Profile and outcome of cardiovascular admissions at the University of Uyo Teaching Hospital, Uyo--a five year review.

OBJECTIVE: The incidence of cardiovascular diseases (CVD) in developing countries has been on the increase in the last few decades. Demographic changes and adoption of negative life style associated with urbanization have been incriminated. This study is to ascertain the burden of cardiovascular disease in Uyo, a town which has been undergoing rapid urbanization in the last decade. SUBJECTS AND METHODS: A five-year retrospective analysis of cardiovascular admissions into the Medical Wards of the University of Uyo Teaching Hospital between September 1996 and September 2001 was carried out. Medical records of patients were used. The Epi Info 2002 software was used to analyse data. RESULTS: Five hundred and fifty eight (19.8%) of the 2875 medical admissions were patients with cardiovascular diseases. Their mean age was 52 +/- 12.7 years and mean duration of hospital stay was 9 +/- 7 days. Hypertension accounted for 311 (55.7%) of the cases, of these 107 (34.4%) presented with cerebrovascular accident (CVA). 44.3% presented in Heart failure and causes included Hypertension (14.9%), Cardiomyopathies particularly the dilated type (15.1%), Rheumatic heart disease (6.6%) and Anaemia (7.7%). 69 (12.4%) cardiovascular deaths were recorded, of these 34 (6.1%) were in patients with Cerebrovascular accident. Most deaths occurred within seven (7) days of admission. Duration of stay significantly influenced outcome (p = 0.000). CONCLUSION: Cardiovascular diseases constitute a significant health problem in our community. Intensive cardiovascular health education and promotion of healthy life style are advocated. Tertiary health care facilities should be equipped to cope with cardiovascular care in view of the looming epidemic of cardiovascular disease even in developing countries.

Seasonal variation in admission for heart failure, hypertension and stroke in Uyo, South-Eastern Nigeria.

BACKGROUND: Seasonal variation in hospitalization for cardiovascular disease has been described in the temperate regions of the world as well as in Northern Nigeria. Increase admission rates during the cold seasons have been reported in these areas. No studies have been done in Southern Nigeria. This study is thus aimed at describing the seasonal variation in admissions for heart failure, uncontrolled hypertension and hypertension related-stroke in Southern Nigeria. METHODS: Hospital records of patients admitted to the medical wards of the University of Uyo Hospital (UUTH) with heart failure of all causes, uncontrolled hypertension and hypertension-related stroke (Cerebrovascular accident) between January 1998 and December 2001 were used. Epi-info 2002 software was used to analyze data. RESULTS: Of the 3500 patients admitted during the study period 542 (15.3%) were on account of heart failure, uncontrolled hypertension and hypertension related cerebrovascular accident (CVA). The mean age of patients was 52 +/- 12.8 years. The average monthly admission was eleven (11). More admissions were recorded in the rainy (cold) season than in the dry (hot) season. The observed difference was however statistically significant only for heart failure and uncontrolled hyper tension (P < .05). CONCLUSION: Admissions for heart failure and uncontrolled hypertension are therefore more during the wet (cold) season in southern Nigeria. This may be attributed to the high default rate to follow up visit in this season when agricultural activity is intense and less attention given to medical care. This leads to poor compliance to medications and clinical deterioration. The already bad road network both in rural and urban centers also become worse at this time making access to medical care difficult. Facilities and measures should thus be put in place to provide adequate medical care for these patients during that period of the year.

Seasonal variation in admission for heart failure, hypertension and stroke in Uyo, south-eastern Nigeria

Background:Seasonal variation in hospitalization for cardiovascular disease has been described in thetemperate regions of the world as well as in Northern Nigeria. Increase admission rates during the coldseasons have been reported in these areas. No studies have been done in Southern Nigeria. This studyis thus aimed at describing the seasonal variation in admissions for heart failure, uncontrolledhypertension and hypertension related-stroke in Southern Nigeria.Methods:Hospital records of patients admitted to the medical wards of the University of Uyo Hospital(UUTH) with heart failure of all causes, uncontrolled hypertension and hypertension­related stroke(Cerebrovascular accident) between January 1998 and December 2001 were used. Epi-Info 2002software was used to analyze data.Results:Of the 3500 patients admitted during the study period 542 (15.3%) were on account of heartfailure, uncontrolled hypertension and hypertension related cerebrovascular accident (CVA). The meanage of patients was 52±12.8 years. The average monthly admission was eleven (11). More admissionswere recorded in the rainy (cold) season than in the dry (hot) season. The observed difference washowever statistically significant only for heart failure and uncontrolled hypertension (P<.05).Conclusion:Admissions for heart failure and uncontrolled hypertension are therefore more during thewet (cold) season in southern Nigeria. This may be attributed to the high default rate to follow up visitin this season when agriculturalactivity is intense and less attention given to medical care. This leads topoor compliance to medications and clinical deterioration. The already bad road network both in ruraland urban centers also become worse at this time making access to medical care difficult. Facilities andmeasures should thus be put in place to provide adequate medical care for these patients during thatperiod of the yea

Study of T-lymphocyte subsets of healthy and Mycobacterium avium subsp. paratuberculosis-infected cattle.

The relative contributions of T-lymphocyte subsets to host defense in cattle infected with Mycobacterium avium subsp. paratuberculosis is reported. The subsets were purified with appropriate monoclonal antibodies and a magnetic bead column separation system, and their purity was verified by flow cytometry. Biological activity of each subset, expressed as lymphoproliferation and gamma interferon (IFN-gamma) production, was measured in response to phytohemagglutinin (PHA) and an M. avium antigen preparation (A-PPD). IFN-gamma was measured by antibody capture enzyme-linked immunosorbent assay. The results showed a correlation between proliferation and IFN-gamma production in response to A-PPD but not to PHA. In response to PHA, CD4+ lymphocytes were the most prolific producers of IFN-gamma. CD8+ lymphocytes produced IFN-gamma to a lesser extent, whereas gammadelta+ T lymphocytes produced little or no IFN-gamma. Differences observed between the amount of IFN-gamma produced by CD4+ versus CD8+ cells and CD4+ versus gammadelta+ cells were significant (P < 0.01), but those between peripheral blood mononuclear cells (PBMC) and CD4+ T cells were not. Similar responses to A-PPD were observed except that PBMC produced higher levels of IFN-gamma than did CD4+ T cells. These data for cattle are similar to observations made for other animal species, where CD4+ cells are the major type of T lymphocytes producing IFN-gamma. They further suggest that whatever the role gammadelta+ T cells may play in paratuberculosis, it is not likely to be mediated by IFN-gamma production.

Candidate antigens for improved serodiagnosis of tuberculosis.

OBJECTIVE: To explore the possibility that an analysis of antibody specificity to separated components of mycobacteria in a group of tuberculous patients may reveal a combination of target antigens whose antibodies could form the basis of a useful serodiagnostic test. DESIGN: Immunoblots of 1-dimensional (SDS-PAGE) and 2-dimensional (isoelectric focusing/SDS-PAGE) separation of antigenic extracts of Mycobacterium tuberculosis H37Rv (MTSE) and M. bovis bacille Calmette-Guérin (BCG) (MBSE) with 52 tuberculous and 59 BCG-vaccinated control human sera were analyzed for band and spot reactivity patterns that are indicative of infection with M. tuberculosis. RESULTS: Reactivity to antigens banding in the 10-18 kDa, 37-43 kDa and 70-90 kDa regions allowed a good discrimination between patients and normal subjects. Patients' sera reacting with antigens in the 22-30 and 70-88 kDa regions differentiated responses to MTSE and MBSE. In 2-D immunoblotting, patients' sera only reacted with antigens separating at approximately pI 6.5/26-28 kDa, pI 4.8/38 kDa and pI 6.5/70-79 kDa position and the responses were specific for M. tuberculosis (MTSE). CONCLUSION: These results provide evidence that a combination of these M. tuberculosis antigens may be a useful basis for developing a diagnostic antibody test. Additionally, they may help to define antigens, and host antibody responses that are specific to one but not the other of the two closely related species.

T-cell response to mycobacterial proteins: a comparative study of tuberculous and control immunoblots of Mycobacterium tuberculosis and M. bovis BCG.

OBJECTIVE: To evaluate and compare the lymphoproliferative response of human peripheral blood mononuclear cells (PBMC) to fractionated soluble extracts of Mycobacterium tuberculosis H37Rv (MTSE) and M. bovis bacille Calmette-Guérin (BCG) (MBSE), and thereby determine responses that correlate to infection, and to contrast antibody and T-cell responses. DESIGN: Membrane blots of SDS-PAGE fractionated M. tuberculosis H37Rv and M. bovis BCG were employed for antibody immunoblotting and T-cell proliferative responses using sera and PBMC from seven tuberculous and seven BCG vaccinated control subjects. RESULTS: The profiles of responses contrasted rather interestingly, with antibody and T-cells responding more to higher and lower molecular weight fractions respectively. T-cells responding to antigens in the 59-88 kDa region discriminated between tuberculous and BCG vaccinated controls (P < 0.05) even though the differences were more toward the 70-75 kDa fractions within the region in question. Responses to smaller molecular weight fractions of both MTSE and MBSE were high in direct contrast to antibody responses. Additionally, responses to MBSE in these regions were generally higher than for MTSE in vaccinated controls. The reverse was the case with tuberculous subjects where responses to MTSE were generally higher, though not sufficiently significant in enough of the tuberculous subjects to be considered discriminatory. CONCLUSION: T-cell proliferative responses to mycobacterial antigens in the 59-88 kDa region, and particularly antigens in the 70-75 kDa region, can be an indication of infection with M. tuberculosis, as well as the basis for discriminating between active disease and vaccination with BCG.