Department of Internal Medicine, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University

INT RODUCTIO N: Th e eld erly h ypert en si ve pa ti ent s of ten h aveincreased prevalence of cardiometabolic risk factors and their attendantco-morbidities. The aim of this study was to determine the prevalenceof cardiometabolic risk factors and blood pressure control among elderlyhypertensive patients, and to determine the influence of modifiablecardiometabolic risk factors on the control of hypertension amongelderly hypertensive patients.SUBJECTS AND METHODS: A case-control comparative and hospital-based study involving a total of 190 consenting elderly (>65 years),hypertensive patients (subjects) (n=100) and normotensive controls(n=90) was carried out over a period of ten months. Using interviewer-administered questionnaire, biodata and information regarding theirlifestyle was obtained. Standard protocols were used to measure bloodpressure, weight, height, waist circumference, fasting plasma glucoseand fasting lipid profile of the subjects. Body mass index was derivedfrom weight and height.RESULTS: The mean age of the subjects was 71.5 ± 6.3 years and thecontrols was 72.3 ± 7.2 years. Forty-eight percent (48%) and 47.8% ofthe subjects and controls were females (p = 0.651). The level of controlof hyperten sion was poor in over two-thirds (68%) of the elderlyhypertensive patients. The prevalence of modifiable cardiometabolicrisk factors burden was higher in the hypertensive subjects when comparedwith the controls. Prevalence of Dyslipidaemia was 76% in the subjectsand 51% in the controls (p = 0.004). Prevalence of Diabetes Mellituswas 40% among the subjects and 17.8% in the controls (p = 0.0001);prevalence of Obesity was 24% in the subjects and 4.4% in the controls(p=<0.001); prevalence of excess alcohol intake was 49% in the subjectsand 14.4% in the controls (p=<0.001). Prevalence of sedentary lifestyle was high in both the subjects (53%) and controls (50%), p=0.679.Poor blood pressure control was predicted by dyslipidaemia and centralobesity.CONCLUSION: The level of control of hypertension was poor amongthe elderly and modifiable cardiometabolic risk factors were relativelyprevalent. Central obesity and dyslipidaemia were predictive of poorcontrol of hypertension. Addressing these factors may therefore improveblood pressure control

Obesity; overweight; and underweight among urban Nigerians

Background: Disease burden from communicable and noncommunicable diseases is a significant health challenge facing many developing nations. Among the noncommunicable diseases; is obesity; which has become a global epidemic associated with urbanization. Objective: The aim was to evaluate the prevalence of weight abnormalities; their pattern of distribution and regional differences among apparently healthy urban dwelling Nigerians. Methods: A cross-sectional community-based descriptive survey was carried out in five urban cities; each from one geo-political zone of Nigeria. Multistage sampling procedures were used to select participants using the World Health Organization STEPS instrument. Ethical approval and consents were duly and respectively obtained from the Ethics Committee in the tertiary centers and participants in each of these cities. Analysis was performed using SPSS version 20 (IBM Corp.; Amonk; NY; released 2011) with P value set at 0.05. Results: A total of 5392 participants were recruited; of which; 54.5 and 45.5 were males and females respectively. Mean (standard deviation) age and body mass index (BMI) were 40.6 (14.3) years and 25.3 (5.1) kg/m 2 . Obesity; overweight; and underweight were found in 17; 31; and 5 of participants respectively. Significantly; while underweight declined with increasing age; overweight; and obesity increased to peak in the middle age brackets. Age of ? 40 years was found to confer about twice the risk of becoming overweight. The prevalence of obesity and mean BMI were significantly higher both among the females and the participants from southern zones. Conclusion: Obesity and overweight are common in our urban dwellers with accompanying regional differences. Attainment of middle age increases the likelihood of urban dwelling Nigerians to become overweight/obese. There is therefore the need to institute measures that will check development of overweight/obesity early enough; while improving the nutritional status of the few who may still be undernourished

The Frequency of Various Indications for Plain Chest Radiography in Nnamdi Azikiwe University Teaching Hospital Nnewi (Nauth)

Background: With soaring advances in the field of medicine; the place of older radiologic imaging modalities is being reduced to basic screening tools. Yet the modern imaging modalities like computerized tomography (CT); magnetic resonance imaging (MRI); ultrasound and nuclear medicine are hardly available.Study Objectives: To study the frequency of various indications of plain chest radiography; remind us of its uses and to enhance the preparedness of the department to maximally accomplish the ideals of this investigation.Methodology: A total of 1476 consecutive patients for chest radiography in the department of radiology; NAUTH; Nnewi from the period of February 2009 and whose request form contain adequate data were recruited for this study. These data were analyzed using SSPS.Results: A total of 1476 patient were included in this study. There was female preponderance with male to female ratio of 1.3:1. Mean Age of the patients is 39.32 years (std19.56). The most frequent indication for chest radiography is certain infections and parasitic diseases (40.9 and the greatest source of referral for this study is General outpatient (GOPD)/family medicine department.Conclusion: The most frequent indications for chest radiography in the study are certain infection and parasitic diseases. Chest Radiography is the most frequent plain radiography study in our environment where infectious diseases are still very rampant. This makes chest radiography an important study for screening patient for possible diagnosis and classifying the need for further radiographic investigation of our patients

The Pattern of Hysterosalpingographic Findings in Women Being Investigated for Infertility in Nnewi; Nigeria

Background: Tubal occlusion is the commonest cause of female infertility in the developing societies. Hysterosalpingography remains a vital method of assessing tubal patency especially in resource limited settings such as ours. Objective: To review the pattern of hysterosalpingographic findings among women being investigated for infertility in Nnamdi Azikiwe University Teaching Hospital Nnewi; Nigeria over a period of five years (2001- 2005). Method: The data obtained from the request forms and radiologists' reports were analyzed using SPSS version 11. The level of statistical significance was set at p

The Prevalence and Bacteriology of Asymptomatic Bacteriuria among Antenatal Patients in Nnamdi Azikiwe University Teaching Hospital Nnewi; South Eastern Nigeria

Urinary tract infection in pregnancy leads to poor pregnancy outcome. Diagnosis and treatment of asymptomatic bacteriuria markedly improves pregnancy outcome as well as reduce the incidence of acute pyelonephritis. To determine the prevalence and bacteriology of asymptomatic bacteriuria among Antenatal patients in our centre; and to know if routine screening will be justifiable. This was a prospective study carried out between April and August 2008. Sample size was statistically determined.Women who consented were interviewed and mid stream urine samples were collected and processed in the microbiology laboratory; using standard microbiological methods. Out of 357 women studied; 65(18.21) had significant bacteriuria. was the commonest isolate (25.6); while was the least frequent isolate (3.66). Women in third trimester had the highest prevalence (25.68) while those in the first trimester had the least (15.79).Women that had only primary education had the highest prevalence (27.50) while those that had tertiary education had the least prevalence (21.10). The prevalence of significant asymptomatic bacteriuria among the women studied was high. Screening of all the pregnant women and treatment will reduce the incidence and complications of overt urinary tract infection in pregnancy among these women

The Pattern of Cervical Cytology in Obstetrics and Gynaecology Clinics in Nnewi; South-Eastern Nigeria

Background: Cervical cytology screening has decreased the incidence of and mortality from invasive cervical cancer in developed and even some developing countries. The story is still different in Nigeria because there is no national screening programme in place.Objectives: The aim of this study was to evaluate the pattern of cervical cytology and relate it to some known risk factors such as age; parity; age at coitarche; number of sexual partners and clinical presentation.Subjects and Methods: A total of 100 women were seen at two Obstetrics and Gynaecology clinics in Nnewi over a three month period (May-July 2005) were screened. Conventional method of staining was used. The first fifty sexually active women that consented to completing the study questionnaire in the two clinics were included.Main Outcome Measures: The work noted the pattern of reports in relation to some known risk factors and adequacy of the sampling.Results: Sampling adequacy was 93; epithelial cell abnormality was reported in only one smear; 58 were reported as normal; 14 showed benign cellular changes (i.e. infective); and 18 reactive changes (i.e. atrophy). Conclusion: Now that infective aetiology has been established in cancer of the cervix; the co-factors may be some of these causes of benign cellular changes of the cervix

Cytokine Profiles and Antibody Responses to Plasmodium Falciparum Malaria Infection in Individuals Living in Ibadan; Southwest Nigeria

Background: The ability of the host immune system to efficiently clear Plasmodium falciparum parasites during a malaria infection depends on the type of immune response mounted by the host. Study design: In a cross-sectional study; we investigated the cellular-and antibody responses in individuals with P. falciparum infection; in an attempt to identify immunological signs indicative of the development of natural immunity against malaria in Ibadan; Nigeria. Levels of IL-10; IL-12(p70); IFN-a; and IgM; IgG and IgG1-4 subclasses in the serum of 36 symptomatic children with microscopically confirmed malaria parasitaemia and 54 asymptomatic controls were analysed by ELISA. Results: IFN-a and IL-10 were significantly higher in the symptomatic children (p=0.009; p=0.025 respectively) than in the asymptomatic controls but no differences were seen for IL-12(p70). Estimated higher ratios of IFN-a/IL-10 and IFN-a/IL-12 were also observed in the symptomatic children while the asymptomatic controls had higher IL-12/IL-10 ratio. The mean concentration levels of anti-P. falciparum IgG1; IgG2; IgG3 antibodies were statistically significantly higher in the individuals 5 years of age than 5 years while anti-P. falciparum IgG3 antibodies were notably low in 5 years category. Children 5 years had higher IgM antibodies than IgG and the expression of IgG subclasses increased with age. Conclusion: Taken together; malaria infection is on a delicate balance of pro- and anti-inflammatory cytokines. The higher levels of IFN-a seen in the symptomatic children (6months) may be instrumental in immune-protection against malaria by limiting parasite replication. The observed variations in immunoglobulin subclass levels were age- dependent and exposure-related

Epidemiological Factors that Promote the Development of Severe Malaria Anaemia in Children in Ibadan

Background: Effective control and management of severe malaria cases depends on a clear understanding of the local epidemiological factors and specific clinical manifesta- tions of the disease in the different endemic regions. Objectives: To determine the prevalence of severe malaria and epidemiological factors that affect the development of malaria anaemia. Methods: A cross-sectional survey was carried out among children below 5 years of age; at the Adeoyo State Maternity Hospital;Ibadan; Nigeria. Question-naires and case histories were taken from patients clinically diagnosed of malaria.Thus; 372 volunteers wererecruited into the study from the 3131 paediatric cases that reported over the10-week period to the out-patient department (OPD) ofthe hospital. 229 (61.6) of the recruited volunteers presented with fever (37.5 oC) at consultation.These had malaria parasite andPCV tests done. Results: Clinical diagnosis was confirmed microscopically in 78(290/372) for Plasmodium infection using thick film slides. Anaemia (PCV 28) prevalence was 28.2. Factors that contributed to the rapid progression of uncomplicated malaria to severestatus included: age of the child; level of parasitaemia; careless response and attitude of parents or guardians to fever in the children;parents' preoccupation with their jobs or other healthy children and unwillingness to use available health facilities. Conclusion: The study underscores the need for community involved partnership for malaria control especially through healtheducation for the home manage- ment of malaria; espeically among those experiencing some form of inequity in access to healthcare

Studies in intestinal parasitic disease agents in stools of people in a rural area of Nigeria

A summary of 300 villagers who reported at the parasitology Laboratory of the school of Medical Laboratory of (S.M.L.T.) Vom; Plateau State; Nigeria was carried out for the presence of parasites' cysts; eggs; or larva. The Laboratory identified several kinds of parasites