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ORIGINAL ARTICLES
Effect of change in body position on resting electrocardiogram in young healthy adults
Supreet Khare, Anuj Chawala
July-December 2016, 13(2):125-129
DOI:10.4103/0189-7969.187711  
Background: The electrocardiogram (ECG) is recorded in the supine position and values of various parameters are based on calculations made from supine ECG recordings. In certain situations, such as exercise stress testing and evaluation of syncope by the head-up tilt test, the ECG is recorded in the upright position. Thus, it becomes equally important to study and quantify the nature and magnitude of changes seen in the ECG with a change of posture from supine to upright in healthy individuals. Aim: To study and investigate the effect of a change in body position on the frontal plane on ECG. Materials and Methods: Thirty healthy adult subjects (15 male and 15 female) in the age group of 18-25 years were included. The ECG was recorded in four body positions, supine, reclining with the trunk flexed at 70°, sitting upright, and standing. Results: The mean frontal plane QRS axis recorded in the supine and standing positions was comparable. The reclining and sitting ECG show a significant variation of the mean QRS axis as compared to the supine position. The T-wave axis was found to be comparable in the supine and standing positions. The corrected QT (QTc) interval showed a significant change with a change in the body position from supine to standing. Conclusion: All the subjects showed similar ECG changes, but differences in the magnitude of the changes with change in body position. The change in the QTc interval with standing needs to be explored.
  16,139 643 -
Prevalence of hypertension and associated factors among residents of Ibadan-North Local Government Area of Nigeria
Ikeoluwapo O Ajayi, Ibukun Opeyemi Sowemimo, Onoja Matthew Akpa, Ndudi Edmund Ossai
January-June 2016, 13(1):67-75
DOI:10.4103/0189-7969.165168  
Background: Hypertension is a major public health challenge worldwide. It is the most important risk factor for cardiovascular disease. Objectives: This study aimed to investigate the prevalence of hypertension and associated factors among the residents of Yemetu community in Ibadan-North Local Government Area of Oyo State, Nigeria. Methods: A descriptive cross-sectional design was used. The study involved 806 respondents aged from 18-90 years from 171 households, selected by cluster sampling technique. It was a house-to-house survey. Behavioural risk factors were measured using World Health Organisation (WHO) STEPwise approach to chronic disease risk factor surveillance (STEPS 1 & 2). Hypertension was defined as Systolic blood pressure (SBP) ≥ 140 and/or Diastolic blood pressure (DBP) ≥ 90mm Hg or currently on anti-hypertensive medication. Data were analysed using descriptive statistics, Chi-square and binary logistic regression tests at P<0.05. Results: The overall prevalence of hypertension was 33.1% (male 36.8% and female 31.1%). The proportion of self reported hypertension was 11.1%, while 5.1% were currently on anti-hypertensive medication. The mean age of the respondents was 38.8 ±15.6 years. The body mass index of the respondents was 5.2%, 52.0%, 29.5% and 13.3% for underweight, normal, overweight and obese, respectively. Alcohol and tobacco use were found in 11.5% and 3.2%, respectively. The result of binary logistic regression analysis revealed that hypertension was significantly associated with being in age groups 30-49 years (OR 2.258, 95% CI: 1.311 - 3.884), ≥50 years (OR 7.145, 95% CI: 3.644 - 14.011), being overweight or obese (OR 2.281, 95% CI: 1.022 – 5.088). Hypertension was inversely associated with being underweight (OR 0.537, 95% CI: 0.395 – 0.832). Conclusion: This study revealed a high prevalence of hypertension. These data underscores the need for urgent steps to create awareness and implement interventions for prevention and early detection of hypertension, especially among those aged ≥30 years and the overweight or obese.
  14,713 1,062 3
Significant pleural effusion in congestive heart failure necessitating pleural drainage
Eyo Effiong Ekpe, Ime O Essien, Umoh Idongesit
July-December 2015, 12(2):106-110
DOI:10.4103/0189-7969.152020  
Background: Pleural effusion is very common in congestive heart failure, and should resolve with treatment of congestive heart failure, including diuretic. However, refractory, recurrent, massive, or significant pleural effusions contributing to symptoms in the patients with congestive heart failure warrant treatment by pleural drainage. We sought to discover the clinic-pathologic characteristic of such pleural effusion in our congestive heart failure patients. Materials and Methods: Retrospective analysis of medical records of congestive heart failure patients admitted for inpatient treatment between January 2007 and June 2011. Results: Out of the 342 patients that presented with congestive heart failure during the study period, ten (2.9%) patients had significant pleural effusions in 12 pleural spaces that contributed to symptoms and refused to resolve on treatment of the congestive heart failure including diuretic. Male:Female was 1.2:1, modal age range 40-50 years, 50% in the left, 30% in the right, and 20% bilateral. The estimate of the pleural effusion was <1000 ml->2000 ml with 90% being transudate and 10% exudates. One patient had associated pericardial effusion. Upon drainage, 70% of the patients improved immediately. Conclusion: We recommend drainage of refractory, recurrent, massive, significant pleural effusion in congestive heart failure contributing to symptoms and responding to diuretic therapy.
  13,223 465 1
LETTERS TO EDITOR
The Pan-African Society of Cardiology: A retrospection
Ayodele O Falase, Olufemi Jaiyesimi
January-June 2013, 10(1):31-36
DOI:10.4103/0189-7969.118579  
  10,149 227 -
REVIEW ARTICLES
Heart failure: Definition, classification, and pathophysiology – A mini-review
Saheed O Adebayo, Taiwo O Olunuga, Amina Durodola, Okechukwu S Ogah
January-June 2017, 14(1):9-14
DOI:10.4103/0189-7969.201913  
Heart failure is a clinical syndrome characterized by dyspnea, fatigue, and clinical signs of congestion leading to frequent hospitalizations, poor quality of life, and shortened life expectancy. It is a final common pathway to various cardiac conditions. It is a growing problem worldwide with serious consequences in Sub-Saharan Africa where it occurs at a younger age with limited resources to manage the condition. The incidence and prevalence vary worldwide. In this mini-review, we looked at the definition, classification, and pathophysiology of the condition.
  7,804 895 1
The eighth joint national committee on the prevention, detection, evaluation, and treatment of high blood pressure (joint national committee-8) report: Matters arising
Ogba Joseph Ukpabi, Iheanyi Damian Ewelike
January-June 2017, 14(1):15-18
DOI:10.4103/0189-7969.201909  
America's Joint National Committee (JNC) on the prevention, detection, evaluation, and treatment of high blood pressure is one of the foremost regional regulatory bodies on the management of hypertension. Its latest report (JNC-8) of 2014 has attracted a lot of strong criticisms. The aim of this review is to offer a summarized insight into the different opinions that have trailed its process and content since its publication.
  6,567 1,096 2
REIVEW ARTICLE
Peripartum cardiomyopathy
Solomon Sulei Danbauchi, Albert I Oyati, Mohammad S Isa, Mohammed A Alhassan
July-December 2014, 11(2):66-73
DOI:10.4103/0189-7969.142084  
Peripartum cardiomyopathy is cardiovascular disorder that is seen only in females in third trimester to 6 months post delivery. It is a diagnosis of exclusion. The syndrome is still seen in Nigeria more especially Northern Nigeria where the largest cohort of patients were described in the early 70s. The longest follow up (30-35) years of the syndrome was also done in Zaria, Northern Nigeria. The etiology of the syndrome is unknown but from different parts of the world clinicians have associated the syndrome to different risk factors. The authors did a Medline, AJOL and other search to review write ups on this syndrome. Of the 27 publications on the syndrome from Nigeria, 90% came from the Northern Nigeria. In Nigeria the syndrome was associated with the famous Wakan Jeko which composes of a triad of hot baths, ingestion of pap (kunun kanwa) which is made with lake salt that has high levels of sodium (Na + ). Other authors have associated it with hypertension, myocarditis, use of tocolytics and deficiency of trace elements like selenium. Recently the South Africans have also proposed the possibility by products of stress on Prolactin leading to cardiac damage/Peripartum cardiomyopathy has maternal and child health implications in Nigeria, sometimes it does lead to maternal mortality so also infant mortality. Patients have been reported to have developed recurrent Peripartum cardiac failure if they did not take heed to the advice regarding avoiding the wakan jeko. Some of these patients have gone on to develop hypertension and presented with hypertensive cardiac failure or cerebrovascular accident. Peripartum cardiomyopathy etiology is still an enigma. A coordinated national and international effort is required to do a comprehensive research on this syndrome to put to rest or uphold some of the theories regarding etiology.
  3,756 1,357 -
LETTERS TO EDITOR
Management of hypertension in Nigerians: Ad hoc or rational basis?
Ayodele O Falase, Akinyemi Aje, Okechukwu S Ogah
July-December 2015, 12(2):158-164
DOI:10.4103/0189-7969.161791  
  4,546 267 1
ORIGINAL ARTICLES
Acute coronary syndrome among diabetic patients in invasive versus noninvasive hospitals
Abdulhalim J Kinsara, Waeil A Batwa, Ibtesam O Alzain, Zuhoor S Almansouri, Oyindamola B Yusuf
July-December 2015, 12(2):61-64
DOI:10.4103/0189-7969.152006  
Background: Risk stratification is an important step in proper management of acute coronary syndromes (ACS). This should be carried in every hospital as it might improve the outcome even in hospitals with no coronary angiogram facility but are following the guideline of management. Objective: We present the characterization based on thrombolysis in myocardial infarction (TIMI) risk profile of unstable angina (UA)/non-ST-segment elevation (NSTEMI) myocardial infarction - ACS in diabetic patients in King Abdulaziz Medical City National Guard Hospital (KAMC) in Jeddah, a noninvasive facility and compared with 4 other hospitals in the Kingdom of Saudi Arabia with cardiac catheterization facilities. These hospitals were involved in multicenter international diabetes-ACS study. In addition, we compared the characterization of two therapeutic modalities used in management of such cases: Glycoprotein (GP) IIb/IIIa inhibitors and coronary angiogram. Materials and Methods: The characterization of the risk profile of 35 diabetic patients from KAMC, noninvasive hospital were compared with 142 patients from four hospitals in KSA, and 3,624 patients from the international hospitals who had cardiac catheterization facility admitted with UA/NSTEMI, ACS. Results: The distributions of TIMI scores were similar among the three groups. The odds ratios were also comparable across the three groups. When GP IIb/IIIa inhibitors usages were compared, the usage for a particular group was not different. The high risk factors were similar in patients who underwent coronary angiogram in the centers of KSA who had cardiac catheterization in comparison to those international centers. Conclusions: The nonavailability of catheterization facilities does not cause referral bias, with risk factors being similar and treatment approach was matching. Immediate triage and risk stratification, e.g. TIMI score will affect the outcome of cardiovascular mortality and might explain some similarity in the outcome between invasive and noninvasive hospitals.
  1,685 2,719 -
The serum electrolytes, urea and creatinine values in children with chronic heart failure on diuretic therapy
Wilson E Sadoh, Osajie J Idemudia, Patrick A Ekpebe, Paul Aikhoriojie
January-June 2014, 11(1):18-21
DOI:10.4103/0189-7969.130049  
Background: The response to chronic heart failure (CHF) involves activation of neurohormonal mechanisms that may alter the water and electrolytes homeostasis. Diuretic therapy also influences the electrolytes and water balance. Objective: This study aims to evaluate the electrolytes, urea and creatinine levels in children with CHF on diuretic therapy in comparison with controls who do not have heart failure and are not on diuretics. Methods: This cross-sectional study involved children with congenital heart disease on high ceiling diuretic, spironolatone and captopril with their age and sex matched controls. The electrolytes, urea and creatinine values were determined in standard fashion and compared between subjects and controls. Results: There were 25 each of subjects and controls recruited for the study. The differences in the mean electrolytes, urea and creatinine values between subjects and controls were not significantly different, P > 0.05. There was no case of hypokalemia in either subject or control. There were more subjects than controls who had hyponatremia, P = 0.25. The mean electrolytes, urea and creatinine in subjects on therapy for <6 months were not significantly different from those on therapy for ≥6 months, P > 0.05. Conclusion: The combination of high ceiling diuretic, spironolactone and captopril was able to maintain most electrolytes, urea and creatinine levels in children with CHF. However, subjects were more likely to have hyponatremia than controls. Regular electrolyte determination to exclude hypotremia is therefore recommended in children with CHF on diuretic therapy.
  4,163 210 -
CASE REPORTS
Endomyocardial fibrosis: Seven decades later in the Nigerian setting
Godsent Chichebem Isiguzo, Onyebuchi Micheal, James Audu Onuh, Adesua Sandra Muoneme, Nandom Kenneth Bitrus, Basil Nwaneri Okeahialam
January-June 2015, 12(1):45-50
DOI:10.4103/0189-7969.148488  
Background: Endomyocardial fibrosis (EMF), an obliterative cardiomyopathy of uncertain etiology, is the most common restrictive cardiomyopathy worldwide with no specific treatment and usually associated with poor prognosis due to late presentation. First described in the literature in 1946 among Africans, the prevalence seem to be decreasing, but without much change in its management in the region due to late presentation and inadequate surgical responsiveness. Earlier literature described EMF as a disease of the rain forest, only restricted to dwellers in the coastal regions. Despite the growing body of knowledge on this condition, there is not enough corresponding advancement in therapeutic interventions for the sufferers in Nigeria. Materials and Methods: Between May 2010 and July 2011, we reviewed cases of endomyocardial fibrosis presenting to the cardiology unit of Jos University Teaching Hospital, Plateau State Nigeria. The institutional board of the hospital approved the review, and consent was obtained from the patients/guardians. Effort was made to withhold identity of the patients in accordance with established protocol. Result: The first case was an 18-year-old female student with features of chronic heart failure who has earlier been misdiagnosed as having rheumatic valvular heart disease, but had biventricular EMF. Case 2 was a 33-year-old man who presented with breathlessness and hemoptysis and was erroneously on treatment for tuberculosis. Echocardiography revealed right ventricular EMF. The final case was a 27-year-old farmer with cough, progressive shortness of breath and abdominal swelling. Holter monitoring revealed ventricular and atrial arrhythmias, and echocardiography showed pericardial effusion with features of right ventricular EMF. He had bouts of arrhythmia with collapse, and finally died suddenly. Conclusion: There have been little advances in management of EMF seven decades after it was discovered, and despite being one of the major causes of heart failure in the tropics, awareness and response to management in these areas have lagged behind.
  3,884 165 1
EDITORIAL
Electrocardiographic reference values for Nigerian children
Wilson E Sadoh
July-December 2014, 11(2):65-65
DOI:10.4103/0189-7969.142080  
  1,240 2,749 -
Intracranial atherosclerotic disease in Nigeria: Any relationship with rising stroke burden in the country?
Okechukwu S Ogah, Ayodele O Falase
July-December 2013, 10(2):45-46
DOI:10.4103/0189-7969.126997  
  1,337 2,634 -
ORIGINAL ARTICLES
Orchidectomy reduces blood pressure, but testosterone increases it in intact and orchidectomized normotensive rats
Fati O Aliyu, Abdullateef I Alagbonsi, Ali AU Dikko
July-December 2016, 13(2):93-97
DOI:10.4103/0189-7969.187705  
Background: The cardioprotective effect of estrogen has been well documented, and the effect of testosterone on blood pressure (BP) is controversial and remains inconclusive. Aim: The present study is aimed at investigating the effect of testosterone on BP in normotensive rats. Materials and Methods: In a blind study, 30 male albino rats (200-250 g) were divided into 5 oral treatment groups (n = 6 rats each) as follows: Groups I and II were intact rats that received 1 ml/kg normal saline (vehicle) and 25 mg/kg testosterone subcutaneously for 24 days. Group III was sham-operated and received normal saline for 24 days. Groups IV and V were bilaterally orchidectomized and received normal saline and 25 mg/kg testosterone subcutaneously for 24 days. Results: The systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP) of the sham-operated rats that received normal saline were not significantly different from the intact (control) rats that received normal saline (P > 0.05). Testosterone treatment in control rats caused a sustainably higher SBP (P < 0.001), DBP (P < 0.001), PP (P < 0.001), and MAP (P < 0.001) when compared to control that received normal saline. The SBP (P < 0.01), DBP (P < 0.001), MAP (P < 0.001), but not PP (P > 0.05) was significantly reduced in orchidectomized rats that received normal saline when compared to control. However, administration of testosterone in orchidectomized rats abolished orchidectomy-induced reduction in SBP, DBP, MAP, but not PP and further increased them above the control level (P < 0.05). Conclusion: This study shows that testosterone is prohypertensive in normotensive rats.
  1,490 2,437 -
CASE REPORTS
Pulsatile chest wall mass - A trap for the unwary
Subramanian Senthilkumaran, Shah Sweni, Ramachandran Meenakshisundaram, Ponniah Thirumalaikolundusubramanian
July-December 2014, 11(2):130-132
DOI:10.4103/0189-7969.142119  
Syphilis is less commonly seen in clinical practice. Hence, presenting features of primary, secondary, and tertiary forms of syphilis are not recalled during discussion. A case of syphilitic aneurysm observed in a 54-year-old male is presented to create awareness of this condition among healthcare professionals and stress importance of this entity in the differential diagnosis and treatment of mass in the chest wall.
  3,575 122 -
REVIEW ARTICLES
Quality of life in heart failure: A review
Saheed O Adebayo, Taiwo O Olunuga, Amina Durodola, Okechukwu S Ogah
January-June 2017, 14(1):1-8
DOI:10.4103/0189-7969.201914  
Heart failure (HF) is a major cause of morbidity and mortality worldwide. HF severity and mortality can be predicted by measurement of quality of life (QOL). Generic and disease-specific instruments for measurement of QOL have been shown to be effective in clinical settings and in research. QOL compares favorably with traditional calibrators of HF severity such as New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), 6-min walk test (6MWT), and B-type natriuretic peptide levels. QOL measurement using domains such as social interaction, emotion, environmental interaction, sexual activity, and demographic characteristics, among others, can be used effectively in resource-limited environments, as well as adjunct to echocardiography and BNP. Lower QOL predicts early and more frequent HF hospitalization, depression, higher NYHA class, poor 6MWT, lower estimated glomerular filtration rate, and lower LVEF. Older age, lower socioeconomic status, longer duration of HF, and comorbidities correspond to lower QOL scores. Clinical trials incorporating QOL as primary and/or secondary end-point show improved QOL with the use of angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, beta blockers, device therapies, such as implantable cardiac defibrillator, and exercise-based rehabilitation. The aim of this paper is to review information on QOL in HF.
  3,128 529 1
ORIGINAL ARTICLES
Awareness and perception of harmful effects of smoking in Abia State, Nigeria
Ugochukwu U Onyeonoro, Innocent I Chukwuonye, Okechukwu O Madukwe, Andrew U Ukegbu, Moses O Akhimien, Okechukwu S Ogah
January-June 2015, 12(1):27-33
DOI:10.4103/0189-7969.148483  
Background: The goal of the health education is to influence their perception of tobacco use, thereby discouraging smokers and would be-smokers from smoking. Objective: This study is aimed at ascertaining the level of awareness of the warning against smoking, perception of tobacco use and tobacco control measures among residents of Abia State, South-East Nigeria. Materials and Methods: A cross-sectional, population-based survey of respondents (aged 18 years and above) were selected by multi-staged sampling technique. Responses were elicited from them using an interviewer-administered questionnaire on sociodemographic characteristics; awareness of warning against tobacco use, sources of information, perception of harmful effect of tobacco and tobacco control measures. Results: About 88% of the respondents were aware of warning against tobacco use, the most common source of information was media adverts (50.7%). Awareness of warning against tobacco use was found to be associated with sociodemographic characteristics, history of smoking, exposure to smoke at home and public places, and perception of tobacco use. Conclusion: The findings from this study present an opportunity for initiating more robust policies, programs and interventions for tobacco control in the state.
  3,242 314 1
Pattern of cardiovascular disease amongst medical admissions in a regional teaching hospital in Southeastern Nigeria
Nelson I Oguanobi, Emmanuel C Ejim, Basden JC. Onwubere, Samuel O Ike, Benedict C Anisiuba, Vincent O Ikeh, Emmanuel O Aneke
July-December 2013, 10(2):77-80
DOI:10.4103/0189-7969.127005  
Background: Cardiovascular disease (CVD) is responsible for a large proportion of death and disability worldwide. However, a substantial portion of the increasing global impact of CVD is attributable to economic, social, and cultural changes that have led to increases in risk factors for CVD. These changes are most pronounced in the countries comprising the developing world. Because the majority of the world's population lives in the developing world, the increasing rate of CVD in these countries is the driving force behind the continuing dramatic worldwide increase in CVD. Objective: This study was aimed at determining the frequency and pattern of cardiovascular disorders in the medical wards as well as the emergency and intensive care units of the University of Nigeria Teaching Hospital (UNTH) Enugu, Southeast Nigeria. Methods: A retrospective study of consecutive adult patients with diagnosis of cardiovascular disorders admitted into the medical wards and/or the emergency/intensive care units of UNTH Enugu between January 2000 and January 2007 was carried out using the ward admission and discharge registers. Results: A total of 6,162 patients (males 3,385 (54.93%); female 2,777 (45.07%)) were admitted over the period covered by the study. Out of these; 1,261 (20.46%) patients were found to have cardiovascular disorder. Prevalence of cardiovascular disorders was found to be higher among the female patients than among the males: 693 (24.95%) and 568 (16.78%) years, respectively. The ages ranged between 18 and 92 years with a mean ± standard deviation (SD) of 55.13 ± 15.37. The pattern of CVD observed in this study were hypertension and its complications (86.36%), rheumatic heart disease (4.52%), dilated cardiomyopathy (3.09%), and alcoholic heart muscle disease (0.95%). Conclusion: CVDs were major causes of morbidity in the environment of study. Early detection, improved outpatient care, as well as inclusion of appropriate secondary prevention programs in patient's management especially at the community level is recommended in order to reduce complications and the need for hospital admissions.
  2,962 392 3
Atherosclerosis of the intracranial carotid arteries in Nigerians: A pilot autopsy study
Olulola O Oladapo, Jimmy Olusakin, Gabriel O Ogun, Effiong Akang
July-December 2013, 10(2):62-67
DOI:10.4103/0189-7969.127002  
Background: Evidence suggests that intracranial cerebral atherosclerosis (ICCA) occurs rarely in Caucasians, but more frequently in Asians, African-Americans, and Hispanics. Pathological studies verifying this claim are few in Africans. Objective: This prospective study aimed at grading the extent, severity, and frequency of atherosclerosis of the circle of Willis in Nigerians, using the American Heart Association (AHA) classification. Methods: This study is part of a descriptive, cross-sectional survey carried out on bodies referred for post-mortem to the Department of Morbid Pathology in the University College Hospital, Ibadan, Oyo State, Nigeria. The circle of Willis of 44 consecutive patients ≥20 years of age were examined for atherosclerosis using the AHA classification. Results: Twenty (45.5%) of the 44 patients studied had atherosclerotic lesions in their intracranial cerebral vessels. The internal carotid arteries (ICAs) (10.1%) were the most frequently affected, followed by the basilar artery (BA) and the middle cerebral arteries (MCAs) (8.5% each). Fifteen (75%) of the 20 patients who had atherosclerotic lesions had at least one risk factor for atherosclerosis. Age, waist circumference, and abdominal wall thickness were strong risk factors for ICCA. A total of 188 (30.5%) atherosclerotic lesions were found in the 616 histological sections of blood vessels examined in the 44 patients. Ninety-six (51.1%) of the lesions were mild, 53 (28.2%) were moderate, and 39 (20.7%) were severe. Severe atherosclerotic lesions were most frequently observed in the Lt ICA (20.5%) and Rt MCA (15.4%). Using the AHA classification, type I lesions were found in 6.4%, type II 17.6%, type III 27.1%, type IV 10.1%, type V 18.1%, type VI 11.7%, type VII and IX 0.5%, and type VIII lesions were found in 8.0% patients. Conclusions: The frequency of ICCA in our study was 45.5%, and this is worrisome for a population in a low-resource setting such as Nigeria, as the risk of stroke and recurrence in patients with symptomatic ICCA is high. Our findings are at variance with the other studies on ethnic or racial distribution of cerebral atherosclerosis, in which Chinese, Japanese, Hispanics, and African-Americans have higher rates of ICCA, and Caucasians have higher rates of extracranial carotid artery atherosclerosis (ECCA).
  3,105 240 2
CASE REPORTS
Dextrocardia seen in the children in Aminu Kano Teaching Hospital: A report of 8 cases
Aliyu Ibrahim, Asani O Mustafa
January-June 2014, 11(1):49-53
DOI:10.4103/0189-7969.130128  
Dextrocardia occurs when the heart is located on the right side of the thoracic cavity. It may be classified as dextroposition, isolated dextrocardia, dextrocardia with situs inversus, and dextrocardia with situs ambiguous. Dextrocardia may also be associated with other co-morbidities. We report cases of dextrocardia seen over a seven-year period with varied presentations.
  2,981 236 -
REIVEW ARTICLE
Catamenial pneumothorax: A scourge not to be ignored
Kelechi E Okonta, Gerry C Nkwocha, Goddy Bassey
July-December 2013, 10(2):47-50
DOI:10.4103/0189-7969.126998  
Catamenial pneumothorax (CP) is defined as spontaneous pneumothorax occurring within 72 h before or after the onset of menstruation. It is the most common form of thoracic endometriosis syndrome (TES), which includes catamenial hemoptysis, catamenial hemothorax, catamenial hemopneumothorax, and endometrial nodular lung mass. The purported pathogeneses are the retrograde menstruation and implantation of endometrial tissue in the thoracic cavity, the entry of endometrial cells into the venous system and "metastatic" spread of endometrial tissue, the coelomic metaplasia and the effect of the potent prostaglandin F2 causing the rupture of subpleural blebs at peak of menstruation. This condition was considered a rare entity even in our local setting; however, a prospective study about a decade ago showed that 25% of women hospitalized in an 18-month period for surgical treatment of spontaneous pneumothorax had this condition. The diagnosis is established by clinical evaluation with chest computerized tomography scan and video-assisted thoracoscopy, and immediate multimodality treatment using hormonal and surgical interventions will substantially reduce morbidity and mortality.
  2,174 979 -
ORIGINAL ARTICLES
Experience with permanent pacemaker insertion at the University College Hospital, Ibadan, Nigeria
Peter O Adeoye, Kelechi E Okonta, Mudasiru A Salami, Victor O Adegboye
January-June 2013, 10(1):3-5
DOI:10.4103/0189-7969.118572  
Objective: The aim is to determine the characteristics of patients for permanent pacemaker insertion (PPI), treatment outcome, and factors affecting the early insertion of the pacemaker. Methods: Fifty patients who had permanent pacemaker implanted (PPI) between July 2008 and June 2011 were prospectively followed-up. The patients' demographic data, medical history, details of pacemaker hardware used, complications were collected into a proforma.The data were analyzed using the SPSS Version 17 statistical software package (SPSS, Inc. Chicago Illinois). Results: During the 3 year period, a total of 50 patients had PPI with a mean age of 66.1 years (ranged 30-88 years). Thirty-three (66%) were males 15 (30%) had hypertension as a co-morbidity, 39 (78%) had complete heart block. In 48 (96%), the cause was not known, 1 (2%) was chloroquine induced. The breakdown of the symptoms showed that syncope accounted for 21 (36.2%), dyspnea 20(34.5%) and recurrent dizziness 9 (15.5%). The pulse rate in 29 (58%) was <40/min. The mean pulse rate 39.4 min (range, 32-65), the mean pre-operation days on admission was 16.09 (ranged 2-60 days) while the mean post-operation days was 7.06 (ranged 2-14 days). The complications included lead dislodgement in 2(4%) patients, infective endocarditis in 1 (2%) and diaphragmatic pacing in 1 (2%). Two (4%) deaths were recorded. The mean survival in months was 14.9 (ranged 12-48 month) during the follow-up. Conclusion: PPI is well-acceptable in the elderly with improvement in their clinical state. However, plans should be put in place to ensure reduction in the time spent while in the hospital when trying to procure the pacemaker by creating a pacemaker bank in Hospitals that engage in pacemaker insertion in the country.
  2,748 246 1
ABSTRACTS
Abstract proceedings of the 42 nd Annual General Meeting

July-December 2013, 10(2):88-100
  2,736 181 -
ORIGINAL ARTICLES
Hypertension and lower extremity peripheral artery disease: An overlooked association
Umuerri E Martha, Edo Andrew, Obasohan A Osemwingie
January-June 2013, 10(1):26-30
DOI:10.4103/0189-7969.118578  
Background: Hypertension is a major risk factor for atherosclerosis and by extension lower extremity peripheral artery disease (LEAD). There is however, paucity of data on the prevalence of LEAD among hypertensive patients in Nigeria. Methods: This study determined the prevalence of LEAD among hypertensive patients attending the hypertension clinic, consultant out-patient department, University of Benin Teaching Hospital, Benin City. It also examined the relationship of certain risk factors known to be associated with atherosclerosis generally. A total of 153 hypertensive patients aged 18 years and above were consecutively enrolled in the study. LEAD was defined as an ankle-brachial index (ABI) <0.9 in either leg using the hand-held Doppler ultrasound scan. The Edinburgh Claudication Questionnaire was administered to determine a history of intermittent claudication, the major symptom of LEAD. Results: Nearly, 41.8% of the patients had ABI <0.9 in either leg. Among patients with LEAD majority were asymptomatic with a ratio of 1:8 for symptomatic versus asymptomatic disease. Conclusion: LEAD is common among hypertensive patients, with prevalence of 41.8%. Majority of patients with LEAD were asymptomatic.
  2,503 281 -
Ischemia modified albumin in myocardial infarction and its correlation with selected acute phase reactants
Neepa Chowdhury, Angshuman De, Rabindra Bhattacharya, Indranil Chakraborty
July-December 2015, 12(2):65-70
DOI:10.4103/0189-7969.152028  
Background: There is evidence that ischemia modified albumin increases (IMA) in acute coronary syndrome, but enough work has not been done in assessing the correlation between IMA and inflammatory markers in myocardial infarction (MI). Objective: The objective of the present study was to observe whether IMA would significantly be altered in MI patients and also whether the same would be correlated with selected acute phase reactants. Methods: The present hospital based, noninterventional, cross-sectional study was undertaken in Medical College and Hospital, Kolkata. Fifty cases of acute MI (AMI) and 50 suitable controls were enrolled for the study. Serum IMA, serum albumin, serum total cholesterol, serum high-sensitivity C-reactive protein (hsCRP), serum ceruloplasmin and serum transferrin were measured in blood from the study population. Results: Serum IMA and hsCRP (P < 0.0005) were significantly higher in cases whereas serum transferrin (P < 0.0005) and albumin (P < 0.005) were significantly lower in cases as compared to controls. In cases, IMA was found to be positively correlated (r = 0.470, P = 0.001) with hsCRP, one of the common markers of inflammation in AMI. Serum IMA, hsCRP and transferrin play a significant role (P < 0.05) in assessing the severity of inflammation. Conclusion: Serum IMA was altered in AMI patients and positive correlation was obtained between IMA and positive acute phase reactant hsCRP. This study encourages future studies probing the role of inflammation in the causation of MI.
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