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   Table of Contents - Current issue
Coverpage
July-December 2018
Volume 15 | Issue 2
Page Nos. 71-117

Online since Wednesday, July 3, 2019

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REIVEW ARTICLE  

Echocardiographic findings in Nigerian patients with stroke p. 71
Jamila Ado Ya'u, Kamilu Musa Karaye, BN Okeahialam
DOI:10.4103/njc.njc_6_18  
Stroke is the third leading cause of death in several industrial countries and cardio-embolism accounts for 15–30% of ischaemic strokes. Studies investigating associations between echocardiographic parameters and stroke mechanisms are limited. This study therefore aimed at assessing echocardiographic parameters and left ventricular (LV) functions in stroke patients in comparison with apparent healthy controls. This was a case-control study conducted at Aminu Kano Teaching Hospital Kano, Nigeria. 100 stroke subjects were consecutively recruited and compared with 100 age and sex matched controls. Echocardiographic parameters studied include LV and Left atrial (LA) dimensions, LV hypertrophy (LVH), LV systolic and diastolic dysfunctions, regional wall motion abnormalities (RWMA), intracardiac thrombus, and valvular diseases using transthoracic echocardiography. The mean age of cases and controls was 56.4 ± 15.8years and 54.5 ± 15.4 years (P = 0.39), and M:F ratio was 1.1:1 among both cases and controls (P = 0.887). LVH was the most prevalent echocardiographic finding; found in 62% and 21% (P<0.01) of the cases and controls, respectively. Concentric LVH was found in 42% of the cases and 13% of controls, eccentric LVH in 23% of cases and 9% of the controls, while concentric remodeling was found in 5% of cases and 2% of controls (P < 0.001, 0.002 and 0.272 respectively). LV systolic dysfunction was found in 10% of the cases and 3% of the controls (P = 0.044), LV diastolic dysfunction in 48% of the cases and 18% of the controls (P < 0.001), while combined systolic and diastolic dysfunction was found in 12% of cases and 4% of the controls respectively (P = 0.038). Regional wall motion abnormality, Increased LA size, Aortic valve sclerosis and rheumatic valvular heart disease were commoner amongst cases than controls. Echocardiographic abnormalities were common among stroke patients and their presence could influence clinical decisions and outcomes. This study therefore supports echocardiographic evaluation of stroke patients.
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ORIGINAL ARTICLES Top

Microalbuminuria among participants with high-normal blood pressure attending a tertiary health institution in Nigeria p. 77
Saidu Hadiza, Karaye K Musa, Okeahialam Basil
DOI:10.4103/njc.njc_18_17  
Background: Participants with high-normal blood pressure (BP) (systolic BP [SBP] 130–139 mmHg and/or diastolic BP [DBP] 85–89 mmHg) have higher cardiovascular disease (CVD) risk factors compared with optimal BP (SBP <120 mmHg and/or DBP <80 mmHg). In the present study, the prevalence of microalbuminuria, factors associated with it, and other CVD risk factors were assessed among participants with high-normal BP in comparison to controls. Methods and Results: Out of 200 participants screened, 92 with high-normal BP (Group 1) and 97 with optimal BP (Group 2) who had no history of hypertension or diabetes mellitus were consecutively recruited after satisfying the inclusion criteria. Microalbuminuria was determined using Micral test strips using first-morning urine sample. The mean age of participants in Group 1 was 33.39 ± 5.17 years, while that for Group 2 was 27.01 ± 7.4 years (P ≤ 0.001). The prevalence of microalbuminuria was higher among participants in Group 1 than in participants in Group 2 (12.9% vs. 4.1%, P = 0.037). Participants in Group 1 were older, had higher mean SBP, DBP, body mass index (BMI), fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol, and triglycerides than those in Group 2. Pearson's correlation coefficient showed a significant association between BMI and microalbuminuria among all the study participants (r = 0.625, P ≤ 0.007), and the BMI explains 37.7% of the variability of urinary albumin excretion among participants (R2 = 0.377, P = 0.007). Conclusion: Participants with high-normal BP had a higher prevalence of microalbuminuria and risk factors for CVD than those with optimal BP. The results suggest that participants' BMI is linked to urinary albumin excretion, and if proven in larger studies, the findings might be useful in the early prevention of CVD among individuals with high-normal BP.
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Audit of 24 h ambulatory electrocardiography (Holter) of 281 Nigerian patients in Benin city metropolis p. 83
Veronica Adaku Josephs, W Sadoh, J Ikhidero
DOI:10.4103/njc.njc_2_17  
Background: Recent advances in cardiovascular management have been the result of the implementation of technological advances in the form of facilities in patient care. Continuous ambulatory electrocardiography (ECG) is used for the diagnosis of symptomatic and asymptomatic arrhythmias of the cardiac patient which are not immediately apparent to the clinician, but otherwise amenable to treatment. Objective: The aim of this study is to examine the relevance of 24-h ambulatory ECG in the management of arrhythmias in the Nigerian patient. The study was carried out from Winsephs' family clinic, a private cardiology clinic in Benin City. Methods: A retrospective study of 281 adult patients referred for 24 h ambulatory ECG (Holter) between January 2006 and June 2015. Results: The indications for Holter-ECG were as follows: unexplained recurrent palpitations (174) (61.9%); effort intolerance (67) (23.8%); probable ischemic heart disease (53) (18.9%); chest pain (53) (18.9%); and an assessment of arrhythmia in congestive cardiac failure (48) (17.1%). Others were syncopal attacks (23) (8.9%) and extreme weakness (15) (5.3%). The most common rhythm abnormalities and the number of individuals affected were as follows: premature atrial contractions (PAC) (188) (66.1%), sinus tachycardia (ST) (165) (58.7%), ventricular extrasystoles (148) (52.7%), paroxysmal supraventricular tachycardia (127) (45.2%), ventricular tachycardia (55) (19.6%), bradycardia (57) (20.3%), and pause (51) (18.2%). Other significant rhythm abnormalities were atrial fibrillation (17) (6.1%) and atrial flutter (10) (3.6%). Myocardial ischemia indicated by ST depressive episodes was observed in (32) (11.4%) patients, and the majority of those affected were >55 years of age. There were five normal reports. Conclusion: Holter-ECG is becoming an indispensable tool in diagnosis, management, and follow up of the cardiac patient.
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Clinical utility of transthoracic echocardiography in assessing frequency and pattern of atrial masses among patients with cardiac diseases p. 89
Tolulope Taiwo Shogade, Ime Okon Essien, Idongesit Odudu Umoh, Clement Tom Utin, Joseph John Andy
DOI:10.4103/njc.njc_3_18  
Background: Echocardiography plays a fundamental role in the evaluation of patients with atrial masses. The ability to distinguish tissue characteristics such as location, attachment, shape, size, and mobility noninvasively, quickly, cheaply, and without the use of ionizing radiation makes echocardiography the ideal diagnostic modality. With careful attention to mass location and morphology and appropriate application of clinical information, echocardiography can usually distinguish between the three principal atrial masses as follows: tumor, thrombus, and vegetation. Although transesophageal echocardiography has better sensitivity and specificity for detecting atrial masses, transthoracic echocardiography (TTE) can also detect atrial masses with specificity and sensitivity of about 58% and 98%, respectively. Objectives: The study is aimed at assessing the frequency and patterns of atrial masses in an urban teaching hospital using TTE. Materials and Methods: A retrospective review of our echocardiogram reports from July 2009 to June 2014 was done to identify the frequency of atrial masses, gender distribution, sizes, clinical presentations, and locations. Results: A total of 1027 echo examinations were done over this period, comprising 503 males (48.98%) and 524 females (51.02%). Nonvegetative atrial masses were found in six of these patients representing 0.58% of the study population. Myxoma was the most common mass noted, 3 out of 4 were found in female, and all were found in the left atrium. The two atrial thrombi were detected in the right atrium and both were found in males. Conclusion: Atrial masses are not rare and TTE is still valuable in the diagnosis and initial characterization of atrial masses.
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Availability and utilization of electrocardiogram as cardiac diagnostic tool in private hospitals in Port Harcourt p. 94
Chizindu Akubudike Alikor, Chibuike Eze Nwafor
DOI:10.4103/njc.njc_8_18  
Background: Electrocardiography is a low cost, easy to perform method of investigation of the cardiovascular system with diagnostic and prognostic value, and great clinical usefulness. There is an increasing prevalence of cardiovascular disease in Africa and other developing nations of the world. The private hospitals serve as the first port of call to a large number of cardiac patients. Hence, they need to determine the availability and utilization of electrocardiogram (ECG) in the private hospitals. Methodology: This is a cross-sectional, descriptive study involving medical practitioners who offer medical services in the private hospitals in Port Harcourt. A structured self-administered questionnaire was used in this study with a total of 120 analyzable data generated. Results: In this study, 72.5% of the respondents were male with females constituting 27.5%. Most of the respondents were general practitioners and mostly < 10 years of medical practice. This study found that approximately two-third of the respondents had ECG facility in their practice with good utilization (83.2%). However, most of the respondents (60%) have no formal training in the interpretation of ECG with only 6.2% having competence in ECG interpretation, and only 15.6% would seek specialist opinion/interpretation. This study further found that 98.3% of the respondents expressed willingness for formal training to improve their ECG interpretation skills. Conclusion: There are good availability and utilization of ECG facilities among private practitioners in Port Harcourt. The knowledge and competence for interpretation of ECG are poor. There is, therefore, a need for formal training in ECG interpretation for general and private medical practitioners in Port Harcourt, Nigeria.
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Consanguineous marriage makes congenital heart diseases more complex p. 98
Ramachandra Barik, Prafulla Kumar Swain, Mimansa Barik
DOI:10.4103/njc.njc_40_17  
Introduction: Inbreeding increases homozygotes for autosomal recessive disorders resulting in high prevalence of congenital heart disease (CHD). This cross-section looks whether consanguineous marriage (CM) makes CHDs more complex. Subjects and Methods: This was an observational study which looked at the cross-section of a cohort of consecutive 113 patients having different CHD who visited Nizam Institute of Medical Sciences, Andhra Pradesh, during the year 2016 for surgery or intervention. The definitive diagnosis of CHD was supported by clinical profile, chest X-ray, echo, ultrasound abdomen, and cardiac catheterization which is appropriate. The study population was divided into CM group and distance marriage (DM) group. The categorical variables were analyzed using descriptive statistics. Results: Out of 113 patients with CHD, 61 (54%) were females. A majority 104 (94%) were Hindu. About 74% of patients were from below poverty line category. Approximately 27% and 73% patients were born out of consanguineous and DM, respectively. Most of the patients were from a rural background, and 63.7% had an education level of ≤10th class. Approximately, a total of 50 (44.2%) patients had complex CHDs (CCHDs). CCHD had significant association with CM (odds ratio: 2.60 95% confidence interval: 1.11–6.09, and P = 0.02). Conclusion: As there was a significant association of CCHD with inbreed marriage, this observation discourages CM.
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Relationship between some electrocardiographic parameters of ventricular repolarization and Vitamin D status in apparently healthy individuals p. 102
Erdogan Sokmen, Cahit Uçar, Mustafa Çelik, Serkan Sivri, Yalçin Boduroglu, Sinan Cemgil Özbek, Alp Yildirim
DOI:10.4103/njc.njc_9_18  
Background: Vitamin D (VitD) is a vitamin affective on the cardiovascular system. VitD deficiency has been related to increased cardiac and all-cause mortality even in healthy controls. Evidence showed that such relatively novel electrocardiographic (ECG) parameters of ventricular repolarization (EPVR) as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios might be related to increase cardiac arrhythmias and even sudden cardiac death. Little data are available about the effect of VitD deficiency on EPVR. The purpose of this study was to evaluate the EPVR in apparently healthy controls with VitD deficiency. Methods: A total of 72 consecutive VitD deficient and 51 consecutive VitD nondeficient healthy controls who presented to our hospital's outpatient clinics were included in the study as two different groups. The relevant data were obtained through physical examination, electrocardiography, and echocardiography. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were calculated from surface ECG and compared between the two groups using the Mann–Whitney U-test. Results: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were all observed to be greater in VitD deficient group compared with the VitD nondeficient group, with robust statistical significance (68.1 ms [61.7–75.4] vs. 58 ms [54–66.2]; 0.197 [0.179–0.210] vs. 0.164 [0.147–0.187]; and 0.172 (0.156–0.191) versus 0.150 (0.137–0.164); respectively; P ≤ 0.001]). Conclusion: Our study reveals that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio increase in VitD deficiency in apparently healthy controls, which may be related to SCD. Further studies are needed to support our results.
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CASE REPORTS Top

First successful atrial myxoma excision in Nigeria: A 21-year follow-up p. 108
Dabeluchi Chiedozie Ngwu, Vincent Adindu Okwulehie, Martins Anthony C Aghaji
DOI:10.4103/njc.njc_1_18  
A young man presented to our institution in New York Heart Association (NYHA) Class III, following a referral from a peripheral hospital where he had been on asthma treatment for over 8 years until he developed digital clubbing, and further clinical evaluation suggested cardiac disease. The preoperative diagnosis of left atrial myxoma was confirmed with transthoracic echocardiography. He had successful excision of the tumor, made a quick recovery, and has remained in NYHA Class I, with no cardiac events.
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A rare case of bidirectional ventricular tachycardia due to aconite poisoning p. 111
Biswajit Majumder, Praveen Shukla, KN Sudeep, Pritam K Chatterjee, Subhro Chakraborty
DOI:10.4103/njc.njc_34_17  
A 45-year-old female patient presented with sweating and palpitation with wide spectrum of electrocardiography changes from polymorphic ventricular ectopics to bidirectional ventricular tachycardia (VT). She had a concealed history of aconite intake in large doses as part of homeopathic use. There are very few causes of bidirectional tachycardia such as digitalis toxicity, catecholaminergic polymorphic VT, and rarely aconite poisoning. Here, we report a rare case of aconite poisoning presenting with bidirectional VT.
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LETTER TO EDITOR Top

Secondary prophylaxis to control rheumatic heart disease in developing countries: Put rheumatic heart disease into a cage if cannot be eradicated p. 114
Ramachandra Barik
DOI:10.4103/njc.njc_29_17  
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