Pulmonary hypertension as seen in a rural area in sub-Saharan Africa: high prevalence, late clinical presentation and a high short-term mortality rate during follow up

Abstract Background: Anti-melanoma differentiation-associated protein-5 (anti-MDA5) positive patients are characterized by the high mortality rate caused by interstitial lung disease (ILD). We conducted a retrospective study to summarize the clinical features and identify the initial predictors for death in anti-MDA5 positive patients.Methods:We designed a retrospective cohort of anti-MDA5 positive patients.The demographic and clinical data recorded on first admission, as well as the outcomes during the first six months follow-up were collected. Risk factors for death were identified using multivariate analyses.Results: A total of 90 anti-MDA5 positive patients were included in this study. Eighty-one (90%) patients presentedILD on admission and 35(38.9%) patients developed rapidly progressive ILD (RP-ILD) subsequently.During the first six months of follow-up, 22 (24.4%) patients died of respiratory failure at an average time of 6.6 ± 5.9 weeks.Univariate analysis identified several factors associated with death, including demographic, clinical, laboratory and image variables. Multivariate analysis showed that total CT GGO score≥4(HR 4.8, 95%CI 1.3-17.9,P=0.020), KL-6>1600U/ml (HR3.7, 95%CI 1.5-9.1, P=0.004) and CRP>5.8mg/L (HR3.7, 95%CI 1.0-12.8, P=0.044) were poor prognostic risk factors, however initial combined treatment(HR 0.3, 95%CI 0.1-0.8, P=0.019) predicted good prognosis in anti-MDA5 positive patients.Conclusion: Anti-MDA5 positive patients demonstrated a high prevalence of ILD on admission, leading to a high short-term mortality rate. Higher total GGO score, higher levels of initial KL-6 and CRP predict poor outcome in anti-MDA5 positive patients. However, in tial intensive treatment may improve the prognosis.

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Establishing Cohorts to Generate the Evidence Base to Reduce the Burden of Breast Cancer in Sub-Saharan Africa: Results From a Feasibility Study in Kenya

Journal of Global Oncology ◽

10.1200/jgo.18.00225 ◽

2019 ◽

pp. 1-10

Author(s):

Sujha Subramanian ◽

Robai Gakunga ◽

Madeleine D. Jones ◽

Asaph Kinyanjui ◽

Emily Ochieng' ◽

...

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Cohort Studies ◽

Socioeconomic Factors ◽

Sub Saharan Africa ◽

Short Term ◽

Cancer Symptoms ◽

Sub Saharan

PURPOSE By 2025, Kenya is estimated to experience a two-thirds increase in the incidence of breast cancer. Local research is necessary to generate evidence to inform policy, public health, and medical practice. There have been no longitudinal cohort studies in sub-Saharan Africa of women with and without breast cancer. Our aim is to assess the feasibility of conducting cohort studies in Kenya that consider clinical characteristics, socioeconomic factors, and self-care behaviors. METHODS We initiated a short-term follow-up cohort study of women with and without a diagnosis of breast cancer with baseline face-to-face data collection and one follow-up interview (at approximately 3 months by telephone). We developed tailored instruments to capture demographics, socioeconomic factors, breast cancer risk, ability to identify breast cancer symptoms, treatments received for breast cancer, and quality of life of survivors. RESULTS We recruited 800 women between the ages of 20 and 60 years and successfully collected baseline data. Completeness of the data was high for demographic variables, but there was a larger proportion of missing information for specific variables required for assessing breast cancer risk. Respondents were able to complete standardized instruments to assess breast cancer knowledge among those without breast cancer and identification of symptoms among survivors. We were able to successfully contact approximately 80% of the participants for follow-up. CONCLUSION This short-term follow-up study provides evidence that women can be successfully tracked and contacted for follow-up in the Kenyan setting and offers lessons to establish future longitudinal cohorts to identify approaches to improve breast cancer outcomes.

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Mortality, morbidity and follow-up after acute poisoning by substances of abuse: A prospective observational cohort study

Scandinavian Journal of Public Health ◽

10.1177/1403494818779955 ◽

2018 ◽

Vol 47 (4) ◽

pp. 452-461 ◽

Cited By ~ 2

Author(s):

Odd Martin Vallersnes ◽

Dag Jacobsen ◽

Øivind Ekeberg ◽

Mette Brekke

Keyword(s):

Mental Illness ◽

Mortality Rate ◽

Health Services ◽

Acute Poisoning ◽

Short Term ◽

Increased Risk ◽

Short Term Mortality ◽

Repeated Poisoning ◽

Substances Of Abuse

Aims: Despite the excess mortality and morbidity associated with acute poisoning by substances of abuse, follow-up is frequently not organised. We assessed morbidity, including repeated poisoning, and follow-up after acute poisoning by substances of abuse through charting contacts with health services. We also charted short-term mortality. Methods: Patients 12 years and older treated for acute poisoning by substances of abuse at a primary care emergency outpatient clinic in Oslo, Norway, were included consecutively from October 2011 through September 2012. We retrieved information from national registers on fatalities, hospital admissions, and contacts at outpatient specialist health services and with general practitioners (GPs), during the 90 days following a poisoning episode. Results: We included 1731 patients treated for 2343 poisoning episodes. During the 90 days following the poisoning, 31% of the patients were treated at somatic hospitals, 9% admitted to psychiatric hospitals, 37% in treatment at outpatient psychiatric/addiction specialist health services, 55% saw their GP, while 34% had no follow-up. The short-term mortality rate was 2.0%, eight times higher than expected. Increasing age, suicidal intention, opioid poisoning, and severe mental illness were associated with increased risk of death. Increasing age, male gender, opioid poisoning, and severe mental illness were associated with repeated poisoning. Patients with increased risk of repeated poisoning were more likely to be in follow-up at outpatient specialist psychiatric/addiction services and in contact with their GP. Conclusions: Follow-up measures seem targeted to those most in need, though one out of three had none. The mortality rate calls for concern.

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Multiple Mammarenaviruses Circulating in Angolan Rodents

Viruses ◽

10.3390/v13060982 ◽

2021 ◽

Vol 13 (6) ◽

pp. 982

Author(s):

Jana Těšíková ◽

Jarmila Krásová ◽

Joëlle Goüy de Bellocq

Keyword(s):

Geographical Area ◽

Sub Saharan Africa ◽

Virus Diversity ◽

High Prevalence ◽

Biogeographical Regions ◽

Sub Saharan ◽

Rodent Community ◽

High Virus ◽

Almost All ◽

Virus Genomes

Rodents are a speciose group of mammals with strong zoonotic potential. Some parts of Africa are still underexplored for the occurrence of rodent-borne pathogens, despite this high potential. Angola is at the convergence of three major biogeographical regions of sub-Saharan Africa, each harbouring a specific rodent community. This rodent-rich area is, therefore, strategic for studying the diversity and evolution of rodent-borne viruses. In this study we examined 290 small mammals, almost all rodents, for the presence of mammarenavirus and hantavirus RNA. While no hantavirus was detected, we found three rodent species positive for distinct mammarenaviruses with a particularly high prevalence in Namaqua rock rats (Micaelamys namaquensis). We characterised four complete virus genomes, which showed typical mammarenavirus organisation. Phylogenetic and genetic distance analyses revealed: (i) the presence of a significantly divergent strain of Luna virus in Angolan representatives of the ubiquitous Natal multimammate mouse (Mastomys natalensis), (ii) a novel Okahandja-related virus associated with the Angolan lineage of Micaelamys namaquensis for which we propose the name Bitu virus (BITV) and (iii) the occurrence of a novel Mobala-like mammarenavirus in the grey-bellied pygmy mouse (Mus triton) for which we propose the name Kwanza virus (KWAV). This high virus diversity in a limited host sample size and in a relatively small geographical area supports the idea that Angola is a hotspot for mammarenavirus diversity.

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Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00822-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Hafte Kahsay Kebede ◽

Lillian Mwanri ◽

Paul Ward ◽

Hailay Abrha Gesesew

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Hiv Care ◽

Care Services ◽

Validity Assessment ◽

Sub Saharan ◽

Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

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Persistence of mRNA indicative of Plasmodium falciparum ring-stage parasites 42 days after artemisinin and non-artemisinin combination therapy in naturally infected Malians

Malaria Journal ◽

10.1186/s12936-020-03576-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Almahamoudou Mahamar ◽

Kjerstin Lanke ◽

Wouter Graumans ◽

Halimatou Diawara ◽

Koualy Sanogo ◽

...

Keyword(s):

Combination Therapy ◽

Artemisinin Combination Therapy ◽

Parasite Prevalence ◽

Sub Saharan Africa ◽

Ring Stage ◽

Qrt Pcr ◽

Sub Saharan ◽

Stage Parasite ◽

Ring Stage Parasite

Abstract Background Malaria control in sub-Saharan Africa relies upon prompt case management with artemisinin-based combination therapy (ACT). Ring-stage parasite mRNA, measured by sbp1 quantitative reverse-transcriptase PCR (qRT-PCR), was previously reported to persist after ACT treatment and hypothesized to reflect temporary arrest of the growth of ring-stage parasites (dormancy) following exposure to artemisinins. Here, the persistence of ring-stage parasitaemia following ACT and non-ACT treatment was examined. Methods Samples were used from naturally infected Malian gametocyte carriers who received dihydroartemisinin–piperaquine (DP) or sulfadoxine–pyrimethamine (SP–AQ) with or without gametocytocidal drugs. Gametocytes and ring-stage parasites were quantified by qRT-PCR during 42 days of follow-up. Results At baseline, 89% (64/73) of participants had measurable ring-stage parasite mRNA. Following treatment, the proportion of ring-stage parasite-positive individuals and estimated densities declined for all four treatment groups. Ring-stage parasite prevalence and density was generally lower in arms that received DP compared to SP–AQ. This finding was most apparent days 1, 2, and 42 of follow-up (p < 0.01). Gametocytocidal drugs did not influence ring-stage parasite persistence. Ring-stage parasite density estimates on days 14 and 28 after initiation of treatment were higher among individuals who subsequently experienced recurrent parasitaemia compared to those who remained free of parasites until day 42 after initiation of treatment (pday 14 = 0.011 and pday 28 = 0.068). No association of ring-stage persistence with gametocyte carriage was observed. Conclusions The current findings of lower ring-stage persistence after ACT without an effect of gametocytocidal partner drugs affirms the use of sbp1 as ring-stage marker. Lower persistence of ring-stage mRNA after ACT treatment suggests the marker may not reflect dormant parasites whilst it was predictive of re-appearance of parasitaemia.

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