Hypertension control and other cardiovascular risk factors among diabetic patients at Muhimbili National Hospital, Tanzania.

BACKGROUND: Hypertension among diabetics is a well recognized cardiovascular risk factor. This study aimed at determining the prevalence of hypertension, its control and the prevalence of other cardiovascular risk factors among diabetic patients. METHODS: We consecutively enrolled 150 adult diabetics. Their age, sex weight, height, blood pressure, fasting capillary blood glucose, lipid and renal profiles, hypertension and diabetes therapy were ascertained. RESULTS: Hypertension prevalence was 54.7%. Treatment and control rates of hypertension were 81.7% and 34% respectively. Hypertensive patients were older, more overweight/obese, had a longer duration of diabetes and elevated serum creatinine. The prevalence of Dyslipidemia, overweight and obesity were 88%, 48.7% and 18.7% respectively. Poor diabetes control was observed in 76.7% of patients. Cigarette smoking was uncommon. CONCLUSION: Hypertension, hyperglycemia, dyslipidemia and obesity are prevalent among our diabetic patients. Both hypertension and glycemia were poorly controlled. Addressing individuals' global cardiovascular risk profiles is vital in diabetics.

Comparison of PCR, culture, and histopathology for diagnosis of tuberculous pericarditis.

Nucleic acid amplification techniques for the diagnosis of tuberculosis (TB) are rapidly being developed. Scant work, however, has focused on pericardial TB. Using cryopreserved specimens from a prior study of pericarditis, we compared PCR to culture and histopathology for the diagnosis of tuberculous pericarditis in 36 specimens of pericardial fluid and 19 specimens of pericardial tissue from 20 patients. Fluid and tissue were cultured on Lowenstein-Jensen and Middlebrook solid media and in BACTEC radiometric broth. Tissue specimens were stained with hematoxylin-eosin, Ziehl-Neelsen, auramine O, and Kinyoun stains and were examined for granuloma formation and acid-fast bacilli. PCR was performed with both fluid and tissue with IS6110-based primers specific for the Mycobacterium tuberculosis complex by published methods. Sixteen of the 20 patients had tuberculous pericarditis and 4 patients had other diagnoses. TB was correctly diagnosed by culture in 15 (93%) patients, by PCR in 13 (81%) patients, and by histology in 13 of 15 (87%) patients. PCR gave one false-positive result for a patient with Staphylococcus aureus pericarditis. Considering the individual specimens as the unit of analysis, M. tuberculosis was identified by culture in 30 of 43 specimens (70%) from patients with tuberculous pericarditis and by PCR in 14 of 28 specimens (50%) from patients with tuberculous pericarditis (P > 0.15). The sensitivity of PCR was higher with tissue specimens (12 of 15; 80%) than with fluid specimens (2 of 13; 15%; P = 0.002). In conclusion, the overall accuracy of PCR approached the results of conventional methods, although PCR was much faster. Therefore, PCR merits further development in this regard. The sensitivity of PCR with pericardial fluid was poor, and false-positive results with PCR remain a concern.

Medication compliance among Tanzanian hypertensives.

The clinical records of 702 patients starting antihypertensive treatment between 1985 and 1990 were collected and reviewed at the end of 1992. At the end of an average observation period of three years, 47% of the patients had dropped out of the cardiac clinic. The medication compliance of 146 patients was estimated by both interview method as well as by the pill count method in 1991 and 1992. Medication compliance was related to the frequency and time of dosing as well as to the number of drugs. Once daily regimens had better compliance than three times daily ones and medication compliance was greatest for morning dosing, second greatest for evening dosing and least for dosing at noon. A need for improvement of patient doctor communication was emphasised.

Tuberculous pericarditis in Tanzanian patients with and without HIV infection.

SETTING: Large academic medical center in Tanzania. OBJECTIVES: To determine the etiologies and outcomes of large pericardial effusions in HIV-infected and uninfected patients. DESIGN: Prospective cohort study of patients admitted with new large pericardial effusions, confirmed echocardiographically. Patients had pericardial biopsies and drainage with extensive analysis of tissue and fluid specimens, and were followed with clinical and echocardiographic examinations. RESULTS: Of 28 patients with large pericardial effusions, 19 were infected with HIV-1. 22 had invasive diagnostic procedures: 14 of 14 HIV-infected patients, but only 4 of 8 non-HIV-infected patients, had tuberculous pericarditis (P = 0.01). All but 1 of the HIV-infected patients had strongly positive tuberculin skin tests, and short-term outcomes were similar in the 2 groups. CONCLUSION: TB is the predominant cause of large pericardial effusion in HIV-infected patients in this setting; non-HIV-infected patients are more likely to have other etiologies. These patients were at an early stage of HIV infection and responded well to treatment. In settings where microbiological studies are not routinely available, HIV-infected patients with large pericardial effusions may be treated empirically for tuberculosis and monitored for improvement. If improvement does not follow within 2-4 weeks further studies are indicated. HIV-negative patients should undergo diagnostic evaluation initially.

Chronic chloroquine use- A cause of complete heart block

There have been occasional reports of complete heart block in chronic use of chloroquine; in most of these cases this has followed chronic abuse. Self medication is common in Tanzania; where malaria is endemic and chloroquine is easily available in ordinary shops and pharmacies. This is a report of a patient who developed complete heart block; and poor vision following chronic chloroquine abuse

Efficacy, tolerability and safety of isradipine (Lomir) in the treatment of mild to moderate Tanzanian hypertensives.

Isradipine (Lomir) a new dihydropyridine calcium antagonist was evaluated for its efficacy, tolerability and safety among mild to moderate Tanzanian hypertensives. Twenty nine patients (7 males and 22 females), mean age 42.7 +/- 8.5 years entered active treatment phase, of the 16 week open label therapeutic trial. A mean decrease from base line in supine systolic blood pressure (SBP) of 17.6 mmHg (p < 0.001) and diastolic blood pressure (DBP) of 13.5 mmHg (p < 0.001) were achieved at the end of the study period. The corresponding changes from base line in standing SBP and DBP were 18 mmHg (p < 0.001) and 13.5 mmHg (p < 0.001) respectively. The efficacy was excellent or good in 84% and fair or none in 16% of the study patients. The tolerability of the drugs was excellent or good in 88.8% of patients, fair in 7.4% and bad in 3.8%. The mild side effects included headache, palpitations, tiredness and nocturia. But these improved with continued treatment. Isradipine (Lomir) at a dose of 1.25mg to 2.5mg twice daily is effective, safe and tolerable in mild to moderate hypertension.