

Relationship between epistaxis and hypertension: a study of patients seen in the emergency units of two tertiary health institutions in Nigeria.

BACKGROUND: Both epistaxis and hypertension are common in the general population. OBJECTIVE: This study aimed at determining the prevalence of hypertension among epistaxics, and the relationship between epistaxis and hypertension. METHODS: Retrospective analysis of 62 adults comprising 31 each of males and females with a mean age of 41.4 +/- 16.6 years (range: 18-90 years) that presented in the emergency units of two tertiary health institutions seen over 11 years was done. Main outcome measure was the prevalence of hypertension amongst epistaxics. Seventy-six age and sex-matched patients with bleeding from sites other than the nostrils with no record of epistaxis were selected by simple random sampling as controls. RESULTS: Peak prevalence of epistaxis occurred during the months of January and March. Compared to the controls, the epistaxics had significantly higher blood pressures: (146.1 +/- 40.7 mmHg versus 123.2 +/- 16.3 mmHg systolic, P=0.001), and (91.3 +/- 24.8 mmHg versus 78.2 +/- 12.8 mmHg diastolic, P=0.001), and higher proportions of patients with previous history of hypertension (32.3% versus 7.9%; p<0.001) and family history of hypertension (12.9% versus 2.6%; p<0.02). The proportion of subjects with blood pressure elevation at presentation that remained sustained was significantly higher among the epistaxics than the nonepistaxics (87.5% versus 47.6%, chi2=8.1, P=0.005). The epistaxics had significantly higher prevalence of hypertension than the non-epistaxics (45.2% versus 13.2%, chi2=17.5, p=0.001). Univariate analysis demonstrated association between epistaxis and hypertension (OR=5.4, 95% CI=2.4-12.5, P=0.001), and between epistaxis and age (OR=0.9, 95% CI=1.3-12.5, P=0.02). On multivariate analysis using logistic regression the association between epistaxis and hypertension persisted, after adjusting for age, sex, season and causes of epistaxis (OR=5.6, 95% CI=1.7-15.6, P=0.01). CONCLUSIONS: Our findings support an association between epistaxis and hypertension in the study population.

Prescription pattern of anti-hypertensive drugs in a tertiary health institution in Nigeria.

OBJECTIVE: This study examined the pattern of physicians' prescription of antihypertensive drugs and its possible effects on blood pressure control as well as physicians' compliance with recommended guidelines. METHODS: Records of 145 patients aged 17-91 (mean: 52.6+/-14.6) years, with male to female ratio of 1:1.2 were randomly selected. Information on antihypertensive prescriptions was recorded. Blood pressure control was defined as systolic and diastolic blood pressure less than 140 mm Hg and 90 mmHg, respectively. RESULTS: Of the 145 patients studied, 20% (29) were on monotherapy and 80% (116) on combination therapy. Of the patients on combination therapy, 61.2% (71), 33.6% (39) and 5.2% (6) were on 2, 3 and 4 drugs, respectively. Diuretic was the most frequently p rescribed drug either as a single agent (44.8%) or as combination therapy (88.8%). Mean reductions in both systolic and diastolic blood pressures were more in patients on calcium channel blocker than those on diuretic monotherapy (t=2.5 and 3.6 for reductions in systolic and diastolic BP, respectively; P<.05 for both), and, in patients on combination therapy than those on monotherapy (t=3.64 and 3.27 for reductions in systolic and diastolic BP, respectively; P<.01 for both). Blood pressure control rate was 30.5%. CONCLUSION: Our results are consistent with the previously observed benefits of antihypertensive combination therapy, and demonstrate an apparent higher efficacy of calcium channel blocker monotherapy than diuretic monotherapy in blood pressure lowering in the study population. Major limitations of this work include its retrospective nature and the inability to determine the actual patients' adherence to therapy.

The metabolic syndrome: Review of current concepts.

The metabolic syndrome incorporates into a single entity, insulin resistance and its associated cluster of related cardiovascular metabolic risk factors including type 2 diabetes mellitus, essential hypertension, dyslipidamia and central obesity. Various hypotheses (thrifty genotype/phenotype, limbic-hypothalamic and altered homeostatic mechanisms) have been used to explain the interaction between genetic, intrauterine and environmental factors, leading to this enigmatic concept. Current interest addresses the roles of fat-derived adiponectin, inflammatory markers (C-reactive protein, leucocytes, interleukin and tumour necrosis factor), endothelial dysfunction and disordered haemostasis (plasminogen activator inhibitor-1 and fibrinogen). Angiotensin II, endothelin-1 and increased salt sensitivity contribute to the development of hypertension in metabolic syndrome. The main significance of the syndrome is the heightened risk of cardiovascular morbidity and mortality arising from increased atherogenic potential. Therapeutic interventions are multidimensional in approach, and aimed at enhancing insulin sensitivity and ameliorating the consequences of insulin resistance. Promotion of African native lifestyle characterised by high degree of physical activity and fibre diet is and appropriate tool for primary prevention of metabolic syndrome.

Demographic and clinical correlates of metabolic syndrome in Native African type-2 diabetic patients.

OBJECTIVES: To describe the metabolic syndrome and its demographic and clinical correlates in native African type-2 diabetic patients. METHODS: Cross-sectional analysis of 254 type-2 diabetic indigenous Nigerians consecutively recruited in a teaching hospital. The main outcome measure was metabolic syndrome. Variables of interest included family history/duration of diabetes mellitus and hypertension, gender, socioeconomic class, occupation and place of domicile (urban or rural). Intergroup comparisons were made with Chi-squared tests or t-tests. RESULTS: Patients were aged 35-80 years (mean: 52.0 +/- 11.7 years) and made of 154 (60.6%) males and 100 (39.4%) females. Full-blown metabolic syndrome was noted in 52 patients (20.5%). Metabolic syndrome, as defined by the WHO, was noted in 150 patients (59.1%). About 72.4% of patients were dyslipidemic, 54.3% were hypertensive, 42.5% were obese, 44.9% were microalbuminuric and 32.3% were hyperuricemic. Ischemic heart disease (myocardial infarction) occurred in only 2.4% of patients. Concurrent hypertension and dyslipidemia; obesity and dyslipidemia; and hypertension and obesity occurred in 44.4%, 42.5% and 33.1% of type-2 diabetics, respectively. Compared to the diabetics without metabolic syndrome, those with the syndrome had a significantly higher proportion of patients with a family history of hypertension and diabetes (44% versus 25%; p = 0.003); among the upper/middle socioeconomic class: 52.0% versus 30.8% (p = 0.001); and among the urban dwelling: 68.0% versus 49.0% (p = 0.004). Metabolic syndrome was inversely proportional to the physical activity of an individual (chi2 = 21.69, df = 5, p = 0.001). Blood pressure was significantly higher among patients with metabolic syndrome than those without it (140.6 +/- 22.9/85.2 +/- 12.9 mmHg versus 126.9 +/- 15.4 mmHg; P < 0.01). CONCLUSIONS: The development of metabolic syndrome in African type-2 diabetic patients is influenced by demographic and clinical factors. Vigilant dietary habit and physical exercise may reduce the chance of metabolic syndrome in urban Nigerian type-2 diabetics.

Case Report: Acute Limb Ischaemia and Gangrene associated with Peripartum Cardiomyopathy.

UNLABELLED: Thromboembolic complications are frequent in patients with peripartum cardiomyopathy (PPCM). Peripheral artery occlusions are however rare. This case report describes a 30-year-old grand multiparous woman with PPCM complicated by acute lower limb ischaemia and gangrene. This followed left intraventricular thrombi despite maintenance of sinus rhythm. We suspect that the thrombosis is caused by the hypercoagulable state of peripartum period, ventricular dilatation and hypokinesis. The impacts of economic and sociocultural factors in the management of this rare complication of PPCM in a resource depleted nation are highlighted. KEYWORDS: peripartum cardiomyopathy, limb ischaemia.

Comparative analysis of lipid profiles among patients with type 2 diabetes mellitus, hypertension and concurrent type 2 diabetes, and hypertension: a view of metabolic syndrome.

Type 2 diabetes mellitus and hypertension are independent risk factors for atherosclerotic lesions that are partly linked with dyslipidaemia. This risk is additive when diabetes and hypertension occur concurrently. In order to determine if concurrent type 2 diabetes and hypertension results in putative increases in dyslipidaemia in a Nigerian population, we compared the plasma lipid levels, atherogenic index and prevalence of dyslipidaemia among age and sex-matched indigenous Nigerians with type 2 diabetes, hypertension and concurrent diabetes and hypertension. Age and sex-matched healthy Nigerians that are free of diabetes and hypertension served as controls. The patients as a whole were more likely to have dyslipidaemia than controls (p < 0.05). High-density lipoprotein cholesterol was similar among patients and controls. Mean total cholesterol, high-density lipoprotein cholesterol; low-density lipoprotein cholesterol and triglyceride levels, atherogenic index and prevalence of dyslipidaemia did not differ significantly among patients with hypertension, diabetes, and concurrent hypertension and diabetes (p = 0.99 for each parameter). It is concluded that concurrent hypertension and type 2 diabetes does not result in a more severe dyslipidaemia than when either of the two conditions occurs in isolation. We attribute this to the common pathogenic link between hypertension, diabetes and dyslipidaemia in metabolic syndrome. Evidence, albeit indirect, of this syndrome among native Africans is, therefore, provided.

Seasonal variation in hospitalisation for hypertension-related morbidities in Sokoto, north-western Nigeria.

OBJECTIVE: To determine the relationship between hospital admissions of hypertension-related morbidities, seasons and meteorological factors in a tropical climate. STUDY DESIGN: Retrospective analysis of hospitalised patients (440) with hypertension-related morbidities including heart failure (36.4 %), stroke (34.8%), chronic renal failure (7.1%) and others (21.7%) from 1995 to 2000. The relationship between hospital admission, seasons and meteorological factors was determined using simple proportions, univariate, multivariate and regression analysis. RESULTS: The subjects were aged 21-85 years and represented 9.3 % of all hypertensives and 7.0% of medical admissions. Mean blood pressure was 187.3 +/- 34.0/120 +/- 23 mmHg. Mild, moderate and severe hypertension occurred in 30 (6.8%), 59 (13.4%) and 351 (79.8%) patients, respectively. The monthly admission rate ranged from 3-11; (mean 6.1 +/- 1.9) patients. Admission rates peaked in January/February and August/September, corresponding with the peaks of harmattan and the wet seasons, respectively. Mean monthly admission rates were significantly higher during harmattan than during the hot season (6.7 +/- 2 versus 5.2 +/- 1.4 patients; p < 0.05), and during wet season than during the hot season (6.4 +/- 1.9 versus 5.2 +/- 1.4 patients; p < 0.05). Considering the hypertensives as a whole, a significantly higher proportion of patients was hospitalised during the cold season than during the hot season (11% versus 8.2%; odds ratio = 1.34). Linear regression analysis showed that hospital admission was significantly associated with the monthly minimum temperature (p = 0.02) and solar radiation (p = 0.01). Multiple regression analysis revealed that hospital admission was also significantly associated with combined meterological factors (temperature, radiation, dust haze days and relative humidity) (p = 0.04). CONCLUSIONS: Hospital admissions of patients with hypertension-related morbidities showed seasonal variation. Appropriate clothing and health planning during cold seasons are recommended.