Epidemiological Analysis of Surgically Treated Acute Traumatic Epidural Hematoma

This study is a retrospective analysis of demographic, clinical, radiological and outcome data of surgically treated acute traumatic epidural hematomas. Forty-six consecutive cases of epidural hematomas were operated at the University Hospital Center of Yaoundé, Cameroon, between February 2006 and December 2013. The mean age was 29.56 years and63.04% of patients were between 21 and 30 years. Almost 94% of patients were males. Thirty-five percent of patients were motorcycle riders. Road traffic accident was the cause in 70% of cases. Mean time between head trauma and surgical evacuation was 78 hours. Head trauma was moderate in 52.17%. Initial loss of consciousness was found in 78.26% and lucid interval in 65.23%. Seventy-four percent of patients had signs of intracranial hypertension on admission, 35% had at least one neurologic focal sign and 50% had a scalp wound. Eight patients (17.39%) presented with unilateral or bilateral mydriasis. On computed tomography, the hematoma was on the left side in 60.86% of patients and frontal-parietal location was the most frequent. Computed tomography showed mass effect in 97.82% of patients. The most frequent surgical procedure was craniotomy. Six (13.04%) patients died, but 82.60% recovered fully (GOS 5). In Cameroon, traumatic acute epidural hematoma affects primarily healthy young men in their twenties and thirties. Road traffic accidents are the main etiology. Most patients had moderate head trauma and presented with intracranial hypertension. Early surgery is rarely done. Nevertheless, even with delayed surgery, most patients have good outcome.

Clinical Aspects and Precipitating Factors of Hepatic Encephalopathy Associated with Cirrhosis in a Cameroonian Population

Background: Hepatic Encephalopathy (HE), a common complication of cirrhosis, is associated with a pejorative prognosis. This study aims to describe the clinical presentation, precipitating factors and outcome of HE. Methods: This was a cross-sectional multicenter inpatient study in cirrhotic patients admitted for HE in four tertiary hospitals in Yaoundé (Cameroon) from December 2016 to May 2017. The diagnosis of HE was based on West Haven clinical criteria. The diagnosis of cirrhosis was made using clinical and/or biological, endoscopic and/or ultrasonography signs. Results: A total of 53 patients with HE (mean age: 49.9 ± 18.9 years, 35 Males) were included. The frequency of hospital admission for HE was 4.9%. HE grade III was the most common (37.7%), followed by grades I and II (26.4% and 26.4%, respectively). Grade IV was present in 9.4% of cases. According to the Child-Pugh score, 72.1% of the patients were at stage C and 27.9% at stage B. The main precipitating factors found were: constipation (38.5%), hyponatremia (35.9%), hepatocellular carcinoma (HCC) (31.7%), herbal medicine (28.3%), hypokalemia (25.6%), gastrointestinal bleeding (22.6%) and ascitic fluid infection (spontaneous bacterial peritonitis) (13.8%). In 5.7% of cases, no factor was identified. Mortality rate during hospitalization was 45.3% and was significantly associated with stage III (RR = 11.1;95% CI: 1.9 - 64.5;p = 0.003) and IV (RR = 24;95% CI: 1.6 - 40.9;p = 0.01) of HE;Child-Pugh C score (RR = 15.2;95% CI: 1.7 - 30.1;p = 0.003) and hypokalemia (RR = 12.2;95% CI: 1.3 - 19;p = 0.01). Conclusion: HE is a common complication during cirrhosis with a poor prognosis. In the majority of cases, a precipitating factor could be determined.

Epidemiology of Venous Thrombo-Embolic Disease in Yaounde: A Cross-Sectional Study in Sub-Saharan Africa

Background: Venous thromboembolic disease (VTE) is one of the main causes of cardiovascular death and a public health problem worldwide. It is?one of the most complications in admitted patients, particularly inlow-income settings. The epidemiological data on VTE are still lacking. Methods: We carried out a cross-sectional study in three hospitals in Yaoundé. We retrospectively reviewed records of patients admitted for VTE from January 2013 to December 2017. We collected data on socio-demography, clinical presentation, venous Doppler/pulmonary CT scan, and outcome. Results: We included 93 patients (43 males) with VTE. Their mean age was 53.3 ± 16.6 years. There were 46 (49.5%) cases of Deep Vein Thrombosis (DVT), 36 (38.7%) cases of Pulmonary Embolism (PE), and 11 (11.8%) cases of PE associated with DVT. The main risk factors were obesity/overweight (58.1%), immobility (43%), HIV infection (22.6%), prior admission (22.6%), and long trip (19.4%). The most frequent clinical presentation for PE was dyspnea (100%), tachypnea (87.2%), and chest pain (70.2%). For DVT, limb pain (93%), calf stiffness (86%), limb volume > 3 cm (82.4%) were the most common presentation. There were 9 (9.7%) in-hospital deaths. Mean hospital stay was 20.7 ± 30.8 days. Conclusion:VTE is underdiagnosed in our setting. Obesity and immobility were the main risk factors. Dyspnea and tachypnea were the main clinical presentation for PE whereas limb pain and calf stiffness were the main symptoms for DVT. In-hospital mortality is still high.