BackgroundVery little is known about the burden of chronic low back pain in Africa. This study aimed at assessing disability and associated factors in chronic low back patients in Cameroon.MethodsWe carried a hospital-based cross-sectional study including patients suffering from low back pain (LBP) of at least 12 weeks’ duration. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ). RMDQ > 4 described persons with dysfunctional levels of disability.Multivariable linear regression was used to investigate factors associated with higher RMDQ scores hence greater disability. Variables investigated included; gender, age, marital status, employment status and type, smoking history, alcohol consumption, income, pain intensity, LBP duration, psychological wellbeing, sleep satisfaction, leg pain, numbness/paresthesia, bowel/bladder dysfunction symptoms (BBDS), body mass index (BMI), and days of work absence.ResultsA sample of 136 adults (64% female) with a mean age of 50.6 ± 12.2 years participated in the study. Median duration of LBP was 33 (25th – 75th percentile: 12–81) months. Mean RMDQ score was 12.8 ± 6. In multivariable linear regression, pain intensity (β = 0.07, p = 0.002), longer days of work absence (β = 0.15, p = 0.003) and BBDS (β =2.33, p = 0.029) were associated with greater disability. Factors such as consumption of alcohol (β = − 3.55, p = 0.005) and higher psychological wellbeing scores (β = − 0.10, p = 0.004) significantly contributed to less disability (lower RMDQ scores). Dysfunctional levels of disability were present in 88.1% of patients.ConclusionCLBP is associated with significant disability and this relationship is driven by several factors. Multidisciplinary management strategies especially those targeted to improve pain control, manage BBDS and improve psychological wellbeing could reduce disability and improve quality of life.

Acquired immune-deficiency syndrome (AIDS) is becoming an increasing problem to the surgeon. The impact of HIV/AIDS on surgical practice include the undoubted risk to which the surgeon will expose him or herself, the atypical conditions that may be encountered and the outcome and long term benefit of the surgical treatment in view of disease progression. The two factors most associated with surgical outcome and poor wound healing were AIDS and poor performance status (ASA score). This article questions whether gastrointestinal surgical procedures can be safe and effective therapeutic measures in HIV/AIDS patients and if surgical outcome is worthy of the surgeon's ethical responsibility to treat. As HIV/AIDS patients are not a homogeneous group, with careful patient selection, emergency laparotomy for peritonitis confers worthwhile palliation. However, aggressive surgical intervention must be undertaken with caution and adequate peri-operative care is required. Symptomatic improvement of anorectal pathology may make delayed wound healing an acceptable complication. Alternatives to surgery can be contemplated for diagnosis, prophylaxis or palliation.

A 70-year-old woman presented with a short history of a spontaneous enterocutaneos fistula in the left inguinal region. A laparotomy revealed a fistulizing Richter's hernia. The fistulizing small bowel segment was resected and the femoral hernia repaired from below. Although rare, a complicating Richter's hernia should be considered in the differential diagnosis of a groin fistula.

Background The stress response to surgery involves catabolism and gluconeogenesis resulting in postoperative hyperglycaemia. Postoperative hyperglycaemia is a risk factor for postoperative complications and preoperative fasting further aggravates this response. A carbohydrate (CHO) drink instead of fasting is expected to decrease insulin resistance and reduce post-operative hyperglycaemia. The aim of this study was to assess the effect of the reduction of the pre-operative fasting period on post-operative hyperglycaemia and post-operative complications in open surgery. Methods A hospital-based prospective case control study of 70 patients scheduled for elective surgery were sampled to either a case (carbohydrate-loaded) or a control (FAST) group. Postoperative hyperglycaemia and complications were the primary and secondary outcomes respectively reported. Results 70 patients were recruited with 35 patients per group. 40 (57%) were females. The mean blood glucose on the first postoperative day was significantly higher in those who fasted (146.20 ± 38.36 mg/dl) than in those who received the energy drink (123.06 ± 26.64 mg/dl), p = 0.004. Postoperative infections were significantly higher in the control group than in the CHO group (31.43%; and 8.57%; 95% C.I: 1.23–19.47) p = 0.033. The mean length of hospital stay was longer in the FAST (12.54days ± 15.08) than in the CHO (9.17days ± 12.65) group although the difference was not statistically significant p = 0.315. The mean age, surgery type and mean duration of surgery were significant between groups but not upon logistic regression for significant clinical and demographic variables. Conclusion Preoperative CHO loading is effective and safe in reducing post-operative hyperglycaemia and infection in open general surgery even in a low resource setting. Highlights

Emergency medical services with pre-hospital care remain poorly developed in sub-Saharan Africa and the developing world at large. The provision of timely treatment during life-threatening emergencies is not a priority for many health systems in developing countries. In this review, the authors reviewed the evidence indicating the need to develop and/or strengthen emergency medical care systems in sub-Sahara Africa with perspectives drawn from Cameroon.

ObjectiveTo evaluate health-related quality of life (HRQoL) and its determinants in chronic low back pain (CLBP) patients in Cameroon.DesignObservational cross-sectional study.SettingTertiary hospital.ParticipantsThere were 150 eligible adults with low back pain of at least 12 weeks who provided informed consent. Of these, 136 with complete questionnaires were analysed.OutcomesHRQoL was measured using the WHO Quality of Life questionnaire (WHOQOL-BREF). Outcome measures included its four domain (physical health, psychological, social relationships and environmental) scores and two independent scores for overall quality of life (OQOL) and general health satisfaction (GH).ResultsParticipants had a median age of 52 years, and median pain duration of 33 (IQR: 69) months. The median OQOL score was 50 (IQR: 25). After multivariable adjustment, tertiary education (β=11.43, 95% CI 3.12 to 19.75), age (β=0.49, 95% CI 0.12 to 0.87) and being a student (β=23.07, 95% CI 0.28 to 45.86) contributed to better OQOL. Age (β=0.57, 95% CI 0.10 to 1.04) and physical-type employment (β=−14.57, 95% CI −25.83 to −3.31) affected GH. Smoking (β=−20.49, 95% CI −35.49 to −5.48) and radiological anomalies (β=−7.57, 95% CI −14.64 to −0.49) affected the physical health domain, while disability (β=−0.67, 95% CI −1.14 to −0.20) and duration of pain (β=−0.13, 95% CI −0.20 to −0.05) affected the psychological domain. Income (β=14.94, 95% CI 4.06 to 25.81) affected the social domain, while education (β=9.96, 95% CI 1.41 to 18.50) and disability (β=−0.75, 95% CI −1.26 to −0.24) affected the environmental domain.ConclusionsOur findings suggest that CLBP affects HRQoL and multiple socioeconomic and clinical factors influence its impact on different domains of HRQoL. Multipronged management programmes, especially those that reduce disability, could improve HRQoL in patients with CLBP.

Background: Postoperative infections (POIs) contribute to morbidity and mortality of surgical patients. There was no data on the prevalence and associated risk factors of POIs in the Limbe Regional Hospital (RLH). Methods: Selected patients were those who underwent a surgical procedure and were admitted into the surgical or maternity ward of the LRH between January 2009 and August 2012. Data studied included demographic variables, type of surgical procedure performed and postoperative follow-up. Data was analyzed for evidence of POIs using the Chi-square test for categorical variables and test for significance of association between POI and sex, age, procedures performed, hospitalization ward and duration of hospital stay. Results: 848 patients were selected among whom 78.8% were females. 62.1% of the patients were selected from the Obstetric and Gynaecology ward, while 37.9%were from the surgical ward. The mean age of the study subjects was 32.3±12.4 years. 175 patients met the criteria for POI giving a prevalence of 20.6%. The Obstetrics and Gynaecology ward had the highest prevalence of POI (61.7%). Prevalence of POIs was highest (64.3%) among patients in the 0-10 years age group. Males (26.7%) were at a higher risk of developing POIs .There was a statistically significant difference between POI and participants' age group (p<0.05). Peritonitis displayed the highest rate of POI (36.6%) while tubal ligation had the lowest (0%). Purulent wound discharge was the most frequent diagnostic criteria for postoperative infection. Conclusion: The prevalence of POIs ranged from 0-36.6%. Male sex and patients' age seemed to be associated with a higher risk of POIs. Surgery for acute generalized peritonitis had the highest risk of developing POIs.

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