Correlation between colposcopic impression and histologic diagnosis of premalignant lesions of the cervix

Background: Cervical cancer is the commonest cancer in sub-Saharan African with majority of the women presenting with an advanced disease stage. This is largely due to the unavailability of an established cervical cancer screening programme in most countries. This also includes the use of colposcopy which is still not available to many gynaecologists practicing in Nigeria. Aim: To review reports of colposcopy carried out at the University of Abuja Teaching Hospital, Abuja, Nigeria and to determine the degree of concurrence between colposcopic impression and histologic diagnosis. Methods: A retrospective analysis of the colposcopic findings of 84 patients was done. Subsequent correlation with histopathology report was carried out in 53 patients who had colposcopically directed biopsies between March 2012 and February 2014. Results: The commonest impression made on colposcopy was high grade CIN in 40(47.6%) patients. The concurrence rate between colposcopic findings and histology diagnosis was 64.2% (34/53) {K =0.302, 95%CI= -0.010-0.436}. The concurrence rate was higher for high grade CIN 29/40(72.5%) than for low grade CIN 5/12 (41.7 %). There was an overestimation of colposcopic diagnosis in 13(24.5%) patients and an underestimation in 6(11.3%) patients. The sensitivity of colposcopy for detecting high grade lesions or more was 32/36(88.9%) while the specificity was 8/17(47.1%). False positive rate for high grade lesions was 9/17(52.9%) and false negative rates for low grade lesions was 4/36(11.1%). Positive predictive value (PPV) of high grade colposcopic diagnosis or more was 32/41(78.04%) while the negative predictive value (NPV) was 8/12(66.73%). Conclusion: The strength of agreement between colposcopic diagnosis and cervical pathology was fair and colposcopy performs better in the detection of high grade lesions

Awareness of hypertension guidelines and the diagnosis and evaluation of hypertension by primary care physicians in Nigeria

Background: The availability of numerous hypertension guidelines seems not to have impacted significantly on the burden of hypertension. We evaluated awareness of hypertension guidelines among primary-care physicians (PCPs) in Nigeria and its relationship to hypertension diagnosis and work up.Methods: Anonymous self-administered questionnaires were filled in by PCPs categorised into two groups: hypertension guideline aware (GA) and unaware (GU). Results: The 403 participating PCPs had a mean age and experience of 40 ± 11.34 and 14 ± 11.10 years, respectively, with 46.7% (n = 188) of them being GA. Out of the 19 questions assessed, GA and GU PCPs performed better in seven and two questions, respectively, while the two subgroups had a similar performance in 10 questions. The performance of the PCPs in government and private practice was similar.Conclusions: There is a gap between guideline recommendations and hypertension care in Nigeria that is further widened by PCPs' unawareness of the guidelines.Popularising hypertension guidelines among PCPs may significantly improve hypertension care and reduce the burden of disease

Impact of prehypertension on left ventricular mass and QT dispersion in adult black Nigerians.

BACKGROUND: Prehypertension has been associated with target-organ damage. This study sought to determine the impact of prehypertension (PHT) on QT dispersion and left ventricular hypertrophy (LVH) in adult black Nigerians. METHODS: One hundred and one subjects with office blood pressure (BP) < 140/90 mmHg were categorised according to their office BP into normotensive (normal BP < 120/80 mmHg, n = 57) and prehypertensive (prehypertensive BP 120-139/80-89 mmHg, n = 44) groups. Echocardiography and electrocardiography (ECG) were performed on the subjects. RESULTS: Thirty-four males aged 53.65 ± 16.33 years and 67 females aged 52.42 ± 12.00 years were studied. The mean QT interval dispersion (QT(d)) of the normotensive (38.96 ± 11.06 ms) and prehypertensive (38.41 ± 11.81 ms) groups were similar (p = 0.81). Prehypertensive subjects had higher left ventricular mass (LVM) (165.75 ± 33.21 vs 144.54 ± 35.55 g, p = 0.024), left ventricular mass index 1 (LVMI-1) (91.65 ± 16.84 vs 80.45 ± 18.65 g/m(2), p = 0.021) and left ventricular mass index 2 (LVMI-2) (54.96 ± 10.84 vs 47.51 ± 12.00 g/m(2.7), p = 0.017). QT(d) was independent of echocardiographic and electrocardiographic LVH (p > 0.05). CONCLUSIONS: Compared with normotension, prehypertension is associated with higher LVM but similar QT(d). This suggests that structural remodelling precedes electrical remodelling in prehypertension.

QT dispersion in hypertensive Nigerians with and without left ventricular hypertrophy.

BACKGROUND: Increased QT dispersion (QTd) has been implicated as a marker of arrhythmogenesis and cardiac death. Paucity of literature on QTd in Nigeria necessitated an inquiry into QTd in adult hypertensive population. This study sought to: (i) compare the QTd values of adult hypertensive subjects with age and sex matched normotensive subjects and (ii)examine the relationship between QTd and left ventricular hypertrophy (LVH). STUDY DESIGN: One hundred and fifty-one hypertensive patients and 101 age and sex-matched controls were recruited into this study. A resting 12- lead ECG was obtained from all subjects for determination of QTd and ECG LVH using Sokolow Lyon (SL) and Araoye's codes. Echocardiographic LVH was determined for 60 hypertensive subjects and 60 age/sex matched controls. RESULTS: Hypertensive subjects had higher mean QTd than the controls (65.6 ± 28.1 ms vs 38.7 ± 11.3 ms, p< 0.0001). QTd of hypertensives with ECG LVH was significantly higher than those without ECG LVH (Araoye: 71.5 ± 22.0 ms vs 62.2 ± 24.1 ms, p = 0.02, SL; 72.0 ± 24.4 ms vs 61.6 ± 23.1 ms p = 0.009). Similarly the QTd of hypertensives with echocardiographic LVH (72.6 ± 21.3 ms) was higher than those without (60.1 ± 22.2 ms) but did not achieve statistical significance (p = 0.085). CONCLUSIONS: Hypertension with or without ECG LVH is associated with significantly increased QTd. Echo-cardiographic LVH is associated with a non significant increase in QTd in hypertensive subjects.

QT Dispersion in Healthy Adult Nigerians.

BACKGROUND: Increase in QT dispersion (QTd) is associated with an increased risk of cardiovascular morbidity and mortality. OBJECTIVES: This study sought to (i) determine the mean QTd and (ii) characterise QTd in a healthy Nigerian population. METHODS: One hundred healthy Nigerian adults were studied. Healthy status of the subjects was determined by history and physical examination. A resting 12- lead ECG was obtained from all subjects for determination of QTc, QTd and ECG left ventricular hypertrophy (LVH) using Sokolow Lyon (SL) and Araoye's codes. Echocardiography was used to determine LV systolic function, LVM and LVMI for 60 subjects. RESULTS: The QTd ranged from 15-70ms with a mean value of 38.5 ± 11.2ms. QTd was independent of age (p = 0.86), sex (p = 0.97), heart rate (p = 0.22), blood pressure (p > 0.05), BMI (p = 0.81), QTc (p = 0.41), LVH (ECG and echo) and LV systolic function (p > 0.05). CONCLUSION: QT dispersion is independent of demographic parameters, LV systolic function and LV hypertrophy in healthy adult Nigerians.

Trends in acute emergency room hypertension related deaths: an autopsy study.

INTRODUCTION: Hypertension is associated with increased morbidity and mortality. Paradigm shift and novel drugs that go beyond blood pressure control have debuted in the last decade globally and in Nigeria. The study therefore proposed to investigate the effect of the above if any on hypertension related acute deaths in patients admitted to the emergency room of the Lagos University Teaching Hospital. METHOD: Autopsy reports for bodies deposited from the medical emergency room (ER) were reviewed. Details of the time of admission, time of death and blood pressure status prior to the event were obtained. Subjects were batched into two groups 1982 1991 and 1992 2001 based on periods of paradigm shift in hypertension diagnosis and management. RESULT: There were 297 hypertension related deaths but 252 were analyzed. There were 168 (66.7%) males and 84 (33.3%) females (M:F 2:1) and mean age was 47.33 +/- 12.18 years (14-85 yr). Two thirds of the subjects (65.5%) were = 50 yrs of age. The mean duration of admission was 5.88 +/- 6.41 hours. One third (35.3%) died within an hour of admission. The commonest causes of death were stroke (52.8%) and heart failure 103 (40.9%). Intra-cerebral hemorrhage was the commonest type of stroke seen, 69 (52.3%). There were fewer cases of acute deaths in the second decade under review 95 (37.7%) vs. 157 (62.3%), p = 0.02 and strokes during this period, 47 (49.47) Vs 86 (54.78), p = 0.06. CONCLUSION: There is a trend towards reduction of hypertension related acute deaths. However stroke remains a major cause of acute hypertensive death and the patients are still dying young.

Dolor articular y artritis reumatoidea: calidad de atencion / Rheumatoid arthritis and articular pain: quality health care

Una de cada seis visitas al primer nivel son motivadas por un problema musculoesqueletico. Se analizo la Artritis Reumatoidea (AR) por su prevalencia. La relacion mujer/ varon es de 3/1; entre 30 y 60 años. Produce incapacidad laboral con alto impacto socioeconomico. La terapeutica adecuada se basa en el diagnostico, seguimiento y tratamiento oportuno. Objetivos: caracterizacion epidemiologica de la poblacion con dolor articular (DA) y sospecha de AR. Analizar el tratamiento segun la calidad de atencion. Material y metodos: investigacion descriptiva de corte transversal. La poblacion pertenece a nueve zonas rurales de Tucuman. Se encuestaron personas con DA mayores de 18 años. Se excluyeron personas con enfermedad neurologica y oncologica. Resultados: 342/2807 presentaron DA. Con sospecha de AR 2,2 por ciento, 84 por ciento fue poliarticular, el 70 por ciento consulto menos de 3 veces, 40 por ciento toma DAINES, 14 por ciento drogas de segunda linea y ninguno tratamiento no farmacologico. Conclusion: la prevalencia de DA y AR es considerable. La escasa respuesta de los servicios se evidencia por: bajo numero de consultas, tratamiento farmacologico sintomatico y ausencia de tratamiento no farmacologico; agravandose el pronostico con deterioro de la calidad de vida. La reumatologia debe plantearse estrategias poblacionales para no consentir un desarrollo cientifico limitado a unos pocos

Dolor articular y artritis reumatoidea: calidad de atencion / Rheumatoid arthritis and articular pain: quality health care

Una de cada seis visitas al primer nivel son motivadas por un problema musculoesqueletico. Se analizo la Artritis Reumatoidea (AR) por su prevalencia. La relacion mujer/ varon es de 3/1; entre 30 y 60 años. Produce incapacidad laboral con alto impacto socioeconomico. La terapeutica adecuada se basa en el diagnostico, seguimiento y tratamiento oportuno. Objetivos: caracterizacion epidemiologica de la poblacion con dolor articular (DA) y sospecha de AR. Analizar el tratamiento segun la calidad de atencion. Material y metodos: investigacion descriptiva de corte transversal. La poblacion pertenece a nueve zonas rurales de Tucuman. Se encuestaron personas con DA mayores de 18 años. Se excluyeron personas con enfermedad neurologica y oncologica. Resultados: 342/2807 presentaron DA. Con sospecha de AR 2,2 por ciento, 84 por ciento fue poliarticular, el 70 por ciento consulto menos de 3 veces, 40 por ciento toma DAINES, 14 por ciento drogas de segunda linea y ninguno tratamiento no farmacologico. Conclusion: la prevalencia de DA y AR es considerable. La escasa respuesta de los servicios se evidencia por: bajo numero de consultas, tratamiento farmacologico sintomatico y ausencia de tratamiento no farmacologico; agravandose el pronostico con deterioro de la calidad de vida. La reumatologia debe plantearse estrategias poblacionales para no consentir un desarrollo cientifico limitado a unos pocos (AU)