Cardio-embolic stroke: Lessons from a single centre in Sub-Saharan Africa.

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>140mmHg (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.

HIV infection does not influence stroke outcomes in HIV-infected patients: A prospective study.

BACKGROUND: Human immunodeficiency virus (HIV) infection, opportunistic infections and antiretroviral therapy contribute to the pathogenesis of stroke, yet, little is known about the influence of HIV infection on outcome in stroke patients. The aim of this study was to compare the outcome of stroke in HIV-infected patients with that of HIV-negative patients at the Douala General Hospital (DGH). PATIENTS AND METHODS: A prospective cohort study was carried out at the Neurology unit and the Intensive Care Unit of the DGH from January 2010 to December 2015. All patients aged 15 years and above, admitted for stroke confirmed by brain imaging were included. HIV testing was systematically prescribed for all stroke patients. HIV-infected patients were then compared with HIV-uninfected patients. Quantitative variables were expressed as means while qualitative variables were expressed as frequencies, and were compared with the Chi2 test or the Fisher test and the Student test respectively. Stroke outcome was evaluated by the mortality, in-hospital stay and functional outcome at 6 months post-stroke. Kaplan-Meyer method was used to determine survival. RESULTS: Forty of the 608 patients with stroke were HIV-positive, giving an in-hospital HIV prevalence of 6.6%. Mean age of the HIV-infected stroke patients was 51.3±10.4 years as against 59.6±13.53 in the HIV-uninfected group (P=0.001). The proportion of dyslipidemia in HIV-infected stroke patients with was greater than that in HIV-uninfected stroke patients (57.5% vs 8.9%, P<0.001). The most common type of stroke was ischemic in two-thirds of the patients in both groups. HIV-infected stroke patients had a mean hospital stay longer than that of HIV-uninfected patients (10.3±8.1 days vs 8.1±6.3 days, P=0.042). Post-stroke infections were more frequent in HIV-infected patients (17.5% vs 6.9%, P=0.014). The cumulative mortality rates at 6 months were 37.5% and 34.5% for the HIV-infected and the HIV-uninfected groups respectively (P=0.471). The functional outcome was similar in both groups at the 6th month post-stroke (Rankin score>2: 38.5%vs 38.8%, P=0.973). There was no difference in survival between the two groups. CONCLUSION: HIV infection does not affect in-hospital mortality and functional outcome in stroke patients a part the length of hospital stay.

Correlates of cigarette smoking among university students in Cameroon.

OBJECTIVE: To determine factors associated with smoking among university students in Cameroon. DESIGN: A cross-sectional survey was carried out using an anonymous self-administered questionnaire among a convenience sample of 3000 students from three universities (the Université des Montagnes, and the Universities of Douala and Yaounde 1) in Cameroon; 190 students (5.9%) did not consent to the survey. Socio-demographic characteristics and smoking trends were recorded. Logistic regression was used to identify risk factors for smoking. RESULTS: Of the students selected, 1862 (62%) were male. The mean age was 23.3 years. We found that 30.1% of students had tried smoking and that 5.6% (n = 168) reported regular smoking. Smoking prevalence among male and female students was respectively 9.5% and 1%. The mean age of smokers was 24.1 years. Only 12.5% of regular smokers were nicotine-dependent. Factors motivating smoking were pleasure, imitation, snobbery and curiosity. In the multivariate analysis, smoking was statistically associated with age, male sex, exposure to friends who smoke and living with smokers. CONCLUSION: Although the prevalence of smoking found in our study was low, effective tobacco control programmes targeting factors such as age, male sex and peer influence should be implemented in universities. Future studies are needed to evaluate the impact of these interventions.

[Neuromeningeal cryptococcosis in patients apparently non-immunodeficient: report of 3 cases in Dakar, Senegal]. / Cryptococcose neuroméningée chez des patients apparemment non-immunodéprimes: à spropos de 3 cas à Dakar, Sénégal.

Cryptococcal infection is common in immunocompromised patients. Its occurrence in immuno-competent patients is rare. We report here 3 cases of neuromeningeal cryptococcosis in patients without any immunosuppressive documented factors. They were respectively 25, 36 and 50 years old presenting clinical signs of chronic meningo-encephalitis. The HIV test was negative for all of them and the CD4 counts were normal. One patient died on the seventh day of the treatment with amphotericin B; the second was discharged on parents' request, while the third patient improved with intravenous fluconazole. This study suggests that when facing a sub-acute or chronic meningitis, an investigation for cryptococcal infection is recommended as before AIDS epidemic.