Biomedical subjects

J J Andy

Publications and source records attributed to J J Andy.

At least 19 recordsLinked to original sources

PubMed2001

The changing incidence of juvenile mitral stenosis and natural history of rheumatic mitral valvulitis in Al Baha, Saudi Arabia.

This study aimed to evaluate the impact of improved socio-economic conditions and health care on chronic mitral valve complications of rheumatic heart disease in Al Baha in the Kingdom of Saudi Arabia. Altogether, 190 cases of acute rheumatic fever (ARF) seen between 1982 and 1996 and 146 cases of symptomatic mitral stenosis seen between 1984 and 1996 were analysed. 2-D/Doppler echocardiography was used to evaluate the severity and progression of mitral regurgitation (MR)/mitral stenosis (MS). Of 90 cases of ARF who presented initially with MR, the murmur remained unchanged in 40%, increased in 30% and had decreased or disappeared in 30%. In cases with recurrence of ARF, mitral incompetence deteriorated in 16 of 26 cases (61.5%) and remained stable in ten (38%). Severe MS developed during follow-up in three cases of ARF, all aged less than 20 years. Seven of 50 cases (14%) of severe MS studied were aged 20 years or less. The 43% (25 of 58 cases) of severe cases of MS aged 20 years or less reported from King Faisal Hospital, Riyadh in 1981 compared with 14% of severe cases aged 20 years or less in this study indicates a significant slowing down of the rate of progression of MS following an attack of ARF in this region. Among individuals with MR during an ARF attack who reliably take their antibiotic prophylaxis, 70% will lose that murmur within 5 years of follow-up. In this series, only 30% showed a decrease or loss of MR and this probably reflects the degree of non-compliance with secondary antibiotic prophylaxis in our cases. The rate of default from antibiotic prophylaxis was 32.6%.

Acute Disease↗

PubMed1998

Helminth associated hypereosinophilia and tropical endomyocardial fibrosis (EMF) in Nigeria.

There should be a recognisable trend between the incidence of hypereosinophilia and the duration of tropical endomyocardial fibrosis (EMF), if the hypothesis, that EMF is the burnt out phase of eosinophil associated heart disease, is correct. We tested this hypothesis in a prospective study of 89 consecutive EMF cases over an 18 year period at two Nigerian locations (Ife in South West and Calabar in South East). We carefully dated the duration of EMF symptoms at first presentation and screened for hypereosinophilia (eosinophilia > or = 1500/mm3), and their causes. When no cause was identified for hypereosinophilia we gave a therapeutic trial with diethylcarbamazine to the patients. An eosinophil count > or = 1000/mm3 was recorded in 80% of 24 cases seen within 6 months; 55% of 46 cases seen 0-24 months; 54% of 18 cases seen 25-48 months and 21% of 25 cases seen more than 49 months of onset of symptoms: while the respective distribution of eosinophil count > or = 1500/mm3 for similar periods were 66, 44, 27 and 21%. This reflects a highly significant (P < 0.001) inverse relationship between hypereosinophilia and the duration of EMF and strengthens the concept that EMF (without eosinophilia) represents the late stage of eosinophilic heart disease. The localisation of endemic EMF to the low-lying tropical rain forest Zone and its predominant occurrence among rural dwellers and farmers suggest a vector borne etiologic agent. Microfilaria was the most likely cause of hypereosinophilia in the cases presented.

Adolescent↗

PubMed1996

Haemoglobin C gene in south eastern Nigeria.

Haemoglobin C (Hb C) is very rare in eastern Nigeria (east of River Niger). Isolated cases have been reported. The incidence is however as high as 6% in western Nigeria. This study was undertaken to locate the isolated cases with a view to determining their origin. Hb electrophoresis was performed on 4,263 subjects in Akwa Ibom State in south eastern region of Nigeria. The subjects were selected from all the local government areas of the state and were aged 15 years and above. They comprised secondary school children, civil servants, farmers and fishermen. The results revealed complete absence of Hb C from the upland population whereas this was present in the fishing settlement population (6 or 0.4% Hb AC and one or 0.07% Hb SC subjects). The possible entry points of Hb C gene into south eastern Nigeria is discussed.

Adolescent↗

PubMed1992

Demographic, life style and anthropometric correlates of blood pressure of Nigerian urban civil servants, factory and plantation workers.

Demographic, life style and anthropometric correlates of blood pressure were analysed in 5,200 civil servants, factory and plantation workers living in an urban setting in the South Eastern part of Nigeria. The subjects were 4,382 men (84.2%) and 818 (15.8%) women. The prevalence of hypertension, using the WHO criteria among the workers was 8.1%, and was lower in women than men, 3.5% and 8.9% respectively. Only 19.6% of the hypertensive population knew that they had hypertension, whilst 29.4% of the total population under study gave a positive family history of hypertension. The blood pressure and the prevalence of hypertension rose with age, number of children in the family, salary scale and with the number of cigarettes smoked per day. The prevalence of hypertension was higher in medium and heavy drinkers than the non-drinkers and light drinkers. The prevalence was also higher in medium and heavy smokers. Multiple regression analysis showed a significant positive relation between the systolic blood pressure and sex, age, marital status, number of children in the family, salary scale, tobacco consumption and weight (P less than 001). On the other hand, occupation (P less than 01) educational qualification (P less than 001), support system (P less than 03) and height (P less than 001) had significant negative relationships with systolic blood pressure. There was also a significant positive relation between the diastolic blood pressure and number of children in the family (P less than 002) and salary scale (P less than 001). It is suggested that hypertension screening and treatment should be incorporated in the primary health care programmes of African communities.

Adolescent↗

PubMed1990

A disappearing urban/rural blood pressure difference in Nigerian children: an evaluation of possible determining factors.

Urban Nigerian school children are reported to have a higher systolic blood pressure and diastolic blood pressure than rural community school children until the age of 11-12 years when this difference tends to disappear. We evaluated 874 urban day-school children and 674 rural community school children aged 5-16 (mean 11.9) years in south-eastern Nigeria to confirm this changing pattern, and to assess the contributions of some known factors to the differences as well as the changing pattern. This study confirmed the changing pattern of urban/rural blood pressure of school children. Differences in weight, height and Body Mass Index (BMI), though important, appeared insufficient to explain this pressure difference and the changing pattern. Urban children aged 12-14 years were found to excrete more sodium and (unexpectedly) more potassium in their 24-h urine samples. The observed urban/rural blood pressure difference appears to be sustained by a multiplicity of factors, including differences in weight, BMI, height, electrolytes (especially sodium) consumption, and increased exposure to Western-type education.

Adolescent↗

PubMed1989

A clinical profile of patients with coronary artery disease in Nigeria.

Observations are reported on 31 patients with coronary artery disease (CAD) from Nigeria (a region where CAD is rare). Hypertension either alone (12 cases), or associated with diabetes mellitus and obesity (4 cases), with diabetes mellitus and heavy cigarette smoking (1 case) was a frequent associated illness. Serum cholesterol measured in 15 cases was high in 13, but nine others without cholesterol assay were in the high socio-economic group, and serum cholesterol was likely to be relatively elevated in them also. Hyper-cholesterolaemia was the one factor that Nigerian patients with CAD had, but which is rare in the Nigerian general population. This observation appears to support the view that other major pre-disposing factors to CAD cause this disease usually when there is a back-ground of hyperlipidaemia.

Adult↗

PubMed1987

Cardiovascular complications of tropical pyomyositis.

Clinical observations are described in 13 cases of pyomyositis with various cardiovascular complications: (a) pyogenic pericarditis (10 cases) with tamponade in 7 and myopericarditis in 1 case, and (b) acute bacterial endocarditis (3 cases). Blood cultures grew Staphylococcus aureus in all 3 with endocarditis and in 5 of 10 with pericarditis. These complications probably resulted from the bacteraemia which sometimes complicates pyomyositis. Enhanced susceptibility of cardiac muscles to infection in pyomyositis however remains another possibility.

Adolescent↗

PubMed1987

Surgical considerations in the management of giant emphysematous bullae.

Nine cases with giant emphysematous bullae causing progressive incapacitating dyspnea due to gradual but progressive compression of adjacent lung tissue are reviewed. All the patients selected for surgery had peripheral arterial oxygen saturation of not less than 92 percent at rest. A total of 13 excisions was carried out in the nine patients with resultant increase in their postoperative arterial oxygen tension and improvement in exercise tolerance. There were no deaths from the operations.

Adult↗

PubMed1986

Coronary artery pathology of 111 consecutive Nigerians.

A detailed study of the coronary arteries of 111 consecutive necropsies at Ile-Ife, Nigeria is reported. Coronary occlusive disease occurred in eight (7.2%) subjects and involved less than 50% of luminal size in five, and greater than 50% of luminal size in three subjects. Previous medical history was available in four of eight subjects and all four had hypertension. All three subjects with greater than 50% luminal occlusion were hypertensive patients and professionals, one was additionally diabetic and a heavy smoker and serum cholesterol (available in one) was 250 mg/ml. The mean age of the subjects with moderate and severe disease was 54 (range 35 to 71) years. Thus coronary occlusive disease among Nigerians occurred in elderly, affluent and hypertensive patients exposed to Western diets and habits.

Adolescent↗

PubMed1985

Blood pressure distribution of Nigerians in the first two decades of life.

The systolic and diastolic blood pressures of 2301 Nigerian boys and 2017 Nigerian girls were measured. Their ages, which were in the range 1-20 years, heights and weights were also recorded. The relationship between these variables are discussed. Selected percentiles of systolic and diastolic pressures for different ages and weights are given.

Adolescent↗

PubMed1983

Complete heart block in chronic chloroquine poisoning.

Complete heart block of recent onset is reported and is attributed to chronic chloroquine abuse. Total blood chloroquine was more than two times higher in this patient than in 4 patients following therapeutic doses of chloroquine, and chloroquine basic metabolites were also proportionally higher in this patient's blood.

Chloroquine↗

PubMed1983

Enzymes of collagen synthesis and type III procollagen amino-propeptide in serum from Nigerians with chronic endomyocardial fibrosis.

The hallmark of cardiac pathology in chronic African endomyocardial fibrosis is the laying down of excess collagen in the endomyocardium. Preliminary observations on the assay of enzymes of collagen synthesis and type III procollagen aminopropeptide in chronic African endomyocardial fibrosis are reported. Serum immunoreactive prolyl hydroxylase protein was elevated in 4, serum galactosyl-hydroxylysyl glucosyl transferase activity was elevated in 5, and type III procollagen aminopropeptide was also elevated in 5 patients. Cardiac cirrhosis and endomyocardial fibrosis could be responsible for the elevated values in these patients. The relative contribution of fibrosis of the myocardium to these elevated values remains to be clarified.

Adolescent↗

PubMed1983

Liver immunoreactive prolyl hydroxylase protein in human primary hepatocellular carcinoma.

Total prolyl hydroxylase protein was measured in hepatic tissues of 8 patients with primary hepatocellular (PHC), 5 with acute viral hepatitis, and 5 with cirrhosis (3 alcoholic and 2 with secondary biliary cirrhosis). The mean values were compared with the mean value of 10 normal hepatic tissues. The mean values were all highly significantly elevated (P less than 0.001) in PHC, acute viral hepatitis and the cirrhotic patients, respectively. The mean L-IRPH value in PHC was about 9.50 times the control mean, while in acute viral hepatitis, and cirrhosis the mean L-IRPH values were about 3.00 and 2.30 times the control mean respectively. The mean level of L-IRPH in PHC was 4.06 times the mean level of L-IRPH in cirrhosis and 3.14 times the mean value in acute viral hepatitis. The findings of this study provide a basis for the elevated serum values of this intracellular enzyme of collagen synthesis in patients with primary hepatocellular carcinoma and the data indicate that this enzyme may be elevated to compensate for an increased rate of collagen synthesis in the malignant liver tissue.

Acute Disease↗

PubMed1982

Clinical feminization and serum testosterone levels in male patients with chronic African endomyocardial fibrosis.

Thirteen out of 19 male patients aged sixteen years and above who had clinically diagnosed chronic African endomyocardial fibrosis (E.M.F.) had some clinical evidence of feminization. Serum was obtained from ten patients and assayed together with serum of ten age- and sex-matched normal controls for testosterone. The serum testosterone level in the 10 E.M.F. patients was uniformly below the lowest normal level, and the mean serum level for E.M.F. was significantly lower than the mean for the controls. Persistent and severe hepatic congestion in E.M.F. may lead to feminization long before cardiac cirrhosis occurs.

Adolescent↗

PubMed1981

Relation of severe eosinophilia and microfilariasis to chronic African endomyocardial fibrosis.

Over a two-year period, 44 patients had an eosinophil count above the 97th centile. Thirteen of these 44 had heart disease presenting within six months of the onset of symptoms. Microfilariasis was the most likely cause of the raised total eosinophil in these 13 patients. In all, the raised eosinophil count we returned to normal by the use of diethylcarbamazine (Banocide). Eleven of the 13 were followed up and eight of them (73%) developed clinical features of cardiac constriction and tricuspid regurgitation. The mean duration of follow-up was two years. Limited cardiac catheterisation studies in six of the patients showed evidence of constriction or of tricuspid regurgitation. The clinical features of these eight patients were indistinguishable from those found in chronic endomyocardial fibrosis. This disease was further suggested by recurrent cerebral embolism in one, and a large pericardial effusion in another; and it was also present in the one patient to come to necropsy. Thus, microfilaria-induced eosinophilia, when high, is frequently associated with heart disease which appears to be chronic endomyocardial fibrosis many months after the eosinophilia has returned to normal.

Adolescent↗

PubMed1981

Loasis as a possible trigger of African endomyocardial fibrosis: a case report from Nigeria.

A Nigerian boy, previously in good health, presented with a two-day history of fever with chills; followed on the third day by periorbital swelling, urticarial rash and itching; and on the sixth day by dyspneoa, abdominal swelling and leg swelling. There was clinical, radiological and electrocardiographic evidence of dominant right-sided heart failure. Loa-loa was isolated from the blood and eosinophilia was marked but both were cured by diethylcarbamazine therapy. Heart failure, however, persisted and ended fatally 25 1/2 months later. Endomyocardial fibrosis, more severe on the right sided chambers, but affecting both ventricles was diagnosed. Evidence is presented from the literature to indicate loasis as the trigger of endomyocardial damage in this patient.

Child↗

PubMed1979

Staphylococcal pericarditis with pyopericardium.

Seven previously well patients with acute staphylococcal pericarditis and purulent pericardial effusion are described. All had a septicaemic illness in which worsening heart failure with signs of cardiac tamponade became the major problems of management. Tropical pyomyositis was probably the predisposing illness in four patients. This number of proven cases within an 18-month period suggests that staphylococcal pyopericardium is in a tropical environment probably commoner than realised.

Adolescent↗

PubMed1977

Echocardiographic observations in opiate addicts with active infective endocarditis. Frequency of involvement of the various values and comparison of echocardiographic features of right- and left-sided cardiac valve endocarditis.

Echocardiographic observations are described in 25 opiate addicts with active infective endocarditis involving apparently previously normal valves. Infective endocarditis was isolated to the tricuspid valve in 11 patients, involved both right- (tricuspid valve) and left-sided valves in 7 and was isolated to the left-sided valves in 7 (mitral valve in 6). Twenty patients (80%) had tricuspid valve regurgitation, 12 had mitral regurgitation, 3 had aortic regurgitation and none had pulmonary valve regurgitation. Considering the 75 cardiac valves (excluding the pulmonary) in the 25 patients, echocardiographic abnormalities consistent with active infective endocarditis were detected in 26 (74%) of the 35 clinically incompetent valves but in none of the 40 competent valves. Comparison of the 20 incompetent tricuspid valves with the 12 incompetent mitral valves indicated that (1) the echocardiogram was less sensitive in detecting tricuspid valve lesions, (2) rupture of tricuspid valve chordae tendineae was absent or not detectable, and (3) tricuspid valve vegetations tended to be larger.

Adult↗