Muhammad S Mijinyawa

Rationale and design of the Investigation of the Management of Pericarditis (IMPI) trial: a 2 × 2 factorial randomized double-blind multicenter trial of adjunctive prednisolone and Mycobacterium w immunotherapy in tuberculous pericarditis.

BACKGROUND In spite of antituberculosis chemotherapy, tuberculous (TB) pericarditis causes death or disability in nearly half of those affected. Attenuation of the inflammatory response in TB pericarditis may improve outcome by reducing cardiac tamponade and pericardial constriction, but there is uncertainty as to whether adjunctive immunomodulation with corticosteroids and Mycobacterium w (M. w) can safely reduce mortality and morbidity. OBJECTIVES The primary objective of the IMPI Trial is to assess the effectiveness and safety of prednisolone and M. w immunotherapy in reducing the composite outcome of death, constriction, or cardiac tamponade requiring pericardial drainage in 1,400 patients with TB pericardial effusion. DESIGN The IMPI trial is a multicenter international randomized double-blind placebo-controlled 2 × 2 factorial study. Eligible patients are randomly assigned to receive oral prednisolone or placebo for 6 weeks and M. w injection or placebo for 3 months. Patients are followed up at weeks 2, 4, and 6 and months 3 and 6 during the intervention period and 6-monthly thereafter for up to 4 years. The primary outcome is the first occurrence of death, pericardial constriction, or cardiac tamponade requiring pericardiocentesis. The secondary outcome is safety of immunomodulatory treatment measured by effect on opportunistic infections (eg, herpes zoster) and malignancy (eg, Kaposi sarcoma) and impact on measures of immunosuppression and the incidence of immune reconstitution disease. CONCLUSIONS IMPI is the largest trial yet conducted comparing adjunctive immunotherapy in pericarditis. Its results will define the role of adjunctive corticosteroids and M. w immunotherapy in patients with TB pericardial effusion.

Overweight and Obesity among Adolescents in Kano, Nigeria

Background: Childhood and adolescent obesity is a global public health concern because of associated increased risk of cardiovascular diseases later in life. Although there are several studies on childhood obesity in Nigeria, few have assessed it in adolescents. Objectives: This study intends to assess the prevalence of overweight and obesity in adolescents in urban northern Nigeria. Method: A cross sectional school based survey was conducted to determine the prevalence of overweight and obesity. Stratified sampling was used to select 718 students. Their weight and height were measured and used to compute the Body Mass Index (BMI). Overweight and obesity were defined using the International Obesity Task Force (IOTF). Results: The prevalence of obesity and overweight were 0.84% and 1.98% respectively; with advancing age as a risk factor for both overweight and obesity. Multivariate logistic regression showed that the risk of overweight was almost two times higher with advancing age adjusted odds ratio of {1.79} with a p-value of { 0.03} and C.I. { 1.05 - 3.09}, adjusted for gender and school type. Conclusion: The data suggest the prevalence of overweight and obesity are low, and that advancing age is a risk factor for obesity.

Prevalence and Correlates of HIV-Associated Neurocognitive Disorders (HAND) in Northwestern Nigeria

HIV-associated Neurocognitive Disorders (HAND) are common among HIV-positive individuals. This study explored the prevalence and correlates of HAND in Nigeria. 80 HIV-positive and 40 HIV-negative adults selected from Aminu Kano Teaching Hospital (AKTH) received comprehensive evaluations. A multidomain neuropsychological test (MDNPT) battery assessing 7 domains was administered to the participants and their performance was combined with measures of functional status to classify impairments into various grades of HAND. Univariate and multivariate analyses were performed to identify correlates of symptomatic HAND. Among the HIV-positive individuals, 50% were highly active antiretroviral therapy-experienced (HAART+) and 50% were highly active antiretroviral therapy naive (HAART−). Symptomatic HAND was found among 40% of the HAART− individuals and 30% of the HAART+ individuals. Respective prevalence of HIV-associated dementia (HAD) was 23% and 5%, respectively (p = 0.0002). In a binary logistic regression model, only fewer years of education independently predicted symptomatic HAND [Odds Ratio (OR) = 1.2, 95% confidence interval (CI) = 1.04–1.44, p = 0.016]. The prevalence of HAND in Nigeria is high with HAD being commoner among HAART− patients. Provision of HAART and strict monitoring of patients at risk of HAND are needed to scale down the burden of the disease.

Endomyocardial Fibrosis Presenting Outside the Tropical Rain Forest

Endomyocardial fibrosis (EMF), an idiopathic cardiac disorder, occurs predominantly in the tropical and subtropical regions of the world. We present herein a report of EMF in a young man from the savannah belt of Nigeria. He was a 19-year-old young man who presented with recent onset of palpitation and dyspnea and was followed up elsewhere for 3 years as a case of chronic liver disease due to progressive abdominal distension. Clinical examination revealed an undernourished young man with atrial fibrillation and features of heart failure. His electrocardiogram showed features of atrial fibrillation, while echocardiogram showed enlarged right atrium, tricuspid incompetence, and signs of fibrosis in the ventricles. Although EMF occurs primarily in the subtropical regions of Africa in its typical manifestation, in this report it was in the savannah belt.

Prevalence and Characteristics of Peripartum Cardiomyopathy among Women with Cadiac Failure Referred for Echocardiography in a Tertiary Hospital in Northern Nigeria

Introduction: Peripartum cardiomyopathy (PPCM) is a common clinical condition in northern Nigeria. This study aimed to determine the prevalence and characteristics of PPCM among women with heart failure referred for echocardiography. Materials and Methods: This is a retrospective study of 401 women managed for heart failure referred for echocardiography between October 2016 and September 2017. Their reports were analyzed for demographic and echocardiographic parameters. Results: The mean age of the 401 individuals studied was 41.28 ± 16.25 years. The commonest cause of heart failure was PPCM, accounting for 256 (69.5%), followed by hypertension 79 (19.7%) and rheumatic heart disease (RHD) 24 (5.9%). Conclusion: PPCM is a common and important cause of heart failure among women in Northern Nigeria.

Echocardiographic pattern of heart diseases in a North - Western Nigerian tertiary health institution

Background: Transthoracic Echocardiography is an important non-invasive technique which provides information about cardiac structure and function, thus useful in the evaluation and management of cardiac diseases. Previous studies on echocardiography findings in our environment documented Hypertensive heart disease, Dilated Cardiomyopathy and Rheumatic Heart Disease as the commonest findings in patients with cardiac diseases. This study aimed to provide an update on the common echocardiography findings in this part of the country since previous studies were done over a decade ago. Materials and Methods: We reviewed echocardiographic reports of 1012 consecutive patients aged ≥15 years from September 2011 to August 2014 (3 years). The reports were reviewed for demographic parameters, indications for the procedure and main echocardiography diagnoses. Results: The mean age of the 1,012 individuals studied was 41.28 ± 16.25 years. There were 330 males and 682 females. The commonest clinical indication for echocardiography was Systemic hypertension/Hypertensive heart disease (41%) followed by Peripartum cardiomyopathy (20%) and Congestive cardiac failure (12%) of unknown cause. The most prevalent echocardiographic diagnoses was Hypertensive heart disease seen in 40.3%, followed by Peripartum cardiomyopathy (32%), Dilated cardiomyopathy (5.9%), and Rheumatic heart disease 4.6%. Normal echocardiographic findings were seen in 14.9% of the subjects. Conclusion: Hypertensive heart disease remains the most common echocardiographic indication and diagnosis. Peripartum cardiomyopathy was frequent in our centre and this may be related to the increased availability and accessibility to echocardiographic facility as well as the low socioeconomic status of the category of patients that attend the centre.

Impact of Symptomatic HIV- Related Neurocognitive Disorders in Survivalof HIV- Infected Individuals: A Systematic Review and Meta-Analyses

Background: HIV- related symptomatic neurocognitive disorders (SNCD) negatively influence the survival of affected patients. We conducted this meta-analysis to provide pooled estimates of mortality risk attributable to SNCD. Methods: MEDLINE, Google scholar, Cochrane library PsycINFO and EMBASE were the data bases thoroughly searched up to April 2014. Two parallel meta-analyses were performed to derive hazard ratio (HR) and relative risk (RR) of mortality from 7 and 6 studies respectively. The level statistical heterogeneity in the included studies was assessed using I-squared (I2) statistic while metaregression and subgroup analyses mainly explored clinical and methodological heterogeneity. Other assessments were analyses for publication bias, small study effect, single study effect and study quality. Results: Thirteen studies with satisfactory quality met the inclusion criteria. A total of 84 421 HIV+ individuals across 21 countries from Europe and America were involved. Subjects with SNCD have more than twice risk of death compared to subjects without SNCD: HR=2.1, 95% confidence interval (CI)=1.52-2.58; RR=2.46, 95% CI=1.63-3.69. The estimated HR translates in to 72% probability of subjects with SNCD dying earlier than subjects without SNCD. Risk of mortality is associated with declining CD4 cell count (p=0.038) and neurocognitive impairment in psychomotor and memory domains. In subgroup analyses, there was no significant difference in mortality risk with respect to HAART utilization, type of SNCD and availability of demographically adjusted normative scores. Despite limiting generalizability of findings to sub-Saharan Africa, inclusion of studies conducted in developed countries reduces confounding and increases the accuracy of defining pooled estimates. Conclusion: HIV- related SNCD negatively influence survival in affected patients. Routine care of these patients should include neurocognitive screening preferably with a battery assessing domains that are predictive of mortality such as psychomotor and memory domains.

Prevalence and risk factors for hepatotoxicity among patients with HIV/AIDS on highly active antiretroviral therapy in North-Western Nigeria

Introduction: Highly active antiretroviral therapy (HAART) has become more accessible to human immunodeficiency virus (HIV)/AIDS patients in resource-poor countries, especially sub-Saharan Africa. However, its use is often complicated by the occurrence of drug-related toxicities and interactions limiting this benefit in a substantial proportion of individuals. Hepatotoxicity being one of the adverse effects of HAART has led to the interruption of therapy from sub-clinical and clinical hepatitis and sometimes led to death. This study, therefore, sets out to determine the prevalence and risk factors for hepatotoxicity among HIV/AIDS patients on HAART in our environment. Materials and Methods: This was a cross-sectional comparative study carried out at Aminu Kano Teaching Hospital, Kano, North-Western Nigeria. HIV positive patients aged 18 years and above who consented to take part in the study were recruited. The study subjects were made up of patients on HAART for at least 6 months who were compared with age-and sex-matched HAART naοve subjects. Data were collected using a pretested interviewer administered questionnaire. Sociodemographic information, clinical characteristics, possible risk factors, CD4 cell count, HAART regimen, etc., were extracted from the case notes of the subjects. Venous blood samples were collected for necessary investigations and analyzed at the hospital central laboratory. Results: Four hundred and forty subjects consisting of 220 HAART-experienced (group 1) as cases; while the other 220 (group 2) HAART-naοve served as controls. The prevalence of hepatotoxicity for the HAART-experienced group was 36.4%, with severe hepatotoxicity occurring in 3.2%. There was no statistically significant difference in the prevalence of hepatotoxicity between in the two groups (P = 0.738). Over 90% of liver enzyme elevations were asymptomatic. Independent risk factors for hepatotoxicity were concurrent use of antituberculosis drugs and HAART and low CD4 count. Conclusion: There is a need for pre-emptive regular monitoring of liver function tests in patients on HAART since cases of hepatotoxicity found in this study were predominantly asymptomatic. Careful selection of less hepatotoxic HAART regimens in patients with identifiable risk factors is an important strategy in preventing the hepatotoxicity.

Prevalence of thinness among adolescents in Kano, Northwestern Nigeria

Background: Thinness in older children has been associated with delayed pubertal maturation, reduced muscular strength and work capacity. There is paucity of studies on thinness among adolescents in Nigeria. Objectives: The aim of this study was to determine the prevalence of thinness among adolescents in Kano, Northwestern Nigeria . Materials and Methods: In this descriptive cross-sectional survey, we used a multi-staged random sampling technique to select 718 students from six secondary schools in Kano metropolis. A pretested questionnaire was used to collect socio-demographic data. Physical measurements for weight and height were carried out using standard procedures. Results: The overall prevalence of thinness was 60.6%, with a higher prevalence among boys (63.0%) compared with girls (58.7%). Grades-I, II and III thinness were found in 26.0%, 15.5% and 19.1% of the studied subjects respectively. The prevalence of grade III thinness was higher among boys (19.4%) compared with girls (18.8%). The rate of thinness was observed to increase with age up to 16 years after which it starts to fall. Older age was also found to be independently associated with thinness among our subjects. Conclusion: The prevalence of thinness among adolescents in Kano is high, with a slightly higher rate in boys than girls. There is need for concerted effort by policy makers to come up with programmes aimed at reducing the burden of undernutrition among school children in our setting.

Prevalence of hypertension and its relationship with indices of obesity in Maiduguri, Northeastern Nigeria

Background: Hypertension is the greatest preventable cause of death one of the most important modifiable risk factors for cardiovascular diseases. There is paucity of studies on the relationship between obesity and hypertension in northern Nigeria. Objective: To determine the prevalence of hypertension and its relationship with indices of obesity in Maiduguri, northeastern Nigeria. Materials and Methods: We recruited 1700 consenting adults aged 15-70 years using a multistage random sampling technique. Data on socio-demographic characteristics were obtained using a pretested questionnaire. Physical measurements for anthropometric indices and blood pressure (BP) were carried out using standard procedures. Hypertension was defined as systolic BP ≥ 140mmHg and/or diastolic BP ≥ 90mmHg. Multiple logistic regressions were fitted and odds ratios with 95% confidence intervals were calculated to identify associated factors. Results: Of the 1700 subjects recruited, 1650 responde, d yielding a response rate of 97%. The overall prevalence of hypertension was 32.3%, with a higher prevalence among women than men (46.1% vs. 34.5%, P 40 years), BMI and WC were found to be independently associated with hypertension. There is need for further studies to determine the role of lifestyle modification in reducing the burden of hypertension in our environment.