Metabolic dysfunctions in non-antiretroviral treated HIV/AIDS patients

AIDS related metabolic and morphologic disorders have been attributed to protease inhibitor based antiretroviral therapy. HIV/AIDS is however amulti-systemic disease with potential for alteration ofmetabolic and endocrine functions. To determine ifmetabolic disorders occur in non-antiretroviral treatedHIV/AIDS patients. Case control study of prospectively recruited 48 HIV seropositive patients, and randomly selected age and sex-matched controls. Main outcome measures included plasma lipid concentrations and intravenous glucose tolerance measured using glucose assimilation coefficient, K. A K-value less than 1.2 constituted an impaired glucose tolerance. Compared to the controls,HIV/AIDS patients had significantly lower glucose assimilation coefficient (1.5 ± 0.5 versus 2.7 ± 0.9; p < 0.001); higher proportion of individuals with impaired glucose tolerance (35.4% versus 7.5%; P = 0.01); and higher plasma triglyceride concentration (166.5 ± 20.7mg/dL versus 148.9 ± 13.5mg/dL; p = 0.04). The proportion of patients with hypertriglyceridaemia was also significantly higher among patients than controls (56.3%versus 17.5%; p = 0.04). Metabolic dysfunctions occur inHIV/AIDS independent of antiretroviral therapy.Routinemonitor of plasma lipids and glucose is therefore advocated inHIV/AIDS patients.Keywords: HIV/AIDS,metabolic dysfunction

A probable case of right atrial myxoma presenting with features of restrictive cardiomyopathy

Cardiac tumors are very rare and most frequently benign. Myxomas are the most common primary cardiac tumors accounting for about 50% of cases. The clinical presentation of atrial myxomas depends on size, anatomical location and their effects on the surrounding structures rather than the histological type. Restrictive cardiomyopathy can present with features of heart failure with typical massive ascites out of proportion to peripheral oedema known as egg on stick appearance. We present a case of a probable right atrial myxoma in a 20year old lady mimicking restrictive cardiomyopathy. Case report: Mrs. HD, a 20-year old Fulani lady was referred to us with 3 years history of progressive abdominal swelling, dyspnea on exertion and easy fatiguability. No orthopnea, paroxysmal nocturnal dyspnea, chest pain, palpitation or syncope. Relevant examination findings include a chronically ill looking young lady, with egg on stick appearance and mild pitting pedal edema. She had tachycardia, blood pressure 90/70mmHg &amp; elevated Jugular venous pressure. The liver was palpable about 4cm below the right costal margin and there was massive ascites demonstrable by fluid thrill. Trans- thoracic echocardiography revealed huge, well-defined right atrial mass measuring 64 x 35 x 56.8 mm attached to the superior wall of the atrium on apical four chamber view. Conclusion:Atrial mass should be considered in the differential diagnosis of a patient presenting with features of restrictive cardiomyopathy. Echocardiography and histology are required for definitive diagnosis

Dextrocardiawith situs viscerum inversus totalis in a 65 year old man: a case report

We report a 65 year old hypertensive and type 2 diabetic low income male observed during physical examination to have right sided cardiac apex and heart sounds. Radiologic, electrocardiography, echocardiography and computed tomogram scan studies confirmed dextrocardia with situs viscerum inversus totalis. There was neither coexisting congenital cardiac anomaly nor disconcordant atrio-ventricular connection. In spite of being diabetic and hypertensive, he had no evidence of ischaemic heart disease. The blood pressure and blood glucose were adequately controlled using appropriate agents. This case, to our knowledge, may be the documented oldest Nigerian with situs inversus dextrocardia, and shows that individuals with this rare thoracic-abdominal organ developmental anomaly may have normal life expectancy similar to the general population.Keywords: Dextrocardia, situs inversus

Spectrum of congenital heart diseases in children with Down Syndrome at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Objective: Congenital heart diseases (CHD) frequently occur in children with Down syndrome. A few studies in Nigeria have highlighted the pattern of CHD in such patients, but results are variable with no data from the study area for comparison. This study aims to determine the pattern of CHD among children with Down syndrome as seen at UDUTH, SokotoMethods: A prospective study conducted between 1st October 2011 and 31st April 2015. Subjects included all children with phenotypic features of Down syndrome (DS) who were seen at the Pediatric cardiology clinic and had echocardiography diagnosis of congenital heart diseases.Results: Of the 41 cases of DS seen during the study period, 32 (78.0%) children aged 2 weeks to 22 months (Mean +SD = 5.6 ± 4.0 months) were diagnosed with CHD. Male to female ratio was 2.2:1. Atrioventricular septal defect (AVSD) was the commonest CHD seen in 18 (56.3%) patients. Nine (28.1%) patients had isolated ventricular septal defect (VSD), three (9.4%) had VSD coexisting with atrial septal defect (ASD) while one (3.1%) patient each had isolated ASD and Fallot's tetralogy respectively. Only three (9.4%) patients had surgical closure abroad, with good postoperative outcome in two of the patients.Conclusion: AVSD is the commonest CHD in our series, which is similar to previous reports. Increased access to definitive intervention is advocated since surgical outcome in such patients may be favorable.Keywords: Down syndrome, congenital heart diseases, pattern, Sokot

The Aqueous Calyx Extract of Hibiscus sabdariffa Lowers Blood Pressure and Heart Rate via Sympathetic Nervous System Dependent Mechanisms

Summary: The antihypertensive effect of Hibiscus sabdariffa (HS) has been validated in animals and man. This study tested the hypothesis that its hypotensive effect may be sympathetically mediated. The cold pressor test (CPT) and handgrip exercise (HGE) were performed in 20 healthy subjects before and after the oral administration of 15mg/Kg HS. The blood pressure (BP) and heart rate (HR) responses were measured digitally. Mean arterial pressure (MAP; taken as representative BP) was calculated. Results are expressed as mean ±SEM. P&lt;0.05 was considered significant. CPT without HS resulted in a significant rise in MAP and HR (111.1±2.1mmHg and 100.8±2.0/min) from the basal values (97.9±1.9mmHg and 87.8±2.1/min; P&lt;0.0001 respectively). In the presence of HS, CPT-induced changes (ΔMAP=10.1±1.7mmHg; ΔHR= 8.4±1.0/min) were significantly reduced compared to its absence (ΔMAP= 13.2±1.2mmHg; ΔHR= 13.8±1.6/min; P&lt;0.0001 respectively). The HGE done without HS also resulted in an increase in MAP and HR (116.3±2.1mmHg and 78.4±1.2/min) from the basal values (94.8±1.6mmHg and 76.1±1.0/min; p&lt;0.0001 respectively). In the presence of HS the HGE-induced changes (ΔMAP= 11.5±1.0mmHg; ΔHR= 3.3±1.0/min) were significantly decreased compared to its absence (ΔMAP=21.4±1.2mmHg; ΔHR= 12.8±2.0/min; P&lt;0.0001 respectively). The CPT and HGE -induced increases in BP and HR suggest Sympathetic nervous system activation. These increases were significantly dampened by HS suggesting, indirectly, that its hypotensive effect may be due to an attenuation of the discharge of the sympathetic nervous system.Keywords: Hibiscus sabdariffa, Cold pesssor test, Hand grip exercise, Blood pressure, Heart rat

Effect of Mobile Phone Radiofrequency Electromagnetic Fields on Cardiovascular Parameters in Apparently Healthy Individuals

Summary: Since cell phones emit radiofrequency electromagnetic fields (EMFs), this study tested the hypothesis that cell phones placed near the heart may interfere with the electrical rhythm of the heart or affect the blood pressure. Following informed consent, eighteen randomly selected apparently healthy male volunteers aged 21.44 ± 0.53 years had their blood pressure, pulse rates and ECG measured before and after acute exposure to a cell phone. The ECG parameters obtained were: heart rate (HR), QRS complex duration (QRS), PR interval (PR) and Corrected QT interval (QTc). Results are presented as mean ± SEM. Statistical analyses were done using two-tailed paired t test for blood pressure and pulse rate data and one way ANOVA with a post hoc Tukey test for the ECG data. P&lt;0.05 was considered statistically significant. The blood pressure and pulse rates before and after exposure to the cell phone showed no significant difference. The ECG parameters (HR: beats/min, QRS:ms, PR:ms and QTc respectively) did not differ before (66.33 ± 2.50, 91.78 ± 1.36, 151.67 ± 5.39 and 395.44 ± 4.96), during (66.33 ± 2.40, 91.11 ± 1.61, 153.67 ± 5.06 and 394.33 ± 4.05) and after calls (67.22 ± 2.77, 91.11 ± 1.67, 157.44 ± 4.46 and 396.56 ± 4.93) compared to baseline (67.17 ± 2.19, 94.33 ± 1.57, 150.56 ± 4.93 and 399.56 ± 3.88). These results suggest that acute exposure to EMFs from cell phones placed near the heart may not interfere with the electrical activity of the heart or blood pressure in healthy individuals.Keywords: Cell phone radio waves, Blood pressure, Electrocardiogramme

Effect of Dried Lake Salt (Kanwa) on Lipid profile and Heart Histology of Female Albino Rats

Peripatum cardiomyopathy is a devastating form of cardiac failure affecting women mainly in their last month of pregnancy or early postpartum with high incidence in Northern Nigeria where the consumption of dried lake salt postpartum is high. The current work was designed to study the effect of dried lake salt on lipid profile and histology of heart in female albino rats. The rats were administered graded doses of the salt for 4 weeks. The group administered 300mg/kg body weight of the dried lake salt has significantly (P&lt;0.05) lower high density lipoprotein-cholesterol as compared with the control. There was no significant (P&gt;0.05) increase in low density lipoprotein-cholesterol but total cholesterol, triglyceride and very low density lipoprotein- cholesterol levels were lower compared to the control. Atherogenic index of the group administered 300mg/kg body weight was significantly (P&lt;0.05) higher compared to the control. The histological examinations of section of the heart reveal chamber dilation, hypertrophy and focal atrophy. The study suggests that consumption of dried lake salt for 4 weeks caused alteration to heart tissue and may cause heart related diseases in rats.Keywords: Peripartum cardiomyopathy, Dried lake salt, Postpartum, Pregnanc

COST-EFFECTIVENESS ANALYSIS OF MICROSCOPY, CULTURE AND SENSITIVITY STUDY AS A DECISION TOOL IN CHOICE OF ANTIBIOTICS IN CLINICAL PRACTICE.

This study evaluated the clinical utility and cost effectiveness of traditional MCS studies as decision tools in choosing antibiotics to treat infections in two tertiary hospitals in Northern Nigeria by retrospective evaluation of MCS records over six consecutive months. Of the 942 MCS studies that included 385(40.9%), 296(31.4%), 144 (15.3%) 45 (4.8%) , 40 (4.3%), 26(3.1%) and 6(0.2%) urine, high vaginal swabs (HVS) , stool, sputum, pus, endocervical swabs (ECS) and urethral swabs specimens performed, respectively on 510(54%) males and 432 (46%) females, only 9 (0.6%) had results that offered demonstrable influence on patients’ treatment at a cost effectiveness ratio of 4260.6 International dollars per 1. The estimated cost of MCS studies to the Nigerian economy (public health care provider) was 39.8million International dollars per annum. Our findings suggest that the traditional algorithm for decision on choice of antibiotic is not cost-effective. We proposed that empirical treatment based on community profiling of bacterial sensitivity to antibiotics may be superior

Prevalence and clinical forms of malaria among febrile HIV-infected children seen at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Background: Malaria and HIV infections are major health problems facing the world today. Sub-Saharan Africa with 10 percent of world’s population harbors more than half the burden of the scourge. The present study determined the prevalence and clinical forms of malaria among febrile HIV-infected children aged 3months to 15years, seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria.Materials and Methods: Cross-sectional study among febrile HIV-infected children and their control cohort were carried out between May and October 2016. The participants had the following investigations: malarial parasite, packed cell volume, random blood sugar, retroviral test.Results: A total of 140 febrile HIV-infected children aged 3 months to 15 years and 140 febrile HIV-negative age- and gender-matched children were recruited; 100 of the HIV-infected children were on ART and cotrimoxazole. The prevalence of malaria among the febrile HIV-infected children was 71.4% (100/140) which was significantly lower than the prevalence of 94.3% (132/140) among the control group (χ2 27.72, p=0.001). Among the febrile HIV-infected children that had malaria, 54(54.0%) had uncomplicated malaria while 46(46.0%) had severe malaria. Of the 132 controls that had malaria, 48(36.4%) had uncomplicated malaria and 84(63.6%) had severe malaria (χ2 =7.184, p=0.007).Conclusion: Malaria is a problem in HIV-infected children. Since nearly half of the febrile HIV-infected children had severe form of malaria, it is recommended that health promotion, intermittent malaria prophylaxis, early diagnosis and prompt effective treatment should be instituted for HIV-infected children. This may prevent severe form of malaria and its attendant mortality. Key words: Malaria; Prevalence and clinical forms of malaria; Febrile, HIV-infected, Sokoto state

Oxidative stress among subjects with metabolic syndrome in Sokoto, North.Western Nigeria

Background: Oxidative stress is known to play a role in the pathophysiology of metabolic syndrome and its components. Racial differences may exist in the level of markers of oxidative stress and antioxidants in patients with metabolic syndrome.Aim: The aim of this study was to determine the oxidative stress and antioxidants status in subjects with metabolic syndrome in Sokoto, North.Western Nigeria.Methods: A cross.sectional community.based study was carried out. Two hundred subjects (96 males and 104 females) were recruited for the study using a multi.stage sampling technique. Demographic data were obtained from the participants. Evaluation of anthropometric variables, blood pressure, blood  glucose levels, lipid profiles, plasma insulin levels, total antioxidant status, and oxidative stress markers was performed.Results: The subjects with metabolic syndrome had significantly higher malondialdehyde as compared to those without metabolic syndrome (236.4 [92.2] vs. 184 [63.2] nmol/l). The antioxidant enzymes  (superoxide dismutase, glutathione peroxidase and catalase) were significantly lower in subjects with metabolic syndrome than in those without metabolic syndrome (11.3 [4.2] vs. 13.9 [4.1] U/ml, 160[42] vs. 220[32] U/ml, and 2.12 [0.2] vs. 2.42 [0.2] U/ml, respectively). Similarly, the antioxidant Vitamins (A, C, and E) levels were significantly lower in subjects with metabolic syndrome than in those withoutmetabolic syndrome (7.1 [4.1] vs. 7.7 [4.2] µmol/L, 225 [55.3] vs. 227.6 [62.3] µmol/L, and 75.9 [13.9] vs. 82.8 [18.6] mg/dl, respectively). There was a positive correlation between components of metabolic syndrome and free radicals.Conclusion: Significantly increased oxidative stress and diminished antioxidant defenses were found among Nigerians with metabolic syndrome.Key words: Antioxidants, metabolic syndrome, oxidative stres