S. Choukem - Academia.edu (original) (raw)

Papers by S. Choukem

Background HIV remains an epidemic of major public health importance in Cameroon but a decline in... more Background HIV remains an epidemic of major public health importance in Cameroon but a decline in HIV prevalence has been observed according to population-based surveys conducted in 2004, 2011 and 2018. We sought to review current evidence for declining HIV prevalence despite increasing survival owing to ‘universal test and treat’ and to explore the reason for the decrease, particularly the role of behavioural change. Methods We conducted a secondary analysis using HIV prevalence, behavioural and social determinants data of the Demographic and Health Survey Program databases. Trend lines were fitted to data that were available for a minimum of three points in time during the 1991–2018 period. Regression coefficients, associated p-values and 95% confidence intervals were obtained using Microsoft Excel software. Results Overall adult HIV prevalence decreased significantly from 5.4% (95%CI: 4.8-6.0) in 2004 to 4.3% (95%CI: 3.8–4.8) in 2011 and further down to 2.7% (95%CI: 2.3–3.1) in 2...

Journal of Wound Care, 2006

Objective: To determine the clinical features, regularly associated microorganisms and their susc... more Objective: To determine the clinical features, regularly associated microorganisms and their susceptibility to antibiotics, and the clinical outcomes of foot ulcers in patients with diabetes at the Yaounde Central Hospital, Cameroon. Method: A retrospective analysis of routinely collected hospital data, and data validation by survey of clinical notes was conducted from November 1999 to October 2002 for adult diabetic patients with foot ulcers. Clinical data were recorded for each patient, followed by a record of microbiological investigations where available. Results: Of 503 patients with diabetes admitted during the study period, 54 (10.7%) had foot ulcers. Male subject represented 66.7% of this population. The mean age of the study population was 59.66 ± 1.52 years. The foot ulcer led to the diagnosis of diabetes in six patients in whom the condition was previously unidentified. Of the 54 patients with foot ulcers, nine (16.7%) were selected for surgery and the remaining 45 were m...

Journal of Hypertension, 2011

Primary Care Diabetes, 2012

To report the prevalence of undiagnosed diabetes and its determinants among adults Cameroonian ur... more To report the prevalence of undiagnosed diabetes and its determinants among adults Cameroonian urban dwellers. On May 17th 2011, a community-based combined screening for diabetes and hypertension was conducted simultaneously in four major Cameroonian cities. Adult participants were invited through mass media. Fasting blood glucose was measured in capillary blood. Of the 2120 respondents, 1591 (52% being men) received a fasting glucose test. The median age was 43.7 years, and 64.2% were overweight or obese. The sex-specific age adjusted prevalence (for men and women) were 10.1% (95% confidence interval [CI]: 8.1-12.1%) and 11.2% (95%CI: 9.1-13.3%) for any diabetes, and 4.6% (95%CI: 2.6-6.6%) and 5.1% (95%CI: 3.0-7.2%) for screened-detected diabetes, respectively. The prevalence of diabetes increased with increasing age in men and women (all p ≤ 0.001 for linear trend). Older age (p<0.001), region of residence (p<0.001), excessive alcohol intake (p=0.02) were significantly associated with screened-detected diabetes, while physical inactivity, body mass index, and high waist girth were not significantly associated with the same outcome. Prevalence of undiagnosed diabetes is very high among Cameroonian urban dwellers, indicating a potentially huge impact of screening for diabetes, thus the need for more proactive policies of early detection of the disease.

Background: Recent studies suggest that pain in osteoarthritis (OA) is not only nociceptive, but ... more Background: Recent studies suggest that pain in osteoarthritis (OA) is not only nociceptive, but also has neuropathic characteristics (1). To our knowledge, no study has been carried out in sub-Saharan Africa to assess the neuropathic pain associated with knee OA. Objectives: To determine the prevalence of chronic pain with neuropathic characteristics and associated factors in patients with knee OA in Cameroon. Methods: We performed a cross-sectional study at the Douala General Hospital from December 2018 to April 2019. Patients over the age of 21 with a diagnosis of knee OA (ARA, 1986; Kellgren–Lawrence radiographic grading ≥ 2) were included. The intensity of the pain was measured using the visual analog scale. Neuropathic pain was detected using the DN4 questionnaire with a cut-off at DN4 ≥ 4 (2) and functional impairment assessed using the Lequesne algofunctional index. Logistic regression analysis was used to assess the association between patients’ characteristics and DN4. The...

Pan African Medical Journal, 2019

Introduction: hypogonadism refers to a syndrome that results from failure of gonads to function p... more 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.

BMC Hematology, 2017

Background: Sickle Cell Disease (SCD) is associated with chronic multisystem complications that s... more Background: Sickle Cell Disease (SCD) is associated with chronic multisystem complications that significantly influence the quality of life (QOL) of patients early in their life. Although sub-Saharan Africa bears 75% of the global burden of SCD, there is a paucity of data on these complications and their effects on the QOL. We aimed to record these chronic complications, to estimate the QOL, and to identify the corresponding risk factors in patients with SCD receiving care in three hospitals in Cameroon. Methods: In this cross-sectional study, a questionnaire was used to collect data from consecutive consenting patients. Information recorded included data on the yearly frequency of painful crisis, the types of SCD, and the occurrence of chronic complications. A 36-Item Short Form (SF-36) standard questionnaire that examines the level of physical and mental well-being, was administered to all eligible participants. Data were analyzed with STATA® software. Results: Of 175 participants included, 93 (53.1%) were female and 111 (aged ≥14 years) were eligible for QOL assessment. The median (interquartile range, IQR) age at diagnosis was 4.0 (2.0-8.0) years and the median (IQR) number of yearly painful crisis was 3.0 (1.0-7.0). The most frequent chronic complications reported were: nocturnal enuresis, chronic leg ulcers, osteomyelitis and priapism (30.9%, 24.6%, 19.4%, and 18.3% respectively). The prevalence of stroke and avascular necrosis of the hip were 8.0% and 13.1% respectively. The median (IQR) physical and mental scores were 47.3 (43.9-58.5) and 41.0 (38.8-44.6) respectively. Age and chronic complications such as stroke and avascular necrosis were independently associated with poor QOL. Conclusions: In this population of patients living with SCD, chronic complications are frequent and their QOL is consequently poor. Our results highlight the need for national guidelines for SCD control, which should include newborn screening programs and strategies to prevent chronic complications.

BMC research notes, 2017

Unilateral renal cystic disease is a rare condition that shares morphological similarities with m... more Unilateral renal cystic disease is a rare condition that shares morphological similarities with multicystic dysplastic kidney, the former often distinguished from the latter on some clinical and histopathological grounds. However serious diagnostic and therapeutic dilemmas set in when there is a considerable overlap in the distinguishing features between these entities. A 19-year-old African female presented with a chronic severe debilitating right lower quadrant abdominal pain refractory to analgesics. Biochemical investigations and imaging studies revealed a non-functional polycystic right kidney and no identifiable pelvicalyceal system or ureter but with preserved renal function. The marked overlap in clinical presentation between unilateral renal cystic disease and multicystic dysplastic kidney in this patient necessitated further investigation to pose an appropriate diagnosis. A right nephrectomy was performed and histopathological analysis of the resected kidney done, the resu...

BMC Research Notes, 2017

Background: Right iliac vein thrombosis is uncommon in pregnancy. Nonetheless, when it does occur... more Background: Right iliac vein thrombosis is uncommon in pregnancy. Nonetheless, when it does occur, its presentation could be very unspecific with important diagnostic challenges and this could have negative therapeutic consequences especially in a resource limited setting. Case presentation: The historical, clinical and laboratory data of a 30 year old G2P1001 woman of African ethnicity at 11 weeks of gestation pointed towards a right iliac vein thrombosis missed for an acute appendicitis with subsequent appendectomy and failure to cure. Following the diagnosis of right iliac vein thrombosis post-appendectomy, the patient was started on low molecular weight heparin and the clinical progress thereafter was favourable. Conclusion: Pelvic vein thrombosis should be considered a differential diagnosis of intractable lower abdominal pain in early pregnancy. A high index of suspicion could lead to early diagnosis, prompt management and a favourable prognosis even in a low-income setting.

BMC Research Notes, 2017

Background: Tropical diabetic hand syndrome describes a complex hand sepsis affecting patients wi... more Background: Tropical diabetic hand syndrome describes a complex hand sepsis affecting patients with diabetes across the tropics and often results from a trivial hand trauma. The clinical presentation of this syndrome is variable and ranges from localised swelling and cellulitis, with or without ulceration of the hand to progressive fulminant hand sepsis, and gangrene affecting the entire limb which may be fatal. Tropical diabetic hand syndrome could lead to permanent disability and death as a result of delay in presentation, late diagnosis and late medical and surgical intervention. This indexed case acts as an eye opener for physicians to the existence of this hand sepsis. Case presentation: We report the case of a 57 year-old black African female diabetic who was referred to our centre for the management of a suppurating ulcer and swelling of the left hand of two weeks duration. On examination and work-up, the patient was found to have Lawal Group III left diabetic hand syndrome and was managed with parenteral antibiotics, radical debridement and the hand was eventually amputated. She died 7 days following amputation from overwhelming sepsis. Conclusion: Though tropical diabetic hand syndrome is a relatively rare complication of diabetes, it can be fatal as in this case report. Early diagnosis and proper management would yield better outcome. Initial management should include aggressive intravenous broad-spectrum antibiotics with anaerobic coverage. Classification of tropical diabetic hand syndrome will assist physicians and surgeons in decision making, proper management and easy communication.

Diabetes & Metabolism, 2017

Background and objectives.-Peripheral tissue resistance to insulin action is a characteristic of ... more Background and objectives.-Peripheral tissue resistance to insulin action is a characteristic of type 2 diabetes mellitus (T2DM). It has also been reported that some chronic viral infections can contribute to insulin resistance. Human herpesvirus (HHV)-8 infection has been detected in T2DM patients in previous studies. Our study investigated whether the presence of the virus is associated with insulin resistance in patients with ketosis-prone type 2 diabetes (KPD), as reported with other viruses. Research design and methods.-A total of 11 insulin-free KPD patients positive (+) and seven patients who were negative (−) for HHV-8 infection were recruited; the latter had KPD that was well controlled (HbA 1c = 6.2 ± 0.7%). A two-step euglycaemic-hyperinsulinaemic clamp test coupled with deuterated [6,6-2H2]glucose was used to assess insulin sensitivity, non-esterified fatty acid (NEFA) suppression and endogenous glucose production. Results.-In KPD patients, whether HHV-8+ or HHV-8−, there were no differences in NEFA release, endogenous glucose production or insulin sensitivity (M value). Conclusion.-Asymptomatic HHV-8 infection does not appear to be associated with decreased insulin sensitivity in diabetic patients. These results should now be confirmed in a larger sample population.

Médecine des Maladies Métaboliques, 2015

La majorité des diabètes résultent d'une interaction gène-environnement. Il est reconnu que les i... more La majorité des diabètes résultent d'une interaction gène-environnement. Il est reconnu que les infections virales en tant que facteurs environnementaux peuvent jouer un rôle dans l'apparition, le maintien, ou l'exacerbation, des désordres métaboliques observés au cours des diabètes. À côté des formes classiques de diabète, type 1 (DT1) et type 2 (DT2), le diabète atypique (Ketosis-prone diabetes, KPD), forme clinique intermédiaire aux deux précédents, est très fréquent chez les Africains. Certains virus ont été identifiés comme associés, ou décrits comme étiologies probables, dans ces trois formes de diabète, à savoir les entérovirus dans le DT1, le virus de l'hépatite C et le virus de l'immunodéficience humaine (VIH) dans le DT2, et le virus herpès humain de type 8 (HHV-8) pour le KPD. Mots-clés : Diabète-diabète atypique (Ketosis-prone diabetes)-virus-Afrique.

Médecine des Maladies Métaboliques, 2007

Annals of the Rheumatic Diseases, 2015

Background: Previous report has suggested that hyperuricemia and gout must be integrated into the... more Background: Previous report has suggested that hyperuricemia and gout must be integrated into the metabolic syndrome items Objectives: To evaluate the association between gout and metabolic syndrome in a sub-Saharan Cameroonian population Methods: A cross-sectional study from January 2004 to December 2014 was conducted in the Rheumatology Unit of the General Hospital, Douala, Cameroon. We included patients with diagnosis of gout according to 1977 ACR criteria. Metabolic syndrome was defined according to the NCEP-ATP III criteria Results: We included 511 patients (415 men and 96 women). The mean age was 55.9±10.8 years. The mean serum uric acid was 82.4 mg/L ±22.3, with hyperuricemia found in 401 patients (78.4%). The association between gout and items of metabolic syndrome were all significant (p<0.0001) (Table 1). This association was significant from the existence of at least two components of metabolic syndrome (Table 2).

Diabetes & Metabolism, 2015

rôle dans la diminution de la sécrétion d'insuline en réponse au glucose des îlots-J vs N., mais ... more rôle dans la diminution de la sécrétion d'insuline en réponse au glucose des îlots-J vs N., mais les mécanismes en jeu restent à déterminer. Déclaration d'intérêt Les auteurs déclarent ne pas avoir d'intérêt direct ou indirect (financier ou en nature) avec un organisme privé, industriel ou commercial en relation avec le sujet présenté. P163 Rôle de la somatostatine dans le contrôle de la sécrétion de glucagon par le glucose et des inhibiteurs des canaux KATP

BMC endocrine disorders, Jan 9, 2014

We aimed to evaluate the predictive utility of common fasting insulin sensitivity indices, and no... more We aimed to evaluate the predictive utility of common fasting insulin sensitivity indices, and non-laboratory surrogates [BMI, waist circumference (WC) and waist-to-height ratio (WHtR)] in sub-Saharan Africans without diabetes. We measured fasting glucose and insulin, and glucose uptake during 80/mU/m2/min euglycemic clamp in 87 Cameroonians (51 men) aged (SD) 34.6 (11.4) years. We derived insulin sensitivity indices including HOMA-IR, quantitative insulin sensitivity check index (QUICKI), fasting insulin resistance index (FIRI) and glucose-to-insulin ratio (GIR). Indices and clinical predictors were compared to clamp using correlation tests, robust linear regressions and agreement of classification by sex-specific thirds. The mean insulin sensitivity was M = 10.5 ± 3.2 mg/kg/min. Classification across thirds of insulin sensitivity by clamp matched with non-laboratory surrogates in 30-48% of participants, and with fasting indices in 27-51%, with kappa statistics ranging from -0.10 t...

Diabetes Care, 2008

OBJECTIVE—To characterize insulin action in Africans with ketosis-prone diabetes (KPD) during rem... more OBJECTIVE—To characterize insulin action in Africans with ketosis-prone diabetes (KPD) during remission. RESEARCH DESIGN AND METHODS—At Saint-Louis Hospital, Paris, France, 15 African patients with KPD with an average 10.5-month insulin-free near-normoglycemic remission period (mean A1C 6.2%) were compared with 17 control subjects matched for age, sex, BMI, and geographical origin. Insulin stimulation of glucose disposal, and insulin suppression of endogenous glucose production (EGP) and nonesterified fatty acids (NEFAs), was studied using a 200-min two-step (10 mU · m−2 body surface · min−1 and 80 mU · m−2 · min −1 insulin infusion rates) euglycemic clamp with [6,6-2H2]glucose as the tracer. Early-phase insulin secretion was determined during an oral glucose tolerance test. RESULTS—The total glucose disposal was reduced in patients compared with control subjects (7.5 ± 0.8 [mean ± SE] vs. 10.5 ± 0.9 mg · kg−1 · min−1; P = 0.018). EGP rate was higher in patients than control subject...

Diabetes Care, 2012

OBJECTIVE Ketosis-prone atypical diabetes (KPD) is a subtype of diabetes in which the pathophysio... more OBJECTIVE Ketosis-prone atypical diabetes (KPD) is a subtype of diabetes in which the pathophysiology is yet to be unraveled. The aim of this study was to characterize β- and α-cell functions in Africans with KPD during remission. RESEARCH DESIGN AND METHODS We characterized β- and α-cell functions in Africans with KPD during remission. The cohort comprised 15 sub-Saharan Africans who had been insulin-free for a median of 6 months. Patients in remission were in good glycemic control (near-normoglycemic) and compared with 15 nondiabetic control subjects matched for age, sex, ethnicity, and BMI. Plasma insulin, C-peptide, and glucagon concentrations were measured in response to oral and intravenous glucose and to combined intravenous arginine and glucose. Early insulin secretion was measured during a 75-g oral glucose tolerance test. Insulin secretion rate and glucagon were assessed in response to intravenous glucose ramping. RESULTS Early insulin secretion and maximal insulin secreti...

Diabetes & Metabolism, 2014

de 75 ans avaient une HbA1c < 7 %. La prévalence des différents traitements hypoglycémiants, chez... more de 75 ans avaient une HbA1c < 7 %. La prévalence des différents traitements hypoglycémiants, chez les sujets > 75 ans vs < 75 ans, était respectivementþ: metformine 52 % vs 72 %, sulfamides 33 % vs 38 %, insuline basale 33 % vs 25 %, insuline en multi injections 27 % vs 20 %, glinides 17 % vs 9 %, iDPP4 14 % vs 21 %, analogue GLP1 10 % vs 18 % et acarbose 7 % vs 4 % (toutes p < 0,005). La prévalence dans le sous-groupe de 306 patients âgés de plus de 75 ans avec IR était : insuline basale 38 %, metformine 37 %, multi-injections 36 %, sulfamides 27 %, glinides 20 %, iDPP4 12 %, analogue GLP1 10 % et acarbose 6 %. Conclusion : Les sulfamides restent les insulinosécretagogues les plus prescrits chez les DT2 âgés de plus de 75 ans du registre SURCOUF, suivis des glinides et des iDPP4, y compris dans le sous-groupe de patients avec IR, malgré le risque hypoglycémique surajouté. P102 Patients diabétiques et connaissance du coût de la prise en charge thérapeutique : quelle adéquation ?

Diabetes & Metabolism, 2013

Background HIV remains an epidemic of major public health importance in Cameroon but a decline in... more Background HIV remains an epidemic of major public health importance in Cameroon but a decline in HIV prevalence has been observed according to population-based surveys conducted in 2004, 2011 and 2018. We sought to review current evidence for declining HIV prevalence despite increasing survival owing to ‘universal test and treat’ and to explore the reason for the decrease, particularly the role of behavioural change. Methods We conducted a secondary analysis using HIV prevalence, behavioural and social determinants data of the Demographic and Health Survey Program databases. Trend lines were fitted to data that were available for a minimum of three points in time during the 1991–2018 period. Regression coefficients, associated p-values and 95% confidence intervals were obtained using Microsoft Excel software. Results Overall adult HIV prevalence decreased significantly from 5.4% (95%CI: 4.8-6.0) in 2004 to 4.3% (95%CI: 3.8–4.8) in 2011 and further down to 2.7% (95%CI: 2.3–3.1) in 2...

Journal of Wound Care, 2006

Objective: To determine the clinical features, regularly associated microorganisms and their susc... more Objective: To determine the clinical features, regularly associated microorganisms and their susceptibility to antibiotics, and the clinical outcomes of foot ulcers in patients with diabetes at the Yaounde Central Hospital, Cameroon. Method: A retrospective analysis of routinely collected hospital data, and data validation by survey of clinical notes was conducted from November 1999 to October 2002 for adult diabetic patients with foot ulcers. Clinical data were recorded for each patient, followed by a record of microbiological investigations where available. Results: Of 503 patients with diabetes admitted during the study period, 54 (10.7%) had foot ulcers. Male subject represented 66.7% of this population. The mean age of the study population was 59.66 ± 1.52 years. The foot ulcer led to the diagnosis of diabetes in six patients in whom the condition was previously unidentified. Of the 54 patients with foot ulcers, nine (16.7%) were selected for surgery and the remaining 45 were m...

Journal of Hypertension, 2011

Primary Care Diabetes, 2012

To report the prevalence of undiagnosed diabetes and its determinants among adults Cameroonian ur... more To report the prevalence of undiagnosed diabetes and its determinants among adults Cameroonian urban dwellers. On May 17th 2011, a community-based combined screening for diabetes and hypertension was conducted simultaneously in four major Cameroonian cities. Adult participants were invited through mass media. Fasting blood glucose was measured in capillary blood. Of the 2120 respondents, 1591 (52% being men) received a fasting glucose test. The median age was 43.7 years, and 64.2% were overweight or obese. The sex-specific age adjusted prevalence (for men and women) were 10.1% (95% confidence interval [CI]: 8.1-12.1%) and 11.2% (95%CI: 9.1-13.3%) for any diabetes, and 4.6% (95%CI: 2.6-6.6%) and 5.1% (95%CI: 3.0-7.2%) for screened-detected diabetes, respectively. The prevalence of diabetes increased with increasing age in men and women (all p ≤ 0.001 for linear trend). Older age (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), region of residence (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), excessive alcohol intake (p=0.02) were significantly associated with screened-detected diabetes, while physical inactivity, body mass index, and high waist girth were not significantly associated with the same outcome. Prevalence of undiagnosed diabetes is very high among Cameroonian urban dwellers, indicating a potentially huge impact of screening for diabetes, thus the need for more proactive policies of early detection of the disease.

Background: Recent studies suggest that pain in osteoarthritis (OA) is not only nociceptive, but ... more Background: Recent studies suggest that pain in osteoarthritis (OA) is not only nociceptive, but also has neuropathic characteristics (1). To our knowledge, no study has been carried out in sub-Saharan Africa to assess the neuropathic pain associated with knee OA. Objectives: To determine the prevalence of chronic pain with neuropathic characteristics and associated factors in patients with knee OA in Cameroon. Methods: We performed a cross-sectional study at the Douala General Hospital from December 2018 to April 2019. Patients over the age of 21 with a diagnosis of knee OA (ARA, 1986; Kellgren–Lawrence radiographic grading ≥ 2) were included. The intensity of the pain was measured using the visual analog scale. Neuropathic pain was detected using the DN4 questionnaire with a cut-off at DN4 ≥ 4 (2) and functional impairment assessed using the Lequesne algofunctional index. Logistic regression analysis was used to assess the association between patients’ characteristics and DN4. The...

Pan African Medical Journal, 2019

Introduction: hypogonadism refers to a syndrome that results from failure of gonads to function p... more 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.

BMC Hematology, 2017

Background: Sickle Cell Disease (SCD) is associated with chronic multisystem complications that s... more Background: Sickle Cell Disease (SCD) is associated with chronic multisystem complications that significantly influence the quality of life (QOL) of patients early in their life. Although sub-Saharan Africa bears 75% of the global burden of SCD, there is a paucity of data on these complications and their effects on the QOL. We aimed to record these chronic complications, to estimate the QOL, and to identify the corresponding risk factors in patients with SCD receiving care in three hospitals in Cameroon. Methods: In this cross-sectional study, a questionnaire was used to collect data from consecutive consenting patients. Information recorded included data on the yearly frequency of painful crisis, the types of SCD, and the occurrence of chronic complications. A 36-Item Short Form (SF-36) standard questionnaire that examines the level of physical and mental well-being, was administered to all eligible participants. Data were analyzed with STATA® software. Results: Of 175 participants included, 93 (53.1%) were female and 111 (aged ≥14 years) were eligible for QOL assessment. The median (interquartile range, IQR) age at diagnosis was 4.0 (2.0-8.0) years and the median (IQR) number of yearly painful crisis was 3.0 (1.0-7.0). The most frequent chronic complications reported were: nocturnal enuresis, chronic leg ulcers, osteomyelitis and priapism (30.9%, 24.6%, 19.4%, and 18.3% respectively). The prevalence of stroke and avascular necrosis of the hip were 8.0% and 13.1% respectively. The median (IQR) physical and mental scores were 47.3 (43.9-58.5) and 41.0 (38.8-44.6) respectively. Age and chronic complications such as stroke and avascular necrosis were independently associated with poor QOL. Conclusions: In this population of patients living with SCD, chronic complications are frequent and their QOL is consequently poor. Our results highlight the need for national guidelines for SCD control, which should include newborn screening programs and strategies to prevent chronic complications.

BMC research notes, 2017

Unilateral renal cystic disease is a rare condition that shares morphological similarities with m... more Unilateral renal cystic disease is a rare condition that shares morphological similarities with multicystic dysplastic kidney, the former often distinguished from the latter on some clinical and histopathological grounds. However serious diagnostic and therapeutic dilemmas set in when there is a considerable overlap in the distinguishing features between these entities. A 19-year-old African female presented with a chronic severe debilitating right lower quadrant abdominal pain refractory to analgesics. Biochemical investigations and imaging studies revealed a non-functional polycystic right kidney and no identifiable pelvicalyceal system or ureter but with preserved renal function. The marked overlap in clinical presentation between unilateral renal cystic disease and multicystic dysplastic kidney in this patient necessitated further investigation to pose an appropriate diagnosis. A right nephrectomy was performed and histopathological analysis of the resected kidney done, the resu...

BMC Research Notes, 2017

Background: Right iliac vein thrombosis is uncommon in pregnancy. Nonetheless, when it does occur... more Background: Right iliac vein thrombosis is uncommon in pregnancy. Nonetheless, when it does occur, its presentation could be very unspecific with important diagnostic challenges and this could have negative therapeutic consequences especially in a resource limited setting. Case presentation: The historical, clinical and laboratory data of a 30 year old G2P1001 woman of African ethnicity at 11 weeks of gestation pointed towards a right iliac vein thrombosis missed for an acute appendicitis with subsequent appendectomy and failure to cure. Following the diagnosis of right iliac vein thrombosis post-appendectomy, the patient was started on low molecular weight heparin and the clinical progress thereafter was favourable. Conclusion: Pelvic vein thrombosis should be considered a differential diagnosis of intractable lower abdominal pain in early pregnancy. A high index of suspicion could lead to early diagnosis, prompt management and a favourable prognosis even in a low-income setting.

BMC Research Notes, 2017

Background: Tropical diabetic hand syndrome describes a complex hand sepsis affecting patients wi... more Background: Tropical diabetic hand syndrome describes a complex hand sepsis affecting patients with diabetes across the tropics and often results from a trivial hand trauma. The clinical presentation of this syndrome is variable and ranges from localised swelling and cellulitis, with or without ulceration of the hand to progressive fulminant hand sepsis, and gangrene affecting the entire limb which may be fatal. Tropical diabetic hand syndrome could lead to permanent disability and death as a result of delay in presentation, late diagnosis and late medical and surgical intervention. This indexed case acts as an eye opener for physicians to the existence of this hand sepsis. Case presentation: We report the case of a 57 year-old black African female diabetic who was referred to our centre for the management of a suppurating ulcer and swelling of the left hand of two weeks duration. On examination and work-up, the patient was found to have Lawal Group III left diabetic hand syndrome and was managed with parenteral antibiotics, radical debridement and the hand was eventually amputated. She died 7 days following amputation from overwhelming sepsis. Conclusion: Though tropical diabetic hand syndrome is a relatively rare complication of diabetes, it can be fatal as in this case report. Early diagnosis and proper management would yield better outcome. Initial management should include aggressive intravenous broad-spectrum antibiotics with anaerobic coverage. Classification of tropical diabetic hand syndrome will assist physicians and surgeons in decision making, proper management and easy communication.

Diabetes & Metabolism, 2017

Background and objectives.-Peripheral tissue resistance to insulin action is a characteristic of ... more Background and objectives.-Peripheral tissue resistance to insulin action is a characteristic of type 2 diabetes mellitus (T2DM). It has also been reported that some chronic viral infections can contribute to insulin resistance. Human herpesvirus (HHV)-8 infection has been detected in T2DM patients in previous studies. Our study investigated whether the presence of the virus is associated with insulin resistance in patients with ketosis-prone type 2 diabetes (KPD), as reported with other viruses. Research design and methods.-A total of 11 insulin-free KPD patients positive (+) and seven patients who were negative (−) for HHV-8 infection were recruited; the latter had KPD that was well controlled (HbA 1c = 6.2 ± 0.7%). A two-step euglycaemic-hyperinsulinaemic clamp test coupled with deuterated [6,6-2H2]glucose was used to assess insulin sensitivity, non-esterified fatty acid (NEFA) suppression and endogenous glucose production. Results.-In KPD patients, whether HHV-8+ or HHV-8−, there were no differences in NEFA release, endogenous glucose production or insulin sensitivity (M value). Conclusion.-Asymptomatic HHV-8 infection does not appear to be associated with decreased insulin sensitivity in diabetic patients. These results should now be confirmed in a larger sample population.

Médecine des Maladies Métaboliques, 2015

La majorité des diabètes résultent d'une interaction gène-environnement. Il est reconnu que les i... more La majorité des diabètes résultent d'une interaction gène-environnement. Il est reconnu que les infections virales en tant que facteurs environnementaux peuvent jouer un rôle dans l'apparition, le maintien, ou l'exacerbation, des désordres métaboliques observés au cours des diabètes. À côté des formes classiques de diabète, type 1 (DT1) et type 2 (DT2), le diabète atypique (Ketosis-prone diabetes, KPD), forme clinique intermédiaire aux deux précédents, est très fréquent chez les Africains. Certains virus ont été identifiés comme associés, ou décrits comme étiologies probables, dans ces trois formes de diabète, à savoir les entérovirus dans le DT1, le virus de l'hépatite C et le virus de l'immunodéficience humaine (VIH) dans le DT2, et le virus herpès humain de type 8 (HHV-8) pour le KPD. Mots-clés : Diabète-diabète atypique (Ketosis-prone diabetes)-virus-Afrique.

Médecine des Maladies Métaboliques, 2007

Annals of the Rheumatic Diseases, 2015

Background: Previous report has suggested that hyperuricemia and gout must be integrated into the... more Background: Previous report has suggested that hyperuricemia and gout must be integrated into the metabolic syndrome items Objectives: To evaluate the association between gout and metabolic syndrome in a sub-Saharan Cameroonian population Methods: A cross-sectional study from January 2004 to December 2014 was conducted in the Rheumatology Unit of the General Hospital, Douala, Cameroon. We included patients with diagnosis of gout according to 1977 ACR criteria. Metabolic syndrome was defined according to the NCEP-ATP III criteria Results: We included 511 patients (415 men and 96 women). The mean age was 55.9±10.8 years. The mean serum uric acid was 82.4 mg/L ±22.3, with hyperuricemia found in 401 patients (78.4%). The association between gout and items of metabolic syndrome were all significant (p<0.0001) (Table 1). This association was significant from the existence of at least two components of metabolic syndrome (Table 2).

Diabetes & Metabolism, 2015

rôle dans la diminution de la sécrétion d'insuline en réponse au glucose des îlots-J vs N., mais ... more rôle dans la diminution de la sécrétion d'insuline en réponse au glucose des îlots-J vs N., mais les mécanismes en jeu restent à déterminer. Déclaration d'intérêt Les auteurs déclarent ne pas avoir d'intérêt direct ou indirect (financier ou en nature) avec un organisme privé, industriel ou commercial en relation avec le sujet présenté. P163 Rôle de la somatostatine dans le contrôle de la sécrétion de glucagon par le glucose et des inhibiteurs des canaux KATP

BMC endocrine disorders, Jan 9, 2014

We aimed to evaluate the predictive utility of common fasting insulin sensitivity indices, and no... more We aimed to evaluate the predictive utility of common fasting insulin sensitivity indices, and non-laboratory surrogates [BMI, waist circumference (WC) and waist-to-height ratio (WHtR)] in sub-Saharan Africans without diabetes. We measured fasting glucose and insulin, and glucose uptake during 80/mU/m2/min euglycemic clamp in 87 Cameroonians (51 men) aged (SD) 34.6 (11.4) years. We derived insulin sensitivity indices including HOMA-IR, quantitative insulin sensitivity check index (QUICKI), fasting insulin resistance index (FIRI) and glucose-to-insulin ratio (GIR). Indices and clinical predictors were compared to clamp using correlation tests, robust linear regressions and agreement of classification by sex-specific thirds. The mean insulin sensitivity was M = 10.5 ± 3.2 mg/kg/min. Classification across thirds of insulin sensitivity by clamp matched with non-laboratory surrogates in 30-48% of participants, and with fasting indices in 27-51%, with kappa statistics ranging from -0.10 t...

Diabetes Care, 2008

OBJECTIVE—To characterize insulin action in Africans with ketosis-prone diabetes (KPD) during rem... more OBJECTIVE—To characterize insulin action in Africans with ketosis-prone diabetes (KPD) during remission. RESEARCH DESIGN AND METHODS—At Saint-Louis Hospital, Paris, France, 15 African patients with KPD with an average 10.5-month insulin-free near-normoglycemic remission period (mean A1C 6.2%) were compared with 17 control subjects matched for age, sex, BMI, and geographical origin. Insulin stimulation of glucose disposal, and insulin suppression of endogenous glucose production (EGP) and nonesterified fatty acids (NEFAs), was studied using a 200-min two-step (10 mU · m−2 body surface · min−1 and 80 mU · m−2 · min −1 insulin infusion rates) euglycemic clamp with [6,6-2H2]glucose as the tracer. Early-phase insulin secretion was determined during an oral glucose tolerance test. RESULTS—The total glucose disposal was reduced in patients compared with control subjects (7.5 ± 0.8 [mean ± SE] vs. 10.5 ± 0.9 mg · kg−1 · min−1; P = 0.018). EGP rate was higher in patients than control subject...

Diabetes Care, 2012

OBJECTIVE Ketosis-prone atypical diabetes (KPD) is a subtype of diabetes in which the pathophysio... more OBJECTIVE Ketosis-prone atypical diabetes (KPD) is a subtype of diabetes in which the pathophysiology is yet to be unraveled. The aim of this study was to characterize β- and α-cell functions in Africans with KPD during remission. RESEARCH DESIGN AND METHODS We characterized β- and α-cell functions in Africans with KPD during remission. The cohort comprised 15 sub-Saharan Africans who had been insulin-free for a median of 6 months. Patients in remission were in good glycemic control (near-normoglycemic) and compared with 15 nondiabetic control subjects matched for age, sex, ethnicity, and BMI. Plasma insulin, C-peptide, and glucagon concentrations were measured in response to oral and intravenous glucose and to combined intravenous arginine and glucose. Early insulin secretion was measured during a 75-g oral glucose tolerance test. Insulin secretion rate and glucagon were assessed in response to intravenous glucose ramping. RESULTS Early insulin secretion and maximal insulin secreti...

Diabetes & Metabolism, 2014

de 75 ans avaient une HbA1c < 7 %. La prévalence des différents traitements hypoglycémiants, chez... more de 75 ans avaient une HbA1c < 7 %. La prévalence des différents traitements hypoglycémiants, chez les sujets > 75 ans vs < 75 ans, était respectivementþ: metformine 52 % vs 72 %, sulfamides 33 % vs 38 %, insuline basale 33 % vs 25 %, insuline en multi injections 27 % vs 20 %, glinides 17 % vs 9 %, iDPP4 14 % vs 21 %, analogue GLP1 10 % vs 18 % et acarbose 7 % vs 4 % (toutes p < 0,005). La prévalence dans le sous-groupe de 306 patients âgés de plus de 75 ans avec IR était : insuline basale 38 %, metformine 37 %, multi-injections 36 %, sulfamides 27 %, glinides 20 %, iDPP4 12 %, analogue GLP1 10 % et acarbose 6 %. Conclusion : Les sulfamides restent les insulinosécretagogues les plus prescrits chez les DT2 âgés de plus de 75 ans du registre SURCOUF, suivis des glinides et des iDPP4, y compris dans le sous-groupe de patients avec IR, malgré le risque hypoglycémique surajouté. P102 Patients diabétiques et connaissance du coût de la prise en charge thérapeutique : quelle adéquation ?

Diabetes & Metabolism, 2013