Effect of Hibiscus sabdariffaon blood pressure and electrolyte profile of mild to moderate hypertensive Nigerians: A comparative study with hydrochlorothiazide.

BACKGROUND: Hibiscus sabdariffa (HS) is widely consumed in Nigeria as a refreshing beverage and also as an antihypertensive agent. Since three decades ago when its antihypertensive activities were reported in several animal experiments, its consumption has greatly increased. AIM: The aim of this study is to investigate the effect of HS consumption on blood pressure (BP) and electrolytes of mild to moderate hypertensive Nigerians and compare it with that of hydrochlorothiazide (HCTZ), a diuretic widely used as first-line antihypertensive drug. SUBJECTS AND METHODS: Eighty newly diagnosed, but untreated mild to moderate hypertensive subjects attending Medical Out-Patients clinic of Enugu State University Teaching Hospital, Enugu, were recruited for the study. They were randomly divided into three groups: A, B and C. Those in Groups A were given placebo; those in Group B took HCTZ while those in Group C were given HS. Treatment lasted for 4 weeks. BP, serum, and urine electrolytes were measured at baseline, weekly during treatment and 1 week after withdrawal of treatment. RESULTS: At the end of treatment, both HCTZ and HS significantly (P<0.001) reduced systolic BP, diastolic BP, mean arterial pressure and serum Na+ compared to placebo. When compared to each other, HCTZ significantly (P<0.001) reduced serum Na+ and Cl- compared to HS and significantly (P<0.001) increased K+ and Cl- output in urine. After withdrawal of treatment, the fall in BP and serum Na+ in HS group were significant compared to HCTZ where they returned to baseline values. No side effect was reported during the study. CONCLUSION: HS was a more effective antihypertensive agent than HCTZ in mild to moderate hypertensive Nigerians and did not cause electrolyte imbalance. HS showed longer duration of action compared to HCTZ and reduction in serum Na+ may be another antihypertensive mechanism of action of HS.

Estimated probability of stroke among medical outpatients in enugu South East Nigeria.

BACKGROUND: Stroke is a growing noncommunicable disease in Africa and accounts for a substantial number of medical and neurological admissions in Nigerian hospitals. The prevalence of some risk factors for stroke such as hypertension and diabetes are high and growing among Africans. AIM: The aim was to investigate the distribution of stroke risk factors and estimate the 10-year probability of stroke among patients attending the out-patient clinics in the two biggest hospitals in Enugu South East Nigeria. SUBJECTS AND METHODS: Consecutive consenting patients attending out-patient clinics at University of Nigeria Teaching Hospital and Enugu state University of Science and Technology Teaching Hospital all in Enugu were enrolled. Risk factors for stroke were evaluated using a series of laboratory tests, medical history and physical examinations. The 10-year probability of stroke was determined by applying the Framingham stroke risk equation. Statistical analysis was performed with the use of the SPSS 17.0 software package (SPSS Inc., Chicago, IL, USA). RESULTS: A total of 165 patients were evaluated. Of these 94 were male and 71 were female. The most common risk factors were left ventricular hypertrophy 70.3% (116/165) and raised systolic blood pressure 52.7% (87/165). The mean age of patients was 66.1 (8.1) years. The mean 10-year probability of stroke was 18.1 (14.6) (19.7 [14.9] in men and 14.5 [14.6] women) and was higher in older age groups. CONCLUSION: The 10-year probability of stroke in Nigerians attending medical outpatient Clinic in SE Nigeria may be high. Aggressive interventions are needed to reduce risk factors and the probability of stroke risks especially in men in SE Nigeria.

Pattern of medical admissions at enugu state university of science and technology teaching hospital: a 5 year review.

BACKGROUND: Rapid urbanization and changing lifestyle have modified the profile and pattern of various medical disorders in many Nigerian communities. Surveys of medical admissions into various Nigerian health institutions show an increasing burden of non-communicable diseases in our communities. AIM: To determine the profile and pattern of medical cases admitted and their outcome in a new tertiary medical institution in South East Nigeria. MATERIALS AND METHODS: A review of medical admissions into the Enugu State University of Science and Technology Teaching Hospital (ESUTTH), Enugu, Nigeria over 5 years between January 1, 2006 and December 30, 2010 was undertaken. Morbidity and mortality data were obtained from ward registers and subsequently medical record registers. Classifications of medical disorders were grouped using ICD 10 coding system. RESULTS: A total of 3,865 case records were analyzed. Males were 2,312/3,865 (59.6%) and females 1,660/3,865 (40.2%). The age range was 14-105 years with a mean age of 54.3 (18.1) years. The 4 commonest causes of medical ward admissions were neurological disorders-850/3,865 (22%), endocrine disorders-735/3,865 (19.1%), cardiovascular disorders-718/3,865 (18.5%) and infectious diseases-604/3,865 (15.6%). The diseases encountered most were diabetes mellitus-735/3,865 (19.1%), hypertension/congestive cardiac failure-703/3,865 (18.2%), strokes-614/3,865 (15.9%) and human immunodeficiency virus (HIV)/AIDS-503 (13.1%). The overall mortality was 766/3,865 (19.8%) men-467/2,312 (20.2%); women-299/2,312 (19.3%). Strokes accounted for most of the deaths-171/766 (22.3%) followed by HIV/AIDS 127/766 (16.6%). Hypertension/cardiac failure and diabetes each accounted for 116/766 (15.1%) of all deaths. Case fatality rates for strokes and HIV/AIDS were the highest (171/614 (27.9%) and 127/503 (25.2%) respectively). Mortality rate was highest in the above 70 years age group. CONCLUSION: Non-communicable disorders are the commonest causes of medical ward admission in this tertiary institution. Efforts aimed at primary prevention will help to reduce the burden of these disorders in the community.

Outcome and challenges of kidney transplant in patients with sickle cell disease.

Sickle cell nephropathy is a common presentation in patients with sickle cell disease. End-stage kidney disease is the most severe presentation of sickle cell nephropathy in terms of morbidity and mortality. Sickle cell disease patients with end-stage kidney disease are amenable to renal replacement therapy including kidney transplant. Kidney transplant in these patients has been associated with variable outcome with recent studies reporting short- and long-term outcomes comparable to that of patients with HbAA. Sickle cell disease patients are predisposed to various haematological, cardiorespiratory, and immunological challenges. These challenges have the potential to limit, delay, or prevent kidney transplant in patients with sickle cell disease. There are few reports on the outcome and challenges of kidney transplant in this group of patients. The aim of this review is to highlight the outcome and challenges of kidney transplant in patients with sickle cell disease.

Profile of aerobic bacteria isolated in chronic maxillary sinusitis patients.

OBJECTIVES: To determine the pattern of aerobic bacteria isolated in patients with chronic maxillary sinusitis at the Ear, Nose and Throat Clinic of the University of Nigeria Teaching Hospital, Enugu, and the antibiotics sensitivity pattern of these organisms. METHODS: A prospective hospital-based clinical study. RESULTS: Fifty - four patients with clinical diagnosis of chronic maxillary sinusitis were evaluated. Out of 54 maxillary sinus aspirate specimens studied, 31 yielded bacterial growths and 32 no bacterial growth. The common aerobic bacteria isolated were Staphylococcus aureus (32.3% ), Pseudomonas aeruginosa and Escherichia coli were 16.1% each. Staphylococcus aureus was sensitive to Erythromycin, and the gram-negative organisms to Gentamicin. CONCLUSION: Bacteria isolated in chronic maxillary sinusitis and their sensitivity patterns varied. Bacteriologic study of the antral washings / aspirates should be done in every patient with chronic maxillary sinusitis. Combination chemotherapy that included Erythromycin and Gentamicin was recommended.

Correlation of plain radiological diagnostic features with antral lavage results in chronic maxillary sinusitis.

To justify the continued relevance of plain radiography of maxillary sinus in establishing diagnosis and planning treatment of chronic maxillary sinusitis, its specificity and predictive values must have a high degree of confidence. The objective of this study was to examine different plain radiographic features and correlate them with antral lavage results in patients suffering from chronic maxillary sinusitis. Air-fluid level and antral opacity have specificity of 92.3% each and positive predictive value of 87.5% and 96.0% respectively. Gross mucosal thickening and haziness showed low specificity and predictive values of 36.7% and 29.4% respectively. Normality of radiographs was reliable in predicting clear antral lavage effluent. Plain radiograph of the maxillary sinus is still relevant in establishing diagnosis and planning treatment in chronic maxillary sinusitis.