Patients characteristics and outcome of 518 arteriovenous fistulas for hemodialysis in a sub-Saharan African setting.

BACKGROUND: To present the particular aspects of arteriovenous fistula (AVF) for hemodialysis in sub-Saharan Africa in terms of patients' characteristics, patency and complication rates, as well as factors influencing them. METHODS: From November 2002 to November 2009, 518 fistulas were constructed on adults. Demographic data, patency, and complications were analyzed. The association between age, sex, and comorbidities (HIV, hypertension, diabetes) on one hand and complications as well as AVF patency on the other was sought. RESULTS: Males represented 73.7% of the patient population, and the mean age of the population was 45.3 years. As far as etiologies of end-stage renal disease (ESRD) and comorbidities are concerned, chronic glomerulonephritis was the leading cause of ESRD (134; 25.9%), followed by hypertension (22.3%), although prevalent in 83.2% of patients, and diabetes (20.1%), although prevalent in 22.2%. No cause for the ESRD could be identified in 89 patients (17.2%). Only 20.64% had AVF as the initial vascular access. The main types of AVF constructed were radiocephalic (68%) and brachiocephalic (24.9%). The median follow-up period was 275 days. The cumulative patency rate at 1 year and 2 years was 76% and 51%, respectively. Altogether, 188 complications occurred in 16% of the AVFs. Aneurysms, failure to mature, and thrombosis were the most frequent complications occurring in 27.65%, 14.89%, and 10.63% of cases, respectively. The management options for the complications included the creation of a new access for 63 complications (33.51%) and nonoperative management in 44.14% of the cases. We found no adverse effect of comorbid factors like diabetes mellitus (χ(2) = 3.58, P > 0.05) and HIV-positive status (χ(2) = 0.64, P > 0.05) on the complications rate. CONCLUSION: According to our patients' characteristics, there is a possibility of constructing AVF on nearly every hemodialysis patient with a good outcome.

The TP63 Gene Polymorphism rs17506395 is Associated with Early Breast Cancer in Cameroon.

BACKGROUND: Breast cancer (BC) is a leading female cancer worldwide and cause of cancer-related death, especially in developing countries. Genetic predispositions to BC development in African population is poorly studied, and meanwhile the SNP rs17506395 in TP63 gene locus has been associated with the development of breast cancer in Asian women, no investigation has been undertaken within African population. We investigated the impact of this polymorphism in a representative African population. METHODS: We undertook a case-control study including 335 women, of which 111 were breast cancer patients and 224 controls. Using blood-derived germline DNA, PCR-RFLP was used to investigate the polymorphism of TP63 gene at rs17506395 locus. Unconditional logistic regression was used to study the association between the TP63 gene polymorphism and risk of BC development. After stratification into different age and ethno-linguistic groups as well as menopausal status, the Cochran-Mantel-Haenszel test was used to measure significance of the associations. RESULTS: Comparing cases with controls, no significant associations between genotype and disease development was observed. Similarly, when cases were stratified according to menopausal status and ethno-linguistic groups, no significant association was observed between genotype and disease development. However, in women of 40 years and below, TT and TG genotypes were associated with breast cancer development. The minor G allele seems to protective against early breast cancer onset OR of 0.5 (95%CI = 0.26-0.94, p = 0.03). CONCLUSION: Our data revealed an association between rs15706395 and the risk of early breast cancer onset. The GG genotype seems to reduce the risk of early breast cancer. Larger studies are needed to confirm the potential of this SNP as biomarker for breast cancer prognostic.
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Management of neural tube defects in a Sub-Saharan African country: the situation in Yaounde, Cameroon.

BACKGROUND: Neural tube defect is a serious disabling but preventable congenital malformation with an incidence of 1.99 per 1000 births in Yaounde [A.K. Njamnshi, V. d e P. Djientcheu, A. Lekoubou, M. Guemse, M.T. Obama, R. Mbu, S. Takongmo, I. Kago. Neural tube defects are rare among black Americans but not in Sub-Saharan black Africans: The case of Yaounde-Cameroon. Journal of the Neurological Sciences 2008; 270: 13-17]. The management requires highly qualified personnel and a significant social cost. The aim of this study was to evaluate the management of neural tube defect in a resource-limited developing Sub-Saharan nation like Cameroon. METHODS: We reviewed all patients with neural tube defects admitted in the neonatology unit of the Mother and Child Center (Chantal Biya Foundation Yaounde) between January 1st 2000 and December 31st 2006. RESULTS: Sixty-nine (69) patients were enrolled. There was a male predominance (69.57%) in the sample. Myelomeningomecele represented 68.11% of cases, followed by encephalocele (27.54%) and meningocele (4.35%). Antenatal ultrasound examinations were done in 27 cases (32.8%). The prenatal diagnosis was made only in 8 cases. No medical abortion was performed in any of these cases. Medical abortion is illegal in Cameroon (except in certain specific situations) as well as other Sub-Saharan African countries. Hydrocephalus was diagnosed in 40.02% of cases. As most of the patients (62.32%) could not afford modern treatment, only 26.09% of them were operated at birth. The rest sought traditional and other forms of treatment, due to poverty or cultural beliefs. Eight patients (11.59%) died before surgery. Surgery consisted of local closure alone (40%) or local closure associated to CSF shunting (60%). The complications were wound dehiscence (13.69%), shunt infection (1.37%), meningitis (1.37%) and iatrogenic pulmonary oedema (1.37%). CONCLUSION: Neural tube defects are the most frequent and disabling malformations in neonates in the Sub-Saharan African paediatric environment. Prenatal management and outcome at birth are limited by poverty and cultural beliefs. Prevention is possible and may be better than palliative care in developing countries.

Bacteriological assessment of the hospital environment in two referral hospitals in Yaoundé-Cameroon.

INTRODUCTION: Many studies still show significant numbers of surgical patients contracting nosocomial infections each year globally with high morbidity and mortality. The aim of this study was to identify potential bacteria reservoirs that may be responsible for nosocomial infection in surgical services in the Yaoundé University Teaching Hospital (YUTH) and the Central Hospital Yaoundé (CHY). METHODS: A cross sectional descriptive study was conducted from June to August 2012. Air, water, and surface samples were collected from two surgical services and subjected to standard bacteriological analysis. RESULTS: A total of 143 surface samples were collected. Bacteria were isolated in all surfaces except from one trolley sample and a surgical cabinet sample. The predominant species in all services was coagulase negative Staphylococcus (CNS). The average number of colonies was 132. 82 CFU/25 cm(2). The bacteria isolated in the air were similar to those isolated from surfaces. From the 16 water samples cultured, an average of 50.93 CFU/100ml bacteria were isolated. The distribution of isolated species showed a predominance of Burkholderia cepacia. CONCLUSION: These results showed the importance of the hospital environment as a potential reservoir and source of nosocomial infections amongst surgical patient at YUTH and CHY, thus we suggest that Public health policy makers in Cameroon must define, publish guidelines and recommendations for monitoring environmental microbiota in health facilities.

Determination of chemical composition of gall bladder stones: basis for treatment strategies in patients from Yaounde, Cameroon.

AIM: Gallstone disease is increasing in sub-saharan Africa (SSA). In the west, the majority of stones can be dissolved with bile salts, since the major component is cholesterol. This medical therapy is expensive and not readily accessible to poor populations of SSA. It was therefore necessary to analyze the chemical composition of biliary stones in a group of patients, so as to make the case for introducing bile salt therapy in SSA. METHODS: All patients with symptomatic gallstones were recruited in the study. All stones removed during cholecystectomy were sent to Houston for x-ray diffraction analysis. Data on age, sex, serum cholesterol, and the percentage by weight of cholesterol, calcium carbonate, and amorphous material in each stone was entered into a pre-established proforma. Frequencies of the major components of the stones were determined. RESULTS: Sixteen women and ten men aged between 27 and 73 (mean 44.9) years provided stones for the study. The majority of patients (65.38%) had stones with less than 25% of cholesterol. Amorphous material made up more than 50% and 100% of stones from 16 (61.53%) and 9 (34.61%) patients respectively. CONCLUSION: Cholesterol is present in small amounts in a minority of gallstones in Yaounde. Dissolution of gallstones with bile salts is unlikely to be successful.

[Synovial Osteochondromatosis At The Rheumatology Unit Of The Yaounde Central Hospital]. / Osteochondromatose Synoviale En Rhumatologie A L'Hopital Central De Yaounde, Cameroun.

Synovial osteochondromatosis is a disease characterized by a benign metaplastic cartilaginous proliferation. There are very few studies on synovial osteochondromatosis in Sub Saharan Africa. We report on 10 observations.We conducted a retrospective study carried out from January 2004 to December 2008, in Synovial osteochondromatosis patients attending the Rheumatology Unit of the Yaounde Central Hospital. We studied 3 women and 7 men, with an average age of 27 years±13 (range: 14 and 89 years old). The knee was the most affected joint (observed in 9 cases) and the metacarpophalangeal joint of the thumb was affected in 1 case. Pain was constant, and joint motion limitation was observed in 6 cases, swelling of the joint in 4 cases, cracking of the joint in 2 cases and nodules were noted in 1 case. None of these patients presented an inflammatory syndrome. Radiological signs were: calcified chondromas in all 10 cases, associated with degenerative lesions in 3 cases. Every patient received an analgesic and a non-steroidal anti-inflammatory medication. Only 3 patients (patients 1, 4 and 5) underwent surgical synovectomy. None of the patients underwent arthroscopic surgery or synoviorthesis.Synovial osteochondromatosis manifestations in our patients were similar to what has been described in the literature, only differing in that surgical care was not constant.

L'ostéochondromatose synoviale est une maladie, qui se caractérise par une prolifération métaplasique bénigne cartilagineuse. Elle est peu décrite en Afrique Sub Saharienne. Nous rapportons dix observations.Il s'agissait d'une étude rétrospective sur dossier des cas d'ostéochondromatose synoviale colligés dans le service de rhumatologie de l'Hôpital Central de Yaoundé de Janvier 2004 à Décembre 2008.Dix observations ont été retenues chez trois femmes et de Sept hommes, dont l'âge moyen était de 27 ans±13, avec les extrêmes de 14 et 89 ans. Le genou était atteint dans 9 cas et l'atteinte de l'articulation métacarpophalangienne a été observée dans un cas. La douleur était constante, le blocage articulaire était noté dans 6 cas, la tuméfaction articulaire dans 4 cas, le craquement articulaire dans 2 cas et la présence de nodules dans un cas. Aucun patient n'avait eu un syndrome inflammatoire. Les signes radiologiques observés étaient les suivants : chondromes calcifiés dans les 10 cas, associés à des lésions dégénératives dans 3 cas. Tous les patients avaient reçu un traitement associant un antalgique et un anti-inflammatoire non stéroïdien. Seuls trois patients avaient eu un traitement chirurgical (patients 1, 4, 5), consistant en une synovectomie totale. Aucun patient de cette série n'avait eu une arthroscopie ni une synoviorthèse.La présentation de l'ostéochondromatose synoviale des patients de cette série était superposable aux données de la littérature, à la seule différence de la prise en charge chirurgicale qui n'était pas constante.

Meckel's diverticulum: a case report from the University Hospital Center Yaoundé, Cameroon.

To the best of our knowledge there is no reported case of Meckel's diverticulum (MD) in Cameroon. The prevalence of MD in the general population is 2-3 %. The aim of this paper is to recapitulate the role of this pathology in acute abdomens and abdominal pain of uncertain aetiology in young patients and to review the medical literature.