Optimum Threshold Estimation of Thorax CT Scan for COVID-19 Diagnosis in a Single Center in Cameroon

Objective: To evaluate the lung CT scan as a possible predictive diagnostic method for COVID-19 in the Cameroonian context. Methods: We designed a cross sectional study. Suspected cases of COVID-19 during the first wave at the national social insurance fund (NSIF) hospital were screened with both COVID-19 with lung CT scan and a PCR test. Univariate analysis was performed for sample description and multivariate analysis to assess the correlation between positive results for the PCR and other parameters. We estimated the optimum threshold of sensitivity/specificity, and area under curve using the empirical method and package. Results: A total of 62 suspected COVID-19 cases were recorded, predominantly males (Sex Ratio = 2.2) with a median age of 58.5 (IQR = 19.7). Among our 62 patients, 29 (46.8%) were confirmed COVID-19 cases with positive PCR results. All the patients had a thorax CT scan with a median impairment of 40% (IQR = 20%). The optimum threshold estimate for CT scan for COVID-19 infection diagnosis was 60% (95% CI = 25% - 80%). Overall, the sensitivity and specificity estimates were 0.30 (95% CI = 0.15 - 0.49) and 0.87 (95% CI = 0.70 - 0.96), respectively, leading to an Area Under Curve (AUC) estimate of 0.59 (95% CI = 0.46, 0.71). Conclusion: In this setting, lung CT scan was neither sensitive nor specific to predict COVID-19 disease.

Prevalence and Correlates of Macrovascular Complications at Type 2 Diabetes Diagnosis in a Tertiary Hospital in Yaoundé, Cameroon

Introduction: The presence of vascular complications at type 2 diabetes (T2D) diagnosis is a heavy burden for developing countries. We aimed to determine the prevalence and correlates of macrovascular complications at T2D diagnosis in Yaoundé, Cameroon. Materials and Methods: We conducted a cross-sectional study at the Essos Hospital Center in Yaoundé from January 2017 to June 2021. We recruited patients newly diagnosed with T2D who, simultaneously, with assessed macrovascular complications including stroke, myocardial infarction (MI) and arterial foot ulcer (AFU). Correlates were investigated using Chi square test and logistic regressions. The significance level was set at 5%. Results: In all, 286 newly diagnosed diabetic patients (51.7% being men) were included. The mean age was 52.6 ± 12.3 years. Prevalent cardiovascular risk factors at diabetes diagnosis were a dyslipidemia (63.6%), sedentary lifestyle (57.7%) and family history of type 2 diabetes (51.6%). The prevalence of macrovascular complications was 17.5% with 8.4% stroke, 5.6% myocardial infarction and 3.4% arterial foot ulcer. Hypertension was associated with all macrovascular complications (p Conclusion: Macrovascular complications are frequent at type 2 diabetes diagnosis and are represented by stroke and myocardial infarction in our study, highlighting the importance of cardiovascular risk evaluation and reduction in people with diabetes right from diagnosis.

Insulin Sensitivity of Term Newborns Exposed in Utero to HIV and Antiretrovirals in Yaoundé

Introduction: Antiretrovirals (ARVs) and the human immunodeficiency virus (HIV) are implicated in the onset of insulin resistance. They cross the placental barrier thereby inducing early modifications of the fetal environment. The aim of our study was to assess insulin sensitivity in full-term newborns exposed in utero to HIV and ARVs in Yaoundé. Materials and Methods: We conducted an analytical cross-sectional study in 2 maternities in the city of Yaoundé from November 2021 to June 2022. We generated two groups of newborns (NBs): one group born to HIV positive mothers on ARVs and the other control group born to HIV negative mothers. Clinical data from mothers and NBs were collected. A homeostatic model assessment of insulin resistance (HOMA-IR) like index with C peptide served to assess insulin sensitivity. We used the Spearman correlation to measure the strength of association between insulin sensitivity and the different variables. A p-value Results: Of 70 neonates included, 35 were born to HIV positive mothers on ARVs and 35 to HIV negative mothers. The median age of HIV positive and negative mothers was 30 (27 - 32) and 34 (24 - 47) years, respectively (p = 0.791). The body mass index before pregnancy as well as the average newborn weights were comparable in both groups. The ARV protocol associating Tenofovir, Lamivudine, Efavirenz was used by 97.1% of HIV positive mothers. In the exposed NBs group, C peptide was significantly lower (p < 0.001) and blood glucose significantly higher (p < 0.001). The median values of HOMA-IR were 1.4 (0.8 - 1.9) and 2 (1.4 - 2.6) (p = 0.001) for exposed and unexposed NBs, respectively. Conclusion: Newborns exposed to HIV and ARVs had lower C peptide levels and were more sensitive to insulin. Close metabolic monitoring of these newborns would allow early diagnosis and management of any glucose regulation disorder.

Gout: A Possible Cause of Lumbal Canal Stenosis. Cases Report in Sub-Saharan Area and Literature Review

Introduction: Gout is defined as an arthritic condition resulting from the deposition of monosodium urate crystals in and/or around joints, following long-standing hyperuricemia. This may cause gouty arthritis in joints and tophi in soft tissues. Spinal gout is rare and never mentioned in our context. It can appear as acute back pain, radiculopathy, spinal cord compression, spondylodiscitis or neoplasic/infectious epiduritis. Our aim was to share our surgical experience and proceed of a Literature review. Cases Presentation: Between January and August 2022, two patients male were surgically cared, aged of 42 and 60 years old. The gout was unknown in the youngest and poorly followed in the eldest. There was no past medical history of tuberculosis or immunodeficiency in both. The early diagnosis retained was unspecific lumbar spondylodiscitis due to clinical features: Patients complained both of lower back pain with initial fever. It was of a progressive left L5S1 deficit with erectile defect and dysuria in the first case and a progressive paraplegia without sphincter disorders in the second case. We proceeded with a lumbar laminectomy with a biopsy on both patients. The spinal tophus was ligamentous in one case and arthro-ligamentous in the other. There was a progressive motor recovery from postoperative Day-2 till postoperative Month-1. A probabilistic antituberculosis treatment was promptly initiated postoperatively based on radioclinic features while waiting for histologic proof. The Polymerase Chain Reaction (PCR) of Mycobacterium tuberculosis was negative and the histology was of a chronic calcified osteitis with dense fibrosis in both. The anti-gout treatment was implemented after 15 days with blood test evidence. A rheumatologic follow-up was also initiated and adjuvant physio-therapy. The results were very satisfactory from 4 - 6 months with independent walking. Discussion Conclusion: Spinal Gout may be suggested in 40-male-old faced with any acute rachialgia with neuro deficit with dubious neuro-imaging.

Adolescent Sexual Behavior in an Urban Area of a Resource-Limited African Country, Cameroon

Introduction: The substantial changes that occur in adolescence may lead to sexual behaviors that adversely affect their health. We have described sexual patterns in adolescents in various neighborhoods of Yaounde in order to underscore the sexual challenges that they face. Methods: We carried out a cross-sectional descriptive study in District number V of Yaounde from August 1st to 31st 2018. To characterize their sexual lives, we surveyed 1800 adolescents between 10 and 19, and analyzed the data using SPSS version 25.0. Results: In our study, 1023 (56.8%) adolescents were female, and 777 (43.2%) were male. Most of the adolescents were between ages 18 and 19 years (25.4%), unmarried (93.1%), had a secondary level of education (81.9%) and lived with their families (87.3%). One-third of the adolescents (30.7%) were sexually active and 41.1% had multiple sexual partners. The average age of coitarche was 15.1 years. Among the females, 17.1% reported one prior pregnancy and 30.8% had one abortion. Most of the sexual encounters were heterosexual (82.6%) and 30.2% regularly used male condoms. 66.0% and 47.7% obtained information about sexuality primarily from social media and mass media, respectively. Conclusion: Sexual encounters in adolescents of District V of Yaounde were premature, mostly heterosexual and often unprotected. The consequences were an increased incidence of early pregnancies and abortions.

Recognition of Warning Signs by the Patient with Ischemic Stroke and Impact on Emergency Department Admission Times

The general objective of this study was to assess the impact of the recognition of warning, signs of ischemic stroke, on the reduction of emergency admission times and the improvement of the prognosis of the patient suffering from ischemic stroke in the emergency department of the Yaounde central hospital. Methods: This was a prospective study with a descriptive and analytical aim carried out in the medical emergency department of the central hospital of Yaounde over a period of 3 months, going from October to December 2020. All patients admitted to emergency departement, during this period, for a diagnosis of ischemic stroke confirmed by a brain CT scan were included in the study. The data was collected on a survey sheet divided into 3 sections: the patient, the assessment of his knowledge and his reaction to the stroke. The variables studied were socio-demographic data, cardiovascular risk factors and warning signs of stroke. Data analysis was conducted with Census and Survey Processing System (CSPRO). Results: During the study period, 62 patients met the inclusion criteria. Adults under 50 (41.94%) were the most represented age group. The mean age of the patients was 52.3 years with ranges ranging from 36 to 82 years. The sex ratio was 1.38 in favor of women. The most common unmodifiable cardiovascular risk factor was age over 55 years 44%. High blood pressure 61% was the most common modifiable risk factor. More than half of the study population had no knowledge of the warning signs of ischemic stroke. The most well-known warning sign was 40% mouth deformation. The anamnesis noted that the weakness of the hemibody, the limb or the leg was found in our cohort in 77% of cases, followed by balance disorder (73%) and speech disorder (50%). The main associated sign was asthenia 32%. Direct admission to hospital through the emergency department was the first call for alert 58%, followed by self-medication 32% and seeking help from a family member 31%. The emergency department admission time was over 4 hours 30 minutes in more than half of the cases. Conclusion: Ischemic stroke is an important cause of death in sub-Saharan Africa in the acute phase. Information, education and communication about the warning signs of ischemic stroke reduce the time to emergency room visits and improve the prognosis of these patients.

Facial and Periorbital Emphysemas Following a Violent Sneezing: An Atypical Clinical Situation

Introduction: Facial emphysema is the presence of air in the subcutaneous tissues of the facial region. They can be clinically recognized by the crackling sensation felt when the affected area is palpated. Observation: The authors describe left orbito-facial emphysema that occurred after a violent sneezing episode in a 36-year-old patient. He had significant edema of the left facial and ipsilateral periorbital region associated with major emphysema and complete closure of the left eye. Nasal cavities endoscopy revealed inflammation of the distal orifice of the nasolacrimal duct. The clinical ophthalmologic examination performed in emergency showed left chemosis, slight ocular hypertonia of mechanical origin, and a slight decrease in visual acuity. Pupillary reflexes and retinography were normal. A craniofacial computed tomography (CT) revealed a significant left orbital emphysema, a fracture of the left medial orbital wall (ethmoidal lamina papyracea) with intraconal fat incarceration without entrapment of the medial rectus and significant air infiltration of all the left hemifacial soft tissues. A broad-spectrum antibiotic and anti-inflammatory treatment were instituted, as well as practical advice to prevent a recurrence. We observed progressive resorption of the edema with a return to the normal of the soft tissues and the palpebral cleft in 15 days. Conclusion: These atypical cases can be serious. It is essential to exclude signs of visual deficit and ocular compression. Multidisciplinary management is important.