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

Prevalence and determinants of comprehensive eye care in a group of patients with diabetes: a cross-sectional study in a sub-Saharan African setting

Objectives We aimed to investigate the determinants of comprehensive eye examination in diabetes patients. We conducted a cross-sectional study at the eye department of the Douala General Hospital. Adult patients with diabetes were consecutively interviewed on the history of their diabetes. Main outcomes were a first ever comprehensive eye examination including fundoscopy, and diagnosis-to-fundoscopy time. Results 52 patients were included of whom 59.6% were males with a mean age of 55.9 ± 10.9 years. 51.9% have had counselling on the risk of visual impairment and blindness due to diabetes, and 61.5% [95% CI 47–74.7] have had a comprehensive eye examination. Of those with a first ever fundoscopy, only 21.9% had the test performed within 1 year of diagnosis. Thus, after an average of 10 years of the diagnosis of diabetes, 13.5% (7/52) of patients have had a comprehensive eye examination within 1 year of diagnosis. Only dose with duration of diabetes of more than 10 years were 7–24 times more likely to have a comprehensive eye examination. In summary, patients with diabetes in this low-income setting do not receive a comprehensive eye care as recommended. Most patients will get an eye examination at least 10 years after the diagnosis of diabetes

Prevalence and patterns of congenital heart diseases in Africa: a systematic review and meta-analysis protocol

Introduction: Congenital heart diseases (CHD) are common causes of cardiovascular morbidity and mortality among young children and adolescents living in Africa. Accurate epidemiological data are needed in order to evaluate and improve preventive strategies. This review aims to determine the prevalence of CHD and their main patterns in Africa. Methods and analysis: This systematic review and meta-analysis will include cross-sectional, case-control and cohort studies of populations residing inside African countries, which have reported the prevalence of CHD, confirmed by an echocardiographic examination and/or describing different patterns of these abnormalities in Africa. Relevant abstracts published without language restriction from 1 January 1986 to 31 December 2016 will be searched in PubMed, Exerpta Medica Database and online African journals as well as references of included articles and relevant reviews. Two review authors will independently screen, select studies, extract data and assess the risk of bias in each study. The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate of the prevalence of CHD across studies. Clinical and statistical heterogeneity will be assessed, and we will pool studies judged to be clinically homogeneous. On the other hand, statistical heterogeneity will be evaluated by the ÷2 test on Cochrane's Q statistic. Funnel-plots analysis and Egger's test will be used to detect publication bias. Results will be presented by geographic region (central, eastern, northern, southern and western Africa). Ethics and dissemination: The current study will be based on published data, and thus ethical approval is not required. This systematic review and meta-analysis is expected to serve as a base which could help in estimating and evaluating the burden of these abnormalities on the African continent. The final report of this study will be published in a peer-reviewed journal. Trial registration number: PROSPERO CRD42016052880

Challenges in the diagnosis and management of anti-phospholipid syndrome: a case from Cameroon

Abstract Background Anti-phospholipid syndrome (APLS) is a condition characterized by the presence of raised plasma levels of anti-phospholipid antibodies associated with thrombo-embolic disease and/or poor obstetrical outcomes in women. The epidemiology of APLS is unknown in most sub-Saharan African countries due to limited access to diagnosis tools. Case summary We report the case of APLS in a 29-year-old obese woman that was preceded by pre-eclampsia and fetal death. The diagnosis of APLS was made during a thrombo-embolic episode 4 years after the poor obstetrical outcome. Her management was challenging, as she had three thrombo-embolic events within 18-months despite treatment with anti-coagulant (acenocoumarol). Conclusion This case highlights the need for screening for APLS after an episode of hypertensive disease in pregnancy or fetal death, and the challenges faced with the treatment, such as resistance to antivitamin K anti-coagulants and the desire for maternity

Prevalence and associated factors of active smoking among individuals living with hypertension and/or diabetes in Africa: a systematic review and meta-analysis protocol

Introduction: Tobacco use significantly increases cardiovascular complications in people living with hypertension and/or diabetes. We aim to summarise data on the prevalence and factors associated with active smoking in these conditions in Africa. Method and analysis We will search PubMed, Embase, Google Scholar and African Journals Online for relevant abstracts of studies on active smoking in individuals living with diabetes and/or hypertension published from 1 January 2000 to 31 December 2016, with no language restriction. Additionally, relevant unpublished papers and conference proceedings will be checked, as well as references of included articles. Two investigators will independently screen, select studies, extract data and assess the risk of bias in each study. Data will be analysed using Stata software (Stata V.14, Texas, USA). The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate of the prevalence of smoking across studies. Also, we will assess factors associated to smoking. Heterogeneity of studies will be evaluated by the χ2 test on Cochrane’s Q statistic. Funnel plots analysis and Egger’s test will be done to detect publication bias. Results will be presented by geographic region (central, eastern, northern, southern and western Africa). A p value less than 0.05 will be considered significant for factors associated to smoking. Ethics and dissemination This study is based on published data, and therefore ethical approval is not a requirement. This systematic review and meta-analysis is expected to serve as a basis for designing cost-effective interventions to reduce and prevent smoking in patients with diabetes and/or hypertension, and as a guide for future research based on the remaining gaps. The final report of this study in the form of a scientific paper will be published in peer-reviewed journals. Findings will further be presented at conferences and submitted to relevant health authorities

Global prevalence of diabetes mellitus in patients with tuberculosis: a systematic review and meta-analysis protocol

Introduction: Diabetes mellitus (DM) is an important risk factor for active tuberculosis (TB), which also adversely affect TB treatment outcomes. The escalating global DM epidemic is fuelling the burden of TB and should therefore be a major target in the strategy for ending TB. This review aims to estimate the global prevalence of DM in patients with TB. Methods and analysis This systematic review will include cross-sectional, case–control or cohort studies of populations including patients diagnosed with TB that have reported the prevalence of DM using one of the fourth standard recommendations for screening and diagnosis. This protocol is written in accordance with recommendations from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 statement. Relevant abstracts published in English/French from inception to 31 December 2016 will be searched in PubMed, Excerpta Medica Database and online journals. Two investigators will independently screen, select studies, extract data and assess the risk of bias in each study. The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate of the prevalence of diabetes across the studies. Heterogeneity will be assessed, and we will pool studies judged to be clinically homogenous. On the other hand, statistical heterogeneity will be evaluated by the χ² test on Cochrane’s Q statistic. Funnel-plots analysis and Egger’s test will be used to investigate publication bias. Results will be presented by continent or geographic regions. Ethics and dissemination This study is based on published data. An ethical approval is therefore not required. This systematic review and meta-analysis is expected to inform healthcare providers as well as general population on the co-occurrence of DM and TB. The final report will be published as an original article in a peer-reviewed journal, and will also be presented at conferences and submitted to relevant health authorities. We also plan to update the review every 5 years. Protocolregistration number PROSPERO International Prospective Register of Systematic Reviews (CRD42016049901)

Le régime cétogène : efficace contre le cancer ?

Le régime cétogène vise à réduire l’apport nutritionnel d’hydrates de carbone en augmentant les lipides. Ce régime est une option thérapeutique reconnue, en particulier chez les enfants souffrant d’épilepsie réfractaire. Il fait aujourd’hui l’objet d’un regain d’intérêt de la part des médecins et des chercheurs, en raison de son potentiel effet thérapeutique dans d’autres pathologies comme certaines maladies neurodégénératives, le syndrome métabolique ou même le cancer. Le cancer étant l’un des grands défis de santé publique, les approches complémentaires pour améliorer l’efficacité des thérapies anticancéreuses standards font l’objet de nombreuses recherches. Cet article fait le point sur la place du régime cétogène comme thérapie complémentaire dans le cancer, les évidences scientifiques et les éventuels aspects pratiques d’une telle approche

Effects of nonsurgical periodontal treatment on glycated haemoglobin on type 2 diabetes patients (PARODIA 1 study): a randomized controlled trial in a sub-Saharan Africa population

Abstract Background There is a burglar association between diabetes and periodontitis. Many studies has shown that periodontitis treatment can help improving glycemic control in diabetes patients but little evidence of non-surgical treatment benefit is available in sub Saharan african diabetes patients. We aimed to assess the effects of non-surgical periodontal treatment (NSPT) of chronic periodontitis on glycaemic control in poorly controlled type 2 diabetes patients (T2D) in a sub-Saharan Africa urban setting. Methods A total of 34 poorly controlled T2D patients with chronic periodontitis aged 51.4 ± 8.8 years (mean ± SD), with known duration of diabetes of 55.5 ± 42.6 months, and HbA1c of 9.3 ± 1.3% were randomly assigned to two groups. The treatment group (Group 1, n = 17) received immediate ultrasonic scaling, scaling and root planning along with subgingival 10% povidone iodine irrigation, whereas the control group (Group 2, n = 17) was assigned to receive delayed periodontal treatment 3 months later. Pharmacological treatment was unchanged and all participants received the same standardized education session on diabetes management and dental hygiene. The primary outcome was the 3-month change in HbA1c from baseline. Plaque index (PI), gingival bleeding index (GBI), pocket depth (PD), clinical attachment loss (CAL) were also assessed prior to, at 6 and 12 weeks after enrolment. Results Two subjects in each group were excluded from the study. Data were analyzed on thirty patients (15 per group). Non-surgical periodontal treatment with education for better dental hygiene (group 1) significantly improved all periodontal parameters whereas education only (group 2) improved only the plaque index among all periodontal parameters. Immediate non-surgical periodontal treatment induced a reduction of HbA1c levels by 3.0 ± 2.4 points from 9.7 ± 1.6% at baseline to 6.7 ± 2.0% 3 months after NSPT, (p ˂ 0.001) but the change was not significant in group 2, from mean 8.9 ± 0.9% at baseline vs 8.1 ± 2.6% after 3 months (p = 0.24). Conclusion Non-surgical periodontal treatment markedly improved glycaemic control with an attributable reduction of 2.2 points of HbA1c in poorly controlled T2D patients in a sub Saharan setting. Trial registration ClinicalTrials.gov Identifier: NCT02745015 Date of registration: July 17, 2016 ‘Retrospectively registered’

Heart rate variability in hyperthyroidism on sub Saharan African patients: a case–control study

Abstract Objective We aimed to determine heart rate variability in freshly diagnosed untreated hyperthyroidism patients. We enrolled 10 patients (9 females) and 10 matched controls for sex and age. Each eligible patient underwent five different tests according to Ewing battery tests for cardiac autonomic dysfunction assessment. HRV was assessed during each maneuver and on 24 h using a continuous electrocardiogram with automatic estimation of SDNN, RMSSD, LF HF and HF/LH ratio. Results of tests were compared between hyperthyroidism patients and matched controls using the non-parametric test of Mann–Whitney. Results Heart rate was significantly higher in patients with thyrotoxicosis (82.91 ± 10.99 vs 67.04 ± 6.80; 0.006) compared to their controls. On time-domain analysis, there was a trend towards reduction in SDNN (39.52 vs. 63.75; p = 0.2) as well as the RMSSD (30.44 vs 64.03; p = 0.09) in patients with hyperthyroidism. The frequency-domain analysis showed non-significant higher values for the LF (43.87 vs 38.85 ± 12.85; p = 0.8) and lower for the HF (32.54 vs 43.39; p = 0.3). Test’s results were mostly impaired in hyperthyroid patients and all patients presented abnormal results for parasympathetic activity. Untreated and recently diagnosed hyperthyroidism is associated to an altered parasympathetic activity in sub Saharan African patients

Knowledge, attitudes and practices of cardiovascular disease risk factors in in a self-selected group of adults with HIV infection in Cameroon.

Background: Human Immune-deficiency Virus (HIV) infection is a public health problem worldwide, with the greatest burden in low-income settings. Increased survival associated with the use of anti-retroviral treatment is associated with an increase in the burden of cardiovascular disease (CVD). Primordial prevention of CVD requires an adequate knowledge, attitude, and practice of the risk factors.Aim: Assess the knowledge, Attitude, and Practices (KAP) of CVD risk factors in adults with HIV infection in Cameroon.Methods: We carried out a KAP survey at the Yaounde Central Hospital. Participants were consenting adults with HIV, aged > 18 years, of both sex who received regular care at the day hospital. Each participant had a face-to-face interview with a trained investigator using a standardized questionnaire.Results: A total of 329 participants were interviewed. Their mean age was 46.6 ± 10.6 years. Ten (3%) participants had good knowledge of CVD risk factors. Higher level of education was associated with good Knowledge (OR: 3.9, [95% CI: 2 – 7.6], p<0.001). Obtaining information from the staff (OR 0.3 [95% CI: 0.2–0.6], p <0.001), and having a family history of cardiovascular diseases (OR = 0.4 [95% CI: 0.2–0.7], p = 0.004) was associated with good knowledge. 211 (64.1%) participants had inappropriate attitudes, and 40 (12.2%) participants had adequate practices. These were associated with the level of knowledge (OR = 2.0, [95% CI: 1– 3.9], p = 0.040).Conclusion: This study suggests that people with HIV in Cameroon have poor knowledge of cardiovascular risk factors, and this is associated to inadequate practices towards CVD risk factors.Key words: Knowledge, Attitudes, Practices, HIV, Cardiovascular risk factors