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Post Blast Tympanic Perforations, Clinical and Paraclinical Study at Six yaounde hospitals

International Journal of Otolaryngology and Head & Neck Surgery 2024年第2期13卷 126-134页

作者： Andjock Nkouo Yves Christian Lekassa Pierrette Meva’a Biouele Roger Christian Moboung Prudence Mindja Eko David Djomou Francois Njock Richard Ndjolo Alexis Ophthalmology-Ear-Nose-Throat (ENT)-Stomatology Department Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon ENT-Cervico-Facial-Surgery (CFS) Service Yaounde General Hospital Yaounde Cameroon ENT-CFS Service Omar Bongo Ondimba Military Teaching Hospital Libreville Gabon ENT-CFS Service Yaounde Central Hospital Yaounde Cameroon ENT-CFS Service Yaounde Teaching Hospital Yaounde Cameroon ENT-CFS Service Douala General Hospital Douala Cameroon

Introduction: Post-blast tympanic perforations represent an entity of traumatic perforations;various mechanisms are at the origin of the latter, and the increase in conflicts and acts of violence are increasing the studies on this subject, but few data are available in our context. Objective: This paper aims to study post-blast tympanic perforations in yaounde, specifically the epidemiological, clinical, and paraclinical aspects. Methodology: We conducted a descriptive cross-sectional study with retrospective and prospective data collection in six yaounde hospitals over 63 months from January 1, 2018, to March 31, 2023. All patients with at least one post-blast tympanic perforation were included. Socio-demographic, clinical and paraclinical data were collected on a questionnaire and analysed using SPSS 28 software. Results: We included 124 patients. The prevalence of post-blast tympanic perforations was 0.1% of the consultations in the departments. 71 The average age was 28.6 ± 9.1 years, with extremes ranging from 7 to 49 years. The median consultation time was five days. The most frequent injury circumstances were physical aggression (81.45%) and armed conflict (10.5%). The injury mechanisms were slaps (75%), punches (21.74%) and grenades (4.8%). The main symptoms on admission were hearing loss (63.7%), tinnitus (58.1%) and otalgia (57.3%). The tympanic perforations were unilateral in all cases, the anterior-inferior location was more characteristic, and the deafness was conductive in 58.3% of cases, followed by mixed deafness in 23.3% of cases. Conclusion: Post-blast tympanic perforations are rare in consultation. The population is primarily male and from the second decade of life. The main circumstance is aggression.

关键词： Tympanic Perforation Blast yaounde

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Clinical Presentation, Therapeutic Aspects and Results of Urogental Prolapse in yaounde

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Open Journal of Urology 2024年第2期14卷 83-94页

作者： Junior Barthelemy Mekeme Mekeme Pierre Joseph Fouda Marie Josiane Ntsama Essomba Jean Cedric Fouda Marie Salome Eko’o Neme Marcel Junior Yon Mekeme Achille Y. Kpanou Bright Che Awondo Philip Fernandez Owon’Abessolo Marcella Biyouma Achille Aurele Mbassi Robinson Mbu Robinson Fru Angwafo III Department of Urology and Andrology Yaounde Central Hospital Yaounde Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Department of Surgery Yaounde University Teaching Hospital Yaounde Cameroon Faculty of Medicine and Pharmaceutical Sciences Douala Douala Cameroon Department of Urology and Andrology Laquintini Hospital Douala Douala Cameroon Department of Obstetrics and Gynaecology Yaounde Obstetrics Gynaecology and Pediatrics Hospital Yaounde Cameroon

Introduction: Urogenital prolapse is the descent of one or more elements of the abdominal-pelvic contents into the vaginal cavity. The anterior, middle and posterior anatomical compartments may be involved giving rise to several types of genital prolapse. However, there are various therapeutic modalities ranging from observational procedures to surgery. In yaounde, urogenital prolapse appears to be a rare clinical entity, and its treatment has not been clearly stated. There is limited data about this subject in our context. Our aim was to study the clinical and therapeutic aspects of urogenital prolapse in yaounde. Methods: We conducted a descriptive cross-sectional study with retrospective data collection at the yaounde Gynaecological Obstetric and Pediatric hospital (YGOPH) and the yaounde Central hospital (YCH) over a period of 05 months (from February 2022 to June 2022). All women aged ≥30 years and all women with documented urogenital prolapse admitted to the maternity and urology departments of these two health facilities were included. Data were collected using a structured questionnaire. Data was analyzed using IBM SPSS (statistical package for social sciences) software version 23.0 and the data were reported as mean, standard deviation, frequencies and percentages. Results: A total of 50 patients were recruited;the mean age was 45.8 ± 17 years. The age range was from 21 to 72 years. Majority of the patients were aged more than 55 years (32%). Most of the patients attended primary education (48%). Forty percent of the patients were housewives. The majority of the patients were from West Cameroon (26%). The most common reason for consultation was pelvic heaviness (54%). The most prevalent clinical sign was cystocele (56%), followed by hysterocele (54%). According to the Baden Walker classification, one-third of the patients were classified as first degree (36%). More than half (58%) of patients had the condition located at the first stage. Surgery was perform

关键词： Urogenital Prolapse Cystocele Hysterocele Clinical Surgery

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Predictors of Fatal Outcome in hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary hospitals in Sub-Saharan Africa

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Open Journal of Nephrology 2024年第1期14卷 86-103页

作者： Denis Georges Teuwafeu Fombo Enjeh Jabbossung Maimouna Mahamat Eric Aristide Nono Tomta Mbapah Leslie Tasha Francois Kaze Folefack Gloria Ashuntantang Faculty of Health Sciences University of Buea Buea Cameroon Triad Research Fundation Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Department of nephrology Yaounde General Hospital Yaounde Cameroon Departement of Nephrology Yauonde Teaching Hospital Yaounde Cameroon

Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.

关键词： Predictors Fatal Outcome Acute Kidney Injury Tertiary hospital

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Phenotypic Characterization of Extended Spectrum Beta-Lactamase, Class C Cephalosporinase and Carbapenemase-Producing Klebsiella Species Isolated from Patients Consulted at Four yaounde-Based hospitals

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Open Journal of Medical Microbiology 2024年第2期14卷 105-119页

作者： Emilia Enjema Lyonga Mbamyah Mangum Patience Kumcho Michel Toukam Dieudonné Sedena Florence Anjabie Enyeji Aime-Caesar Teukam Modestine Djuissi Martha Tongo Mesembe George Mondinde Ikomey Agnes Bedie Eyoh Hortense Kamga Gonsu Faculty of Medicine and Biomedical Sciences The University of Yaounde 1 Yaounde Cameroon Center for the Study and Control of Communicable Diseases Faculty of Medicine and Biomedical Sciences The University of Yaounde 1 Yaounde Cameroon Department of Microbiology School of Health Sciences Catholic University of Central Africa Yaounde Cameroon Faculty of Science University of Buea Buea Cameroon Bacteriology Unit Yaounde University Teaching Hospital Yaounde Cameroon

Background: Klebsiella spp. are bacteria of medical importance for their role in opportunistic infections which are often difficult to treat because of resistance to one or several antimicrobials. The aim of this study was to determine antimicrobial resistance due to Extended Spectrum Beta-lactamase (ESBL), Class C cephalosporinase (AmpC) and carbapenemase enzymes in Klebsiella spp. isolated from patients consulted at four hospitals. Methodology: The study was cross-sectional and descriptive. A total of 4190 non-repetitive patients specimens from 13 types of clinical specimens were analysed from February to November 2020. Two hundred and twenty-five (225) Klebsiella spp isolates were identified using API 20E and antimicrobial susceptibility testing done according to the Kirby Bauer disc diffusion method. ESBL and AmpC phenotypes were determined by the combination disc method and carbapenemases by double disc synergy method, referenced by EUCAST guidelines for the resistance testing. Results: The frequency of the species was Klebsiella pneumoniae (69%, 155/255), K. oxytoca (14%, 31/255), K. ozaenae (12%, 27/225) and K. rhinoscleromatis (5%, 11/225). Isolates were most resistant to sulphomethoxazole trimethoprim (84%, 189/225), cepaholosporins (80%, 180/225), and least resistant to carbapenems (10.7%, 24/225). Two K. oxytoca and one K. pneumoniae were resistant to all antibiotics tested. Klebsiella pneumoniae had the most multidrug resistant isolates (59.4%, 134/225). Most isolates (83.6%, 188/225) expressed at least one enzyme, while 63.6% (143/225) of the isolates expressed at least two enzymes. Some isolates were ESBL (71.6%, 161/225), carbapenemase (10.7%, 24/225) and AmpC (6.6%, 15/225) producers. Three carbapenemases (Klebsiella pneumoniae carbapenemase-KPC, Metallo-Beta Lactamase-MBL and OXA-48) were detected. Conclusion: These results revealed that resistance of Klebsiella spp. to cephalosporins is high and this may be exacerbated by co-expression of AmpC and

关键词： Klebsiella Spp. Multidrug Resistance ESBL AmpC Carbapenemase

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Diagnosis and management of malaria in the intensive care unit

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Journal of Intensive Medicine 2024年第1期4卷 3-15页

作者： George Akafity Nicholas Kumi Joyce Ashong Department of Research Monitoringand EvaluationCape Coast Teaching HospitalCape CoastGhana Intensive Care Unit Department of Critical Care and AnesthesiaCape Coast Teaching HospitalCape Coast Department of Paediatrics and Child Health Cape Coast Teaching HospitalCape CoastGhana

Malaria is responsible for approximately three-quarters of a million deaths in humans globally each *** of the morbidity and mortality reported are from Sub-Saharan Africa and Asia,where the disease is *** non-endemic areas,malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination *** malaria often requires intensive care unit admission and can be complicated by cerebral malaria,respiratory distress,acute kidney injury,bleeding complications,and *** care management includes prompt diagnosis and early initiation of effective antimalarial therapy,recognition of complications,and appropriate supportive ***,the lack of diagnostic capacities due to limited advances in equipment,personnel,and infrastructure presents a challenge to the effective diagnosis and management of *** article reviews the clinical classification,diagnosis,and management of malaria as relevant to critical care clinicians,highlighting the role of diagnostic capacity,treatment options,and supportive care.

关键词： Malaria Intensive care unit Severe malaria Antimicrobial resistance Antimalarials Artemisinin-based combination therapy

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Evaluation of the Quality of Micturition in Patients Who Underwent Anastomotic Urethroplasty at the yaounde Central hospital, Cameroon

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Open Journal of Urology 2024年第2期14卷 115-127页

作者： Achille Aurele Mbassi Landry Oriole Mbouche Junior Mekeme Mekeme Jean Crepin Eloundou Nkolo Bright Che Awondo Jean Cedrik Fouda Frantz Guy Epoupa Ngalle Cyril Kamadjou Pamela Anaba Laure Pierre Joseph Fouda Fru Forbuzshi III Angwafo Higher Institute of Medical Technology Yaounde Cameroon Higher Institute of Health Sciences Bangangte Cameroon Urology and Andrology Department Yaounde Central Hospital Yaounde Cameroon Department of Surgery and Subspecialties Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon yaounde Gynecology Obstetrics and Pediatric Hospital Yaounde Cameroon

Introduction: Radiological investigation which is the gold standard to perform following anastomotic urethroplasty in order to evaluate the quality of micturition is costly. In our context, due to financial limitations, reconstructive urologists prefer to use the uroflowmetry in order to assess the micturition post-surgery. Therefore, the objective of the study was to assess the quality of micturition using the uroflowmetry after anastomotic urethroplasty. Methodology: We conducted an 11-year retrospective review (1st January 2006-31st December 2017) and a cross-sectional descriptive observational study for a period of 8 months (November 2017-June 2018) at the Urology and Andrology Department of the yaounde Central hospital (YCH) of patients who were diagnosed with urethral stenosis and underwent an anastomotic urethroplasty at the YCH. We excluded patients who had incomplete files, patients lost to follow-up and did not do pre-operative uroflowmetry. Quality of micturition was evaluated using a uroflowmetry. Data was analyzed using EPI info 7.0. Parametric variables were reported as means and standard deviations and percentages and counts were used to report categorical variables. Results: We had a sample of 60 patients. The mean age was 42 ± 5 years with extremes ranging from 20 to 76 years. Twenty-seven (27) patients, or 45%, had no post-operative complications, and those who did had a urinary tract infection (26.70%). In our series, we had 82% excellent results (patient satisfied with his urination with bell-shaped urinary stream and urinary flow greater than or equal to 15 ml/sec);15% good results (patient with moderate dysuria with average urinary stream and urinary flow between 10 and 14.9 ml/sec) and 3% poor results (severe dysuria with urinary flow less than 10 ml/sec, urinary retention or urinary incontinence). Based on these results we can say that the success rate in our series was 97%. 96.70% of patients were satisfied against 3.3%

关键词： Urethra Stricture Anastomotic Urethroplasty

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Is tumor necrosis factor-α monoclonal therapy with proactive therapeutic drug monitoring optimized for inflammatory bowel disease? Network meta-analysis

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 571-584页

作者： Fang-Yuan Zheng Kai-Si Yang Wen-Cheng Min Xin-Zhu Li Yu Xing Shuai Wang Ying-Shi Zhang Qing-Chun Zhao teaching hospital of Shenyang Pharmaceutical University General Hospital of Northern Theater CommandShenyang 110016Liaoning ProvinceChina

BACKGROUND The efficacy and safety of anti-tumor necrosis factor-α(TNF-α)monoclonal antibody therapy[adalimumab(ADA)and infliximab(IFX)]with therapeutic drug monitoring(TDM),which has been proposed for inflammatory bowel disease(IBD)patients,are still *** To determine the efficacy and safety of anti-TNF-αmonoclonal antibody therapy with proactive TDM in patients with IBD and to determine which subtype of IBD patients is most suitable for proactive TDM *** As of July 2023,we searched for randomized controlled trials(RCTs)and observa-tional studies in PubMed,Embase,and the Cochrane Library to compare anti-TNF-αmonoclonal antibody therapy with proactive TDM with therapy with reactive TDM or empiric *** and network meta-analyses were used to determine the IBD patient subtype that achieved clinical remission and to determine the need for *** This systematic review and meta-analysis yielded 13 studies after exclusion,and the baseline indicators were *** found a significant increase in the number of patients who achieved clinical remission in the ADA[odds ratio(OR)=1.416,95%confidence interval(CI):1.196-1.676]and RCT(OR=1.393,95%CI:1.182-1.641)subgroups and a significant decrease in the number of patients who needed surgery in the proactive vs reactive(OR=0.237,95%CI:0.101-0.558)and IFX+ADA(OR=0.137,95%CI:0.032-0.588)subgroups,and the overall risk of adverse events was reduced(OR=0.579,95%CI:0.391-0.858)according to the pairwise ***,the network meta-analysis results suggested that patients with IBD treated with ADA(OR=1.39,95%CI:1.19-1.63)were more likely to undergo TDM,especially in comparison with patients with reactive TDM(OR=1.38,95%CI:1.07-1.77).CONCLUSION Proactive TDM is more suitable for IBD patients treated with ADA and has obvious advantages over reactive *** recommend proactive TDM in IBD patients who are treated with ADA.

关键词： Inflammatory bowel disease Therapeutic drug monitoring Adalimumab Infliximab Network meta-analysis

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Comparative Study of Early Neonatal Complications between the First and Second Twin during Twin Vaginal Deliveries at the yaounde Gynaeco-Obstetric and Pediatric hospital, and the yaounde Central hospital

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Open Journal of Obstetrics and Gynecology 2024年第3期14卷 381-392页

作者： Florent Ymele Fouelifack Felicite Nguefack Patricia Bashir Kadidja Roosvelt Dongmo Tiodjou Jeanne Hortence Fouedjio Pascal Foumane Higher Institute of Medical Technology of Nkolondom Yaounde Cameroon Obstetrics and Gynaecology Unit of yaounde Central hospital Yaounde Cameroon Associative Group for Research Education and Health La Falaise “GARES-Falaise” Dschang Cameroon Obstetrics and Gynaecology Unit of the yaounde Gynaeco-Obstetrics and Pediatric hospital Yaounde Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon

Introduction: Twin birth is the expulsion of two fetuses and their appendages out of the woman’s reproductive tract. It’s a high-risk delivery because of the high frequency of maternal, fetal and neonatal complications. Few studies exist on the comparative prognoses of twins. Our objective was to compare early neonatal complications in first and second twins. Methods: We carried out a cross-sectional prospective study from January 2 to April 30, 2020 (4 months) at the yaounde Gynaeco-Obstetric and Pediatric hospital, and the yaounde Central hospital. Data collected were analyzed using IBM SPSS version 23. Descriptive statistics were done in frequencies and percentages, means and standard deviations. Paired-sample student's t-test were used to compare means. McNemar’s Chi-square and Ficher’s exact tests were used to compare proportions. Statistical significance was set at p-values less than 0.05. Results: Of a total of 2183 deliveries during the study period, 43 (1.96%) were twin vaginal deliveries. Among the 43 women, 41 consented to have their newborns participate in the study. Overall, APGAR scores were better for the first twins at the first (p = 0.004) and fifth (p = 0.031) minutes than for the second twins. Although both twins had complications and that there were 4 neonatal deads of the second twin, there was no relationship between studied complications and the rank of the twin (p = 0.310). Conclusion: As the APGAR score seemed to be better for first twins, clinicians should pay more attention during twin births, in order to improve the prognosis of the second twin.

关键词： Comparison Vaginal Birth Rank of Twin Early Neonatal Complications

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Optimized sequential therapy vs 10- and 14-d concomitant therapy for eradicating Helicobacter pylori: A randomized clinical trial

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World Journal of Gastroenterology 2024年第6期30卷 556-564页

作者： Hassan Seddik Jihane Benass Sanaa Berrag Asmae Sair Reda Berraida Hanae Boutallaka Department of Gastroenterology II Mohammed V Military Teaching Hospital of RabatRabat 10100Morocco Department of Gastroenterology Mohammed V University in RabatRabat 10100Morocco Department of Gastroenterology I Mohammed V Military Teaching Hospital of RabatRabat 10100Morocco

BACKGROUND A cure for Helicobacter pylori(***)remains a problem of global *** prevalence of antimicrobial resistance is widely rising and becoming a challenging issue *** sequential therapy seems to be one of the most attractive strategies in terms of efficacy,tolerability and *** most common sequential therapy consists of a dual therapy[proton-pump inhibitors(PPIs)and amoxicillin]for the first period(5 to 7 d),followed by a triple therapy for the second period(PPI,clarithromycin and metronidazole).PPIs play a key role in maintaining a gastric pH at a level that allows an optimal efficacy of antibiotics,hence the idea of using new generation *** open-label prospective study randomized 328 patients with confirmed *** infection into three groups(1:1:1):The first group received quadruple therapy consisting of twice-daily(bid)omeprazole 20 mg,amoxicillin 1 g,clarith-romycin 500 mg and metronidazole 500 mg for 10 d(QT-10),the second group received a 14 d quadruple therapy following the same regimen(QT-14),and the third group received an optimized sequential therapy consisting of bid rabe-prazole 20 mg plus amoxicillin 1 g for 7 d,followed by bid rabeprazole 20 mg,clarithromycin 500 mg and metronidazole 500 mg for the next 7 d(OST-14).AEs were recorded throughout the study,and the *** eradication rate was determined 4 to 6 wk after the end of treatment,using the 13C urea breath *** In the intention-to-treat and per-protocol analysis,the eradication rate was higher in the OST-14 group compared to the QT-10 group:(93.5%,85.5%P=0.04)and(96.2%,89.5%P=0.03)***,there was no statist-ically significant difference in eradication rates between the OST-14 and QT-14 groups:(93.5%,91.8%P=0.34)and(96.2%,94.4%P=0.35),*** overall incidence of AEs was significantly lower in the OST-14 group(P=0.01).Furthermore,OST-14 was the most cost-effective among the three *** The optimized 14-

关键词： Helicobacter pylori Quadruple therapy Sequential Proton-pump inhibitor Optimization

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“FISH VERTEBRA” about 3 Sickle Cell Patients Followed at Laquintinie hospital, Douala

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Open Journal of Rheumatology and Autoimmune Diseases 2024年第1期14卷 20-25页

作者： Same Bebey Francine Mbono Betoko Ritha Eloundou Onomo Paul Mantho Fopa Pauline Eposse Ekoube Charlotte Megne Tamo Estelle Ebene Mbende Romain Singwe Ngandeu Madeleine Rheumatology Unit Laquintinie Hospital Douala Douala Cameroon Paediatric Unit Laquintinie Hospital Douala Douala Cameroon La Cite Verte hospital yaounde Yaounde Cameroon Paediatric Surgery Unit Laquintinie Hospital Douala Douala Cameroon La Cite des palmiers hospital Douala Douala Cameroon Rheumatology Unit Central Hospital Yaounde Yaounde Cameroon

Vertebral involvement in particular is common in sickle cell patients. We report 3 cases of “fish vertebra” fractures in sickle cell patients aged 16, 18, and 24 years old respectively at Laquintinie hospital, Douala. When the vertebral fractures were diagnosed, the 3 patients had back pain and kyphosis deformities of the dorsal spine. Treatment with an infusion of biphosphonates (zoledronic acid at a dose of 0.5 mg·per·kg) was offered to all three patients. Two out of three patients received treatment with biphosphonates with a successful outcome. Profound vitamin D deficiency is associated with increased bone remodeling and a history of fractures. In sickle cell anemia, vertebral fractures may also result from bone fragility, which is often overlooked as aseptic osteonecrosis and osteomyelitis, which are very often suspected.

关键词： Vertebral Fractures Sickle Cell Anemia Vertebral Bone Fragility

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