Clinical predictors of significant intracranial computed tomography scan findings in adults experiencing headache disorder.

INTRODUCTION: Radiological assessments for adult headache disorder show significant intracranial findings in 2.5% to 10% of performed computed tomography scans (CT-scans), leading to an overuse consideration for CT-scan requests by physicians in headache-experiencing patients. Therefore, we undertook this study in order to determine predictors of significant intracranial CT-scan findings in adults experiencing headache disorder; in order to help physicians better select patients who need imaging, which would subsequently decrease the costs of headache disorder management and the useless irradiation rates. METHODS: We carried out a cross-sectional study in the medical imaging departments of Yaounde Central Hospital and Douala Laquintinie Hospital, which are two teaching hospitals in Cameroon, over a period of five months. We consecutively and non-exhaustively included all consenting patients aged eighteen years and above, referred to the radiology department to perform a head CT-scan as aetiological workup of headache disorder, from either a traumatic or non-traumatic mechanism. Patients having a known brain lesion and those with a Glasgow coma scale less than thirteen were excluded. The clinical history of patients was taken and a complete physical examination was performed. Demographic data, clinical characteristics of the headache, results of neurological and physical examinations were collected and correlated to the results of head CT-scan. RESULTS: We enrolled 169 patients in the study, 56.2% were males, with a sex ratio of 1.3; sudden onset of headache increased by two the risk of discovering significant intracranial pathology (p = 0.032). Occipital and cervical location of headache, headache evolving by crisis, and recurrent paroxysmal headache were rather significantly correlated to no structural brain finding. An abnormal neurological examination with specifically abnormal stretch reflexes, aphasia, loss of consciousness, raised intracranial signs, weakness, and meningeal signs were predictive of structural intracranial pathology. Otorrhagia, epistaxis, and periorbital ecchymosis in addition were predictive in post-traumatic headaches. CONCLUSION: Abnormal results from neurological examination are the best clinical parameters to predict structural intracranial pathology on CT-scan in adult patients experiencing headache disorder. In case of post-traumatic headaches, in addition, otorrhagia, epistaxis, and periorbital ecchymosis are too highly predictive.

Sero-epidemiology of human immunodeficiency virus, hepatitis B and C viruses, and syphilis infections among first-time blood donors in Edéa, Cameroon.

BACKGROUND: Blood safety remains an issue of major concern in transfusion medicine in sub-Saharan Africa. Blood-borne agents such as the human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and Treponema pallidum are among the greatest threats to blood safety for the recipient. This study aimed to determine the seroprevalence and risk factors of HIV, HCV, HBV, and syphilis infections among first-time blood donors at the new hospital-based blood bank in Edéa, Cameroon. METHODS: We carried out a retrospective analysis of blood donor data recorded between December 2011 and May 2012 at the blood bank of the Edéa Regional Hospital. Antibodies to HIV types 1 and 2 were screened with the Determine and ImmunoComb tests. Hepatitis B surface antigen and antibodies to HCV were detected using DIASpot test strips. Syphilis was diagnosed using the Venereal Disease Research Laboratory (VDRL) test and the Treponema pallidum hemagglutination assay (TPHA). RESULTS: A total of 543 blood donors were included, among whom 349 (64.3%) were family replacement donors. One hundred and fifteen donors (21.2%) were infected with at least one pathogen. The overall seroprevalence rates of HIV, HBV, HCV, and syphilis were 4.1%, 10.1%, 4.8%, and 5.7%, respectively. We found a total of 26 dual infections. The most common combinations were HBV-HCV and HBV-HIV. There was a significant association between HIV and HBV infections (adjusted odds ratio (aOR) 3.46, 95% CI 1.29-9.39; p=0.014), and between HBV and HCV infections (aOR 2.81, 95% CI 1.02-10.12; p=0.036). Compared to voluntary donors, family replacement donors were significantly more infected by at least one screened pathogen (aOR 1.81, 95% CI 1.14-2.88; p=0.013), and more infected specifically by HIV (aOR 3.66, 95% CI 1.07-12.55; p=0.039) and syphilis (aOR 2.81, 95% CI 1.05-7.46; p=0.039). CONCLUSIONS: Our findings indicate that blood safety remains a major problem in Cameroon where hospital-based blood banks and family replacement donors are predominant. There is an urgent need for a national blood transfusion program in Cameroon that will establish a nationally coordinated blood transfusion service based on the principles of voluntary regular non-remunerated blood donation.