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

Troubles cognitifs post accidents vasculaires cerebraux a Douala (Cameroun)

Introduction: Les troubles cognitifs peuvent être des séquelles après un accident vasculaire cérébral (AVC). Leur incidence est d’autant plus élevée avec la population vieillissante, l’augmentation de la prévalence des facteurs de risque cérébrovasculaire, et la diminution du taux de mortalité post AVC.Objectif: Déterminer la prévalence des troubles cognitifs post AVC et les facteurs associés à l’Hôpital Général de Douala (HGD).Méthode: Il s’agissait d’une étude transversale analytique menée à l’unité de Neurologie de l’HGD sur une période de 6 mois. Etait inclus dans l’étude tout patient âgé de plus de 15 ans, ayant eu un premier épisode d’AVC confirmé par une imagerie cérébrale et datant d’au moins 3 mois. Nous avons exclu tout patient présentant des troubles cognitifs avant l’AVC, ayant une autre cause de troubles cognitifs et aphasique. Les cas d’hémorragie sous arachnoïdienne ou de thrombose veineuse cérébrale étaient aussi exclus. Les données sociodémographiques, cliniques et d’imagerie médicale cérébrale ont été recueillies à l’aide d’un questionnaire. Le diagnostic de trouble cognitif s’est fait à l’aide du Mini Mental State Examination (MMSE). La démence était diagnostiquée chez les patients ayant des troubles cognitifs sévères à l’aide du DSM IV. Les données ont été analysées à l’aide du logiciel SPSS version 20. Le test de T de Student et le test de Khi-2 ont été utilisés pour comparer respectivement les variables quantitatives et qualitatives. L’analyse des facteurs déterminants l’apparition des troubles cognitifs post AVC a été réalisée en utilisant le modèle de régression logistique multivariée. Le seuil de signification statistique a été fixé à 0,05.Résultats: Au total, 114 participants étaient inclus, dont 51,8% d’hommes. L’âge moyen était de 57,2 ± 9,9 ans. 51,8% des patients avaient un niveau d’instruction correspondant au secondaire. Le principal facteur de risque cérébro-vasculaire était l’hypertension artérielle (73,2%). Les AVC ischémiques représentaient 63,9%. La prévalence des troubles cognitifs était de 41,2%. Les troubles cognitifs étaient légers, modérés et sévères (démence) respectivement à 26,3%, 8,8% et 6,1%. Après analyse univariée, les facteurs associés aux troubles cognitifs étaient le sexe féminin (P = 0,02), le niveau d’instruction < 7 ans de scolarité (P <0,001), la profession (P=0,005) et les cardiopathies (P=0,04). Seul le niveau d’instruction < 7 ans de scolarité était apparu comme prédictif de la survenue des troubles cognitifs (OR: 12,42 ; IC : [3,3 - 46,6] ; P < 0,001).Conclusion: Trois patients sur cinq victimes d’AVC présentent des troubles cognitifs. La démence est rare. La prévention primaire et l’accès à l’éducation au plus grand nombre de la population pourraient réduire l’impact des troubles cognitifs post AVC.Mots clés: Accident vasculaire cérébral, Cameroun, Douala, Troubles cognitifsEnglish Title: Post stroke cognitive impairment in Douala (Cameroon)English AbstractBackground: Cognitive impairment (CI) are possible sequelae after stroke. Data on post stroke CI in Sub Saharan Africa are scarce.Objective: To assess post stroke CI at the Douala General Hospital (DGH).Method: We carried out a cross-sectional study at the Neurology Unit of the DGH over a period of 6 months. Were included in the study, all patients above 15 years old with a first episode of stroke confirmed by brain imaging since at least 3 months back, and followed at the DGH. We excluded any patient with prior CI before the stroke onset, or/and with any other condition which may explain CI. Patients with subarachnoid haemorrhage or cerebral venous thrombosis were also excluded. Diagnosis of CI was made using the MMSE and the DSM IV criteria was used to confirm dementia. Data was analyzed using SPSS Version 20. The Student T test and the Chi-2 test were used to compare quantitative and qualitative variables, respectively. Factors associated and predicted of CI post stroke were identifying using logistic regression. The statistical significance was set at p < 0.05.Results: A total of 114 stroke patients were included with 51.8% being male and the mean age was 57.2 ± 9.9 years. The major cerebrovascular risk factor was hypertension (73.2%) and 51.8% of patients had attended at least secondary school. Ischemic stroke accounted for 63.9%. The prevalence of CI was 41.2%. Cognitive disorders were categorized as mild (26.3%), moderate (8.8%), and severe (dementia) (6.1%). Factors associated with CI were female gender (P = 0.02), education level < 7 years (P<0.001), lack of occupation (P=0.005) and cardiopathy (P=0.04). After multivariate analysis, only the educational level < 7 years was independently associated with CI (OR 12.42, CI [3.3 to 46.6]; P < 0.001).Conclusion: The prevalence of post stroke CI at the DGH is high. Only the low level of education appeared to be an independent predictor of post stroke CI in this study.Keywords: Stroke, Cameroon, Cognitive impairment, Doual

The prognostic value of serum uric acid in the acute phase of hemorrhagic stroke patients in black Africans

Introduction: very few studies have been conducted to evaluate the prevalence of hyperuricemia and its impact on the prognosis amongst acute hemorrhagic stroke (AHS) patients. The objectives was to determine the prevalence of hyperuricemia in AHS patients and examined the association between hyperuricemia and stroke outcomes in the Douala General Hospital (DGH). Methods: this was a hospital based prospective cohort which included AHS patients with baseline SUA levels and 3 months post stroke follow-up data. SUA values were divided into quintiles. Associations between hyperuricemia and stroke outcomes were analyzed using multiple logistic regression and survival analysis (cox regression and Kaplan Meier).   Results: a total of 221 AHS patients were reviewed with a mean age of 55.8±11.8 years. The prevalence of hyperuricemia among AHS patients was 34.4% with mean SUA level of 376.8±131.9 µmol/l. On multivariate analysis, hyperuricemia was not independently associated with early death [(OR = 1.072 (CI: 0.370-3.056; p = 0.897)] and poor functional outcome [(OR=2.487 (CI: 0.771-8.699; p = 0.154)] after hemorrhagic stroke. No significant increase in stroke deaths was observed across higher SUA quintiles amongst hemorrhagic stroke patients (p = 0.326). No statistically significant correlation was observed between SUA level and NIHSS (r = 0.063, p = 0.353) and between SUA level and mRS (r = 0.030, p = 0.662) in hemorrhagic stroke. Conclusion: about one third of patients present with hyperuricemia in the acute phase of hemorrhagic stroke. Hyperuricemia can act as risk factor for stroke because of its relationship with CVRFs but hyperuricemia has no impact on the severity and short-term outcome amongst black African hemorrhagic stroke patients

Knowledge, attitudes and practices regarding urinary schistosomiasis among adults in the Ekombe Bonji Health Area, Cameroon

Introduction: Urinary schistosomiasis (US) is endemic in Cameroon. Knowledge, attitudes and practices (KAP) are important aspects for control of the disease. However, data on these remain scanty. We aimed at evaluating knowledge, attitudes and practices regarding urinary schistosomiasis among adults in households in the Ekombe Bonji health area. Methods: A community-based, cross-sectional study was carried out at Ekombe Bonji health area from February to March, 2017, involving all 12 communities. A pre-tested questionnaire was used to assess knowledge, attitudes and practices regarding urinary schistosomiasis among 198 adults and to record their socio-demographic, environmental and clinical variables. Data were stored in Excel version 2013 and analysed using Stata version 14.2. Results: Of the 198 adults interviewed, only 35.4% had prior knowledge about urinary schistosomiasis. Among these, 94.3%, 74.3%, 57.7% knew the signs and symptoms, modes of transmission and preventive measures respectively. Only 14.3% knew the cause and treatment. 81.2% considered urinary schistosomiasis a serious disease and 77.1% believed it could be prevented, albeit, their practices to prevent infection were inadequate. Conclusion: Knowledge, attitudes and practices regarding urinary schistosomiasis among adults are inadequate, since most of them are not aware of the disease. Therefore, there is need for community-based interventions especially health education to effectively reduce the disease burden

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

Spectre des maladies cérébro-vasculaires chez le sujet jeune à Douala

Introduction: Les accidents vasculaires cérébraux (AVC) constituent la seconde cause de mortalité dans le monde. Au Cameroun, les AVC du sujet jeune ne sont pas étudiés. L’objectif de ce travail était de déterminer la proportion des AVC du sujet jeune, les facteurs de risque cérébrovasculaire (FRCV) et de rechercher les facteurs prédictifs de décès intra-hospitalier à l’Hôpital Général de Douala (HGD). Méthodes: Il s’agissait d’une étude de cohorte prospective menée à l’HGD pendant une durée de 5 ans incluant les sujets âgés de 15 à 45 ans ayant fait un AVC confirmé par imagerie cérébrale. L’analyse univariée avait permis de déterminer les facteurs associés au décès et les facteurs ayant un p = 0,200 avaient été inclus pour l’analyse multivariée afin de déterminer les facteurs prédictifs de décès intra-hospitaliers. Résultats: 511 patients avaient été admis pour AVC dont 78 sujets jeunes (15,26%). Le sexe masculin était majoritaire (62,8%) et l’âge moyen des patients était de 38,36 ± 5,83 ans. L’hypertension artérielle (74,35%), l’alcoolisme (38,46%), les dyslipidémies (14,10%), le diabète (12,82%), l’obésité (11,53%) et le tabagisme (10,25%) étaient les principaux FRCV. Les AVC hémorragiques représentaient 56% des cas dont 11% d’hémorragie sousarachnoïdienne. La mortalité était de 26,92%. Le score de Glasgow inférieur 9/15 était apparu comme un facteur prédictif indépendant de décès intra-hospitalier (p = 0,02 ; OR = 0,12 ; IC 95% = 0,02-0,75). Conclusion: La proportion des AVC du sujet jeune est élevée ainsi que la mortalité. Les FRCV sont classiques et surtout modifiables d’où l’intérêt primordial de la sensibilisation, du dépistage précoce de la prise en charge des FRCV.Pan African Medical Journal 2016; 2

Trends in, and factors associated with, HIV infection amongst tuberculosis patients in the era of anti-retroviral therapy: a retrospective study in England, Wales and Northern Ireland

Background: HIV increases the progression of latent tuberculosis (TB) infection to active disease and contributed to increased TB in the UK until 2004. We describe temporal trends in HIV infection amongst patients with TB and identify factors associated with HIV infection. / Methods: We used national surveillance data of all TB cases reported in England, Wales and Northern Ireland from 2000 to 2014 and determined HIV status through record linkage to national HIV surveillance. We used logistic regression to identify associations between HIV and demographic, clinical and social factors. / Results: There were 106,829 cases of TB in adults (≥ 15 years) reported from 2000 to 2014. The number and proportion of TB patients infected with HIV decreased from 543/6782 (8.0%) in 2004 to 205/6461 (3.2%) in 2014. The proportion of patients diagnosed with HIV > 91 days prior to their TB diagnosis increased from 33.5% in 2000 to 60.2% in 2013. HIV infection was highest in people of black African ethnicity from countries with high HIV prevalence (32.3%), patients who misused drugs (8.1%) and patients with miliary or meningeal TB (17.2%). / Conclusions: There has been an overall decrease in TB-HIV co-infection and a decline in the proportion of patients diagnosed simultaneously with both infections. However, high rates of HIV remain in some sub-populations of patients with TB, particularly black Africans born in countries with high HIV prevalence and people with a history of drug misuse. Whilst the current policy of testing all patients diagnosed with TB for HIV infection is important in ensuring appropriate management of TB patients, many of these TB cases would be preventable if HIV could be diagnosed before TB develops. Improving screening for both latent TB and HIV and ensuring early treatment of HIV in these populations could help prevent these TB cases. British HIV Association guidelines on latent TB testing for people with HIV from sub-Saharan Africa remain relevant, and latent TB screening for people with HIV with a history of drug misuse, homelessness or imprisonment should also be considered

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

International audienc

Cofilin Signaling in the CNS Physiology and Neurodegeneration

All eukaryotic cells are composed of the cytoskeleton, which plays crucial roles in coordinating diverse cellular functions such as cell division, morphology, migration, macromolecular stabilization, and protein trafficking. The cytoskeleton consists of microtubules, intermediate filaments, and actin filaments. Cofilin, an actin-depolymerizing protein, is indispensable for regulating actin dynamics in the central nervous system (CNS) development and function. Cofilin activities are spatiotemporally orchestrated by numerous extra- and intra-cellular factors. Phosphorylation at Ser-3 by kinases attenuate cofilin’s actin-binding activity. In contrast, dephosphorylation at Ser-3 enhances cofilin-induced actin depolymerization. Cofilin functions are also modulated by various binding partners or reactive oxygen species. Although the mechanism of cofilin-mediated actin dynamics has been known for decades, recent research works are unveiling the profound impacts of cofilin dysregulation in neurodegenerative pathophysiology. For instance, oxidative stress-induced increase in cofilin dephosphorylation is linked to the accumulation of tau tangles and amyloid-beta plaques in Alzheimer’s disease. In Parkinson’s disease, cofilin activation by silencing its upstream kinases increases α-synuclein-fibril entry into the cell. This review describes the molecular mechanism of cofilin-mediated actin dynamics and provides an overview of cofilin’s importance in CNS physiology and pathophysiology