Emmanuel Ejim | University of Nigeria, Nsukka (original) (raw)

Papers by Emmanuel Ejim

Research paper thumbnail of Marfan Syndrome with Aortic Root Disease, Severe Heart Failure and Aortic Dissection- Two Case Reports

Nigerian Journal of Clinical Practice

Marfan syndrome is an uncommon inheritable connective tissue disease which affects the cardiovasc... more Marfan syndrome is an uncommon inheritable connective tissue disease which affects the cardiovascular system. This paper presents two cases of Marfan Syndrome with predominant aortic root disease that were seen at the Cardiology Clinic of University of Nigeria Teaching Hospital, Enugu, Nigeria. Their biography, clinical features and echocardiography parameters were captured using structured questionnaire. Both were young males in their 4th decade of life, and had advanced aortic root diseases which were complicated by left ventricular failure in both, while one of them had aortic dissection and ischemic stroke. Young adult Nigerians with Marfan syndrome presented with advanced aortic root diseases, heart failure, aortic dissection and stroke.

Research paper thumbnail of Review - Cardiovascular endocrinology: shared pathways and clinical crossroads

Research paper thumbnail of Echocardiographic screening for pulmonary arterial hypertension in HIV-positive patients

Infection, 2014

Human immunodeficiency virus (HIV) infection is associated with an increased risk for pulmonary a... more Human immunodeficiency virus (HIV) infection is associated with an increased risk for pulmonary arterial hypertension (PAH). Upon the screening of 220 asymptomatic HIV-positive individuals by echocardiography, we detected and confirmed HIV-associated PAH in 0.45 % of cases. Mild elevations of systolic pulmonary arterial pressure most probably owing to left ventricular diastolic dysfunction were found in 7.7 % of cases, without progress after 2 years. We suggest that the screening of asymptomatic HIV-positive patients for PAH should not be performed.

Research paper thumbnail of Marfan Syndrome with Aortic Root Disease, Severe Heart Failure and Aortic Dissection- Two Case Reports

Nigerian Journal of Clinical Practice, 2022

Marfan syndrome is an uncommon inheritable connective tissue disease which affects the cardiovasc... more Marfan syndrome is an uncommon inheritable connective tissue disease which affects the cardiovascular system. This paper presents two cases of Marfan Syndrome with predominant aortic root disease that were seen at the Cardiology Clinic of University of Nigeria Teaching Hospital, Enugu, Nigeria. Their biography, clinical features and echocardiography parameters were captured using structured questionnaire. Both were young males in their 4th decade of life, and had advanced aortic root diseases which were complicated by left ventricular failure in both, while one of them had aortic dissection and ischemic stroke. Young adult Nigerians with Marfan syndrome presented with advanced aortic root diseases, heart failure, aortic dissection and stroke.

Research paper thumbnail of Echocardiographic Screening for Pulmonary Arterial Hypertension in Nigerian Adults with Sickle Cell Anaemia

College of Medicine, University of Nigeria, 2009

Human immunodeficiency virus (HIV) infection is associated with an increased risk for pulmonary a... more Human immunodeficiency virus (HIV) infection is associated with an increased risk for pulmonary arterial hypertension (PAH). Upon the screening of 220 asymptomatic HIV-positive individuals by echocardiography, we detected and confirmed HIV-associated PAH in 0.45 % of cases. Mild elevations of systolic pulmonary arterial pressure most probably owing to left ventricular diastolic dysfunction were found in 7.7 % of cases, without progress after 2 years. We suggest that the screening of asymptomatic HIV-positive patients for PAH should not be performed.

Research paper thumbnail of Unruptured sinus of valsalva aneurysm, with dissection into the interventricular septum

International Journal of Medicine and Health Development, 2017

Sinuses of Valsalva or aortic sinuses are 3 focal expansions at the root of the aorta and are nam... more Sinuses of Valsalva or aortic sinuses are 3 focal expansions at the root of the aorta and are named right, left and non-coronary sinuses. These sinuses serve as support system for the aortic valve and prevent occlusion of the coronary ostia as the aortic cusps open in systole. Sinus of Valsalva aneurysm (SOVA) is congenital in most cases, due to deficiency of the elastic lamina between the aortic media and the annulus fibrosus. The anatomical location of these sinuses can predict some clinical consequences, when complications occur. We report the case of a 29yr old Nigerian man who presented at the accident and emergency unit of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, with clinical features of heart failure. Electrocardiography showed complete heart block, and later supraventricular tachycardia, while echocardiography showed a right sinus of valsalva aneurysm dissecting into the interventricular septum, without evidence of rupture.

Research paper thumbnail of Atrial Septal Aneurysm in Adults – is It a Degenerative Heart Disease?

Journal of Hypertension, 2021

Research paper thumbnail of Atrial fibrillation cases seen at the University of Nigeria Teaching Hospital, Enugu

International Journal of Medicine and Health Development, 2005

Aim : To determine the incidence of atrial fibrillation (AF) on electrocardiograms (ECG) of patie... more Aim : To determine the incidence of atrial fibrillation (AF) on electrocardiograms (ECG) of patients attending the University of Nigeria Teaching Hospital (UNTH), Enugu. Subjects and Methods : Electrocardiograms done at the UNTH between April and September 2004 were analysed. The patients were mainly in-patients. Further information on the patients were obtained from their medical records. Results : 860 ECGs were studied. 30 of them (3.5%) had atrial fibrillation (AF). Seventeen (56.7%) were males and thirteen (43.3%) females. 66.7% of the cases were aged 50 years and above. In 33.3% of the cases, hypertension was the underlying disease, followed by valvular heart disease (23.3%). Conclusion : The incidence of AF in UNTH was 3.5%. There were more males than females with AF. Most of the cases were in the older age group. Hypertension was the commonest underlying disease. Keywords : atrial fibrillation, UNTH Journal of College of Medicine Vol. 10(2) 2005: 102-106

Research paper thumbnail of Plain chest radiograph in hypertensive patients — An analysis of cases seen in a Tertiary Hospital in Nigeria

International Journal of Medicine and Health Development, 2015

Aim: To analyze the chest findings in patients clinically diagnosed with hypertension at the Univ... more Aim: To analyze the chest findings in patients clinically diagnosed with hypertension at the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Nigeria. Methods: A retrospective analysis of patients who had plain chest radiographs at the UNTH, Ituku/Ozalla, Enugu, Nigeria between 2009 and 2011. Results: Of the 500 patients studied, 60.2% (301/500) were females and 39.8% (199/500) were males. There were 9.8% (49/500) patients with normal chest findings while 90.2% (451/500) had diverse chest findings which included: cardiomegaly 69% (345/500)), aortomegaly 51% (255/500), artheromatous plaque 6.6% (33/500)), upper lobe blood vessel diversion 11% (55/500), and perivascular cuffing 5% (25/500). The remaining 0.8% (4/500) had unrelated chest findings. Conclusion: Simple chest radiograph interpreted by a competent radiologist is a very useful ancillary diagnostic tool in the detection and management of hypertension.

Research paper thumbnail of Arterial blood pressure in adult Nigerians with sickle cell anemia

Journal of Cardiology, 2010

This study was aimed at comparing the arterial blood pressures in steady state adult sickle cell ... more This 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. Methods: A 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. Results: Significant increase in pulse rate was found in the study subjects (87.68 ± 8.91 bpm) compared with the controls (72.13 ± 6.79 bpm) (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. Conclusion: Relatively 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.

Research paper thumbnail of Pattern and presentation of epilepsy in Nigerian Africans: a study of trends in the southeast

Transactions of The Royal Society of Tropical Medicine and Hygiene, 2009

One-quarter of the 40 million individuals estimated to have epilepsy in the developing world live... more One-quarter of the 40 million individuals estimated to have epilepsy in the developing world live in Africa. Data on epilepsy in Nigeria are scanty. The disease is associated with significant socioeconomic effects. This study reviewed the pattern of presentation of epilepsy in Enugu, southeast Nigeria. A retrospective study was performed of adult epilepsy patients who presented to the medical clinic at the University of Nigeria Teaching Hospital, Enugu, from January 2002 to December 2006. Case records were reviewed and data were extracted using a pro forma and analysed. A total of 207 patients were studied (113 males and 94 females). Most affected were those aged 15-34 years. Approximately 22% had childhood seizures and approximately 88% had generalised convulsive seizures. Electroencephalography was not performed in 85% of cases. Alcohol use and head injury were seizure risks in 12% and 20% of patients, respectively. More than 25% reported socioeconomic effects, including stigmatisation and job loss. Monotherapy was used in 89% of patients, with 71% having good control. Epilepsy is a considerable source of stigma and misery for sufferers in Nigeria. There is a need for greater public health education as well as training and re-training of specialists in its management.

Research paper thumbnail of Ventricular septal defects at the University of Nigeria Teaching Hospital, Enugu: a review of echocardiogram records

Transactions of The Royal Society of Tropical Medicine and Hygiene, 2009

This research aimed to evaluate the prevalence of ventricular septal defect (VSD) and to determin... more This research aimed to evaluate the prevalence of ventricular septal defect (VSD) and to determine the age and gender distribution of this defect and its common associated congenital cardiac anomalies among patients referred for echocardiographic examination at the echocardiography laboratory of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Echocardiogram reports from the 10-year period February 1991-September 2001 were analysed. There were 2486 echocardiogram scans with an additional 334 repeat scans; 593 subjects had congenital anomalies, of which 165 (28%; 98 males and 67 females) had VSDs. The highest prevalence of VSDs (118; 70%) was in children age 0-9 years although VSDs were found in adults aged up to 50 years and above. Persistent ductus arteriosus and atrial septal defect were the commonest associated congenital anomalies. The study has shown that VSD is a relatively common congenital heart disease and that many patients present with VSD in adult life. There is a need for thorough scrutiny to be made for other cardiac anomalies in all patients with VSD, as well as for corrective surgery to be made affordable to those affected by this defect and other associated anomalies.

Research paper thumbnail of Registry for Acute Coronary Events in Nigeria (RACE‐Nigeria): Clinical Characterization, Management, and Outcome

Journal of the American Heart Association

Background Coronary artery disease was hitherto a rarity in Africa. Acute coronary syndrome (ACS)... more Background Coronary artery disease was hitherto a rarity in Africa. Acute coronary syndrome (ACS) accounts for coronary artery disease–related morbidity and mortality. Reports on ACS in Africa are few. Methods and Results We enrolled 1072 indigenous Nigerian people 59.2±12.4 years old (men, 66.8%) with ACS in an observational multicentered national registry (2013–2018). Outcome measures included incidence, intervention times, reperfusion rates, and 1‐year mortality. The incidence of ACS was 59.1 people per 100 000 hospitalized adults per year, and comprised ST‐segment–elevation myocardial infarction (48.7%), non–ST‐segment–elevation myocardial infarction (24.5%), and unstable angina (26.8%). ACS frequency peaked 10 years earlier in men than women. Patients were predominantly from urban settings (87.3%). Median time from onset of symptoms to first medical contact (patients with ST‐segment–elevation myocardial infarction) was 6 hours (interquartile range, 20.1 hours), and only 11.9% p...

Research paper thumbnail of Cardiac Arrhythmias in Recently Diagnosed Hypertensive Patients at First Presentation an Electrocardiographic Based Study

Abstr 21st Sci Meet Int …, 2006

Various forms of cardiac arrhythmias have been documented in hypertensive subjects, and hypertens... more Various forms of cardiac arrhythmias have been documented in hypertensive subjects, and hypertension is an important risk factor for the development of atrial and ventricular arrhythmias and sudden death. Electrocardiography at rest easily documents significant arrhythmias in patients, and this study was carried out to determine the types and frequency of arrhythmias in hypertensive subjects at first presentation in the Hypertension Clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. The study was hospitalbased and retrospective in nature. The resting 12lead ECG reports of 346 consecutive hypertensive subjects seen at the Hypertension clinics of the UNTH Enugu over a 14 month period were retrieved from the case files and studied. Other information obtained from the case files included the age and gender of the subjects. The mean age of the subjects was 57.3 years. Ninety-five of the subjects had arrhythmias representing 27% of the study population, out of which fifty-five were males (57.9%) and forty were females (42.1%). However 26.9% of all the male subjects had arrhythmias while 28.2% of all the females had arrhythmias. Multiple ventricular ectopics, sinus tachycardia, sinus bradycardia and atrial fibrillation were the most prevalent arrhythmias. This study showed that a significant proportion of hypertensive subjects present initially with significant rhythm disturbances.

Research paper thumbnail of Effects of age and body mass index on blood pressure and blood glucose in three rural agrarian communities in Enugu State

International Journal of Medicine and Health Development

Background: Hypertension is a major contributor to the global burden of disease and global mortal... more Background: Hypertension is a major contributor to the global burden of disease and global mortality, with a projection of 39.1 million cases in Nigeria by the year 2030. Aim: The aim of this study was to evaluate the effect of body mass index on blood pressure (BP) and blood glucose in three rural agrarian communities in Enugu State, Nigeria. Materials and Methods: This was an opportunistic cross-sectional study in three rural agrarian communities––Ibagwa, Akpugo, and Egede, all in Enugu State. Volunteer adults of 18 years and above were consecutively recruited and screened. Omron BP monitors were used mostly and supplemented by mercury BP sphygmomanometers. Each participant had their BP measured after at least 5 min of rest, and repeated twice after 3–5 min interval and also received a questionnaire about demographics, lifestyle, and environmental factors. Hypertension was defined as a systolic BP equal to or more than 140mm Hg and/or diastolic BP equal to or more than 90mm Hg or in those on treatment for hypertension. Ethical approval was obtained and all participants gave informed consent before screening. Data were collated and analyzed. Result: People of middle (40–64 years) and elderly (>65 years) age groups constituted the majority of participants. Most of the participants in the three groups had normal body mass index. The proportion of participants with hypertension was 15.2%, 21.9%, and 31.9% for Ibagwa, Akpugo, and Egede communities, respectively. The mean BMI was 27.08 kg/m2, 24.70 kg/m2 and 24.45 kg/m2 for participants from Ibagwa, Egede, and Akpugo communities, respectively. Prevalence of overweight and obesity was higher among Ibagwa people, whereas the prevalence of underweight was higher among Egede people (P < 0.001). Conclusion: Low proportion of participants had hypertension in the three communities and rising age was more associated with hypertension than overweight and obesity.

Research paper thumbnail of Prevalence of Cardiovascular Risk Factors in the Middle-Aged and Elderly Population of a Nigerian Rural Community

Journal of tropical medicine, Apr 5, 2011

Cardiovascular diseases (CVDs) causes of worldwide preventable morbidity and mortality. CVDs are ... more Cardiovascular diseases (CVDs) causes of worldwide preventable morbidity and mortality. CVDs are a leading cause of mortality and morbidity in developing countries, and rates are expected to rise over the next few decades. The prevalence of CVD risk factors is dramatically increasing in low-and middle-income African countries, particularly in urban areas. We carried out a cross-sectional population-based survey in Imezi-Owa, a rural community in South East Nigeria to estimate the prevalence of major cardiovascular risk ...

Research paper thumbnail of Low-Dose Lisinopril in Normotensive Men With Idiopathic Oligospermia and Infertility: A 5-Year Randomized, Controlled, Crossover Pilot Study

Clinical Pharmacology & Therapeutics, Feb 29, 2012

The outcomes of drug treatment for male infertility remain conjectural, with controversial study ... more The outcomes of drug treatment for male infertility remain conjectural, with controversial study results. Our pilot study employed a randomized, placebo-controlled, crossover methodology with intention-to-treat analysis. Thirty-three men with idiopathic oligospermia were randomized to start either daily oral lisinopril 2.5 mg (n= 17) or daily oral placebo (n= 16). Lisinopril was found to cause a normalization of seminal parameters in 53.6% of the participants. Although the mean ejaculate volume was unchanged (P≥ ...

Research paper thumbnail of The Effect of Nebivolol on Office Blood Pressure of Blacks Residing in Sub-Saharan Africa (A Pilot Study)

Frontiers in Cardiovascular Medicine

Introduction: There is substantial clinical evidence that monotherapy with beta-blockers are less... more Introduction: There is substantial clinical evidence that monotherapy with beta-blockers are less effective in reducing blood pressure among hypertensive Black patients compared to Whites. The highly selective beta-1 agents like nebivolol and bisoprolol have, however, been reported to be effective in reducing blood pressure in African Americans. However, results in African Americans cannot be extrapolated to native Africans because of genetic admixture and gene-environment interaction. There is, therefore, the need for us to generate data that are applicable to Africans residing in sub-Saharan Africa. We therefore decided to evaluate the efficacy and tolerability of highly selective beta-1 agent nebivolol in hypertensive Black patients residing in sub-Saharan Africa.Materials and Methods: The nebivolol study was a multicenter, prospective, observational program among hypertensive patients with 4- and 8-week follow up which was conducted in 5 cities in Nigeria of Abuja, Calabar, Enug...

Research paper thumbnail of A0012 Determinants of descending thoracic aortic size measured by echocardiography

Research paper thumbnail of Left ventricular systolic function in sickle cell anaemia: An echocardiographic evaluation in adult Nigerian patients

African Health Sciences, 2017

Background: Reliable diagnostic measures for the evaluation of left ventricular systolic performa... more 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-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 ± 5.28 (range 18-42) and 24.17 ± 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 output , cardiac index and velocity of circumferential shortening were all significantly increased in the cases compared with the controls. The end systolic stress-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.

Research paper thumbnail of Marfan Syndrome with Aortic Root Disease, Severe Heart Failure and Aortic Dissection- Two Case Reports

Nigerian Journal of Clinical Practice

Marfan syndrome is an uncommon inheritable connective tissue disease which affects the cardiovasc... more Marfan syndrome is an uncommon inheritable connective tissue disease which affects the cardiovascular system. This paper presents two cases of Marfan Syndrome with predominant aortic root disease that were seen at the Cardiology Clinic of University of Nigeria Teaching Hospital, Enugu, Nigeria. Their biography, clinical features and echocardiography parameters were captured using structured questionnaire. Both were young males in their 4th decade of life, and had advanced aortic root diseases which were complicated by left ventricular failure in both, while one of them had aortic dissection and ischemic stroke. Young adult Nigerians with Marfan syndrome presented with advanced aortic root diseases, heart failure, aortic dissection and stroke.

Research paper thumbnail of Review - Cardiovascular endocrinology: shared pathways and clinical crossroads

Research paper thumbnail of Echocardiographic screening for pulmonary arterial hypertension in HIV-positive patients

Infection, 2014

Human immunodeficiency virus (HIV) infection is associated with an increased risk for pulmonary a... more Human immunodeficiency virus (HIV) infection is associated with an increased risk for pulmonary arterial hypertension (PAH). Upon the screening of 220 asymptomatic HIV-positive individuals by echocardiography, we detected and confirmed HIV-associated PAH in 0.45 % of cases. Mild elevations of systolic pulmonary arterial pressure most probably owing to left ventricular diastolic dysfunction were found in 7.7 % of cases, without progress after 2 years. We suggest that the screening of asymptomatic HIV-positive patients for PAH should not be performed.

Research paper thumbnail of Marfan Syndrome with Aortic Root Disease, Severe Heart Failure and Aortic Dissection- Two Case Reports

Nigerian Journal of Clinical Practice, 2022

Marfan syndrome is an uncommon inheritable connective tissue disease which affects the cardiovasc... more Marfan syndrome is an uncommon inheritable connective tissue disease which affects the cardiovascular system. This paper presents two cases of Marfan Syndrome with predominant aortic root disease that were seen at the Cardiology Clinic of University of Nigeria Teaching Hospital, Enugu, Nigeria. Their biography, clinical features and echocardiography parameters were captured using structured questionnaire. Both were young males in their 4th decade of life, and had advanced aortic root diseases which were complicated by left ventricular failure in both, while one of them had aortic dissection and ischemic stroke. Young adult Nigerians with Marfan syndrome presented with advanced aortic root diseases, heart failure, aortic dissection and stroke.

Research paper thumbnail of Echocardiographic Screening for Pulmonary Arterial Hypertension in Nigerian Adults with Sickle Cell Anaemia

College of Medicine, University of Nigeria, 2009

Human immunodeficiency virus (HIV) infection is associated with an increased risk for pulmonary a... more Human immunodeficiency virus (HIV) infection is associated with an increased risk for pulmonary arterial hypertension (PAH). Upon the screening of 220 asymptomatic HIV-positive individuals by echocardiography, we detected and confirmed HIV-associated PAH in 0.45 % of cases. Mild elevations of systolic pulmonary arterial pressure most probably owing to left ventricular diastolic dysfunction were found in 7.7 % of cases, without progress after 2 years. We suggest that the screening of asymptomatic HIV-positive patients for PAH should not be performed.

Research paper thumbnail of Unruptured sinus of valsalva aneurysm, with dissection into the interventricular septum

International Journal of Medicine and Health Development, 2017

Sinuses of Valsalva or aortic sinuses are 3 focal expansions at the root of the aorta and are nam... more Sinuses of Valsalva or aortic sinuses are 3 focal expansions at the root of the aorta and are named right, left and non-coronary sinuses. These sinuses serve as support system for the aortic valve and prevent occlusion of the coronary ostia as the aortic cusps open in systole. Sinus of Valsalva aneurysm (SOVA) is congenital in most cases, due to deficiency of the elastic lamina between the aortic media and the annulus fibrosus. The anatomical location of these sinuses can predict some clinical consequences, when complications occur. We report the case of a 29yr old Nigerian man who presented at the accident and emergency unit of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, with clinical features of heart failure. Electrocardiography showed complete heart block, and later supraventricular tachycardia, while echocardiography showed a right sinus of valsalva aneurysm dissecting into the interventricular septum, without evidence of rupture.

Research paper thumbnail of Atrial Septal Aneurysm in Adults – is It a Degenerative Heart Disease?

Journal of Hypertension, 2021

Research paper thumbnail of Atrial fibrillation cases seen at the University of Nigeria Teaching Hospital, Enugu

International Journal of Medicine and Health Development, 2005

Aim : To determine the incidence of atrial fibrillation (AF) on electrocardiograms (ECG) of patie... more Aim : To determine the incidence of atrial fibrillation (AF) on electrocardiograms (ECG) of patients attending the University of Nigeria Teaching Hospital (UNTH), Enugu. Subjects and Methods : Electrocardiograms done at the UNTH between April and September 2004 were analysed. The patients were mainly in-patients. Further information on the patients were obtained from their medical records. Results : 860 ECGs were studied. 30 of them (3.5%) had atrial fibrillation (AF). Seventeen (56.7%) were males and thirteen (43.3%) females. 66.7% of the cases were aged 50 years and above. In 33.3% of the cases, hypertension was the underlying disease, followed by valvular heart disease (23.3%). Conclusion : The incidence of AF in UNTH was 3.5%. There were more males than females with AF. Most of the cases were in the older age group. Hypertension was the commonest underlying disease. Keywords : atrial fibrillation, UNTH Journal of College of Medicine Vol. 10(2) 2005: 102-106

Research paper thumbnail of Plain chest radiograph in hypertensive patients — An analysis of cases seen in a Tertiary Hospital in Nigeria

International Journal of Medicine and Health Development, 2015

Aim: To analyze the chest findings in patients clinically diagnosed with hypertension at the Univ... more Aim: To analyze the chest findings in patients clinically diagnosed with hypertension at the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Nigeria. Methods: A retrospective analysis of patients who had plain chest radiographs at the UNTH, Ituku/Ozalla, Enugu, Nigeria between 2009 and 2011. Results: Of the 500 patients studied, 60.2% (301/500) were females and 39.8% (199/500) were males. There were 9.8% (49/500) patients with normal chest findings while 90.2% (451/500) had diverse chest findings which included: cardiomegaly 69% (345/500)), aortomegaly 51% (255/500), artheromatous plaque 6.6% (33/500)), upper lobe blood vessel diversion 11% (55/500), and perivascular cuffing 5% (25/500). The remaining 0.8% (4/500) had unrelated chest findings. Conclusion: Simple chest radiograph interpreted by a competent radiologist is a very useful ancillary diagnostic tool in the detection and management of hypertension.

Research paper thumbnail of Arterial blood pressure in adult Nigerians with sickle cell anemia

Journal of Cardiology, 2010

This study was aimed at comparing the arterial blood pressures in steady state adult sickle cell ... more This 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. Methods: A 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. Results: Significant increase in pulse rate was found in the study subjects (87.68 ± 8.91 bpm) compared with the controls (72.13 ± 6.79 bpm) (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. Conclusion: Relatively 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.

Research paper thumbnail of Pattern and presentation of epilepsy in Nigerian Africans: a study of trends in the southeast

Transactions of The Royal Society of Tropical Medicine and Hygiene, 2009

One-quarter of the 40 million individuals estimated to have epilepsy in the developing world live... more One-quarter of the 40 million individuals estimated to have epilepsy in the developing world live in Africa. Data on epilepsy in Nigeria are scanty. The disease is associated with significant socioeconomic effects. This study reviewed the pattern of presentation of epilepsy in Enugu, southeast Nigeria. A retrospective study was performed of adult epilepsy patients who presented to the medical clinic at the University of Nigeria Teaching Hospital, Enugu, from January 2002 to December 2006. Case records were reviewed and data were extracted using a pro forma and analysed. A total of 207 patients were studied (113 males and 94 females). Most affected were those aged 15-34 years. Approximately 22% had childhood seizures and approximately 88% had generalised convulsive seizures. Electroencephalography was not performed in 85% of cases. Alcohol use and head injury were seizure risks in 12% and 20% of patients, respectively. More than 25% reported socioeconomic effects, including stigmatisation and job loss. Monotherapy was used in 89% of patients, with 71% having good control. Epilepsy is a considerable source of stigma and misery for sufferers in Nigeria. There is a need for greater public health education as well as training and re-training of specialists in its management.

Research paper thumbnail of Ventricular septal defects at the University of Nigeria Teaching Hospital, Enugu: a review of echocardiogram records

Transactions of The Royal Society of Tropical Medicine and Hygiene, 2009

This research aimed to evaluate the prevalence of ventricular septal defect (VSD) and to determin... more This research aimed to evaluate the prevalence of ventricular septal defect (VSD) and to determine the age and gender distribution of this defect and its common associated congenital cardiac anomalies among patients referred for echocardiographic examination at the echocardiography laboratory of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Echocardiogram reports from the 10-year period February 1991-September 2001 were analysed. There were 2486 echocardiogram scans with an additional 334 repeat scans; 593 subjects had congenital anomalies, of which 165 (28%; 98 males and 67 females) had VSDs. The highest prevalence of VSDs (118; 70%) was in children age 0-9 years although VSDs were found in adults aged up to 50 years and above. Persistent ductus arteriosus and atrial septal defect were the commonest associated congenital anomalies. The study has shown that VSD is a relatively common congenital heart disease and that many patients present with VSD in adult life. There is a need for thorough scrutiny to be made for other cardiac anomalies in all patients with VSD, as well as for corrective surgery to be made affordable to those affected by this defect and other associated anomalies.

Research paper thumbnail of Registry for Acute Coronary Events in Nigeria (RACE‐Nigeria): Clinical Characterization, Management, and Outcome

Journal of the American Heart Association

Background Coronary artery disease was hitherto a rarity in Africa. Acute coronary syndrome (ACS)... more Background Coronary artery disease was hitherto a rarity in Africa. Acute coronary syndrome (ACS) accounts for coronary artery disease–related morbidity and mortality. Reports on ACS in Africa are few. Methods and Results We enrolled 1072 indigenous Nigerian people 59.2±12.4 years old (men, 66.8%) with ACS in an observational multicentered national registry (2013–2018). Outcome measures included incidence, intervention times, reperfusion rates, and 1‐year mortality. The incidence of ACS was 59.1 people per 100 000 hospitalized adults per year, and comprised ST‐segment–elevation myocardial infarction (48.7%), non–ST‐segment–elevation myocardial infarction (24.5%), and unstable angina (26.8%). ACS frequency peaked 10 years earlier in men than women. Patients were predominantly from urban settings (87.3%). Median time from onset of symptoms to first medical contact (patients with ST‐segment–elevation myocardial infarction) was 6 hours (interquartile range, 20.1 hours), and only 11.9% p...

Research paper thumbnail of Cardiac Arrhythmias in Recently Diagnosed Hypertensive Patients at First Presentation an Electrocardiographic Based Study

Abstr 21st Sci Meet Int …, 2006

Various forms of cardiac arrhythmias have been documented in hypertensive subjects, and hypertens... more Various forms of cardiac arrhythmias have been documented in hypertensive subjects, and hypertension is an important risk factor for the development of atrial and ventricular arrhythmias and sudden death. Electrocardiography at rest easily documents significant arrhythmias in patients, and this study was carried out to determine the types and frequency of arrhythmias in hypertensive subjects at first presentation in the Hypertension Clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. The study was hospitalbased and retrospective in nature. The resting 12lead ECG reports of 346 consecutive hypertensive subjects seen at the Hypertension clinics of the UNTH Enugu over a 14 month period were retrieved from the case files and studied. Other information obtained from the case files included the age and gender of the subjects. The mean age of the subjects was 57.3 years. Ninety-five of the subjects had arrhythmias representing 27% of the study population, out of which fifty-five were males (57.9%) and forty were females (42.1%). However 26.9% of all the male subjects had arrhythmias while 28.2% of all the females had arrhythmias. Multiple ventricular ectopics, sinus tachycardia, sinus bradycardia and atrial fibrillation were the most prevalent arrhythmias. This study showed that a significant proportion of hypertensive subjects present initially with significant rhythm disturbances.

Research paper thumbnail of Effects of age and body mass index on blood pressure and blood glucose in three rural agrarian communities in Enugu State

International Journal of Medicine and Health Development

Background: Hypertension is a major contributor to the global burden of disease and global mortal... more Background: Hypertension is a major contributor to the global burden of disease and global mortality, with a projection of 39.1 million cases in Nigeria by the year 2030. Aim: The aim of this study was to evaluate the effect of body mass index on blood pressure (BP) and blood glucose in three rural agrarian communities in Enugu State, Nigeria. Materials and Methods: This was an opportunistic cross-sectional study in three rural agrarian communities––Ibagwa, Akpugo, and Egede, all in Enugu State. Volunteer adults of 18 years and above were consecutively recruited and screened. Omron BP monitors were used mostly and supplemented by mercury BP sphygmomanometers. Each participant had their BP measured after at least 5 min of rest, and repeated twice after 3–5 min interval and also received a questionnaire about demographics, lifestyle, and environmental factors. Hypertension was defined as a systolic BP equal to or more than 140mm Hg and/or diastolic BP equal to or more than 90mm Hg or in those on treatment for hypertension. Ethical approval was obtained and all participants gave informed consent before screening. Data were collated and analyzed. Result: People of middle (40–64 years) and elderly (>65 years) age groups constituted the majority of participants. Most of the participants in the three groups had normal body mass index. The proportion of participants with hypertension was 15.2%, 21.9%, and 31.9% for Ibagwa, Akpugo, and Egede communities, respectively. The mean BMI was 27.08 kg/m2, 24.70 kg/m2 and 24.45 kg/m2 for participants from Ibagwa, Egede, and Akpugo communities, respectively. Prevalence of overweight and obesity was higher among Ibagwa people, whereas the prevalence of underweight was higher among Egede people (P < 0.001). Conclusion: Low proportion of participants had hypertension in the three communities and rising age was more associated with hypertension than overweight and obesity.

Research paper thumbnail of Prevalence of Cardiovascular Risk Factors in the Middle-Aged and Elderly Population of a Nigerian Rural Community

Journal of tropical medicine, Apr 5, 2011

Cardiovascular diseases (CVDs) causes of worldwide preventable morbidity and mortality. CVDs are ... more Cardiovascular diseases (CVDs) causes of worldwide preventable morbidity and mortality. CVDs are a leading cause of mortality and morbidity in developing countries, and rates are expected to rise over the next few decades. The prevalence of CVD risk factors is dramatically increasing in low-and middle-income African countries, particularly in urban areas. We carried out a cross-sectional population-based survey in Imezi-Owa, a rural community in South East Nigeria to estimate the prevalence of major cardiovascular risk ...

Research paper thumbnail of Low-Dose Lisinopril in Normotensive Men With Idiopathic Oligospermia and Infertility: A 5-Year Randomized, Controlled, Crossover Pilot Study

Clinical Pharmacology & Therapeutics, Feb 29, 2012

The outcomes of drug treatment for male infertility remain conjectural, with controversial study ... more The outcomes of drug treatment for male infertility remain conjectural, with controversial study results. Our pilot study employed a randomized, placebo-controlled, crossover methodology with intention-to-treat analysis. Thirty-three men with idiopathic oligospermia were randomized to start either daily oral lisinopril 2.5 mg (n= 17) or daily oral placebo (n= 16). Lisinopril was found to cause a normalization of seminal parameters in 53.6% of the participants. Although the mean ejaculate volume was unchanged (P≥ ...

Research paper thumbnail of The Effect of Nebivolol on Office Blood Pressure of Blacks Residing in Sub-Saharan Africa (A Pilot Study)

Frontiers in Cardiovascular Medicine

Introduction: There is substantial clinical evidence that monotherapy with beta-blockers are less... more Introduction: There is substantial clinical evidence that monotherapy with beta-blockers are less effective in reducing blood pressure among hypertensive Black patients compared to Whites. The highly selective beta-1 agents like nebivolol and bisoprolol have, however, been reported to be effective in reducing blood pressure in African Americans. However, results in African Americans cannot be extrapolated to native Africans because of genetic admixture and gene-environment interaction. There is, therefore, the need for us to generate data that are applicable to Africans residing in sub-Saharan Africa. We therefore decided to evaluate the efficacy and tolerability of highly selective beta-1 agent nebivolol in hypertensive Black patients residing in sub-Saharan Africa.Materials and Methods: The nebivolol study was a multicenter, prospective, observational program among hypertensive patients with 4- and 8-week follow up which was conducted in 5 cities in Nigeria of Abuja, Calabar, Enug...

Research paper thumbnail of A0012 Determinants of descending thoracic aortic size measured by echocardiography

Research paper thumbnail of Left ventricular systolic function in sickle cell anaemia: An echocardiographic evaluation in adult Nigerian patients

African Health Sciences, 2017

Background: Reliable diagnostic measures for the evaluation of left ventricular systolic performa... more 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-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 ± 5.28 (range 18-42) and 24.17 ± 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 output , cardiac index and velocity of circumferential shortening were all significantly increased in the cases compared with the controls. The end systolic stress-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.