0541: Management of heart failure: experiences in African patients

AimTo determine clinical characteristics and mode of treatment of patients with heart failure in Yaounde military hospital (YMH).MethodsData of patients with heart failure (HF) followed on a period of 6 months in YMH were used to determine clinical characteristics and mode of treatment.ResultsA total of 72 patients were consecutively studied comprising 45 men (62.5%) and 27 women (37.5%) aged 62.8±16.5 and 61.1±19.4 years, respectively. All the patients presented with NYHA functional class III or IV. Alcohol was the most common etiological factor of HF (66.7%) hypertension was the most common risk factor for HF (37.5%) while only 16.7% of the patients were smokers. Global heart failure was the common presentation (60.9%). Left bundle branch was present in 47% of electrocardiograms while 8.7% of the patients were in atrial fibrillation. Dilated cardiomyopathy was the common lesion (80%). Most patients presented with severe left ventricular (LV) systolic dysfunction (66.6%). Male subjects had worse LV systolic dys-function compare to women without significant difference (56.3% vs 43.8% p=0.8). Diabete was not associated with severe LV dysfunction (78.9% on non diabetic vs 6.3% of diabetic patients). Current recommended pharmacology therapies were used in most of the cases. Diuretics were used in 100% while ACE inhibitors were in 91.3% of cases. 52.4% of patients had beta blockers.ConclusionMost heart failure patients in Cameroon present in the sixth decade with severe heart failure. All the recommended therapies are not available in our country

Troubles cognitifs post accidents vasculaires cerebraux a Douala (Cameroun)

Introduction: Les troubles cognitifs peuvent être des séquelles après un accident vasculaire cérébral (AVC). Leur incidence est d’autant plus élevée avec la population vieillissante, l’augmentation de la prévalence des facteurs de risque cérébrovasculaire, et la diminution du taux de mortalité post AVC.Objectif: Déterminer la prévalence des troubles cognitifs post AVC et les facteurs associés à l’Hôpital Général de Douala (HGD).Méthode: Il s’agissait d’une étude transversale analytique menée à l’unité de Neurologie de l’HGD sur une période de 6 mois. Etait inclus dans l’étude tout patient âgé de plus de 15 ans, ayant eu un premier épisode d’AVC confirmé par une imagerie cérébrale et datant d’au moins 3 mois. Nous avons exclu tout patient présentant des troubles cognitifs avant l’AVC, ayant une autre cause de troubles cognitifs et aphasique. Les cas d’hémorragie sous arachnoïdienne ou de thrombose veineuse cérébrale étaient aussi exclus. Les données sociodémographiques, cliniques et d’imagerie médicale cérébrale ont été recueillies à l’aide d’un questionnaire. Le diagnostic de trouble cognitif s’est fait à l’aide du Mini Mental State Examination (MMSE). La démence était diagnostiquée chez les patients ayant des troubles cognitifs sévères à l’aide du DSM IV. Les données ont été analysées à l’aide du logiciel SPSS version 20. Le test de T de Student et le test de Khi-2 ont été utilisés pour comparer respectivement les variables quantitatives et qualitatives. L’analyse des facteurs déterminants l’apparition des troubles cognitifs post AVC a été réalisée en utilisant le modèle de régression logistique multivariée. Le seuil de signification statistique a été fixé à 0,05.Résultats: Au total, 114 participants étaient inclus, dont 51,8% d’hommes. L’âge moyen était de 57,2 ± 9,9 ans. 51,8% des patients avaient un niveau d’instruction correspondant au secondaire. Le principal facteur de risque cérébro-vasculaire était l’hypertension artérielle (73,2%). Les AVC ischémiques représentaient 63,9%. La prévalence des troubles cognitifs était de 41,2%. Les troubles cognitifs étaient légers, modérés et sévères (démence) respectivement à 26,3%, 8,8% et 6,1%. Après analyse univariée, les facteurs associés aux troubles cognitifs étaient le sexe féminin (P = 0,02), le niveau d’instruction < 7 ans de scolarité (P <0,001), la profession (P=0,005) et les cardiopathies (P=0,04). Seul le niveau d’instruction < 7 ans de scolarité était apparu comme prédictif de la survenue des troubles cognitifs (OR: 12,42 ; IC : [3,3 - 46,6] ; P < 0,001).Conclusion: Trois patients sur cinq victimes d’AVC présentent des troubles cognitifs. La démence est rare. La prévention primaire et l’accès à l’éducation au plus grand nombre de la population pourraient réduire l’impact des troubles cognitifs post AVC.Mots clés: Accident vasculaire cérébral, Cameroun, Douala, Troubles cognitifsEnglish Title: Post stroke cognitive impairment in Douala (Cameroon)English AbstractBackground: Cognitive impairment (CI) are possible sequelae after stroke. Data on post stroke CI in Sub Saharan Africa are scarce.Objective: To assess post stroke CI at the Douala General Hospital (DGH).Method: We carried out a cross-sectional study at the Neurology Unit of the DGH over a period of 6 months. Were included in the study, all patients above 15 years old with a first episode of stroke confirmed by brain imaging since at least 3 months back, and followed at the DGH. We excluded any patient with prior CI before the stroke onset, or/and with any other condition which may explain CI. Patients with subarachnoid haemorrhage or cerebral venous thrombosis were also excluded. Diagnosis of CI was made using the MMSE and the DSM IV criteria was used to confirm dementia. Data was analyzed using SPSS Version 20. The Student T test and the Chi-2 test were used to compare quantitative and qualitative variables, respectively. Factors associated and predicted of CI post stroke were identifying using logistic regression. The statistical significance was set at p < 0.05.Results: A total of 114 stroke patients were included with 51.8% being male and the mean age was 57.2 ± 9.9 years. The major cerebrovascular risk factor was hypertension (73.2%) and 51.8% of patients had attended at least secondary school. Ischemic stroke accounted for 63.9%. The prevalence of CI was 41.2%. Cognitive disorders were categorized as mild (26.3%), moderate (8.8%), and severe (dementia) (6.1%). Factors associated with CI were female gender (P = 0.02), education level < 7 years (P<0.001), lack of occupation (P=0.005) and cardiopathy (P=0.04). After multivariate analysis, only the educational level < 7 years was independently associated with CI (OR 12.42, CI [3.3 to 46.6]; P < 0.001).Conclusion: The prevalence of post stroke CI at the DGH is high. Only the low level of education appeared to be an independent predictor of post stroke CI in this study.Keywords: Stroke, Cameroon, Cognitive impairment, Doual

The prognostic value of serum uric acid in the acute phase of hemorrhagic stroke patients in black Africans

Introduction: very few studies have been conducted to evaluate the prevalence of hyperuricemia and its impact on the prognosis amongst acute hemorrhagic stroke (AHS) patients. The objectives was to determine the prevalence of hyperuricemia in AHS patients and examined the association between hyperuricemia and stroke outcomes in the Douala General Hospital (DGH). Methods: this was a hospital based prospective cohort which included AHS patients with baseline SUA levels and 3 months post stroke follow-up data. SUA values were divided into quintiles. Associations between hyperuricemia and stroke outcomes were analyzed using multiple logistic regression and survival analysis (cox regression and Kaplan Meier).   Results: a total of 221 AHS patients were reviewed with a mean age of 55.8±11.8 years. The prevalence of hyperuricemia among AHS patients was 34.4% with mean SUA level of 376.8±131.9 µmol/l. On multivariate analysis, hyperuricemia was not independently associated with early death [(OR = 1.072 (CI: 0.370-3.056; p = 0.897)] and poor functional outcome [(OR=2.487 (CI: 0.771-8.699; p = 0.154)] after hemorrhagic stroke. No significant increase in stroke deaths was observed across higher SUA quintiles amongst hemorrhagic stroke patients (p = 0.326). No statistically significant correlation was observed between SUA level and NIHSS (r = 0.063, p = 0.353) and between SUA level and mRS (r = 0.030, p = 0.662) in hemorrhagic stroke. Conclusion: about one third of patients present with hyperuricemia in the acute phase of hemorrhagic stroke. Hyperuricemia can act as risk factor for stroke because of its relationship with CVRFs but hyperuricemia has no impact on the severity and short-term outcome amongst black African hemorrhagic stroke patients

Spectre des maladies cérébro-vasculaires chez le sujet jeune à Douala

Introduction: Les accidents vasculaires cérébraux (AVC) constituent la seconde cause de mortalité dans le monde. Au Cameroun, les AVC du sujet jeune ne sont pas étudiés. L’objectif de ce travail était de déterminer la proportion des AVC du sujet jeune, les facteurs de risque cérébrovasculaire (FRCV) et de rechercher les facteurs prédictifs de décès intra-hospitalier à l’Hôpital Général de Douala (HGD). Méthodes: Il s’agissait d’une étude de cohorte prospective menée à l’HGD pendant une durée de 5 ans incluant les sujets âgés de 15 à 45 ans ayant fait un AVC confirmé par imagerie cérébrale. L’analyse univariée avait permis de déterminer les facteurs associés au décès et les facteurs ayant un p = 0,200 avaient été inclus pour l’analyse multivariée afin de déterminer les facteurs prédictifs de décès intra-hospitaliers. Résultats: 511 patients avaient été admis pour AVC dont 78 sujets jeunes (15,26%). Le sexe masculin était majoritaire (62,8%) et l’âge moyen des patients était de 38,36 ± 5,83 ans. L’hypertension artérielle (74,35%), l’alcoolisme (38,46%), les dyslipidémies (14,10%), le diabète (12,82%), l’obésité (11,53%) et le tabagisme (10,25%) étaient les principaux FRCV. Les AVC hémorragiques représentaient 56% des cas dont 11% d’hémorragie sousarachnoïdienne. La mortalité était de 26,92%. Le score de Glasgow inférieur 9/15 était apparu comme un facteur prédictif indépendant de décès intra-hospitalier (p = 0,02 ; OR = 0,12 ; IC 95% = 0,02-0,75). Conclusion: La proportion des AVC du sujet jeune est élevée ainsi que la mortalité. Les FRCV sont classiques et surtout modifiables d’où l’intérêt primordial de la sensibilisation, du dépistage précoce de la prise en charge des FRCV.Pan African Medical Journal 2016; 2

Sensitivity, specificity, and accuracy of left ventricular systolic function indices and structure in detecting early systolic dysfunction assessed by speckle-tracking two-dimensional strain: An echocardiographic cross-sectional study

Background: Reduced global longitudinal strain (GLS) is an early marker of subclinical left ventricular (LV) dysfunction, permitting timely interventions to slow disease progression. This technique is not widely available in echocardiographs in routine use. Aim: We sought to know if LV systolic function indices and structural left heart changes could predict a reduced GLS. Methods: We carried out a cross-sectional analytic study in May 2017. We measured GLS (reference test), LV ejection fraction, LV midwall shortening (MWS), LV mass index, LV diastolic diameter, LV volumes, and left atrial volume (predictors). We calculated the sensitivity, specificity, accuracy, predictive values, and likelihood ratios of the predictor variables. We assessed the discriminatory power of the indices with the Youden Index and area under the receiver operator characteristic curve (AUC). Results: A total of 32 participants (14 males) were retained for this study. Their mean (standard deviation) age was 62 (15.3) years. Eccentric LV hypertrophy (LVH) was the most frequent LV geometric pattern – 14 (43.8%) participants. A reduced GLS was the most frequent LV functional anomaly – 20 (62.5%) participants. A low MWS <36.5% had a good predictive power of a reduced GLS – sensitivity: 80%, specificity: 83.2%, accuracy: 81.3%, and AUC: 0.817. The presence of LVH had a fair prediction power of reduced GLS – sensitivity: 70%, specificity: 81.8%, accuracy: 65.6%, and AUC: 0.741. The composite of MWS <36.5% and or LVH had a fair discriminatory power (AUC: 0.783, Youden Index: 0.567), with a good sensitivity – 90%. Conclusion: Low MWS of the LV and the presence of LVH were found to be good predictors of reduced GLS

Rheumatic heart disease awareness in the South West region of Cameroon: A hospital based survey in a Sub-Saharan African setting.

BACKGROUND:Early diagnosis and adequate treatment of Group A streptococcal throat infection is an important initial stage in the primary prevention of acute rheumatic fever and rheumatic heart disease. This preventable condition associated with high mortality rates mandates a thorough understanding by the general public and the health. OBJECTIVE:The aim of the study was to assess the level of awareness about different aspects of rheumatic heart disease in patients coming to the outpatient department of the Buea regional Hospital, South West region of Cameroon. METHODS:This was a cross-sectional descriptive study carried in the outpatient department of the Buea Regional Hospital, Cameroon. The study population was adults and children aged 9 years and above. Data collection was done by using a self-administered questionnaire addressed to assess awareness on rheumatic heart disease. RESULTS:A total of 256 participants were interviewed, of which 70 (27.3%) were males. Their mean age was 34.4 ± 11.9 years (males: 36.2 ± 12.7 years versus females: 33.7 ± 11.6 years, p = 0.129). Most of the participants were in the 20 to 29 year old group (37.9%). More than two thirds (71.1%) of the participants reported having had sore throat at least once. The disease was treated with antibiotics in only 45.4%, with the treatment prescribed by a health care professional in 35.8% of the cases. About 73% of the respondents did not know what causes sore throat, and most (71.1%) were unaware of any complications that could arise from poorly treated sore throat. More than 70% of the participants did not know that sore throat can be associated with heart disease. Rheumatic heart disease was unknown to 82% of the participants and 95% of them did not know what causes RHD. Only 5.1% percent of the participants had an adequate knowledge of RHD. Age ≤ 35 years, post-secondary level of education, and having heard of RHD were significantly associated with an adequate knowledge. After adjusting for age, post-secondary education (aOR: 9, [95% C: 1.2-67.5], p = 0.019), and having heard of RHD (aOR: 18.1, [95% CI: 4.7-70.3], p<0.001) were still associated with a fair knowledge. CONCLUSIONS:Levels of knowledge and awareness on rheumatic heart disease is low. This study provides important insight into the perception and practices related to sore throat that can be used in the design of awareness activities aimed reducing the risk of RHD in Cameroon. The appropriateness of antibiotics prescribed, and the health care provider awareness and knowledge levels regarding RHD in Cameroon has not been reported yet in the literature. This grey area deserves more research

Dissection aortique dans le syndrome de Marfan: à propos d'un cas au CHU de Yaoundé

La dissection aortique est le déchirement de la paroi de l'aorte. Ce phénomène est rare et grave, car il peut conduire à la rupture totale de l'aorte et à une mort certaine. Une fois le diagnostic posé, la chirurgie doit être rapidement réalisée. Nous rapportons le cas d'un jeune homme de 30 ans chez qui nous avons fait le diagnostic de la dissection aortique dans le syndrome de Marfan. Il a pu bénéficier d'une intervention chirurgicale à coeur ouvert avec un remplacement de la valve aortique. A ce jour, 30ème mois après l’opération aucune complication n’est notée.Mots-clés: Dissection aortique, Syndrome de Marfan, YaoundéEnglish AbstractAortic dissection is defined as the separation of the layers within the aortic wall. This phenomenon is rare and could be very dangerous in the case of total aortic rupture with resultant death. Once the diagnosis is made, surgery should not be delayed. We present the case of a 30 years old man, in whom the diagnosis of aortic dissection was made in the context of Marfan's syndrome. He underwent a open heart surgical intervention with replacement of the aortic valve. No complications have been noted till date (30 months post surgery)Keywords: Aortic dissection, Marfan's syndrome, Yaound

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 &gt; 20 mmHg for systolic and/or &gt; 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 &gt; 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

Clinical and electrocardiographic profile of patients with palpitations in cardiology outpatient consultations in Yaounde

Introduction: Palpitation is a major cause of consultation in Cardiology clinics and Emergency departments. In Cameroon, there are few studies done on this frequent symptom and therefore is poorly understood in our setting. Purpose: To describe the clinical and electrocardiographic profile of patients presenting with palpitations at the cardiology outpatient consultations of two reference hospitals in Yaoundé Methods: We carried out a descriptive cross-sectional study from November 2016 to May 2017 in two reference hospitals in Yaoundé: General Hospital and Central Hospital. Participants in the outpatient unit with palpitation as presenting complain were recruited after giving their consent. Data collected were analysed using IBM SPSS 23.0. Results: 210 participants were included. The hospital prevalence of palpitation was 18.7% for the General Hospital and 25.9% for the Central Hospital and an overall prevalence of 21%. The mean age of the participants was 47.3 +/- 18 years. The most represented age group was “56 and older” group (n=69, 32.8%). Females constituted 75% (n=157) of our study population. Hypertension was the most frequent predisposing factor (n=59, 28.1%). The most frequent associated symptom was dyspnea (n=80, 38.1%); 28.6% (n=60) of participants had chest pain. The most observed sign on physical examination was a heart murmur (n=45, 21.4%). On electrocardiography, 86.8% (n=182) of the study population had a normal sinus rhythm. The most common abnormality on ECG was a left ventricular hypertrophy (n=26, 12.4%). Sinus tachycardia was found to be the most frequent rhythm disturbance (n=25, 11.9%) followed by sinus bradycardia (n=12, 5.7%) and atrial fibrillation (n=8, 3.8%). Conclusion: Palpitation is a very frequent symptom in our setting. It is mostly associated was dyspnea. The most frequent findings on ECG are left ventricular hypertrophy and sinus tachycardia. Keywords: Palpitation, Clinical aspects, ECG, Hospita

Availability, cost and affordability of essential cardiovascular disease medicines in the south west region of Cameroon: Preliminary findings from the Cameroon science for disease study.

BACKGROUND:More than 80% of premature deaths due to cardiovascular disease (CVD) occur in low- and middle-income countries. However, access to, and affordability of medications remain a challenge in these countries. OBJECTIVE:To assess the availability, cost and affordability of essential cardiovascular medicines in the South West region of Cameroon. METHODS:In an audit of 63 medicine outlets, twenty-six essential medicines were surveyed using the World Health Organisation (WHO) /Health Action International methodology. Availability, costs and the ratio of the median price to the international reference price were evaluated in public, confessional, private facility medicine outlets, and community pharmacies. Affordability was assessed by calculating the number of days' wages it will cost the lowest-paid unskilled government worker to purchase a month worth of chronic treatment. FINDINGS:Availability ranged from 25.3% (public facility outlets) to 49.2% (community pharmacies) for all medicines. This was higher in urban and semi-urban compared to rural outlets. Cost of medicines was highest in community pharmacies and lowest in public facility outlets. Aspirin, digoxin, furosemide, hydrochlorothiazide and nifedipine were affordable (cost a day's wage or less). Medicines for heart failure and dyslipidaemia (beta blockers, angiotensin converting enzyme inhibitors and statins) required 2-5 days and 6-13 days wages respectively for one month of chronic treatment. CONCLUSION:Overall availability of CVD essential medicines was lower than WHO recommendations, and medicines were largely unaffordable. While primary prevention is pivotal, improving availability and affordability of medicines especially for public facilities would provide additional benefit in curbing the CVD burden