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Background Limited information is available about cardio-embolic stroke (CES) in sub-Saharan Africa. The aim of this study was to describe the epidemiology, clinical features, etiology, the management and outcome of CES in our setting. Methods A retrospective cohort study was carried out in the Douala General Hospital (DGH), using files of ischemic stroke patients admitted in the Neurological Unit and the Intensive Care Unit. Socio-demographic, clinical and paraclinical data were collected. After hospitalization, follow-up was performed with focus on mortality, stroke recurrence and the functional outcome assessed with Barthel score. Multivariate analysis was performed to determine the factors associated with death. Results Of the 704 stroke cases included, 368 were ischemic with 86 (23.4%) of them being cardio-embolic. The mean age of patient with CES was 67 ± 13.3 years. The main etiologies of CES were: atrial fibrillation (82.1%), dilated cardiomyopathy (12.8%), and rheumatic mitral stenosis (5.1%). Anti-platelet agents were the most prescribed anti-thrombotic drugs (50.7%). The in-hospital mortality rate was 23.3% with lesion in both internal carotid arteries [OR = 110.3; 95% CI: 1.2–1040.7; P = 0.043] and heart disease [OR = 46.9; 95% CI: 1.2–1789.9; P = 0.038] appeared to be predictive of this. Stroke recurrence was observed in 8 patients (12.1%) and the survival probability in 5 years was 10%. Functional outcome was progressively worse with the systolic blood pressure > 140 mmHg (P = 0.025) been the associated factor. Conclusion CES accounted for 1/4 of ischemic stroke with a high risk of early death and long-term recurrence. Atrial fibrillation was the leading cause of CES. The association of VKA and anti-platelet agent should be avoided to reduce early death during acute stroke.

Aims: This study was designed to elucidate the antioxidant, analgesic and antipyretic activities of the ethanol extract of the stem bark of Dichaetanthera africana. Place and Duration of Study: Department of Pharmacognosy and Phytochemistry, Faculty of Pharmacy, VNS Group of Institutions, Bhopal, India, between September 2014 and November 2014. Methodology: Antioxidant activities were determined in vitro by the total phenolic, total flavonoid, ferric reducing antioxidant power (FRAP), DPPH, hydrogen peroxide and ABTS methods. Analgesic and antipyretic activities were investigated using the acetic acid induced writhing and brewer’s yeast induced hyperpyrexia assays respectively. Results: Ethanol extract had high phenolic (4.15-44.35 mgCA/g) and flavonoid (85.56-596.7 mgCA/g) contents and FRAP (187.87-371.41 mgCA/g). This extract exhibited strong DPPH (IC50 = 0.49 µg/ml), H2O2(IC50 = 1.62 µg/ml) and ABTS (IC50= 0.43 µg/ml) radical scavenging activities. Significant reduction of abdominal writhing (P< 0.001) and fever (P< 0.001) were observed in rats in a dose dependent manner after administration of the ethanol extract with the most effective dose being 400 mg/kg b.w. Conclusion: These results provide promising baseline information for the potential use of Dichaetanthera africana in the treatment of pain and fever.

Background: Thunderclap headache is a severe headache of sudden onset that peaks within a few seconds. The aim of this study was to describe the clinical characteristics, etiologies and long-term prognosis of thunderclap headaches in HIV positive patients. Patients and Methods: This was a 5-year retrospective study of thunderclap headaches in HIV positive patients with a long-term follow-up at the Neurology Unit of the Internal Medicine Department of the Douala General Hospital. All patients had a cerebral magnetic resonance imaging and cerebrospinal fluid analysis. Patients were followed-up at the out-patient department after hospitalization. Results: 65 patients were recorded with thunderclap headaches over the study period, and 5 were infected with HIV type 1 (7, 69%). The mean age was 50, 8±15, 4 years. There were three females and the mean CD4 count was 328, 6±195, 8 cells/mm3. The aetiologies of thunderclap headache were one case each of subarachnoid haemorrhage, ischemic stroke, primary thunderclap headache, cryptoccocal meningitis and migraine without aura respectively. The mean duration of the out-patient follow-up was 17 months±10, 2 (1-25) months; 95% CI (5, 7-24). There was no relapse of thunderclap headache and the mortality rate was 20%. Conclusion: Thunderclap headache in HIV positive patients occurs spontaneously and is independent of the level of CD4 count. The aetiologies are heterogeneous, and show no predominance of subarachnoid haemorrhage thus highlighting the important role of neuroimaging in the diagnosis of its cause.

Background and Objectives: Cerebro-vascular accident or stroke constitutes a major challenge in sub-Saharan Africa. In Cameroon, basic epidemiologic data are not routinely available. Aims: The aim of this study was to determine the type, the associated risk factors, time to admission, the clinical presentation and the case fatality of stroke at the Douala General Hospital (DGH) in Cameroon. Methods: A cross-sectional study was performed from January 1, 2010 to December 31, 2012 at the neurology and intensive care units of the DGH. All patients above 15 years of age with a diagnosis of established stroke were enrolled. For each patient, socio-demographic, clinical and paraclinical data were recorded as well as the duration of hospitalization and the case fatality. Results: In all, 325 patients were enrolled with males constituting 68.1% and general mean age of 58.66 ± 13.6 years. The mean initial consultation delay was 47.36 ± 18.48 hours. The majors cerebro-vascular risk factors were hypertension (81.15%), chronic alcohol consumption (28.3%), diabetes mellitus (20.61%), obesity (18.15%), cigarette smoking (16%), dyslipidemia (8.9%) and atrial fibrillation (3.07%). Ischemic stroke accounted for 52% of cases while 48% were hemorrhagic. The mean duration of hospitalization was 8.58 ± 6.35 days with a case fatality rate of 26.8%. Septic conditions appeared to be the leading cause of death accounting for 35.6% of cases. Conclusion: Stroke in the DGH is associated with a high case fatality rate and hypertension remains the number one risk factor. There is a clear and urgent need for public health authorities to reinforce measures for the control of modifiable stroke risk factors.

Objectives: Describe the clinical, aetiological and prognostic features of infectious meningitis in adults at the Douala General Hospital (DGH). Patients and Methods: We carried out a 5-year retrospective cross-sectional study at the DGH, on data from the registers of the bacteriology and biochemistry laboratories. Cases of meningitis were identified from the results of the cerebrospinal fluid (CSF) analysis, and the patient clinical file was obtained. Cases files of patients aged 15 years and above were included. For each patient, sociodemographic, clinical features and hospital mortality data were extracted. Results: During study period, 1877 CSF analyses were recorded and 135 were enrolled for data analysis. Up to 74 patients (55%) were male and the mean age was 40.04 ± 12.5 years. The time lapse between the onset of symptoms and consultation was 12.24 ± 11.16 days. The main clinical signs were meningeal syndrome (96.3%), neck stiffness (71.1%), reduced alertness (64.4%) and confusional states (55.6%). The main aetiology was bacterial (45.19%) with Streptococcus pneumoniae (45.90%) and Neisseria meningitis (29.51%) leading. The other aetiologies were viral (21.48%), fungal with Cryptococcus neoformans (20%) and meningeal tuberculosis (13.33%). Fifty eight patients (42.9%) had a positive HIV serology. The mean duration of hospitalization was 9.05 ± 8.1 days, and the total in-hospital mortality was 25.18%. 117 patients (86.8%) had received antibiotherapy before diagnosis. Conclusion: The clinical features of meningitis in the DGH are as in classical description. However, the mortality is high and

Introduction: avec l'introduction de la tritherapie dans les annees 1996, la morbidite et la mortalite liees a l'infection par le VIH a nettement diminue. Concomitamment avec ce succes clinique, plusieurs changements metaboliques incluant diabete, hypertension arterielle, dyslipidemie et lipodystrophie ont ete observes, ceux-ci etant des pourvoyeurs d'accidents vasculaires cerebraux. L'objectif de ce travail etait de determiner l'incidence des accidents vasculaires cerebraux chez les patients VIH positifs sous traitement antiretroviral au long court. Methodes: il s'agissait d'une etude de cohorte retrospective, menee dans le Centre de Traitement Agree de l'Hopital General de Douala (HGD), avec un recueil des donnees sur 10 ans allant de Mai 2001 a avril 2010, portant sur les patients VIH positifs adultes sous traitement antiretroviral depuis au moins 6 mois. Les patients etaient suivis selon le protocole national de prise en charge du Cameroun. La survenue d'un AVC a ete determinee par la methode Kaplan-Meyer tandis que les facteurs associes a la survenue d'un AVC ont ete recherche par le test de Khi-2. Le seuil de signification statistique etait fixe a 0,05. Resultats: 307 patients etaient inclus dont 62,4% de sexe feminin, et l'âge moyen etait de 40,1 ± 9,9 ans. L'incidence des AVC etait de 1,7% sur 72 mois de suivi sans difference significative entre les femmes et les hommes (P= 0,76). Le taux d'incidence calcule etait de 0,3 pour 100 personnes annees. Dans 85,7% des cas il s'agissait d'un AVC ischemique. Le delai moyen de survenue d'un AVC etait de 33,4 mois. Les facteurs associes a la survenue d'un AVC etaient: les patients ayant initie leur traitement au stade III et IV de l'OMS et le taux de CD4 > 100/mm3 a l'initiation du traitement antiretroviral. Conclusion: l'incidence des AVC chez les patients VIH positifs sous traitement antiretroviral est similaire a celle rapportee anterieurement mais ces AVC surviennent a un âge precoce et justifie une surveillance accrue par les cliniciens prenant en charge ces patients. Une etude prospective avec une population temoins est necessaire. The Pan African Medical Journal 2016;24

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; 23

Background Chronic Kidney disease is a major health problem in the world. Native arteriovenous Fistula (AVF) is well established as the best vascular access for haemodialysis. Little is known about the outcome of AVF in sub-Saharan Africa. We aim to analyze the outcome of patients undergoing AVF creation during the pilot program established at the Douala general hospital (DGH). Method This was hospital-based, longitudinal study with a retrospective phase (April 2010-January 2014) and a prospective phase (January 2014-April 2014). All consecutive patients operated for AVF creation were included in this study. Socio-demographics data, functionality, and complications were analyzed. Results Eighty-one patients including 52 men were enrolled in this study (49 prospectively and 32 retrospectively). The mean age was 52, 3 years (range 18-81 years). Hypertension (66, 7%), diabetes (17, 3%), and HIV (8, 6%) were the most observed co-morbidities. About 96.3% of AVF were native and 3.7% were prosthetic graft. Radiocephalic AVF was performed at a rate of 77.8%. The primary function rate was 97.7% and the mean follow-up period 43.4 weeks. The overall rate of complications was 44.4% of whom 30.5% were early, 30.5% secondary, and 39% lasted. The treatment of these complications was conservative in 48.7% of cases. Conclusions The results of the pilot program of AVF creation at the DGH are encouraging. However, the sustainability of this project requires human capacity building.

Maintaining identity of clones is essential in breeding programs. New EST-SSR markers have been developed for banana and used to screen a diploid population for clonal identity. A total of 410 primer pairs were designed from an EST database, validated using polyacrylamide gel electrophoresis (PAGE) and a subset was optimized for accurate genotyping on a capillary genetic analyzer. Combining PAGE and capillary electrophoresis, about 44% of the designed primers were informative in the diploid population. The majority of markers produced two alleles as expected in a diploid population. However, some showed three to four alleles, possibly indicating closely-related members of gene families. Screening of field samples using SSR markers revealed genotype identity issues in the target population. The present study demonstrates the applicability of SSRs in the establishment of parentage and relatedness between accessions. The newly-developed SSRs will be valuable tools in the understanding of Musa genetics, in marker-trait associations, thereby enhancing the effectiveness of breeding programs. Key words : EST, SSRs, markers, Musa, breeding.

Décrire les caractéristiques épidémiologiques et histo-pathologiques des tumeurs malignes du sein au Cameroun. Il s'agissait d'une étude rétrospective descriptive portant sur les tumeurs malignes du sein, colligées, dans les registres des différents laboratoires d'Anatomie Pathologique publiques et privés repartis dans cinq régions (centre, littoral, Ouest, Nord-ouest, Sud-ouest), pendant une période de 10 ans (2004-2013). Les paramètres étudiés étaient la fréquence, l’âge, le sexe, la localisation, le type et le grade histologique, et les récepteurs hormonaux. Un total de 3044 cas de cancers du sein a été recensé, soit une fréquence annuelle de 304,4 cas en moyenne. Le sexe féminin était le plus représenté avec 2971 cas (97,60%) et les hommes avec 73 cas (2,40%), soit un sexe ratio (H/F) de 0,02. L’âge moyen des patients était de 46±15,87 ans, avec des extrêmes de 13 et 95 ans. Selon la localisation, le sein gauche était atteint dans 1244 cas (52%) et le sein droit dans 1115 cas (47%). Au plan histologique, on retrouvait essentiellement des carcinomes avec 96,50% des cas, des sarcomes 1,39%, des lymphomes 1,07% et la maladie de Paget du mamelon, 1,03%. Les tumeurs épithéliales étaient infiltrantes dans 2049 cas (84,46%), avec une prédominance du carcinome canalaire infiltrant (1870 cas) et non infiltrantes dans 377 cas (15,54%). Le grade histo-pronostic de SBR avait révélé une prédominance du grade II dans 66% des cas. Les cancers du sein restent une pathologie fréquente au Cameroun et atteignent principalement la population féminine en âge de procréer. Ils sont caractérisés par la prédominance du carcinome canalaire infiltrant.

Decrire les caracteristiques epidemiologiques et histo-pathologiques des tumeurs malignes du sein au Cameroun. Il s'agissait d'une etude retrospective descriptive portant sur les tumeurs malignes du sein, colligees, dans les registres des differents laboratoires d'Anatomie Pathologique publiques et prives repartis dans cinq regions (centre, littoral, Ouest, Nord-ouest, Sud-ouest), pendant une periode de 10 ans (2004-2013). Les parametres etudies etaient la frequence, l’âge, le sexe, la localisation, le type et le grade histologique, et les recepteurs hormonaux. Un total de 3044 cas de cancers du sein a ete recense, soit une frequence annuelle de 304,4 cas en moyenne. Le sexe feminin etait le plus represente avec 2971 cas (97,60%) et les hommes avec 73 cas (2,40%), soit un sexe ratio (H/F) de 0,02. L’âge moyen des patients etait de 46±15,87 ans, avec des extremes de 13 et 95 ans. Selon la localisation, le sein gauche etait atteint dans 1244 cas (52%) et le sein droit dans 1115 cas (47%). Au plan histologique, on retrouvait essentiellement des carcinomes avec 96,50% des cas, des sarcomes 1,39%, des lymphomes 1,07% et la maladie de Paget du mamelon, 1,03%. Les tumeurs epitheliales etaient infiltrantes dans 2049 cas (84,46%), avec une predominance du carcinome canalaire infiltrant (1870 cas) et non infiltrantes dans 377 cas (15,54%). Le grade histo-pronostic de SBR avait revele une predominance du grade II dans 66% des cas. Les cancers du sein restent une pathologie frequente au Cameroun et atteignent principalement la population feminine en âge de procreer. Ils sont caracterises par la predominance du carcinome canalaire infiltrant.

A well-saturated genetic linkage map is valuable for fundamental and applied genetic research. Genetic linkage maps of two half-sib diploid banana populations were constructed using allele-specific-polymerase chain reactions (AS-PCRs), diversity array technology (DArT), and simple sequence repeat (SSR) markers. Molecular maps were produced for each parent using the pseudo-testcross mapping strategy. The first maternal map (6142-1, 81 individuals) consisted of 231 markers divided as followed: 121 DArT, 106 SSR and 4 AS-PCR markers in 15 linkage groups (LGs) covering 670 cM. The second maternal map (6142-1-S, 58 individuals) contained a total of 152 markers including 71 DArTs, 79 SSRs, and 2 AS-PCRs mapped to 16 LGs that spanned 698 cM. The combined paternal map (139 individuals) comprised 316 markers (196 DArTs, 117 SSRs and 3 AS-PCRs) distributed over 15 LGs with a total map length of 1,004 cM. While distorted segregation of some markers was observed in all maps, this was much more frequent for the male parent. Homology between maps was assessed using common markers. While there was generally good congruity with regard to marker order across maps, incongruity in other cases may reflect chromosomal rearrangement events such as inversions, translocations, or deletions. The new banana map can provide a better understanding of the Musa genome and could be used for the identification of economically important traits and improvement of breeding strategies.

The aim of this study was to determine the prevalence, aetiologies and outcome of neurological disorders at the emergency centre (EC) of the Douala General Hospital (DGH). Patients and methods: A cross-sectional study was carried out from 1st January to 30th April 2014, at the EC of the DGH, in Cameroon. We included all patients above 15 years of age who presented with isolated or associated neurological complaints. Data collected for each patient were: socio-demographic, clinical and laboratory characteristics, time lapse before management and the prognosis. Patients with no definitive diagnosis made in the EC, had their files reviewed on the wards by the investigators for the final diagnosis and/or aetiology. Results: Of 1844 patients who were consulted in the EC over the study period, 502 of them presented with neurological disorders (27.2%). The mean age was 44.4 ± 17.8 years with 53.6% males. The common symptoms were headache (47.8%), loss of consciousness (19.5%), lumbar pain (11%), hemiparesis (8.4%), and seizure (7%). Non-traumatic neurological disorders were common (86.1%). The common aetiologies were malaria (16.9%), stroke (13.5%), primary headaches (13.1%), head injury (12.9%) and metabolic encephalopathy (12.4%). Mean time lapse to be consulted by a general practitioner was 23.1 ± 20.7 min and 2.1 ± 1.3 h for neurologist’s consultation. The time lapse to receive initial medical care was 26.3 ± 30.6 min. The mean duration to have an imaging result was 1.3 ± 0.9 h and 3.1 ± 1.7 h for laboratory tests. The in-hospital mortality rate of neurological disorders was 15.1%. Conclusion: Neurological disorders are common in the emergency centre of the DGH. Aetiologies are diverse and in-hospital mortality is high. This highlights the need to organize neurologist calls at the EC and/or to improve the human resources capacity through regular training and evaluation.