Correlation Between the Clinical Diagnosis and Sonographic Diagnosis in Women with First-Trimester Vaginal Bleeding.

BACKGROUND: Vaginal bleeding is the most common cause of presentation at the emergency department in the first trimester. Clinical presentation helps determine the likely cause of first-trimester vaginal bleeding. However, ultrasound imaging is required to reach a definitive diagnosis. OBJECTIVE: To determine the relationship between clinical diagnosis and ultrasonographic findings in women with first-trimester vaginal bleeding. METHODS: A prospective longitudinal study was conducted on 94 pregnant patients with a history of bleeding per vagina (PV) in the first trimester by using transvaginal ultrasound. RESULTS: PV spotting was noted in 64.9% and heavy bleeding in 35.1%. The most common clinically associated symptom was abdominal pain (68, 72.3%), and the least common clinically associated symptom was vesicle expulsion (2.1%). The most common predisposing factor was fever (31, 33.0%). The most frequent clinical diagnosis was threatened abortion (48, 51.1%), and the least common clinical diagnosis was gestational trophoblastic disease (GTD) and inevitable abortion (1, 1.1%). The most common ultrasound diagnosis at the initial scan was incomplete abortion (19.2%), while at follow-up scans, it was threatened abortion (48, 51.1%). The overall concordance between clinical diagnosis and ultrasound was 38.8%, with both complete abortion and GTD showing a concordance of 100%. The least concordance was seen in missed abortions (25%). CONCLUSION: Clinical assessment is insufficient in the identification of the cause of vaginal bleeding due to the overall low concordance rate. A combination of clinical assessment and ultrasonography is required for decision-making in every case.

The Impact of Co-Morbidities on the Pattern of Blood Pressure Control in Elderly Hypertensives in Nigeria.

INTRODUCTION: The elderly hypertensive patients often have increased prevalence of cardiometabolic risk factors and their attendant co-morbidities. The aim of this study was to determine the prevalence of cardiometabolic risk factors and blood pressure control among elderly hypertensive patients, and to determine the influence of modifiable cardiometabolic risk factors on the control of hypertension among elderly hypertensive patients. SUBJECTS AND METHODS: A case-control comparative and hospitalbased study involving a total of 190 consenting elderly (>65 years), hypertensive patients (subjects) (n=100) and normotensive controls (n=90) was carried out over a period of ten months. Using interviewer-administered questionnaire, biodata and information regarding their lifestyle was obtained. Standard protocols were used to measure blood pressure, weight, height, waist circumference, fasting plasma glucose and fasting lipid profile of the subjects. Body mass index was derived from weight and height. RESULTS: The mean age of the subjects was 71.5 ± 6.3 years and the controls was 72.3 ± 7.2 years. Forty-eight percent (48%) and 47.8% of the subjects and controls were females (p = 0.651). The level of control of hypertension was poor in over two-thirds (68%) of the elderly hypertensive patients. The prevalence of modifiable cardiometabolic risk factors burden was higher in the hypertensive subjects when compared with the controls. Prevalence of Dyslipidaemia was 76% in the subjects and 51% in the controls (p = 0.004). Prevalence of Diabetes Mellitus was 40% among the subjects and 17.8% in the controls (p = 0.0001); prevalence of Obesity was 24% in the subjects and 4.4% in the controls (p=<0.001); prevalence of excess alcohol intake was 49% in the subjects and 14.4% in the controls (p=<0.001). Prevalence of sedentary life style was high in both the subjects (53%) and controls (50%), p=0.679. Poor blood pressure control was predicted by dyslipidaemia and central obesity. CONCLUSION: The level of control of hypertension was poor among the elderly and modifiable cardiometabolic risk factors were relatively prevalent. Central obesity and dyslipidaemia were predictive of poor control of hypertension. Addressing these factors may therefore improve blood pressure control.

INTRODUCTION: Les patients hypertendus âgés présentent souvent une prévalence accrue de facteurs de risque cardiométaboliques et de leurs comorbidités. Le but de cette étude était de déterminer la prévalence des facteurs de risque cardiométabolique et le contrôle de la pression artérielle chez les patients hypertendus âgés, et de déterminer l'influence des facteurs de risque cardiométabolique modifiables sur le contrôle de l'hypertension chez les patients hypertendus âgés. SUJETS ET MÉTHODES: Une étude cas-témoins comparative et hospitalière portant sur un total de 190 patients âgés (e"65 ans) consentants, hypertendus (sujets) (n=100) et témoins normotendus (n=90) a été réalisée sur une période de dix mois. A l'aide d'un questionnaire administré par un enquêteur, des données biographiques et des informations concernant leur mode de vie ont été obtenues. Des protocoles standard ont été utilisés pour mesurer la pression artérielle, le poids, la taille, le tour de taille, la glycémie à jeun et le profil lipidique à jeun des sujets. L'indice de masse corporelle a été calculé à partir du poids et de la taille. RÉSULTATS: L'âge moyen des sujets était de 71,5±6,3 ans et celui des témoins de 72,3±7,2 ans. Quarante-huit pour cent (48 %) et 47,8 % des sujets et des témoins étaient des femmes (p=0,651). Le niveau de contrôle de l'hypertension était faible chez plus de deux tiers (68 %) des patients hypertendus âgés. La prévalence des facteurs de risque cardiométabolique modifiables était plus élevée chez les sujets hypertendus que chez les témoins. La prévalence de la dyslipidémie était de 76 % chez les sujets, 51 % chez les témoins (p=0,004). La prévalence du diabète sucré était de 40% chez les sujets et de 17,8% chez les témoins (p= 0,0001), la prévalence de l'obésité était de 24% chez les sujets et de 4,4% chez les témoins (p=<0,001), la prévalence de la consommation excessive d'alcool était de 49% chez les sujets et de 14,4% chez les témoins (p=<0,001). La prévalence du style de vie sédentaire était élevée chez les sujets (53%) et les témoins (50%), p=0,679. Un mauvais contrôle de la pression artérielle était prédit par la dyslipidémie et l'obésité centrale. CONCLUSION: Le niveau de contrôle de l'hypertension était faible chez les personnes âgées et les facteurs de risque cardiométaboliques modifiables étaient relativement prévalents. L'obésité centrale et la dyslipidémie étaient prédictives d'un mauvais contrôle de l'hypertension. La prise en compte de ces facteurs peut donc améliorer le contrôle de la pression artérielle. Mots clés: Pression artérielle, Facteurs de risque cardiométabolique, Personnes âgées.

Department of Internal Medicine, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University

INT RODUCTIO N: Th e eld erly h ypert en si ve pa ti ent s of ten h aveincreased prevalence of cardiometabolic risk factors and their attendantco-morbidities. The aim of this study was to determine the prevalenceof cardiometabolic risk factors and blood pressure control among elderlyhypertensive patients, and to determine the influence of modifiablecardiometabolic risk factors on the control of hypertension amongelderly hypertensive patients.SUBJECTS AND METHODS: A case-control comparative and hospital-based study involving a total of 190 consenting elderly (>65 years),hypertensive patients (subjects) (n=100) and normotensive controls(n=90) was carried out over a period of ten months. Using interviewer-administered questionnaire, biodata and information regarding theirlifestyle was obtained. Standard protocols were used to measure bloodpressure, weight, height, waist circumference, fasting plasma glucoseand fasting lipid profile of the subjects. Body mass index was derivedfrom weight and height.RESULTS: The mean age of the subjects was 71.5 ± 6.3 years and thecontrols was 72.3 ± 7.2 years. Forty-eight percent (48%) and 47.8% ofthe subjects and controls were females (p = 0.651). The level of controlof hyperten sion was poor in over two-thirds (68%) of the elderlyhypertensive patients. The prevalence of modifiable cardiometabolicrisk factors burden was higher in the hypertensive subjects when comparedwith the controls. Prevalence of Dyslipidaemia was 76% in the subjectsand 51% in the controls (p = 0.004). Prevalence of Diabetes Mellituswas 40% among the subjects and 17.8% in the controls (p = 0.0001);prevalence of Obesity was 24% in the subjects and 4.4% in the controls(p=<0.001); prevalence of excess alcohol intake was 49% in the subjectsand 14.4% in the controls (p=<0.001). Prevalence of sedentary lifestyle was high in both the subjects (53%) and controls (50%), p=0.679.Poor blood pressure control was predicted by dyslipidaemia and centralobesity.CONCLUSION: The level of control of hypertension was poor amongthe elderly and modifiable cardiometabolic risk factors were relativelyprevalent. Central obesity and dyslipidaemia were predictive of poorcontrol of hypertension. Addressing these factors may therefore improveblood pressure control

The Prevalence and Pattern of Thyroid Dysfunction in HAART-Naïve HIV Patients in Enugu, Nigeria: A Cross-Sectional Comparative Study.

BACKGROUND: HIV/AIDS is a multi-system disease that has been associated with several endocrinopathies including thyroid dysfunction. Thyroid dysfunction in patients with HIV/AIDS, among other factors, may arise from the direct cytopathic effects of HIV on the thyroid gland in addition to the adverse effects of highly active anti-retroviral drugs (HAART). STUDY OBJECTIVE: The study aimed to determine the prevalence and pattern of thyroid dysfunction in HAART naïve HIV patients in Enugu. MATERIALS & METHODS: Study was cross sectional, casecontrol based, involving 250 HAART naïve HIV sero-positive patients and 250 HIV sero-negative subjects. Anthropometric measurements and physical examination were done. Assay for fT3, fT4, TSH (for thyroid function) was done using the Enzyme Linked Immunoassay (ELISA) method. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23. RESULTS: The HAART naïve sero-positive cohorts comprised 112 males and 138 females while the control subjects consisted of 125 males and 125 females. Mean ages (years) of test and control groups were 38.84± 10.60 and 39.58 ±11.68 respectively. Prevalence of thyroid dysfunction among the study subjects was 36.4% and 7.6% in the controls. Subclinical hypothyroidism was the most common prevalent type of thyroid dysfunction in both test and control groups at 17.6% and 7.2% respectively. In the test group, sick euthyroid syndrome (17.2%) ranked second while in the controls, primary hypothyroidism (7.2%) was the second commonest dysfunction. CONCLUSION: Thyroid dysfunction was more common in HAART-naïve HIV sero-positive subjects than in the general population with subclinical hypothyroidism emerging as the commonest abnormality.

CONTEXTE: Le VIH/SIDA est une maladie multisystémique qui a été associée à plusieurs endocrinopathies, dont la thyroïde associée à plusieurs endocrinopathies, y compris le dysfonctionnement de la dysfunctionnement. Le dysfonctionnement thyroïdien chez les patients atteints du VIH/SIDA, entre autres facteurs, peut être due aux effets cytopathiques directs du cytopathiques directs du VIH sur la glande thyroïde, en plus des effets indésirables des médicaments antirétroviraux hautement actifs (HAART). OBJECTIF DE L'ÉTUDE: L'étude visait à déterminer la prévalence et le modèle de dysfonctionnement thyroïdien chez les patients VIH naïfs de traitement HAART à Enugu. MATÉRIEL ET MÉTHODES: L'étude était transversale, basée sur un cas-témoin, impliquant 250 patients séropositifs n'ayant jamais reçu de HAART et 250 patients séronégatifs et 250 sujets séronégatifs. Des mesures anthropométriques et un examen physique ont été effectués. Les dosages de fT3, fT4, TSH (pour la fonction thyroïdienne) a été effectué à l'aide de l'Enzyme Linked Immunoassay (ELISA). Les données ont été analysées en utilisant le progiciel statistiques pour sciences sociales (SPSS) version 23. RÉSULTATS: Les cohortes séropositives n'ayant jamais reçu de HAART comprenaient 112 hommes et 138 femmes, tandis que les sujets témoins comprenaient 125 hommes et 125 femmes. Les âges moyens (années) des groupes test et groupes témoins étaient respectivement de 38,84± 10,60 et 39,58 ±11,68. La prévalence du dysfonctionnement de la thyroïde parmi les sujets de l'étude était de 36,4 % et 7,6 % chez les témoins. L'hypothyroïdie subclinique était le type de dysfonctionnement thyroïdien le plus répandu dans les groupes test et témoin soit 17,6 % et 7,2 % respectivement. Dans le groupe test, le syndrome d'euthyroïdie maladive (17,2 %) arrivait en deuxième position, tandis que dans le groupe témoin, l'hypothyroïdie primaire (7,2 %) était le deuxième type de dysfonctionnement le plus courant. CONCLUSION: Les dysfonctionnements de la thyroïde étaient plus fréquents chez les personnes suivantes sujets séropositifs n'ayant jamais reçu de traitement antirétroviral que dans la population générale, l'hypothyroïdie subclinique apparaissant comme la l'anomalie la plus fréquente. MOTS-CLÉS: Prévalence, Modèle, HAART-naïf, patients VIH, dysfonctionnement de la thyroïde, Nigéria.

Association between glycemic status and thyroid dysfunction in patients with type 2 diabetes mellitus.

BACKGROUND: Thyroid dysfunction has been widely reported to be more common in patients with type 2 diabetes mellitus (T2DM) in various parts of the world; however, there is paucity of data on this in our environment. OBJECTIVE: The aim of this study was to determine the possible relationship between glycemic status and thyroid dysfunction. METHODOLOGY: A total of 354 T2DM patients and 118 non-diabetic persons (controls) were recruited for the study. A pretested questionnaire was filled for each subject after due explanations. Their blood samples were tested for HbA1c, fT3, fT4, and TSH. Information retrieved from patient's medical records included age at diagnosis of diabetes (DM) and duration of DM. Testing statistics done included Student's t-test, chi square test, and regression analysis. P-value of less than 0.05 was taken to be statistically significant. RESULTS: The results show that 43.5% and 37.3% of T2DM and control subjects, respectively, were males. Mean HbA1c was significantly higher in T2DM patients than in the controls (7.8±2.0% vs 5.8±1.2%, p=0.001), while mean fT3 was significantly lower in T2DM patients than in the controls (2.3±1.5 pg/mL vs 2.7±2.2 pg/mL, p=0.03). Mean HbA1c was significantly higher in T2DM patients with thyroid dysfunction compared to their euthyroid counterparts (8.1±1.9% vs 5.1±1.2%, p=0.001). HbA1c had a positive linear relationship with the presence of thyroid dysfunction (regression coefficient=1.89, p=0.001). CONCLUSION: There was a positive linear relationship between HbA1c and the presence of thyroid dysfunction in the T2DM patients in this study. There was an inverse relationship between HbA1c and serum fT3.

The Value of Internet Tools in Undergraduate Surgical Education: Perspective of Medical Students in a Developing Country.

OBJECTIVE: Advances in information technology (IT) in the past decade present opportunities and challenges in undergraduate surgical education. There may be need to evaluate the knowledge base and the use of Internet tools among medical students in settings where traditional mode of education is preeminent. This may help to establish a conceptual framework for integrating e-learning into the traditional teaching to enhance learning experience. In this study, we evaluated the medical students' knowledge and use of Internet tools, and their opinion on the application of these tools in surgical education. METHODS: We undertook a cross-sectional survey of 2013 and 2014 graduating medical class of College of Medicine University of Nigeria, Enugu using structured self-administered questionnaire. The survey assessed the knowledge, utility, and application of Internet tools in surgical education using 5-point Likert scale. RESULTS: Overall response rate was 78% (227/291) comprising 151 (66.5%) males and 76 (33.5%) females. The median age was 24 years (range 20-33 years). Although 106 (46.7%) had formal training on information technology, 223 (98.2%) can access Internet, and 162 (71.4%) use one or more of the Internet tools, 90.6% (96/106) of those trained on ICT use Internet for education/learning compared to 88.4% (107/121) of those without ICT training (p = 0.76). Google™ search tool had the highest rating in terms of familiarity and utility for education/learning (mean rating 4.3 on a scale of 5.0), while Skype™ had the least rating (mean 2.0). Overall, 89% of respondents (mean rating 4.5 on a scale of 5.0) indicated that Internet tools could be effectively applied in surgical education specifically in areas of lectures, assignments, real-time procedure demonstration, case discussion, and interaction with surgical experts. The key benefits are utility as a regular self-assessment tool (mean rating = 4.6) and offer of flexible learning schedule (mean rating = 4.0). Fifty-two percent (118/227) strongly agree that combination of the use of Internet tools with the traditional teaching may give better learning outcome (mean rating 4.44). The major challenges were cost of accessing Internet (n = 126; 55.5%), lack of facility with the technology (n = 115; 50.7%), and network availability (n = 96; 42.3%). Availability of affordable Internet (n = 205; 90.3%), improvement of training on ICT (n = 135; 59.5%), and encouragement of the use of these tools by faculty (n = 107; 47.1%) were the major suggestions to address the challenges. CONCLUSION: In our setting, a substantial number of undergraduate medical students are familiar with and use Internet tools for learning and believe that the tools may have utility in surgical education. However, to further consolidate and enhance learning experience, it may be useful to integrate this learning modality with the traditional mode of teaching through a well thought out curriculum modification.

Giant Mucinous Cystadenoma in Nnewi, Nigeria.

Mucinous ovarian tumors are the second commonest type of epithelial ovarian tumors. Most of these tumors are benign. Occasionally, these tumors may reach enormous dimensions without being symptomatic. We reported the occurrence of a huge benign ovarian tumor (mucinous cystadenoma) in Nnewi. The data were collected from history taking, clinical examination, laboratory investigation, ultrasonographic examination, operative findings and histopathological examination of the surgical specimen. The case was reported as a massive ovarian mucinous cystadenoma. This case report emphasizes the importance of a thorough evaluation of women who presented with vague abdominal pain. Although the condition is very rare, it is potentially hazardous if early diagnosis and timely intervention is not instituted.

Genital tract microbial isolate in women with preterm pre-labour rupture of membranes in resource-constrained community setting.

This study determined patterns of microbial isolates in genital tract of women with preterm pre-labour rupture of membranes (PPROM) compared with cases without PPROM. Endocervical swabs of women with confirmed diagnosis of PPROM were examined microbiologically and compared in blinded pattern with gestational-age-matched controls. One hundred and five microbiological results each for cases and controls were analysed. Positive microbial cultures were seen in 79.05% of cases versus 6.67% of controls. Streptococcus spp. (31.43%) was the commonest organism isolated in cases (p < 0.001), while Candida albicans was significantly more in controls (p < 0.001). The highest incidence of PPROM (82.86%) occurred in gestational ages of 28-30 and 34-36 weeks. No fewer than 75.24% cases occurred in low parity (0-2). Majority occurred in extremes of viable preterm gestation and in women of low parity.

Obesity; overweight; and underweight among urban Nigerians

Background: Disease burden from communicable and noncommunicable diseases is a significant health challenge facing many developing nations. Among the noncommunicable diseases; is obesity; which has become a global epidemic associated with urbanization. Objective: The aim was to evaluate the prevalence of weight abnormalities; their pattern of distribution and regional differences among apparently healthy urban dwelling Nigerians. Methods: A cross-sectional community-based descriptive survey was carried out in five urban cities; each from one geo-political zone of Nigeria. Multistage sampling procedures were used to select participants using the World Health Organization STEPS instrument. Ethical approval and consents were duly and respectively obtained from the Ethics Committee in the tertiary centers and participants in each of these cities. Analysis was performed using SPSS version 20 (IBM Corp.; Amonk; NY; released 2011) with P value set at 0.05. Results: A total of 5392 participants were recruited; of which; 54.5 and 45.5 were males and females respectively. Mean (standard deviation) age and body mass index (BMI) were 40.6 (14.3) years and 25.3 (5.1) kg/m 2 . Obesity; overweight; and underweight were found in 17; 31; and 5 of participants respectively. Significantly; while underweight declined with increasing age; overweight; and obesity increased to peak in the middle age brackets. Age of ? 40 years was found to confer about twice the risk of becoming overweight. The prevalence of obesity and mean BMI were significantly higher both among the females and the participants from southern zones. Conclusion: Obesity and overweight are common in our urban dwellers with accompanying regional differences. Attainment of middle age increases the likelihood of urban dwelling Nigerians to become overweight/obese. There is therefore the need to institute measures that will check development of overweight/obesity early enough; while improving the nutritional status of the few who may still be undernourished

Obesity, overweight, and underweight among urban Nigerians.

BACKGROUND: Disease burden from communicable and noncommunicable diseases is a significant health challenge facing many developing nations. Among the noncommunicable diseases, is obesity, which has become a global epidemic associated with urbanization. OBJECTIVE: The aim was to evaluate the prevalence of weight abnormalities, their pattern of distribution and regional differences among apparently healthy urban dwelling Nigerians. METHODS: A cross-sectional community-based descriptive survey was carried out in five urban cities, each from one geo-political zone of Nigeria. Multistage sampling procedures were used to select participants using the World Health Organization STEPS instrument. Ethical approval and consents were duly and respectively obtained from the Ethics Committee in the tertiary centers and participants in each of these cities. Analysis was performed using SPSS version 20 (IBM Corp., Amonk, NY; released 2011) with P value set at < 0.05. RESULTS: A total of 5392 participants were recruited; of which, 54.5% and 45.5% were males and females respectively. Mean (standard deviation) age and body mass index (BMI) were 40.6 (14.3) years and 25.3 (5.1) kg/m 2 . Obesity, overweight, and underweight were found in 17%, 31%, and 5% of participants respectively. Significantly, while underweight declined with increasing age, overweight, and obesity increased to peak in the middle age brackets. Age of ≥ 40 years was found to confer about twice the risk of becoming overweight. The prevalence of obesity and mean BMI were significantly higher both among the females and the participants from southern zones. CONCLUSION: Obesity and overweight are common in our urban dwellers with accompanying regional differences. Attainment of middle age increases the likelihood of urban dwelling Nigerians to become overweight/obese. There is therefore the need to institute measures that will check development of overweight/obesity early enough, while improving the nutritional status of the few who may still be undernourished.

Awareness of human immunodeficiency virus (HIV) infection among antenatal clients in Nnewi Nigeria.

OBJECTIVE: To determine the level of awareness of Human Immunodeficiency Virus (HIV) infection among antenatal clients in Nnewi Nigeria. SUBJECTS AND METHODS: A cross sectional descriptive study of six hundred consecutive antenatal clients attending the Nnamdi Azikiwe University Teaching Hospital and five private specialist hospitals (run by Consultant Obstetricians) in Nnewi was conducted over a six-month period (1st September 2008 -28th February 2009). Anonymous, structured, pretested questionnaire designed to assess the awareness of HIV infection was used. RESULTS: The mean age of all the 600 clients was 31.4 (SD 2.8) years, majority were married (94%) and in the third trimester of pregnancy (69%). Most (58%) attended secondary school while 0.83% had no formal education. Only 2% had complete knowledge of the modes of HIV transmission while majority (96.5%) had partial knowledge. There was a statistically significant relationship between level of education and knowledge of HIV (p < 0.00001). HIV test was done on 419 (69.84%); 37 tested positive giving a seroprevalence rate of 8.83%. Among those tested, only 51.55% had counseling before testing. CONCLUSION: This study showed that the knowledge of HIV among women of child bearing age and the practice of voluntary counseling and testing are still poor in our environment. Improved public enlightenment and training of health workers are urgently needed.

Cardiovascular risk factors in middle-aged and elderly residents in South-East Nigeria: the influence of urbanization.

Cardiovascular diseases (CVD) were previously considered a problem of the developed nations only. Emerging facts show that CVD and their risk factors are now prevalent in developing countries. We carried out a cross-sectional, population-based survey to determine the relation between place residence (rural or urban) and the burden of CVD risk factors in South East Nigeria. Hypercholesterolaemia, hypertension, abnormal blood glucose and obesity were assessed for, in middle-aged and elderly residents of two communities in Enugu, South East Nigeria. A total of 543 adults (308 at Ogwofia Owa and 235 at Emene) participated in the study. The mean and 95% CI for mean of the characteristics of subjects showed that they were in the middle-age group with apparently normal mean cardiovascular risk indices except for systolic and diastolic blood pressure indices which suggested pre-hypertension. The subjects residing in the rural area were older than those residing in the urban area but cardiovascular risk factors had higher mean values in urban residents except systolic blood pressure (SBP). The most prevalent cardiovascular risk factors in the study group were hypertension and obesity. Urban residence was found to influence the prevalence of risk factors, specifically obesity and diastolic hypertension.

The pattern and obstetric outcome of hypertensive disorders of pregnancy in Nnewi, Nigeria.

BACKGROUND: Hypertension is a common medical complication of pregnancy. It is one of the leading causes of maternal and fetal mortality and morbidity worldwide. Early detection, close surveillance and timely delivery are necessary to reduce complications associated with the condition. OBJECTIVES: To determine the pattern, risk factors, maternal and fetal outcomes in women with hypertensive disorders of pregnancy. METHODOLOGY: This was a descriptive retrospective study of the pattern and obstetrics outcome of hypertensive disorders in Nnewi. The Obstetric variables from 148 women with hypertensive disorders of pregnancy at the Nnamdi Azikiwe University Teaching Hospital Nnewi, from the 1st January 2004 to 31st December 2008 were analyzed. Stastical analysis was done using Epi Info version 3.3.2. The level of statistical significance was set at P < 0.05. RESULTS: of the 4021 deliveries in the hospital during the period under review, 148 (3.7%) were managed for hypertensive disorders of pregnancy. Only 138 folders were used for analysis. The mean age of the women was 31.3 +/- 5.7 years. Majority of the women were unbooked (57.2%). Pre-eclampsia was the commonest type of hypertensive disorder of pregnancy (46.4%) with the majority presenting with severe disease. The level of proteinuria was significant in 74.6% of cases of preeclampsia. The mean gestational age at delivery was 35.3 +/- 1.5 weeks. The mean birth weight was 1.6 +/- 0.3 kg. Twenty-four intra uterine deaths were recorded giving a stillbirth rate of 17.4%. The perinatal mortality rate was 20.9%. Diagnosis was made in the ante-partum period in 92.0% of the cases while 55.2% of the women delivered through Caesarean section. Eight maternal deaths were recorded, giving a case fatality rate of 5.8%. CONCLUSION: Hypertensive disorders of pregnancy are associated with high maternal and fetal morbidity and mortality in Nnewi, Nigeria. Antenatal care will help in early diagnosis and timely intervention of the cases. There is need for strengthening of communication and referral systems in the healthcare.

Control to goal of cardiometabolic risk factors among Nigerians living with type 2 diabetes mellitus.

BACKGROUND: Cardiovascular risk factors contribute to morbidity and mortality among diabetic patients. National and international guidelines on management of diabetes therefore emphasize control to goals of blood glucose, blood pressure, dyslipidemia, and obesity so as to minimize the development of complications and enhance the patients' quality of life. OBJECTIVE: To evaluate the status of control to goals of cardiometabolic risk factors among the diabetic patients attending the Diabetes clinic of University of Nigeria Teaching Hospital, Enugu. MATERIALS AND METHODS: A survey of 233 type 2 diabetic patients recruited from the Diabetes clinic of our hospital was carried out. Standard procedures as described in the WHO STEP instrument were used to determine the waist circumference, weight, height, and systolic and diastolic blood pressure. Fasting blood glucose and lipid profiles were also assessed. Therapeutic goals used to define risk or poor control were values adopted by expert groups such as American diabetes association (ADA), National cholesterol education program (NCEP), American association of clinical endocrinologist (AACE) and International diabetes federation (IDF). RESULTS: There were 98 males and 135 females with mean (SD) duration of diabetes mellitus (DM) of 6.7 (6.3) years. Suboptimal glycemic, blood pressure control and dyslipidemia were observed in 65.7%, 51.9%, 97.1% of the subjects respectively while 60.1% of the subjects were found to be overweight/obese. Comparing the mean indices of risk factors with the recommended therapeutic goals, status of control was optimal for HDL-cholesterol, waist circumference and triglycerides. All the other risk factors were suboptimal. CONCLUSION: Control to goals of cardiovascular risk factors is poor among the patients. There is the need to identify and tackle the possible contributing factors so as to reduce the morbidity and mortality in these patients.

Large supralevator puerperal haematoma following a normal delivery.

BACKGROUND: Puerperal Haematomas are not very common and supralevator haematomas following normal vaginal deliveries are quite rare. METHOD: We report a case of supralevator haematoma following a normal spontaneous vertex delivery, necessitating laparotomy. RESULTS: A 29 year old multiparous woman who had a normal pregnancy and normal labour, developed a large supralevetor haematoma. She had a laparotomy and her recovery was uneventful. CONCLUSION: Supralevator haematomas should be considered in patients presenting with lower abdominal pains and absence of vaginal bleeding following normal delivery. Ultrasound scan is helpful, but not conclusive in the diagnosis of supralevator haematomas.

Pattern of Blood Pressure Indices among the Residents of a Rural Community in South East Nigeria.

Cardiovascular diseases (CVDs) are the main causes of death in industrialized countries, and are significant causes of morbidity and mortality in sub-Saharan Africa. Hypertension is the most common cardiovascular disease in Nigerians, and the risk of CVD associated with hypertension is independent of other risk factors. Despite the high level of awareness of its presence in the developed countries, the level of control is still poor. CVDs tend to be commoner in urban settlements, and it has been hypothesized that rural sub-Saharan Africa is at an early stage of epidemiological transition from communicable to non-communicable diseases (NCD) because of the gradual adoption of unhealthy lifestyles. This study aimed at describing the pattern of blood pressure indices among the hypertensive residents of a rural community in South East Nigeria. A total of 858 individuals comprising 247 males and 611 females took part in the study. 46.4% of the subjects had hypertension. Hypertension was commoner in the males (50.2% vs. 44.8%) (χ(2)(1) = 1.484; P = 0.223). The males were significantly older and heavier than the females while the females had higher mean values of BMI and WC. The prevalence of hypertension is becoming alarmingly high in the rural communities of sub-Saharan Africa.

Prevalence of cardiovascular risk factors in the middle-aged and elderly population of a nigerian rural community.

Cardiovascular diseases (CVDs) causes of worldwide preventable morbidity and mortality. CVDs are a leading cause of mortality and morbidity in developing countries, and rates are expected to rise over the next few decades. The prevalence of CVD risk factors is dramatically increasing in low-and middle-income African countries, particularly in urban areas. We carried out a cross-sectional population-based survey in Imezi-Owa, a rural community in South East Nigeria to estimate the prevalence of major cardiovascular risk factors in both men and women aged 40-70 years. A total of 858 individuals made up of 247 (28.8%) males and 611 (71.2%) females were recruited. The mean age of the subjects was 59.8 ± 9.9 years. The prevalence of the different cardiovascular risk factors among the 858 subjects was as follows: hypertension 398 (46.4%) subjects, generalized obesity as determined by BMI 257 (30%) subjects, abdominal obesity 266 (31%) subjects, dysglycaemia 38 (4.4%) subjects and hypercholesterolaemia 32 (3.7%) subjects. Prevalence of hypertension and dysglycaemia was higher in men while the others were higher in women. Only hypertension (P = .117) and hypercholesterolaemia (P = .183) did not reveal any significant association with gender. Prevalence of CVD risk factors was highest in subjects aged 65 to 70 years.

The pattern of hysterosalpingographic findings in women being investigated for infertility in Nnewi, Nigeria.

BACKGROUND: Tubal occlusion is the commonest cause of female infertility in the developing societies. Hysterosalpingography remains a vital method of assessing tubal patency especially in resource limited settings such as ours. OBJECTIVE: To review the pattern of hysterosalpingographic findings among women being investigated for infertility in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria over a period of five years (2001-2005). METHOD: The data obtained from the request forms and radiologists' reports were analyzed using SPSS version 11. The level of statistical significance was set at p < 0.05. RESULTS: Of the 320 studied, 230 were found suitable for analysis. Their ages ranged from 20 to 44 years (mean 32.8 +/- 5.8 years). The indications were primary infertility in 103 (44.8%), secondary infertility in 88(38.3%), while in 39 (16.9%) patients the type of infertility was not specified. The reports revealed that 67 (29.1%) had normal HSG Cervical abnormalities were found in 34 (14.8%), uterine cavity abnormalities in 108 (47.0%). Tubal pathologies were seen in 100 (43.5%) with bilateral tubal occlusion in 43 (18.7%) and bilateral hydrosalpinges in 6 (2.6%) patients. CONCLUSION: Tubal pathology remains a major contributor to female infertility in this part of the world.