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Estimation of the Direct Cost of Management of Venous Thromboembolism in Three Reference Hospitals in the City of Yaoundé: A Retrospective Study over a Three-Year Period

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World Journal of Cardiovascular Diseases 2024年第2期14卷 99-114页

作者： Hamadou Ba Nganou-Ngnindjio Chris Nadège Tatchim samuel Aimé Kamdem Félicité Tchoukoua Serge Honoré Ahmadou Jingi Danwe Dieudonne kingue samuel Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Department of Internal Medicine Garoua General Hospital Garoua Cameroon Cardiology Department Yaoundé Central Hospital Yaoundé Cameroon Higher Institute of Health Sciences University of the Mountains Bagangté Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Internal Medicine Douala General Hospital Douala Cameroon Faculty of Health Sciences University of Bamenda Bamenda Cameroon Cardiology Department Yaoundé General Hospital Yaoundé Cameroon

Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in developing countries like ours where less than 7% of the population has health insurance. This study aimed to estimate the direct cost of managing VTE in three reference hospitals in Yaoundé. Methods: This was a cross-sectional retrospective study over a three-year period (from January 1st 2018 to December 31 2020) carried out in the Cardiology departments of the Central and General Hospitals, and the Emergency Centre of the city of Yaoundé. All patients managed during the study period for deep vein thrombosis and pulmonary embolism confirmed by venous ultrasound coupled with Doppler and computed tomography pulmonary angiography respectively were included. For each patient, we collected sociodemographic and clinical data as well as data on the cost of consultation, hospital stay, workups and medications. These data were analysed using SPSS version 23.0. Results: A total of 92 patient’s records were analysed. The median age was 60 years [48 - 68] with a sex ratio of 0.53. The median direct cost of management of venous thromboembolism was 766,375 CFAF [536,455 - 1,029,745] or $1415 USD. Management of pulmonary embolism associated with deep vein thrombosis was more costly than isolated pulmonary embolism or deep vein thrombosis. Factors influencing the direct cost of management of venous thromboembolism were: hospital structure (p = 0.015), health insurance (p 0.001), type of pulmonary embolism (p = 0.021), and length of hospital stay (p = 0.001). Conclusion: Management of VTE is a major financial burden for our patients and this burden is influenced by the hospital structure, health insurance, type of pulmonary embolism and length of hospital stay.

关键词： Cost Management Venous Thromboembolism Yaoundé

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

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World Journal of Cardiovascular Diseases 2022年第7期12卷 374-381页

作者： Joshua Njimbuc Walinjom Jerome Boombhi Martine Etoa Collins Chenwi Ambe Emerentia Eho Alain Menanga samuel kingue Faculty of Medicine and Biomedical Sciences (FMBS) University of Yaoundé I Yaoundé Cameroon Medical and Cardiology Unit General Hospital Yaoundé Yaoundé Cameroon Central Hospital Yaoundé Yaoundé Cameroon Mvangan District Hospital Mvangan 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.

关键词： Asymptomatic Cardiovascular Manifestations Left ventricular Diastolic Dysfunction Silent Myocardial Ischemia Type 2 Diabetes Cameroon

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Venous Thromboembolic Disease and Thrombolysis at the YaoundéEmergency Center during the Past Five Years, Cameroon

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World Journal of Cardiovascular Diseases 2022年第4期12卷 199-208页

作者： Chris Nadège Nganou-Gnindjio Bâ Hamadou Ludovic Kadji Jules Thierry Elong Daryl Tcheutchoua Nzokou Honoré Kemnang Yemele Alain Patrick Menanga samuel kingue Jacqueline Ze Minkande Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon

Background: Venous thromboembolic disease (VTE) is a clinical entity whose two clinical manifestations are deep vein thrombosis (DVT) and pulmonary embolism (PE). It is a frequent and severe disease in Cameroon, thus constituting a significant public health problem. We aimed to describe VTE management in the Yaoundé Emergency Center, in particular the use of thrombolysis. Methods: This was a retrospective study on patients hospitalized at the Yaoundé Emergency Center for DVT and/or PE from January 1, 2015, to December 31, 2020. We collected clinical signs, paraclinical signs, risk factors of VTE, and management methods from each patient. Results: We recruited 106 participants. Dyspnea was the most frequent symptom;PE was the most common form of VTE in eight patients on 10. Obesity and high blood pressure were the main cardiovascular risk factors. The main clinical signs were oedema and pain in the limb for DVT, dyspnea, and tachycardia for PE. Heparinotherapy was the most commonly used management modality. Thrombolysis was performed in 7.5% of participants, especially in the case of hypotension or massive PE. Conclusion: In VTE management, thrombolysis remains the least used therapeutic modality in our context. Heparinotherapy remains the basis of the therapy.

关键词： Venous Thromboembolic Disease Thrombolysis Yaoundé-Cameroon

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Therapeutic Routes of a Group of Heart Failure Patients Followed in a Cameroonian Urban Setting

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World Journal of Cardiovascular Diseases 2023年第10期13卷 686-700页

作者： Chris Nadège Nganou-Gnindjio Bâ Hamadou Melissa Djuidje Djampouop Marie Ntep Gwet Félicité Kamdem Pierre Mintom Juliette Valerie Ndobo Siddikatou Djibrilla Guillaume Ebene Manon Joel Noutackdie Tochie samuel kingue Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Institut Supérieur des Sciences de la Santé Université des Montagnes Bangangte Cameroon Faculty of Medicine and Pharmaceuticals Sciences University of Douala Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon

Background: Heart failure (HF) is a rising global health problem. Patients with HF tend to use several therapies obtained via different treatment routes to relieve their symptoms. It is rampant in sub-Saharan Africa (SSA), leading to poor health-seeking behaviours and worsened HF health outcomes. We aimed to describe the different therapeutic routes of HF patients from the onset of their first symptom until treatment in a specialised cardiology centre to identify and rebuke harmful therapeutic routes. Materials and Methods: This was a cross-sectional study at the Yaoundé Central Hospital in Cameroon between December 2018 to July 2019. Patients were recruited by consecutive convenient sampling. Adult patients aged above 18 years with confirmed HF were included using the Framingham criteria. Variables relating to socio-demographic and clinical data and the health-seeking behaviours of HF patients were studied. Results: We included 132 patients with a mean age of 62.90 years (62.88% women). Very few patients (0.90%) followed an ideal route;60.71% of subjects had a pseudo-ideal route, 19.64% accessed a specialised facility directly, and 21.42% used an erratic route. At the arrival time in a cardiology unit, 49.24% and 35.61% of our subjects were in NYHA stage III and IV HF compared to 15.15% for stage II. None of them was in Stage I. Conclusion: Most heart failure patients in Cameroon have resorted to non-specialised care, which worsens their clinical presentation. There is an urgent need for health education of HF patients in our context.

关键词： Heart Failure Therapeutic Care Route Cameroon

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Hygienic and Dietary Measures in Cameroonian Hypertensive Patients Followed at the Douala General Hospital: Knowledge, Compliance and Effect on Blood Pressure Control

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World Journal of Cardiovascular Diseases 2023年第1期13卷 21-31页

作者： Félicité Kamdem Grace Eugénie Makota Ndongo Christelle Noche Domngang Hamadou Ba Jaff Fenkeu Kweban Glwadys Ngono Atéba Sidick Mouliom Henri Ngoté Lade Viché Caroline Kenmegne Marie Solange Ndom Ebongue Siddikatou Djibrilla Elysée Claude Bika Léle samuel kingue Department of Internal Medicine Douala General Hospital Douala Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Institut Supérieur des Sciences de la Santé Université des Montagnes Bangangté Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Intensive Care Unit Douala General Hospital Douala Cameroon Faculty of Medicine and Biomedical Sciences University of N’Gaoundéré N’Gaoundéré Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Physiology and Medicine of Physical Activities and Sports Unit University of Douala Douala Cameroon

Introduction: The management of hypertension is mostly based on pharmacotherapy and hygienic and dietary measures (HDMs) for which little data is available in Cameroon. The concern to improve the quality of life of hypertensive patients led us to study the knowledge, compliance and effect of HDMs among Cameroonian hypertensive patients. Methods: This was a cross-sectional study carried out at the Douala General Hospital;the census of patients was carried out from 05 March to 10 May 2018. The data evaluated were knowledge and compliance with HDMs with an inference of their effect on blood pressure control. Results: We recruited 330 participants at mean age of 60 ± 11 years, 37.9% men;57.3% with blood pressure (BP) controlled. Out of 330 subjects, 308 (93.3%) who had been educated about dietary health measures for hypertension were assessed on knowledge, compliance and effect of these measures against 22 (6.7%) who had never heard about them. Around 85.7% of participants had good knowledge of HDMs and 78.9% had good compliance with them. There was no statistically significant influence of knowledge and compliance with HDMs on blood pressure control. Conclusion: The level of knowledge and adherence to HDMs of hypertensive patients at the Douala General Hospital was appreciable. It is however appropriate for physicians to intensify patient education on HDMs and BP control.

关键词： Hypertension Hygienic and Dietary Measures Blood Pressure Control Knowledge Compliance

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Assessment of Knowledge, Attitudes and Practices (KAP) on Rheumatic Heart Disease among Senior Medical Students in Cameroon

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World Journal of Cardiovascular Diseases 2020年第6期10卷 363-378页

作者： David Chelo Leslie Mbapah Tasha Anastase Dzudie Tamdja Clovis Nkoke Denis Georges Tewafeu Nelson Njedock samuel kingue Mother and Child Center Chantal BIYA Foundation Yaoundé Cameroon Department of Pediatrics Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Department of Internal Medicine University of Buea Buea Cameroon Department of Internal Medicine Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroun

Background: Rheumatic heart disease (RHD) is the commonest cause of valvular heart disease in low and middle-income countries (LMICs). The low cardiologist to patient ratio leaves a big challenge of RHD prevention and management to general practitioners in Cameroon. This makes it important to assess the aptitude of senior medical students who are doctors-to-be on RHD. This could thus give a base on which to increase awareness and decrease the burden of the disease. Therefore, we sort to evaluate the knowledge, attitudes, and practices (KAP) of senior medical students on rheumatic heart disease. General objective: To determine the level of knowledge, attitudes on rheumatic heart disease, and assess practices towards RHD and its prevention. Methodology: A cross-sectional study was conducted in four medical schools in Cameroon for a period of 3 months (from January 1st to April 1st, 2019). The senior medical students were recruited using a structured self-administered questionnaire and electronic forms. Data were entered into an excel spreadsheet and analysed with IBM SPSS version 25.0 for windows. The knowledge level was divided into tertiles (poor, moderate and good) while the attitudes and practices were divided into poor

关键词： Senior Medical Students Rheumatic Heart Disease Cameroon Attitude Knowledge and Practice General Practitioners

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Clinical Presentations and Outcome of Cardiovascular Emergencies in Yaounde: A Cross-Sectional Study

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World Journal of Cardiovascular Diseases 2018年第2期8卷 133-142页

作者： Ba Hamadou Yaya Toure Kalissou Ahmadou Musa Jingi Sylvie Ndongo Amougou Sandrine Edie Dikosso Rodrigue Njouoguep samuel kingue Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon Internal Medicine Service Cardiology Unit Yaounde Central Hospital Yaounde Cameroon Yaounde Emergency Center Yaounde Cameroon

Background: Cardiovascular emergencies have become a public health problem with a high burden in low-income settings. This is due to the high rates of cardiovascular risk factors that are fast reaching epidemic?proportions. There is paucity of data on cardiovascular emergencies to guide repost strategies in our setting. Our aim was to determine the clinical presentation and outcome of cardiovascular emergencies at Yaounde Emergency Center.?Methods: We carried out this cross-sectional study between June 2015 and May 2017. We included all patients with confirmed cardiovascular emergency. We consecutively collected data on socio-demography, symptoms on admission, past history, clinical findings, and final diagnosis at discharge or in the event of death. Results: Of the 8285 patients admitted for medical emergencies, 388 (4.7%) were cardiovascular emergencies. Their mean age was 59.5 ± 13.8 years, and 59% were males. The Medical Emergency Aid Service was the means of transporting 4% of patients. The median time of arrival at the hospital was 48 hours. Symptoms on admission were mainly weakness of a limb (43.8%), and altered consciousness (33.5%). The most common cardiovascular emergencies were ischemic stroke (30.9%), hypertensive emergency (21.4%), and hemorrhagic stroke (16.5%). The most common comorbidity was diabetes (21.9%). The death rate in the 24 - 72 hours was 14.4%. The causes of death were hypertensive emergency (35.7%), and hemorrhagic stroke (30.3%). Conclusion: Stroke and hypertensive emergency were the most frequent cardiovascular emergencies. The early mortality was high. Hemorrhagic stroke and hypertensive emergencies accounted for most cases of death.

关键词： Cardiovascular Emergencies Ischemic Stroke Hemorrhagic Stroke Cameroon

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Epidemiological Profile of Obesity among Health Staff at the YaoundéCentral Hospital and at the YaoundéUniversity Teaching Hospital

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World Journal of Cardiovascular Diseases 2019年第8期9卷 511-523页

作者： Sylvie Ndongo Amougou Liliane Linda Yangou Tchangoum Marie Ntep Gweth Dieudonné Danwe Camille Mba Maadjjhou samuel kingue Jean Claude Mbanya Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Yaoundé University Teaching Hospital Yaoundé Cameroon Higher Institute of Medical Technology Yaoundé Cameroon Yaoundé Central Hospital Yaoundé Cameroon

Background: Obesity is a real pandemic and with ever increasing prevalence. Health professionals play a vital role in the fight against this condition. They are also affected by obesity and could be even more affected than the general population. These health workers sometimes have a wrong perception of their own weight which interferes with their ability to counsel their patients. The purpose of this study was to determine the prevalence and factors associated with obesity among health care workers and increase their awareness of the problem. Methodology: This was a cross-sectional study conducted at the Yaoundé Central Hospital (YCH) and the Yaoundé University Teaching Hospital (YUTH) during a 6 months period. The data were collected through a questionnaire structured according to WHO STEP wise approach to chronic disease risk factor surveillance (STEPS). We measured weight, height, waist circumference, and blood pressure according to the WHO STEPS procedure. The Chi square test and logistic regression were used to measure the association between the qualitative variables. A p value 0.05 was considered statistically significant. Results: A total of 350 health personnel participated in this study. The prevalence of obesity was 30.3%. That of abdominal obesity was 46.9%. The factors independently associated to overall obesity were age > 40 years [OR = 2.22 95% CI (1.28 - 3.87)], nursing assistant profession [OR = 2.31 95% IC (1.21 - 4.41)] and high blood pressure [OR = 3.38 95% CI (1.16 - 9.84)] and to abdominal obesity, age > 40 years [OR = 3.35 95% CI (1.96 - 5.71)], female gender [OR = 5.47 95% CI (2.95 - 10.14)], marriage [OR = 1.84 95% CI (1.08 - 3.14)], and High blood pressure [OR = 3.76 95% CI (1.01 - 13.94)]. Conclusion: Obesity is very common among YCH and YUTH staff. Staff awareness and the introduction of proper lifestyle promotion programs are more than ever needed to win the fight against obesity.

关键词： Epidemiological Profile Obesity Health Personnel Yaoundé

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

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World Journal of Cardiovascular Diseases 2020年第4期10卷 178-187页

作者： Ba Hamadou Sylvie Ndongo Amougou Ismaila Daouda Chris Nadege Nganou-Gnindjio Liliane Mfeukeu-Kuate Jerome Boombhi Ahmadou Musa Jingi Alain Menanga samuel kingue Department of Medicine and Specialties Faculty of Medicine and Biomedical SciencesUniversity of Yaounde IYaoundeCameroon Cardiology Unit Central Hospital of YaoundeYaoundeCameroon Cardiology Unit University Teaching Hospital of YaoundeYaoundeCameroon Faculty of Medicine and Biomedical Sciences University of Yaounde IYaoundeCameroon Cardiology Unit Medicine BGeneral Hospital of YaoundeYaoundeCameroon

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.

关键词： Heart Failure Parasympathetic Dysfunction Heart Rate Variability Deep Breathing Test

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Evaluation of Sub Clinical Myocardial Systolic Dysfunction Using 2D Global Longitudinal Strain Assessment in Type 2 Diabetes Patients in Sub-Saharan Africa

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World Journal of Cardiovascular Diseases 2020年第10期10卷 707-715页

作者： Alain Patrick Menanga Chris Nadège Nganou-Gnindjio Ladé Viché André Jules Ahinaga Franck Ngowa Guy Sadeu Wafeu Donald Paulin Tchapmi Njeunje Hamadou Bâ samuel kingue Internal Medicine and Specialities Department Faculty of Medicine and Biomedical Sciences University of Yaoundé Yaoundé Cameroon Internal Medicine Department Yaoundé General Hospital Yaoundé Cameroon Cardiology Department Yaoundé Central Hospital Yaoundé Cameroon Internal Medicine Department Douala General Hospital Douala Cameroon Efoulan District Hospital Yaoundé Cameroon

Background: Heart failure is the commonest cardiovascular complication in type 2 diabetes mellitus. However, subclinical left ventricular dysfunction can’t be detected using 2D echocardiography which is routinely used for cardiac evaluation of diabetic patients. We aimed to determine the prevalence and factors associated to left ventricular global longitudinal strain (LV GLS) impairment in type 2 diabetes Cameroonians patients. Methods: We conducted a cross-sectional study from January 2019 to June 2019, including type 2 diabetes patients with preserved left ventricle ejection fraction. Clinical and echocardiographic data were collected, and LV GLS was assessed using speckle tracking technique, a value ≤ -16% been considered as normal value. Results: We recruited 95 patients, with a mean age of 57.4 ± 11.8 years old and median diabetes duration of 5 [2 - 12] years. Echocardiographic evaluation found 56.3% of left ventricle remodelling, 51.6% of left ventricle diastolic dysfunction and mean left ventricle ejection of 63.3% ± 6.6%. LV GLS impairment was present in 43.2% (95% CI: 32.6 - 53.7) of the participants. After adjustment to all significantly associated factors, Obesity (aOR: 4;95% CI: 1.5 -

关键词： 2D Echocardiography Myocardial Strain Left Ventricle Function Diabetes Mellitus Cameroon

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