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Galdakao, Spain

Pefura-Yone E.W.,University of Yaounde I | Soh E.,Pneumology Service | Kengne A.P.,University of Cape Town | Balkissou A.D.,University of Yaounde I | Kuaban C.,University of Yaounde I
Journal of Infection and Public Health | Year: 2013

Purpose: To assess the prevalence and determinants of non-adherence to antiretroviral therapy (ART) as well as the concordance of two screening criteria in a major center for human immunodeficiency virus (HIV) treatment in Yaounde, Cameroon. Methods: In 2011, we conducted a cross-sectional study involving a random sample of 889 adults (age > 18 years, 67.9% women) infected with HIV who were receiving chronic care at the Yaounde Jamot Hospital. Adherence was assessed via self-administered questionnaires using the Community Programs for Clinical Research on AIDS (CPCRA) index and the Center for Adherence Support Evaluation (CASE) index. Results: The prevalence of non-adherence to ART was 22.5% based on the CPCRA index and 34.9% based on the CASE index, with a low agreement between the two indexes [kappa = 0.37 (95% confidence interval 0.31-0.44)]. Independent determinants of CPCRA-diagnosed non-adherence were as follows: being a remunerated employee [odds ratio (95% confidence interval): 1.61 (1.14-2.28)], Pentecostal Christianity [2.18 (1.25-3.80)], alcohol consumption [1.65 (1.16-2.34)] and non-adherence to cotrimoxazole prophylaxis [5.73 (3.92-8.38)]. The equivalents for CASE-diagnosed non-adherence were [1.59 (1.19-2.12)], [1.83 (1.36-2.47)], [1.70 (1.27-2.28)], respectively, in addition to association with changes to the ART regimen [1.61 (1.17-2.20)]. Conclusions: Non-adherence to ART remains high in this population. The careful evaluation of patients for the presence of determinants of non-adherence identified in this study may aid ART optimization. © 2013 King Saud Bin Abdulaziz University for Health Sciences. Source

Rodriguez-Rodriguez E.,Complutense University of Madrid | Ortega R.M.,Complutense University of Madrid | Gonzalez-Rodriguez L.G.,Complutense University of Madrid | Penas-Ruiz C.,Complutense University of Madrid | Rodriguez-Rodriguez P.,Pneumology Service
European Journal of Pediatrics | Year: 2014

The aim of this work was to study the relationship between dietary total antioxidant capacity (TAC) and current asthma in a group of Spanish schoolchildren. A total of 78 Spanish schoolchildren (26 asthmatic and 52 healthy controls) were randomly selected from a cohort of 564 children (9-12 years of age). The weight and height of all subjects were recorded. A questionnaire, completed by the subjects' parents, was used to obtain personal and health information. Current asthma was established when children had ever had asthma, they had been diagnosed with asthma by a physician, and they had been treated with medications at some time in the previous 12 months. Food intake was monitored using a 3-day food record. All consumed foods were converted into energy and nutrients. Dietary TAC was evaluated using the ferric reducing antioxidant power (FRAP), radical-trapping antioxidant parameter (TRAP), and Trolox equivalent antioxidant capacity (TEAC) assays. The TAC measured using all the assays was significantly lower in children with asthma than in children without this condition (2.95 (2.10-3.75)mmol Fe(II)/day vs. 3.70 (3.08-4.49)mmol Fe(II)/day, p<0.01; 1.50 (1.06-2.05)mmol Trolox equivalents/day vs. 2.10 (1.40-2.65)mmol Trolox equivalents/day, p<0.05; and 1.60 (1.08-2.00)mmol Trolox equivalents/day vs. 1.85 (1.50-2.68)mmol Trolox equivalents/day, p<0.05 for FRAP, TEAC, and TRAP, respectively). After adjusting for energy intake, children with FRAP values higher than 3.5 mmol Fe(II)/day (p50) and TEAC values higher than 1.9 mmol Trolox equivalents/day (p50) had 22.6 and 35.0 %, respectively, lower likelihood of suffering asthma episodes than children with lower values. When logistic regression analysis was performed separately for children with nonsmoker and smoker (at least one) parents, the association between dietary TAC and asthma was only observed in the nonsmoker group (OR=0.257, 95 % CI=0.107-0.618, p=0.002 for FRAP; OR=0.212, 95 % CI=0.069-0.639, p=0.006 for TEAC; and OR=0.264, 95 % CI=0.091-0.769, p=0.015 for TRAP assay). Conclusion: Dietary TAC may have a favorable role in asthma in children and, specially, in those with nonsmoker parents. © 2013 Springer-Verlag. Source

Perez-de-Llano L.A.,Pneumology Service | Carballada F.,Hospital Xeral Caldec | Castro Anon O.,Pneumology Service | Pizarro M.,Pneumology Service | And 4 more authors.
European Respiratory Journal | Year: 2010

We aimed to evaluate the accuracy of baseline exhaled nitric oxide fraction (FeNO) to recognise individuals with difficult-to-treat asthma who have the potential to achieve control with a guideline-based stepwise strategy. 102 consecutive patients with suboptimal asthma control underwent stepwise increase in the treatment with maximal fluticasone/salmeterol combination dose for 1 month. Then, those who remained uncontrolled received oral corticosteroids for an additional month. With this approach, 53 patients (52%) gained control. Those who achieved control were more likely to have positive skin results (60.4% versus 34%; p=0.01), positive bronchodilator test (57.1% versus 35.8%; p50.02) and peak expiratory flow variability ≥20% (71.1% versus 49.1%; p=0.04). Conversely, depression was more frequent in those who remained uncontrolled (18.4 % versus 43.4 %; p=0.01). An FeNO value ≥30 ppb demonstrated a sensitivity of 87.5% (95% CI 73.9-94.5%) and a specificity of 90.6% (95% CI 79.7-95.9%) for the identification of responsive asthmatics. The current results suggest that FeNO can identify patients with difficult-to-treat asthma and the potential to respond to high doses of inhaled corticosteroids or systemic steroids. Copyright©ERS 2010. Source

Poka-Mayap V.,Pneumology Service | Pefura-Yone E.W.,Pneumology Service | Pefura-Yone E.W.,University of Yaounde I | Kengne A.P.,University of Cape Town | And 2 more authors.
BMJ Open | Year: 2013

Objectives: Mortality has declined in people with HIV infection, subsequent to the improved access to antiretroviral therapy (ART). We assessed the incidence and determinants of mortality among patients with HIV-1 infection who were started on ART in a referral treatment centre for HIV infection in Yaounde, Cameroon. Design: Cohort study with baseline assessment between 2007 and 2008, and follow-up during 5 years until June 2012. Setting: The accredited HIV treatment centre of the Yaounde Jamot Hospital in the capital city of Cameroon. Participants: People living with HIV infection who started ART between 2007 and 2008 at the study centre. Outcome measures: All-cause mortality over time; accelerated failure time models used to relate baseline characteristics to mortality occurrence during follow-up. Results: Of the 1444 patients included, 827 (53.7%) were men, and the median age (25-75th centiles) was 38 (31-45) years. The median duration of follow-up was 14.1 (1.1-46.4) months, during which 235 deaths were recorded (cumulative incidence rate: 16.3%), including 208 (88.5%) during the first year of follow-up. Baseline predictors of mortality were male gender (adjusted HR 2.15 (95% CI 1.34 to 3.45)), active tuberculosis (2.35 (1.40 to 3.92)), WHO stages III-IV of the disease (3.63 (1.29 to 10.24)), low weight (1.03 (1.01 to 1.05)/kg), low CD4 count (1.04 (1.01 to 1.07)/10/mm3 lower CD4) and low haemoglobin levels (1.12 (1.00 to 1.26)/g/dL lower). Conclusions: Mortality rate among patients with HIV is very high within the first year of starting ART in this centre. Early start of the treatment at a less advanced stage of the disease, and favourable levels of CD4 could reduce early mortality, but would have to be tested. Source

Pefura-Yone E.W.,Pneumology Service | Pefura-Yone E.W.,University of Yaounde I | Kengne A.P.,University of Cape Town | Kuaban C.,Pneumology Service | And 2 more authors.
BMJ Open | Year: 2014

Objectives: Sensitisation of asthmatic patients to mites in sub-Saharan Africa has been less described. The aim of this study was to assess the prevalence and determinants of sensitisation to mites in asthmatic adolescents and adults in Yaounde, Cameroon. Design: This was a cross-sectional study. Logistic regression models were employed to investigate the determinants of sensitisation to mites. Setting: This study was carried out at the Jamot Hospital and CEDIMER private centre, in Yaounde, capital city of Cameroon. Participants: All asthmatic patients received in consultations from January 2012 to June 2013 and in whom prick-skin tests for perennial aeroallergens were performed were included. Outcome measures: Prevalence of sensitisation to mites and associated factors. Results: In total, 201 patients (132 being women, 65.7%), with a median age of 36 (25th-75th centiles: 20-54) years were included, with 135 (67.2%) having a positive skin test for mites. Sensitisation to Dermatophagoïdes pteronyssinus, Dermatophagoides farinae and Blomia tropicalis was found in 53.2%, 49.8% and 47.8% of the patients, respectively. Intermittent rhinitis (16.3% vs 7.6%) and persistent rhinitis (43.0% vs 22.7%) were more frequent in sensitised patients than in the non-sensitised ones (p<0.010). Independent allergological determinants of sensitisation to mites were sensitisation to Alternaria alternata (adjusted OR 14.98 (95% CIs 1.96 to 114.4)) and sensitisation to Blattella germanica (3.48 (1.34 to 9.00)). Conclusions: Sensitisation to mites was found in about two-thirds of asthmatic patients in this setting, with a frequent multiple sensitisations to A alternata and Blattella germanica. Systematically investigating asthmatic patients for mites' sensitisation and determinants will help optimising the care in this setting by combining the aetiological treatment for the allergy with symptomatic treatment for asthma, in order to modify the natural course of the disease. Source

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