Prevalence and clinical profile of heart failure patients with atrial fibrillation in a tertiary hospital in Kano, Nigeria.

Introduction: Atrial fibrillation (AF) is one of the most prevalent sustained arrhythmias that is seen in clinical practice. AF commonly coexists with heart failure (HF) and there is growing evidence that it confers an adverse prognostic impact on the natural course of the disease. We set out to describe the prevalence and clinical profile of HF patients with AF in Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Materials and Methods: We conducted a cross-sectional study of all adults aged 18 years and above, who presented at the AKTH, Kano, and were hospitalised for HF. Those who consented were consecutively recruited into the study. Sociodemographic and clinical characteristics of patients at presentation were documented. Thromboembolic risk was assessed using CHA2DS2-VASc scoring system. A 12-lead electrocardiogram recording was obtained from each of the recruited patients to confirm the presence of AF. The prevalence of AF was determined amongst the admitted HF patients. Those with AF were compared with those without AF in terms of sociodemographic and clinical characteristics. Results: A total of 240 Nigerians were recruited. Sixty per cent were female and the whole group had a mean age of 50.85 ± 18.90 years. The prevalence of AF was found to be 12.5% amongst the recruited HF patients. The HF patients with AF had a significantly higher mean age (58 ± 16.7 years vs. 49.8 ± 19.0 years) (P = 0.021), and they also had a higher prevalence of palpitation and body swelling. The mean CHA2DS2-VASc score of the AF patients was 3.4 ± 1.0. Conclusion: AF is prevalent amongst HF patients in our environment with high thrombotic risk. More studies are needed to fully study the prevalence of AF and its clinical profile amongst HF patients in our country.

Factors associated with hypertension among adults in high burden kidney disease areas of Jigawa State, Nigeria: A cross-sectional survey.

Background: Hypertension is the leading risk factor for preventable cardiovascular-related complications and mortalities worldwide. Materials and Methods: A cross-sectional survey was conducted to assess the prevalence and factors associated with hypertension among 361 adults from four local government areas (LGAs) of Jigawa state identified to have high burden of kidney diseases. The Modified WHO STEPS questionnaire and multi-stage sampling technique were employed and data were analysed using IBM SPSS version 22.0. Results: The age of the respondents ranged from 18 to 102 years with a median of 45 (interquartile range = 30-80) years. More than a quarter (34.9%) of the respondents were unemployed. Few reported history of alcohol ingestion (0.8%) and cigarette smoking (1.1%). The prevalence of systolic hypertension was 116 (32.1%), while that of diastolic hypertension was 133 (36.8%). Jahun LGA had higher cases (36.7%) of systolic hypertension, whereas Dutse LGA had higher cases (47.8%) of diastolic hypertension. Systolic hypertension was significantly higher (P < 0.001) among those >35 years of age. The odds of developing systolic hypertension were significantly lower among those between the ages of 18 and 35 years, and those between the ages of 18 and 35 years were less likely to have systolic hypertension than those above the age of 35 years (adjusted odds ratio = 9.0; 95% confidence interval = 4.6-17.6). Similarly, those who reported family history of diabetes and hypertension (P < 0.001) had a significantly higher proportion of systolic hypertension. Conclusions: The prevalence of hypertension was alarming in the high burden kidney disease areas. The government should develop a sustainable model for the mass community screening of risk factors and community-based health insurance for the effective management of all identified cases.

Start-up designs for response-adaptive randomization procedures with sequential estimation.

Response-adaptive randomization procedures are appropriate for clinical trials in which two or more treatments are to be compared, patients arrive sequentially and the response of each patient is recorded before the next patient arrives. However, for those procedures that involve sequential estimation of model parameters, start-up designs are commonly required in order to provide initial estimates of the parameters. In this paper, a suite of such start-up designs for two treatments and binary patient responses are considered and compared in terms of the numbers of patients required in order to give meaningful parameters estimates, the number of patients allocated to the better treatment, and the bias in the parameter estimates. It is shown that permuted block designs with blocks of size 4 are to be preferred over a wide range of parameter values. For the case of two treatments, normal responses and selected start-up procedures, a design incorporating complete randomization followed appropriately by repeats of one of the treatments yields the minimum expected number of patients and is to be preferred.

Socio-demographic and Nutritional Factors Associated with Obesity amongst Adults from High Burden Kidney Diseases Areas of Jigawa State, Nigeria: A Community-based Survey.

Background: Obesity is a preventable public health problem associated with a significantly increased risk of non-communicable diseases. This study aimed to find the socio-demographic and nutritional factors associated with obesity amongst adults from high-burden kidney disease areas of Jigawa State, Nigeria. Methodology: A cross-sectional survey was conducted to assess the socio-demographic and nutritional factors associated with obesity among 361 adults from four local government areas (LGAs) of Jigawa state identified to have a high burden of kidney diseases. The Modified WHO STEPS questionnaire and multi-stage sampling technique were employed, and data were analyzed using IBM SPSS version 22.0. Results: The minimum age of the respondents was 18, and the maximum was 102 with a median of 45 (interquartile range = 30-80) years. The prevalence of obesity and overweight in the high-burden LGAs of Jigawa state was 33.0% and 27.1% respectively. Hadejia LGA had the highest (68.1%) prevalence of obesity. The prevalence of overweight was higher in Jahun LGA (38.9%). About one-third (38.2%) had a waist circumference (WC) greater than 88cm. Up to half of the female respondents had a waist-hip ratio (WHR) greater than 0.85. For male respondents, many (74.3%) had a WHR of greater than 0.9, and obesity was significantly higher (39.8%, P s< 0.001) among those ≥40 years of age. Obesity was significantly higher (39.8%,P < 0.001) among those ≥40 years of age, known diabetic, (57.1%, P=0.02), and rare consumption of vegetables, (45.8%, P<0.001).The odds of developing obesity were significantly higher among those who were known diabetics and were 3 times more likely to be obese than those who were not known to be diabetics (adjusted odds ratio [aOR] = 3.1, 95% CI = [1.1-8.9]. Conclusions: The prevalence of obesity was high in the areas with high burdens of kidney disease. The government and relevant stakeholders should develop a cost-effective prevention, early diagnosis, and treatment model.

Primary Hodgkin's Lymphoma of bone in 7-year-old- an exceptional case report of youngest child in literature.

Hodgkin lymphoma (HL) is mainly considered a nodal disease but extra nodal involvement can also be seen with variable frequency. Solitary bone involvement in HL known as Primary osseous hodgkin lymphoma (POHL) is very rare. It is defined as a lymphoma that is restricted to the bone without any simultaneous organ or lymph node involvement at the time of initial diagnosis. Primary Hodgkin lymphoma of the bone can be very challenging to diagnose because of its rarity especially in children and its variable presentation. Here we report the youngest case of POHL in a girl 7 years of age. She presented with the left leg pain and B-symptoms of fever and weight loss. Initial workup and imaging were suggestive of infection or a bone tumor. Bone biopsy of left hip joint after the multiple courses of antibiotics revealed Reed Sternberg cells in the mixed inflammatory background with CD30 and PAX-5 immunohistochemical positivity confirming classical hodgkin lymphoma, mixed cellularity type. CD99 and CD1a were negative excluding ewing sarcoma and langerhan cell Histiocytosis respectively. Absence of significant lymphadenopathy or visceromegaly on staging computerized tomography (CT) scan confirmed a very rare POHL. She received standard conventional chemotherapy with radiation. Our patient is in remission for five years after treatment.