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   Table of Contents - Current issue
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January-June 2018
Volume 15 | Issue 1
Page Nos. 1-70

Online since Monday, May 7, 2018

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ORIGINAL ARTICLES  

Clinical and echocardiographic determinants of heart disease in uncomplicated type II Nigerian diabetic patients p. 1
Taiwo Tolulope Shogade, Ime Okon Essien, Udeme Ekpenyong Ekrikpo, Idongesit Odudu Umoh, Clement Tom Utin, Bernard Chigozie Unadike, Joseph John Andy
DOI:10.4103/njc.njc_27_17  
Background: Recent epidemiological studies indicate an increasing prevalence of type 2 diabetes mellitus (T2DM) in the world. T2DM is now widely accepted as a major predisposing factor to ischemic heart disease, stroke, dilated cardiomyopathy, and congestive heart failure (HF). Significant subclinical myocardial dysfunction before overt HF can easily be detected by Echocardiography. Aims: The aim is to detect the prevalence and types of abnormal left ventricular (LV) functions and geometry in uncomplicated, normoalbuminuric normotensive T2DM in Nigeria, before the onset of overt heart disease. Subjects and Methods: This was a cross-sectional study conducted at the diabetic and Cardiology clinics of University Teaching Hospital State, Nigeria, from January 2013 to March 2014. Diabetic patients positive for albuminuria were excluded and echo-derived indices of LV functions and geometry were compared between the two groups. Results: Fifty normotensive T2DM patients who had no albuminuria were selected with 59 age- and sex-matched normal controls for the study. LV diastolic dysfunction (LVDD) was significantly more in normoalbuminuric T2DM compared to healthy controls (54% vs. 36%) P = 0.007. LV systolic dysfunction was rare in T2DM and in controls. Abnormal geometric patterns were higher in patients than controls, 70% versus 36% (P = 0.002). Age (odds ratio [OR] =1.05, 95% confidence interval (CI) of 1.01–1.11, P = 0.0273) and presence of diabetes mellitus (DM) (OR = 2.70, 95% CI of 1.12–6.53, P = 0.0273) were the independent predictor of LVDD in the participants. Conclusions: LV diastolic function and geometry are altered in Nigerian normotensive normoalbuminuric T2DM; therefore, its prognostic importance and effectiveness of intervention need to be further elucidated.
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Pattern and outcome of pediatric patients referred abroad for cardiac surgery from a tertiary hospital in the Niger Delta region of Nigeria p. 9
Chika O Duru, Njideka Mesiobi-Anene, Susan Ujuanbi, Emmanuel Akalonu, Ibrahim Aliyu, Felix Akinbami
DOI:10.4103/njc.njc_36_17  
Background: The high cost of open-heart surgery, poor funding, and lack of adequate facilities and workforce are some of the challenges facing Nigerian children with structural heart diseases in need of cardiac surgery. This study was undertaken to highlight the pattern and outcome of those referred abroad for cardiac surgery from a tertiary institution in the Niger Delta region of Nigeria. Materials and Methods: Thirty-five children attending the pediatric cardiology clinic of the Niger Delta University Teaching Hospital over a 5-year period (February 01, 2012 to January 31, 2017) were enrolled in the study. A cardiac register was opened at the onset of this program and those in need of cardiac surgery were recruited to a list. When space was available, they were sent to Italy for corrective surgery. Results: Over the 5-year period, 13 (37.1%) of the 35 patients seen at the cardiology clinic had cardiac surgery abroad. Ventricular septal defects and tetralogy of Fallot were the most common structural heart diseases seen. The types of surgeries performed included patent ductus arteriosus ligation, Glenn shunt, embolization of aortopulmonary collaterals, closure of atrial and ventricular septal defects, pulmonary aortoplasty, mitral valve replacement, and total intracardiac repair of tetralogy of Fallot. There was an average duration of 6.77 ± 3.14 months between initial presentation and surgical intervention. There was no in-hospital mortality, but there was a case fatality of 15.4% after 30 days postsurgery. Causes of death were cardiac arrhythmias and infective endocarditis. Eight of the 35 children died giving a mortality rate of 22.9%. Six (75%) died awaiting surgery. Conclusion: Financial aid from nongovernmental organizations is insufficient to meet the growing demand for surgical intervention of pediatric cardiology patients in Nigeria. Reduction in the cost of open-heart surgery, equipping surgical facilities, and training local medical personnel could help to increase access to pediatric cardiac surgical care in Nigeria.
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Early results of open-heart surgery for acquired heart diseases in Ibadan, Nigeria p. 14
Mudasiru Abedayo Salami, Oluranti A Akinyemi, Victor O Adegboye
DOI:10.4103/njc.njc_25_17  
Background: Cardiovascular disease burden is disproportionately high in Sub-Saharan Africa (SSA) where resources to provide optimum care for cardiothoracic patients are still very limited. Previous reports of open-heart surgery from new centers in SSA have shown a preponderance of valvular heart disease in published series, with wide variations in reported morbidity and mortality. Objectives: We report on a series of patients who underwent open-heart surgery for acquired heart diseases to demonstrate pattern of disease, type of cardiac surgery done, and our results. Methods: We conducted a retrospective review of patients who had open-heart surgery for acquired heart diseases between October 2013 and November 2016. Data collected included demographics, presenting symptoms, indication for surgery, preoperative evaluation and preparation, operative procedure, postoperative complications, and follow-up. Statistical analysis was carried out descriptively using frequencies and percentages. Results: A total of 35 patients have undergone open-heart surgery between October 2013 and November 2016. The patients who had surgery for acquired heart disease were 17 (48.6%). These included valvular heart disease in 13 patients while the remaining patients had coronary artery bypass grafting (CABG) for ischemic heart disease. The mean age of patients who had valve replacement and CABG were 39 and 60 years, respectively. Parsonnet risk scoring was used with an average score of 8.5. Three (17.6%) patients were in good risk category while 7 (41.2%) patients each were in fair and poor risk categories. Postoperative complications included paravalvular leaks in two patients. There was no hospital mortality. Conclusion: Early results of valvular and coronary artery bypass surgeries from our center show good outcome comparable to global standards with zero hospital mortality and low morbidity. The result is aided by good case selection, adequate preparation, and teamwork.
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Detection of extension and distribution diversity of coronary artery diseases by gender using Syntax score I p. 20
Yalcin Boduroglu, Nazan Erenoglu Son, Osman Son
DOI:10.4103/njc.njc_8_17  
Background: Although the extension and distribution of coronary artery diseases by gender was found in a same pattern, some studies reported controversial results, so we aimed to investigate these differences. Materials and Methods: Our study included a total of 963 patients with 67% of men and 33% of women. Results: Baseline features were similar except diabetes mellitus and age which were higher in women (P = 0,004 and P < 0,001, respectively). There was a significant difference between groups (P = 0.031). Women had significantly more one-vessel left anterior descending (LAD) lesions (30.8% vs. 22.0%; P = 0.004). However, there were no differences for other locations (P > 0.05). When collecting all kind of lesions in a same cluster (including one-, two-, and three-vessel diseases totally), the left circumflex artery (LCx) cluster was found significantly more in men (55.7% vs. 48.7%, P = 0.043). There was no difference in segmental distribution of lesions (P = 0.473). Low Syntax score was found to be the best determinant for one-vessel LAD lesions (P < 0.001); in contrast, intermediary and high Syntax scores were found for LCx cluster (P < 0.001). Syntax score I was found to be a significant negative predictor for one-vessel LAD lesions (P < 0.001, OR: 0.857), and low-density lipoprotein (LDL) cholesterol and Syntax score I and HbA1c were significant positive predictors for LCx cluster (P = 0.011, odds ratio [OR]: 1.011; P < 0.001, OR : 1,10; P = 0,015, OR: 1,22, respectively). Conclusions: We found one-vessel LAD lesions to be significantly more in women and LCx cluster in men. Syntax score I was found to be a negative predictor for one-vessel LAD lesions, but Syntax score I, LDL cholesterol, and HbA1c were positive predictors for LCx cluster.
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Open-heart surgery recommenced in Ibadan: Early results of congenital cases p. 28
Mudasiru Adebayo Salami, Oluranti A Akinyemi, Victor O Adegboye
DOI:10.4103/njc.njc_24_17  
Background: The incidence of cardiothoracic disease continues to increase globally especially in developing countries. Cardiothoracic surgery is also growing in Nigeria despite limitations posed by infrastructure, political, and cost issues. The first open-heart surgery (OHS) in Ibadan was in December 1978. Previous reports of OHS from new centers in Sub-Saharan Africa have shown a preponderance of septal defects and Tetralogy of Fallot (TOF) in published series, with wide variations in reported morbidity and mortality. Objectives: We report a series of patients who underwent OHS for congenital heart diseases (CHD) to demonstrate disease pattern, types of procedures, outcomes, challenges, and lessons learnt. Methods: We conducted a retrospective study of patients with congenital heart disease who had OHS in Ibadan between October 2013 and November 2016. Data collected included demographics, presenting symptoms, indication for surgery, preoperative evaluation and preparation, operative procedure, postoperative complications, and follow-up. Statistical analysis was carried out descriptively using frequencies and percentages. Results: A total of 18 patients had OHS for congenital heart disease (CHD). These include atrial septal defects and ventricular septal defects (VSDs) in 10 patients (55.6%). There were 7 (38.9%) patients with TOF and a case of pulmonary stenosis. Complications recorded included a case of reoperation for bleeding and two patients who had VSD patch leaks. No hospital mortality was recorded. Conclusion: Early results of open-heart surgeries for congenital heart disease show excellent outcome comparable to current global standards with zero 30-day mortality and low morbidity. The result is aided by good case selection, correct anatomical diagnosis, adequate preparation, and teamwork. Adequate financing of cardiac care remains a challenge.
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A comparative and correlation study of electrocardiographic and echocardiographic left ventricular parameters in hypertension p. 33
Oluseyi Adegoke, Adewole A Adebiyi
DOI:10.4103/njc.njc_4_17  
Background: Routine echocardiographic assessment of left ventricular (LV) size and function in hypertensive individuals is desirable, but in resource-challenged African countries where this may be impracticable it is important to identify patients who after electrocardiographic (ECG) evaluation would benefit from further evaluation with echocardiography. Objective: To compare the echocardiographic parameters reflective of LV size and systolic function in hypertensive patients with normal ECG, LV hypertrophy (LVH) by voltage criteria only, and LVH with strain on electrocardiogram. Subjects and Methods: A cross-sectional comparative study of echocardiographic LV size and systolic function in hypertensive participants with normal ECG (60 participants), LVH with strain (51 participants), and LVH by voltage criteria only (50 participants) on ECG, attending the Cardiology Clinic of a University Teaching Hospital in Lagos, Nigeria. Results: ECG LVH with strain was associated with greater LVM index, higher prevalence of echocardiographic derived LVH, increased tendency toward hypertrophic LV geometric patterns, increased LV internal dimensions, LV systolic dysfunction, dilated left atrium and aortic root, as compared with ECG LVH by voltage criteria only and normal ECG in Nigerian hypertensive patients. Conclusion: ECG LVH with strain identifies a group of hypertensive individuals who are at increased cardiovascular risk and would benefit from further evaluation by echocardiography. Where echocardiography may not be readily accessible, this ECG pattern may aid decision making on appropriate therapeutic interventions.
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Abdominometer: A novel instrument to determine the level of risk for cardiometabolic diseases p. 41
Anil I Sirisena, Basil N Okeahialam, E Emeka Ike, D Stephen Pam, J Linus Barki
DOI:10.4103/njc.njc_20_17  
Background: The standard measure for classifying obesity, the body mass index (BMI) has been found to be deficient in some populations, Sub-Saharan Africans inclusive. Until recently, waist-to-height ratio (WHtR) was considered an improvement in this regard. Abdominal height (AH) measured with a novel appliance was recently found to be a superior cardiac anthropometric measure in our population; hence, there is a need to correlate it mathematically with the older indices. Objective: To determine a mathematical formula that permits computation of AH from BMI and WHtR. Methodology: A total of 200 randomly selected consenting young adult Nigerians (100 males and 100 females) between the ages 16 and 44 years who were undergoing preadmission medical examinations in a higher educational institution participated in this study. Height and weight were measured to determine BMI; waist and hip circumferences were measured and waist-to-hip ratio and WHtR computed. Results: Correlations between two anthropometric indices, BMI, and WHtR with AH were determined, and linear relationships were established using regression analysis to compute the AH using BMI and WHtR (P < 0.01). Reference levels of AH for low risk, increased risk, substantially increased risk, and severe risk were established. From this study, AH for severe risk level was found to be >32 cm and 30 cm by BMI and WHtR classifications, respectively. Conclusion: Where there is no abdominometer to measure AH, it is possible from BMI and WHtR to determine AH; which has been shown to predict cardiometabolic diseases better in our population.
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Prevalence, profile, and pattern of congenital heart disease in Central India: A prospective, observational study p. 45
Rajkumar Motiram Meshram, Vishal Shankarrao Gajimwar
DOI:10.4103/njc.njc_22_17  
Objective: The objective of this study was to assess the prevalence and pattern of congenital heart disease (CHD) using echocardiography. Materials and Methods: Patients of 0–12-year-old attending outpatient and inpatient of pediatric department clinically diagnosed with heart disease were further evaluated with chest radiography, twelve-lead electrocardiograms, and the confirmation of the diagnosis was done using two-dimensional echocardiography. Results: Among a total of 42,423 patients availing outpatient and inpatient facilities at the pediatric department of a tertiary referral center, 655 were clinically suspected as having heart disease among which 430 patients were identified as CHD, giving a prevalence of 10.13/1000 live births. About 56.28% patients were below 1 year and male:female ratio was 1.3:1. Consanguinity was observed in 42.09% and most of them were of third degree. Breathlessness was the most common symptom and tachycardia was the most common sign. About 66.74% of patients were diagnosed with acyanotic and 33.26% with cyanotic type. The most common CHD was ventricular septal defect (VSD) (30.01%) followed by atrial septal defect (20.70%), tetralogy of fallot (TOF) (16.05%), and patent ductus arteriosus (10.23%). The most common cyanotic CHD was TOF followed by transposition of great vessels, total anomalous pulmonary venous connection, and single ventricle. Case fatality rate was 19.23% and most of the deaths in neonatal age group due to complex CHD, refractory congestive cardiac failure, sepsis, and pneumonia. Conclusion: The prevalence of CHD in this study was 10.13/1000 live births. VSD and TOF were the most common acyanotic and cyanotic CHD, respectively. Case fatality rate was 19.23% and most of the deaths occurred in neonatal age.
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Development of the taksande's score: A new scoring system for the diagnosis of pulmonary arterial hypertension p. 50
Amar M Taksande, Rewat Meshram, Amol Lohakare, Sadhana Purandare, Aakshi Gandhi
DOI:10.4103/njc.njc_31_17  
Background: In the pediatric population, pulmonary arterial hypertension (PAH) is associated with a number of underlying diseases which causes significant morbidity and mortality. PAH in children is mainly idiopathic or associated with congenital heart disease (CHD). No scoring systems have been developed to aid in the diagnosis of PAH. Aim: This study aims to develop a PAH scoring system that is more applicable to the children. Materials and Methods: This prospective diagnostic study was conducted on the 428 CHD children admitted to a tertiary referral hospital. The pediatricians had examined independently and used the palpation and auscultation to detect the study participants for PAH (Index text). Echocardiography for PAH (Reference standard) was performed after the clinical assessments of the children. For the development of the new scoring system, the data collected which include anthropometry, clinical signs (tachypnea, cyanosis, pedal edema, and hepatomegaly) and the cardiovascular examination (Loud second heart sound, palpable P2, ejection click, dullness in 2nd intercostal space, and murmur). All statistical analyses were performed using STATA statistical software (version 10.0). Results: The study population consisted of 428 children who had CHD. On examination, 71% children were wasted, 44.63% had tachypnea, 20% had cyanosis, 18.46% children had pedal edema, and 41% had hepatomegaly. Murmur was present in 53% of the study cases. The optimal cutoff threshold score derived from the receiver operating characteristic curve analysis was 5. Based on this optimal cutoff threshold, the calculated sensitivity and specificity were 85.5% (95% confidence interval [CI] 76.7%–91.8%) and 92.5% (95% CI 89.1%–95.1%), respectively. The positive predictive value and negative predictive value were 76.6% and 95.6%, respectively. The diagnostic accuracy of the new score was 89.71. Conclusions: This new PAH scoring system is easy and simple to apply as the majority of the parameters can be obtained from a routine history and clinical examination.
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Serum leptin and future cardiovascular events in patients with acute coronary syndrome p. 57
Noha Hassanin Hanboly, Sameh Salama, Mervat Gaber, Omar Marzouk
DOI:10.4103/njc.njc_33_17  
Background: Coronary artery disease (CAD) is a major cause of death worldwide. Acute coronary syndrome (ACS) encompasses acute myocardial infarction and unstable angina. Leptin is 16-kDa hormone with pleiotropic actions in multiple organ systems. There is increasing interest in the potential role of leptin in the cardiovascular system. Studies comparing levels of leptin in patients with ACS to healthy matched controls, especially in the developing countries, are limited and rare. Aim of Study: This study was conducted to study leptin in ACS patients, comparing the results to a healthy matched control group and correlating the levels to the in-hospital outcome. Patients and Methods: The study was conducted at Cairo University Hospital. Serum leptin levels were studied in 50 patients admitted with the ACS (Group-I) compared to matched control group (Group-II) and correlating these levels to hospital morbidity and mortality. Diagnostic coronary artery catheterization was done to patients through femoral artery access to assess the severity and extent of CAD. Results: Serum leptin levels were significantly higher in ACS group compared to the normal controls, (P = 0.001). Although not statistically significant leptin levels were increased in eventful compared to the uneventful group. Conclusion: In patients with ACS, persistent elevation of serum leptin during serial measurements was invariably associated with worse in-hospital outcome. Positive correlation of serum leptin levels with other chronic inflammatory state such as obesity, hypertension, and female gender supports the hypothesis that leptin is a determinant of CAD possibly through its proinflammatory action.
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Study of platelet count and platelet volume indices in the spectrum of coronary artery diseases and its clinicopathological correlation p. 63
Biswajit Majumder, Himanshu Jain, Sharmistha Chatterjee, Tushar Kanti Das
DOI:10.4103/njc.njc_9_17  
Introduction: Larger platelets are enzymatically and metabolically more active and have higher thrombotic ability compared to the smaller one. The mean platelet volume (MPV) and other platelet volume indices quantification have been appreciated as biomarker of cardiovascular disease. Aims and Objectives: To determine the platelet count, the various platelet volume indices and and to evaluate any statistical difference between these values among the patients of acute myocardial infarction (AMI), unstable and stable angina in age and sex matched control group. Materials and Methods: 35 cases of AMI/unstable angina, 35 cases of stable angina were compared with 35 non cardiac patients with respect to platelet counts, MPV, PDW and PCT. All the parameters were measured as per standard protocol. Patients with bleeding disorder, thrombocytopenia, liver and kidney disease were excluded. Result and Analysis: In our study MPV and mean PDW were significantly higher in acute myocardial infarction/unstable angina patients than stable angina (P < 0.05). Statistically significant higher PDW and MPV were also observed in AMI/UA patients than control subjects (P < 0.05). Conclusion: Measurement of platelet count and platelet volume indices may be of some benefit in detecting those patients at higher risk of an acute coronary syndrome.
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CASE REPORT Top

Takayasu arteritis in Umuahia, South East Nigeria p. 67
Ogba Joseph Ukpabi, Abali Chuku, Eme Mark Offia, Osita Ikenna Okoli, Uchechukwu Callistus Ibewuike
DOI:10.4103/njc.njc_35_17  
Takayasu arteritis is a rare, systemic inflammatory large vessel vasculitis of unknown etiology that predominantly affects women of childbearing age. It is defined as granulomatous inflammation of the aorta and its major branches. Although the disease has a worldwide distribution, it is observed more frequently in Asian countries. It is rare in the black race as only a few cases have been documented. The objective of this study is to present a case of Takayasu arteritis diagnosed in South East, Nigeria, which is a rare disease in blacks. A 34-year-old female with clinical and radiological features of Takayasu arteritis is presented and related literatures reviewed. Although Takayasu arteritis is rare in the black race, with heightened clinical suspicion and appropriate investigations, more cases may be diagnosed.
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