Chronic Kidney Disease and Its Clinical Correlates in a Rural Community in Southwestern Nigeria.

Chronic kidney disease (CKD) is a burgeoning problem globally, and more than a billion adults were affected as of 2016, with 1.2 million people dying from renal failure in 2017. To arrest the seemingly relentless progression of CKD to renal failure, there is a need to detect CKD early in the community. A community-based study was carried out to look at the prevalence and risk factors of CKD. Anthropometric and other clinical variables were measured. Blood samples were taken for determining creatinine, uric acid, urea, and lipids. CKD was defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m2. Electrocardiograms and renal ultrasound scans were performed. In total, 201 people were recruited. Those with CKD had a male:female ratio of 1:3.9 and were older. The prevalence of autosomal-dominant polycystic kidney disease and CKD was 531.9 persons/100,000 population and 46.3%, respectively. Systolic blood pressure, pulse pressure, total cholesterol, triglycerides, high-density lipoprotein (HDL), uric acid, QTc interval, and electrocardiographic left ventricular hypertrophy were higher in those with CKD. Age, female sex, and HDL were independently associated with CKD. There was a steep rise in CKD at the community level. Increased awareness of CKD and prompt interventions are therefore imperative.

Awareness of and Attitude towards glaucoma among an adult rural population of Osun State, Southwest Nigeria.

PURPOSE: To obtain baseline data and assess the level of awareness and attitudes towards glaucoma among rural communities of Osun State, Nigeria. MATERIALS AND METHODS: This was a community-based study that involved interviews and descriptive cross-sectional analysis. Serial-recruitment was performed of consenting participants who presented at a community-based screening service in March 2011. Socio-demographic data and information about glaucoma were obtained through face-to-face semi-structured questionnaires. RESULTS: The study population comprised 259 respondents (mean age 49.73 ± 16.6 years; range 18 to 90 years). There were 159 females (61.4%). Skilled workers were the most common 130/259 (50.3%) participants. Only 41 (15.8%; 95% CI: 11.4-20.2) participants had ever heard of glaucoma. Sources of information were from visits to an eye clinic for 21/41 (51.2%; 95% CI: 35.9-66.5) participants and 15/41 (36.6%) participants who know someone with glaucoma. Reponses to the causes of glaucoma included 20/41 (48.8%; 33.5-64.1) participant who said 'I don't know' and 24.4% of participants who responded 'curse-from-God'. Responses to questions on treatment included 20/41 (48.8%) participants who responded 'I don't know how it can be treated' and 10/41 (36.6%) said 'medically'. Thirty 30/41 (73.2%) participants would refuse surgery, half of them because 'it cannot cure or reverse the disease' while (26.7%) would refuse out of 'fear'. Only 8/41 (19.5%; 95% CI: 7.4-31.6) would accept surgery for maintenance. Statistically significant predictors of glaucoma awareness were older participants, males and skilled workers (teachers) (P = 0.028, P = 0.018, P = 0.0001, respectively). CONCLUSIONS: The outcomes of study indicate a low level of awareness of glaucoma. Health education at all levels of health and eye care services is required to prevent ocular morbidity and irreversible blindness from glaucoma.

Relationship between Tei index of myocardial performance and left ventricular geometry in Nigerians with systemic hypertension.

INTRODUCTION: Left ventricular geometry is associated with cardiovascular events and prognosis. The Tei index of myocardial performance is a combined index of systolic and diastolic dysfunction and has been shown to be a predictor of cardiovascular outcome in heart diseases. The relationship between the Tei index and left ventricular geometry has not been well studied. This study examined the association between the Tei index and left ventricular geometry among hypertensive Nigerian subjects. METHODS: We performed echocardiography on 164 hypertensives and 64 control subjects. They were grouped into four geometric patterns based on left ventricular mass and relative wall thickness. The Tei index was obtained from the summation of the isovolumic relaxation time and the isovolumic contraction time, divided by the ejection time. Statistical analysis was done using SPSS 16.0. RESULTS: Among the hypertensive subjects, 68 (41.4%) had concentric hypertrophy, 43 (26.2%) had concentric remodelling, 24 (14.6%) had eccentric hypertrophy, and 29 (17.7%) had normal geometry. The Tei index was significantly higher among the hypertensives with concentric hypertrophy (CH), concentric remodelling (CR) and eccentric hypertrophy (EH) compared to the hypertensives with normal geometry (0.83 ± 1.0, 0.71 ± 0.2, 0.80 ± 0.2 vs 0.61 ± 0.2, respectively). The Tei index was higher among hypertensives with CH and EH than those with CR. Stepwise regression analysis showed that the Tei index was related to ejection fraction, fractional shortening and mitral E/A ratio. CONCLUSION: Among Nigerian hypertensives, LV systolic and diastolic functions (using the Tei index) were impaired in all subgroups of hypertensive patients according to their left ventricle geometry compared to the control group. This impairment was more advanced in patients with concentric and eccentric hypertrophy.

Metabolic syndrome: comparison of occurrence using three definitions in hypertensive patients.

OBJECTIVE: To compare the frequency of occurrence of metabolic syndrome using three international definitions and to study the distribution of cardiovascular risk factors among newly diagnosed hypertensive Nigerian subjects. DESIGN: Cross sectional study. SETTINGS: Cardiology unit of LAUTECH Teaching Hospital, Osogbo, Nigeria. PARTICIPANTS: One hundred forty newly diagnosed hypertensive Nigerian subjects, and 70 normotensive controls (age- and sex-matched) were included in this study. METHODS: Clinical history and relevant laboratory investigations were performed on all study participants. The definition of metabolic syndrome was based on three international definitions: World Health Organization (WHO), International Diabetes Federation (IDF), and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Ethical approval was obtained for the study. Statistical analyses were performed using SPSS 16.0. RESULTS: There was no difference in age and gender distribution between the hypertensive subjects and controls. (55.14 ± 10.83 years, females 53.6% vs. 54.67 ± 10.89 years, females 52.9% respectively, P>0.05). The frequency of occurrence of metabolic syndrome among hypertensives was 34.5% according to WHO, 35.0% according to NCEP ATP III, and 42.5% according to IDF criteria. Visceral obesity and reduced high-density lipoprotein (HDL) were the other common cardiovascular risk factors among newly diagnosed hypertensive subjects. Female hypertensives had a higher prevalence of visceral obesity and low HDL. CONCLUSION: Frequency of occurrence of metabolic syndrome was similar using the NCEP ATP III and WHO definitions. However, the IDF definition resulted in a higher frequency because of the lower cut-off for waist circumference used for identification of visceral obesity. Metabolic syndrome is present in a significant proportion of newly diagnosed hypertensive subjects. Therefore, appropriate screening and treatment are required.

Assessment of exercise capacity in African patients with chronic heart failure using six minutes walk test.

BACKGROUND: The purpose of this study was to assess the functional capacity during a 6-minute corridor walk and a 6-minute bicycle ergometry exercise in patients with chronic heart failure (CHF). METHOD: Thirty five patients with stable CHF were recruited for the study. Each subject performed six minutes corridor walk and 6-minute bicycle ergometry testing. The 6-minute walk required the subjects to walk at a self selected speed on a 20 meter marked level ground for 6-minute. All the subjects also performed a 6-minute exercise on a stationary bicycle ergometer with initial resistance of 20 watts and increased by 10 watts after 3-minutes. The perceived rate of exertion was assessed using a modified Borg Scale after each exercise mode. The maximum oxygen consumption was derived using American College of Sport Medicine equations. RESULTS: Result showed high positive correlation between distance walked in the 6-minute and the maximum volume of oxygen (VO(2) max) (r = 0.65, P < 0.01). The average distance walked was 327 m +/- 12.03 m. The VO(2) max estimated during bicycle ergometry was higher (13.7 +/- 1.9 L) than during the six minutes walk (8.9 +/- 1.2 L). CONCLUSION: Six minutes walk could be useful to evaluate exercise tolerance in patients with chronic heart failure, while the bicycle ergometer could be more appropriate in the assessment of maximum functional capacity in these patients.

Relationship between left ventricular geometric pattern and systolic and diastolic function in treated Nigerian hypertensives.

INTRODUCTION: Despite a high worldwide prevalence of left ventricular hypertrophy among black patients, the association of a specific left ventricular geometric pattern with left ventricular dysfunction is rare. The aim of this study was to explore the possibility of such an association in Nigerian hypertensives. METHODS: This was a retrospective study consisting of 188 treated hypertensives. Echocardiography was used to allocate the patients to the following four groups: normal geometric pattern, concentric remodelling, eccentric hypertrophy and concentric hypertrophy. RESULTS: The mean age of the study population was 55.95 +/- 10.71 years. There were 75 females (39.9%). Concentric hypertrophy occurred in 72 (38.3%) patients and concentric remodelling in 53 (28.2%). Only 30 (16%) had a normal left ventricular geometric pattern. Hypertensive subjects with eccentric hypertrophy had the lowest ejection fraction, fractional fibre shortening and left ventricular ejection time but these did not reach statistical significance. The mean left atrial dimension was highest in the subjects with eccentric hypertrophy. CONCLUSION: In this study population of treated Nigerian hypertensives, concentric remodelling and hypertrophy were the predominant left ventricular geometrical patterns.

Prevalence and pattern of hypertension in a semiurban community in Nigeria.

BACKGROUND: Hypertension has been reported to be a major problem of the blacks. There is a paucity of studies, however, on community-based surveys on the prevalence and pattern of hypertension in Nigeria in the recent time. This study sought to investigate the prevalence and pattern of hypertension in the adult population living in the ancient semiurban community of Ile-Ife, southwest Nigeria. DESIGN AND METHODS: Two thousand and ninety-seven adults of above 20 years of age were recruited into the door-to-door survey through a multistage cluster sampling technique. Diagnosis of hypertension was based on blood pressure (BP) threshold of 160/95 mmHg and the World Health Organization /International Society of Hypertension guidelines (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines) definitions. Resting blood pressure was taken using electronic sphygmomanometer. RESULTS: The mean age and BP of the participants were aged 44.2 +/- 11.6 years and 127/77 mmHg, respectively. The participants (36.6%) had a BP of greater than or equal to 140/90 mmHg whereas 13.3% had BP of greater than or equal to 160/95 mmHg. 22.1% had isolated systolic hypertension whereas 14.5% had isolated diastolic hypertension using the BP of greater than or equal to 140/90 mmHg cut off-point. Using the BP of greater than or equal to 160/95 mmHg, isolated systolic hypertension and isolated diastolic hypertension were 6.63%, respectively. A male-to-female ratio of 1.7 : 1 and 1 : 5 was observed for BP greater than or equal to 140/90 mmHg and BP greater than or equal to 160/95 mmHg, respectively. Hypertension prevalence increased across age gradient from young to old adults. CONCLUSION: The prevalence estimates of hypertension obtained in this study was higher than those found in most earlier studies from Nigeria, other West Africa nations and for African-Americans.