Bonaventure Jemea

Feasibility of a simple drainage system in Cameroonian children after thoracotomy and decortication for empyema thoracis

BACKGROUND To analyse the outcome of children with empyema thoracis treated by decortication followed by a simple drainage system. PATIENTS AND METHODS Retrospective chart review from July 2001 to June 2010 of all cases of children who had a thoracotomy for empyema. We used an endotracheal tube as chest drain and a urinary bag as a collector. Statistical analyses were done using EXCEL and SPSS 9.0. RESULTS Forty one children underwent thoracotomy and decortication for empyema, there were 23 boys and 18 girls with a sex ratio of 1, 21. The mean age was 2½ years with a minimum of 1 month and a maximum of 15 years of age; 27 children were below two years of age. All the patients have received antibiotic for a long period before surgery. The culture was negative, except in two cases where we found Klebsiella pneumonia and Staphylococcus aureus. In five cases, the empyema was due to Mycobacterium tuberculosis. Three children presented a complication: One child had a persistent purulent drainage for 2 weeks; another one was re-operated upon because of necrotic lung abscess and one child died of sepsis. In most cases, the chest tube was removed between day 4 and day 6 post-operatively. The average length of hospital stay after the surgery was 10 days. CONCLUSION Thoracotomy and decortication in children with empyema can be safely done in Cameroon using a simple drainage system with good results compared to those in the literature.

Complex Pulmonary Aspergilloma: Surgical Challenges in a Third World Setting

Background Surgery for pulmonary aspergilloma (PA), especially complex forms, is greatly challenging in a resource-poor setting such as Cameroon. We report our experience of surgical management of PA in this environment. Method We prospectively assessed patients who underwent surgery for PA from January 2012 to May 2015, at the University Hospital Center of Yaoundé. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures, and outcomes. The study has received approval from the institutional ethics committees. Results In total, 20 patients (17 males and 3 females (sex ratio, 5.66); mean age, 30 years; range, 23–65 years) with a past history of tuberculosis were assessed. The median follow-up was 21.5 months. The primary symptom was hemoptysis, followed by cough and chest pain. All patients underwent surgical treatment and lung resection. Postoperative complications (bleeding, air leak, empyema, and severe anemia) occurred in 4 patients and 1 patient died. Although 3 patients were lost to follow-up, the survival rate was 80% with improvement of the preoperative symptoms. Conclusion Although surgery for complex aspergilloma is very challenging in environments such as ours, we believe that it is the best treatment modality for symptomatic diseases in our setting.

Prevalence, Awareness, and Control of Hypertension in Health Workers of Two Teaching Hospitals of Yaounde-Cameroon: The Hypertension Awareness Initiative (THAI) Pilot Survey

Introduction: High blood pressure is a public problem worldwide because of its high morbidity and mortality. The greatest burden is in low-income set-tings. The burden of disease has not been studied in health workers in our setting. Methods: Between December 2016 and June 2017, we carried out a cross-sectional descriptive and analytic study in two teaching hospitals in Yaounde, using the WHO STEP wise approach. Participants were consenting Physicians, Nurses, Midwives, and Nursing assistants of both sex, aged ≥ 21 years. Results: A total of 266 health workers were screened—31 Physicians, 144 Nurses, 80 Nursing assistants, and 11 Midwives. Their mean age was 41.1 ± 7.6 years (25 to 66 years), and 84.6% were females. The prevalence of Hypertension was 13.9%, of which 54.1% were newly diagnosed—Awareness rate of 45.9%. The control rate of known cases of hy-pertension was 64.7% (64.3% in those on monotherapy, and 66.7% in those on bitherapy). Age > 40 years, and adiposity were significantly associated with hypertension. Conclusion: Compared to the general population, the prevalence of hypertension amongst health workers was low, but with a high rate of un-awareness.

Unusual Life-Threatening Pneumothorax Complicating a Ruptured Complex Aspergilloma in an Immunocompetent Patient in Cameroon

An aspergilloma is a well-recognized lesion of the lung caused most of the time by the fungus Aspergillus fumigatus. Its main complication is hemoptysis and has been very rarely associated with tension pneumothorax. We present the case of a 47-year-old man with a history of treated and healed tuberculosis, which was successfully managed in our service for a ruptured right upper lobe complexed aspergilloma, complicated by a massive and tension pneumothorax. The patient underwent thoracotomy and lung resection with quick recovery. Conclusively, although rare, an aspergilloma may rupture and cause a life-threatening air leakage.

Vascular hyperreactivity in black Cameroonian hypertensive and normotensive patients: a comparative study

Introduction Vascular hyperreactivity is a risk factor and a factor predicting hypertension (high blood pressure). Unlike other continents where several studies were carried out, it has rarely been studied in black Africa in general and in Cameroon in particular. Methods Vascular reactivity was measured by the cold test. Vascular hyperreactivity was defined as an increase in blood pressure > 20 mmHg for systolic and/or > 15 mmHg for diastolic. Khi2, Man-Withney, Wilcoxons signed ranks and logistic regression tests were used for statistical analysis. Results A total of 31 hypertensive and 31 normotensive patients matched by age and sex participated in this study. Vascular hyperreactivity was present in 77.4% hypertensive patients and 51.6% normotensive patients. There was a significant association between vascular hyperreactivity and hypertension [OR = 3.2 (1.07 - 9.63), p = 0.034]. The median arterial pressure was higher in responders compared to non-responders in the normotensive group. Age > 45 years, female sex, obesity and family history of hypertension appeared to be associated with vascular hyperreactivity, but only in normotensive patients. Conclusion Vascular hyperreactivity appears to be a risk factor for high blood pressure in black Cameroonians. It appeared to be associated with low blood pressure, age, sex, obesity and family history of hypertension but this was only in the normotensive.

Paediatric fractures in a sub-saharan tertiary care center: a cohort analysis of demographic characteristics, clinical presentation, therapeutic patterns and outcomes

Introduction Paediatric fractures are often of good prognosis due to auto-correction of insufficient fracture reduction by bone remodeling. In sub-Saharan Africa, traditional healers are renowned for managing fractures and there is a neglect for specialized pediatric fracture care. We aimed to determine the demographic characteristics, clinical presentation, treatment patterns and outcomes of paediatric fractures in a tertiary health care centre in Yaoundé. Methods We conducted a prospective cohort study of all consenting consecutive cases of fractures in patients younger than 16 years managed between January 2011 and June 2015 at the University Teaching Hospital, Cameroon. We analysed demographic data, injury characteristics, fracture patterns, treatment details, therapeutic challenges and outcome of treatment at 12 months of follow-up. Results We enrolled 147 fractures from 145 children with a mean age of 7 years and male-to-female sex ratio of 2.5:1. The main mechanisms of injury were games (53%) and accidental falls (20.7%). Forearm fractures were the most common fractures (38%). The mainstay of management was non-operative in 130 (88.5%) fractures, with 29.3% manipulations under anesthesia and 17 (11.5%) open reductions with internal fixation. The most surgically reduced fractures were supracondylar humeral fractures. Major difficulties were long therapeutic delay, lack of diligent anaesthesia and the lack of fluoroscopy. The outcome of treatment was favorable in 146 (99.3%) paediatric fractures. Conclusion With the growing population of sub-Saharan Africa and the objective of becoming an emergent region, public policies should match the technical realities.

Surveillance of nosocomial infections in the Yaounde University Teaching Hospital, Cameroon

BackgroundNosocomial infections (NI) represent a real public health problem in developing countries. Their surveillance is recommended to provide needed information for better control. The aim of this study was to describe the frequency and distribution of NI in the Yaoundé University Teaching Hospital (YUTH).MethodsIt was a longitudinal and descriptive study targeting hospitalized patients in the intensive care, gynaecological, surgical and neonatal units. Each consenting patient was administered a questionnaire at the beginning of the study and followed up daily for the duration of their hospitalization using a standardized grid to detect all nosocomial infections. Cumulative incidence was used to estimate NI frequency.ResultsThere were 307 patients included. The cumulative incidence and specific mortality rate of NI were 19.21% (16.9–21.5) and 28% (16.2–42.5) respectively. Septicaemia (20.34%), infection of the skin and soft tissues (20.34%) and urinary tract infections (15.25%) were the most frequent type of NI. Klebsiella spp. was the most frequently isolated bacterium (27%).ConclusionNosocomial infections contribute to high hospital morbidity in the Yaounde University Teaching Hospital. Strategies need to be identified for a sustainable and continuous monitoring of NI in all health facilities of Cameroon. In addition, Further studies should identify NI determinants and interventions for efficient and better control.