Search

Background: Chronic Hepatitis B (CHB) infection is a major public health problem in the world. Cameroon has a high prevalence, estimated at about 11.2%. In Cameroon the management of CHB remains very challenging. The study aims at assessing the clinical assessment and the steps of the Continuum of Care (CoC) of chronic hepatitis B patients. Methods: A hospital based retrospective cohort study reviewing files of CHB patients who attended care from January 2014- December 2017 in the Douala General Hospital, a tertiary hospital in Cameroon. The CoC was assessed As follows step 1- enrolment in care, step 2-basic work up done, step 3- antiviral treatment uptake, step 4- viral load suppression. Descriptive statistics was used to represent proportions, the Kaplan Meier curve estimated retention in care and multivariate analysis identified independent association with treatment uptake. Results: The mean age at diagnosis was 33.7 (±12.0) years, males were predominant with 59.4%. The characteristics of the CoC were as follows: were enrolled in care 1033 patients, 492 (47.6%) completed the basic work up, were initiated on treatment 121 (11.7%); and viral load suppression was achieved in 53 (5.1%). Sociodemographic characteristics such as male gender (aOR: 2.1, CI: 1.2- 3.5), older age > 34 years (aOR 0.03, CI: 0.003-0.33), having a medical insurance (aOR: 5.7, CI: 3.0-10.9) were independently associated with treatment uptake. Conclusion: The study clearly showed a decreasing proportions of patients at various steps of the CoC, with treatment uptake mostly influenced by some sociodemographic factors. The real need to develop strategies to improve the CoC of CHB in Cameroon is therefore very apparent.

Resume Introduction L’impact de la pandemie a COVID-19 sur les malades renaux chroniques en instance de dialyse en Afrique sub-saharienne est inconnu. L’objectif de cette etude est de decrire le profil epidemio-clinique et la survie a court terme des patients incidents en hemodialyse chronique au cours de la pandemie a COVID-19 au Cameroun. Materiel et methode Nous avons conduit une cohorte prospective de 6 mois incluant tous les patients incidents en hemodialyse chronique a l’hopital general de Douala, d’avril a octobre 2020. Les patients avec une infection suspectee ou confirmee a SARS-CoV2 etaient identifies comme COVID-19. Nous nous sommes interesses aux donnees socio-demographiques, cliniques et biologiques a l’admission en dialyse, et a la mortalite dans les 9 jours. Resultats Au total, 57 patients incidents ont ete enregistres, soit une moyenne mensuelle de 9,5 patients. La moyenne d’âge etait de 46,9 ± 13,1 ans. Vingt-quatre patients (42 %) avaient une COVID-19 (49 % des dialyses en urgence). L’œdeme aigu du poumon (79,2 % vs 42,4 % ; p = 0,006) et l’encephalopathie uremique (83,4 % vs 53,6 % ; p = 0,022) etaient plus frequents au cours de la COVID-19 compares aux patients non COVID-19. La survie globale a 90 jours etait de 49 %, avec une tendance plus faible chez les patients COVID-19 et ceux ayant un faible niveau socio-economique. En regression de Cox, le risque de deces instantane augmentait de 3,08 en cas de niveau socio-economique faible. Conclusion L’infection a SARS-CoV2 est associee a une tendance a la majoration des urgences et de la mortalite a court terme en dialyse dans notre contexte.

BACKGROUND Data on the prevalence and factors associated with low back pain (LBP) in schoolchildren are scarce in Africa, particularly in sub-Saharan Africa. OBJECTIVES To assess the prevalence and factors associated with LBP in schoolchildren in Cameroon. PATIENTS AND METHODS We performed a cross-sectional study in 10 randomly selected schools (public and private) in Douala, Cameroon. Using a self-administrated questionnaire, sociodemographic, usual physical activity, and clinical data were collected and all the schoolbags were weighted. Informed consent was obtained from the parents. Statistical significance was established at P

Background Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. The aim of this study was to standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. Methods This was a prospective, multicentric study from 1 December 2018 to 31 July 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the number connection test-A, number connection test-B, serial dotting test, line tracing test were expressed in seconds and those of the digit symbol test in points. Results A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3 ± 15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62 ± 3.9 years in cirrhotic patients. The PHES of the healthy volunteer group was − 0.08 ± 1.28 and the cut-off between normal and pathological values was set at − 3 points. PHES of the cirrhotic patients was − 7.66 ± 5.62 points and significantly lower than that of volunteers (p Conclusion PHES cut-off value in Cameroonians is − 3, with MHE prevalence of 74% among cirrhotic patients.

Background Limited information is available about cardio-embolic stroke (CES) in sub-Saharan Africa. The aim of this study was to describe the epidemiology, clinical features, etiology, the management and outcome of CES in our setting. Methods A retrospective cohort study was carried out in the Douala General Hospital (DGH), using files of ischemic stroke patients admitted in the Neurological Unit and the Intensive Care Unit. Socio-demographic, clinical and paraclinical data were collected. After hospitalization, follow-up was performed with focus on mortality, stroke recurrence and the functional outcome assessed with Barthel score. Multivariate analysis was performed to determine the factors associated with death. Results Of the 704 stroke cases included, 368 were ischemic with 86 (23.4%) of them being cardio-embolic. The mean age of patient with CES was 67 ± 13.3 years. The main etiologies of CES were: atrial fibrillation (82.1%), dilated cardiomyopathy (12.8%), and rheumatic mitral stenosis (5.1%). Anti-platelet agents were the most prescribed anti-thrombotic drugs (50.7%). The in-hospital mortality rate was 23.3% with lesion in both internal carotid arteries [OR = 110.3; 95% CI: 1.2–1040.7; P = 0.043] and heart disease [OR = 46.9; 95% CI: 1.2–1789.9; P = 0.038] appeared to be predictive of this. Stroke recurrence was observed in 8 patients (12.1%) and the survival probability in 5 years was 10%. Functional outcome was progressively worse with the systolic blood pressure > 140 mmHg (P = 0.025) been the associated factor. Conclusion CES accounted for 1/4 of ischemic stroke with a high risk of early death and long-term recurrence. Atrial fibrillation was the leading cause of CES. The association of VKA and anti-platelet agent should be avoided to reduce early death during acute stroke.

Background and Aims: Diagnostic colonoscopy allows exploration of the colonic mucosa. Indications are multiple. The purpose of this work was to describe the indications and to report the lesions observed during colonoscopy at the General Hospital of Douala. Methods: This was a cross-sectional study with retrospective data collection over a period of 7 years (January 1, 2010 to January 31, 2017). The data collected from the reports were socio-demographic characteristics, indications and lesions observed at colonoscopy. Binary logistic regression allowed us to identify the independent risk factors associated with the presence of tumors and polyps. Results: We included 719 exams. The main indications were rectorrhagia (29.5%), abdominal pain (25.9%) and constipation (17.8%). A colonic lesion was found in 60.1% of cases. A colorectal tumor accounted for 10.3% of cases. Factors independently associated with colonic tumor were complete colonoscopy (aOR: 0.167 95% CI [0.096 - 0.289], p < 0.001), presence of abdominal or rectal mass (aOR: 13.390 95% CI) [5.684 - 31.544], p < 0.001) and weight loss (aOR: 5.143, 95% CI [2.450 - 10.797], p < 0.001). Conclusion: The presence of weight loss, abdominal or rectal mass should motivate the realization of a complete colonoscopy in search of a colorectal tumor. The most observed lesions remain hemorrhoids, polyps and diverticulosis of the colon.

Background: Venous thromboembolic (VTE) disease burden is increasing worldwide, representing a major cause of cardiovascular death and public health problem. Pulmonary embolism (PE) is the most serious clinical presentation of VTE. Epidemiological and clinical data on PE are still lacking in Africa, particularly in Cameroon. This study aimed at determining the clinical features as well as imaging presentation and outcome of pulmonary embolism. Methods: A cross-sectional study was carried out in three hospitals in Douala. We retrospectively reviewed patient records admitted for PE from January 2009 to May 2017. We collected data on epidemiology, clinical presentation, venous Doppler/pulmonary computed tomographic angiography (CTA), and outcome. Results: We included 103 patients (56 males) with PE. Their median age was 52 years. The main risk factors were obesity (49.5%), hypertension (35.0%), long trip (24.3%) and cancer (18.4%). The most frequent clinical presentations were dyspnoea (83.4%), chest pain (78.6%), and cough (40.8%). Additionally, pleural effusion (32.8%), atelectasis (25.7%) and pulmonary hyperlucency (20.0%) were the most frequent findings on chest X-ray. The main abnormalities found in electrocardiogram were sinus tachycardia (63.4%), S1Q3T3 aspect (37.6%) and right axial deviation (28.7%). Moreover, right cavities dilatation (26.0%), pulmonary artery hypertension (35.0%) and pulmonary artery dilatation (21.0%) were the main echocardiographic findings. Low-molecular-weight heparin (LMWH) was the initial anticoagulant in all cases. There were 19 (18.4%) in-hospital deaths, and the mean hospital stay was 8.5 ± 5 days. Conclusion: PE is not rare in our setting. Obesity, long trip and cancer are the main risk factors, while dyspnoea, chest pain and respiratory distress are the main clinical presentation for PE. LMWH remains the therapeutic agent of choice. Lastly, in-hospital mortality is very high.

Rituximab (RTX), a chimeric monoclonal anti-CD20 antibody has become part of the standard therapy for patients with CD20-expressing B-cell lymphoma and rheumatoid arthritis. After encouraging results with open studies in systemic lupus erythematosus (SLE), RTX has not shown its effectiveness in randomized controlled trials. However, its efficacy has been validated in renal, hematological, and neuropsychiatric disorders. Understanding the history of RTX in SLE would be instructive in the hydroxychloroquine (HCQ) saga in COVID-19. Three steps would be necessary and sufficient before definitively closing the debate: 1) determine the effective and safe dose of HCQ, as well as the minimum duration of treatment in COVID-19; 2) define the profile of patients in whom HCQ would be more likely to be effective (especially in asymptomatic patients and/or at the onset of the first signs of the disease) and 3) conduct one or more multicentre RCT to evaluate the efficacy and safety of HCQ in COVID-19 in SSA.

Introduction L’impact de la pandémie à COVID-19 sur les malades rénaux chroniques en instance de dialyse en Afrique sub-saharienne est inconnu. L’objectif de cette étude est de décrire le profil épidémio-clinique et la survie à court terme des patients incidents en hémodialyse chronique au cours de la pandémie à COVID-19 au Cameroun. Matériel et méthode Nous avons conduit une cohorte prospective de 6 mois incluant tous les patients incidents en hémodialyse chronique à l’hôpital général de Douala, d’avril à octobre 2020. Les patients avec une infection suspectée ou confirmée à SARS-CoV2 étaient identifiés comme COVID-19. Nous nous sommes intéressés aux données socio-démographiques, cliniques et biologiques à l’admission en dialyse, et à la mortalité dans les 9 jours. Résultats Au total, 57 patients incidents ont été enregistrés, soit une moyenne mensuelle de 9,5 patients. La moyenne d’âge était de 46,9 ± 13,1 ans. Vingt-quatre patients (42 %) avaient une COVID-19 (49 % des dialyses en urgence). L’œdème aigu du poumon (79,2 % vs 42,4 % ; p = 0,006) et l’encéphalopathie urémique (83,4 % vs 53,6 % ; p = 0,022) étaient plus fréquents au cours de la COVID-19 comparés aux patients non COVID-19. La survie globale à 90 jours était de 49 %, avec une tendance plus faible chez les patients COVID-19 et ceux ayant un faible niveau socio-économique. En régression de Cox, le risque de décès instantané augmentait de 3,08 en cas de niveau socio-économique faible. Conclusion L’infection à SARS-CoV2 est associée à une tendance à la majoration des urgences et de la mortalité à court terme en dialyse dans notre contexte.

Background: Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. Aim: To standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. Methods: This was a prospective, multicentric study from December 1st, 2018 to July 31st, 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the Number Connection Test-A (NCT-A), Number Connection Test-B (NCT-B), Serial Dotting Test (SDT), Line Tracing Test (LTT) were expressed in seconds and those of the Digit Symbol Test (DST) in points. Results: A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3±15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62±3,9 years in cirrhotic patients. The PHES of the healthy volunteer group was -0.08 ± 1.28 and the cut-off between normal and pathological values was set at −3 points. PHES of the cirrhotic patients was -7.66 ± 5.62 points and significantly lower than that of volunteers (p Conclusion: PHES cut-off value in Cameroonians is -3, with MHE prevalence of 74% among cirrhotic patients.

Background: With easy accessibility to combination Antiretroviral Therapy (cART), mortality amongst hospitalized HIV/AIDS patients needs to be described. Objective: We aimed at determining the trends, causes and factors associated with in-hospital mortality amongst HIV/AIDS patients in the Douala General Hospital. Methods: We retrospectively reviewed hospitalisation records of HIV/AIDS patients hospitalized in the medical wards of the DGH from 2007 to 2015. Four cause-of-death categories were defined: 1. Communicable conditions and AIDS-defining malignancies, 2. Chronic non-communicable conditions and non-AIDS defining malignancies’, 3. Other non-communicable conditions and 4. Unknown conditions. Logistic regression was used to determine factors associated mortality. Results: We analyzed 891 eligible files. The mean age was 43 (standard deviation (SD): 10) years and median length of hospital stay was 9 (interquatile range (IQR)4 - 15) days. The overall all-cause mortality was 23.5% (95% CI: 20.8% - 26.4%). The category - communicable conditions and AIDS defining malignancies represented 79.9%, of deaths and this remained constant for each year during the study period. Tuberculosis was the most common specific cause of death (23.9%). Patients who had two (OR=2.35, 95%CI: 1.35 - 4.06) and more than two (OR=4.23, 95%CI: 1.62 – 11.12) opportunistic infections, a haemoglobin level less than 10g/l (OR=2.38, 95%CI: 1.58 - 3.59) had increased odds of dying. Conclusion: In-hospital mortality is high amongst HIV/AIDS patients at the Douala general hospital. The category - communicable conditions and AIDS defining malignancies - is still the main underlying cause of death. We hope that our findings will help to develop interventions aimed at reducing in-hospital mortality.

BACKGROUND: Increased aortic pulse wave velocity (PWV), a direct measure of arterial stiffness (AS) is an independent predictor of cardiovascular events (CVEs) in chronic kidney disease (CKD) patients. This study assessed the patterns of PWV among Cameroonian patients with CKD in whom that marker of early vascular aging has not been explored so far. METHODS: We enrolled 150 Black African patients (mean age: 52±15 years, 56.7% males) with CKD in a cross-sectional study conducted at Douala General Hospital, Douala, Cameroon. Sociodemographic, anthropometric and biologic variables, blood pressure (BP) and PWV were recorded in all participants. Estimated aortic PWV was measured using a Mobil-O-Graph automatic brachial oscillometric device. RESULTS: PWV increased with aging (P

There is no Occupational Health and Safety (OHS) system for the mining sector in Cameroon, and miners are exposed to numerous health and safety risks inherent from Artisanal Gold Mining (AGM) activity. Also very few studies have addressed the health problems in AGM in Cameroon. This study seeks to create an awareness of the health and environmental issues surrounding the mining sector in Cameroon so as to foster its development. It was a cross-sectional, observational, and communitybased study involving 273 respondents from three different communities. Questionnaires and interviews were used to collect data. OHS risk assessment was conducted through direct observation and inspection of five different workplaces. Blood samples were collected and analyzed for the presence of mercury and lead. Gold miners in Batouri are exposed to the risk of physical injuries, respiratory conditions, diarrheal conditions, psychotic disorders, dermatophyte infections, helminthic infestations, malaria and musculoskeletal problems. The most common health problems among miners are musculoskeletal disorders (35.6%), malaria (26.4%) and hernias (14.9%), while malaria (18.7%) and musculoskeletal disorders (15.4%) are common among stakeholders. The mean blood mercury and lead levels among miners is 2.27 ± 8.85 μg/L and 12.73 ± 32.73 μg/L respectively, and 9.1% of them are chronically intoxicated with mercury, reporting ≥ 4 symptoms possibly related to mercury intoxication. The major environmental problems are deforestation, land degradation, water pollution, air pollution and water-logged pits. AGM in Batouri, therefore, has a negative impact on human health and environmental sustainability.

Background: The hospital environment is largely contaminated with pathogenic microorganisms. This colonization is a threat for hospitalized patients, especially in high-risk services. The purpose of this study was to identify the germs found on surfaces and medical devices in some departments of the General Hospital of Douala, and to establish their susceptibility profile to most commonly used antibiotics in this health facility. Results: We collected 114 surface and medical device samples, and seeded different culture media for Gram-positive and Gram-negative aerobic bacteria. Of the total samples, 108 were positive and 137 bacterial strains were isolated. The colony count revealed a high rate of contamination. Enterobacter cloacae was the most represented specie (53.3%), followed by Pseudomonas aeruginosa (22.6%) and Klebsiella pneumoniae (6.6%). Various coagulase-negative Staphylococci have been isolated in some departments, as well as Cryptococcus laurentii and molds. The isolated strains showed low susceptibility to the antibiotics tested. Enterobacter cloacae showed low susceptibility for all tested molecules, except for carbapenems with rates ranging from 82% to over 94% in Maternity, Intensive Care and Neonatology units. The strains coming from the Haematology Protected Ward were resistant to all antibiotics, except fluoroquinolones with a susceptibility rate of 50% for ofloxacin. Conclusion: The hospital surfaces and medical devices are highly contaminated by environmental bacteria, with low susceptibility rates to antibiotics. Microbiological controls of the environment should be regular in critical areas in order to reinforce measures to prevent diffusion of multi-resistant bacteria.

Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality worldwide. It is also the most common complication in hospitalized patients. Aims: To study the in-hospital prevalence of VTE, describe the socio-demographic characteristics of patients, determine the frequency of risk factors, describe the clinical presentations, and determine the short term outcome of VTE in hospitalized patients in a low-income tertiary hospital setting. Methods: We carried out a cross-sectional descriptive retrospective study over a period of 6 years and 4 months (January 2008 to April 2014) in the Douala General Hospital—Cameroon. Patients were cases of confirmed venous thromboembolic disease (VTE). Results: A total of 78 case files were retained for this study, giving an in-hospital prevalence of 4.4 per 1000 admissions. There were 42 (53.8%) males and 36 (46.1%) females. Their ages ranged from 18 to 89 years (median: 53 years, [IQR: 40 - 61]). There were 37 (47.4%) cases of Deep Vein Thrombosis (DVT), 31 (39.7%) cases of Pulmonary Embolism (PE), and 10 (12.8%) cases of PE associated with DVT (12.8%). The main risk factors were obesity (44.9%), hypertension (37.2%), immobility (20.5%), and long-haul travel (17.9%). The most frequent clinical presentations in PE were dyspnea (80.5%) and chest pain (65.9%). There were 8 (10%) in-hospital deaths. Conclusion: About twelve cases of VTE are seen yearly at the DGH, with an in-hospital mortality of ten percent. Obesity and hypertension were the main risk factors, with dyspnea and chest pain being the main clinical manifestations in PE, and lower limb swelling the main symptom in DVT.

Background: The burden of peripheral artery disease (PAD) is not well known among apparently healthy people in Africa. Aim: To determine the prevalence and associated risk factors of PAD in a group of blood donors seen at the Douala General Hospital—Cameroon. Methods: Between 1st November 2015 and 30th April 2016, we carried out a cross-sectional study. Participants were consenting adults of both sexes, aged ≥ 21 years who presented for blood donation, and were tested HIV negative. We collected socio-demographic data and their past history. We carried out a physical examination and measured their Ankle-Brachial Index (ABI). We defined PAD as an ABI < 0.9. We also measured their fasting blood glucose and lipid profile. Results: We recruited 103 participants, 55.4% males. The mean age was 33 ± 10 years. The mean ABI on left and right leg was 1.04 ± 0.1 and 1.02 ± 0.1respectively. ABI was higher in males than females both legs (p < 0.05). PAD was seen in 11 (10.7%) participants. This was higher in females than males (3.6% versus 19.2%, p = 0.026). Among those with PAD, 8 (72.7%) were asymptomatic (Males: 100% versus Females: 66%, p = 0.9). After adjusting for age and gender, sedentary lifestyle (aOR: 7.14, [95% CI: 1.38 - 33.3], p = 0.019), and female gender (aOR: 6.2, [95% CI: 1.26 - 30.5], p = 0.025) were significantly associated with PAD. Conclusion: The prevalence of PAD was high in this group of HIV negative blood donors, most of whom were asymptomatic. This was associated with females, and a sedentary lifestyle.

Objective: There are limited data on AKI in sub-Saharan Africa. We aim to determine the incidence, characteristics and prognosis of AKI in Cameroon. Patients and methods: A prospective study including all consenting acute admissions in the internal medicine and the ICU of a tertiary referral hospital in Cameroon from January 2015 to June 2016. Serum creatinine assay was done on admission, days 2 and 7 to diagnose AKI. For patients with AKI, serum creatinine was done on discharge, days 30, 60 and 90. AKI was defined according to the modified KDIGO 2012 criteria as an increase or decrease in serum creatinine of 3 mg/l or greater, or an increase of 50% or more from the reference value obtained at admission or the known baseline value. AKI severity was graded using KDIGO2012 criteria. Outcome measures were renal recovery, mortality and causes of death. Renal recovery was complete if serum creatinine between the first 90 days was less than baseline or reference, partial if less than diagnosis but not baseline or reference, no-recovery if creatinine did not decrease or if the patient remained on dialysis. Results: Of the 2402 patients included, 536 developed AKI giving a global incidence of 22.3% and annual incidence of 15 per 100 patients-years. Of the 536 patients with AKI, 43.3% were at stage 3, 54.7% were males, median age was 56 years. Pre-renal AKI (61.4%) and acute tubular necrosis (28.9%) were the most frequent forms. Main etiologies were sepsis (50.4%) and volume depletion (31.6%). Renal outcome was unknown in 34% of patients. Of the 354 patients with known renal function at 3 months, 84.2% recovered completely, 14.7% partially and 1.1% progressed to CKD. Global mortality rate was 36.9% mainly due to sepsis. Conclusions: AKI is frequent in our setting, mainly due to sepsis and hypovolemia. It carries a poor prognosis.

Background Lumbar spinal stenosis (LSS) refers to narrowing of the lumbar central spinal canal, lateral recess, and/or neuro-foramina. Radiographic LSS plays an important role in clinical LSS but is not solely accountable for the presence of symptoms. We sought to characterise clinical LSS and to determine factors associated with presence of symptoms of LSS in patients with radiographic LSS in a sub Saharan Africa setting. Methods After prior ethical clearance, a case control study was done in a tertiary hospital in Douala-Cameroon, including 105 patients with radiographic LSS: 57 with symptoms of LSS (cases) and 58 with no symptoms (controls). Spinal stenosis was assessed using computed tomography (CT) scans. Data were analysed using SPSS version 23. Results The mean age of our study participants was 53.4 ± 13.1 years. The mean age of onset of symptoms of LSS was 50.3 ± 11.6 years and the most common symptoms were Low back pain (100.0%), radicular symptoms (98.2%) and neurogenic claudication (98.2%). Obesity (p

The authors assessed the frequency of glucose homeostasis abnormalities among 839 Cameroonians with newly diagnosed hypertension (mean age: 50.8±11 years; 49.9% female) in a cross‐sectional survey conducted at the Douala General Hospital, Douala, Cameroon. In all participants, blood pressure, fasting plasma glucose (FPG), and lipids were recorded. Impaired fasting glycemia was described as an FPG level between 100 and 125 mg/dL and provisional diabetes as an FPG level ≥126 mg/dL. The FPG was 101±30 mg/dL. The overall proportion of abnormal glucose homeostasis was 38.3%, while 7.7% of patients (n=65) had known diabetes. A total of 23.7% (n=199) had impaired fasting glycemia and 6.8% (n=57) had provisional diabetes. Multivariable logistic regression revealed that male sex (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.15–2.06), age older than 55 years (OR, 1.55; 95% CI, 1.15–2.09), and low‐density lipoprotein cholesterol >1 g/L (OR, 1.34; 95% CI, 1.00–1.82) were independently associated with abnormal glucose homeostasis (all P

Background: Studies suggest that sex differences have an impact on patients with stroke, but existing data in Africa remain inconclusive about this inference. Objectives: To study sex differences in terms of the clinical profile and short-term outcome of stroke in the Douala General Hospital, Cameroon. Methods: A hospital-based prospective cohort study was carried out in a tertiary care hospital over an 8-year period, which included all patients admitted for confirmed acute stroke. Information about the history of stroke with emphasis on clinical profile and outcome was collected. Descriptive statistics, t test, and chi square test were used for comparisons, while the Kaplan-Meier curve was used for survival rate analysis. Results: Of the 818 patients included, 455 (55.6%) were male patients. When compared to males, female patients are more likely to experience a stroke at an older age (mean age 62.3 ± 14.1 vs. 58.4 ± 12.9 years, p < 0.001), to be unmarried, to remain unemployed, and to have higher rates of cardio-embolic stroke (p = 0.049), body mass index (p = 0.031), altered levels of consciousness at presentation (p = 0.005), higher mean HDL cholesterol levels (p = 0.001), and in-hospital complications (p = 0.011), especially urinary tract infections (p = 0.018). Males were more likely to have health insurance, to smoke, to consume alcohol (p < 0.001), and to have higher rates of dysarthria (p = 0.004), higher mean uric acid (p = 0.013), and creatinine (p < 0.001) concentrations. Ischemic and hemorrhagic strokes were more prevalent in men (p = 0.003). There are no sex differences in terms of stroke severity, length-of-hospital stay, case fatality, and functional outcome on admission. Conclusions: Sex differences exist in the clinical profile of stroke but not in the outcome. Knowledge of these differences could help influence stroke prevention, thereby improving stroke burden in Africa.

International audience; Cryptococcal antigen (CrAg) screening and targeted preemptive fluconazole in antiretroviral-naive human immunodeficiency virus-infected adults with CD4 cell counts

Background: Cardiac surgery is a growing activity in Sub-Saharan Africa, however, data related to long-term mortality are scarce. We aimed to analyze outcome data of cardiac interventions in two hospitals in Cameroon over 10 years' period. Methods: we conducted a retrospective analytical and descriptive study at the Douala General Hospital and Yaoundé General Hospital. All patients operated between January 2007 and December 2017, or their families were contacted by phone between January and April 2018 for a free of charges medical examination. Results: Of a total of 98 patients operated during the study period, 8 (8.2%) were lost to follow-up. Finally, 90 patients [49 (54.4%) women and 41 (45.6%)] men were included. The mean age was 49±22 years (range, 13-89 years). The surgical indications were valvular heart diseases in 37 (41.1%) cases, congenital heart diseases in 11 (12.2%) cases, chronic constrictive pericarditis in 4 (4.4%) cases, and intra cardiac tumor in 1 (1.1%) case. Valve replacement was the most common type of surgery carried out in 37 (41.1%) cases-mostly with mechanical prosthesis. Pacemaker-mostly dual-chambers were implanted in 36 (40.0%) patients. The median follow-up was 26 months. The overall late mortality was 5.7%, and the overall survival rates at 5 and 10 years were 95.5% and 94.4% respectively. The overall survival rates at 5 and 10 years for mechanical valve prosthesis were 93.3% and 90% respectively. The survival at 10 years was 100% for patients with bioprosthesis. The survival rates at 10 years were 94.1% and 100% respectively for dual and single chamber pacemaker. Conclusions: Long-term outcome of cardiac surgery in hospitals in Cameroon are acceptable with low mortality rate. However, outcome metrics beyond mortality should be implemented for a prospective data collection., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction Le cancer de l'œsophage est une affection rare. Le pronostic péjoratif est lié au diagnostic tardif. La survie à 5 ans est de moins de 20%. Le but de ce travail était de rechercher les facteurs associés à la survie des patients atteints d'un cancer de l'œsophage au Cameroun. Méthodes Il s'agissait d'une étude pronostique, sur une période de 11 ans allant du 1er janvier 2005 au 31 décembre 2015 dans les Hôpitaux Généraux de Yaoundé et de Douala. Les paramètres étudiés étaient ceux associés à la survie. La survie était établie en fonction de la date du diagnostic et de la date du décès ou de la dernière consultation. Le logiciel SPSS (Statistical Package for Social Sciences) version 23 a permis l'analyse des données. La survie était présentée sous forme de courbe de Kaplan Meier. Le Test de Log Rank a permis la comparaison entre les différents groupes. La régression de Cox a permis de ressortir les différents facteurs associés. Le seuil de significativité était de 0,05. Résultats Nous avons colligé 49 dossiers. L'âge moyen était de 57,83 ans. Le sexe masculin était présent dans 71,4% (n = 35) des cas pour un sex ratio à 2,49. Le suivi moyen était de 3,2 mois. La médiane de survie était de 6,67 mois (IC95% [1,33-10,4]) et la moyenne de survie était de 7,99 mois (IC95% [4,42-11,17]). En analyse multivariée après ajustement il ressortait que le stade IV était un facteur prédictif de mortalité (HR = 2,79; IC95% [1,13-6,89], p = 0,025]). Conclusion Le cancer de l'œsophage reste une affection rare au pronostic péjoratif. Le facteur pronostique est le stade tumoral.

While gastrointestinal disease is common among HIV infected individuals, the prevalence and distribution of ano-rectal pathology has not been well studied in our setting. The objective of this study therefore was to determine the prevalence and determinants of ano-rectal pathology in HIV infected patients attending the Douala General Hospital HIV treatment centre. A hospital-based cross-sectional study was undertaken. We collected socio-demographic, clinical and laboratory data using a structured questionnaire and patients’ files. Each study participant had a full physical and ano-rectal examination. We further studied factors associated with having at least one ano-rectal lesion by logistic regression reporting odds ratios (ORs) and their 95% confidence intervals (CI). We included 390 HIV infected patients. The mean age was 41 (SD: 8) years and 48% were men. Median duration since HIV diagnosis was 3 (interquartile range: 2–5) years and median CD4 cell count was 411 (interquartile range: 234–601) cells/mm3. Prevalence of ano-rectal pathology was 22.8% (95% CI: 18.7–27.3). Hemorrhoids and proctitis were most common lesions found; each in 10% of patients. From multivariate logistic regression, factors associated with ano-rectal pathology were CD4

Introduction: Hepatitis C virus (HCV) infection is a major public health problem, especially in resource-limited settings where many patients are diagnosed at the stage of complications. In Cameroon, where HCV is endemic, little is known about the clinical, biological, and virological profile of HCV-infected patients. Methods: A clinical case note review of all patients positive for antibodies against HCV diagnosed at the gastroenterology outpatient clinic of the Douala General Hospital, Cameroon, from January 2008 to December 2014, was performed. Results: A total of 524 patients were included in the study, 53% of whom were female. The mean age was 56 ± 13 years. A history of blood transfusion and a history of scarification were the most common potential risk factors for HCV exposure, as found in 16% and 13% of the study population, respectively. Current alcohol use was found in 24% of patients. Co-infection with hepatitis B virus and HIV was 3.6% and 3.4%, respectively. Among the patients, 39% had no complaint at diagnosis; only 16% were diagnosed through a routine medical checkup. Clinically, the most common finding was hepatomegaly (26.1% of patients). Transaminases above the upper limit of normal were found in 55.2% of patients, particularly those aged >57 years (p = 0.001). Genotypes 1 (43.95%), 2 (25.11%), and 4 (28.25%) were the most common. Liver cirrhosis was present in 11% of patients and hepatocellular carcinoma in 4%, the latter being more common in males (p 57 years (p = 0.03). Conclusions: In the gastroenterology clinic of Douala General Hospital, while almost 40% of patients who were anti-HCV antibody-positive were asymptomatic and diagnosed fortuitously, some already presented complications, including cirrhosis and hepatocellular carcinoma. There is an urgent need to put in place programs to increase awareness and diagnosis of HCV infection and to develop extensive and targeted anti-HCV treatment guidelines to improve the management of these patients in Cameroon.

The Human Leucocyte Antigens (HLA) work in concert with other immune factors to modulate immunity to viral infections. Extensive variation has been reported in the genetic sequences and functions of classical HLA class I genes in many (mostly Western) populations, and several HLA associations with infectious disease outcomes have been reported. Little is known about their role in the susceptibility or resistance to hepatitis viruses in Central African populations. The aim of this study was to determine variants of two HLA class I genes (HLA-A and -C) in adults infected with hepatitis B (HBV)- or -C (HCV) virus in Cameroon. In this case-control study, a total of 169 unrelated adults comprising 68 HCV-infected, 38 HBV-infected and 63 uninfected (controls) individuals participated. Each consented participant was screened for HBV, HCV, and HIV infections and willingly donated a single blood sample for genomic DNA isolation and some clinical laboratory tests. HLA-A and HLA-C were genotyped using previously described sequence-based techniques (SBT). A total of 54 HLA alleles were identified in the study population (27 HLA-A and 27 HLA-C). HLA-A∗23:01 and HLA-C∗07:01 were the most common alleles with genotype frequencies of 31.4% and 29.3%, respectively. Hepatitis individuals were six times more likely to be HLA-A∗30:01 carriers than uninfected controls (OR = 6.30, p = 0.020 (HBV); OR = 6.21, p = 0.010 (HCV), respectively). Similarly, carriers of HLA-C∗17:01 were over-represented in the HBV-infected compared to the uninfected control group (21.9% vs. 6.4%, respectively) suggesting that this allele could play a role in the susceptibility to HBV infection. These findings demonstrate that carriers of HLA-A∗30:01 were over-represented in the hepatitis group compared to uninfected controls while HLA-C∗17:01 was completely absent in the HCV + group., Cell biology; Immunology; Clinical genetics; Genetics; Molecular biology; HLA; HBV; HCV; Association study; Cameroon

Background Evidence from epidemiological studies suggests an important association between gout and the metabolic syndrome (MetS). However, to the best of our knowledge, prevalence of metabolic syndrome in gout has not been reported in sub-Saharan African (SSA) settings. Objectives The aim of this study was to determine the prevalence and characteristics of MetS in gout in a SSA population. Method After prior ethical clearance, we carried out a cross-sectional study involving gout patients in a referral hospital in Douala-Cameroon. Metabolic syndrome was defined using International Diabetes Foundation criteria. Associations between variables were assessed using logistic regression.p Results On 174 gout patients (48.3% females) who consented to participate in the study, the median (IQR) age was 55.00 (14.25) years, and the median (IQR) duration of gout was 7.5 (10.0) years. Prevalence of metabolic syndrome was 54.6% (95% CI: 47.9%–62.8%). One hundred and forty-seven (84.5%) participants had central obesity, 62 (35.6%) raised triglycerides, 79 (45.4%) reduced HDL-C, 129 (74.1%) raised blood pressure, and 85 (48.9%) had raised fasting plasma glucose. On logistic regression analyses, gout patients with metabolic syndrome significantly had a higher body mass index (OR: 1.09, 95% CI: 1.02–1.17), and higher levels of serum uric acid (OR: 1.02, 95% CI: 1.01–1.04). Conclusions About 1 out of every 2 gout patients in this population have metabolic syndrome. These gout patients with metabolic syndrome significantly have a higher body mass index, and higher levels of serum uric acid. Cohort studies are required to clearly establish the direction of the relationship between gout and metabolic syndrome.

Human immunodeficiency virus (HIV) infection, opportunistic infections and antiretroviral therapy contribute to the pathogenesis of stroke, yet, little is known about the influence of HIV infection on outcome in stroke patients. The aim of this study was to compare the outcome of stroke in HIV-infected patients with that of HIV-negative patients at the Douala General Hospital (DGH).A prospective cohort study was carried out at the Neurology unit and the Intensive Care Unit of the DGH from January 2010 to December 2015. All patients aged 15 years and above, admitted for stroke confirmed by brain imaging were included. HIV testing was systematically prescribed for all stroke patients. HIV-infected patients were then compared with HIV-uninfected patients. Quantitative variables were expressed as means while qualitative variables were expressed as frequencies, and were compared with the ChiForty of the 608 patients with stroke were HIV-positive, giving an in-hospital HIV prevalence of 6.6%. Mean age of the HIV-infected stroke patients was 51.3±10.4 years as against 59.6±13.53 in the HIV-uninfected group (P=0.001). The proportion of dyslipidemia in HIV-infected stroke patients with was greater than that in HIV-uninfected stroke patients (57.5% vs 8.9%, P0.001). The most common type of stroke was ischemic in two-thirds of the patients in both groups. HIV-infected stroke patients had a mean hospital stay longer than that of HIV-uninfected patients (10.3±8.1 days vs 8.1±6.3 days, P=0.042). Post-stroke infections were more frequent in HIV-infected patients (17.5% vs 6.9%, P=0.014). The cumulative mortality rates at 6 months were 37.5% and 34.5% for the HIV-infected and the HIV-uninfected groups respectively (P=0.471). The functional outcome was similar in both groups at the 6HIV infection does not affect in-hospital mortality and functional outcome in stroke patients a part the length of hospital stay.

Diabetes mellitus (DM) is associated with poor outcomes in acute stroke patients (ASPs). This study aims to determine the prevalence of NDDM in the ASPs and to compare the outcome in NDDM and previously diagnosed DM (PDDM) in Cameroon.This was a hospital-based prospective cohort study that included ASPs with NDDM and PDDM. Outcome data were collected within 3 months of stroke onset. Chi-square and t tests were used for comparisons, whereas survival analysis was performed using Cox regression and Kaplan-Meier analysis.Of the 701 ASPs included, 24.8% had PDDM (n = 174) and 9.4% NDDM (n = 66). NDDM had a higher mortality rate on admission and 3 months after stroke (P .05). PDDM were more likely to survive within 3 months after stroke onset (log-rank test P = .008). The risk of dying among NDDM was increased (adjusted hazard ratio = 1.809; 95% confidence interval: 1.1532.839; P = .010). NDDM were more likely to have higher mean National Institutes of Health Stroke Scale and modified Rankin score (P .05) on admission. PDDM were more likely to develop urinary tract infections during hospitalization (P = .015). There was no significant difference between functional outcome on admission and 3 months after stroke (P .05).NDDM are associated with increased mortality and are more likely to have poorer functional outcomes and more severe stroke than those with PDDM.

Introduction : the rising global burden of non-communicable diseases (NCDs) is gradually affecting Africa. We aimed to determine the eligibility for statin of people living with type 2 diabetes mellitus (T2DM), using the

Diabetes mellitus has been associated with cognitive impairment but this has not been well investigated in sub-Saharan Africa. The aim of this study was to determine the prevalence and risk factors of cognitive dysfunction in patients with type 2 diabetes and to assess its influence on medication adherence. We carried out a cross-sectional study over a period of 4 months at the outpatient diabetes and endocrinology clinic of the Douala General Hospital. Consecutive patients with type 2 diabetes attending the clinic underwent cognitive assessment using the Mini Mental State Exam (MMSE). The patient Health Questionnaire-9 (PHQ-9) was used to rule out the confounding effect of depression, and the Morisky score was used to assess medication adherence. Data were analyzed using SPSS version 20 for Windows. Of the 223 participants (54.3% females) with a mean age of 56 ± 9.5 years, 33 (14.8%) had cognitive dysfunction (12.6, 1.8, and 0.4% having mild, moderate, and severe cognitive dysfunction, respectively). Level of education ≤7 years (OR = 5.314, 95% CI 2.443–11.561, p

Introduction : patients living with type 2 diabetes are at increased risk of cardiovascular related death but there is little data on the influence of diabetes on early outcomes of cardiovascular emergencies (CVEs). This study aimed at describing the influence of diabetes on early outcome of patients admitted for CVEs. Methods : database of Cardiovascular Intensive Care Unit (CICU) of the Douala General Hospital was queried for patients admitted for CVEs between November 2012 and November 2015. We compared patients with and without known diabetes for sociodemographic profile and risk factors for CVEs using 2-sided tests (Chi-squared & one-way ANOVA). While Cox regression and Kaplan Meier survival models were used to compare in-hospital complications and mortality. Results : of the 333 patients admitted during the study period, 99 (29.7%) had a diagnosis of diabetes. Patients with diabetes were older (65.8 ± 13.8 vs 60.4 ± years, p