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Diop IB, Balde D, Cavagna P, Adoubi A, Ikama MS, Suliman A, Hounkponou M, Empana JP, Camara Y, Mfeukeu-Kuate L, Toure C, Kabore H, Lubenga Y, Jouven X, Kingue S. Detection and characteristics of hypertension patients admitted in 37 cardiology departments from 17 Sub-Saharan African countries. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
High blood pressure (BP) is a major risk factor for several common cardiovascular (CV) disease such as stroke, heart failure or chronic kidney disease. The Sub-Saharan Africa (SSA) should face the highest rate of hypertension worldwide with an overall prevalence estimation of 46%. Due to scarce resources and inadequate healthcare provision, SSA have scarce hard data on treatment and control of high BP.
Purpose
To assess the detection and characteristics of hypertension patients admitted in hospitalizations 17 SSA countries
Methods
We conducted a transversal and longitudinal study in CV department of 37 hospitals from 23 cities in 17 SSA countries (10 low income: Niger, Guinea, Benin, Mali, Democratic Republic of the Congo, Tchad, Burkina Faso, Togo, Burundi, Ethiopia and 7 middle income: Cote d'Ivoire, Senegal, Cameroon, Congo, Soudan, Mauritania, Gabon). The February study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all inpatients in February from each year since 2016. Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians. Hypertension and severity of hypertension were defined according to 2018 ESC/ESH guidelines and BP was measured twice using standardized method. All analyses were performed through scripts developed in the R software (4.0.3 (2020-10-10))
Results
The study involved 4360 patients. Hypertension was measured on 1906 (43.7%) patients at admission. Proportion of patients with high BP in hospital increased from 42.2% in 2016 to 52.2% in 2021 (p<0.05) and differed significantly across countries from 77.6% in Niger to 100% in Chad. Among hypertensive patients, men represented 59.6% of patients and mean of age was 59±15.1 years. Overall, 61.4% of patients were from low income countries. The mains causes of admission among hypertensive patients were heart failure (37.8%) and stroke (18.9%). Average of systolic BP was 159±29.3 mmHg and average of diastolic BP was 96.7±16mmHg. Overall, 760 (40.3%), 525 (27.8%) and 602 (31.9%) had grade 1, grade 2 and grade 3 hypertension respectively. History of CV disease was observed in 51.5% of patients. Thus, 70.4% of patients had at least one CV risk factor other than hypertension. Angiotensin converting enzyme inhibitors and diuretics was prescribed in 56.9% and 55.8% of patients respectively. The average amount of antihypertensive drugs prescribed in hospital was 2.09±1.18. Overall, 237 (12.4%), 295 (15.5%), 640 (33.6%) and 734 (38.5%) received respectively no drug, monotherapy, two-drug strategies and three and more drug strategies.
Conclusion
In patients admitted in cardiology departments, hypertension is a huge burden in SSA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I B Diop
- Fann Universitary Hospital , Dakar , Senegal
| | - D Balde
- University Hospital of Conakry, Cardiology , Conakry , Guinea
| | - P Cavagna
- Pitie Salpetriere APHP University Hospital, Pharmacy , Paris , France
| | - A Adoubi
- University Hospital of Bouake, Cardiology , Bouake , Côte d'Ivoire
| | - M S Ikama
- National University Hospital of Brazzaville, Marien Ngouabi University , Brazzaville , Congo
| | - A Suliman
- Shaab Teaching Hospital, Cardiology , Khartoum , Sudan
| | - M Hounkponou
- National University hospital of Hubert K. MAGA (CNHU-HKM) , Cotonou , Benin
| | - J P Empana
- Paris Cardiovascular Research Center (PARCC) , Paris , France
| | - Y Camara
- University Hospital of Kati , Bamako , Mali
| | | | - C Toure
- Abidjan Institute of Cardiology , Abidjan , Côte d'Ivoire
| | - H Kabore
- Paul VI Medical Center , Ouagadougou , Burkina Faso
| | - Y Lubenga
- University Clinic of Kinshasa , Kinshasa , Congo (Democratic Republic of the)
| | - X Jouven
- European Georges Pompidou Hospital, AP-HP Centre, University of Paris , Paris , France
| | - S Kingue
- University of Yaoundé, Ministry of Public Health , Yaounde , Cameroon
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Limbole E, Mipinda JB, Cavagna P, Hermann Y, Tchuem Tchuente-Noutchogouin M, Souleymane C, Asselin A, Mbaye A, Kamdem F, Sidy Ali A, Thiam S, N'da N'kenon Watani J, Antignac M, N'Guetta R, Jouven X. Stroke care in 17 Sub-Saharan African countries: the FEBRUARY study (2016–2021) from African research network. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Stroke is one of the leading causes of morbidity and mortality worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability would occur in low- and middle-income countries. Between 2002 and 2020, estimation stroke mortality in Sub-Saharan Africa (SSA) was tripled. There is scarce data on management of stroke in SSA.
Purpose
To describe stroke care in cardiology departments in 17 SSA countries
Methods
We conducted a transversal and longitudinal study in CV department of 37 hospitals from 23 cities in 17 SSA countries (10 low income: Niger, Guinea, Benin, Mali, Democratic Republic of the Congo (DCR), Tchad, Burkina Faso, Togo, Burundi, Ethiopia and 7 middle income: Cote d'Ivoire, Senegal, Cameroon, Congo, Soudan, Mauritania, Gabon). The FEBRUARY study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all inpatients in February from each year since 2016. Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians. All analyses were performed through scripts developed in the R software (4.0.3 (2020-10-10)).
Results
Overall, 4360 patients were admitted to hospital over the 6 years of the study. Stroke was the third cause of hospitalization with 477 (11%) patients admitted. Proportions of patients admitted for stroke varied across countries from 0% in Ethiopia to 52% in DRC (p<0.01) (figure) and over the years from 11% in 2016 to 16.5% in 2021. Men represented 60.1% of stroke patients. Mean of age was 62.5±13.4 years. Overall, 300 patients (62.9%) were from low-income countries and 177 patients (37.1%) from middle-income countries. A majority of patients were living in urban areas (N=387; 82.9%) compared to rural areas (N=80; 17.1%). Individual wealth index was low, middle and high in 105 (23.2%), 152 (33.6%) and 196 (43.3%) patients respectively. Among stroke patients, 413 (89.8%) had a computed tomography. Ischemic stroke represented 71.8% of patients with stroke. Among CV risk factors, high blood pressure was identified in 81.9% of patients. In-hospital antithrombotic therapy was prescribed for 2 patients (0.42%). Anticoagulant therapy and antiplatelet therapy were prescribed for 26.4% and 53.5% of patients respectively. Proportions of patients treated with antiplatelet therapy varied across countries (p<0.05). At discharge, 8% and 44.4% of patients received anticoagulant therapy or antiplatelet therapy respectively. Mean of length of stay was 12.4±18.4 days. Stroke represent the second cause of mortality (18.7%) and did not vary significantly across countries.
Conclusion
Stroke was the third cause of admission with more than 1/10 patients and the second cause of mortality with almost 1/5 patients in cardiology departments in SSA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Limbole
- Ngaliema Hospital , Kinshasa , Congo (Democratic Republic of the)
| | - J B Mipinda
- University hospital, Cardiology , Libreville , Gabon
| | - P Cavagna
- Pitie Salpetriere APHP University Hospital, Pharmacy , Paris , France
| | - Y Hermann
- Abidjan Institute of Cardiology , Abidjan , Côte d'Ivoire
| | | | - C Souleymane
- Point G university hospital center , Bamako , Mali
| | - A Asselin
- Paris Cardiovascular Research Center (PARCC) , Paris , France
| | - A Mbaye
- Grand Yoff General Hospital , Mdakar , Senegal
| | - F Kamdem
- Douala General Hospital , Douala , Cameroon
| | - A Sidy Ali
- Centre National de Cardiologie, Cardiology , Nouakchott , Mauritania
| | - S Thiam
- El Hadji-Ibrahima Niass Hospital, Cardiology , Kaolac , Senegal
| | | | - M Antignac
- Pitie Salpetriere APHP University Hospital, Pharmacy , Paris , France
| | - R N'Guetta
- Abidjan Institute of Cardiology , Abidjan , Côte d'Ivoire
| | - X Jouven
- European Georges Pompidou Hospital, AP-HP Centre, University of Paris, Cardiology , Paris , France
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3
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Ali Toure I, Traore AK, Cavagna P, Damorou JM, Diao M, Dzudie A, N'Guetta R, Kouam Kouam C, Hermann Y, Limbole E, Gaye B, Toure C, Yameogo V, Jouven X, Antignac M. Causes of admission and mortality among patients admitted in 37 cardiology departments in 17 Sub-Saharan African countries: the FEBRUARY observatory (2016–2021) from African Research Network. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiovascular disease (CVD) is a major cause of death worldwide. At least two-third of CVD death occurs in low- (LIC) and middle-income (MIC) countries. An estimated 1 million deaths were attributable to CVD in sub-Saharan Africa (SSA) alone. Scarce data are available about the admission for CVD and outcome in cardiology department in SSA.
Purpose
To describe admission for CVD and outcome of hospitalization in 17 in SSA countries.
Methods
We conducted a transversal and longitudinal study in CV department of 37 hospitals from 23 cities in 17 SSA countries (10 low income: Niger, Guinea, Benin, Mali, Democratic Republic of the Congo, Tchad, Burkina Faso, Togo, Burundi, Ethiopia and 7 middle income: Cote d'Ivoire, Senegal, Cameroon, Congo, Soudan, Mauritania, Gabon). The February study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all inpatients in February from each year since 2016.Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians. All analyses were performed through scripts developed in the R software (4.0.3 (2020-10-10))
Results
Overall, 4360 patients were included in the February study. Men represented 56.4%. Mean of age was 56.7±16.8 years. The main cause of admission was heart failure (41.5%) followed by acute coronary syndrome (11.9%) and stroke (11%). Cause of admission varied significantly across countries (p<0.01) and over the years (p<0.01). Proportions of admission for heart failure varied from 20% in Ethiopia to 62% in Guinea. Mean of length of stay was 9.95±22.4 days. All causes of admission confounded, in-hospital mortality rate was 11% (N=423). Mortality rate differed significantly according to causes of admission (p<0.01).Mortality rate among patients admitted for stroke, heart failure and acute coronary syndrome was respectively 18%, 12.3% and 9.5%. Overall, 31 (0.7%) were admitted for endocarditis and mortality rate among them was 20.8% (figure). Overall, mortality rate did not vary according to gender or over the years but was significantly different according to patient wealth index (p<0.05), countries (p<0.01) and level income countries (p<0.01). Mortality rate was significantly higher in LIC.
Conclusion
Heart failure, acute coronary syndrome and stroke represent the two-third of causes of admission. Overall, mortality rate in cardiology departments in SSA reached 11%.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ali Toure
- Amirou Boubacar Diallo Hospital, Internal Medicine and Cardiology , Niamey , Niger
| | - A K Traore
- Hospital of Sikasso, Cardiology , Sikasso , Mali
| | - P Cavagna
- Pitie Salpetriere APHP University Hospital, Pharmacy , Paris , France
| | - J M Damorou
- Campus Teaching Hospital, Cardiology , Lome , Togo
| | - M Diao
- Aristide Le Dantec Hospital, Cardiology , Dakar , Senegal
| | - A Dzudie
- Douala General Hospital , Douala , Cameroon
| | - R N'Guetta
- Abidjan Institute of Cardiology , Abidjan , Côte d'Ivoire
| | - C Kouam Kouam
- Regional Hospital of Bafoussam , Bafoussam , Cameroon
| | - Y Hermann
- Abidjan Institute of Cardiology , Abidjan , Côte d'Ivoire
| | - E Limbole
- Ngaliema Hospital, Cardiology , Kinshasa , Congo (Democratic Republic of the)
| | - B Gaye
- Paris Cardiovascular Research Center (PARCC) , Paris , France
| | - C Toure
- Abidjan Institute of Cardiology , Abidjan , Côte d'Ivoire
| | - V Yameogo
- University Hospital of Yalgado Ouédraogo , Ouagadougou , Burkina Faso
| | - X Jouven
- European Georges Pompidou Hospital, AP-HP Centre, University of Paris , Paris , France
| | - M Antignac
- Pitie Salpetriere APHP University Hospital, Pharmacy , Paris , France
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4
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Diop IB, Antignac M, Nhavoto C, Sidy Ali A, Balde D, Empana JP, Dzudie A, Thiam S, Cavagna P, Adoubi A, Perier MC, Takombe JL, Ikama MS, Houenassi MD, Jouven X. P3459Research Network in Africa (RNA): gender differences in cardiovascular risk factors and complications in 12 African countries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular diseases are rapidly growing epidemic in Sub-Saharan Africa. Unlike other regions of the world, death rates due to hypertension are greater for women than men in Africa. Scarce data were available on factors associated with gender in cardiovascular risk factors and complications in Sub-Saharan Africa.
Purpose
To assess gender differences in cardiovascular risk factors pattern in patients with hypertension in 12 Sub-Saharan countries.
Methods
We conducted a cross-sectional survey in urban clinics of twelve countries in Africa. Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. BP control was defined as BP<140/90 mmHg and hypertension grades were defined according to European Society of Cardiology guidelines. The separate association between women factors and BP control was investigated using Generalized Linear Mixed-Effects Models adjusted on age; A random effect on the country was added (generalized estimated equation models) to account for inter-country variability.
Results
The EIGHT study enrolled 2198 patients with hypertension in 12 sub-Saharan countries between January 2014 and November 2015. The proportion of women (60,2%) was higher than men and varied significantly according to countries (p<0.001), ranged from 33.7% (Guinea) to 71.9% (Gabon). Mean age was 57.7±12.0 years for women and 59.2±11.4 years for men (p<0.001).
Compared to men, women had a higher rate of family cardiovascular background (79% vs 70%, for women and men respectively) (p<0.0001), cardiovascular risk factors (74.3% vs 68.1) (p=0.008), such as obesity (25.8% vs 12.1%) (p<0.0001), sedentary behavior (42.1% vs 35.0%) (p=0,006). BP control didn't differ according to gender, the repartition of grades of hypertension was similar between women and men and proportion of uncontrolled BP was 77.2% in women and 77.8% in men (p=0.4), with same proportion of women and men receiving antihypertensive treatment (96 vs 97.5%) (NS).
However, African women had less cardiovascular complications than men (39% vs 52.4%) (p<0.0001) (OR: 0.50 [CI 95% 0.41–0.61]).
Conclusions
Our study highlighted gender differences in cardiovascular risk factors pattern in Sub-Saharan hypertensive patients. Tailoring medical (public health) programs to improve cardiovascular disease prevention that take into women characteristics may enhance their effectiveness.
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Affiliation(s)
- I B Diop
- CH FANN, Cardiology Department, Dakar, Senegal
| | - M Antignac
- Hospital Saint-Antoine - INSERM PARCC, Paris, France
| | - C Nhavoto
- Cardiology Institute, Cardiology Department, Maputo, Mozambique
| | - A Sidy Ali
- Cardiology Clinics, Cardiology Department, Nouakchott, Mauritania
| | - D Balde
- University Hospital of Conakry, Cardiology Department, Conakry, Guinea
| | - J P Empana
- Paris Cardiovascular Research Center (PARCC), INSERM U970, Paris, France
| | - A Dzudie
- Douala General Hospital, Douala, Cameroon
| | - S Thiam
- El hadj Ibrahima Niass, Cardiology Department, Kaolak, Senegal
| | - P Cavagna
- Hospital Saint-Antoine - INSERM PARCC, Paris, France
| | - A Adoubi
- Universitary Hospital of Bouake, Cardiology Department, Bouake, Côte d'Ivoire
| | - M C Perier
- Paris Cardiovascular Research Center (PARCC), INSERM U 970, Paris, France
| | - J L Takombe
- University Hospital of Kinshasa, Internal Medicine Department, Kinshasa, Congo (Democratic Republic of the)
| | - M S Ikama
- University Hospital, Cardiology Department, Brazzaville, Congo
| | - M D Houenassi
- National University Hospital of Hubert K. MAGA (CNHU-HKM), Cotonou, Benin
| | - X Jouven
- European G. Pompidou Hospital- INSERM U970 PARCC, Cardiology Department, Paris, France
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5
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Kane A, Cavagna P, Diop IB, Gaye B, Mipinda JB, Macquart De Terline D, Limbole E, Narayanan K, Houenassi MC, Koffi F, N'goran Y, Marijon E, Kramoh KE, Jouven X, Antignac M. P1586Research network in Africa (RNA): antihypertensive drugs strategies in 12 African countries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
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.
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Affiliation(s)
- A Kane
- ST Louis Hospital, Cardiology Department, St Louis, Senegal
| | - P Cavagna
- Hospital Saint-Antoine - INSERM PARCC, Paris, France
| | - I B Diop
- Fann Hospital, Cardiology Department, Dakar, Senegal
| | - B Gaye
- AP-HP H. Europeen G. Pompidou, INSERM U970, Cardiology Department, Paris, France
| | - J B Mipinda
- University Hospital, Cardiology Department, Libreville, Gabon
| | | | - E Limbole
- University Hospital of Kinshasa, Internal Medicine Department, Kinshasa, Congo (Democratic Republic of the)
| | - K Narayanan
- Department Cardiology, Maxcure Hospitals, Hyderabad, India
| | - M C Houenassi
- National University hospital of Hubert K. MAGA (CNHU-HKM), Cotonou, Benin
| | - F Koffi
- Abidjan Institute of Cardiology, Abidjan, Côte d'Ivoire
| | - Y N'goran
- Abidjan Institute of Cardiology, Abidjan, Côte d'Ivoire
| | - E Marijon
- AP-HP H. Europeen G. Pompidou, INSERM U970, Cardiology Department, Paris, France
| | - K E Kramoh
- Abidjan Institute of Cardiology, Abidjan, Côte d'Ivoire
| | - X Jouven
- AP-HP H. Europeen G. Pompidou, INSERM U970, Cardiology Department, Paris, France
| | - M Antignac
- Hospital Saint-Antoine - INSERM PARCC, Paris, France
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Abstract
Alzheimer's disease (AD) is widely identified as the most common cause of sporadic dementia. Its aetiology is still debated, as despite several hypotheses, different factors seem to play a role in its establishment and development. Recent studies have proposed a possible preventing role of nutrition. The weight loss typical of earlier phase of disease and the finding of malnutrition as a common trait between patients leads to hypothesize that a supplementation of specific nutrients seems to be useful and effective in terms of improvement of cognitive functions. Malnourished patients show also altered parameters when investigating inflammation markers: for example, hyperhomocysteinemia is a typical finding in elderly affected by dementia, and it can be prevented and corrected by using a proper nutrients supplementation. Pro-inflammatory state can be reduced with supplementation of polyunsaturated fatty acids, vitamins of the group B and phosphatidylserine, that can act reducing IL-1β (pro-inflammatory cytokine) and improving IL-10 (anti-inflammatory cytokine) synthesis. While investigating the role of nutrition, it seems to be deeply linked with genetic; a genetic onset AD-related could be latent and can be influenced by nutritional attitude. AD can be considered a sort of latent clinical condition that would disclose or not, depending also on micro-environment and nutritional parameters. The genetic expression can be influenced by assumptions or not of specific nutrients, with the promotion of different pro- or anti-inflammatory settings. The specific role of each micronutrient (in particular vitamins) and trace elements still needs to be punctuated, as they are involved in a pool of different reactions. Also genes acts not independently but in an interconnected pattern, in which the role of a single gene needs to be cleared, depending on others. This complex system of predisposing conditions and a possible role of nutrition as modulator of the inflammatory state is the object of this review.
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Affiliation(s)
- L. Venturini
- Department of Internal Medicine, Therapeutics, Cellular Phatophysiology and Clinical Immunology Laboratory, Azienda di Servizi alla Persona di Pavia, University of Pavia, Italy
| | - S. Perna
- Department of Public Health, Neuroscience, Experimental and Forensic Medicine, Section of Human Nutrition and Dietetics, Azienda di Servizi alla Persona di Pavia, University of Pavia, Italy
| | - F. Sardi
- Department of Internal Medicine, Therapeutics, Cellular Phatophysiology and Clinical Immunology Laboratory, Azienda di Servizi alla Persona di Pavia, University of Pavia, Italy
| | - M.A. Faliva
- Department of Public Health, Neuroscience, Experimental and Forensic Medicine, Section of Human Nutrition and Dietetics, Azienda di Servizi alla Persona di Pavia, University of Pavia, Italy
| | - P. Cavagna
- DSSAP Department of Applied and Phychic Behavioural Sciences, University of Pavia, Italy
| | - L. Bernardinelli
- DSSAP Department of Applied and Phychic Behavioural Sciences, University of Pavia, Italy
- Statistical Laboratory, Centre for Mathematical Sciences, University of Cambridge, Cambridge, UK
| | - G. Ricevuti
- Department of Internal Medicine, Therapeutics, Cellular Phatophysiology and Clinical Immunology Laboratory, Azienda di Servizi alla Persona di Pavia, University of Pavia, Italy
| | - M. Rondanelli
- Department of Public Health, Neuroscience, Experimental and Forensic Medicine, Section of Human Nutrition and Dietetics, Azienda di Servizi alla Persona di Pavia, University of Pavia, Italy
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7
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Waisblat V, Mercier FJ, Langholz B, Berthoz A, Cavagna P, Benhamou D. Effet du mouvement de balancement sur la douleur du travail avant la mise en place du cathéter péridural en position assise. ACTA ACUST UNITED AC 2010; 29:616-20. [DOI: 10.1016/j.annfar.2010.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 04/12/2010] [Indexed: 10/19/2022]
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8
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Donatelli F, Cavagna P, Di Dedda G, Catenacci A, Di Nicola M, Lorini L, Fumagalli R, Carli F. Correlation between pre-operative metabolic syndrome and persistent blood glucose elevation during cardiac surgery in non-diabetic patients. Acta Anaesthesiol Scand 2008; 52:1103-10. [PMID: 18840111 DOI: 10.1111/j.1399-6576.2008.01693.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiopulmonary-bypass (CPB) induces hyperglycemia. There is growing evidence that perioperative maintenance of blood glucose within the physiological range improves patients' outcome. Nevertheless, perioperative normoglycemia is often difficult to achieve during surgery with CPB and the response to insulin infusion is characterized by a considerable variability. The aim of this study was to determine to what extent the presence of pre-operative metabolic syndrome (MS) influences the blood glucose and insulin response during cardiac surgery. METHODS Forty-five patients scheduled for elective cardiac surgery were screened for the presence of MS according to the International Diabetes Federation definition. Patients were then assigned to two groups: those with metabolic syndrome (MSP) and those without (control). During surgery, blood glucose levels were measured in all patients and hyperglycemia was treated with a standard protocol of continuous insulin infusion. RESULTS The mean blood glucose levels during CPB increased only in the MSP group (P<0.001). Mean blood glucose in control patients did not increase during CPB (P=0.4). Patients with MS received 13.3+/-8.4 IU of insulin during CPB, while the control group did not require insulin treatment (P<0.001). Forty percent of patients in the control group and 100% of those in the MSP group developed post-operative insulin resistance. C-reactive protein was higher in the MSP group before, during and at 48 h after surgery. CONCLUSIONS The mean blood glucose levels during CPB increased only in patients with MS, while they remained unchanged in patients in the control group.
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Affiliation(s)
- F Donatelli
- Department of Anesthesia, Ospedali Riuniti di Bergamo, Bergamo, Italy.
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9
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Abstract
We used chromosome paints from both the domestic cat and humans to directly establish chromosomal homology between the genome of these species and the domestic ferret. The chromosome painting data indicate that the ferret has a highly conserved karyotype closer to the ancestral carnivore karyotype than that of the cat. The cat chromosome paints revealed 22 homologous autosomal regions in the ferret genome: 16 ferret chromosomes were hybridized by a single cat paint, while 3 ferret chromosomes were hybridized by two cat paints. In situ hybridization combined with banding showed that ferret Chromosome (Chr) 1 = cat A2p/C2, Chr 2 = F2/C1q, and Chr 3 = A2q/D2. Five ferret chromosomes are homologous to single arms of cat chromosomes: ferret 4 = A1q, 5 = B1q, 6 = C1p, 10 = A1p, and 12 = B1p. The human chromosome paints revealed 32 + XY homologous regions in the ferret genome: 9 ferret chromosomes were each hybridized by a single human paint, 7 by two paints, 3 by three paints. The 10 ferret chromosomes hybridized by multiple human paints produced the following associations: ferret 1 = human 19/3/21, 2 = 8q/2q, 3 = 10/7, 5 = 8/4, 8 = 15/14, 9 = 10/12/22, 11 = 20/2, 12 = 8/4, 14 = 12/22/18, 18 = 19/16. We present an index of genomic diversity, Z, based on the relative number of conserved whole chromosome and chromosome segments as a preliminary statistic for rapid comparison between species. The index of diversity between human-ferret (Z = 0. 812) is slightly less than human-cat (Z = 0.843). The homology data presented here allow us to transfer gene mapping data from both cats and humans to the ferret.
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Affiliation(s)
- P Cavagna
- Department of Experimental Biology, University of Genoa Viale Benedetto XV, 16132 Genoa, Italy
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10
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Plaisance P, Lurie KG, Vicaut E, Adnet F, Petit JL, Epain D, Ecollan P, Gruat R, Cavagna P, Biens J, Payen D. A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. French Active Compression-Decompression Cardiopulmonary Resuscitation Study Group. N Engl J Med 1999; 341:569-75. [PMID: 10451462 DOI: 10.1056/nejm199908193410804] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We previously observed that short-term survival after out-of-hospital cardiac arrest was greater with active compression-decompression cardiopulmonary resuscitation (CPR) than with standard CPR. In the current study, we assessed the effects of the active compression-decompression method on one-year survival. METHODS Patients who had cardiac arrest in the Paris metropolitan area or in Thionville, France, more than 80 percent of whom had asystole, were assigned to receive either standard CPR (377 patients) or active compression-decompression CPR (373 patients) according to whether their arrest occurred on an even or odd day of the month, respectively. The primary end point was survival at one year. The rate of survival to hospital discharge without neurologic impairment and the neurologic outcome were secondary end points. RESULTS Both the rate of hospital discharge without neurologic impairment (6 percent vs. 2 percent, P=0.01) and the one-year survival rate (5 percent vs. 2 percent, P=0.03) were significantly higher among patients who received active compression-decompression CPR than among those who received standard CPR. All patients who survived to one year had cardiac arrests that were witnessed. Nine of 17 one-year survivors in the active compression-decompression group and 2 of 7 in the standard group, respectively, initially had asystole or pulseless electrical activity. In 12 of the 17 survivors who had received active compression-decompression CPR, neurologic status returned to base line, as compared with 3 of 7 survivors who had received standard CPR (P=0.34). CONCLUSIONS Active compression-decompression CPR performed during advanced life support significantly improved long-term survival rates among patients who had cardiac arrest outside the hospital.
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Affiliation(s)
- P Plaisance
- Department of Anesthesiology and Critical Care, Lariboisière University Hospital, Paris, France.
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Stanyon R, Yang F, Cavagna P, O'Brien PC, Bagga M, Ferguson-Smith MA, Wienberg J. Reciprocal chromosome painting shows that genomic rearrangement between rat and mouse proceeds ten times faster than between humans and cats. Cytogenet Cell Genet 1999; 84:150-5. [PMID: 10393417 DOI: 10.1159/000015244] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Reciprocal chromosome painting between mouse and rat using complete chromosome probe sets of both species permitted us to assign the chromosomal homology between these rodents. The comparative gene mapping data and chromosome painting have a better than 90% correspondence. The reciprocal painting results graphically show that mouse and rat have strikingly different karyotypes. At least 14 translocations have occurred in the 10-20 million years of evolution that separates these two species. The evolutionary rate of chromosome translocations between these two rodents appears to be up to 10 times greater than that found between humans and cats, or between humans and chimpanzees, where over the last 5-6 million years just one translocation has occurred. Outgroup comparison shows that the mouse genome has incorporated at least three times the amount of interchromosomal rearrangements compared to the rat genome. The utility of chromosome painting was also illustrated by the assignment of two new chromosome homologies between rat and mouse unsuspected by gene mapping: between mouse 11 and rat 20 and between mouse 17 and rat 6. We conclude that reciprocal chromosome painting is a powerful method, which can be used with confidence to chart the genome and predict the chromosome location of genes. Reciprocal painting combined with gene mapping data will allow the construction of large-scale comparative chromosome maps between placental mammals and perhaps other animals.
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Affiliation(s)
- R Stanyon
- Laboratory of Genomic Diversity, National Cancer Institute, Frederick, MD, USA
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Cavagna P, Marzella R, Rocchi M, Chiarelli B. Suppression of chimpanzee NORS in hamster/chimpanzee hybrid: report on cell line R48-26. Somat Cell Mol Genet 1998; 24:303-6. [PMID: 10696238 DOI: 10.1023/b:scam.0000007133.59395.8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We present the first documented NOR suppression in a hybridoma other than man-mouse for the hamster-chimpanzee hybrid cell line R48-26. Alu PCR and chromosome painting showed that in this cell line chimpanzee chromosomes 13-15-23 are maintained. NORs on chimpanzee chromosomes 15-23, whose presence was directly verified by FISH with H 28s rDNA, resulted inactive while telomeric rDNA on hamster chromosomes resulted active even if hamster chromosomes presented extensive rearrangements. We observed an all or nothing model in accordance with a model of regulation by selective transcriptional factors. The rearrangements of hamster chromosomes have not involved the location of NORs because they maintain a telomeric position.
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Affiliation(s)
- P Cavagna
- Istituto di Antropologia Università di Firenze
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Cavagna P. [Short procedures in otorhinolaryngological surgery. Problems with anesthesia]. Soins Chir 1994:13-5. [PMID: 7984862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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