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   2015| January-June  | Volume 12 | Issue 1  
    Online since January 5, 2015

 
 
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ORIGINAL ARTICLES
Awareness and perception of harmful effects of smoking in Abia State, Nigeria
Ugochukwu U Onyeonoro, Innocent I Chukwuonye, Okechukwu O Madukwe, Andrew U Ukegbu, Moses O Akhimien, Okechukwu S Ogah
January-June 2015, 12(1):27-33
DOI:10.4103/0189-7969.148483  
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.
  7,023 498 4
CASE REPORTS
Endomyocardial fibrosis: Seven decades later in the Nigerian setting
Godsent Chichebem Isiguzo, Onyebuchi Micheal, James Audu Onuh, Adesua Sandra Muoneme, Nandom Kenneth Bitrus, Basil Nwaneri Okeahialam
January-June 2015, 12(1):45-50
DOI:10.4103/0189-7969.148488  
Background: Endomyocardial fibrosis (EMF), an obliterative cardiomyopathy of uncertain etiology, is the most common restrictive cardiomyopathy worldwide with no specific treatment and usually associated with poor prognosis due to late presentation. First described in the literature in 1946 among Africans, the prevalence seem to be decreasing, but without much change in its management in the region due to late presentation and inadequate surgical responsiveness. Earlier literature described EMF as a disease of the rain forest, only restricted to dwellers in the coastal regions. Despite the growing body of knowledge on this condition, there is not enough corresponding advancement in therapeutic interventions for the sufferers in Nigeria. Materials and Methods: Between May 2010 and July 2011, we reviewed cases of endomyocardial fibrosis presenting to the cardiology unit of Jos University Teaching Hospital, Plateau State Nigeria. The institutional board of the hospital approved the review, and consent was obtained from the patients/guardians. Effort was made to withhold identity of the patients in accordance with established protocol. Result: The first case was an 18-year-old female student with features of chronic heart failure who has earlier been misdiagnosed as having rheumatic valvular heart disease, but had biventricular EMF. Case 2 was a 33-year-old man who presented with breathlessness and hemoptysis and was erroneously on treatment for tuberculosis. Echocardiography revealed right ventricular EMF. The final case was a 27-year-old farmer with cough, progressive shortness of breath and abdominal swelling. Holter monitoring revealed ventricular and atrial arrhythmias, and echocardiography showed pericardial effusion with features of right ventricular EMF. He had bouts of arrhythmia with collapse, and finally died suddenly. Conclusion: There have been little advances in management of EMF seven decades after it was discovered, and despite being one of the major causes of heart failure in the tropics, awareness and response to management in these areas have lagged behind.
  6,630 319 1
ORIGINAL ARTICLES
Correlates of psychosocial stress and white blood cell count following exercise training program: A randomized controlled trial on men with essential hyperten sion
Sikiru Lamina, Chuba G Okoye, Charles I Ezema, Amaeze A Austin, Anthonia U Ezugwu, Maduabuchukwu J Nwankwo, Ngozi F Amaeze
January-June 2015, 12(1):1-7
DOI:10.4103/0189-7969.148478  
Objective: The aim of this study was to determine the effect of continuous training program on the correlates of white blood cell count (WBCc) and psychosocial stress in black African (Nigerian) male subjects with essential hypertension. Materials and Methods: Male subjects with diagnosis of essential hypertension attending the hypertensive clinic of Murtala Muhammed Specialist Hospital (MMSH), Kano, Nigeria form the population for the study. Two hundred and seventeen subjects with stage 1 and 2 [systolic blood pressure (SBP) between 140 and 180 and diastolic blood pressure (DBP) between 90 and 109 mmHg) hypertension were age matched and randomly grouped into continuous (112) and control groups (105). The continuous group involved in an 8 weeks continuous training (60-79% HR max) of between 45 and 60 minutes, three times per week, while the controls group remain sedentary. Blood pressure (SBP and DBP), WBCc, VO 2 max and psychosocial status were assessed. Student t test and Pearson correlation test were used in data analysis. Results: The study revealed significant beneficial effect of continuous training programs on VO 2 max, SBP, DBP, WBCc and psychosocial status (P< 0.05). Psychosocial status and WBCc were positively and negatively correlated, respectively, with VO 2 max at P< 0.01. Conclusion: This study supports the recommendations of moderate intensity (continuous) training program as an adjunct multi-therapy in blood pressure, inflammatory, and psychosocial stress management in hypertension.
  3,914 270 1
CASE REPORTS
Neonatal Marfan syndrome: A rare presentation
Rajesh Das, Biswajit Majumder, Debabrata Bera, Sougat Chakraborty
January-June 2015, 12(1):57-59
DOI:10.4103/0189-7969.148491  
Marfan syndrome is one of the most common single gene defects with an incidence of around 2-3 per 10000 persons. Neonatal Marfan syndrome is a rare and severe phenotype of this disease. Mortality is very high and is due to congestive heart failure and valvular regurgitations with suboptimal response to medical therapy. We present such a rare case of neonatal Marfan syndrome who had severe heart failure symptoms right after birth due to multivalvular lesions and was treated with prolonged conservative therapy.
  3,616 256 1
Nephropathy in a 5-year-old Nigerian child with cyanotic congenital
Ibrahim Aliyu
January-June 2015, 12(1):39-41
DOI:10.4103/0189-7969.148486  
Nephropathy in cyanotic congenital heart disease is common and the dominant feature is glomerular damage which is related to the duration of cyanosis and the extent to which the hematocrit is elevated. Previous reports have been mostly on adult Caucasians and a few case reports in Nigerian children. However nephrotic syndrome has been rarely reported and rarer still gross hematuria in a child. I report a case of a 5-year-old Nigerian boy with tetralogy of Fallot with recurrent gross hematuria and nephrotic syndrome.
  3,384 284 -
ORIGINAL ARTICLES
Trans-thoracic open ligation of the persistent ductus arteriosus in Ile-Ife, Nigeria
Uvie U Onakpoya, Akinwumi B Ogunrombi, Adewale O Aladesuru, John A. O. Okeniyi, Anthony T Adenekan, Afolabi M Owojuyigbe
January-June 2015, 12(1):8-12
DOI:10.4103/0189-7969.148479  
Background: Surgical ligation of a patent ductus arteriosus (PDA) is often the only available option in resource-poor countries such as Nigeria in order to prevent pulmonary hypertension and other complications of a patent ductus. Objective: The purpose of our study was to review our surgical experience, highlighting our techniques at a University Teaching Hospital in Nigeria. Materials and Methods: This is a retrospective audit of the patients who had trans-thoracic open surgical (TTOS) patent ductus ligation over a 5-year period (2009-2013). Result: Sixteen patients (2 boys and 14 girls) aged 4 months-19 years (Mean = 7.1 ± 6.7 years) had TTOS PDA ligation utilizing a triple suture ligation technique. Only three (18.8%) were asymptomatic pre-operatively. Eleven (68.9%) had isolated PDA and others had associated cardiac and extracardiac lesions. The most common post-operative complication was chylothorax, which occurred in two patients (12.5%), and most patients (75%; n = 12) were discharged home by the 5 th post-operative day. Conclusion: Careful attention during transthoracic open surgical closure of the persistent ductus arteriosus will ensure a safe procedure associated with relatively few complications and short post-operative hospital stay.
  3,332 274 1
CASE REPORTS
Sinus bradycardia caused by flurbiprofen intoxication
Selcuk Yaylaci, Ibrahim Kocayigit, Ahmet B Genc, Ali Tamer, Huseyin Gunduz
January-June 2015, 12(1):34-35
DOI:10.4103/0189-7969.148484  
Flurbiprofen is a powerful nonsteroidal anti-inflammatory agent that has analgesic, anti-inflammatory, and antipyretic effects. Its most frequent side-effects are the gastrointestinal side-effects. In this study, we present a case with sinus bradycardia developed due to high-dose flurbiprofen consumption.
  3,056 241 -
ORIGINAL ARTICLES
Electrocardiographic characteristics of children with obstructive sleep apnea in a tertiary health center in Kano
Aliyu Ibrahim, Abdulazeez Ahmed
January-June 2015, 12(1):23-26
DOI:10.4103/0189-7969.148482  
Background: Obstructive sleep apnea in children may be associated with cardiovascular complications and these may be identifiable on the electrocardiogram. Some of those changes seen in adults include ventricular hypertrophy and arrhythmias; however the exact prevalence of these in children is not known. Therefore, this study seeks to characterize the electrocardiographic features in children with obstructive sleep apnea. Materials and Methods: This study reviewed 43 electrocardiograms (ECGs) of children clinically diagnosed with obstructive sleep apnea (OSAS) aged 4-14 years; their ECG parameters were compared with 43 apparently healthy controls matched for age and sex. Results: There were 21 males and 22 females with male to female ratio of 1:1. The PR interval and QRS duration were higher in the obstructive sleep apnea group in the 4-9-year age group except for the QRS and P-wave axes. While in the 10-14-year-old age group lower values in the QRS axis, PR interval, QRS duration, and T-wave axis were recorded in those with obstructive sleep apnea; however, these were not statistically significant. The mean R- and S-waves amplitude in V 4 R, V 2 , V 5 and V 6 though higher in the obstructive sleep apnea group, but were not statistically significant. Premature ventricular complex was identified in only one of the subjects, phasic sinus arrhythmia in three of the subjects, and two ECGs had premature junctional complexes. T-wave inversion involving precordial leads V 4 R to V 3 was most predominant in all the age groups Conclusion: The ECG characteristics of children with OSAS in this study were comparable to previous report in children and the prevalence of arrhythmia was also low.
  2,925 251 -
Initial experience with echocardiography at the federal medical centre, Umuahia, Nigeria
Kelechukwu Uwanuruochi, Eme Offia, Ogba J Ukpabi, Abali Chuku, Okechukwu S Ogah
January-June 2015, 12(1):13-17
DOI:10.4103/0189-7969.148480  
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.
  2,898 264 2
CASE REPORTS
Infective endocarditis in a 12-year-old with subclinical rheumatic carditis
Ibrahim Aliyu
January-June 2015, 12(1):42-44
DOI:10.4103/0189-7969.148487  
Infective endocarditis is rare in children. It occurs mostly in children with an underlining heart defect. The clinical feature could be variable and most of the immunological features seen in adults are often absent in children. Rheumatic fever is a huge disease burden in developing countries and rheumatic valvular heart disease remains a risk factor for infective endocarditis. Therefore the case of a 12-year-old girl who hitherto had no complaint suggestive of underlining cardiac defect was diagnosed with infective endocarditis and subclinical rheumatic carditis which was confirmed by echocardiography; she responded to antibiotics and aspirin treatment and was discharged after 6-weeks on admission; she is being currently followed-up in the cardiac clinic.
  2,923 205 -
Pulmonary arterial hypertension in pregnancy
Manish K Multani, Pratik Uttarwar
January-June 2015, 12(1):54-56
DOI:10.4103/0189-7969.148490  
Pulmonary hypertension (PH) in pregnancy is associated with high morbidity and mortality of mother and baby. Therefore, pulmonary hypertension (PH) is regarded as a contraindication to pregnancy. The normal physiological changes in pregnancy are poorly tolerated by women with  PH. Moreover, diagnosis is difficult because symptoms are nonspecific and several signs of right heart failure such as, hepatomegaly, ascites and pedal edema are hard to identify during pregnancy. We report a rare case of 20-year-old female with PH in pregnancy. This patient was treated and survived because of early diagnosis, early intervention and multidisciplinary team approach. The risk of complications during pregnancy remains high in patients with PH, so women with PH should be advised against pregnancy and if they become pregnant termination should be done.
  2,711 219 -
ORIGINAL ARTICLES
Comparison of spectrum of heart diseases between an Indian and a Nigerian tertiary centre: An echocardiographic study
Kelechukwu Uwanuruochi, Ruchita Shah, Okechukwu S Ogah, Clement O Odigwe
January-June 2015, 12(1):18-22
DOI:10.4103/0189-7969.148481  
Background: Changing epidemiographic profile with increase in cardiovascular risk factors in developing nations is well documented. Our study sought to describe how this has affected the cardiovascular disease profile of patients reviewed by echocardiography in two hospitals, one in South-East Nigeria and the other in South-East India. Objective: We compared the range of cardiovascular diagnoses encountered in a Nigerian hospital and an Indian hospital. The underlying objective was to document any difference in cardiovascular disease patterns between the two tertiary hospitals in different regions of the developing world. Materials and Methods: This is a descriptive, retrospective study of echocardiographic records of the two hospitals: November 19, 2012 to September 20, 2013 for Federal Medical Centre (FMC), Umuahia, Nigeria and March 4, 2013 to April 30, 2013 for Madras Medical Mission (MMM), Chennai, India. Results: In FMC, Umuahia, hypertensive heart disease was the only common echocardiographic abnormality. Valvular heart disease and cardiomyopathy were also frequently encountered. In the MMM, ischemic heart disease and valvular heart disease were common echocardiographic abnormalities. Echocardiographic diagnosis correlated significantly with gender in MMM. Conclusions: The findings of this limited study underscore the need for the intensification of therapeutic measures and lifestyle modifications to reverse the trend in India as well as Blood pressure control and other strategies to avert the gathering cardiovascular storm in Nigeria.
  2,490 246 -
CASE REPORTS
Pulmonary vein compression by paravertebral abscess: An atypical presentation of tuberculosis
Debabrata Bera, Biswajit Majumder, Deepesh Venkatraman, Monika Bhandari
January-June 2015, 12(1):51-53
DOI:10.4103/0189-7969.148489  
Tuberculosis is a common disease in developing countries. It can cause dyspnea due to primary involvement of lungs with pulmonary Koch's, but one of the uncommon presentations may be solely due to compression of pulmonary veins (PVs) and/or left atrium resulting in exertional dyspnea resembling cardiac disease. Though there are case reports of lung metastasis, pulmonary artery aneurysm and left atrial myxoma causing PV compression, in literature PV compression due to cold abscess is extremely rare. Here, we report a case of paravertebral cold abscess causing symptoms effectively due to PV compression who got cured with anti-tubercular therapy.
  2,402 194 -
Troublesome recurrent paroxysms of arrhythmia due to arrhythmogenic right ventricular dysplasia
Basil N Okeahialam
January-June 2015, 12(1):36-38
DOI:10.4103/0189-7969.148485  
Arrhythmias could unsettle a clinician ill-equipped to define it and cause haemodynamic derangement in the patient. A young adult Nigerian female with no known family history of heart disease or sudden death is reported. She presented with recurrent palpitations which over time became more frequent and interfered with her life. She had no history of obvious heart disease or anything to explain the occurrence. In the course of evaluation her ECG suggested arrhythmogenic right ventricular dysplasia. It is being reported as it is said to be rare in Africa, and rarer still among females
  2,060 168 -
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