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Management and Outcome of Urethral Strictures at Two Tertiary Health Facilities in Cameroon

Open Journal of Urology 2024年第8期14卷 435-446页

作者： Martin Divine Mokake Divine Enoru Eyongeta Ekani Mahamat Ekani Diana Nunga theophile chunteng nana Ntungwetape Ngwane Mwambo Nalova Elroy Patrick Weledji Chichom Alain Mefire Marcellin Ngowe Ngowe Department of Surgery and Specialties Faculty of Health Sciences University of Buea Buea Cameroon Department of Surgery Regional Hospital Buea Buea Cameroon Department of Surgery Regional Hospital Limbe Limbe Cameroon Department of Surgery Douala General Hospital Douala Cameroon

Introduction and Objectives: Urethral stricture is a reduction in the caliber of the urethral lumen impeding the outflow of urine. It predominantly affects males. The disease burden is severe in our milieu where access to specialized care is limited. Our goal was therefore to assess the management and outcome of male urethral stricture at two tertiary hospitals in Douala, Cameroon. Materials and Methods: This was a hospital-based retrospective study of patients managed for urethral stricture over 5 years (January 1st, 2017 to December 31st, 2021) at the Douala General and Laquintinie Hospitals. Data on sociodemographic, clinical, paraclinical, and treatment options were extracted using pre-structured forms. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 28. Statistical significance was set at p-value Results: We exploited 130 medical records. The mean age of patients was 46.5 years. Dysuria and weak urine stream were the major presenting complaints (63.8% and 23.8% respectively). The etiology of urethral stricture was iatrogenic in 42.3% of cases. The strictures were mostly single (89.8%), and the bulbar urethra was most affected (46.9%). 28 patients had urinary tract infections and the most frequently isolated germ was E. coli in 29.6%. Direct visual internal urethrotomy (DVIU) was performed in 42.3% of cases. Surgery, especially excision and primary anastomosis (EPA) was done in 28.5% of cases. Major complications were wound infection, acute kidney injury (AKI), and urethrocutaneous fistulae affecting 3.1, 2.3, and 1.5% of cases respectively. The recurrence rate was 17% with a mortality rate of 0.08%. Conclusion: Urethral stricture is common in our adult male population. The cause is mainly iatrogenic and the bulbar urethra is most affected. Minimally invasive and open reconstruction are frequently used treatment options with significant recurrence rates in the long term.

关键词： Urethral Stricture Management Outcomes

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A Retrospective Analysis of the Patterns and Outcomes of Tile B and Tile C Pelvic Fractures in Cameroon

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Open Journal of Orthopedics 2023年第4期13卷 157-167页

作者： chunteng theophile nana Tsiagadigui Tsiagadigui Jean Gustave Ngo Yamben Marie-Ange Batchom Daudet Bombah Freddy Muluem Kenedy Mokake Divine Ngomba Ekani Boukar Mahamat Ali Mahamat Takou Bougoue Andre Gaetan Simo Wambo Tagakou Mboula Christian Fotso Ndasi Henry Pius Fokam Department of Surgery Faculty of Health Sciences University of Buea Buea Cameroon Department of Surgery and Specialties Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon Department of Surgery and Specialties Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon

Background: Pelvic fractures constitute about 2% - 8% of all fractures. This incidence may rise up to 25% in poly-traumatised patients. These fractures have a high mortality rate due to the fact that they occur usually as a result of high energy trauma, and most of the injured are poly-traumatised with concomitant haemodynamic instability. The aim of this study is to describe the patterns of injury and complications of unstable pelvic fractures treated in a level III hospital in Cameroon. Methodology: This was a hospital based retrospective analysis of files of patients admitted and treated for unstable pelvic fractures at the Regional Hospital Limbe within a period of 10 years (from 1st of January 2009 to 31st of December 2018). Results: A total of 139 cases of pelvic fractures were identified, amongst which 77 were unstable;68 were finally analyzed. The ages ranged from 18 to 80 years with a mean of 39 ± 5 years. The age group from 20 - 40 years was most represented (58.88%, n = 40). There were 45 males and 23 females giving a sex-ratio of 2:1. Road traffic injuries accounted for most of the cases (73.53%, n = 50). Forty-five (66.2%) were classified Tile B and 23 (33.82%) were Tile C, and 15 cases were open fractures (22.06%). Associated lesions were recorded in 30 cases, fractures of the lower extremity being the most common (33.33%, n = 10). Most of the cases were definitively treated surgically (80.89%, n = 55). The most common complications were surgical site infections (23.64%, n = 13). Conclusion: Unstable pelvic fractures are relatively common. Young males in the age group 20 - 40 years are the most affected, and the most common cause of injury was road traffic accident. Surgical site infections, pressure ulcers, severe anaemia and thrombo-embolism are common complications.

关键词： Unstable Pelvic Fracture Patterns Complications Cameroon

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Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting

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Open Journal of Orthopedics 2024年第4期14卷 173-186页

作者： Loïc Fonkoue Gaspary Fodjeu Kennedy Olivier Muluem Olivier Ngongang theophile nana Marie Ange Ngo Yamben DésiréAkaba Urich Tambekou Daniel Eone Handy Department of Orthopaedics and Trauma Yaound&#233 General Hospital Yaound&#233 Cameroon. Department of Surgery and Specialities University of Yaound&#233 1 Yaound&#233 Cameroon Department of Orthopaedics and Trauma Yaound&#233 Emergency Center Yaound&#233 Cameroon Department of Orthopaedics and Trauma Yaound&#233 Central Hospital Yaound&#233 Cameroon

Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas o

关键词： Proximal Femoral Fracture Watson-Jones Approach Dynamic Hip Screw Low Resource Setting

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Chronic Lymphoedema and Bone Infarction: Rare Complications of Multiple Segmental Fractures of the Lower Limb in a Young Adult

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Open Journal of Orthopedics 2022年第3期12卷 79-84页

作者： Ngo Yamben Marie-Ange nana chunteng theophile Nseme Etouckey Eric Muluem Kennedy Olivier Tsiagadigui Tsiagadigui Jean Gustave Ndongo Mvela Laurent Stephane Manga Alexandre Guifo Marc Leroy Faculty of Medecine and Biomedical Sciences Department of Surgery and Specialities University of Yaounde 1 Yaounde Cameroon National Center of Rehabilitation of Disabilities Persons Yaounde Cameroon Faculty of Health Sciences Department of Surgery University of Buea Buea Cameroon Teaching Hospital of Yaounde Yaounde Cameroun

Multiple segmental fractures of the lower limbs, common in developing countries, are the prerogative of Road Traffic Accidents (RTA) involving two-wheeled vehicles. Their management is difficult, associated with complications, and is most often based on a two-stage strategy: Damage Control Orthopaedics, followed by delayed internal osteosynthesis. The aim is to allow early functional rehabilitation and rapid recovery of patients. We report the case of a 39-year-old man, bike rider, after his RTA, presented with segmental homolateral fractures of the femur and two bones of the left leg. Short-term evolution was marked by the appearance of significant lymphedema and bone infarctions of the lower left limb necessitating a transfemoral amputation. Through this observation, the authors highlight the problems related to the complexity of the management of multiple segmental fractures of the lower limb by emphasizing two post-traumatic complications rarely described but to be feared: chronic lymphedema and bone infarction.

关键词： Lymphœdema Multiple Fractures Bone Infarction Amputation Damage Control Orthopaedic

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Quality of Life Following Major Limb Amputations in a Rural Community in Cameroon

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Open Journal of Orthopedics 2022年第3期12卷 97-112页

作者： nana theophile chunteng Ngo-Yamben Marie-Ange Bombah F. Mertens Wamba Y. Jeazet Andrew Eyoh Edjua Ekani Boukar Mahamat Muluem Kennedy Manga Alex Assob Clement Department of Surgery Faculty of Health Sciences University of Buea Buea Cameroon Department of Surgery and Specialties Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Department of Surgery and Specialties Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Journalism and Mass Communication Faculty of Social and Management Sciences University of Buea Buea Cameroon

Background: Limb amputation is considered the last resort when the limb is no longer salvageable or when the limb is dead or dying, viable but nonfunctional or endangering the patient’s life. It is associated with profound economic, social, and psychological effects on the patients. The aim of this study is to evaluate the quality of life of major limb amputees in a rural setting in western Cameroon. Methods: This was a cross-sectional descriptive and analytical study carried out at the BATSENGLA-DSCHANG community in the West Region of Cameroon. Participants were interviewed and data collected using a pre-defined accredited questionnaire of the WHOQOL-BREF to assess the quality of life. Results: There were 63 participants, and a majority (60.32%) reported trauma as the cause of amputation. Participants with prostheses had a better quality of life. Conclusion: The age range of the study participants was 18 to 85 years with a mean of 46.73 ± 18.31 years. The majority were males (74.6%). Most of them (41.27%) had attained at least a secondary level of education, a majority (80.95%) were unemployed and more than half (55.56%) have less than the guaranteed inter-professional minimum wage. Major limb amputations were mostly due to traumatic causes (72%) and involved the lower limbs. Only a few (12.70%) used prostheses. Almost all of them (90.48%) had symptoms consistent with a phantom limb. The quality of life after major limb amputation in this study was generally fair according to the WHO quality of life tool.

关键词： Amputation Limbs Phantom Limb Prosthesis Quality of Life

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Obstetric Brachial Plexus Palsy of Newborns and Infants: Functional Outcomes after Rehabilitation by Their Own Parents

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Open Journal of Orthopedics 2022年第4期12卷 212-224页

作者： Ngo Yamben Marie-Ange Manga Alexandre Muluem Kennedy Mvondo Obama Serge Arnaud Nseme Etouckey Eric nana chunteng theophile Tsiagadigui Tsiagadigui Jean-Gustave Mosoh Franklin Muluh Mbassi Awa Ibrahima Farikou Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaounde Cameroon National Centre for the Rehabilitation of Persons with Disabilities in Yaoundé Yaounde Cameroon Yaoundé General Hospital Yaounde Cameroon Faculty of Health Sciences University of Buea Cameroon Mother-Children Center of the Chantal Biya Foundation of Yaoundé Yaounde Cameroon

Introduction: Obstetric palsy of the brachial plexus (OPBP) is a paralytic lesion common to obstetric trauma, whose clinical presentation varies according to the severity and extent of the root lesions at birth. Early and appropriate rehabilitation is necessary in order to improve the functional prognosis of the injured limb. Under special conditions, parents could carry out this physiotherapy themselves. Objective: The aim of this work was to assess limb functional recovery in newborns and infants with OPBP after rehabilitation by their parents. Patients and Methods: We conducted a prospective study at the NCRDP in Yaoundé over a period of 18 months. We included all patients aged 0 to 2 years with OPBP, isolated or associated with other lesions and followed at least two (02) years at the NCRDP. Results: We recruited 69 cases. The hospital frequency of OPBP was estimated at 1.02%. The age at first consultation was [0 - 28 d] in 50.8% of cases. The sex ratio was 0.68. The right side was reached in 54.4% of cases. The Erb’s palsy predominated in 79.7% of cases. The risk factors for OPBP were vaginal delivery, cephalic presentation, shoulder dystocia and macrosomia. Physiotherapy was performed as prescribed in 94.9% of cases allowing excellent and good functional recovery in 76.81% of cases. Conclusion: In the care of their children’s OPBP rehabilitation by sensitized, actively involved and supervised parents would be a good alternative to professional physiotherapy in all situations where the latter would not be possible.

关键词： Obstetric Palsy Brachial Plexus Functional Rehabilitation Macrosomia Childbirth Dystocia

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Assessment of Health-Related Quality of Life of Tuberculosis Patients in Fako Division, South-West Region of Cameroon

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Journal of Tuberculosis Research 2020年第3期8卷 93-110页

作者： Benjamin D. Thumamo Pokam Pius Fokam theophile nana Njamen Prisca Wabo Guemdjom Anne E. Asuquo Department of Medical Laboratory Science Faculty of Health Sciences University of Buea Buea Cameroon Department of Surgery Faculty of Health Sciences University of Buea Buea Cameroon Department of Obstetrics and Gynecology Faculty of Health Sciences University of Buea Buea Cameroon Department of Public Health Faculty of Health Sciences University of Buea Buea Cameroon Department of Medical Laboratory Science Faculty of Allied Medical Sciences College of Medical Sciences University of Calabar Calabar Nigeria

Background: Tuberculosis (TB) caused by Mycobacterium tuberculosis is one of the top 10 causes of death worldwide. Despite the global impact of TB and treatment received, a gap persists between treatment and quality of life of the patients especially in resource limited countries. This study therefore evaluated the health related quality of life of TB patients and the different factors influencing their quality of life at the post intensive phase of their treatment in the Fako division of the South-West Region of Cameroon. Methods: A hospital based cross sectional study was carried out in 4 tuberculosis treatment centers, namely two regional (Buea and Limbe) and two district (Tiko and Muyuka) hospitals in Fako Division between June and July 2017. One hundred and sixty-seven TB patients were enrolled in the study and relevant information from them was gathered using the SF-36 questionnaire. Various aspects such as their perception of the disease, their socio-demographics and socio-economics conditions were evaluated. Results: Of the 167 participants enrolled in the study, 95 (56.9%) were male and 72 (43.1%) were female. One hundred and thirty-three (79.6%) of the 167 participants were affected by pulmonary tuberculosis and 34 (20.4%) by extra-pulmonary tuberculosis. Fifty-five (32.9%) were HIV positive and 90 (53.9%) had been receiving treatment for 4 - 6 months, 73 (43.7%) for 1 - 3 months and 4 (2.4%) for 7 - 9 months. The lowest and highest scores were recorded on the role limitation due to emotional problems scale (30.54 ± 35.36), and on the social functioning scale (47.68 ± 16.33) respectively. There was a significant difference (p = 0.021), between pulmonary and extra pulmonary tuberculosis (49.15 ± 16.08 vs. 41.91 ± 16.25) on the social functioning. Financial difficulty restraining drug collection affected the general health perception (p = 0.003), vitality (p = 0.007), emotional well-being (p < 0.001) and social functioning (p = 0.

关键词： Tuberculosis Quality of Life Continuation Phase of Treatment SF-36 Questionnaire South West Region Cameroon

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HIV+ Status and Cervical Cancer: Cytological Aspects of Cervical Smear in Cameroon Setting

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Open Journal of Obstetrics and Gynecology 2020年第1期10卷 76-84页

作者： Essome Henri Engbang Jean Paul Ekono Michel Roger nana Njamen theophile Mve Koh Valere Boten Merlin Tocki Toutou Grace Fewou Amadou Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Laquintinie Hospital Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaoundé Cameroon

Introduction: The early detection of precancerous lesions being very important for the preventive management of cervical cancer, we felt it was important to identify these lesions on potential backgrounds including HIV-positive (HIV+) women to suggest control strategies of cervical cancer in Cameroon. Objective: To determine the prevalence of precancerous lesions in women infected with the human immunodeficiency virus (HIV), to investigate the determinants of the HIV and cervical cancer association, and to make recommendations regarding cervical cancer screening in these patients of the city of Douala. Methodology: Our study was a case-control cross-sectional study from July 2017 to December 2017 (6 months) including 108 women among which 34 HIV+ matched with 74 HIV-. HIV serology was done using the complete HIV enzygnost test. Cervical smears for cytological lesions were fixed to the cyto-fixator and then stained by the Papanicolaou technique and read under an optical microscope. The cervical smear slides for viral excretion were fixed with a methanol-acetone mixture of equal volume;HPV testing was done by the indirect immune-peroxidase technique using P16 protein. The excretion of HSV type 1 & 2 was investigated by the indirect immunofluorescence technique using the Simplex Virus type 1 & 2 Rabbit anti-Herpes from DAKO (France). Results: The two groups of women were compared with the chi square test with a significance threshold of P 0.05. The average age was 40.07 with extremes of 21 and 71 years and a standard deviation of 9.99. Of the 34 HIV+ patients, 23 had an abnormal cervix compared to 36 cases of abnormal cervix among HIV- with a statistically significant difference (P = 0.006649). 12 cases of dysplasia were observed in the 34 HIV+ women and distributed as follows: 0% of mild dysplasia, 18.92% of moderate dysplasia and 13.51% of severe dysplasia. In HIV- women we detected 6 cases of dysplasia including 1.35% of mild dysplasia, 4.05% of moderate dysplasia a

关键词： HIV HPV Dysplasia Cervical Cancer

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Attainment of the Fifth Millennium Development Goal: Utopia or Reality Based on Trends in Maternal Mortality in 12 Years in Two Regional Hospitals in Fako Division, Cameroon? A Retrospective Study

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Open Journal of Obstetrics and Gynecology 2014年第13期4卷 771-781页

作者： Gregory Edie Halle Ekane Thomas Egbe Obinchemti Charlotte Nguefack Tchente Lydia Kahgomia Fokunang theophile nana Njamen Ndamezie Nkafu Bechem Martin Mafany Njie Daniel Latum Department of Surgery and Gynecology/Obstetrics Faculty of Health Sciences University of BueaBuea Cameroon Department of Obstetrics and Gynecology Douala General Hospital Douala Cameroon Department of Gynecology and Obstetrics Regional Hospital Buea Buea Cameroon Department of Obstetrics and Gynecology Limbe Regional Hospital Limbe Cameroon Department of Public and Community Health University of Yaoundé 1 Yaoundé Cameroon

Introduction: According to WHO, globally an estimated 585,000 women die each year from complications of pregnancy and childbirth. One of the targets of Millennium Development Goal 5 (MDG 5) is to reduce maternal mortality by three quarters of the 1999 value by the year 2015. However, three years to 2015, very little is known on the trends in maternal mortality ratio, causes of maternal deaths and their associated factors in the Tiko Cottage Hospital (TCH) and Limbe Regional Hospital (LRH) in the South-West Region, Cameroon. Methods: This was a retrospective, analytical cross-sectional study that was carried out from 1st January 2000 to December 2012. After obtaining ethical clearance, the records of cases of maternal deaths and a reference group of women who survived after a pregnancy during the same period were carefully reviewed. The data were analyzed with SPSS 10 and EPI 3.5.1. Results: There were 14,480 live births and 132 maternal deaths during the study period, giving an adjusted Maternal Mortality Ratio (MMR) of 892/100,000 live births. Patients’ age ranged from 15 - 40 years (SD 2.3). We observed a downwards trend of Maternal Mortality Ratio (MMR). Seventy-eight percent of the maternal deaths were due to direct causes. The triad of hemorrhage (54.5%), abortions (17.4%), and eclampsia (10.6%) was the leading cause of death. HIV-related complications and hepatitis constituted the main indirect causes of maternal death. In 85.4% of cases, maternal deaths were avoidable. Lack of blood for transfusion and late referral of cases were the main avoidable factors. Patients less than 35 years (p = 0.01), no antenatal care (ANC) (p = 0.001), unemployment [OR = 1.52;95% CI: (1.38 - 48.28);p = 0.02] were significantly associated with maternal deaths while grand multiparity [OR = 1.20;95% CI (0.30 - 4.86);p = 0.79], marital status [OR = 1.20;95% CI: (0.70 - 2.07);p = 0.51] and education level were not significantly associated with maternal deaths. Conclusion: The trend s

关键词： Maternal Mortality Ratio Causes Trends MDG 5 South West Region

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Assessment of the Content and Utilization of Antenatal Care Services in a Rural Community in Cameroon: A Cross-Sectional Study

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Open Journal of Obstetrics and Gynecology 2014年第14期4卷 846-856页

作者： Gregory Edie Halle-Ekane Thomas Egbe Obinchemti Jeffrey-Lewis Nnomzo’o Nzang Ngoe Morike Mokube Martin Mafany Njie theophile nana Njamen Boniface T. Nasah Department of Surgery and Gynecology/Obstetrics Faculty of Health Sciences University of Buea Buea Cameroon Department of Gynecology and Obstetrics Regional Hospital Buea Buea Cameroon

Background: Pregnant women receive antenatal care (ANC) to ensure favorable pregnancy outcomes. Despite the high ANC coverage rate registered nationally in Cameroon;rural women, women with no formal education and those in the most deprived quintile still face difficulties in having access to quality ANC. The impact of the aforementioned factors on ANC use in the Muea Health Area (MHA) is unknown. The objective of this study was to determine the proportion of women attending ANC and the factors influencing ANC attendance in the MHA. Materials and Methods: This was a community based, analytical, cross sectional survey that involved pregnant women and women with children less than two years old who gave an informed consent or assent. Data were collected using a semi structured questionnaire. EPI info Version 7 and Stat Pac for Windows version 12??1998-2011 (Stat Pac Inc, Bloomington, USA) were used for data analysis. Associations were considered statistically significant for p values less than 0.05. Results: Two hundred and twenty women were interviewed. The mean age was 25 years (SD 5.28). Ninety-nine percent of women had at least one ANC visit meanwhile 84.8% had at least four ANC visits. Only 27.2% of women booked for ANC in the first trimester. Rural (Maumu) residence was associated with inappropriate ANC attendance (attending less than four times) (χ2?= 18.5;p = 0.001). Semi urban women (87%;95% C.I. = 85.10% - 89.0%) were more likely to attend four or more sessions than rural (Maumu) women (60.7%;95% C.I. = 44.2% - 77.3%) (p = 0.001). Participant’s educational level was a significant predictor of early booking for ANC (χ2?= 26.8;p = 0.0002). Semi urban wom- en (79.1%;95% C.I. = 76.0% - 82.2%) were significantly more likely to have a vaginal examination done than rural (Maumu) women (42.1%;95% C.I. = 17.5% - 68.2%) (p = 0.0001). Women who met a doctor during ANC (84.0%;95% C.I. = 80.8% - 87.0%) were more likely to have a vaginal examination done than women who onl

关键词： Assessment Utilization Antenatal Care Preferences Buea

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