Automatic detection of end QRS notching or slurring

The purpose of this study was to define criteria suited to automated detection of end QRS notching and slurring and to evaluate their accuracy. One hundred resting 12 lead ECGs from young adult men, split randomly into equal training and test sets, were examined independently by two reviewers for the presence of such notching or slurring. Consensus was reached by re-examination. Logic was added to the Glasgow resting ECG program to automate the detection of the phenomenon. After training, the automated detection had a sensitivity (SE) of 92.1% and a specificity (SP) of 96.6%. For the test set, SE was 90.5%, SP 96.5%. Two populations of healthy subjects – one Caucasian, one Nigerian – were analysed using the automated method. The prevalence of notching/slurring with peak/onset amplitude respectively ≥ 0.1 mV in two contiguous inferolateral leads was 23% and 29% respectively. In conclusion, the detection of end QRS notching or slurring can be automated with a high degree of accuracy

Knowledge and practice of hypertensive patients as seen in a tertiary hospital in the middle belt of Nigeria

No Abstract

PENENTUAN KRITERIA DESAIN PENGEMBANGAN OBJEK WISATA WADUK SEMPOR DENGAN METODE PARTISIPATORI ERGONOMI

Waduk Sempor adalah objek wisata yang juga dimanfaatkan sebagai sumber mata pencaharian bagi sebagian warga sekitarnya. Saat ini terjadi penurunan jumlah pengunjung yang disebabkan rusaknya beberapa fasilitas penunjang dan persaingan dengan objek wisata lain. Dalam upaya peningkatan daya saing diperlukan pengembangan objek wisata. Berdasarkan hal tersebut maka dalam penelitian ini dilakukan penentuan kriteria desain pengembangan Waduk Sempor. Penentuan kriteria desain dilakukan dengan pendekatan metode Partisipatori Ergonomi, penentukan korelasi dan prioritas kriteria dianilisis menggunakan Partial Least Square (PLS). Hasil strukturisasi  kriteria desain pengembangan Waduk Sempor berdasarkan tingkat signifikansi pengaruh dari nilai tertinggi hingga terendah terdiri dari: daya tarik, akomodasi, fasilitas dan pelayanan wisata, kebersihan, aksesibilitas, keamanan dan keselamatan keamanan, infrastruktur lain

Current trends in the management of acute kidney injury in children

Acute Kidney Injury (AKI) previously known as acute renal failure (ARF) is a common problem in the paediatric emergency wards with infections likesepsis and malaria being the commonest causes in Nigeria. It has been known by various nomenclatures with a lack of standardised definition. This has made comparison of data very difficult. In the last decade, attempts have been made to standardize the definition by developing a classification criterion termed “RIFLE”. This is in turn undergoing variousmodifications with the most recent classification system developed by the Kidney Disease: Improving Global Outcomes (KDIGO). Despite these interesting developments, the basis of these classifications which is the use of serum creatinine measurements is fraught with its own limitations.This has led to discovery of various urinary and serum biomarkers like the cystatin C and neutrophil gelatinase associated lipocalin (NGAL) which appear to have very promising advantages over the well known creatinine measurements. Management of AKI continues to be anticipatory with appropriate fluid therapy and adequate treatment of infections. The benefits of furosemide and dopamine in management are still a constant source of debate. Treatment of life threatening complications like hyperkalaemia and hypertension as well as maintaining the kidney through the period of non-function can lead to remarkable recovery of renal homeostatic function.Keywords: acute kidney injury, paediatrics, managemen

The use of first line Highly Active Anti-Retroviral Therapy (HAART) is not associated with QTC prolongation in HIV patients

 Background: HAART has improved survival of HIV patients. Its contribution to the development of new cardiovascular abnormalities has generated much interest. This study aimed at determining the prevalence of QTc prolongation among HIV patients and determining the influence if any of the use of HAART on the QTc and on the risk of having QTc prolongation.Materials and Methods: One hundred and fifty HIV positive subjects comprising 76 HIV positive subjects on HAART (Group A), 74 who were HAART- naïve (Group B), and 150 age and sex-matched healthy controls (Group C) were studied. All subjects had electrocardiography, and QTc duration was calculated.Results: Mean QTc was significantly different among the three groups (P <0.001), highest in Group B > Group A > Group C. Frequency of QTc prolongation was highest in Group B (32%)>, Group A (17.3%)> Group C (4.7%) (P<0.001). Mean QTc was significantly longer among patients with CD4 count <200 cells/mm3 than among those with >200 cells/mm3 0.445 + 0.03secs vs 0.421 + 0.03secs (P<0.001). QTc prolongation was commoner among individuals with CD4 count <200 cells/mm3 50% vs 20.5% (P<0.001). On binary logistic regression, none of the HAART medications used by our patients was predictive of the occurrence of QTc prolongation.Conclusion: The QTc is longer, and QTc prolongation occurs more frequently in HAART-naïve HIV patients than patients on HAART and healthy controls. None of the HAART medications used by our patients was predictive of the development of QTc prolongation. Keywords: QTc prolongation, HIV/AIDS, Highly Active Anti-Retroviral Therapy (HAART

Symmetrical peripheral gangrene in a child following severe malaria with concomitant sepsis

Symmetrical peripheral gangrene (SPG) is a welldocumented but rare clinical syndrome characterized by symmetrical distal ischemic damage  leading to gangrene of two or more sites in the absence of large vessel obstruction or vasculitis. The aetiological factors responsible for SPG are vast and it could follow many common diseases such as malaria. This is a report of a 9month old child who developed symmetric peripheral gangrene following severe malaria (severe anaemia) and sepsis. Gangrene involved the 2nd to the 5thdigits and 3rd and 4thdigits of the left and right hands and all the toes. Autoamputation of the affected digits followed several weeks after discharge and was limited to the distal  interphalangeal joints. There is the need for a high index of suspicion, early detection and prompt management of patients with disorders associated with SPG in order to limit the risk of permanent disability in otherwise treatable diseases. Key words: peripheral, gangrene, malaria, chil

Challenges in the Management of Mucopolysaccharidosis Type II (Hunter’s Syndrome) in a Developing Country: a Case Report

BACKGROUND: Mucopolysaccharidosis type II (Hunter's syndrome) is an X-linked chromosomal storage disorder due to deficiency of the lysosomal enzyme iduronate-2-sulfatase with patients rarely living till adulthood. Failure to identify patients early could contribute to an increased morbidity as identified in this case report.CASE DETAILS: An eight year old patient with Hunter's syndrome identified five years after disease onset with severe cardiovascular complications exemplifies the challenges faced in resource-limited countries towards making diagnosis and treatment of rare conditions. Elevated urinary glycosaminoglycans levels or a strong clinical suspicion of Hunter's syndrome, as identified in the index case, is a prerequisite for enzyme activity testing. Urinary mucopolysaccharide(MPS) level was 69.6mg/mmol(normal range is 0.0 - 11.6mg/mmol), and the confirming MPS electrophoresis analysis showed elevated heparan sulphate in the urine sample. Enzyme activity testing, with absent or very low iduronate-2-sulfatase activity, is diagnostic. However, the scarce availability and high cost of these tests is another constraint in making a diagnosis.CONCLUSION: Identification and management of mucopolysaccharidosis type II pose a problem in resource-constrained countries due to late presentation, lack of facility for diagnosis and treatment, cost and expertise required for the management.KEYWORDS: Mucopolysaccharidosis, Hunter's syndrome, Mucopolysaccharid

Angiotensin Converting Enzyme- Inhibitors Associated Cough: A Prospective Evaluation in Hypertensives

Background/Objective: To determine the prevalence of ACE-Is induced cough among Nigerian hypertensives and evaluate any association with patients' age or sex. Methods: A prospective case-control study.One hundred and sixty-eight hypertensive patients on angiotensin converting enzyme-inhibitors (ACE-Is; captopril and lisinopril) were matched in age and sex with controls that were on anti-hypertensives that excluded ACE-Is (nifedipine, aldomet and moduretic). Both groups of patients were followed up on either drug as a monotherapy over an average of 9 months. Results: The prevalence of ACE-Is induced cough was 20.2%, while that of the alternative group was 0.6%. There was a significant statistical difference between ACE-Is and the alternatives medications-induced cough: OR=42.37(95%CI; 6.11-843.32), P< 0.0001.There was however, no significant statistical difference between captopril and lisinopril-induced cough, OR=1.30 (95%CI;0. 6-2.81), P value=0.587 and no significant age or sex differences were observed in the occurrence of cough; OR=0.97 (95%CI; 0.52-1.81), P value= 0.95 and OR=0.79(95%CI; 0.27-2.28), P value=0.808 respectively. Conclusion: Cough complicating ACE-Is therapy is not uncommon; however, it has no link with the patients' age or sex.Fond/Objectif : Pour d\ue9terminer la pr\ue9dominance de la toux induite de ACE-Is parmi des hypertensifs nig\ue9rians et \ue9valuer n'importe quelle association avec l'\ue2ge ou le sexe des malades. La m\ue9thode : une \ue9tude \ue9ventuelle de cas commande.cent et soixante-huit de malades hypertensifssur inhibiteurs de l'enzyme de conversion de l'angiotensine(ACE-Is : captopril et lisinopril) ont \ue9t\ue9 \ue9gal\ue9 en l'\ue2ge et en sexe avec les contr\uf4les qui \ue9taient sur anti-hypertensifs excluant l'ACE-Is (nif\ue9dipine, aldomet et modulatoire). Les deux groupes de malades ont \ue9t\ue9 observ\ue9s sur la drogue comme une monoth\ue9rapie par-dessus une moyenne de 9 mois. R\ue9sultats : la pr\ue9dominance de la toux induite d'ACE-Is \ue9tait 20,2 %, pendant que celle du groupe alternatif \ue9tait 0,6 %. Il y avait une diff\ue9rence statistique significative entre l'ACE-Is et la toux induite m\ue9dications alternatives : OR=42.37 (95%CI; 6.11-843.32), P <0.0001. Il y avait pourtant, aucune diff\ue9rence statistique significative entre captopril et latoux induite lisinopril, OR=1.30 (95%CI; 0. 6-2.81), P valeur=0,587 et aucun \ue2ge significatif ou diff\ue9rences sexuelles n'a \ue9t\ue9 observ\ue9 dans l'occurrence de toux; OR=0.97 (95%CI; 0.52-1.81), P valeur = 0.95 et OR=0.79 (95%CI; 0.27-2.28), P valeur=0.808 respectivement. La conclusion : la Toux compliquant de la th\ue9rapie d'ACE-Is n'est pas rare ; cependant, il n'a pas de lien avec l'\ue2ge ou le sexe des malades

Antihypertensive Therapy Among Hypertensive Patients as Seen in the Middle Belt of Nigeria

Background: In spite of increased awareness on hypertension among Nigerians, control of blood pressure among hypertensive patients is still unacceptably poor. This study was therefore designed to assess the compliance rate to antihypertensive therapy among Nigerians and factors influencing it. Method: Two hundred and twenty four consecutive hypertensive patients were prospectively studied using a pre-tested questionnaire. Results: A total of 100 males (44.6%) and 124 females participated in the study. The age ranged between 35-82 years. Calcium channel blockers were the most frequently prescribed medication (39.3%) followed by diuretics (14.3%). Combination therapy was seen in 35.7% of the patients. B-blockers were the rarest drug as a single agent (1.8%). Using multivariate analysis, access to the hospital was the only independent predictor of Systolic Blood Pressure level. 39.3% of the respondents volunteered history of having stopped their drugs at one time or the other over a one year period for different reasons with high cost and scarcity of drugs being the most prevalent. 85.7% of the patients spent between two hundred and two thousand Naira monthly on drug procurement. Conclusion: Calcium channel blockers are rapidly gaining ground as first line antihypertensive agents in tertiary hospitals in Nigeria. This study has underscored the need to bring health care centres closer to the people in a bid to improve the control of blood pressure