Electrocardiographic findings in a cross-sectional study of human immunodeficiency virus (HIV) patients in Enugu, south-east Nigeria.

BACKGROUND: Electrocardiographic (ECG) abnormalities are prevalent in subjects with human immunodeficiency virus (HIV) infection. In this study, three groups of subjects were investigated and the prevalence of ECG abnormalities was analysed. METHODS: A cross-sectional study was carried out on adults between November 2010 and November 2011 at the University of Nigeria Teaching Hospital, Enugu, Nigeria. One hundred HIV-infected patients on highly active anti-retroviral therapy (HAART), 100 HIV-infected HAART-naïve patients and 100 HIV-negative controls were recruited. Twelve-lead electrocardiograms were done on all subjects. Data were analysed using the chi-squared, Student's t-, one-way ANOVA and Duncan post hoc tests. RESULTS: Left-axis deviation was seen in 15 (16%) of the HIV-positive subjects on HAART, 10 (13.7%) of the HAART-naïve subjects and eight (21%) of the controls (p = 0.265). Eight (11%) subjects with left ventricular hypertrophy (p < 0.001) and two (2.7%) with ST-segment elevation were found among the HIV-positive HAART-naïve subjects (p = 0.134). Prolonged QTc interval was seen in 17 (18.2%) of the HIV-positive patients on HAART, 12 (16.4%) of the HIV-positive HAART-naïve patients and four (10.5%) of the controls (p = 0.012). CONCLUSION: The prevalence of ECG abnormalities was higher in the HIV-positive patients on HAART (93%) and the HIV-positive HAART-naïve patients (73%) compared to the controls.

Medical Causes of Death in a Teaching Hospital in South-Eastern Nigeria: A 16 Year Review

Background: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. This affects the pattern of death in this region. Objective: The objective of this study is to determine the causes of death in the medical wards of the University of Nigeria Teaching Hospital; Ituku/Ozalla; Enugu; South-East Nigeria from 1995 to 2010. Materials and Methods: Data were collected retrospectively from January 1995 to December 2010. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc. Chicago; IL; USA) version 17.0 was used. Simple descriptive statistics were done. Student's t-test was used to compare means of continuous variables; while Chi-square test was used to test significance of differences between two proportions. Results: The mortality rate was 22.8 (6250/27;514) admissions. The male to female ratio was 1.7:1. Infections (20.2) were the most common cause of death. However; chronic kidney disease was the single most common disease entity causing death (12.3). Other important causes of death in order of prevalence were cerebrovascular accident (10.5); acquired immune deficiency syndrome and tuberculosis either alone or as co-infection (10.3); heart failure (8.8); chronic liver disease (7.0); septicemia (6.5); respiratory failure (5.3); diabetes mellitus (4.6); cardiac arrhythmias (2.9); and primary liver cell carcinoma (2.7). There were few deaths from tetanus; malaria; typhoid fever; and coronary artery disease. Conclusion: Mortality is high in our medical wards and reflects the emerging trend of mixed disease spectrum comprising communicable and noncommunicable diseases

Medical causes of death in a teaching hospital in South-Eastern Nigeria: A 16 year review.

BACKGROUND: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. This affects the pattern of death in this region. OBJECTIVE: The objective of this study is to determine the causes of death in the medical wards of the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, South-East Nigeria from 1995 to 2010. MATERIALS AND METHODS: Data were collected retrospectively from January 1995 to December 2010. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) version 17.0 was used. Simple descriptive statistics were done. Student's t-test was used to compare means of continuous variables, while Chi-square test was used to test significance of differences between two proportions. RESULTS: The mortality rate was 22.8% (6250/27,514) admissions. The male to female ratio was 1.7:1. Infections (20.2%) were the most common cause of death. However, chronic kidney disease was the single most common disease entity causing death (12.3%). Other important causes of death in order of prevalence were cerebrovascular accident (10.5%), acquired immune deficiency syndrome and tuberculosis either alone or as co-infection (10.3%), heart failure (8.8%), chronic liver disease (7.0%), septicemia (6.5%), respiratory failure (5.3%), diabetes mellitus (4.6%), cardiac arrhythmias (2.9%), and primary liver cell carcinoma (2.7%). There were few deaths from tetanus, malaria, typhoid fever, and coronary artery disease. CONCLUSION: Mortality is high in our medical wards and reflects the emerging trend of mixed disease spectrum comprising communicable and noncommunicable diseases.

Intra-cardiac masses in adults: a review of echocardiogram records at two echocardiographic laboratories in Enugu, South-East Nigeria.

BACKGROUND: Transthoracic echocardiography (TTE) is an excellent initial diagnostic technique used to evaluate and diagnose cardiac masses, even though transoesophageal echocardiography (TEE) provides superior image resolution and better visualization of cardiac masses, especially in patients with suboptimal transthoracic echocardiographic studies. TTE is the clinical procedure of choice for identification of left ventricular thrombi. TTE has greater than 90% sensitivity and greater than 85% specificity for detection of left ventricular thrombi and is probably superior to the sensitivity and specificity of TEE, especially for apical thrombi. AIMS: The study aimed to identify the common types of cardiac masses and their commonest locations in the heart. MATERIALS AND METHODS: We did a retrospective review of our echocardiogram reports from May 2003 to July 2012 to identify the frequency of intra-cardiac masses in adults, as well as the gender distribution and commonest location of these masses. RESULTS: There were 2,814 echo examinations in adults over this period, comprising 1,661 males (59.1%) and 1,153 females (40.9%). Intra-cardiac masses were found in 20 of these patients representing 0.7% of the study population. Thrombi were the commonest masses noted in our study, and there were more masses in the atria than in the ventricles. The left heart chambers also had more masses than the right heart chambers. There was no sex difference in the frequency of cardiac masses. CONCLUSION: Intra-cardiac masses are rare, and transthoracic echocardiography is still valuable in the diagnosis and initial characterization of cardiac masses.

Pattern of cancer deaths in the medical wards of a teaching hospital in South East Nigeria.

BACKGROUND: Cancers are emerging public health problems in developing countries like Nigeria. The epidemiological shift and aging population make cancers a challenge. OBJECTIVE: We set out to describe the pattern of death due to cancer in our medical ward. The hospital is one of the premier hospitals covering the South East zone of Nigeria. MATERIALS AND METHODS: We retrospectively reviewed the case notes and death certificates of all who died of cancer in our adult medical wards for 16 years (January 1995 to December 2010). STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL) version 17.0 was used. RESULTS: Twenty seven thousand, five hundred and fourteen patients were admitted into the medical wards. Six thousand, two hundred and fifty died. Out of the 6250 deaths, cancers accounted for 7.6%. Male to Female ratio was 2.4:1. The mean age at death was 43.7 ± 17.4 years. The mean age at death in both sexes was similar (42.9 ± 17.5 for men and 45.7 ± 17.0 years for women), P = 0.109. Primary liver cell carcinoma was the most common cause of death among men (40.8%), while cancer of hematopoietic organ was the most common in women (48.7%). The overall fatality rate was 1.7% (477/27 514) of medical admissions. Younger and middle age groups were most commonly affected in both sexes. CONCLUSION: Since the most productive age groups were affected, governments in developing countries should as a matter of urgency put in place adequate cancer preventive and curative services.

Intra-Cardiac Masses in Adults: A Review of Echocardiogram Records at Two Echocardiographic Laboratories in Enugu; South-East Nigeria

Background: Transthoracic echocardiography (TTE) is an excellent initial diagnostic technique used to evaluate and diagnose cardiac masses; even though transoesophageal echocardiography (TEE) provides superior image resolution and better visualization of cardiac masses; especially in patients with suboptimal transthoracic echocardiographic studies. TTE is the clinical procedure of choice for identification of left ventricular thrombi. TTE has greater than 90 sensitivity and greater than 85 specificity for detection of left ventricular thrombi and is probably superior to the sensitivity and specificity of TEE; especially for apical thrombi.Aims: The study aimed to identify the common types of cardiac masses and their commonest locations in the heart.Materials and Methods: We did a retrospective review of our echocardiogram reports from May 2003 to July 2012 to identify the frequency of intra-cardiac masses in adults; as well as the gender distribution and commonest location of these masses.Results: There were 2;814 echo examinations in adults over this period; comprising 1;661 males (59.1) and 1;153 females (40.9). Intra-cardiac masses were found in 20 of these patients representing 0.7 of the study population. Thrombi were the commonest masses noted in our study; and there were more masses in the atria than in the ventricles. The left heart chambers also had more masses than the right heart chambers. There was no sex difference in the frequency of cardiac masses.Conclusion: Intra-cardiac masses are rare; and transthoracic echocardiography is still valuable in the diagnosis and initial characterization of cardiac masses

Clinical and electrocardiographic evaluation of sickle-cell anaemia patients with pulmonary hypertension.

Pulmonary hypertension is an emerging complication of sickle cell anaemia with associated increased risk of mortality. In order to evaluate the clinical and electrocardiographic findings in adult sickle-cell patients with pulmonary hypertension, a cross sectional study was conducted on sixty two sickle cell anaemia patients and sixty two age and sex matched normal controls. Elevated pulmonary artery pressures (PAP), defined by PAP ≥ 30 mm Hg on echocardiography, was demonstrated in 41.9% of patients with sickle cell anaemia and in 3.2% of the controls; χ(2) = 26.571, P < 0.001. Right ventricular hypertrophy, increased P-wave duration, QTc interval, and QTc dispersion were significantly associated with pulmonary hypertension. Significant correlation was found between mean PAP and (1) Frequency of crisis (Spearman correlation = 0.320; P = 0.011), (2) body mass index (Pearson's correlation = -0.297; P = 0.019), and (3) QTc interval (Pearson's correlation 0.261; P = 0.040). Pulmonary hypertension in adult sickle anaemia patients is associated with electrocardiographic evidence of right ventricular hypertrophy, and correlates significantly with frequency of vaso-occlusive crisis, and QTc interval. The observations by this study tend to suggest that these parameters could be useful for early detection and prevention of pulmonary hypertension in patients with sickle cell anaemia.

An evaluation of ankle-brachial blood pressure index in adult Nigerians with sickle cell anaemia.

AIM: There are few studies to be found in the literature on ankle-brachial index in sickle cell disease. The aim of this study was to compare ankle-brachial index of steadystate adult sickle cell anaemia patients with that of normal controls. METHODS: A descriptive cross-sectional study of 62 sickle cell anaemia patients and 62 age- and gender-matched normal controls was carried out in the adult outpatient sickle cell clinics and the cardiac centre of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria from February to August 2007. The supine brachial and ankle blood pressures were measured separately with the cuff of the mercury sphygmomanometer applied to the right arm and right calf, respectively. RESULTS: The ankle systolic blood pressure was lower in patients with sickle cell anaemia than in the controls (p < 0.001). The mean indices for ankle-brachial index were 0.88 ± 0.09 and 1.03 ± 0.06, respectively for patients and controls. This difference was statistically significant (p < 0.001). Seventy three per cent of the patients had ankle-brachial index less than 0.9 compared with controls (5%). This was also significant (p < 0.001).

Electrocardiographic findings in sickle cell cardiovascular autonomic neuropathy.

BACKGROUND: There is a lack of data on the relationship between cardiovascular autonomic neuropathy (CAN) and electrocardiographic parameters in sickle cell anaemia. AIMS AND OBJECTIVES: The purpose of the study was to compare the electrocardiographic findings in adult sickle cell anaemia patients with CAN with those of patients without this complication. METHODS: A cross sectional study was done using 62 consecutively recruited sickle cell anaemia patients who met the inclusion criteria for the study. Cardiovascular autonomic dysfunction was determined based on abnormal values in at least two of five non-invasive tests: Valsalva manoeuver, heart rate variation during deep breathing, heart rate response to standing, blood pressure response to sustained hand grip, and blood pressure response to standing. The subjects were subsequently evaluated with electrocardiography. RESULTS: Sickle cell anaemia patients with CAN had statistically significantly increased P-wave duration (p < 0.001), PR-interval (p < 0.05) and QTc dispersion (p < 0.05) compared with patients without CAN. Significantly increased frequencies of Q waves and first degree atrio-ventricular block were found in patients with CAN than in those without CAN (p = 0.026, p = 0.014, respectively). Significant correlations were noted between the severity of CAN [number of abnormal autonomic function tests (AFT)] and (1) P-wave duration (p = 0.008), (2) PR- interval (p = 0.013). Significant association was found between the number of abnormal AFT and (1) presence of Q-waves, and (2) degree of anaemia (haematocrit class). CONCLUSION: Electrocardiographic features consistent with atrio-ventricular and ventricular repolarization abnormalities are associated with CAN in sickle cell anaemia. Further studies are required to evaluate the prognostic implications of these findings in sickle cell patients with cardiovascular autonomic dysfunction.

Cardiac arrhythmias in recently diagnosed hypertensive patients at first presentation: an electrocardiographic-based study.

Various forms of cardiac arrhythmias have been documented in hypertensive subjects, and hypertension is an important risk factor for the development of atrial and ventricular arrhythmias and sudden death. Electrocardiography at rest easily documents significant arrhythmias in patients, and this study was carried out to determine the types and frequency of arrhythmias in hypertensive subjects at first presentation in the Hypertension Clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. The study was hospitalbased and retrospective in nature. The resting 12lead ECG reports of 346 consecutive hypertensive subjects seen at the Hypertension clinics of the UNTH Enugu over a 14 month period were retrieved from the case files and studied. Other information obtained from the case files included the age and gender of the subjects. The mean age of the subjects was 57.3 years. Ninety-five of the subjects had arrhythmias representing 27% of the study population, out of which fifty-five were males (57.9%) and forty were females (42.1%). However 26.9% of all the male subjects had arrhythmias while 28.2% of all the females had arrhythmias. Multiple ventricular ectopics, sinus tachycardia, sinus bradycardia and atrial fibrillation were the most prevalent arrhythmias. This study showed that a significant proportion of hypertensive subjects present initially with significant rhythm disturbances.

Atrial septal defects presenting initially in adulthood: patterns of clinical presentation in enugu, South-East Nigeria.

This paper aimed to evaluate the patterns of clinical presentation of adults with atrial septal defects (ASDs) who were diagnosed from transthoracic echocardiographic examination at the echocardiographic laboratory of the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria, from February 2002 to June 2010. 2251 new echocardiogram scans, with additional 373 repeat scans, were done within the period. 32 adults had ASDs (1.3%), made up of 9 males and 23 females. Secundum ASD constituted 75% while dyspnoea on exertion was the commonest symptom. Congestive cardiac failure was the clinical syndrome most commonly encountered, and most patients presented in the third decade. This paper demonstrated that ASDs are common congenital heart diseases in adult Nigerians, and that they are important causes of congestive heart failure. All adults with congestive heart failure must be referred for echocardiography for early identification of causes like ASDs, which are often forgotten, before the development of irreversible changes in the lungs.

P-wave dispersion: relationship to left ventricular function in sickle cell anaemia.

BACKGROUND: The prognostic implications of P-wave dispersion in patients with a variety of cardiac disease conditions are increasingly being recognised. The relationship between P-wave dispersion and left ventricular function in sickle cell anaemia is unknown. OBJECTIVE: This study was aimed at evaluating the relationship between P-wave dispersion and left ventricular function in adult Nigerian sickle cell anaemia patients. METHODS: Between February and August 2007, a total of 62 sickle cell anaemia patients (aged 18-44 years; mean 28.27 ± 5.58) enrolled in the study. These were drawn from patients attending the adult sickle cell clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. An equal number of age- and gender-matched normal subjects served as controls. All the participants were evaluated with electrocardiography and echocardiography. P-wave dispersion was defined as the difference between the maximum and minimum P-wave duration measured in a 12-lead electrocardiogram. RESULTS: P-wave duration and P-wave dispersion were significantly higher in patients than in controls. Significant correlation was demonstrated between P-wave dispersion and age in the patients (r = 0.387; p = 0.031). A comparison of subsets of sickle cell anaemia patients and controls with comparable haematocrit values (30-35%) showed significantly higher P-wave duration and P-wave dispersion in the patients than in the controls. The P-wave duration in patients and controls, respectively, was 111.10 ± 14.53 ms and 89.14 ± 16.45 ms (t = 3.141; p = 0.006). P-wave dispersion was 64.44 ± 15.86 ms in the patients and 36.43 ± 10.35 ms in the controls (t = 2.752; p = 0.013). Significant negative correlation was found between P-wave dispersion and left ventricular transmitral E/A ratio (r = -0.289; p = 0.023). CONCLUSION: These findings suggest that P-wave dispersion could be useful in the evaluation of sickle cell patients with left ventricular diastolic dysfunction. Further prospective studies are recommended to evaluate its prognostic implication on the long-term disease outcome in sickle cell disease patients.

Blood pressure correlates in orthopaedic and plastic patients at a regional orthopaedic hospital in Nigeria.

BACKGROUND: Raised blood pressure is a significant surgical risk factor. Post operative complications are worse in both orthopaedic and plastic patients when there is associated hypertension. There has not been any known study on blood pressure variables in patients presenting at the National Orthopaedic Hospital Enugu, Nigeria. This informed the need for the authors to evaluate the blood pressure correlates in patients presenting at this hospital. METHODS: Patients attending the outpatient clinics of the hospital, between June 2003 and September 2004, were recruited into the study. Their biodata, demographic and clinical characteristics were recorded under standard conditions. Their blood pressure awareness indices, lifestyle habits and co-morbid conditions were evaluated. Structured questionnaires were used with self administered screening done. RESULTS: Two hundred and eighteen patients with mean age 41.4 (+/- 17.2) years, were screened, Fifty three percent of them were hypertensive, with 87% of these presenting as orthopaedic cases. While 68% irregularly or never checked their blood pressure, those who took alcohol had 54.5% among them, with hypertension. CONCLUSIONS: This study has shown a high prevalence of hypertension among patients presenting at the study centre. There is also a high degree of association between the lifestyle habits and level of blood pressure. The implications of this for surgical outcome are highlighted.

Left ventricular diastolic function in a predialysis patient population.

BACKGROUND: Diastolic dysfunction is common in chronic kidney disease (CKD) accounting for 40%-66% of cardiovascular complications. OBJECTIVE: To determine the prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in adult Nigerians with CKD at presentation and to compare findings with those of hypertensive patients with normal renal function. METHODS: Eighty-six consecutive patients with CKD were studied, comprising 43 hypertensives and 43 age- and sex-matched healthy subjects as controls. Clinical, laboratory, and echocardiographic variables were measured. RESULTS: Left ventricular diastolic dysfunction was present in 62.8% of CKD patients, 79.1% of hypertensive patients and 25.6% of normal controls (p<0.001). There was a positive correlation between left ventricular diastolic function (LVDF) and systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), severity of SBP, severity of DBP in CKD patients but not in hypertensive patients. There was a negative correlation between LVDF and age in CKD patients and hypertensive patients. Linear multiple regression analysis showed age as the only predictor of LVDD. CONCLUSION: There is a high prevalence of diastolic dysfunction in CKD patients at first presentation to a nephrologist in Nigeria.

Congestive heart failure in subjects with thyrotoxicosis in a black community.

INTRODUCTION: Thyroid hormone has profound effects on a number of metabolic processes in virtually all tissues but the cardiovascular manifestations are prominent usually creating a hyperdynamic circulatory state. Thyrotoxicosis is not a common cause of congestive heart failure among black communities. OBJECTIVES: To determine the hospital prevalence, clinical characteristics and echocardiographic findings in patients with thyrotoxicosis who present with congestive heart failure (CCF) in the eastern part of Nigeria. SUBJECTS AND METHODS: A total of 50 subjects aged 15 years and above who were diagnosed as thyrotoxic following clinical and thyroid function tests were consecutively recruited. Fifty age- and sex-matched controls with no clinical or biochemical evidence of thyrotoxicosis and no comorbidities were used as controls. Two-dimensional echocardiography was carried out on all the subjects. CCF was determined clinically and echocardiographically. RESULTS: Eight patients (5 females and 3 males) out of a total of 50 thyrotoxic patients presented with congestive heart failure. CONCLUSION: The study revealed that congestive heart failure can occur in thyrotoxicosis in spite of the associated hyperdynamic condition. The underlying mechanism may include direct damage by autoimmune myocarditis, congestive circulation secondary to excess sodium, and fluid retention.

Arterial blood pressure in adult Nigerians with sickle cell anemia.

AIM AND OBJECTIVE: This study was aimed at comparing the arterial blood pressures in steady state adult sickle cell patients with those of age- and sex-matched healthy controls. METHODS: A descriptive cross-sectional study of 62 sickle cell anemia patients and 62 age- and sex-matched healthy controls was carried out in the adult outpatient sickle cell clinics and the cardiac center of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Brachial blood pressures were measured in the right arm in all subjects. RESULTS: Significant increase in pulse rate was found in the study subjects (87.68 ± 8.91 bpm) compared with the controls (72.13 ± 6.79 bpm) (p<0.05). The mean systolic blood pressure was comparable in the two groups. However, the patients had significantly lower diastolic blood pressure, lower mean arterial blood pressure, as well as a higher pulse pressure than the control subjects. Significant correlations were found between blood pressure indices and hematocrit, body mass index, frequency of crisis, and body surface area. CONCLUSION: Relatively lower arterial blood pressure is a significant finding in patients with sickle cell anemia. Hematocrit, frequency of crisis, body mass index, and body surface area are significant determinants of blood pressure indices in sickle cell anemia.

Electocardiographic findings in adult Nigerians with sickle cell anaemia.

BACKGROUND: Cardiovascular system abnormalities are common causes of morbidity and mortality in sickle cell anaemia. OBJECTIVES: The study aims at determining the pattern of electrocardiographic changes in adult Nigerian sickle cell anaemia patients. METHODS: A descriptive cross sectional study was done on sixty sickle cell anaemia patients seen at the adult sickle cell clinic of University of Nigeria Teaching Hospital (UNTH) Enugu, and sixty age and sex matched normal controls. All the subjects had clinical evaluation as well as electrocardiographic examination. RESULTS: The mean heart rate, P-wave duration, P-wave dispersion, PR interval, QRS duration, QRS dispersion, QTc interval and QTc dispersion were significantly higher in the patients than in the control group. Electrocardiographic abnormalities identified by this study were: left ventricular hypertrophy (75%; 1.7%), left atrial enlargement (40%; 0%), biventricular hypertrophy (11%; 0), ST-segment elevation (10%; 0%) and increased P-wave and QTc dispersions. ST segment elevation was found more in patients with moderate and severe anaemia (P= 0.02, Spearman correlation r= 0.342; P= 0.007), CONCLUSION: Sickle cell anaemia is associated with significant electrocardiographic abnormalities. Further prospective studies are recommended to evaluate the prognostic significance of the electrocardiographic intervals dispersion on the long term disease outcome in sickle cell anaemia.

Left ventricular systolic function in a Nigerian pre-dialysis patient population with chronic kidney disease.

AIMS AND OBJECTIVES: This study evaluates left ventricularsystolic function (LVSF) and factors affecting it in CKD patients at first presentation, using two dimensional echocardiography. PATIENTS AND METHODS: One hundred consecutive patients with CKD who were presenting to the medical outpatient and renal clinics of university of Nigeria teaching hospital, Enugu for the first time, who satisfied the study criteria were screened. Eighty six patients completed the study. Forty-eight sex matched hypertensive patients with normal renal function and forty-six age and sex matched subjects (with normal blood pressure and renal function) were selected as controls. Clinical and laboratory parameters and echocardiographic indices were measured. RESULTS: Left ventricular systolic dysfunction (LVSD) was present in 13 (15.1%) of CKD patients and 4 (8.3%) of hypertensive patients (p < 0.001). The mean fractional shortening in CKD patients (35.1 +/- 10.4%) was significantly lower than the hypertensive patients (40.1 +/- 9.8), p = 0.008. Positive correlation was found between fractional shortening (FS) and estimated glomerular filtration rate, haemoglobin level, CKD stage, diastolic blood pressure, serum albumin and systolic blood pressure.(r = 0.281, P < 0.001; r = 0.277, p < 0.001; r = 0.270, p = < 0.001; r = 0.237; P = 0.001; r = 0.230, p = 0.002; and r = 0.199, p = 0.007) respectively. Left ventricular mass index and mean arterial blood pressure, correlated negatively with LV systolic function (r = -0.315, P < 0.001; and r = -0.223, P Stepwise multiple regression analysis showed that of all the factors that correlated with LVSF. CONCLUSION: This study has shown that LVSF is impaired in a significant number of our CKD patients at presentation.

Knowledge, perceptions and practices of lifestyle-modification measures among adult hypertensives in Nigeria.

Hypertension remains the most rapidly rising cardiovascular disease in Africa. This study was designed to evaluate the perception, knowledge and practices of Nigerian hypertensive patients regarding hypertension and lifestyle modification measures. Consecutive hypertensive patients attending the cardiac clinics of the University of Nigeria Teaching Hospital, Enugu, Nigeria, were recruited. A pre-tested structured interviewer-administered questionnaire was used to collect data. Questions were categorised to elicit patients' demographic characteristics, knowledge, perception and practice of various lifestyle-modification measures. chi(2) tests were performed. More than half (54.2%) of the 260 respondents had no formal, or just primary, education. About 25% were no longer taking their antihypertensive medication. Fifty per cent of the patients thought that hypertension was caused by stress. Most knew about the lifestyle measures through health personnel. More than 50% adopted the lifestyle-modification measures once they became aware of their effects. This study has shown a poor level of perception of hypertension and awareness of the lifestyle-modification measures through the mass media, but a high level of willingness to adopt the lifestyle measures. Concerted strategies are required to change the perception of hypertension and increase the awareness of the lifestyle-modification measures in this part of the world.