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Pilly Chillo, Eva Mujuni Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Purpose: Chronic kidney disease (CKD) is prevalent in sub-Saharan Africa and is a significant cause of mortality, which may result from kidney failure or congestive heart failure – a frequent complication of CKD. There is however scarcity of documented literature on the magnitude and associated factors of echocardiographically determined left ventricular (LV) dysfunction among CKD patients in Tanzania. Patients and methods: A prospective cross-sectional study was conducted from May 2014 to January 2015 at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Patients ≥18 years with CKD were consecutively enrolled. Clinical characteristics, cardiovascular risk profiles, and laboratory findings including serum creatinine, urea, hemoglobin, and cholesterol levels were collected. Echocardiography was performed to assess LV function using standard criteria. Results: One hundred and ninety-one CKD patients fulfilled the inclusion criteria. The mean ± SD age was 48 ± 13 years, and 54.5% were men. A total of 98.4% of the patients were hypertensive, and diabetes was present in 22.8% while 97.9% had end-stage renal disease. The prevalence of LV systolic and diastolic dysfunction was 16.2% and 68.6%, respectively. A ­clinical finding of heart failure was the only independent predictor of LV systolic dysfunction (odds ratio [OR] = 2.9, p = 0.012), while independent predictors of LV diastolic dysfunction were anemia (OR = 4.9, p = 0.01), severe hypertension (OR = 9.2, p = 0.001), and female gender (OR = 1.7, p = 0.002). Conclusion: LV dysfunction is prevalent among CKD patients seen at MNH and is associated with clinical heart failure, anemia, severe hypertension, and female gender. Echocardiography should be performed in patients with CKD to detect overt or subclinical LV dysfunction. Keywords: chronic kidney disease, left ventricular dysfunction, sub-Saharan Africa

Abstract Background Mortality from trauma remains a major public health issue as it is the leading cause of death in persons aged 5 to 44 years .Uncontrolled hemorrhage and coagulopathy is responsible for over 50% of all trauma related deaths within the first 48hrs of admission. Coagulation profiles are not routinely done among trauma patients in resource limited settings and there is a paucity of data on acute traumatic coagulopathy (ATC) in sub Saharan Africa. The study was conducted to evaluate the prothrombin time and partial thromboplastin time (PT/PTT) as predictors of mortality and morbidity among major trauma patients. Methods A prospective cohort study was carried out, in which major trauma patients admitted in A&E department between December 2011 to April 2012 were recruited. Five (5) mls of venous blood was drawn from a convenient vein within 10 minutes of the patient’s arrival at A&E for analysis of PT/PTT. Patients were stratified into two groups by the presence/absence of coagulopathy then followed up for a 2 week period for morbidity and mortality. Results A total of 182 major trauma patients were recruited; 149 (81.9%) were males, the mean age was 29.5 years (SD 9.8). Prevalence of coagulopathy was 54% (98/182). The mean ISS for the ATC group was 36.9 and the non ATC group was 26.9 (p=0.001). Patients with ATC stayed longer in hospital 11.24 days than non ATC patients 8 days (p=0.001). ATC was strongly associated with ARI (p= 0.003). Mortality was more in the ATC group 29 deaths compared to 9 deaths in the non ATC group. PTT was a strong independent predictor of mortality. Conclusion A significant proportion of major trauma patients were coagulopathic. Initial coagulation profile is useful in predicting outcomes for major trauma patients.

Competing Interests: Funding Support and Author Disclosures Supported by a grant from the National Heart Lung and Blood Institute (R01HL160332). All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Background: People living with HIV (PLWH) have a higher prevalence of diastolic dysfunction and left ventricular hypertrophy (LVH) in cross-sectional studies. Longitudinal data are lacking, especially from Africa., Objectives: The aim was to examine: 1) the incidence of diastolic dysfunction in PLWH compared to community controls in Tanzania; 2) the progression of diastolic function and LVH in PLWH after antiretroviral therapy initiation; and 3) traditional, endemic, and HIV-specific risk factors for diastolic function and LVH., Methods: This was a prospective longitudinal cohort of PLWH and HIV-uninfected controls who had an echocardiogram at enrollment and in follow-up. Adjusted Cox proportional HR models were used to determine the incidence of diastolic dysfunction, and multivariable mixed effects regressions were used to determine the progression and risk factors for diastolic function., Results: A total of 781 participants (367 PLWH) were followed for up to 5 years. There was no difference in incidence of diastolic dysfunction by HIV serostatus (aHR: 0.93 [95% CI: 0.61-1.42]). Baseline differences in echo parameters prior to antiretroviral therapy initiation resolved within 3 years of treatment for LVH (baseline difference = 3.57 g/m 2 [95% CI: 0.87-6.26]; no difference after 3 years) and other diastolic dysfunction markers. Hypertension and obesity were important modifiable risk factors for diastolic dysfunction (both P  < 0.001), while subclinical kidney disease, anemia, and manual labor were predictors of LVH and diastolic dysfunction., Conclusions: The incidence of diastolic dysfunction was similar in PLWH and HIV-uninfected controls. Efforts to prevent diastolic heart failure in Africa must focus on addressing hypertension and obesity while also investigating nontraditional risk factors., Competing Interests: This study is funded by grants from the 10.13039/100000050National Heart, Lung, and Blood Institute (R01HL160332 and K24HL170902). The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Objective: In recent years, the prevalence and mortality of heart failure (HF) and other associated cardiovascular diseases have doubled in sub-Saharan Africa (SSA). Studies in high-income countries indicate that HF with concurrent atrial fibrillation (AF) is linked to increased mortality. Our objective was to determine the incidence and clinical outcomes of AF among patients with HF in SSA., Design: A prospective cohort study using data collected between October 2018 and May 2020., Setting: Outpatient clinic at a tertiary hospital in Mwanza, Tanzania., Participants: 303 adult participants (aged ≥18 years) with HF as defined by the European Society of Cardiology guidelines (2016) and 100 adults with HF as defined by clinical criteria alone were enrolled into the study. Patients with comorbid medical condition that had prognosis of <3 months (ie, advance solid tumours, advance haematological malignancies) were excluded., Methods: Participants were screened for AF, and their medical history, physical examinations and sociodemographic information were obtained. Multivariable logistic regression models were used to examine factors associated with AF incidence. Cox regression models were used to analyse 3-month mortality and its associated risk factors., Results: We enrolled 403 participants with HF (mean age 60±19 years, 234 (58%) female). The AF prevalence was 17%. In multivariable models, factors associated with AF were low income, alcohol consumption and longer duration of HF. At the end of the 3-month follow-up, 120 out of 403 (30%) participants died, including 44% (31/70) of those with AF. Higher heart rate on ECG, more severe New York Heart Association HF class, rural residence and anaemia were significantly correlated with mortality., Conclusion: AF is common, underdiagnosed and is associated with significant mortality among outpatients with HF in Tanzania (HR 1.749, 95% CI 1.162 to 2.633, p=0.007). Our findings additionally identify tachycardia (>110 bpm, HR 1.879, 95% CI 1.508 to 2.340, p<0.001) as an easily measurable, high-impact physical examination finding for adverse outcomes in patients with HF., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The paucity of data describing cardiovascular disease (CVD) in pregnancy in many parts of Africa including Tanzania has given rise to challenges in proper management by the healthcare providers. This study is set out to (1) determine the prevalence of a range of CVDs during pregnancy in women attending antenatal clinics in Tanzania and (2) determine the impact of these CVDs on maternal and fetal outcomes at delivery., Methods and Analysis: This is a cross-sectional study with a prospective component to be conducted in two referral hospitals in Tanzania. Pregnant women aged ≥18 years diagnosed with a CVD during the antenatal period are being identified and extensively characterised by performing clinical assessment, modified WHO staging, electrocardiography, echocardiography and laboratory tests. Patients identified with CVDs (exposed) and a subset without (unexposed) will be followed up to determine maternal and fetal outcomes at delivery. A minimum sample of 1560 will be sufficient to estimate the prevalence of CVDs with a 95% CI of 2.75% to 5.25%., Ethics and Dissemination: The study is being conducted in accordance with the Helsinki declaration on studies involving human subjects. Ethical approvals have been obtained from Muhimbili University (reference number DA.282/298/01.C/) and Bugando Medical Centre (reference number CREC/330/2019) Ethics Committees. Informed consent is sought from all potential participants before any interview or investigations are performed. Study findings will be disseminated to the scientific community through different methods. Results will also be communicated to policymakers and to the public, as appropriate., Competing Interests: Competing interests: JA and LK are employees and shareholders of GlaxoSmithKline. They were only involved in the review and editing of the protocol and the manuscript. They will not be involved in data collection or any activity that is directly related to the execution of the research., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)