Prognostic Significance of Pre-Discharge Plasma BNP among Heart Failure Patients in Ilorin, Nigeria.

INTRODUCTION: Although the usefulness of plasma brain natriuretic peptide (BNP) in early diagnosis of heart failure has been extensively studied, its value in predicting outcome of these patients has not been fully determined, particularly among African patients. OBJECTIVE: This study was aimed to evaluating the prognostic implications of pre-discharge BNP among hospitalized heart failure patients in Nigeria. METHODS: One hundred consecutive acutely decompensated heart failure patients managed in our center were recruited into the study. All subjects had clinical and echocardiographic evaluation. All had BNP assayed and were followed-up for six months. RESULTS: Fifteen patients (out of 91 who completed the study) died at the end of the study, giving a 6-month mortality rate of 16.5%. The mean BNP among non-survivors (655.0 ± 142.3pg/ml) was higher than survivors (409.7±178.2pg/ml) P <0.001. A plasma BNP level >525pg/ml was 87% sensitive and 75% specific for predicting death within 6-months (AUC0.854,95% CI 0.756-0.951, p<0.001). Kaplan-Meier survival curve also showed six-month survival to be significantly reduced in patients discharged with BNP levels >525pg/ml (57.6%) than in those with levels <525pg/ml (98.3%), p<0.001. CONCLUSION: Pre-discharge plasma BNP>525pg/ml in heart failure patients is predictive of early death within six months.

INTRODUCTION: Bien que l'utilité du peptide natriurétique plasma-cerveau (BNP) dans le diagnostic précoce de l'insuffisance cardiaque ait été largement étudiée, sa valeur pour prédire l'issue de ces patients n'a pas été entièrement déterminée, en particulier chez les patients africains. OBJECTIF: Cette étude visait à évaluer les implications pronostiques du BNP avant la sortie chez les patients hospitalisés pour insuffisance cardiaque au Nigeria. MÉTHODES: Cent patients consécutifs atteints d'insuffisance cardiaque en décompensation aiguë, pris en charge dans notre centre, ont été recrutés dans l'étude. Tous les sujets ont eu une évaluation clinique et échocardiographique. Tous avaient un dosage du BNP et ont été suivis pendant six mois. RÉSULTATS: Quinze patients (sur 91 ayant terminé l'étude) sont décédés à la fin de l'étude, ce qui donne un taux de mortalité à 6 mois de 16,5 %. Le BNP moyen parmi les non-survivants (655,0 ± 142,3 pg/ml) était supérieur à celui des survivants (409,7± 178,2 pg/ml) P < 0,001. Un taux plasmatique de BNP > 525 pg/ml était sensible à 87 % et spécifique à 75 % pour prédire le décès dans les 6 mois (ASC 0,854, IC à 95 % 0,756-0,951, p <0,001). La courbe de survie de Kaplan-Meier a également montré que la survie à six mois était significativement réduite chez les patients sortis avec des taux de BNP > 525 pg/ml (57,6 %) que chez ceux avec des taux < 525 pg/ml (98,3 %), p < 0,001. CONCLUSION: Le BNP plasmatique avant la sortie > 525 pg/ml chez les patients insuffisants cardiaques est prédictif d'un décès précoce dans les six mois. Mots clés: Insuffisance cardiaque décompensée aiguë, pronostic, peptide natriurétique cérébral, mortalité, Nigérians.

Relation between some haematological abnormalities, degree of immunosuppression and viral load in treatment-naïve HIV-infected patients.

This cross-sectional study at a teaching hospital in north-eastern Nigeria estimated the prevalence of anaemia, leukopenia and thrombocytopenia in treatment-naïve HIV-infected patients (177 males and 316 females), and the associations with virological and immunological markers. The overall prevalences of anaemia, leukopenia and thrombocytopenia were 49.5%, 5.5% and 4.5% respectively. The prevalence of anaemia was significantly higher in males than females (61.6% versus 42.7%), while the rates of leukopenia (5.1% versus 5.7%) and thrombocytopenia (5.7% versus 3.8%) were similar. Almost two-thirds of the HIV treatment-naïve studied patients, 293/493 (59.4%), had cytopenia and would require antiretroviral drugs. AIDS was diagnosed by clinical or immunological criteria in 70% of patients. The degree of cytopenia was directly related to the degree of immunosuppression and clinical AIDS status. No relationship was observed between cytopenia and viral load.

Relation between some haematological abnormalities, degree of immunosuppression and viral load in treatment-na‹ve HIV-infected patients

This cross-sectional study at a teaching hospital in north-eastern Nigeria estimated the prevalence of anaemia, leukopenia and thrombocytopenia in treatment-naive HIV-infected patients [177 males and 316 females], and the associations with virological and immunological markers. The overall prevalences of anaemia, leukopenia and thrombocytopenia were 49.5%, 5.5% and 4.5% respectively. The prevalence of anaemia was significantly higher in males than females [61.6% versus 42.7%], while the rates of leukopenia [5.1% versus 5.7%] and thrombocytopenia [5.7% versus 3.8%] were similar. Almost two-thirds of the HIV treatment-naive studied patients, 293/493 [59.4%], had cytopenia and would require antiretroviral drugs. AIDS was diagnosed by clinical or immunological criteria in 70% of patients. The degree of cytopenia was directly related to the degree of immunosuppresslon and clinical AIDS status. No relationship was observed between cytopenia and viral load

Communities' awareness, perception and participation in the Community-Based Medical Education of the University of Maiduguri.

BACKGROUND: Community-based medical education (CBME) is no longer a new innovation in medical education since the establishment of The Network: Towards Unity for Health (The Network: TUFH) 25 years ago. The CBME of the University of Maiduguri medical college is 14 years old and has never been assessed in terms of the population it serves. The study was conducted to determine the level of awareness, perception, and participation of the communities in CBME. METHODS: A cross-sectional survey was carried out in 11 village units of three Local Government Areas (LGAs) using a 14-item structured questionnaire administered to adults in randomly selected households. The questionnaire was based on guide questions used for focus group discussions held earlier with community leaders. RESULTS: Awareness of students' visits among respondents was 73.7%. Knowledge of the frequency of presence of the students in the communities was 72.2%. "To examine and treat" (33.6%) and "to ask questions" (16.6%) were the most prominent reasons given for the visits. The majority of respondents perceived the visits as beneficial (72.2%). More frequent visits were requested by 54.4% of the respondents. The communities were willing to be more accessible and felt that the LGAs should provide more logistic support to the program. DISCUSSION: This study revealed that communities were aware of students' visits and knew reasons for the visits, thought visits were beneficial, and were willing to provide more support for these visits.