Histo-Phenotypic Aspects of Breast Cancer in Women under 40 Years Old, in Yaoundé

Introduction: Breast cancer is the most common cancer in women worldwide, with an increasing incidence. Although it is rare and no much studied in young women, it represents 7% of cases worldwide and often appears more aggressive with a poor prognosis compared to its counterpart in older women. The main objective of our study was to describe the histological and phenotypic aspects of breast cancer in women of age under 40. Methodology: We conducted a descriptive and analytical cross-sectional study, with retrospective collection of data over a period of 05 years. All women diagnosed with breast cancer were included and divided into 2 study groups: under 40 years old and over 40 years old. Data were analyzed using SPSS version 23.0 software, compared using the Chi square or Fisher exact test. A p value Results: We retained 196 files, either 89 for those under 40 and 107 for those over 40. Young patients with breast cancer had a higher stage, grade and tumor size. Lymph node involvement was more observed in women under 40 years (69.6% vs 53.2%). Older women were more likely to be hormone receptor positive (54.2% vs 38.2%);p = 0.018. HER-2 overexpression was higher in women younger than 40 years (39.32% vs 25.23%);p = 0.080 with a high Ki67 proliferation index (30.3% versus 2.8%);p 0.001. Triple-negative and Her-2 tumors were much more frequent in young women (48.3% vs. 36.4%;p = 0.063) and (17.97% vs. 10.3%;p = 0.125). Conclusion: Breast cancer in young women remains more aggressive and is dominated by triple negative and Her-2 phenotypes.

Evaluation of Spontaneous Fertility after Medical Treatment of Tubal Ectopic Pregnancy in Two Hospitals in the City of Yaounde

Background: Ectopic pregnancy is a major cause of maternal morbidity and mortality, estimated to occur in 1% - 2% of pregnancies worldwide. This condition also has an adverse effect on the fertility prospects of women who experience it. Objective: To determine the outcomes of subsequent spontaneous fertility after medical treatment of patients with methotrexate (MTX) in patients with ectopic pregnancy at two university teaching hospitals of Yaounde. Methodology: We carried out a cross-sectional study with retrospective data collection in two university teaching hospitals of Yaounde during a six years period from 1st January 2015 to 31st May 2021. Seventy records of patients who had medical treatment for ectopic pregnancy were included in this study. Statistical analysis was performed using SPSS. 23. The Chi-2 statistical test was used to compare qualitative variables. Binary logistic regression method was performed to identify independent risk factors associated with infertility after medical treatment of tubal ectopic pregnancy (TEP). The significance level was set at 0.05. Results: The mean age in our study population was 27.8 ± 3.8 years. According to the past medical history, 52.9% had a pelvic inflammatory disease (PID) and the most frequently germ found was C. trachomatis (47.1%). Almost 15% of our study population had previous surgery for EP. The median Fernandez score was 11 with a minimum score of 4 and a maximum score of 13. The route of administration of methotrexate was intramuscular in all our patients, and the single-dose protocol was used most frequently (58.6%). After medical treatment of the EP, we found a spontaneous conception rate of 58.6%. After multivariate analysis, we were unable to confirm that there was an association between a history of sexually transmitted infections (STIs) and fertility prognosis. Conclusion: The spontaneous fertility rate after medical management of EP was 58.6%, of which 73.2% were term pregnancies and 14.6% were recurrent ectopic pregnancies.

Clinical Epidemiology and Surgical Treatment of Spontaneous Perforations of the Terminal Ileum: A Multicentre Study in Cameroon

Background: Perforations of the terminal ileum are a frequent clinical situation and a therapeutic challenge. Surgical treatment is controversial. Several surgical modalities have been proposed and postoperative morbidity and mortality remain high. The aim of this study was to review our experience in the surgical management of perforations of the terminal ileum. Patients and methods: This is a descriptive cross-sectional study with retrospective data collection from January 1, 2017 to December 31, 2021, in five hospitals in Cameroon. Patients’ demographic, clinical presentation, surgical findings and 30-days postoperative outcomes data were collected. Results: We collected 34 files. The sex ratio was 1.4 and the average age was 20.28 years. The average consultation time was 9.1 days. Abdominal pain was present in all our patients. Peritoneal irritation was present in 46 cases (88.5%). The mean time to treatment after admission was 17.5 hours. The perforation was unique in 40 cases (76.9%) and located between 6 and 10 cm from the ileocecal valve in 29 cases (55.8%). Typhoid was the most suspected etiology intraoperatively in 38 cases (73.1%). A simple suture was performed in 18 patients (34.6%), resection with anastomosis in 11 patients (21.2%) and an ileostomy in 5 patients (9.6%). The average length of hospitalization was 21.74 days. Postoperative morbidity and mortality were 32.7% and 17.3% respectively. Conclusion: Perforations of the terminal ileum are common and affect young people. Surgical procedures are varied. Reducing consultation and care times and respecting treatment principles could improve postoperative morbidity and mortality, which remain high.

Hospital Outcome of Newborns with a Health Cheque System in Comparison to Those Without

Introduction: The health cheque system is a prepayment mechanism aimed at reducing neonatal and maternal mortality through improving the management of pregnant women. The pregnant woman with the health cheque system that she pays at six thousand francs XAF (African financial community) is covered free of charge for all the care provided by the cheque system in the health facilities accredited to the health cheque project. We did a study, with objective to determine the hospital outcome of newborns with a health cheque system (HCS) compared to those without health cheque system. Method: A descriptive cross-sectional study with retrospective data collection was carried out at the Ngaoundere Regional Hospital from January 2018 to September 2021. Results: During our study period, 2985 newborns were received. We saw an increase in admissions over the years, particularly in the group of newborns with the health cheque system. Comparatively, the percentage of newborns cured in the health cheque system group was 76.73% (n = 1643) versus 77.72% (n = 656) those in the non-health cheque system group. Those who died were 8.96% (n = 192) in the health cheque system group compared to 6.27% (n = 53) in the non-health cheque system group. Conclusions and Recommendations: Most patients admitted to our service have the health cheque system. We notice an increase in hospital attendance with the health cheque project. The outcome of the newborn under the health cheque system is not different from that without health cheque system. The health cheque system was successful in getting the larger number of newborns into care. The next step is to put strategies in place to keep these patients in care for the duration of hospitalization.

Testicular Burkitt’s Lymphoma: A Case Report and Literature Review

Background: Burkitt’s lymphoma of the testis (TBL) is a rare and extremely aggressive malignant usually diagnosed in front of a testicular mass. We describe an interesting single case of TBL managed by a combined multimodal approach with a review of the literature. Case Report: A patient aged 69-year-old male, newly hypertensive, who presented with a twelve-month history of right testis progressive painful scrotal swelling, which worsens following a motorbike accident. Clinical examination revealed a large tender mass in an erythematous right scrotal bursa. A scrotal ultrasound showed a right heterogenous intra-testicular mass. The patient underwent unilateral (right) radical orchiectomy. Histopathological examination revealed presence of monomorphic lymphoid cells, with moderate to increased size, dissociated inconstantly by macrophages consistent with a Burkitt’s-like non-Hodgkin Lymphoma. After surgery, the patient was transferred to oncologist for adjuvant chemotherapy. Conclusion: A testicular mass is a usual circumstance for the discovery of a primary tumour of the testicle. Burkitt’s testicular lymphoma is a rare tumour whose diagnosis is based on histological findings. There are non-consensual etiological or predisposing factors. The treatment depends imperatively on the stage of the disease. Therapeutic modalities relay on in surgical excision, chemotherapy and radiation therapy but the accurate procedures are not standardized.

Evaluation of Oxidative Status of Patients with Gout Attack in a Cameroonian Urban Hospital

Background: Gout is the leading cause of microcrystalline arthritis worldwide and the most common cause of arthritis in adult men. The prevalence of cardiovascular disease, type II diabetes and metabolic syndrome is high among gout patients;one of the current hypotheses that may explain this relationship is based on oxidative stress;however, few studies have sought to investigate this relationship. Objective: The aim of this study was to determine the oxidative status of patients with gout attack. Methods: We conducted a case-control study over a 4 months period at the Rheumatology service of the Yaoundé Central Hospital. Cases were patients with an acute gout attack and controls were healthy subjects matched for sex and age. We evaluated uricemia, serum levels of Superoxide Dismutase (SOD), Glutathione Peroxidase (GPx), Catalase and Malondialdehyde (MDA). Oxidative stress was defined by an increase in MDA and/or a decrease in SOD, Catalase and GPx. Statistical analysis was performed by the S.P.S.S. 21.0 software. The Student’s T-test was used to compare means;the significance threshold was 0.05. Results: Sixty subjects were recruited of which 30 with an acute gout attack and 30 healthy subjects. The mean ages of the cases and controls were respectively 58 ± 8 years and 57.6 ± 8 years. Uricemia was statistically higher in cases (81 ± 20 mg/L) compared to controls (47 ± 11 mg/L) (p < 0.001). MDA levels were higher among cases (1.37 ± 0.46 mmol/L) compared to controls (1.14 ± 0.39 mmol/L) (p < 0.05). There was no significant difference in serum levels of catalase, SOD and GPx between cases and controls. Conclusion: Patients with gout attack have an elevated serum level of malondialdehyde but their oxidative status seems similar to that of normal individuals.

Changes in smoking patterns after HIV diagnosis or antiretroviral treatment initiation: a global systematic review and meta-analysis

Background:Tobacco consumption is more life-threatening in people living with human immunodeficiency virus(HIV)than within the general population;therefore,people living with HIV(PLWH)should be highly motivated to take action towards quitting smoking at or after HIV diagnosis.The aim of this systematic review with meta-analysis was to investigate changes in smoking habits among PLWH over time.Main text:We considered prospective and retrospective cohort studies including PLWH aged 15 years and above,which have measured the prevalence of tobacco smoking(current,former or never)at study initiation and completion,and published between January 1,2000 and April 15,2018 without language or geographical restriction.We searched PubMed,EMBASE,Web of Science,Africa Journal Online,and Global Index Medicus.We used a random-effects model to pool data.Nine studies were included.The proportion of current and former smokers decreased slightly over time,around 2.5 and 3.8%,respectively.However,the proportion of never smokers decreased sharply by 22.5%,and there were 2.1 and 1.5%PLWH who shifted from never and former smoking to current smoking,respectively.On the other hand,10.5%PLWH shifted from current to former smoking,7.1%tried to quit tobacco consumption but failed,and 10.1%stayed in the"never smoking"category over time.Conclusions:PLWH seem not to change positively their smoking habits towards quitting tobacco consumption.There is urgent need to increase actions aimed at helping this vulnerable population to quit tobacco consumption,including individually tailored therapeutic education,psychosocial and pharmacologic supports.