Pronostic Factors and Survival of Colorectal Cancer in Cameroun: A Retrospective Hospital-Based Study

Background: Colorectal cancer represents a major health problem in the world today, the 3rd most common cancer and the 2nd in terms of mortality. Despite of the fact that the incidence rate remains the lowest in Africa, it is still a provider of a stronger lethality in most western countries. In Cameroon according to WHO 2018, 421 new cases (4.5% of all cancers) and 451 deaths (4.3% of all cancers) were registered. Objective: Determine the prognostics factors and the survival of patients suffering from colorectal cancer followed up in Douala. Patients and Method: This was a retrospective cohort study over a period from January 1st, 2009 to December 31st, 2018. All patients with histologically proven colorectal cancer, at the gastroenterological, oncological, anatomopathological, radiotherapy and surgery Department of Laquintinie and General Hospitals of Douala were included. The data collected were recorded and analyzed by SPSS version 25 and Excel 2016 statistical computer software. Survival was determined by the Kaplan Meier method and the search for prognostic factors was carried out using the Cox proportional hazards model. The significance level was p = 0.05. Results: The median survival was 43 months CI: [35,255 - 50,745]. Survival at 1 year, 2 years, 3 years, 4 years and 5 years was 79.6%, 61.5%, 46.3%, 22.6%, 12.2% respectively. In multivariate analysis, the low degree of differentiation (HR = 16.278, p = 0.007), the presence of synchronous metastases or stage IV patients (HR = 42.004;p = 0.011) were independent factors of poor prognosis while curative surgery (HR = 0.172;p = 0.001) was an independent factor of good prognosis. Conclusion: In our study, the median overall survival was 43 months and the survival at 1 year, 2 years, 3 years, 4 years and 5 years was respectively;79.6%, 61.5%;46.3%;22.6%;12.2%. The low degree of differentiation and the presence of synchronous metastases were factors of poor prognosis while curative surgery is a factor of good prognosis.

Diagnosis and Treatment of Digestive Emergencies in Two Hospitals in Douala (Cameroon)

Background: Gastrointestinal tract (GIT) surgical emergencies represent a significant amount within surgical pathologies, in Africa and throughout the world. Our study was aimed to assess the etiological, therapeutic and prognostic aspects of GIT surgical emergencies in patients from two hospitals in Douala, Cameroon. Patients and Method: A longitudinal prospective study was conducted from December 2018 to May 2019, including 203 patients of all ages and both sexes who presented with a GIT surgical emergency in any clinical form, and who underwent surgery within one of our hospitals. We collected patients’ parameters through a survey, from complete history to clinical examination, then followed them up from surgery to post-operative time. Gathered information was analyzed by IBM Statistical Package for Social Science (SPSS) 23.0 software version. Results: GIT surgical emergencies accounted for 27.5% of all surgical emergencies. Our target population included 55.2% (n = 112) of men, and 44.8% (n = 91) of women, observing a sex-ratio of 1.23. The mean age of the patients was 36.3 ± 17.1 years, with extreme values of 6 months and 86 years. Abdominal pain was the most common symptom, vomiting and lack of bowel movement or gas pass, were the main associated symptoms in 27.6% and 16.7% of cases, respectively. Etiologically, leading pathologies were intestinal obstruction (32.0%, 64 cases), acute appendicitis (24.6%, 50 cases), then came peritononitis and abdominal trauma with respectively 22.7% (46 cases) and 21.7% (43 cases). Most patients underwent surgery within 24 hour. Laparotomy was the primary method used in 90.6%, and laparoscopy (9.4%). Post-operative suture breakage and parietal suppuration were the most common complications post-operatively. Totally, the overall morbidity and mortality rates were respectively 8.9% and 0.98% among our patients. Conclusion: Acute surgical abdomens occupy an important place in surgical pathology because of their frequency. They have various aetiologies and require a diagnostic evaluation and multidisciplinary management without delay.

Prognosis and Survival of Nasopharyngeal Cancer in Cameroon

Background: Nasopharyngeal carcinoma (NPC) is an entity belonging to up-per aerodigestive tract Cancers. NPC is more widespread in Southern China and South East Asia. In our country, it is the leading cause of head and neck cancers. Its prognosis remains bleak because of the late stage at diagnostic. Objectives: The objectives of this study were to determine the prognostic fac-tors and survival rate of patients with nasopharyngeal cancer in six reference hospitals in Cameroon. Material and Methods: It was a retrospective analytic study, conducted from January 2009 to December 2018. It was conducted in oncology, surgery and Ear Nose and Throat (ENT) units of six reference hos-pitals. Data from 114 files meeting the inclusion were collected. We have drawn survival curves and determined the different survival probabilities with the help of Kaplan-Meier Method. The different survival curves were compared using the Log-Rank Test (P < 0.05), variables that were statistically associated with the 5% cut off were introduced into the Cox regression model for multivariate analysis, thus allowing us to bring out the prognostic factors significantly associated with survival. Results: The mean age at the time of diagnosis of the 114 patients recruited was 45.30 ± 17.14 years. The predominant histological type was the UCNT (Undifferentiated Carcinoma of the NasoPharynx) representing 84.2%. According to the WHO classification, 2 patients were classified as stage I (1.8%), 33 as stage II (28.9%), 42 as stage III (36.8%), 25 as stage IV A (21.9%) and 12 as stage IV B (10.5%). At the end of the survival assessment period, 34 patients were dead and 73 patients (64%) were still alive. The median overall survival was 44 months. The overall survival rates at one, two, three, and four years were 80%;74%;68%;44%, respectively. The prognostic factors associated with poor survival were: late consultation time of more than 12 months, N3 lymph node involvement, 3 and 4 advanced clinical stages. Conclusion: The study showed a low survival, with a median overall survival of 44 months. The overall survival rates at one, two, three, and four years were 80%;74%;68%;44% respectively. The prognostic factors associated with poor survival were late consultation time of more than 12 months, N3 lymph Node involvement, 3 and 4 advanced clinical stages. In order to improve this survival, it is recommended that special emphasis be placed on early detection.

Prognostic Factors and Survival of Laryngeal Cancer in Cameroon

Background: Laryngeal cancer is a major cause of morbidity and mortality worldwide. It is ranked worldwide as the second ENT cancer with 238,000 new cases and 106,000 deaths each year. In Africa, data on the prognostic factors and the survival of this pathology remain quite limited. Objective: To study the prognostic factors of laryngeal cancer and the survival of patients with laryngeal cancer in Yaoundé and Douala. Methods and Materials: We performed an analytical, longitudinal (retrospective) study over a period from January 1, 2009 to December 31, 2018 including all patients with histologically proven laryngeal cancer, at the ENT, oncological, anatomopathological, radiotherapy and surgery Department of three reference health structures in the cities of Douala and Yaoundé (Laquintinie Hospital and General Hospital of Douala, General Hospital of Yaounde). The data collected were recorded and analyzed by SPSS version 25 and Excel 2013 statistical computer software. Survival was determined by the Kaplan Meier method and the search for prognostic factors was carried out using the Cox proportional hazards model. The significance level was p = 0.05. Results: We selected 80 patients whose vital status we knew and who had been followed up after histological evidence. The sex ratio was 5.66. The median age at cancer diagnosis was 62 years old. 60 (75%) were exposed to tobacco, 52 (65%) had alcohol-tobacco poisoning. The Center and Littoral regions were the most represented with 37.5% and 48.8% respectively. Dysphonia was present in 98.8% of patients. The histological type encountered was squamous cell carcinoma in 78 patients;in the majority of cases the cancer was diagnosed at stage IV and the glottis was the most frequent site (86.2%). The median overall survival was 1.41 with 95% CI [1.08 - 1.74]. The overall survival rates at 1 year, 3 years, 5 years and 8 years were 70%, 18%, 3% and 1.5%, respectively. The poor prognosis factor found was: age greater than or equal to 70 years. Conclusion: Present study showed that survival in laryngeal cancer in Cameroon is very low with a median overall survival of 1.41 years. The overall survival rates at 1 year, 3 years, 5 years and 8 years are 70%, 18%, 3% and 1.5%, respectively. The age greater than or equal to 70 years is the poor prognosis factor, while receiving surgery in combination with neoadjuvant chemotherapy or surgery in combination with adjuvant radiotherapy is the factor of good prognosis.

Excessive Weight Gain during Pregnancy and Prognosis of Childbirth in Douala (Cameroun)

The objective was to describe the maternofetal outcome of childbirth in women with excessive weight gain during pregnancy. We conducted a cross-sectional analytical study over a period of 03 months in the Obstetrics Department of Laquintinie Hospital in Douala (HLD). Our study population consisted of any pregnant in labor or waiting for a caesarean section. We compared two groups of pregnant women with excessive weight gain during pregnancy (exposed) and those without excessive weight gain during pregnancy (unexposed). We recorded 240 pregnant women who gave birth at the HLD maternity, 59 of whom had excessive weight gain during pregnancy, which gave us a proportion of 24.6%. The only sociodemographic characteristic associated with excessive weight gain during pregnancy was the married marital status of the pregnant women (OR: 2.0 (1.1 - 3.8) P = 0.023). Pregnant women with maternal complications associated with excessive weight gain had an average elevated uterine height of 35.4 (P = 0.007). The increase in caesarean section rate (P = 0.094) and the onset of pregnancy-related hypertension (HTA) showed differences close to significance (P = 0.063). Mean birth weight was higher (P = 0.023) in pregnant women with excessive weight gain during pregnancy. Ultimately, excessive weight gain during pregnancy has deleterious effects on the course of pregnancy and childbirth. It promotes the onset of pregnancy HTA and macrosomia.

Kaolin Clay Consumption and Pregnancy:Prevalence,Hematological Consequences and Outcome of Labour in the Douala

Objective: To determine the prevalence, haematological repercussions and prognosis of childbirth in the event of consumption of kaolin during pregnancy. Materials and Methods: It was a study over a period of 3 months at the Laquintinie Hospital Douala. It compared two groups of women, one of whom had consumed kaolin during pregnancy (exposed group) and the other had not consumed it (non-exposed group). Results: A total of 342 women were included in our study, 121 (35.4%) of whom had consumed kaolin during pregnancy. Women exposed to this consumption (P < 0.05) after univariate analysis were those of pregnant women from the Far North (OR = 3.37, CI: 1.29 - 8.79, P = 0.013), single (OR = 1.65, CI = 1.05 - 2.59, P = 0.029), those with primary education (OR = 2.25, CI = 1.06 - 4.79, P = 0.035) and those with HIV (OR = 2.75, IC = 1.02-7.43, P = 0.045). Consumption was more frequent in the first trimester of pregnancy (37%) and in the third quarter (34%), at a predominantly weekly rate (47.9%). The most frequently cited reasons were envy (82%), and nausea (45%). This consumption was associated with a risk of premature delivery (RR = 2.26, IC = 1.27 - 4.05, P = 0.001), yellowish amniotic fluid (RR = 4.66, IC = 1.81 - 11, P = 0.001), birth weight < 2500 g in newborns (RR = 1.72, IC = 3.36 - 9.56, P = 0.025), but increased the probability of delivery (RR = 1.94, IC = 0.96 - 3.90, P = 0.039). For the hematological aspect, the occurrence of anemia (RR = 1.55, IC = 0.97 - 2.31, P = 0.003) and a decrease in mean hemoglobin concentration (RR = 1.29, IC = 0.83 - 2.03, P = 0.041) were associated with kaolin in pregnancy. After multivariate logistic regression, the complications included premature delivery, yellowish colour of the amniotic fluid and decreased hemoglobin. Conclusion: The use of kaolin is a frequent feeding behavior in pregnancy, mainly motivated by envy, which nevertheless presents serious maternal and fetal complications.