Systemic thromboembolism in endomyocardial fibrosis (EMF): clinical observations, aetio-pathogenesis and treatment.

Mural thrombi and thromboemboli are very common in idiopathic hypereosinophilic syndrome (HES), whose cardiac pathology is indistinguishable from endomyocardial fibrosis (EMF). Although mural thrombi are common in EMF cases, and post mortem embolic infarcts are frequently seen; clinical recognition of thromboembolism in EMF is unusual. We report here 4 cases of clinically recognized thromboembolism among 106 consecutive cases of EMF (including a case with a sudden onset of vascular occlusion and a below knee infarction and auto-amputation of the right leg). Two of the 4 cases had hypereosinophilia that was probably induced by microfilaria. The mechanisms of mural thrombosis and thromboembolic infarcts in EMF cases are discussed, and the possibility shown that helminth induced eosinophilic myocarditis can induce similar acute mural thrombosis and thromboembolism. The place of anticoagulant therapy in EMF is discussed.

A Controlled study of effect of counseling on psychological symptoms among people living with HIV/AIDS in Uyo, Nigeria

Psychological symptoms are common complications of HIV/AIDS. More often; decision making during management neglects the use of counseling; a common but important therapy in people living with HIV/AIDS. The increasing morbidity due to maladjustment to supportive care often results in poor quality of life. The objectives of this study were to determine the effect of counseling in people living with HIV/AIDS and compare the levels of anxiety and depression in them. Four hundred and twenty newly diagnosed persons living with HIV/AIDS referred to the University of Uyo Teaching Hospital in January 2007 were randomly divided into two groups; 1 and 2. Group 1 was instantly assessed for symptoms of anxiety and depression; using the Hospital Anxiety and Depression Scale (HADS); while; Group 2 was assessed one month later after undergoing intensive counseling. A total of 392 respondents; consisting of 210 in group 1 and 182 in group 2 were analyzed; 28 (13.3) respondents in group 2 defaulted from the clinic and were excluded from the study. The sociodemographic characteristics of the respondents in both groups were similar. Majority; 162 (77.1) respondents in group 1 and 137 (58.8) in group 2 aged between 20-49 years. Although; anxiety and depression were markedly reduced in 137 (34.9) and 35 (19.2) respondents in group 2 with counseling compared to 199 (50.8) and 90 (42.8) respondents in group 1 without counseling; the demographic variables of the respondents did not influence the level of anxiety and depression. However; depression was high in 24 (54.9) respondents in group 2 who had counseling and were unemployed; depression was associated with occupation (P0.04). Counseling reduces psychological symptoms in people living with HIV/AIDS. Therefore its use should be encouraged in people living with the disease to boost self-esteem needed for improved quality of life

Profile and outcome of cardiovascular admissions at the University of Uyo Teaching Hospital, Uyo--a five year review.

OBJECTIVE: The incidence of cardiovascular diseases (CVD) in developing countries has been on the increase in the last few decades. Demographic changes and adoption of negative life style associated with urbanization have been incriminated. This study is to ascertain the burden of cardiovascular disease in Uyo, a town which has been undergoing rapid urbanization in the last decade. SUBJECTS AND METHODS: A five-year retrospective analysis of cardiovascular admissions into the Medical Wards of the University of Uyo Teaching Hospital between September 1996 and September 2001 was carried out. Medical records of patients were used. The Epi Info 2002 software was used to analyse data. RESULTS: Five hundred and fifty eight (19.8%) of the 2875 medical admissions were patients with cardiovascular diseases. Their mean age was 52 +/- 12.7 years and mean duration of hospital stay was 9 +/- 7 days. Hypertension accounted for 311 (55.7%) of the cases, of these 107 (34.4%) presented with cerebrovascular accident (CVA). 44.3% presented in Heart failure and causes included Hypertension (14.9%), Cardiomyopathies particularly the dilated type (15.1%), Rheumatic heart disease (6.6%) and Anaemia (7.7%). 69 (12.4%) cardiovascular deaths were recorded, of these 34 (6.1%) were in patients with Cerebrovascular accident. Most deaths occurred within seven (7) days of admission. Duration of stay significantly influenced outcome (p = 0.000). CONCLUSION: Cardiovascular diseases constitute a significant health problem in our community. Intensive cardiovascular health education and promotion of healthy life style are advocated. Tertiary health care facilities should be equipped to cope with cardiovascular care in view of the looming epidemic of cardiovascular disease even in developing countries.

Seasonal variation in admission for heart failure, hypertension and stroke in Uyo, South-Eastern Nigeria.

BACKGROUND: Seasonal variation in hospitalization for cardiovascular disease has been described in the temperate regions of the world as well as in Northern Nigeria. Increase admission rates during the cold seasons have been reported in these areas. No studies have been done in Southern Nigeria. This study is thus aimed at describing the seasonal variation in admissions for heart failure, uncontrolled hypertension and hypertension related-stroke in Southern Nigeria. METHODS: Hospital records of patients admitted to the medical wards of the University of Uyo Hospital (UUTH) with heart failure of all causes, uncontrolled hypertension and hypertension-related stroke (Cerebrovascular accident) between January 1998 and December 2001 were used. Epi-info 2002 software was used to analyze data. RESULTS: Of the 3500 patients admitted during the study period 542 (15.3%) were on account of heart failure, uncontrolled hypertension and hypertension related cerebrovascular accident (CVA). The mean age of patients was 52 +/- 12.8 years. The average monthly admission was eleven (11). More admissions were recorded in the rainy (cold) season than in the dry (hot) season. The observed difference was however statistically significant only for heart failure and uncontrolled hyper tension (P < .05). CONCLUSION: Admissions for heart failure and uncontrolled hypertension are therefore more during the wet (cold) season in southern Nigeria. This may be attributed to the high default rate to follow up visit in this season when agricultural activity is intense and less attention given to medical care. This leads to poor compliance to medications and clinical deterioration. The already bad road network both in rural and urban centers also become worse at this time making access to medical care difficult. Facilities and measures should thus be put in place to provide adequate medical care for these patients during that period of the year.

Seasonal variation in admission for heart failure, hypertension and stroke in Uyo, south-eastern Nigeria

Background:Seasonal variation in hospitalization for cardiovascular disease has been described in thetemperate regions of the world as well as in Northern Nigeria. Increase admission rates during the coldseasons have been reported in these areas. No studies have been done in Southern Nigeria. This studyis thus aimed at describing the seasonal variation in admissions for heart failure, uncontrolledhypertension and hypertension related-stroke in Southern Nigeria.Methods:Hospital records of patients admitted to the medical wards of the University of Uyo Hospital(UUTH) with heart failure of all causes, uncontrolled hypertension and hypertension­related stroke(Cerebrovascular accident) between January 1998 and December 2001 were used. Epi-Info 2002software was used to analyze data.Results:Of the 3500 patients admitted during the study period 542 (15.3%) were on account of heartfailure, uncontrolled hypertension and hypertension related cerebrovascular accident (CVA). The meanage of patients was 52±12.8 years. The average monthly admission was eleven (11). More admissionswere recorded in the rainy (cold) season than in the dry (hot) season. The observed difference washowever statistically significant only for heart failure and uncontrolled hypertension (P<.05).Conclusion:Admissions for heart failure and uncontrolled hypertension are therefore more during thewet (cold) season in southern Nigeria. This may be attributed to the high default rate to follow up visitin this season when agriculturalactivity is intense and less attention given to medical care. This leads topoor compliance to medications and clinical deterioration. The already bad road network both in ruraland urban centers also become worse at this time making access to medical care difficult. Facilities andmeasures should thus be put in place to provide adequate medical care for these patients during thatperiod of the yea

Prevalence and pattern of abnormal glucose tolerance in adult Nigerians with primary hypertension.

BACKGROUND: Hypertension and diabetes mellitus relate to one another aetiologically and prognostically. Studies show that hypertension occurs frequently in diabetics than non-diabetics. Data on the prevalence of abnormal glucose tolerance in hypertensive Nigerians are scanty This study assesses the magnitude of this problem in adult Nigerians with primary hypertension. METHOD: Oral glucose tolerance test was performed on 124 adult Nigerians (64 hypertensives, 60 normotensives) to determine the prevalence of abnormal glucose tolerance. Body mass index and waist circumference were measured. Plasma glucose was analyzed by the glucose oxidase method. RESULTS: The hypertensive (32 males, 32 females) and normotensive (30 males, 30 females) had mean ages of 47.6 +/- 10.1 years and 44.2 +/- 7.6 years. The mean body mass index and waist circumference of hypertensives and normotensives were 30.2 +/- 80 kg/m, 100.8 +/- 17.2 cm and 28.5 kg/m, 88.5 +/- 14.1 cm. The mean plasma glucose in mmols/l, during oral glucose tolerance test of hypertensives and normotensives, at 0 hr, 1 hr and 2 hrs were, 4.79 +/- 0.99, 6.94 +/- 1.5, 5.96 +/- 1.82 and 4.42 +/- 0.90, 6.25 +/- 1.02, 5.05+ +/- 1.8 respectively. The response to glucose load was significantly higher in the hypertensives than normotensives particularly at 2 hours p < 0.001. 62.5% of hypertensives responded normally to glucose load. 32.8% had impaired glucose tolerance. All controls responded normally. 6.25% of hypertensives had impaired fasting glucose. 4.6% of hypertensives had diabetes. No control had diabetes. The hypertensives with abnormal glucose tolerance had higher body mass index and waist circumference, than hypertensives with normal glucose tolerance, and controls. CONCLUSION: Mean venous plasma glucose levels are higher in hypertensive adult Nigerians, than their normotensive counterparts. Impaired glucose tolerance is more prevalent than impaired fasting glucose and diabetes mellitus.

A comparative study of attitude to mental illness between journalists and nurses in Uyo, Nigeria.

The pernicious attitudes to mental illness often result from ignorance and enduring sociocultural prejudices. The endless negative depiction of mentally ill persons by the society is responsible for poor mental health services and care, thus the increasing number of persons with mental illness roaming the streets in our environment. The objectives of the study were: First to assess the attitude of the Journalists to mental illness. Secondly to compare the journalists' attitudes with that of the Nurses. Two hundred and fifty Journalists in Uyo were randomly assessed for attitudes to mental illness, using Taylor and Dear Inventory of Community Attitude to mental illness. This was compared with Nurses from Health Centers in Uyo. Data from 210 (84.0%) Journalists and 154 (85.6%) Nurses were analyzed, 40 (16.0%) of Journalists and 26 (14.4%) of Nurses were excluded due to incomplete information. The mean age of the two groups was 39.4 +/- 8.3 and 34.4 +/- 7.6 years respectively. The difference in the mean was statistically significant (p = 0.001). Responses were similar in the two groups. Negative opinions were prevalent among the respondents in the region of over 70% among Journalist and 60% in Nurses in most cases. Except marrying people with mental illness, other responses were statistically significant. There is a widespread negative attitude to mental illness among Journalists and this is a reflection of the general population. The media is the primary source of public information. Therefore, accurate and positive portrayal of mental illness on both electronic and printing media may be necessary to sensitize the public so as to improve the negative cultural environment surrounding persons with mental illness.

Prevalence and Pattern of Abnormal Glucose Tolerance in Adult Nigerians with Primary Hypertension

Background: Hypertension and diabetes mellitus relate to one another aetiologically and prognostically. Studies show that hypertension occurs frequently in diabetics than non-diabetics. Data on the prevalence of abnormal glucose tolerance in hypertensive Nigerians are scanty. This study assesses the magnitude of this problem in adult Nigerians with primary hypertension. Method: Oral glucose tolerance test was performed on 124 adult Nigerians (64hypertensives; 60normotensives) to determine the prevalence of abnormal glucose tolerance. Body mass index and waist circumference were measured. Plasma glucose was analyzed by the glucose oxidase method. Results: The hypertensive(32 males;32females) and normotensive (30males; 30females) had mean ages of 47.6+/-10.1years and 44.2+/-7.6years.The mean body mass index and waist circumference of hypertensives and normotensives were 30.2+/-80kg/m;100.8+/-17.2cm and28.5kg/m;88.5+/-14.1cm. The mean plasma glucose in mmols/l; during oral glucose tolerance test of hypertensives and normotensives; at 0hr; 1hr and 2hrs were;4.79+/-0.99;6.94+/-1.5;5.96+/-1.82 and4.42+/-0.90;6.25+/-1.02;5.05++/-1.8 respectively. The response to glucose load was significantly higher in the hypertensives than normotensives particularly at 2hours p

Prevalence and Pattern of Abnormal Glucose Tolerance in Adult Nigerians with Primary Hypertension

Background: Hypertension and diabetes mellitus relate to one another aetiologically and prognostically. Studies show that hypertension occurs frequently in diabetics than non-diabetics. Data on the prevalence of abnormal glucose tolerance in hypertensive Nigerians are scanty. This study assesses the magnitude of this problem in adult Nigerians with primary hypertension. Method: Oral glucose tolerance test was performed on 124 adult Nigerians (64hypertensives; 60normotensives) to determine the prevalence of abnormal glucose tolerance. Body mass index and waist circumference were measured. Plasma glucose was analyzed by the glucose oxidase method. Results: The hypertensive(32 males;32females) and normotensive (30males; 30females) had mean ages of 47.6+/-10.1years and 44.2+/-7.6years.The mean body mass index and waist circumference of hypertensives and normotensives were 30.2+/-80kg/m;100.8+/-17.2cm and28.5kg/m;88.5+/-14.1cm. The mean plasma glucose in mmols/l; during oral glucose tolerance test of hypertensives and normotensives; at 0hr; 1hr and 2hrs were;4.79+/-0.99;6.94+/-1.5;5.96+/-1.82 and4.42+/-0.90;6.25+/-1.02;5.05++/-1.8 respectively. The response to glucose load was significantly higher in the hypertensives than normotensives particularly at 2hours p

Tuberculosis in Calabar: a ten-year review (1994-2003).

BACKGROUND: The aim of the study is to determine the pattern of tuberculosis as seen in Calabar over 10 years (1994-2003). METHODS: A ten-year retrospective study (1994-2003) was carried out to evaluate the pattern of tuberculosis among subjects in Calabar, Nigeria. A total of 6,737 cases of confirmed pulmonary and extrapulmonary tuberculosis seen during the period of survey were reviewed. The cases were drawn from the Infectious Disease hospital (IDH) Calabar, University of Calabar teaching hospital (UCTH), and TBL unit of the Ministry of Health, Calabar. Subjects, apart from being symptomatic were confirmed to have Pulmonary Tuberculosis (PTB) by Ziehl-Neelsen's sputum staining technique. Positive confirmation was attained if a patient's sputum was positive for acid fast bacilli on at least two separate times in line with the World Health Organisation's (WHO's) recommendation. In addition, some patients had chest radiograph, and those with evidence of pleural effusion were confirmed by pleural aspirate. However, cases with extrapulmonary tuberculosis (EPTB) were considered separately and the site of the lesions noted. RESULTS: The results revealed some progressive yearly increase in the number of tuberculosis [TB] cases over the 10-year period with more children being diagnosed. Tuberculosis of the spine was the most common type of extrapulmonary tuberculosis among the patients with EPTB. The treatment outcome over the period was not satisfactory with a cure rate of 57% and a mean mortality rate of 14% (with a range of 12% to 17%), and a default rate of 18%. CONCLUSION: The implication is that either the available tools are not properly utilized or extra-measures will be required to contain the scourge. We therefore recommend an increased supervision of the intensive phase of therapy and provision of facilities for culture and drug sensitivity testing at treatment centres, in case drug resistance is a factor.

Traditional healers' practices and the spread of HIV/AIDS in south eastern Nigeria.

A 3-year (1997-1999) prospective study was carried out to evaluate the possible role of traditional healers (THs) in the spread of HIV/AIDS in south eastern Nigeria. Their patients' knowledge of HIV infection was also ascertained during the review period. Four contiguous states in south eastern Nigeria with high prevalent rates of HIV infection were chosen for the survey. Sixty-nine patients ofTHs were randomly selected and contacted from the patients' list of five selected THs in each state. Thus, a total of 20 THs and 69 patients formed subjects of the study. The study involved a face-to-face interview of the subjects by trained health personnel in each state using a prepared structured questionnaire. The questionnaire elicited information on their biodata, past/present medical history, social/family history, nature and mode of treatment received or administered, and their knowledge of HIV infection, where applicable. The results showed that there was a serious HIV/AIDS related risk inherent in the practices of Nigerian THs patronized by over 60% of the population. This was suggested by the continuous usage of unsterilized instruments and cross contamination with patients' blood and body fluid in their practices. It was further revealed that, the patients' HIV/AIDS related knowledge was poor (30%). Basic education on HIV/AIDS must be given to all groups in Nigeria including THs, their patients and general public. The World Health Organization and other agencies involved in the fight against HIV infection should focus on the safety of THs' practices as a possible mode of transmission of HIV infection in Africa. Unless this aspect is taken seriously along with other preventive strategies already adopted, the epidemic of the disease condition may continue to spread in Africa.

Acute bacterial meningitis in a developing country: diagnosis related mortality among paediatric patients.

OBJECTIVES: To evaluate the effect of late diagnosis and other factors on outcome of paediatric bacterial meningitis (BM) and recommend appropriate intervention. DESIGN: Case series. SETTING: University of Calabar Teaching Hospital, Calabar, Nigeria. SUBJECTS: 62 consecutive BM patients aged two months to 16 years admitted between 1991 and 1994. MAIN OUTCOME MEASURES: Mortality rate. RESULTS: Diagnostic difficulties experienced in 58% of cases and other factors resulted in delayed diagnosis and high mortality (20 to 47%). CONCLUSION: Only elimination of the identified inadequacies in management can significantly reduce the BM-related high mortality in developing countries.