Prevalence, Management and Outcomes of Enterocutaneous Fistulas in Buea Regional Hospital and Laquintinie Hospital of Douala. A Five Years Retrospective Study

Background: An Enterocutaneous fistula (ECF) is an abnormal connection between the intestinal tracts or stomach and the skin. They are a major catastrophe to the patient and surgeons and still have a high incidence of morbidity and mortality which varies between 6% - 33%;their management remains a big challenge. These patients frequently face complications, and a well-organized multidisciplinary approach must be implemented in their management to improve outcomes. Objectives: Our study aims to assess the prevalence, management and outcomes of enterocutaneous fistulas in Buea regional hospital and Laquintinie hospital of Douala over the past 5 years. Methods: This was a hospital-based retrospective study in Buea regional hospital and Laquintinie hospital of Douala. Records of patients who had enterocutaneous fistulas within the period of 1st January 2017 to 31st December 2020 in the surgical departments. Data included demographics, pre-operative diagnosis, comorbidities, type of fistula, management modality and means, the indication of operative treatment, length of stay in the hospital and outcomes. Data was analysed using SPSSv26. Results: The study constituted 1343 medical records of which 83 medical records of patients with enterocutaneous fistulas, giving a prevalence of 6.2%, female predominance at 59% (n = 49), 42.2% (n = 35) were referred cases from the periphery for better management. A vast majority (96.4%) occurred as post-operative complications with appendectomy the most common indication (18.8%). High output fistulas were predominant (43.4%). 59% (n = 47) were managed medically, 6% (n = 5) received both conservative and surgical modalities while 35% (n = 5) were managed surgically. 64.1% (n = 50) were placed on enteral nutrition while 35.9% (n = 28) were placed on parenteral nutrition. Peritonitis/infection 50% (n = 18) was the commonest indication of surgical treatment, followed by failure of medical treatment 25% (n = 9) then high output fistulas 16.7% (n = 6). Resection with end-to-end anastomosis was the preferred repaired work at 61% (n = 22). The mortality rate was 38.5% (n = 32), 29% (n = 24) healed after conservative treatment, 21.7% (n = 18) healed after surgery, 7.2% (n = 6) persisted after surgery while 3.6% (n = 3) persisted after conservative treatment. Anaemia, sepsis, electrolyte imbalance, dehydration and malnutrition were the commonest complications. Conclusion: The prevalence of enterocutaneous fistulas was high, with a female predominance and a mean age of 38 years. Most cases were seen as a referral from the periphery for better management. The greatest majority of fistulas occurred as a postoperative complications. Conservative management with enteral feedings was preferred, they had better outcomes and gave more chances of healing. The commonest indication of surgical treatment was an infection. Resection with end-to-end anastomosis was the preferred repaired work. The mortality rate was high, and anaemia, sepsis and electrolyte imbalance were the commonest complications.

Effects of Hepatitis B Virus Co-Infection and Antiretroviral Therapy on Disease Progression among HIV Patients Treated at the Buea Regional Hospital, Southwest Region, Cameroon: A Case-Control Study

In the era of “test and treat”, when AIDS-defining events have been drastically reduced, chronic liver disease associated with viral hepatitis and antiretroviral therapy (ART) remains an important cause of non-AIDS morbidity and mortality among HIV-infected patients. Compared to the general population, HIV-infected patients are about 10-times at risk of hepatitis B virus infection. Additionally, several antiretroviral regimens are hepatotoxic. Therefore, effective monitoring and management of ART and HBV co-infection are essential to ending the AIDS epidemic and eliminating viral hepatitis by 2030. This was a hospital-based, matched (age and sex) case-control study. HIV patients (case patients) on ART for at least six months and “healthy” controls aged 18 years and older were enrolled. Blood samples were collected for immuno-hematologic indices and transaminases measurements. Data were presented as counts, percentages, median (IQR) and means (SD), and a p-value 1.5) and mild (0.6 - 1.5) liver fibrosis based on the APRI score was 0.5% and 8%, respectively. Significant fibrosis (>3.25) was 0.9%, while 18.4% had inconclusive fibrosis (1.45 - 3.25) based on the FIB-4 score. HIV/HBV co-infected patients had a higher occurrence of liver fibrosis (APRI: 0.5% vs FIB-4: 0.9%). Co-infections with HBV increase the risk of liver-related morbidity in HIV patients. Therefore, screening for serological markers of chronic HBV infection and hepatic transaminase levels in HIV patients remains crucial in the continuum of care.

Obstetrical Outcomes of Pregnancy during a Period of Socio-Political Instability in the Buea and Bamenda Regional Hospitals, Cameroon

Background: Armed conflict increases the occurrence of adverse obstetrical outcomes especially in low and middle-income countries. However, there is paucity of data on obstetrical outcomes in the South-West and North-West Regions of Cameroon since the onset of the socio-political instability. Objectives: Our aim was to evaluate obstetrical outcomes in the Buea and Bamenda Regional Hospitals, Cameroon during the period of socio-political instability. Methods: A hospital-based retrospective cohort study was carried out at the aforementioned hospitals. Data was collected from case notes of pregnant women before the period of socio-political instability (from January 1, 2014 to December 31, 2016) and during the period of socio-political instability (from January 1, 2017 to October 31, 2019). The Chi square and Fischer’s exact test were used to compare categorical variables where appropriate and modeled into multivariate analysis. A p-value Results: The mean maternal age was 27.09 (±5.25) years, before and during the conflict. The mean weight of neonates (regardless of gestational age) during the conflict was significantly higher [3.28 (±0.65) kg] compared to that before the conflict [3.21 ± (0.52) kg] (p yrs [OR = 1.97;CI (1.16 - 3.37), p = 0.01], and delivery during the period of socio-political instability [OR = 1.97;CI (1.16 - 3.37)], p = 0.01 and [OR = 1.89;CI (1.53 - 2.33)], p Conclusion: This study identifies increased incidence of adverse maternal outcomes in mothers exposed to socio-political instability.

Pap Smear Screening, the Way Forward for Prevention of Cervical Cancer? A Community Based Study in the Buea Health District, Cameroon

Introduction: Cancer of the cervix is the second most common gynecologic malignancy in the world due to lack of awareness and poor uptake of cervical cancer screening services especially in low income countries. In Cameroon, though there is a national cervical cancer-screening program the service has been limited to some main cities without an appreciable impact. Aims: The objectives of this study were to determine the knowledge, attitude, practice towards Pap smear screening, thus evaluating its suitability as a screening procedure in Cameroon, through this pilot study in the Buea Health District. Methods: The study was a community-based cross-sectional descriptive survey that involved 309 women. Women from 18 years were enrolled for the study from 9th?October to 20th?November 2013. Results: The mean age of the participants was 32.3 years (SD = 11.7 years). Most of the women (29.5%) who had gone for the Pap test were in the 41 - 50 years age group. Only 3.6% of the study participants had “good” knowledge of cervical cancer and Pap smear screening. Approximately 20% of the women had a previous Pap smear test with 55.7% of them having the test just once. Eighty two percent of those who had secondary and tertiary levels of education had never had a Pap smear test. Awareness of risk factors for cervical cancer was low. Fear of pain, positive results after screening, non-curability of cervical cancer were some factors associated with a low Pap test uptake (p < 0.05). Conclusion: There is poor knowledge and perceived barriers by women about Pap smear screening and follow-up services. For an impact to be made in the prevention of cervical cancer, Pap smear screening is not the preferred method because of these limitations in this community.

Prevalence, Aetiology, and Clinical Profile of Acute Abdomen in Pregnancy in Southwest Cameroon: A 5-Year Retrospective Study

Background: Acute abdomen is one of the commonest reasons for presentation at the emergency department. The physiologic changes of pregnancy increase the chances of developing acute abdomen. The global incidence of acute abdomen in pregnancy range from 1 in 500 to 1 in 635 pregnant women. In 2018, a study in Azerbaijan reported a prevalence of 25%. However, to the best of our knowledge, very few studies have been carried out on this subject in Cameroon. Objectives: To determine the prevalence, assess the aetiologies, and review clinical profile of acute abdomen in pregnancy in the Southwest Cameroon. Methods: We conducted a 5-year retrospective study at the Obst/Gyn and Surgical units of Kumba, Buea, and Limbe Regional Hospitals. We included all files of pregnant women that were admitted for acute abdomen within the study period (1st Jan 2017 to 31st Dec 2021). Data was collected using a structured checklist adapted from previous studies. Descriptive statistics and statistical testing was done using SPSS version 25.0. Chi-square was used to compare categorical variables. p Results: Over 14,106 pregnant women were admitted to the aforementioned hospitals within the study period. 335 (2.4%) met our inclusion criteria. The patients’ age ranged from 17 to 43 years. The mean age was 27 years. Acute abdomen was more frequent (65%) in the first trimester. Ectopic pregnancy was the commonest obstetric aetiology while appendicitis was the commonest non obstetric surgical aetiology. Abdominal pain and tenderness were the most common presentation. Conclusion: The prevalence of acute abdomen in pregnancy in the Southwest Cameroon is 10 times higher than the global prevalence. Our study also confirmed the numerous aetiologies and varied clinical presentations of acute abdomen in pregnancy. Hence a wake-up call for primary care physicians.

Osteomyelitis in Children with Sickle Cell Disease: A Challenging Diagnosis: Case Report from Cameroon

Introduction: Sickle Cell Disease (SCD) is the most prevalent genetic disease in the world predominantly in the African population with Sickle Cell Anaemia (SCA) being its dominant form. One of the most frequent complications of SCD is osteomyelitis. SCA is due to a point mutation in the beta globin chain of haemoglobin. This is responsible for the sickled shape of RBCs under low oxygen tension conditions leading to obstruction in the microcirculation. This leads to vaso-occlusive crises (VOC) which has a similar clinical presentation to that of osteomyelitis, another complication of SCD. Case Presentation: We present the case of a three-year-old girl with SCA who presented with an inability to bear weight in a febrile context. A diagnosis of VOC was initially made, which was later on changed to both a left chronic tibial and right distal femoral osteomyelitis following a series of biological, and imaging investigations. Surgical debridement and drainage were performed, resulting 9 weeks later in the involution of fever and leg pain. Conclusion: Osteomyelitis when associated with SCD is a dreadful and deathly disease in low income countries as it also presents like VOC therefore higher suspicion index is recommended. It is therefore important to take this into consideration at an early stage in patients with homozygous sickle cell disease so as to rapidly initiate multidisciplinary care. Appropriate investigations, appropriate antibiotic therapy, and timely surgical intervention would help to greatly reduce morbidity and mortality.