The association between antiretroviral therapy and selected cardiovascular disease risk factors in sub-Saharan Africa: A systematic review and meta-analysis.

BACKGROUND: With increasing adverse cardiovascular disease (CVD) outcomes in HIV/AIDS patients, the possible contribution of antiretroviral therapy (ART) to the prevailing CVD epidemic in sub-Saharan Africa (SSA) through its effect on CVD risk factors has rather been under investigated. This study aimed to assess the extent to which ART is associated with hypertension, diabetes mellitus (DM) and dyslipidemia in SSA. METHODS: This is a systematic review and meta-analysis of studies from SSA, published between January 1946 and December 2017, from Medline, Embase, Africa-wide Information, the Cochrane library, African Index and Medicus databases. Both observational and interventional studies with comparable ART-treated and ART-naïve populations were selected and data was extracted from eligible studies. Pooled estimates of the effect of ART on the outcomes of interest (hypertension, diabetes and abnormal lipid profiles) were obtained using random effects meta-analysis, and meta-regression analysis was used to explore between-study heterogeneity. RESULTS: Twenty cross-sectional studies were included involving 5386 participants. There was no association between ART use and hypertension (OR: 1.9, 95%CI: 0.96-3.76, n = 8, I2 = 73.8%) and DM (OR: 2.53, 95%CI: 0.87-7.35, n = 8, I2 = 73.8%). ART use was associated with high total cholesterol (OR: 3.85, 95%CI: 2.45-6.07, n = 8, I2 = 67.0%), high triglycerides (OR: 1.46, 95%CI: 1.21-1.75, n = 14, I2 = 10.0%) and high LDL-cholesterol (OR: 2.38, 95%CI: 1.43-3.95, n = 11, I2 = 87.6%). ART was associated with rather lower odds of having low HDL-cholesterol (OR: 0.53, 95%CI: 0.32-0.87, n = 8, I2 = 78.2%). There was evidence of between-study heterogeneity for all outcomes except high triglycerides. CONCLUSIONS: ART appears to be associated with CVD risk in HIV/AIDS patients in SSA only through dyslipidemia but not through hypertension and DM, however, high quality and robust research in SSA is mandated to accurately ascertain the actual contribution of ART to the CVD burden in this part of the world. Nevertheless, HIV/AIDS patients should still benefit from systematic CVD screening alongside their regular care services. TRIAL REGISTRATION: Prospero Registration - CRD42016042306

Programming implantable cardioverter-defibrillators in primary prevention: Higher or later

SummaryDefibrillator shocks, appropriate or not, are associated with significant morbidity, as they decrease quality of life, can be involved in depression and anxiety, and are known to be proarrhythmic. Most recent data have even shown an association between shocks and overall mortality. As opposed to other defibrillator-related complications, the rate of inappropriate and unnecessary shocks can (and should) be decreased with adequate programming. This review focuses on the different programming strategies and tips available to reduce the rate of shocks in primary prevention patients with left ventricular dysfunction implanted with a defibrillator, as well as some of the manufacturers’ device specificities

High birth weight in a suburban hospital in Cameroon:An analysis of the clinical cut-off, prevalence, predictors and adverse outcomes

BACKGROUND AND AIMS: High birth weight (HBW) increases the risk of maternal and fetal morbidity and mortality. Its prevalence and adverse outcomes may be reduced if risk factors are identified and managed during pregnancy. The cut-off value for HBW remains debatable. The objectives of this study were to identify the optimal cut-off value and determine the prevalence, predictors and adverse outcomes of HBW in a suburban area of Cameroon. DESIGN: A 6-year retrospective register analysis and a 3-month prospective phase. SETTING: A secondary care level (regional) hospital in the city of Buea (southwest region of Cameroon). PARTICIPANTS: Women who delivered in this hospital over a 6-year period (retrospective phase) and consenting pregnant mothers and their infants (singletons, born at >28 weeks gestation) (prospective phase). OUTCOME MEASURES: 90th centile of birth weights; prevalence of HBW defined as birth weight above the 90th centile; sociodemographic, maternal and obstetrical factors associated with HBW; maternal and neonatal adverse outcomes of HBW. RESULTS: Of the 4941 newborns reviewed in registers, the 90th centile of birth weights was 3850 g. Using this new cut-off, we obtained a prevalence of 14.0% for HBW in the 200 newborns included in the prospective phase. This was significantly higher than the prevalence (9.5%) yielded when the traditional cut-off of 4000 g was used (p=0.003). None of the factors assessed was independently associated with HBW. Newborns with HBW were more likely to have shoulder dystocia (p<0.01), and their mothers more likely to suffer from prolonged labour (p=0.01) and postpartum haemorrhage (p<0.01). CONCLUSIONS: The results of this study suggest that the cut-off for HBW in this population should be 3850 g. Thus, 3 of every 10 babies born with HBW in this hospital are likely not receiving optimal postnatal care because 4000 g is currently used to qualify for additional support

Thermally responsive capillary suspensions

© 2017 American Chemical Society. We demonstrate that stimulus-responsive capillary-structured materials can be formed from hydrophobized calcium carbonate particles suspended in a non-polar phase (silicone oil) and bridged by very small amounts of a hydrogel as the secondary aqueous phase. Inclusion of thermally responsive polymers into the aqueous phase yielded a capillary-structured suspension whose rheology is controlled by a change in temperature and can increase its complex modulus by several orders of magnitude because of the gelation of the capillary bridges between the solid particles. We demonstrate that the rheology of the capillary suspension and its response upon temperature changes can be controlled by the gelling properties as little as 0.1 w/w % of the secondary aqueous phase containing 2 wt % of the gelling carbohydrate. Doping the secondary (aqueous) phase with methyl cellulose, which gels at elevated temperatures, gave capillary-structured materials whose viscosity and structural strength can increase by several orders of magnitude as the temperature is increased past the gelling temperature of the methyl cellulose solution. Increasing the methyl cellulose concentration from 0 to 2 w/w % in the secondary (aqueous) phase increases the complex modulus and the yield stress of the capillary suspension of 10 w/w % hydrophobized calcium carbonate in silicone oil by 2 orders of magnitude at a fixed temperature. By using an aqueous solution of a low melting point agarose as a secondary liquid phase, which melts as the temperature is raised, we produced capillary-structured materials whose viscosity and structural strength can decrease by several orders of magnitude as the temperature is increased past the melting temperature of the agarose solution. The development of thermally responsive capillary suspensions can find potential applications in structuring of smart home and personal care products as well as in temperature-triggered change in rheology and release of flavors in foods and actives in pharmaceutical formulations

Anemia in type 2 diabetic patients and correlation with kidney function in a tertiary care sub-Saharan African hospital: a cross-sectional study

BackgroundAnemia is common in diabetic patients and increases morbidity and mortality, but its burden has been less well characterized in sub-Saharan Africans. We determined the prevalence of anemia and investigated the related factors, with a particular focus on the role of declining renal function, in type 2 diabetic patients attending a tertiary health care institution in Cameroon.MethodsHemoglobin (Hb) levels were measured in a consecutive sample of patients with type 2 diabetes, who reported for annual review at the outpatient section of the Douala General Hospital in 2013. Patients were classified as anemic according to the World Health Organisation criteria (Hb < 12g/dl for females and Hb < 13g/dl for males). Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease Study Group formula. Determinants of Hb concentration and anemia were investigated using multivariable logistic regressions.ResultsA total of 636 patients were examined including 263 (prevalence rate 41.4%) who had anemia. The prevalence of anemia increased significantly with deteriorating kidney function, although up to 31.9% of patients with normal kidney function had anemia. Compared with their non-anemic counterparts, anemic diabetic patients were older, had longer duration of diabetes, lower eGFR, higher prevalence of proteinuria and diabetic retinopathy (all p < 0.05). In multivariable logistic regressions, eGFR (p = 0.001) and presence of retinopathy (p = 0.023) were the independent determinants of prevalent anemia.ConclusionsThe prevalence of anemia is high in type 2 diabetic patients attending referral institutions in Cameroon, including among those without chronic kidney disease. Routine screening for anemia in all diabetic patients may aid early identification and correction as appropriate

Capillary structured suspensions from in situ hydrophobized calcium carbonate particles suspended in a polar liquid media

© 2017 American Chemical Society. We demonstrate that capillary suspensions can be formed from hydrophilic calcium carbonate particles suspended in a polar continuous media and connected by capillary bridges formed of minute amounts of an immiscible secondary liquid phase. This was achieved in two different polar continuous phases, water and glycerol, and three different oils, oleic acid, isopropyl myristate, and peppermint oil as a secondary liquid phase. The capillary structuring of the suspension was made possible through local in situ hydrophobization of the calcium carbonate particles dispersed in the polar media by adding very small amounts of oleic acid to the secondary liquid phase. We observed a strong increase in the viscosity of the calcium carbonate suspension by several orders of magnitude upon addition of the secondary oil phase compared with the same suspension without secondary liquid phase or without oleic acid. The stability and the rheological properties of the obtained capillary structured materials were studied in relation to the physical properties of the system such as the particle size, interfacial tension between the primary and secondary liquid phases, as well as the particle contact angle at this liquid-liquid interface. We also determined the minimal concentrations of the secondary liquid phase at fixed particle concentration as well as the minimal particle concentration at fixed secondary phase concentration needed to form a capillary suspension. Capillary suspensions formed by this method can find application in structuring pharmaceutical and food formulations as well as a variety of home and personal care products

Second season of the Saudi-French mission in al-Yamāma, al-Kharj area (11 November - 18 December 2012)

Report of the archaeological, geophysical, archaeozoological and topographical activities of the French-Saudi mission in the oasis of al-Kharj, 80 km South of Riyadh, in the Central Province of Saudi Arabia carried out from November 11 to December 18 2012. It includes chapters on: - The geographic and historical setting - Description on the Registration system - Report of the exploration of the site of al-Yamāma (geophysical survey, topographical survey, archaeological sounding, , excavation of a mosque, zooarchaeological study, restoration process) and a geomorphological study of al-Kharj area

Comparison of different blood pressure indices for the prediction of prevalent diabetic nephropathy in a sub-Saharan African population with type 2 diabetes

Background: The association between blood pressure (BP) and diabetic kidney diseases in Africans has been less well investigated. We assessed and compared the strength of the association and discriminatory capability of systolic (SBP), diastolic (DBP) BP, pulse pressure (PP) and mean arterial blood pressure (MAP) for nephropathy risk in sub-Saharan Africans with type 2 diabetes. Methods: Participants were 420 consecutive individuals (49% men) with type 2 diabetes receiving chronic care in two main referral centres in the two major cities of Cameroon. Logistic regression models were used to compute the odd ratio (OR) and 95% confidence interval (95% CI) for a standard deviation (SD) higher level of SBP (25 mmHg), DBP (13), PP (18) and MAP (16) with nephropathy risk. Discrimination was assessed and compared with c-statistics and relative integrated discrimination improvement (RIDI, %). Results: The adjusted OR (95% CI) for nephropathy with each SD higher BP variable were: 1.45 (1.15-1.84) for SBP, 1.33 (1.06-1.66) for DBP, 1.35 (1.06-1.71) for PP and 1.42 (1.13-1.78) for MAP. C-statistic comparison showed no difference in discrimination of models with each of the BP variables (p-values B 0.69 for c-statistics comparison). However, RIDI statistic always showed and enhancement in models discrimination when other BP variables were replaced with SBP, although such an enhancement was marginal for MAP. Using BP combination modestly improved models? discrimination. Conclusion: SBP was the best predictor of prevalent nephropathy in this population, while DBP was the less effective. This may have implication for kidney disease risk stratification and protection