Profile and outcome of medical emergencies in a tertiary health institution in Port Harcourt, Nigeria

Medical emergencies are a daily occurrence in medical practice. The profile and outcome medical emergencies are a reflection of the prevailing pattern of disease and the responsiveness of the healthcare system. This study seeks to evaluate the pattern and outcome of medical emergencies presenting to the university of Port Harcourt teaching hospital (UPTH); Port Harcourt.METHODS: A retrospective study of medical records of the accident and emergency unit of UPTH was assessed over a twelve month period (June 2008 May 2009).RESULTS: A total of 7246 patients presented to the emergency room; with 1256 (17.3) medical emergencies. Infectious diseases accounted for 274 (21.8) of emergencies while non-communicable diseases in the cardiovascular 195 (15.5); renal 105 (8.4); neurological 224 (17.8); endocrine 163(13.0) and gastrointestinal/ hepatobiliary 163(13.0) systems were the other prevalent emergencies. The crude mortality rate was 127 deaths (10.2). The major contributors to mortality were HIV/AIDS related infectious diseases (22.4); hypertension related heart disease (18.4) and stroke (15.7). Other contributors to mortality were renal failure (8.8); diabetic emergencies (8.8); chronic liver disease (12.8) and haematological malignancies (9.6).CONCLUSION: The spectrum of medical emergencies and the pattern of mortality indicate a mixed disease burden of infective and non-communicable diseases; with cardiovascular and cerebrovascular diseases and HIV/AIDS related infectious as the most significant contributors. There is need for action to improve on the responsiveness of our healthcare systems to cope with this trend of disease pattern in our emergency rooms and reduce mortality from medical emergencies

Prevalence of Risk Factors for Chronic Kidney Disease in a Rural Adult Population in Rivers State

Background: The prevalence of chronic kidney disease (CKD) is on the increase globally with attendant heavy disease burden and high morbidity and mortality especially in the resource poor countries. Preventive measures are increasingly being explored. We undertook a survey to determine the prevalence of some risk factors of CKD and identify the at-risk individuals. Methods: Body mass index (BMI); dip-stick urine protein and urine glucose; random blood glucose and blood pressures were measured in adult subjects of Barako; a rural community in the Gokana Local Government area of Rivers state during a one-day Rotary eye camp exercise. Results: Out of the 154 subjects that responded; 152 satisfied the inclusion criteria and were studied. They had a mean age of 48.9 + 14.8(18-85) years and M:F ratio of 1:1.4. The mean body mass index (BMI) was 25.8 + 4.8 (11.1-40 .9) kg/m2. Forty-nine subjects (34.8) were pre-obese while 13.5were Obese. Proteinuria was seen in 29.7while none of the subjects had glycosuria. The mean random blood glucose was 6.6 +1.4(4.2-9.8) mmol/l. Four subjects (5) were previously diagnosed diabetics.The mean systolic blood pressure was 129.9 + 21.6(100-220) mmHg; mean diastolic blood pressure was 70.9 + 13.1(50-110) mmHg and the prevalence of hypertension was 27.9. BMI showed positive correlation with proteinuria (r = +0.2); while both systolic and diastolic blood pressures showed weak positive correlations with proteinuria (r = +0.02 and r = +0.06 respectively). Conclusions: The study shows; that the evaluated risk factors of CKD; obesity; hypertension; diabetes and proteinuria are common in this rural community of Rivers State

Relative Risk of Metabolic Syndrome Components in Nigerians: the Adult Treatment Panel III Definition

Background: The prevalence of metabolic syndrome is increasing in all populations worldwide and is associated with a substantially elevated risk of type 2 diabetes (5-fold) and of cardiovascular disease (2-3 fold). Metabolic syndrome is now established as a simple means of identifying individuals at increased risk of future cardio vascular disease and type 2 diabetes mellitus. Aim: To determine the prevalence of metabolic syndrome among adult Nigerians attending Family Medicine Clinics at two health facilities in Rivers State; Nigeria and to determine how much each diagnostic criterion contributed to the diagnosis of metabolic syndrome. Methods: Subjects were bled after an overnight fast; and venous blood obtained for lipid studies and fasting blood glucose estimation. Measurements were made to determine height; weight; waist circumference and blood pressure. The diagnosis of metabolic syndrome was based on the National Cholesterol Education Project: Adult Treatment Panel III (ATP III) definition. Results: The unadjusted and age-adjusted prevalence rates of metabolic syndrome at one centre were 19.8and 20.9respectively while they were 34.2and 31.6respectively at the other centre. The prevalence of low HDL-cholesterol was very high at both centres (78.3at one centre and 92.1at the other). Metabolic syndrome is most prevalent in females and older subjects. Conclusion: The prevalence of metabolic syndrome (19.8and 20.9; unadjusted and age-adjusted; respectively) were lower at one centre than the other (34.2and 31.6; unadjusted and age-adjusted; respectively). Despite the very high prevalence of low HDL- cholesterol; the relative risk for metabolic syndrome was not statistical significant (RR=6.73; 95CI: 0.99-45.55)

Current epidemiology of hypertension in Port Harcourt metropolis, Rivers state, Nigeria

Background: Hypertension is the sustained elevation of the blood pressure to 140/90 mmHg or more. It is the commonest non-communicable disease in the world and all races are affected with variable prevalence. In Nigeria, prevalence was between 10 and 14% based on a national survey conducted over a decade ago. Since that survey, the definition of hypertension has changed and social and demographic changes have also taken place, and so changes in prevalence and epidemiology are expected, hence the need for the present survey. Methods: A cluster sample of adult Nigerians, aged 18 years and above, living in Port Harcourt, Rivers State, drawn from civil servants at the Federal secretariat, state secretariat, six selected secondary schools, two major markets, two major motor parks and one of the higher institutions as well as staff of the University of Port Harcourt Teaching Hospital formed the cohort for this study. Their blood pressures were measured in the various locations on the day of visit using standard protocol. The height and weight of all participants were measured, social and demographic information was obtained as well as history of previous hypertension, treatment if any and family history of diabetes mellitus or hypertension. The information obtained was entered into the questionnaire designed for the survey. All pregnant females were excluded. Results: A total of nine hundred and twenty one (921) adult Nigerians made up of 449 males (48.75%) and 472 females (51.25%) participated in the survey. The age range was 19 to 68 years, mean age was 39.94 ± 8.61 years, mean systolic blood pressure was 129.99 ± 22.85 mmHg and mean diastolic blood pressure was 84.84 ± 28.02 mmHg. A total of 376 of those surveyed were hypertensive giving a prevalence of 40.82%, out of which 49 (13.03%) were aware of being hypertensive and 33 (67.35%) of these were receiving treatment. Among those found to be hypertensive, 17.55% had family history of hypertension, and 12.23% had family history of diabetes mellitus. The mean body mass index (BMI) was 26.14 ± 8.08 kg/m2, 408 (44.30%) had a normal BMI of ≤ 24.9, 343 (37.24%) were overweight (BMI = 25-29.9) and 170 (18.46%) were obese with BMI of ≥ 30. Conclusion: The prevalence of hypertension in Port Harcourt is high and only a small fraction of hypertensives are aware of their condition. There is need for large scale screening and education of the public as a major public health measure to reduce the numerous catastrophic complications of hypertension

The prevalence of obesity as indicated by BMI and waist circumference among Nigerian adults attending family medicine clinics as outpatients in Rivers State

Background: The prevalence of overweight and obesity in most developed countries and in urban areas of many less developed countries has been increasing markedly over the past twenty years. This study's aims were to determine the prevalence of obesity using BMI and waist circumference among Nigerian adults attending Family Medicine Clinics as outpatients and to assess the relative associations with CVD risk factors. Methods: Subjects, who all volunteered for this study reported at the study centres after an overnight fast, to be weighed (in kg), for their heights (in metres), blood pressure and waist circumference (in cm) measured, and their venous blood samples taken for lipid studies and fasting blood glucose estimation. Results were analysed using SPSS for windows software (version 11) and Epi Info (version 6. 04d). Results: The prevalence of obesity as determined by large waist circumference was 31.7% at the Okrika (rural) centre and 16.9% at the Port Harcourt centre. It was 16.3% at the Okrika centre and 14% at the Port Harcourt centre, as determined by BMI > or = 30 kgm(-2). Obesity as determined by BMI > or = 30 kgm(-2) is more prevalent among young adults (< 40 years) in Port Harcourt than at Okrika. Obesity by both definitions is more prevalent among females than among males (p < 0.01) and more among subjects older than 40 years. Both indices of obesity appear to be significantly associated with CVD risk factors. Conclusion: Obesity in our environment is strongly associated with a family history of obesity and a sedentary lifestyle. It is therefore not surprisingly more prevalent among females and older members of society. Healthier eating and social habits, and increased physical activity need to be strongly encouraged