Internal Medicine Commons^™

Does Upgrade To Tri-Ventricular Pacemaker Improve Long-Term Clinical Response In Non-Responders To Biventricular Cardiac Resynchronization Therapy?, Sharon Hw Man, Jeilan Mohamed, Shoaib Siddiqui, G. André Ng

Internal Medicine, East Africa

Up to one third of patients with biventricular (BiV) cardiac resynchronization therapy (CRT) are non-responders.1 § Greater clinical response to CRT has been shown in patients given TriV CRT compared to BiV CRT as de novo device therapy. 2 This abstract investigates if upgrade to TriV CRT in non-responders to BiV CRT will improve long-term clinical outcome

Initial Impressions And Review Of Literature Concerning Factors Affecting The Use Of Palliative Care Assessment Tools In An African Setting, John Weru

Internal Medicine, East Africa

Introduction: Quality palliative care encompasses early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Despite the importance of symptom assessment in palliative care, use of assessment tools in practice is limited. The aim of this study was to assess factors that influence use of symptom assessment tools.

Methodology: 1:1 interviews were conducted using a guideline developed by the researcher. Ten participants who met the inclusion criteria were interviewed. The data was recorded and then transcribed with topics and issues being isolated and grouped together into themes.

Findings: The themes were perception of palliative …

Gender Differences In Clinical Characteristics And Outcome Of Acute Heart Failure In Sub-Saharan Africa: Results Of The Thesus-Hf Study, Okechukwu S. Ogah, Beth A. Davison, Karen Sliwa, Bongani M. Mayosi, Albertino Damasceno, Mahmoud U. Sani, Charles Mondo, Anastase Dzudie, Dike B. Ojji, Charles Kouam, Ahmed Suliman, Neshaad Schrueder, Gerald Yonga, Sergine Abdou Ba, Fikru Maru, Bekele Alemayehu, Christopher Edwards, Gad Cotter

Internal Medicine, East Africa

Background: The impact of gender on the clinical characteristics, risk factors, co-morbidities, etiology, treatment and outcome of acute heart failure in sub-Saharan Africa has not been described before. The aim of this study was to evaluate the sex diffe rences in acute heart failure in sub-Saharan Africa using the data from The sub-Saharan Africa Survey of Heart Failure (THESUS-HF).

Methods and results: 1,006 subjects were recruited into this prospective multicenter, international observational heart failure survey. The mean age of total population was 52.4 years (54.0 years for men and 50.7 years for women). The men were significantly older (p …

Interventions To Promote Adherence To Antiretroviral Therapy In Africa: A Network Meta-Analysis, Edward J. Mills, Richard Lester, Kristian Thorlund, Maria Lorenzi, Katherine Muldoon, Steve Kanters, Sebastian Linnemayr, Robert Gross, Yvette Calderon, K Rivet Amico, Harsha Thirumurthy, Cynthia Pearson, Robert H. Remien, Lawrence Mbuagbaw, Lehana Thabane, Michael Chung, Ira B. Wilson, Albert Liu, Olalekan A. Uthman, Jane Simoni, David Bangsberg, Sanni Yaya, Till Bärnighausen, Nathan Ford, Jean B. Nachega

Internal Medicine, East Africa

Background: Adherence to antiretroviral therapy (ART) is necessary for the improvement of the health of patients and for public health. We sought to determine the comparative effectiveness of different interventions for improving ART adherence in HIV-infected people living in Africa.

Methods: We searched for randomised trials of interventions to promote antiretroviral adherence within adults in Africa. We searched AMED, CINAHL, Embase, Medline (via PubMed), and ClinicalTrials.gov from inception to Oct 31, 2014, with the terms “HIV”, “ART”, “adherence”, and “Africa”. We created a network of the interventions by pooling the published and individual patients' data for comparable treatments and comparing …

Emerging Antiretroviral Drug Resistance In Sub-Saharan Africa: Novel Affordable Technologies Are Needed To Provide Resistance Testing For Individual And Public Health Benefits, Gert U. Van Zyl, Lisa M. Frenkel, Michael Chung, Wolfgang Preiser, John W. Mellors, Jean B. Nachega

Internal Medicine, East Africa

In industrialized countries, viral load monitoring and genotypic antiretroviral drug resistance testing (GART) play an important role in the selection of initial and subsequent combination antiretroviral therapy (cART) regimens. In contrast, resource constraints in Africa limit access to assays that could detect virologic failure, transmitted drug resistance (TDR) and acquired drug resistance to cART. This has adverse consequences for both individual and public health. Although the further roll-out of antiretrovirals for prevention, including preexposure prophylaxis (PrEP) and universal test and treat (UTT) strategies, could reduce HIV-1 incidence, these strategies may increase TDR [1,2]. Here, we present arguments that the scale …

Oligonucleotide Ligation Assay Detects Hiv Drug Resistance Associated With Virologic Failure Among Antiretroviral-Naive Adults In Kenya, Michael Chung, Ingrid A. Beck, Sandra Dross, Kenneth Tapia, James N. Kiarie, Barbra A. Richardson, Julie Overbaugh, Samah R. Sakr, Grace C. John-Stewart, Lisa M. Frenkel

Internal Medicine, East Africa

Background: Transmitted drug resistance (TDR) is increasing in some areas of Africa. Detection of TDR may predict virologic failure of first-line non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART). We evaluated the utility of a relatively inexpensive oligonucleotide ligation assay (OLA) to detect clinically relevant TDR at time of ART initiation.

Methods: Pre-ART plasmas from ART-naive Kenyans initiating an NNRTI-based fixed-dose combination ART in a randomized adherence trial conducted in 2006 were retrospectively analyzed by OLA for mutations conferring resistance to NNRTI (K103N, Y181C, and G190A) and lamivudine (M184V). Post-ART plasmas were analyzed for virologic failure (≥1,000 copies/mL) at 6 month …

Carotid Atherosclerosis And Right Ventricular Diastolic Dysfunction In A Sample Of Hypertensive Nigerian Patients, Adeseye A. Akintunde, Philip B. Adebayo, Ademola A. Aremu, Oladimeji G. Opadijo

Internal Medicine, East Africa

Aim: To determine the association of carotid atherosclerosis and right ventricular diastolic dysfunction (DD) among treated hypertensive Nigerian patients.

Methods  This was a single center cross-sectional study performed at the Cardiology Clinic of LAUTECH Teaching Hospital, Ogbomoso, Nigeria between January and December 2012. The study included 122 hypertensive Nigerians (mean age, 57.3 ± 14.7 years, 36.9% women). Patients’ clinical, demographic, and echocardiographic parameters were obtained. Diastolic dysfunction was assessed with the trans-tricuspid Doppler flow.

Results: Patients with DD were significantly older than those with normal diastolic function. Mean and maximum carotid intima media thickness measurements were significantly higher among patients …