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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Coronary artery aneurysms are seen in 1.5-5% of patients presenting for coronary angiography, but giant aneurysms, defined as being greater than 2 cm in diameter, are rare. Clinical presentation, prognosis and management of giant coronary artery aneurysm are not well defined due to limited experience, so each case is a learning tool in itself. We report the rare case of a 56-year-old female patient who presented to us with effort angina and was subsequently found to have a giant right coronary artery aneurysm with a fistulous communication to right atrium. This case describes one of the varied presentations of an ill defined and heterogeneous disease process.

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Background and Aims: Androgen deprivation has been shown to be associated with dyslipidemia. Ameliorative effect of Vitamin C on dyslipidemia has also been reported. This study aimed at investigating the role of Vitamin C supplementation in castration-induced dyslipidemia. Materials and Methods: Twenty male rats were randomly divided in a blinded fashion into 4 groups (n = 5 each): Groups I and II were sham-castrated and received normal saline (1 ml/kg) and 1.25 g/kg Vitamin C, respectively, whereas Groups III and IV were rendered bilaterally castrated and received normal saline (1 ml/kg) and 1.25 g/kg Vitamin C for 4 weeks. Results and Conclusions: Castrated rats had reduced high-density lipoprotein, testosterone, estradiol, but increased low density lipoprotein, triglycerides, total cholesterol, and Castelli index and had no effect on follicle stimulating hormone when compared to sham-operated rats. Vitamin C supplements improved these parameters in normal and castrated rats. This study showed that castration-associated dyslipidemia and atherogenic risk in male rats is dependent on testosterone and estradiol. In addition, Vitamin C improves these parameters in normal and castrated rats by increasing testosterone and estradiol production, possibly from extra-testicular sites. However, there is a need for further study to ascertain the actual extra-testicular testosterone and estradiol production site.

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Background: Structural heart defects constitute one of the commonest reasons for Paediatric Cardiology consultations. The availability of echocardiography has obviated the need for invasive procedures in providing an accurate diagnosis and description in such children. Objective: To describe the pattern of congenital and acquired heart diseases seen in children referred to the Paediatric Cardiology Clinic of the University College Hospital, Ibadan Methods: Consecutive cases referred to the Paediatric Cardiology Clinic over a twelve-month period were evaluated by clinical examination, chest x-ray, electrocardiography and echocardiography. Data were analysed using SPSS for Windows software, version 20.0. Frequency distributions were generated and the Wilcoxon signed rank test was used to test the association between the age at onset of symptoms and the age at presentation. Level of significance was set at P < 0.05 Results: Two hundred and forty children underwent echocardiography; 80.4% were aged 5 years and below. Structural heart defects were encountered in 210 (87.5%) children. Congenital defects comprised 80% of the cases, the commonest being VSD, occurring either singly (24.1%) or in combination with other defects in 18.7%. The commonest cyanotic lesion, Fallot's Tetralogy (9.2%) occurred more commonly than other isolated acyanotic lesions. Acquired heart disease accounted for 7.5% of cases, dilated cardiomyopathy, rheumatic heart disease, and pericardial effusion (occurring in 2.9%, 2.5% and 2.1% respectively). The median age at presentation (13 months) was significantly higher than that at onset of symptoms (11 months) (P = <0.001). Conclusions: Ventricular septal defect remains the commonest structural defect seen in our centre. Fallot's Tetralogy however is more common than isolated patent ductus arteriosus or atrial septal defect. Dilated cardiomyopathy and RHD are equally common.

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Background: Sex verification using electrocardiogram (ECG) is a new application of the biological signal. Objective: This study aimed to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of an electrocardiographic score in sex verification. Methods: A total of 2442 apparently healthy fresh undergraduates who presented for health screening in a tertiary institution were recruited for the study. The technical team documented the sex of the participants and had their resting 12-lead ECG recorded according to standard protocol. Two physicians who were blinded to the participants and the recorded sex utilized Ogunlade Sex Determination Electrocardiographic Score (OSDES) to determine the sex. The validity of OSDES was estimated using sex recorded by the technical team as the standard while the accuracy of scoring system was determined using receiver operating characteristic curve. Results: The mean (± standard deviation) of age of the participants was 20.71 ± 3.62 years. Among the male population, true positives (TPs), false positives (FPs), false negatives (FNs), and true negatives (TN) were 1131, 49, 90, and 1172, respectively. Among the females TP, FP, FN, and TN were 1172, 90, 49, and 1131, respectively. Among males, the sensitivity, specificity, PPV, and NPV were 92.63% (95% confidence interval [CI]: 91.02-94.03%), 95.99% (95% CI: 94.73-97.02%), 95.85% (95% CI: 94.55-96.91%), and 92.87% (CI: 91.31-94.23%) respectively while among the females, the sensitivity, specificity, PPV, and NPV were 95.99% (95% CI: 94.73-97.02%), 92.63% (95% CI: 91.02-94.03%), 92.87% (95% CI: 91.31-94.23%), and 95.85% (95% CI: 91.02-94.03%) respectively. The area under curve was 0.943. Conclusion: This study concluded that ECG has a reasonable level of sensitivity and specificity with excellent accuracy in verification of sex among fresh Nigerian undergraduates.

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Background: Transcatheter closure of coronary artery fistula has emerged as an alternative to surgery. The management of coronary artery fistula is complicated, and recommendations have been based on anecdotal cases or very small retrospective series. Objective: The objective of this study is to determine the safety, feasibility, and immediate and intermediate follow-up results of the transcatheter closure of coronary arterial fistula. Methods: We reviewed the records of all patients presenting with significant coronary arterial fistulae between January 2011 and May 2014. Those with additional complex cardiac disease requiring surgical management were excluded from the study. A total of nine patients aged 11 months to 58 years with congenital coronary arterial fistulae underwent percutaneous transcatheter closure using various devices between January 2011 and March 2014. The immediate closure results and clinical follow-up were reviewed using information from a database or telephone calls to the center. Results: Fistulae originated from the right coronary artery in 4 patients (44.4%), left circumflex coronary artery in 3 patients (33.3%), and left anterior descending coronary artery in 2 patients (22.2%). The drainage site was the right atrium in 5 patients (55.6%), right ventricle in 2 patients (22.2%), left ventricle in 1 patient (11.1%), and coronary sinus in 1 patient (11.1%). All of the patients (100%) underwent successful transcatheter closure using the various devices. Angiography after device deployment revealed complete occlusion in 7 patients (77.7%) and trivial to mild residual flow in 2 patients (22.2%). Two patients (22.2%) had transient ST-T wave changes after the procedure. The Amplatzer Vascular Plug II was used in four patients (44.4%), Amplatzer Duct Occluder II was used in three patients (33.3%), and Lifetech Duct Occluder was used in two patients (22.2%). The left ventricular end-diastolic volume decreased from a mean baseline value of 82.77 ± 4.55 ml/m ² to 77.22 ± 3.49 ml/m ² at 1 month after the procedure (P = 0.001) and had normalized in all of the patients at 2 months postprocedure. The cardiothoracic ratio decreased from a mean baseline value of 0.57 ± 0.035 to 0.53 ± 0.02 at the 1-month follow-up and further decreased to 0.50 ± 0.007 at 2 months (P < 0.001). Follow-up was 100% complete and ranged from 2 months to 3 years (mean = 1.44 ± 0.79 years). There were no early or late deaths. All of the patients were asymptomatic at 1 month postclosure, except one patient (11%) who had a mild residual shunt until 3 months of follow-up and dyspnea on exertion that was medically managed. One patient (11%) had an associated ostium secundum atrial septal defect that was percutaneously closed. Conclusion: Transcatheter closure of coronary arterial fistula is feasible and safe in anatomically suitable vessels and is a promising alternative to surgery in most patients.

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Background: Several studies have reported the burden of smoking and associated risk factors. However, only a few studies have explored the prevalence, pattern of exposure, and risk factors associated with exposure to secondhand smoke (SHS) in Sub-Saharan Africa and particularly Nigeria. Objective: This study was, therefore, aimed at ascertaining the prevalence and risk factors of exposure to SHS in Abia State, Nigeria. Methods: Data of 2787 respondents selected using multi-staged cluster sampling technique were analyzed. Prevalence of exposure to SHS at home and public places was calculated for each sociodemographic and economic group. Results: Exposure to tobacco smoke was more common in respondents who were young, males, unmarried or used alcohol. Females were less frequently and intensely exposed to SHS both at home and public places than males. Predictors of SHS at home were gender, odds ratio (OR) =1.85 (95% confidence interval [CI] 1.20-2.83) and use of alcohol OR = 2.06 (95% CI 1.04-4.09); and in public places were age OR = 1.55 (95% CI 1.10-2.20), gender OR = 2.73 (95% CI 1.96-3.81), and use of alcohol OR = 2.55 (95% CI 1.51-4.28). Conclusions: The findings of study provide basis for designing tobacco control interventions to address exposure to SHS at home and public places.

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The second natural history of a congenital bicuspid aortic valve with the early symptomatic presentation is eventful. The spectrum takes it start from intrauterine life. The cumulative history may include valvotomy by balloon or surgery, valve replace replacement, stuck valve, thromboembolic complications, thrombolysis, anticoagulation-related bleeding diathesis, redo of replacement, and transcathetor aortic valve implantation. In addition, a retained foreign body granuloma in such cases further lengthens the story. We report a 48-year-old male with congenitally single kidney who underwent redo aortic valve replacement (AVR) and resection textiloma after 15 years of AVR. The eventful second natural history included surgical valvotomy in pre-balloon valvotomy era, AVR, thrombolysis for stuck valve for six times, thromboembolic episode, redo AVR, and excision of paracardiac textiloma.

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Classical triatriatum sinistrum or cor triatriatum sinistrum is a rare congenital heart disorder arising from the left atrium being divided into two chambers and may present with undistinguishing features such as exertional dyspnea, hemoptysis, and orthopnea. It has been scarcely reported among adult Nigerians. The case being reported presented at an unusual age of 30 years. Most cases previously reported were in children. Definitive treatment is a corrective surgery with an excellent outcome. Nonintervention could have a catastrophic outcome. Therefore, there must be a high index of clinical suspicion and early diagnosis. This report is to increase awareness of such condition.

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Isolated left ventricular noncompaction (ILVNC) is a form of cardiomyopathy caused by the intrauterine failure of the myocardium to compact (endomyocardial morphogenesis) resulting in multiple trabeculations of the left ventricular myocardium and deep intertrabecular recesses and thickened myocardium. The condition is relatively uncommon and is often complicated by heart failure, malignant arrhythmias, and thromboembolism. There have been a few reports of this condition from some parts of Africa (Djibouti, Sudan, and South Africa). To the best of our knowledge, there has not been previous report from Nigeria. The purpose of this paper is to report a case of ILVNC from Ibadan, Nigeria.

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A 70-year-old amputee, who was a known case of diabetes, hypertensive, and smoker presented with disabling ischemic symptoms and signs of gangrene in the stump of the left lower leg. He had undergone above knee amputation 2 months back for the gangrene of left foot with an  ankle-brachial index (ABI) of 3. Computed tomography of infrarenal aorta and both the lower limbs arteries revealed total occlusion of common iliac artery, external iliac, and common femoral artery in the amputated leg. The occluded arterial segment was successfully opened percutaneously from left brachial approach. The message of this illustration is never ignore the exact extent of peripheral disease before amputation.

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Ectopia cordis is a rare congenital abnormality characterized by partial or complete displacement of the heart outside the thoracic cavity. It can be associated with other congenital abnormalities. The present case is the prenatal ultrasonographic diagnosis of ectopia cordis with sternal cleft, gastroschisis, fetal ascites, and bilateral pleural effusion illustrated in a 34 weeks gestation fetus and correlated with postnatal findings.

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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.

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Aim: A major concern with epirubicin-based neoadjuvant chemotherapy, a mainstay of neoadjuvant treatment for breast cancer in Nigeria, is their association with cardiotoxicity. We investigated for possible changes in the level of cardiac markers, troponin T, and N-terminal pro-brain natriuretic peptide (NT-ProBNP) detectable after least three cycles of epirubicin in the neoadjuvant setting. Methods: Thirty consenting female patients who had received at least three cycles of epirubicin-based neoadjuvant chemotherapy were recruited from the Surgical Oncology Unit of the University College Hospital. Patients who were eligible for neoadjuvant chemotherapy for breast cancer but who had not commenced the same were recruited to serve as controls. Samples for troponin T and NT-ProBNP were collected on the day of commencement of the next cycle, before the administration of the dose. Results: The mean troponin T and median NT-ProBNP values were significantly higher among the women on epirubicin-based chemotherapy (0.76 ng/ml vs. 0.68 ng/ml, P = 0.047 and 114.5 pg/ml vs. 103 pg/ml, P = 0.007), respectively. Values of NT-ProBNP exceeding 200 pg/ml were significantly more frequently observed in the same group (40% vs. 16.7%, P = 0.01). A significant relationship between the number of cycles received and level of NT-ProBNP was observed (P = 0.015). A similar relationship was not observed with troponin T. Conclusion: Epirubicin-based chemotherapy may be associated with increased elaboration of the cardiac markers, NT-ProBNP, and troponin T early during neoadjuvant chemotherapy. The potential clinical utility of these markers in predicting cardiotoxicity needs to be further evaluated in prospective studies.

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