Porphyria in Africa

A CAJM article on Porphyria in Africa.Until recently, porphyria has been regarded as a rare condition in most countries and has merited but passing comment in standard textbooks of medicine. As this is a condition requiring a high index of diagnostic suspicion, it seems a useful task to present the common features of the disorder as seen in Europeans and Africans, to comment on the procedures necessary for diagnosis and to speculate on the factors precipitating its onset. It is becoming increasingly apparent that porphyria occurs frequently in South and Central Africa, both amongst those of European and African stock. As in other countries, the increase in diagnosis is due to the wider knowledge of its clinical manifestations and to the combined interest of both clinicians and biochemists

Cardiovascular Risk Factors In Middle-Aged Men In 24 Towns

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Adiposity, adipokines, and risk of incident stroke in older men

Background and Purpose—The association between adiposity and adipocytes and risk of stroke in older adults is uncertain. We have examined the association between adiposity measures and adipocytes (adiponectin and leptin) with incident stroke events in older men. Methods—Prospective study of 3411 men aged 60 to 79 years with no previous diagnosis of myocardial infarction, heart failure, or stroke followed-up for an average of 9 years, during which there were 192 incident major stroke events. Results—In age-adjusted analyses, body mass index and waist circumference were not significantly associated with risk of stroke in older men, although obese men (body mass index >30 kg/m2) showed the lowest risk of stroke. Despite the strong positive correlation between leptin and body mass index and waist circumference, risk of stroke was significantly increased in those in the top quartile of the leptin distribution. The increased risk remained after adjustment for potential confounders, including systolic blood pressure (adjusted hazard ratios top quartile versus bottom quartile: 2.03; confidence interval, 1.27–3.27]). Further adjustment for markers of inflammation (c-reactive protein), endothelial dysfunction (von Willebrand factor), fibrinolytic activity (d-dimer), and γ-glutamyl transferase attenuated the increased risk, but risk remained significantly increased (adjusted hazard ratios, 1.73; confidence interval, 1.06–2.83]). By contrast, no association was seen between adiponectin and risk of stroke. Conclusions—Conventional adiposity measures were not associated with increased stroke risk in older men. However, leptin (a good marker of percent fat mass), but not adiponectin, predicted stroke, suggesting a link between fat mass and stroke risk.</p

Cardiovascular Risk Factors In Middle-Aged Men In 24 Towns

Abstract included in text