Cardiomyopathies in Sub-Saharan Africa: Hypertensive Heart Disease (Cardiomyopathy), Peripartum Cardiomyopathy and HIV-Associated Cardiomyopathy

Cardiomyopathy is an important cause of cardiac-related morbidity and mortality in sub-Saharan Africa. Dilated cardiomyopathy is responsible for 20–30% of adult heart failure (HF) in the region. It is only second to hypertensive heart disease as etiological risk factor for HF in many parts of the continent. The aim of the chapter is to review the current epidemiology, clinical features, management, and prognosis of hypertensive heart disease, peripartum cardiomyopathy, and HIV-associated cardiomyopathy in sub-Saharan Africa

Effect of Different Sources of Heat on Nutritional Composition of Tilapia Fish (Oreochromis niloticus)

A study was conducted to investigate the effect of traditional smoking methods on fresh tilapia fish (Oreochromis niloticus). For this purpose, proximate, mineral and amino acid compositions of tilapia fish smoked with sawdust, rice bran, melon husk and electric oven (control) heat treatments were determined using standard analytical technique. The results showed that crude protein content (%) ranged between 55.10 to 64.16% with the highest value recorded in sample smoked with rice bran heat treatment while crude fat had the highest value (18.10%) also in rice bran smoked sample. Sodium was found to be more abundant in all the samples (5.75 – 10.10 mg/100g) compared with magnesium (5.45 – 9.15 mg/100g), potassium (4.55 – 6.45 mg/100g) and phosphorus (4.70 – 6.00 mg/100g) while the least abundant mineral was chromium (0.05 – 0.15 mg/100g). The harmful metals such as cadmium and lead were not at detectable range of atomic absorption spectrophotometer (AAS). The amino acid profile revealed that only Oreochromis niloticus fish sample smoked with sawdust enhanced the contents of total amino acid (TAA), total essential amino acid (TEAA) and total sulphur amino acid (TSAA) by 3.77, 3.95 and 7.03%, respectively while melon husk and rice bran heat treatments reduced TAA, TEAA and TSAA. The limiting amino acid (LAA) for all the samples with different heat treatments was Ile except sample smoked with rice bran which has Val as LAA. Generally, all the smoked samples contained nutritionally useful quantities of total essential amino acids. Keywords: Oreochromis niloticus, agricultural wastes, smoke, proximate, amino acids

Graves’ disease presenting as paranoid schizophrenia in a Nigerian woman: a case report

Paranoid syndromes in Graves’ disease are rare. The true incidence is lacking. Most reports have emanated from developed countries where medical investigations are readily available. No report of such has emanated from Nigeria. We report a 43-year-old female Nigerian with Graves’ disease associated with paranoid schizophrenia and review the literature

Economic burden of heart failure: investigating outpatient and inpatient costs in abeokuta, southwest Nigeria

Background: Heart failure (HF) is a deadly, disabling and often costly syndrome world-wide. Unfortunately, there is a paucity of data describing its economic impact in sub Saharan Africa; a region in which the number of relatively younger cases will inevitably rise. Methods: Heath economic data were extracted from a prospective HF registry in a tertiary hospital situated in Abeokuta, southwest Nigeria. Outpatient and inpatient costs were computed from a representative cohort of 239 HF cases including personnel, diagnostic and treatment resources used for their management over a 12-month period. Indirect costs were also calculated. The annual cost per person was then calculated. Results: Mean age of the cohort was 58.0±15.1 years and 53.1% were men. The total computed cost of care of HF in Abeokuta was 76, 288,845 Nigerian Naira (US$508, 595) translating to 319,200 Naira (US$2,128 US Dollars) per patient per year. The total cost of in-patient care (46% of total health care expenditure) was estimated as 34,996,477 Naira (about 301,230 US dollars). This comprised of 17,899,977 Naira- 50.9% ($US114,600) and 17,806,500 naira −49.1$US118,710) for direct and in-direct costs respectively. Out-patient cost was estimated as 41,292,368 Naira ($US 275,282). The relatively high cost of outpatient care was largely due to cost of transportation for monthly follow up visits. Payments were mostly made through out-of-pocket spending. Conclusion: The economic burden of HF in Nigeria is particularly high considering, the relatively young age of affected cases, a minimum wage of 18,000 Naira ($US120) per month and considerable component of out-of-pocket spending for those affected. Health reforms designed to mitigate the individual to societal burden imposed by the syndrome are required

Spectrum of heart diseases in a new cardiac service in Nigeria: An echocardiographic study of 1441 subjects in Abeokuta

<p>Abstract</p> <p>Background</p> <p>Echocardiography is a non-invasive, relatively cheap and useful imaging technique for the evaluation of cardiac diseases. The procedure has reliable levels of accuracy.</p> <p>Echocardiography commenced at the Federal medical centre Abeokuta on September 9, 2005.</p> <p>The aim of this study is to report our experience with the procedure, and to define the clinical cases seen in our setting.</p> <p>Methods</p> <p>This is a retrospective analysis of a prospectively collected data. Echocardiography was performed using Aloka SSD 1,100 echocardiograph equipped with 2.5–5.0 MHz transducer</p> <p>Results</p> <p>During the period of 18 months under review (September 2005–February 2007), 1629 procedures were performed. The reports of 188 echocardiograms were excluded due to poor echo-window, repeated procedure or incomplete report. 1441 reports were reviewed for demographic parameter, indications for the procedure and the main echocardiographic diagnoses.</p> <p>The mean age of the 1441 individuals studied was 54 +/- 14.3 years (15–90). There were 744 men and 697 women. Eight hundred and seventeen subjects (56.7%) had hypertensive heart disease, 53 subjects (3.7%) had rheumatic heart disease while 44(3.0%) had dilated cardiomyopathy. Pericardial diseases, cor-pulmonale, ischaemic heart disease, congenital heart diseases, diabetic heart disease, thyroid heart disease, sickle cell cardiopathy were present in 26(1.8%), 23(1.6%), 9(0.6%), 6(0.4%), 6(0.4%), 6(0.4%), 1(0.1%), and 1(0.1%) respectively. Four hundred and forty nine (31.2%) subjects had normal study.</p> <p>Conclusion</p> <p>Hypertensive heart disease was found to be the most prevalent cardiac condition in this study. The relatively frequent diagnoses of rheumatic heart disease, cardiomyopathies and pericardial diseases reflect the impact of infections and infestations on the cardiovascular health of adult Nigerians.</p> <p>We suggest that prevention and treatment of cardiac diseases in our setting should among other things focus on blood pressure control and early treatment of infections causing heart diseases.</p

Formulation and evaluation of nanosized hippadine-loaded niosome : extraction and isolation, physicochemical properties, and in vitro cytotoxicity against human ovarian and skin cancer cell lines

Chemical compounds extracted from plants have been used in the development of many medicinal products. Hippadine is a compound extracted from Crinum jagus, a plant that has been widely used traditionally for the treatment of ailments such as asthma, malaria, depression, convulsions, and cancer. However, the therapeutic applications of hippadine is limited due to its poor solubility and bioavailability. In the context of drug delivery, nanotechnology has been employed widely to improve the bioavailability of poorly soluble compounds through the encapsulation and the delivery of these compounds to their target sites. This study aims to evaluate the cytotoxic activities on two human cancer cell lines of hippadine through its encapsulation into niosome nanoparticles which are a bilayer vesicle widely employed for drug delivery. Firstly, hippadine was extracted and isolated from C. jagus bulbs and encapsulated into niosome nanoparticles composed of span 60 (SP60) and cholesterol, prepared by microfluidic mixing. The prepared nanoparticles had spherical morphology, and were small, uniform, and monodisperse with an average particles size <150 nm when loaded or empty. The encapsulation efficiency was 36 ± 1%. Hippadine loaded niosomes showed superior cytotoxic effects over free hippadine as indicated by the significant (p < 0.05) decrease in the IC 50 values when tested in vitro on human ovarian carcinoma (A2780) and human skin cancer cells (A375). This is the first study that reports the use of SP60 niosomes for successful encapsulation and delivery of hippadine into cancer cells

Fish bone foreign body presenting with an acute fulminating retropharyngeal abscess in a resource-challenged center: a case report

<p>Abstract</p> <p>Introduction</p> <p>A retropharyngeal abscess is a potentially life-threatening infection in the deep space of the neck, which can compromise the airway. Its management requires highly specialized care, including surgery and intensive care, to reduce mortality. This is the first case of a gas-forming abscess reported from this region, but not the first such report in the literature.</p> <p>Case presentation</p> <p>We present a case of a 16-month-old Yoruba baby girl with a gas-forming retropharyngeal abscess secondary to fish bone foreign body with laryngeal spasm that was managed in the recovery room. We highlight specific problems encountered in the management of this case in a resource-challenged center such as ours.</p> <p>Conclusion</p> <p>We describe an unusual presentation of a gas-forming organism causing a retropharyngeal abscess in a child. The patient's condition was treated despite the challenges of inadequate resources for its management. We recommend early recognition through adequate evaluation of any oropharyngeal injuries or infection and early referral to the specialist with prompt surgical intervention.</p

Readmission and death after an acute heart failure event: predictors and outcomes in sub-saharan africa: results from the thesus-hf registry

Aims: Contrary to elderly patients with ischaemic-related acute heart failure (AHF) typically enrolled in North American and European registries, patients enrolled in the sub-Saharan Africa Survey of Heart Failure (THESUS-HF) were middle-aged with AHF due primarily to non-ischaemic causes.We sought to describe factors prognostic of re-admission and death in this developing population. Methods and results: Prognostic models were developed from data collected on 1006 patients enrolled in THESUS-HF, a prospective registry of AHF patients in 12 hospitals in nine sub-Saharan African countries, mostly in Nigeria, Uganda, and South Africa. The main predictors of 60-day re-admission or death in a model excluding the geographic region were a history of malignancy and severe lung disease, admission systolic blood pressure, heart rate and signs of congestion (rales), kidney function (BUN), and echocardiographic ejection fraction. In a model including region, the Southern region had a higher risk. Age and admission sodium levels were not prognostic. Predictors of 180-day mortality included malignancy, severe lung disease, smoking history, systolic blood pressure, heart rate, and symptoms and signs of congestion (orthopnoea, peripheral oedema and rales) at admission, kidney dysfunction (BUN), anaemia, and HIV positivity. Discrimination was low for all models, similar to models for European and North American patients, suggesting that the main factors contributing to adverse outcomes are still unknown. Conclusion: Despite the differences in age and disease characteristics, the main predictors for 6 months mortality and combined 60 days re-admission and death are largely similar in sub-Saharan Africa as in the rest of the world, with some exceptions such as the association of the HIV status with mortality

Epidemiological and Entomological Evaluations after Six Years or More of Mass Drug Administration for Lymphatic Filariasis Elimination in Nigeria

The current strategy for interrupting transmission of lymphatic filariasis (LF) is annual mass drug administration (MDA), at good coverage, for 6 or more years. We describe our programmatic experience delivering the MDA combination of ivermectin and albendazole in Plateau and Nasarawa states in central Nigeria, where LF is caused by anopheline transmitted Wuchereria bancrofti. Baseline LF mapping using rapid blood antigen detection tests showed mean local government area (LGA) prevalence of 23% (range 4–62%). MDA was launched in 2000 and by 2003 had been scaled up to full geographic coverage in all 30 LGAs in the two states; over 26 million cumulative directly observed treatments were provided by community drug distributors over the intervention period. Reported treatment coverage for each round was ≥85% of the treatment eligible population of 3.7 million, although a population-based coverage survey in 2003 showed lower coverage (72.2%; 95% CI 65.5–79.0%). To determine impact on transmission, we monitored three LF infection parameters (microfilaremia, antigenemia, and mosquito infection) in 10 sentinel villages (SVs) serially. The last monitoring was done in 2009, when SVs had been treated for 7–10 years. Microfilaremia in 2009 decreased by 83% from baseline (from 4.9% to 0.8%); antigenemia by 67% (from 21.6% to 7.2%); mosquito infection rate (all larval stages) by 86% (from 3.1% to 0.4%); and mosquito infectivity rate (L3 stages) by 76% (from 1.3% to 0.3%). All changes were statistically significant. Results suggest that LF transmission has been interrupted in 5 of the 10 SVs, based on 2009 finding of microfilaremia ≥1% and/or L3 stages in mosquitoes. Four of the five SVs where transmission persists had baseline antigenemia prevalence of >25%. Longer or additional interventions (e.g., more frequent MDA treatments, insecticidal bed nets) should be considered for ‘hot spots’ where transmission is ongoing