Adverse drug reactions of Highly Active Antiretroviral Therapy (HAART) in HIV infected patients at the General Hospital, Douala, Cameroon: A cross sectional study

Background: The use of highly active antiretroviral therapy (HAART) as the main option for management of people living with Human Immunedeficiency virus (HIV) is associated with decrease morbidity and mortality. This is due to its effectiveness in inhibiting viral replication. However thiseffectiveness is not without adverse drug effects which in many settings are not monitored. Methods: A cross sectional clinical chart review ofadult Cameroonian patients on HAART between 2003 and 2009 at the Douala General Hospital was done in search of reported HAART-associatedAdverse Drug effects (ADRs). The prevalence of ADR defined as the proportion of the study population with ADR was determined and stratified by age, sex, weight and HAART regimen.Results: Sixty-six (19.5%) of the 339 patients on HAART reported ADRs. Among those who reported ADRs, 29.6% were on D4T-3TC-EFV, 29.3% on D4T-3TC-NVP, 16% on AZT-3TC-EFV and 10.8% on AZT-3TC-NVP. Peripheral Neuropathy was the most common ADR and represented 21.2% of all ADRs. Patients on D4T containing regimens were more likely to develop ADR (OR = 3.5, 95% CI 1.5 –9.8, p<0.01) and 56.1% of all ADRs were associated to D4T. Hospital admissions were for patients with severe anaemia, no fatal cases of ADRs were recorded. Conclusion: HAART-associated ADRs are common and therefore should be actively looked for by caregivers so as to ameliorate the quality of life of HIV patients on treatment.Key words: Adverse drug reaction, HAART, HI

Impact of routine cryptococcal antigen screening and targeted pre-emptive fluconazole therapy in antiretroviral naive HIV-infected adults with less than 100 CD4 cells/μL: a systematic review and meta-analysis.

Cryptococcal antigen (CrAg) screening and targeted pre-emptive fluconazole in antiretroviral naive HIV-infected adults with less than 100 CD4 cells/μL seems promising 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; 35,644 participants) and asymptomatic CM in CrAg-positives, incidence of CM and all-cause mortality in screened participants. Pooled prevalence of blood CrAg-positivity was 6% (95%CI: 5 - 7) and asymptomatic CM in CrAg-positives was 33% (95%CI: 21 - 45). Incidence of CM without pre-emptive fluconazole was 21.4% (95%CI: 11.6 - 34.4) and 5.7% (95%CI: 3.0 - 9.7) with pre-emptive fluconazole initiated at 800 mg/day. In CrAg-positives, post-screening lumbar puncture prior to initiating pre-emptive fluconazole at 800 mg/day further reduced incidence of CM to null and showed some survival benefits. However, all-cause mortality remained significantly higher in CrAg-positives than CrAg-negatives: RR: 2.2 (95%CI: 1.7 - 2.9, p<0.001)

In vitro anti-Helicobacter pylori activity of Lycopodium cernuum (Linn) Pic. Serm

Helicobacter pylori, a gram negative microaerophilic bacterium is a major etiological agent in duodenal, peptic and gastric ulcers. In this study, gastric biopsy samples were obtained from patients presentingwith gastroduodenal complications. H. pylori was isolated from the specimens following standard microbiology procedures, and isolates subjected to pure fractions of Lycopodium cernuum extracts forantimicrobial assays. Extracts were fractionated by partition chromatography with solvents of increasing polarity to obtain pure fractions. The disk diffusion method was used to determine thesusceptibility of 15 strains of H. pylori to the fractions. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for the most active fraction was also determined by thebroth dilution method. Results were analyzed by the Fisher’s exact test. All the fractions tested demonstrated antimicrobial activity with zone diameters of inhibition between 0 - 30 mm. Of the 5 fractions obtained, the hexane (Hex) fraction was the most active. The lowest MIC and MBC recorded for the hexane (Hex) fraction were 0.016 and 0.125 mg/mL, respectively. There was no statistically significant difference (P>0.05) in the potency of the fraction on the different bacterial strains tested, both for the MIC and MBC. It is concluded that this plant may contain compounds with therapeutic activity, which may be found in the Hex fraction (100%)

Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis.

INTRODUCTION: HIV-associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub-Saharan Africa (SSA). We performed a systematic review and meta-analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings. METHODS: We searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized-controlled trials (RCTs) or investigator-managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short-term (in-hospital or two weeks), medium-term (up to 10 weeks) and long-term (up to six months). RESULTS AND DISCUSSION: Seventy-nine studies met inclusion criteria. In routine care settings, pooled short-term mortality from cryptococcal meningitis was 44% (95% confidence interval (95% CI):39% to 49%, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole-based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21% (95% CI:17% to 25%), 17 studies). Pooled short-term mortality of TB meningitis was 46% (95% CI: 33% to 59%, 11 studies, all routine care). For pneumococcal meningitis, pooled short-term mortality was 54% in routine care settings (95% CI:44% to 64%, nine studies), with similar mortality reported in two included randomized-controlled trials. Few studies evaluated long-term outcomes. CONCLUSIONS: Mortality rates from HIV-associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV-associated meningitis in the region

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 Yaound&amp;eacute; I, Yaound&amp;eacute;, 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&amp;#39; milieu &amp;ndash; 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 &amp;ndash; 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