Electrocardiographic Left Ventricular Hypertrophy Among Gambian Diabetes Mellitus Patients

Background: The global prevalence of diabetes and its complications is increasing worldwide. Its role in coronary heart disease has been linked with the presence of left ventricular hypertrophy (LVH). The present study aims to determine the prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) in adult diabetic subjects, its epidemiological and clinical correlates.Methods: A descriptive cross-sectional study involving 534 patients was conducted at the Edward Francis Small Teaching Hospital (formerly Royal Victoria Teaching Hospital), The Gambia. Four hundred and forty patients were included using a standard questionnaire. Anthropometry, laboratory investigations and electrocardiogram were carried out. We used the Lewis, Cornell, and Sokolow-Lyon Voltage criteria to define ECG-LVH. MinitabTM statistical software version 13.20 was used for analysis.Results: 146 (35.2%) patients had ECG-LVH using all 3 criteria and this prevalence was higher among women being 116 (79.5%). A generally high prevalence of overweight (155/37.4%) and obesity (119/28.6%) was observed among study participants, and both clinic-day systolic and diastolic blood pressure (BP) were significantly higher in those with ECG-LVH. Poor diabetes control was observed in both groups.Conclusion: There was a high prevalence of ECGLVH and it is especially so with combining multiple criteria, hence the need for screening. Clinic-day hypertension was associated with ECG-LVH hence the need for diagnosing and aggressive treatment of hypertension in patients with diabetes mellitus.Keywords: Diabetes mellitus, ECG-LVH, The Gambia, voltage criteri

The impact of oil and global markets on Saudi stock market predictability: A machine learning approach

Data availability: Data available on request from the authors.JEL classification: C45; D53; G15.This study investigates the predictability power of oil prices and six international stock markets namely, China, France, UK, Germany, Japan, and the USA, on the Saudi stock market using five Machine Learning (ML) techniques and the Generalized Method of Moments (GMM). Our analysis reveals that prior to the 2006 collapse, oil exerted the least influence on the Saudi market, while the UK and Japan were the most influential stock markets. However, after the collapse, oil became the most influential factor, highlighting the strong dependence of Saudi Arabia's economic structure on oil production. This finding is particularly noteworthy given Saudi Arabia's efforts to reduce its reliance on oil through Vision 2030. We further demonstrate that China's influence on the Saudi market increased significantly after the 2006 collapse, surpassing that of the UK. This is attributable to the substantial trade between China, Japan, and Saudi Arabia, as well as the rise in Saudi foreign direct investment in China, and the decline in such investment in the UK post-collapse. Our results carry important implications for stock market investors and policymakers alike. We suggest that policymakers in Saudi Arabia should continue to diversify their economy away from oil and strengthen economic ties with emerging markets, particularly China, to reduce their vulnerability to oil price fluctuations and ensure sustainable economic growth.The authors received no financial support for the research, authorship, and/or publication of this article

Isonatraemic haemodialysis in the management of salt and water overload: a crossover trial at an academic hospital in Dakar, Senegal

Introduction: The aims of this study were to assess the impact of isonatraemic haemodialysis on reduction of interdialytic weight gain (IDWG) and blood pressure (BP) as well as its tolerability in our study population. Methods: This crossover trial, at the Aristide Le Dantec University Hospital in Senegal, was conducted on 32 patients with kidney failure who were stable on treatment with chronic haemodialysis. In the initial “control phase”, patients had nine haemodialysis sessions with a dialysate sodium (Na+) concentration (Na+ dialysate) of 138 mmol/L. The serum Na+ set point (SP) for each patient was calculated from three predialytic mid-week values. In the second phase, the “individualized phase”, patients had nine haemodialysis sessions with Na+ dialysate equal to their SP. Results: The mean age of the patients was 55.5 ± 12.1 years, with a male/female ratio of 1.3 and the most common cause of kidney disease was hypertension (47%). Mean predialytic serum Na+ concentration was 135.8 ± 1.9 mmol/L, with a mean intra-individual coefficient of variation of 2%. Mean interdialytic weight gain (IDWG) was 1.9 kg and 1.8 kg in the control and individualized phases, respectively (P = 0.75). A reduction in postdialytic systolic blood pressure (BP) was observed during the individualized phase (P = 0.04). A similar trend was noted in pre- and intradialytic BP but this was not statistically significant. Apart from headaches, which were more common in the individualized phase (P = 0.04), isonatraemic haemodialysis was well tolerated. Conclusions: IDWG as well as pre- and intradialytic BP were unaffected by isonatraemic haemodialysis. Postdialytic BP was significantly reduced. Introduction: Les objectifs de cette étude étaient d’évaluer l’impact de l’hémodialyse isonatrémique sur la réduction de la prise de poids inter-dialytique (PPID) et de la pression artérielle (PA) ainsi que sa tolérance dans notre population d’étude. Méthodes: Cet essai croisé a été mené au centre hospitalier universitaire Aristide Le Dantec de Dakar (Sénégal) chez des patients hémodialysés chroniques. Durant la première phase dite « phase contrôle », les patients ont eu neuf séances d’hémodialyse avec une concentration de sodium dans le dialysat (Na+ dialysat) de 138 mmol/L. Le set-point (SP) de la natrémie a été calculé pour chaque patient et correspondait à la moyenne de 3 natrémies pré-dialytiques en milieu de semaine. Durant la deuxième phase dite « phase individualisée », les patients ont eu neuf séances d’hémodialyse avec du Na+ dialysat égal à leur SP. Résultats: Trente-deux patients ont été inclus. L’âge moyen était de 55,5 ± 12,1 ans avec un ratio homme/femme de 1,3 et la néphropathie initiale la plus fréquente était l’hypertensive (47%). La natrémie pré-dialytique moyenne était de 135,8 ± 1,9 mmol/L, avec un coefficient de variation intra-individuel moyen de 2 %. La PPID moyenne était de 1,9 kg et 1,8 kg dans les phases de contrôle et individualisé, respectivement (P = 0,75). Une diminution de la PA systolique post-dialytique a été observée au cours de la phase individualisée (P = 0,04). Une tendance similaire sans significativité statistique a été notée sur les PA pré- et intra-dialytiques. Hormis les céphalées, plus fréquentes pendant la phase individualisée (P = 0,04), l’hémodialyse isonatrémique a été bien tolérée. Conclusions: La PPID, les PA pré- et intra-dialytiques n’ont pas été affectées par l’hémodialyse isonatrémique. La PA post-dialytique était significativement réduite

Volatility contagion between cryptocurrencies, gold and stock markets pre-and-during COVID-19: evidence using DCC-GARCH and cascade-correlation network

JEL Classification: C45; D53; E42; G10Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.The rapid rise of Bitcoin and its increasing global adoption has raised concerns about its impact on traditional markets, particularly in periods of economic turmoil and uncertainty such as the COVID-19 pandemic. This study examines the extent of the volatility contagion from the Bitcoin market to traditional markets, focusing on gold and six major stock markets (Japan, USA, UK, China, Germany, and France) using daily data from January 2, 2011, to June 2, 2022, with 2958 daily observations. We employ DCC-GARCH, wavelet coherence, and cascade-correlation network models to analyze the relationship between Bitcoin and those markets. Our results indicate long-term volatility contagion between Bitcoin and gold and short-term contagion during periods of market turmoil and uncertainty. We also find evidence of long-term contagion between Bitcoin and the six stock markets, with short-term contagion observed in Chinese and Japanese markets during COVID-19. These results suggest a risk of uncontrollable threats from Bitcoin volatility and highlight the need for measures to prevent infection transmission to local stock markets. Hedge funds, mutual funds, and individual and institutional investors can benefit from using our findings in their risk management strategies. Our research confirms the utility of the cascade-correlation network model as an innovative method to investigate intermarket contagion across diverse conditions. It holds significant implications for stock market investors and policymakers, providing evidence for potentially using cryptocurrencies for hedging, for diversification, or as a safe haven.Brunel Research Initiative and Enterprise Fund to FD

Vascular access in Senegalese patients starting chronic haemodialysis

Introduction: It is recommended that patients should start chronic haemodialysis using an arteriovenous fistula (AVF). We aimed to determine the proportion of Senegalese patients who used an AVF at the start of  haemodialysis and examined the factors associated with its use. Methods: We conducted a cross-sectional study from 1 June 2021 to 2 October 2021 among patients on chronic haemodialysis in 10 centres in the Dakar and Thiès regions. Clinical and laboratory data were collected from medical records and also via patient interviews. Results: The patients (n = 543) had a median age of 50 years [interquartile range (IQR) 40–62 years] and 50.6% were male. The socio-economic level was low in two-thirds of cases. The median duration of haemodialysis was 40 (IQR 17–76) months. Hypertension was noted in 92% and diabetes in 13%. Hypertensive kidney disease was the cause of kidney failure in 33%. Only 47 patients (9%) had started dialysis using an arteriovenous fistula. Factors associated with its use at haemodialysis initiation were socio-economic level (OR 0.48; 95% confidence interval (CI) 0.25–0.94 for low socio-economic level) and duration of pre-dialysis follow-up by a nephrologist for >4 months (OR 7.82; 95% CI 3.05–26.50). In 65% of prevalent patients, the vascular access used was an AVF, a tunnelled central venous catheter in 28%, an arteriovenous graft in 2% and a temporary central venous catheter in 4.4%. Conclusions: The proportion of Senegalese patients with an AVF at the start of haemodialysis was low. AVF use was associated with socio-economic level and pre-dialysis follow-up by a nephrologist for >4 months

Profil De L’asthmatique Admis Au Centre Hospitalier National Universitaire De Fann (CHNU) A Dakar (Senegal)

Au Sénégal, la prévalence de l’asthme n’est pas encore évaluée. Les caractéristiques sociodémographiques, épidémiologiques et la provenance des patients asthmatiques consultés au Centre Hospitalier National Universitaire (CHNU) de Fann demeurent peu connues. Cet article contribue à la connaissance du profil des patients asthmatiques admis au CHNU. Il s’est agi d’une étude rétrospective, prospective et transversale à avisée analytique associant l’approche quantitative et qualitative qui s’est déroulée de janvier 1999 à août 2017 à la clinique de pneumologie du CHNU. La population d’étude était constituée des asthmatiques reçus en consultation. Les paramètres analysés concernent les caractéristiques de la population étudiée (âge, sexe, profession et statut matrimonial). Au total 296 patients asthmatiques, soit 36,5% d’hommes contre 63,5% de femmes, ont été enregistrés avec un âge médian qui était de 35 ans. 234 répondants à la variable catégorie socioprofessionnelle, étaient composés de ménagères (24,8%), d’élèves et d’étudiants (20,1%), de commerçants (17,5%), de bureaucrates (6,8%), de personnel de santé (6%) et d’enseignants et de maîtres coraniques (3,8%). A cela s’ajoutait, des ouvriers (3,8%), des couturiers (3,4%), des coiffeurs (3%), des chauffeurs (2,6%), des agriculteurs et éleveurs (2,6%), des mécaniciens et garagistes (1,3%), des pêcheurs et marins (1,3%), des restaurateurs et restauratrices (1,3%) et d’autres (1,7%). Selon le statut matrimonial, 54,3% étaient des mariés, 42,7% de célibataires et 3% de divorcés. Parmi les 296 asthmatiques, 250 résidaient en milieu urbain dakarois. Les antécédents se résumaient sur les signes et les symptômes des patients avec de la toux (34%), de la dyspnée expiratoire nocturne (34%), des expectorations nummulaires (18%) et des crises d’asthme (14%). Le profil des patients asthmatiques présente une population jeune avec une prédominance féminine. In Senegal, the prevalence of asthma has not yet been assessed. The socio-demographic, epidemiological and provenance characteristics of asthmatic patients consulted at the National Hospital University Center (CHNU) remain little known. This article contributes to the knowledge of the profile of asthmatic patients admitted to the CHNU. This was a retrospective, prospective and cross-sectional, analytical wise study combining the quantitative and qualitative approach which took place from January 1999 to august 2017 at the CHNU pulmonology clinic. The study of asthmatics received in consultation. The parameters analyzed relate to the characteristics of the population studied (age, sex, profession and marital status). A total of 296 asthmatic patients, or 36.5% male versus 63.5% female, were registered with a median age of 35 years. 234 respondents to the socio-professional category variable, were made up of housewives (24.8%), pupils and students (20.1%), traders (17.5%), bureaucrats (6.8%), health personnel (6%) and koranic teachers and teachers (3.8%). In addition, workers (3.8%), dressmakers (3.4%), hairdressers (3%), drivers (2.6%), farmers and ranchers (2.6%), mechanics and mechanics (1.3%), fishermen and sailors (1.3%), restaurateurs and restorers (1.3%), and others (1.7%). According to marital status, 54.3% were married, 42.7% were single and 3% were divorced. Among the 296 asthmatics, 250 resided in an urban Dakar environment. The history was summarized by the signs and symptoms of patients with cough (34%), nocturnal expiratory dyspnea (34%), sputum (18%) and asthma attacks (14%). The profile of asthmatic patients presents a young population with a female predominance

High blood viscosity is associated with high pulse wave velocity in African sickle cell trait carriers

Background: Sickle cell trait (SCT) is the benign condition of sickle cell disease. Often asymptomatic, the SCT carriers have hemorheological disturbances such as blood hyper-viscosity compared to healthy subjects. These disturbances could lead to structural and functional changes in large vessels. The aim of the study was to evaluate the association between blood viscosity (ηb) and pulse wave velocity (PWV) in SCT carriers.Methods: Thirteen SCT with high blood viscosity (SCT_hηb) aged 34±12 years (4 men) were compared to 13 SCT with low blood viscosity (SCT_lηb) aged 32±9 years (5 men) recruited from the National Blood Transfusion Center (CNTS) in Dakar (Senegal). Pulse wave velocity finger-toe (PWVft) was assessed using pOpmètre® (Axelife SAS-France). Cardiovascular risk (CVR) was assessed according to the Framingham Laurier score.Results: SCT_hηb had higher PWVft (m/s) than SCT_lηb respectively 8.98±1.98 and 7.11±1.18 (p = 0.004). CVR score (%) was higher in SCT_hηb than SCT_lηb, but this difference was not statistically significant (5.96±7.45 vs 2.09±2.15; p=0.31). Multivariate linear regression showed a positive correlation between PWVft and ηb and CVR score (r2=0.74, F=21.19, p˂0.001).Conclusions: Present results indicate that the SCT_hηb carriers have arteries stiffer than SCT_lηb and ηb and CVR could remain independent determinants of arterial stiffness in SCT carriers

Right-heart infective endocarditis: apropos of 10 cases

The prevalence and characteristics of right heart endocarditis in Africa are not well known. The aim of this study was to describe the epidemiological, clinical and laboratory profiles of patients with right-heart infective endocarditis. This was a 10-year retrospective study conducted in 2 cardiology departments in Dakar, Senegal. All patients who met the diagnosis of right heart infective endocarditis according to the Duke's criteria were included. We studied the epidemiological, clinical as well as their laboratory profiles. There were 10 cases of right-heart infective endocarditis representing 3.04% of cases of infective endocarditis. There was a valvulopathy in 3 patients, an atrial septal defect in 1 patient, parturiency in 2 patients and the presence of a pacemaker in one patient. Anaemia was present in 9 patients whilst leukocytosis in 6 patients. The port of entry was found to be oral in three cases, ENT in one case and urogenital in two cases. Apart from one patient with vegetations in the tricuspid and pulmonary valves, the rest had localized vegetation only at the tricuspid valve. However, blood culture was positive in only three patients. There was a favorable outcome after antibiotic treatment in 4 patients with others having complications; three cases of renal impairment, two cases of heart failure and one case of pulmonary embolism. There was one mortality. Right heart infective endocarditis is rare but associated with potentially fatal complications.Pan African Medical Journal 2015; 2

Evaluation de l’état hydrique chez les patients hémodialysés chroniques : une étude transversale monocentrique: Assessment of the hydration status in chronic hemodialysis patients: a single-center cross-sectional study

Context and objective. For many practitioners, blood pressure is the main indicator of the hydration status of the chronic hemodialysis patient. The objective of this study was to assess the extent to which bioimpedance analysis (BIA) can assist in determining acute changes in fluid volume during the hemodialysis session. Methods. This was a 9-week longitudinal study. The total body water (TBW) was measured with a BIA analyzer, before and after 6 successive sessions. The ΔWeight was compared to the ΔTBW by calculating the P/V ratio (ΔWeight/ΔTBW) with the assumption that the dry weight is reached when P/V = 1. Results. The measurements made in 22 patients (46.6 years, 54.5% men, 92.3 months on dialysis) were reproducible. There was no statistically significant difference between ΔTBW and ΔWeight. However, at the individual level, significant differences had been observed. Using hypertension as a marker for a state of hyperhydration, a 31.8% agreement was noted between the P/V ratio and hypertension. Conclusion. Although the loss of water predicted by the BIA did not always correspond to the weight loss, BIA is a technique that can be used to assess the variations in TBW during the hemodialysis session in patients. Contexte et objectif. La pression artérielle est pour de nombreux praticiens, l’indicateur principal du statut hydrique du patient hémodialysé chronique. L’objectif de la présente étude était d’évaluer dans quelle mesure l’analyse d’impédance bioélectrique (BIA) pourrait aider à la détermination des variations aigues du volume hydrique au cours de la séance d’hémodialyse. Méthodes. Il s’agissait d’une étude de suivi longitudinal sur 9 semaines. Le volume total d’eau (VTE) a été mesuré par BIA, avant et après 6 séances. Le ΔPoids a été comparé au ΔVTE par le calcul du ratio P/V (ΔPoids / ΔVTE) dans l’hypothèse que le poids sec est atteint lorsque P/V = 1. Résultats. Les mesures faites chez 22 patients (46,6 ans, 54,5% hommes, 92,3 mois en dialyse) étaient reproductibles. Il n’y avait pas de différence statistiquement significative entre le ΔVTE et le ΔPoids. Cependant à l’échelon individuel des différences importantes étaient observées. En utilisant l’hypertension artérielle (HTA) comme marqueur d’un état d’hyperhydratation, une concordance de 31,8% était notée entre le ratio P/V et l’HTA. Conclusion. Bien que la perte d’eau prédite par la BIA ne corresponde pas toujours à celle du poids, la BIA est une technique qui peut être utilisée pour évaluer les variations du VTE au cours de la séance d’hémodialys

Ascite fébrile chez la femme, ne pas méconnaitre une tumeur de Krukenberg

Les tumeurs de Krukenberg (TK) se définissent comme des métastases ovariennes d'un cancer, le plus souvent digestif. Elles représentent 5 à 15% des tumeurs malignes ovariennes. Notre objectif était de décrire les caractéristiques épidémiologiques, diagnostiques, thérapeutiques et évolutives.Nous  rapportons deux observations de tumeur de Krukenberg découvertes à l'occasion de l'exploration d'une ascite fébrile.Il s'agit de deux patientes multipares âgées respectivement de 32 ans et 50 ans. Les signes d'appel étaient essentiellement digestifs. La découverte de ces métastases ovariennes était survenue à distance des foyers primitifs. L'atteinte des ovaires était bilatérale dans le premier cas et unilatérale  droite dans le second cas. Le diagnostic est apporté par la tomodensitométrie abdominopelvienne dans les deux cas. La fibroscopie oesogastroduodénale avait permis de retrouver le foyer primitif  respectivement sous forme d'un processus bourgeonnant et d'un ulcère en position antrale avec des stigmates d'hémorragies. L'examen anatomopathologique des biopsies réalisées mettait en évidence un adénocarcinome tubuleux moyennement différencié de l'estomac avec composante mucineuse dans la première observation et un adénocarcinome de type intestinal moyennement différencié dans la seconde. Le traitement chirurgical confirme le diagnostic histologique. Dans notre série, le traitement n'a pu être que symptomatique en raison de l'existence constante d'une carcinose péritonéale et de l'altération profonde de l'état général. Les deux patientes ont été confiées à l'institut de cancérologie pour une chimiothérapie palliative. La première est décédée 1 mois après. La tumeur de Krukenberg est une  maladie rare. Le diagnostic est facilité par la radiologie et confirmé par l'histologie. Son pronostic  demeure encore très sombre. Le seul espoir réside dans les mesures préventives.Key words: Métastases ovariennes, tumeur de Krukenberg, pronostic sombre