An open trial of lisinopril ('ZESTRIL') in mild to moderate hypertension in Nigeria.

Fifty-one native Nigerian patients with mild to moderate essential hypertension received Lisinopril ('Zestril') in doses of 10 mg to 40 mg once daily. All patients received an initial dose of 10 mg, which was titrated up to a maximum of 40 mg if normotensive diastolic blood pressure had not been achieved. Reduction in mean diastolic blood pressure, when compared with baseline data, was significant (p < 0.001) following 16 weeks of treatment. Of the 46 evaluable patients, 32 (70%) had their blood pressure controlled (i.e. diastolic blood pressure < or = 90 Hg). Lisinopril ('Zestril') was well tolerated, with 27% of patients reporting adverse reactions of which cough was the most common. In conclusion, this study shows that Lisinopril ('Zestril"), when administered to Nigerian patients, is a clinically effective and well-tolerated for mild to Customer to supply Mss.

Concurrent adenocarcinoma of the colon and chronic intestinal parasitoses: a case report.

A 25-year-old patient presented with recurrent bloody diarrhoea associated with intestinal parasitoses. Radiography and tissue histology confirmed the diagnosis of an annular colonic adenocarcinoma. The incidence and management of colonic malignancy in young Africans is discussed in the light of its described associationship with protozoal/helminthic parasitoses.

Affective disorder and hyperthyroidism. Review and case report.

The presence of psychiatric symptoms in thyroid dysfunctions has long been recognised. The literature review shows that such presence is not common and often overlooked. A case seen and managed by both authors is presented. The benefit derived by such patients treated where access to several specialties are available is emphasised.

A double-blind comparison of acebutolol (Sectral) and propranolol (Inderal) in the treatment of hypertension in black Nigerian patients.

Acebutolol and propranolol were compared in forty-five Black African patients in a double-blind randomized trial carried out at Ahmadu Bello University Teaching Hospital in Kaduna, Nigeria. After a wash-out period of 6 weeks, including placebo administration for the last 4 of those weeks, twenty-seven patients were given acebutolol once daily and eighteen were given propranolol twice daily for 12 weeks, followed by a tapering-off period of 2 weeks, making a total of 14 weeks on active treatment. The two beta-receptor blocking drugs were effective in controlling hypertension with final daily doses ranging from 160 to 320 mg in the propranolol group and 400 to 800 mg in the acebutolol group. The supine systolic blood pressure responses with acebutolol were statistically significant and better than those elicited by propranolol. Acebutolol produced less (resting) bradycardia than did propranolol; this may be related to acebutolol's intrinsic sympathomimetic activity. The only unpleasant side-effects reported in this study were slight dizziness in two patients treated with propranolol and slight tiredness in one patient treated with acebutolol. No significant abnormal changes were noted in laboratory tests or chest X-rays. Electrocardiography detected supraventricular tachyarrythmia in five patients: this disappeared by the end of the study. Acebutolol was shown to be a safe, effective and reliable antihypertensive drug, at least comparable to and probably slightly better than, propranolol in the treatment of hypertension in Black Nigerians. It has the added advantage of a once-daily dose schedule.

Cardiac failure in pregnant Northern Nigerian women.

Thirty-nine gravidae with congestive cardiac failure and ten pregnant patients with acute pulmonary edema treated at the Ahmadu Bello University Teaching Hospital in Kaduna, Nigeria, over a five-year period are presented. Congestive cardiac failure occurred more frequently in the postnatal period, and parity and socioeconomic class were not significantly related to cardiac failure. Maternal mortality was low in spite of all patients being in functional grades III and IV. Idiopathic cardiomegaly and chronic rheumatic heart disease were the most common underlying causes of heart failure in pregnancy. The dominant valvular lesions in the patients with rheumatic heart disease was mitral incompetence.

Cardiovascular disease in Northern Nigeria.

The case files of 4,456 medical admissions in 1975--1976 at Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria, included 354 cardiovascular patients. The most common causes were hypertension (45.5%), cardiomyopathy (20.6%) and chronic rheumatic heart disease (14.4%). The mean age of hypertensive and cardiovascular patients was lower than in Europe. The majority of hypertensive patients suffer from essential hypertension. Congestive cardiac failure is the commonest complication of hypertension and cardiomyopathy. Rheumatic valvular disease with mitral incompetence is frequent and sometimes severe in young people. Other cardiovascular diseases included pericardial disease, bacterial endocarditis, cor pulmonale, anaemic heart failure, congenital and syphilitic heart disease. Coronary heart disease was only encountered in non-Africans. Cardiovascular mortality in hospital was high (20%).

Comparative trial of co-trimoxazole and tetracycline in the treatment of lower respiratory tract infection.

One hundred and twenty-six adult patients with acute lower respiratory infection were studied in a double-blind trial. One group was treated with co-trimoxazole (480 mg trimethoprim and 2400 mg sulphamethoxazole) per day and the other group with tetracycline 2 g per day. The results showed that co-trimoxazole was significantly more effective than tetracycline as judged by clinical improvement, and the reduction in sputum volume and purulence. No haematological abnormalities were observed, but the incidence of side-effects, though mostly mild, was higher in the group of patients on tetracycline than in the co-trimoxazole group. The results of this study strongly suggest that co-trimoxazole may be a useful and reliable drug in the treatment and control of acute lower respiratory tract infection in the developing countries.

Comparative clinical trial of amoxycillin and chloramphenicol in the treatment of typhoid in adults.

A randomized clinical trial in sixty-two adult patients suffering from typhoid fever, proved by blood and marrow culture, showed that amoxycillin in a dosage schedule of 1 g 8-hourly orally for fourteen days was better than chloramphenicol with regard to clinical and temperature response and in respect of carriers and relapse rates. One patient developed a hypersensitivity reaction to amoxycillin which cleared on withdrawal of the drug. Success was achieved in 90% of cases. These findings lend very strong support to the value of amoxycillin as a superior alternative to chloramphenicol in the treatment of typhoid fever.

Incidence of hypertension in Ahmadu Bello University Hospital Kaduna--Nigeria.

The incidence and pattern of hypertension in General Out Patient Department of Ahmadu Nello University Teaching Hospital, Kaduna have been described. Two thousand nine hundred and fifty adult patients with 1,636 males and 1,314 females, aged 20 to 70 years were examined in this study. One hundred and twelve patients (3.79%) with 47 males (2.87%) and 65 females (4.94%) were found to be suffering from hypertension. The incidence in females was significantly more than in males. The mode of presentation of 112 cases with hypertension has been discussed. Thirty four (30.35%) with 14 males and 20 females were asymptomatic. Sixteen (14.28%) with 7 males and 9 females presented with cardiac failure. Contrary to previous opinion this study has shown that hypertension is probably more common in Northern Nigeria than was previously realized. There appears to be ample justification for further and more detailed study of hypertension in the rural and urban communities in this area.

Acute emphysematous cholecystitis.

Acute emphysematous cholecystitis is an uncommon condition caused by gas-forming organisms and characterized by the presence of gas in the wall and lumen of the gallbladder. Its incidence is higher among male diabetics. AEC in an elderly North American diabetic man with Indian ancestry is reported with a brief review of the world literature. The diagnosis was made preoperatively with the aid of plain radiographic films of the abdomen. A gangrenous distended gallbladder was removed at operation. Clostridium perfringens was cultured from the gallbladder contents and wall. If AEC is suspected, intensive antimicrobial therapy and fluid and electrolyte replacement should be given prior to early surgical intervention.