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BACKGROUND: Adolescent substance use is a global concern. Identifying factors associated with it can help in preparing prevention programmes. OBJECTIVES: The objectives were to determine the sociodemographic factors associated with substance use and the prevalence of associated psychiatric morbidity among secondary school students in Ilorin. MATERIALS AND METHODS: Instruments used were a sociodemographic questionnaire, a modified WHO Students' Drug Use Survey Questionnaire, and the General Health Questionnaire-12 (GHQ-12) which was used to determine psychiatric morbidity, using a cut-off score of 3. RESULTS: Substance use was associated with older age groups, male gender, parental substance use and poor relationship with parents, and urban location of school. Reported religiosity did not confer protection against substance use. The overall prevalence of psychiatric morbidity was 22.1% (n= 442). Psychiatric morbidity was more common among users of opioids, organic solvents, cocaine and hallucinogens, with current opioid users having ten times the odds of psychiatric morbidity. CONCLUSION: Factors influencing adolescent substance use serve as a substrate for interventions. A good relationship with parents and teachers are protective factors, while parental substance use calls for holistic psychosocial support. The association of substance use with psychiatric morbidity highlights the need to incorporate behavioural treatment in substance use interventions.

CONTEXTE: La Consommation de Substances Psychoactives chez les Adolescents est une Préoccupation Mondiale. L'Identification des Facteurs qui y sont Associés Peut Aider à Préparer des Programmes de Prévention. OBJECTIFS: Déterminer les facteurs socio-démographiques associés à la consommation de substances psychoactives chez les élèves du secondaire à Ilorin. Déterminer la prévalence de la morbidité psychiatrique chez les étudiants et son association avec la consommation de substances. MATÉRIAUX ET MÉTHODES: Les instruments utilisés étaient un questionnaire sociodémographique, un questionnaire modifié de l'enquête de l'OMS sur la consommation de drogues par les étudiants, et le Questionnaire de santé générale-12 (GHQ-12) qui a été utilisé pour déterminer la morbidité psychiatrique, en utilisant un score seuil de 3. RÉSULTATS: La consommation de substances psychoactives était associée à des groupes d'âge plus élevés, au sexe masculin, à la consommation de substances psychoactives par les parents et à une mauvaise relation avec les parents, ainsi qu'à la localisation urbaine de l'école. La religiosité déclarée ne confère pas de protection contre la consommation de substances. La prévalence globale de la morbidité psychiatrique était de 22,1% (n= 442). La morbidité psychiatrique était plus fréquente chez les consommateurs d'opioïdes, de solvants organiques, de cocaïne et d'hallucinogènes, les consommateurs actuels d'opioïdes ayant dix fois plus de chances de souffrir de morbidité psychiatrique. CONCLUSION: Les facteurs qui influencent la consommation de substances psychoactives chez les adolescents servent de substrat aux interventions. Une bonne relation avec les parents et les enseignants sont des facteurs de protection, tandis que la consommation de substances par les parents nécessite un soutien psychosocial global. L'association entre la consommation de substances et la morbidité psychiatrique souligne la nécessité d'intégrer un traitement comportemental dans les interventions en matière de consommation de substances. Mots clés: Santé des adolescents, médecine des adolescents, services de santé mentale en milieu scolaire, consommation d'alcool avant l'âge légal, toxicomanie, oral, pédopsychiatrie. Traduit avec.

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Objective: The COVID-19 pandemic has had tremendous effect on the medical and scientific community. Measures instituted to curb the spread of the disease such as physical distancing and ban on large gatherings have significantly altered conferencing activities of medical professional associations. With no end in sight to the pandemic, it is certain that medical professional associations may have to make do with purely virtual or hybrid conferencing for some time to come. The objective of this paper is to highlight the benefits, disadvantages and challenges of virtual conferencing Methods: We searched Pubmed, Embase, Scopus, and AJOL databases from January 1, 2021 to December 31, 2021 for publications describing the benefits, disadvantages and challenges of virtual conferencing during the pandemic. This, together with authors' experience formed the resource base for this work. Conclusion: We propose ways the scientific community in Nigeria can maximize the virtual conferencing while the pandemic lasts. We also advocate increased discussion about how to improve the virtual conferencing culture and the development of guidelines for purely virtual or hybrid scientific conferences

Objectif de l'étude: La pandémie de COVID-19 a eu un effet considérable sur la communauté médicale et scientifique. Les mesures instituées pour freiner la propagation de la maladie, telles que l'éloignement physique et l'interdiction des grands rassemblements, ont considérablement modifié les activités de conférence des associations professionnelles médicales. Sans fin en vue de la pandémie, il est certain que les associations professionnelles médicales devront se contenter de conférences purement virtuelles ou hybrides pendant un certain temps encore. L'objectif de cet article est de mettre en évidence les avantages, les inconvénients et les défis de la conférence virtuelle. Méthodes de l'étude : Nous avons effectué des recherches dans les bases de données Pubmed, Embase, Scopus et AJOL du 1er janvier 2021 au 31 décembre 2021 pour trouver des publications décrivant les avantages, les inconvénients et les défis des conférences virtuelles pendant la pandémie. Ceci, combiné à l'expérience des auteurs, a constitué la base de ressources pour ce travail. Conclusion : Nous proposons des moyens pour que la communauté scientifique du Nigéria puisse maximiser les conférences virtuelles pendant la durée de la pandémie. Nous préconisons également une discussion accrue sur la manière d'améliorer la culture des conférences virtuelles et l'élaboration de lignes directrices pour les conférences scientifiques purement virtuelles ou hybrides

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INTRODUCTION: Although the usefulness of plasma brain natriuretic peptide (BNP) in early diagnosis of heart failure has been extensively studied, its value in predicting outcome of these patients has not been fully determined, particularly among African patients. OBJECTIVE: This study was aimed to evaluating the prognostic implications of pre-discharge BNP among hospitalized heart failure patients in Nigeria. METHODS: One hundred consecutive acutely decompensated heart failure patients managed in our center were recruited into the study. All subjects had clinical and echocardiographic evaluation. All had BNP assayed and were followed-up for six months. RESULTS: Fifteen patients (out of 91 who completed the study) died at the end of the study, giving a 6-month mortality rate of 16.5%. The mean BNP among non-survivors (655.0 ± 142.3pg/ml) was higher than survivors (409.7±178.2pg/ml) P <0.001. A plasma BNP level >525pg/ml was 87% sensitive and 75% specific for predicting death within 6-months (AUC0.854,95% CI 0.756-0.951, p<0.001). Kaplan-Meier survival curve also showed six-month survival to be significantly reduced in patients discharged with BNP levels >525pg/ml (57.6%) than in those with levels <525pg/ml (98.3%), p<0.001. CONCLUSION: Pre-discharge plasma BNP>525pg/ml in heart failure patients is predictive of early death within six months.

INTRODUCTION: Bien que l'utilité du peptide natriurétique plasma-cerveau (BNP) dans le diagnostic précoce de l'insuffisance cardiaque ait été largement étudiée, sa valeur pour prédire l'issue de ces patients n'a pas été entièrement déterminée, en particulier chez les patients africains. OBJECTIF: Cette étude visait à évaluer les implications pronostiques du BNP avant la sortie chez les patients hospitalisés pour insuffisance cardiaque au Nigeria. MÉTHODES: Cent patients consécutifs atteints d'insuffisance cardiaque en décompensation aiguë, pris en charge dans notre centre, ont été recrutés dans l'étude. Tous les sujets ont eu une évaluation clinique et échocardiographique. Tous avaient un dosage du BNP et ont été suivis pendant six mois. RÉSULTATS: Quinze patients (sur 91 ayant terminé l'étude) sont décédés à la fin de l'étude, ce qui donne un taux de mortalité à 6 mois de 16,5 %. Le BNP moyen parmi les non-survivants (655,0 ± 142,3 pg/ml) était supérieur à celui des survivants (409,7± 178,2 pg/ml) P < 0,001. Un taux plasmatique de BNP > 525 pg/ml était sensible à 87 % et spécifique à 75 % pour prédire le décès dans les 6 mois (ASC 0,854, IC à 95 % 0,756-0,951, p <0,001). La courbe de survie de Kaplan-Meier a également montré que la survie à six mois était significativement réduite chez les patients sortis avec des taux de BNP > 525 pg/ml (57,6 %) que chez ceux avec des taux < 525 pg/ml (98,3 %), p < 0,001. CONCLUSION: Le BNP plasmatique avant la sortie > 525 pg/ml chez les patients insuffisants cardiaques est prédictif d'un décès précoce dans les six mois. Mots clés: Insuffisance cardiaque décompensée aiguë, pronostic, peptide natriurétique cérébral, mortalité, Nigérians.

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BACKGROUND: Complications of hypertension are particularly common in people of African descent but previous reports had suggested rarity of hypertensive retinopathy in black Africans. We evaluated retinal changes among Nigerian hypertensive patients and determined their relationship with renal function. METHODS: Consecutive Hypertensive patients who were ≥18 years were selected for the study. Socio-demographic characteristics, anthropometric parameters and blood pressure were measured. All patients had ophthalmoscopic examination and retinal changes were graded according to Keith-Wegener's classification. Blood samples were taken for blood urea nitrogen, lipids and C-reactive protein; and urine was collected for creatinine and microalbuminuria. Serum creatinine was determined using modified Jaffe method and estimated glomerular filtration (eGFR) was calculated using MDRD equation: 186 × (Creatinine/88.4)-1.154 × (Age)-0.203 × (0.742 if female) × (1.210 if black). RESULTS: Of the 240 patients studied, 187 (78 %) had one form of retinopathy or the other. While 85 (35.4 %) patients had grade 1 retinopathy, 87 (36.3 %) had grade 2, 13 (5.4 %) had grade 3 and 2 (0.83 %) had grade 4 respectively. Comparison of patients with and without retinopathy showed that, the former were older (p = 0.001) and had longer duration of hypertension (p = 0.001). Similarly, hypertensive patients with retinopathy had higher total cholesterol and low density lipoprotein cholesterol (p = 0.017, p = 0.041 respectively). However, eGFR was lower in individuals with retinopathy (46.2 ml/min/1.73) than those with normal retinal (55.9 ml/min/1.73) findings, p = 0.019. Multi-variable adjusted odds ratios showed increased probability of retinopathy with age (odds ratio-1.08, p = 0.001) and body mass index (odds ratio-1.20, p = 0.013). CONCLUSIONS: Hypertensive retinopathy is a common clinical finding among hypertensive Nigerians and may occur pari passu with renal damage as consequences of long standing hypertension.

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Contribution of left ventricular diastolic dysfunction to adverse events in patients with cardiovascular diseases is increasingly being recognized and individuals with pedigree for hypertension are thought to exhibit anatomic and or functional changes in their left ventricle before they become hypertensive. This study aimed at characterizing left ventricular diastolic function in normotensive offspring of hypertensive Nigerians. Sixty-five offspring of hypertensive parents aged 15-25 years (subjects) with 65-age and sex-matched offspring of normotensive parents (controls) were studied for early makers of hypertensive cardiovascular disease using Doppler echocardiogram. Mean mitral E velocity was reduced (P = 0.01) in the subjects (73.3 ± 12.6 cm/s) compared with the controls (80.2 ± 22.5 cm/s). Similarly, mean S velocity of pulmonary venous flow was lower (P = 0.01) in the subjects than in the controls. Left atrial dimension and mitral E/A ratio in the subjects with left ventricular hypertrophy were higher (P = 0.002, 0.004 respectively) than in the subjects without this abnormality. We concluded that normotensive offspring of hypertensive Nigerians showed early alterations in indexes of left ventricular diastolic filling and these abnormalities were exaggerated in the presence of left ventricular hypertrophy.

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Background: Relationship between type 2 DM and cardiovascular disease (CVD) is well known, with CVD being the most common cause of mortality in diabetics. Significant myocardial injury before overt CVD in DM can be identified early using echocardiography. This study therefore aimed at evaluating left ventricular structure and function of patients with type 2 DM. Materials and Methods: One hundred and fifty adult type 2 DM patients were recruited with 150 age- and sexmatched controls. Patients and subjects with systemic hypertension, pregnancy, sickle cell disease and structural heart disease were excluded from the study. Participants were evaluated clinically; had anthropometric parameters and electrocardiogram taken. Echocardiograms were obtained according to the American Society of Echocardiography (ASE) recommendations. Results: Mean age of the patients (55.4±11.6 years) was similar to that of the control (54.2±9.6 years) (P=0.348) and the duration of DM was 4.53 years. Left ventricular (LV) systolic function was normal in both groups but was higher in patients than controls (ejection fraction=70.3±10.7% and 64.4 ± 9.4%, P =0.001 respectively). The prevalence of LV diastolic dysfunction (LVDD) was 72% in the patients compared with 6% in controls (P=0.001). Patients' age, body weight, duration of DM, LV mass index and left atrial dimension were positive correlates of LVDD while patients' age, weight and left atrial dimension were independent predictors of LVDD. Conclusion: There is high prevalence of alterations in LV structure and function in normotensive type 2 DM; and there is a need for early intervention to prevent overt LV dysfunction

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OBJECTIVE: Microalbuminuria (MA) is a marker of vascular damage and has prognostic implications in hypertension. The objective of this study was to determine if the presence of MA increases the risk of hypertensive retinal damage in nondiabetic adult Nigerians with hypertension. MATERIALS AND METHODS: A total of 96 consecutive newly diagnosed hypertensive patients attending the outpatient clinic and who consented and met the criteria for the study were recruited. There was also the same number of age- and sex-matched normotensive controls. RESULTS: MA was present in 31 (32.3%) of the patients and 6 (6.3%) of the controls. The mean (±SD) ages of patients with and without MA were 52.5 ± 11.9 years and 48.3 ± 13.0 years, respectively. The diastolic blood pressure (P = 0.03) and mean arterial pressure (P = 0.01) were statistically higher in hypertensive patients with MA than in their counterparts without it. Patients with MA were more likely to have hypertensive retinopathy (HRP) than patients without it (71% vs 37%, P = 0.001). Advanced HRP, i.e., Grades III - IV, was more common in patients with MA than in those without it (22.6% vs 1.5%). CONCLUSION: This study shows a high prevalence of HRP in Nigerian hypertensives with MA.

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BACKGROUND: Systemic hypertension is a common cause of left ventricular diastolic dysfunction. However, its prevalence in Nigerians with untreated systemic hypertension is unknown. OBJECTIVE: To determine the prevalence of left ventricular diastolic dysfunction in newly diagnosed Nigerians with systemic hypertension using Doppler transmitral inflow and pulmonary venous flow velocities. METHODS: Two-dimensional echocardiography including Doppler was performed on 150 newly diagnosed cases of systemic hypertension and 150 normotensive controls. They were divided into hypertensives without left ventricular hypertrophy and those with left ventricular hypertrophy based on echocardiographically determined left ventricular mass index. Pulsed Doppler transmitral inflow and the pulmonary venous flow waves were used to categorise the patterns of diastolic dysfunction. RESULTS: The hypertensives and the normotensive controls were comparable in their baseline characteristics. The E/A ratio differed significantly between hypertensives with and without left ventricular hypertrophy and controls (1.00+0.30, 1.04±0.42, 1.33±0.27, p < 0.001). Left ventricular diastolic dysfunction occurred in 62% of systemic hypertension and 11.3% of the controls. Impaired relaxation was the commonest pattern (84.9%) of diastolic dysfunction. CONCLUSION: Our study showed that left ventricular diastolic dysfunction is prevalent in Nigerians with newly diagnosed systemic hypertension and effort should be made to routinely screen for them.

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BACKGROUND: Echocardiography is increasingly being used as a screening test to identify sources of cardiogenic embolism in patients with ischemic stroke or transient ischaemic attack (TIA). However; no consensus exists presently on the utilization of this imaging facility in individuals with stroke. OBJECTIVE: To evaluate the yield of transthoracic echocardiography in patients with ischaemic stroke with a view to providing guidance in its use in clinical management of stroke. METHODS: One hundred and twenty-six consecutive stroke patients with 90 controls were recruited prospectively. Patients were examined echocardiographically for evidence of intramural thrombus; congenital defects; valvular heart disease; wall motion abnormalities and intra-cardiac masses using twodimensional; m-Mode and Doppler facilities. RESULTS: Potential cardiac source of emboli (CSE) was identified in 23.0of the stroke patients. Those who had CSE identified aged 53.0(20.8) years were younger (p=0.0001) than those who did not have CSE; 57.2 (13.5) years. Five (4.0) patients had rheumatic valvular heart disease with demonstrable clots in the left atrium. On the other hand; four(3.2) patients had RHD without thrombi seen. Two patients had biventricular thrombi. One of these patients had giant clots within the ventricles and multiple freely mobile thrombi in right ventricle without obvious cardiac structural defect. CONCLUSION: Young stroke or transient ischaemic attacks patients who have clinical signs suggesting the heart as the potential CSE should have low threshold for echocardiography. However; there is a need for rationalisation of request for echocardiography where such clinical signs are absent

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BACKGROUND: The heart rate corrected QT interval (QTc) on the electrocardiogram (ECG) has been proposed as a risk factor for ventricular arrhythmias and death in apparently healthy populations, patients with myocardial infarction and diabetes mellitus. However, data on the significance of QTc prolongation in heart failure are scarce. OBJECTIVE: Our objective was to examine the prevalence of QTc prolongation in adult Nigerians with heart failure and its association with arrhythmias. METHODS: Ninety consecutive patients with heart failure were recruited along with 90 age-and sex-matched controls. All the subjects had a 12-lead ECG and a rhythm strip (lead II). The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using a 2D guided m-mode and Doppler echocardiogram respectively. RESULTS: The mean age of the patients was 51.9 (16) years compared with 50.3 (15.2) years for the control group, p = 0.47. Mean left ventricular ejection fraction was significantly lower in the patients than in the controls (38.9 (11)% versus 72.2 (8)%), p = 0.001. The mean QTc was significantly prolonged in the patients than in the controls (0.472 (0.036) versus 0.390(0.032) respectively), p = 0.001. The prevalence of QTc prolongation was 63% in the patients against 4.4% in the controls. There was a significant association between ventricular arrhythmias and QTc prolongation. CONCLUSION: The results of this study shows that there is a high prevalence of QTc prolongation in adult Nigerians with heart failure and this may be harbinger for ventricular arrhythmias and sudden death.

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BACKGROUND: Stroke occurs commonly in individuals above 65 years, especially in the background of atherosclerosis and other risk factors. In young persons below 45 years it is a rare disorder with devastating sequelae on the affected individual. OBJECTIVE: Presently there are few reports on the aetiology/risk factors for stroke in young adults in Nigeria. This is due to limited facility for thorough investigation; therefore management of such cases poses a diagnostic challenge. In this report we present a case of embolic stroke in a male undergraduate that began with two brief episodes of transient left sided weakness before a completed stroke four hours later. 2-D echocardiography showed that the likely source of emboli to be a non-pedunculated left atria tumour attached to the root of posterior mitral valve leaflet. CONCLUSION: Intracardiac mass should be considered a possible risk factor for ischemic stroke in young adult, especially in the absence of other risk factors such as connective tissue disorders, HIV/AIDS, hemoglobinopathy or use of recreational drugs. High index of suspicion is required in order not to overlook such source of emboli. Early diagnosis offers the best panacea for a definitive therapy and prevention of stroke recurrence with its devastating sequelae.

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BACKGROUND AND OBJECTIVES: Prognostic survival studies for heart-rate corrected QT interval in patients with chronic heart failure are few; although these patients are known to have a high risk of sudden cardiac death. This study was aimed at determining the mortality risk associated with prolonged QTc in Nigerians with heart failure. MATERIALS AND METHOD: Ninety-six consecutive patients with heart failure were recruited with 90 age and sex-matched controls. All the subjects had a 12-lead electrocardiogram at a paper speed of 25 mm/sec and a rhythm strip (lead II) at 50 mm/sec. The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using 2D guided M-mode and Doppler echocardiogram respectively. They were followed-up for six months. RESULTS: Ninety-one patients and 90 controls completed the study. Five patients were lost to follow-up. The mean age (51.9 +/- 16 years) of the patients was similar to that of the controls (50.3 +/- 15) (P = 0.475). Twenty-eight (30.8%) patients died after 6 months of follow-up against none of the controls. The mean QTc was significantly longer in the non-survivors (0.494 +/- 0.027) than in the survivors (0.462 +/- 0.035) (P = 0.0001). The percentage mortality in patients with prolonged QTc against those with normal QTc was 41% and 14% respectively (P = 0.001). In the stepwise regression analysis, QTc was an independent predictor of mortality (R = 0.412, R2 = 0.17, P= 0.001). CONCLUSION: QTc prolongation is a predictor of mortality in CHF and may be an important adjunct in risk stratification of patients with heart failure.

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OBJECTIVE: To determine the prevalence of both systolic and diastolic hypertensions in relation to age and their impacts on target organ among adult Nigerians with hypertension. DESIGN: Observational study. PLACE AND DURATION OF STUDY: The Cardiovascular Clinic of the University of Ilorin Teaching Hospital, Nigeria, from July 2002 to June 2003. PATIENTS AND METHODS: Newly diagnosed adult hypertensives, with blood pressure >or= 140/90mmHg, taken twice with mercury column sphygmomanometer at 3 weeks interval, were studied. The total number of hypertensive patients treated over this period was also taken into consideration. The newly diagnosed hypertensives were classified using JNC VI classification. The frequency of occurrence of target organ damage such as Left Ventricular Hypertrophy (LVH), heart failure, renal impairment etc. was charted according to systolic and or diastolic pressures. The occurrence of systolic or diastolic blood pressure was also related with the age of the patients. Blood metabolic parameters were compared in both systolic and diastolic blood pressures for their possible contributory role. RESULTS: Two thousand seven hundred and ninety-two adult hypertensive patients were managed over the study period. Of them, 218 (7.8%) were newly diagnosed and studied. There were 94 males and 124 females. Seventy-seven (35.3%) were aged 60 years and above with equal frequency in the gender. One hundred and seventy-eight (81.7%) cases had combined systolic and diastolic pressures. Twenty-nine (13.3%) patients had systolic hypertension. Twenty-five (86.2%) of these 29 were aged 50 years and above and 20 (69.0%) were aged 60 years and above. Eleven (5.0%) patients had isolated diastolic hypertension and they were all in the age bracket 40-49 years. Systolic blood pressure was found to be rising with advancing age while diastolic blood pressure peaked at mid 40's and declined. Target organ damage occurred more frequently with systolic hypertension and advancing age than with diastolic hypertension. CONCLUSION: Systolic hypertension occurred more frequently in this series of adult Nigerians with hypertension. It was higher with advancing age and associated with more target organ damage than the diastolic hypertension.

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Seventy adult Nigerians with hypertensive heart disease (HHD) and 68 healthy controls were studied for ventricular arrhythmias (VA). The roles of QT prolongation and left ventricular hypertrophy in these arrhythmias were received. The mean age of the study population was 49.9 +/- 6.0 years. 14 (20.0%) patients had cardiac arrhythmias with 3 patients having premature ventricular contractions (PVC). Ten (14.3%) cases had QTc prolongation out of which 1 patient had PVC. Some factors that were found to be associated with QT prolongation in HHD include: left ventricular hypertrophy, persistently elevated systolic blood pressure and female gender. There was a positive correlation between left ventricular hypertrophy and QTc prolongation and also between QTc prolongation and frequency of ventricular arrhythmias.

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Type 2 diabetes mellitus and hypertension are independent risk factors for atherosclerotic lesions that are partly linked with dyslipidaemia. This risk is additive when diabetes and hypertension occur concurrently. In order to determine if concurrent type 2 diabetes and hypertension results in putative increases in dyslipidaemia in a Nigerian population, we compared the plasma lipid levels, atherogenic index and prevalence of dyslipidaemia among age and sex-matched indigenous Nigerians with type 2 diabetes, hypertension and concurrent diabetes and hypertension. Age and sex-matched healthy Nigerians that are free of diabetes and hypertension served as controls. The patients as a whole were more likely to have dyslipidaemia than controls (p < 0.05). High-density lipoprotein cholesterol was similar among patients and controls. Mean total cholesterol, high-density lipoprotein cholesterol; low-density lipoprotein cholesterol and triglyceride levels, atherogenic index and prevalence of dyslipidaemia did not differ significantly among patients with hypertension, diabetes, and concurrent hypertension and diabetes (p = 0.99 for each parameter). It is concluded that concurrent hypertension and type 2 diabetes does not result in a more severe dyslipidaemia than when either of the two conditions occurs in isolation. We attribute this to the common pathogenic link between hypertension, diabetes and dyslipidaemia in metabolic syndrome. Evidence, albeit indirect, of this syndrome among native Africans is, therefore, provided.

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Left ventricular hypertrophy (LVH) is considered an independent risk factor even in the absence of systemic hypertension. Electrocardiographic (ECG) LVH with repolarisation changes has been found in some countries to carry more coronary risk than LVH alone. How far this observation is true among adult Nigerians is not known. We therefore decided to study adult Nigerians with ECG-LVH with or without ST-T waves changes and compare them with normal age matched controls (without ECG-LVH) in relation with established modifiable risk factors such as systemic hypertension (BP), body mass index (BMI), fasting blood sugar (FBS) and serum lipids such as total cholesterol (Tc), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglyceride (TG). Adult Nigerians who were consecutively referred to the ECG laboratory were randomly recruited. Three hundred patients were studied. Their blood pressures (BP) as well as body mass indices were recorded after recording their resting 12 read ECG using portable Seward 9953 ECG machine. Their waist-hip ratio (WHR) was also recorded. Blood samples were taken to determine their fasting blood sugar and serum lipids. Their ECG tracings were read by the cardiologists involved in the study while the blood samples were analysed by the chemical pathologist also involved in the study. At the end of the ECG reading, the patients were divided into 3 groups according to whether there was no ECG-LVH (control group A), ECG-LVH alone (group B), and ECG-LVH with ST-T waves changes (group C). One hundred and fifty (50%) patients belonged to group A, 100 (33.3%) patients to group B and 50 (16.7%) group C. Group B patients were found to have higher modifiable risk factors in form of systemic BP. Tc, LDL-C, and WHR compared to group A. However, the group C patients had increased load of these coronary risk factors in terms of BP elevation, higher BMI, FBS, and scrum cholesterol compared to group B. In addition, more female patients were involved in group C. The mean age of group C patients compared to group B was also significantly higher (P<0.001) even though no significant age difference was noted between group C and group A patients. It is concluded that Nigerians with ECG-LVH with ST-T waves changes have increased risk of cardiovascular risk factors compared to normal group A patients and even patients with EGC-LVH (group B) alone. Hence, they represent subset of patients to be aggressively followed up with multiple risk factors intervention.

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One hundred and seven consecutive Black Africans hypertensive heart failure patients made of 52 Gambians and 55 Nigerians (51 males + 56 females) aged 53.6 +/- 12.1 years were followed-up for 12 months or till death. One-year survival curve was determined using Kaplan-Meiers method. The survivors and the deceased were compared using univariate and multivariate analysis. Mean blood pressures were 180.4 +/- 28.2 mmHg (range: 130-250 mmHg) systolic and 117.0 +/- 12.9 mmHg (range: 100-160 mmHg) diastolic. Duration of hypertension ranged from 0.5 to 23 years. The rate of undetected hypertension was 44%. Overall one-year survival rate was 71%. Twenty two percent of deaths occurred within the first 3 months of HHF. One-year survival rate among the survivors of this period was 89.4%. A strong negative correlation existed between cumulative survival and the duration of heart failure (y = 0.9812, x(2) = 0.1173, R = 0.965). Compared to the survivors, the deceased had significantly higher systolic blood pressure (191.9 +/- 32.2 mmHg versus 175.1 +/- 25.2 mmHg; P < 0.05), diastolic blood pressure (123.7 +/- 15.8mmHg versus 114.3 +/- 10.3 mmHg; P < 0.05), cardiothoracic index (69.2 +/- 3.9% versus 66.2 +/- 4.2%; P < 0.05) and serum creatinine (148.6 +/- 42.2 umol/L versus 113.8 +/- 36.4 umol/L; P < 0.05). Compared to the patients aged 40 or more years, patients aged below 40 years had significantly lower one-year survival rate (41.7% versus 74.1%; P < 0.05). One-year survival rate was significantly higher among patients on captopril medication than those without (75% versus 52.6%; P < 0.05). However, only serum creatinine had statistically differing values between the deceased and survivors (df = 1 SS = 10272, F = 7.60, p = 0.007). Basic clinical and biochemical parameters could therefore be useful prognostic markers in hypertensive heart failure.

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Arryhthmias can afflict any heart, even in the absence of disease. Given that Cardiac Output (CO) is a product of heart rate and stroke volume, the end-result of brady- and tachy-arrhythmias is the same: low CO with symptoms of low-output state. In bradyarrhythmias, myocardial inotropy operates maximally but the product of stroke volume and slow heart rate yields a low CO. In tacharryhthmias, myocardial inotropy is redundant because the product of low stroke volume arising from low Diastolic Filling Time (DFT) and heart rate also yields a low CO. The hallmark of extrasystole is the duplex of symptoms: dizziness followed by palpitation.

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Axis deviation is one of the variables most commonly sought for in Electrocardiography (ECG). Although no one doubts the superiority of vector cardiography (VCG) as the most accurate in axis determination, most clinicians adopt the Hexaxial Reference System (HRS) of the 12-Lead ECG (12LS) as the most accessible for routine use. The question therefore arises: How accurate is the HRS? The 12LS and Orthogonal (Frank Lead) ECG (OLS) were recorded in 664 adult Nigerians without heart or metabolic diseases. Their VCG were constructed manually for the QRS complexes. On each subject, QRS axis was determined by three methods: the HRS for the 12LS, the trigonometric method for the OLS and the direction of the maximum deflection vector for the VCG. Axes by the three modalities were analysed and compared statistically as applicable to paired samples. The frontal plane (FP) QRS axis ranged between O degree and +90 degrees in 98.2% of cases by VCG, 96% by the OLS and 93.6% by the 12LS. There was excellent correlation between axes obtained by VCG and OLS (r = 0.85; P < 0.0001). It was lower but highly significant between VCG and the 12LS (r = 0.70; P < 0.0001). In the horizontal plane (HP), the 97 per centile distribution ranged from 240 degrees through 0 degree to 30 degrees; that is, posteriorly and to the left. In the left sagittal plane (LSP), the 95 per centile distribution ranged from 60 degrees counter-clockwise to 210 degrees; that is inferiorly and posteriorly. In a sample of healthy adult Nigerians, the QRS axis by VCG was located posteriorly, inferiorly and to the left. Axis determination by the 12LS is limited to the FP only, and it bears a good correlation with VCG. This commends the H RS as a condonable tool for estimating wave axis routinely and for epidemiologic studies.

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Sickle cell disease (SCD) is predominantly a problem of black community in whom a higher prevalence of hypertension has been reported. Despite these observations, a lower mean arterial blood pressure is observed to be common in homozygous sickle cell anaemia (SCA) patients, especially from outside Africa. In view of the well known diversity in both clinical and haematological presentations of SCD, we have evaluated the effects of sickled haemoglobin on blood pressure distribution in Nigerians with SCA. Arterial blood pressure was measured using mercury sphygmomanometer and the mean arterial pressure calculated in 64 adult Nigerians with SCA and 60 normal individuals. The mean age of SCA group was 22.14 +/- 4.90 years with a range of 18-57 years and in the controls was 27.18 +/- 8.06 years with a range of 18-54 years. The mean values of MAP 72.69 +/- 7.30 mmHg in SCA was significantly lower than 87.25 +/- 9.98 mmHg in the controls p < 0.007. The cause of this observed lower blood pressure in SCA is still speculative. We postulate that the differences in weight between SCA patients and normal individuals may contribute to this phenomenon. However, it is possible that nitric oxide (NO) or endothelial relaxing factor (EDRF) may also contribute to this lower blood pressure and the decrease in peripheral resistance in SCA.

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