Moderate endurance exercise in patients with sickle cell anaemia: effects on oxidative stress and endothelial activation.

Very few studies have investigated the effects of exercise on the biological parameters involved in vaso-occlusive events in sickle cell anaemia (SCA). The aim of this study was to test how a mild-moderate endurance exercise modulates oxidative stress, nitric oxide bioavailability and endothelial activation in SCA patients and healthy individuals. Eleven patients with SCA and 15 healthy subjects completed a 20-min duration submaximal cycling exercise at ≈45 Watts. Plasma markers of oxidative stress, antioxidant activity, endothelial activation and nitric oxide bioavailability were investigated before and after the exercise. Nitric oxide levels, anti-oxidant capacity, soluble (s)E-selectin and sP-selectin did not change in response to this exercise. Except for the malondialdehyde levels, which increased in the two groups, the other markers of oxidative stress remained unchanged in both groups in response to exercise. Soluble vascular cell adhesion molecule 1 levels were increased at the end of exercise in both groups. sL-selectin decreased and soluble intercellular adhesion molecule 1 increased with exercise in SCA patients only. The present data suggest that patients with SCA may undertake mild-moderate physical activities without any acute clinical complications, but care should be taken because oxidative stress and endothelial activation significantly increased in some patients.

Mild haemorheological changes induced by a moderate endurance exercise in patients with sickle cell anaemia.

The levels and duration of physical activity that can be considered as completely safe in patients with sickle cell anaemia (SCA) is unknown. The present study compared the haemorheological and haematological profile, cell density distribution and basic biochemistry between a group of 17 patients with SCA and 21 healthy subjects before and after a 20 min duration submaximal cycling exercise at the same absolute workload. Blood was sampled at rest and 3 min after the end of exercise for measurement of biological parameters. Exercise did not affect the haematocrit and blood viscosity in the two groups. Plasma viscosity was not different between the two groups at rest and similarly increased with exercise. The proportion of intermediary dense cells (with density between 1·11 and 1·12 g/ml) decreased with exercise in the SCA group resulting in an increase in the proportion of red blood cells with a density >1·12 g/ml. No change was observed in the control group. The present study suggests that mild-moderate exercise is not very harmful for SCA patients. The haemorheological and haematological changes were very mild, except for the formation of dense cells but no clinically significant signs of medical complication were present in any of the patients.

Dose-effect relation between regular consumption of 100% cocoa powder and blood pressure in young, healthy black Africans.

BACKGROUND: Some previous works have focused on dose-response relationship between cocoa consumption and blood pressure in Caucasians. As black subjects have lower nitric oxide bioavailability, the aim of this work was to determine the dose-effect relation between cocoa and blood pressure in black Africans. METHOD: One hundred and thirty healthy black African males aged 18-30 were randomly assigned into four groups: three groups consuming 10 g, 5 g, or 2 g of cocoa powder daily for three weeks and one control group that did not consume cocoa. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured on day 1 (D1, before any subject consumed cocoa), D8, D15, and D22. Means of the parameters at each of the four visits and changes of the means were compared among the groups. RESULTS: Significant decrease in SBP was noted in consumers of 10 g compared to controls in the 1st week, and compared to consumers of 2 g in the 2nd and 3rd weeks of follow-up. Means and changes of DBP were statistically similar among the four groups. CONCLUSION: Among our cohort, decrease in SBP was significantly greater in the heavy cocoa consumer group (10 g) compared to the low consumer group (2 g), but there was no statistically significant difference when compared with the intermediate consumer group (5 g). The dose-response relationship between cocoa consumption and changes in SBP was not linear. No relationship was found between cocoa consumption and DBP.

Weekly Physiological Changes in Blood Pressure During Three Weeks Daily Consumption of 10 Grams of Cocoa Powder Among Young Black Africans in Côte d'Ivoire.

BACKGROUND: In Caucasians, regular consumption of cocoa induces a drop in arterial blood pressure via an increase in nitric oxide (NO) production. However, black individuals have a different NO biodisponibility compared to Caucasians. The aim of this study was to determine, in black Africans, the physiological variations in arterial blood pressure among cocoa consumers. METHOD: In total, 49 male black African volunteers, aged between 18 and 30 years old, were randomized into two groups; those consuming 10 g of cocoa powder per day (1,680 mg of flavonoids per day) for 3 weeks (consumer group), and those not consuming cocoa (control group). Systolic (SBP) and diastolic blood pressures (DBP), and heart rate (HR) were measured in the morning on an empty stomach (fasting), on day (D) 1 (without cocoa), D8, D15, and D22. Data were collected by groups and by subgroups established according to the level of SBP, DBP, or HR on D1. The means and variations of the means (between D1 and the subsequent days) of the recorded parameters were calculated and compared between groups and between subgroups. RESULTS: On D8, the variations in SBP in the consumer group were significantly different from the control group (-3.72 ± 6.01 versus 0.57 ± 6.66 mmHg; p = 0.02). Between the control and consumer subgroups according to SBP, no statistical difference in the means or variations in SBP was noted. On D8 and D22, the variations in the SBP of consumers with SBP ≥ 110 mmHg on D1 were significantly different from those of other consumers (D8: -6.55 ± 5.96 versus -1.1 ± 4.93 mmHg; p = 0.01; D22: -6.63 ± 7.77 versus 0.35 ± 5.58 mmHg; p = 0.01). In the subgroups with a DBP < 75 mmHg on D1, the mean DBP of the consumers was significantly lower than that of the controls on D8 (65 ± 5 versus 69 ± 6 mmHg; p = 0.03). CONCLUSION: In young black African men living in Côte d'Ivoire, regular consumption of cocoa resulted in a decrease in SBP and DBP. The decrease in SBP appeared to be greater the higher the baseline SBP was.

Effects of hydration and dehydration on blood rheology in sickle cell trait carriers during exercise.

This study compared the hemorheological responses of a group of sickle cell trait (SCT) carriers with those of a control (Cont) group in response to 40 min of submaximal exercise (exercise intensity, 55% aerobic peak power) performed in two conditions: one with water offered ad libitum, i.e., the hydration (Hyd) condition, and one without water, i.e., the dehydration (Dehyd) condition. Blood and plasma viscosities, as well as red blood cell rigidity, were determined at rest, at the end of exercise, and at 2 h recovery with a cone plate viscometer at high shear rate and 37 degrees C. The SCT and Cont groups lost 1 +/- 0.7 and 1.6 +/- 0.6 kg of body weight, respectively, in the Dehyd condition, indicating a significant effect of water deprivation compared with the Hyd condition, in which body weight remained unchanged. Plasma viscosity increased with exercise and returned to baseline during recovery independently of the group and condition. As previously demonstrated, resting blood viscosity was greater in the SCT carriers than in the Cont group. Blood viscosity increased by the end of exercise and returned to baseline at 2 h recovery in the Cont group in both conditions. The blood viscosity of SCT carriers did not change in response to exercise in the Dehyd condition and remained elevated at 2 h recovery. This extended hyperviscosity, in association with other biological changes induced by exercise, could be considered as a risk factor for exercise-related events in SCT carriers, similar to vasoocclusive crises, notably during the recovery. In contrast, the Hyd condition normalized the hyperviscosity and red blood cell rigidity of the SCT carriers, with blood viscosity values reaching the same lower values as those found in the Cont group during the recovery. Adequate hydration of SCT carriers should be strongly promoted to reduce the clinical risk associated with potential hyperviscosity complications.

Gender influence on the MVV / FEVi ratio in a population of healthy young adults.

INTRODUCTION: Maximal voluntary ventilation (MVV) and flow expiratory volume in the first second (FEVi) are important spirometric parameters. They are both gender-dependent. However, estimating the MVV, which is widely practiced in cardiopulmonary function testing, by multiplying FEVi by a constant value (equal to MVV/FEVi ratio) does not seem to take this into account. The purpose of this study was to compare the MVV/FEVi ratio by gender among healthy young adults. METHODS: This cross-sectional prospective study involved 67 medical sciences students, including 36 females of the same race, height, and age group. Their ventilatory function was assessed using a computerized spirometer, according to international recommendations. Pearson's test made it possible to correlate different spirometric parameters and linear regression was established between MVV and FEVi. The nonparametric Kruskal-Wallis test was used to compare the MVV/FEVi ratio between females and males. Comparisons by gender were made also between our data and previous prediction equations. RESULTS: In both females and males, FEVi was the spirometric parameter with which MVV had the highest correlation (r = .91 in females, r = .63 in males). A comparison of the means of the MVV/FEVi ratio by gender showed a statistically significant (p < .005) decrease in females (35.68 vs. 38.87). The previous prediction equations showed statistically significant under and overestimation of MVV values when gender was not taken into account. CONCLUSION: For the same height, age, and race, the ratio MVV/FEVi was significantly lower for females. So, the use of a preset constant value in estimating the MVV without taking gender into account was methodologically questionable. This work, which could have clinical implications, would benefit from being confirmed in a larger population.

Physiological variations of blood pressure according to gender and age among healthy young black Africans aged between 18 and 30 years in Côte d'Ivoire, West Africa.

In Africa, abnormal high blood pressure is common and affects young subjects. The risk of organ damage and mortality increases with blood pressure level. Therefore, the purpose of this study was to assess the blood pressure profile of a black African population aged between 18 and 30 years in Côte d'Ivoire. Five hundred fifty-one healthy black African students, men and women, with sedentary lifestyle, aged between 18 and 30 years were selected. Systolic (SBP) and diastolic (DBP) blood pressures and heart rate were recorded after 5 min of rest. Regression models were used to estimate the effects of age, gender, and body mass index (BMI) on SBP and DBP. Each increase of 1 year in age and 1 kg/m2 of BMI is significantly associated, respectively, with an increase of 20% (p = .002) and 17% (p = .008) in the risk of having an SBP ≥ 130 mmHg. The same risk is 3.8 times greater for men than women (p = .01). Among subjects with SBP < 120 mmHg, men have an SBP 5.22 mmHg higher than women (p < .001). The increase in the age of 1 year is significantly correlated with a rise of 36% of having a DBP ≥ 85 mmHg (p = .0001). Also, in men population, the age increase of 1 year is associated with a rise of 41% of having a DBP ≥ 85 mmHg (p = .0001). Among young black African students aged between 18 and 30 years in Côte d'Ivoire, SBP is positively associated with male gender, age, and BMI. For DBP, it is only an increase with age.

Sleep patterns in villagers and urban African volunteers in a humid tropical climate: Influence of accessibility to electric light?

Recent publications focusing on sleep-wake alternation, using actigraphic recordings in hunter-gatherers, stressed the existence of a potential effect of electricity availability on sleep habits. These reports prompted us to achieve a new analysis of the polysomnographic data already obtained in healthy African volunteers in equatorial Africa during two different investigations. Comparison of the 24-h polysomnographic sleep patterns were done between 9 volunteers sleeping in a laboratory in Abidjan (Abidjan cohort) and 11 villagers living in electricity-free bush villages (Sinfra cohort). Sleep was lighter in the villagers, with more stage 1 and less slow wave sleep (SWS). Latency to SWS was also shorter. Total sleep time, however, was not different between the two groups. There were no indications as to whether the observed differences were attributable to the availability of electrical power. Reactivity of human sleep structure to the environment was discussed in terms of multifactorial influences such as daylight length, temperature, humidity, electromagnetic field, time of sleep onset, thermoregulatory mechanisms, stress or anxiety.

[Doping practices and behaviours among Ivorian soccer players]. / Pratiques et conduites dopantes dans le football ivoirien.

We have conducted a survey of doping among soccer players in Côte d'Ivoire with a representative sample of 150 soccer players who filled out an anonymous questionnaire. The aim of this survey was to get a clearer picture of doping in Ivorian soccer in order to suggest preventive actions against doping. The results of this study showed that doping was known by the Ivorian soccer players; about 18.7% admitted to the use of doping substances, 42% recognised that they felt tempted by doping, while 38% knew another soccer player who had already used a doping substance. Government and sports organisations should recognize the importance of education and information in the antidoping campaign and agree on effective preventive as well as repressive strategies.

[The sleep of Africans and Europeans in the Ivory Coast: questionnaire study]. / Le Sommeil d'Africains et d'Européens en Côte d'lvoire: étude par questionnaires.

Sleep behaviour has been extensively studied with questionnaires in industrialised countries to investigate the epidemiology of sleep-wake disorders. However, only few attempts have yet been made to examine sleep behaviour of people living in Africa. Although, a large number of studies in hot or cold environments have used short-term exposures, reporting disrupted sleep for most of them, long-term exposures to stressful thermal environments are rare in the literature. Prior to the present investigation, we used questionnaires to analyse the effects of seasonal heat increase on perceived sleep behaviour and sleep quality in young native African students in Niger [7], even though these methods of investigation are by no means as accurate as polysomnographic recordings. The hypothesis was that sleep behaviour may be influenced by climatic variations in a hot dry tropical climate. Such climatic variations have been shown to induce seasonal heat acclimatisation marked by changes in body temperature rhythms in the hot versus the cool season [13]. Sleep behaviour was examined during two 7-day periods in January ("cool-dry" season, 88 subjects) and May ("hot-dry" season, 53 subjects). The questionnaire was completed after night sleep and/or naps. The subjects slept an average of 7 1/2 hours a day, most of them having afternoon naps. They experienced no major seasonal variation in their sleep behaviour, but for an increased number of awakenings during the hot season. Restorative quality of sleep scored lower after a nap than after nocturnal sleep. Therefore, general sleep characteristics were not modified by seasonal temperature variations in African native students, perhaps because of the limited changes in daylight under the low latitude of Niamey. Another investigation was carried out using the same 12-item questionnaire in Abidjan on 78 medical students who did not have a nap [9]. Contrary to the Niamey students, the Abidjan subjects adopted short duration sleep schedules, without any effect on the subjective quality of the restorative properties of their sleep.

Influence of high ovarian hormones on QT interval duration in young African women.

Abstract The longer QT interval duration observed in women compared to men is usually attributed to sexual hormones. The aim of our study was to investigate, among black African women, the influence of hormonal variations during the menstrual cycle on the duration of the QT interval. Fourteen young black African women, healthy, sedentary, aged 24 ± 1.7 years, with a regular menstrual cycle (28 ± 1 days) were selected from 59 volunteers. At each phase of their menstrual cycle, menstrual 2.9 ± 0.6 days, follicular 13 ± 1.5 days, and luteal 23.1 ± 1.4 days, an electrocardiogram was performed in supine position after a resting period of 30 min, to measure QT interval duration. QT interval was corrected by Bazett's (QTcb) and Fridericia's (QTcf) formulae. Then, blood samples were obtained to measure estradiol, progesterone, and serum electrolytes (K(+), Ca(2+), Mg(2+)). There was no significant difference in uncorrected QT intervals between the three phases of the menstrual cycle. It was the same for QTcb and QTcf. Moreover, during the menstrual cycle, we did not observe any correlation between each QT, QTcb, QTcf, and estradiol levels which raised during the follicular phase (356.61 ± 160.77 pg/mL) and progesterone levels which raised during the luteal phase (16.38 ± 5.88 ng/mL). Finally, the method of Bland and Altman demonstrated that the corrections of QT by Bazett and Fridericia formulae were not interchangeable. The results of this study showed that high levels of estradiol and progesterone in young black African women did not influence the QT, QTcb and QTcf intervals duration during the menstrual cycle.

The PhysioFlow thoracic impedancemeter is not valid for the measurements of cardiac hemodynamic parameters in chronic anemic patients.

The aim of the present study was to test the validity of the transthoracic electrical bioimpedance method PhysioFlow® to measure stroke volume in patients with chronic anemia. Stroke volume index (SVI), as well as cardiac index (CI) obtained by transthoracic electrical bioimpedance method and doppler echocardiography were compared in healthy subjects (n = 25) and patients with chronic anemia (i.e. mainly with sickle cell anemia; n = 32), at rest. While doppler echocardiography was able to detect difference in SVI between the two populations, the Physioflow® failed to detect any difference. Bland & Altman analyses have demonstrated no interchangeability between the two methods to assess CI and SVI in anemic patients and healthy subjects. While doppler echocardiography displayed a good concordance for SVI results with those obtained in the literature for anemic patients, the Physioflow® did not. Finally, in contrast to doppler echocardiography: 1) the CI obtained with the Physioflow® was not correlated with the hemoglobin level and 2) the stroke volume determined by the Physioflow® was highly influenced by body surface area. In conclusion, our findings indicate that the Physioflow® device is inaccurate for the measurement of SVI and CI in patients with chronic anemia and has a poor accuracy for the measurement of these parameters in African healthy subjects.

Moderate endurance exercise is not a risk for rhabdomyolysis or renal failure in sickle cell trait carriers.

This study tested the hypothesis that trained sickle cell trait (SCT) carriers are not subjected to greater risk of rhabdomyolysis or renal failure in response to moderate submaximal exercise than subjects with normal hemoglobin (CONT). Blood markers in 11 trained SCT carriers and 12 control counterparts were measured before and after 40 min of exercise at 55% of peak power output (Ppeak) conducted in thermoneutral environment. Body weights decreased with exercise in the same proportion in the two groups (from 65.1 ± 7.0 kg to 64.1 ± 7.0 kg and from 70.2 ± 6.6 to 68.6 ± 6.6 kg at the end of exercise in SCT and CONT, respectively). Heart rate and rectal temperature increased in the two groups in response to exercise, but the groups remained closely matched. Serum urea, CRP, CK and LDH were similar in the two groups and remained unchanged in response to exercise. Creatinine, Na(+), K(+), Cl(-) and myoglobin concentrations increased above baseline in response to exercise, with changes of the same magnitude in the two groups. In summary, the results of the present study suggest that moderate submaximal exercise is not unsafe from a biochemical point of view for sportsmen carrying SCT.