Carotid atherosclerosis and right ventricular diastolic dysfunction in a sample of hypertensive Nigerian patients

Aim

To determine the association of carotid atherosclerosis and right ventricular diastolic dysfunction (DD) among treated hypertensive Nigerian patients.

Methods

This was a single center cross-sectional study performed at the Cardiology Clinic of LAUTECH Teaching Hospital, Ogbomoso, Nigeria between January and December 2012. The study included 122 hypertensive Nigerians (mean age, 57.3 ± 14.7 years, 36.9% women). Patients’ clinical, demographic, and echocardiographic parameters were obtained. Diastolic dysfunction was assessed with the trans-tricuspid Doppler flow.

Results

Patients with DD were significantly older than those with normal diastolic function. Mean and maximum carotid intima media thickness measurements were significantly higher among patients with right ventricular DD than in those with normal diastolic function. Mean systolic blood pressure (148.3 ± 31.9 vs 128.0 ± 2.8 mm Hg, P = 0.049) and interventricular septal thickness in diastole (12.8 ± 2.3 vs 11.6 ± 2.8mm, P = 0.048) were significantly higher and tricuspid annular pulmonary systolic excursion (33.6 ± 4.9 vs 23.0 ± 4.2 mm, P = 0.035) was significantly lower in patients with right ventricular DD than in those with normal diastolic function. Carotid intima media thickness measurements were correlated with early trans-tricuspid Doppler flow and early transtricuspid diastolic flow/late right atrial transtricupsid diastolic flow ratio.

Conclusion

Right ventricular DD in hypertensive patients was significantly correlated with increased carotid atherosclerosis. Carotid intima media thickness measurements may therefore be a surrogate marker for DD in hypertensive subjects.Systemic hypertension has been shown to be associated with right ventricular abnormalities in both morphology and function. Right ventricular diastolic dysfunction (DD) may be an early indicator of hypertensive heart disease accompanying left ventricular DD (1-3). It can be diagnosed by various means including the ratio of early and late trans-tricuspid Doppler inflow velocities and tissue Doppler velocities.Atherosclerosis is the underlying factor for many cases of cardiovascular morbidity and mortality (4). A useful surrogate marker for carotid atherosclerosis is carotid intima media thickness (5). This parameter reflects the severity of thickening/atherosclerosis of the major arteries and is directly linked with the severity of hypertension and target organ damage associated with hypertension (2,4). DD is a typical part of the cardiovascular risk spectrum with increased risk for accelerating progressive cardiac dysfunction (6). However, it is still not known whether carotid intima media thickness, which has been shown to correlate with many conventional cardiovascular risk factors, is associated with right ventricular DD, especially among Africans (7). This study aims to determine the association between right ventricular DD and carotid intima media thickness in a sample of Nigerian hypertensive patients.     

Musculoskeletal Disorders: Epidemiology and Treatment Seeking Behavior of Secondary School Students in a Nigerian Community

Background:Epidemiological information paucity exists on musculoskeletal disorders (MSD) among secondary school students in Nigeria. We aimed to determine prevalence, pattern, and treatment seeking behaviors (TSB) of MSD in south-west Nigeria.Results:A total of 133 students had 204 MSD representing 3.0% prevalence among the 4,441students screened. Eighty-one (60.9%) students had congenital disorders and 52 (39.1%) were acquired. The lower limbs (93.1%) were most commonly affected and 87 (65.4%) students presented with knee deformity. Other abnormalities were limb length discrepancy 6.8%, scoliosis 4.4%, pes planus 3.9%, and poliomyelitis 2.9%. One hundred students (75.2%) had no form of treatment, 18.8% receive treatment in the hospital, 3.7% in traditional healing home and 2.3% in church. Age, family, and school type were significant factors (P < 0.05) in health seeking behavior. The factors affecting treatment outcome were the place of treatment, hospital specific treatment, and reasons for stopping treatment.Conclusion:Treatable cases constitute a large proportion of MSD among secondary school students, but TSB was generally poor. Parental socio-economic and health services factors were related to the health seeking behavior. Strengthening of school health services and improved linkage with orthopedic services, community education on MSD, and education of all cadres of health professionals are recommended.     

Leucocyte counts during pregnancy and the puerperium and at birth in Nigerians

Serial observations have been made on the total and differential leucocyte counts of Nigerian primigravidae during pregnancy and the puerperium, and of their newborn infants. There was a neutrophil leucocytosis of double non-pregnant values during the 2nd and 3rd trimesters, and a peak during labor. The total white cell and neutrophil counts behaved in a manner similar to that reported in Caucasians, but counts were on average about 3.0 x 1 billionth 1 lower in the Nigerians. Eosinophil counts were high, presumably due to helminthic infections, but were lower in pregnancy than in non-pregnant state: there was a dramatic lowering of the eosinophil count at the time of delivery. Visual counting did not allow meaningful observations on changes in the basophil count. Monocyte counts were unaltered by pregnancy, but there was a significant drop in mean count caused by a great number of 0 differential counts at delivery. There was a slight but significant depression of lymphocyte count during pregnancy, but no further change at the time of delivery. All counts at 6 weeks after delivery were similar to those of adult male Nigerians. The leucocyte counts of African and Caucasian newborn appear to be similar. The data provide reference ranges of white cell counts in African or women of African descent during pregnancy.     

Parameterized algorithms for quantitative differentials in spectrally equivalent medical diagnostic x-ray beams

Qualitative and quantitative equivalence of spectra transmitted by two different elemental filters require a good match in terms of shape and size over the entire energy range of 0-150 keV used in medical diagnostic radiology. However, the photoelectric absorptions and Compton scattering involved in the interaction of x rays with matter at these relatively low photon energies differ in a nonuniform manner with energy and atomic number. By careful choice of thicknesses for filter materials with an atomic number between 12 and 39, when compared with aluminum, it is possible to obtain transmitted beams of the same shape (quality) but not of the same size (quantity). In this paper, calculations have been carried out for the matching of the shapes and sizes of beams transmitted through specified thicknesses of aluminium filter and spectrally equivalent thicknesses of other filter materials (different from aluminium) using FORTRAN source codes traceable to the American Association of Physics in Medicine (AAPM), College Park, MD, USA. Parametrized algorithms for the evaluation of quantitative differentials (deficit or surplus) in radiation output (namely, photon fluence, exposure, kerma, energy imparted, absorbed dose, and effective dose) from these transmitted spectrally equivalent beams were developed. These differentials range between 1%, and 4% at 1 mm Al filtration and between 8%, and 25% for filtration of 6 mm Al for different filter materials in comparison with aluminum. Also developed were models for factors for converting measures of photon fluence, exposure-area product, (EAP), and kerma-area product (KAP) to risk related quantities such as energy imparted, absorbed dose, and effective dose from the spectrally equivalent beams. The thicknesses of other filter materials that are spectrally equivalent to given thicknesses of aluminum filter were characterized using polynomial functions. The fact that the use of equivalent spectra in radiological practice can provide means of ranking the differentials in radiographic image quality and stochastic risk is discussed.     

Method for the evaluation of a average glandular dose in mammography

This paper concerns a method for accurate evaluation of average glandular dose (AGD) in mammography. At different energies, the interactions of photons with tissue are not uniform. Thus, optimal accuracy in the estimation of AGD is achievable when the evaluation is carried out using the normalized glandular dose values, g(x,E), that are determined for each (monoenergetic) x-ray photon energy, E, compressed breast thickness (CBT), x, breast glandular composition, and data on photon energy distribution of the exact x-ray beam used in breast imaging. A generalized model for the values of g(x,E) that is for any arbitrary CBT ranging from 2 to 9 cm (with values that are not whole numbers inclusive, say, 4.2 cm) was developed. Along with other dosimetry formulations, this was integrated into a computer software program, GDOSE.FOR, that was developed for the evaluation of AGD received from any x-ray tube/equipment (irrespective of target-filter combination) of up to 50 kVp. Results are presented which show that the implementation of GDOSE.FOR yields values of normalized glandular dose that are in good agreement with values obtained from methodologies reported earlier in the literature. With the availability of a portable device for real-time acquisition of spectra, the model and computer software reported in this work provide for the routine evaluation of AGD received by a specific woman of known age and CBT.     

A simple dose regimen of artesunate and amodiaquine based on arm span- or age range for childhood falciparum malaria: a preliminary evaluation

A dose regimen of artesunate and amodiaquine based on arm span- or age range (DRAAAS), derived from a study of 1674 children, was compared with standard dose regimen of the same drugs calculated according to body weight (SDRAA) in 68 malarious children. Children on DRAAAS received 0.8-1.0 of artesunate/kg and 0.9-1.2 times amodiaquine/kg compared with those receiving SDRAA. Parasite and fever clearance and fall in hematocrit in the first 3 days were similar; both regimens were well tolerated. DRAAAS is simple and is efficacious.