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Management of Spontaneous Intracerebral Haemorrhage (sICH) at the University Hospital of Brazzaville (CONGO)

Neuroscience & Medicine 2024年第1期15卷 23-38页

作者： Ekouele Mbaki Hugues Brieux Ngoma Niangui Léocia Exaucée diatewa josué euberma Boukaka Kala Rel Gerald Ngackosso Olivier Brice Mpandzou Ghislain Armel Boukassa Léon Ossou-Nguiet Paul Macaire Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo Multipurpose Surgery Department University Hospital Center of Brazzaville Brazzaville Republic of the Congo Neurology Department University Hospital Center of Brazzaville Brazzaville Republic of the Congo

Spontaneous intracerebral haemorrhage (sICH) is characterised by bleeding within the brain parenchyma, without any accompanying vascular malformation, parenchymal abnormality or coagulation disorder. The study aimed to depict the management of sICH at the University Hospital of Brazzaville (UHB). It was an observational, descriptive, and cross-sectional analysis. Data collection was conducted retrospectively, covering the period from January 1, 2020 to August 31, 2022, spanning two years and eight months. The study examined socio-demographic, diagnostic, therapeutic, and evolutionary variables. We included 274 cases. We observed 160 men (58.4%) and 114 women (41.6%), resulting in a sex ratio of 1.4. The mean age was 55.3 ± 11.4 years, with ages ranging from 31 to 93 years. The detection of sICH was typically a result of experiencing motor deficits (59.5%) or disorders of consciousness (37.2%). The weightiness of one half of the body was the most common reason for seeking medical advice. Hematoma was capsulo-lenticular in 159 cases (58%) and capsulo-thalamic in 63 cases (23%). Hematomas were 30 ml in 112 cases (40.9%), and associated with hydrocephalus in 11.7% of cases. Conservative medical treatment was administered in 257 cases (94.2%) while surgical treatment was performed in 16 cases (5.8%). The surgical techniques used were external ventricular drainage (EVD) in 2 cases, ventriculo-peritoneal shunt in 5 cases, and hematoma evacuation in 10 cases. Death occurred before the 7th day of hospitalisation in 73 cases (57.8%) and after in 46 cases (42.2%). The median time to death was four days (Q1 = 2 days;Q3 = 7 days), with extremes of 0 and 216 days. .

关键词： Spontaneous Intracerebral haemorrhage Management Brazzaville

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Impact of Tension-Type Headaches in the Workplace in Brazzaville

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Neuroscience & Medicine 2024年第2期15卷 77-91页

作者： Happhia Dinah Boubayi Motoula Latou josué euberma diatewa Ghislain Armel Mpandzou Prince Eliot Galieni Sounga Bandzouzi Jean Brice Mouendenguia Karen Lise Obondzo Aloba Paul Macaire Ossou-Nguiet Faculty of Health Sciences Universit Marien Ngouabi Brazzaville Congo Department of Neurology Brazzaville University Hospital Congo Department of Neurology Loandjili General Hospital Pointe-Noire Congo

Introduction: Tension-type headaches are the most widespread of the primary headache disorders. Due to their high prevalence, tension-type headaches represent a major public health problem with an enormous socio-economic burden. Determining their impact remains a challenge. Objective: To assess the impact of occupational tension-type headache in Brazzaville and identify associated factors. Population and Methods: This was an analytical case-control study conducted in public and private companies in the city of Brazzaville over a period of four (04) months. The case population consisted of cephalalgic employees;the control population was drawn from the same companies and was free of tension-type headaches. Study variables were divided into socio-professional, clinical and individual impact variables. Individual impact variables were represented by: the HIT-6 score, which incorporates a very broad conception of disability, covering several domains, namely: severity of pain during attacks and the restrictive and limiting nature of attacks. Results: Individual impact was severe in 18 (62.1%) men and 11 (37.9%) women. Mean age was 36.3 6.14 years for cases with severe impact. The mean duration of headache was 40.3 32.7 months for cases with severe impact. Tension headache evolved in attacks in 22 (75.9%) cases with severe impact, and continuously in seven (24.1%) cases. The average number of attacks per month was 2.52 1.04 for cases with severe impact. Cases with severe impact included 14 (48.3%) with chronic headache and 15 (51.7%) with episodic headache. Pain of severe intensity present in 48.3% of cases was associated with a severe impact of tension-type headache: OR = 151.66 [2.36 - 44245.95] and p-value = 0.037. At least one days absence from work per year was observed in 47.4% of our cases. The number of days off work per year due to tension-type headache had an interquartile range between 0 and 3 days and extremes from 0 to 14 days. It was the consequence of a sev

关键词： Impact Tension Headache Workplace

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Mortality from Stroke in Young People in Brazzaville

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World Journal of Neuroscience 2024年第1期14卷 37-55页

作者： Motoula Latou Happhia Dinah Boubayi josué euberma diatewa Ghislain Armel Mpandzou Prince Eliot Galieni Sounga Bandzouzi Elizeth Richtellah Fouti Kouapele Karen Lise Obondzo Aloba Paul Macaire Ossou-Nguiet Faculty of Health Sciences Université Marien Ngouabi Brazzaville The Republic of the Congo Department of Neurology Brazzaville University Hospital Brazzaville The Republic of the Congo Department of Neurology Loandjili General Hospital Pointe-Noire The Republic of the Congo

Introduction: Cerebrovascular accidents (CVA) are an absolute neurovascular emergency and the main cause of mortality and acquired disability in adults. In the Congo, stroke is the leading cause of mortality and the leading cardiovascular emergency, with a hospital frequency of between 49.74% and 56.2%. The aim of the study was to identify the mortality factors associated with stroke in young people in Brazzaville. Patients and Methods: This is a longitudinal analytical study conducted from February to period from February to September 2019 in the neurology, general intensive care and medical emergency departments of the Brazzaville University Hospital (CHUB). All subjects aged 18 - 55 years of completed age, admitted for arterial stroke confirmed by brain imaging, were included. Study variables were: age, gender, socioeconomic level, laterality, time to admission and CT scan, vascular risk factors, history of cardiomyopathy, atrial fibrillation, TIA (transient ischemic attack) or stroke, NIHSS (National Institutes of Health Stroke Scale) score, Glasgow score, blood pressure, temperature, heart rate, occurrence or non-occurrence of complications, blood glucose, creatinine, lipid profile and blood count. Data were analyzed using SPSS 21 software. Descriptive analyses were performed using SPSS 21 software. Results: 103 patients were included in the study, of whom 45 (43.7%) had ischemic stroke and 58 (56.3%) with hemorrhagic stroke. Mortality was high at 29.1% in our study, and mainly concerned hemorrhagic strokes (73.7%). Two-week mortality in our study accounted for 63.33% of total lethality. After simple logistic regression, the factors associated with death within two weeks were age between 40 - 44 years (OR (odds ratio) = 2.95;p = 0.01), hemorrhagic stroke (OR = 1.41;p = 0.07), mass effect (OR = 3.26;p 15 (OR = 5.89 (2.90 - 11.95);p <

关键词： Brazzaville Mortality Stroke Young Subjects

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Role of CD4+ and CD8+ T Lymphocyte in the Onset of Stroke in People Living with HIV in Pointe-Noire

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World Journal of Neuroscience 2022年第1期12卷 1-7页

作者： Prince Eliot Galieni Sounga Bandzouzi Ghislain Armel Mpandzou josué euberma diatewa Dina Happia Motoula-Latou Charles Godefroy Koubemba Paul Macaire Ossou-Nguiet Donatien Moukassa Faculty of Health Sciences Marien N’Gouabi University Brazzaville Republic of Congo Department of Neurology Loandjili General Hospital Pointe-Noire Republic of the Congo Department of Neurology University Hospital Center of Brazzaville Brazzaville Republic of Congo

Objective: To determine the role of CD4+ and CD8+ T lymphocytes in the onset of stroke in people living with HIV. Methodology: This was a descriptive, cross-sectional study from January to July 2019, in the neurology department of loandjili general hospital, including any patient hospitalized for a first episode of stroke confirmed by brain scan. The study variables were: age, sex, CRP value, serum T cell CD4+, CD8+. The statistical analysis was carried out using the EPI info 7 software. Results: Twenty stroke patients were included. The relative frequency of HIV was 20%. The risk factors were potentiated by immunosuppression of CD4+ T cells. Sixty percent (60%) of the patients had a CD4+ count 3 and the mean CD4+ count was ±191/mm3. Stroke was the predominant mechanism of injury with a frequency of 70%, the only injury mechanism of stroke in patients with CD8+ T cell count > 800/mm3 (p = 0.04). Conclusion: Risk factors are potentiated by TCD4+ lymphocyte immunosupression, also CD8+ lymphocytes of immune system activation marker are a cardiovascular risk factor for living people with HIV.

关键词： CD4+ CD8+ T Lymphocytes HIV Stroke Pointe-Noire

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Cost of Stroke Care at Public Hospitals in Brazzaville and Implication of Third Parties in Stroke Care Expenditure

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World Journal of Neuroscience 2022年第2期12卷 82-92页

作者： josué euberma diatewa Ghislain Armel Mpandzou Patrice Bruno Mokoko Dinah Happhia Boubayi Motoula-Latou Eliot Prince Galiéni Sounga-Banzouzi Paul Macaire Ossou-Nguiet Neurology Department University Hospital of Brazzaville Brazzaville Congo Faculty of Health Sciences Marien Ngouabi University Brazzaville Congo Neurology Department Loandjili General Hospital Pointe Noire Congo

Background: Among the main challenges of healthcare system throughout the world, there is stroke management. It is important to have data on the in-hospital costs of stroke care to help decision-makers to implement a health insurance system. Objectives: To evaluate the in-hospital costs of stroke care in Brazzaville;to determine the factors influencing the total mean in-hospital cost of stroke care;to identify third parties contributing to stroke care expenditure. Methods: This was a cross-sectional prospective and analytical study. It was carried out at 4 public hospitals in Brazzaville (University Hospital Center, Chinese and Congolese Friendship Hospital, Talangaï Hospital and Makélékélé Hospital), from May to August 2019 (4 months). It focused on patients who had a first episode of stroke confirmed by brain imaging and were at least 18 years old. The bottom-up approach was used to determine the in-hospital costs of stroke care. Results: This study included 109 patients who fulfilled inclusion criteria. Their mean age was 59.2 ± 13.7 years old, with limits of 35 and 90 years old. The total direct in-hospital cost of stroke care was 47,308,330 francs CFA (72,122 euro). The total mean in-hospital cost of stroke care was 1,389,590 francs CFA (2118 euro). The mean cost of intracerebral hemorrhage care was 510,988 francs CFA (779 euro) versus 373,457 francs CFA (569 euro) for cerebral arterial infarction care. The following factors affected the total mean cost of stroke care: type of hospital (p < 0.0001), length of hospital stay (p = 0.001), type of stroke (p = 0.01), stroke severity (p = 0.001) and complications (p = 0.001). The level of contribution to stroke care expenditure covered by third parties was: 78% for patient families;2.8% for community self-help associations. Conclusion: In Congo, the mean in-hospital cost of stroke care is elevated considering the guaranteed minimum wage of 70,000 francs CFA (107 euro). Five factors affect the total mean cost of

关键词： Stroke Hospital Cost Associated Factors Brazzaville

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Psychological Experience of Children and Adolescents with Homozygous Sickle Cell Disease in Brazzaville

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Open Journal of Pediatrics 2021年第1期11卷 35-49页

作者： Engoba Moyen Ghislain Armel Mpandzou Matimé Julianna Déborah Boukoulou josué euberma diatewa Armel Landry Batchi-Bouyou Paul Macaire Ossou-Nguiét Georges Moyen Université Marien Ngouabi Brazzaville Congo Service de Soins Intensifs Pédiatriques CHU de Brazzaville Brazzaville Congo Service de Neurologie CHU de Brazzaville Brazzaville Congo

Introduction: Sickle cell disease, the most frequent hemoglobinopathy, is one of many causes of psychological repercussions. Objectives: To determine the prevalence of psychological disorders in children/adolescents living with sickle cell disease and to identify the associated factors. Patients and Method: An analytical cross-sectional study was conducted from June to September 2019 at the national sickle cell center and at the mother-child consultation of the University Hospital of Brazzaville. Children/adolescents aged six to 19 years old followed for sickle cell disease were included. Psychological disorders were assessed using the Diagnostic and Statistical Manual of Mental Disorders “DSM-5” which assesses depression and anxiety disorders, the Rosenberg Self-Esteem Scale, and the Brief Illness Perception Questionnaire which assesses representations of chronic diseases. SPSS 20.0 software was used for statistical analysis.

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Knowledge about Stroke among Workers in Public and Private Enterprises in Brazzaville and Their Attitudes towards Stroke Victims

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World Journal of Neuroscience 2022年第4期12卷 163-180页

作者： josué euberma diatewa Cécilia Océane Kwama-Matiti Ghislain Armel Mpandzou Dinah Happhia Boubayi Motoula-Latou Eliot Prince Galiéni Sounga-Banzouzi Paul Macaire Ossou-Nguiet Neurology Department University Hospital of Brazzaville Brazzaville Republic of the Congo Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo Neurology Department Loandjili General Hospital Pointe Noire Republic of the Congo

Background: Stroke causes multiple complications, sequelae and a high mortality rate. Therefore, it is important to initiate or improve stroke awareness. Objectives: To assess knowledge about stroke among workers, explore workers’ attitudes towards stroke victims and identify factors influencing knowledge about stroke and workers’ attitudes. Methods: It was an analytical cross-sectional study. It was conducted from 16 August to 30 December 2020 (4.5 months). It was carried out in public and private enterprises in the formal sector in Brazzaville. It focused on workers aged 19 years and above. The study variables were socio-professional, psychosocial, epidemiological and clinical. Results: This study included 543 workers who fulfilled inclusion criteria. The knowledge scores for at least one warning sign and one risk factor were 74% and 77.7%, respectively. The average knowledge scores for warning signs and risk factors were 11.4% and 16.7%, respectively. For prevention measures, average knowledge score was 16.5%. The average score of knowledge for items related to post-stroke life of stroke victims was 78.3%. The average rate of positive attitudes of workers towards stroke victims was 81.4%. The determinants of knowledge about stroke were education (p = 0.039) and information (p = 0.040). The factors influencing workers’ normal attitude were education (p = 0.023) and knowledge about stroke (p Conclusion: Although the attitudes towards stroke victims are overall good, the level of knowledge about warning signs, risk factors and prevention measures is low. Because of this, it is important to organize public regular awareness and education campaigns in order to improve and increase knowledge about stroke.

关键词： Stroke Knowledge Attitudes Enterprises Brazzaville

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Knowledge about the Management of Anti-Epileptic Drug Treatment among General Practitioners in Brazzaville, Congo

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Neuroscience & Medicine 2023年第2期14卷 9-28页

作者： josué euberma diatewa Inès Frédérique Nsondé-Mondzié Dinah Happhia Boubayi Motoula-Latou Eliot Prince Galiéni Sounga-Banzouzi Yacouba Kaba Ghislain Armel Mpandzou Paul Macaire Ossou-Nguiet Neurology Department University Hospital of Brazzaville Brazzaville Republic of the Congo Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo Neurology Department Loandjili General Hospital Pointe Noire Republic of the Congo

Background: Epilepsy is a chronic brain disorder. It often leads to disabilities and handicaps. In Africa, epilepsy is almost exclusively treated by general practitioners (GPs) because of a shortage of epilepsy specialists. It is therefore important to know the level of knowledge about epilepsy among GPs in order to improve their skills. Objectives: To assess the level of knowledge about the management of anti-epileptic drug treatment among GPs in Brazzaville;to investigate the relationship between demographic factors and GPs’ knowledge. Methods: This was a cross-sectional analytical study. It was conducted from 20 July to 1 September 2021. It focused on GPs working in public hospitals and private care centers in Brazzaville. Information on treatment aspects was collected through a standardized 11-item questionnaire. Results: Among the 137 participants, there were 84 (61.3%) men and 53 (38.7%) women. Of these participants, 36 (26.3%) were trained in Congo versus 101 (73.7%) in other countries. Only 21 (15.3%) GPs had good knowledge about the management of anti-epileptic drug treatment. The overall average knowledge score among GPs was low (31.4%). No significant associations were found between low and good levels of knowledge and gender (OR = 1.03;95% CI = 0.40 - 2.68;p = 1.000), age groups (OR 0.05), training country (OR = 0.62;95% CI = 0.19 - 1.98;p = 0.591), practice hospital (OR = 0.40;95% CI = 0.05 - 3.20;p = 0.695) and duration of professional experience (OR 0.05). Conclusion: The study population has insufficient knowledge about the management of anti-epileptic drug treatment. Demographic factors have no impact on GPs’ knowledge. Epilepsy education programs are needed to improve GPs’ knowledge and skills.

关键词： Epilepsy Drug Treatment General Practitioners Knowledge Brazzaville

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Epileptic Seizures in Neonates Treated with Hypothermia for Hypoxo-Ischemic Encephalopathy in Brazzaville, Congo: Types and Evolution

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Neuroscience & Medicine 2023年第4期14卷 63-75页

作者： josué euberma diatewa Dinah Happhia Boubayi Motoula-Latou Benoîte Gracia diatewa Gabrielle Ontsira Grâce Kadidja Cléona Nkounkou-Milandou Eliot Prince Galiéni Sounga-Banzouzi Ghislain Armel Mpandzou Jean Robert Mabiala-Babela Paul Macaire Ossou-Nguiet Neurology Department University Hospital of Brazzaville Brazzaville Republic of Congo Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of Congo Neonatology Department Blanche Gomez Mother and Child Hospital Brazzaville Republic of Congo Neonatology Department University Hospital of Brazzaville Brazzaville Republic of Congo Neurology Department Loandjili General Hospital Pointe Noire Republic of Congo

Background: Moderate to severe hypoxic-ischemic encephalopathy (HIE) in neonates is often treated with hypothermia. However, some neonates may experience epileptic seizures during therapeutic hypothermia (TH). Data on the electrophysiologic and evolutionary aspects of these seizures are scarce in African countries. Objectives: To determine the types of epileptic seizures caused by HIE in neonates in Brazzaville;to describe the evolution of background EEG activities during TH and rewarming;to report the evolution of epileptic seizures. Methods: This was a cross-sectional, descriptive study conducted from January 2020 to July 2022. It took place in Brazzaville in the Neonatology Department of the Blanche Gomez Mother and Child Hospital. It focused on term neonates suffering from moderate or severe HIE. They were treated with hypothermia combined with phenobarbital for 72 hours. Results: Among 36 neonates meeting inclusion criteria, there were 18 boys and 18 girls. Thirty-one (86.1%) neonates had grade 2 and 5 (13.9%) grade 3 HIE. In our neonates, HIE had induced isolated electrographic seizures (n = 11;30.6%), electroclinical seizures (n = 25;69.4%), and 6 types of background EEG activity. During TH and rewarming, there were 52.8% of patients with improved background EEG activity, 41.7% of patients with unchanged background EEG activity, and 5.5% of patients with worsened background EEG activity. At the end of rewarming, only 9 (25%) patients still had seizures. Conclusion: Isolated electrographic and electroclinical seizures are the only pathological entities found in our studied population. In neonates with moderate HIE, the applied therapeutic strategy positively influences the evolution of both seizures and background EEG activity. On the other hand, in neonates with severe HIE, the same therapeutic strategy is ineffective. .

关键词： Epileptic Seizures Neonate Hypoxo-Ischemic Encephalopathy Therapeutic Hypothermia Antiepileptic Drugs Brazzaville

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What Strategy for a Severe Stroke in Africa: Palliative Care or Unreasonable Obstinacy?

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World Journal of Neuroscience 2020年第1期10卷 37-41页

作者： Paul Macaire Ossou-Nguiet Ghislain Armel Mpandzou Dinah Happhia Motoula Latou josué euberma diatewa Karen Lise Charmel Obondzo Aloba Prince Eliot Sounga Bandzouzi Bertrand Fikahem Ellenga Mbolla Faculty of Health Sciences of Brazzaville Brazzaville Congo Department of Neurology Brazzaville University Hospital Brazzaville Congo

Introduction: Palliative care, firstly used for chronic diseases, is currently indicated for some acute pathology such as Stroke. Its implementation improves the quality of care for end-of-life patients. The aim of our study is to report a series of patients who died in the intensive care stroke unit of Brazzaville. Method: It was a descriptive study of a series of 13 cases of severe stroke, admitted to the intensive care unit of the university hospital of Brazzaville, between January 2015 and December 2017. Sociodemographic, clinical, paraclinical and prognostic variables were studied. Result: The mean age of the patients was 46 ± 11.5 years with a male predominance in 69.2% (n = 9). They were all hypertensive. The motor deficit and consciousness disorder association was the reason for admission in 84.6% (n = 11) and an epileptic seizure of 15.4% (n = 2). The mean NIHSS at admission was 21 ± 5, that of Glasgow 6 ± 3. Stroke was hemorrhagic in 84.6% (n = 11) and malignant infarction in 15.4% (n = 2). All of these patients received invasive resuscitation with assisted ventilation and all died within 8 days of admission. Conclusion: The issue of limitation of care deserves to be debated, and is proposed on a case-by-case basis, in the face of a serious stroke. Therapeutic relentlessness is not only expensive, but also raises the problem of suffering of the individual at the end of life.

关键词： Severe Stroke Palliative Care Stroke Unit Africa

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