Prevalence of HIV infection among stroke patients in Douala.

To determine the prevalence of HIV infection among stroke patients admitted to the Douala General Hospital (DGH) and to describe the clinical characteristics and outcome of the stroke patients with HIV infection. This prospective cohort study took place in 2010-2015 at the DGH. The study included patients older than 15 years with a CT-confirmed stroke. All patients underwent HIV tests with Western-Blot confirmation. The functional prognosis of the patients was assessed by the Rankin score at 6 months after stroke onset. The prevalence rate of HIV among stroke patients was 6.6% (40/608). Of the 40 HIV-positive patients, 58% were aware of their status at admission; 83% of these patients were receiving antiretroviral therapy. Males were predominant (65%), and the mean age was 51.3 ± 10.4 years. Hypertension was the main cerebrovascular risk factor (65%). At admission, 47.5% of HIV+ patients were febrile, and 7.5% presented with coma. Ischemic stroke accounted for 60% of cases. The mean CD4 cell count was 351 ± 236/mm3 with a median of 330/mm3. The length of stay was 10 ± 8 days. At 6 months, the cumulative mortality of HIV+ patients was 37.5%, and 38.5% were dependent (Rankin>2). HIV prevalence is high among stroke patients in our setting. This suggests that an HIV test should be routinely proposed to stroke patients.

[Measurement of lacrimal secretion in chronic hemodialysis patients at Douala General Hospital - Cameroon]. / Mesure de la sécrétion lacrymale chez des patients hémodialysés chroniques à l'hôpital général de Douala-Cameroun.

PURPOSE: To measure lacrimal secretion and to investigate dry eye symptoms in chronic hemodialysis patients. PATIENTS AND METHODS: This was a cross-sectional descriptive study carried out in the hemodialysis center of Douala General Hospital from June to August 2016. The degree of symptomatology related to dry eye was assessed by the Ocular Surface Disease Index (OSDI) questionnaire. Lacrimal secretion was measured by the Schirmer test without anesthesia. We defined normal as wetting>10mm and hyposecretion as a value≤10mm after 5minutes. RESULTS: Thirty-five patients were involved in the study, 16 men (45.7%) and 19 women (54.3%) for a total of 70 eyes examined. The mean age was 41.9 years, with an average duration of dialysis of 35.5 months±30.2. The symptoms were "normal" for 21 patients (60%), "minimal" for 5 (14.3%), "moderate" for 8 (22.9%) and "severe" for 1 (2.8%). Lacrimal hyposecretion was found in 19 eyes (27.1%). It was severe in 8 eyes. A correlation was found between diabetes, gender and hyposecretion. CONCLUSION: Hemodialysis patients are likely to develop lacrimal hyposecretion mostly because of comorbities. It is therefore important to systematically evaluate lacrimal secretion in these patients.

Risk factors for mortality in patients with tuberculosis and HIV in Douala (Cameroon).

Despite prevention efforts, and free treatment, TB-HIV co-infection still occurs in Cameroon. The objective of this work is to present the risk factors for mortality in patients co-infected with TB and HIV in Douala from 2009 to 2014. This transversal, analytic, and retrospective study took place from November 2014 to May 2015 in the Laquintinie Hospital in Douala. A review of our records identified patients aged at least 15 years, with this co-infection who received TB treatment, with or without antiretroviral agents. The bivariate analysis compared qualitative variables with Pearson's Chi2 test. In the multivariate analysis, we determined the risk factors for mortality by backward stepwise logistic regression. Model fit was tested with the Hosmer-Lemeshow test. The study identified 394 patients, 213 (54.1%) of whom were women (sex ratio 0.84). The mean age was 39 ± 10 years. All patients received drugs to treat tuberculosis drugs; 351 (89%) also received antiretroviral drugs, 78.2% of them including efavirenz; and 320 (81.2%) received cotrimoxazole prophylaxis. During the study period, 67.3% were cured of tuberculosis and 15.7% died. The multivariate regression results show that hepatitis B (P <0.0009), absence of cotrimoxazole prophylaxis (P <0.005), poor treatment adherence (P <0.0001), and a CD4 count <50 (P <0.0001) were risk factors for mortality. The cure rate for patients co-infected with TB and HIV in Cameroon remains low, and their mortality high. Comorbidities and the presence of opportunistic diseases are risk factors for death. Appropriate measures to prevent this co-infection and the systematic use of cotrimoxazole should reduce this mortality rate.

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

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