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Background Central nervous system (CNS) infections are serious and debilitating diseases with significant mortality, and high prevalence in the context of human immunodeficiency virus (HIV) pandemic in Africa. However, their diagnosis remains challenging due to outdated technical platform. We aimed to determine the frequency of CNS infection and to describe the epidemiological, clinical and outcome of this at the Douala General Hospital (DGH), Cameroon. To carry out this study, we collected the medical records of patients hospitalized for CNS infections in the internal medicine department of DGH from January 2015 to December 2019. Results Among 8430 files reviewed, 336 cases of CNS infection were identified giving a frequency of CNS infection of 3.99% among which 204 files were included in the study (54.4% were male). HIV infection was found in 147 patients (72.1%) with 38.1% (n = 56) of them on regular follow-up. The most common clinical signs were fever (84.8%), headache (68.6%), meningeal syndrome (38.7%), and seizures (36.3%). Cerebral toxoplasmosis (24.5%), cryptococcal meningitis (21.1%), and acute bacterial meningitis (8.3%) were leading aetiologies. Of the 143 CSF samples, 70.6% (n = 101) were sterile. The in-hospital mortality rate was 23.5% with CNS infection of unknown cause (22.1%) be independently associated to this [OR = 2.24; 95% CI 1.04–4.80, p = 0.039]. Conclusion Clinical presentations of CNS infections are same with classical data. HIV-related opportunistic infections are the main aetiologies. About one over four patients with CNS died. Two thirds of CSF are sterile using basic laboratory assessment giving a need to identify simple tests to increase sensibility and specificity of diagnostic tools in our setting.

Background: Post-stroke outcomes are poorer in patients with diabetes mellitus (DM). The aim of this study was to determine the prevalence of DM in acute stroke and to compare the outcome in patients with or without diabetes in a tertiary care hospital in Douala, Cameroon. Methods: This was a hospital-based prospective cohort study included both diabetic and non-diabetic acute stroke patients (ASP). Demographic, clinical profile and outcome data was collected within 3 months of stroke onset. Descriptive statistics, t-test and chi square test used for comparisons while associations between DM and stroke outcomes, were analyzed using multiple logistic regression and survival analysis. Results: Of the 701 ASP included, the overall prevalence of diabetes in stroke was 34.2% (n = 240) while 9.4% (n = 66) had newly diagnosed diabetes. Mortality was significantly elevated amongst patients with diabetes during hospitalization (p = 0.034) and at 3 months post stroke onset (p = 0.004), but on multivariate analysis, diabetes was not an independent predictor of mortality [OR = 0.984; (95% CI: 0.506 - 1.913); p = 0.961)]. On Cox proportional hazards regression model, the risk of dying was about 1.5 times higher amongst the DM patients compared to non-diabetic patients [adjusted HR (95% CI) of 1.502 (1.128 - 2.000); p = 0.005]. Diabetes was not an independent predictor of poor functional outcome within 3 months post stroke. Conclusion: About 1 in 3 ASP had DM on admission. Survival is better in non-diabetes versus diabetes mellitus ASP. DM was associated with high mortality but does not influence the functional outcome of ASP in our setting

Background Depression is the most common psychiatric disorder in patients with diabetes. We aimed to investigate the prevalence and factors associated with depression in patients with type 2 diabetes and to assess the relationship between depression and attainment of treatment targets. Methods In this cross-sectional study, we included patients with type 2 diabetes who were receiving chronic care in the outpatient diabetes unit of the Douala General Hospital, Cameroon. Depression was assessed using the 9-Item-Patient Health Questionnaire (PHQ-9). Logistic regression models were used to identify independent associations. Results Of the 177 participants, 52 (29.4 %, 95 % CI: 22.8–36.7) had depression. In bivariate analysis factors associated with depression were; age > 48 years, physical inactivity, major life event, pill burden (≥5 medication types and ≥7 tablets/day), nephropathy and neuropathy. In multivariate analysis neuropathy (aOR: 3.25, 95 % CI: 1.47–7.19; p = 0.004) and major life event (aOR: 8.38, 95 % CI: 2.79–25.15; p 7 % (aOR: 2.50, 95 % CI: 1.23–5.00; p = 0.010). Conclusion Depression is common in this group of Cameroonians with type 2 diabetes and is strongly associated with major life event, neuropathy and poor glycaemic control. Our results portray the need to systematically screen and manage depression in patients with type 2 diabetes in this setting.

Background: Data on spontaneous intracerebral haemorrhagic (SICH) are scarce in Africa. Our objectives were to determine the prevalence of SICH, describe the clinical profile, aetiology and evaluate the prognosis (fatality case, functional outcome) of patients in a tertiary health care hospital in Cameroon. Methods: This was a hospital-based retrospective cohort which included patients with SICH and followed up for 6 months after stroke. Subarachnoid haemorrhage, cerebral venous thrombosis with bleeding or bleeding related with ischemic or brain tumour were excluded. Predictive factors were obtained using multiple logistic regression and survival by Kaplan Meier method. Results: The prevalence of SICH was 37% with male predominance (64.0%), a mean age of 55.6 ± 11.8 years. Deep coma was found in 30.3% on admission. The basal ganglion was the most frequent location of haemorrhage (85.1%) while intraventricular blood effusion, mass effect, cerebral oedema and herniation occurred in 31.4%, 25.7%, 8.8% and 5.0% respectively. Hypertension (57.5%) was the most common aetiology. The mean length of hospitalization was 9.0 ± 7.7 days and chest infection (30.7%) was the most frequent complication. The cumulative case fatality rate after 24 hours (day 1), during admission, month 1 and month 3 was 9.6%, 39.9%, 46.0%, 59.8% respectively. On multivariate analysis, GCS -month survival was 37.8%. Conclusion: About one-third of stroke patient were haemorrhagic. Hypertension is the leading CVRF and aetiology of spontaneous ICH. About 1 over 2 patients with SICH would die within 3 months while 50% of survivors would have a poor functional outcome at 6th month.

Background. Stroke is a severe disease due to its morbidity-mortality. It is the first cause of acquired disability including erectile dysfunction (ED). The purpose of this study was to determine the prevalence of ED in stroke patients at the Douala General Hospital, to identify associated factors and to evaluate their quality of life. Materials and Methods. A cross-sectional study was conducted over a period of seven months from November 2016 to May 2017 on two groups of patients in neurology, cardiology, and endocrinology units of the Douala General Hospital (Cameroon): stroke patients (stroke+) and nonstroke patients (stroke-). We collected sociodemographic and clinical data using a preestablished questionnaire. Erectile function was assessed using International Index of Erectile Function (IIEF-5). Associated and predictive factors were determined using univariate and multivariate analyses. Results were significant for a p value < 0.05. Results. A total of 269 patients were included, among them 87 stroke+ (32.34%) and 182 stroke- (67.66%) (controlled group). The mean age was 56.37 ± 12.89 years and 57.18 ± 10.24 years of stroke+ and stroke-, respectively ( p = 0.608 ). Prevalence of poststroke ED was 64.4% ( OR = 3.41 , 95% CI: 1.99-5.82, p < 0.001 ). The average time of occurrence of the poststroke ED was 5 ± 5.85 months. Diabetes and dyslipidemia were the predictive factors of occurrence of poststroke ED. Depression was found both in stroke+ with ED and stroke+ without ED with no difference ( p = 0.131 ). Conclusion. About two-thirds of stroke patients developed ED. Diabetes and dyslipidemia were predictive factors of ED in stroke patients.

Background: Venous thromboembolic (VTE) disease burden is increasing worldwide, representing a major cause of cardiovascular death and public health problem. Pulmonary embolism (PE) is the most serious clinical presentation of VTE. Epidemiological and clinical data on PE are still lacking in Africa, particularly in Cameroon. This study aimed at determining the clinical features as well as imaging presentation and outcome of pulmonary embolism. Methods: A cross-sectional study was carried out in three hospitals in Douala. We retrospectively reviewed patient records admitted for PE from January 2009 to May 2017. We collected data on epidemiology, clinical presentation, venous Doppler/pulmonary computed tomographic angiography (CTA), and outcome. Results: We included 103 patients (56 males) with PE. Their median age was 52 years. The main risk factors were obesity (49.5%), hypertension (35.0%), long trip (24.3%) and cancer (18.4%). The most frequent clinical presentations were dyspnoea (83.4%), chest pain (78.6%), and cough (40.8%). Additionally, pleural effusion (32.8%), atelectasis (25.7%) and pulmonary hyperlucency (20.0%) were the most frequent findings on chest X-ray. The main abnormalities found in electrocardiogram were sinus tachycardia (63.4%), S1Q3T3 aspect (37.6%) and right axial deviation (28.7%). Moreover, right cavities dilatation (26.0%), pulmonary artery hypertension (35.0%) and pulmonary artery dilatation (21.0%) were the main echocardiographic findings. Low-molecular-weight heparin (LMWH) was the initial anticoagulant in all cases. There were 19 (18.4%) in-hospital deaths, and the mean hospital stay was 8.5 ± 5 days. Conclusion: PE is not rare in our setting. Obesity, long trip and cancer are the main risk factors, while dyspnoea, chest pain and respiratory distress are the main clinical presentation for PE. LMWH remains the therapeutic agent of choice. Lastly, in-hospital mortality is very high.

Rituximab (RTX), a chimeric monoclonal anti-CD20 antibody has become part of the standard therapy for patients with CD20-expressing B-cell lymphoma and rheumatoid arthritis. After encouraging results with open studies in systemic lupus erythematosus (SLE), RTX has not shown its effectiveness in randomized controlled trials. However, its efficacy has been validated in renal, hematological, and neuropsychiatric disorders. Understanding the history of RTX in SLE would be instructive in the hydroxychloroquine (HCQ) saga in COVID-19. Three steps would be necessary and sufficient before definitively closing the debate: 1) determine the effective and safe dose of HCQ, as well as the minimum duration of treatment in COVID-19; 2) define the profile of patients in whom HCQ would be more likely to be effective (especially in asymptomatic patients and/or at the onset of the first signs of the disease) and 3) conduct one or more multicentre RCT to evaluate the efficacy and safety of HCQ in COVID-19 in SSA.

Among 472 patients with human immunodeficiency virus-associated cryptococcal meningitis, 16% had severe visual loss at presentation, and 46% of these were 4-week survivors and remained severely impaired. Baseline cerebrospinal fluid opening pressure ≥40 cmH2O (adjusted odds ratio [aOR], 2.56; 95% confidence interval [CI], 1.36–4.83; P = .02) and fungal burden >6.0 log10 colonies/mL (aOR, 3.01; 95% CI, 1.58–5.7; P = .003) were independently associated with severe visual loss.

Highlights • In Cameroon, the most common cause of CSE was stroke followed by infection. • Despite resource limitations, developing countries can effect protocols for CSE. • Despite limited antiseizure medications, outcomes were similar in Cameroon to multicenter outcomes.

Background: The burden of peripheral artery disease (PAD) is not well known among apparently healthy people in Africa. Aim: To determine the prevalence and associated risk factors of PAD in a group of blood donors seen at the Douala General Hospital—Cameroon. Methods: Between 1st November 2015 and 30th April 2016, we carried out a cross-sectional study. Participants were consenting adults of both sexes, aged ≥ 21 years who presented for blood donation, and were tested HIV negative. We collected socio-demographic data and their past history. We carried out a physical examination and measured their Ankle-Brachial Index (ABI). We defined PAD as an ABI < 0.9. We also measured their fasting blood glucose and lipid profile. Results: We recruited 103 participants, 55.4% males. The mean age was 33 ± 10 years. The mean ABI on left and right leg was 1.04 ± 0.1 and 1.02 ± 0.1respectively. ABI was higher in males than females both legs (p < 0.05). PAD was seen in 11 (10.7%) participants. This was higher in females than males (3.6% versus 19.2%, p = 0.026). Among those with PAD, 8 (72.7%) were asymptomatic (Males: 100% versus Females: 66%, p = 0.9). After adjusting for age and gender, sedentary lifestyle (aOR: 7.14, [95% CI: 1.38 - 33.3], p = 0.019), and female gender (aOR: 6.2, [95% CI: 1.26 - 30.5], p = 0.025) were significantly associated with PAD. Conclusion: The prevalence of PAD was high in this group of HIV negative blood donors, most of whom were asymptomatic. This was associated with females, and a sedentary lifestyle.

Background Because of rapid demographic changes, the prevalence of movement disorders (MDs) is expected to increase in Africa. The objective of this study was to estimate the prevalence of MDs in an inpatient/outpatient-based study of rural and urban health care centers in Cameroon. Methods In this retrospective medical chart review, the inpatient/outpatients settings covered an urban population (3,000,000) and a rural population (380,276). Neurological diseases were classified according to the International Statistical Classification of Diseases-Related Health Problems, 10th revision (ICD-10). Crude prevalence was calculated per 100 with 95% confidence intervals (CIs). Results Of 20,131 medical charts reviewed (13% from the rural area), 4187 patients (20.8%) with neurological complaints were identified. MDs were diagnosed exclusively from urban centers in 134 patients (3.2%): the mean patient age was 48.6 ± 18.6 years, and 54.7% were women. The most prevalent MDs were hyperkinetic movements (tremor, myoclonus, and drug-induced MDs [ICD-10 code G25]; prevalence, 1.19%; 95% CI, 1.192–1.194%), Parkinson's disease (ICD-10 code G20; prevalence, 0.78%; 95% CI, 0.785–0.787%), dystonia (ICD-10 code G24; prevalence, 0.61%; 95% CI, 0.612–0.613%), secondary parkinsonism (ICD-10 code G21; prevalence, 0.56%; 95% CI, 0.564–0.565%), Huntington's disease (ICD-10 code G10; prevalence, 0.09%; 95% CI, 0.091–0.092%), and ataxia (ICD-10 code R29; prevalence, 0.04%; 95% CI, 0.0451–0.0456). Conclusion Although the burden of MDs is expected to increase, MDs are likely underdiagnosed in rural areas. High-quality movement disorder training is essential to tackle this need.

Introduction La fibrillation auriculaire (FA) represente la principale cause cardio-embolique des accidents ischemiques cerebraux (AIC) mais est souvent sous diagnostiquee et rarement evoquee dans les litteratures africaines bien que multipliant par 5 la probabilite de faire un AIC. Objectifs Decrire les caracteristiques epidemiologiques, cliniques, therapeutiques, et evaluer le pronostic des patients ayant fait un AIC par FA dans un centre hospitalier de reference en Afrique subsaharienne. Methode Il s’agissait d’une etude de cohorte retrospective sur 8 ans menee a l’hopital General de Douala (HGD). Etaient inclus les dossiers de patients ayant fait un AIC par FA confirme respectivement par le scanner cerebral et l’electrocardiogramme (ECG). L’echographie doppler transthoracique (ETT) etait realisee en hospitalisation. Des scores etaient utilises pour l’evaluation de la gravite de l’AIC (NIHSS), du risque embolique (CHA2DS2-VASc2), du risque hemorragique sous anticoagulant (HAS-BLED) et le pronostic fonctionnel (score modifie de Rankin). Resultats 85 dossiers etaient inclus (5 cas valvulaires) avec un âge moyen de 69 ± 11,96 ans. Un haut risque embolique et de saignement etait present dans 91,3 % et 94,1 % des cas. La survie etait de 19,1 % a 2 ans. La recidive etait de 11 %(7) pour un delai moyen de survenue de 3,4 mois et associee a une FA preexistante (p = 0,001) et la non prise d’antithrombotique (p = 0,001). La recuperation fonctionnelle etait bonne chez 80 % des survivants a 6 mois. Discussion Quoique le risque embolique soit eleve, seuls 40 % des patients avaient recu un traitement coagulant et preferentiellement les anti-vitamines K qui sont accessibles mais de monitorage difficile dans notre contexte. D’autres contraintes etaient dues a l’etat clinique et l’etendue des lesions au scanner. Conclusion Un patient sur 10 recidives preferentiellement dans le premier mois. Un patient sur 5 est vivant a 2 ans. Pres d’un patient sur 2 decede dans les 3 mois post-AVC.

Diabetes mellitus has been associated with cognitive impairment but this has not been well investigated in sub-Saharan Africa. The aim of this study was to determine the prevalence and risk factors of cognitive dysfunction in patients with type 2 diabetes and to assess its influence on medication adherence. We carried out a cross-sectional study over a period of 4 months at the outpatient diabetes and endocrinology clinic of the Douala General Hospital. Consecutive patients with type 2 diabetes attending the clinic underwent cognitive assessment using the Mini Mental State Exam (MMSE). The patient Health Questionnaire-9 (PHQ-9) was used to rule out the confounding effect of depression, and the Morisky score was used to assess medication adherence. Data were analyzed using SPSS version 20 for Windows. Of the 223 participants (54.3% females) with a mean age of 56 ± 9.5 years, 33 (14.8%) had cognitive dysfunction (12.6, 1.8, and 0.4% having mild, moderate, and severe cognitive dysfunction, respectively). Level of education ≤7 years (OR = 5.314, 95% CI 2.443–11.561, p

Introduction : patients living with type 2 diabetes are at increased risk of cardiovascular related death but there is little data on the influence of diabetes on early outcomes of cardiovascular emergencies (CVEs). This study aimed at describing the influence of diabetes on early outcome of patients admitted for CVEs. Methods : database of Cardiovascular Intensive Care Unit (CICU) of the Douala General Hospital was queried for patients admitted for CVEs between November 2012 and November 2015. We compared patients with and without known diabetes for sociodemographic profile and risk factors for CVEs using 2-sided tests (Chi-squared & one-way ANOVA). While Cox regression and Kaplan Meier survival models were used to compare in-hospital complications and mortality. Results : of the 333 patients admitted during the study period, 99 (29.7%) had a diagnosis of diabetes. Patients with diabetes were older (65.8 ± 13.8 vs 60.4 ± years, p

Introduction : the world is facing an epidemic of Diabetes. Polyneuropathy is a length dependent symmetric sensorimotor type of neuropathy a main risk factor of diabetic foot ulcers. The diabetic neurological examination (DNE) score and yearly foot examinations have been recommended for clinical diagnosis of Diabetic polyneuropathy (DPN). The DNE score is lengthy. Other simple tools for accurate diagnosis exist. Risk factors for DPN are not known in our setting. The objectives were to determine the prevalence of Diabetic Polyneuropathy; To compare the Vibratory Perception Threshold (VPT), Monofilament score (MS) and Diabetic Neurological Symptom Score to the DNE score. Identify risk factors of DPN; To estimate Clinician and patient awareness of foot care. Methods : we conducted a cross sectional analytic study of diabetic patients in the Buea and Limbe regional hospitals during 4 months. Co-founders of diabetic polyneuropathy, alcoholics and HIV patients were excluded. Results : 360 patients with mean age of 56 years. 236(65.6%) women and 348(9.67%) T2DM were recruited. The prevalence of DPN was 30.6% (110) using the DNE score. VPT was most specific (96%), sensitive (94.6% and correlated (0.59) to the DNE score. The monofilament and DNS had sensitivities, specificities and correlations of (95.8%, 79.5%, r = 0.48) and (62.2%, 83.5%, r = 0.16) respectively. Determinants of DPN were age>60 years (p10 (p = 0.003), treatment with insulin and oral hypoglycaemics (p = 0.005), history of foot ulcer (p = 0.03), hypertension (p=0.04). During the preceding year, 264(73%) patients’ feet were not examined, 272(80%) did not check their foot wear before wearing, 255(71%) used razor to trim their nails, 144(40%) walked barefeet, and 72(21%) wore tight shoes.

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: Indoor air pollution is a major health problem in the developing world. In sub-Saharan Africa more than 90% of people rely on biomass to meet their domestic energy demands. Pollution from biomass fuel ranks 10th among preventable risk factors contributing to the global burden of diseases. Objectives: The present study aimed to determine the prevalence of respiratory symptoms and the factors associated with reduced lung function in a population of women exposed to cooking fuel smoke. Methods: A cross-sectional study was conducted in a semi-rural area in Cameroon. We compared forced respiratory volume between women using wood (n5145) and women using alternative sources of energy (n5155) for cooking. Results: Chronic bronchitis was found in 7.6% of the wood smoke group and 0.6% in the alternative fuels group. We observed two cases of airflow obstruction in the wood smoke group. Factors associated with lung function impairment were chronic bronchitis, use of wood as cooking fuel, age, and height. Conclusion: Respiratory symptoms and reduced lung function are more pronounced among women using wood as cooking fuel. Improved stoves technology should be developed to reduce the effects of wood smoke on respiratory health.

International audience; Although HIV/AIDS has been anything but neglected over the last decade, opportunistic infections (OIs) are increasingly overlooked as large-scale donors shift their focus from acute care to prevention and earlier antiretroviral treatment (ART) initiation. Of these OIs, cryptococcal meningitis, a deadly invasive fungal infection, continues to affect hundreds of thousands of HIV patients with advanced disease each year and is responsible for an estimated 15%–20% of all AIDS-related deaths [1, 2]. Yet cryptococcal meningitis ranks amongst the most poorly funded “neglected” diseases in the world, receiving 0.2% of available relevant research and development (R&D) funding, according to Policy Cures’ 2016 Global Funding of Innovation for Neglected Diseases (G-Finder) Report [3, 4].

Summary of all categorical variables; whole cohort and separately for HSES and LSES. HSES = High socioeconomic status; LSES = Low socioeconomic status; IQR = inter-quartile range; *p-value from chi-squared tests, HSES vs.LSES; †of those who receive pocket money, median (IQR) = 150 (100, 200) FCFA. (DOCX 16 kb)

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

L’accident vasculaire cerebral (AVC) constitue un defi majeur pour les systemes de soins dans les pays en developpement. La maladie renale chronique (MRC) se definit par un debit de filtration glomerulaire

Background: There is a paucity of literature on the burden of neurological diseases in sub-Saharan Africa. Objective: To create a registry and surveillance of neurological diseases from urban and rural health centers in Cameroon. Methods: Retrospective review of medical records of inpatients and outpatients from two urban public hospitals in Douala and two rural health care centers, from 2013 to 2015 was conducted. In the urban areas, the diagnosis was made by a neurologist but this was not the case in the rural areas. The following variables were analyzed: demographics, medical center characteristics, presenting neurological complaint, medical history, neurological diagnosis, death and disability. Neurological diseases were classified according to ICD-10. Results: Out of 20,131 medical charts available (13% from the rural area), 4,187 cases (20.7%) with neurological complaints were identified and reviewed, mean age 48.67 + 18.62 years, females 54.7%, 188 children (4.4%). The most frequent neurological complaints were: paresis/weakness (G.82, 25.2%) and headache (R.51, 22.0%). The most common concurrent medical history was hypertension (I10, 40.0%), and HIV (B20, 16.45%). The most common neurological diagnoses were cerebrovascular disease (G45, G46, 51.5%), and infection (B50, G00, G04, G06, 24.13%) in adults, and epilepsy (G40, 64.0%) in children. Death due to neurological cause was recorded in 428 patients (19.1%), and disability in 1,072 (57.2%). Neurodegenerative diseases were exclusively diagnosed in urban areas. Conclusion: Population aging and changes in the distribution of risk factors have accelerated the prevalence of non-communicable diseases such as cerebrovascular disease. However, additional work to characterize the nature of diagnosis, treatment and care is important to advance quality of care in the adult and pediatric neurological disorders. A health policy geared towards prevention and neurological training for health professionals is warranted.

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

Introduction En Afrique Subsaharienne, le cout de prise en charge des AVC est supporte par les patients et leur famille. Peu d’etudes existent sur le cout des AVC au Cameroun. Objectifs Determiner le cout direct de prise en charge d’un AVC en hospitalisation dans les deux hopitaux de reference de la ville de Douala. Patients et methodes Etude descriptive, transversale sur une periode de six mois, du 1er mars au 31 aout 2013 a l’hopital general de Douala (HGD) et a l’Hopital Laquintinie de Douala (HLD). Etaient les patients hospitalises pour AVC, confirme par un scanner cerebral. Les donnees sur le cout de prise en charge ont ete recueillies. L’analyse des couts s’est faite en francs CFA, la monnaie utilisee au Cameroun (1 Euro = 656 FCFA). Resultats Nous avons inclus 208 patients dont 49,5 % de femmes, d’âge moyen 60 ± 12,8 ans. Le cout moyen de prise en charge des AVC a l’HGD etait estime a 951 855 FCFA (1450 €) par patient, et 435 672 FCFA (664 €) a l’HLD. Les facteurs determinant le cout de prise en charge des AVC etaient : le type d’hopital, le type d’AVC, la duree d’hospitalisation. Discussion Le cout de prise en charge hospitaliere est plus eleve dans les hemorragies que les ischemies. De nombreuses etudes ont deja ete realisees sur le cout de prise en charge des AVC partout dans le monde. En Afrique, le financement de la sante se fait par les patients, l’Etat intervenant peu dans cette prise en charge. Conclusion Le cout moyen de prise en charge hospitaliere des AVC au Cameroun est tres eleve, representant 17 fois le salaire minimum. Il est deux fois plus eleve pour les hemorragies.

Introduction Les atteintes renales sont apparues dans les etudes recentes, comme un facteur pronostique des AVC. Souvent, l’atteinte renale est diagnostiquee a l’occasion du diagnostic de l’AVC. Objectifs Decrire le profil renal des patients victimes d’AVC et evaluer la valeur pronostique de l’atteinte renale a 3 mois (m3) post-AVC. Methodes Il s’agissait d’une etude de cohorte incluant les patients victimes d’AVC a la phase aigue. Les anomalies renales etaient definies par un debit de filtration glomerulaire (DFG) Resultats Des 504 patients inclus, l’âge moyen etait de 59,56 ± 13,08 ans. La prevalence globale des anomalies renales etait de 55,6 % (soit une proteinurie isolee chez 27 % des patients ; 12,5 % des patients avec baisse de DFG isolee et atteinte mixte chez 16,1 %). La mortalite globale etait de 26,6 % a m3 et plus importante chez les patients avec atteinte renale (p = 0,002). Le taux de dependance etait de 43,44 % a m3 sans difference entre patient avec atteinte renale et sans atteinte renale (p = 0,13). Discussion L’atteinte renale est frequente chez le sujet victime d’AVC. La proteinurie et la baisse du DFG impactent le pronostic des AVC tels que rapporte par d’autres auteurs. Conclusion Les anomalies renales sont predictives du pronostic vital a la phase aigue des AVC mais n’influencent pas la recuperation fonctionnelle.

After completion of treatment, a proportion of pulmonary TB (pTB) patients experience lung function impairment which can influence their quality of life. This study aimed to determine the prevalence of lung function impairment in patients treated for pTB and investigate its associated factors.A cross-sectional study was conducted in TB clinic of the Douala Laquintinie Hospital in Cameroon. Patients aged 15 and above who were treated for pTB between 2008 and 2012 were included in the study. Demographic data, respiratory symptoms prior TB diagnosis, comorbidities and chest radiography findings prior to TB treatment were collected. All participants underwent spirometric measurements. Airflow obstruction was defined as a post-bronchodilation FEV1/FVC70% with FVC80%, restrictive defects as an FEV1/FVC ratio of ≥70% with an FVC80% predicted, and mixed defects as FVC of80% predicted and an FEV1/FVC ratio of70%. Lung function impairment was defined by the presence of at least one of these three abnormalities. Logistic regression analysis was employed to investigate risk factors of lung function impairment.Of a total of 269 participants included in the study, 146 (54.3%) were male. The median age of participants was 33 years. The median duration of symptoms before diagnosis of TB was 4 weeks [interquartile range (IQR) 3-8]. The prevalence of lung function impairment was 45.4% (95% CI 39-51). The multivariate analysis identified duration of symptoms [OR 1.08; 95% CI (1.01-1.15)] and fibrotic pattern [OR 3.54; 95% CI (1.40-8.95)] as independent risk factors for lung function impairment.Post-tuberculous pulmonary function impairment is frequent in Douala. Sensitization of patient with symptoms of pulmonary TB for an earlier visit to healthcare facilities could reduce the impact of pTB on lung function of patients.

A retrospective study was carried out at Douala General Hospital, Cameroon, between July 2007 and July 2011, to determine the prevalence of HIV infection among the pulmonary tuberculosis (pTB) patients and to compare epidemiological profiles with respect to TB/HIV co-infection. The cases of all patients aged 15 years and above and diagnosed with pTB during the study period were reviewed. Sociodemographic data, sputum examination for acid-fast bacilli, previous TB-treatment status, and HIV status were recorded. The chi-square or Fisher’s exact tests were used to compare the proportions. The independent sample t-test was used to compare means for the quantitative data. Of the 383 pTB patients included, 56.1% were males. The mean age was 38.9 ± 13.9 years (range 15–95). The age group 25–44 years was most represented, with 55.6% of the patients, while the least represented age group was that of patients over 65 years. The mean age of the females (36.2 ± 13.6 years) was statistically lower than that of the males (41.1 ± 13.8 years). Smear-positive pTB was diagnosed in 208 cases (54.6%). All the patients were tested for HIV infection. The overall prevalence of HIV among the pTB patients was 50.4%. There were no significant differences between the HIV-positive and HIV-negative groups with respect to age, sex, sputum examination for acid-fast bacilli, and previous TB-treatment status. The results suggest that the TB/HIV co-infection rate in Cameroon is high. Intensification of the screening of HIV infection in the general population and early management of HIV disease, especially in young women, could reduce the incidence of TB.Keywords: co-infection, epidemiology, health management, quantitative research, screening, sub-Saharan AfricaAfrican Journal of AIDS Research 2012, 11(4): 349–352

There is a huge need for health research to support contextually relevant health service and policy solutions to better the health of populations in sub-Saharan Africa. This need contrasts with the very timid engagement of healthcare practitioners in research in the region.It is against this background that the Douala General Hospital (a tertiary-care hospital in Cameroon), under the stewardship of its chief executive officer, organised the first annual scientific and research day in October 2014. This maiden event saw the participation of local research leaders and the eminent director of the South African Hatter Institute for Cardiovascular Research in Africa, who co-chaired the event. The aim was to educate students, clinicians and junior researchers on the importance of clinical research and evidence-based medicine around the leading theme of the event: action for clinical research and good medical practice.Several abstracts were presented, covering various aspects of medicine, including cardiology, rheumatology, paediatrics, pulmonology, HIV medicine, and obstetrics and gynaecology, together with key lectures on cardiac disease and pregnancy, and plenary sessions on research methodology, scientific writing and publishing. It is hoped that this event will enhance clinical research and the dissemination of research findings to improve evidence-based clinical practice in the country.

Objective: To determine the prevalence and risk factors of allergic rhinitis among bakers in Douala. Design: A cross-sectional study; the logistic regression model was use to find the risk factors of allergic rhinitis. Setting: The study was conducted in 42 bakeries randomly selected among a total of 151 bakeries in the city of Douala. Participants: All bakers who consented to participate in the study between 1 May and 31 July 2013. Outcome measures: Allergic rhinitis was the outcome of interest. It was defined as the presence of the following symptoms: itchy nose, rhinorrhea, nasal obstruction and sneezing. Results: During the study period, a total of 273 bakers were invited and 229 finally agreed to participate in this study. Males were the most represented gender with 222 (96.9%) participants. The mean age of the participants was 36.29±8.9 years. Smoking was found in 55 participants (24.5%). The symptoms of allergic rhinitis were observed in 24.5% of participants. Work related nasal symptoms were present in 15% of participants. Sensitisation to wheat flour and α-amylase was found in 16.6% and 8.3% of participants, respectively. The Prick test was positive for mites in 12.2% of participants. After multivariate analysis, sensitisation to flour (OR 3.95, 95% CI 1.85 to 8.47) and storage mites (OR 3.44, 95% CI 1.45 to 8.18) were the factors independently associated with symptoms of allergic rhinitis. Conclusions: Allergic rhinitis is frequent among bakers in Cameroon. Implementation of preventive measures against inhalation of airborne allergens in bakeries and clinical monitoring of bakers sensitised to wheat flour and mites could help to reduce the prevalence of allergic rhinitis among bakers.

Objective: Evaluate the prognostic impact of PWV and AIx, both biomarkers of EVA on mortality in Cameroonian patients with acute stroke. Design and Method: We prospectively enrolled 138 patients admitted with acute stroke in the two main public teaching hospitals of Douala town, Cameroon (53.9 % females, mean age: 64 ± 13 years). The severity of stroke was assessed on admission with the National Institutes of Health Stroke Scale (NIHSS) score. Heart rate (HR), central blood pressures (BP), AI corrected for HR (AIx) and aortic PWV were measured (SphygmoCor) ≤ one week following stroke onset. The outcome was evaluated at discharge with in-hospital mortality and after discharge with community mortality within 30 days following stroke onset. Results: BP did not differ between died vs. survived patients (p > 0.05). PWV was faster in patients with NIHSS score >14 as compared to those with NIHSS score ≤ 14 on admission: 10.7 ± 2.3 m/s vs 9.7 ± 1.9 m/s, P = 0.012. PWV and AIx were greater in died vs. survived patients: 10.9 ± 2.2 m/s vs 9.7 ± 1.9 m/s P = 0.0022 and 31 ± 12% vs 26 ± 12% P = 0.023, respectively. PWV increased markedly with aging in patients who died as compared to those who survived (P = 0,014). Importantly, aged-adjusted PWV≥10 m/s was strongly associated with early and high mortality rate as compared to participants with PWV 0.05). Multivariate regression analysis revealed that PWV≥ 10 m/s, diabetes mellitus, Glasgow score≤ 8 and NIHSSscore >14, were independent predictors of mortality during acute stroke in our study population. Conclusions: Increased aortic PWV is associated with early and high mortality rate in black Cameroonian patients with acute stroke; independently of other known prognostic factors. EVA may be a potential underlying mechanism explaining severe burden of stroke in black African ancestry.

Objective: Hypertension is the main driver of the cardiovascular disease epidemic in Africa. It is suggested that hypertension - related mortality eclipses that of HIV/AIDS and malaria, though this is underappreciated. This study aimed at investigating the morbidity and mortality of patients admitted for cardiovascular emergencies at the Cardiac Intensive Care Unit (ICU) of the Douala General Hospital, Cameroon. Design and method: This was a retrospective cohort study. All patients aged ≥18years and hospitalized for cardiovascular emergencies between October 2012 and December 2014 were included. Data on socio-demographic, clinical profiles and intra-hospital outcomes were collected. Kaplan Meier estimator and logistic regression models were used to relate baseline characteristics to mortality during admission. Results: Of 333 patients hospitalized for cardiovascular emergencies (overall mean age was 62 ± 13.8 years, 53.2% were men), 75.1% (250/333) were hypertensive. The main presenting features were at least one focal neurologic deficit (42.6%) and dyspnea (41.1%). Stroke – (42.1%; 24.6% ischaemic, 17.7% haemorrhagic) and hypertensive heart failure (25.2%) were the most prevalent emergencies. In-hospital mortality was 31.8%, of which 50% were secondary to stroke (32.1% haemorrhagic, 18.9% ischaemic) and 20.8% due to acute heart failure. The main predictors of in-hospital mortality include Glasgow score