The clinical utility of echocardiography as a cardiological diagnostic tool in poor resource settings

Background: There has been a decline in the auscultatory and other clinical skills of physicians especially in developed countries. The advent of echocardiography has revolutionized the diagnosis of cardiovascular diseases and made up for the decline in clinical skills.Objective: To assess the sensitivity and specificity of auscultatory and clinical skills in the diagnosis of cardiovascular diseases using echocardiography as the gold standard.Materials and Methods: All the adult echocardiographic studies (321) performed over a 1.year period were collated for analysis. The clinical indications of the studies were compared with the final diagnoses by echocardiography. The sensitivity and specificity of the clinical diagnosis of hypertensive heart disease (HHD), rheumatic heart disease (RHD), and the cardiomyopathies were determined.Results: Of the 244 (76.0%) clinically diagnosed as HHD, 188 (58.6%) were confirmed by echocardiography. For RHD 9 (2.8%) were diagnosed clinically while on echocardiography, 13 (4.1%) were diagnosed. All the 31 (9.7%) cases of dilated cardiomyopathy were confirmed on echocardiography. No case of ischemic heart disease was confirmed.Seventy.one (22.0%) had normal studies. The sensitivity of clinical  diagnosis for RHD was low (41.7%) while for HHD and dilated  cardiomyopathy, sensitivity was high, 95.7% and 75.0%, respectively. Specificity was high for all three cardiovascular diseases analyzed.Conclusion: Auscultatory and clinical skills are still sensitive and specific tools in the diagnosis of cardiovascular diseases in developing countries and should be sustained. However, echocardiography is indispensable in the diagnosis of cases with subtle clinical signs and should be made more available and affordable.Key words: Cardiovascular diseases, clinical diagnosis, echocardiograph

Heart Failure among Paediatric Emergencies in Calabar, South Eastern Nigeria

A study of heart failure among paediatric emergencies in the University of Calabar Teaching Hospital, Calabar, was prospectively carried out over a period of 9 months in the Children's Emergency Room (CHER). Two hundred & thirty four out of 1512 admissions presented with heart failure giving a prevalence of 15.5%. The main causes of heart failure among the 234 children were anaemia (73.1%), pneumonia (17.5%) and ventricular septal defect (3,8%). Pneumonia (61% of cases) and ventricular septal defect (78%) of cases) were largely encountered in infants. Majority (69%) of the patients with anaemic heart failure were aged between 1 and 5 years. The main diseases associated with anaemia were malaria (73.9%), sickle cell anaemia (12.5%) and septicaemia (6.3%). Heart failure constituted 1.7% (26 out of 1512) of total deaths in CHER during the period. The fatality rates for patients in whom heart failure complicated anaemia, pneumonia and ventricular septal defect were 9.9%, 12.2% and 44.4% respectively. Most of the deaths (77%) occurred within the first 24 hours of hospitalization. Anaemia and acute respiratory infections, which are the leading causes of heart failure in our children, must be promptly identified, treated and prevented. Key Words: Anaemia, heart failure, paediatric emergencies, pneumonia, prevalence. Mary Slessor Journal of Medicine Vol.4(1) 2004: 58-6

ASSOCIATION OF ACUTE SORE THROAT WITH GROUP A BETA HEAMOLYTIC STREPTOCOCCI CARRIAGE AMONG CHILDRED IN A PUBLIC SCHOOL IN CALABAR-IMPLICATIONS FOR THE CONTROL OF RHEUMATIC FEVER/RHEUMATIC HEART DISEASE (RH/RHD) IN DEVELOPING COUNTRIES

Two Hundred and Seventeen (217) throat swabs were obtained from apparently healthy children aged 4-13 years attending a public primary school in Calabar, South Eastern Nigeria. The swabs were transported in Staurts transport medium to the Microbiology Laboratory of the University of Calabar Teaching Hospital, Calabar Nigeria and examined bacteriologically using 7% sheep blood agar incubated in 5% carbondioxide environment at 37oC for 48 hours. Seventy one (32.7%) were found positive for Group A beta-haemolytic streptococci (GABHS). Children aged 4-5 years had the highest carriage rate, (45.0%). Carriage rate decreased with age but did not vary significantly with sex. The rate of detection of GABHS was highest among children with current sore throat, (76.9%). Relative risk ratio associating GABHS with acute sore throat was 7.2 (95% C.I, 2.23-0.71). This high odds ratio provides a strong positive predictive index for the diagnosis of GABHS in cases of acute sore throat. These findings further re-enforce the view that the target group for primary prevention of RF/RHD is young school-aged children. We suggest that all cases of acute sore throat in children be treated for GABHS. Control efforts should include improvement in overall living standards, nutrition and integration of primary preventive strategies for RF/RHD into Primary Health Care (PHC) / School Heath programmes. Key Words: Streptococcal throat carriage among Nigerian children. (Global J Med Sci: 2002 1(1): 55-59

Prevalence and pattern of abnormal glucose tolerance in adult Nigerians with primary hypertension

ABSTRACT Background: Hypertension and diabetes mellitus relate to one another aetiologically and prognostically. Studies show that hypertension occurs frequently in diabetics than non-diabetics. Data on the prevalence of abnormal glucose tolerance in hypertensive Nigerians are scanty. This study assesses the magnitude of this problem in adult Nigerians with primary hypertension. Method: Oral glucose tolerance test was performed on 124 adult Nigerians (64hypertensives, 60normotensives) to determine the prevalence of abnormal glucose tolerance. Body mass index and waist circumference were measured. Plasma glucose was analyzed by the glucose oxidase method. Results: The hypertensive(32 males,32females) and normotensive (30males, 30females) had mean ages of 47.6+/-10.1years and 44.2+/-7.6years.The mean body mass index and waist circumference of hypertensives and normotensives were 30.2+/-80kg/m,100.8+/-17.2cm and28.5kg/m,88.5+/-14.1cm. The mean plasma glucose in mmols/l, during oral glucose tolerance test of hypertensives and normotensives, at 0hr, 1hr and 2hrs were,4.79+/-0.99,6.94+/-1.5,5.96+/-1.82 and4.42+/-0.90,6.25+/-1.02,5.05++/-1.8 respectively. The response to glucose load was significantly higher in the hypertensives than normotensives particularly at 2hours

Review of six year cardiovascular mortality at a tertiary hospital in south-east Nigeria

Background: The profile and pattern of cardiovascular mortality continues to warrant ongoing research, in view of ongoing epidemiologic transition. However, the causes, gender distribution, annual incidence as well as the average age at death are important statistics in public health policy formulation.Objective: The aim of this study was to describe the causes of cardiovascular mortality In the Federal Medical Centre, Umuahia with respect to causes, gender, age at death and duration of hospital stay.Methods: We retrospectively reviewed record of mortality seen between February 2002 – December 2008 at the Federal Medical Centre, Umuahiausing the Deaths Register at our Records department.Results: There were 665 cases of cardiovascular mortality, comprising 19.3% of the total number of mortalities. The cardiovascular cases were mainly cases of cerebrovascular accident (60.2%), cardiac failure (27.4%) and hypertensive emergencies (11.4%). Cardiovascular mortalities were more prevalent in males(57.1%). The mean age at death was highest for stroke, 65.0years, likewise the mean duration of hospitalization 6.2 days.Conclusion: Public health attention should be sustained at reducing morbidity and mortality of cardiovascular diseases.Keywords: Six Year Cardiovascular Mortality, Tertiary hospital, South-east Nigeri