Prevalence and characteristics of metabolic syndrome in gout patients in a hospital setting in sub-Saharan Africa

Background

Evidence from epidemiological studies suggests an important association between gout and the metabolic syndrome (MetS). However, to the best of our knowledge, prevalence of metabolic syndrome in gout has not been reported in sub-Saharan African (SSA) settings.

Operative management of thyroid abnormalities in a general medical practice hospital in sub-Saharan Africa

This is a retrospective analysis of 82 patients undergoing thyroid operations in a general medical practice hospital in sub-Saharan Africa. All patients complained of neck swelling, and in 75% of patients this was the only symptom. Indications for operation included cosmesis in 74%, suspected malignancy in 13%, hyperthyroidism in 7% and pressure symptoms in 5%. Operative complications included recurrent laryngeal nerve injury in two (2.4%), wound haematoma in two (2.4%), wound infection in three (3.6%) and hypoparathyroidism in one (1.2%).There were no deaths and no instances of thyroid storm.Thyromegaly can be operatively managed in a hospital such as ours with a relatively low morbidity rate using conservative gland extirpation techniques.This conservative approach may result in under treatment for thyroid malignancies but should result in a lower incidence of recurrent nerve damage and hypoparathyroidism in the majority of people who undergo thyroidectomy solely for cosmetic indications.     

Spondyloarthropathies in sub-Saharan Africa

HLA-B27 is virtually absent in most of the sub-Saharan Africa populations, and ankylosing spondylitis is rare; only a few patients have been reported from central and southern Africa. HLA-B27 was present in only one of 17 patients (6%). The disease shows clinical features that are similar to those observed in white HLA-B27-negative patients with ankylosing spondylitis; ie, the disease onset is later compared with HLAB27-positive patients, the patients rarely get acute anterior uveitis as one of the extra-articular manifestations, and familial occurrence of ankylosing spondylitis is rarely observed. There is a virtual absence of ankylosing spondylitis even in the west African countries of Gambia and Senegal, where 3% to 6% of the general population has HLA-B27. The epidemic of HIV infection in sub-Saharan Africa in recent years, however, has been associated with a dramatic upsurge in the prevalence of spondyloarthropathies other than ankylosing spondylitis, primarily reactive arthritis and undifferentiated forms of the disease, and less often psoriatic arthritis. HLA-B27, because of its rarity and virtual lack of association with the observed cases of spondyloarthropathy in this population, cannot be used as an aid to diagnosis of spondyloarthropathy in black Africans. Conversely, HIV infection is increasingly showing such a strong association with reactive arthritis, psoriatic arthritis, and undifferentiated spondyloarthropathies in sub-Saharan African populations that any patient with acute or chronic inflammatory arthritis may need to be tested for possible HIV infection. More research is needed on the evaluation of risk and protective factors in sub-Saharan African populations to better delineate the relative importance of genetic and environmental factors in the pathogenesis of spondyloarthropathies.     

Risk factors of symptomatic osteoarthritis of the knee at a hospital in Indonesia

Aim: To determine the risk factors of symptomatic osteoarthritis (OA) of the knee. Methods: Two hundred and thirty‐nine cases of symptomatic OA of the knee (ACR Criteria for OA 1986) with radiographic OA (Kellgren‐Lawrence I or more) taken from a rheumatology outpatient clinic were compared to 279 controls without radiographic (Kellgren‐Lawrence 0) OA taken from general internal medicine outpatient clinic at the same hospital. Independent variables to be assessed were age, sex, ethnic group, body mass index (BMI), education, marital status, parity, smoking, and history of acute trauma, hysterectomy, anatomical abnormality of knee, diabetes mellitus, and uric acid levels. Multiple logistic regression analysis was done to assess the independent risk factors. Results: After going through the steps of multiple logistic regressions analysis, the results were: symptomatic cases compared to controls: age > 50 (OR: 1.86, 95% CI = 1.78–2.82), being female (OR: 2.08, 95% CI = 1.35–3.50), BMI > 25 units (OR: 3.28, 95% CI = 2.20–4.89), elementary education (OR: 0.29, 95% CI = 0.14–0.61) and genu valgus (OR: 4.07, 95% CI = 2.43–7.93). For the female subset of symptomatic cases compared with controls: age > 50 (OR: 9.34, 95% CI = 4.77–18.24), BMI > 25 units (OR: 5.27, 95% CI = 2.85–9.73) and genu valgus (OR: 13.64, 95% CI = 4.58–41.44). Conclusions: Age > 50, being female, BMI > 25 units and genu valgus, may be the risk factors for symptomatic OA of the knee.     

Diabetes care in sub-Saharan Africa

The increasing numbers of people with type 2 diabetes is a worldwide concern. It presents an added challenge in sub-Saharan Africa, where diabetes must compete for resources with communicable diseases. A scarcity of financial resources and appropriate staff mean that many people with type 2 diabetes have complications and that those with type 1 diabetes have an extremely short life-expectancy, whether or not they have been diagnosed with the disorder. We review the current evidence on diabetes care in sub-Saharan Africa and propose an 11-point action plan to address this problem in the region.     

Palliative care in sub-Saharan Africa

Control of pain and symptoms and terminal care are necessary for quality HIV and cancer care in sub-Saharan Africa. However, what constitutes feasible, accessible, and effective palliative care, and how to develop such services, remains to be resolved. Africa-specific palliative care includes components that carry resource implications. Home and community-based care has been largely successful, but community capacity and the resources and clinical supervision necessary to sustain quality care are lacking. Coverage and referrals must be primary concerns. Simple lay and professional protocols have been developed, but opioid availability remains a major constraint. Areas of good practice, and areas where further success may be achieved include: attention to community needs and capacity; explicit frameworks for service development and palliative-care integration throughout the disease course (including antiretroviral provision); further education and protocols; strengthening and dissemination of diverse referral and care systems; increasing advocacy; and funding and technical skills to build audit and quality assessment.     

Self-management in osteoarthritis of hip or knee: a randomized clinical trial in a primary healthcare setting

OBJECTIVE: To assess in a primary healthcare setting the efficacy of a self-management program in middle-aged patients with osteoarthritis (OA). METHODS: This was a 2-group randomized controlled trial, with 273 patients aged 40 to 60 years with OA of the hip(s) and/or knee(s). The experimental intervention was compared with care-as-usual. Treatments and followup measurements were performed in a general healthcare setting by general practitioners. Duration of followup was 21 months after start of the intervention. Instruction in self-management techniques was given by physiotherapists. The main outcome measures were pain severity in hips and knees, other significant complaints, and functional limitations. RESULTS: To begin, 297 patients were randomized: 149 as self-management and 148 controls; before the intervention 24 withdrew for practical reasons (17 self-management, 7 controls). At 3-month followup the intervention group was significantly improved on a visual analog scale (VAS) for knee pain (score 0.67; SD 2.10) and the WOMAC (score 2.46; SD 9.49), while the control group showed stable VAS knee pain (0.01; SD 2.00) and deterioration on WOMAC (-0.53; SD 9.47). At 21-month followup the differences between the groups increased in favor of the intervention group (VAS pain knee: p values from 0.023 at 3 mo to 0.004 at 21 mo; WOMAC: p values from 0.030 to 0.022). CONCLUSION: The self-management program positively influenced knee pain and self-reported functional level in this sample of patients with OA. Differences between the study groups increased during followup in favor of the intervention group.     

A prospective review of acute coronary syndromes in an urban hospital in sub-Saharan Africa

Objectives

To determine the epidemiology of acute coronary syndromes (ACS) in sub-Saharan Africa.

Methods

A prospective survey was carried out of all patients with a diagnosis of ACS who were admitted to the critical care unit of a tertiary teaching hospital over a 25-month period. Demographics, presentation, management and outcomes were subsequently recorded.

Results

A total of 111 (5.1% of all hospitalisations) patients were recruited, with 56% presenting with ST-elevation myocardial infarction (STEMI) and the rest non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA). Chest pain was the most common presenting symptom, and up to one-third of all STEMI patients did not receive any form of reperfusion therapy, primarily due to late presentation. As in the developed world, diabetes, hypertension and cigarette smoking still account for the most common predisposing risk-factor profile, and the mortality associated with ACS is about six to 10% in our unit.

Conclusions

ACS, contrary to common belief, is increasingly more prevalent in sub-Saharan Africa, with similar risk profiles to that in the developed world. Late presentation to hospital is common and accounts for the increased mortality associated with this condition.     

Medical schools in sub-Saharan Africa

Small numbers of graduates from few medical schools, and emigration of graduates to other countries, contribute to low physician presence in sub-Saharan Africa. The Sub-Saharan African Medical School Study examined the challenges, innovations, and emerging trends in medical education in the region. We identified 168 medical schools; of the 146 surveyed, 105 (72%) responded. Findings from the study showed that countries are prioritising medical education scale-up as part of health-system strengthening, and we identified many innovations in premedical preparation, team-based education, and creative use of scarce research support. The study also drew attention to ubiquitous faculty shortages in basic and clinical sciences, weak physical infrastructure, and little use of external accreditation. Patterns recorded include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development. Ten recommendations provide guidance for efforts to strengthen medical education in sub-Saharan Africa.