[Epidemiological and clinical profile of age-related macular degeneration in Cameroon]

PURPOSE

To determine the epidemiological and clinical characteristics of age-related macular degeneration in patients in Yaoundé.

METHODOLOGY

A multicenter, analytical and cross-sectional study was carried out from March 2017 to June 2018 in four hospitals in the city of Yaoundé. Included were all consenting patients aged at least 40 years with an established diagnosis of AMD both clinically and by imaging. The data were analyzed with CSPro software version 7.0. Chi² and Student's "t" tests in univariate mode and logistic regression in multivariate mode were used with a significance of P≤5%.

RESULTS

Of the 9,989 patients who were seen during the 16-month study period, 38 met our inclusion criteria - a frequency of 0.4%. The sex ratio was 0.3, and the mean age was 68±11 years. As a function of geographic origin, AMD is more common in patients from the forest and mountain areas. The systemic comorbidities associated recorded were hypertension (47.4%) and diabetes (21.1%). After optical correction, 60 of 76 eyes (78.9%) had useful visual acuity according to WHO criteria, and the rate of blindness was 9.2%. Fundus examination revealed fewer lesions than optical coherence tomography, which demonstrated miliary drusen in 57 (75%) eyes, serous drusen in 27 (35.5%), retinal atrophy in 19 (25%) and neovascularization in 3 (3.9%). The clinical forms were dominated by age-related maculopathy, found in 45 eyes (69.2%), followed by atrophic AMD in 17 (26.2%) and finally by exudative AMD in 3 (4.6%), for a total of 65 out of 76 eyes. Age was related to the risk of MLA and atrophic AMD (P≤0.05).

CONCLUSION

AMD is an uncommon pathology in our setting, predominant in women over the age of 60 years.

[Retinal manifestations of neuro-malaria or "malarial retinopathy" in Yaoundé]

AIM

Contribute to the improvement of diagnostic and prognostic approaches to treating children with neuro-malaria in Yaoundé.

PATIENTS AND METHOD

A prospective and analytical study carried out in 2 hospitals of Yaoundé from October 2015 to March 2016. All patients aged 3 months to 15 years hospitalized for neuro-malaria in one of the 2 hospitals benefited from a fundus examination. The variables studied were: age, sex, Glasgow or Blantyre score, fundus examination and parasitaemia. For statistical analysis, we used the software R 3.3.0, Chi², exact of Fisher or Kolmogorov-Smirnov tests with a significance P<5%.

RESULTS

Out of the 178 children hospitalized during the study period, 44 had neuro-malaria (24.71%) and 26 (46 diseased eyes) among them presented retinal lesions at a frequency of 14.60%. The mean age was 5.54±3.49 years with a sex ratio of 1.09. The under 5-years-old were the most affected with 31 (70.45%) cases. The fundus lesions of 26 (59.09%) were retinal hemorrhages in 24 (54.54%), retinal whitening and vessel discoloration in 8 (18.18%) respectively. Papillary edema was associated in 4 (9.09%). Macular involvement was noted in 9 cases. These lesions were correlated with age, depth of coma, duration, and clinical course. The rate of parasitaemia did not affect their occurrence.

CONCLUSION

Retinal lesions are frequent and serious during neuro-malaria in our environment, especially in children under five. They must therefore be an emphasis in the systematic exam to rule it out for a better prognostic evaluation and a fast and adequate multidisciplinary management.

Targeting Serotonin 2A and Adrenergic α1 Receptors for Ocular Antihypertensive Agents: Discovery of 3,4-Dihydropyrazino[1,2-b]indazol-1(2H)-one Derivatives

Glaucoma affects millions of people worldwide and causes optic nerve damage and blindness. The elevation of the intraocular pressure (IOP) is the main risk factor associated with this pathology, and decreasing IOP is the key therapeutic target of current pharmacological treatments. As potential ocular hypotensive agents, we studied compounds that act on two receptors (serotonin 2A and adrenergic α₁ ) linked to the regulation of aqueous humour dynamics. Herein we describe the design, synthesis, and pharmacological profiling of a series of novel bicyclic and tricyclic N2-alkyl-indazole-amide derivatives. This study identified a 3,4-dihydropyrazino[1,2-b]indazol-1(2H)-one derivative with potent serotonin 2A receptor antagonism, >100-fold selectivity over other serotonin subtype receptors, and high affinity for the α₁ receptor. Moreover, upon local administration, this compound showed superior ocular hypotensive action in vivo relative to the clinically used reference compound timolol.

[Characteristics of post-traumatic blindness at the Yaoundé Army Training, Application and Referral Hospital]

PURPOSE

To study the characteristics of blindness after ocular trauma.

METHODOLOGY

In this retrospective descriptive study, we considered the files of patients who had consulted the service for ocular trauma between January 2008 and December 2014. Included were patients of both sexes and all ages whose monocular or binocular vision with best optical correction was strictly below 1/20. Statistical analysis was performed with EPI Info version 3.5.4 software, and the Chi² test was used with statistically significant values of P≤0.05.

RESULTS

Over the period from 2008 to 2014, we found 100 cases of blindness (101 eyes) resulting from 591 cases of ocular trauma, for a frequency of 16.92 %. Among them, 75 men with a median age of 35.5±19.8 years. Children younger than 15 years accounted for 11 % of the series. The blindness was monocular in 99 % and binocular in 1 %, distributed as follows: 55 cases (55 %) category V, 27 (27 %) category IV and 18 (18 %) category III according to the CIM-10. In the anterior segment, cataract was responsible for category III and IV blindness, while in the posterior segment, retinal detachment was found in all categories. In all age ranges irrespective of sex, category V blindness was most frequent.

CONCLUSION

Blindness following ocular trauma is frequent in our context. It can be avoided. Consequently, it is essential to put in place strategies for prevention of ocular trauma via education of the population through public awareness campaigns.

[Epidemiological and clinical aspects of tropical endemic limbo-conjunctivitis in students in Yaoundé]

INTRODUCTION

TELC, tropical endemic limbo-conjunctivitis, is a keratoconjunctivitis seen more frequently in dry intertropical settings than humid ones. We aim to determine the epidemiologic and clinical profile of this condition in a city with a humid equatorial climate.

PATIENTS AND METHODS

During first third of 2014, we conducted a cross-sectional descriptive study in schools. Included were children aged 3-15 years who received parental consent. The selection was conducted in two steps. After an initial examination of children within the schools, the diagnosis was then confirmed by a complete ophthalmologic examination carried out in the hospital. For ethical clearance, the study received all necessary authorizations. The data were analyzed using the CSPro version 4.0 software in French and the comparison test used was χ² with a confidence limit of 95 %.

RESULTS

Out of 353 students examined, 129 were referred to the Yaoundé central hospital, among which 82 (23.2 %) were confirmed with TELC. The median age of the children diagnosed with TELC was 8.24+0.6 years. Boys (57.3 %) were affected more than girls. The age range of 6-12 years (64.6 %) was the most represented. A recrudescence of the attacks was observed during the dry season (93 %) of cases. Dust (49 %) and sun exposure (43 %) were aggravating factors.

CONCLUSION

The prevalence of TELC observed in school in this study is significant.

(+)-Podocarpic Acid as Chiral Template in the Synthesis of Aphidicolane, Stemodane and Stemarane Diterpenoids †

In this review the synthetic work in the field of aphidicolane, stemodane and stemarane diterpenoids, in which readily available (+)-podocarpic acid (4) was used as chiral template for the construction of their polycyclic structures, is described as it developed along the years. In the frame of this work (+)-podocarpic acid (4) was a very useful tool in a model study leading to the syntheses of tetracyclic ketones 7 and 8, models of key intermediates 5a and 6 in the syntheses of (+)-aphidicolin (1) and (+)-stemodin (2a), respectively. (+)-Podocarpic acid (4) was also converted into (+)-2-deoxystemodinone (2d), allowing confirmation of the stemodane diterpenoids absolute configuration, into (+)-aphidicol-15-ene (36) and into Stemodia chilensis tetracyclic diterpenoid (+)-19-acetoxystemodan-12-ol (2f), allowing confirmation of its structure. (+)-Podocarpic acid (4) was then extensively used in the work which led to the synthesis of (+)-stemar-13-ene (57) and (+)-18-deoxystemarin (3b). Finally, (+)-4 was converted into (+)-2-deoxyoryzalexin S (66), which made it possible to demonstrate that the structure of (+)-66 could not be attributed to a Chilean Calceolaria isolated diterpenoid to which this structure had been assigned.

Proof of the Structure of the Stemodia chilensis Tetracyclic Diterpenoid (+)-19-Acetoxystemodan-12-ol by Synthesis from (+)-Podocarpic Acid: X-ray Structure Determination of a Key Intermediate

The first synthesis of (+)-19-acetoxystemodan-12-ol (1), a stemodane diterpenoid isolated from Stemodia chilensis, is described. The structure was supported by an X-ray crystallographic analysis of intermediate (+)-9a, which confirmed the proposed structure and excluded the structure of (-)-19-hydroxystemod-12-ene as a possible candidate for the Chilean Calceolaria diterpenoid to which the (-)-19-hydroxystemar-13-ene structure (9b) had been erroneously assigned.

Kinetics and mechanistic study of competitive inhibition of thymidine phosphorylase by 5-fluoruracil derivatives

In a previous investigation, cationic liposomes formulated with new 5-FU derivatives, differing for the length of the polyoxyethylenic spacer that links the N(3) position of 5-FU to an alkyl chain of 12 carbon atoms, showed a higher cytotoxicity compared to free 5-FU, the cytotoxic effect being directly related to the length of the spacer. To better understand the correlation of the spacer length with toxicity, we carried out initial rate studies to determine inhibition, equilibrium and kinetic constants (KI, KM, kcat), and get inside inhibition activity of the 5-FU derivatives and their mechanism of action, a crucial information to design structural variations for improving the anticancer activity. The experimental investigation was supported by docking simulations based on the X-ray structure of thymidine phosphorylase (TP) from Escherichia coli complexed with 3'-azido-2'-fluoro-dideoxyuridin. Theoretical and experimental results showed that all the derivatives exert the same inhibition activity of 5-FU either as monomer and when embedded in lipid bilayer.

Regio- and diastereoselective synthesis and X-ray structure determination of (+)-2-deoxyoryzalexin S from (+)-podocarpic acid. Structural nonidentity with its nominal natural isolated enantiomer

(+)-2-Deoxyoryzalexin S (1), the nominal enantiomer of a diterpenoid isolated in Chile from Calceolaria species, was regio- and diastereoselectively synthesized from (+)-podocarpic acid. (+)-2-Deoxyoryzalexin S (1) was characterized also as its acetyl derivative, (+)-2, whose structure was confirmed by X-ray crystallographic analysis. Surprisingly, comparison of the data recorded for (+)-1 and (+)-2 and those reported in the literature for the Calceolaria isolated diterpenoid 1 and its derivative (-)-2 showed some differences, suggesting that the latter do not possess the proposed structures.

[Keratouveitis and lens opacity caused by butterfly hair]

Butterfly hair is known to cause eye injury. In Africa, incriminated butterflies are Hylesia (spp). We report a case of a sub-epithelial keratitis associated with anterior uveitis following a trauma by a butterfly that was complicated by late lens opacity due to butterfly hair. Ocular lesions caused by butterfly hair are rare, but require an urgent management to prevent late and severe complications due to intraocular migration of the hairs.

Diastereoselective total synthesis of (+)-13-stemarene by fourth generation methods: a formal total synthesis of (+)-18-deoxystemarin

The problem of constructing diastereoselectively the C/D ring system of stemarane diterpenes from a bicyclo[2.2.2]octane intermediate was solved resulting in very simple synthesis of (+)-13-stemarene 1. The obtaining of the latter represents also a formal synthesis of (+)-18-deoxystemarin 2. In the key step, the epimeric mixture 10, dissolved in toluene, was converted by the action of TsOH into (+)-stemar-13-en-15-one 28.

In vivo (19)F MRI and (19)F MRS of (19)F-labelled boronophenylalanine-fructose complex on a C6 rat glioma model to optimize boron neutron capture therapy (BNCT)

Boron neutron capture therapy (BNCT) is a promising binary modality used to treat malignant brain gliomas. To optimize BNCT effectiveness a non-invasive method is needed to monitor the spatial distribution of BNCT carriers in order to estimate the optimal timing for neutron irradiation. In this study, in vivo spatial distribution mapping and pharmacokinetics evaluation of the (19)F-labelled boronophenylalanine (BPA) were performed using (19)F magnetic resonance imaging ((19)F MRI) and (19)F magnetic resonance spectroscopy ((19)F MRS). Characteristic uptake of (19)F-BPA in C6 glioma showed a maximum at 2.5 h after compound infusion as confirmed by both (19)F images and (19)F spectra acquired on blood samples collected at different times after infusion. This study shows the ability of (19)F MRI to selectively map the bio-distribution of (19)F-BPA in a C6 rat glioma model, as well as providing a useful method to perform pharmacokinetics of BNCT carriers.

Design, synthesis and applications of hyaluronic acid-paclitaxel bioconjugates

Paclitaxel (1a), a well known antitumor agent adopted mainly for the treatment of breast and ovarian cancer, suffers from significant disadvantages such as low solubility, certain toxicity and specific drug-resistance of some tumor cells. To overcome these problems extensive research has been carried out. Among the various proposed strategies, the conjugation of paclitaxel (1a) to a biocompatible polymer, such as hyaluronic acid (HA, 2), has also been considered. Coupling a bioactive compound to a biocompatible polymer offers, in general, many advantages such as better drug solubilization, better stabilization, specific localization and controlled release. Hereafter the design, synthesis and applications of hyaluronic acid-paclitaxel bioconjugates are reviewed. An overview of HA-paclitaxel combinations is also given.

Spectroscopic characterization of 6-hydroxy and 1-methyl-6-hydroxybicyclo[2.2.2]octan-2-one ethylene acetals and ethylene dithioacetals

6-endo- and 6-exo-Hydroxybicyclo[2.2.2]octan-2-one and 1-methyl-6-endo- and 6-exo-hydroxybicyclo[2.2.2]octan-2-one ethylene acetals and ethylene dithioacetals 1-4 have been characterized by 1D and 2D NMR methods.

[Ocular complications of HIV/AIDS in Cameroon: is there is any correlation with the level of CD4 lymphocytes count?]

PURPOSE

This study aimed to identify the ocular complications of HIV/AIDS in Cameroon and to determine if there is any correlation between their occurrence and the level of CD4 lymphocytes count.

MATERIAL AND METHODS

This prospective study was carried out at the General Hospital, Douala, from October 2004 to September 2005. All HIV positive patients with known CD4 count were retained for the study. Each patient had an exhaustive ocular examination.

RESULTS

A total of 57 patients including 30 females (52.9%) and 27 males (47.4%) were examined. The mean age was 38.9 years +/- 10.3. The eye examination was pathological in 36 patients (63.2%) and normal in 21 patients (36.8%). An ocular complaint was the inaugural manifestation of the disease in 31.6% of patients. The principal lesions of the anterior segment were herpetic keratitis (10.5%) and herpes zoster ophthalmicus (12.3%). The most common posterior segment lesions were cytomegalovirus retinitis (14%) and uveitis (15.8%). The mean CD4 count in our series was 118.3/mm3 +/- 106.7. 91.7% of patients with ocular complications have a CD4 count of less than 200/mm3. A non linear correlation was found between the CD4 level and the occurrence of ocular complications.

CONCLUSION

With the improvement of access to antiretroviral treatment, the ocular complications of HIV/AIDS are more common. The role of the ophthalmologist is therefore essential in the diagnosis and management of these patients.

Multi-nuclear MRS and 19F MRI of 19F-labelled and 10B-enriched p-boronophenylalanine-fructose complex to optimize boron neutron capture therapy: phantom studies at high magnetic fields

Reaction yield optimization for the synthesis and the complexation of a boron neutron capture therapy agent (19)F-labelled, (10)B-enriched p-boronophenylalanine-fructose ((19)F-BPA-fr) complex was obtained. (1)H, (19)F, (13)C and (10)B magnetic resonance spectroscopy (MRS) of the (19)F-BPA-fr complex in aqueous and rat blood solution phantoms and its spatial distribution mapping using (19)F magnetic resonance imaging (MRI) results are reported. 7 T and 9.4 T magnetic fields were used to perform MRI and MRS respectively. Our in vitro results suggest that in vivo studies on (19)F-BPA through (19)F NMR will be feasible.