Knowledge, Attitude and Practice of Breast Self-Examination amongst Women in Two Communities of Cameroon

Breast cancer is a major health problem in the world. It is the most common cancer in women and is equally the leading cause of cancer death in women. Though in controversy Breast self-examination (BSE) remains a useful tool in early diagnosis of breast cancer. The aim of this study was to evaluate the knowledge, attitude and practice of BSE amongst women in Yaoundé and Monatele. We carried out a cross sectional study in two communities of Cameron over a period of eight months, targeting females older than 15 years. After obtaining authorization, we randomly interviewed 402 consenting participants, using a pretested questionnaire. Data were entered using CS Pro 7.3 and analysed using SPSS 23. Of a total of 402 participants, 256 (63.7%) in Monatele and 146 (36.3%) in Yaoundé VI, the mean age was 26.55 ± 9.57 years. Exactly 50% (201) had earlier heard of BSE. Health personnel and media represented the main sources of information on BSE. Of the total, 46 (11.4%) knew BSE should be done monthly. Fifty-three percent had poor knowledge and 51.0% had a generally low attitude towards BSE. Out of 402 participants, 65.2% reported not practicing BSE. For those practicing, 71.6% had poor practices. The main reason for not practicing was lack of knowledge. Poor knowledge increased poor practice. In conclusion half of the women had heard about BSE even though the majority had a poor knowledge on BSE and very low overall attitude and practice. Health personnel and media played a key role in passing of information. Increasing the number of health campaigns, multiplying TV shows and health talks about breast self-examination will improve knowledge and hence attitude and practice.

Maternal and Fetal Outcomes of COVID-19 Pregnant Women Followed Up at a Tertiary Care Unit: A Descriptive Study

Background: The SARS-CoV-2 and associated corona virus disease COVID-19 have been declared a pandemic having a poor prognosis among individuals with debilitating conditions and those who are immune-compromised. Current evidence is however limited on maternal and fetal transmission and pregnancy outcomes. We aimed to describe the pattern of SARS-CoV-2 infection and outcomes in a group of pregnant women followed up at a tertiary care unit in Cameroon. Methods: This was an observational study conducted over a period of 3 months (April 1 to June 30, 2020) at the Yaounde Central Hospital. All pregnant women who were tested positive for SARS-CoV-2 and who provided a signed written informed consent were included in the study. Results: Out of 83 pregnant women who presented with symptoms suspicious of COVID-19, 25 were tested positive. The median age of these women was 31 (27 - 35) years. A total of 76% consulted within 6 days of onset of symptoms and 68% had a gestational age greater than 28 weeks. The most common presenting complaint was fever (88%). All 25 pregnant women who were tested positive for COVID-19 were followed up with 9/25 deliveries registered. There were two intra-uterine fetal deaths and seven live births. All the live birth babies were tested negative on Real Time-Polymerase Chain Reaction (RT-PCR) testing which was performed after birth. Conclusion: Deliverance of live and SARS-CoV-2 negative babies from COVID-19 pregnant women is possible.

Inflammatory bowel diseases and human reproduction:A comprehensive evidence-based review

To evaluate the effects of inflammatory bowel diseases(IBDs)on human reproduction,we reviewed the current literature using a systematic search for published studies(articles and/or abstracts)without limits for English language.We searched on Medline(through PubMed),the Institute for Scientific Information,the Web of Science and the websites for the registration of controlled trials(http://controlled-trials.com/).Bibliographies of retrieved articles,books,expert opinion review articles and reviewed bibliographies from subject experts were manually searched.Titles and abstracts were screened initially,and potential relevant articles were identified and reviewed.Whenever possible,data were analyzed by comparing IBD patients vs healthy controls,and patients with active IBDs vs those with disease in remission.The effects of IBDs on female fertility,fertility in infertile couples,pregnancy and male infertility were examined separately.Patients with IBDs in remission have normal fertility.At the moment,there is no established guideline for the preservation of fertility in women with IBD undergoing surgery.Further data are needed regarding guidelines for the management of these patients.Data regarding IBDs and infertility are currently completely lacking.Considering the prevalence of intestinal pathology in young adults of childbearing age,this field is of great scientific and clinical interest,opening up important future perspectives.Another important and as yet unexplored point is the response to treatments for infertility in patients with IBDs.In particular,the question is whether the reproductive outcomes(clinical and biological)can be influenced by the IBD of one of the partners.The goals for successful reproductive outcomes in IBD population are correct counseling and disease remission.IBDs significantly affect several reproductive aspects of human(female,male,couple)reproduction.Further data are needed to develop guidelines for the clinical management of subjects of reproductive age with IBDs.

Illness Perception in Gestational Trophoblastic Disease Patients: How Mental Representations Affect Anxiety, Depression, and Infertility-Related Stress

Gestational Trophoblastic Disease encompasses a group of pregnancy-related disorders that derive from the placenta. Taking Leventhal’s Common Sense Model as a starting point, this study aims to investigate how illness perception could influence patients’ psychological adaptation to these rare diseases. Thirty-seven women completed: the Illness Perception Questionnaire-Revised, the Beck Depression Inventory Short Form, the State-Trait Anxiety Inventory, and the Fertility Problem Inventory. Results show that the perception of severe illness consequences significantly predicts the level of anxiety patients reported at the time of questionnaire completion. Furthermore, mental representations of illness present a significant association with infertility-related stress. Specifically, the belief in the efficacy of the treatment results in fewer feelings of discomfort and isolation from family and social context due to infertility-related problems. Since patients’ illness perception was found to have a specific impact on both anxiety and infertility-related stress, this variable should be considered in the planning of a clinical intervention.

Obstetrical and Perinatal Outcomes of Adolescent Pregnancies in Cameroon: A Retrospective Cohort Study at the YaoundéGeneral Hospital

Background: Adolescent pregnancy is a serious health and social problem worldwide as well as in Cameroon. The aim of this study was to determine the obstetrical and perinatal outcomes of nulliparous adolescent pregnancies in a reference hospital in Cameroon. Methods: A retrospective cohort study to compare the outcomes of nulliparous adolescent pregnancies to those of nulliparous women aged 20 to 25 years was carried out at the Yaoundé General Hospital between January 1993 and December 2012. Results: Adolescent deliveries represented 2.84% (331 deliveries) of all deliveries registered during the study period. The adolescent mothers had a significantly higher incidence of preeclampsia/eclampsia, preterm delivery and low birth weight babies (<2500 g) when compared to the control group (OR, 3.46;CI 95%, 1.46 - 8.18;OR, 1.94 CI 95%, 1.34 - 2.79;OR, 1.98, CI 95%, 1.39 - 2.46, respectively). However, placenta previa, abruptio placenta, episiotomy, cesarean section, vaginal instrumental delivery, perineal tears and post partum hemorrhage were not significantly different in the two groups. Furthermore, there was no statistically significant difference between the two groups regarding fetal distress, low Apgar score (st and 5th minutes), the rate of admission in the neonatal intensive care unit, stillbirth and neonatal death. Conclusion: Adolescent pregnancy is associated with an increased risk of preeclampsia/ eclampsia, preterm birth and low birth weight.

Maternal and Perinatal Complications of Severe Preeclampsia in Three Referral Hospitals in Yaoundé, Cameroon

Objective: The aim of this study was to determine maternal and perinatal complications of pregnancies complicated by severe preeclampsia in three tertiary care centers in Cameroon. Methods: We carried out a descriptive cross sectional study from the 1st of June 2012 to the 31th of June 2014, among pregnant women with severe preeclampsia followed up in three tertiary level hospitals in Yaoundé, Cameroon: the Yaoundé General Hospital, the Yaoundé Central Hospital, and the Yaoundé University Hospital. Statistical analysis was performed using EPI 3.5.5. Data were described as means ± standard deviation, percentages and numbers. Chi-square and Fisher exact tests were used where appropriate. Results: Of the 2500 deliveries registered during the study period, 111 cases (8.49%) were managed as severe preeclampsia. Four patients refused to participate and were excluded from the study. Most of these patients were non workers (58.0%), pauciparous (61.7%) and young (median age of 27.47 years ± 6.46). Eclampsia (12.14%), abruptio placentae (11.21%) and hypertensive retinopathy (7.47%) were the most frequent maternal complications. Two cases (1.86%) of maternal deaths occurred in patients who had eclampsia. Prematurity (48.6%), intra uterine fetal death (13.1%) and oligoamnios (11.2%) were the most frequent fetal complications. All four neonatal deaths occurred in women in whom the diagnosis of severe preeclampsia was done between 28 and 33 weeks of gestation. Conclusion: Pregnancies complicated by severe preeclampsia had significantly high maternal and perinatal morbidity and mortality in Cameroon. The complications of severe preeclampsia can be prevented by more widespread use of antenatal care, education of primary medical care personnel, prompt diagnosis of high-risk patients and timely referral to tertiary medical centers.

Voluntary Induced Abortion in Cameroon: Prevalence, Reasons, and Complications

In Cameroon, induced abortion is permitted when a woman’s life is at risk, to preserve her physical and mental health and on the grounds of rape or incest. Objectives: The aim of this study was to determine the prevalence, reasons and complications of voluntary induced abortion among women attending the obstetrics and gynecology services in an urban area, Yaoundé and in a rural area, Wum in Cameroon. Methods: We carried out a cross sectional study, with 509 women recruited between August 1, 2011 and December 31, 2011 in three health facilities in Cameroon. We appreciated the frequency, complications and reasons for Voluntary induced abortions. Results: The prevalence of voluntary induced abortion was 26.3% (134/509) globally;25.6% (65/254) in urban area and 27.1% (69/255) in rural area. One hundred and eleven (83%) cases of induced abortions were carried out in a health structure and 23 (17%) cases in private homes. Medical doctors and nurses were the most frequent abortion providers in both urban (84.7%) as well as rural setting (77.2%). The three main reasons for induced abortion were to pursue their studies (34.3%), not yet married (22.6%) and fear of parents (13.9%). Complications were reported by 20% (27/134) of respondents who had carried out voluntary induced abortion. Excessive bleeding was the most reported complication (70.4%). Conclusion: Despite its illegality in Cameroon, the prevalence of voluntary induced abortion was high in this study.

Knowledge, Attitudes and Practices of Infertile Women on Child Adoption in Douala (Cameroon)

Background: The aim of the study was to evaluate the knowledge, attitude and practices on child adoption among infertile women in Douala (Cameroon). Methods: It was a prospective descriptive study of six months duration at the General Hospital and the Dawn Medical Foundation Clinic. Patients of the gynecologic unit presenting with infertility were included. A questioner was administer to each patient with the following variables: Age, marital status, profession, level of education, past gynecologic history, number of children, type and the duration of infertility. Their knowledge, attitude and practice toward child adoption were investigated. Data collected was analyzed using the statistical software EPI-INFO 6.04 and R. p value < 0.05 was considered to be statistically significant. Results: Among the 300 women included, 269 (89.7%) had already heard about adoption, 62.1% through the media. Seventeen percent knew who to meet in order to adopt a child in Cameroon. Two hundred and thirty patients (76.7%) were in favor of adoption but 48.7% of them didn’t want to adopt a child. One percent of patient had adopted a child. The attitude towards adoption was significantly influenced by the duration of infertility of more than 10 years (p = 0.0014). Among women who have at least one child 9.4% wanted adoption against 21.4% who did not want adoption (p = 0.0305). Among women aged between 25 and 30 years, 28.2% wanted to adopt a child against 79.1% who did not want it (p = 0.000). Eighty five percent of women who had secondary infertility did not want to adopt against 44.7% who wanted it (p = 0.0003). Conclusion: The level of knowledge is high in educated patient. However, many women don’t know the right procedure and the structures in charge of adoption. Their attitude is favorable but the practice of adoption remains low.

Circadian Rhythm of Childbirths and Maternal and Neonatal Prognosis at the YaoundéCentral Hospital

Background: The circadian variation of childbirths has been described by several authors around the globe. De Graaf showed that hospital childbirths at night were associated with increased perinatal mortality and adverse perinatal outcome. To improve obstetric care, we carried out this study to evaluate the circadian rhythm of childbirths and to assess the outcome following variations in the time of childbirths during the day. Methods: It was a cross-sectional descriptive study at the Yaoundé Central Hospital (YCH), over a two years period. We collected data from files of women who delivered from the 1st of January 2017 to 31st December 2018. We included files of women who delivered at least at 28 weeks of pregnancy. We excluded files of those who delivered by elective caesarean section, those whose hour of delivery was not noted and those who delivered before reaching the hospital. Sociodemographic, obstetrical characteristics, and immediate prognosis were recorded. Data were entered into excel, then analysed with SPSS v23 software. Tools used to appreciate our results were means, median, number, percentage, P, and OR with its 95% confidence interval. The difference in p is significant if p is less than 5%. Results: We analyzed 6041 files bearing the time of birth. Childbirths took place at all hours of the day, but the times of the day where the highest numbers of births were recorded were 10, 11, 12, 13 (that’s 1pm), 14 (that’s 2 pm), 15 (that’s 3 pm), 16 (that’s 4 pm), 17 (that’s 5 pm) and 23 (that’s 11 pm) hours, with respectively 224 (3.7%), 277 (4.6%), 256 (4.2%), 265 (4.4%), 207 (3.4%), 255 (4.2%), 228 (3.8%), 216 (3.6%) and 226 (3.7%) births. The peak of births was at 11 am while the time of day where the lowest number of births was recorded was 6 pm, with 175 (2.9%) births. The mean age of participants was 27.34 ± 6.03 years with extremes of 13 and 49, with 87.6% between 20 to 39 years. Sociodemographic characteristics of participants, prematurity and bleeding during delivery, had no dependence on the time of delivery. Perineal tear, duration of observation, Apgar score of the newborn, birthweight, delivery mode, health personnel who performed the delivery, and episiotomyseemed to be influenced by the time of delivery. Daily shifts were not independently associated with the poor Apgar score (0 - 6) at 5 mins, when adjusted for all other factors (p = 0.109). Conclusion: Childbirths were more frequent between 10 am and 5 pm. The period where episiotomy was most performed is the same as when there was macrosomia childbirth. Tears of the perineum are more frequent between 2 pm and 10 pm. There was no independent association between Daily shifts and poor Apgar score. The poor APGAR score would be more related to low birth weight.

Complications of Twin Delivery and Associated Factors: A Hospital-Based Cross-Sectional Analytical Study in Yaoundé

Background: Twin birth is considered a high-risk obstetrical situation. Despite the progress in obstetrical and pediatric care that has occurred in recent years, twin delivery is still associated with high maternal morbidity and perinatal mortality. Few recent studies have focused on the complications and risk factors associated with complications of twin birth in our environment. The objective of our study was to identify the complications of twin birth and the factors associated with them. Methodology: We carried out a cross-sectional analytical study. Data collection was prospective, over a period of 4 months (January 1, 2022 to April 30, 2022), at the maternity units of the Gyneco-Obstetric and Pediatric Hospital of Yaoundé and the Central Hospital of Yaoundé. The study population included all pregnant women who gave birth to twins during our study period at these hospitals. Data analysis was done using the SPSS software (Statistical Package for the Social Sciences) version 23.0. The Chi-square test was used to compare proportions and the student’s t test to compare means. A p-value of less than 0.05 was considered statistically significant. Results: In total, we recorded 37 complicated twin deliveries out of a total of 66 twin deliveries. This corresponded to a complication rate of 56%. Maternal complications occurred in 11.38% of cases, the majority being soft tissue lesions (4.54%), and postpartum hemorrhage (4.54%). Perinatal complications at the time of delivery were dominated by early neonatal infections (12.12%), non-reassuring fetal condition (10.6%) and intrauterine fetal death (6.06%). Factors associated with complications of twin births after univariate analysis were: maternal age ≤ 30 years (OR = 8.15;CI = 9.78 - 71.06;P = 0.03), being a student, (OR = 5.09;CI = 3.65 - 7.10;P = 0.00), primary level of education (OR = 1.48;CI = 3.30 - 6.63;P = 0.00), having less than four prenatal contacts (OR = 5.76;CI = 12.2 - 27, 24;P = 0.02), lack of ultrasound assessments (OR = 2.65;CI = 1.08 - 4.65, P = 0.04), diagnosis of twinning at labor (P = 0.03), admission for preeclampsia and eclampsia (OR = 2.01;CI = 1.24 - 5.9;P = 0.04), qualification of birth attendant as midwife (OR = 2.33;CI = 6, 38 - 8.50;P = 0.00), delivery time greater than 15 minutes for the second twin (OR = 2.45;CI = 1.14 - 5.26;P = 0.019). Conclusion: twin birth remains associated with high maternal and neonatal morbidity in our environment. The rate of maternal-fetal complications is 56% in our series. Post-partum hemorrhage, soft tissue injury and early neonatal infections are the main complications. These are closely linked to a number of factors whose control would improve the prognosis of twin birth.

Insulin Sensitivity of Term Newborns Exposed in Utero to HIV and Antiretrovirals in Yaoundé

Introduction: Antiretrovirals (ARVs) and the human immunodeficiency virus (HIV) are implicated in the onset of insulin resistance. They cross the placental barrier thereby inducing early modifications of the fetal environment. The aim of our study was to assess insulin sensitivity in full-term newborns exposed in utero to HIV and ARVs in Yaoundé. Materials and Methods: We conducted an analytical cross-sectional study in 2 maternities in the city of Yaoundé from November 2021 to June 2022. We generated two groups of newborns (NBs): one group born to HIV positive mothers on ARVs and the other control group born to HIV negative mothers. Clinical data from mothers and NBs were collected. A homeostatic model assessment of insulin resistance (HOMA-IR) like index with C peptide served to assess insulin sensitivity. We used the Spearman correlation to measure the strength of association between insulin sensitivity and the different variables. A p-value Results: Of 70 neonates included, 35 were born to HIV positive mothers on ARVs and 35 to HIV negative mothers. The median age of HIV positive and negative mothers was 30 (27 - 32) and 34 (24 - 47) years, respectively (p = 0.791). The body mass index before pregnancy as well as the average newborn weights were comparable in both groups. The ARV protocol associating Tenofovir, Lamivudine, Efavirenz was used by 97.1% of HIV positive mothers. In the exposed NBs group, C peptide was significantly lower (p < 0.001) and blood glucose significantly higher (p < 0.001). The median values of HOMA-IR were 1.4 (0.8 - 1.9) and 2 (1.4 - 2.6) (p = 0.001) for exposed and unexposed NBs, respectively. Conclusion: Newborns exposed to HIV and ARVs had lower C peptide levels and were more sensitive to insulin. Close metabolic monitoring of these newborns would allow early diagnosis and management of any glucose regulation disorder.

Acute right lower abdominal pain in women of reproductive age:Clinical clues

AIM: To study possible gynecological organ pathologies in the differential diagnosis of acute right lower abdominal pain in patients of reproductive age.

Protective effects of intravenous anesthetics on kidney tissue in obstructive jaundice

AIM: To evaluate the protective effects on kidney tissue of frequently used intravenous anesthetics (ketamine, propofol, thiopental, and fentanyl) in rats with obstructive jaundice.

Management of Cervical Intra Epithelial Neoplasia by Loop Electrosurgical Excision Procedure in a Low Resource Country: An Experience from the YaoundéGeneral Hospital, Cameroon

Background: Cervical cancer is the third most common cancer worldwide, and 80% of cases occur in the developing world. A critical component of effective cervical cancer screening programs is the ability to offer women appropriate and effective treatment for cervical intra epithelial neoplasia (CIN). Objectives: This study aimed at assessing the primary experience of management of CIN by Loop Electrosurgical Excision Procedure (LEEP) in a low resource country. Methods: We carried out a descriptive cross sectional study at the Yaoundé General Hospital in Cameroon. Results: Twenty three cases of CIN were treated by LEEP. Mean age of patients was 40.5 ± 9.9 years. Six (26.1%) patients were infected by the Human Immunodeficiency Virus (HIV). LEEP was indicated in 21 (91.30%) cases for CIN2 and CIN3. The mean duration of the surgical procedure was 10 ± 3 minutes. There was one (4.3%) complication (persistent cervical bleeding). Surgical margins were negative for dysplasia or invasive carcinoma in 18 (78.26%) cases and non-applicable in 5 (21.73%) cases (thermal artefacts of margins and cervicitis without CIN). One patient with micro invasive carcinoma on post-operative histology was treated by total hysterectomy. Cervical cytology was normal at 6 months post LEEP for 15 cases out of 16 (93.8%) patients who performed the test. One woman achieved pregnancy and delivered a term baby. Conclusion: Treatment of CIN by LEEP is feasible, safe and effective in our setting.

Successful robot-assisted surgery for treating endometrial cancer affecting bicornuate-bicollis or didelphic uterus

Uterine anomalies are mainly associated with improper development of Mullerian ducts. To our knowledge, reports describing the use of a da Vinci Robot System for treating an endometrial cancer in a woman with an abnormal uterus are lacking. Here, we reported the description of two extremely obese women, affected by endometrial cancer and presenting bicornuate-bicollis and didelphic uterus have been treated by Robot System-assisted surgery. No operative and postoperative complications were recorded. Both women are disease-free to follow-up. A robot-assisted surgery could represent an effective treatment option for complex hysterectomies and in complicated patients, as those showing an extreme obesity.

Prenatal Diagnosis of Congenital Malformations in Douala General Hospital

To determine the prevalence of congenital malformations and the proportion of cases diagnosed before birth;to specify this proportion according to the type of malformation and the sonographer qualification. Methods: It was a cross-sectional study carried out at the Douala General Hospital in the obstetric and neonatal units over a period of 42 months, from January 2008 to June 2012. The procedure consisted of;firstly an explanation of the study purpose with consent of parents obtained, thereafter, the parents were interviewed and data extracted from their files. The new born had a complete clinical exam. Morphological and biological assessment were done to ascertain diagnosis if needed. They were then followed up for 48 hours. Data were analysed using SPSS. Statistical analyses were mainly descriptive: mean, median, mode and frequency were calculated. Results: During this period, 6048 neonates were examined, 99 of whom had a malformation giving a prevalence of 1.64%. Musculoskeletal defects were the most common (36.4%), followed by digestive tract defects (22.2%). Ultrasounds were carried out mainly in the second term. Among the malformed babies, only 16.2% were diagnosed during the prenatal period. The obstetricians did better than radiologist in the prenatal diagnosis of congenital malformations. All the urinary tract malformations and 33.3% of the polymalformations were diagnosed by prenatal echography. Among the malformed babies, 33% died within the first 48 hours of life and poly-malformed babies were more concerned (66.7%). Conclusion: The prevalence of congenital birth defect was 1.64%. The rate of prenatal diagnosis remained low, meanwhile one third of the affected babies die after births. An early diagnosis would anticipate on medical care at birth and allow therapeutics abortions when indicated.

Unmet Needs for Family Planning among Adolescent Girls Giving Birth in Three Teaching Hospitals in Yaoundé

Many adolescent girls are pressured into having sex at an early age, which puts them at high risk of unwanted pregnancies and unsafe abortions. The overall objective of this study was to evaluate the unmet needs of adolescents who give birth. A descriptive cross-sectional study was carried out in three university hospitals in Yaoundé, Cameroon: Yaoundé Central Hospital, Yaoundé Gyneco-Obstetrics and Pediatric Hospital and the District Hospital of Biyem-Assi, from February 1, 2020 to June 30, 2020. Included were any teenage mothers speaking English or French. Data were entered using CSPRO 7.3, analyzed by Excel 2010 and SPSS version 23.0. The tools used to express our results were the number, the frequency, the mean, the odds ratio (OR) and the P. P was significant if less than 5%. Of a total of 2692 births recorded, 188 (7%) were from adolescents. Of these, 157 fulfilling our selection criteria were recruited and data analyzed. The average age of the participants was 17.9 ± 1.12 years with extremes of 13 and 19, the average parity was 1.2 ± 0.4 with extremes of 1 and 3. Out of 157 participants, 2 who fell in the age range of 10 to 14 years (100%) and 106 of 155 (68.4%) whose age ranged from 15 to 19 years had unmet need for family planning. Only unmarried participants had unmet needs after multivariate analysis [aOR 2.4 (1.1 - 5.3);p = 0.035)]. Being unmarried was independently associated with the occurrence of unmet needs. The intensification of campaigns for provider behavior changes communication and the creation of services dedicated to the sexual and reproductive health of adolescents would help to reduce the rate of unmet needs for family planning among adolescent girls.

Longitudinal Epigastric Incision for Caesarean Section in a Morbidly Obese Patient in a Low-Resource Setting (Cameroon): A Case Report

Obesity is a metabolic condition associated with a significant morbidity and mortality rate. In the pregnant context, this risk is even higher because of the contingent of metabolic and haemodynamic complications present in the ante-, intra- and post-partum periods. In these people, the recommended delivery method is caesarean section, which is not easy to perform. Our aim is to explain the particularities and advantages of epigastric incision in obese women during a caesarean section. The authors report the case of a patient who was admitted to the maternity ward of the Yaounde Central Hospital for management of a post-date, and in whom an elective caesarean section was indicated with an epigastric approach. The vertical supra umbilical incision should be recommended because it is subject to fewer complications and reduces the operating time and hospital stay.

Study on the bone marrow mesenchymal stem cells induced drug resistance in the U937 cells and its mechanism

Background The hematopoietic microenvironment （HM） plays a critical role in malignant cell growth, patient survival, and response to chemotherapy in hematologic malignancies. However, mechanisms associated with this environmental influence remain unclear. In this study, we investigated the role of bone marrow derived mesenchymal stem cells （MSCs） in U937 cell line, the MSCs. to find out the relations between leukemia drug resistance and Methods U937 cells were cultured in suspension or grew adherently with MSCs. The cell growth curve was drawn and the cell cycle was measured by flow cytometry. Apoptosis and sensitivity of U937 to daunoblastina （DNR） were quantified by DNA ladder detection and trypan blue exclusion assays, respectively. The gene expression profile chip technology was used to determine and analyze the changes in apoptosis-related gene expression after adherent culture and the expression of MDR 1 mRNA was assessed by reverse transcriptional polymerase chain reaction （RT-PCR） at the same time. Results In the adherent culture, the proliferation of the U937 cells was inhibited, the G0/G1 phase cells increased （F=64.9726, P〈0.0001）, G2/M phase cells were decreased （F=98.1361, P〈0.0001） and the natural apoptosis rate was decreased （F=24.0866, P〈0.0001） compared with those in the suspended culture. U937 cell viability was enhanced and cell apoptosis was blocked during DNR treatment in adherent culture with MSCs. Thirty-nine differently expressed genes were screened from the 487 apoptosis related genes in the adherent culture U937 cells. Among the 37 upregulated genes, Bcl-XL was upregulated most significantly. Two genes were downregulated. Adherent culture did not induce MDR1 mRNA expression in U937 cells. Conclusions MSCs play a role in modulating the proliferation of U937 cells and response of U937 cells to DNR, and Bcl-XL apoptosis-inhibiting gene may be most important in determining the sensitivity of leukemic cells to treatment, which is not related to MDR1.