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Ngongang Ouankou C, Chendjou Kapi LO, Azabji Kenfack M, Nansseu JR, Mfeukeu-Kuate L, Ouankou MD, Kowo M, Magny Thiam E, Kagmeni G, Kaze FJ, Ngu Blackett K. [Severe high blood pressure recently diagnosed in an urban milieu from Subsahelian Africa: Epidemiologic, clinical, therapeutic and evolutionary aspects]. Ann Cardiol Angeiol (Paris) 2019; 68:241-248. [PMID: 31471040 DOI: 10.1016/j.ancard.2019.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES High Blood Pressure (HBP) is a worldwide public health problem. It can be particularly severe in the Black race. Recent studies in Cameroon, showed an alarming prevalence, leading us to want to study the epidemiological, clinical, therapeutic and evaluative aspects of severe, (BP op to 180/110mmHg), recently diagnosed HBP in Yaounde. Our objective was to determine its clinical presentation and evolution. METHODS We conducted nine months prospective cohort study, from January to September 2016. We recruited from the active population participants who voluntarily accepted blood pressure screening offered in various localities in Yaounde, and were aged from 18 years and above. RESULTS Of a total of 6519 people who participated in the screening, 1875 (28.8%.), presented a HBP and 363 (5.6%) had severe HBP. Our cohort comprised 153 (42.1%) of these individuals with sustained severe hypertension, not on medication, who accepted the invitation to participate in the study. The range of 45-54 years and 55-64 years were the most represented; the sex ratio was 0.9. The cardiovascular risk factors number range from 5 to 8 with a median of 6. Systolic BP ranged from 184 to 225mmHg with a median of 200mmHg; while the diastolic BP ranged between 111-132.5mmHg with a median of 119mmHg. Kidney injury (77.8%) was the main complications. We identified 3 clinical forms: hypertensive emergencies 121 (79.1%) cases and hypertensive crises 32 (20.9%) cases. In these two groups, 33 (21.6%) patients presented with "super HBP" (a blood pressure>250/150mmHg). The average rate of BP control over 6 month was 39%. The main cause of poor BP control was lack of therapeutic compliance. We registered one death at the 3rd month of follow up due to acute kidney injury. CONCLUSION Severe HBP prevalence in Yaounde is high in the active fraction of the population insidiously affected. Particularly, unsuspected renal impairment appears to be the major complication. The bad blood pressure control is linked to poor therapeutic observance and persistence.
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Affiliation(s)
- C Ngongang Ouankou
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - L O Chendjou Kapi
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Institut supérieur des sciences de la santé, université des Montagnes, Bangangté, Cameroun.
| | - M Azabji Kenfack
- Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - J R Nansseu
- Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun; Direction de la lutte contre la maladie, les épidémies et les pandémies, Yaoundé, Cameroun.
| | - L Mfeukeu-Kuate
- Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun; Centre cardiologique et médical, Yaoundé, Cameroun.
| | - M D Ouankou
- Centre cardiologique et médical, Yaoundé, Cameroun.
| | - M Kowo
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - E Magny Thiam
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - G Kagmeni
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - F J Kaze
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
| | - K Ngu Blackett
- Centre hospitalier et universitaire de Yaoundé, Cameroun; Faculté de médecine et de sciences biomédicales, université de Yaoundé I, Cameroun.
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Ngatchou W, Lemogoum D, Ménanga AP, Nana A, Olinga A, Boukaert Y, Perrin L, Kouzam S, Preumont N, Ramadam A, Berre J, Degaute JP, Jansens JL, Cogan E, Gelin M, Ayele P, Kouam C, Essono R, Ntchoya R, Ngo Nonga B, Fokou M, Toukam M, Yonta E, Ndjebet J, Ambassa C, Monkam Y, Ndobo P, Simo Moyo J, Njolo A, Nouedoui C, Njuimo AG, Binam F, Ngu Blackett K, Pagbe JJ, Kingue S, Ndam EC, Muna W, Nguimbous JF, De Cannière D. [Cardiac surgery in Cameroon. Results at one year of the pilot phase]. Rev Med Brux 2011; 32:14-17. [PMID: 21485459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.
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Mendis S, Thygesen K, Kuulasmaa K, Giampaoli S, Mahonen M, Ngu Blackett K, Lisheng L. World Health Organization definition of myocardial infarction: 2008-09 revision. Int J Epidemiol 2010; 40:139-46. [DOI: 10.1093/ije/dyq165] [Citation(s) in RCA: 296] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Njamnshi AK, Mbong EN, Wonkam A, Ongolo-Zogo P, Djientcheu VDP, Sunjoh FL, Wiysonge CS, Sztajzel R, Mbanya D, Blackett KN, Dongmo L, Muna WFT. The epidemiology of stroke in sickle cell patients in Yaounde, Cameroon. J Neurol Sci 2006; 250:79-84. [PMID: 16905153 DOI: 10.1016/j.jns.2006.07.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Revised: 06/14/2006] [Accepted: 07/10/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Stroke, a severe and recurrent but preventable complication of sickle cell disease (SCD), has not been well studied in Cameroon. To obtain baseline data towards the development of a national stroke prevention programme in SCD, we studied a sample of sickle cell patients with the aim of determining stroke prevalence, clinical presentation and management practices. PATIENTS AND METHODS Homozygous sickle cell patients in two centres in Yaounde were screened for stroke, in a cross-sectional study. Stroke was diagnosed clinically and confirmed where possible with brain computerized tomography. The National Institutes of Health Stroke Score (NIHSS) and modified Rankin scale (mRS) were used to assess stroke severity. Management practices were noted from patient charts. RESULTS One hundred and twenty patients aged 7 months to 35 years (mean age 13.49+/-8.79 years) were included. Eight cases of stroke (mean age 16.6+/-11.2 years) were identified, giving a stroke prevalence of 6.67%. Cerebral infarction was thrice as common as cerebral hemorrhage and clinical presentation was classical. Cerebral infarction was more frequent in patients aged below 20 years and hemorrhage in those above 20 (p=0.11). The annual recurrence rate was 25%. Missed diagnosis rate by attending physician was 25%. The NIHSS and mRS showed high stroke severity. Stroke management practices were insufficient and no patient received any form of stroke prophylaxis. CONCLUSION Stroke prevalence and presentation in sickle cell patients in Yaounde is similar to that observed in developed countries, but the wide management gap calls for rapid action. Our situation is ideal for the study of the natural history of stroke in sickle cell disease.
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Affiliation(s)
- A K Njamnshi
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Cameroon.
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Shey Wiysonge CU, Ngu Blackett K, Mbuagbaw JN. Risk factors and complications of hypertension in Yaounde, Cameroon. Cardiovasc J S Afr 2004; 15:215-9. [PMID: 15483733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIM To determine the risk factors and complications of hypertension, isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) in Yaounde. METHODS AND RESULTS Between January and September 1998 we examined 813 consecutive adult patients (46.5% men) in the Yaounde University Teaching Hospital, with special focus on risk factors of hypertension and clinical findings in the cardiovascular system. We measured systolic blood pressure, diastolic blood pressure, body mass index and plasma glucose, and recorded chest X-ray, electrocardiogram and echocardiogram. Hypertension, ISH and IDH were defined using the WHO-ISH 1999 criteria. After controlling for the confounding effects of age and sex, hypertension was significantly associated with obesity, family history of hypertension, alcohol intake, heart failure, stroke and left ventricular hypertrophy (p < 0.01); smoking was significantly associated with ISH (p = 0.04), and no factor was independently associated with IDH. CONCLUSIONS A prevention strategy for hypertension and its resultant complications in Cameroon should include measures aimed at obesity and alcohol consumption, as well as early diagnosis with the institution of effective and affordable therapy.
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Affiliation(s)
- C U Shey Wiysonge
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
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Abstract
OBJECTIVE To study the cardiac abnormalities in HIV infected patients in relation to the clinical stage of the disease and the immunological status of the patients. METHODS A total 75 consecutive patients tested for HIV on the basis of clinical suspicion of the disease from July to September 1996 at the University Hospital Centre, Yaounde, Cameroon were recruited. The patients were classified into AIDS, HIV positive non-AIDS, and HIV negative according to clinical findings and outcome of ELISA and western blot testing. Every patient underwent a clinical examination, two dimensional and M-mode echocardiography, and blood lymphocyte typing. RESULTS Dilated cardiomyopathy occurred in 7/30 (23.33%) AIDS patients, 1/24 (4.17%) HIV positive non-AIDS patient, but in none of the HIV negative patients. Other echocardiographic abnormalities included pericardial separation, effusion, thickening, and mitral valve prolapse. Although these abnormalities were more frequent in HIV infected patients, the differences did not reach levels of statistical significance. Dilated cardiomyopathy occurred in six (31.58%) of the patients with a CD4 cell count < or =100/mm(3) and two (6.06%) in those with absolute CD4 counts >100/mm(3) (chi(2) = 4.02, p = 0.03). CONCLUSIONS Cardiovascular abnormalities are frequent in African HIV infected patients but clinically discrete. Low CD4 cell counts are associated with dilated cardiomyopathy. These abnormalities should be expected with greater frequency in cardiological clinical practice as management of opportunistic infections improves in a situation of continued high disease prevalence in Africa.
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Affiliation(s)
- D Nzuobontane
- Wirral Hospital Trust, St Catherine's Hospital, Birkenhead, Merseyside, UK.
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Ngouesse B, Basco LK, Ringwald P, Keundjian A, Blackett KN. Cardiac effects of amodiaquine and sulfadoxine-pyrimethamine in malaria-infected African patients. Am J Trop Med Hyg 2001; 65:711-6. [PMID: 11791962 DOI: 10.4269/ajtmh.2001.65.711] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The cardiac effect of amodiaquine and sulfadoxine-pyrimethamine was studied in adult Cameroonian patients with acute uncomplicated Plasmodium falciparum malaria by electrocardiographic monitoring over the course of 7 days. Clinical and parasitological responses were monitored until Day 14. Bradycardia was observed in 16 of 20 amodiaquine-treated patients on Day 2, which corresponds to the time when maximal cumulative plasma concentration is reached, and in 12 of 20 patients on Day 7. A bradycardic effect lasting several days was not noted in patients treated with sulfadoxine-pyrimethamine. Significantly prolonged P, PQ, QRS, and QTc intervals were recorded on Day 2 after both 30 and 35 mg of amodiaquine base per kilogram of body weight had been administered, but these intervals were not correlated with the plasma monodesethylamodiaquine (main human active metabolite of amodiaquine) level. Electrocardiographic changes after therapy with sulfadoxine-pyrimethamine were minor and transient. All patients had fever and parasite clearance on or before Day 3 and remained free of fever and parasites until Day 14. None of the patients complained of cardiovascular adverse effects during the follow-up. These results suggest the absence of significant cardiac effects of amodiaquine and sulfadoxine-pyrimethamine at usual therapeutic doses, but they should draw the attention of clinicians treating malaria-infected patients who have taken other antimalarial drugs with cardiovascular side effects or those who are under treatment with cardiovascular drugs.
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Affiliation(s)
- B Ngouesse
- Centre Hospitalo-Universitaire de Yaoundé, Faculté de Médecine, Université de Yaoundé I, Cameroon
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Kuaban C, Bercion R, Jifon G, Cunin P, Blackett KN. Acquired anti-tuberculosis drug resistance in Yaounde, Cameroon. Int J Tuberc Lung Dis 2000; 4:427-32. [PMID: 10815736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
SETTING Tuberculosis centre of Hôpital Jamot, Yaounde, Cameroon. OBJECTIVES To determine the prevalence of acquired resistance (ADR) to the main anti-tuberculosis drugs, and to identify risk factors associated with its occurrence in Yaounde. DESIGN A total of 111 previously treated adults admitted consecutively to the tuberculosis centre with sputum smear-positive pulmonary tuberculosis between June 1996 and July 1997 were included in the study. Information on potential risk factors for ADR was obtained from each patient, and human immunodeficiency virus (HIV) serostatus was determined. Drug susceptibility testing to the main anti-tuberculosis drugs was performed on cultures of Mycobacterium tuberculosis complex isolated from sputum samples of each patient by the indirect proportion method. All patients whose isolates tested resistant to at least one anti-tuberculosis drug were defined as having ADR. RESULTS Growth of M. tuberculosis complex was obtained from sputum specimens of 98 (88.3%) of the 111 patients studied; 57 (58.2%) of these were resistant to at least one anti-tuberculosis drug. Resistance to isoniazid was the most common (54.1%), followed by resistance to rifampicin (27.6%), streptomycin (25.5%) and ethambutol (12.2%). Multidrug resistance was observed in 27 (27.6%) of the cases. In a multivariate logistic regression analysis, ADR was significantly associated only with monotherapy use in previous tuberculosis treatment(s) (P = 0.03). CONCLUSION The rate of ADR of M. tuberculosis is quite high in Yaounde. Acquired resistance to rifampicin alone or in combination with isoniazid is also high. Monotherapy in previous anti-tuberculosis treatment(s) is a significant predictor of ADR in previously treated patients in Yaounde. These results underscore the urgent need for the re-establishment of a tuberculosis control programme, using the DOTS strategy, in Cameroon.
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Affiliation(s)
- C Kuaban
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde/Hôpital Jamot, Cameroon.
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Ngu Blackett K. Medicine: alternative, complementary or competitive? Some thoughts on other ways of doing things. J R Coll Physicians Lond 1997; 31:155-157. [PMID: 9131513 PMCID: PMC5420897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Alternative medicine depends on which side of the fence one is sitting. In an African setting 'modern medicine' is often treated as competitive or complementary to traditional medicine. Differences in views as to what is health, and what causes disease can result in altered treatment objectives. Health needs to be seen in a wider context, and management with patient participation, rather than 'imposed treatment', is called for. Although we need to be open to new ideas, these need to be critically assessed if we are to do no harm to our patients. For patients to take part in the decision-making process they need adequate information. We need to improve our communication skills, and to understand that a pathophysiological explanation of illness does not answer the basic question which we all ask when ill--'Why me?' In this respect we can do well to learn from traditional healers who try to treat the whole patient and not just the disease.
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Affiliation(s)
- K Ngu Blackett
- Faculty of Medicine and Biological Sciences, University of Yaounde, Cameroon.
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