Prognostic Significance of Pre-Discharge Plasma BNP among Heart Failure Patients in Ilorin, Nigeria.

INTRODUCTION: Although the usefulness of plasma brain natriuretic peptide (BNP) in early diagnosis of heart failure has been extensively studied, its value in predicting outcome of these patients has not been fully determined, particularly among African patients. OBJECTIVE: This study was aimed to evaluating the prognostic implications of pre-discharge BNP among hospitalized heart failure patients in Nigeria. METHODS: One hundred consecutive acutely decompensated heart failure patients managed in our center were recruited into the study. All subjects had clinical and echocardiographic evaluation. All had BNP assayed and were followed-up for six months. RESULTS: Fifteen patients (out of 91 who completed the study) died at the end of the study, giving a 6-month mortality rate of 16.5%. The mean BNP among non-survivors (655.0 ± 142.3pg/ml) was higher than survivors (409.7±178.2pg/ml) P <0.001. A plasma BNP level >525pg/ml was 87% sensitive and 75% specific for predicting death within 6-months (AUC0.854,95% CI 0.756-0.951, p<0.001). Kaplan-Meier survival curve also showed six-month survival to be significantly reduced in patients discharged with BNP levels >525pg/ml (57.6%) than in those with levels <525pg/ml (98.3%), p<0.001. CONCLUSION: Pre-discharge plasma BNP>525pg/ml in heart failure patients is predictive of early death within six months.

INTRODUCTION: Bien que l'utilité du peptide natriurétique plasma-cerveau (BNP) dans le diagnostic précoce de l'insuffisance cardiaque ait été largement étudiée, sa valeur pour prédire l'issue de ces patients n'a pas été entièrement déterminée, en particulier chez les patients africains. OBJECTIF: Cette étude visait à évaluer les implications pronostiques du BNP avant la sortie chez les patients hospitalisés pour insuffisance cardiaque au Nigeria. MÉTHODES: Cent patients consécutifs atteints d'insuffisance cardiaque en décompensation aiguë, pris en charge dans notre centre, ont été recrutés dans l'étude. Tous les sujets ont eu une évaluation clinique et échocardiographique. Tous avaient un dosage du BNP et ont été suivis pendant six mois. RÉSULTATS: Quinze patients (sur 91 ayant terminé l'étude) sont décédés à la fin de l'étude, ce qui donne un taux de mortalité à 6 mois de 16,5 %. Le BNP moyen parmi les non-survivants (655,0 ± 142,3 pg/ml) était supérieur à celui des survivants (409,7± 178,2 pg/ml) P < 0,001. Un taux plasmatique de BNP > 525 pg/ml était sensible à 87 % et spécifique à 75 % pour prédire le décès dans les 6 mois (ASC 0,854, IC à 95 % 0,756-0,951, p <0,001). La courbe de survie de Kaplan-Meier a également montré que la survie à six mois était significativement réduite chez les patients sortis avec des taux de BNP > 525 pg/ml (57,6 %) que chez ceux avec des taux < 525 pg/ml (98,3 %), p < 0,001. CONCLUSION: Le BNP plasmatique avant la sortie > 525 pg/ml chez les patients insuffisants cardiaques est prédictif d'un décès précoce dans les six mois. Mots clés: Insuffisance cardiaque décompensée aiguë, pronostic, peptide natriurétique cérébral, mortalité, Nigérians.

Structural echocardiographic abnormalities seen in HIV/AIDS patients are independent of cd4 count.

INTRODUCTION: The human immunodeficiency virus (HIV) infection remains one of the most daunting public health challenges today. Cardiac involvement in HIV/acquired immune deficiency syndrome (AIDS) is frequent and has been recognized on autopsy since the emergence of the pandemic. The objective of the study was to assess the pattern of structural echocardiographic (echo) findings in HIV/AIDS patients and compare this to the echo findings in apparently healthy HIV-negative controls. MATERIALS AND METHODS: One hundred and fifty HIV-positive patients were recruited consecutively from the HIV patients attending the University of Ilorin Teaching Hospital, Ilorin, North Central, Nigeria. One hundred and fifty age- and sex-matched controls were also recruited from the surrounding community. All the individuals had clinical examination, electrocardiography (ECG) and echocardiography (echo) done. RESULTS: ECG abnormalities were seen in 55.3% of the HIV-positive patients compared with 2.7% of controls (P < 0.001). The overall prevalence of echo abnormalities among the patients was 54%, against 15.3% (P < 0.001) of the controls. All the structural dimensions of the cardiac chambers were significantly greater than the cardiac chamber dimensions in the controls except for left atrial dimension (LAD). When the patients were considered in two groups of those with CD4 count less than 200 cells/mm3 than those with CD4 count more than 200 cells/mm3, the structural chamber dimensions were similar between both groups. CONCLUSIONS: Echo is an important tool for detecting cardiac abnormalities in HIV/AIDS patients. There is a high prevalence of echo abnormalities among HIV patients seen in our centre. The HIV infection was associated with increased structural dimensions of cardiac chambers compared with HIV-negative controls. This however did not seem to be related to disease severity as the chamber dimensions were similar between those with CD4 count below and above 200 cells/mm3.

Racial differences in the ECG--selected aspects.

INTRODUCTION: Racial differences in the ECG have been known about for many years but there has been no significant comparison of large population groups. This study set out to remedy this shortcoming. METHODS: Digital ECG data were available for four population samples gathered in Scotland, Taiwan, Nigeria and India. All ECGs were recorded in the different countries and processed centrally by the University of Glasgow ECG Analysis Program. Measurements were analysed statistically to look for significant differences. RESULTS: There were 4223 individuals in the study (2559 males and 1664 females). In general terms, findings such as QRS duration being longer in males than females applied to all four races. More specifically, QRS voltages were higher in young black males compared to others, while ST amplitudes, as in V2, were higher in Chinese and Nigerian males than in Caucasians. CONCLUSION: Race requires to be taken into account to enhance automated interpretation of the ECG.

Knowledge and practice of hypertensive patients as seen in a tertiary hospital in the middle belt of Nigeria.

BACKGROUND: Hypertension remains the commonest non-communicable disease in Nigeria and a leading cause of cardiovascular morbidity and mortality. Knowledge and practice among hypertensive patients were therefore assessed as a prelude towards attaining better blood pressure control. MATERIALS AND METHOD: 224 consecutive hypertensive patients were prospectively studied using a pre-tested questionnaire. RESULTS: Majority of the hypertensive patients attending University of Ilorin Teaching Hospital were either traders or business men/women (44.5%). Only 35.8% had their blood pressure well controlled and about 61% were diagnosed for the first time to be hypertensive in the teaching hospital. 34% of the patients commuted a distance of more than 5 km to the hospital to receive antihypertensive care. 52% and 25% of the patients checked their blood pressure monthly and three-monthly respectively. One patient volunteered history of smoking. 48% and 51.8% knew that smoking increases the propensity to develop complications and that exercise is beneficial for the control of blood pressure respectively. Knowledge of the possible complications of hypertension was very poor as 58.9% of the patients scored less than average. Only 41.1% and 1.8% of the patients were aware that excessive salt and fat intake could adversely affect the control of hypertension respectively. CONCLUSION: Blood pressure control is still unacceptably poor among hypertensive Nigerians. This may not be unconnected with the poor knowledge of hypertension and adverse practices by the patients.

Prevalence of QTc prolongation in adult Nigerians with chronic heart failure.

BACKGROUND: The heart rate corrected QT interval (QTc) on the electrocardiogram (ECG) has been proposed as a risk factor for ventricular arrhythmias and death in apparently healthy populations, patients with myocardial infarction and diabetes mellitus. However, data on the significance of QTc prolongation in heart failure are scarce. OBJECTIVE: Our objective was to examine the prevalence of QTc prolongation in adult Nigerians with heart failure and its association with arrhythmias. METHODS: Ninety consecutive patients with heart failure were recruited along with 90 age-and sex-matched controls. All the subjects had a 12-lead ECG and a rhythm strip (lead II). The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using a 2D guided m-mode and Doppler echocardiogram respectively. RESULTS: The mean age of the patients was 51.9 (16) years compared with 50.3 (15.2) years for the control group, p = 0.47. Mean left ventricular ejection fraction was significantly lower in the patients than in the controls (38.9 (11)% versus 72.2 (8)%), p = 0.001. The mean QTc was significantly prolonged in the patients than in the controls (0.472 (0.036) versus 0.390(0.032) respectively), p = 0.001. The prevalence of QTc prolongation was 63% in the patients against 4.4% in the controls. There was a significant association between ventricular arrhythmias and QTc prolongation. CONCLUSION: The results of this study shows that there is a high prevalence of QTc prolongation in adult Nigerians with heart failure and this may be harbinger for ventricular arrhythmias and sudden death.

Prognostic significance of QT interval prolongation in adult Nigerians with chronic heart failure.

BACKGROUND AND OBJECTIVES: Prognostic survival studies for heart-rate corrected QT interval in patients with chronic heart failure are few; although these patients are known to have a high risk of sudden cardiac death. This study was aimed at determining the mortality risk associated with prolonged QTc in Nigerians with heart failure. MATERIALS AND METHOD: Ninety-six consecutive patients with heart failure were recruited with 90 age and sex-matched controls. All the subjects had a 12-lead electrocardiogram at a paper speed of 25 mm/sec and a rhythm strip (lead II) at 50 mm/sec. The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using 2D guided M-mode and Doppler echocardiogram respectively. They were followed-up for six months. RESULTS: Ninety-one patients and 90 controls completed the study. Five patients were lost to follow-up. The mean age (51.9 +/- 16 years) of the patients was similar to that of the controls (50.3 +/- 15) (P = 0.475). Twenty-eight (30.8%) patients died after 6 months of follow-up against none of the controls. The mean QTc was significantly longer in the non-survivors (0.494 +/- 0.027) than in the survivors (0.462 +/- 0.035) (P = 0.0001). The percentage mortality in patients with prolonged QTc against those with normal QTc was 41% and 14% respectively (P = 0.001). In the stepwise regression analysis, QTc was an independent predictor of mortality (R = 0.412, R2 = 0.17, P= 0.001). CONCLUSION: QTc prolongation is a predictor of mortality in CHF and may be an important adjunct in risk stratification of patients with heart failure.

Human immunodeficiency virus-associated tuberculosis: pattern and trend in the University of Ilorin Teaching Hospital.

To define the incidence and spectrum of extra pulmonary tuberculosis (EPTB) and the trend of pulmonary tuberculosis (PTB) among human immunodeficiency virus (HIV) infected patients in the University of Ilorin teaching hospital, a tertiary care centre in Nigeria. Review of all PTB cases diagnosed by Ziehl-Neelsen staining technique and EPTB diagnosed by tissue histology and/or cytology between January 2000 and December 2004. HIV/TB coinfection occurred in 40% (297 cases) of the 744 new cases of tuberculosis (TB) seen in the last 5 years, HIV/PTB occurred in 79% and HIV/EPTB occurred in 21%. About 47 new cases of HIV/PTB and 12 of HIV/EPTB were diagnosed per year. Tuberculous pleurisy with effusion; 23%, tuberculous meningitis; 16% and genital tuberculosis; 10% as (tuberculous: orchitis, endometritis and frozen pelvis) were common form of extra pulmonary presentation. The chance of mixed presentation was 3 times higher amongst the HIV positive than HIV negative patients; 27 vs. 11: X2 = 6.99, OR 3.25; 95% CI = 1.32-8.14, p-value = 0.008. Similarly the chance of miliary tuberculosis was 4 1/2 times higher in the HIV positive group; 9 vs. 2: X2 = 4.29, OR 4.67; 95% CI = 0.90-45.93, p-value = 0.03. Both conditions recorded the lowest CD4+ cells count; 88 cells/ul and 93.6.6 cells/ul, thus serving as features of advanced HIV illness. PTB and EPTB are common amongst the HIV infected patients; miliary spread and mixed presentation are signs of severe immunosuppression.

Prevalence and determinants of erectile dysfunction among people with type 2 diabetes in Ilorin, Nigeria.

STUDY OBJECTIVES: To determine the prevalence and determinants of Erectile Dysfunction (ED) among men with Type 2 diabetes mellitus. MATERIALS AND METHODS: Seventy-seven adult men with Type 2 Diabetes Mellitus were assessed for Erectile Dysfunction using the 'IIEF-5' questionnaire. They were also assessed for the presence of certain clinical factors in other to determine their degree of correlation with ED. RESULTS: The mean age of the study subjects was 56.8(+/-2.4) years. Almost all (96.1%) were married. Forty-four (56.4%) men volunteered a history of Erectile Dysfunction. When assessed with the 'IIEF - 5' questionnaire, the prevalence of any degree of ED was 74% while moderate to severe ED was found in 39(51%) of the patients. The only clinical variables that had statistically significant correlation with ED were the age of the patients (p=0.04) as well as the duration of diabetes (p=0.04). CONCLUSION: - Erectile Dysfunction is a very common condition among men with Type 2 Diabetes mellitus in Ilorin, Nigeria and should therefore be routinely sought for by the clinicians. The two clinical factors that confer significant risk to development of ED, from this study are non-modifiable. More emphasis should therefore be placed on treatment rather than the prevention of this condition.

Left ventricular hypertrophy and hypertension.

BACKGROUND: Hypertension is the commonest non-communicable disease in our environment. Left ventricular hypertrophy is quite prevalent among this category of patients. METHODS: An endeavour was therefore made to review the literature on left ventricular hypertrophy in hypertension using MEDLINE and bibliographic searches for English language studies. RESULTS: The epidemiology, pathogenesis, molecular mechanism, pathophysiology, pathology and diagnosis of left ventricular hypertrophy in hypertension were presented. Effect of left ventricular hypertrophy on morbidity and mortality and the probable consequence of its regression were also discussed. CONCLUSION: Left ventricular hypertrophy in hypertension can be detected through an avalanche of diagnostic modalities and criteria. It carries not just management but also prognostic implications.

Correlation between left ventricular mass and electrocardiographic variables among hypertensive Nigerians.

In a study of 60 newly diagnosed hypertensive patients, left ventricular mass was assessed echocardiographically by 2-D-derived M-mode, using the Penn cube function. Electrocardiographic variables of R1, RaVF, RaVL, RV5, RV6, SV1, SV2, SV1 + RV6, SV2 + RV6 and Estes' point score were determined for each of the patients. These variables were then compared in-turn with the left ventricular mass to determine the degree of correlation. ECG variables correlate very poorly with Echo left ventricular mass with Estes point score showing the highest correlation(0.39) and RaVL the least(-0.01). Since these ECG variables constitute the criteria used in the diagnosis of left ventricular hypertrophy caution should therefore be applied in the reliance on electrocardiography for the diagnosis of this clinical entity.

Blood sugar control among fasting Muslims with type 2 diabetes mellitus in Ilorin.

Fasting in the month of Ramadan represents a recurring annual event in the life of a Muslim. It also represents one of the five pillars around which the Islamic faith revolves making it desirable to even diabetic Muslims if only to live a spiritually fulfilling life. We therefore embarked upon the study of 33 patients with Type 2 Diabetes Mellitus who fasted in the month of Ramadan of 1417 Hijra year (1997 Gregorian) with a view to establishing the effect of fasting on their blood sugar control. This is meant to serve as a framework for establishing a scientific basis for advice to Muslim diabetic patients who may wish to fast in subsequent years. Eight point three percent of patients considered for enrollment signified their non-willingness to fast even after health-education. In the month preceding fasting the mean +/- SD for fasting blood sugar (FBS) was 6.71 +/- 2.81 mmol/L, 6.50 +/- 2.34 mmol/L for the month of Ramadan and 6.93 +/- 2.53 mmol/L for the month after. There was no statistically significant difference between the means for the three months. However, larger percentage of patients (76%) had their fasting blood sugar improved upon during fasting than either before or after. In addition, there was no reported case of acute complication from diabetic emergencies all through the period of the study. Based on these findings, it was concluded that most Type 2 diabetic patients actually do as well, like their normal counterparts during fasting and could be encouraged to do so provided they are clinically stable.