Surgery for rheumatic mitral valve disease in sub-saharan African countries: why valve repair is still the best surgical option

Rheumatic valve disease, a consequence of acute rheumatic fever, remains endemic in developing countries in the sub-Saharan region where it is the leading cause of heart failure and cardiovascular death, involving predominantly a young population. The involvement of the mitral valve is pathognomonic and mitral surgery has become the lone therapeutic option for the majority of these patients. However, controversies exist on the choice between valve repair or prosthetic valve replacement. Although the advantages of mitral valve repair over prosthetic valve replacement in degenerative mitral disease are well established, this has not been the case for rheumatic lesions, where the use of prosthetic valves, specifically mechanical devices, even in poorly compliant populations remains very common. These patients deserve more accurate evaluation in the choice of the surgical strategy which strongly impacts the post-operative outcomes. This report discusses the factors supporting mitral repair surgery in rheumatic disease, according to the patients' characteristics and the effectiveness of the current repair techniques compared to prosthetic valve replacement in developing countries. The Pan African Medical Journal 2016;2

Correlations of left ventricular systolic function indices with aortic root systolic excursion (ARSE): A cross-sectional echocardiographic study.

BACKGROUND:Heart failure (HF), is a major public health issue globally. Echocardiography is cost-effective in the diagnosis in expert hands. This study was conducted to estimate the usefulness of Aortic Root Systolic Excursion (ARSE) as a simple and accurate measure to estimate Left Ventricular (LV) function. METHODS:This was a cross-sectional echocardiographic study among adults aged ≥ 18 years, with or without heart failure, in sinus rhythm, and with no LV out-let obstruction. We studied the correlations of ARSE with some selected indices of LV Systolic Functions. We determined optimal cut-offs of ARSE in detecting LV dysfunction. We generated a simple regression equation to best estimate LV ejection fraction according to the modified Simpson method. RESULTS:Overall 213 echocardiograms were included from 106 males (49.8%), with mean age of the participants being 52.4 (SD: 18.3) years. The rate of LV systolic dysfunction was highest with Teicholz method (17.4%) and lowest with MAPSE method (5.2%). ARSE correlated with the LV functions. This was highest for the Simpson method (r = 0.619, p<0.001), and lowest for the ITV method (r = 0.319, p<0.001). Optimal cut-offs to detect LV systolic dysfunction was ≈ 6.6 mm. For an LV ejection fraction < 55%, the sensitivity was 82.9%, and the specificity was 97.2%, with an AUROC of 91.6%.The logarithmic regression equation was best in predicting LV ejection fraction (AUC: 60.2%), followed by the power model (AUC: 56.7%), and the linear model (AUC: 53.6%). CONCLUSION:ARSE correlated well with LV systolic function. The cut-off ≤ 6.5 mm suggest LV systolic dysfunction. LV Ejection Fraction was best estimated with the generic equation: LVEF (%) = 29 x In [ARSE]

Magnitude, determinants and reasons for parallel use of plants in the management of hypertension in Cameroon: a cross-sectional study

Background: Most people living in sub-Saharan Africa tend to use medicinal plants to treat various ailments including hypertension. The aim of this study was to gather data on the magnitude, determinants, and reasons for their use in the setting of hypertension in our setting.Method: We carried out a cross-sectional study in a group of patients with hypertension in Yaounde. This study was carried out between November 2016 and April 2017. In a face-to-face interview, we gathered data on socio-demography, use of medicinal plants, parts of plant used, method of preparation, and prescriber of herbal remedy.Results: Overall, 410 individuals (152 males and 258 females) participated in the study. The mean age was 66.6 ± 11.1 years. Use of medicinal plants was reported by 149 patients (36.3%, [95% CI: 32 – 41]). The most frequently used plants were Annona muricata (47.7%), Allium sativum (37.6%), and Cymbopogon citratus (37.6%). The main reason underlying the parallel use of plants was a supposed synergistic effect (34.9%). The most used parts of plants were the leaves (81.2%). Decoction was the most frequent mode of preparation (68.5%). Friends mostly recommended the herbal remedy (51.7%). No factor was associated with the parallel use of medicinal plants.Conclusion: More than one in three patients with hypertension use medicinal plants mostly as decoction of the leaves besides conventional treatment. This use was mainly supported by a supposed synergistic action.Keywords: Plants, Hypertension, Cameroo

Factors predicting in-hospital all-cause mortality in COVID 19 patients at the Laquintinie Hospital Douala, Cameroon.

Despite being a global pandemic, little is known about the factors influencing in-hospital mortality of COVID-19 patients in sub-Saharan Africa. This study aimed to provide data on in-hospital mortality among COVID-19 patients hospitalized in a single large center in Cameroon. A hospital-based prospective follow-up was conducted from March 18 to June 30, 2020, including patients >18 years with positive PCR for SARS-COV-2 on nasopharyngeal swab admitted to the Laquintinie Douala hospital COVID unit. Predictors of in-hospital mortality were assessed using Kaplan Meir survival curves and Weibull regression for the accelerated time failure model. Statistical significance was considered as p < 0.05. Overall 712 patients (65,7% men) were included, mean age 52,80 ± 14,09 years. There were 580 (67,8% men) in-hospital patients. The median duration of hospital stay was eight days. The in-hospital mortality was 22.2%. Deceased patients compared to survivors were significantly older, had a higher temperature, respiratory rate, and heart rate, and lowest peripheral oxygen saturation at admission. After adjusting for age, sex, and other clinical patient characteristics, increased heart rate, increased temperature, decreased peripheral oxygen saturation. The critical clinical status was significantly associated with increased in-hospital mortality. In contrast, hospitalization duration greater than eight days and the use of hydroxychloroquine (HCQ) + azithromycin (AZM) therapy was associated with decreased risk of in-hospital mortality. One in five hospitalized COVID-19 patients die in a low-middle income setting. Critical clinical status, dyspnea, and increased heart rate were predictors of in-hospital mortality. This study will serve as a prerequisite for more robust subsequent follow-up studies. Also, these results will aid in revising national guidelines for the management of COVID-19 in Cameroon