Pattern and determinants of health-related quality of life of adolescents with congenital heart disease in Cameroon: A single-center cross-sectional study.

Background: Health-related quality of life (HRQoL) assessment is necessary for the management of patients with congenital heart diseases (CHD). No study has yet been reported on Cameroonian adolescents. The aim of this study was to evaluate the profile of and look for determinants of HRQoL in adolescents with CHD in Cameroon. Methods: This was a cross-sectional study with prospective recruitment carried out on 71 adolescents diagnosed with CHD aged 12 to 18 years and recruited at the Douala General Hospital. Sociodemographic and clinical data were collected using a structured questionnaire. HRQoL was assessed using the pediatric quality of life inventory (PedsQL4.0) for child and parent reports. Multivariate linear regression was used to assess the determinants of HRQoL. Differences were considered significant for p < 0.05. Results: Mean age of participants was 15 ± 2 years with 54.9% women. Mean physical and psychosocial functioning scores were 50.7 ± 13.9 and 60.5 ± 9.6 for parent report and 49.5 ± 13.4 and 59.1 ± 9.1 for child report respectively; with no significant difference according to gender. Distribution of functioning scores according to anatomical complexity showed no significant difference while it was lower in patients with a greater physiological severity and to those with no surgical intervention compared to the others. After multivariate adjustments, physiological stage 3 or 4 was negatively associated while cardiac intervention was positively associated with HRQoL. Conclusion: CHD adolescents exhibit a low level of quality of life. Cardiac intervention positively affects HRQoL and should be targeted in the reduction of HRQoL burden from CHD in Cameroon.

Performance of systolic pressure index for lower limb peripheral arterial disease in a group of elderly in sub-Saharan Africa.

BACKGROUND: The automatic measurement of the ankle-brachial index (ABI) constitutes a reliable, simple, safe, rapid, and inexpensive alternative diagnostic screening test compared with the Doppler method for peripheral arterial disease (PAD). We aimed to compare the diagnostic performance of automatic ABI measurement tests to Doppler ultrasound for PAD in a group of patients aged 65 years and above, in Sub-Saharan Africa. METHODS: This was an experimental comparative study of the performance of Doppler ultrasound to the automated ABI test in the diagnosis of PAD in patients aged ≥ 65 years followed-up at the Yaoundé Central Hospital, Cameroon between January to June 2018. An ABI threshold < 0.90 is defined as a PAD. We compare the sensitivity, and specificity of the high ankle-brachial index (ABI-HIGH), low ankle-brachial index (ABI-LOW), and the mean ankle-brachial index (ABI-MEAN) for both tests. RESULTS: We included 137 subjects with an average age of 71.7 ± 6.8 years. In the ABI-HIGH mode, the automatic device had a sensitivity of 55% and a specificity of 98.35% with a difference between the two techniques of d = 0.024 (p = 0.016). In the ABI-MEAN mode, it had a sensitivity of 40.63% and a specificity of 99.15%; d = 0.071 (p < 0.0001). In the ABI-LOW mode, it had a sensitivity of 30.95% and a specificity of 99.11%; d = 0.119 (p < 0.0001). CONCLUSION: The Automatic measurement of systolic pressure index has a better diagnostic performance in the detection of Peripheral Arterial Disease compared to the reference method by continuous Doppler in sub-Saharan African subjects aged ≥ 65 years.

Epidemiological features and mortality risk factors of peripartum cardiomyopathy in a group of Sub-Saharan African population.

BACKGROUND: Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure occurring during pregnancy. Its prevalence seems more frequent in Africa but its epidemiological, clinical and evolutionary particularities remain unknown. This study aimed to evaluate the epidemiological features and mortality risk factors of PPCM. MATERIAL AND METHOD: We conducted a retrospective cross-sectional study over 38 months (January 2018 to March 2021) in 3 hospitals in the city of Douala(Cameroon). We included all patients with heart failure between the last month of pregnancy and 5 months after delivery without an identified cause. Were excluded, files not containing data on echocardiography, patients with heart failure without dilation or with LVEF≥ 45% and patients with a history of heart disease of known aetiology. Chi² tests and binary logistic regression were used for data analysis; the survival curve according to Kaplan Meier was drawn for the evolution. The threshold of significance was set at 0.05. RESULTS: A total of 2102 medical records of women with heart failure were searched. In these records, a total of 59 patients showed signs of peripartum heart failure and only 29 fulfilled the inclusion criteria. From a socio-demographic point of view, the average age was 29 ± 7 years and 51.7% of patients were over 30 years old. Among these patients, 79.3% of patients lived in urban areas and 10.3% of patients had a low socio-economic level. The hospital frequency of PPCM was 1.3%. Clinically, primiparous and pauciparous women were the most affected; the diagnosis was made after more than a month of progression in 65.5% of patients. Dyspnea was present in all patients. In addition, 89.7% of patients had a left ventricular end-diastolic diameter ≥ 62 m, 48.3 % had a left ventricular ejection fraction (LVEF) between 30% and 45%, and 51.7% had an LVEF < 30%. The associated mortality rate was 27.7%. The only prognostic factor independently associated with mortality was age < 30 years. CONCLUSION: The frequency of PPCM is relatively low in Cameroonian urban settings. Moreover, its diagnosis is generally delayed and it induces high mortality. Its occurrence in a woman under the age of 30 is a factor of poor prognosis.

Interpretation of A1C measurement in sub-Saharan Africa beyond the global A1C-Derived Average Glucose (ADAG) equation.

Introduction: optimal metabolic control is crucial for prevention of diabetes associated complications. HbA1c is a correlate of chronic hyperglycemia and is associated with long-term diabetes complications. We investigate the relationship between A1C and estimated average blood glucose (eAG) from the multicenter A1C-Derived Average Glucose (ADAG) study, in a sub-Saharan African population. Methods: forty-seven patients with diabetes mellitus and ten normoglycemic individuals were consecutively recruited from a tertiary reference hospital in Cameroon. This observational study was conducted in the framework of the ADAG study. eAG was derived from single values obtained from self-monitored blood glucose (SMBG) and from continuous glucose monitoring (CGM). Spearman correlation coefficient was used to examine the relationship between eAG and A1C levels. Results: there was a strong linear relationship between eAG using SMBG with A1C level; eAG (mmol/l) =1.22 x A1C (%) - 0.25; R2 = 0.58; p<0.001. This suggests that a one percent increase in A1C corresponds to a 1.22 mmol/l increment of eAG. A similar relationship was found between A1C level and eAG from the continuous glucose monitoring (CGM) measurements albeit with a smaller accretion; eAG (mmol/l) =0.95 x A1C (%) + 1.52; R2 = 0.52; p<0.001. The bias of the global ADAG equation was lower than 5% below A1C level of 7% and progressively increased with higher values of A1C. Conclusion: consistent with previous reports, using a population specific equation, A1C can be better derived from eAG in individuals from sub-Saharan African origin.

Quality of life group of cameroonian patients aged over 65 years in an urban setting: A cross-sectional study

Background. The quality of life of the elderly can be compromised by several chronic diseases. This has a considerable impact on their physical and mental capacities.This study aimed to evaluate the quality of life of the elderly at the Yaoundé Central Hospital. Methods.We carried out a cross-sectional study of elderly patients who consulted at the Yaounde Central Hospital forfive months. Sociodemographic characteristics were taken, and we also took data concerning their chronic conditions and depressive symptoms. The presence of any cognitive impairment was evaluated using the Mini-mental state Examination (MMSE). Their functional capacity was assessed with the six-minute walk test. Quality of life was evaluated using the older people's quality of life questionnaire (OPQOL). The multivariate analysis was done on the logistic regression model, and the p values < 0.05 were considered statistically significant. Results.66 participants were included (35 women) with a median age of 70 (IQR: 67 -75) years. About 87.8% had at least one chronic condition, and 47% had two or more. The most prevalent chronic condition was hypertension (71.2%), followed by abdominal obesity (40.9%) and heart failure (24.2%). Mild depressive symptoms were present in 1.5% of our study population. Fourteen participants (21.2%) had a poor quality of life. The factors associated with a poor quality of life was a distance covered in the 6 MWT less than 350m (OR: 3.7, p < 0.05). Conclusion.There is a high prevalence of poor quality of life among elderly patients consulting at the Yaoundé Central Hospital. A distance covered in the 6MWT less than 350m is associated with poor quality of life.

Introduction. La qualité de vie des personnes âgées peut être compromise par la survenue de plusieurs pathologies chroniques. Cela a un impact considérable sur leurs capacités physiques mais aussi sur leurs capacités mentales. Le but de cette étude était d'évaluer la qualité de vie des personnes âgées suivies à l'Hôpital Central de Yaoundé. Méthodologie. Nous avons réalisé une étude transversale analytique sur des patients âgés ayant consulté à l'hôpital central de Yaoundé pendant une période de cinq mois. Les caractéristiques sociodémographiques ont été prises, ainsi que leurs différentes comorbidités. La présence d'un déficit cognitif a été évaluée à l'aide du Mini Mental State Examination(MMSE). Leur capacité fonctionnelle a été évaluée à l'aide du test de marche de six minutes. La qualité de vie a été évaluée à l'aide du score OPQOL.. L'analyse multivariée a été effectuée sur le modèle de régression logistique et les valeurs de p < 0,05 ont été considérées comme statistiquement significatives. Résultats. 66 participants ont été inclus (35 femmes) avec un âge médian de 70 (IQR : 67 -75) ans. Parmi eux, environ 87,8 % avaient au moins une maladie chronique et 47 % en avaient deux ou plus. L'affection chronique la plus répandue était l'hypertension artérielle (71,2 %), suivie de l'insuffisance cardiaque (24,2 %) et de l'arthrose (12,1 %). Des symptômes dépressifs légers étaient présents chez 1,5 % de la population de notre étude. 14 participants (21,2 %) avaient une mauvaise qualité de vie. Les facteurs associés à unemauvaise qualité de vie étaient une distance parcourue dans le 6MWT inférieure à 350m (OR : 3,7, p < 0,05). Conclusion. Il existe une forte prévalence de la mauvaise qualité de vie chez ce groupe de patients âgés camerounais dont le facteur associé retrouvéest une distance parcourue durant le 6MWT inférieure à 350m.Ceci confirme le bénéfice de l'activité physique sur le plan physique et mental, indispensable pour une meilleure qualité de vie.

Prevalence, complications and factors associated with severely elevated blood pressure in patients with hypertension: a cross-sectional study in two hospitals in Yaoundé, Cameroon.

Introduction: severely elevated blood pressure significantly increases cardiovascular morbidity and mortality in hypertensive Black patients. The objective of this study was to determine the prevalence, complications and factors associated with severe high blood pressure in hypertensive patients in Yaoundé, Cameroon. Methods: we conducted a cross-sectional study in the outpatient and cardiology units of two teaching hospitals in Yaoundé. We included consenting hypertensive patients aged over 18 years. We first measured their blood pressure (BP), then we collected their sociodemographic data, cardiovascular risk factors, follow-up data, and ended with a complete physical examination. We performed a regression analysis to assess correlates of severe hypertension. Results: we included a total of 153 patients with 33 (21.6%) of them having severe hypertension. Among the 33 patients, 16 (48.5%) were male and 17 (51.5%) were female. Their mean age was 60.52 ± 12.83 years. Chronic kidney disease (78.8%), hypertensive retinopathy (69.7%) and left ventricular hypertrophy (48.5%) were the most common complications. On multiple logistic regression analysis, inadequate follow-up was independently associated with severe hypertension (adjusted OR=7.09; 95% CI [2.29-21.9]). Conclusion: severely elevated BP is common among hypertensive patients in our setting with important physical and economic consequences. Increased patients awareness and improving access to primary care physicians and cardiologists, through health insurance or other means, may be an effective strategy for reducing cardiovascular morbidity and mortality among hypertensive Black patients.

Evaluation of the Efficiency of Telemedicine in the Management of Cardiovascular Diseases in Primary Healthcare in Sub-Saharan Africa: A Medico-Economic Study in Cameroon.

OBJECTIVE: To assess the efficiency of tele-expertise (tele-ECG) for patients and for health facilities in managing patients with cardiovascular diseases (CVDs) in primary health care in Cameroon. METHOD: This study was a medico-economic study combining two approaches: cost minimization and cost-effectiveness analysis. It was conducted alongside the previous published controlled multicenter study carried out in Cameroon's two health facilities where tele-ECG has been implemented (intervention centres) and two other where telemedicine has been not implemented (control centres). RESULTS: The average total cost for patients was 9 286 F CFA (US$: 16) in the intervention centres compared to 28 357 F CFA (US$: 49) in the control centres (p <0.01). The calculated ICER favouring tele-ECG was 25 459.6 F CFA (US$: 44). DISCUSSION: Telemedicine is efficient for managing patients with CVDs in primary health care in Cameroon. It enables health facilities in remote areas to offer new healthcare services at a lower cost and improve patients' financial access to healthcare.

Cardiometabolic effects of ZingiberOfficinale Roscoe extracts in Type 2 diabetic Cameroonians patients after six weeks of add-on Therapy : A single clinical-arm trial.

OBJECTIVE: We sought to evaluate ginger's cardiovascular and metabolic effects (Zingiberofficinale) add-on therapy in type 2 diabetes patients over six weeks. METHODS: We performed a single-arm clinical trial. In well-to-moderately controlled Type 2 diabetic patients with unchanged treatment for at least three months, the intervention consisted of 6-week add-on oral supplementation of powdered ginger extracts in capsules at a dose of 399 mg three times per day. Transthoracic Doppler echocardiography, ambulatory blood pressure monitoring (ABPM), glycatedhaemoglobin (HbA1c), lipid profile, kidney and liver function analysis were performed at initial and final visits, with a follow-up visit on day 21. Adherence to treatment, palatability and safety were also assessed. RESULTS: Overall, 21 participants (16 females) were included in the analysis. We found a non-significant decrease of E' wave from 0.05[0.04-0.09] to 0.06[0.05-0.7]cm/s, A-wave from 0.8[0.6-0.8] to 0.7[0.6-0.8] cm/s, and E-wave from 0.6[0.5-0.7] to 0.5[0.425-0.6]cm/s. There was a significant reduction of HbA1c from 49.7[47.0-57.4] to 44.3[38.8-53.0] mmol/mol and triglycerides from 1.6[1.4-1.9] to 1.2[0.9-1.8] mmol/l. A 5% decrease or more was observed for diurnal DBP, diurnal MAP and 24-hour DBP. CONCLUSION: Zingiberofficinale used as add-on therapy tend to improve diastolic function, blood pressure and lipid profile of type 2 diabetes patients. Further studies are needed to define the dosage and duration of this supplementary treatment accurately. TRIAL REGISTRATION NUMBER: NCT04222738.

Prevalence and factors associated with hypertension among school children and adolescents in urban and semi-urban areas in Cameroon.

Few data to date exist on pediatric hypertension (PH) prevalence and risk factors in semi-urban areas in Cameroon, and they are believed to be the same as urban areas. These data are needed to design targeted preventive strategies and contribute to reducing the burden of PH in Cameroon and countries with equivalent standards of care. The authors conducted a cross-sectional study, from November, 2017 to June, 2018, in primary and secondary schools, from semi-urban (Bamboutos, West Region) and urban (Mfoundi, Center Region) settings in Cameroon, including children and adolescent aged between 3 and 19 years, recruited on a stratified probability sampling. PH was defined according to the American Academy of Pediatrics 2017. Overall, 1001 and 842 participants were, respectively, included in urban and semi-urban areas. The overall average age was 13.9 ± 4.03 years, and two-thirds were girls. Overweight and obesity were more prevalent in urban area (overweight: 17.1%; obesity: 5.9%), compared to semi-urban (overweight: 1.1% and obesity: 0.8%) (p < .001). The prevalence of hypertension was higher in urban (12%) than semi-urban areas (8.6%) (p = .01). We have identified as factors associated with PH: age > 14 years (OR = 3.18 [1.6; 6.2]) and secondary level of education (OR = 2.5 [1.2; 5.5]) in urban areas; family history of hypertension (OR 1.93 [1.1; 3.4] in semi-urban areas. PH prevalence is higher in urban than semi-urban areas, and the associated factors are not the same. Policies to address hypertension in the pediatric population must be targeted and tailored to the different population profiles.

Persistent hypertension after preeclampsia in a group of Cameroonians: Result of a cross-sectional study and perspectives to reduce its burden in Limited Income Countries.

Preeclampsia/eclampsia significantly increases the risk of future hypertension. Several factors may be involved in this process. The purpose of this study was to identify them in Cameroonians. We conduct a cross-sectional study including women aged 18 to 45 years, who deliver between December 2011 and 2016, and were diagnosed and followed up for preeclampsia/eclampsia in two major obstetrical and gynecologic units in Yaoundé (Cameroon). Those with persistent high-blood pressure after 6 months were classified as persistent hypertension (PH). Associated factors were investigated using multivariate analysis with logistic regression and presented with an adjusted odds ratio (aOR) and the 95% confidence interval. 92 participants were included, with 30 (32.6%) with PH. The independent factors associated with PH were as follows: maternal age during preeclampsia above 30 years (aOR = 6.30 [1.1; 35.4], p = .03), at least five deliveries prior preeclampsia (aOR = 1.50 [2; 6.6], p = .008), and family history of diabetes (aOR = 14.8 [2.6; 85.7], p = .003). About one in three women with preeclampsia/eclampsia will have PH. The clinician needs to pay more attention to the potential risk factors identified above. More appropriate strategies need to address the burden of this condition in the context of low resources.

Evaluation of the Effectiveness of Telemedicine in the Management of Cardiovascular Diseases in Primary Health Care in Cameroon: An Interventional Study.

OBJECTIVE: This study aimed to evaluate the effectiveness of tele-expertise (tele-ECG) in primary health care in Cameroon for the management of patients with cardiovascular diseases or risk factors. METHOD: It is a controlled multicenter study carried out in Cameroon's two health facilities where tele-ECG has been implemented (intervention centers) and two other where telemedicine has been not implemented (control centers). Patients having cardiovascular risk factors or diseases received usual primary health care in the control centers. In contrast, they received usual primary health care and could perform an ECG associated with cardiologists' remote expertise (tele-ECG) in the intervention centers. The primary outcome was to evaluate the rate of patients' access to an ECG test and to cardiologist' expertise. RESULTS AND DISCUSSION: Telemedicine is effective for the management of patients with cardiovascular diseases in primary health care. It could improve healthcare providers' clinical processes, clinical outcomes of patients and their satisfaction.

Left atrial structural and functional remodeling study in type 2 diabetic patients in sub-Saharan Africa: Role of left atrial strain by 2D speckle tracking echocardiography.

OBJECTIVE: To evaluate the role of peak atrial longitudinal strain (PALS) through speckle tracking 2D echocardiography for the assessment of structural and functional left atrial (LA) remodeling in a type 2 diabetes mellitus (T2DM) population. METHODOLOGY: We conducted a cross-sectional study during a 9-month period. T2DM adults aged 18 and above were included. The variables assessed during the study include age and gender of participants, diabetes characteristics, cardiovascular risk factors, clinical anthropometric and hemodynamic parameters, standard echocardiographic parameters, volume-derived LA functions, and 2D PALS. RESULTS: We included a total of 102 patients. The mean age was 58 ± 11.7 years, and the M/F sex ratio was 1:1.5. Coexistent arterial hypertension (HTN) was observed in more than half (59.8%) of the population sample. Mean 2D PALS was 29.2 ± 8.9% with 58.8% (95% CI: 50.0-68.6) of subjects having a reduced LA strain (ie,<32%). Reservoir and pump functions were the most altered LA volumetric phasic functions. Mean indexed LA maximal volume was 22.2 ± 6.8 mL/m2 . There was a significant association between abnormal PALS and age, Body mass index (BMI), indexed LA volume, E/E' ratio, LA active ejection fraction (pump function), and LA expansion index (reservoir function). CONCLUSION: Left atrial remodeling is a recurrent condition in adult T2DM Cameroonians. The reservoir and pump LA functions were the most affected. Assessment of LA global strain allows early detection of LA remodeling with comparison to LA size standard analyses. Age, BMI, indexed LA volume, E/E' ratio, and reservoir and pump LA functions were associated to 2D LA global strain impairment.

Prevalence and determinants of masked hypertension among obese individuals at the Yaoundé Central Hospital: a cross-sectional study in sub-Saharan Africa.

OBJECTIVES: The aim of this study was to investigate the prevalence and associated factors of masked hypertension in obese patients in Yaounde. METHODS: We carried out a cross-sectional study from January to September 2017 at the National Obesity Center of the Yaounde Central Hospital. Masked hypertension was defined when the mean 24 h SBP was greater than or equal to 130 mmHg and/or the mean 24 h DBP was greater than or equal to 80 mmHg with normal office blood pressure (SBP/DBP) <140/90 mmHg. Logistic regression was used to examine the relationship of masked hypertension with associated factors. RESULTS: Among the 90 participants included, 67.8% were females. The mean age (±SD) was 46 (±8) years. The mean clinical measurements were 120 ± 9.4 mmHg and 75.5 ± 7.9 mmHg, respectively, for the SBP and the DBP. On 24 h ambulatory measurement, the mean was 123.9 ± 14.4/74.7 ± 8.9 mmHg, respectively, for the SBP/DBP. The prevalence of masked hypertension was 33.3%. Masked hypertension was significantly associated with high-normal office blood pressure [odds ratio (OR) = 2.90, P = 0.02] and to dyslipidemia (OR = 3.60, P = 0.01), but not to the male sex, diabetes, physical activity, and tobacco/alcohol. CONCLUSION: Our findings suggest that the prevalence of masked hypertension is high and that physicians should consider ambulatory blood pressure monitoring for obese individuals with high-normal office blood pressure or dyslipidemia.

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.

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.

An interesting case of tricuspid aortic valve with a quadricuspid function.

Quadricuspid aortic valve (QAV) is a rare congenital heart defect, often related to severe aortic regurgitation, and usually detected by echocardiography or at the time of aortic valve surgery. We report a case of an interesting and extremely rare variant of "false" QAV, detected preoperatively by transthoracic and transesophageal echocardiography, in a severely symptomatic patient, admitted to our hospital for dyspnea. Three leaflets of aortic valve appeared quadricuspid, because the left coronary cusp was divided into 2 parts, as confirmed by MRI and pathology. Most frequently, QAV presents with all 4 leaflets equal in size.