Association between Alanine Aminotransferase, Hypertension and Obesity in Nigerians

BACKGROUND

Cardiovascular diseases (CVDs) are the leading causes of morbidity and mortality worldwide. Alanine aminotransferase (ALT) is associated with hypertension and obesity.

OBJECTIVES

To determine the association between ALT within the reference range with hypertension and obesity.

METHODS

This study utilized the data of a cross-sectional health survey involving 558 adult participants. Anthropometry, blood pressure, and plasma glucose were determined with standard protocols. Quartiles of log-transformed ALT were generated and the association with obesity/hypertension was determined with ANOVA and regression analysis.

RESULTS

There were 205 (36.7%) men. The mean fasting plasma glucose (FPG) of all participants was 4.7 (1.6) mmol/L. In men, there was a positive correlation between ALT and body mass index (BMI) (r=0.148; p=0.038), waist circumference (WC) (r=0.166; p=0.020), and waist-to-height-ratio (WHtR) (r=0.163; p=0.021). No correlation was observed between ALT and anthropometric indices in women, or with blood pressure indices in both genders. In men, only WHtR (p for trend, 0.045) was significantly associated with ALT quartiles, whereas in women, only WC (p for trend, 0.028) was significantly associated with ALT quartiles. In men, compared to 1st quartile, the OR for general obesity of the 4th quartile of Log ALT was 2.662 (95% CI 1.219 - 5.816; p=0.014). In women, the OR for hypertension of the 3rd quartile of Log ALT versus the 1st quartile was 1.955 (95% CI 0.694 - 2.416; p=0.041). Log ALT did not predict hypertension and obesity in men and women, respectively.

CONCLUSIONS

The risks of obesity and hypertension increase as the ALT level increases within the normal ALT range. People with normal levels of ALT in the upper limits need to be evaluated for metabolic disorders.

Plasma Lipids and CD4 Count of Newly Diagnosed HIV Sero-Positive Patients at Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria

INTRODUCTION

The pathogenesis of HIV has been linked to the affectation of a number of CD4 positive T cells upon which the severity of the disease is graded. Patients who present with complications such as disorders of lipid metabolism may be missed if appropriate laboratory investigations are not done. Dyslipidemia is a common phenomenon in patients with HIV infection. Early consideration of this may prevent further associated complications.

OBJECTIVES

To determine the baseline parameters in plasma lipid profile in HIV positive patients and how they are affected by the severity of infection as measured by CD4 count.

METHODS

This is a retrospective study of which records of patients that attended Anti-Retroviral Therapy (ART) clinic of Ekiti State University Teaching Hospital (EKSUTH), Ado Ekiti, Ekiti State Nigeria were looked into. All patients who attended our treatment sites for HIV/AIDS Counselling and Testing Program from June 2008 and October 2013 for the first time were reviewed. Records of four hundred and sixty-one (461) patients were found suitable and used for the study. Information about the age.

RESULTS

There are statistical significant differences among categories of patients in plasma Triglyceride (TG) mmol/L (p<0.001) and TC/HDL-Chol (p<0.001). The plasma TG (mmol/L) and TC/HDL-Chol are highest in patients with CD4 count <200 cells/µl. All compared categories in plasma TG (mmol/L) are statistically significant (p<0.001) except when CD4 count between 300 and 399 cells/µl and >400 cells/µl (p=1.000) categories were compared. Comparisons of TC/HDL-Chol in different study classifications show significant differences when CD4 count of <200 cells/µl category was compared with CD4 count of 300-399 cells/µl (p=0.021) and >400 cells/µl categories (p<0.001).

CONCLUSION

Plasma TG and TC/HDL-Chol were observed to have an association with severity of HIV infection as measured by a corresponding reduction in CD4 count.

Knowledge and Prevalence of Heart Disease Risk Factors Among Staff of a Tertiary Institution in Nigeria

BACKGROUND

Cardiovascular disease is the most common cause of mortality worldwide. Hence, awareness of cardiovascular risk factors is an essential step towards effective reduction of the disease burden. This study determined the knowledge and prevalence of cardiovascular risk factors among Staff of Ekiti State University. Ado-Ekiti, Nigeria.

METHODS

A cross-sectional study which comprised of 223 members of staff.

RESULTS

There were 103 males (46.2%). Low knowledge of heart disease risk factors was found in 68.6% of the respondents. The prevalence of hypertension, diabetes mellitus, overweight, obesity, physical inactivity was 35.4%, 12.1%, 31.8%, 23.3%, and 83% respectively. Family history of hypertension was a predictor of a high level of knowledge.

CONCLUSION

A low level of knowledge and increasing prevalence of cardiovascular risk factors existed among staff of Ekiti State University, Nigeria. Hence, there should be a step-up of awareness campaigns and promotion of healthy lifestyle among this category of people.

Serum Uric Acid Predicts Antihypertensive Medication Adherence in Nigeria: A Hospital Based Study

BACKGROUND

Hypertension is a major risk factor for cardiovascular morbidity and mortality. Optimum adherence to medication is still a perplexing matter for hypertensive patients in Nigeria and serum markers use as predictor for medication adherence has not been conclusive.

AIM

To define the level of antihypertensive medication adherence, its possible correlation with serum uric acid (SUA) levels and other predictors of antihypertensive medication adherence among Nigerian patients.

METHODS

Patients were recruited from the University Teaching Hospital Cardiology Clinic. Blood was drawn for SUA levels. Validated 8-item MMAS-8 was administered to hypertensives to measure adherence, and correlations analysed between SUA levels and the MMAS-8 score, with SPSS-23. SUA is defined as elevated in men with concentrations of =430µmols/l, normal range 200-430µmols/l, and =360µmol/l in women, normal range140-360µmol/l. Linear regression analysis of the predictors of antihypertensive medication adherence was done. A statistical p value of <0.05 was considered significant.

RESULTS

The total number and mean age of the cases were 271 and 60.8±12.3years respectively. MMAS-8 revealed that about half of the hypertensives (131 cases, 48.3%) had low adherence (MMAS-8 score 4), 81 cases (29.5%) had medium adherence (MMAS-8 score 2) while 59 cases (22.1%) showed high adherence (MMAS-8 score 0). Bivariate Correlation between SUA levels in hypertensives and antihypertensive medication adherence was of moderate degree and significant (r=0.396, p<0.001) suggesting that SUA levels increased with increasing non-adherence to antihypertensive medications. This correlation remained significant after adjusting for singular confounding variables like age (r=0.371 fair relationship, p=<0.001), DM (r=0.382 fair relationship, p<0.001); blood pressure (BP) duration and class r=0.356, 0.306, fair relationship p<0.001 respectively). The correlation between SUA levels and adherence to antihypertensive medications was weakened (r=0.209, p<0.001) after adjusting for combined confounding variables. Linear regression revealed that SUA levels is a predictor of antihypertensive medication adherence.

CONCLUSION

Antihypertensive medication adherence was unsatisfactory, elevated SUA levels correlated with low antihypertensive adherence, and this correlation was influenced by several singular and combined confounding variables in our patient population. Hence SUA levels can be a predictor and a marker of antihypertensive medication adherence.

Echocardiographic Assessment of Cardiac Changes During Normal Pregnancy Among Nigerians

BACKGROUND

Pregnancy is a physiological process associated with an increased hemodynamic load and cardiac structural remodeling. Limited echocardiographic information exists on cardiac chambers, left ventricular (LV) systolic and diastolic functions, and LV mass during trimesters of normal pregnancy among African women.

MATERIALS AND METHODS

Echocardiography was done at the beginning of the second trimester, beginning of the third trimester, and middle of the third trimester for 100 normal pregnant women and at one visit for age-matched 100 nonpregnant women. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17 software. Analysis of variance was used to compare within trimesters, and a P value of <0.05 was considered significant.

RESULTS

The mean (SD) ages of the patients and controls were 28.20 (±5.91) and 28.35 (±6.06) years, respectively (age range = 19–44 years, P = 0.86). Cardiac chambers, LV systolic function, and LV mass and its index increased significantly during pregnancy. A significant increase in A-wave velocity but slight increase in E-wave velocity and a reduction in tissue e′ velocity at the septal margin but a progressive increase in a′ velocity were also observed (P < 0.05).

CONCLUSION

Cardiac chamber dimensions, LV wall thickness, and mass, most indices of LV systolic and diastolic function, though within normal range, were significantly higher in pregnant than in nonpregnant Nigerian women.

Coexistence of Cor triatriatum sinistrum and a prominent Eustachian valve mimicking a Cor triatriatum dextrum

Cor triatriatum is among the rarest of all congenital cardiac abnormalities accounting for 0.1-0.4% of all congenital heart disease. Its coexistence with a very prominent Eustachian valve which mimics a Cor triatriatum dextrum is an exceptionally rare finding in an asymptomatic adult. We report the case of a 44 year old male who presented to our department on observing a pulse rate of 44 beats per minute during a home blood pressure check with his digital sphygmomanometer. Clinical examinationwas however, unremarkable and resting electrocardiography showed sinus rhythm with atrial premature complexes. The diagnosis was made on a two dimensional transthoracic echocardiography. Isolated atrial premature complexes and bradycardia may be a clinical presentation of Cor triatriatum in adult population. Although extremely rare, its coexistence with a prominent Eustachian valve may remain asymptomatic into adult life.

Ambulatory blood pressure profile and left ventricular geometry in Nigerian hypertensives

Background:

Left ventricular hypertrophy (LVH) is an independent cardiac risk factor in hypertensives and the structural classification of left ventricular (LV) geometry provides additional prognostic information. Ambulatory blood pressure (ABP) monitoring has been shown to be superior to office blood pressure (BP) in relation to hypertension LVH. We investigated ambulatory BP variables in relation to LV geometric patterns in Nigerian hypertensives.

Materials and Methods:

A total of 130 patients (males = 96, females = 34) with hypertension had their 24-hours ambulatory BP and trans-thoracic 2D/M- mode echocardiography. Data were analyzed with SPSS 13.0. P < 0.05 was considered statistically significant.

Results:

The mean age of the patients was 54.08±11.88 years. The prevalence rate of abnormal LV geometry was 48.4%. Mean ambulatory Systolic BP (day time, night time and 24-hour-average) was significantly higher in patients with LVH compared with those without LVH. Day-night systolic and diastolic BP decay (i.e. percentage nocturnal decline in BP) was also significantly lower in LVH group than in the group without LVH. Patients with eccentric LVH had abnormal day time mean ambulatory systolic BP, night time mean ambulatory systolic BP, elevated day time and night time systolic BP loads, as well as non-dipping diastolic BP pattern. Significant correlates of LV mass index in this study population were mean ambulatory systolic BP (day time: r = 0.355, P = 0.004; night time: r = 0.343, P = 0.005; 24- hour average: r = 0.358, P = 0.004) and day-night decay (systolic: r = -0.388, P = 0.007; diastolic: r = -0.290, P = 0.022) as well as 24-hour systolic BP variability.

Conclusion:

The presence of LVH in hypertension was associated with higher mean ambulatory systolic BP and lower percentage nocturnal decline in systolic and diastolic BP than its absence which appeared to be worse in patients with eccentric LV geometry when compared with other geometric patterns.

The significance of mild renal dysfunction in chronic heart failure

BACKGROUND

Heart failure is a major public health concern. Prediction models in heart failure have employed echo-cardiography and other advanced laboratory parameters in predicting the risk of mortality. However, most of the patients in the resource poor economies still do not have easy access to these advanced technology.

OBJECTIVE

To determine the clinical and echocardiographic correlates of patients with chronic heart failure (CHF) in the presence or mild renal disease (MRD).

METHODS

One hundred CHF patients were categorized based on their estimated glomerular filtration rates into either normal renal function or MRD. The clinical and echocardiographic variables of both groups were compared.

RESULTS

There were 38 females and 62 males with an overall mean age of 54 years. A significantly greater proportion of patients with mild renal disease presented in New York Heart Association classes 3 and 4 (82.9% vs 27.1%). Patients with MRD had echocardiographic findings of a significantly larger left atrial dimension, lower ejection fraction and fractional shortening and shorter deceleration time. A significantly greater proportion of patients with mild renal disease also had moderate-severe mitral and tricuspid regurgitation and grades 2-3 diastolic dysfunction compared to patients without mild renal disease. Patients with MRD also exhibited a significantly greater degree of deterioration in the fractional shortening and ejection fraction compared to non-MRD patients. Multivariate regression analysis indicated that a low ejection fraction and a low fractional shortening were significantly associated with MRD.

CONCLUSION

Identification of MRD in chronic heart failure patients using the estimated glomerular filtration rate is valuable in resource poor countries. The presence of MRD in CHF is associated with poor left ventricular function and increased deterioration of ventricular function.

CD4+ T-lymphocytes cell counts in adults with human immunodeficiency virus infection at the medical department of a tertiary health institution in Nigeria

OBJECTIVES

To evaluate the CD4+ cell counts in adults with human immunodeficiency virus (HIV) infections presenting at the medical department of the Federal Medical Centre, Ido-Ekiti, Nigeria.

METHODS

This study was carried out at the medical department of the Federal Medical Centre (FMC), Ido-Ekiti, Nigeria, in the period July-December 2006. FMC, Ido, was recently upgraded to serve as the only center for HIV/AIDS referral, diagnosis and treatment in Ekiti State. The center offers free antiretroviral therapy. All patients with a diagnosis of HIV/AIDS, either diagnosed at the center or referred from other hospitals, admitted to the medical department within the study period had their blood sample taken for CD4 cell counts estimation at the first visit to the center, as part of the routine workup to assess their disease status and need for antiretroviral therapy.

RESULTS

A total of 87 patients comprising of 54 (62.1%) females and 33 (37.9%) males had their CD4+ T-Lymphocytes cell counts evaluated within their first week of presentation. The total mean age of the population studied was 33.17 +/- 7.01 years. The mean age of the females was 31 +/- 5.6 years, while that of the males was 36.5 +/- 8.2 years. The difference between the mean ages of females and males was statistically significant (P = 0.0004). The female: male ratio was 1.6:1. Out of the 87 patients, 30 were referrals from other hospitals within the state. The total mean CD4+ cell count was 230.7 +/- 311.9 cells/microL. The mean CD4 cell count of females was 212.17 +/- 264.96 cells/microL, while that of males was 261.0 +/- 389.19 cells/microL. This difference was not significant (P = 0.4876). Majority of the patients (75, [86.2%]), had CD4 cell count < 350 cells/microL, comprising of 48 females and 27 males. Of the 75 patients, 57 (76%) had a CD4 cell count < 200 cells/microL (33 females vs. 24 males).

CONCLUSION

At the time of HIV diagnosis, majority of our patients had a CD4+ cell count < 200 cells/microL. This was consistent with a relatively advanced disease. More women than men in the population were found positive for HIV. More sustained and vigorous awareness campaigns need be embarked upon in the HIV propaganda in the Ekiti State on one hand and Nigeria on the other hand to bring down this Hydra-headed monster called HIV/AIDS.

Pattern and outcome of diabetic admissions at a federal medical center: a 5-year review

BACKGROUND

Prevalence of diabetes mellitus (DM) is increasing worldwide, with the major increases expected to occur in developing countries. It has been observed that the pattern of hospital admissions can be used to determine the effectiveness of outpatient care of DM.

OBJECTIVE

This study was aimed to examine diabetes-related admissions to medical wards of a federal medical center in Ekiti, Nigeria. Such data would be useful to determine the burden on health care system and in the planning of appropriate management strategies.

METHODS

A 5-year retrospective analysis of diabetes-related admissions to the medical wards of Federal Medical Centre, Ido Ekiti, Ekiti State, between 2003 and 2007 was carried out using medical records of the patients. SPSS 13 software was used to analyze data.

RESULTS

Of the total 2,696 medical admissions, 118 (4.4%) were diabetes related. The mean age of these patients was 57 +/- 16.2 years. Majority (37.29%) of the patients were admitted for diabetic foot ulcer. Other major reasons for admission were severe hypertension (13.56%), uncontrolled hyperglycemia (13.56%), hyperglycemic emergencies (11.86%) and stroke (10.17%). Duration of hospital stay ranged from 1 to 107 days, with a mean duration of 17.5 +/- 9.2 days. Mean duration of hospital stay was the longest (25.3 +/- 23.9 days) for those admitted for diabetic foot ulcer. Most (74.6%) of the patients were discharged and only 4 (3.4%) died. Majority of those who left against medical advice were admitted for diabetic foot ulcer.

CONCLUSION

There is a need to emphasize foot care as one of the cardinal features of optimal diabetes care. Establishing clinics specializing in treating diabetes and having facilities for treatment of all aspects of diabetes, including diabetic complications, will help in providing better patient care and in minimizing hospital admissions.

Blood pressure response to an exercise treadmill test, and echocardiographic left ventricular geometry in Nigerian normotensive diabetics

OBJECTIVES

This study evaluated normotensive diabetic patients' blood pressure response to graded exercise and their echocardiographic pattern of left ventricular geometry.

METHODS

A descriptive, cross-sectional, hospital-based study was carried out on 30 normotensive type 2 diabetic patients and 34 controls, aged 30 to 60 years. The outcome measures were to determine the exercise-related variable, blood pressure response, and left ventricular geometry by means of echocardiography.

RESULTS

Nineteen (29.7%) and 11 (17.2%) normotensive diabetic subjects had normal left ventricular geometry and concentric left ventricular remodelling, respectively. None of the subjects had concentric or eccentric left ventricular hypertrophy. On this basis, the normotensive diabetic subjects were divided to two groups: G1 (normal) and G2 (concentric left ventricular remodelling). The groups had comparable mean age, body mass index (BMI), fasting blood glucose (FBG) and two-hour post-prandial blood glucose values, and heart rate, systolic (SBP) and diastolic blood pressure (DBP) at rest. G2 patients had higher mean duration of diabetes than G1 subjects (69.0 +/- 9.48 vs 18.7 +/- 8.7 months; p = 0.007). Peak systolic blood pressure was significantly higher in G2 than G1 subjects (213.6 +/- 20.1 vs 200.0 +/- 15.3 mmHg; p = 0.04). Although there was no statistically significant difference in the left ventricular (LV) mass index between the groups, G2 patients had significantly higher relative wall thicknesses than G1 patients (0.53 +/- 0.03 vs 0.41 +/- 0.04; p < 0.001).

CONCLUSION

Normotensive diabetic subjects with concentric left ventricular remodelling have increased blood pressure reactivity to exercise. It is probable, as suggested in earlier studies, that increased blood pressure reactivity to exercise is an indicator of target-organ damage, particularly in normotensive diabetics.

Surveillance of humoral immunity to measles virus in Ilorin, Nigeria and environ

Detection of measles specific IgG in serum was done on 618 samples obtained from Nigerians (aged 11 years or more) resident in Ilorin (urban) and Shao (a suburban outlay of Ilorin). An enzyme-linked immunosorbent assay (ELISA) method was used. Eighty-six percent of the sampled population had detectable antibody levels. Significant differences were found between positivity rates in the two locations studied and between the sexes in the urban samples.