Cardiac tamponade complicating thoracocentesis: a case for image-guided procedure

We present a case of cardiac tamponade that was precipitated by thoracocentesis and discovered at autopsy

Relationship between body mass index, waist circumference, waist hip ratio and erosive gastroesophageal reflux disease in a tertiary centre in Nigeria: A case control study

Background: Gastro-oesophageal reflux disease (GERD) is a condition that develops when the reflux of stomach content causes troublesome symptoms with or without mucosa damage and or complications. GERD is believed to be evolving among blacks.Objectives: The objective of this study was to look at the relationship of GERD to body mass index (BMI), waist circumference (WC), hip circumference (HC) and waist hip ratio (WHR) among patients with distal oesophageal erosive GERD and controls.Methods: A case control study among patients with dyspepsia that had diagnostic upper gastrointestinal endoscopy. Patients with erosive GERD were grouped into cases while those without GERD were controls. GERD was graded using the Los Angeles classification. BMI, WC, HC and WHR were measured among cases and controls. Obesity was defined as BMI ≥ 30 kg/m2 or WC ≥ 88 cm or ≥WHR 0.85 in females and BMI ≥ 30 kg/m2 or WHR ≥ 0.9 or WC ≥102 cm for males. Data were analysed using descriptive and inferential statistics.Results: A total of 160 subjects (80 cases and 80 controls) were analysed. Mean (SD) age for cases was 51.1 (±12.4) years and 50.1 (±13.7) years for controls. When cases with GERD were compared with controls; males were less likely to be obese, BMI < 30 kg/m2, have normal WC, HC and WHR while females were more likely to be obese, BMI ≥ 30 kg/m2 and have increased WC, and HC, (p < 0.05).Conclusion: Central obesity is a risk factor for distal oesophageal erosive GERD among female Nigerians but not among males.Keywords: Gastro esophageal reflux, Central obesity, Dyspepsia, Nigeri

Willingness of Family Caregivers to Consent to Relative’s Postmortem Examination that Die Suddenly in a Nigerian Tertiary Hospital

BACKGROUND: Postmortem examination is necessary to diagnose the cause of sudden death, and family caregivers are expected to consent to this examination. This study assessed knowledge, attitude, practices and willingness of family caregivers to consent to postmortem examination of their relative if they die suddenly in a Nigerian tertiary hospital.METHODS: Descriptive cross-sectional study of family caregivers of our patients that completed an interviewer administered semistructured questionnaire assessing their knowledge, attitude, practices and willingness to consent to postmortem examination of their relative if they die suddenly. Data were analyzed using descriptive and inferential statistics.RESULTS: A total of 224 caregivers were interviewed. The mean age (SD) was 34.95 (11.74), ranging 22-75 years. They were parents (32.6%), siblings (37.9%), spouses (11.2%) and other relatives (18.3%). Only 17% had adequate knowledge, 44.6% positive attitude and 11.2% good practices to postmortem examination of sudden death. The majority (75.9%) would consent to postmortem examination of their relatives if they die suddenly. Sociodemographic variables associated with willingness to consent to postmortem examination after relative’s sudden death include being male (AOR 3.61; 95%CI 3.09-8.92; p=0.001), having tertiary education (AOR 4.83; 95%CI 1.01-8.29; p=0.034), Christianity (AOR 2.59; 95%CI 1.25-5.35; p=0.010) and skilled worker (AOR 1.43; 95%CI 1.33-3.80; p=0.020).CONCLUSION: Some family caregivers would not consent to postmortem examination of their relatives when they die suddenly. Sensitization programs targeting family caregivers are necessary to increase knowledge and enhance prevention of sudden death as well as improve willingness to consent to postmortem examination when their relatives die suddenly

Right atrial myxoma as a possible cause of hemorrhagic stroke and sudden death

Right atrial myxomas are rare primary tumors of the heart. They may remain asymptomatic or eventually cause constitutional signs and symptoms. Less frequently, obstruction of the tricuspid valve occurs, resulting in exertional dyspnea, syncope, or sudden death. Neurological manifestation as initial presentation of atrial myxomas is rarely, if ever, associated with right atrial myxomas and may be secondary to cerebral infarction, cerebral hemorrhage and, more rarely subarachnoid hemorrhage. We review the case of a previously unknown, middle‑aged Nigerian man who presented to hospital with severe headache and sudden loss of consciousness. A clinical diagnosis of hypertensive hemorrhagic cerebrovascular accident was made. The patient died suddenly a few hours after presentation. Post‑mortem examination revealed a small intracerebral hemorrhage in the left superior temporal lobe as well as a large right atrial myxoma, a ventricular septal defect in the muscular septum, and right ventricular hypertrophy. The liver showed fatty change while the kidneys showed evidence of benign nephrosclerosis. Right atrial myxomas may, therefore, be remotely considered as a cause of intracranial hemorrhage, especially in the presence of predisposing cardiac anomalies such as a ventricular septal defect. Similarly, being a known cause of right heart failure, sudden death, and other constitutional derangements, it may contribute significantly to disease outcome. Hence, it should be given due consideration in the differential diagnosis of cerebrovascular accidents.Keywords: Cause and contributor, disease outcome, left hemorrhagic stroke, right atrial myxoma, sudden deathNigerian Medical Journal | Vol. 53 | Issue 2 | April-June | 201

An autopsy review of abdominal injuries resulting from road traffic accidents: The Ile-Ife experience

>Background: Road traffic accidents (RTAs) are a leading cause of blunt force trauma to the abdomen. They remain an important cause of death globally and especially in Nigeria.Aims: The aim was to review the autopsy findings of victims with abdominal injuries following RTAs.Subjects and Methods: The autopsy records and case notes of victims of RTAs fatalities who sustained abdominal injuries over a 10-year period were reviewed. This was carried out at a tertiary health institution in Sub-Saharan Africa.Statistical Analysis Used: Statistical Package for Social Sciences version 15.0.Results: Seventy-six cases were reviewed. The male to female ratio was 4.1:1. The mean age of the victims was 34.2 years while the age range was from 4 to 85 years. The 30–40-year age group accounted for 34.2% of cases. About 53.9% of the victims died at the accident scene, whereas 34.2% died while on hospital admission. About 42.1%, 32.9%, and 21.1% of the victims were passengers, drivers, and pedestrians, respectively. The spleen was injured in 67.1% of cases while the liver and intestines were injured in 22.4% and 15.8% of cases, respectively. Death was due to the combined effects of multiple injuries in 67.1% of cases, whereas 26.3% of victims died as a result of severe hypovolemia.Conclusions: Abdominal injuries in RTAs fatalities are more common in males and the most productive young adult population. The spleen is the most frequently injured intra-abdominal organ. The majority of deaths in this group of patients are due to the combined effects of multiple injuries in various body structure. Rapid management of patients with abdominal injuries is essential and particular consideration must be placed on those injuries involving other body parts