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.

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.

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]