Objective The profile, success and progression of patients undergoing coronary artery bypass graft at the institute has not adequately been reviewed. Coronary artery bypass graft though a widely performed procedure in developed countries, it is uncommon procedure in a few centers found in developing countries. The procedure is skill and expertise demanding. The study aimed to evaluate patients’ characteristics, number and disposition of patients after coronary artery bypass graft surgery. Methods This was a retrospective study that enrolled all patients who underwent coronary revascularization at the centre from May 2016 through November 2022. Patients’ demographic was entered into a structured data sheet, excluded were those whom their surgical and clinical details could not be retrieved. Preoperative clinical details, intraoperative and postoperative patients’ profile were recorded and entered into a data sheet in SPSS version 20 program and analyzed; Chi square (2) was used to compare categorical variables. Results There was a total of 220 patients who underwent coronary artery bypass graft from May 2016 through November 2022. Male patients were 172 (78.2%) and female patients were 48(21.8%). Male patients outnumbered female patients by 3.6 folds. The minimum age was 42 years and maximum were 89 years with a mean year age of 63.7± 8years. The majority of patients were overweight and obese in 73%. The mean duration of presentation was 13.5 ± 8.6 months and the overall early mortality rate was 10.5%. Conclusion The key to a successful of a well-established cardiac centre in sub-Saharan countries of Africa and to any newly established cardiac center requires government commitment to invest in human resource; that in turn forms a local core cardiac team that should work focused to archive its goals. Investing into a well-planned structure that fits the requirement of a cardiac Centre. There should be a system that ensures availability and constant supply of consumables. The success and progress of open heart surgery demonstrated by Jakaya Kikwete Cardiac Institute from simple open heart procedures to complex surgical procedures required a well-planned short and long term plan with good coordination and focus, backed by unwavering government commitment
To determine the prevalence, correlates and prognostic implications of anaemia and iron deficiency (ID) in patients with heart failure (HF) in Tanzania.
Method
This was a cross-sectional and prospective observational study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients were ≥18 years of age, with HF defined according to the Framingham criteria. The primary outcome was anaemia and the secondary outcome was a composite of hospitalisation for HF or all-cause mortality.
Results
A total of 401 HF patients (median age 56 years, IQR 41–67 years; women 51%) were included. The prevalence of anaemia was 57%. The overall prevalence of ID was 49% distributed as 69% versus 21% in subjects with and without anaemia (p<0.001). Normocytic anaemia was seen in 18% of the patients while none had macrocytic anaemia. The risk of having anaemia was positively associated with residency outside Dar es Salaam (OR 1.72 (95% CI 1.02 to 2.89); p=0.038), atrial fibrillation (4.12 (1.60 to 10.61); p=0.003), LVEF <45% (2.70 (1.57 to 4.67); p<0.001) and negatively (ORs per unit decrease) with creatinine clearance (0.98 (0.97 to 0.99); p=0.012) and total cholesterol (0.78 (0.63 to 0.98); p=0.029). One-year survival free from a composite endpoint was 70%. The presence of ID anaemia increased the likelihood for an event (HR 2.67; 95% CI 1.39 to 5.07; p=0.003), while anaemia without ID did not influence the risk.
Conclusions
ID anaemia was common in Tanzanian patients with HF and was independently associated with the risk for hospitalisation or death.
Abstract Objective The profile, success and progression of patients undergoing coronary artery bypass graft at the institute has not adequately been reviewed. Coronary artery bypass graft though a widely performed procedure in developed countries, it is uncommon procedure in a few centers found in developing countries. The procedure is skill and expertise demanding. The study aimed to evaluate patients’ characteristics, number and disposition of patients after coronary artery bypass graft surgery. Methods This was a retrospective study that enrolled all patients who underwent coronary revascularization at the centre from May 2016 through November 2022. Patients’ demographic was entered into a structured data sheet, excluded were those whom their surgical and clinical details could not be retrieved. Preoperative clinical details, intraoperative and postoperative patients’ profile were recorded and entered into a data sheet in SPSS version 20 program and analyzed; Chi square (χ2) was used to compare categorical variables. Results There was a total of 220 patients who underwent coronary artery bypass graft from May 2016 through November 2022. Male patients were 172 (78.2%) and female patients were 48(21.8%). Male patients outnumbered female patients by 3.6 folds. The minimum age was 42 years and maximum were 89 years with a mean year age of 63.7 ± 8years. The majority of patients were overweight and obese in 73%. The mean duration of presentation was 13.5 ± 8.6 months and the overall early mortality rate was 10.5%. Conclusion The key to a successful of a well-established cardiac centre in sub-Saharan countries of Africa and to any newly established cardiac center requires government commitment to invest in human resource; that in turn forms a local core cardiac team that should work focused to archive its goals. Investing into a well-planned structure that fits the requirement of a cardiac Centre. There should be a system that ensures availability and constant supply of consumables. The success and progress of open heart surgery demonstrated by Jakaya Kikwete Cardiac Institute from simple open heart procedures to complex surgical procedures required a well-planned short and long term plan with good coordination and focus, backed by unwavering government commitment.
Metastatic cardiac tumors are far more common than primary tumors. Although the hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom reported and can be difficult to recognize. A 21-year-old man of African descent presented to our center complaining of shortness of breath, awareness of heart beats, easy fatigability, swelling of lower limbs, and left-side chest discomfort for the past 6 months getting worse for the last 3 months prior to his third readmission. In 2004 he was admitted with the diagnosis of osteosarcoma of his left calcaneus bone confirmed by bone biopsy and treated at an oncology center with several cycles of radiotherapy and chemotherapy; he was declared cured after 5 years of annual clinical and radiological skeletal survey follow-ups. In the current admission, a physical examination revealed bilateral lower limb swelling, pansystolic murmur on the left side of his sternum at fourth intercostal space (tricuspid area) grade three, hepatomegaly with a liver span of 17 cm, and a positive fluid test and shifting dullness. This case report presents a 21-year-old man with relapsed osteosarcoma manifesting as metastatic lesions to his right ventricle encroaching on his interventricular septum, which was identified by transthoracic/transesophageal echocardiography computed tomography scan and cardiac magnetic resonance imaging.
Abstract Background The evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania. Methodology: A hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student’s T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p < 0.05 was used to denote a statistical significance. Results A total of 1201 hypertensive patients were enrolled in this study. The mean age was 58.1 years and females constituted nearly two-thirds of the study population. About three quarters had excess body weight, 16.6% had diabetes, 7.7% had history of stroke, 5.7% had heart failure, 16.7% had renal dysfunction, 53.7% had anemia, 27.7% had hypertriglyceridemia, 38.5% had elevated LDL, and 2.4% were HIV-infected. Nearly two-thirds of participants had uncontrolled blood pressure and 8.7% had orthostatic hypotension. Overall, 524 (43.6%) of participants had cognitive impairment. During bivariate analysis in a logistic regression model of 16 characteristics, 14 parameters showed association with cognitive functions. However, after controlling for confounders, multivariate analysis revealed ≤ primary education (OR 3.5, 95%CI 2.4–5.2, p < 0.001), unemployed state (OR 1.7, 95%CI 1.2–2.6, p < 0.01), rural habitation (OR 1.8, 95%CI 1.1–2.9, p = 0.01) and renal dysfunction (OR 1.7, 95%CI 1.0-2.7, p = 0.04) to have independent association with cognitive impairment. Conclusion This present study underscore that cognitive decline is highly prevalent among individuals with systemic hypertension. Moreover, our observation suggests that low education, rural life, unemployment status and renal dysfunction interactions with elevated blood pressure has the potential to predict cognitive performance over time. As the effective disease-modifying treatments for cognitive impairment are lacking, these findings imply that several modifiable risk factors including hypertension represents a potentially vital mechanism for prevention or delay of cognitive impairment.
