Mendelian randomization analyses suggest a causal role for circulating GIP and IL-1RA levels in homeostatic model assessment-derived measures of ß-cell function and insulin sensitivity in Africans without type 2 diabetes.

BACKGROUND: In vitro and in vivo studies have shown that certain cytokines and hormones may play a role in the development and progression of type 2 diabetes (T2D). However, studies on their role in T2D in humans are scarce. We evaluated associations between 11 circulating cytokines and hormones with T2D among a population of sub-Saharan Africans and tested for causal relationships using Mendelian randomization (MR) analyses. METHODS: We used logistic regression analysis adjusted for age, sex, body mass index, and recruitment country to regress levels of 11 cytokines and hormones (adipsin, leptin, visfatin, PAI-1, GIP, GLP-1, ghrelin, resistin, IL-6, IL-10, IL-1RA) on T2D among Ghanaians, Nigerians, and Kenyans from the Africa America Diabetes Mellitus study including 2276 individuals with T2D and 2790 non-T2D individuals. Similar linear regression models were fitted with homeostatic modelling assessments of insulin sensitivity (HOMA-S) and ß-cell function (HOMA-B) as dependent variables among non-T2D individuals (n = 2790). We used 35 genetic variants previously associated with at least one of these 11 cytokines and hormones among non-T2D individuals as instrumental variables in univariable and multivariable MR analyses. Statistical significance was set at 0.0045 (0.05/11 cytokines and hormones). RESULTS: Circulating GIP and IL-1RA levels were associated with T2D. Nine of the 11 cytokines and hormones (exceptions GLP-1 and IL-6) were associated with HOMA-S, HOMA-B, or both among non-T2D individuals. Two-stage least squares MR analysis provided evidence for a causal effect of GIP and IL-RA on HOMA-S and HOMA-B in multivariable analyses (GIP ~ HOMA-S ß = - 0.67, P-value = 1.88 × 10-6 and HOMA-B ß = 0.59, P-value = 1.88 × 10-5; IL-1RA ~ HOMA-S ß = - 0.51, P-value = 8.49 × 10-5 and HOMA-B ß = 0.48, P-value = 5.71 × 10-4). IL-RA was partly mediated via BMI (30-34%), but GIP was not. Inverse variance weighted MR analysis provided evidence for a causal effect of adipsin on T2D (multivariable OR = 1.83, P-value = 9.79 × 10-6), though these associations were not consistent in all sensitivity analyses. CONCLUSIONS: The findings of this comprehensive MR analysis indicate that circulating GIP and IL-1RA levels are causal for reduced insulin sensitivity and increased ß-cell function. GIP's effect being independent of BMI suggests that circulating levels of GIP could be a promising early biomarker for T2D risk. Our MR analyses do not provide conclusive evidence for a causal role of other circulating cytokines in T2D among sub-Saharan Africans.

Non-cigarette tobacco use and stroke among West Africans: evidence from the SIREN study.

INTRODUCTION: Non-cigarette tobacco (NCT) represents a form of tobacco use with a misperceived significance in chronic disease events. Whether NCT use is sufficient to promote stroke events, especially among Africans, is yet to be understood. This study assessed the relationship between NCT use and stroke among indigenous Africans. METHODS: A total of 7,617 respondents (NCT users: 41 vs. non-NCT: 7576) from the Stroke Investigation Research and Educational Network study were included in the current analysis. NCT use was defined as self-reported use of smoked (cigars or piper) or smokeless (snuff or chewed) tobacco in the past year preceding stroke events. Stroke was defined based on clinical presentation and confirmed with a cranial CT/MRI. Multivariable-adjusted logistic regression was applied to estimate the odds ratio (OR) and 95% confidence interval (CI) for the relationship between NCT and stroke at p<0.05. RESULTS: Out of the 41 (0.54%) who reported NCT use, 27 (65.9%) reported using smokeless NCT. NCT users were older than non-smokers (62.8±15.7 vs 57.7±14.8 years). Overall, NCT use was associated with first-ever stroke (OR: 2.08; 95%CI: 1.02, 4.23) in the entire sample. Notably, smokeless NCT use was independently associated with higher odds of stroke (OR: 2.74; 95%CI: 1.15, 6.54), but smoked NCT use (OR: 0.16; 95%CI: 0.02, 1.63) presented a statistically insignificant association after adjusting for hypertension and other covariates. CONCLUSIONS: NCT use was associated with higher odds of stroke, and public health interventions targeting NCT use might be promising in reducing the burden of stroke among indigenous Africans. IMPLICATIONS: A detailed understanding of the relationship between NCT use and stroke will likely inform well-articulated policy guidance to promote evidence-based recommendations for public health prevention and management of stroke on the African continent.

Causes of hospitalization and predictors of in-hospital mortality among people living with HIV in Sicily-Italy between 2010 and 2021.

BACKGROUND: Despite the rising number of people living with human immunodeficiency virus (HIV), there is a lack of knowledge about the factors that lead to PLWHs being hospitalized in worldwide literature. Our study aimed to investigate PLWH admissions in Sicily (Italy) between January 2010 and September 2021 and to analyze the characteristics and risk factors for in-hospital mortality and differences between Italians and foreigners. METHODS: Data from the hospital discharge forms of all people living with HIV (PLWH) hospitalized in Sicilian hospitals were retrospectively collected. Age, sex, nationality, length of stay, acquired immunodeficiency syndrome (AIDS), and non-AIDS-related diseases were evaluated using univariate analysis according to in-hospital mortality rates. The factors associated with mortality were included in the logistic regression model. RESULTS: In total, 5281 admissions from 2726 PLWHs occurred, most of which were related to non-AIDS diseases. Approximately 20 % regarded foreign patients, mainly from Africa. Logistic regression analysis revealed an association between in-hospital mortality and some AIDS- and non-AIDS-related diseases (wasting syndrome, lymphomas, Kaposi sarcomas, progressive multifocal leukoencephalopathy, cryptococcosis, abscesses, sepsis, cardiovascular disease, nephropathy, and respiratory diseases). African patient admissions were significantly associated with tuberculosis, toxoplasmosis, Burkitt lymphoma, and hepatitis B diagnoses. CONCLUSIONS: Our study showed that most hospitalizations were related to non-AIDS-defining diseases, with differences between Italian and foreign patients, mainly from Africa.

Topography and Composition of the Iliolumbar Veins in a South African Cohort: Implications for Spinal Surgery.

STUDY DESIGN: A descriptive cross-sectional study of the anatomical variations, morphometry, and histology of the iliolumbar veins (ILVs). PURPOSE: This study aimed to describe the anatomical variations of the ILVs and determine their tissue composition in South African cadavers of European descent. OVERVIEW OF LITERATURE: A safe anterior surgical approach to the L4/L5 intervertebral disc space requires understanding the anatomy of the ILVs. Limited understanding of ILVs and their variations may lead to inadvertent avulsion of veins with subsequent hemorrhage and damage to the adjacent nerves intraoperatively. Variations in ILVs are population specific, but such reports are limited in the South African population. METHODS: Eighty-nine adult cadavers were dissected to reveal ILV patterns. The variations (origin, course, and drainage pattern), morphometries, and topography of the ILVs were studied. A total of 19 (10 proximal, nine distal) ILVs were processed for hematoxylin and eosin, Masson's trichrome, and Verhoeff's histological staining to determine the tissue composition. RESULTS: The ILVs were identified in 100% of the cases, and 45% of the ILVs were anastomosed to each other bilaterally. The rightside ILVs terminated into the posterior surfaces of the iliac vessels (p =0.001), whereas the left-side ILVs terminated into the lateral surfaces (p =0.001). The left-side proximal ILVs had higher elastic fiber composition (p =0.030). The ratio of the ILVs' elastic fibers to collagen fibers was 1:9, and 61% of the cadavers exhibited type 1 ILV pattern. Moreover, 42% of the ILVs were at the S1 vertebral level with 31% lying between L4 and L5 spinal nerve roots. The obturator nerve coursed anteriorly to the ILVs in 96% of cases. CONCLUSIONS: The ILV variations described for South Africans present new additional patterns, such as bilateral anastomosis and laterality of the terminal drainage. The ILVs have more collagen fibers than elastic fibers, predisposing them to avulsion during surgical retraction. The identification of all the ILVs is crucial to minimize inadvertent hemorrhage and damage to adjacent structures.

Intraocular Pressure Elevation Following the Use of Topical Dexamethasone Ointment After Squint Surgery.

Purpose: To describe the pattern of intraocular pressure (IOP) changes after squint surgery in eyes of black Africans at the University College Hospital, Ibadan, Nigeria. Materials and Methods: This was a retrospective review of the clinical records of patients who underwent squint surgery between 2010 and 2019. Data on demographic characteristics, preoperative and postoperative intraocular pressure values, co-existing ocular pathology, type of strabismus, surgery performed, frequency and duration of postoperative topical steroid use and treatment received for elevated intraocular pressure were collected and descriptively summarised. Results: Thirty-six (39.1%) out of 92 patients who had squint surgery during the study period met study inclusion criteria. Mean age was 20.5 ± 13.6 years. All patients were administered Maxitrol® ointment postoperatively. Baseline, peak and net change in IOP were 12.9 ± 2.6 mmHg, 21.3 ± 6.8 mmHg and 8.39 ± 7.2 mmHg respectively. Thirty-one (86.1%) patients had elevation in IOP from baseline; 21 (67.7%) of these had significant IOP elevation. Topical steroid therapy was tailed off rapidly for all patients with significant IOP elevation. Twelve patients were commenced on topical IOP lowering medications, with normalization of intraocular pressure in majority of them by three months after surgery. Conclusion: Elevated intraocular pressure with the use of topical dexamethasone ointment after squint surgery was common in this study and majority of the patients had significant elevation in intraocular pressure. Close monitoring of the intraocular pressure of black patients, especially children, on topical steroid medication after squint surgery is strongly recommended.

"Espantosa mortandade": desembarques, demografias e enfermidades africanas / "Appalling mortality": disembarkation, demographics, and African diseases

Resumo Este artigo contribui para conhecermos melhor as condições a que africanos estavam submetidos no imediato desembarque, estendendo o estudo para além do navio. Destaca a importância dos africanos orientais no Sudeste brasileiro no início do século XIX, o que deve ser considerado para o aprofundamento da análise sobre reinvenções identitárias, doenças e práticas de cura. As dores dessas pessoas tiveram como pano de fundo os debates e as negociações políticas em torno da proibição do tráfico atlântico e da independência do Brasil.

Abstract This article contributes to a better understanding of the conditions which Africans endured immediately after landing in Brazil, taking the study beyond what happened in the slave ships. It highlights the importance of Eastern Africans in the southeast of Brazil, in the beginning of the nineteenth century, something that must be considered in order to do a deeper analysis of identity reinventions, diseases, and healing practices. The background of the suffering of those people can be found in the debates and political negotiations surrounding the prohibition of the Atlantic slave trade and the independence of Brazil.

Effect of Obesity on Resistin Concentrations in Normal, Pre-Obese and Obese Apparently Healthy Nigerian-Africans.

BACKGROUND: Among Caucasians, conflicting findings exist on resistin in obesity and its relation to metabolic indices, with scarcity of such in Nigerian-Africans. Therefore, the study assessed plasma resistin and explored its relationship with obesity and selected cardiometabolic risks. METHODS: A cross-sectional comparative-analytical study on 87 randomly-selected non-diabetic Nigerians allocated into three groups by the WHO criteria: 24 normal; 23 pre-obese and 40 obese. Resistin was measured via enzyme-linked immunosorbent assay. One-way Analysis of Variance (ANOVA) and Independent Kruskal-Wallis test determined differences in BMI categories. Spearman's correlation and Multivariate Logistic Regression assessed relationships. A sub-group analysis excluding subjects with first time incidental finding of high blood pressure, determined further associations. RESULTS: Resistin concentrations trended towards higher levels in obese than normal controls {Mean ± SD, 6.72 ± 4.25 ng/mL versus 5.10 ± 2.58 ng/mL}, with significantly (p<0.05) higher obesity indices, fasting insulin (FI) and HOMA-IR in obese than normal controls. Hyperresistinaemia involved 8(9.2%) subjects as against 79(90.8%) with normoresistinaemia, {Mean ± SD, 15.1 ± 2.6 ng/mL versus 5.3 ± 2.8 ng/mL, (p<0.001)}. Log (Ln10) hyperresistinaemia was significantly (p<0.05) positively correlated to obesity indices (BMI, r=0.29, p=0.006; WC, r=0.23, p=0.04) but not to HOMA-IR, FI, FBG, SBP, DBP and age. Ln10 Hyperresistinaemia in females was significantly (p=0.05, OR: 1.12, 95% CI, 1.0-1.25) associated with central obesity by the IDF criteria in both unadjusted and step-wise age, sex, SBP & DBP adjusted models. Similar finding was for generalized obesity, albeit with low odds in all subjects (p=0.009), with persistence in the step-wise age, sex and SBP/DBP adjusted models. In the sub-group analysis, resistin showed similar findings to that of the whole sample population. CONCLUSION: Resistin concentrations trended towards higher levels in obese than normal healthy non-diabetic Nigerian-Africans. Its lack of correlation with HOMA-IR and mild correlations/marginal relations to obesity indices may suggest possible interplay of other proinflammatory cytokines or hormones which may be evaluated in further studies.

CONTEXTE: Chez les Caucasiens, il existe des résultats contradictoires sur la résistine dans l'obésité et sa relation aux indices métaboliques avec la rareté de telles chez les Nigérians-Africains. Par conséquent, l'étude a évalué la résistine plasmatique et a exploré sa relation avec l'obésité et certains risques cardiométaboliques. MÉTHODES: Une étude transversale comparative et analytique a été réalisée sur 87 nigérians non-diabétiques sélectionnés au hasard et répartis en trois groups selon les critères de l'OMS : 24 normaux ; 23 préobèses et 40 obèses. La résistine a été mesurée par dosage immuno-enzymatique. Analyse de variance à sens unique (ANOVA) et test indépendant de Kruskal-Wallis ont déterminé les différences entre les catégories d'IMC. La corrélation de Spearman et la régression logistique multivariée ont évalué les relations. Une analyse de sous-groupe excluant les sujets chez qui une hypertension artérielle avait été découverte par hasard pour la première fois a déterminé d'autres associations. RÉSULTATS: Les concentrations de résistine tendent à être plus élevées chez les sujets obèses que chez les témoins normaux {Moyenne ± SD, 6,72 ± 4,25 ng/mL contre 5,10 ± 2,58 ng/mL}, avec des indices d'obésité significativement (p<0,05) plus élevés, l'insuline à jeun (IF) et l'HOMAIR chez les obèses que chez les témoins normaux. L'hyperrésistinémie concernait 8 (9,2%) sujets contre 79 (90,8%) avec normorésistinémie, {Moyenne ± SD, 15,1 ± 2,6 ng/mL contre 5,3 ± 2,8 ng/mL, (p<0,001)}. L'hyperrésistinémie log (Ln10) était significativement (p<0,05) corrélée positivement aux indices d'obésité (IMC, r=0,29, p=0,006 ; tour de taille, r=0,23, p=0,04) mais pas à HOMA-IR, FI, FBG, SBP, DBP et l'âge. Ln10 L'hyperrésistinémie chez les femmes était significativement (p=0,05, OR : 1,12, IC 95 %, 1,0-1,25) associée à une obésité l'obésité centrale selon les critères de la FID, à la fois de manière non ajustée et par paliers. l'âge, le sexe, la TAS et la TAD. Une constatation similaire a été faite pour l'obésité généralisée, bien qu'avec une faible probabilité chez tous les sujets (p=0,009), avec une persistance dans les modèles ajustés par étape en fonction de l'âge, du sexe et du SBP/DBP. lDans l'analyse de sous-groupe, la résistine a montré des résultats similaires à ceux de l'ensemble de la population de l'échantillon. CONCLUSION: Les concentrations de résistine tendent vers des niveaux plus élevés chez les Nigérians-Africains obèses que chez les Nigérians non-diabétiques en bonne santé. Son manque de corrélation avec HOMA-IR et des corrélations légères/marginales avec les indices d'obésité aux indices d'obésité peut suggérer une interaction possible avec d'autres cytokines ou hormones pro-inflammatoires, ce qui pourrait être évalué dans des études ultérieures. Mots clés: Résistine, obésité, surpoids, non-obésité, non-diabète, Africains Nigérians en bonne santé, risques cardiométaboliques.

[Perception of the cancer diagnosis announcement in a university hospital setting in Ivory Coast: About 120 patients followed in oncology and onco-hematology services]. / Perception de l'annonce du diagnostic de cancer dans un cadre hospitalo-universitaire en Côte d'Ivoire. À propos de 120 patients suivis dans les services d'oncologie et d'onco-hématologie.

BACKGROUND: The diagnostic of cancer is generally associated with a psychological shock. Body's defense mechanisms and drugs cannot resolve emotional distress and symptoms of cancer. A need for psychosocial management of the African patient is necessary. OBJECTIF: Study of perception of the cancer diagnosis announcement by Ivory Coast patients suffering of cancer. PATIENTS AND METHODS: This is a bicenter retrospective and cross-sectional study which aims at describing data over a period of seven (7) months (November 2017 to May 2018). This study took place in the haematology and oncology departments respectively in CHU of Yopougon and Treichville. Patient recruitment was carried out exhaustively. The data was collected using a standardized questionnaire, developed in the french language, which was given individually under the direction of the oncopsychiatrist investigator. The investigation required the presence of an interpreter for patients who did not speak French. This study exhibits sociodemographic, clinical, therapeutical and medico-psychosocial data. So, 120 patients were included. RESULTS: Breast's cancer was frequent (61%) and found at advanced stages (71%). Incurability and death's idea were 0.8% and 3.3%, respectively. Diagnostic announcement was good in 95% cases, but patients developed sadness (63.3%), denial (10%) and idea of suicide (3.4%). The psychosocial life of patients was affected by depressed state (35%). The therapeutical route was marked by medical treatment (42%), religious (41%), herbal treatment (9%). Altogether, 68.3% of patients had a social support, either given by friends (47.6%) or were financially supported (36.6 %) . CONCLUSION: This study was oriented towards formalization or integration of a psycho-oncological intervention during the management of a black patient group suffering from various cancers.

Dinâmica comparada: fluxos dos escravizados africanos em São Paulo, Minas Gerais e Maranhão (1804-1848) / Comparative dynamics: flows of enslaved Africans in São Paulo, Minas Gerais and Maranhão (1804-1848) / Dinámica comparada: flujos de africanos esclavizados en São Paulo, Minas Gerais y Maranhão (1804-1848)

Analisamos comparativamente informes demográficos de qualidade aceitável acerca dos escravizados nascidos na África para Minas Gerais, São Paulo e Maranhão de 1804 a 1848. As parcelas dos nascidos na África em relação aos escravizados e às razões de sexo de todos os cativos, de acordo com as idades, auxiliaram-nos a remontar a dinâmica retrospectiva da chegada dos africanos às regiões. Supondo certas hipóteses e procedimentos, a partir das coortes etárias, estimamos as proporções de africanos e as razões de sexo da população cativa para os períodos anteriores aos das listas nominativas de habitantes. A dinâmica retrospectiva da introdução de africanos reconstruída mostrou-se bastante correlacionada à história econômica das diferentes regiões estudadas.

We compare the surviving enslaved people present in demographic censuses of acceptable quality for Minas Gerais, São Paulo and Maranhão from 1804 to 1848. The share of those born in Africa in relation to slaves and the sex ratio of all captives according to their ages helped us find the retrospective dynamics of the arrival of Africans to these regions. When using age cohorts, we estimate, assuming certain hypotheses and procedures, the proportions of Africans and the sex ratios of the captive population for periods prior to those of the nominative lists of inhabitants. The retrospective dynamics of the reconstructed introduction of these Africans proved to be closely correlated with the economic history of the different regions analyzed.

Analizamos comparativamente a los sobrevivientes esclavizados presentes en los informes demográficos evaluados como de calidad aceptable para Minas Gerais, São Paulo y Maranhão entre 1804 y 1848. La proporción de los nacidos en África en relación con los esclavizados y la proporción de sexos de todos los cautivos, según las edades, nos ayudaron a trazar la dinámica retrospectiva de la llegada de africanos a estas regiones. Utilizando las cohortes de edad, estimamos, asumiendo ciertas hipótesis y procedimientos, las proporciones de africanos y las proporciones de sexos de la población cautiva para períodos anteriores a las listas nominativas de habitantes. La dinámica retrospectiva de la introducción reconstruida de africanos demostró estar altamente correlacionada con la historia económica de las diferentes regiones estudiadas.

Spondyloarthritis in African Populations Compared to Europeans Living in the United Kingdom.

BACKGROUND: With the aim to study Spondyloarthritis in patients originating from Africa and compare the disease with the way it is manifested in Europeans, data was analysed from 62 African patients and compared with 56 Europeans living in the same geographical area (north East London, United Kingdom) and treated under the same health system (NHS). Data analysed were demographic, social and clinical characteristics. RESULTS: Comparisons showed differences in prevalence of psoriasis (more in Caucasians), uveitis (more in Africans), smoking (more in Europeans), and significantly fewer patients of African origin declared family history of SpA. African patients have less disease activity (but not significantly better measured by BASDAI), and statistically significant better functional ability (BASFI) compared to Europeans. No difference has been noted in gender distribution, age of disease onset, disease duration, delay in diagnosis, disease associations with IBD, night pain, or overall wellbeing. CONCLUSIONS: SpA is different in Africans in that it shows to be milder in terms of disease activity and functional ability with more uveitis less psoriasis and less family history of SpAs.

The role of ALDH1A1 in contributing to breast tumour aggressiveness: A study conducted in an African population.

Aldehyde dehydrogenase 1 member A1 (ALDH1A1) is one of the most well studied breast cancer stem cells. Its expression has been associated with poor clinicopathological features and clinical outcomes in several studies. This paper studies the expression of ALDH1A1 and its combination with CD44+/CD24-/low breast cancer stem cell and their association with clinicopathological parameters and molecular subtypes. METHOD: Tissue Microarray was constructed from 222 Formalin Fixed Paraffin Embedded (FFPE) breast cancer tissues. The expression of ALDH1A1, CD44 and CD24 were assessed by Immunohistochemistry (IHC). The association of ALDH1A1 and its association with clinicopathological parameters, molecular subtypes, CD44 and CD24 were studied in an African population. The association between CD44+/CD24-/low/ALDH1+ and the clinicopathological phenotypes were also studied. RESULTS: A high ALDH1A1 expression of 90% was recorded in this study. No association was found between ALDH1A1 and clinicopathological parameters. ALDH1A1 was positively associated with CD24 (r = 0.228, OR-4.599 95% CI- 1.751-12.076, p = 0.001) and CD44 (r = 0.228, OR-5.538 95%CI- 1.841-16.662, p = 0.001) but not associated with CD44+/CD24-/low (r = 0.134, OR- 2.720 95%CI- 0.959-7.710, p = 0.052). CD44+/CD24-/ALDH1+ however had significant associations with Age (p- 0.020, r = 0.161, OR- 2.771, 95%CI 1.147-6.697), Gender (p = 0.004, OR- 15.333 95%CI 1.339-175.54), Tumour grade (p = 0.005, r = 0.197, OR-3.913 95%CI 1.421-10.776) and clinical prognostic staging (p = 0.014, r = 0.182, OR-3.028 95%CI- 1.217-7.536). There was no association between CD44+/CD24-/ALDH1+ and the molecular subtypes. CONCLUSION: The high expression of ALDH1A1 in breast cancer makes it an important target for targeted therapy. This study further confirms the increased tumourigenicity of CD44+/CD24-/ALDH1+ combination phenotype and its association with increased tumour grade and clinical prognostic stage. Survival studies of ALDH1A1 and other breast cancer stem cells in African populations are strongly recommended to help further understand their effect on tumour aggressiveness.

Diagnostic performance of glomerular PLA2R and THSD7A antibodies in biopsy confirmed primary membranous nephropathy in South Africans.

BACKGROUND: Serum and tissue-based tests using phospholipase A2 receptor 1 (PLA2R) and thrombospondin type-1 domain containing 7A (THSD7A) are established immune biomarkers for the diagnosis of primary membranous nephropathy (PMN). This study assessed the diagnostic performance of these biomarkers in the diagnosis of PMN in South Africans. METHODS: This was a cross-sectional analysis from a single centre in Cape Town, South Africa. Relevant biodata was collected from all patients. Histology, including slides for PLA2R and THSD7A were processed and assessed by typical microscopic and immunohistochemical features. Biopsy tissues of patients with membranous lupus nephritis (LN-V) and diabetic nephropathy (DN) were used as controls. The diagnostic accuracy for diagnosis of PMN using positive PLA2R and THSD7A were evaluated. RESULTS: Of the 88 patients included, 41 had PMN with a mean age of 44.5 ± 17.5 years and 61.0% were female. Histologically, PLA2R and THSD7A were only positive in the PMN group (51.2% and 4.9%, respectively) but negative in both control groups. The sensitivity of PLA2R and THSD7A for identifying PMN was 51.2% and 4.9%, respectively. The sensitivity of both tests together was 53.7% while the specificity and positive predictive values (PPV) for any of the tests (alone or in combination) was 100%. There was no difference in the sensitivity and specificity when using PLA2R alone compared to combining the two tests (p=0.32). CONCLUSION: Glomerular staining of PLA2R and THSD7A could have potential diagnostic values in South Africans. This has implications on how immunotherapies can be initiated and used in these settings.

Dermatofibrosarcoma protuberance in a black African cohort-a clinicopathologic study.

BACKGROUND: Dermatofibrosarcoma protuberance (DFSP) is the commonest, yet rare, dermal sarcoma globally. There are few reports in the literature of this neoplasm in Nigerians and indeed in sub-Saharan Africa. This study documents our institutional practice observation and compares it with those from other regions of the world. METHODS AND MATERIALS: This study was a retrospective review of all cases of histologically diagnosed DFSP at the University College Hospital, Ibadan, Nigeria, spanning a period of 27 years (January 1989-December 2016). Data on patient age, gender, tumour location, size, tumour recurrence and metastasis status were obtained from clinical and surgical pathology archival files and records. RESULTS: Sixty-nine cases of DFSP were recorded over the period reviewed with a male-female ratio of 1.6:1. The mean age of the study population was 39.6 years. The youngest patient was 5-year old, while the oldest was 86 years and the modal age group was the 4th decade. The trunk was the commonest anatomic tumour location. Recurrences were seen in seven cases with recurrence interval ranging from 6 to 240 months. The correlation between tumour size and age was non-significant (r = -0.183; p = 0.182). There was fibrosarcoma-like transformation in three cases (4.3%) studied. CONCLUSION: Dermatofibrosarcoma protuberance is rare in our population and occurs more commonly in males and on the trunk. Recurrence can occur beyond the recommended follow-up period of 10 years.

"Hipnóticos" na metrópole: africanos no Hospital Colonial de Lisboa nas primeiras décadas do século XX / "Hypnotics" in the metropolis: Africans in the Colonial Hospital of Lisbon during the early twentieth century

Resumo No início do século XX, alguns médicos portugueses foram à África estudar a chamada doença do sono. Entre eles estava Ayres Kopke, membro da primeira missão médica à África Ocidental Portuguesa. De regresso a Lisboa, o professor da Escola de Medicina Tropical continuou suas pesquisas, inclusive por meio da observação de doentes trazidos para a metrópole. Desde 1903, as repartições de saúde nas colônias estavam incumbidas de enviar doentes com determinadas patologias exóticas para o Hospital Colonial de Lisboa. Com base em documentos desse hospital, incluindo fotografias dos doentes, então chamados de hipnóticos, o artigo aborda a importância das experiências com humanos na metrópole para o avanço da medicina tropical durante o colonialismo.

Abstract At the start of the twentieth century, some Portuguese physicians traveled to Africa to study sleeping sickness (African trypanosomiasis). One was Ayres Kopke, a member of the first medical mission to Portuguese West Africa and professor at the School of Tropical Medicine. After returning to Lisbon, Kopke continued his research, which included observation of patients brought to the metropolis. Starting in 1903, health departments in the colonies were responsible for sending patients with certain exotic diseases to the Colonial Hospital of Lisbon. Based on documents from this hospital including photographs of patients (who at that time were called "hypnotics"), this article discusses the importance of human experiments in Lisbon for advances in tropical medicine during the colonial period.

Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania.

OBJECTIVES: The aim of this study was to identify the parameters that predict the risk of future foot ulcer occurrence in patients with diabetes. RESEARCH DESIGN AND METHODS: 1810 (male (M)/female (F): 1012/798) patients, with no foot ulcer at baseline, participated in this study. Data from a set of 28 parameters were collected at baseline. During follow-up, 123 (M/F: 68/55) patients ulcerated. Survival analyses together with logistic regression were used to identify the parameters that could predict the risk of future diabetic foot ulcer occurrence. RESULTS: A number of parameters (HR (95% CI)) including neuropathy (2.525 (1.680 to 3.795)); history of ulceration (2.796 (1.029 to 7.598)); smoking history (1.686 (1.097 to 2.592)); presence of callus (1.474 (0.999 to 2.174)); nail ingrowth (5.653 (2.078 to 15.379)); foot swelling (3.345 (1.799 to 6.218)); dry skin (1.926 (1.273 to 2.914)); limited ankle (1.662 (1.365 to 2.022)) and metatarsophalangeal (MTP) joint (2.745 (1.853 to 4.067)) ranges of motion; and decreased (3.141 (2.102 to 4.693)), highly decreased (5.263 (1.266 to 21.878)), and absent (9.671 (5.179 to 18.059)) sensation to touch; age (1.026 (1.010 to 1.042)); vibration perception threshold (1.079 (1.060 to 1.099)); duration of diabetes (1.000 (1.000 to 1.000)); and plantar pressure at the first metatarsal head (1.003 (1.001 to 1.005)), temperature sensation (1.019 (1.004 to 1.035)) and temperature tolerance (1.523 (1.337 to 1.734)) thresholds to hot stimuli and blood sugar level (1.027 (1.006 to 1.048)) were all significantly associated with increased risk of ulceration. However, plantar pressure underneath the fifth toe (0.990 (0.983 to 0.998)) and temperature sensation (0.755 (0.688 to 0.829)) and temperature tolerance (0.668 (0.592 to 0.0754)) thresholds to cold stimuli showed to significantly decrease the risk of future ulcer occurrence. Multivariate survival model indicated that nail ingrowth (4.42 (1.38 to 14.07)); vibration perception threshold (1.07 (1.04 to 1.09)); dry skin status (4.48 (1.80 to 11.14)); and temperature tolerance threshold to warm stimuli (1.001 (1.000 to 1.002)) were significant predictors of foot ulceration risk in the final model. The mean time to ulceration was significantly (p<0.05) shorter for patients with: dry skin (χ2=11.015), nail ingrowth (χ2=14.688), neuropathy (χ2=21.284), or foot swelling (χ2=16.428). CONCLUSION: Nail ingrowth and dry skin were found to be strong indicators of vulnerability of patients to diabetic foot ulceration. Results highlight that assessments of neuropathy in relation to both small and larger fiber impairment need to be considered for predicting the risk of diabetic foot ulceration.

Necrobiosis lipoidica in a Nigerian woman - Report of a case.

Necrobiosis lipoidica (NL), one of a group of "necrobiotic" granulomatous cutaneous disorders, is characterized histologically by layers of poorly defined, horizontally oriented, altered "necrobiotic" collagen surrounded by, and alternating with, layers of chronic inflammatory cells, histiocytes, and giant cells throughout the full thickness of the dermis. It is a rare disease associated mostly with diabetes mellitus in whom it may affect 0.3%-1.2% although it has also been associated with other cutaneous and systemic disorders and may occur in otherwise normal people. NL has been reported from all over the world, but there appears to be very few reports of NL in Black Africans. We report the case of a 55-year-old diabetic Nigerian woman who presented with typical NL lesions on the lower legs and who responded very well to topical betamethasone dipropionate 0.05% cream. We also briefly review the probable underlying mechanisms leading to the condition and the various treatments that have been found useful.

Tenofovir-associated kidney disease in Africans: a systematic review.

BACKGROUND: Data on chronic kidney disease development in HIV infection is important towards building a comprehensive knowledge of HIV, ageing and polypharmacy in Africa. Several previous studies on tenofovir-associated kidney disease in Africa have shown conflicting results. This review summarises what is known about the development of kidney disease in HIV-positive African patients on tenofovir disoproxil fumarate (TDF)-containing ART. We set out to document the occurrence of kidney disease in HIV-positive Africans on TDF-containing ART in population-based studies and to evaluate the renal safety of TDF in Africans. METHODS: We conducted a systemic review using published studies which were identified through a computerized search of original research using the Medline/PubMed database, EMBASE, EBM Reviews, Proquest Google Scholar and Global Health reported from inception until 5 October 2017. Two reviewers independently abstracted the data and performed quality assessment of the included studies. We screened 595 articles and included 31 in the qualitative analysis performed. RESULTS: A total of 106 406 patients (of whom 66,681 were on Tenofovir) were involved in these 31 studies with sample sizes ranging from 30 to 62,230. Duration on tenofovir-containing ART ranged from those initiating ART at baseline to those who received TDF for up to 9 years. All but one of the studies involved only patients 16 years and older. The studies had differing definitions of kidney dysfunction and were of variable study design quality. The documented outcomes had substantial discrepancies across the studies, most likely due to methodological differences, study size and disparate outcome definitions. CONCLUSIONS: Our review identified studies in Africans reporting statistically significant renal function decline associated with TDF use but the clinical significance of this effect was not enough to contraindicate its continued use in ART regimens. Consistent with studies in other populations, patients are at greater risk if they have pre-existing renal disease and are more advanced in age. More research is needed on paediatric populations under 16 years of age. Trial registration This review was registered on Prospero (registration number CRD42018078717).

Illness representations and coping practices for self-managing hypertension among sub-Saharan Africans: A comparative study among Ghanaian migrants and non-migrant Ghanaians.

OBJECTIVE: Hypertension (HTN) control is a major obstacle among sub-Saharan African populations partly due to poor self-management. We explored and compared how persons' social and physical context shapes their illness representations regarding HTN and the coping strategies they develop and adapt to mitigate challenges in self-managing HTN. METHODS: A cross sectional multisite qualitative study using semi-structured interviews among 55 Ghanaians with HTN living in The Netherlands and urban and rural Ghana. A thematic approach was used in data analysis. RESULTS: Family HTN history, personal experiences with HTN and outcomes of using biomedical and traditional treatments shaped participants' illness representations and coping strategies. Migrants and urban non-migrants modified medication schedules and integrated taking medication into daily routine activities to cope with experienced side effects of taking antihypertensive medication while rural non-migrants used traditional remedies and medicines to mitigate experienced medication side effects and/or in search for a cure for HTN. CONCLUSION: Contextual factors within participants' social and physical environments shape their illness representations and coping strategies for HTN though interactive phrases. PRACTICE IMPLICATIONS: Health professionals should harness the relationships within peoples' social and physical environments, encourage implementation of family-wide behavioural changes and involve family and communities in HTN treatment to enhance patients' self-management of HTN.

Prevalence of ECG abnormalities among adults with metabolic syndrome in a Nigerian Teaching Hospital.

BACKGROUND: Co-existence of metabolic syndrome (MetS) and electrocardiography (ECG) abnormalities heightens the risk of sudden cardiac death. However, there is a gap in evidence of how ECG changes cluster among continental Africans with or without MetS. METHODS: We included 491 participants with interpretable ECG tracings who were consecutively recruited into the Cardiovascular Risk Prediction Registry (CRP). CRP is a registry of newly presenting patients into cardiology clinic of the University College Hospital, Nigeria, with a main objective of cardiovascular risk stratification to prevent cardiovascular morbidity and mortality. Using the International Diabetic Federation (IDF) criteria they were divided into those with metabolic syndrome and non-metabolic syndrome. RESULTS: Four hundred and ninety-one participants comprising 48.3% women with mean age 53.72±15.2 years who met the IDF criteria with complete ECG interpretations were analyzed with 44.2% (men 38.6%; women 50.2%) of the participants having MetS while 74% had ECG abnormalities. Compared to women, men had higher mean serum total cholesterol, creatinine, smoking, and alcohol use, family history of hypertension and diabetes mellitus, QT prolongation, LVH plus or minus strain pattern, and ECG abnormalities in general. Women were heavier, had higher heart rate and proportions of MetS. ECG findings among those with or without MetS were not significantly different. In men, IDF metabolic score was associated with conduction abnormalities (p=0.039) and combined ECG abnormality (p=0.042) which became more significant with an exclusion of QT prolongation (p=0.004). Also, IDF abdominal obesity was associated with QT prolongation (p=0.017), combined ECG abnormality (p=0.034) while HDLc correlated with ECG abnormalities (0.037) in men. There was no significant associations of components of metabolic syndrome with ECG abnormalities among women. CONCLUSION: There was a high prevalence of MetS and abnormal ECG among the studied population. Abnormal ECG findings were more common in men with no differential association in people with or without MetS. However, a significant association existed between certain components of MetS and ECG abnormalities in men only. Male gender and HDLc were independent predictors of ECG Abnormalities.

Cardiotoxicity of Pesticides: Are Africans at Risk?

Cardiovascular disease has maintained the unenviable position as the number one cause of death in the world. It is now clear that the traditional risk factors of cardiovascular disease are driven by primary factors like globalisation, urbanisation, industrialisation and agricultural practices. Pesticide use is an integral component of modern and improved agriculture. The abuse and misuse of these chemicals has caused significant poisoning worldwide and particularly in low- and middle-income countries where Africa belongs. This review surveys the widening population of people poisoned by pesticides in Africa and examines the possibility of pesticide-induced cardiotoxicity. The exposed group includes workers in pesticide industries, transporters of these chemicals, farmers, farm workers who apply these pesticides, vendors and sellers of farm produce and consumers of foodstuffs that are treated with pesticides as well as persons who consume water and inhale air filled with pesticides. There are numerous animal model studies that employ electrocardiography, echocardiography, enzyme studies and histopathology to demonstrate pesticide-induced cardiotoxicity in many parts of the world. There are also case reports and epidemiological data of pesticide-induced cardiovascular intoxication in man. With the increasing reports of pesticide-induced central system nervous toxicity in Africa, there are enough reasons to suspect cardiovascular system poisoning as well. The poorly developed clinical toxicology specialty may explain the low index of suspicion of pesticide-induced cardiovascular diseases. With the pervading ignorance, indiscriminate sale, unguarded use, lack of adequate legislation, inadequate enforcement of legal institutes associated with pesticide use in Africa, there is no doubt that the increasing prevalence and incidence of cardiovascular diseases may partly be due to exposure to these chemicals. Africans may after all be at risk of pesticide-induced cardiotoxicity, but more studies will be required to examine the pattern of cardiotoxicity as well as factors that modulate its occurence.