A case report of ruptured ectopic pregnancy plus massive hemoperitoneum on a heterotrophic pregnancy in a resource-poor setting, Mbengwi, Cameroon.

Heterotopic pregnancy is a rare obstetrics phenomenon and carries significant maternal morbidity and mortality due to the risk of rupture of the ectopic pregnancy. Physicians tend to feel comfortable and relieved when an intrauterine gestation sac is seen. This results in an inadequate inspection of the adnexae and remaining structures during emergency bedside ultrasound despite a strong initial clinical suspicion of ectopic pregnancy. We present a case report of ruptured ectopic pregnancy and massive hemoperitoneum in a patient with heterotopic pregnancy. The diagnosis was done on bedside ultrasonography in a clinically unstable 32-year-old patient with a history of infertility. She presented with acute abdominal pain, body weakness, and amenorrhea. She underwent emergency laparotomy and salpingectomy. In our context where ultrasound is not readily available, practitioners carrying out salpingectomy for ruptured ectopic pregnancies should bear in mind the plausibleness of heterotopic pregnancy to properly handle the uterus.

Malaria in patients with sickle cell anaemia: burden, risk factors and outcome at the Laquintinie hospital, Cameroon.

BACKGROUND: It is believed that the current prevalence of malaria in endemic areas reflects selection for the carrier form of sickle cell trait through a survival advantage. Malaria has been incriminated as a great cause of mortality in people with sickle cell disease (SCD). However, people with SCD, a high-risk group, do not benefit from free or subsisized malaria prevention and treatment in Cameroon unlike other vulnerable groups which may be due to insufficient evidence to guide policy makers. This study aimed at describing clinical and socio-demographic characteristics of patients with malaria, determining the prevalence of malaria in hospitalized children and in those with SCD and without, compare frequency of presentation of malaria related complications (using clinical and laboratory elements that define severe malaria) between children admitted for malaria with SCD and those without and finally, determing the risk factors for death in children admitted for malaria. METHODS: This was a retrospective analysis of admission records of children age 1 to 18 years with a confirmed malaria diagnosis admitted at the Laquintinie Hospital during January 2015 through December 2018. Clinical features, laboratory characteristics and outcome of malarial infections, stratified by SCD status were studied. Patients with HIV infection, malnutrition, renal failure and discharged against medical advice were excluded from the study. Data were analysed using Epi-info 7 software and analysis done. Chi square test, Odds ratios, CI and student's t test were used to determine association between variables. Statistical significance was set at p-value ≤0.05. RESULTS: The prevalence of malaria was lower among children with SCD than it was among children without SCD (23.5% vs 44.9%). Similarly, among those with a positive microscopy, the mean parasite density was significantly lower among children with SCD than it was among children without SCD (22,875.6 vs 57,053.6 parasites/ µl with t-value - 3.2, p-value 0.002). The mean hemoglobin concentration was lower in SCD as compared to non SCD (5.7 g/l vs 7.4 g/l, t-value - 12.5, p-value < 0.001). Overall mortality in SCD was 3.4% and malaria was reponsible for 20.4% of these deaths as compared to the 35.4% in non SCD patients. Convulsion and impaired consciousness were significantly lower in SCD group (OR:0.1, CI: 0.1-0.3, p value < 0.01 and OR:0.1, CI:0.1-0.2, p-value < 0.001 respectively). Death was significantly higher in SCD patients with malaria as compared to SCD patients admitted for other pathologies (3.2% vs 1.5%., OR:2.2, CI:1-5, p-value 0.050). CONCLUSION: The SCD population has a lower mortality related to malaria compared to the non-SCD population. Meanwhile, within the SCD population, those admitted with malaria are twice more likely to die than those admitted for other pathologies. Jaundice, hepatomegaly and splenomegaly were common in SCD with malaria, however no risk factors for malaria severity or malaria related death was identified.

Predictors of mortality of pediatric burn injury in the Douala General Hospital, Cameroon.

INTRODUCTION: Burn injuries are a major cause of hospitalization and are associated with significant morbidity and mortality, particularly in children aged four years or below. In Cameroon, the mortality rate of pediatric severe burns was estimated at 41.2%. There is need to determine the predictors of such mortality in order to guide appropriate management. METHODS: This study is aimed at assessing the predictors of mortality of pediatric patients who sustained a burn injury over a period of 11 years (between 1st of January 2006 and 31st of December 2016) in Douala General Hospital (DGH). The data for this study was entered in an electronic questionnaire and analyzed using Epi info version 7. All variables thought to be associated with mortality were entered in a multiple binary logistic regression model. The magnitude or risk was measured by odds ratio, and the 95% confidence interval was estimated. RESULTS: A total of 125 cases of pediatric burns were recorded over the study period. A total of 69 (55.65%) were males, giving a male to female ratio of 1.25:1. The median age was 4 years. Most pediatric burns resulted from accidents. Most patient 78 (69%) came before 8 hours following injury. Scalding was the predominant mechanism of injury in 56 (45.5%) of patients. Most patients had partial thickness burn and most burns involved 1-9.9% body surface areas (BSA). The mean length of hospital stay in this study was 7 days, more than half of the patients had no complications during admission. Among those that developed complications, 19 (35%) developed sepsis. CONCLUSION: Mortality rate of pediatric burns obtained in this study was 29%, mostly due to cardiac arrest. Flame burns (p=0.03) and BSA >25% (p=0.001) were statistically significant predictors of mortality.

Management of face presentation, face and lip edema in a primary healthcare facility case report, Mbengwi, Cameroon.

Face presentation is a rare obstetric event and most practitioners will go through their carriers without ever meeting one. Face presentation can be delivered vaginally only if the foetus is in the mentum anterior position. More than half of the cases of face presentation are delivered by caesarean section. Newborn infants with face presentation usually have severe facial oedema, facial bruising or ecchymosis. These syndromic facial features usually resolved within 24-48 hours.