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Objectives: Mortality during tuberculosis (TB) remains high in Africa. The purpose of our study was to determine the incidence and predictors of death during TB treatment in Cameroon. Materials and Methods: Data of subjects aged ≥15 years were retrospectively extracted from registers in all TB diagnostic and treatment centers in the Western and Northern regions of Cameroon from 2010 to 2015. Cox regression models were used to determine predictors of death during TB treatment. Results: Of the 19,681 patients included, 12,541 (63.7%) were male and their median age (25th-75th percentile) was 34 (26–45) years. The cumulative incidence (95% confidence interval [CI]) of death during TB treatment was 8.0% (7.5–8.5%). The predictors (hazard ratios [95% CI]) of death were: Age >34 years (1.479 [1.295–1.688], P < 0.001), female sex (1.471 [1.286–1.683], P < 0.001), extra-pulmonary TB (1.723 [1.466–2.026], P < 0.001), human immunodeficiency virus infection (3.739 [3.269–4.276], P < 001]), TB treatment in the Western region (2.241 [1.815–2.768], P < 0.001), treatment before 2012 (1.215 [1.073–1.376], P = 0.002)and low body weight (1st quartile and 2nd quartile) (2.568 [2.133–3.092], [P < 0.001]) and (1.569 [1.298–1.896], P < 0.001) respectively. Conclusion: The incidence of death during TB was relatively high in the Western and Northern regions of Cameroon. Recognition of these persons at greatest risk may improve care and reduce death durinng TB treatment.

Objective: To determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychlo- roquine and Azithromycin. Design: Prospective study. Setting: Treatment centres of the city of Yaounde, Cameroon, from May 7th to 24th 2020. Participants: We enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200 mg twice daily during seven #days plus Azithromycin 500 mg the first day and 250 mg the remaining 4 days as per national standard. Main Outcomes Measures: The primary end-point was the change in QTc interval between day 0 (D0), day 3 (D3) and day 7 (D7). Secondary endpoints were changes in all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic events during the course of treatment. Results: The population (29 men and 22 women) was aged 39 ± 11 years (range 17 to 61 years). Mean Tisdale score was 3.35 ± 0.48. No significant change from baseline (D0) of QTc was observed at D7 (429 ± 27 ms at D0 versus 396 ± 26 ms at D7; p = 0.27). A reduction of heart rate was observed between the D0 and D7 (75 ± 13 bpm versus 70 ± 13 bpm, p = 0.02) with increased QRS duration between D0 and D7 (95 ± 10 ms versus 102 ± 17 ms, p = 0.004). No symptomatic arrhythmic events occurred during the treatment course. Conclusions: No life-threatening modification of the QT interval was observed in non-severe COVID-19 patients treated ambulatory with hydroxychloroquine and azithromycin. Studies are needed in critical-ill and older patients.

Objectives: To identifyHaemophilus species and characterise the antimicrobial susceptibility of isolates from patients with respiratory tract infections (RTIs) in Cameroon. Methods: Isolates (n = 95) were from patients with RTIs obtained from two hospitals in Yaoundé, Cameroon. Isolates were identified by biochemical assay, a polymerase chain reaction (PCR)-based method, matrix-assisted laser desorption ionization-time of flight (MALDI-TOF), and whole genome sequencing. Antibiotic minimum inhibitory concentrations were determined by E-test. Results: Haemophilus influenzae (H. influenzae) was the most prevalent species, varying from 76.8 to 84.2% according to the different methods. The isolates were mainly non-typeable (n = 70, 96%). Three H. influenzae isolates were capsulated (b, e and f). The isolates were genetically diverse and 40 unique sequence types were identified, including 11 new ones. Resistance to ampicillin was observed among 52 of 94 (55.3%), and 14 of the 52 (26.9%) produced TEM-1 β-lactamase. PBP3 mutations occurred in 40 of 52 (76.9%) ampicillin-resistant isolates. Eleven isolates were chloramphenicol-resistant, with eight of 10 (80%) producing chloramphenicol acetyltransferase. Four Haemophilus isolates were rifampicin-resistant, with two mutations in rpoB gene. Five isolates were ciprofloxacin-resistant and harboured mutations in the quinolone-resistance-determining regions of gyrA and parC genes. Conclusion: TheH. influenzae isolates were highly diverse and showed high levels of antibiotic resistance. H. influenzae serotype b is still circulating in the post-vaccination era.

Resume Introduction Les aminosides, couramment utilises dans le traitement de la tuberculose multiresistante (TB-MR) sont responsables d’une ototoxicite. Le but de notre etude etait de determiner l’incidence et d’identifier les facteurs associes a l’ototoxicite liee a la kanamycine au cours du traitement de la TB-MR a Yaounde. Methodes Les dossiers des patients traites pour TB-MR avec un protocole incluant la kanamycine a l’hopital Jamot de Yaounde de mai 2008 a juillet 2015 ont ete analyses. La regression logistique a ete utilisee pour rechercher les facteurs associes a l’ototoxicite au cours de ce traitement. Resultats Des 79 patients inclus, 60,7 % etaient des hommes et leur âge median (25e–75e percentile) etait de 31 (25–43) ans. Dix-huit (22,8 %) patients avaient une infection a VIH. L’incidence de l’ototoxicite [intervalle de confiance a 95 % (IC a 95 %)] induite par la kanamycine etait de 36,7(26,9–47,7) %. Les facteurs associes a cette ototoxicite [odds ratio (IC a 95 %)] etaient l’âge > 40 ans [13,47 (3,66–49,49)] et la denutrition (indice de masse corporelle Conclusion L’incidence de l’ototoxicite liee a la kanamycine au cours du traitement de la TB-MR est relativement elevee. La prise en consideration de ces facteurs a l’initiation du traitement de la TB-MR permettrait d’en limiter le handicap fonctionnel irreversible.

Background. Sleep apnea syndrome (SAS), a growing public health threat, is an emerging condition in sub-Saharan Africa (SSA). Related SSA studies have so far used an incomplete definition. This study is aimed at assessing SAS using an American Academy of Sleep Medicine (AASM) complete definition and at exploring its relationship with comorbidities, among patients hospitalized in a Cameroonian tertiary hospital. Methods. This cross-sectional study was conducted in cardiology, endocrinology, and neurology departments of the Yaoundé Central Hospital. Patients aged 21 and above were consecutively invited, and some of them were randomly selected to undergo a full night record using a portable sleep monitoring device, to diagnose sleep-disordered breathing (SDB). SAS was defined as an apnea − hypopnea index AHI ≥ 5 /h, associated with either excessive daytime sleepiness or at least 3 compatible symptoms. Moderate to severe SAS (MS-SAS) stood for an AHI ≥ 15 / h . We used chi-square or Fisher tests to compare SAS and non-SAS groups. Findings. One hundred and eleven patients presented a valid sleep monitoring report. Their mean age ± standard deviation (range) was 58 ± 12.5 (28–87) years, and 53.2% were female. The prevalence (95% confident interval (CI)) of SAS was 55.0 (45.7, 64.2)% and the one of MS-SAS 34.2 (25.4, 43.1)%. The obstructive pattern (90.2% of SAS and 86.8% of MS-SAS) was predominant. The prevalence of SAS among specific comorbidities ranged from 52.2% to 75.0%. Compared to SAS free patients, more SAS patients presented with hypertension (75.4% vs. 48.0%, p = 0.005 % ), history of stroke (36.7% vs. 32.0%, p = 0.756 ), cardiac failure (23.0% vs. 12.0%, p = 0.213 ), and combined cardiovascular comorbidity (80.3% vs. 52.0%, p = 0.003 ). Similar results were observed for MS-SAS. Metabolic and neuropsychiatric comorbidities did not differ between SAS and SAS-free patients. Conclusion. The SAS diagnosed using modified AASM definition showed high prevalence among patients hospitalized for acute medical conditions, as it was found with SDB. Unlike HIV infection, metabolic and brain conditions, cardiovascular comorbidities (hypertension and cardiac failure) were significantly more prevalent in SAS patients.

Introduction:in Cameroon patients with multidrug/rifampicin resistant pulmonary tuberculosis (MDR/RR-PTB) are treated with a 9-11 month standardised shorter treatment regimen. Despite its effectiveness, factors associated with the occurrence of an unfavourable treatment outcome in this group of patients are not known. Determine the incidence and identify factors associated with an unfavourable treatment outcome among patients with rifampicin resistant pulmonary tuberculosis (RR-PTB) in Yaoundé. Methods:we conducted a retrospective record review of all consecutive patients with bacteriologically confirmed RR-PTB followed up at the specialised MDR/RR-TB treatment centre of the Jamot Hospital in Yaoundé (JHY) from January 2013 to November 2019. A patient was classified as having an unfavourable outcome if he/she had treatment failure, died or was lost to follow-up during the course of treatment. Results:a total of 242 RR-PTB patients with a mean age of 35.59 ± 12.02 years including 144 (59.5%) males were registered. Forty-nine (49) of the 242 patients had an unfavourable treatment outcome giving a cumulative incidence of 20.20% (95% confidence interval (95% CI): 15.40-25.90%). Multivariable analysis revealed that patients with an unfavourable outcome were more likely to be males (odds ratio (OR): 2.94; 95% CI: 1.24-7.00, p= 0.015), HIV infected (OR: 2.67; 95% CI: 1.17-6.06, p = 0.019), and have a baseline haemoglobin level ≤ 10g/dl (OR: 2.87; 95% CI: 1.25-6.58, p = 0.013). Conclusion:the rate of an unfavourable treatment outcome among patients with RR-PTB at the specialised MDR/RR-TB treatment centre of the JHY is relatively high. The male sex, HIV infection and moderate to severe anaemia are independent factors associated with an unfavourable treatment outcome.

Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research Question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study Design and Methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P =.021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P 50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.

ObjectiveTo determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychloroquine and Azithromycin.DesignProspective study.SettingTreatment centres of the city of Yaounde, Cameroon, from May 7th to 24th 2020.ParticipantsWe enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200mg twice daily during seven days plus Azithromycin 500 mg the first day and 250 mg the remaining 4 days as per national standard.Main outcomes measuresThe primary end-point was the change in QTc interval between day 0 (D0), day 3 (D3) and day 7 (D7). Secondary endpoints were changes in all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic events during the course of treatment.ResultsThe population (29 men and 22 women) was aged 39 ± 11 years (range 17 to 61 years). Mean Tisdale score was 3.35±0.48. No significant change from baseline (D0) of QTc was observed at D7 (429±27 ms at D0 versus 396±26 ms at D7; p=0.27). A reduction of heart rate was observed between the D0 and D7 (75±13 bpm versus 70±13 bpm, p = 0.02) with increased QRS duration between D0 and D7 (95±10 ms versus 102±17 ms, p = 0.004). No symptomatic arrhythmic events occurred during the treatment course.ConclusionsNo life-threatening modifications of the QT interval was observed in non-severe COVID-19 patients treated ambulatory with hydroxychloroquine and azithromycin. Studies are needed in critical-ill and older patients.

Introduction The prevalence of asthma varies from one country to another due to differences in ethnicity, socio-economics status, environmental and climatic risk factors. The aim of this study was to determine the prevalence and determinants of current asthma in Cameroonian adults. Material and methods Data from 4 cross-sectional community-based studies from 2014 to 2018 were analyzed. Participants aged 19 years and above were selected through multilevel stratified random sampling methods across 2 urban areas, 2 semi-urban areas and 1 rural area. Current asthma was defined as “wheezing in the last 12 months in a subject with self-reported asthma or having used drugs for asthma treatment”. Logistic regression was used to investigate the determinants of current asthma. Results A total of 10,707 adults [median age (interquartile range) = 36 (26–52) years, 44.5% of men] were definitively enrolled in the study. The overall prevalence [95% confidence interval (CI)] of current asthma was 3.9% (3.5–4.3)%. Determinants [odd's ratio (OR), (95%CI)] of current asthma were: Sudanese ethnicity [1.9(1.4–2.7)], rural area [1.5(1.1–2.1)], urban area [1.6(1.2–2.2)], past history of pneumonia [1.9(1.1–3.4)], allergic rhino-conjunctivitis [6.5(4.7–8.9)], atopic eczema [2.3(1.5–3.6)], body mass index (BMI) ≥ 40 kg/m2 [1.9(1.0–3.4)] and BMI Conclusion The prevalence of current asthma is close to the low value of the Sub-Saharan African range. Sudanese ethnicity, rural area, urban area, history of pneumonia, allergic disease, severe obesity and underweight were determinants of current asthma in Cameroon. More research is surely warranted to understand the mechanisms underlying the association of asthma with Sudanese ethnicity.

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p, Testing practices vary based on geography and disease severity, and IDSA/ATS/ERS testing recommendations are rarely followed http://ow.ly/80Iy30lxo1c

Introduction La connaissance des facteurs associes a une mauvaise observance au traitement par pression positive continue (PPC) permettrait d’ameliorer le suivi des patients presentant un syndrome d’apnees obstructives du sommeil (SAOS). Le but de cette etude etait de rechercher les facteurs associes a une mauvaise observance au traitement par PPC a domicile. Methodes Dans cette etude retrospective, les donnees sociodemographiques, psychometriques, cliniques et polysomnographiques (nuit diagnostique et nuit de titration par PPC) des patients presentant un SAOS modere a severe traites par PPC et suivis au CHU Brugmann ont ete collectees. L’observance a ete evaluee au 4e mois (M4) et au 16e mois (M6) de traitement. Differents seuils de mauvaise observance ont ete testes : Resultats Des 261 patients inclus, 193 (73,9%) etaient des hommes et l’âge moyen (ecart-type) etait de 52 (13) ans. A M4 de suivi, la PPC etait utilisee durant une mediane (25e–75e percentile) de 85 (57–97)% des jours et la duree moyenne d’utilisation etait de 5,6 (4,3–6,7) h par jour d’utilisation effective. Une amelioration significative des parametres d’observance etait objectivee a M6 de suivi (5,6 h vs 6,2 h ; p Conclusion La race non-caucasienne, une absence d’augmentation du pourcentage du stade N3 lors de la nuit de titration par PPC, un antecedent de depression et la mauvaise qualite du sommeil sont associes a une mauvaise observance au traitement par PPC. Un suivi rapproche et adapte doit etre propose aux patients presentant ces caracteristiques afin d’ameliorer leur observance.

Introduction La tuberculose (TB) demeure un veritable probleme de sante publique mondiale. Le but de notre etude etait de determiner l’incidence et les facteurs predictifs des perdus de vue (PDV) au cours de la tuberculose dans deux regions camerounaises. Methodes Une cohorte retrospective des sujets d’au moins 15 ans etait reconstituee dans les tous les centres de diagnostic et de traitement (CDT) des regions de l’Ouest et du Nord au Cameroun. Les donnees des registres de 2010 a 2015 etaient collectees. La regression logistique a ete utilisee pour determiner les facteurs predictifs des PDV au cours de la tuberculose. Resultats Sur 19 681 patients enregistres, 404 (2,1 %) patients transferes dans un autre centre de traitement ont ete exclus. Des 19 277 patients definitivement inclus [12 293 (63,8 %) sujets de sexe masculin], l’âge median (intervalle interquartile) etait de 34 (19) ans. L’incidence cumulee [intervalle de confiance (IC) a 95 %] des PDV au cours de la tuberculose etait de 2,9 % (2,7–3,1 %). Les facteurs predictifs [odds ratio (IC a 95 %)] des PDV etaient l’âge [1,011 (1,002–1,020) par diminution d’un an, p = 0,022], le sexe masculin [1,599 (1,195–2,141), p = 0,002], les nouveaux cas de TB [2,830 (1,876–4,270), p Conclusion L’incidence des PDV au cours de la tuberculose est faible dans les regions du Nord et Ouest au Cameroun. Les facteurs predictifs des PDV sont les nouveaux cas de TB, sujets jeunes de sexe masculin sans comorbidites, ayant debutes leur traitement entre 2010 et 2012 dans la region du Nord. Le controle des facteurs modifiables permettrait d’ameliorer le succes du traitement au cours de la tuberculose au Cameroun.

Background: Previous studies have shown that tuberculosis (TB) is a risk factor for chronic airflow limitation. Chronic obstructive pulmonary disease (COPD) is recognized as the result of chronic inflammation, usually related to noxious particles. Post-TB airflow obstruction (post-TB/AFO) and tobacco-related COPD (COPD/tobacco) have the same functional pathway characterized by persistent airflow limitation. We sought to compare the profile of 29 cytokines in the sputum of subjects with post-TB/AFO and those with COPD/tobacco. Results: The forced expiratory volume in the first second (FEV 1 ) and FEV1/forced vital capacity (FEV 1 /FVC) ratio were lower in the COPD/tobacco subgroup compared to the COPD/post-TB subgroup. The stages of the disease were more advanced in COPD / tobacco patients. Among the cytokines, IL-1α, IL-1β, MIP-1β, sCD40L and VEGF levels were higher in COPD patients, compared to the controls with p values ​​of 0.003, 0.0001, 0.03, 0.0001 and 0.02 respectively. When the two COPD subgroups were compared, IL-1α, IL-6, TNF-α and IL-8 levels were higher in the COPD/tobacco subgroup compared to the COPD/post-TB subgroup with p-values ​​of 0.031, 0.05, 0.021 and 0.016 respectively. Conclusion: COPD/tobacco is more severe than post-TB/AFO. The pathogenesis of post-TB/AFO appears to involve the cytokines IL-1RA, IL-1α, IL-1β, IL-17, GRO and sCD40L, while COPD/tobacco involves more cytokines.

PURPOSE: Obstructive sleep apnea and hypopnea syndrome (OSAHS) is poorly documented in Sub-Saharan Africa, especially in the hospital setting. The aim of this study was to determine its prevalence and to investigate the associated factors in patients admitted in a tertiary referral hospital in Cameroon. METHODS: In this cross-sectional study conducted in the Cardiology, Endocrinology and Neurology departments of the Yaounde Central Hospital; all patients aged 21 and older were included consecutively. A sample of randomly selected patients was recorded using a portable sleep monitoring device (PMD). OSAHS was defined as apnea-hypopnea index (AHI) ≥ 5/hour (with > 50% of events being obstructive) and moderate to severe OSAHS as an AHI > 15/hour. Logistic regression was used to identify factors associated to OSAHS. RESULTS: Of the 359 patients included, 202 (56.3%) patients were women. The mean age (standard deviation) was 58 (16) years. The prevalence of OSAHS assessed by PMD (95% CI) was 57.7% (48.5-66.9%), 53.8% in men and 62.7% in women (p = 0.44). The median (25th-75th percentiles) AHI, body mass index and Epworth Sleepiness Scale score of OSAHS patients were 17 (10.6-26.9)/hour, 27.4 (24.7-31.6) kg/m2 and 7 (5-9) respectively. The only factor associated to moderate to severe OSAHS was hypertension [odds ratio (95% CI)]: 3.24 (1.08-9.72), p = 0.036. CONCLUSION: OSAHS is a common condition in patients in this health care centre of Cameroon. In the hospital setting, screening for OSAHS in patients with hypertension is recommended., SCOPUS: ar.j, info:eu-repo/semantics/published

Objective: To determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychloroquine plus Azithromycin. Design: Prospective study. Setting: Treatment centres of the city of Yaounde, Cameroon, from May 7th to 24th 2020. Participants We enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200mg twice daily during seven days plus Azithromycin 500 mg the first day and 250 mg the remaining 6 days. Main Outcomes Measures: The primary end-point was the change in QTc interval between the day 0 (D0), the day 3 (D3) and the day 7 (D7). Secondary end-points were modifications of all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic events during the treatment course. Results: The mean age of the population was 39 ± 11 years (ranged between 17 to 61 years). The male gender was predominant (n=29 ; 56.86%). The mean Tisdale score was 3.35±0.48. The modification of QTc was not statistically significant between the D0 and the D7 (429±27 ms versus 396±26 ms ; p value= 0.27). There were statistical electrocardiographic changes in mean heart rate and QRS duration between the D0 and the D7. A reduction of heart rate was observed between the D0 and D7, 75±13 bpm versus 70±13 bpm (p value= 0.02). There were also a statistically significant increased of the QRS duration between D0 to D7 ; 95±10 ms versus 102±17 (p value= 0.004). No symptomatic arrhythmic events occurred during the treatment course. Conclusions: No life-threatening modifications of the QT interval was observed in non-severe COVID-19 patients treated ambulatory with hydroxychloroquine and azithromycin in Cameroon. More studies are needed particularly in critical-ill and older patients. Funding Statement: None. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: The study was approved by the National Committee on Research Ethics for Human Health in cameroon before the conduct of the study (N°2020/05/1505/L/CNERSH/SP).

Background: Chronic kidney disease (CKD) is a major health problem with growing prevalence in sub-Saharan Africa. We present the prevalence and determinants of CKD in Garoua and Figuil cities of the North region of Cameroon. Methods: A cross-sectional survey was conducted from January to June 2018 in the two cities, using a multi-level cluster sampling. All adults with low estimated glomerular filtration rate (eGFR) (< 60 ml/min/1.73 m2) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and/or albuminuria (≥ 30 mg/g) were reviewed three months later. Logistic regression models (accounting for the sampling strategy) were used to investigate the predictors of the outcomes. Results: A total of 433 participants were included, with a mean age (95%CI) of 45.0 (43.4-46.6) years, 212 (48.7%) men, 294 (67.9%) from Garoua and 218 (45.6%) with no formal education. Risk factors for chronic nephropathy were highly prevalent including longstanding use of street medications (52.8%), herbal medicines (50.2%) and non-steroidal anti-inflammatory drugs (50%), alcohol consumption (34.4%), hypertension (33.9%), overweight/obesity (33.6%), hyperuricemia (16.8%), smoking (11.3%) and hyperglycemia (6.5%). The prevalence of CKD was 11.7% overall, 10.7% in Garoua and 13% in Figuil participants. Equivalents figures for CKD G3-5 and albuminuria were 2.8%, 2.0% and 4.5%; and 9.1%, 9.3% and 8.5% respectively. History of diabetes, increase systolic blood pressure, hyperglycemia and hyperuricemia were predictors of CKD. Conclusion: The prevalence of CKD is as high in these northern cities as previously reported in southern cities of Cameroon, driven mostly by known modifiable risk factors of chronic nephropathy.

BACKGROUND The objective of this study was to assess the association between spirometric restrictive ventilatory pattern (sRVP) and type 2 diabetes mellitus (T2DM) and investigate factors associated with sRVP in subjects with T2DM. MATERIALS AND METHODS In this comparative cross-sectional study, subjects with T2DM (diabetes group) were compared to a group of subjects without diabetes (non-diabetes group) from December 2018 to March 2019 (4months) at the National Obesity Center of the Yaounde Central Hospital. sRVP was defined as the ratio of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) above the lower limit of normal, and FVC

Background Restrictive spirometric pattern is a risk factor for all-cause and cause-specific mortality. Objective We assessed the prevalence of restrictive pattern and investigated its determinants in a major sub-Saharan Africa city. Methods Participants were adults (≥ 19 years) who took part in a population-based survey in Yaounde (Cameroon) between December 2013 and April 2014. Restrictive pattern was based on a FVC below the lower limit of the normal (LLN) and a ratio forced expiratory volume in one second (FEV1)/FVC ≥ LLN (LLN-based restrictive pattern) or a FVC Results In all, 1003 participants [514 (51.2%) women] with a mean age of 33.7 years were included. The prevalence of restrictive pattern was 18.8% (95%CI: 16.6-21.2) based on LLN and 15.0% (13.0-17.2) based on fixed cut-off. LLN-based restrictive pattern was mild in 148 (78.3%) subjects, moderate in 35 (18.5%) and severe in 6 (3.2%). Determinants of LLN-based restrictive pattern were age ≥ 60 years [adjusted odds ratio 2.90 (95%CI 1.46-5.77), p=0.002), history of pulmonary tuberculosis [3.81(1.42-10.20), p=0.008], prevalent heart diseases [3.81 (1.20-12.12), p=0.024] and underweight [5.15(1.30-20.39), p=0.020]. Determinants were largely similar with slightly different effect sizes for fixed cut-off based restrictive pattern. Conclusion Restrictive pattern was very frequent in this city. Clinical implications These results enhance the needs to increase the efforts to prevent and control tuberculosis, cardiovascular diseases and underweight in this setting.

Resume Introduction Les objectifs de cette etude etaient d’evaluer l’incidence et les facteurs de risque de la persistance des opacites pleurales residuelles (OPR) significatives en fin de traitement antituberculeux (TAT) et six mois apres la fin du TAT (M12) pour tuberculose pleurale (TBP). Methodes Dans cette etude prospective realisee de septembre 2010 a aout 2013, tous les patients suivis dans le service de pneumologie A de l’hopital Jamot de Yaounde pour TBP etaient inclus. L’OPR etait significative si sa largeur sur la radiographie du thorax etait ≥ 10 mm. La regression logistique etait utilisee pour rechercher les facteurs de risque d’OPR significative. Resultats Des 193 patients inclus (59,6 % d’hommes), leur âge median (intervalle interquartile) etait de 33 (25–42) ans. Une OPR significative etait retrouvee respectivement chez 22 % (IC a 95 % : 14,9–29,1) et 11 % (4,9–17,1) des patients a la fin du TAT et a M12. Les facteurs de risque independants de l’OPR significative en fin du TAT et a M12 etaient le tabagisme, les lesions parenchymateuses associees et l’hypoglycopleurie. Conclusion L’incidence des sequelles pleurales ≥ 10 mm diminue de moitie entre la fin du TAT et six mois apres. La connaissance des facteurs de risque de l’OPR ≥ 10 mm devrait permettre une prise en charge optimale de ces patients.

Introduction La tuberculose (TB) demeure un veritable probleme de sante publique mondial. Le but de notre etude etait de determiner l’incidence et les facteurs predictifs du deces au cours de la TB dans deux regions du Cameroun. Methodes Les sujets âges d’au moins 15 ans traites pour TB dans les regions du Nord et de l’Ouest du Cameroun de janvier 2010 a decembre 2015 etaient inclus dans cette etude de cohorte retrospective. La regression logistique a ete utilisee pour determiner les facteurs predictifs de deces au cours de la TB. Resultats Sur 19 681 patients enregistres, 404 (2,1 %) patients transferes dans un autre centre de traitement ont ete exclus. Des 19 277 patients definitivement inclus, 12 293 (63,8 %) sujets etaient de sexe masculin et l’âge median (intervalle interquartile) etait de 34(19) ans. L’incidence cumulee [intervalle de confiance (IC) a 95 %] du deces etait de 8,1 % (7,7–8,5) %. Les facteurs predictifs [odds ratio (IC a 95 %)] du deces de tuberculose retrouves dans notre etude etaient l’âge [1,022 (1,017–1,028) par augmentation d’un an, p Conclusion L’incidence du deces au cours de la tuberculose est elevee au Nord et a l’Ouest Cameroun. Les facteurs predictifs de deces sont les femmes âgees, denutries, avec une co-infection TB extrapulmonaire/VIH, ayant debutees leur traitement entre 2010 et 2012 dans la region de l’Ouest Cameroun. Une prise en charge adequate du VIH diminuerait le taux de deces au cours de la TB.

Introduction Le syndrome d’apnees obstructives du sommeil (SAOS) et le diabete sont associes de maniere bidirectionnelle. Le but de cette etude etait de comparer la prevalence du haut risque de SAOS entre les sujets avec et sans diabete de type 2 (DT2) et de rechercher les facteurs associes. Methodes Dans cette etude transversale menee de decembre 2018 a mars 2019 a l’hopital Central de Yaounde au Cameroun, nous avons compare un groupe des sujets presentant un DT2 a un groupe de sujets sans diabete apparies pour l’âge et le sexe. Le haut risque de SAOS etait defini par un score STOP-BANG ≥ 3. La regression logistique a ete utilisee pour rechercher les facteurs independants associes au haut risque de SAOS dans le groupe de sujets avec DT2. Resultats Des 254 participants inclus dans chaque groupe, 156 (61,4 %) etaient des femmes, l’âge median (25e–75e percentile) etait de 57 (47–64) ans. Le score STOP-BANG etait plus eleve dans le groupe diabete (2 vs 1 ; p = 0,039). La prevalence du haut risque de SAOS [intervalle de confiance (IC) a 95 %] etait de 22 % (17,1–27,6 %) dans le groupe diabete et de 17,3 % (12,8–22,5 %) dans le groupe sans diabete, p = 0,181. Il n’existait pas d’association independante entre le haut risque de SAOS et le DT2 (p = 0,161). Le non-respect des mesures hygienodietetiques [odds ratio (IC a 95 %) : 2,79 (1,30–5,98)] etait independamment associe au haut risque de SAOS dans le groupe diabete. Conclusion Pres du quart des patients presentant un diabete de type 2 a un haut risque de SAOS de meme que les sujets sans diabete et le non-respect des mesures hygienodietetiques y est associe. L’evaluation du risque et le diagnostic du SAOS permettrait d’assurer la prise en charge globale des patients ayant le diabete, notamment ceux ne respectant pas les mesures hygienodietetiques.

Lower respiratory tract infections (LRTIs) remain a challenge in African healthcare settings and only few data are available on their aetiology in Cameroon. The purpose of this study was to access the bacterial cause of LRTIs in patients in Cameroon by two methods.Methods. Participants with LRTIs were enrolled in the referral centre for respiratory diseases in Yaoundé city and its surroundings. To detect bacteria, specimens were tested by conventional bacterial culture and a commercial reverse-transcriptase real-time polymerase chain reaction (RT-PCR) assay. One hundred forty-one adult patients with LRTIs were enrolled in the study. Among the participants, 46.8% were positive for at least one bacterium.Streptococcus pneumoniaeandHaemophilus influenzaewere the most detected bacteria with 14.2% (20/141) followed byKlebsiella pneumoniae, 9.2% (13/141),Staphylococcus aureus, 7.1% (10/141), andMoraxella catarrhalis, 4.3% (6/141). Bacterial coinfection accounted for 23% (14/61) withHaemophilus influenzaebeing implicated in 19.7% (12/61). The diagnostic performance of RT-PCR for bacteria detection (43.3%) was significantly different from that of culture (17.7%) (p< 0.001). OnlyStreptococcus pneumoniaedetection was associated with empyema by RT-PCR (p

Background Although smoking is the main cause of the chronic obstructive pulmonary disease (COPD), previous tuberculosis (TB) infection can also induce the disease. While the management of COPD is mainly performed with anti-inflammatory molecules, inflammatory profile of post tuberculosis obstructive disease is not yet known. The purpose of this study was to compare certain inflammatory cells of post tuberculosis COPD to that of post tobacco COPD. Methods This cross-sectional study conducted at the Yaoundé Jamot hospital consisted of 92 participants comprising 22 post tobacco COPD patients (COPD/tobacco), 24 post tuberculosis COPD (COPD/TB) and 46 healthy individuals constituting the control group. Sputum and blood were collected for cells counts. Results In sputum, the mean count of neutrophils, lymphocytes and monocytes was statistically higher in COPD patients compared to the control group with p-values respectively of 0.0001, 0.0001 and 0.0001. Comparison of the two COPD groups showed that, neutrophils cells count is higher in COPD/tobacco than in COPD/TB patients (p = 0.04). Monocytes and lymphocytes counts were similar between the two groups of patients with COPD with p-value of 0.052 and 0.91respectivelly. In blood, the rate of CD4 cells was higher in COPD patients compared to controls with a significant p-value of 0.0006. The blood CD8 cell count was not statistically different between COPD patients and the controls group (p = 0.6). Comparing the two COPD groups together, we had a blood CD8 rate higher in COPD/tobacco than COPD/TB (p = 0.0043), and blood CD4 rate were not statistically different between the two COPD groups. Conclusions Neutrophils, monocytes and lymphocytes are involved both in the COPD/tobacco and COPD/TB, with high levels of sputum neutrophiles and blood CD8 cells in COPD/tobacco patients. In blood TCD8 and CD4 lymphocytes may be involved in the pathogenesis of COPD.

Introduction Obstructive sleep apnea (OSA) patients may develop central respiratory events under continuous positive airway pressure (CPAP), referred to as complex sleep apnea (CompSA). Objective We aimed to assess prevalence and predictive factors of complex apnea and to evaluate treatment response to CPAP. Methods Within a retrospective cohort study, we assessed clinical data of OSA patients, attending the sleep lab during a 15-months period. Included participants underwent two consecutive polysomnographies; baseline diagnosis and treatment trial. Complex apnea patients, defined by a central apnea index ≥ 5 per hour during pressure auto-titration, were compared to remainders. Results Among 263 included patients, the prevalence of complex apnea was 9.1%. The mean apnea hypopnea index only dropped from 52.7 to 39.9 per hour in CompSA patients, while it improved from 40.9 to 7.3 in patients without CompSA. Although a decreased sleep-fragmentation under CPAP was observable in both groups, the enhancement of Non-REM sleep was superior in patients without CompSA. The CompSA patients showed higher median apnea-hypopnea, mixed apnea and central apnea indices at baseline and displayed higher rates of comorbid heart failure and obstructive pulmonary disease, but no higher severity of associated daytime fatigue and sleepiness symptoms. Conclusion Despite evidenced partial improvement of obstructive events, nocturnal hypoxemia and sleep fragmentation, the occurrence of complex apnea presented here as a clear therapeutic failure of auto-titrating CPAP and was associated with heart failure, COPD and higher central and mixed apnea indices at baseline.

Author(s): Ekoru, Kenneth; Young, Elizabeth H; Dillon, David G; Gurdasani, Deepti; Stehouwer, Nathan; Faurholt-Jepsen, Daniel; Levitt, Naomi S; Crowther, Nigel J; Nyirenda, Moffat; Njelekela, Marina A; Ramaiya, Kaushik; Nyan, Ousman; Adewole, Olanisun O; Anastos, Kathryn; Compostella, Caterina; Dave, Joel A; Fourie, Carla M; Friis, Henrik; Kruger, Iolanthe M; Longenecker, Chris T; Maher, Dermot P; Mutimura, Eugene; Ndhlovu, Chiratidzo E; Praygod, George; Pefura Yone, Eric W; Pujades-Rodriguez, Mar; Range, Nyagosya; Sani, Mahmoud U; Sanusi, Muhammad; Schutte, Aletta E; Sliwa, Karen; Tien, Phyllis C; Vorster, Este H; Walsh, Corinna; Gareta, Dickman; Mashili, Fredirick; Sobngwi, Eugene; Adebamowo, Clement; Kamali, Anatoli; Seeley, Janet; Smeeth, Liam; Pillay, Deenan; Motala, Ayesha A; Kaleebu, Pontiano; Sandhu, Manjinder S | Abstract: BackgroundAnti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TG) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.MethodsPooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (g2.3 mmol/L) was analysed using regression models.FindingsAmong 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51-2.77, I2=45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.InterpretationEvidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.

Purpose: To assess the inter-observer agreement in reading adults chest radiographs (CXR) and determine the effectiveness of observers in radiographic diagnosis of pulmonary tuberculosis (PTB) in a tuberculosis endemic area. Methods: A quasi-observational study was conducted in the Pneumology Department of Yaounde Jamot Hospital (Cameroon) from January to March 2014. This included six observers (two chest physicians, two radiologists, two end-training residents in medical imaging) and 47 frontal CXRs (4 of diffuse interstitial lung disease, 6 normal, 7 of lung cancers, 7 of bacterial pneumonia, 23 of PTB). The sample size was calculated on the basis of an expected 0.47 Kappa with a spread of 0.13 (α = 5%, CI = 95%) for six observers and five diagnostic items. The analysis of concordance was focused on the detection of nodules, cavitary lesions, pleural effusion, adenomegaly and diagnosis of PTB and lung cancer. These intervals of kappa coefficient were considered: discordance ( 0.81). Results: The average score for the detection of caverns was the highest (58.3%) followed by that of the correct diagnosis of tuberculosis (49.3%). Pneumologists had the highest proportions of correct diagnosis of tuberculosis (69.6% and 73.9%) and better inter-observer agreement (k = 0.71) for PTB diagnosis. Observers were more in agreement for the detection of nodules (0.32 - 0.74), adenomegalies (0.43 - 0.69), and for the diagnosis of cancer (0.22 - 1) than for the diagnosis of tuberculosis (0.19 - 0.71). Disagreements were more frequent for the detection of pleural effusions (－0.08 - 0.73). Conclusion: The inter-observer agreement varies with the type of lesions and diagnosis. Pneumologists were most effective for the diagnosis of pulmonary tuberculosis. Observers were more in agreement for the detection of nodules and the diagnosis of cancer than for the diagnosis of pulmonary tuberculosis.

Resume Introduction Le but de cette etude etait de determiner la prevalence et investiguer les facteurs associes a la sensibilisation a Blomia tropicalis (BT) chez les patients adolescents et adultes suivis pour asthme a Yaounde (Cameroun). Methodes Cette etude transversale a ete realisee de janvier 2012 a juin 2013. Tous les malades asthmatiques vus en consultation pendant la periode d’etude, et chez qui un test cutane aux pneumallergenes avait ete effectue, ont ete inclus dans l’etude. Resultats Des 201 patients inclus, 132 (65,7 %) patients etaient de sexe feminin, avaient un âge median (intervalle interquartile) de 36 ans (20,5–54,0) et 96 (47,8 %) patients avaient des tests cutanes positifs a BT. Le seul facteur clinique associe a une sensibilisation a BT etait la presence d’une rhinite persistante (odds ratio [intervalle de confiance a 95 %] : 2,06 [1,12–3,81]). Les facteurs allergologiques independamment associes a une sensibilisation a BT etaient la sensibilisation a Dermatophagoides pteronyssimus (3,49 [1,49–8,19]), Dermatophagoides farinae (4,88 [2,10–11,36]) et a la blatte germanique (4,16 [1,72–10,09]). Conclusion La sensibilisation a BT est frequente chez les malades asthmatiques a Yaounde et s’integre le plus souvent dans un contexte de polysensibilisation aux autres acariens et a la blatte germanique.

Objective Mycobacterium tuberculosis isolates that fail to hybridize to at least one rpoB wild-type or any mutation probe on the Genotype MTBDRplus strip are assumed to be rifampicin-resistant. However, the precise mutation(s) are unknown. We sought to identify the mutations in isolates with such hybridization patterns and determine if the mutations are associated with resistance to rifampicin. Methods In this study, 275 M. tuberculosis isolates were screened with the Genotype MTBDRplus assay to identify isolates with the hybridization pattern. These isolates were sequenced and their minimum inhibitory concentrations (MIC) determined using the Bactec MGIT 960 system. Results Among the 275 isolates tested, 15 (6%) isolates with the hybridization pattern were identified. Sequencing showed that failure to hybridize to rpoB wild-type probes resulted from the presence of ‘disputed' rifampicin mutations, which are mutations not always associated with a rifampicin-resistant phenotype. All, except 3/15, isolates had a rifampicin-resistant phenotype (MIC > 1 μg/mL). One of the three isolates with a rifampicin-susceptible phenotype had the same mutation at position 526 (His526Leu) as another isolate that had a rifampicin-resistant phenotype. Conclusion The recommendation of the Genotype MTBDRplus assay to assume rifampicin resistance based solely on failure to hybridize to rpoB wild-type probe allows the identification of important RIF-resistant isolates. About 20% (3/15) of such isolates could be missed by relying only on the standard MGIT 960 DST assay for drug susceptibility testing.

Background Drug-resistant tuberculosis, especially multidrug-resistant tuberculosis (MDR-TB), is a major public health problem. Effective management of MDR-TB relies on accurate and rapid diagnosis. In this study, we assessed the diagnostic accuracy of the Genotype MTBDRplus assay in diagnosing MDR-TB in Cameroon, and then discuss on its utility within the diagnostic algorithm for MDR-TB. Methods In this cross-sectional study, 225 isolates of Mycobacterium tuberculosis cultured from sputum samples collected from new and previously treated pulmonary tuberculosis patients in Cameroon were used to determine the accuracy of the Genotype MTBDRplus assay. We compared the results of the Genotype MTBDRplus assay with those from the automated liquid culture BACTEC MGIT 960 SIRE system for sensitivity, specificity, and degree of agreement. The pattern of mutations associated with resistance to RIF and INH were also analyzed. Results The Genotype MTBDRplus assay correctly identified Rifampicin (RIF) resistance in 48/49 isolates (sensitivity, 98% [CI, 89%–100%]), Isoniazid (INH) resistance in 55/60 isolates (sensitivity 92% [CI, 82%–96%]), and MDR-TB in 46/49 (sensitivity, 94% [CI, 83%–98%]). The specificity for the detection of RIF-resistant and MDR-TB cases was 100% (CI, 98%–100%), while that of INH resistance was 99% (CI, 97%–100%). The agreement between the two tests for the detection of MDR-TB was very good (Kappa = 0.96 [CI, 0.92–1.00]). Among the 3 missed MDR-TB cases, the Genotype MTBDRplus assay classified two samples as RIF-monoresistant and one as INH monoresistant. The most frequent mutations detected by the Genotype MTBDRplus assay was the rpoB S531 L MUT3 41/49 (84%) in RIF-resistant isolates, and the KatG S315 T1 (MUT1) 35/55 (64%) and inhA C15T (MUT1) 20/55 (36%) mutations in INH-resistant isolates. Conclusion The Genotype MTBDRplus assay had good accuracy and could be used for the diagnosis of MDR-TB in Cameroon. For routine MDR-TB diagnosis, this assay could be used for Mycobacterium tuberculosis cultures containing contaminants, to complement culture-based drug susceptibility testing or to determine drug resistant mutations.

Data on association between excessive daytime sleepiness (EDS) and hypertension are very limited in sub-Saharan Africa. The aim of this study was to look for an independent association between EDS and hypertension and identify the factors associated to EDS in adult subjects with hypertension in Cameroon. Data from cross-sectional community surveys conducted from 2015 to 2018 in three regions of Cameroon (West, Littoral, and North) were analyzed. The participants aged ≥ 19 years were included using multilevel stratified random sampling method. EDS was defined as an Epworth score ≥ 10. Subjects were considered to have hypertension if they were on treatment for hypertension or had a blood pressure ≥ 140/90 mmHg measured by standard protocols. Logistic regression was used to investigate the factors associated to EDS. The p-value < 0.05 was set as significant statistical threshold. A total of 8288 subjects (55.2% females) of median age (25th -75th percentiles) of 39 (27-54) years were included. The prevalence of EDS was higher in subjects who had hypertension as than in those without hypertension (13.4% vs 11.5%, p = 0.015), with an unadjusted odds ratio (IC 95%) of 1.19 (1.04-1.38). After multivariate analysis including place of residence, age, sex, education level and body mass index (BMI), we did not find an independent association between EDS and hypertension [odds ratio 95% CI): 1.01 (0.8-1.18), p = 0.937]. The determinants of EDS in subjects with hypertension were residence in Bandjoun [2.23 (1.12-4.11), p = 0.10], Douala [2.78 (1.48-5.25), p = 0.002] and Garoua [1.95 (1.01-3.74), p = 0.045] compared to Figuil; and BMI [1.04 (1.02-1.06) per 1kg/m2 increase, p = 0.001]. In conclusion, we did not find an independent association between EDS and hypertension in Cameroon. Obesity is associated with EDS in subjects with hypertension.

Introduction La tuberculose demeure un veritable probleme de sante publique dans le monde. Au Cameroun, 24 905 cas de tuberculose etaient declares en 2017, parmi lesquels 31 % personnes vivant avec le VIH [1] . L’incidence de la tuberculose etait de 194 (126–298) pour 100 000 habitants durant la meme annee. Le but de notre etude etait de determiner l’incidence et les facteurs predictifs de son devenir defavorable. Methodes Une cohorte retrospective des sujets d’au moins 15 ans etait reconstituee dans les tous les CDT de la ville de Yaounde, les regions de l’Ouest et du Centre au Cameroun. Les donnees des registres de 2010 a 2016 etaient collectees. Etait definit comme devenir defavorable, les patients dont le devenir etait deces, echec et abandon. Les patients gueris et ayant complete leur traitement etaient classe comme succes therapeutique. Les caracteristiques des patients ayant un devenir defavorable ont ete comparees a ceux des patients avec succes therapeutique. La regression logistique a ete utilisee pour determiner les facteurs predictifs du devenir defavorable. Resultats Des 26 195 patients inclus, 16 381 (62,5 %) sujets etaient de sexe masculin et l’âge median (intervalle interquartile) etait de 34 (19) ans. L’incidence (IC95 %) du devenir defavorable etait de 14,8 % (14,4–15,3 %). Le devenir defavorable etait represente respectivement par 2171 (8,2 %) decedes, 1427 (5,5 %) perdus de vue et 285 (1,1 %) patients en echec de traitement de categorie I. Les facteurs predictifs [odds ratio (IC95 %)] du devenir defavorable au cours de la tuberculose retrouves dans notre etude etaient le sexe masculin [1,673 (1,479–1,892), p Conclusion L’incidence du devenir defavorable au cours de la tuberculose est elevee au Cameroun. Les facteurs predictifs de devenir defavorable sont l’âge, le sexe masculin, le faible poids, les regions du Centre et de l’Ouest, et la co-infection TB/VIH. Une prise en charge adequate du VIH, diminuerait le taux de deces au cours de la tuberculose.

Introduction To derive and validate against the Ralph et al. score, a simplified chest X-ray (CXR) score (SCS) for predicting the outcome of smear-positive pulmonary tuberculosis (SPPTB) among patients with high prevalence of human immunodeficiency virus (HIV) infection. Methods CXR for 636 SPPTB patients (377 men, median age 31 years) from the Yaounde Jamot Hospital (Cameroon) were examined for the presence of tuberculosis lesions, and estimation of the proportion of lungs affected. SPPTB's evolution was based on sputum smear examination after 2 months of treatments. Logistic regressions were used to derive the SCS with internal validation via bootstrap resampling. Receiver operating characteristic curves (AUC) analyses were used to validate, determine of the optimal cut-offs and compare models' performance. Results HIV co-infection was present in 191 (30%) patients. Sputum smear non-conversion was found in 45 (7.1) patients after 2 months of treatment. The SCS was expressed as proportion of lung affected plus 23 if cavitation is present. The AUC (95% confidence interval) was 0.718 (0.640–0.795), with little variation in bootstrap validation, and no sizable difference from the Ralph et al. model [0.714 (0.633–0.7860), P = 0.717 for the difference). Both models had good calibration (Hosmer–Lemeshow P ≥ 0.183). The optimal cut-off for predicting non-conversion of the sputum at 2 months was 52 for the SCS (sensitivity/specificity 66.7%/62.8%) and 74.5 (62.2%/74.3%) with Ralph et al. score. Conclusions The outcome of SPPTB among patients with high prevalence of HIV can acceptably be predicted by simple scores comprising baseline CXR variables, including the Ralph et al. score and the SCS from this study.

Purpose: The complexity of chest radiography (CXR) is a source of variability in its interpretation. We assessed the effect of an interpretation grid on the detection of CXR anomalies and radio- graphic diagnosis of tuberculosis in an endemic area for tuberculosis. Methods: The study was conducted in Yaounde (Cameroon). Six observers (2 pulmonologists, 2 radiologists and 2 senior residents in medical imaging) interpreted 47 frontal CXR twice two months apart without (R1) and with (R2) the aid of an interpretation grid. We focused on the detection of micro nodules (n = 16), cavitations (n = 12), pleural effusion (n = 6), adenomegaly (n = 6), and diagnosis of tuberculosis (n = 23) and cancer (n = 7). Results: The average score for accurate detection of elementary lesions was 40.4% [95%CI: 25% - 58.3%] in R1 and 52.1% [36.9% - 65.3%] in R2. The highest im- provement was observed for micro nodules (19.8%). Cavitations had the highest proportions of accurate detections (58.3% in R1 and 65.3% in R2). The average score of accurate diagnosis was 46.1% in R1 and 57.4% in R2. Accurate diagnosis improved by 3.6% for tuberculosis and 19% for cancer between R1 and R2. Intra-observer agreement was higher for the diagnosis of cancers (0.22 ≤ k ≤ 1) than for diagnosing tuberculosis (0.21 ≤ k ≤ 0.68). Inter-observer agreement was highly variable with a modest improvement for the diagnosis of tuberculosis in R2. Conclusion: Standardized interpretation scheme improved the detection of CXR anomalies and diagnosis of tuberculosis. It significantly improved inter-observer’s agreement in diagnosing tuberculosis but not in detecting most lesions.

Background: Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations. Methods: We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individuallevel data on one or more of the following traits in HIVþ and HIV-, or ARTþ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants. Results: Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, 0.59; 95% CI, 0.86 to 0.31), BMI (SMD, 0.32; 95% CI, 0.45 to 0.18), SBP (SMD, 0.40; 95% CI, 0.55 to 0.25) and DBP (SMD, 0.34; 95% CI, 0.51 to 0.17). Among HIVþ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, 0.34; 95% CI, 0.62 to 0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits. Conclusions: Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important to clarify these findings to reliably assess the need for monitoring and managing cardiometabolic risk in HIV-infected populations in SSA. http://ije.oxfordjournals.org/ http://dx.doi.org/10.1093/ije/dyt198

Summary: Purpose: To assess the prevalence and determinants of non-adherence to antiretroviral therapy (ART) as well as the concordance of two screening criteria in a major center for human immunodeficiency virus (HIV) treatment in Yaounde, Cameroon. Methods: In 2011, we conducted a cross-sectional study involving a random sample of 889 adults (age > 18 years, 67.9% women) infected with HIV who were receiving chronic care at the Yaounde Jamot Hospital. Adherence was assessed via self-administered questionnaires using the Community Programs for Clinical Research on AIDS (CPCRA) index and the Center for Adherence Support Evaluation (CASE) index. Results: The prevalence of non-adherence to ART was 22.5% based on the CPCRA index and 34.9% based on the CASE index, with a low agreement between the two indexes [kappa = 0.37 (95% confidence interval 0.31–0.44)]. Independent determinants of CPCRA-diagnosed non-adherence were as follows: being a remunerated employee [odds ratio (95% confidence interval): 1.61 (1.14–2.28)], Pentecostal Christianity [2.18 (1.25–3.80)], alcohol consumption [1.65 (1.16–2.34)] and non-adherence to cotrimoxazole prophylaxis [5.73 (3.92–8.38)]. The equivalents for CASE-diagnosed non-adherence were [1.59 (1.19–2.12)], [1.83 (1.36–2.47)], [1.70 (1.27–2.28)], respectively, in addition to association with changes to the ART regimen [1.61 (1.17–2.20)]. Conclusions: Non-adherence to ART remains high in this population. The careful evaluation of patients for the presence of determinants of non-adherence identified in this study may aid ART optimization. Keywords: Antiretroviral therapy, Adherence, HIV infection, Cameroon

Background: Spirometric reference values vary substantially across ethnic groups, and remain largely poorly characterized among Africans. We derived spirometric reference equations for adult Cameroonians and compared their performance with those derived from other ethnic groups. Methods: Spirometric variables according to the American Thoracic Society/European Respiratory Society 2005 guidelines were acquired in voluntary healthy non-smoker subjects in Yaounde (Capital City) and Foumbot (semi-urban area in West Region), in Cameroon during November 2011 to January 2012 (Yaounde) and August 2012 (Foumbot). Reference equations were derived separately for men and women from multiple linear regressions. Results: A total of 411 subjects (206 men) met the inclusion criteria. The mean age was 39.5 ± 16.1 years (min - max: 18 - 85 years) for men and 39.2 ± 14.1 years (18 - 90 years) for women. Age and height were the only variables significantly associated with spirometric values in the final linear regression models. Derived reference values were lower than those derived from Global Lung Initiative 2012 equations for different ethnic groups, except for the forced expiratory volume in 1 second/forced vital capacity ratio (FEV1/FVC ratio). The mean FEV1/FVC ratio was 0.88 ± 0.07 for Cameroonian men and 0.89 ± 0.07 for Cameroonian women. Variations in the performance of derived models in bootstrap internal validation were marginal. Conclusion: This study highlights the importance of deriving specific predictive equations for each ethnic group. The use of adjustment factors applied to Caucasian equations when compared with the values derived in our study leads to an overestimation of the values for FEV1 and FVC.