MUSCULOSKELETAL PRESENTATION OF MULTIPLE MYELOMA AT GENERAL HOSPITAL DOUALA, CAMEROON.

UNLABELLED: Background: very little is known about musculoskeletal features of multiple myeloma (MM) in Africa. OBJECTIVES: To describe the musculoskeletal features of multiple myeloma at presentation in a tertiary health care centre in sub-Saharan Africa. DESIGN: A Cross sectional observational study. SETTING: The Douala General Hospital, Cameroon from 2007 to 2013. SUBJECTS: A patient was said to have MM according the current international consensus criteria for diagnosis and staging of MM. Patients with monoclonal gammopathy of undetermined significance, solitary plamocytoma and other haematologic malignancies were excluded. RESULTS: A total of 62 patients were diagnosed with multiple myeloma, 63% were female. Mean age was 57 ± 12,1 (19-81) years. Musculoskeletal presentation included spine bone pains (75.6%); vertebral fracture with spinal cord compression in 46.8 %. Other clinical features at presentation included anaemia (70.93%), and nephropathy (17.74%). The average percentage of bone marrow plasmacytosis at diagnosis was 33% and Immunoglobulin G was found in 86% of patients. Sixty three per cent of patients were diagnosed at stage III of the disease. CONCLUSION: Presence of bone pain and anaemia should alert the clinician to investigate along the lines of multiple myeloma. Majority of the patients have osteolytic lesions and pathologic fractures at the time of diagnosis.

Blood donor haemovigilance in Yaoundé, Cameroon.

BACKGROUND: Blood availability is an issue of concern in countries of sub-Saharan Africa where both the demand and discard rates of blood are high. Although some degree of attention is paid when transfusion reactions occur in recipients, no information is available on donor reactions in this setting. OBJECTIVES: This study was carried out in order to obtain some data on adverse reactions (ARs) to blood donations. It would make it possible to monitor and improve the safety of the donation procedure, which constitutes a strategy towards increasing donor supply by encouraging first-time donors to return in the absence of any negative outcomes of donation. METHODS: A hospital blood bank-based descriptive and prospective study was carried out to document ARs among 1034 blood donors from September 2010 to January 2011. A pre-structured data collection tool was used to record the signs and symptoms observed. RESULTS: The ARs occurred at a rate of 2.8%. The most frequent reaction was hypotension which constituted 26.62% of all ARs. Haematomas represented 18.42% while weakness and dizziness were each noted in 13.16% of donors. There was no severe vasovagal reaction. Associated factors to vasovagal reactions were first-time donor status (P = 0.004), female sex (P = 0.01) and low body weight (P = 0.02). CONCLUSION: Our results suggest that blood donation is a relatively safe procedure in our context. The frequency is higher than studies from developed countries. The association of AR with first-time blood donation needs to be verified in a larger study. However, it could suggest another benefit of regular blood donation.

Asymptomatic carriage of malaria parasites in blood donors in Yaoundé.

BACKGROUND: Malaria can be transmitted through blood transfusion, but there is paucity of data concerning transfusion-transmitted malaria in Cameroun. OBJECTIVE: To determine prevalence of malaria infection and association with epidemiological and clinical data obtained from donors' responses. METHODS: Microscopic examination of stained thick and thin blood smears for the detection, quantification and specification of Plasmodium sp was performed on 493 blood donors in two main hospitals in Yaoundé during October and November 2007. RESULTS: Overall 6 · 5% of blood donors were detected positive for Plasmodium sp infection: 90 · 6% was Plasmodium falciparum and 9 · 4% was Plasmodium malariae. Parasite counts ranged from 80 to 800 µL(-1) with a median of 320 µL(-1). Asexual and sexual forms were found in 75 · 9 and 24 · 1% of cases, respectively. Age, sex, type of blood donor (voluntary non-remunerated vs familial/replacement) and fate of blood donation (selected vs discarded) did not affect the prevalence of malaria carriage. The lack of malaria prophylaxis as well as the manifestation of malaria symptoms within 2 weeks and 1 month preceding blood donation were significantly associated with high frequency of parasites carriage. CONCLUSION: Malaria parasites carriage is frequent among blood donors in Yaoundé. These data seem to describe high-risk donor profile and may help improving blood safety related to transfusion-transmitted malaria in Cameroon.

Hemophilia care in Africa: Status and challenges.

Haemophilia care remains challenging especially in resource-limited settings where haemophilia and other non-communicable diseases may not be considered a healthcare priority, in comparison to malaria, HIV/AIDS and other infectious diseases. This article is a review of the evolution in haemophilia care in Africa, with focus on countries with varying degrees of care (Cameroon with budding care; Senegal with more evolved care and Egypt with a more longstanding history of care). The indispensable role of the World Federation of Haemophilia is highlighted in all the contexts of care.

The blood donor in sub-Saharan Africa: a review.

The high prevalence of numerous endemic and epidemic diseases such as malaria, HIV infection and viral hepatitis in some areas of sub-Saharan Africa (SSA) affects the health status of blood donors. Considering the difficulties in ensuring sufficient and safe blood supply, analysing epidemiological factors that impact blood donors in this community may further bring light on issues of supply and safety, and help in planning for its rational use. This review does not aim to propose new strategies but describes the main characteristics of blood donors in SSA as collected from different reports. Data were mainly obtained from the reports of the World Health Organization and national blood transfusion programmes and also from relevant literature and conference reports. Several characteristics are common in blood donors, such as the predominance of young adult males, the high frequency of Transmission-transmitted Infections (TTIs) and some erythrocytic phenotypes. The data indicate variations in the level of improvement of blood collection and blood safety from one area to another, particularly in the field of donor motivation or screening strategies for TTIs. These data could be useful to supplement previous reports and to provide updates for governments and international organizations' programs involved in the improvement of blood safety in Africa.

Factors influencing the return of inactive blood donors in a Cameroonian blood bank.

Identify factors that influence the return of donors to increase their loyalty while improving blood safety is crucial in our context. Between October 2017 and April 2018, we conducted a descriptive cross-sectional study at the Blood Bank of the Yaoundé University Teaching Hospital. The study included all former donors who had not donated blood voluntarily for over a year. Quantitative variables were described using means and standard deviations. Fisher's exact test and Chi2 test were used for association measures between qualitative variables. Statistical test results were considered significant for a P<0.05 value. We interviewed a total of 101 inactive donors. The study population was 74.3% male, donors average 30±7 years. Female gender and good staff hospitality were the factors most associated with the intention to return. The barriers to donor return were mainly lack of information on blood needs (35.60%) and time constraint for blood donation (26.73%). Pro-social motivations such as altruism (30.70%) were the main possible sources of motivation cited. To reduce blood deficiency and mortality due to lack of blood products, non-financial material compensation, good outreach and communication strategy can increase inactive donors' loyalty and consequently in improving blood safety in our context.

[The erythrocyte phenotype in ABO and Rh blood groups in blood donors and blood recipients in a hospital setting of Cameroon: adapting supply to demand]. / Le phénotype érythrocytaire dans les systèmes ABO et Rh chez le donneur et le receveur de produits sanguins en milieu hospitalier camerounais: adapter l'offre à la demande.

The administration of ABO and Rh compatible blood products is primordial for the immulogic safety of blood during blood transfusion, more so in resource limited settings where blood grouping is confined to ABO and Rh testing only. Thus, from an immunological perspective, the frequency of blood phenotypes and the qualitative balance between supply and demand of blood products in a Cameroonian hospital were analyzed. All blood collected was phenotypically typed and compared to the phenotypes of all transfusion recipients during the same period. A total of 1007 units of blood and 1013 recipients were typed. Our results showed that in the donor group, the frequencies of phenotypes A, B, AB, O, and RH1 were respectively 24.2 %, 18.8 %, 5.7 %, 51.3 % and 97.6 %. In the recipient group, the respective frequencies were 40 %, 12.4 %, 3.4 %, 44.2 % and 96.9 %. The supply for blood phenotypes O, B and AB was higher than the demand, and the reverse was true for phenotype A and RH-1. Further sensitization of phenotype A and RH-1 donors may enhance meeting these needs.

[The new HemoCue system Hb 301 for the haemoglobin measurement in pregnant women]. / Evaluation du nouvel appareil HemoCue Hb 301 dans le dosage de l'hémoglobine chez des femmes enceintes camerounaises.

The performance of the HemoCue apparatus in the diagnosis of anaemia in pregnancy was evaluated using the HemoCue Hb 301 and the HemoCue Hb 201+ apparatus. The HemoCue Hb 201 + was considered as the reference method in this study. Two hundred and thirty six pregnant women attending the University Teaching Hospital in Yaoundé (Cameroon) were included in the analysis. Anaemia was defined as haemoglobin < 11 g/dL in pregnant women during the first and the third trimester of pregnancy and as <10. 5 g/dL during the second trimester of pregnancy. With the reference method, anaemia was present in 17.7% of pregnant women compared to 11% using the HemoCue 301 method. The sensitivity, specificity, positive and negative predictive values for the HemoCue 301 method were respectively 61.9%, 100%, 100% and 92.3%. A strong correlation was shown with a Pearson's coefficient of 0.98. Using the Bland and Altman method for assessing agreement between two methods, the 95% (+/- 2SD) distribution of Hb levels about the mean was not much spread (0.06 - 0.52) though it was positive, with slightly higher Hb levels in the HemoCue Hb 301 method, compared to the reference method. Considering the study of the precision, coefficient of variation of the two methods were similar. It may be concluded that the HemoCue Hb 301 method compared to the HemoCue Hb 201+ method has acceptable sensitivity and is very specific in the diagnosis of anaemia in the Cameroonian pregnant woman. Although it gives slightly higher values, it is precise and exact in measuring Hb levels.

[Concentrated red blood cells transfusion in Yaoundé, Cameroon: what quality?]. / Transfusion de concentrés de globules rouges à Yaoundé, Cameroun: quelle qualité ?

As part of a quality assurance process in the transfusion service of a hospital blood bank of Yaoundé, Cameroon, a selection of units of red cell concentrates (RCC) were evaluated for volume, haemoglobin, and haematocrit levels as well as blood cell content. Blood samples were all collected into standard double blood bags containing an anticoagulant, citrate-phosphate-dextrose and adenine. During a three-month period, 35 bags intended for the preparation of the RCC were analysed. After relevant screening for transfusion transmissible infections ,and ABO and rhesus (RH1) blood grouping, the bags were centrifuged to obtain RCC. The resultant red cell bags were weighed and the volumes estimated. Full blood counts were performed on samples of the RCC using an electronic particle counter (DIANA 5, HYCEL Diagnostics, Reims, France). The results obtained showed that, based on ISO 9001: 2000 norms, there were 57, 66 and 80% of RCC respectively with volumes, hemoglobin levels as well as hematocrit that were in conformity with the norms. When the data was analysed based on the Algerian norms, 83, 66 and 95% respectively conformed. The significance of these findings and the need for establishing local norms for quality assurance in our community are discussed.

[Blood safety: malaria and blood donation in Africa]. / Sécurité transfusionnelle: paludisme et don de sang en Afrique.

Malaria is a principal cause of mortality in Africa and represents a major blood-borne disease. The studies made on the continent show that transfusion-associated malaria is highly prevalent in blood donors groups and that some risk factors and clinical manifestations are frequently observed. The disease is mostly asymptomatic and the signs are mild, which reduces significantly an efficient selection of the blood donors during the predonation interview and a secure supply of blood products. Furthermore, the lack of appropriate screening assays of the malaria in blood banks on the continent limit the diagnosis of the disease and hamper the blood safety. However, the prevention of transfusion-associated malaria is a frequently asked question. The destruction of the parasite in the blood bag and the recipient anti-malarial prophylaxis are the described possibilities, added to local programs against the vectors of the disease.

Impact of HIV-1infection on survival in patients with haematological malignancies in Yaoundeé, Cameroon.

The impact of HIV-1 infection on the survival of patients with haematological cancers in Yaoundeé, Cameroon, was examined. The prevalence of HIV-1 was 26.2% among 172 patients, predominantly lymphoid malignancies. At the time of analysis, 75% of patients had died giving an incidence rate of 0.05 deaths per year and a median of survival of 15 (6-27) months. However, the hazard ratio for HIV-infected patients to die was not statistically different from that of uninfected patients (1.3, 95% confidence interval: 0.9-2.0).

[Factors associated with thrombocytopenia among pregnant women in Cameroon]. / Facteurs associés aux thrombocytopénies chez les femmes enceintes au Cameroun.

To determine the factors associated with thrombocytopenia among pregnant women in Cameroon, this cross-sectional survey studied 1124 pregnant women aged 15-40 years (mean: 25.35+/-5.48) attending antenatal clinics at two hospitals in Yaoundé. Each woman underwent a thorough medical interview and clinical examination and complete blood count to diagnose anaemia and thrombocytopenia (platelets<150x10(9)/L). When thrombocytopenia was identified, a battery of other tests followed: standard coagulation screening tests, HIV screening, and thick and thin blood films to identify blood parasites. The prevalence of thrombocytopenia was 8.9% (N=100). While a prolonged bleeding time was noted in 20% of women with thrombocytopenia, the Quick test (prothrombin time) and kaolin-cephalin clotting time were normal in all of them. The major factors associated with thrombocytopenia were anaemia (29.8%), history of intermenstrual bleeding (25.7%), history of preeclampsia (23.3%), current hypertensive disorders (23.2%), malaria (22.3%), HIV infection (21.0%) and the absence of antimalaria prophylaxis (16.2%). Thrombocytopenia was not significantly associated with third-trimester bleeding (P=0.57) or with a history of postpartum haemorrhage (P=0.06).

Identification of rare HIV-1 Group N, HBV AE, and HTLV-3 strains in rural South Cameroon.

Surveillance of emerging viral variants is critical to ensuring that blood screening and diagnostic tests detect all infections regardless of strain or geographic location. In this study, we conducted serological and molecular surveillance to monitor the prevalence and diversity of HIV, HBV, and HTLV in South Cameroon. The prevalence of HIV was 8.53%, HBV was 10.45%, and HTLV was 1.04% amongst study participants. Molecular characterization of 555 HIV-1 specimens identified incredible diversity, including 7 subtypes, 12 CRFs, 6 unclassified, 24 Group O and 2 Group N infections. Amongst 401 HBV sequences were found a rare HBV AE recombinant and two emerging sub-genotype A strains. In addition to HTLV-1 and HTLV-2 strains, sequencing confirmed the fifth known HTLV-3 infection to date. Continued HIV/HBV/HTLV surveillance and vigilance for newly emerging strains in South Cameroon will be essential to ensure diagnostic tests and research stay a step ahead of these rapidly evolving viruses.

The epidemiology of stroke in sickle cell patients in Yaounde, Cameroon.

BACKGROUND AND PURPOSE: Stroke, a severe and recurrent but preventable complication of sickle cell disease (SCD), has not been well studied in Cameroon. To obtain baseline data towards the development of a national stroke prevention programme in SCD, we studied a sample of sickle cell patients with the aim of determining stroke prevalence, clinical presentation and management practices. PATIENTS AND METHODS: Homozygous sickle cell patients in two centres in Yaounde were screened for stroke, in a cross-sectional study. Stroke was diagnosed clinically and confirmed where possible with brain computerized tomography. The National Institutes of Health Stroke Score (NIHSS) and modified Rankin scale (mRS) were used to assess stroke severity. Management practices were noted from patient charts. RESULTS: One hundred and twenty patients aged 7 months to 35 years (mean age 13.49+/-8.79 years) were included. Eight cases of stroke (mean age 16.6+/-11.2 years) were identified, giving a stroke prevalence of 6.67%. Cerebral infarction was thrice as common as cerebral hemorrhage and clinical presentation was classical. Cerebral infarction was more frequent in patients aged below 20 years and hemorrhage in those above 20 (p=0.11). The annual recurrence rate was 25%. Missed diagnosis rate by attending physician was 25%. The NIHSS and mRS showed high stroke severity. Stroke management practices were insufficient and no patient received any form of stroke prophylaxis. CONCLUSION: Stroke prevalence and presentation in sickle cell patients in Yaounde is similar to that observed in developed countries, but the wide management gap calls for rapid action. Our situation is ideal for the study of the natural history of stroke in sickle cell disease.

[Evaluation of two methods for haemoglobin measurement in Cameroonian blood donors]. / Evaluation de deux techniques de dosage de l'hémoglobine chez des donneurs de sang camerounais.

In order to identify a rapid feasible and adaptable method of haemoglobin measurement for use in a blood bank, two methods were evaluated against the automated method in 204 blood donors in Yaoundé, Cameroon. Anaemia was defined as Haemoglobin<12 g/dl. Using the World Health Organisation (WHO) haemoglobin colour scale (HCS), the Hemocue method (HemoCue AB, Angelhom, Suède) and the Celly Electronic counter (Hycel Diagnostics, Reims, France), anaemia was found in 27.5, 29.4 and 31.9% of donors respectively (P<0.05). The sensitivity and specificity of the HCS was 75.38 and 94.96% respectively compared to 86.15 and 97.13% respectively in the HemoCue method. Correlation studies between each method compared to automated method showed r=0.70 for the WHO. colour scale method and 0.91 for the Hemocue method. Using the Bland and Altman statistical method, the haemoglobin distribution around the mean was wider in the WHO scale (-2.74;+2.96) than in the Hemocue method (-2.06; +1.38). We conclude that while the two methods can be used to detect anaemia in the blood bank, that the Hemocue method is more sensitive and more specific.

Reducing risks of Transfusion-transmitted infections in a resource-limited hospital-based blood bank: the case of the Yaoundé University Teaching Hospital, Cameroon.

BACKGROUND AND OBJECTIVES: Although interest in assessing risk of TTIs, very few trends in blood safety epidemiological data from resource-limited blood services are reported in the literature. This analysis aims at reporting trends in seroprevalences of TTIs in blood donations in the Yaoundé University Teaching Hospital (UTH) from 2011 to 2015 and to describe reasons for these changes. MATERIALS AND METHODS: All donations of 2015 were tested for HIV 1&2 antibodies and the P24 antigen, HBsAg, HCV antibody and the Treponema pallidum antibody. Screening for HIV uses a national algorithm based on the systematic use of two assays of different principles: a rapid determination testing assay and an EIA HIV 1 & 2 Ab-Ag. The tests used for HBsAg and HCVAb screening were all based on EIA techniques. Treponema pallidum antibody screening was based on Treponema Pallidum hemagglutination assay (TPHA) and rapid immunochromatographic test (RIT). Screening techniques and results from 2015 were compared to retrospective data from 2011, 2012, 2013 and 2014. RESULTS: In 2015, 13·4% (n = 214) of 1,596 blood donations were seropositive for at least one screened TTIs. The most frequent serological marker was HBsAg with 123 (7·7%) blood units contaminated. Nineteen (1·2%) and 18 (1·1%) blood units was positive for HIV and syphilis, respectively. There was a significant decrease in the total number of blood donations (P < 10-4) and HIV, HBsAg and syphilis seroprevalences and an increase in the proportion of voluntary non-remunerated blood donor (P < 0·05). HCVAb seroprevalence was 3·8% in 2015 and has not decreased significantly over the years (P = 0·09). CONCLUSION: Significant progress is noted in reduction in seroprevalences of HIV, HBV, HCV and syphilis since the beginning of a regular registration of data in 1990.

Reduced insulin secretion in offspring of African type 2 diabetic parents.

OBJECTIVE: To determine the early biochemical predictors of increased susceptibility to develop diabetes in offspring of African type 2 diabetic parents. RESEARCH DESIGN AND METHODS: A total of 69 offspring (case subjects) of 26 families in Cameroon with at least one type 2 diabetic parent were studied, and 62 offspring (control subjects) from 25 families in Cameroon with no parent with type 2 diabetes underwent an oral glucose tolerance test. Early insulin secretion was calculated using the ratio of the 0- to 30-min incremental insulin values to the 0- to 30-min incremental glucose. Anthropometric parameters were also measured. RESULTS: Of the case subjects, 23% were glucose intolerant (4% with diabetes and 19% with impaired glucose tolerance [IGT]) compared with 6.5% (all with IGT) of control subjects (P = 0.02). There was also an increasing prevalence of glucose intolerance, especially IGT with increasing number of glucose-intolerant parents. Fasting serum insulin levels were not different in the two groups; however, at 30 min, the case subjects had lower insulin levels than the control subjects (P < 0.006). Case subjects with IGT had lower 30-min insulin concentration, early insulin secretion, and 2-h insulin levels than those with normal glucose tolerance (NGT) (F = 4.1, P < 0.05; F = 4.1, P < 0.04; and F = 5.1, P < 0.03, respectively). Furthermore, case subjects with NGT and IGT had lower early insulin secretion than control subjects (F = 4. 1, P < 0.03). These differences remained after adjustment for BMI and regardless of the status of parental diabetes. Two-hour insulin concentration showed a positive association (odds ratio = 0.95 CI 0.90-0.99, P = 0.039) with IGT in the case subjects. CONCLUSIONS: Diabetes and IGT are more prevalent in the offspring of African type 2 diabetic parents, and this may be due to an underlying degree of beta-cell impairment marked by reduced early-phase insulin secretion.

Left ventricular mass and systolic function in African diabetic patients: association with microalbuminuria.

OBJECTIVE: To assess echocardiographic evidence of cardiomyopathy and its association with microalbuminuria in type 2 normotensive non-proteinuric diabetic patients. MATERIAL AND METHODS: Forty consecutive normotensive non-proteinuric type 2 diabetic patients were studied. Body mass index, blood pressure, urinary albumin excretion, ECG at rest and after exercise, left ventricular mass, and shortening fraction using two-dimensional and M-mode echocardiography were measured in every patient. RESULTS: Among the 40 patients studied, 17 (42.5%) presented with microalbuminuria, 16 (40.0%) with left ventricular hypertrophy, 22 (55.0%) with systolic dysfunction and 3 (7.5%) with ECG changes compatible with cardiac ischaemia. No significant difference existed between normoalbuminuric and microalbuminuric patients for age, known duration of diabetes, body mass index, systolic and diastolic blood pressure. Ventricular mass correlated to urinary albumin excretion rate (r=0.34; p=0.04) and shortening fraction to diastolic blood pressure (r = - 0.40; p=0.01). CONCLUSION: Left ventricular structure and function might be altered in African type 2 diabetic patients in the absence of hypertension, and microalbuminuria may be an early biochemical marker of these abnormalities.

Metabolic and hormonal effects of five common African diets eaten as mixed meals: the Cameroon Study.

OBJECTIVE: To evaluate glycaemic and insulinaemic index and in vitro digestibility of the five most common Cameroonian mixed meals consisting of rice+tomato soup (diet A), bean stew+plantains (B), foofoo corn+ndolé (C), yams+groundnut soup (D), and koki beans+cassava (E). SUBJECTS: Ten healthy non-obese volunteers, aged 19-31 y, with no family history of diabetes or hypertension. INTERVENTIONS: A 75 g oral glucose tolerance test followed by the eating of the test diets with carbohydrate content standardized to 75 g every 4 days with blood samples taken at 0, 15, 30, 60, 120 and 180 min. In vitro digestion of each diet according to Brand's protocol. MAIN OUTCOME MEASURES: Plasma glucose, cholesterol, triglyceride, insulin and C-peptide, with calculation of glycaemic and insulinaemic index defined as the area under the glucose and insulin response curve after consumption of a test food divided by the area under the curve after consumption of a control food containing the same amount of carbohydrate, and digestibility index. RESULTS: Glycaemic index (GI) varied from 34.1 (diet C) to 52.0% (diet E) with no statistical difference between the diets, and insulinaemic index varied significantly from 40.2% (C) to 70.9% (A) (P=0.03). The digestibility index varied from 18.9 (C) to 60.8% (A) (P<0.0001), and did not correlate with glycaemic or insulinaemic indices. However, carbohydrate content correlated with GI (r=0.83; P=0.04), digestibility index (r=-0.70; P<0.01), and insulinaemic index (r=0.91; P<0.01). Plasma C-peptide and plasma lipids showed little difference over 180 min following the ingestion of each meal. CONCLUSIONS: Glycaemic index of these African mixed meals are relatively low and might not be predicted by in vitro digestibility index.