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.

Comparative Evaluation of Midventral and Flank Laparotomy Approaches in Goat.

The aim of the study was to compare two laparotomy approaches (flank and midventral). Ten (n = 10) apparently healthy goats of different breeds and sex, average age of 12 ± 2.1 months, and average weight of 13.4 ± 2 kg were used for the investigation. The goats were randomly divided into flank and midventral groups, each group comprising five goats (n = 5). Standard aseptic laparotomy was performed under lumbosacral epidural anaesthesia with mild sedation. Postsurgical wound score showed significant difference (P < 0.05) in erythema at 18-24 hours and 10-14 days after surgery between the two approaches; significant difference of dehiscence between the two groups was also recorded at 10-14 days after surgery. Total white blood cells (WBC) and lymphocytes counts were significantly different (P < 0.05) at the first and second week after surgery. There was significant difference of platelets critical value and platelets dimension width at the first and second week after surgery. Significant difference of packed cells volume between the two approaches was also recorded one week after surgery. It was concluded that midventral laparotomy approach can be conveniently and safely performed under aseptic precautions without fear of intra- and postoperative clinical problems.

Prevalence of dementia and dementia subtypes among community-dwelling elderly people in northern Nigeria.

BACKGROUND: Dementia has important public health implications. The magnitude of the problem remains largely unknown in the developing countries. METHODS: Three hundred and twenty-two community dwelling elderly persons and their caregivers in Zaria, Northern-Nigeria were enrolled in this study. They were interviewed using Community Screening Interview for Dementia (CSI-D), Consortium to Establish Registry for Alzheimer's disease (CERAD), Stick Design Test (SDT), Blessed Dementia Scale and a sociodemographic questionnaire. The data obtained were analyzed using the Statistical Package for Social Sciences version 15 for Windows. Diagnosis was based on fulfilling criteria for dementia in both the International Classification of Disease, 10th edition and the Diagnostic and Statistical Manual, 4th edition. RESULTS: The mean age of the subjects was 75.5 ± 9.4 years. The prevalence of dementia was 2.79% (CI 1-4.58%). Alzheimer's disease constituted 66.67% of all the cases of dementia in this community. Age was the only demographic factor associated with dementia. CONCLUSION: The prevalence rates of dementia and dementia subtypes in the developing countries are similar using standard diagnostic criteria and methods.

Intracardiac tumor: a risk factor for stroke in the young--a case report.

BACKGROUND: Stroke occurs commonly in individuals above 65 years, especially in the background of atherosclerosis and other risk factors. In young persons below 45 years it is a rare disorder with devastating sequelae on the affected individual. OBJECTIVE: Presently there are few reports on the aetiology/risk factors for stroke in young adults in Nigeria. This is due to limited facility for thorough investigation; therefore management of such cases poses a diagnostic challenge. In this report we present a case of embolic stroke in a male undergraduate that began with two brief episodes of transient left sided weakness before a completed stroke four hours later. 2-D echocardiography showed that the likely source of emboli to be a non-pedunculated left atria tumour attached to the root of posterior mitral valve leaflet. CONCLUSION: Intracardiac mass should be considered a possible risk factor for ischemic stroke in young adult, especially in the absence of other risk factors such as connective tissue disorders, HIV/AIDS, hemoglobinopathy or use of recreational drugs. High index of suspicion is required in order not to overlook such source of emboli. Early diagnosis offers the best panacea for a definitive therapy and prevention of stroke recurrence with its devastating sequelae.