Thrombocytose au cours d’un syndrome d’activation macrophagique compliquant un lupus érythémateux systémique

Le syndrome d'activation macrophagique (SAM) est une complication du lupus érythémateux systémique  (LES), due à l'activation et la prolifération incontrôlée des macrophages dans la moelle osseuse. La  bycytopénie voire la pancytopénie est constante. Nous rapportons un cas atypique de SAM diagnostiqué au même moment qu'un LES chez une patiente noire de 17 ans. Le tableau initial associait une fièvre, un  syndrome inflammatoire, une anémie, un taux normal de leucocytes et plus surprenant, une thrombocytose.Key words: Syndrome d´activation macrophagique, Lupus érythémateux systémique, Cytopénie, Thrombocytose, Afrique Subsaharienn

Refractory relapsing polychondritis: challenges and solutions

Fernando Kemta Lekpa,1,2 Xavier Chevalier3 1Faculty of Health Sciences, University of Buea, Buea, 2Reheumatology Unit, Internal Medicine Department, General Hospital, Douala, Cameroon; 3Department of Rheumatology, Henri Mondor Hospital, University Paris 12, Créteil, France Abstract: Relapsing polychondritis is a severe systemic immune-mediated disease characterized by an episodic and progressive inflammatory condition with progressive destruction of cartilaginous structures. This disease has for nearly a century kept secrets not yet explained. The real incidence and prevalence of this rare disease are unknown. The multiple clinical presentations and episodic nature of relapsing polychondritis cause a significant diagnosis delay. No guidelines for the management of patients with relapsing polychondritis have been validated to date. The challenges remain, both in the understanding of its pathophysiology and diagnosis, evaluation of its activity and prognosis, and its treatment. Possible solutions involve the sharing of data for relapsing polychondritis from worldwide reference centers. Thus, we would be able to evolve toward a better knowledge of its pathophysiology, the publication of new diagnosis criteria, which will include biological markers and imaging findings, the prediction of life-threatening or organ-threatening situations, and the publication of therapeutic evidence-based guidelines after performing at randomized controlled trials. Keywords: relapsing polychondritis, diagnosis, criteria, disease activity, treatments, biologic

Prevalence and risk factors of chronic kidney disease in newly diagnosed and untreated hypertensive patients in cameroon: A cross-sectional study

Chronic kidney disease (CKD) has emerged as a worldwide problem and is a major cause for comorbidity in hypertensive patients. In an attempt to enhance awareness and to help in establishing preventive measures and care, it is necessary to describe CKD among newly diagnosed and untreated hypertensive patients. We conducted a cross-sectional study to describe the characteristics of CKD among newly diagnosed, treatment naïve, hypertensive patients in four health-care centers in the city of Douala, Cameroon. Sociodemographic and biological data were collected and serum creatinine was measured by enzymatic – colorimetric methods. We calculated estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease equation and described CKD as eGFR 55 years [OR: 5.29 (3.33–8.42)], obesity [OR: 0.15 (0.10–0.26)], kalemia [OR: 1.33 (1.03–1.72)] were independently associated to CKD. CKD is a common condition in newly diagnosed and untreated hypertensive patients in Cameroon. Individuals with hypertension should be carefully evaluated for the presence of CKD, especially those with decreased GFR

Factors influencing disability in patients with chronic low back pain attending a tertiary hospital in sub-Saharan Africa

BackgroundVery little is known about the burden of chronic low back pain in Africa. This study aimed at assessing disability and associated factors in chronic low back patients in Cameroon.MethodsWe carried a hospital-based cross-sectional study including patients suffering from low back pain (LBP) of at least 12weeks' duration. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ). RMDQ >4 described persons with dysfunctional levels of disability.Multivariable linear regression was used to investigate factors associated with higher RMDQ scores hence greater disability. Variables investigated included; gender, age, marital status, employment status and type, smoking history, alcohol consumption, income, pain intensity, LBP duration, psychological wellbeing, sleep satisfaction, leg pain, numbness/paresthesia, bowel/bladder dysfunction symptoms (BBDS), body mass index (BMI), and days of work absence.ResultsA sample of 136 adults (64% female) with a mean age of 50.612.2years participated in the study. Median duration of LBP was 33 (25th - 75th percentile: 12-81) months. Mean RMDQ score was 12.8 +/- 6. In multivariable linear regression, pain intensity (=0.07, p=0.002), longer days of work absence (=0.15, p=0.003) and BBDS ( =2.33, p=0.029) were associated with greater disability. Factors such as consumption of alcohol (=-3.55, p=0.005) and higher psychological wellbeing scores (=-0.10, p=0.004) significantly contributed to less disability (lower RMDQ scores). Dysfunctional levels of disability were present in 88.1% of patients.Conclusion CLBP is associated with significant disability and this relationship is driven by several factors. Multidisciplinary management strategies especially those targeted to improve pain control, manage BBDS and improve psychological wellbeing could reduce disability and improve quality of life

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