Cardiovascular disease and metabolic syndrome in health transition and evidence-based medicine: a perspective from Africa

The Cardiovascular Disease (CVD) pandemic worldwide presents a true challenge today with a high health burden that is only expected to rise. I address the causes and prevention of CVD, as well as CVD rehabilitation and physiology. As a member of the American Heart Association and European Society of cardiology, I practice under the level of evidence and the strength of recommendation of particular treatment options, as outlined in the tables below

Causes of visual disability among Central Africans with diabetes mellitus

Background: Diabetic Retinopathy (DR) remains a common and one of the major causes of blindness in the developed and western societies. The same situation is shown in emerging economic areas (5,6). In sub-Saharan Africa (SSA) however, the issues of visual disability due to diabetes mellitus (DM) are overshadowed by the presence of the prevalent and common nutritional deficiency diseases and eye infectionsObjective: This clinic-based study was conducted to determine whether diabetic retinopathy is independently related to visual disability in black patients with diabetes mellitus (DM) from Kinshasa, Congo.Methods: A total of 299 urban patients with DM and low income including 108 cases of visual disability and matched for time admission and DM type to 191 controls, were assessed. Demographic, clinical, and ophthalmic data were assessed using univariate and multivariate analyses.Results: Age >60 years, female sex, presence of diabetic retinopathy (DR), proliferative DR, shorter DM duration, glaucoma, macular oedema, diabetic nephropathy were the univariate risk factors of visual disability. Using logistic regression model, visual disability was significantly associated with female sex and diabetic retinopathy.Conclusion: The risk of visual disability is 4 times higher in patients with diabetic retinopathy and 2 times higher in females with DM. Therefore, to prevent further increase of visual disability, the Congolese Ministry of Health should prioritize the eye care in patients with DM.Keywords: Visual disability, diabetic retinopathy, females, risk factors, Central Afric

The Protective Effect of Phaseolus Vulgaris on Cataract in Type 2 Diabetes: A Profitable Hypothesis

The pathophysiology of major ocular complications in type 2 diabetes mellitus (T2DM) among Bantu is not well understood. Several studies have been conducted to determine the basic reasons of visual deficiencies (VD) (blindness, visual impairment, and ocular eye diseases) in T2DM among Bantu from Central Africa. The quality of dietary intake was assessed in patients along with other ophthalmological assessments for diabetic retinopathy, cataract, glaucoma, and macular edema. Beans (Phaseolus vulgaris) and leafy vegetables are rich in antioxidants. The consumption of at least 3 ladles per meal, 3 times or more per week, has been identified as a potential protective factor against cataract. The anti-radical activity of beans is well known in the literature. Beans are considered to have a comparatively higher antioxidant activity than in many other vegetables. Our findings from previous epidemiologic studies establish that the antioxidant activity of P. vulgaris helps control blood glucose. We, therefore, hypothesize that the dietary supplements of bean can be a low-cost prevention approach to reduce cataract and much other visual comorbidity associated with T2DM. However, further epidemiological studies combined with molecular research need to be conducted to prove this hypothesis

Impacts of supplemental irrigation as a climate change adaptation strategy for maize production: a case of the Eastern Cape Province of South Africa

Dry spells and climatic hazards are responsible for maize output decline, sometimes to levels below potential yield levels. There is a pressing need to reduce the gap between actual and potential maize yield/ha, especially among farmers in semi-arid regions. This present study examines the potential role of supplemental irrigation and its differential impact on maize yield in the Eastern Cape Province of South Africa. In this study, maize yield data were generated from information recorded over a period of 20 years by farmers in Ntabankulu through cross-sectional interviews with 124 randomly-selected farming households. Maize yields for interviewed farmers were analysed for each of the experienced climatic hazards, for yield decline per ha and preferable adaptation strategies. Maize yield analyses show a maximum ceiling/attainable yield of 0.234 t/ha and average farm yield of 0.146 t/ha. Floods or hailstorms cause 75% decline in maize yield/ha and there was no significant difference between farmers practising irrigation and those practising dryland farming (P > 0.05). Low/no rains throughout the season; delay or low onset of rainfall and a rain-break for a week or more in a season results in 75%; 54% and 50.5% decline in maize yield/ha, respectively. On a scale of 1 to 10, farmers highly rank practicing supplementary irrigation (8.4) and change of planting date (7.8) as important adaptation strategies. Rescheduling planting date from the traditional planting times to earlier or later planting dates, assisted by use of weather reports and forecasting, to some extent curbs the impact of delays or slow onset of rainfall on yield. Supplemental irrigation is instrumental in reducing the impact of mid-season drought (rains break for a week) and light rainfall throughout the season. Analyses of actual yields and yield decline against each of the experienced climatic hazards provided insight into management possibilities to stabilize maize output.Keywords: agronomic practices, climatic hazards, supplemental irrigation, semi-arid area

Glycosylated haemoglobin is markedly elevated in new and known diabetes patients with hyperglycaemic ketoacidosis

Background: Glycosylated haemoglobin (HbA1c) and random blood glucose are markers of chronic and acute hyperglycaemia respectively.Objective: We compared HbA1c levels in ketoacidosis (DKA) occurring in known and newly diagnosed diabetes.Methods: Retrospective review of medical records for 83 DKA admissions in 2008 and 2009 with results for HbA1c at presentationResults: There were 52 and 31 DKA admissions in known and newly diagnosed diabetes patients respectively. Fifty of the 83 DKA admissions were in females. The mean age (per admissions) and HbA1c of all admissions are 43.4 ± 20.3 years (n=83) and 12.7 ± 3.4 % (n=83) respectively. Mean HbA1c in known Type 1, known Type 2 and newly diagnosed diabetes patients were similarly very high: 12.4 ± 3.3 %, 12.5 ± 3.3 %, 13.1 ± 3.7 %; P = 0.6828. The HbA1c levels in newly diagnosed diabetes patients less than 30 years (likely Type 1 diabetes) and ≥ 30 years (likely Type 2 diabetes) were similar. There was a tendency to significantly positive correlation between blood glucose and HbA1c in new diabetes patients.Conclusions: In our setting, DKA is associated with markedly elevated HbA1c levels in known type 1, known type 2 and new onset diabetes.Key words: Glycosylated haemoglobin, ketoacidosis, Known and newly diagnosed diabete

The Role of T Helper 17 (Th17) and Regulatory T Cells (Treg) in the Pathogenesis of Vulvovaginal Candidiasis among HIV-Infected Women

Background. The study sought to describe relationships between 20 cytokines and chemokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17, G-CSF, GM-CSF, IFN-γ, MCP-1, MIP-1β, TNF-α, TGF-β1, TGF-β2, and TGF-β3) and the presence of vulvovaginal candidiasis (VVC) in women, stratified by HIV status. Methods. Plasma and genital samples were obtained from 51 clinic attendees in KwaZulu-Natal between June 2011 and December 2011. Cytokine and chemokine concentrations were measured by Luminex® multiplex immunoassays. Multiple comparisons of means of cytokine/chemokine levels displaying significant differences in univariate analyses across the study groups were performed using post hoc Bonferroni pairwise tests considering a type I error rate of 0.05. A discriminant analysis (DA) was carried out to identify linear combinations of variates that would maximally discriminate group memberships. Results. Of the 51 participants, 16/26 HIV-infected and 15/25 HIV-uninfected women were diagnosed with VVC. DA identified 2 variables (MIP-1β and TGF-β3) in plasma (Box’s M (5.49), p (0.57) > α (0.001); Wilks’ lambda = 0.116, p α (0.001); Wilks’ lambda = .677, p<0.0001) as able to discriminate the HIV + VVC + group, whilst TGF-β1 in plasma discriminated the HIV + VVC − group. Mean concentrations of genital IL-6, IL-8, IL-10, IL-17, and TGF-β3 were significantly higher in HIV infected women coinfected with VVC. Conclusions. In HIV-infected women, VVC might be explained by a decline of Th17 cells, hence a decrease of Th17/Treg ratio

The Protective Effect of Phaseolus Vulgaris on Cataract in Type 2 Diabetes: A Profitable Hypothesis

The pathophysiology of major ocular complications in type 2 diabetes mellitus (T2DM) among Bantu is not well understood. Several studies have been conducted to determine the basic reasons of visual deficiencies (VD) (blindness, visual impairment, and ocular eye diseases) in T2DM among Bantu from Central Africa. The quality of dietary intake was assessed in patients along with other ophthalmological assessments for diabetic retinopathy, cataract, glaucoma, and macular edema. Beans (Phaseolus vulgaris) and leafy vegetables are rich in antioxidants. The consumption of at least 3 ladles per meal, 3 times or more per week, has been identified as a potential protective factor against cataract. The anti-radical activity of beans is well known in the literature. Beans are considered to have a comparatively higher antioxidant activity than in many other vegetables. Our findings from previous epidemiologic studies establish that the antioxidant activity of P. vulgaris helps control blood glucose. We, therefore, hypothesize that the dietary supplements of bean can be a low-cost prevention approach to reduce cataract and much other visual comorbidity associated with T2DM. However, further epidemiological studies combined with molecular research need to be conducted to prove this hypothesis