Left ventricular hypertrophy in African children infected with HIV/AIDS: a case-control study.

Introduction: left ventricular hypertrophy (LVH) measured by echocardiography seen in human immunodeficiency virus/acquired immunodeficiency disease (HIV/AIDS) affects the morbidity and mortality. The hemodynamic and metabolic changes in (HIV/AIDS) affect the heart adversely causing hypertrophic remodeling with left ventricular hypertrophy. The aim of this study was to determine the prevalence and risk factors associated with LVH in African children with HIV/AIDS. Methods: an analytical case-control study was conducted using echocardiography to assess cardiac function. Descriptive statistics was used to determine percentages and univariate analysis to find association between dependent variable and independent variables. Independent variables that had an association in a univariate were included in the multivariate model to determine strength of association. Results: the mean age of the study population was 7.8 ± 2.07 years for controls and 8.3 ± 3.04 years for cases respectively. They were made up of 51.2% (n= 86) males and 48.8% (n = 82) females (M: F=1.05: 1). We studied eighty-four (n= 84) cases, and LVH was seen in 67.7% (n= 56) of the patients. Mean left ventricular mass index (g/m2) was significantly higher in the cases (90.37± 35.50) than controls (89.37 ± 14.25, p= 0.04.) Relative wall thickness (mm) was within normal in the control, 0.35 ± 0.06 and high in the cases, 0.67 ± 0.17, p= 0.01. Eccentric hypertrophy was the most common type seen in 36.9% (n= 31) of the patients. Multiple linear regression analysis, revealed that the presence of LVH was associated with 0.212 (95% CI: 0.001 - 0.014; p= 0.001) lower Body mass index (BMI) for age and 0.396 (95% CI; 0.002 - 0.066; p= 0.03) lower CD4+ cell count as predictors of LVH. Conclusion: the prevalence of LVH was high. Lower body mass index (BMI) and CD4+cells count predicted LVH. This supports the recommendation by the National Heart, Lung and Blood Institute (NHLBI) working group on research priorities for cardiovascular complications in HIV/AIDS, for baseline and periodic echocardiography in the management of children with HIV/AIDS.

Vitamin D3 supplementation as an adjunct in the management of childhood infectious diarrhea: a systematic review.

BACKGROUND: Some studies have reported the possible role of vitamin D3 in ameliorating disease outcomes in childhood infectious diarrhea. However, findings about its effectiveness and the association of serum vitamin D levels with diarrhea risk appear inconsistent. We aimed to determine the efficacy of oral vitamin D3 as an adjunct in managing childhood infectious diarrhea and the relationship between vitamin D status and the disease. METHODS: We searched the PubMed and Google Scholar electronic databases for relevant articles without limiting their year of publication. We selected primary studies that met the review's inclusion criteria, screened their titles and abstracts, and removed duplicates. We extracted data items from selected studies using a structured data-extraction form. We conducted a quality assessment of randomized controlled trials (RCTs) and non-randomized studies with the Cochrane collaboration tool and the Newcastle Ottawa Scale, respectively. We assessed the strength of the relationship between serum vitamin D levels and diarrhea using the correlation model. We estimated the I2 and tau2 values to assess between-study heterogeneity. RESULTS: Nine full-text articles were selected, consisting of one RCT, three cross-sectional studies, two cohort studies, two longitudinal/prospective studies, and one case-control study. A total of 5,545 participants were evaluated in the nine studies. Six non-randomized studies provided weak evidence of the relationship between vitamin D levels and diarrhea risk as there was no correlation between the two variables. The only RCT failed to demonstrate any beneficial role of vitamin D3 in reducing the risk of recurrent diarrhea. The calculated I2 and tau2 values of 86.5% and 0.03, respectively suggested a high between-study heterogeneity which precluded a meta-analysis of study results. CONCLUSION: Oral vitamin D3 may not be an effective adjunct in managing childhood infectious diarrhea. Additionally, the relationship between vitamin D status and infectious diarrhea appears weak. We recommend more adequately-powered RCTs to determine the effectiveness of vitamin D3 as an adjunct therapy in infectious diarrhea.

Outcomes of Surgical Management for Patent Ductus Arteriosus in Infants in Nigeria.

BACKGROUND: Patent ductus arteriosus is a common cardiac anomaly in infants that, if untreated, is associated with high morbidity and mortality rates. In lower-middle-income countries, such as Nigeria, obtaining cardiovascular surgical care for infants remains difficult. In recent years, especially with the assistance of international voluntary cardiac organizations, efforts have increased to provide cardiac surgical services to this underserved population. METHODS: In this case series, the authors describe outcomes in 30 infants surgically treated for patent ductus arteriosus between 2013 and 2019 at an emerging cardiac center in Nigeria (9 male [30%] and 21 female [70%]; mean [SD] age, 8.2 [3.01] months; mean [SD] weight, 5.3 [1.52] kg; mean [range] weight deficit, 34.5% [15%-60%]). RESULTS: All the infants presented with patent ductus arteriosus as the main cardiac lesion, and 4 (13%) were syndromic. The mean (SD) patent ductus arteriosus diameter was 4.73 (1.46) mm. Surgical closure was completed in 29 infants; 1 died before surgery. No procedure-related deaths occurred, but 2 cases of trivial residual patent ductus arteriosus were recorded. CONCLUSION: Overall, surgical outcomes were excellent, with acceptable mortality rates. Perioperative care will continue to improve as the center is built to a self-sustaining capacity. Findings of this research at this emerging cardiac center in a developing country are a testament to the positive contribution made by international voluntary cardiac missions.

Assessment of left ventricular diastolic function in children with HIV/AIDS attending a tertiary health Facility in Enugu, Nigeria: a Doppler echocardiographic study.

OBJECTIVE: To determine the prevalence and factors associated with left ventricular diastolic dysfunction in children with HIV/AIDS. METHOD: Echocardiographic studies were carried out in 90 children/adolescents aged 18 months to 14 years. with HIV/AIDS and a healthy control group of 90 age and gender matched. RESULTS: 47.8% of the HIV/AIDS patients (subjects) had LVDD. This was more pronounced in the AIDS group (100%). The E/A ratio was 1.9 ± 0.56 in the HIV group, 2.09 ± 0.04 in the AIDS group, and 1.20 ± 0.39 in the control group (p = 0.04). The mean Left ventricular isovolumic relaxation time (IVRT) was 79.4 ± 20.12 in the HIV group, 110.4 ± 10.12 in the AIDS group and 89.22 ± 25.76 in the control group. (p = 0.04). Deceleration time (DT) was also lower in HIV carrier group compared to AIDS group, p = 0.02. A restrictive filling pattern was the most described; with 27 (36.5%) in the HIV group, 16 (100.0%) in the AIDS group and 2 (2.2%) in the control group. (p = 0.02). The impaired relaxation pattern, 3 (4.0%) seen in the HIV group only. Positive correlation exists between body surface area (BSA) and LVDD. Body surface area and younger age were the significant predictors (BSA: r = 0.425, p = 0.038 in HIV and r = 0.827, p = 0.042) of LVDD in the AIDS group. CONCLUSION: This study showed a high prevalence of LVDD in Nigerian children with HIV and AIDS. This justifies inclusion of echocardiographic studies in the policy care of children with HIV/AIDS in sub-Sahara Africa region.

Management of complex CHD at the National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Enugu: the role of foreign cardiac missions in 3.5 years.

BACKGROUND: CHD is defined as structural defect(s) in the heart and proximal blood vessels present at birth. The National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital (UNTH), Enugu, through the aid of visiting Cardiac Missions has managed a significant number of patients within the last 3.5 years. Aim/Objective The objective of this study was to review surgical options and outcome of complex CHD among patients attending UNTH, Enugu, Enugu. Materials and Method During the period of 3.5 years (March, 2013 to June, 2016), a total of 20 cases of complex CHD were managed by cardiac missions that visited UNTH, Enugu. Their case notes and operating register were retrieved, reviewed, and analysed using SPSS version 19 (Chicago). RESULTS: There were eight females and 12 males, with a ratio of 2:5. The age range was from 5 months to 34 years with a mean of 1.7. Among all, five patients died giving a mortality rate of 25%. The operative procedures ranged from palliative shunts to complete repair. The outcome was relatively good. CONCLUSION: Complex CHD are present in our environment. Their surgical management in our centre is being made possible by periodic visits of foreign cardiac missions.

Left ventricular systolic function in Nigerian children infected with HIV/AIDS: a cross-sectional study.

BACKGROUND: Cardiac complications contribute significantly to morbidity and mortality in children with HIV/AIDS. These rates have been under-reported in sub-Saharan African children. METHODS: This was an observational, cross-sectional Doppler echocardiographic study of ventricular systolic function, performed at a tertiary clinic on children with HIV/AIDS. RESULTS: Left ventricular systolic dysfunction was present in 27.0% of the children with HIV infection and 81.2% of those with AIDS. The mean fractional shortening in the AIDS group (31.6 ± 9.5%) was significantly lower than in the HIV-infected group (35.3 ± 10.5%, p = 0.001). A significant correlation was found with CD4(+) cell count and age, and these were the best predictors of left ventricular systolic dysfunction in the stepwise multiple regression analysis (r = 0.396, p = 0.038; r = -0.212, p = 0.025, respectively). CONCLUSION: Left ventricular systolic dysfunction is common in Nigerian children with HIV/AIDS.

Nutritional status of congenital heart disease (CHD) patients: Burden and determinant of malnutrition at university of Nigeria teaching hospital Ituku - Ozalla, Enugu.

BACKGROUND AND OBJECTIVES: Children with congenital heart disease (CHD) are prone to malnutrition. This can have a significant effect on the outcome of surgery. Our objective was to determine the burden and determinant of malnutrition in children with several types of congenital heart disease (CHD). METHODS: This is a descriptive cross sectional study of children attending the outpatient clinic of UNTH, Ituku - Ozalla, Enugu State, over a six year period from March 2007 to April 2014. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 19 (Chicago IL). RESULTS: Forty thousand one hundred and twenty three (40,123) children attended the outpatient clinic during the study period. Of these, 50 had congenital heart disease, from which 46 were found to have various degree of malnutrition, giving a prevalence of 92% among children with congenital disease and 0.11% in the general population. Malnutrition showed significant correlation between age in years, age appropriate dietary adequacy and pulmonary hypertension. (r= 0.22, p = 0.01; r = 0.20, p = 0.02; r = 0.15, p = 0.01). CONCLUSION: Children with CHD develop severe malnutrition and growth failure. The significant contributing factors are mean age at presentation and age appropriate dietary adequacy.

Atrial septal defects: Pattern, clinical profile, surgical techniques and outcome at Innova heart hospital: A 4-year review.

BACKGROUND: Atrial septal defect (ASD) is a congenital heart defect that leads to shunting of blood between left and right atria. It may be asymptomatic and sometimes may present with heart failure. Surgical repair is definitive, but currently non-surgical procedure is used to close the defect. MATERIALS AND METHODS: It is a retrospective study of patients who underwent transcatheter closure of ASD at Innova Heart Hospital, Hyderabad, India. Echocardiography was repeated at intervals of 24 hours, then at 1, 3 and 6 months after the procedure to assess complications. The morphological characteristics of the ASD, including its diameter, location, shape and the width of surrounding septal margins, were also evaluated. RESULTS: From April 2007 to June 2011, 69 consecutive children (29 males, 40 females) with a median age of 9.0 years (range = 3.2-19 years) registered with diagnosis of ASD. The median weight was 31.5 kg (range = 7.5-39.0 kg). Five patients (7.2%) were young children aged 3-5 years. Forty-four (63.8%) of these children presented with symptoms of heart failure, whereas 47 (68.1%) of the cases repaired with device were large-sized ASD. The most common interventional procedures done were Searcare Heart(®) and Amplatzer(®) technique with a highest success rate obtained in 2010. CONCLUSIONS: ASD is a common congenital heart disease with a high success rate for those who undergo intervention.

Synopsis of congenital cardiac disease among children attending University of Nigeria Teaching Hospital Ituku Ozalla, Enugu.

BACKGROUND: The objective of this study was to determine the pattern of congenital cardiac disease among children attending UNTH, Enugu, Nigeria. The nature of these abnormalities and the outcome were also considered. The exact etiology is unknown but genetic and environmental factors tend to be implicated. The difference in the pattern obtained worldwide and few studies in Nigeria could be due to genetic, environmental, socioeconomic, or ethnic origin. METHODS: A retrospective analysis of discharged cases in which a review of the cases of all children attending children outpatient clinics including cardiology clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu over a five year period (January 2007-June 2012) was undertaken. All the children presenting with cardiac anomalies were included in the study and the cases were investigated using ECG, X-ray and echocardiography studies. RESULTS: A total of 31,795 children attended the children outpatient clinics of the hospital over the study period. Of these, seventy one (71) had cardiac diseases. The overall prevalence of cardiac disease is 0.22%. The commonest symptoms were breathlessness, failure to thrive and cyanosis. Almost all types of congenital detects were represented, the commonest being isolated ventricular septal detect (VSD), followed by tetralogy of Fallot. One of these cardiac anomalies presented with Downs's syndrome and another with VACTERAL association. CONCLUSIONS: The results of this study show that 0.22% per cent of children who attended UNTH in Enugu State had congenital cardiac abnormalities and the commonest forms seen were those with VSD.