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 & 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

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<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<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<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<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<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<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

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

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<0.05) lower high density lipoprotein-cholesterol as compared with the control. There was no significant (P>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<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

Prevalence and gender distribution of the metabolic syndrome

<p>Abstract</p> <p>Background</p> <p>The Metabolic syndrome (MetS) is a cardiovascular risk factor of public health significance and of recent has become a topical issue. The prevalence of diabetes mellitus (DM) is on the increase and with this scenario, a possible increase in burden of DM which may be largely attributed to cardiovascular complications is expected. The objective of this report is to determine the prevalence of the MetS and compare gender characteristics in subjects with type 2 DM.</p> <p>Methods</p> <p>Subjects with type 2 DM were recruited from an urban hospital for the study. Clinical data was obtained by interviewing the patients and referring to their Case folders. The anthropometric indices and blood pressure measurements were documented. Laboratory parameters analysed for included total cholesterol, high density and low density cholesterol, triglyceride and glycosylated haemoglobin. Statistical analysis included usage of Student's t test and chi square.</p> <p>Results</p> <p>963 patients with type 2 DM aged between 35-85 years were recruited for the study. The main outcome measures included the prevalence of the metabolic syndrome and the gender differences of its components. The prevalence of the metabolic syndrome was 86%. The frequency of occurrence of the MetS was similar for men (83%) and women (86%) and increased with age in both sexes. The prevalence of MetS increased from 11% among participants aged 20 through 29 years to 89% in participants aged 70 through 79. In our patients with DM, the commonest occurring and least detected MetS defining parameters are central obesity and elevated triglyceride levels respectively. The components of the MetS that differed significantly in both sexes was HDL-C. The combination of the components of the MetS were comparable in both genders and 5.8% of the subjects with the MetS had all components of the MetS.</p> <p>Conclusion</p> <p>The prevalence of the MetS in type 2DM is high in both genders and increases with age thus posing a potential high cardiovascular risk in this group of patients. The modifiable risk factors for the MetS should be a focus point in the management of subjects with type 2 DM,</p

Diabetes mellitus type 2 in urban Ghana: characteristics and associated factors

BACKGROUND: Sub-Saharan Africa faces a rapid spread of diabetes mellitus type 2 (DM2) but its potentially specific characteristics are inadequately defined. In this hospital-based study in Kumasi, Ghana, we aimed at characterizing clinical, anthropometric, socio-economic, nutritional and behavioural parameters of DM2 patients and at identifying associated factors. METHODS: Between August 2007 and June 2008, 1466 individuals were recruited from diabetes and hypertension clinics, outpatients, community, and hospital staff. Fasting plasma glucose (FPG), serum lipids and urinary albumin were measured. Physical examination, anthropometry, and interviews on medical history, socio-economic status (SES), physical activity and nutritional behaviour were performed. RESULTS: The majority of the 675 DM2 patients (mean FPG, 8.31 mmol/L) was female (75%) and aged 40-60 years (mean, 55 years). DM2 was known in 97% of patients, almost all were on medication. Many had hypertension (63%) and microalbuminuria (43%); diabetic complications occurred in 20%. Overweight (body mass index > 25 kg/m2), increased body fat (> 20% (male), > 33% (female)), and central adiposity (waist-to-hip ratio > 0.90 (male), > 0.85 (female)) were frequent occurring in 53%, 56%, and 75%, respectively. Triglycerides were increased (≥ 1.695 mmol/L) in 31% and cholesterol (≥ 5.17 mmol/L) in 65%. Illiteracy (46%) was high and SES indicators generally low. Factors independently associated with DM2 included a diabetes family history (adjusted odds ratio (aOR), 3.8; 95% confidence interval (95%CI), 2.6-5.5), abdominal adiposity (aOR, 2.6; 95%CI, 1.8-3.9), increased triglycerides (aOR, 1.8; 95%CI, 1.1-3.0), and also several indicators of low SES. CONCLUSIONS: In this study from urban Ghana, DM2 affects predominantly obese patients of rather low socio-economic status and frequently is accompanied by hypertension and hyperlipidaemia. Prevention and management need to account for a specific risk profile in this population

The risk of metabolic syndrome as a result of lifestyle among Ellisras rural young adults

The study aimed to investigate the association between metabolic syndrome (MetS) and lifestyle risk factors among Ellisras adults. A cross-sectional study was conducted on 624 adults (306 males and 318 females). MetS was defined according to the criteria of the International Diabetes Federation. The prevalence of MetS was 23.1% (8.6% males and 36.8 % females). Females appeared to have higher mean values for waist circumference (WC), fasting blood glucose (FBG), total cholesterol (TCHOL) and low-density lipoprotein cholesterol (LDL-C), while males had high mean values for high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), systolic blood pressure (SBP) and diastolic blood pressure (DBP). No significant age and gender differences were observed for dietary intake. Significantly more females (51.9%) presented with increased WC than males (4.6%). Participants who had a high dietary energy intake were significantly less likely to present with larger WC (OR: 0.250 95% CI [0.161; 0.389]), low HDL-C (OR: 0.306 95% CI [0.220; 0.425]) and high LDL-C (OR: 0.583 95% CI [0.418; 0.812]) but more likely to present with elevated FBG (OR: 1.01 95% CI [0.735; 1.386]), high TCHOL (OR: 1.039 95% CI [0.575; 1.337]), high TG (OR: 1.186 95% CI [0.695; 2.023]) and hypertension (OR: 5.205 95% CI [3.156; 8.585]). After adjusting for age, gender, smoking, and alcohol status, high energy intake was more than two times likely to predict MetS in adults with a large WC (OR: 2.766 95% CI [0.863; 3.477] and elevated FBG (OR: 2.227 95% CI [1.051; 3.328]). Therefore, identifying groups that are at an increased risk and those that are in their early stages of MetS will help improve and prevent the increase of the MetS in the future

Estimating the burden of selected non-communicable diseases in Africa: a systematic review of the evidence

Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa