Pattern of Cardiovascular Diseases Among Elderly Patients Admitted in Medical Wards at Muhimbili National Hospital Dar es salaam Tanzania

Cardiovascular disease is the most frequent cause of death in persons over the age 50 years and most importantly it is responsible for considerable morbidity and large burden of disability in the community. Cardiovascular diseases are an increasing cause of admissions among elderly in Africa, yet little research is available on pattern and magnitude of the problem. To determine the pattern of cardiovascular disease in elderly patients admitted in medical wards at Muhimbili National Hospital Dar es Salaam Tanzania. This was a descriptive cross sectional study that was carried our between September 2008 and September 2009. Social demographic information; medical history physical examination; electrocardiographic and echocardiography examination; biochemical and haematological parameters were collected from study patients One hundred eighty five elderly patients admitted at MNH, medical department, were enrolled into the study, all were of African black race. Majority, 116 (62.7%), were male. Their mean age was 66.1 (SD, 9.3; range, 50-87) years. The mean body mass index\ud (BMI) was 23.9 (SD, 3.9; range, 16.6-40.1) kg/m2. Hypertension was the most frequent condition encountered affecting both males (67.2%)and females (68.1%). Congestive heart failure was second common condition affecting 37% elderly patients. According to the echocardiogram findings, among 185 elderly patients 68.6% were diagnosed to have cardiovascular disease. There were no significant sex differences in the prevalence of cardiac disease (p>005). The commonest echocardiographic diagnosis were left ventricular hypertrophy (LVH) secondary to hypertension found in 45%, diastolic dysfunction found in 31% and systolic dysfunction 25%.The least common types were septal defect, pulmonary hypertension and calcified mitral valve found in one percent each. The commonest clinical presentations were palpitations, dyspnoea, orthopnoea, pedal oedema and right upper quadrant abdominal pain. Obese patients presenting with cardiovascular abnormalities were 9 (7.1%). Anaemia was the leading co- morbidity affecting 90.3% of the patients Hypertension, congestive heart failure and left ventricular hypertrophy were the commonest cardiovascular diseases among elderly patients at MNH. Coexistence of anaemia, stroke, renal impairment and diabetes was also frequent. Elderly patients should be screened for cardiovascular diseases especially hypertension whenever they are admitted to the hospital even if the reasons for admission are not cardiovascular problems.\u

Intronic variants in the long non-coding RNA CDKN2B-AS1 are strongly associated with the risk of coronary artery disease in the Northern Tribes of Tanzania

Introduction: Sub-Saharan Africa (SSA) is facing a rising epidemic of non-communicable diseases including the coronary artery disease (CAD) ranking at the top of the list. Chromosome locus 9p21.3 containing CDKN2B antisense RNA 1 (CDKN2B-AS1), identified in many genome-wide association studies for coronary artery disease (CAD), encompasses multiple single nucleotide polymorphisms (SNPs). This study aimed to conduct the first genetic study evaluating the common polymorphisms in 9p21.3 locus in Tanzanian CAD patients from different regions of Tanzania and their associations with CAD risk factors. Material and Methods: A total of 90 patients from Northern region (N-CAD) of Tanzania and 65 patients from other regions (South, East, West and Central) (R-CAD) were included in the study. Further the biochemical analysis the genotyping of common variants was performed with the LightSNiP typing assay using qRT-PCR method.  Results: Our analyses revealed that both genotype and allele frequencies of rs10757274, rs10757278 and rs10811656 were significantly different between the groups (p<0.05, respectively). We identified that one previously undescribed three-marker haplotype (rs1333049, rs10757274 and rs10757278) encompassing CDKN2B-AS1 was overrepresented (G-G-G, the risk haplotype, p<0.05) in N-CAD group compared to R-CAD group. The AUC of a risk model based on non-genetic factors was 0.730 (0.654-0.797) and the combination with genetic risk factors improved the AUC to 0.784 (95%CI=0.713-0.844, p<0.0001). Conclusion: Our results identified the presence of a novel three-marker haplotype having a significant association with CAD in Northern Tanzania. Moreover, combination of the nongenetic and genetic risk models were demonstrated to indicate good diagnostic accuracy for CAD in Northern Tanzania

Comparison between interventional versus medical therapy in patients with rheumatic mitral valve stenosis in Tanzania

Background: Rheumatic heart disease remains the most common cardiovascular disease in children and young adults. The outcome of interventional versus medical therapy on the long term is not fully elucidated yet. This study provides contemporary data on the clinical profile, treatment and follow up of patients with rheumatic mitral stenosis (MS) in Tanzania. Methods: Patients' medical information, investigations and treatment data were recorded in this prospective cohort study. They were followed up for 6–24 months to determine the long-term outcome. Interventional therapy was defined as a combination of surgery and percutaneous balloon mitral valvuloplasty. Kaplan–Meier curves and Cox proportional hazards model were used in analyses. p-Value < 0.05 was considered statistically significant. Results: We enrolled 290 consecutive patients. Interventions were done in half of the patients. Median follow up was 23.5 months. Mortality was higher in the medical than interventional treatment (10.4% vs. 4%, log-rank p = 0.001). Median age was 36 years, females (68.3%) and low income (55.5%). Multivalvular disease was found in 116 (40%) patients, atrial fibrillation (31.4%), stroke/transient ischaemic attack (18.9%) and heart failure class III–IV (44.1%). Median (IQR) duration of disease was 3 (4) years, secondary prophylaxis (27.7%) and oral anticoagulants use (62.3%). In multivariable analysis, the risk of death among patients on medical was 3.07 times higher than those on interventional treatment (crude HR 3.07, 95% CI 1.43–6.56, p = 0.004), 2.44 times higher among patients with arrhythmias versus without arrhythmias (crude HR 2.44, 95% CI 1.19–4.49, p = 0.015) and 2.13 times higher among patients with multivalvular than single valve disease (crude HR 2.13, 95% CI 1.09–4.16, p = 0.026). Conclusions: Intervention is carrying low mortality compared to medical treatment. Arrhythmias and multivalvular disease are associated with a high mortality. Rheumatic MS is more prevalent in young people, females and individuals with low income. There is a late hospital presentation and a low use of both secondary prophylactic antibiotics and anticoagulants

Low CD4 count plus coma predicts cryptococcal meningitis in Tanzania

<p>Abstract</p> <p>Background</p> <p>Largely due to the lack of diagnostic reagents, the prevalence and clinical presentation of cryptococcal meningitis in Tanzania is poorly understood. This in turn is limiting the impact of increased fluconazole availability.</p> <p>Methods</p> <p>We evaluated a cohort of 149 consecutive HIV-infected adult inpatients presenting with headache or altered mental status for clinical features, CD4 count, cryptococcal infection, and outcome. Cryptococcal meningitis was diagnosed via India ink and latex agglutination assay of CSF (<it>n </it>= 24 and 40 positive, respectively). Associations between cryptococcal meningitis and clinical features were evaluated by t-test. The sensitivity, specificity, and positive likelihood ratio of such features were determined.</p> <p>Results</p> <p>Cryptococcal meningitis was associated with confusion, social withdrawal, seizures, fever, tachycardia, meningismus, oral candidiasis, and low Glasgow coma scales and CD4 count. CD4 count < 100/μl provided the highest sensitivity for the diagnosis (93%), coma (Glasgow coma scale ≤ 8) provided the highest specificity (84%), and the combination provided the highest positive likelihood ratio (3.8). All cryptococcal meningitis patients were initiated on 800 milligrams of fluconazole daily and 50% survived to discharge, however no clinical or laboratory findings correlated with prognosis.</p> <p>Conclusion</p> <p>Cryptococcal meningitis is common among Tanzanian HIV inpatients presenting with headache or altered mental status. Purely clinical features are insensitive for establishing the diagnosis or prognosis. We advocate expanding laboratory capacity for cryptococcal antigen testing to maximize survival.</p

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