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Normal Range of Neutrophile to Lymphocyte Ratio in Healthy, Chronic Kidney Disease Stage 4 - 5 and Hemodialysis Participant in a Sub-Saharan African Context

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Open Journal of Nephrology 2024年第1期14卷 104-114页

作者： Fouda Menye Epse Ebana Hermine Danielle Elimby Lionel Thierry Sevele Deussi De Ngaha Bogne Takam Yvan halle marie-patrice Eveline Ngouadjeu Dongho Department of Medicine and Specialties General Hospital of Douala Douala Cameroon Department of Internal Medicine and specialties Faculty of Medicine and Biomedical Sciences of Yaounde Yaounde Cameroon Department of Internal Medicine and specialties Faculty of Medicine and Pharmaceutic Sciences of Douala Douala Cameroon

Background: Neutrophile to lymphocyte ratio (NLR) is a well-established marker of inflammation. It has been reported to be high in chronic kidney disease (CKD) and it is described as a prognosis factor in hemodialysis patients. However, limited data are available about the normal range of NLR in healthy adults as well as CKD patients including hemodialysis black Africans in Sub-Saharan countries. We sought to study NLR in healthy and advanced CKD in a single Cameroonian health facility. Methods: Blood samples were obtained from blood donors, CKD stage 4 and non-dialysis stage 5, and hemodialysis patients for more than 6 months. Patients with confounding factors such as positive CRP, infection, and recent use of steroids were excluded. RNL means standard deviations (SDs), and 95% confidence intervals (95% CI) were determined. RNL range was defined as percentiles P2.5 to P97.5. Results: A total of 102 participants were included. Mean age was 40.45 ± 9.97 years and 58.8% were male. Age and sex distribution were similar in the three groups. Leucopenia and neutropenia were common in all the groups. Means NLR was 1.29 ± 0.57 (95% CI 1.08 - 1.49) range between 0.55 to 2.67;2.31 ± 1.3 (95% CI 1.75 - 2.88) with range between 0.69 to 4.31 and 2.14 ± 0.98 (95% CI 1.85 - 2.44) with range between 0.77 to 4.32 respectively in controls, CKD, and hemodialysis participants. NLR was comparable in CKD and hemodialysis patients (p = 0.99). Compared to controls, NLR was significantly elevated in CKD (p = 0.043) and hemodialysis patients (p Conclusion: Our data suggest that the normal range for NLR in adult nongeriatric healthy and advanced CKD patients including those on chronic hemodialysis may vary between 0.55 to 2.67 and 0.69 to 4.32 respectively.

关键词： NLR CKD Hemodialysis Cameroon

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Early Mortality (120 Days) amongst Incident Hemodialysis with End Stage Kidney Disease: A 5-Year Retrospective Study

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Open Journal of Nephrology 2022年第3期12卷 332-346页

作者： Denis Georges Teuwafeu Dianna Fontania Mafouk Fopa halle marie patrice Ronald Gobina Hermine Fouda Kaze Folefack Francois Faculty of Health Sciences University of Buea Buea Cameroon

Background: End stage kidney failure (ESKF) is a major public health problem worldwide. Haemodialysis is the principal method in its management, and is associated with high mortality mostly owing to cardiovascular disease (CVD). In Cameroon, data on its predictors is lacking. Objectives: This study aimed at determining the 120 day mortality, causes of death and its predictors and amongst incident haemodialysis patients with end stage kidney disease in Cameroon. Methods: We retrospectively reviewed medical records of patients admitted for ESKF who started haemodialysis between January 2016 and December 2020 (5 years) and who died within 120 days. For these patients, the variables collected were: age, gender, comorbidities, dialysis parameters, para-clinical parameters, cause of death. The causes of death were registered as stated by the attending physician. Data were analysed using SPSS 20. A p-value Results: Out of 1012 incident patients, 258 died giving a mortality rate of 25.5%. Of these, 59.7% were males. The mean age (SD) was 46.52 (15.6) years. The main causes of death included sepsis (45.61%), CVD (12.86%), and severe anaemia (9.94%);and were comparable between males and females except for anaemia which was more prevalent in females (p = 0.003). Catheters related infections (77.9%), and chest infections (9.0%) were the main sources of sepsis while sudden death (76.2%), myocardial infarction (9.5%), and heart failure (9.5%) were the main cardiovascular causes of death. Hypertension (65%), CVD (35.6%), and diabetes (9.19%) were the main comorbidities associated to death. The main vascular access was central venous catheter 96%. CVD (p = 0016, aOR;4.107), Albumin ≤ 3.5 g/dl (p = 0.015, aOR;23.083), and Creatinine > 20 mg/dl (p = 0.024, aOR;5.649) were independent predictors of mortality. Conclusion: One in four patients on haemodialysis died early. CVD, hypoalbuminemia and late initiation were predictors of mortality. Majority of patients die from preventable cau

关键词： Early Mortality Predictors Causes of Death Haemodialysis Cameroon

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Monitoring Frequency of Haemoglobin, Calcium and Phosphorus and the Impact on Correction in Patients on Maintenance Haemodialysis in Douala-Cameroon

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Open Journal of Nephrology 2022年第3期12卷 311-322页

作者： halle marie patrice Kenfack Tatienou Orest Landry Tatang Mambap Alex Same Bebey Francine Fouda Hermine Ashuntantang Enow Gloria Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Internal Medicine Douala General Hospital Douala Cameroon Faculty of Health Sciences University of Bamenda Bamenda Cameroon Bamenda Regional Hospital Bamenda Cameroon Douala Laquintinie Hospital Douala Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Department of Internal Medicine Yaounde General Hospital Yaounde Cameroon

Background: There is scarcity of data on the actual frequency of routine blood work-up for patients on maintenance haemodialysis and how this affects the achievement of therapeutic goals in sub-Saharan Africa. This study aimed to review these in a referral hospital in Cameroon. Methods: A prospective hospital-based cohort study carried out from November 2019 to April 2020 including patients on maintenance haemodialysis in Douala general hospital. Patients were followed during 6 months to determine the frequency of monitoring of haemoglobin, serum calcium and phosphorus. Targeted values for haemoglobin were ≥10 g/dL, 80 - 100 mg/L for serum calcium and 25 - 45 mg/L for serum phosphorus. Pearson correlation test was used to define the correlation between monitoring frequencies and blood values at the end of the study. Results: For all 154 patients included in the study, the median frequency of monitoring for haemoglobin was once every 8 week (IQR: 6 - 12) and once every 12 weeks (IQR: 8 - 24) for serum calcium and phosphorus. The proportion of patients who achieved haemoglobin, serum calcium and phosphorus targets at the end of the study were 27.4%, 63% and 74% respectively. No correlation was found between the frequency of monitoring and the haemoglobin, serum phosphorus and calcium levels at the end of the study. Conclusion: The frequency of monitoring of serum haemoglobin, calcium and phosphorus by patients in this study was low with a high prevalence of patients not achieving target value.

关键词： Monitoring Haemoglobin Phosphorus Calcium Haemodialysis Douala

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Evaluation of Bleeding Risk by Hemostatic Parameters in Hemodialysis at the Douala General Hospital: Comparison between Patients on Hemodialysis before 3 Months and after 12 Months

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Open Journal of Nephrology 2023年第1期13卷 31-38页

作者： Fouda Menye Epouse Ebana Hermine Danielle Elimby Lionel Dongmo Tsague Elvire Ali Nasser Ngo Bitoungui Valentina Josiane halle marie patrice Ngouadjeu Dongho Eveline General Hospital of Douala Douala Cameroon Faculty of Medicine and Biomedical Sciences of Yaounde Yaounde Cameroon Faculty of Medicine and Pharmaceutical Sciences of Dschang Dschang Cameroon Faculty of Medicine and Pharmaceutical Sciences of Douala Douala Cameroon

Background: Bleeding disorders are common and may be a life-threating complication among patients with End Stage Kidney Disease (ESKD), especially for those in hemodialysis (HD). Bleeding risk can be evaluated by hemostatic parameter such as platelet count, prothrombine time (PT) or activated prothromplastin time (aPTT) and may be influenced by duration in HD. Objective: Evaluate bleeding risk in HD patients by analyzing some hemostatic parameters according to duration in dialysis. Patients and methods: We conducted a cross sectional study of 3 months (March to May 2022) in the HD center of the Douala General Hospital. All consenting adult patients with ESKD admitted in HD for less than 3 months or more than 12 months were included. Bleeding risk was evaluated by platelet count, PT, aPTT and fibrinogen. Chi-square test and logistic regression were used to compare data and evaluate association with hemostatic disorder. Results: A total of 80 (60% male) patients were included;30 patients were on HD for less than 3 months and 50 for more than 12 months. Median age was 45 [30 - 60] years in the first group and 43 [30 - 55] years in the second group. Increased bleeding risk was noted in 50% (n = 40) of patients and was similar in both groups. Thrombocytopenia was more common in patients on HD ≥ 12 months (20% (n = 6) vs 44% (n = 22), p = 0.02). Prolong aPTT was more common in HD patients ≥ 3 months (OR = 6.6 [1.88 - 23.5], p = 0.0013) and those with HD catheter (OR = 21.3 [4.6 - 45.7], p < 0.001). Fibrinogen and PT were comparable in both groups. HD catheter was associated with prolong PT (OR = 5.3 CI [1.5 - 8.9], p = 0.03). Conclusion: Increased bleeding risk is common in HD patients. Thrombocytopenia is common in HD patients ≥ 12 months, while prolong aPTT are mainly found in HD patients ≤ 3 months with catheter and may reflect heparin overdose.

关键词： Thrombocytopenia Prolongactivated Prothromplastin Time Hemodialysis Cameroon

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Spectrum of Neurological Disorders amongst Patients on Maintenance Haemodialysis in Douala, Cameroon: A Cross-Sectional Study

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Open Journal of Nephrology 2022年第1期12卷 112-123页

作者： halle marie patrice Tchouamou Tchouamou Eric Gildas Fouda Hermine Gams Massi Daniel Ngamby Vincent Ebenezer Tewafeu Denis Kaze Folefack Francois Mapoure Njankouo Yacouba Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Internal Medicine Douala General Hospital Douala Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Department of Internal Medicine Douala Laquintinie Hospital Douala Cameroon Department of Internal Medicine Regional Hospital of Buea Buea Cameroon Yaounde Teaching Hospital Yaounde Cameroon

Context: Neurologic disorders are common in patients on maintenance haemodialysis (MHD). Data in Sub-Saharan Africa are scarce. Aim: To determine the prevalence and associated factors of neurological disorders amongst patients on MHD in Cameroon. Settings and Design: This was a four-month cross-sectional study carried out at the Douala General Hospital (DGH) a tertiary referral hospital in Cameroon. Methods: The diagnosis of neuropathy was made using the Michigan Neuropathy Screening Instrument (MNSI), neuropathic pain with the DN4 score, Restless Legs Syndrome (RLS) with the International Restless Legs Syndrome Study Group questionnaire (IRLSSG) and cognitive disorders with the Mini-Mental State Examination test (MMS). Student T and Chi-square tests were used to compare qualitative and quantitative variables. The level of significance was set at p Results: A total of 157 patients were included with 65% being males. The mean age was 48.8 ± 13.7 years. The main comorbidities were hypertension (90.4%), diabetes (19.1%), hepatitis C (10.5%) and HIV infection (10.8%). The median dialysis vintage was 36 (1 - 178) months. The overall prevalence of neurological disorders was 85.4%. The leading type was sensory polyneuropathy (57.3%), cognitive dysfunction (52.9%), neuropathic pain (23%), and restless legs syndrome (17.8%). Male gender was statistically associated with neuropathic pain, while age ≥ 40 years and diabetes were associated with sensory neuropathy and RLS. Conclusions: The burden of neurological disorders is high among patients on MHD as up to 4/5 of them had neurological involvement dominated by sensory polyneuropathy and cognitive dysfunction.

关键词： Neurological Disorder Haemodialysis Prevalence Cameroon

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Tensile strength and failure behavior of rock-mortar interfaces: Direct and indirect measurements

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Journal of Rock Mechanics and Geotechnical Engineering 2024年第1期16卷 41-55页

作者： Ghasem Shams patrice Rivard Omid Moradian Civil Engineering and Building Engineering Department Universitéde SherbrookeSherbrookeQuébecCanada Department of Earth Sciences Swiss Federal Institute of Technology(ETH)ZurichSwitzerland Department of Civil and Environmental Engineering Colorado School of MinesGoldenCOUSA

The tensile strength at the rock-concrete interface is one of the crucial factors controlling the failure mechanisms of structures,such as concrete gravity *** the critical importance of the failure mechanism and tensile strength of rock-concrete interfaces,understanding of these factors remains very *** study investigated the tensile strength and fracturing processes at rock-mortar interfaces subjected to direct and indirect tensile *** image correlation(DIC)and acoustic emission(AE)techniques were used to monitor the failure mechanisms of specimens subjected to direct tension and indirect loading(Brazilian tests).The results indicated that the direct tensile strength of the rock-mortar specimens was lower than their indirect tensile strength,with a direct/indirect tensile strength ratio of 65%.DIC strain field data and moment tensor inversions(MTI)of AE events indicated that a significant number of shear microcracks occurred in the specimens subjected to the Brazilian *** presence of these shear microcracks,which require more energy to break,resulted in a higher tensile strength during the Brazilian *** contrast,microcracks were predominantly tensile in specimens subjected to direct tension,leading to a lower tensile *** monitoring of the cracking processes in the rock-mortar interfaces revealed that they show AE precursors before failure under the Brazilian test,whereas they show a minimal number of AE events before failure under direct *** to different microcracking mechanisms,specimens tested under Brazilian tests showed lower roughness with flatter fracture surfaces than those tested under direct tension with jagged and rough fracture *** results of this study shed light on better understanding the micromechanics of damage in the rock-concrete interfaces for a safer design of engineering structures.

关键词： Rock-mortar Rock-concrete Moment tensor inversion(MTI) Acoustic emission(AE) Digital image correlation(DIC) Tensile strength Direct tensile test Brazilian test

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Sleep Quality on Maintenance Hemodialysis Patients in Douala General Hospital in Cameroon

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Open Journal of Nephrology 2017年第3期7卷 61-68页

作者： Fouda Menye Ebana Hermine Danielle Maimouna Mahamat Kaze Folefack Francois halle marie-patrice Ashuntantang Gloria Department of Internal Medicine Faculty of Medicine and Biomedical Sciences of Yaoundé Yaoundé Cameroon Department of Internal Medicine Faculty of Medicine and Pharmaceutic Sciences of Douala Douala Cameroon

Background: Poor sleep quality is reported to be common in hemodialysis patients. However, limited data are available about its prevalence in sub-Saha-ran region. The aim of this study was to assessed sleep quality and its predictors among hemodialysis patients. Methods: We conducted a cross sectional study of 2 weeks in the Douala General Hospital hemodialysis center of Cameroon involving 46 chronic hemodialyzed patients for at least six months with arteriovenous fistula. Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) and laboratory data were collected in patients’’ fields. Result: Thirty-five (76.1%) subjects reported poor sleep quality. The most frequent abnormal sleep components were subjective sleep quality, sleep disturbances and sleep latency (87%, 85% and 76% respectively). In univariate linear regression, hemoglobin level, sleep quality, sleep latency, sleep duration, habitual sleep efficiency and sleep disturbance were associated with poor sleep quality. In multivariate linear regression only hemoglobin level (p = 0.004) and sleep latency (p = 0.002) were associated with poor sleep quality. Conclusion: Poor sleep quality is frequent in our hemodialysis patients and hemoglobin seems to be a good predictor of sleep quality in these patients.

关键词： Sleep Quality Hemodialysis Cameroon Anemia

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Clinical Profile and Outcome of Pediatric Acute Kidney Injury in Cameroon: Comparison between an Urban and a Semi-Urban Health Facility

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Open Journal of Nephrology 2018年第2期8卷 56-64页

作者： Fouda Menye Ebana Hermine Danielle Teuwafeu Denis George halle marie-patrice Kaze Folefack Francois Ashuntantang Gloria Faculty of Medicine and Biomedical Sciences of Yaoundé University of Yaoundé I Yaoundé I Cameroon General Hospital of Douala Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Regional Hospital of Buea Buea Cameroon Faculty of Medicine and Pharmaceutic Sciences University of Douala Douala Cameroon Teaching Hospital of Yaoundé Yaoundé Cameroon General Hospital of Yaoundé Yaoundé Cameroon

Introduction: Pediatric Acute Kidney Injury (AKI) seems to be a major cause of morbidity and mortality in Subsahara Africa. However, data on its epidemiology are scare and mainly originate from tertiary and urban health facilities such as large university Teaching hospitals with a nephrology service. Objective: The aim of this study was to compare the epidemiology of pediatric AKI in urban and semi-urban health facility. Patients and method: We conducted a retrospective study of 16 months in a tertiary urban hospital (General Hospital of Douala) and a secondary semi-urban health facility (Region hospital of Buea). Diagnostic of AKI was done using usual criteria. Age, sex distribution, etiologies of AKI, access to dialysis, renal recovery at hospital discharge, at 1 and 3 months and patient survival at hospital discharge was compared. Results: A total of 31 patients were included (GD 17 and RHB 14). Boys were more prevalent in the semi-urban setting (86% Vs 47% p = 0.029). Median age was comparable in the both group although most semi-rural patient were older (6.5 Vs 10 years p = 0.093). Hospital acquired AKI was only found in urban setting and account for 40% of pediatric urban AKI. Malaria related AKI (mainly black water fever) and sepsis were the main etiologies of AKI in urban and semi-urban milieu. Dialysis access was the same but 30% of children could not access to it in urban setting compare to none in semi-urban area. Reasons of non-access to dialysis were lack of pediatric material and financial constraints. In Hospital mortality was the same but was more severe amount patient who could not receive dialysis. Among the survivor, CKD was only found in urban setting. Conclusion: Although mainly due to malaria, pediatric AKI differs from urban tertiary and semi-urban secondary health facility in Cameroon. Hospital acquired AKI is only found in urban setting where children are younger and less boys. AKI in urban setting seems to be more severe with less access to

关键词： Pediatric AKI Urban Tertiary Health Facility Semi-Urban Secondary Health Facility Malaria Black Water Fever Boys Hospital Acquired AKI CKD

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Intradialytic Hypertension and Associated Factors among Chronic Haemodialysed Patients in Sub-Saharan Africa: An Example from Cameroon

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Open Journal of Nephrology 2018年第4期8卷 105-116页

作者： halle marie patrice Bana Eric Loic Fouda Hermine Nda Mefo’o Jean Pierre Tewafeu Denis Kaze Folefack Francois Ashuntantang Enow Gloria Faculty of Medicine and Pharmaceutical Sciences University of DoualaCameroon Faculty of Medicine and Biomedical Sciences University of Yaounde IYaoundeCameroon Faculty of Health Sciences University of BueaBueaCameroon

Background: Hemodialysis (HD) is a therapy during which complications such as intradialytic hypertension (IDH) are frequent. We aimed to determine the incidence of IDH and associated factors amongst patients on maintenance hemodialysis in Cameroon. Method: It was a prospective cohort study including end stage kidney disease patients on HD. Data collected were: socio-demographic, comorbidities, current medication, weight, heart rate ultrafiltration rate (UF), albuminemia and electrocardiogram. The first blood pressure (BP) measurement was obtained at the beginning of the session and the last at the end. IDH was defined as an increase in systolic BP ≥ 10 mmHg between the first and the last measurement. Logistic regression was used to look for associated factors, p-value Results: Mean age was 49.06 ± 13.97 years with 64.2% males. Mean number of dialysis session was 11.26 ± 2.49. Incidence of IDH was 48.36%. The median number of IDH episodes was 5 (Range 0 - 12). Factors increasing the risk were hypertension (p = 0.003), number of antihypertensive drugs ≥ 2 (p Conclusion: IDH is frequent amongst patients on maintenance hemodialysis in our setting, with various patients related factors associated.

关键词： Hemodialysis Intradialytic Hypertension Incidence Associated Factors Cameroon

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Digital Twin-Assisted Semi-Federated Learning Framework for Industrial Edge Intelligence

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China Communications 2024年第5期21卷 314-329页

作者： Wu Xiongyue Tang Jianhua marie Siew Shien-Ming Wu School of Intelligent Engineering South China University of TechnologyGuangzhou 511442China Electrical and Computer Engineering Department Carnegie Mellon UniversityPittsburghPA 15213United States

The rapid development of emerging technologies,such as edge intelligence and digital twins,have added momentum towards the development of the Industrial Internet of Things(IIo T).However,the massive amount of data generated by the IIo T,coupled with heterogeneous computation capacity across IIo T devices,and users’data privacy concerns,have posed challenges towards achieving industrial edge intelligence(IEI).To achieve IEI,in this paper,we propose a semi-federated learning framework where a portion of the data with higher privacy is kept locally and a portion of the less private data can be potentially uploaded to the edge *** addition,we leverage digital twins to overcome the problem of computation capacity heterogeneity of IIo T devices through the mapping of physical *** formulate a synchronization latency minimization problem which jointly optimizes edge association and the proportion of uploaded nonprivate *** the joint problem is NP-hard and combinatorial and taking into account the reality of largescale device training,we develop a multi-agent hybrid action deep reinforcement learning(DRL)algorithm to find the optimal *** results show that our proposed DRL algorithm can reduce latency and have a better convergence performance for semi-federated learning compared to benchmark algorithms.

关键词： digital twin edge association industrial edge intelligence(IEI) semi-federated learning

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