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.

Rheumatic diseases in patients attending a clinic at a referral hospital in Yaounde, Cameroon.

BACKGROUND: The spectrum of rheumatic diseases in sub-Saharan Africa remains poorly defined. OBJECTIVES: To determine the spectrum of rheumatic diseases in Yaounde. DESIGN: Descriptive cross-sectional study. SETTING: Rheumatology clinic at the Yaounde General Hospital, Cameroon. SUBJECTS: Twelve thousand four hundred and ninety four patients were referred to the outpatient department of the Internal Medicine service of the General Hospital of Yaounde over a 12-month period. Of these cases, 536 (9.4%) were diagnosed as belonging to the general class of rheumatic conditions. There were 334 (62.31%) females and 202 (37.69%) males. The mean age was 52.72 +/- 5.3 years. RESULTS: The 536 cases were further classified as follows: degenerative disease of the spine 196 (36.5%), osteoarthritis of the limbs 110 (20.5%), regional musculo-skeletal disorders 83 (15.5%), arthritis associated with infections 50 (9.3%), chronic inflammatory and connective tissue diseases 44 (8.2%), crystalline arthropathies 32 (5.9%) and miscellaneous (unclassified) rheumatic conditions 21 (4.1%). CONCLUSION: From these results, we concluded that degenerative disease of the spine and limbs are the most common forms of rheumatic disease in this region. Gout is the most commnon acute inflammatory arthropathy and rheumatoid arthritis the most prevalent arthropathy due to chronic inflammation.

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.

[Cardiovascular emergencies in Subsaharan Africa]. / Urgences cardiovasculaires en Afrique subsaharienne.

BACKGROUND: The increasing prevalence of cardiovascular diseases in subsaharan Africa and their related mortality and morbidity have been established. A large number of them present as emergencies. The purpose of this first multicentric study was to assess the causes, management and outcome of cardiovascular emergencies in savannah and forest environments. METHODS: A total of 665 patients were included from seven participating centers in seven countries: 417 were classified as belonging to the savannah zone (Dakar, Nouakchott, Ouagadougou, N'djamena) whereas 248 patients were from the forest zone (Abidjan, Libreville, Yaounde). Patients were examinated by one or several cardiologists. Statistical analysis was performed by the Medical Statistic Unit of the Hopital Nord, Marseille (France). RESULTS: There were more men (53.4%) than women (46.6%). 77.7% of the patients lived in urban areas. Most of them had low or very low incomes. Patients reached the hospitals in ambulances only in 6.2% of cases. The remaining others were transported by routine urban vehicle or bicycle or ambulation. The mean delay between the onset of symptoms and the arrival to the emergency unit was 6.8 days. Three immediate situations were preponderant: severe hypertension (32.2%), heart failures NYHA IV (27.5%), stroke (20.3%). Underlying conditions were: mainly chronic hypertension (52.3%), cardiomyopathies (20.6%), valvular heart diseases (11.1%). Coronary heart diseases were rare (6.1%). The observed mortality was 21.2% without any differences in age groups. The most common emergencies resulting in death included: stroke (31.9%), vascular collapses (18.4%), pulmonary embolism (9.2%). The patients from the savannah zone were younger, more often classified in the low or average socioeconomic level. Hypertension was more frequent in forest zones. Valvular heart diseases were more frequent in savannah. Cardiomyopathies were comparable in both zones. Coronary heart disease was slightly more common in the savannah area. DISCUSSION: Compared with patients from western countries, the African patients are younger because some diseases affect young people like rheumatic heart disease or postpartum and infectious cardiomyopathies. The difficulties to reach health care facilities made the outcome more severe. Hypertension and valvular heart disease deserve priority in preventive strategy. Cardiomyopathies have to be studied to precise their causes. Finally, the management of cardiovascular emergencies needs a special care in the hospitals owing to their increasing frequency and their severity.

[Gallbladder kinetics in the black African subject with and without cholelithiasis. An ultrasonographic study]. / La vidange vésiculaire chez le sujet noir africain avec et sans lithiase. Une étude ultrasonographique.

PURPOSE: Gallbladder hypomotility could play a significant role in the process of lithogenesis, but this role has yet to be defined in black African populations. This role was assessed by measuring gallbladder emptying after stimulation by a fat meal in a group of black African subjects with and without cholelithiasis. MATERIALS AND METHODS: Fifteen subjects with cholelithiasis and thirty controls divided in two pools were studied. Gallbladder emptying was stimulated by fat meals of 610 and 740 Kcal, and was measured with ultrasound for a period of 120 min. RESULTS: The mean fasting gallbladder Volume of the subjects with lithiasis was significantly superior to that of the controls. Compared to what has been previously published in Caucasian subjects, gallbladder emptying was generally more rapid in our study. Further more, gallbladder emptying was significantly better in the control group than in the group of subjects with cholelithiasis. Two groups of subjects with cholelithiasis were isolated. The first group had poor gallbladder emptying and normal fasting gallbladder Volume; the second had normal gallbladder emptying but significantly increased fasting gallbladder Volume. CONCLUSION: Impaired gallbladder emptying and/or increased fasting gallbladder Volume probably play a role in lithogenesis. Hypomotility seems to play a significant role only for those subjects with normal fasting gallbladder Volume.

[Venous thromboembolism in Cameroon (report of 18 cases)]. / La maladie thrombo-embolique veineuse au Cameroun (a propos de 18 cas).

The purpose of this report was to describe clinical and ultrasound findings associated with venous thromboembolism of the lower extremities and pulmonary embolism observed in our department with special emphasis on the utility of venous ultrasound in the diagnosis of venous thromboembolism. Between January 1, 1998 and December 31, 1999, a total of 47 venous ultrasound procedures were carried out according to the standard technique using a Logic 400 MD system (General Electric). Deep venous thrombosis was diagnosed in 18 cases (38.3%). There were 10 men and 8 women with a mean age of 46 years (range, 24 to 71 years). Thrombosis involved the internal saphenous, popliteal, or sural vein in 12 cases, the common or deep femoral vein in 4, and the external iliac vein in 2. The most common risk factors observed in our series were surgery, predisposing conditions, history of venous thrombosis and morbid obesity (66.8% of case). Prolonged periods of bed confinement and neoplasm (lower extremity Kaposi's disease) were more uncommon (22.2%). Pulmonary embolism occurred during the observation period in six cases (33.3%) including 3 (50%) that were fatal. Based on these findings it can be concluded that although its incidence is relatively low in black African patients at risk, thromboembolic disease is often fatal and requires routine preventive treatment using heparin.

[Prolactinomas in Yaounde: analytical study of 36 consecutive cases followed in the internal medicine department of the Yaounde Hospital from 1990 to 1996]. / Les adénomes à prolactine à Yaoundé: étude analytique de 36 cas consécutifs suivis dans le service de médecine interne de l'Hôpital de Yaoundé de 1990 à 1996.

We analysed the epidemiological, clinical, biological, morphological and therapeutic characteristics of 36 cases of pituitary prolactinomas in Yaoundé, Cameroun. Diagnosis was made on the basis of neuro-ophthalmological, gynaecological and sexual symptoms associated with quantity determinations of prolactinemia, total testosterone and blood oestrogen, folliculo stimulating hormone and luteining hormone. Expected levels of prolactinemia are above 150 micrograms/l. Cerebral tomodensitometry and, where possible, magnetic resonance imaging were used. Among the 24 patients on whom a tomodensitometry was performed, 4 male patients presented macroprolactinomas; the remaining 20 patients--mostly female--had microprolactinomas. Macroprolactinomas were found in male patients only, leading to an acute ophthalmological emergency for 2 of them who were operated in Paris-France. All the patients were put on bromocriptine; this molecule has antisecretory and antiproliferative properties, which are very useful in Africa, since surgery is very expensive. Cases of resistance to the molecule exist and new dopaminergic agonists are not yet being used in Cameroon.

Predictive value of abdominal obesity cut-off points for hypertension in blacks from west African and Caribbean island nations.

BACKGROUND: Waist circumferences (WC) >/=94 cm for men and >/=80 cm for women (action level I) and >/=102 cm for men and >/=88 cm for women (action level II) have been suggested as limits for health promotion purposes to alert the general public to the need for weight loss. In this analysis we examined the ability of the above cut-off points to correctly identify subjects with or without hypertension in Nigeria, Cameroon, Jamaica, St Lucia and Barbados. We also determined population- and gender-specific abdominal adiposity cut-off points for epidemiological identification of risk of hypertension. METHODS: Waist measurement was made at the narrowest part of the torso as seen from the front or at midpoint between the bottom of the rib cage and 2 cm above the top of the iliac crest. Sensitivity and specificity of the established WC cut-off points for hypertension were compared across sites. With receiver operating characteristics (ROC), population- and gender-specific cut-off points associated with risk of hypertension were determined over the entire range of WC values. RESULTS: Predictive abilities of the established WC cut-off points for hypertension were poor compared to the specific cut-off points estimated for each population. Different values of WC were associated with increased risk of hypertension in these populations. In men, WC cut-off points of 76, 81, 80, 83 and 87 cm provided the highest sensitivity for identifying hypertensives in Nigeria, Cameroon, Jamaica, St Lucia and Barbados, respectively. The analogous cut-off points in women were 72, 82, 85, 86 and 88 cm. CONCLUSIONS: The waist cut-off points from this study represent values for epidemiological identification of risk of hypertension. For the purpose of health promotion, the decision on what cut-off points to use must be made by considering other additional factors including overall impact on health due to intervention (e.g. weight reduction) and potential burden on health services if a low cut-off point is employed. There is a need to develop abdominal adiposity cut-off points associated with increased risks for cardiovascular diseases in different societies, especially for those populations where the distribution of obesity and associated risk factors tends to be very different from those of the technologically advanced nations. International Journal of Obesity (2000) 24, 180-186

Abdominal adiposity in six populations of West African descent: prevalence and population attributable fraction of hypertension.

OBJECTIVES: The objective of this investigation was to examine the prevalence of abdominal adiposity and its association with the prevalence of hypertension among African descent populations in Nigeria, Cameroon, Jamaica, St. Lucia, Barbados, and the United States (US). RESEARCH METHOD: The data for this investigation were obtained from the International Collaborative Study on Hypertension in Blacks. Hypertension was defined as mean diastolic blood pressure > or =90 mmHg, systolic blood pressure > or = 140 mmHg or current treatment with prescribed anti-hypertension medication. Abdominal overweight was defined as waist circumference (WC) > or =94 and > or =80 cm for men and women, respectively. Abdominal obesity was defined as WC > or =102 and > or =88 cm for men and women, respectively. We estimated the site-specific prevalence of abdominal overweight and obesity across age and body mass index cut-points. We also calculated the population attributable fraction (AF) of hypertension due to abdominal adiposity. RESULTS: The prevalence of hypertension in these populations was tightly linked to abdominal adiposity. Increases in abdominal overweight accompanied an increasing degree of Westernization, rising from 6.4% and 26.3% in Nigeria, 16.5% and 62.8% in Cameroon, 15.8% and 58.6% in Jamaica, 14.3% and 62.1% in St. Lucia, 21.4% and 70.3% in Barbados to 38.9%, and 76.4% in the US for men and women, respectively. The corresponding values for abdominal obesity were 1.6% and 12.3% in Nigeria, 5.1% and 38.9% in Cameroon, 5.5% and 34.0% in Jamaica, 2.7% and 40.7% in St. Lucia, 7.8% and 44.7% in Barbados to 21.7% and 54.1% in the US for men and women, respectively. Body mass index-adjusted estimates of AF suggest that in most of these populations, especially in females, avoidance of abdominal overweight or obesity would help to curb the development of hypertension. DISCUSSION: An important public health challenge is to clarify how lifestyle factors influence risks of abdominal adiposity and ultimately the increased risk of cardiovascular diseases.

[Ultrasonic demonstration of carotid atherosclerosis in black Cameroonian adults with cardiovascular risk]. / Mise en évidence ultrasonographique de l'athérosclérose carotidienne chez l'adulte noir camerounais à risque cardiovasculaire.

The objective of this study was to determine the prevalence of carotid atherosclerosis in black Cameroonian adults presenting cardiovascular risk factors (CVRF). It was based on 77 subjects over the age of 40 years (50 men and 27 women) with at least one major CVRF, such as hypertension (HT), smoking, dyslipidaemia or diabetes mellitus. Obesity [body mass index (BMI), waist/hips ratio (W/H)] and hyperuricaemia were also taken into account. Duplex ultrasound examination of the carotid arteries was performed with a Siemens apparatus equipped with a 7.5 MHz transducer array. An atheromatous plaque was defined as medio-intimal thickening > or = 1.5 mm, with either protrusion or hyperechogenicity. Risk factors were distributed as follows in our serie: HT: 82%, Obesity: 49% (W/H) and 32% (BMI); Diabete: 32%; Smoking: 23%; Hyperuricaemia: 21%; Hypercholesterolaemia: 13%. 19 subjects (25%) (12 men and 7 women with a mean age of 63 years) presented one or more atheromatous plaques in the carotid arteries. Hyperuricaemia and hypercholesterolaemia were significantly correlated with the presence of plaques, with a marked tendency in subjects over the age of 70. In this study, hyperuricaemia and advanced age appeared to be independent arterial risk factors on multivariate analysis. In conclusion, our data show that carotid atherosclerosis does exist in our populations, especially in elderly subjects with cardiovascular risk factors. The particular role of hyperuricaemia as a predictive factor of atheromatous plaques in black Cameroonian subjects needs to be defined.

Prostatic abscesses in sub-Saharan Africa: a hospital-based experience from Cameroon.

Abscesses of the prostate are encountered less frequently today and the bacteria responsible have changed over the years. Herein we report our experience with 6 patients with varying presentations. The role of imaging techniques in diagnosis and percutaneous needle aspiration of prostatic abscesses is highlighted.

Hyperthyroide chez les malades traites par Amiodarone a Yaounde: a propos de 6 observations.[Lettre]

6 dossiers de malades sous Amiodarone ayant une hyper-thyroide par surcharge iodee sont analyses; ils representent 10 pour cent de la population d'hyperthyroidies en 4 ans. L'Amiodarone a ete prescrite comme anti-arythmique et anti-angoroux; apres une longue amelioration; l'aggravation de l'arythmie et l'angor a permis de diagnostiquer l'hyperthyroidie par surcharge iodee. En l'absence d'investigation scintigraphique en Afrique; l'iodurie de 24 heures elevee; les hormonemies thyroidiennes elevees; la TSH basse et l'absence d'anticorps antithyroidiens permettent de poser le diagnostic. L'evolution est en general bonne; apres sevrage de l'Amiodarone et mise sous propylthiouracile et corticoide. Les auteurs concluent que le malade sous Amiodarone en Afrique noire; comme ailleurs; doit beneficier d'une surveillance attentive; notamment pour la complication majeure qu'est l'hyperthyroidie par surcharge iodee

L'experience camerounaise en chirurgie cardiaque: a propos de 83 cas operes de 1985 a 1990

La chirurgie cardiaque a ete introduite au Cameroun en 1985 au CHU de Yaounde. Six missions de chirurgie cardiaque ont ete effectuees au Cameroun de juillet 1985 a avril 1990. Nous nous sommes proposes d'evaluer cette experience initiale dans notre pays et d'essayer d'etablir la courbe de survie des patients operes cardiaques. L'etude a ete essentiellement menee au CHU de Yaounde. Au total; 83 sujets dont 42 femmes et 41 hommes ont ete operes. Leur age varie de 9 a 60 ans avec une moyenne de 29 ans. Parmi ces malades 53 pour cent des sujets etaient au stade fonctionnel III et IV de la NYHA en preoperatoire et 95;3 pour cent presentaient une insuffisance cardiaque refractaire au traitement medical. Les remplacements valvulaires sur valvulopathies post-rhumatismales representaient la principale indication (77 cas). 4 cardiopathies congenitales (1 communication interauriculaire; 1 communication interventriculaire et 2 canaux arteriels persistants); 5 pericardites (2 constrictives; 1 serofibrineuse et 1 purulente) et 1 endomyocardite fibreuse ont egalement ete repertoriees. Les resultats ont ete remarquables; car ils ont permis a une grande majorite d'operes une survie d'au moins 5 ans. Cependant; le cout de la chirurgie cardiaque reste toujours eleve quoique de loin preferable a celui d'une evacuation sanitaire a l'etranger

L'experience camerounaise en chirurgie cardiaque: a propos de 83 cas operes de 1985 a 1990

La chirurgie cardiaque a ete introduite au Cameroun en 1985 au CHU de Yaounde; sous l'egide du Ministere de la Sante Publique et grace a l'impulsion de quelques pionniers camerounais; avec la collaboration des equipes chirugicales francaises de Lyon et de Marseille. Nous nous sommes proposes d'evaluer cette experience initiale dans notre pays et d'essayer d'etablir la courbe de survie des patients operes cardiaques. Au total; 83 sujets ont ete operes. leur age varie de 9 a 60 ans avec une moyenne de 29 ans. Parmi ces malades 53 pour cent des sujets etaient au stade fonctionnel III et IV de la NYHA en preoperatoire et 95;3 pour cent presentaient une insuffisance refractaire au traitement medical. [abstract terminated]

Cardiovascular disorders in Africa.

The availability of basic and reliable data on cardiovascular problems in Africans is limited and this hinders the presentation of a comprehensive review of the subject. Nevertheless, there is a strong suggestion that the spectrum and pattern of cardiovascular disorders in Africa is rapidly becoming indistinguishable from that observed in developed countries. The classic risk factors appear to be on the rise and smoking may attain levels equal to or exceeding those in many developed countries. Infectious and inflammatory cardiovascular conditions may still be the most common, although limitations in the technology available for accurate diagnosis make this difficult to verify. Rheumatic fever and rheumatic heart disease remain common, and the potential for educational and other preventive strategies is being realized in many countries. Hypertension at frequencies exceeding 5-10% in most rural areas and 12% in most urban areas, together with complications such as stroke, heart failure and renal failure, are leading causes of morbidity and mortality. Hypertension is the major public health problem in most African countries. The cardiomyopathies are a common problem, and the limited availability of specific diagnostic procedures is matched by limited therapeutic options for most Africans. The prevalence of atherosclerosis and coronary artery disease and its complications, such as myocardial infarction and other degenerative disorders, remains low, but the situation is rapidly changing, especially in urban areas where appropriate diagnostic capabilities exist. It is thought that changes or modifications in lifestyle, risk-prone behaviour, diet, cultural attitudes and certain other consequences of rapid urbanization and demographic tendencies largely explain the observed trends.(ABSTRACT TRUNCATED AT 250 WORDS)

The importance of cardiovascular research in Africa today.

Cardiovascular disorders currently receive little or no attention in most African countries. Projections based on recent studies suggest that the management of these disorders will represent a major challenge for the over-extended and shrinking health budgets of these poor nations in the very near future. Given the prevalence of such common cardiovascular conditions as hypertension, which in some cases can be 25% or higher, treatment is beyond the budgetary possibilities of any of these countries. Other conditions--including infections involving the heart and related structures, rheumatic fever and its complications, cardiomyopathies, and congenital heart disease--are also common, taken together, and recent trends suggest that ischemic heart disease may be less uncommon than was previously thought. Health planners and policy makers must be educated on the crucial role of health research in general, and cardiovascular research in particular, as a basis for formulating a rational health care policy and making managerial decisions. The needs for training and funding, and especially the leadership required to develop and sustain research activity, will require a multidisciplinary, multidirectional, collaborative approach at national and international levels, as well as firm local commitment. As is the case for most other important health problems, cardiovascular disorders are rapidly becoming a global issue and should be recognized as such.