Spontaneous subarachnoid hemorrhage in a referral health Centre in Central Africa.

Background: Spontaneous subarachnoid hemorrhage (sSAH) is a medicosurgical emergency with high morbidity and mortality. The aimed of this study was to describe the clinical features and outcome of sSAH in Cameroon. Methods: We reviewed medical records of patients aged ≥15 years old, admitted for sSAH from Januray 2011 to December 2020 in the Douala General Hospital. The diagnosis of sSAH was confirmed by neuroimaging (CT scan or MRI). Clinical and radiological severities were assessed by the WFNS score and the modified Fisher score respectively. Factors associated to in-hospital mortality was identified using cross-table (RR and 95%CI). Results: Among the 111 cases of sSAH reviewed in emergencies records, we included 70 patients. The mean age was of 55.6 ± 13.6 years. Female were predominant (57.1%). Altered consciousness was the main clinical feature (55.7%). The WFNS score was grade 4-5 in 54.3% of patients. And 75.7% of cases presented a modified Fisher score of 3-4. Ruptured of intracranial aneurysm was the most common etiology (46.2%). Endovascular treatment and/or surgical treatment were not avaible. Hospital-based mortality was 40% and factor associated with death were Altered consciousness (RR: 4.3, 95%CI:1.52-12.33, p = 0.004), coma (RR: 23.9, 95%CI:2.85-200.62, p = 0.004), WFNS grade 5 (RR: 18.2, 95%CI:3.7-92.3, p < 0.001), and hospital length ≤ 7 days (RR: 13.5, 95%CI:4.28-42.56, p < 0.001). Conclusion: Mortality and disability of sSAH are still high in our setting. Further studies with prospective follow up of patients are needed to determine the long-term outcome of these patients.

Spectrum of central nervous system infections in a tertiary health care centre in Cameroon.

BACKGROUND: Central nervous system (CNS) infections are serious and debilitating diseases with significant mortality, and high prevalence in the context of human immunodeficiency virus (HIV) pandemic in Africa. However, their diagnosis remains challenging due to outdated technical platform. We aimed to determine the frequency of CNS infection and to describe the epidemiological, clinical and outcome of this at the Douala General Hospital (DGH), Cameroon. To carry out this study, we collected the medical records of patients hospitalized for CNS infections in the internal medicine department of DGH from January 2015 to December 2019. RESULTS: Among 8430 files reviewed, 336 cases of CNS infection were identified giving a frequency of CNS infection of 3.99% among which 204 files were included in the study (54.4% were male). HIV infection was found in 147 patients (72.1%) with 38.1% (n = 56) of them on regular follow-up. The most common clinical signs were fever (84.8%), headache (68.6%), meningeal syndrome (38.7%), and seizures (36.3%). Cerebral toxoplasmosis (24.5%), cryptococcal meningitis (21.1%), and acute bacterial meningitis (8.3%) were leading aetiologies. Of the 143 CSF samples, 70.6% (n = 101) were sterile. The in-hospital mortality rate was 23.5% with CNS infection of unknown cause (22.1%) be independently associated to this [OR = 2.24; 95% CI 1.04-4.80, p = 0.039]. CONCLUSION: Clinical presentations of CNS infections are same with classical data. HIV-related opportunistic infections are the main aetiologies. About one over four patients with CNS died. Two thirds of CSF are sterile using basic laboratory assessment giving a need to identify simple tests to increase sensibility and specificity of diagnostic tools in our setting.

Chronic heart failure, selected risk factors and co-morbidities among adults treated for hypertension in a cardiac referral hospital in Cameroon.

BACKGROUND: Information on clinical characteristics of heart failure (HF) among Africans with hypertension is needed to help define the burden of hypertension in this population, but currently there is little data available. AIMS: To determine the clinical characteristics of HF, related risk factors and co-morbidities among adult Cameroonians treated for hypertension. METHODS AND RESULTS: Medical files of 1218 patients with hypertension followed at the cardiac clinic of Yaounde General Hospital were evaluated over a 10-year period from 1995 to 2005. One hundred and forty (11.5%) patients with clinical HF or asymptomatic left ventricular dysfunction were included in the present analysis. Ages ranged from 26 to 84 years (mean 54.9 years) and 86 (61.4%) were men. Systolic dysfunction and isolated diastolic HF were found in 64% and 23% of patients, respectively. Seventy nine (56.4%) patients had at least one co-morbidity and 43 (30.7%) had multiple co-morbidities. Co-morbidities included: renal impairment (24.3%), overweight and obesity (20.7%), chronic obstructive pulmonary disease (17.1%), gout (16.4%), anaemia (15.7), diabetes mellitus (13.5%), atrial fibrillation (12.9%), stroke (9.3%), and ischaemic heart disease (5.7%). CONCLUSIONS: HF is frequent among Cameroonian patients treated for hypertension and is regularly associated with co-morbidities. Efforts are needed to improve the control of hypertension and enhance early detection of these co-morbidities in this context.

Serum Uric Acid Is Associated with Poor Outcome in Black Africans in the Acute Phase of Stroke.

BACKGROUND: Prognostic significance of serum uric acid (SUA) in acute stroke still remains controversial. OBJECTIVES: To determine the prevalence of hyperuricemia and its association with outcome of stroke patients in the Douala General Hospital (DGH). METHODS: This was a hospital based prospective cohort study which included acute stroke patients with baseline SUA levels and 3-month poststroke follow-up data. Associations between high SUA levels and stroke outcomes were analyzed using multiple logistic regression and survival analysis (Cox regression and Kaplan-Meier). RESULTS: A total of 701 acute stroke patients were included and the prevalence of hyperuricemia was 46.6% with a mean SUA level of 68.625 ± 24 mg/l. Elevated SUA after stroke was associated with death (OR = 2.067; 95% CI: 1.449-2.950; p < 0.001) but did not predict this issue. However, an independent association between increasing SUA concentration and mortality was noted in a Cox proportional hazards regression model (adjusted HR = 1.740; 95% CI: 1.305-2.320; p < 0.001). Furthermore, hyperuricemia was an independent predictor of poor functional outcome within 3 months after stroke (OR = 2.482; 95% CI: 1.399-4.404; p = 0.002). CONCLUSION: The prevalence of hyperuricemia in black African stroke patients is quite high and still remains a predictor of poor outcome.

Comparison of the clinical profile of Parkinson's disease between Spanish and Cameroonian cohorts.

BACKGROUND: There are limited data in terms of the clinical profile of Parkinson's disease in sub-Saharan African patients. OBJECTIVE: To compare the clinical profile and access to standard antiparkinsonian therapies of a Cameroonian cohort of patients with an age, sex, and disease duration-matched Spanish cohort (Longitudinal Study of Parkinson's disease, ELEP). METHODS: Observational, cross-sectional design. Demographic data were collected and the following ELEP assessments were applied: Scales for Outcomes in Parkinson's disease (SCOPA) Motor, Autonomic, Cognition, Sleep and Psychosocial; Hoehn and Yahr staging; modified Parkinson Psychosis Rating Scale; Cumulative Illness Rating Scale-Geriatrics; Hospital Anxiety and Depression Scale; pain and fatigue visual analog scales; Zarit, and EuroQoL. RESULTS: 74 patients with idiopathic Parkinson's disease were included (37 from each country) with a mean age of 64.4±10.5 years old, 70.3% males, and mean disease duration of 5.6±5.9 years. Compared to the Spanish cohort, Cameroonians were intermittently treated, less frequently received dopaminergic agonists (p<0.001), had a trend for taking lower doses of levodopa (p=0.06), and were more frequently on anticholinergics (p<0.0005). Cameroonians were more severely impaired in terms of motor (Hoehn Yahr stage, p=0.03; SCOPA-Motor, p<0.001), cognitive status (p<0.001), anxiety and depression (p<0.001), psychosis (p=0.008), somnolence, fatigue and pain (p<0.001, respectively), caregiver burden (p<0.0001), and quality of life (p=0.002). Instead, autonomic, comorbidity, and nocturnal sleep problems were similarly found. CONCLUSIONS: Limited and intermittent access to dopaminergic drugs has a negative impact on motor symptoms, nonmotor symptoms and quality of life in patients with Parkinson's disease and their caregivers.

Crises epileptiques au cours de la toxoplasmose cerebrale chez les patients immunodeprimes au V IH

Décrire les caractéristiques des crises épileptiques au cours de la toxoplasmose cérébrale (TC) chez les patients immunodéprimés au VIH à l'Hôpital Général de Douala (HGD).Matériel méthodes Il s'agissait d'une étude descriptive rétrospective des cas de TC diagnostiquée entre janvier 2000 et décembre 2012. La prévalence, le type, la fréquence des crises épileptiques et les thérapeutiques antiépileptiques ont été étudiées. Les patients avec un antécédent de crises épileptiques étaient exclus. Le test de Khi-2 a été utilisé pour rechercher les facteurs associés à la survenue des crises épileptiques tandis que le test de Student a été utilisé pour comparer les moyennes. P < 0,05 était considéré comme statistiquement significatif. Résultats 146 patients étaient inclus avec 78 femmes pour un sex-ratio de 0,87 en faveur des femmes. L'âge moyen était de 39,38 ± 9,88 ans. Le taux de CD4 moyen était de 115,63 ± 142,70 éléments/ml. La prévalence des crises épileptiques était de 45,2% et 61% des épileptiques étaient répétées. Les crises épileptiques généralisées prédominaient avec 75,8%. Seuls la fièvre (p < 0,012), les céphalées (p < 0,004), le syndrome d'hypertension intracrânienne (p < 0,038), un taux de CD4 < 50/ mm3 (p < 0,02) et un taux d'hémoglobine <10g/dl (p < 0,017) étaient statistiquement associés à la survenue des crises épileptiques. Un traitement antiépileptique était prescrit chez 43,2% des patients. Conclusion Les crises épileptiques sont fréquentes au cours de la toxoplasmose cérébrale. Elles peuvent se répéter et justifier d'un traitement antiépileptique

Prevalence du tabagisme chez le personnel de l'Hopital General de Douala; Cameroun

Introduction: La prevalence du tabagisme parmi le personnel de sante hospitalier au Cameroun n'est pas connue alors que le tabagisme est en expansion dans ce pays avec 13;2de fumeurs selon l'OMS. Pour combler ce manque une enquete sur les consommations; les connaissances; opinions et attitudes vis-a-vis des fumeurs a ete conduite a l'Hopital General de Douala; l'un des hopitaux de reference du Cameroun. Methodes: Du 1er au 30 Avril 2010; des questionnaires anonymes ont ete distribues par des enqueteurs dans les services ou via les surveillants et recueillis et analyses de facon anonyme. Resultats: Sur 402 questionnaires distribues 277 ont ete recuperes. La prevalence de fumeurs est de 3;6 parmi les soignants et de 9;4 parmi les autres personnels soit en moyenne sur l'ensemble de l'hopital 5;4. Les produits fumes etaient toujours des cigarettes. L'initiation du tabagisme a souvent ete tardive (21;5 ans) et la dependance est absente ou faible chez 33 des fumeurs. Les personnes pensent que c'est leur devoir de questionner sur le tabac et de prendre en charge les fumeurs; mais ils sont presque un sur deux a ignorer la loi Camerounaise. Conclusion: Le tabagisme chez le personnel hospitalier est une realite au Cameroun ; le personnel soignant et les pouvoirs publics devraient s'impliquer davantage dans la lutte contre ce fleau qui est en expansion dans les pays du sud