Takayasu's arteritis in an adult female from Cameroon: diagnosis via Doppler echocardiography

No abstract available

Screening, risk stratification, and management of atrial fibrillation

Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with high morbidity and mortality. Major improvements have been made in the diagnosis and management of AF in the past two decades. However, important questions pertaining to the screening, prognosis, risk stratification, and management of AF remain unanswered. This thesis presents original studies addressing knowledge gaps in these aspects of AF. In Chapter 2, using a large cohort of individuals from the UK Biobank, we investigated the association between lung function and incident AF. We observed that reduced ventilatory function was associated with increased risk of AF independently of age, sex, smoking, and several other known AF risk factors. This suggests that individuals with substantial reduction of their lung function might represent an appropriate population for targeted AF screening and ventilatory parameters might improve AF risk prediction. Chapter 3 assesses data related to implantable cardiac monitors (ICM). The first section reports AF diagnostic yield in a real-world cohort of patients receiving prolonged cardiac monitoring with ICM for stroke and unexplained syncope. It indicates that patients with stroke or transient ischemic attack (TIA) have a higher rate of AF detection compared with patients with unexplained syncope. However, this real-world study shows AF detection rates following stroke significantly lower than what has been previously reported. The second section of this chapter summarizes data on AF detection rates across different rhythm monitoring strategies (non-invasive and ICM) in patients with cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS). It shows that the yield of ICM increases with the duration of monitoring; more than a quarter of patients with CS or ESUS will be diagnosed with AF during follow-up. About one in seven patients have AF detected within a month of mobile cardiac outpatient telemetry, suggesting that a non-invasive rhythm monitoring strategy should be considered before invasive monitoring. Chapters 4 and 5 address risk stratification in patients with AF. Chapter 4 has two sections. The first section is a meta-analysis that comprehensively summarizes data from prospective cohort studies on clinical predictors of stroke in anticoagulant-naïve patients with AF. It shows that although weighted similarly in most risk stratification schemes such as the CHA2DS2-VASc score, the absolute risk of stroke attributable to hypertension, diabetes, vascular disease, and heart failure may not be the same in individual patients. Furthermore, it shows that female sex seems not to be universally associated with stroke or systemic embolism, suggesting that the decision to initiate oral anticoagulation should not be made on the sole basis of female sex as currently recommended by some scientific societies. By compiling evidence from various studies, the second section of this chapter demonstrates that some anatomic and functional cardiac imaging parameters are associated with stroke in patients with AF and therefore, might improve stroke risk stratification in these patients. Chapter 5 presents two systematic reviews and meta-analysis which show that AF and carotid artery disease frequently co-exist, with about one in ten patients with AF who has carotid stenosis, and vice versa; and non-stenotic carotid disease being much more frequent. Moreover, there is an association between carotid atherosclerosis and the risk of stroke in patients with AF, suggesting that the incorporation of carotid atherosclerosis and characteristics of carotid plaques into scoring systems might improve stroke prediction in patients with AF. Taking this further, the last section of this chapter investigates the potential added value of high-risk carotid plaques on stroke risk stratification compared to the classical CHA₂DS₂-VASc score in a prospective cohort of patients with AF. It shows a low prevalence (5.5%) of moderate to severe carotid stenosis (≥ 50%), whereas one in three participants have carotid plaques considered vulnerable or high-risk. Neither the degree of carotid stenosis nor the presence of vulnerable plaques is associated with incident ischemic stroke, suggesting that carotid disease is probably not an important cause of ischemic stroke in this group of patients with AF and therefore, vulnerable carotid plaques might not improve stroke risk stratification in patients with AF. Chapter 6 presents two pooled analyses of data on the prognostic impact of AF on acute coronary syndromes (ACS) and acute pulmonary embolism (aPE). The first section of the chapter shows that AF is common in patients with ACS (one in nine) and that it (especially newly diagnosed AF) is associated with poor short-term and long-term outcomes including re-infarction, heart failure, stroke, acute kidney injury, heart failure, major bleeding, and death. Likewise, the second section of the chapter demonstrates that AF is frequent in patients with aPE (one in eight) and is associated with increased short-term and long-term mortality. Considering this strong prognostic impact of AF in patients with ACS and aPE, its incorporation into risk stratification schemes for these patients should be considered. Furthermore, considering the significant incidence of AF in patients with ACS and aPE, studies are needed to determine the appropriate rhythm monitoring strategies in these patients. Chapters 7-9 focus on sex differences in the management of AF. Chapter 7 analyses data from 142 randomized controlled trials (RCTs) of AF published in top tiers cardiovascular journals and shows that despite recent progress, females remain substantially less represented in RCTs of AF. This raises concern about the generalizability of these trials and the validity of the evidence guiding the treatment of females. Furthermore, primary outcomes are infrequently reported by sex in these RCTs of AF. Considering established benefit of risk factor modification on outcomes in patients with AF, Chapter 8 assesses sex differences in weight-loss, cardiorespiratory fitness gain, and progression and recurrence of AF in patients undergoing aggressive risk factor modification. It shows that despite sex differences in some baseline characteristics, the benefits of weight-loss and fitness gain were favourable for both males and females. However, improvement in fitness had a much greater benefit for total arrhythmia freedom for females, whereas there was a trend towards more common regression from persistent to paroxysmal AF in males. These findings reinforce the need to address lifestyle risk factors to minimize arrhythmia recurrence and reduce symptom severity for all individuals. Finally, Chapter 9 investigates the impact of sex on the clinical profile, utilization of rhythm control therapies, in-hospital mortality, length of stay (LOS), and cost of hospitalization in patients admitted for AF in the United States. It shows similarities and disparities in risk factors for mortality between males and females, and that unlike what has been reported in several previous studies, although women had a relatively higher mortality rate, after risk adjustment, female sex was not a predictor of mortality.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 02

Pneumonie varicelleuse du nouveau-né: à propos d’un cas

La varicelle est une maladie contagieuse fréquente chez l’enfant, mais rare chez la femme enceinte. La survenue de varicelle pendant la grossesse peut entrainer des complications périnatales dont la pneumonie varicelleuse du nouveau-né. Cette atteinte pulmonaire est accompagnée d’un taux élevé de décès. Nous rapportons un cas de pneumonie varicelleuse grave chez un nouveau-né qui a été contaminé par le virus de la varicelle par voie transplacentaire. Le tableau clinique associait un syndrome infectieux, une détresse respiratoire sévère avec coma, des râles sous-crépitants diffus aux deux champs pulmonaires, et une éruption cutanée disséminée faite de macules, vésicules, croûtes, évocatrice de la varicelle. La radiographie du thorax montrait un syndrome interstitiel diffus aux deux poumons. Un traitement par l’aciclovir injectable associé à l’oxygénothérapie continue a permis une évolution vers la guérison. La pneumonie varicelleuse du nouveau-né est situation associée à une forte mortalité mais dont le traitement par l’aciclovir injectable peut permettre la guérison. La prophylaxie par administration intraveineuse d’aciclovir ou d’immunoglobulines polyvalentes chez le nouveau-né permet de diminuer la sévérité et la mortalité de la varicelle périnatale.Pan African Medical Journal 2012; 13:2

Mechanism of worsening diabetic retinopathy with rapid lowering of blood glucose: the synergistic hypothesis

Insulin treatment has been associated with a paradoxical worsening of diabetes retinopathy since many years in European cohorts. Recently, this issue has been stressed by some studies conducted in other parts of the world. However, the mechanism underlying such evolution is not well understood. An osmotic theory has been evocated but failed to explain the clinical features of the disease. Considering recent findings from basic and clinical research, we discuss the possibility of a synergistic hypothesis based on the simultaneous action of insulin and vascular endothelial growth factor on eye blood vessels. We postulate that exogenous insulin could act synergistically with the vascular endothelial growth factor expressed by ischemic retina so as to trigger vascular proliferation and the worsening of diabetes retinopathy

Neurological complications of sickle cell disease in Africa: protocol for a systematic review

INTRODUCTION: Sickle cell disease (SCD) is highly prevalent in Africa. Considered as a public health problem, it is associated with high morbidity and mortality. Neurological complications of SCD can cause significant disability with important socioeconomic and psychological impact on the patients and their families, and can even lead to death if not properly managed. There are important knowledge gaps regarding the burden of neurological complications of SCD in African populations. We propose to conduct the first systematic review to summarise the epidemiological data available on neurological complications of SCD in Africa. METHODS AND ANALYSIS: We will search PubMed, MEDLINE, EMBASE and the African Index Medicus from 1 January 1950 to 31 May 2016 for studies of neurological complications of SCD in Africa. After study selection, full-text paper acquisition, data extraction and synthesis, we will assess all studies for quality, risk of bias and heterogeneity. Appropriate methods of meta-analysis will be used to pool prevalence estimates from studies with similar features, globally and in major subgroups. This protocol complies with the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA-P) guidelines. ETHICS AND DISSEMINATION: The proposed study will use published data. Therefore, there is no requirement for ethical approval. This review is expected to provide relevant data to help quantify the burden of neurological complications of SCD in African populations, inform policymakers and identify further research topics. The final report of the systematic review will be published in a peer-reviewed journal and presented at conferences. REVIEW REGISTRATION NUMBER: CRD42016039574

Association between hyperuricemia and glycated hemoglobin in type 2 diabetes at the District Hospital of Dschang

Introduction: given the difficulty to obtain glycemic control in type 2 diabetes, the exploration of others pathophysiological hypotheses could improve the understanding of this phenomenon. We conducted this study to search for an association between uric acid and uncontrolled diabetes. Methods: it was a cross-sectional study in a population of type 2 diabetes with normal postprandial and fast blood sugar for the last three months at the District Hospital of Dschang. Chi square test were used to analyzed categorical variables and Pearson correlation coefficient to evaluate the relationship between uric acid level and HbA1c. Means were compared using Kruskal-Wallis´s or Student´s test. Results: our study of 80 patients found that, female sex and central obesity were risk factors for hyperuricemia. Prevalence of hyperuricemia and uncontrolled diabetes was respectively 27.5% and 33.8%. The proportion of women with hyperuricemia was significantly higher than that of men (59.1% versus 40.9%, p=0.021) and this inequality of proportion was more marked particularly after 45 years (40% versus 18.8%, p=0.022). Hyperuricemia was not significantly associated to uncontrolled diabetes (OR=2.01 IC (0.73-5.52), p=0.095). Serum uric acid was positively and significantly correlated to glycated hemoglobin (r=0.318, p=0.002) and hyperuricemia was significantly correlated to uncontrolled diabetes (r=0.712, p=0.035). The mean of glycated hemoglobin is abnormal (7.14%) when uric acid level is around 5.75 mg/dl without sex distinction. Conclusion: these results suggest that the rate of glycated hemoglobin is associated to serum uric acid variations during type 2 diabetes

Maternal hyperglycemia during labor and related immediate post-partum maternal and perinatal outcomes at the Yaoundé Central Hospital, Cameroon

Abstract Background Data on the prevalence and complications of gestational diabetes are very scarce in Cameroon. The aim of this study was to evaluate the uptake of screening for gestational diabetes and assess the immediate post-partum outcome of hyperglycemic parturient mothers and perinatal outcome of their babies. Methods A prospective cohort study was held at the Maternity of the Yaoundé Central Hospital from March to June 2013. One hundred volunteer women in labor without overt diabetes mellitus and having fasted for 8 to 12 h were recruited. No intervention was given. A clinical examination was done and capillary glucose recorded. Parturient women were categorized into two groups (hyperglycemic and non-hyperglycemic subjects) based on glycemia results interpreted according to the International Association of Diabetes and Pregnancy Study Groups. Mothers’ clinical examination was repeated and neonates examined immediately after delivery. Perinatal outcomes associated with maternal hyperglycemia during labor were assessed using relative risks. A p value <0.05 was considered statistically significant. Results One hundred women with a mean age of 27 (SD 6) years were recruited. Of them, 22 (22 %) had already been screened for gestational diabetes at baseline. Thirty-one (31 %) were diagnosed with hyperglycemia during labor, and this condition was highly associated with macrosomia in neonates (RR = 8.9, 95 % CI 2.70–29.32; p < 0.001). Other complications associated with maternal hyperglycemia during labor were perineal tears, cesarean section, and intrauterine fetal death, though the association was not statistically significant. Conclusions The main finding of this study is that maternal hyperglycemia during labor is highly associated with macrosomia in neonates. About a third of mothers were concerned with hyperglycemia during labor, and gestational diabetes was insufficiently screened in this series