Diastolic versus systolic dysfunction in patients with chronic liver disease ­ a single center study in South-South, Nigeria

Objectives: The term cirrhotic cardiomyopathy (CCM) has been used to describe the constellation of cardiovascular abnormalities including diastolic and systolic dysfunctions in patients with chronic liver disease (CLD). CCM contributes to morbidity and mortality associated with CLD. The aim of the study was to evaluate the left atrial and ventricular geometry, systolic and diastolic functions in patients with CLD. Material and Methods: This was a cross-sectional analytical study that involved 80 patients with CLD seen at University of Calabar Teaching Hospital, Calabar, Nigeria, and 80 apparently healthy controls matched for age/ gender. The participants were interviewed, examined and had resting transthoracic echocardiography. The data were analyzed using IBM SPSS version 20.0. Results: A total of 160 subjects were recruited into the study with a male to female ratio of 2.8:1. There was no difference in the mean age of cases and controls (P = 0.115). Systolic function of the left ventricle was similar in the two arms. However, left ventricular diastolic dysfunction, left atrial enlargement, and increased left ventricular mass index (LVMI) were more prevalent among the patients with CLD compared to controls (P < 0.05). Conclusion: The study demonstrated increased left atrial diameter, increased LVMI associated with diastolic dysfunction, and preserved systolic function at rest among CLD patients. Keywords: Chronic liver disease, Diastolic dysfunction, Systolic dysfunction

Hepatitis E in Namibia: A Historical Review

Namibia has had three outbreaks of Hepatitis E Virus (HEV), in 1983, 1995 and 2017. HEV is particularly dangerous to pregnant women. The objective of this study was to present a thorough review of the history of HEV in Namibia; the genotypes which have appeared since 1983, and the possible reasons for the nationwide spread of HEV that has occurred since 2017. MATERIALS AND METHODS As this is a review article, no primary research data will be presented. However, an exhaustive literature study has been undertaken and there will be in-depth discussion of the findings of primary researchers in Namibia and elsewhere. RESULTS The first two episodes were confined to the Rundu area. The 1983 outbreak may have been genotype 1; that of 1995 contained genotypes 1 and 2. The genotype of 2017 episode has not been clearly established. Increased road traffic may have spread HEV during 2017-2020. Lack of clean water and washing facilities, and lack of awareness of what causes HEV, are the main factors in spreading it. CONCLUSIONS AND RECOMMENDATIONS There remain challenges to the containment of HEV. A recent government initiative to stop COVID-19 has helped slow its progress. Both infections are propagated by poor hygienic practice and lack of clean water.