Gender disparities in pulmonary hypertension at a tertiary centre in Cameroon

Background. Pulmonary hypertension (PH) is a potent cause of heart failure and has been little investigated in the African setting. Objective. To investigate the effects of gender on the clinical presentation, echocardiographic features and outcomes of patients with PH in Douala, Cameroon. Methods. A prospective cohort study was conducted from March 2012 to December 2013 as part of the Pan African Pulmonary Hypertension Cohort study. PH was diagnosed by echocardiography and defined as a right ventricular systolic pressure >35 mmHg in the absence of acute right heart failure. Patients were followed up for a maximum of 12 months for primary endpoint mortality. Results. In total, 130 patients with PH were recruited; 71 (54.6%) were women. The median age was 59.2 years for men and 58.3 years for women (p=0.76). Active smoking and alcohol use were more frequent in men than women (both p<0.001), but women had greater exposure to indoor cooking fumes than men (p<0.001). Previous tuberculosis infection (11.3% v. 1.7%) and S3 gallop rhythm (30.9% v. 11.9%) were more common in women (both p<0.03). Women had a significantly higher mean systolic blood pressure (134 mmHg v. 125 mmHg; p=0.04) and pulse pressure (53.8 mmHg v. 44.9 mmHg; p=0.01) and a lower mean haemoglobin concentration (10.4 g/dL v. 12.4 g/dL; p<0.05) compared with men. Echocardiographic left ventricular (LV) systolic dysfunction was more frequent in men: mean LV ejection fraction 42.6% v. 51.5% (p=0.01) and mean fractional shortening 21.4% v. 28.6% (p=0.01). The overall mortality rate was 20.3%, and rates were similar in the two groups (Kaplan-Meier log rank 1.1; p=0.30). Conclusions. Despite differences in baseline characteristics including cardiovascular risk factors, mortality rates on follow-up were similar in men and women in this study. However, these different baseline characteristics probably suggest differences in the pathogenesis of PH in men and women in our setting that need further investigation.S Afr Med J 2017;107(10):892-89

A Template-Dependent Dislocation Mechanism Potentiates K65R Reverse Transcriptase Mutation Development in Subtype C Variants of HIV-1

Numerous studies have suggested that the K65R reverse transcriptase (RT) mutation develops more readily in subtype C than subtype B HIV-1. We recently showed that this discrepancy lies partly in the subtype C template coding sequence that predisposes RT to pause at the site of K65R mutagenesis. However, the mechanism underlying this observation and the elevated rates of K65R development remained unknown. Here, we report that DNA synthesis performed with subtype C templates consistently produced more K65R-containing transcripts than subtype B templates, regardless of the subtype-origin of the RT enzymes employed. These findings confirm that the mechanism involved is template-specific and RT-independent. In addition, a pattern of DNA synthesis characteristic of site-specific primer/template slippage and dislocation was only observed with the subtype C sequence. Analysis of RNA secondary structure suggested that the latter was unlikely to impact on K65R development between subtypes and that Streisinger strand slippage during DNA synthesis at the homopolymeric nucleotide stretch of the subtype C K65 region might occur, resulting in misalignment of the primer and template. Consequently, slippage would lead to a deletion of the middle adenine of codon K65 and the production of a -1 frameshift mutation, which upon dislocation and realignment of the primer and template, would lead to development of the K65R mutation. These findings provide additional mechanistic evidence for the facilitated development of the K65R mutation in subtype C HIV-1

Evolving uses of oral reverse transcriptase inhibitors in the HIV-1 epidemic: From treatment to prevention

The HIV epidemic continues unabated, with no highly effective vaccine and no cure. Each new infection has significant economic, social and human costs and prevention efforts are now as great a priority as global antiretroviral therapy (ART) scale up. Reverse transcriptase inhibitors, the first licensed class of ART, have been at the forefront of treatment and prevention of mother to child transmission over the past two decades. Now, their use in adult prevention is being

Traitement chirurgical du spondylolisthésis lombaire à Douala. A propos de 25 cas

Le but de ce travail était de préciser les résultats du traitement chirurgical des cas de spondylolisthésis réfractaires au traitement conservatoire à l’Hôpital Général de Douala. Il s’agissait d’une étude prospective qui s’est déroulée au service de chirurgie de l’Hôpital Général de Douala du mois d’avril 2007 au mois d’avril 2012. Etaient inclus vingt-cinq patients  présentant une sciatique paralysante sur spondylolisthésis réfractaire au traitement médical après 12 semaines au moins de suivi. L’intensité de la douleur était évaluée par l’échelle visuelle analogique (EVA), alors que l’incapacité fonctionnelle était évaluée par l’échelle fonctionnelle  d’OSWESTRY. Tous les patients ont bénéficié d’une laminectomie suivie d’arthrodèse. La réduction de la douleur était significative à l’EVA dès le troisième mois après la chirurgie (P< 0.001). De même l’amélioration de l’incapacité fonctionnelle était significative à partir du troisième mois après la chirurgie. Deux patients ont été ré-opérés pour repositionnement des vis pédiculaires. La chirurgie du spondylolisthésis associant la décompression  et l’arthrodèse est une option thérapeutique efficace après l’échec au traitement conservateur.Mots clés : Spondylolisthésis lombaire, laminectomie, arthrodèse. The aim of this study was to determine the outcome of surgical treatment of spondylolisthesis cases refractory to conservative treatment in Douala General Hospital. This was a prospective study which took place in the  surgical department of the Douala General Hospital from April 2007 to April 2012. Were included twenty five patients with paralytic sciatica  spondylolisthesis in medically refractory after at least 12 weeks of follow-up .The intensity of pain was evaluated by visual analogue scale (VAS), whilefunctional disability was assessed functional scale OSWESTRY. All patients underwent laminectomy followed by arthrodesis. Reduction of pain by visual analogue scale was significant from the third month post-surgery  (P<0.001).The functional disability assessed by the OSWESTRY scale also improved from third month post-surgery (P< 0.001).Two patients were re-operated for repositioning of pedicle screw. Surgery of spondylolisthesis involving decompression and fusion is an effective treatment option after failed conservative treatment.Keywords: lumbar spondylolisthesis, laminectomy,fusion

The antiphospholipid antibody syndrome: a case report

Henry Namme Luma,1,2 Marie-Solange Doualla,1,2 Elvis Temfack,1 Servais Albert Fiacre Eloumou Bagnaka,1 Emmanuella Wankie Mankaa,3 Dobgima Fofung41Department of Internal Medicine, Douala General Hospital, Douala, Cameroon; 2Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; 3Department of Radiology, Douala General Hospital Douala, Cameroon; 4Department of Abdominal Surgery, Daniel Muna Memorial Clinic, Douala, CameroonAbstract: Antiphospholipid antibody syndrome is defined by the presence of thromboembolic complications and/or pregnancy morbidity in the presence of persistently increased titers of antiphospholipid antibodies. Its clinical presentation can be diverse and any organ can be involved, with a current impact in most surgical and medical specialties. The authors present the case of a 43-year-old man who, over a 13-year period of follow-up, presented with thrombosis of the mesenteric vein, inferior vena cava, and axillary and subclavian veins in a setting where diagnostic and therapeutic options are limited and costly. Through this case report, the authors aim to describe the evolution of this complex pathology, which to date has not been described in the authors' milieu – probably because of its challenging diagnosis and the limited treatment options available. The authors conclude that clinicians need to have a high index of suspicion of APS in patients who present with a thrombotic episode – clinicians should investigate for the presence of antiphospholipid antibodies, as early diagnosis may influence the course of the disease. Furthermore, resources for the detection of antiphospholipid antibodies should be made readily available in resource-limited settings. Finally, patient education on the importance of drug compliance, periodic monitoring, and prevention of thrombosis is indispensable, especially as mortality could be associated with the effects of vascular thrombosis and/or the effects of bleeding due to anticoagulants.Keywords: thrombosis, mesenteric venous thrombosis, anticardiolipin antibodies, Budd-Chiari syndrome, Cameroo

The clinical features and outcome of patients admitted with acute upper gastrointestinal bleeding in the General Hospital Douala, Cameroon: a cross sectional analysis

L’hémorragie digestive haute (HDH) est une urgence médico-chirurgicale avec un taux de mortalité élevé dans le monde. Le diagnostic exact et une prise en charge efficace bien que les moyens technique soient limités sont des facteurs de bonne évolution. Le but de notre étude était la description clinique et l’évolution des patients admis  pour hémorragie digestive haute dans un hôpital de référence à Douala au Cameroun. Nous avons mené une étude transversale portant sur les dossiers de patients admis pour hémorragie digestive haute à l’hôpital général de Douala entre janvier 2008 et décembre 2011. L’objectif général de cette étude était de déterminer le taux de mortalité et plus spécifiquement la durée moyenne d’hospitalisation, le nombre d’unité de sang transfusé, la récidive hémorragique et l’indication chirurgicale chez les patients  hospitalisés pour hémorragie digestive haute. Un total de 80 dossiers avait été colligé. La moyenne d’âge était de 53,5 ans ± 18,2. Le sexe masculin  représentait 73,7% de la population. L’extériorisation les plus retrouvées étaient l’hématémèse et le méléna chez 65% des patients. Les comorbidités associées à l’hémorragie digestive haute représentaient 43% dont les plus fréquentes étaient le diabète, l’hypertension artérielle et la cirrhose. Les patients en état de choc à l’admission avaient respectivement une hypotension dans 52,5% des cas et une hémoglobine inférieure à 7 g/dl dans 48,8% des cas. L’ulcère était l’étiologie la plus fréquente avec 57,7%. Le saignement par rupture des varices  oesophagiennes était retrouvé dans 11,3% des cas et l’évolution était défavorable causant 80% de tous les décès, 66,7% de récidive hémorragique, une durée moyenne d’hospitalisation plus longue de 8,1 jours. De façon général, la mortalité et la récidive hémorragique représentait respectivement 6,3% et 3,8% des cas ; aucun patient n’avait reçu un traitement chirurgical. L’hémorragie digestive haute est une cause majeure de morbimortalité dans notre milieu. L’ulcère est la cause la plus fréquemment retrouvée, mais l’étiologie associée à une évolution défavorable est le saignement par varice oesophagienne. L’indication chirurgicale est rare dans l’hémorragie digestive haute dans notre milieu.Mots clés : hémorragie- digestive- haute, endoscopie,résultat

Prevalence and risk factors of peripheral artery disease in black Africans with HIV infection: a cross-sectional hospital-based study

Félicité Kamdem,1,2 Yacouba Mapoure,1,2 Ba Hamadou,3 Fanny Souksouna,2 Marie Solange Doualla,1,3 Ahmadou Musa Jingi,3 Caroline Kenmegne,1 Fernando Kemta Lekpa,1,4 Jaff Kweban Fenkeu,1 Gisèle Imandy,5 Jean Pierre Nda Mefo’o,2,5 Henry Luma1,3 1Internal Medicine Service, Douala General Hospital, Douala, Cameroon; 2Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; 3Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon; 4Faculty of Health Sciences, University of Buea, Buea, Cameroon; 5Chemical Pathology Laboratory, Douala General Hospital, Douala, Cameroon Background: The prevalence of peripheral artery disease (PAD) is not well known among HIV-infected patients in Africa. The aim of this study was to determine the prevalence and associated risk factors of PAD among HIV-infected patients at the Douala General Hospital (DGH).Methods: This was a cross-sectional descriptive and analytic study between November 2015 and April 2016. We recruited patients aged ≥21 years, diagnosed with HIV infection, and who were receiving care at the DGH. We collected sociodemographic data and past medical history of patients. We measured their ankle-brachial index (ABI). We defined PAD as an ABI <0.9. We also measured their fasting blood glucose and lipid profile.Results: We recruited 144 patients for this study. The mean age was 46±9 years, and 72.2% were females. Of which, 89% were on antiretroviral treatment (ARV). Their mean CD4+ T lymphocytes count was 451±306 cells/mm3. Their mean ABI was 1.12±0.17 and 1.07±0.11, respectively, on the left and right legs (P>0.05). The prevalence of PAD was 6.9% (95% CI: 3.4–12.4), and 60% of patients with PAD were symptomatic. After adjusting for age, sex and ARV, ARV treatment was protective (aOR: 0.18, [95% CI: 0.04–0.82], P=0.034), while WHO stages III or IV was associated with PAD (aOR: 11.1, [95% CI: 2.19–55.92], P=0.004).Conclusion: The prevalence of PAD was not as high as expected in this group of patients with high cardiovascular risk infected with HIV. Advanced HIV disease was associated with PAD, while ARV was protective. Keywords: HIV, peripheral artery disease, prevalence, risk factors, Afric