Comparison of different blood pressure indices for the prediction of prevalent diabetic nephropathy in a sub-Saharan African population with type 2 diabetes

Background: The association between blood pressure (BP) and diabetic kidney diseases in Africans has been less well investigated. We assessed and compared the strength of the association and discriminatory capability of systolic (SBP), diastolic (DBP) BP, pulse pressure (PP) and mean arterial blood pressure (MAP) for nephropathy risk in sub-Saharan Africans with type 2 diabetes. Methods: Participants were 420 consecutive individuals (49% men) with type 2 diabetes receiving chronic care in two main referral centres in the two major cities of Cameroon. Logistic regression models were used to compute the odd ratio (OR) and 95% confidence interval (95% CI) for a standard deviation (SD) higher level of SBP (25 mmHg), DBP (13), PP (18) and MAP (16) with nephropathy risk. Discrimination was assessed and compared with c-statistics and relative integrated discrimination improvement (RIDI, %). Results: The adjusted OR (95% CI) for nephropathy with each SD higher BP variable were: 1.45 (1.15-1.84) for SBP, 1.33 (1.06-1.66) for DBP, 1.35 (1.06-1.71) for PP and 1.42 (1.13-1.78) for MAP. C-statistic comparison showed no difference in discrimination of models with each of the BP variables (p-values B 0.69 for c-statistics comparison). However, RIDI statistic always showed and enhancement in models discrimination when other BP variables were replaced with SBP, although such an enhancement was marginal for MAP. Using BP combination modestly improved models? discrimination. Conclusion: SBP was the best predictor of prevalent nephropathy in this population, while DBP was the less effective. This may have implication for kidney disease risk stratification and protection

Determinants of hyperuricemia in non-dialysed chronic kidney disease patients in three hospitals in Cameroon

Abstract Background Chronic kidney disease (CKD) poses a substantial health burden in sub-Saharan Africa, with risk factors ranging from communicable to non-communicable diseases. Hyperuricemia has been recently identified as a factor of progression of CKD. Identifying factors associated with hyperuricemia in CKD patients would help determine interventions to reduce CKD mortality, particularly in resources limited countries. We sought to determine the prevalence and factors associated with hyperuricemia in non-dialysed CKD adult patients in Cameroon. Methods This was a cross-sectional study of non-dialysed CKD patients, conducted in 3 referral nephrology units in Cameroon. Relevant clinical and laboratory data were collected using interviewer-administered questionnaires. Serum uric acid, spot urine protein and spot urine creatinine were assessed. Associations between variables were assessed using multivariate analysis. Level of statistical significance was set at α < 0.05. Results A sample of 103 participants was included. Mean age of study participants was 55.78 ± 12.58 years, and 59.3% were men. Sixty-nine (67%) had hyperuricemia. Patient’s age (OR: 1.08, 95% CI: 1.03–1.13), estimated glomerular filtration rate (OR: 0.94, 95% CI: 0.90–0.98), spot urine protein-creatinine ratio (OR: 1.83, 95% CI: 1.07–3.12), no hypertension (OR: 0.09, 95% CI: 0.02–0.46), urate lowering therapy (OR: 4.99, 95% CI: 1.54–16.16), loop diuretics (OR: 3.39, 95% CI: 1.01–11.42), obesity (OR: 6.12, 95% CI: 1.15–32.55) and no anaemia (OR: 0.04, 95% CI: 0.00–0.29) were independently significantly associated with hyperuricemia. Conclusions In this sample of non-dialysed CKD patients in Cameroon, about 7 out of 10 had hyperuricemia. Hyperuricemia was independently associated with patient’s age, estimated glomerular filtration rate, spot urine protein-creatinine ratio, hypertension, urate lowering therapy, loop diuretics, obesity and anaemia. More studies are required to establish causal relationships between these associations

Oxidative Stress in Patients with Chronic Inflammatory Diseases in a Tertiary Health Care Setting in Africa

International audienc

Influence de la qualite du sommeil sur la pression arterielle des patients Camerounais souffrant d’hypertension arterielle

Objectif. L’hypertension artérielle (HTA) constitue un problème majeur de santé publique dans les pays en développement à cause de sa prévalence et sa morbi-mortalité élevées. Face à un développement industriel galopant, des modifications du mode de vie entraineraient des troubles du sommeil, nouveau problème émergeant de santé publique à cause de son influence néfaste sur la pression artérielle et le risque accru d’HTA. Au Cameroun, la prévalence des troubles du sommeil est peu documentée et son influence sur la pression artérielle encore moins.Méthodologie. Nous avons recruté consécutivement 148 hypertendus suivis depuis au moins un an dans l’unité de cardiologie de l’Hôpital Général de Douala. La pression artérielle et la fréquence cardiaque ont été mesurées chez tous les participants par un investigateur expérimenté dans les conditions optimales de standardisation. La qualité du sommeil a été évaluée à l’aide du questionnaire de Pittsburgh Sleep Quality Index (PSQI). Un score PSQI ≥6 correspond à une mauvaise qualité.Résultats: L’âge moyen des participants était de 57 ± 10 ans. La proportion du surpoids/obésité, de l’obésité abdominale, de l’HTA non contrôlée, du syndrome métabolique et de la mauvaise qualité du sommeil était respectivement de : 83,8% ,77%, 78,4%, 41,2% et 64,2%. Seule la pression artérielle diastolique était corrélée de façon significative au score de PSQI. Les pressions systoliques étaient plus élevées chez ceux qui avaient un sommeil de mauvaise qualité.Conclusion : Cette étude révèle que la mauvaise qualité du sommeil est fréquente chez les hypertendus camerounais et serait étroitement associée au mauvais contrôle de leur pression artérielle.Mots clés : mauvaise qualité du sommeil, hypertension artérielle, Douala

Characteristics and determinants of clinical symptoms in radiographic lumbar spinal stenosis in a tertiary health care centre in sub-Saharan Africa

Abstract Background Lumbar spinal stenosis (LSS) refers to narrowing of the lumbar central spinal canal, lateral recess, and/or neuro-foramina. Radiographic LSS plays an important role in clinical LSS but is not solely accountable for the presence of symptoms. We sought to characterise clinical LSS and to determine factors associated with presence of symptoms of LSS in patients with radiographic LSS in a sub Saharan Africa setting. Methods After prior ethical clearance, a case control study was done in a tertiary hospital in Douala-Cameroon, including 105 patients with radiographic LSS: 57 with symptoms of LSS (cases) and 58 with no symptoms (controls). Spinal stenosis was assessed using computed tomography (CT) scans. Data were analysed using SPSS version 23. Results The mean age of our study participants was 53.4 ± 13.1 years. The mean age of onset of symptoms of LSS was 50.3 ± 11.6 years and the most common symptoms were Low back pain (100.0%), radicular symptoms (98.2%) and neurogenic claudication (98.2%). Obesity (p < 0.001) and a high waist circumference (p = 0.002) were significantly associated with presence of LSS symptoms in persons with radiographic LSS. After adjusting for body mass index, a positive family history of low back pain (p = 0.004), vertebra lesion at L2 (p = 0.034), L3 (p = 0.002), L4 (p = 0.025) and multiple (p = 0.008) levels, degenerative disc protrusion (p = 0.044), disc lesion at L3-L4 (p = 0.001), L4-L5 (p = 0.011) and multiple (p = 0.046) levels were significantly associated with presence of symptoms of LSS in persons with radiographic LSS. Conclusion Characteristics of clinical LSS have been described in this sub-Saharan Africa population. Obesity, a high waist circumference and a positive family history of low back pain are significantly associated with presence of symptoms of LSS in persons with radiographic LSS

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

Malnutrition in patients admitted to the medical wards of the Douala General Hospital: a cross-sectional study

Abstract Background Malnutrition is common in acutely ill patients occurring in 30–50% of hospitalized patients. Awareness and screening for malnutrition is lacking in most health institutions in sub-Saharan Africa. This study aimed at screening for malnutrition using anthropometric and laboratory indices in patients admitted to the internal medicine wards. Methods A cross-sectional study. We screened for malnutrition in 251 consecutive patients admitted from January to March 2013 in the internal medicine wards. Malnutrition defined as body mass index (BMI) less than 18.5 kg/m2 and/or mid upper arm circumference (MUAC) less than 22 cm in women and 23 cm in men. Weight loss greater than 10% in the last 6 months prior to admission, relevant laboratory data, diagnosis at discharge and length of hospital stay (LOS) were also recorded. Results Mean age was 47 (SD 16) years. 52.6% were male. Mean BMI was 24.44 (SD 5.79) kg/m2 and MUAC was 27.8 (SD 5.0) cm. Median LOS was 7 (IQR 5–12) days. 42.4% of patients reported weight loss greater than 10% in the 6 months before hospitalization. MUAC and BMI correlated significantly (r = 0.78; p < 0.0001) and malnutrition by the two methods showed moderate agreement (κ = 0.56; p < 0.0001). Using the two methods in combination, the prevalence of malnutrition was 19.34% (35/251). Blood albumin and hemoglobin were significantly lower in malnourished patients. Malnourished patients had a significantly longer LOS (p = 0.019) when compared to those with no malnutrition. Malnutrition was most common amongst patients with malignancy. Conclusion Malnutrition is common in patients admitted to the medical wards of the Douala General Hospital. Nutritional screening and assessment should be integrated in the care package of all admitted patients

Survie globale des patients âgés de moins de 65 ans, porteurs du myélome multiple sous chimiothérapie à l’Hôpital Général de Douala

English Title: The overall survival of patients aged less than 65 years old with multiple myeloma under chemotherapy at the General Hospital of DoualaEnglish AbstractAbstract: the multiple myeloma or Khaler’s disease is a malignant hemopathy who falls under both old and young person. It is the second malignant hemopathy after the lymphomas. It is responsible for about 1% of death’s cancer and about 19% of death’s malignant hemopathy. The purpose of this study was to determine the overall survival of patients aged less than 65 years with multiple myeloma undergoing chemotherapy over a 10 years period at the General Hospital of Douala.Method: it was a retrospective, descriptive and analytical study conducted in the department of internal medicine (Hematology unit) going on 05 December 2016 to June 30 2017. The sample method was non-random, with consecutive and exhaustive type of recruitment of patient records obedient of the inclusion criteria. The analyzed variables were demographic, paraclinical, therapeutic and evolutionary. The survival curves were plotted using the Kapplan Meier method. The survival comparisons were made by the Log Rank test and the p-values interpreted at a threshold of 5%.Results: 51 patient’s records from 19 to 65 years old were eligible. The average age of patients was from 54,22 years to 8,608years. There was a slight female predominance with a sex ratio of 0, 21. The monoclonal gamma peak was in 81,81% of cases objective. The immunoglobulin G was predominant and the Kappa light evolution was found in 81, 1% of cases. Our patients were predominately on stage 3 of Durie and Salmon (70, 58%) and 50% at stage 3 of the ISS score. Our patients have been treated using VMCP, MP and MPT protocols. The VMCP was the most used protocol on the first and second line (58, 82% and 54, 16%) with a very good practical response rate of 60% in the first line. The second-line protocol choice and compliance were statistically significant on treatment response (p=0,02; p=0,026 respectively). For an average follow-up of 24,06 months (range: 1-120), the median SG was 38 months. The percentage of SG in 5 years was 26,90%. The median progression-free survival was 69 months. The survival with progression was 84, 36 months. The factors associated with the overall survival in our level were the protocol choice and the percentage of hemoglobin. (p= 0,04; p=0,08 respectively).Conclusion: the patients are diagnosed at an advanced stage. The health care, the good compliance and the use of news molecules could improve the survival of our patients. This group of patients benefit from the therapeutic intensification by an auto implantation not yet available in our context.Keywords: Mylemo of the young subject, survival, General Hospital in Doual