Noncommunicable diseases behavioural risk factors among secondary school adolescents in Urban Cameroon.

Adolescence is a crucial period for noncommunicable disease (NCD) risk factors, and interventions to reduce the NCD burden must target this age group. This study aimed to evaluate the NCD behavioural risk factors in adolescents attending state secondary schools in an urban setting in Cameroon. We conducted a cross-sectional survey using adapted structured questionnaires to assess the prevalence and correlates of NCD behavioural risk factors among adolescents attending selected urban state secondary schools in Douala IV, one of the six subdivisions in Douala, Cameroon. Of the 645 students who completed the study questionnaires, half of them did not have adequate knowledge about NCDs and their risk factors. Only 20% met recommended physical activity levels, nearly half lived sedentary lifestyles, and only 7% ate a healthy diet. Almost half of all participants reported drinking alcohol during the month, while 3% reported cigarette smoking. Participants with inadequate knowledge of NCDs were more likely to have elevated blood pressure values, and males had increased odds of high blood pressure. Contrarily, being male appeared to be protective against overweight and obesity. The odds of being sedentary decreased with age, and the odds of alcohol drinking seemed to grow with a higher maternal level of education. Our survey shows inadequate knowledge about NCDs and a high prevalence of NCD behavioural risk factors in adolescents in urban state secondary schools in Cameroon. These findings predict a higher NCD burden in future adults in the country, reinforcing the need for urgent public health interventions, especially regarding knowledge and sedentary living. Further research is needed to establish the transition of adolescent risk factors to adult disease through life course approaches in these settings.

Immune response to hepatitis B vaccine following complete immunization of children attending two regional hospitals in the Southwest region of Cameroon: a cross sectional study.

BACKGROUND: Hepatitis B virus (HBV) infection despite being a vaccine preventable disease remains a global public health problem. In Cameroon, the hepatitis B vaccine was introduced in the expanded program on immunisation in 2005, but there has been limited evaluation of the HBV surface antibody response post vaccination. OBJECTIVE: We investigated the immune response to hepatitis B vaccine in infants who received the DPT-Hep B-Hib vaccine, and we assessed HBsAg carriage in non-responders. We also investigated factors associated with non-response or poor response. METHODS: Using a hospital based cross sectional design and a structured questionnaire over a four-month period (January to April 2019), we collected data to determine factors associated with hepatitis B surface antibody (anti-HBs) response from infants aged 6 to 9 months attending infant welfare clinics (IWC) at the Buea and Limbe regional hospitals. We collected venous blood and measured anti-HBs titres using a quantitative Foresight® ELISA. We entered and analysed data using EpiData version 3.1 and SPSS version 25 respectively. RESULTS: Of the 161 infants enrolled, 159 (98.8%) developed anti-HBs antibodies. Of these 159, 157 (97.5%) and 117 (72.7%) developed ≥ 10.0 mIU/ml (seroprotection) and ≥ 100.0 mIU/ml anti-HBs titres respectively. Being younger (6 months old) was associated with seroprotection (Cramer V = 0.322, p = 0.001). Spearman rho's relational analysis showed that immunity against HBV reduced as the duration since the last dose increased (r = -0.172; P = 0.029). However, a Firth logistic regression showed no significant association of factors with inadequate immunity. All 12 (7.5%) infants exposed to HBV at birth, received the hepatitis B vaccine at birth, including four who received HBIG, and all were protected. Four infants (2.5%) had anti-HBs titres < 10.0 mIU/mL (non-responders) but had no peculiarity. CONCLUSION: The seroprotective rate following hepatitis B vaccination of infants is high even in exposed infants. Our study suggests that Cameroon's HBV vaccine in the Expanded Program on Immunisation (EPI) is effective against HBV, although we could not account for the 2.5% non-response rate. Large scale studies are needed to further explore non-response to the vaccine.

Iron stores in pregnant women with sickle cell disease: a systematic review.

BACKGROUND: Gradual improvements in the management of sickle cell disease (SCD), have led to an increase in the number of women with SCD who reach the age of procreation. However, evidence on the iron status of pregnant women with sickle cell disease (PWSCD) remains inconclusive. We conducted the first systematic review on the prevalence, determinants and maternal/foetal outcomes of iron deficiency anaemia among PWSCD. METHODS: We searched MEDLINE, EMBASE, Global Health, Africa Index Medicus, the Cochrane library databases and reference lists of retrieved publications for studies describing the iron status of PWSCD. The literature search was done over a period of 1 month, with no language or date restrictions applied. Data were extracted on a Microsoft excel sheet. Two authors assessed all included studies for methodological quality and risk of bias. RESULTS: A total of 710 reports were identified for title and article screening. Five retained studies were conducted before or during the 90s and included 67 participants. After quality assessment, the observational studies were designated to have a "fair" quality assessment while the randomised control trial had an "unclear" quality assessment. The prevalence of iron deficiency anaemia among PWSCD varied by study design and diagnostic method. The overall prevalence ranged from 6.67-83.33%. None of the studies provided evidence on factors associated with iron deficiency anaemia and the randomized trial reported no difference in outcomes between PWSCD who had iron supplementation and those who did not. CONCLUSION: Evidence on factors associated with iron deficiency anaemia among PWSCD and maternal/foetal outcomes in PWSCD who have iron deficiency anaemia is poor. The studies included in this review suggests that iron deficiency anaemia may be highly prevalent in PWSCD but due to the very small sample sizes and varied study designs, this evidence is inconclusive. The review shows that there is a need for more studies with robust designs and adequate sample sizes to assess the disease burden of iron deficiency anaemia in PWSCD.

Evaluation of emergency obstetric and neonatal care services in Kumba Health District, Southwest region, Cameroon (2011-2014): a before-after study.

BACKGROUND: There is uncertainty regarding the status of emergency obstetric and neonatal care (EmONC) in the Cameroonian context where maternal and neonatal mortality are persistently high. This study sought to evaluate the coverage, functionality and quality of EmONC services in Kumba health district (KHD), the largest health district in Southwest Cameroon.. METHODS: A retrospective study of routine EmONC data for the periods 1 January 2011 to 31 December 2012 (when EmONC was being introduced) and 1 January 2013 to 31 December 2014 (when EmONC was fully instituted) was conducted. Coverage, functionality and quality of EmONC services were graded as per United Nations (UN) standards. Data was analysed using Epi-Info version 7 statistical software. RESULTS: Among the 31 health facilities in KHD, 12 (39%) had been delivering EmONC services. Three (25%) of these were geographically inaccessible Among the 9 facilities that were assessed, 4 facilities (44%) performed designated signal functions, with 2 being comprehensive (CEmONC) and 2 basic (BEmONC). These exceeded the required minimum of 2.8 EmONC facilities/500000, 0.6 CEmONC facilities/500000 and 2.2 BEmONC facilities/500000, with reference to an estimated KHD population of 265,071. The signal functions that were least likely to be performed were neonatal resuscitation, manual evacuation of retained products and use of anticonvulsants. In 2011-2012, the facilities performed 35% of expected deliveries. This dropped to 28% in 2013-2014. Caesarean sections as a proportion of expected deliveries remained very low: 1.5% in 2010-2011 and 3.6% in 2013-2014. In 2011-2012, met needs were 6.8% and increased to 7.3% in 2013-2014. Direct obstetric fatality rates increased from 8 to 11% (p = 0.64). Intrapartum and very early neonatal deaths increased from 4.% to 7 (p = 0.89). CONCLUSION: Major gaps were observed in the performance of signal functions as well as the quality and utilization of EmONC. While the results of this study seem to indicate the need to sustainably scale up the utilization of quality EmONC, the interpretations of our findings require consideration of improvements in reporting of mortality data associated with the introduction of EmONC as well as dynamics in country-specific maternal health policies and the potential influence of these policies on EmONC indicators.

Mortality analysis of burns in a developing country: a CAMEROONIAN experience.

BACKGROUND: Burns are a serious public health problem worldwide accounting for an estimated 265,000 deaths annually from fires alone. The vast majority (96%) of deaths from fire-related burns occur in low- and middle-income countries and burns are one of the leading causes of disability-adjusted life-years (DALYs) in the developing world. Most burn centres are situated in large cities and are inadequate for the high incidence of injuries. An 8 year review of 440 patients in the Douala General Hospital, showed that the majority of patients burned were males (n = 281, 68.9%), the mean age was 25.2 ± 17.77 years with an admission rate of 69.5% (306 patients). The modal and median age were 31.0 years and 25.0 years respectively, interquartile range (0.4-82). Majority of burns (n = 237, 53.9%) had burn surface area ≥ 10%, most burns were 2nd degree (n = 215, 48.9) and the commonest burn agents were flames (n = 170, 37.3%), electricity (n = 119, 26.3%) and water (n = 114, 25.2%). The paucity of data on burn mortality in Cameroon motivated this study and is aimed at determining the mortality rate, causes and factors associated with death of burnt patients in the burn unit of the Douala General Hospital (DGH). METHODS: It was a retrospective observational study carried out from the 1st of January 2008 to the 31st of December 2015 in the Burn Unit of the Douala General Hospital. An adapted questionnaire was used to collect demographic data, burn agents, burn depth; diagnostic delay, burn surface area, complications, comorbidity, mortality and its causes. Data was transferred to Microsoft Excel 2015 and the Statistical Package for Social Sciences (SPSS) version 20.0 for data analysis. RESULTS: During this 8 year period, 440 patients were studied and the mortality rate was 23.4% (103 patients). The fatal burn agents were, flames (n = 69, 67.0%), electricity (n = 15, 14.6%), water (n = 12, 11.6%), contact (n = 4, 3.9%), Oil (n = 2, 1.9%) and chemicals (n = 1, 1.0%). The causes of death were shock (n = 36, 35.0%), sepsis (n = 25, 24.3%), acute respiratory distress (n = 25, 24.3%), acute renal failure (n = 6, 5.8%), severe anaemia (n = 4, 3.9%) and unrecorded causes (n = 7, 6.7%). CONCLUSION: A quarter of all patients died mostly from flame burns and to a lesser extent, electricity and scalds. Increase in burn depth and burn surface area worsened the prognosis. Shock (the commonest cause of death), sepsis, acute respiratory distress, acute renal failure and wound infection were significantly associated with mortality.

Iron supplementation in pregnant sicklers: an opinion.

Morbidity associated with iron deficiency anaemia in pregnancy is increased in the presence of sickle cell anaemia. Iron supplementation in pregnant sicklers in a bid to resolve iron deficiency anaemia is recommended only after laboratory confirmation of iron deficiency. However, the greatest burden of sickle cell disease is seen in low and middle income countries where equipment for measuring body iron indices are unavailable.Sickle cell anaemia is an inherited disorder of haemoglobin synthesis characterized by life-long severe haemolytic anaemia. People with sickle cell anaemia are at increased risk of iron overload from haemolysis and recurrent multiple transfusions. Iron overload a complication of sickle cell disease, which is more often in thalassemias, is typically given undue fear in sickle cell anaemia especially in patients with no recent transfusion history. About a third of the haemolysis in sickle cell anaemia is intravascular, and the resulting excess iron is lost in urine. This may lead to a negative iron balance and iron deficiency. There is little evidence of iron overload in pregnant sicklers, and iron deficiency may be more common than suspected. Even when iron overload does occur in a condition called siderosis, the deposited iron is irreversible and thus cannot be reused by the body in case of susceptibility to iron deficiency. More so, in pregnancy there is an increase in the body's iron requirement by about 1000-1200 mg which is usually not met by dietary intake. Iron supplements could be given to pregnant sicklers, caution should however be taken in patients with history of recurrent transfusion.Anaemia is a common and feared complication in pregnancy. The co-existence of iron deficiency anaemia and sickle cell anaemia worsens prognosis of pregnancy. Iron overload a possible complication of sickle cell anaemia is related to multiple transfusions. The urinary losses from intravascular haemolysis and increased dietary requirement in pregnancy predispose even pregnant sicklers to iron deficiency anaemia. Iron supplements should thus conveniently be given to pregnant sicklers with no history of recurrent transfusions.

Prevalence and factors associated with depression among medical students in Cameroon: a cross-sectional study.

BACKGROUND: Depression is an important contributor to the global burden disease that affects people of communities all over the world. With high level of demands in academics and psychosocial pressure, medical students during their course of training tend to become depressed, leading to problems later in professional life and compromising patient care. In Cameroon, there is lack of data on the prevalence of depression and its impact on medical students. To determine the prevalence and predisposing factors associated with depression among medical students in Cameroon (preclinical and clinical). We also evaluated the impact of depression on self-reported academic performance. METHODS: A cross sectional study was carried out in all 4 state medical schools in 4 different regions from December 2015 to January 2016. Diagnosis of depression, major depression and its associated factors were assessed using the 9-Item-Patient Health Questionnaire (PHQ-9) and a structured questionnaire respectively. We included 618 medical students (response rate: 90.4%). RESULTS: About a third of them (30.6%, 95% CI: 22.8-36.7) were found to have major depressive disorder (PHQ Score ≥ 10). With regards to the severity of depression, 214 (34.6%), 163 (26.4%), 21 (3.4%), and 5 (0.80%) students were classified as having mild, moderate, moderately severe and severe depression respectively. The presence of a chronic disease (OR: 3.70, 95% CI: 1.72-7.94, p = 0.001), major life events (OR: 2.17, 95%CI: 1.32-3.58, P = 0.002), female gender (OR: 1.59, 95% CI: 1.06-2.37, p = 0.024) and being a student at the clinical level (OR: 4.26, 95% CI: 2.71-6.71, p < 0.001) were independently associated with depression. There was no association between depression and self-reported academic performance, (OR: 1.2, 95% CI: 0.9-1.7, p = 0.080). CONCLUSION: The prevalence of major depressive disorders among medical students in Cameroon is high and is associated with the presence chronic disease, major life events, female gender and being a student at the clinical level. So we recommend clinicians attending to medical students with demographic features suggestive of greater risk of depression, to make an in depth investigation on the possible presence of depression. Despite this high prevalence of major depression among medical students, it was not associated with self-reported academic performance.

A prospective analysis of pinch grafting of chronic leg ulcers in a series of elderly patients in rural Cameroon.

BACKGROUND: Chronic leg ulcers (CLUs) pose serious public health concerns worldwide. They mainly affect the elderly population. Pinch grafting (PG) could be used to treat a variety of CLUs. However, in Cameroon, there is scarce data on the outcome of PG of CLUs in elderly patients in rural hospitals where most of these patients seek for medical attention and where clinicians rely on unconventional wound dressing methods to treat CLUs. Our objective was to describe the outcome of PG of CLUs in elderly patients in rural Cameroon. METHODS: This was a prospective study conducted in a rural hospital of North West Cameroon. From February 2015 to January 2016, comprehensive historical and clinical data were collected per elderly patient who presented with a chronic leg ulcer necessitating PG. PG was done using a simple procedure and each patient followed up for 8 months. Outcome was described in terms of ulcer healing and pain and donor site complications. RESULTS: Our series included 13 patients: 8 males (61.54%; 95% CI: 31.58-86.14) and 5 females (38.46%; 95% CI: 13.86-68.42) aged from 69 to 88 years (mean: 77.54 ± 5.70 years). Three patients (23.08%; 95% CI: 5.04-53.81) had associated co-morbidities. All the ulcers were unilateral with durations ranging from 7 to 41 months (mean: 19.46 ± 11.03 months). The ulcers ranged in size from 9.0 to 38.1 cm2 (mean: 17.66 ± 8.35 cm 2). We registered one (7.69%; 95% CI: 0.19-36.03) graft rejection. Concerning the other ulcers, ten (83.33%; 95% CI: 51.59-97.91) had healed after 12 postoperative weeks while 2 (16.67%; 95% CI: 2.09%-48.41) had healed after 14 postoperative weeks and the mean healing time was 12.33 ± 0.78 weeks. Patients with healed ulcers had reduced ulcer site pain from the immediate postoperative period but there was no significant difference in the mean pain scores before and after graft (6.77 against 4.23, p = 0.13). These ulcers remained healed after 8 postoperative months. Each donor site had healed 2 weeks after PG. Donor site problems were minimal and included hypopigmentation. CONCLUSION: The outcome of PG of CLUs in our series of older patients was satisfactory. This finding does not discount the role of conservative therapy, but we encourage clinicians in rural Cameroon to consider PG over long-term unconventional conservative therapy in the elderly.

Wide Complex Tachycardia as a Rare Pointer of Intra-aortic Balloon Pump Migration Into the Left Ventricle: A Case Report and Literature Review.

Intra-aortic balloon pumps (IABPs) are used to assist with left ventricular (LV) unloading in patients with cardiogenic shock (CS). There are different mechanical devices that can be used in CS, of which the IABP represents the simplest, the easiest to insert and remove, and the most cost-effective. Compared to traditional femoral IABPs, axillary IABPs allow patients to remain ambulatory. This is especially beneficial in patients awaiting heart transplants. Our case presents a patient with CS, where axillary IABP was used to unload the LV. However, our patient developed ventricular arrhythmia secondary to IABP migration to the LV.

Neurosarcoidosis: A Unique Presentation of a Rare Disease.

Sarcoidosis is defined as an immune-mediated multi-organ granulomatous disease with unknown etiology, which is characterized by the presence of multiple non-caseating granulomas in the absence of a definite infective or toxic cause. Neurosarcoidosis (NS) occurs when sarcoid granulomas invade the central or peripheral nervous systems. Sarcoidosis usually presents with non-specific manifestations, including dry cough, fatigue, night sweats, weight loss, skin changes, and eye manifestations. Many patients who develop NS present with neurological manifestations within two years of being diagnosed with sarcoidosis. Herein, we present a case of newly diagnosed sarcoidosis in a 49-year-old male patient initially presenting with neurological manifestations of unknown origin, later identified as NS on peripheral lymph node biopsy with non-caseating granuloma.

Right Atrial Thrombi, the Management Conundrum: 2 Case Reports.

BACKGROUND There are no guidelines providing an algorithmic approach for the management of right atrial thrombi, to date, owing to a lack of strong supporting studies. In this case series, we describe 2 cases of high-risk patients with massive right atrial thrombi who had different outcomes. CASE REPORT Case 1: A 62-year-old man with ischemic cardiomyopathy and atrial fibrillation, who was on a permanent pacemaker for sick sinus syndrome and was noncompliant with medication for 2 years, presented to the Emergency Department for evaluation of a 2-month history of progressive shortness of breath and swollen neck veins. A cardiac ultrasound confirmed a large right atrial thrombus, and a computed tomography (CT) pulmonary angiogram was negative for pulmonary emboli. He was managed with a heparin infusion and thrombolytic therapy with favorable evolution. Case 2: A 66-year-old man, with a past medical history of nonischemic cardiomyopathy, atrial fibrillation, deep venous thrombosis, and pulmonary emboli a year earlier, presented to an urgent care unit with sudden onset of shortness of breath. A cardiac ultrasound confirmed a large right atrial thrombus, and a CT pulmonary angiogram confirmed bilateral pulmonary emboli. He was managed with a heparin infusion and EkoSonic endovascular system therapy. He subsequently needed venoarterial extracorporeal membrane oxygenation for cardiopulmonary resuscitation and underwent mechanical aspiration thrombectomy. The patient's evolution was unfavorable. CONCLUSIONS In the absence of an evidence-based guideline to approach right atrial thrombi, management should be individualized for each patient, based on the type of thrombi, hemodynamic status, and presence or absence of associated pulmonary emboli.

Proinflammatory and Hyperinsulinemic Dietary Patterns Are Associated With Specific Profiles of Biomarkers Predictive of Chronic Inflammation, Glucose-Insulin Dysregulation, and Dyslipidemia in Postmenopausal Women.

Background: Dietary patterns promoting hyperinsulinemia and chronic inflammation, including the empirical dietary index for hyperinsulinemia (EDIH) and empirical dietary inflammatory pattern (EDIP), have been shown to strongly influence risk of weight gain, type 2 diabetes, cardiovascular disease, and cancer. EDIH was developed using plasma C-peptide, whereas EDIP was based on plasma C-reactive protein (CRP), interleukin-6, and tumor necrosis factor alpha receptor 2 (TNF-αR2). We investigated whether these dietary patterns were associated with a broader range of relevant biomarkers not previously tested. Methods: In this cross-sectional study, we included 35,360 women aged 50-79 years from the Women's Health Initiative with baseline (1993-1998) fasting blood samples. We calculated EDIH and EDIP scores from baseline food frequency questionnaire data and tested their associations with 40 circulating biomarkers of insulin response/insulin-like growth factor (IGF) system, chronic systemic inflammation, endothelial dysfunction, lipids, and lipid particle size. Multivariable-adjusted linear regression was used to estimate the percent difference in biomarker concentrations per 1 standard deviation increment in dietary index. FDR-adjusted p < 0.05 was considered statistically significant. Results: Empirical dietary index for hyperinsulinemia (EDIH) and empirical dietary inflammatory pattern (EDIP) were significantly associated with altered concentrations of 25 of the 40 biomarkers examined. For EDIH, the percent change in biomarker concentration in the insulin-related biomarkers ranged from +1.3% (glucose) to +8% (homeostatic model assessment for insulin resistance) and -9.7% for IGF-binding protein-1. EDIH impacted inflammation and endothelial dysfunction biomarkers from +1.1% (TNF-αR2) to +7.8% (CRP) and reduced adiponectin by 2.4%; and for lipid biomarkers: +0.3% (total cholesterol) to +3% (triglycerides/total cholesterol ratio) while reducing high-density lipoprotein cholesterol by 2.4%. EDIP showed a similar trend of associations with most biomarkers, although the magnitude of association was slightly weaker for the insulin-related biomarkers and stronger for lipids and lipid particle size. Conclusions: Dietary patterns with high potential to contribute to insulin hypersecretion and to chronic systemic inflammation, based on higher EDIH and EDIP scores, were associated with an unfavorable profile of circulating biomarkers of glucose-insulin dysregulation, chronic systemic inflammation, endothelial dysfunction and dyslipidemia. The broad range of biomarkers further validates EDIH and EDIP as mechanisms-based dietary patterns for use in clinical and population-based studies of metabolic and inflammatory diseases.

Associations of Dairy Intake with Circulating Biomarkers of Inflammation, Insulin Response, and Dyslipidemia among Postmenopausal Women.

BACKGROUND: Cardiometabolic diseases are prevalent in aging Americans. Although some studies have implicated greater intake of dairy products, it is not clear how dairy intake is related to biomarkers of cardiometabolic health. OBJECTIVE: Our aim was to test the hypothesis that associations of dairy foods with biomarkers of lipid metabolism, insulin-like growth factor signaling, and chronic inflammation may provide clues to understanding how dairy can influence cardiometabolic health. DESIGN: This was a cross-sectional study in the Women's Health Initiative using baseline food frequency questionnaire data to calculate dairy intake. PARTICIPANTS/SETTING: Participants were 35,352 postmenopausal women aged 50 to 79 years at 40 clinical centers in the United States. MAIN OUTCOME MEASURES: Baseline (1993-1998) concentrations of 20 circulating biomarkers were measured. STATISTICAL ANALYSES: Multivariable-adjusted linear regression was used to estimate percent difference in biomarker concentrations per serving of total dairy and individual foods (milk, cheese, yogurt, butter, and low-fat varieties). RESULTS: Lower triglyceride concentrations were associated with greater intake of total dairy (-0.8% [95% CI -1.2% to -0.3%]), mainly driven by full-fat varieties. Individual dairy foods had specific associations with circulating lipid components. For example, greater total milk intake was associated with lower concentrations of total cholesterol (-0.4% [95% CI -0.7% to -0.2%]) and high-density lipoprotein cholesterol (-0.5% [95% CI -0.9% to -0.1%]), whereas greater butter intake was associated with higher total cholesterol (0.6% [95% CI 0.2% to 1.0%]) and high-density lipoprotein cholesterol (1.6% [95% CI 1.1% to 2.0%]) concentrations. In contrast, higher total yogurt intake was associated with lower total cholesterol (-1.1% [95% CI -2.0% to -0.2%]) and higher high-density lipoprotein cholesterol (1.8% [95% CI 0.5% to 3.1%]). Greater total dairy intake (regardless of fat content), total cheese, full-fat cheese, and yogurt were consistently associated with lower concentrations of glucose, insulin, and C-reactive protein. However, milk and butter were not associated with these biomarkers. CONCLUSIONS: Higher dairy intake, except butter, was associated with a favorable profile of lipids, insulin response, and inflammatory biomarkers, regardless of fat content. Yet, specific dairy foods might influence these markers uniquely. Findings do not support a putative role of dairy in cardiometabolic diseases observed in some previous studies.

Insulinemic and Inflammatory Dietary Patterns Show Enhanced Predictive Potential for Type 2 Diabetes Risk in Postmenopausal Women.

OBJECTIVE: The empirical dietary index for hyperinsulinemia (EDIH) and empirical dietary inflammatory pattern (EDIP) scores assess the insulinemic and inflammatory potentials of habitual dietary patterns, irrespective of the macronutrient content, and are based on plasma insulin response or inflammatory biomarkers, respectively. The glycemic index (GI) and glycemic load (GL) assess postprandial glycemic potential based on dietary carbohydrate content. We tested the hypothesis that dietary patterns promoting hyperinsulinemia, chronic inflammation, or hyperglycemia may influence type 2 diabetes risk. RESEARCH DESIGN AND METHODS: We calculated dietary scores from baseline (1993-1998) food frequency questionnaires among 73,495 postmenopausal women in the Women's Health Initiative, followed through March 2019. We used multivariable-adjusted Cox regression to estimate hazard ratios (HRs) and 95% CIs for type 2 diabetes risk. We also estimated multivariable-adjusted absolute risk of type 2 diabetes. RESULTS: During a median 13.3 years of follow-up, 11,009 incident cases of type 2 diabetes were diagnosed. Participants consuming the most hyperinsulinemic or proinflammatory dietary patterns experienced greater risk of type 2 diabetes; HRs (95% CI) comparing highest to lowest dietary index quintiles were EDIH 1.49 (1.32-1.68; P trend < 0.0001) and EDIP 1.45 (1.29-1.63; P trend < 0.0001). The absolute excess incidence for the same comparison was 220 (EDIH) and 271 (EDIP) cases per 100,000 person-years. GI and GL were not associated with type 2 diabetes risk: GI 0.99 (0.88-1.12; P trend = 0.46) and GL 1.01 (0.89-1.16; P trend = 0.30). CONCLUSIONS: Our findings in this diverse cohort of postmenopausal women suggest that lowering the insulinemic and inflammatory potentials of the diet may be more effective in preventing type 2 diabetes than focusing on glycemic foods.

Inflammatory and Insulinemic Dietary Patterns: Influence on Circulating Biomarkers and Prostate Cancer Risk.

Prostate cancer is common in countries with affluent dietary patterns and represents a heterogeneous collection of subtypes with varying behavior. Reductionist strategies focusing on individual nutrients or foods have not clearly defined risk factors. We have developed mechanisms-based dietary patterns focusing upon inflammation and chronic insulin hypersecretion, processes that are hypothesized to impact prostate carcinogenesis. In the Prostate, Lung, Colorectal, and Ovarian cancer cohort, we calculated the empirical dietary index for hyperinsulinemia (EDIH) and empirical dietary inflammatory pattern (EDIP) scores from food frequency questionnaire data among 3,517 men and women who provided a blood sample at enrollment. We used these scores in multivariable-adjusted linear regression to validate EDIH and EDIP against relevant circulating biomarkers. In a separate sample of 49,317 men, we used multivariable-adjusted Cox regression to evaluate associations of EDIH and EDIP with prostate cancer (total and subtypes) risk. Participants consuming the most hyperinsulinemic diets (EDIH quintile 5) had significantly higher concentrations of C-peptide, insulin, c-reactive protein, TNFα-R2, and lower adiponectin, than those in quintile 1. Similarly, participants consuming the most proinflammatory diets had significantly higher concentrations of IL6, TNFα-R2, C-peptide, insulin, and lower adiponectin. Men consuming hyperinsulinemic diets were at higher total prostate cancer risk: HRquintile5vs1, 1.11; 95% confidence interval (CI), 1.01-1.23; P trend = 0.03, especially high-grade cancer: HRquintile5vs1, 1.18; 95% CI, 1.02-1.37; P trend = 0.06. The EDIP was not associated with prostate cancer risk. In summary, EDIH and EDIP predicted concentrations of known insulinemic and inflammatory biomarkers, and EDIH further predicted risk of future prostate cancer. Interventions to reduce the adverse role of hyperinsulinemic diets may be a means of prostate cancer prevention.

Systematic review of therapeutic outcomes of multidrug resistant tuberculosis and their predictors in adults receiving integrated treatment of tuberculosis and human immuno-deficiency virus in low- and middle-income countries: a study protocol.

BACKGROUND: Programs that integrate tuberculosis (TB) and human immunodeficiency virus (HIV) treatment aim to provide efficient treatment services and maximize successful treatment outcomes through the delivery of both TB and HIV treatment by one provider at the same time and location. However, multi-drug resistant tuberculosis (MDR-TB) is more difficult to treat as compared to drug-sensitive TB, and in low- and middle-income countries (LMICs), the potential of programs integrating TB/HIV treatment to sustain favourable MDR-TB treatment outcomes is poorly elucidated. The objective of this review is to perform a systematic collection, critical appraisal and synthesis of existing evidence on therapeutic outcomes of MDR-TB and their predictors among adults receiving integrated treatment for TB/HIV in LMICs. METHODS: A systematic review of quantitative evidence from observational cohort studies will be performed. MEDLINE, Embase, and Global Health electronic databases will be searched for relevant studies published from March 2004 to December 2019. Two investigators will independently screen the search output, review the eligible studies, and assess the quality of the eligible studies using quality assessment tools of the National Heart Lung and Blood Institute. Random-effects meta-analysis will be used to obtain summary estimates. Heterogeneity across studies will be assessed using the I2 statistic. The confidence in the summary estimates will be rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The final review will be reported following the guidelines of the Preferred Reporting System for Systematic Reviews and Meta-analysis, presented at scientific conferences and published in a peer-reviewed journal. DISCUSSION: This study is expected to report the performance of integrated TB/HIV treatment programs as regards their potential to uphold successful MDR-TB treatment outcomes in LMICs. Furthermore, the review will indicate patient-related and healthcare-related factors that should be addressed to improve on survival of patients with MDR-TB/HIV co-infection in LMICs. SYSTEMATIC REVIEW REGISTRATION: This review has been registered with the International Prospective Register of Systematic Reviews and the reference ID is CRD42020159745.

Iron stores in pregnant women with sickle cell disease: a protocol for a systematic review and meta-analysis.

INTRODUCTION: Sickle cell disease (SCD) is the most common inherited disease worldwide. The greatest disease burden is seen in sub-Saharan Africa. Early diagnosis and improved care of people living with SCD have led to an increase in the number of women with SCD reaching the reproductive age. Iron deficiency anaemia remains the most common cause of anaemia in pregnancy, affecting 51%-63% of pregnancies in Africa. However, the unavailability of guidelines on supplementation of iron in this pregnant subpopulation often leaves clinicians in a fix. We propose to conduct the first systematic review and possibly a meta-analysis on the prevalence, associated factors and maternal/fetal outcomes of iron deficiency anaemia among pregnant women with SCD. METHODS AND ANALYSIS: We will search the following electronic databases for studies on the iron status of pregnant women with SCD: PubMed, MEDLINE, EMBASE, Google Scholar, African Journals Online, African Index Medicus, Popline and the Cochrane Library. After the selection of eligible studies from the search output, review of full text, data extraction and data synthesis will be performed. Studies obtained from the review shall be evaluated for quality, risk of bias and heterogeneity. Appropriate statistical methods shall be used to pool prevalence estimates for matching studies globally and in subpopulations. This protocol has been reported as per the 2015 guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. ETHICS AND DISSEMINATION: There is no requirement for ethical approval as the proposed study will use published data. The findings of this study will be published in a peer-reviewed journal and will be presented at conferences. TRIAL REGISTRATION NUMBER: CRD42018109803.

Non-obstetric vulva haematomas in a low resource setting: two case reports.

Vulva haematomas are uncommon outside the obstetric population, with an incidence of 3.7% and represent only 0.8% of all gynaecological emergencies. The first case is a 24-year-old G2P1011 referred after the failure of conservative management of a progressively increasing right labia majora swelling. Vulva incision, exploration and relieve of hematoma were done under local anaesthesia. The second case is a 17-year-old G1P1001, a student who presented with spontaneous pain and swelling of the left labia majora. The swelling was rapidly increasing, tense and tender. It spontaneously ruptured, clots were drained and the wound was packed. Vulva hematomas are not very common hence necessitating careful assessment, right diagnosis and management. Management could be conservative (analgesics, local compression) as well as surgical in cases of hemodynamic instability, rapidly increasing size of hematoma and pain intensity. Prompt surgical management reduces the risk of infection and longer hospital stays, which is important in low resource settings like ours.

Prevalence and predictors of recreational drug use among medical and nursing students in Cameroon: a cross sectional analysis.

OBJECTIVE: Medical and nursing students in Cameroon are likely to have mental health problems given the stressful nature of their studies. Paucity of mental health institutions in the country implies they hardly get access to professional help when needed and are obliged to develop coping strategies such as recreational drug use. This study aims to determine the prevalence and predictors of recreational drug use among a group of Cameroonian medical and nursing students. RESULTS: Cross-sectional analysis of 852 medical and nursing students (mean age 21.78 ± 3.14, 31.49% males) recruited by convenience sampling from three state-owned medical schools; and from two state-owned and two private nursing schools in Cameroon over a four-month period (January-April 2018). Information was collected via a printed self-administered and structured questionnaire from consenting students. Multivariable logistic regression analysis was used to identify independent predictors of recreational drug use. The overall prevalence of recreational drug use was 1.64% with tramadol and marijuana noted as the drugs used by these students. Independent predictors of recreational drug use were: presence of a chronic illness (OR 5.26; 95% CI 1.32, 20.97; p = 0.019), alcohol consumption (OR 5.08; 95% CI 1.54, 16.73; p = 0.008) and Total Oldenburg Burnout Inventory score (OR 1.11; 95% CI 1.02, 1.21; p = 0.021). The use of recreational drugs by medical and nursing students in Cameroon remains worrisome despite its very low prevalence, as it may negatively impact their performance and health.

Blighted ovum and tubal pregnancy: a rare form of heterotopic pregnancy: case report.

BACKGROUND: Heterotopic pregnancies are rare in spontaneous conceptions. Nonetheless, when it does occur, the intrauterine pregnancy is usually viable. We herein present a true rarity of the coexistence of a blighted ovum and an ectopic pregnancy. CASE PRESENTATION: A 25 year old G2P1001 married seamstress of African ethnicity at 8 weeks of amenorrhoea presented to our health facility with a 4 day history of lower abdominal pains and vaginal bleeding for which physical examination revealed a closed cervix. Trans-abdominal ultrasound scan confirmed a diagnosis of a blighted ovum and an ectopic pregnancy. Patient was managed with surgical therapy. Evolution thereafter was uneventful. CONCLUSION: The case presented confirms that HP can occur in the absence of predisposing factors, and that the detection of a blighted ovum should not preclude the possibility of a simultaneous ectopic pregnancy. A high index of suspicion could lead to early diagnosis, prompt management and a favourable prognosis even in a low-income setting.