Dyslipidemia in Nigeria: prevalence and pattern.

BACKGROUND: Dyslipidemia is a major risk factor for cardiovascular disease. Data are scanty on the prevalence and pattern of dyslipidemia in Nigeria. However, some studies on the subject are now becoming available. This article reviews these studies on the prevalence and pattern of this important risk factor for cardiovascular disease in Nigeria. MATERIALS AND METHODS: Intensive internet search on studies done in different parts of Nigeria showing the prevalence and pattern of dyslipidemia in various focal groups that include apparently healthy individuals, the elderly, diabetics, hypertensives, and diabetic hypertensives was carried out. RESULTS: Dyslipidemia was highly prevalent in all the geopolitical zones of Nigeria with the consistent pattern being low HDL-Cholesterol and high LDL-C. Overall, the prevalence of dyslipidemia ranged from 60% among apparently healthy Nigerians to 89% among diabetic Nigerians. CONCLUSION: Dyslipidemia is highly prevalent in Nigeria and health education to increase awareness of the need for and to actually screen for dyslipidemia will facilitate early detection and treatment.

Prevalence of hepatitis B surface antigen seropositivity among HIV-infected and non-infected individuals in Nnewi, Nigeria.

BACKGROUND: Co-infection of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) is common as both viruses share common routes of transmission. HIV significantly affects the natural history of HBV, hence the need to determine the prevalence of co-infection. MATERIALS AND METHODS: This was a retrospective study between 2005 and 2009, in which is a total of 2018 subjects who reported at our University Teaching Hospital blood bank and human immunodeficiency virus clinic were studied. Hepatitis B surface antigen (HBsAg) was tested for using a one step lateral flow rapid chromatographic immunoassay (Acumen labs and diagnostic centre, Bangalore, India) and HIV 1/2 was tested using two kits, Determine (made by Abbot, Japan for Inverness Medical, Japan). RESULTS: A total of 2018 subjects were studied out of which 1176 were HIV positive (964 males and 212 females) and 842 (334 males and 508 females) were negative. The prevalence of HBsAg positivity in the study population was 5.9%. It was 6.3% and 5.6% in the HIV-infected and un-infected population, respectively. Although the prevalence was higher in those who are HIV infected, the difference was not statistically significant (P=0.52). Males who were HIV positive were found to be more likely to have co-infection than females (8.7% vs. 4.2%, P=0.02, OR=1.917). CONCLUSION: This study showed that in south-eastern Nigeria, infection with HBV is relatively common in both HIV-infected and un-infected individuals. Routine screening for HBV should be done for all HIV positive individuals.

Armillifer armillatus infection.

We report a case of human pentastomiasis in a 70-year-old retired long-distance driver/farmer whose diagnosis was made incidentally while being investigated for a 1-month history of cough and abdominal pain. The chest X-ray revealed multiple comma-shaped and rounded opacities in keeping with Armillifer infection, most likely Armillifer armillatus. The patient made an uneventful recovery after a 10-day course of mebendazole (an antihelminthic) tablet and ciprofloxacin (antibiotic) capsules and was discharged home. He is presently being followed up. This is the first case we have seen in our medical unit thus we are reporting it.

Evaluation of the effect of duration of diabetes mellitus on peripheral neuropathy using the United Kingdom screening test scoring system, bio-thesiometry and aesthesiometry.

BACKGROUND AND OBJECTIVES: Risk factors predisposing to foot ulceration in diabetic subjects are multiple. Long duration of diabetes mellitus is a major risk factor, likewise peripheral neuropathy (PN), which globally, is recognized as the commonest risk factor for foot disease in diabetic subjects. OBJECTIVES: To evaluate the effect of duration of diabetes mellitus on peripheral neuropathy using the United Kingdom Screening Test (UKST) Scoring System, Bio-thesiometry and Aesthesiometry, in Nigerian diabetic subjects without current or previous foot ulceration. SUBJECTS AND METHODS: One hundred and twenty (120) diabetes mellitus (DM) subjects with and without symptoms of peripheral neuropathy receiving care at the medical outpatient department (MOPD) and the diabetic clinic of the Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria, were recruited consecutively as they presented. Data collected included subjects age (years), gender, age at first diagnosis of DM, duration of DM (years) and baseline fasting venous plasma glucose. The United Kingdom Screening Test (UKST) symptom score was used to separate the participants into two groups those with symptoms of PN and those without and the subjects further assessed by three methods the UKST Signs score, Bio-thesiometry and Aesthesiometry to determine the presence . of PN. RESULTS: Among the 120 diabetic participants, 83(69.2%) had neuropathic symptoms (the symptomatic participants) while 37 (30.8%) were asymptomatic (the asymptomatic participants). The different methods of diagnosing PN increasingly detected PN with increasing duration of diabetes. For the symptomatic group, the UKST method detected PN least in those with duration of DM <5 years (73.9%) and 100.0% in those with duration of DM >15 years while for the asymptomatic group, it detected PN in 25.0% of those with duration of DM <5 years, and 100.0% for those with duration of DM >15 years. For the symptomatic group, Aesthesiometry detected PN in 65.2% of those with duration of DM <5 years and 91.7% in those with duration of DM >15 years. For the asymptomatic group, it detected PN in 29.2% of those with duration of DM <5 years and 100.0% in those with duration of DM >15 years. Likewise, for the symptomatic group, Bio-thesiometry detected PN in 47.8% of those with duration of DM <5 years and 100.0% in those with duration of DM >15 years. For the asymptomatic group, it detected PN in 16.7% of those with duration of DM <5 years and 100.0% in those with duration of DM >15 years. CONCLUSION: Long duration of diabetes mellitus and peripheral neuropathy are risk factors for foot complication in Nigerians with diabetes mellitus. Diabetic subjects with long duration of diabetes (>10 years) almost always have associated peripheral neuropathy, and should be recognized as a special group at high risk for foot disease from DM. Specific preventive programs should target this group to reduce the rate of avoidable loss of limbs to diabetes.

Are the symptoms of diabetic peripheral neuropathy in Nigerian patients objective? An evaluation using the United Kingdom Screening Test (UKST) and Bio-Thesiometry.

BACKGROUND: Symptoms suggestive of peripheral neuropathy (PN) in diabetes mellitus (DM) do not always indicate presence ofunderlying PN. OBJECTIVE: A pioneering study among Nigerian diabetic subjects to evaluate the objectivity of their symptoms of PN using two objective diagnostic instruments for PN the United Kingdom Screening Test (UKST) and Bio-Thesiometry. SUBJECTS AND METHODS: One hundred and twenty diabetic participants and a similar number of non-diabetic controls were screened for symptoms of PN using the UKST symptoms score and subsequently separated into two groups those with symptoms ofPN and those without. The "symptomatic" cases and controls were further evaluated with the UKST signs score and Bio-Thesiometry to assess the objectivity of the symptoms. RESULTS: Among 120 diabetic participants, 83(69.2%) had neuropathic symptoms (the symptomatic cases) while 10 (8.3%) of the 120 non-diabetic controls had neuropathic symptoms (the symptomatic controls). Among the cases, UKST signs score detected PN in 89.2% (74/83) and Bio-Thesiometry 71.1% (59/83), the difference in the ability of the two methods to detect PN in this group being statistically significant (X2 = 8.51, df = 1, p < 0.01). Among the controls, UKST detected PN in 100.0% (10/10) compared to Bio-thesiometry (50.0%; 5/10), the difference in the ability of the two methods to detect PN in this group also being statistically significant (X2 = 4.27, df = 1, p < 0.05, using continuity correction factor). The difference in the ability of both methods to detect PN between the cases and controls was however not statistically significant (X2 = 0.68, df = 1, p > 0.3) CONCLUSION: The symptoms of PN among Nigerian diabetic subjects when evaluated with a gold standard for scoring the symptoms (the UKST symptoms score) are real, objective and truly indicate presence of underlying PN. Diabetic subjects presenting to medical clinics with symptoms of PN should receive serious attention and evaluation using this gold standard to detect early those with genuine PN and are at risk of foot ulceration from PN.

Evaluation of "care of the foot" as a risk factor for diabetic foot ulceration: the role of internal physicians.

BACKGROUND AND OBJECTIVES: Several risk factors predispose the diabetic patient to foot ulceration, including "inadequate care of the foot". This risk factor for foot ulceration has not been previously evaluated among Nigeria diabetic patients and is the objective of this study. SUBJECTS AND METHODS: One hundred and twenty (120) diabetic patients with and without symptoms of peripheral neuropathy receiving care at the medical outpatient department (MOPD) and the diabetic clinic of the Nnamdi Azikiwe University Teaching Hospital Nnewi were recruited consecutively as they presented. They were administered structured questionnaires to assess some variables concerning care of their feet as provided to them by their physicians. RESULTS: Among the 120 diabetic participants, 83 (69.2%) had neuropathic symptoms (the symptomatic participants) while 37 (30.8%) were asymptomatic (the asymptomatic participants). Eighty (80; 96.4%) of the symptomatic vs 36 (97.3%) of the asymptomatic participants had never had their feet examined by their physician. Also, 26 (31.3%) of the symptomatic vs 12 (32.4%) of the asymptomatic participants had never received any form of advice on how to take special care of their feet by their physician, and 26 (31.3%) of the symptomatic vs 6 (16.2%) of the asymptomatic participants walked unshod most times in their immediate surroundings. CONCLUSION: Physicians do not provide adequate care to the feet of their diabetic patients irrespective of the presence or absence of neuropathic symptoms, making this variable a critical risk factor for diabetic foot ulceration and amputation. Continuing medical education to health care providers emphasizing adequate "care of the foot" of the diabetic patient, will reduce avoidable loss of limbs to diabetes.

Pattern of medical admissions at the Federal Medical Centre, Asaba-a two year review.

OBJECTIVE: A two-year retrospective evaluation of the pattern of medical admissions at the Federal Medical Centre (FMC), Asaba, Delta State, Nigeria. METHODOLOGY: Case notes of all admissions and deaths in the medical wards between November 2005 and October 2007 were retrieved and reviewed. The mean, standard deviation and percentages of relevant data were derived and presented in simple descriptive statistics. RESULTS: One thousand, eight hundred and sixty patients were admitted over the study period. One thousand and eight of these [1008; 54.2%], were male, while eight hundred and fifty two [850; 45.8%] were female, making a female/male ratio of 1:1.18.The patients ages ranged between fifteen and ninety years, with a mean of 51.56 +/- 18.35 years. The age range of male patients ranged from 16 to 88 years, with a mean of 55.55 +/- 17.99 years, while that of the female patients ranged from 15 to 90 years, with a mean of 57.14 +/- 13.79.The length of stay in the ward ranged from 1 to 97 days, with a mean of 10.32 +/- 10.93 days. There were 23.25 patients per bed per year and a bed occupancy rate of 65.74%. There were 240 deaths [12.90% of total admissions]. The interval between admission and death ranged between 1 and 31 days, with a mean of 7.14 +/- 6.7 days. One hundred and twenty four patients [124; 6.7%] were referred to other health facilities, while ninety six [96; 5.2%] left against medical advice.The commonest causes of admission in males was hypertension, diabetes mellitus and HIV, while in females, it was HIV, hypertension and diabetes mellitus. Commonest causes of death in males were hypertension, HIV and diabetes, while in female subjects, it was HIV, hypertension and diabetes. CONCLUSION: Non-communicable diseases- [hypertension, diabetes mellitus] and HIV/AIDS were the major causes of admissions and death in both genders.

Is asymptomatic peripheral neuropathy present in Nigerian diabetic patients? An assessment using the United Kingdom screening test (UKST) and bio-thesiometry.

Diabetes mellitus (DM) is commonly complicated by peripheral neuropathy (PN). Symptoms suggestive of peripheral neuropathy (PN) in diabetes mellitus (DM) do not always indicate presence of underlying PN, while absence of symptoms does not rule out presence of underlying PN. To determine the prevalence of asymptomatic PN in diabetic patients using two methods--the United Kingdom Screening Test (UKST) and Bio-Thesiometry. 120 diabetic participants and a similar number of non-diabetic controls were screened for symptoms of PN using the UKST symptoms score and subsequently separated into two groups--those with symptoms of PN and those without. The "asymptomatic" cases and controls were further screened for underlying PN using the UKST signs score and Bio-Thesiometry Among 120 diabetic participants, 37 (30.8%) had no symptoms of PN (the asymptomatic cases) compared to 110 (91.7%) of the 120 non-diabetic controls (the asymptomatic controls). The UKST signs score detected PN more significantly among the cases than the controls (43.2% (16/37) vs 9.1% (10/110); /2 = 22.5, df = I, p < 0.01). Similarly, Bio-thesiometry detected PN more significantly among the cases than the controls (29.7% (11/37) vs 9.1% (10/110); X2 = 9.57, df = 1, p < 0.01) Asymptomatic PN is present among Nigerian diabetic subjects and the absence of "alarm" symptoms of PN does not exclude the presence of genuine PN.

Prevalence of dyslipidaemia in apparently healthy professionals in Asaba, South South Nigeria.

BACKGROUND: Hypercholesterolaemia is a major risk factor for coronary heart disease (CHD) especially in industrialized societies. Coronary heart disease is becoming an increasing cause of death even in the developing world. OBJECTIVE: To determine the prevalence of dyslipidaemia in apparently healthy professionals in a developing economy. METHOD: One hundred apparently healthy professionals were recruited from several professions by stratified random sampling. This population was believed to be at higher risk of dyslipidaemia considering their more likely "western diet" lifestyle. Total cholesterol, LDL-cholesterol, HDL-cholesterol and Triglycerides were determined using standard cholesterol LDL precipitating reagents/kits. RESULTS: The mean age of the subjects was 41.59 +/- 8.22 years (range 29 to 58 years) with male to female ratio of 1:1.2. Mean total cholesterol was 180.69 +/- 36.248 mg/dl (4.67 +/- 0.94 mmol/L), LDL cholesterol 122.68 +/- 44.42 mg/dl (3.17 +/- 1.15 mmol/L), HDL-cholesterol 37.47 +/- 9.91 mg/dl (0.96 +/- 0.26 mmol/L) and Triglyceride 83.139 +/- 66.888 mg/dl (0.94 +/- 0.76 mmol/L). Using the Third Report of the NCEP Expert Panel on Detection. Evaluation and Treatment of high blood cholesterol in Adults (ATP III) definition and risk classification, 5% of the study population had hypercholesterolaemia, 23% elevated total serum cholesterol, 51% elevated LDL-cholesterol and 60% low HDL-cholesterol, with females recording better overall lipid profile. CONCLUSION: Dyslipidaemia was highly prevalent in the population studied, with low HDL-cholesterol being the most frequent lipid abnormality. Dyslipidaemia is becoming a serious health problem in the developing world also, even among the apparently healthy, and necessitates periodic lipid profile screening.