RESUMEN
BACKGROUND: Pulmonary hypertension (PH) is a potent cause of heart failure and has been little investigated in the African setting. OBJECTIVE: To investigate the effects of gender on the clinical presentation, echocardiographic features and outcomes of patients with PH in Douala, Cameroon. METHODS: A prospective cohort study was conducted from March 2012 to December 2013 as part of the Pan African Pulmonary Hypertension Cohort study. PH was diagnosed by echocardiography and defined as a right ventricular systolic pressure >35 mmHg in the absence of acute right heart failure. Patients were followed up for a maximum of 12 months for primary endpoint mortality. RESULTS: In total, 130 patients with PH were recruited; 71 (54.6%) were women. The median age was 59.2 years for men and 58.3 years for women (p=0.76). Active smoking and alcohol use were more frequent in men than women (both p<0.001), but women had greater exposure to indoor cooking fumes than men (p<0.001). Previous tuberculosis infection (11.3% v. 1.7%) and S3 gallop rhythm (30.9% v. 11.9%) were more common in women (both p<0.03). Women had a significantly higher mean systolic blood pressure (134 mmHg v. 125 mmHg; p=0.04) and pulse pressure (53.8 mmHg v. 44.9 mmHg; p=0.01) and a lower mean haemoglobin concentration (10.4 g/dL v. 12.4 g/dL; p<0.05) compared with men. Echocardiographic left ventricular (LV) systolic dysfunction was more frequent in men: mean LV ejection fraction 42.6% v. 51.5% (p=0.01) and mean fractional shortening 21.4% v. 28.6% (p=0.01). The overall mortality rate was 20.3%, and rates were similar in the two groups (Kaplan-Meier log rank 1.1; p=0.30). CONCLUSIONS: Despite differences in baseline characteristics including cardiovascular risk factors, mortality rates on follow-up were similar in men and women in this study. However, these different baseline characteristics probably suggest differences in the pathogenesis of PH in men and women in our setting that need further investigation.
RESUMEN
BACKGROUND: The prevalence of chronic kidney disease (CKD) is increasing in Australia and is independently associated with a higher risk of hospitalisation and death. Australian data may be useful in guiding improved hospital management of this growing cohort of patients. AIM: To assess and compare the trends and outcomes of CKD patients requiring hospital and intensive care unit (ICU) admission at a tertiary referral hospital and state public hospitals. METHODS: We conducted a retrospective analysis of all acute care admissions to St Vincent's Hospital Melbourne and all Victorian public hospitals using the Victorian Admitted Episodes Data Set (VAED) for the years 2010-2014 to determine CKD prevalence, demographic and outcome associations. The Elixhauser ICD-10 comorbidity classification of renal failure was used to identify CKD (ElixRF). Chi-squared test, Kruskal-Wallis test and logistic regression were used for analysis. RESULTS: A total of 101 817 patients was included from our institution, with 6.4% classified as having ElixRF. ELixRF increased from 5.2% in 2010 to 8.6% in 2014 for all hospital admissions and from 8.3% to 13.3% for ICU admissions. ElixRF was associated with longer hospital and ICU length of stay, male gender, older age, higher comorbidity and independently with increased mortality. The VAED contained 2 044 507 episodes for the same period with similar trends and associations. CONCLUSIONS: CKD prevalence amongst patients admitted to hospital and ICU is increasing and is associated with worse outcomes. ElixRF may be a useful administrative flag for nephrologist involvement in care and for prompting consideration of advanced care planning.
Asunto(s)
Admisión del Paciente/tendencias , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Comorbilidad , Cuidados Críticos , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Clasificación Internacional de Enfermedades , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Centros de Atención TerciariaRESUMEN
Background. Pulmonary hypertension (PH) is a potent cause of heart failure and has been little investigated in the African setting.Objective. To investigate the effects of gender on the clinical presentation, echocardiographic features and outcomes of patients with PH in Douala, Cameroon.Methods. A prospective cohort study was conducted from March 2012 to December 2013 as part of the Pan African Pulmonary Hypertension Cohort study. PH was diagnosed by echocardiography and defined as a right ventricular systolic pressure >35 mmHg in the absence of acute right heart failure. Patients were followed up for a maximum of 12 months for primary endpoint mortality.Results. In total, 130 patients with PH were recruited; 71 (54.6%) were women. The median age was 59.2 years for men and 58.3 years for women (p=0.76). Active smoking and alcohol use were more frequent in men than women (both p<0.001), but women had greater exposure to indoor cooking fumes than men (p<0.001). Previous tuberculosis infection (11.3% v. 1.7%) and S3 gallop rhythm (30.9% v. 11.9%) were more common in women (both p<0.03). Women had a significantly higher mean systolic blood pressure (134 mmHg v. 125 mmHg; p=0.04) and pulse pressure (53.8 mmHg v. 44.9 mmHg; p=0.01) and a lower mean haemoglobin concentration (10.4 g/dL v. 12.4 g/dL; p<0.05) compared with men. Echocardiographic left ventricular (LV) systolic dysfunction was more frequent in men: mean LV ejection fraction 42.6% v. 51.5% (p=0.01) and mean fractional shortening 21.4% v. 28.6% (p=0.01). The overall mortality rate was 20.3%, and rates were similar in the two groups (Kaplan-Meier log rank 1.1; p=0.30).Conclusions. Despite differences in baseline characteristics including cardiovascular risk factors, mortality rates on follow-up were similar in men and women in this study. However, these different baseline characteristics probably suggest differences in the pathogenesis of PH in men and women in our setting that need further investigation
Asunto(s)
Camerún , Identidad de Género , Hipertensión Pulmonar , Factores de Riesgo , Sexo , Resultado del Tratamiento , TuberculosisRESUMEN
Earlier studies, mostly overseas, have explored the reasoning and thought processes underlying women's desires to conceive. A retrospective qualitative study was conducted to explore the motivations and anxieties of an Australian sample of women proceeding to a pregnancy and to explore their decision-making process. Twenty women over 18 years old who had one or more successful pregnancies and were recruited from a tertiary centre and private clinics, completed a questionnaire and a semi-structured interview. Thematic analysis was applied to the data. Multiple factors motivated women to proceed to a pregnancy and including influences arising from society or existing personal relationships, goals and desired experiences for parenthood and innate drives and reproductive related issues. The motivations of an urban Australian sample to proceed to a pregnancy differed little from studies elsewhere. This knowledge may assist in dealing with the concerns that underlie any pregnancy allowing for better obstetric management.
Asunto(s)
Madres/psicología , Motivación , Embarazo/psicología , Adulto , Australia , Cultura , Toma de Decisiones , Relaciones Familiares/psicología , Femenino , Humanos , Relaciones Interpersonales , Relaciones Madre-Hijo/psicología , Religión , Estudios Retrospectivos , Encuestas y Cuestionarios , Población Urbana , Adulto JovenRESUMEN
Earlier studies, mostly overseas, have explored the reasoning and thought processes underlying women's desires to conceive. A retrospective qualitative study was conducted to explore the motivations and anxieties of an Australian sample of women proceeding to a pregnancy and to explore their decision-making process. Twenty women over 18 years old who had one or more successful pregnancies and were recruited from a tertiary centre and private clinics, completed a questionnaire and a semi-structured interview. Thematic analysis was applied to the data. Multiple factors motivated women to proceed to a pregnancy and including influences arising from society or existing personal relationships, goals and desired experiences for parenthood and innate drives and reproductive related issues. The motivations of an urban Australian sample to proceed to a pregnancy differed little from studies elsewhere. This knowledge may assist in dealing with the concerns that underlie any pregnancy allowing for better obstetric management.
RESUMEN
A novel series of arylcyclopropanecarboxyl guanidines was synthesized and evaluated for activity against the sodium hydrogen exchanger isoform-1 (NHE-1). In biological assays conducted in an AP1 cell line expressing the human NHE-1 isoform, the starting cyclopropane 3a (IC(50) = 3.5 microM) shows inhibitory activity comparable to cariporide (IC(50) = 3.4 microM). Structure-activity relationships are used to optimize the affinity of various acyl guanidines for NHE-1 by screening the effect of substituents at both aryl and cyclopropyl rings. It is demonstrated that introduction of appropriate hydrophobic groups at the phenyl ring and a gem-dimethyl group at the cyclopropane ring enhances the NHE-1 inhibitory activity by up to 3 orders of magnitude (compound 7f, IC(50) = 0.003 microM). In addition, the gem-dimethyl series of analogues seem to display improved oral bioavailability and longer plasma half-life in rats. Furthermore, the lead benzodihydrofuranyl analogue 1 (BMS-284640) shows over 380-fold increased NHE-1 inhibitory activity as well as improved selectivity for NHE-1 over NHE-2 compared to cariporide.
Asunto(s)
Proteínas de Transporte de Catión , Ciclopropanos/síntesis química , Guanidinas/síntesis química , Proteínas de la Membrana/antagonistas & inhibidores , Intercambiadores de Sodio-Hidrógeno/antagonistas & inhibidores , Administración Oral , Animales , Disponibilidad Biológica , Línea Celular , Cricetinae , Cristalografía por Rayos X , Ciclopropanos/química , Ciclopropanos/farmacología , Guanidinas/química , Guanidinas/farmacología , Humanos , Isoformas de Proteínas/antagonistas & inhibidores , Ratas , Intercambiador 1 de Sodio-Hidrógeno , Estereoisomerismo , Relación Estructura-ActividadRESUMEN
OBJECTIVE: To assess echocardiographic evidence of cardiomyopathy and its association with microalbuminuria in type 2 normotensive non-proteinuric diabetic patients. MATERIAL AND METHODS: Forty consecutive normotensive non-proteinuric type 2 diabetic patients were studied. Body mass index, blood pressure, urinary albumin excretion, ECG at rest and after exercise, left ventricular mass, and shortening fraction using two-dimensional and M-mode echocardiography were measured in every patient. RESULTS: Among the 40 patients studied, 17 (42.5%) presented with microalbuminuria, 16 (40.0%) with left ventricular hypertrophy, 22 (55.0%) with systolic dysfunction and 3 (7.5%) with ECG changes compatible with cardiac ischaemia. No significant difference existed between normoalbuminuric and microalbuminuric patients for age, known duration of diabetes, body mass index, systolic and diastolic blood pressure. Ventricular mass correlated to urinary albumin excretion rate (r=0.34; p=0.04) and shortening fraction to diastolic blood pressure (r = - 0.40; p=0.01). CONCLUSION: Left ventricular structure and function might be altered in African type 2 diabetic patients in the absence of hypertension, and microalbuminuria may be an early biochemical marker of these abnormalities.
Asunto(s)
Albuminuria/fisiopatología , Población Negra , Diabetes Mellitus Tipo 2/fisiopatología , Sístole , Función Ventricular Izquierda , Adulto , Anciano , Albuminuria/orina , Presión Sanguínea , Camerún , Cardiomiopatías/complicaciones , Cardiomiopatías/diagnóstico por imagen , Estudios Transversales , Diabetes Mellitus Tipo 2/orina , Retinopatía Diabética/fisiopatología , Ecocardiografía , Electrocardiografía , Prueba de Esfuerzo , Femenino , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana EdadRESUMEN
AIM: The aim of this study was to investigate left ventricular diastolic function in a group of homozygous Black African patients with sickle-cell disease via echocardiography-Doppler, and to describe the possible hemodynamic implications of these findings. PATIENTS AND METHODS: Fifty patients with sickle-cell anemia from two hematology departments in Yaoundé volunteered to participate in the study, carried out between May-October 1995. The presence of any other associated pathology (cardiovascular disorder, acute drepanocytic anemia, pregnancy) was excluded following a clinical, hematological and echocardiographic examination. A sex- and age-matched control group consisting of 50 healthy subjects was selected after the same examination criteria had been met. Mitral flow recorded by pulsed Doppler was measured, and the amplitudes of the E and A waves of the proto- and telediastolic flow, the E/A ratio, the decrease over time (DT) for the E wave, and the left ventricular isovolumetric relaxation time were also calculated. The limits of the confidence interval for the mean DT of the control group were used as the criterion to determine the following in the patient population: i) relaxation disorder profile, with DT > 154 ms; ii) restrictive disorder profile, with DT < 137 ms. RESULTS: The dimensions of the cardiac cavities and the left ventricular mass were higher in the patient population; 34 cases of left auricular dilatation (68%) and 33 cases of left ventricular dilatation 8 66%) were observed. In only two patients was a systolic dysfunction noted. The amplitudes of the mitral flow E and A waves were increased, and the DT was longer in the sickle-cell group. Forty patients (80%) had abnormal diastolic function, with a marked predominance of the 'relaxation disorder' profile (60%). The restrictive disorder profile was only observed in ten sickle-cell patients (20%), while ten others displayed a normal profile (20%). The means of the various clinical and echocardiographic parameters of the three categories of sickle-cell patients (based on their diastolic profile, i.e., normal, relaxation disorder, restrictive disorder) were compared. The clinical parameters could be superimposed in the 3 categories. The dimensions of the left auricle and the telesystolic diameter of the left ventricle were significantly larger in the restrictive disorder category. The latter category appeared to be more symptomatic, and included the two isolated cases of systolic dysfunction. CONCLUSION: Left ventricular diastolic dysfunction is commonly encountered in sickle-cell cases in the Cameroon. The restrictive disorder profile is less frequently observed, but appears to be more harmful at the hemodynamic level. The present results suggest that the study of diastolic function in patients with sickle-cell anemia could help identify hemodynamically at-risk subjects who require more specific cardiovascular care, even before a noticeable alteration in systolic function has taken place.
Asunto(s)
Anemia de Células Falciformes/fisiopatología , Función Ventricular Izquierda , Adolescente , Adulto , Anemia de Células Falciformes/genética , Camerún , Diástole , Femenino , Homocigoto , Humanos , MasculinoRESUMEN
Microalbuminuria and retinopathy was studied in a non-proteinuric diabetic population of Cameroon. Patients were enrolled on a consecutive basis in two referral hospitals in Yaoundé. Retinopathy was evaluated by direct ophthalmoscopy and biomicroscopy, and controlled by mydriatic fundus photography. Detection of microalbuminuria was carried out on an overnight urine sample using Micral II test (Boehringer Mannheim). Anthropometric and blood pressure measurements were done using validated methods. In 64 non-proteinuric diabetic patients (9 IDDM and 55 NIDDM) aged 19-70 years with known duration of diabetes of 1-23 years, the prevalence of retinopathy was 37.5%. Microalbuminuria was detected in 53.1% of patients. Microalbuminuria correlated with duration of diabetes, and blood pressure, retinopathy was positively correlated with age, and blood pressure. Retinopathy was not significantly associated with the known duration of diabetes. Retinopathy was found to be independently associated with microalbuminuria (P < 0.001) and microalbuminuria appeared to be a sensitive marker of retinopathy. The prevalence of retinopathy and microalbuminuria in this population was high. Microalbuminuria and non-proliferative retinopathy are independently associated, and are both associated with increased blood pressure levels in the study population. As shown in previous studies microalbuminuria may also be a sensitive marker of early diabetic retinopathy in African diabetic patients.
Asunto(s)
Albuminuria/epidemiología , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/epidemiología , Retinopatía Diabética/epidemiología , Adulto , Factores de Edad , Anciano , Albuminuria/complicaciones , Albuminuria/fisiopatología , Camerún/epidemiología , Diabetes Mellitus Tipo 1/orina , Diabetes Mellitus Tipo 2/orina , Nefropatías Diabéticas/complicaciones , Retinopatía Diabética/complicaciones , Retinopatía Diabética/fisiopatología , Femenino , Fondo de Ojo , Humanos , Hipertensión/complicaciones , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oftalmoscopía , Prevalencia , Encuestas y Cuestionarios , Orina/químicaRESUMEN
A novel series of matrix metalloproteinase (MMP) inhibitors is described. Incorporation of a terminal alpha-mercaptoketone or alpha-mercaptoalcohol in the zinc binding domain of a series of inhibitors led to compounds exhibiting low nanomolar activity against collagenase-1 (MMP-1), stromelysin (MMP-3), and gelatinase-B (MMP-9).
Asunto(s)
Alcoholes/química , Cetonas/química , Metaloendopeptidasas/antagonistas & inhibidores , Inhibidores de Proteasas/química , Compuestos de Sulfhidrilo/química , Alcoholes/síntesis química , Alcoholes/farmacología , Sitios de Unión , Diseño de Fármacos , Ácidos Hidroxámicos/química , Ácidos Hidroxámicos/farmacología , Cetonas/síntesis química , Cetonas/farmacología , Cinética , Metaloproteinasa 1 de la Matriz , Metaloproteinasa 9 de la Matriz , Inhibidores de la Metaloproteinasa de la Matriz , Estructura Molecular , Inhibidores de Proteasas/síntesis química , Inhibidores de Proteasas/farmacología , Relación Estructura-Actividad , Compuestos de Sulfhidrilo/síntesis química , Compuestos de Sulfhidrilo/farmacología , Zinc/metabolismoRESUMEN
The optically active and fully protected gamma,gamma-di-t-butyl N-Fmoc-L-gamma-carboxyglutamate was synthesized from the relatively inexpensive D-serine. The overall yield of the synthesis was about 30%. Our studies review that, under TFA and various acidic conditions, L-Gla and its derivatives were stable with no decarboxylation. Finally, gamma,gamma-di-t-butyl N-Fmoc-L-gamma-carboxyglutamate was successfully used in peptide synthesis by Fmoc strategy on solid phase.
Asunto(s)
Ácido 1-Carboxiglutámico/análogos & derivados , Ácido 1-Carboxiglutámico/química , Péptidos/síntesis química , Secuencia de Aminoácidos , Estabilidad de Medicamentos , Humanos , Datos de Secuencia Molecular , EstereoisomerismoRESUMEN
We undertook a prospective study of cancerous lesions of the liver in 163 patients (136 males and 27 females) considered to be on high risk. These patients were, healthy carriers of HBs Antigen (n = 70), had chronic hepatitis (n = 45) or cirrhosis (n = 48). The screening was done from two main tests: liver ultrasound and blood alphafoetoprotein. Amongst the 163 patients, malignancy was diagnosed in 29 (22 males and 7 females) giving a prevalence of 17.8 percent: 9 cancers were diagnosed in the group with chronic hepatitis (20 percent), 20 in the group with cirrhosis (41.6 percent) and none in the group of healthy carriers. These results show that in Cameroun, cirrhosis is the most frequent abnormality associated with development of hepatocarcinoma. Thus the strategy against liver cancer should be oriented towards two main objectives; vaccination of children after eliminating healthy carriers and a regular follow-up of patients at risk.
Asunto(s)
Carcinoma Hepatocelular/epidemiología , Neoplasias Hepáticas/epidemiología , Tamizaje Masivo/métodos , Camerún/epidemiología , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/etiología , Femenino , Hepatitis/complicaciones , Hepatitis/epidemiología , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/epidemiología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/etiología , Masculino , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Ultrasonografía , alfa-Fetoproteínas/químicaRESUMEN
In a collection of 3,571 patient's files admitted in the University Teaching Hospital and the Yaounde General Hospital, we studied 27 patients suspected of chronic pancreatitis. 20 patients with calcified chronic pancreatitis benefited from a detailed history, physical examination and a complete paraclinical work-up. From the data collected, chronic alcoholism seemed to have been the main aetiology. Industrial beer from barley alone and/or associated with other traditional liquors was most consumed. The majority of patients were heavy alcoholics and daily consumption varied from 75 to 124 g of pure alcohol. The natural history of the disease and physical examination were identical to that observed in the western countries. Associated pathology was observed in 10% of the patients. This included peptic ulcer disease, cirrhosis and bile stones. Complications included diabetics, obstructive jaundice, and malabsorption syndrome. As a conclusion, chronic pancreatitis is a pathology whose prevalence seems to be progressing constantly.
Asunto(s)
Alcoholismo/complicaciones , Pancreatitis/etiología , Adulto , Anciano , Alcoholismo/epidemiología , Camerún/epidemiología , Enfermedad Crónica , Comorbilidad , Femenino , Hospitales Generales , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis/epidemiología , Pancreatitis/fisiopatología , Prevalencia , Factores de RiesgoRESUMEN
Plasma Renin Activity (PRA) was determined in a group of 50 Cameroonian newborns and 50 Cameroonian children aged 1-15 years under resting conditions in order to establish baseline values, and also to investigate the relationship between PRA distribution, and blood pressure levels, age, or body weight. Mean PRA values were 0.98 +/- 0.78 ng/ml/h at birth and 1.17 +/- 0.92 ng/ml/h in older children. These values did not correlate with birth weight, age, or blood pressure levels. These results are lower than figures reported in comparable groups of American white and black children, and also in European or Asian children.
Asunto(s)
Renina/sangre , Adolescente , Factores de Edad , Peso al Nacer , Población Negra , Presión Sanguínea/fisiología , Camerún , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Factores SexualesAsunto(s)
Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/etiología , Clima Tropical , Adulto , África/epidemiología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/epidemiología , Factores Epidemiológicos , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Diálisis Renal/efectos adversosRESUMEN
A simplified method for isolating highly purified laterobasal membranes (LBM) from enterocytes is based on treatment of membranes with 8 mM CaCl2 concentration in order to aggregate intracellular membrane contaminants. The resultant LBM showed an average 15-fold enrichment and constituted 8% of the original K-stimulated phosphatase in the initial crude homogenate. It showed typical LBM migration on counter-current distribution (CCD) and was essentially free of contamination with endoplasmic reticulum and Golgi membranes. This method is highly efficient and yields sufficient purified LBM to allow comprehensive analysis of enterocyte membrane events.