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Mungania, Joyster, Kigen, Gabriel, Kamuren, Zipporah, Maritim A. Lipid Control and Factors Associated with LDL-C Control among Patients with Type 2 Diabetes Mellitus on Statins in Western Kenya. International Journal of Scientific and Research Publications 2024;14Abstract

Background: Dyslipidemia is the presence of abnormal blood lipid parameters, characterized by increased LDL-C, triglycerides, and total cholesterol but reduced HDL-C. It is a common finding in patients with T2DM, occurring at a prevalence rate of between 70% and 85%, and promotes the development of long-term cardiovascular complications, which are the leading cause of mortality in this population. Statins are the first-line drugs, but lipid control varies from patient to patient despite being widely used.Objective: To assess lipid control and the factors associated with LDL-C control in patients with type 2 DM who are on statins at a national referral hospital in Western Kenya.Methods: A retrospective study on 211 patients with type 2 DM who had been on a statin for at least three months. Data was obtained from patient records and lipid measures categorized as controlled or uncontrolled based on the Kenya National Guidelines for the Management of Diabetes Mellitus, 2018. Chi-square and Fischer’s exact test determined the association between variables. A multivariate logistic regression model was fit for variables significant at the bivariate level, and a P value of <0.05 was considered significant.Results: Most (99%) were on a single lipid-lowering drug, mainly atorvastatin, and 92% were on moderate-intensity dosing. Regarding lipid control, 50.3% had uncontrolled LDL-C, 30% had uncontrolled HDL-C, and 47% had uncontrolled triglyceride levels. Being on a high-intensity statin increased the likelihood of LDL-C control compared to moderate-intensity dosing (OR 8.57 [95% CI 4.3-16.9, P<0.001]).Conclusion: LDL-C was the most poorly controlled parameter. Patients on high-intensity statins had better LDL-C control; therefore, high-intensity statin therapy should be initiated in diabetic patients who do not achieve their LDL-C targets.

Boltz TA, Chu BB, Liao C, Sealock JM, Ye R, Majara L, Fu JM, Service S, Zhan L, Medland SE, Chapman SB, Rubinacci S, DeFelice M, Grimsby JL, Abebe T, Alemayehu M, Ashaba FK, Atkinson EG, Bigdeli T, Bradway AB, Brand H, Chibnik LB, Fekadu A, Gatzen M, Gelaye B, Gichuru S, Gildea ML, Hill TC, Huang H, Hubbard KM, Injera WE, James R, Joloba M, Kachulis C, Kalmbach PR, Kamulegeya R, Kigen G, Kim S, Koen N, Kwobah EK, Kyebuzibwa J, Lee S, Lennon NJ, Lind PA, Lopera-Maya EA, Makale J, Mangul S, McMahon J, Mowlem P, Musinguzi H, Mwema RM, Nakasujja N, Newman CP, Nkambule LL, O’Neil CR, Olivares AM, Olsen CM, Ongeri L, Parsa SJ, Pretorius A, Ramesar R, Reagan FL, Sabatti C, Schneider JA, Shiferaw W, Stevenson A, Stricker E, Stroud RE, Tang J, Whiteman D, Yohannes MT, Yu M, Yuan K,, R.K., Akena D, Atwoli L, Kariuki SM, Koenen KC, Newton CRJC, Stein DJ, Teferra S, Zingela Z, Pato CN, Pato MT, Lopez-Jaramillo C, Freimer N, Ophoff RA, Olde Loohuis LM, Talkowski ME, Neale BM, Howrigan DP, Martin AR. A blended genome and exome sequencing method captures genetic variation in an unbiased, high-quality, and cost-effective manner [Internet]. bioRxiv 2024; Website Abstract

We deployed the Blended Genome Exome (BGE), a DNA library blending approach that generates low pass whole genome (1-4x mean depth) and deep whole exome (30-40x mean depth) data in a single sequencing run. This technology is cost-effective, empowers most genomic discoveries possible with deep whole genome sequencing, and provides an unbiased method to capture the diversity of common SNP variation across the globe. To evaluate this new technology at scale, we applied BGE to sequence >53,000 samples from the Populations Underrepresented in Mental Illness Associations Studies (PUMAS) Project, which included participants across African, African American, and Latin American populations. We evaluated the accuracy of BGE imputed genotypes against raw genotype calls from the Illumina Global Screening Array. All PUMAS cohorts had R2 concordance >=95% among SNPs with MAF>=1%, and never fell below >=90% R2 for SNPs with MAF<1%. Furthermore, concordance rates among local ancestries within two recently admixed cohorts were consistent among SNPs with MAF>=1%, with only minor deviations in SNPs with MAF<1%. We also benchmarked the discovery capacity of BGE to access protein-coding copy number variants (CNVs) against deep whole genome data, finding that deletions and duplications spanning at least 3 exons had a positive predicted value of \~{}90%. Our results demonstrate BGE scalability and efficacy in capturing SNPs, indels, and CNVs in the human genome at 28% of the cost of deep whole-genome sequencing. BGE is poised to enhance access to genomic testing and empower genomic discoveries, particularly in underrepresented populations.Competing Interest StatementThe authors have declared no competing interest.

Wauye VM, Njiru E, Amadi AK, Hagembe MN, Kigen G. Chronic myelomonocytic leukemia primarily presenting as life-threatening pericardial effusion, Eldoret, Kenya: A case report [Internet]. Clinical Case Reports 2024;12:e9048. Website Abstract

Key Clinical Message Chronic myelomonocytic leukemia, a rare case of hematological malignancy mainly affects the elderly and may present with life threatening pericardial effusion as an initial manifestation. High index of suspicion is hence key for early management. Abstract We present a case of an 81-year-old African male who presented with progressive cough, respiratory distress and bilateral lower limb swelling, and was diagnosed with life-threatening pericardial effusion resulting from chronic myelomonocytic leukemia following complete blood count, peripheral blood film, bone marrow aspirate with trephine biopsy, and flow cytometry studies.

Gabriel Kigen

Associate Professor of Pharmacology & Therapeutics

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