African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic

Objectives To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic. Method A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1–3, 4–6 and 7–9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a ‘low’ level of agreement. Results A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting. Conclusions The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges

Rheumatoid polyarthritis suspected in an HIV patient with scleritis, peripheral ulcerative keratitis, and anterior uveitis

Christelle Domngang Noche,1 Madeleine Singwé-Ngandeu,2 Assumpta Lucienne Bella2 1Université des Montagnes, Yaoundé, Cameroon; 2Université de Yaoundé 1, Yaoundé, Cameroon Introduction: Scleritis and peripheral ulcerative keratitis are ocular manifestations found in many inflammations and infections. Therefore, their association should prompt a search for inflammatory or infectious causes that may be life-threatening, especially in the context of AIDS due to HIV infection. Findings: We report the case of a 37-year-old female, first seen in 2011 with a nodular scleritis in the right eye and a peripheral ulcerative keratitis, a necrotizing scleritis, and a granulomatous anterior uveitis in the left eye, in the context of chronic polyarthropathies that had evolved over 6 months. The patient was diagnosed with AIDS (HIV) in 2008 and was on antiretroviral therapy for the past 2 years. Ophthalmic workup was negative for opportunistic infections and potential causes of scleritis and peripheral ulcerative keratitis, and the patient was unresponsive to topical antibacterial and anti-inflammatory treatment. Ocular lesion resolution and articular swelling improvement was observed less than 6 weeks after sulfasalazine treatment. Based on American College of Rheumatology/European League Against Rheumatism classification criteria, and considering the good response to the treatment (sulfasalazine), diagnosis of rheumatoid arthritis was made in the absence of confirmatory lab tests results. Conclusion: In the context of ocular manifestations associated with polyarthropathies, coexisting pathologies should be considered. Diagnostic workup of chronic inflammatory rheumatism should be carried out, even in the context of HIV/AIDS. Keywords: scleritis, peripheral ulcerative keratitis, anterior uveitis, rheumatoid arthritis, HIV/AID

Aspects diagnostiques et thérapeutiques des déformations d’axe des membres inférieurs de l’enfant africain. Revue de 43 cas.

La description des aspects cliniques des déformations d’axe des membres inférieurs de l’enfant intéresse de plus en plus, les auteurs africains. Toutefois, leur prise en charge thérapeutique et notamment le volet chirurgical mérite d’être mieux codifiée. L’étude rétrospective de juillet 1998 à décembre 2003, dans deux services d’Orthopédie-Traumatologie de Yaoundé et Douala avait pour but de dégager les aspects diagnostiques et thérapeutiques de ces affections dans notre contexte. Elle a porté sur les dossiers médicaux des enfants opérés pour déformations d’axe des membres inférieurs. Pour chaque patient, le diagnostic était radio-clinique et l’essentiel du geste chirurgical représenté par les ostéotomies tibiales et ou fémorales cunéiformes et les épiphysiodèses par agrafage. Quarante trois dossiers ont été colligés parmi lesquels 31 filles et 12 garçons, soit un sex ratio de 0,3. L’âge moyen de nos patients était de 9,5 ans. Trente huit pour cent et demi des patients présentaient une déviation angulaire supérieure ou égale à 45°. Soixante dix ostéotomies cunéiformes et 3 épiphysiodèses par agrafage étaient réalisées. Le taux de complication était de 0,6 par genou opéré. La chirurgie est une méthode efficace pour traiter les déformations d’axe des membres inférieurs dans leurs formes sévères, fréquentes en Afrique

Acute Gout Attack in Cameroonians and Oxidative Stress: Cause and Effect?

International audienc

Erodibility of Cultivated Soils in the Foumbot Area (West Cameroon)

Agricultural lands in Western highlands of Cameroon are likely to face severe erosion because of the interactions of the following factors: high intensity of agricultural activities, poor farming practices and high rainfall intensity. However, the severity of this soil erosion can vary significantly with the ease with which soil is detached and transported by erosion agents. That is why a study was carried out in the Foumbot area in order to evaluate the soil erosion risk variation with some soil types. Thirty one soil samples were collected at 0–20 cm depth from three main soil types encountered in the area (Andosols, Acrisols and Ferralsols). Soil samples were analyzed for particle size distribution (Total clay, Total silt, Water dispersible clay, Water dispersible silt), Soil organic matter, Soil reaction, CEC, Exchangeable bases, clay dispersion ratio, dispersion ratio, clay aggregation and Mean weight diameter). Soil erodibility indicators were determined and used to estimate soil erosion risk for the three soil types. The results showed high dispersive potential of the three soil types. Soil characteristics and the deriving soil erodibility vary from one soil type to another. The most vulnerable soils are the Acrisols and the less erodible are the Andosols. Soil mineralogy seems to be the key factor regulating soil erodibility variation in the area. The Water-Dispersible Silt (WDS) correlates positively with the Soil organic matter (r=+0.67, p=0.000). The Water-Dispersible Clay (WDC) significantly correlates negatively with the soil organic matter (r=-0.61, p=0.000). WDC also showed significant negative correlation with calcium (r=-0.67, p=0.016) and potassium (r=-0.74, p=0.000). Based on its strong correlation with erodibility parameters, soil organic matter content appeared as the main soil characteristic through which soil conservation measures could easily be implemented in the studied area

Occupational factors are not factors for chronicity in patients with low back pain in sub-Saharan Africans: a hospital-based study from Cameroon

Background: Factors associated to chronicity of nonspecific Low Back Pain (LBP) are scarce in sub-Saharan Africa (SSA). Objectives: To identify the factors associated to the persistence at two years of nonspecific LBP in rheumatology outpatients seen in a teaching hospital in Cameroon. Design: This was a cross-sectional study done in the General Hospital, Douala. Methods: Adult patients with chronic LBP were included and divided into two groups according to disease duration (<2 years and ≥2 years). Factors associated to the persistence at 2 years of LBP was statistically significant if p<0.05. Results: Two hundred and three patients (157 women) with nonspecific LBP with mean age 55.9±12.8 years were included. The patients  were grouped into workers involved in heavy labour or in jobs that require physical efforts (n = 122; 60.1%) and workers in blue-collar jobs with prolonged standing and/or sitting (n = 81; 31.9%). The following factors were significantly associated with the persistence at two years of LBP: advanced age, female gender, high number of children (for women), history of LBP, multiple recurrences with persistent pain and the high pain intensity. Even though there is a tendency towards the statistical significance of the lifting of heavy loads (p=0.06), we did not find any significant association between the occupational factors and the persistence at two years of LBP. Conclusion: There is a lack of association between the occupational factors and the persistence at two years of the LBP in a sub-Saharan population in Cameroon. Only some socio-demographic and clinical factors are statistically significant

Modulation of Anopheles gambiae Epsilon glutathione transferase activity by plant natural products in vitro

Elevated glutathione transferase (GST) E2 activity is associated with DDT resistance in the mosquito Anopheles gambiae. The search for chemomodulators that inhibit the function of AgGSTE2 would enhance the insecticidal activity of DDT. Therefore, we examined the interaction of novel natural plant products with heterologously expressed An. gambiae GSTE2 in vitro. Five of the ten compounds, epiphyllocoumarin(Tral-1), knipholone anthrone, isofuranonaphthoquinones (Mr 13/2, Mr 13/4) and the polyprenylated benzophenone (GG1) were shown to be potent inhibitors of AgGSTE2 with IC50 values of 1.5 mu M, 3.5 mu M, 4 mu M, 4.3 mu M and 4.8 mu M respectively. Non-competitive inhibition was obtained for Tral 1 and GG1 with regards to GSH (K-i of 0.24 mu M and 0.14 mu M respectively). Competitive inhibition for Tral1 was obtained with CDNB (K-i = 0.4 mu M) whilst GG1 produced mixed type of inhibition. The K-i and K-i' for GSH for Tral-1 and GG1 were 0.2 mu M and 0.1 mu M respectively. These results suggest that the novel natural plant products, particularly Tral-1, represent potent AgGSTE2 in vitro inhibitors

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

Research capacity strengthening in Africa: Perspectives from the social sciences, humanities, and arts

Global and human development and freedoms increasingly thrive on robust and policy-orientated research and related activities. Yet, the African research landscape faces a myriad of challenges which have resulted in a very unequal continent in terms of research and research capacity. The prevailing research inequities and challenges in Africa are even more pronounced in the social sciences, humanities, arts, and related fields (SSHA). Here, the strengths and impact of scholarship in SSHA fields are often overshadowed by deficits and apparent preferential investment in research in science, technology, engineering, and mathematics-related fields. In response, the African Academy of Sciences commissioned a study in 2020 to generate evidence on the SSHA research support landscape in Africa. This paper summarizes findings from literature review, key informant interviews, a bibliometric analysis, a survey with a sample of 670 respondents from SSHA communities in Africa, and a series of focus group discussions. We highlight key messages and make recommendations focussing on lessons learnt, opportunities, needs, and priorities for intervention to enhance significant SSHA research leadership capacity strengthening and, ultimately, minimize research inequalities in Africa