Search

Background: Critical value notification (CVN) entails notifying doctors or other laboratory users of aberrant laboratory results that threaten the patient's life and of any values for which reporting delays could negatively impact the patient's health. Critical value notification practices in clinical laboratories in Nigeria and sub-Saharan Africa are largely unknown. Objective: We conducted a nationwide survey to obtain baseline information on CVN practice by Nigeria's laboratories. Methods: This cross-sectional study was conducted among purposively selected secondary- and tertiary-tier, public and private clinical laboratories across northern and southern Nigeria between October 2015 and December 2015. Consenting senior laboratory staff completed and returned a structured questionnaire, that gathered data on respondents' demographics, designations, and institutional characteristics and practices regarding CVN. Results: One hundred and thirty-four laboratories responded to the questionnaires. Only 69 (51.5 %) laboratories practised CVN; only 23 (33.3%) had existing written policies guiding the practice. Most (43; 62.3%) laboratories use similar critical values (CVs) for adult and paediatric populations. Most laboratories (27; 39.1%) obtained their CVs by combining published literature and local opinions from stakeholders. Physical dispatch (42; 60.9%) followed by telephone calls (38; 55.1%) were the most common means of notification. Private laboratories, compared with public hospital laboratories, were likelier to have separate paediatric CV lists (p = 0.019) and practise telephone notifications (p < 0.001). Conclusion: Critical value notification practices vary and are often suboptimal in many clinical laboratories in Nigeria, which is exacerbated by the absence of guiding policies and national recommendations for post-analytical procedures. What this study adds: This study provides baseline information on CVN practice by Nigeria's laboratories. The study explores the causes of practice variations that can serve as a foundation for enhancing critical reporting and post-analytical services, particularly in clinical laboratories in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Aims: The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North‐West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere. Methods and results: Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow‐up, relative to baseline status, were assessed by echocardiography. During median 17 months follow‐up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all‐cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (<70 μg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2%; P = 0.025), but the supplement did not have significant impact on myocardial remodelling. Conclusions: This study has shown important non‐racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation. [ABSTRACT FROM AUTHOR]

Sickle cell disease is often complicated by retinopathy, which can be proliferative or non proliferative. Proliferative sickle cell retinopathy potentially leads to blindness. There is a paucity of data on sickle cell disease-related retinopathy from Africa, where the disease is most prevalent. We aimed to determine the clinical, ophthalmic, and laboratory predictors of sickle cell retinopathy in an African population. We conducted a cross-sectional study of 262 participants, aged 13 years and above, with sickle cell disease. Demographic and clinical data were collected using a structured questionnaire and standard physical examinations. Vitreo-retinal specialists performed eye examinations on all the participants. Hematological and biochemical assessments were conducted using standard methods. A multivariate stepwise forward logistic regression was performed to determine the predictors of retinopathy. The median age of the participants was 20 years (interquartile range: 17–25 years). Most of the participants had a homozygous Hb S (HBB: c.20A>T) genotype (96.9%), with 3.1% who carried a Hb S/Hb C (HBB: c.19G>A) genotype. The prevalence of non proliferative sickle cell retinopathy was 24.4%. Only 1.9% had proliferative sickle cell retinopathy (PSCR). Elevated systolic blood pressure (BP) [odds ratio (OR): 6.85, 95% confidence interval (95% CI): 1.05–44.45, p = 0.059], moderate visual impairment (OR: 5.2, 95% CI: 1.39–19.63, p = 0.015), and anterior segment changes (OR: 2.21, 95% CI: 1.19–4.13, p = 0.012) were independently predictive of retinopathy. This study provides new insight into predictors of retinopathy in sickle cell disease, with implications on early screening and prevention. [ABSTRACT FROM AUTHOR]

Purpose: Type 2 diabetes poses a major global health threat both in the developed and developing countries. Factors responsible for the soaring epidemic of T2DM in the developing countries include urbanization, ageing population, physical inactivity and increasing obesity rates. Our aim was to determine the pattern of obesity among patients with T2DM at the Aminu Kano Teaching Hospital (AKTH), Kano, Northwestern Nigeria. Patients and methods: We consecutively recruited 220 patients with type 2 diabetes attending the diabetes clinic of AKTH for the study. Patients with Type 1 diabetes, patients who could not stand or are wheelchair bound and pregnant women were excluded from the study. A pretested questionnaire was used to collect data on socio-demographic characteristics, treatment history for diabetes and history of hypertension from each participant. Results: Of the 220 patients recruited for this study, 97(44.1%) were men, while 123(55.9%) were women. The prevalence of generalized obesity among the study participants was 27.4% (women −30.9% vs men- 22.7%, X2=4.76, p=0.190). Grades I. II and III obesity were found in 17.3%, 5.9% and 3.2% of the study participants, respectively. All the participants with grade III obesity were women. Central obesity defined by WC was detected in 111(50.5%) [20(20.6%) men and 91(73.9%) women, X2=1.93, p=0.001]. Obesity defined by WHR was recorded in 182(82.7%) participants [80(43.9%) men and 102(56.0%) women, X2= 1.97, 0.001]. Using a cut-off of ≥0.5, abnormal WhtR was detected in 179(81.4%) [72(40.2%) men and 107(59.8%) women, X2= 5.82, p=0.01], while using a cut-off of ≥0.6, abnormal WhtR was detected in 84(38.2%) participants [29 (34.5%) men and 55(65.5%) women, X2=6.38, p=0.09]. Hypertension was detected in 103(46.8%) participants, with a higher prevalence among women compared with men [46.3. % vs 47.4%, X2= 1.03 p=0.87]. Conclusion: The prevalence of obesity in our cohort of patients with type 2 diabetes was high. The predominant form of obesity was central obesity, which was most prevalent when indexed by WHR. The WhtR was as good as the WHR, but fared better than WC in detecting central obesity in our patients. [ABSTRACT FROM AUTHOR]

Context: Highly active antiretroviral therapy (HAART), an effective treatment for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) results in significant reduction in viral load, increased CD4 cell count and improved quality of life of people living with HIV/AIDS. HAART being a life-long treatment increases the propensity for manifesting long-term complications like changes in lipid profile. Aims: This study set out to assess therapy induced lipid profile changes among patients on HAART in Kano North-Western Nigeria. Design: Cross-sectional. Settings: This study was conducted at the HIV clinic of the Aminu Kano Teaching Hospital, Nigeria. Subjects and Methods: The study group consist of 120 patients on HAART (Group I) and 120 HAART naïve patients (Group II). Results: The mean values of cholesterol, triglyceride (TG), low-density lipoprotein cholesterol (LDLC) and high-density lipoprotein cholesterol (HDLC) were 4.15 mmol/L ± 1.03, 1.79 mmol/L ± 0.67, 2.79 mmol/L ± 0.98 and 0.99 mmol/L ± 0.28 in Group I, respectively and were statistically significantly higher than 3.50 mmol/L ± 0.94, 1.21 mmol/L ± 0.55, 1.13 mmol/L ± 0.45 and 0.91 mmol/L ± 0.30 in Group II (P < 0.05). The prevalence of dyslipidaemia was high total cholesterol in Group I (25%) Group II (7.5%): high TG in Group I (30%) > Group II (7.5%): High LDLC in Group I (30%) > Group II (17.5%) low HDLC in Group II (40%) > Group I (35%). The prevalence of hypertriglyceridemia was 43% in the protease inhibitor (PI) based and 16.7% in 'the non-PI based groups respectively. Conclusions: This study confirms the existence of artherogenic lipid profile in patients on HAART (especially those on PI-based regimen) and further underscores the importance of close monitoring to prevent cardiovascular complications. [ABSTRACT FROM AUTHOR]

Background: Nigeria has the highest incidence of peripartum cardiomyopathy (PPCM) in the world. However, data on PPCM-related outcomes are limited.Objectives: The purpose of this study was to examine the clinical profile, myocardial remodeling, and survival of patients with PPCM in Nigeria.Methods: This study consecutively recruited 244 PPCM patients (median 7 months postpartum) at 14 sites in Nigeria and applied structured follow-up for a median of 17 months (interquartile range: 14 to 20 months). Left ventricular reverse remodeling (LVRR) was defined as the composite of left ventricular (LV) end-diastolic dimension <33 mm/m2 and absolute increase in left ventricular ejection fraction (LVEF) ≥10%. LV full recovery was defined as LVEF ≥55%.Results: Overall, 45 (18.7%) patients died during follow-up. Maternal age <20 years (hazard ratio [HR]: 2.40; 95% confidence interval (CI): 1.27 to 4.54), hypotension (HR: 1.87; 95% CI: 1.02 to 3.43), tachycardia (HR: 2.38; 95% CI: 1.05 to 5.43), and LVEF <25% at baseline (HR: 2.11; 95% CI: 1.12 to 3.95) independently predicted mortality. Obesity (HR: 0.16; 95% CI: 0.04 to 0.55) and regular use of beta-blockers at 6-month follow-up (HR: 0.20; 95% CI: 0.09 to 0.41) were independently associated with reduced risk for mortality. In total, 48 patients (24.1%) achieved LVRR and 45 (22.6%) achieved LV full recovery. LVEF <25% at baseline (HR: 0.66; 95% CI: 0.47 to 0.92) and regular use of beta-blockers at 6-month follow-up (HR: 1.62; 95% CI: 1.17 to 2.25) independently determined the risk for LV full recovery. Progressive reverse remodeling of all cardiac chambers was observed. In total, 18 patients (7.4%) were hospitalized during the study.Conclusions: This is the largest study of PPCM in Africa. Consistent with late presentations, the mortality rate was high, whereas frequencies of LVRR and LV full recovery were low. Several variables predicted poor outcomes, and regular use of beta-blockers correlated with late survival and LV functional recovery. [ABSTRACT FROM AUTHOR]

Introduction: Severe acute symptomatic hypocalcemia, requiring emergency medical intervention, is a significant but poorly understood condition with high morbidity. In our setting, patients present to emergency rooms with painful carpo-pedal spasms that last for several hours, sometimes mimicking seizure disorders. Metabolomics and genetic profiling are innovative approaches that pinpoint molecular and genetic determinants of hypocalcemia risk which can be adopted to guide treatment in our population., Objective: To determine the prevalence of hypocalcemia in urban Kano as a preliminary step towards identifying key risk factors., Methods: We obtained retrospective data from patients who presented to a tertiary hospital between January and December 2023. Serum calcium levels were measured on Abbott Architect c4000 autoanalyzer. We analyzed data using R statistical software (version 4.3.2). Chi-square tests were used to assess significant differences (p < 0.05)., Results: A total of 1,270 samples were analyzed, consisting of 59.3% (n = 753) males, their mean age was 36.2 ± 4 years. Mean serum calcium levels were 2.05 ± 0.34 mmol/L to 2.11 ± 1.00 mmol/L. Overall prevalence of hypocalcemia (serum calcium < 2.2 mmol/L) was 52.2%. Females exhibited a significantly higher prevalence (58.8%) compared to males (p = 0.03). The highest prevalence was observed in the 40-59-year age group (p < 0.01)., Conclusion: Hypocalcemia is highly prevalent in our population emphasizing the need for innovative approaches to better understand the genetic predictors, enable early intervention and prevent the long-term complications. These findings also provide a foundation for future multicenter studies and could inform public health policies targeting at risk groups. Keywords: Hypocalcaemia, Risk prediction,Metabolomics, Genetic markers., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)