Early mortality during initial treatment of tuberculosis in patients co-infected with HIV at the Yaoundé Central Hospital, Cameroon : an 8-year retrospective cohort study (2006-2013)

BACKGROUND: Understanding contributors to mortality during the initial phase of tuberculosis (TB) treatment in patients co-infected with HIV would guide targeted interventions to improve survival. The aim of this study was to ascertain the incidence of death during the initial 2 months (new cases) and 3 months (retreatment cases) of TB treatment and to assess correlates of mortality in HIV co-infected patients. METHODS: We conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify co-infected TB/HIV inpatients aged 15 years and older who died during TB treatment. Death was defined as any death occurring during TB treatment, as per World Health Organization recommendations. We collected socio-demographic, clinical and laboratory data. We conducted multivariable logistic binary regression analysis to identify factors associated with death during the intensive phase of TB treatment. Magnitudes of associations were expressed by adjusted odds ratio (a OR ) with 95% confidence interval. A p value < 0.05 was considered statistically significant. RESULTS: The 99 patients enrolled had a mean age of 39.5 (standard deviation 10.9) years and 53% were male. Patients were followed for 276.3 person-months of observation (PMO). Forty nine patients were died during intensive phase of TB treatment. Death incidence during the intensive phase of TB treatment was 32.2 per 100 PMO. Having a non-AIDS comorbidity (a OR 2.47, 95%CI 1.22-5.02, p = 0.012), having extra-pulmonary TB (a OR 1.89, 95%CI 1.05-3.43, p = 0.035), and one year increase in duration of known HIV infection (aOR 1.23, 95%CI 1.004-1.49) were independently associated with death during the intensive phase of TB treatment. CONCLUSIONS: Mortality incidence during intensive phase of TB treatment was high among TB/HIV co-infected patients during TB treatment; and strongly associated with extra pulmonary TB suggesting advanced stage of immunosuppression and non-AIDS comorbidities. Early HIV diagnosis and care and good management of non-comorbidities can reduce this incidence

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Surgical treatment of lateral ankle instability. Does allograft tendon have a better functional result?

IntroductionSurgical treatment of lateral ankle instability can be performed with or without allograft. We compared these two technical options referring to patients’ functional, radiological and ultrasound data.Material and methodsForty patients were surgically treated for lateral painful instability of the ankle. Twenty patients underwent ligamentoplasty using the Broström-Gould technique and twenty underwent a ligamentoplasty by allograft tendon. Patients were matched in age and gender. The assessment was done at 2.5 years postoperatively by functional scores (Olerud &amp; Molander, and Foot &amp; Ankle Outcome), dynamic x-rays (focused on varus and anterior drawer stress tests) and ultrasound examination (focused on anterior talo-fibular and calcaneo-fibular ligaments). ResultsNo significant difference was found between the two techniques for all scores. DiscussionFunctional scores were more than 75% and the complication rate was low (&lt;10%). Regarding the surgical technique, the tendon allograft could not prove to be more beneficial

Management of Patella Dislocation in Say-Barber-Biesecker-Young-Simpson’s Syndrome: A Report of Two Cases

Say-Barber-Biesecker-Young-Simpson’s syndrome is one of the Ohdo-like syndromes. It is a very rare congenital condition that is commonly defined by its main clinical features that are blepharophimosis, ptosis, mental retardation, and delayed motor development. They are often associated with skeletal manifestations that are joint laxity, long thumbs and toes, and hypoplastic and/or dislocated patellae. To our knowledge, the available literature does not report any case where attention is drawn to management of skeletal aspect of this specific syndrome, especially surgically. We report 2 cases of SBBYS syndrome with patellar dislocation that we followed for 11 years. One case (with bilateral dislocation) was managed conservatively, and the other (with unilateral dislocation) underwent conservative and surgical treatment. Both had good functional outcome at follow-up. This experience shows that patellar abnormality in this condition can be efficiently addressed conservatively and/or surgically with satisfying results

Functional evaluation of unstable distal radius fractures treated with an angle-stable volar T-plate

Evaluation of the levels of function, disability and quality of life of 23 patients with an unstable fracture of the distal radius treated with an angle-stable volar T-plate. During the period from 24/10/2004 to 01/02/2006 we carried out a prospective study including 23 patients. The fractures were 23A22 (n = 5), 23C11 (n = 4), 23C12 (n = 4) and 23C13 (n = 6). Impairment, disability and quality of life were evaluated 6 months after the injury. The evaluation of impairment included assessment of mobility of the wrist, global hand strength, key pinch strength and sensibility. There was an average loss of 0.715 for the Zscore of the grip strength and 0.531 for the Z-score of the key pinch strength. For sensibility, there was no significant difference between the fractured side and the uninjured side. The radiographs demonstrated a correction of volar tilt from -11.2° to 4.9°, of ulnar inclination from 14.3° to 22.9°, of radial shift from 19.9 mm to 16.8 mm, of radial length from 5.7 mm to 11.2 mm and of the RUI from -1.9 mm to 0.6 mm. The global DASH score was 55.7. The level of pain was 1.3 on the VAS. The mental SF-12 score was 48.4 and the physical SF-12 score 46.4. Treatment of unstable distal radius fractures with volar fixed-angle plates without additional bone graft led to good reduction of the fractures without significant secondary displacement © 2014, Acta Orthopædica Belgica

Surgical treatment of lateral ankle instability. Does allograft tendon have a better functional result?

Surgical treatment of lateral ankle instability can be performed with or without allograft. We compared these two technical options referring to patients’ functional, radiological and ultrasound data. Forty patients were surgically treated for lateral pain- ful instability of the ankle. Twenty patients underwent ligamentoplasty using the Broström-Gould technique and twenty underwent a ligamentoplasty by allograft tendon. Patients were matched in age and gender. The assessment was done at 2.5 years postoperatively by functional scores (Olerud & Molander, and Foot & Ankle Outcome), dynamic x-rays (focused on varus and anterior drawer stress tests) and ultrasound examination (focused on anterior talo-fibular and calcaneo-fibular ligaments). No significant difference was found between the two techniques for all scores. Functional scores were more than 75% and the com- plication rate was low (<10%). Regarding the surgical technique, the tendon allograft could not prove to be more beneficial

La correction du DMAA dans la cure de l'hallux valgus: un atout essentiel d'un point de vue clinique et radiologique?

La correction du DMAA dans la cure de l'hallux valgus: un atout essentiel d'un point de vue clinique et radiologique

K-13 propeller gene polymorphisms isolated between 2014 and 2017 from Cameroonian Plasmodium falciparum malaria patients.

The emergence of artemisinin-resistant parasites since the late 2000s at the border of Cambodia and Thailand poses serious threats to malaria control globally, particularly in Africa which bears the highest malaria transmission burden. This study aimed to obtain reliable data on the current state of the kelch13 molecular marker for artemisinin resistance in Plasmodium falciparum in Cameroon. DNA was extracted from the dried blood spots collected from epidemiologically distinct endemic areas in the Center, Littoral and North regions of Cameroon. Nested PCR products from the Kelch13-propeller gene were sequenced and analyzed on an ABI 3730XL automatic sequencer. Of 219 dried blood spots, 175 were sequenced successfully. We identified six K13 mutations in 2.9% (5/175) of samples, including 2 non-synonymous, the V589I allele had been reported in Africa already and one new allele E612K had not been reported yet. These two non-synonymous mutations were uniquely found in parasites from the Littoral region. One sample showed two synonymous mutations within the kelch13 gene. We also observed two infected samples with mixed K13 mutant and K13 wild-type infection. Taken together, our data suggested the circulation of the non-synonymous K13 mutations in Cameroon. Albeit no mutations known to be associated with parasite clearance delays in the study population, there is need for continuous surveillance for earlier detection of resistance as long as ACTs are used and scaled up in the community

Kaplan-Meier survival curve of cumulative survival over time during tuberculosis treatment of patients co-infected with HIV.

<p>Kaplan-Meier survival curve of cumulative survival over time during tuberculosis treatment of patients co-infected with HIV.</p