[Niveau d'activité physique et déconditionnement des patients insuffisants cardiaques suivis dans deux hôpitaux de la ville de Yaoundé : étude observationnelle au Cameroun]. / Physical activity and deconditioning of heart failure's patients followed at two Yaoundé's hospitals settings : A cross-sectional study in Cameroon.

OBJECTIVE: To assess the basic physical condition of chronic heart failure's Cameroonian patients. PATIENTS AND METHODS: We carried out a cross-sectional study from February to June 2020 at the Yaoundé Central and General Hospitals, including all consenting adults with stage I or II chronic heart failure of the New York Heart Association without sign of decompensation and received in outpatient consultation. Socio-demographic data and the level of physical activity assessed according to the International Questionnaire on PhysicalActivity were recorded. Quality of Life was evaluated using the "Minnesota Living with Heart Failure Questionnaire". Associated factors were analysed using the Chi-square test, the strength of association expressed by the odds ratio, and its 95% confidence interval. The significance level was 0.05. RESULTS: We recruited 102 participants, including 60 women with a median age of 64 [56,68]. Daily physical activity was moderate in 54% of participants and low in 45%, with no significant difference between the sexes (p = 0.3). About 39.2% of patients had an altered physical condition, and the most effective associated factors were obesity (p = 0.01), low daily physical activity (p = 0.002) and non-compliance to the treatment (p = 0.03). The mean Quality of Life score was low (36.7 ± 22.4), and the deterioration in physical condition harmed it (p < 0.001). CONCLUSION: More than a third of the study population had a poor physical condition, which negatively affected their Quality of Life. Therefore, we can suggest that prescribing appropriate physical activity should be an integral part of heart failure management in our context.

Long-term prognosis of patients with permanent cardiac pacemaker indication in three referral cardiac centers in Cameroon: Insights from the National pacemaker registry.

BACKGROUND: There is evidence that cardiac pacemakers improve symptoms and quality of life in patients with severe bradycardia. Globally, the number of pacemaker implantations is on the rise. However, the associated high-cost limits pacemaker's accessibility in low resource settings. This study aimed to investigate access to pacemakers and the long-term outcome of patients requiring a pacemaker. METHOD: We conducted a cohort study in 03 health care structures in Cameroon. Participants aged at least 18 years with indication for a permanent pacemaker between January 2010 and May 2016 were included. Clinical profile, electrocardiography, pacemaker implantation parameters were recorded. Long-term survival was studied by event-free analysis using the Kaplan-Meier method. RESULTS: In total, 147 participants (mean age 67.7±13.7 years, female 58.5%) were included. Fatigue (78.7%), dyspnoea (77.2%), dizziness (47.1%) and palpitations (40.4%) were the main symptoms while syncope was present in 35.7% of patients. The main indication for cardiac pacemaker was atrioventricular block (85.3%). Forty (27.2%) could not be implanted with 34 (85%) of participants highlighting cost of intervention as main reason. VVIR was the main mode of stimulation (70.5%). Of 125 patients in which follow-up was ascertained, 17(13.5%) died after a median survival time of 2.8 years post diagnosis [IQR: 1.8-4.2]. The survival curve was better in participants with a pacemaker with a Hazard ratio of 2.7 [CI: 1.0-7.3, P=0.045]. CONCLUSION: Our patients with severe heart blocks presented late and more than a quarter did not have access to pacemaker but its implantation multiplied the survival rate by 2.7 times at approximately 3 years post diagnosis. Improving early detection of heart blocks and access to cardiac pacing to reduce mortality shall be a key future priority.

Sickle cell retinopathy and other chronic complications of sickle cell anemia: A clinical study of 84 Sub-Saharan African cases (Cameroon).

OBJECTIVE: Sickle retinopathy is a severe complication of sickle cell disease than can lead to blindness. We aim to describe the epidemiology of sickle retinopathy in homozygous sickle cell (SS) African patients and to analyze its association with non-ophthalmologic disease complications of sickle cell anemia. METHODS: We conducted a nested study within the CADRE cohort in Cameroon. Eighty-four consecutive SS outpatients, aged 10 years and older, with no visual symptoms, underwent an ophthalmologic examination. Mean age was 23±10 years. Clinical and biological features were compared between patients with and without sickle retinopathy. We compared the prevalence of the clinical complications and main biological characteristics in patients with and without sickle retinopathy using a univariate logistic regression. The same analysis was used to compare the patients with non-proliferative sickle retinopathy to those with proliferative sickle retinopathy. Statistical analyses were done using the R software (version 3.1.2). RESULTS: Fifty-two patients (62%) displayed sickle retinopathy, among them 23 (27%) had a non-proliferative sickle retinopathy, and 29 (35%) had proliferative sickle retinopathy. Patients with proliferative sickle cell retinopathy had a mean age of 28±11 years. Sickle retinopathy was associated with higher hemoglobin level (P=0.047) and fewer leg ulcers (P=0.018). Proliferative SR was associated with increasing age (P=0.008) and male sex (P=0.025) independently of the hemoglobin level. CONCLUSIONS: Sickle retinopathy is particularly frequent in sub-Saharan sickle cell SS patients, which advocates for early systematic screening.

Assessment of cardiac function in children with congenital adrenal hyperplasia: a case control study in Cameroon.

BACKGROUND: High level of androgens found in congenital adrenal hyperplasia (CAH) seems to have a deleterious effect on heart function. We therefore evaluate cardiac function of children with CAH in comparison with a healthy group. METHODS: We carried out a case-control study in the single endocrinology unit of the Mother and Child Center of Chantal Biya's Foundation. Cases were matched for age and genotypic sex to 2 healthy controls. We analyzed the ejection fraction (LVEF), fractional shortening and left ventricular mass; output and cardiac index; E and A waves velocities, E/A ratio and the mitral deceleration time and diameter of the left atrium; tricuspid annular plane systolic excursion and pulmonary artery systolic pressure were also measured. RESULTS: We included 19 patients with a median age of 6.26 ± 3.75 years and 38 controls stackable distribution. The left ventricular mass of cases was greater than that of controls. A case of reversible cardiomyopathy on hormone replacement therapy was found. For the cases, the average ejection fraction was 71.95 ± 7.88%; the average fractional shortening was 40.67 ± 7.02%. All these values ​​were higher than those of controls, although the difference was not statistically significant. Diastolic left ventricular function was more impaired among the cases. Right ventricular function was similar in both groups. These abnormalities were highly correlated to the late age at diagnosis and duration of treatment. CONCLUSION: This study shows an altered cardiac function in CAH compared to healthy control and highlights importance of an early diagnosis of cases, a tight control of androgens levels and a regular monitoring of cardiac function.

Prevalence of selected rcardiometabolic risk factors among adults in urban and semi-urban hospitals in four sub-Saharan African countries

Aim: Cardiovascular diseases (CVDs) are a global challenge but the burden in sub-Saharan African (SSA) countries is less well documented than elsewhere. We aimed to describe the key cardiometabolic risk factors in four SSA countries. Methods: A cross-sectional, multi-national, hospital-based study was carried out among adults (> 35 years) across four SSA countries from 12 December 2011 to 7 February 2013. Risk factors were defined using the World Health Organisation and International Diabetes Federation guidelines.Results: Of the 844 adults (57.4% female, mean age 52.6 years), 76.6% were urban residents. The predominant CVD risk factors were hypertension (74.1%), obesity (36.2%) and excessive alcohol consumption (25.6%). Diabetes (17.7 vs10.0%), obesity (42.8 vs 16.8%) and hypercholesterolaemia (25.8 vs 18.0%) were more prevalent among the hypertensive subjects (all p < 0.007) than the normotensives. The metabolic syndrome (39.4%) was more common in women and hypertensive subjects.Conclusions: Hospital patients in SSA countries present with excessive rates of cardiometabolic risk factors. Focus on their prevention and control is warranted

Artériopathie oblitérante asymptomatique des membres inférieurs chez un groupe de patients avec des facteurs de risque cardiovasculaire à Yaoundé

INTRODUCTION. L'artériopathie oblitérante des membres inférieurs (AOMI) évolue chez près de 70% des malades de manière asymptomatique. Le but de notre étude était de décrire les aspects épidémiologiques, cliniques et diagnostiques de l'AOMI chez un groupe de patients consultant à l'Hôpital Général de Yaoundé. METHODOLOGIE. Il s'agit d'une étude transversale, descriptive qui s'est déroulée d'Octobre 2012 à Avril 2013 dans l'unité de Cardiologie de l'Hôpital général de Yaoundé. Nous avons recruté 42 sujets ayant au moins un facteur de risque cardiovasculaire majeur. Pour chaque sujet, nous avons collecté des données cliniques, anthropométriques. Puis nous avons mesuré l'Indice des pressions systoliques(IPS) et l'épaisseur intima média (EIM) fémorale. RESULTATS. La moyenne d'âge des sujets était de 54,3 ± 10,3 ans avec un sex-ratio (H/F) de 3,2. Une AOMI (IPS < 0,90) a été retrouvée chez 16,7% des sujets, tandis que 7,1% avaient un IPS > 1,30. L'EIM fémorale moyenne était de 0,82 ± 0,19 mm et 26,2% des sujets avaient une EIM augmentée (> 1 mm). CONCLUSION. L'AOMI asymptomatique est fréquente chez les patients présentant plusieurs facteurs de risque cardiovasculaire à Yaoundé

Strengthening human resources for health through multisectoral approaches and leadership: the case of Cameroon.

PROBLEM: Cameroon has a severe shortage of human resources for health (HRH) and those that are available are concentrated in urban areas. APPROACH: As the result of a national emergency plan for the years 2006-2008, innovative strategies and a multisectoral partnership - led by the Ministry of Public Health and supported by diverse national and international organizations - were developed to address the shortages and maldistribution of HRH in Cameroon. LOCAL SETTING: At the time that the emergency plan was developed, Cameroon had health services of poor quality, an imbalance between HRH training and employment, a maldistribution of HRH between urban and rural areas and a poor allocation of financial resources for HRH. It also lacked an accreditation system for use in the training of health workers. RELEVANT CHANGES: Between 2007 and 2009, the number of active health workers in Cameroon increased by 36%, several new institutions for higher education in health care and training schools for paramedical staff and midwives were opened, and a national strategy for universal health coverage was developed. LESSONS LEARNT: In the improvement of HRH, strong leadership is needed to ensure effective coordination and communication between the many different stakeholders. A national process of coordination and facilitation can produce a consensus-based view of the main HRH challenges. Once these challenges have been identified, the stakeholders can plan appropriate interventions that are coordinated, evidence-based and coherent.

Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa.

To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After ≥4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.

Hyperkaliemie chez les patients en hemodialyse chronique a Yaounde : prevalence; manifestations cliniques et electrocardiographiques

Introduction : L'hyperkaliemie est frequente chez les patients hemodialyses. Elle expose ces derniers au risque de mort subite. Son dosage ne fait pas partie des examens de routine en hemodialyse au Cameroun. Le but de notre etude etait de determiner sa prevalence et ses manifestations cliniques et electrocardiographiques chez les patients hemodialyses chroniques a l'Hopital General de Yaounde. Patients et methodes : Nous avons mene une etude transversale de novembre 2012 a fevrier 2013. Tous les patients hemodialyses depuis plus de 03 mois ayant accepte de participer a l'etude ont ete inclus. Chez chacun d'entre eux nous avons realise avant le debut de leurs premiere et deuxieme seances hebdomadaires de dialyse; un examen clinique; un dosage sanguin de potassium; de sodium et de calcium ionise et un electrocardiogramme. Resultats :Un total de 88 patients a ete retenu. La prevalence de l'hyperkaliemie etait de 38;7avant le debut de la premiere seance de dialyse et e 17 avant la seconde seance. Une paresie a ete retrouvee dans 03 cas et dans tous ces cas le taux de kaliemie etait au moins de 7;5 mEq/l. Deux cas ont presente un signe electrocardiographique pouvant se rapporter a l'hyperkaliemie; il s'agissait d'une onde T ample. Conclusion : L'hyperkaliemie est bien frequente chez nos patients hemodialyses chroniques; mais ses manifestations cliniques et electrocardiographiques ne sont pas courantes

Prevalence and determinants of electrocardiographic abnormalities in sub-Saharan African individuals with type 2 diabetes.

AIM: This study assessed the prevalence and determinants of electrocardiographic abnormalities in a group of type 2 diabetes patients recruited from two referral centres in Cameroon. METHODS: A total of 420 patients (49% men) receiving chronic diabetes care at the Douala General and Yaoundé Central hospitals were included. Electrocardiographic abnormalities were investigated, identified and related to potential determinants, with logistic regressions. RESULTS: The mean age and median duration of diagnosis were 56.7 years and four years, respectively. The main electrocardiographic aberrations (prevalence %) were: T-wave abnormalities (20.9%), Cornell product left ventricular hypertrophy (16.4%), arrhythmia (16.2%), ischaemic heart disease (13.6%), conduction defects (11.9%), QTc prolongation (10.2%) and ectopic beats (4.8%). Blood pressure variables were consistently associated with all electrocardiographic abnormalities. Diabetes-specific factors were associated with some abnormalities only. CONCLUSIONS: Electrocardiographic aberrations in this population were dominated by repolarisation, conduction defects and left ventricular hypertrophy, and were more related to blood pressure than diabetes-specific factors.

High levels of discordance between office-based and ambulatory blood pressure measurements for diagnosing optimal blood pressure control in high-risk diabetic populations from a developing country.

This study investigated the concordance between office-based blood pressure (BP) readings and ambulatory BP monitoring (ABPM) in 51 consenting type 2 diabetes patients (25 males) in Cameroon with hypertension who had been receiving stable treatment for at least 3 months. The prevalence of optimal BP control was 63% based on office measurements and 23% based on ABPM. Agreement between the two methods was poor (kappa statistic: 0.15; 95% confidence interval: -0.08 to 0.29). Using ABPM as the standard, office BP was helpful for ruling out optimal BP control (specificity: 75%), but not for ruling it in (sensitivity: 41%). Our results suggest that ABPM should be recommended in such settings as ours only for those patients who have already achieved stable optimal BP control according to office measurements.

Achieving blood preSsure goals sTudy in uncontrolled hypeRtensive pAtients treated with a fixed-dose combination of ramipriL/hydrochlorothiazide: the ASTRAL study.

BACKGROUND: Hypertension is a common cardiovascular disease, affecting adults worldwide and it accounts for up to 30% of all deaths. The need for better control of arterial hypertension justifies observational studies designed to better understand the real-life management of hypertensive patients. The ASTRAL study was primarily designed to evaluate the percentage of hypertensive patients achieving blood pressure goals after eight weeks of treatment with a fixeddose combination of ramipril/hydrochlorothiazide (HCTZ). METHODS: The study was a multi-centre, non-comparative, Open-label, observational study conducted in 36 centres in five sub-Saharan African countries, namely Cameroon, Congo Brazzaville, Democratic Republic of Congo (DRC), Madagascar and Nigeria. Four hundred and forty-nine men and women 18 years of age or older with hypertension not controlled by an ACE inhibitor, a diuretic or any other monotherapy or anti-hypertensive combination not containing a diuretic in a fixed dose were considered eligible for inclusion in this eight-week study. The study consisted of three visits, visit one (V1) at baseline, visit two (V2) after four weeks and visit three (V3) after eight weeks. RESULTS: The mean age of the patients was 54.7 ± 11.7 years (20-90 years) and most were categorised by the WHO criteria as either overweight or obese (71.6%). After four and eight weeks of treatment with the study drug, systolic and diastolic blood pressures significantly changed from baseline: -24.7/-14.2 mmHg (p < 0.001) and -31.7/-17.9 mmHg (p < 0.001), respectively. There were 60.2% of the non-diabetics on prior monotherapy who, at eight weeks, fulfilled the primary blood pressure goal for SBP and DBP, versus 26.5% of the diabetic patients, also on monotherapy. Few adverse events were reported, with facial oedema and dry cough recurring twice in two patients. CONCLUSION: Fixed-dose combination of ramipril/HCTZ is therefore effective, tolerable and has a good safety profile for blood pressure control in black Africans.

[Cardiac surgery in Cameroon. Results at one year of the pilot phase]. / Chirurgie cardiaque au Cameroun. Résultats à un an de la phase pilote.

In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.

Pattern and clinical aspects of congenital heart diseases and their management in Cameroon.

UNLABELLED: The aim of the study was to investigate the occurrence, pattern and clinical aspects of congenital heart diseases and their management in Cameroon. In this multicentred retrospective study from January 2006 till November 2009, out of 51,636 consulting in three referral centres, 505 were recruited. All the patients presented with the following symptoms: cyanosis, clubbing, frequent respiratory tract infections, failure to thrive, growth retardation, precordial murmur and dyspnoea. Patients were sent for the screening of congenital heart disease. After the comprehensive Doppler echocardiography, the recruited patients were diagnosed with congenital (67.2%) and in few, acquired heart disease. Heart murmur, dyspnoea and growth retardation was the triad mostly encountered. The occurrence of congenital heart diseases in Cameroon is 9.87%. In Douala, isolated ventricular septal defect, interatrial septal defect and isolated pulmonary valve stenosis were more diagnosed than in Shisong (P <0.05) and Yaoundé (P <0.05). In Yaoundé, there were more cases of common arterial trunk, transposition of great arteries with ventricular septal defect and Ebstein disease than in Shisong (P <0.05) and Douala (P < 0.05). At Shisong, tetralogy of Fallot, arterial duct, coarctation of the aorta, congenital mitral valve regurgitation, atresia of the tricuspid valve, double outlet right ventricle, anomalous pulmonary venous return and left isomerism were more diagnosed than in Yaoundé (P <0.05) and in Douala (P <0.05). Thirty percent of the patients were operated abroad; 9% in the cardiac centre. CONCLUSION: Our data show that congenital heart diseases are represented in Cameroon as in the literature; isolated ventricular septal defect is the predominant pathology.

[Cardiovascular emergencies in Subsaharan Africa]. / Urgences cardiovasculaires en Afrique subsaharienne.

BACKGROUND: The increasing prevalence of cardiovascular diseases in subsaharan Africa and their related mortality and morbidity have been established. A large number of them present as emergencies. The purpose of this first multicentric study was to assess the causes, management and outcome of cardiovascular emergencies in savannah and forest environments. METHODS: A total of 665 patients were included from seven participating centers in seven countries: 417 were classified as belonging to the savannah zone (Dakar, Nouakchott, Ouagadougou, N'djamena) whereas 248 patients were from the forest zone (Abidjan, Libreville, Yaounde). Patients were examinated by one or several cardiologists. Statistical analysis was performed by the Medical Statistic Unit of the Hopital Nord, Marseille (France). RESULTS: There were more men (53.4%) than women (46.6%). 77.7% of the patients lived in urban areas. Most of them had low or very low incomes. Patients reached the hospitals in ambulances only in 6.2% of cases. The remaining others were transported by routine urban vehicle or bicycle or ambulation. The mean delay between the onset of symptoms and the arrival to the emergency unit was 6.8 days. Three immediate situations were preponderant: severe hypertension (32.2%), heart failures NYHA IV (27.5%), stroke (20.3%). Underlying conditions were: mainly chronic hypertension (52.3%), cardiomyopathies (20.6%), valvular heart diseases (11.1%). Coronary heart diseases were rare (6.1%). The observed mortality was 21.2% without any differences in age groups. The most common emergencies resulting in death included: stroke (31.9%), vascular collapses (18.4%), pulmonary embolism (9.2%). The patients from the savannah zone were younger, more often classified in the low or average socioeconomic level. Hypertension was more frequent in forest zones. Valvular heart diseases were more frequent in savannah. Cardiomyopathies were comparable in both zones. Coronary heart disease was slightly more common in the savannah area. DISCUSSION: Compared with patients from western countries, the African patients are younger because some diseases affect young people like rheumatic heart disease or postpartum and infectious cardiomyopathies. The difficulties to reach health care facilities made the outcome more severe. Hypertension and valvular heart disease deserve priority in preventive strategy. Cardiomyopathies have to be studied to precise their causes. Finally, the management of cardiovascular emergencies needs a special care in the hospitals owing to their increasing frequency and their severity.

[A new look at adult chronic heart failure in Africa in the age of the Doppler echocardiography: experience of the medicine department at Yaounde General Hospital]. / Nouveau regard sur l'insuffisance cardiaque chronique de l'adulte en Afrique à l'ère de l'échocardiographie Doppler: experience du service de médecine de l'Hôpital General de Yaoundé.

OBJECTIVE: Heart failure is a frequent and severe condition in Africa, yet few African data are available that take into account modern advances like echocardiography in diagnosis. This study aimed to characterize the epidemiological, clinical, etiologic and therapeutic features of heart failure at Yaounde General Hospital. METHODS: A descriptive study was carried from October 1998 to November 2001. One hundred and sixty-seven patients presenting with clinical and echocardiographic signs of heart failure were included, among which 99 men and 68 women, mean aged 57 years. RESULTS: Heart failure was the reason for 5,77% of all hospital admissions. Rehospitalisation rate was 8,33%, the prevalence 30% and overall mortality was 9,03%. 44% of patients were in class III of the NYHA and 7% in class IV. Dyspnoea was a constant symptom (95,20%); hepatomegaly was the most frequent physical finding (41,92%). Cardiac cavities were dilated and left ventricular ejection fraction was low in patients with systolic (70%) and combined (20%) dysfunction. Isolated diastolic heart failure accounted for 10% of cases. Main aetiologies were: Hypertension (54,49%), cardiomyopathies (26,34%) and valvular heart diseases (24,55%). Ischaemic heart disease was the fifth aetiology (2,39%). Medical treatment consisted of loop diuretics (90%), angiotensin-converting enzyme inhibitor (64,7%), digoxin (30,5%) and beta blockers (19,8%). CONCLUSIONS: The clinical syndrome of heart failure constitutes a major public health problem in Cameroon. Echocardiography is of paramount importance in confirming the diagnosis and precising its aetiology. Preventive and public health strategies need to be defined according to the local characteristics.

[Venous thromboembolism in Cameroon (report of 18 cases)]. / La maladie thrombo-embolique veineuse au Cameroun (a propos de 18 cas).

The purpose of this report was to describe clinical and ultrasound findings associated with venous thromboembolism of the lower extremities and pulmonary embolism observed in our department with special emphasis on the utility of venous ultrasound in the diagnosis of venous thromboembolism. Between January 1, 1998 and December 31, 1999, a total of 47 venous ultrasound procedures were carried out according to the standard technique using a Logic 400 MD system (General Electric). Deep venous thrombosis was diagnosed in 18 cases (38.3%). There were 10 men and 8 women with a mean age of 46 years (range, 24 to 71 years). Thrombosis involved the internal saphenous, popliteal, or sural vein in 12 cases, the common or deep femoral vein in 4, and the external iliac vein in 2. The most common risk factors observed in our series were surgery, predisposing conditions, history of venous thrombosis and morbid obesity (66.8% of case). Prolonged periods of bed confinement and neoplasm (lower extremity Kaposi's disease) were more uncommon (22.2%). Pulmonary embolism occurred during the observation period in six cases (33.3%) including 3 (50%) that were fatal. Based on these findings it can be concluded that although its incidence is relatively low in black African patients at risk, thromboembolic disease is often fatal and requires routine preventive treatment using heparin.

[Diastolic function of the left ventricle in a North-African patient with homozygous sickle-cell anemia]. / Etude de la fonction diastolique du ventricule gauche chez le drépanocytaire homozygote noir africain.

AIM: The aim of this study was to investigate left ventricular diastolic function in a group of homozygous Black African patients with sickle-cell disease via echocardiography-Doppler, and to describe the possible hemodynamic implications of these findings. PATIENTS AND METHODS: Fifty patients with sickle-cell anemia from two hematology departments in Yaoundé volunteered to participate in the study, carried out between May-October 1995. The presence of any other associated pathology (cardiovascular disorder, acute drepanocytic anemia, pregnancy) was excluded following a clinical, hematological and echocardiographic examination. A sex- and age-matched control group consisting of 50 healthy subjects was selected after the same examination criteria had been met. Mitral flow recorded by pulsed Doppler was measured, and the amplitudes of the E and A waves of the proto- and telediastolic flow, the E/A ratio, the decrease over time (DT) for the E wave, and the left ventricular isovolumetric relaxation time were also calculated. The limits of the confidence interval for the mean DT of the control group were used as the criterion to determine the following in the patient population: i) relaxation disorder profile, with DT > 154 ms; ii) restrictive disorder profile, with DT < 137 ms. RESULTS: The dimensions of the cardiac cavities and the left ventricular mass were higher in the patient population; 34 cases of left auricular dilatation (68%) and 33 cases of left ventricular dilatation 8 66%) were observed. In only two patients was a systolic dysfunction noted. The amplitudes of the mitral flow E and A waves were increased, and the DT was longer in the sickle-cell group. Forty patients (80%) had abnormal diastolic function, with a marked predominance of the 'relaxation disorder' profile (60%). The restrictive disorder profile was only observed in ten sickle-cell patients (20%), while ten others displayed a normal profile (20%). The means of the various clinical and echocardiographic parameters of the three categories of sickle-cell patients (based on their diastolic profile, i.e., normal, relaxation disorder, restrictive disorder) were compared. The clinical parameters could be superimposed in the 3 categories. The dimensions of the left auricle and the telesystolic diameter of the left ventricle were significantly larger in the restrictive disorder category. The latter category appeared to be more symptomatic, and included the two isolated cases of systolic dysfunction. CONCLUSION: Left ventricular diastolic dysfunction is commonly encountered in sickle-cell cases in the Cameroon. The restrictive disorder profile is less frequently observed, but appears to be more harmful at the hemodynamic level. The present results suggest that the study of diastolic function in patients with sickle-cell anemia could help identify hemodynamically at-risk subjects who require more specific cardiovascular care, even before a noticeable alteration in systolic function has taken place.

[Ultrasonic demonstration of carotid atherosclerosis in black Cameroonian adults with cardiovascular risk]. / Mise en évidence ultrasonographique de l'athérosclérose carotidienne chez l'adulte noir camerounais à risque cardiovasculaire.

The objective of this study was to determine the prevalence of carotid atherosclerosis in black Cameroonian adults presenting cardiovascular risk factors (CVRF). It was based on 77 subjects over the age of 40 years (50 men and 27 women) with at least one major CVRF, such as hypertension (HT), smoking, dyslipidaemia or diabetes mellitus. Obesity [body mass index (BMI), waist/hips ratio (W/H)] and hyperuricaemia were also taken into account. Duplex ultrasound examination of the carotid arteries was performed with a Siemens apparatus equipped with a 7.5 MHz transducer array. An atheromatous plaque was defined as medio-intimal thickening > or = 1.5 mm, with either protrusion or hyperechogenicity. Risk factors were distributed as follows in our serie: HT: 82%, Obesity: 49% (W/H) and 32% (BMI); Diabete: 32%; Smoking: 23%; Hyperuricaemia: 21%; Hypercholesterolaemia: 13%. 19 subjects (25%) (12 men and 7 women with a mean age of 63 years) presented one or more atheromatous plaques in the carotid arteries. Hyperuricaemia and hypercholesterolaemia were significantly correlated with the presence of plaques, with a marked tendency in subjects over the age of 70. In this study, hyperuricaemia and advanced age appeared to be independent arterial risk factors on multivariate analysis. In conclusion, our data show that carotid atherosclerosis does exist in our populations, especially in elderly subjects with cardiovascular risk factors. The particular role of hyperuricaemia as a predictive factor of atheromatous plaques in black Cameroonian subjects needs to be defined.