Initiating the first rheumatic heart disease clinic in Cameroon: A descriptive study.

Background and Aim: Rheumatic heart disease (RHD) is a significant cause of heart failure in sub-Saharan Africa. The causes of death from RHD are multiple, many of which can be prevented with appropriate follow-up of patients and effective secondary prophylaxis. An RHD Clinic was initiated to attempt a solution in Yaoundé, Cameroon. Over 6 months, its impact was evaluated. Methods: Two echocardiography registers were accessed, and patients diagnosed with RHD between 2005 and 2018 were contacted. Consenting carers and patients pioneered the first RHD Clinic. Activities of the clinic comprised health education, medical visits, and benzylpenicillin G (BPG) injections. Text messages and phone calls were used to remind patients of their monthly appointments. Results: Out of 1200 first-time cardiac ethnographies, 70 patients (5.83%) had been diagnosed with RHD. The case fatality rate of RHD was 16.67%. Twenty-three patients were successfully registered and followed-up by the clinic, 70% of whom were female. The age range was 4-22 years. Fifty-three percent had an NYHA score of 2 or more at the time of admission into the clinic. There was an increase in adherence to secondary prophylaxis with BPG from 42.9% at baseline to 87%-95% in the last 3 months. Conclusion: Our short experience running an RHD Clinic was marked by increased treatment adherence among persons living with RHC.

Stroke and its correlates among patients on maintenance hemodialysis in Cameroon.

BACKGROUND: End-stage kidney disease is an independent risk factor for stroke; however, the relationship between hemodialysis and stroke in Sub-Saharan Africa has not been established. OBJECTIVE: To evaluate the incidence, associated factors, and clinical outcome of stroke among patients undergoing maintenance hemodialysis in Cameroon. METHODS: A hospital-based retrospective study using data from the medical files of 1060 patients on maintenance hemodialysis (given twice a week) was conducted. Patients with stroke prior to starting hemodialysis were excluded. Socio-demographic data, comorbidities, dialysis parameters, and data concerning the diagnosis of stroke were retrieved and analyzed. RESULTS: The dialysis vintage (duration of time on dialysis) averaged 11.4 ± 9.2 months. The incidence of stroke was 6.1 events per 1000 patient-years, with hemorrhagic stroke being most common (66%). Eighty percent of strokes occurred before the 30th month of dialysis. Sixty percent of strokes occurred within 24 h of a dialysis session. Predictive factors for stroke were diabetes mellitus (p = 0.026), heart failure (p = 0.045), poor dialysis compliance (p = 0.001), and short vintage (p = 0.001). The overall mortality rate was 52% and was higher for hemorrhagic stroke (60%). The leading causes of death were multiple organ failure and sepsis. CONCLUSION: The incidence of stroke is high among hemodialysis patients in Cameroon and hemorrhagic stroke is the commonest type. Diabetes and heart failure triple the risk of stroke. Mortality in patients who suffered a stroke was high.

Real-World Effectiveness and Safety of Two-Drug Single Pill Combinations of Antihypertensive Medications for Blood Pressure Management: A Follow-Up on Daily Cardiology Practice in Douala, Cameroon.

INTRODUCTION: Hypertension is the leading cause of morbidity and mortality in sub-Saharan Africa (SSA). Current guidelines recommend using two or more antihypertensive agents in single pill combinations (SPCs) to treat hypertension, but data from African patients that support these recommendations are lacking. We assessed the effectiveness and tolerance of three SPCs in lowering blood pressure (BP) amongst hypertensive patients in Douala. METHOD: All patients included in the hypertension registry of the Douala General Hospital and the Douala Cardiovascular Center between January 2010 and May 2020, and receiving a two-drug SPCs (renin-angiotensin system inhibitors (RAASi) + diuretics (DIU), calcium channel blockers (CCB) + RAASi, or DIU + CCB) were tracked from baseline through 16 weeks. Our primary outcome was a decrease in systolic BP (SBP) from baseline up to 16 weeks after initiation of treatment. A mixed linear repeated model was used to evaluate the change of SBP from baseline to week 16, while controlling for age, gender, and baseline SBP. Statistical significance was set at p < 0.05. RESULTS: Of 377 participants on two-drug SPCs, 123 were on CCB + DIU, 96 on RAASi + CCB, and 158 on RAASi + DIU. The mean age was 54.6 (± 11.2) years. At baseline, participants on RAASi + CCB presented with slightly higher SBP compared to the other two groups. Overall, the SBP decreased by 34.3 (± 14.2) mmHg from baseline values and this was comparable across the three groups of SPCs (p = 0.118). The control rate after 16 weeks of follow-up was 62.3% with no significant difference between groups. The occurrence of adverse events was 3.4% and was comparable among the three groups. CONCLUSION: The three two-drug SPCs were highly effective in reducing and controlling BP with low and similar rates of adverse effects. Long-term data documenting safety and whether these agents exert a differential cardiovascular effect in addition to and independent of their BP-lowering effect are needed for SSA populations.

A case report of Trichinella spiralis pericarditis: an unusual cause of pericardial effusion and cardiac tamponade in an immunocompetent urban black African.

Background: Cardiac trichinellosis is unusual and it is associated with high mortality. We report a case of Trichinella pericarditis complicated by a large pericardial effusion and cardiac tamponade in a setting where the aetiologic diagnosis of pericardial disease is challenging. Case summary: A 27-year-old immune-competent male patient from Cameroon consulted for pleuritic chest pain associated with fever, dry cough, and gradually worsening dyspnoea on exertion of 1-month duration. Upon admission, his blood pressure was 100/73 mmHg, the heart rate was 130/min. The clinical examination revealed a pericardial friction rub, jugular venous distension, and tender hepatomegaly. There was no lower extremity oedema. The diagnosis of pericarditis was made. A two-dimensional transthoracic echocardiogram performed showed a moderate fibrinous circumferential pericardial effusion with echocardiographic signs of tamponade. Pericardiocentesis was performed and analysis of the fluid revealed multiple, motile, roundworms which were identified as Trichinella spiralis, a nematode parasite. There was no eosinophilia on complete blood count. He was treated with Albendazole 800 mg daily per os. His clinical condition improved with resolution of the symptoms and a reduction in the size of the pericardial effusion. Discussion: Trichinella spiralis is a rare cause of pericarditis which can be life-threatening. With the existing challenges in diagnosing the aetiology of pericardial disease in African resource-limited setting, the diagnosis can be missed leading to fatal outcomes.

Survival rate and predictors of 36-month mortality in patients with heart failure in Sub Saharan Africa: insights from the Douala Heart Failure Registry (Do-HF).

Background: Heart failure (HF) is a growing public health concern with a high mortality rate in sub-Saharan Africa. However, few studies have reported the long-term predictors of mortality in this region. This study sought to determine the 3-year mortality rate and the predictors of mortality amongst HF patients in Douala, Cameroon. Methods: We conducted a prospective analysis on patients recruited in the Douala Heart Failure (Do-HF) registry, an ongoing prospective data collection on patients with HF at four cardiology units in Douala, Cameroon. Patients included were followed for 36 months from the index date of inclusion, with all-cause mortality as the primary outcome. Cox proportional hazard regression models were used to determine predictors of mortality. Results: Out of the 347 participants included, 318 (91.6%) completed follow-up. The mean age was 64±14 years, 172 (49.6%) were men. Hypertensive cardiomyopathy and dilated cardiomyopathy were the most frequent causes of heart failure. The median follow-up was 33 months, and 150 (47.2%) patients died. Independent predictors of mortality included New York Heart Association functional class III & IV (aHR 2.23; 95% CI: 1.49-3.33; P<0.001), presence of pulmonary rales (aHR 1.87; 95% CI: 1.30-2.68; P=0.005), chronic kidney disease (aHR 2.92; 95% CI: 1.79-4.78; P<0.001), enrolment as inpatient (aHR1.96; 95% CI: 1.17-2.54; P=0.005), no formal education (aHR 2.06; 95% CI: 1.28-3.33; P=0.003), and a monthly income of at most three minimum wage (aHR 2.06; 95% CI: 1.28-3.33; P=0.003). Conclusions: This study shows that almost half of HF patients die after 36 months of follow-up. Also, late presentation and poverty-related conditions were associated with poor outcomes. These findings suggest prioritizing preventive strategies that target early diagnosis and socioeconomic status to improve the prognosis of HF.

Gender Differences in Cardiovascular Risk Factors, Clinical Presentation, and Outcome of Patients Admitted with a Hypertensive Crisis at the Buea Regional Hospital, Cameroon.

Background: Several recent studies have shown differences in the risk profile and outcome of cardiovascular diseases between men and women, with a dearth of data from African populations. This study aimed to examine gender differences in a group of patients from Cameroon hospitalized with a hypertensive crisis. Methods: We conducted a cross-sectional study from June 2018 until June 2019. The criteria to define a hypertensive crisis (HC) were systolic and/or diastolic blood pressure should be ≥180/110 mmHg. We compared the clinical presentation and outcome of males versus females. Results: Out of the 1536 patients admitted, 95 (6.2%) had an HC. There were 49 (51.6%) men. There was no significant age difference between men and women (52.7 years vs. 49.3 years, p = 0.28). Alcohol consumption (p < 0.0001), previous stroke (p = 0.04), and smoking (p = 0.03) were significantly higher in men compared to women. Men had a higher proportion of psychomotor agitation (p = 0.05). There was an equal proportion of men and women with hypertensive emergencies. Although acute left ventricular failure was most frequent in women (46.4% vs 42.9%), cerebral infarction (14.3% vs 17.9%), and acute coronary syndrome (0% vs 7.1%) were higher in men, the differences were not statistically significant (all p > 0.05). Case fatality was also higher in men compared to women but the difference was not statistically significant. Conclusions: Men admitted for an HC had a significantly higher cardiovascular risk burden and higher psychomotor agitation. However, there were no significant differences in the types of hypertensive emergencies and outcomes between men and women.

Tricuspid valve infective endocarditis in a patient with psoas abscess complicated by septic pulmonary emboli and severe tricuspid regurgitation in Cameroon: challenges in the diagnosis and management in a resource limited setting (a case report).

Infective endocarditis of the tricuspid valve is rare in non-intra-venous drug abusers. Few cases of psoas abscess complicated by tricuspid infective endocarditis have been reported. A 61-year-old man underwent a laminectomy. Three weeks later he developed persistent fever, abdominal pain, back pain and hip pain, weight loss, gradually and abdominal distension. Abdomino-thoracic computed tomographic scan showed a left psoas muscle abscess and cavitary pulmonary lesions suggestive of septic pulmonary emboli. Two dimensional transthoracic echocardiography showed an oscillating mass on the anterior leaflet of the tricuspid valve compatible with a vegetation. There was severe tricuspid regurgitation with right atrial and right ventricular dilatation. Secondary psoas abscess though rare is an important cause of bacteremia and there is a potential of bacteremia progressing to serious systemic infection like tricuspid endocarditis which can be fatal without prompt and appropriate treatment.

Prolapsing left atrial mass causing severe pulmonary hypertension in a new cardiac service in a rural hospital in Cameroon: a case report.

We report a case of a left atrial mass in a 62-year-old patient with no relevant past history. He presented with dyspnea of 1 year duration. Clinical examination revealed a blood pressure of 130/82mmHg, a heart rate of 80 beats per minute. The heart sounds S1 and S2 were normal with no added sounds. Electrocardiogram showed a normal sinus rhythm at 78 beats per minute with premature ventricular contractions. Two dimensional echocardiography revealed a large mobile mass attached to the interatrial septum occupying the most of the left atrium and prolapsing into the left ventricle during diastole. There was dilatation of the right atrium and right ventricle with elevated pulmonary artery systolic pressure (85mmHg). The mean transmitral pressure gradient was 5.5mmHg. The mass was compatible with a myxoma. The patient was sent for surgical resection of the mass but this could not be performed due to financial constraints.

Prevalence, correlates and in-hospital outcomes of kidney dysfunction in hospitalized patients with heart failure in Buea-Cameroon.

BACKGROUND: Kidney dysfunction is common in patients with heart failure (HF) and has been associated with poor outcomes. This study aimed to determine the prevalence, correlates, and prognosis of kidney dysfunction in patients with HF in Cameroon, an understudied population. METHODS: We conducted a cross-sectional study in consecutive patients hospitalized with HF between June 2016 and November 2017 in the Buea Regional Hospital, Cameroon. Kidney dysfunction was defined as an estimated glomerular filtration rate < 60 ml/min/1.73m2. Prognostic outcomes included death and prolonged hospital stay (> 7 days). We also performed a sensitivity analysis excluding racial considerations. RESULTS: Seventy four patients (86.1% of those eligible) were included. Their median age was 60 (interquartile range: 44-72) years and 46.0% (n = 34) were males. Half of patients (n = 37) had kidney dysfunction. Correlates of kidney dysfunction included previous diagnosis of HF (adjusted odds ratio [aOR]4.3, 95% CI: 1.1-17.5) and left ventricular hypertrophy (aOR3.4, 95% CI: 1.1-9.9). Thirty-six (48.9%) had prolonged hospital stay, and seven (9.5%) patients died in hospital. Kidney dysfunction was not associated with in-hospital death (aOR 0.4, 95% CI: 0.1-2) nor prolonged hospital stay (aOR 2.04, 0.8-5.3). In sensitivity analysis (excluding racial consideration), factors associated with Kidney dysfunction in HF were; anemia (aOR: 3.0, 95% CI: 1.1-8.5), chronic heart failure (aOR: 4.7, 95% CI: 0.9-24.6), heart rate on admission < 90 bpm (aOR: 3.4, 95% CI: 1.1-9.1), left atrial dilation (aOR: 3.2, 95% CI: 1.04-10), and hypertensive heart disease (aOR: 3.1, 95% CI: 1.2-8.4). Kidney dysfunction in HF was associated with hospital stay > 7 days (OR: 2.6, 95% CI: 1-6.8). CONCLUSION: Moderate-to-severe kidney dysfunction was seen in half of the patients hospitalized with HF in our setting, and this was associated with a previous diagnosis of HF and left ventricular hypertrophy. Kidney dysfunction might not be the main driver of poor HF outcomes in this population. In sensitivity analysis, this was associated with anemia, chronic heart failure, heart rate on admission less than 90 bpm, left atrial dilatation, and hypertensive heart disease. Kidney dysfunction was associated with hospital stay > 7 days.

Pulmonary hypertension among patients hospitalized with acute heart failure in Buea, South West Region of Cameroon.

Introduction: pulmonary hypertension (PH) is a common and severe complication in patients with heart failure (HF). It is associated with increased morbidity and mortality. There is limited data in Cameroon on the prevalence of PH in hospitalized HF patients and its impact on outcome. Methods: we analyzed data from consecutive adult patients hospitalized with. Pulmonary hypertension (PH) was defined as pulmonary artery systolic pressure (PASP) ≥ 35mmHg. Results: eighty-six (86) consecutive patients were hospitalized and 66(76.7%) had measurable PASP on echocardiography. Of those with echocardiographically measurable PASP (66), there were 39 (59.1%) females. The median (IQR) age was 60 (42-76) years. The prevalence of PH was 93.9%. PH was present in all (100%) patients with right heart failure (RHF) and in 62 (93.9%) patients with left heart failure (LHF). Severe PH (PASP ≥55 mmHg) was seen in 45 (68.2%, [95% CI: 55.6-75.1]) patients. The mean PASP was significantly higher in those with isolated RHF compared with those who had isolated left or bi-ventricular failure. Factors likely associated with moderate-to-severe PH (PASP ≥ 45 mmHg) were female sex, RHF, and right atrial dilatation. After adjusting for sex, right atrial dilation was independently associated with moderate-to-severe PH. In-hospital death occurred in 7 (10.6%, [95% CI: 4.4-20.6]) patients. The median (IQR) time to death was 6 (3-7) days and ranged from 2 to 8 days. All deaths (100%) occurred in those with moderate-to-severe PH. Conclusion: the prevalence of pulmonary hypertension in hospitalized heart failure patients was high with two third of the patients having severe PH, and most commonly occurred in females. All deaths occurred in patients with moderate-to-severe PH.

Large hemorrhagic pericardial effusion with cardiac tamponade in a 16-year-old adolescent in an endemic area of tuberculosis: a case report.

Pericardial effusion complicated by cardiac tamponade is a medical emergency. Large pericardial effusion and tamponade are rare in childhood. Tuberculosis remains a major cause of pericardial effusion in endemic areas. A 16-year-old adolescent with no significant past history was admitted to the medical unit of the Buea Regional hospital in the South West region of Cameroon for heart failure after presenting with abdominal distension, shortness of breath and fever of two weeks duration. Echocardiographic study during admission revealed a large pericardial effusion (27mm in thickness) with echocardiographic signs of tamponade. Echocardiographic guided pericardiocentesis was performed through a sub-xiphoid route and about 500 cc of heavily stained blood fluid that was not coagulating was drained. Pericardial fluid analysis for acid fast bacilli was negative. There was no evidence of malignancy. A strong suspicion of tuberculosis was made and he was started on anti-tuberculosis medications for presumptive hemorrhagic tuberculous pericarditis. Patient was asymptomatic during follow up and repeat echocardiographic examinations showed no re-accumulation of pericardial fluid. Tuberculosis should be considered as the etiology of pericardial effusion in endemic areas although the identification of mycobacterium is challenging in these settings.

Profile and outcomes of patients admitted with hyperglycemic emergencies in the Buea Regional Hospital in Cameroon.

INTRODUCTION: hyperglycemic emergencies (diabetic ketoacidosis and hyperglycemic hyperosmolar state) are the most common serious acute metabolic complications of diabetes which result in significant morbidity and mortality. There is paucity of data on hyperglycemic emergencies in Cameroon. The objective of this study was to investigate the precipitants and outcomes of patients admitted for hyperglycemic emergencies in the Buea Regional Hospital in the South West Region of Cameroon. METHODS: in this retrospective study the medical records of patients admitted for hyperglycemic emergencies between 2013 and 2016 in the medical unit of the Buea Regional Hospital were reviewed. We extracted data on demographic characteristics, admission clinical characteristics, precipitants, and treatment outcomes. Logistic regression was used to determine predictors of mortality. RESULTS: data were available for 60 patients (51.7% females) admitted for hyperglycemic emergencies. The mean age was 55.2±16.3 (range 18-86). Overall there were 51 (85%) cases of hyperosmolar hyperglycemic state. Twenty six (43.3%) of the patients had hypertension. The most common precipitants of hyperglycemic emergencies were infections (41.7%), newly diagnosed diabetes (33.3%) and non-adherence to medications (33.3%). Mean admission blood glucose was 574mg/dl±70.0mg/dl. The median length of hospital stay was 6 days. Overall case fatality rate was 21.7%. Six (46.2%) deaths were related to infections. Predictors of mortality were a Glasgow coma score <13(p<0.001), a diastolic blood pressure <60 mmHg (p=0.034) and a heart rate >90(0.057) on admission. CONCLUSION: admission for hyperglycemic emergencies in this semi-urban hospital is associated with abnormally high case fatality. Infections, newly diagnosed diabetes and non-adherence to medications are the commonest precipitants of hyperglycemic emergencies. Public health measures to reduce morbidity and mortality from hyperglycemic crisis are urgently needed.

Differences in socio-demographic and risk factor profile, clinical presentation, and outcomes between patients with and without RHD heart failure in Sub-Saharan Africa: results from the THESUS-HF registry.

BACKGROUND: Rheumatic heart disease (RHD) was found in the THESUS-HF registry to be the third most common cause of acute heart failure (AHF) in Sub-Saharan Africa. METHODS: One thousand six patients with AHF from 9 Sub-Saharan African countries were recruited in THESUS-HF, of which 143 (14.3%) had RHD-AHF. Clinical characteristics and outcomes in patients with RHD-AHF and non-RHD-AHF were compared. Kaplan-Meier plots for time to all-cause death and/or HF readmission according to the presence of RHD-AHF and non-RHD-AHF were performed and survival distributions compared using the log-rank test. Cox regression was used to determine the hazard ratio of death to day 180 and death or readmission to day 60 after adjusting for confounders. RESULTS: Patients with RHD-AHF were younger, more often females, had higher rates of atrial fibrillation, had less hypertension, hyperlipidemia and diabetes, had lower BP, and higher pulse rate and better kidney function and echocardiographic higher ejection fraction larger left atria and more diastolic dysfunction. Patients with RHD-AHF had a numerically longer mean stay in the hospital (10.5 vs. 8.8 days) and significantly higher initial hospitalization mortality (9.1% vs. 3.4%). CONCLUSIONS: In conclusion, patients with HF related to RHD were younger, have higher rate of atrial fibrillation and have a worse short-term outcome compared to HF related to other etiologies in Sub-Saharan Africa.

May Measurement Month 2019: an analysis of blood pressure screening results from Cameroon.

The multi-country May Measurement Month (MMM) screening campaign aims to raise awareness on blood pressure (BP) and hypertension in individuals and communities, and measure BP, ideally, of those who had no BP measurement in the preceding year. We here report key findings from the Cameroon arm of MMM 2019. An opportunistic sample of adults (≥18 years) was included from 5 May to 5 June 2019 across 15 sites (markets, churches, homes, motor parks, workplaces, and hospitals/clinics). Data collection, cleaning, the definition of hypertension, and statistical analysis followed the standard protocol. The mean age of the 30 187 participants screened was 36.9 (SD: 14.9) years, 50.4% were female (5% of whom were pregnant), and 94.4% were screened out of the hospital/clinic settings. After multiple imputation of missing data, 6286 (20.8%) had hypertension, 24.0% were taking antihypertensive medication, and 705 (11.2%) of all participants with hypertension had controlled BP. In linear regression models adjusted for age, sex, and antihypertensive medicines use, a previous diagnosis of hypertension, a history of stroke, and use of antihypertensive medicines were significant predictors of systolic and diastolic BP levels. BPs were also significantly higher when measured in public outdoors, public indoors (diastolic BP only), workplaces, and other unspecified areas compared to hospitals/clinic settings. MMM19 is the largest ever BP screening campaign in a single month, in Cameroon and despite the limitations resulting from non-random sample selection, the opportunistic screening allows access to awareness and screening for hypertension out of the hospital/clinic settings.

Resting heart rate predicts all-cause mortality in sub-Saharan African patients with heart failure: a prospective analysis from the Douala Heart failure registry (Do-HF).

BACKGROUND: Higher resting heart rate (HR) is associated with mortality amongst Caucasians with heart failure (HF), but its significance has yet to be established in sub-Saharan Africans in whom HF differs in terms of characteristics and etiologies. We assessed the association of HR with all-cause mortality in patients with HF in sub-Saharan Africa. METHODS: The Douala HF registry (Do-HF) is an ongoing prospective data collection on patients with HF receiving care at four cardiac referral services in Douala, Cameroon. Patients included in this report were followed-up for 12 months from their index admission, for all-cause mortality. We used Cox-regression analysis to study the association of HR with all-cause mortality during follow-up. RESULTS: Of 347 patients included, 343 (98.8%) completed follow-up. The mean age was 64±14 years, 176 (50.7%) were female, and median admission HR was 85 bpm. During a median follow-up of 12 months, 78 (22.7%) patients died. Mortality increased steadily with HR increase and ranged from 12.2% in the lower quartile of HR (≤69 bpm) to 34.1% in the upper quartile of HR (>100 bpm). Hazard ratio of 12-month death per 10 bpm higher HR was 1.16 (1.04-1.29), with consistent effects across most subgroups, but a higher effect in participants with hypertension vs. those without (interaction P=0.044). CONCLUSIONS: HR was independently associated with increased risk of all-cause mortality in this study, particularly among participants with hypertension. The implication of this finding for risk prediction or reduction should be actively investigated.

Epidemiology of hypertensive crisis in the Buea Regional Hospital, Cameroon.

Hypertensive crisis (HC) includes hypertensive urgency (HU) and hypertensive emergency (HE). There is scarcity of data on the epidemiology of patients presenting with HC in Cameroon. The aim of this study was to determine the prevalence, clinical characteristics, and outcome of HU and HE. We conducted a cross-sectional study from June 2018 until June 2019. The criteria to define a hypertensive crisis were systolic and/or diastolic blood pressure ≥180/110 mm Hg. We compared HU vs HE. Out of the 1536 patients admitted, 95(6.2%) had a HC. There were 49(51.6%) men and 56 (58.9%) had a HE. The mean age was 51.1 ± 14.9 years. A history of hypertension was found in 75.3% of the patients but only 24.2% were on treatment. 33.7% consumed alcohol and 24.2% had chronic kidney disease. Headache (34.7%), dyspnea (34.7%), and neurological deficit (23.2%) were the most common symptoms. Patients with HE had higher systolic and diastolic blood pressures though the difference was not significant. The most frequent forms of HE were acute left ventricular failure with pulmonary edema (44.6%), intracerebral hemorrhage (21.4%), and cerebral infarction (16.1%). The most commonly prescribed medication was labetalol (44.2%). Mean length of hospital stay was 8.4 days. Patients with HE had a longer hospital stay (9.8 vs 6.3 days, P < .001). In-hospital case fatality was 6.3%. Hypertensive crisis accounted for 6.2% of admissions in the medical unit with HE being more common than HU. Acute left ventricular failure with pulmonary edema and stroke were the most frequent target organ lesions in HE.

Incidence of Venous Thromboembolism, Risk Factors and Prophylaxis in Hospitalized Patients in the South West Region of Cameroon.

BACKGROUND: Venous thromboembolism (VTE) is a serious complication in hospitalized patients. It is associated with considerable morbidity and mortality. Therefore, its prevention is of great importance. There is paucity of data on the incidence of VTE in hospitalized patients in Cameroon. The aim of this study was to determine the incidence of symptomatic VTE, its risk factors and the proportion of patients at risk that receive thromboprophylaxis in patients hospitalized in the medical and surgical units in two hospitals in the South West Region of Cameroon. METHODS: A prospective study was performed in the medical and surgical units from January to March 2018. All consecutive eligible patients admitted for at least 3 days were included. Patient profile and risk factors were recorded. Patients were followed and evaluated for signs and symptoms of VTE until discharge from hospital. Suspected VTE was confirmed using compression ultrasonography and computed tomography. RESULTS: A total of 314 patients were included of which 58.7% were females. The mean age was 46±17.9 years. Patients aged <40 years represented 42% of the study population. Three cases of symptomatic VTE were recorded. The incidence of symptomatic VTE was 1% (95% CI: 0.3-2.8%). The prevalence of VTE risk was 93.6% with 32.5% being at high risk. The risk was 94.6% in medical patients and 92.8% in surgical patients. Among the patients at risk, only 32.5% received thromboprophylaxis. Thromboprophylaxis was significantly higher in surgical patients compared to medical patients (45.2% versus 18.7%; p<0.0001). CONCLUSION: The incidence of VTE in hospitalized medical and surgical patients appeared low but likely underestimated considering the high prevalence of patients at risk of VTE coupled with the underutilization of thromboprophylaxis. Clinicians should assess risk of VTE in conjunction with the clinical situation to determine the most appropriate type of prophylaxis as well as the duration of prophylaxis for VTE.

A meta-analytic evaluation of the diagnostic accuracy of the electrocardiographic Peguero-Lo Presti criterion for left ventricular hypertrophy.

Although electrocardiography (ECG) is a cost-effective and convenient tool for routine screening of left ventricular hypertrophy (LVH), its performance has been shown to be poor. The Peguero-Lo Presti, a novel voltage criterion, was found to be potentially better than the most commonly used criteria. We conducted a systematic review and meta-analysis of its diagnostic accuracy compared to Cornell and Sokolow-Lyon voltage criteria. Bibliographic databases were searched to identify relevant articles. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (ROC) curves were performed for comparison. Ten studies reporting data from 5984 individuals were included in the meta-analysis. Peguero-Lo Presti had the highest pooled sensitivity (43.0%, 95% confidence interval [CI]: 30.2-56.9) followed by Cornell (26.1%; 95% CI: 16.9-37.9) and Sokolow Lyon (22.0%; 95% CI: 14.1-32.7). However, Peguero-Lo Presti had the lesser pooled specificity (90.5%; 95% CI: 86.3-93.5) and Cornell the highest (94.9%; 95% CI: 90.3-97.3). The pooled DOR was 6.63 (95% CI: 3.95-11.13), 5.50 (95% CI: 3.64-8.30), and 2.94 (95% CI: 2.20-3.92) for Peguero-Lo Presti, Cornell, and Sokolow-Lyon, respectively. Peguero-Lo Presti had the best accuracy according to summary ROC curves, with an area under the curve of 0.827 compared to 0.715 for Cornell, and 0.623 for Sokolow-Lyon. In conclusion, according to this meta-analysis, Peguero-Lo Presti has a better diagnostic performance than Cornell and Sokolow-Lyon and might be more useful in routine clinical practice as a screening tool for LVH.

Prescription of pharmacotherapy and blood pressure control among hypertensive outpatients in two semi-urban hospitals in Cameroon: a cross-sectional study.

INTRODUCTION: several international guidelines are available on drug treatment for hypertension, but the control of hypertension remains very poor in sub-Saharan Africa (SSA). We investigated the commonly prescribed antihypertensive drugs and their association with blood pressure (BP) control in adult Cameroonians. METHODS: we consecutively recruited hypertensive outpatients attending the Buea and Limbe Regional Hospitals (southwest region of Cameroon). Controlled BP was defined as BP < 140/90mmHg in hypertensive patients aged 60 years or younger, diabetics or patients with chronic kidney disease or a BP < 150/90mmHg in non-diabetic hypertensive patients older than 60 years of age (JNC8). RESULTS: of the 408 participants included (mean age 61.1 years), 67% were female. The median duration of hypertension was 6 years and the median duration of the current treatment was 22 weeks. Commonly prescribed antihypertensives were calcium channel blockers (CCB, 35.1%), thiazide/thiazide-like diuretics (TD/TLD, 26.1%) and angiotensin-converting enzyme inhibitors (ACEI, 19.5%). The median monthly cost of antihypertensive was 10279.6 CFA (approximately equal to US$ 172). Seventy percent (70%) of participants were receiving at least 2 drugs, with ACEI+TD/TLD, CCB+TD/TLD, and ACEI+CCB+TD/TLD being the most frequent combination. The rate of BP control was 52% overall, and 60% in participants on monotherapy. CONCLUSION: CCBs were the most prescribed single antihypertensive drugs in this setting while ACEI+TD/TLD was the most common combination. About half of patients were at target BP control levels Improving availability and affordability of these medications may improve hypertension management and control.

Echocardiographic left atrial remodelling and determinants of left atrial size in the early phase of high blood pressure: a comparative cross-sectional study in Douala, Cameroon.

BACKGROUND: Left atrial remodelling (LAR) has been described in Western populations with chronic hypertension and is associated with a higher risk of adverse cardiovascular events. Although hypertension tends to occur earlier and is more severe in sub-Saharan Africa than in more developed nations, LAR and its associated factors in these African hypertensive subjects have been poorly elucidated. OBJECTIVES: To assess left atrial structural remodelling in black hypertensive patients and determine factors associated with left atrial size. METHODS: This was a cross-sectional, comparative study carried out in two tertiary hospitals in Douala, Cameroon over a period of three months. Fifty-two patients, either newly diagnosed with hypertension or known hypertensives treated for less than a year, were consecutively recruited. These patients were matched (unpaired matching) for age and gender to 40 randomly selected healthy subjects. The posterior-anterior diameter indexed to body surface area (BSA), volume indexed to BSA, and longitudinal and transverse diameters of the left atrium (LA) were measured using transthoracic echocardiography, in accordance with the American Society of Echocardiography guidelines. LAR was defined as increase in LA size, characterised by LA volume ≥ 34 ml/m2. Early morning urine was analysed for microalbuminuria using urine strips to obtain spot albumin/creatinine ratio. Data were analysed using SPSS version 23 and statistical significance was set at p < 0.05. RESULTS: The gender distribution and mean age were similar between the two groups. Hypertensive patients had significantly higher mean body mass index, left ventricular mass and an altered diastolic function. They also had significantly higher LA longitudinal diameter (50.0 vs 47.4 mm; p = 0.045), surface area (17.9 vs 15.5 cm2; p = 0.003) and volume (52.4 vs 43.8 ml; p = 0.002) compared to the non-hypertensive counterparts. Fourteen patients (26.9%) had LA enlargement compared to one (2.5%) in the non-hypertensive group (odds ratio = 9.78, CI: 2.67-35.8, p < 0.0001). Diastolic dysfunction (p = 0.008) was the only independent predictor of LA size in the hypertensive subjects. Microalbuminuria did not significantly correlate with LA size. CONCLUSIONS: Our study shows evidence of LAR in newly diagnosed black African patients with hypertension, characterised by an increase in the LA length, surface area and volume. Future studies are warranted to better elucidate the biological mechanisms underlying the link between the early phase of hypertension and LAR, as well as its prognostic implications in our population.