Bone Mineral Density and Vitamin D Status in Nigerians: The Impact of HIV

BACKGROUND

Both HIV infection and antiretroviral therapy (ART) may be associated with metabolic complications including bone loss. To further inform guidance on screening and treatment of bone disease, we evaluated the impact of HIV and ART on vitamin D (VD) levels and bone mineral density (BMD) among HIV-infected and uninfected Nigerians.

METHODS

We carried out a cross-sectional study of HIV-infected participants and uninfected matched controls, who were recruited from a large clinical site in Jos, Nigeria. Calcaneal ultrasonography was used to assess BMD. VD levels were determined using electrochemiluminescence binding assay, with vitamin D deficiency (VDD) defined as <25 ng/ml.

RESULTS

There were 241 participants (61 ART-experienced, 60 ART-naïve, and 120 HIV-uninfected), and the mean age was 39±10 years; 66% were female. VDD was present in 70.5% (95% CI:64.3–76.2%) of all participants; occurring in 70.0% of ART-experienced, 73.0% of ART-naïve and 69.0% of HIV-uninfected controls (p = 0.84). Overall, the prevalence of low BMD was 21.1% (95% CI: 16.1–26.8%); being present in 24.5% of ART-experienced, 26.6% of ART-naïve and 16.6% of HIV-uninfected controls (p = 0.22). Only female sex (OR 6.82; 95% CI:1.93–24.0, p <0.001) was significantly associated with low BMD in the HIV group. No HIV-specific factor including ART use and type was associated with low BMD.

CONCLUSION

VDD and low BMD are both prevalent among HIV-infected and uninfected individuals in Nigeria. HIV, ART use, and VDD were not associated with low BMD.

Secondhand smoke exposure is independently associated with stroke among non-smoking adults in West Africa

BACKGROUND

Stroke is a leading cause of disability and mortality worldwide, but little is known about the contribution of secondhand smoke exposure (SHSE) to stroke epidemiology among indigenous Africans.

OBJECTIVE

To evaluate the association of SHSE with stroke among indigenous Africans.

METHODS

We analyzed the relationship of SHSE with stroke among 2990 case-control pairs of adults who had never smoked (identified in the SIREN study) using conditional logistic regression at a two-sided P < 0.05.

RESULTS

Multivariable-adjusted odds ratio and 95% confidence interval; 1.25 (1.04, 1.50; P = 0.02) revealed SHSE was positively associated with stroke independent of stroke subtypes.

CONCLUSION

Culturally relevant primary prevention strategies targeted at SHSE might be promising in preventing stroke among Africans.

Data-independent acquisition mass spectrometry in severe rheumatic heart disease (RHD) identifies a proteomic signature showing ongoing inflammation and effectively classifying RHD cases

BACKGROUND

Rheumatic heart disease (RHD) remains a major source of morbidity and mortality in developing countries. A deeper insight into the pathogenetic mechanisms underlying RHD could provide opportunities for drug repurposing, guide recommendations for secondary penicillin prophylaxis, and/or inform development of near-patient diagnostics.

METHODS

We performed quantitative proteomics using Sequential Windowed Acquisition of All Theoretical Fragment Ion Mass Spectrometry (SWATH-MS) to screen protein expression in 215 African patients with severe RHD, and 230 controls. We applied a machine learning (ML) approach to feature selection among the 366 proteins quantifiable in at least 40% of samples, using the Boruta wrapper algorithm. The case-control differences and contribution to Area Under the Receiver Operating Curve (AUC) for each of the 56 proteins identified by the Boruta algorithm were calculated by Logistic Regression adjusted for age, sex and BMI. Biological pathways and functions enriched for proteins were identified using ClueGo pathway analyses.

RESULTS

Adiponectin, complement component C7 and fibulin-1, a component of heart valve matrix, were significantly higher in cases when compared with controls. Ficolin-3, a protein with calcium-independent lectin activity that activates the complement pathway, was lower in cases than controls. The top six biomarkers from the Boruta analyses conferred an AUC of 0.90 indicating excellent discriminatory capacity between RHD cases and controls.

CONCLUSIONS

These results support the presence of an ongoing inflammatory response in RHD, at a time when severe valve disease has developed, and distant from previous episodes of acute rheumatic fever. This biomarker signature could have potential utility in recognizing different degrees of ongoing inflammation in RHD patients, which may, in turn, be related to prognostic severity.

Chronic obstructive pulmonary disease in sub-Saharan Africa

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and an important cause of death in sub-Saharan Africa (SSA). We conducted a systematic review and meta-analysis on the prevalence of and risk factors for COPD in SSA.METHODS: We conducted a protocol-driven systematic literature search in MEDLINE, EMBASE, CINAHL and Global Health, supplemented by a manual search of the abstracts from thoracic conference proceedings from 2017 to 2020. We did a meta-analysis of COPD prevalence and its association with current smoking.RESULTS: We identified 831 titles, of which 27 were eligible for inclusion in the review and meta-analysis. The population prevalence of COPD ranged from 1.7% to 24.8% (pooled prevalence: 8%, 95% CI 6-11). An increased prevalence of COPD was associated with increasing age, smoking and biomass smoke exposure. The pooled odds ratio for the effect of current smoking (vs. never smoked) on COPD was 2.20 (95% CI 1.62-2.99).CONCLUSION: COPD causes morbidity and mortality in adults in SSA. Smoking is an important risk factor for COPD in SSA, and this exposure needs to be reduced through the combined efforts of clinicians, researchers and policymakers to address this debilitating and preventable lung disease.

Predictors and Prognosis of Stroke in Jos, North-Central Nigeria

BACKGROUND

Stroke is the second leading cause of death worldwide. Stroke mortality has been shown to be higher in blacks in multiracial studies. It is also a very important cause of disability with its attendant deterioration in the quality of life in survivors.

OBJECTIVE

The study sought to determine the risk and prognostic factors associated with stroke in Jos, North Central Nigeria.

METHODS

A prospective cohort study of stroke patients that were followed up for 90 days to determine outcomes. The stroke patients were admitted into the neurology unit of Jos University Teaching Hospital between September 2016 and August 2018.

RESULTS

We recruited a total of 246 subjects comprising 131 (53.3%) males aged 59.5 ± 13.1 years and 115 (46.6%) females aged 56.7 ± 14.2 years. Obesity, hypertension, dyslipidaemia and alcohol consumption were the commonest risk factors identified. The 90-day case fatality rate of stroke was 22%. Elevated glycated haemoglobin (p = 0.001), loss of consciousness at presentation (p <0.001), atrial fibrillation (p= 0.022), cardiac disease (p < 0.001) and HIV infection (p = 0.001) were significantly associated with poor outcome for stroke. Furthermore, subjects with a high NIHSS had three times the risk of death compared with those with low scores (RR = 2.93; 95% CI = 2.38 - 3.61, p <0.001).

CONCLUSION

The prognosis of stroke was poor. The predictors of poor stroke outcome were coma, HIV infection, cardiac disease, high NIHSS and total cholesterol.

Domestic solid fuel combustion in an adult population in Nigeria: A cross sectional analysis of association with respiratory symptoms, quality of life and lung function

BACKGROUND AND OBJECTIVES

We examined the association of respiratory symptoms, health status, and lung function with the use of solid fuel (wood, charcoal, coal or crop residue) for cooking or heating in a predominantly non-smoking population.

METHODS

Using the protocol of the Burden of Obstructive Lung Diseases (BOLD) initiative, we collected representative population data using questionnaires and spirometry tests. We categorized solid fuel use into 'never user', 'ex user' and 'current user' based on responses to the survey. We developed regression models to evaluate the relation between use of solid fuel and the prevalence of respiratory symptoms, quality of life and lung function adjusting for confounding variables.

RESULTS

Out of 1147 respondents with complete information on domestic fuel type, 33% were 'never-users', 19% were 'ex-users' while 48% reported current use of solid fuel for domestic cooking and/or indoor heating. Compared with never-users, current solid fuel users were more likely to report cough (OR: 1.7, 95% CI: 1.0, 2.9), cough or phlegm (OR: 1.6, 95% CI: 1.0, 2.5) and the association was stronger among women (OR: 3.0, 95% CI: 1.3, 7.1 and OR: 2.3, 95% CI: 1.1, 5.2, respectively). Current solid fuel users also had lower mental health status (coefficient: ?1.5, 95% CI: ?2.8, - 0.2) compared with the group of never-users. Current or previous domestic use of solid fuels for cooking or heating was not associated with higher prevalence of chronic airflow obstruction (FEV₁/FVC < LLN).

CONCLUSIONS

Using solid fuel for domestic cooking or heating was associated with a higher risk of cough or phlegm and a lower mental quality of life. However we found no significant effect in the prevalence of chronic airflow obstruction in Ife, Nigeria.

Clinical Outcomes in 3343 Children and Adults With Rheumatic Heart Disease From 14 Low- and Middle-Income Countries

Background:

There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease or information on their predictors. We report the 2-year follow-up of individuals with rheumatic heart disease from 14 low- and middle-income countries in Africa and Asia.

Methods:

Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for 2 years to assess mortality, congestive heart failure, stroke or transient ischemic attack, recurrent acute rheumatic fever, and infective endocarditis.

Results:

Vital status at 24 months was known for 2960 (88.5%) patients. Two-thirds were female. Although patients were young (median age, 28 years; interquartile range, 18–40), the 2-year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.80–3.11), congestive heart failure (HR, 2.16; 95% CI, 1.70–2.72), New York Heart Association functional class III/IV (HR, 1.67; 95% CI, 1.32–2.10), atrial fibrillation (HR, 1.40; 95% CI, 1.10–1.78), and older age (HR, 1.02; 95% CI, 1.01–1.02 per year increase) at enrollment. Postprimary education (HR, 0.67; 95% CI, 0.54–0.85) and female sex (HR, 0.65; 95% CI, 0.52–0.80) were associated with lower risk of death. Two hundred and four (6.9%) patients had new congestive heart failure (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or transient ischemic attack (8.45/1000 patient-years), 19 (0.6%) had recurrent acute rheumatic fever (3.49/1000 patient-years), and 20 (0.7%) had infective endocarditis (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/transient ischemic attack or systemic embolism. Patients from low- and lower-middle–income countries had significantly higher age- and sex-adjusted mortality than patients from upper-middle–income countries. Valve surgery was significantly more common in upper-middle–income than in lower-middle– or low-income countries.

Conclusions:

Patients with clinical rheumatic heart disease have high mortality and morbidity despite being young; those from low- and lower-middle–income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and the treatment of clinical rheumatic heart disease are required to improve outcomes.