Metabolic Syndrome and its Correlates among Hypertensive Patients in Abuja, North Central Nigeria.

BACKGROUND: Metabolic syndrome is a constellation of abnormalities which includes central obesity, dyslipidaemia, elevated blood pressure and hyperglycemia. Hypertension, (which is a very common component of metabolic syndrome), and diabetes mellitus, are independently associated. Also, studies examining metabolic syndrome inAbuja, a city with affluence-driven lifestyle, are not available. This study aimed to investigate the prevalence of metabolic syndrome among hypertensive patients in Abuja, Nigeria, as well as to examine the associations between metabolic syndrome and certain factors in that cohort of hypertensive patients. METHODS: This was a retrospective study that used data from hypertensive patients who attended clinic over a period of five years. Eight hundred and fifty-eight, (858-combined), case files of pre-treated, (previously known hypertensive patients) and newly diagnosed hypertensive participants were used for the study. The student t-tests were used to compare continuous variables, while Chi-square (χ2) tests were used for relationship between qualitative variables. The likelihood ratio test was employed to further confirm the statistical significance of certain independent variables relating with metabolic syndrome. A P-value of < 0.05 was considered statistically significant. RESULTS: The mean ages were 48.70±12.18, 49.19±11.06 and 48.2±13.3 years for combined group, the pre-treated and the newly-diagnosed groups respectively. The pre-treated, group consists of those previously known hypertensive patients, while the new group consists of those who were newly diagnosed hypertensive patients and were treatment naïve. The prevalence of metabolic syndrome in this study was 45.5% in the combined group, 47.23% in the pre-treated group and 37.3% in the newly diagnosed group. The commonest component of metabolic syndrome was reduced high density lipoprotein cholesterol, HDL-C. CONCLUSION: Metabolic syndrome is prevalent among hypertensive patients in Abuja, Nigeria. Some correlates of metabolic syndrome include; elevated BMI, truncal obesity, elevated total cholesterol, the use of thiazide diuretics and beta blockers as antihypertensives.

CONTEXTE: Le syndrome métabolique est une constellation d'anomalies qui comprend l'obésité centrale, la dyslipidémie, l'élévation de la pression artérielle et l'hyperglycémie. L'hypertension, qui est un composant très courant du syndrome métabolique, et le diabète sucré sont indépendamment associés. De plus, des études examinant le syndrome métabolique à Abuja, une ville au mode de vie axé sur l'aisance, ne sont pas disponibles. Cette étude visait à enquêter sur la prévalence du syndrome métabolique parmi les patients hypertendus à Abuja, au Nigeria, ainsi qu'à examiner les associations entre le syndrome métabolique et certains facteurs dans cette cohorte de patients hypertendus. MÉTHODES: Il s'agissait d'une étude rétrospective utilisant des données de patients hypertendus ayant fréquenté la clinique sur une période de cinq ans. Huit cent cinquante-huit (858 - combinés) dossiers de cas de patients hypertendus préalablement traités (patients hypertendus connus) et nouvellement diagnostiqués ont été utilisés pour l'étude. Les tests t de Student ont été utilisés pour comparer les variables continues, tandis que les tests du chi-carré (χ2) ont été utilisés pour examiner la relation entre les variables qualitatives. Le test du rapport de vraisemblance a été utilisé pour confirmer davantage la signification statistique de certaines variables indépendantes liées au syndrome métabolique. Une valeur P < 0,05 était considérée comme statistiquement significative. RÉSULTATS: Les âges moyens étaient de 48,70 ± 12,18, 49,19 ± 11,06 et 48,21 ± 13,3 ans pour le groupe combiné, le groupe prétraité et le groupe nouvellement diagnostiqué, respectivement. La prévalence du syndrome métabolique dans cette étude était de 45,5% dans le groupe combiné, 47,23% dans le groupe prétraité et 37,3% dans le groupe nouvellement diagnostiqué. Le composant le plus courant du syndrome métabolique était une diminution du cholestérol lipoprotéique de haute densité, le HDL-C. CONCLUSION: Le syndrome métabolique est prévalent parmi les patients hypertendus àAbuja, au Nigeria. Certains corrélats du syndrome métabolique comprennent un IMC élevé, une obésité tronculaire, une augmentation du cholestérol total, l'utilisation de diurétiques thiazidiques et de bêta-bloquants comme antihypertenseurs. Mots-clés: Syndrome métabolique, corrélats, patients hypertendus, Abuja Nigeria.

Epidemiologic Characteristics, Clinical Features and Outcomes of COVID 19: Patients Admitted at the Asokoro District Hospital Isolation and Treatment Center, Abuja, North Central Nigeria.

BACKGROUND: The COVID -19 pandemic spread rapidly across the globe, making a land-fall on the Nigerian geo-space in early 2020. Key presenting features were; fever, dry cough, fatigue, myalgia, headache, sore-throat, abdominal pain, diarrhea, dyspnoea amongst others, with a clinical spectrum ranging from mild through severe forms. Aside infection control and supportive care, there was no specific therapy until trials with Remdesivir. Studies have described limited epidemiological findings, presentations and outcomes of COVID patients in Nigeria and elsewhere, but not for the Federal Capital Territory, (FCT) specifically Abuja, the Nation's capital city and the second epicenter of the pandemic in Nigeria. The objective of this study therefore, was to describe the Clinical and demographic characteristics of the patients admitted at the Asokoro District Hospital (ADH), Abuja. METHODS: Retrospective study that used records of patients admitted, between April and September 2020. Data include; Socio-demographics, medical history, exposure, residential area, co-morbidities, symptoms, signs, treatment measures, duration of hospital stay and outcomes. RESULTS: 270 patients were enrolled for this study. 170(63%) males and 100(37%) females. Mean age was 40.03+13.5years. Forty-one(15.2%) had travel history while 99(36.7%) had contact with confirmed cases. Majority of the patients were married(63.33%), and had tertiary education(74.82%). Commonest symptoms were cough(43.33%), fever(36.67%), headaches(32.22%) and fatigue(31.48%). The duration of stay at the ADH ranged from 2 hours to 28 days. CONCLUSION: Our patients were young, mainly of the upper class, educated people with mild to severe disease. There was one death, a case with multiple comorbid factors.

CONTEXTE: La pandémie COVID-19 s'est propagée rapidement à travers le globe, faisant une chute sur le géo-espace Nigérian au début 2020. Les principales caractéristiques de présentation étaient les suivantes : fièvre, toux sèche, fatigue, myalgie, maux de tête, maux de gorge, douleurs abdominales, diarrhée, dyspnée, entre autres, avec un spectre clinique allant de doux à travers des formes sévères. En dehors de la lutte contre l'infection soins, il n'y avait pas de traitement spécifique avant les essais avec Remdesivir. Des études ont décrit des résultats épidémiologiques limités, présentations et résultats des patients atteints de COVID au Nigeria et ailleurs, mais pas pour le Territoire de la capitale Fédérale, plus précisément Abuja, la Capitale de la nation et épicentre de la pandémie au Nigeria. L'objectif de cette étude par conséquent, était de décrire le clinique et démographique caractéristiques des patients admis dans le district d'Asokoro Hôpital (ADH), Abuja. MÉTHODES: Étude rétrospective utilisant les dossiers des patients admis, entre avril et septembre 2020. Les données comprennent : Sociodémographie, antécédents médicaux, exposition, quartier résidentiel, comorbidités, symptômes, signes, mesures de traitement, durée de séjour à l'hôpital et des résultats. RÉSULTATS: 270 patients ont été inscrits pour cette étude. 170 (63 %) hommes et 100 (37 %) femmes. L'âge moyen était de 40,03 + 13,5 ans. Quarante et un (15,2 %) avaient des antécédents de voyage, tandis que 99 (36,7 %) avaient des contacts avec cas confirmés. La majorité des patients mariés (63,33 %) et ayant fait des études supérieures (74,82%). Les symptômes les plus fréquents étaient la toux (43,33 %), la fièvre (36,67 %), maux de tête (32,22 %) et fatigue (31,48 %). Durée du séjour à l'ADH variait de 2 heures à 28 jours. CONCLUSION: Nos patients étaient jeunes, principalement de la partie supérieure de la classe, des gens instruits atteints de maladies bénignes à graves. Il y avait un décès, un cas avec de multiples facteurs comorbides. MOTS-CLÉS: Socio-démographie, caractéristiques cliniques, résultats, Patients de la COVID, Abuja-Nigeria.

Outcome of surgery for toxic goitres in Maiduguri: a single teaching hospital's perspective.

BACKGROUND: Thyrotoxicosis a common endocrine disorder of the thyroid gland in Nigeria is commonly treated surgically. The outcome of thyroidectomy for toxic goiters in Maiduguri Nigeria is evaluated. MATERIALS AND METHODS: Over the last 5 years (Jan 2005-July 2010) , in a prospective review, the demographic, and clinical data of patients operated for toxic goiters in our department was entered, into a predesigned proforma and analyzed. The objective of the study is to review our experience with subtotal and near-total thyroidectomy as treatment for benign toxic goiters. RESULTS: Seventy-eight patients, 11 males (14.1%) and 67 females (85.9%), with male: female ratio of 1:6.1 and the mean age of 30 ± 10.9 (range, 17-65 years), underwent thyroidectomy for toxic goiters. The mean duration of symptoms was 41.9 (range 3-126 months). There were 53 patients with toxic diffuse goiters (Grave's disease) with their mean age of 27.6 ± 6.93 (range 17-38 years), 23 with toxic multinodular goiters, the mean age of 43.7 ± 15.68 (range 17-65 years) and two with toxic nodule. There was no case of permanent recurrent laryngeal nerve palsy or permanent hypocalcemia. Transient hypocalcemia occurred in 9 (11.5%) patients and hemorrhage with hematoma, requiring exploration in 4 (5.1%). There were two cases of wound infection and no postoperative mortality. The mean hospital stay was 7.6 ± 2.34 (range 5-15 days). There was no disease recurrence over a mean follow-up of 20.7 (range 2-48) months. CONCLUSION: Subtotal thyroidectomy is an effective procedure for the treatment of thyrotoxicosis with few postoperative complications and majority of patients being euthyroid after long follow-up.

Congenital aganglionic megacolon in Nigerian adults: two case reports and review of the literature.

Congenital aganglionic mega colon (Hirschsprung's disease) is a motor disorder in the gut, due to a defect in the craniocaudal migration of the neuroblast originating from the neural crest that occurs during the first twelve weeks of gestation, causing a functional intestinal obstruction, with its attendant complications, in infants. Despite modern pediatric practice, with emphasis on early diagnosis, Hirschsprung's disease is seen in adults in regions where perinatal care is limited. We report two cases of Nigerian adults with longstanding, recurrent constipation, getting relieved by laxatives and herbal enemata, and then presented to our Emergency Department with a history of progressive abdominal distention, colicky pain, occasional vomiting, and weight loss. Per rectal examination revealed a gripping sensation in the rectum, 10 cm from the anal verge, with rectal fecal load. Barium enema showed a grossly distended proximal large colon, with high fecal retention, with the transition zone at the middle one-third of the rectum. Due to difficulty in bowel preparation of these patients, emergency laparotomy was done. The first case had a diverting sigmoid colostomy and later had a low anterior resection. The second case had a one-stage procedure. Histology of both the cases showed aganglionosis of the stenotic segment and a normal distal rectum. Both patients had complete resolution of the symptoms, without complications, in a three-year follow-up. The related literatures were reviewed. Hirschsprung's disease should be considered in adults patient presenting with chronic constipation. Low anterior resection of the rectum would be a surgical option for the treatment of short and zonal segment of adult Hirschsprung's disease.

Tuberculous ileal perforation in a HIV positive patient: a case report and review of literature.

BACKGROUND: Tuberculosis is prevalent worldwide. Even in developed countries there is a resurgence of tuberculosis mainly due to increasing HIV infection. Tuberculous ileal perforation is uncommon. It is, however, a potentially fatal complication of intestinal tuberculosis especially in HIV/AIDS patient. AIM: To highlight tuberculous ileal perforation as an underestimated complication of intestinal tuberculosis in an HIV patient presenting with acute abdomen. METHOD: A 42-year-old HIV positive long distance truck driver with tuberculous ileal perforation is presented and related literatures reviewed. CONCLUSION: Intestinal perforation due to abdominal tuberculosis is an aetiological factor in acute HIV abdomen. High index of suspicion remains the key to diagnosis.

Male breast cancer in north eastern Nigeria.

BACKGROUND: Carcinoma of the male breast is generally rare and constitutes 1% of all breast cancers. They often present late in developing countries and therefore has poor prognosis. The aim of this paper is to highlight the pattern of presentation and problems associated with management of this disease in Maiduguri, North Eastern Nigeria. PATIENTS AND METHOD: Case records of eleven (11) histologically diagnosed male breast cancers out of a total of two hundred and ninety-five (295) cases of breast cancer managed at the University of Maiduguri Teaching Hospital between 1989-2003 were retrospectively studied and analysed. RESULTS: Male breast cancer constitutes 3.7% of all cases of breast cancers seen in this hospital during the study period under review. The male to female ratio was 1:26. The peak age range at presentation was 40-49 years and all were advanced at presentation. The time interval between onset of symptoms and presentation were all over 12 months. All the patients either had toilet mastectomy or modified radical mastectomy. In addition, two patients had sub capsular orchidectomy while nine had Tamoxifen. Four patients had additional cytotoxic chemotherapy. Two patients died in the course of follow-up while the rest were lost to follow-up shortly after discharge. Only one patient was followed-up for more than two years. CONCLUSION: Male breast cancer though rare, is a serious clinical problem associated with late presentation. It is hoped that increased public awareness will improve the outcome of management.

Sildenafil citrate (Viagra) for the treatment of erectile dysfunction in Nigerian men.

Fifty-eight Nigerian outpatients with documented erectile dysfunction (ED) received open-label sildenafil citrate (Viagra) for 8 weeks. The 50-mg starting dose could be adjusted to 100 or 25 mg based on response and tolerability. The International Index of Erectile Function (IIEF) Questionnaire, a global efficacy question, and intercourse data recorded in a patient event log were used to assess efficacy. Frequency of penetration and maintained erection were both significantly enhanced (P<0.0001); 95% of patients reported improved erections and 81% of all attempts at intercourse were successful. Orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction also improved significantly (P&<0.0001). The most frequent adverse events (all-cause) were headache (17%) and myalgia (3%); only one patient discontinued treatment because of headache, which was considered unrelated to sildenafil. Oral sildenafil significantly improved erectile function and was well tolerated in this trial of Nigerian men suffering from ED. Our results are consistent with reports from other countries.

Treatment of ganglion using hypertonic saline as sclerosant.

Twenty-nine patients with ganglion of the wrist were treated in this hospital using hypertonic saline as sclerosant. All patients were treated as outpatients. Under aseptic conditions, the ganglia were aspirated using #18 hyperdermic needle. A mixture of 2 cc of hypertonic saline and 1 cc 1% xylocaine were injected into the empty cavity and crepe bandage applied for 24-48 hours. After a follow-up period of 24-36 months, there was only one recurrence which was believed to be accidental injection of the saline outside the empty cavity. This was treated by the same procedure. The most common complication was swelling of the wrist and dorsum of the hand which were seen in 50% of cases. This subsided spontaneously within 72 hrs of treatment. Severe pain necessitating ingestion of analgesics (Paracetamol) was reported in 6 patients (20%), which subsided within 48 hours. It is hoped that this new treatment which is cheap and less invasive may be a break through in the treatment of ganglia which hitherto was characterised by high recurrence rate of up to 23%.

Gastric outlet obstruction in Maiduguri.

In a review of sixty-four (64) cases of gastric outlet obstruction (G.O.O.) seen at the University of Maiduguri Teaching Hospital between 1991 and 1996, cicatrising chronic duodenal ulcer accounted for 65.7% of cases, followed by antral carcinoma of the stomach 15%, congenital hypertrophic pyloric stenosis 9.4%, carcinoma of the head of pancreas 6% and congenital bands 3%. The usual presentations were forceful vomiting in a patient with background history of dyspepsia of varying duration depending on cause, visible persistalsis, weight loss, abdominal masses and electrolyte imbalances. Diagnoses was easy clinically and confirmed by barium studies and/or gastroduodenoscopy. Treatment offered depended on the cause of gastric outlet obstruction.

Crush injuries of the hand.

A retrospective review of 58 patients presenting with crush injuries of the hand within the 6 year period April 1984 to March 1990 was undertaken. The male-female ratio was 3:1, with a mean age of 25.13 +/- 15.1 years. The peak incidence was in the 3rd decade of life. Machines (55.17%) were the commonest cause with the pepper grinder featuring most prominently. The dorsum (60.3%), little (55.1%) and ring (53.5%) fingers of the right hand were the most commonly involved. Most of the injuries were multiple. Management was mainly conservative and entailed initial limited debridement, thorough washing with soap and water under adequate anaesthesia, bulky boxing glove dressing, elevation, antibiotics and early hand physiotherapy with late reconstruction. Results were excellent in 13 (22.41%), good in 19 (32.76%) poor in 23 (39.66%) and unknown in 3 (5.17%) who were lost to follow-up. Our poor result is perhaps the warning signal that we should abandon our extreme conservative stance and be more aggressive in our attitude to these injuries.

Grinding machine injury of the hand: a preliminary report.

Case notes of 20 patients who presented with grinding machine injury to the hand from April 1984 to March 1990 were analysed for pattern of injury, method of management and outcome of treatment. Thirteen cases were seen in the last three years of this period (the SAP era) compared to seven cases in first three years of the period (the pre-SAP era). Children from low socio-economic class were the commonest victims. The right hand was commonly involved alone. Most injuries were multiple but the skin of the dorsum of the hand and ring finger were most commonly injured. Associated fractures of the metacarpals, carpals, joint dislocations in the hand and injuries to other parts of the body were uncommon. Thorough washing of the wound with soap and water, careful, limited initial debridement, elevation of the hand, antibiotics, antitetanus prophylaxis and early intensive hand physiotherapy yielded good to excellent results in seventeen patients. Eventhough the viability of the crushed skin on the dorsum of the hand may be questionable at initial presentation most of it will 'take' and we advocate that as much of this skin as is possible should be spared.