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Purpose: Non-dipping status is associated with increased total and cardiovascular mortality in many disease conditions including diabetes mellitus. The pattern and its implications are not well described among Africans. This study was done to describe the frequency of abnormal blood pressure (BP) dipping among T2DM subjects, its determinants and correlates in Ogbomoso, Nigeria. Methods: This was a cross-sectional study done at the LAUTECH Teaching Hospital, Ogbomoso. One hundred individuals diagnosed with T2DM were recruited and they had 24-hour ambulatory BP monitoring, echocardiography, ECG, and carotid Doppler among other evaluations. Statistical analysis was done using SPSS 27.0 (Chicago Ill, USA). Results: The mean age of the participants was 59.3 ± 10.8 years, mean body mass index 27.7 ± 5.9 kg/m2 with a mean duration of diabetes of 7.52 ± 5.54 years. Abnormal BP dipping was present in 89% (consisting of 41% or reverse dippers and 48% non-dippers). T2DM subjects with abnormal dipping pattern were more likely to be females, had higher glycated haemoglobin, lower fractional shortening, higher left atrial volume and left ventricular mass index, and a higher DM duration than those with normal BP dipping status. The major determinants of abnormal dipping pattern were the duration of diabetes and low HDL-C concentration. Conclusion: Abnormal BP dipping pattern is highly prevalent in T2DM subjects, especially among females. Abnormal BP dipping was also associated with markers of increased cardiovascular risk such as impaired kidney function, left ventricular hypertrophy, postural hypotension, history of intermittent claudication, and presence of plaques on carotid Doppler studies. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01337-8.

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Background: Type 2 diabetes mellitus (T2DM) is a disease of public health importance globally with an increasing burden of undiagnosed pre-diabetes and diabetes in low- and middle-income countries, Nigeria in particular. Pre-diabetes and diabetes are established risk factors for cardiovascular complications. However, data are scanty on the current prevalence of these conditions in Nigeria, based on haemoglobin A1c (HbA1c) diagnosis as recommended by the WHO in 2009. We aimed to determine the prevalence of pre-diabetes, diabetes, and undiagnosed diabetes among the adult population of Nigeria using HbA1c. Methodology: A cross-sectional, multi-site population study was carried out in selected states in Nigeria (namely, Ekiti, Lagos, Osun, Oyo, and Kwara states) involving 2,708 adults (≥18 years) in rural and urban community dwellers, without prior diagnosis of pre-diabetes or diabetes. Participants with ongoing acute or debilitating illnesses were excluded. Data were collected using an interviewer-administered pretested, semi-structured questionnaire. Socio-demographic, clinical (weight, height, blood pressure, etc.), and laboratory characteristics of participants including HbA1c were obtained. Data were analysed using STATA version 16. Results: The mean age of participants was 48.1 ± 15.8 years, and 65.5% were female. The overall prevalence of pre-diabetes and undiagnosed diabetes was 40.5% and 10.7%, respectively, while the prevalence of high blood pressure was 36.7%. The prevalence of pre-diabetes was the highest in Lagos (48.1%) and the lowest in Ekiti (36.7%), while the prevalence of diabetes was the highest in Kwara (14.2%) and the lowest in Ekiti (10%). There was a significant association between age of the participants (p< 0.001), gender (p = 0.009), educational status (p = 0.008), occupation (p< 0.001), tribe (p = 0.004), marital status (p< 0.001), blood pressure (p< 0.001), and their diabetic or pre-diabetic status. Independent predictors of diabetes and pre-diabetes include excess weight gain, sedentary living, and ageing. Participants within the age group 45-54 years had the highest total prevalence (26.6%) of pre-diabetes and diabetes. Conclusion: Over half of the respondents had pre-diabetes and diabetes, with a high prevalence of undiagnosed diabetes. A nationwide screening campaign will promote early detection of pre-diabetes and undiagnosed diabetes among adult Nigerians. Health education campaigns could be an effective tool in community settings to improve knowledge of the risk factors for diabetes to reduce the prevalence of dysglycaemia.

Asunto(s)

Diabetes Mellitus Tipo 2 , Estado Prediabético , Adulto , Humanos , Femenino , Persona de Mediana Edad , Masculino , Hemoglobina Glucada , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Estado Prediabético/diagnóstico , Estado Prediabético/epidemiología , Estudios Transversales , Prevalencia , Nigeria/epidemiología

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Background: Several atherogenic indices derived from the lipid profiles are postulated to better detect dyslipidemias and predict the risk of having cardiovascular events even in the presence of insignificant changes in individual lipid parameters. Objective: To compare the lipid ratios and atherogenic index of plasma (AIP) to conventional atherogenic indices among hypertensive type 2 diabetics to hypertensive nondiabetes (HND) controls. Materials and Methods: A case­control study in which 210 participants with type 2 diabetes mellitus with hypertension (hypertensive­diabetic [HD]) compared with 150 (n = 155) hypertensive without diabetes (HND) with similar ages were enrolled. Blood samples for fasting lipid profile were collected and analyzed, and the following indices and ratios were calculated: (TC/high­density lipoprotein­cholesterol [HDL­C]), (low­density lipoprotein­cholesterol [LDL­C]/HDL­C), (HDL­C/ LDL­C), and AIP. The indices were compared in both the participants and control group. Results: There was no significant difference in the clinical characteristics of HD compared to the HND except the systolic blood pressure, weight, and HDL­C which were lower in the HND group. The frequency of dyslipidemia was found to be significantly higher in the HD group except elevated LDL­C in males (25.8% vs. 17.4%, χ2 = 0.055, respectively). Furthermore, all the lipid ratios, except (Castelli risk index II [CRI­ II] were found to be significantly different among HD as compared to HND group (P = 0.002, P = 0.045, respectively). Conclusions: This study concludes that Nigerians with both type 2 diabetes and hypertension have worse dyslipidemia and abnormal lipid ratios compared to those with only hypertension.

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Diabetes Mellitus Tipo 2 , Dieta Aterogénica , Hipertensión , Plasma , Dislipidemias

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BACKGROUND: Peripheral artery disease (PAD) is common in persons with type 2 diabetes (T2DM) and contributes significantly to cardiovascular morbidity and mortality. Controversy exists regarding the utility of ankle brachial index (ABI) for clinical diagnosis of PAD in persons with diabetes. The aim of this study was to evaluate the reliability of ABI for diagnosis of PAD in patients with T2DM using duplex ultrasonography (DUS) as the gold standard. RESULTS: A total of 319 legs from 163 patients comprising of 156 subjects with intact legs and 7 patients who had undergone unilateral lower limb amputations were studied. The mean age of the participants was 56.1 ± 17.3 years. One hundred and ninety-five legs (61.1%) had sonographically confirmed PAD which was mild, moderate and severe in 40%, 41.5% and 18.5% respectively. The accuracy of ABI in detecting PAD was 76.7% for mild stenosis, 91.7% for moderate stenosis and 93.1% for severe stenosis. The sensitivity of ABI improved with increasing severity of arterial stenosis, reaching 100% in severe cases. ABI demonstrated good agreement with DUS [kappa = 0.65 (95% CI 0.49-0.88), P < 0.001]. CONCLUSION: In comparison to DUS, the ABI demonstrated good reliability for diagnosis of PAD in high risk T2DM patients. The utility of this simple and non-invasive procedure should therefore be maximized in clinical practice.

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Índice Tobillo Braquial , Presión Arterial , Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/diagnóstico , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/diagnóstico , Ultrasonografía Doppler Dúplex , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico , Angiopatías Diabéticas/etiología , Angiopatías Diabéticas/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/etiología , Enfermedad Arterial Periférica/fisiopatología , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad

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Double diabetes otherwise known as hybrid diabetes, a new variant, is a combination of both type 1 and type 2 diabetes in children and adolescents. It is a diabetes variant increasing in prevalence in developed countries because of epidemic obesity among children and adolescents but extremely rare in developing countries. Double diabetes is characterized by features of both type 1 (diabetes auto-antibodies) and type 2 (obesity and insulin resistance). This occurrence can either develop on a background of type 1 diabetes due to an abnormal increase in weight from physiological growth spurt in adolescents or from high insulin dosage developing on a background of type 2 diabetes. The variant has been linked to possible increased cardiovascular risks and worsened morbidity including poor glycaemic control. Here, we report a case of a 17-year-old girl who developed features of type 2 diabetes on a background of type 1 diagnosed 6 years after T1D diagnosis.

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Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Resistencia a la Insulina , Adolescente , Autoanticuerpos/análisis , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Nigeria , Obesidad Infantil/epidemiología

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INTRODUCTION: mobile phone technology is increasingly used to overcome traditional barriers to limiting access to diabetes care. This study evaluated mobile phone ownership and willingness to receive and pay for mobile phone-based diabetic services among people with diabetes in South-West, Nigeria. METHODS: two hundred and fifty nine patients with diabetes were consecutively recruited from three tertiary health institutions in South-West, Nigeria. Questionnaire was used to evaluate mobile phone ownership, willingness to receive and pay for mobile phone-based diabetic health care services via voice call and text messaging. RESULTS: 97.3% owned a mobile phone, with 38.9% and 61.1% owning smartphone and basic phone respectively. Males were significantly more willing to receive mobile-phone-based health services than females (81.1% vs 68.1%, p=0.025), likewise married compared to unmarried [77.4% vs 57.1%, p=0.036]. Voice calls (41.3%) and text messages (32.4%), were the most preferred modes of receiving diabetes-related health education with social media (3.1%) and email (1.5%) least. Almost three-quarter of participants (72.6%) who owned mobile phone, were willing to receive mobile phone-based diabetes health services. The educational status of patients (adjusted OR [AOR]: 1.7{95% CI: 1.6 to 2.1}), glucometers possession (AOR: 2.0 [95% CI: 1.9 to 2.1) and type of mobile phone owned (AOR: 2.9 [95% CI: 2.8 to 5.0]) were significantly associated with the willingness to receive mobile phone-based diabetic services. CONCLUSION: the majority of study participants owned mobile phones and would be willing to receive and pay for diabetes-related healthcare delivery services provided the cost is minimal and affordable.

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Teléfono Celular/estadística & datos numéricos , Diabetes Mellitus/terapia , Propiedad/estadística & datos numéricos , Telemedicina/métodos , Adulto , Anciano , Estudios Transversales , Atención a la Salud/economía , Atención a la Salud/métodos , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Aceptación de la Atención de Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Telemedicina/economía , Envío de Mensajes de Texto

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BACKGROUND: Most occurrences of type 1 diabetes cases in any population are sporadic rather than familial. Hence, type 1 diabetes among siblings is a rare occurrence. Even more rare is for three or more siblings to develop type 1 diabetes. In this report, we describe a case of a Nigerian family in which type 1 diabetes occurred in three siblings among four children with neither parent having diabetes. All three siblings are positive for glutamic acid decarboxylase and anti-islet cell antibodies. CASE SUMMARY: There were four siblings (three males and one female) born to a couple without a diagnosis of diabetes. The eldest child (male) was diagnosed with diabetes at the age of 15, the second child (female) was diagnosed at the age of 11 and the fourth child (male) was diagnosed at the age of 9. All the siblings presented with similar osmotic symptoms and were diagnosed of diabetic ketoacidosis. All of them had markedly reduced serum C-peptide levels with high levels of glutamic acid decarboxylase and insulinoma-associated protein-2 antibodies. We could not perform genetic analysis of HLA-DR, DQ and CTLA4 in the siblings as well as the parents; hence haplotypes could not be characterized. Both parents of the probands have no prior history of diabetes, and their blood glucose and glycated hemoglobin levels were within normal ranges. The third child (male) has no history suggestive of diabetes, and his blood glucose and glycated hemoglobin have remained within normal ranges. CONCLUSION: Although the occurrence of type 1 diabetes in proband siblings is uncommon, screening for diabetes among siblings especially with islet autoantibodies should be encouraged.

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BACKGROUND: Insulin is one of the most important anti-diabetic agents in the management of diabetes even among type 2 diabetic. OBJECTIVE: There was need to assess insulin adherence, mode of insulin delivery and burden of insulin usage among diabetics. METHODS: A cross-sectional, prospective questionnaire, orally administered at a Diabetes Clinic of a University Teaching Hospital, SouthWest, Nigeria. Participants were consecutive patients with diabetes who were 18 years or older presently on insulin either alone or in combination with other anti-diabetic agents for at least 3 months. Baseline demographic and insulin treatment information were obtained. RESULTS: Two hundred and thirteen (213) participants were studied. Of these, 21 (9.9%) had T1DM and 192 (90.1%) had T2DM, (means age, 58.6 ± 13.1 years, mean duration of diabetes, 7.0 ± 6.9 years). Insulin adherence was noted in 72.8% with better adherence among those who self-injected insulin compared to those who were injected by health care professionals (HCPs) or relations. Among the respondents, 80.8% were on human insulin and pre-mixed insulin was the most commonly used form of insulin (52.6%). Most participants (52.6%) were taking 10-20 units per day, only 22 (10.3%) were on >40units/day. Reuse of insulin needle was found in 74.6% of the participants. Major reasons for insulin omission were non-availability of insulin and patients being tired of insulin injection. CONCLUSION: The insulin adherence among diabetics in this study was high. Non-availability of insulin, insulin injection pain and being tired of continual insulin usage were some of the reasons for non-adherent to insulin usage.

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Diabetes Mellitus/tratamiento farmacológico , Utilización de Medicamentos/estadística & datos numéricos , Hipoglucemiantes/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Adulto , Anciano , Estudios Transversales , Vías de Administración de Medicamentos , Quimioterapia Combinada , Femenino , Hemoglobina Glucada , Conocimientos, Actitudes y Práctica en Salud , Humanos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Reacción en el Punto de Inyección , Insulina , Masculino , Cumplimiento de la Medicación/psicología , Persona de Mediana Edad , Nigeria , Estudios Prospectivos , Factores Socioeconómicos

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BACKGROUND: There exists a synergy between chronic kidney disease (CKD) and cardiovascular risk factors (CVRFs) with increased morbidity and poor outcomes. OBJECTIVES: Data relating to this clustering in black homogenous populations is scanty. We aim to investigate this relationship in Nigerian communities. PATIENTS AND METHODS: It was a cross-sectional observation study from semi-urban communities in South-West Nigeria. We used modified World Health Organization (WHO) questionnaire on chronic diseases (WHO STEPS) to gather information on socio-demographic data, biophysical and clinical characteristics. Biochemical analysis of plasma samples was done. RESULTS: We analyzed data of 1084 with mean age of 56.3 ± 19.9 years (33.4% female). Prevalence of stage 3 CKD was 14.2% (3a and 3b were 10.3% and 3% respectively). Prevalence of hypertension (systolic and diastolic blood pressure) and low high-density lipoprotein cholesterol (HDL-C) increased as clustering of cardiovascular (CV) risk factors (CVFRs) increased both in CKD and proteinuria (P < 0.05). CKD prevalence increases with number of risk factors. There was an inverse relationship between increasing risk factors and mean estimated glomerular filtration rate (eGFR) (P < 0.05). Clustering at least 2 CVRFs in the population with CKD compared to those without CKD was significantly higher (76.6% vs. 65.1%, OR: 1.8, 95% CI: 1.2-2.6, P = 0.005). Similarly, in a univariate analysis, albuminuria had an increased odds of clustering (69.7% vs. 59.6%, OR: 1.9, 95% CI 0.6-6.2, P = 0.409). Using multivariate logistic analysis, there is significantly increased odds of clustering when eGFR is <45 mL/min/1.73 m2 (OR: 2.66, 95% CI: 1.12-6.32) and microalbuminuria 1.74 (95% CI: 1.10-2.75). CONCLUSIONS: Reduced kidney function and proteinuria significantly clustered with CVRFs. This data suggests that individuals with CV clusters should be screened for CKD or vice versa and they should be considered for prompt management of their CVRFs.

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BACKGROUND AND OBJECTIVES: The increasing frequency of cardiovascular disease (CVD) rests on the presence of major cardiovascular risk factors including dyslipidemia. This dyslipidemia is also a target for the prevention and treatment of many cardiovascular diseases. Hence, identification of individuals at risk of CVD is needed for early identification and prevention. The study was carried out to evaluate dyslipidemia using the lipid ratios and indices instead of just the conventional lipid profile. METHODOLOGY: It was a cross-sectional study with 699 participants recruited from semi-urban communities in Nigeria. Anthropometric indices, blood pressure, and fasting lipid profiles were determined. Abnormalities in lipid indices and lipid ratios with atherogenic index were also determined. SPSS software version 17.0 were used for analysis, P< 0.05 was considered statistically significant. RESULTS: There were 699 participants with a mean age of 64.45 ± 15.53 years. Elevated total cholesterol, high low-density lipoprotein-cholesterol, elevated triglyceride, and low high-density lipoprotein were seen in 5.3%, 19.3%, 4.4%, and 76.3% of the participants, respectively. The Castelli's risk index-I (CRI-I) predicted the highest prevalence of predisposition to cardiovascular risk (47.8%) with females being at significantly higher risk (55.2% vs. 29.3%, P< 0.001). Atherogenic coefficient, CRI-II, CHOLIndex, atherogenic index of plasma (AIP) predicted a cardiovascular risk prevalence of 22.5%, 15.9%, 11.2%, and 11.0%, respectively, with no significant difference in between the sexes. CONCLUSIONS: Serum lipid ratios and AIP may be used in addition to lipid parameters in clinical practice to assess cardiovascular risks even when lipid profiles are apparently normal. AIP was more gender specific amidst the lipid ratios.

Asunto(s)

Enfermedades Cardiovasculares/epidemiología , Dislipidemias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Aterosclerosis , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios Transversales , Dislipidemias/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , Factores de Riesgo , Factores Sexuales , Población Suburbana , Triglicéridos/sangre , Población Urbana

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OBJECTIVES: To evaluate the risk of obstructive sleep apnea (OSA) in a primary care population of elderly Nigerians and to determine its correlates. METHODS: Clinical and demographic data of 414 elderly individuals in a primary care clinic were obtained. Their risk of OSA was estimated using Berlin questionnaire while Epworth sleepiness scale and the Center for Epidemiologic Studies Depression Scale (CESD-10) were also administered. RESULTS: Of the 414 subjects, 96 (23.2%) met the criteria for a high risk for OSA with a male to female ratio of 1:1. Subjects at high OSA risk (high OSA risk group) were younger than those at low OSA risk (low OSA risk group) (71.4±6.8 vs 73.6±7.7, p=0.011). Mean body mass index (BMI, kg/m(2)) (27.3±5.8 vs 24.7±5.1, p<0.001) and waist circumference (WC, cm) (90.7±13.1 vs 86.5±13.9, p=0.011) were higher in the high OSA risk group compared with the low OSA risk group. A total of 215 (51.9%) and 62 (15.0%) subjects had clinically significant depressive symptoms (CESD-10 score≥10) and excessive daytime sleepiness (EDS), respectively. On regression, the odds of EDS, depressive symptoms, increased BMI and younger age were significantly higher in the high OSA risk group compared with the low OSA risk group. CONCLUSIONS: High risk for OSA and depressive symptoms are common in our sample of elderly Nigerians. Depressive symptoms, EDS, BMI and age independently predict high OSA risk in the elderly.

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One hundred and sixty-five pregnant Nigerian women attending the antenatal clinic of LAUTECH teaching hospital, Ogbomoso, Nigeria between January and April 2014 were interviewed using a structured questionnaire. Socio-demographic characteristics of the respondents were obtained. Respondents were also asked: if they had had their eye examined by an eye specialist during the index pregnancy, frequencies of visit to eye care centers and indications for their visitation. A history of previous eye examination by eye care specialist/visit to eye clinic was considered as eye care utilisation. Selection of eligible subjects who consented to participate in the study was done using simple random technique. Logistic regression model was used to control sociodemographic and obstetric factors in order to determine independent covariate factor influencing the use of eye care services. Among the population studied, only 46 (32%) had eye examination during the index pregnancy. Level of education and occupational status of the respondents were found to be statistically significant factors (p = 0.001 and 0.008, respectively). There is a need for a policy that will encourage regular eye care services usage during pregnancy.

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Oftalmología/estadística & datos numéricos , Optometría/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Mujeres Embarazadas , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Escolaridad , Empleo , Femenino , Humanos , Modelos Logísticos , Nigeria , Oftalmología/métodos , Optometría/métodos , Embarazo , Atención Prenatal/métodos , Adulto Joven

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INTRODUCTION: Stroke is a major public health problem worldwide. Hypertension, diabetes mellitus, dyslipidaemia and smoking are some of the common modifiable risk factors in the occurrence of stroke. Therefore, this study was designed to assess the prevalence and patterns of dyslipidaemia among individuals with acute stroke. METHODS: This is a retrospective descriptive cross-sectional study, carried out in the Departments of Medicine at the LAUTECH Teaching hospital, Ogbomoso and General Hospital, Orile-Agege, Lagos, South-West, Nigeria, over a 18-month period between September 2012 and February 2014. One hundred and six (106) patients with acute stroke confirmed with computed tomography (CT) brain scan were recruited. Clinical features, risk factors, lipid profiles and stroke patterns were identified. RESULTS: Mean age was significantly higher in ischaemic stroke compared to haemorrhagic (64.08±10.87 Vs, 56.21±12.38years, p=0.001). There was slight male preponderance in both stroke types (1.3:1). Out of 106 patients, 65 (61.3%) had ischaemic stroke, 38 (35.8%) intracerebral haemorrhage and 3 (2.9%) with subarachnoid haemorrhage. Dyslipidaemia is the most frequent risk factor (85.9%), followed by hypertension (66.0%) and diabetes mellitus (15.1%). Dyslipidaemia was significantly higher in the ischaemic stroke compared to haemorrhagic. Reduced HDL-cholesterol is the most prevalent fraction of lipid abnormalities (74.5%). CONCLUSION: Dyslipidaemia, particularly low HDL-C, was the most frequent risk factor in our patients with stroke. Hence, prevention of dyslipidaemia as well as other risk factors is key to reducing the burden of stroke in our country.

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Isquemia Encefálica/etiología , Dislipidemias/complicaciones , Accidente Cerebrovascular/etiología , Adulto , Anciano , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/epidemiología , Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/etiología , HDL-Colesterol/sangre , Estudios Transversales , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Lípidos/sangre , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/epidemiología , Hemorragia Subaracnoidea/epidemiología , Hemorragia Subaracnoidea/etiología , Tomografía Computarizada por Rayos X

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INTRODUCTION: Obesity is a global epidemic. There are rising rates of obesity and its associated disorders, especially in developing countries, including among Health Service Providers (HSPs). Obesity is associated with early retirement, increased morbidity and mortality. Thus, obesity has the potential of reducing long-term retention of HSPs in inadequately staffed health systems of developing countries. This study aimed to determine the magnitude of and factors associated with obesity among HSPs of a tertiary health care facility in Lagos, Nigeria. METHODS: A cross sectional study was carried out with a questionnaire, which included the International Physical Activity Questionnaire short form (IPAQ-SF). Obesity was defined as BMI ≥30kg/m2. Statistical significance was set at p < 0.05. RESULTS: 300 HSPs were recruited, of which 47.7% were medical doctors and dentists, 43.3% were nurses and other categories of HSPs. The mean age and BMI of the HSPs were 39.3(9.0) years and 27.7(4.6) kg/m2 respectively. Eight two (27.3%) HSPs were obese and 134 (44.7%) were overweight, 149(49.7%) had central obesity. After adjusting for confounding variables using multivariate logistic regression, age > 40 years (OR 3.51, p=0.003), female gender (OR 2.84, p=0.007) and earning a monthly salary of ≤ 200,000 naira relative to 201,000-400,000 naira (OR 2.58, p=0.006) were significantly associated with obesity. CONCLUSION: Obesity was prevalent among these Nigerian HSPs. This calls for concern, especially with the implication of loosing health workers to obesity related disorders and early retirement.

Asunto(s)

Personal de Salud/estadística & datos numéricos , Obesidad/epidemiología , Sobrepeso/epidemiología , Adulto , Índice de Masa Corporal , Estudios Transversales , Países en Desarrollo , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , Encuestas y Cuestionarios , Centros de Atención Terciaria

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BACKGROUND: QTc interval prolongation signifies an increased risk of life-threatening arrhythmia and sudden cardiac death. Cardiac manifestations of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome have become increasingly important causes of morbidity and mortality. We investigated HIV-positive patients to determine the effects of HIV infection, antiretroviral drugs, and identifiable confounders on QTc prolongation. MATERIALS AND METHODS: A case-control study was conducted in a rural tertiary health center in Nigeria. Data collected included demographic variables, body mass index, blood pressure, HIV status, antiretroviral treatment (ART), duration of HIV infection and treatment, CD4 T-lymphocyte count, heart rate (HR), and QT interval. QT was corrected for HR using Bazett's formula. RESULTS: The sample frame comprised 89 (42.4%) HIV-negative subjects (39.3% male, 60.7% female; mean age, 36.28 ± 7.03 years); 45 (21.4%) HIV-positive, ART-naïve patients (31.1% male, 68.9% female; mean age, 36.48 ± 9.12 years); and 76 (36.2%) HIV-positive patients on ART (27.6% male, 72.4% female; mean age, 39.00 ± 7.68 years). The QTc interval and resting HR were higher in HIV-positive, drug-naïve patients than in the other two groups (P < 0.001). Female sex was associated with prolonged QTc intervals in all groups. CONCLUSION: HIV-positive patients may be at higher risk of sudden cardiac death due to fatal arrhythmia secondary to QTc interval-related cardiac events. Healthcare providers should be aware that a prolonged QTc interval is a potential indicator of increased cardiovascular risk and should exercise caution in prescribing potentially QT-prolonging medications to HIV-positive patients.

Asunto(s)

Terapia Antirretroviral Altamente Activa , Electrocardiografía/métodos , Infecciones por VIH/tratamiento farmacológico , Síndrome de QT Prolongado/fisiopatología , Adulto , Presión Sanguínea , Índice de Masa Corporal , Enfermedades Cardiovasculares , Estudios de Casos y Controles , Electrocardiografía/efectos de los fármacos , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/fisiopatología , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Síndrome de QT Prolongado/complicaciones , Síndrome de QT Prolongado/diagnóstico , Masculino , Persona de Mediana Edad , Nigeria , Factores de Riesgo

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INTRODUCTION: Over 80% of cardiovascular deaths take place in low- and middle-income countries; most of these deaths are due to modifiable risk factors. The study aimed at estimating the prevalence and pattern of major cardiovascular risk factors in both men and women older than 18 years. METHODS: This is a cross-sectional study of cardiovascular risk factors among semi-urban dwellers in Ekiti State, south-western, Nigeria. 750 participants were drawn from 10 communities. The instrument used was the standard WHO STEPS (II) questionnaire, while blood samples were obtained for analysis. RESULTS: There were 750 participants with 529 (70.53%) females. The mean age of participants was 61.7±18.50 years and participants' ⩾65 years comprised 38.3%. There were 0.8%, 24.9% and 12.4%, who at the time of this study smoked cigarettes, consumed alcohol, and ate a high salt diet, respectively. The prevalence of hypertension, diabetes, generalized and abdominal obesity was 47.2%, 6.8%, 8.5% and 32.0%, respectively, with only 48.9% receiving hypertension treatment. Elevated total cholesterol, LDL-cholesterol, and low HDL was seen in 4.4%, 16.7% and 56.3% respectively. CONCLUSION: High prevalence of cardiovascular risk factors call for an urgent need for more public health attention and reinforcement of primary preventive strategies to curb its menace.

Asunto(s)

Enfermedades Cardiovasculares/etiología , Anciano , Colesterol/sangre , Estudios Transversales , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Obesidad Abdominal/epidemiología , Prevalencia , Factores de Riesgo

RESUMEN

Background. Although the association between lipoatrophy and highly active antiretroviral therapy (HAART) is well known, other nondrug factors may be associated with lipoatrophy in people living with HIV/AIDS (PLWHA). There are no reports of lipoatrophy from Nigeria, a country with the second largest number of PLWHA. We aimed to determine the prevalence, characteristics, and factors associated with lipoatrophy in a cohort of patients attending the HIV clinic in Lagos University Teaching Hospital, Nigeria. Methods. Two hundred and eighty-eight patients with HIV infection were recruited for the study. The study protocol involved administration of a questionnaire, targeted physical examination (including anthropometric indices and skin fold thickness), and bioelectrical impedance analysis measurements. Lipoatrophy was defined clinically. Results. Lipoatrophy was present in 75 (26.0%) persons. It was associated with lower body circumferences, skin fold thicknesses, and lower % body fat with preservation of skeletal muscle mass (all P < 0.05). Male gender and HAART use were the factors associated with lipoatrophy on multivariate analysis (P < 0.05). Conclusion. Lipoatrophy is frequently encountered in patients with HIV infection in Nigeria, with HAART use conferring an added factor in its development. There is need for more physician and patient awareness of this condition.

RESUMEN

INTRODUCTION: Diabetes mellitus (DM) afflicts at least 5 million people in Nigeria, with more than 80% having type 2 diabetes mellitus (T2DM). Microvascular complications increase both morbidity and mortality inpatients with T2DM. The aims of this study were to report the burden of various microvascular complications in T2DM and to identify various factors associated with these complications in patients with T2DM attending the diabetes outpatients' clinic. METHODS: Ninety (90) patients with T2DM who have attended diabetes clinic for at least 3 months were recruited for this study. Detailed history, physical examination and biochemical analysis was done in each of the patients. All patients underwent a detailed standard evaluation to detect diabetic retinopathy (fundoscopy), neuropathy (10g monofilament and/or diabetes neuropathy scores), and nephropathy (microalbuminuria, macroalbuminuria, serum creatinine and estimated glomerular filtration rate). RESULTS: There was high prevalence of microvascular complications among patients with T2DM. Almost half of patients with T2DM had some form of microvascular complications; diabetic neuropathy being the commonest (69.6%),followed by nephropathy (54.5%) and retinopathy (48.9%). The factors associated with developing these complications were increasing age, duration of diabetes, hypertension and dyslipidaemia for nephropathy and neuropathy. CONCLUSION: There is a high burden of microvascular complications in patients with type 2 diabetes. Age, male gender, hypertension, glycaemic control, BMI and duration of diabetes, and glycaemic control were factors associated with microvasular complications.

Asunto(s)

Albuminuria/epidemiología , Enfermedades Cardiovasculares/epidemiología , Costo de Enfermedad , Diabetes Mellitus Tipo 2/epidemiología , Angiopatías Diabéticas/epidemiología , Neuropatías Diabéticas/epidemiología , Retinopatía Diabética/epidemiología , Adulto , Factores de Edad , Anciano , Albuminuria/complicaciones , Albuminuria/etiología , Glucemia/análisis , Índice de Masa Corporal , Enfermedades Cardiovasculares/etiología , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/mortalidad , Angiopatías Diabéticas/etiología , Neuropatías Diabéticas/etiología , Retinopatía Diabética/etiología , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Morbilidad , Nigeria/epidemiología , Prevalencia , Calidad de Vida , Factores de Riesgo

RESUMEN

BACKGROUND: Low and middle-income countries like Nigeria face many challenges in emergency medical care owing to poor treatment facilities and inadequately trained personnel. Most Nigerians live in rural areas. The disease and death burdens in accident and emergency departments in this setting have not been closely studied. AIM: To determine the basic demographics, disease burden, and outcomes for accident and emergency admissions. SETTINGS AND DESIGN: This retrospective study was carried out on patients admitted to an accident and emergency department. MATERIALS AND METHODS: A retrospective review of medical admissions to the accident and emergency wards of the Federal Medical Centre, Ido-Ekiti, Ekiti State, southwest Nigeria, between January 2010 and December 2012. STATISTICAL ANALYSIS USED: The data were analyzed using SPSS Version 16 software. The results were presented in descriptive and tabular forms. RESULT: In all, 2922 patients were admitted during the study period (age range, 11-100 years; mean, 51.89 ± 20.11 years). There were 1679 (57.5%) males and 1243 (42.5%) females, with a ratio of 1.4:1. Young adults (aged 40 years and under) formed the highest age group (46.8%). The number of patients admitted for non-communicable diseases were high (1989 patients: 68.07%). Among non-communicable diseases, cardiovascular disorders were the most frequent (797; 27.28%). The most common cause of deaths was cardiovascular disease (33.5%). CONCLUSION: Young adults and males were the groups most commonly admitted. Non-communicable diseases were more frequent than communicable diseases. The proportion of patients discharged against medical advice and fatalities requires urgent attention.

RESUMEN

BACKGROUND: There is a scarcity of data in rural health centers in Nigeria regarding the relationship between socioeconomic status (SES) and HIV infection. We investigated this relationship using indicators of SES. METHODS: An analytical case-control study was conducted in the HIV clinic of a rural tertiary health center. Data collection included demographic variables, educational attainment, employment status, monthly income, marital status, and religion. HIV was diagnosed by conventional methods. Data were analyzed with the SPSS version 16 software. RESULTS: A total of 115 (48.5%) HIV-negative subjects with a mean age of 35.49±7.63 years (range: 15-54 years), and 122 (51.5%) HIV-positive subjects with a mean age of 36.35±8.31 years (range: 15-53 years) were involved in the study. Participants consisted of 47 (40.9%) men and 68 (59.1%) women who were HIV negative. Those who were HIV positive consisted of 35 (28.7%) men and 87 (71.3%) women. Attainment of secondary school levels of education, and all categories of monthly income showed statistically significant relationships with HIV infection (P=0.018 and P<0.05, respectively) after analysis using a logistic regression model. Employment status did not show any significant relationship with HIV infection. CONCLUSION: Our findings suggested that some indicators of SES are differently related to HIV infection. Prevalent HIV infections are now concentrated among those with low incomes. Urgent measures to improve HIV prevention among low income earners are necessary. Further research in this area requires multiple measures in relation to partners' SES (measured by education, employment, and income) to further define this relationship.