Short, Medium, and Long-Term Stroke Mortality in Libreville and Associated Factors

Strokes are common around the world and especially in sub-Saharan Africa. They are responsible for severe sequelae and the majority of deaths. In Gabon, no study on stroke mortality has been conducted. Objective: To determine short, medium, long-term mortality and factors associated with long-term stroke mortality. Method: Our study took place in the Neurology Department of the University Hospital Center of Libreville (UHCL). It was a historical cohort study with descriptive and analytical purposes covering the period from June 1 to August 31, 2018 and taking into account hospitalized patients from January 1, 2013 to December 31, 2017. We conducted a comprehensive systematic recruitment of patients with stroke, 18 years old and more, and had been agreed to give information. We included all patients meeting the inclusion criteria. The data was gathered using Epi-Info 7 software. The CHI-2 test was used for the comparison of frequencies and the Student’s test, for comparison of means. Multivariate analysis with logistic regression allowed us to look for factors associated with long-term mortality. A result was statistically significant for a p 0.05 value. Results: At 3 months, 28 patients (18.1%) died, at 6 months thirty-one patients or 20.1% died. At 5 years old, fifty-three patients or 34.4% had died. The factors associated with long-term mortality, if the lost of sight were all alive were tobacco (p = 0.01) and stroke (p = 0.008). If all those who were lost to sight had died, no factor was associated with 5-year mortality. Conclusion: Stroke mortality must not be taken for granted, it can be underestimated because of the large number of lost sight. Measures must be put in place to strengthen post-stroke monitoring. .

Rainfall Dynamics and Landslides in Urban Areas of Gabon: The Case of Libreville-Est (Gabon)

Due to its abundant rainfall, the city of Libreville, which concentrates more than half of Gabon’s population, is frequently confronted with the impacts of natural disasters such as floods and landslides. This study attempts to identify the complex relationships between the dynamics of land use and the role of rainfall in the occurrence of landslides. On the one hand, it uses statistics on landslides compiled from information taken from general news bulletins and, on the other, daily rainfall data obtained from the National Meteorological Department. The study revealed that the Libreville East sector, dominated by Mount Nkol Ogoum, one of Libreville’s most prominent landforms, is affected by a land-use dynamic in which human settlement has been progressing for some thirty years, to the detriment of the original vegetation which, among other things, helped to stabilise the soil on the hillsides and the marshy areas at the foot of the slopes. The result is not only an uncontrolled occupation of the land, but also a major landslide every two years in this part of the city, causing significant loss of life and property. However, an analysis of the time series shows little rainfall variability, marked in particular by a predominance of negative anomalies, and the occurrence of a few exceptional daily rainfall peaks. Similarly, the period from 20 October to 20 November, which receives the most rainfall, also appears to be the most conducive to landslides.

Antidiabetic Prescriptions at the University Hospital Center of Libreville (Gabon) Facing the Concept of Therapeutic Inertia: An Andragogical Perspective

Context: Diabetes mellitus is experiencing an alarming progression throughout the world, but more and more drugs are available with the use not always adapted. The aim of this work is to analyze the anti-diabetic prescriptions at the university hospital center of Libreville (Gabon) and confront them with the concept of therapeutic inertia. Patients and Methods: In diabetics coming for their periodic control, we transcripted for 2 months, beyond their characteristics, their glycated hemoglobin rate and the treatment followed. Results: 200 patients have consulted and among them, 160 (80%) had done their A1c analysis. 46% had an A1c ≤ 7% and 54% above with sometimes an unsuitable treatment evoking therapeutic inertia, the factors of which we discuss. Conclusion: Therapeutic inertia is a multifactorial problem, one of the components of which may be the resistance to change of the adult learners who are the practitioners.

The Difficulties of Congenital Syphilis Diagnosis about 3 Cases at Libreville, Gabon

First described embryo fetopathy, congenital syphilis remains a public health problem mostly in developing countries. The diagnosis mainly based on bacteriological and immunological evidence of mother-child couple is not always easy, as it is shown in our three clinical cases. Those three clinical observations demonstrate the difficulties encountered in the diagnosis of congenital syphilis in our country where only the TPHA (Treponema Pallidum Haemaglutination Assay) and VDRL (Venereal Disease Research Laboratory) tests are the only ones to be routinely carried out. Actually, these tests can be negative at the earliest stage of the syphilis or in case of zonal phenomenon. In addition, maternal antibodies could be found in child blood, even if the baby is in good health. At last, the child could have been contaminated belatedly while tests were negative at the third month of pregnancy. Congenital syphilis still exists in our developing countries and, in order to better manage this pathology, a proposition of an efficient algorithm is submitted.

Management of Priapism in Sickle Cell Patients: Experience of the Urology Department of the University Hospital Centre of Libreville

Introduction: Priapism is a rare pathology, known since antiquity. Sickle cell disease is the main aetiology in Africa. The aim of our work was to report our experience in its treatment. Material and Methods: This is a prospective, descriptive study carried out at the urology department of the Libreville University Hospital from January 2018 to December 2020. All sickle cell patients admitted to urology for priapism were included. The parameters studied were socio-demographic, clinical and therapeutic parameters as well as the evolution after treatment. Result: We collected 19 priapisms in sickle cell patients. The average age was 20.9 years with extremes of 4 and 53 years. Fifteen patients were homozygous SS. All patients had stasis priapism. The average consultation time was 22.4 hours. All patients had perioperative medical management combining hyperhydration, analgesia and antibiotic prophylaxis. A vasoactive drug was administered to 13 patients. Sixteen patients had a puncture of the corpus cavernosum. A distal cavernosal-spongiosum shunt under penile block was performed in 6 patients. The outcome was favorable from the outset in 12 cases, marked by complete detumescence of the corpus cavernosum. Partial detumescence was noted in 7 patients with the need for a new puncture of the cavernous body. A complication such as edema of the penis was in only one of our patients. A recurrence was noted in 2 patients. After an average follow-up of 6 months, no sequelae erectile dysfunction was observed. Conclusion: Priapism is a frequent complication among sickle cell patients in Libreville. Medical management associated with a cavernous puncture with administration of vasoactive drugs allows a favourable evolution without after-effects.

Clinical Characteristics of Nystagmus in Albinos Living in Libreville

Introduction: Nystagmus is a static ocular disorder characterized by an oscillatory, involuntary and rhythmic movement of eyes. In Libreville, no data on the subject is available. The purpose of this study is to describe clinical characteristics of nystagmus in albinos living in Libreville. Methods: This is a descriptive, cross-sectional study including 43 albinos with oculocutaneous albinism and nystagmus during the period from February 01, 2017 to February 01, 2018. Variables studied were age, sex, visual acuity, objective refraction, characteristics of the nystagmus including morphology, direction, intensity and associated signs such as stiff neck and squint. Results: The mean age was 21.2 ± 17 years with a female-dominated ratio of 0.53. The visual acuity from afar without correction (AVLSC) was less than 3/10 in 88.4% of the cases. The most common ametropia was astigmatism in 51.2% of cases. Nystagmus was present in all albinos. The spring type was found in 69.7% of cases. The direction was horizontal in 67.4% of the cases and rotary in 32.6% of the cases. The intensity was moderate in 55.8% of cases. The blocking position was the primary near vision position in 69.7% of the cases. Nystagmus was associated with a stiff neck in 28% of the cases and strabismus in 48.8% of the cases. Conclusion: The albinos nystagmus living in Libreville is of the spring type, horizontal direction, of moderate intensity and calmed in the primary position in near vision.

Olecranon Fractures in Children: About 21 Cases Treated at the Owendo University Hospital Center at Libreville (Gabon)

Background: The olecranon fractures in children are relatively rare articular fractures. The aim of this work is to study the epidemiological, clinical and therapeutic particularities of this fracture in children at Owendo University Teaching Hospital. Patients and Methods: This was a retrospective analytical, monocentric study over 2 years from January 1, 2018 to January 1, 2020 at the Owendo University Hospital in Libreville and relating to the medical files of patients treated for a fracture of the olecranon in children in the service and regularly followed in outpatient consultation. Results: We collected 21 patients with an average age of 8.7 years. Falls dominated the etiologies. The Bracq classification was the one used in our series with the predominance of type D. The treatment was orthopedic in 33.3% of cases and surgical in 66.7% of cases. With an average follow-up of 12 months, the results were good in 71.5%, average in 19.0% and poor in 9.5%. Conclusion: The analysis of our results compared to those of the authors of the literature according to the precise parameters seems satisfactory.

Sexual Functional Prognosis of Penile Emergencies at the University Hospital of Libreville

Introduction: Penile emergencies are multiple and varied, and they can jeopardize the sexual functional prognosis of the patient. The objective of our study was to evaluate the sexual functional prognosis of patients admitted for penile emergencies. Patients and Methods: We conducted a cross-sectional study from January 1 to 31, 2021, in the urology department of the University Hospital. Variables included sociodemographic, diagnostic, and evolutionary data of sexually active patients admitted for a penile emergency. Results: During this period, 68 patients were admitted for penile emergencies. We included 45 sexually active patients, with a mean age ranging from 34.5 ± 14.1 years with extremes of 16 and 90 years. The most frequent penile emergencies were priapism (62.2%) and penile fracture (22.2%), with a mean time for treatment of 21.4 ± 52.5 hours. The sexual functional prognosis was very satisfactory (normal erection) in 71.1% (n = 32) of patients. Loss of erectile function was observed in 4.4% (n = 2) of cases. Conclusion: Penile emergencies are relatively frequent, dominated by priapism and penile fracture in our context. The sexual functional prognosis is good.

Epidemiology of Nosocomial Bacteremia Due to Bacteria from the “<i>Burkholderia cepacia</i>Complex” at Libreville University Hospital Center

Introduction: Burkholderia cepacia is a non-fermenting emergent bacterium common in nosocomial infections and can cause life-threatening infections whose multidrug resistance makes them a serious threat in hospitals. The aim of this study was to determine the prevalence of B. cepacia infections during nosocomial infections at Libreville University teaching hospital. Methodology: In this cross-sectional study, lasting 19 months, 412 blood cultures were analyzed. The BacT/ALERT 3D (Biomerieux, France) was used to detect the positivity of blood culture flasks and the Viteck 2 compact (Biomerieux, France) for the identification of germs and the study of their susceptibility to antibiotics. Results: Our study population consisted of 412 patients. The sex-ratio M/F was 1.06 in favor of the male gender (n = 201, 51%). The age of the patients varied between 0 and 82 years. The bacteremia of B. cepacia mainly affected children under 15 years of age with a prevalence of 7% (n = 28). The pediatric ward was more represented with a frequency of 36% (n = 10). The antibiotic sensitivity profile showed high resistance of 100% for aminoglycosides (amikacin, tobramycin, and gentamycin), tetracycline, beta-lactams (Amoxicillin, Imipenem, Ticarcillin, Cefoxitin and Cefotaxime), and ciprofloxacin. However, four molecules were active on B. cepacia (Levofloxacin 100%, Trimethoprim + sulfamethoxazole 92.3%, ceftazidime 80% and cefepime 35%). Conclusion: Ultimately, infection and multi-resistance due to Burkholderia cepacia calls for a review of hospital hygiene in the pediatric ward and a review of antibiotic therapy in young children.

Seroprevalence of HIV, Hepatitis B and C Viruses Infections among Candidates for Cataract Surgery

Introduction: The safety issue of mass surgeries in areas of higher endemicity for HIV, HBV and HCV is raised. Objective: The objective was to determine the frequency of HIV, HBV and HCV among people undergoing a cataract surgery during humanitarian surgical mission. Patients and Method: This prospective study was conducted at CHU Owendo from April to September 2018. Cataract-operated patients were the targeted population. Rapid screening tests were used for diagnosis. Parameters such as age, sex, frequency of HIV, HBV, HCV, and co-infections were analyzed. Sero-positivity was correlated with age and sex. A total of 1403 patients were included. Statistical analysis was performed with EPI Info 7.2 (Chi2 uncorrected, Mann-Whitnney and Wilcoxon, p Results: Patients mean age was 66.3 ± 11.6 years;42.1% of them were male. With 18.0% of the study population, HIV-positive people had mean age of 78.4 ± 9.3 years, compared to 61.2 ± 10.1 years for sero-negative (p < 0.001). HIV prevalence was 4.6% (95% CI = [3.7 - 5.9]), HBV was 2.9% (95% CI = [2.1 - 3.9]), and HCV was 11.8% (95% CI = [10.2 - 13.6]). Co-infections occurred in 1.2% (95% CI = [0.8 - 1.9]) of patients undergoing surgery. Conclusion: This study showed high prevalence of HIV, HBV and HCV among patients undergoing cataract surgery with predominance for HCV. Viral co-infections prevalence was also significant.

Prostatic Burkitt Lymphoma, a Rare Secondary Location

Introduction: Non-Hodgkin’s malignant lymphoma is found primarily in African children. Prostate localization is a rare entity. We report the case of a secondary prostatic localization of Burkitt lymphoma in a 14-year-old child. Observation: the 14-year-old child NNJ was followed at the Libreville Cancer Institute (ICL) for Burkitt maxillo-facial stage II bilateral Murphy lymphoma. The clinical examination noted an alteration of the general state, total hematuria, a voluminous prostatic mass filling the rectal ampoule. The paraclinical assessment noted renal insufficiency, a prostatic mass on ultrasound. Anatomo-pathological examination of the prostatic biopsy diagnosed Burkitt type non-Hodgkin’s malignant lymphoma. He died a week later. Conclusion: Primary or secondary prostatic lymphoma is rare. Obstructive renal insufficiency is an additional complication that darkens its prognosis by delaying etiological treatment based on polychemotherapy.

The Short-Term and Medium-Term Prognosis of a Stroke and the Factors of Poor Prognosis in Liberville

Objectives: was to determine the factors influencing stroke prognosis in Libreville. Methods: This was a multicenter study prospective with a descriptive and analytical focus carried out from March 1st to July 31, 2014. Recruitment was systematic and exhaustive. The data collected was processed and analyzed using Epi-Info 3.3.5 software. Results: This study involved 66 patients including 27 male (40.9%) and 39 female (59.1%). Mean age was 55.1 +/? 15.3 years, mostly female. There were 57.5% ischemic stroke, 42.5% hemorrhagic stroke. The mean NIHSS was 7.8 +/? 6.6 at admission. Intra- hospital stroke mortality rates at 1 and 3 months were 7.6% and 9.1% respectively, ranging from 18.2% to 31.8%. The following factors were identified as associated with death at 1 month: age, high NIHSS at admission, high blood pressure, leukocytosis, hyperthermia and delay in admission. As for functional outcome, patients were relatively autonomous at discharge and factors associated with poor functional outcome (Rankin Conclusion: This study highlights many factors influencing prognosis of stroke. The poor prognostic factors were age, high NIHSS at admission, high blood pressure, hyperthermia, blood glucose, leukocytosis, delay in admission and length of hospital stay. Addressing these factors in the acute phase management strategies may improve the prognosis of stroke patients in Gabon.

Study of the Types of Refractive Disturbances Obseved during Hyperglycemia in Humans

Introduction: Refractive disturbances have been observed during hyperglycemia. However, there remains controversy as to the types of disturbances that it induces. Objective: To determine the types of refractive disturbances observed during hyperglycemia in humans. Population and Methods: This was an observational and cross-sectional study with an analytical purpose conducted from July to November 2021. Emmetropia, hypermetropia, and myopia as well as blood glucose levels were compared between day 0 (D0) and day 30 (D30) after initiation of hypoglycemic therapy in 222 people (444 eyes) with recently discovered hyperglycemia (Chi-2;p Results: At D0, the mean of blood glucose was 18.1 mmol/L ± 8.2 vs 6.9 mmol/L ± 3.0 at D30 (p = 0.001). At day 0, 80% (n = 355) of eyes were hypermetropic compared to 73.9% (n = 328) at D30 (p = 0.02). At D0, 14.2% of eyes (n = 63) were myopic compared to 11.3% (n = 50) at D30 (p = 0.02). Refraction improved from 0.75 to 1.5D for 34.5% (n = 18) of hypermetropic eyes and 10.2% (n = 2) of myopic eyes. Conclusion: Our results show that hypermetropia is the most common ametropia during hyperglycemia. Moreover, these data suggest that the normalization of blood glucose improves refraction.