The Burden of Pulmonary Hypertension in Patients with Degenerative Mitral Valve Disease in Enugu South‑East Nigeria: An Echocardiographic Based Study

Background: Pulmonary hypertension is a common complication of degenerative mitral valve disease, and contributes significantly to both morbidity and mortality. The use of medications for reduction of pulmonary pressure in patients is not a common practice by most physicians in this part of the world because of the absence of data on pulmonary hypertension. Aim: The authors set out to find the prevalence of pulmonary hypertension in patients with degenerative mitral valve disease and to determine if there are gender differences in affectation. This will form a basis for future research on the management of pulmonary hypertension in sub‑Saharan Africa. Subjects and Methods: The echocardiographic records of 1390 patients carried out over a period of 4 years were retrospectively reviewed. The examinations were done with a Logic 500 MD echocardiographic machine. Tricuspid valve regurgitation velocity above 250 cm/s defined pulmonary hypertension. Data obtained included presence of degenerative mitral valve disease, pulmonary hypertension, age, and gender. Results: A total of 1390 echocardiogram reports done at Conquest Medical Imaging, Enugu, from July 2009 to August 2013 were retrospectively reviewed. Degenerative mitral valve disease was noted in 18.7% of the patients, (259/1390) made up of 149 males and 110 females with a mean age of 68.3 (14.4) years. Pulmonary hypertension was present in 30% of the patients (78/259) and affected males more than females. Conclusion: Pulmonary hypertension is common in patients with degenerative mitral valve disease in Enugu, and affects males more than females.Keywords: Degenerative mitral valve disease, Nigeria, Pulmonary hypertensio

Financial Development and Economic Growth in Nigeria: A Reconsideration of Empirical Evidence.

This paper empirically investigated the impact of financial development on economic growth in Nigeria during the period 1986 – 2012.To achieve the purpose of this research, we estimated the real GDP as a function of the gross fixed capital formation, financial development (the ratio of private sector credits to GDP), liquidity ratio, and the interest rate. The methods used are: the Ordinary Least Squares (OLS) techniques, Augmented Dickey-Fuller unit root test, Johansen cointegration test, error correction technique, and the Granger causality test. The empirical results revealed that: all the variables used are integrated of the same order, I(1); there is evidence of the existence of a long run relationship among the variables used; the normalized cointegration coefficients revealed that financial development affects economic growth negatively in the long run. However, the short run impact of financial development on economic growth is positive. This goes to show that the finance-led growth hypothesis is valid in Nigeria only in the short run. There is also evidence of stability of both long run and short run relationship between the real GDP and financial development in Nigeria and the adjustment process to restore equilibrium after disturbance is effectively slow (6.50 percent of discrepancies is corrected in each period). Also, causality runs from economic growth to financial development and there is no bi-directional causality between growth and finance which lends support to the demand-leading hypothesis. Based on these findings, the study therefore recommends among other things that: the government should device a means to energise the micro finance sector so as to make credits available and accessible to micro entrepreneurs who are often deprived of credits by the conventional credit markets. This will help boost the private sector development and investment which is the engine of growth. Keywords: Financial Development, Economic Growth, Unit Root, Cointegration, Causality

Cross-Border Transmission of Interest Rate Shocks: A VAR Analysis of the Nigerian Economy

This paper examined if interest rate shocks from the U.S are transmitted to Nigeria. For this purpose, we collected data on four Nigerian variables (real GDP, CPI, exchange rate and interest rate) and two foreign variables (U.S FFR and the world CPI) for the period 1983-2011. The impulse response analysis of our VAR model shows that Nigerian variables respond insignificantly to shocks from foreign variables. We therefore concluded that shocks in Nigeria are basically home-made.  We recommended that monetary authorities in Nigeria should base their policy making on domestic shocks, as considering external factors might mislead them. Keywords: Interest rate shock, International transmission, Nigeria, U.S.A., VAR

An Examination of External Shocks and Government Revenue in Nigeria

This paper investigates the empirical relationship between external shocks and government revenue in Nigeria using cointegration approach and error correction mechanism (ECM). The result of the study confirms a long run relationship between government revenue and the explanatory variables (oil revenue, government expenditure, tax revenue, terms of trade shock and exchange rate). The significance of external shocks and its negative sign shows that external shocks exert substantial pressure and uncertainty on government revenue in Nigeria. The coefficient of oil revenue and its significance also is an indication that oil revenue remains the main determinant of government revenue in Nigeria. Based on these findings, the study recommended among others things that government should intensify committed efforts to diversify its source of revenue. Keywords: External Shock, Government Revenue, Exchange rate and Diversification

Left ventricular systolic function in sickle cell anaemia: an echocardiographic evaluation in adult Nigerian patients.

Background: Reliable diagnostic measures for the evaluation of left ventricular systolic performance in the setting of altered myocardial loading characteristics in sickle cell anaemia remains unresolved. Objective: The study was designed to assess left ventricular systolic function in adult sickle cell patients using non-invasive endsystolic stress \u2013 end-systolic volume index ratio. Methods: A descriptive cross sectional comparative study was done using 52 patients recruited at the adult sickle cell anaemia clinic of the University of Nigeria Teaching Hospital Enugu. An equal number of age and sex-matched healthy volunteers served as controls. All the participants had haematocrit estimation, haemoglobin electrophoresis, as well as echocardiographic evaluation. Result: The mean age of the patients and controls were 23.93 \ub1 5.28 (range 18-42) and 24.17 \ub1 4.39 (range 19 -42) years respectively, (t = 0.262; p= .794). No significant difference was seen in estimate of fractional shortening, and ejection fraction. The cardiac out-put, cardiac index and velocity of circumferential shortening were all significantly increased in the cases compared with the controls. The end systolic stress \u2013 end systolic volume index ratio (ESS/ESVI) was significantly lower in cases than controls. There were strong positive correlation between the ejection phase indices (ejection fraction and fractional shortening) and end systolic stress and ESS/ESVI. Conclusion: The study findings suggest the presence of left ventricular systolic dysfunction in adult sickle cell anaemia. This is best detected using the loading-pressures independent force-length relationship expressed in ESS/ESVI ratio

Arterial blood pressure in adult Nigerians with sickle cell anemia

SummaryAim and objectiveThis study was aimed at comparing the arterial blood pressures in steady state adult sickle cell patients with those of age- and sex-matched healthy controls.MethodsA descriptive cross-sectional study of 62 sickle cell anemia patients and 62 age- and sex-matched healthy controls was carried out in the adult outpatient sickle cell clinics and the cardiac center of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Brachial blood pressures were measured in the right arm in all subjects.ResultsSignificant increase in pulse rate was found in the study subjects (87.68±8.91bpm) compared with the controls (72.13±6.79bpm) (p<0.05). The mean systolic blood pressure was comparable in the two groups. However, the patients had significantly lower diastolic blood pressure, lower mean arterial blood pressure, as well as a higher pulse pressure than the control subjects. Significant correlations were found between blood pressure indices and hematocrit, body mass index, frequency of crisis, and body surface area.ConclusionRelatively lower arterial blood pressure is a significant finding in patients with sickle cell anemia. Hematocrit, frequency of crisis, body mass index, and body surface area are significant determinants of blood pressure indices in sickle cell anemia

Intra‑cardiac masses in adults: A review of echocardiogram records at two echocardiographic laboratories in Enugu, South‑East Nigeria

Background: Transthoracic echocardiography (TTE) is an excellent initial diagnostic technique used to evaluate and diagnose cardiac masses, even though transoesophageal echocardiography (TEE) provides superior image resolution and better visualization of cardiac masses, especially in patients with suboptimal transthoracic echocardiographic studies. TTE is the clinical procedure of choice for identification of left ventricular thrombi. TTE has greater than 90% sensitivity and greater than 85% specificity for detection of left ventricular thrombi and is probably superior to the sensitivity and specificity of TEE, especially for apical thrombi.Aims: The study aimed to identify the common types of cardiac masses and their commonest locations in the heart.Materials and Methods: We did a retrospective review of our echocardiogram reports from May 2003 to July 2012 to identify the frequency of intra‑cardiac masses in adults, as well as the gender distribution and commonest location of these masses.Results: There were 2,814 echo examinations in adults over this period, comprising 1,661 males (59.1%) and 1,153 females (40.9%). Intra‑cardiac masses were found in 20 of these patients representing 0.7% of the study population. Thrombi were the commonest masses noted in our study, and there were more masses in the atria than in the ventricles. The left heart chambers also had more masses than the right heart chambers. There was no sex difference in the frequency of cardiac masses.Conclusion: Intra‑cardiac masses are rare, and transthoracic echocardiography is still valuable in the diagnosis and initial characterization of cardiac masses.Keywords: Adults, echocardiography, intra‑cardiac masses, NigeriaNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Being a PhD student in the age of COVID-19: Reflections from the 2019 Faculty of Education cohort of the University of Ottawa

In March 2020, the University of Ottawa, like many other universities across Canada and the world, transitioned to online learning in response to the global COVID-19 pandemic. This shift resulted in confusion, anxiety, and uncertainty as students had to adjust their schedules, their study habits, and, for some, their living situation. Within the Faculty of Education, the 2019 PhD student cohort wondered how the shift to online learning would affect their work and their research. This paper outlines the experiences of 12 members of this cohort. By writing this paper, we hope to not only share our feelings with other scholars, but to validate the feelings of other students across Canada. Although this paper is intended for graduate students, we feel that the sentiments and experiences expressed here may also offer valuable insight for both University and College administration

The use of plants in the traditional management of diabetes in Nigeria: Pharmacological and toxicological considerations

Ethnopharmacological relevance: The prevalence of diabetes is on a steady increase worldwide and it is now identified as one of the main threats to human health in the 21st century. In Nigeria, the use of herbal medicine alone or alongside prescription drugs for its management is quite common. We hereby carry out a review of medicinal plants traditionally used for diabetes management in Nigeria. Based on the available evidence on the species׳ pharmacology and safety, we highlight ways in which their therapeutic potential can be properly harnessed for possible integration into the country׳s healthcare system. Materials and methods: Ethnobotanical information was obtained from a literature search of electronic databases such as Google Scholar, Pubmed and Scopus up to 2013 for publications on medicinal plants used in diabetes management, in which the place of use and/or sample collection was identified as Nigeria. ‘Diabetes’ and ‘Nigeria’ were used as keywords for the primary searches; and then ‘Plant name – accepted or synonyms’, ‘Constituents’, ‘Drug interaction’ and/or ‘Toxicity’ for the secondary searches. Results: The hypoglycemic effect of over a hundred out of the 115 plants reviewed in this paper is backed by preclinical experimental evidence, either in vivo or in vitro. One-third of the plants have been studied for their mechanism of action, while isolation of the bioactive constituent(s) has been accomplished for twenty three plants. Some plants showed specific organ toxicity, mostly nephrotoxic or hepatotoxic, with direct effects on the levels of some liver function enzymes. Twenty eight plants have been identified as in vitro modulators of P-glycoprotein and/or one or more of the cytochrome P450 enzymes, while eleven plants altered the levels of phase 2 metabolic enzymes, chiefly glutathione, with the potential to alter the pharmacokinetics of co-administered drugs. Conclusion: This review, therefore, provides a useful resource to enable a thorough assessment of the profile of plants used in diabetes management so as to ensure a more rational use. By anticipating potential toxicities or possible herb–drug interactions, significant risks which would otherwise represent a burden on the country׳s healthcare system can be avoided

Management of hypertension in Nigeria: The barriers and challenges

In recent years there has been increasing concern about the growing burden of cardiovascular disease (CVD) in developing countries. Systemic hypertension remains the commonest form of CVD and is identified as a key modifiable risk factor for cardiovascular morbidity and mortality. Primary and secondary prevention of cardiovascular adverse events are public health priorities. This review highlights the potential barriers and challenges to hypertension care in Africa&rsquo;s most populous country, Nigeria, and proffers relevant recommendations