Massive vulvar edema in a woman with severe preeclampsia. A case report and review of literature.

We report a case of massive vulvar edema in a 20 years old primigravida woman with severe preeclampsia at 32 weeks gestation. Other causes of vulvar edema were excluded. The vulvar edema appeared as the blood pressure increased, and cesarean section was performed for increasing preeclampsia and fetal distress. In the post partum period, the vulvar edema resolved progressively. By the fourteenth day post cesarean section, the vulvar edema had completely regressed and the blood pressure was within the normal range. The aim of this report is to alert clinicians that vulvar edema complicating preeclampsia could be a poor prognostic sign.KEY WORDS: Vulvar - Edema - Pre-eclampsia

Coelioscopie pour douleur pelvienne: Résultats d.une série de 40 cas

Dans le but d.étudier objectivement les causes des pelvialgies, nous avons, de Janvier 2001 à Novembre 2005 soumis au Centre de Recherche et d.Application en Chirurgie Endoscopique et Reproduction Humaine de Yaoundé (CRACERH), 40 patientes Camerounaises à des coelioscopies de bilan, pour pelvialgie chronique. La moyenne d.âge était de 35,25 ans ± 6,23 (23 . 51) ; il s.agissait de pelvialgie indépendante du cycle chez 36 patientes (90%), de dyspareunie profonde chez 16 patientes (40%) et de dysménorrhée secondaire chez 15 patientes (37,50%). La durée moyenne de la pelvialgie était de 3ans ± 1,5 (1 . 7). Les antécédents de maladie inflammatoire pelvienne à Chlamydia trachomatis, d.avortement septique, et de laparotomie pelvienne étaient retrouvés respectivement dans 55 % (22 cas); 50 % (20 cas); 19 cas (47, 5%). Les pathologies essentiellement rencontrées chez nos patientes, et par ailleurs reconnues algogènes étaient : les adhérences pelviennes (particulièrement utéro-douglaso-annexielles) 77,50% (31 cas), les hydrosalpinx 27,50% (11 cas), l.endométriose 22,50% (9 cas ), les varices pelviennes 22,50% (9 cas ), les kystes ovariens 12,50% (5 cas) et les fibromes utérins 15% ( 6 cas ). Vingt trois patientes (57,5%) étaient porteuses chacune d.au moins 2 pathologies pelviennes algogènes. Cette étude vient témoigner davantage le rôle fondamental de la coelioscopie dans le dépistage, et par conséquent la bonne prise en charge des pelvialgies chroniques. Clinics in Mother and Child Health Vol. 3(1) 2006: 427-43

A comparative study of the diagnostic methods for Group A streptococcal sore throat in two reference hospitals in Yaounde, Cameroon

Introduction: Sore throat is a common complaint in general practice which is more frequent in children. The most frequent pathogenic bacteriaassociated with this infection is Streptococcus pyogenes. Rapid Antigen Diagnostic Test (RADT) facilitates the rapid identification and consequentlyprompt treatment of patients, prevents complications, and also reduces the risk of spread of Group A Streptococcus (GAS). The main objective ofthis study was to assess the diagnostic value of a rapid streptococcal antigen detection test in patients with sore throat. Methods: A crosssectional descriptive study was carried out from January to April 2011 on patients aged 3 to 72 years consulting for pharyngitis or sore throat at the paediatric and Ear, Nose and Throat units of the University Teaching Hospital Yaounde and the Central Hospital Yaounde. Two throat swabs were collected per patient. One was used for the rapid test and the other for standard bacteriological analysis.Results: The prevalence of GAS in the study population was 22.5%. Out of the 71 samples collected, the RADT detected group A streptococcal  antigens in 12 of 16 positive cultures giving a sensitivity of 75%. The specificity of the rapid test was 96%, with positive predictive value of 85.7%, and negative predictive value of 93% respectively.Conclusion: Rapid test may have an additional value in the management of patients with high risk of having GAS infection. However, tests with a higher sensitivity are needed for accurate and reliable results for early  diagnosis of patients with sore throat caused by GAS

Resistance pattern of enterobacteriaceae isolates from urinary tract infections to selected quinolones in Yaoundé

Introduction: It is estimated that 150 million urinary tract infections (UTIs) occur yearly worldwide, resulting in more than 6 billion dollar in direct healthcare cost. The etiology of UTIs is predictable, with Escherichia coli, an Enterobacteriaceae being the principal pathogen. Quinolones are usually the drug of choice. In this study, we report the resistance pattern of Enterobacteriaceae isolates from UTIs to quinolones among in-patients and out-patients at the Yaoundé Reference Hospital in Cameroon. Methods: A cross-sectional descriptive study was carried out for a ten-month period. Consecutive clean-catch mid-stream urine samples were collected from 207 in and out-patients. Identification was done using the Api 20E, and susceptibility testing using the Kirby Bauer’s disc diffusion method and the MIC was done using the E-test. Results: Out of the 207 isolates, 58(28.0%) were found to be resistant to all the quinolones used in the study. The resistances observed by species were in the order: Enterobacter 4(30.8%); Klebsiella 19(29.7%); Escherichia25 (29.4%); Proteus 2(11.8%); Serratia 4(25.0%). Quinolone resistance for Escherichia was 42.9% for In-Patients (IP) and 16.3% for Out-Patient (OP) (P-value = 0.006); Klebsiella 35.9% for IP and 20% for OP; Proteus 11.1% for IP and 12.5% for OP; Serratia 18.2% for IP and 40% for OP;Enterobacter 22.2 for IP and 50% for OP. Conclusion: High resistance rates to quinolones were observed not only for in-patients but also for out-patients with urinary tract enterobacterial infections. These findings demonstrate the importance of antibiotics susceptibility testing in improving quinolones prescription practices in Cameroon

Targeting Antibody Responses to the Membrane Proximal External Region of the Envelope Glycoprotein of Human Immunodeficiency Virus

Although human immunodeficiency type 1 (HIV-1) infection induces strong antibody responses to the viral envelope glycoprotein (Env) only a few of these antibodies possess the capacity to neutralize a broad range of strains. The induction of such antibodies represents an important goal in the development of a preventive vaccine against the infection. Among the broadly neutralizing monoclonal antibodies discovered so far, three (2F5, Z13 and 4E10) target the short and hidden membrane proximal external region (MPER) of the gp41 transmembrane protein. Antibody responses to MPER are rarely observed in HIV-infected individuals or after immunization with Env immunogens. To initiate antibody responses to MPER in its membrane-embedded native conformation, we generated expression plasmids encoding the membrane-anchored ectodomain of gp41 with N-terminal deletions of various sizes. Following transfection of these plasmids, the MPER domains are displayed on the cell surface and incorporated into HIV virus like particles (VLP). Transfected cells displaying MPER mutants bound as efficiently to both 2F5 and 4E10 as cells transfected with a plasmid encoding full-length Env. Mice immunized with VLPs containing the MPER mutants produced MPER-specific antibodies, the levels of which could be increased by the trimerization of the displayed proteins as well as by a DNA prime-VLP boost immunization strategy. Although 2F5 competed for binding to MPER with antibodies in sera of some of the immunized mice, neutralizing activity could not be detected. Whether this is due to inefficient binding of the induced antibodies to MPER in the context of wild type Env or whether the overall MPER-specific antibody response induced by the MPER display mutants is too low to reveal neutralizing activity, remains to be determined

Untreated Human Infections by Trypanosoma brucei gambiense Are Not 100% Fatal

The final outcome of infection by Trypanosoma brucei gambiense, the main agent of sleeping sickness, has always been considered as invariably fatal. While scarce and old reports have mentioned cases of self-cure in untreated patients, these studies suffered from the lack of accurate diagnostic tools available at that time. Here, using the most specific and sensitive tools available to date, we report on a long-term follow-up (15 years) of a cohort of 50 human African trypanosomiasis (HAT) patients from the Ivory Coast among whom 11 refused treatment after their initial diagnosis. In 10 out of 11 subjects who continued to refuse treatment despite repeated visits, parasite clearance was observed using both microscopy and polymerase chain reaction (PCR). Most of these subjects (7/10) also displayed decreasing serological responses, becoming progressively negative to trypanosome variable antigens (LiTat 1.3, 1.5 and 1.6). Hence, in addition to the “classic” lethal outcome of HAT, we show that alternative natural progressions of HAT may occur: progression to an apparently aparasitaemic and asymptomatic infection associated with strong long-lasting serological responses and progression to an apparently spontaneous resolution of infection (with negative results in parasitological tests and PCR) associated with a progressive drop in antibody titres as observed in treated cases. While this study does not precisely estimate the frequency of the alternative courses for this infection, it is noteworthy that in the field national control programs encounter a significant proportion of subjects displaying positive serologic test results but negative results in parasitological testing. These findings demonstrate that a number of these subjects display such infection courses. From our point of view, recognising that trypanotolerance exists in humans, as is now widely accepted for animals, is a major step forward for future research in the field of HAT

Multi-ancestry genome-wide association meta-analysis of Parkinson?s disease

Although over 90 independent risk variants have been identified for Parkinson’s disease using genome-wide association studies, most studies have been performed in just one population at a time. Here we performed a large-scale multi-ancestry meta-analysis of Parkinson’s disease with 49,049 cases, 18,785 proxy cases and 2,458,063 controls including individuals of European, East Asian, Latin American and African ancestry. In a meta-analysis, we identified 78 independent genome-wide significant loci, including 12 potentially novel loci (MTF2, PIK3CA, ADD1, SYBU, IRS2, USP8, PIGL, FASN, MYLK2, USP25, EP300 and PPP6R2) and fine-mapped 6 putative causal variants at 6 known PD loci. By combining our results with publicly available eQTL data, we identified 25 putative risk genes in these novel loci whose expression is associated with PD risk. This work lays the groundwork for future efforts aimed at identifying PD loci in non-European populations

Targeting antibody responses to the membrane proximal external region of the envelope glycoprotein of human immunodeficiency virus

Breit neutralisierende Antikörper (bnAk) sind ein wichtiges Ziel der HIV-Impfstoffentwicklung, aber schwer zu induzieren. Drei bnAk (2F5, 4E10, Z13) sind gegen die $\textit {membrane proximal externalregion}$ (MPER) des Transmembranproteins gp41 gerichtet. Um die Antikörperantworten gegen die natürliche Konformation von MPER auszurichten, wurden N-terminal verkürzte Varianten erzeugt, welche in die Zellmembran und in virusähnliche Partikel (VLP) eingebaut werden können. In der Durchflusszytometrie zeigten 2F5 und 4E10 eine erhöhte Bindung an Zellen, welche die MPER-Mutanten anstatt Volllänge gp41 präsentierten. Immunisierung von Mäusen mit VLPs, welche die MPER-Mutanten enthielten, induzierte MPER-spezifische Antikörper. Eine Trimerisierung der MPER und ein DNA $\it {prime}$ konnten deren Titer noch erhöhen. Obwohl 2F5 mit den induzierten Antikörpern um Bindung an die MPER konkurrierte, konnte keine neutralisierende Aktivität detektiert werden. Die Gründe hierfür bedürfen weiterer Untersuchungen

Profil spermatique des patients infertiles suivis au centre de recherche et d'application en chirurgie endoscopique et reproduction humaine (Yaounde-Cameroun): résultat d'une série de 42 cas

Dans le but de connaître le profil spermatique du Camerounais infertile, nous avons, de janvier 2001 à février 2005 sélectionné au Centre de Recherche et d'Application en Chirurgie Endoscopique et Reproduction Humaine de Yaoundé (CRACERH), 42 patients infertiles ; l'âge moyen est de 37, 41 ans (27-50) et 25 d'entre eux (59,52 % ) ont un antécédent d'infection génitale à Chlamydia trachomatis. La coelioscopie pratiquée à chaque fois chez les conjointes a permis d'éliminer d'éventuelles pathologies (endométriose, séquelles tubo-péritonéales, voire ovariennes de maladies inflammatoires pelviennes …) susceptibles de biaiser notre population d'étude. Seuls les partenaires des femmes normales sont recrutés. L'oligoasthénozoospermie sévère est retrouvée chez la majorité des patients , 24 cas (57,14 %), suivi de l'azoospermie, 9 cas (21,42%), l'oligo-asthénozoospermie sévère associée à une nécrozoospermie, 7 cas(16,66 %) , et dans une moindre mesure l'oligospermie modérée, 2 cas (4,76 %). Ceci nous amène à évoquer, sous réserve d'une étude plus étendue, que l'infertilité masculine chez le Camerounais ne se produit que dans les cas d'altérations sévères du sperme. L'impact péjoratif des radicaux libres et des superoxydes sur l'altération du sperme est fortement incriminé actuellement au cours des infections à Chlamydia trachomatis. Toutefois, la prévention des infections sexuellement transmises et leur prise en charge précoce reste de règle dans notre contexte. Clinics in Mother and Child Health Vol. 2(2) 2005: 343-34