Marcelin Ngowe

The challenge of intra-abdominal sepsis

UNLABELLED An overview of intra-abdominal sepsis is necessary at this time with new experimental studies, scoring systems and audits on management outcomes. The understanding of the pathophysiology of the peritoneum in the manifestation of surgical sepsis and the knowledge of the source of pathogenic organisms which reach the peritoneal cavity are crucial in the prevention of intra-abdominal infection. Inter-individual variation in the pattern of mediator release and of end-organ responsiveness may play a significant role in determining the initial physiological response to major sepsis and this in turn may be a key determinant of outcome. The ability to identify the presence of peritoneal inflammation probably has the greatest influence on the final surgical decision. The prevention of the progression of sepsis is by early goal-directed therapy and source control. Recent advances in interventional techniques for peritonitis have significantly reduced the morbidity and mortality of physiologically severe complicated abdominal infection. In the critically ill patients there is some evidence that the prevention of gut mucosal acidosis improves outcome. The aim of this review is to ascertain why intra-abdominal sepsis remains a major clinical challenge and how a better understanding of the pathophysiology may enable its prevention and better management. METHOD Electronic searches of the medline (PubMed) database, Cochrane library, and science citation index were performed to identify original published studies on intra-abdominal sepsis and the current management. Relevant articles were searched from relevant chapters in specialized texts and all included.

Risk Factors of Cardiovascular Diseases in HIV/AIDS Patients on HAART

Background : The introduction and widespread use of combination antiretroviral therapy referred to as highly active antiretroviral therapy (HAART) in the mid 1990’s, has led HIV-infected individuals to experience a dramatic decline in immunodeficiency-related events and death. There is growing concern on metabolic complications associated with HIV and HAART which may increase cardiovascular risk and disease. The aim of this study was to investigate the cardiovascular risk profile of HIV/AIDS patients receiving HAART and those not receiving HAART at HIV/AIDS treatment centres in the South West Region of Cameroon. Methods : Consenting participants, who had been receiving HAART, were compared with HAART naive participants. A questionnaire was administered; anthropometric and blood pressure measurements were recorded under standard conditions. Blood samples were obtained for the determination of plasma glucose and lipid levels. Results : Two hundred and fifteen participants were recruited, 160 (74.4%) were on HAART and 55 (25.6%) were HAART naive. Among the individual lipid abnormalities, increased total cholesterol was the most prevalent (40.0%). Participants on HAART were significantly about 8 times at risk of developing hypercholesterolemia when compared to the HAART inexperienced group (OR 8.17; 95% CI: 3.31-20.14; p<0.001). Hypertension had a prevalence of 25.6% (95% CI: 15.3%-35.9%) and was about 2 times significantly higher in the HAART treated than the HAART untreated group (p=0.033). The prevalence of low HDL-c was significantly higher in males (24.1%) compared to females (11.2%) (p=0.0196). Many females (27.3%) were obese compared to males (7.4%) (p=0.0043). HAART use and treatment duration of more than five years were significantly associated with higher prevalence of CVD risk factors. Conclusion : HAART treatment was associated with significantly higher prevalence of hypercholesterolemia, increased LDL-c and hypertension, hence the risk of cardiovascular diseases.

How grim is hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a complex disease and a major cause of death in high endemic areas of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. HCC has gone from being a universal death sentence to a cancer that can be prevented, detected at an early stage and effectively treated. Liver resection or tumour ablation techniques may be effective bridge to liver transplantation if they fulfill the Milan criteria. The areas of progress in HCC are in the control of HBV or HCV and the development of adjuvant or neoadjuvant therapies.

Burkitt's lymphoma masquerading as appendicitis--two case reports and review of the literature.

Two cases of Burkitt’s lymphoma masquerading as appendicitis are reported herein. The diagnoses were made post-operatively from the appendix specimen in one case and from an ileocecal resection specimen for cecal fistula complicating an appendicectomy in the second case. These cases highlight the importance of routine histological examination of appendicectomy specimens.

The Relationship between Uric Acid and Hypertension in Adults in Fako Division, SW Region Cameroon

Uric acid has been associated with hypertension in many studies involving different populations but little or no information was found on this association in a Cameroonian population. The aim of this study therefore was to correlate serum uric acid concentrations with blood pressure measurements in individuals who are hypertensive, pre-hypertensive and normotensive, and to investigate the possibility of existence of an association between uric acid levels and other risk factors for hypertension. A total of 297 adults from Fako Division participated in the study. Blood pressure, serum uric acid, fasting blood glucose (subjects with ≥ 110mg/dl were excluded), lipids, body mass index and waist circumference were measured. Individuals who were pre- hypertensive had the highest mean uric acid concentration which was significantly higher than that for normotensives (P<0.0001). There was a significant positive correlation between uric acid with systolic and diastolic blood pressure (P<0.0001; P<0.0001), respectively. A significant positive correlation was also observed between serum uric acid levels with gender, age, triglycerides and life style patterns (P<0.0001). However, adjusting for these confounders did not change the increasing trend observed between serum uric acid with both systolic and diastolic blood pressure.

Strangulated or incarcerated spontaneous lumbar hernia as exceptional cause of intestinal obstruction: case report and review of the literature

Lumbar hernias are rare conditions and about 300 cases have been reported since the first description by Barbette in 1672. Therefore strangulation or incarceration are also exceptionally encountered. We present a 62 -year-old-man who had strangulated left lumbar hernia and consequent mechanical small-bowel obstruction, alongside with a non strangulated right lumbar hernia. Through a median laparotomy, an intestinal necrosis was found. A bowel resection with end to end anastomosis was performed and the lumbar hernias were repaired on both sides. The recovery was uneventfull. To the best of our knowlwdge thanks to the litterature review presented here, this is the 19th case of incarcerated or strangulated spontaneous lumbar hernia described in the surgical litterature since 1889.

A Rare Presentation of Maydl's Hernia

We present a case of an unsual type of obstructed indirect inguinal hernia with impending strangulation. The operative findings revealed a sliding Maydls hernia with an ischemic inner ileal loop and an adherent inflamed appendix. This case highlights the importance of intraoperative examination of the intra-abdominal bowel loops proximal to the hernia sac of an incarcerated, obstructed, or strangulated hernia.

Gastric leiomyosarcoma as a rare cause of gastric outlet obstruction and perforation: a case report.

BackgroundGastrointestinal stromal tumours are the most common mesenchymal malignancies of the gastrointestinal (GI) tract and gastric leiomyosarcoma represent 1-3% of gastric malignancies.Case presentationWe report a case of a 69-year- old black African man who presented with a rare cause of gastric outlet obstruction and duodenal perforation. A Billroth- II gastrectomy was performed and histology confirmed a gastric leiomyosarcoma.ConclusionsIt is important to identify the gastric leiomyosarcoma which is a variant of the more common malignant gastrointestinal stromal tumours as the pathogenesis and management are currently well established. As the facilities for differentiating these are not easily available in resource-limited areas gastrointestinal stromal tumours may remain underdiagnosed and undertreated.

Intestinal metaplasia and anastomotic recurrence of gastric carcinoma

Intestinal metaplasia (IM) of the stomach has been shown to increase the relative risk of gastric cancer. Endoscopic surveillance has been proposed and advocated for populations at risk. Those patients who had undergone surgery for gastric malignancy exhibited precancerous lesions such as atrophic gastritis and IM, and the possibility of anastomotic recurrence is higher than for the patients who had undergone benign gastric surgery. At present, there are no other recognized good markers of gastric dysplasia or cancer. We reviewed the literature on IM of the stomach to ascertain whether residual premalignant (type III) IM may predispose to anastomotic recurrence of gastric cancer.

Incidence and risk factors of anti-tuberculosis drugs induced hepatotoxicity in HIV/AIDS patients attending the Limbe and Buea Regional Hospitals.

Background: Hepatotoxicity is one of the most frequent adverse events induced by anti-tuberculosis chemotherapy and remains one of the main causes of treatment interruption during TB treatment leading to hospitalization and life threatening events. Despite the high prevalence of TB/HIV co-infection in sub-Sahara Africa, paucity of data still exists on anti-TB drugs induced hepatotoxicity in HIV patients. Therefore, this study was aimed to determine the incidence and risk factors of hepatotoxicity induced by anti-tuberculosis drugs in HIV patients. Methods: From March to September 2013, we conducted a nested case-control study by retrospectively following up TB/HIV co-infected patients on anti-TB treatment at the Buea and Limbe Regional Hospitals. Patients who developed hepatotoxicity due to increased liver enzymes (ALAT and ASAT) after anti-TB treatment initiation were labelled as “cases” while those without hepatotoxicity were “controls”. Each case was compared with 3 randomly selected controls. Results: From the 191 TB/HIV patients recruited in the study, 26 developed hepatotoxicity. These 26 were labelled as cases and were compared to 78 randomly selected controls. WHO HIV/AIDS clinical stage 4, BMI<18.5 Kg/m2, CD4 count<50 cells/mm3, hepatitis B co-infection, and extra pulmonary TB were significantly associated with the development of anti-TB drug induced hepatotoxicity. These variables were then analysed using multivariate logistic regression and BMI<18.5 Kg/m2 [P=0.033; AOR=3.7] and hepatitis B co-infection [P=0.019; AOR=6.6] were identified as independent predictors of anti-TB induced hepatotoxicity. Conclusion: The incidence of anti-TB drug induced hepatotoxicity was 13.61%. The findings suggest that TB/ HIV co-infected patients presenting with poor nutritional status as defined by BMI<18.5 Kg/m2 andhepatitis B should be closely monitored by clinicians especially during the intensive phase of anti-tuberculosis chemotherapy for better patient management and for the prevention of morbidity and mortality