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.

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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.

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Background: Functional and structural consequences of hypertension on the right ventricle (RV) have received scarce attention due to the complex shape and orientation. The aim of the current study is to study the RV systolic and diastolic function in untreated hypertensive patients using two-dimensional speckle tracking analysis and correlating the findings with the morphological and functional changes of the left ventricle. Methods: This cross-sectional study involved 80 patients with mild to moderate untreated systemic hypertension and 40 healthy controls. M-mode echocardiography measurements of the right ventricular wall (RVW) diastolic thickness, tricuspid annular plane systolic excursion, left ventricular (LV) dimensions, and systolic function were performed. Pulsed Doppler echocardiography was used to measure peak early (TE) and peak atrium (TA) right ventricular diastolic filling velocities. Similar parameters of the LV diastolic filling were recorded. Tissue Doppler imaging (TDI) was done to determine the left and right myocardial annular velocities. Mean pulmonary artery pressure (MPAP) was measured noninvasively by the estimation of pulmonary artery acceleration time (AT). Apical 4-chamber images were acquired at high frame rate to extract RV peak systolic strains. Results: The current study revealed significantly thicker RVW in hypertensive group (5.3 vs. 2.8 mm in controls, P < 0.001). The RV diastolic dysfunction (RVDD) defined as tricuspid E/A ratio <0.8 was recorded in 60% of the hypertensive group. Significant positive correlation was found between tricuspid and mitral E/A ratio. Pulmonary AT was significantly reduced in hypertensive group (128.1 ± 5.4 vs. 143.6 ± 1.8 ms in healthy group, P < 0.001). Pulmonary artery systolic pressure (PASP) was significantly elevated in untreated hypertensive group 39.3 ± 7.8 mm Hg. The RV diameter was 2.2 and 2.1 cm in controls and hypertensive group (P = 0.011). Global RV systolic strain values were remarkably reduced in hypertensive group (−19.6 ± 1.4 vs. −24.1 ± 2.2% in controls, P < 0.001). Conclusions: The RV diastolic and systolic dysfunction was found in 60% and 30%, respectively, in the hypertensive group. Body mass index is a predictor of RVDD while several variables were found to be significantly (P < 0.001) associated with RV systolic dysfunction. These variables were left atrium dimensions, systolic blood pressure, and PASP. Possible causes of these structural and functional changes in the RV are translation of the increased LV filling pressure in the pulmonary circulation and interaction of the right and left ventricle.

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Background: Developing countries though faced with increasing burden of cardiovascular disease have the least contribution in articles published on cardiovascular research. There is a paucity of report on the trend of cardiovascular diseases particularly no report is available on the trend in Nigerian female patients. The aim of this study is to determine the trend of cardiovascular diseases and the gender effect. Materials and Methods: A retrospective analysis of medical admission in a public, secondary health center over a 5-year period (1997–2001) was carried out. Results: Of the 2474 patients, 37.0% with a mean age of 54.9 (14.6) years had cardiovascular diseases, 51.3% were females. Mean duration of hospital stay was 11.8 (9.1) days, range 1–90 days. This was a significant steady rise in the trend of cardiovascular disease which was higher among females (P = 0.003). Hypertension and hypertension-related complications constituted the bulk of cardiovascular diseases. Overall mortality was 155 (17%) for cardiovascular diseases although not significantly different gender wise was higher in males (86, 55.5%), P = 0.063. Conclusion: Targeted research and control of cardiovascular diseases among women may enhance the control of the menace of cardiovascular diseases.

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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.

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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.

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Introduction: Undetected hypertension and diabetes could result in cardiovascular and cerebrovascular complications and may result in fatal road accidents if they occur while driving. Commercial drivers are prone to risk factors for these diseases. This study determined the prevalence of hypertension and diabetes among commercial drivers in Ibadan metropolis, South-western Nigeria. Methodology: A cross-sectional study was conducted among 305 commercial drivers selected using multistage sampling technique from motor parks across Ibadan metropolis. The WHO stepwise interviewer-administered questionnaire was used for data collection on respondents' sociodemographic characteristics, work-related characteristics, knowledge about hypertension and diabetes, physical activity, alcohol consumption, and tobacco use. Blood pressure, anthropometry, and blood sugar level measurements were carried out. Hypertension was defined as systolic blood pressure of ≥140 mmHg and diastolic blood pressure of ≥90 mmHg and diabetes was defined as ≥126 mg/dl fasting blood sugar. Data were analyzed using descriptive statistics, Chi-square test. and logistic regression at α = 5%. Results: Mean age of respondents was 45.3 ± 10.5 years. About 47.5% and 37.8% demonstrated good knowledge about hypertension and diabetes, respectively. About 49% reported to have ever smoked, 78.0% had consumed alcohol, 45.5% ever had traffic accident, and 44.6% reported physical inactivity. The prevalence of hypertension was 27.7% and diabetes was 3.4% while 42.9% had comorbidity. Hypertension was found among 26.2% of those who had ever smoked and 47.2% of those obese (body mass index ≥30 kg/m²). Age ≥41 years (adjusted odds ratio [aOR] = 2.42, 95% confidence interval [CI] = 0.99–5.88) and abdominal obesity (aOR = 2.41, 95% CI = 0.99–5.83) were predictors of hypertension, and frequent fruit consumption was predictor of diabetes (aOR = 2.71, 95% CI = 0.23–32) although not significant. Conclusions: High prevalence of hypertension and relatively low prevalence of diabetes among commercial drivers in Ibadan metropolis call for health awareness campaign and free health screening in motor parks for early detection and prevention of the diseases.

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Background: The advent of echocardiography has tremendously improved the diagnosis of cardiovascular diseases. We present a review of cardiovascular disorders diagnosed using transthoracic echocardiography over 3 years. Materials and Methods: Echocardiographic data of patients from January 2011 to December 2013 were retrieved. All subjects had standard transthoracic echocardiography including Doppler modalities where appropriate. Descriptive statistics was used in assessing the occurrence of the different cardiac disorders. Results: One thousand three hundred and two echocardiograms were considered, out of which 1224 (94%) comprising 591 (48.3%) males and 633 (51.7%) females were analyzed. Ages ranged from 4 days to 105 years with a mode of 60 years and a mean of 39.62 ± 20.58 years. The most common indications were hypertensive heart disease (HHD) (28.2%) and congestive cardiac failure (23.4%). HHD was the most common diagnosis (25.1%) followed by cardiomyopathies (23.9%). Idiopathic dilated (29.3%) and peripartum cardiomyopathy (23.1%) were the most common cardiomyopathies. Valvular heart diseases (VHD) were diagnosed in 14.9%, with rheumatic (60.4%), and degenerative (36.4%) being dominant. Congenital heart disease was diagnosed in 7.2%, with 70.5% of the cases in those ≤14 years. Ischemic heart disease was diagnosed in 6.6%. Pericardial diseases were found in 3.2%, while cor pulmonale was documented in 0.8%. Atrial myxoma dissection of the ascending aorta, athlete's heart, and amniotic fluid embolism were each observed in <1%. A normal echocardiogram was reported in 13.3%. Conclusion: The most common echocardiographic diagnoses in our center are HHD, cardiomyopathies, and VHD. Congenital and ischemic heart diseases are also prevalent.

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Background: The high prevalence of hypertension in developing countries has stimulated a lot of research, one of which is tracking of childhood blood pressure (BP). To the authors' knowledge, the point prevalence of elevated BP among primary school children in Kano Metropolis, Kano State, Nigeria has not been documented. Objective: To determine the BP levels and the point prevalence of elevated BP among primary school children in Kano Metropolis, Nigeria. Materials and Methods: A multistage sampling technique was used to select 2000 pupils from 66 primary schools in Kano aged 6–14 years. Data were collected using a standardized pretested questionnaires completed by the parents/guardians. BP was measured with a mercury sphygmomanometer. Average of three readings was recorded for each pupil as his/her BP. Weight and height were also recorded using standard techniques. Elevated BP was defined using the criteria by the 4^th task force, according to age, gender, and height. Results: A total of 2000 pupils were studied with 1058 females and 942 boys with a ratio of 1.1:1. The mean systolic blood pressures (SBP) among males and females were 93.17 ± 8.70 and 94.28 ± 9.06 mm Hg while the mean diastolic blood pressures (DBP) were 59.1 ± 6.9 and 60.3 ± 6.9 mm Hg, respectively. Overall, there was a significant positive correlation between SBP (r = 0.44) and DBP (r = 0.38) with body mass index (BMI). Using criteria by the 4^th report, 3% of pupils had elevated BP in this study. Conclusion: There is a positive correlation between SBP/DBP and BMI, the overall prevalence rate of elevated BP among the study population was 3%.

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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.

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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.

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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).

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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.

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Background: Every congenital structural defect in the body represents an inborn error in morphogenesis and may affect one or more systems and Orofacial clefts are one of the commonest birth defects. Objective: Cleft lips and/or palate are frequently associated with other congenital anomalies including cardiovascular. Methods: All pediatric orofacial cleft patients presenting for free treatment during a surgical outreach at the University of Port Harcourt Teaching Hospital were examined by the pediatric cardiologist, pedodontist, oral and maxillofacial surgeon, and anesthetist. Results: Of the 20 patients studied, three (15%) had congenital heart disease (CHD), 1 (5%) had skeletal anomaly and one of the children with CHD had an ileo-vaginal hernia (digestive and urogenital system anomaly). Conclusions: The most common associated congenital abnormality was CHD in 15% of children.

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Background: Proper interpretation of electrocardiogram (ECG) in children relies on comparisons with standards derived from normal population. Comprehensive data on ECG in Nigerian children are lacking. Objective: To determine the ECG reference values for Nigerian Children. Subjects and Methods: A cross-sectional study was conducted on 1500 apparently healthy Nigerian children between 0-12 years at Ilorin. The ECG was recorded at a sampling rate of 1000Hz with V ₃ R replacing V ₃ and the ECG parameters were measured by hand. Results: The means and standard deviations of the lead independent ECG indices are as follows: Heart rate, 117 ± 23; QRS duration 0.05 ± 0.01 PR Interval 0.13 ± 0.02, QRS axis 63.80 ± 37.6, P wave axis 46.6 ± 18.4, T wave axis 44.5 ± 18.5, P wave duration 0.07 ± 0.01, P wave amplitude 1.4 ± 0.48. These values are similar to those of the Caucasian children. The mean amplitude values of Q, R, S and T waves are also similar to the Caucasian Children. The 98 ^th percentile values in some of these leads are substantially higher than that of the Caucasian children. This calls for caution when interpreting ECG in Nigerian children. Conclusion: ECG normal limits have been established in Nigerian children at Ilorin. Similar studies should be conducted in other geo-political zones in Nigeria so that ECG reference values for Nigerian children could be established.

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Background: Heart diseases of childhood are of public health importance, especially in developing countries. Community-based studies are important in ascertaining the burden of disease. We set out to clinically evaluate the prevalence of heart disease among primary school children in Hwolshe electoral Ward, Jos, Plateau State. Subjects and Methods: A total of 418 primary school pupils were selected by multistage sampling from three schools in Hwolshe ward of Jos South Local Government Area, Plateau State. They were studied for the prevalence of heart disease using clinical examination, followed by chest radiography, electrocardiography and echocardiography (echo) in those with clinical signs of heart disease. Results: The 418 subjects were aged 6-12 (mean 9.0 ± 1.95) years. 252 (55.5%) were girls. Significant tachycardia and pulse irregularity were present in 1 (0.24%) and 3 (0.72%) children respectively. None had hypertension - according to the seventh Joint National Committee criteria. 4 (0.96%) had audible murmurs of which 3 (0.72%) were pathologic. These three subjects were subsequently confirmed by echo to have congenital heart disease (CHD) - two ventricular septal defects and one atrial septal defect. The heart disease prevalence was therefore, 0.72%. All three identified cases of CHD had associated cardiac dysrhythmias: Wandering atrial pacemaker, first degree heart block, and incomplete right bundle branch block, respectively. No case of rheumatic heart disease was identified. Conclusions: Prevalence of heart disease by clinical screening in Jos South school children is approximately 0.72%. Careful cardiac auscultation as part of compulsory health screening at primary school entry and exit will help detect asymptomatic children with heart disease and facilitate treatment before the onset of complications.

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Background: Rheumatic heart disease (RHD) is a major public health problem in resource-poor countries. According to the World Health Organization (WHO), rheumatic fever (RF)/RHD affects about 15.6 million people worldwide, with 282,000 new cases and 233,000 deaths each year. There are about 2 million people with RHD requiring repeated hospitalization and 1 million likely to require surgery globally. Objective: The objective of the study is to explore the pattern of RHD in Abeokuta where such a study has not been reported in the past. Materials and Methods: This is an analysis of a prospectively collected data over a period of 5 years (Jan 2006-Dec 2010). We collected information on the bio-data, clinical features and echocardiographic diagnoses. Results: During this period, a total of 107 cases of RHD were seen, 66 females (61.7%) and 41 males (38.3%) aged 43.9 ± 19.3 years (range, 7 to 92 years). Mitral regurgitation was the most common lesion (63.6%). Other common lesions include pure mitral stenosis (14.0%), mixed mitral valve disease (6.5%), and mixed mitral and aortic regurgitation (5.6%). Complications of RHD observed included secondary pulmonary hypertension, valvular cardiomyopathy, atrial fibrillation, stroke and infective endocarditis. Conclusions: Our data show that RHD is an important cause of heart disease in this city although the prevalence is lower than studies done in southern Nigeria in the 60s and 70s. Most present with complications and many do not have access to surgical therapy. There is, therefore, a need for improved surveillance and control of the disease at the community level.

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Background: The burden of noncommunicable diseases (NCDs) is increasing in developing countries largely due to epidemiological transition. In this study, data of individuals who were seen in specialist medical clinics and wards in a hospital located in a fast-growing urban area were analyzed to identify the pattern of NCDs among the attendees. Materials and Methods: A retrospective study of available registers and electronic medical records of adult patients with diagnoses of medical disorders seen between January 2006 and January 2016 at the specialist medical outpatient clinics and medical, emergency, and intensive care wards of Federal Medical Centre, Keffi, Nasarawa State, Nigeria, was carried out between January 2015 and January 2016. Medical records of 682 individuals were reviewed, and their data were extracted and analyzed. Results: Females (59.1%) and people in the middle-age group (44.6%) constituted majority of adult participants who were seen in the facility for medical diseases. The prevalence of NCDs was 64.4%, with cardiovascular disease (CVD) being the most common (37.7%). Hypertension was the most prevalent CVD (70%). Conclusion: NCDs were the predominant diseases seen at the specialist clinics and medical wards in the study. CVDs were the most prevalent NCDs followed by endocrine diseases.

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Background: Rheumatic heart disease is the leading cause of acquired valvular heart disease in low- and middle-income countries and sometimes requires mechanical valve replacement. Postsurgical management of these patients is vital and includes lifelong anticoagulation with close monitoring. This study aims to report our experience with anticoagulation monitoring of patients with mechanical heart valves using a handheld portable device. Patients and Methods: This retrospective review involved 12 patients that were enrolled in the anticoagulation clinic (AC) of a local nongovernmental organization, at different times between 2003 and 2012. Patients' sociodemographic variables, international normalized ratio (INR) assay results, and clinical status were routinely entered into a register and were retrieved for the present review. Results: The 12 patients comprised three males and nine females and were resident between 3.7 and 300 km from the AC. Their age ranged from 7 to 26 years (mean 14.1 ± 3.3 years, median 13 years) at the time of enrollment into the AC. Seven hundred and ninety-four INR assays were done during the period under review (mean 12.2 ± 5.4 INR assays per patient per year). Of the 794 assays, 38.5% were within target (INR levels between 2.5 and 3.5 or between 2.0 and 3.0 for patients with mechanical valves at the mitral and aortic positions, respectively) 35.7% were below the target range, and 25.7% were above the target range. Conclusion: Our experience with point-of-care INR testing in a clinic setting suggests that adopting this approach could improve the quality of anticoagulation monitoring by increasing patients' access to the device, the frequency of assays per patient, and, ultimately, the number of within-target INR assays.

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Arrow-related injuries are rare in most developed countries and may occasionally occur as sports-related injuries; however, this is still a problem in most crisis-prone areas in Nigeria. Though arrow-related injuries are classified as low velocity injuries, they may cause enormous damage to vital structures as in the case of a penetrating arrow-related cardiac injury in a Fulani boy; though he presented late and it took almost 48-hours before surgical intervention, he was successfully managed and discharged home without any complication.

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Background: Diabetes mellitus is a syndrome with multiple aetiology characterized by chronic hyperglycaemia consequent on defects of insulin secretion, insulin action or both. Long term complications of chronic hyperglycaemia arise from underlying microvascular and macrovascular diseases. Objective: Diabetes mellitus is a major independent risk factor for cardiovascular diseases with diabetic subjects known to be at increased risk of cardiovascular diseases when compared with non-diabetic counterparts. Haemorheological parameters were thus evaluated in type 2 diabetics as possible risk factors for cardiovascular diseases. Method: One hundred patients with type 2 diabetes mellitus (78 normotensive, 22 hypertensives) were evaluated along with fifty apparently healthy age matched non-diabetic people serving as controls. Fasting blood glucose (FBG), Fibrinogen level (Fib), platelet count (PC), packed cell volume (PCV), plasma viscosity (PV), whole blood viscosity (WBV), white blood cells (WBC), and erythrocyte sedimentation rate (ESR) were determined using conventional methods. Results: FBG, ESR and Fib were significantly higher in the hypertensive diabetics (126.9±22.3mg/dl, 37.15±22.01mm/hr, and 3.75±1.09g respectively) compared with healthy non-diabetic controls, (83.9±11.5mg/dl, 8.50±4.75mmhr and 2.09±0.286g respectively (P<0.05). There were no significant differences in other measured parameters of normotensive and hypertensive diabetics though plasma viscosity (PV), showed slight but non-significant increase in diabetics with hypertension when compared with non-diabetic controls. Conclusion: We conclude that elevated blood glucose level results in increased level of fibrinogen and ESR in hypertensive T2DM with possible increased risk of other cardiovascular diseases.

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Background: Echocardiography is an important non-invasive cardiac procedure which has revolutionalized the practice of cardiology globally. The procedure commenced at the Federal Medical Centre, Umuahia, Nigeria on 19 ^th November 2012. Objective: The aim of this report is to present our initial experience with the procedure in our center. Materials and Methods: This is essentially a descriptive study. Data was prospectively obtained on demographic parameters, indications for the procedure and the main echocardiographic diagnoses. The procedure was performed using Vivid I echocardiograph (Vivid, General Electric Inc. USA) equipped with 2.5-5.0 MHz transducer. Results: Three hundred and nine procedures were carried out between November 19, 2012 and September 20, 2013. There were 163 males and 146 females who were aged 53.9 ± 23.0 and 46.0 ± 23.0 respectively. The mean age for all the subjects was 51.5 ± 22.0 years. Hypertensive heart disease and congestive cardiac failure comprised 28.7% and 26.3% respectively of the indications for the procedure. The various diagnoses made include: Hypertensive heart disease 121 (39.2%), valvular heart disease 30 (9.7%), pericardial disease 24 (7.8%), cor-pulmonale17 (5.5%), cardiomyopathy 14 (4.5%), congenital heart disease no (3.2%), ischaemic heart disease no (1.0%) and aortic aneurysm no (0.3%). Normal echo was recorded in 89 (28.8). Conclusion: Hypertensive heart disease was the most common diagnoses in our study. Other diagnoses include valvular heart disease, pericardial disease, corpulmonale and cardiomyopathies. Ischaemic heart disease was uncommon.

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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.

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Background: Heart disease in pregnancy is a potentially serious medical complication in pregnancy. Limited studies have been conducted in India to assess heart disease in pregnancy. Objective: To determine the type of cardiac lesions and to assess the maternal and fetal outcomes in patients with heart disease in pregnancy. Materials and Methods: In this retrospective study, 42 pregnant women with known or newly diagnosed heart disease were followed from January 2012 to December 2013. The data analysis was done using statistical software Systat 12. Results: Out of total 42 subjects selected for the study, maximum 13 (30.9%) were in the age group of 26-30 years. Majority of the women 30 (71.4%) were primigravida. Mostly 26 (61.9%) patients belonged to New York Heart Association (NYHA) class I andII. In total, 30 (71.4%) women presented with rheumatic heart disease and 6 (14.3%), with congenital heart disease. Majority 22 (52.4%) had spontaneous vaginal deliveryand only 8 (19.0%) required induction of labor. Most common maternal complication was heart failure (16.7%) and maternal deaths were 4.8%. The live birth was recorded in 38 cases (90.5%) of them 16 (42.1%) were preterm babies. Intrauterine death occurred in four cases while five babies died in neonatal period. Conclusion: The study results conclude that the rheumatic heart disease is still a predominant lesion and heart disease in pregnancy is associated with increased maternal and fetal risk.

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