Regular screening among sportsmen in Nigeria: rationale and basis.

BACKGROUND: Participation in regular prolonged physical exercise is associated with specific adaptation in cardiac structure and function which could predispose to sudden cardiac death and has been recorded in celebrated cases and with an increasing frequency in recent time especially in Nigerian footballers. There is no policy or strategy in place for preventing recurrence OBJECTIVE: To review the current literature on sudden death in athletes generally, identify current strategies that have been found useful and recommend measures to prevent or reduce prevalence in Nigerian sportsmen. METHOD: Internet search on the subject using Google and Medline web search engine. The search words were sudden death, athletes, Africans and sports screening. RESULT: Sudden death in young athletes is rare occurring in in n 100,000 to 1 in 280,000 persons per year and hypertrophic cardiomyopathy is the commonest cause and blacks are more affected than caucasians. Screening guidelines are available in some countries and mandatory pre participatory screening has reduced the incidence of sudden death in athletes in these countries. In Nigeria there is no legislation or policy on routine screening in sportsmen or measures to prevent or reduce incident of sudden death in athletes. CONCLUSION: There has been increased report of sudden death in Nigerian footballers in recent years and the investigations into these deaths are shrouded in secrecy. There is no policy for routine screening of sports participants in Nigeria, there is urgent need to develop a policy to ensure appropriate pre participation screening for all sportsmen and women each year or at the beginning of each sports season.

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

Electrocardiographic evaluation of structural and electrical abnormalities in Nigerians with undiagnosed systemic hypertension

Essential hypertension has emerged as the commonest cardiovascular disorder in developing countries especially in Sub Saharan Africa. Blacks are known to suffer more severe hypertension and develop complications early. Some of the complications of hypertension can be detected early through non-invasive electrocardiography. The aim of this study is to evaluate the hypertension related abnormalities on the electrocardiograph of patients with untreated hypertension.Methodology: A detailed prospective analysis of the electrocardiographic tracing of all patients with untreated essential hypertension at first presentation over a six month period was undertaken. The patients were recruited from the medical outpatient clinic of the University of Port Harcourt Teaching Hospital.Result: A total of eighty three adult Nigerians aged 18years to 90 years who presented with untreated essential hypertension over the six months study period had their ECGs analyzed. There were thirty three males and fifty females (0.7:1); mean systolic blood pressure was 192.78+38.4mmHg and the mean diastolic blood pressure was 116.6+16.9mmHg. Sixty percent (60.22) had normal rhythm; and forty percent had various rhythm abnormalities; 77.6 had normal axis while 22.4 had left axis deviation; 45.8 had repolarisation abnormalities; 25.3 had evidence of left ventricular hypertrophy and 26.5 had various ventricular arrhythmias.Conclusion: Adult Nigerians presenting with hypertension for the first time have significant rhythm and structural abnormalities that should influence their clinical management and drug treatment choice. ECG is an important investigation and should be a mandatory evaluation for all newly presenting hypertensives

Prevalence of left ventricular hypertrophy in hypertensive and normotensive type 2 diabetic females in Port Harcourt.

This study investigated the prevalence of electrocardiographically determined left ventricular hypertrophy in hypertensive and normotensive type 2 diabetic females who went for consultation at the University of Port Harcourt Teaching Hospital (UPTH), Rivers State, Nigeria. Two hundred participants mean age 52 years, attending the medical outpatient clinic over a 6-month period were recruited for the study. Of the population studied, 16.5% of the hypertensive and 13.0% of the normotensive diabetics had left ventricular hypertrophy. Cardiovascular abnormalities notably bifascicular block, left atrial block, right ventricular enlargement, and right atrial enlargement were predominately among hypertensive diabetes and also notably was arrhythmia and atrial flutter among normotensive diabetes. The significance of these findings is discussed.

Serum lipids profile of untreated hypertensive patients in Port Harcourt, Nigeria

Background: Hypertension is the commonest non-communicable disease with variable prevalence rates in different parts of the world. Dyslipidaemia is associated with and predisposes to hypertension and hence increases the risk of cardiovascular disease. Aim: To determine the lipid profile in newly diagnosed hypertensive patients and compare them with age, sex and body mass index (BMI) of matched healthy non-hypertensive controls. Methods: A prospective descriptive study of newly diagnosed and treatment naive hypertensive patients. Healthy non-hypertensive adult Nigerians, who gave informed consent, consisting mainly of hospital staff and relatives of patients, matched for sex, age and BMI were recruited as controls. Results: A total of 89 patients, 42 females and 47 males and 87 healthy adults matched for age, sex, and body size were recruited as controls. Mean age of hypertensive subjects was 42.6±9.3 years and mean age for the control subjects was 41.5±4.5 years. The mean systolic blood pressure in the hypertensive subjects was 177.6±20.1 mmHg and mean diastolic blood pressure was 110.9 ±9.9 mmHg. The mean BMI in the hypertensive patients was 28.7±4.2 kg/m2, while the controls had mean BMI of 28.2±4.0 kg/m2 (P=0.5178). The mean total cholesterol (TCH) was 5.3±1.1 mmol/l in the study subjects and 4.7±0.95 mmol/l in the controls (P =0.0002). The mean low density lipoprotein cholesterol 250 in the study subjects was 4.3±1.1 mmol/l and 3.6±0.9 mmol/l in the control group (P=0.000054), while the mean triglyceride in the subjects was 1.3±0.3 mmol/l and 1.0±0.3 mmol/l in the controls (P=0.0000). Conclusion: Newly diagnosed hypertensives have significantly higher serum cholesterol levels than non-hypertensives of comparable age, sex and body size

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

Tubal ectopic pregnancy after bilateral tubal ligation: A case report.

BACKGROUND: Tubal ligation is a common method of contraception, and pregnancy after this method of sterilization is uncommon. We here present a report of Tubal pregnancy after a Bilateral Tubal Ligation (BTL). METHOD: The case notes of a 35 year Nigerian female who presented with a tubal pregnancy after BTL and a review of literature on the subject was used. RESULT: A 35-year-old para 4=0 had bilateral tubal ligation during caesarean section for her last childbirth. She presented 3 years later with a six weeks history of irregular vaginal bleeding and lower abdominal pain and had a laparotomy for a right tubal ectopic pregnancy. CONCLUSION: Ectopic pregnancy after bilateral tubal ligation is uncommon. Females who undergo BTL should be adequately counseled on the possibility of failure of this procedure for contraception.

Addison's disease presenting as acute chest syndrome: case report and review of literature.

BACKGROUND: Addison's disease is due to primary adrenal failure. It is an uncommon condition with equal prevalence in both males and females. The onset of symptoms is gradual and manifestation is non specific, hence diagnosis is easily missed without a high index of suspicion. METHODS: The medical records of a patient who presented with acute chest pain to the cardiac unit of the University of Port Harcourt Teaching Hospital were reviewed. A review of the literature using manual library and Medline search on Addison's disease was also done. RESULT: A 48 years old male presented in our medical outpatient department with a three day history of sudden onset of severe precordial chest pain that started while playing football which was associated with nausea, vomiting and difficulty in breathing. After initial clinical evaluation a diagnosis of acute myocardial infarction and cardiac failure with a suspicion of background Addison's disease was made. Serial electrocardiography done over a two week period did not show evidence of myocardial infarction, but the patient had elevated serum ACTH and very low serum cortisol levels. An abdominal CT scan done two weeks after admission showed absence of the Adrenal glands bilaterally, confirming Addison's disease. He received treatment for cardiac failure, analgesics, prednisolone and a mineralocorticoid to which he responded satisfactorily and has remained healthy. He also received a six months course of antituberculous treatment empirically. CONCLUSION: Addison's disease is an uncommon endocrine disorder which can present insidiously in a non specific manner. Diagnosis requires a high index of suspicion.

Echocardiography in the University of Port Harcourt Teaching Hospital: April 2000 to March 2003.

BACKGROUND: Echocardiography is a cheap and non-invasive technique for the investigation of cardiac diseases with reliable levels of accuracy. Echocardiography services commenced in the Cardiac unit of the University of Port Harcourt Teaching Hospital (UPTH) in April 2000. There is a need to establish an accurate pattern of cardiac diseases seen in the centre based on echocardiography assessment. The aim of the study was to review the pattern of cardiac diseases diagnosed by echocardiography in the cardiology unit of the University of Port Harcourt Teaching hospital. METHOD: A prospective descriptive study of patients referred to the cardiology unit of UPTH for echocardiography for a variety of cardiac complain was done. Subjects had two dimensional and M-mode echocardiography assessment using a Siemens Sonoline SL 1 machine with a 3.5 MHz sector probe. RESULTS: One hundred and forty one subjects aged between 16-84 years with a mean age of 44.2 +/- 11.5 years had echocardiography assessment over the three year period. Eighty two (58.2%) of the subjects were males while 59 (41.8%) were females. Fourty eight (34.0%) of subjects had hypertensive heart disease, 28 (19.9%) had Cardiomyopathies, 13 (9.2%) had rheumatic heart disease. Pericardial disease, congenital heart disease and cor pulmonale was found in 6 (4.3%), 2 (1.4%) and 1 (0.7%) respectively. Fourty three (30.5%) of subjects had normal findings on echocardiography. CONCLUSION: Hypertensive heart disease was found to be the most prevalent cardiac condition followed by the cardiomyopathies and rheumatic heart disease in that order. This trend is very similar to what obtains in sub Saharan Africa as documented by similar studies.

Lipid profile of healthy adult Nigerians in Port Harcourt, Nigeria.

BACKGROUND: Hyperlipidaemia is a major cardiovascular risk factor for coronary artery disease, atherosclerosis, hypertension and stroke. It is thought that serum cholesterol levels are low in Nigerians as shown by results of a population survey done over twenty years ago. In addition the last national non communicable disease survey recorded a low prevalence of Hyperlipidaemia (4.0%) in Nigeria. With increasing urbanisation and socioeconomic improvement, changing population dynamics is expected to influence disease pattern and noncommunicable diseases are expected to rise. Thus there is a need to screen healthy adults for their lipid pattern in Port Harcourt a city with high population dynamics where such studies have not been previously reported. METHOD: A prospective descriptive population survey was carried out among healthy adults residing in Port Harcourt. A total of ninety two adults were screened after obtaining informed consent. Weight, height, blood pressure, fasting blood sugar and fasting lipid profile were measured. Results were analysed using simple statistical methods. RESULTS: A total of ninety two subjects were recruited into the study. Fourty seven (51.1%) of the subjects were males while fourty five (48.9%) were females. The age range of subjects was 24-59 years with mean of 38.84 +/- 8.36 years. The mean BMI was 28.76 +/- 5.91 Kg/m2. There was no significant statistical difference between the mean BMI for males and females. The mean fasting blood sugar, mean total cholesterol and mean LDL cholesterol were 4.45 +/- 0.89 mmol/L, 4.76 +/- 1.06 mmol/L and 3.65 +/- 0.89 mmol/L. The mean total triglyceride was 1.02 +/- 0.30 mmol/L while the mean HDL was 0.90 +/- 0.25 mmol/L. There was an increase in total cholesterol with increasing age and an increase in total cholesterol and LDL cholesterol with increasing social class. Subjects with total cholesterol above 6.5 mmol/L constituted 31.52% of study subjects. Subjects with BMI between 25-29 Kg/m2 made up 43.48% of subjects while 33.69% of subjects had BMI above 30 Kg/m2. CONCLUSION: A high mean total and LDL cholesterol values were observed among healthy adults in Port Harcourt. The prevalence of obesity was also found to be high. There is a need for public health action to address these findings especially as high serum cholesterol levels have a direct correlation with coronary artery disease. Further large scale urban survey of non communicable diseases in the country is therefore necessary at this time.

Echocardiography in the University of Port Harcourt Teaching Hospital: April 2000 to March 2003

Background: Echocardiography is a cheap and non-invasive technique for the investigation of cardiac diseases with reliable levels of accuracy. Echocardiography services commenced in the Cardiac unit of the University of Port Harcourt Teaching Hospital (UPTH) in April 2000. There is a need to establish an accurate pattern of cardiac diseases seen in the centre based on echocardiography assessment. The aim of the study was to review the pattern of cardiac diseases diagnosed by echocardiography in the cardiology unit of the University of Port Harcourt Teaching hospital. Method: A prospective descriptive study of patients referred to the cardiology unit of UPTH for echocardiography for a variety of cardiac complain was done. Subjects had two dimensional and M-mode echocardiography assessment using a Siemens Sonoline SL 1 machine with a 3.5 MHz sector probe. Results: One hundred and forty one subjects aged between 16-84 years with a mean age of 44.2 ± 11.5 years had echocardiography assessment over the three year period. Eighty two (58.2%) of the subjects were males while 59(41.8%) were females. Fourty eight (34.0%) of subjects had hypertensive heart disease, 28(19.9%) had Cardiomyopathies, 13(9.2%) had rheumatic heart disease. Pericardial disease, congenital heart disease and cor pulmonale was found in 6(4.3%), 2(1.4%) and 1(0.7%) respectively. Fourty three (30.5%) of subjects had normal findings on echocardiography. Conclusion: Hypertensive heart disease was found to be the most prevalent cardiac condition followed by the cardiomyopathies and rheumatic heart disease in that order. This trend is very similar to what obtains in sub Saharan Africa as documented by similar studies

Lipid profile of healthy adult nigerians in Port Hacourt, Nigeria

Background: Hyperlipidaemia is a major cardiovascular risk factor for coronary artery disease, atherosclerosis, hypertension and stroke. It is thought that serum cholesterol levels are low in Nigerians as shown by results of a population survey done over twenty years ago. In addition the last national non communicable disease survey recorded a low prevalence of Hyperlipidaemia (4.0%) in Nigeria. With increasing urbanisation and socioeconomic improvement, changing population dynamics is expected to influence disease pattern and noncomminucable diseases are expected to rise. Thus there is a need to screen healthy adults for their lipid pattern in Port Harcourt a city with high population dynamics where such studies have not been previously reported. Method: A prospective descriptive population survey was carried out among healthy adults residing in Port Harcourt. A total of ninety two adults were screened after obtaining informed consent. Weight, height, blood pressure, fasting blood sugar and fasting lipid profile were measured. Results were analysed using simple statistical methods. Results: A total of ninety two subjects were recruited into the study. Fourty seven (51.1%) of the subjects were males while fourty five (48.9%) were females. The age range of subjects was 24-59 years with mean of 38.84 ± 8.36 years. The mean BMI was 28.76 ± 5.91 Kg/m2. There was no significant statistical difference between the mean BMI for males and females. The mean fasting blood sugar, mean total cholesterol and mean LDL cholesterol were 4.45 ± 0.89 mmol/L, 4.76 ± 1.06 mmol/L and 3.65 ± 0.89 mmol/L. The mean total triglyceride was 1.02 ± 0.30 mmol/L while the mean HDL was 0.90 ± 0.25 mmol/L. There was an increase in total cholesterol with increasing age and an increase in total cholesterol and LDL cholesterol with increasing social class. Subjects with total cholesterol above 6.5mmol/L constituted 31.52 % of study subjects. Subjects with BMI between 25-29 Kg/m2 made up 43.48% of subjects while 33.69% of subjects had BMI above 30Kg/m2. Conclusion: A high mean total and LDL cholesterol values were observed among healthy adults in Port Harcourt. The prevalence of obesity was also found to be high. There is a need for public health action to address these findings especially as high serum cholesterol levels have a direct correlation with coronary artery disease. Further large scale urban survey of non communicable diseases in the country is therefore necessary at this time

Drug compliance among hypertensive patients in Port Harcourt, Nigeria.

BACKGROUND: Hypertension contributes significantly to cardiovascular morbidity and mortality. Adequate blood pressure control would therefore reduce cardiovascular morbidity and mortality, however adequate blood pressure control requires good treatment compliance. METHODS: One hundred consecutive patients aged 30-79 years attending the cardiac clinic of the medical out-patients clinic of the University of Port Harcourt Teaching Hospital were directly questioned about compliance with their antihypertensive drugs and results entered into the questionnaire designed for the study. RESULTS: Compliance was good in sixty percent (60%) of respondents, fair in twenty nine percent (29%) and poor in eleven percent (11%). Compliance was also found to be good in sixty-seven percent (67%) of patients with tertiary education, good in forty one percent (41%) of those with primary education. Compliance was good in seventy four percent (74%) of those taking one drug, good in only thirty three percent (33%) of those taking four drugs. Patients taking single daily dose drugs had good compliance in seventy percent (70%), twice daily dosing had good compliance in fifty five percent (55%) and among those taking thrice daily dosage, compliance was good in only seventeen percent (17%). CONCLUSION: The study shows that good compliance with anti-hypertensive therapy is best achieved with monotherapy given as single dosage. It also shows the role of education in the level of compliance.

[Contribution to the study of the origin of cellulase activities of the gut in earthworm Eisenia fetida andrei]. / Contribution à l'étude de l'origine des activités cellulasiques du tube digestif du lombricien Eisenia fetida andrei.

In order to determine the origin of cellulases in the gut of the earthworm Eisenia fetida andrei, the wall tissues of the different parts of the disinfected gut are cultured in vitro. Enzymatic activities (FPase: filter paper activity; CMCase: carboxymethycellulase, cellobiase) were measured both in the tissues and in the culture medium: the following activities were found, carboxymethycellulase (CMCase), filter paper activity (FPase). The first located in the crop, gizzard and midgut wall, the second in the foregut and midgut wall. The cellobiase was detected only in the crop and gizzard tissues, whereas it is present in each part of the gut of holoxenic worms. This fact indicates that this enzyme is mainly produced by microorganisms ingested. These results allow us to propose the hypothesis of the existence of synergy, for the cellulose hydrolysis between tissular enzymes and cellulolytic microorganisms.