Pattern of Right Ventricular Changes in Patients with Uncomplicated Systemic Hypertension at a Tertiary Centre in Southwest Nigeria.

BACKGROUND AND AIMS: Hypertension is an independent risk factor for cardiovascular complications. The effect of systemic hypertension on the right ventricle (RV) has received less attention probably due to its complex structure and location. The aim of the study was to assess the effect of systemic hypertension on the structure and function of the right ventricle using transthoracic echocardiography. METHOD: One hundred hypertensives and 100 healthy controls were recruited into the study. Transthoracic echocardiography was used to measure RV wall thickness (RVWT) in diastole, RV internal dimensions in diastole, tricuspid annular plane systolic excursion (TAPSE), right ventricular filling velocities (TE and TA), and RV systolic excursion velocity (RVSm). These measurements were repeated on the left ventricle. RESULTS: There was significantly thicker RV wall (0.51 + 0.08cm vs 0.44+0.08cm; p=0.001) in the hypertensive group and higher frequency of RV hypertrophy (48.45% vs 18.75%; p<0.001). Tricuspid annular plane systolic excursion (TAPSE) and the tricuspid annular peak systolic excursion velocity (TSm) were significantly lower in the hypertensive group (2.34+0.45cm vs 2.50+0.36cm; p=0.008, and 11.70+3.03cm/s vs 12.60+2.93cm/s p=0.039, respectively), though no participant had abnormal TAPSE. Tricuspid E/A ratio was lower in the hypertensive group (1.13+ 0.33 vs 1.24+0.27; p=0.011). The tricuspid E/A ratio had positive correlation with mitral E/A ratio. CONCLUSION: Right ventricular structural and functional changes are found in systemic hypertension, even in the absence of other systemic complications. These changes could have been mediated by ventricular interdependence and altered humoral factors.

CONTEXTES ET OBJECTIFS: L'hypertension artérielle est un facteur de risque indépendant pour les complications cardiovasculaires. L'effet de l'hypertension artérielle systémique sur le ventricule droit (VD) a reçu moins d'attention probablement en raison de sa structure complexe et de son emplacement. L'objectif de l'étude était d'évaluer l'effet de l'hypertension artérielle systémique sur la structure et la fonction du ventricule droit en utilisant l'échocardiographie transthoracique. MÉTHODE: Cent hypertendus et 100 témoins en bonne santé ont été recrutés dans l'étude. L'échocardiographie transthoracique a été utilisée pour mesurer l'épaisseur de la paroi du VD (EPVD) en diastole, les dimensions internes du VD en diastole, l'excursion plane systolique annulaire tricuspide (TAPSE), les vitesses de remplissage ventriculaire droit (TE et TA), et la vitesse d'excursion systolique ventriculaire droit (RVSm). Ces mesures ont été répétées sur le ventricule gauche. RÉSULTATS: Il y avait une paroi du VD significativement plus épaisse (0,51 ± 0,08 cm vs 0,44 ± 0,08 cm ; p=0,001) dans le groupe hypertendu et une fréquence plus élevée d'hypertrophie ventriculaire droite (48,45% vs 18,75% ; p<0,001). L'excursion plane systolique annulaire tricuspide (TAPSE) et la vitesse maximale systolique annulaire tricuspide (TSm) étaient significativement plus basses dans le groupe hypertendu (2,34 ± 0,45 cm vs 2,50 ± 0,36 cm ; p=0,008, et 11,70 ± 3,03 cm/s vs 12,60 ± 2,93 cm/s p=0,039, respectivement), bien qu'aucun participant n'ait eu de TAPSE anormal. Le rapport E/A tricuspide était plus bas dans le groupe hypertendu (1,13 ± 0,33 vs 1,24 ± 0,27 ; p=0,011). Le rapport E/A tricuspide avait une corrélation positive avec le rapport E/A mitral. CONCLUSION: Des modifications structurales et fonctionnelles du ventricule droit sont retrouvées dans l'hypertension artérielle systémique, même en l'absence d'autres complications systémiques. Ces changements pourraient avoir été médiés par l'interdépendance ventriculaire et des facteurs humoraux modifiés. MOTS-CLÉS: Hypertension ; Échocardiographie ; Hypertrophie ventriculaire droite ; Dysfonction diastolique ventriculaire droit.

Patient and family perceptions of a discharge bedside board.

Objective: To explore patient and family perspectives of a discharge bedside board for supporting engagement in patient care and discharge planning to inform tool revision. Methods: This qualitative descriptive study included 45 semi-structured interviews with a purposeful sample of English-speaking patients (n = 44; mean age 58.5 years) and their family members (n = 5) across seven adult inpatient units at a tertiary acute care hospital in mid-western Canada. Thematic (interviews), content (board, organization procedure document), and framework-guided integrated (all data) analyses were performed. Results: Four themes were generated from interview data: understanding the board, included essential information to guide care, balancing information on the board, and maintaining a sense of connection. Despite application inconsistencies, documented standard procedures aligned with recommended board (re)orientation, timely patient-friendly content, attention to privacy, and patient-provider engagement strategies. Conclusion: Findings indicate the tool supported consultation and some involvement level engagement in patient care and discharge. Board information was usually valued, however, perceived procedural gaps in tool education, privacy, and the quality of tool-related communication offer opportunities to strengthen patients' and families' tool experience. Innovation: Novel application of a continuum engagement framework in the exploration of multiple data sources generated significant insights to guide tool revision.

Clinical and echocardiographic correlates of pulmonary hypertension among heart failure patients in Lagos, south-western Nigeria.

BACKGROUND: Pulmonary hypertension (PH) is very prevalent among heart failure (HF) subjects and is now recognised as an independent predictor of poor prognosis. There is a paucity of data in our environment about the frequency and correlates of PH in HF. We aimed to determine the frequency of PH in HF patients in an academic hospital and assess its correlates using echocardiography. METHODS: A total of 219 heart failure patients in NYHA functional class II to IV, and without co-morbidities that could cause PH, were consecutively recruited. Demographic, clinical and echocardiographic data were obtained from all subjects. RESULTS: The frequency of PH was 38.8%, using an estimated pulmonary artery systolic pressure (PASP) cut-off value of > 36 mmHg. HF subjects with PH tended to be male with a worse NYHA functional class compared with subjects without PH. HF subjects with PH also had significantly higher left ventricular (LV) filling pressures (higher left atrial volume index and E/e' ratio), more severe mitral regurgitation (MR), poorer LV systolic function, and worse parameters of right ventricular (RV) structure and function compared with those without PH. Echocardiographic variables that correlated significantly with PASP include LV filling pressures (p < 0.001 for all), mitral regurgitant volume (r = 0.269, p < 0.001) and LV ejection fraction (r = -0.239, p > 0.001). On multivariate analysis, the left atrial volume index and E/e' ratio were independently associated with PASP. CONCLUSIONS: PH is common among HF subjects in our environment and is associated with higher LV filling pressure, more severe MR, poorer LV systolic function and worse RV remodelling. Routine screening for PH among HF patients is recommended for better risk stratification and management.

Soil transmitted helminth infection among farmers in Ukwa West Local Government Area, Abia State, south-east, Nigeria.

Background: Farmers like most groups of workers are faced with a multiplicity of hazards and biological hazards like Soil Transmitted Helminths - a major Public health problem in the tropical like Nigeria is one of them. This study was to determine the prevalence of Soil-Transmitted Helminths (STHs) infections among farmers in Ukwa West Local Government Area (LGA) of Abia State, South East Nigeria. Methods: Following ethical clearance,290 consenting farmers were recruited to participate in this descriptive cross sectional study. They responded to pre-tested, structured, close ended interviewer administered questionnaires which probed socio-demographics,knowledge and behaviour towards STHs. Also, stool and blood samples were collected from participants and examined for helminth ova and estimation of packed cell volume respectively. A Walk Through Survey of the farms for immediate work place situation and safety was carried out. Collected data were analysed using descriptive and analytical tools. Results: There was a 33.1% prevalence of infection with STHs and a 67.6% prevalence of anaemia among respondents. Hookworm had the highest (59.6%) prevalence just as anaemia amongst farmers with STHs was higher than among respondents who were not diagnosed with the disease. Knowledge of STHs and the availability and use of personal protective equipment (PPEs) were poor. Conclusion: There was a high prevalence of STHs among farmers in Ukwa West Local Government Area of Abia State, South East Nigeria occasioned inter alia by the behaviour and poor use of PPEs. Health Education, routine de-worming and use of PPEs are recommended.

The pattern of distribution of encephalocele in University of Port Harcourt Teaching Hospital--a three year experience.

BACKGROUND: Encephalocele is a congenital anomaly that results from failure of complete neural tube closure during foetal development. It is a known cause of mortality and morbidity in infants. This study was carried out to highlight its distribution pattern in University of Port Harcourt Teaching Hospital over a three-year-period. METHODOLOGY: This is a retrospective study of children with encephalocele admitted from January 2007 to December 2009. The following information were obtained from their medical records: sex, age at diagnosis, distribution pattern, place of origin, detailed antenatal history, maternal occupation/level of education, family history, associated anomalies and outcome of surgery. RESULTS: 17 cases (10 females and 7 males) were seen over this period. 12 presented as frontal encephalocele while 5 were occipital. Their ages at diagnosis were: prenatal (determinded by abdominal ultrasound) 5, 0-6 months 11, and 7-12 months 1. 9 of 17 mothers were unbooked. Pregnancy was uneventful in all cases. None had family history of encephalocele. 5 had multiple anomalies while 12 had only encephalocele. 10 patients had surgery, of which 9 were successful. 1 died in the immediate postoperative period. 7 patients did not have surgery. Among these, 3 died before surgery while the parents of 4 children refused operation. 10 mothers had primary education, 5 secondary, while 2 had attained tertiary education. CONCLUSION: Encephalocele may be frontal or occipital. The distribution pattern of our cases was in favour of frontal location, with slight female preponderance.

Evaluation of the level of awareness of the role of folic acid in the prevention of neural tube defects amongst women of reproductive age in a tertiary health institution.

BACKGROUND: Neural tube defects are major cause of infant mortality and disability. Their occurrence has been linked to folate deficiency during pregnancy. Periconceptional use of folate has been shown to significantly reduce their incidence. Awareness of this relationship is key to adopting appropriate measures to prevent them. This study was carried out to assess the level of this awareness among reproductive-age female employees in a tertiary hospital. METHODOLOGY: Questionnaires designed to assess respondents' knowledge about neural tube defects and folic acid were completed by women of child-bearing age working in various departments of the University of Port Harcourt Teaching Hospital. Data were collated and analysed by a third party who had no knowledge of the respondents. RESULTS: 94.4% of the respondents had some knowledge about folic acid. 29.6% knew something about neural tube defects. 24.1% were aware that folate has a beneficial role in their prevention. 70.4% said they would not take it daily if they were not pregnant. CONCLUSION: The level of awareness about the role of folate in prevention of neural tube defects among respondents in this study is low; and thus there is poor response to suggestions regarding its periconceptional use. There is need to enhance this awareness to ensure that populations at risk benefit from research on the subject.

The treatment of idiopathic edema, a cause of chronic pelvic pain in women: effectively controlled chronic refractory urticaria--case reports.

PURPOSE: To corroborate or refute a previous case report from 20 years ago whether treatment with sympathomimetic amines is effective in controlling chronic urticaria. METHODS: All cases of chronic urticaria in our reproductive endocrinology and infertility practice were identified. All four had been treated with dextroamphetamine sulfate. Quickness and duration of response were then determined. RESULTS: Four women were identified. All showed improvement within the first month. The marked improvement did not dissipate including two patients whose duration of improvement was 8.5 and 13 years, respectively. CONCLUSIONS: Gynecologists should consider idiopathic edema as an etiology when facing chronic pelvic pain and urticaria. Since allergists and dermatologists do not seem to be aware of this treatment option, the initiation of therapy may need to come from the gynecologist.

Evaluation of sperm nuclear morphology in specimens with abnormal sperm chromatin structural assays.

Two recent tests have claimed to identify the subfertile male even when other semen parameters were normal: the sperm chromatin structure assay (SCSA) and abnormal sperm nuclear morphology using much higher magnification. The present study attempted to determine if having a high (> 30%) DNA fragmentation index (DFI), thus resulting in an abnormal SCSA test, is associated with a greater likelihood of sperm with abnormal nuclei. Four males with high DFI scores (57.6%, 65.4%, 31.0%, and 35.3%) had their nuclei evaluated by a complex microscope set-up that magnifies the sperm at least 6000x. The corresponding % of normal nuclei was 0%, 20.0%, 23.7% and 40.0%. The mean and median % of normal nuclei was 20.9+/-16.43 and 21.8, respectively. More studies of similarly matched refractory in vitro fertilization cases, where males have normal DFI scores, are needed to determine if having a high DFI index is associated with a lower percentage of normal nuclei.

An immunohistochemical study in thyroid cancer.

Follicular, papillary, anaplastic and medullary cancers of the thyroid were investigated using immunohistochemical methods. The following antibodies were used: anti-S-100, antineuron-specific enolase (NSE), antikeratin, antithyroglobulin, anticalcitonin, anticarcinoembryonic antigen (CEA), antiepithelial membrane antigen (EMA); the following hormones were also tested in the medullary carcinoma: gastrin, ACTH and serotonin. Papillary and follicular carcinoma in particular reacted with anti-S-100 and anti-NSE; the anaplastic neoplasia reacted with anti-S-100 (25%), anti-NSE (12%), antikeratin (12%), antithyroglobulin (12%), anti-CEA (37%) and anti-EMA (37%). Medullary carcinoma reacted with anticalcitonin (100%), anti-CEA (96%), anti-NSE (79%), anti-EMA (4%) and anti-S-100 (17%). We were not able to correlate the virulence of the medullary carcinoma with the anticalcitonin and anti-CEA reactivity, while the hyperplastic C cells were immunoreactive both with calcitonin or with CEA.