Libreville Hospital

Importance:In patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO), the benefit of intravenous thrombolysis (IVT) administered beyond 4.5 hours from the last time known well before endovascular therapy (EVT) is uncertain. Recently, the TIMELESS trial failed to demonstrate a benefit of IVT in this setting, but this trial focused on patients directly admitted to comprehensive stroke centers (CSCs) with fast access to EVT. Objective:To assess the efficacy and safety of IVT initiated beyond 4.5 hours in patients with AIS-LVO initially admitted to primary stroke centers (PSCs) and subsequently transferred to a CSC for EVT, allowing substantial time for the IVT to take effect. Design, Setting, and Participants:This multicenter retrospective cohort study was conducted between January 2020 and December 2024, with 3-month follow-up, at 20 French PSCs. All consecutive patients with AIS-LVO admitted beyond 4.5 hours from the last time they were known well in the PSC and subsequently transferred to a CSC for EVT, with or without IVT administered prior to transfer, were eligible for inclusion. Data analysis was performed between May 2025 and July 2025. Main Outcomes and Measures:The primary outcome was the 3-month modified Rankin Scale score, analyzed in the ordinal approach. Propensity score with overlap weighting (PSOW) balanced covariates between patients treated with IVT vs those without. Results:A total of 584 patients were included, among whom 309 patients (52.9%) were female. Median (IQR) age was 71 (61-81) years, median (IQR) baseline National Institutes of Health Stroke scale score was 15 (10-19), median (IQR) time from last known well to PSC imaging was 10.5 (6.9-14.0) hours, and 232 patients (39.7%) received IVT before transfer. Advanced brain imaging (magnetic resonance imaging or computed tomography [CT] with CT-perfusion) was performed at the PSC in 544 patients (93.2%). IVT use before transfer was independently associated with a shift toward better 3-month outcomes (PSOW-common odds ratio [OR], 1.97; 95% CI, 1.33-2.92; P = .001) and higher odds of recanalization during transfer (PSOW-OR, 8.69; 95% CI, 3.16-23.87; P < .001) compared with those without. The rate of any intracerebral hemorrhage and symptomatic intracerebral hemorrhage were similar between groups. Conclusions and Relevance:In this multicenter cohort study, IVT initiated beyond 4.5 hours prior to interhospital transfer for EVT was associated with higher rates of recanalization during transfer and improved 3-month functional outcomes, without safety concerns. These findings offer encouraging support for clinical trials evaluating IVT in the late time window before interhospital transfer.

RESUME Introduction. La survenue de troubles du rythme chez l'adulte jeune au cœur structurellement sain constitue un défi diagnostique et étiologique, particulièrement en Afrique subsaharienne où les explorations spécialisées sont limitées. Cette étude visait à décrire les caractéristiques cliniques, épidémiologiques et la prise en charge de ces arythmies au Centre Hospitalier Universitaire de Libreville (CHUL). Méthodologie. Nous avons mené une étude rétrospective observationnelle incluant tous les patients âgés de 15 à 55 ans, hospitalisés entre 2013 et 2024 pour un trouble du rythme documenté, avec une fonction ventriculaire gauche et une échocardiographie normale. Les données cliniques, paracliniques et thérapeutiques ont été analysées. Résultats. Sur 61 patients inclus (âge moyen 41±10 ans, prédominance féminine), la fibrillation atriale était l'arythmie la plus fréquente (44,2%), suivie du flutter atrial (29,5%). Les palpitations constituaient le symptôme principal (86,7%). Un facteur de risque cardiovasculaire, principalement l'hypertension artérielle (49,2%), était présent chez la majorité des patients. Un bilan thyroïdien et une kaliémie n'ont été réalisés que dans 59% des cas. L'imagerie par résonance magnétique cardiaque a été rarement effectuée (4%). Le traitement reposait principalement sur les bêta-bloquants (62,5%). La mortalité hospitalière était de 6,6%. Conclusion. La fibrillation atriale est l'arythmie la plus fréquente chez le jeune adulte gabonais au cœur apparemment sain, souvent associée à une hypertension artérielle. L'exploration étiologique, notamment métabolique et par imagerie avancée, est insuffisante, soulignant la nécessité de protocoles diagnostiques standardisés. ABSTRACT Introduction. The occurrence of arrhythmias in young adults with structurally normal hearts poses a diagnostic and etiological challenge, particularly in sub-Saharan Africa where specialized investigations are limited. This study aimed to describe the clinical, epidemiological characteristics and management of these arrhythmias at the University Hospital of Libreville (CHUL). Methodology. We conducted a retrospective observational study including all patients aged 15-55 years, hospitalized between 2013 and 2024 for a documented arrhythmia, with normal left ventricular function and echocardiography. Clinical, paraclinical, and therapeutic data were analyzed. Results. Among 61 included patients (mean age 41±10 years, female predominance), atrial fibrillation was the most frequent arrhythmia (44.2%), followed by atrial flutter (29.5%). Palpitations were the main symptom (86.7%). A cardiovascular risk factor, mainly hypertension (49.2%), was present in the majority. Thyroid function tests and serum potassium were performed in only 59% of cases. Cardiac magnetic resonance imaging was rarely performed (4%). Treatment was primarily based on beta-blockers (62.5%). In-hospital mortality was 6.6%. Conclusion. Atrial fibrillation is the most frequent arrhythmia in young Gabonese adults with apparently normal hearts, often associated with hypertension. Etiological investigation, particularly metabolic and advanced imaging, is insufficient, highlighting the need for standardized diagnostic protocols.

Objective To develop and implement a structured protocol for breaking gynecological cancer diagnoses in Gabon, and evaluate its feasibility and acceptability among healthcare professionals and patients. Methods Two-phase prospective study (2024–2025). Phase 1: exploratory survey among 19 professionals documenting existing practices and needs. Phase 2: protocol implementation in five healthcare facilities followed by satisfaction surveys among 23 professionals and 50 patients with breast or cervical cancer. Quantitative analyses (Mann-Whitney test) and thematic qualitative analyses were performed. Results Phase 1 revealed major gaps: insufficient training (89.5%), lack of standardized tools (68.4%), and limited institutional support (63.2%). Phase 2 demonstrated favorable acceptability: 56.5% of professionals reported high comfort levels, 61% practice improvement, and 60.9% positive overall satisfaction. Oncologists-radiotherapists perceived significantly superior impact compared to gynecologists on practice evolution (p = 0.004 ), first contact improvement ( p = 0.025) , and professional well-being (p = 0.032). Among patients, 84% found communication clear and 80.0% understood information, but 70.0% deemed emotional support insufficient. Main limitations: impersonal nature (39.1%) and lack of transcultural adaptation (21.7%). Conclusions This first-in-Gabon protocol demonstrates feasibility and acceptability. However, optimal effectiveness requires complementary training in relational skills and cultural adaptation. Controlled longitudinal studies are needed to measure long-term impact on quality of life and treatment adherence.

Central nervous system (CNS) infections are an important cause of morbidity and mortality among people living with HIV (PLWHIV), particularly in resource-limited settings. Cryptococcosis, toxoplasmosis and cerebral malaria often present with overlapping neurological symptoms, complicating diagnosis where confirmatory tests are unavailable. This study aimed to determine the prevalence and associated signs and symptoms of parasitic and fungal infections with neurological tropism in PLWHIV hospitalized in Libreville. A retrospective review was conducted at the Infectious Diseases Ward of the Centre Hospitalier Universitaire de Libreville (IDW-CHUL) between April and September 2021. Data were recorded from the medical files of PLWHIV hospitalised for suspected cryptococcal meningoencephalitis presenting with fever and headache alone or associated with other neurological signs. Diagnoses of cryptococcosis, toxoplasmosis, and malaria were based on microscopy, cryptococcal antigen testing, and brain CT scan. Cases of tuberculosis, other bacterial or viral meningitis were not included. Sociodemographic, clinical, and immunological data were analysed, and associations between symptoms and CNS infections were assessed. Among 255 hospitalised PLHIV, most were aged under 55 years (86.3

Introduction : La paralysie cérébrale (PC) est la cause la plus fréquente de handicap moteur chez l’enfant. Son profil épidémiologique est peu documenté au Gabon. Méthodologie : Étude rétrospective descriptive réalisée au CHUME FJE de janvier 2022 à décembre 2024. Résultats : Sur 156 cas de PC, la prévalence était de 1,8 pour 1000 naissances vivantes. Les facteurs de risque principaux étaient : la prématurité (42%), l’asphyxie périnatale (28%), les infections périnatales (18%). La forme spastique prédominait (68%). Conclusion : La PC est fréquente au Gabon. La prématurité est le principal facteur de risque. Une prévention périnatale est essentielle. Mots-clés : paralysie cérébrale, épidémiologie, prématurité, Gabon.