[Collaboration in nephrology between Geneva and Yaoundé: a convincing example]. / Néphrologie solidaire : la coopération Genève-Yaoundé.

Chronic kidney disease (CKD) has a high prevalence in Cameroon and will become an important public health problem. Its management must be comprehensive, starting with CKD prevention to the implementation of renal replacement therapies best suited to the needs of patients and resources available in Cameroon. Practical interventions involving nephrology departments in both Africa and Europe can contribute to an improved management of CKD in Africa. The current collaboration between the Geneva University Hospitals and the Yaoundé teaching hospitals is a convincing example. It includes a clinical trial on the treatment of metabolic acidosis linked to CKD, assistance with the placement of hemodialysis catheters by sonography and the initiation of a kidney transplantation program with living donors.

La maladie rénale chronique (MRC) a une haute prévalence au Cameroun et va devenir un important problème de santé publique. Sa prise en charge doit être globale, partant de la prévention de la MRC jusqu'à la mise en place des techniques de suppléance extrarénale les plus adaptées aux besoins des patients et aux ressources disponibles localement. Des actions concrètes, dans le cadre d'une néphrologie solidaire, impliquant des services de néphrologie d'Afrique et d'Europe, peuvent y contribuer. La collaboration entre les Hôpitaux universitaires de Genève et ceux de Yaoundé en est un exemple probant, avec la mise en place d'un essai clinique sur le traitement de l'acidose métabolique liée à la MRC, une aide à la pose des cathéters de dialyse par sonographie et l'initiation d'un programme de transplantation rénale avec des donneurs vivants.

Prevalence and determinants of chronic kidney disease in urban adults' populations of northern Cameroon.

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

Monthly direct and indirect costs of management of CKD 3 - 5 non-dialysis patients in an out-of-pocket expenditure system: The Case of Yaoundé.

Chronic kidney disease (CKD) affects ~ 10% of the world population. In most developing nations, the costs for the treatment of CKD are met by patients. Data on the economic burden of early stages of CKD are scarce; few studies have evaluated the cost of management of CKD stages 3 - 5 in non-dialysis (ND) patients in an out-of-pocket expenditure system. This study estimated the direct, indirect, and global economic cost of management of CKD stages 3 - 5 ND patients in Yaoundé, Cameroon. It was 1-month retrospective cost analysis. Sampling was consecutive and exhaustive of CKD 3 - 5 ND patients. We evaluated direct medical, direct non-medical, and indirect costs. 69 patients were included in the study, and the mean age was 55 years. The median monthly salary of the population was USD 162. Only 1.4% of patients had 100% health insurance coverage. The total cost of management was ~ USD 163. Direct medical, direct non-medical, and indirect costs accounted for 86.4%, 7.1%, and 6.3%, respectively. That global cost was prohibitive to Cameroonians and was tantamount to 2.7 times the minimal wage in Cameroon.

Birth weight and renal markers in children aged 5-10 years in Cameroon: a cross-sectional study.

BACKGROUND: A relationship exists between birth weight (BW) and glomerular filtration rate (GFR) in postnatal kidney. Willing to fill a gap of knowledge in sub-Saharan Africa, we assessed the effect of BW on blood pressure (BP), proteinuria and GFR among Cameroonians children. METHODS: This was a cross-sectional hospital-based study from January to April 2018 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital (YGOPH). We recruited low BW (LBW) [< 2500 g], normal BW (NBW) [2500-3999 g] and high BW (HBW) [> 4000 g] children, aged 5-10 years, born and followed-up at YGOPH. We collected socio-demographic, clinical (weight, height, BP), laboratory (proteinuria, creatinine), maternal and birth data. The estimated GFR was calculated using the Schwartz equation. RESULTS: We included 80 children (61.2% boys) with 21 (26.2%) LBW, 45 (56.2%) NBW and 14 (15.5%) HBW; the median (interquartile range) age was 7.3 (6.3-8.1) years and 17 (21.2%) were overweight/obese. Two (2.5%) children, all with a NBW (4.4%), had an elevated BP whereas 2 (2.5%) other children, all with a LBW (9.5%), had hypertension (p = 0.233). Seven (8.7%) children had proteinuria with 19, 2.2 and 14.3% having LBW, NBW and HBW, respectively (p = 0.051). Equivalent figures were 18 (22.5%), 14.3, 24.2 and 28.6% for decreased GFR, respectively (p = 0.818). There was a trend towards an inverse relationship between BW and BP, proteinuria and GFR (p > 0.05). CONCLUSION: Proteinuria is more pronounced in childhood with a history of LBW and HBW while LBW children are more prone to develop hypertension. Regular follow-up is needed to implement early nephroprotective measures among children with abnormal BW.

Fatal outcomes among patients on maintenance haemodialysis in sub-Saharan Africa: a 10-year audit from the Douala General Hospital in Cameroon.

BACKGROUND: End-Stage Renal disease (ESRD) is associated with increased morbidity and mortality. We assessed the occurrence, time-trend and determinants of fatal outcomes of haemodialysis-treated ESRD patients over a 10-year period in a major referral hospital in Cameroon. METHODS: Medical records of ESRD patients who started chronic haemodialysis at the Douala General Hospital between 2002 and 2012 were reviewed. Baseline characteristics and fatal outcomes on dialysis were recorded. Accelerated-failure time and logistic regression models were used to investigate the determinants of death. RESULTS: A total of 661 patients with 436 (66 %) being men were included in the study. Mean age at dialysis initiation was 46.3 ± 14.7 years. The median [25th-75th percentiles] duration on dialysis was 187 [34-754] days. A total of 297 (44.9 %) deaths were recorded during follow-up with statistical difference over the years (p < 0.0001 for year by year variation) but not in a linear fashion (p = 0.508 for linear trend), similarly in men and women (p = 0.212 for gender*year interaction). The death rate at 12 months of follow-up was 26.8 % (n = 177), with again similar variations across years (p < 0.0001). In all, 34 % of deaths occurred within the first 120 days. Year of study and background nephropathies were the main determinants of mortality, with the combination of diabetes and hypertension conveying a 127 % (95 % CI: 40-267 %) higher risk of mortality, relative to hypertension alone. CONCLUSION: Mortality in dialysis is excessively high in this setting. Because most of these premature deaths are potentially preventable, additional efforts are needed to offset the risk and maximise the benefits from the ongoing investments of the government to defray the cost of haemodialysis. Potential actions include sensitisation of the population and healthcare practitioners, early detection and referral of individuals with CKD; and additional subsidies to support the cost of managing co-morbidities in patients with CKD in general.

A practical approach to low protein diets for patients with chronic kidney disease in Cameroon.

Cameroon is a low-middle income country with a rich diversity of culture and cuisine. Chronic kidney disease (CKD) is common in Cameroon and over 80 % of patients present late for care, precluding the use of therapies such as low protein diets (LPDs) that slow its progression. Moreover, the prescription of LPDs is challenging in Cameroon because dieticians are scarce, there are no renal dieticians, and people often have to fund their own healthcare. The few nephrologists that provide care for CKD patients have limited expertise in LPD design. Therefore, only moderate LPDs of 0.6 g protein per kg bodyweight per day, or relatively mild LPDs of 0.7-0.8 g protein per kg bodyweight per day are prescribed. The moderate LPD is prescribed to patients with stage 3 or 4 CKD with non-nephrotic proteinuria, no evidence of malnutrition and no interrcurrent acute illnesses. The mild LPD is prescribed to patients with stage 3 or 4 CKD with nephrotic proteinuria, non-symptomatic stage 5 CKD patients or stage 5 CKD patients on non-dialysis treatment. In the absence of local sources of amino and keto acid supplements, traditional mixed LPDs are used. For patients with limited and sporadic access to animal proteins, the prescribed LPDs do not restrict vegetable proteins, but limit intake of animal proteins (when available) to 70 % of total daily protein intake. For those with better access to animal proteins, the prescribed LPDs limit intake of animal proteins to 50-70 % of total daily protein intake, depending on their meal plan. Images of 100 g portions of meat, fish and readily available composite meals serve as visual guides of quantities for patients. Nutritional status is assessed before LPD prescription and during follow up using a subjective global assessment and serum albumin. In conclusion, LPDs are underutilised and challenging to prescribe in Cameroon because of weakness in the health system, the rarity of dieticians, a wide diversity of dietary habits, the limited nutritional expertise of nephrologists and the unavailability of amino and keto acid supplements.

Prevalence and determinants of chronic kidney disease in rural and urban Cameroonians: a cross-sectional study.

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem that disproportionally affects people of African ethnicity. We assessed the prevalence and determinants of CKD and albuminuria in urban and rural adults Cameroonians. METHODS: This was a cross-sectional study of 6-month duration (February to July 2014), conducted in the health district of Dschang (Western Region of Cameroon), using a multistage cluster sampling. All adults diagnosed with albuminuria (≥ 30 mg/g) and/or decreased estimated glomerular filtration rate (eGFR) (< 60 ml/min/1.73 m(2)) were re-examined three months later. Logistic regression models were used to relate baseline characteristics with prevalent CKD. RESULTS: We included 439 participants with a mean age of 47 ± 16.1 years; with 185 (42.1 %) being men and 119 (27.1 %) being urban dwellers. There was a high prevalence of hypertension (25.5 %), diabetes (9.8 %), smoking (9.3 %), alcohol consumption (59.7 %), longstanding use of herbal medicine (90.9 %) and street medications (87.5 %), and overweight/obesity (53.3 %) which were predominant in rural area. The prevalence of CKD was 13.2 % overall, 14.1 % in rural and 10.9 % in urban participants. Equivalents figures for CKD stages G3-G4 and albuminuria were 2.5 %, 1.6 % and 5.0 %; and 12.1 %, 14.1 % and 6.7 % respectively. Existing hypertension and diabetes were associated with all outcomes. Elevated systolic blood pressure and the presence of hypertension and diabetes were the predictors of albuminuria and CKD while urban residence was associated with CKD stages G3-G4. CONCLUSION: The prevalence of CKD and albuminuria was high in this population, predominantly in rural area, and driven mostly by the commonest risk factors.

Prevalence and risk factors of chronic kidney disease in urban adult Cameroonians according to three common estimators of the glomerular filtration rate: a cross-sectional study.

BACKGROUND: Chronic kidney disease (CKD) is a major threat to the health of people of African ancestry. We assessed the prevalence and risk factors of CKD among adults in urban Cameroon. METHODS: This was a cross-sectional study of two months duration (March to April 2013) conducted at the Cité des Palmiers health district in the Littoral region of Cameroon. A multistage cluster sampling approach was applied. Estimated glomerular filtration rate (eGFR) was based on the Cockcroft-Gault (CG), the four-variable Modification of Diet in Renal Disease (MDRD) study and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Logistic regression models were used to investigate the predictors of CKD. RESULTS: In the 500 participants with a mean age of 45.3 ± 13.2 years included, we observed a high prevalence of overweight and obesity (60.4 %), hypertension (38.6 %) and diabetes (2.8 %). The mean eGFR was 93.7 ± 24.9, 97.8 ± 24.9 and 99.2 ± 31.4 ml/min respectively with the MDRD, CG and CKD-EPI equations. The prevalence of albuminuria was 7.2 % while the prevalence of decreased GFR (eGFR < 60 ml/min) and CKD (any albuminuria and/or eGFR < 60 ml/min) was 4.4 and 11 % with MDRD, 5.4 and 14.2 % with CG, and 8.8 and 10 % with CKD-EPI. In age and sex adjusted logistic regression models, advanced age, known hypertension and diabetes mellitus, increasing body mass index and overweight/obesity were the predictors of albuminuria, decreased GFR and CKD according to various estimators. CONCLUSION: There is a high prevalence of CKD in urban adults Cameroonian, driven essentially by the commonest risk factors for CKD.

Epidemiological profile of patients with end stage renal disease in a referral hospital in Cameroon.

BACKGROUND: Data regarding the epidemiology of end-stage renal disease (ESRD) and dialysis in sub-Saharan Africa are scarce and knowledge about the spectrum renal disease is very limited. This study is on the profile of patients with ESRD in a referral hospital in Cameroon. METHODS: Medical records of patients with ESRD covering a 10-year period of activities of the Douala General Hospital were reviewed. Data were retrieved on socio demographic, and clinical data such as major comorbidities, the presumed aetiology of ESRD, blood pressure, biological variables and renal replacement therapy. RESULTS: In all 863 patients were included with 66% being men. Mean age was 47.4 years overall, 48.9 in men and 44.5 in women (p < 0.001). The main background aetiologies of ESRD were hypertension (30.9%), glomerulonephritis (15.8%), diabetes (15.9%), HIV (6.6%) and unknown (14.7%). Participants with HIV, glomerulonephritis or unknown background nephropathy were younger, more likely to be women, to be single and unemployed, while those with hypertension and/or diabetes were older, more likely to be men, to be either married or widow, and to be retired or working in the public sector. A total of 677 patients started haemodialysis with decreasing trend across age quartiles (p = 009), and variation across background nephropathies (p < 0.001). Emergency dialysis unplanned on a temporary catheter occurs in 88.3% of patients. CONCLUSION: This study has revealed substantial gender and age differentials in the socio-demographic features and background nephropathy in patients with ESRD in this setting. The likelihood of starting maintenance dialysis varied across background nephropathies, driven at least in part by age differences across background nephropathies.

Post-partum trend in blood pressure levels, renal function and proteinuria in women with severe preeclampsia and eclampsia in Sub-Saharan Africa: a 6-months cohort study.

BACKGROUND: Preeclampsia and eclampsia, which are the most frequent hypertensive disorders in pregnancy, are associated with renal involvements. We aimed to assess the time trend in blood pressure levels, renal function and proteinuria after delivery, and investigate their determinants in Cameroonian women with severe preeclampsia and eclampsia. METHODS: This was a prospective cohort study involving 54 women with severe preeclampsia and eclampsia, conducted between July 2010 and February 2012 at the central maternity unit of the Yaoundé Central Hospital. Clinical and laboratory parameters were recorded from day-1 to 6 months after delivery. Mixed-linear and logistic regression models were used to relate baseline and within follow-up levels of covariates, with changes in blood pressure levels, renal function and proteinuria, as well as persisting hypertension, renal failure and proteinuria. RESULTS: During follow-up, a significant improvement was observed in blood pressure, renal function and proteinuria (all p < 0.002). Thirteen (24.1%) patients with renal failure at delivery recovered completely within six weeks. Twenty-six (48.1%), 17 (31.5%) and 1 (1.8%) patients had persisting proteinuria at 6 weeks, 3 months and 6 months post-delivery, respectively. Corresponding figures for persisting hypertension were 23 (42.6%), 15 (27.8%) and 8 (14.8%). Advanced age, higher body mass index, low gestational age at delivery, low fetal birth weight, and proteinuria at delivery were the main risk factors for persisting hypertension at 3 months, meanwhile low fetal birth weight, severe preeclampsia and proteinuria at delivery were correlated with persisting proteinuria at 3 months. Advanced age and higher body mass index were the only determinants of the composite outcome of persisting hypertension or proteinuria at three and six months. CONCLUSION: Hypertension and proteinuria are very common beyond the postpartum period in Cameroonian women with severe preeclampsia and eclampsia. Long-term follow-up of these women will help preventing and controlling related complications.

Acquired cystic kidney disease in patients on maintenance hemodialysis, prevalence and associated factors: a cross-sectional study.

Introduction: Acquired Cystic Kidney Disease (ACKD) is a known complication in patients on maintenance hemodialysis, and it is associated with a high risk of malignant transformation. There is a paucity of data on ACKD in sub-Saharan Africa. Objectives: To determine the prevalence and factors associated with acquired cystic kidney disease in patients on maintenance hemodialysis. Methods: patients on maintenance hemodialysis were screened for ACKD. Patients with hereditary cystic kidney disease were excluded. Renal ultrasounds were performed by two radiologists. ACKD was defined as 3 or more bilateral renal cysts in a small or normal size kidney. Associated factors were determined using logistic regression. A p-value <0.05 was significant. Results: a total of 158 participants were enrolled and 61.4% (97) were male. Their mean (SD) age was 45.8 (14.9) years. The median dialysis vintage was 33.5 [10.7-63.2] months. The mean (SD) length of the kidneys was 85.1 (17.5) mm on the left and 81.2 (17.1) mm on the right. The prevalence of ACKD was 31.6% (n=50). Septated cysts (4), calcification of the wall of the cysts (2), irregular thick calcified wall (1), septated cysts with calcification (1) and hemorrhagic cyst (1) cysts were also observed. Dialysis vintage > 36 months (OR 7.1, 95% CI: 3.3 - 15.5) and male sex (OR 2.6, 95% CI: 1.2-5.6) were independently associated with ACKD. Conclusion: the prevalence of ACKD is high in a population of Cameroonians on maintenance. This result calls for the implementation of strategies to screen for the condition and its complications.

Complications of arteriovenous fistula for hemodialysis: an 8-year study.

BACKGROUND: To assess the frequency and characteristics of complications of arteriovenous fistula (AVF) and their effect on fistula outcome. METHODS: We retrospectively reviewed 628 AVFs constructed from November 2002 to October 2010 to record the complications and their management options. The association between age, sex, comorbidities (HIV, hypertension, and diabetes), fistula type, and complications was sought. RESULTS: Most patients were males (73.7%). The mean age was 45.3 years. Comorbidities seen included diabetes mellitus (22.12%), hypertension (83.12%), and HIV infection (9.87%). AVFs constructed were mainly radiocephalic (68%) and brachiocephalic (24.9%). The median follow-up period was 275 days. The cumulative patency rate was 76% and 51% at 1 year and 2 years, respectively. Altogether, 211 complications occurred in 16% of the AVFs. Among them, 36.96% were severe, 25.11% moderate, and 43.91% minor. With respect to the time of occurrence, 63.98% were late complications, 12.79% immediate, and 23.22% early. Aneurysms, failure to mature, and thrombosis were the most frequent complications occurring in 26.54%, 14.69%, and 12.79% of cases, respectively. The management options for the complications included the creation of a new access in 36.96%, a temporary catheter before a new AVF in 10.52%, and nonoperative management in 43.12%. We found no adverse effect of comorbid factors such as diabetes mellitus (χ(2) = 3.58, P > 0.05) or HIV-positive status (χ(2) = 0.64, P > 0.05) on the complication rate. CONCLUSION: This study shows an overall frequency of complications of 16%. These results show the potential for low complication rate of AVF in selected population.

Patients characteristics and outcome of 518 arteriovenous fistulas for hemodialysis in a sub-Saharan African setting.

BACKGROUND: To present the particular aspects of arteriovenous fistula (AVF) for hemodialysis in sub-Saharan Africa in terms of patients' characteristics, patency and complication rates, as well as factors influencing them. METHODS: From November 2002 to November 2009, 518 fistulas were constructed on adults. Demographic data, patency, and complications were analyzed. The association between age, sex, and comorbidities (HIV, hypertension, diabetes) on one hand and complications as well as AVF patency on the other was sought. RESULTS: Males represented 73.7% of the patient population, and the mean age of the population was 45.3 years. As far as etiologies of end-stage renal disease (ESRD) and comorbidities are concerned, chronic glomerulonephritis was the leading cause of ESRD (134; 25.9%), followed by hypertension (22.3%), although prevalent in 83.2% of patients, and diabetes (20.1%), although prevalent in 22.2%. No cause for the ESRD could be identified in 89 patients (17.2%). Only 20.64% had AVF as the initial vascular access. The main types of AVF constructed were radiocephalic (68%) and brachiocephalic (24.9%). The median follow-up period was 275 days. The cumulative patency rate at 1 year and 2 years was 76% and 51%, respectively. Altogether, 188 complications occurred in 16% of the AVFs. Aneurysms, failure to mature, and thrombosis were the most frequent complications occurring in 27.65%, 14.89%, and 10.63% of cases, respectively. The management options for the complications included the creation of a new access for 63 complications (33.51%) and nonoperative management in 44.14% of the cases. We found no adverse effect of comorbid factors like diabetes mellitus (χ(2) = 3.58, P > 0.05) and HIV-positive status (χ(2) = 0.64, P > 0.05) on the complications rate. CONCLUSION: According to our patients' characteristics, there is a possibility of constructing AVF on nearly every hemodialysis patient with a good outcome.

Sex and gender differences in chronic kidney disease and access to care around the globe.

The difference between sex, the biological construct, and gender, the social construct, may be most evident in settings of vulnerability. Globally, chronic kidney disease is more prevalent among women, but the prevalence of end-stage kidney failure, and especially receipt of kidney replacement therapy, is higher in men. These differences likely reflect a combination of physiological and social/structural risk factors that independently modulate kidney disease and/or its progression. The distribution of the most common risk factors such as hypertension and obesity differ between men and women and may impact disease risk differentially. Social and structural gender-related inequities remain stark across the globe. More women live in poverty, receive less education, and are more dependent on others for health care decision making, but men may have a higher risk of injury, occupational exposures, and less access to screening, prevention, and primary care. In this article, we explore how social determinants of health affect kidney disease risk and access to care differentially across genders, and differently across the globe. We also describe specific challenges experienced by boys and girls with kidney disease, how culture and geography may impact kidney care in places where resources are particularly limited such as sub-Saharan Africa, and give examples of social and structural circumstances that place young men and women at high risk of kidney disease in Mexico and Central America, illustrated by case vignettes. The coronavirus disease-2019 pandemic has raised awareness of pervasive gender-based inequities within all societies. This applies to kidney disease and is not new. The nephrology community must add its voice to the calls for action, for a more just society overall, and for the recognition of the roles of sex and gender as modulators of kidney disease risk and access to care.

Spontaneous Twin Pregnancy: A Challenging and Exceptional Scenario in a Patient on Maintenance Hemodialysis in Sub-Saharan Africa.

Chronic hemodialysis is associated with reduced fertility. Hence, pregnancy remains rare, challenging, and deleterious when unplanned, especially in low-resource countries. Contraception and births are very important in these settings. Though the main modes of contraception have been proposed in the chronic kidney disease (CKD) population, contraception still remains challenging in patients on maintenance hemodialysis. Most doctors, however, overlook contraception because of the low fertility, high rate of amenorrhea, and low libido. Furthermore, patients are less receptive to contraceptive counseling either because of a high desire to give birth or due to amenorrhea and low libido. Management of unplanned pregnancies is therefore very challenging and a multidisciplinary approach is the rule; however, it does not guarantee a good prognosis for both the mother and child. Very few cases of multiple pregnancies without induction of ovulation have been reported in patients with severe renal failure, especially those on maintenance dialysis. A 32-year-old multiparous woman with end-stage kidney failure (ESKF) and a residual diuresis of 700 mL per day who had been on inadequate maintenance hemodialysis for 36 months, presented with abdominal distension, which was confirmed on abdominal ultrasound to be a twin pregnancy at 22 weeks of gestation. Thereafter, we intensified hemodialysis (3 sessions/week), managed hypertension and anemia. The obstetrical course was uneventful until the 25th week of gestation when she developed grade 3 (WHO) hypertension and peripheral fluid overload. At the 29th week, she had a spontaneous vaginal preterm delivery of 2 babies weighing 1,350 g and 1,000 g, with an Apgar score of 8 and 7, respectively. Babies, however, died on day 1 and day 5 postpartum, respectively, from respiratory distress and early neonatal infection. The evolution of the mother was uneventful as she continued with her hemodialysis sessions. Twin pregnancies are a rare and very high-risk condition in end-stage renal disease and require multidisciplinary management.

Prevalence of unrecognized or "silent" myocardial ischemia in chronic kidney disease patients: Protocol for a systematic review and meta-analysis.

INTRODUCTION: Chronic kidney disease (CKD) patients are at an extremely high risk of silent myocardial ischemia (SMI). However, there is a dearth of evidence on the worldwide prevalence of this very lethal and yet unrecognizable complication of CKD. The proposed systematic review and meta-analysis aims to estimate the global prevalence of SMI among CKD patients. METHODS AND ANALYSES: This protocol was conceived according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. The systematic review will involve all observational studies and clinical trials published until April 30, 2021, and reporting on the prevalence of SMI in CKD patients. Electronic sources including MEDLINE, Embase, Web of Science, and Cochrane database of systematic reviews will be perused for potentially eligible studies, restricted to only studies published in English or French. Two investigators will independently select studies and use a pre-pilot tested form to extract data. Further, they will independently perform a qualitative assessment of the risk of bias and overall quality of the selected studies, followed by a quantitative assessment using funnel plots and Egger's tests. The heterogeneity between studies will be assessed with the Cochrane's Q statistic, and the I2 statistic will measure the percentage of variation across studies that is due to their heterogeneity rather than chance; the I2 will decide if a meta-analysis can be conducted. In case it cannot be conducted, a descriptive analysis will be performed. Otherwise, study-specific estimates will be pooled using either a fixed-effects or a random-effects model, depending on the value of the I2 statistic. Subgroup and random effects meta-regression analyses will further investigate the potential sources of heterogeneity. Finally, sensitivity analyses will be performed to measure the impact of low-quality studies on the results of the meta-analysis, and power calculations will determine the probability that we will detect a true effect if it does exist. PROSPERO REGISTRATION NUMBER: CRD42020211929. STRENGTHS AND LIMITATIONS OF THIS STUDY: The intended systematic review and meta-analysis will fill the knowledge gap on the global prevalence of silent myocardial ischemia (SMI) in CKD patients. The eligible studies will be identified through a methodic literature search followed by a rigorous screening process; we will then use robust meta-analysis tools to pool the data and provide reliable estimates of the global prevalence of SMI in CKD patients. Two major limitations could be: the predominance of clinical trials that might limit the generalizability of the findings, given that some informative patients might have been sidelined by the strict inclusion criteria of these studies; the high probability of type 1 error originating from the important number of subgroup and sensitivity analyses.

Short-term effects of perindopril-amlodipine vs perindopril-indapamide on blood pressure control in sub-Saharan type 2 diabetic individuals newly diagnosed for hypertension: A double-blinded randomized controlled trial.

Poor blood pressure (BP) control contributes to complications in sub-Saharan African (SSA) type 2 diabetic individuals. Experts have advocated the use of combination therapies for effective BP control in these patients. The suggested combinations should include a RAAS antagonist and either a CCB or a thiazide diuretic; however, their efficacy is yet to be established in SSA. We investigated the short-term effects of two combination therapies on BP control in SSA type 2 diabetic individuals. This was a double-blinded randomized controlled trial conducted at the Yaoundé Central Hospital (Cameroon) from October 2016 to May 2017. We included type 2 diabetic patients, newly diagnosed for hypertension. After baseline assessment and 24-hour ABPM, participants were allocated to receive either a fixed combination of perindopril + amlodipine or perindopril + indapamide for 42 days. Data analyses followed the intention-to-treat principle. We included fifteen participants (8 being females) in each group. Both combinations provided good circadian BP control after 6 weeks with similar efficacy. Twenty-four-hour SBP dropped from 144 to 145 mm Hg vs 128 to 126 mm Hg with perindopril-amlodipine and perindopril-indapamide, respectively (P = 0.003 for both groups). Twenty-four-hour DBP dropped from 85 to 78 mm Hg (P = 0.013) vs 89 to 79 mm Hg (P = 0.006) in the same respective groups. No significant adverse effect was reported. A fixed initial combination of perindopril-amlodipine or perindopril-indapamide achieved similar effective BP control after 6 weeks in SSA type 2 diabetic individuals with newly diagnosed hypertension. Therefore, these combinations can be used interchangeably in this indication.

Effects of hydroquinone-containing creams on capillary glycemia before and after serial hand washings in Africans.

BACKGROUND: Hydroquinone-containing creams cause false increases in capillary glycemia. However, the magnitude of this false increase, and the means to reverse it have not been investigated. OBJECTIVE: To evaluate the technical and clinical impact of hydroquinone-containing creams on capillary glycemia and investigate the efficacy of hand washing and other common practices, in reversing cream effects. METHODS: We included 91 participants in a quasi-experimental study in Buea, Cameroon. After determining the hydroquinone content of a cream, Caro Light, we used two glucometers with different enzymatic systems (Accu-Chek Active and OneTouch Ultra 2) to measure fasting glycemia after: initial hand washing (reference), application of 1 ml of hydroquinone-containing cream, finger swabbing with wet gauze, sanitizer application and a series of three hand washings following cream application. Reference glycemia was compared to those obtained after various interventions. Statistical significance was assessed by paired sample t-test, clinical significance by total error allowable (TEa), and clinical impact by Parke's error grid analysis. RESULTS: The mean differences in capillary glycemia (Intervention-reference) measured by Accu-Chek Active in mg/dl were 28, 27, 38, 16, 4, and -2 after cream application, finger swabbing, sanitizer application, one, two, and three hand washings respectively. Corresponding values for OneTouch Ultra2 were 41, 44, 64, 22, 5 and -5. These differences, except after two and three hand washings were both statistically (p < 0.0001) and clinically significant (TEa). After cream application, Accu-Check had 9.9% of values in Parke's Zones C-E, while OneTouch had 18.7%. CONCLUSION: Hydroquinone-containing creams cause significant false increase in capillary glycemia irrespective of the enzymatic system of the glucometer used, and can lead to potentially wrong clinical decisions. A minimum of two hand washings is required prior to capillary glucose measurement.

HIV/AIDS occurrence in the main university teaching hospital in Cameroon: audit of the 2001 activities of the service of internal medicine.

AIM: This study describes the impact of HIV/AIDS on the inpatient service of the main teaching hospital in Cameroon in 2001. METHODS: The authors analyzed routinely collected hospital data and data validated by survey of clinical notes. RESULTS: Admission and bed utilization rates for HIV/AIDS over the period accounted for 20.1% and 17%, respectively, primarily due to the management of opportunistic infections in young people (mean age, 39.9 years). Housewives (21.9%) and students (10.3%) were the most identified groups. Tuberculosis (23.3%), the most frequent infection, was associated with a good prognosis. Hospital stay ranged from 1 to 99 days. HIV/AIDS accounted for 49.3% of deaths registered. CONCLUSION: HIV/AIDS is the major cause of hospital admissions and death in this service. This situation is likely to remain constant for some time given the national prevalence of HIV. Consideration needs to be given to the options for prevention and provision of care.