ObjectiveTo determine the association between left ventricular hypertrophy and insulin resistance in Gambians.DesignCross-sectional study.SettingOutpatient clinics of Royal Victoria Teaching Hospital and Medical Research Council Laboratories in Banjul.ParticipantsThree hundred and sixteen consecutive patients were enrolled from outpatient clinics. The data of 275 participants (89 males) were included in the analysis with a mean (± standard deviation) age of 53.7 (±11.9) years.InterventionsA questionnaire was filled and anthropometric measurements were taken. 2-D guided M-mode echocardiography, standard 12-1ead electrocardiogram, fasting insulin and the oral glucose tolerance test were performed.Main Outcome MeasuresThe Penn formula was used to determine the left ventricular mass index, 125 g/m2 in males and 110 g/m2 in females as the cut-off for left ventricular hypertrophy. Using the fasting insulin and fasting glucose levels, the insulin resistance was estimated by the homeostatic model assessment formula. Logistic regression analysis was used to determine the association between left ventricular hypertrophy and insulin resistance.ResultsThe mean Penn left ventricular mass index was 119.5 (±54.3) and the prevalence of Penn left ventricular mass index left ventricular hypertrophy was 41%. The mean fasting glucose was 5.6 (±2.5) mmol/l, fasting insulin was 6.39 (±5.49) μU/ml and insulin resistance was 1.58 (±1.45). There was no association between Penn left ventricular mass index left ventricular hypertrophy and log of insulin resistance in univariate (OR = 0.98, 95% CI = 0.80 – 1.19, p = 0.819) and multivariate logistic regression (OR = 0.93, 95% CI = 0.76–1.15, p = 0.516) analysis.ConclusionNo association was found in this study between left ventricular hypertrophy and insulin resistance in Gambians and this does not support the suggestion that insulin is an independent determinant of left ventricular hypertrophy in hypertensives.

Anaemia is a widespread public health problem, and in Ghana it is the fourth leading cause of hospital admissions and the second factor contributing to death. Mist Tonica, an herbal haematinic produced by the Centre for Scientific Research into Plant Medicine (CSRPM), Ghana, was assessed for its effectiveness and safety in humans after Ethics Committee approval. Clinically established anaemic-patients aged, 13 years and above, with haemoglobin levels less than 11.5 g/dl and 13.5g/dl for females and males respectively were treated with Mist Tonica, 8.96 g/ 40 mls three times daily for two weeks . The mean haemoglobin rise per week caused by Mist Tonica was 1.92 (0.76) g/dl, range (1.66 -2.55) g/dl/week and over 88 % of the patients on Mist Tonica had their appetite for food improved. Haematological profile, liver and kidney functions were not adversely affected by Mist Tonica. Results of the study suggest that Mist Tonica is an effective and safe herbal haematinic.

Background: One of the major risk factors for cardiovascular diseases is lipid abnormalities. Objective: To determine the mean lipid levels and the prevalence of lipid disorders among patients attending outpatient clinics in Banjul, The Gambia. Design: Cross-sectional study. Setting: Outpatient clinics of Royal Edward Francis Small Teaching Hospital and Medical Research Council Laboratories in Banjul, The Gambia. Methods: Two hundred and eight consecutive patients with systemic hypertension on treatment and 108 non-hypertensive patients aged over 25 years were enrolled. A questionnaire was filled and anthropometric measurements were taken. An oral glucose tolerance test (OGTT) was done as well as blood investigations including total cholesterol (TC), high-density lipoprotein cholesterol (HDL) and triglycerides (TG). Low-density lipoprotein cholesterol (LDL) was calculated using the Friedwald formula. There were 305 participants with complete lipid results and these were included in the analysis. Results: The mean (standard deviation) TC was 4.92 (1.78) mmol/L; mean TG was 0.94 (0.56) mmol/L; mean HDL was 1.28 (0.48) mmol/L and mean LDL was 3.20 (1.41) mmol/L. The prevalence of lipid abnormalities was 41% for high TC, 9% for high TG, 36% for low HDL, 49% for high LDL and 6% for atherogenic dyslipidaemia. Conclusion: The mean lipid level and the prevalence of lipid disorders in patients attending clinics in Banjul were high.

The presence of Left Ventricular Hypertrophy (LVH) in a patient with systemic hypertension deserves serious attention and makes its clinical diagnosis a priority. Over the years various criteria have been proposed for the electrographic (ECG) diagnosis of LVH and the sensitivity and specificity of these criteria have been extensively studied in Caucasians. Recent evidence indicates that they are inapplicable to people of African descent. Unlike echocardiography (ECHO), the ECG is generally available, cheap but has a lower sensitivity in detecting LVH compared to echocardiography. This study was conducted to evaluate ECG criteria against 2-dimensional (2-D) guided M-mode echocardiography in the diagnosis of LVH in adult Gambians. Secondly, to determine the ECG criteria using the Minnesota, Araoye, Sokolow and Lyon or Wolff criteria with the overall best accuracy for the diagnosis of LVH. Two hundred and eight (208) consecutive patients with systemic hypertension (BP ≥140/90mmHg) with or without treatment and an age matched group of 108 non-hypertensive patients were enrolled from outpatient clinics. A questionnaire was filled. All patients were investigated with 2-D guided M-mode echocardiography and a standard 12-1ead ECG. Anthropometric measurements were also taken. The gold standard was the Penn formula to determine the left ventricular mass index (of 125 g/m 2 in males and 110 g/m 2 in females as the cutoff for LVH). Using this gold standard the prevalence of echocardiographic LVH was 47.5% and 27.8 % in the hypertensives and non-hypertensives respectively (P<0.01). By the Receiver Operating Characteristic (ROC) Curves Sokolow and Lyon was nearest to the top left-hand corner in the hypertensives with a distance of 6.6 cm. But in the non-hypertensives Wolff was nearest to the top left-hand corner with a distance of 8.5 cm. There was correlation between the Minnesota, Araoye, Sokolow and Lyon and Wolff ECG criteria and echocardiographic left ventricular mass index in the hypertensives (Spearman rho = 0.25-0.34, P < 0.01) but in the non-hypertensives there was no correlation (P > 0.05). Sokolow and Lyon criterion had overall best accuracy for the electrocardiographic diagnosis of left ventricular hypertrophy in hypertensives and is further recommended for use as such. But for non-hypertensives, the Wolff criterion had overall best accuracy.

Background: Chronic kidney disease (CKD) is manifested by irreversible worsening renal function and is associated with proteinuria and hyperuricaemia.Objective: To determine the prevalence of CKD, hyperuricaemia and proteinuria and explore the relationship between CKD, hyperuricaemia and proteinuria among outpatients in Banjul, The Gambia.Design: Prospective cross-sectional studySetting: Outpatient clinics of Edward Francis Small Teaching Hospital and Medical Research Council Laboratories in Banjul.Methods: Two hundred and eight consecutive patients with hypertension on treatment and 108 nonhypertensive patients aged over 25years were enrolled. A questionnaire was filled and anthropometric measurements were taken. An oral glucose tolerance test was done. Serum uric acid and creatinine were determined from venous blood samples and proteinuria was determined by urine dipsticks. The estimated glomerular filtration rate (GFR) was calculated using the Cockcroft and Gault equation. CKD was defined and classified by The National Kidney Foundation’s Kidney Diseases Outcomes Quality Initiative guidelines.Results: The results of 300 participants were included in this analysis. The prevalence of hyperuricaemia was 36%, proteinuria 25% and CKD 41% (10.7% of participants had Stage 1, 6.7% Stage 2, 21.7% Stage 3, 1.3% Stage 4 and 0.3% Stage 5). The mean uric acid was 0.33 (0.13) mmol/L, mean creatinine 88.1 (54.1) μmol/L and mean GFR was 103.2 (80.2) ml/min/1.73 m2 .There was a strong and significant association between hyperuricaemia, proteinuria and CKD among these participants before and even after controlling for age, sex, hypertension and diabetes mellitus.Conclusion: The prevalence of CKD, hyperuricaemia and proteinuria in patients attending clinics in Banjul was high. There was a strong and significant association between CKD, hyperuricaemia and proteinuria.