Publications by authors named "Eugene Sobngwi"

138 Publications

Antidyslipidemic Potential of Water-Soluble Polysaccharides of in MACAPOS-2-Induced Obese Rats.

Evid Based Complement Alternat Med 2021 18;2021:2452057. Epub 2021 Aug 18.

Laboratory of Phytoprotection and Valorization of Genetic Resources, Biotechnology Centre-Nkolbisson, P.O. Box 17673 Etetak, Yaoundé, Cameroon.

Increased consumption of high-calorie foods leads to obesity usually associated with metabolic disorders including diabetes, hyperglycemia, and dyslipidemia. is a nonedible mushroom traditionally used in West Cameroon for the treatment of many diseases including hypertension, diabetes, and hepatitis. This study was designed to investigate the antidyslipidemic potential of water-soluble polysaccharides of in MACAPOS-2- (maize, cassava, palm oil, and sugar) induced obese rats. For this purpose, obesity was induced on 6-8-week-old male Wistar rats with a local high-fat diet for four months. polysaccharides (GAPs) obtained by hot water extraction were orally administered to obese rats for two months at different dose levels (50, 100, and 150 mg/kg bodyweight), and its potential was investigated on food consumption, bodyweight gain, serum, and tissue lipids parameters. GAP extract increased the bodyweight gain by raising the food intake of obese rats. Furthermore, the administration of GAP extract at different dose levels significantly decreased the total cholesterol, triglyceride, low-density lipoprotein cholesterol levels, and the atherogenic index from 50 to 150 mg/kg bodyweight. Conversely, GAP extract improved the high-density lipoprotein cholesterol level in obese rats compared with untreated rats after two months' study period. These results indicated that GAP extract may be considered as a novel bioactive compound against dyslipidemia and its associated complications.
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http://dx.doi.org/10.1155/2021/2452057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8390130PMC
August 2021

REPRINT OF: CLASSIFICATION OF DIABETES MELLITUS.

Diabetes Res Clin Pract 2021 Jul 31:108972. Epub 2021 Jul 31.

Boden Institute, University of Sydney, Australia.

Executive Summary This document updates the 1999 World Health Organization (WHO) classification of diabetes. It prioritizes clinical care and guides health professionals in choosing appropriate treatments at the time of diabetes diagnosis, and provides practical guidance to clinicians in assigning a type of diabetes to individuals at the time of diagnosis. It is a compromise between clinical and aetiological classification because there remain gaps in knowledge of the aetiology and pathophysiology of diabetes. While acknowledging the progress that is being made towards a more precise categorization of diabetes subtypes, the aim of this document is to recommend a classification that is feasible to implement in different settings throughout the world. The revised classification is presented in Table 1. Unlike the previous classification, this classification does not recognize subtypes of type 1 diabetes and type 2 diabetes and includes new types of diabetes ("hybrid types of diabetes" and "unclassified diabetes").
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http://dx.doi.org/10.1016/j.diabres.2021.108972DOI Listing
July 2021

Effects of non-surgical treatment of chronic periodontitis on insulin resistance and glucose tolerance in subjects without diabetes (PARODIA 2 study).

J Investig Med 2021 10 14;69(7):1377-1381. Epub 2021 Jul 14.

Department of Internal Medicine and Specialties, University of Yaounde I Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon

This study aimed to assess the effects of non-surgical periodontal treatment (NSPT) of chronic periodontitis on insulin sensitivity, glucose tolerance, and serum C reactive protein (CRP) level in individuals without diabetes. Twenty individuals without diabetes with chronic periodontitis underwent NSPT, which consisted of complete scaling, polishing, root planing, and irrigation of the periodontal pockets with a 10% povidone-iodine solution. Periodontal indices (plaque index, gingival bleeding index, pocket depth, and clinical attachment loss), insulin sensitivity using the Short Insulin Tolerance Test index (KITT), glucose tolerance derived from oral glucose tolerance test, and serum CRP level were measured before and 3 months after the intervention. This study was carried out at the National Obesity Center of Yaoundé Central Hospital, Cameroon. After 3 months, we observed significant improvement in periodontal parameters (all p<0.001) and insulin sensitivity (3.72 (2.99-4.17) %/min before treatment vs 4.04 (3.67-4.78) %/min after treatment, p=0.001) and significant decrease in serum CRP level (2.35 (1.46-4.18) mg/L before vs 1.53 (1.03-2.12) mg/L after, p=0.033). There was a trend toward improvement in glucose tolerance, although not statistically significant after the intervention. This study suggests that NSPT of chronic periodontitis in individuals without diabetes is associated with increased insulin sensitivity and decreased serum CRP levels.Trial registration number NCT02830113.
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http://dx.doi.org/10.1136/jim-2021-001831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485124PMC
October 2021

Association between measures of adiposity and blood pressure levels in adult Cameroonians.

Health Sci Rep 2021 Jun 3;4(2):e259. Epub 2021 May 3.

Non-Communicable Diseases Research Unit Medical Research Council Cape Town South Africa.

Introduction: Several anthropometric measurements are variably recommended to assess adiposity in routine practice, with less agreement on their comparative performance. We assessed and compared the relationship of seven anthropometric measures of adiposity-waist circumference (WC), waist-to-height ratio (WHtR), Body Mass Index (BMI), Ponderal Index (PI), Conicity Index (C index), A Body Shape Index (ABSI), and Body Roundness Index (BRI)-with blood pressure (BP) levels and prevalent hypertension in adult Cameroonians.

Methods: Data were collected as Cameroon's contribution to the global May Measurement Month 2017(MMM17) survey. Participants were nonpregnant adults, who had no BP measurement in the past year and with no prior hypertension diagnosis. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic ≥90 mm Hg. Odds ratios (ORs) for the presence of hypertension per 1 SD increase in each adiposity metrics were estimated in separate logistic regression models. Assessment and comparison of discrimination used the area under the receiver operating characteristics curve (AUC) and nonparametric methods.

Results: We included 14 424 participants (8210 [58.25%] female; 39.84 ± 14.33 years). There was a graded association between measures of adiposity and prevalent screen-detected (newly diagnosed) hypertension, with effect sizes being mostly within the same range across measures of adiposity. AUC for hypertension prediction ranged from 0.709 with PI to 0.721 with BRI for single measures, and from 0.736 to 0.739 with combinations of measures of adiposity.

Conclusion: WC, WHtR, and BRI were strongly associated with BP and better predicted prevalent hypertension, with effects enhanced with the inclusion of BMI.
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http://dx.doi.org/10.1002/hsr2.259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093855PMC
June 2021

Non-autoimmune diabetes mellitus and the risk of virus infections: a systematic review and meta-analysis of case-control and cohort studies.

Sci Rep 2021 04 26;11(1):8968. Epub 2021 Apr 26.

Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, 3851, Yaoundé, Cameroon.

A significant number of studies invoked diabetes as a risk factor for virus infections, but the issue remains controversial. We aimed to examine whether non-autoimmune diabetes mellitus enhances the risk of virus infections compared with the risk in healthy individuals without non-autoimmune diabetes mellitus. In this systematic review and meta-analysis, we assessed case-control and cohort studies on the association between non-autoimmune diabetes and viruses. We searched PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Web of Science with no language restriction, to identify articles published until February 15, 2021. The main outcome assessment was the risk of virus infection in individuals with non-autoimmune diabetes. We used a random-effects model to pool individual studies and assessed heterogeneity (I) using the χ2 test on Cochrane's Q statistic. This study is registered with PROSPERO, number CRD42019134142. Out of 3136 articles identified, we included 68 articles (90 studies, as the number of virus and or diabetes phenotype varied between included articles). The summary OR between non-autoimmune diabetes and virus infections risk were, 10.8(95% CI: 10.3-11.4; 1-study) for SARS-CoV-2; 3.6(95%CI: 2.7-4.9, I = 91.7%; 43-studies) for HCV; 2.7(95% CI: 1.3-5.4, I = 89.9%, 8-studies;) for HHV8; 2.1(95% CI: 1.7-2.5; 1-study) for H1N1 virus; 1.6(95% CI: 1.2-2.13, I = 98.3%, 27-studies) for HBV; 1.5(95% CI: 1.1-2.0; 1-study) for HSV1; 3.5(95% CI: 0.6-18.3 , I = 83.9%, 5-studies) for CMV; 2.9(95% CI: 1-8.7, 1-study) for TTV; 2.6(95% CI: 0.7-9.1, 1-study) for Parvovirus B19; 0.7(95% CI: 0.3-1.5 , 1-study) for coxsackie B virus; and 0.2(95% CI: 0-6.2; 1-study) for HGV. Our findings suggest that, non-autoimmune diabetes is associated with increased susceptibility to viruses especially SARS-CoV-2, HCV, HHV8, H1N1 virus, HBV and HSV1. Thus, these viruses deserve more attention from diabetes health-care providers, researchers, policy makers, and stakeholders for improved detection, overall proper management, and efficient control of viruses in people with non-autoimmune diabetes.
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http://dx.doi.org/10.1038/s41598-021-88598-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076178PMC
April 2021

Effect of Topical Capsaicin on Painful Sensory Peripheral Neuropathy in Patients with Type 2 Diabetes: A Double-Blind Placebo-Controlled Randomised Clinical Trial.

Cureus 2020 Oct 25;12(10):e11147. Epub 2020 Oct 25.

Diabetes and Endocrinology, Central Hospital, Yaounde, CMR.

Objective The aim of this study was to evaluate the efficacy of capsaicin in inducing significant pain relief in a population of sub-Saharan African type 2 diabetic patients with painful peripheral neuropathy. Design This was a prospective double-blind placebo-controlled randomised clinical trial. Setting A single tertiary-level hospital diabetes center in Yaounde, Cameroon. Participants Twenty-two participants with type 2 diabetes mellitus, presenting with painful diabetic neuropathy, aged 18 years and above. Intervention Participants were equally randomised to capsaicin or placebo. Each drug was to be applied on the lower limbs thrice daily. Follow-up was done every two weeks for eight weeks.  Main outcome measure Reduction in the median pain score from baseline, as assessed by the Visual Analogue Scale.  Results Twenty-two participants aged 57.5 (50-60) years with a median pain intensity of 6.8 units in the capsaicin group and 5.8 units in the placebo group were included; at inclusion, there was no significant difference in the two groups (p=0.29). After two weeks, the value of pain intensity was 3.3 [2.5-4.0] vs 5.0 [4.0-7.4] (p=0.003); at week four, 3.0 [2.5-3.3] vs 5.0 [4.2-5.5] (p=0,02); at week six, 3.3 [2.5-4.0] vs 4.8 [4.0-6.0] (p=0.03); and at week eight, 6.6 [6.0-7.0] vs 5.2 [5.0-6.0] (p=0.54) for capsaicin and placebo respectively. Conclusion This study, carried out due to a paucity of information on the effect of capsaicin and painful diabetic neuropathy in sub-Saharan African diabetes patients, shows that capsaicin significantly reduces neuropathic pain with worsening after eight weeks of use. Trial registration number Pan Africa Trial Registry: PACTR202003714748946.
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http://dx.doi.org/10.7759/cureus.11147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685815PMC
October 2020

The Follow-Up and Well-Being of Geriatric Outpatients During COVID-19 Pandemic in Cameroon: Insights From the Yaounde Central Hospital.

Gerontol Geriatr Med 2020 Jan-Dec;6:2333721420959242. Epub 2020 Sep 25.

University of Yaounde, Yaounde, Cameroon.

Although total confinement has not been adopted by the government of Cameroon, the COVID-19 pandemic is keeping geriatric patients out of hospital, despite a decline in their health status. In addition, the pandemic might have a significant effect on their general well-being. This study aimed to examine the effects of the COVID-19 pandemic on the follow-up and well-being of older outpatients seen at geriatric consultation in Cameroon. We carried out a telephone survey of patients who did not attend an appointment at our geriatrics outpatient clinic on April 2020. Overall, 30 participants were recruited of whom 70% were female ( = 21) with a median age of 74 years (IQR 68.8-85). Most patients (73%,  = 22) did not attend their appointment because of fear of being infected by SARS-CoV-2 at hospital. Approximately 23% ( = 7) of participants reported a decline of their functional status since the last geriatric visit. Loss of appetite and weight loss were both reported in 30% ( = 9) of patients. Half of participants ( = 15) self-rated their health status as bad and three of them died in private health facilities. Strategies to ensure a continuum of care for this vulnerable population during this pandemic are highly needed in our setting.
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http://dx.doi.org/10.1177/2333721420959242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522829PMC
September 2020

Assessment of Systems and Services for Management of Diabetes and Diabetic Retinopathy in Cameroon.

Ophthalmic Epidemiol 2021 04 31;28(2):114-121. Epub 2020 Jul 31.

Faculty of Medicine and Biomedical Sciences, University of Yaoundé I., Yaoundé, Cameroon.

Aim: To evaluate systems and services for management of diabetes and diabetic retinopathy.

Methodology: The National Program for Blindness Control conducted a nationwide descriptive study from 1 February to 31 October 2016. Data was collected using WHO's:"Tool Assessment of Diabetic Retinopathy and Diabetes Management Systems" adapted to the context. Using direct interviews, all previously identified stakeholders, were involved from all levels of management and throughout the territory. The IBM version 20 software permitted analysis.

Results: Out of the 48 individuals selected, 46 agreed to participate in the survey. Four participants (8.7%) worked at the central level of the Ministry of Public Health, 2 (4.4%) were NGOs partners, 6 (13%) diabetic patients, and 34 (73.9%) health staff. According to the answers of participants, diabetes stands among priorities in the national health policy. Diabetic care services have been integrated into the National action plan for Chronic Non-Communicable Diseases, but a specific program for control of diabetes has not been created neither are national guidelines recommended by the Ministry available. Some health facilities provide care for diabetes and its complications. Modern technologies for evaluation and follow-up of diabetes of its complications are available only in tertiary level hospitals and in some private clinics. The cost of care obtained is the responsibility of the patients and families.

Conclusion: The political will to manage diabetes and diabetic retinopathy is recognized by stakeholders and beneficiaries but not translated into an effective program. A suitable implementation strategy is necessary.
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http://dx.doi.org/10.1080/09286586.2020.1799414DOI Listing
April 2021

Metabolic effects of exposure to pesticides during gestation in female Wistar rats and their offspring: a risk factor for diabetes?

Toxicol Res 2020 Jul 4;36(3):249-256. Epub 2020 Feb 4.

Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, 3851 Yaoundé, Cameroon.

Some pesticides increase the risk of type 2 diabetes, but whether fetal exposure carries transgenerational risk remains unknown. We evaluated the metabolic effects of gestational exposure to chlorpyrifos and imidacloprid in female Wistar rats and their offspring. We studied female nulliparous Wistar rats, including six exposed to imidacloprid (IMI) and six to chlorpyrifos (CPF) once daily throughout gestation at 1/10 lethal dose 50, while six (control group) received distilled water. These were explored 1 month after the birth of the offspring, while their offspring were explored at weaning (4 weeks) and adult age (12 weeks). Blood glucose, insulin and lipid profile were determined at each stage, while glucose transporter 4 (GLUT4) and nuclear factor kappa beta (NFkβ) protein expression was measured in skeletal muscle at the end of follow up. Exposure to pesticides was associated with significantly higher fasting glucose (+25.4 to 30.9%) and insulin (> 100%) levels, with > 100% increased insulin resistance (HOMA-IR), - 18.3 to - 21.1% reduced HDL-cholesterol and + 60.9 to + 102.6% increased LDL-cholesterol in mothers. GLUT4 expression was reduced by 28.9-42.3% while NFkβ expression increased by 32.8-35.4% in mothers. In offspring, similar abnormalities were observed at weaning (+ 18.4 to 67.4% fasting glucose, + 57.1 to 72.2% LDL-cholesterol, + 72.3 to 78.2% fasting insulin), persisting at adult age with decreased expression of GLUT4 (- 52.8 to 54.5%) and increased expression of NFkβ (+ 30.5 to 30.7%). Gestational exposure to imidacloprid and chlorpyrifos induces hyperglycemia, insulin resistance and dyslipidemia in female Wistar rats and their offspring. The effects on offspring persist until adult age, suggesting intergenerational adverse effects.
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http://dx.doi.org/10.1007/s43188-019-00028-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351921PMC
July 2020

Use of capillary ketones monitoring in treatment of mild ketotic crisis in people with ketosis-prone atypical diabetes.

J Investig Med 2020 08 14;68(6):1193-1195. Epub 2020 Jul 14.

Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.

This study was carried out to assess the potential reduction in duration of intensive diabetic ketoacidosis treatment in adults with ketosis-prone atypical diabetes (KPD) when using capillary versus urinary ketones. In this cross-sectional study, we included 20 people with KPD presented at the National Obesity Center of the Yaoundé Central Hospital with hyperglycemic decompensation (random capillary glucose ≥13 mmol/L) and significant ketosis (ketonuria≥++) requiring intensive insulin treatment. In all subjects, intensive insulin treatment was initiated at 10 UI per hour with simultaneous measurement of capillary beta-hydroxybutyrate and ketonuria every 2 hours until disappearance of ketonuria. Time-to-disappearance of urine ketones was compared with the time-to-normalization of capillary β-hydroxybutyrate concentrations. Subjects were aged 46±13 years with a median duration of diabetes of 1.5 (IQR: 0-2.5) years. On admission, the mean blood glucose was 22.8±5 mmol/L and capillary ketones level was 2.9±2.7 mmol/L. The median time-to-disappearance of ketonuria was 5 (IQR: 3-8) hours compared with the time-to-normalization of capillary β-hydroxybutyrate of 4 (IQR: 2-6) hours, p=0.0002. The absolute difference in time-to-normalization of ketonuria versus ketonemia was 2 (IQR: 1-3) hours and the relative time reduction of treatment was 32.5%±18.0%. Our results suggested that the use of capillary ketones versus ketonuria would allow a significant reduction in duration of intensive insulin treatment by one third in people with KPD.
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http://dx.doi.org/10.1136/jim-2019-001267DOI Listing
August 2020

Findings from Community-Based Screenings for Type 2 Diabetes Mellitus in at Risk Communities in Cape Town, South Africa: A Pilot Study.

Int J Environ Res Public Health 2020 04 21;17(8). Epub 2020 Apr 21.

Non-Communicable Diseases Research Unit, South African Medical Research Council (SAMRC), Cape Town 7505, South Africa.

Completed and ongoing implementation activities globally advocate for community-based approaches to improve strategies for type 2 diabetes prevention. However, little is known about such strategies in the African region where there are higher relative increases in diabetes prevalence. We reported findings from the first 8-month pilot phase of the South African diabetes prevention program. The study was conducted across eight townships (four black and four mixed-ancestry communities) in Cape Town, South Africa, between August 2017 and March 2018. Participants were recruited using both random and self-selected sampling techniques because the former approach proved to be ineffective; <10% of randomly selected individuals consented to participate. Non-laboratory-based diabetes risk screening, using the African diabetes risk score, and based on targeted population specific cut-offs, identified potentially high-risk adults in the community. This was followed by an oral glucose tolerance test (OGTT) to confirm prevalent pre-diabetes. Among the 853 adults without prior diabetes who were screened in the community, 354 (43.4%) were classified as high risk, and 316 presented for further screening. On OGTT, 13.1% had dysglycemia, including 10% with screen-detected diabetes and 67.9% with glycated haemoglobin (HbA1c)-defined high risk. Participants with pre-diabetes ( = 208) had high levels of common cardiovascular risk factors, i.e., obesity (73.7%), elevated total cholesterol (51.9%), and hypertension (29.4%). Self-referral is likely an efficient method for selecting participants for community-based diabetes risk screening in Africa. Post-screening management of individuals with pre-diabetes must include attention to co-morbid cardiovascular risk factors.
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http://dx.doi.org/10.3390/ijerph17082876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215538PMC
April 2020

Clinical profile and early therapeutic response to cabergoline of patients with hyperprolactinemia in a Cameroonian population.

Pan Afr Med J 2020 2;35. Epub 2020 Jan 2.

National Obesity Centre, Diabetes and Metabolic Diseases Unit, Yaounde Central Hospital, Yaounde, Cameroon.

Hyperprolactinemia is responsible for 20 to 25% of consultations of secondary amenorrhea and 17% for female infertility. Dopamine agonists are the gold standard treatment of hyperprolactinemia. Although they are associated with various adverse effects, cabergoline is generally preferred due to better compliance, limited side effects and good therapeutic response. However, bromocriptine is widely and satisfactorily used in a context of limited availability of cabergoline. We sought to describe clinical manifestations of hyperprolactinemia and response to cabergoline in a sub Saharan Africa (SSA) setting. We describe the profile of all patients with a diagnosis of hyperprolactinaemia from 1 July 2012 to 15 May 2014 at the Endocrinology Department of Yaoundé Central Hospital. Patients with physiological hyperprolactinemia were not considered. All patients were routinely started on cabergoline at 0.5mg/week or at 1mg/week in case of macroprolactinoma or desire to become pregnant. The duration of follow up was 8-16 months. After three months of treatment, 8 of 10 patients with amenorrhea had menses and serum prolactin levels decreased significantly at month 2-3 (p = 0.025). In conclusion, our study suggests that cabergoline yields an excellent therapeutic response in a short period of time and may thus be cost saving in sub Saharan context despite its unit price.
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http://dx.doi.org/10.11604/pamj.2020.35.2.12883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026510PMC
March 2020

Observational study of disorders of sex development in Yaounde, Cameroon.

J Pediatr Endocrinol Metab 2020 Mar;33(3):417-423

Mother and Child Center of the Chantal Biya Foundation Yaounde, Faculty of Medicine and Biomedical Sciences, Department of Paediatrics, Yaounde, Cameroon.

Introduction According to the current classification of the Lawson Wilkins Pediatric Endocrine Society (LWPES) and the European Society for Pediatric Endocrinology (ESPE) of Disorders of Sex Development (DSD), etiologies vary around the world. Ethnic or genetic diversity probably explains this variability. We therefore conducted the present study on etiologies of DSDs in a country from central Africa. Methods We carried out an observational retrospective study at the Pediatric Endocrinology Unit of the Mother and Child Centre of the Chantal Biya Foundation in Yaounde, Cameroon from May 2013 to December 2019. All patients diagnosed with a DSD were included, and incomplete files excluded. Results We included 80 patients diagnosed with DSD during the study period. The 46,XX DSD were the most frequent in our study population (n = 41, 51.25%), with congenital adrenal hyperplasia (CAH) as the main diagnosis. The 46,XY DSD accounted for 33.75% and sex chromosome DSD group represented 15% of the study population. Conclusions DSDs are not an exceptional diagnosis in a Sub-Saharan context. 46,XX DSD are the most prevalent diagnosis in our setting. The diagnosis of all these affections is late compared to other centers, justifying advocacy for neonatal screening of DSDs in our context.
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http://dx.doi.org/10.1515/jpem-2019-0458DOI Listing
March 2020

Prevalence of Diabetes and Associated Risk Factors among a Group of Prisoners in the Yaoundé Central Prison.

J Diabetes Res 2020 24;2020:5016327. Epub 2020 Jan 24.

Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Background: Diabetes is a public health problem worldwide, associated with increased morbidity and mortality. According to the International Diabetes Federation (IDF) 2017 data, around 425 million people worldwide suffer from diabetes. This number is expected to increase to 629 million in 2045. Various occidental studies reported the increased prevalence and lower control of diabetes among prisoners. However, there is no data on the characteristics of inmates with diabetes in sub-Saharan Africa.

Methods: A cross-sectional study among incarcerated detainees from the Yaoundé Central Prison was conducted from January to July 2017. Diabetes was defined according to the American Diabetes Association (ADA) criteria. Analyzed variables included phenotypic characteristics, lifestyle, the reason for detention, the sentence severity, and the length of detention.

Results: We recruited 437 inmates (344 men) with an average age of 37.0 (95% CI: 35.9-38.3) years. The most frequent age group was 20 to 39 years with 281 (64.7%) inmates, and the mean prison stay was 29.1 (95% CI: 25.7-32.8) months. The prevalence of diabetes in the Yaoundé Central Prison was 9.4%. The main cardiovascular risk factors were a sedentary lifestyle (91.1%), hypertension (39.6%), smoking (31.6%), and alcohol consumption (28.1%). Hypertension ( = 0.005), obesity ( = 0.005), obesity ( = 0.005), obesity ( = 0.005), obesity ( = 0.005), obesity ( = 0.005), obesity (.

Conclusion: Diabetes prevalence in the Yaoundé Central Prison was high, at 9.4%, compared to that in the general population. It was associated with other classical cardiovascular risk factors and factors linked to the sentence (minor and major crimes). This trial is registered with CE00617/CRERSHC/2016.
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http://dx.doi.org/10.1155/2020/5016327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003275PMC
November 2020

Is PCSK9 Associated with Plasma Lipid Levels in a Sub-Saharan African Population of Patients with Obesity and Type 2 Diabetes?

Diabetes Metab Syndr Obes 2019 31;12:2791-2797. Epub 2019 Dec 31.

Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.

Purpose: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key regulator of circulating LDL cholesterol. There are inconsistent data in some populations concerning the association between PCSK9, LDL and CRP. The emerging importance of the inhibition of PCSK9 for the treatment of hypercholesterolemia warrants investigations in different populations. The aim of this study from a Sub-Saharan African population was to evaluate the association between PCSK9 and hs-CRP levels and plasma lipid levels in patients with type 2 diabetes (T2D) and obese and lean controls.

Patients And Methods: A cross-sectional analytical study was conducted in a major hospital in Yaoundé, Cameroon in a cohort of 162 participants (53% females). There were 54 non-obese T2D patients matched for age and sex to 54 obese nondiabetic and 54 nondiabetic lean subjects. PCSK9 level was assessed by sandwich ELISA method and hsCRP by nephelometry.

Results: PCSK9 and hs-CRP levels were significantly higher in obese and T2D subjects when compared to lean controls (p<0.001 and p=0.002, respectively). The association between PCSK9 and triglyceride levels in the overall population was gender dependent (p=0.04) and subgroup analysis showed a significant positive correlation between PCSK9 and triglyceride levels in males but not in females (=0.56, p=0.02 and =0.2 and p=0.1, respectively). Multilinear regression analysis identified BMI as an independent predictor for PCSK9 levels and this association was maintained after adjustment for confounders; adjusted β-coefficient; 36.1 (95% CI; 29.2-47.4). We did not find an association between PCSK9 and any plasma lipid levels in obese and T2D subjects, nor between PCSK9 and hs-CRP levels.

Conclusion: Obese and type 2 diabetes subjects have higher PCSK9 levels when compared to lean controls, suggesting that these metabolic states potentially impact PCSK9 levels in Cameroonian patients.
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http://dx.doi.org/10.2147/DMSO.S234243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946635PMC
December 2019

Smartphone-Assisted Glaucoma Screening in Patients With Type 2 Diabetes: a Pilot Study.

Med Hypothesis Discov Innov Ophthalmol 2020 1;9(1):61-65. Epub 2020 Jan 1.

Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon.

We aimed to determine true and false positives of glaucoma screening, relying solely on photos of the retina, taken with a smartphone. We performed a descriptive and analytical study on patients with type 2 diabetes at the National Obesity Centre, Yaoundé, Cameroon. Participating patients had retinal photography sessions using an iPhone 5s (iOS 10.3.3; Apple, Cupertino, CA) coupled to the Make in India Retinal Camera (MIIRetCam; MIIRetCam Inc., Coimbatore, TN, India). Obtained pictures of the retina were stored and transferred via the internet to an ophthalmologist to assess glaucoma. Selected patients were then invited to undergo a conventional ophthalmological examination to confirm the diagnosis. A total of 395 patients were screened, 39 (including 20 women) were diagnosed with suspicion of glaucoma based on retinal photos, a prevalence rate of 9.87%. The following signs were found; Cup/Disc ratio (C/D) ≥0.5 in 64.1% (25/39), asymmetric C/D >0.2 in 35.9% (14/39), papillary haemorrhage in 10.2% (4/39) and retinal nerve fibre deficiency in 2.5% (1/39). Only 14 of 39 patients with suspicion of glaucoma were examined, giving a lost-to-follow-up rate of 64.1%. Chronic open-angle glaucoma was confirmed in 8 patients (true positives) and absent in 6 patients (false positives). The prevalence of smartphone-detected glaucoma and lost-to-follow-up rates were high. So we need to improve this type of screening, with additional tests like transpalpebral applanation tonometer and the smartphone Frequency Doubling Technique visual field combined with better education of patients to increase their adherence to follow-up.
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January 2020

Short term optimization of glycaemic control using insulin improves sympatho-vagal tone activities in patients with type 2 diabetes.

Diabetes Res Clin Pract 2019 Nov 3;157:107875. Epub 2019 Oct 3.

Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; National Obesity Center and Endocrine and Metabolic Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon.

Introduction: Diabetic cardiac autonomic neuropathy (CAN) is potentially life threatening and its severity might further be aggravated by poor glycaemic control. A decrease in Heart rate variability (HRV) is the earliest finding of CAN even at the sub clinical stage. While intensive glycaemic control prevents the development of CAN in patients with type 1 diabetes, it is not known whether the intensification of glycaemic control using insulin would improve cardiovascular autonomic functions in type 2 diabetes patients. This study aimed to determine the short term effects of optimizing glycaemic control using insulin on the HRV in type 2 diabetes patients.

Methods: We conducted a single arm open label clinical trial. Participants were poorly controlled non-insulin treated type 2 diabetes mellitus patients (HbA1c ≥ 7%). The intervention lasted 60 days and consisted in the intensification of glycaemic control through the initiation of a basal plus insulin regimen with titration of insulin to protocol defined glycaemic targets which were; fasting glycaemia: 0.70-1.30 g/L and post prandial glycaemia <1.80 g/L. Long term HRV measurement was done using a 24-h ambulatory electrocardiographic (ECG) recording on day 0 and day 60. Wilcoxon signed rank test was used to compare differences in HRV parameters before and after the intervention.

Results: A total of 29 (14 males and 15 females) consenting type 2 diabetes mellitus patients without clinical signs of CAN were enrolled and allocated to intervention (14 males and 15 females). The median age was 52 [43-59] years, and duration of diabetes 3.0 [0.6-6.7] years. The intervention induced a reduction in HbA1c from 10.1 [9.1-11.9]% to 6.7 [5.9-6.9]% (p < 0.001) without severe hypoglycaemic events. Concerning HRV parameters, there was a significant improvement in markers of the parasympathetic tone (PNN50: 5.7 [3.6-10.3]% to 8.1 [3.1-16.9]%, p = 0.008) and sympathetic tone (SDNN: 102.01 [90.45-111.05] ms to 122.40 [91.70-135.95] ms, p = 0.01).

Conclusion: The optimization of glycaemic control using a basal plus insulin regimen while inducing a significant reduction in glycated hemoglobin, significantly improves 24-h ambulatory ECG derived sympathetic and parasympathetic activities. This suggests that tight glycaemic control using insulin may revert cardiac autonomic neuropathy in type 2 diabetes mellitus patients.
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http://dx.doi.org/10.1016/j.diabres.2019.107875DOI Listing
November 2019

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study.

JAMA Oncol 2019 12;5(12):1749-1768

Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.

Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.

Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.

Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).

Conclusions And Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.
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http://dx.doi.org/10.1001/jamaoncol.2019.2996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777271PMC
December 2019

The clinical and psychological profiles of patients with hypogonadism, followed in 3 reference hospitals of Cameroon: an observational study.

Pan Afr Med J 2019 22;33:47. Epub 2019 May 22.

National Obesity Center, Endocrinology and Metabolic Disease Unit, Yaoundé Central Hospital, Yaoundé, Cameroon.

Introduction: Hypogonadism refers to a syndrome that results from failure of gonads to function properly. The main concern is considerable rise in morbidity, as shown by increased cardiovascular risk, infertility, osteoporosis and above all, the psychological impact on the life of the patients with hypogonadism. Judicious steroid replacement and culturally-sensitive psychological support before and during steroid therapy remains the key tool in the management of this condition. The present study aimed at filling the knowledge gap on hypogonadism in Cameroon.

Methods: We conducted a cross-sectional study over a period of 12 months, in 3 reference hospitals of Cameroon. We included males and females diagnosed with hypogonadism, aged 16 to 50 years and 16 to 45 years respectively. After a complete clinical examination, patients were invited to fill the modified middlesex hospital questionnaire for psychoneurotic evaluation.

Results: We recruited 59 patients with a sex ratio of 1:1. The mean age of the females and males were 27.7 ± 9.1years and 30.8 ± 11.7 years respectively. Normosmic Idiopathic Hypogonadotropic Hypogonadism (NIHH) was the most common presentation. Compulsive obsessive traits, phobic anxiety and hysterical trait, were most pronounced in these patients. Testosterone titers significantly correlated positively with testicular size and negatively with body mass index (BMI). A significant positive correlation was found between the testicular volumes measured with ultrasound (US) and with the orchidometer.

Conclusion: Normosmic idiopathic hypogonadotropic hypogonadism is the most common presentation of hypogonadism in the study population. There is a significant psychosocial impact requiring further investigation and attention.
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http://dx.doi.org/10.11604/pamj.2019.33.47.18352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689844PMC
September 2019

Gestational Exposure to Pesticides Induces Oxidative Stress and Lipid Peroxidation in Offspring that Persist at Adult Age in an Animal Model.

Toxicol Res 2019 Jul 15;35(3):241-248. Epub 2019 Jul 15.

Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon.

Pesticide exposure may induce biochemical alterations including oxidative stress and lipid peroxidation. However, in the context of developmental origin of health and disease, putative trans-generational effect of exposure to pesticides are insufficiently studied. We therefore aimed to evaluate the biochemical effect of gestational exposure to four pesticides on female Wistar rats and their offspring at adult age. We studied 30 female nulliparous Wistar rats divided into 5 equal groups. Group 1 served as the control group and received distilled water while group 2, 3, 4 and 5 received orally pesticide 1 (imidacloprid), pesticide 2 (chlorpyrifos), pesticide 3 (imidacloprid + lambda cyhalothrin) and pesticide 4 (oxamyl) respectively once daily throughout gestation at a dose equivalent to 1/10 lethal dose 50. The mothers were followed up until one month post gestation. The offspring were followed up from birth until adult age (12 weeks). In all animals at each time point we evaluated malondialdehyde (MDA), oxidative stress and liver function enzymes. There was similar variation of total body weight in all the groups during and after gestation. However, Female Wistar rats of the exposed groups had significant alterations in liver SOD (-30.8% to +64.1%), catalase (-38.8% to -85.7%) and GSH (-29.2% to -86.5%) and; kidney catalase (> 100%), GSH (> 100%). Moreover, MDA, alanine transaminase (ALT) and aspartate transaminase (AST) levels were significantly higher in pesticide exposed rats compared to the control group. Similar alterations in antioxidant enzymes, MDA and liver function enzymes were observed in offspring of treated rats evidenced at weaning and persisting until adult age. Exposure to pesticides causes oxidative stress and lipid peroxidation in exposed female Wistar rats and their offspring. The persistence in offspring at adult age suggests transgenerational adverse effects.
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http://dx.doi.org/10.5487/TR.2019.35.3.241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6629439PMC
July 2019

Short-term effects of perindopril-amlodipine vs perindopril-indapamide on blood pressure control in sub-Saharan type 2 diabetic individuals newly diagnosed for hypertension: A double-blinded randomized controlled trial.

J Clin Hypertens (Greenwich) 2019 07 8;21(7):1002-1008. Epub 2019 Jun 8.

Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.

Poor blood pressure (BP) control contributes to complications in sub-Saharan African (SSA) type 2 diabetic individuals. Experts have advocated the use of combination therapies for effective BP control in these patients. The suggested combinations should include a RAAS antagonist and either a CCB or a thiazide diuretic; however, their efficacy is yet to be established in SSA. We investigated the short-term effects of two combination therapies on BP control in SSA type 2 diabetic individuals. This was a double-blinded randomized controlled trial conducted at the Yaoundé Central Hospital (Cameroon) from October 2016 to May 2017. We included type 2 diabetic patients, newly diagnosed for hypertension. After baseline assessment and 24-hour ABPM, participants were allocated to receive either a fixed combination of perindopril + amlodipine or perindopril + indapamide for 42 days. Data analyses followed the intention-to-treat principle. We included fifteen participants (8 being females) in each group. Both combinations provided good circadian BP control after 6 weeks with similar efficacy. Twenty-four-hour SBP dropped from 144 to 145 mm Hg vs 128 to 126 mm Hg with perindopril-amlodipine and perindopril-indapamide, respectively (P = 0.003 for both groups). Twenty-four-hour DBP dropped from 85 to 78 mm Hg (P = 0.013) vs 89 to 79 mm Hg (P = 0.006) in the same respective groups. No significant adverse effect was reported. A fixed initial combination of perindopril-amlodipine or perindopril-indapamide achieved similar effective BP control after 6 weeks in SSA type 2 diabetic individuals with newly diagnosed hypertension. Therefore, these combinations can be used interchangeably in this indication.
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http://dx.doi.org/10.1111/jch.13557DOI Listing
July 2019

Validation of Smartphone-Based Retinal Photography for Diabetic Retinopathy Screening.

Ophthalmic Surg Lasers Imaging Retina 2019 05;50(5):S18-S22

Backround And Objective: Screening for diabetic retinopathy (DR) is cost-effective when compared with disability loss for those who go blind in the absence of a screening program. We aimed to evaluate the sensitivity and specificity of a smartphone-based device for the screening and detection of DR.

Patients And Methods: A cross-sectional study of 220 patients with diabetes (440 eyes, all patients age 25 years or older) was completed. Tropicamide 0.5% was used for iris dilation followed by an indirect ophthalmoscopy using a 20-D lens. Retinal images were later obtained using a smartphone attached to an adaptable camera device. Retinal images permitted the visualization of the macular and papillary regions and were sent without compression via the internet to a retinal specialist for interpretation. Sensitivity and specificity were calculated for all cases and stages of DR.

Results: Using our standard examination method, the prevalence of DR and macular edema were 13.6% and 6.4%, respectively. With the smartphone-based retinal camera, the prevalence of DR and macular edema were 18.2% and 8.2%, respectively. Sensitivity and specificity for the detection of all stages of DR was 73.3% and 90.5%, respectively. For the detection of macular edema, sensitivity was 77.8%, and specificity was 95%. For severe nonproliferative DR (NPDR), sensitivity and specificity were 80% and 99%, respectively; for proliferative DR (PDR), they were both 100%. In the early stages of DR, specificity was 89.8% for mild NPDR and 97.1% for moderate NPDR. Sensitivity was 57.1% and 42.9%, respectively.

Conclusion: Screening for DR using a smartphone-based retinal camera has a satisfactory specificity at all DR stages. Its sensitivity seems to be high only in the stages of DR necessitating a specific therapeutic decision (eg, macular edema, severe NPDR, and PDR). A smartphone-based retinal camera may be a useful device to screen for DR in resource-limited settings. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:S18-S22.].
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http://dx.doi.org/10.3928/23258160-20190108-05DOI Listing
May 2019

Effect of patient education through a social network in young patients with type 1 diabetes in a Sub-Saharan context.

Pediatr Diabetes 2019 05 7;20(3):361-365. Epub 2019 Mar 7.

Faculty of Medicine and Biomedical Sciences, Department of Pediatrics, University of Yaounde I, Yaounde, Cameroon.

Background: Patient education is essential in management of type 1 diabetes (T1D).

Objective: To evaluate the short-term impact of patient education through WhatsApp on the knowledge of the disease and glycemic control of adolescents and young adults living with T1D in a resource-limited setting.

Methods: A double arm non-randomized clinical trial was carried out in two clinics for diabetes in Cameroon, over a period of 2 months. The intervention consisted in providing four sessions of patient education through WhatsApp to an intervention group compared to a control group with their classic follow-up. We evaluate their knowledge on diabetes, acute events, and glycemic control, before and after intervention.

Results: We recruited 54 patients of which 25 subjects and 29 controls. Median age was 19 (17-20) and 19 (17-21) years for the intervention and control group, respectively. There was a significant improvement of knowledge on diabetes in the intervention group from 13/20 to 16/20 (P < 0.01) after 2 months, compared to a slight decrease in control group (from 11.6/20 to 11.3/20 (P = 0.33). The mean proportion of acute complications decreased from 28% to 16% (P = 0.46) in the intervention group, and increased from 7% to 34%, P = 0.01 in the control group. There was no improvement in glycosylated hemoglobin level in both groups.

Conclusion: Patient education through social network helped to improve knowledge on T1D and to reduce acute complications without an improvement of glycemic control after 2 months.
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http://dx.doi.org/10.1111/pedi.12835DOI Listing
May 2019

Glycemic control and correlates in a group of sub Saharan type 1 diabetes adolescents.

BMC Res Notes 2019 Jan 22;12(1):50. Epub 2019 Jan 22.

Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.

Objectives: This study aims to describe the prevalence of glycemic control and related factors in a population of Sub-Saharan African T1D patients. We carried out a cross-sectional study including children and adolescents from seven different centers of the Changing Diabetes in Children (CDiC) program. All children enrolled in the program where recruited after parental consent. Diabetes history, daily practice anthropometrics parameters and HbA1c were assessed for each participant.

Results: We enrolled 95 children adolescents, aged from 06 to 19 years. The mean HbA1c was 9.2 ± 2.5% and 67.4% of participant had poor glycemic control. There was an association between study level of the patients (p = 0.03), healthy eating habits (p < 0.001), diabetes duration (p < 0.001) and level of glycemic control on univariate analysis. On multivariate analysis, diabetes diagnosed for more than 2 years was associated to a good control compared to those with diagnosis that is more recent. Glycemic control of adolescents with type1 diabetes remain very poor in Cameroon despite the implementation of free diabetes care through the program CDiC.
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http://dx.doi.org/10.1186/s13104-019-4054-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341641PMC
January 2019

Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016.

N Engl J Med 2018 12;379(25):2429-2437

Background: The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases.

Methods: We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.

Results: The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation.

Conclusions: In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).
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http://dx.doi.org/10.1056/NEJMoa1804492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247346PMC
December 2018

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

BMC Res Notes 2018 Nov 15;11(1):814. Epub 2018 Nov 15.

National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon.

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.
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http://dx.doi.org/10.1186/s13104-018-3922-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238279PMC
November 2018

Expert Opinion: Patient Selection for Premixed Insulin Formulations in Diabetes Care.

Diabetes Ther 2018 Dec 3;9(6):2185-2199. Epub 2018 Nov 3.

Department of Endocrinology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Premixed insulins are an important tool for glycemic control in persons with diabetes. Equally important in diabetes care is the selection of the most appropriate insulin regimen for a particular individual at a specific time. Currently, the choice of insulin regimens for initiation or intensification of therapy is a subjective decision. In this article, we share insights, which will help in rational and objective selection of premixed formulations for initiation and intensification of insulin therapy. The glycemic status and its variations in a person help to identify the most appropriate insulin regimen and formulation for him or her. The evolution of objective glucometric indices has enabled better glycemic monitoring of individuals with diabetes. Management of diabetes has evolved from a 'glucocentric' approach to a 'patient-centered' approach; patient characteristics, needs, and preferences should be evaluated when considering premixed insulin for treatment of diabetes.Funding: Novo Nordisk, India.
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http://dx.doi.org/10.1007/s13300-018-0521-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250631PMC
December 2018

Diabetes and HIV.

Curr Diab Rep 2018 10 8;18(11):125. Epub 2018 Oct 8.

National Obesity Center and Endocrine and Metabolic Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon.

Purpose Of Review: This review seeks to address the epidemiology and pathophysiological basis of the interaction between HIV infection and diabetes and the implication for treatment. Its importance stems from the current context of the growing burden of both conditions and the possible mechanisms of interactions that may exist but not yet sufficiently examined.

Recent Findings: HIV infection is associated with increased risk of insulin resistance, and ART is associated with metabolic derangement and the occurrence of type 2 diabetes. The increasing survival among people with HIV infection in developing countries is paralleled by a growing burden of chronic non-communicable diseases (NCDs) especially cardiovascular diseases and diabetes mellitus. The prevalence of diabetes mellitus is higher in HIV-positive persons compared to the general population, and especially those with associated hepatitis C virus (HCV) co-infection. Antiretroviral therapy (ART) during chronic HIV infection is the most incriminated risk factor for the development of diabetes mellitus through diverse mechanisms depending on the ART leading to insulin resistance and increased inflammatory status. A staggering 629 million of people 20-79 years are projected to have diabetes by 2045 while the world will soon enter the fourth decade of the HIV infection. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Although the relative contribution of each risk factor has not yet been quantified, several lines of evidence suggest that ART is a major contributor to hyperglycemia in HIV infection. ARTs have also led to an increase in metabolic dysfunction, including insulin resistance syndromes, dyslipidemia, and lipodystrophy. The association between ARTs and the risk of developing diabetes therefore calls for a careful choice of medication and evaluation of the risk of developing diabetes.
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http://dx.doi.org/10.1007/s11892-018-1076-3DOI Listing
October 2018
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