[Seroprevalence of hepatitis B and C viruses, HIV-1/2 and syphilis among blood donors in the Yaoundé Central Hospital in the centre region of Cameroon]. / Séroprévalence des virus des hépatites B et C, du VIH-1/2 et de la syphilis chez les donneurs de sang de l'hôpital central de Yaoundé, région du centre, Cameroun.

OBJECTIVES: Prevention of blood transfusion-transmitted infections includes blood donor screening and effective infectious markers screening for donated blood. This study had two main objectives: to determine seroprevalence of HBV, HCV, HIV and syphilis in blood donors of the Yaoundé Central Hospital and to study sociodemographic factors of blood donors. PATIENTS AND METHODS: A retrospective study of consecutive blood donors' records from January to December 2013 was conducted. Seroprevalence of hepatitis B, hepatitis C, human immunodeficiency viruses and syphilis were determined in 9024 whole blood donations collected in the Yaoundé Central Hospital in the centre region, Cameroon using Elisa kits. RESULTS: Mean age of donors was 28 years. The male to female ratio was 14.8. Most of blood donors were replacement donors (97.2%) and first-time donors (76.8%). Up to 19.3% of the donors tested positive for at least one infectious agent, in which 0.1% presented a positive test for three viruses (HIV, HCV and HBV). The overall seroprevalence in blood donors was 12.6% for HBsAg, 3.2% for hepatitis C antibody, 3.3% for HIV-1/2 antibodies and 0.2% for syphilis. The prevalence of HBsAg was significantly higher in men (P=0.001), among first-time donors (P=0.003), in blood group A (P=0.01) and those with the rhesus positive blood (P=0.01). The prevalence of anti-HCV was significantly higher among first-time donors (P=0.05). The prevalence of anti-HIV was significantly higher in first-time donors (3.7% vs 2.2%, P=0.02). CONCLUSION: First-time blood donors and replacement donors are the two types of donors in Cameroon. Replacement donors are considered as having a major risk of transmission of infections to recipients. The seroprevalence of HIV, HBV, HCV, and syphilis among these donors is high and reflects how much these agents are present in Cameroon. Effective infectious markers screening and organization of blood donors into an association of volunteer's donors are necessary to secure blood transfusion in Cameroon.

[Risk factors associated with gastroduodenal lesions in a Douala referral hospital (Cameroon)]. / Facteurs de risques associés aux lésions gastroduodénales dans un hôpital de référence à Douala (Cameroun).

INTRODUCTION: The causes of gastroduodenal lesions are multifactorial, and few studies have assessed the impact of each of these factors in Africa. The aim of this study was to identify factors associated with the occurrence of gastroduodenal lesions in Cameroon. METHOD: This prospective, analytical study took place over a 5-month period in the endoscopy unit of the Douala General Hospital. Lifestyle, medical history, demographic, and clinical variables were collected. Infection with Helicobacter pylori was determined with a rapid urease (CLO) test. Multivariate regression was used to determine risk factors. RESULTS: The study included 234 of 265 patients seen in the department over the study period. Gastroscopy was normal for 54.2% of the subjects. The prevalence of peptic ulcers was 17.1% and of inflammatory lesions 26.4%. Risk factors associated with a gastroduodenal lesion were: age greater than 60 years [OR age = 2.953; 95% CI: 1.399 to 6.231; p = 0.004], H. pylori infection [OR = 2.953; 95% CI: 1.399 to 6.231; p = 0.003] and regular NSAID use [OR = 0.912; 95% CI: 0.112 to 2.733; p = 0.044] either a month before the examination or over the long term. CONCLUSION: Age greater than 60 years, NSAID consumption, and H. pylori infection are associated with the occurrence of gastroduodenal lesions.

Analyse démographique et endoscopique des patients atteints d'ulcère gastroduodénal à Yaoundé au Cameroun : qu'est ce qui a changé depuis les années 1990 ?

Objectif : La prévalence de l'ulcère gastro-duodénal semble être en diminution marquée ces dernières années dans les pays africains. Au Cameroun en 1990, elle était de 32%. L'objectif de notre étude était d'évaluer l'évolution de la prévalence de l'ulcère gastroduodénal et d'identifier ses caractéristiques démographiques et endoscopiques à Yaoundé, 25 ans après.Patients et méthodes : Etude rétrospective de la période allant du 1er janvier 2011 au 31 décembre 2014 dans trois hôpitaux universitaires de Yaoundé. Les comptes rendus d'endoscopie de 4685 patients consécutifs référés pour une endoscopie digestive haute ont été réexaminés. Nous avons inclus 489 patients (312 hommes et 177 femmes) avec un ulcère gastro-duodénal prouvé en endoscopie. Les données démographiques et endoscopiques ont été recueillies. Résultats : L'ulcère duodénal et l'ulcère gastrique étaient identifiés respectivement chez 295 (60,3%) et 157 (32,1%) patients, la double localisation gastrique et duodénale chez 37(7,6%), faisant une prévalence globale de 10,4%. L'âge moyen des patients était de 48,9 ans (extrêmes : 4 à 90 ans). Les patients ulcéreux gastriques étaient relativement plus âgés que les patients ulcéreux duodénaux (54,4 ans vs. 45,4 ans, p < 10-5). Le ratio homme/femme était de 2,2/1 pour l'ulcère duodénal et 1,2/1 pour l'ulcère gastrique. La prévalence globale de l'infection à H. pylori à l'histologie et/ou au test rapide à l'uréase était de 63,0% (308/489). L'infection était plus fréquente dans l'ulcère duodénal que gastrique (67,8% vs. 51,0%, p = 0,0005). L'ulcère gastro-duodénal était révélé par les épigastralgies (71,8%) et l'hémorragie (31,5%). L'hémorragie était liée à l'ulcère duodénal (p = 0,07) et au sexe masculin (p = 0,01). Il n'y avait pas de différence significative selon l'âge (p = 0,16). H. pylori protégeait contre l'hémorragie, risque relatif 0,7 (IC à 95% : 0,6-0,8 ; p = 0,00006).Conclusion : La prévalence de l'ulcère gastroduodénal a significativement diminué au Cameroun par rapport à 1990. Les patients ulcéreux sont devenus plus âgés avec une tendance à l'occidentalisation de la maladie ulcéreuse

Hepatite B chronique à antigene Hbe negative à Yaoundé, Cameroun

OBJECTIFS. L'hepatite B chronique a antigene HBe (AgHBe) negatif est associee a un mauvais pronostic et a un taux de reponse soutenue au traitement antiviral faible. Notre etude avait pour but de determiner les aspects epidemiologiques de l'hepatite B chronique a AgHBe negatif a Yaounde; centre de reference du traitement des hepatites chroniques au Cameroun. PATIENTS ET MeTHODES. De 2004 a 2012; 315 patients consecutifs porteurs chroniques de l'AgHBs ont ete enregistres. Les analyses serologiques ont ete effectuees en utilisant des kits commerciaux ELISA pour detecter l'AgHBs; les anti-HBc totaux; l'AgHBe; les anti-HBe; l'anti-delta et les anti-VHC. Les taux d'ADN VHB ont ete mesures par la technique COBAS Ampliprep (Roche). Les tests biochimiques pour le calcul du fibrotest/actitest ont ete realises avec l'automate COBAS (Roche). La prevalence de l'hepatite B chronique a AgHBe negatif; les donnees demographiques; l'association entre le taux d'ADN VHB et les dommages hepatiques ont ete explorees. ReSULTATS. La prevalence de l'hepatite B chronique a AgHBe negatif etait de 92;1%(290/315) [IC a 95% 88;4-94;7]. Le sexe ratio H/F etait de 2;8. Les transaminases ALAT etaient normales chez 67;2% (195/290) de patients. La cirrhose existait chez 6;1% (8/132). La viremie mediane etait de 1140 UI/ml; 70;3% (166/236) avaient un ADN VHB = 2000UI/ml et 20;3%(48/236) un ADN VHB indetectable. Aucune association statistiquement significative n'a ete notee entre le taux d'ADN VHB et l'age; le taux de transaminases ALAT ou la cirrhose. CONCLUSION. L'hepatite B chronique a AgHBe negatif est la forme predominante au Cameroun. Cette particularite souleve le probleme de la prise en charge therapeutique vu son mauvais pronostic

Indications, résultats et rendement de la coloscopie dans un environnement économique défavorable: le cas du Cameroun

OBJECTIF : le rendement diagnostique de la coloscopie dépend de plusieurs facteurs, notamment les indications. La pertinence de ces indications est influencée par l'environnement économique et les structures locales. Le but de notre étude était d'analyser les indications et les résultats des coloscopies, et d'évaluer leur rendement diagnostique afin de juger de la pertinence de ces indications. MATÉRIELS ET MÉTHODES : un recueil rétrospectif de données de coloscopies réalisées de janvier 2001 à juin 2011 dans trois hôpitaux universitaires de Yaoundé a été effectué. Les variables enregistrés étaient l'âge, le sexe, les indications et les résultats. RÉSULTATS : un total de 908 protocoles de coloscopie ont satisfait à nos critères de sélection (dont 622 hommes (68,5%)). L'âge médian était de 48 ans (IQR 36-59 ans). Les indications principales étaient les rectorragies 281 patients (30,9%), les douleurs abdominales 267 patients (29,4%) et les diarrhées chroniques 107 patients (11,8%). L'examen était normal 451 fois (49,7%). Les lésions retrouvées étaient les polypes colorectaux 110 cas (12,1% ; IC 95% : 10,1-14,5), les hémorroïdes 104 cas (11, 5% ; IC 95% : 9,5-13,7), la diverticulose 71 cas (7,8% ; IC 95% : 6,2-9,8) le cancer colorectal 64 cas (7,0% ; IC 95% : 5,5-9,0) et les colites 64 cas (7,0% ; IC 95% : 5,5-9,0). Le rendement diagnostique de la coloscopie pour le cancer colorectal selon les indications était élevé en cas d'image radiologique suspecte (27,7%), de masse abdominale (25%) et d'anémie ferriprive (22,2%). les douleurs abdominales et/ou TFI non accompagnées de perte de sang macroscopique ou occulte, la constipation et le dépistage du cancer colorectal avaient un rendement faible. CONCLUSION : le rendement diagnostique de la coloscopie dans la détection des principales lésions coliques n'est pas différent dans un environnement économique défavorable malgré les indications peu pertinentes. Les symptômes digestifs avec une valeur prédictive positive élevée pour le diagnostic de cancer colorectal sont retrouvés. Les polypes et les hémorroïdes constituent les principales lésions colorectales au Cameroun. Le cancer colorectal a une prévalence élevée et inattendue méritant notre attention

[Lipodystrophy and echographic hepatic steatosis in HIV-positive patients under highly active antiretroviral therapy (HAART) in Yaounde (Cameroon)]. / Lipodystrophie et stéatose hépatique échographique chez les patients VIH positifs sous multithérapie antirétrovirale (ARV) à Yaoundé (Cameroun).

The association between sonographic liver steatosis and clinical lipodystrophy in AIDS patients treated by highly active antiretroviral therapy (HAART) has been studied. We conducted a cross-sectional study reviewing medical files of 117 AIDS patients followed up in Yaounde, Cameroon (6.3 F/1 M, mean age = 40 ± 9.4 years), and treated the patients with HAART protocol comprising stavudine or zidovudine for at least six months. All participants underwent abdominal ultrasonography and anthropometric assessment including body mass index (BMI). Data analysis included determining the association between sonographic liver steatosis, clinical lipodystrophy, and other clinical and biological data using the ¢(2) test, and the calculation of odd ratio. Fifty-one patients presented clinical lipodystrophy. The sonographic prevalence of hepatomegaly and splenomegaly was 70.1% and 25.6%, respectively. The overall prevalence of sonographic steatosis was 28.2%; specifically 37.3% among lipodystrophic patients and 21.1% among nonlipodystrophic patients (P = 0.03). According to the type of lipodystrophy, the prevalence was 40.6% among lipohypertrophic patients, 38.5% among lipodystrophic patients, and 16.7% among lipoatrophic patients. Clinical lipohypertrophy was statistically associated with a higher prevalence of sonographic steatosis (odd ratio = 2.5; 95% CI: [1.01-6.39], and P = 0.04). HAART protocol including stavudine was associated with lipodystrophy. The prevalence of sonographic liver steatosis is high among AIDS patients under HAART and is associated with lipohypertrophy.

[Gallbladder kinetics in the black African subject with and without cholelithiasis. An ultrasonographic study]. / La vidange vésiculaire chez le sujet noir africain avec et sans lithiase. Une étude ultrasonographique.

PURPOSE: Gallbladder hypomotility could play a significant role in the process of lithogenesis, but this role has yet to be defined in black African populations. This role was assessed by measuring gallbladder emptying after stimulation by a fat meal in a group of black African subjects with and without cholelithiasis. MATERIALS AND METHODS: Fifteen subjects with cholelithiasis and thirty controls divided in two pools were studied. Gallbladder emptying was stimulated by fat meals of 610 and 740 Kcal, and was measured with ultrasound for a period of 120 min. RESULTS: The mean fasting gallbladder Volume of the subjects with lithiasis was significantly superior to that of the controls. Compared to what has been previously published in Caucasian subjects, gallbladder emptying was generally more rapid in our study. Further more, gallbladder emptying was significantly better in the control group than in the group of subjects with cholelithiasis. Two groups of subjects with cholelithiasis were isolated. The first group had poor gallbladder emptying and normal fasting gallbladder Volume; the second had normal gallbladder emptying but significantly increased fasting gallbladder Volume. CONCLUSION: Impaired gallbladder emptying and/or increased fasting gallbladder Volume probably play a role in lithogenesis. Hypomotility seems to play a significant role only for those subjects with normal fasting gallbladder Volume.

[Developing cancer from a probable misdiagnosed pancreatic cystadenoma]. / Cancérisation d'un probable cystadénome pancréatique méconnu.

This paper reports the malignant transformation of a benign pancreatic cyst treated by internal drainage in a 30-year-old woman. The initial lesion was diagnosed on surgical biopsy of the cyst wall. The diagnosis of pancreatic carcinoma was made after one year of satisfactory course, by fine needle cytologic aspiration of the fibrous retraction of the cyst; at that time the patient had severe pancreatic pain with multinodular liver on ultrasonography. The conclusion is the recommendation of total excision of pancreatic cysts whenever the diagnosis is incomplete or imprecise.

[Postoperative necrotizing fasciitis in infants. Apropos of a case]. / Fasciite nécrosante post-opératoire chez le nourrisson. A propos d'un cas.

A case of postoperative necrotizing fasciitis after a right incarcerated inguinal hernia repair is reported in a six week old baby hospitalized in the paediatric surgical unit of the Yaounde General Hospital. Treatment consisted in a medical reanimation, surgical debridement and an appropriate antibiotherapy. Medical literature was reviewed and therapeutic indications discussed.

[Late exterioration of a postoperative cecal fistula in children. Apropos of a rare clinical case]. / Fistule caecale postopératoire tardivement extériorisée chez l'enfant. A propos d'une observation clinique rare.

The authors report a rare clinical observation of a post-appendectomy caecal fistula retardedly exteriorized, in a 18 year old adolescent, managed in the surgical service of the Yaounde General Hospital. The radical treatment was surgical and consisted in right hemicolectomy. Literature was reviewed and therapeutic indications discussed.

[Periportal fibrosis in Schistosoma mansoni schistosomiasis. An ultrasonographic study in the area of Nkolbisson (Cameroon)]. / Fibrose périportale dans la schistosomiase à Schistosoma mansoni. Une étude ultrasonographique dans le foyer de Nkolbisson (Cameroun).

PURPOSE: The appearance of Symmers' periportal fibrosis (SPF) is considered a major event in the natural history of Schistosoma mansoni infection, because of the risk of portal hypertension and subsequent intestinal hemorrhage. Ultrasonography has been found useful in the assessment of this lesion. We undertook the present study to determine the prevalence of SPF in Nkolbisson (near Yaoundé), where previous studies had shown Schistosoma mansoni infection to be endemic. METHODS AND MATERIALS: 147 patients more than 15 years old (mean age: 32 years) were prospectively studied during a 3 month period. 107 subjects (51 male, and 56 female) were excreting Schistosoma mansoni eggs in the stools (mean egg output = 336 egg/g), and 40 controls had a negative stool exam. A medical history, a physical examination, and an abdominal ultrasound examination were performed on each subject. The degree of SPF was graded according to Homeida's scale. RESULTS: 39 Subjects (24 male, 15 female) with positive stool examination had SPF giving a prevalence rate of 37%, while it was found to be 5% for controls. 28 patients had mild fibrosis (grade I), 7 patients had moderate fibrosis (grade II), and 4 patients had severe fibrosis (grade III). Higher prevalence rates of SPF were associated with longer duration of infection and very high egg outputs (> 1,000 egg/g). The positive predictive value of hepatomegaly or splenomegaly for the presence of SPF was 0.52, and the negative predictive value 0.69. CONCLUSION: We conclude that SPF affects a significant proportion of infected patients and ultrasonography is a valuable tool in the study of this lesion in our patients.

[Value of rectoscopy in the diagnosis of Schistosoma mansoni bilharziasis. Study at Nkolbisson-Cameroon]. / Intérêt de la rectoscopie dans le diagnostic de la bilharziose a Schistosoma mansoni. A propos d'une étude réalisée à Nkolbisson--Cameroun.

The aim of this study was to investigate endoscopically and histologically rectal mucosa complications in bilharzia patients. Coprology using KATO's technique was carried out in 1406 school children aged 4 to 18 years. 134 (9.53%) were infested. Among the infested school children and the sample population, a random selection of 80 school children (40 infested and 40 of sample population) was made, in whom rectoscopy and biopsy of rectal mucosa were carried out. The lesions found were classified on endoscopic and histologic basis. The prevalence of the disease 9.53% appears to be in constant regression. Inflammatory lesions are more common in bilharzia patients. Histology facilitated the unveiling of a specific rectitis in 72.5% bilharzia patients and 12.5% of the sample population. This study confirm the effectiveness of the several bilharzia eradication campaigns carried out in the Nkolbisson area. Rectoscopy with biopsy of the rectal mucosa should be reserved to symptomatic patients, in whom many coprologies have turned out negative.

[Transvaginal ultrasonography in the diagnosis of abnormal uterine bleeding in women of reproductive age. Comparison with transvesical ultrasonography]. / L'échographie endovaginale dans le diagnostic des saignements utérins anormaux de la femme en activité génitale. Comparaison avec l'échographie transvésicale.

We undertook this study to compare the diagnostic value of endovaginal sonography and transvesical sonography in the diagnosis of abnormal uterine bleeding in reproductive age women in Yaoundé (Cameroon). 130 consecutive patients were included in this prospective study. Inclusion criteria were the presence of a missed period and abnormal uterine bleeding, absence of local or vaginal lesion on speculum examination, and the performance of transvaginal and transabdominal sonography within 12 hours. The results of each technique were compared for image quality and diagnostic information. The diagnoses included ovarian cyst (33), abnormal intra-utérine pregnancy (22), ectopic gestation (14), endometrial abnormality (14), fibroids (11), normal intra-uterine pregnancy (4), appendicitis (1), no abnormality (12). Transvaginal sonogram was of better image quality in 108 patients (83.1%). It provided more diagnostic information in 99 patients (76.1%). For 38 patients (29.2%), it provided pertinent information which altered the diagnosis made after transvesical sonography. Our results suggest that endovaginal sonography should be considered the first sonographic technique to use for reproductive age patients with abnormal uterine bleeding in Yaoundé (Cameroon).

[Solitary extra-osseous ovarian plasmacytoma. Apropos of an unusual case in a 12 year old child]. / Le plasmocytome solitaire extraosseux ovarien. A propos d'un cas exceptionnel chez une enfant de 12 ans.

A rare case of extramedullary or solitary ovarian plasmocytoma in a 12 years old patient is reported. Surgery consisted of left adnexectomy associated with omentectomy. Chemotherapy with abdomino-pelvic iradiation were effectuated afterwards. Review of literature and therapeutic indications are discussed.

[Morbidity and histo-endoscopic study of Schistosoma mansoni bilharziasis in Nkolbisson (Cameroon)]. / Morbidité et étude histo-endoscopique de la bilharziose a Schistosoma mansoni a Nkolbisson (Cameroun).

This study confirms the efficiency of bilharzia eradication campaigns at Nkolbisson. The authors recommend rectal mucosa biopsy of symptomatic patients in whom several investigations have turned out negative.

[Screening of hepatocellular carcinoma in the middle of a high risk population in Cameroon]. / Dépistage du carcinome hépatocellulaire au sein d'une population de sujets à haut risque au Cameroun.

We undertook a prospective study of cancerous lesions of the liver in 163 patients (136 males and 27 females) considered to be on high risk. These patients were, healthy carriers of HBs Antigen (n = 70), had chronic hepatitis (n = 45) or cirrhosis (n = 48). The screening was done from two main tests: liver ultrasound and blood alphafoetoprotein. Amongst the 163 patients, malignancy was diagnosed in 29 (22 males and 7 females) giving a prevalence of 17.8 percent: 9 cancers were diagnosed in the group with chronic hepatitis (20 percent), 20 in the group with cirrhosis (41.6 percent) and none in the group of healthy carriers. These results show that in Cameroun, cirrhosis is the most frequent abnormality associated with development of hepatocarcinoma. Thus the strategy against liver cancer should be oriented towards two main objectives; vaccination of children after eliminating healthy carriers and a regular follow-up of patients at risk.

[Chronic pancreatitis in Cameroon. Analysis of etiological and clinical aspects]. / Pancréatites chroniques au Cameroun. Analyse des aspects étiologiques et cliniques.

In a collection of 3,571 patient's files admitted in the University Teaching Hospital and the Yaounde General Hospital, we studied 27 patients suspected of chronic pancreatitis. 20 patients with calcified chronic pancreatitis benefited from a detailed history, physical examination and a complete paraclinical work-up. From the data collected, chronic alcoholism seemed to have been the main aetiology. Industrial beer from barley alone and/or associated with other traditional liquors was most consumed. The majority of patients were heavy alcoholics and daily consumption varied from 75 to 124 g of pure alcohol. The natural history of the disease and physical examination were identical to that observed in the western countries. Associated pathology was observed in 10% of the patients. This included peptic ulcer disease, cirrhosis and bile stones. Complications included diabetics, obstructive jaundice, and malabsorption syndrome. As a conclusion, chronic pancreatitis is a pathology whose prevalence seems to be progressing constantly.

[Diagnostic value of abdominal echography in cirrhosis of the African black. A study of 99 cases]. / Valeur diagnostique de l'échographie abdominale dans la cirrhose du noir africain. Une étude de 99 cas.

We reviewed sonographic findings and evaluated the impact of conventional ultrasound (US) in the management of 99 consecutive black africans with liver cirrhosis. Patients were studied in the University teaching Hospital of Yaoundé (Cameroon). There were 73 males and 26 females, with a mean age of 49 years (range 15 to 71 years). 90 p. cent patients presented with symptoms suggestive of liver disease. The commonest sonographic liver abnormalities were: echo coarseness with poor depiction of intrahepatic vessels, irregularity of the liver surface, hypertrophy of caudate lobe, hepatomegaly, and decreased beam penetration through the liver. Ascitis and other signs of portal hypertension were present respectively in 44 p. cent and 33 p. cent of subjects. 15 p. cent of subjects had hepatocellular carcinoma. Choletithiasis was seen in 6 subjects (6%), and chronic pancreatitis in 3 patients (3 p. cent). For 21 patients (21 p. cent), US depicted significant abdominal disease which was not clinically suspected, and for 10 patients (10 p. cent), it discovered silent liver cirrhosis. Our findings suggest that conventional US may be a useful tool in the management of some black african subjects with liver cirrhosis.

Hepatocellular carcinoma in Cameroon : sonographic findings and clinical outcome : a study of 72 cases in the University Teaching Hospital; Yaounde; Cameroon

Sonographic findings and clinical outcome of 72 consecutive patients with hepatocellular carcinoma (HCC) in the Yaounde University Teaching during a period of 20 months are reviewed. The purpose of the study was to assess the sonographic pattern and natural history of HCC in Cameroon. The diagnosis was established by fine needle biopsy; or by a combination of clinical features; elevated serum alphafoetoprotein and sonographic findings. There were 55 males and 17 females. Fifty-five (76 per cent) patients presented with hepatomegaly. Three types of HCC were found : nodular; diffuse and mixed. Twenty-two patients had significant ascites. A thrombus in a major portal vein was present in 19 patients. Ten had secondary lesions on presentation. Only one patient was operated on; but the tumour was not resectable