More intensive glucose control achieved with a regimen that included greater use of gliclazide, insulin, metformin and other agents, did not affect the risk of cancer events or death in patients with type 2 diabetes.

Background Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. Methods We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. Results Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42–4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44–2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08–3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20–3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17–2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79–14.13). Conclusions Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.

Purpose of The Study:The aim of this study was to describe sexual function disorders and investigate associated factors in women on maintenance hemodialysis in Cameroon. Methods:This was a cross-sectional study of three months duration (August-October 2014) in adult women on maintenance hemodialysis (HD) at three HD facilities in Cameroon. Patients with active psychiatric disease, infection or uncontrolled congestive heart failure were excluded. We use the Rosen questionnaire for evaluating female sexual function (FSFI), the Beck depression Inventory (BDI) and the short form (SF-36) of WHOQOL-BREF questionnaire to evaluate the quality of life (QOL). Logistic regressions were used to investigate the predictors of sexual function disorders. Results:We included 52 women with the mean age of 38±13 years (min-max: 18-69), with 31 (62%) being of child-bearing age (18-44 years). All participants had at least one sexual function abnormality including sexual dysfunction (75%), abnormalities of the menstrual cycle (83%), and sexual inactivity (30%). In women of child-bearing age, reported menstrual disorders were: irregular menses (45%), non-gravid amenorrhea (40%), oligo-menorrhea (25%), poly-menorrhea (25%), metrorrhagia (6%), and menorrhagia (3%). Ten of the 31 women had more than one menstrual disorder. Sexual dysfunction included: decreased sexual desire (56%), decreased sexual arousal (39%), decreased vaginal lubrication (49%), and failure to achieve orgasm (46%), sexual dissatisfaction (51%), and dyspareunia (36%). Advanced age (p = 0.0046), depression (p<0.0001), anemia (p=0.0005) and poor quality of life were negatively associated with sexual dysfunction. Sexual inactivity (p = 0.035) was equally associated with poor quality of life. Conclusion:Our results suggest that disorders of sexual function are common in women on maintenance hemodialysis, and are associated with depression, poor quality of life, advanced age, and anemia.

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Objective: The aim was to determine the prevalence, distribution, concordance and associations of chronic kidney disease (CKD) assessed by five glomerular filtration rate (GFR) formulae in urban black residents of Cape Town. Design and method: In this population-based cross-sectional study, stratified for age and gender, data collection included administered questionnaires, clinical measurements and biochemical analyses, including serum creatinine and cystatin C levels. GFR was based on the CKD Epidemiology Collaboration (CKD-EPI) equations (CKD-EPI creatinine (CKD-EPIcr), CKD-EPI cystatin C (CKD-EPIcys), CKD-EPI creatinine-cystatins (CKD-EPIcr-cys)), Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault formula (CGF). GFR <60 mL/min/1.73 m2 defined CKD. Results: Mean estimated GFR, among 392 men and 700 women, was between 114.0 (CKD-EPIcr) and 135.4 mL/min/1.73 m2 (CGF) in men, and between 107.5 (CKD-EPIcr-cys) and 173.4 mL/min/1.73 m2 (CGF) in women. CKD prevalence ranged from 2.3% (CKD-EPIcr and MDRD) to 5.1% (CKD-EPIcys) in men and 1.6% (CGF) to 6.7% (CKD-EPIcr-cys) in women. Correlations between different estimates of GFR were positive and significant, and there were no significant differences between any two coefficients. The kappa statistic was high between CKD-EPIcr and MDRD (0.934), and CKD-EPIcys and CKD-EPIcr-cys (0.815), but fair-to-moderate between the other equations (0.353–0.565). In the basic regressions, older age and body mass index >30 kg/m2, but not gender, were significantly associated with CKD-EPIcr-defined CKD. In the presence of these three variables, but in separate models, hypertension, heart rate >90 beats/minute, diabetes and increasing low-density lipoprotein cholesterol were significant predictors of prevalent CKD by CKD-EPIcr and MDRD (except for diabetes). Metabolic syndrome, in the model with age and gender only, was significantly associated with CKD-EPIcr- and MDRD-defined CKD. No cardio-metabolic variable was associated with CKD determined by CKD-EPIcys, CKD-EPIcr-cys or CGF. Conclusions: The varying CKD prevalence estimates, on account of different GFR equations used, underscores the need to improve accuracy of CKD diagnoses. Moreover, considering the significant associations of cardio-metabolic diseases with CKD-EPIcr- and MDRD-defined CKD, screening for CKD should be incorporated into the routine assessment of high-risk patients such as those with hypertension or diabetes.

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