Health related quality of life of patients following mechanical valve replacement surgery for rheumatic mitral stenosis in Tanzania

Background: The assessment of outcomes of interventions based on the patient’s perspective using patient-reported outcome measures (PROMs) has been increasingly highlighted in clinical practice. However, health related quality of life (HRQoL), one of the common constructs measured by PROMs remain unknown among patients after heart valve replacement (HVR) in Tanzania. Objectives: To assess the HRQoL amongst patients operated on for rheumatic mitral stenosis at Jakaya Kikwete Cardiac Institute (JKCI). Methods: A prospective study of patients operated on due to rheumatic mitral stenosis at JKCI from January 2020 to April 2021 was undertaken. The HRQoL was assessed by using the MacNew questionnaire, addressing three domains (physical, emotional, and social function); the score ranges from 0 to 7. We categorized HRQoL as low (mean score ≤ 4.9), moderate (5–6) and high (> 6). We analysed several sociodemographic and clinical variables for HRQoL. Results: Out of 54 patients, there were 34 females and 20 males. Their mean (± SD) age was 37.98 (± 12.58) years. The reliability of translated Kiswahili version of MacNew was good. The mean (± SD) global scores were 3.47 ± 0.59, 4.88 ± 0.71 and 6.14 ± 0.50 preoperatively, at 3 months and 6 months respectively (p-values < 0.001 preoperatively vs. 3 months, preoperatively vs. 6 months and at 3 months vs. 6 months). The median of individual mean difference HRQoL score pre-operatively and at 6 months was 2.67. The preoperative and 6 months mean difference HRQoL scores were higher among patients with vs. without atrial fibrillation (2.95 ± 0.59 vs. 2.45 ± 0.53, p = 0.003) and those on anticoagulants (preoperatively) vs. not on anticoagulants (3.14 ± 0.58 vs. 2.57 ± 0.57, 0.009). The mean difference HRQoL scores were similar for sociodemographic and other clinical parameters, including those with stroke vs. without stroke. Conclusion: Six months after HVR the overall MacNew HRQoL scores improved markedly. This improvement in HRQoL was regardless of the presence of comorbidities (e.g. stroke and atrial fibrillation) which underscores the importance of considering valvular surgery if they fit the criteria. Clinicians and researchers in low-resource settings should collaborate to promote the utilization of PROMs in the routine care of patients

Emerging role of circANRIL expression in peripheral blood mononuclear cells as a promising liquid biopsy diagnostic biomarker for coronary artery disease

Abstract Background: Long-non-coding RNAs (lncRNAs) are increasingly recognized to play major roles in coronary artery disease (CAD). ANRIL, a well-known lncRNA is located on the 9p21.3 locus which is the first reported CAD risk locus. This study aimed to evaluate the association of ANRIL and its transcript variants expressions with susceptibility to CAD as well as to investigate the impact of 9p21.3 locus single nucleotid polymorphisms (SNPs) on their expressions in adipose tissues and peripheral blood mononuclear cells (PBMCs) of Tanzanian study cohort.Methods: Expressions of ANRIL, and its variants; circANRIL (hsa_circ_0008574), NR003529, EU741058 and DQ485454 were detected by qRT-PCR in visceral adipose tissues (VAT) (epicardial adipose tissue (EAT) and mediastinal adipose tissue(MAT)), subcutaneous adipose tissue (SAT) and PBMCs of patients undergoing coronary artery bypass grafting due to CAD and non-CAD patients undergoing heart valve surgery. Five SNPs encompassing the 9p21.3 risk locus were genotyped in a cohort of 200 CAD patients an 220 non-CAD patients using qRT-PCR and their impact on gene expressions were further evaluated.Results: ANRIL expression was significantly up-regulated, while the expression of circANRIL significantly down-regulated in CAD patients compared to non-CAD patients. Also, increased circANRIL expression was determined to be significantly inversely associated with the severity of CAD. Moreover, rs10757278 and rs10811656 polymorphisms were significantly associated with expressions of ANRIL, EU741058, NR003529 and circANRIL in VAT and PBMCs. Decreased circANRIL levels were correlated with aggressive clinical characteristics. Moreover, the random forest model was evaluated to feature importance of CAD prediction. Accordingly, the receiver operating characteristics(ROC) curve analysis was evaluated and the result suggested that circANRIL has high diagnostic accuracy. The area under the ROC curve (AUC) was 0.9808, the optimal cut‐off value was 0.33, with a sensitivity of 1.0 and a specificity of 0.88.Conclusion: We report the first data demonstating the presence of, ANRIL and its transcript variants expressions in adipose tissues and PBMCs of CAD patients and the strong association between ANRIL expression and CAD. circANRIL having a synergetic effect with ANRIL plays a protective role in CAD pathogenesis. Therefore, altered circANRIL expression may become a potential diagnostic biomarker for early CAD diagnosis in Tanzania.</jats:p

Acute Right Ventricular Dysfunction Complicating Prolonged Cardiac Tamponade

We report a case of transient right ventricular dysfunction associated with prolonged cardiac tamponade, an unusual complication of uncertain etiology. We believe that in this case dynamic coronary flow restriction resulted in ischemic injury and stunning of the right ventricle. Other possible causes are briefly reviewed. Right ventricular failure can easily emerge undetected during tamponade since both disorders exhibit very similar physical findings. This complication should be considered when patients with pericardial effusion and tamponade deteriorate unexpectedly or fail to respond as anticipated following pericardial drainage. Our patient’s clinical course identifies a potential adverse event associated with delayed diagnosis and treatment of cardiac tamponade which should encourage prompt pericardial drainage at the earliest clinical sign of cardiac compression.Keywords: Tamponade, stunning, right ventricular failur

Bilateral multiple pulmonary artery aneurysms associated with cavitary pulmonary tuberculosis: a case report

Abstract Background Pulmonary artery aneurysms constitute 50%) of cases, however, pulmonary artery aneurysm is a rare sequelae of pulmonary tuberculosis reported in about 5% of patients with chronic cavitary tuberculosis on autopsy. The natural history of this potentially fatal condition remains poorly understood and guidelines for optimal management are controversial. Case presentation A 24-year-old man, a nursing student of African descent, was referred to us from an up-country regional hospital with a 4-week history of recurrent episodes of breathlessness, awareness of heartbeats and coughing blood 3 weeks after completing a 6-month course of anti-tuberculosis drugs. A physical examination revealed conjuctival and palmar pallor but there were no stigmata of connective tissue disorders, systemic vasculitides or congenital heart disease. An examination of the cardiovascular system revealed accentuated second heart sound (S2) with early diastolic (grade 1/6) and holosystolic (grade 2/6) murmurs at the pulmonic and tricuspid areas respectively. Blood tests showed iron deficiency anemia, prolonged bleeding time, and mild hyponatremia. A chest radiograph revealed bilateral ovoid-shaped perihilar opacities while a computed tomography scan showed bilateral multiple pulmonary artery pseudoaneurysms with surrounding hematoma together with adjacent cystic changes, consolidations, and tree-in-bud appearance. Our patient refused to undergo surgery and died of aneurismal rupture after 9 days of hospitalization. Conclusions The presence of intractable hemoptysis among patients with tuberculosis even after completion of anti-tuberculosis course should raise an index of suspicion for pulmonary artery aneurysm. Furthermore, despite of its rarity, early recognition and timely surgical intervention of pulmonary artery aneurysm is crucial to reducing morbidity and preventing the attributed mortality

Osteosarcoma of the lower limb metastasized to the septum and right side of the heart: a case report

Abstract Background Metastatic cardiac tumors are far more common than primary tumors. Although the hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom reported and can be difficult to recognize. Case presentation A 21-year-old man of African descent presented to our center complaining of shortness of breath, awareness of heart beats, easy fatigability, swelling of lower limbs, and left-side chest discomfort for the past 6 months getting worse for the last 3 months prior to his third readmission. In 2004 he was admitted with the diagnosis of osteosarcoma of his left calcaneus bone confirmed by bone biopsy and treated at an oncology center with several cycles of radiotherapy and chemotherapy; he was declared cured after 5 years of annual clinical and radiological skeletal survey follow-ups. In the current admission, a physical examination revealed bilateral lower limb swelling, pansystolic murmur on the left side of his sternum at fourth intercostal space (tricuspid area) grade three, hepatomegaly with a liver span of 17 cm, and a positive fluid test and shifting dullness. Conclusions This case report presents a 21-year-old man with relapsed osteosarcoma manifesting as metastatic lesions to his right ventricle encroaching on his interventricular septum, which was identified by transthoracic/transesophageal echocardiography computed tomography scan and cardiac magnetic resonance imaging

Coronary Artery Bypass Graft Surgery in Tanzania: 5 Years of Experience at Jakaya Kikwete Cardiac Institute

Abstract Cardiac surgery is not widely available in most developing countries, and most patients have no choice but to live in morbid conditions and managed conservatively or the few who are referred abroad for surgical procedures costs the respective countries millions of hard earned foreign currency. The World Health Organization projects that over the next ten years the continent of Africa will experience the largest increase in death rates from cardiovascular disease. The Jakaya Kikwete Cardiac Institute (JKCI) is a government owned National Specialized and Teaching Hospital that serves patients from all the regions of the United Republic of Tanzania with a population of nearly 60,000,000 people and also serves beyond the borders (Rwanda, Burundi, DR Congo, South Sudan, Comoro, Malawi and Zambia) for advanced cardiovascular medical, intervention, vascular and open heart surgery, the Institute was established in 2015. Methods: Here we report all patients who underwent coronary artery bypass surgery grafting only performed at the Centre since its inauguration in 2015- till 2019. Data were collected for basic demography, diagnosis, investigations, clinical and surgical outcome parameters. Results: A total of 85 patients with heart diseases and underwent coronary artery bypass surgery grafting (CABG) are analysed in this study. There were 64 (75%) male and 21 (25%) female patients. Their age ranged from 41–85 years old with almost half 42 (49%) of the cohort being between the age between 61–70 years old. Most of the patients had two or more grafts and an internal mammary artery graft was used over 80% of the procedures. The overall 30-day mortality was 7.1%, incidence of stroke 0.2%, duration of mechanical ventilation was an average of 9.98 hours and intensive care unit (ICU) stay post CABG was an average of 6.48 days and final discharge from the centre ranged from 10–16 days.Conclusion: This study has demonstrated that coronary artery bypass surgery grafting in low/middle income country is safe and feasible. A sustainable program demands highest level of governmental support as seen in this case, and a dedicated multidisciplinary team with profound know how in cardiac pathologies. Furthermore, a need for good local data to know the prevalence of coronary disease is mandatory to determine the magnitude of coronary artery disease in each country.</jats:p