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Aims: To report the prevalence of undiagnosed diabetes and its determinants among adults Cameroonian urban dwellers. Methods: On May 17th 2011, a community-based combined screening for diabetes and hypertension was conducted simul...
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Aims: To report the prevalence of undiagnosed diabetes and its determinants among adults Cameroonian urban dwellers. Methods: On May 17th 2011, a community-based combined screening for diabetes and hypertension was conducted simultaneously in four major Cameroonian cities. Adult participants were invited through mass media. Fasting blood glucose was measured in capillary blood. Results: Of the 2120 respondents, 1591 (52% being men) received a fasting glucose test. The median age was 43.7 years, and 64.2% were overweight or obese. The sex-specific age adjusted prevalence (for men and women) were 10.1% (95% confidence interval [CI]: 8.1-12.1%) and 11.2% (95%CI: 9.1-13.3%) for any diabetes, and 4.6% (95%CI: 2.6-6.6%) and 5.1% (95%CI: 3.0-7.2%) for screened-detected diabetes, respectively. The prevalence of diabetes increased with increasing age in men and women (all p ≤ 0.001 for linear trend). Older age (p < 0.001), region of residence (p < 0.001), excessive alcohol intake (p = 0.02) were significantly associated with screened-detected diabetes, while physical inactivity, body mass index, and high waist girth were not significantly associated with the same outcome. Conclusions: Prevalence of undiagnosed diabetes is very high among Cameroonian urban dwellers, indicating a potentially huge impact of screening for diabetes, thus the need for more proactive policies of early detection of the disease.
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Aim: This study assessed the prevalence and determinants of electrocardiographic abnormalities in a group of type 2 diabetes patients recruited from two referral centres in Cameroon. Methods: A total of 420 patients (49% men) rece...
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Aim: This study assessed the prevalence and determinants of electrocardiographic abnormalities in a group of type 2 diabetes patients recruited from two referral centres in Cameroon. Methods: A total of 420 patients (49% men) receiving chronic diabetes care at the Douala General and Yaoundé Central hospitals were included. Electrocardiographic abnormalities were investigated, identified and related to potential determinants, with logistic regressions. Results: The mean age and median duration of diagnosis were 56.7 years and four years, respectively. The main electrocardiographic aberrations (prevalence %) were: T-wave abnormalities (20.9%), Cornell product left ventricular hypertrophy (16.4%), arrhythmia (16.2%), ischaemic heart disease (13.6%), conduction defects (11.9%), QTc prolongation (10.2%) and ectopic beats (4.8%). Blood pressure variables were consistently associated with all electrocardiographic abnormalities. Diabetes-specific factors were associated with some abnormalities only. Conclusions: Electrocardiographic aberrations in this population were dominated by repolarisation, conduction defects and left ventricular hypertrophy, and were more related to blood pressure than diabetes-specific factors.
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Since the aetiologies of neuropathic pain are most often degenerative or age related, it is not surprising that these conditions are more common in the elderly (Ahmad and Goucke, 2002; Pickering and Capriz-Ribiere, 2008). Neuropat...
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Since the aetiologies of neuropathic pain are most often degenerative or age related, it is not surprising that these conditions are more common in the elderly (Ahmad and Goucke, 2002; Pickering and Capriz-Ribiere, 2008). Neuropathic pain occurs and persists in a heterogeneous group of aetiologically different diseases, with various physio-pathological mechanisms (Cruccu and Truini, 2009; Baron et al., 2012). Patients with neuropathic pain present with various pain-related sensory abnormalities (Baron et al., 2012). Subgrouping patients with neuropathic pain on the basis of individual sensory profiles could guide the choice of pharmacological agents to be proposed to each patient (Bouhassira et al., 2004; Cruccu and Truini, 2009; Baron et al., 2012).
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Little is known about the challenges of routine renal replacement therapy in Sub-Saharan Africa. We investigated the fatal and nonfatal acute hemodialysis (HD) complications in patients with end-stage renal disease (ESRD) in two m...
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Little is known about the challenges of routine renal replacement therapy in Sub-Saharan Africa. We investigated the fatal and nonfatal acute hemodialysis (HD) complications in patients with end-stage renal disease (ESRD) in two main dialysis centers in Cameroon. 1000 consecutive HD sessions incurred over a 4-month period by 129 patients (96 men, 74%) with ESRD, receiving two weekly HD sessions of 4 hours each, were considered. Personal and clinical profiles before, during, and within 24 hours after HD sessions were used to diagnose complications. Participants were aged 7 to 80 years (mean 46 years). In all, 452 acute complications were recorded in 411 (41%) of the 1000 HD sessions. Of the 11 types of complications, hypotension (25%), muscular cramps (22%), hypertensive crisis (14%), pruritus (10%), and fever (7%) were the most frequent. Three hundred and six complications (67.7%) occurred during understaffed nighttime. The vascular access was the main bleeding site with 64%. Being diabetic and ultrafiltration rate >1000mL/h were associated with hypotension and muscle cramps. The shorter duration in dialysis was associated with the risk of bleeding and the disequilibrium syndrome while longer duration was associated with muscle cramps. Four deaths (three from bleeding and one from disequilibrium syndrome) occurred, all during nighttime. Nearly half of dialysis sessions in these settings are associated with acute complications, some of which are fatal. Those complications occurred mostly during understaffed periods. Urgent strategies are needed to quickly solve the human capital crisis in the health care sector.
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Over 61 % of Cameroonians continue to rely on polluting fuels for cooking with negative consequences for health and the environment. To understand current and potential use of electricity as a clean energy source for cooking (eCoo...
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Over 61 % of Cameroonians continue to rely on polluting fuels for cooking with negative consequences for health and the environment. To understand current and potential use of electricity as a clean energy source for cooking (eCooking), we conducted a mixed-methods study among households from three major urban/peri-urban centres in Cameroon: Douala, Yaounde and Mbalmayo. Survey data from 1509 households, followed by an intensive one week "cooking diary" with 25 primary cooks and 10 semi-structured qualitative interviews, provided detailed information on cooking behaviours and fuel choices. Liquefied petroleum gas (LPG) was preferred for daily cooking, with firewood or charcoal used for traditional dishes. Electricity was used only as secondary or tertiary fuel by 20 % (n = 311) of survey respondents and only used once a week or less, mainly to cook rice and pasta or boiling water. For those households using eCooking, the most common appliances were rice cookers and hobs; smart-meters attached to the eCooking appliances showed high voltage fluctuation (＜160 V to 250 + V) which are suboptimal for sustained eCooking use. To scale up adoption of electricity for clean cooking policies for (ⅰ) subsidising cost, (ⅱ) strengthening reliability of service provision and (ⅲ) addressing safety concerns are needed in addition to awareness-raising of the benefits and practicalities of using eCooking appliances for everyday meals.
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The Douala prenatal diagnosis staff meeting is an unprecedented experience. It is a multidisciplinary staff that was created in October 2006 in Douala (Cameroon), involving physicians from both private and public sectors.The aim i...
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The Douala prenatal diagnosis staff meeting is an unprecedented experience. It is a multidisciplinary staff that was created in October 2006 in Douala (Cameroon), involving physicians from both private and public sectors.The aim is to provide quality prenatal diagnosis to patients.The staff allows professionals to discuss cases, perform a 'second prenatal sonography' with a referral practitioner, reach a consensual decision, and carry out genetic and psychological counselling.
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Background: To present the particular aspects of arteriovenous fistula (AVF) for hemodialysis in sub-Saharan Africa in terms of patients' characteristics, patency and complication rates, as well as factors influencing them. Method...
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Background: To present the particular aspects of arteriovenous fistula (AVF) for hemodialysis in sub-Saharan Africa in terms of patients' characteristics, patency and complication rates, as well as factors influencing them. Methods: From November 2002 to November 2009, 518 fistulas were constructed on adults. Demographic data, patency, and complications were analyzed. The association between age, sex, and comorbidities (HIV, hypertension, diabetes) on one hand and complications as well as AVF patency on the other was sought. Results: Males represented 73.7% of the patient population, and the mean age of the population was 45.3 years. As far as etiologies of end-stage renal disease (ESRD) and comorbidities are concerned, chronic glomerulonephritis was the leading cause of ESRD (134; 25.9%), followed by hypertension (22.3%), although prevalent in 83.2% of patients, and diabetes (20.1%), although prevalent in 22.2%. No cause for the ESRD could be identified in 89 patients (17.2%). Only 20.64% had AVF as the initial vascular access. The main types of AVF constructed were radiocephalic (68%) and brachiocephalic (24.9%). The median follow-up period was 275 days. The cumulative patency rate at 1 year and 2 years was 76% and 51%, respectively. Altogether, 188 complications occurred in 16% of the AVFs. Aneurysms, failure to mature, and thrombosis were the most frequent complications occurring in 27.65%, 14.89%, and 10.63% of cases, respectively. The management options for the complications included the creation of a new access for 63 complications (33.51%) and nonoperative management in 44.14% of the cases. We found no adverse effect of comorbid factors like diabetes mellitus (χ 2 = 3.58, P > 0.05) and HIV-positive status (χ 2 = 0.64, P > 0.05) on the complications rate. Conclusion: According to our patients' characteristics, there is a possibility of constructing AVF on nearly every hemodialysis patient with a good outcome.
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Two new steroids, 22E, 24R-stigmast-22-ene-3,6,11-trione (1) and 22E, 24R-3-acetylstigmasta-5,22-diene-7,11-dione (2), and one new ceramide, (2S,3S,4R,5R) N-(1,3,4,5-tetrahydroxyundecan-2-yl)tetradecanamide (7), together with elev...
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Two new steroids, 22E, 24R-stigmast-22-ene-3,6,11-trione (1) and 22E, 24R-3-acetylstigmasta-5,22-diene-7,11-dione (2), and one new ceramide, (2S,3S,4R,5R) N-(1,3,4,5-tetrahydroxyundecan-2-yl)tetradecanamide (7), together with eleven known compounds were isolated from the CH_2Cl_2 extract of the stem bark of Odyendyea gabonensis. The structures of all compounds were determined by comprehensive analyses of their 1D and 2D NMR, mass spectral (EI and ESI) data, chemical reactions, and comparison with previously known analogs. Pure compounds were tested for their activity against the bacteria Bacillus subtilis, Staphylococcus aureus and Escherichia coli, the fungi Mucor miehei and Candida albicans, and the plant pathogen oomycetes Aphanomyces cochlioides, Pythium ultimum and Rhizoctonia solani using the paper disk agar diffusion assay. For active compounds, MICs were determined by the broth microdilution assay. Cytotoxic activity against the human lung adenocarcinoma cell line A 549 was evaluated by the MTT assay. All compounds delivered low to missing antimicrobial activities in the agar diffusion assay and MICs > 1 mg mL~(-1). The alkaloids 10 and 11 displayed cytotoxic activity against the human lung adenocarcinoma cell line A549 with IC _(50) 2.5 and 4.5 μm respectively.
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Background. Sub-Saharan Africa experiences an epidemic surge in hypertension. Studies in African Americans led to the recommendation to initiate antihypertensive treatment in Blacks with a diuretic or a low-dose fixed combination ...
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Background. Sub-Saharan Africa experiences an epidemic surge in hypertension. Studies in African Americans led to the recommendation to initiate antihypertensive treatment in Blacks with a diuretic or a low-dose fixed combination including a diuretic. We mounted the Newer versus Older Antihypertensive Agents in African Hypertensive Patients (NOAAH) trial to compare in native African patients a fixed combination of newer drugs, not involving a diuretic, with a combination of older drugs including a diuretic. Methods. Patients aged 3069 years with uncomplicated hypertension (140179/90109 mmHg) and two or fewer associated risk factors are eligible. After a 4-week run-in period off treatment, 180 patients will be randomized to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg or amlodipine/valsartan 5/160 mg. To attain and maintain blood pressure below 140/90 mmHg during 6 months of follow-up, the doses of bisoprolol and amlodipine in the combination tablets will be increased to 10 mg/day with the possible addition of α-methyldopa or hydralazine. NOAAH is powered to demonstrate a 5-mmHg between-group difference in sitting systolic pressure with a two-sided p-value of 0.01 and 90% power. NOAAH is investigator-led and complies with the Helsinki declaration. Results. Six centers in four sub-Saharan countries started patient recruitment on September 1, 2010. On December 1, 195 patients were screened, 171 were enrolled, and 51 were randomized and followed up. The trial will be completed in the third quarter of 2011. Conclusions. NOAAH (NCT01030458) is the first randomized multicenter trial of antihypertensive medications in hypertensive patients born and living in sub-Saharan Africa.
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To investigate the part played by undernutrition in malaria severity, some biomarkers of nutritional status were assessed in children with severe malarial anaemia (MA) and cerebral malaria (CM) in comparison with healthy children ...
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To investigate the part played by undernutrition in malaria severity, some biomarkers of nutritional status were assessed in children with severe malarial anaemia (MA) and cerebral malaria (CM) in comparison with healthy children or those with uncomplicated malaria. Undernutrition was assessed using the weight-for-age Z score (WAZ). Retinol was determined by HPLC; lipid profile, Ca, Mg and albumin were determined by spectrophotometry. Severe and moderate undernutritions were more prevalent in children with MA and those with the combined symptoms of CM and MA, but not in those with CM alone. Some perturbations were noticed in the lipid profile, but most of the values remained within the normal ranges. The risk of vitamin A deficiency, as assessed by plasma retinol concentration, was noteworthy in children with severe malaria: 0.48 x 10-6 and 0.50 x 10-6 mol/l, respectively, in children with MA and CM (reference value: >0.7 x 10-6 mol/l). A significant difference was obtained for retinol values after an ANOVA of all the groups (P = 0.0029), with the value in the MA group being significantly low than that in the control group (P < 0.05); likewise, a significant difference was obtained after comparison of all the groups for Mg and albumin (P = 0.0064 and 0.0082, respectively). Despite their low number (n 6), fatal cases of CM had a normal mean WAZ on admission, but low values of retinol, albumin and HDL:LDL ratio. Despite these associations, undernutrition itself did not appear to be a primary factor associated with fatal outcome.
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