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Biomedical subjects

D R Lisk

Publications and source records attributed to D R Lisk.

13 recordsLinked to original sources
PubMed2000

Rapid weight gain and benign intracranial hypertension in an AIDS patient on treatment with highly active anti-retroviral therapy (HAART).

We present the case of a 30-year-old woman with HIV/AIDS who experienced a 47% weight gain over a period of a year after commencing treatment with highly active anti-retroviral therapy (HAART) and went on to develop benign intracranial hypertension (BIH). She was not on any other medication associated with BIH. Although weight gain has been reported in patients on treatment with protease inhibitors, such gains have been minimal to moderate. We are unaware of any previous report of this degree of weight gain or BIH in a patient on protease inhibitors.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Prevalence of diabetes in rural and urban populations in southern Sierra Leone: a preliminary survey.

We conducted a preliminary community survey for diabetes in the Bo district of southern Sierra Leone. Five hundred and one subjects comprising 256 rural adults in two villages and 245 urban adults in Bo town were randomly selected and screened for diabetes using random capillary blood glucose according to WHO criteria. There were 6 diabetics, all in the urban area, giving a prevalence of 2.4% in the urban population, and 0% in the rural villages. The mean (s.d.) capillary random blood glucose (RBG) concentration was 5.7 +/- 1.7 mmol/l for the entire study population, while concentrations for the urban and rural populations were 5.8 +/- 2 and 5.5 +/- 1.4 mmol/l respectively (P > 0.05). RBG increased significantly with age. The mean (s.d.) body mass index (BMI) was 22.3 +/- 4.9 kg/m2 for the total population while those for the urban and rural populations were 23.0 +/- 5.8 and 21.6 +/- 3.6 respectively (P < 0.01). Only 5% of the population were obese, i.e. BMI > or = 30 kg/m2. Dietary habits were similar in both town and country. According to this survey, the prevalence of diabetes is very low in rural Sierra Leone, but urban areas may be experiencing increasing prevalence. Mechanisms for effective screening and promotion of proper diet and exercise must be incorporated into existing health services to prevent an escalation of diabetes in urban Sierra Leone.

Adolescent↗
PubMed1996

The significance and trend of hypertension related deaths in urban Sierra Leonean Africans.

In order to determine the impact and trend of hypertension related deaths in the overall mortality of urban Sierra Leoneans, a review of death certificate records in the capital Freetown over the period 1983-1992 was undertaken. A total of 25119 consecutive records were examined to identify those with hypertension as a major or contributory cause of death. For the purpose of this study, hypertensive stroke, cardiac and renal deaths were selected as the main hypertension related disorders. Hypertension related deaths accounted for an average of 7.5% of all deaths and 13.7% of deaths in those aged 40 years and above between 1983 and 1992. For the latter group, stroke deaths accounted for 5.2%, cardiac deaths for 4.7%, and renal deaths for 0.8% of total mortality. There were more male hypertensive stroke deaths but when expressed as a percentage of the total deaths, no sex difference was noted. Hypertensive stroke deaths accounted for 7% of all deaths in the age group 50-69 years in females, while hypertensive cardiac deaths, caused 6% of deaths in the 60-69 year age group in both sexes. Hypertensive renal death was infrequently recorded being present mainly in the 40-49 year age group predominantly in males. When all hypertension related deaths were considered together, their major impact was in the seventh decade in females and in the eighth decade in males accounting for approximately 20% and 16% of all deaths respectively. Hypertension related deaths appeared to show a steady increase over the 10 year study period. Hypertension is a significant cause of death particularly in elderly urban Sierra Leoneans in Freetown and deaths from hypertension may be increasing.

Adolescent↗
PubMed1994

Early presentation of hemispheric intracerebral hemorrhage: prediction of outcome and guidelines for treatment allocation.

Criteria for selecting patients for possible surgery in the management of intracerebral hemorrhage (ICH) are needed to plan a prospective therapeutic evaluation of surgical intervention. This study specifically addressed patients seen in the emergency room within a few hours of the ictus, many of whom were still awake, to identify and subsequently exclude from surgical procedure those expected to recover completely and those expected to die regardless of treatment. We retrospectively studied 75 patients evaluated at a mean time of 3 hours and 37 minutes after hemispheric ICH to determine factors that would predict both good and poor outcomes at the time of discharge. Eighty percent of our patients presented within 6 hours of symptom onset. These patients were younger and had more severe lesions than did those presenting later, yet most were still awake (mean admission Glasgow Coma Scale [GCS] score = 11.0). Using multivariate regression, we created two models. The first model predicts independent outcome, ie, Rankin 0 to 2, of all patients with a GCS score greater than 9 on admission who do not undergo surgery. The significant factors in this model were hemorrhage diameter, intraventricular extension, and age. The second model predicts poor outcome, ie, Rankin 5 and death, of all patients. GCS score, hemorrhage volume, age, and gender were the important factors in this model. We conclude that ICH patients presenting early to the emergency room have more severe lesions radiologically, although their initial clinical status may not be different from those seen late. Our models should identify and thus exclude those with very good and very poor prognoses from future randomized surgical trials.

Adult↗
PubMed1993

Should hypertension be treated after acute stroke? A randomized controlled trial using single photon emission computed tomography.

OBJECTIVE: To determine if previously hypertensive patients with acute ischemic stroke should be treated with antihypertensive medication in the immediate poststroke period. DESIGN: Randomized double-blind, placebo-controlled trial. SETTING: Sixteen consecutive hypertensive patients (four men and 12 women; mean age, 66 years [age range, 46 to 83 years]) with middle cerebral artery infarction within 72 hours of onset and blood pressure between 170 and 220 mm Hg(systolic) and 95 and 120 mm Hg (diastolic). INTERVENTION: Placebo (n = 6), nicardipine hydrochloride (20 mg [n = 5]), captopril (12.5 mg [n = 3]), or clonidine hydrochloride (0.1 mg [n = 2]) given every 8 hours for 3 days. MAIN OUTCOME MEASURES: Decline in blood pressure, change in cerebral blood flow as measured by single photon emission computed tomography, and clinical change as determined by the National Institutes of Health Stroke Scale. RESULTS: Blood pressure fell significantly in both the drug-treated group as a whole and in those patients receiving placebo (P < .001). There was no difference in blood pressure levels between these two groups throughout the study period. Patients receiving nicardipine had a consistently lower pressure than the other groups. A significant negative relationship was noted between the maximum blood pressure fall and improvement in cerebral blood flow. There were four patients whose blood pressure dropped by more than 16% of the baseline value on any 24 hours in the first 3 days. All either failed to increase or actually decreased their cerebral blood flow to the affected area. Three of these patients were treated with nicardipine. There was no significant difference in clinical course between the placebo-and drug-treated groups as a whole. CONCLUSIONS: Hypertensive ischemic stroke patients with a moderate elevation of blood pressure in the first few days may not require antihypertensive therapy. Nicardipine and possibly other calcium channel blockers may cause an excessive fall in blood pressure and impair cerebral blood flow in these patients and should therefore be used with caution.

Aged↗
PubMed1993

Hypertension in Sierra Leone stroke population.

A retrospective study of 87 hospitalized Sierra Leonean stroke patients is presented. The mean age was 50.9 years with a male to female ratio of 2:1. Hypertension was present in 68% of patients but only in those above 30 years of age. It was also more prevalent in females than males. Mean arterial pressure increased with age up to 40 years after which is remained constant. Thirteen patients died during admission. Fatal cases were significantly older (p < 0.001), and had a higher mean arterial pressure (p < 0.05) than survivors. It is considered that hypertension is a greater risk factor in stroke in the West Africans than in other African regional groups. The historical relationship between the West African and black American, who also have a high prevalence of hypertension, is recognized and discussed. More research on hypertension and stroke in populations such as these may reveal important clues to the aetiology and pathogenesis of these serious vascular disorders.

Adolescent↗
PubMed1985

Drug compliance and seizure control in epileptic children.

The drug taking habits and compliance of 16 epileptic children were studied by means of a questionnaire, "pill" count and serum antiepileptic drug levels (AEDL). The questionnaire method overestimated patients' compliance while, because of the pharmacokinetics of antiepileptic drugs in children, single outpatients' drug levels may be misleading thereby not always reflecting the true degree of compliance. Ten patients (62%) took more than 85% of their medication. Above this level of compliance there was a positive relationship to seizure control. It would appear that drug compliance in epileptic children is as unsatisfactory as it is in adults on whom they largely depend for the administration of their medication.

Adolescent↗
PubMedDate not supplied

Blood pressure and hypertension in rural and urban Sierra Leoneans.

OBJECTIVE: To determine the prevalence and awareness of hypertension and determinants of blood pressure in rural and urban Sierra Leoneans. METHOD: 598 subjects from Freetown and 606 subjects from three villages in the northern province of Sierra Leone were selected for this study using multi-stage sampling. All were adults aged 15 years and over. Single blood pressure measurements were made after a minimum rest period of 10 minutes using a mercury sphygmomanometer. Korotkoffs phases I and V were used for systolic and diastolic blood pressures, respectively. Standard anthropometric measurements were made and a questionnaire used to collect information on demographic, dietary, and social factors, including consumption of tobacco products, alcohol, salt, palm oil, and kola nuts. Hypertension was diagnosed if systolic blood pressure(SBP) was equal or greater than 160 mm Hg and/or if diastolic blood pressure(DBP) was equal or greater than 95 mm Hg and/or there was a history of hypertensive therapy. RESULTS: The age-adjusted prevalence of hypertension in the Freetown and Port Loko subjects was 23.4% and 14.7%, respectively (P=0.006). Females had a higher prevalence in both populations. The most significant determinants of blood pressure were age, body mass index (BMI) and a low level of education. When adjusted for BMI and age, no significant difference in prevalence was observed between the two populations. The level of awareness was low, particularly in the rural areas. CONCLUSION: This survey confirms a high prevalence, and low level of awareness, of hypertension in rural and urban Sierra Leoneans.

Adolescent↗
PubMedDate not supplied

A high prevalence of hypertension in rural Sierra Leone.

A cross sectional survey to determine the mean systolic and diastolic blood pressure, prevalence of hypertension, and possible risk factors in two villages, Kychum and Njala Komboya, in Sierra Leone was carried out. A total of 463 subjects were investigated. Hypertension was defined according to WHO criteria, i.e. a systolic pressure equal or greater than 160 mmHg, and/or diastolic equal or greater than 95 mmHg. The mean systolic blood pressure for the total population was 131.39 +/- 26.85 mmHg and the mean diastolic blood pressure was 82 +/- 14.80 mmHg. There was no significant difference in blood pressure levels between the two villages. The mean prevalence of hypertension was 22.4%, with Kychum 17.6%, and Njala Komboya 24.8% (X2 = 1.11, p > 0.05). Systolic and diastolic blood pressure levels were associated with age, snuff, (ground tobacco), smoking tobacco leaf, kolanut consumption and parity, but all these associations disappeared when the sample was controlled for age. Age was therefore the most significant correlate of blood pressure. Blood pressure levels were not related to gender, body mass index or cigarette smoking. Hypertension on the other hand was only 4.8% among the subjects found to be hypertensive. These rural populations studied had higher blood pressure levels and higher prevalence of hypertension than similar populations in other African countries in spite of a low body mass index. These findings emphasize the need for more studies in other areas of Sierra Leone, especially urban areas, and calls for improved screening facilities for the early detection and treatment of hypertension in Sierra Leoneans.

Adolescent↗