Musculoskeletal Presentation of Multiple Myeloma at General Hospital Douala, Cameroon

Background: very little is known about musculoskeletal features of multiple myeloma (MM) in Africa.Objectives: To describe the musculoskeletalfeatures of multiple myeloma at presentation in a tertiary health care centre in sub-Saharan Africa.Design: A Cross sectional observational study.Setting: The Douala General Hospital, Cameroon from 2007 to 2013.Subjects: A patient was said to have MM according the current international consensus criteria for diagnosis and staging of MM. Patients with monoclonal gammopathy of undetermined significance, solitary plamocytoma and other haematologic malignancies were excluded.Results: A total of 62 patients were diagnosed with multiple myeloma, 63% were female. Mean age was 57± 12,1 (19-81) years. Musculoskeletal presentation included spine bone pains (75.6%); vertebral fracture with spinal cord compression in 46.8 %. Other clinical features at presentation included anaemia (70.93%), and nephropathy (17.74%). The average percentage of bone marrow plasmacytosis at diagnosis was 33% and Immunoglobulin G was found in 86% of patients. Sixty three per cent of patients were diagnosed at stage III of the disease.Conclusion: Presence of bone pain and anaemia should alert the clinician to investigate along the lines of multiple myeloma. Majority of the patients have osteolytic lesions and pathologic fractures at the time of diagnosis

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.

Potential Impact of Antiretroviral Chemoprophylaxis on HIV-1 Transmission in Resource-Limited Settings

Background. The potential impact of pre-exposure chemoprophylaxis (PrEP) an heterosexual transmission of HIV-1 infection in resource-limited settings is uncertain. Methodology/Principle Findings. A deterministic mathematical model was used to simulate the effects of antiretroval PreP on an HIV-1 epidemic in sub-Saharan Africa under different scenarios (optimistic neutral and pessimistic) both with and without sexual disinhibition. Sensitivity analyses were used to evaluate the effect of uncertainty in input parameters on model output and included calculation of partial rank correlations and standardized rank regressions. In the scenario without sexual disinhibition after PrEP initiation, key parameters influencing infections prevented were effectiveness of PrEP (partial rank correlation coefficient (PRCC) = 0.94), PrEP discontinuation rate (PRCC=-0.94), level of coverage (PRCC=0.92), and time to achieve target coverage (PRCC=-082). In the scenario with sexual disinhibition, PrEP effectiveness and the extent of sexual disinhibition had the greatest impact on prevention. An optimistic scenario of PrEP with 90% effectiveness and 75% coverage of the general population predicted a 74% decline in cumulative HIV-1 infections after 10 years, and a 28.8% decline with PrEP targeted to the highest risk groups (16% of the population). Even With a 100% increase in at-risk behavior from sexual disinhibition, a beneficial effect (23.4%-62.7% decrease in infections) was seen with 90% effective PrEP across a broad range of coverage (25%-75%). Similar disinhibition led to a rise in infections with lower effectiveness of PrEP (≤50%). Conclusions/Significance. Mathematical modeling supports the potential public health benefit of PrEP. Approximately 2.7 to 3.2 million new HIV-1 infections could be averaged in southern sub-Saharan Africa over 10 years by targeting PrEP (having 90% effectiveness) to those at highest behavioral risk and by preventing sexual disinhibition. This benefit could be lost, however, by sexual disinhibition and by high PrEP discontinuation, especially with lower PrEP effectiveness (≤:50%). © 2007 Abbas et al

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

Hip osteoarthritis in Douala General Hospital: Clinical, radiological patterns and treatment options

Background: Hip osteoarthritis is a chronic debilitating disease that is treatable surgically by total hip replacement, sparingly available in developing countries, particularly in Africa. Few data are available on clinical patterns of hip OA in Cameroon. Objectives: To describe the epidemiological, clinical and radiological profile of hip OA, and also treatment options offered to patients presenting with this condition at the Douala General Hospital, Cameroon. Methods: After prior ethical clearance, a hospital-based cross sectional descriptive study was carried out, including all patients (one patient = one file) diagnosed with symptomatic hip OA during a 10 year period between January 2004 and December 2013 in Rheumatology and Orthopaedic Units at DGH. The Kellgren-Lawrence classification was used. Data was collected using pretested questionnaires and analyzed using Epi info version 7 and Microsoft excel 2007. Results: Of the 9615 cases reviewed, 258 (2.7%) had symptomatic hip OA. The mean age was 53.3 ± 16.3 years (16 – 85 years). Females were more affected (56.4%). The mean BMI was 27.0 ± 4.3 (19.7 – 41.9) Kg/m2. The prevalence increased with age over 50 years. The most frequent clinical findings were pain in the inguinal area, morning stiffness, limping, and limited range of internal rotation hip motion. Pain was usually moderate to severe in intensity. The most frequent radiological grade was K-L grade 4 (39.3%). The condition was unilateral in 73.1% of cases; it was unipolar in 65.4% (superior pole most affected); bicompartmental in 14.1%; tricompatmental in 20.5% of cases. There was no association between pain and radiologic grade of symptomatic hip OA. Out of the hundred with indication of hip arthroplasty, only forty-seven patients underwent surgical hip replacement therapy. The main limitation was financial. Conclusion: Symptomatic hip OA has a female predominance. From the age of 50 years, females are more likely to develop the condition. There is poor correlation between symptoms and radiological findings. Key words: Hip osteoarthritis; Pain; Joint replacement; Afric

Rheumatologic manifestations associated with Hepatitis C virus infection: A cross sectional multicentric study in Cameroon

Background: Hepatitis C Virus (HCV) infection is a worldwide burden whose seroprevalence is higher in developing countries with Cameroon being the third most affected country in Africa. HCV both a hepatotropic and lymphotropic infection is responsible for a great number of hepatic and extra hepatic disorders some of which are rheumatic in nature. These rheumatologic manifestations though extensively studied in western countries; there is little or no data in sub-Saharan Africa. Objective: The study was conducted with the aim to describe the musculoskeletal manifestations associated to HCV infection in a hospital setting in Cameroon. Design: A cross-sectional study. Setting: Three hospitals in Cameroon: the Douala General Hospital, a tertiary referral hospital with a capacity of 320 beds in Douala, the largest city and economic capital of Cameroon; the University Teaching Hospital of the Faculty of Medicine and Biomedical Sciences of the university of Yaoundé 1, a 240 beds hospital in Yaoundé the political capital of Cameroon and the “Centre Médical de la Cathédrale”, a private acceptable standard Gastroenterology clinic also found in Yaoundé. Patients and methods: From February to June 2009, we did a multicentric cross-sectional study of patients from the Gastroenterology, Rheumatology and Internal medicine outpatient clinics of three hospitals in Cameroon. Patients with HIV or HBV infection and those on antiviral treatment were excluded. Results: Among 148 patients with HCV infection identified during the study period, only 62 fulfilled eligibility, 15 (24.2%) of whom had musculoskeletal manifestations related to HCV, the commonest of which were myalgia 9/62 (14.5%) , arthritis 6/62 (9.7%), bone pain 6.4% (4/62), sicca syndrome 3/62 (4.8%), and Raynaud’s phenomenon 6/62 (9.7%). Among patients with rheumatologic manifestations, 9/15 (60%), had rheumatologic symptoms at HCV diagnosis and in 6/15 (40%). HCV infection was discovered during routine medical check-up. Musculoskeletal manifestations were neither associat ed with the genotype (p=0.17) nor with the viral load (p>0.98). Conclusion: Arthralgia is the most common presenting feature of the symptomatic disease. Musculoskeletal manifestations may be confused with symptoms of common tropical infections, leading to delayed diagnosis and treatment of HCV infection. Key words: Hepatitis C Virus, Arthralgia, Extra hepatic manifestations; Afric