A new tetracyclic triterpenoid [4,4,24-trimethylcholesta-Δ(8,9;14,15;24,28)-trien-3β,11β,12α-triol-12-acetate, 3-sulfate] sodium salt (1), together with eight known compounds including ergosterol 5α,8α-endoperoxide (2), 1,9-dihydroxy-3-methoxy-2-methylpterocarpan (3), 3-O-β-D-2-acetyl-amino-2-deoxyglucopyranoxyloleanoic acid (4), hydnocarpin (5), derrone (6), isovitexin (7), erythrinin C (8), and 5,4'-dihydroxy-2''-hydroxyisopropyldihydrofurano [4,5:7,8]-isoflavone (9), were isolated from the EtOAc soluble fraction of the methanol extract of aerial part of Desmodium uncinatum collected in the western highland of Cameroon. The structures of these compounds were established by comprehensive interpretation of their spectral data mainly including 1D- (¹H and ¹³C), 2D-NMR (¹H-¹H COSY, HMQC, HMBC) spectroscopic and ESI-TOF-MS mass spectrometric analysis. The isolation of an integracide-like compound from plant origin is a very unusual finding.
Cameroon ; Ergosterol ; Fabaceae ; Methanol ; Plants ; Sodium

Myiasis is defined as an infestation of live human and vertebrate animals with dipterous larvae, which at least for a period, feed on dead or living tissue of the host, liquid body substances or ingested food. Among several types of myiasis, cutaneous myiasis is classified as the most common type. Cutaneous myiasis is subdivided into furuncular, migratory and wound myiasis based on the infested morphology. Common dipterous larvae for furuncular myiasis include Dermatobia hominis, Cordylobia anthropophaga, Cuterebra spp., Wohlfahrtia vigil and W. opaca. Early lesions resemble other insect bite reactions, but the physician can differentiate the lesions by the visualization of larvae through an aperture with serous exudes as the larvae grow. Although cutaneous myiasis is not uncommon in endemic areas, there has been one previous report of cutaneous myiasis by C. anthropophaga in the Korean dermatological literature. We report here an interesting case of furuncular cutaneous myiasis by C. anthropophaga in a patient after traveling to Cameroon.
Animals ; Benzhydryl Compounds ; Cameroon ; Humans ; Insect Bites and Stings ; Larva ; Myiasis ; Vertebrates

Mixed-species malaria infections are often unrecognized or underestimated. We hereby report the first described case of mixed infection with Plasmodium falciparum and Plasmodium ovale malaria in a returned traveller in Korea. In August 2016, a 25-year-old returned traveller from Cameroon and Democratic Republic of Congo presented with fever. He was diagnosed as P. falciparum malaria and successfully treated with artesunate. And 5 weeks after the completion of treatment, he presented with fever and diagnosed as P. ovale infection. P. ovale infection is a rare cause of malaria and often shows delayed presentation due to its dormant liver stage as hypnozoites. At re-presentation, the immunochromatographic test and microscopic examinations of our patient did not reveal P. ovale, which was only detected via polymerase chain reaction (PCR) assay. This case highlights the importance of considering malaria infection even in persons who have previously received malaria treatment. It also shows the usefulness of PCR testing for diagnosing P. ovale infections, which often present with a low level of parasitaemia.
Adult ; Cameroon ; Coinfection* ; Congo ; Fever ; Humans ; Korea* ; Liver ; Malaria ; Plasmodium falciparum* ; Plasmodium ovale* ; Plasmodium* ; Polymerase Chain Reaction

OBJECTIVES: To propose an alternative procedure, based on a Bayesian network (BN), for estimation and prediction, and to discuss its usefulness for taking into account the hierarchical relationships among covariates. METHODS: The procedure is illustrated by modeling the risk of diarrhea infection for 2,740 children aged 0 to 59 months in Cameroon. We compare the procedure with a standard logistic regression and with a model based on multi-level logistic regression. RESULTS: The standard logistic regression approach is inadequate, or at least incomplete, in that it does not attempt to account for potentially causal relationships between risk factors. The multi-level logistic regression does model the hierarchical structure, but does so in a piecewise manner; the resulting estimates and interpretations differ from those of the BN approach proposed here. An advantage of the BN approach is that it enables one to determine the probability that a risk factor (and/or the outcome) is in any specific state, given the states of the others. The currently available approaches can only predict the outcome (disease), given the states of the covariates. CONCLUSION: A major advantage of BNs is that they can deal with more complex interrelationships between variables whereas competing approaches deal at best only with hierarchical ones. We propose that BN be considered as well as a worthwhile method for summarizing the data in epidemiological studies whose aim is understanding the determinants of diseases and quantifying their effects.
Aged ; Cameroon ; Child ; Diarrhea ; Epidemiologic Studies ; Humans ; Imidazoles ; Logistic Models ; Naphthalenes ; Nitro Compounds ; Risk Factors ; Sulfuric Acids

Cerebral malalria is a life-threatening complication of Plasmodium falciparum infection. RBC exchange transfusion (RCE) can reduce the burden of parasitemia in this situation. We have experienced two cases of cerebral malaria treated with automated RBC exchange as an adjunct to standard chemotherapy. Case 1: A 42-year-old male was referred to the emergency room with a history of 3 days of fever after having returned from Congo. Peripheral blood smear showed the P. falciparum parasitemia of 70-80%. Quinidine and doxycycline were administered but, mental state started to deteriorate. He underwent RCE on hospital day 2 to reduce the parasitemia to 10% after 8 hours. No parasite could be found on day 3 after the RCE. Case 2: A 62-year-old male was referred to the emergency room with a history of 3 days of fever after having returned from Cameroon. P. falciparum parasitemia was 10% on peripheral blood smear. Quinidine and doxycycline were immediately started but headache developed abruptly and he underwent RCE on hospital day 3. After 8 hours following the completion of RCE, parasitemia decreased to less than 1%. Automated RBC exchange transfusion can rapidly reduce the burden of parasitemia and achieve improvement of neurologic symptom and sign in patients with cerebral malaria.
Adult ; Cameroon ; Congo ; Doxycycline ; Drug Therapy ; Emergency Service, Hospital ; Fever ; Headache ; Humans ; Malaria, Cerebral* ; Male ; Middle Aged ; Neurologic Manifestations ; Parasitemia ; Parasites ; Plasmodium falciparum ; Quinidine

Development of a competence-based curriculum is important. This study aimed to develop competence assessment tools in emergency medicine and use it to assess competence of Cameroonian healthcare professionals. This was a cross-sectional, descriptive study. Through literature review, expert survey, and discrimination tests, we developed a self-survey questionnaire and a scenario-based competence assessment tool for assessing clinical knowledge and self-confidence to perform clinical practices or procedures. The self-survey consisted of 23 domains and 94 questionnaires on a 5-point Likert scale. Objective scenario-based competence assessment tool was used to validate the self-survey results for five life-threatening diseases presenting frequently in emergency rooms of Cameroon. Response rate of the self-survey was 82.6%. In this first half of competence assessment, knowledge of infectious disease had the highest score (4.6 ± 0.4) followed by obstetrics and gynecology (4.2 ± 0.6) and hematology and oncology (4.2 ± 0.5); in contrast, respondents rated the lowest score in the domains of disaster, abuse and assault, and psychiatric and behavior disorder (all of mean 2.8). In the scenario-based test, knowledge of multiple trauma had the highest score (4.3 ± 1.2) followed by anaphylaxis (3.4 ± 1.4), diabetic ketoacidosis (3.3 ± 1.0), ST-elevation myocardial infarction (2.5 ± 1.4), and septic shock (2.2 ± 1.1). Mean difference between the self-survey and scenario-based test was statistically insignificant (mean, −0.02; 95% confidence interval, −0.41 to 0.36), and agreement rate was 58.3%. Both evaluation tools showed a moderate correlation, and the study population had relatively low competence for specific aspects of emergency medicine and clinical procedures and skills.
Anaphylaxis ; Cameroon* ; Communicable Diseases ; Curriculum ; Delivery of Health Care* ; Developing Countries ; Diabetic Ketoacidosis ; Disasters ; Discrimination (Psychology) ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Gynecology ; Hematology ; Mental Competency* ; Multiple Trauma ; Myocardial Infarction ; Obstetrics ; Professional Competence ; Shock, Septic ; Surveys and Questionnaires

OBJECTIVETo evaluate the in vitro antibacterial properties and the ability to potentiate some common antibiotics effects of the methanol extracts of 11 Cameroonian food plants on 29 Gram-negative bacteria expressing multidrug resistant (MDR) phenotypes.

METHODSThe antimicrobial activity of the extracts was performed using the broth microdilution method. The phytochemical screening of these extracts was also performed using standard methods.

RESULTSOcimum basilicum, Gnetum africanum and Eucalyptus robusta extracts possessed an antibacterial activity against all the 29 studied bacteria. The extracts from G. africanum and E. robusta were the most active with the lowest minimal inhibitory concentration of 64 μg/mL on Escherichia coli AG100A for both extracts and also against Klebsiella pneumoniae K24 for G. africanum. When tested in the presence of phenylalanine-arginine β-Naphtylamide (PAβN), an efflux pump inhibitor, the extract of Thymus vulgaris and E. Robusta showed the best activities on most tested strains. E. Robusta extract showed good synergistic effects, improving the activity of commonly used antibiotics in about 85% of cases.

CONCLUSIONThe overall results obtained provide the baseline information for the use of the tested plants in the treatment of bacterial infections.

Anti-Bacterial Agents ; pharmacology ; Cameroon ; Drug Resistance, Multiple ; drug effects ; Eucalyptus ; chemistry ; Gnetum ; chemistry ; Gram-Negative Bacteria ; drug effects ; Gram-Negative Bacterial Infections ; drug therapy ; microbiology ; Humans ; Medicine, African Traditional ; methods ; Microbial Sensitivity Tests ; Ocimum basilicum ; chemistry ; Phytotherapy ; methods ; Plant Preparations ; pharmacology ; Plants, Edible ; chemistry