Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and...Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.展开更多
Objective: To evaluate the lung CT scan as a possible predictive diagnostic method for COVID-19 in the Cameroonian context. Methods: We designed a cross sectional study. Suspected cases of COVID-19 during the first wa...Objective: To evaluate the lung CT scan as a possible predictive diagnostic method for COVID-19 in the Cameroonian context. Methods: We designed a cross sectional study. Suspected cases of COVID-19 during the first wave at the national social insurance fund (NSIF) hospital were screened with both COVID-19 with lung CT scan and a PCR test. Univariate analysis was performed for sample description and multivariate analysis to assess the correlation between positive results for the PCR and other parameters. We estimated the optimum threshold of sensitivity/specificity, and area under curve using the empirical method and package. Results: A total of 62 suspected COVID-19 cases were recorded, predominantly males (Sex Ratio = 2.2) with a median age of 58.5 (IQR = 19.7). Among our 62 patients, 29 (46.8%) were confirmed COVID-19 cases with positive PCR results. All the patients had a thorax CT scan with a median impairment of 40% (IQR = 20%). The optimum threshold estimate for CT scan for COVID-19 infection diagnosis was 60% (95% CI = 25% - 80%). Overall, the sensitivity and specificity estimates were 0.30 (95% CI = 0.15 - 0.49) and 0.87 (95% CI = 0.70 - 0.96), respectively, leading to an Area Under Curve (AUC) estimate of 0.59 (95% CI = 0.46, 0.71). Conclusion: In this setting, lung CT scan was neither sensitive nor specific to predict COVID-19 disease.展开更多
Background: Early and non-invasive diagnosis of neonatal hyperbilirubinemia remains critical in dark skinned babies of low resource settings. Objective: To assess correlation/agreement between transcutaneous bilirubin...Background: Early and non-invasive diagnosis of neonatal hyperbilirubinemia remains critical in dark skinned babies of low resource settings. Objective: To assess correlation/agreement between transcutaneous bilirubin (Tcb) and serum bilirubin (Tsb) values in full term neonates with jaundice. Methodology: An analytical cross-sectional study was conducted at the neonatology unit of the Essos Hospital Centre (EHC) from January to June 2019. All full-term neonates aged 0 to 7 days with suspected jaundice who did not receive phototherapy were eligible for the study. The enrolled neonates in the study were assessed clinically, then with the MBJ20 transcutaneous bilirubinometer (TcB). The MBJ20 transcutaneous bilirubinometer highest measurement over the forehead and the sternum were compared to TsB. Data were entered and then analysed with the CsPro7.2 and R (version 3.6.0) software. Correlation was captured by Bland & Alman plots and Concordance Correlation Coefficient (CCC) estimates. The Pearson correlation coefficient and Student test for paired data were used for descriptions purposes, and the significance level was 5%. Results: We recruited 88 neonates. The sex ratio of the babies included was 1.25 favouring males. Median Post-natal age was 3 days with 62% aged 72 hours or more. The mean TcB corresponding to the maximum average between frontal and sternal measurement was 153 mg/dl ± 48 and the average Tsb was 123.80 mg/dl ± 50.48. A good linear correlation was found between TcB and total serum bilirubin level r = 0.86 [0.80;0.91]. Positive correlation was noted between both (forehead and sternum) TcB measurements sites, namely r = 0.78 and r = 0.86. The Bland & Altman plot measured the bias at -29.68 mg/l (confidence interval at 95%, 21.14 - 80.50). The CCC estimate was 0.2 varying from -0.22 to 0.76 according to TcB measurement threshold and post-natal age. The ROC area under the curve value for a threshold < 100 mg/l equals 90% proving to be a good predictor for this threshold. Conclusion: A good linear correlation was found despite a poor agreement between TcB and Tsb. TcB method systematically overestimated the value of TsB.展开更多
Objective: The objective was to measure the prevalence of viral failure (VF) in HIV-1-infected children on first-line antiretroviral therapy (ART) in routine practice. Methods: Serial cross sectional analysis of viral...Objective: The objective was to measure the prevalence of viral failure (VF) in HIV-1-infected children on first-line antiretroviral therapy (ART) in routine practice. Methods: Serial cross sectional analysis of viral load (VL) in HIV-1 infected children on first-line ART for ≥24 weeks was done. VL was measured by Real-Time-Polymerase chain reaction (biocentrics). Samples were collected at 6, 12, 24, 36, 48, 60 months of treatment. Main measurement: Virological failure (VF) defined by a one-off VL > 1000 copies/ml. Results: 375 children aged ≤16 years on first-line-ART were included. Median age at ART start was 4.2 years and ≥50% have started ART ≤3<sup>rd</sup> birthday. A total of 717 measurements of VL were collected. VF was rated between 18% and 26% from 6 - 60 months (mean 20.2%), 95% IC [13.1 - 27.3] at the threshold of 1000 copies/ml, not too different at the threshold of 400 copies/ml, 21% - 30% (mean 23.9%), 95% IC [16.3 - 31.5], p = 0.9. Conclusion: In Yaounde, almost 20% of children on first-line of adherent-ART can experiment VF while improving immune status urging improvement of adherence.展开更多
<strong>Introduction</strong><span style="font-family:Verdana;"><strong>: </strong></span><span style="font-family:Verdana;">Vaccination is very often dela...<strong>Introduction</strong><span style="font-family:Verdana;"><strong>: </strong></span><span style="font-family:Verdana;">Vaccination is very often delayed in premature and low birth weight infants. However, timely vaccination is even more important in this population because of their increased susceptibility to infection.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Objective</span></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:;" "=""> <span style="font-family:Verdana;">To assess immunization practice and factors associated with vaccine promptness</span><span style="font-family:Verdana;"> and completeness in former preterm and low-birth-weight infants.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Methods</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">We conducted a retrospective analytical cross-sectional study (January 2017 to February 2019).</span><b><span style="font-family:Verdana;"> Main Measurement: </span></b><span style="font-family:Verdana;">Promptness and completeness at each contact, Statistical analysis was performed using R software version 3.6.2, logistic regression was used to estimate the Odds Ratio (OR) and their 95% Confidence Interval (CI).</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Results</span></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> We recruited 310 children aged 12 to 36 months born before 37 weeks with low birth weight, 163 (52.6%) of whom were female. Two hundred and fifty-three had received the vaccines at the indicated age, with</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">promptness rate of 81.6%, and 97.7% had completed routine immunization at 9 months. The mean age at vaccination initiation was 6 days ±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">11 and the mean weight at vaccination initiation was 2233</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">g ±</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">494. High </span><span style="font-family:Verdana;">prematurity and very low birth weight were associated with a high rate of</span><span style="font-family:Verdana;"> vaccine delay: 61.5% [OR: 15.56;(CI: 3.22</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">118.52;p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.002)] and 66.7% [OR: 19.19;(CI: 4.67</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">92.52;p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.001)] respectively. Distance > 5 km with EHC [OR: 3.48;(CI: 1.68</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">7.47;p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.001)] was associated with poor vaccination. </span><span style="font-family:Verdana;">Women in common-law unions had the lowest vaccine readiness rate </span><span style="font-family:Verdana;">(60.6%), (OR: 3.36;CI: 1.006</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">10.70;p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.038). The frequency of occurrence of post </span><span style="font-family:Verdana;">immunization adverse events was 24.5%, with fever type in 94.7%.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Conclusion</span></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"> Almost all premature and/or low-birth-weight children hospitalized at Essos Hospital Center had completed routine immunization at 9 months, and the </span><span style="font-family:Verdana;">majority had received the vaccines in a timely manner. Similar</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">study</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">is</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">needed in rural area.</span>展开更多
文摘Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.
文摘Objective: To evaluate the lung CT scan as a possible predictive diagnostic method for COVID-19 in the Cameroonian context. Methods: We designed a cross sectional study. Suspected cases of COVID-19 during the first wave at the national social insurance fund (NSIF) hospital were screened with both COVID-19 with lung CT scan and a PCR test. Univariate analysis was performed for sample description and multivariate analysis to assess the correlation between positive results for the PCR and other parameters. We estimated the optimum threshold of sensitivity/specificity, and area under curve using the empirical method and package. Results: A total of 62 suspected COVID-19 cases were recorded, predominantly males (Sex Ratio = 2.2) with a median age of 58.5 (IQR = 19.7). Among our 62 patients, 29 (46.8%) were confirmed COVID-19 cases with positive PCR results. All the patients had a thorax CT scan with a median impairment of 40% (IQR = 20%). The optimum threshold estimate for CT scan for COVID-19 infection diagnosis was 60% (95% CI = 25% - 80%). Overall, the sensitivity and specificity estimates were 0.30 (95% CI = 0.15 - 0.49) and 0.87 (95% CI = 0.70 - 0.96), respectively, leading to an Area Under Curve (AUC) estimate of 0.59 (95% CI = 0.46, 0.71). Conclusion: In this setting, lung CT scan was neither sensitive nor specific to predict COVID-19 disease.
文摘Background: Early and non-invasive diagnosis of neonatal hyperbilirubinemia remains critical in dark skinned babies of low resource settings. Objective: To assess correlation/agreement between transcutaneous bilirubin (Tcb) and serum bilirubin (Tsb) values in full term neonates with jaundice. Methodology: An analytical cross-sectional study was conducted at the neonatology unit of the Essos Hospital Centre (EHC) from January to June 2019. All full-term neonates aged 0 to 7 days with suspected jaundice who did not receive phototherapy were eligible for the study. The enrolled neonates in the study were assessed clinically, then with the MBJ20 transcutaneous bilirubinometer (TcB). The MBJ20 transcutaneous bilirubinometer highest measurement over the forehead and the sternum were compared to TsB. Data were entered and then analysed with the CsPro7.2 and R (version 3.6.0) software. Correlation was captured by Bland & Alman plots and Concordance Correlation Coefficient (CCC) estimates. The Pearson correlation coefficient and Student test for paired data were used for descriptions purposes, and the significance level was 5%. Results: We recruited 88 neonates. The sex ratio of the babies included was 1.25 favouring males. Median Post-natal age was 3 days with 62% aged 72 hours or more. The mean TcB corresponding to the maximum average between frontal and sternal measurement was 153 mg/dl ± 48 and the average Tsb was 123.80 mg/dl ± 50.48. A good linear correlation was found between TcB and total serum bilirubin level r = 0.86 [0.80;0.91]. Positive correlation was noted between both (forehead and sternum) TcB measurements sites, namely r = 0.78 and r = 0.86. The Bland & Altman plot measured the bias at -29.68 mg/l (confidence interval at 95%, 21.14 - 80.50). The CCC estimate was 0.2 varying from -0.22 to 0.76 according to TcB measurement threshold and post-natal age. The ROC area under the curve value for a threshold < 100 mg/l equals 90% proving to be a good predictor for this threshold. Conclusion: A good linear correlation was found despite a poor agreement between TcB and Tsb. TcB method systematically overestimated the value of TsB.
文摘Objective: The objective was to measure the prevalence of viral failure (VF) in HIV-1-infected children on first-line antiretroviral therapy (ART) in routine practice. Methods: Serial cross sectional analysis of viral load (VL) in HIV-1 infected children on first-line ART for ≥24 weeks was done. VL was measured by Real-Time-Polymerase chain reaction (biocentrics). Samples were collected at 6, 12, 24, 36, 48, 60 months of treatment. Main measurement: Virological failure (VF) defined by a one-off VL > 1000 copies/ml. Results: 375 children aged ≤16 years on first-line-ART were included. Median age at ART start was 4.2 years and ≥50% have started ART ≤3<sup>rd</sup> birthday. A total of 717 measurements of VL were collected. VF was rated between 18% and 26% from 6 - 60 months (mean 20.2%), 95% IC [13.1 - 27.3] at the threshold of 1000 copies/ml, not too different at the threshold of 400 copies/ml, 21% - 30% (mean 23.9%), 95% IC [16.3 - 31.5], p = 0.9. Conclusion: In Yaounde, almost 20% of children on first-line of adherent-ART can experiment VF while improving immune status urging improvement of adherence.
文摘<strong>Introduction</strong><span style="font-family:Verdana;"><strong>: </strong></span><span style="font-family:Verdana;">Vaccination is very often delayed in premature and low birth weight infants. However, timely vaccination is even more important in this population because of their increased susceptibility to infection.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Objective</span></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:;" "=""> <span style="font-family:Verdana;">To assess immunization practice and factors associated with vaccine promptness</span><span style="font-family:Verdana;"> and completeness in former preterm and low-birth-weight infants.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Methods</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">We conducted a retrospective analytical cross-sectional study (January 2017 to February 2019).</span><b><span style="font-family:Verdana;"> Main Measurement: </span></b><span style="font-family:Verdana;">Promptness and completeness at each contact, Statistical analysis was performed using R software version 3.6.2, logistic regression was used to estimate the Odds Ratio (OR) and their 95% Confidence Interval (CI).</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Results</span></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> We recruited 310 children aged 12 to 36 months born before 37 weeks with low birth weight, 163 (52.6%) of whom were female. Two hundred and fifty-three had received the vaccines at the indicated age, with</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">promptness rate of 81.6%, and 97.7% had completed routine immunization at 9 months. The mean age at vaccination initiation was 6 days ±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">11 and the mean weight at vaccination initiation was 2233</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">g ±</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">494. High </span><span style="font-family:Verdana;">prematurity and very low birth weight were associated with a high rate of</span><span style="font-family:Verdana;"> vaccine delay: 61.5% [OR: 15.56;(CI: 3.22</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">118.52;p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.002)] and 66.7% [OR: 19.19;(CI: 4.67</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">92.52;p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.001)] respectively. Distance > 5 km with EHC [OR: 3.48;(CI: 1.68</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">7.47;p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.001)] was associated with poor vaccination. </span><span style="font-family:Verdana;">Women in common-law unions had the lowest vaccine readiness rate </span><span style="font-family:Verdana;">(60.6%), (OR: 3.36;CI: 1.006</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">10.70;p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.038). The frequency of occurrence of post </span><span style="font-family:Verdana;">immunization adverse events was 24.5%, with fever type in 94.7%.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Conclusion</span></b><b><span style="font-family:Verdana;">:</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"> Almost all premature and/or low-birth-weight children hospitalized at Essos Hospital Center had completed routine immunization at 9 months, and the </span><span style="font-family:Verdana;">majority had received the vaccines in a timely manner. Similar</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">study</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">is</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">needed in rural area.</span>
