Ebstein's Anomaly in a Young Nigerian Lady.

BACKGROUND: Ebstein's anomaly (EA) is a rare congenital heart disease with a wide spectrum of presentation from the womb to adulthood characterized by apical displacement of tricuspid valve leaflets into the right ventricle. This is due to defects in embryological processes of uncertain etiology. CASE SUMMARY: A 28-year-old woman who presented with palpitations from childhood occurring in short paroxysms daily and limiting her from strenuous activities. Physical examination findings revealed a small stature with no associated birth defects. The cardiovascular system revealed tachycardia, a small volume irregular pulse with a split S2 heart sound. ECG showed premature atrial complexes, fragmented QRS with Sodi-Pallares sign, and echocardiographic features in keeping with atrialization of right ventricle with apical displacement of septal leaflet of the tricuspid valve into the right ventricle in keeping with EA. The patient was placed on anti-arrhythmics and anticoagulants. CONCLUSION: The diagnosis of EA in adults is often delayed in low-resource settings for multifaceted reasons. However, medical therapy offers a conservative measure to preserve life while surgical correction is advocated for the majority of cases when picked up early.

CONTEXTE: L'anomalie d'Ebstein (AE) est une cardiopathie congénitale rare caractérisée par le déplacement apical des feuillets de la valve tricuspide dans le ventricule droit. Cette affection se manifeste par un large éventail de symptômes, de la vie fœtale à l'âge adulte, et serait due à des défauts dans les processus embryologiques, bien que son étiologie exacte reste incertaine. RÉSUMÉ DU CAS: Une femme de 28 ans s'est présentée avec des palpitations depuis l'enfance, se produisant en courtes paroxysmes quotidiens et la limitant dans les activités physiques intenses. L'examen physique a révélé une petite stature sans malformations associées. L'évaluation cardiovasculaire a indiqué une tachycardie, un pouls irrégulier de faible volume et un dédoublement du deuxième bruit du cœur (B2). Un ECG a montré des complexes atriaux prématurés, des complexes QRS fragmentés avec un signe de SodiPallares, et des résultats échocardiographiques cohérents avec une atrialisation du ventricule droit et un déplacement apical du feuillet septal de la valve tricuspide, confirmant un diagnostic d'AE. La patiente a été prise en charge avec des antiarythmiques et des anticoagulants. CONCLUSION: Dans les milieux à faibles ressources, le diagnostic de l'AE chez l'adulte est souvent retardé en raison de divers défis. Bien que la prise en charge médicale offre une approche conservatrice pour prolonger la vie, une intervention chirurgicale précoce est recommandée dans la plupart des cas pour obtenir de meilleurs résultats. MOTS-CLÉS: Anomalie d'Ebstein, Rapport de cas, Revue de la littérature.

Artificial Intelligence and Cardiology Practice in Nigeria: Are We Ready?

Cardiovascular diseases are the leading cause of death globally. As cardiovascular risk factors continuously rise to pandemic levels, there is intense pressure worldwide to improve cardiac care in preventive cardiology, cardio-diagnostics, therapeutics, and interventional cardiology. Artificial intelligence (AI), an advanced branch of computer science has ushered in the fourth industrial revolution with myriad opportunities in healthcare including cardiology. The developed world has embraced the technology, and the pressure not to be left behind is intense for both policymakers and practicing physicians/cardiologists in low to middle-income countries (LMICs) like Nigeria. This is especially daunting for LMICs who are already plagued with a high burden of infectious disease, unemployment, physician burnt, brain drain, and a developing cardiac practice. Should the focus of cardiovascular care be on men or machines? Is the technology sustainable in a low-resource setting? What lessons did we learn from the COVID-19 pandemic? We attempt to zero in on the dilemmas of AI in the Nigerian setting including AI acceptance, the bottlenecks of cardiology practice in Nigeria, the role of AI, and the type of AI that may be adapted to strengthen cardiovascular care of Nigerians.

Perceptions of the COVID-19 Vaccine and Willingness to Receive Vaccination among Health Workers in Nigeria: A Cross-sectional Study.

BACKGROUND: COVID-19 vaccine hesitancy is a major barrier to vaccine uptake, and the achievement of herd immunity is required to reduce morbidity and mortality and protect the most vulnerable populations. In Nigeria, COVID-19 vaccine hesitancy has been high, and uptake remains very low. Healthcare workers (HCWs) in Nigeria can help support public health efforts to increase vaccine uptake. AIM: This study evaluates Nigerian HCWs' acceptance and intent to recommend the COVID-19 vaccine. SUBJECTS AND METHODS: Cross-sectional survey among 1,852 HCWs in primary, secondary, and tertiary care settings across Nigeria. Respondents included doctors, nurses, pharmacy workers, and clinical laboratory professionals who have direct clinical contact with patients in various healthcare settings. A 33-item questionnaire was used in the study, with two of the questions focused on the COVID-19 vaccine. The responses to the two questions were analyzed using Chi-square (c2) tests and independent t-tests to determine the acceptance of the vaccine. RESULTS: The majority of respondents were younger than 34 years (n = 1,227; 69.2%) and primarily worked in hospitals (n = 1,278; 72.0%). Among the respondents, 79.2% (n = 1,467) endorsed the COVID-19 vaccine as a critical tool in reducing the impact of the disease, and 76.2% (n = 1,412) will accept and recommend the vaccine to their patients. The younger HCWs were more likely to endorse and recommend the vaccine to their patients. CONCLUSION: There is a moderately high COVID-19 vaccine acceptance rate among HCWs surveyed in our study. The confidence of HCWs in its use and their willingness to recommend it to their patients can provide a potentially useful element in increasing acceptance by the larger population in Nigeria.

The Impact of Co-Morbidities on the Pattern of Blood Pressure Control in Elderly Hypertensives in Nigeria.

INTRODUCTION: The elderly hypertensive patients often have increased prevalence of cardiometabolic risk factors and their attendant co-morbidities. The aim of this study was to determine the prevalence of cardiometabolic risk factors and blood pressure control among elderly hypertensive patients, and to determine the influence of modifiable cardiometabolic risk factors on the control of hypertension among elderly hypertensive patients. SUBJECTS AND METHODS: A case-control comparative and hospitalbased study involving a total of 190 consenting elderly (>65 years), hypertensive patients (subjects) (n=100) and normotensive controls (n=90) was carried out over a period of ten months. Using interviewer-administered questionnaire, biodata and information regarding their lifestyle was obtained. Standard protocols were used to measure blood pressure, weight, height, waist circumference, fasting plasma glucose and fasting lipid profile of the subjects. Body mass index was derived from weight and height. RESULTS: The mean age of the subjects was 71.5 ± 6.3 years and the controls was 72.3 ± 7.2 years. Forty-eight percent (48%) and 47.8% of the subjects and controls were females (p = 0.651). The level of control of hypertension was poor in over two-thirds (68%) of the elderly hypertensive patients. The prevalence of modifiable cardiometabolic risk factors burden was higher in the hypertensive subjects when compared with the controls. Prevalence of Dyslipidaemia was 76% in the subjects and 51% in the controls (p = 0.004). Prevalence of Diabetes Mellitus was 40% among the subjects and 17.8% in the controls (p = 0.0001); prevalence of Obesity was 24% in the subjects and 4.4% in the controls (p=<0.001); prevalence of excess alcohol intake was 49% in the subjects and 14.4% in the controls (p=<0.001). Prevalence of sedentary life style was high in both the subjects (53%) and controls (50%), p=0.679. Poor blood pressure control was predicted by dyslipidaemia and central obesity. CONCLUSION: The level of control of hypertension was poor among the elderly and modifiable cardiometabolic risk factors were relatively prevalent. Central obesity and dyslipidaemia were predictive of poor control of hypertension. Addressing these factors may therefore improve blood pressure control.

INTRODUCTION: Les patients hypertendus âgés présentent souvent une prévalence accrue de facteurs de risque cardiométaboliques et de leurs comorbidités. Le but de cette étude était de déterminer la prévalence des facteurs de risque cardiométabolique et le contrôle de la pression artérielle chez les patients hypertendus âgés, et de déterminer l'influence des facteurs de risque cardiométabolique modifiables sur le contrôle de l'hypertension chez les patients hypertendus âgés. SUJETS ET MÉTHODES: Une étude cas-témoins comparative et hospitalière portant sur un total de 190 patients âgés (e"65 ans) consentants, hypertendus (sujets) (n=100) et témoins normotendus (n=90) a été réalisée sur une période de dix mois. A l'aide d'un questionnaire administré par un enquêteur, des données biographiques et des informations concernant leur mode de vie ont été obtenues. Des protocoles standard ont été utilisés pour mesurer la pression artérielle, le poids, la taille, le tour de taille, la glycémie à jeun et le profil lipidique à jeun des sujets. L'indice de masse corporelle a été calculé à partir du poids et de la taille. RÉSULTATS: L'âge moyen des sujets était de 71,5±6,3 ans et celui des témoins de 72,3±7,2 ans. Quarante-huit pour cent (48 %) et 47,8 % des sujets et des témoins étaient des femmes (p=0,651). Le niveau de contrôle de l'hypertension était faible chez plus de deux tiers (68 %) des patients hypertendus âgés. La prévalence des facteurs de risque cardiométabolique modifiables était plus élevée chez les sujets hypertendus que chez les témoins. La prévalence de la dyslipidémie était de 76 % chez les sujets, 51 % chez les témoins (p=0,004). La prévalence du diabète sucré était de 40% chez les sujets et de 17,8% chez les témoins (p= 0,0001), la prévalence de l'obésité était de 24% chez les sujets et de 4,4% chez les témoins (p=<0,001), la prévalence de la consommation excessive d'alcool était de 49% chez les sujets et de 14,4% chez les témoins (p=<0,001). La prévalence du style de vie sédentaire était élevée chez les sujets (53%) et les témoins (50%), p=0,679. Un mauvais contrôle de la pression artérielle était prédit par la dyslipidémie et l'obésité centrale. CONCLUSION: Le niveau de contrôle de l'hypertension était faible chez les personnes âgées et les facteurs de risque cardiométaboliques modifiables étaient relativement prévalents. L'obésité centrale et la dyslipidémie étaient prédictives d'un mauvais contrôle de l'hypertension. La prise en compte de ces facteurs peut donc améliorer le contrôle de la pression artérielle. Mots clés: Pression artérielle, Facteurs de risque cardiométabolique, Personnes âgées.

Knowledge and utilization of electrocardiogram among resident doctors in family medicine in Nigeria.

BACKGROUND: Electrocardiogram (ECG) is a simple, readily affordable, and noninvasive tool for the evaluation of cardiac disorders. There is a dearth of information on the utility of ECG in general practice in Nigeria. We assessed the knowledge and utilization of ECG among family medicine residents in Nigeria. MATERIALS AND METHODS: A cross-sectional evaluation was conducted between November 2011 and May 2012 in four family medicine training centers in Nigeria. A self-administered questionnaire was used to obtain information from the resident doctors regarding their ECG requests, preferred source of interpretation, most common ECG diagnosis, and update of ECG knowledge. RESULTS: Only 61 out of 120 questionnaires (50.8%) were returned. The respondents were mostly between 31 and 40 years (54.7%) and were predominantly males (73.8%) and senior residents (65.6%). Fifty-four (88.3%) respondents made <5 ECG requests/week, and the most common indication was hypertension (50%). ECG interpretation was either self-reported (41%), by a cardiologist (26.5%), or automated reports (21.3%). Self-reporting of ECG was more common among senior residents (P < 0.01). Left ventricular hypertrophy was the most common ECG diagnosis (55.8%). About 69% of respondents did not update their knowledge of ECG. Most respondents (50%) reported basic interpretation as the aspect of ECG for which further learning was desired. Teaching ECG to resident doctors in the update courses of the postgraduate medical colleges and continuing medical education (CME) activities was adjudged the best way to improve knowledge/utility (61.1%). CONCLUSION: The attitude to and utility of ECG among family medicine residents in Nigeria is poor. Improved knowledge, attitude, and utilization of ECG through curriculum revision, hands-on tutorials, and CMEs are highly recommended.

Relationship between Six-Minute Walk Test and Left Ventricular Systolic Function in Nigerian Patients with Heart Failure.

BACKGROUND: Heart failure (HF) is a major public health problem. The six-minute walk test (6MWT) is a submaximal exercise test performed even by HF patients not tolerating maximal exercise testing. The left ventricular ejection fraction is one of the strongest indicators of mortality in HF. Literature reports that relationship between 6MWT and (Left Ventricular Systolic Function (LVSF) were not homogenous, hence the need for this study. METHODS: One hundred and forty consenting HF patients in NYHA II and III were consecutively recruited after obtaining ethical clearance. The patients were made to walk on a level ground at their own convenient pace while attempting to cover as much ground as possible in six minutes. Echocardiography was also performed on all the patients. RESULTS: Eighty-five (60.7%) were women. The population mean age was 48.2 ± 14.5 years. The average distance walked was 272.2 ± 114.0 meters and the mean ejection fraction (EF) was 36.73 ± 15.04. Patients in NYHA II significantly walked longer than those in NYHA III (334.81 ± 98.80m vs 204.05 ± 87.66m; p<0.001). There was no correlation between the distance walked and LVSF; EF(r = -0.402, P = 0.534), SF (r = -0.128, P = 0.878).The independent predictors of distance walked were sex (p=0.021) and NYHA stage(p<0.0001). CONCLUSION: NYHA stage and sex independently predicted the distance walked in our HF patients. There was an inverse relationship between 6MWT and NYHA, with no correlation between 6MWT and LVSF. 6MWT therefore, appears not to be a good measure of LVSF as assessed by M-mode derived EF, in our HF patients.

Rare intracardiac aneurysms seen in Jos, Nigeria: a report of two cases.

BACKGROUND: Some congenital heart diseases are compatible with early life presenting their peculiar challenges in adulthood. Some of them are particularly rare, and are misdiagnosed in the absence of modern imaging facilities. Intra - cardiac aneurysms fall into this group. OBJECTIVE: The clinical presentation of the cases up to point of sudden death were documented and echocardiography done. RESULTS: Two such cases which were never encountered in over 20 years of echocardiography in our unit are reported. One was a ruptured sinus of Valsalva aneurysm dissecting the interventricular septum and the other ventricular septal defect aneurysm involving the tricuspid valve. CONCLUSION: Some congenital heart diseases present late. Increased availability of echocardiography and skilled personnel should lead to early diagnosis preventing fatality that follows late diagnosis as occurred here.

Liver function test abnormalities in Nigerian patients with human immunodeficiency virus and hepatitis B virus co-infection.

Data on baseline hepatic function of HIV and hepatitis B virus (HBV) co-infected patients are limited in sub-Saharan Africa. We assessed liver function test (LFT) abnormalities in Nigerian patients with HIV/HBV co-infection to highlight the impact of HIV on HBV-related liver disease in sub-Saharan Africa. A cross-sectional study involving 100 HIV/HBV co-infected patients and 100 age- and sex-matched HBV mono-infected controls. Blood testing for HIV antibodies, CD4+ cell count, hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), LFTs, platelet count, fasting blood glucose and lipid profile were carried out. Non-invasive hepatic fibrosis scores (aspartate aminotransferase-platelet ratio index [APRI] and FIB-4) were also calculated. Co-infected patients had deranged liver enzymes more than the controls (77% versus 64%, P = 0.04). The predominant patterns of enzyme derangement in co-infected patients were either predominantly ↑ALP (30% versus 4%, P < 0.0001) or mixed (30% versus 15%, P = 0.01) but predominantly ↑AST/ALT in the controls (25% versus 9%, P = 0.003). Co-infected patients had higher fibrosis scores for both APRI (P = 0.002) and FIB-4 (P = 0.0001). On further analysis, LFT abnormalities and fibrosis scores were only significantly higher in co-infected patients in the immune clearance and HBeAg-negative chronic hepatitis phases. LFT abnormalities are common in Nigerians with HBV infection and co-infection with HIV negatively impacts on hepatic function.