Prevalence, clinical presentation, and risk factors of chronic venous disease in Cameroon: A general population-based study.

INTRODUCTION: Chronic venous disease is a global public health problem, with high morbidity and economic distress. There is scarcity of data on this disease in sub-Saharan Africa. METHODS: We conducted the first population-based study over a period of 20 months from 1st February 2020 to 30th September 2021 in the 10 regions of Cameroon. A stratify sampling method was chose to select study site. Socio-demographic data, personal and family history, anthropometric parameters, clinical signs, illustrative images, CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification revised in 2004, VCSS (venous Clinical Severity Score) and risk factor assessment score were used to construct the survey form. Chi-squared test and Fischer exact test were used to compare the prevalence of chronic venous disease across different potential risk factors (sex, age category, previous history of deep vein thrombosis, hypertension, diabetes, smoking status, obesity). Simple and multiple logistic regression models were used to obtain crude and adjusted odds ratio for risk factors associated with chronic venous insufficiency. Statistical analyses were done with R version 4.2 for Linux and the threshold for statistical significance was 0.05. RESULTS: A total of 6578 participants were included in the study, with a mean age of 41.09 ± 16.02 years with female predominance (54.3%). The prevalence of chronic venous disease was 21.8% (95% CI: 20.8-22.9) and the prevalence of chronic venous insufficiency (C3-C6) was 7.02% (n = 462). Night cramps (43.2%), oedema (21.7%), lower limbs pain (20.4%) mostly worsens by walking and heavy legs (16.2%) were more common symptoms. The mean total venous clinical severity score was 0.69 ± 1.76 and this score had a significant positive correlation with C classification (p < .001). In the multivariate analysis, the following factors were independently associated with CVD: Male gender (aOR: 1.27; 95%CI: 1.04-1.56; p = .021), retired people (aOR: 46.9; 95% CI: 12.6-174.5; p < .001), hypertension (aOR: 289.5; 95%CI: 169.69-493.1; p < .001), diabetes (aOR: 2.19; 95% CI: 1.21-3.96; p = .009), obesity (aOR: 10.22; 95%CI: 7.67-13.62; p < .001). Smoking appears as a protective factor (aOR: 0.18; 95%CI: 0.10-0.30; p < .001). CONCLUSION: Chronic venous disease is frequent in Cameroon and main traditional cardiovascular risk factors are associated to this condition. Systematic screening of the CVD in these specific groups could reduce the burden of the disease and its economic impact.

Aortic root enlargement in patients undergoing mitral and aortic replacement: early outcomes in a sub-Saharan population.

Introduction: Aortic root enlargement (ARE) is often required to avoid patient-prosthesis mismatch (PPM) in young patients undergoing aortic surgery, including those undergoing combined mitral and aortic valve replacement (double valve replacement, DVR). Adding ARE to DVR may increase the operative risk by extending the surgical time. Herein, we review our experience with ARE in patients who underwent DVR. Materials and methods: The medical records of 69 patients who underwent DVR at our institution between February 2008 and November 2021 were retrospectively reviewed. The patients were divided into two groups according to the ARE procedure (ARE-DVR: 25 patients; DVR: 44 patients). Descriptive and comparative analyses of demographic, clinical, and surgical data were performed. Results: Among the 69 patients who underwent DVR, 35 were women (sex ratio, 0.97). The mean age at surgery was 26.7 ± 13.9 years (range: 7-62 years). Among the 47 patients aged ≤30 years, 40.4% (19/47) were aged between 10 and 20 years, and 6.3% (3/47) were aged <10 years. Patients in the ARE-DVR group were younger (23.3 ± 12.9 years vs. 28.5 ± 14.2 years, p < 0.05). The New York Heart Association Class ≥III dyspnea was the most common symptom (89.9%), with no differences between the two groups. Of all the patients, 84.1% had sinus rhythm. Rheumatic disease was the most common etiology in the entire cohort (91.3%). The mean aortic annulus diameter was 20.54 mm, with smaller sizes found in the ARE-DVR group (18.00 ± 1.47 mm vs. 22.50 ± 2.35 mm, p < 0.05). The aortic cross-clamping duration was greater in the ARE-DVR group (177.6 ± 37.9 min vs. 148.3 ± 66.3 min, p = 0.047). The operative mortality rate was 5.6% for the entire cohort (ARE-DVR: 8% vs. DVR: 4.5%, p = 0.46). Among the patients who underwent echocardiographic control at follow-up, the mean aortic gradient was 19.6 ± 7.2 mmHg (range: 6.14-33 mmHg), with no differences among the groups. Conclusion: The association between ARE and DVR did not significantly affect operative mortality. ARE can be safely used whenever indications arise to reduce the occurrence of PPM, especially in young patients with growth potential.

Performance of systolic pressure index for lower limb peripheral arterial disease in a group of elderly in sub-Saharan Africa.

BACKGROUND: The automatic measurement of the ankle-brachial index (ABI) constitutes a reliable, simple, safe, rapid, and inexpensive alternative diagnostic screening test compared with the Doppler method for peripheral arterial disease (PAD). We aimed to compare the diagnostic performance of automatic ABI measurement tests to Doppler ultrasound for PAD in a group of patients aged 65 years and above, in Sub-Saharan Africa. METHODS: This was an experimental comparative study of the performance of Doppler ultrasound to the automated ABI test in the diagnosis of PAD in patients aged ≥ 65 years followed-up at the Yaoundé Central Hospital, Cameroon between January to June 2018. An ABI threshold < 0.90 is defined as a PAD. We compare the sensitivity, and specificity of the high ankle-brachial index (ABI-HIGH), low ankle-brachial index (ABI-LOW), and the mean ankle-brachial index (ABI-MEAN) for both tests. RESULTS: We included 137 subjects with an average age of 71.7 ± 6.8 years. In the ABI-HIGH mode, the automatic device had a sensitivity of 55% and a specificity of 98.35% with a difference between the two techniques of d = 0.024 (p = 0.016). In the ABI-MEAN mode, it had a sensitivity of 40.63% and a specificity of 99.15%; d = 0.071 (p < 0.0001). In the ABI-LOW mode, it had a sensitivity of 30.95% and a specificity of 99.11%; d = 0.119 (p < 0.0001). CONCLUSION: The Automatic measurement of systolic pressure index has a better diagnostic performance in the detection of Peripheral Arterial Disease compared to the reference method by continuous Doppler in sub-Saharan African subjects aged ≥ 65 years.

Prevalence, complications and factors associated with severely elevated blood pressure in patients with hypertension: a cross-sectional study in two hospitals in Yaoundé, Cameroon.

Introduction: severely elevated blood pressure significantly increases cardiovascular morbidity and mortality in hypertensive Black patients. The objective of this study was to determine the prevalence, complications and factors associated with severe high blood pressure in hypertensive patients in Yaoundé, Cameroon. Methods: we conducted a cross-sectional study in the outpatient and cardiology units of two teaching hospitals in Yaoundé. We included consenting hypertensive patients aged over 18 years. We first measured their blood pressure (BP), then we collected their sociodemographic data, cardiovascular risk factors, follow-up data, and ended with a complete physical examination. We performed a regression analysis to assess correlates of severe hypertension. Results: we included a total of 153 patients with 33 (21.6%) of them having severe hypertension. Among the 33 patients, 16 (48.5%) were male and 17 (51.5%) were female. Their mean age was 60.52 ± 12.83 years. Chronic kidney disease (78.8%), hypertensive retinopathy (69.7%) and left ventricular hypertrophy (48.5%) were the most common complications. On multiple logistic regression analysis, inadequate follow-up was independently associated with severe hypertension (adjusted OR=7.09; 95% CI [2.29-21.9]). Conclusion: severely elevated BP is common among hypertensive patients in our setting with important physical and economic consequences. Increased patients awareness and improving access to primary care physicians and cardiologists, through health insurance or other means, may be an effective strategy for reducing cardiovascular morbidity and mortality among hypertensive Black patients.

[Epidemiology, clinical and therapeutic aspects of chronic coronary syndrome in Cameroonian cardiology, a look back at 10 years]. / Epidemiologie, aspects cliniques et therapeutiques du syndrome Coronarien chronique en milieu cardiologique camerounais : un regard sur 10 ans.

AIM: The present study aims to describe the epidemiology, clinical and therapeutic aspects of chronic coronary syndrome (CCS) in Cameroonian cardiology setting in order to highlight the current state of practice to guide efficient epidemiological interventions. METHOD: We retrospectively analyzed over 10 years [2010; 2019] the records of patients hospitalized in two cardiology units of referral hospitals in the city of Yaoundé. RESULT: Of the 2756 records retrieved, 47 (1.7%) had CCS according to the 2019 European Society of Cardiology guidelines, with an average age of 58 ± 12 years, and 63.8% were men. The most common cardiovascular risk factors found were hypertension (78.7%), overweight or obesity (84.9%), dyslipidemias (80.9%), smoking (68.1%), and diabetes (67.7%). Chest pain on exertion (74.5%) and exertional dyspnea (70.2%) were the main symptoms. Repolarization disorders (83%) were the most frequent ECG signs; necrosis sequelae were found on ECG in 34% of cases and rhythm disorders in 21.3%. The therapeutic modalities were essentially anti-platelet (95.7%), statins (91.5%), beta blockers (89.4%), and converting enzyme blockers (70.2%). Interventional treatments were rarely performed (2.1%). CONCLUSION: Although chronic coronary syndrome are uncommon in cardiology hospitalization in Cameroon, it is essential that public health policies work to improve the current state of care particularly interventional care.

BUT: La présente étude vise à décrire l'épidémiologie, les aspects cliniques et thérapeutiques du syndrome coronarien chronique (SCC) en milieu cardiologique Camerounais afin de montrer l'état des lieux pour guider les interventions épidémiologiques efficientes. METHODE: Nous avons analysé de façon rétrospective sur 10 ans [2010 ; 2019] les dossiers des patients hospitalisés dans deux unités de cardiologie d'hôpitaux de référence de la ville de Yaoundé. RÉSULTAT: Sur les 2756 dossiers retrouvés, 47 (1,7%) avaient un SCC selon les recommandations de la Société Européenne de Cardiologie de 2019, ayant une moyenne d'âge de 58 ± 12 ans, et 63,8% d'hommes. Les facteurs de risque cardiovasculaire les plus retrouvés étaient l'hypertension artérielle (78,7%), le surpoids ou obésité (84,9%), les dyslipidémies (80.9%), la consommation de tabac (68,1%) et le diabète (67,7%). La douleur thoracique à l'effort (74,5%) et la dyspnée d'effort (70,2%) étaient les maitres symptômes. Les troubles de repolarisation (83%) étaient les signes ECG les plus fréquents ; les séquelles de nécrose étaient retrouvées à l'ECG chez 34% des cas et les troubles du rythme chez 21,3%. Les modalités thérapeutiques étaient essentiellement des anti-agrégants plaquettaires (95,7%), statines (91,5%), beta bloquants (89,4%), et les inhibiteurs de l'enzyme de conversion (70,2%). Les traitements interventionnels étaient rarement réalisés (2,1%). CONCLUSION: Même si les SCC sont peu fréquents en hospitalisation de cardiologie, il est primordial que les autorités de santé publique travaillent à améliorer l'état de la prise en charge actuelle en particulier interventionnelle.

Left atrial structural and functional remodeling study in type 2 diabetic patients in sub-Saharan Africa: Role of left atrial strain by 2D speckle tracking echocardiography.

OBJECTIVE: To evaluate the role of peak atrial longitudinal strain (PALS) through speckle tracking 2D echocardiography for the assessment of structural and functional left atrial (LA) remodeling in a type 2 diabetes mellitus (T2DM) population. METHODOLOGY: We conducted a cross-sectional study during a 9-month period. T2DM adults aged 18 and above were included. The variables assessed during the study include age and gender of participants, diabetes characteristics, cardiovascular risk factors, clinical anthropometric and hemodynamic parameters, standard echocardiographic parameters, volume-derived LA functions, and 2D PALS. RESULTS: We included a total of 102 patients. The mean age was 58 ± 11.7 years, and the M/F sex ratio was 1:1.5. Coexistent arterial hypertension (HTN) was observed in more than half (59.8%) of the population sample. Mean 2D PALS was 29.2 ± 8.9% with 58.8% (95% CI: 50.0-68.6) of subjects having a reduced LA strain (ie,<32%). Reservoir and pump functions were the most altered LA volumetric phasic functions. Mean indexed LA maximal volume was 22.2 ± 6.8 mL/m2 . There was a significant association between abnormal PALS and age, Body mass index (BMI), indexed LA volume, E/E' ratio, LA active ejection fraction (pump function), and LA expansion index (reservoir function). CONCLUSION: Left atrial remodeling is a recurrent condition in adult T2DM Cameroonians. The reservoir and pump LA functions were the most affected. Assessment of LA global strain allows early detection of LA remodeling with comparison to LA size standard analyses. Age, BMI, indexed LA volume, E/E' ratio, and reservoir and pump LA functions were associated to 2D LA global strain impairment.

Medium-term Survival Following of Stroke in Yaoundé (Cameroon): a prospective observational cohort study.

BACKGROUND: With 5.7 million deaths per year, stroke is the second cause of mortality worldwide, and 70% of these deaths occur in developing countries especially in relation to inappropriate clinical pathways and resources. The aim of our study was to assess the survival rate of stroke patients within 90 days and to identify its determinants. METHODS: It was a prospective observational cohort study over a period of 90 days after stroke. Patients were recruited between February and May 2015 in two tertiary hospitals in Yaoundé. The mortality rate was obtained by the Kaplan-Meier method. Multivariate analysis was performed using a Cox proportional hazards model. RESULTS: Sixty-six patients were enrolled of which 54 were followed up to 90 days. The overall mortality rate was 23.2% (95% CI: 12.5-87.5), more than two-thirds of the deaths occurred within the first 30 days. The mortality rates at days 14, 30, 60 day were 9.1% (95% CI: 3.0-16.7), 14.3% (95% CI: 6.3-23.8) and 21.1% (95% CI: 10.5-31.6) respectively. High systolic blood pressure and a low Glasgow coma score on admission were independent risk factors of mortality at 90 days. CONCLUSIONS: The stroke related mortality compels appropriate collective mobilization for an early and adequate management of stroke patients.

Prevalence and determinants of masked hypertension among obese individuals at the Yaoundé Central Hospital: a cross-sectional study in sub-Saharan Africa.

OBJECTIVES: The aim of this study was to investigate the prevalence and associated factors of masked hypertension in obese patients in Yaounde. METHODS: We carried out a cross-sectional study from January to September 2017 at the National Obesity Center of the Yaounde Central Hospital. Masked hypertension was defined when the mean 24 h SBP was greater than or equal to 130 mmHg and/or the mean 24 h DBP was greater than or equal to 80 mmHg with normal office blood pressure (SBP/DBP) <140/90 mmHg. Logistic regression was used to examine the relationship of masked hypertension with associated factors. RESULTS: Among the 90 participants included, 67.8% were females. The mean age (±SD) was 46 (±8) years. The mean clinical measurements were 120 ± 9.4 mmHg and 75.5 ± 7.9 mmHg, respectively, for the SBP and the DBP. On 24 h ambulatory measurement, the mean was 123.9 ± 14.4/74.7 ± 8.9 mmHg, respectively, for the SBP/DBP. The prevalence of masked hypertension was 33.3%. Masked hypertension was significantly associated with high-normal office blood pressure [odds ratio (OR) = 2.90, P = 0.02] and to dyslipidemia (OR = 3.60, P = 0.01), but not to the male sex, diabetes, physical activity, and tobacco/alcohol. CONCLUSION: Our findings suggest that the prevalence of masked hypertension is high and that physicians should consider ambulatory blood pressure monitoring for obese individuals with high-normal office blood pressure or dyslipidemia.

Late mortality after cardiac interventions over 10-year period in two Cameroonian government-owned hospitals.

BACKGROUND: Cardiac surgery is a growing activity in Sub-Saharan Africa, however, data related to long-term mortality are scarce. We aimed to analyze outcome data of cardiac interventions in two hospitals in Cameroon over 10 years' period. METHODS: we conducted a retrospective analytical and descriptive study at the Douala General Hospital and Yaoundé General Hospital. All patients operated between January 2007 and December 2017, or their families were contacted by phone between January and April 2018 for a free of charges medical examination. RESULTS: Of a total of 98 patients operated during the study period, 8 (8.2%) were lost to follow-up. Finally, 90 patients [49 (54.4%) women and 41 (45.6%)] men were included. The mean age was 49±22 years (range, 13-89 years). The surgical indications were valvular heart diseases in 37 (41.1%) cases, congenital heart diseases in 11 (12.2%) cases, chronic constrictive pericarditis in 4 (4.4%) cases, and intra cardiac tumor in 1 (1.1%) case. Valve replacement was the most common type of surgery carried out in 37 (41.1%) cases-mostly with mechanical prosthesis. Pacemaker-mostly dual-chambers were implanted in 36 (40.0%) patients. The median follow-up was 26 months. The overall late mortality was 5.7%, and the overall survival rates at 5 and 10 years were 95.5% and 94.4% respectively. The overall survival rates at 5 and 10 years for mechanical valve prosthesis were 93.3% and 90% respectively. The survival at 10 years was 100% for patients with bioprosthesis. The survival rates at 10 years were 94.1% and 100% respectively for dual and single chamber pacemaker. CONCLUSIONS: Long-term outcome of cardiac surgery in hospitals in Cameroon are acceptable with low mortality rate. However, outcome metrics beyond mortality should be implemented for a prospective data collection.

Prevalence and determinants of pulmonary hypertension in a group of Cameroonian patients without chronic lung disease: a cross-sectional echocardiographic study.

OBJECTIVE: To study prevalence and determinants of pulmonary hypertension (PH) in a group of Cameroonian patients without chronic lung disease. We conducted a cross-sectional study conducted between April and December 2011 in a private cardiology clinic in Bafoussam, Cameroon. We included consenting participants aged ≥ 18, who underwent a Doppler echocardiography. Patients with chronic lung disease were excluded. RESULTS: A total of 178 participants were enrolled, of whom 44.4% were males with a mean age of 63.1 ± 17.3 years. The prevalence of PH was 25.3%. Among patients with PH 44.4% had severe disease, (11.2% of study population). Age ≥ 55 years, systolic blood pressure ≥ 140 mmHg, low left ventricular ejection fraction (< 55%), left atrial enlargement, left ventricular hypertrophy and presence of left heart disease (left ventricular hypertrophy with systolic dysfunction and left atrial enlargement) were predictors of echocardiography PH. Obesity was negatively associated with pulmonary hypertension. Pulmonary hypertension is found in a quarter of the participants. Age, systolic hypertension, and any left heart disease were strongly associated to pulmonary hypertension.

Evaluation des connaissances sur les mesures hygiéno-diététiques chez les hypertendus suivis à l'hôpital général de Yaoundé

Objectifs. Les mesures hygiéno-diététiques représentent un volet important de la prise en charge de l'hypertension artérielle. La bonne connaissance et l'application de ces dernières réduiraient la fréquence des complications de l'hypertension artérielle. Le but de ce travail était d'évaluer le niveau de connaissance des mesures hygiéno-diététiques chez les hypertendus suivis à l'hôpital général de Yaoundé. Méthodes. Il s'agit d'une étude transversale des patients hypertendus sous traitement suivis à l'hôpital général de Yaoundé du 02 janvier au 22 avril 2016.Les données évaluées étaient : le traitement médicamenteux et les mesures hygiéno-diététiques par un questionnaire. Résultats. Nous avons recruté 148 participants hypertendus ; le sex ratio h/f était de 0,56 avec une prédominance de la tranche d'âge de 46 à 65 ans. 64 ,9 % des sujets étaient sous diurétiques thiazidiques. La bithérapie était retrouvée chez 47,3 % des patients et la monothérapie chez 25,7%. Le régime hyposodé était la mesure hygiéno-diététique la plus connue avec un taux de connaissance de 95,9 % suivie respectivement par la réduction de la consommation d'alcool (56,8%), la réduction de la consommation des graisses (53,4%). L'arrêt du tabac et la pratique d'une activité physique régulière étaient connues respectivement par 34 ,2 % et 30,8 % des hypertendus traités tandis que 14,4% d'entre eux considéraient la réduction du poids comme composante du traitement non médicamenteux de l'hypertension artérielle. Au total, 37,2 % des hypertendus avaient globalement une bonne connaissance des mesures hygiéno-diététiques de l'hypertension artérielle. Conclusion. Dans notre population d'hypertendus traités, 62,8 % des sujets avaient une mauvaise connaissance des mesures hygiéno-diététiques. Un tel résultat pourrait suggérer une intensification de l'éducation et de la prescription des mesures hygiéno-diététiques en pratique clinique courante

Effect of low-dose spironolactone on resistant hypertension in type 2 diabetes mellitus: a randomized controlled trial in a sub-Saharan African population.

BACKGROUND: Low-dose spironolactone has been proven to be effective for resistant hypertension in the general population, but this has yet to be confirmed in type 2 diabetic (T2DM) patients. We assessed the efficacy of a low-dose spironolactone on resistant hypertension in a sub-Saharan African population of T2DM patients from Cameroon. METHODS: This was a four-week single blinded randomized controlled trial in 17 subjects presenting with resistant hypertension in specialized diabetes care units in Cameroon. They were randomly assigned to treatment with a daily 25 mg of spironolactone (n = 9) or to an alternative antihypertensive regimen (n = 8), on top of any ongoing regimen and prevailing lifestyle prescriptions. They were seen at the start of the treatment, then 2 and 4 weeks later. The primary outcome was change in office and self-measured blood pressure (BP) during follow-up, and secondary outcomes were changes in serum potassium, sodium, and creatinine levels. RESULTS: Compared with alternative treatment, low-dose spironolactone was associated with significant decrease in office systolic BP (-33 vs. -14 mmHg; p = 0.024), and in diastolic BP (-14 vs. -5 mmHg; p = 0.006). After 1 month of spironolactone, all the patients were controlled based on BP below 130/80 mmHg, with significant office BP reduction from 158 ± 17/86 ± 11 to 125 ± 11/72 ± 8, vs. 158 ± 8/94 ± 8 to 144 ± 17/89 ± 12 mmHg in the alternative treatment group. There was no significant variation in sodium and creatinine levels in both groups, but a mild increase of potassium levels in the spironolactone group. INTERPRETATION: Add-on low-dose spironolactone was effective in reducing BP to optimal levels in T2DM Cameroonian patients despite mild increase in serum potassium. Trial registration ClinicalTrials.gov Identifier NCT02426099. Date of registration April 2015.

Patterns of cardiovascular disease in a group of HIV-infected adults in Yaoundé, Cameroon.

BACKGROUND: Cardiovascular disease is an increasingly important issue in human immunodeficiency viral (HIV)-infected individuals. There is dearth of information on the patterns of cardiovascular disease especially in sub-Saharan Africa (SSA) patients. This study reports on the clinical, biological, electrocardiographic and echocardiographic characteristics of a group of HIV-infected patients presenting with symptoms of heart disease in Yaoundé, Cameroon. METHODS: This was a cross-sectional study conducted at the Yaoundé Central Hospital and Jamot Hospital. Consenting HIV-infected adults aged ≥18 years with symptoms suggestive of heart disease were consecutively recruited between February and July 2014. All participants underwent a complete clinical examination; biological analyses including CD4 cell counts, fasting blood glucose, and serum lipids, resting electrocardiography and cardiac ultrasound, and a venous ultrasound where necessary. RESULTS: Forty four subjects (21 men) were included. Their mean age was 48 (SD 13) years. Thirty patients (68.2%) were in WHO clinical stages 3 and 4 of HIV infection, 27 (61.4%) had a CD4 cell count <200/mm(3), and 31 (70.5%) were on antiretroviral therapy (ART). Hypertension (43.2%, n=19) was the most frequent cardiovascular risk factor; and dyslipidemia which was found in 17 subjects (38.6%) was significantly associated with ART (48.4% vs. 15.4%, P=0.04). Only men where smokers (23% vs. 0%, P=0.019). Exertional dyspnea (86.4%, n=38) and cough (59.1%, n=26) were the most frequent symptoms, and the clinical presentation was dominated by heart failure (75%, n=33). The most frequent echocardiographic abnormalities were pericardial effusion (45.5%, n=20) and dilated cardiomyopathy (22.7%, n=10). Dilated cardiomyopathy was significantly associated with CD4 cell counts <200/mm(3) (100%, P=0.003). Primary pulmonary hypertension (PH) rate was 11.4% (n=5) and all cases occurred at CD4 cell counts ≥200/mm(3) (P=0.005). The most frequent electrocardiographic abnormalities were abnormal repolarization (59%, n=26) and sinus tachycardia (56.8%, n=25). CONCLUSIONS: Cardiovascular risk factors such as hypertension and dyslipidemia are common in HIV-infected adults with heart disease in our milieu. Advanced HIV infection in adults is associated with a high rate of symptomatic heart disease, mostly effusive pericarditis and dilated cardiomyopathy. Primary PH occurred in less advanced HIV disease.

The clinical pattern of renal diseases in the nephrology in-patient unit of the Yaounde General Hospital in Cameroon: a five-year audit.

INTRODUCTION: Kidney diseases are a growing worldwide problem and one of the major public health threats. We analyzed the spectrum of kidney diseases seen over a five-year period in the nephrology in-patient unit of the Yaounde general hospital. METHODS: This was a retrospective analysis of 225 medical records of patients admitted from January 2005 to December 2009 in the unit with a discharge diagnosis of kidney and urinary tract diseases. The first hospitalization was considered for patients admitted several times for the same disease. Socio-demographic and clinical patient data were recorded. RESULTS: The patients mean age was 44.8±16 years with 135 (60%) males and 211 (93.8%) emergency admissions. All 139 (61.8%) patients with chronic kidney disease (CKD) had chronic renal failure. Acute kidney injury (AKI) (28%), nephrotic syndrome (7.6%), renal colic (1.3%) and acute pyelonephritis (1.3%) were other patterns observed. Chronic glomerulonephritis (25.9%), hypertension (22.3%) and diabetes (20.1%) were the main etiological factors of CKD. All AKI patients were in stage RIFLE-F. AKI was secondary to parenchymal (58.7%), functional (25.4%) and obstructive (15.9%) etiologies. Black water fever (36.4%), sepsis (22.7%), drugs (18.2%), eclampsia (13.6%) and herbal concoctions (9.1%) were the etiologies of acute tubular necrosis while enterocolitis (56.2%), heart failure (31.3%) and digestive hemorrhage (12.5%) were the etiologies of functional AKI. CONCLUSION: The clinical pattern of renal diseases is dominated by advanced CKD and AKI secondary to preventable causes. This study suggests a need for an array of actions including sensitization, continuous medical education and strengthening of the health system.

Prevalence and Risk Factors of Hypertension in Urban Areas of Cameroon: A Nationwide Population-Based Cross-Sectional Study.

Accurate estimates of the prevalence rate of hypertension and determinants in Cameroon are crucial to inform efficient prevention and control policies. The authors carried out a cluster-specific cross-sectional survey in urban areas of the 10 regions of Cameroon to assess the prevalence and risk factors of hypertension in Cameroonian adults using the WHO STEPwise approach to Surveillance (STEPS). Sociodemographic data were collected and blood pressure and glycemia were measured using standardized methods. Participants were adults of both sexes aged 16 years or older. A total of 15,470 participants were surveyed. The age-standardized prevalence rate of hypertension was 29.7%. The awareness rate was 14.1%. Independent correlates of hypertension included higher age, male sex, obesity, hyperglycemia, and living in the Savannah zone. The prevalence of hypertension is high in urban areas of Cameroon, with very low awareness. Prevention and control strategies should emphasize on improvement and vulgarization of population opportunistic screening and education.

Pattern and correlates of cardiac lesions in a group of sub-Saharan African patients on maintenance hemodialysis.

INTRODUCTION: Cardiovascular disease is the leading cause of morbidity and mortality in patients on maintenance hemodialysis. We investigated the pattern and correlates of cardiac lesions in a group of Cameroonians on chronic hemodialysis. METHODS: This was a cross-sectional study conducted at the Yaoundé General Hospital's hemodialysis unit, involving 45 patients (29 men, 64%) on maintenance hemodialysis for at least three months using a native arterio-venous fistula. Cardiovascular risk factors, biological, electrocardiographic and echocardiographic data were collected. RESULTS: Hypertension (29%), chronic glomerulonephritis (24%) and diabetes mellitus (24%) were the main etiological factors of chronic kidney disease. Blood pressure was controlled in 14 (31%) patients. Nineteen (42%) patients had anemia and 5 (14%) had a calcium-phosphorus product >55 mg(2)/dl(2). All patients had at least one cardiovascular risk factors with hypertension (95%), anemia (42%) and highcalcium-phosphorus product (42%) being the most frequent. Thirty-eight (84%) patients had at least one cardiac lesion and 11 (29%) had three or more lesions. The cardiac lesions were left ventricular hypertrophy (60%), valvular calcifications (38%), heart failure (36%), conduction disorders (33%), pericardial effusion (13%), valvular diseases (11%) and ischemic heart diseases (2%). Left ventricular hypertrophy was significantly associated with a longer duration on dialysis and low hemoglobin level (both p < 0.047) while cardiac failure and valvular calcifications were associated with advanced age and high interdialytic weight gain (both p <0.05). CONCLUSION: Cardiac lesions and cardiovascular risk factors are frequent in these patients receiving sub-optimal dose maintenance hemodialysis despite their younger age, suggesting an increased susceptibility to cardiovascular complications.

Kidney function, urinalysis abnormalities and correlates in equatorial Africans with sickle cell disease.

BACKGROUND: Little is known about the renal profiles of individuals with sickle cell disease (SCD) in equatorial Africa, the global epicenter of SCD. We evaluated the kidney function, urinalysis abnormalities and their correlates in a group of Cameroonians homozygous for SCD. METHODS: This was a cross-sectional study of 4-month duration involving 72 homozygous SCD patients (39 men, 54%), recruited during routine visit or vaso-occlusive crisis at the Yaoundé Central Hospital in Cameroon. Clinical and laboratory data were used to evaluate the renal and urinalysis parameters, and potential effects of SCD-related clinical and hematological variables on those parameters investigated through linear and logistic regression models. RESULTS: The mean serum creatinine increased with increasing age, translating into a decreasing estimated glomerular filtration rate (eGFR) with age (P < 0.001). One patient (1.4%) had an eGFR of <60 mL/min and nine others (12.5%) had 60 ≤ eGFR ≤ 90 mL/min. The eGFR was lower in women and decreased with increasing systolic blood pressure. The prevalence of proteinuria (>200 mg/g) was 93% and the main urinalysis abnormalities were leukocyturia (77.8%), albuminuria (40.3%), hematuria (13.9%) and cristalluria (9.7%). None of the predictive clinical, hematological and urinary factors studied was associated with proteinuria or albuminuria, while hematuria and leukocyturia were associated with increasing age and male gender. CONCLUSIONS: Cameroonians homozygous for SCD present a high prevalence of proteinuria and urinalysis abnormalities, and a slight renal impairment. Age, blood pressure variables and gender seem to be the main determinants. Urinalysis abnormalities and kidney function assessment should be an active pursuit in women with SCD.

Efficiency of an intervention package for arterial hypertension comprising telemanagement in a Cameroonian rural setting: The TELEMED-CAM study.

INTRODUCTION: Sub-Saharan Africa has a disproportionate burden of disease and an extreme shortage of health workforce. Therefore, adequate care for emerging chronic diseases can be very challenging. We implemented and evaluated the effectiveness of an intervention package comprising telecare as a mean for improving the outcomes of care for hypertension in Rural Sub-Saharan Africa. METHODS: The study involved a telemedicine center based at the Yaounde General Hospital (5 cardiologists) in the Capital city of Cameroon, and 30 remote rural health centers within the vicinity of Yaoundé (20 centers (103 patients) in the usual care group, and 10 centers (165 patients) in the intervention groups). The total duration of the intervention was 24 weeks. RESULTS: Participants in the intervention group had higher baseline systolic (SBP) and diastolic (DBP) blood pressure, and included fewer individuals with diabetes than those in the usual care group (all p < 0.01). Otherwise, the baseline profile was mostly similar between the two groups. During follow-up, more participants in the intervention groups achieved optimal BP control, driven primarily by greater improvement of BP control among High risk participants (hypertension stage III) in the intervention group. CONCLUSION: An intervention package comprising tele-support to general practitioners and nurses is effective in improving the management and outcome of care for hypertension in rural underserved populations. This can potentially help in addressing the shortage of trained health workforce for chronic disease management in some settings. However context-specific approaches and cost-effectiveness data are needed to improve the application of telemedicine for chronic disease management in resource-limited settings.

Hyperkaliemie chez les patients en hemodialyse chronique a Yaounde : prevalence; manifestations cliniques et electrocardiographiques

Introduction : L'hyperkaliemie est frequente chez les patients hemodialyses. Elle expose ces derniers au risque de mort subite. Son dosage ne fait pas partie des examens de routine en hemodialyse au Cameroun. Le but de notre etude etait de determiner sa prevalence et ses manifestations cliniques et electrocardiographiques chez les patients hemodialyses chroniques a l'Hopital General de Yaounde. Patients et methodes : Nous avons mene une etude transversale de novembre 2012 a fevrier 2013. Tous les patients hemodialyses depuis plus de 03 mois ayant accepte de participer a l'etude ont ete inclus. Chez chacun d'entre eux nous avons realise avant le debut de leurs premiere et deuxieme seances hebdomadaires de dialyse; un examen clinique; un dosage sanguin de potassium; de sodium et de calcium ionise et un electrocardiogramme. Resultats :Un total de 88 patients a ete retenu. La prevalence de l'hyperkaliemie etait de 38;7avant le debut de la premiere seance de dialyse et e 17 avant la seconde seance. Une paresie a ete retrouvee dans 03 cas et dans tous ces cas le taux de kaliemie etait au moins de 7;5 mEq/l. Deux cas ont presente un signe electrocardiographique pouvant se rapporter a l'hyperkaliemie; il s'agissait d'une onde T ample. Conclusion : L'hyperkaliemie est bien frequente chez nos patients hemodialyses chroniques; mais ses manifestations cliniques et electrocardiographiques ne sont pas courantes