Epidemiology of Digital Clubbing and Hypertrophic Osteoarthropathy: A Systematic Review and Meta-analysis.

ABSTRACT: Digital clubbing and hypertrophic osteoarthropathy (HOA) are long-standing clinical entities, but their prevalence have not been synthesized. We aimed to estimate the prevalence of digital clubbing and HOA in people with existing medical conditions.We comprehensively searched PubMed, Embase, and Web of Science to select studies addressing HOA or digital clubbing and published through March 23, 2021. Summary estimates of the prevalence were derived through random-effects meta-analysis and narrative synthesis. The review protocol has been registered with PROSPERO, CRD42021243934.Of 3973 records, we included 142 studies. In adults, the pooled prevalence of digital clubbing was 33.4% (95% confidence interval [CI], 16.6-52.8), 31.3% (95% CI, 22.4-41.1), 27% (95% CI, 9.4-49.5), and 22.8% (95% CI, 10.8-37.6) in subjects with intestinal diseases, interstitial lung diseases, infective endocarditis, and hepatic diseases, respectively. In children and adolescents, the pooled prevalence of digital clubbing was 29.1% (95% CI, 19.4-39.9), 23% (95% CI, 9.0-41.1), 19.5% (95% CI, 4.1-42.4), and 17.1% (95% CI, 9.5-26.5) in subjects with human immunodeficiency virus infection, hemoglobinopathies, cystic fibrosis, and tuberculosis. The pooled prevalence of HOA was 10.1% (95% CI, 2.0-23.1) in adults with cancers, and 5% (95% CI, 2.5-8.2) in children and adolescents with cystic fibrosis.In conclusion, the prevalence of digital clubbing varied across disease groups in both adults and children. Full-spectrum HOA was mostly reported in adults with liver disease and cancers, and in children and adolescents with cystic fibrosis.

Adiponectin levels and its relation with insulin secretion and insulin sensitivity in a group of sub-Saharan African women with polycystic ovary syndrome.

OBJECTIVES: Low levels of adiponectin have been reported in Polycystic Ovary Syndrome (PCOS). In sub-Saharan Africa, little data are available on the topic. We aimed to investigate the levels of adiponectin and its relation with insulin secretion and insulin sensitivity in women with PCOS in Yaoundé, Cameroon. A comparative cross-sectional study was conducted in 32 women presenting PCOS and 32 controls matched for age and Body Mass Index. For each participant, adiponectin levels were measured. We estimated insulin sensitivity using Homeostasis model index (HOMA-IR) and insulin secretion with C-peptide levels. RESULTS: Women with PCOS had higher insulin secretion levels than controls (C-peptide: 4.98 ± 3.83 vs 3.25 ± 1.62 mUI/l; p = 0.02). Also, the HOMA-IR index was higher compared to that of women without PCOS (1.15 ± 0.90 vs 0.77 ± 0.38; p = 0.03) suggesting greater insulin resistance. The median [25th-75th percentile] values of adiponectin concentrations were similar between the two groups (22.68 [21.72-23.41] µg/ml vs 22.03 [21.40-22.93] µg/ml; p = 0.1). There was no association between insulin sensitivity and adiponectin levels in the PCOS group. PCOS is not associated with changes in adiponectin in a population of sub-Saharan African women. Further studies are needed to shed more light on this condition.

Epidemiology of infective endocarditis in Africa: a systematic review and meta-analysis.

BACKGROUND: The epidemiology of infective endocarditis in Africa is inadequately characterised. We therefore aimed to comprehensively summarise the available data for the incidence, risk factors, clinical pattern, microbiology, and outcomes of infective endocarditis in Africa. METHODS: We did a systematic review and meta-analysis. We searched PubMed, Embase, African Index Medicus, and African Journals Online for all studies reporting primary data for the epidemiology of infective endocarditis in populations within Africa, published from inception to Jan 14, 2021, irrespective of the language. We used the search terms "endocarditis", "Africa", and the name of all African countries in the search strategy. We excluded articles that did not include primary data, primary studies with a small sample size (<30 participants), and those that report findings from before 1990. We recorded data for study characteristics, sample size, criteria used to define infective endocarditis, risk factors, potential entry site, clinical patterns, microbiology profile, outcomes including complications such as embolic events, heart failure, acute kidney injury, and death, and predictors of death. We used random-effects meta-analysis method to pool estimates. This study is registered with PROSPERO, CRD42021243842. FINDINGS: We retrieved 2141 records from the database and bibliographic searches, of which a total of 42 studies were included in this systematic review. Rheumatic heart disease was the most common risk factor for infective endocarditis in adults (52·0% [95% CI 42·4-61·5]), whereas congenital heart disease was the most common risk factor for infective endocarditis in children (44·7% [29·5-60·5]). Microbiological testing (mostly blood cultures) was positive in 48·6% (95% CI 42·2-51·1) of patients with infective endocarditis, with Staphylococcus species (41·3% [95% CI 36·2-46·5]) and Streptococcus species (34·0% [29·0-39·3]) the most commonly identified microorganisms. The pooled rate of surgical treatment of infective endocarditis was 49·1% (95% CI 43·2-55·1). The pooled in-hospital mortality rate was 22·6% (95% CI 19·5-25·9). Other frequent complications included heart failure (47·0% [95% CI 38·2-56·0]), acute kidney injury (22·8% [18·8-27·0]), and embolic events (31·1% [22·2-40·7]). INTERPRETATION: As the most prevalent risk factor in Africa, rheumatic heart disease should be central in interventions to reduce the burden of infective endocarditis on the continent. In tertiary hospitals with good access to cardiac surgery, the outcomes of infective endocarditis seem relatively similar to what has been reported in other parts of the world, especially in high-income countries. FUNDING: None.

[Epidemiology, clinical and therapeutic aspects of chronic coronary syndrome in Cameroonian cardiology, a look back at 10 years]. / Epidemiologie, aspects cliniques et therapeutiques du syndrome Coronarien chronique en milieu cardiologique camerounais : un regard sur 10 ans.

AIM: The present study aims to describe the epidemiology, clinical and therapeutic aspects of chronic coronary syndrome (CCS) in Cameroonian cardiology setting in order to highlight the current state of practice to guide efficient epidemiological interventions. METHOD: We retrospectively analyzed over 10 years [2010; 2019] the records of patients hospitalized in two cardiology units of referral hospitals in the city of Yaoundé. RESULT: Of the 2756 records retrieved, 47 (1.7%) had CCS according to the 2019 European Society of Cardiology guidelines, with an average age of 58 ± 12 years, and 63.8% were men. The most common cardiovascular risk factors found were hypertension (78.7%), overweight or obesity (84.9%), dyslipidemias (80.9%), smoking (68.1%), and diabetes (67.7%). Chest pain on exertion (74.5%) and exertional dyspnea (70.2%) were the main symptoms. Repolarization disorders (83%) were the most frequent ECG signs; necrosis sequelae were found on ECG in 34% of cases and rhythm disorders in 21.3%. The therapeutic modalities were essentially anti-platelet (95.7%), statins (91.5%), beta blockers (89.4%), and converting enzyme blockers (70.2%). Interventional treatments were rarely performed (2.1%). CONCLUSION: Although chronic coronary syndrome are uncommon in cardiology hospitalization in Cameroon, it is essential that public health policies work to improve the current state of care particularly interventional care.

BUT: La présente étude vise à décrire l'épidémiologie, les aspects cliniques et thérapeutiques du syndrome coronarien chronique (SCC) en milieu cardiologique Camerounais afin de montrer l'état des lieux pour guider les interventions épidémiologiques efficientes. METHODE: Nous avons analysé de façon rétrospective sur 10 ans [2010 ; 2019] les dossiers des patients hospitalisés dans deux unités de cardiologie d'hôpitaux de référence de la ville de Yaoundé. RÉSULTAT: Sur les 2756 dossiers retrouvés, 47 (1,7%) avaient un SCC selon les recommandations de la Société Européenne de Cardiologie de 2019, ayant une moyenne d'âge de 58 ± 12 ans, et 63,8% d'hommes. Les facteurs de risque cardiovasculaire les plus retrouvés étaient l'hypertension artérielle (78,7%), le surpoids ou obésité (84,9%), les dyslipidémies (80.9%), la consommation de tabac (68,1%) et le diabète (67,7%). La douleur thoracique à l'effort (74,5%) et la dyspnée d'effort (70,2%) étaient les maitres symptômes. Les troubles de repolarisation (83%) étaient les signes ECG les plus fréquents ; les séquelles de nécrose étaient retrouvées à l'ECG chez 34% des cas et les troubles du rythme chez 21,3%. Les modalités thérapeutiques étaient essentiellement des anti-agrégants plaquettaires (95,7%), statines (91,5%), beta bloquants (89,4%), et les inhibiteurs de l'enzyme de conversion (70,2%). Les traitements interventionnels étaient rarement réalisés (2,1%). CONCLUSION: Même si les SCC sont peu fréquents en hospitalisation de cardiologie, il est primordial que les autorités de santé publique travaillent à améliorer l'état de la prise en charge actuelle en particulier interventionnelle.

Relationship between periodontal diseases and newly-diagnosed metabolic syndrome components in a sub-Saharan population: a cross sectional study.

BACKGROUND: Oral health is a frequently ignored aspect of global health in sub-Saharan patients. Periodontitis, a very frequent oral disease has been proven to be associated to development of the metabolic syndrome. This study aims to evaluate the relationship between periodontal disease and metabolic syndrome components in a sub-Saharan population. METHODS: We performed a cross sectional study in 3 Yaounde hospitals. Consenting adults aged 21 years and above were recruited. Participants who presented with a tooth loss of at least 50% or any condition which could alter values of biological and periodontal parameters (tobacco smoking, pregnancy, chronic kidney disease, cancer) were excluded. Metabolic syndrome elements (glycaemia, arterial pressure, HDL cholesterol, abdominal circumference, triglycerides) and periodontal variables were recorded (plaque and gingival index of Silness and Loe, periodontal pocket depth and clinical attachment loss). These variables were compared using Fisher's exact Test and odds ratio calculated with 95% confidence intervals. RESULTS: The prevalence of periodontitis and metabolic syndrome were 43.4% and 10.8% respectively. Age (37.75 ± 13.25, P < 0.001) and poor accessory brushing methods were associated risk factors for development of periodontal disease. Sub-Saharan sindividuals with periodontitis had increased odds of having obesity (OR 11.1 [95% CI 3.97-31.03], P < 0.001) and low HDL (OR 4.58 [95% CI 1.79-11.70], P = 0.001) CONCLUSION: Our findings suggest an association between periodontal disease and metabolic syndrome in Sub-Saharan subjects. Increasing age and poor accessory brushing methods are associated risk indicators.

Geriatric syndromes in an urban elderly population in Cameroon: a focus on disability, sarcopenia and cognitive impairment.

INTRODUCTION: geriatric syndromes are multifactorial conditions that are associated with substantial disability, poor quality of life and mortality in the elderly. The patterns of these conditions are poorly described in sub-Saharan Africa. This study aimed to determine the prevalence and correlates of common geriatric syndromes in Cameroon. METHODS: we conducted a cross-sectional study in the geriatrics unit of a university hospital in Cameroon. All people aged ≥55 who attended a health promotion and screening campaign in September 2019 were included. Geriatric syndromes including functional decline, cognitive impairment and sarcopenia were assessed. We also examined sociodemographic characteristics and comorbidities. RESULTS: overall, 104 participants were enrolled with median age of 65 (IQR: 62.2 - 70.8). About 67% of participants presented at least one geriatric syndrome. Disability in activities of daily living and instrumental activities of daily living were present in 10% and 38% of participants respectively and associated factors were male gender (OR 4.7, p=0.005), age 75 and above (OR 5.7, p=0.027), osteoarthritis (OR 3.3, p=0.055) and polypharmacy (OR 7.7, p=0.012). Sarcopenia occurs in 26% with female gender (OR 3.1, p=0.029) and SARC-F ≥4 (OR 4.9, p=0.002) as associated factors. Cognitive impairment was present in 20% of participants and associated with illiteracy (p=0.008). CONCLUSION: our study shows a high prevalence of geriatric syndromes in older adults in an urban area. Geriatric principles and frailty awareness should be considered in clinical care of older adults in our setting.

Active smoking among people with diabetes mellitus or hypertension in Africa: a systematic review and meta-analysis.

The objective was to summarize existing data on the prevalence of active tobacco smoking among patients with hypertension or diabetes mellitus in Africa. We searched PubMed, EMBASE, and AJOL to include studies published from January 01, 2000 to August 23, 2017 reporting on the prevalence of active smoking in individuals aged ≥15 years with hypertension or diabetes mellitus residing inside Africa. We used a random-effects meta-analysis model to pool studies. The pooled prevalence of active smoking among patients with hypertension or diabetes was 12.9% (95%CI: 10.6-15.3; 50 studies; 16,980 patients) and 12.9% (95%CI: 9.6-16.6; 42 studies; 18,564 patients), respectively. For both conditions, the prevalence of active smoking was higher in males than in females (p < 0.001), and in Northern compared to sub-Saharan Africa (p < 0.001). There was no difference between urban and rural settings, and between community-based and hospital-based studies, except for patients with diabetes for whom the prevalence was higher in hospital-based studies (p = 0.032). The prevalence of active smoking is high among patients with hypertension or diabetes mellitus in Africa, with the heaviest burden in Northern Africa. Interventions for smoking prevention or cessation should be implemented in these high risk populations, targeting particularly the males.