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Félicité Kamdem,1,2 Yacouba Mapoure,1,2 Ba Hamadou,3 Fanny Souksouna,2 Marie Solange Doualla,1,3 Ahmadou Musa Jingi,3 Caroline Kenmegne,1 Fernando Kemta Lekpa,1,4 Jaff Kweban Fenkeu,1 Gisèle Imandy,5 Jean Pierre Nda Mefo’o,2,5 Henry Luma1,3 1Internal Medicine Service, Douala General Hospital, Douala, Cameroon; 2Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; 3Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon; 4Faculty of Health Sciences, University of Buea, Buea, Cameroon; 5Chemical Pathology Laboratory, Douala General Hospital, Douala, Cameroon Background: The prevalence of peripheral artery disease (PAD) is not well known among HIV-infected patients in Africa. The aim of this study was to determine the prevalence and associated risk factors of PAD among HIV-infected patients at the Douala General Hospital (DGH).Methods: This was a cross-sectional descriptive and analytic study between November 2015 and April 2016. We recruited patients aged ≥21 years, diagnosed with HIV infection, and who were receiving care at the DGH. We collected sociodemographic data and past medical history of patients. We measured their ankle-brachial index (ABI). We defined PAD as an ABI 0.05). The prevalence of PAD was 6.9% (95% CI: 3.4–12.4), and 60% of patients with PAD were symptomatic. After adjusting for age, sex and ARV, ARV treatment was protective (aOR: 0.18, [95% CI: 0.04–0.82], P=0.034), while WHO stages III or IV was associated with PAD (aOR: 11.1, [95% CI: 2.19–55.92], P=0.004).Conclusion: The prevalence of PAD was not as high as expected in this group of patients with high cardiovascular risk infected with HIV. Advanced HIV disease was associated with PAD, while ARV was protective. Keywords: HIV, peripheral artery disease, prevalence, risk factors, Africa

Background Cardiovascular disease (CVD) is the largest contributor to the non-communicable diseases (NCD) burden in Cameroon, but data on its economic burden is lacking. Methods A prevalence-based cost-of-illness study was conducted from a healthcare provider perspective and enrolled patients with ischaemic heart disease (IHD), ischaemic stroke, haemorrhagic stroke and hypertensive heart disease (HHD) from two major hospitals between 2013 and 2017. Determinants of cost were explored using multivariate generalized linear models. Results Overall, data from 850 patients: IHD (n = 92, 10.8%), ischaemic stroke (n = 317, 37.3%), haemorrhagic stroke (n = 193, 22.7%) and HHD (n = 248, 29.2%) were analysed. The total cost for these CVDs was XAF 676,694,000 (~US$ 1,224,918). The average annual direct medical costs of care per patient were XAF 1,395,200 (US$ 2400) for IHD, XAF 932,700 (US$ 1600) for ischaemic stroke, XAF 815,400 (US$ 1400) for haemorrhagic stroke, and XAF 384,300 (US$ 700) for HHD. In the fully adjusted models, apart from history of CVD event (β = − 0.429; 95% confidence interval − 0.705, − 0.153) that predicted lower costs in patients with IHD, having of diabetes mellitus predicted higher costs in patients with IHD (β = 0.435; 0.098, 0.772), ischaemic stroke (β = 0.188; 0.052, 0.324) and HHD (β = 0.229; 0.080, 0.378). Conclusions This study reveals substantial economic burden due to CVD in Cameroon. Diabetes mellitus was a consistent driver of elevated costs across the CVDs. There is urgent need to invest in cost-effective primary prevention strategies in order to reduce the incidence of CVD and consequent economic burden on a health system already laden with the impact of communicable diseases.

Key Clinical Message This case suggests that young patients with few vascular risk factors, and who present with acute stroke syndrome involving more than one vascular territory should be screened for an inflammatory or infectious cause.

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.

Background:Liver disease related to Hepatitis B (HBV) and C (HCV) infection has become a major cause of morbidity and mortality in HIV/AIDS patients. Data on the prevalence of HBV and HCV in Cameroon remains inconclusive.Objective:We aimed to determine the sero-prevalence and correlates of Hepatitis markers in HIV/AIDS patients in two Regional Hospitals.Methods:A cross-sectional study carried out from December 2014 to March 2015. HIV/AIDS patients aged 21 were included and above, receiving care at HIV treatment centres. Data was collected using a structured questionnaire. Blood samples were collected to screen for Hepatitis with HBsAg and anti HCV antibody rapid immunochromatographic test kits. Correlates of hepatitis were investigated by logistic regression. STATA was used for data analysis.Results:We included 833 HIV/AIDS patients,78.8% (657) were female. Mean age was 44(SD 11) years. Prevalence of Hepatitis in general (total of two viral markers tested) was 8.9% (74/833), with 6.1% for HBsAg and 2.8% for Anti-HCV antibodies. From multivariate analysis, the likelihood of having hepatitis was independently increased by a history of surgical interventions [OR: 1.82(1.06-3.14)], and of sexually transmitted infections [OR: 2.20(1.04-4.67)].Conclusion:Almost one in ten participants with HIV/AIDS attending the BRH and LRH tested positive for either HBsAg or anti HCV antibodies. Screening for HBV and HCV should therefore be integrated to the existing guidelines in Cameroon as it can influence management. More studies are needed to evaluate the extent of liver disease and magnitude of HIV suppression in hepatitis and HIV coinfection in this setting.

In 2018, WHO issued guidelines for the diagnosis, prevention, and management of HIV-related cryptococcal disease. Two strategies are recommended to reduce the high mortality associated with HIV-related cryptococcal meningitis in low-income and middle-income countries (LMICs): optimised combination therapies for confirmed meningitis cases and cryptococcal antigen screening programmes for ambulatory people living with HIV who access care. WHO's preferred therapy for the treatment of HIV-related cryptococcal meningitis in LMICs is 1 week of amphotericin B plus flucytosine, and the alternative therapy is 2 weeks of fluconazole plus flucytosine. In the ACTA trial, 1-week (short course) amphotericin B plus flucytosine resulted in a 10-week mortality of 24% (95% CI -16 to 32) and 2 weeks of fluconazole and flucytosine resulted in a 10-week mortality of 35% (95% CI -29 to 41). However, with widely used fluconazole monotherapy, mortality because of HIV-related cryptococcal meningitis is approximately 70% in many African LMIC settings. Therefore, the potential to transform the management of HIV-related cryptococcal meningitis in resource-limited settings is substantial. Sustainable access to essential medicines, including flucytosine and amphotericin B, in LMICs is paramount and the focus of this Personal View.

Introduction Les donnees concernant la relation entre le taux d’hemoglobine et l’accident ischemique cerebral (AIC) sont rares en Afrique Subsaharienne. Objectifs Evaluer l’impact pronostic du taux d’hemoglobine de la phase aigue des AIC. Patients et methodes Il s’agissait d’une etude de cohorte retrospective sur 9 ans, incluant les dossiers de patients victimes d’AIC âges de plus de 15 ans, admis a l’Hopital General de Douala, ayant realise une Numeration Formule Sanguine dans les 7 jours suivant l’AIC. Le pronostic de l’AIC etait apprecie par : sa severite, la duree moyenne d’hospitalisation, la mortalite, puis le pronostic fonctionnel. Le modele de regression logistique binaire a permis de rechercher les facteurs predictifs de mortalite a 03 mois Resultats Des 691 cas d’AIC inclus, la prevalence de l’anemie etait de 44,4 % [legere 218 (71,0 %), moderee 57 (18,6 %) et severe 32 (10,4 %)]. Il n’y avait pas de difference significative sur le pronostic entre les cas d’AIC avec et sans anemie, ni entre les quartiles du taux d’hemoglobine et les elements pronostic, sauf la recuperation fonctionnelle a 03 mois qui etait defavorable chez les patients avec anemie severe [p = 0,04 ; OR : 4,43 ; IC : 1,02–12,24]. Discussion Au Senegal, Toure et al. [1] rapportent une prevalence de l’anemie a la phase aigue des AIC de 21 % et Milionis et al., 17,5 % en Suisse [2] . Certains auteurs ont demontre que l’anemie etait associee a un mauvais pronostic [3] , [4] alors que d’autres n’ont pas trouve d’association [5] . Conclusion Pres d’un patient sur deux presente une anemie a la phase aigue des AIC. L’anemie severe multiplie par 4 la probabilite d’une mauvaise recuperation fonctionnelle.

Introduction L’amelioration de l’esperance de vie des populations et l’explosion des facteurs de risque cerebro-vasculaire vont exposer les systemes de sante en Afrique a la problematique de la prise en charge des demences. Objectifs Determiner la prevalence hospitaliere et decrire les caracteristiques de la demence a l’Hopital General de Douala (HGD). Patients et methodes Il s’agissait d’une etude transversale portant sur les dossiers des patients suivis de 2010 a 2016 a l’Unite de Neurologie de l’HGD. Etaient inclus tout dossier de patient ayant un âge superieur ou egal a 21 ans suivi pour demence selon les criteres du DSM-IV. Les dossiers des patients presentant un deficit cognitif limite a une fonction superieure, une confusion mentale et des dossiers medicaux incomplets etaient exclus. L’enquete etiologique reposait sur les donnees cliniques, de l’imagerie cerebrale et de la biologie. Resultats Sur les 9640 cas, la prevalence de la demence etait de 2,07 % (n = 200). L’âge moyen des patients etait de 66,26 ± 11,61 ans. Les etiologies de demences etaient degeneratives (45 %), non degeneratives (34 %,) et mixtes dans 21 %. Les causes non degeneratives etaient dominees par la demence vasculaire (24 %), la demence liee au VIH (5,5 %), l’hydrocephalie chronique de l’adulte (2 %), demence secondaire a une tumeur cerebrale (1,5 %) et autres (1 %). Discussion Au Burkina-Faso, Napon et al. ont rapporte une prevalence hospitaliere de 0,455 % dans un contexte de prevalence faible d’infection au VIH [1] . Kengne et al. ont estime la prevalence de la demence degenerative a 3,9 % au Cameroun [2] . Utilisant le HIV/AIDS Dementia Scale, Njamnshi et al. trouvent que les sujets VIH+ avaient une prevalence des demences de 21,1 % contre 2,5 % chez VIH [3] . Conclusion Bien que la prevalence de la demence soit faible dans notre contexte, elle rappelle la place importante de la prevention primaire de celle-ci.

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.

Background.Prognostic significance of serum uric acid (SUA) in acute stroke still remains controversial.Objectives.To determine the prevalence of hyperuricemia and its association with outcome of stroke patients in the Douala General Hospital (DGH).Methods.This was a hospital based prospective cohort study which included acute stroke patients with baseline SUA levels and 3-month poststroke follow-up data. Associations between high SUA levels and stroke outcomes were analyzed using multiple logistic regression and survival analysis (Cox regression and Kaplan-Meier).Results.A total of 701 acute stroke patients were included and the prevalence of hyperuricemia was 46.6% with a mean SUA level of 68.625 ± 24 mg/l. Elevated SUA after stroke was associated with death (OR = 2.067; 95% CI: 1.449–2.950;p< 0.001) but did not predict this issue. However, an independent association between increasing SUA concentration and mortality was noted in a Cox proportional hazards regression model (adjusted HR = 1.740; 95% CI: 1.305–2.320;p< 0.001). Furthermore, hyperuricemia was an independent predictor of poor functional outcome within 3 months after stroke (OR = 2.482; 95% CI: 1.399–4.404;p= 0.002).Conclusion.The prevalence of hyperuricemia in black African stroke patients is quite high and still remains a predictor of poor outcome.

The association between hyperuricemia and stroke outcome still remains controversial worldwide. This study aims to determine the prevalence of hyperuricemia and its association with the outcome of patients with acute ischemic stroke in a tertiary care hospital.This was a hospital-based prospective cohort study that included patients with ischemic stroke with baseline uric acid levels and 3-month post-stroke follow-up data. Associations between hyperuricemia and stroke outcomes were analyzed using multiple logistic regression, Kaplan-Meier, and Cox proportional hazards regression analysis.A total of 480 patients were reviewed with a mean age of 62.8 ± 13.3 years. The prevalence of hyperuricemia was 52.3% with mean uricemia of 71.1 ± 25.3 mg/dL. There was a significant association between hyperuricemia and mortality with unadjusted odds ratio (OR) = 4.120 [95% (confidence interval [CI]: 2.466-7.153); P = .001)], but on multivariate analysis, hyperuricemia was not an independent predictor of stroke mortality [OR = 1.270 (CI: .547-2.946); P = .578)]. An independent association between increasing uric acid levels and mortality was noted on Cox proportional hazards regression; adjusted hazard ratio (95% CI) of 3.395 (2.114-5.452), P value greater than .001. Stroke mortality significantly increased across higher uric acid quintiles in patients with acute stroke (P .001). Hyperuricemia was an independent predictor of poor functional outcome within 3 months after stroke with adjusted OR (95% CI) of 2.820 (1.359-5.851); P = .005.Half of black African patients with ischemic stroke present with hyperuricemia, and hyperuricemia is a predictor of mortality and adverse functional outcomes. Further studies are therefore warranted to determine whether reducing hyperuricemia after stroke would be beneficial within our setting.

Objective To determine factors associated with smoking among university students in Cameroon. Design A cross-sectional survey was carried out using an anonymous self-administered questionnaire among a convenience sample of 3000 students from three universities (the Universite des Montagnes, and the Universities of Douala and Yaounde 1) in Cameroon; 190 students (5.9%) did not consent to the survey. Socio-demographic characteristics and smoking trends were recorded. Logistic regression was used to identify risk factors for smoking. Results Of the students selected, 1862 (62%) were male. The mean age was 23.3 years. We found that 30.1% of students had tried smoking and that 5.6% (n = 168) reported regular smoking. Smoking prevalence among male and female students was respectively 9.5% and 1%. The mean age of smokers was 24.1 years. Only 12.5% of regular smokers were nicotine-dependent. Factors motivating smoking were pleasure, imitation, snobbery and curiosity. In the multivariate analysis, smoking was statistically associated with age, male sex, exposure to friends who smoke and living with smokers. Conclusion Although the prevalence of smoking found in our study was low, effective tobacco control programmes targeting factors such as age, male sex and peer influence should be implemented in universities. Future studies are needed to evaluate the impact of these interventions.

Introduction: avec l'introduction de la tritherapie dans les annees 1996, la morbidite et la mortalite liees a l'infection par le VIH a nettement diminue. Concomitamment avec ce succes clinique, plusieurs changements metaboliques incluant diabete, hypertension arterielle, dyslipidemie et lipodystrophie ont ete observes, ceux-ci etant des pourvoyeurs d'accidents vasculaires cerebraux. L'objectif de ce travail etait de determiner l'incidence des accidents vasculaires cerebraux chez les patients VIH positifs sous traitement antiretroviral au long court. Methodes: il s'agissait d'une etude de cohorte retrospective, menee dans le Centre de Traitement Agree de l'Hopital General de Douala (HGD), avec un recueil des donnees sur 10 ans allant de Mai 2001 a avril 2010, portant sur les patients VIH positifs adultes sous traitement antiretroviral depuis au moins 6 mois. Les patients etaient suivis selon le protocole national de prise en charge du Cameroun. La survenue d'un AVC a ete determinee par la methode Kaplan-Meyer tandis que les facteurs associes a la survenue d'un AVC ont ete recherche par le test de Khi-2. Le seuil de signification statistique etait fixe a 0,05. Resultats: 307 patients etaient inclus dont 62,4% de sexe feminin, et l'âge moyen etait de 40,1 ± 9,9 ans. L'incidence des AVC etait de 1,7% sur 72 mois de suivi sans difference significative entre les femmes et les hommes (P= 0,76). Le taux d'incidence calcule etait de 0,3 pour 100 personnes annees. Dans 85,7% des cas il s'agissait d'un AVC ischemique. Le delai moyen de survenue d'un AVC etait de 33,4 mois. Les facteurs associes a la survenue d'un AVC etaient: les patients ayant initie leur traitement au stade III et IV de l'OMS et le taux de CD4 > 100/mm3 a l'initiation du traitement antiretroviral. Conclusion: l'incidence des AVC chez les patients VIH positifs sous traitement antiretroviral est similaire a celle rapportee anterieurement mais ces AVC surviennent a un âge precoce et justifie une surveillance accrue par les cliniciens prenant en charge ces patients. Une etude prospective avec une population temoins est necessaire. The Pan African Medical Journal 2016;24

Introduction Les donnees comparant le pronostic des accidents vasculaires cerebraux (AVC) entre les patients diabetiques de novo (DN) et les diabetiques connus (DC) chez le sujet noir africain sont rares. Objectifs Determiner la prevalence du DN a la phase aigue des AVC et comparer leur pronostic avec les DC a l’hopital general de Douala, Cameroun. Methodes Il s’agissait d’une etude de cohorte prospective incluant les patients victimes d’AVC a la phase aigue DN et DC. Les donnees sociodemographiques, cliniques et le pronostic etaient enregistres et le pronostic evaluer a 3 mois. Le test de Khi2 etait utilise pour comparer les variables qualitatives tandis que la survie etait determinee en utilisant le modele de regression de Cox et la courbe de Kaplan–Meier. Resultats Des 701 patients inclus, la prevalence du diabete etait de 34,2 % (n = 240) avec 9,4 % (n = 66) des DN. L’AVC etait plus severe et la mortalite plus elevee chez les DN que chez les DC a l’admission et a 3 mois (p Discussion La prevalence du DN est similaire aux 7,1 % rapportes au Nigeria mais faible comparee aux 16,4 % et 25 % respectivement en Autriche et dans le registre de Copenhague. Bien que toutes les etudes s’accordent sur le role deletere du diabete et de l’hyperglycemie a la phase aigue des AVC, peu d’etudes ont compare la valeur pronostique du DN et du DC. Conclusion Un patient AVC sur 10 presente un DN qui augmente la mortalite de 1,8 a 3 mois post-AVC. Le depistage systematique et la prise en charge du diabete en population generale sont recommandes pour reduire l’impact au cours des AVC.

There are limited data in terms of the clinical profile of Parkinson's disease in sub-Saharan African patients.To compare the clinical profile and access to standard antiparkinsonian therapies of a Cameroonian cohort of patients with an age, sex, and disease duration-matched Spanish cohort (Longitudinal Study of Parkinson's disease, ELEP).Observational, cross-sectional design. Demographic data were collected and the following ELEP assessments were applied: Scales for Outcomes in Parkinson's disease (SCOPA) Motor, Autonomic, Cognition, Sleep and Psychosocial; Hoehn and Yahr staging; modified Parkinson Psychosis Rating Scale; Cumulative Illness Rating Scale-Geriatrics; Hospital Anxiety and Depression Scale; pain and fatigue visual analog scales; Zarit, and EuroQoL.74 patients with idiopathic Parkinson's disease were included (37 from each country) with a mean age of 64.4±10.5 years old, 70.3% males, and mean disease duration of 5.6±5.9 years. Compared to the Spanish cohort, Cameroonians were intermittently treated, less frequently received dopaminergic agonists (p0.001), had a trend for taking lower doses of levodopa (p=0.06), and were more frequently on anticholinergics (p0.0005). Cameroonians were more severely impaired in terms of motor (Hoehn Yahr stage, p=0.03; SCOPA-Motor, p0.001), cognitive status (p0.001), anxiety and depression (p0.001), psychosis (p=0.008), somnolence, fatigue and pain (p0.001, respectively), caregiver burden (p0.0001), and quality of life (p=0.002). Instead, autonomic, comorbidity, and nocturnal sleep problems were similarly found.Limited and intermittent access to dopaminergic drugs has a negative impact on motor symptoms, nonmotor symptoms and quality of life in patients with Parkinson's disease and their caregivers.

Background Peripheral neuropathy (PN) which is the most common neurological complication of HIV infection is under recognised and undertreated especially in resource limited settings. This ailment which has a negative impact on the quality of life of HIV/AIDS patients exists in different clinical patterns of which HIV-associated Sensory neuropathy (HIV-SN) is the most common affecting up to two thirds of patients with advanced disease in some settings. In Cameroon where HIV is a major public health problem, the burden of HIV-SN has not yet been well defined. Methods Using the Brief Peripheral Neuropathy Screening (BPNS) tool validated by the AIDS Clinical Trial Group (ACTG) we carried out a cross sectional study to determine the prevalence of HIV-SN and its associated factors among HIV-1 patients at the Douala General Hospital between 1st July and 31st October 2011. HIV-SN was defined as the presence of neuropathic symptoms and at least an abnormal perception of vibrations of a 128Hz tuning fork on the great toe or abnormal ankle reflexes or both and expressed as a percentage of the study population. Results Out of 295 patients studied, 21% had HIV-SN. In HIV-SN patients the median duration of HIV infection was 79.8 months (IQR 46 – 107.5) and their median CD4 count 153cells/μL (IQR 80 – 280). Patient recall and clinical chart review showed that, 83.9% had neuropathic symptoms prior to HAART initiation and 16.1% after HAART initiation. Low CD4 count, history of alcohol intake and history of anti-tuberculosis treatment were strongly associated with HIV-SN (AOR 2.5, 2.8 and 2.9 respectively). Conclusions HIV-SN is common among patients with advanced HIV infection in Cameroon. This simple diagnostic tool (BPNS) should therefore be routinely used to detect those with HIV-SN or at risk so as to minimise the negative impact it has on their quality of life.

Introduction Les accidents vasculaires cerebraux (AVC) constituent la premiere cause d’hospitalisation en neurologie en Afrique Subsaharienne. Objectifs Etudier la survie, les facteurs predictifs de deces per hospitalisation et le pronostic fonctionnel a court, moyen et long terme des AVC a l’hopital General de Douala. Methodes Nous avons mene une etude de cohorte prospective de janvier 2010 a decembre 2014 a l’hopital General de Douala. Etaient inclus dans l’etude, les patients âges de plus de 15 ans hospitalises pour AVC confirmes par l’imagerie cerebrale. Les hemorragies meningees et les thromboses veineuses cerebrales avaient ete exclues de l’etude. La survie a ete determinee par la methode de Kaplan Meier et les facteurs predictifs de deces intra-hospitalier determines par analyse univariee et multivariee selon le modele de Cox. Resultats Cinq cent un patients etaient inclus avec 59,88 % d’hommes et l’âge moyen des patients etait de 58,93 ± 13,19 ans. La mortalite hospitaliere etait de 24,8 %. Le score de Glasgow Discussion La mortalite hospitaliere des AVC etait similaire a celle de litterature. Les scores de Glasgow et de NIHSS ont ete rapportes par d’autres auteurs comme facteurs predictifs de deces postAVC. Conclusion Cette etude suggere que les accidents vasculaires cerebraux sont responsables d’une forte mortalite associee a des sequelles et par consequent d’un cout non negligeable pour la societe.

Background: Cryptococcal meningoencephalitis (CM) kills about half a million human immunodeficiency virus (HIV) patients per year, mostly in Africa. Aim: The aim of this study was to determine the prevalence, clinical presentation and in-hospital outcome of CM among HIV-infected patients in Douala. Materials and Methods: A cross-sectional clinical note review of 672 HIV-1 patients’ files admitted from January 1 st 2004 to December 31 st 2009 at the Internal Medicine unit of the Douala General Hospital, Cameroon was performed. Only patients diagnosed of CM by microscopy of Indian ink stained cerebrospinal fluid (CSF) were studied. Results: The prevalence of CM in the study was 11.2%. Mean age of patients was 36.9 ΁ 12.7 years. Median cluster of differentiation 4 (CD4) cell count was 23 cells/μL, (interquartile range [IQR]: 10-61) and 62.7% of CD4 cell counts were >50 cells/μL. The most prevalent symptom was headache in 97.3% of patients. In CSF, median proteins was 0.9 g/L (IQR: 0.6-1); median glucose 0.2 g/L (IQR: 0.1-0.3) and median leucocyte count 54 cells/μL (IQR: 34-76) mostly of mixed cellularity. The case fatality rate was 52% and low CD4 cell count was strongly associated with death, odd ratio 4.6 (95% confidence interval: 2.6-8.0, P > 0.001). Conclusion: The high case fatality of CM in Douala warrants adequate diagnostic measures and optimization of standardized treatment to reduce mortality.

Background Childhood overweight/obesity is increasing rapidly in developing countries. There is a need to provide more evidence on its burden in sub-Saharan Africa, and to identify associated factors in order to set preventive measures. We aimed to determine the prevalence of overweight/obesity and assess its association with the socioeconomic status in nursery and primary school children in urban Cameroon. Methods In this cross-sectional study, we included by multi-staged cluster random sampling 1343 children from high (HSES, n = 673) and low (LSES, n = 670) socioeconomic status schools in Douala. Parent/child demographic data were collected, and children’s anthropometric parameters were measured using validated methods. The World Health Organization body mass index-for-age reference curves were used. Results The prevalence of overweight/obesity was 12.5% (13.2% in girls, 11.8% in boys). The risk of overweight/obesity was 2.40 (95% CI 1.70, 3.40) higher in HSES children compared to LSES after adjusting for age and gender. However this association was attenuated to 1.18 (95% CI 0.59, 2.35) once adjustment had been made for a range of potential confounders. Conclusions Overweight/obesity is relatively common in sub-Saharan African children and prevalence is associated with HSES. However, this association may be mediated by sweet drink consumption, passive means of travel to school and not doing sport at school. We suggest that these potentially modifiable behaviors may be effective targets for obesity prevention. Further studies should specifically focus on unhealthy behaviors that mediate overweight/obesity as well as other non communicable diseases in children. Electronic supplementary material The online version of this article (doi:10.1186/s40608-017-0146-4) contains supplementary material, which is available to authorized users.

Background It is estimated that about a third of the world’s population is chronically infected with Toxoplasma gondii. Toxoplasma encephalitis (TE), which occurs as a reactivation of quiescent chronic infection, is one of the leading causes of central nervous system (CNS) infection in AIDS. Its diagnosis in most centres still remains difficult. We opted to describe the clinical and radiological features of TE as well as in-hospital outcome and its associated factors. Methods We carried out a cross sectional study on the clinical case notes of adult patients admitted and treated for TE at the Douala General Hospital, Cameroon between January 1st 2004 to December 31st 2009. Results Of 672 patients admitted during the study period, 14.4% (97/672) had TE. The mean age was 36.9 ± 14.1 years and the median CD4 cell count was 68/mm3 (IQR): 43 – 103). Headache and fever were the most common presenting symptoms in 92.8% (90/97) and 87.6% (85/97) of patients. Annular contrast enhanced lesions were the most common brain scan finding in 81.4% (79/97) of patients. In-hospital mortality was 29.9% (29/97). Altered sensorium, presence of focal signs, neck stiffness and low CD4 cell count were factors associated with mortality. Adjusting for low CD4 count, altered sensorium remained strongly associated with fatality, adjusted odd ratio (AOR) 3.5 (95% CI 1.2 – 10.5). Conclusion Toxoplasma encephalitis is common among AIDS patients in Douala. Its high case fatality warrants adequate and compliant prophylactic therapy in severely immune depressed patients as well as early initiation of antiretroviral therapy in HIV-infected patients.

Spastische Lähmung ist eine der häufigsten Folgen von Schlaganfall, manchmal sichtbar vor dem 15. Tag der Verletzung. Eines der größten Probleme für Patienten Körperdeformität und Funktionsbeeinträchtigung, Beschwerden oder Schmerzen.Daher konzentrierte sich das Ziel meiner Diplomarbeit auf vier Studien; 1) Erkunde den ersten Phänomene, die die vollständige Genesung all dieser Patienten und die Vorgehensweise von zerebrale Plastizität (auf neuronaler Ebene, dann in Korrelation mit der Klinik), mit den Werkzeugen Moderne Bildgebung und Neurobiologie. Dies war die klinische Beobachtung des Kurses Erholung im Laufe der Zeit. 2) Studieren Sie das mikrostrukturelle Verhalten des Muskels spastisch, im Vergleich zu gesundem Muskel (durch Bildgebung, dann Immunfluoreszenztechnik) und Immunhistochemie), dann die Wirksamkeit therapeutischer Strategien auf die Plastizität neuromuskuläre und motorische Erholung der oberen Extremitäten durch eine prospektive Studie, kontrolliert und randomisiert (traditionelle Physiotherapie vs. spezifische Rehabilitationstechniken, gezielte Antagonisten und angeleitete Selbsterziehung). Parallel in Studie 3ᵉ mit der Studie 1ᵉʳ und 2ᵉ zur Bewertung der unteren Extremität, die kinematischen Parameter im Vergleich zu denen gesunde Probanden gleichen Alters und schlagen effektive Rehabilitationstechniken vor, um sich zu verbessern nicht nur die Reichweite, sondern auch die Qualität der Wanderung. Eine vierte Studie war auch bei der Parkinson-Krankheit den Einfluss der rhythmischen Hörstimulation verstehen zu den kinematischen Parametern des Gehens bei der idiopathischen Parkinson-Krankheit und sehen Sie, welches Tempo für sicheres Gehen am esten ist. Aus unseren Ergebnissen geht hervor, dass das Nervengewebe nur eine begrenzte Kapazität hat selbst zu modifizieren, zu erneuern und zu reparieren. Das bescheidene Erholungspotenzial beobachtet nach Hirnverletzung, wird auf die "Neuorganisation" von Funktionen unter Verwendung gesunder Schaltkreise zurückgeführt anstatt beschädigtes Gewebe zu reparieren. Die Haupthindernisse für dieses Geminieren sind die "Glianarbe". Dennoch kann eine Form der sogenannten Verhaltensplastizität helfen, den Erholungsgrad erhöhen. Das Erlernen einer Motorik könnte stärken die Schaltkreise der spinalen Interneuronen, die die Bewegung erleichtern. Wir haben uns ergeben berücksichtigen, dass das Erlernen einer einfachen und reziproken Bewegung, verbunden mit aktivem Dehnen, mehrmals am Tag an den Zielmuskeln durchgeführt (Antagonisten waren signifikanter als klassische Physiotherapie) eine Beeinflussung im Rückenmark und im Verlauf Zeit, die gegenseitige Hemmung zwischen den antagonistischen Muskeln. Der Locometer hat es uns ermöglicht die kinematischen Parameter des Gehens bei Schlaganfallpatienten besser zu verstehen. das ein Hörstimulator kann das Tempo des Parkinson-Patienten beeinflussen; zum Gehen mit sehr großen Schritten, ermöglicht eine Erhöhung der Gehgeschwindigkeit als wichtigGehen mit maximaler sicherer Geschwindigkeit und sollte daher in einem indizierten Tempo bevorzugt werden spontan oder vermehrt. Bewegungsmedikamente in der akuten Phase des Schlaganfalls nicht sollte nicht auf Kosten chemischer Medikamente oder medizinischer Verfahren vernachlässigt werden. Denn wie die Vitalprognose, die Funktionsprognose muss auch zeitnah von Ärzte im Allgemeinen., Spastic deforming paresis is one of the common consequences of stroke, sometimes evident before the 15th day of injury. One of the major problems for patients is body deformity and functional limitation, discomfort and / or pain.Thus, the objective of my thesis was centred on four studies; 1) to explore first of all the phenomena limiting the total recovery of all these patients and the modus operandi of cerebral plasticity (at the neuronal level, then in correlation with the clinic), using the tools of modern imagery, and neuronal biology. Clinically observe their recovery over time. 2) Examine the microstructural behaviour of spastic muscle, compared to healthy muscle (by section imaging, then immunofluorescence and immunohistochemistry techniques), then the effectiveness of therapeutic strategies on neuromuscular plasticity, and in motor recovery of the limb higher, via a prospective, controlled and randomized study (traditional physiotherapy vs specific rehabilitation technique, targeted on antagonists and guided self-rehabilitation). In the 3rd study, in parallel with the 1st and the 2nd study, to evaluate the lower limb, the kinematic parameters compared to those of healthy subjects matched in age, and to propose effective rehabilitation techniques, in order to improve not only the perimeter, but also the quality of walking. A 4th study was also carried out in the field of Parkinson's disease, to understand the influence of rhythmic auditory stimulation on the kinematic parameters of walking in idiopathic Parkinson's disease, and to see which gait was better to improve for a safe walk.Following our results, it appears that the nervous tissue has only a limited capacity to modify, renew and repair itself. The modest recovery potential seen after brain injury is attributed to the "reorganization" of functions using remaining healthy circuitry rather than repairing damaged tissue. The main obstacles to this geminating are the “glial scar”. Nevertheless, a form known as behavioural plasticity can help increase the degree of recovery. Learning a motor skill could strengthen the circuits of the spinal interneurons that facilitate movement. We realized that learning a simple and reciprocating movement, associated with active stretching, performed several times a day on target muscles (the antagonists were more important than traditional physiotherapy) would produce an influence on the level of the spinal cord which, over time, inhibits reciprocal between the antagonistic muscles. The locometer allowed us to better understand the kinematic parameters of walking in stroke patients. The auditory stimulator can influence the rhythm of the Parkinsonism subject; when walking at very long strides, allows an increase in walking speed as great as walking at maximum safety speed, and must therefore be favored at a spontaneous or increased indexed cadence. Medication through exercise in the acute phase of stroke should not be overlooked, harming chemical drugs or medical procedures. Because, like the vital prognosis, the functional prognosis must also be requested quickly by doctors in general., La parésie spastique déformante est une des conséquences fréquentes induites par l’AVC, parfois évidente avant le 15ᵉ jour de la lésion. Un des problèmes majeurs des patients est la déformation corporelle et la limitation fonctionnelle, inconfort ou bien douleur.Ainsi, l’objectif de ma thèse était orienté sur quatre études ; 1) explorer tout d’abord les phénomènes limitants la récupération totale de tous ces patients et le modus operandi de la plasticité cérébrale (au niveau neuronal, puis corréler avec la clinique), et ce, à l’aide des outils d’imageries modernes et de biologies neurales. Il était question d’observer cliniquement le décours de récupération dans le temps. 2) Examiner le comportement microstructural du muscle spastique, comparé au muscle sain (par une découpe d’imagerie, puis technique d’immunofluorescence et immunohistochimie), puis l’efficacité des stratégies thérapeutiques sur la plasticité neuromusculaire, et la récupération motrice du membre supérieur, via une étude prospective, contrôlée et randomisée (kinésithérapie traditionnelle Vs techniques de rééducations spécifiques, ciblées sur les antagonistes et autorééducation guidée). Dans la 3ᵉ étude, en parallèle avec l’étude 1ᵉʳ et 2ᵉ, évaluer le membre inférieur, les paramètres cinématiques comparés à ceux des sujets sains appariés en âge et proposer des techniques de rééducation efficaces, afin d’améliorer non seulement le périmètre, mais aussi la qualité de la marche. Une 4ᵉ étude a aussi été menée dans le domaine du Parkinson, comprendre l’influence des stimulations rythmiques auditives sur les paramètres cinématiques de la marche dans la maladie de Parkinson idiopathique et voir quelle cadence était préférable pour une marche sécuritaire.À la suite de nos résultats, il en ressort que le tissu nerveux n’a qu’une capacité limitée de se modifier, se renouveler et se réparer. Le modeste potentiel de récupération observé après lésion cérébrale, est attribué à la « réorganisation » des fonctions utilisant les circuits sains restant plutôt qu’à la réparation du tissu lésé. Les principaux obstacles à cette gémination sont la « cicatrice gliale ». Néanmoins, une forme de plasticité dite comportementale peut aider à augmenter le degré de récupération. L’apprentissage d’une habileté motrice pourrait renforcer les circuits des interneurones spinaux qui facilitent le mouvement. Nous nous sommes rendu compte que l’apprentissage d’un mouvement simple et alternatif, associé à des étirements actifs, fait plusieurs fois en journée sur des muscles cibles (antagonistes était plus significatif que la kiné traditionnelle) produiraient une influence dans la moelle épinière et au décours du temps, l’inhibition réciproque entre les muscles antagonistes. Le locomètre nous permis de mieux comprendre les paramètres cinématiques de marche chez les patients AVC. Le stimulateur auditif est capable d’influencer la cadence de pas du sujet Parkinsonien ; à la marche à très grand pas, permet une augmentation de la vitesse de marche aussi importante qu’une marche à vitesse maximale sécuritaire, et sera donc à privilégier à une cadence indicée spontanée ou augmentée. La médication par l’exercice physique en phase aiguë de l’AVC ne doit pas être négligée, aux dépens de la médication chimique ou actes médicaux. Car, comme le pronostic vital, le pronos-tic fonctionnel doit aussi être précocement sollicité par les médecins en général.