Influence of systolic blood pressure on outcomes in Nigerians with peripartum cardiomyopathy.

Background: The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP). Patients and Methods: PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90-99, 100-109, 110-119, 120-129, 130-139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling. Results: Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90-99 mmHg, 24.7% had 100-109 mmHg, 24.7% had 110-119 mmHg, 18.5% had 120-129 mmHg, 7.5% had 130-139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90-99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49-10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91-0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or ß-receptor blockers had an HR of 1.71 (95% CI 0.93-3.16, P = 0.085). However, SBP was not associated with LV function recovery. Conclusion: In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months.

Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry.

AIMS: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. METHODS AND RESULTS: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. CONCLUSIONS: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria.

A "Stone in the Pond" Approach to Contact Tracing: Responding to a Large-Scale, Nosocomial Tuberculosis Exposure in a Moderate TB-Burden Setting.

A "stone in the pond" strategy is a practical approach to investigating large-scale nosocomial tuberculosis (TB) exposures. Here, we describe such a risk-stratified approach to contact tracing after a TB exposure that occurred over 5 months in a pediatric inpatient ward in a country with a moderate TB burden. Infect Control Hosp Epidemiol 2017;38:1509-1511.

Cardiac Troponin T and creatine kinase MB fraction levels among patients with acute ischemic stroke in Nigeria.

BACKGROUND: Stroke has been a global burden, with increasing morbidity and mortality. Serum cardiac troponin t (cTnT) and creatine kinase (CK-MB) fraction are reported to be elevated in patients admitted with acute ischaemic stroke and high level of these biomarkers indicated more severe stroke and neurologic deficit in some of the patients. OBJECTIVE: To evaluate the serum levels cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in patients with acute ischaemic stroke and relate the analytes to severity of stroke. METHOD: Patients with clinical diagnosis of ischaemic stroke diagnosed, confirmed by brain Computerized Tomography scan and equal number of apparently healthy age and sex-matched were recruited. Serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) were analysed using ELISA method and Stroke severity was determined using National Institute of Health Stroke Score (NIHSS). RESULTS: Mean serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in stroke patients were found to be higher than age sex matched control (p<0.05). NIHS Score of 12.2 ± 5.43 and 9.78 ± 3.97 were observed in Patients with elevated and normal cTnT respectively (p=0.009) while NIHS Score were similar in patients with elevated and normal CK-MB (p = 0.772). CONCLUSION: The mean values of serum cTnT and CK-MB were higher in acute ischaemic stroke patients compared to controls. Serum cardiac Troponin t level may be a significant biomarker of the severity of stroke.

Blood pressure control in long-term stroke survivors evaluated one year post stroke.

AIMS AND OBJECTIVES: Hypertension is the most common modifiable risk factor for stroke and treatment of hypertension has been known to reduce the risk of recurrent stroke. There are no studies done to evaluate the optimal blood pressure (BP) control in long-term stroke survivors in Nigeria. This study is aimed at determining the proportion of stroke survivors attending stroke prevention clinic who have optimal BP control of hypertension one year post stroke and to determine what factors are associated with the suboptimal BP control. PATIENTS AND METHODS: The subjects were consecutively presenting long term stroke survivors attending Neurology Outpatients'Clinic of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. After informed consent, socio-demographic data and clinical characteristic were obtained from the patient using structured questionnaire. Admission stroke severity was obtained retrospectively using National Institute of Health Stroke Score (NIHSS). Modified Rankin scale (mRs) was used to assess the level of handicap . The presence of depression was determined using the Hamilton Depression Rating Scale (HDRS). Blood pressure was measured in the dominant, non-stroke arm of the patients using mercury sphygmomanometer. RESULTS: A total of 68 patients were studied with a mean age of 55.15±11.9 years. Most common co- morbid condition was diabetes mellitus. Only 3(4.4%) patients had a repeat stroke during the one year period. Twenty five (36.8%) of these patients still had sub-optimal BP control. Forty seven (69.1%) of these patients were on combination therapy (including angiotensin converting enzyme inhibitors and diuretics) and 18 (26.5%) were on calcium channel blockers alone. The difference in mean age of stroke survivors with optimal and sub-optima BP control was not statistically significant. However, the mean duration of formal education of the stroke survivors with optimally controlled blood pressure was significantly higher than those with sub-optimal BP control. Eighteen (26.5%) of long term stroke survivors had clinical depression. Significantly higher proportion of the clinically depressed patients had sub-optimal blood pressure at one year compared to those that were not depressed. Formally educated patients had a better blood pressure control compared to those without formal education. Following a multivariate logistic regression, the major independent determinants of sub-optimal blood pressure control at one year post stroke were presence of depression and low levels of formal educational attainment. CONCLUSION: majority of stroke survivors attending the ABUTH neurology outpatients clinic have suboptimal blood pressure control and major determinant of suboptimal BP control were presence of clinical depression and low formal educational status.

Late life depression among elderly hypertensive patients.

AIMS AND OBJECTIVES: To determine the correlates of late life depression among elderly hypertensive patients as seen in Zaria Northern Nigeria. SUBJECTS AND METHODS: Elderly hypertensive patients attending the cardiac clinic of Ahmadu Bello University Teaching Hospital Zaria were recruited for the study. They were interviewed using socio-demographic Questionnaire, Consortium to Establish Registry for Alzheimer's Disease (CERAD), Geriatric Depression Scale-30 and Stick Design Test. Patients that had a score of 11 and above in the GDS-30 were further interviewed using the Geriatric Mental State Schedule (GMSS) AGECAT. Data obtained from the study was analyzed using Statistical Package for Social Sciences windows version 15. All tests of significance were carried out at 5% level of probability. RESULTS: A total of 179 patients participated in the study out of which 110 (65.1%) were females. The mean age of the subject was 68.23±5.72 years. The rate of late life depression based on International Classification of Diseases (ICD), 10th edition and Geriatric Mental State Schedule AGECAT (GMSS-AGECAT) diagnoses were 17. 88% (32) and 20.11 % (36) respectively. There was very good agreement between diagnoses based on ICD-10 criteria and GMSS-AGECAT (kappa=0.82, p<.001). Late life depression was significantly associated with recent bereavement (OR=11.04, p=.001), poverty (OR=4.39, p=.036) and lower diastolic blood pressure (7.04, p=.008). CONCLUSION: The rate of late life depression in this study is comparable to that of other studies reported in the literature. Poverty and bereavement but not high blood pressure, are important factors associated with depression in the elderly.

Normal values of echocardiographic parameters of apparently healthy adult Nigerians in Zaria.

The usefulness of echocardiography as a non invasive tool in the assessment of cardiac function is well established. Ninety two (54 males and 38 females) apparently healthy adult Nigerians were assessed echocardiographically to determine the normal values for the commonly measured parameters in our area of clinical practice. The mean age, body mass index (BMI), cardiothoracic ratio (CTR) and electrocardiographic left ventricular hypertrophy (ECG - LVH) were 51.4 +/- 11.15 years, 23.85 +/- 4.91 kg/m2, 0.49 +/- 0.05, and 27.3 +/- 7.46 mm respectively. The mean systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure ('MAP) were 125.0 +/- 9.94, 79.7 +/- 6.23 and 94.7 +/- 6.54, mmHg respectively. While the results of the echocardiographic measurements followed the same pattern as other published reports from outside Nigeria especially with relation to age, there were still some differences in terms of absolute values. This emphasizes the need to have our own normal reference values. A multicenter study across the country involving much larger number of subjects is required to establish normal reference values for Nigeria.

Influence of HIV infection on presentation of Kaposi's sarcoma.

We report a retrospective review of 57 patients with endemic Kaposi's sarcoma (EKS) seen between 1981 and 1990 and 40 prospectively diagnosed patients with and without human immunodeficiency virus (HIV) infection seen between 1991 and 1995. In the retrospective study 52 patients were males and five were females. Their ages ranged between 15 and 62 years with a mean of 39 years.Thirty-five (61%) patients had symptoms for more than 1 year. Nodular KS was seen in 75% of the patients. In the prospective study 26 patients had EKS while 14 had AIDS associated KS (AAKS). Among the patients with EKS 24 were males and two were females. The mean duration of symptoms was 20 months. The CD4 count done on nine patients ranged between 900 and 1300 cells/mm3 and there was no mortality within 1 year of presentation. Eleven of the patients with AAKS were males and three were females. Their ages ranged between 22 months and 41 years with a mean of 26. Nine patients had symptoms for less than 6 months. Ten patients had peripheral lymphadenopathy. CD4 counts done on 11 patients ranged between 200 and 800 cells/mm3. Five patients (35%) died within 6 months of presentation. Between 1991 and 1995, 486 patients were seen with HIV infection. Patients with AAKS present with fulminant disease which seemed quickly fatal.

The outcome of peripartum cardiac failure in Zaria, Nigeria.

We have studied 227 women who had peripartum cardiac failure (PPCF) in Zaria, Nigeria, since 1969-72. This follow-up and review of survivors in 1993-95 depended chiefly on a Zaria woman (A. Abdullahi) and on her careful reporting. Overall, 31 (13.7%) were completely lost to follow-up, 17 (7.5%) were thought to be alive, and there were data on 179 others (78.8%). Of the 75 known deaths, 55 were cardiovascular--20 due to PPCF, 31 due to cardiac failure unrelated to pregnancy (CF), and four were due to a cerebrovascular accident. PPCF recurred in 13% of 551 subsequent pregnancies. Thirty-two women had a recurrence of PPCF only, and 27 an episode of CF only. Blood pressures rose steadily over the years. An enlarged left ventricle on discharge after the index admission predicted a poor prognosis. In 1993-5, we compared 100 survivors with 100 non-PPCF controls: 96 PPCF women but only 50 control women took extra salt (p = 0.0001). Significantly more PPCF women than controls had a diastolic pressure of 110 mm Hg (p = 0.011). The syndrome is probably provoked in potentially hypertensive women by the traditional practices of eating kanwa, which is rich in Na+, taking additional excess salt and heating the body after delivery. Evidence is presented that PPCF women are potentially hypertensive, and cannot handle the excess ingested sodium which therefore leads to hypervolaemia and thus PPCF.