Tethered Cord Syndrome with Syrinx in A Nigerian Adult Female: A Case Report

Backround: Tethered cord syndrome is a diverse clinical entity secondary to any of a heterogeneous group of spinal disorders that typically occurs in children, but occurs as a rare pathologic entity in adults. The occurrence of tethered cord and spinal cord syrinx in an adult Nigerian is quite rare.Methods: The case record of the patient in review and literature search on the subject of tethered cord syndrome and spinal cord syrinx.Results: A 35 years female Nigerian, admitted into the department of internal medicine of the University of Port Harcourt teaching hospital with one month history of progressive weakness of the lower limbs associated with gradual loss of sensation in legs, urinary incontinence but no fecal incontinence or back pain. There was no history of trauma or chronic cough. Examination revealed reduced power in both lower limbs with loss of peripheral sensation, pain and light touch beginning at the level of L3, power in upper limbs was normal and the cranial nerves were intact. Urogenital and Musculoskeletal systems examination were normal. The respiratory and gastrointestinal systems were all normal. There were no cutaneous stigmata (hypertrichosis). Laboratory investigations showed normal hematological indices. Urinalysis was also normal. An impression of acute transverse myelitis was made. Magnetic resonance imaging showedtethered cord and syrinx in the lumbar region.Conclusion: Tethered cord association with syringomyelia in adults is rare, although with the use of modern imaging tools like MRI, the diagnosis of TCS is no more as rare as it is thought and should be sought for in the appropriate clinical setting.Keywords: Tethered cord; Syringomyelia; MRI; Adult; Nigeria

An Appraisal of Hospital Based Blood Pressure Control in Port Harcourt, Nigeria.

Background: Adequate blood pressure control is a major strategy, in the attempt to reduce the morbidity and mortality of hypertension related cardiovascular disease. The aim of this study was to determine the level of blood pressure control among patients receiving treatment for hypertension in a specialist medical outpatient clinic (MOPD) of The University of Port Harcourt teaching hospital (UPTH).Method: A prospective descriptive cross sectional study was undertaken over three months, to determine the level of blood pressure control among patients receiving treatment for hypertension.Result: Two hundred and seven (207) patients were evaluated. The mean systolic blood pressure of all the study subjects was 149±19.33mmHg while the mean diastolic blood pressure was 93.48±13mmHg. A total of fifty subjects (24.2 %) had controlled blood pressure of less than 140/90mmHg.Conclusion: The percentage of hypertensive patients who achieved adequate blood pressure control is low. There is need to identify impediments to good blood pressure control and deal with them so as to optimize the benefit of antihypertensive treatment.Keywords: Blood Pressure; Control; Port Harcourt Hospita

Gender-Related Differences in the Prevalence of Cardiovascular Disease Risk Factors and their Correlates in Urban Tanzania.

\ud Urban areas in Africa suffer a serious problem with dual burden of infectious diseases and emerging chronic diseases such as cardiovascular diseases (CVD) and diabetes which pose a serious threat to population health and health care resources. However in East Africa, there is limited literature in this research area. The objective of this study was to examine the prevalence of cardiovascular disease risk factors and their correlates among adults in Temeke, Dar es Salaam, Tanzania. Results of this study will help inform future research and potential preventive and therapeutic interventions against such chronic diseases. The study design was a cross sectional epidemiological study. A total of 209 participants aged between 44 and 66 years were included in the study. A structured questionnaire was used to evaluate socioeconomic and lifestyle characteristics. Blood samples were collected and analyzed to measure lipid profile and fasting glucose levels. Cardiovascular risk factors were defined using World Health Organization criteria. The age-adjusted prevalence of obesity (BMI > or = 30) was 13% and 35%, among men and women (p = 0.0003), respectively. The prevalence of abdominal obesity was 11% and 58% (p < 0.0001), and high WHR (men: >0.9, women: >0.85) was 51% and 73% (p = 0.002) for men and women respectively. Women had 4.3 times greater odds of obesity (95% CI: 1.9-10.1), 14.2-fold increased odds for abdominal adiposity (95% CI: 5.8-34.6), and 2.8 times greater odds of high waist-hip-ratio (95% CI: 1.4-5.7), compared to men. Women had more than three-fold greater odds of having metabolic syndrome (p = 0.001) compared to male counterparts, including abdominal obesity, low HDL-cholesterol, and high fasting blood glucose components. In contrast, female participants had 50% lower odds of having hypertension, compared to men (95%CI: 0.3-1.0). Among men, BMI and waist circumference were significantly correlated with blood pressure, triglycerides, total, LDL-, and HDL-cholesterol (BMI only), and fasting glucose; in contrast, only blood pressure was positively associated with BMI and waist circumference in women. The prevalence of CVD risk factors was high in this population, particularly among women. Health promotion, primary prevention, and health screening strategies are needed to reduce the burden of cardiovascular disease in Tanzania.\u

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke — the second leading cause of death worldwide — were conducted predominantly in populations of European ancestry1,2. Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis3, and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach4, we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry5. Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke - the second leading cause of death worldwide - were conducted predominantly in populations of European ancestry(1,2). Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis(3), and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach(4), we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry(5). Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries.</p

Addison's disease presenting as acute chest syndrome: Case report and review of literature

No Abstract. Nigerian Journal of Medicine Vol. 15 (4) October-December 2006: 451-45

Electrocardiographic Evaluation of Structural and Electrical Abnormalities in Nigerians with Undiagnosed Systemic Hypertension

Background: Essential hypertension has emerged as the commonest cardiovascular disorder in developing countries especially in Sub Saharan Africa. Blacks are known to suffer more severe hypertension and develop complications early. Some of the complications of hypertension can be detected early through non-invasive electrocardiography. The aim of this study is to evaluate the hypertension related abnormalities on the electrocardiograph of patients with untreated hypertension. Methodology: A detailed prospective analysis of the electrocardiographic tracing of all patients with untreated essential hypertension at first presentation over a six month period was undertaken. The patients were recruited from the medical outpatient clinic of the University of Port Harcourt Teaching Hospital. Result: A total of eighty three adult Nigerians aged 18years to 90 years who presented with untreated essential hypertension over the six months study period had their ECGs analyzed. There were thirty three males and fifty females (0.7:1), mean systolic blood pressure was 192.78+38.4mmHg and the mean diastolic blood pressure was 116.6+16.9mmHg. Sixty percent (60.22%) had normal rhythm, and forty percent had various rhythm abnormalities, 77.6% had normal axis while 22.4% had left axis deviation, 45.8% had repolarisation abnormalities, 25.3% had evidence of left ventricular hypertrophy and 26.5% had various ventricular arrhythmias. Conclusion: Adult Nigerians presenting with hypertension for the first time have significant rhythm and structural abnormalities that should influence their clinical management and drug treatment choice. ECG is an important investigation and should be a mandatory evaluation for all newly presenting hypertensives. Keywords: Untreated Essential Hypertension; ECG; Port Harcourt; Nigeri

Obesity in Nigeria: Current trends and management

The objective of the study is to review the current knowledge on the problems associated with obesity, as well as the measures and strategies that have evolved in its management. A review of the literature on the subject of obesity, its epidemiology, risk factors, clinical complications and treatment (using Medline computer search). Obesity occurs worldwide and the prevalence is increasing in both developed and developing countries. It has therefore become an important health issue globally because of its negative impact on health especially its contribution to morbidity and mortality in cardiovascular diseases. The development of obesity is a gradual process fuelled by environmental factors, which operate in both developed and developing countries. Its incidence continues to rise globally, but whereas the developed countries are making serious efforts to stem the rising tide, Nigeria, it would appear, is yet to actively join in this campaign.Nigerian Medical Practitioner Vol. 54 (1) 2008: pp. 11-1

Hypertension detection and control in Port Harcourt: knowledge gap factor among primary care physicians

Background: Hypertension detection, awareness and control is low in Nigeria and Africa generally. Several factors, including Physicians' knowledge gap are responsible, but this is not usually emphasized. We sought to identify the role and the degree of knowledge gap in the control and management of hypertension by evaluating basic knowledge in hypertension diagnosis and treatment among a group of primary care physicians attending a continuing medical education program on hypertension. Methodology: A pre-test self-administered questionnaire on knowledge of hypertension diagnosis and treatment among physicians attending a workshop on continuing medical education on  hypertension in Port Harcourt, Nigeria was conducted in June 2013. Post test was also administered. Participants were drawn from both private and public medical practice. The questionnaire contained demographic data and knowledge of diagnosis and treatment of hypertension. The data was analysed with SPSS version  16.0.Results: A total of 30 physicians 8 females (26.7%) and 22 males (73.3%) filled and returned the administered questionnaires out of forty six participants. Age range was 33 to 56 years  mean age was 42.8±7.4 years. Sixteen (53.3%) had knowledge of cut off blood pressure for the diagnosis of hypertension, 10 (33.3%) knew about guidelines for diagnosis and treatment, 18 (60%) knew that diuretics was first line drug in blacks, 10 (33.3%) had knowledge of isolated systolic hypertension.Conclusion: Physicians' knowledge gap in hypertension detection and application of recommended guidelines in its management exist in the group of physicians surveyed and is an important impediment to the control of hypertension in Nigeria. Keywords: Hypertension, Hypertension control, Guidelines, Nigeri

Drug compliance among hypertensive patients in Port Harcourt, Nigeria

No Abstract. Nigerian Journal of Medicine Vol. 14(1) 2005: 55-5