Prevalence and determinants of diabetic polyneuropathy in a sub-Saharan African referral hospital.

BACKGROUND: Diabetic peripheral neuropathy is the commonest complication of diabetes mellitus, and a major cause of limb amputations. In general however, the magnitude of diabetic neuropathy in sub-Saharan Africans with diabetes has been less reliably quantified. We assessed the prevalence and determinants of diabetic polyneuropathy in hospital settings in Cameroon. METHODS: We conducted a cross-sectional survey at the Douala Laquintinie Hospital, which is one of the main reference hospital in the economic capital of Cameroon (3 million populations). Participants included all patients with type 1 (T1DM) or type 2 (T2DM) diabetes who reported to the hospital regardless of the reason, during a 5-month recruitment period. Polyneuropathy was defined as diabetic in a patient with a Diabetic Neuropathy Examination score of >3/16 and/or a monofilament score of <5/9. RESULTS: A total of 306 patients were recruited, including 196 women (64%) and 294 (96%) with T2DM. The mean (standard deviation) values were 59.8 (11.2) years for age and 8.4 (8.2) years for diabetes duration. Clinical signs of polyneuropathy were present in 102 (crude prevalence rate: 33.3%) patients. The polyneuropathy was symptomatic in 79/102 (77.4%) patients. Determinants of polyneuropathy were urban residence (p=0.02), infection with hepatitis C virus (p=0.002), infection with HIV (p=0.012) and presence of albuminuria (p=0.0001). CONCLUSION: About one in three patients with diabetes reporting to the hospital in our setting has prevalent diabetes related polyneuropathy. This emphasizes the importance of routine implementation of therapeutic education and other measures to limit the complications.

[Pasteurella multocida meningitis with cerebral abscesses]. / Méningite à Pasteurella multocida compliquée d'abcès cérébral.

Pasteurella multocida is classically responsible for local soft tissue infections secondary to dog bites or cat scratches. It can be responsible for meningitis in infants and elderly persons. We report the case history of a 5-year-old male child admitted to our pediatric unit for meningitis. Cerebrospinal fluid analysis revealed an infection with P. multocida. The suspected mode of contamination was either from the saliva of a pet dog or through an unnoticed skull fracture sustained after an accident 1 year prior to the occurrence of meningitis. In spite of the neurologic complication (cerebral abscess), the progression was favorable after drainage of the abscess, 5 weeks of parenteral treatment, and 3 weeks of oral antibiotic therapy. Meningitis due to Pasteurella sp. is rare and can lead to neurologic complications. The notion of bites or scratches can be absent and the mode of contamination is sometimes difficult to unveil.

The role of surgery in the management of Pott's disease in Yaoundé. A review of 43 cases.

INTRODUCTION: Pott's disease is a common entity in our hospital. The authors report their experience in the surgical treatment of Pott disease. PATIENTS AND METHODS: This is a retrospective study including all patients who underwent surgery for Pott's disease in our institution between November 1999 and November 2004. RESULTS: Forty-three patients were included, including 23 men and 20 women (ratio 1.15). Location of the disease was cervical (2 cases), dorsal (19 cases), dorsolumbar (2 cases) lumbar (16 cases) and sacrolumbar (4 cases). Ten patients were HIV positive (24%). The surgical indication was sometimes diagnostic, but predominantly therapeutic (medullary compression, instability or deformity). Spinal decompression alone was performed in 23 cases, associated with internal fixation of the spine (17 cases) or external immobilization (Halo Vest) in two cases. The anterior approach was used in four cases and a posterior approach in 38 cases. Decompression by posterior approach included 1 or 2 level laminectomy alone or associated with internal plate fixation (4 pedicle screws and 2 plates). There was no functional recovery in patients with a complete neurological deficit (Frankel A); those with a severe deficit (Frankel B) partially recovered, while those with more moderate deficits (Frankel C and D) recovered completely. Fusion was obtained (graft integration) regardless of the surgical approach used, progression of the deformity was stopped and early mobilization was possible. CONCLUSION: Surgery definitely plays a role in the diagnosis and treatment of Pott's disease, especially in countries where patients are seen at a late stage of the disease when complications have developed. Surgical decompression should not be delayed until lesions become ischemic and irreversible (Frankel A). LEVEL OF EVIDENCE: Level IV. Retrospective study.

Intracranial suppurations in the African child: a severe but preventable complication.

INTRODUCTION: Intracranial suppurations (ICS) are collections of pus of infectious origin in the skull. The authors present their experience. PATIENTS AND METHOD: All children operated for ICS at the Central Hospital of Yaoundé from January 2000 to December 2008 were retrospectively included. RESULTS: Thirty-five patients were recruited: 26 (74.29 %) males and 9 (25.71 %) females. These represent 82.9 % of all ICS operated in our institution. ICS represented 14.3 % of intracranial space-occupying lesions. The mean age was 8.34 years. They presented with headaches (80.77 %), altered consciousness (20 %), convulsions (76 %), vomiting (20 %), unilateral motor deficit (69.23 %), speech disorders (12 %), and fever (89.29 %). Bergman's triad (51.86 %) was frequent. The primary infection was: meningitis, eight cases (22.85 %); sinusitis, six cases (17.14 %); head trauma, five cases (14.28 %); otitis media, one case (2.85 %); suppurations of the face, three cases (8.56 %); cardiopathy, one case (2.85 %); and craniotomy, one case (2.85 %). In seven cases (20 %), the origin was unknown. The lesions were empyema in 23 cases (65.71 %), cerebral abscess in 8 cases (22.85 %) and pyoventriculitis in 2 cases (5.72 %). The surgical procedures were burr holes (88.89 % of empyemas) and trepano-puncture-aspiration (75 % of abscesses). The mortality (21.42 %) and morbidity (42.85 %) were recorded. CONCLUSION: ICS are frequent but preventable (early treatment of the primary infection) pathologies of childhood in developing countries. Burr hole drainage (empyemas) and puncture-aspiration (abscesses) are simple, safe, and effective techniques.

[Brown-Vialetto-Van Laere syndrome: a case with anti-ganglioside GM1 antibodies and literature review]. / Syndrome de Brown-Vialetto-Van Laere. Un cas avec anticorps anti-ganglioside GM1 et revue de la littérature.

We report the case of a woman suffering from progressive bulbopontine paralysis in whose the first symptom, bilateral hypoacousia, began in childhood. This clinical picture is that of the Brown-Vialetto-Van Laere (BVVL) syndrome. Anti-ganglioside GM1 antibodies were moderately elevated in this patient. Intravenous immunoglobulins produced little benefit. The main clinical characteristics of 29 BVVL patients reported in literature are reviewed, and the pathological significance of anti-GM1 antibodies is discussed in the context of this disorder.