Contribution of Ambulatory Pulsed Pressure in the Modification of the Left Ventricular Geometry of the African Black People

Introduction-Purpose: Pulsed pressure is recognized as an important predictor of cardiovascular risk. The purpose of this study was to identify a possible association between high ambulatory pulsed pressure and left ventricular geometry change in African black people. Material and methods: We conducted a bicentric, retrospective descriptive and analytical study that took place from 2010 to 2015 at the Abidjan Heart Institute and the Polyclinic Sainte Anne Marie in Abidjan. The people were selected from MAPA’s archive files. Those aged 18 years and over were included, all of whom had valid echocardiography and MAPA. The analyzed parameters concerned epidemiological data with age, gender and body surface area. The clinical data analyzed included systolic, diastolic, mean and 24-hours pulsed pressures. On the echocardiographic parameters, it was the evaluation of the ventricular mass indexed to the body surface. Results: A total of 177 patients records were selected. The mean age of the patients was 56.32 ± 10.51 years. There was a male predominance with a sex ratio of 1.15. The main cardiovascular risk factors found outside high blood pressure were dyslipidemia (06.87%) and obesity (13.7%). In clinical terms, hypertension was found in 75% of cases (n = 133) versus 25% (n = 44) of normotensive patients. These blood pressure profiles allowed us to classify our study population into two groups: hypertensives people and normotensives people. The hypertensives people had significantly higher mean pulsed pressure levels than the normotensives people. All normotensive patients had normal pulsed pressure. In the hypertensive population, the prevalence of high pulsed pressure was 31% (n = 41) versus 69% (n = 92) normal pulsed pressure. Concerning the relationship between 24 hour ambulatory pulsed pressure and left ventricular mass, hypertensives patients with a high ambulatory pulsed pressure had a significantly higher average indexed ventricular mass than the opposite groups (p = 0.039). Their ejection fraction was significantly lower than those of the opposite populations (p = 0.000). On the analysis of the correlation between the left ventricular mass and the tension profile, we noted in our series, a strong and significant correlation (r = 0.6342;p = 0.0000) between pulsed pressure and the ventricular geometry change. Conclusion: High ambulatory pulsed pressure remains an independent factor of change in left ventricular geometry in black people.

Characterization of six tumorsuppressor genes and microsatellite instability in hepatocellular carcinomain southern African blacks

AIM To analyse cumulative loss of heterozygosity (LOH) of chromosomal regions and tumor suppressor genes in hepatocellular carcinomas (HCCs) from 20 southern African blacks. METHODS p53, RB1, BRCA1, BRCA2, WT1 and E cadherin genes were analysed for LOH, and p53 gene was also analysed for the codon 249 mutation, in tumor and adjacent non tumorous liver tissues using molecular techniques and 10 polymorphic microsatellite markers. RESULTS p53 codon 249 mutation was found in 25% of the subjects, as was expected, because many patients were from Mozambique, a country with high aflatoxin B 1 exposure. LOH was found at the RB1, BRCA2 and WT1 loci in 20%(4/*!20) of the HCCs, supporting a possible role of these genes in HCC. No LOH was evident in any of the remaining genes. Reports of mutations of p53 and RB1 genes in combination, described in other populations, were not confirmed in this study. Change in microsatellite repeat number was noted at 9/*!10 microsatellite loci in different HCCs, and changes at two or more loci were detected in 15%(3/*!20) of subjects. CONCLUSION We propose that microsatellite/genomic instability may play a role in the pathogenesis of a subset of HCCs in black Africans.

Hepatocellular carcinoma in African Blacks: Recent progress in etiology and pathogenesis

Occult hepatitis B virus (HBV) infection was shown to be present in 75% of Black Africans with hepatocellular carcinoma (HCC) in whom the tumor was hitherto not thought to be caused by chronic HBV infection. The association between chronic HBV infection and the development of the tumor is thus even closer than was originally thought. HBV viral load was found to be significantly higher in patients with HCC than in Black African controls. As in other populations, HBV e antigen-positive patients with hepatocellular carcinoma had significantly higher viral loads than patients negative for this antigen. The significance of this finding is discussed. The risk for HCC development with genotype A of HBV, the predominant genotype in African isolates, has not been investigated. Genotype A was shown to be 4.5 times more likely than other genotypes to cause HCC in Black Africans, and tumours occurred at a significantly younger age. Increasing numbers of patients with human immunodeficiency virus (HIV) and HBV co-infection are being reported to develop HCC. A preliminary case/control comparison supports the belief that HIV co-infection enhances the hepatocarcinogenic potential of HBV. A study from The Gambia provides the first evidence that dietary exposure to afltoxin B1 may cause cirrhosis and thatthis may play a contributory role in the pathogenesis of aflatoxin-induced HCC. An animal model has provided experimental support for the clinical evidence that dietary iron overload in the African is directly hepatocarcinogenic, in addition to causing the tumor indirectly through the development of cirrhosis.

Abdominoplasty, Liposuction and Brazilian Butt Lift (BBL) in Kinshasa in the Democratic Republic of Congo. My Experience in This Aesthetic Plastic Surgery with Black African Women in a Low-Income Country

Background: In low-income African countries, the demand and use of plastic surgery operations including abdominoplasty, liposuction and Brazilian butt lift (BBL) are increasing. The goal of this work is to present my experience and the challenges of this aesthetic plastic surgery among black African women. Material and Methods: A retrospective study was conducted about the abdominoplasties, liposuctions and Brazilian butt lift (BBL) which I operated in public and private hospitals at Kinshasa (Democratic Republic of Congo) in black African women. It covers a period of 13 years, going from December 1, 2010 to December 1, 2023. For this study, I had at least 6 months period (to Juin 1, 2024) to assess the occurrence of early and late postoperative complications. Results: I performed 84 abdominoplasties, 144 liposuctions and 23 Brazilian butt lifts (BBL). The average age at the time of abdominoplasty was 44 years with extremes ranging from 26 to 55 years and a concentration of cases (60.7%) in the age group of 40 to 49 years. The age group of 20 to 29 years old represented the lowest rate of requests for abdominoplasty (4.7%). Patients with a BMI of 30 to 2 were the majority (61.9%), followed by those between 25 to 2 (29.7%). 67.8% of patients were obese (BMI ≥ 30 kg/m2). The average age at the time of liposuction was 41 years with extremes ranging from 21 years to 69 years;and more than half of cases (68%) in the age group between 30 and 49 years. As for Brazilian butt lift (BBL), the average age was 33 years with extremes ranging from 24 to 42 years and a concentration of patients (91.3%) between 20 and 39 years. The immediate postoperative complications of abdominoplasties observed were: seroma in 7% of cases, hematoma and partial infection of the surgical site in 5% of cases. Pathological scars (hypertrophic, keloid) after abdominoplasties were observed in 9% of cases. The most common complication of liposuction was contour deformity. I observed 16 patients (11.1%) with soft-tissue depressions or elevations, skin panniculus or folds. For Brazalian Butt Lift (BBL), complications like asymmetry for 2 patients (8.9%), contour irregularities for 2 patients (8.9%), and excessive fat removal for 6 patients (26%), had observed. I have not recorded any cases of death or pulmonary embolism. Conclusion: I perform aesthetic plastic surgery procedures in black African women with a high socioeconomic standard of living compared to the average of the general population. The renunciation of planned surgery is motivated by the impossibility of paying the cost of the operation as well as by popular and religious perceptions regarding cosmetic surgery. The results of these aesthetic plastic surgery procedures carried out are very satisfactory for them. The challenges to overcome are mainly threefold: the unforeseeable complications of these cosmetic plastic surgery procedures, popular and religious perceptions of cosmetic surgery as well as the poverty of the population.

Child-Pugh-Turcott versus Meld score for predicting survival in a retrospective cohort of black African cirrhotic patients

AIM: To compare the performance of the Child-Pugh-Turcott (CPT) score to that of the model for end-stage liver disease (MELD) score in predicting survival of a retrospective cohort of 172 Black African patients with cirrhosis on a short and mid-term basis.METHODS: Univariate and multivariate (Cox model) analyses were used to identify factors related to mortality. Relationship between the two scores was appreciated by calculating the correlation coefficient. The Kaplan Meier method and the log rank test were used to elaborate and compare survival respectively. The Areas Under the Curves were used to compare the performance between scores at 3, 6 and 12 mo.RESULTS: The study population comprised 172 patients, of which 68.9% were male. The mean age of the patient was 47.5 ± 13 years. Hepatitis B virus infection was the cause of cirrhosis in 70% of the cases. The overall mortality was 31.4% over 11 years of follow up. Independent factors significantly associated with mortality were: CPT score (HR = 3.3, 95% CI [1.7-6.2]) (P < 0.001) (stage C vs stage A-B); Serum creatine (HR = 2.5, 95% CI [1.4-4.3]) (P = 0.001) (Serum creatine > 1.5 mg/dL versus serum creatine < 1.5 mg/dL); MELD score (HR = 2.9, 95% CI [1.63-5.21]) (P < 0.001) (MELD > 21 vs MELD < 21). The area under the curves (AUC) that predict survival was 0.72 and 0.75 at 3 mo (P = 0.68), 0.64 and 0.62 at 6 mo (P = 0.67), 0.69 and 0.64 at 12 mo (P = 0.38) respectively for the CPT score and the MELD score.CONCLUSION: The CPT score displays the sameprognostic significance as does the MELD score in black African patients with cirrhosis. Moreover, its handling appears less cumbersome in clinical practice as compared to the latter.

Lay Perceptions about Tuberculosis among Non-UK-Born Black Africans in the United Kingdom

Background: Tuberculosis among non-UK-born Black Africans has been gradually recognized as a public health problem in the UK despite the various interventions implemented. Objectives: To explore the perceptions of non-UK-born Black Africans about TB health risk;to explore the health seeking behavior of the non-UK-born Black Africans in relation to TB and to explore lay views on TB health education and screening as opportunities for health promotion. Methodology and Study Design: A qualitative methodology was used on a purposively selected sample of 12 non-UK-born Black Africans living in Leeds. Face-to-face interviews were conducted to explore the lay perceptions about TB. Thematic analysis was used to derive important themes in accordance to the study objectives. Ethical approval was provided by Leeds Metropolitan University. Setting: Community setting of non-UK-born Black Africans in Leeds, UK. Results: This population holds mixed views and perceptions about tuberculosis, few facilitators and many barriers existed to current TB prevention efforts. The barriers included: language barriers, barriers related to services and systems, immigration status and stigma despite the benefits involved. The potential for black African communities to readily increase the likelihood of behavior change was found as an important finding for this study. Conclusions: Tuberculosis is a preventable public health problem. Involvement of the non-UK-born black Africans communities in the TB prevention may be beneficial for reducing and tackling TB rates in this population. Such an approach is potentially inexpensive and more readily implementable than other suggested strategies such as changes to immigration policies.

Relationship between Obesity, Serum Uric Acid, Serum Potassium and Glomerular Filtration Rate with Electric Left Ventricular Hypertrophy in Blacks Central Africans with High Blood Pressure

The authors conducted a retrospective study over a period of 6 months in a hypertensive population in order to determine the correlation between serum uric acid on glomerular filtration rate (GFR) and estimated serum potassium with left ventricular hypertrophy (LVH) and obesity. This study enrolled 122 patients including 63 women (51.6%). The mean age was 55.9 ± 10.6 years (range 30 to 74 years). Obesity weight was found in 38 cases (31.1%) of which 20?were men (33.9%) and 18 women (28.6%). Abdominal obesity was found in 104 cases (85.2%). The average serum uric acid in patients with obesity weight was 63.3 ± 18.9 mg/L vs 62.4 ± 14.2 mg/L for no-obese patients (p?= 0.63). The average serum potassium in obese patients was 4.06 ± 0.42 mEq/L vs 4.02 ± 0.46 mEq/L for no-obese (p?= 0.65). The average GFR was 73.4 ± 21.4 ml/L in obese patients vs 66.6 ± 22.6 ml/min in no-obese (p?= 0.03). The LVH was found in 81 cases (66.4%). The LVH was found in 65 (62.5%) obese patients vs?16 (88%) non-obese patients (OR = 4.8, 95% 1.04?-?22?p?= 0.02). Only abdominal?obesity has been correlated with left ventricular hypertrophy after multivariate analysis. Emphasis must be focused on public health actions for effective and appropriate measures against obesity and hypertension, whose prevalence is increasing in our region.

Pulse Pressure as a Risk Factor of Atrial Fibrillation in Black African Elderly Patients

Objective: The aim of this study was to show the prognostic role of High Pulse Pressure (PP) in the occurrence of atrial fibrillation in Black African elderly patients. Materials and Methods: In a comparative retrospective study related to 2000 patients admitted to the Institute of Cardiology of Abidjan, from January 1991 to December 2010 for atrial fibrillation, we matched pulse pressure and atrial fibrillation in Black African elderly patients. Results: The mean age of patients was 65 ± 10 years. Patients with high pulse pressure were 4.8 times more at risk to present atrial fibrillation than those with normal pulse pressure. The threshold of high risk pulse pressure was 65 mmHg. Conclusion: Pulse pressure is a factor of bad prognosis of atrial fibrillation in Black African elderly patients.

Trends of Cardiovascular Mortality in Blacks Africans from Central African City: Hospital Based Study, Brazzaville (Congo)

Background: To determine mortality causes and the associated factors. Patients and Method: This cross-sectional study was conducted from June 2014 to May 2015 (1 year) in the department of cardiology at University and teaching Hospital of Brazzaville. Patients admitted for cardiovascular diseases were included. Patients admitted for cardiovascular disease in other departments of the hospital, or without cardiovascular diseases were not included. Results: In total, 1035 patients, 605 women (5804%) were included. Mean age was 57.1 ± 7 years (range: 18 - 85 years). The patients were: elderly (n = 498, 48.1%), educated (n = 809, 78.1%), low-income (n = 253, 24.2%). The medical history of patients was: hypertension (n = 440, 42.5%), diabetes (n = 316, 30.5%), reduced physical activity (n = 154, 14.9%), excessive alcohol intake (n = 56, 5.4%). Heart failure was reported in 386 cases (37.3%). The mortality rate was 8% (n = 83);the mean age of deceased was 61.9 ± 7.3 years (p s in death were dilated cardiomyopathy (n = 37, 44.6%, OR 5, 95%CI 3.1 - 8, p -3.3, p = 0.002), atrial fibrillation (n = 24, 29%, OR 3.6, 95%CI 2.2 - 6, p - 9.8, p = 0.005). The associated death comorbidities were: acute respiratory infection (n = 44, 53%, OR 10.1, 95%CI 6.2 - 16, p - 10 p - 6.8, p Conclusion: Hypertension, heart failure and cardiomyopathies are the leading causes of mortality in the department of cardiology. Prevention and patient education in a low-income environment are essential elements to reduce this morbidity.

Epidemiologic Transition and Heart Failure in Black African Adults

The objective of this study is to report clinical, electrocardiographic, and echocardiographic data on heart failure for the evaluation of its cardiovascular risk factors and causes at the Institute of Cardiology of Abidjan and the National Police Hospital. Patients and Methods: The 12-month prospective study included 989 patients who were diagnosed with heart failure at the Institute of Cardiology of Abidjan and the Heart Department of the National Police Hospital in Cote d’Ivoire. Results: The mean age of the patients was 55 ± 12 years. Patients ≤ 50 years, aged 50 and 70 years, and ≥ 70 years were 42%, 60%, and 18%, respectively. The major cardiovascular risk factors were high blood pression (60%), smoking (19%), type 2 diabetes (11%), and hypercholesterolemia (8%). The status of 11% of HIV positive patients were ignored upon admission to the Heart Hospitals. Severe kidney failure (25%) was found in all hypertensive patients. Atrial fibrillation patients and sinus rhythm subjects were 20% and 80%, respectively. The average duration of QRS was 102 ± 24 ms. 20% of patients had a complete left bundle branch block. The mean of the left ventricular ejection fraction (LVEF) was 35.8% ± 13%. The LVEF was? ≤ 45% in 57% of cases and ≤ 30% in 30% of cases. The identified causes of heart failure were ischemic heart disease (60%), hypertensive heart disease (20%), and rheumatic valvulopathy (12%). Among the patients with ischemic heart disease, 80% were infarction. The coronarography and the myocardial revascularization were performed in 50% of cases. The primitive cardiomyopathy was diagnosed in 15% of cases. The average follow-up was 12.6 ± 8 months. 18% of patients died, 14% of whom deceased within 1 year after the initial diagnosis and 5% of death occurred in 19 months following the first symptoms of heart failure. The end stage of heart failure (13%) was the most frequent cause of death followed by the sudden death (5%) and the terminal kidney failure (2%). The patients were rehospitalized for heart failure (28 cases) and for ischemic stroke during the follow-up. The functional New York Heart Association score of patients was II in 39%, III in 43%, and IV in 18% at 1 month after admission.Conclusion: The heart failure is a major public health issue in Cote d’Ivoire as in many other African countries. The prevalence of ischemic heart disease as the leading cause of heart failure is certainly the reflection of the epidemiologic transition and the advent of the coronarography in the technical platform of the Abidjan Institute of Cardiology. The rapid evolution of the epidemiologic pattern of the heart failure in association with the increasing frequency of cardiovascular risk factors should contribute to implement study and prevention strategies against cardiovascular diseases in Cote d’Ivoire and in Africa.

Evaluation of Sperm DNA Fragmentation amongst Infertile Black Africans. A Nigerian Study

Background: Male infertility is approaching an epidemic proportion. Almost 50% of all cases of infertility may be associated with a male factor. The diagnostic usefulness of sperm DNA integrity is now accessible as an additional tool to Seminal Fluid Analysis. Objective: To assess sperm DNA fragmentation index (SDFI) in male infertility and its relationship with obesity, alcohol consumption and cigarette smoking among infertile Nigerians. Patients and Methods: Patients who presented for infertility at three health facilities of Nordica Fertility Center in Lagos, Asaba and Abuja cities in Nigeria. STATA 13 was used for student’s t-test to compare the means of continuous variables among smokers and non-smokers and among alcohol consumers and non-consumers. Linear regression analysis was employed to assess the correlation between SDFI as dependent variable and some independent variables. Results: There was no significant difference in the SDFI of men aged &#8722;1.80, P-value = 0.04) than that of obese men (30.2%). Obese men were 2.12 times as likely to have SDFI ≥25% compared to normal weight men (χ2&#45;2.16, P-value = 0.14, OR = 2.12, 95% CI: 0.77, 5.80). Mean SDFI of men who consume alcohol (37.1%) was significantly higher (t = &#8722;1.97, P-value = 0.03) than that of those who did not consume alcohol. Although Pearson’s correlation matrix (r) indicated that sperm DNA fragmentation index was positively correlated with history of infertility (r = 0.01), groin surgery (r = 0.04), mumps (r = 0.04) and sexually transmitted illness (r = 0.04), however the degree of correlation was not significant (P-value ≥ 0.5) in each case. Conclusion: This is the first report in Black Africa that describes a correlation between sperm DNA integrity, as measured by the halo test and age, BMI and alcohol consumption. Men with normal BMI were more likely to have excellent to good SDFI and hence good fertility potential. Data from this study indicate that the infertile men had significantly higher sperm DNA fragmentation. Obese men and those engaged in alcohol consumption also had higher sperm DNA fragmentation indices.

Influence of Diet Behavior on Insulin Resistance in Hypertensive Black Sub-Saharan Africans: A Multicentric, Cross-Sectional Study

Background: Insulin resistance (IR) is the backbone of cardiovascular diseases (CVDs). The latter are the most common non-communicable diseases globally. Diet is an important determinant of CVDs. The link between diet and cardiovascular health could be explained by an association between diet pattern and IR. Aims: To investigate the association between salt and specific food consumption as well as different diet patterns (Mediterranean, westernized, and intermediate dietary patterns) with HOMAIR as a surrogate marker of IR, and fasting insulin in Black, sub-Saharan essential hypertensive patients. Methods: The multicentric, cross-sectional analysis involved 77 Congolese Black hypertensive participants with no history of cardiovascular disease. Daily sodium chloride intake (NaCl g/24h) was estimated from 24-hour urine collection. Dietary behaviours were evaluated through a semi-quantitative food frequency questionnaire (FFQ). Homeostatic model assessment of insulin resistance (HOMAIR) ≥ 2.5 was used as surrogate marker of IR. Results: A decrease in weekly consumption of fruits, vegetables and fish would significantly explain an increase of 29% (r = 0.292;p = 0.010), 24% (r = 0.242;p = 0.034) and 23% (r = 0.226;p = 0.048) of the value of HOMAIR respectively. In contrast, an increase in daily sodium chloride intake was associated with 28% (r = 0.283, p = 0.027) of the increase in HOMAIR. Also, a decrease in the average weekly consumption of fruit, vegetables and fish would significantly explain an increase of 25% (r = 0.247;p = 0.030), 30% (r = 0.302;p = 0.008) and 31% (r = 0.313;p = 0.006) of fasting insulin. In contrast, an increase in red meat consumption was associated with a 26% increase (r = 0.257, p = 0.024) in fasting insulin. In multivariable adjusted analysis 45% of variation in fasting insulin (R2 = 0.452;overall p = 0.005) were explained by fruits, vegetables and fish consumption. 38% of variation in HOMAIR (R2 = 0.379;overall p = 0.047) were explained by fruits and vegetable consumption and daily sodium chloride intake (NaCl g/24h). Conclusions: In hypertensive Black sub-Saharan Africans, Salt intake and westernized diet seem to promote insulin resistance whereas Mediterranean diet, fruits, vegetables and fish consumption enhance insulin sensitivity.

当代美国非裔小说中“后黑人性”的文学再现管窥

“后黑人性”文学书写是对“黑人性”文学再现的一种反拔,其核心是以新颖的、反讽的和多元化的视角审视当代非裔美国人的生活体验、身份构建和种族意识。“后黑人性”文学再现形式多元,有文类借用和混合,也有对白人作家经典文本的戏仿性改写,以及对“后种族”未来世界的“乌托邦”式想象。当代“后黑人性”文学再现在种族、身份和历史考察方面有一个可以辨析的传统;该传统可追溯到伊什梅尔·里德的作品,并在科尔森·怀特黑德和保罗·比蒂的小说中不断发展和完善,代表着当代非裔美国小说的走向。

非洲裔黑人选举权与查尔斯顿市的种族关系——以1876年美国南卡罗来纳州州长选举为中心

1876年南卡罗来纳州州长大选前后,查尔斯顿市多次发生种族冲突,既反映了白人至上主义者与坚决捍卫公民权、平等权和选举权的非洲裔黑人之间不可调和的种族矛盾,也揭示了民主党和共和党之间激烈的政治斗争。非洲裔黑人占查尔斯顿市人口的大多数,而种族暴力并非局限在非洲裔黑人和白人之间,也存在于支持不同政党的非洲裔黑人选民之间,使得查尔斯顿市的种族关系存在明显的地方性和复杂性特征。对查尔斯顿市种族冲突的历史考察,有助于加深对美国重建后期非洲裔黑人选举权、种族关系和白人至上主义思想意识,以及民主党和共和党之间的政治斗争等问题的理解。

Haematological Changes of Half-Marathon Runners in the Sub-Saharan African Environment

Background: Measurement of haematological parameters has been historically helpful in the diagnosis of many diseases in endurance sportsmen. The modifications of these parameters during endurance race have not yet been evaluated in many African countries. Objectives: To determine haematological values before and immediately after a half-marathon event, as well as within 24 hours after the race and to analyze the changes observed. Methods: A cross-sectional study was conducted from 10 to 21 August 2018 at Brazzaville, Congo. All measurements were confined to 76 male participants (39 specialists vs 37 no specialists of endurance race) in the Brazzaville half-marathon (21.1 km), aged between 19 - 39 years (mean age: 26.7 ± 2.6 years). Coulter profiles with differential white cell counts and haptoglobin levels were determined in venous sample before and after competitive half-marathon race. The same measurements were performed during the 24 hrs following the competition. Results: In the pre-race sample, mild anemia was detected in 12 subjects and mild thrombocytopenia in 7 subjects. Haptoglobin levels were reduced in 5 subjects. Haematological values, all post-race, varied significantly before and after race, particularly for RBC, Hb, Hct, PLT, MCV, MCH, MCHC, WBC, neutrophil counts, lymphocyte counts, monocyte counts, basophil counts, eosinophil counts and haptoglobin. These differences between specialists and no specialists were statistically (p Conclusion: Our data may help sport physicians, sport physiologists and trainers to better follow-up haematological reactions associated with the half-marathon race.

The Atherogenic Dyslipidemia Ratio Log (Tg)/Hdl-C Was Not Associated with Urinary Albumin Excretion Rate (Uaer) and Increased Cardiovascular Risk in Black Patients with Type 2 Diabetes

Objective: The objective is to assess the relationship of Log (TG)/HDL-c as surrogate estimate of atherogenic dyslipidemia with urinary albumin excretion rate and cardiovascular risk among black patients with type 2 diabetes. Patients and methods: A post-hoc analysis of data from 181 type 2 diabetes patients enrolled in a cross-sectional study of urinary albumin excretion rate seen at a tertiary healthcare. Microalbuminuria and macroalbuminuria were defined as ACR 30 - 299.9 mg/g and ACR ≥ 300 mg/g, respectively. Quartiles of Log (TG)/HDL-c were used as surrogate estimates of atherogenic dyslipidemia. Cardiovascular risk was assessed using WHO chart for estimation of CV risk in low and middle income countries. Comparisons across Log (TG)/HDL-c quartiles were performed using one way ANOVA and Chi square for trend as appropriate. P < 0.05 defined the level of statistical significance. Results: A high prevalence (69%) of atherogenic dyslipidemia (AD) was observed in the present case series of Black Africans with type 2 diabetes. Average total cholesterol levels showed significant (p = 0.010) trends towards lower values across quartiles of Log (TG)/ HDL-c. No significant trends were observed for average UAER and cardiovascular risk across quartiles of Log (TG)/HDL-c. Conclusion: Log (TG)/HDL-c as a surrogate estimate of atherogenic failed to predict cardiovascular risk in the present case series of black patients with type 2 diabetes.

Prevalence of Circadian Blood Pressure Patterns and Factors Associated with Non-Dipping among Black Patients with Untreated and Treated Hypertension: A Cross-Sectional Study

Objective: To determine the prevalence of circadian BP patterns and to assess factors associated with the non-dipping pattern in untreated and treated hypertensive patients, studied separately. Methods: Clinical data and ABPM were obtained from 52 untreated and 168 treated hypertensive patients referred for ABPM to Monkole Hospital in Kinshasa. Twenty-four ABPM was performed using an oscillometric device. Non-dipping pattern encompasses non-dipping (nocturnal systolic BP dip less than 10% of daytime systolic BP) and reverse dipping (mean night SBP higher than the day SBP). Results: the prevalence of non-dipping pattern was 75% (63.5% non-dipping and 11.5% reverse dipping) and 70% (60.1% non-dipping and 10.1% reverse dipping) in untreated and treated hypertensive patients, respectively. Advanced age (adjusted OR 1.80;95%CI 1.96 - 3.38;p = 0.015), female sex (adjusted OR 2.28;95%CI 1.19 - 4.36;p = 0.013), diabetes (adjusted OR 5.06;95%CI 1.38 - 6.95;p = 0.014), reduced kidney function (adjusted OR 3.10;95%CI 1.50 - 6.43;p = 0.018), inflammation (adjusted OR 2.65;95%CI 1.76 - 6.48;p = 0.031), LVH (adjusted OR 4.45;95%CI 1.78 - 7.67;p = 0.024) and antihypertensive therapy (adjusted OR 0.19;95%CI 0.12 - 0.64;p = 0.018) emerged as the main independent factors significantly associated with the non-dipping pattern in the study population. Conclusion: the non-dipping pattern was a common finding in studied patients and associated with traditional and emerging risk factors suggesting that this abnormal pattern could be a marker of high cardiovascular risk.

Left Ventricular Structure, Geometry and Systolic Function among Hypertensive Black Patients with Reduced Kidney Function

Objective: To assess the LV mass, geometry and systolic function in hypertensive patients with reduced kidney function. Methods: According to ASE guidelines, we estimated LV ventricular mass, geometry and systolic function in 155 consecutive hypertensive patients [51% women, mean age 51 ± 12 years, median duration of hypertension 7 years] with reduced kidney function (eGFR 2 or dipstick proteinuria ≥ 1+). LVH was defined as LVMI >125 g/m2 in men, >110 g/m2 in non obese women or >51 g/m2.7 for obese men or women. Where appropriate, we used Student t, Mann Whitney, one way ANOVA or Chi square tests. A P value of 0.05 or less was considered significant. Results: Seventy four patients in the series (48%) had reduced kidney function (eGFR 30 ± 15 ml/min/1.73 m2). Compared to patients with relatively normal kidney function, non obese and obese patients with reduced kidney function had significantly greater LVM [271 (198 - 348) vs 276 (175 - 284) g/m2, p = 0.008] for non obese;LVM 72 (47 - 88) vs 54 (44 - 73) g/m2.7, p = 0.007 for obese] and lower EF (60 ± 14 vs 68 ± 13%, p < 0.001) was significantly lower. LVH of mainly concentric geometric pattern was present in 68 patients with reduced kidney function (92%). Conclusion: In the present case series, reduced kidney function was associated with increased LVM, concentric geometric pattern and impaired systolic function.

Interdialytic 24-Hours Ambulatory Blood Pressure versus Dialysis Unit Blood Pressure for the Diagnosis of Electrocardiographic-Left Ventricular Hypertrophy in Chronic Hemodialysis Black Patients

Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than dialysis unit blood pressure. Therefore, the present study was aimed to assess the diagnostic performance of 24-hours ABPM vs. dialysis unit BPs for the diagnosis of ECG-LVH in steady state chronic hemodialysis black patients. Methods: From March 31 to September 30, 2018, interdialytic ABPM was performed after a mid-week hemodialysis session for 24 hours using a Spacelab 90207 ABPM monitor in the non-access arm in 45 stable chronic hemodialysis black patients (age ≥ 20 years, hemodialysis for at least 3 months and informed consent) attending 3 hemodialysis centers in Kinshasa. Ambulatory BP was recorded every 20 minutes during the day (6 AM to 10 PM) and every 30 minutes during the night (10 PM to 6 AM). ECG-LVH was defined using Cornell product criteria. ROC curve method was used to assess the performance of dialysis unit BPs vs. interdialytic 24-hours ABPM in diagnosing ECG-LVH. P 0.05 defined the level of statistical significance. Results: Whatever the method of BP measurement, all the SBP values were related to ECG-LVH with similar AUC and overlapping 95% CI;however, they were not significantly different from each other. 24-hours interdialytic ambulatory SBP (AUC 0.748;95% CI 0.58 - 0.94) had the highest area under the curve. Conclusion: The present study showed that although all the two BP measurement methods equally detected ECG-LVH, 24-hours ABPM tended to have the highest diagnostic performance.

Light treatment for seasonal Winter depression in African-American vs Caucasian outpatients

AIM: To compare adherence, response, and remission with light treatment in African-American and Caucasian patients with Seasonal Affective Disorder.METHODS: Seventy-eight study participants, agerange 18-64(51 African-Americans and 27 Caucasians)recruited from the Greater Baltimore Metropolitan area, with diagnoses of recurrent mood disorder with seasonal pattern, and confirmed by a Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-Ⅳ, were enrolled in an open label study of daily bright light treatment. The trial lasted6 wk with flexible dosing of light starting with 10000 lux bright light for 60 min daily in the morning. At the end of six weeks there were 65 completers. Three patients had Bipolar Ⅱ disorder and the remainder had Major depressive disorder. Outcome measures were remission(score ≤ 8) and response(50% reduction)in symptoms on the Structured Interview Guide for the Hamilton Rating Scale for Depression(SIGH-SAD)as well as symptomatic improvement on SIGH-SAD and Beck Depression Inventory-Ⅱ. Adherence was measured using participant daily log. Participant groups were compared using t-tests, chi square, linear and logistic regressions. RESULTS: The study did not find any significant group difference between African-Americans and their Caucasian counterparts in adherence with light treatment as well as in symptomatic improvement.While symptomatic improvement and rate of treatment response were not different between the two groups,African-Americans, after adjustment for age, gender and adherence, achieved a significantly lower remission rate(African-Americans 46.3%; Caucasians 75%; P =0.02).CONCLUSION: This is the first study of light treatment in African-Americans, continuing our previous work reporting a similar frequency but a lower awareness of SAD and its treatment in African-Americans. Similar rates of adherence, symptomatic improvement and treatment response suggest that light treatment is a feasible, acceptable, and beneficial treatment for SAD in African-American patients. These results should lead to intensifying education initiatives to increase awareness of SAD and its treatment in African-American communities to increased SAD treatment engagement.In African-American vs Caucasian SAD patients a remission gap was identified, as reported before with antidepressant medications for non-seasonal depression, demanding sustained efforts to investigate and then address its causes.