Gender difference in the association between gout at diagnosis and metabolic syndrome in African population: a retrospective cohort study.

Introduction: few studies have specifically investigated the link between metabolic syndrome (MetS) and gout in sub-Saharan Africa. This report aimed to evaluate in patients with gout the association between gout at diagnosis and MetS and to assess the gender difference. Methods: we performed a single-centre retrospective cohort study on all outpatients seen in the Rheumatology Unit of the General Hospital, Douala, Cameroon. We included records of patients with a recent diagnosis of gout according to the American College of Radiology (ACR) criteria. MetS was defined according to the harmonized criteria. Results: we included 511 patients (415 men), with a mean age at diagnosis of 55.9 ±10.8 years. Women were older than men. The mean serum uric acid was 8.24±2.23 mg/L, with hyperuricemia found in 394 patients (77.1%). MetS was present in 101 patients (19.7% [95% CI: 16.8%-22.1%]), significantly more common in men compared to women (23.6% vs. 10.8%; p<0.001). The main components of the MetS were: increased waist circumference (217 patients, 61.3%), obesity (256 patients, 52.2%), hypertension (208 patients, 40.7%), and diabetes mellitus (52 patients, 10.2%). Furthermore, hypertension, diabetes mellitus, obesity, and increased waist circumference were more frequent in women (p<0.001). There was no difference in dyslipidemia according to gender. The combination of components of the MetS was more frequent in men than women (p<0.001). Conclusion: MetS are common in newly diagnosed Cameroonian patients with gout, with increased waist circumference, obesity, hypertension and diabetes mellitus being the main components. These components are more common in women, but their combination was more frequent in men.

Hydroxychloroquine and COVID-19: can we learn from the use of rituximab in systemic lupus erythematosus?

Rituximab (RTX), a chimeric monoclonal anti-CD20 antibody has become part of the standard therapy for patients with CD20-expressing B-cell lymphoma and rheumatoid arthritis. After encouraging results with open studies in systemic lupus erythematosus (SLE), RTX has not shown its effectiveness in randomized controlled trials. However, its efficacy has been validated in renal, hematological, and neuropsychiatric disorders. Understanding the history of RTX in SLE would be instructive in the hydroxychloroquine (HCQ) saga in COVID-19. Three steps would be necessary and sufficient before definitively closing the debate: 1) determine the effective and safe dose of HCQ, as well as the minimum duration of treatment in COVID-19; 2) define the profile of patients in whom HCQ would be more likely to be effective (especially in asymptomatic patients and/or at the onset of the first signs of the disease) and 3) conduct one or more multicentre RCT to evaluate the efficacy and safety of HCQ in COVID-19 in SSA.

[Prognosis and survival of esophageal cancer in Cameroon: a prognostic study]. / Facteurs pronostiques du cancer de l'œsophage au Cameroun: étude multicentrique.

INTRODUCTION: Esophageal cancer is rare. Poor prognosis is due to delayed diagnosis. Five year survival is less than 20%. This study aimed to investigate the factors associated with survival of patients with esophageal cancer in Cameroon. METHODS: We conducted a prognostic study in the General Hospitals in Yaoundé and in Douala over a period of 11 years from 1 January 2005 to 31 December 2015. The parameters studied were those associated with survival. Survival was established on the basis of the date of diagnosis and of the date of death or of the last visit. SPSS software (Statistical Package for Social Sciences) version 23 allowed for data analysis. Kaplan Meier curve was used to estimate the survival function. Log RankTest allowed for comparison among the different groups. Cox regression helped to highlight the different factors associated with it. Significance level was set at 0.05. RESULTS: We collected data from 49 medical records. The average age of patients was 57.83 years. There was a male predominance (71.4%; n=35) with a sex ratio of 2.49. The follow-up period was 3.2 months. Median survival was 6.67 months (CI 95% [1.33-10.4]) and the average survival time was 7.99 months (CI 95% [4.42-11.17]). Multivariate-adjusted analysis showed that stage IV was a predictive factor of mortality (HR = 2.79; CI95% [1.13-6.89], p = 0.025]). CONCLUSION: Esophageal cancer is a rare disease with poor prognosis. Prognostic factor is the tumor stage.

The prognostic value of serum uric acid in the acute phase of hemorrhagic stroke patients in black Africans.

INTRODUCTION: Very few studies have been conducted to evaluate the prevalence of hyperuricemia and its impact on the prognosis amongst acute hemorrhagic stroke (AHS) patients. The objectives was to determine the prevalence of hyperuricemia in AHS patients and examined the association between hyperuricemia and stroke outcomes in the Douala General Hospital (DGH). METHODS: This was a hospital based prospective cohort which included AHS patients with baseline SUA levels and 3 months post stroke follow-up data. SUA values were divided into quintiles. Associations between hyperuricemia and stroke outcomes were analyzed using multiple logistic regression and survival analysis (cox regression and Kaplan Meier). RESULTS: A total of 221 AHS patients were reviewed with a mean age of 55.8±11.8 years. The prevalence of hyperuricemia among AHS patients was 34.4% with mean SUA level of 376.8±131.9 µmol/l. On multivariate analysis, hyperuricemia was not independently associated with early death [(OR = 1.072 (CI: 0.370-3.056; p = 0.897)] and poor functional outcome [(OR=2.487 (CI: 0.771-8.699; p = 0.154)] after hemorrhagic stroke. No significant increase in stroke deaths was observed across higher SUA quintiles amongst hemorrhagic stroke patients (p = 0.326). No statistically significant correlation was observed between SUA level and NIHSS (r = 0.063, p = 0.353) and between SUA level and mRS (r = 0.030, p = 0.662) in hemorrhagic stroke. CONCLUSION: About one third of patients present with hyperuricemia in the acute phase of hemorrhagic stroke. Hyperuricemia can act as risk factor for stroke because of its relationship with CVRFs but hyperuricemia has no impact on the severity and short-term outcome amongst black African hemorrhagic stroke patients.

Late presentation to HIV/AIDS care at the Douala general hospital, Cameroon: its associated factors, and consequences.

BACKGROUND: The introduction of anti-retroviral treatment (ART) has significantly reduced mortality and morbidity associated with HIV/AIDS. While treatment at early stages of the disease is related to a better prognosis, late presentation (LP) to care is harmful to the infected person, the society and is more costly. We aimed to describe late presentation to HIV care, its associated factors and consequences in patients followed up in a tertiary hospital in Cameroon. METHODS: We retrospectively assessed patients' files between 1996 and 2014 at the Douala general hospital (DGH) HIV treatment centre. Late presentation (LP) to HIV care was defined as a CD4+ T cell count< 350 cells/mm3 or advanced clinical stages of the disease (WHO stages 3/4) at first presentation for care. We used logistic regression to study factors associated with late presentation and assessed occurrence of opportunistic infections and mortality at 3, 6 and 12 months after presentation to care. RESULTS: Of 1866 files studied, mean age was 40 (SD: 10) years, median CD4+ T cell count was 147 (IQR: 63-270) cells/mm3, 58.2% were at HIV clinical stages 3 and 4. The prevalence of late presentation to HIV care was 89.7% (95% CI: 88.2-91.0%) and remained above 80% from 1996 to 2014. Circumstances of diagnosis: prevention of mother to child transmission program/blood donation (OR = 0.16, 95% CI 0.10-0.29), having a positive partner (OR = 0.16, 95%CI = 0.10-0.26), and routine screening (OR = 0.13, 95%CI = 0.10-0.19) reduced the odds of presenting late compared to clinical suspicion. Students had lower odds of presenting late compared to people who had an employment (OR = 0.50, 95%CI = 0.26-0.98). Calendar time OR = 1.64, 95% CI = 1.08-2.48 for ≥2010 vs. < 2005) increased the odds of late presentation. Mortality and opportunistic infections prevalence remained significantly higher in late presenters at 3, 6 and 12 months than in early presenters. CONCLUSION: Late presentation to HIV care is very high at the DGH and is related to poor outcome. More screening and sensitization campaigns should be carried out in the population to diagnose the disease at an earlier stage.

Knowledge, attitudes and practices regarding urinary schistosomiasis among adults in the Ekombe Bonji Health Area, Cameroon.

INTRODUCTION: Urinary schistosomiasis (US) is endemic in Cameroon. Knowledge, attitudes and practices (KAP) are important aspects for control of the disease. However, data on these remain scanty. We aimed at evaluating knowledge, attitudes and practices regarding urinary schistosomiasis among adults in households in the Ekombe Bonji health area. METHODS: A community-based, cross-sectional study was carried out at Ekombe Bonji health area from February to March, 2017, involving all 12 communities. A pre-tested questionnaire was used to assess knowledge, attitudes and practices regarding urinary schistosomiasis among 198 adults and to record their socio-demographic, environmental and clinical variables. Data were stored in Excel version 2013 and analysed using Stata version 14.2. RESULTS: Of the 198 adults interviewed, only 35.4% had prior knowledge about urinary schistosomiasis. Among these, 94.3%, 74.3%, 57.7% knew the signs and symptoms, modes of transmission and preventive measures respectively. Only 14.3% knew the cause and treatment. 81.2% considered urinary schistosomiasis a serious disease and 77.1% believed it could be prevented, albeit, their practices to prevent infection were inadequate. CONCLUSION: Knowledge, attitudes and practices regarding urinary schistosomiasis among adults are inadequate, since most of them are not aware of the disease. Therefore, there is need for community-based interventions especially health education to effectively reduce the disease burden.

Acute Stroke Patients with Newly Diagnosed Diabetes Mellitus Have Poorer Outcomes than Those with Previously Diagnosed Diabetes Mellitus.

BACKGROUND: Diabetes mellitus (DM) is associated with poor outcomes in acute stroke patients (ASPs). This study aims to determine the prevalence of NDDM in the ASPs and to compare the outcome in NDDM and previously diagnosed DM (PDDM) in Cameroon. METHODS AND MATERIALS: This was a hospital-based prospective cohort study that included ASPs with NDDM and PDDM. Outcome data were collected within 3 months of stroke onset. Chi-square and t tests were used for comparisons, whereas survival analysis was performed using Cox regression and Kaplan-Meier analysis. RESULTS: Of the 701 ASPs included, 24.8% had PDDM (n = 174) and 9.4% NDDM (n = 66). NDDM had a higher mortality rate on admission and 3 months after stroke (P < .05). PDDM were more likely to survive within 3 months after stroke onset (log-rank test P = .008). The risk of dying among NDDM was increased (adjusted hazard ratio = 1.809; 95% confidence interval: 1.1532.839; P = .010). NDDM were more likely to have higher mean National Institutes of Health Stroke Scale and modified Rankin score (P < .05) on admission. PDDM were more likely to develop urinary tract infections during hospitalization (P = .015). There was no significant difference between functional outcome on admission and 3 months after stroke (P > .05). CONCLUSION: NDDM are associated with increased mortality and are more likely to have poorer functional outcomes and more severe stroke than those with PDDM.

The Prognostic Value of Serum Uric Acid in the Acute Phase of Ischemic Stroke in Black Africans.

BACKGROUND: The association between hyperuricemia and stroke outcome still remains controversial worldwide. This study aims to determine the prevalence of hyperuricemia and its association with the outcome of patients with acute ischemic stroke in a tertiary care hospital. METHODS: This was a hospital-based prospective cohort study that included patients with ischemic stroke with baseline uric acid levels and 3-month post-stroke follow-up data. Associations between hyperuricemia and stroke outcomes were analyzed using multiple logistic regression, Kaplan-Meier, and Cox proportional hazards regression analysis. RESULTS: A total of 480 patients were reviewed with a mean age of 62.8 ± 13.3 years. The prevalence of hyperuricemia was 52.3% with mean uricemia of 71.1 ± 25.3 mg/dL. There was a significant association between hyperuricemia and mortality with unadjusted odds ratio (OR) = 4.120 [95% (confidence interval [CI]: 2.466-7.153); P = .001)], but on multivariate analysis, hyperuricemia was not an independent predictor of stroke mortality [OR = 1.270 (CI: .547-2.946); P = .578)]. An independent association between increasing uric acid levels and mortality was noted on Cox proportional hazards regression; adjusted hazard ratio (95% CI) of 3.395 (2.114-5.452), P value greater than .001. Stroke mortality significantly increased across higher uric acid quintiles in patients with acute stroke (P < .001). Hyperuricemia was an independent predictor of poor functional outcome within 3 months after stroke with adjusted OR (95% CI) of 2.820 (1.359-5.851); P = .005. CONCLUSIONS: Half of black African patients with ischemic stroke present with hyperuricemia, and hyperuricemia is a predictor of mortality and adverse functional outcomes. Further studies are therefore warranted to determine whether reducing hyperuricemia after stroke would be beneficial within our setting.

Gender-Related Differences and Short-Term Outcome of Stroke: Results from a Hospital-Based Registry in Sub-Saharan Africa.

BACKGROUND: Studies suggest that sex differences have an impact on patients with stroke, but existing data in Africa remain inconclusive about this inference. OBJECTIVES: To study sex differences in terms of the clinical profile and short-term outcome of stroke in the Douala General Hospital, Cameroon. METHODS: A hospital-based prospective cohort study was carried out in a tertiary care hospital over an 8-year period, which included all patients admitted for confirmed acute stroke. Information about the history of stroke with emphasis on clinical profile and outcome was collected. Descriptive statistics, t test, and chi square test were used for comparisons, while the Kaplan-Meier curve was used for survival rate analysis. RESULTS: Of the 818 patients included, 455 (55.6%) were male patients. When compared to males, female patients are more likely to experience a stroke at an older age (mean age 62.3 ± 14.1 vs. 58.4 ± 12.9 years, p < 0.001), to be unmarried, to remain unemployed, and to have higher rates of cardio-embolic stroke (p = 0.049), body mass index (p = 0.031), altered levels of consciousness at presentation (p = 0.005), higher mean HDL cholesterol levels (p = 0.001), and in-hospital complications (p = 0.011), especially urinary tract infections (p = 0.018). Males were more likely to have health insurance, to smoke, to consume alcohol (p < 0.001), and to have higher rates of dysarthria (p = 0.004), higher mean uric acid (p = 0.013), and creatinine (p < 0.001) concentrations. Ischemic and hemorrhagic strokes were more prevalent in men (p = 0.003). There are no sex differences in terms of stroke severity, length-of-hospital stay, case fatality, and functional outcome on admission. CONCLUSIONS: Sex differences exist in the clinical profile of stroke but not in the outcome. Knowledge of these differences could help influence stroke prevention, thereby improving stroke burden in Africa.

Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses among haemodialysis patients in two newly opened centres in Cameroon.

INTRODUCTION: Haemodialysis (HD) patients are potentially susceptible to infection with blood borne viral agents especially; Human Immunodeficiency Virus (HIV), hepatitis B (HBV) and hepatitis C Viruses (HCV), compared to the general population. We described their epidemiology in two newly created haemodialysis units in Cameroon: the Buea and Bamenda haemodialysis centres. METHODS: A cross sectional study: included were patients who had spent at least three months in haemodialysis. HBV, HCV and HIV serologies were determined and patients' characteristics extracted from patient's records. RESULTS: We included 104 participants (44 in Buea and 60 in Bamenda). Mean age was 48 years and 65.4% were men. Median duration in dialysis was 14 months. One of the three viral markers was present in 40.1% of patients. The hepatitis B surface antigen, anti-HCV and anti-HIV antibody prevalence were respectively 10.6%, 19.2%, 13.5%. A history of sexually transmitted infection was the only variable associated with anti-HIV antibody positivity. CONCLUSION: The sero-prevalence of HBsAg, HCV and HIV are high in the two centres. HIV prevalence may have reflected its etiology as a cause of ESKD. HCV remains a cause for concern and needs further evaluation. There is urgent need for the implementation of preventive and control measures.

Malnutrition in patients admitted to the medical wards of the Douala General Hospital: a cross-sectional study.

BACKGROUND: Malnutrition is common in acutely ill patients occurring in 30-50% of hospitalized patients. Awareness and screening for malnutrition is lacking in most health institutions in sub-Saharan Africa. This study aimed at screening for malnutrition using anthropometric and laboratory indices in patients admitted to the internal medicine wards. METHODS: A cross-sectional study. We screened for malnutrition in 251 consecutive patients admitted from January to March 2013 in the internal medicine wards. Malnutrition defined as body mass index (BMI) less than 18.5 kg/m2 and/or mid upper arm circumference (MUAC) less than 22 cm in women and 23 cm in men. Weight loss greater than 10% in the last 6 months prior to admission, relevant laboratory data, diagnosis at discharge and length of hospital stay (LOS) were also recorded. RESULTS: Mean age was 47 (SD 16) years. 52.6% were male. Mean BMI was 24.44 (SD 5.79) kg/m2 and MUAC was 27.8 (SD 5.0) cm. Median LOS was 7 (IQR 5-12) days. 42.4% of patients reported weight loss greater than 10% in the 6 months before hospitalization. MUAC and BMI correlated significantly (r = 0.78; p < 0.0001) and malnutrition by the two methods showed moderate agreement (κ = 0.56; p < 0.0001). Using the two methods in combination, the prevalence of malnutrition was 19.34% (35/251). Blood albumin and hemoglobin were significantly lower in malnourished patients. Malnourished patients had a significantly longer LOS (p = 0.019) when compared to those with no malnutrition. Malnutrition was most common amongst patients with malignancy. CONCLUSION: Malnutrition is common in patients admitted to the medical wards of the Douala General Hospital. Nutritional screening and assessment should be integrated in the care package of all admitted patients.

Anorectal pathology amongst HIV infected patients attending the Douala General Hospital: a cross-sectional study.

While gastrointestinal disease is common among HIV infected individuals, the prevalence and distribution of ano-rectal pathology has not been well studied in our setting. The objective of this study therefore was to determine the prevalence and determinants of ano-rectal pathology in HIV infected patients attending the Douala General Hospital HIV treatment centre. A hospital-based cross-sectional study was undertaken. We collected socio-demographic, clinical and laboratory data using a structured questionnaire and patients' files. Each study participant had a full physical and ano-rectal examination. We further studied factors associated with having at least one ano-rectal lesion by logistic regression reporting odds ratios (ORs) and their 95% confidence intervals (CI). We included 390 HIV infected patients. The mean age was 41 (SD: 8) years and 48% were men. Median duration since HIV diagnosis was 3 (interquartile range: 2-5) years and median CD4 cell count was 411 (interquartile range: 234-601) cells/mm3. Prevalence of ano-rectal pathology was 22.8% (95% CI: 18.7-27.3). Hemorrhoids and proctitis were most common lesions found; each in 10% of patients. From multivariate logistic regression, factors associated with ano-rectal pathology were CD4 < 350 cells/ml (OR: 2.1, 95% CI: 1.1-4.2), not on highly active antiretroviral therapy (OR: 2.2, 95% CI: 1.1-4.6), inpatient (OR: 2.3, 95% CI: 1.2-4.3), ano-rectal intercourse (OR: 5.0, 95% CI: 1.7-15.1), and more than one sexual partner (OR: 2.4, 95% CI: 1.3-4.2). Ano-rectal pathology is common amongst HIV infected patients. Care givers should actively investigate and treat them as this will improve the quality of life of people living with HIV/AIDS.

Sero-prevalence and Correlates of Hepatitis B and C Co-infection Among HIV-infected Individuals in Two Regional Hospitals in Cameroon.

BACKGROUND: Liver disease related to Hepatitis B (HBV) and C (HCV) infection has become a major cause of morbidity and mortality in HIV/AIDS patients. Data on the prevalence of HBV and HCV in Cameroon remains inconclusive. OBJECTIVE: We aimed to determine the sero-prevalence and correlates of Hepatitis markers in HIV/AIDS patients in two Regional Hospitals. METHODS: A cross-sectional study carried out from December 2014 to March 2015. HIV/AIDS patients aged 21 were included and above, receiving care at HIV treatment centres. Data was collected using a structured questionnaire. Blood samples were collected to screen for Hepatitis with HBsAg and anti HCV antibody rapid immunochromatographic test kits. Correlates of hepatitis were investigated by logistic regression. STATA was used for data analysis. RESULTS: We included 833 HIV/AIDS patients,78.8% (657) were female. Mean age was 44(SD 11) years. Prevalence of Hepatitis in general (total of two viral markers tested) was 8.9% (74/833), with 6.1% for HBsAg and 2.8% for Anti-HCV antibodies. From multivariate analysis, the likelihood of having hepatitis was independently increased by a history of surgical interventions [OR: 1.82(1.06-3.14)], and of sexually transmitted infections [OR: 2.20(1.04-4.67)]. CONCLUSION: Almost one in ten participants with HIV/AIDS attending the BRH and LRH tested positive for either HBsAg or anti HCV antibodies. Screening for HBV and HCV should therefore be integrated to the existing guidelines in Cameroon as it can influence management. More studies are needed to evaluate the extent of liver disease and magnitude of HIV suppression in hepatitis and HIV coinfection in this setting.

Hepatitis B, Hepatitis C, and Human Immune deficiency Virus Seroconversion Positivity Rates and Their Potential Risk Factors Among Patients on Maintenance Hemodialysis in Cameroon.

INTRODUCTION: Maintenance hemodialysis is a high-risk environment for transmission of blood-borne viruses. We aimed to assess the seroconversion rates of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immune deficiency virus (HIV) infections in patients on maintenance hemodialysis in a tertiary care hospital in Cameroon. MATERIALS AND METHODS: Patients with serology records at initiation of hemodialysis, and a minimum duration on hemodialysis of 4 months were included. Baseline demographic and clinical data were recorded. Patients were tested with a third and fourth generation immune-enzymatic assay for hepatitis B surface antigen and anti-HCV antibodies, respectively. For HIV, a rapid Ag/Ab combo test and an ImmunoComb II HIV (for confirmation) were used. RESULTS: Ninety-seven patients, 66% men, mean age of 51 ± 14 years and mean duration on hemodialysis of 32.8 ± 27.5 months, were included. Seroprevalence at dialysis initiation was 6.2%, 20.6%, and 9.3%, respectively, for HBV, HCV, and HIV. Ninety patients (92.8%) received blood transfusions while on hemodialysis. Seroconversion rates were 1.1% for hepatitis B surface antigen, 11.8%, for anti-HCV antibodies, and 0.0% for HIV. Longer duration on dialysis was associated with HCV seroconversion (62.7 months versus 29.2 months, P < .001). CONCLUSIONS: Seroconversion rate in hemodialysis was high for HCV, low for HBV, and nil for HIV. Longer duration on dialysis was associated with HCV seroconversion. Our study suggests an urgent need to lay emphasis on universal precaution measures in order to reduce the risk of hepatitis seroconversion in the unit.

[Incidence of strokes in HIV-positive patients treated with long term antiretroviral treatment]. / Incidence des accidents vasculaires cérébraux chez les patients VIH positifs sous traitement antirétroviral au long court.

INTRODUCTION: With the introduction of triple therapy regimen in 1996, the morbidity and mortality associated with HIV infection decreased significantly. Concomitantly with this clinical success, several metabolic changes including diabetes, arterial hypertension, dyslipidemia and lipodystrophy were observed, being associated with the risk of stroke. This study aims to determine the incidence of strokes in HIV-positive patients treated with long term antiretroviral treatment. METHODS: This was a retrospective cohort study of HIV-positive adult patients receiving long term antiretroviral treatment for at least 12 months. It was conducted at the Approved Treatment Centres of Douala General Hospital (HGD); data collection spanned a 10-year period from May 2001 to April 2010. Patients were treated according to Cameroon national treatment guidelines. The Kaplan-Meyer method was used to determine the time of stroke onset. The Khi-2 test was used to investigate the association between two qualitative variables. The statistical significance level was set at 0.05. RESULTS: 407 patients were included in the study, 62.4% were female, the average age was 40.1 ± 9.9 years. The incidence of strokes was 1.7% over 72 months follow up with no significant difference between women and men (P = 0.76). The incidence rate was calculated to be 0.3 per 100 person years. 85.7% of cases had an ischemic stroke. The mean time from stroke onset was 33.4 months. Factors associated with stroke occurrence were: patients who underwent treatment at WHO Clinical Stage III and IV and with CD4 count> 100/mm3at the start of antiretroviral therapy. CONCLUSION: The incidence of stroke in HIV-positive patients treated with long term antiretroviral therapy is similar to that previously reported but these strokes occur at an early age and justify increased clinical monitoring. A prospective study involving a control population is needed.

Characteristics of anti-hepatitis C virus antibody-positive patients in a hospital setting in Douala, Cameroon.

INTRODUCTION: Hepatitis C virus (HCV) infection is a major public health problem, especially in resource-limited settings where many patients are diagnosed at the stage of complications. In Cameroon, where HCV is endemic, little is known about the clinical, biological, and virological profile of HCV-infected patients. METHODS: A clinical case note review of all patients positive for antibodies against HCV diagnosed at the gastroenterology outpatient clinic of the Douala General Hospital, Cameroon, from January 2008 to December 2014, was performed. RESULTS: A total of 524 patients were included in the study, 53% of whom were female. The mean age was 56±13 years. A history of blood transfusion and a history of scarification were the most common potential risk factors for HCV exposure, as found in 16% and 13% of the study population, respectively. Current alcohol use was found in 24% of patients. Co-infection with hepatitis B virus and HIV was 3.6% and 3.4%, respectively. Among the patients, 39% had no complaint at diagnosis; only 16% were diagnosed through a routine medical checkup. Clinically, the most common finding was hepatomegaly (26.1% of patients). Transaminases above the upper limit of normal were found in 55.2% of patients, particularly those aged >57 years (p=0.001). Genotypes 1 (43.95%), 2 (25.11%), and 4 (28.25%) were the most common. Liver cirrhosis was present in 11% of patients and hepatocellular carcinoma in 4%, the latter being more common in males (p<0.001) and in those aged >57 years (p=0.03). CONCLUSIONS: In the gastroenterology clinic of Douala General Hospital, while almost 40% of patients who were anti-HCV antibody-positive were asymptomatic and diagnosed fortuitously, some already presented complications, including cirrhosis and hepatocellular carcinoma. There is an urgent need to put in place programs to increase awareness and diagnosis of HCV infection and to develop extensive and targeted anti-HCV treatment guidelines to improve the management of these patients in Cameroon.

Patterns of knee osteoarthritis in a hospital setting in sub-Saharan Africa.

Osteoarthritis (OA), the most prevalent joint disease in adults, ranks among the top 5 causes of disability. The burden of OA is expected to be greater in developing countries, where life expectancy is increasing and access to joint replacement therapy is not readily available. Risk factors associated with knee OA in Africa may differ from those identified in other parts of the world. This study aimed to establish the prevalence, clinical presentation, and associated factors of knee OA in two large referral centers in Cameroon. Between February and July 2012, we performed a cross-sectional analysis of 148 patients with knee OA followed at two rheumatology units in Douala. We included all patients with mechanical knee pain, who fulfilled the 1986 ACR for the classification and reporting of knee OA. One thousand four hundred ninety-six patients with musculoskeletal complaints were seen; 148 (9.9%) with knee OA were analyzed. Mean age was 56.9 ± 10.7 years, 75% were females, and 68% were post-menopausal. The VAS of pain at the time of diagnosis was higher than 50/100 mm in 64.2% of patients. Mean pain duration was 1 year (7 months-3.5 years). Obesity (BMI > 30) was present in 52% of patients, hypertension in 37.2%, and diabetes in 8.8%. Knee x-ray showed 35.5% of patients with grades III and IV on Kellgren and Lawrence classification. Bilateral bi-compartmental knee OA was found in 38.5% of patients and bilateral tricompartmental in 14.2%. The mean Lequesne disability index (LDI) was 8.4 ± 2.8. Pain intensity did not correlate with radiological findings whereas there was an association between pain and LDI. Knee OA is not rare among patients in Cameroon. Multiple factors including limited access to health care may account for why knee OA patients present at later stages of the disease with severe disability.

The way forward for clinical research in Cameroon: first scientific and research day in Douala, 2014.

There is a huge need for health research to support contextually relevant health service and policy solutions to better the health of populations in sub-Saharan Africa. This need contrasts with the very timid engagement of healthcare practitioners in research in the region.It is against this background that the Douala General Hospital (a tertiary-care hospital in Cameroon), under the stewardship of its chief executive officer, organised the first annual scientific and research day in October 2014. This maiden event saw the participation of local research leaders and the eminent director of the South African Hatter Institute for Cardiovascular Research in Africa, who co-chaired the event. The aim was to educate students, clinicians and junior researchers on the importance of clinical research and evidence-based medicine around the leading theme of the event: action for clinical research and good medical practice.Several abstracts were presented, covering various aspects of medicine, including cardiology, rheumatology, paediatrics, pulmonology, HIV medicine, and obstetrics and gynaecology, together with key lectures on cardiac disease and pregnancy, and plenary sessions on research methodology, scientific writing and publishing. It is hoped that this event will enhance clinical research and the dissemination of research findings to improve evidence-based clinical practice in the country.