Background: Central nervous system (CNS) infections are serious and debilitating diseases with significant mortality, and high prevalence in the context of human immunodeficiency virus (HIV) pandemic in Africa. However, their diagnosis remains challenging due to outdated technical platform. We aimed to determine the frequency of CNS infection and to describe the epidemiological, clinical and outcome of this at the Douala General Hospital (DGH), Cameroon. To carry out this study, we collected the medical records of patients hospitalized for CNS infections in the internal medicine department of DGH from January 2015 to December 2019. Results: Among 8430 files reviewed, 336 cases of CNS infection were identified giving a frequency of CNS infection of 3.99% among which 204 files were included in the study (54.4% were male). HIV infection was found in 147 patients (72.1%) with 38.1% (n = 56) of them on regular follow-up. The most common clinical signs were fever (84.8%), headache (68.6%), meningeal syndrome (38.7%), and seizures (36.3%). Cerebral toxoplasmosis (24.5%), cryptococcal meningitis (21.1%), and acute bacterial meningitis (8.3%) were leading aetiologies. Of the 143 CSF samples, 70.6% (n = 101) were sterile. The in-hospital mortality rate was 23.5% with CNS infection of unknown cause (22.1%) be independently associated to this [OR = 2.24; 95% CI 1.04–4.80, p = 0.039]. Conclusion: Clinical presentations of CNS infections are same with classical data. HIV-related opportunistic infections are the main aetiologies. About one over four patients with CNS died. Two thirds of CSF are sterile using basic laboratory assessment giving a need to identify simple tests to increase sensibility and specificity of diagnostic tools in our setting.

Status epilepticus (SE) is a neurologic emergency with disproportionate mortality and morbidity in low- and middle-income countries. Existing SE guidelines are largely based on high-income country contexts, limiting applicability in settings with diagnostic, therapeutic, and infrastructural constraints. We aimed to examine expert clinician perspectives on SE management across recourse-limited settings to identify common barriers and context-specific strategies. This study used a convergent parallel mixed methods approach, interconnecting quantitative and qualitative data collected from an online survey. Experts in SE management were purposively sampled to balance clinical expertise across 3 physician disciplines (neurology, emergency medicine, and critical care) and geographic locations. Invitations to participate were sent to 48 experts from 22 different countries. Qualitative data using thematic analysis and descriptive statistics for quantitative analysis was used. We received responses from 28 clinical experts, spanning 15 countries across 4 continents. Over 96% (27/28) agreed on the importance of guidelines or relevant subsections applicable to resource-limited settings. Experts highlighted inadequate SE education at multiple levels, but less than half (12/28) reported discussing SE management during routine clinic visits. A common theme was a lack of access to anti-seizure medications (ASMs), with 86% (24/28) agreeing that oral ASMs should be included in SE guidelines, although there was no consensus on what these should be. Only 39% (11/28) of experts had consistent access to electroencephalography (EEG), and there was little agreement about the duration and frequency of serial intermittent EEGs in the absence of continuous EEG. Nearly all experts (27/28) agreed that multicenter international efforts are essential to understand current practices and to improve patient outcomes. Other proposed solutions included implementing locally adapted practices to improve care, such as remote tele-monitoring and improving SE education and training. This study provides the most geographically diverse expert insight to date on SE care in recourse-limited settings, underscoring systemic barriers that transcend clinical decision-making. Inclusive, context-sensitive frameworks and implementation strategies are urgently needed. Our findings provide expert-informed priorities to guide future policy, research, and clinical practice for equitable SE care.

Background: Brain tumors represent group of neoplasms originating from intracranial tissues and the meninges. The aim of this study was to determine the epidemiological profile of brain tumors seen in a referral health center in Cameroon. We carried out a 10-year retrospective study in the neurosurgical, neurology, pathology, oncology and radiotherapy units of our hospital. Results: We found 150 complete case files accounting for 0.7% of total admissions in the various units. Males accounted for 50.7% of the cases. Children less than 14 years represented 12.7% of cases (n = 19). Primary brain tumors constituted 92% (n = 138). Most patients with primary brain tumors were between 25 and 54 years of age, making up 57% of cases (n = 79). The most prevalent histological type of brain tumor was meningioma (26%, n = 39), followed by astrocytoma (24.7%, n = 37), and pituitary adenomas (18%, n = 27). The majority of cases presented with signs of raised intracranial pressure with headache being the most frequent symptom (88%). Some patients presented with seizures (34%), neurological deficit (13%), visual disturbances (10%), and cognitive disorders (7%). Conclusion: Young adults represent the most affected age group. Meningioma, astrocytoma and pituitary adenomas were the most frequent brain tumors in adults. Further studies are needed to assess the long-term outcome of patients with BTs.

Introduction: Parkinson’s disease (PD) has become a global public health challenge as disability and death due to the disease are growing rapidly in comparison to other neurological disorders. There are no up-to-date comprehensive reviews on the epidemiology, environmental and genetic risk factors, phenotypic characterization, and patient-reported outcomes of PD in Africa. This data is crucial to understanding the current and future burden and suggesting actionable and/or researchable gaps aimed at improving disease outcomes. Methodology: We conducted a systematic literature search using the electronic databases of Cochrane Central Register of Controlled Trials (CCRT), EMBASE, Medline, PsychINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), African Journals (AJOL) and other unpublished literature. We included all studies providing data on people with PD in Africa from the start of each database till February 2023. Studies were not restricted based on diagnostic criteria or language. Outcomes of interest were summarised based on epidemiology, genetics, environmental risk factors, clinical characteristics, patient-reported outcomes (experience and quality of life), disease management and outcomes, access to care, patient support, and healthcare workforce training. We also investigated collaboration between African countries (internal) and across continents/world regions (external) and journal impact factors. Results: A total of 4,855 articles were identified, of which 180 were included in this review. The majority were published from North Africa (mainly from Tunisia, and involved collaboration with investigators from France, the United Kingdom, and the United States of America). West Africa (Nigeria), Southern Africa (South Africa) and East Africa (mainly Tanzania) also had a relatively high number of publications. Methodological design varied across studies. Based on the pre-determined outcomes, articles identified were genetics (67), clinical features (65), environmental risk factors (16), epidemiology (14), patient experience and quality of life (10), management and access to care (5) and education and training (3). Conclusions: The main hubs of PD-related research output in Africa are the Northern, Western and Southern regions of Africa (although with limited involvement of countries within these regions). External collaboration (outside the continent) currently predominates. There are considerable actionable and researchable gaps across all outcomes of interest, with a dearth of published information on health workforce capacity building, disease management and access to care, patient and caregiver engagement, and quality of life of people with PD in Africa. We recommend strengthening existing and emerging intercontinental networks for research, education, training and policy formulation and funding, leveraging on more recent developments such as the International Parkinson’s Disease Genomics Consortium-Africa (IPDGC-Africa), the International Parkinson and Movement Disorder Society Africa Section (MDS-AS), World Health Organisation (WHO) and initiatives with similar objectives.

Anti-SRP myopathy represents 4 to 6% of all the inflammatory myopathies. It has been described since the 80s and its influence on pregnancy and vice versa has been highlighted recently. We report two cases of anti-SRP myopathy associated with pregnancy. In the first case, the initial manifestations of the disease started in post partum and the second case was an anti-SRP myopathy patient before pregnancy. In both cases we objectified outbreaks during post-partum. Pregnancy seems to promote outbreaks. The inactive myopathy seems to presents no serious maternal-fetal complications as well as the usual dose of corticosteroids. The treatment (corticosteroid) during pregnancy is indicated given the risk of worsening during the post-partum.

Background: Thoracolumbar spine injury (TLSI) is a major concern worldwide despite its low prevalence. Studies demonstrate a gradual rise in annual incidence. There have been improvements in its management. However, a lot is still to be done. TLSI secondary to trauma usually occurs abruptly and leaves demeaning consequences, especially in our setting where the prognosis from several studies is poor. This study aimed to describe the etiology, management principles, and prognosis of TLSI in Douala General Hospital and as such contribute data on those aspects in the research community. Method: This was a hospital-based five-year retrospective study. The study population was patients treated for TLSI in the Douala General Hospital from January 2014 to December 2018. Patients’ medical records were used to retrieve data. Data analysis was done using SPSS Version 23. Logistic regression models were fitted to assess the association between dependent and independent variables. Statistical significance was set at 95% CI, with a P-value < 0.05. Results: We studied a total of 70 patients’ files including 56 males. The mean age of occurrence of TLSI was 37.59 ± 14.07 years. The most common etiology was road traffic accidents (45.7%) and falls (30.0%). Half of our patients (n = 35) had an incomplete neurological deficit (Frankel B – D). Paraplegia was the most common motor deficit (42.9%). The lumbar spine was affected in 55.7% of cases. The most common CT scan finding was fracture of the vertebrae (30%) while the most reported MRI finding was disc herniation with contusion (38.5%). More than half (51.4%) of our patients were referred from peripheral health centers. The median arrival time was 48 h (IQR: 18–144) with 22.9% reporting after a week post-injury. Less than half (48.1%) benefited from surgery, and 41.4% of our population benefited from in-hospital rehabilitation. The median in-hospital delay time for surgery was 120 h (IQR: 66–192). While the median time between injury and surgery was 188 h (IQR: 144–347). The mortality rate was 5.7% (n = 4). Almost all (86.9%) of the patients developed complications and we had a 61.4% improvement in neurological status upon discharge. Being covered by health insurance was a predictor of improved neurological status (AOR = 15.04, 95%CI:2.90–78.20, P = 0.001) while being referred was a predictor of a stationary neurological status upon discharge (AOR = 0.12, 95%CI:0.03–0.52, P = 0.005). The average hospital stay was 20 days. We did not identify any predictors of lengthy hospital stay. Conclusion: Road traffic accident is the most common etiology of TLSI. The arrival time to a neurosurgery specialized center after a traumatic injury, and the in-hospital delay time for surgery is high. Reduction of these delays, encouraging universal health insurance coverage, and improving on management to reduce complications would better the outcome of TLSI which is comparable with those in other studies.