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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 18 | Issue 1
Page Nos. 1-34

Online since Thursday, August 11, 2022

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ORIGINAL ARTICLES  

Early practice with two-dimensional transthoracic echocardiography at the Ekiti State University Teaching Hospital. Ado Ekiti Nigeria p. 1
Oladapo Adedamola Adewuya, Olatunji Olubukola Olaoye, Opeyemi Ezekiel Ojo, Oluwaseun Olusegun Areo
DOI:10.4103/njc.njc_17_20  
Background: Transthoracic echocardiography (TTE) is an essential noninvasive heart study technique which has changed the practice of cardiology worldwide. The procedure began at the Ekiti State University Teaching Hospital on October 24, 2017, till date. Objective: The objective of the study is to present our early practice with TTE in our location. Materials and Methods: It is a descriptively analyzed retrospective data acquired on demographic parameters, indications for the procedure, echocardiographic parameters, and diagnoses. The procedure was performed using general electric ultrasound machine Logiq C5 premium equipped with 3.5–5.0MHz transducer. Results: Three hundred and three procedures were done between October 24, 2017, and December 17, 2019 (2 years 2 months). There were 158 males and 145 females who were aged 52.8 ± 18.1and 56.6 ± 17.2 respectively. The mean age for all the subjects was 54.6 ± 17.8 years. Hypertension made up 168 (55.4%) and arrhythmia 25 (8.3%) of the indications for the procedure. The various diagnoses made include hypertensive heart disease (HHDx) (47.2%), cardiomyopathy (7.3%), valvular heart disease (rheumatic type) (5.9%), congestive cardiac failure (2.6%), pericardial disease (2.0%), left ventricular failure (1.7%), cor-pulmonale (1.7%), thyrotoxic heart disease (0.7%), ischemic heart disease, incomplete echo due to orthopnea, congenital heart disease (0.3%), and normal echo was recorded in (30%). Conclusion: HHDx was the most common diagnosis in our study. Other diagnoses include dilated cardiomyopathy, valvular heart disease (rheumatic type), cor pulmonale, congestive cardiac failure with varied ejection fractions, and peripartum cardiomyopathies. Congenital heart disease was uncommon.
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Pattern of electrocardiographic abnormalities in pediatric HIV/AIDS clients at Federal Medical Center, Abeokuta p. 6
Musa Kayode Yusuf, Adebiyi O Olowu, Chinyere C Uzodimma, Florence IO Dedeke
DOI:10.4103/njc.njc_13_20  
Background: Sub-Saharan Africa presently contributes about 70% of global HIV/AIDS population with little or no emphasis on the contribution of cardiovascular abnormalities to the associated morbidity and mortality in the region. Objectives: The objective is to determine the prevalence of electrocardiographic (ECG) abnormalities and association of such abnormalities with HIV/AIDS severity in terms of clinical manifestations and level of CD4 depletion. Design: A hospital-based cross-sectional case-control study. Methodology: One hundred and five (105) HIV-infected children attending HIV clinic and equivalent age- and sex-matched HIV un-infected controls attending pediatrics General Outpatient Clinics at FMCA were consecutively recruited over 8 months. They were evaluated clinically and had CD4 count, hematocrit, plasma calcium and potassium, and standard 12-lead ECG done. Results: Thirty-five (33.3%) of the subjects had ECG abnormalities compared with four (3.8%) in the controls (χ2 = 28.34, P < 0.05). The left ventricular hypertrophy was the commonest (13.3%) among other detected abnormalities such as Q-wave abnormalities, right ventricular hypertrophy, and ventricular repolarization abnormalities. The detected abnormalities were not significantly associated with advanced clinical or immunological stage of HIV/AIDS (χ2 < 4.0, P > 0.05). Conclusion: There was a high prevalence of ECG abnormalities in children with HIV/AIDS. These abnormalities occurred irrespective of the extent of the disease advancement. There is therefore a need for at least an ECG to identify from among HIV infected children those who may subsequently require echocardiography since the cost of echocardiography is presently too high and precludes its routine use in the Sub-Saharan Africa.
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Association of total lymphocyte count and echocardiographic parameters in human immunodeficiency virus-positive patients p. 14
Abaram Chesa Mankwe, Jonah Sydney Aprioku
DOI:10.4103/njc.njc_38_20  
Background: The pathophysiology of cardiovascular diseases in HIV infection has been linked to chronic inflammation that precipitates atherosclerosis and low lymphocyte count is a common finding during the systemic inflammatory response. Aim: The aim of this study is to evaluate the relationship between total lymphocyte count (TLC) and echocardiographic parameters in HIV positive subjects. Method: TLC of 100 HAART naïve newly diagnosed HIV/AIDS subjects, recruited from a Nigerian Tertiary Health Institution were analyzed, and their left ventricular (LV) function and geometry were evaluated using transthoracic echocardiography. Results: Abnormalities in LV function and geometry were observed in the HIV seropositive subjects and their TLCs were lower in those with severe forms of abnormalities. Conclusion: Concluding, TLC is inversely associated with LV dysfunction or abnormal geometry.
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Cardiac troponin T reference interval of healthy Nigerian children aged 5–17 years p. 22
Anthony Chibueze Nlemadim, Henry Chima Okpara, Maxwell Udo Anah, Martin Madu Meremikwu
DOI:10.4103/njc.njc_39_20  
Background: Cardiac troponin T (cTnT), a biomarker for myocardial injury, reference values is unknown in Nigeria. The establishment and use of pediatric cTnT normative values may be better than the use of adult-derived cTnT values. Aim: The aim of this study is to determine cTnT reference interval among healthy Nigerian children. Methods: One hundred and thirty-two healthy children aged 5–17 years were consecutively recruited over a 9-month period after meeting the inclusion criteria. Blood was taken and the sera analyzed for cTnT by the electrochemiluminescence immunoassay method using high-sensitive assay. Data were analyzed using RefVal software and SPSS version 23.0. Results: The male: female ratio was 1.03:1 with median (interquartile range) serum cTnT of 5.1 (5.0–5.1) ng/L. The reference interval has a lower reference limit (2.5th percentile) of 5.0 (5.0–5.0) ng/L and upper reference limit (97.5th percentile) of 6.8 (5.7–7.2) ng/L. The 99th percentile of cTnT was 7.2 ng/L. Serum cTnT had weak association with age (rs[130] = 0.19, P = 0.033) but no significant relationship with body mass index-for-age-and-sex, sex and social class. Conclusion: This cTnT reference interval can be beneficial in low-middle-income settings who lack indigenous reference intervals. We recommend its use for the identification of myocardial injury among children instead of adult intervals to prevent under-treatment. Stakeholders are encouraged to make cTnT affordable to the less privileged.
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CASE REPORTS Top

Rare but not forgotten: Case series of pulmonary embolism with S1Q3T3 pattern p. 28
Bui Khiong Chung, Zhun Foo Tan
DOI:10.4103/njc.njc_35_20  
Pulmonary embolism (PE) is a common acute cardiovascular disorder. The most common electrocardiograph (ECG) finding in PE is sinus tachycardia. However, the S1Q3T3 pattern of acute cor pulmonale also called McGinn-White sign is classic. We report three cases of a 48-year-old man, 41-year-old woman, and a 66-year-old woman diagnosed with PE with the ECG findings of S1Q3T3 pattern. In conclusion, recognizing these ECG findings could prompt clinicians to consider PE and lead to earlier diagnosis.
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Acute ST-elevation myocardial infarction in a patient with polycystic kidney disease in Kano, Nigeria p. 31
BL Muhammad, Naser Ahmad Ishaq, Sadiq Hassan Ringim, Sabi'u M Hamza, Haruna Y Abubakar, Shamsiddeen Abdulrahman, SA Ahmad, Fatima M Bashir, Tijjani Abdulsalam, A Muhammad, Isyaka Alfa, Ruqayya N Sani, M Bashir, SI Salele, HA Sani, A Hussain, Shehu A Kana, Muhammad S Mijinyawa, Mahmoud U Sani, Kamilu Musa Karaye
DOI:10.4103/njc.njc_37_20  
A 37-year-old male patient known to have polycystic kidney disease (PKD) for the past 5 years presented with a 2-day history of severe chest pain at rest that was confirmed as acute inferior myocardial infarction (MI). He was a known hypertensive for the past 5 years with a difficult-to-control blood pressure, but with preserved renal function. He had no family history of similar illness and has no personal history of diabetes mellitus, dyslipidemia, smoking, alcohol consumption, or recreational drugs use. Apart from elevated blood pressure of 150/100 mmHg, physical examination was unremarkable. He was found to have dyslipidemia with high-density lipoprotein cholesterol of 0.87 mmol/l and hypertriglyceridemia (2.7 mmol/l), but other serum lipid fractions and fasting plasma glucose were within normal limits. His echocardiogram showed normal sizes of all cardiac chambers with preserved left ventricular (LV) function, inferior wall hypokinesia, and Grade I LV diastolic dysfunction, and he had no aortic aneurysm. He was admitted for 5 days, treated conservatively, and discharged after resolution of symptoms, troponin, and raised ST segments. To the best of our knowledge, this is the first report from Nigeria illustrating the rare association between PKD and acute MI in the young.
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