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Background Little is known about the changes in disease makers and risk factors in patients with chronic kidney disease (CKD) under nephrological care in Africa. This study aimed to evaluate the baseline level of markers of CKD and their 12-month time-trend in newly referred patients in a tertiary hospital in Cameroon. Methods This was a retrospective cohort study including 420 patients referred for CKD between 2006 and 2012 to the nephrology unit of the Douala General Hospital in the littoral region of Cameroon. Their disease and risk profile was assessed at baseline and every 3 months for 1 year. Estimated glomerular filtration rate (eGFR) was based on MDRD and Schwartz equations. CKD was diagnosed in the presence of eGFR2 and/or proteinuria> 1+ and/or abnormal renal ultrasound persisting for ≥3 months. Data analysis used mixed linear regressions. Results Of the 420 patients included, 66.9% were men and mean age was 53.8 (15.1) years. At referral, 37.5% of the participants were at CKD Stage 3, 30.8% at stage 4 and 26.8% at stage 5. There was 168 (40%) diabetic and 319 (75.9%) hypertensive patients. After some improvement during the first 3 months, eGFR steadily decreased during the first year of follow-up, and this pattern was robust to adjustment for many confounders. Systolic and diastolic blood pressure levels significantly fluctuated during the first twelve months of follow-up. Changes in the levels of other risk factors and markers of disease severity over time were either borderline or non-significant. Conclusion Patients with CKD in African settings are referred to the nephrologist at advanced stages. This likely translates into a less beneficial effects of specialised care on the course of the disease.

English Title: The overall survival of patients aged less than 65 years old with multiple myeloma under chemotherapy at the General Hospital of DoualaEnglish AbstractAbstract: the multiple myeloma or Khaler’s disease is a malignant hemopathy who falls under both old and young person. It is the second malignant hemopathy after the lymphomas. It is responsible for about 1% of death’s cancer and about 19% of death’s malignant hemopathy. The purpose of this study was to determine the overall survival of patients aged less than 65 years with multiple myeloma undergoing chemotherapy over a 10 years period at the General Hospital of Douala.Method: it was a retrospective, descriptive and analytical study conducted in the department of internal medicine (Hematology unit) going on 05 December 2016 to June 30 2017. The sample method was non-random, with consecutive and exhaustive type of recruitment of patient records obedient of the inclusion criteria. The analyzed variables were demographic, paraclinical, therapeutic and evolutionary. The survival curves were plotted using the Kapplan Meier method. The survival comparisons were made by the Log Rank test and the p-values interpreted at a threshold of 5%.Results: 51 patient’s records from 19 to 65 years old were eligible. The average age of patients was from 54,22 years to 8,608years. There was a slight female predominance with a sex ratio of 0, 21. The monoclonal gamma peak was in 81,81% of cases objective. The immunoglobulin G was predominant and the Kappa light evolution was found in 81, 1% of cases. Our patients were predominately on stage 3 of Durie and Salmon (70, 58%) and 50% at stage 3 of the ISS score. Our patients have been treated using VMCP, MP and MPT protocols. The VMCP was the most used protocol on the first and second line (58, 82% and 54, 16%) with a very good practical response rate of 60% in the first line. The second-line protocol choice and compliance were statistically significant on treatment response (p=0,02; p=0,026 respectively). For an average follow-up of 24,06 months (range: 1-120), the median SG was 38 months. The percentage of SG in 5 years was 26,90%. The median progression-free survival was 69 months. The survival with progression was 84, 36 months. The factors associated with the overall survival in our level were the protocol choice and the percentage of hemoglobin. (p= 0,04; p=0,08 respectively).Conclusion: the patients are diagnosed at an advanced stage. The health care, the good compliance and the use of news molecules could improve the survival of our patients. This group of patients benefit from the therapeutic intensification by an auto implantation not yet available in our context.Keywords: Mylemo of the young subject, survival, General Hospital in Douala

Introduction. Il est établi qu’une consommation excessive de sel augmente la pression artérielle (PA) et le risque d’hypertension artérielle (HTA). Le but de cette étude était d’évaluer l’impact de la consommation de sel, estimée par l’excrétion urinaire de sodium, sur la PA et le risque HTA dans l’extrême-Nord du Cameroun.Méthodes. Des enquêteurs bien entraînés ont recueilli les données socio-démographiques, les habitudes de vie et l’histoire médicale de 889 adultes (âge moyen : 39±15ans, 58.5% d’hommes), dont 461 en milieu urbain (Maroua) et 428 en milieu rural (Tokombere), et obtenu l’indice de masse corporelle (IMC), la circonférence abdominale (CA), la PA, la glycémie capillaire à jeûn et un échantillon casuel d’urines matinales. L’excrétion urinaire de sodium et potassium était mesurée par photométrie de flamme. Conformément aux directives de la Société Européenne de Cardiologie, l’HTA était définie pour une PA≥140/90 mmHg ou la prise de traitement anti-hypertenseur.Résultats. La prévalence globale d’HTA standardisée pour l’âge était de 37.8% (urbain : 41.2% ; rural : 34%;). Les PA systolique (PAS), diastolique (PAD) et moyenne (PAM) ajustées pour l’âge étaient plus élevées chez les participants de Maroua que chez ceux de Tokombere (tous les p 140/90mmHg or ongoing antihypertensive therapy.Results. The age-standardized prevalence of hypertension was 37.8% (rural: 34%; urban: 41.2%). Age-adjusted systolic (SBP), diastolic (DBP) and mean arterial (MAP) BP were higher in urban than rural dwellers (all p

Introduction: Un déficit et une mauvaise qualité du sommeil représentent des facteurs émergents du risque cardio-métabolique tel que l’hypertension artérielle (HTA). L’objectif de cette étude était d’évaluer l’impact de la qualité et de la durée du sommeil sur la variabilité de la pression artérielle (PA) et le risque d’HTA chez l’adulte Camerounais.Méthodologie : Il s’agit d’une étude transversale menée chez 499 participants (âge moyen =36±12ans ; femmes=60.9%) recrutés aléatoirement par un échantillonnage en grappe, respectivement à Douala (milieu urbain, n=249) et à Njombé (zone rurale, n=250). Chez tous les participants, nous avons mesuré la PA et la glycémie capillaire à jeûn et récolté des données anthropométriques. La qualité et la durée du sommeil ont été évaluées à l’aide du questionnaire Pittsburgh Sleep Quality Index (PSQI). Un score de PSQI >5 correspond à une mauvaise qualité du sommeil, tandis qu’un déficit était défini comme une durée de sommeil 5. La prévalence d’HTA et de diabète était plus élevée (p5 par rapport à ceux avec PSQI ≤5 : 26% vs 14.3% et 10% vs 6.5%, respectivement. Comparés aux sujets dormant ≥ 6 heures/nuit, les participants avec une dette de sommeil avaient des PAS et PAD plus élevées et une prévalence plus marquée d’HTA (21.7% vs 20.5%, p=ns) et de diabète (13.8% vs 5.8%, p

Background: Increased augmentation index (AI), a surrogate measure of arterial stiffness (AS) and a direct index of wave reflection is an independent predictor of cardiovascular events in chronic kidney disease (CKD) patients. This study aimed to assess the patterns of wave reflection among blacks Cameroonian patients with CKD.Methods: 150 CKD patients (Mean age: 52±15 years, 57% males) were enrolled in this cross-sectional study performed at the Douala General Hospital, between November 2015 and May 2016. Sociodemographic, biologic variables, medical history and current medication, weight, height, waist circumference, blood pressures (BP), heart rate (HR) and AI corrected for HR (Aix) were recorded in all participants. Estimated brachial and aortic AIx, pulse pressure (systolic minus diastolic BP) (PP) were measured using a Mobil-O-Graph automatic brachial oscillometric device.Results: Age, sex and height-adjusted AIx was similar between in non-dialysed (n = 90) and in hemodialysed (n = 60) patients: 22.6 ±4.5% vs 22.2 ±3.7 (P = 0.51). AIx ≥ 30%, suggestive of subclinical aorta damage, was higher in non-dialysis than in hemodialysed patients, especially in post-dialysis: 27.8% vs 18.3%, P = 0.002. Importantly, hemodialysis acutely decreased markedly brachial PP, another surrogate measure of AS, by 6 mmHg (P = 0.008) in patients on maintenance dialysis. Multivariable regression analysis showed that male gender was inversely, while MAP and stage 5 CKD were positively associated with AIx in the whole study group (RR 0.230, P

Introduction: La prévalence de l’hypertension artérielle (HTA) chez les enfants et les adolescents est en nette augmentation en Afrique sub-Saharienne. Toutefois, au Cameroun, son ampleur chez les adolescents reste peu documentée. D'où l'intérêt de notre étude dont le but était d’estimer la prévalence de l’HTA et d’identifier les facteurs de risque associés chez les adolescents scolarisés au Cameroun.Méthode: Il s’agit d’une étude transversale menée auprès d’un échantillon aléatoire représentatif de 815 élèves (54% de filles, âge moyen = 17,8 ± 2,5 ans) scolarisés dans les districts de santé de Biyem-Assi (Milieu urbain, n = 420) et de Bandjoun (Zone rurale, n = 395). Chez tous les participants, nous avons récolté les données anthropométriques et les habitudes de vie ainsi que la moyenne de trois mesures de la pression artérielle (PA). L’HTA était définie pour la PA systolique (PAS) ou diastolique (PAD) > 95ème percentile ajustée pour le sexe, l’âge et la taille.Résultats: La PAD était plus élevée chez les élèves scolarisés en ville que chez leurs congénères scolarisés en zone rurale (78 ±10 vs 75 ±11mmHg, P< 0,0001) tandis que leur PAS était similaire. La prévalence de l’HTA, du surpoids/obésité, du tabagisme, de l’activité physique, de la consommation d’alcool et de fruits/légumes était respectivement de : 17,9% (urbain = 19,2%, rural = 16.7%, P = 0.4); 27.7% (urbain = 20.8%, rural = 34.2%, P 95th percentile adjusted for age, gender and height.Results. DBP was higher in urban adolescents than in their rural counterparts (78 ±10 vs 75 ±11mmHg, P< 0,0001), while SBP was similar in the both two groups. The overall prevalence of hypertension, overweight/obesity, cigarette smoking, physical activity, alcohol drinking and fruit/vegetables consumption was respectively: 17,9% (urban = 19,2%, rural = 16,7%, p = 0,4); 27,7% (urban = 20,8%, rural = 34,2%, P

Introduction: L’hypertension artérielle est un problème majeur de santé publique dans le monde ; c’est une maladie progressive résultant de plusieurs étiologies parmi lesquelles l’hypoxémie nocturne. Face aux difficultés d’obtenir un contrôle des pressions artérielles en pratique malgré les recommandations des sociétés savantes, nous avons mené cette étude dans le but de déterminer l’influence de la saturation nocturne en oxygène sur les pressions artérielles des hypertendus camerounais.Méthodologie: Les hypertendus étaient regroupés en hypertendus contrôlés pour ceux qui avaient les pressions artérielles

Introduction: La vaccination contre la poliomyélite est systématique chez l’enfant mais la présence des foyers épidémiques dans certains pays sub-sahariens a permis de l’adopter comme un vaccin international de façon transitoire. Les vaccinations peuvent être émaillées de nombreuses complications. Les myélites aigues post vaccinales sont peu fréquentes chez l’adulte. Nous rapportons un cas de myélite aigue post-vaccinale après administration d’un vaccin unique combiné.Cas clinique: Un patient âgé de 32 ans, a consulté pour faiblesse musculaire des quatre membres d’installation rapide après une vaccination unique combinant la diphtérie, le tétanos et la poliomyélite. L’examen clinique a montré un patient fébrile, une tétra parésie flasque symétrique mais prédominant aux membres inférieurs associée à un déficit sensitif bilatéral ayant un niveau supérieur cervical. L’étude du liquide céphalo-rachidien (LCR) a révélé une réaction méningée et la culture sur milieux usuels était négative. Les tests sérologiques et les marqueurs auto-immuns étaient tous négatifs. L’imagerie par résonnance magnétique (IRM) médullaire montrait un hyper signal cervical extensif de toute la moelle cervical en séquence T2 et l’IRM cérébrale était normale. Le diagnostic de myélite aigue post vaccinal a été retenu après avoir éliminé toutes les autres causes de myélite extensives. Un traitement à base de corticoïdes a été institué associé à une physiothérapie avec une récupération motrice totale sans séquelles ni récidive clinique après un an.Conclusion: Les complications post vaccinales sont multiples et possibles avec tous les vaccins. Elles peuvent être graves chez l’adulte d’où la nécessité de bien évaluer la balance risque /bénéfice avant son administration.Mots clés: myélite, vaccination, corticothérapie, poliomyéliteEnglish Title: Post-vaccination acute myelitis in a young AfricanEnglish AbstractBackground: Immunization against poliomyelitis is routine in children, but the presence of epidemic foci in some sub-saharan countries makes it adopted as an international vaccine. Vaccinations can lead to many complications. Post vaccination myelitis is infrequent in adult. We report a case of post-vaccination acute myelitis after administration of a single combination vaccine.Case report: A 32-year-old patient presented with a rapid onset of 4 limbs weakness ten days after receiving a single vaccination combining diphteria, tetanus and poliomyelitis. At clinical examination, the patient was febrile with tetraparesia predominent at lower limbs associated with a bilateral sensory deficit at the superior cervical level. Cerebrospinal fluid analysis revealed a meningeal irritation and sterial culture on usual media. Serological tests and autoimmune markers were also negative. Medullar MRI showed extensive cervical hypersignal of the whole cervical cord in T2 sequence. The cerebral MRI was normal. The diagnosis of post-vaccination acute myelitis was retained after eliminating all other causes of extensive myelitis. Corticosteroid treatment was instituted with physiotherapy with total motor recovery without sequelae and no clinical recurrence after one year.Conclusion: Post-vaccination complications are multiple and possible with all vaccines. They can be serious in adults, hence it’s important to evaluate the risk /benefit ratio before administration.Keywords: Myelitis, Vaccination, Corticotherapy, Poliomyélytis

Context: Human immunodeficiency virus (HIV) infection and resulting immune depression are associated with increase proportions of extrapulmonary tuberculosis (EPTB). The prevalence of EPTB varies across studies between 15 and 50% and depends on the region, ethnic group studied, and HIV coinfection rates. In Cameroon, no studies have been done so far to evaluate the magnitude of this form of tuberculosis (TB), the various sites involved, and their association with HIV infection. Aims: To determine the prevalence of EPTB, the various organ sites affected and their association with HIV infection in a population of patients treated for TB. Settings and Design: We did cross-sectional analysis of the data from the TB register of the Douala General Hospital, a tertiary health institution situated in Douala, Cameroon. All cases of TB diagnosed between 1 st July 2007 and 30 th June 2011 were included. Results: Of total of 749 patients recorded for anti-TB treatment, the overall prevalence of HIV was 41.5% (95% confidence interval [CI]38-45.1). The prevalence of EPTB was 42.9% (321). HIV infection was present in 33.6% of patients with EPTB. The most affected sites of disease were bones and joints (29.6%), lymph nodes (17.8%), the pleura (15%), peritoneum (14.3%), and the central nervous system and meninges (9%). Neuromeningeal TB however, less common was most strongly associated with HIV infection, odd ratio (OR)2.3 (95% CI 1.1-5.0, p < 0.05). Conclusions: The proportion of EPTB among TB patients treated in the Douala General Hospital is relatively high with bone and joints being the most affected sites. HIV infection is most strongly associated with neuromeningeal forms.