Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction

Acute aortic dissection is the most frequent and deadly presentation of acute aortic syndromes. Its incidence is estimated at three to four cases per 100 000 persons per year. Its clinical presentation may be misleading, with misdiagnosis ranging between 14.1 and 38% in many series. A late diagnosis or absence of early and appropriate management is associated with mortality rates as high as 50 and 80% by the third day and second week, respectively, especially in proximal lesions. We report on the case of a 53-year-old man who presented with type A aortic dissection, misdiagnosed as acute myocardial infarction, who later died on day 12 of hospitalisation. Although a relatively rare condition, poor awareness in Africa probably accounted for the initial misdiagnosis. Thorough investigation of acute chest pain and initiation of clinical registries are potential avenues to curb related morbidity and mortality

Aspects épidémiologiques, cliniques et échocardiographiques des cardiopathies congénitales chez les nouveaux nés et nourrissons à l’Hôpital Général de Douala

Introduction : les cardiopathies congénitales sont responsables de 3% de décès infantile dans le monde. Elles constituent la principale malformation humaine et sont encore sous diagnostiquées en Afrique. Leurs conséquences sont dramatiques, avec un taux élevé de morbidité et de mortalité. L’objectif de notre étude était d’évaluer les aspects épidémiologiques, cliniques et échocardiographiques des cardiopathies congénitales chez les nouveaux nés et nourrissons à l’Hôpital Général de Douala. Méthodologie : nous avons mené une étude descriptive, transversale et rétrospective portant sur 283 dossiers des nouveaux nés et nourrissons reçus à l’Unité de Cardiologie de l’Hôpital Général de Douala sur une période de dix ans de janvier 2006 à décembre 2015. Les données recherchées comprenaient l’âge, le sexe, les antécédents de prématurité, petit poids de naissance, symptômes et signes cliniques présentés, le diagnostic échocardiographique. Les différences ont été considérées comme significatives pour p<0,05. Résultats : Sur les 283 participants, l’âge moyen était de 120 jours et 17,1 % de la population était des nouveaux nés. Le souffle cardiaque était le signe le plus représenté 60%, suivi de la cyanose 14,9% et 92% de la population ne présentait aucun symptôme. Les cardiopathies avec shunt gauche-droit représentaient 56% et leur taux était significativement plus élevée chez les nouveaux nés (p=0,008). De même, le nombre de transposition des gros vaisseaux était significativement plus élevé chez les nouveaux nés (4,3% vs 0% ; p=0,029). La communication interventriculaire, la sténose pulmonaire, le canal artériel persistant et la communication interauriculaire étaient les cardiopathies les plus fréquentes avec des taux respectifs de 32,7% ; 23,6% ; 16% et 14,5%. Conclusion : Les cardiopathies congénitales sont présentes au Cameroun. Leur recherche chez les nouveaux nés et les nourrissons devant des signes d’appel reste un moyen efficace pour réduire la morbi-mortalité. Mots clés : cardiopathies congénitales, nouveaux nés, nourrissons, Douala English Title: Epidemiological, clinical and echocardiographic aspects of heart disease births in newborns and infants at the General Hospital of Douala Introduction: congenital heart disease is responsible for 3% of infant deaths worldwide. They constitute the main human malformation and are still under diagnosed in Africa. Their consequences are dramatic, with a high rate of morbidity and mortality. The objective of our study was to assess the epidemiological, clinical and echocardiographic aspects of congenital heart disease in newborns and infants at the Douala General Hospital. Methodology: we conducted a descriptive, cross sectional and retrospective study on 283 files of newborns and infants received at the Cardiology Unit of the Douala General Hospital over a ten-year period from January 2006 to December 2015. The data searched included age, gender, history of prematurity, low birth weight, symptoms and clinical signs presented, echocardiographic diagnosis. The differences were considered significant for p <0.05. Results: Of the 283 participants, the average age was 120 days and 17.1% of the population was newborn. Heart murmur was the most represented sign 60%, followed by cyanosis 14.9% and 92% of the population had no symptoms. Heart disease with left-to-right shunt represented 56% and its rate was significantly higher in newborns (p = 0.008). Likewise, the number of transpositions of large vessels was significantly higher in newborns (4.3% vs 0%; p = 0.029). Interventricular communication, pulmonary stenosis, persistent arterial canal and interauricular communication were the most frequent heart diseases with respective rates of 32.7%; 23.6%; 16% and 14.5%. Conclusion: Congenital heart diseases are present in Cameroon. Their search for newborns and infants in the presence of warning signs remains an effective way to reduce morbidity and mortality.Keywords: congenital heart disease, newborns, infants, Doual

Santé parodontale et hypertension artérielle : étude pilote à l’Hôpital Général de Douala

English Title: Periodontal health and Arterial hypertension: pilot study at the Douala General Hospital Introduction : L’hypertension artérielle (HTA) constitue le facteur de risque cardiovasculaire majeur dans le monde. Les études  scientifiques récentes rapportent un lien de causalité entre la parodontite et l’HTA. L’objectif de ce travail était d’évaluer la santé parodontale des patients hypertendus suivis à l’Hôpital Général de Douala. Matériels et Méthode : Une étude transversale a été menée sur une durée de 2 mois du 15 Janvier au 20 Mars dans les services de Cardiologie et de Stomatologie de l’Hôpital Général de Douala au Cameroun. Pour être inclus dans l’étude le patient devait être âgé de 30 ans au moins, hypertendu et accepter de participer à l’étude. Chaque patient a bénéficié de 2 mesures de pression artérielle brachiale à l’aide d’un tensiomètre automatique. L’HTA était considérée contrôlée chez les participants avec une PA<140/90 mmHg sous traitement antihypertenseurs. Un sondage parodontal a permis de recueillir les mesures de Profondeur de Poche (PP) et de Perte d’Attache Clinique (PAC). La parodontite a été définie selon les critères du Centers for Disease Control and Prevention et l'American  Academy of Periodontology 2007. Résultats : 80 patients ont accepté de participer à l’étude. L’âge moyen de la population était de 57 ± 10 ans. Le sexe ratio H/F était de  0,7. La durée moyenne de l’HTA était de 9 ± 8 ans. L’HTA était contrôlée chez 17% d’entre eux. La fréquence de la parodontite était de 46%, soit 22,5% pour la forme modérée, 15% pour la forme légère et 8,8% pour la forme sévère. La parodontite légère était plus fréquente chez les hypertendus contrôlés que chez ceux non contrôlés (35,5% versus 9,5% p=0,02). La parodontite sévère a été décrite uniquement chez les non contrôlés. Conclusion : Les patients hypertendus de l’Hôpital Général de Douala présentent une fréquence élevée de parodontite. Mots clés : Santé Parodontale, Parodontite, Hypertension Artérielle, Contrôle, Hôpital Général, Douala

Resting heart rate predicts all-cause mortality in sub-Saharan African patients with heart failure: a prospective analysis from the Douala Heart failure registry (Do-HF)

Background: Higher resting heart rate (HR) is associated with mortality amongst Caucasians with heart failure (HF), but its significance has yet to be established in sub-Saharan Africans in whom HF differs in terms of characteristics and etiologies. We assessed the association of HR with all-cause mortality in patients with HF in sub-Saharan Africa. Methods: The Douala HF registry (Do-HF) is an ongoing prospective data collection on patients with HF receiving care at four cardiac referral services in Douala, Cameroon. Patients included in this report were followed-up for 12 months from their index admission, for all-cause mortality. We used Cox-regression analysis to study the association of HR with all-cause mortality during follow-up. Results: Of 347 patients included, 343 (98.8%) completed follow-up. The mean age was 64±14 years, 176 (50.7%) were female, and median admission HR was 85 bpm. During a median follow-up of 12 months, 78 (22.7%) patients died. Mortality increased steadily with HR increase and ranged from 12.2% in the lower quartile of HR (≤69 bpm) to 34.1% in the upper quartile of HR (>100 bpm). Hazard ratio of 12-month death per 10 bpm higher HR was 1.16 (1.04–1.29), with consistent effects across most subgroups, but a higher effect in participants with hypertension vs. those without (interaction P=0.044). Conclusions: HR was independently associated with increased risk of all-cause mortality in this study, particularly among participants with hypertension. The implication of this finding for risk prediction or reduction should be actively investigated

Prevalence and risk factors of pre‐hypertension and high blood pressure among adolescents in Cameroonian schools

Abstract Blood pressure (BP) is the main driver of mortality with 12.8% of all deaths worldwide. Adolescents are not spared, precisely in Cameroon where they constitute more than half of its population. The objective of our work was to describe the prevalence and risk factors of pre‐hypertension and high blood pressure (HBP) among adolescents in Cameroonian schools. Descriptive study over 5 months; from January to May 2019. The study population consisted of students from private and public schools in the city of Douala. Sociodemographic, anthropometric, and personal background data were collected. Physical activity (PA) was assessed using the short International Physical Activity Questionnaire (IPAQ). Multivariate logistic regression was used to determine factors associated with pre‐hypertension and HBP. Differences were considered significant for p < .05. We recruited 771 students with an average age of 16 ± 1 years with female predominance (51.4%). The prevalences of pre‐hypertension and HBP were 6.6% and 3%, respectively. Overweight/obesity (OR = 4.6; p < .0001), hyperglycemia [(OR = 4.06; p = .001)] physical inactivity (OR = 1.85; p = .019), and public institutions (OR = 1.87; p = .02) were associated with pre‐hypertension. Similarly, overweight/obesity (OR = 2.99; p = .022), hyperglycemia (OR = 14.05; p < .0001), and physical inactivity (OR = 8.58; p < .0001) were correlated with HBP. Pre‐hypertension and HBP are high in Cameroonian school adolescents and their risk factors are overweight/obesity, hyperglycemia, and physical inactivity

Clinical outcome of patients with venous thromboembolism on Rivaroxaban versus vitamin K antagonists : A preliminary report from Douala, Cameroon

Background: Direct Oral Anticoagulants (DOACs) which are increasingly used for the management of Venous Thromboembolism (VTE) have demonstrated efficacy and safety in clinical trials. However, little is known on outcomes in those managed with DOACs compared to Vitamin K Antagonists (VKAs) in routine clinical practice in Africa. In this preliminary study, we sought to compare the non-fatal clinical outcomes in VTE patients managed with Rivaroxaban versus VKAs in Douala. Materials and Methods: This preliminary study analyzed medical records of VTE patients managed with oral anticoagulants over a 3-year retrospective period in Douala General Hospital and Douala Cardiovascular Center. Outcomes of interest included bleeding, recurrent VTE and post-thrombotic syndrome. Data was analyzed using SPSS version 23. Results: Eighty-seven medical records were identified; Deep venous thrombosis (DVT) was diagnosed in 36.8% and 13.8% had both DVT and pulmonary embolism. Rivaroxaban was prescribed in 77% of cases. We included 82 medical records for the outcome analysis. Adverse clinical outcomes were recorded in 19 (23.2%) medical records amongst which 15 (78.9%) in the Rivaroxaban group. All (4 patients) who bled, 6 (66.7%) patients who had VTE recurrence and 5 (71.4%) patients with post-thrombotic syndrome were managed with Rivaroxaban, however, these were not statistically significantly different from those managed with VKAs. No predictor of clinical outcome was identified. Though more outcomes occurred within 30 days of oral anticoagulation, this was not statistically significant. Conclusion: Three-quarters of VTE patients were managed with Rivaroxaban. Although more bleeding was observed with rivaroxaban group, clinical outcomes were similar with VKA group. This seeds the idea of a prospective study in real life with a larger sample size in Africa. Keywords: Outcomes, Deep vein thrombosis, pulmonary embolism, Venous thromboembolism, Oral anticoagulation, Cameroo