BACKGROUND:Recommendations on atrial fibrillation (AF) screening by various scientific societies are inconsistent due to uncertainty about its benefit. This study aimed to summarize data from randomized controlled trials (RCTs) on the impact of AF screening on thromboembolism, major bleeding, and mortality. METHODS AND RESULTS:We searched PubMed/MEDLINE and Embase to identify studies providing relevant data through 5 September 2024. Risk ratios (RRs) for each reported outcome of interest were pooled through a meta-analysis with random effects models. We included six RCTs reporting data from 74 145 individuals. AF screening was associated with higher AF detection compared with no intervention [RR 2.54, 95% confidence interval (CI): 1.57-4.11, P < 0.001], and more common initiation of oral anticoagulation (RR 2.19, 1.51-3.18, P < 0.001). Incident ischaemic stroke (RR 0.93, 0.87-1.00, P = 0.048) and thromboembolism including ischaemic stroke, transient ischaemic attack, or systemic embolism (0.93, 95% CI: 0.87-0.99, P = 0.026) were less frequent in individuals who underwent AF screening vs. controls. There was no difference for major bleeding, (RR 0.99, 95% CI: 0.93-1.06, P = 0.830), haemorrhagic stroke (RR 0.94, 95% CI: 0.80-1.11, P = 0.497) and all-cause mortality (RR 0.99, 95% CI: 0.95-1.02, P = 0.411). CONCLUSION:AF screening might be beneficial, especially in reducing thromboembolic events.

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.

Cardiovascular (CV) outcomes can be improved with commonality between provider and patient regarding gender and race/ethnicity. Slow growth in CV care provider diversity is an obstacle for women and underrepresented groups. The hope for more equitable outcomes is unlikely to be realized unless trends change in selection of CV fellows and program directors (PDs). We investigate longitudinal trends of gender and racial/ethnic composition of CV FITs. De-identified demographic data were compiled in a descriptive cross-sectional study from AAMC of internal medicine (IM) residents and CV FITs from 2011 through 2021 to evaluate gender and race/ethnicity trends among CV trainees. Trends of CV fellows who later became program directors were analyzed. In the US between 2011 and 2021, 53% of IM residents were male while 40% female (7% unreported). Among CV FITs, 78% were male and 21% female. Races/ethnicities among CV FITs consisted of 36% non-Hispanic white, 28% non-Hispanic Asian, 5% Hispanic, 4%Black, and 25% were classified within other race/ethnicity categories. The proportion who became CV program directors followed similarly: 79% of PDs were male and 21% female. Demographic profiles for CV FITs have not significantly changed over the past decade despite increased diversity among IM residents. Efforts to improve diversity of CV FITs and PDs need to be analyzed. Slow growth of diversity in CV FITs is outpaced by rising patient diversity, leading to disparities in care and poorer CV outcomes for women and underrepresented minorities. Recruiting, training, and retaining diverse CV FITs is necessary.

The between-subject variability in diabetes risk persists in epidemiological studies, even after accounting for obesity. We investigated whether the humero-femoral index (HFI) was associated with prevalence of type 2 diabetes mellitus (T2DM) and assessed the incremental value of HFI as a marker of T2DM. This population-based cross-sectional study used data from the National Health and Nutrition Examination Survey from 1999 to 2018. We assessed 42,088 adults aged ≥ 30 years. HFI was defined as the upper arm length/upper leg length ratio. The outcome included undiagnosed diabetes (based on 2-hour plasma glucose levels, fasting glucose and hemoglobin A1C) and history of diabetes (diagnosed diabetes or taking antidiabetic drugs). As compared with the bottom quartile, the prevalence ratio of T2DM was 1.28 (95

Cytokeratin (CK) 7 is normally expressed in the vast majority of lung adenocarcinoma (ADC). However, on rare occasions, as reported in this paper, CK7 negativity can challenge the diagnosis of pulmonary ADC. Hence, the need to use a combination of 'immunomarkers' such as thyroid transcription factor 1, Napsin A, p40, p63 and CK20.

As the world progressively recovers from the acute stages of the coronavirus disease 2019 (COVID-19) pandemic, we may be facing new challenges regarding the long-term consequences of COVID-19. Accumulating evidence suggests that pulmonary vascular thickening may be specifically associated with COVID-19, implying a potential tropism of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus for the pulmonary vasculature. Genetic alterations that may influence the severity of COVID-19 are similar to genetic drivers of pulmonary arterial hypertension. The pathobiology of the COVID-19-induced pulmonary vasculopathy shares many features (such as medial hypertrophy and smooth muscle cell proliferation) with that of pulmonary arterial hypertension. In addition, the presence of microthrombi in the lung vessels of individuals with COVID-19 during the acute phase, may predispose these subjects to the development of chronic thromboembolic pulmonary hypertension. These similarities raise the intriguing question of whether pulmonary hypertension (PH) may be a long-term sequela of SARS-COV-2 infection. Accumulating evidence indeed support the notion that SARS-COV-2 infection is indeed a risk factor for persistent pulmonary vascular defects and subsequent PH development, and this could become a major public health issue in the future given the large number of individuals infected by SARS-COV-2 worldwide. Long-term studies assessing the risk of developing chronic pulmonary vascular lesions following COVID-19 infection is of great interest for both basic and clinical research and may inform on the best long-term management of survivors.

BACKGROUND Vasoplegia is a common complication of cardiac surgery but its causal relationship with preoperative use of renin angiotensin system (RAS) blockers [angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB)] is still debated. AIM To update and summarize data on the effect of preoperative use of RAS blockers on incident vasoplegia. METHODS All published studies from MEDLINE, EMBASE, and Web of Science providing relevant data through January 13, 2021 were identified. A random-effects meta-analysis method was used to pool estimates, and post-cardiac surgery shock was differentiated from vasoplegia. RESULTS Ten studies reporting on a pooled population of 15672 patients (none looking at ARBs exclusively) were included in the meta-analysis. All were case-control studies. Use of ACEIs was associated with an increased risk of vasoplegia [pooled adjusted odds ratio (Aor) of 2.06, 95%CI: 1.45-2.93] and increased inotropic/vasopressor support requirement (pooled aOR 1.19, 95%CI: 1.10-1.29). Post-cardiac surgery shock was increased in the presence of left ventricular dysfunction (pooled aOR 2.32, 95%CI: 1.60-3.36; I2 49%) but not increased by the use of beta blockers (pooled aOR 0.78, 95%CI: 0.36-1.69; I2 77%). Two randomized control trials (RCTs), not eligible for the meta-analysis, did not show an association between continuation of RAS blockers and vasoplegia. CONCLUSION Preoperative continuation of ACEIs is associated with an increased need for inotropic support postoperatively and with an increased risk of vasoplegia in observational studies but not in RCTs. The absence of a consensus definition of vasoplegia should lead to the use of perioperative cardiovascular monitoring when designing RCTs to better understand this discrepancy.

Aortic insufficiency (AI) is a common complication that increases morbidity and mortality in patients with left ventricular assist devices (LVAD). Significant AI during LVAD support creates a substantial regurgitant flow loop, negatively affecting cardiac recovery and exposing blood to longer residence time and higher shear stress. The mechanism of AI development and progression is linked to a lack of aortic valve opening, which alters the valvular tissue mechanics. Pre-existing AI also worsens following LVAD implantation, interfering with the pump benefits. This chapter will evaluate AI development with LVAD support compared with naturally occurring AI and present the features, mechanisms, and links to clinical treatment options.

The prevalence of type 2 diabetes (T2D) has almost doubled since 1980 with tar-geted glycated hemoglobin (A1C) < 7% being recommended to prevent complica-tions (1). A recent study reported that 41% of a cohort of 35,304 patients with T2D from the U.S. and Sweden had sub-optimal glycemic control (2). Therapeutic inertia, de fi ned as “ the failure to advance or deintensify treatment ” when appropri-ate to do so (3), is a key driver of uncon-trolled hyperglycemia. The current evidence-based clinical guidelines (1) rec-ommend early initiation of insulin in cases of very high glycemia (VHG) (i.e., A1C > 10% or blood glucose levels $ 300 mg/ dL [16.7 mmol/L]). Although therapeutic inertia can occur at any time during the disease process, it is more likely at insulin initiation due to fear of hypoglycemia or weight gain (3). Epidemiological data on therapeutic inertia to insulin initiation are limited, and factors associated with noninitiation of insulin treatment despite VHG (NIIT) remain unexplored at the popula-tion level. identify factors associated with and NIIT and to the

Introduction: Chronic use of ACE-i has been presented as a risk factor of post operative vasoplegia after cardiac surgery. However, a recent meta analysis of studies in the general cardiac surgery population identified renal failure as the only pre-operative risk factor for vasoplegia. We sought to systematically review the relationship of chronic ACE-i and vasoplegia in patients undergoing CABG /valve surgery. Hypothesis: Studies on vasoplegia after CABG / valve surgery were extracted by a research librarian (registered review CRD42017072923) before bias and quality of studies were assessed. We adjudicated vasoplegia as MAP < 60 mmHg and use of at least one non dopaminergic vasoactive drug up to 4 hours post operatively. Otherwise, studies reported vasoplegia as MAP < 60 mmHg, CI > 2.5 l/min/m2 and SVR < 600 dynes/sec/cm2 in the CSICU. We pooled the incidence of vasoplegia then completed a meta-analysis with random effect model using RevMan and Stata. Methods: Of the 2337 articles obtained (1940 non relevant, 22 reviews, 5 duplicates and 5 editorials), we pre-selected 365 abstracts and summarized data from 8,818 patients out of 7 articles selected after full text review. Results: All but one study looked at patients with LVEF > 40%. The pooled incidence of vasoplegia was 11.2% (95% CI 4.7-28.2). The OR of vasoplegia in patients on chronic ACE-i was 1.74 (95% CI: 1.47-2.06). We could not investigate the importance of pre-existing renal failure on the risk of post operative vasoplegia in patients on ACE-i. Accounting for substantial heterogeneity, the Egger test was in favour of small-study effects due to the number of cases of vasoplegia and the size of the cohorts studied (p=0.073). Conclusions: The risk of vasoplegia seems to be higher in patients on ACE-i undergoing CABG/valve surgery in this population. Two RCT's (161 patients) did not prove the benefit of temporary discontinuation of RAS blockade on the incidence of distributive shock during the first days after surgery. Because ACE-i are frequently prescribed in patients awaiting CABG, our work calls for larger and more elaborated studies to reduce the risk of vasoplegia.

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.

IMPORTANCEHuman immunodeficiency virus (HIV) infection remains a major cause of morbidity and mortality worldwide. Many studies have found a higher prevalence of hearing impairment among HIV-positive individuals.OBJECTIVETo investigate the effect of HIV and highly active antiretroviral treatment (HAART) on the hearing function in a Cameroonian population.DESIGN, SETTING, AND PARTICIPANTSWe conducted a prospective case-control study from March 1, 2012, through January 31, 2013. The study took place at the National Social Insurance Fund Hospital in Yaoundé, Cameroon, a public health facility. We included 90 HIV-positive case patients and 90 HIV-negative control patients aged 15 to 49 years without any history of hearing loss or treatment with a known ototoxic drug. The case group was further divided into 3 subgroups: 30 HAART-naive patients, 30 patients receiving first-line HAART, and 30 patients receiving second-line HAART.INTERVENTIONSHearing function was assessed by pure-tone audiometry and classified according to the criteria of the Bureau International d'Audio-Phonologie.MAIN OUTCOMES AND MEASURESHearing loss due to HIV and HAART.RESULTSThe HIV-positive patients had more otologic symptoms (hearing loss, dizziness, tinnitus, and otalgia) than HIV-negative patients (41 vs 13, P = .04). There were 49 cases (27.2%) of hearing loss in the HIV-positive group vs 10 (5.6%) in the HIV-negative group (P = .04). Compared with HIV-negative individuals, the odds of hearing loss were higher among HIV-infected HAART-naive patients (right ear: odds ratio [OR], 6.7; 95% CI, 4.3-9.7; P = .004; left ear: OR, 6.2; 95% CI, 3.5-8.3; P = .006), patients receiving first-line HAART (right ear: OR, 5.6; 95% CI, 1.9-10.5; P = .01; left ear: OR, 12.5; 95% CI, 8.5-15.4; P < .001), and patients receiving second-line HAART (right ear: OR, 6.7; 95% CI, 3.3-9.6; P = .004; left ear: OR, 3.7; 95% CI, 3.0-5.0; P = .08).CONCLUSIONS AND RELEVANCEHearing loss is more frequent in HIV-infected patients compared with uninfected patients. Therefore, HIV-infected patients need special audiologic care. Further studies are needed because controversy remains regarding the factors that lead to ear damage.

We measured the glycated haemoglobin (HbA(1c)) levels of a total of 24 non-diabetic volunteers and diabetic patients using a point-of-care (POC) analyser in three Cameroonian cities at different altitudes. Although 12 to 25% of duplicates had more than 0.5% (8 mmol/mol) difference across the sites, HbA(1c) values correlated significantly (r = 0.89-0.96). Further calibration studies against gold-standard measures are warranted.

L'obésité accroit le risque d'infertilité car l'hyperinsulinisme associé cause une hyperandrogenémie interférant avec la folliculogénèse et la secrétion des gonadotrophines centrales. Le syndrome des ovaires polykystiques (SOPK), plus souvent retrouvé chez des patientes d'IMC de 25 kg/m2, constitue la principale cause d'infertilité. L'effet bénéfique de la perte de pondérale sur le pronostic des patientes obèses souffrant d'infertilité serait secondaire à l'augmentation de l'insulinosensibilité. Nous présentons ici les résultats préliminaires de l'étude d'une cohorte de patientes camerounaises en surpoids ou obèses souffrant d'infertilité. Nous avons recruté, à l'Hopital Gynéco-Obstétrique et Pédiatrique de Yaoundé, 36 patientes suivies pour infertilité et récolter leurs paramétres anthropométriques et anamnestiques. Le test de tolérance à l'insuline a servi à mesurer l'insulinosensibilité et les critères de Rotterdam à diagnostiquer un SOPK. L'âge des patientes variait de 22–43 ans avec un IMC de 27,3 ± 4,7 kg/m2, la moitié des patientes souffrait d'aménorrhée primaire et le tiers avait une sensibilité normale à l'insuline. Les 15 patientes atteintes d'un SOPK étaient plus agées (35,0 ± 4,2 vs 28,8 ± 5,5, p < 0,001) et souffraient plus souvent de spanioménorrhées (p < 0,002) que celles ne remplissant pas les critères diagnostiques. Ni la sensibilité à l'insuline, ni le profil lipidique n'étaient significativement différents entre les groupes SOPK et non SOPK. La glycémie à jeun (r = 0,86) et le cholestérol total (r = – 0,63) sont apparus comme facteurs prédictifs de sensibilité à l'insuline chez les femmes atteintes de SOPK. Ces résultats illustrent la complexité de la relation entre insulinosensibilité et infertilité, cette dernière n'étant pas obligatoirement liée à un trouble insulinique. Le suivi des patientes sera entrepris pour déterminer la valeur pronostique de l'insulinosensibilité sur la survenue de grossesses menées à terme.

The advent of highly active antiretroviral therapy (HAART) has decreased the morbidity and mortality of HIV but has been associated, in some studies, with an increased metabolic burden and vascular injuries in Caucasians, Asians and people of African origin. However, there is now controversy surrounding the cardiometabolic consequences of HAART as it has been proven that HIV infection alone causes increased visceral fat accumulation, diabetes, insulin resistance and HIV-induced vasculopathy. In some case reports, early timing of HAART altered the evolution of the latter, which includes cerebrovascular injuries, peripheral vascular disease, aortic lesions, vasculitis and hypertension. We aimed here to evaluate the metabolic and vascular correlates of different durations of HAART in HIV-infected Cameroonian patients attending a certified HIV clinic in this self-resource limited area. This is a single center cohort study carried out at the Yaoundé Central Hospital. We recruited 143 unselected, consecutive HIV-infected patients. Anthropometry, free fat mass (FFM, measured by bioimpedancemetry), lipid profile, fasting blood glucose (FBG), insulin sensitivity (measured using the short insulin tolerance test) and lipids levels were measured. Patients were 72% women distributed in 4 intervals of HAART duration: treatment-naïve (n=28), 1-13 months (n=44), 14-33 months (n=35) and 34-86 months (n=36). Their mean age was 39.5 (SD: 9.8 yrs) and 52% were on a stavudin-containing regimen. Systolic (p=0.04) and diastolic (p=0.03) blood pressures, and prevalence of hypertension (p=0.04) were significantly increased with HAART duration. While hypercholesterolemia (p=0.007), body mass index and waist to hip ratio (both p = 0.02) were also increased with HAART duration, FFM, triglycerides, FBG and insulin sensitivity were unaffected. In a small sized analysis, insulin-resistant patients (lower tertile of KITT) had lower BMI (p=0.009), FFM (p<0.01) and waist circumference than insulin-sensitive patients. Higher blood pressure levels are associated with HAART duration together with hypercholesterolemia, obesity and fat distribution. However, our study did not find a significant relationship between HAART-induced hypertension, FFM and glucose metabolism.

Aims. - This study assessed the relationship between highly active antiretroviral therapy (HAART) duration and cardiometabolic disorders in HIV-infected Cameroonians.Methods. - HIV-infected Cameroonians aged 21 years or above were cross-sectionally recruited at the Yaounde Central Hospital, a certified HIV care centre, and their anthropometry, body composition (impedancemetry), fasting blood glucose (FBG) and lipid levels, and insulin sensitivity (IS; short insulin tolerance test) were measured.Results. - A total of 143 participants with various durations of HAART [treatment-naive (n=28), 1-13 months (n=44), 14-33 months (n=35) and 34-86 months (n=36)] were recruited. They were mostly women (72%), and had a mean age of 39.5 (SD: 9.8) years. Half (52%) were using a stavudine-containing regimen. There was a significant trend towards a positive change in body mass index and waist-to-hip ratio with increasing duration of HAART (all P = 0.02). Systolic (P = 0.04) and diastolic (P = 0.03) blood pressure, total cholesterol (P = 0.01), prevalence of hypertension (P = 0.04) and hypercholesterolaemia (P = 0.007) were also significantly increased with HAART duration, whereas triglycerides, FBG and IS were unaffected. Clustering of metabolic disorders increased (P = 0.02 for >= 1 component of the metabolic syndrome and P = 0.09 for >= 2 components) with HAART duration.Conclusion. - HAART duration is associated with obesity, fat distribution, blood pressure and cholesterol levels in HIV-infected Cameroonians, but does not appear to significantly affect glucose metabolism. (C) 2012 Published by Elsevier Masson SAS.

In Figure 3A, no-MetS month 36 should show n=2. In Figure 3B, All patients month 24 should show n=16, and All patients month 36 should show n=16. Please see the corrected Figure 3 here: http://plosone.org/corrections/pone.0060117.g003.cn.tif