Suspected Conn's Syndrome in A Female Adult Hypertensive: A Case Report.

Background: The presentation of adrenal adenoma with ventricular fibrillation and sudden death is rare. Ventricular fibrillation is the most common cause of sudden death. Coronary artery disease, cardiac valvular or myocardial diseases, and non -cardiac abnormalities may also lead to ventricular fibrillation. We present a patient with recurrent ventricular fibrillation and associated adrenal tumour.Methods: The case records of the index patient and a review of the literature on the subject.Result: A 39 year old hypertensive woman presented in the accident and emergency department of the University of Port-Harcourt Teaching Hospital with a history of extreme weakness and inability to walk of four day duration. While being evaluated, she had a cardiac arrest and was successfully resuscitated. She had two more episodes of cardiac arrest in the Intensive care unit. Investigations revealed ventricular fibrillation from ventricular tachycardia and severe hypokalaemia with metabolic alkalosis. Abdominal CT scan revealed a right adrenal mass. ACTH level, serum and urinary cortisol levels were normal. A diagnosis of Conn's syndrome was made and patient did well on spironolactone and other antihypertensives as she awaits surgery.Conclusion : There is a need for high index of suspicion for the secondary causes of hypertension while dealing with young patients and whenever there is an unusual presentation. This case highlights the need for proper investigation of patients.Key Words: Conn's syndrome; Cardiac Arrest; Adrenal tumor; Nigerian Female

Mortality among Diabetes In-Patients in Port-Harcourt, Nigeria

Background: Diabetes mellitus is a major cause of mortality and morbidity among in-patients in Nigeria. It may result from the acute metabolic complications or from the inexorable effects of chronic complications in the major organ systems. Objectives: This study was to determine the death rates and causes of death among in-patients with diabetes at an urban tertiary hospital in Port-Harcourt. Materials and Methods: The medical records of patients admitted with diabetes mellitus into the medical wards of the University of Port Harcourt Teaching Hospital from 1995-2004 were reviewed. The sources of data were the ward admission, death registers, death certificates and medical records. The annual and overall fatality rates were calculated from the available data. Results: During the period under review, 6,574 patients were admitted into the medical wards. Out of these, 686 (10.4%) were due to diabetes and its complications. The diabetic patients comprised of 428 (62.4%) males and 258 (37.6%) females giving a M:F ratio of 1.7:1. One hundred and eighteen of the diabetic patients died giving a case fatality of 17.2%. The main causes of death were diabetic ketoacidosis (DKA) (21.2%), diabetic mellitus foot syndrome (DMFS) (19.5%) and renal failure (12.7%). Diabetic emergencies accounted for 39.8% of all deaths. Conclusion: Diabetes mellitus is a significant cause of medical admissions in Port-Harcourt. The case mortality is very high especially from acute metabolic causes. There is a need for improved management of diabetes in Nigeria. Keywords: Mortality, Diabetes in-patients, Niger Delta

Situs Inversus in A 53 Year Old Man: A Case Report

Background: Total or complete visceral situs inversus is the complete inversion of position of the thoracic and abdominal viscera. It may be isolated or associated with malformations, especially cardiac or alimentary. It may be discovered in infancy because of associated anomalies but often remains asymptomatic and discovered by chance in adult life.Method: The case records of the index patient and literature review on the subject were utilized.Result: A 53 year old man was referred to the cardiology clinic from the general outpatient department on account of an abnormal ECG. On examination his apex could not be located on the left and was subsequently located on the right 5th intercostal space mid-clavicular line. Examination of the abdomen revealed an inversion of position of the liver and spleen. Chest X-ray showed the heart in the right hemithorax with the cardiac apex pointing to the right, the aortic arch and gastric air bubble were located on the right as well. Lungs and thoracic cage were normal. Echocardiography showed a mirror image dextrocardia. While electrocardiography revealed inverted P waves in lead 1 with predominantly downward QRS complexes in leads 1, V and V . 5 6 Abdominal scan showed mirror-image anatomy of the abdominal viscera.Conclusion: Situs inversus totalis though a rare condition, should be sought for when clinical and radiologic findings indicate dextrocardia, especially as it may be an incidental finding.Key Words: Dextrocardia; Situs Inversus; Totalis; Nigerian male

Pattern of non-communicable diseases among medical admissions in Port Harcourt, Nigeria.

To determine the pattern of non-communicable diseases in themedicalwards of the University of Port Harcourt Teaching Hospital (UPTH), over four consecutive years (June 2000 to June 2004). The study was retrospective and datawere obtained from themedical registers in themedicalwards and the records department of the UPTH. Medical admissions due to non-communicable diseases were carefully selected and analyzed. There were 1853 cases of various non-communicable diseases out of a total medical admission of 3294 constituting 56.2% of total medical admissions. Diseases of the cardiovascular, endocrine and renal systems were the most prevalent constituting 35.7%, 18.5% and 16.8% respectively. Hypertension, diabetes mellitus, and chronic renal failure were the most common cardiovascular, endocrine and renal disorders respectively Non-communicable diseases are a major cause of morbidity in Port Harcourt. There is need for adequate health education and lifestyle modification to reduce the burden of non-communicable diseases in Nigeria. Keywords: Non-Communicable Diseases; Medical Admissions; PortHarcourt Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.14-1

Carcinoid syndrome

No Abstract

Holistic approach to prevention and management of type 2 diabetes mellitus in a family setting

Sandra N Ofori, Chioma N Unachukwu Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria Abstract: Diabetes mellitus (DM) is a chronic, progressive metabolic disorder with several complications that affect virtually all the systems in the human body. Type 2 DM (T2DM) is a major risk factor for cardiovascular disease (CVD). The management of T2DM is multifactorial, taking into account other major modifiable risk factors, like obesity, physical inactivity, smoking, blood pressure, and dyslipidemia. A multidisciplinary team is essential to maximize the care of individuals with DM. DM self-management education and patient-centered care are the cornerstones of management in addition to effective lifestyle strategies and pharmacotherapy with individualization of glycemic goals. Robust evidence supports the effectiveness of this approach when implemented. Individuals with DM and their family members usually share a common lifestyle that, not only predisposes the non-DM members to developing DM but also, increases their collective risk for CVD. In treating DM, involvement of the entire family, not only improves the care of the DM individual but also, helps to prevent the risk of developing DM in the family members. Keywords: cardiovascular disease, multifactorial managemen

The pattern and distribution of communicable diseases among medical admissions in Port Harcourt, Nigeria

Background: Global and regional estimates show that non-communicable diseases are rising in importance relative to other causes of ill health as populations age and the fight continues against communicable diseases. However, communicable diseases remain a major cause of mortality and morbidity in the developing world. Aim: The study was carried out to determine the pattern of communicable diseases in the medical wards of the University of Port Harcourt Teaching Hospital, (UPTH) over four consecutive years (June2000 June 2004). Methods: The study was retrospective and data were obtained from the medical registers in the medical wards and the records department of the University of Port Harcourt Teaching Hospital. Medical admissions due to communicable diseases were carefully selected and analyzed. Results: There were 1441 cases of various communicable diseases out of a total of 3294 medical admissions constituting 43.8%, while non-communicable diseases accounted for 56.2%.The top ten communicable diseases identified were tuberculosis, HIV/AIDS, septicaemia, lobar pneumonia, acute viral hepatitis, chronic liver disease(viral), enteric fever, malaria, urinary tract infections and amoebic liver disease. Conclusion: Communicable diseases still remain a major cause of morbidity in Port Harcourt hence the double burden of disease. There is need for improvement in housing, provision of portable water, immunization, health education and improved sanitation amongst other social amenities to reduce the scourge of communicable diseases in Nigeria. Port Harcourt Medical Journal Vol. 1(1) September 2006: 52-5

Thyrotoxicosis - A review

Background: Thyrotoxicosis is the clinical and biochemical manifestations of exposure of tissues to excessive quantities of thyroid hormones, specifically free thyroxine (T4 ), tri-iodothyronine (T3) or both. The terms “thyrotoxicosis”, “hyperthyroidism” and “Graves\' disease” are used interchangeably because hyperthyroidism due to Graves\' disease is the commonest cause of thyrotoxicosis. Studies in most countries reveal an increasing incidence of thyrotoxicosis. Aim: To present an update on the causes and management of thyrotoxicosis with emphasis on Graves\' disease. Methods: A review of publications obtained from medline search and Google on “thyrotoxicosis” or “Graves\' disease” or “hyperthyroidism” was done. Results: Graves\' disease constitutes about 70% of cases of thyrotoxicosis.The common clinical features include weight loss despite enhanced appetite, hyperactivity and heat intolerance etc. Features specific to Graves\' disease include ophthalmopathy, pretibial myxoedema and thyroid acropachy. Thyrotoxicosis affects about 1% of women and 0.1% of men globally. It is indicated in most cases by an elevated serum concentration of total T4 and T3 and a suppressed thyroid stimulating hormone (TSH). Thyroid imaging and radiotracer uptake measurements combined with serological data enable specific aetiological diagnosis. The three treatment modalites for Graves\' disease are antithyroid drugs, 131I therapy and thyroidectomy. Conclusion: The incidence of thyrotoxicosis is increasing globally. Optimal clinical and laboratory evaluation of the patient is necessary to identify the cause and institute appropriate therapy. There is need for prospective studies to identify the factors for the observed increasing incidence of thyrotoxicosis in our population. Keywords: Thyrotoxicosis, Hyperthyroidism, Graves\' disease, ReviewPort Harcourt Medical Journal Vol. 2 (3) 2008: pp. 184-19

The bacteriology of diabetic foot ulcers in Port Harcourt, Nigerian

No Abstract. Nigerian Journal of Medicine Vol. 14(2) 2005: 173-17

Case Report: Diabetes Mellitus In An Infant: An Unusual Presentation

No Abstract AvailableNigerian Journal of Clinical Practice Vol.7(2) 2004: 97-9