Differential Clubbing and a Triad of Patent Ductus Arteriosus, Ventricular Septal Defect and Supravalvular Ring Mitral Stenosis: A Case Report.

It is not uncommon for congenital heart defects to occur in clusters. Those involving a right to left heart shunt commonly cause cyanosis and finger clubbing. Differential clubbing involving only the lower limb digits is a strong pointer to the presence of patent ductus arteriosus with reversal of shunt. We report a case of 25-year-old man with effort intolerance and differential clubbing. He was found to have the uncommon triad of patent ductus arteriosus, ventricular septal defect and supravalvular ring mitral stenosis. The presence of differential clubbing on a background of patent ductus arteriosus usually indicates a reversal of shunt and negates surgical intervention. This general rule may however not apply with co-existing mitral stenosis as the elevated pulmonary pressure may be predominantly post-capillary. The finding of mitral stenosis in a patient with patent ductus arteriosus and differential limb clubbing may signify a good prognostic surgical outcome.

Il n'est pas rare que des malformations cardiaques congénitales surviennent en clusters. Celles impliquant un shunt cardiaque droitegauche provoquent souvent une cyanose et un hippocratisme digital. L'hippocratisme digital différentiel touchant uniquement les orteils des membres inférieurs est un indicateur fort de la présence d'un canal artériel persistant avec inversion du shunt. Nous rapportons le cas d'un homme de 25 ans présentant une intolérance à l'effort et un hippocratisme digital différentiel. Il a été diagnostiqué avec la triade peu commune de canal artériel persistant, de communication interventriculaire et de sténose mitrale à anneau supravalvulaire. La présence d'un hippocratisme digital différentiel sur un fond de canal artériel persistant indique généralement une inversion du shunt et exclut une intervention chirurgicale. Cependant, cette règle générale peut ne pas s'appliquer en présence d'une sténose mitrale concomitante, car la pression pulmonaire élevée peut être principalement post-capillaire. La découverte d'une sténose mitrale chez un patient atteint de canal artériel persistant et d'un hippocratisme digital différentiel peut indiquer un bon pronostic pour l'intervention chirurgicale.

Biventricular Hypertrophic Cardiomyopathy in a 26-year-old Nigerian Woman with Noonan Syndrome.

BACKGROUND: Cardiac disorders are found in about half of cases of Noonan syndrome (NS). The most common congenital heart diseases in this syndrome include pulmonary valvular stenosis obstructive or nonobstructive hypertrophic cardiomyopathy (17%). Biventricular hypertrophic cardiomyopathy (HCM) is very rare in this condition. OBJECTIVE: The objective is to report a case of biventricular hypertrophic cardiomyopathy in a 26-year-old Nigerian female with the phenotype. METHODS: This is a descriptive case report. RESULTS: The patient presented with dyspnoea on exertion which started at the age of 7 years and has progressively worsened. There was associated precordial chest pain and palpitation. Clinical examination revealed a young woman, who is small for her age. She had some dysmorphic features such as a webbed neck, lowset ears, low posterior hairline, crowded teeth, high arched palate, a small and asymmetric chin and a high carrying angle at the elbows. The pulses were synchronous and there was no radio-radial or radiofemoral delay and her blood pressures were within normal limits. Cardiac auscultation was unremarkable. The 12-lead ECG showed biventricular hypertrophy with a strain pattern. The echocardiogram showed features in keeping with biventricular hypertrophic cardiomyopathy. CONCLUSION: Biventricular HCM is relatively uncommon in Noonan syndrome. Patients with typical dysmorphia should have a full cardiac evaluation to look for these anomalies.

CONTEXTE: Des troubles cardiaques sont présents chez environ la moitié des patients atteints du syndrome de Noonan. Les cardiopathies congénitales les plus fréquentes dans ce syndrome incluent la sténose valvulaire pulmonaire (60 %), la communication interauriculaire (25 %) et la cardiomyopathie hypertrophique obstructive ou non obstructive (17 %). La cardiomyopathie hypertrophique (HCM) biventriculaire est très rare dans ces conditions. OBJECTIF: L'objectif est de rapporter un cas de cardiomyopathie hypertrophique biventriculaire chez une femme nigériane de 26 ans présentant le phénotype. MÉTHODES: Il s'agit d'un rapport de cas descriptif. RÉSULTATS: La patiente s'est présentée avec une dyspnée à l'effort, débutant à l'âge de 7 ans et s'aggravant progressivement. Il y avait des douleurs précordiales associées ainsi que des palpitations. L'examen clinique a révélé une jeune femme, petite pour son âge, avec quelques traits dysmorphiques tels qu'un cou palmé, des oreilles basses, une implantation basse des cheveux à l'arrière, des dents serrées, un palais ogival, un menton petit et asymétrique et un angle de port élevé au niveau des coudes. Les pouls étaient synchrones, sans retard radio-radial ou radiofémoral, et la tension artérielle était dans les limites normales. L'auscultation cardiaque n'a révélé aucune anomalie. L'électrocardiogramme à 12 dérivations a montré une hypertrophie biventriculaire avec un pattern de strain. L'échocardiogramme a révélé des caractéristiques compatibles avec une cardiomyopathie hypertrophique biventriculaire. CONCLUSION: La cardiomyopathie hypertrophique biventriculaire est relativement rare dans le syndrome de Noonan. Les patients présentant une dysmorphie typique devraient subir une évaluation cardiaque complète afin de détecter ces anomalies. MOTS CLÉS: Syndrome de Noonan, Dysmor phie, Cardiomyopathie hypertrophique.

Clinical Characteristics, Management, and Six-Month Outcomes after Discharge of Patients Admitted for Acute Heart Failure in Ibadan, Nigeria.

BACKGROUND: The burden of acute heart failure (AHF) is on the increase globally however, there are few studies on AHF in Nigeria and among black populations. OBJECTIVE: This study described the clinical profile, conventional management and six-months outcome after discharge of patients admitted for acute heart failure at the University College Hospital, Ibadan, Nigeria. METHODS: The study was a prospective study of 160 consecutive AHF patients. Socio-demographic details, clinical history, basic laboratory parameters electrocardiographic and echocardiographic parameters were assessed. They were followed-up for six-months after discharge to ascertain death or readmission. RESULTS: The mean ± standard deviation (SD) age of all the patients was 58.0 ±15.1 years. Those aged 60 years and above constituted about half of the participants. Males comprised 59.3% and hypertension was the most common risk factor (77.5%). One hundred and thirty-four subjects (83.8%) were in New York Heart Association functional classes III or IV. The most common AHF type was heart failure with reduced ejection fraction and mostly presented de novo. The mean duration of admission was 11 days while intrahospital mortality and mortality at 6 months after discharge were 6.3% and 25.6% respectively. CONCLUSION: This study provided a real-world data of AHF at UCH, Ibadan, Nigeria. It showed AHF was predominantly associated with hypertension. There was high mortality among these AHF subjects. There is a need for more strategy in our environment for preventing AHF and its adverse outcomes.

CONTEXTE: Le fardeau de l'insuffisance cardiaque aiguë (ICA) est en augmentation dans le monde entier ; cependant, il existe peu d'études sur l'ICA au Nigeria et parmi les populations noires. OBJECTIF: Cette étude décrit le profil clinique, la prise en charge conventionnelle et le résultat six mois après la sortie des patients admis pour une insuffisance cardiaque aiguë à l'University College Hospital, Ibadan, Nigeria. MÉTHODES: L'étude était une étude prospective de 160 patients consécutifs souffrant d'insuffisance cardiaque aiguë. Les détails sociodémographiques, l'histoire clinique, les paramètres de laboratoire de base, les paramètres électrocardiographiques et échocardiographiques ont été évalués. Ils ont été suivis pendant six mois après leur sortie de l'hôpital pour vérifier le décès ou la réadmission. RÉSULTATS: L'âge moyen ± écart-type (ET) de tous les patients était de 58,0 ±15,1 ans. Les personnes âgées de 60 ans et plus constituaient environ la moitié des participants. Les hommes représentaient 59,3 % et l'hypertension était le facteur de risque le plus fréquent (77,5 %). Cent trente-quatre sujets (83,8 %) appartenaient aux classes fonctionnelles III ou IV de la New York Heart Association. Le type d'AHF le plus fréquent était l'insuffisance cardiaque avec fraction d'éjection réduite et se présentait le plus souvent de novo. La durée moyenne d'admission était de 11 jours tandis que la mortalité intrahospitalière et la mortalité à 6 mois après la sortie étaient respectivement de 6,3% et 25,6%. CONCLUSION: Cette étude a fourni des données réelles de l'AHF à l'UCH, Ibadan, Nigeria. Elle a montré que l'AHF était principalement associée à l'hypertension. Il y avait une mortalité élevée parmi ces sujets AHF. Il y a un besoin de plus de stratégie dans notre environnement pour prévenir l'AHF et ses résultats défavorables. Mots-clés: Insuffisance cardiaque. Insuffisance cardiaque aiguë, Nigeria, Hypertension, Maladie cardiovasculaire.

Premature Atherosclerotic Cardiovascular Disease: A Case of Myocardial Infarction Seven Years after Bentall Procedure in a Nigerian Man.

Surgical procedures often carry varying risk of post-procedural complications. The Bentall procedure for managing aortic root diseases has known complications including graft infection, pseudoaneurysm of the aorta or coronary arteries, embolisation and coronary insufficiency. The last three complications can cause myocardial infarction, are evaluated with coronary angiography and have been well described in the literature. Surprisingly, none of these possible complications was found in our patient. This case report describes a young Nigerian man with atherosclerotic coronary artery disease seven years after Bentall procedure.

Les interventions chirurgicales comportent souvent un risque variable de complications postopératoires. L'intervention de Bentall pour traiter les maladies de la racine aortique présente des complications connues, notamment l'infection du greffon, le pseudo-anévrisme de l'aorte ou des artères coronaires, l'embolisation et l'insuffisance coronarienne. Les trois dernières complications peuvent provoquer un infarctus du myocarde, sont évaluées par coronarographie et ont été bien décrites dans la littérature. Il est surprenant de constater qu'aucune de ces complications possibles n'a été constatée chez notre patient. Ce rapport de cas décrit un jeune homme nigérian avec une maladie coronarienne athérosclérotique sept ans après la procédure de Bentall. Mots-clés: Procédure de Bentall, Coronaropathie, Cardiopathie ischémique, Infarctus du myocarde, Nigeria.

Comparative Analysis of Left Ventricular Geometry in Adult Nigerians with and without Chronic Kidney Disease: Results from Ibadan CRECKID STUDY.

BACKGROUND: Chronic kidney disease (CKD) is associated with increased risk of cardiovascular morbidity and mortality. Left ventricular hypertrophy (LVH) is considered the strongest independent predictor of cardiovascular disease and events among CKD patients. We reported the echocardiographic left ventricular geometry in CKD patients compared to non-CKD hypertensive and apparently healthy controls in Ibadan. MATERIALS AND METHODS: A total of 683 participants in the CRECKID STUDY comprising 220(32.2%) CKD patients, 281(41.1%) non-CKD hypertensive patients and 182(26.6%) healthy controls were included in this analysis. Basic demographic and clinical information with echocardiographic parameters were obtained. RESULTS: Study participants in the non-CKD hypertensive group were on average older than the CKD and the healthy controls (56.2±13.1 vs 47.2±14.6, and 46.8±13.3 years, respectively; p<0.01). Compared with other groups, greater proportions of participants with CKD were men (40.5% vs.38.1% and 21.3%; p<0.0001). The left atrial and left ventricular dimensions were significantly higher in CKD compared with others. LVH was significantly more prevalent among CKD patients (68.2%) compared to hypertensive (43.9%) and normotensive (19.5%) group (p<0.01). The participants with CKD had a greater proportion of abnormal LV geometry with concentric LVH predominating (p<0.0001). Having LVH was associated with lower mean estimated glomerular filtration rate (eGFR) (40.6±37.71 vs 67±37.38, p<0.0001). CONCLUSION: In our study, patients with CKD had the highest prevalence of abnormal LV geometry and functions. A unit decrease in eGFR was associated with increased left ventricular mass. Early detection and prompt management of abnormal LV geometry may help in reducing adverse cardiovascular outcome in patients with CKD.

CONTEXTE: L'insuffisance rénale chronique (MRC) est associée àrisque accru de morbidité et de mortalité cardiovasculaires. Gauche l'hypertrophie ventriculaire (LVH) est considérée comme la plus forte prédicteur indépendant des maladies cardiovasculaires et des événements chez Patients atteints d'IRC. Nous avons rapporté l'échocardiographie ventriculaire gauche géométrie chez les patients atteints d'IRC par rapport aux patients hypertendus non atteints d'IRC etcontrôles apparemment sains à Ibadan. MATÉRIAUX ET MÉTHODES: Un total de 683 participants à la ÉTUDE CRECKID portant sur 220 (32.2%) patients atteints d'IRC,281 (41.1 %) patients hypertendus non atteints d'IRC et 182 (26.6 %) en bonne santé ont été inclus dans cette analyse. Démographie et clinique de base des informations avec des paramètres échocardiographiques ont été obtenues. RÉSULTATS: Participants à l'étude dans le groupe hypertendu non atteint d'IRC étaient en moyenne plus âgés que l'IRC et les témoins sains(56.2±13.1 vs 47.2±14.6 et 46.8±13.3 ans, respectivement; p<0.01). Par rapport à d'autres groupes, plus grande proportion de participants avec l'IRC étaient des hommes (40.5 % contre 38.1 % et 21.3 %; p<0.0001). Les dimensions auriculaire gauche et ventriculaire gauche étaient significativement plus élevées chez CKD par rapport à d'autres. La LVH était significativement plus répanduechez les patients atteints d'IRC (68.2 %) par rapport aux patients hypertendus (43.9 %) et le groupe normotensif (19.5 %) (p<0.01). Les participants avec CKD avait une plus grande proportion de géométrie LV anormale avec LVH concentrique prédominante (p<0.0001). Avoir LVH était associé à un débit de filtration glomérulaire estimé moyen plus faible (DFGe)(40.6±37.71 contre 67±37.38, p<0,0001). CONCLUSION: Dans notre étude, les patients atteints d'IRC avaient le plus haut prévalence d'une géométrie et de fonctions LV anormales. Une diminution unitaire de Le DFG était associé à une augmentation de la masse ventriculaire gauche. Tôt la détection et la gestion rapide de la géométrie LV anormale peuvent aider à réduire les résultats cardiovasculaires indésirables chez les patients atteints de CKD. Mots-clés: Maladie rénale chronique, Hypertensives, ventriculaire gauche géométrie.

Epidemiology and Management of Oculoplastic Disorders at a Tertiary Hospital: A 4-Year Review.

PURPOSE: To describe the epidemiology and management of oculoplastic disorders at a tertiary hospital in Nigeria. METHODS: This was a retrospective review of patients with oculoplastic disorders at the Department of Ophthalmology, Obafemi Awolowo University Teaching Hospitals Complex, IleIfe, Nigeria from January 2013 to December 2016. The general ophthalmology service records were reviewed to identify patients with oculoplastic disorders. Data retrieved from patient records included date of initial visit, age at presentation, gender, oculoplastic diagnosis and aetiology, modality of treatment given, and indications for patient referrals. RESULTS: There were 563 (7.4%) patients with oculoplastic disorders, out of 7,575 ophthalmology department patients. They had 573 oculoplastic disorders in all. There were 281 (49.9%) males and 282 (50.1%) females. The median age at presentation was 28 years (range, 1 day to 100 years). Eyelid laceration (n=68; 11.9%) and chalazion (n=63; 11%) were the commonest disorders. Trauma (n=125; 21.8%) was the commonest aetiology, followed by inflammatory (n=121; 21.1%) and infective (n=108; 18.8%) causes. There were 162 (28.3%) surgical interventions; eyelid repair (n=67; 41.4%) was the commonest, followed by evisceration (n=25; 15.4%), and excisional biopsy (n=25; 15.4%). No patient had ptosis or lacrimal surgery. Orbital disorders (n=21; 42.9%) were the commonest indication for a referral elsewhere. CONCLUSION: Eyelid laceration was the commonest oculoplastic disorder, trauma was the commonest aetiology, and eyelid repair was the commonest oculoplastic surgery done. Further training in oculoplastics with emphasis on ptosis, lacrimal and orbital surgery, as well as the provision of equipment needed for optimal oculoplastic service delivery are recommended.

OBJECTIF: Décrire l'épidémiologie et la gestion des troubles oculoplastiques dans un hôpital tertiaire du Nigeria. MÉTHODES: Il s'agissait d'un examen rétrospectif des patients atteints de troubles oculoplastiques au département d'ophtalmologie, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, de janvier 2013 à décembre 2016. Les dossiers du service d'ophtalmologie générale ont été examinés afin d'identifier les patients souffrant de troubles oculoplastiques. Les données extraites des dossiers des patients comprenaient la date de la première visite, l'âge au moment de la présentation, le sexe, le diagnostic oculoplastique et l'étiologie, la modalité du traitement administré et les indications pour le renvoi des patients. RÉSULTATS: 563 (7,4 %) des 7 575 patients du service d'ophtalmologie présentaient des troubles oculoplastiques. Ils présentaient 573 troubles oculoplastiques au total. Il y avait 281 (49,9%) hommes et 282 (50,1%) femmes. L'âge médian à la présentation était de 28 ans (intervalle de 1 jour à 100 ans). Paupière (n=68 ; 11,9%) et le chalazion (n=63 ; 11%) étaient les troubles les plus courants. Le traumatisme (n=125 ; 21,8%) était l'étiologie la plus fréquente, suivie par les causes inflammatoires (n=121 ; 21,1%) et infectieuses (n=108 ; 18,8%). Il y a eu 162 (28,8 %) interventions chirurgicales ; la réparation de la paupière (n=67 ; 41,4 %) était la plus courante, suivie de l'éviscération (n=25 ; 15,4%) et de la biopsie excisionnelle (n=25 ; 15,4%). Aucun patient n'a subi de ptose ou de chirurgie lacrymale. Les troubles orbitaux (n=21 ; 42,9%) étaient l'indication la plus fréquente d'un renvoi ailleurs. CONCLUSION: La lacération de la paupière était le trouble oculoplastique le plus courant, le traumatisme était l'étiologie la plus courante et la réparation de la paupière était la chirurgie oculoplastique la plus courante. Il est recommandé de poursuivre la formation en oculoplastie en mettant l'accent sur le ptosis, la chirurgie lacrymale et orbitale, ainsi que de fournir l'équipement nécessaire à une prestation optimale des services oculoplastiques. Mots clés: Troubles oculoplastiques, prévalence, chirurgie, traumatisme.

Trends in Eye Removal Surgeries at a Tertiary Care Hospital Over Three Decades.

PURPOSE: To determine the trends in eye removal surgeries at a tertiary hospital in Nigeria over 26 years. METHODS: A retrospective comparative review of clinical records of all patients who had eye removal surgery at a tertiary hospital in Ile-Ife, Nigeria, between 2014 and 2019 was done. Patients' demographic and clinical data, including indication for eye removal and type of surgery were analysed and compared with two earlier studies at the same hospital between 1994 and 2013. RESULTS: There was an average of 14.3 surgeries per year between 2014 and 2019. Patients' ages ranged from 2 to 102 years, M:F was 1.5:1, the commonest indication for eye removal was infection (n=30, 34.9%), and the most common surgery was evisceration (n=70, 81.4%). Studies from 1994 to 2003 and 2005 to 2013, reported an average of 9.2 and 10 surgeries per year; ages ranging from 4 days to 88 years and 3 months to 88 years; with a M:F of 2.1:1 and 3.4:1 respectively. In both studies, the commonest indication for eye removal was trauma (43.4% and 43.8% respectively) and the most common surgery was enucleation (57.6% and 55% respectively). Trend data showed a progressive increase in eye infections (12% vs 15% vs 34.9%) and eviscerations (19.6% vs 31.2% vs 81.4%) over time. CONCLUSION: There was a change in trend towards an increase in eviscerations and infective indications for eye removal at the hospital over three decades. Prompt and optimal treatment of orbito-ocular infections is recommended to reduce the incidence of eye removal surgeries.

BUT: Déterminer les tendances des chirurgies d'ablation de l'oeil dans un hôpital tertiaire du Nigeria sur une période de 26 ans. MÉTHODES: Un examen comparatif rétrospectif des dossiers cliniques de tous les patients ayant subi une chirurgie d'ablation de l'œil dans un hôpital tertiaire d'Ile-Ife, au Nigeria, entre 2014 et 2019, a été effectué. Les données démographiques et cliniques des patients, y compris l'indication de l'ablation de l'œil et le type de chirurgie, ont été analysées et comparées à deux études antérieures menées dans le même hôpital entre 1994 et 2013. RÉSULTATS: Il y avait une moyenne de 14,3 chirurgies par an entre 2014 et 2019. L'âge des patients allait de 2 à 102 ans, le rapport M:F était de 1,5:1, l'indication la plus courante pour l'ablation de l'œil était l'infection (n=30, 34,9%), et la chirurgie la plus fréquente était l'éviscération (n=70, 81,4%). Les études menées de 1994 à 2003 et de 2005 à 2013 ont fait état d'une moyenne de 9,2 et 10 interventions chirurgicales par an, d'âges allant de 4 jours à 88 ans et de 3 mois à 88 ans, et d'un rapport M:F de 2,1:1 et 3,4:1 respectivement. Dans les deux études, l'indication la plus courante pour l'ablation de l'œil était le traumatisme (43,4 % et 43,8 % respectivement) et la chirurgie la plus courante était l'énucléation (57,6 % et 55 % respectivement). Les données sur les tendances ont montré une augmentation progressive des infections oculaires (12 % vs 15 % vs 34,9 %) et des éviscérations (19,6 % vs 31,2 % vs 81,4 %) au fil du temps. CONCLUSION: On constate un changement de tendance vers une augmentation des éviscérations et des indications infectieuses pour l'ablation des yeux à l'hôpital sur trois décennies. Un traitement rapide et optimal des infections orbitooculaires est recommandé pour réduire l'incidence des chirurgies d'ablation des yeux. Mots clés: Anesthésie, énucléation, éviscération, exentération, implant orbitaire, tendances.

Comparative analysis of fibroblast growth Factor-23 as a correlate of cardiovascular disease among individuals with chronic kidney disease, hypertensives, and healthy controls.

Background: Chronic kidney disease (CKD) is a global growing public health epidemic with attending morbidity and huge financial cost. Cardiovascular disease (CVD), a major complication of CKD, contributes to its excessive mortality rate. The aetio-pathogenesis of the excess burden of CVD in CKD is a feature yet to be unravelled. Fibroblast growth factor-23 (FGF-23) has been implicated as a risk factor for CVD among patients with CKD. However, most of these studies were predominantly among the Caucasian population. Aim: This study aims to determine the correlation between FGF-23 and CVD among Nigerians with CKD. Patients and Methods: A cross-sectional comparative study composed of three groups: participants with CKD, hypertensives without CKD, and healthy individuals, represented as group 1, 2, and 3, respectively. Information obtained included demographic data and occurrence of risk factors for CVD. Cardiovascular risks were assessed by echocardiography and all the participants had kidney function tests done with plasma FGF-23. Results: The study sample size consisted of 135 participants. The mean (SD) age for participants with CKD and controls were 50.2 (12.7), 54.3 (15.5), and 40.2 (14.1) years, respectively. The median [interquartile range (IQR)] of plasma FGF-23 for participants with CKD 210 (139-304) RU/ml, and controls 124 (86-170) RU/ml, and 71 (38 - 89) RU/ml P < 0.001. Most participants with CKD had left ventricular hypertrophy (LVH) (80.0%), compared to the controls; 28.9% and 6.7% P < 0.001. Similarly, majority of participants with CKD had elevated plasma FGF-23 with LVH (85.7%) compared to controls 55.6% and 11.5%, whereas for aortic valve calcification with elevated plasma FGF-23 among CKD and controls were 53.6% (P = 0.29), 37.0% (P = 0.03), and 19.2% (P = 0.06), respectively. Conclusion: Individuals with CKD had frequencies of elevated plasma FGF-23, LVH, and cardiac valve calcification, which are surrogates of cardiovascular events.

Pregnancy-associated Acute Myocardial Infarction (PAMI): Case Report.

Cardiovascular diseases are recognised complications of pregnancy, however, pregnancy-associated acute myocardial infarction (PAMI) is uncommon. Pregnancy is known to increase risk of myocardial infarction even in the absence of traditional risk factors for atherosclerotic vascular disease. Our patient presented with acute chest pain two weeks after delivery and her electrocardiogram was in keeping with STelevation myocardial infarction (STEMI). Coronary angiography revealed coronary artery dissection and she was managed conservatively. Various pathophysiological mechanisms of PAMI have been described in literature including spontaneous coronary artery dissection (SCAD) found in our case. The diagnosis is often missed and earlier reported cases were diagnosed at autopsy. Therefore, we report this case as a learning tool. Also, there is a need for a high index of suspicion in pregnant patients presenting with features suggestive of aortic dissection, and its diagnosis should be thought of in peripartum women presenting with acute chest pain.

Les maladies cardiovasculaires sont des complications reconnues de la grossesse, cependant, l'infarctus aigu du myocarde associé à la grossesse (IPAM) est rare. La grossesse est connue pour augmenter le risque d'infarctus du myocarde même en l'absence de facteurs de risque traditionnels de maladie vasculaire athéroscléreuse. Notre patiente s'est présentée avec une douleur thoracique aiguë deux semaines après l'accouchement et son électrocardiogramme était conforme à l'infarctus du myocarde avec élévation de l'échelle (STEMI). La coronarographie a révélé une dissection de l'artère coronaire et elle a été gérée de manière conservatrice. Divers mécanismes physiopathologiques de PAMI ont été décrits dans la littérature, y compris la dissection spontanée des artères coronaires (SCAD) trouvée dans notre cas. Le diagnostic est souvent manqué et les cas signalés antérieurement ont été diagnostiqués à l'autopsie. Par conséquent, nous rapportons ce cas comme un outil d'apprentissage. En outre, il existe un besoin d'un indice de suspicion élevé chez les patientes enceintes présentant des caractéristiques suggérant une dissection aortique, et son diagnostic doit être envisagé chez les femmes en péripartum présentant une douleur thoracique aiguë.

Menstrual Characteristics of sub-Sahara Black African Women with and without Endometriosis.

BACKGROUND: One gynecological disorder which is often a mystery to premenopausal women who are affected is endometriosis, a benign condition characterized by ectopic endometrium growing outside the uterus but behaving as if it is still within the uterus. MATERIALS AND METHODS: Hospital records of 226 women who consulted for fertility management at Nordica Fertility Center were surveyed retrospectively. These women were stratified by age into <35 years and >35 years and by BMI into <18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight) and >30 (obese). There were 113 who had laparoscopic diagnosis of endometriosis and 113 without endometriosis but just infertility. STATA 13 statistical software was used for analysis of data. RESULTS: The mean (±sd) age of the women in the study was 34.3 (4.9) with no significant difference among those with (33.9 (4.3)) and without (34.6 (5.4)) endometriosis. There was a significant difference (t=-3.36, P-value=0.0005) in the mean BMI (Kg/m2) of women with endometriosis (25.8±4.9) compared to that of women without endometriosis (27.9±4.5). The probability of endometriosis among normal weight women was higher at age <35 years (OR=2.76, 95% Confidence Interval 1.33,5.73) than at age >35 years (OR=1.59, 95% Confidence Interval 0.62, 4.10). The mean (±SD) parity among those with endometriosis (0.13±0.34) was significantly lower (t-test=2.31; P-value=0.01) than that among women without endometriosis (0.28 ± 0.60). Primary infertility was more prevalent (62.0%) than secondary infertility (38.0%) among those with endometriosis while secondary infertility was more prevalent (55.8%) than primary infertility (44.3%) among those without endometriosis. The mean age (years) at menarche of women without endometriosis (13.3±1.6) was significantly higher (t-test=1.88, P-value=0.03) than that among those with endometriosis (12.9±1). Those with endometriosis were most likely to have dysmenorrhea alone, menorrhagia alone and both dysmenorrhea and menorrhagia concurrently than those without the disease. CONCLUSION: Anthropometric and abnormal menstrual profile of patients presenting with pelvic pain, co-morbidity of dysmenorrhea and menorrhagia, infertility and low parity can guide clinicians and gynecologist to make early and proper diagnosis of endometriosis for better treatment outcomes.

CONTEXTE: Un mal gynécologique qui est souvent un mystère pour les femmes préménopausées qui sont touchées est l'endométriose, une affection bénigne caractérisée par un endomètre ectopique poussant à l'extérieur de l'utérus mais se comportant comme s'il était toujours dans l'utérus. MATÉRIEL ET MÉTHODES: Les dossiers hospitaliers de 226 femmes ayant consulté pour la gestion de la fertilité au Nordica Fertility Center ont été étudiés rétrospectivement. Ces femmes ont été stratifiées par âge en <35 ans et> 35 ans et par IMC en <18,5 (poids insuffisant), 18,5 à 24,9 (normal), 25,0 à 29,9 (surpoids) et> 30 (obèse). Il y avait 113 qui avaient un diagnostic laparoscopique d'endométriose et 113 sans endométriose, mais juste l'infertilité. Le logiciel statistique STATA 13 a été utilisé pour l'analyse des données. RÉSULTATS: L'âge moyen (± sd) des femmes de l'étude était de 34,3 (4,9) sans différence significative entre celles avec (33,9 (4,3)) et sans (34,6 (5,4)) endométriose. Il y avait une différence significative (t = -3,36, valeur p = 0,0005) dans l'IMC moyen (Kg / m2) des femmes atteintes d'endométriose (25,8 ± 4,9) par rapport à celle des femmes sans endométriose (27,9 ± 4,5). La probabilité d'endométriose chez les femmes de poids normal était plus élevée à l'âge <35 ans (OR = 2,76, intervalle de confiance à 95% 1,33,5,73) qu'à l'âge> 35 ans (OR = 1,59, intervalle de confiance à 95% 0,62, 4,10). La parité moyenne (± ET) parmi les personnes atteintes d'endométriose (0,13 ± 0,34) était significativement plus faible (test t = 2,31; valeur p = 0,01) que chez les femmes sans endométriose (0,28 ± 0,60). L'infertilité primaire était plus fréquente (62,0%) que l'infertilité secondaire (38,0%) chez les personnes atteintes d'endométriose, tandis que l'infertilité secondaire était plus fréquente (55,8%) que infertilité primaire (44,3%) chez les personnes sans endométriose. L'âge moyen (années) à la ménarche des femmes sans endométriose (13,3 ± 1,6) était significativement plus élevé (test t = 1,88, valeur p = 0,03) que celui des femmes atteintes d'endométriose (12,9 ± 1). Les personnes atteintes d'endométriose étaient plus susceptibles de souffrir de dysménorrhée seule, de ménorragie seule et à la fois de dysménorrhée et de ménorragie en même temps que celles sans maladie. CONCLUSION: Le profil anthropométrique et menstruel anormal des patientes présentant des douleurs pelviennes, une comorbidité de dysménorrhée et de ménorragie, l'infertilité et une faible parité peuvent guider les cliniciens et le gynécologue pour faire un diagnostic précoce et approprié de l'endométriose pour de meilleurs résultats de traitement. Mots clés: femmes noires africaines, dysménorrhée, endométriose, infertilité, ménorragie, parité, profil menstruel, sub-saharienne.

Eye Movements and White Matter are Associated with Emotional Control in Children Treated for Brain Tumors.

OBJECTIVE: Children treated for brain tumors often experience social and emotional difficulties, including challenges with emotion regulation; our goal was to investigate the attention-related component processes of emotion regulation, using a novel eye-tracking measure, and to evaluate its relations with emotional functioning and white matter (WM) organization. METHOD: Fifty-four children participated in this study; 36 children treated for posterior fossa tumors, and 18 typically developing children. Participants completed two versions of an emotion regulation eye-tracking task, designed to differentiate between implicit (i.e., automatic) and explicit (i.e., voluntary) subprocesses. The Emotional Control scale from the Behavior Rating Inventory of Executive Function was used to evaluate emotional control in daily life, and WM organization was assessed with diffusion tensor imaging. RESULTS: We found that emotional faces captured attention across all groups (F(1,51) = 32.18, p < .001, η2p = .39). However, unlike typically developing children, patients were unable to override the attentional capture of emotional faces when instructed to (emotional face-by-group interaction: F(2,51) = 5.58, p = .006, η2p = .18). Across all children, our eye-tracking measure of emotion regulation was modestly associated with the parent-report emotional control score (r = .29, p = .045), and in patients it was associated with WM microstructure in the body and splenium of the corpus callosum (all t > 3.03, all p < .05). CONCLUSIONS: Our findings suggest that an attention-related component process of emotion regulation is disrupted in children treated for brain tumors, and that it may relate to their emotional difficulties and WM organization. This work provides a foundation for future theoretical and mechanistic investigations of emotional difficulties in brain tumor survivors.

Self-reported Sleep Disorder and Ambulatory Blood Pressure Phenotypes in Patients with or without Chronic Kidney Disease: Findings from Ibadan CRECKID Study.

BACKGROUND: Sleep disordered breathing has been closely linked to pathogenesis, poor control of hypertension, and progression of chronic kidney disease (CKD). Though hypertension and CKD are highly prevalent in Nigeria, the effects of sleep disorders on CKD and hypertension phenotypes have not been widely studied. This study investigated the relationship between self-reported sleep disorders, and ambulatory blood pressure phenotypes in patients with hypertension and those with or without CKD. METHODS: Participants aged 18 years and above who consented were recruited into the study. Anthropometric measurements including height, weight, and waist and hip circumferences were obtained, Office/clinic hypertension was defined as SBP =140mmHg and/or DBP =90mmHg or being on pharmacological treatment for hypertension. 24-hour ambulatory blood pressure monitoring were done. Obstructive sleep apnea was assessed using Stop Bang questionnaire. Estimated GFR was calculated using CKD-EPI Creatinine 2Equation and CKD was defined as eGFR<60ml/min/1.73m . RESULTS: A total of three hundred and forty-nine (349) patients were enrolled for the study: 175 males and 174 females. Moderate to severe risk for obstructive sleep apnea (OSA) was observed in 51.4% of patients with CKD, 58.5% of hypertensive and 17.3% of apparently healthy participants. Male participants were more likely than female patients to have moderate and high OSA risk (41.7% vs 32.8%) and (10.3% vs 4.6%) respectively. Compared with other groups, CKD patients had the highest office and ambulatory blood pressure parameters; p<0.0001. CONCLUSION: This study has demonstrated that obstructive sleep apnoea is prevalent among patients with chronic kidney disease and hypertension. Furthermore, the phenotypes of hypertension are accentuated in CKD and therefore, OSA may well be an important risk factor for CKD.

Development of short-range white matter in healthy children and adolescents.

Neural communication is facilitated by intricate networks of white matter (WM) comprised of both long and short range connections. The maturation of long range WM connections has been extensively characterized, with projection, commissural, and association tracts showing unique trajectories with age. There, however, remains a limited understanding of age-related changes occurring within short range WM connections, or U-fibers. These connections are important for local connectivity within lobes and facilitate regional cortical function and greater network economy. Recent studies have explored the maturation of U-fibers primarily using cross-sectional study designs. Here, we analyzed diffusion tensor imaging (DTI) data for healthy children and adolescents in both a cross-sectional (n = 78; mean age = 13.04 ± 3.27 years) and a primarily longitudinal (n = 26; mean age = 10.78 ± 2.69 years) cohort. We found significant age-related differences in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) across the frontal, parietal, and temporal lobes of participants within the cross-sectional cohort. By contrast, we report significant age-related differences in only FA for participants within the longitudinal cohort. Specifically, larger FA values were observed with age in frontal, parietal, and temporal lobes of the left hemisphere. Our results extend previous findings restricted to long range WM to demonstrate regional changes in the microstructure of short range WM during childhood and adolescence. These changes possibly reflect continued myelination and axonal organization of short range WM with increasing age in more anterior regions of the left hemisphere. Hum Brain Mapp 39:204-217, 2018. © 2017 Wiley Periodicals, Inc.

APOL1, CDKN2A/CDKN2B, and HDAC9 polymorphisms and small vessel ischemic stroke.

OBJECTIVE: Worldwide, the highest frequencies of APOL1-associated kidney variants are found in indigenous West Africans among whom small vessel disease (SVD) ischemic stroke is the most common stroke phenotype. The objective of this study was to investigate the association and effect sizes of 23 selected SNPs in 14 genes of relevance, including the APOL1 G1 variants, with the occurrence of SVD ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. MATERIALS AND METHODS: Cases were consecutively recruited consenting adults (aged 18 years or older) with neuroimaging-confirmed first clinical stroke. Stroke-free controls were ascertained using a locally validated version of the Questionnaire for Verifying Stroke-Free Status (QVSFS). Logistic regression models adjusting for known vascular risk factors were fitted to assess the associations of the 23 SNPs in rigorously phenotyped cases (N = 154) of SVD ischemic stroke and stroke-free (N = 483) controls. RESULTS: Apolipoprotein L1 (APOL1) rs73885319 (OR = 1.52; CI: 1.09-2.13, P-value = .013), rs2383207 in CDKN2A/CDKN2B (OR = 3.08; CI: 1.15-8.26, P -value = .026) and rs2107595 (OR = 1.70; CI: 1.12-2.60, P-value = .014) and rs28688791 (OR = 1.52; CI: 1.03-2.26, P-value = .036) in HDAC9 gene were associated with SVD stroke at 0.05 significance level. Polymorphisms in other genes did not show significant associations. CONCLUSION: This is the first report of a specific association of APOL1 with a stroke subtype. Further research is needed to confirm these initial findings and deepen understanding of the genetics of stroke in people of African ancestry with possible implications for other ancestries as all humans originated from Africa.

Axial length/corneal radius of curvature ratio and refractive status in an adult Nigerian population.

AIM/BACKGROUND: Associations between axial length (AL) to corneal radius of curvature (CR) ratio and refractive status in a healthy Nigerian adult population were studied. MATERIALS AND METHODS: Healthy students and members of staff of Obafemi Awolowo Teaching Hospitals Complex, Ile-Ife, South West Nigeria, free of obvious ocular diseases except possible refractive errors were recruited. Consecutive consenting volunteers were recruited by simple random sampling and a proportionate sample of each population based on its representative fraction in the hospital community was recruited. The study was conducted between June and August 2011. Noncycloplegic objective refraction was done and spherical equivalent refraction (SER) of the right eyes was used for calculation. The AL, CR, and keratometric readings were measured with the IOL Master. The AL/CR ratio was calculated. The data were analyzed with statistical software package STATA 13. RESULTS: Three hundred and fifty volunteers aged 18-60 years were studied. The mean ± standard deviation of AL/CR and SER were 3.04 ± 0.10 and -0.38 ± 1.42D, respectively. AL in myopia was significantly higher than in emmetropia and hypermetropia. There were no significant differences between CR in the refraction groups. Myopes had significantly higher AL/CR than nonmyopes. On controlling for age and gender, 1 mm increase in AL increased SER by -0.77D (95% confidence interval [CI] -0.91--0.64D) while a unit increase in AL/CR increased SER by -8.89D (95% CI -10.00--7.78D). Whereas AL accounts for 39% of variability in SER (P < 0.001), AL/CR accounts for 51% of the variability observed in SER (P < 0.001). CONCLUSION: This study has further confirmed that the AL remains a strong determinant of refraction, but a derived factor AL/CR accounts for more variation in final refractive status than AL in isolation.

Visual impairment and blindness in type 2 diabetics: Ife-Ijesa diabetic retinopathy study.

Diabetes and blindness are important health issues globally; we determined the prevalence of blindness, diabetic retinopathy, and other eye diseases in Nigerian-type 2 diabetics. A prospective, cross-sectional study was conducted on consenting type 2 diabetic patients who had scheduled comprehensive eye examination including dilated funduscopy with +78DS. Visual status was graded using the WHO criteria. Approval from Institutional Ethics Committee was obtained. Primary outcome measures were the prevalence and causes of blindness as well as prevalence of diabetic retinopathy. Secondary outcome measures were the presence of other eye diseases. Data were analyzed using SPSS version 13. Two hundred and sixty-six eyes of 133 type 2 diabetic patients aged 22-89 years were studied; 69 (51.9 %) were males while 64 (48.1 %) were females. Five (3.8 %) patients were blind while 27 (20.3 %) were visually impaired. Cataract was the leading cause of blindness (60 %) and visual impairment was found in 59.3 %. Diabetic retinopathy was present in 37 (27.8 %) diabetic patients of which 5 (3.8 %) were proliferative. Diabetic macular edema was present in 31 (23.3 %) patients. Severe visual impairment and blindness were commoner in those with diabetic retinopathy. Refractive error 67 (25.2 %), cataract 63 (23.7 %), and chronic glaucoma 44 (16.5 %) were the most prevalent non-diabetic retinopathy eye diseases. High prevalence of blindness, diabetic retinopathy, and other diseases are seen in type 2 diabetics. Health education, early diagnosis as well as treatment of diabetic retinopathy and other diseases will largely alleviate these ocular morbidities.

Diagnostic accuracy of tru-cut biopsy of breast lumps at University College Hospital, Ibadan.

BACKGROUND: Tru-cut needle biopsies form an integral part of Triple assessment of breast cancer and include clinical assessment, mammography and core needle biopsy. No study has been done to evaluate the validity of the procedure in our environment. This study was done to evaluate the validity of core needle biopsies in our centre. METHOD: A retrospective study of patients with tru-cut needle biopsies of breast lumps and follow-up excisional biopsy or mastectomy done in the Department of Surgery, University College Hospital, Ibadan over a ten year period was done. Fifty one patients who fulfilled the inclusion criteria had their records obtained from the Department of Pathology. The diagnosis was classified into benign and malignant with the excisional biopsy or mastectomy diagnosis used as the gold standard. The sensitivity, specificity and accuracy were calculated and kappa was also done to evaluate the degree of agreement. RESULTS: A total of 51 cases were included in this study. The average age of the patients was 47 ± 13 years with a range from 19 to 81 years. Thirty of the biopsies (59%) had a definitive diagnosis of malignancy while twenty one (41%) were benign. The overall sensitivity, specificity and accuracy were 86%, 71% and 80.4% respectively. The specificity of malignant biopsies was 68% while benign was 35%. The level of agreement for malignant biopsies was higher than benign biopsies with a kappa of 0.39 for malignant diagnosis as against 0.29 for benign. CONCLUSION: Tru-cut needle biopsies have a comparable sensitivity and specificity to excisional biopsies. Diagnostic accuracy can be further enhanced with the adoption of image guided biopsies.

ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES.

BACKGROUND: Ophthalmic surgical procedures are performed under anaesthesia to enhance comfort and cooperation of patient. OBJECTIVE: To review factors influencing the choice of anaesthesia for ophthalmic surgical procedures. DESIGN: Restrospective descriptive study. SETTING: Eye unit of a tertiary hospital. SUBJECTS: All patients who had ophthalmic surgeries in the operating theatre from January 2002 to December 2009. RESULTS: Two hundred and ninety ophthalmic surgeries were carried out during the study period. Age range was 1-95 years and mean of 61.0 ± 1.9; most (55%) were elderly while 4.8% were children. One hundred and fourty seven (50.7%) were males, 143(49.3%) females; male:female of 1.03:1. Local anaesthesia was the more commonly (92.1%) employed while general anaesthesia was used in 23(7.9%) patients. General anaesthesia was used more frequently (71.4%) in children compared to other age groups; the mean age and standard error of means for patients who had general anaesthesia (27.2 /5.4 years) is smaller compared to 63.9/0.93 years for patients who had local anaesthesia (p < 0.0001). Regional anaesthesia was the most frequently used for all types of procedures except for eye wall repairs in which general anaesthesia was used for 71.4% of patients (p < 0.0001). General anaesthesia was indicated in seven (41.2%) of emergency ophthalmic surgical procedures as compared to 16 (5.9%) of elective ophthalmic procedures P < 0.0001. CONCLUSION: General anaesthesia was more commonly employed in children, eye wall repairs and emergency ophthalmic surgical procedures.

Prevalence and pattern of eye disorders among commercial motorcycle riders in Ile-Ife, Osun state.

AIMS AND OBJECTIVES: To describe the prevalence and pattern of eye disorders existing among commercial motorcycle riders (CMRs) in Ile-Ife, Osun State. Materials, Subjects and Methods: A total of 1626 registered CMRs operated in 40 registered motorcycle assembly units in Ile-Ife. Using a multi- staged random sampling technique, a total of 322 riders were randomly selected from 10 units. Equal number of 322 was selected from the sample space as control. Structured questionnaires were administered and ocular examination carried out. RESULTS: SA total of 312 (96.9%) CMRs had normal vision (better than 6/18) in the better eye. The observed prevalence of subnormal visual acuity (<6/18-3/60) was 3.1% (10 CMRs) while prevalence of monocular vision was 2.8% (9 riders). Cataract and glaucoma were the major causes of visual impairment and blindness. The common ocular conditions seen were presbyopia (11.8%), allergic conjunctivitis (11.5%), glaucoma suspect (8.1%), pterygium (4.7%), pingueculum (4.0%), uncorrected refractive error (3.7%) and cataract (2.8%). It was also observed that the longer the years of riding experience of these riders, the higher the occurrence of pterygium with a significant statistical impact of p value of 0.009. Presbyopia was also the commonest disorder amongst the control group (11.2%). CONCLUSION: Presbyopia was the most common finding from the study while the commonest anterior segment disorder was pterygium which was an occupation- related ocular disorder. Causes of blindness seen were avoidable.

BURDEN OF ERECTILE DYSFUNCTION AMONG HEART FAILURE PATIENTS IN A CENTRE IN THE SOUTH-WESTERN NIGERIA: A PILOT STUDY.

Background: Erectile dysfunction (ED) is a common problem among heart failure (HF) patients but is usually ignored in busy clinics in developing countries like Nigeria. Evidence abound that it has a great impact on the quality of life, survival, and prognosis of HF patients. Objective: This study sought to evaluate the burden of ED among HF patients at the University College Hospital, Ibadan. Methods: This pilot cross-sectional study was conducted in the Cardiology clinic of the Medical Outpatient Unit of the Department of Medicine, University College Hospital, Ibadan. Consenting male patients with chronic HF were consecutively recruited into the study between June 2017 and March 2018. The International Index of Erectile Function-version five (IIFE-5) was used to access the presence and degree of ED. Statistical analysis was done with SPSS version 23. Results: A total of 98 patients were recruited with a mean± standard deviation (SD) age of 57.6 ±13.3 years, and age range of 20-88 years. The majority of the participants were married (78.6%), and the mean ± SD duration of HF diagnosis was 3.7 ±4.6years. The overall frequency of ED was 76.5%, and those with previous self-reported ED were 21.4%. Mild erectile dysfunction, mild to moderate erectile dysfunction, moderate erectile dysfunction, and severe erectile dysfunction were present in 24(24.5%), 28(28.6%), 14(14.3%), and 9(9.2%) respectively. Conclusion: Erectile dysfunction is common among chronic heart failure patients in Ibadan. Therefore, adequate attention is needed for this sexual health issue among males with heart failure to improve their quality of care.