Évaluation du Risque Cardiovasculaire Absolu Chez les Patients Hémodialysés Diabétiques et Non diabétiques au Centre National d’Hémodialyse de Donka Conakry

Le risque cardiovasculaire chez les hémodialysés semble varier en fonction du statut diabétique ainsi que d’autres facteurs associés et constitue un problème de santé publique en Afrique en général et particulièrement en Guinée. Dans ce sens, l’objectif de cette étude était d’évaluer le risque de survenue d’une pathologie cardiovasculaire absolu chez les patients hémodialysés diabétiques, par rapport aux patients hémodialysés non diabétiques. La présente, étude transversale, descriptive et analytique a été réalisée entre le 1 ier avril et le 30 juin 2019 au Centre National d’Hémodialyse de Donka. L’étude a inclus les 140 patients hémodialysés durant la période. Le recrutement était exhaustif et concernait tous les patients hémodialysés répondant aux critères de sélection. Les données ont été recueillies prospectivement chez les patients hémodialysés puis compilées et traitées dans Epi info. 7.2.2.6. Un questionnaire semi-administré a été utilisé à ce fin. Pour évaluer le risque cardiovasculaire chez les patients le FRAMINGHAM RISK SCORE (FRS) a été aussi utilisé. L’enquête a concerné 140 individus dont 91 (65,00%) étaient des hommes, contre 49 (35,00%) de femmes, soit un sex- ratio de 1,86 soit 2 hommes pour une femme. L’âge moyen était de 41 ± 4,1 ans avec des extrêmes de (30 ; 74) ans. On notait une prédominance chez les hommes des facteurs de risque, pour le tabagisme. L’étude a trouvé 39 diabétiques contre 101 non diabétiques. Le risque était élevé chez 23 diabétiquessur 39 ; et 25 sur 101 des patients non diabétiques. L’étude montre qu’un patient sur quatre aurait un risque absolu élevé chez les patients non diabétiques et un patient sur deux chez les patients diabétiques. Ce risque est majoré par d’autres facteurs associés. Introduction: Cardiovascular risk in hemodialysis appears to vary depending on diabetic status and other associated factors and is a public health problem in Africa in general and particularly in Guinea. The objective of this study was to assess the risk of absolute cardiovascular disease in diabetic hemodialysis patients, compared to non-diabetic hemodialysis patients. Methods: Between April 1 and June 30, 2019, a descriptive and analytical cross-sectional study was conducted at the National Hemodialysis Centre in Donka. The study included 140 hemodialysis patients during the period. Recruitment was comprehensive and involved all hemodialysis patients meeting the selection criteria. The data were collected prospectively in hemodialysis patients and then compiled and processed in Epi info. 7.2.2.6. A semi-administered questionnaire had been used. To assess cardiovascular risk in patients, FRAMINGHAM RISK SCORE (FRS) was used. Results: The survey involved 140 individuals, 91 of whom (65.00%) 49 (35.00%) were men. sex ratio of 1.86 or 2 men per woman. The average age was 41-4.1 years with extremes of (30; 74) years. There was a predominance among men of risk factors for smoking. The study found 39 diabetics versus 101 non-diabetics. The risk was high in 23 out of 39 diabetics; and 25 out of 101 non-diabetic patients. Conclusion: The study shows that one in four patients would have a high absolute risk in diabetic and non-diabetic patients and also confirms the association of other factors that increase this risk. The survey involved 140 individuals, 91 of whom (65.00%) 49 (35.00%) were men. sex ratio of 1.86 or 2 men per woman. The average age was 41-4.1 years with extremes of (30; 74) years. There was a predominance among men of risk factors for smoking and diabetes. In our series, most of our patients had a low risk level of 56 (40%). Conclusion: This survey finds a low risk in this hemodialysis population. This should lead to strengthening strategies for preventing cardiovascular disease in this at-risk population

Kidney failure screening in the general population of rural Africa

Kidney failure is a silently progressive disease too often unknown to the patients. The objective of this study was to assess the impact of kidney disease in Conakry so as to develop strategies for early detection and prevention.This was a descriptive-type prospective study carried out over six months, from January 31 to July 31, 2012. The study was carried out in two areas: In health facilities where the population were at a higher risk of developing kidney disease (diabetes, uropathies, infectious diseases and HIV, hypertension and cardiovascular disease), and in an apparently healthy population. In the study we included black subjects hospitalised in different targeted wards, as well as fully active apparently healthy subjects of the general population. Renal function was assessed with the simplified MDRD formula. Data collection included clinical parameters: Blood pressure, weight, height and blood laboratory parameters (creatinine, glucose) and urine (urine dipstick, 24h quantitative proteinuria).One hundred and ninety-nine patients were selected for the study: 117 men and 82 women ageing from 20 to 90 years. The prevalence of renal failure was 59% in the population at risk, with 53.3% of men and 16% in apparently healthy population with 60% of men with a statistically significant difference: p = 0.00000001. Proteinuria was observed in 86 patients in the population at risk against 19 in the healthy population

Importance of screening for urinary tract infection in African Black diabetics

Urinary tract infections are common and often latent in diabetic patients. The objective of this study was to determinethe frequency of urinary tract infections and the organisms responsible.This is a descriptive type prospective study conducted in the Endocrinology and Diabetology ward of Donka UniversityHospital. All diabetic patients hospitalised from January 3rd to April 4th 2013 were included in the study.Two hundred and sixty-two diabetics had been screened, 64 (24.42%) had a urinary tract infection 41 women (64%)and 23 men (36%). The average age was 56.48 16.3 years with a range of 20-90 years. Urinary tract infections weremore frequent between the ages of 45 and 74 (67.20%). Sixty patients were married, four were single. Fifty-six patientswere type 2 diabetes against eight type I diabetes. Urine test strips showed 60 cases of pyuria, 36 cases of nitruria, 21cases of proteinuria and three cases of hematuria. Organisms identified were: Escherichia coli in 31 cases (48.43%): 25women and six men; Klebsiella pneumoniae in 14 cases (21.87%): nine women and five men; Staphylococcus aureusin 11 cases (17.18%): six women and five men; and Proteus mirabilis in eight cases (12.51%): two women and six men.The clinical manifestations were: asymptomatic bacteriuria in 57 cases (89.06%); acute cystitis in five cases (7.81%); andacute urethritis in two cases (3.13%).Urinary infection in African diabetics is very common. It requires a systematic screening with urine test strips becauseasymptomatic types are by far the most common. This would allow early treatment and avoid serious complications

Use of Viremia to Evaluate the Baseline Case Fatality Ratio of Ebola Virus Disease and Inform Treatment Studies: A Retrospective Cohort Study.

BACKGROUND: The case fatality ratio (CFR) of Ebola virus disease (EVD) can vary over time and space for reasons that are not fully understood. This makes it difficult to define the baseline CFRs needed to evaluate treatments in the absence of randomized controls. Here, we investigate whether viremia in EVD patients may be used to evaluate baseline EVD CFRs. METHODS AND FINDINGS: We analyzed the laboratory and epidemiological records of patients with EVD confirmed by reverse transcription PCR hospitalized in the Conakry area, Guinea, between 1 March 2014 and 28 February 2015. We used viremia and other variables to model the CFR. Data for 699 EVD patients were analyzed. In the week following symptom onset, mean viremia remained stable, and the CFR increased with viremia, V, from 21% (95% CI 16%-27%) for low viremia (V < 104.4 copies/ml) to 53% (95% CI 44%-61%) for intermediate viremia (104.4 ≤ V < 105.2 copies/ml) and 81% (95% CI 75%-87%) for high viremia (V ≥ 105.2 copies/ml). Compared to adults (15-44 y old [y.o.]), the CFR was larger in young children (0-4 y.o.) (odds ratio [OR]: 2.44; 95% CI 1.02-5.86) and older adults (≥ 45 y.o.) (OR: 2.84; 95% CI 1.81-4.46) but lower in children (5-14 y.o.) (OR: 0.46; 95% CI 0.24-0.86). An order of magnitude increase in mean viremia in cases after July 2014 compared to those before coincided with a 14% increase in the CFR. Our findings come from a large hospital-based study in Conakry and may not be generalizable to settings with different case profiles, such as with individuals who never sought care. CONCLUSIONS: Viremia in EVD patients was a strong predictor of death that partly explained variations in CFR in the study population. This study provides baseline CFRs by viremia group, which allow appropriate adjustment when estimating efficacy in treatment studies. In randomized controlled trials, stratifying analysis on viremia groups could reduce sample size requirements by 25%. We hypothesize that monitoring the viremia of hospitalized patients may inform the ability of surveillance systems to detect EVD patients from the different severity strata

Subsequent mortality in survivors of Ebola virus disease in Guinea: a nationwide retrospective cohort study.

BACKGROUND: A record number of people survived Ebola virus infection in the 2013-16 outbreak in west Africa, and the number of survivors has increased after subsequent outbreaks. A range of post-Ebola sequelae have been reported in survivors, but little is known about subsequent mortality. We aimed to investigate subsequent mortality among people discharged from Ebola treatment units. METHODS: From Dec 8, 2015, Surveillance Active en ceinture, the Guinean national survivors' monitoring programme, attempted to contact and follow-up all survivors of Ebola virus disease who were discharged from Ebola treatment units. Survivors were followed up until Sept 30, 2016, and deaths up to this timepoint were recorded. Verbal autopsies were done to gain information about survivors of Ebola virus disease who subsequently died from their closest family members. We calculated the age-standardised mortality ratio compared with the general Guinean population, and assessed risk factors for mortality using survival analysis and a Cox proportional hazards regression model. FINDINGS: Of the 1270 survivors of Ebola virus disease who were discharged from Ebola treatment units in Guinea, information was retrieved for 1130 (89%). Compared with the general Guinean population, survivors of Ebola virus disease had a more than five-times increased risk of mortality up to Dec 31, 2015 (age-standardised mortality ratio 5·2 [95% CI 4·0-6·8]), a mean of 1 year of follow-up after discharge. Thereafter (ie, from Jan 1-Sept 30, 2016), mortality did not differ between survivors of Ebola virus disease and the general population. (0·6 [95% CI 0·2-1·4]). Overall, 59 deaths were reported, and the cause of death was tentatively attributed to renal failure in 37 cases, mostly on the basis of reported anuria. Longer stays (ie, equal to or longer than the median stay) in Ebola treatment units were associated with an increased risk of late death compared with shorter stays (adjusted hazard ratio 2·62 [95% CI 1·43-4·79]). INTERPRETATION: Mortality was high in people who recovered from Ebola virus disease and were discharged from Ebola treatment units in Guinea. The finding that survivors who were hospitalised for longer during primary infection had an increased risk of death, could help to guide current and future survivors' programmes and in the prioritisation of funds in resource-constrained settings. The role of renal failure in late deaths after recovery from Ebola virus disease should be investigated. FUNDING: WHO, International Medical Corps, and the Guinean Red Cross

Clinical Presentation of Patients with Ebola Virus Disease in Conakry, Guinea

BACKGROUND: In March 2014, the World Health Organization was notified of an outbreak of Zaire ebolavirus in a remote area of Guinea. The outbreak then spread to the capital, Conakry, and to neighboring countries and has subsequently become the largest epidemic of Ebola virus disease (EVD) to date. METHODS: From March 25 to April 26, 2014, we performed a study of all patients with laboratory-confirmed EVD in Conakry. Mortality was the primary outcome. Secondary outcomes included patient characteristics, complications, treatments, and comparisons between survivors and nonsurvivors. RESULTS: Of 80 patients who presented with symptoms, 37 had laboratory-confirmed EVD. Among confirmed cases, the median age was 38 years (interquartile range, 28 to 46), 24 patients (65%) were men, and 14 (38%) were health care workers; among the health care workers, nosocomial transmission was implicated in 12 patients (32%). Patients with confirmed EVD presented to the hospital a median of 5 days (interquartile range, 3 to 7) after the onset of symptoms, most commonly with fever (in 84% of the patients; mean temperature, 38.6°C), fatigue (in 65%), diarrhea (in 62%), and tachycardia (mean heart rate, \u3e93 beats per minute). Of these patients, 28 (76%) were treated with intravenous fluids and 37 (100%) with antibiotics. Sixteen patients (43%) died, with a median time from symptom onset to death of 8 days (interquartile range, 7 to 11). Patients who were 40 years of age or older, as compared with those under the age of 40 years, had a relative risk of death of 3.49 (95% confidence interval, 1.42 to 8.59; P=0.007). CONCLUSIONS: Patients with EVD presented with evidence of dehydration associated with vomiting and severe diarrhea. Despite attempts at volume repletion, antimicrobial therapy, and limited laboratory services, the rate of death was 43%

Epidemiology of chronic kidney diseases in the Republic of Guinea; future dialysis needs

Background: Chronic kidney disease (CKD) is increasing worldwide and can lead to end-stage renal disease (ESRD). Objectives: Because few patients with ESRD in the Republic of Guinea have access to haemodialysis, we retrospectively evaluated the prevalence of CKD, ESRD and access to supportive therapies. Patients and Methods: 579 CKD patients (304 males; mean age: 44 ± 16 years) were admitted into Conakry nephrology department, the only centre in the Republic of Guinea, between 2009 and 2013. Most patients (63%) resided within Conakry (the capital), 12.5% came from lower Guinea, 11.7% from middle Guinea, 7.9% from upper Guinea and 4.8% from forest Guinea. Results: Reasons for referral were increased serum creatinine (49.5%), hypertension (27%) and diffuse edema (17%). Also, 11% were diabetic, 12.5% were smokers, 17% were HIV-positive, 8.3% were HBV-positive and 15% were HCV-positive. The most frequent symptom at admission was nausea/vomiting (56%). Upon admission, 70.5% of patients already had ESRD. Although no kidney biopsies were performed it was assumed that 34% and 27% of patients had vascular nephropathy and chronic glomerulonephritis, respectively. Of the 385 ESRD patients, only 140 (36.3%) had access to haemodialysis (two sessions/week, 4 hours each). Most patients that received haemodialysis resided within the Conakry region (P < 0.0001). There were significant associations between mortality and (i) terminal stage of CKD (P = 0.0005), (ii) vascular nephropathy (P = 0.002), and (iii) nephropathies of unknown origin (P = 0.0001). Conclusions: A fourfold increase in haemodialysis machines is needed in Conakry, plus four new nephrology/haemodialysis centres within the Republic of Guinea, each holding ≥30 haemodialysis machines

Quality of life of patients with end-stage renal disease in Guinea

This questionnaire-based study included 69 patients from the Republic of Guinea with end-stage renal disease (ESRD) and was conducted over 12 months. The factors that affected their quality of life (QoL) were determined. The included ESRD patients had an estimated creatinine clearance (CCr) of <15 mL/minute using MDRD formula. We used the SF36 question-naire and classified the results into two groups: Scores <50/100 as poor QoL and scores 50/100 as good QoL. Factors that determined the QoL were cessation of all activities and additional effort required, severe or mild pain, good or bad health, and reduced or not reduced social and physical activities. Of the 69 patients, 32 (46.3%) had a good QoL and 37 (53.7%) had a poor QoL. The estimated CCr was similar in both groups. The average age of the poor QoL group was 54 ± 4 years, the good-QoL group′s average age was of 47.6 ± 4 years (P = 0.01). Patients with a good QoL had better overall health, but this was not statistically significant [OR = 0.42 (0.14-1.28); P = 0.14]. Patients with a poor QoL had more severe pain (P = 0.002); however, good QoL did not protect against mental problems [OR = 46.67 (8.18-351.97); P = 0.0001]. Mental status (P = 0.01) and social activities (P = 0.001) were reduced, and there were more comorbidities in the poor-QoL group (29.7%, with >4, P = 0.01). Good QoL was associated with younger age, fewer comorbidities, less severe physical pain, and fewer physical or social limitations. QoL could be increased by improving comorbidity treatments, giving more effective pain control, and providing more assistance for social and physical limitations

Ebola Virus Imported from Guinea to Senegal, 2014

In March 2014, the World Health Organization declared an outbreak of Ebola virus disease in Guinea. In August 2014, a case caused by virus imported from Guinea occurred in Senegal, most likely resulting from nonsecure funerals and travel. Preparedness and surveillance in Senegal probably prevented secondary cases