Prevalence of musculoskeletal disorders among taxi drivers in Yaoundé, Cameroon: preventive effect of physical activity.

BACKGROUND: Musculoskeletal Disorders (MSDs) are very common conditions in the workplace. Among professional drivers, there would be an increased risk of developing these disorders. Identifying the associated factors would allow us to better devise effective prevention strategies. Our objective was to determine the prevalence of MSDs among taxi drivers in the city of Yaoundé and to search for associated factors, mainly the level of physical activity. METHODS: We conducted an analytical cross-sectional study of 151 adult male professional taxi drivers. We used a non-probabilistic consecutive and non-exhaustive sampling method. Sociodemographic, anthropometric and occupational data were collected. MSDs over the past 12 months were assessed using the Nordic Questionnaire and physical activity level was determined by the World Health Organization (WHO) Global Physical Activity Questionnaire (GPAQ). Univariate logistic regression models, followed by a multivariate logistic regression, were used to determine factors associated with the presence of MSDs. RESULTS: The overall prevalence of MSDs was 86.8% (95% CI 80.8 - 91.4); the most affected areas were mainly the lower back (72.8%) the neck (42.4%), and the knees (29.1%). Job dissatisfaction was associated with MSDs (OR = 2.1 95%CI = 1.1-3.9). Most taxi drivers (62.9%) had a low physical activity level and no association was found between the physical activity level and MSDs. CONCLUSIONS: MSDs are common ailments among taxi drivers in Yaoundé (Cameroon). There is a need to think about how to address job dissatisfaction and better identify other associated factors in order to define good prevention strategies.

Acute glycaemic effects of co-trimoxazole at prophylactic dose in healthy adults.

BACKGROUND: Cases of severe hypoglycaemia were reported in HIV/AIDS patients receiving high dose of the sulfonylurea co-trimoxazole for opportunistic infections. Whether co-trimoxazole at prophylactic dose would induce similar side effects is unknown. We aimed to investigate the acute effects of co-trimoxazole at prophylactic dose on glucose metabolism in healthy adults. METHODS: We enrolled 20 healthy volunteers (15 males and 5 females) aged 23.0 (SD 2.0) years, with mean BMI of 22.3 (SD 3.6) Kg/m2 with normal glucose tolerance, hepatic and renal function. We performed a 75-g oral glucose tolerance test (OGTT) with and without concomitant oral co-trimoxazole administered 60 min before the test. Blood glucose response was measured using a capillary test at baseline and at 30, 60, 90, 120 and 180 min following oral glucose load on the two occasions. C-peptide response was also measured. Absolute values of blood glucose and C-peptide with and without co-trimoxazole were compared using the Wilcoxon test. RESULTS: During the OGTT without co-trimoxazole (control) vs. the OGTT with co-trimoxazole (test), the glycaemia varied from 4.83 (SD 0.39) mmol/l vs. 4.72 (SD 0.28) mmol/l at T0 (P = 0.667), to 8.00 (SD 1.11) mmol/l vs. 7.44 (SD 0.78) mmol/l at T30 (P = 0.048), 8.00 (SD 1.17) mmol/l vs. 7.67 (SD 1.00) mmol/l at T60 (P = 0.121), 7.33 (SD 0.94) mmol/l vs. 7.11 (SD 0.83) mmol/l at T90 (P = 0.205), 6.78 (SD 1.00) mmol/l vs. 6.67 (SD 1.00) mmol/l at T120 (P = 0.351) and 4.72 (SD 1.39) mmol/l vs. 4.72 (SD 1.56) mmol/l at T180 (P = 0.747). The ratio of area under the glycaemia curve during the control and test investigation was 96.7 %, thus a 3.3 decreased glycaemic response (p = 0.062). A decrease of glycaemia by more than 10 % occurred in 6/20 participants at T30, 7/20 participants at T60 and 1/20 participant at T30 and T60. None of the volunteers experienced co-trimoxazole-induced hypoglycaemia. At the same time, the C-peptide response during the control vs. the test investigation varied from 278.1 (SD 57.5) pmol/l vs. 242.8 (SD 42.5) pmol/l at T0 (P = 0.138), to 1845.6 (SD 423.6) pmol/l vs. 2340.6 (SD 701.3) pmol/l at T60 (P = 0.345) and 1049.8 (SD 503.1) pmol/l vs. 1041.63 (SD 824.21) pmol/l at T180 (P = 0.893). CONCLUSION: Ninety minutes after its administration, co-trimoxazole induced a significant reduction of the early glycaemic response to oral glucose in parallel with a 27-% increase in insulin secretory response. Co-trimoxazole induced within 120 min a more than 10-% blood glucose reduction in 2/3 of participants. However none of the volunteers experienced hypoglycaemia.

Impact of daily supplementation of Spirulina platensis on the immune system of naïve HIV-1 patients in Cameroon: a 12-months single blind, randomized, multicenter trial.

BACKGROUND: Micronutrient deficiencies occur early in Human Immunodeficiency Virus (HIV) infections they have reverse effects on the nutritional status. The diet supplementation with a natural nutraceutical rich in proteins and micronutrient like Spirulina platensis, may be effective and efficient in delaying HIV disease progression by frequently reported improvement in immune response. METHODS: A prospective single-blind, randomized, multicenter study conducted on 320 HIV-1 ARV-naïve participants for 12 months. Participants received either S. platensis supplementation and standard care or standard care and local balanced diet without S. platenis. Selected hematological and biochemical as well as CD4 count cells, viral load copies were assessed at three separate times. RESULTS: Among the 169 ART-naïve participants enrolled in the study, the female was mostly represented (67.1%). The significant increase of CD4 count cells (596.32-614.92 cells count) and significant decrease of viral load levels (74.7 × 10(3)-30.87 × 10(3) copies/mL) of the patients who received a supplementation of S. platensis was found after 6 months of treatment. Haemoglobin level was also significantly higher in the same group while the fasting blood glucose concentration decreased after 12 months compared to control. CONCLUSION: A daily supplementation with S. platensis to diet combined with a reasonable balanced diet has significantly increased the CD4 cells and reduced the viral load after 6 months. Further studies are recommended among a large specific group of people infected by the HIV in order to investigate the mechanisms involved on the effect of S. platensis on immune system.

Effects of Spirulina platensis supplementation on lipid profile in HIV-infected antiretroviral naïve patients in Yaounde-Cameroon: a randomized trial study.

BACKGROUND: Cardiovascular diseases (CVD) and metabolic alterations are among the majors public health concern that have been reported in people living with HIV infections. Factors contributing to cardio metabolic syndrome in HIV include body fat distribution, dyslipidemia, insulin resistance, cardiovascular dysfunction and inflammation. The aim of the study was to determine the effect of Spirulina platensis (Cyanobacteriaceae) supplementation versus local diet on lipid profile in HIV-infected antiretroviral-naive patients. METHODS: A prospective single-blind, randomized, multicentre study was conducted from February 2010 to December 2012. A total of 320 HIV antiretroviral-naïve patients were screened and 169 were recruited in this study. Patients were randomized and received either Spirulina supplementation combined with local diet (n=82) or local diet only (n=87). Age, weight, body mass index (BMI), lipid profile, CD4 count, and local food intake variables were assessed on three separate occasions (three, six and twelve months). RESULTS: An average age of the patients was 35.6±9 years. The majority of participants were female 67.1%. Regarding the lipid profile, there is a significant increase in HDL-cholesterol and a significant decrease in total cholesterol, LDL-cholesterol and triglycerides in the group of patients who consumed Spirulina platensis. A change in the atherogenic index defined by the ratio CT/HDL-C substitutable by LDL-C/HDL-C and the TC/HDL decreased significantly from 10.83 at baseline to 2.22 after 12 months (p=0.21 and p<0.0001) in the patients taking Spirulina. CONCLUSIONS: Nutritional supplementation with Spirulina combined with a quantitative and qualitative balanced diet for at least six months can retard an exposition to lipid abnormalities in HIV-infected antiretroviral-naive patients. Further studies are recommended on a large group of people not infected with HIV and exposed to cardiovascular risk factors.

Short term optimization of glycaemic control using insulin improves sympatho-vagal tone activities in patients with type 2 diabetes.

INTRODUCTION: Diabetic cardiac autonomic neuropathy (CAN) is potentially life threatening and its severity might further be aggravated by poor glycaemic control. A decrease in Heart rate variability (HRV) is the earliest finding of CAN even at the sub clinical stage. While intensive glycaemic control prevents the development of CAN in patients with type 1 diabetes, it is not known whether the intensification of glycaemic control using insulin would improve cardiovascular autonomic functions in type 2 diabetes patients. This study aimed to determine the short term effects of optimizing glycaemic control using insulin on the HRV in type 2 diabetes patients. METHODS: We conducted a single arm open label clinical trial. Participants were poorly controlled non-insulin treated type 2 diabetes mellitus patients (HbA1c ≥ 7%). The intervention lasted 60 days and consisted in the intensification of glycaemic control through the initiation of a basal plus insulin regimen with titration of insulin to protocol defined glycaemic targets which were; fasting glycaemia: 0.70-1.30 g/L and post prandial glycaemia <1.80 g/L. Long term HRV measurement was done using a 24-h ambulatory electrocardiographic (ECG) recording on day 0 and day 60. Wilcoxon signed rank test was used to compare differences in HRV parameters before and after the intervention. RESULTS: A total of 29 (14 males and 15 females) consenting type 2 diabetes mellitus patients without clinical signs of CAN were enrolled and allocated to intervention (14 males and 15 females). The median age was 52 [43-59] years, and duration of diabetes 3.0 [0.6-6.7] years. The intervention induced a reduction in HbA1c from 10.1 [9.1-11.9]% to 6.7 [5.9-6.9]% (p < 0.001) without severe hypoglycaemic events. Concerning HRV parameters, there was a significant improvement in markers of the parasympathetic tone (PNN50: 5.7 [3.6-10.3]% to 8.1 [3.1-16.9]%, p = 0.008) and sympathetic tone (SDNN: 102.01 [90.45-111.05] ms to 122.40 [91.70-135.95] ms, p = 0.01). CONCLUSION: The optimization of glycaemic control using a basal plus insulin regimen while inducing a significant reduction in glycated hemoglobin, significantly improves 24-h ambulatory ECG derived sympathetic and parasympathetic activities. This suggests that tight glycaemic control using insulin may revert cardiac autonomic neuropathy in type 2 diabetes mellitus patients.

Heart rate variability in hyperthyroidism on sub Saharan African patients: a case-control study.

OBJECTIVE: We aimed to determine heart rate variability in freshly diagnosed untreated hyperthyroidism patients. We enrolled 10 patients (9 females) and 10 matched controls for sex and age. Each eligible patient underwent five different tests according to Ewing battery tests for cardiac autonomic dysfunction assessment. HRV was assessed during each maneuver and on 24 h using a continuous electrocardiogram with automatic estimation of SDNN, RMSSD, LF HF and HF/LH ratio. Results of tests were compared between hyperthyroidism patients and matched controls using the non-parametric test of Mann-Whitney. RESULTS: Heart rate was significantly higher in patients with thyrotoxicosis (82.91 ± 10.99 vs 67.04 ± 6.80; 0.006) compared to their controls. On time-domain analysis, there was a trend towards reduction in SDNN (39.52 vs. 63.75; p = 0.2) as well as the RMSSD (30.44 vs 64.03; p = 0.09) in patients with hyperthyroidism. The frequency-domain analysis showed non-significant higher values for the LF (43.87 vs 38.85 ± 12.85; p = 0.8) and lower for the HF (32.54 vs 43.39; p = 0.3). Test's results were mostly impaired in hyperthyroid patients and all patients presented abnormal results for parasympathetic activity. Untreated and recently diagnosed hyperthyroidism is associated to an altered parasympathetic activity in sub Saharan African patients.

Effect of propranolol on heart rate variability in hyperthyroidism.

OBJECTIVES: We aimed to determine the effect of propanolol on heart rate variability (HRV) in hyperthyroidism before antithyroid treatment. This was a before and after study, on ten patients presenting overt hyperthyroidism naïve to treatment. In each patient, a resting electrocardiogram was done followed by estimation of cardiac autonomic dysfunction during five maneuvers (Ewing battery tests). Long term HRV measurement was done using 24 h ambulatory electrocardiographic recording. This automatically provided estimation of HRV using SDNN and RMSSD index, LF, HF, and HF/LF ratio. After baseline investigations, 40 mg of propanolol was given twice a day for 3 days and same parameters were measured after 72 h of treatment. RESULTS: Our patients were aged 40 ± 10 years. Propanolol significantly reduced RR and HR interval (669 ms vs 763 ms and 91 vs 79 bpm; p < 0.01). QT and PR space were significantly extended (360 vs 384 ms and 133 vs 172 ms; p = 0.01). It increases QRS complex and blood pressure response to sustained handgrip but failed to modify previously decreased heart response to deep breathing. HRV parameters such as SDNN, RMSSD, LF, HF and sympathovagal balance estimate by HF/LF ratio remained unchanged. Although a significant reduction in heart excitability, propanolol failed to restore a good sympathovagal balance in hyperthyroidism. Trial registration NCT03393728 "Retrospectively registered".

Poor glycemic control impacts heart rate variability in patients with type 2 diabetes mellitus: a cross sectional study.

OBJECTIVE: We aimed to determine and compare HRV parameters in poorly and well controlled type 2 diabetes. 54 normotensive type 2 diabetes patients without clinical signs of CAN were enrolled; 29 poorly controlled (HbA1c ≥ 7%) and 25 controls matched for age, sex and BMI. HRV analysis was performed using 24-h ambulatory ECG, with automatic estimation of the time and frequency domain ranges. Comparisons were performed using Mann-Whitney test. RESULTS: We included 54 participants (26 males) aged 56 years [43-62], with known duration of diabetes 3 years [1-7]. HbA1c was 10.1% [9.1-11.9] vs 5.3% [5.1-6.3] (p < 0.001). Blood pressure was 126 mmHg [121-130] vs 124 mmHg [113-133] in the poorly controlled group and the well-controlled group respectively (p = 0.5). 24-h mean heart rate was significantly higher in poorly controlled vs well controlled patients (79 bpm [77-83] vs 75 bpm [69-79], p = 0.006). In the time domain analysis, markers of the overall variability were lower and thus altered in the poorly controlled group (SDNN: 102 ms [90.5-111.1] vs 112.3 ms [104.4-131.2], p = 0.01 and SDANN 88 ms [72.9-99.7] vs 97.8 ms [91.8-114.5], p = 0.01). The frequency domain analysis showed trends towards lower values of sympathovagal balance markers in the poorly controlled group. Reduced HRV is associated with poorly controlled type 2 diabetes mellitus and may be an early marker in clinical practice.

Human herpesvirus 8 infection DNA positivity is associated with low insulin secretion: A case-control study in a sub-Saharan African population with diabetes.

BACKGROUND: Viruses have been considered potential triggers for the development of diabetes. This study assessed insulin secretion and insulin sensitivity in human herpesvirus 8 (HHV8)-infected and uninfected sub-Saharan African people with diabetes. METHODS: In all, 173 people with non-autoimmune diabetes were enrolled consecutively: 124 with type 2 diabetes mellitus (T2DM) and 49 with ketosis-prone diabetes (KPD) admitted in hyperglycemic crisis. Those with KPD were further subdivided into those with new-onset ketotic-phase KPD (n = 34) or non-ketotic phase KPD (n = 15). All participants were screened for HHV8-specific antibodies and genomic DNA. Blood samples were collected for analysis of fasting glucose, HbA1c, lipid profile, and C-peptide, with insulin resistance and secretion estimated by homeostasis model assessment. RESULTS: Among the 173 diabetic participants, 88 (50.9%) were positive for HHV8 antibodies (Ac-HHV8+), including 15 (8.7%) positive for HHV8 DNA (DNA-HHV8+). The seroprevalence of HHV8 was similar between T2DM (55.6%) and KPD (61.2%) subjects. Of those with and without ketotic-phase KPD, 35.3% and 46.7% were Ac-HHV8+, respectively. Body mass index was significantly in lower DNA-HHV8+ than DNA-HHV8- subjects. Low-density lipoprotein and total cholesterol were significantly higher, but C-peptide and homeostatic model assessment of ß-cell function (HOMA-ß) were significantly lower in DNA-HHV8+ than DNA-HHV8- participants. After excluding DNA-HHV8+ participants, triglyceride concentrations were significantly higher in Ac-HHV8+ (n = 73) than Ac-HHV8- (n = 85) subjects. In contrast, HOMA-ß was significantly higher among Ac-HHV8+ than Ac-HHV8- participants. CONCLUSIONS: In the present study, HHV8 DNA positivity was associated with low insulin secretion in this sub-Saharan African diabetes population.

Reproducibility of the 75 g oral glucose tolerance test for the diagnosis of gestational diabetes mellitus in a sub-Saharan African population.

OBJECTIVE: To evaluate the reproducibility of the 75 g oral glucose tolerance test and factors associated with non-reproducible results in Cameroonian pregnant women. RESULTS: Twenty-seven of the 84 participants (32.1%) who did the first oral glucose tolerance test were diagnosed with gestational diabetes mellitus. There was no difference between the means of the glycaemic responses at T0 (p = 0.64), T30 (p = 0.08), T60 (p = 0.86), T90 (p = 0.51), and T120 (p = 0.34) between the two oral glucose tolerance test. Age (p = 0.001) and BMI (p = 0.001) were significantly associated with non-reproducible results. The reproducibility of the oral glucose tolerance test in this study was 74.2%, and the kappa statistic's 0.46. In conclusion, the results of the oral glucose tolerance test were reproducible in only 74.2% of pregnant women in this study. This highlights that a single oral glucose tolerance test for the diagnosis of gestational diabetes mellitus should be interpreted with caution.

Cameroonian professional soccer players and risk of atherosclerosis.

BACKGROUND: Elevated titers of antibodies against oxidized low-density lipoproteins-cholesterol (ox-LDL-Ab) have been reported among professional athletes, paradoxically reflecting an increased risk of developing atherogenic and/or cardiovascular events. This study aimed to determine titers of ox-LDL-Ab in a group of Cameroonian professional soccer players, and evaluate their evolution during part of a competition season as well as the plasmatic antioxidant status to find out if this latter correlates with ox-LDL-Ab . METHODS: We conducted a descriptive cohort study in 2012 including 18 healthy male soccer players. Three samplings were performed in March (T1), May (T2), and July 2012 (T3) to assess the lipid profile, titers of ox-LDL-Ab, and plasmatic concentrations of four antioxidants: the ferric reducing antioxidant power (FRAP), reduced glutathione (GSH), superoxide dismutase (SOD), and uric acid. RESULTS: Ages ranged from 16 to 28 years with a median (interquartile range) of 19.5 (19-23) years. Total cholesterol, high-density lipoproteins-cholesterol (HDL-C), low-density lipoproteins-cholesterol (LDL-C) and triglycerides varied within normal ranges throughout the three samplings. While total cholesterol and LDL-C titers increased significantly (p = 0.003 and p = 0.006, respectively), triglycerides and HDL-C values varied non-significantly throughout the measurements (p = 0.061 and p = 0.192, respectively). The median ox-LDL-Ab titers were respectively: 653.3 (468.2-838.8) mIU/ml at T1, 777.7 (553.7-1150.7) mIU/ml at T2, and 1037.7 (901.7-1481.5) mIU/ml at T3. Overall, ox-LDL-Ab titers increased significantly from T1 to T3 (p = 0.006). Concomitantly, uric acid and FRAP concentrations decreased significantly (p = 0.001 and p = 0.003, respectively); on the contrary, GSH and SOD values increased, but insignificantly (p = 0.115 and p = 0.110, respectively). There was a positive and significant correlation between ox-LDL-Ab and HDL-C (ρ = 0.519, p = 0.027), and between ox-LDL-Ab and SOD (ρ = 0.504, p = 0.033) at T2. Ox-LDL-Ab values were expected to increase with each new visit (ß = 201.1; p = 0.041) and each IU/ml of SOD titers (ß = 23.6; p = 0.019). CONCLUSION: These Cameroonian professional soccer players exhibited high levels of ox-LDL-Ab reflecting elevated levels of oxidatively-modified LDL-C particles with an increment over time, this being insufficiently counterbalanced by the antioxidant defense mechanisms. As a consequence, they may be at increased atherogenic and cardiovascular risks.

Impact of a 12-week aerobic exercise training program on anthropometric and metabolic parameters of a group of type 2 diabetes Cameroonian women aged ≥50 years.

BACKGROUND: We examined whether aerobic exercise could have an impact on anthropometric and metabolic parameters of type 2 diabetes mellitus (T2DM) Cameroonian women aged ≥50 years. METHODS: We enrolled 23 T2DM Cameroonian women aged ≥50 years regularly followed at the National Obesity Center of Yaounde, Cameroon, in a 12-week aerobic exercise program monitored by a pedometer. Exercise intensity was progressively set between 55% and 75% of maximum heart rate. We measured weight, body mass index (BMI), fat, lean mass, visceral fat, maximum oxygen uptake, glycaemia and insulin tolerance index at baseline, after six and twelve weeks. A mixed ANOVA model was used to evaluate changes of outcome measures over time. RESULTS: Total body weight was significantly reduced after 12 weeks (P<0.05), waist circumference after 6 and 12 weeks (P<0.05). There was an increase of the lean mass from 6 weeks (P<0.001) and a reduction of the mean visceral fat at 12 weeks (P<0.001). At the end of the program, the mean glycaemia was significantly decreased (P<0.05), and the maximum oxygen uptake was enhanced (P<0.05). CONCLUSIONS: The 12-week aerobic exercise program improved the anthropometric and metabolic parameters as well as the aerobic capacity of T2DM Cameroonian women aged ≥50 years.

The effect of Arthrospira platensis capsules on CD4 T-cells and antioxidative capacity in a randomized pilot study of adult women infected with human immunodeficiency virus not under HAART in Yaoundé, Cameroon.

Dietary supplements are often used to improve the nutritional status of people living with HIV/AIDS (PLHIV). Arthrospira platensis (Asp), also known as Spirulina, is a cyanobacterium rich in proteins and micronutrients. Cell and animal trials described immune-modulating, antiretroviral and antioxidant activities. This pilot study describes the effects of the supplementation of 5 g/day of Asp on a pre-highly-active antiretroviral therapy (pre-HAART), HIV-infected, adult female population. It was conducted as a three-month randomized controlled trial (RCT) that compared a cup supplementation of five grams/day of Asp with a placebo of equal protein content and energy. The study included 73 HIV-infected women. The immediate outcome variables were CD4 T-cells, viral load and immune activation by CD8 T-cells expressing CD38. The antioxidant status was assessed by way of the total antioxidant capacity of the serum (TAOS). The renal function was documented by way of creatinine, urea and the calculated glomerular filtration rate. Statistical analyses were carried out with non-parametric tests, and the effect size of each interaction was calculated. No differences in the immunological and virological markers between the Asp and the placebo group could be observed. In the placebo group, 21 of 30 patients (70%) developed concomitant events, while in the Asp group, only 12 of 28 patients (43%) did. Both groups registered a significant weight increase; 0.5 kg (p < 0.05) in the Asp group and 0.65 kg (p < 0.05) in the placebo group. The antioxidant capacity increase of 56 (1-98) µM for Asp was significantly different from the decrease observed in the placebo group (p < 0.001). A slight increase in the creatinine level of 0.1 g/dL (p < 0.001) was observed in the Asp group, and no effect was observed in the urea levels. The improvement of the antioxidant capacity under Asp, shown for the first time on PLHIV, could become a focus for future research on the nutritional and health effects of Spirulina. The observed slight, but significant increase of serum creatinine needs further evaluation, especially with varying doses of Asp.

Acute phase ketosis-prone atypical diabetes is associated with a pro-inflammatory profile: a case-control study in a sub-Saharan African population.

BACKGROUND: It is unknown whether inflammation plays a role in metabolic dysfunction on ketosis-prone diabetes (KPD). We aimed to assess the inflammatory profile in sub-Saharan African patients with KPD during the acute ketotic phase as well as during non-ketotic hyperglycemic crises. METHODS: We studied 72 patients with non-autoimmune diabetes: 23 with type 2 diabetes mellitus (T2D), and 49 with KPD, all admitted in hyperglycemic crisis (plasma glucose ≥250 mg/dl). The T2D and KPD groups were matched by sex, age, and Body Mass Index. KPD was sub-classified into new-onset ketotic phase (n = 34) or non-ketotic phase (n = 15). We measured TNF-α, MCP-1, MIP1-α, IL-8, MIP1-ß, and VEGF in the serum of all participants. RESULTS: TNF-α and IL-8 were higher in participants with KPD compared to those with T2D (p = 0.02 TNF-α; p = 0.03 IL-8). TNF-α and IL-8 were also higher in the ketotic phase KPD group compared to the T2D group (p = 0.03 TNF-α; p < 0.001 IL-8) while MIP1-α was lower in people with ketotic phase KPD compared to their T2D counterparts (p = 0.03). MIP1-α was lower in the ketotic phase KPD group compared to the non-ketotic phase KPD group (p = 0.04). MCP-1 was lower in non-ketotic phase KPD compared to T2D (p = 0.04), and IL-8 was higher in non-ketotic phase KPD compared to T2D (p = 0.02). CONCLUSIONS: Participants with KPD had elevated pro-inflammatory cytokines compared to their T2D counterparts. Ketotic phase KPD is associated with a different pro-inflammatory profile compared to non-ketotic phase KPD, and the inflammatory profile appears to be comparable between non-ketotic phase KPD and T2D patients.

Hospital-based injury data from level III institution in Cameroon: retrospective analysis of the present registration system.

BACKGROUND: Data on the epidemiology of trauma in Cameroon are scarce. Presently, hospital records are still used as a primary source of injury data. It has been shown that trauma registries could play a key role in providing basic data on trauma. Our goal is to review the present emergency ward records for completeness of data and provide an overview of injuries in the city of Limbe and the surrounding area in the Southwest Region of Cameroon prior to the institution of a formal registration system. METHODS: A retrospective review of Emergency Ward logs in Limbe Hospital was conducted over one year. Records for all patients over 15 years of age were reviewed for 14 data points considered to be essential to a basic trauma registry. Completeness of records was assessed and a descriptive analysis of patterns and trends of trauma was performed. RESULTS: Injury-related conditions represent 27% of all registered admissions in the casualty department. Information on age, sex and mechanism of injury was lacking in 22% of cases. Information on vital signs was present in 2% (respiratory rate) to 12% (blood pressure on admission) of records. Patient disposition (admission, transfer, discharge, or death) was available 42% of the time, whilst location of injury was found in 84% of records. Road traffic injury was the most frequently recorded mechanism (36%), with the type of vehicle specified in 54% and the type of collision in only 22% of cases. Intentional injuries were the second most frequent mechanism at 23%. CONCLUSION: The frequency of trauma found in this context argues for further prevention and treatment efforts. The institution of a formal registration system will improve the completeness of data and lead to increased ability to evaluate the severity and subsequent public health implications of injury in this region.

Day-to-day variation of insulin requirements of patients with type 2 diabetes and end-stage renal disease undergoing maintenance hemodialysis.

OBJECTIVE: To evaluate day-to-day variations of insulin needs in type 2 diabetic patients with end-stage renal disease (ESRD) on maintenance hemodialysis. RESEARCH DESIGN AND METHODS: We developed a 24-h euglycemic clamp in patients who received an average of 2,200 calories in a standardized three-meal and two-snack regimen per day, adjusted to body size and sex. Intravenous insulin was adjusted every 30 min to achieve 5.5 +/- 1.1 mmol/l glycemia over 24 h prehemodialysis, during hemodialysis session, and 24 h posthemodialysis in 10 type 2 diabetic patients, aged 55.7 +/- 8.7 years with 11.9 +/- 4.5 years diabetes duration, undergoing maintenance hemodialysis for 2.3 +/- 2.3 years. Insulin requirements were derived from the dose of insulin administered to maintain euglycemia per period of time and day-to-day comparisons performed. RESULTS: Mean capillary glycemia was 5.5 +/- 0.3 mmol/l prehemodialysis and 5.3 +/- 0.2 mmol/l posthemodialysis (P = 0.39). Pre- and posthemodialysis areas under the glucose curve were comparable. This was achieved by infusing 23.6 +/- 7.7 IU/24 h prehemodialysis vs. 19.9 +/- 4.9 IU/24 h posthemodialysis, indicating a 15.3% decrease posthemodialysis (P = 0.09). Basal insulin needs decreased from 0.4 +/- 0.1/h prehemodialysis to 0.3 +/- 0.1/h posthemodialysis (P = 0.01). Total boluses were decreased by 2.2 +/- 3.1 IU (P = 0.15). Changes in blood urea did not correlate with changes in insulin needs (r = 0.1, P = 0.79). CONCLUSIONS: The present study has demonstrated a significant 25% reduction in basal insulin requirements the day after dialysis compared with the day before. No significant change in boluses was observed, and overall the reduction of total insulin requirements was -15% equivalent to -4 IU/day posthemodialysis of marginal statistical significance.

Phase I dynamics of cardiac output, systemic O2 delivery, and lung O2 uptake at exercise onset in men in acute normobaric hypoxia.

We tested the hypothesis that vagal withdrawal plays a role in the rapid (phase I) cardiopulmonary response to exercise. To this aim, in five men (24.6+/-3.4 yr, 82.1+/-13.7 kg, maximal aerobic power 330+/-67 W), we determined beat-by-beat cardiac output (Q), oxygen delivery (QaO2), and breath-by-breath lung oxygen uptake (VO2) at light exercise (50 and 100 W) in normoxia and acute hypoxia (fraction of inspired O2=0.11), because the latter reduces resting vagal activity. We computed Q from stroke volume (Qst, by model flow) and heart rate (fH, electrocardiography), and QaO2 from Q and arterial O2 concentration. Double exponentials were fitted to the data. In hypoxia compared with normoxia, steady-state fH and Q were higher, and Qst and VO2 were unchanged. QaO2 was unchanged at rest and lower at exercise. During transients, amplitude of phase I (A1) for VO2 was unchanged. For fH, Q and QaO2, A1 was lower. Phase I time constant (tau1) for QaO2 and VO2 was unchanged. The same was the case for Q at 100 W and for fH at 50 W. Qst kinetics were unaffected. In conclusion, the results do not fully support the hypothesis that vagal withdrawal determines phase I, because it was not completely suppressed. Although we can attribute the decrease in A1 of fH to a diminished degree of vagal withdrawal in hypoxia, this is not so for Qst. Thus the dual origin of the phase I of Q and QaO2, neural (vagal) and mechanical (venous return increase by muscle pump action), would rather be confirmed.

Simultaneous determination of the kinetics of cardiac output, systemic O(2) delivery, and lung O(2) uptake at exercise onset in men.

We tested whether the kinetics of systemic O(2) delivery (QaO(2)) at exercise start was faster than that of lung O(2) uptake (Vo(2)), being dictated by that of cardiac output (Q), and whether changes in Q would explain the postulated rapid phase of the Vo(2) increase. Simultaneous determinations of beat-by-beat (BBB) Q and QaO(2), and breath-by-breath Vo(2) at the onset of constant load exercises at 50 and 100 W were obtained on six men (age 24.2 +/- 3.2 years, maximal aerobic power 333 +/- 61 W). Vo(2) was determined using Grønlund's algorithm. Q was computed from BBB stroke volume (Q(st), from arterial pulse pressure profiles) and heart rate (f(h), electrocardiograpy) and calibrated against a steady-state method. This, along with the time course of hemoglobin concentration and arterial O(2) saturation (infrared oximetry) allowed computation of BBB QaO(2). The Q, QaO(2) and Vo(2) kinetics were analyzed with single and double exponential models. f(h), Q(st), Q, and Vo(2) increased upon exercise onset to reach a new steady state. The kinetics of QaO(2) had the same time constants as that of Q. The latter was twofold faster than that of Vo(2). The Vo(2) kinetics were faster than previously reported for muscle phosphocreatine decrease. Within a two-phase model, because of the Fick equation, the amplitude of phase I Q changes fully explained the phase I of Vo(2) increase. We suggest that in unsteady states, lung Vo(2) is dissociated from muscle O(2) consumption. The two components of Q and QaO(2) kinetics may reflect vagal withdrawal and sympathetic activation.

Cardiac output by Modelflow method from intra-arterial and fingertip pulse pressure profiles.

Modelflow, when applied to non-invasive fingertip pulse pressure recordings, is a poor predictor of cardiac output (Q, litre x min(-1)). The use of constants established from the aortic elastic characteristics, which differ from those of finger arteries, may introduce signal distortions, leading to errors in computing Q. We therefore hypothesized that peripheral recording of pulse pressure profiles undermines the measurement of Q with Modelflow, so we compared Modelflow beat-by-beat Q values obtained simultaneously non-invasively from the finger and invasively from the radial artery at rest and during exercise. Seven subjects (age, 24.0 +/- 2.9 years; weight, 81.2 +/- 12.6 kg) rested, then exercised at 50 and 100 W, carrying a catheter with a pressure head in the left radial artery and the photoplethysmographic cuff of a finger pressure device on the third and fourth fingers of the contralateral hand. Pulse pressure from both devices was recorded simultaneously and stored on a PC for subsequent Q computation. The mean values of systolic, diastolic and mean arterial pressure at rest and exercise steady state were significantly ( P < 0.05) lower from the finger than the intra-arterial catheter. The corresponding mean steady-state Q obtained from the finger (Qporta) was significantly ( P < 0.05) higher than that computed from the intra-arterial recordings (Qpia). The line relating beat-by-beat Qporta and Qpia was y =1.55 x -3.02 ( r2 = 0.640). The bias was 1.44 litre x min(-1) and the precision was 2.84 litre x min(-1). The slope of this line was significantly higher than 1, implying a systematic overestimate of Q by Qporta with respect to Qpia. Consistent with the tested hypothesis, these results demonstrate that pulse pressure profiles from the finger provide inaccurate absolute Q values with respect to the radial artery, and therefore cannot be used without correction with a calibration factor calculated previously by measuring Q with an independent method.

Correction of cardiac output obtained by Modelflow from finger pulse pressure profiles with a respiratory method in humans.

The beat-by-beat non-invasive assessment of cardiac output (Q litre x min(-1)) based on the arterial pulse pressure analysis called Modelflow can be a very useful tool for quantifying the cardiovascular adjustments occurring in exercising humans. Q was measured in nine young subjects at rest and during steady-state cycling exercise performed at 50, 100, 150 and 200 W by using Modelflow applied to the Portapres non-invasive pulse wave (Q(Modelflow)) and by means of the open-circuit acetylene uptake (Q(C2H2)). Q values were correlated linearly ( r = 0.784), but Bland-Altman analysis revealed that mean Q(Modelflow) - Q(C2H2) difference (bias) was equal to 1.83 litre x min(-1) with an S.D. (precision) of 4.11 litre x min(-1), and 95% limits of agreement were relatively large, i.e. from -6.23 to +9.89 litre x min(-1). Q(Modelflow) values were then multiplied by individual calibrating factors obtained by dividing Q(C2H2) by Q(Modelflow) for each subject measured at 150 W to obtain corrected Q(Modelflow) (Qcorrected) values. Qcorrected values were compared with the corresponding Q(C2H2) values, with values at 150 W ignored. Data were correlated linearly ( r = 0.931) and were not significantly different. The bias and precision were found to be 0.24 litre x min(-1) and 3.48 litre x min(-1) respectively, and 95% limits of agreement ranged from -6.58 to +7.05 litre x min(-1). In conclusion, after correction by an independent method, Modelflow was found to be a reliable and accurate procedure for measuring Q in humans at rest and exercise, and it can be proposed for routine purposes.