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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.

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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.

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Background: The emergency room is most often the gateway to many hospitals and health facilities. The spectrum of medical disease (including cardiac disease) in this department is often a reflection of the pattern of diseases in the immediate environment. Objective: The aim of this study therefore is to describe the spectrum of cardiac diseases presenting at the emergency room of Federal Medical Centre, Abeokuta, Ogun State, Nigeria. Methods: This was a retrospective analysis of a prospectively acquired data over a period of 24 months (January 2006 to December 2007) and was conducted at the Emergency Department of the Federal Medical Centre, Abeokuta, Nigeria. All cardiac cases presenting to the centre during the period of the study were consecutively captured using structured and uniform case report form. Data collected include the patient's bio data, data of admission as well as clinical diagnosis. Disease classifications were based on International Classification of Disease-10. Results: A total of 414 patients classified as cardiac presented to the medical emergency room between January 2006 and December 2007. This constituted 17.4% of all medical cases seen at this department during this period. There were 208 men (50.2%) and 206 women (49.8%). The mean age of all the subjects was 54.7±14.6 (range 15-90 years). Majority of the patients (48.5%) were between the ages of 40 years and 59 years. The most common reasons for cardiac related admissions include severe hypertension, acute heart failure or acute left ventricular heart failure. Conclusions: Cardiac related admissions in the emergency room in Abeokuta are related to hypertension and its complication-heart failure. Prevention as well as management of cardiac diseases should be tailored to hypertension and its associated risk factors. Facilities for management of hypertension and heart failure should be provided in our emergency room.

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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: Diastolic dysfunction can occur either as an early marker or in late stages of hypertensive heart disease. Knowledge about its determinants is crucial to its management. Reports about clinical and echocardiographic determinants of diastolic dysfunction among Nigerian hypertensive subjects are few. This study aimed at describing the main clinical and echocardiographic determinants of diastolic dysfunction among Nigerian hypertensive subjects. Methods: Two hundred and forty-five hypertensive subjects and 68 age and sex-matched normotensives that had echocardiography were used for this study. Diastolic function was assessed by a combination using the ratio of early and late mitral flow velocity E/A ratio, isovolumic relaxation time (IVRT) and deceleration time (DT). Statistical analysis was carried out with the SPSS 16.0. Correlation and stepwise regression analysis were used for univariate and multivariate analysis respectively. Results: Mean age of the hypertensive subjects was similar with that of the controls (56.8±12.2 vs. 55.0±7.9 respectively, P>0.05). Diastolic dysfunction was commoner among hypertensive subjects than controls. Age, systolic and diastolic blood pressure (BP), and left ventricular chamber dimensions generally showed the greatest correlation with indices of diastolic function among the study population. Using the multivariate analysis, age was the strongest determinant of DT and IVRT followed by left ventricular chamber dimension for DT and systolic BP for IVRT. Left ventricular internal chamber dimension was the strongest determinant of mitral E/A ratio followed by diastolic BP. Conclusion: Age, systolic BP, and left ventricular volume and dimension are the major determinants of the diastolic dysfunction among hypertensive Nigerians. They affect different aspect of the diastolic parameters.

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Background: High blood pressure (HBP) is a leading cause of end-stage renal disease (ESRD) in black African populations and it is frequently associated with autosomal polycystic kidney disease (ADPKD). We assessed the impact of HBP on progression of renal disease in black Africans with ADPKD. Objectives and Methods: We performed a retrospective study between 1995 and 2010 in nephrology out-patient clinic. ADPKD was diagnosed according to recent unified criteria add reference and seventh Joint National Committee classification was used for HBP definition. Statistical analyzes were performed with Stata 12 (Statacorp LP, TX, USA). Results: We included 71 patients (39 males and 32 females) with a mean age of 47±5 years. Prevalence of hypertension was 71.8% and it was present at diagnosis of ADPKD in 48 patients (67.6%). Median delay between HBP and ADPKD diagnosis was 25.6 months. Mean systolic/diastolic blood pressure was 168±30/96±16 mm Hg. After median follow-up of 1823 days, adjusted incidence rate of ESRD in hypertensive and normotensive patients was respectively 0.05 events/100,000 patient-years and 0.03 events/100,000 patient-years (P=0.02). Anti-hypertensive therapy included angiotensin-converting-enzyme (ACE) inhibitors in 51% of patients, but less than 1/3 normalized their blood pressure. At univariate analysis, ESRD was correlated with age, gender, body mass index, HBP and proteinuria. Multiple logistic regression analysis identified age (odds ratio (OR)=1.14; P=0.06) and HBP (OR=1.67; P=0.02) as associated with ESRD. Conclusion: Hypertension with organ damage is frequent in black African patients with ADPKD. Age and HBP at diagnosis were the main factors associated with ESRD.

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Background: The left ventricle assumes different geometric patterns in hypertension. The effect of gender on cardiac remodeling in hypertension is not established as previous studies have reported conflicting results. Objective: This study therefore seeks to determine the effect of gender on left ventricular geometric adaptation in hypertension. Methods: This study was performed in the cardiac clinic of the University of Benin Teaching Hospital, Benin City, Edo State and it is a cross-sectional study. Echocardiography was carried out for 247 hypertensive subjects to determine their left ventricular geometry. Of these, 127 were females while 120 were males. The distribution of the left ventricular geometric patterns was then determined in each gender group. Statistical Analysis: Continuous variables were expressed as means. Independent t-test was used to compare two groups while one-way analysis of variance (ANOVA) when more than two groups. Duncan multiple range test was then used to locate the source of difference. Categorical variables were expressed as percentages and the significance determined using the Chi-squared test. A P value of <0.05 was considered statistically significant. Results: In women, the distribution of the geometric patterns were as follows eccentric hypertrophy (EH) 31.5%, normal geometry (NG) 18.9%, concentric remodeling (CR) 22%, and concentric hypertrophy (CH) 27.6%. The distribution in men was NG 25.8%, CR 16.7%, CH 33.3% and EH 24.2%. There was no significant association between gender and left ventricular geometry (P value=0.249). Conclusions: Gender has no effect on left ventricular geometric adaptation in hypertension.

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