49 research outputs found
Male versus female condoms for contraception
No full textCITATION: Motaze, N. V., Okwundu, C. I., Temfack, E. & Mboudou, E. 2013. Male versus female condoms for contraception. Cochrane Database of Systematic Reviews, 6. Art. No.: CD010579, doi:10.1002/14651858.CD010579.The original publication is available at http://www.cochranelibrary.comThe main objective of this review is to compare the female condom to the male condom as a method of contraception.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010579/ful
Épidémiologie et prise en charge optimale de la méningo-encéphalite à cryptocoque associée au sida au Cameroun
No full textCryptococcal meningitis (CM), caused by an encapsulated yeast is a leading cause of AIDS related opportunistic infection in adults in sub-Saharan Africa and a major driver of mortality, second to tuberculosis. We aimed at optimising the management of AIDS-related cryptococcal meningitis in Cameroon through interventional studies. As such, we designed and performed three studies on the role of cryptococcal antigen (CrAg) in CM diagnosis, contributed in a major phase III non-inferiority clinical trial for inductive treatment of CM in the African setting and analysed the trial participants’ tolerability of the antifungals used in the trial. We also contributed in a review on the long-term prognosis of CM and finally in an advocacy paper for CM to be recognised as a neglected tropical disease. In Cameroon, serum CrAg detection, a major risk factor for incident CM in AIDS patient is prevalent in 7.5% of patients initiating antiretroviral therapy (ART) at less than 100 CD4 cells/μL, of whom 45% have cerebrospinal fluid (CSF) evidence of asymptomatic CM. The new Biosynex CryptoPS test for CrAg detection is comparable to the IMMY lateral flow assay test and shows promise for correctly classifying patients with high serum CrAg titre, a predictor of confirmed CM. Post CrAg screening, enhanced adherence to ART and to fluconazole-based pre-emptive therapy to CrAg positive patients who present with no CM is effective in preventing incident CM within the first year of ART. In HIV patients presenting with symptoms of central nervous system disease, compared to Indian ink staining and/or culture of CSF, serum CrAg detection is highly presumptive of CM and CSF CrAg detection is diagnostic of first episode of CM. In African patients with confirmed CM, inductive therapy based on oral fluconazole-flucytosine combination or seven-day amphotericin B-flucytosine combination are as effective and more tolerated than standard fourteen-day amphotericin B-flucytosine combination. In spite advances in HIV care, mortality due to CM remains unacceptably high warranting CM to be recognised as a neglected tropical disease for which targeted resources need to be allocated to reduce HIV-related mortality. Overall, in Cameroon, putting in place of local pragmatic algorithms based on the availability of simple but highly performant diagnostic tools and sustainable recommended treatment are indispensable to decrease AIDS-associated CM-related morbidity and mortality.Pas de résum
The antiphospholipid antibody syndrome: a case report
No full textHenry Namme Luma,1,2 Marie-Solange Doualla,1,2 Elvis Temfack,1 Servais Albert Fiacre Eloumou Bagnaka,1 Emmanuella Wankie Mankaa,3 Dobgima Fofung41Department of Internal Medicine, Douala General Hospital, Douala, Cameroon; 2Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; 3Department of Radiology, Douala General Hospital Douala, Cameroon; 4Department of Abdominal Surgery, Daniel Muna Memorial Clinic, Douala, CameroonAbstract: Antiphospholipid antibody syndrome is defined by the presence of thromboembolic complications and/or pregnancy morbidity in the presence of persistently increased titers of antiphospholipid antibodies. Its clinical presentation can be diverse and any organ can be involved, with a current impact in most surgical and medical specialties. The authors present the case of a 43-year-old man who, over a 13-year period of follow-up, presented with thrombosis of the mesenteric vein, inferior vena cava, and axillary and subclavian veins in a setting where diagnostic and therapeutic options are limited and costly. Through this case report, the authors aim to describe the evolution of this complex pathology, which to date has not been described in the authors' milieu – probably because of its challenging diagnosis and the limited treatment options available. The authors conclude that clinicians need to have a high index of suspicion of APS in patients who present with a thrombotic episode – clinicians should investigate for the presence of antiphospholipid antibodies, as early diagnosis may influence the course of the disease. Furthermore, resources for the detection of antiphospholipid antibodies should be made readily available in resource-limited settings. Finally, patient education on the importance of drug compliance, periodic monitoring, and prevention of thrombosis is indispensable, especially as mortality could be associated with the effects of vascular thrombosis and/or the effects of bleeding due to anticoagulants.Keywords: thrombosis, mesenteric venous thrombosis, anticardiolipin antibodies, Budd-Chiari syndrome, Cameroo
Diagnostic and therapeutic strategies in cryptococcosis: impact on outcome
No full textCryptococcosis diagnosis has been recently improved by the use of rapid cryptococcal antigen testing with lateral flow assays, which have proved sensitive and specific. Using “test and treat” screening strategies for cryptococcal disease with these tests has been showed effective in reducing cryptococcal meningitis (CM) in HIV-infected patients. Recommended induction, consolidation, and maintenance therapeutic strategy for CM is widely unavailable and/or expensive in low and middle-income settings. New therapeutic strategies, mostly using reduced duration, have recently shown acceptable outcome or are currently tested. Diagnostic and therapeutic guidelines for cryptococcal disease in limited resources countries are undergoing a paradigmatic shift
Infertility and associated factors in three hospitals in Douala, Cameroon: a cross-sectional study
No full textAim: We determined the prevalence and factors associated with couple
infertility in three hospitals in Douala, Cameroon. Methods: We
conducted a cross-sectional study from December 18th 2015 to March 18th
2016 in three public hospitals in Douala. Three hundred and sixty
participants were studied prospectively for associated factors using a
multivariate logistic regression model and 4732 files were studied
retrospectively for the prevalence of infertility. Statistical
significance was set at p < 0.05. Results: The prevalence of couple
infertility was 19.2%. In logistic models, the factors which
independently increased the risk of couple infertility were a history
of reproductive tract infection/STI, a history of uterine fibroids, a
history of dysmenorrhea and abortion for the females while for males it
was a history of mumps, erectile dysfunction and exposure to
chemicals/toxic substances/pesticides. Conclusion: One in every five
couples in this study was infertile. Several factors affect the risks
associated with couple infertility. The identification of these factors
could help detect subgroups of couples at high risk of infertility.
Reproductive health education, screening programmes for STI\u2019s
that may lead to infertility should be offered to couples
Viral suppression and HIV-1 drug resistance 1 year after pragmatic transitioning to dolutegravir first-line therapy in Malawi: a prospective cohort study.
No full textBACKGROUND
Many countries are now replacing non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line antiretroviral therapy (ART) with a regimen containing tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD). Recognising laboratory limitations, Malawi opted to transition those on NNRTI-based first-line ART to TLD without viral load testing. We aimed to assess viral load and HIV drug resistance during 1 year following transition to TLD without previous viral load testing.
METHODS
In this prospective cohort study, we monitored 1892 adults transitioning from NNRTI-based first-line ART to the TLD regimen in the Médecins Sans Frontières-supported decentralised HIV programme in Chiradzulu District, Malawi. Eligible adults were enrolled between Jan 17 and May 11, 2019, at Ndunde and Milepa health centres, and between March 8 and May 11, 2019, at the Boma clinic. Viral load at the start of the TLD regimen was assessed retrospectively and measured at month 3, 6, and 12, and additionally at month 18 for those ever viraemic (viral load ≥50 copies per mL). Dolutegravir minimal plasma concentrations (Cmin) were determined for individuals with viraemia. Drug-resistance testing was done at the start of TLD regimen and at viral failure (viral load ≥50 copies per mL, followed by viral load ≥500 copies per mL; resistance defined as Stanford score ≥15).
FINDINGS
Of 1892 participants who transitioned to the TLD regimen, 101 (5·3%) were viraemic at TLD start. 89 of 101 had drug-resistance testing with 31 participants (34·8%) with Lys65Arg mutation, 48 (53·9%) with Met184Val/Ile, and 42 (40·4%) with lamivudine and tenofovir disoproxil fumerate dual resistance. At month 12 (in the per-protocol population), 1725 (97·9% [95% CI 97·1-98·5]) of 1762 had viral loads of less than 50 copies per mL, including 83 (88·3% [80·0-94·0]) of 94 of those who were viraemic at baseline. At month 18, 35 (97·2% [85·5-99·9]) of 36 who were viraemic at TLD start with lamivudine and tenofovir disoproxil fumarate resistance and 27 (81·8% [64·5-93·0]) of 33 of those viraemic at baseline without resistance had viral load suppression. 14 of 1838 with at least two viral load tests upon transitioning had viral failure (all with at least one dolutegravir Cmin value <640 ng/mL; active threshold), suggesting suboptimal adherence. High baseline viral load was associated with viral failure (adjusted odds ratio [aOR] 14·1 [2·3-87·4] for 1000 to <10 000 copies per mL; aOR 64·4 [19·3-215·4] for ≥10 000 copies per mL). Two people with viral failure had dolutegravir resistance at 6 months (Arg263Lys or Gly118Arg mutation), both were viraemic with lamivudine and tenofovir disoproxil fumarate resistance at baseline.
INTERPRETATION
High viral load suppression 1 year after introduction of the TLD regimen supports the unconditional transition strategy in Malawi. However, high pre-transition viral load, ongoing adherence challenges, and possibly existing nucleoside reverse transcriptase inhibitor resistance can lead to rapid development of dolutegravir resistance in a few individuals. This finding highlights the importance of viral load monitoring and dolutegravir-resistance surveillance after mass transitioning to the TLD regimen.
FUNDING
Médecins Sans Frontières.
TRANSLATIONS
For the French and Portuguese translations of the abstract see Supplementary Materials section
Prevalence and risk factors of chronic kidney disease in newly diagnosed and untreated hypertensive patients in cameroon: A cross-sectional study
No full textPhenotypic Detection of ESBL and AmpC producing Enterobacteriaceae isolated in a General Hospital
No full textObjective: The antibiotic resistance of Enterobacteriaceae is a worldwide preoccupation, and misuse antibiotics of beta-lactam group allowed the development of bacteria producing extended spectrum beta-lactamase and cephalosporinase AmpC enzymes type resistance. The aim of this study was to determine the frequency of these enzymes among strains isolated at the General Hospital in Douala, Cameroon.Methods: We conducted a cross-sectional study. For phenotypic detection of resistance enzymes, MASTDISCS™ test impregnated third and fourth generation cephalosporin 's was used by diffusion on Mueller Hinton agar. Measuring the inhibition areas and comparing the inhibition diameters determined the nature of the resistance mechanism.Results: This study included 195 strains of Enterobacteriaceae. The most frequent species were Escherichia coli and Klebsiella pneumoniae, with a frequency of 49.2% and 31.3% respectively. After determination of resistance phenotypes, 101 (51.8%) isolates were found to be producing resistance enzymes. The frequency of ESBL-producing Enterobacteriaceae was 19.5%; AmpC producing was 14.3% and both enzymes (AmpC + ESBL) 17.9%. E. coli and K. pneumoniae resistance rates were 90% and 83.7% for Cotrimoxazole, 82.5% and 78.3% for ciprofloxacin, 20% and 13.5% for Amikacin, respectively. Imipenem, Amikacin and Fosfomycin were the most active molecules with 4.9%, 19.8% and 33.6%, out of 101 resistant strains, respectively.Conclusion: This study showed a high frequency of resistance enzyme producing strains. This situation leads to resistance to antibiotics most commonly used. This finding justifies a change in prescription habits for protection of molecules that are still active. J Microbiol Infect Dis 2018; 8(3):113-119 [J Microbiol Infect Dis 2018; 8(3.000): 113-119
Malnutrition in patients admitted to the medical wards of the Douala General Hospital: a cross-sectional study
No full text
