Jerome Boombhi

Thrombo-Embolism Risk and Prophylaxis amongst Hospitalized Patients in Two Hospitals in Cameroon: A Cross-sectional Study in Sub-Saharan Africa

Background: Venous thrombo-embolism (VTE) is frequent worldwide. It has not been sufficiency studied in sub-Saharan Africa, with few data on the prevalence and treatment from urban settings. Objectives: We sought to study the thromboembolic risk and rate of thrombo-prophylaxis for VTE in hospitalized patients. Methods: Between November 2016 and April 2017, we carried out a cross-sectional descriptive study in two hospitals in the Far North region- Cameroon. Participants were consenting adult patients hospitalized in the medical and surgical wards. We excluded those with diagnosed VTE. We evaluated the risk for VTE with Caprini Risk Assessment model and we assessed prophylaxis measures used. Results: A total of 520 patients were included - 282 (54.2%) from the surgical units and 238 (45.8%) from the medical units. The mean age was 49 ± 17 years, and 296 (57%) were males. The mean duration of hospitalization was 10 ± 9 days. Risk for VTE was seen in 284 (54.6%) patients -182 (64.5%) in the surgical units, and 102 (42.8%) in the medical units (p<0.001). Of those at risk, 165 (58.1%) were males. Adequate VTE thrombo-prophylaxis was carried out in 120 (42.3%) patients - 86 (47.3%) in the surgical units, and 33 (32.4%) in the medical units. Conclusion: The risk for VTE was seen in more than half of hospitalized patients in these semi-urban and rural hospitals. Less than half of those at risk received adequate thrombo-prophylaxis. The surgical units had significantly higher VTE risk and adequate prophylaxis rate than the medical units.

Aetiologies and correlates of secondary mitral regurgitation in patients with dilated cardiopathy in Cameroon: a cross-sectional study

Background: Dilated cardiopathy is a heterogeneous group of heart disease in which there is progressive ventricular remodeling, with or without secondary functional mitral regurgitation (MR). MR has prognostic implications, and has not been studied in our setting. This work aimed at studying the occurrence, aetiologies and correlates of secondary MR in a group of patients with dilated cardiopathy in a resource limited setting in sub-Saharan Africa. Methods: We carried out a cross-sectional study in the echocardiography laboratories of three tertiary hospitals in the city of Yaounde, Cameroon. Participants were consecutively recruited over an eight month period, after results of echocardiograms. The severity of MR was assessed from the size of the regurgitant orifice and the mechanism of MR assessed with the Carpentier classification. Results: A total of 25 participants (13 males) with an echocardiographic dilated left ventricle were included in the study. Their mean age was 53.2 years (range: 22 to 84 years). All patients had MR, of whom 6 (24%) had severe MR (grade IV). Type I MR was seen in 14 (46%), type III in 10 (40%), and type I and III in 1 (4%) of patients. The baseline heart disease were primary 4 (16%), ischemic 10 (40%), hypertensive 10 (40%), and peri-partum cardiomyopathy. The left atrium was dilated in 22 (88%), raised filling pressure in 19 (76%), and raised pulmonary pressure in 15 (60%). The severity of MR significantly correlated with age (r=0.5, P=0.011), left ventricle end diastolic diameter (r=0.41, P=0.04), low ejection fraction (r=−0.378, P=0.031), and left atrial size (r=0.431, P=0.022). Conclusions: Secondary MR is almost always present in patients with dilated cardiopathy. The severity of MR correlated with age, low ejection fraction, left ventricular end diastolic diameter, and left atrial size.

Infective Endocardatis at the Yaounde General Hospital: Clinical aspects and outcome (Case Series)

Introduction: Infectious endocarditis (IE) is a severe pathology. Its epidemiological, clinical and evolutive profi le varies a lot depending if it is in the context of a developed country or developing country. In our context, very little data exists on the subject.

Prevalence and correlates of chronic kidney disease in a group of patients with hypertension in the Savanah zone of Cameroon: a cross-sectional study in Sub-Saharan Africa

Background The prevalence of chronic kidney disease (CKD) is increasing worldwide due to an increase in the risk factors such as hypertension. The greatest burden is in low-income settings, coupled with late diagnosis and limited management resources. This work aimed at studying the prevalence and risk factors of CKD in a group of patients with hypertension in the Savanah zone in Sub-Saharan Africa (SSA). Methods We carried out a cross-sectional study between January and May 2016 in the regional Hospital of Garoua-Cameroon. Participants were adults ≥18 years of both sexes, who had a diagnosis of hypertension. Patients underwent a comprehensive clinical, biological, and electrocardiographic evaluation. Results A total of 400 patients with hypertension were included, of whom 132 (33%; 95% CI: 28.6-37.8%) were males. Their mean age was 54.16±11.17 years. Hypertension was controlled in 122 (30.5%; 95% CI: 26.2-35.2%) participants. Twelve percent had a positive urine dipstick for proteins. The mean glomerular filtration rate (GFR) was 75.27±24.87 mL/min/1.73m2. The prevalence of CKD was seen in 129 (32.3%; 95% CI: 27.9-36.98) participants. Stage 3A was the most frequent (62.01%). The main comorbidities were anemia (44.5%), obesity (39.75%), diabetes (32%), consumption of traditional medicines (15.75%), and hyperuricemia (10.75%). After multivariate analysis, age >50 years (aOR: 1.75; 95% CI: 1.06-2.89; P=0.027), female sex (aOR: 2.21; 95% CI: 1.29-3.78; P=0.0035), obesity (aOR: 1.58, 95% CI: 1.01-2.44; P=0.026) and the hyperuricemia (aOR: 3.67; 95% CI: 1.78-7.58; P<0.001) were independently associated with CKD. Conclusions The prevalence of CKD in adults with hypertension was high. This was associated with age greater than 50 years, female sex, obesity and the hyperuricemia.

A new look at acquired heart diseases in a contemporary sub-Saharan African pediatric population: the case of Yaoundé, Cameroon

BACKGROUND Acquired heart diseases (AHD) in children cause significant morbidity and mortality especially in low resource settings. There is limited description of acquired childhood heart diseases in Cameroon, making it difficult to estimate its current contribution to childhood morbidity and mortality. Echocardiography is the main diagnostic modality in low resource settings and has a key role in the characterization and management of these disorders. We aimed to determine the prevalence and spectrum of AHD in children in Yaoundé-Cameroon, in an era of echocardiography. These data are needed for health service and policy formulation. METHODS Echocardiography records from August 2003 to December 2013 were reviewed. Echocardiography records of children ≤18 years with an echocardiographic diagnosis of a definite AHD were identified and relevant data extracted from their records. RESULTS One hundred and fifty eight children (13.4%) ≤18 years had an AHD. The mean [± standard deviations (SD)] age was 11.9 (±4.4) years .The most common affected age group was 15-18 years (36.1%). Heart failure (20.3%), suspicion of rheumatic heart disease (RHD) (12.0%) and the presence of a heart murmur (8.9%) were the most common indications for echocardiography. RHD (41.1%), pericardial disease (25.3%), dilated cardiomyopathy (DCM) (15.8%) and endomyocardial fibrosis (EMF) (13.9%) were the most common AHD. Cor pulmonale was rare (1.3%). Fifty-seven (87.7%) children with RHD had mitral regurgitation alone or in combination with other heart valve lesions and 63.3% of the lesions were severe. CONCLUSIONS RHD remains the most common AHD in children in this setting and is frequently severe. Multicenter collaborative studies will help to better describe the pattern of AHD and there should be a renewed focus on the prevention of RHD.