ASSESSMENT OF MEASURES OF ADIPOSITY THAT CORRELATE WITH BLOOD PRESSURE AMONG HYPERTENSIVE AFRICANS.

BACKGROUND: Studies differ on which anthropometric measure of adiposity shows good correlation with cardiovascular diseases. In this study, we evaluated the effects of common epidemiological measures of adiposity as a correlate of elevated blood pressure in an African population. METHODOLOGY: The study was carried out between June 2009 and December 2011 at the medical out-patient department of a tertiary healthcare center in Nigeria. Correlation analysis was used to assess the relationship between blood pressure and body mass index (BMI), waist to height ratio (WHtR), and waist circumference (WC). RESULTS: A total of 1,416 Hypertensives comprising 1090 (77%) adult females recruited over two and half years. Women were significantly older (49.2±8.1 vs. 48.0±10.0 years, p=0.039) and shorter (1.6±6.3 vs 1.7±6.8 meters, p<0.0001) when compared with men. Blood pressure parameters were comparable between women and men. Approximately 1 out of 5 participants had good blood pressure control with no gender difference. Anthropometric measurements showed that 446(32%) were overweight, 404(29%) obese and 40(3%) were morbidly obese. Compared with their male counterparts, females were significantly more likely to be obese (P<0.0001). Similarly, 51.6% of the subjects had abdominal obesity, with female preponderance (P<0.0001). Likewise, a greater proportion of women had substantially higher measured waist circumference risk. Compared with other measures of adiposity, body mass index correlated best with diastolic blood pressure in both gender (P< 0.05). CONCLUSION: This study adds to the evidence that obesity is a major cardiovascular risk factor. BMI, as a measure of adiposity, was found to correlate best with blood pressure. These findings support other observations in other populations that BMI rather than waist to height ratio (WHtR), and waist circumference (WC) is a better correlate of hypertension.

Epidemiology of active epilepsy in a suburban community in Southeast Nigeria: A door-to-door survey.

CONTEXT: Epilepsy is one of the most common neurologic conditions afflicting an estimated 65 million people the world over. Current community-based data on the prevalence of active epilepsy in Africa are sparse. AIMS: This study was aimed at determining the prevalence and profile of active epilepsy in a suburban community in Southeast Nigeria. METHODS: It was a two phase cross-sectional descriptive study. In the first phase, those with possible active epilepsy were identified in a door-to-door survey using a modification of the World Health Organization Neuroscience research protocol. In the second phase, cases of active epilepsy were identified and the clinical forms of epilepsy diagnosed based on the International League against Epilepsy guidelines 1993. RESULTS: A total of 6,800 persons was screened in the first phase of the study. There were 29 cases (16 males and 13 females) of active epilepsy. The point prevalence of active epilepsy was 4.3/1,000 (95% confidence interval (95% CI): 2.7-5.9) for the total population, 4.9/1,000 (95% CI: 2.5-7.3) for males and 3.7/1,000 (95% CI: 1.7-5.7) for females. The age-adjusted prevalence for the total population was 4.1/1,000 (US Population 2000). Classified using clinical criteria only, generalized seizures occurred in 62.1% (n=18) while partial seizures occurred in 37.9% (n=11) of cases. CONCLUSIONS: The prevalence of active epilepsy in Southeast Nigeria is comparable to that found in developed and some developing countries but less than that reported in suburban Southwest Nigeria about three decades ago.

Illness concept among people with epilepsy and their caregivers and preferred treatment methods in a suburban community in Southeast Nigeria.

BACKGROUND: Epilepsy, one of the world's most prevalent chronic diseases is still regarded as a supernatural disease in many parts of the world. These superstitious and cultural beliefs tend to influence treatment seeking behavior of people living with epilepsy (PWE) and their caregivers. STUDY DESIGN: People living with epilepsy in a semi-urban community in Southeast Nigeria were identified in a two phase door-to-door cross-sectional descriptive study. Those identified and their caregivers were further interviewed to determine their concepts of the disease, their treatment (actual and preferred) and what informed treatment. RESULTS: We found 29 cases of active epilepsy, 16 (55.2%) males and 13 (44.8%) females. Witchcraft was held as a major cause of epilepsy in the community accounting for 36.2% (n=17) of the responses. The three major treatment modalities used were spiritual (healing churches), traditional (herbal medicines) and orthodox treatment with antiepileptic drugs. Spiritual treatment was the preferred treatment modality, though most (89.7%) have used traditional (herbal medicine) treatment at one point in the course of the disease. Beliefs on epilepsy and information on the disease obtained mostly from non-medical sources informed treatment. CONCLUSION: The epileptic population studied preferred spiritual treatment though use of traditional treatment was also common. Treatment seeking behavior was greatly influenced by their beliefs and information on the disease obtained mainly from non-medical sources.

Epilepsy treatment gap: prevalence and associated factors in Southeast Nigeria.

OBJECTIVES: The treatment gap of epilepsy in developing countries is high, and data on the magnitude and causes of epilepsy treatment gap in Africa are sparse. We aimed to determine the prevalence and causes of epilepsy treatment gap among people with epilepsy in a Suburban community in Southeast Nigeria. MATERIALS AND METHODS: The direct method was used to determine epilepsy treatment gap in a two-phase cross-sectional study. Those with probable epilepsy were identified in a door-to-door survey using a modification of World Health Organization (WHO) protocol in the first phase. In the second phase, an epilepsy-specific questionnaire that was further designed to determine the magnitude and causes of epilepsy treatment gap was used. RESULTS: The overall treatment gap of epilepsy was 76% (n = 22/29). The major contributors to the overall treatment gap were people who were never diagnosed accounting for a diagnostic gap of 38% (n = 11/29) and those who were diagnosed but discontinued antiepileptic drug (AED) treatment of their own volition accounting for a therapeutic gap of 38% (n = 11/29). CONCLUSIONS: Epilepsy treatment gap in Southeast Nigeria is comparable to that in many developing countries. Fifty percent of the overall treatment gap was caused by patients discontinuing AED treatment of their own volition despite continuing fits. This result may indicate that perhaps with appropriate education on the need to adhere to therapy, the treatment gap in the community may be narrowed.

Characteristics of inflammatory bowel disease in three tertiary health centers in southern Nigeria.

BACKGROUND: Inflammatory bowel disease (IBD) refers to two chronic inflammatory disorders of the gastrointestinal tract which is generally believed to be rare in most African countries. The objectives of the current study were to present the experience of three tertiary gastroenterology centers in southern part of Nigeria on IBD, highlighting the age distribution of the patients seen, management and the impact on the quality of their life in university-based community-type practices in Nigeria. METHODS: This was a retrospective review of charts of inflammatory bowel disease seen between January 2007 and June 2010 at three teaching hospitals in Southern Nigeria. Diagnosis of IBD was made from clinical manifestations, colonoscopic and histopathological findings. RESULTS: During the study period, 12 patients presented with clinical features consistent with inflammatory bowel disease. There were 8 (66.7%) males and 4 (33.3%) females and had ages ranged from 18 years to 80 years with a median of 26.5 years. Eight (66.7%) patients had ulcerative colitis while 4(33.3%) had Crohn's disease. Ten (83.3%) patients had severe disease with main clinical features being recurrent diarrhoea and passage of mucoid bloody stools. All the patients had treatments with sulphasalazine or mesalazine, steroids and antibiotics with good responses. One patient died following the occurrence of toxic megacolon. CONCLUSION: Although IBD is uncommon in Nigeria, high index of suspicion is necessary by attending physicians managing patients with recurrent passage of mucoid bloody stools. Prompt gastroenterological referral and judicious use of colonoscopy and biopsy will assist in making the diagnosis.

The clinical and pathological features of hepatocellular carcinoma in Nnewi, Nigeria.

BACKGROUND: Hepatocellular carcinoma (HCC) remains the commonest malignancy of the liver. In spite of the recent advances in treatment, prognosis is still abysmal especially in developing countries. This article aims to review the clinical and pathological features of HCC in a tertiary hospital at Nnewi. METHOD: This was a cross-sectional study. Patients with HCC seen at the Medical Out-patient Department or admitted into the Medical wards of the Nnamdi Azikiwe University Teaching Hospital Nnewi were recruited. The study lasted from June 2007 to May, 2008. Subjects were clinically evaluated and blood samples collected for HBsAg, anti-HCV and HBeAg assays. RESULTS: The prevalence of HCC was 2.4%. Of the 60 patients studied, 38 were males and 22 were females with a male to female ratio of 2:1. Their ages ranged from 19-86 years with a mean age of 50.62 +/- 17.54. The mean duration of symptoms before presentation was 16 weeks and the mean duration from onset of symptoms to death is 20 weeks. Common presenting symptoms were painful right hypochondrial mass, abdominal swelling, weight loss, early satiety and fatigue while coagulopathy, ascites and hepatic encephalopathy were the most common complications. Multiple lesions affecting both lobes of the liver was seen in 48 patients on ultrasound, 36.6% were positive for HBsAg of which 41% were HBeAg positive. HCV antibodies were present in 8.3% of the patients. Well differentiated HCC of the pseudo-glandular variety was the most common histological type. CONCLUSION: HCC affects middle aged Nigerians. Though well differentiated, it presents late with clinical features of advanced disease leading to death within six months. It is more often associated with chronic HBV than HCV infection.

The hypolipidemic effects of Afzelia africana in type II diabetic patients in Nigeria.

BACKGROUND: The projected rise in the world prevalence of diabetes mellitus poses new challenges in poor countries. Soluble fibre incorporation into the diet of diabetic patients has been shown to reduce the glyceamia and lipaemia of diabetes mellitus. DESIGN AND METHOD: The hypolipidemic effect of soluble fibre supplementation using the seed of locally available legume tree plant--Afzelia africana was studied in 13 Nigerian patients with type 2 diabetes mellitus. The subjects were randomly selected from the out patient diabetes mellitus clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi. They were fed with unsupplemented and supplemented standardized diet for the first 2 days and subsequent 4 days respectively. The fibre supplementation was prepared and incorporated into the meal portions according to previously described technique and acceptability study. OUTCOME MEASURES: The fasting serum levels of TC, TG, HDL-C, LDL-C and HDL/TC ratio were estimated before and after the unsupplemented and fibre supplemented meals. The data obtained were analyzed using paired t-test. The correlation between the total energy requirement and the reduction in TC, pre and post fibre supplemented meals were determined using the linear coefficients. RESULT: The results showed a significant reduction (P<0.05) in mean fasting TG, LDL-C and improvement in HDL/TC ratio following a 4 day supplemented meal. The relation between the difference in TC before and after the supplemented meal and total energy requirement was not significant (P> 0.05). CONCLUSION: The exploitation and incorporation of this source of soluble fibre in diabetic diets reduced the lipaemia of diabetes mellitus.

Leprosy control in the post leprosaria abolition years in Nigeria: reasons for default and irregular attendance at treatment centres

A questionnaire was administered to all patients with leprosy seen at the four leprosy clinics in Anambra State in a face to face interview. The questions covered, among other items, the clinic attendance behaviour and the single most important reason, monthly, for absenteeism in the preceding year. The total and individual frequencies of the reasons for absenteeism were determined for the various behavioural subgroups. The differences in frequencies and associations were analysed. Values of P < 0.05 were considered as significant. The results showed that 27 females and 26 males were interviewed. 39.6 per cent of the patients were irregular attenders 735 per cent were defaulters. Attendance at meetings (P < .001); work at home (P < 0.01) fear/shame/indignation (P < 0.05); no confidence in treatment (P < 0.025) were significant reasons for absenteeism among irregular attenders inter-current illnesses as reasons for absenteeism did not differ significantly between regular and irregular attendees. The association between clinic attendance behaviour and lesion location (revealed Vs concealed) was not statistically significant (X(2)0.3). The findings in this study indicate that in the post leprosaria abolition years, default and irregular clinic attendance by patients with leprosy are numerically large and may compound the problems of control programmes, and thus negate the realization of the global goal of intercepting leprosy transmission.

Leprosy control in the post leprosaria abolition years in Nigeria: reasons for default and irregular attendance at treatment centres.

A questionnaire was administered to all patients with leprosy seen at the four leprosy clinics in Anambra State in a face to face interview. The questions covered, among other items, the clinic attendance behaviour and the single most important reason, monthly, for absenteeism in the preceding year. The total and individual frequencies of the reasons for absenteeism were determined for the various behavioural subgroups. The differences in frequencies and associations were analysed. Values of P < 0.05 were considered as significant. The results showed that 27 females and 26 males were interviewed. 39.6% of the patients were irregular attenders 735% were defaulters. Attendance at meetings (P < .001); work at home (P < 0.01) fear/shame/indignation (P < 0.05); no confidence in treatment (P < 0.025) were significant reasons for absenteeism among irregular attenders inter-current illnesses as reasons for absenteeism did not differ significantly between regular and irregular attendees. The association between clinic attendance behaviour and lesion location (revealed Vs concealed) was not statistically significant (X(2)0.3). The findings in this study indicate that in the post leprosaria abolition years, default and irregular clinic attendance by patients with leprosy are numerically large and may compound the problems of control programmes, and thus negate the realization of the global goal of intercepting leprosy transmission.

Brain cardiac events in Nigerian patients with cocaine abuse.

Epidemiological evidences indicated that substance abuse disorders are increasingly prevalent among Nigerians. The psychosocial deleterious effects of these drugs appear well recognised, but their medical consequences are less often considered in the region. The potential for these drugs to precipitate life threatening cardiac and brain event needs to be reemphasised. We report the clinical and laboratory findings in 4 Nigerians in whom non-intravenous use (recreational and ritualistic) of cocaine was temporally related to acute myocardial ischaemia, cardiac dysarrhythmias, convulsion and cerebrovascular accident. These findings suggest that the observations--that underlying heart disorders were not sinequanon for the cardiotoxic effects of cocaine; the brain and cardiac consequences were not restricted to parenteral use of the drug; the development of seizures were not prerequisite for cerebrovascular accident and vice versa; and that massive doses of the drug needed not be ingested to produce toxic effects on the heart and brain--may also apply in these Nigerian patients. Perhaps with the increase in user population, it is timely to embark on public enlightenment on the medical dangers of cocaine abuse, as these are no less important than the psychosocial consequences.

Utilisation of clinical chemistry tests, with special reference to lipid profile, in disease management in a Nigeria setting.

BACKGROUND: Previous reports show that most Nigerian patients have not been subjected to detailed clinical chemistry investigations, especially lipid profiles during the course of their management. OBJECTIVE: To evaluate the level of utilisation of clinical chemistry tests, especially lipid profile, in the management of certain selected diseases. DESIGN: Analytical study of clinical chemistry tests done in patients with hypertension, liver diseases, nephrotic syndrome and peripheral neuropathy and in control subjects between January 1995 and December 1996. SETTING: Department of Chemical Pathology, Nnamdi Azikiwe University Teaching Hospital, Nigeria. RESULTS: The distribution of the chemical pathology tests in all the disease groups varied significantly. The mean values of TC, LDLC, TG and VLDLC increased while HDLC/TC ratio reduced in the hypertensive patients when compared with the control subjects. The variations in the mean values of HDLC and urea among the hypertensive patients and controls were not statistically significant. CONCLUSION: Our findings suggest an increase in the risk of cardiovascular disease in hypertensive patients and these observations should be remembered by all clinicians and other health workers during the management of hypertension and other diseases. We recommend that the investigations of lipid and lipoprotein indices and other clinical chemistry parameters should be encouraged during management of disease in Nigerians.

Aspects of ethnobotanical medicine in southeast Nigeria.

OBJECTIVE: To document the diversity and traditional use of tropical plants as medicine by the indigenous people of southeast Nigeria. DESIGN: Information was obtained by interviews conducted with the aid of questionnaires and facilitators during field surveys carried out from January 1993 to June 1994. Voucher herbarium specimens were identified at the University of Nigeria, Nsukka Herbarium, in collaboration with Bernhard Zepernick (former Curator), Botanisches Museum, Berlin. Specimens were photographed. RESULTS: Data are summarized in the form of a table, summarizing the plants commonly used by the traditional doctors or medicine men. Herbal preparations are arranged alphabetically under family and species. The data are presented in the order: botanical name, collection number, vernacular name, locality, plant habit/status, and reported medicinal applications.

Preliminary studies of the antifungal activities of some medicinal plants against Basidiobolus and some other pathogenic fungi.

The antifungal activities of extracts of 10 medicinal plants collected from south-eastern parts of Nigeria were tested against seven pathogenic fungi using the broth dilution and agar plate methods. All the extracts at 1:10 dilution inhibited the growth of Basidiobolus haptosporus and B. ranarum but did not inhibit that of Aspergillus fumigatus, Geotrichum candidum and Candida albicans. While extracts from Piper guineense, Ocimum gratissimum, Moringa oleifera and Erythrophleum suaveolens inhibited the growth of Trichophyton rubrum and T. mentagrophytes, those from Fatropha curcas, Mitracarpus villosus, Azadirachta indica and Gongronema latifolium failed to do so at 1:10 dilution. Extract from Piper sp. was also able to inhibit the growth of B. haptosporus at a concentration as low as 1:80 dilution followed by those of Ocimum and Rauvolfia spp. at 1:40 dilution. These results indicate possible use of certain plant extracts in the treatment of subcutaneous phycomycosis in humans and animals.

Ocular findings in leprosy patients in Nigeria.

An ophthalmic assessment of patients in four out of the five leprosy clinics in Anambra State, eastern Nigeria, showed that 63% had ocular disease and 43.5% had sight-threatening disorders. Most of the problems occurred in multibacillary leprosy patients. The blindness rate of (8.7%) is nearly 10 times higher than that within the general population in area. The causes of blindness were cataract, exposure keratopathy and uveitis. Some patients also had glaucoma and chorioretinal lesions. Eye health service within the leprosy control service in the area is non-existent. The importance of giving priority to blindness prevention in leprosy patients in the area is emphasised.

Diabetic Ketoacidosis Presenting with Fournier's Gangrene

A case of survival of a patient with Fournier's gangrene and diabetic ketoacidosis is described. Careless handling of itchy scrotal disease in this diabetic patient was responsible for the onset of scrotal gangrene. Early recognition of diabetic ketoacidosis and Fournier's gangrene and prompt treatment led to survival. Consequently; early consultation of a physician/dermatologist is advised when diabetics have itchy groin lesions; while doctors are urged to routinely examine the scrotum of patients with diabetic ketoacidosis