Left Ventricular Diastolic Dysfunction and Silent Myocardial Ischemia amongst Asymptomatic Type 2 Diabetic Patients in Two Referral Hospitals in Cameroon

Background: Cardiovascular events, the leading cause of death among diabetic patients, are usually under-diagnosed due to subclinical presentation. Methods: We conducted a cross-sectional study from March-2019 to September-2020, in two reference hospitals in Yaoundé, Cameroon, to assess the prevalence of asymptomatic Left Ventricular Diastolic Dysfunction (LVDD) and Silent Myocardial Infarction (SMI) and potentially associated factors. Results: Out of 95 participants (mean age ± SD: 43 ± 7 years;M/F sex-ratio 1.6), 22 (23.1%;95% CI: 15.8% - 32.6%) had LVDD and fewer (n = 13, 13.6%;95% CI: 8.2% - 22.0%) had SMI, p = 0.86. Though not statistically significant, patients with ≥5 years diabetes duration, as well as patients with HbA1C ≥ 7.5% had two-fold increased risk of LVDD (p = 0.22 and p = 0.15 respectively). LVDD was significantly higher in patients with SMI (29% vs 6.3%, p Conclusion: The significant presence of asymptomatic cardiovascular manifestations in this population entails mandatory preventive screening, especially, in patients with long standing diabetes and poor glycemic control, to allow timely detection and management.

Electrocardiographic Safety of Daily Hydroxychloroquine 400 mg Plus Azithromycin 250 mg as an Ambulatory Treatment for COVID-19 Patients in Cameroon

Objective: To determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychlo- roquine and Azithromycin. Design: Prospective study. Setting: Treatment centres of the city of Yaounde, Cameroon, from May 7th to 24th 2020. Participants: We enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200 mg twice daily during seven #days plus Azithromycin 500 mg the first day and 250 mg the remaining 4 days as per national standard. Main Outcomes Measures: The primary end-point was the change in QTc interval between day 0 (D0), day 3 (D3) and day 7 (D7). Secondary endpoints were changes in all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic events during the course of treatment. Results: The population (29 men and 22 women) was aged 39 ± 11 years (range 17 to 61 years). Mean Tisdale score was 3.35 ± 0.48. No significant change from baseline (D0) of QTc was observed at D7 (429 ± 27 ms at D0 versus 396 ± 26 ms at D7;p = 0.27). A reduction of heart rate was observed between the D0 and D7 (75 ± 13 bpm versus 70 ± 13 bpm, p = 0.02) with increased QRS duration between D0 and D7 (95 ± 10 ms versus 102 ± 17 ms, p = 0.004). No symptomatic arrhythmic events occurred during the treatment course. Conclusions: No life-threatening modification of the QT interval was observed in non-severe COVID-19 patients treated ambulatory with hydroxychloroquine and azithromycin. Studies are needed in critical-ill and older patients.

Stroke Associated with Covid-19 at the YaoundéGeneral Hospital, Cameroon: Series of 10 Cases

Background: The Covid-19 pandemic, which is an infection due to the SARS Cov-2 virus, mainly causes severe damage to the respiratory system, but several studies have reported neurological damage with different manifestations including headaches, seizures, encephalopathies, and stroke. We report a series of 10 patients infected with Covid-19 who had an ischemic stroke at the Yaoundé General Hospital, Cameroon. Patients and Methods: We carried out a prospective study for 12 months between April 2020 and March 2021 by collecting data from patients admitted for Covid-19 at the Yaoundé general hospital. Were included all patients with a diagnosis of stroke confirmed by brain imaging (CT/MRI) following a focal neurological deficit of sudden onset and whose test (nasopharyngeal swab confirmed by PCR) for Covid-19 was positive. Patients diagnosed with a stroke more than 2 weeks (14 days) after the positive Covid-19 PCR test were excluded. Results: The prevalence of ischemic stroke in this hospital-based series was 1.46%. These were six men and four women. The mean NIHSS score was 13.57. The average age of our patients was 58 years. Brain imaging was performed in each patient revealing hypodense lesion in a large arterial territory in 8 of them, for two patients we found multilacunar infarcts. All patients had negative HIV serology and D-dimers greater than 500 μg/L. Conclusion: This work on strokes in Covid-19 infected patients shows that it is a fairly frequent neurological complication, which can occur even in young subjects without known risk factors, the symptoms of viral infection are not systematically present before the onset of stroke.

Acute Coronary Syndrome Occurring in a Sub-Saharan Patient Treated with a Reduced Dose of Sorafenib for an Unresectable Hepatocellular Carcinoma: Case Report

Sorafenib is a chemotherapy used as first line treatment in primary liver cancers. It is an oral antiangiogenic treatment which reduces the progression of the tumor. Some mild or severe side effects have been reported among which some uncommon cardiac events: myocardial infarction and cardiogenic stroke. Sorafenib treatment remains expensive and not frequently used in Sub-Saharan countries. Thus, few studies have described its side effects in this milieu. We report a case of acute coronary syndrome occurring in a 75-year-old female patient, without cardiovascular risks factors, after nine months of sorafenib chemotherapy at a reduced dose for an unresectable hepatocellular carcinoma in a Sub-Saharan Africa country. The management was conducted by cardiologists, in collaboration with gastroenterologists and oncologists. We decided to completely stop sorafenib chemotherapy. We observed a reduction of the pain 48 hours after her admission, and a regression of electrocardiographic signs after 8 days. In conclusion, the sorafenib treatment can be associated with cardiac events despite the dose reduction.

Management Dilemma of Pulmonary Embolism Associated with Haemorrhagic Stroke in Low-Income Settings: A Case Report

Management of thromboembolic disease in an acute bleeding circumstance like haemorrhagic stroke is a real challenge in low-income settings. We report a case of a 37-year-old woman who was treated in the neurologic service for a haemorrhagic stroke that occurred one week after a caesarean section. Six weeks after her discharge, she presented signs of bilateral deep vein thrombosis and pulmonary embolism confirmed by venous Doppler ultrasound and a thoracic angiography respectively. Transthoracic cardiac ultrasound showed right ventricular dysfunction with a clot in the right atrium. Considering the high risk of complications due to anticoagulant treatment, surgical treatment and a vena cava filter were proposed. But it could not be performed because it was not accessible. After a multidisciplinary consultation meeting and informed consent of the patient, anticoagulant treatment was the preferred expectation. Three weeks after the beginning of the anticoagulant therapy, the evolution was favourable, and the patient was discharged.

Parasympathetic Dysfunction in Black African Patients with Heart Failure:A Cross-Sectional Study in Sub-Saharan Africa

Background: Heart Failure (HF) is a major public health problem worldwide. Neurohormonal changes associated with HF are current therapeutic targets. The parasympathetic system in HF has not been well studied especially in black Africans. Aim: This study aimed to report on the prevalence and determinants of parasympathetic dysfunction in patients with heart failure in sub-Saharan Africa. Methods: We conducted a cross-sectional study between December 2017 and April 2018 in the outpatient and inpatient departments in two teaching hospitals in Yaounde-Cameroon. Cases were patients with HF matched with controls without HF according to age, sex, and risk factors (hypertension, diabetes, and obesity). We assessed the parasympathetic function via the Deep Breathing Test using an electrocardiograph. Results: We recruited 35 patients in each group. The mean age was 57 ± 11.68 years. Vagal dysfunction was seen in 51.4% of cases and 11.4% of controls (aOR: 10.1 [95% CI: 2.7 - 38.3], p = 0.001). This risk increased with the severity of HF-aOR: 11.8, [95% CI: 1.8 - 77.9], p = 0.01 for dyspnea stage III-IV, and aOR: 9.27, [95% CI: 1.3 - 65.3], p = 0.025) for HF with reduced Ejection fraction. This risk was not associated with the classic cardiovascular risk factors. Conclusion: Parasympathetic dysfunction as assessed with the Deep Breathing Test was seen in over half of the patients with HF and this was associated with the severity and type of HF.