IntroductionHIV patients are now having longer life expectancies with the use of antiretroviral therapy (ART). However, the issue of mental illness has surfaced with depression being the most common in these patients, which has markedly reduced patient adherence to ART. In Cameroon, the management of HIV/AIDS does not incorporate psychiatric manifestations and depression is therefore underdiagnosed. The aim of our study was to determine the prevalence and determinants of depressive symptoms and their association with adherence to ART among HIV/AIDS patients on HAART in the Southwest Regional Hospitals of Cameroon.MethodsThis was a cross-sectional hospital-based study carried out in the BRH and LRH over a 3-month period. Three hundred HIV patients aged 21 and above were recruited. Depression and adherence to treatment were assessed using the nine-item Patient Health Questionnaire (PHQ-9) and eight-item Morisky Medication Adherence Scale questionnaires, respectively. Data were analysed using Epi-info version 3.4.5.ResultsThe prevalence of depression was 26.7% (95% CI 20.6–33.7%); 75.0% of those with depression were non-adherent to HAART compared to 37.3% of those without depression (p value <0.001). The statistically significant risk factors associated with depression were unemployment (OR 2.38; 95% CI 1.26–4.50), age ≤40 years (OR 2.13; 95% CI 1.20–3.70) and CD4 counts ≤200 cells/µl (OR 3.70; 95% CI 1.45–9.09).ConclusionThe prevalence of depression was high and depression was significantly associated with non-adherence to HAART. Interventions to enhance early identification and treatment of depression in patients with HIV/AIDS are needed. Depression screening should be included as part of the routine consultation of HIV/AIDS patients to ensure early detection and treatment.

‘Failure to rescue’ is a significant cause of mortality in gastrointestinal surgery. Differences in mortality between high and low-volume hospitals are not associated with large difference in complication rates but to the ability of the hospital to effectively rescue patients from the complications. We reviewed the critical complications following surgery for oesophageal and gastric cancer, their prevention and reasons for failure to rescue. Strategies focussing on perioperative optimization, the timely recognition and management of complications may be essential to improving outcome in low-volume hospitals.

BackgroundSickle 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.MethodsIn 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.ResultsOf 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.ConclusionsIn 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 new-born screening programs and strategies to prevent chronic complications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12878-017-0079-7) contains supplementary material, which is available to authorized users.

Obstetric injury is the commonest cause of anal incontinence. We report a case of anal incontinence as a result of severe chronic fourth-degree perineal tear secondary to birthing with complete disruption of the perineum. Secondary repair consisting of an anterior sphincter repair and levatorplasty in a poor resourced area rendered excellent immediate clinical result. The outcome of anterior sphincter repair following obstetric trauma is good but long-term follow-up is required because of the underlying complexity of obstetric injury. As prevention is not always possible, immediate recognition and adequate primary treatment is of importance.

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