Promoting evidence-based practices for breast cancer care through web-based collaborative learning.

The Knowledge Summaries for Comprehensive Breast Cancer Control (KSBCs) are a series of 14 publications aligned with World Health Organization guidance on evidence-based breast cancer control and accepted frameworks for action. To study utilization of the KSBCs in the development of locally relevant breast cancer control policies and programs in limited resource settings, the National Cancer Institute Center for Global Health, the University of Washington and the Fred Hutchinson Cancer Research Center developed the Project ECHO® for KSBCs (KSBC ECHO). Project ECHO is an online model which employs case-based learning, while promoting multi-directional learning and network-building. The program was evaluated using a pre-post study design to assess if this online collaborative learning platform can be an effective model for dissemination and utilization of the KSBCs to inform breast cancer control programs and policy advocacy in limited resource settings. A total of 28 KSBC ECHO participants (57%) responded to the baseline and endpoint program evaluation surveys. Across all 28 respondents, analysis of the data indicates that knowledge increase was statistically significant overall: average knowledge gain was 0.77, 95% CI [0.44 - 1.08] and p value < 0.0001. A majority of responding team leads reported that the core ECHO components (case/didactic presentations, discussion) contributed to a great extent to strengthening their project proposal/goals. Program evaluation survey responses indicate that utilization of this online platform provided an opportunity for individual knowledge gain, multi-directional information exchange, network-building, and strengthening of the proposed breast cancer control projects based in limited resource settings.

[Primary lymphomas of the urinary in the urological service of the Yaounde Central Hospital]. / Les lymphomes primitifs urogénitaux : l'expérience du service d'urologie de l'hôpital Central de Yaoundé (Cameroun).

OBJECTIVE: The objective of this study were to recruit and present epidemiological, clinical, histological and therapeutic aspects of primary lymphomas of the urogenital tract in Cameroon. MATERIAL AND METHOD: This was a retrospective study over a 10-year period (1999-2008) done on clinical records of the Urological Unit of the Yaounde Central Hospital. From these records, we noted the age and the sex of the patients, their clinical presentation and histological aspect. The patients were treated by surgical resection and chemotherapy. RESULTS: Twenty cases were recruited between this period of the study. The age of the patients varied from 6 to 60 years with a mean age of 35 years. There were 19 men and one woman. Eighteen cases involved the testis, one case the kidney and one penile involvement. On histology, there were 19 cases of Burkitt's lymphoma and one case of large B cell lymphoma involving the penis. Three patients had positive syphilis serology and two other were HIV positive. All the patients in this series had a complete remission after treatment but the tumour recurs after 6 to 9 months. CONCLUSION: Burkitt's lymphoma is the first malignant tumour of the testis in Cameroonian. Unfortunately, patients consult late, there are no supports for the treatment and this will lead to a poor prognosis.

Acute and subacute toxicity of Aspilia africana leaves.

This study was designed to evaluate the toxicity of the aqueous extract of Aspilia africana leaves. Oral doses of 500 mg/kg and 1000 mg/kg were administered for 28 days to rats after every 2 days for sub-acute toxicity. For acute toxicity, 5 doses of 2, 4, 8, 12 and 16 g/Kg body weight were investigated in mice. The control groups consisted of mice or rats administered with distilled water. The signs of toxicity fluctuated lightly from one mammal to another throughout the experiment. The liver, kidneys and heart weight of rats revealed no significant differences between the test groups and the control. The results indicated that the medium lethal dose (LD(50)) was found to be greater in females than males with an average of 6.6 g/Kg body weight for both sexes. Regardless of the significant differences observed at certain points in some biochemical parameters (ALT, AST, ALP, Creatinine and Glutathione); none showed any linear dose responsiveness. On the other hand, most of the parameters investigated were found to be gender dependent. These results suggested that A Africana can be classified among substances with low toxicity.

Visual inspection with acetic acid and cytology as screening methods for cervical lesions in Cameroon.

OBJECTIVES: To assess the accuracy of visual inspection with acetic acid (VIA) as a screening method for cervical lesions. METHODS: VIA and cytological smears were carried out on the cervices of non-pregnant women aged 30-60 years with no previous history of cervical cancer. Cervices with aceto white lesions or positive Pap smears, and one in ten negative cervices (control), were biopsied. RESULTS: 5010 women were enrolled, 4813 (96.1%) were screened. 4767 (99.%) had adequate cytology smears. 574 (11.9%) had colposcopy. 1743 biopsies were obtained of which 528 were controls. The sensitivity of VIA was 70.4% versus 47.7% for Pap smear. VIA specificity was 77.6% versus 94.2% for Pap smear; PPV for VIA was 44.0% versus 67.2% for Pap smear; and NPV for VIA was 91.3% versus 87.8% for Pap smear. CONCLUSIONS: VIA has acceptable test qualities and may in low resource settings be implemented as a large scale screening method.

[Precancerous lesions of the uterine cervix in cameroonian women. Cytological and epidemiological aspects of 946 cases]. / Lésions précancéreuses du col utérin chez la femme camerounaise. Aspects cytologiques et épidémiologiques de 946 cas.

OBJECTIVE: The aim of this study was to present the cytological and epidemiological aspects of precancerous lesions of the uterine cervix of women living in the two first cameroonian cities (Yaounde and Doubla). MATERIAL AND METHODS: The material was made of pap smears registrar of the Yaounde Central Hospital pathological laboratory and the reports of cervical cancer screening from Douala and Yaounde within a period of five years (1st January 1994 to 31st December 1998). We recruited all cases showing a precancerous lesion of the uterine cervix. For each case, we noted: the type of lesion, the age of the patient, the age at the first sexual intercourse, the age at the first delivery, the number of pregnancies, the parity, the marital status, the socioeconomical class. RESULTS: From a total of 13524 pap smears done, 946 (7%) have shown precancerous lesions. 70% of these were high grade while 30% were low grade. These lesions were observed at all age from the range of 11 to 15 years. All women showing these lesions had had sexual intercourse. 30% of these lesions were noted among women who have had their first sexual intercourses between 10 and 15 years. 40% were observed among women who have had their first sexual intercourses between 16 and 18 years. 66% among women who have had their first delivery between 13 and 21 years. 92% are observed among women who have had more than five pregnancies, more than five parities; 54% among women who are married and 76% among bachelors and widows; 64% among women with low socioeconomical status; 9% among women with high socioeconomical status. CONCLUSION: Many cameroonian women are prone to cervical cancer.

[Lymphoid nodules of the breast. Report of 10 cases observed in Cameroon]. / Les nodules lymphoïdes du sein. A propos de 10 cas observés en milieu camerounais.

The aim of this study was to present clinico-pathological aspects of breast lymphoid nodules in Cameroon. From the collection of the pathology laboratory of the Yaounde Central Hospital, all the cases of breast lymphoid nodules diagnosed between 1st January 1993 and 30th June 1998 were recorded. For each case, the following data were noted: age of the patient, clinical informations (signs and symptoms), microscopical aspects and histological description. 10 cases of breast lymphoid nodules were recorded. These were observed in women aged 19 to 50 and most of them were painless. All were mobile and felt by the patients before excision-biopsy. They were mostly found on the right and were less than 1 cm in diameter. Histologically, they presented as diffuse lymph node hyperplasia.

[Cancer localisation in men and women aged over 50 in Cameroon]. / Localisations des cancers chez les hommes et les femmes âgés de plus de 50 ans au Cameroun.

The aim of this study was to present the sites of cancers diagnosed in men and women aged 50 years and above in Cameroon. From the registries of the pathology laboratory of the Yaoundé Central Hospital which at the national level receives the majority of samples sent for histopathology analysis, we recorded all cases of cancers diagnosed in people aged 50 years and above, during the period from 1st January 1987 to 31st August 1996 (9 years 8 months). 1,925 cancers were recorded: -1,005 of these (52.2%) were issued from men aged fifty years and above. These 1,005 cancers came from seventeen sites, the most common being: liver (226 cases = 22.49%), prostate (222 cases = 22.09%), skin (195 cases = 19.40%) and ENT (100 cases = 9.95%); that made 73.93% (above 3/4) of cancers observed in men aged fifty years and above from this study. -920 of these (47.8%) were diagnosed from women aged fifty years and above. These 920 cancers came from twenty-two sites, the most common being: uterine cervix (292 cases = 31.74%), breast (170 cases = 18.48%), skin (111 cases = 12.07%) and liver (90 cases = 9.78%); that made 72.07% (about 3/4) of cancers observed in women aged fifty years and above, from this study.