Clinical and echocardiographic findings in a cross-sectional study of HIV-infected adults in Enugu, Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV) infection and highly active antiretroviral therapy (HAART) are implicated in cardiovascular diseases. The objective of this study was to evaluate the clinical and echocardiographic findings in HIV-infected adults. METHODS: One hundred HIV subjects on HAART, 100 HAART-naïve patients and 100 controls were recruited in this cross-sectional study. RESULTS: Mean CD4 cell count was significantly higher in the HAART-exposed (408.43 ± 221.62) than the HAART-naïve groups (250.06 ± 154.26) (p < 0.001). Weight loss (49%), skin lesions (14%), body weakness (24%), oral thrush (10%) and lymphadenopathy (10%) were more prevalent in HAART-naïve patients (p < 0.05). Dimensions of aortic root (2.71 cm), left atrium (3.27 cm) and left ventricular mass index (79.95) were significantly higher in HIV-positive subjects on HAART (p < 0.05). CONCLUSIONS: Clinical features of HIV and the CD4 nadir were more prevalent in the HIV-positive, HAART-naïve subjects. Dimensions of the aortic root, left atrium and left ventricle were relatively larger in the HAART-exposed patients while wall thickness and ejection fraction were higher in the HAART-naïve subjects.

Echocardiographic assessment of left ventricular function in thyrotoxicosis and implications for the therapeutics of thyrotoxic cardiac disease.

INTRODUCTION: Thyrotoxicosis is an endocrine disorder with prominent cardiovascular manifestations. Thyroid hormone acts through genomic and non-genomic mechanisms to regulate cardiac function. Echocardiography is a useful, non-invasive, easily accessible, and affordable tool for studying the structural and physiological function of the heart. AIM: We studied thyrotoxicosis patients in a Nigerian Teaching Hospital and employed trans-thoracic echocardiography to find out if there were abnormalities in the hearts of these patients. METHODS: Fifty adult thyrotoxicosis patients diagnosed with clinical and thyroid function tests in the medical out-patient unit of the hospital were recruited and we performed transthoracic echocardiography with a Sonos 2000 HP machine. RESULTS: We documented the presence of abnormalities in the following proportion of thyrotoxicosis patients: left ventricular enhanced systolic function in 30%, enhanced diastolic function in 34%, diastolic dysfunction in 34%, heart failure with preserved ejection fraction in10%, heart failure with reduced ejection fraction in 6%, and left ventricular hypertrophy in 34%. CONCLUSION: Echocardiography was useful in the stratification of cardiac function abnormalities and is indispensable as a guide in the choice of therapeutic options in patients with thyrocardiac disease. The finding of left ventricular enhanced systolic and diastolic functions signify early echocardiographic detectable cardiac abnormalities in thyrotoxicosis, and the clinical management includes the use of anti-thyroid drugs and ß-adrenoceptor blockade. Diastolic dysfunction in thyrotoxicosis patients asymptomatic for cardiac disease should be treated with anti-thyroid drugs, and ß-adrenoceptor blockade. The judicious application of clinical therapeutics will guide the use of anti-thyroid drugs, diuretics, digoxin, angiotensin inhibitors, and ß-adrenoceptor blockade in the successful management of thyrotoxicosis patients with heart failure and reduced, preserved, or increased ejection fraction: parameters which are derived from echocardiography.

Predisposing factors associated with uncomplicated type 2 diabetes among adults in a diabetic clinic, Enugu State, Nigeria.

BACKGROUND: The role of micronutrients and other predisposing factors associated with the aetiology of type 2 diabetes in Nigeria is not well established. The objectives of this study were to investigate predisposing factors associated with uncomplicated type 2 diabetes among a Nigerian adult population. METHODS: Predisposing factors associated with uncomplicated type 2 diabetes were investigated in 60 Igbo (a major tribe in Eastern Nigeria) adults aged 30-90 years. This study was carried out at the Diabetic Clinic, University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu. Packed cell volume (PCV), serum ferrtin and some anthropometric parameters were measured alongside fasting blood sugar (FBS). RESULTS: PCV recorded a statistically significant lower (p<0.001) mean value at 32.94±0.61% in the patients when compared with the control group with a mean value of 39.06±1.02%. Serum ferritin revealed a statistically significant higher (p<0.01; 110.20±15.17 ng/ml) mean value in the patients when compared with the control group (20.4±5.64 ng/ml). However, PCV (32.00±0.88%) and body mass index (BMI) (31.99±1.12 Kg/m(2)) recorded a statistically significant lower (p<0.05) mean value in female patients when compared with their corresponding males. There was no significant correlation (p>0.05) between serum iron ferritin, FBS and all other anthropometric predictors of incidence of type 2 diabetes. CONCLUSION: Type 2 diabetes is not associated with elevated levels of serum iron ferritin. Hence, serum ferritin may not be a better predictor of type 2 diabetes, especially in uncomplicated cases.

Clinical findings associated with cardiovascular autonomic dysfunction in adult sickle cell anaemia patients.

BACKGROUND: Involvement of the cardiovascular autonomic nervous system in various diseases is often associated with increased morbidity and mortality. OBJECTIVE: The objective of this study was to examine the clinical features associated with cardiovascular autonomic neuropathy (CAN) in adult Nigerians with sickle cell anaemia. METHODS: A cross-sectional study was carried out on 62 steady state sickle cell anaemia patients recruited from the adult out-patient clinic. Cardiovascular autonomic dysfunction was determined based on abnormal values in at least two of five non-invasive tests: Valsalva manoeuvre, heart rate variation during deep breathing, heart rate response to standing, blood pressure response to sustained handgrip, and blood pressure response to standing. All the subjects were initially evaluated in the clinic for symptoms of cardiovascular disease and peripheral vascular disease, and then clinically examined to assess their cardiovascular and neurological status at rest. RESULTS: Out of the 44 patients with cardiovascular autonomic neuropathy 23 were males, while 21 were females. The mean ages were 28.3 +/- 5.8 y for patients with CAN and 28.0 +/- 5.0 y for patients without CAN (P = 0.817). Sickle cell anaemia patients with CAN had significantly lower ankle systolic blood pressure, reduced ankle brachial blood pressure index, mean arterial blood pressure and haematocrit than patients without CAN. Of all the variables evaluated leg ulcers, postural dizziness, erectile dysfunction in men, and history of recurrent acute chest syndromes were found significantly more in patients with CAN than without. Clinical abnormalities tend to worsen with increasing degree of cardiovascular autonomic dysfunction. CONCLUSION: Significant cardiac morbidity is associated with abnormal cardiovascular autonomic function in sickle cell anaemia.

Comparison of haematological parameters determined by the Sysmex KX - 2IN automated haematology analyzer and the manual counts.

BACKGROUND: This study was designed to determine the correlation between heamatological parameters by Sysmex KX-21N automated hematology analyzer with the manual methods. METHOD: Sixty (60) subjects were randomly selected from both apparently healthy subjects and those who have different blood disorders from the University of Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Enugu State, Nigeria. Three (3)mls of venous blood sample was collected aseptically from each subject into tri-potassium ethylenediamine tetra-acetic acid (K3EDTA) for the analysis of haematological parameters using the automated and the manual methods. RESULTS: The blood film report by the manual method showed that 50% of the subjects were normocytic-normochromic while the other 50% revealed different abnormal blood pictures. Also, there were statistically significant differences (p < 0.05) in mean cell hemoglobin concentrations (MCHC) between the two methods. Similarly, the mean (S.E) values of hemoglobin, packed cell volume, platelet and total white cell counts demonstrated statistically significant difference (p < 0.001) and correlated positively when both methods were compared. CONCLUSION: From the present study, it can be concluded that the automated hematology analyzer readings correlated well with readings by the standard manual method, although the latter method gave additional diagnostic information on the blood pictures. While patients' care and laboratory operations could be optimized by using manual microscopic examination as a reflective substitute for automated methods, usage of automated method would ease our workload and save time for patients.

The health workforce crisis: the brain drain scourge.

BACKGROUND: The magnitude of the health workforce crisis engendered by brain drain particularly in Africa, and nay more especially Nigeria, has been assuming increasingly alarming proportions in the past three decades. The challenge it poses in meeting the manpower needs in the healthcare sector as well as in the larger economy of the sending countries is enormous. This paper thus sets out to highlight the scope of this brain drain, its effects and the reasons sustaining it, as well as makes concrete suggestions to help stern the tide. METHOD: A review of the literature on brain drain with particular emphasis on the health workforce sector was done, with focus on Africa, and specifically Nigeria. Literature search was done using mainly the Medline, as well as local journals. RESULTS: The historical perspectives, with the scope of external and internal brain drain are explored. The glaring effects of brain drain both in the global workforce terrain and specifically in the health sectors are portrayed. The countries affected most and the reasons for brain drain are outlined. Strategic steps to redress the brain drain crisis are proffered in this paper. CONCLUSION: The health workforce crisis resulting from brain drain must be brought to the front-burner of strategic policy decisions leading to paradigm shift in political, social and economic conditions that would serve as incentives to curb the scourge.