FACULTY OF CLINICAL SCIENCES
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Item Pattern of heart failure in Abuja, Nigeria: an echocardiographic(2009) Ojji, D.B.; Alfa, J.; Ajayi, S.O.; Mamven, M.H.; Falase A.O.Aim: Despite heart failure having been identified in subjects in sub-Saharan Africa over the last 60 years, there is still a dearth of data, especially echocardiographic data on heart failure. We therefore set out to analyse the clinical and echocardiographic features of all consecutive subjects presenting with heart failure in a tertiary institution in Nigeria. Methods: Three hundred and forty subjects with heart failure, according to the guidelines of the European Society of Cardiology, were studied. Each patient had two-dimensional guided transthoracic echocardiography. Results: The mean age of the patients was 50.60 ± 15.29 years, and 50.9% of the study population were males while 49.1% were females. The commonest cause of heart failure identified was hypertension in 61.5% of the patients; 75.5% had systolic heart failure, whereas 23.5% had heart failure with preserved ejection fraction. Conclusions: Untreated hypertension has been identified as the leading cause of heart failure in Abuja, Nigeria, which is similar to that in many other parts of sub-Saharan Africa. Coronary artery disease is a rare cause of heart failure in this population group.Item Prevalence of dyslipidemia in normoglycemic subjects with newly diagnosed high blood pressure in Abuja, Nigeria.(2009) Ojji, D.B.; Ajayi, S.O.; Manmak, H. M.; Atherthon J.The H3Africa Consortium (2014). Enabling the Genomic Revolution In Africa. American Association for the Advancement of Science: . 1346-1348pp. ISBN: 1612309842 (United States of America ) (Contribution : 20%) h. Background: High blood pressure and dyslipidemia additively increases the risk of cardiovascular disease. There is a high prevalence of high blood pressure in Nigeria, but there are little data regarding the prevalence of dyslipidemia in subjects with high blood pressure. OBJECTIVE: In this observational prospective study, we examined the prevalence of dyslipidemia in newly diagnosed normoglycemic subjects with high blood pressure. Methods: A total of 171 subjects presenting with high blood pressure for the first time in the cardiology and nephrology clinics at the University of Abuja Teaching Hospital were studied. Height, weight, and blood pressure were measured. Total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were determined in fasting plasma. The total cholesterol/HDL-C and non–HDL-C values were calculated. These measures were then classified according to the 2001 report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. RESULTS: Of the 171 subjects studied, 84 (49%) were male and 87 (51%) were female. Low HDL-C was present in 71 (45.8%), elevated LDL-C in 29 (17%), elevated total cholesterol in 19 (11.1%), and elevated triglyceride in 13 (7.6%), whereas eight (4.7%) of the study population had combined elevated total cholesterol and triglyceride. Female subjects had higher total cholesterol and lower HDL-C than male subjects, but these differences were not statistically significant. Obese subjects, compared to the nonobese, had significantly higher LDL-C and total cholesterol/HDL-C ratios in males and significantly higher triglyceride levels in females. Conclusions: Given the prevalence of dyslipidemia seen in this study, we suggest that fasting lipid measurements should be performed in all Nigerians with high blood pressure. These data suggest the need for health education and lifestyle modifications in hypertensive Nigerians to reduce both types of risk factors.Item Hypertension and chronic kidney disease(2007) Ajayi, S.O.; Harris, K.P.G.Item Assessment of risk factors for kidney disease in an unselected population of nigerians: a report of the routine screening conducted during the national kidney disease awareness and sensitizing programme.(2006) Ulasi I.; Arogundade, F.A.; Aderibigbe, A.; Oviasu, E.; Akinsola, A.; Arije, A.; Ijoma, C.K.; Anteyi, E.A.; Ajayi, S.O.; Mamven, M.; Adeniyi A.B.; Mbah I.; Salako B.L.; Sanusi A.A.; Angbarzo I.; Kwaifa A.To be able to define some risk factors for renal disease in an unselected population of Nigerians the Nigerian Association of Nephrology conducted a screening exercise during the National Kidney Disease Awareness and Sensitization Programme whose theme was “Renal Disease in Nigeria: Taming the Lion” which was held at the capital city of Abuja on the 9th of February 2006. A total of unselected 129 respondents who consented were screened. One hundred and nine (56 male and 72 female respondents) were analyzed and the others [2] could not be analyzed because of incomplete data. The mean age of respondents was 27.03 (±10.75) years and majority (89.1 %), were in age group 15 to 44 years with no sex preference. Most of the respondents had normal BMI, the mean being 23.32 (±4.52)mg/m2. More females than males were found to be obese (16% versus 4%), the difference was not statistically significant (p=0.76). A relatively high percentage of respondents gave positive family history of hypertension (40%) as against 25% for diabetes mellitus. Only 5% of respondents gave positive history of renal disease. Use of nephrotoxic agents - medicated soap, native medication and herbal supplements/tea was found in 40%, 30% and 19% respectively. More than half of the studied population did not have routine medical check and about a third engaged in self medication. The prevalence of hypertension and proteinuria were 13.6% and 19% respectively. It is concluded from this study that the risk factors for development of chronic kidney disease (CKD) is high in the studied population and the level of awareness regarding need for routine medical check and appropriate attitude to health low. There is crying need for more intensive, aggressive and comprehensive education aimed at increasing the health seeking attitude of our population as well as establishment of preventive programmes against CKD in the country.Item Cardiac baroreceptor sensitivity: a prognostic marker in predialysis chronic kidney disease patients?(2005) Bavanandan S.; Ajayi, S.O.; Fentum B.; Paul S.K.; Carr S. J.; Robinson T.G.Background. Small, uncontrolled studies of dialysis dependent chronic kidney disease (CKD) patients have demonstrated abnormalities of cardiovascular autonomic control and vascular compliance, which may contribute to adverse cardiovascular morbidity in this population. However, there is little information utilizing newer, noninvasive techniques in predialysis patients with increasing degrees of uremia. Methods. One hundred and five nondialysis CKD patients with a median GFR of 23 mL/min/1.73m2 (range: 6 to 102) at baseline were studied. Cardiac baroreceptor sensitivity (BRS) was recorded by time- and frequency-domain techniques, and its relationship with increasing degrees of uremia studied. During a mean follow-up period of 42 months (range: 3 to 70), primary (death, dialysis, transplantation) and secondary (fatal and nonfatal cardiovascular events) outcome measures were recorded. The importance of cardiac BRS in comparison to other important renal and cardiovascular prognostic variables in predicting outcome was assessed. Results. Median cardiac BRS by time domain analysis at baseline was 8.85 msec/mm Hg (interquartile range: 6.85), and impaired cardiac BRS was related to reduced GFR, increasing age, and hypertension on quantile regression analysis. ‘Impaired’ cardiac BRS was associated with a trend toward increased likelihood of both primary and secondary outcomes, and may act as a surrogate measure of other cardiovascular risk factors, including age, hyperlipidemia, hypertension, previous cardiovascular disease, and doubling of creatinine. Conclusion. Nondialysis-dependent CKD patients have impaired cardiac BRS, and this was related to decreasing GFR. There was a trend toward poorer prognosis in patients with impaired cardiac BRS that requires further study. Cardiac BRS may provide a simple, bedside, noninvasive assessment of overall cardiovascular risk in this population.Item Decreased dose requirement of antihypertensive agents with age.(2001) SalakoB.L.; Ajayi, S.O.; Kadiri, S.; Arije, A.Hypertension is very prevalent in the elderly and treatment has been shown to be beneficial. However, inappropriate doses of drugs may impair the quality of life in this group of patients. In an attempt to assess the role of advancing age on therapy and doses of antihypertensives, the authors studied the antihypertensive dose/response pattern as hypertensive subjects on regular treatment move from the young to the elderly age group. Forty-nine hypertensives who were still being followed up at the medical outpatient clinic. University College Hospital, Ibadan were recruited into the study. The patients were extensively inter viewed and information relating to age, sex, year, age of diagnosis, as well as blood pressure at diagnosis, 6 months and 5 years of therapy were noted. There were HI males and 39 females with mean ages of 66.5 ± 6.6 and 64.5 ± 4.5 years respectively. The mean ages at diagnosis for both male and female groups were 52 ± 9.3 and 50 ± 7.5 years respectively. At diagnosis, 22 (44.8%) patients were started on single (antihypertensive) drug therapy, 23 (46.9%) on two drags while 4 (8.3%) were on 3 drugs. By 5 years of fairly consistent therapy, there were 33 (67.3%) patients on single drug and 16 (32.7%) patients on 2 drugs. No patient was on 3 drugs regimen. The mean blood pressure at diagnosis of 174 ± 24/105 ± 9 mmHg dropped significantly and was maintained at 6 months of therapy at (139 ± 20 / 87 ± 13 mmHg) p < 0.001. After 5 years of therapy the mean was (139 ±24/81 ±8 mmHg) inspite of dose reduction in these patients (p < 0.001). The authors concluded that, in a hypertensive patient who is un regular treatment, consistent and gradual reduction of antihypertensive doses may be carried out with blood pressure remaining within acceptable limits as the patient grows old.Item Variability in the relationship between serum creatinine and creatinine clearance in hypertensives and normotensives with normal renal function(2000) Kadiri, S.; Ajayi, S.O.Variabilities exist in the relationship between serum creatinine (Se-C) and creatinine clearance (CCr) due to the influences of age, muscle mass and gender on creatinine production. We studied this variability in a group of hypertensives (n = 62, 30 male, age 44 ± 7 years) and normotensives (n = 90, 47 male, age 42 ± 1 0 years) with normal renal function (Se-C< 0.01) and females (84 ± 19mL/min Vs 96 ± 19mL/min, P < 0.01). Crude CCr was significantly higher in men than women (.P < 0.05) in the whole group but not significantly in the normotensive or hypertensive subgroups. After adjustment, the differences diminished and became insignificant in the whole group. Some subgroups had identical mean Se-C values but different adjusted CCr. A particular Se-C value did not always indicate a particular CCr. Adjustment of CCr to 1.73 m2 BSA reduced the variability between Se-C and CCr and the difference between the genders. CCr showed significant difference in renal function between subgroups where Se-C did not.Item Bronchial asthma: a risk factor for hypertension?(2000) Salako, B.L.; Ajayi, S.O.Several attempts have been made to improve primary prevention of essential hypertension and many of these have been directed at avoiding the well known risk factors. Both asthma and hypertension are spastic disorders of smooth muscle, also asthmatics and hypertensives have been found to be salt sensitive. There is a suspicion that the similarities between these two diseases may predispose the individuals with one disease to the other, as pulmonary hypertension has been described during exercise- induced bronchoconstriction. We therefore, studied the blood pressure pattern during and after acute severe asthma (ASA) along with the frequency of hypertension in stable asthmatic patients. Two groups of patients were studied. Group 1 consisted of 12 patients with ASA (2 males, 10 females) with a mean age of 30 ± 9,9.years. The mean blood pressure during attack of ASA (147±16.9/ 100±8.2 mmHg) was higher than the mean BP (132±8.3/82±7 mmHg) 2 weeks after discharge from hospital without treatment in all patients (P < 0.05). Group 2 included 134 asthmatic subjects in stable state (54 males, 80 females) with a mean age of 45 ± 15 years and a range of 15-90 years. The overall frequency of hypertension was 37% with a proportion of 39% in males and 35% in females. Hypertension was defined as systolic blood pressure of £ 140mmHg and or diastolic blood pressure of £ 90mmHg. There was no difference between the frequency of attack of ASA in hypertensives (5.7 ±5.6 per year) and nonhypertensives (5.5 ± 3.8 per year), P < 0.05. We concluded that transient elevation of blood pressure may occur during ASA. The frequency of hypertension among asthmatics is quite high and concurrent family history of hypertension and frequency of attack of ASA did not seem to determine the status of blood pressure. Patients with asthma should have regular blood pressure check during follow-up visits.Item Quinolones for short-term treatment of uncomplicated urinary tract infection.(1999) Kadiri, S.; Ajayi, S.O.; Toki, R.A.Objectives: To investigate whether quinolones produce in vivo responses comparable to reported in vitro activity against the spectrum of organisms in uncomplicated urinary tract infection (UTI) in Nigeria, Design: Equal numbers of patients with urine culture positive UTI were randomised to oral quinolone, pefloxacin 400 mg Bd and ofloxacin 200 mg Bd for 5 days. Setting: Out-patient clinics and wards at the University College Hospital. Ibadan. Subjects: Sixty patients aged sixteen years and above with uncomplicated UTI. Main outcome measures: Number of isolates, number of patients with clinical and bacteriological cure one week after commencing therapy. Relative effectiveness and side effects of the drugs. Results: Sixty four bacterial isolates were obtained with the enterobacteriaccae comprising 86%. 62 (97%) were sensitive to both drugs in vitro. Clinical cure occurred in 57 patients (95%), being 28 (93%) in those taking perfloxacin and 29 (97%) in those taking ofloxacin. Bacteriological cure occurred in 55 patients (92%), being 27 (90%) in those taking perfloxacin and 28 (93%) in those taking ofloxacin. 59 of the 64 isolates (92%) were eliminated week, 30 of 33 (91 %) in those taking pefloxacin, and 29 of 31 (94%) in those taking ofloxacin; the difference was insignificant (p=1.16). The enterobacteriaceae were generally susceptible to both drugs. Side effects were minor and infrequent. Conclusion: Quinolones were highly active against the common urinary pathogens in these Nigerian patients and can be reliably employed in treatment when culture results are unavailable.Item Skin malignancies in ibadan: a comparative study(2008) Gana J.Y; Ademola S.A.Background: The incidence of skin cancers is on the rise in Caucasians. There is also an observed increase in the diagnosis of basal cell carcinoma in blacks. This study evaluated the pattern of skin cancers in Southwestern Nigeria and compared the trends with what obtained three decades earlier. Patients and Methods: A retrospective study of skin malignancies in Ibadan, Nigeria, based on Cancer Registry data was performed. Between January 1981 and December 2000, four hundred and ninety four (494) histologically confirmed cases of skin malignancies were recorded in the Ibadan Cancer Registry. Result: The commonest lesion recorded was squamous cell carcinoma accounting for 40.5% (200) of the cases. This was followed by malignant melanoma (25.1%), dermatofibrosarcoma protuberance (9.5%), Kaposi's sarcoma 8.3% and basal cell carcinoma (6.7%). Less common histological types included adenocarcinoma, undifferentiated carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, fibrosarcoma and mycosis fungoides. Conclusion: Though squamous cell carcinoma is still the leading cause of skin malignancy in Ibadan. There is a statistically significant decline in its proportion and a statistically significant increase in the proportion of basal cell carcinoma, compared to proportions documented three decades earlier. This change is due to subtle differences in aetiology. The proportion of Kaposi's sarcoma has also increased probably due to increasing HIV infection rate. Hospital prevalence for basal cell carcinoma and malignant melanoma did not show the progressive increase in incidence noted among Caucasians.