Quality of life of patients operated for lumbar stenosis at the Yaoundé Central Hospital.

Introduction: Several studies have been conducted in many African countries on lumbar stenosis but none on the quality of life of patients after surgery. We conducted this study to evaluate the quality of life of patients following surgery indicated for lumbar stenosis.Methods: A cross-sectional study from January 2010 to December 2015 in the neurosurgery department of the Yaoundé Central Hospital. We included all patients operated for lumbar stenosis, whose post-operative follow-up was at least of one year. Sampling was consecutive using operating room registries and archives of the neurosurgery department. We used the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) to evaluate patient's quality of life.Results: We recruited 52 patients. The mean age was 58.13 years. Pre-operatively, 67.3% of patients presented with severe pain (mean VAS of 8.9). At 3 months, 59.6% presented with moderate pain (mean VAS = 4.75). At six months following surgery, 92.3% of patients had mild pain (mean VAS = 2.92). At one year, all patients had only mild pain (mean VAS = 1.05). Pre-operatively, 67.30% of patients presented with severe walking disability; the mean ODI was 77.88% and a third were bedridden. Three months after surgery 61.50% presented with moderate disability and the mean ODI was 38.17%. Six months following surgery, 48.10% of patients presented with moderate disability and 42.30% presented with a mild disability (the mean ODI was 24.80%). At one year, 82% of patients presented with mild disability and the mean ODI was 12.67%.Conclusion: Surgery improved the physical condition of patients.

Visual outcome of surgically managed pituitary adenomas followed-up at the Yaoundé Central Hospital.

INTRODUCTION: Pituitary adenomas are benign brain tumours arising from the adenohypophysis; representing 10-15% of all intra-cranial tumours. Despite improved management, they are still related to high morbidity. Visual impairment is a common presentation and visual field defects representing 37-96%. We aimed at describing the clinical presentation of operated patients and their visual outcome. METHODS: We conducted a cross-sectional study for 6 months at the Yaoundé Central Hospital's Neurosurgery, Endocrinology and Ophthalmology departments. We included all patients with histopathological confirmation, having pre-operative visual assessment and operated from January 2010 to June 2016. RESULTS: Twenty-five participants (50 eyes) were enrolled. Three subtypes of pituitary adenomas were identified: Non-functional pituitary adenomas (64%) > Somatotropinomas (20%) > Prolactinomas (16%). All cases were macroadenomas. The median duration of symptoms was 14 months. All participants presented with vision impairment and 80% with headaches. Craniotomy was used in 88% of cases. The temporal hemifield was the most quantitatively affected; 76% of eyes presented with visual acuity (VA) < 6/12 and 24% of eyes a visual acuity ≥6/12. Thirty percent of eyes presented with optic atrophy; cranial nerve III palsy was the most observed. The Mean deviation (MD), an automated visual field index, improved though non-significant and 16% of eyes had a normal visual field printout after surgery. Left eye mean deviation improved significantly (p = 0.04). After surgery, there was a mild improvement of VA with 62% of eyes having a VA< 6/12 and 38% a VA ≥6/12. There was no ophthalmoplaegia after surgery. Long delay before diagnosis significantly jeopardizes pre-operative and post-operative visual acuity (r = 0.5; p = 0.01). CONCLUSION: Quantitative vision parameters comparison are suggestive of a potential improvement of vision. This conclusion will be better ascertained on a large-scale sample size. Long delay before diagnosis is associated to poor visual outcome.

Risk factors for HIV-associated neurocognitive disorders (HAND) in sub-Saharan Africa: the case of Yaoundé-Cameroon.

BACKGROUND: The prevalence of HIV-associated neurocognitive disorders (HAND), especially HIV-associated dementia (HAD) is influenced by several risk factors. The prevalence as well as risk factors for HAD are not well known in sub-Saharan Africa (SSA). We have shown that the International HIV Dementia Scale (IHDS) is a useful screening tool for HAND in Yaoundé [Njamnshi AK, Djientcheu VdP, Fonsah JY, Yepnjio FN, Njamnshi DM, Muna WFT. The IHDS is a useful screening tool for HAD/Cognitive Impairment in HIV-infected adults in Yaoundé-Cameroon. Journal of Acquired Immune Deficiency Syndromes 2008;49(4):393-397], but no study in Cameroon has yet investigated the risk factors for HAND or HAD. PATIENTS AND METHODS: A cross-sectional study was conducted in Yaoundé, the capital of Cameroon from September to December 2006. One hundred and eighty-five HIV-positive subjects were included. Diagnosis of HAND was done using the IHDS with a score < or = 10 considered as abnormal. Age, sex, level of education, IV drug use, body mass index (BMI), CDC clinical stage, CD4 counts, hemoglobin levels, administration of highly active antiretroviral therapy (HAART) and type of regimen used, were considered in univariate analysis, with level of significance set at P < or = 0.05. A binary logistic regression was used to determine independent risk factors. RESULTS: The following factors were independent predictors of HAND: advanced clinical stage (OR=7.43, P=0.001), low CD4 count especially CD4 < or = 200 cells/microL (OR=4.88, P=0.045) and low hemoglobin concentration (OR=1.16, P=0.048). CONCLUSION: This first study of the risk factors for HAND in Yaoundé-Cameroon shows findings similar to those described in other studies. These results call for rapid action by policy makers to include HAND prevention strategies such as providing early universal access to HAART based on these risk factors, in the management of HIV patients at risk of HAND in resource-limited settings of SSA like ours.

Neural tube defects are rare among black Americans but not in sub-Saharan black Africans: the case of Yaounde - Cameroon.

BACKGROUND: Neural tube defects (NTD) are complex malformations rare in black Americans and Japanese. The incidence related to births or community-based studies have not been published in Cameroon or in black sub-Saharan countries, except one study in the Nigerian middle belt [Airede KI. Neural tube defects in the middle belt of Nigeria. J Trop Pediatr 1992;38 27-30.][corrected]. METHODS: To evaluate the incidence of neural tube defects in Yaounde, the birth record of the maternities was retrospectively exploited during the last ten years period (1997-2006). RESULTS: A total of 52,710 births were recorded in the 03 main hospitals of Yaounde. Ninety eight (98) cases of NTD with an incidence of 1.99 cases per 1000 births were registered. Spina bifida cystica (myelomeningocele, meningocele) represented 71%, followed by encephalocele (21.1%) and anencephaly (5.4%). Periconceptional folic acid was not taken by any of the mothers in our study. Abortion of affected pregnancies is illegal in Cameroon. CONCLUSION: Neural Tube Defects may not be so rare in sub-Saharan black Africans particularly in Yaounde (Cameroon). Spina bifida is the most frequent malformation. The results of this study make a case for periconceptional folic acid supplementation in our communities. The respective contributions of racial (genetic) versus environmental (or nutritional) factors will however have to be studied in order to develop a comprehensive prevention strategy.

The epidemiology of stroke in sickle cell patients in Yaounde, Cameroon.

BACKGROUND AND PURPOSE: Stroke, a severe and recurrent but preventable complication of sickle cell disease (SCD), has not been well studied in Cameroon. To obtain baseline data towards the development of a national stroke prevention programme in SCD, we studied a sample of sickle cell patients with the aim of determining stroke prevalence, clinical presentation and management practices. PATIENTS AND METHODS: Homozygous sickle cell patients in two centres in Yaounde were screened for stroke, in a cross-sectional study. Stroke was diagnosed clinically and confirmed where possible with brain computerized tomography. The National Institutes of Health Stroke Score (NIHSS) and modified Rankin scale (mRS) were used to assess stroke severity. Management practices were noted from patient charts. RESULTS: One hundred and twenty patients aged 7 months to 35 years (mean age 13.49+/-8.79 years) were included. Eight cases of stroke (mean age 16.6+/-11.2 years) were identified, giving a stroke prevalence of 6.67%. Cerebral infarction was thrice as common as cerebral hemorrhage and clinical presentation was classical. Cerebral infarction was more frequent in patients aged below 20 years and hemorrhage in those above 20 (p=0.11). The annual recurrence rate was 25%. Missed diagnosis rate by attending physician was 25%. The NIHSS and mRS showed high stroke severity. Stroke management practices were insufficient and no patient received any form of stroke prophylaxis. CONCLUSION: Stroke prevalence and presentation in sickle cell patients in Yaounde is similar to that observed in developed countries, but the wide management gap calls for rapid action. Our situation is ideal for the study of the natural history of stroke in sickle cell disease.

Les hematomes extra-duraux post traumatiques : prise en charge medico-chirurgicale a Yaounde (post-traumatic extra dural hematoma: medical and surgical management in Yaounde)

Introduction : L'hematome extra dural (HED) est une urgence chirurgicale majeure. Son diagnostic et sa prise en charge dans les pays en voie de developpement se heurtent a des difficultes inherentes a la fois a la modestie des plateaux techniques et au cout trop onereux des soins pour des malades souvent demunis; sans systeme d'entraide national. Objectif : Le but de cette etude est d'etablir le profil epidemiologique des patients victimes d'un HED a Yaounde; de relever les difficultes dans la prise en charge et d'evaluer les resultats a court et a moyen terme.Patients et Methodes Il s'agit d'une etude descriptive allant de Janvier 1999 a Decembre 2004. Tous les patients pris en charge (trousse neurochirurgicale d'urgence) pour un hematome extra dural dans l'une des formations hospitalieres de Yaounde ont ete inclus. Resultats : Sur les 38 patients recrutes; le sexe masculin etait preponderant avec un sexe ratio de 3.8/1. L'age moyen etait de 24;5 ans (extreme allant de 3 a 48 ans). Les accidents de la voie publique constituaient l'etiologie la plus frequente (55;3des cas). Le traitement chirurgical etait principalement une craniotomie (81;1des patients operes). Le traitement medical avant la chirurgie etait variable. Le GOS dans le collectif etait evalue a 5 (2 patients decedes); 2 (4 patients avec des sequelles) et 1 (32 patients avec une recuperation complete). Conclusion : Ce travail demontre l'interet de disposer d'une trousse neurochirurgicale d'urgence pour une prise en charge optimale dans notre contexte