Alarming rates of virological failure and HIV-1 drug resistance amongst adolescents living with perinatal HIV in both urban and rural settings: evidence from the EDCTP READY-study in Cameroon

Objectives: Adolescents living with perinatal HIV infection (ALPHI) experience persistently high mortality rates, particularly in resource-limited settings. It is therefore clinically important for us to understand the therapeutic response, acquired HIV drug resistance (HIVDR) and associated factors among ALPHI, according to geographical location. Methods: A study was conducted among consenting ALPHI in two urban and two rural health facilities in the Centre Region of Cameroon. World Health Organization (WHO) clinical staging, self-reported adherence, HIVDR early warning indicators (EWIs), immunological status (CD4 count) and plasma viral load (VL) were assessed. For those experiencing virological failure (VF, VL ≥ 1000 copies/mL), HIVDR testing was performed and interpreted using the Stanford HIV Drug Resistance Database v.8.9-1. Results: Of the 270 participants, most were on nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens (61.7% urban vs. 82.2% rural), and about one-third were poorly adherent (30.1% vs. 35.1%). Clinical failure rates (WHO-stage III/IV) in both settings were < 15%. In urban settings, the immunological failure (IF) rate (CD4  < 250 cells/μL) was 15.8%, statistically associated with late adolescence, female gender and poor adherence. The VF rate was 34.2%, statistically associated with poor adherence and NNRTI-based antiretroviral therapy. In the rural context, the IF rate was 26.9% and the VF rate was 52.7%, both statistically associated with advanced clinical stages. HIVDR rate was over 90% in both settings. EWIs were delayed drug pick-up, drug stock-outs and suboptimal viral suppression. Conclusions: Poor adherence, late adolescent age, female gender and advanced clinical staging worsen IF. The VF rate is high and consistent with the presence of HIVDR in both settings, driven by poor adherence, NNRTI-based regimen and advanced clinical staging

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Burkitt lymphoma: The Cameroon 2008 CBC protocol - preliminary report

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Oxalate Free Averrhoa Carambola Fruit Juice and Wine Produced by a Modified Oxalate Route (Synthesis of Zinc Oxalate)

Carambola is highly valued for its fruits, especially the pulp which is used for a wide variety of domestic and industrial purposes. The Carambola fruit is a nutritious food containing acids, vitamins, phytosterols and other phytochemicals. The drinks (Fruit juice and fruit wine) from Averrhoa Carambola L. are specific due to their taste and flavor. However, they contain oxalate at concentrations which are not health promoting when consumed. We are taking this advantage to explore wine fermentation from Carambola fruit pulp by focusing on the effect of different parameters such as time of treatment for juice extraction, yeast inoculate for wine fermentation and secondary fermentation to wine quality, and to  precipitated the oxalate ions from the juice and wine using metal zinc ions as a fruit metal.  The main fermentation was done at 25o C in 13 days, and 1 week of secondary fermentation in dark bottle at 25o C. The wine produced was characterized for alcoholic content, pH, titratable acidity, Brix, and consumer acceptability while the precipitate (Zinc Oxalate) was characterized by FTIR and PXRD. The carambola fruit pulp juice and wine produced were of acceptable quality (clear, sweet, sparkling, smooth and flavoured) following the olfactory test. The drink had a pH of 4.02 and 11.2 %, alcohol content while the FTIR and PXRD results revealed that oxalate ions were precipitated from the juice and wine by zinc ions, and   after precipitation of the juice and wine, the oxalate concentration in the drinks were reduced to health promoting levels. Furthermore, the precipitation process did not affect the acceptability of the wine as the olfactory parameter were not actually affected