Factors associated with hepatitis B and C among adults in Buea, Cameroon: A community-based cross-sectional study.

INTRODUCTION: Viral hepatitis is a major cause of death in Africa. A paucity of community-based studies on the determinants of viral hepatitis in Africa impedes efforts to appropriately target prevention, screening, and treatment interventions. We assessed factors associated with hepatitis B virus (HBV) and hepatitis C virus (HCV) in a semi-urban health district in Cameroon. METHODS: We conducted a community-based, cross-sectional study from 28 February to 15 May 2021 in the Buea Health District in Buea, Cameroon. We recruited a sample of consenting individuals aged over 15 years old. Participants were surveyed for factors associated with HBV/HCV and were screened for HBV surface antigen (HBsAg) and HCV antibody using rapid point-of-care tests. We performed univariable and multivariable logistic regression analyses to identify factors associated with HBsAg and HCV seropositivity. RESULTS: We screened 1144 participants (66% female) with a median age of 30 years (IQR: 23-44). HBsAg prevalence was 5.7% (95%CI: 4.5-7.2%) and HCV seropositivity was 1.9% (95%CI: 1.3-2.9%). Three people (0.3%) were seropositive for both HBsAg and HCV antibody. Male sex (adjusted OR [aOR] = 2.31; 95%CI: 1.28-4.18) and a history of traditional operation or scarification (aOR = 2.87; 95%CI: 1.67-4.92) were associated with HBsAg. None of the assessed factors was significantly associated with HCV antibody. CONCLUSION: Men and participants with a history of traditional operation and scarification had higher odds of HBsAg. We did not observe any associations with HCV seropositivity. Prevention and screening efforts among adults in this setting should prioritize men and those with a history of traditional operation and scarification.

Impact of Routine Cryptococcal Antigen Screening and Targeted Preemptive Fluconazole Therapy in Antiretroviral-naive Human Immunodeficiency Virus-infected Adults With CD4 Cell Counts <100/µL: A Systematic Review and Meta-analysis.

Cryptococcal antigen (CrAg) screening and targeted preemptive fluconazole in antiretroviral-naive human immunodeficiency virus-infected adults with CD4 cell counts <100/µL seems promising as a strategy to reduce the burden of cryptococcal meningitis (CM). We searched MEDLINE, EMBASE, and Web of Science and used random-effect meta-analysis to assess the prevalence of blood CrAg positivity (31 studies; 35644 participants) and asymptomatic CM in CrAg-positive participants and the incidence of CM and the all-cause mortality rate in screened participants. The pooled prevalence of blood CrAg-positivity was 6% (95% confidence interval [CI], 5%-7%), and the prevalence of asymptomatic CM in CrAg-positive participants was 33% (95% CI, 21%-45%). The incidence of CM was 21.4% (95% CI, 11.6%-34.4%) without preemptive fluconazole and 5.7% (95% CI, 3.0%-9.7%) with preemptive fluconazole therapy initiated at 800 mg/d. In CrAg-positive participants, postscreening lumbar puncture before initiating preemptive fluconazole at 800 mg/d further reduced the incidence of CM to null and showed some survival benefits. However, the all-cause mortality rate remained significantly higher in CrAg-positive than in CrAg-negative participants (risk ratio, 2.2; 95% CI, 1.7-2.9; P < .001).

Hepatitis C Continuum of Care in a Treatment Center in Sub-Saharan Africa.

BACKGROUND: Hepatitis C virus (HCV) infection is a major public health challenge in Cameroon with over three million people infected. Government efforts to improve care and treatment are unsatisfactory and need to be assessed. We aimed at studying the several steps along the HCV continuum of care in one of two hepatitis treatment centers in Cameroon. METHODS: We undertook a retrospective chart review of anti-HCV positive individuals, who attended the Douala general hospital between 2008 and 2015. We defined the HCV treatment cascade as follows: step 1-HCV RNA testing, step 2-complete pre-therapeutic evaluation (genotyping and liver fibrosis markers), step 3-initiation of treatment, step 4-treatment completion, and step 5-sustained virological response (SRV). Each successive step in the HCV care continuum was dependent on passing through the previous step. RESULTS: The mean age of the 669 anti-HCV antibody positive individuals was 57 (sd: ±13) years. Females were 52.8% of the study population. 410 (61.3%) were tested for HCV RNA. Three hundred and sixty-six (54.7%) were confirmed to have viral replication (HCV RNA positive). One hundred and eighty (26.9%) did a complete pre-therapeutic evaluation (both HCV genotyping and liver fibrosis assessment included). Eighty-one (12.1%) initiated treatment with pegylated interferon/ribavirin. Seventy-two (10.8%) completed treatment and 44 (6.6%) had SVR. Sociodemographic characteristics including age, gender, marital status, having medical insurance, and profession were associated with attaining later steps in the care cascade. CONCLUSION: This study shows that HCV continuum of care and treatment is less optimal at the Douala general hospital and is highly impacted by socio-economic factors. Continued efforts are needed to improve HCV care.

Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction.

Acute aortic dissection is the most frequent and deadly presentation of acute aortic syndromes. Its incidence is estimated at three to four cases per 100 000 persons per year. Its clinical presentation may be misleading, with misdiagnosis ranging between 14.1 and 38% in many series. A late diagnosis or absence of early and appropriate management is associated with mortality rates as high as 50 and 80% by the third day and second week, respectively, especially in proximal lesions. We report on the case of a 53-year-old man who presented with type A aortic dissection, misdiagnosed as acute myocardial infarction, who later died on day 12 of hospitalisation. Although a relatively rare condition, poor awareness in Africa probably accounted for the initial misdiagnosis. Thorough investigation of acute chest pain and initiation of clinical registries are potential avenues to curb related morbidity and mortality.

Prevalence and Characteristics of Hepatitis Delta Virus Infection in a Tertiary Hospital Setting in Cameroon.

BACKGROUND/AIMS: Hepatitis B virus (HBV) and hepatitis D virus (HDV) coinfection is associated with more severe liver disease than HBV alone. More knowledge on the epidemiology and clinical impact of HDV-infected individuals is needed in Cameroon.We aimed at determining the frequency of anti-HDV antibody testing in hepatitis B surface antigen (HBsAg) positive patients, the proportion of anti-HDV positivity, and the characteristics of anti-HDV positive compared to anti-HDV negative patients in a tertiary hospital setting in Cameroon. METHODS: A cross-sectional study was conducted. Clinical records of chronic HBV-infected patients attending the gastroenterology unit at the Douala General Hospital from 2010 to 2014 were reviewed. RESULTS: Of 365 files of HBsAg-positive patients defined as chronic HBV infection, 80.5% (294) were tested for anti-HDV antibodies, among whom 10.5% (31/294) were positive. Median aspartate aminotransferase (P < 0.0001), alanine aminotransferase (P < 0.0001), and gamma glutaryl transpeptidase (P < 0.0001) were significantly higher while platelets count (P < 0.002) and prothrombin time (P < 0.0001) were significantly lower in anti-HDV positive compared to anti-HDV negative patients. Liver necroinflammation (P < 0.0001), fibrosis score (P < 0.0001), and decompensated cirrhosis (P < 0.0001) were also significantly associated with anti-HDV positivity. CONCLUSION: The proportion of anti-HDV antibody positivity remains high in this setting and was significantly associated with more severe liver disease compared to those who were anti-HDV negative. More studies are needed to evaluate rates of HDV testing in other centers in Cameroon and the subregion. Preventive strategies for HBV prevention, which also apply to HDV, must still be reinforced by healthcare providers and policy makers.

Serum Uric Acid Is Associated with Poor Outcome in Black Africans in the Acute Phase of Stroke.

BACKGROUND: Prognostic significance of serum uric acid (SUA) in acute stroke still remains controversial. OBJECTIVES: To determine the prevalence of hyperuricemia and its association with outcome of stroke patients in the Douala General Hospital (DGH). METHODS: This was a hospital based prospective cohort study which included acute stroke patients with baseline SUA levels and 3-month poststroke follow-up data. Associations between high SUA levels and stroke outcomes were analyzed using multiple logistic regression and survival analysis (Cox regression and Kaplan-Meier). RESULTS: A total of 701 acute stroke patients were included and the prevalence of hyperuricemia was 46.6% with a mean SUA level of 68.625 ± 24 mg/l. Elevated SUA after stroke was associated with death (OR = 2.067; 95% CI: 1.449-2.950; p < 0.001) but did not predict this issue. However, an independent association between increasing SUA concentration and mortality was noted in a Cox proportional hazards regression model (adjusted HR = 1.740; 95% CI: 1.305-2.320; p < 0.001). Furthermore, hyperuricemia was an independent predictor of poor functional outcome within 3 months after stroke (OR = 2.482; 95% CI: 1.399-4.404; p = 0.002). CONCLUSION: The prevalence of hyperuricemia in black African stroke patients is quite high and still remains a predictor of poor outcome.

Cross-sectional assessment of three commonly used measures of adherence to combination antiviral therapy in a resource limited setting.

Nowadays, global coverage of combination antiretroviral therapy (cART) has increased due to a continuous process to scale up access. This increase has potentially transformed HIV-infection from a fatal to a chronic disease: a transformation only possible if the prescribed medications are taken accordingly. We therefore evaluated optimal adherence to cART by three commonly used methods: visual analogue scale (VAS), four days recall (FDR) and clinic attendance (CA) for the last six months in 301 HIV-infected patients on cART for at least six months at the Douala General Hospital, Cameroon. Optimal adherence was defined to be greater than or equal to the 95th percentile estimate of each method. We found that 70.8% of our study population was female. The mean age was 40.8 years (SD 10.5) and 85% were on first line cART. Median CD4 count was 397 cells/ml (252-559). Optimal adherence by VAS, FDR and CA, was 68.1%, 83.4%, and 73.4%, respectively. VAS and FDR inter-correlated strongly (Pearson's Chi square coefficient, r = 0.58, p < 0.001). Higher CD4 count above 200 cells/ml was associated with optimal adherence by CA (Adjusted Odds Ratio [AOR]:2.6 (95% CI: 1.2-5.3, p < 0.001)). As high optimal adherence to cART is associated with good clinical outcome in HIV patients, simple methods such as the VAS for evaluating adherence, should be integrated to the HIV clinic of the Douala General Hospital.

Hyperuricaemia in patients with type 2 diabetes in a tertiary healthcare centre in sub-Saharan Africa: prevalence and determinants.

Hyperuricaemia in type 2 diabetes mellitus (T2DM) has been less well investigated in sub-Saharan Africans. Our study of 438 patients found that alcohol intake, body mass index ≥25 kg/m2, hydrochlorothiazide use, statin use, diabetic retinopathy and glomerular filtration rate <60 mL/min/1.73m2 were independently positively associated with hyperuricaemia; whereas smoking reduced this risk. Hyperuricaemia is strongly associated with some modifiable factors, diabetic complications and certain drugs. Our results suggest that further studies should evaluate the potential cost-benefit of screening for hyperuricaemia in type 2 diabetes.

The changing epidemiology of hepatitis C virus infection in the United States: National Health and Nutrition Examination Survey 2001 through 2010.

BACKGROUND & AIMS: In light of the dramatically changing hepatitis C therapeutic landscape, knowledge of the current burden of HCV infection in the general population of the United States is critical. METHODS: The National Health and Nutrition Examination survey collects nationally representative data on HCV infection in the civilian population of the United States. Data from 2001 to 2010 were combined for this study. HCV testing was completed in 38,025 participants. RESULTS: The prevalence of anti-HCV in the United Sates decreased from 1.9% (95% CI 1.5%-2.5%) in 2001-2002 to 1.3% (95% CI 0.9%-1.8%) in 2005-2006, and remained stable up to 2010. About 67% of all infected persons were positive for HCV RNA, indicating 2.3 million people with chronic HCV infection, of whom 68% have genotype 1. Seventy percent of infected persons were born between 1945 and 1965, with prevalence of 3.5% (95% CI 2.2%-4.8%). The stable rate since 2006 is mostly related to prevalent cases and foreign born persons migrating into US. Other important risk factors include less education and low economic status. Race, HIV status, number of sexual partners, and blood transfusions are no longer associated with HCV infection. CONCLUSIONS: As of 2010, approximately 2.3 million persons were chronically infected with Hepatitis C in the US. Most of those infected are prevalent, rather than incident cases. The prevalence of HCV was on the decline, but has stabilized since 2006. Future studies should explore reasons for no decline in HCV prevalence since 2006.

Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005-2010.

BACKGROUND & AIMS: We investigated the prevalence of and trends and risk factors for fecal incontinence (FI) in the United States among non-institutionalized adults from 2005 to 2010. METHODS: We analyzed data from 14,759 participants in the U.S. National Health and Nutrition Examination Survey (49% women, 20 years or older) from 2005 to 2010 (the FI Severity Index was added in 2005-2006). FI was defined as accidental leakage of solid or liquid stool or mucus at least once in preceding month. Sampling weights were used to obtain estimates for the national population. Logistic regression was used to identify risk factors for FI. RESULTS: The prevalence of FI among non-institutionalized U.S. adults was 8.39% (95% confidence interval, 7.76-9.05). It was stable throughout the study period: 8.26% in 2005-2006, 8.48% in 2007-2008, and 8.41% in 2009-2010. FI resulted in release of liquid stool in most cases (6.16%). Prevalence increased with age from 2.91% among 20- to 29-year-old participants to 16.16% (14.15%-18.39%) among participants 70 years and older. Independent risk factors for FI included older age, diabetes mellitus, urinary incontinence, frequent and loose stools, and multiple chronic illnesses. FI was more common among women only when they had urinary incontinence. CONCLUSIONS: FI is a common problem among non-institutionalized U.S. adults. Its prevalence remained stable from 2005-2010. Diabetes mellitus and chronic diarrhea are modifiable risk factors. Future studies on risk factors for FI should assess for presence of urinary incontinence.

Helicobacter pylori isolates recovered from gastric biopsies of patients with gastro-duodenal pathologies in Cameroon: current status of antibiogram.

OBJECTIVE: To determine the prevalence of Helicobacter pylori in patients with gastro-duodenal pathologies and the susceptibility patterns of isolates to the currently recommended antibiotic treatment regimen used in Cameroon. METHODS: Consecutive dyspeptic patients referred to Douala General Hospital, Cameroon for endoscopy were recruited in the study. Gastric biopsies were collected from the patients and H. pylori isolated and identified following standard microbiology and biochemical techniques. Antibiotic susceptibility was determined by disk diffusion and agar dilution methods against clarithromycin, tetracycline, amoxicillin and metronidazole. Data were analysed using chi-square test and significance considered at P < 0.05. RESULTS: Seventy-one (92.2%) of the 77 patients (mean age 44.5 +/- 15.7, range 15-77 years) were positive for H. pylori. The antibiotic susceptibility rates were 56% for tetracycline, 55.3% for clarithromycin, 14.4% for amoxicillin and 6.8% for metronidazole. The prevalence of clarithromycin resistance in males vs. females was 42.1%vs. 46.7%, while for metronidazole it was 89.5%vs. 94.7% (P > 0.05). Antimicrobial susceptibility results also revealed 12 antibiotypes based on resistance to the antimicrobial agents investigated. The resistance pattern, amoxicillin and metronidazole (AMR(R) MET(R)) was the most common (23.7%) amongst the isolates. More than 60% of the isolates exhibited multi-drug resistance to three or four antibiotics. CONCLUSION: Multi-drug resistance is common against the current treatment regimen in Cameroon and, therefore, calls for urgent studies involving newer and broad spectrum antibiotics to address the problem.

In vitro anti-Helicobacter pylori activity of extracts of selected medicinal plants from North West Cameroon.

ETHNOPHARMACOLOGICAL RELEVANCE: Helicobacter pylori, a gram negative microaerophilic bacterium is a major etiological agent in duodenal, peptic and gastric ulcers. The growing problem of antibiotic resistance by the organism demands the search for novel compounds from plant based sources. AIM OF STUDY: The present study is aimed at evaluating the antimicrobial activity of some selected medicinal plants on clinical isolates of H. pylori circulating in Cameroon in a bid to identify potential sources of cheap starting materials for the synthesis of new drugs. MATERIALS AND METHODS: Gastric biopsy samples were obtained from patients presenting with gastroduodenal complications. H. pylori was isolated from the specimens following standard microbiology procedures. The disk diffusion method was used to determine the susceptibility of 15 isolates to ten methanol plant extracts (Ageratum conyzoides, Scleria striatinux, Lycopodium cernua, Acanthus montanus, Eryngium foetidium, Aulutandria kamerunensis, Tapeinachilus ananassae, Euphorbia hirta, Emilia coccinea and Scleria verrucosa). The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for the most active plant extracts were also determined by the agar dilution method. Results were analyzed statistically by the Fisher's exact test. RESULTS: All the plants tested demonstrated antimicrobial activity with zone diameters of inhibition ranging from 0-30mm. Of these, A. conyzoides, S. striatinux and L. cernua showed very potent antibacterial activity on the isolates. The lowest MIC and MBC recorded were 0.032mg/mL and 0.098mg/mL respectively. However, the MIC of the extracts ranged from 0.032-1.0mg/mL for S. striatinux; 0.063-0.5mg/mL for L. cernua and 0.063-1.0mg/mL for A. conyzoides. The MBC of the extracts ranged from 0.098-15.0mg/mL for S. striatinux; 0.098-12.5mg/mL for A. conyzoides, and 0.195-12.5mg/mL for L. cernua. The extracts had a wide spectrum of activity. The three most potent extracts possessed significant (P<0.05) inhibitory activities. CONCLUSION: The plant extracts may contain compounds with therapeutic activity.

In-vitro antimicrobial activity of selected honeys on clinical isolates of Helicobacter pylori.

BACKGROUND: Helicobacter pylori is a gram-negative bacterium incriminated in gastroduodenal ulcers, and mucosa-associated lymphoid tissue lymphoma imposing a major burden on health care systems worldwide. Honeys have been shown to have in vitro activity against microorganisms and suitable for use in ulcers, infected wounds and burns. OBJECTIVE: The study was aimed at evaluating the antimicrobial potential of honeys (Manuka™, Capillano®, Eco- and Mountain) at different concentrations (10%v/v, 20%v/v, 50%v/v and 75%v/v) against clinical isolates of H. pylori. METHODS: H. pylori was isolated from gastric biopsies of patients with gastroduodenal pathologies following standard microbiological procedures. Antimicrobial susceptibility of the isolates to different honey varieties was determined by the disk diffusion assay. Also, the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the most potent honey was determined by the agar dilution method. Data were analysed using the Fisher exact test and statistical significance considered at p<0.05. RESULTS: All the four honey varieties exhibited antibacterial activity. The strongest inhibitory activity (82.22%) was demonstrated by Mountain honey at 75%v/v, followed by Capillano® and Manuka™ honeys (75.56%), and Eco-honey (73.36%) at the same concentration. However, no statistically significant difference (p>0.05) was noted between the honeys at different concentrations. The MIC and MBC concentrations of Mountain honey were in the range 0.117 - 0.938ì/mL and 0.366 - 2.965ìg/mL respectively. The antimicrobial potential of these honeys at different concentrations were highly comparable to clarithromycin, the positive control. CONCLUSION: These honeys may contain compounds with therapeutic potential against our local isolates of H. pylori.