Downsized: gray whales using an alternative foraging ground have smaller morphology

Describing individual morphology and growth is key for identifying ecological niches and monitoring the health and fitness of populations. Eastern North Pacific ((ENP), approximately 16 650 individuals) gray whales primarily feed in the Arctic/sub-Arctic regions, while a small subgroup called the Pacific Coast Feeding Group (PCFG, approximately 212 individuals) instead feeds between northern California, USA and British Columbia, Canada. Evidence suggests PCFG whales have lower body condition than ENP whales. Here we investigate morphological differences (length, skull, and fluke span) and compare length-at-age growth curves between ENP and PCFG whales. We use ENP gray whale length-at-age data comprised of strandings, whaling, and aerial photogrammetry (1926-1997) for comparison to data from PCFG whales collected through non-invasive techniques (2016-2022) to estimate age (photo identification) and length (drone-based photogrammetry). We use Bayesian methods to incorporate uncertainty associated with morphological measurements (manual and photogrammetric) and age estimates. We find that while PCFG and ENP whales have similar growth rates, PCFG whales reach smaller asymptotic lengths. Additionally, PCFG whales have relatively smaller skulls and flukes than ENP whales. These findings represent a striking example of morphological adaptation that may facilitate PCFG whales accessing a foraging niche distinct from the Arctic foraging grounds of the broader ENP population.

Chronic lower back pain in aquaculture clam farmers: adoption and feasibility of self-management strategies introduced using a rapid prototype participatory ergonomic approach

Objectives. Lower back pain (LBP) is extremely prevalent in seafood harvesters who often have limited or no access to ergonomic consultation, occupational health support and rehabilitation services. This pilot study aimed to describe a participatory ergonomic approach and determine the feasibility and extent of adoption of self-management strategies in clam farmers with LBP. Methods. A rapid prototype participatory ergonomic approach was used to develop context-specific self-management strategies. Options to adjust lifting and repetitive stress were introduced using video clips, demonstrations and discussions in the workplace. Workers chose and implemented three strategies for 8 weeks with weekly reminders. Survey and qualitative data from focus groups were analyzed. Results. Team strategies were the most popular, but individual options were used more often. Strategies were considered feasible, acceptable and relatively easy to use. Strategies were implemented relatively consistently, and most improved productivity with decreased pain. Challenges for uptake included changing habit, culture and team dynamics. Conclusions. Participatory rapid prototyping provided a feasible and efficient option to introduce strategies for clam farmers with small teams, variable work processes and workloads, and time restrictions. Strategies were considered acceptable and easy to use, and most increased productivity. These methods show potential for future research.

Outcomes of Participatory Ergonomics and Self-management in Commercial Clam Farmers with Chronic Low Back Pain: A Feasibility Study

PURPOSE

Participatory ergonomics engages workers in the development of strategies to reduce workplace-related pain, offering a flexible and practical option to create individualized context-specific strategies. This paper describes the outcomes of a feasibility study using a participatory approach for self-management of low back pain in clam farmers.

METHODS

A within-subject time-control design with repeated baseline and post-intervention assessment was used. After refining individual and team-based strategies, stakeholder interviews, and rapid prototyping, workers selected three strategies to use for 8 weeks. Frequency and ease of use for strategies are described. Pre-post paired t-tests were used for analysis of pain-related disability, difficulty and pain with work tasks, pain-related fear, self-efficacy, and coping. Analysis of improvements exceeding published and individual variability was calculated.

RESULTS

Participants chose both team and individual strategies, most using strategies 5 days a week >50% of the time. Significant improvements in pain-related disability, pain during specific tasks, pain-related anxiety, and coping were seen after 8 weeks of implementing strategies. No changes in task difficulty, fear, self-efficacy and average resting pain were reported. Pain improvements > MDC₉₅ were reported by 74% with 56-64% > personalized MDC₉₅ for lifting tasks.

CONCLUSIONS

Pain-related disability, work activity pain ratings and related pain anxiety and coping improved beyond individual variability in this feasibility study. Multiple strategies allowed workers to choose relevant self-management options. Introduction of work-related changes in the workplace, visual demonstration, review of team videos and reminders were helpful. Further studies of this approach are needed.

[Chronic Right Ventricular Failure Revealing a Large Compressive Hydatid Cyst at the Cardiology Department of the Aristide le Dantec Hospital (Dakar, Senegal)]

Hydatidosis, an anthropozoonosis caused by the development of the Echinococcus granulosus larva in human, is a parasitic infection that is endemic in many countries. Pericardial localization in the absence of other cardiac involvement is extremely rare. Its spontaneous evolution is serious because of the risk of rupture. We report the case of a 65-year-old patient, who received limb edema that had been going on for 4 months, and in whom the physical examination noted a 3/6 tricuspid regurgitation and a right heart failure syndrome. Transthoracic echocardiography revealed an intra-pericardial mass whose contents appeared fluid with hyperechogenic area. It measured 86x61 mm and significantly compressed the straight cavities. Thoracic computed tomography showed an appearance in favor of an aged intrapericardic hydatid cyst (GHARBI V) with mass effect on the right cavities. The hydatid serology was negative. The patient did not accept the surgical cure. She had been put on albendazole and diuretic treatment. Fatal outcome was reported after two-month follow-up.

P1586Research network in Africa (RNA): antihypertensive drugs strategies in 12 African countries

Background

High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce.

Purpose

Our study aims to describe antihypertensive drugs strategies in Africa.

Methods

We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)).

Results

A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p<0.001), monotherapy ranged from 12.7% in Niger to 47.1% in Democratic Republic of the Congo (figure). Furthermore we observed a significantly difference of strategies between low and middle income countries (55.3% and 44.7% of monotherapy respectively) (p<0.001). According to hypertension grades 1, 2 and 3, the proportion of three-drugs or more combination was 25%, 28% and 34% in middle-income and lower in low-income countries (18%, 19% and 25%). Furthermore, Grade 3 hypertension in low income countries was still treated with monotherapy (36%) instead of 19% in middle income countries (p<0.01).

Antihypertensive strategies by country

Conclusion

Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.

[Skin Leishmaniosis : Epidemiological And Clinical-Biological Study In Two Public Hospitals In Nouakchott]

Many cases of cutaneous leishmaniasis are observed during hospital consultations in Nouakchott. The objective of our study is to collect all cases of cutaneous leishmaniasis in Nouakchott and to study its epidemiological and clinico-biological characteristics.

METHOD

This is a prospective multicenter descriptive study conducted in two specialized hospital departments in Nouakchott from September 1st, 2016 to the end of October 2017. All patients with suspicious lesions of cutaneous leishmaniasis during this period were selected. Parasitological skin sampling, PCR and histology have been performed to patients.

RESULTS

Twenty one out of 9000 patients were diagnosed during the study period, with an average age of 23 years (ranging from 3 to 70 years). A male predominance was noted with a sex ratio of 2/1. The most frequent locations are the discovered parts of the body (the 4 members). The ulcero-crusty form is encountered in 2/3 of the cases. L. major is more frequently identified (61.9%) followed by L infantum in 23.8% of cases. Meglume Antimoniate was administered intralesionally in 57.1% of patients. In Nouakchott, cutaneous leishmaniasis is not uncommon. The cases observed are related to an origin or a stay in the southern regions.

Non-tubercular caseous adenopathy in Senegal

The authors report the case of a 22-year-old man referred seven months after the onset of papulo-nodular skin lesions, lymphadenopathy, splenomegaly and hepatomegaly. Mycologic and histologic examination of skin lesions enabled the diagnosis of African histoplasmosis, by Histoplasma capsulatum var duboisii. The lymph nodes were caseous. The culture in Lowenstein-Jensen medium was negative.

[Prevalence of cardiovascular risk factors in semi-rural area in Senegal]

OBJECTIVES

We aim to determine the prevalence of cardiovascular risk factors in the semi-rural population of the community of Gueoul in Senegal.

PATIENTS AND METHOD

This is a cross-sectional, observational and descriptive study. We conducted an exhaustive survey in 2012 according to the STEPS wise approach of the world health organization against Senegalese aged of 35 years and over who resided for at least 6 months in semi-rural area in the community of Gueoul. Pregnant women were excluded. Classical cardiovascular risk factors were collected and data analyzed using SPSS 18.0 software. The significance level was agreed for a value of P<0.05.

RESULTS

We examined 1411 subjects (1052 women) with a mean age of 48.5±12.68 years. The main cardiovascular risk factors were dyslipidemia (61,1%), physical inactivity (56.2%), abdominal obesity according to the International Diabetes Federation (53.9%), hypertension (46.4%), global obesity (13%), diabetes (7.2%) and smoking (2.5%). Hypertension was significantly associated with diabetes (P=0.001), abdominal obesity (P=0.001) and global obesity (P=0.0001). Sedentarity (P=0.001), global obesity (P=0.0001) and hypertension (P=0.001) were more frequent in women.

CONCLUSION

Cardiovascular risk factors are frequent and often associated in semi-rural area of Senegal, particularly in women. This condition should lead to develop prevention strategies of cardiovascular complications.

[Ambulatory Blood Pressure Measurement's Reults And Indications At Cadiology Department At Hôpital Aristide Le Dantec]

High blood pressure (HTA) is a public health problem. It affects more than one billion people around the world, more than a quarter of the world's population. In recent years the ABPM (Ambulatory Blood Pressure Measurement) has become a valuable and widely used tool for the diagnosis and management of hypertension. The aims of this study were to determine the indications of MAPA to the cardiology department of Aristide le Dantec Hospital; to determine the results and to evaluate the blood pressure profile of our patients.

METHODS

We carried out a retrospective study, over 37 months from December 2010 to December 2013 covering all the results of the ABPMs recorded during this period. Was included any patient over 18 years of age with an ABPM. All ABPMs with less than 50 good measures per 24 hours were not included.

RESULTS

A total of 204 MAPA results were included of a total of 307. The mean age was 49.6 ± 11.5 years with extremes of 25 years and 78 years. The sex ratio was 1.5 in favour of women. Indications were dominated by labile HTA (34.8%); masked HTA (27.9%) and suspicious of the white coat effect (12.3%). The analysis of the results showed that MAPA was normal in 49.5%. The white coat effect was found in 32% (65 patients) of ABPM. In patients with abnormal ABPM, permanent systolic-diastolic hypertension predominated (57%). HTA masked was noted in 25.7% of our patients and HTA white coat was found in 3.8% of cases. In the hypertensive patients treated, MAPA revealed a poor blood pressure balance in 42.1%. Among the HTA prognostic factors we noted32.4% of patients were "Non Dippers", a pulse pressure greater than or equal to 60 mmHg in 59%.

CONCLUSION

The use of this exploration is an important aid to practitioners in the diagnostic, therapeutic and prognosis phase of the management of hypertension. It should become more important as it provides better information on the blood pressure profile for the patients.

Cardiac magnetic resonance imaging-indeterminate/negative cardiac sarcoidosis revealed by 18F-fluorodeoxyglucose-positron emission tomography: two case reports and a review of the literature

Background

Sarcoidosis is an inflammatory disorder of immune dysregulation characterized by non-caseating granulomas that can affect any organ. Cardiac sarcoidosis is an under-recognized entity that has a heterogeneous presentation and may occur independently or with any severity of systemic disease. Diagnosing cardiac sarcoidosis remains problematic with endomyocardial biopsies associated with a high risk of complications. Several diagnostic algorithms are currently available that rely on histopathology or clinical and radiological measures. The dominant mode of diagnostic imaging to date for cardiac sarcoidosis has been cardiac magnetic resonance imaging with gadolinium enhancement.

Case presentations

We report the cases of two adult patients: case 1, a 50-year-old white man who presented with severe congestive cardiac failure; and case 2, a 37-year-old white woman who presented with complete heart block. Both patients had a background of untreated pulmonary sarcoidosis. Cardiac magnetic resonance imaging did not show evidence of sarcoidosis in either patient and both proceeded to ¹⁸F-fluorodeoxyglucose-positron emission tomography scans that were highly suggestive of cardiac sarcoidosis. Both patients were systemically immunosuppressed with orally administered prednisone and methotrexate and had subsequent improvement by clinical and nuclear medicine imaging measures.

Conclusions

Current consensus guidelines recommend all patients with sarcoidosis undergo screening for occult cardiac disease, with thorough history and examination, electrocardiogram, and transthoracic echocardiogram. If any abnormalities are detected, advanced cardiac imaging should follow. While cardiac magnetic resonance imaging identifies the majority of cardiac sarcoidosis, early disease may not be detected. These cases demonstrate ¹⁸F-fluorodeoxyglucose-positron emission tomography is warranted following an indeterminate or normal cardiac magnetic resonance imaging if clinical suspicion remains high. Unidentified and untreated cardiac sarcoidosis risks significant morbidity and mortality, but early detection can facilitate disease-modifying immunosuppression and cardiac-specific interventions.

[Left ventricular hypertrophy in black African subjects with artery hypertension: Results of a cross-sectional survey conducted in semi-rural area in Senegal]

OBJECTIVES

To assess the prevalence of left ventricular hypertrophy according to electrocardiographic and echocardiographic criteria among hypertensive patients living in semi-rural Senegalese area.

PATIENTS AND METHODS

According to the World Health Organization STEPSwise approach, we conducted, in November 2012, a cross-sectional and exhaustive study in the population aged at least 35 years old and living for at least six months in the semi-rural area of Guéoul. We researched electrocardiographic and echocardiographic left ventricular hypertrophy in hypertensive subjects. Data were analyzed with SPSS 18.0 software version. The significance level was agreed for a value of P<0.05.

RESULTS

We examined 1411 subjects aged on average of 48.5±12.7 years. In total, 654 subjects were hypertensive and screening of left ventricular hypertrophy (LVH) was effective in 515 of them. According to Sokolow-Lyon index, 86 subjects (16.7%) presented electrocardiographic LVH, more frequently in men (P=0.002). According to Cornell index and Cornell product, LVH was founded respectively in 66 (12.8%) and 52 subjects (10.1%), more frequently in female (P=0.0001; P=0.004). It was more common in grade 3 of hypertension however criteria. In echocardiography, prevalence of LVH was 2.2% (13 cases) according to the left ventricular mass, 9.3% (48 cases) according to the left ventricular mass indexed to body surface area and 8.2% (42 cases) according to the left ventricular mass indexed to height^2.7. LVH was significantly correlated with the electrocardiographic LVH according to Sokolow-Lyon index (P<0.0001) and the grade 3 of hypertension (P=0.003).

CONCLUSION

Although rare in hypertensive Senegalese living in semi-rural area, left ventricular hypertrophy is correlated with severity of grade of hypertension. Screening by electrocardiogram will allow better follow-up of these hypertensive subjects.

[Congenital heart disease in adolescents and adults: Management in a general cardiology department in Senegal]

BACKGROUND

Congenital heart diseases in adults include malformations treated in childhood that decompensate secondarily and those asymptomatic at birth, appear later. This study aims to identify congenital heart diseases in adults in general cardiology department of Senegal and to assess clinical presentations, treatment and outcomes.

METHODS

We conducted a cross-sectional and descriptive study based on the records of patients aged at least 16 years and followed for congenital heart disease in the cardiology department of the General Hospital of Grand-Yoff in Dakar between May 2003 and March 2015. Diagnosis of heart disease was based on echocardiography.

RESULTS

We have registered 50 dossiers of patients equivalent to a prevalence of 0.75%, with a female predominance (64%). The average age of patients was 36.2±18.4 years (16-79 years), and mean age of diagnosis was 29.76±22.58 years. Dyspnea was the main sign (60%). Main malformations were the atrial septal defect (38%), pulmonary stenosis (14%), the ventricular septal defect (12%) and patent ductus arteriosus (10%). According to the classification of Bethesda, heart disease was simple complexity (42%), intermediate (58%) or severe (10%). The treatment was medical in 43 patients and 7 patients had surgical repair. Main complications were infective endocarditis (10%), atrial fibrillation (12%), heart failure (24%) and pulmonary arterial hypertension (50%).

CONCLUSION

Congenital heart diseases in adults seem underestimated in our countries. Surgical repair is rare. It is necessary to ensure a good management of the transition between pediatric and adult age.

[Comparative Study Of Coronary Artery Disease In Diabetics And Non-Diabetics In The Department Of Cardiology Of Aristide Le Dantec University Hospital]

The aim of this study was to compare the features of coronary artery disease between diabetic and non-diabetic patients.

PATIENTS AND METHODS

A case-control study was carried out from 1 May 2013 to 31 July 2015 in the department of cardiology of Aristide le Dantec university hospital. Forty-five diabetic patients and forty-five non-diabetic patients who underwent coronary angiography and / or angioplasty were included.

RESULTS

There was a male predominance with a sex ratio of 1.6 in both groups. The mean age was 62.26 years for diabetics and 59.06 years for non-diabetics (p = 0.6). In diabetics, symptomatology was dominated by silent ischemia (48.9%) versus typical angina pain (68.9%) in non-diabetics. Myocardial infarction was the most common indication of coronary angiography in both groups. Coronary angiography revealed one-vessel disease (46.6% versus 41.7% p = 0.822), double vessel disease (26.7% versus 41.7% p = 0.091) and triple vessel disease (26.7% versus 16.6% p = 0.561). Angioplasty was indicated in 37.8% of diabetics versus 63.9% of non-diabetics. Nine diabetic patients and three non-diabetic patients had an indication of coronary artery bypass grafting.

CONCLUSION

Our study confirms the greater frequency of silent ischemia and multiple-vessel disease in diabetics as well as a more frequent indication of coronary artery bypass grafting in these patients.

[Cardiovascular manifestations in systemic lupus erythematosus in Dakar: Descriptive study about 50 cases]

Systemic lupus erythematosus is a non-specific inflammatory disorder of an organ of unknown cause and autoimmune origin. Visceral injuries, including those cardiovascular, determine the prognosis of this disease primarily affecting women. The objectives of this study were to determine the frequency and describe the cardiovascular manifestations in systemic lupus erythematosus in a lupus population of the Dakar region. This is a multicenter prospective study descriptive and analytical conducted in the region of Dakar (Senegal) from 14 February 2011 to 2 July 2012. Patients were either hospitalized or monitored as outpatients. Included were all patients with lupus and meeting at least four criteria of the American College of Rheumatology of lupus disease classification 1997. All patients underwent physical examination, an electrocardiogram and an echocardiogram looking for cardiovascular damage. The collected data were entered into the Epi Info version 3.5.1 and processed with SPSS 16.0 software. Quantitative variables are described in the median and the qualitative workforce, percentage and frequency. We have included 50 patients. The average age of the population was 36.18 years. A female predominance is noted with a sex ratio man/woman of 0.09. Cardiovascular functional symptoms were dominated by dyspnea stage II to IV NYHA (26%) and palpitations (22%). The physical signs we have found were mainly tachycardia (40%), spontaneous turgor of the jugular veins (29%), a muffling of the heart sounds (29%) and a infandibulopulmonairy shock (18%). The frequency of cardiovascular events was 46%. Electrical cardiac events were dominated by sinus tachycardia (40%) of repolarization disorders (16.3%) type of ischemia, injury, ischemia injury, necrosis and hypertrophy with 18% atrial and left ventricular hypertrophy each. Furthermore, one case of BAV first degree at 280 ms was recorded. We found 19 cases of pericarditis including 2 tamponade, 3 cases of dilated cardiomyopathy hyperkinesias with impaired ejection fraction less than 35% and 8 patients with mild PAH important. In systemic lupus erythematosus, cardiovascular events are worrying and may remain asymptomatic for awhile. Their research must be systematic in order to treat early.

[Ito hypomelanosis: Four case reports]

Ito hypomelanosis is a rare neurocutaneous condition. We report on four observations in infants aged between 8 and 20 months. They all presented with epilepsy, psychomotor delay, and diffuse hypomelanosis. The electroencephalograms showed diffuse irritative abnormalities. Brain imaging was normal in two infants and showed hemispheric atrophy in another case. Despite antiepileptic treatment and physical therapy, no significant progression was noted and all children continued to have drug-resistant epilepsy and psychomotor delay.

Perspectives on Adherence to Recommended Health Behavior among Low-Income Patients

Although patient nonadherence with health care recommendations is a known barrier to controlling health care costs and improving health outcomes, little is known about variables that affect adherence to recommended health behaviors among low-income patients. Four focus groups were conducted among a sample of low-income patients, to examine their perceptions of adherence with recommendations for appointment keeping, special diets, and medications. Continuity of care and patient fears emerged as common themes contributing to adherence. Continuity of care consisted of having a positive interpersonal relationship with a single primary physician, and a system of coordinated care among multiple specialty physicians. Fear of dying, not living well, getting worse, and feeling bad again were strong promoters of adherence. Among low-income patients and care delivery systems with capitated funding, efforts are needed to improve continuity of care and increase provider awareness of the fears that patients bring to a care encounter.

Electrocardiographic Left Ventricular Hypertrophy Among Gambian Diabetes Mellitus Patients

BACKGROUND

The global prevalence of diabetes and its complications is increasing worldwide. Its role in coronary heart disease has been linked with the presence of left ventricular hypertrophy (LVH). The present study aims to determine the prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) in adult diabetic subjects, its epidemiological and clinical correlates.

METHODS

A descriptive cross-sectional study involving 534 patients was conducted at the Edward Francis Small Teaching Hospital (formerly Royal Victoria Teaching Hospital), The Gambia. Four hundred and forty patients were included using a standard questionnaire. Anthropometry, laboratory investigations and electrocardiogram were carried out. We used the Lewis, Cornell, and Sokolow-Lyon Voltage criteria to define ECG-LVH. Minitab™ statistical software version 13.20 was used for analysis.

RESULTS

146 (35.2%) patients had ECG-LVH using all 3 criteria and this prevalence was higher among women being 116 (79.5%). A generally high prevalence of overweight (155/37.4%) and obesity (119/28.6%) was observed among study participants, and both clinic-day systolic and diastolic blood pressure (BP) were significantly higher in those with ECG-LVH. Poor diabetes control was observed in both groups.

CONCLUSION

There was a high prevalence of ECG-LVH and it is especially so with combining multiple criteria, hence the need for screening. Clinic-day hypertension was associated with ECG-LVH hence the need for diagnosing and aggressive treatment of hypertension in patients with diabetes mellitus.

[Multifocal histoplasmosis due to Histoplasma capsulatum var. duboisii in a 22 year-old Senegalese patient without proven immunodepression]

The authors report a case of multifocal African histoplasmosis with polymorphic skin involvement occuring in a patient without proven immunosuppression. He was a young 22-year-old patient from eastern Senegal - but born in Ouganda - who presented with polymorphic skin lesions: ombilicated papulo-nodules, gums and ulcerative and budding lesions. He showed lymphadenopathies without clinical inflammation and with a cheesy appearance of the biopsy but without tuberculosis and also hepatosplenic and bone involvement. Mycological samples of the skin and lymph nodes biopsies revealed yeasts of Histoplasma capsulatum var. duboisii with a positive culture on Sabouraud medium. HIV serology, HTLV1et 2, the serum proteins electrophoresis were unremarkable. Treatment with amphotericin B was irregular because of its inaccessibility in the national territory and its cost. The patient died of sepsis together with the aggravation of his disease.

[Prevalence of atherosclerotic carotid plaques in semi-rural Gueoul, Senegal: Survey of 1411 subjects]

AIMS

The purpose of this study was to investigate the prevalence of atherosclerotic carotid plaques and association with cardiovascular risk factors and vascular diseases in a semi-rural area of Gueoul in Senegal.

PATIENTS AND METHOD

This was a cross-sectional, descriptive study over a period of one month in 2012 in Senegalese people who were older than 35 years, and resided in semi-rural Gueoul for at least six months. Carotid plaques were measured with a portable Doppler Diadop 50(®) and defined by an intima-media thickness greater than 1.5mm. P-values less than 0.05 were considered statistically significant.

RESULTS

The survey involved 1411 individuals with a sex ratio of 2.93 and an average age of 48.5 years. Prevalence of risk factors was high: dyslipidemia (61.1 %), physical inactivity (56.2 %), abdominal obesity (53.9 %), hypertension (46.4 %), obesity (12 %), diabetes (7.2 %) and smoking (2.5 %). Prevalence of atherosclerotic carotid plaques was 6.8 %, including 42.7 % with bilateral plaques. Prevalence increased with age (P=0.001), hypertension (P=0.0001), diabetes (P=0.004) and metabolic syndrome (P=0.008). There were no significant associations with the other risk factors. The presence of carotid plaques was associated with medical history of stroke (P=0.01), myocardial infarction (P=0.02) and peripheral artery obstructive disease (P=0.5).

CONCLUSION

Prevalence of atherosclerotic carotid plaques seems weak but it is associated with many cardiovascular risk factors. It requires measures for early diagnosis and prevention of cardiovascular diseases in Senegal.

[Study of echocardiographic parameters of rheumatoid arthritis black African without clinically evident cardiovascular manifestations: A cross-sectional study of 73 cases in Senegal]

INTRODUCTION

Research of cardiac involvement in patients with rheumatoid arthritis can prevent complications and place in a logical secondary prevention. The objective of this study was to investigate the echocardiographic parameters in a population of Senegalese patients with rheumatoid arthritis without clinically evident cardiovascular manifestations.

PATIENTS AND METHOD

We conducted a descriptive cross-sectional study, which included prospectively from outpatients in the internal medicine department of university hospital center Aristide Le Dantec in Dakar, Senegal, with a diagnosis of rheumatoid arthritis without clinically evident cardiovascular disease. It focused on a sample of 73 patients of both sexes aged at least 18 years. Following clinical examination, we conducted laboratory tests (CRP, fibrinogen, ESR, rheumatoid factors: Latex and Waaler-Rose, anti-CCP, antinuclear factors and anti-ENA antibodies), ECG, echocardiography standard. Data were analyzed using a descriptive study of the different variables with the calculation of proportions for categorical variables, and the positional parameters and dispersion for quantitative variables.

RESULTS

A total of 73 patients with rheumatoid arthritis without obvious cardiac events and meeting the criteria of definition of the ACR 1987 were included in the study. The mean age was 44.17±14.43 years with extremes of 18 and 75 years. The mean duration of RA was 5.93±4.78 years. The concept of family inflammatory arthritis was reported in 35.60% of cases and almost one in six patients had at least a factor of cardiovascular risk (16.96%). The abnormalities found in Doppler echocardiography were dominated by diastolic LV dysfunction (42.46%), increased left ventricular mass in 35.61%. Valvular leaks of variable grades were highlighted regarding all orifices but were rarely significant.

CONCLUSION

The realization of echocardiography in patients with rheumatoid arthritis without clinically evident cardiovascular manifestations helps to highlight cardiovascular abnormalities related to the natural course of the disease.