Like much of the developing world, sub-Saharan Africa (SSA) is facing a major challenge. This challenge is due to noncommunicable diseases (NCDs) whose rates are rising dramatically in SSA. Two conditions that frequently coexist head the list of NCDs as either established disease entities or risk factors for NCDs. These are hypertension and diabetes. Hypertension is the foremost cardiovascular condition. The objective of this scoping review is to examine peer-reviewed publications for the period 2009–2019 related to the detection and management of hypertension in SSA. We seek to define the issues confronted in managing hypertension in SSA, what measures have been implemented and evaluated, and what barriers and facilitators have been found. By mapping the complex, heterogeneous literature, we aim to identify the key concepts that underpin a major public health issue in SSA. The central question that this review addresses is how to control hypertension in SSA.

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Background: Metabolic syndrome is a constellation of cardiovascular risk factors characterized by insulin resistance, prothrombotic and pro-inflammatory state. This study was an attempt to evaluate ECG changes as markers for metabolic syndrome before development of overt cardiovascular disease. Aims: We evaluated association between metabolic syndrome and ECG indices: QT dispersion, QTc dispersion, TpTe interval and TpTe/QT ratio. Settings and Design: Cross-sectional study Methods and Material: The study was conducted on 108 patients with metabolic syndrome and compared with age and sex matched 50 controls. Indices were measured from 12 lead ECG and data was compared. Statistical analysis used: SPSS Results: Metabolic syndrome was more common in females with most common criteria present being waist circumference followed by hypertriglyceridemia Metabolic syndrome group had higher levels of BMI, waist circumference, fat percentage, serum triglycerides and fasting glucose, systolic and diastolic pressure as well as lower HDL levels than control subjects. The QTc dispersion, QT dispersion, TpTe intervals and TpTe/QT ratio were significantly increased in Metabolic syndrome group compared to the control group. Increased Odd's ratio of the ECG parameters in comparison with the control group was also calculated. ROC curve revealed that QTc dispersion and TpTe/ QT ratio were better predictors for future metabolic syndrome. Conclusions: Hence ECG indices (QT dispersion, QTc dispersion, TpTe interval and TpTe/ QT ratio) can be used to predict cardiovascular risk in such patients.

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Objectives: Chemerin is a proinflammatory adipokine whose role in metabolic syndrome and insulin resistance is well known. Chemerin has shown to carry a good prognostic/predictive value in patients of Coronary Artery Diseases (both chronic as well as acute) in the studies done in the US and Europe. However, no such study has been reported from India. Hence, this study was undertaken to evaluate Chemerin in patients of Acute Coronary Syndrome (ACS) and assess their role in cardiodiabetic patients. Materials and Methods: We included seventy cases of ACS and further subdivided them into two groups - (1) with co-existing diabetes mellitus (ACS-DM) (n = 33) and (2) without co-existing DM (ACS-NDM) (n = 37). Thirty healthy age and sex matched controls were included for comparison. Chemerin levels were measured by ELISA, hs C Reactive Protein (hs CRP) by turbidimetric assay, Creatine Kinase MB (CK-MB) by immunoinhibition (IFCC method) and Troponin I (Trop I) by Chemiluminescent Microparticle immunoassay. All the data were analyzed using Social Science Statistics Calculators. Results: Serum Chemerin levels were highest in ACS-DM (0.80 ± 0.61 ng/ml) as compared to ACS-NDM (0.42 ± 0.22 ng/ml) and controls (0.25 ± 0.10 ng/ml). On comparison, the difference amongst all was statistically significant. Furthermore, Chemerin showed a positive correlation with all the three parameters of ACS – hs CRP, CK- MB and Trop I. Conclusion: Chemerin levels are markedly elevated in ACS patients, more so in those with coexisting diabetes [cardio diabetics]. Chemerin is a novel biomarker of ACS.

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Aim: The aim is to study the right ventricular (RV) function in patients of first myocardial infarction (MI). Methods: This study compared 25 patients of inferior wall MI (IWMI) with or without RVMI and 20 patients of anterior wall MI (AWMI) with 25 healthy age-matched controls. RV function was assessed using Tei index, tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic (S'), early diastolic (E'), and late diastolic (A') velocities using tissue Doppler imaging (TDI) at first presentation and after 24 h. Results: In patients with IWMI, the Tei index was significantly increased (0.44 ± 0.09 vs. 0.22 ± 0.05; P < 0.001), TAPSE was reduced (1.25 ± 0.32 cm vs. 2.09 ± 0.26 cm; P < 0.001) and tricuspid annular S'(12.04 ± 1.74 cm/s vs. 16.48 ± 3.38 cm/s; P < 0.001) and E' (10.16 ± 2.23 cm/s vs. 12.32 ± 3.74 cm/s; P = 0.006) significantly decreased on TDI, compared to controls. Interestingly, patients with AWMI also had significantly increased Tei index (0.45 ± 0.16 vs. 0.22 ± 0.05; P < 0.001) and reduced TAPSE (1.52 ± 0.35 cm vs. 2.09 ± 0.26 cm; P < 0.001) and tricuspid annular S' (13.4 ± 2.5 cm/s vs. 16.48 ± 3.38 cm/s; P = 0.001) compared to controls. IWMI patients with associated RVMI had significantly reduced TAPSE (1.01 ± 0.24 cm vs. 1.43 ± 0.25 cm; P < 0.001) but did not differ with respect to the Tei index (0.42 ± 0.09 vs. 0.44 ± 0.09; P = 0.56) compared to those without ECG evidence of RVMI. Serial echocardiography showed significant improvements in measures of RV function. Conclusion: RV function is affected in all cases of MI, including AWMI, due to ventricular interaction and interdependence. Furthermore, RV function improves rapidly on follow-up.

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Background: Iron deficiency (ID) often coexists with heart failure and has recently become a therapeutic option in its management. Multiple markers are often required to adequately estimate iron status. This study was aimed at describing the status of iron homeostasis among heart failure patients in Nigeria. Materials and Methods: This was a cross-sectional study done at two tertiary centers in Nigeria. One hundred and forty patients with a diagnosis of heart failure were recruited into the study. Full blood count, total serum iron, total iron-binding capacity, and serum ferritin were measured. Anemia was defined by standardized criteria. Data analysis was done with SPSS 20.0. Results: The mean age of the study patients was 62.96 ± 16.34 years. Disordered iron homeostasis was common, often characterized by predominantly low total serum iron and low transferrin saturation in the presence of normal or high serum ferritin. ID was reported in 60.0% of all patients including 61.3% of anemic and 51.9% of nonanemic patients, P = not significant. High ferritin level was documented in fifty (35.7%) patients (36.8% anemic vs. 32.4% nonanemic patients, P = 0.40). Pulmonary hypertension was more frequent among anemic patients found in 45 patients (including 42.5% of anemic vs. 8.8% of nonanemic patients). ID was associated with poor functional status including ejection fraction, deranged renal function, and advanced disease. Conclusion: Functional ID is very common among heart failure patients in Nigeria irrespective of their anemia status. It is associated with poor functional status and may be a potential therapeutic strategy in Africans with heart failure.

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Congenital portosystemic shunts (CPSSs) are rare developmental vascular anomalies which are classified into extrahepatic and intrahepatic malformations. Here, we report a 7-year-old girl who presented with a history of progressive dyspnea, pandigital cyanosis, and clubbing. On evaluation, she was found to have a rare combination of both type II extrahepatic and intrahepatic portosystemic shunts which were closed endovascularly in the same setting. Diagnosis of CPSS needs a very high index of clinical suspicion. Timely diagnosis with specific imaging modalities will help in deciding the treatment strategy and may prevent long-term complications.

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