James Ayodele Ogunmodede

Factors influencing adherence to antiretroviral medication in Ilorin, Nigeria.

Background: Good adherence to highly active antiretroviral therapy (HAART) is required for viral suppression and prevention of drug resistance. Patients’ adherence to HAART has not been determined since the commencement of HAART at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, over 5 years ago. Objectives: To determine the adherence level of people living with HIV/AIDS (PLWHA) to HAART and identify associated factors. Methodology: A semistructured questionnaire was administered to PLWHA, who were accessing treatment. Sociodemographic, lifestyle, HIV medical, and drug history were obtained from them. Adherence was self-reported. Good adherence was taking of 95% of the prescribed doses of HAART over the preceding 30 days before consultation. Results: Study participants were 253; majority, 58.5%, were females. About 70.8% of them had good adherence. Older age and male sex correlated better with adherence. Conclusion: People living with HIV/AIDS were quite adherent to HAART. Male sex and older age were positive predictors of adherence. Adherence among the young age and females needs strengthening.

Advanced sickle cell associated interstitial lung disease presenting with cor pulmonale in a Nigerian

Previous studies have reported abnormal pulmonary function and pulmonary hypertension among Nigerians with sickle cell disease, but there is no report of interstitial lung disease among them. We report a Nigerian sickle cell patient who presented with computed tomography proven interstitial lung disease complicated by pulmonary hypertension and cor pulmonale.

Left Ventricular Hypertrophy Is Associated with Diastolic Filling Alterations in Normotensive Offspring of Hypertensive Nigerians

Contribution of left ventricular diastolic dysfunction to adverse events in patients with cardiovascular diseases is increasingly being recognized and individuals with pedigree for hypertension are thought to exhibit anatomic and or functional changes in their left ventricle before they become hypertensive. This study aimed at characterizing left ventricular diastolic function in normotensive offspring of hypertensive Nigerians. Sixty-five offspring of hypertensive parents aged 15–25 years (subjects) with 65-age and sex-matched offspring of normotensive parents (controls) were studied for early makers of hypertensive cardiovascular disease using Doppler echocardiogram. Mean mitral E velocity was reduced (P = 0.01) in the subjects (73.3 ± 12.6 cm/s) compared with the controls (80.2 ± 22.5 cm/s). Similarly, mean S velocity of pulmonary venous flow was lower (P = 0.01) in the subjects than in the controls. Left atrial dimension and mitral E/A ratio in the subjects with left ventricular hypertrophy were higher (P = 0.002, 0.004 respectively) than in the subjects without this abnormality. We concluded that normotensive offspring of hypertensive Nigerians showed early alterations in indexes of left ventricular diastolic filling and these abnormalities were exaggerated in the presence of left ventricular hypertrophy.

Structural echocardiographic abnormalities seen in HIV/AIDS patients are independent of CD4 count

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

Pattern and predictive factors of health-related quality of life of patients with hypertension, diabetes and concomitant hypertension with diabetes in Ilorin, Nigeria.

Background: Hypertension and diabetes are the two most important modifiable risk factors for cardiovascular disease (CVD) among Nigerian population. Because of the lifelong nature of the two diseases and the attendant long treatment regimen required, assessing the health-related quality of life (HRQoL) is an important outcome of these diseases. Objective: This study assessed the pattern and predictive factors of HRQoL among patients with hypertension, diabetes and concomitant hypertension and diabetes using the 36-item short-form version 2. Patients and Methods: A cross-sectional study of 1203 patients attending the outpatient clinics of the University of Ilorin Teaching Hospital, Ilorin; the patients were sampled using systematic random sampling methods. Patients were divided into those with hypertension, diabetes and both diseases. The predictors of physical and mental component summaries of HRQoL were analysed using Norm-based Scoring. The level of significance was set at P < 0.05 and 95% confidence interval. Results: The patients with both diseases have lowest physical HRQoL (45.6), while the diabetic patients have the worst mental HRQoL (39.5). Negative predictors of physical HRQoL across the three groups were: drug regimen (hypertension P < 0.001, diabetes P < 0.001, both P = 0.005), CVD complication (hypertension P < 0.001, diabetes P = 0.025) and accompanying persons (P < 0.001). The positive predictors of physical HRQoL across the three groups were medication adherence (hypertension P < 0.001, diabetes P < 0.001 and both P = 0.002). Similarly, medication adherence was the positive predictor for mental HRQoL across the three groups of patients (hypertension P < 0.001, diabetes P = 0.001 and both P < 0.001). Conclusion: This study provided evidence to show that HRQoL across the three categories of patients in Ilorin, Nigeria, is suboptimal. Drug regimen, medication adherence and support from accompanying persons were important predictive factors of HRQoL.

Public knowledge of heart attack symptoms and prevalence of self-reported cardiovascular risk factors in Ilorin, Nigeria

Background and objectives: Despite reduction in door-to-balloon time in the management of acute myocardial infarction (AMI), prehospital delay by the patients has remained a major concern as benefits derivable from reperfusion treatments are time dependent. This study aimed at evaluating knowledge and perception of warning signs of heart attack among civil servants in Ilorin, Nigeria. Materials and Methods: A pretested structured questionnaire was designed to obtain relevant information on knowledge and perception of heart attack symptoms; and action to be taken if one experiences the condition. Results: Questionnaires from 601 subjects consisting of 312 (51.9%) males and 289 (48.1%) females were analyzed. Although, 78% of the respondents have heard about heart attack, only 44.4% could discriminate a heart attack symptom from other conditions. Higher proportion of women (50.2%) than men (39.1%) could identify a core symptom of heart attack (P < 0.05). Similarly, higher percentage of participants 40 years and older (48.3%) were more knowledgeable than those younger than 40 years (42.9%), but the difference was not statistically significant (P > 0.05). Higher percentage of women reported prior cardiovascular disease/risk factors than men. Conclusion: We concluded that participants have low knowledge of heart attack symptoms with women being more knowledgeable than their male counterparts. There is the need for community education on heart attack warning signs and the need for early hospital presentation by affected individuals.