Flexible nasal bronchoscopy vs. Airtraq® videolaryngoscopy for awake tracheal intubation: a randomised controlled non-inferiority study.

Videolaryngoscopy is a suitable alternative to flexible bronchoscopy to facilitate awake tracheal intubation. The relative effectiveness of these techniques in clinical practice is unknown. We compared flexible nasal bronchoscopy with Airtraq® videolaryngoscopy in patients with an anticipated difficult airway scheduled for awake tracheal intubation. Patients were allocated randomly to flexible nasal bronchoscopy or videolaryngoscopy. All procedures were performed with upper airway regional anaesthesia blockade and a target-controlled intravenous infusion of remifentanil. The success rate with the allocated technique was the primary outcome. A non-inferiority analysis with a predefined limit of 8% was planned. Seventy-eight patients were recruited, allocated randomly and analysed. The rate of successful intubation was 97% and 82% in the flexible bronchoscopy and videolaryngoscopy groups, respectively, p = 0.032. The median (IQR [range]) time to tracheal intubation was shorter with the Airtraq, 163 (105-332 [40-1004]) vs. 217 (180-364 [120-780]) s, p = 0.030. There were no significant differences for complications found between the groups. The median visual analogue scale for ease of intubation was 8 (7-9 [0-10]) for Airtraq vs. 8 (7-9 [0-10]) for flexible bronchoscopy, p = 0.710. The median visual analogue scale for patient comfort for Airtraq was 8 (6-9 [2-10]) vs. 8 (7-9 [3-10]) for flexible bronchoscopy, p = 0.370. The Airtraq videolaryngoscope is not non-inferior to flexible bronchoscopy for awake tracheal intubation in a clinical setting when awake tracheal intubation is indicted. It may be a suitable alternative when judged on a case-by-case basis.

Phénotypes de résistance des souches d'escherichia coli responsables des infections urinaires communautaires dans la ville de Yaoundé (Cameroun)

Introduction. L'objectif etait de rechercher les phenotypes de resistance des souches d'Escherichia coli (E. coli) dans les infections urinaires a Yaounde. Methodologie. Il s'agissait d'une etude prospective realisee de juin a decembre 2012. Les souches collectees dans quelques laboratoires ont ete identifiees par la galerie API 20E ; l'antibiogramme a ete realise par la methode des disques selon le CA-SFM 2012. La cytologie urinaire a ete effectuee par coloration de Papanicolaou. Resultats. Au total 103 souches d'E. coli ont ete isolees sur une cytologie urinaire avec des cellules transitionnelles reactives. L'antibiogramme a revele un haut niveau de resistance aux penicillines 76%-93;2% et inhibiteurs; cefalotine 60% et cefotaxime 69;9%. L'imipeneme a ete active sur toutes les souches. Les phenotypes de haut niveau de resistance etaient frequents chez les sujets de plus de 60 ans. Conclusion. Les phenotypes de resistance des souches d'E. coli ont ete frequemment retrouves dans la communaute

Environmental exposure to carcinogens in northwestern Cameroon.

BACKGROUND: In developing countries, 6% of deaths are due to cancer but cancer prevention is not practiced. Humans can prevent themselves from a number of workplace and environmental carcinogens. OBJECTIVES: To assess exposure to carcinogens, risky behaviours and associated preventive methods. METHODS: A structured questionnaire was used to collect information on carcinogen exposure in the workplace and environment through trained field staff from volunteers after gaining informed consent. Data was analysed using SPSS. RESULTS: Participants were exposed to recognized carcinogens and environmental hazards. Thirty-five (83.3%) [95% CI: 72.0- 94.6] participants knew the carcinogen names they were exposed to. Common hygienic practices such as taking a bath and washing work dresses at the workplace, use of detergents to wash hands, and no smoking or eating at the workplace were poor. Twenty-nine (69.0%) [95% CI: 47.0 - 75.0] participants could smell the carcinogenic chemicals they use. Thirty (71.4%) [95% CI: 65.0 - 77.0] participants had been instructed in the use of protective equipment against carcinogens. Participants used preventive devices like hand gloves, laboratory coats, boots, face masks, goggles, ear plugs and respirators. CONCLUSIONS: Exposure to carcinogens is common necessitating case-control and cohort studies in this locality on cancer prevalence and incidence.

One year survey of human rotavirus strains suggests the emergence of genotype G12 in Cameroon.

In this study the emergence of rotavirus A genotype G12 in children <5 years of age is reported from Cameroon during 2010/2011. A total of 135 human stool samples were P and G genotyped by reverse transcriptase PCR. Six different rotavirus VP7 genotypes were detected, including G1, G2, G3, G8, G9, and G12 in combinations with P[4], P[6] and P[8] VP4 genotypes. Genotype G12 predominated in combination with P[8] (54.1%) and P[6] (10.4%) genotypes followed by G1P[6] (8.2%), G3P[6] (6.7%), G2P[4] (5.9%), G8P[6] (3.7%), G2P[6] (0.7%), G3P[8] (0.7%), and G9P[8] (0.7%). Genotype P[6] strains in combination with various G-types represented a substantial proportion (N=44, 32.6%) of the genotyped strains. Partially typed strains included G12P[NT] (2.2%); G3P[NT] (0.7%); G(NT)P[6] (1.5%); and G(NT)P[8] (0.7%). Mixed infections were found in five specimens (3.7%) in several combinations including G1+ G12P[6], G2+ G3P[6] + P[8], G3+ G8P[6], G3 + G12P[6] + P[8], and G12P[6] +P[8]. The approximately 10% relative frequency of G12P[6] strains detected in this study suggests that this strain is emerging in Cameroon and should be monitored carefully as rotavirus vaccine is implemented in this country, as it shares neither G- nor P-type specificity with strains in the RotaTeq® and Rotarix® vaccines. These findings are consistent with other recent reports of the global spread and increasing epidemiologic importance of G12 and P[6] strains.

HIV-1/HIV-2 co-infection among voluntary counselling and testing subjects at a regional hospital in Cameroon.

BACKGROUND: HIV/AIDS is a major public health problem in Cameroon which had a prevalence of 5.1% in 2010 with 141 new infections per day. The fear of voluntary counseling and testing (VCT) is an obstacle to HIV prevention. OBJECTIVES: To determine the prevalence of HIV-1, HIV-2 and HIV-1/HIV-2 co-infection among people attending a health facility for VCT. METHODS: Venous blood was collected from participants using aseptic techniques in a descriptive observational cross-sectional study. DETERMINE HIV-1/2 and SD BIOLINE HIV-1/2 3.0 qualitative tests were used for the detection of HIV-1 and HIV-2 in their sera. Range and consistency checks were carried out on the data and analysed using Epi-Info. RESULTS: Of 290 individuals tested, 78(26.9%) were positive for HIV-1 and HIV-2. Among the 78 HIV positive individuals, 62 (79.5%) had HIV-1, 1(1.3%) had HIV-2 and 15(19.2%) had concurrent HIV-1/ HIV-2. Among those infected, 57(73.1%) were females including 21(26.9%) males. CONCLUSION: HIV-1 is the major cause of AIDS and VCT is well accepted. Co-infection with HIV-1/HIV-2 may lead to anti-retroviral drug resistance. VCT should be encouraged so that positive cases can initiate therapy on time to stay ahead of anti-retroviral drug resistance.

The incidence of feco-oral parasites in street-food vendors in Buea, south-west region Cameroon.

BACKGROUND: The street-food industry lacks legal recognition, it operates in unstable and precarious conditions, involving women and men with minimal or no knowledge of hygienic food handling practices. Infective eggs, bacteria, toxins and cysts of faecal orally transmissible parasites are common agents responsible for food contamination in developing countries. OBJECTIVE: To determine the incidence of digestive faecal-oral parasites among street-food vendors in Buea, South-west region of Cameroon, METHODS: From March to May 2009, physical and laboratory analysis of stool samples of 150 randomly selected street-food vendors, residing in four different zones in the municipality were carried out. Information on environmental and personal hygiene was also collected. RESULTS: Results revealed that 56.7% of the sampled population was infected with faecal-oral parasites. The major faecal-oral parasites detected in stool samples were: Entamoeba coli (14.0%), Entamoeba histolytica (12.67%), Ascaris lumbricoides (11.33%), Ankylostoma duodenalis (10.67%). Childcare activities, lack of deworming, poor personal hygiene, poor sanitary and toilet facilities, were factors promoting the spread of faecal-oral infections. CONCLUSION: Food vendors should be educated on personal hygiene and safe food handling measures. Regulatory procedures on environmental hygiene and regular medical and paramedical follow up of food vendors should be enforced.

A critical review on HIV/AIDS and wound care

Wound infections in AIDS patients increase discomfort; prolong hospital stay; render an additional burden upon an already debilitated patient and weaken the immune system further. Treatment must relate to the aetiology of the wound and take into account the patients underlying health problems. The treatment of wounds in HIV-AIDS patients is not different from the standard treatment. There are wound -related criteria for selecting the appropriate types of dressing. The best dressing for postoperative wound healing by secondary intention is unknown. Continuing wound evaluation and the appraisal of what dressing is useful for the type of wound and stage of healing is the basis of optimum wound care Optimum wound care; emotional support; health education will enhance both the emotional and physical wellbeing of the HIV-AIDS patient

Epidemiological studies on proteeae isolates from clinical specimens in the Laquintinie Hospital in Douala, Cameroon

The tribe Proteeae is a group of bacteria within the family Enterobacteriaceae and is responsible for most cases of nosocomial infections in hospital settings. The objective of this study was to determine the prevalence of members of Proteeae from clinical specimens in Laquintinie hospital in Douala. Specimens were collected from patients and screened for Proteeae using standard microbiological and biochemical methods (API 20 Enterobacteriaceae gallery). Of the 3414 clinical specimens made of 2712 urine; 264 blood; 243 CSF and 195 wounds and burns; 1136 (33.3) yielded a positive bacterial growth; of which 230 (20.2) were Gram positive and 906 (79.7) were Gram negative. 164 (14.4) isolates were identified as members of Proteeae of which 110 (67.1) were from urine; 37( 22.6) from wounds and burns; 10(6.1) from blood and 7( 4.3) from CSF. Speciation of the Proteeae isolates showed that 111 (67.7) were Proteus mirabilis; 21(12.8) Proteus vulgaris; 11 (6.7) Providencia alcalifaciens; 6 (3.6) Providencia stuartii; 4 (2.4) Morganella morganii and 5 (3.0) Proteus penneri and Providencia rettgeri. There was a significant difference between the type of clinical specimens and the age of patients (X2 = 52.623 p0.05). Most Proteeae isolates where susceptible to imipemen; ceftazidine; chloramphenicol; gentamicin; nalidixic acid; ofloxacin and amikacin. These findings have significant clinical and epidemiological implications

Schistosomiasis in Cameroon: an assessment of community knowledge pattern.

OBJECTIVE: Schistosomiasis is one of the most widespread of all human parasitic diseases and is a serious health problem in Cameroon despite tremendous efforts by health authorities. The purpose of this study was to determine community knowledge of the infection in order to evaluate control programmes put in place. METHODS: A random sampling method was used to administer questionnaires to 3200 individuals in 80 communities throughout the ten regions of the country. RESULTS: Globally the percentage of persons with good knowledge of schistosomiasis was low (28.8%). Of the 2586 who responded 1311 (50.7%) were females and 1275 (49.3%) were males. There was a statistically significant difference in the community knowledge pattern by gender (chi2 = 157.28, P < 0.05), and persons with good knowledge were more frequent among males than females (61.8% vs. 38.2% P < 0.05). The percentage of people who had good knowledge about the disease was highest in the Far North region (35.4), followed by the North (33.8) and the Southwest (31.1) regions. There was a statistically significant difference in community knowledge pattern of Schistosomiasis by region and gender (chi2 = 1265.648 P < 0.001). Also, there was a statistically significant difference in community knowledge pattern of by setting (chi2 = 38.538 P = 0.001) and the percentage of people who had a good knowledge of the disease was higher in rural areas than in urban areas (72.5% vs. 3.1% P < 0.05). CONCLUSION: was a low community knowledge pattern of schistosomiasis, mostly among the female population and among people living in urban areas. We advocated that health education should be adopted as one of the control strategies by the

Knowledge, attitudes and practices relating to malaria in a semi-urban area of Cameroon: choices and sources of antimalarials, self-treatment and resistance.

UNLABELLED: BACHGROUND: Malaria is a major public health problem in sub-Saharan Africa where it kills a child below five years ever 30 seconds. In Cameroon, malaria accounts for 40-45% of medical consultations, 57% of hospitalization days and 40% of mortality among children below 5 years. Community knowledge, attitudes and practices can enhance the fight against this disease. OBJECTIVE: To make a local analysis of the malaria problem and to establish epidemiological and behavioural baseline data and their implications for malaria control. METHODS: The study design was an observational community-based cross-sectional study in a semi-urban setting. Two hundred and fifty three participants of different socio-demographic status took part in the study from among 350 contacted. A structured questionnaire was administered to volunteers. The respondent's consent was sought and gained and subjects who could not read or write or understand English language were communicated to in the local language. The questionnaire was administered by a trained interviewer according to the schedule of the respondent. The data was analysed using SPSS. RESULTS: Antimalarials commonly cited for malaria treatment were chloroquine (26.09%) and nivaquine (14.62%) and analgesics: panadol (22.92%) and paracetamol (12.25%) including native drugs (6.32%). One hundred and forty-one (55.7%) [95% confidence interval (CI): 49.58-61.82%)] participants practiced self-treatment of malaria. Only 26.09% participants knew the correct adult malarial dosage for chloroquine and/or nivaquine. One hundred and twenty five (40.41%) [95% CI: 34.36-46.46%] participants got their antimalarials from authorized sources. One hundred and twenty five (40.41%) participants indicated that they get their antimalarials from the health center, 27(10.61%) from the shop, 24(9.49%) from hawkers, 23(9.09%) from the open market and 16 (6.3%) from herbalists. Only 66 (26.09%) [95% CI: 20.67-31.50%] participants knew the correct adult dosage for chloroquine or nivaquine treatment of malaria. Eighty five (33.6%) [95% CI: 27.78-36.57%] participants had correct knowledge of malarial resistance. Of the 85 (33.6%) participants who had knowledge of malaria resistance, 52(20.55%) ascribed malaria resistance to continuous fever for a long time during treatment, 15 (5.93%) to serious fever during treatment and 18 (7.12%) when chloroquine does not stop the malarial fever. Most (27.06%) of those who had the correct knowledge of malarial resistance were in the age group 31-35 bracket compared with other age groups (P>0.05). There was no difference in correct knowledge of malarial resistance and participant's professions. CONCLUSION: Malaria self-treatment is common but knowledge of malaria resistance is poor. This method should be improved upon by giving correct information on the dosage of adult malaria treatment on radio, television, posters and newspapers because banning it will push many people to use it in hiding since it has its advantages. Malaria drug abuse can lead to drug resistance hence in-vitro and in-vivo tests are warranted to confirm malaria resistance.

Seroprevalence of Toxoplasma Gondii Infection among Pregnant Women in Cameroon

Toxoplasmosis is caused by an intracellular protozoan; Toxoplasma gondii; which has a wide geographical distribution. The congenital form results in a gestational form that can present a temporary parasiteamia that will infect the fetus. For this reason early diagnosis in pregnancy is highly desirable; allowing prompt intervention in cases of infection. The aim of this study was to determine the seroprevalence of Toxoplasma gondii antibodies among pregnant women attending the Douala General Hospital. The study was carried out between March and July 2009; whereby 110 pregnant women were tested for IgG and IgM antibodies and information about eating habits and hygienic conditions was collected using a questionnaire. These women's ages ranged from 20-44 years old with an average of 29.9 years; the overall IgG and IgM seroprevalence was 70and 2.73respectively. Seroprevalence was significantly high amongst women who ate raw vegetables (76.39; P0.05) and there was a significant trend towards a higher seroprevalence in women who did not have a good source of water (75.58; P0.05). This research showed that consumption raw vegetables and poor quality drinking water are two risk factors associated with Toxoplasma gondii infection amongst pregnant women attending the Douala General Hospital in Cameroon

[Diagnosis of pheochromocytoma in Yaoundé (Cameroon): a study of nine cases]. / Phéochromocytomes au Cameroun: neuf observations.

The aim of this study was to describe methods used for diagnosis of pheochromocytoma inYaoundé, Cameroon. This retrospective study was based on analysis of the charts of patients treated in the surgical department of the Yaoundé University Teaching Hospital from 1985 to 2009. Nine patients with histologically confirmed pheochromocytoma were identified. There were 8 women and 1 man with a mean age of 39.5 years (range, 12 and 66). Pheochromocytoma was associated with hypertension in 6 cases. In two women with hypertension, diagnosis was based on palpation of an abdominal tumor after caesarean section following pregnancy associated with arterial hypertension. In another woman, diagnosis was made during laparotomy for a left hypochondrial tumor. In 7 patients, diagnosis was based on laboratory findings showing high urinary levels of vanyl mandelic acid (VMA). In six patients, ultrasound examination allowed topographic diagnosis that was confirmed by CT-scan in 3 cases. Two patients presented extra-renal pheochromocytomas in the abdomen. In three patients, i.e., one third of cases, histology showed malignant features. The findings of this study indicated that diagnosis of pheochromocytoma in Yaoundé be improved with the introduction MRI, scintigraphy, and modern techniques for assaying urinary methoxyderivates.

[Risk factors of bilateralization of breast cancer: description of five cases in Libreville (Gabon) and review of the literature]. / Facteurs de risque de bilatéralisation du cancer mammaire: cinq observations à Libreville (Gabon).

Approximately 10% of patients diagnosed with breast cancer will develop cancer in the contralateral breast within 10 years. The risk factors for bilateralization are now better understood thanks to advances in molecular biology. Based on reports in the literature the main risk factors are presence of brca 1 or 2 gene mutations and family history. Despite the increasing incidence of breast cancer, this special aspect of the disease remains poorly studied in Gabon as well as in Black Africa in general. Incidence is increasing. This report describes 5 patients and discusses their profiles in relation to the literature. This study provides on update on current knowledge.

Interactions between human immunodeficiency virus and herpes viruses within the oral mucosa.

There is evidence from clinical case reports and epidemiological studies that human immunodeficiency virus (HIV) can be transmitted through oral sex. Herpes viruses that appear in the oral mucosa might influence the oral replication of HIV. A review of data suggesting that interactions occur between HIV and herpes viruses indicates that such interactions might operate in the oral mucosa. Defining the mechanisms by which herpes viruses interact with HIV in the oral mucosa should permit intervention measures to be targeted more precisely.

[Purulent meningitis in children in Yaounde (Cameroon). Survey of complications using echoencephalography]. / Méningites purulentes de l'enfant à Yaoundé (Cameroun). Recherche des complications par l'échoencéphalographie.

Sixty-one infants aged 0 to 12 months with documented purulent meningitis underwent transfontanellar ultrasonography at the Yaounde Central Hospital. Twenty-eight (45.90%) infants had evidence of complications including communicating hydrocephalus (20 patients; 71.43%), ventriculitis (5; 17.86%), abscess with ventriculitis (2; 7.14%), and cerebral atrophy (1; 3.57%). An analysis of the main epidemiological, bacteriological and clinical parameters found no correlation between the presence of ultrasound evidence of complications and age, sex, or color of the CSF. Conversely, a close correlation was found with both the time elapsed between onset and initiation of treatment and the severity of clinical manifestations (coma, seizures). The authors, recommend routine ultrasound encephalography in infants with meningitis, improved information of parents, and close collaboration between pediatric radiologists and neurosurgeons.

Cerebral complications of purulent meningitis in children assessed by transfontanellar ultrasonography in Yaounde (Cameroon).

Sixty-one children, aged 0 to 12 months, all having meningitis confirmed by bacteriological and biochemical studies of CSF, were subjected to transfontanellar US exploration and clinical follow-up. Thirty-three (54.1%) children were normal, and 28 (45.9%) presented cerebral complications: hydrocephalus 20 cases (71.4%), ventriculitis 5 cases (17.9%), abscess and ventriculitis 2 cases (7.1%) and cerebral atrophy 1 case (3.6%). 36.1% of patients with purulent or turbid CSF presented with complications. 24.6% of complications were due to unidentified bacteria and 11.4% due to pneumococcus group. 90.9% patients with coma, and 76.4% with convulsion showed cerebral complications. The authors recommend routine us exploration of children with confirmed meningitis in tropical milieu.