Heart Diseases

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    Burden of chronic disease comorbidities among cancer patients attending oncology services at Queen Elizabeth and Kamuzu Central hospitals in Malawi
    (Kamuzu University of Health Sciences, 2020-10-16) Chiwanda, Jonathan
    Problem to be studied: This doctoral study is focusing on estimating burden of chronic diseases among cancer patients. In Malawi, cancers are increasingly contributing to high burden of diseases. There is also high burden of other chronic diseases, however, there is no available data on prevalence of specific comorbidities among cancer patients. Therefore, understanding the prevalence of chronic disease comorbidities among cancer patients will help in developing appropriate interventions for prevention, management and treatment of comorbidities with the aim of improving quality of life and survival. Type of study: The project has two study designs; cross-sectional and Randomized Control Trial (RCT) components at different phases. Broad objective/ aim: 1. Explore common chronic comorbid conditions among cancer patients at two main referral hospitals of Queen Elizabeth and Kamuzu Central. Objectives Phase one 1. To estimate prevalence of chronic disease comorbidities among cancer patients. 2. To compare prevalence of comorbidities across gender, age and urban versus rural settings among cancer patients. 3. To identify factors associated with disease comorbidities among cancer patients 4. To compare quality of life among cancer patients with chronic disease comorbidities to those without comorbidities. Phase two 5. To compare quality of life among cancer patients with chronic disease comorbidities between the intervention and control groups. 6. To estimate survival among cancer patients with comorbidities Methodology: The study has two phases. The initial phase which is formative will use a crosssectional study design to estimate the prevalence of comorbidities among cancer patients presenting at Queen Elizabeth and Kamuzu Central Hospitals. The sample size will be a minimum of one hundred and ten. This will be followed by a single-blinded randomized control trial involving delivery of SMS alerts delivery to participants. The study will have two arms namely; intervention and control. Individual participants from the intervention arm will know about their receiving of SMS alerts but they will not be given information about whether everyone is getting similar messages. The end line will measure the effectiveness of the intervention (use of SMS alerts) in terms of improving quality of life and estimate survival. Ethical Consideration: The permission to conduct the study will be sought from Kamuzu Central Hospital (KCH) and Queen Elizabeth Central Hospital (QECH). Ethics approval will be sought from the College of Medicine Research Ethics Committee (COMREC). Expected findings: We expect to have high burden of chronic diseases among cancer patients due to direct proportionality of high burden of cancers and other chronic diseases in Malawi. Results dissemination: All results will be disseminated through research dissemination conferences both at College of Medicine and other available international symposia. Copies of the findings will be shared with COMREC, QECH, KCH and Ministry of Health Headquarters.
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    Investigating prevalence, progression and histologic characteristics of atherosclerosis in intracranial arteries of black Malawian population: A post-mortem study
    (Kamuzu University of Health Sciences, 2021-12-10) Nyasa, Charles
    Type of study This will be a cross-sectional anatomical study involving brain arterial samples obtained from 60 recently-deceased adult black Malawians. The study will be conducted within a period of 1 year in the laboratories of the Division of Anatomy at the Kamuzu University of Health Sciences. Statement of problem The past few decades have seen development of high-performance imaging modalities invaluable at diagnosing atherosclerotic changes in the brain’s arterial tree and subsequent stratification of patient groups at-risk. Similarly, research in intracranial atherosclerosis has increased over the years. However, studies on patho-anatomical characteristics in this area have stagnated, and this is partly due to the rigor often associated with gathering human cadaveric specimens coupled with the relative inaccessibility of brain arteries. The lag of anatomical knowledge in this area presents a missing link as various vessel imaging parameters need to be validated against pathologically-observed phenomena to adequately inform clinical decisions. This makes arrival at definite diagnosis using imaging data a challenge. Meanwhile, the prevalence of intracranial atherosclerosis is reportedly high among Africans, Asians and Hispanics but less so among Caucasians, yet there has been scanty research on atherosclerosis in Africa in general. To date, the prevalence of intracranial atherosclerosis and mechanisms of atherogenesis in Malawians not well known. Aim and objectives The proposed study aims at investigating the prevalence of atherosclerosis and mechanisms of atherogenesis in intracranial arteries of adult black Malawian population. The study’s broad objectives are: • To evaluate the prevalence of atherosclerosis in intracranial arteries of adult black Malawians at systematically selected portions of the cerebral arterial tree (carotid syphon, basilar arteries, cerebral arterial circle and cerebral arteries)To describe the pattern of vessel involvement, histologic characteristics and progression of atherosclerosis in intracranial arteries of adult black Malawians, with respect to known risk factors, intracranial plague location, and populational diversity. The specific objectives of the study are: • To screen for the presence of atherosclerotic plaques in intracranial arteries of adult black Malawians at systematically-selected portions of the cerebral arterial tree using a system described by Resch and Baker • To analyse the pattern of vessel involvement and histologic characteristics of observed atherosclerotic plagues through phenotypic classification and morphological analyses • To assess the intensity and progression of intracranial atherosclerosis among known risk-stratified patient groups (i.e. individuals with HTN, Diabetes or HIV), as well as across varying portions of the cerebral arterial tree through AHA staging • To compare the intensity of histologic characteristics and progression of intracranial atherosclerotic plaques observed among Malawians with those observed in other diverse population groups. Methodology In this proposed study, arteries will be extracted from brains of conveniently-sampled autopsy candidates. Participants will be grouped into four categories (trauma, diabetes, hypertension, and HIV/AIDS) based upon their respective medical histories. For each category, samples will be obtained from 22 designated sites in the region of the interpeduncular fossa of the brain, washed with isotonic saline, glossed and classified based upon a systematic method by Resch and Baker. After that, the harvested segments will be decalcified overnight in 10% formic acid, before perfusion fixing in 4% formaldehyde and stored at 25°C until the time of histological processing. Routine staining and immunofluorescence techniques for CD68 will be applied in order to identify intimal damage and macrophage infiltration respectively. Analysis will involve semi-quantitative classification of plaque components, luminal narrowing, and degree of macrophage infiltration. This research conforms to the Declaration of Helsinki on the use of human subjects as well as the Malawi Anatomy Act of 1990 (amended version) and will be conducted after the approval of COMREC. Expected findings and their dissemination This study will provide insights on the prevalence, progression and pathological mechanisms of intracranial atherosclerosis in adult black Malawian population. The knowledge will assist in promoting effective assessment and management of risk factors for the disease and its attributable sequelae, ischaemic stroke. An understanding of the histologic profile of atherosclerosis vis-a-vis mechanisms of atherogenesis in this population group will adequately inform design of clinical trials and allow identification of biomarkers for use in screening, diagnosis, risk-stratification and pathological validation of vessel wall imaging (VWI) parameters. Moreover, a study of this calibre, carried out in varying patient categories, will shed light on presence of salient plaque characteristics (such as degree of intra-plaque haemorrhage, calcification and inflammatory cell infiltration) that contradistinct plaque vulnerability and ICAS progression across established risk-stratified patient groups. Lastly, investigating variations in patterns of atherogenesis among varying portions of the intracranial arterial tree may allow researchers to comment on the role of variations in anatomical configuration of the cerebral arterial circle in the development of atherosclerosis. This may partly give explanations to observed differences in prevalence of ICAD and ischaemic stroke among Asians, Caucasians and Blacks. Findings of the study will be presented in various research dissemination forums, published in referred journals, and shared with the university and the COMREC.
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    The prevalence of cardiac complications among children with sickle cell disease, attending paediatric sickle cell clinic at Queen Elizabeth Central Hospital, Blantyre, Malawi
    (Kamuzu University of Health Sciences, 2020-11-11) Moyo, Dominic
    Study design: This is a Cross- sectional study. Problem statement Cardiovascular diseases like pulmonary hypertension, cardiomyopathy and left and right ventricular systolic and diastolic dysfunction are important complications and cause for morbidity and mortality among patients with Sickle Cell Disease. Routine monitoring for detection of these complications is recommended for early detection and institution of measures to mitigate them. The magnitude of these complications and how they present at Queen Elizabeth Central Hospital, paediatric Sickle Cell Disease clinic is not known. Over 120 children are routinely followed up in this clinic and monitoring for cardiovascular complications in not routinely done. This study aims at establishing the prevalence of cardiovascular complications in our cohort and characterising their presentation. Objectives: Primary objective: To characterise describe the prevalence of cardiac complications among children aged 2 to 16 years, attending paediatric sickle cell clinic. at Queen Elizabeth Central hospital. Secondary Objectives: 1. To determine the prevalence of characterise the cardiac complications among children aged 2 to 16 years, attending paediatric sickle cell clinic at Queen Elizabeth central hospital. 2. To determine the risk factors associated with cardiac complications among children aged 2-16-year, attending paediatric sickle cell clinic. at Queen Elizabeth Central Hospital. 3. To evaluate the clinical features of cardiacovascular complications among children aged 2- 16-year-old children attending paediatric sickle cell clinic at Queen Elizabeth Central Hospital. Research questions to be answered 1. What is the prevalence of cardiovascular complications of children ages 2-16 years attending paediatric sickle cell clinic at Queen Elizabeth Central Hospital? 2. What are the risk factors associated with these complications among these children? Methodology The study will be conducted at Queen Elizabeth Central Hospital paediatric Sickle cell clinic. 117 children aged 2-16 years will be recruited after screening and obtaining informed consent and assent from the guardian and the children who are able to give assent respectively. Data on medical history of the child will be collected from the health passport book and interviews. A comprehensive physical examination of the child will also be performed. This will be followed by an echocardiographic examination of the heart using an ultrasound machine. Data will be collected on a tablet fitted with an Open Data Kit (ODK) platform. The outcome variable of interest will be whether a child attending the clinic has cardiac complications. Descriptive analysis to obtain the prevalence of the cardiovascular complications and their characterisation will be done. This will be followed by bivariate and multivariate logistic regression analysis to identify the risk factors associated with these complications at a P-value of <0.05. Expected findings The prevalence of cardiovascular complications among children attending paediatric Sickle Cell clinic at Queen Elizabeth Central Hospital and the risk factors associated with them. Results dissemination The study report of all results will be submitted to the funders of the study and the College of Medicine – University of Malawi. College of Medicine Research Ethics Committee (COMREC) will also receive a copy as well as the participating patients that wish to receive the results. The results will further be submitted to a peer-reviewed journal for publication.