The baseline glomerular filtration rate, predictive of six-year survival in sub-Saharan African patients on antiretroviral therapy for HIV: Cohort study.

BACKGROUND: Recently, serious morbidity events associated with initial glomerular filtration rate (GFR) have been described during HIV infection, but this is insufficiently investigated in sub-Saharan Africa very affected by HIV. OBJECTIVE: To assess the impact of baseline GFR prevailing during the first semester of the HIV infection management on six-year survival in peoples taking antiretroviral therapy. PATIENTS AND METHODS: Closed retrospective cohort study. The death was the expected outcome, the baseline GFR (mL/min/1.73m2) in the first semester of the follow-up was the main exposure. Kaplan-Meier method, Cox regression were used for analysis. RESULTS: According to baseline GFR: <60, 60-89 and≥90, the six-year survival was 81.6%; 95.8% and 96.4% (P=0.067 Breslow). Adjusted hazard ratio for baseline GFR<60 and 60-89 (vs. ≥90) were respectively 5.4 (95%CI: 1.4-19.9; P=0.012) and 1.2 (95%CI: 0.3-4.0; P=0.754). The etiological fraction of deaths attributable to baseline GFR: GFR<60: 81% (95%CI: 0.31-0.95), GFR=60-89: 18.0% (95%CI: -0.7-0.8). Prognostic concordance index=0.84 (95%CI: 0.59-0.95) for GFR<60 and 0.55 (95%CI: 0.27-0.81) for GFR 60-89. DISCUSSION: The etiological fraction of death and prognostic concordance index associated to baseline GFR level increase significantly with decline of baseline GFR. CONCLUSION: Baseline GFR seems to predict the six-year survival in African sub-Saharan patients treated for HIV.

Intravenous infusion of glucose 5% despite sodium mixed, is main contributor of acquired hyponatremia in adult polyvalent medicine service: Case control study.

BACKGROUND: Acquired hyponatremia is a life threatening event. Intravenous infusion of a mixture of 5% glucose and sodium solute is mainly used, but its contribution in the occurrence of acquired hyponatremia in adult, is under-investigated outside intensive care unit. OBJECTIVE: To evaluate the place of intravenous infusion of a mixture of 5% glucose and sodium in predicting acquired hyponatremia in adult polyvalent medicine service. PATIENTS AND METHODS: A case-control study have been conducted. The main exposure was intravenous infusion of a mixture of 5% glucose and sodium solute (4 grams NaCl/liter of 5% glucose). OUTCOME: Acquired hyponatremia during hospitalization. By logistic regression, the global multifactorial model predicting acquired hyponatremia, and its sub-models were established; as well as following parameters: area under the Receiving Operator Characteristic curve (AUC), maximal Youden's index with its couple of coordinates (sensibility-specificity), Nagelkerke's R-squared adjusted. RESULTS: Adjusted odds ratio (cases/controls; main exposure; outcome) ORa=2.73 (95% CI 1.40-5.32; P=0.003). Prediction of acquired hyponatremia: global multifactorial model: AUC=0.78 (95% CI 0.72-0.85; P<0.0001), Youden's index=0.34 (95% CI 0.24-0.41); sub-model (global multifactorial model without main exposure): AUC=0.72 (95% CI 0.66-0.78; P<0.0001), Youden's index=0.18 (95% CI 0.07-0.22). CONCLUSION: Intravenous infusion of a mixture of 5% glucose and sodium mainly used, highly contribute to predict acquired hyponatremia in adult polyvalent medicine service, and should be the first cause to consider for managing this acquired hyponatremia.

[Mixed connective tissue disease: prevalence and clinical characteristics in African black, study of 7 cases in Gabon and review of the literature]. / La connectivite mixte: prévalence et caractéristiques cliniques chez le noir africain, étude de 7 cas au Gabon et revue de la littérature.

The literature reports that mixed connective tissue disease seems more frequent in the black population and among Asians. This study aims to determine the prevalence of mixed connective tissue disease (MCTD) among connective tissue disorders and all rheumatologic pathologies in a hospital population in Gabon as well as to describe the clinical features of this disease. We conducted a retrospective study by reviewing the medical records of patients treated for mixed connective tissue disease (Kasukawa criteria) and other entities of connective tissue disorders (ACR criteria) in the Division of Rheumatology at the University Hospital in Libreville between January 2010 and December 2015. For each case of MCTD the parameters studied were articular and extra-articular manifestations, anti-U1RNP antibodies levels, patient's evolution. Over a period of 6 years, data were collected by medical records of 7 patients out of 6050 patients and 67 cases of connective tissue disorders, reflecting a prevalence of 0.11% and 10.44% respectively. the 7 patients were women (100%), with an average age of 39.5 years. Articular manifestations included: polyarthritis, myalgias, chubby fingers and Raynaud's phenomenon in 87.5%, 87.5%, 28.6% and 14% respectively. The 7 patients had high anti-U1RNP antibodies levels, ranging between 5 and 35N (N≤ 7 IU). A case of death due to pulmonary arterial hypertension (PAH) was certified. This is the largest case series of MCTD reported in Black Africa. The disease seems to be rare among the black Africans; the reason could be genetic. The demographic and clinical aspects appear similar to those in Caucasians, Asians and Blacks except for a low frequency of Raynaud?s phenomenon among Blacks.

[Still disease in subSaharan Africa: report of four cases in Gabon]. / Maladie de Still en Afrique subsaharienne : à propos de quatre observations gabonaises.

Still disease is an inflammatory rheumatism occurring predominantly in children and adolescents, but which is sometimes diagnosed in adults. A combination of fever, arthralgia, transient dermatological lesions, hyperleucocytosis predominantly neutrophilic, and ferritinaemia greater than 1,000 µg/L is suggestive of this disease, but infectious, haematological, immunological, and tumor diseases must first be ruled out. Accordingly, patients' financial limitations keep this disease from being diagnosed often in sub-Saharan Africa. We report four cases of Still disease with favourable outcome after corticosteroid therapy.