BackgroundThere are few studies from Nigeria and Africa regarding the contribution of obesity and hypertension to cardiovascular risk in HIV-infected patients. This study investigates the prevalence of hypertension and obesity and their association with HIV infection and antiretroviral treatment (ART).MethodsWe conducted a cross-sectional cohort study in a rural tertiary health center in Nigeria. The data collected included demographic variables, blood pressure, body mass index (BMI), monthly income, educational attainment, HIV status and ART treatment, duration of treatment, and CD4 T-lymphocyte count.ResultsA total of 403 participants met the inclusion criteria. There were 153 (38.0%) HIV-negative subjects (42.5% male, 57.5% female; mean age: 35.5±7.6 years), 120 (29.8%) HIV-positive drug-naïve subjects (42.5% male, 57.5% female; mean age: 36.5±9.1 years), and 130 (32.2%) HIV-positive subjects taking antiretroviral drugs (33.1% male, 66.9% female; mean age: 38.6±8.0 years). The prevalence of hypertension was 13.7% in HIV-negative subjects, 19.0% in HIV-positive drug-naïve subjects, and 12.3% in HIV-positive ART subjects. The prevalence of obesity was 15.9% in the HIV-negative group, 3% in the HIV-positive drug-naïve group, and 8% in the HIV-positive ART group. Multivariate regression analysis showed no relationship between hypertension and HIV status (P=0.293) or ART status (P=0.587). In contrast, BMI showed a strong relationship with HIV status (odds ratio: 0.281; 95% confidence interval: 0.089–0.884; P=0.030) but not with ART status (P=0.593). BMI was a significant predictor of hypertension.ConclusionHIV or ART status was not associated with hypertension. HIV infection was associated with a lower BMI, and a lower prevalence of obesity compared with HIV-negative subjects.

BackgroundThe Tei index is a Doppler-derived myocardial performance index. It is a measure of the combined systolic and diastolic myocardial performance of both the left and right ventricles. The incidence of heart failure (HF) is increasing globally, and its severity can be clinically assessed using the New York Heart Association (NYHA) functional classification and more objectively using echocardiographic assessment of systolic and diastolic functions. Thus, a measure of the combined systolic and diastolic myocardial performance could be a useful predictor of the severity of the clinical status of patients with HF.ResultsSeventy-five newly presenting patients with HF of NYHA class II to IV and 60 normal controls were consecutively recruited. Using conventional two-dimensional and Doppler echocardiography techniques, the left ventricular parameters assessed were the isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), ejection time (ET), ejection fraction (EF), and end-diastolic volume (EDV). The Tei index was determined using the formula IVCT + IVRT/ET. The mean Tei index of patients was significantly higher than that of controls (0.884 ± 0.321 vs. 0.842 ± 0.14; p < 0.001). The Tei index ranged from 0.33 to 1.94 in patients and from 0.56 to 1.24 in controls. The mean EF was lower in patients than in controls (50.47% ± 19.01% vs. 68.35% ± 7.75%; p = 0.001). The mean EDV was higher in patients than in controls (171.39 ± 100.96 vs. 94.15 ± 28.54; p < 0.001). Comparison of the mean Tei indices of patients with HF of NYHA classes II, III, and IV showed statistically significant differences among all three groups (p < 0.001).ConclusionsThe Tei index seems to be a clinically relevant indicator of cardiac function. It is reflective of the severity of HF as clinically assessed using the NYHA functional classification in patients with HF.

Type 2 diabetes mellitus (T2DM) is emerging as a new clinical disorder among children and adolescents. Although there is increasing prevalence of this clinical entity among adolescents worldwide, its diagnosis among Nigerian children and adolescents is still uncommon, hence, the reason many physicians still misdiagnose T2DM in adolescents as type 1 diabetes mellitus for reason of age of onset. Here, we present a 15-year old, overweight, girl who presented with history of polyuria, polydipsia and weight loss; her blood glucose level was 14.3 mmol/l, glycated haemoglobin 12.4% and glycosuria (3+), with no ketonuria or proteinuria. She was initially diagnosed as type 1 diabetes and managed with multiple doses of insulin by the pediatric team until she was later reviewed by the endocrinology unit. The diagnosis was later changed to early-onset T2DM (Youth-onset T2DM) based on a BMI of 29.75 kg/m 2 , presence of acanthosis nigricans, absence of ketosis, preserved beta-cell function as shown by normal serum C-peptide levels, absence of anti-glutamic acid decarboxylase (GAD) antibodies and islet cell antibody, and also response to oral anti-diabetic agents while her insulin therapy was discontinued. Therefore, a possibility of T2DM should be suspected in childhood and adolescent with diabetes associated with overweight or obesity, relatives with T2DM and features of insulin resistance (IR) like acanthosis nigricans, hypertension, dyslipidaemia, non-alcoholic fatty liver disease (NAFLD), hyperandrogenism, or polycystic ovarian syndrome (PCOS).