Influence of systolic blood pressure on outcomes in Nigerians with peripartum cardiomyopathy.

Background: The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP). Patients and Methods: PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90-99, 100-109, 110-119, 120-129, 130-139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling. Results: Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90-99 mmHg, 24.7% had 100-109 mmHg, 24.7% had 110-119 mmHg, 18.5% had 120-129 mmHg, 7.5% had 130-139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90-99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49-10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91-0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or ß-receptor blockers had an HR of 1.71 (95% CI 0.93-3.16, P = 0.085). However, SBP was not associated with LV function recovery. Conclusion: In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months.

Cancer Related Mortality in Port Harcourt, Southern Nigeria.

BACKGROUND: Globally, cancer is a leading cause of death and source of resistance to increasing life expectancy. In 2019, the World Health Organisation estimated cancer as the first or second leading cause of death before the age of 70 in 112 countries and third or fourth in 23 other countries. Despite the fact that cancer has been recognized as a public health problem, there is paucity of data on cancer mortality in Nigeria. The aim of this study is to determine the pattern of cancer mortality at the University of Port Harcourt Teaching Hospital. MATERIALS AND METHODS: This is a 5 year retrospective study of all cancer related deaths at the University of Port Harcourt Teaching Hospital from 1st January, 2014 to 31st December, 2018. Relevant data were extracted and analyzed using Statistical Package for Social Sciences version 24. RESULTS: There were 4449 deaths during the period under review, of which 293 were cancer related deaths, giving a mortality rate of 6.59%. There were 114 males and 179 females giving a male to female ratio of 1:1.6. Cancer of the breast was the most common cause of cancer death and accounted for 61 (20.8%) deaths within the study period. CONCLUSION: Cancer is a major cause of mortality in Nigeria. Cancer of the breast is the leading cause of cancer mortality in females and overall while cancer of the prostate remains the commonest in men.

CONTEXTE: Dans le monde entier, le cancer est l'une des principales causes de décès et une source de résistance à l'augmentation de l'espérance de vie. En 2019, l'Organisation mondiale de la santé estime que le cancer sera la première ou la deuxième cause de décès avant l'âge de 70 ans dans 112 pays et la troisième ou quatrième dans 23 autres pays. Malgré le fait que le cancer ait été reconnu comme un problème de santé publique, il y a peu de données sur la mortalité par cancer au Nigeria. L'objectif de cette étude est de déterminer le profil de la mortalité par cancer au l'hôpital universitaire de Port Harcourt. MATÉRIEL ET MÉTHODES: Il s'agit d'une étude rétrospective sur 5 ans de tous les décès liés au cancer à l'hôpital universitaire de Port Harcourt du 1er janvier 2014 au 31 décembre 2018. Les données pertinentes ont été extraites et analysées à l'aide du progiciel de statistiques pour les sciences sociales version 24. RÉSULTATS: Il y a eu 4449 décès au cours de la période examinée, dont 293 étaient liés au cancer, soit un taux de mortalité de 6,59 %. Il y avait 114 hommes et 179 femmes soit un rapport homme/femme de 1:1,6. Le cancer du sein était la cause la plus fréquente de décès par cancer et représentait 61 (20,8 %) des décès dans la région. (20,8 %) des décès survenus pendant la période d'étude. CONCLUSION: Le cancer est une cause majeure de mortalité au Nigeria. Le cancer du sein est la principale cause de mortalité par cancer chez les femmes et dans l'ensemble du pays, tandis que le cancer de la prostate reste le plus fréquent chez les hommes. Mots clés: Cancer, mortalité, Port Harcourt, Nigeria.

Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry.

AIMS: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. METHODS AND RESULTS: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. CONCLUSIONS: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria.

CURRENT MANAGEMENT OF PERIPARTUM CARDIOMYOPATHY: A REVIEW.

BACKGROUND: Demarkis et al in 1971 described 27 patients who presented during pueperium with cardiomegaly, abnormal electrocardiographic findings, congestive heart failure and named the syndrome "peripartum cardiomyopathy". The aim of this review is to document the current concepts in the management of peripartum cardiomyopathy. MATERIALSAND METHODS: A search of the literature was done using PubMed, Goggle scholar and books from authors' collections. RESULTS: The cause of the disease might be environmental and genetic factors. Diagnostic echocardiographic criteria include left ventricular ejection fraction of less than 45% or a combination of M-mode fractional shortening of less than 30% and end diastolic dimension of greater than 2.7 cm/m². Electrocardiogram, magnetic resonance imaging, endomyocardial biopsy and cardiac catheterization aid in the diagnosis and management of peripartum cardiomyopathy. Treatment includes both conventional pharcomological heart failure and peripartum cardiomyopathy targeted therapies.Therapeutic decisions are influenced by drug safety profiles during pregnancy and lactation. Mechanical support and transplantation might be necessary in severe cases. CONCLUSION: Peripartum cardiomyopathy is an uncommon but life threatening cardiac failure of unknown aetiology encountered in late pregnancy or postpartum period. Management aims at improving heart failure symptoms through conventional therapies and then at administering targeted therapies.The risk of recurrence in future pregnancies should always be considered.

Regular screening among sportsmen in Nigeria: rationale and basis.

BACKGROUND: Participation in regular prolonged physical exercise is associated with specific adaptation in cardiac structure and function which could predispose to sudden cardiac death and has been recorded in celebrated cases and with an increasing frequency in recent time especially in Nigerian footballers. There is no policy or strategy in place for preventing recurrence OBJECTIVE: To review the current literature on sudden death in athletes generally, identify current strategies that have been found useful and recommend measures to prevent or reduce prevalence in Nigerian sportsmen. METHOD: Internet search on the subject using Google and Medline web search engine. The search words were sudden death, athletes, Africans and sports screening. RESULT: Sudden death in young athletes is rare occurring in in n 100,000 to 1 in 280,000 persons per year and hypertrophic cardiomyopathy is the commonest cause and blacks are more affected than caucasians. Screening guidelines are available in some countries and mandatory pre participatory screening has reduced the incidence of sudden death in athletes in these countries. In Nigeria there is no legislation or policy on routine screening in sportsmen or measures to prevent or reduce incident of sudden death in athletes. CONCLUSION: There has been increased report of sudden death in Nigerian footballers in recent years and the investigations into these deaths are shrouded in secrecy. There is no policy for routine screening of sports participants in Nigeria, there is urgent need to develop a policy to ensure appropriate pre participation screening for all sportsmen and women each year or at the beginning of each sports season.

Tuberculosis of the breast.

BACKGROUND: Tuberculosis of the breast is a rare disease with non specific manifestations. It should be included in the differential diagnosis of breast lesions in immune compromised patients especially in tuberculosis endemic areas of the world. CASE REPORT: We report a case of a 31 year old HIV positive lady who presented with an ulcerated mass on the left breast of 3 months' duration. Incision biopsy of the lesion confirmed tuberculosis of the breast. Treatment with standard anti tuberculous drugs resulted In complete resolution. CONCLUSION: A high index of suspicion is required to make a diagnosis of breast tuberculosis. The disease can be treated conservatively with standard anti tuberculous drugs while surgery is reserved for rare cases.