Search

Background: Fractures are more and more frequent, because of the extent of traffic road accidents and the rise of moto-taxis in Cameroon context. However, there are major public health challenges in the therapeutic response within the pyramidal care chain. Method: This was a cross-sectional study with mixed component (qualitative and quantitative) that lasted ten months (from October 2017 to July 2018). It covered a six-year period (between 2012 and 2018) and was carried in the departments of orthopedic surgery and traumatology of Yaounde Central Hospital. Included were the medical records of patients with fractures. Results: The sample consisted of 428 patients, with a clear male predominance (sex ratio of 2.6) and a median age of 39 years. Biomedicine and ethnomedicine represented the most widely used treatment options in first (52.3%) and second-line (57%) respectively. As for self-medication, it constituted 44% of the first recourse, because of its geographical accessibility, and 40.2% of the third remedies. The orthopedic itineraries are very erratic, because of the medical pluralism observed within the health system. In addition, the therapeutic response within the pyramidal care chain has been marked by several public health challenges. They were respectively epidemiological (with extent of fractures and traffic road accidents), organizational (due to poor organization of front-line services) and financial (because of ineffectiveness of universal health coverage and socio-economic context specific to low-resource countries). Conclusion: This study will make efficient data available to stakeholders, in order to improve the supply’s organization of orthopedic care according to the demand, through perspectives of resolution of epidemiological, organizational and financial challenges in the pyramidal chain of fractures management.

Background: Post-traumatic osteomyelitis is bone infection secondary to a trauma (open fracture or bone surgery). It is a painful and frustrating disease characterised by a high rates of therapeutic failures and a costly management. However, treatment is increasingly becoming difficult because of the phenomenon of antibiotic resistance. The present study was realised to determine the epidemiological and susceptibility profile of bacterial isolates in posttraumatic osteomyelitis in a tertiary hospital in the city of Yaounde. Method: A descriptive cross-sectional study was carried out between November 2016 and May 2017. Patients admitted for post-traumatic osteomyelitis were recruited. After recoding clinical informations, deep specimens were taken during surgical debridement and were cultured in Blood, Mannitol Salt and MacConkey plates at 37 oC for 24-72hrs. Culture isolates were identified by standard biochemical reactions. Antibiotic susceptibility was performed by Kirby-Bauer method using the CASFM guidelines. Results: A total of 31 patients were recruited; the modal age range was 21-50 years (67.8%) and the sex ratio 1.8:4. The commonest bones affected were the tibia (48.5%) and femur (32.3%). Predisposing factors identified included open fractures (76%), delay surgical debridement (83.3%), presence of prosthesis (58%) and surgical wound infections (23%). Out of 31 samples, 29 yielded positive culture giving rise to 48 bacteria isolates. Fourteen samples (48%) were polybacterial. The most predominant species was Escherichia coli (29%), followed by Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella pneumoniae (all 22.6%). The Gram positive organisms showed good sensitivity to Imipenem, Rifampicin, Fucidine, Lincomycin, and to Vancomycin whereas the Gram negative bacilli were mostly sensitive to Imipenem (96.7%), Amikacin (82.1%) and to a lesser extend Quinolones (54%) and Piperacillin/Tazobactam and Ceftazidime (48%). Conclusion: Nosocomial bacteria dominate the bacterial flora of posttraumatic osteomyelitis in our setting and many multidrug resistant strains are emerging thus emphasizing on the importance of hygiene and targeted antibiotherapy.

L’ostéo-onycho-dystrophie héréditaire (OODH) est une maladie héréditaire autosomique dominante traduisant une mutation du gène LMX1B et peu de cas ont été décrits dans la littérature. Le but de ce travail était d’ajouter ce cas rare au registre de la littérature mondiale. Les auteurs rapportent un cas vraisemblable d’osteo-onycho-dystrophie héréditaire chez un petit enfant de 3 ans avec hérédité d’onycho- dystrophie maternelle, présentant une agénésie bilatérale des rotules, un trouble de la migration testiculaire mais aucune anomalie unguéale ni atteinte rénale. La littérature est révisée. Le diagnostic d’ostéo-onycho-dystrophie héréditaire repose sur un faisceau d’arguments au premier rang desquels la mutation du gène LMX1B. On comprend mieux les difficultés diagnostiques de tels cas dans nos contrées sous-médicalisées où le bilan génétique n’est pas encore entré dans les moeurs.Mots-clés : Ostéo-onycho-dystrophie, hérédité, enfant, Yaoundé, Cameroun.English AbstractContextHeditary osteo-onychodystroplasia HOOD is an autosomal dominant heriditary disease due to a mutation of the LMX1B gene and only a few cases have been described in litterature.ObjectiveThe aim of our work was to add this rare cas to the world literature register.Cas reportSome authors report one similar cas of heriditary osteo-onychodystroplasia in a 3 years child with famillial maternal onycho-dystroplasia presenting with bilateral patella agenesis, anomaly of testicular migration ,but no nail nor renal involvement was observed. Literature was reviewed.Discussion-ConclusionThe diagnosis of heriditary osteo-onychodysplasia replies on a group of argument with mutation in LMX1B gene being at the forefront. We can then understand the diagnostic difficulties of such cases in under medicalised countries where genotypic workups are not yet routinely done.Keywords: Ostéo-onychodystroplasia, heredity, child, Yaounde, Cameroon

Background: Postoperative infections (POIs) contribute to morbidity and mortality of surgical patients. There was no data on the prevalence and associated risk factors of POIs in the Limbe Regional Hospital (RLH). Methods: Selected patients were those who underwent a surgical procedure and were admitted into the surgical or maternity ward of the LRH between January 2009 and August 2012. Data studied included demographic variables, type of surgical procedure performed and postoperative follow-up. Data was analyzed for evidence of POIs using the Chi-square test for categorical variables and test for significance of association between POI and sex, age, procedures performed, hospitalization ward and duration of hospital stay. Results: 848 patients were selected among whom 78.8% were females. 62.1% of the patients were selected from the Obstetric and Gynaecology ward, while 37.9%were from the surgical ward. The mean age of the study subjects was 32.3±12.4 years. 175 patients met the criteria for POI giving a prevalence of 20.6%. The Obstetrics and Gynaecology ward had the highest prevalence of POI (61.7%). Prevalence of POIs was highest (64.3%) among patients in the 0 - 10 years age group. Males (26.7%) were at a higher risk of developing POIs .There was a statistically significant difference between POI and participants' age group (p

Objective: This review paper aims at demonstrating that mobile health services for HIV infection in resource-constrained countries may be particularly useful for HIV screening and treatment of HIV disease and associated co-morbidities, especially for people who have limited access to fixed health facilities, including remote or nomadic populations and socially marginalised people.Data source: PubMed database was used to retrieve appropriate literature related to the following MeSH terms: HIV, testing, counselling, mobile counselling and testing, routine offer of counselling and testing, provider-initiated testing and counselling,home-based counselling and testing, decentralisation.Study selection: All articles that met these inclusion criteria and described work conducted in sub-Saharan Africa were considered. Articles were reviewed for information pertaining to mobile health facilities in the field of HIV infection. Wealso reviewed available articles describing alternative approaches to HIV screening and care delivery in resource-limited settings without time period restrictions up to December 2015.Data synthesis: Data collected were analysed and the results related to the aim of the study.Conclusions: The development of mobile services has benefitted from the simplification of laboratory tests, including reliable rapid diagnostic tests for HIV, and “point of care” (“POC”) tests for CD4 enumeration. The mobile strategy aims to reach more patients,particularly those living in remote areas, to reduce loss-to-follow-up, and to improve patient outcomes. With a reduction in HIV-related stigma and associated discrimination by using these services, the mobile strategy may assist decentralisation of programs devoted to HIV screening, anti-retroviral treatment and HIV care.

L’exstrophie vésicale est une malformation congénitale complexe qui a une réputation de rareté dans la littérature mondiale avec une fréquence estimée à un cas pour 10 000 à 50 000 naissances. Lorsqu’elle est fermée c’est à dire continente, il s’agit d’une situation exceptionnelle dont aucun cas documenté n’a été rapportée en Afrique à notre connaissance. Le but de ce travail était d’ajouter cette forme rare au registre de la littérature mondiale tout en soulignant les difficultés thérapeutiques en milieu africain. Les auteurs rapportent chez une fillette de 5 ans à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé un cas exceptionnel d’exstrophie vésicale fermée avec diastasis pubien majeur, implantation basse de l’ombilic et présence d’un urètre hypoplasique laissant à peine passer une sonde urinaire CH10. L’on notait la présence d’un col vésical fonctionnel, puisque la fillette était continente. Le clitoris était bifide et de taille normale. A la cystoscopie, la vessie était de grande capacité et trabéculée, témoignant d’une gêne à l’évacuationdes urines. Le vagin était horizontalisé mais de taille normale (6 cm) avec présence d’un col utérin d’aspect normal. A l’échographie urinaire, les 2 reins étaient bien différenciés sans dilatation des voies excrétrices. La nécessité d’une évacuation de cette vessie par cathétérisme intermittent type Mitrofanoff est une option à discuter dans notre contexte. Le traitement de l’exstrophie vésicale, notamment en milieu africain « est une entreprise hérissée de difficultés et dont le résultat est plus ou moins hasardeux ».Mot clés : exstrophie vésicale fermée, Yaoundé, Cameroun.Bladder exstrophy is a rare complex congenital malformation, worldwide the frequency reported is 1 /10,000 to 50,000 livebirths. Closed bladder exstrophy is even more exceptional and to the best of our knowledge, no case has been reported in Africa so far. The aim of this report was to add this case to those currently existing in the medical literature worldwide and present the therapeutic difficulties in an African setting. The authors report a case of a 5 years old girl seen at the paediatric surgery service at the Yaounde Gynaeco-Obstetric and Pediatric Hospital. The patient presented with a low set umbilicus, wide pubic diastasis and a hypoplasic urethra that could not admit a size 10 foley catheter. However, the bladder neck was functional, as the patient was continent. The clitoris was bifid but of normal size. Endoscopic evaluation showed a dilated bladder probably resulting from chronic bladder outlet obstruction. The vagina was horizontalised but normal in size (6 cm) and the cervix appeared normal. The kidneys were well differentiated and no dilatation of the calices was seen at the adbominal ulstrasound.Key words: closed bladder exstrophy, Yaounde, Cameroon.

Les auteurs rapportent l’observation originale d’un garçon de 5 ans présentant une surélévation congénitale de la scapula de grade 3 de Cavendish. Le patient a été traité avec succès selon la procédure chirurgicale décrite par Woodward en 1961, dans le service de chirurgie pédiatrique de l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY). Les auteurs soulignent la rareté de l’affection qui a été peu décrite en Afrique sub-saharienne et font une revue de la littérature sur la question. Mots clés : surélévation congénitale de la scapula, enfant, traitement chirurgical, Cameroun.We report a case of congenital undescended scapula Cavendish grade 3 in a 5 year old child. The patient was successfully treated at the Woodward surgical procedure, in the pediatric surgical unit of the Yaounde, Gyneco-Obstetric and Pediatric Hospital. The authors stress on the rarity of this disorder in sub-saharan Africa, and literature review is done.Key words: Undescended scapula, children, surgical treatment, Cameroon.

No Abstract.

We present a case of intestinal infarctus through the vagina. This was a consequence of induced abortion done clandestinely. The main objective was to point out the surgical complications of uterine dilatation and curettage by means of this rare case.

La fracture bimalléolaire est une lésion fréquente dont les études sont rares en milieu Africain et au Cameroun en particulier. Le but de ce travail était de rapporter les résultats de l’ostéosynthèse des fractures bimalleolaires isolées sur une série de patients consécutivement observés sur une durée de quatre ans. Nous avons entrepris une étude transversale et analytique allant de septembre 2007 à Septembre 2011. Etait inclus les patients opérés et présentant un dossier clinique et radiologique complet. Etaient exclus les patients aux dossiers incomplets perdus de vue, ceux ayant des lésions associées, et multiples. Trente patients ont été inclus ; ils étaient âgés de 16 à 74 ans, avec une moyenne de 39 ans et une répartition normale dont le pic était située dans la quatrième décennie (53%). Le sex-ratio de 2/3 était en faveur du sexe féminin. Le type radiologique selon la classification de Weber était représenté par le type B suivi du type C ; nous n’avons pas observé de type A. La durée moyenne d’hospitalisation était de 06 jours après l’intervention. On a déploré deux débricolages de matériel d’ostéosynthèse et trois cas d’infection superficielle. L’ostéosynthèse des fractures bimalleolaires isoléespeut être réalisée dans notre contexte avec des résultats satisfaisants.Mots clés : Bimalleolaire ; Ostéosynthèse ; Fracture ; Cheville

Les affections chirurgicales des nerfs périphériques sont des pathologies peu étudiées en milieu neurochirurgical à Yaoundé. L’objectif de cetravail était d’étudier l’épidémiologie et les facteurs pronostiques de ces pathologies. Il s’agissait d’une étude rétrospective incluant tous lespatients opérés à l’Hôpital Central de Yaoundé d’une pathologie du nerf périphériques de Novembre 1999 à Novembre 2007. Vingt neuf (29) patients étaient inclus. Les pathologies traumatiques (15 patients), les syndromes canalaires (11 patients) et les tumeurs (3 patients) ont été observés. Concernant les traumatismes, le type de lésion retrouvé en per opératoire était la fibrose autour du tronc nerveux dans 10 cas (58,38%), la section complète du tronc nerveux dans 4 cas (23,52%) et la section partielle du tronc nerveux chez 1 patient (5,89%). Dans 2 cas aucune lésion n’était retrouvée. Le traitement chirurgical consistait en une neurolyse (10 cas) et une anastomose (direct ou avec greffon interposé) (4 cas) et une transposition du nerf (1 cas). Les résultats de la neurolyse étaient bons. Le taux de bons résultats était plus faible dans le groupe d’anastomose. Le facteur pronostic le plus important était le délai opératoire supérieur à 15 mois. Les syndromes canalaires dont 10 cas de canal carpien et les tumeurs (neurinomes) étaient plus rares.Mots clés : Nerfs périphériques, affections chirurgicales, traumatismes, neurinome, neurofibrome, syndrome du canal carpien, africainSurgical pathologies of peripheral nerves are less studied in neurosurgical units in Yaoundé. The aim of this study was to present the epidemiologyand the prognostic factors of these pathologies after surgery. We carried out a retrospective study enrolling all patients operated at the Yaoundé Central hospital for peripheral nerve pathology within the period of November 1999 to November 2007. Twenty-nine (29) patients were included. Trauma (15%), entrapment syndrome (11%) and neoplasia(3%) cases were observed. Concerning trauma cases, 10 cases (58.38 %) of fibrosis around the nerve bundle, 4 cases (23.52%) of completed nerve trunk section, and 1 case (5.89%) of partial nerve trunk section were diagnosed in the per operatory period. No lesion was found in two cases. The surgical management consisted of neurolysis (10 cases) and anastomosis in 4 cases (directly or with an onlay graft) and nerve transposition in 1 case. We obtained good results with neurolysis while the results with anastomosis were poor. The most important prognosticfactor was the delay of surgery above 15 months. The entrapment syndromes particularly carpal tunnel syndrome and neoplasia (neurinomas) were rare and represented only 10 cases.Key words : peripheral nerves, surgical pathologies, trauma, neurinomas, neurofibroma, carpal tunnel syndrom

Objectives: To evaluate the current reported incidence of diaphragmatic injuries (DI) and to determine criteria that could help make the diagnosis of DI and improve its recognition in traumatised patients in Cameroon.Design: A retrospective study.Subjects: The cases of all diaphragmatic injuries repaired and diagnosed in two major hospitals in Cameroon.Setting: The General Hospital of Douala and the University Hospital centre of Younde, Cameroon.Results: During a ten-year period we have repaired eight diaphragmatic injuries. Five of them were consecutive to penetrating trauma and three after blunt trauma. All the patients were males. The mean age was 34. 5 years. Seven injuries occurred on the right side. The average Injury Severity Score was 37. 5 and all the patients had associated injuries to other organs. DI represents only 0.05% of all trauma cases. DI is underestimated in Cameroon and under diagnosed because physicians are not trained to think or to recognise it and autopsy is rarely performed after a traumatic death. Although there are no specific signs or symptoms, we have found some criteria which can raise suspicion of DI.Conclusion: Diaphragmatic injury is a very difficult diagnosis, and it is under diagnosed in Cameroon. We suspect that many patients severely injured may have associated DI which is not recognised and may contribute to increased mortality rate after major trauma

Vingt deux fractures diaphysaires fémorales ont été colligées et traitées en 7 ans et 9 mois chez 21 enfants âgés de 0 à 15 ans. La prédominance masculine, la primauté du siège au1/3 moyen diaphysaire et du chevauchement comme déplacement ont été remarquables. Le traitement orthopédique a constitué l'essentiel du geste thérapeutique prenant en compte l'âge, le type de fracture, les lésions associées et le coût. Le traitement chirurgical chez un patient a été compliqué d’une pseudarthrose septique à distance. Quelque soit la méthode thérapeutique, 27,2% des patients ont présenté une inégalité de longueur des membres inférieurs d’au moins 10mm. Les auteurs soulignent les aspects thérapeutiques de ces affections.Mots clés : fractures diaphysaires, fémur, enfant.

Background: Gastric cancer is the second most common cancer of the gastrointestinal tract behind colorectal cancer in Cameroon. Total gastrectomy which is recommended for proximal gastric cancer is rarely performed and has not been reported in this country.Aim: To report emergency gastrectomy for life threatening haemorrhage of proximal gastric tumours.Methods: The case notes of all the patients who had total gastrectomy in two major hospitals in Cameroon from August 2002 to September 2009 were reviewed.Results: During the period, 15 patients had total gastrectomy for cancer. Five (5) patients out of these had emergency total gastrectomy for uncontrollable bleeding proximal ulcer cancer. All the cases were males with the mean age of 64.6years. A total gastrectomy with a D2 lymph node dissection and a Roux-en-Y oesophago-jejunostomy was carried out. A splenectomy was done in cases when the spleen was involved. Histo-pathological report revealed an adenocarcinoma in 4 cases (80%) and a lymphoma in one case (20%). There was no perioperative mortality but there was a minor complication of superficial wound infection in one case. One patient was lost to follow-up. Two (2) patients died at 18 months and 2 years respectively after the surgery while 2 patients are still alive.Conclusion: Proximal gastric cancer is more common in men in Cameroon. From our results, it is implied that total gastrectomy can be performed in Cameroon with few complications and an acceptable survival rate. Keywords: Emergency total gastrectomy; Cancer; Bleeding; Oesophago-jejunostomy

Les brûlures représentent 70% des accidents domestiques des enfants. Les brûlures graves sont responsables d'importantes perturbations mettant en jeu le pronostic vital. Cette étude s'est proposée de définir les caractéristiques épidémiologiques et les modalités thérapeutiques des brûlures graves chez les enfants admis en réanimation pédiatrique de l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaounde. Il s'agit d'une étude rétrospective réalisée de septembre 2002 à mars 2004 (soit 19 mois). Les dossiers complets des patients de 0 à 15 ans pour brûlures graves étaient retenus. 560 enfants ont été hospitalisés et parmi ceux-ci 20 ont été admis pour brûlures graves. Il y avait 12 garçons et 8 filles soit un sexe ratio de 1,5. La tranche d'âge de 0 à 3 ans a été la plus représentée (75%). Les liquides chauds ont représenté l'agent causal le plus fréquemment rencontré. Aucun patient n'a été pris en charge au lieu de l'accident, cependant des méthodes traditionnelles ont été utilisées (poils d'animaux, miel, oeuf…). La prise en charge intra-hospitalière a consisté en un remplissage vasculaire, l'analgésie, des pansements locaux, des antisécrétoires et des anxiolytiques. 50% des enfants ont reçu une antibiothérapie systématique aux urgences dès leur admission. Nous concluons que les brûlures graves chez l'enfant sont fréquentes ; les liquides chauds étant le principal agent causal. Les mesures de prévention basées sur l'éducation des populations s'imposent. Une prise en charge adéquate et pluridisciplinaire est indispensable. Mots clés: Brûlures graves, enfants, epidémiologie, thérapeutique. Clinics in Mother and Child Health Vol. 1(2) 2004: 85-88