The prevalence and risk factors of irritable bowel syndrome (PRIBS study) among adults in low- and middle-income countries: A multicenter cross-sectional study.

Background and Aims: Because of the plenty and abundance of risk factors and the expected increase in the prevalence of irritable bowel syndrome (IBS) in the world in general and in low- and middle-income countries in particular, this international cross-sectional study was conducted in 15 low- and middle-income countries according to our previous protocol, NCT05340400. Methods: Participants were recruited in the period from April 22, 2022 to June 14, 2022. The diagnosis of IBS was according to ROME IV. We determined the physical activity, daily stress, and fatigue of the participants. A large number of collaborators were chosen from different regions and institutions within each country to achieve diversity within the sample and reduce the probability of bias. Results: The prevalence of IBS appears to be higher in low- and middle-income countries (mean = 25.2%, range [6.2%-44.2%]) than in high-income countries, with a higher prevalence among Africans than Caucasians and Asians. The prevalence of IBS increased in the fourth decade by 32.1% and in the fifth decade by 31.1% (p-value < 0.001). In addition to the previously known risk factors for IBS such as female sex, smoking, psychological stress, and chronic fatigue, other risk factors were discovered such as chronic diseases, including high blood pressure and diabetes, allergies to some substances, previous infection with COVID-19, and the participant having a first-degree relative with a patient. There are also some other modifiable risk factors, such as an abnormal body mass index (whether high or low), smoking, a protein- or fat-rich diet, drinking caffeine-containing beverages, and poor physical activity. Conclusions: Highlighting the prevalence and increasing risk factors of IBS in developing countries should draw the attention of those responsible for health care in these countries and reduce the risk factors.

Prevalence and risk factors of posttraumatic stress symptoms among Internally Displaced Christian couples in Erbil, Iraq.

Background: Research about the impact of war and displacement experiences on the mental health of Internally Displaced People (IDPs) has recently grown. However, a limited number of studies focus on minorities. The objective of the present preliminary study was to estimate the prevalence of posttraumatic stress symptoms (PTSSs) among IDPs who live outside camps and belong to the Christian minority in Iraq, and to identify possible predictors. Methods: Overall, 108 internally displaced Christians (54 married couples) participated in the study. Traumatic events and PTSSs were assessed using the Harvard Trauma Questionnaire. Multivariable linear regression models were used to investigate possible predictors of PTSSs. Multivariable logistic regression models have been developed to estimate the odds of presenting PTSSs. Results: Results demonstrated high rates of trauma exposure, with all participants having experienced at least three traumatic events. The estimated prevalence of PTSSs was 20.3%. A low economic status, the number of traumatic events, and a second experience of displacement were associated with increased PTSSs. Five traumatic events were identified as the main predictors of PTSSs. Conclusion: Findings from the current preliminary study indicated the impact of war-related traumatic events on IDPs' mental health and the negative effects of post-displacement experiences. These findings may have important implications for setting up psychosocial interventions, as well as for further promoting physical and mental health services among these populations.

Upward Migration and Coiling of the Distal Catheter Toward the Valve Site.

Hydrocephalus, which is caused by the accumulation of cerebrospinal fluid (CSF), is a common condition in children. It is known to be most likely treated by the insertion of a ventriculoperitoneal (VP) shunt. However, a VP shunt can lead to multiple complications. The upward migration of a VP shunt is considered rare. A newborn male baby with a known case of Chiari malformation type 2 associated with myelomeningocele (MMC) and hydrocephalus had a VP shunt inserted for control of the hydrocephalus. He presented two months after the surgery with occipital swelling at the surgical site. Shunt series followed by Computerized tomography (CT) scan showed that the distal end of the catheter had migrated upward and coiled around the valve. Urgent revision of the VP shunt was performed. Reabsorption of subgaleal fluid, increased abdominal pressure, repeated abdominal wall contraction, and repeated head motion of the child are the previously suggested theories of upward migration of distal catheter to the site of the valve. However, the combination of multiple theories can be the logical explanation, as they do not oppose each other.

Supporting Iraqi Kurdistan Health Authorities in Post-conflict Recovery: The Development of a Health Monitoring System.

Background: Iraq has endured several conflicts and socio-political tensions that have disrupted its public health system. Nowadays, because health data are not collected on a routine basis, the country still lacks proper statistics and, consequently, response plans to meet present and future health needs of its population. An international partnership is developing in the Iraqi Kurdistan a Health Monitoring System with the aim of supporting evidence-based health policy decisions. Methods: The pilot phase for assessing the feasibility of the programme was launched in 2015. In 2018 the implementation phase began. The first step was to choose the software platform and the coding system, as well as to identify the public hospitals (PH) and Public Health Centers (PHC) to be included in the e-health system. The technical infrastructure of each PHC or PH was updated. The staff of each center was trained in the use of the e-health system and in disease coding. Several seminars introduced regional and district health managers to the basic concepts of data-driven decision making. A local team of experts was trained to create a highly specialized staff with the objective of "training the trainers" and ensuring the future self-sufficiency of the system. Results: By September 2019, 59 PHC and PH were entering data in the Health Monitoring System, while 258 health operators (medical doctors, administrative staff, nurses, statisticians, IT and public health specialists, pharmacists) have been already trained. Currently, more than 600,000 disease events have been collected. Additionally, further 734 medical doctors, statisticians, and health managers have been trained on the basics of public health practice. The goal during the next 3 years is to reach 120 operative centers within the region, envisaging a subsequent expansion of the system to all Iraq. Conclusions: The creation of a functioning health monitoring system is feasible also in regions characterized by socio-political tensions. However, multiple stakeholder partnerships are essential. The provision of an e-health information system, coupled with the establishment of a team of local experts, allows the routinely and timely collection of health information, facilitating prompt responses to present and emerging needs, while guiding the formulation and evaluation of health policies.

Relationship between intra-operative hypotension and post-operative complications in traumatic hip surgery.

BACKGROUND AND AIMS: The relationship between intra-operative hypotension and post-operative complications has been recently studied in non-cardiac surgery. Little is known about this relationship in traumatic hip surgery. Our study aimed to investigate this relationship. METHODS: A retrospective study was conducted on patients who underwent surgical correction of traumatic hip fracture between 2010 and 2015. We reviewed the perioperative blood pressure readings and the episodes of intra-operative hypotension. Hypotension was defined as ≥30% decrease in the pre-induction systolic blood pressure sustained for ≥10 min. The relationship between intra-operative hypotension and post-operative complications was evaluated. Post-operative complications were defined as new events or diseases that required post-operative treatment for 48 h. Factors studied included type of anaesthesia, blood transfusion rate, pre-operative comorbidities and delay in surgery. We used the Statistical Package for Social Sciences (SPSS, IBM 25) to perform descriptive and non-parametric statistics. RESULTS: A total of 502 patients underwent various types of traumatic hip surgery during the study period. Intra-operative hypotension developed in 91 patients (18.1%) and 42 patients (8.4%) developed post-operative complications. Significantly more patients with hypotension developed post-operative complications compared to patients with stable vitals (18.7% vs. 6.1; P < 0.001). There was no statistically significant difference in the incidence of post-operative complication in patients receiving general or spinal anaesthesia. Pre-operative comorbidities had no significant relationship with post-operative complications. Intra-operative blood transfusion was related to both intra-operative hypotension and post-operative complications. CONCLUSION: There was an association between intra-operative hypotension and post-operative complications in patients undergoing traumatic hip surgery.

Cardio-embolic stroke: Lessons from a single centre in Sub-Saharan Africa.

BACKGROUND: Limited information is available about cardio-embolic stroke (CES) in sub-Saharan Africa. The aim of this study was to describe the epidemiology, clinical features, etiology, the management and outcome of CES in our setting. METHODS: A retrospective cohort study was carried out in the Douala General Hospital (DGH), using files of ischemic stroke patients admitted in the Neurological Unit and the Intensive Care Unit. Socio-demographic, clinical and paraclinical data were collected. After hospitalization, follow-up was performed with focus on mortality, stroke recurrence and the functional outcome assessed with Barthel score. Multivariate analysis was performed to determine the factors associated with death. RESULTS: Of the 704 stroke cases included, 368 were ischemic with 86 (23.4%) of them being cardio-embolic. The mean age of patient with CES was 67±13.3 years. The main etiologies of CES were: atrial fibrillation (82.1%), dilated cardiomyopathy (12.8%), and rheumatic mitral stenosis (5.1%). Anti-platelet agents were the most prescribed anti-thrombotic drugs (50.7%). The in-hospital mortality rate was 23.3% with lesion in both internal carotid arteries [OR=110.3; 95% CI: 1.2-1040.7; P=0.043] and heart disease [OR=46.9; 95% CI: 1.2-1789.9; P=0.038] appeared to be predictive of this. Stroke recurrence was observed in 8 patients (12.1%) and the survival probability in 5 years was 10%. Functional outcome was progressively worse with the systolic blood pressure>140mmHg (P=0.025) been the associated factor. CONCLUSION: CES accounted for 1/4 of ischemic stroke with a high risk of early death and long-term recurrence. Atrial fibrillation was the leading cause of CES. The association of VKA and anti-platelet agent should be avoided to reduce early death during acute stroke.

HIV infection does not influence stroke outcomes in HIV-infected patients: A prospective study.

BACKGROUND: Human immunodeficiency virus (HIV) infection, opportunistic infections and antiretroviral therapy contribute to the pathogenesis of stroke, yet, little is known about the influence of HIV infection on outcome in stroke patients. The aim of this study was to compare the outcome of stroke in HIV-infected patients with that of HIV-negative patients at the Douala General Hospital (DGH). PATIENTS AND METHODS: A prospective cohort study was carried out at the Neurology unit and the Intensive Care Unit of the DGH from January 2010 to December 2015. All patients aged 15 years and above, admitted for stroke confirmed by brain imaging were included. HIV testing was systematically prescribed for all stroke patients. HIV-infected patients were then compared with HIV-uninfected patients. Quantitative variables were expressed as means while qualitative variables were expressed as frequencies, and were compared with the Chi2 test or the Fisher test and the Student test respectively. Stroke outcome was evaluated by the mortality, in-hospital stay and functional outcome at 6 months post-stroke. Kaplan-Meyer method was used to determine survival. RESULTS: Forty of the 608 patients with stroke were HIV-positive, giving an in-hospital HIV prevalence of 6.6%. Mean age of the HIV-infected stroke patients was 51.3±10.4 years as against 59.6±13.53 in the HIV-uninfected group (P=0.001). The proportion of dyslipidemia in HIV-infected stroke patients with was greater than that in HIV-uninfected stroke patients (57.5% vs 8.9%, P<0.001). The most common type of stroke was ischemic in two-thirds of the patients in both groups. HIV-infected stroke patients had a mean hospital stay longer than that of HIV-uninfected patients (10.3±8.1 days vs 8.1±6.3 days, P=0.042). Post-stroke infections were more frequent in HIV-infected patients (17.5% vs 6.9%, P=0.014). The cumulative mortality rates at 6 months were 37.5% and 34.5% for the HIV-infected and the HIV-uninfected groups respectively (P=0.471). The functional outcome was similar in both groups at the 6th month post-stroke (Rankin score>2: 38.5%vs 38.8%, P=0.973). There was no difference in survival between the two groups. CONCLUSION: HIV infection does not affect in-hospital mortality and functional outcome in stroke patients a part the length of hospital stay.

Epidemiology of malignant hemopathies recorded in hospitals in Cameroon.

Data about malignant blood diseases are sparse in Cameroon. Their epidemiology was studied in patients at the General Hospital of Douala (GHD) and the Yaoundé Central Hospital (CHY) from 2004 through 2014. The variables we studied were social and demographic (age, sex, occupation, marital status), clinical (reasons for consultation, clinical signs, year of diagnosis), and biological (blood count, myelogram and blood smear, immunophenotyping, biopsy, and cytogenetics). In all, 4409 files were reviewed and 454 cases identified, documented and confirmed (248 in GHD and 206 in CHY). The prevalence of malignant blood diseases was 10.4%. The patients' mean age was 44.3 ± 19 [range : 1-80] years and the M/F sex ratio 1.4/1. In 32.2% of the cases, the patient consulted because of a tumor. The most frequent malignant blood diseases, in decreasing order, were non-Hodgkin's lymphoma (31.1%), chronic myeloid leukemia (21.4%), chronic lymphoid leukemia (12.6%), multiple myeloma (11.2%), acute lymphoblastic leukemia (7.4%), and acute myeloblastic leukemia (6.4%). Their incidence by age group showed that acute lymphoblastic leukemia was most common among children (20%), and chronic myeloid leukemia among young adults (28.9%). The main hemogram abnormalities were anemia (73.7%), hyperleukocytosis (57.3%), and thrombopenia (39.2%). Various types of malignant blood diseases thus exist in the hospital environment in Cameroon, and their forms are underdiagnosed.

Neurological manifestations in chronic hepatitis C patients receiving care in a reference hospital in sub-Saharan Africa: A cross-sectional study.

BACKGROUND: Chronic hepatitis C infection is a major public health concern, with a high burden in Sub-Saharan Africa. There is growing evidence that chronic hepatitis C virus (HCV) infection causes neurological complications. This study aimed at assessing the prevalence and factors associated with neurological manifestations in chronic hepatitis C patients. METHODS: Through a cross-sectional design, a semi-structured questionnaire was used to collect data from consecutive chronic HCV infected patients attending the outpatient gastroenterology unit of the Douala General Hospital (DGH). Data collection was by interview, patient record review (including HCV RNA quantification, HCV genotyping and the assessment of liver fibrosis and necroinflammatory activity), clinical examination complemented by 3 tools; Neuropathic pain diagnostic questionnaire, Brief peripheral neuropathy screen and mini mental state examination score. Data were analysed using Statistical package for social sciences version 20 for windows. RESULTS: Of the 121 chronic hepatitis C patients (51.2% males) recruited, 54.5% (95% Confidence interval: 46.3%, 62.8%) had at least one neurological manifestation, with peripheral nervous system manifestations being more common (50.4%). Age ≥ 55 years (Adjusted Odds Ratio: 4.82, 95%CI: 1.02-18.81, p = 0.02), longer duration of illness (AOR: 1.012, 95%CI: 1.00-1.02, p = 0.01) and high viral load (AOR: 3.40, 95% CI: 1.20-9.64, p = 0.02) were significantly associated with neurological manifestations. Peripheral neuropathy was the most common neurological manifestation (49.6%), presenting mainly as sensory neuropathy (47.9%). Age ≥ 55 years (AOR: 6.25, 95%CI: 1.33-29.08, p = 0.02) and longer duration of illness (AOR: 1.01, 1.00-1.02, p = 0.01) were significantly associated with peripheral neuropathy. CONCLUSION: Over half of the patients with chronic hepatitis C attending the DGH have a neurological manifestation, mainly presenting as sensory peripheral neuropathy. Routine screening of chronic hepatitis C patients for peripheral neuropathy is therefore necessary, with prime focus on those with older age and longer duration of illness.

Correlates of cigarette smoking among university students in Cameroon.

OBJECTIVE: To determine factors associated with smoking among university students in Cameroon. DESIGN: A cross-sectional survey was carried out using an anonymous self-administered questionnaire among a convenience sample of 3000 students from three universities (the Université des Montagnes, and the Universities of Douala and Yaounde 1) in Cameroon; 190 students (5.9%) did not consent to the survey. Socio-demographic characteristics and smoking trends were recorded. Logistic regression was used to identify risk factors for smoking. RESULTS: Of the students selected, 1862 (62%) were male. The mean age was 23.3 years. We found that 30.1% of students had tried smoking and that 5.6% (n = 168) reported regular smoking. Smoking prevalence among male and female students was respectively 9.5% and 1%. The mean age of smokers was 24.1 years. Only 12.5% of regular smokers were nicotine-dependent. Factors motivating smoking were pleasure, imitation, snobbery and curiosity. In the multivariate analysis, smoking was statistically associated with age, male sex, exposure to friends who smoke and living with smokers. CONCLUSION: Although the prevalence of smoking found in our study was low, effective tobacco control programmes targeting factors such as age, male sex and peer influence should be implemented in universities. Future studies are needed to evaluate the impact of these interventions.

Prevalence and determinants of electrocardiographic abnormalities in sub-Saharan African individuals with type 2 diabetes.

AIM: This study assessed the prevalence and determinants of electrocardiographic abnormalities in a group of type 2 diabetes patients recruited from two referral centres in Cameroon. METHODS: A total of 420 patients (49% men) receiving chronic diabetes care at the Douala General and Yaoundé Central hospitals were included. Electrocardiographic abnormalities were investigated, identified and related to potential determinants, with logistic regressions. RESULTS: The mean age and median duration of diagnosis were 56.7 years and four years, respectively. The main electrocardiographic aberrations (prevalence %) were: T-wave abnormalities (20.9%), Cornell product left ventricular hypertrophy (16.4%), arrhythmia (16.2%), ischaemic heart disease (13.6%), conduction defects (11.9%), QTc prolongation (10.2%) and ectopic beats (4.8%). Blood pressure variables were consistently associated with all electrocardiographic abnormalities. Diabetes-specific factors were associated with some abnormalities only. CONCLUSIONS: Electrocardiographic aberrations in this population were dominated by repolarisation, conduction defects and left ventricular hypertrophy, and were more related to blood pressure than diabetes-specific factors.

Monitoring tuberculosis treatment outcome: analysis of national surveillance data from a clinical perspective.

BACKGROUND: In 1998, the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD) published recommendations standardising the evaluation of tuberculosis treatment outcome in Europe. These guidelines fail to account for clinically appropriate alterations in the management of patients. OBJECTIVES: To evaluate tuberculosis treatment outcome in England, Wales and Northern Ireland by redefining the outcome criteria and investigate factors associated with unsuccessful treatment outcome 12 months after notification. METHODS: This was a prospective analysis of a cohort of patients diagnosed in England, Wales and Northern Ireland and reported to the Enhanced Tuberculosis Surveillance system in 2001 and 2002. Proportions of success and failure were calculated based on a new set of criteria following discussion with clinicians treating tuberculosis cases. Logistic regression was used to study risk factors for unsuccessful treatment outcome. RESULTS: 13 048 cases were notified in the study period. Of the 2676 that were identified as new sputum smear positive pulmonary cases, 2209 (82.5%) had treatment outcome data reported. Using the WHO/IUATLD criteria, 76.8% were classified as successful. In contrast, applying the new criteria, the success rate was 87.5%. This rate exceeds the 85% success target set by the WHO. Risk factors for unsuccessful treatment outcome included male sex (OR 1.27; 95% CI 1.08 to 1.49), being elderly (p trend < 0.001), having pulmonary tuberculosis (OR 1.28; 95% CI 1.08 to 1.53) and having resistance to any antituberculosis drug (OR 1.90; 95% CI 1.44 to 2.52). CONCLUSION: The proportion of tuberculosis cases with a successful treatment outcome exceeded the target of 85% success rate based on the modified outcome categories. Although the tuberculosis treatment outcome criteria set by WHO/IUATLD appear to be clear, they mix measures of process and outcome. Further refinement may be necessary in low incidence high income countries, especially those with a high mortality among the elderly.

[Ocular complications of HIV/AIDS in Cameroon: is there is any correlation with the level of CD4 lymphocytes count?]. / Complications oculaires de l'infection a VIH-SIDA en milieu Camerounais: y a-t-il une correlation avec le taux de CD4?

PURPOSE: This study aimed to identify the ocular complications of HIV/AIDS in Cameroon and to determine if there is any correlation between their occurrence and the level of CD4 lymphocytes count. MATERIAL AND METHODS: This prospective study was carried out at the General Hospital, Douala, from October 2004 to September 2005. All HIV positive patients with known CD4 count were retained for the study. Each patient had an exhaustive ocular examination. RESULTS: A total of 57 patients including 30 females (52.9%) and 27 males (47.4%) were examined. The mean age was 38.9 years +/- 10.3. The eye examination was pathological in 36 patients (63.2%) and normal in 21 patients (36.8%). An ocular complaint was the inaugural manifestation of the disease in 31.6% of patients. The principal lesions of the anterior segment were herpetic keratitis (10.5%) and herpes zoster ophthalmicus (12.3%). The most common posterior segment lesions were cytomegalovirus retinitis (14%) and uveitis (15.8%). The mean CD4 count in our series was 118.3/mm3 +/- 106.7. 91.7% of patients with ocular complications have a CD4 count of less than 200/mm3. A non linear correlation was found between the CD4 level and the occurrence of ocular complications. CONCLUSION: With the improvement of access to antiretroviral treatment, the ocular complications of HIV/AIDS are more common. The role of the ophthalmologist is therefore essential in the diagnosis and management of these patients.

[Amblyopia and strabismus in our environment]. / L'amblyopie chez le strabique en milieu camerounais.

PURPOSE: This study aimed to identify the characteristics of amblyopia in a group of strabismic patients in our environment in order to improve management. METHODS: A prospective study was carried out in the General Hospital, Douala, from July 1991 to July 2003. All strabismic patients had a complete ophthalmological examination including an oculomotor evaluation and skiascopy after cycloplegia. RESULTS: 330 patients were examined. The mean age at initial consultation was 13.97 years +/- 12.21. The prevalence of amblyopia was 80.46% in esotropia and 59.40% in exotropia. The precocity of strabismus, eccentric fixation, torticollis, presence of a vertical element and nystagmus were aggravating factors for amblyopia. CONCLUSION: In order to carry out early and coherent management of strabismus, it is important to train and inform all those who are involved in the care process.