Epidemiological African day for evaluation of patients at risk of venous thrombosis in acute hospital care settings.

INTRODUCTION: This study aimed to identify patients at risk for venous thromboembolism (VTE) among all patients hospitalised, and to determine the proportion of at-risk hospital patients who received effective types of VTE prophylaxis in sub-Saharan Africa (SSA). METHODS: A multinational, observational, cross-sectional survey was carried out on 1 583 at-risk patients throughout five SSA countries. RESULTS: The prevalence of VTE risk was 50.4% overall, 62.3% in medical and 43.8% in surgical patients. The proportion of at-risk patients receiving prophylaxis was 51.5% overall, 36.2% in medical and 64% in surgical patients. Low-molecular weight heparin was the most frequently used prophylactic method in 40.2% overall, 23.1% in medical and 49.9% in surgical patients. DISCUSSION: This study showed a high prevalence of VTE risk among hospitalised patients and that less than half of all at-risk patients received an American College of Clinical Pharmacy-recommended method of prophylaxis. CONCLUSION: Recommended VTE prophylaxis is underused in SSA.

Epidemiological African Day for Evaluation of Patients at Risk of Venous Thrombosis in Acute Hospital Care Settings : Cardiovascular Topic

Introduction : This study aimed to identify patients at risk for venous thromboembolism (VTE) among all patients hospitalised; and to determine the proportion of at-risk hospital patients who received effective types of VTE prophylaxis in sub-Saharan Africa (SSA). Methods: A multinational; observational; cross-sectional survey was carried out on 1 583 at-risk patients throughout five SSA countries. Results: The prevalence of VTE risk was 50.4 overall; 62.3 in medical and 43.8 in surgical patients. The proportion of at-risk patients receiving prophylaxis was 51.5 overall; 36.2 in medical and 64 in surgical patients. Low-molecular weight heparin was the most frequently used prophylactic method in 40.2 overall; 23.1 in medical and 49.9 in surgical patients. Discussion: This study showed a high prevalence of VTE risk among hospitalised patients and that less than half of all at-risk patients received an American College of Clinical Pharmacy-recommended method of prophylaxis. Conclusion: Recommended VTE prophylaxis is underused in SSA

QT dispersion in hypertensive Nigerians with and without left ventricular hypertrophy.

BACKGROUND: Increased QT dispersion (QTd) has been implicated as a marker of arrhythmogenesis and cardiac death. Paucity of literature on QTd in Nigeria necessitated an inquiry into QTd in adult hypertensive population. This study sought to: (i) compare the QTd values of adult hypertensive subjects with age and sex matched normotensive subjects and (ii)examine the relationship between QTd and left ventricular hypertrophy (LVH). STUDY DESIGN: One hundred and fifty-one hypertensive patients and 101 age and sex-matched controls were recruited into this study. A resting 12- lead ECG was obtained from all subjects for determination of QTd and ECG LVH using Sokolow Lyon (SL) and Araoye's codes. Echocardiographic LVH was determined for 60 hypertensive subjects and 60 age/sex matched controls. RESULTS: Hypertensive subjects had higher mean QTd than the controls (65.6 ± 28.1 ms vs 38.7 ± 11.3 ms, p< 0.0001). QTd of hypertensives with ECG LVH was significantly higher than those without ECG LVH (Araoye: 71.5 ± 22.0 ms vs 62.2 ± 24.1 ms, p = 0.02, SL; 72.0 ± 24.4 ms vs 61.6 ± 23.1 ms p = 0.009). Similarly the QTd of hypertensives with echocardiographic LVH (72.6 ± 21.3 ms) was higher than those without (60.1 ± 22.2 ms) but did not achieve statistical significance (p = 0.085). CONCLUSIONS: Hypertension with or without ECG LVH is associated with significantly increased QTd. Echo-cardiographic LVH is associated with a non significant increase in QTd in hypertensive subjects.

QT Dispersion in Healthy Adult Nigerians.

BACKGROUND: Increase in QT dispersion (QTd) is associated with an increased risk of cardiovascular morbidity and mortality. OBJECTIVES: This study sought to (i) determine the mean QTd and (ii) characterise QTd in a healthy Nigerian population. METHODS: One hundred healthy Nigerian adults were studied. Healthy status of the subjects was determined by history and physical examination. A resting 12- lead ECG was obtained from all subjects for determination of QTc, QTd and ECG left ventricular hypertrophy (LVH) using Sokolow Lyon (SL) and Araoye's codes. Echocardiography was used to determine LV systolic function, LVM and LVMI for 60 subjects. RESULTS: The QTd ranged from 15-70ms with a mean value of 38.5 ± 11.2ms. QTd was independent of age (p = 0.86), sex (p = 0.97), heart rate (p = 0.22), blood pressure (p > 0.05), BMI (p = 0.81), QTc (p = 0.41), LVH (ECG and echo) and LV systolic function (p > 0.05). CONCLUSION: QT dispersion is independent of demographic parameters, LV systolic function and LV hypertrophy in healthy adult Nigerians.

Echocardiographic patterns in treatment-naïve HIV-positive patients in Lagos, south-west Nigeria.

INTRODUCTION: Cardiovascular abnormalities are common in HIV-infected patients, although often clinically quiescent. This study sought to identify by echocardiography early abnormalities in treatment-naïve patients. METHODS: One hundred patients and 50 controls with no known traditional risk factors for cardiovascular disease were recruited for the study. The cases and controls were matched for age, gender and body mass index. Both groups had clinical and echocardiographic evaluation for cardiac abnormalities, and CD4 count was measured in all patients. RESULTS: The cases comprised 57 females (57.0%) and 43 males (43.0%), while the controls were 28 females (56.0%) and 22 males (44.0%) (χ(2) = 0.01; p = 0.913). The mean age of the cases was 33.2 ± 7.7, while that of the controls was 31.7 ± 9.7 (t = 1.02; p = 0.31). Echocardiographic abnormalities were significantly more common in the cases than the controls (78 vs 16%; p = 0.000), including systolic dysfunction (30 vs 8%; p = 0.024) and diastolic dysfunction (32 vs 8%; p = 0.002). Other abnormalities noted in the cases were pericardial effusion in 47% (χ(2) = 32.10; p = 0.000) and dilated cardiomyopathy in 5% (five); none of the controls had either complication. One patient each had aortic root dilatation, mitral valve prolapse and isolated right heart dilatation and dysfunction. CONCLUSION: Cardiac abnormalities are more common in HIV-infected people than in normal controls. A careful initial and periodic cardiac evaluation to detect early involvement of the heart in the HIV disease is recommended.

Psychiatric morbidity in hypertensives attending a cardiology outpatient clinic in West Africa.

OBJECTIVES: To determine kinds of psychiatric morbidity among a sample of stable hypertensive outpatients in a teaching hospital. MATERIALS AND METHODS: A cross-sectional study of 260 enrolled outpatients. Psychiatric morbidity was assessed using a 2-stage evaluation method with the General Health Questionnaire Version 12 (GHQ-12) and Structured Clinical Interview for DSM-IV (SCID) to assess for psychiatric diagnosis. RESULTS: 28 (10.8%) of the 260 patients endorsed some psychological distress, with a mean GHQ-12 score of ≥ 2. At the second stage, 16.1% (N=13 of 81) interviewed had one or more psychiatric disorder on the SCID. The commonest psychiatric diagnosis made were mood disorders, with current major depressive disorder occurring at a rate of 6.2%. Other disorders found were past major depressive episode (2.5%), organic mood syndrome (3.7%), and somatoform disorder (3.7%). CONCLUSION: The relationship between hypertension and mood disorders should inform a higher index of suspicion among physicians and general practitioners in order to give patients appropriate treatments or referrals where necessary. It is recommended that collaboration with mental health service providers be encouraged.

Achieving blood preSsure goals sTudy in uncontrolled hypeRtensive pAtients treated with a fixed-dose combination of ramipriL/hydrochlorothiazide: the ASTRAL study.

BACKGROUND: Hypertension is a common cardiovascular disease, affecting adults worldwide and it accounts for up to 30% of all deaths. The need for better control of arterial hypertension justifies observational studies designed to better understand the real-life management of hypertensive patients. The ASTRAL study was primarily designed to evaluate the percentage of hypertensive patients achieving blood pressure goals after eight weeks of treatment with a fixeddose combination of ramipril/hydrochlorothiazide (HCTZ). METHODS: The study was a multi-centre, non-comparative, Open-label, observational study conducted in 36 centres in five sub-Saharan African countries, namely Cameroon, Congo Brazzaville, Democratic Republic of Congo (DRC), Madagascar and Nigeria. Four hundred and forty-nine men and women 18 years of age or older with hypertension not controlled by an ACE inhibitor, a diuretic or any other monotherapy or anti-hypertensive combination not containing a diuretic in a fixed dose were considered eligible for inclusion in this eight-week study. The study consisted of three visits, visit one (V1) at baseline, visit two (V2) after four weeks and visit three (V3) after eight weeks. RESULTS: The mean age of the patients was 54.7 ± 11.7 years (20-90 years) and most were categorised by the WHO criteria as either overweight or obese (71.6%). After four and eight weeks of treatment with the study drug, systolic and diastolic blood pressures significantly changed from baseline: -24.7/-14.2 mmHg (p < 0.001) and -31.7/-17.9 mmHg (p < 0.001), respectively. There were 60.2% of the non-diabetics on prior monotherapy who, at eight weeks, fulfilled the primary blood pressure goal for SBP and DBP, versus 26.5% of the diabetic patients, also on monotherapy. Few adverse events were reported, with facial oedema and dry cough recurring twice in two patients. CONCLUSION: Fixed-dose combination of ramipril/HCTZ is therefore effective, tolerable and has a good safety profile for blood pressure control in black Africans.

Sexual dysfunction among subjects with hypertension in a Nigerian teaching hospital.

BACKGROUND: In Africa, few studies highlight associations between sexual dysfunction and other medical conditions. It is important to know the experiences of these patients, how it affects their subsequent compliance with medications prescribed and also identify relevant factors that may be useful in planning for their care hence this study. OBJECTIVES: The study is to examine the patterns of sexual dysfunction among stable hypertensive out patients. METHODS: In a cross sectional descriptive study, 186 patients were enrolled. The Arizona Sexual Experiences scale (ASEX) and the General Health Questionnaire Version 12 (GHQ-12) were used. RESULTS: One hundred and eleven 56.7% had sexual dysfunctions, of these (33.3%) males and (66.6%) females. The mean sexual dysfunction score (on ASEX) for the hypertensive group was 14.51 (SD +/- 4.32), this was significantly higher than the figure obtained for the control group. Overall, female hypertensives experienced sexual dysfunction more than males. Males had mostly libido problems and most women had orgasmic problems. CONCLUSION: The study showed that sexual dysfunction is highly prevalent among stable patients with hypertension. Erectile dysfunction and orgasmic problems were the most common sexual dysfunctions experienced among male and female hypertensives respectively. It is recommended that monotherapy be encouraged and interventions planned for patients at higher risk.

Marfan syndrome: a study of a Nigerian family and review of current cardiovascular management.

BACKGROUND: Marfan's syndrome is a connective tissue disorder inherited as an autosomal dominant disorder. It causes a myriad of distinct clinical problems, of which the musculoskeletal, cardiac, and ocular system problems predominate. Nearly 50 percent of patients have to undergo aortic surgery in their lifetime resulting in reconstruction or replacement of the aortic root or total of this vessel's parts. OBJECTIVE: To describe a Nigerian family with multiple cases of Marfan syndrome and discuss current cardiovascular management of the syndrome. MATERIALS: Detailed history, clinical and laboratory investigations including ophthalmologic assessment and echocardiography were carried out on all members of a nuclear family of a child who reported with complaints of poor eye sight later diagnosed to have Marfan syndrome. RESULTS: Diagnosis of Marfan syndrome was made in three members of the nuclear family--a father and his two children following eye examination of one of the children. Afollow up cardiovascular assessment revealed that the father required aortic surgery while the two children also had aortic root dilatation. CONCLUSION: This report underlines the importance of a detailed history, physical examination and family study in patient assessment. Current cardiovascular management in Marfan syndrome involves a blocker therapy and an annual cardiovascular evaluation involving clinical history, examination and echocardiography. Prophylactic aortic surgery should be considered when aortic diameter at the sinus valsalva exceeds 50 mm.

Trends in acute emergency room hypertension related deaths: an autopsy study.

INTRODUCTION: Hypertension is associated with increased morbidity and mortality. Paradigm shift and novel drugs that go beyond blood pressure control have debuted in the last decade globally and in Nigeria. The study therefore proposed to investigate the effect of the above if any on hypertension related acute deaths in patients admitted to the emergency room of the Lagos University Teaching Hospital. METHOD: Autopsy reports for bodies deposited from the medical emergency room (ER) were reviewed. Details of the time of admission, time of death and blood pressure status prior to the event were obtained. Subjects were batched into two groups 1982 1991 and 1992 2001 based on periods of paradigm shift in hypertension diagnosis and management. RESULT: There were 297 hypertension related deaths but 252 were analyzed. There were 168 (66.7%) males and 84 (33.3%) females (M:F 2:1) and mean age was 47.33 +/- 12.18 years (14-85 yr). Two thirds of the subjects (65.5%) were = 50 yrs of age. The mean duration of admission was 5.88 +/- 6.41 hours. One third (35.3%) died within an hour of admission. The commonest causes of death were stroke (52.8%) and heart failure 103 (40.9%). Intra-cerebral hemorrhage was the commonest type of stroke seen, 69 (52.3%). There were fewer cases of acute deaths in the second decade under review 95 (37.7%) vs. 157 (62.3%), p = 0.02 and strokes during this period, 47 (49.47) Vs 86 (54.78), p = 0.06. CONCLUSION: There is a trend towards reduction of hypertension related acute deaths. However stroke remains a major cause of acute hypertensive death and the patients are still dying young.

Pattern of dyslipidaemia among Nigerians with type 2 diabetes mellitus.

OBJECTIVE: To characterize the pattern of lipid profile abnormalities among Nigerians with type 2 diabetes mellitus attending the Diabetes clinic of a tertiary referral centre in Nigeria. METHOD: A cross sectional analysis of 192 diabetic patients consecutively recruited from patients attending the Diabetes clinic and 52 volunteering non-diabetic and non-hypertensive controls was undertaken. The main outcome measures were lipid profile and anthropometric indices. Data analysis was done with SPSS version 10. Results were expressed as mean +/- SD. Differences between groups were regarded as significant atp < 0.05. Comparisons of means, test of association were done using independent t-test, chi-square test and bivariate (Pearson's) correlation analysis. RESULTS: Eighty-nine percent of the patients had at least one abnormal lipid profile while 64.5% had combined dyslipidaemia. Reduced HDL-C and raised TG constituted the most (88.0%) and least (25.0%) prevalent abnormalities respectively. Significant difference in the mean values of HDL-C and LDL-C was observed between the patients and controls. CONCLUSION: Dyslipidaemia is common among patients with type 2 diabetes mellitus in Nigeria with majority of the patients having a combined dyslipidaemia. There is therefore the need to pay great attention to the lipid parameters in Nigerians with type 2 diabetes mellitus.

Bradypacing: indications and management challenges in Nigeria.

BACKGROUND: Permanent pacemaker implantation is a life-saving procedure that is performed worldwide. There is paucity of reports on pacemaker surgery in Nigeria. The aims of the study were to determine the indications for pacemaker insertion, the demographic distribution of the patients requiring it, the electrocardiographic (ECG) changes, and the management challenges in Nigeria. MATERIALS AND METHOD: One hundred consecutive patients who had pacemaker insertion done by our team from 1999 were included in the study. The patients' biodata, indications for pacemaker insertion, ECG changes, and the treatment profile were recorded. RESULTS: There was female preponderance (93.0%) among the patients studied. Third-degree heart block was the indication in 86.0% of the patients and most patients did well with single lead ventricular pacing which is generally cheaper than the dual chamber pacing. CONCLUSION: The majority of bradyarrhythmia patients in this environment can be maintained on single lead ventricular pacemaker.

Comparative study of the effect of tocotrienols and -tocopherol on fasting serum lipid profiles in patients with mild hypercholesterolaemia: a preliminary report.

OBJECTIVES: Hypercholesterolaemia is a risk factor for cardiovascular diseases. Tocotrienols reportedly possess hypocholesterolaemic activity. This study examined the effect of tocotrienols (T3) in TOCOVIDTM Suprabio TM on serum lipids. Patients and Methods :A randomised (2:1), open-label study of patients with mild hypercholesterolaemia (= 5.18mmol/L to <7.77mmol/L) and one additional cardiovascular risk factor was carried out. Subjects received either tocotrienols (as TOCOVIDTM Suprabio TM ) (n=28) or vitamin E (a-tocopherol) 500mg daily (n=16). Fasting lipids were compared at baseline and after 4 weeks therapy. RESULTS: Following 4 weeks therapy, mean +/- SD total cholesterol declined significantly in the tocotrienol group (from 6.10+/-0.66 to 5.47+/-1.16; P=0.02) compared to the a-tocopherol group (from 5.92+/-0.52 to 5.47+/-0.76; P>0.05). Mean LDL-C levels (mmol/L) were also significantly reduced in the tocotrienol group (3.82+/-0.85 to 3.24+/-1.26; P=0.04), but not in those on a-tocopherol (3.84+/-0.75 to 3.28+/-0.94; P>0.05). There were no significant changes in HDL-C and triglycerides in both groups. The tocotrienol group experienced a net decline in TG (7.1+/-31.4 %; P>0.05) while the a-tocopherol group had a net increase at week 4 (38.6+/-61.7%; P>0.05). CONCLUSION: The study adds to existing evidence of the favourable effect of tocotrienols on total cholesterol and LDL-C. However, the results need further evaluation.

A Review of Chest Pain in Nigerian Hypertensive Patients Presenting to the Out-Patient's Clinic of a Teaching Hospital

In a prospective 6-month study; chest pain was reviewed in hypertensive man above 40 years and post menopausal women on antihypertensive therapy. The subjects were made up of 230 volunteers made up of 101 males and 129 females. Their mean age was 54.5 + 10 years (males 51.3 + 8.9 years vs. female 53.3 + 9.8 years). Forty seven percent of subjects admitted to pain as being located in the retrosternal area; in 38 it was cited at the precordial area and the remainder (9) cited the pain on the right side of the chest and 6 submamary. Twenty six percent and 22 of subjects described pain as being pressure like or dull consecutively. In 42 of patients pain was aggravated by exertion; in 32 of subjects pain had no aggravating factor; 14 and 3 had pain aggravated by hunger and the use of non steroidal anti-inflammatory agents. In the remaining 9 pain was aggravated by breathing particularly during the inspiratory phase of respiration. The relieving factors described include rest in 34; analgesia in (25); change of position in 4 and antacid in 12. In the remaining 25 no relieving factor was identified. Pain radiation was described was mainly to the epigastrium. Based on the symptoms; 11 had all the three parameters of pain description suggestive of angina pectoirs. 5 of patients had symptom suggestive of atypical angina and 17 had just one character present and considered non cardiac. The difference in serum cholesterol level in patients described as having classic angina and atypical were statistically significantly higher than those in subjects who did not complain of chest pain. Patients with atypical chest pain had the highest blood pressure; those with non cardiac pain had the highest WHR while those with no pain had the highest BMI. A proper approach to patients with chest pain irrespective of how trivial it may seem; should include a careful description and characterization of the chest pain; careful and a thorough physical examination. A rational and judicious utilisation of facilities should be employed carrying out the available investigations and possibly following chest pain protocols.

Effect of cervical traction on cardiovascular and selected ECG variables of cervical spondylosis patients using various weights.

BACKGROUND: There is currently no consensus among the clinicians regarding the tractive force to be employed during cervical traction (CT) that will correlate precisely with the percentage body weight of the patient and reduce the side effects associated with CT therapy. OBJECTIVE: This study therefore aimed to investigate the response of cervical spondylosis (CS) patients to different CT weights and to establish the effect of CT on the cardiovascular system of patients with cervical spondylosis (CS). METHODS: Sixty out of 78 subjects participated in the study. They were randomly assigned into three experimental groups A, B and C. Their systolic and diastolic blood pressures (SBP and DBP) and heart rates (HR) were measured. Rate pressure product (RPP) was calculated using standard equation18 and ECG recorded using the KENZ, 201 machine. Subjects' cardiovascular and ECG responses were monitored in a supine resting position (baseline) and under three experimental conditions using the subjects' 7.5% kg total body weights (TBW), 10% kg TBW and 15% TBW at different time intervals (5, 10 and 15 minutes respectively). RESULTS: Compared with the baseline values, there was a drop in SBP, DBP and RPP for all subjects in the three groups. The SBP, DBP and RPP alteration were not significant for the 7.5% TBW CT, but significant (p <0.05) for the 10% and 15% TBW tractions. The HR and ECG variables revealed no significant difference in all the groups, these results signified that the cardiac muscles were not adversely affected by any of the traction weights during application. Twenty subjects had side-effects including 5 subjects that terminated the treatment due to pain during the CT application. CONCLUSIONS: Cardiovascular alterations do occur during the application of cervical traction weights resulting in untoward patient's reactions. Efforts should be made to monitor the cardiovascular variables during and immediately after CT especially in "high risk" patients, that is, elderly patients and patients with unstable cardiovascular systems.

Electrocardiographic and echocardiographic findings of Nigerian athletes. A Lagos Study

Summary In a prospective study spanning over 6 months involving one hundred and nineteen male and female subjects comprising 98 Nigerian athletes and 55 age and sex matched controls all had electrocardiography and echocardiographic assessment of left ventricular dimensions and systolic function. Athletes were found to have significant prevalence of bradycardia when compared to the non-athletes. (P=0.03). In addition a greater percentage of the athletes had T wave invertion in the anterior leads (V1-V3) and electrocardiographic features consistent with left ventricular hypertrophy; and first-degree heart block. Athletes were also found to have significantly larger left ventricular end diastolic dimension (p0.01); increased left ventricular posterior wall thickness (p0.01); greater left ventricular mass (p0.01) and left ventricular mass index (p0.01) than the control group. These parameters were found to be significantly higher in each gender category as well. Power trained athletes were found to have greater relative left ventricular wall thickening when compared to the endurance trained athletes. Left ventricular systolic functions of both categories of athletes were found to be within normal limits and better than the control group. None of the athlete had echocardiographic features suggestive of hypertrophic cardiomyopathy

Medical admission into the intensive care unit (ICU) of the Lagos University Teaching Hospital.

The paper presents patterns of medical admissions into the intensive care unit of the Lagos University Teaching Hospital (LUTH) over an eight-year period from September 1990 to August 1998. Medical admission constituted 15% out of which 1% received surgery for medical complications. Patients with neurological diseases recorded the highest number of admission most of them being for tetanus. The commonest indication for admission was for respiratory insufficiency (33%). All the patients admitted for sub arachnoid haemorrhage, fulminant hepatitis, meningitis and motor neurone disease died. The least mortality was found amongst patients admitted for tetanus who constituted about 44% of the total number of medical admissions. The overall mortality rate was 69% and it was observed that the ages of the patients did not appear to affect the outcome except in patients who were admitted for myocardial infarction and cardiogenic shock. This study emphasizes the need to evolve a system of health evaluation of predicting the survival index of individual patients. There is an urgent need for proper training, motivation of staff and maintenance of equipment used in the ICU.

A randomised trial to compare the efficacy and safety of Felodipine (Plendil) and Nifedipine (Adalat) retard in patients with mild-to-moderate hypertension.

The efficacy and tolerability of Felodipine extended-release was compared with Nifedipine retard in the management of patients with mild-to-moderate hypertension. A total of one hundred and thirty three patients were screened out of which one hundred and twenty-one patients were enrolled in a 9-week multicentre open, randomised rising-dose trial to receive either Felodipine 5-10 mg once daily or Nifedipine 10-20 mg twice daily. Blood pressure was measured at the end of the dosing interval that is 24 hours and 12 hours after Felodipine and Nifedipine respectively. Both drugs, Felodipine and Nifedipine were found to lower blood pressure significantly compared with baseline. After three weeks of treatment, seated blood pressure was reduced by 20/14 mmHg (systolic/diastolic) and by 24/16 mmHg after 6 weeks in the felodipine group. Corresponding values in the Nifedipine group were 16/09 mmHg and 24/13mmHg. Pulse rate was not significantly affected by either drugs. The percentage of patients who had satisfactory control after 3 weeks treatment was 57.6% for Felodipine and 33.3% for Nifedipine (significant). After dose titration (where necessary), at the end of the study the response rates were 76.3% (n=45) and 79.6% (n=43) for Felodipine and Nifedipine respectively (non significant). Both drugs were metabolically inert and did not derange the haematologic and biochemical profile of patients. They produced no significant weight changes. The pattern of side effects were similar in both groups but tended to be more severe with Nifedipine necessitating withdrawal of two patients in this group. In conclusion, Felodipine ER 5mg - 10mg once daily, and Nifedipine Retard, 20mg twice daily were equally effective medications for mild-to-moderate hypertension but Felodipine was better tolerated.

Factory floor injury in a Lagos sawmill.

We retrospectively reviewed injuries sustained in 36 consecutive accidents in a wood-processing factory and managed at a private hospital over a 2-year period in Lagos. The commonest injuries were lacerations by revolving saws, followed by crush injuries from entrapment by machines and from falling logs and planks. The upper limbs were involved in 24 (66%) of these accidents cases. Of 137 workers on the factory floor, the highest injury rate (64%) occurred among machine operators. While 80.6% of these injuries were simple ones treated by suturing and dressing, 7 (19.4%) were life-threatening enough to warrant hospitalisation and major surgery, with 6 sustaining a mean permanent disability of 7.1 +/- 6%. Although factory-floor injuries constituted only 6.5% of 553 hospital attendance recorded within the period from the company, they were responsible for 44.2% of total medical expenditure by the company within the same period. Non-use of protective gears and disregard for safety procedures were noted in most of the accidents. The in-house first-aid program was adjudged as life-saving in the few major cases managed. We concluded that while many factory-floor injuries in wood-processing factories may be minor hand injuries, provision and strict observance of safety protocols as well as an active first-aid program are invaluable to minimise morbidity, cost and loss of productive man-hours in wood processing factories.

Clinical and echocardiographic assessment of Nigerian patients seen at the Lagos University Teaching Hospital with features of mitral valve prolapse.

In a 3-year prospective echocardiographic study of patients with clinical features of mitral valve prolapse who presented to the cardiology clinic of the medical out patients clinic of the Lagos University Teaching Hospital comprising of sixty-two patients. The most common complaints found were vague chest discomfort (42%) and chest pain. (28%) Their mean body mass index was 20.8 +/- 5.56 Kg/m2. The most common auscultatory sign was apical clicks (8%). Hypertension (12%) was the most common clinical association while the anterior leaflet (87%) was more affected. Mitral regurgitation was present in 35.7% of cases, which were mostly mild in severity (93%). There were statistical differences in the chamber and wall dimension measurements of those with isolated mitral valve prolapse when compared with those associated with other clinical conditions. (p < 0.05). Subjects with isolated mitral valve prolapse were found to have significant differences in the echocardiographic measurements when compared with those with coexisting diseases suggesting that mitral valve prolapse is a relatively benign condition except coexisting with other conditions like hypertension, valvular defects and obesity. These associated conditions tended to increase cardiac risk.