Giant anogenital tumor of Buschke-Löwenstein in a patient living with human immunodeficiency virus/acquired immunodeficiency syndrome: a case report.

BACKGROUND: Buschke-Löwenstein tumor is a giant condyloma acuminata infection that is characterized by degeneration, invasion, and recurrence. It is associated with human papilloma virus infection. It develops around the genital and perineal area, sometimes causing a large budding ulcerated lesion. Although human immunodeficiency virus infection is frequent in Africa, there are few descriptions of Buschke-Löwenstein tumor diagnosis and its management. Screening for other sexually transmitted infections must be systematic among these patients. CASE PRESENTATION: We report herein the case of a 21-year-old African origin male patient who developed a perineal swelling. Physical examination showed evidence of a huge exophytic tumor made up of budding pinkish vegetations, with serrated crests, a ''butterfly wing'' structure, and a cauliflower-like appearance crowned with centrifugal circinate lesions. Multiple condylomatous lesions of the anal margin were also present. The patient tested positive for human immunodeficiency virus (cluster of differentiation 4 count of 119 cells/mm3) and hepatitis B infections. Real-time polymerase chain reaction revealed human papilloma virus-16 and other high-risk human papilloma virus deoxyribonucleic acid. The diagnosis of Buschke-Löwenstein tumor was made on mass biopsy, and the patient underwent multidisciplinary intervention (surgery, podophyllin application, and antiretroviral therapy). Medium-term evolution was, however, fatal due to opportunistic infection. CONCLUSION: Buschke-Löwenstein tumor is a rare tumor associated with human immunodeficiency virus infection. It is more frequent in male human immunodeficiency virus-positive patients. There is a need to screen for other sexually transmitted infections. In most cases, the treatment is surgical, in association with local therapies. However, recurrences are common.

Seroprevalence of hepatitis B and associated factors among inmates: a cross sectional study in the Douala New Bell Prison, Cameroon.

INTRODUCTION: in Cameroon, data on viral hepatitis B infection in prison environments is limited. We determined the prevalence of hepatitis B infection (HBV) and correlates among prisoners incarcerated at the Douala New Bell Central Prison in Cameroon. METHODS: this was a cross-sectional study carried out in July 2018 and included 940 randomly selected prisoners. Data were collected using pre-tested questionnaire while blood screening for HBV surface antigen (HBs Ag) used rapid test, with confirmation via Elisa test. Sociodemographic characteristics and risk factors were compared among the three age groups with respect to the prison's partitioning. Factors associated with positive HBs Ag were identified using logistic regression adjusted to age and gender. Confounders were then excluded by logistic multivariate analysis. All p values less than 0.05 were considered statistically significant. RESULTS: of the 940 prisoners selected, 94% were male. The mean age of the study population was 33.81 ± 10.35 years. The median duration of incarceration and median number of incarcerations were 12 months (IQR: 5-36) and 1 (IQR: 1-2) respectively. HBV prevalence was 12.9% (95% CI: 10.7-15%). The use of non-injectable illicit drugs (OR: 3.5; 95% CI: 1.9-6.2; P<0.001), sharing of needle or razors (aOR: 24.1; 95% CI: 12.9-45.0; P<0.001), sharing of tooth brushes(aOR: 2.7; 95% CI: 0.9-7.4) (P=0.053), having tattoos or piercings (aOR: 1.9; 95% CI: 1.1-3.1; P=0.01) were significantly associated with HBs Ag seropositivity. CONCLUSION: prisoners in this setting had a high prevalence of HBV and related risk factors. These findings highlight an urgent need to implement control strategies and programs that reach people in detention centers in Cameroon.

Normalisation of the psychometric encephalopathy score within the Cameroonian population.

BACKGROUND: Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. The aim of this study was to standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. METHODS: This was a prospective, multicentric study from 1 December 2018 to 31 July 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the number connection test-A, number connection test-B, serial dotting test, line tracing test were expressed in seconds and those of the digit symbol test in points. RESULTS: A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3 ± 15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62 ± 3.9 years in cirrhotic patients. The PHES of the healthy volunteer group was - 0.08 ± 1.28 and the cut-off between normal and pathological values was set at - 3 points. PHES of the cirrhotic patients was - 7.66 ± 5.62 points and significantly lower than that of volunteers (p < 0.001). Prevalence of MHE was 74% among cirrhotic patients. Age and education level were associated with MHE. CONCLUSION: PHES cut-off value in Cameroonians is - 3, with MHE prevalence of 74% among cirrhotic patients.

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.

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.

Variation of HLA class I (-A and -C) genes in individuals infected with hepatitis B or hepatitis C virus in Cameroon.

The Human Leucocyte Antigens (HLA) work in concert with other immune factors to modulate immunity to viral infections. Extensive variation has been reported in the genetic sequences and functions of classical HLA class I genes in many (mostly Western) populations, and several HLA associations with infectious disease outcomes have been reported. Little is known about their role in the susceptibility or resistance to hepatitis viruses in Central African populations. The aim of this study was to determine variants of two HLA class I genes (HLA-A and -C) in adults infected with hepatitis B (HBV)- or -C (HCV) virus in Cameroon. In this case-control study, a total of 169 unrelated adults comprising 68 HCV-infected, 38 HBV-infected and 63 uninfected (controls) individuals participated. Each consented participant was screened for HBV, HCV, and HIV infections and willingly donated a single blood sample for genomic DNA isolation and some clinical laboratory tests. HLA-A and HLA-C were genotyped using previously described sequence-based techniques (SBT). A total of 54 HLA alleles were identified in the study population (27 HLA-A and 27 HLA-C). HLA-A∗23:01 and HLA-C∗07:01 were the most common alleles with genotype frequencies of 31.4% and 29.3%, respectively. Hepatitis individuals were six times more likely to be HLA-A∗30:01 carriers than uninfected controls (OR = 6.30, p = 0.020 (HBV); OR = 6.21, p = 0.010 (HCV), respectively). Similarly, carriers of HLA-C∗17:01 were over-represented in the HBV-infected compared to the uninfected control group (21.9% vs. 6.4%, respectively) suggesting that this allele could play a role in the susceptibility to HBV infection. These findings demonstrate that carriers of HLA-A∗30:01 were over-represented in the hepatitis group compared to uninfected controls while HLA-C∗17:01 was completely absent in the HCV + group.

Evaluation of hepatic fibrosis in HIV/HCV co-infected individuals in Yaoundé, Cameroon: usefulness of APRI score in resource-constrained settings.

BACKGROUND: HIV infection exacerbates the prognosis of HCV infection, with a faster progression of hepatitis. Hepatic fibrosis is the major disruption of the hepatic tissue architecture characterized by anarchic deposition and excess of the extracellular matrix. The objective of this study was to evaluate hepatic fibrosis in HIV/HCV co-infected individuals as compared to HCV mono-infected. METHODS: A total of 97 participants (mean age 60.2 ± 14.3 years and 0.76 male/female sex ratio) was enrolled in a study conducted in Yaoundé, Cameroon from November 2018 to January 2019. Liver fibrosis was assessed by the APRI score (Aspartate Aminotransferase or AST/Platelet Ratio Index) which identifies the stage of fibrosis as classified by the Metavir system (F0 to F4). CD4 counts and plasmatic HIV viral load of HIV/HCV co-infected individuals were determined and the correlation between hepatic fibrosis and immuno-virological status established. Statistical analysis was done using Microsoft Excel 2016 and EpiInfo7 software. RESULTS: A high proportion (63.6%) of HIV/HCV co-infected participants had an abnormal AST level: 73.6 ± 45.8 IU/L as compared to 58.5 ± 39.3 IU/L (59.3%) among HCV mono-infected participants. The frequency of thrombocytopenia was 63.6% with a mean platelet count of 137 ± 50 ×  103 IU/L in HIV/HCV co-infected participants as compared to 176 ± 67 × 103 IU/L in HCV mono-infected participants (38.4%). The progression of hepatic fibrosis in participants with clinically significant fibrosis: F2, F3 and F4 was higher among HIV/HCV co-infected and the mean APRI score was 1.7 ± 1.4 versus 1 ± 0.8 among HCV mono-infected (26.7%). All participants (100%) with detectable HIV viral load had clinically significant fibrosis compared to 33.4% in those with undetectable HIV viral load (p = 0.55). Only 42.9% participants with CD4 >  500 cells/µL had clinically significant fibrosis (p = 0.72) while 100% participants with CD4 <  200 cells/µL had clinically significant fibrosis (p = 0.58). CONCLUSIONS: A high level of AST combined with thrombocytopenia (APRI score > 1.5) is an indicator of hepatic fibrosis in HIV/HCV co-infected individuals. Because of its non-invasive and less costly nature, the APRI score can be a suitable biomarker to monitor hepatic fibrosis in HIV/HCV co-infected individuals in resource constrained settings.

Achieving a high cure rate with direct-acting antivirals for chronic Hepatitis C virus infection in Cameroon: a multi-clinic demonstration project.

OBJECTIVES: Highly effective direct-acting antivirals (DAAs) for Hepatitis C treatment are largely inaccessible in sub-Saharan Africa. Data on treatment feasibility and outcomes in clinical settings are limited. We assessed the feasibility of achieving a high (≥90%) cure rate with DAAs in six gastroenterology clinics in Cameroon. METHODS: Patients with chronic Hepatitis C virus (HCV) infection were treated for 12 or 24 weeks with ledipasvir/sofosbuvir, ledipasvir/sofosbuvir/ribavirin or sofosbuvir/ribavirin, depending on the stage of liver disease and HCV genotype. The cure rate was defined as the proportion of patients with a sustained virological response 12 weeks after treatment completion (SVR12) among all treatment completers. RESULTS: We identified 190 HCV RNA positive patients between September-2017 and August-2018, 161 (84.7%) of whom started treatment. 105 (65.2%) were female, median age was 61.3 years [IQR = 55.9-66.9] and 11 (6.8%) were HIV-positive. Median plasma HCV RNA was 6.0 log10 IU/mL [IQR = 5.6-6.4]. HCV genotypes identified were 1 (34.8%), 2 (13.7%), 4 (50.9%), 1 and 4 (0.6%); 46 (28.6%) strains of 160 single-genotype infections were non-subtypeable. Of 158 treatment completers, 152 (96.2%, 95%CI = 91.9-98.6%) achieved SVR12. Six patients did not achieve SVR12: five carried HCV with NS5A resistance mutations and one with NS5B resistance mutations. Three patients died before and two after treatment completion. The most common adverse events were asthenia (12.0%), headache (11.4%) and dizziness (18.9%). CONCLUSION: High cure rates of Hepatitis C with DAAs are achievable in clinical settings of Cameroon. However, the accessibility and provision of HCV screening, diagnosis, treatment, monitoring and care should be addressed for large-scale implementation.

OBJECTIFS: Les antiviraux à action directe (AAD) hautement efficaces pour le traitement de l'hépatite C sont largement inaccessibles en Afrique subsaharienne. Les données sur la faisabilité du traitement et les résultats en milieu clinique sont limités. Nous avons évalué la faisabilité d'atteindre un taux de guérison élevé (≥90%) avec les AAD dans six cliniques de gastro-entérologie au Cameroun. MÉTHODES: Les patients atteints d'une infection chronique par le virus de l'hépatite C (VHC) ont été traités pendant 12 ou 24 semaines avec le ledipasvir/sofosbuvir, le ledipasvir/sofosbuvir/ribavirine ou le sofosbuvir/ribavirine, selon le stade de la maladie du foie et le génotype du VHC. Le taux de guérison a été défini comme la proportion de patients présentant une réponse virologique soutenue 12 semaines après la fin du traitement (SVR12) parmi tous les patients ayant terminé le traitement. RÉSULTATS: Nous avons identifié 190 patients positifs pour l'ARN du VHC entre septembre 2017 et août 2018, dont 161 (84,7%) ont commencé le traitement. 105 (65,2%) étaient des femmes, l'âge médian était de 61,3 ans [IQR = 55,9-66,9] et 11 (6,8%) étaient positifs pour le VIH. L'ARN plasmatique médian était de 6,0 log10 UI/mL [IQR = 5,6-6,4]. Les génotypes du VHC identifiés étaient 1 (34,8%), 2 (13,7%), 4 (50,9%), 1 et 4 (0,6%); 46 (28,6%) souches provenant de 160 infections à génotype unique n'étaient pas sous-typables. Sur 158 patients ayant terminé le traitement, 152 (96,2%, IC95%: 91,9-98,6%) ont atteint la RVS12. Six patients n'ont pas atteint la RVS12: cinq portaient le VHC avec des mutations de résistance NS5A et un avec des mutations de résistance NS5B. Trois patients sont décédés avant et deux après la fin du traitement. Les événements indésirables les plus courants étaient l'asthénie (12,0%), les céphalées (11,4%) et les étourdissements (18,9%). CONCLUSION: Des taux élevés de guérison de l'hépatite C avec les AAD sont réalisables dans les milieux cliniques du Cameroun. Cependant, l'accessibilité et la fourniture du dépistage, le diagnostic, du traitement, de la surveillance et des soins du VHC devraient être adressés pour une mise en œuvre à grande échelle.

[Cryoglobulin and factors associated with it in patient with anti-hepatitis-C antibodies living in resource-limited countries]. / Cryoglobuline et facteurs associés chez le patient porteur de l'anticorps du virus de l'hépatite C dans un pays à ressources limitées.

INTRODUCTION: hepatitis C virus (HCV) has several extra-hepatic manifestations including cryoglubulinemia. Cryoglobulinemia is defined as the abnormal presence in the blood of one or several proteins (cryoglobulins) that can precipitate at low temperatures. METHOD: We conducted a cross-sectional analytical study in the Laboratory of Biology and in the Unit of Hepatology of the General Hospital in Douala (HGD) over a period of 6 months. All patients agreeing to participate to the study and with anti-hepatitis-C antibodies under treatment or not were enrolled. Cryoglobulins were detected using biuret method and the classification was performed using Brouet immunoelectrophoresis. A multivariate analysis was conducted, confounding factors such as age, sex and the length of time after Hepatitis C Virus screening were adjusted. RESULTS: The study enrolled 116 patients. The average age of patients was 58.47±9.95 years. Male sex accounted for 50.86% of cases. Arthralgia was found in 69.80% of cases. Cryoglobulin was found in 63.80% of patients. After adjustment, female sex (OR =2.18; CI 95% [0,97-4,90]; p= 0.059), asthenia alone (OR =2.45;CI 95% [1,04-5,80]; p= 0.041), asthenia combined with arthralgia (OR =2.84;CI 95% [1,13-7, 10]; p= 0.026) and the presence of HCV RNA (OR =2.84;CI 95% [1,13-7,10]; p= 0.028) were factors independently associated with the presence of cryoglobulin. CONCLUSION: The prevalence of cryoglobubin is high in patients with anti-hepatitis-C antibodies at the HGD. Simple biological methods are used to detect it. Cryoglobulin test in patients with HCV is essential in resource-limited countries.

Cryoglobuline et facteurs associés chez le patient porteur de l'anticorps du virus de l'hépatite C dans un pays à ressources limitées

Introduction: le virus de l'hépatite C (VHC) a plusieurs manifestations extra hépatiques parmi lesquelles la cryoglubulinémie. La cryoglobulinémie se définit par la présence anormale dans le sang d'une ou plusieurs protéines (cryoglobuline) pouvant précipiter au froid. Méthodes: nous avons mené une étude transversale et analytique dans le service du laboratoire de biologie et l'unité d'hépatologie de l'Hôpital Général de Douala (HGD) pendant une durée de 6 mois. Etaient inclus dans le travail tous les patients acceptant de participer et porteurs d'un anticorps anti VHC avec ou sans traitement. Les cryoglobulines étaient recherchés par la méthode de Biuret et la classification était réalisée par une immunoélectrophorèse de Brouet. Une analyse multivariée a été réalisée, des facteurs de confusion tels que l'âge, le sexe et la durée après dépistage du VHC ont été ajustés.Résultats: nous avons inclus 116 patients. L'âge moyen était de 58,47 ± 9,95 ans. Le sexe masculin représentait 50,86% des cas. L'arthralgie était présente dans 69,80% des cas. La cryoglubiline était présente chez 63,80% des cas. Apres ajustement, le sexe féminin (ORa =2,18; IC à 95% [0,97-4, 90]; p= 0,059), l'asthénie seule (ORa =2,45; IC à 95% [1,04-5,80]; p= 0,041), l'asthénie couplée à l'arthralgie (ORa =2,84; IC à 95% [1,13-7, 10]; p= 0,026) et la présence de l'ARN du VHC (ORa =2,84; IC à 95% [1,13-7, 10]; p= 0,028) étaient des facteurs indépendamment associés à la présence de cryoglobuline.Conclusion: la prévalence de la cryoglobubine est élevée chez les patients porteurs de l'Ac anti VHC à l'HGD. Elle est recherchée par les méthodes biologiques simples. La recherche de cryoglobuline chez les patients porteurs du VHC est essentielle dans un pays à ressource limité

High Burden of HBV-Infection and Atypical HBV Strains among HIV-infected Cameroonians.

AIM: To investigate the prevalence and genotypic profile of overt and occult hepatitis-B infection (OBI) among HIV-infected individuals in Cameroon. METHODS: 212 HIV-infected Cameroonians, aged 37.6 [IQR: 32.6-46.6] followed-up at the University Health Centre in Yaoundé, were tested for HBsAg, anti-HBs, anti-HBc IgG/IgM, HBV-DNA and anti-HCV IgG. HBV positive cases were tested for Hepatitis Delta virus (HDV) using anti-HDV IgG and HDV-RNA. Liver function was assessed by alanine and aspartate aminotransaminases. OBI was defined as negative-HBsAg and detectable HBV-DNA. In occult or overt HBVinfected participants, HBV reverse transcriptase (RT)/surface (S) sequences were analyzed for drug resistance, immuneescape mutants, and phylogeny. RESULTS: Overall, 78.3% (166/212) participants had past/ongoing HBV-exposure, with 39.1% (83/212) carrying "HBcAbpositive alone". Prevalence of overt HBV (positive-HBsAg) was 11.8% (25/212), prevalence of HBV and HDV was respectively 6.9% (12/175) and 12% (3/25). Phylogeny of HBV-RT/S revealed the co-circulation of genotypes A and E. All HBV-coinfected participants harbored HBV strains with at least one immune-escape mutation. Of note, one HBV variant carried the vaccine-escape mutation G145R that hinders HBsAg neutralization by antibodies. For the first time, a novel 9 aa-deletion (s115-s123), located in the HBsAg "a" determinant, was found concomitantly with OBI. A stop codon in the S region (associated with increased risk of hepatocellular carcinoma) was found in six cases. CONCLUSION: High prevalence of overt/occult HBV-infection and circulating atypical strains highlight the importance of HBV-surveillance among HIV-infected Cameroonians and strategies to detect OBI in highly endemic countries.

Clinical Outcome of a Portosplenomesenteric Venous Thrombosis in Necrotizing Acute Pancreatitis with Protein C and S Deficiency Treated by Anticoagulation Therapy Alone.

Cases of splanchnic venous thrombosis have not been described in Cameroon. Their prevalence in acute pancreatitis is variable. With the emergence of acute intra-abdominal infections including typhoid fever and peritoneal tuberculosis in situations of acquired immunodeficiency syndrome, these cases will become frequent. We report the case of a portosplenomesenteric venous thrombosis related to necrotizing acute pancreatitis associated with proteins C and S deficiency, in a 46-year-old Cameroonian man, without particular past medical history. He was admitted for abdominal pain which had been evolving for 3 weeks and accompanied by vomiting. In the absence of hemorrhagic risk factor, the patient received low molecular weight heparin followed by oral warfarin. The abdominal ultrasound check on the 12th day showed a partial recanalization of venous thrombosis. The abdominal contrast-enhanced CT scanner at day 30 on oral anticoagulation therapy showed collateral vessels and small bowel edema. At the same time the upper gastrointestinal endoscopy showed grade II esophageal varices. We have maintained oral anticoagulation therapy. This case highlights that an early effective anticoagulation heparin therapy is needed for a clear benefit in case of suspected PSMVT. It is certain that the sooner the treatment is given, the better outcome will be.

Epidemiology of hepatitis C: related hepatocellular carcinoma in Cameroon.

INTRODUCTION: Hepatocellular carcinoma (HCC) is a global public health problem. Hepatitis C virus (HCV) infection accounts for close to 24% of HCC in developing countries especially when associated with cirrhosis. There exists no vaccine against HCV to prevent the occurrence of HCV-related HCC. A sound knowledge of the epidemiology and prevention of the initial infection is vital. The aim of our study was to determine the epidemiologic profile of HCV-related HCC in Cameroon to improve its' management. METHODS: It was a prospective study of histologically proven HCV-related HCC seen in two University Centers in Yaounde, Cameroon from March 2012 to January 2013. Demographic data (age, gender), alcohol abuse (>80g/day), presence of cirrhosis, tobacco abuse and parenteral exposition were analyzed. RESULTS: Twenty-six patients with histologically proven HCV-related HCC were included (18 men (69.2%) and 8 women (30.8%); mean age +/- SD, 61.46+/-10.18 years). A total of 22 (84.6%) patients had a parenteral exposition, 02 (7.7%) patients were alcoholics and 06 (23.1%) patients were smokers. The proportion of patients with cirrhosis was 69.2% against 30.8% cirrhosis-free. Patients with cirrhosis were relatively younger than those cirrhosis-free (mean age +/- SD, 59.05+/-10.05 years vs 66.87+/- 8.72 years, p=0.06). HCV-related HCC was more prevalent in 60 years and above patients (53.8%, 95%CI: 33.4-73.4). The relative risk of HCC among alcoholics patients was high (RR: 1.5, 95%CI: 1.13-1.99, p<0.05). CONCLUSION: In Cameroon, HCV-related HCC is more prevalent among age older than 60 years, a finding which is relatively less to that found in western countries, male gender is twice more at risk than female gender and cirrhosis frequency is less compared to that observed elsewhere. HCV and alcohol play a synergistic role in the occurrence of HCC in our environment.

Indications, résultats et rendement de la coloscopie dans un environnement économique défavorable: le cas du Cameroun

OBJECTIF : le rendement diagnostique de la coloscopie dépend de plusieurs facteurs, notamment les indications. La pertinence de ces indications est influencée par l'environnement économique et les structures locales. Le but de notre étude était d'analyser les indications et les résultats des coloscopies, et d'évaluer leur rendement diagnostique afin de juger de la pertinence de ces indications. MATÉRIELS ET MÉTHODES : un recueil rétrospectif de données de coloscopies réalisées de janvier 2001 à juin 2011 dans trois hôpitaux universitaires de Yaoundé a été effectué. Les variables enregistrés étaient l'âge, le sexe, les indications et les résultats. RÉSULTATS : un total de 908 protocoles de coloscopie ont satisfait à nos critères de sélection (dont 622 hommes (68,5%)). L'âge médian était de 48 ans (IQR 36-59 ans). Les indications principales étaient les rectorragies 281 patients (30,9%), les douleurs abdominales 267 patients (29,4%) et les diarrhées chroniques 107 patients (11,8%). L'examen était normal 451 fois (49,7%). Les lésions retrouvées étaient les polypes colorectaux 110 cas (12,1% ; IC 95% : 10,1-14,5), les hémorroïdes 104 cas (11, 5% ; IC 95% : 9,5-13,7), la diverticulose 71 cas (7,8% ; IC 95% : 6,2-9,8) le cancer colorectal 64 cas (7,0% ; IC 95% : 5,5-9,0) et les colites 64 cas (7,0% ; IC 95% : 5,5-9,0). Le rendement diagnostique de la coloscopie pour le cancer colorectal selon les indications était élevé en cas d'image radiologique suspecte (27,7%), de masse abdominale (25%) et d'anémie ferriprive (22,2%). les douleurs abdominales et/ou TFI non accompagnées de perte de sang macroscopique ou occulte, la constipation et le dépistage du cancer colorectal avaient un rendement faible. CONCLUSION : le rendement diagnostique de la coloscopie dans la détection des principales lésions coliques n'est pas différent dans un environnement économique défavorable malgré les indications peu pertinentes. Les symptômes digestifs avec une valeur prédictive positive élevée pour le diagnostic de cancer colorectal sont retrouvés. Les polypes et les hémorroïdes constituent les principales lésions colorectales au Cameroun. Le cancer colorectal a une prévalence élevée et inattendue méritant notre attention

Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease.

UNLABELLED: Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in affluent countries. Accurate noninvasive tests for liver injury are urgently needed. The aim of this study was to evaluate the accuracy of transient elastography for the diagnosis of fibrosis and cirrhosis in patients with NAFLD and to study factors associated with discordance between transient elastography and histology. Two hundred forty-six consecutive patients from two ethnic groups had successful liver stiffness measurement and satisfactory liver biopsy specimens. The area under the receiver-operating characteristics curve (AUROC) of transient elastography for F3 or higher and F4 disease was 0.93 and 0.95, respectively, and was significantly higher than that of the aspartate aminotransferase-to-alanine aminotransferase ratio, aspartate aminotransferase-to-platelet ratio index, FIB-4, BARD, and NAFLD fibrosis scores (AUROC ranged from 0.62 to 0.81, P < 0.05 for all comparisons). At a cutoff value of 7.9 kPa, the sensitivity, specificity, and positive and negative predictive values for F3 or greater disease were 91%, 75%, 52%, and 97%, respectively. Liver stiffness was not affected by hepatic steatosis, necroinflammation, or body mass index. Discordance of at least two stages between transient elastography and histology was observed in 33 (13.4%) patients. By multivariate analysis, liver biopsy length less than 20 mm and F0-2 disease were associated with discordance. CONCLUSION: Transient elastography is accurate in most NAFLD patients. Unsatisfactory liver biopsy specimens rather than transient elastography technique account for most cases of discordance. With high negative predictive value and modest positive predictive value, transient elastography is useful as a screening test to exclude advanced fibrosis. Liver biopsy may be considered in NAFLD patients with liver stiffness of at least 7.9 kPa.

[Brief intervention about alcohol use]. / Intervention brève en alcoologie.

The brief intervention lasts from 5 to 20 minutes and uses motivational interview techniques. This brief intervention is addressed not at alcohol-dependent patients (approximately 1.5 million people in France) but at those whose consumption is harmful or at risk (estimated at approximately 4 million people in France), especially men. The efficacy of the brief intervention is demonstrated by numerous randomized studies and meta-analyses. A mean reduction of one glass of an alcoholic beverage a day results, with consumption returning to a moderate rather than at-risk level for approximately 30%. This efficacy has been demonstrated for a duration of at least 4 years. Given that evidence also supports the behavioral changes, these findings should be taken into account by healthcare providers.