Health-related quality of life and its determinants in patients with chronic low back pain at a tertiary hospital in Cameroon: a cross-sectional study.

OBJECTIVE: To evaluate health-related quality of life (HRQoL) and its determinants in chronic low back pain (CLBP) patients in Cameroon. DESIGN: Observational cross-sectional study. SETTING: Tertiary hospital. PARTICIPANTS: There were 150 eligible adults with low back pain of at least 12 weeks who provided informed consent. Of these, 136 with complete questionnaires were analysed. OUTCOMES: HRQoL was measured using the WHO Quality of Life questionnaire (WHOQOL-BREF). Outcome measures included its four domain (physical health, psychological, social relationships and environmental) scores and two independent scores for overall quality of life (OQOL) and general health satisfaction (GH). RESULTS: Participants had a median age of 52 years, and median pain duration of 33 (IQR: 69) months. The median OQOL score was 50 (IQR: 25). After multivariable adjustment, tertiary education (ß=11.43, 95% CI 3.12 to 19.75), age (ß=0.49, 95% CI 0.12 to 0.87) and being a student (ß=23.07, 95% CI 0.28 to 45.86) contributed to better OQOL. Age (ß=0.57, 95% CI 0.10 to 1.04) and physical-type employment (ß=-14.57, 95% CI -25.83 to -3.31) affected GH. Smoking (ß=-20.49, 95% CI -35.49 to -5.48) and radiological anomalies (ß=-7.57, 95% CI -14.64 to -0.49) affected the physical health domain, while disability (ß=-0.67, 95% CI -1.14 to -0.20) and duration of pain (ß=-0.13, 95% CI -0.20 to -0.05) affected the psychological domain. Income (ß=14.94, 95% CI 4.06 to 25.81) affected the social domain, while education (ß=9.96, 95% CI 1.41 to 18.50) and disability (ß=-0.75, 95% CI -1.26 to -0.24) affected the environmental domain. CONCLUSIONS: Our findings suggest that CLBP affects HRQoL and multiple socioeconomic and clinical factors influence its impact on different domains of HRQoL. Multipronged management programmes, especially those that reduce disability, could improve HRQoL in patients with CLBP.

Prevalence and pattern of lower extremity injuries due to road traffic crashes in Fako Division, Cameroon.

INTRODUCTION: Low and middle income countries are disproportionately affected with road traffic injuries and the lower extremity is one of the most affected anatomical body parts. There exist very limited data on the pattern of lower extremity injuries in the Cameroon especially in the South West Region. We therefore, hypothesized that lower limb injuries are common in road traffic crashes and motorized two wheelers are the commonest cause. METHODS: This was a hospital based prospective, cross sectional study. It involved four hospitals (Limbe and Buea Regional Hospitals, Baptist hospital Mutengene and Tiko District Hospital) in the Fako Division. It was carried out for three months. Victims of road traffic crashes received at emergency department of these hospitals during this period were assessed. Crash characteristics and injury characteristics were assessed and recorded. RESULTS: We analyzed 411 crash victims, 197(47.93%) had lower extremity injuries. The male to female ratio was 1.4:1. Majority of crash victims were in their 3rd and 4th decades of life. The mean age of patients who had lower limb injuries was 33.30(±16.04). The most vulnerable road users were pedestrians (26.52%) and passengers on motor bikes (38.44%) and the commonest mechanism by which crash victims sustained injuries were: bike-car collisions (22.84%), and bike-pedestrian collisions (19.29%). Commercial motor bikes (62.77%) and taxis (22.38%) were the road users most involved in road traffic collisions. The leg 98(49.75%), thigh 23(11.68%), and knee 20(10.15%) were the most injured anatomical parts of the lower extremity. Fractures 68 (34.52%), lacerations 53(26.90%), and bruises 49(24.87%) were the most recurrent pattern of lower extremity injuries. CONCLUSION: In view of our findings we conclude therefore as follows: The prevalence of lower extremity injuries from Road Traffic Crashes in our study area was 47.93%. Associated risk factors to the road traffic crashes as identified by the victims were bad roads (10.15%) and bad weather (5.05%). The safety gargets were not adequately utilized by our victims, with 87.72% confirming that they did not wear the helmet and 87.50% affirming that they did not wear the seat belt at the time of the crash. The occupations mostly affected in our series were pupils and students (20.3%) and business people (19.2%), then the bike riders (15.23%). We thus recommend that the laws on the use of road safety gargets, especially helmets and seatbelts, be enforced, with riding and driving speeds reduced to below 60km/hour. Road usage should be avoided in bad weather and pedestrians lanes and zebra crossings be provided to minimize pedestrian-car or -bike collision.

Factors influencing disability in patients with chronic low back pain attending a tertiary hospital in sub-Saharan Africa.

BACKGROUND: Very little is known about the burden of chronic low back pain in Africa. This study aimed at assessing disability and associated factors in chronic low back patients in Cameroon. METHODS: We carried a hospital-based cross-sectional study including patients suffering from low back pain (LBP) of at least 12 weeks' duration. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ). RMDQ > 4 described persons with dysfunctional levels of disability. Multivariable linear regression was used to investigate factors associated with higher RMDQ scores hence greater disability. Variables investigated included; gender, age, marital status, employment status and type, smoking history, alcohol consumption, income, pain intensity, LBP duration, psychological wellbeing, sleep satisfaction, leg pain, numbness/paresthesia, bowel/bladder dysfunction symptoms (BBDS), body mass index (BMI), and days of work absence. RESULTS: A sample of 136 adults (64% female) with a mean age of 50.6 ± 12.2 years participated in the study. Median duration of LBP was 33 (25th - 75th percentile: 12-81) months. Mean RMDQ score was 12.8 ± 6. In multivariable linear regression, pain intensity (ß = 0.07, p = 0.002), longer days of work absence (ß = 0.15, p = 0.003) and BBDS (ß =2.33, p = 0.029) were associated with greater disability. Factors such as consumption of alcohol (ß = - 3.55, p = 0.005) and higher psychological wellbeing scores (ß = - 0.10, p = 0.004) significantly contributed to less disability (lower RMDQ scores). Dysfunctional levels of disability were present in 88.1% of patients. CONCLUSION: CLBP is associated with significant disability and this relationship is driven by several factors. Multidisciplinary management strategies especially those targeted to improve pain control, manage BBDS and improve psychological wellbeing could reduce disability and improve quality of life.

Prevalence and pattern of lower extremity injuries due to road traffic crashes in Fako Division, Cameroon

Introduction: low and middle income countries are disproportionately affected with road traffic injuries and the lower extremity is one of the most affected anatomical body parts. There exist very limited data on the pattern of lower extremity injuries in the Cameroon especially in the South West Region. We therefore, hypothesized that lower limb injuries are common in road traffic crashes and motorized two wheelers are the commonest cause.Methods: this was a hospital based prospective, cross sectional study. It involved four hospitals (Limbe and Buea Regional Hospitals, Baptist hospital Mutengene and Tiko District Hospital) in the Fako Division. It was carried out for three months. Victims of road traffic crashes received at emergency department of these hospitals during this period were assessed. Crash characteristics and injury characteristics were assessed and recorded.Results: we analyzed 411 crash victims, 197(47.93%) had lower extremity injuries. The male to female ratio was 1.4:1. Majority of crash victims were in their 3rd and 4th decades of life. The mean age of patients who had lower limb injuries was 33.30(±16.04). The most vulnerable road users were pedestrians (26.52%) and passengers on motor bikes (38.44%) and the commonest mechanism by which crash victims sustained injuries were: bike-car collisions (22.84%), and bike-pedestrian collisions (19.29%). Commercial motor bikes (62.77%) and taxis (22.38%) were the road users most involved in road traffic collisions. The leg 98(49.75%), thigh 23(11.68%), and knee 20(10.15%) were the most injured anatomical parts of the lower extremity. Fractures 68 (34.52%), lacerations 53(26.90%), and bruises 49(24.87%) were the most recurrent pattern of lower extremity injuries.Conclusion: in view of our findings we conclude therefore as follows: The prevalence of lower extremity injuries from Road Traffic Crashes in our study area was 47.93%. Associated risk factors to the road traffic crashes as identified by the victims were bad roads (10.15%) and bad weather (5.05%). The safety gargets were not adequately utilized by our victims, with 87.72% confirming that they did not wear the helmet and 87.50% affirming that they did not wear the seat belt at the time of the crash. The occupations mostly affected in our series were pupils and students (20.3%) and business people (19.2%), then the bike riders (15.23%). We thus recommend that the laws on the use of road safety gargets, especially helmets and seatbelts, be enforced, with riding and driving speeds reduced to below 60km/hour. Road usage should be avoided in bad weather and pedestrians lanes and zebra crossings be provided to minimize pedestrian-car or -bike collision

Gastrointestinal surgery and the acquired immune deficiency syndrome.

Acquired immune-deficiency syndrome (AIDS) is becoming an increasing problem to the surgeon. The impact of HIV/AIDS on surgical practice include the undoubted risk to which the surgeon will expose him or herself, the atypical conditions that may be encountered and the outcome and long term benefit of the surgical treatment in view of disease progression. The two factors most associated with surgical outcome and poor wound healing were AIDS and poor performance status (ASA score). This article questions whether gastrointestinal surgical procedures can be safe and effective therapeutic measures in HIV/AIDS patients and if surgical outcome is worthy of the surgeon's ethical responsibility to treat. As HIV/AIDS patients are not a homogeneous group, with careful patient selection, emergency laparotomy for peritonitis confers worthwhile palliation. However, aggressive surgical intervention must be undertaken with caution and adequate peri-operative care is required. Symptomatic improvement of anorectal pathology may make delayed wound healing an acceptable complication. Alternatives to surgery can be contemplated for diagnosis, prophylaxis or palliation.

A rare spontaneous enterocutaneous fistula.

A 70-year-old woman presented with a short history of a spontaneous enterocutaneos fistula in the left inguinal region. A laparotomy revealed a fistulizing Richter's hernia. The fistulizing small bowel segment was resected and the femoral hernia repaired from below. Although rare, a complicating Richter's hernia should be considered in the differential diagnosis of a groin fistula.

Meckel's diverticulum: a case report from the University Hospital Center Yaoundé, Cameroon.

To the best of our knowledge there is no reported case of Meckel's diverticulum (MD) in Cameroon. The prevalence of MD in the general population is 2-3 %. The aim of this paper is to recapitulate the role of this pathology in acute abdomens and abdominal pain of uncertain aetiology in young patients and to review the medical literature.