[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.

Prevalence and determinants of electrocardiographic abnormalities in sub-Saharan African individuals with type 2 diabetes.

AIM: This study assessed the prevalence and determinants of electrocardiographic abnormalities in a group of type 2 diabetes patients recruited from two referral centres in Cameroon. METHODS: A total of 420 patients (49% men) receiving chronic diabetes care at the Douala General and Yaoundé Central hospitals were included. Electrocardiographic abnormalities were investigated, identified and related to potential determinants, with logistic regressions. RESULTS: The mean age and median duration of diagnosis were 56.7 years and four years, respectively. The main electrocardiographic aberrations (prevalence %) were: T-wave abnormalities (20.9%), Cornell product left ventricular hypertrophy (16.4%), arrhythmia (16.2%), ischaemic heart disease (13.6%), conduction defects (11.9%), QTc prolongation (10.2%) and ectopic beats (4.8%). Blood pressure variables were consistently associated with all electrocardiographic abnormalities. Diabetes-specific factors were associated with some abnormalities only. CONCLUSIONS: Electrocardiographic aberrations in this population were dominated by repolarisation, conduction defects and left ventricular hypertrophy, and were more related to blood pressure than diabetes-specific factors.

Comparative life parameters of transgenic and wild strain of Aedes aegypti in the laboratory.

The release of genetically-modified Aedes aegypti males is considered an effective method of suppressing this vector of dengue. One of the prerequisites is the capability to mass produce the genetically-modified mosquito in the laboratory before release. To do so would necessitate the understanding of the lifecycle and parameters of the transformed strain. In this regard, comparative life-history parameters of a wild-type laboratory strain of Ae. aegypti (WT) and a genetically transformed Ae. aegypti (LA513) were studied in the laboratory. The following parameters were statistically indistinguishable in both strains: the number of eggs laid, the number of unhatched eggs, the egg-hatching rate, the duration of larval period in all four instars, larval survivorship, pupation, adult eclosion rate, gonotrophic cycle, adult fecundity, adult lifespan and offspring sex ratio. The basic life-history and growth rate of the genetically-modified Ae. aegypti was not affected by genetic manipulation and that its mating competitiveness will remain intact, which is important for the successful use of this technology.

[Ocular complications of HIV/AIDS in Cameroon: is there is any correlation with the level of CD4 lymphocytes count?]. / Complications oculaires de l'infection a VIH-SIDA en milieu Camerounais: y a-t-il une correlation avec le taux de CD4?

PURPOSE: This study aimed to identify the ocular complications of HIV/AIDS in Cameroon and to determine if there is any correlation between their occurrence and the level of CD4 lymphocytes count. MATERIAL AND METHODS: This prospective study was carried out at the General Hospital, Douala, from October 2004 to September 2005. All HIV positive patients with known CD4 count were retained for the study. Each patient had an exhaustive ocular examination. RESULTS: A total of 57 patients including 30 females (52.9%) and 27 males (47.4%) were examined. The mean age was 38.9 years +/- 10.3. The eye examination was pathological in 36 patients (63.2%) and normal in 21 patients (36.8%). An ocular complaint was the inaugural manifestation of the disease in 31.6% of patients. The principal lesions of the anterior segment were herpetic keratitis (10.5%) and herpes zoster ophthalmicus (12.3%). The most common posterior segment lesions were cytomegalovirus retinitis (14%) and uveitis (15.8%). The mean CD4 count in our series was 118.3/mm3 +/- 106.7. 91.7% of patients with ocular complications have a CD4 count of less than 200/mm3. A non linear correlation was found between the CD4 level and the occurrence of ocular complications. CONCLUSION: With the improvement of access to antiretroviral treatment, the ocular complications of HIV/AIDS are more common. The role of the ophthalmologist is therefore essential in the diagnosis and management of these patients.

Therapeutic trials for a rabbit model of EBV-associated Hemophagocytic Syndrome (HPS): effects of vidarabine or CHOP, and development of Herpesvirus papio (HVP)-negative lymphomas surrounded by HVP-infected lymphoproliferative disease.

Epstein-Barr virus-associated hemophagocytic syndrome (EBV-AHS), which is often associated with fatal infectious mononucleosis or T-cell lymphoproliferative diseases (LPD), is a distinct disease characterized by high mortality. Treatment of patients with EBV-AHS has proved challenging. To develop some therapeutic interventions for EBV-AHS, we examined the effectiveness of an antiviral agent (vidarabine) or chemotherapy (CHOP), using a rabbit model for EBV-AHS. Fourteen untreated rabbits were inoculated intravenously with cell-free virions of the EBV-like virus Herpesvirus papio (HVP). All of the rabbits died of HVP-associated (LPD) and hemophagocytic syndrome (HPS) between 21 and 31 days after inoculation. Furthermore, three HVP-infected rabbits treated with vidarabine died between days 23 and 28 after inoculation, and their clinicopathological features were no different from those of untreated rabbits, indicating that this drug is not effective at all to treat HVP-induced rabbit LPD and HPS. Three of the infected rabbits that were treated with one course, with an incomplete set of three courses, or with three full courses of CHOP treatment died of HVP-induced LPD and HPS with a bleeding tendency and/or with opportunistic infections. They died on the 26th, 62nd and 105th day after virus inoculation, respectively. CHOP treatment transiently suppressed the HVP-induced LPD and contributed to the prolonged survival time of two infected rabbits. However, it did not remove all of the HVP-infected cells from the infected rabbits, and residual HVP-infected lymphocytes caused recurrences of rabbit LPD and HPS. The most interesting finding of this experiment was observed in the infected rabbit with the longest survival time of 105 days: HVP-negative lymphomas surrounded by HVP-induced LPD developed in the larynx and ileum of this rabbit, causing an obstruction of the lumen. We concluded that these were not secondary lymphomas caused by CHOP treatment, because no suspicious lesions were detected in three uninfected rabbits that were treated with three courses of CHOP for 120 days. It is therefore necessary to clarify the mechanism by which HVP-negative lymphomas associated with HVP-induced LPD can develop. Our data from therapeutic trials using EBV-AHS animal models indicate that vidarabine is not effective as an agent to treat HVP-infected rabbits, and even the cytotoxic chemotherapy of CHOP is not sufficient to cure the HVP-infected rabbits or to prolong the survival time of infected rabbits. Further studies will therefore be required to develop better therapies to treat EBV-AHS.

[Quantitative analysis of color of the nasal mucosa].

The color of the nasal mucosa was quantitatively studied. Chromaticity of the nasal mucosa was indicated by two parameters, x (red component in RGB) and y (green in RGB) values, measured with a chromameter (MINOLTA Co., CS-100). According to preliminary studies in normal subjects, the following conditions were thought to make the method suitable for measuring the color of the nasal mucosa. 1) The chromameter can be held in the hand. 2) Brightness of the nasal mucosa should be kept as constant as possible. 3) The inferior turbinate mucosa is easier to measure than the septal one. In the preliminary study there was no significant difference in chromaticity measurements among the examiners. Chromaticity of the inferior turbinate was compared among patients with perennial nasal allergy (PNA, n = 19), with cedar pollinosis (CP, n = 11), and normal subjects serving as a control (n = 15). The x values in the PNA and CP groups were significantly lower than those in the control group (p < 0.01), and the y values were significantly higher (p < 0.02). The results agreed with the macroscopic observations made by trained rhinologists. The x values increased when azelastin was administered in five of the PNA group. This increase was related to improvement of their subjective symptoms. Quantitative analysis of the nasal mucosal color could be useful for objective evaluation of the clinical course of allergic rhinitis.

[Revision endoscopic sinus surgery--long-term follow up and operative findings].

Among 170 cases (301 sides) with chronic sinusitis who underwent endoscopic sinus surgery, 15 cases (25 sides) were reoperated on because of unsatisfactory results. We examined 12 such cases, periodically, with an endoscope following the first operation. Postoperative endoscopic management, including removal of polyps in the middle nasal meatus and irrigation of the maxillary sinus with sterilized saline water through the enlarged opening, had been done if necessary. However, stenosis of the middle nasal meatus had gradually progressed and mucous or purulent discharge had increased despite postoperative endoscopic treatment. The middle nasal meatus in 17 of the 25 sides had been closed by polyps or/and adhesion at the time of reoperation. The adhesion occurred between the lateral wall of the anterior ethmoid cavity and the middle turbinate. As a result, the opening of the frontal sinus became narrow or even closed, and pus retention was noted in 14 frontal sinuses during revision surgery. In contrast, only seven maxillary sinuses had pus retention. We concluded that adhesion in the middle nasal meatus holds the key to control of inflammatory changes in the paranasal sinuses.