Cardiovascular risk and stroke mortality in persons living with HIV: a longitudinal study in a hospital in Yaounde

Introduction: HIV infection is a well-known risk factor for stroke, especially in young adults. In Cameroon, there is a death of data on the outcome of stroke among persons living with HIV (PLWH). This study aimed to assess the cardiovascular risk profile and mortality in PLWH who had a stroke. Methods: this was a retrospective cohort study of all PLWH aged ≥18 years admitted for stroke between January 2010 and December 2019 to the Cardiology Unit of the Yaoundé Central Hospital, Cameroon. Cardiovascular risk was estimated using the modified Framingham score, with subsequent dichotomization into low and intermediate/high risk. Mortality was assessed on day 7 during hospitalization (medical records), at one month, and one year by telephone call to a relative. Results: a total of 43 PLWH who had a stroke were enrolled. Their mean age was 52.1 (standard deviation 12.9) years, most of them were female (69.8%, n = 30). There were 25 (58.1%) patients on concomitant antiretroviral therapy. The Framingham cardiovascular risk score at admission was low in 29 patients (67.4%) and intermediate to high in 14 patients (32.6%). Ischemic stroke was the most common type of stroke in 36 persons (83.7%). The length of hospital stay was 11.4 (interquartile range 9.2-13.7) days. Mortality at 1 year was 46.5% (n = 20). Conclusion: stroke mortality was high in this population of PLWH. Most patients had a low Framingham score, suggesting that this risk estimation tool underestimates cardiovascular risk in PLWH

A predominance of hypertensive heart disease among patients with cardiac disease in Buea, a semi-urban setting, South West Region of Cameroon

Abstract Objective The pattern of heart disease is diverse within and among world regions. The little data on the spectrum of heart disease in Cameroon has been so far limited to major cities. We sought to describe the pattern of heart disease in Buea, the South West Region of Cameroon, a semi-urban setting. This was a descriptive cross-sectional study. Between June 2016 and April 2017 the echocardiography register of the Buea Regional Hospital was surveyed. We extracted data on the age, sex and echocardiographic diagnosis. Results Out of 529 patients who underwent echocardiography, 239 (45.2%) had a definite heart disease. There were 137 (57.3%) females. The mean age was 58 years (range 3–94 years). The most common echocardiographic diagnoses were hypertensive heart disease (43.2%), dilated cardiomyopathies (17.6%), ischemic heart diseases (9.6%), and cor pulmonale (8.8%). Rheumatic heart disease affected 6.7% of the patients. The most common rheumatic heart disease was mitral stenosis followed by mitral regurgitation. Congenital heart disease represented 2.1% and 5 patients (2.1%) had pulmonary hypertension. Hypertensive heart disease is the most common cardiac disease in this semi-urban region in Cameroon. Rheumatic heart disease still affects a sizable proportion of patients. Prevention of cardiac disease in our setting should focus on mass screening, the treatment and control of hypertension

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

Relative faible taux de mortalité de la COVID-19 au Cameroun : et si l’âge était le principal facteur ?

Depuis le début de la pandémie à COVID-19, un scénario catastrophique en termes de mortalité avait été prédit en Afrique subsaharienne. Dans cette correspondance, à partir des données de mortalité belge selon l’âge, nous réalisons une extrapolation à la population du Cameroun. Cette extrapolation montre que même avec le scénario belge, on devrait s’attendre à environ 2.319 décès par COVID-19 au Cameroun, soit une mortalité par habitant 10,3 fois moindre. En conclusion, la jeunesse de la population camerounaise pourrait être un des principaux facteurs de faible mortalité liée à la COVID-19 dans ce pays. Cependant des études sont nécessaires pour éliminer d’autres facteurs, notamment génétiques et environnementaux.[Relatively low mortality rate of COVID-19 in Cameroon: what if age was the main factor?] Since the beginning of the COVID-19 pandemic, a catastrophic scenario in terms of mortality was predicted in Sub-Saharan Africa. In this correspondence, we have compared adjusted case fatality rate of Belgian to that of Cameroon. Our estimates showed that, even with the Belgian scenario, about 2319 COVID-19 deaths should be expected in Cameroon, i.e. 10.3 times lower per inhabitant mortality. In conclusion, the youthfulness of the Cameroonian population could be the main factor of low mortality rate related to COVID-19 in this country. However, studies are needed to eliminate other factors, notably genetic and environmental

Challenges in the diagnosis and management of anti-phospholipid syndrome: a case from Cameroon

Abstract Background Anti-phospholipid syndrome (APLS) is a condition characterized by the presence of raised plasma levels of anti-phospholipid antibodies associated with thrombo-embolic disease and/or poor obstetrical outcomes in women. The epidemiology of APLS is unknown in most sub-Saharan African countries due to limited access to diagnosis tools. Case summary We report the case of APLS in a 29-year-old obese woman that was preceded by pre-eclampsia and fetal death. The diagnosis of APLS was made during a thrombo-embolic episode 4 years after the poor obstetrical outcome. Her management was challenging, as she had three thrombo-embolic events within 18-months despite treatment with anti-coagulant (acenocoumarol). Conclusion This case highlights the need for screening for APLS after an episode of hypertensive disease in pregnancy or fetal death, and the challenges faced with the treatment, such as resistance to antivitamin K anti-coagulants and the desire for maternity

Vascular hyperreactivity in black Cameroonian hypertensive and normotensive patients: A comparative study

Introduction: Vascular hyperreactivity is a risk factor and a factor predicting hypertension (high blood pressure). Unlike other continents where several studies were carried out, it has rarely been studied in black Africa in general and in  Cameroon in particular.Methods: Vascular reactivity was measured by the cold test. Vascular  hyperreactivity was defined as an increase in blood pressure > 20 mmHg for systolic and/or > 15 mmHg for diastolic. Khi2, Man-Withney, Wilcoxon's signed ranks and logistic regression tests were used for statistical analysis.Results: A total of 31 hypertensive and 31 normotensive patients matched by age and sex participated in this study. Vascular hyperreactivity was present in 77.4%hypertensive patients and 51.6% normotensive patients. There was a significant association between vascular hyperreactivity and hypertension [OR = 3.2 (1.07 - 9.63), p = 0.034]. The median arterial pressure was higher in responders compared to non-responders in the normotensive group. Age > 45 years, female sex, obesity and family history of hypertension appeared to be associated with vascular hyperreactivity, but only in normotensive patients.Conclusion: Vascular hyperreactivity appears to be a risk factor for high blood pressure in black Cameroonians. Itappeared to be associated with low blood pressure, age, sex, obesity and family history of hypertension but this was only in the normotensive. Key words: Vascular hyperreactivity, high blood pressure, black Cameroonian, cold tes

Poor glycemic control impacts heart rate variability in patients with type 2 diabetes mellitus: a cross sectional study

Abstract Objective We aimed to determine and compare HRV parameters in poorly and well controlled type 2 diabetes. 54 normotensive type 2 diabetes patients without clinical signs of CAN were enrolled; 29 poorly controlled (HbA1c ≥ 7%) and 25 controls matched for age, sex and BMI. HRV analysis was performed using 24-h ambulatory ECG, with automatic estimation of the time and frequency domain ranges. Comparisons were performed using Mann–Whitney test. Results We included 54 participants (26 males) aged 56 years [43–62], with known duration of diabetes 3 years [1–7]. HbA1c was 10.1% [9.1–11.9] vs 5.3% [5.1–6.3] (p < 0.001). Blood pressure was 126 mmHg [121–130] vs 124 mmHg [113–133] in the poorly controlled group and the well-controlled group respectively (p = 0.5). 24-h mean heart rate was significantly higher in poorly controlled vs well controlled patients (79 bpm [77–83] vs 75 bpm [69–79], p = 0.006). In the time domain analysis, markers of the overall variability were lower and thus altered in the poorly controlled group (SDNN: 102 ms [90.5–111.1] vs 112.3 ms [104.4–131.2], p = 0.01 and SDANN 88 ms [72.9–99.7] vs 97.8 ms [91.8–114.5], p = 0.01). The frequency domain analysis showed trends towards lower values of sympathovagal balance markers in the poorly controlled group. Reduced HRV is associated with poorly controlled type 2 diabetes mellitus and may be an early marker in clinical practice

MOESM3 of Prevalence and determinants of pulmonary hypertension in a group of Cameroonian patients without chronic lung disease: a cross-sectional echocardiographic study

Additional file 3: Table S3. Determinants of pulmonary hypertension without chronic lung disease

Evaluation of pharmacological management of acute hypertensive heart failure in two Reference Hospitals of Yaoundé: a cross-sectional study

Introduction: Heart failure is a major cause of cardiovascular mortality and morbidity in sub-Saharan Africa with hypertension being one of its main drivers. We aim to assess the pharmacologic management of acute heart failure secondary to hypertensive heart disease in two reference hospitals of Yaoundé.Methods: This was a retrospective cross-sectional study spanning from January 2017 to December 2018. It was carried out in the cardiology units of the Yaoundé Central hospital and General hospital. Patients’ medical records were used for data collection. We included all patients aged 18 years or more, who were admitted for acute heart failure secondary to hypertensive heart disease and who had two-dimensional echocardiography with reduced ejection fraction and/or signs of diastolic dysfunction.Results: We found 159 patients who met the inclusion criteria. The mean age was 69.5 ± 12.9 years with a sexratio of 0.73. There was a greater proportion of patients with preserved left ventricular ejection fraction&nbsp; compared to those who had mid-range or reduced left ventricular ejection fraction. Almost all 157 (98.7%) ofthe patients were treated with diuretics (loop diuretics and/or thiazides) and 15 (9.4%) with vasodilators (nitrates). Angiotensin converting enzyme inhibitors were administered to 100 (62.9%) patients and angiotensin II receptor blockers to 16 (10.1%) patients. None of them have received an inotropic agent. The inhospital dead rate was25 (15.7%) and there was no significant difference between those who received diuretics alone or in combination with vasodilators.Conclusion: Loop diuretics are the first-line drugs used for treatment of acute hypertensive heart failure in Yaoundé. Only a few patients were treated with vasodilators. More multicenter research with bigger samples sizes are needed to determine the optimal treatment for the management of acute HF in Sub-Saharan Africa. Keywords: pharmacologic management, acute heart failure, hypertensive heart disease, Yaoundé French abstract: Evaluation du traitement pharmacologique de l’insuffisance cardiaque d’origine hypertensive dans deux hôpitaux de référence de Yaoundé : une étude transversaleIntroduction. L’insuffisance cardiaque est une cause majeure de morbi-mortalité cardiovasculaire en Afrique subsaharienne dont l’hypertension artérielle constitue une des principales causes. Nous avons voulu évaluer le traitement pharmacologique de l’insuffisance cardiaque congestive due à la cardiopathie hypertensive chez des patients Camerounais. Méthodes : Il s’agissait d’une étude transversale rétrospective menée à l’hôpital central et l’hôpital général de Yaoundé sur la période allant de Janvier 2017 à Décembre 2018. Les données sociodémographiques, cliniques et thérapeutiques ont été collectées dans les dossiers médicaux des patients. Nous avons inclus des patients âgés d’au moins 18 ans, admis pour prise en charge d’une insuffisance cardiaque congestive sur cardiopathie hypertensive et ayant une échocardiographie bidimensionnelle avec une diminution de la fraction d’éjection et/ou une dysfonction diastolique. Résultats : Nous avons retrouvé des dossiers de 159 patients remplissant les critères d’inclusion. L’âge moyen des patients était de 69,5 ± 15,9 ans avec un sex-ratio de 0,73. La plus grande proportion des patients avait une fraction d’éjection préservée 72 (45,3%). La quasi-totalité des patients 157 (98,7%) était traitée avec des diurétiques (de l’anse et/ou thiazidiques) et 15 (9,4%) avec des vasodilatateurs (dérivés nitrés). Aucun patient n’avait reçu d’inotrope. Les inhibiteurs de l’enzyme de conversion ont été prescrits chez 100 (62,9%) patients et le antagoniste des récepteurs de l’angiotensine II chez 16 (10,1%) patients. La mortalité hospitalière était de 25 (15,7%) et il n’y avait aucune différence significative entre les patients traités par diurétiques seuls ou en combinaison avec les vasodilatateurs. Conclusion : Les diurétiques de l’anse représentent le traitement de première ligne de l’insuffisance cardiaque congestive à Yaoundé. Très peu de patients ont été traités avec des vasodilatateurs. Des études ultérieures multicentriques portant sur un plus grand échantillonnage sont nécessaires afin de mieux préciser le traitement optimal de prise en charge de l’insuffisance cardiaque congestive en Afrique Sub-Saharienne. Mots clés : traitement pharmacologique, insuffisance cardiaque aigue, cardiopathie hypertensive, Yaoundé