Anemia in patients on chronic hemodialysis in Cameroon: prevalence, characteristics and management in low resources setting

Background: Anemia is a common complication of chronic kidney disease. We investigated the prevalence, characteristics and management of anemia in patients on chronic hemodialysis and assessed the response to blood-transfusion based management in Cameroon.Methods: This was a cohort study of five months’ duration (August-December 2008) conducted at the Yaoundé General Hospital’s hemodialysis center, involving 95 patients (67 men, 70.5%) on chronic hemodialysis by a native arterio-venous fistula. A monthly evaluation included full blood counts, number of pints of red cell concentrates transfused, and vital status.Results: At baseline, 75 (79%) patients had anemia which was microcytic and hypochromic in 32 (43%). Anemia was corrected in 67 (70.5%) patients using blood transfusion only, while 28 (29.5%) patients were receiving erythropoietin (11 regularly, 39%). Only 77.2% of 342 pints (median 3.0, range 0-17 per patients) of red cell concentrates prescribed were effectively received during the follow-up at an unacceptably high cost to patients and families. Mean hemoglobin and mean corpuscular hemoglobin levels remained stable during follow-up, while mean corpuscular volume increased. Erythropoietin treatment was the main determinant of favorable trajectories of hematological markers.Conclusions: Patients on chronic hemodialysis have predominantly microcytic hypochromic anemia, with limited capacity for correction using blood transfusion.Key words: Anemia; Blood transfusion; End stage renal disease; Hemodialysis; Sub-Saharan Afric

Fistule artério-veineuse ulno-basilique pour hémodialyse au CHU de Yaoundé: à propos de deux cas

La fistule ulno-basilique est une éventualité peu sollicitée dans le choix des abords vasculaires pour hémodialyse. Elle est construite sur la veine basilique qui est souvent la seule veine épargnée par les ponctions veineuses de routine dans les services de médecine. De par l'existence de nombreuses complications comme l'infection des prothèses et des cathéters centraux, les thromboses, les patients hémodialysés chroniques nécessitent plus d'un accès veineux au cours de leur suivi médical. Les fistules artério-veineuses natives présentent moins de risques de complications que les prothèses d'une façon générale et une plus longue durée de vie. La confection d'une fistule sur une topographie proximale compromet le recourt à cette veine sur une localisation distale ultérieurement. Il existe donc une hiérarchisation dont il faut tenir compte pour une utilisation optimale du capital veineux disponible. Nous rapportons ici deux observations concernant des patients chez qui deux fistules ulnobasiliques ont été réalisées avec succès au CHU de Yaoundé.Key words: Fistule artério-veineuse, hémodialyse, ponction veineus

Characterization, reactivity and rheological behaviour of metakaolin and Meta-halloysite based geopolymer binders

The type of aluminosilicate precursor used in the synthesis of geopolymer binders plays a huge role in the resulting performance. Thus, it is critical to understand the properties of precursors and how they influence the corresponding performance of geopolymer binders. In this study, metakaolin and meta halloysite are used as the aluminosilicate precursor in the synthesis of geopolymer binders. These precursors are obtained locally in order to propel the sustainable development and application of geopolymers. The precursors were characterized and the corresponding influence on the reactivity, rheology and setting times of geopolymers was investigated. In addition to the influence of precursor type on the properties of the geopolymers, the effect of two silica moduli (i.e. 1.3 and 1.5) was also evaluated. The results from this study indicated that increasing the activator silica modulus from 1.3 to 1.5 extended the setting times and increased the stress strain of the geopolymer binders. Characterization of the precursors indicated that metakaolin has a higher amorphous content compared to that of meta halloysite. However, the finer particles of meta halloysite embodied it with the ability to participate in a faster geopolymerization and result in more formation of activation products

Meta-halloysite to improve compactness in iron-rich laterite-based alkali activated materials

In this paper, the results of the experimental investigation were used to understand the effect of fine meta-halloysite on the reactivity, mechanical and microstructural properties of laterite-based geopolymers. Laterite was replaced by 0, 20, 30 and 50 wt% of meta-halloysite in order to improve the physico-chemical performance. Meta-halloysite was prepared by calcination of natural halloysite at 600 °C. The moduli (molar ratio SiO2/Na2O) of the activating solutions were 1.04, 0.92, and 0.75 with H2O/Na2O = 9.78, 10.45 and 12.04, respectively. The results indicated that calcined laterite has a high specific surface area (43.00 ± 0.12 m2/g), notwithstanding a high average particle size (d50 = 45.20 μm) compared to meta-halloysite with a smaller average particle size (d50 = 8.40 μm) and a specific surface (29.80 ± 0.16 m2/g). The compressive strength of geopolymers increased upon the addition of meta-halloysite from 12 MPa to 45 MPa at 28 days. While the setting time and water absorption decrease with increase in the of meta-halloysite content as well as with increase in Si/Al, Si/Fe, Al/Fe and Na/Al molar ratios used in the synthesis of geopolymers. The use of fine meta-halloysite resulted in better efficiency and improved mechanical performance of synthesized products

Efficiency of an intervention package for arterial hypertension comprising telemanagement in a Cameroonian rural setting: The TELEMED-CAM study

Introduction: Sub-Saharan Africa has a disproportionate burden of disease and an extreme shortage of health workforce. Therefore, adequate care for emerging chronic diseases can be very challenging. We implemented and evaluated the effectiveness of an intervention package comprising telecare as a mean for improving the outcomes of care for hypertension in Rural Sub-Saharan Africa. Methods: The study involved a telemedicine center based at the Yaounde General Hospital (5 cardiologists) in the Capital city of Cameroon, and 30 remote rural health centers within the vicinity of Yaoundé (20 centers (103 patients) in the usual care group, and 10 centers (165 patients) in the intervention groups). The total duration of the intervention was 24 weeks. Results: Participants in the intervention group had higher baseline systolic (SBP) and diastolic (DBP) blood pressure, and included fewer individuals with diabetes than those in the usual care group (all p<0.01). Otherwise, the baseline profile was mostly similar between the two groups. During follow-up, more participants in the intervention groups achieved optimal BP control, driven primarily by greater improvement of BP control among High risk participants (hypertension stage III) in the intervention group. Conclusion: An intervention package comprising tele-support to general practitioners and nurses is effective in improving the management and outcome of care for hypertension in rural underserved populations. This can potentially help in addressing the shortage of trained health workforce for chronic disease management in some settings. However context-specific approaches and cost-effectiveness data are needed to improve the application of telemedicine for chronic disease management in resource-limited settings.Key words: Hypertension, control, telemedicine, Cameroon, sub-saharan Afric

Sustainability assessment of geopolymer concrete synthesized by slag and corncob ash

Globally, sustainable construction materials are promoted in the construction and building sector due to the high utilization of Portland cement as a conventional binder and its associated energy and environmental impacts. Consequently, geopolymer concrete emerges as a substitute for conventional concrete. This study designed two grades of geopolymer concrete (GPC) strengths (C 30 and 40 MPa) with ground granulated blast furnace slag (GGBFS) and corncob ash (CCA) as alternative binders. The binders, varied at 0–100 wt% of GGBFS by CCA, were activated with sodium hydroxide (SH) and sodium silicate (SS) solutions. After 28 days of curing, the compressive strength of the concrete cubes was determined. Furthermore, the environmental impacts of the concrete constituents were assessed. At the same time, their sustainability and economic indexes were estimated via the Inventory of Carbon and Energy (ICE) within the cradle-to-site confinement. The findings showed that GGBFS-CCA-based geopolymer concrete exhibited lesser environmental impact and higher sustainable and economic efficiency than Portland cement concrete. Thus, these outcomes can be advantageous in achieving a cleaner built milieu and sustainable construction

GRChombo: An adaptable numerical relativity code for fundamental physics

GRChombo is an open-source code for performing Numerical Relativity time evolutions, built on top of the publicly available Chombo software for the solution of PDEs. Whilst GRChombo uses standard techniques in NR, it focusses on applications in theoretical physics where adaptability, both in terms of grid structure, and in terms of code modification, are key drivers