The causes, treatment, and outcome of acute heart failure in 1006 Africans From 9 countries

Background: Acute heart failure (AHF) in sub-Saharan Africa has not been well characterized. Therefore,wesought to describe the characteristics, treatment, and outcomes of patients admitted with AHF in sub-Saharan Africa. Methods: The Sub-Saharan Africa Survey of Heart Failure (THESUS–HF) was a prospective, multicenter, observational survey of patients with AHF admitted to 12 university hospitals in 9 countries. Among patients presenting with AHF, we determined the causes, treatment, and outcomes during 6 months of follow-up. Results: From July 1, 2007, to June 30, 2010, we enrolled 1006 patients presenting with AHF. Mean (SD) age was 52.3 (18.3) years, 511 (50.8%) were women, and the predominant race was black African (984 of 999 [98.5%]). Mean (SD) left ventricular ejection fraction was 39.5% (16.5%)... Conclusions: In African patients, AHF has a predominantly nonischemic cause, most commonly hypertension. The condition occurs in middle-aged adults, equally in men and women, and is associated with high mortality. The outcome is similar to that observed in non- African AHF registries, suggesting that AHF has a dire prognosis globally, regardless of the cause

Gender differences in clinical characteristics and outcome of acute heart failure in sub-Saharan Africa: results of the THESUS-HF study

Background: The impact of gender on the clinical characteristics, risk factors, co-morbidities, etiology, treatment and outcome of acute heart failure in sub-Saharan Africa has not been described before. The aim of this study was to evaluate the sex diffe rences in acute heart failure in sub-Saharan Africa using the data from The sub-Saharan Africa Survey of Heart Failure (THESUS-HF). Methods and results: 1,006 subjects were recruited into this prospective multicenter, international observational heart failure survey. The mean age of total population was 52.4 years (54.0 years for men and 50.7 years for women). The men were significantly older (p = 0.0045). Men also presented in poorer NYHA functional class (III and IV), p = 0.0364). Cigarette smoking and high blood pressure were significantly commoner in men (17.3 vs. 2.6 % and 60.0 vs. 51.0 % respectively). On the other hand, atrial fibrillation and valvular heart disease were significantly more frequent in women. The mean hemoglobin concentration was lower in women compared to men (11.7 vs. 12.6 g/dl, p ≤ 0.0001), while the blood urea and creatinine levels were higher in men (p \u3c 0.0001). LV systolic dysfunctional was also seen more in men. Men also had higher E/A ratio indicating higher LV filling pressure. Outcomes were similar in both sexes. Conclusions: Although the outcome of patients admitted for AHF in sub-Saharan regions is similar in men and women, some gender differences are apparent suggesting that in men more emphasis should be put on modifiable life risk factors, while in women prevention of rheumatic heart diseases and improved nutrition should be addressed vigorously

A Randomized Parallel Controlled Study of the Efficacy and Safety of Lornoxicam Versus Etoricoxib after Total Knee Arthroplasty

Objectives: The aim of the study was to compare the postoperative analgesic efficacy and safety of lornoxicam versus etoricoxib for the first 48 hours after surgery. Methods: We conducted a prospective randomized controlled study on 110 patients ASAI-II scheduled for TKA under spinal anesthesia, who received either lornoxicam 8 mg PO at the end of surgery and a further 8 mg after 12 hours (Lornoxicam Group) or etoricoxib 120 mg at the end of surgery and one placebo pill after 12 hours (Etoricoxib Group). The primary outcome measure was the cumulative dose of morphine administered during the first postoperative 24 and 48 hours. Secondary outcomes were duration of analgesia and the side effects of the treatment. Results: The groups were similar in terms of demographic data. There are no significant differences between groups regarding the morphine consumption at 24 hours (36.2 ± 12 in Lornoxicam group and 34.5 ± 14.1 in Etoricoxib group) and 48 hours postoperatively (15.6 ± 12.8 in Lornoxicam group and 18 ± 12.3 in Etoricoxib group) or between the duration of analgesia (314.5 ± 70.4 in Lornoxicam group and 320.4 ± 89.2 in Etoricoxib group). Conclusion: Postoperative use of lornoxicam for 48 hours in the dose of 8 mg PO twice a day in patients undergoing TKA has an analgetic effect comparable to etoricoxib 120 mg, fewer patients experienced adverse symptoms in the etoricoxib group, but the difference was not statistically significant

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Awareness and low uptake of post exposure prophylaxis for HIV among clinical medical students in a high endemicity setting

BACKGROUND: Adequate knowledge and practices on post exposure prophylaxis (PEP) for HIV among health care providers are crucial for HIV prevention. However there is limited data on PEP knowledge and practice from developing countries where the burden of HIV infection continues to increase. We assessed the knowledge of clinical medical students on PEP, their practices in response to occupational exposure to HIV, as well as the determinants of good knowledge on PEP. METHODS: A cross-sectional study was conducted in November 2014 involving 154 consecutively recruited clinical medical students (4(th)-6(th) year undergraduates). Data were acquired using a structured questionnaire. Knowledge on PEP was assessed using a questionnaire comprising 25 questions and categorized as: good (20 or more correct answers), moderate (13–19 correct answers) and poor (12 or fewer correct answers). RESULTS: For the 154 students included (57.8 % being male), the mean age was 23.2 ± 2.4 years, and 89 % had heard about PEP for HIV. The majority of students had moderate (61.7 %) and poor (32.5 %) knowledge on PEP. Overall knowledge score increased with increasing level of studies (p < 0.05). Only 10 (6.5 %) had had previous training on PEP, most of whom were senior level students (p = 0.01). Fifty-four students (35.1 %) knew the appropriate duration of PEP and this awareness increased with level of studies (p = 0.001). Of the 81 (52.6 %) who reported occupational exposure to HIV in the past, only 4 (4.9 %) received PEP. CONCLUSIONS: Overall, knowledge on PEP among clinical medical students in this setting was non-optimal with very low uptake PEP. Intensification of HIV curricula to involve PEP as well as continuous medical education programs and workshops are potential avenues to improve awareness in this vulnerable population

Priorities to reduce the burden of hypertension in Africa through ACHIEVE

No abstract availabl

Relationship between self-reported weight change, educational status, and health-related quality of life in patients with diabetes in Luxembourg

&lt;p&gt;&lt;b&gt;BACKGROUND: &lt;/b&gt;The aim of this study was to assess the relationship between self-reported weight change, socio-economic status, and health-related quality of life (HRQOL) in patients with diabetes, 5 years after they underwent coronary angiography.&lt;/p&gt;&lt;p&gt;&lt;b&gt;METHODS: &lt;/b&gt;Between 2013 and 2014, 1873 of 4391 patients (319 with diabetes) who underwent coronary angiography between 2008 and 2009 participated in a follow-up study. Three out of four domains of the World Health Organization Quality of Life (WHOQOL)-BREF (physical health, psychological health and social relationships) were surveyed during the follow-up period. To assess the relationship between weight change and HRQOL, generalized linear models were constructed for every dimension of the WHOQOL-BREF, with educational level as a predictor and sex, age, marital status, smoking status, hypertension, cholesterol, ischemic heart disease, acute myocardial infarction, and stable angina pectoris as covariates.&lt;/p&gt;&lt;p&gt;&lt;b&gt;RESULTS: &lt;/b&gt;The mean age of the patients was 70 years and almost three-quarters of the patients (72.7 %) were men. During the 12 months preceding the follow-up survey, 22.6 % of the patients reported weight loss, 20 % reported weight gain, and 57.4 % reported no weight change. There were significant differences in the HRQOL scores between patients who reported weight loss and those who reported either weight gain or unchanged weight. The most affected domains were physical and psychological health, with higher scores for patients who reported weight loss (54.7 and 67.2, respectively) than those who reported weight gain (46.3 and 58.5, respectively). The generalized linear model confirmed higher HRQOL scores among patients who reported weight loss and revealed an association between the HRQOL score and education level.&lt;/p&gt;&lt;p&gt;&lt;b&gt;CONCLUSION: &lt;/b&gt;Weight change and education level were associated with HRQOL in patients with diabetes. Self-reported weight loss and no weight change were positively associated with HRQOL in patients with diabetes, while weight gain was negatively associated with HRQOL.&lt;/p&gt;</p

Right ventricular remodeling in pulmonary hypertension due to left heart disease in a sub-saharan tertiary hospital. an echocardiographic analysis of patients with hypertensive heart disease

Objective: Right ventricular (RV) dysfunction has been shown to occur early and has major prognostic implications for patients with pulmonary arterial hypertension (PAH), but in patients with pulmonary hypertension (PH) due to left heart disease (LHD), data is scarce. We aimed to compare the echocardiographic changes of right heart in a group of patients having hypertensive heart disease with pulmonary hypertension (HHDPH) and hypertensive heart disease no pulmonary hypertension (HHDnPH). Design and Method: This was a cross sectional hospital-based study. 109 participants underwent a detailed structural and functional 2D echocardiographic right heart assessment. PH was defined as an estimated right ventricular systolic pressure at or greater than 35 mmHg. 34 patients with HHDPH were compared to 65 patients with HHDnPH while 10 were excluded due to PH associated with chronic pulmonary disease, chronic thromboembolism & HIV. Data was analyzed using SPSS v. 22. Results: Overall, the mean age was 59.1 ± 14.3years and 56.6% were female. No age or sex difference was observed between HHDnPH and HHDPH groups. Compared to HHDnPH group, patients with HHDPH had a longer mean duration of hypertension (9.6 vs. 4.8 years, p = 0.001) and presented with lower mean systolic (138.6 ± 23.1 vs 153.8 mmHg, p = 0.02) and diastolic blood pressures (79.4 ± 14.4 vs 92.4 mmHg, p = 0.001). Right ventricular (RVfwt) free wall thickness (0.8 ± 0.2 cm vs 0.6 ± 0.2 cm, p = 0.014), RV basal diameter (4.1 ± 0.7 cm vs 3.6 ± 0.6 cm, p < 0.001), and right atrial area (21.6 ± 8.1 cm2 vs 13.9 ± 3.4 cm2, p < 0.001) were higher in those with HHDPH compared to HHDnPH, while Tricuspid Annular Plane Systolic Excursion (TAPSE) (1.9 ± 0.5 cm vs 2.3 ± 0.5 cm, p < 0.001) was lower in HHDPH. Conclusions: Our findings suggest that right heart remodeling occurs in parallel with progression of left heart disease and probably worsen with superimposition of pulmonary hypertension. A multicenter study of a larger sample is warranted to confirm these findings.No Full Tex