Crises epileptiques au cours de la toxoplasmose cerebrale chez les patients immunodeprimes au vih.

Objectif Décrire les caractéristiques des crises épileptiques au cours de la toxoplasmose cérébrale (TC) chez les patients immunodéprimés au VIH à l’Hôpital Général de Douala (HGD).Matériel méthodesIl s’agissait d’une étude descriptive rétrospective des cas de TC diagnostiquée entre janvier 2000 et décembre 2012. La prévalence, le type, la fréquence des crises épileptiques et les thérapeutiques antiépileptiques ont été étudiées. Les patients avec un antécédent de crises épileptiques étaient exclus. Le test de Khi-2 a été utilisé pour rechercher les facteurs associés à la survenue des crises épileptiques tandis que le test de Student a été utilisé pour comparer les moyennes. P < 0,05 était considéré comme statistiquement significatif.Résultats 146 patients étaient inclus avec 78 femmes pour un sex-ratio de 0,87 en faveur des femmes. L’âge moyen était de 39,38 ± 9,88 ans. Le taux de CD4 moyen était de 115,63 ± 142,70 éléments/ml. La prévalence des crises épileptiques était de 45,2% et 61% des épileptiques étaient répétées. Les crises épileptiques généralisées prédominaient avec 75,8%. Seuls la fièvre (p < 0,012), les céphalées (p < 0,004), le syndrome d’hypertension intracrânienne (p < 0,038), un taux de CD4 < 50/ mm3 (p < 0,02) et un taux d’hémoglobine < 10g/dl (p < 0,017) étaient statistiquement associés à la survenue des crises épileptiques. Un traitement antiépileptique était prescrit chez 43,2% des patients.Conclusion Les crises épileptiques sont fréquentes au cours de la toxoplasmose cérébrale. Elles peuvent se répéter et justifier d’un traitement antiépileptique.Mots clés : Toxoplasmose cérébrale, VIH, Crises épileptiques, Douala, Cameroun

Stroke; early physiotherapy? what content? proposal of physiotherapy content in the acute phase (D1 at D14), part II: specific to the patient massively injured by the stroke.

International audienceRehabilitation of the patient on the other hand. This rightly shows the importance of early intervention (if no contraindication) of physiotherapy, in order to improve the functional prognosis soon (guide post-lesional plasticity) and maximize the use of the remaining residual capacities. (behavioral Post-stroke complications can obviously appear from the first moments, or days after stroke, like skin disorders: hyper pressure on one side of the body or limb (pressure sore), swallowing pneumonia, shoulder syndrome. hand, thromboembolic disorders (phlebitis), cardiovascular disorders (edema), vesicosphere disorders (magnified by non-verticalization), psychoaffective disorders, falls, depression, muscular atrophy and many others, complicating, and making dark the functional prognosis and apostériori the difficulty of the work of the physiotherapist on the one hand, and the plasticity). The same as the brain (brain is time) is time, the functional prognosis is also a question of time. Because the member which is not used (`` use it, or lose it: use it and improuv it '') loses its volume of cortical representation, at the level of the motor cortex, which could have been avoided if the physiotherapist with a early (scientific content) by systemic, passive and analytical posture (relearning by gentle and oriented task) while introducing as we move away from the stroke active, evolving movements (both in stress and in duration) according to the subject's skills, the clinic of the day and the efforts of the day before

Plasticité musculaire et traitement physique dans la parésie spastique déformante : physiopathologie de la sous-utilisation et réversibilité par le réentrainement intensif

International audienceOne of the biggest problems for our stroke patients is the deformity of their body. The patient more easily accepts having reduced motor skills and functionality than having a deformed body. They do not often consult for reasons of spasticity, they come to complain of stiffness, deformities, limitations in functional abilities, discomfort, and/or pain. The main goal of stroke rehabilitation is to restore patients’ independence in their activities of daily living (ADL), and, alongside, their health-related quality of life (HR-QoL). While it is true that strokes leave a context of motor vulnerability of the paresis type, it is nevertheless true that underutilization aggravates this state, and initiates another underlying local pathology, spastic myopathy, which appears as early as the first days after a stroke ; it also initiates neural degeneration via a reorganisation of the related circuits (mis-adaptive plasticity) which increases the primary motor impairment. This mechanism leads to deforming spastic paresis, which is reversible as soon as the impaired side is reactivated. Exercise or physiotherapy treatments are more effective than pharmacological treatments when it comes to motor recovery, maintenance or adaptation of people's functional abilities in general, particularly in case of brain damage. It is thus important, alongside pharmacological treatments, to offer focal physical treatment targeting the appropriate muscles (the antagonists) using techniques of aggressive, prolonged stretching, also entailing alternative movements of maximum amplitude, both in consultation with the patient and at home (via a guided self-education contract and register) in order not only to break the vicious cycle of underuse acquired after a stroke, but also to overcome the bodily distortions that sometimes create despair in the subject's social and professional life.Un des problèmes majeurs des patients ayant fait un accident vasculaire cérébral (AVC) est la déformation corporelle. Ces patients acceptent plus facilement d’avoir une motricité et une fonctionnalité diminuées que d’avoir un corps déformé. Ils ne consultent pas en raison de la spasticité mais ils viennent se plaindre de raideur, déformations, limitations des capacités fonctionnelles, inconfort, et/ou douleur. L’objectif principal de la réadaptation après un AVC est de restaurer l’indépendance des patients dans leurs activités de vie quotidienne. S’il est vrai que les AVC laissent un contexte de vulnérabilité motrice de type parésie, il n’en est pas moins vrai que la sous-utilisation aggrave cet état et initie une autre pathologie locale sous-jacente, la myopathie spastique, qui apparaît dès les premiers jours post-AVC, et centrale, la dégénérescence neuronale, par une réorganisation des circuits afférents (plasticité mal adaptative) qui augmente la déficience motrice primaire. Ce mécanisme entraîne la parésie spastique déformante qui est réversible à partir du moment où l’on commence à utiliser activement le côté lésé. Les traitements par les exercices ou les thérapies physiques sont plus efficaces que les traitements pharmacologiques lorsqu’il s’agit de la récupération motrice, du maintien ou des adaptations des capacités fonctionnelles des personnes en générale, et des cérébrolésés en particulier. C’est pourquoi il est nécessaire, à côté des traitements pharmacologiques, de proposer une quantité plus importante de traitements physiques focaux des muscles cibles (les antagonistes) par des techniques d’étirement agressif, prolongé, activo-dynamique et des mouvements alternatifs d’amplitude maximale, tant en cabinet avec le patient, qu’à domicile (via un contrat d’auto-rééducation guidée et un registre) afin de non seulement briser le cercle néfaste de la sous-utilisation acquise après un AVC, mais aussi de vaincre ces déformations corporelles inesthétiques qui créent parfois du désespoir dans la vie sociale et professionnelle de ces patients

Neurological manifestations in chronic hepatitis C patients receiving care in a reference hospital in sub-Saharan Africa: A cross-sectional study

<div><p>Background</p><p>Chronic hepatitis C infection is a major public health concern, with a high burden in Sub-Saharan Africa. There is growing evidence that chronic hepatitis C virus (HCV) infection causes neurological complications. This study aimed at assessing the prevalence and factors associated with neurological manifestations in chronic hepatitis C patients.</p><p>Methods</p><p>Through a cross-sectional design, a semi-structured questionnaire was used to collect data from consecutive chronic HCV infected patients attending the outpatient gastroenterology unit of the Douala General Hospital (DGH). Data collection was by interview, patient record review (including HCV RNA quantification, HCV genotyping and the assessment of liver fibrosis and necroinflammatory activity), clinical examination complemented by 3 tools; Neuropathic pain diagnostic questionnaire, Brief peripheral neuropathy screen and mini mental state examination score. Data were analysed using Statistical package for social sciences version 20 for windows.</p><p>Results</p><p>Of the 121 chronic hepatitis C patients (51.2% males) recruited, 54.5% (95% Confidence interval: 46.3%, 62.8%) had at least one neurological manifestation, with peripheral nervous system manifestations being more common (50.4%). Age ≥ 55 years (Adjusted Odds Ratio: 4.82, 95%CI: 1.02–18.81, p = 0.02), longer duration of illness (AOR: 1.012, 95%CI: 1.00–1.02, p = 0.01) and high viral load (AOR: 3.40, 95% CI: 1.20–9.64, p = 0.02) were significantly associated with neurological manifestations. Peripheral neuropathy was the most common neurological manifestation (49.6%), presenting mainly as sensory neuropathy (47.9%). Age ≥ 55 years (AOR: 6.25, 95%CI: 1.33–29.08, p = 0.02) and longer duration of illness (AOR: 1.01, 1.00–1.02, p = 0.01) were significantly associated with peripheral neuropathy.</p><p>Conclusion</p><p>Over half of the patients with chronic hepatitis C attending the DGH have a neurological manifestation, mainly presenting as sensory peripheral neuropathy. Routine screening of chronic hepatitis C patients for peripheral neuropathy is therefore necessary, with prime focus on those with older age and longer duration of illness.</p></div

Antiretroviral therapy in public and private routine health care clinics in Cameroon : lessons from the Douala antiretroviral (DARVIR) initiative

A review of the hospital charts for 788 patients treated in 19 public and private clinics in Cameroon showed that clinical follow-up visits, biologic follow-up visits, and drug supply were irregular and that many patients interrupted treatment. Virological and immunologic effectiveness of therapy was as expected in patients for whom results were available

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

F&eacute;licit&eacute; 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 Gis&egrave;le Imandy,5 Jean Pierre Nda Mefo&rsquo;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 &ge;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 &lt;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&plusmn;9 years, and 72.2% were females. Of which, 89% were on antiretroviral treatment (ARV). Their mean CD4+ T lymphocytes count was 451&plusmn;306 cells/mm3. Their mean ABI was 1.12&plusmn;0.17 and 1.07&plusmn;0.11, respectively, on the left and right legs (P&gt;0.05). The prevalence of PAD was 6.9% (95% CI: 3.4&ndash;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&ndash;0.82], P=0.034), while WHO stages III or IV was associated with PAD (aOR: 11.1, [95% CI: 2.19&ndash;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

Cognitive assessment findings.

<p>Cognitive assessment findings.</p

Paraclinical factors associated with neurological manifestations in hepatitis C infected patients.

<p>Paraclinical factors associated with neurological manifestations in hepatitis C infected patients.</p