Disparities in clinical features and outcomes of peripartum cardiomyopathy in high versus low prevalent regions in Nigeria.

AIMS: The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North-West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere. METHODS AND RESULTS: Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow-up, relative to baseline status, were assessed by echocardiography. During median 17 months follow-up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all-cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (<70 µg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2%; P = 0.025), but the supplement did not have significant impact on myocardial remodelling. CONCLUSIONS: This study has shown important non-racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation.

Notes From the Field: Availability of Satellite Pharmacies and Pharmacy Service Units in Nigerian Hospitals-Implications for Pharmaceutical Care.

The optimal provision of pharmaceutical care services requires an adequate number of pharmacists, satellite pharmacies and service units at healthcare facilities. We examined the availability of these requirements at Nigerian hospitals using the 2016 nationwide inspection reports of hospital pharmacies conducted by the Pharmacists Council of Nigeria. Records of 254 hospitals inspected were retrieved, of which 171 (67.3%) were public. The total number of pharmacists across facilities was 753. The most common satellite pharmacy units recorded were antiretroviral 80 (31.5%) and emergency departments 48 (18.8%). The most common service units were drug revolving funds 176 (69.3%) and drug information 112 (44.1%) units. These findings suggest the availability of pharmacists, satellite pharmacies and service units are inadequate for the optimal delivery of pharmaceutical care services at healthcare facilities in Nigeria. Therefore, there is a need for interventions to improve the provision of pharmaceutical care services at health care facilities in Nigeria.

Pollution of microcystins in waters in Shaoxing City / 预防医学

Objective To understand microcystins (MCs) pollution in important waters of Shaoxing, so as to provide evidence for risk assessment and supervision of water quality safety. Methods Water samples were collected from 15 points set in three Shaoxing waters during September 2016 to September 2017. Six kinds of MCs (MC-LR, MC-RR, MC-YR, MC-LA, MC-LY, MC-LF) in samples were detected by ultra performance liquid chromatography tandem mass spectrometry, and the results were compared according to different time and place. Results MCs were detected positive in 22 of the 135 samples , the total detection rate was 16.3％.The detection rates of Xiaoshao River, Puyang River and Cao′e River were 7.9％, 18.5％和26.7％ respectively; the detection rates in July, August and September were 13.3％, 40％ and 46.7％ respectively, and the other months were not detected. In 22 positive samples, the detection rates of 6 MCs from high to low as follows: MC-LR (100％), MC-RR (100％), MC-YR (22.7％), MC-LY (18.2％), MC-LF (13.6％) and MC-LA (0％) . Conclusion In the three important waters of Shaoxing, microcystins were polluted in summer and autumn, which were mainly MC-LR and MC-RR.

Right ventricular dysfunction in a hypertensive population stratified by patterns of left ventricular geometry.

INTRODUCTION: The aim of this study was to assess the prevalence, determinants and correlates of right ventricular (RV) systolic and diastolic dysfunction (RVSD and RVDD, respectively) in hypertensives, stratified by left ventricular (LV) geometric patterns. METHODS: The study was carried out in Aminu Kano Teaching Hospital in Kano, Nigeria, and was cross-sectional in design. Hypertensive subjects referred for echocardiography were consecutively recruited after satisfying the inclusion criteria. RVSD was defined as either tricuspid annular plane systolic excursion (TAPSE) of < 16 mm, or peak velocity of the systolic wave (S(m)) in tissue Doppler imaging (TDI) of the RV lateral tricuspid annulus of < 10 cm/s, or both. RVDD was defined as the ratio of < 1.0 of the peak velocities of the early (E(m)) to late (A(m)) diastolic waves in the TDI of the RV lateral tricuspid annulus. Subjects with normal LV geometry (NG) served as controls, and were compared with those who had eccentric (EH) or concentric (CH) LV hypertrophy or concentric LV remodelling. RESULTS: A total of 128 subjects were recruited. Overall, the prevalence of RVDD almost doubled that of RVSD in the studied subjects (61.72 vs 32.03%, respectively). Subjects with EH had the highest prevalence of RVSD (52.63%), while those with CH had the lowest prevalence (20.69%) (p < 0.01). By contrast, the prevalence of RVDD was high across the four groups without significant statistical difference; as high as 68.52% in subjects with NG and as low as 42.86% in those with CR. LVEF was the only independent determinant of RVSD after controlling for confounding variables, while age was the only determinant of RVDD. Likewise, age was the only correlate for E(m):A(m) ratio, while the best correlate for both TAPSE and S(m) was LVEF. CONCLUSION: The study has revealed that about two-thirds of the hypertensives had RVDD while about one-third had RVSD. Subjects with EH had the highest prevalence of RVSD, while RVDD was common across all the groups. LVEF and age were the only independent determinants of RVSD and RVDD, respectively.

Sero-prevalence of agglutinins to Listeria monocytogenes in Nigerian domestic animals.

A survey using tube agglutination test was conducted to determine the antibody prevalence to Listeria monocytogenes serotypes 1/2a, 1/2b, 1/2c, 3a and 4b in 1,190 serum samples of 8 animals species from various sources in Kano and Kaduna states of Nigeria. Following absorption with Staphylococcus aureus antigen to remove cross-reacting agglutinins, 52 (68.4 p. 100) of the horse samples were positive. Twenty-six (36.1 p. 100) pig, 52 (20.8 p. 100) cattle, 50 (20.0 p. 100) goat, 20 (20.0 p. 100) dog, serum samples were also positive. Free-ranging chickens had an antibody prevalence of 18 (32.1 p. 100) while those intensively managed had 3 (6.8 p. 100), a difference found to be statistically significant (P less than or equal to 0.01; X2). Sheep sera collected from Zaria abattoir had a prevalence of 30 (14.7 p. 100) while those from Ahmadu Bello University, Veterinary Teaching Hospital had 6 (13.0 p. 100) prevalence. The prevalence in camel was 4 (4.3 p. 100). Overall, of the 1,190 serum samples tested, 26 (21.9 p. 100) were sero-positive for L. monocytogenes agglutinins. Each species of animal tested for L. monocytogenes was positive for all five serotypes, except camel which was negative for serotype 3a. Fourty-four (53.0 p. 100) samples were positive at a titre of greater than or equal to 480 for serotypes 1/2a, 60 (58.3 p. 100) for 1/2b, 57 (52.3 p. 100) for 1/2c, 7 (13.7 p. 100) for 3a and 23 (39.0 p. 100) for 4b. It is concluded that L. monocytogenes infection is widespread in domestic animals in Nigeria.