Brachial circumference as an alternative to body mass index for the detection of in-hospital undernutrition in a referal hospital, Cameroon.

The prevalence of undernutrition in hospitals in Africa is estimated at about 57 %. Simple anthropometric methods are available to detect it, including measurement of the brachial circumference (BC) and the body mass index (BMI). The aim of this study was to identify a threshold value that might make it possible to diagnose undernutrition in hospitals. It was a cross sectional study carried out at Douala General Hospital - Cameroon over a five months period. The measurements studied were: BMI, BC and percentage of weight loss. The Pearson test was used to compare the quantitative variables. The Receiving Operating Characteristic curve enabled us to determine a threshold value of the BC according to BMI. The study included 333 patients, with a mean age of 45 ± 16 years (range : 18-86). BMI and BC were strongly correlated; BC =11.69 + 0.68(BMI), with r2 = 0.65 (P < 0.01)). The threshold value of BC retained to detect undernutrition was 27 cm. The prevalence of undernutrition at the Douala General Hospital varies according to the anthropometric parameter used. At a BC threshold of 27 cm, the prevalence of undenutrition in our population was 24,3%.

[Clinical and immunological profile of HIV-infected patients at the initiation of antiretroviral therapy in Douala]. / Profil clinique et immunologique des patients infectés par le VIH à l'initiation du traitement antirétroviral à Douala.

The aim of this study was to describe the clinical and immunological profile of patients infected with HIV after initiation of antiretroviral therapy. Sociodemographic characteristics, clinical and immunological patients were recorded. Chi square test and Mann-Whitney were used to compare variables. The multivariate regression model identified risk factors. So that, 936 (56.2%) patients were in stages III and IV of the WHO and 65.2% at an advanced stage of the disease. Factors associated with initiation at an advanced stage, were male sex (p = 0.007) and time to diagnosis (p = 0.005). In 2/3 cases, treatment is started at an advanced stage of disease. It is therefore important to intensify awareness campaigns for early detection and encourage patients to ensure regular medical follow-up screening.

Fractionated half-body irradiation (HBI) for the rapid palliation of widespread, symptomatic, metastatic bone disease: a randomized Phase III trial of the International Atomic Energy Agency (IAEA).

PURPOSE: To find the fastest and most effective/efficient method to economically deliver fractionated half-body irradiation (HBI) for widespread (WS), symptomatic, metastatic bone cancer. METHODS AND MATERIALS: A Phase III trial with 3 HBI arms: (Arm A) Control (15 Gy/5 fractions/5 days); (Arm B) Hyperfractionation (HF) (8 Gy/2 fractions/1 day); (Arm C) Accelerated HF (12 Gy/4 fractions/2 days). Six countries randomized 156 patients (all with WS bone metastases): 51, 56, and 49 patients to Arms A, B, and C, respectively. There were 72 (46%) breast, 50 (32%) prostate, 9 (6%) lung, and 25 (16%) miscellaneous primary tumors. Initial performance status (PS) was 1-2 in 101 (65%) and PS 3-4 in 55 (35%). The lower, upper, and middle halves of the body were treated 79, 68, and 9 times. RESULTS: Pain relief was seen in 91% of patients (45% complete [CR] and 46% partial [PR]) within 3-8 days. Overall (OS), median (MST), and pain-free (PFS) survival was 174, 150, and 122 days. Breast tumors had a higher OS (279 days) than that of other primary tumors, but when analyzed by treatment, was not significantly different than prostate tumors in Arm A. No survival differences were found in patients with PS 1-2 vs. 3-4, CR vs. PR, bone with/without visceral metastases, or by the number of metastases (< or > 15 bone lesions). Quality of life (QOL) assessed by the percent of the remaining life free of pain was 71%; furthermore significant improvements in PS, pain, and narcotic scores were seen after HBI. Toxicity was very acceptable (41% none, 50% mild/moderate, 12% severe but transitory); more was seen with upper HBI. CONCLUSION: In terms of response, time to response, OS, MST, PFS, QOL, and toxicity, schedules for Arms A and C were similar for all but prostate primaries. Schedule for Arm B, which delivered the lowest biologic dose in the shortest time, had significantly worse results in pain relief, OS, MST, PFS, and QOL. Results indicate that, for most primary tumor types (except prostate), delivering two HBI daily doses of 3 Gy in 2 consecutive days is as effective as delivering a daily dose of 3 Gy for 5 consecutive days. Thus, this is a faster and much more convenient HBI schedule for the palliation of pain in widespread cancer.

[Cancer localisation in men and women aged over 50 in Cameroon]. / Localisations des cancers chez les hommes et les femmes âgés de plus de 50 ans au Cameroun.

The aim of this study was to present the sites of cancers diagnosed in men and women aged 50 years and above in Cameroon. From the registries of the pathology laboratory of the Yaoundé Central Hospital which at the national level receives the majority of samples sent for histopathology analysis, we recorded all cases of cancers diagnosed in people aged 50 years and above, during the period from 1st January 1987 to 31st August 1996 (9 years 8 months). 1,925 cancers were recorded: -1,005 of these (52.2%) were issued from men aged fifty years and above. These 1,005 cancers came from seventeen sites, the most common being: liver (226 cases = 22.49%), prostate (222 cases = 22.09%), skin (195 cases = 19.40%) and ENT (100 cases = 9.95%); that made 73.93% (above 3/4) of cancers observed in men aged fifty years and above from this study. -920 of these (47.8%) were diagnosed from women aged fifty years and above. These 920 cancers came from twenty-two sites, the most common being: uterine cervix (292 cases = 31.74%), breast (170 cases = 18.48%), skin (111 cases = 12.07%) and liver (90 cases = 9.78%); that made 72.07% (about 3/4) of cancers observed in women aged fifty years and above, from this study.

A regional training programme for radiotherapists and allied professionals for the west African health community.

With 47% of the population under 15 years of age and the control of infectious and other communicable diseases, cancer will likely constitute a major health problem in West Africa in future. Radiotherapy facilities and trained manpower to run them are very limited within the subregion. This paper quantifies the severity of the situation and discusses a practical approach aimed at coping with the situation through the organisation of a training programme for radiotherapists, medical physicists and radiation technologists as part of the strategies for cancer control in West Africa. A curriculum is proposed for the training of radiotherapists.