Development and implementation of a nutrition education programme for school-going adolescents in the context of double burden of malnutrition: a narrative essay.

The early prevention of non-communicable diseases in Cameroon schools program was initiated in 2018 to address the alarming trend of obesity among adolescents through a nutrition education intervention aimed at increasing knowledge on nutrition and the benefits of healthy eating and physical activity. The program included: school surveys to document eating habits and health-risky behaviors in students, the development of a training curriculum, training and sensitization sessions for school staff, school vendors and students, and advocacy meetings with parliamentarians and mayors. We carried out a quasi-experimental study to assess the effect of the intervention on the student's knowledge and eating behavior three months after the training sessions. We compared the knowledge of a sample of students from five schools that were part of the program (IG) to that of students that were not (CG). The mean (±SD) score was 14.4/20 (±2.1) and 9.7/20 (±2.7) for IG and CG, respectively (p<0.001). Those who scored above 12/20 accounted for 89.8% of IG vs 23.8% of CG (p<0.001). Other significant achievements of this program are the amendment of the National School Hygiene Policy to include compulsory training in food hygiene and nutrition education for school canteen vendors and the integration of nutrition education sensitization sessions into the routine activities of school healthcare. The study showed that a well-structured multi-sectoral nutritional education program could be the bedrock to improve healthy nutrition among adolescents, thereby serving as a vehicle for non-communicable disease prevention.

Doxycycline vs Hydroxychloroquine + Azithromycin in the Management of COVID-19 Patients: An Open-Label Randomized Clinical Trial in Sub-Saharan Africa (DOXYCOV).

Objective We aimed to compare the safety and efficacy of a doxycycline-based regimen against Cameroon National Standard Guidelines (hydroxychloroquine plus azithromycin) for the treatment of mild symptomatic COVID-19. Methods We conducted an open-label, randomized, non-inferiority trial in Cameroon comparing doxycycline 100 mg, twice daily for seven days versus hydroxychloroquine 400 mg daily for five days and azithromycin 500 mg at day 1 and 250 mg from day 2 through 5 in mild COVID-19 patients. Clinical recovery, biological parameters, and adverse events were assessed. The primary outcome was the proportion of clinical recovery on days 3, 10, and 30. Non-inferiority was determined by the clinical recovery rate between protocols with a 20-percentage points margin. Results One hundred and ninety-four participants underwent randomization and were treated either with doxycycline (n = 97) or hydroxychloroquine-azithromycin (n = 97). On day 3, 74/92 (80.4%) participants on doxycycline versus 77/95 (81.1%) on hydroxychloroquine-azithromycin-based protocols were asymptomatic (p = 0.91). On day 10, 88/92 (95.7%) participants on doxycycline versus 93/95 (97.9%) on hydroxychloroquine-azithromycin were asymptomatic (p = 0.44). On day 30, all participants were asymptomatic. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) polymerase chain reaction (PCR) test was negative on day 10 in 60/92 (65.2%) participants who were assigned to doxycycline and in 63/95 (66.3%) participants who were assigned to hydroxychloroquine-azithromycin. None of the participants were admitted for worsening of the disease after treatment initiation. Conclusion Doxycycline 100 mg twice daily for seven days proved to be safe and non-inferior in terms of efficacy when compared to hydroxychloroquine-azithromycin for preventing clinical worsening of mild symptomatic or asymptomatic COVID-19 and achieving virological suppression.

The phenotype of type 1 diabetes in sub-Saharan Africa.

The phenotype of type 1 diabetes in Africa, especially sub-Saharan Africa, is poorly understood. Most previously conducted studies have suggested that type 1 diabetes may have a different phenotype from the classical form of the disease described in western literature. Making an accurate diagnosis of type 1 diabetes in Africa is challenging, given the predominance of atypical diabetes forms and limited resources. The peak age of onset of type 1 diabetes in sub-Saharan Africa seems to occur after 18-20 years. Multiple studies have reported lower rates of islet autoantibodies ranging from 20 to 60% amongst people with type 1 diabetes in African populations, lower than that reported in other populations. Some studies have reported much higher levels of retained endogenous insulin secretion than in type 1 diabetes elsewhere, with lower rates of type 1 diabetes genetic susceptibility and HLA haplotypes. The HLA DR3 appears to be the most predominant HLA haplotype amongst people with type 1 diabetes in sub-Saharan Africa than the HLA DR4 haplotype. Some type 1 diabetes studies in sub-Saharan Africa have been limited by small sample sizes and diverse methods employed. Robust studies close to diabetes onset are sparse. Large prospective studies with well-standardized methodologies in people at or close to diabetes diagnosis in different population groups will be paramount to provide further insight into the phenotype of type 1 diabetes in sub-Saharan Africa.

Gestational diabetes mellitus in Cameroon: prevalence, risk factors and screening strategies.

Background: The burden of gestational diabetes (GDM) and the optimal screening strategies in African populations are yet to be determined. We assessed the prevalence of GDM and the performance of various screening tests in a Cameroonian population. Methods: We carried out a cross-sectional study involving the screening of 983 women at 24-28 weeks of pregnancy for GDM using serial tests, including fasting plasma (FPG), random blood glucose (RBG), a 1-hour 50g glucose challenge test (GCT), and standard 2-hour oral glucose tolerance test (OGTT). GDM was defined using the World Health Organization (WHO 1999), International Association of Diabetes and Pregnancy Special Group (IADPSG 2010), and National Institute for Health Care Excellence (NICE 2015) criteria. GDM correlates were assessed using logistic regressions, and c-statistics were used to assess the performance of screening strategies. Findings: GDM prevalence was 5·9%, 17·7%, and 11·0% using WHO, IADPSG, and NICE criteria, respectively. Previous stillbirth [odds ratio: 3·14, 95%CI: 1·27-7·76)] was the main correlate of GDM. The optimal cut-points to diagnose WHO-defined GDM were 5·9 mmol/L for RPG (c-statistic 0·62) and 7·1 mmol/L for 1-hour 50g GCT (c-statistic 0·76). The same cut-off value for RPG was applicable for IADPSG-diagnosed GDM while the threshold was 6·5 mmol/L (c-statistic 0·61) for NICE-diagnosed GDM. The optimal cut-off of 1-hour 50g GCT was similar for IADPSG and NICE-diagnosed GDM. WHO-defined GDM was always confirmed by another diagnosis strategy while IADPSG and GCT independently identified at least 66·9 and 41·0% of the cases. Interpretation: GDM is common among Cameroonian women. Effective detection of GDM in under-resourced settings may require simpler algorithms including the initial use of FPG, which could substantially increase screening yield.

Incidence and prevalence of type 1 diabetes in Africa: a systematic review and meta-analysis protocol.

INTRODUCTION: Type 1 diabetes is reported to have significant mortality in Africa. However, there is a paucity of data on pooled estimates of its incidence and prevalence in Africa. This first systematic review and meta-analysis will be conducted to determine the incidence and prevalence of this condition in Africa. METHODS: Based on predefined criteria, electronic databases, including PubMed, Excerpta Medica database, Africa Journal Online and Web of Science, will be searched for relevant studies involving paediatric and adult patients, with no language restrictions. Quality assessment of the individual studies will be performed, and the Q-statistic test and I2 statistic test will be used to assess statistical heterogeneity. Appropriate meta-analysis will then be used to pool studies judged to be clinically homogenous. Egger's test will be used to detect publication bias. The planned search dates for the eligible articles are from 1 September to 30 September 2022. ETHICS AND DISSEMINATION: Since this review will use previously published studies, it will not require the consent of an ethics committee. The results will be prepared and disseminated through a peer-reviewed journal and will be presented in relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42021278227.

Stimulated UCPCR Levels Are Lower in People With Type 1 Diabetes Than in Other Diabetes Types in Sub-Saharan Africa: Results From a Preliminary Cross-Sectional Study.

Background: The clinical utility of Urinary C-Peptide to Creatinine Ratio (UCPCR) is well understood in people with different types of diabetes in Caucasian populations, but studies are lacking in African populations. We, therefore, aimed to examine Urinary C-Peptide to Creatinine Ratio levels among groups of people with different types of diabetes in a sub-Saharan African population. Methods: A total of 47 adults with diabetes; 10 with type 1 diabetes, 26 with type 2 diabetes, 11 with ketosis-prone diabetes, and 22 healthy control individuals, were recruited from Yaoundé Central Hospital in Cameroon. Fasting blood glucose and C-peptide were measured in venous blood and urine. Stimulated Urinary C-Peptide to Creatinine Ratio was determined in all subjects after ingestion of a standardized mixed meal. We compared the stimulated Urinary C-peptide to Creatinine Ration concentration in subjects with type 1 diabetes to the other groups. Results: The basal C-peptide and HOMA-ß were lower in T1D than in the T2D group [median 57 (34, 69) vs. 398 (335, 502) pmol/l; p ≤ 0.001] and [median 3.0 (1.63, 5.25) vs. 30.6 (17.94, 45.03); p < 0.001] respectively. Also, basal C-peptide and HOMA-ß were lower in T1D than in those with KPD [median 57 (34, 69) vs. 330 (265, 478) pmol/l; p = 0.003] and [median 3.0 (1.63, 5.25) vs. 47.1 (16.2, 63.1), p = 0.001] respectively. Basal C-peptide was not different between participants with T2D and KPD; 398 (335, 502) vs. 330 (265, 478) pmol/l, p = 0.19. Stimulated UCPCR was lower in T1D compared to T2D, KPD and control participants; [median 0.29 (0.14, 0.68) vs. 0.89 (0.40, 1.69) nmol/moll; p = 0.009], [median 0.29 (0.14, 0.68) vs. 1.33 (0.84, 1.59) nmol/mol; p = 0.006] and [median 0.29 (0.14, 0.68) vs. 1.21 (0.85, 1.21) nmol/mol; p = 0.005] respectively. However, stimulated UCPCR was similar between the T2D and KPD study participants; 0.89 (0.40, 1.69) vs. 1.33 (0.84, 1.59) nmol/mol, p = 0.36. Conclusions: Stimulated Urinary C-Peptide to Creatinine Ratio (UCPCR) is lower in participants with type 1 diabetes compared to those with other types of diabetes in this population. This means stimulated UCPCR could potentially differentiate type 1 diabetes from other diabetes types among people with diabetes in sub-Saharan Africa.

Procalcitonin levels in children affected by severe malaria compared to those with uncomplicated malaria in the absence of bacterial infection: a cross-sectional study.

BACKGROUND: Procalcitonin is an inflammatory marker strongly associated with the presence of bacterial infection. It has been considered raised in severe malaria infection as opposed to uncomplicated malaria. There are suggestions that it may be raised only when there is concomitant unnoticeable bacterial infection during a malaria crisis. We aimed to assess the difference in plasma procalcitonin levels between children affected by severe and uncomplicated malaria. METHODS: We assessed plasma procalcitonin levels in 83 children diagnosed with malaria with no clinical and biological evidence of concomitant bacterial infection. Severity of malaria was established using WHO guidelines. Procalcitonin was determined using the ELISA method. Non-parametric Mann-Whitney U test was used to compare medians across the 2 groups. Statistical significance was set for all p values < 0.05. RESULTS: Of the 83 participants, 28 had uncomplicated malaria, and 55 had severe malaria. PCT levels were obtained in 24 and 40 subjects of each group, respectively, and were similar in both groups; [2.76 (2.52-2.93) vs 2.74 (2.52-2.98) ng/ml, p = 0.916]. The parasite density was lower in the uncomplicated malaria group than in the severe malaria group, but not statistically significant; [22,192 (9110-44 654) vs 31 684 (13 960-73 500) parasites/µl, p = 0.178]. There was no correlation between the parasite density in the general study population and PCT levels (r = 0.072, p = 0.572). CONCLUSION: In the absence of overt bacterial infection, procalcitonin levels are not different between children affected with uncomplicated malaria and those with severe malaria. Therefore, bacterial infection should be thoroughly checked for in children with raised serum procalcitonin diagnosed with severe malaria.

Mortality amongst children and adolescents with type 1 diabetes in sub-Saharan Africa: The case study of the Changing Diabetes in Children program in Cameroon.

INTRODUCTION: Type 1 diabetes in Africa has been associated with high mortality attributed mainly to poor insulin access. Free insulin provision programs for people with type 1 diabetes have been introduced across Africa recently. We aimed to determine the mortality rate and associated factors in a cohort of children and adolescents with type 1 diabetes who receive free insulin treatment in sub-Saharan Africa. METHODS: We conducted a retrospective analysis using the Changing Diabetes in Children (CDiC) medical records in Cameroon between 2011 and 2015. RESULTS: The overall mortality rate was 33.0 per 1000 person-years (95% CI 25.2-43.2). Most deaths (71.7%) occurred outside of the hospital setting, and the cause of death was known only in 13/53 (24.5%). Mortality was substantially higher in CDiC participants followed up in regional clinics compared to the main urban CDiC clinic in Yaounde; 41 per 1000 years (95% CI 30.8-56.0) versus 17.5 per 1000 years (95% CI 9.4-32.5), and in those with no formal education compared to those who had some level of education; 68.0 per 1000 years (95% CI 45.1-102.2) versus 23.6 per 1000 years (95% CI 16.5-33.8). In Cox proportional multivariable analysis, urban place of care (HR = 0.23, 95% CI 0.09-0.57; p = 0.002) and formal education (HR = 0.42, 95% CI 0.22-0.79; p = 0.007) were independently associated with mortality. CONCLUSION: Despite free insulin provision, mortality remains high in children and adolescents with type 1 diabetes in Cameroon and is substantially higher in rural settings and those with no formal education.

Procalcitonin Correlates With Cardiovascular Risk Better Than Highly Sensitive C-Reactive Protein in Patients With Type 2 Diabetes in Sub-Saharan Africa: Results From a Cross-Sectional Study.

Objective Inflammatory markers such as C-reactive protein and procalcitonin have been shown to be independent markers of cardiovascular diseases. We aimed to assess the correlation between serum levels of procalcitonin, C-reactive protein and cardiovascular risk in type 2 diabetes. Methods We carried out a cross-sectional study at a tertiary level reference hospital in Yaounde, Cameroon. We assessed the cardiovascular risk using the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) cardiovascular risk prediction model in 80 adults with type 2 diabetes. Serum procalcitonin and C-reactive protein were measured in 80 and 76 subjects respectively, using a highly sensitive quantitative enzyme-linked immunosorbent assay (ELISA) method. Correlations were examined using Spearman's rank correlation test and the correlation coefficients were compared using the Z-test statistic. Results Females represented the majority of the study population (62.5%). The median duration of diabetes was 5 (3-10) years and 62.5% of participants had a high cardiovascular risk score. Median serum procalcitonin levels was significantly higher in females compared to male participants: 2.48 (1.76-3.01 ng/mL) vs 1.42 (0.86-1.87 ng/mL); p<0.001. There was no difference in the serum C-reactive protein levels between females and males: 1.20 (0.33-3.33) mg/L vs 0.85 (0.36-2.77) mg/L; p=0.669. Procalcitonin was moderately correlated with cardiovascular risk (r=0.58, p<0.001). The correlation was slightly higher in females (R=0.56, p<0.001) versus males (R=0.49, p=0.005) although not significantly different (Z-statistic=0.734, p=0.463). Serum C-reactive protein did not show a meaningful correlation with cardiovascular risk (R=0.23, p=0.050). At a threshold of 2 ng/ml, serum procalcitonin identified participants with a high cardiovascular risk score, with a sensitivity and specificity of 64% and 80% respectively. Conclusion Compared to C-reactive protein, procalcitonin may be a better surrogate marker for cardiovascular risk prediction in this population with type 2 diabetes.

Effects of non-surgical treatment of chronic periodontitis on insulin resistance and glucose tolerance in subjects without diabetes (PARODIA 2 study).

This study aimed to assess the effects of non-surgical periodontal treatment (NSPT) of chronic periodontitis on insulin sensitivity, glucose tolerance, and serum C reactive protein (CRP) level in individuals without diabetes. Twenty individuals without diabetes with chronic periodontitis underwent NSPT, which consisted of complete scaling, polishing, root planing, and irrigation of the periodontal pockets with a 10% povidone-iodine solution. Periodontal indices (plaque index, gingival bleeding index, pocket depth, and clinical attachment loss), insulin sensitivity using the Short Insulin Tolerance Test index (KITT), glucose tolerance derived from oral glucose tolerance test, and serum CRP level were measured before and 3 months after the intervention. This study was carried out at the National Obesity Center of Yaoundé Central Hospital, Cameroon. After 3 months, we observed significant improvement in periodontal parameters (all p<0.001) and insulin sensitivity (3.72 (2.99-4.17) %/min before treatment vs 4.04 (3.67-4.78) %/min after treatment, p=0.001) and significant decrease in serum CRP level (2.35 (1.46-4.18) mg/L before vs 1.53 (1.03-2.12) mg/L after, p=0.033). There was a trend toward improvement in glucose tolerance, although not statistically significant after the intervention. This study suggests that NSPT of chronic periodontitis in individuals without diabetes is associated with increased insulin sensitivity and decreased serum CRP levels.Trial registration number NCT02830113.

Effect of Topical Capsaicin on Painful Sensory Peripheral Neuropathy in Patients with Type 2 Diabetes: A Double-Blind Placebo-Controlled Randomised Clinical Trial.

Objective The aim of this study was to evaluate the efficacy of capsaicin in inducing significant pain relief in a population of sub-Saharan African type 2 diabetic patients with painful peripheral neuropathy. Design This was a prospective double-blind placebo-controlled randomised clinical trial. Setting A single tertiary-level hospital diabetes center in Yaounde, Cameroon. Participants Twenty-two participants with type 2 diabetes mellitus, presenting with painful diabetic neuropathy, aged 18 years and above. Intervention Participants were equally randomised to capsaicin or placebo. Each drug was to be applied on the lower limbs thrice daily. Follow-up was done every two weeks for eight weeks.  Main outcome measure Reduction in the median pain score from baseline, as assessed by the Visual Analogue Scale.  Results Twenty-two participants aged 57.5 (50-60) years with a median pain intensity of 6.8 units in the capsaicin group and 5.8 units in the placebo group were included; at inclusion, there was no significant difference in the two groups (p=0.29). After two weeks, the value of pain intensity was 3.3 [2.5-4.0] vs 5.0 [4.0-7.4] (p=0.003); at week four, 3.0 [2.5-3.3] vs 5.0 [4.2-5.5] (p=0,02); at week six, 3.3 [2.5-4.0] vs 4.8 [4.0-6.0] (p=0.03); and at week eight, 6.6 [6.0-7.0] vs 5.2 [5.0-6.0] (p=0.54) for capsaicin and placebo respectively. Conclusion This study, carried out due to a paucity of information on the effect of capsaicin and painful diabetic neuropathy in sub-Saharan African diabetes patients, shows that capsaicin significantly reduces neuropathic pain with worsening after eight weeks of use. Trial registration number Pan Africa Trial Registry: PACTR202003714748946.

Metabolic effects of exposure to pesticides during gestation in female Wistar rats and their offspring: a risk factor for diabetes?

Some pesticides increase the risk of type 2 diabetes, but whether fetal exposure carries transgenerational risk remains unknown. We evaluated the metabolic effects of gestational exposure to chlorpyrifos and imidacloprid in female Wistar rats and their offspring. We studied female nulliparous Wistar rats, including six exposed to imidacloprid (IMI) and six to chlorpyrifos (CPF) once daily throughout gestation at 1/10 lethal dose 50, while six (control group) received distilled water. These were explored 1 month after the birth of the offspring, while their offspring were explored at weaning (4 weeks) and adult age (12 weeks). Blood glucose, insulin and lipid profile were determined at each stage, while glucose transporter 4 (GLUT4) and nuclear factor kappa beta (NFkß) protein expression was measured in skeletal muscle at the end of follow up. Exposure to pesticides was associated with significantly higher fasting glucose (+25.4 to 30.9%) and insulin (> 100%) levels, with > 100% increased insulin resistance (HOMA-IR), - 18.3 to - 21.1% reduced HDL-cholesterol and + 60.9 to + 102.6% increased LDL-cholesterol in mothers. GLUT4 expression was reduced by 28.9-42.3% while NFkß expression increased by 32.8-35.4% in mothers. In offspring, similar abnormalities were observed at weaning (+ 18.4 to 67.4% fasting glucose, + 57.1 to 72.2% LDL-cholesterol, + 72.3 to 78.2% fasting insulin), persisting at adult age with decreased expression of GLUT4 (- 52.8 to 54.5%) and increased expression of NFkß (+ 30.5 to 30.7%). Gestational exposure to imidacloprid and chlorpyrifos induces hyperglycemia, insulin resistance and dyslipidemia in female Wistar rats and their offspring. The effects on offspring persist until adult age, suggesting intergenerational adverse effects.

Adverse drug reactions to anti-diabetic drugs are commonest in patients whose treatment do not adhere to diabetes management clinical guidelines: cross-sectional study in a tertiary care service in sub-Saharan Africa.

AIMS: The study aimed to identify and describe adverse drug reactions and adherence to clinical guidelines in patients receiving treatment for type 2 diabetes mellitus (T2DM) in Cameroon. METHODS: The method used was a cross-sectional study at a tertiary diabetes care service in Yaoundé, Cameroon. Adult T2DM patients attending the diabetes clinic were interviewed using a pre-structured data collection form. Adverse drug reactions (ADRs) were self-reported by the patients. Naranjo's algorithm and Hartwig and Siegel's scale were used for assessment of causality and severity of ADRs, respectively. A blinded senior endocrinologist assessed whether treatment pattern of patients was "adherent" or not to local clinical guidelines for the management of diabetes. RESULTS: Of a total of 350 patients enrolled into the study 61.1% were on oral hypoglycaemic agents only, 24.9% were on both oral hypoglycaemic agents and insulin, while 13.4% were on insulin alone. Metformin was used by 96.3% of the patients. Ninety patients reported 101 suspected ADRs. The proportion of ADRs among patients with poor adherence to clinical guidelines was higher than ADRs reported among adherent patients (Chi-square test = 7.3273; p = 0.007). Hypoglycaemia was more frequent ADR among non-adherent (25.7% of the suspected ADR) than adherent participants (11.6%). In the participants whose treatment pattern did not adhere to local clinical guidelines, ADRs were definite in 63.9%, probable in 16.6%, doubtful in 13.9% and possible in 5.6% of the cases. ADRs were moderate in 61.1% and severe in 19.4% of cases whose treatment pattern was non-adherent to clinical guidelines. INTERPRETATION: Adverse drug reactions may be frequent in type 2 diabetes patients whose treatment pattern does not adhere to local clinical guidelines in Cameroon. Therefore, the promotion of active pharmacovigilance and the design of training activities to promote the appropriate use of medicines at hospital level in Cameroon could help to improve the management of diabetes and reduce the incidence of avoidable ADRs in the future.

Smartphone-Assisted Glaucoma Screening in Patients With Type 2 Diabetes: a Pilot Study.

We aimed to determine true and false positives of glaucoma screening, relying solely on photos of the retina, taken with a smartphone. We performed a descriptive and analytical study on patients with type 2 diabetes at the National Obesity Centre, Yaoundé, Cameroon. Participating patients had retinal photography sessions using an iPhone 5s (iOS 10.3.3; Apple, Cupertino, CA) coupled to the Make in India Retinal Camera (MIIRetCam; MIIRetCam Inc., Coimbatore, TN, India). Obtained pictures of the retina were stored and transferred via the internet to an ophthalmologist to assess glaucoma. Selected patients were then invited to undergo a conventional ophthalmological examination to confirm the diagnosis. A total of 395 patients were screened, 39 (including 20 women) were diagnosed with suspicion of glaucoma based on retinal photos, a prevalence rate of 9.87%. The following signs were found; Cup/Disc ratio (C/D) ≥0.5 in 64.1% (25/39), asymmetric C/D >0.2 in 35.9% (14/39), papillary haemorrhage in 10.2% (4/39) and retinal nerve fibre deficiency in 2.5% (1/39). Only 14 of 39 patients with suspicion of glaucoma were examined, giving a lost-to-follow-up rate of 64.1%. Chronic open-angle glaucoma was confirmed in 8 patients (true positives) and absent in 6 patients (false positives). The prevalence of smartphone-detected glaucoma and lost-to-follow-up rates were high. So we need to improve this type of screening, with additional tests like transpalpebral applanation tonometer and the smartphone Frequency Doubling Technique visual field combined with better education of patients to increase their adherence to follow-up.

The clinical and psychological profiles of patients with hypogonadism, followed in 3 reference hospitals of Cameroon: an observational study.

INTRODUCTION: Hypogonadism refers to a syndrome that results from failure of gonads to function properly. The main concern is considerable rise in morbidity, as shown by increased cardiovascular risk, infertility, osteoporosis and above all, the psychological impact on the life of the patients with hypogonadism. Judicious steroid replacement and culturally-sensitive psychological support before and during steroid therapy remains the key tool in the management of this condition. The present study aimed at filling the knowledge gap on hypogonadism in Cameroon. METHODS: We conducted a cross-sectional study over a period of 12 months, in 3 reference hospitals of Cameroon. We included males and females diagnosed with hypogonadism, aged 16 to 50 years and 16 to 45 years respectively. After a complete clinical examination, patients were invited to fill the modified middlesex hospital questionnaire for psychoneurotic evaluation. RESULTS: We recruited 59 patients with a sex ratio of 1:1. The mean age of the females and males were 27.7 ± 9.1years and 30.8 ± 11.7 years respectively. Normosmic Idiopathic Hypogonadotropic Hypogonadism (NIHH) was the most common presentation. Compulsive obsessive traits, phobic anxiety and hysterical trait, were most pronounced in these patients. Testosterone titers significantly correlated positively with testicular size and negatively with body mass index (BMI). A significant positive correlation was found between the testicular volumes measured with ultrasound (US) and with the orchidometer. CONCLUSION: Normosmic idiopathic hypogonadotropic hypogonadism is the most common presentation of hypogonadism in the study population. There is a significant psychosocial impact requiring further investigation and attention.

Gestational Exposure to Pesticides Induces Oxidative Stress and Lipid Peroxidation in Offspring that Persist at Adult Age in an Animal Model.

Pesticide exposure may induce biochemical alterations including oxidative stress and lipid peroxidation. However, in the context of developmental origin of health and disease, putative trans-generational effect of exposure to pesticides are insufficiently studied. We therefore aimed to evaluate the biochemical effect of gestational exposure to four pesticides on female Wistar rats and their offspring at adult age. We studied 30 female nulliparous Wistar rats divided into 5 equal groups. Group 1 served as the control group and received distilled water while group 2, 3, 4 and 5 received orally pesticide 1 (imidacloprid), pesticide 2 (chlorpyrifos), pesticide 3 (imidacloprid + lambda cyhalothrin) and pesticide 4 (oxamyl) respectively once daily throughout gestation at a dose equivalent to 1/10 lethal dose 50. The mothers were followed up until one month post gestation. The offspring were followed up from birth until adult age (12 weeks). In all animals at each time point we evaluated malondialdehyde (MDA), oxidative stress and liver function enzymes. There was similar variation of total body weight in all the groups during and after gestation. However, Female Wistar rats of the exposed groups had significant alterations in liver SOD (-30.8% to +64.1%), catalase (-38.8% to -85.7%) and GSH (-29.2% to -86.5%) and; kidney catalase (> 100%), GSH (> 100%). Moreover, MDA, alanine transaminase (ALT) and aspartate transaminase (AST) levels were significantly higher in pesticide exposed rats compared to the control group. Similar alterations in antioxidant enzymes, MDA and liver function enzymes were observed in offspring of treated rats evidenced at weaning and persisting until adult age. Exposure to pesticides causes oxidative stress and lipid peroxidation in exposed female Wistar rats and their offspring. The persistence in offspring at adult age suggests transgenerational adverse effects.

Validation of Smartphone-Based Retinal Photography for Diabetic Retinopathy Screening.

BACKROUND AND OBJECTIVE: Screening for diabetic retinopathy (DR) is cost-effective when compared with disability loss for those who go blind in the absence of a screening program. We aimed to evaluate the sensitivity and specificity of a smartphone-based device for the screening and detection of DR. PATIENTS AND METHODS: A cross-sectional study of 220 patients with diabetes (440 eyes, all patients age 25 years or older) was completed. Tropicamide 0.5% was used for iris dilation followed by an indirect ophthalmoscopy using a 20-D lens. Retinal images were later obtained using a smartphone attached to an adaptable camera device. Retinal images permitted the visualization of the macular and papillary regions and were sent without compression via the internet to a retinal specialist for interpretation. Sensitivity and specificity were calculated for all cases and stages of DR. RESULTS: Using our standard examination method, the prevalence of DR and macular edema were 13.6% and 6.4%, respectively. With the smartphone-based retinal camera, the prevalence of DR and macular edema were 18.2% and 8.2%, respectively. Sensitivity and specificity for the detection of all stages of DR was 73.3% and 90.5%, respectively. For the detection of macular edema, sensitivity was 77.8%, and specificity was 95%. For severe nonproliferative DR (NPDR), sensitivity and specificity were 80% and 99%, respectively; for proliferative DR (PDR), they were both 100%. In the early stages of DR, specificity was 89.8% for mild NPDR and 97.1% for moderate NPDR. Sensitivity was 57.1% and 42.9%, respectively. CONCLUSION: Screening for DR using a smartphone-based retinal camera has a satisfactory specificity at all DR stages. Its sensitivity seems to be high only in the stages of DR necessitating a specific therapeutic decision (eg, macular edema, severe NPDR, and PDR). A smartphone-based retinal camera may be a useful device to screen for DR in resource-limited settings. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:S18-S22.].

Economic Impact of Diabetes in Africa.

PURPOSE OF REVIEW: This review seeks to address knowledge gaps around the economic burden of diabetes in Africa. Africa is home to numerous endemic infections and also prevalent non-communicable diseases including diabetes. It is projected that the greatest increases in diabetes prevalence will occur in Africa. The importance of this review therefore lies in providing adequate knowledge on the economic challenges that diabetes poses to the continent and describe the way forward in tackling this epidemic. RECENT FINDINGS: Diabetes contributes to a huge amount of the global health expenditure in the world. There is a dearth of information on the economic burden of diabetes in Africa with very limited number of studies in the area. Predictions do show that Africa has the greatest predicted increase in both the burden of diabetes and associated diabetic complications but yet contributes the lowest in the global annual healthcare expenses with regard to diabetes care. In 2017, the International Diabetes Federation (IDF) estimated the total health expenditure due to diabetes at $3.3 billion. In Nigeria, the national annual direct costs of diabetes was estimated in the range of $1.071 billion to $1.639 billion per year while the estimated monthly direct medical costs per individual in Cameroon stands at $148. In Sudan, the direct cost of type 2 diabetes control was $175 per year which only included the cost of medications and ambulatory care. People with diabetes are likely to experience one or more chronic illness and a significant portion of the costs associated with these complications are attributed to the underlying diabetes. The growing epidemics of diabetes and associated diabetic complications worldwide poses catastrophic financial costs, especially in Africa where most of the expenses are paid by patients and families. The most common method used for the estimation of the economic burden of a public health problem like diabetes is the cost-of-illness approach. Cost-of-illness studies traditionally divide costs into three categories: direct, indirect, and intangible. The IDF estimated the total health expenditure due to diabetes at $3.3 billion worldwide in 2017. Most of the existing studies in Africa estimated only the direct costs. The medical direct cost of type 1 diabetes was higher than type 2. However, the estimations of costs of diabetes in many countries in Africa may be underestimated due to absence of data on the relative contribution of cost of diabetes complications.

Heart rate variability in hyperthyroidism on sub Saharan African patients: a case-control study.

OBJECTIVE: We aimed to determine heart rate variability in freshly diagnosed untreated hyperthyroidism patients. We enrolled 10 patients (9 females) and 10 matched controls for sex and age. Each eligible patient underwent five different tests according to Ewing battery tests for cardiac autonomic dysfunction assessment. HRV was assessed during each maneuver and on 24 h using a continuous electrocardiogram with automatic estimation of SDNN, RMSSD, LF HF and HF/LH ratio. Results of tests were compared between hyperthyroidism patients and matched controls using the non-parametric test of Mann-Whitney. RESULTS: Heart rate was significantly higher in patients with thyrotoxicosis (82.91 ± 10.99 vs 67.04 ± 6.80; 0.006) compared to their controls. On time-domain analysis, there was a trend towards reduction in SDNN (39.52 vs. 63.75; p = 0.2) as well as the RMSSD (30.44 vs 64.03; p = 0.09) in patients with hyperthyroidism. The frequency-domain analysis showed non-significant higher values for the LF (43.87 vs 38.85 ± 12.85; p = 0.8) and lower for the HF (32.54 vs 43.39; p = 0.3). Test's results were mostly impaired in hyperthyroid patients and all patients presented abnormal results for parasympathetic activity. Untreated and recently diagnosed hyperthyroidism is associated to an altered parasympathetic activity in sub Saharan African patients.