Transcatheter aortic valve replacement in patients with a pre-existing prosthetic mitral valve: a single center experience with two cases.

BACKGROUND: The performance of transcatheter aortic valve replacement (TAVR) in patients with pre-existing prosthetic mitral valves is technically challenging due to the potential interference between both prosthetic devices. At present, there are no clear recommendations for this patient subset due to their exclusion from clinical trials. We report our experience of two cases with pre-existing prosthetic mechanical mitral valves who underwent TAVR. CASE PRESENTATION: The first case was a 57 year old man with severe aortic stenosis and type 2 diabetes mellitus who had a mitral valve replacement 32 years ago. Operative mortality risk assessed by the Society for Thoracic Surgery (STS) Score was 1.7%, but he was considered high risk in view of previous cardiac surgery. Pre-procedure CT evaluation revealed favorable aortic root and femoral access anatomy with the mechanical mitral valve located 6.3 mm below the aortic annular plane. He underwent TAVR with a Medtronic Evolut R 29 mm self-expanding transcatheter heart valve via the femoral approach. The second case was a 66 year old lady who presented with severe aortic stenosis, atrial fibrillation and a history of mitral valve replacement 17 years ago for rheumatic mitral stenosis. Her STS score was 3.5%. Pre-procedure CT showed favorable aortic root and femoral access parameters with a mitral-aortic distance of 3.6 mm. TAVR was performed with a balloon expandable Myval 21.5 mm transcatheter heart valve via a transfemoral access. Both procedures were done successfully. CONCLUSION: This report highlights the feasibility of TAVR in post-mitral valve replacement patients provided careful pre-procedural evaluation, and planning is done.

Trends and outcomes of cardiovascular disease admissions in Lagos, Nigeria: a 16-year review.

BACKGROUND: Cardiovascular disease (CVD)-related admissions are on the increase in Nigeria and the rest of Africa. This study was carried out to highlight the burden, patterns and outcomes of CVD admissions in a tertiary hospital over a 16-year period in Lagos, Nigeria. METHODS: Admissions records of patients admitted into the medical wards within the study period (January 2002 to December 2017) were reviewed and relevant information pertaining to the study objectives was retrieved for analysis. RESULTS: There were a total of 21 369 medical admissions and 4 456 (20.8%) CVD-related admissions. A total of 3 582 medical deaths were recorded and 1 090 (30.4%) CVD-related deaths. The median age of the patients was 56.6 (46.0-68.0) years and 51.4% of these were males. Stroke, heart failure, hypertensive disease and acute coronary syndrome constituted 51.2, 36.2, 11.3 and 1.6% of all CVD admissions, respectively. There was a cumulative increase in the number of CVD admissions and deaths (p < 0.001, respectively) during the period under review. CONCLUSIONS: CVD admissions are not only common in Nigeria, but there was also a temporal exponential increase in both the admission and death rates, most likely reflecting the epidemiological transition in Nigeria.

Heart failure in Nigeria: protocol for a systematic review and meta-analysis.

Background: Heart failure is now a significant contributor to the burden of non-communicable diseases in developing countries like Nigeria which is experiencing epidemiologic and demographic transition. The epidemiology of heart failure in this country is poorly characterized. The aim of the review is to determine the prevalence of heart failure, the associated risk factors, the aetiology, management, and outcomes of the condition in the country. Methods: Relevant databases such as PubMed /Medline, EMBASE, Web of Science, Google Scholar, African Index Medicus, and African journal online would be searched for articles published in English from January 2000 to December 2021. The analysis will include observational studies conducted among Nigerian adults aged 12 years and above. Article selection shall be conducted by pairs of independent reviewers. Data extraction shall be done by 2 independent reviewers. Results: The primary outcome would be the pooled prevalence of heart failure while the secondary outcomes would be to identify the risk factors and management of heart failure in Nigeria. Conclusion: This will be the first systematic review and meta-analysis of heart failure epidemiology in Nigeria which will hopefully identify gaps for future research and guidance for policy interventions.

Effects of pregnancy on cardiac structure and function in women with sickle cell anemia: a longitudinal comparative study.

BACKGROUND: Sickle cell anemia is the commonest hemoglobinopathy in pregnant Nigerian women, and cardiac manifestations are a significant feature of the disease especially in pregnancy. Pregnant women with sickle cell anemia are at high risk of morbidity and mortality and cardiac dysfunction in them increases this risk and may compromise their post-partum health. OBJECTIVE: To evaluate the cardiac size and function in women with sickle cell anemia (HbSS) during late pregnancy and postpartum. METHODOLOGY: This was a longitudinal comparative study in which 40 women, consisting of 20 pregnant HBSS and 20 pregnant HBAA women controls, were recruited. Echocardiography was performed in the third trimester of pregnancy and 6 weeks postpartum. RESULTS: There was a decrease in the mean left atrial diameter (p < .001), left ventricular diameter in diastole (p = .041), and left ventricular mass (p = .004) of HBSS women in the postpartum period compared to their antepartum state. In contrast, there was no significant difference in most cardiac dimensions of pregnant vs postpartum HBAA women. There was no significant change in cardiac function in the pregnant vs postpartum states in both study groups. There were significant differences in cardiac size but not function when comparing HBSS and HBAA women in pregnancy and postpartum. CONCLUSION: Changes in cardiac size of sickle cell women in pregnancy does not appear to affect cardiac function during pregnancy and in the puerperium, suggesting that the increased size may purely be a response to their chronic anemic state. Studies following women up for longer periods including those with co-morbidities are recommended.

Sodium acetate prevents nicotine-induced cardiorenal dysmetabolism through uric acid/creatine kinase-dependent pathway.

BACKGROUND: Cigarette smoking or nicotine replacement therapy has been associated with cardiometabolic disorders (CMD). Hyperuricemia has been implicated in the pathogenesis of CMD and cardiorenal dysfunction. Gut microbiota-derived short chain fatty acids (SCFAs) have been reported to have beneficial glucoregulatory and cardiorenal protective effects. This study aimed at investigating the effect of acetate, a gut-derived SCFA, on nicotine-induced CMD and associated cardiorenal dysmetabolism. MATERIALS AND METHOD: Twenty-four male Wistar rats (n = 6/group) were grouped as: vehicle (p.o.), nicotine-exposed (1.0 mg/kg; p.o.), and sodium acetate-treated (200 mg/kg; p.o.) with or without nicotine exposure daily for 6 weeks. Glucose regulation was evaluated by oral glucose tolerance test and homeostatic model assessment of insulin resistance. Cardiac and renal triacylglycerol (TG), lactate, nitric oxide (NO), uric acid (UA) levels, lactate dehydrogenase (LDH), creatine kinase (CK), adenosine deaminase (ADA), and xanthine oxidase (XO) activities were measured. RESULTS: The CMD were confirmed in the nicotine-exposed rats that exhibited lower body weight, insulin resistance, endothelial dysfunction, glucose intolerance, increased cardiac and renal TG, TG/HDL-cholesterol, UA, lactate, lipid peroxidation, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, LDH, CK, ADA and XO activities. Concurrent treatment with acetate prevented nicotine-induced glucometabolic and cardiorenal alterations. CONCLUSION: In summary, these results implied that nicotine exposure caused glucometabolic dysregulation and surplus lipid deposit in the heart and kidney through increased UA production and CK activity. Therefore, oral acetate administration prevents cardiorenal lipotoxicity and glucometabolic dysregulation via suppression of UA production and CK activity in nicotine-exposed rats.

Prevalence of positive chronic kidney Disease screening in professional male long haul drivers at risk of cardiovascular Disease in Lagos, Nigeria: a cross-section study.

BACKGROUND: Professional drivers are known to be at high risk for cardiovascular disease (CVD) on account of the higher prevalence co-occurring risk factors they harbour. Chronic kidney disease (CKD) and CVD share similar risk factors. Both impact each other adversely. The renal profile of professional drivers in Nigeria is not well characterised. We decided to study the prevalence of positive CKD screening amongst professional male long distance drivers in Lagos, Southwest Nigeria so as to quantify the burden and its predictors. METHODS: Two hundred and ninety-three drivers were recruited. Details of their socio-demographic characteristics were obtained. Their anthropometric indices, blood pressure, fasting plasma blood glucose and lipid profile were measured. Serum creatinine was measured and estimated glomerular filtration rate, eGFR, was calculated with Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Urinary Albumin Creatinine Ratio (UACR) was determined. A 10 year CVD risk of the subjects was calculated with the Framingham Risk Score (FRS). RESULTS: Mean age of the study population was 44.8 + 9.7 years. The prevalence of alcohol use and smoking were 71.0 and 19.5% respectively. One hundred and twenty-one (62.8%) of the subjects were either overweight or obese while 70(24.1%) had abdominal obesity. The prevalence of hypertension and diabetes were 39.7 and 13.9% respectively. Prevalence of CKD by eGFR< 60 ml/min/1.73m2 or UACR > 30 mg/g was 51.7% (95% CI; 46.0-57.5). The odds for CKD increased with lower HDL-c levels; OR 3.5 (95% CI, 1.1-11.2; p = 0.03) and longer duration of professional driving > 20 years; OR 2.4(95% CI, 1.5-4.0). CONCLUSION: Professional male long distance drivers in addition to having very high prevalence of clustering of both CVD and CKD risk factors have a significant burden of asymptomatic CKD. UACR appears to be an earlier marker of CKD in this population. Health awareness promotion and aggressive risk factor reduction are advocated as ways to reduce this burden.

A rare case of an isolated aneurysmal supravalvar mitral ring in a young Nigerian adult: a cor-triatriatum mimic.

Supravalvar mitral ring is a rare congenital abnormality characterized by a ridge of connective tissue located above the mitral valve. It is a cause of congenital mitral stenosis typically presenting in childhood and usually associated with other cardiac abnormalities. We report the rare case of a 24-year-old male presenting with an isolated aneurysmal supravalvar mitral ring. He presented at the emergency room with a 2-week history of worsening heart failure symptoms and antecedent effort intolerance of 4 years duration. He was referred from a primary care facility with an echo diagnosis of cor-triatriatum. Echocardiography done at our centre revealed an isolated aneurysmal supravalvar mitral ring of the intramitral variant. This report highlights the unusual isolated presentation of a supravalvar mitral ring in a young adult and the need to carefully differentiate it from cor-triatriatum, a possible close mimic.

Prevalence of cardiometabolic risk factors among professional male long-distance bus drivers in Lagos, south-west Nigeria: a cross-sectional study.

BACKGROUND: Professional drivers are known to be at high risk of cardiovascular disease (CVD). This study was carried out to highlight these risk factors and their predictors among male long-distance professional bus drivers in Lagos, south-west Nigeria, with a view to improving health awareness in this group. METHOD: Socio-demographic data, anthropometric indices, blood pressure, fasting plasma blood glucose levels and lipid and physical activity profiles of 293 drivers were measured. RESULTS: Mean age of the study population was 48 ± 9.7 years; 71.0 and 19.5% of the drivers used alcohol and were smokers, respectively; and 50.9% were physically inactive. The prevalence of overweight and obesity was 41.7 and 21.1%, respectively, while 39.7 and 13.9% were hypertensive and diabetic, respectively. Ninety (31.3%) subjects had impaired fasting glucose levels while 56.3% had dyslipidaemia. Predictors of hypertension were age and body mass index (BMI). BMI only was a predictor of abnormal glucose profile. CONCLUSION: Professional male long-distance bus drivers in this study showed a high prevalence of a cluster of risk factors for CVD.

Effect of taurine and caffeine on plasma c-reactive protein and calcium in Wistar rats.

BACKGROUND: Caffeine is a component of several beverages such as coffee and tea. It has been shown to possess psychoactive properties because it increases alertness, energy and ability to concentrate at moderate doses. Taurine on the other hand, is an amino acid which has the capacity to promote neural development, osmoregulation and neuroprotection. There is paucity of information on the effect of the combined administration of taurine and caffeine on C-reactive protein (CRP)--a marker of inflammation and plasma calcium level in rats. AIM: The present study was designed to investigate the effects of combined taurine and caffeine on the plasma level of CRP, Ca2+ as well as the effect of nifedipine on calcium level. METHOD: Fifty four rats weighing 120-140 g were used for these studies. The animals were divided into nine groups consisting of six animals each. Group 1 was treated with 10 m/kg of normal saline, Groups 2 and 3 were given 100 mg/kg and 200 mg/kg of taurine respectively, groups 4 and 5 received 7.5 mg/kg and 15 mg/kg of caffeine respectively while group 6 was administered taurine (200 mg/kg) and caffeine (15 mg/kg), groups 7 and 8 were treated with taurine (200 mg/kg) plus nifedipine (10 mg/kg) and taurine (200 mg/kg)plus furosemide (20 mg/kg) respectively while group 9 was given taurine plu caffeine plus nifdipine plus furosemide. Treatment was done once daily for 21 days and blood was finally collected via cardiac puncture for the assay of CRP and calcium while the animals were under anaesthesia. RESULTS: The results showed that CRP was significantly decreased in five of the treated groups compared with the control with the exception of the group treated with taurine alone (Group 2), and that treated with combined taurine and caffeine (Group 6). The Ca2+ level of groups treated with caffeine (11.70 ± 0.29 mg/dL) and taurine with caffeine (11.64 ± 0.15 mg/dL) were significantly (p < 0.05) increased compared with the control (10.70 ± 0.29 mg/dL). However, treatment with taurine and nifedipine (Group 7) led to significant (p < 0.05) reduction in plasma Ca2+ level. CONCLUSION: The results have shown that combined caffeine and taurine can boost plasma calcium level and decrease plasma CRP level. Moreover, taurine combined with nifedipine but not furosemide can act synergistically to lower both plasma Ca2+ and CRP levels, a result which may have implication for the treatment of hypertension.

A randomized controlled trial of a high support hospital discharge team for elderly people.

The Home Treatment Team (HTT), a hospital discharge team for elderly patients, was created to provide practical help and promote independence of patients at home for up to 6 weeks after hospital discharge. Patients were those judged to be at particular risk of failing to resettle, and thus being readmitted to hospital or admitted to a residential or nursing home. An open randomized controlled trial compared patients receiving the HTT (n = 29) with controls (n = 25) receiving appropriate conventional community services. Fewer HTT patients were readmitted (four by 6 weeks and nine by 12 weeks) than controls (nine by 6 weeks and 14 by 12 weeks, p < 0.05) and more were at home at 6 weeks (24, 83% and 10, 40%, p < 0.05), 12 weeks (21, 72% and 11, 44%, p < 0.05) and 12 months (17, 58% and 10, 40%, p < 0.05). The HTT group spent fewer days in hospital than controls during 12 weeks (median difference 34 days, 95% confidence interval 0-75, p < 0.05) and more days at home during 12 months (90; 247-0, p = 0.02). Neither group showed any significant change in mental state or functional abilities over 12 weeks. Potentially confounding factors were considered insufficient explanation for the difference in outcome between the groups. It is concluded that the HTT was of benefit but the mechanism of its effect was not identified.

Serum immunoglobulin concentration in Nigerian infants.

Serum immunoglobulin (Ig) G, M and A were determined at 3-monthly intervals during the first year of life in 35 healthy Nigerian infants. The neonatal IgG values were high, but dropped rapidly by 3 months to about 37% of the neonatal value, and thereafter rose steadily. The neonatal IgM values dropped slightly (10%) by 3 months and then rose steadily to reach a level above the neonatal value after 1 year. IgA was not detected in most of the children during the neonatal period, but where it was detected and was measurable, the values were very low and then rose steadily until the age of 1 year. There was a suggestion that the pattern of immunoglobulin in infancy might be influenced by the level of maternal education.

Serum immunoglobulins in Nigerian neonates.

Serum immunoglobulins G, M and A levels were studied in 187 Nigerian neonates. Estimations were done by the radial immunodifusion method of Mancini. Immunoglobulin G shows a fall in value in the first few days of life to about 62% of the value in the last days of the neonatal period. There is however a gradual increase in the level of IgM to about double at the end of the neonatal period. IgA level remained relatively constantly low throughout this period. The effect of maternal education on the levels of immunoglobulins of their neonates was also investigated. This had a positive influence at the secondary educational level, affecting only the IgG and IgA.

Psychosocial and cultural factors associated with the management of spina bifida cystica in Nigeria.

A prospective study of the psychosocial and cultural factors influencing the management of spina bifida cystica was carried out on Nigerian children (48 males, 28 females) seen at the University College Hospital, Ibadan, between January 1982 and December 1983. The parents of 74 of the 76 children had never heard of the disease, many had no idea of its causation and one-third incriminated witchcraft. Of primary concern was the cyst on the back. The better-educated parents tended to demand surgical treatment more than the illiterate parents. 22 children were treated surgically. The default rate was high because parents failed to get the expected hospital treatment. Most mothers showed relief rather than remorse on the death of their child.

Social conditions of children in day-care centers and nurseries in Nigeria.

A study of the social conditions of 278 children of Nigerian working mothers attending day-care centers and nurseries in Ibadan reveals that about one quarter of the children were under the age of 2 years and were known to spend 6-11 h every day in the child-care centres and away from their parents. Nearly half of the children were placed in such preschool institutions because parents felt that children learnt more from nursery education. About one third were so placed because there was no one at home to care for them whilst their parents, mostly professionals, were away at work. The study further shows that in some cases where the work period of the mothers exceeded the opening hours of the child-care centres, the substitute mother-figures were often unsuitable. In order to prevent emotional disturbances which can occur following mother-child separation in early life, it is suggested that the quality of care in these child-care centres be improved upon and opportunities for mothers to interact with their children created. To this end, management utilizing the services of working mothers must provide day-care and nursery facilities for the children of their female employees.

Social-cultural problems affecting management of diabetes mellitus in Nigerian children.

The case histories of five children with diabetes mellitus have been analysed and socio-cultural problems affecting management examined. Difficult family situations have been highlighted and their effects discussed. Suggestions have been made on how such negative factors can be detected early and/or averted particularly by making use of Home Visitors trained on the job. It is concluded that juvenile diabetes can be managed successfully in our community provided the patients and their parents or guardians are willing to participate actively in the management of the disorder and are given necessary physical, emotional and sometime economic support on a continuous basis.