CardioVascular Journal of Afr ica (off icial journal for PASCAR) www.cvja.co.za 34 KENYA CARDIAC SOCIETY 40th ANNUAL SCIENTIFIC CONGRESS 26 - 29th JULY, MOMBASA
AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 2 Disclaimer The Abstracts for Kenya Cardiac Society were reviewed by an independent Abstract Review Committee appointed by the Congress Organizing Committee and not by the Editor-in-Chief, Regional Editors or reviewers of the Cardiovascular Journal of Africa. Only accepted and presented abstracts are published. 40th Kenya Cardiac Society Annual Scientific Congress
CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 3 AFRICA Dear Readers It is with great pleasure and enthusiasm that we present to you the abstract booklet for the 40th Kenya Cardiac Society Annual Scientific Congress held on 26 – 29th July at the Sarova Whitesands Hotel, Mombasa, Kenya. This booklet serves as a compilation of the diverse and cutting-edge research that were submitted to the congress. This congress serves as a platform for the exchange of ideas, collaboration, and the dissemination of knowledge from Kenya and across the region on CVDs. This year’s event has attracted an impressive array of local and international health professionals, researchers, industry professionals, and students. The resulting diversity of perspectives, expertise, and experiences provides a vibrant and enriching intellectual environment. We would like to extend our heartfelt appreciation to all the authors who submitted their abstracts for consideration. We acknowledge the tireless efforts and unwavering dedication of the contributors to advancing knowledge in the field of cardiovascular diseases (CVDs). We would also like to express our gratitude to the reviewers and members of the organizing committee who dedicated their time and expertise to ensure the quality and relevance of the abstracts included in this booklet. Finally, we would like to extend our warmest welcome to all the congress attendees. We hope that your participation in this event will be an enriching and memorable experience, filled with new connections, stimulating discussions, and inspiring discoveries. Once again, we express our gratitude to all who have contributed to the abstract booklet and the success of the 40th Kenya Cardiac Society Annual Scientific Congress. We wish you an inspiring and rewarding journey as you explore the abstracts and engage in the exchange of knowledge at this remarkable event. Sincerely, Dr. Felix Barasa Chair, Abstract review Committee
AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 4 Submission ID Lead Author Title Topic Other authors Country 1 Malcom Masikati Spectrum of causes of isolated (pure) Aortic Regurgitation at a South African Public Sector Tertiary Care Institution Valvular Heart Disease Basera W, Pennel T, Ntsekhe M South Africa 2 Emmanuel Benge Factors associated with non-uptake of Implantable Cardioverter-Defibrillator among eligible patients in Kenya Heart Failure Mzee Leonard Ngunga, Mohamed Hasham Varwani, Jasmit Shah Kenya 3 Ombaba Osano Diagnosis of children admitted over a 5-year period with congenital heart disease at Kenyatta National Hospital Pediatric Cardiology D. Kimonge, E. Kimani, E. Chesire, N. Gachara, C. Yuko-Jowi Kenya 4 Raphael Kinuthia Treading the patient pathway: Healthy Heart Africa approach to awareness, screening, diagnosis and treatment of hypertension at Faith-Based Health Facilities in Kenya. Hypertension Jacinta Mutegi, Angela Mwanza, Anastacia Ruuri, Pauline Kihoro, Pauline Mue, Janet Nzai, Margaret Kigwe, Nelson Otieno Kenya 5 Mazaher Jaffer Case Study with an unusual cause for paroxysmal AFIB Arrhythmia P K J Patel Kenya 6 Premanand Ponoth Surgical treatment of HOCM: A Kenyan Experience Heart Failure Anthony Gikonyo, Dan Gikonyo Kenya 7 Premanand Ponoth Sub-aortic Stenosis: A gratifying surgical treatment for a rare ailment Cardiac Surgery Anthony Gikonyo, Dan Gikonyo Kenya 8 Shamsa Yahya Prevalence and Factors associated with undernutrition among children with Congenital Heart Disease at three Tertiary Hospitals in Nairobi, Kenya Pediatric Cardiology Del-rossi S. Quadros, Naomi Gachara Kenya 9 Mercy Ng'eno Late diagnosis of CHD and its associated factors in Kenya: an analytic cross-sectional study Pediatric Cardiology Del-rossi S. Quadros, Naomi Gachara, Isaac Kihurani and Gerald Yonga Kenya 10 Daniel Muriuki Focused Cardiac Ultrasound: Competency among medical officer trainees in differentiatng cardiovascular causes of dyspnoea Cardiovascular Imaging Joshi M. D., Kagima J.W., Joekes E., Kwasa T.O. Kenya 11 Zenab Mbarak Pediatric cardiac disease burden as seen at coast general teaching and referral hospital Pediatric Cardiology Bakari Suleiman Mwashambi, Zenab Thabit Mbarak Kenya 12 William Katiku Echocardiography imaging in patients undergoing chemotherapy Cardiovascular Imaging Bernard Samia Kenya 13 Stephen Mutiso Evaluating the impact of Electronic Medical Records (EMR) system in improving the care process, treatment outcomes and data quality in hypertensive clinics in two counties - 2021/2022. Hypertension Mwenda V, Gathecha G. Kenya 14 John Otieno Odhiambo Case series on prosthetic valve thrombosis treated with intravenous thrmbolysis at a tertary teaching hospital in Nairobi - Kenya Valvular Heart Disease Salim Salim Abdallah, Mzee Ngunga Kenya 15 Jimmy Njoroge The effects of beta vulgaris juice on the common carotid artery of an albino rat (Rattus norvegicus) following prolonged administation of a high salt diet Hypertension Khulud Nurani, Jeremiah Munguti Kenya 16 Alice Muhuhu First Kenyan – Made Low Cost and Portable ECG Monitor Cardivascular Imaging Bernard Samia, Mohsen Gaballa Kenya
CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 5 AFRICA 17 Adam Ndamayape Medication administration errors for patients admitted at Jakaya Kikwete Cardiac Institute Dar es salaam Tanzania. Medication administration errors Tanzania 18 James Oguta Prevalence and factors associated with Ideal Cardiovascular Health in Kenya: A cross-sectional study using data from the 2015 Kenya STEPwise survey Preventive Cardiology Elvis Wambiya, Catherine Akoth, Peter Kibe , Peter Otieno, Lilian Mbau , Yvette Kisaka , Elizabeth Onyango, Grace Mbuthia, Jemima Kamano, Penny Breeze, and Pete Dodd United Kingdom 19 Anthony Etyang Training the next generation of hypertension researchers: The Improving Hypertension Control in Rural Africa Global Health Research Group Hypertension Alexander Perkins, Syreen Hassan, Modou Jobe, Elijah Ogola, Assan Jaye, Samson Kinyanjui, Melanie Morris, Pablo Perel, and the IHCoR-Africa Group Kenya 20 Charles Masese Role of clinical officers-cardiology in preventive cardiology Preventive Cardiology Muhia Maureen et. al Kenya 21 Kieran Mwazo Relationship between obstructive sleep apnoea and hypertension: A single clinic experience Hypertension Brian Nduati Kenya 22 Jared Owuor The use of Tele - ECG & Point of Care Ultrasound in primary , for Early detection and referral of cardiovascular patients in Siaya County. A process paper Cardivascular Imaging Karekezi Catherine, Gitonga Caroline, Adema Irene, Yonga Gerald Kenya 23 Elvis Wambiya Structure and cost-effectiveness of integrated care models for the prevention and management of cardiometabolic multimorbidity: A systematic literature review Care models James Oguta, Robert Akparibo, Duncan Gillespie, Pete Dodd United Kingdom 24 Arega Fekadu Leta Outcome after Cox-maze IV Procedure for Atrial Fibrillation in Rheumatic Heart Disease Patients: Experience from Tenwek Hospital (A Preliminary Report) Cardiac Surgery Agneta Odera, Yonas A. Teferi, Diana Sang, Ian Mutai, Evaline Chemutai Kenya 25 Arega Fekadu Leta Pre-operative MELD-Na Score as an independent predictor of perioperative mortality after valve surgery in Rheumatic Heart Disease patients: Experience from Tenwek Hospital Cardiac Surgery Yonas A. Teferi, Lidetu Kayamo, Evaline Chemutai Kenya 26 Victor Wauye Primary Causes of Heart Failure and Direct Medical Cost of Hospitalization at Moi Teaching and Referral Hospital, Kenya Heart Failure Oduor CO, Barasa FA Kenya 27 Peter Mugo Sub-aortic Vulvular Stenosis mimicking Hypertrophic Obstructive Cardiomyopathy (HOCM) Valvular Heart Disease Ngunga LM, Mohamed J Kenya 28 Rajesh Kumar Transcatheter closure of Unligated Vertical vein in post operative TAPVC repair causing physiological left to right shunt Pediatric Cadiology India Submission ID Lead Author Title Topic Other authors Country
AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 6 29 Rajesh Kumar Transcatheter closure of large Tubular Hypertensive PDAs in small children using MFO device as effective alternative to Double disk muscular VSD occluders Pediatric Cardiology India 30 Rajesh Kumar Transcatheter Debanding options for Swiss Cheese VSD Pediatric Cardiology India 31 Sylviah Chelagat Challenges and implication of atypical presentation of acute myocardial infarction in peripheral Sub-Saharan Africa: A Case report. Coronary Artery Disease Stephen Jaoko, Anthony Gikonyo, Dan Gikonyo, Premanand Ponoth, Kenya 32 Yusuf Mahat Patient characteristics and treatment outcome among hypertensive patients in Kenya 2023-cross-sectional study Hypertension Valerian Mwenda, Shukri Mohamed, Oren Ombiro, Gladwell Gathecha, Jacob Masai Kenya 33 Lois Wagana Non-invasive Diagnostic Measures in Cardiac Amyloidosis: A Case Series Cardiomyopathy N. Muriithi, Alex Gachoya Kenya 34 Chitira Agnes Reaching the Unreached: How the Mater Hospital in Kenya is bridging a huge gap in Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD) Prevention, Diagnosis and Treatment Valvular Heart Disease Kenya 35 Albert Nyanga Takayasu arteritis presenting as acute ischemic stroke and coronary artery disease Vascular Disease Mzee Ngunga, Jeilan Mohamed, Naushad Karim, Hanika Patel. Kenya 36 Willy Mucyo Physicians' adherence to guidelines on prescriptiion and uptitration of medical therapy for heart failure with reduced ejection fraction Heart Failure J Shah, H Varwani, M Jeilan, M Ngunga Kenya 37 Hassan Awil Deif A normal coronary intervention turns into a anigtmare and how we came out of it Coronary Artery Disease Muhamed Shaloob, Mohammed Hassan Yusuf, Said Abdillahi Good, Ridwan Osman Garas. Somaliland 38 Kieran Mwazo Duchenne Muscular Dystrophy Cardiomyopathy Aisha A, J. Mkilo, S. Kiwo, B. Nduati Kenya 39 Sheila Mukarye A case report on the management of cardiac disease in pregnancy in a public hospital in Kenya Cardiac disease in Pregnancy Kieran Mwazo. Kenya 40 Kieran Mwazo Utility of multimodality imaging in prosthetic valve assessment Cardiovascular Imaging B Nduati, Ummekulsum A Varvani Kenya 41 Chebet Chepkwony Unusual presentation of an anomalous right coronary artery Congential Heart Disease Kenya 42 Favour Kemunto Mitral clip in functional mitral regurgitation: A case report Coronary Artery Disease Redemptar Kimeu, Charles Kariuki Kenya 43 Mohammed Noor A snap shot survey to establish the vascular disease burden in Nairobi, Kenya Vascular Disease Brian Ruhiu, Obed Morara, Mustafa Musajee Kenya 44 Rick Simiyu Saving the Limb & saving the Life: our experience with two complex trauma cases at Public Hospital! Cardiac Surgery Obed Morara, Enoch Makori, Okumo ,Ron, Bashisth Mishra Kenya Submission ID Lead Author Title Topic Other authors Country
CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 7 AFRICA Submission ID: 1 SPECTRUM OF CAUSES OF ISOLATED (PURE) AORTIC REGURGITATION AT A SOUTH AFRICAN PUBLIC SECTOR TERTIARY CARE INSTITUTION M MASIKATI, W BASERA, T PENNEL, M NTSEKHE 1. DEPARTMENT OF MEDICINE, UNIVERSITY OF CAPE TOWN AND GROOTE SCHUUR HOSPITAL, CAPE TOWN, SOUTH AFRICA. 2. DEPARTMENT OF MEDICINE, DIVISION OF CARDIOLOGY, UNIVERSITY OF CAPE TOWN AND GROOTE SCHUUR HOSPITAL, CAPE TOWN, SOUTH AFRICA 3. DEPARTMENT OF SURGERY, CHRIS BARNARD DIVISION OF CARDIOTHORACIC SURGERY, UNIVERSITY OF CAPE TOWN, SOUTH AFRICA. 4. SCHOOL OF PUBLIC HEALTH & FAMILY MEDICINE, UNIVERSITY OF CAPE TOWN, SOUTH AFRICA. Background Aortic Regurgitation (AR) is due to primary abnormalities of the aortic valve or peri-valvular apparatus and structures such as the aortic root and the ascending aorta. The etiology and mechanisms of AR is relatively well described in Europe and North America, little information exists about their spectrum and frequency in a South African context. The aims of this study were to determine the spectrum of disorders that cause isolated AR and their proportion, the predominant mechanisms of isolated AR and the accuracy of pre-op determination of etiology by clinical and imaging evaluation. Methods This is a retrospective review of 141 hospital records of patients who had aortic valve replacement (AVR) for isolated AR from Jan 2003 to June 2018 at Groote Schuur Hospital (GSH). For this study the etiology and pathological mechanism was confirmed by macroscopic examination at surgery and pathological examination of the explanted valve was confirmed by preoperative clinical and echocardiographic findings or pathological examination where available. In the absence of histology, clinical,echocardiographic, and macroscopic examination were used to determine etiology. Results Rheumatic heart disease 32.6% (46/141) was the most common disease causing AR in our study.The mean age of the cohort was 43 years (29-57) with a male predominance of 63.1% (89/141). Preoperative evaluation with clinical and echocardiographic assessment was able to accurately identify the mechanisms of 95.7% (135/141) the patients.Five predominant categories of mechanisms were found. Conclusion In a SA cohort, we show that AR in our setting is a disease of young patients, the majority of which is caused by RHD. Other important causes in our setting included IE, HPT, aortitis and bicuspid valves. These findings evaluating the spectrum of causes of isolated AR in an urban African environment are in contrast to those in the global north where isolated AR is predominantly degenerative valve disease, BAV or of unknown etiology. With many of the patients referred in the north being older patients (55-70). Variable Total Aortic Root Aortic Bicuspid Aortic Degenerative Valve (N=141) Dilatation (N=38) Dissection (N=14) Valve (N=2) Disease (N=6) Demographics Sex Male 89 (63.1) 23 (60.5) 8 (57.1) 0 4 (66.7) Female 52 (36.9) 15 (39.5) 6 (42.9) 2 (100) 2 (33.3) Age (years) 43.1 (±14) 45.0 (±15) 44.9 (±13) 44.0 (±17) 43.1 (±19) Medical history Hypertension 61 (43.3) 20 (52.6) 8 (57.1)L 1 (50.0) 2 (33.3) Diabetes mellitus 2 (1.4) 0 0 0 1 (16.7) Dyslipidaemia 13 (9.2) 5 (13.2) 2 (14.3) 1 (50.0) 1 (16.7) Coronary Heart Disease 6 (4.3) 3 (7.9) 0 1 (50.0) 0 CKD 7 (5.0) 2 (5.3) 0 0 1 (16.7) COPD 8 (5.7) 4 (10.5) 0 0 1 (16.7) HIV positive 21 (16.9) 5 (15.6) 1 (8.3) 1 (50.0) 0 On HAART 13 (61.9) 3 (60.0) 1 (100) 1 (100) - CD4 count 344 (259-545) 173 (96-357) 490 (490) 239 (239) - Syphilis reactive 12 (8.5) 4 (10.5) 1 (7.1) 0 1 (16.7) Clinical presentation NYHA I 15 (10.8) 5 (13.9) 2 (14.3) 0 0 II 45 (32.4) 14 (38.9) 5 (35.7) 2 (100) 2 (33.3) III 65 (46.8) 15 (41.7) 7 (50.0) 0 1 (16.7) IV 14 (10.1) 2 (5.6) 0 0 3 (50.0) Heart failure 104 (73.8) 25 (65.8) 9 (64.3) 1 (50.0) 6 (100) Pulmonary Oedema 33 (23.4) 6 (15.8) 3 (21.4) 0 4 (66.7) Aortic valve morphology Bicuspid 11 (7.9) 2 (5.4) 1 (7.7) 1 (50.0) 1 (16.7) Tricuspid 128 (92.1) 35 (94.6) 12 (92.3) 1 (50.0) 5 (83.3) Presence of minimal/functional MR 97 (71.9) 29 (80.6) 6 (50.0) 1 (50.0) 5 (83.3) Presence of mild AS 12 (8.8) 4 (11.1) 1 (8.3) 0 1 (16.7) AoVPG <35 mmHg 91 (64.5) 23 (60.5) 4 (28.6) 2 (100) 4 (66.7) Grading of AR Mild 2 (1.4) 0 1 (7.1) 0 0 Moderate 18 (12.8) 8 (21.1) 1 (7.1) 1 (50.0) 2 (33.3) Severe 121 (85.8) 30 (79.0) 12 (85.7) 1 (50.0) 4 (66.7) Surgical Intervention Mechanical prosthesis 88 (68.2) 21 (58.3) 6 (46.2) 1 (50.0) 2 (40.0) Bioprosthesis 24 (18.6) 5 (13.9) 1 (7.7) 1 (50.0) 2 (40.0) David’s procedure 17 (13.2) 10 (27.8) 6 (46.2) 0 1 (20.0) Demographics,comorbidities, clinical presentation, echocardiographic findings and causes of AR
AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 8 Submission ID: 2 FACTORS ASSOCIATED WITH NON-UPTAKE OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR AMONG ELIGIBLE PATIENTS IN KENYA OLUOCH EMMANUEL BENGE1, MZEE LEONARD NGUNGA1, MOHAMED HASHAM VARWANI1, JASMIT SHAH1 1. AGA KHAN UNIVERSITY HOSPITAL, NAIROBI Background The safety and efficacy of Implantable Cardioverter-Defibrillator (ICD) implantation in both primary and secondary prevention of Sudden Cardiac Death (SCD) in at-risk populations is well established. ICD implantation rates remain low particularly in Africa with a paucity of data regarding factors associated with non-uptake and reasons for implant refusal. The study’s aim was to characterize these factors and identify reasons for ICD refusal. Understanding these factors and reasons for non-implantation will provide the opportunity to optimize ICD uptake among eligible patients hence reducing sudden cardiac arrest. Methods This was a retrospective study of heart failure patients seen from 2018 to 2020. Demographics, etiology of heart failure, comorbidities, NYHA functional class, primary physician, and insurance status were abstracted. Logistics regression models were used to compare the ICD recipient and ICD non-recipient groups to determine predictors for non-uptake. Results Of the 206 ICD device-eligible patients, only 69 (33.5%) had an ICD implantation. Compared to ICD recipients, ICD non-recipients were more likely to be of African race (91.2%vs. 79.7%; p=0.019) and rural dwellers (18.7% vs 8.2%; p=0.031). In multivariate analysis, factors independently associated with non-uptake were lack of private insurance (42.3% vs 63.8%; p=0.005), non-cardiology physician (16.1% vs 5.8%; p=0.045), and non-ischemic cardiomyopathy (54.7% vs 36.4% p=0.014). The most common reason for refusal of ICD implantation was the inability to pay for the device. Conclusion ICDs are underutilized in Kenya. Certain patient and practice factors including lack of private insurance, non-cardiology primary physician, and non-ischemic cardiomyopathy, were independently associated with non-uptake of ICD. The findings of this study hold significance in enhancing the utilization of ICDs in sub-Saharan Africa. Submission ID: 3 DIAGNOSIS OF CHILDREN ADMITTED OVER A 5-YEAR PERIOD WITH CONGENITAL HEART DISEASE AT KENYATTA NATIONAL HOSPITAL B. OMBABA OSANO, D. KIMONGE, E. KIMANI, E. CHESIRE, N. GACHARA, C. YUKO-JOWI Background Congenital Heart disease (CHD) are clinically significant structural heart disease present at birth. CHD is found in 8-12 babies per 1,000 live births. Common CHDs include atrial septal defects, ventricular septal defects, Patent Ductus Arteriosus, pulmonary stenosis, coarctation of aorta and tetralogy of Fallot. The number of patients with their CHDs admitted at KNH hasn’t been documented. Objective: To establish the clinical diagnosis of children admitted in KNH with CHD from 1st January 2016 to December 2021. Methodology Retrospective review of patient records for period 1st January 2016 to December 2021. We collected data for all patients diagnosed with congenital heart disease for patients aged below 18 years who had ever been admitted at Kenyatta National Hospital. Descriptive statics were generated for social demographic and the clinical diagnosis. Continuous data was summarized with appropriate measures of central tendency and distribution. Results We reviewed 1,247 medical records for children with CHDs. A majority (1,102 -88.4%) were aged three years or below. There were slightly more males (730 - 58.5%). Most of the children were referred for cardiac evaluation (858 - 68.8%). Nairobi county had the highest number of patients (509 - 40.8%). The common presenting were respiratory symptoms (difficulties in breathing – 906, 72.7%, cough – 57, 17.3% and difficulties in feeding/breastfeeding – 169, 13.6%). The common acyanotic CHDs were PDA (435 - 34.9%), VSD (365 – 29.2%) and ASD (267 – 21.4%) while the common cyanotic CHDs were ToF (92 - 7.3%) and DORV (18 - 1.4%). Conclusion The common CHDs seen were VSD, PDA and ASD for acyanotic while ToF and DORV were the common cyanotic CHDs. Submission ID: 4 TREADING THE PATIENT PATHWAY: HEALTHY HEART AFRICA APPROACH TO AWARENESS, SCREENING, DIAGNOSIS AND TREATMENT OF HYPERTENSION AT FAITH-BASED HEALTH FACILITIES IN KENYA. 1RAPHAEL KINUTHIA, 1JACINTA MUTEGI, 1ANGELA MWANZA, 1ANASTACIA RUURI, 1PAULINE KIHORO, 1PAULINE MUE, 1JANET NZAI, 2MARGARET KIGWE, 2NELSON OTIENO 1. KENYA CONFERENCE OF CATHOLIC BISHOPS – HEALTH DEPARTMENT, P.O BOX 13475, 00800, NAIROBI 2. HEALTHY HEART AFRICA – ASTRAZENECA MEA SUB SAHARAN AFRICA, P.O BOX 10107, 00100, NAIROBI Background AstraZeneca’s HHA program launched in 2014, is a sustainability access program designed to contribute to prevention and control of hypertension and decreasing the burden of cardiovascular diseases in Africa. HHA is delivered in partnership with MOH-Kenya and Kenya Conference of Catholic Bishops and aspires to reach 10 million people with elevated blood pressure across Sub-Saharan Africa by 2025. Methods Focusing on strengthening the patient pathway, CHVs and relevant healthcare providers were trained in awareness creation and education with provision of IEC materials, hypertension protocols and registers to track patient journey and outcomes. Screening is done by CHVs at the community or Healthcare Providers at triage to identify, refer and link patients with elevated blood pressure for diagnosis and treatment. Psychosocial support groups are formed for adherence and retention. Results From January 2016 to February 2023, 10,779,740 people were screened, 2,183,241 (20.3%) were found with elevated blood pressure 615,397 (28.2%) individuals with elevated blood pressure were referred. 421,736 (85.6%) were newly diagnosed with hypertension and linked to care, 208,000 (46.7%) initiated on treatment. Conclusion HHA pathway demonstrated successful implementation of hypertension interventions within the primary care setting in Kenya. The initiative was able to identify high numbers of hypertensive patients for care. HHA approach, demonstrates mechanisms to attain early detection, prevention and treatment of hypertension in Kenya.
CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 9 AFRICA HHA patient pathway from January 2016 to February 2023 Submission ID: 5 CASE STUDY WITH AN UNUSUAL CAUSE FOR PAROXYSMAL AFIB MAZAHER JAFFER, P K J PATEL Introduction More than half of the life-threatening arrhythmias are labelled idiopathic without clear identifiable cause. Since 2017, there are studies confirming a large proportion of these cases have an autoimmune origin. There is an estimated global prevalence of 10% for autoimmune disease in general, with an approximate threefold increased risk in arrhythmias within patients suffering from the same. Method An 80-year-old woman who has been suffering from recurrent atopic reactions including recurrent respiratory symptoms, unusual rashes, significant orthostatic symptoms, and a long-standing incidences of recurrent paroxysmal atrial fibrillation attacks, for which she could not use most antiarrhythmic drugs due to atopic reactions and has significant muscle wasting due to prolonged beta blocker usage. She underwent thrombotic CVA and was started on aspirin. She declined use of LABA/ICS for her symptoms and had been on long term follow up with a cardiologist for her symptoms. She underwent testing for autoimmune disease and found multiple markers that led to her commencing of Baricitinib. The results of the same led to a relative resolution of her antibody levels, and most of her symptoms as well as a lack of arrhythmia incidents over a 3-month period. Results Control of the autoimmune condition was associated with control of the arrhythmic events without additional use of antiarrhythmic drugs in this case. Conclusion It is worth screening and controlling for Autoimmune disease in all patients identified with arrhythmia as part of its management of the same. Submission ID: 6 SURGICAL TREATMENT OF HOCM: A KENYAN EXPERIENCE DR. PREMANAND PONOTH THE KAREN HOSPITAL, NAIROBI Background Septal myectomy is currently considered the safest and most durable way to reduce obstruction caused by Hypertrophic Obstructive Cardiomyopathy (HOCM). HOCM is a genetic disorder of the myocardium, characterized by marked myocardial hypertrophy that may lead to the development of symptoms such as dyspnea, angina pectoris, or stress-induced syncopes, with an increased risk of sudden cardiac death, due to obstruction of the left ventricular outflow tract. Methods Between 2020 to 2023 we had 2 cases with hypertrophic obstructive cardiomyopathy which was subjected for septal myomectomy. Age varied between 40 -60.M:F ratio 1:1. Both had significant LVOT mean gradient of more than 60mmof Hg with associated LVH. Septal thickness was more than 25 mm. One patient has mild Systolic Anterior Motion of the Mitral Valve (SAM). Results Both the patient underwent septal myomectomy through aortic approach on Cardio Pulmonary bypass. Procedure was uneventful. Post OP gradient across aortic valve was less than 25mm of Hg at the time of discharge. One patients came back after 2 weeks with fever associated with cough and dyspnoea. On investigation he had massive left pleural effusion, which on ICD drainage, found to be haemorragic. This patient has covid pneumonia few months before the surgery, and a provisional working diagnosis of covid reinfection was made as HRCT showed infiltrative lesion. He died on the 2nd day after readmission. The other patient is doing well and is on regular follow up. Conclusion HOCM can cause the leaflets of the mitral valve elongated.
AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 10 Repairing the valve (Horizontal Plication), removal of residual or extra portions of the mitral valve should be done. Surgical septal myectomy is the therapeutic gold standard for the treatment of drug-refractory disabling symptoms in HOCM caused by LVOT obstruction. Alcohol septal ablation for HOCM has been proposed as a less-invasive alternative to surgical myectomy, although its role in the management of HOCM associated with SAM requires further investigations. Submission ID: 7 SUBAORTIC STENOSIS: A GRATIFYING SURGICAL TREATMENT FOR A RARE AILMENT DR.PREMANAND PONOTH THE KAREN HOSPITAL, NAIROBI Background This is a rare heart disease with an unclear etiology and variable clinical presentation. which result in left ventricular outflow tract obstruction. The etiology of the stenosis ranges from a discrete subaortic membrane to tunnel type narrowing of the entire left ventricular outflow tract which results in left ventricular outflow obstruction. Reports of a familial incidence, suggest a genetic predisposition. Discrete subaortic stenosis (DSS) is the most basic form. SAS usually develops during the first decade of life and might appear as an isolated lesion or in association. Methods Between 2022 and 2023 we had two cases of subaortic stenosis of varying pathology. The pediatric patient of 4 years had dicreate sub aortic membrane causing palpitation, which was diagnosed on cardiac evaluation. The child had mild MR, normal LV. The adult patient aged 28 years has subaortic ridge causing chest discomfort with DOE, NYHA class III. The peak gradient across the aortic valve was 90mm of Hg, the echo evaluation was otherwise normal. Both the patient had resection of the subaortic pathology on cardiopulmonary bypass and had uneventful recovery. Results Both patients are on regular follow up. The adult patient the mean gradient was 4 mm of Hg and peak of 12 mm of Hg. The pediatric patient is on follow-up with the concerned paed cardiologist. Conclusion Sub Aortic Stenosis with subaortic membrane, should be differentiated from aortic stenosis of other etiology. Resection of SAM carries long-term benefits. Routine septal myectomy appears to be associated with a low risk of recurrence. The timing of intervention is debatable. Many centres supported waiting until the gradient reaches a peak echocardiographic measurement of 25–30 mmHg, or AI or LVH develops. Myectomy may serve to disrupt this circumferential ring of genetically predisposed cells. Recurrence still remains a problem, especially in the presence of a predisposing associated congenital heart defect. Freedom from re-operation is about 85% at 15 years, regular echocardiographic follow-up is adviced. Submission ID: 8 PREVALENCE AND FACTORS ASSOCIATED WITH UNDERNUTRITION AMONG CHILDREN WITH CONGENITAL HEART DISEASE AT THREE TERTIARY HOSPITALS IN NAIROBI, KENYA SHAMSA YAHYA1, DEL-ROSSI S. QUADROS1, NAOMI GACHARA1 1DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH, AGA KHAN UNIVERSITY HOSPITAL, NAIROBI, KENYA Background Children with Congenital heart disease (CHD) have a high burden of undernutrition. Factors associated with undernutrition include type and complexity of heart defect, late diagnosis, timing of surgical correction, lack of adequate nutritional support as well as other associated clinical comorbidities. Methods A cross-sectional study conducted between July 2021 and March 2022 at three tertiary care hospitals in Nairobi, Kenya; The Aga Khan University Hospital, Nairobi, Kenyatta National Hospital and Mater Hospital. Objective was to establish the prevalence and factors associated with undernutrition among children with CHD. Undernutrition included any child who had at least one indicator of stunting, wasting, underweight or thinness using relevant WHO standard Z-scores. Univariate and multivariate logistic regression analysis was done to assess for associated factors. Results Of the 242 children recruited, 116 were undernourished, a prevalence of 47.9% (95% CI: 41.5%-54.4%) with 35.5% (n=86) being underweight, 25.6% (n=62) were wasted, 17.4% (n=42) were stunted and 8.3% (n=20) had thinness. In the multivariate analysis, children who were undernourished were 2.8 times more likely to receive nutritional support than those who were well nourished (p=0.001,OR: 2.88; 95% CI:1.57-5.34). The type of CHD was not significantly associated with undernutrition (p=0.847, OR:0.94; 95% CI: 0.48-1.84), however, children with comorbidities were 3.2 times more likely to be undernourished (p<0.001, OR: 3.26; 95% CI:1.61-6.84). Other factors that were not statistically significantly associated with undernutrition were sociodemographic factors, presence of pulmonary hypertension, surgical correction of defect, age at diagnosis. Conclusion and recommendations The prevalence of undernutrition among children with CHD is high, therefore, the need for nutritional rehabilitation as part of the multidisciplinary care given to these children. Submission ID: 9 LATE DIAGNOSIS OF CHD AND ITS ASSOCIATED FACTORS IN KENYA: AN ANALYTIC CROSS-SECTIONAL STUDY MERCY NG’ENO1, DEL-ROSSI S. QUADROS1 , NAOMI GACHARA1, ISAAC KIHURANI1 AND GERALD YONGA2 1DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH, AGA KHAN UNIVERSITY HOSPITAL, NAIROBI, KENYA AND 2NON- COMMUNICABLE DISEASE RESEARCH TO POLICY UNIT, AGA KHAN UNIVERSITY, NAIROBI, KENYA Introduction Burden of congenital heart disease (CHD) in Africa is generally underestimated mainly due to significant under-reporting and earlyrelated fetal and neonatal mortality. Methods A cross-sectional study on paediatric patients with CHD, aged 0–18 years, seen over a 5-year period, between January, 2011 and December, 2016. The objective was to determine the prevalence and factors associated with late diagnosis of CHD seen at three tertiary care hospitals in Kenya (Aga Khan University Hospital Nairobi, Mater Hospital, and Kenyatta National Hospital). Patients were stratified into those diagnosed late (>1 year of age) and those diagnosed early (<1 year of age). Multiple logistic regression analysis was done to determine factors associated with late diagnosis. Results The study enrolled 411 patients, with equal gender distribution. Prevalence of late diagnosis (>1 year of age) of CHDwas 60.6% (95% CI 55.7–65.3). Median age at diagnosis was 15 (IQR 5–48) months.
CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 11 AFRICA Presence of a cardiac murmur (OR = 0.87; 95% CI 0.72–0.92, p-value = 0.016) and level of parental education (OR = 4.99; 95% CI 2.25–11.40, p-value <0001) were associated with a decreased odds of late diagnosis. Other factors like cyanosis, an increase in the number of healthcare workers and healthcare facilities per 10,000 population showed some association with decreased odds of late diagnosis of CHD, but these were not statistically significant. Conclusion Late diagnosis of CHD remains alarmingly high in our setting. Initiatives to enhance early detection and screening of CHD should be adopted to reduce related mortality and morbidity. Submission ID: 10 FOCUSED CARDIAC ULTRASOUND: COMPETENCY AMONG MEDICAL OFFICER TRAINEES IN DIFFERENTIATING CARDIOVASCULAR CAUSES OF DYSPNOEA MURIUKI D.M., JOSHI M. D., KAGIMA J.W., JOEKES E., KWASA T.O. Background Differentiation of cardiovascular causes of acute dyspnea in resource-limited healthcare settings can be challenging. Diagnostics such as Brain Natriuretic Peptide (BNP) and echocardiography are Submission ID: 11 PEDIATRIC CARDIAC DISEASE BURDEN AS SEEN AT COAST GENRAL TEACHING AND REFRRAL HOSPITAL ZENAB MUBARAK, BAKARI SULEIMAN MWASHAMBI, ZENAB THABIT MBARAK Background The burden of paediatric cardiac disease is immense in Africa and it’s the second leading cause of death of children in the first year of life. Despite the advancement in technology that has improved the outcomes of children with cardiac disease in developed countries, Africa still lags behind and little is known on the outcomes of these children. There is little research work done on the topics of both congenital and acquired diseases especially in sub-Saharan Africa whereby most of the population is marginalised. Several factors have been identified in previous research as financial challenges and lack of access to quality health care being the main reasons. As little effort has been done to improve the outcome, the burden of disease is growing and carries important implications on the future of the children and families in these regions. Methods A total of 10 free echo screening outreach camps were conducted in 8 marginalised areas in Kenya. The camps were conducted within often unavailable. The use of Focused Cardiac Ultrasound (FoCUS) protocols may potentially alleviate these challenges. The Cardiac Ultrasound for Resource-limited Settings (CURLS) protocol is nonvalidated, context specific, easy to train Sub-Xiphoid single window FoCUS tool. We sought to assess trainee competence in evaluating cardiovascular causes of dyspnea using CURLS after a brief training in three domains: Image Interpretation, Image Acquisition, and Image Quality Methods This was a quasi-experimental study conducted at a public tertiary hospital. Forty-five medical pre-interns, novices in echocardiography, underwent simulated didactic and hands-on FoCUS skills training using the CURLS protocol and their skills were assessed. Image Interpretation was assessed using a standardized case-based MCQ test. Image Acquisition Skills were assessed using an OSCE checklist. Image Quality was graded by two FoCUS experts using the 2018 ACEP 5 Point Image Quality Assurance Grading Scale. Data analysis involved computing trainee scores in the 3 domains using ranges, means, medians and 95% confidence intervals. Proportions of trainees who attained competence were expressed in percentages. Results Aggregate image interpretation competency was attained by n=38 (84 %) of trainees with a median score of 80%. The proportion of trainees attaining category-specific image interpretation competency was: Pericardial Effusion n=44 (98%), Left Atrial Enlargement n= 40 (89%), Cardiomyopathy n=38 (84%), Left Ventricular Hypertrophy n=37 (82%), and Right Ventricular Enlargement n=29 (64%). Image Acquisition Skills Competency was attained by n=36 (80%) of trainees with a median score of 82 %. The two experts were in agreement that 77% of trainee-obtained images were of good quality. Conclusions The majority of trainees in our study attained competency in FoCUS skills after training with the CURLS protocol. The simplicity, ease of training and use of the CURLS protocol make it an ideal FoCUS screening tool for training healthcare personnel to use at the point of care in resource-limited settings. The training conditions and participant selection bias limit the generalizability of our results. 1. Huson MAM, Kaiminstein D, Heller T. The Ultrasound Journal. 2019;(11:34) 2. Neskovic AN, Skinner H, Price S, Via G. European Heart Journal. 2018 January;(19): 475-481. 3. American College of Emergency Physicians. acep. [Online].; 2018
AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 12 Submission ID: 12 ECHOCARDIOGRAPHY IMAGING IN PATIENTS UNDERGOING CHEMOTHERAPHY WILLIAM KATIKU, BERNARD SAMIA MPSHAH HOSPITAL Introdution Echocardiography is non-invasive imaging modality that provides comprehensive evaluation of the heart at all stages in cancer treatment and is able to detect complications secondary to therapeutic regime used( Radiotherapy or chemotherapy).Echo remains to be the leader in imaging due to its accessibility ,portability and lack of exposure to radiation. Modalities 2D Echocardiography 3D Echocardiography Strain Echocardiography. Results Echocardiography is widely used technique in diagnosis, prevention and risk assessment in CTRCD (cancer therapy related cardiac dysfunction) Utility of advanced Echo has proved helpful in detecting changes in myocardial mechanics before changes in LV ejection Fraction occur. a period of 1 year. The areas include: Malindi, Kilifi, Msambweni, Kinango, Voi, Lamu, Garissa and Mandera.Both children and adults with congenital heart diseases as well children with acquired cardiac diseases were identified and various treatment plans and medications were provided. Results A total of 651 individuals were screened out of which 581 were children and 70 were adults. Among the 651 individuals screened 299 were diagnosed with a cardiac disease. This represents 45.9% of the total individuals screened. Of the 299 patients 12 (5%)were adult and 287(95%) paediatrics. Diagram Conclusion There are a lot of paediatrics cardiac cases in our community that are undiagnosed and a lot of these patients are dying. Different Echocardiography methods and their shortcomings. Advantages Disadvantages. 1.2D Echocardiography Widely available Easy assessment Powerful prediction of death and advanced outcomes in heart failure. Load dependent High observer variability compared to 3D echo Not sensitive to detect cardio toxicity. 2.3D Echocardiography Better in determination of LVEF compared to 2D Echo Better Reproducibility. High reliability on quality of images. Less available Depended on the experience of operator. 3.Global Longitudinal Strain Ability to detect subclinical cardio toxicity in early stages. Superior prediction of mortality compared to 2D LVEF Less Load dependent Dependent on image quality Operator dependent and experience. Vendor/software specific. International guidelines Definition of cardiotoxicity by echocardiography: LVEF: a decline in LVEF by > 10% (absolute percentage points) to a value < 50%, Definition of probable subclinical cardiotoxicity by echocardiography: LVEF: a decline in LVEF by > 10% (absolute percentage points) to a value ≥ 50% with an accompanying fall in GLS > 15% (where GLS measurement is available). Conclusion Echo remains to be the leader in imaging due to its accessibility, portability and lack of exposure to radiation. Echocardiography has been utilized in chemotherapy patients for monitoring heart function in all stages of chemotherapy adminstration.Major focus has been on the LVEF and any changes that arise in the course of treatment. Recent advances in echocardiography (Strain Echocardiography), has been in the forefront in monitoring the patients. Submission ID: 13 EVALUATING THE IMPACT OF ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM IN IMPROVING THE CARE PROCESS, TREATMENT OUTCOMES AND DATA QUALITY IN HYPERTENSIVE CLINICS IN TWO COUNTIES - 2021/2022. MUTISO SM1,2, MWENDA V2, GATHECHA G.2 1KENYA FIELD EPIDEMIOLOGY AND LABORATORY TRAINING PROGRAM 2MINISTRY OF HEALTH DEPARTMENT OF NON-COMMUNICABLE DISEASES Introdution A quarter of the Kenyan adult population has hypertension with only 4% having adequate control. This study aimed to evaluate the impact of an EMR on care, outcomes, and data quality, by comparing a clinic using an EMR and one using a paper-based system. Methods We carried out a cross-sectional retrospective review of records to assess effectiveness of an EMR system in improving care as well as surveillance. Makueni and Nyeri were our intervention and comparison sites respectively. Analysis included descriptive statistics, bivariate analysis and logistic regression modelling. Data quality audits were carried out to assess completeness and consistency.
CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 13 AFRICA Results We enrolled 729 records with 77.8% (n = 562) being female and 25.6%60-69 years. Makueni mean systolic / diastolic blood pressure was 143/82mmHg (SD 13/8) while Nyeri was 139/84 mmHg (SD 17/7). Makueni performed better in tracking comorbidity screening (p=<0.0001) with regression modelling showing relevance of this in control. Data completeness in Makueni was higher for investigations, body mass index (BMI) and counselling on complications, as well as higher consistency to the Kenya Health Information System reports. Discussion There were improved outcomes and surveillance particularly with comorbidity screening and counselling where the EMR was deployed. Scale-up of EMR systems was recommended. Key Words Hypertension, Electronic Medical Records Systems, Non – Communicable Disease Surveillance, Kenya Submission ID: 14 CASE SERIES ON PROSTHETIC VALVE THROMBOSES TREATED WITH INTRAVENOUS THROMBOLYSIS AT A TERTIARY TEACHING HOSPITAL IN NAIROBI – KENYA JOHN OTIENO ODHIAMBO, SALIM SALIM ABDALLAH, LEONARD MZEE NGUNGA THE AGA KHAN UNIVERSITY HOSPITAL, NAIROBI Introduction Valvular heart disease is a prevalent condition that significantly contributes to the cardiovascular disease burden worldwide, especially in developing countries. Rheumatic heart disease (RHD) is the most common etiology in developing countries. RHD tends to occur among younger individuals aged 5-15. In the past several decades, many patients have undergone valve replacement, with mechanical prostheses being preferred over biological valves due to their longevity. However, complications following valve replacements can either be valve-related or nonvalve-related, with thromboembolism, bleeding, and prosthetic valve endocarditis being common. The incidence of prosthetic valve thrombosis is reported to be 0.03% in bioprosthetic valves and 0.5% to 8% in mechanical valves in the aortic and mitral positions, respectively. The clinical presentation of prosthetic valve thromboses varies among patients and can manifest as heart failure or peripheral embolism features. The commonest precipitants for prosthetic thrombosis are inadequate anticoagulation and poor patient compliance locally. This report presents two cases of patients who presented with heart failure post-valve replacement for rheumatic heart disease. The patients were managed with anticoagulation and fibrinolysis. Cases Case 1: 42 – year old female who had a mitral valve replacement for RHD in 2016 and had been on torsemide 10mg OD, bisoprolol 2.5mg OD, and warfarin 4mg BID. In December 2022, she was admitted with dyspnoea and productive cough. A few weeks earlier, she had been evaluated at a gynaecology clinic for heavy menses and her warfarin dose was reduced. On evaluation, she had features of heart failure. Her INR was 1.29. Transesophageal echo done confirmed presence of thrombus in the mitral valve. She was thrombolysed with alteplase 100mg infusion over 2 hours on day 5 admission. Thereafter, she had tremendous clinical improvement. Case 2: 37-year-old male with RHD status post Aortic valve replacement in 2004 on warfarin since then. He was admitted in March 2023 with NYHA III dyspnea associated with chest pains, fever, and chills. He had an antecedent history of diarrhoeal illness. On evaluation, he was hypotensive, mildly hypoxic requiring minimal oxygen supplementation, and had a grade IV systolic ejection murmur over the right upper sternal border with radiation to the carotids, and grade II diastolic murmur best heard at the left lower sternal border with the patient leaning forward. His INR was at 1.54. The INR was at 2.1 one month prior to the presentation. 2D Echo showed severe aortic regurgitation and high gradient across the aortic valve mechanical prosthesis. He subsequently underwent a transesophageal echocardiogram, which showed severe prosthetic valve regurgitation and an immobile prosthetic aortic valve. A mass concerning for thrombus was seen on one of the leaflets. LV systolic function was preserved with EF 55-60%. The patient was thrombolysed with alteplase 100mg infusion over 2 hours. Thereafter, his symptoms improved and his blood pressure got better. Discussion The predisposing factor in the first case was the alteration of the dose of warfarin while in the second case, there was reduced warfarin bioavailability of the warfarin in the background of an already borderline INR. Conclusion Suspected valve thrombosis requires prompt treatment with thrombolysis which be lifesaving. Alteplase was used successfully without any significant adverse events. Submission ID: 15 THE EFFECTS OF BETA VULGARIS JUICE ON THE COMMON CAROTID ARTERY OF AN ALBINO RAT (RATTUS NORVEGICUS) FOLLOWING PROLONGED ADMINISTRATION OF A HIGH SALT DIET JIMMY GAKURE NJOROGE, KHULUD NURANI, JEREMIAH MUNGUTI Background High salt diets have been linked to an increase in the incidence of hypertension in Africa. African societies have reported inadequate access to conventional antihypertensive care, raising the need for a cheaper mode of control. The red beetroot (Beta vulgaris) has been shown to have beneficial effects in cardiovascular disease. However, changes in vascular composition associated with Beta vulgaris use remain unexplored. Materials and methods Thirty-eight (38) male rats aged two months were used for this study. Two (2) rats were used to demonstrate baseline anatomy of the common carotid artery. Fifteen (15) rats were used in each of the experimental groups (High salt and high salt + beetroot) while six (6) rats were used in the control (Standard rat chow and water) group. Beta vulgaris juice was administered by oral gavage at a dosage of 10 ml/kg. Thereafter, at week 2, 5 and 8, 5 rats from each of the experimental groups and 2 rats from the control group were euthanized, perfused with formal saline and their common carotid arteries (CCAs) harvested and processed. The variables measured were carotid intima- media thickness, elastic fiber density and vascular smooth muscle cell density. GROUP CIMT MEDIANS + IQR (µm) WEEK 0 WEEK 2 WEEK 5 WEEK 8 P Value (BASELINE) Control 26.44 27.88 32.96 37.15 p=0.083 (25.98-26.89) (27.41-28.34) (32.12-33.80) (36.81-37.45) HS - 33.80 43.37 53.09 p=0.002* (32.16-34.25) (36.50-44.53) (51.23-54.66) HS+B - 32.17 35.96 43.85 p=0.006* (32.05-33.22) (31.75-33.66) (42.68-44.96) P value - p=0.90 p=0.018* p=0.009* TABLE: CAROTID INTIMA-MEDIA THICKNESS RESULTS
AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 14 Submission ID: 16 FIRST KENYAN – MADE LOW COST AND PORTABLE ECG MONITOR ALICE MUHUHU1, BERNARD SAMIA2, MOHSEN GABALLA2, FESC FSCAI 1 UNIVERSITY OF NAIROBI 2 MP SHAH HOSPITAL Introduction The World Health Organizations Global Status Report on Noncommunicable Diseases (NCDs) indicated that chronic diseases, including cardiovascular disease, contributed to 74% of all deaths in 2012. Unsurprisingly, 77% of NCD deaths occurred in middle- and lowincome countries, with the majority caused by cardiovascular disease. The rapid rise in NCD is predicted to impede poverty reduction initiatives in LMIC. Lack of adequate Results The high salt group had a significant increase in intima-media thickness (p=0.002). The administration of Beta vulgaris juice limited this effect(p=0.05). Furthermore, prolonged high salt administration was associated with a significant increase in smooth muscle density(p=0.023). This effect was ameliorated by the administration of Beta vulgaris juice (p= 0.22). Moreover, there was a progressive decrease in elastic fiber density (p= 0.004). This effect was ameliorated by Beta vulgaris juice administration(p=0.066). Conclusion The administration of Beta vulgaris juice is protective against structural effects caused by prolonged administration of high salt diets. Therefore, Beta vulgaris juice can be indicated as a dietary supplement to the control of hypertension. Figure. 1.1 Figure. 1.2 Figure. 1.3 Figure 1.1 – Image of the pocketsize wireless ECG devices. Figure 1.2 – Image demonstrating the wearable ECG device with electrode adhesives. Figure 1.3 – Dashboard showing real time ECG data, BPM, HRV, GSR, Steps, Acceleration and Temperature (BLE data transmission from hardware to software interface). primary care, including access to physicians, technologies, and treatments, contributes to poor CVD outcomes. ECG devices have traditionally been used in large city hospitals in screening, diagnosis, and monitoring the treatment of cardiovascular disease. However, these devices are still largely inaccessible and unaffordable to most regions in Kenya. Objective To assess the implementation and impact of a low-cost wireless ECG device in remote urban areas in Kenya. We demonstrated the primary diagnostic capability and safety of a newly developed adhesive ECG monitoring device. Methodology This device provided similar diagnostic accuracy with superior noise-signal ratio and image acquisition reliability compared to conventional currently market-available ECG monitoring systems. It could distinguish various arrhythmias, including atrial flutter/ fibrillation, ventricular premature beat, sinus pause, and AV block. Inter-device variability with other adhesive ECG monitoring devices was not significant. Results In this study, we demonstrated the primary diagnostic capability and safety of a newly developed adhesive ECG monitoring device. This device provided similar diagnostic accuracy and superior noise control and image acquisition reliability compared to conventional ECG monitoring systems. It could distinguish various arrhythmias, including atrial flutter/fibrillation, ventricular premature beat, sinus pause, and Mobitz type I second degree AV block in a similar fashion as other commercial devices (Phillips and GE). Conclusion In this preliminary study, we proved that the new portable ECG monitoring device demonstrated comparable results with conventional ECG monitoring devices in detecting arrhythmias. Submission ID: 17 MEDICATION ADMINISTRATION ERRORS FOR PATIENTS ADMITTED AT JAKAYA KIKWETE CARDIAC INSTITUTE DAR ES SALAAM TANZANIA ADAM NDAMAYAPE Background medication administration errors are among the most common type in medication error. They are the most common health threatening mistakes that affect the health and safety of the patient. Such mistakes are considered as a global problem which increases mortality rates, length of hospital stays, and related costs. Objective: To explore the types, causes and why medication administration errors are not reported. Methods The present descriptive cross-sectional study was conducted on 75 nurses randomly selected from Jakaya Kikwete Cardiac Institute working in wards and intensive care units. A four-part questionnaire was used. The first part was on the participant demographic characteristics. The second part consisted of 15 questions on why medication errors occur. The third part consisted of 8 items asking on why medication errors are not reported and the fourth part comprised of 9 items on percent of each type of error reported. Data were analyzed using SPSS software version 20. The significant p-value was considered less than 0.05. Results Majority of the participants were female 72%, male 28%. The mean age was 34.5+-1.93, the majority had diploma level 65.4%, bachelor degree 29.3%, and master degree 5.3%. The most reported error was wrong time of administration and omission error. The most possible cause of error was tiredness due to excess work,
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