Profile and Correlates of Sleep Quality and Obstructive Sleep Apnoea among Young Persons in Ibadan, Southwestern Nigeria

BACKGROUND

Sleep breathing disorders (SDB), especially obstructive sleep apnoea (OSA), are poorly studied in the young population. This study aimed to determine the prevalence of OSA and its associated risk factors among young persons.

METHODS

A cross-sectional study design was used, and participants aged 16-35 years were recruited from five tertiary institutions in Ibadan, South Western, Nigeria. The study used a structured questionnaire, stadiometer, weighing scale, tape measure, and digital blood pressure machine to collect data. Patient Health Questionnaire (PHQ 9), Generalized Anxiety Disorder-7(GAD-7), and Pittsburgh sleep quality index (PSQI) were used to assess depression, anxiety, and sleep quality respectively. To assess the risk of OSA, we used both the STOP-Bang questionnaire and the NOSAS score. The Statistical Package for the Social Sciences version 23 was used to analyse the data, and statistical significance was set at <0.05.

RESULTS

A total of 354 participants were included in this report with a mean age of 21.2±3.5 years. The female: male ratio was 1.9:1. The mean ±standard deviation of PSQI, GAD-7 score and PHQ-9 were 2.2±1.1, 12.4±5.1 and 15.0±5.4 respectively. The following percentages of participants were found to be at low, intermediate, and high risk for OSA: 94.1%, 5.6%, and 0.3%, respectively. This study showed that age and GAD-7 score were independently associated with the PSQI score while age, body mass index, neck cuff size and PHQ-9 score for OSA score.

CONCLUSION

There is a burden of OSA among this population of young people; and modifying anthropometric and psychosocial factors can help mitigate the risk of OSA outcomes.

Clinical Characteristics, Management, and Six-Month Outcomes after Discharge of Patients Admitted for Acute Heart Failure in Ibadan, Nigeria

BACKGROUND

The burden of acute heart failure (AHF) is on the increase globally however, there are few studies on AHF in Nigeria and among black populations.

OBJECTIVE

This study described the clinical profile, conventional management and six-months outcome after discharge of patients admitted for acute heart failure at the University College Hospital, Ibadan, Nigeria.

METHODS

The study was a prospective study of 160 consecutive AHF patients. Socio-demographic details, clinical history, basic laboratory parameters electrocardiographic and echocardiographic parameters were assessed. They were followed-up for six-months after discharge to ascertain death or readmission.

RESULTS

The mean ± standard deviation (SD) age of all the patients was 58.0 ±15.1 years. Those aged 60 years and above constituted about half of the participants. Males comprised 59.3% and hypertension was the most common risk factor (77.5%). One hundred and thirty-four subjects (83.8%) were in New York Heart Association functional classes III or IV. The most common AHF type was heart failure with reduced ejection fraction and mostly presented de novo. The mean duration of admission was 11 days while intrahospital mortality and mortality at 6 months after discharge were 6.3% and 25.6% respectively.

CONCLUSION

This study provided a real-world data of AHF at UCH, Ibadan, Nigeria. It showed AHF was predominantly associated with hypertension. There was high mortality among these AHF subjects. There is a need for more strategy in our environment for preventing AHF and its adverse outcomes.

BURDEN OF ERECTILE DYSFUNCTION AMONG HEART FAILURE PATIENTS IN A CENTRE IN THE SOUTH-WESTERN NIGERIA: A PILOT STUDY

Background

Erectile dysfunction (ED) is a common problem among heart failure (HF) patients but is usually ignored in busy clinics in developing countries like Nigeria. Evidence abound that it has a great impact on the quality of life, survival, and prognosis of HF patients.

Objective

This study sought to evaluate the burden of ED among HF patients at the University College Hospital, Ibadan.

Methods

This pilot cross-sectional study was conducted in the Cardiology clinic of the Medical Outpatient Unit of the Department of Medicine, University College Hospital, Ibadan. Consenting male patients with chronic HF were consecutively recruited into the study between June 2017 and March 2018. The International Index of Erectile Function-version five (IIFE-5) was used to access the presence and degree of ED. Statistical analysis was done with SPSS version 23.

Results

A total of 98 patients were recruited with a mean± standard deviation (SD) age of 57.6 ±13.3 years, and age range of 20-88 years. The majority of the participants were married (78.6%), and the mean ± SD duration of HF diagnosis was 3.7 ±4.6years. The overall frequency of ED was 76.5%, and those with previous self-reported ED were 21.4%. Mild erectile dysfunction, mild to moderate erectile dysfunction, moderate erectile dysfunction, and severe erectile dysfunction were present in 24(24.5%), 28(28.6%), 14(14.3%), and 9(9.2%) respectively.

Conclusion

Erectile dysfunction is common among chronic heart failure patients in Ibadan. Therefore, adequate attention is needed for this sexual health issue among males with heart failure to improve their quality of care.

876 Veriset Haemostatic Patch, Indications, Benefits and Complications: A Systematic Review

Aim

Achieving haemostasis intraoperatively is important for minimising blood loss, complications, and operation time. Suturing, cauterisation, fibrin glues and patches are used for this purpose. We explore Veriset, a patch consisting of polyethylene glycol and oxidised cellulose, to determine and compare its safety and effectiveness.

Method

Medline, Embase, Web of Science, Scopus, Cinahl and Cochrane databases were searched. Data points collected were Study/subject characteristics/demographics, surgery/specialty, time to haemostasis, proportion of haemostasis achieved, intraoperative adverse events, post operative complications, follow up time, and biochemical/histological analysis. Risk of Bias was assessed by Newcastle-Ottawa Scale

Results

Six studies were included; four human trials (3 RCTs, 1 case series) and two animal trials.

The human trials combined had 250 patients, with 147 using Veriset. In two RCTs, Veriset showed faster time to haemostasis and higher proportion of haemostasis achieved vs suturing and Tachosil haemostatic patch. In all three RCTs, no significant differences in adverse events and complications were seen between Veriset and suturing/Tachosil. Vascular, nephrectomy and hepatic surgery were investigated.

In the animal studies, the pig trial showed similar effectiveness and safety as the human trials. The rat study compared novel experimental patches to Veriset, and showed similar effectiveness to Veriset, at reduced costs.

Conclusions

Although current literature is scarce, Veriset is more effective than alternatives for haemostasis, with similar safety, although there are now other experimental patches that could have better health economic implications. Further clinical trials would be necessary to determine the breadth of applicable surgical fields for Veriset.

Comparative Analysis of Left Ventricular Geometry in Adult Nigerians with and without Chronic Kidney Disease: Results from Ibadan CRECKID STUDY

BACKGROUND

Chronic kidney disease (CKD) is associated with increased risk of cardiovascular morbidity and mortality. Left ventricular hypertrophy (LVH) is considered the strongest independent predictor of cardiovascular disease and events among CKD patients. We reported the echocardiographic left ventricular geometry in CKD patients compared to non-CKD hypertensive and apparently healthy controls in Ibadan.

MATERIALS AND METHODS

A total of 683 participants in the CRECKID STUDY comprising 220(32.2%) CKD patients, 281(41.1%) non-CKD hypertensive patients and 182(26.6%) healthy controls were included in this analysis. Basic demographic and clinical information with echocardiographic parameters were obtained.

RESULTS

Study participants in the non-CKD hypertensive group were on average older than the CKD and the healthy controls (56.2±13.1 vs 47.2±14.6, and 46.8±13.3 years, respectively; p<0.01). Compared with other groups, greater proportions of participants with CKD were men (40.5% vs.38.1% and 21.3%; p<0.0001). The left atrial and left ventricular dimensions were significantly higher in CKD compared with others. LVH was significantly more prevalent among CKD patients (68.2%) compared to hypertensive (43.9%) and normotensive (19.5%) group (p<0.01). The participants with CKD had a greater proportion of abnormal LV geometry with concentric LVH predominating (p<0.0001). Having LVH was associated with lower mean estimated glomerular filtration rate (eGFR) (40.6±37.71 vs 67±37.38, p<0.0001).

CONCLUSION

In our study, patients with CKD had the highest prevalence of abnormal LV geometry and functions. A unit decrease in eGFR was associated with increased left ventricular mass. Early detection and prompt management of abnormal LV geometry may help in reducing adverse cardiovascular outcome in patients with CKD.

Pregnancy-associated Acute Myocardial Infarction (PAMI): Case Report

Cardiovascular diseases are recognised complications of pregnancy, however, pregnancy-associated acute myocardial infarction (PAMI) is uncommon. Pregnancy is known to increase risk of myocardial infarction even in the absence of traditional risk factors for atherosclerotic vascular disease. Our patient presented with acute chest pain two weeks after delivery and her electrocardiogram was in keeping with STelevation myocardial infarction (STEMI). Coronary angiography revealed coronary artery dissection and she was managed conservatively. Various pathophysiological mechanisms of PAMI have been described in literature including spontaneous coronary artery dissection (SCAD) found in our case. The diagnosis is often missed and earlier reported cases were diagnosed at autopsy. Therefore, we report this case as a learning tool. Also, there is a need for a high index of suspicion in pregnant patients presenting with features suggestive of aortic dissection, and its diagnosis should be thought of in peripartum women presenting with acute chest pain.

PATTERN OF LIVER CANCER ADMISSIONS AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN - A 4-YEAR REVIEW

BACKGROUND

Liver Cancer (LC) is a common malignancy globally, and it exacts an enormous toll on the health care system. Therefore, it is imperative to have an epidemiological profile for effective planning.

METHODS

This study examined the basic demographic, admission profile and outcome of this category of patients through a retrospective cross-sectional study. The study was carried out using data of clinical diagnoses of LC admitted into the Gastro-intestinal Unit (GLU), Department of Medicine, University College Hospital, Ibadan between 1st January 2011 and 31st December 2014.

RESULTS

Two hundred and six patients (16.8%) had diagnoses of LC out of the 1228 total cases admitted by the GLU. The total male patients were 147(71.4%) and female 59 (28.6%) while the most prominent age group for both genders and males were 41-50 years in the male group and 51-60 years among females. The mean ± SD and median hospital stay was 10.6±11.6 days and eight days for LC patients, respectively. The intrahospital fatality rate was 37.9% and occurred mainly within five days of admission.

CONCLUSION

Liver Cancer is an important disorder in gastrointestinal practice and had high fatality within a few days of admission; hence, efforts should be made to improve the care of the patients.

OROFACIAL CLEFTS AND CARDIOVASCULAR RISK AND DISEASES: THE CAUSAL RELATIONSHIP AND ASSOCIATIONS

There is a complex interplay between orofacial clefts (OFCs) or cleft of the lip and palate and cardiovascular risk factors and cardiac diseases. The presence of maternal cardiovascular risk factors serves as a potent predisposing factor to the development of OFCs during foetal development in addition to the fact that various congenital anomalies are associated with OFCs either in syndromic or non-syndrome relationship. This article narratively explores this complex interplay, which is not uncommon.

Impact of Epilepsy on Adolescents in a Rural Nigerian Community: A Case-Control Study

BACKGROUND

Epilepsy is associated with impaired physical, psychological and social functioning. Assessing its impact on these parameters is important to improving the wellbeing of those with the disorder.

OBJECTIVE

To assess the impact of epilepsy on the physical, psychological and social status of adolescents in a rural community.

METHODS

Adolescents with epilepsy (Subjects) were identified in a community house to house survey. Controls (adolescents without epilepsy) matched for age and sex were randomly selected from the community. Information obtained from the subjects, controls and their care givers using a structured questionnaire included: Age, Sex, Social Class, Knowledge of epilepsy, Characteristics of epilepsy, Treatment options utilized, Health-Related Quality of Life (HRQOL), Body Mass Index (BMI), Academic performance and Epilepsy related problems.

RESULTS

Eighteen subjects, 10.5/1000 of the adolescent (10-19 years) population, had epilepsy. The mean age was 16.7± 2.6 years and 16.3± 2.6 years for the subjects and controls respectively. Most of the subjects were males (83.3%). All the subjects had generalized epilepsy, were on traditional medication and none was on orthodox medical therapy. Occurrence of seizures, cost of accessing orthodox medical treatment and stigma were the major problems identified. Ingestion of traditional medication was the commonest modality for overcoming the major problems identified. Seven (38.8%) were underweight but it was not significant (p>0.05). Epilepsy was significantly associated with impaired HRQOL, academic performance and social relationships (p>0.05).

CONCLUSION

Epilepsy had a negative impact on the psychosocial and academic status of adolescents. It highlights the need to provide comprehensive adolescent health and social services in epilepsy management.

ASSESSMENT OF MEASURES OF ADIPOSITY THAT CORRELATE WITH BLOOD PRESSURE AMONG HYPERTENSIVE AFRICANS

BACKGROUND

Studies differ on which anthropometric measure of adiposity shows good correlation with cardiovascular diseases. In this study, we evaluated the effects of common epidemiological measures of adiposity as a correlate of elevated blood pressure in an African population.

METHODOLOGY

The study was carried out between June 2009 and December 2011 at the medical out-patient department of a tertiary healthcare center in Nigeria. Correlation analysis was used to assess the relationship between blood pressure and body mass index (BMI), waist to height ratio (WHtR), and waist circumference (WC).

RESULTS

A total of 1,416 Hypertensives comprising 1090 (77%) adult females recruited over two and half years. Women were significantly older (49.2±8.1 vs. 48.0±10.0 years, p=0.039) and shorter (1.6±6.3 vs 1.7±6.8 meters, p<0.0001) when compared with men. Blood pressure parameters were comparable between women and men. Approximately 1 out of 5 participants had good blood pressure control with no gender difference. Anthropometric measurements showed that 446(32%) were overweight, 404(29%) obese and 40(3%) were morbidly obese. Compared with their male counterparts, females were significantly more likely to be obese (P<0.0001). Similarly, 51.6% of the subjects had abdominal obesity, with female preponderance (P<0.0001). Likewise, a greater proportion of women had substantially higher measured waist circumference risk. Compared with other measures of adiposity, body mass index correlated best with diastolic blood pressure in both gender (P< 0.05).

CONCLUSION

This study adds to the evidence that obesity is a major cardiovascular risk factor. BMI, as a measure of adiposity, was found to correlate best with blood pressure. These findings support other observations in other populations that BMI rather than waist to height ratio (WHtR), and waist circumference (WC) is a better correlate of hypertension.

Prevalence of cigarette smoking and the knowledge of its health implications among Nigerian soldiers

OBJECTIVE

Several studies have reported a negative relationship between smoking and military performance. This study was conducted to determine the prevalence of cigarette smoking and knowledge of its health implications among Nigerian Army personnel.

MATERIALS AND METHODS

A descriptive cross-sectional survey of 853 soldiers using a self-administered pre-tested semi-structured questionnaire.

RESULTS

One hundred and seventy three respondents (20.3%) out of 853 respondents smoked. About three-quarter of them started smoking in the army. Derivation of pleasure and relaxation (24.9%), allaying anxiety (21.4%) and peer influence (34.1%) were the most frequent reasons for smoking. Skin disorder (75.9%), lung cancer (68.6%), addiction (65.2%) and dental problems (57.5%) were the most commonly reported effects of smoking. Only half (50.3%) of the total respondents believed that these effects of smoking could limit military fitness and performance. Forty five (26.1%) of the smokers had attempted to quit smoking. Majority (92.7%) of all the respondents have never had anti-smoking sensitization while in the army.

CONCLUSION

The prevalence of smoking among the respondents was high. In spite of their knowledge its health hazards, the respondents could not relate this to military fitness and combat effectiveness. Also, their knowledge of the adverse effects did not translate to their smoking behaviour. There is need for continuous anti-smoking programmes to be established by the medical authority in the Nigerian Army to sensitize personnel on the dangers of cigarette smoking.

Differential effects of U46619 on renal regional hemodynamics in the rat: involvement of endothelin

Many vasoactive agents produce qualitatively similar effects on blood flow in the renal cortex and medulla, evoking reductions or increases in blood flow in both regions. We demonstrated previously that endothelin-1 (ET-1) is an exception because it evoked an increase in medullary perfusion despite a potent cortical vasoconstriction ( Hercule and Oyekan 2000). We report here that U46619 (11,9 epoxymethano-prostaglandin H2), a selective agonist of prostaglandin H2 (PGH2)/thromboxane A2 (TxA2) (TP) receptor, evokes similar effects as ET-1. In the pentobarbital-anesthetized (60 mg/kg) rat, 1, 3, and 5 microg/kg U46619 dose dependently reduced mean arterial blood pressure by -2 +/- 4, -8 +/- 10, and -31 +/- 10 mm Hg, respectively; renal cortical blood flow (CBF) by -50 +/- 11, -174 +/- 45, and -349 +/- 43 perfusion units (PU), respectively; but increased medullary blood flow (MBF) by 42 +/- 16, 51 +/- 18, and 61 +/- 21 PU, respectively. Prostaglandin F2alpha, a TxA2 mimetic, produced similar effects as U46619. SQ29548 ([1S-[1alpha,2alpha(Z), 3alpha,4alpha]]-7-[3[[2-[(phenylamino)carbonyl[hydrazino] methyl]-7-oxabicyclo[2.2.1]hept-2-yl]-5-heptenoic acid) (0.1 mg/kg), an antagonist of PGH2/TxA2 (TP), blunted U46619-induced hemodynamic changes without affecting that produced by phenylephrine. BMS182874 [5-(dimethylamino)-N-(3,4-dimethyl-5-isoxazolyd)-1-naphthalene sulfonamide] (40 mg/kg), an ET(A)-selective antagonist, blunted U46619-induced reduction in CBF by 54 +/- 9% (p < 0.05) and the increase in MBF by 59 +/- 18% (p < 0.05). Similarly, BQ788 (N-cis 2,6-dimethylpiperidinocarbonyl-L-gamma-methylleucyl-D-1-methoxycarbonyltryptophanyl-D-norleucine) (1 mg/kg), an ET(B)-selective antagonist, blunted the effects of U46619 on CBF and MBF by 19 +/- 3% (p < 0.05) and 48 +/- 19% (p < 0.05), respectively. Combined administration of BMS182874 and BQ788 further attenuated U46619-induced reduction in CBF by 67 +/- 8% (p < 0.05) and that on MBF by 61 +/- 18% (p < 0.05). Phosphoramidon (10 mg/kg), an endothelin converting enzyme inhibitor, markedly blunted U46619-induced changes on CBF and MBF (p < 0.05). These findings are the first to demonstrate that U46619, through activation of ET(A) and ET(B) receptors, elicits renal cortical vasoconstriction and medullary vasodilation in the rat.