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   2013| July-December  | Volume 10 | Issue 2  
    Online since February 13, 2014

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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
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.
  6,280 652 13
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
  3,130 3,753 -
Catamenial pneumothorax: A scourge not to be ignored
Kelechi E Okonta, Gerry C Nkwocha, Goddy Bassey
July-December 2013, 10(2):47-50
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.
  4,118 1,842 1
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
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).
  5,481 425 4
Abstract proceedings of the 42 nd Annual General Meeting

July-December 2013, 10(2):88-100
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The clinical, radiographic, and electrocardiographic correlates of childhood pericardial effusion diagnosed with echocardiography
Wilson E Sadoh, Stanley U Okugbo, Isoken A Isah
July-December 2013, 10(2):51-56
Background: Pericardial effusion (PE) is best detected with echocardiography. In settings where echocardiography is unavailable, other methods are relied on to diagnose PE. Objective: To evaluate the clinical, radiologic, and electrocardiographic (ECG) correlates of PE in children with echocardiographically detected PE. Methods: Children referred for echocardiography over a 4 year period at the University of Benin Teaching Hospital, were recruited if they also had PE. The clinical features, chest radiographic, and ECG findings were correlated with echocardiographically determined PE size using Spearman's correlation test. Statistical Package for Social Sciences (SPSS) 16 was used in the analysis of data. Results: Of the 1,023 echocardiograms, 54 (5.2%) had PE. The mean age was 66.4 ± 53.4 months with 27 (50.0%) being males. PE was incidentally detected echocardiographically in 48 (88.89%) children. PE was mild, moderate, and severe in 12 (22.2%), 25 (46.3%), and 17 (31.5%), respectively. Of the 40 (74.1%) children managed in our center, 32 (80.0%) had heart failure. Four (10.0%) and six (15.0%) children, respectively had clinical tamponade and distant heart sound. Of the 15 cases with globular heart silhouette on chest radiograph, 12 (80%) had severe PE. Low voltage on ECG was seen in six (15.0%) children, who all had severe PE. Cases with distant heart sound, cardiomegaly on chest radiograph, and low voltages on ECG were significantly positively correlated with more severe PE, ρ, and (P-values), respectively were 0.49 (<0.0001), 0.54 (<0.0001), and 0.40 (0.005). There were five deaths of which two had shock from tamponade. Conclusion: Childhood PE is commonly caused by diseases causing heart failure. Clinical evaluation, ECG, and radiographic findings are not sensitive in identifying mild and moderate PE, while mortality is high in cases of tamponade.
  4,212 361 -
Heart-hand syndrome in an African child
Aliyu Ibrahim
July-December 2013, 10(2):81-84
Heart-hand syndrome is a heterogeneous group of congenital malformation characterized by congenital heart defects and limb malformations. The upper and/or the lower limbs may be affected in the same individual, however the severity often differs even in the same kindred. The commonest form is the Holt-Oram syndrome in which the carpal bones are usually affected; but the case of a 3-year-old boy who had umbilical hernia, ventricular septal defect and pulmonary arterial hypertension with a preaxial polydactyly as the only upper limb defect is reported.
  4,291 226 -
A study of hemorrhological parameters as risk factors for cardiovascular diseases in Nigerian type 2 diabetes mellitus patients
Olatunde Odusan, Hussean T Raimi, Oluranti B Familoni, O Olayemi, Jacob O Adenuga
July-December 2013, 10(2):72-76
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.
  3,674 297 2
Nail in the heart of a 4-year-old Nigerian girl
Ibrahim Aliyu, Ismail M Inuwa
July-December 2013, 10(2):85-87
Children are very active and explorational, some of the plays they engage in occasionally put them in harm's way. Common problems often encountered especially in those less than 3 years are cases of foreign body aspiration and ingestion. However, we report a case of traumatic chest penetrating nail injury with penetration of the right ventricle in a 4-year-old Nigerian girl; who was fortunate to have survived following successfully surgical extraction of the nail.
  3,380 228 -
Assessment of left ventricular ejection fraction in patients undergoing cardiac rehabilitation following acute myocardial infarction
Samuel S Singh, Candy Sodhi, Joydeep Singh, John Pramod
July-December 2013, 10(2):57-61
Background: Cardiovascular disorders are the leading cause of mortality and morbidity in the industrialized world and are becoming an increasingly important problem in the developing countries including India. The left ventricular ejection fraction (LVEF) serves as a good assessment tool to document beneficial effects of cardiac rehabilitation (CR) program in cardiac patients. Objective: The aim of this study was to evaluate the effect of short-term CR program on LVEF in patients with myocardial infarction (MI). Methods: This study was conducted on 100 patients of less than 75 years of age with acute uncomplicated anterior wall or anterolateral wall MI. Cases were randomized into two groups of age and sex matched 50 patients each. Group I (study group) patients were administered secondary prevention advice and were started on the CR exercise protocol, Group II (control group) patients were administered secondary prevention advice only. Results: At baseline, LVEF was 42.5% in the study group and 41.4% in the control group patients and was statistically comparable. After 10 weeks study group showed the LVEF of 47.78% and control group had LVEF of 42.26%. The differences are being statistically significant. Conclusion: Significant improvement in LVEF in in patients who had been engaged in CR program besides the secondary prevention strategies when compared with the control group patients who followed secondary prevention strategies only. The present study is amplify the beneficial effects of simple CR program, which additionally improves the key cardiac parameters like LVEF in the recovery period.
  3,306 241 -
Caval division technique and venous drainage after surgery for sinus venosus atrial septal defect
Kelechi E Okonta, Vijay Agarwal
July-December 2013, 10(2):68-71
Bacgrounnd: The main reason for the adoption of the caval division technique is primarily to avoid sinus node dysfunction post-operatively. Equally, this technique also has the advantage of reduced complication of venous obstruction either across the superior vena cava right atrial (SVC-RA) appendage junction and/or pulmonary veins area. Objectives: To assess the impact of Caval Division Technique on venous drainage after surgery. Methods: The medical records for 38 consecutive patients who had a sinus venous atrial septal defect repair using the caval division technique from September 2009 to October 2011 were retrospectively reviewed and grouped into two: A total of 33 patients with normal intraoperative pressure across the anastomotic and venous areas (Group 1) and 5 patients with increased intraoperative venous pressure gradient across these areas (Group 2) with 1 patient in Group 2 having immediate surgical intervention. Results: The pressure across the cavoatrial anastomotic sites in 2 patients was 8 mmHg, in 2 patients was 6 mmHg and in 1 patient was 11 mmHg as indicated by the intraoperative pressure monitoring line and/or transesophageal echocardiograpy. However, the echocardiography performed at follow up showed no gradient across the SVC-RA appendage anastomotic site and there was no mortality recorded. Conclusion: In conclusion, the early operative impact of the caval division technique on venous drainage is of a good outcome and even when detected by intraoperative pressure line monitoring or transesophageal echocardiography, it can resolved spontaneous or attended to by additional band resections, especially in young children.
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