INTRODUCTION: geriatric syndromes are multfifactorial conditions that are associated with substantial disability, poor quality of life and mortality in the elderly. The patterns of these conditions are poorly described in sub-Saharan Africa. This study aimed to determine the prevalence and correlates of common geriatric syndromes in Cameroon. METHODS: we conducted a cross-sectional study in the Geriatrics Unit of a university hospital in Cameroon. All people aged ≥55 who attended a health promotion and screening campaign on September 2019 were included. Geriatric syndromes including functional decline, cognitive impairment and sarcopenia were assessed. We also examined sociodemographic characteristics and comorbidities. RESULTS: overall, 104 participants were enrolled with median age of 65 (IQR: 62.2 - 70.8). About 67% of participants presented at least one geriatric syndrome. Disability in activities of daily living and instrumental activities of daily living were present in 10% and 38% of participants respectively and associated factors were male gender (OR 4.7, p=0.005), age 75 and above (OR 5.7, p= 0.027), osteoarthritis (OR 3.3, p=0.055) and polypharmacy (OR 7.7, p=0.012). Sarcopenia occurs in 26% with female gender (OR 3.1, p=0.029) and SARC-F ≥4 (OR 4.9, p=0.002) as associated factors. Cognitive impairment was present in 20% of participants and associated with illiteracy (p=0.008). CONCLUSION: our study shows a high prevalence of geriatric syndomes in older adults in an urban area. Geriatric principles and frailty awarness should be considered in clinical care of older adults in our setting.

Background: Immune checkpoint inhibition with anti-PD(L)1 and anti-CTLA4 antibodies has significantly changed cancer treatment during the last 10 years. Nevertheless, boosting the immune system with immune checkpoint inhibition can result in immune-related adverse events, affecting different organ systems, among which the endocrine system is the most affected. However, there are few descriptions of the association of immune-related adverse events, and the pathophysiology of some is still lacking. Case summary: Here, we report a 70-year-old Caucasian patient treated with nivolumab (anti-PD1 monoclonal antibody) after resection of a unique relapse of melanoma in the neck region who presented with sicca syndrome, extreme fatigue, and weight loss 6 months after the start of anti-PD1 therapy. Blood tests revealed hypoglycemia and secondary hypocortisolism due to isolated adrenocorticotrophic hormone deficiency. Interestingly, brain methionine positron emission tomography/magnetic resonance revealed physiological metabolism of the pituitary gland, which was not increased in size, and no hypophyseal metastasis was detected. The sicca syndrome investigation revealed the absence of anti-SSA/SSB antibodies, while the labial salivary gland biopsy showed lymphoplasmatocytic infiltrates with a focus score of 1. To provide new insights into the physiopathology of the anti-PD1-related sialadenitis, we investigated the distribution of aquaporins 5 by immunostaining on the labial salivary gland acini, and compared this distribution with the one expressed in the primary Sjögren’s syndrome. Contrary to patients with primary Sjögren’s syndrome (in whom aquaporins 5 is mainly expressed at the basolateral side), but similar to the patients with no sialadenitis, we observed expression of aquaporins 5 at the apical pole. This new finding deserves to be confirmed in other patients with anti-PD1-related sialadenitis. Owing to these immune-related adverse events, anti-PD1 was stopped; nevertheless, the patient developed a new relapse 1 year later (March 2020) in the neck region, which was treated by radiotherapy. Since then, no relapse of melanoma was seen (1.5 years after radiotherapy), but the patient still requires hypophyseal replacement therapy. The sialoadenitis resolved partially. Conclusion: We report a combination of sialoadenitis and hypophysitis explaining extreme fatigue in a patient who was treated in the adjuvant setting with anti-PD1 for a melanoma relapse.

Although total confinement has not been adopted by the government of Cameroon, the COVID-19 pandemic is keeping geriatric patients out of hospital, despite a decline in their health status. In addition, the pandemic might have a significant effect on their general well-being. This study aimed to examine the effects of the COVID-19 pandemic on the follow-up and well-being of older outpatients seen at geriatric consultation in Cameroon. We carried out a telephone survey of patients who did not attend an appointment at our geriatrics outpatient clinic on April 2020. Overall, 30 participants were recruited of whom 70% were female (n = 21) with a median age of 74 years (IQR 68.8–85). Most patients (73%, n = 22) did not attend their appointment because of fear of being infected by SARS-CoV-2 at hospital. Approximately 23% (n = 7) of participants reported a decline of their functional status since the last geriatric visit. Loss of appetite and weight loss were both reported in 30% (n = 9) of patients. Half of participants (n = 15) self-rated their health status as bad and three of them died in private health facilities. Strategies to ensure a continuum of care for this vulnerable population during this pandemic are highly needed in our setting.

Adult-onset-Still’s disease is a rare, multi-systemic condition with difficult and delayed diagnosis, characterized by a diversity of signs and symptoms related to hyperactivation of macrophages and neutrophils. Although diagnosis in the classical form is easily realized, there are atypical presentations that can be challenging, particularly in the absence of diagnostic means. We report the case of a 28-year-old single African woman who had been experiencing prolonged fever and diffuse inflammatory joint pain for months, and who had manifested odynophagia and a fleeting, salmon-pink skin rash in her upper limbs, in whom, after thorough evaluation, the diagnosis of adult-onset-Still’s disease was made. This was based on the various symptoms presented by the patient, a positive acute phase reactant with elevation of C-reactive protein, erythrocyte sedimentation rate, and high serum ferritin with a low percentage of glycosylated ferritin (< 20%), an absence autoimmunity markers and comorbidities, and confirmed by both Fautrel and Yamaguchi diagnostic criteria, within the month following admission after excluding all differential diagnoses. Adult-onset-Still’s disease is a rare pathology considered as a diagnosis of exclusion, which should be considered in the face of any fever of unknown origin. It is present in young adults over 16 years old, with an average peak at diagnosis of 38–39 years old and a sex ratio of 2:1 (female:male), with a female predominance of the disease. Rapid diagnosis and appropriate management with steroids, biologics and immunosuppressants are the keys to a favorable prognosis for this condition.

Objectives: With the ongoing epidemiological transition in sub-Saharan Africa (SSA), conditions that require invasive treatment (surgery, cancer, and anaesthesia, etc.) will become increasingly common. Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic process aimed at identifying older people at risk of negative outcomes. It is important to know whether this approach integrates care management strategies for older people in a context where health services for older people are scarce, and staff members have little training in geriatrics. The current work is a situational analysis on the use of CGA on invasive care (cancer, surgery, etc.) among older people in SSA. Methods: We searched PubMed-MEDLINE and other sources for studies reporting on CGA and conditions requiring invasive treatment in older patients in SSA. Results/Conclusions: We found no study that had comprehensively examined CGA and invasive care in SSA. There is, however, evidence that the offer of invasive care to older people has improved in SSA. Further research is needed to explore the applicability of CGA in SSA. Similarly, more investigations are needed on the role of CGA in the care trajectories of older people in SSA, in terms of outcomes and affordability.