Medical Causes of Death in a Teaching Hospital in South-Eastern Nigeria: A 16 Year Review

Background: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. This affects the pattern of death in this region. Objective: The objective of this study is to determine the causes of death in the medical wards of the University of Nigeria Teaching Hospital; Ituku/Ozalla; Enugu; South-East Nigeria from 1995 to 2010. Materials and Methods: Data were collected retrospectively from January 1995 to December 2010. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc. Chicago; IL; USA) version 17.0 was used. Simple descriptive statistics were done. Student's t-test was used to compare means of continuous variables; while Chi-square test was used to test significance of differences between two proportions. Results: The mortality rate was 22.8 (6250/27;514) admissions. The male to female ratio was 1.7:1. Infections (20.2) were the most common cause of death. However; chronic kidney disease was the single most common disease entity causing death (12.3). Other important causes of death in order of prevalence were cerebrovascular accident (10.5); acquired immune deficiency syndrome and tuberculosis either alone or as co-infection (10.3); heart failure (8.8); chronic liver disease (7.0); septicemia (6.5); respiratory failure (5.3); diabetes mellitus (4.6); cardiac arrhythmias (2.9); and primary liver cell carcinoma (2.7). There were few deaths from tetanus; malaria; typhoid fever; and coronary artery disease. Conclusion: Mortality is high in our medical wards and reflects the emerging trend of mixed disease spectrum comprising communicable and noncommunicable diseases

Intra-Cardiac Masses in Adults: A Review of Echocardiogram Records at Two Echocardiographic Laboratories in Enugu; South-East Nigeria

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

Left Ventricular Diastolic Function in a Predialysis Patient Population

BACKGROUND: Diastolic dysfunction is common in chronic kidney disease (CKD) accounting for 40-66of cardiovascular complications. OBJECTIVE: To determine the prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in adult Nigerians with CKD at presentation and to compare findings with those of hypertensive patients with normal renal function. METHODS: Eighty-six consecutive patients with CKD were studied; comprising 43 hypertensives and 43 age- and sexmatched healthy subjects as controls. Clinical; laboratory; and echocardiographic variables were measured. RESULTS: Left ventricular diastolic dysfunction was present in 62.8of CKD patients; 79.1of hypertensive patients and 25.6of normal controls (p 0.001. There was a positive correlation between left ventricular diastolic function (LVDF) and systolic blood pressure (SBP); diastolic blood pressure (DBP); mean arterial pressure (MAP); severity of SBP; severity of DBP in CKD patients but not in hypertensive patients. There was a negative correlation between LVDF and age in CKD patients and hypertensive patients. Linear multiple regression analysis showed age as the only predictor of LVDD. CONCLUSION: There is a high prevalence of diastolic dysfunction in CKD patients at first presentation to a nephrologist in Nigeria