Cameroonian Patient Research Articles

Macular Thickness in Cameroonians Sickle Cell Patients

Introduction: Sickle cell disease is the most common genetic disease in the world. It is particularly prevalent in Africa south of the Sahara. In Cameroon. Several authors have described morphological changes from the macula to Optical Coherence Tomography-Spectral Domain (SD OCT) including the thinning of the predominant inner layers in the temporal area. Methodology: This is a prospective analytic study. It was conducted mainly at the specialized ophthalmology department of the Army Military Application and Reference Hospital of Yaounde (HMARAY) in Cameroon. Clinical ophthalmologic exam was done and biological parameters (rate of hemoglobin, electrophoretic quantification of S hemoglobin) registered from October 2016 to June 2017.We included: Any AS patient or Cameroonian SS patient who is 20 years of age or older; sickle cell patients AS or SS without intercurrent retinal pathology (strong myopia, diabetic retinopathy, vitreoretinal interface pathology). Results: In our study the average age is 31 years. There is a predominance of female versus male sex ratio H/F=0.56. 84% of eyes had retinal lesions suggestive of non-proliferative retinopathy in the retina. The solar black spots were the most found retinal lesions (66.66%). Lesions were more localized temporally. In the OCT measurement, 60% of the eyes showed a decreased retinal thickness SD with 53% concerning the temporal retina. An hemoglobin level between 7 and 10 g/dl was found in 40% of our patients, 24% has severe anemia (hemoglobin<7 g/dl). All our patients had a percentage of hemoglobin S greater than 80%. No decrease in visual acuity in our patients who had a decrease in retinal thickness at OCT SD. Conclusion: There is a thinning of the retinal layers in SS Cameroonian sickle cell patients in the temporal region of the macula. Patients with retinal thinning are asymptomatic with preserved visual acuity.

Cerebral venous thrombosis secondary to an occult maxillary sinusitis in a young male from sub-Saharan Africa

Cerebral venous thrombosis (CVT) also termed cerebral venous sinus thrombosis (CVST), is a special type of cerebrovascular disease characterized by cerebral venous infarction [1]. As from 1825 when the first case was described by Ribes[2], epidemiological descriptions are still restricted to case reports and small retrospective cross-sectional studies yielding low butincreasing incidence: &lt;10 cases per million per year in 1995 to about 13.2 cases per million per year in 2012.CVT mainly occurs in women of child bearing age, probably owing to the use of oral contraceptive pills, and mostly has an acute or subacute course [1]. It can be categorized as primary/idiopathicand secondary. Secondary CVT can further be classified into infective (mainly due to bacterial or fungal infections) and non-infective CVT; the latterbeing due tocoagulation disorders, neoplasms, procoagulant hemodynamic states, vascularitis,homocystinuria, or head trauma [3].With the advent of antibiotics, the epidemiology of CVT has shifted from predominant infective CVT to predominant non-infective CVT, leading to increased risk of misdiagnosis and delayed treatment [3]. We report occult purulent maxillary sinusitis-related CVT in a male Cameroonian patient who presented with headaches, seizures and acute stroke syndrome. The aim of this paper is to reiterate CVT as the main cause of acute stroke syndrome in young adults irrespective of ethnic origin and sex, and suggest systematic screening of infections in those patients, especially in regions with high rates of infections likesub-Saharan Africa.We describe this case with regard to CARE guidelines.

Acute Coronary Syndrome in Patient with Viral Hepatitis C: An Underdiagnosed Condition in Sub-Saharan Africa

Viral hepatitis C (VHC) infection is associated with many systemic diseases. Amongst these, the association with ischemic heart disease is underdiagnosed in Sub-Saharan Africa context. We present a case of acute coronary syndrome in a Cameroonian patient with viral hepatitis C with low cardiovascular risk. A 75 years old female followed up for hepatocellular carcinoma secondary to VHC cirrhosis. She was admitted in the hospital for a sudden, resting, intense constrictive thoracic pain lasting more than one hour. This patient initially consulted the gastroenterologist, but secondarily the cardiologist 24 hours after the previous consultation. The initial workup showed ST segment elevation in lead V1 to V4 with Q Wave in the same territory and elevated value of Troponin I_us and CPKMB. Cardiac ultrasonography found akinesia in the anteroseptal and apical segments. Other biological exams showed a dyslipidemia without other cardiovascular risk factors. Despite poor financial resources, the patient was managed with Enoxaparine 8000 UI/12H, Clopidogrel 75mg/24H, Aspirine 100mg/24h. Rosuvastatine 10Mg/24h, Ramipril 2,5mg/24h and Nebivolol 2.5mg/24h, tramadol 100mg/8h, trimetazidine 35mg/12h, omeprazole 40mg/24h, molsidomine 1mg/8h. The pain disappeared 24hours after the beginning of the treatment. In sub-Saharan Africa with high burden of viral hepatitis C infection, we should consider this possibility in patients who present ischemic heart disease with lowcardiovascular risk.

Clinical and biological characteristics of diabetic patients under age 40 in Cameroon: Relation to autoantibody status and comparison with Belgian patients

AimsWe investigated the prevalence of diabetes autoantibodies (Abs) in Cameroonian patients and controls, assessed their contribution in disease classification and compared results with data from Belgium. MethodsAbs against GAD (GADA), IA-2 (IA-2A) and zinc transporter 8 (ZnT8A) were assessed in 302 recently diagnosed Cameroonian patients with diabetes and 184 control subjects without diabetes aged below 40 years. ResultsOnly 27 (9%) Cameroonian patients were younger than 15 years. Overall, 29% of patients presented at least one diabetes-associated antibody vs 9% in healthy controls (24% vs 7% for GADA (p<0.001), 10% vs 3% for IA-2A (p<0.006), 4% vs 2% for ZnT8A). Ab+ patients had lower C-peptide levels (p<0.001), were more often insulin-treated (p<0.002) and were as frequently diagnosed with type 1 diabetes as Ab− patients. Only 43% of Ab+ patients aged 15–39 years were clinically classified as having type 1 diabetes in Cameroon vs 96% in Belgium (p<0.001). Not one Ab+ Cameroonian patient carried HLA-DQ2/DQ8 genotype vs 23% of Belgian Ab+ patients (p<0.001). Younger age at diagnosis and antibody positivity were independent predictors of insulin therapy. Ab+ Cameroonian patients were older (p<0.001), had higher BMI (p<0.001) and lower Ab titers than Belgian Ab+ patients. In ketonuric patients, prevalence of autoantibodies was similar as in non-ketonuric patients. ConclusionsIn Cameroonian patients with diabetes aged under 40 years, antibody-positivity is not clearly related to disease phenotype, but may help predict the need for insulin treatment.

First evidence of a HIV-1 M/O recombinant form circulating outside Cameroon

HIV-1 are now classified into four groups: M (major), O (outlier), N (non-M – non-O), and a new group P, the prototype of which is the divergent strain recently characterized in a Cameroonian patient [1]. Recombination between HIV strains is a very frequent phenomenon, greatly increasing genetic div

Genomic cloning and complete sequence analysis of a highly divergent African human immunodeficiency virus isolate

Analysis of the complete sequence of a human immunodeficiency virus (HIV) isolate (Ant70) obtained from a Cameroonian patient indicates that this virus is the most divergent strain within the HIV-1 family hitherto described. Comparison of the Pol protein, usually highly conserved within the HIV-1 family, shows only about 73% similarity with the HIVmm isolate, whereas for the more variable proteins such as envelope, similarities of 50% or lower are found. The principal neutralizing determinant (V3 loop) and the immunodominant region within gp41 also contain some unusual substitutions, which may have implications for protein function as well as for serological assays based on these regions. Phylogenetic analyses show that this isolate occupies a unique position relative to the human HIV-1 isolates and the recently described SIVcpz virus, indicating that this Cameroonian isolate may provide us with new insights into the origins of the HIV-1 family.

A new subtype of human immunodeficiency virus type 1 (MVP-5180) from Cameroon

A new subtype (MVP-5180) of human immunodeficiency virus type 1 (HIV-1) was isolated from a Cameroonian AIDS patient. MVP-5180 was grown in several human T-cell lines and the monocytic U937 line. MVP-5180 DNA could not be amplified by nested primer PCR with conventional env primers and could be only very faintly amplified with gag and pol primers. Most German, Ivoirian, and Malawian anti-HIV-1 sera reacted faintly or moderately with Env proteins in an MVP-5180 immunoblot, whereas some Cameroonian sera reacted strongly. Of HIV-1-infected Cameroonians, 8% were identified by serological methods as infected with MVP-5180; 7% were positive when MVP-5180-specific PCR env primers were used. DNA sequence analysis of MVP-5180 showed that its genetic organization was that of HIV-1, with 65% similarity to HIV-1 and 56% similarity to HIV-2 consensus sequences. The env gene of MVP-5180 had similarities to HIV-1 and HIV-2 of 53 and of 49%, respectively. V3 loop analysis identified a crown of Gly-Pro-Met-Arg by using cloned DNA and Gly-Pro-Leu-Arg by using PCR-amplified DNA, neither of which configuration has been described for other HIV strains. In an analysis of relationships, MVP-5180 occupied a position distant to all other HIV-1 strains, including the chimpanzee simian immunodeficiency virus type 1 SIVcpz and the Uganda virus U455, and closer to the HIV-1/HIV-2 divergence node. MVP-5180, together with another Cameroonian isolate, ANT-70, constitutes a group subtype O of the most divergent HIV-1 isolates yet identified. Characterization of MVP-5180 is important for understanding the natural history of the primate immunodeficiency viruses and for the development of vaccines and diagnostics.