Godsent Isiguzo

Liver function test abnormalities in Nigerian patients with human immunodeficiency virus and hepatitis B virus co-infection.

Summary Data on baseline hepatic function of HIV and hepatitis B virus (HBV) co-infected patients are limited in sub-Saharan Africa. We assessed liver function test (LFT) abnormalities in Nigerian patients with HIV/HBV co-infection to highlight the impact of HIV on HBV-related liver disease in sub-Saharan Africa. A cross-sectional study involving 100 HIV/HBV co-infected patients and 100 age- and sex-matched HBV mono-infected controls. Blood testing for HIV antibodies, CD4+ cell count, hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), LFTs, platelet count, fasting blood glucose and lipid profile were carried out. Non-invasive hepatic fibrosis scores (aspartate aminotransferase-platelet ratio index [APRI] and FIB-4) were also calculated. Co-infected patients had deranged liver enzymes more than the controls (77% versus 64%, P = 0.04). The predominant patterns of enzyme derangement in co-infected patients were either predominantly ↑ALP (30% versus 4%, P < 0.0001) or mixed (30% versus 15%, P = 0.01) but predominantly ↑AST/ALT in the controls (25% versus 9%, P = 0.003). Co-infected patients had higher fibrosis scores for both APRI (P = 0.002) and FIB-4 (P = 0.0001). On further analysis, LFT abnormalities and fibrosis scores were only significantly higher in co-infected patients in the immune clearance and HBeAg-negative chronic hepatitis phases. LFT abnormalities are common in Nigerians with HBV infection and co-infection with HIV negatively impacts on hepatic function.

Prevalence and predictors of impaired fasting glucose among Nigerian patients with hepatitis B virus infection.

AIM Previous studies on the relationship between hepatitis B virus (HBV) infection and type 2 diabetes mellitus (DM) are conflicting. We aimed to elucidate the relationship by investigating the prevalence and predictors of impaired fasting glucose (IFG) in HBV-infected patients. METHODS A total of 204 consecutive patients with hepatitis B surface antigen (HBsAg) seropositivity for ≥ 6 months were recruited in a cross-sectional study. Patients with DM were excluded. Information regarding age, gender, ethnicity, residence, family history of DM, alcohol use, and cigarette smoking were obtained using a structured questionnaire. Fasting plasma glucose, lipid profile, liver enzymes and hepatitis Be antigen (HBeAg) were tested. RESULTS The participants had a mean age of 33.6 ± 8.4 years and included 123 (60.3%) females, 40 (19.6%) with HBeAg seropositivity, and 29 (14.2%) with family history of DM. The prevalence of IFG was 52 (25.5%). On multivariate analysis, the independent predictors of IFG were family history of DM (OR = 8.23, 95% CI = 2.78-24.31), male gender (OR = 2.83, 95% CI = 1.17-6.64), HBeAg seropositivity (OR = 4.97, 95% CI = 1.87-13.18) and elevated GGT (OR = 7.27, 95% C.I = 2.88-18.35). CONCLUSION The prevalence of IFG among HBV-infected patients is high. Targeted screening and follow-up of HBV-infected patients for abnormalities of glucose metabolism is recommended.

Nocturnal Non-dipping Blood Pressure Profile in Black Normotensives Is Associated with Cardiac Target Organ Damage

PURPOSE A non-dipping pattern of nocturnal blood pressure in hypertensive patients is an established predictor of cardiovascular risk, especially in Blacks. However, data on non-dipping normotensives and cardiovascular risk in this population is sparse. In this study, we aim to determine if a non-dipping profile in a cohort of Black normotensives is associated with cardiac target organ damage. METHODS We studied ambulatory blood pressure patterns in 43 normotensive Black patients of Caribbean origin and classified their profiles as dippers (DP) and non-dippers (NDP) based on their nocturnal blood pressure profiles. Cardiac target organ damage was estimated from 2-D echocardiogram. RESULTS The mean age of the cohort was 52 years. Both groups were similar with respect to baseline age, sex, weight, height, body mass index and daytime ambulatory BP. There was a statistically significant difference in nocturnal blood pressure between DP and NDP groups (112 ± 7/64 ± 2 mm Hg vs 117 ± 3/69 ± 2 mm Hg, P=.004). The NDP cohort showed evidence of cardiovascular target damage on echocardiography with a significantly increased relative wall thickness (.35 ± .07 cm vs .42 ± .05 cm, P=.001), left ventricular mass index (95 ± 14 vs 105 ± 14 g/m(2), P=.018) and left atrial volume index (26 ± 3.5 vs. 30 ± 3.4, P=.001). Left ventricular geometry in the non-dippers also showed increased concentric remodeling, concentric and eccentric hypertrophy. CONCLUSIONS Our study demonstrates that nocturnal non-dipping of blood pressure in normotensive Blacks of Caribbean origin may be associated with cardiovascular end organ damage thereby providing new surveillance and therapeutic targets.

Sputum bacteriology and antibiotic sensitivity patterns of community-acquired pneumonia in hospitalized adult patients in Nigeria: a 5-year multicentre retrospective study.

Abstract Background: A clear knowledge of the pathogens responsible for community-acquired pneumonia (CAP) in a given region and their antibiotic sensitivity patterns is necessary for optimal treatment. We determined the common bacterial pathogens causing CAP in Nigeria and further reviewed their antibiotic senstivity patterns with a view to providing recommendations to improve antibiotic management of CAP. Methods: Case notes of all adult patients who were 18 years or more admitted to four major tertiary hospitals in South East Nigeria with a diagnosis of CAP between 2008 and 2012 were retrospectively studied. To be eligible, patients were required to have sputum culture and sensitivity results available. Socio-demographic, clinical, pre-admission and in-hospital treatment data were also obtained. Results: Of 400 patients with a radiologically confirmed diagnosis of CAP, 232 fulfilled the study criteria; 122 (52.6%) were women and the mean age was 50.6 ± 18.8 years. Aetiological agents were identified from sputum in 189 (81.5%) patients. Streptococcus pneumoniae (n = 90, 47.6%) was the most frequent isolate followed by Klebsiella pneumoniae (n = 62, 32.8%), Staphylococcus aureus (n = 24, 12.7%) and Streptococcus pyogenes (n = 13, 6.9%). The pathogens were most sensitive to levofloxacin (77%), ceftazidime (75.5%) and ofloxacin (55.8%). The susceptibility of the isolates to antibiotics most frequently presecribed for empirical therapy was low (co-amoxiclav, 47.6%; ciprofloxacin, 45.9% and ceftriaxone, 47.6%) and this was associated with higher mortality and/or longer duration of hospital stay in survivors. Conclusion: Strep. pneumoniae and K. pneumoniae were the most common causes of CAP. The pathogens were most sensitive to levofloxacin and ceftazidime. We suggest that these antibiotics should increasingly be considered as superior options for empirical treatment of CAP in Nigeria.

Predictors of in-hospital mortality and length of stay in community-acquired pneumonia: a 5-year multi-centre case control study of adults in a developing country

BACKGROUND We investigated predictors of in-hospital mortality and length of hospital stay among adults with community-acquired pneumonia (CAP) in Nigeria in order to provide recommendations to improve CAP outcomes in developing countries. METHODS This was a multi-centre case control study of patients ≥18 years who were admitted with CAP between 2008 and 2012. Case notes of 100 consecutive patients who died (cases) and random sample of 300 patients discharged (controls) were selected. RESULTS Mean ages were 55.4±19.6 (cases) and 49.3±19.2 (controls). Independent predictors of mortality were CURB-65 score ≥3: adjusted odds ratio (aOR) 24.3, late presentation: aOR 8.6, co-morbidity: aOR 3.9, delayed first dose antibiotics (>4 hours): aOR 3.5, need for supplemental oxygen: aOR 4.9, multilobar pneumonia: aOR 4.0, non-pneumococcal aetiology: aOR 6.5, anaemia: aOR 3.8 and hyperglycemia: aOR 8.6. CURB-65 ≥3 predicted mortality with a high specificity (96.1%) but low sensitivity (75%); positive predictive value of 88.2% and negative predictive value of 90.8%. Care in hospital A and B: aOR 3.3 and 2.2 respectively, male gender aOR 2.1, co-morbidity aOR 3.0, anaemia aOR 2.1 and elevated serum creatinine aOR 6.3 independently predicted length of hospital stay >10 days among survivors. CONCLUSIONS Several modifiable patient-related and process-of-care factors predicted in-hospital mortality, and length of hospital stay among survivors. Our findings should be used to improve CAP outcomes in developing countries.

OS 37-02 HYPERTENSION IN HIV-INFECTED ADULTS IN NORTH-CENTRAL NIGERIA: PREVALENCE, ASSOCIATED RISK FACTORS AND ASSESSMENT OF RISK USING THE FRAMINGHAM RISK SCORE.

Objective: To evaluate the prevalence of Hypertension and associated risk factors in HIV+ adults and assessment of these risks using the Framingham risk score ‘FRS’. Design and Method: A cross-sectional analytical study. One hundred and fifty consecutive HIV+ adults presenting at the HIV clinic of Jos University Teaching Hospital (90 on HAART) with 50 HIV- as controls were recruited. Relevant history, physical examination (including blood pressure measured according to standard guidelines), laboratory specimen (fasting plasma sugar and lipids, CD4 count and viral load) and electrocardiogram were obtained from the participants. The prevalence of hypertension and associated risk factors was determined and the FRS for each participant was calculated and interpreted to assess cardiovascular risk. Data was analyzed using Epi info version 7 statistical software; p value < 0.05 was considered significant. Results: There were 94 females and 30 females among the HIV+ and HIV- respectively. The mean ages of HIV+ and HIV- were 41 ± 7 and 40 ± 8 years respectively (p = 0.77). The prevalence of hypertension in the HIV+ and HIV- was 46.0% and 10.0% respectively, p < 0.01. Among the HIV+, 123 (82%) had at least 1 risk factor while 37 (25%) had at least 4 compared to 31 (62%) and 0 (0%) respectively in the HIV-, p < 0.01. The use of HAART was associated with higher prevalence of hypertension, dyslipidaemia, diabetes mellitus and obesity among the HIV+ (Data not shown). The mean FRS of those on HAART (4.8 ± 0.6) and those not on HAART (3.3 ± 0.6) were significantly higher than that of the controls (2.5 ± 1.0); p = 0.04. Furthermore, those on HAART had significantly higher mean FRS compared to those not on HAART, p < 0.01. The use of protease inhibitor based regimen predisposed to higher mean FRS 7.9 ± 2.0 versus 3.2 ± 0.7, p < 0.01. Conclusions: Hypertension and associated risk factors are common in HIV+ persons. Early diagnosis with prompt treatment will significantly reduce morbidity and mortality in these patients.

Determinants of HIV-related cardiac disease among adults in north central Nigeria.

Objective The aim of the present study was to evaluate the determinants of HIV-related cardiac disease (HRCD) among adults in north central Nigeria. This was a hospital-based cross-sectional study recruiting patients who were HIV positive attending the HIV clinic at Jos University teaching Hospital, Nigeria. Methods A total of 200 adults who were HIV positive and aged ≥18 years were consecutively recruited. All patients were administered a questionnaire and underwent clinical examination, laboratory investigation for haemoglobin estimation, CD4 cell count, viral load, serum lipid profile, hepatitis B surface antigen, anti-hepatitis C virus antibody, electrocardiogram and two-dimensional echocardiography Doppler studies. The outcome measure was echocardiography-defined cardiac disease, such as systolic dysfunction, diastolic dysfunction, isolated left ventricular dilatation, right ventricular dysfunction or pulmonary hypertension. Results The mean age of the study population was 38±9 years. The majority (71%) were women and were on average younger than the men (36±8 years vs 47±9 years, p<0.0002). Highly active anti-retroviral therapy (HAART) use was seen in 84.4% of subjects. The median CD4 cell count for the study population was 358 cells/µL; the count was 459 (95% CI 321 to 550) cells/µL for subjects without HRCD and 193 (95% CI 126 to 357) cells/µL for subjects with HRCD (p<0.001). HAART-naive subjects with HRCD had a mean CD4 cell count of 121 cells/µL vs 200 cells/µL for those on HAART (p<0.01). CD4 cell count (OR = 0.25, 95% CI 0.15 to 0.45) and duration of diagnosis (OR=3.88, 95% CI 1.20 to 13.71) were the significant determinants of HRCD on multivariate analysis. Conclusions Duration of HIV diagnosis and degree of immunosuppression were the significant determinants of HRCD. There is therefore a need to reduce cardiovascular morbidity in patients infected with HIV through early diagnosis/sustained use of HAART, early screening for HRCD and prompt intervention.

PS 14-05 LEFT VENTRICULAR DYSFUNCTION IN ASYMPTOMATIC HYPERTENSIVE PATIENTS WITH AND WITHOUT TYPE 2 DIABETES: PREVALENCE, PATTERNS AND ASSOCIATED FACTORS

Objective: To evaluate the prevalence, patterns and associated factors of left ventricular dysfunction (LVD) in asymptomatic hypertensive patients with and without type 2 diabetes. Design and Method: A cross-sectional analytical study. Fifty consecutive hypertensive adults (HTN+) and another fifty with hypertension and type 2 diabetes mellitus (HTN+/DM+) were enrolled from the cardiology/diabetes clinics of Jos University Teaching Hospital. Relevant history, physical examination (including blood pressure measured according to standard guidelines), laboratory specimen (fasting plasma sugar and lipids, urea, creatinine and haemoglobin concentration) and electrocardiogram were obtained from the participants. Thereafter electrocardiography guided echocardiograph assessment of LV function was performed on each participant. Data was interpreted and subsequently analyzed using Epi info version 7 statistical software; p value < 0.05 was considered significant. Results: There were 27 females and 29 females in the HTN+ and HTN+/DM+ groups respectively. The mean ages were 49 ± 8 and 49 ± 7 years respectively (p = 0.95). The comparison of mean values of the systolic and diastolic parameters measured is shown (table 1). The systolic parameters showed statistically significant differences for both genders. The HTN+/DM+ group had lower mean values of systolic parameters for both genders. Similarly, the HTN+/DM+ group had a higher prevalence of LVD compared to the HTN+ group (56% versus 30%, p < 0.01) and worse diastolic patterns (figure 1). In the HTN+ group, duration of hypertension and left atrial diameter correlated significantly with the systolic parameters. Both further emerged as independent predictors on multivariate regression analysis. In the HTN+/DM+ group, duration of DM correlated significantly with systolic and diastolic parameters while duration of hypertension correlated significantly with systolic parameters. Both further emerged as independent predictor on multivariate regression analysis (Data not shown). Conclusions: Left ventricular dysfunction is common in hypertensives; co-morbid diabetes mellitus worsens it. Early diagnosis with prompt treatment will significantly reduce morbidity and mortality in these patients.

PS 08-74 KNOWLEDGE, ATTITUDE AND UTILITY OF ECG AMONG FAMILY MEDICINE RESIDENTS IN NIGERIA

Objective: There is limited information on the utility of electrocardiogram (ECG) in General practice in Nigeria. We assessed the knowledge, attitude and utility of ECG among Nigerian Family Medicine residents. Design and Method: A cross-sectional evaluation was conducted in four Family Medicine training centres in Nigeria. Using a self-administered questionnaire information on the resident doctors ECG requests, preferred source of interpretation, most common ECG diagnosis and update of ECG knowledge were obtained. Results: Only 61 out of 120 questionnaires (50.8%) were returned. The respondents were mostly between 31–40 years (54.7%); predominantly males (73.8%) and senior residents (65.6%). Fifty four (88.3%) made <5 ECG requests/week and the commonest indication was hypertension (50%). Their ECG interpretation was mostly self-reported (41%), followed by cardiologist (26.5%) or automated reports (21.3%). Self-reporting of ECG was commoner among senior residents (p < 0.01). Left ventricular hypertrophy was the commonest ECG diagnosis (55.8%). Majority (69%) did not update their ECG knowledge. Half of them desired further learning on basic ECG interpretation. Teaching ECG in updates/contious medical education (CMEs) was adjudged the best way to improve knowledge/utility (61.1%). Conclusions: The attitude and utility of ECG among Family Medicine residents in Nigeria is poor. Improvement through curriculum revision, hands-on tutorials and CMEs is highly recommended.

PS 02-54 AWARENESS OF HYPERTENSION AND DRUG COMPLIANCE AMONG ADULTS IN SOUTH EAST NIGERIA: A FALLOUT FROM 2015 WORLD HYPERTENSION DAY

Objective: Hypertension has remained a leading cause of cardiovascular disease morbidity and mortality worldwide despite concerted efforts at control. Majority of the populace are unaware of their blood pressure (BP), others are not consistent with follow up and drug use. As part of 2015 world hypertension day theme of ‘know your number’, we undertook a study in 4 different locations in Abakaliki, Nigeria to evaluate the level of hypertension burden and drug adherence. Design and Method: Interviewer administered questionnaire was used to access knowledge of hypertension status, regularity with BP check, use of and adherence to therapy. Participants height and weight were measured, BP checked using mercury in glass sphygmomanometer, and average of three measurements using standard protocol recorded as the persons BP. Data was then entered into a spread sheet for analysis. P value of <0.05 was considered significant. Results: The study involved 383 adults ≥ 18 years mean age 43 years, 55.8% (214) were females and the mean BMI was 23.9 kg/m2. Prevalence of hypertension was 47.5% (182), 16.7% (64) {95% CI 0.26–0.39] previously knew they were hypertensive. Mean age in those with elevated BP and those normal BP were 48 years and 38 years respectively. Among those previously diagnosed with hypertension, 81.3% have been commenced on anti-hypertensive drugs, but only 25% were compliant (p < 0.005). Mean BP was 129/81mmHg, 22.7% (87) and 12.5% (48) of cohorts had Grade1 and Grade 2 hypertension respectively, while 41.9% (18) and 31.3% of those regular and not regular with medications had Grade 2 hypertension. Mean of last blood pressure check among the participants (in weeks) was 33 weeks. Conclusions: Awareness of BP status and drug adherence remain poor among adults in south east Nigeria, calling for greater emphasis on campaign aimed at attitudinal change at every level in line with WHO emphasis on know your number.