The Use of Visual Tests in the Screening Strategy of Cervical Dysplasies and Cervical Cancer at the Laquintinie Hospital Douala, Cameroon: A Cross-Sectional Study

Introduction: The prevalence of cervical cancer in Cameroon is 80.73/100,000 women, with an estimated incidence of 40/100,000 women-years. It is a real public health problem. There is no systematic and effective screening program for cervical cancer in our country, despite the advent of visual tests that are simple to use, low cost, and adapted to the modest income of our social groups. Objectives: We aimed at determining the usefulness and place of visual tests in screening for cervical dysplasia and cervical cancer for its implementation at the Laquintinie Hospital Douala, Cameroon. Methods: We conducted a prospective analytic cross-sectional study of cervical dysplasia and cervical cancer screening by visual testing at the Laquintinie Hospital Douala from December 1, 2016 to March 31, 2017. Data collection was by consecutive non-probabilistic method and consenting sexually active women older than 21 years were enrolled for study. Data analysis was with Epi InfoTM version 7. Associations were done with the Chi square, student t-test and Fischer’s exact test where appropriate. Bivariate and multivariate analysis was done and reported as odd ratios, adjusted odd ratios and 95% confidence intervals. Statistical significance was set at P 0.05. Results: We received 1590 women, of whom 1506 (94.7%) screened for dysplastic lesions and cervical cancer during the study period. The results obtained were: 1417 (94.1%) had a normal result;64 (4.2%) had a positive visual test (TV+);and 25 (1.7%) visual tests were inconclusive (TV-nC). Of the 64 women whose visual tests were positive, 15 (23.5%) were HIV+. We performed 80 colposcopies and biopsies, including 61 women with positive visual tests and 19 non-conclusive visual tests. Among women with TV+, we found 06 cancers (squamous cell carcinoma: 05, adenocarcinoma: 01) and 05 dysplasias (CIN1: 04, CIN3: 01). Histological examination in women with TV-nC revealed 02 dysplasias (CIN1: 02). Half of the women with cervical cancer were HIV+. In our series, the prevalence of cervical dysplasia and cervical cancer was respectively 05 per 1000 women and 04 per 1000 women. The early onsets of sexual intercourse and co-infection with HIV were the main factors associated. Visual tests were very sensitive (84.62%), but with a relatively low specificity (25.37%). Conclusion: Visual tests prove to be a useful tool for mass screening of precancerous and cancerous lesions of the cervix in view of its sensitivity, cost and performance.

Epidemiology of Male Sexual Dysfunction (MSD) in Patients Consulting in Some Health Services in the City of Douala, Cameroon

Sexual dysfunction is a group of diseases, disorders or difficulties experienced by men or women during any stage of normal sexual activity. In Africa in general and Cameroon in particular, statistical data concerning the prevelance and the main causes of male sexual dysfunction are rare due to socio-cultural and religious burdens and sometimes self-medication. The objective of this work was to determine the prevalences, comorbidities and the risk factors of the main sexual dysfunction in some hospitals in city of Douala. Through a descriptive retrospective study carried out from Novembre 2019 to June 2021, sociodemographic parameter, reasons of consultation, risk factors and type of male sexual dysfunction (erectile dysfunction or erectile dysfunction (ED), ejaculation disorders (EjD), libido disorders (LD) and disorders of sexual activity with pain or painful sexual intercourse (PSI)) were collected in the medical files of patients who have made urological consultation between 2016 and 2020 at the Deido District hospital, Laquintinie Douala Hospital and Douala General hospital respectively. At the end of our data collection, out of a total of 24995 consultations, 2743 (10.98%) patients were suffering from at least one male sexual dysfunction. Moreover, sexual disorders were the 2nd reason of urological consultation (13.69%) after urinary disorders (33.85%). Among sexual disorders, erectile (76%) and ejaculatory (20%) disorders were the predominant pathologies recorded with the prevalences of 9.79 et 2.62% respectively, and were mostly represented in patients from [41 - 50] for erectile dysfunction, and [18 - 30] years old for ejaculative dysfunction. In addition, the number of patients with ejaculatory and erectile dysfunctions was more important in patients from [18 - 30] and [31 - 40] years old respectively. Among patients presenting sexual disorders, several risk factors or pathologies were associated with the dysfunction: benign prostatic hyperplasia and metabolic syndrome (in patients over 50 years old);psychosocial problems, infections, and alcohol (in patients under 50 years old). These findings could be useful in the elaboration of therapeutic strategies for the management of the Cameroonian population suffering from sexual dysfunctions.

Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon)

Background: Quality control of care aims to reduce or eliminate unnecessary care and to improve the quality of those who are useful both in their indication and in their implementation. Objective: We conducted this study to assess the rate of caesarean section, the rate of irrelevant indications, materno-foetal morbidity and mortality, biases in the management in order to suggest corrective approaches. Methods: It was a cross-sectional study conducted in the gynaeco-obstetrics department of the Laquintinie Hospital of Douala over a period of 4 months from January 1 to April 30, 2017. We included all pregnant women who had a caesarean section and who gave consent to our study as well as new-borns from these caesareans. We excluded caesarean deliveries from other health structures and referred to Laquintinie Hospital due to morbid operative follow-up. The variables collected were grouped under 3 main headings: socio-demographic data, clinical data and post-operative follow-up. Results: A total of 281 caesarean sections were performed out of a total of 967 deliveries;a caesarean section rate of 29.06% in 4 months. After data mining, 250 caesarean sections were included in the study because 31 cases of caesarean deliveries were unusable. Referred pregnancies accounted for 46.8% of the total population and the most common reason for referral was stationary labour (23% of cases). All caesareans were performed by the gynaeco-obstetricians. Women who had caesarean deliveries were informed by the operator of the surgical procedure in 28.4% of cases and 27.6% were notified of the indication for surgery. The operative kit was present in 98% of cases. The operating room was available in 93% of cases. Caesareans were performed mostly in an emergency context (91.2%) with a median turnaround time of 214 minutes (3 h 56 mins). Mechanical dystocia was the major indication in our series (21.2%) and 29 indications were irrelevant (11.6%). Intraoperative complications occurred in 3.2% of cases. Overall maternal mortality (per- and post-operative) was 0.8% (2 cases). We recorded 15 neonatal deaths out of which 8 were still births. Regarding the postoperative period, 78% of the operated patients did not have a good immediate postoperative monitoring. The post-operative protocol was not respected in 17% of cases. Postoperative complications occurred in 21.6% of patients with first cause being infections (10.8% with 5.6% being parietal suppurations). Conclusion: The frequency of Caesarean sections at Laquintinie Hospital is above the World Health Organization’s recommendations of 5% - 15%. There is a very big delay in the execution time of emergency caesareans, far above the international standards despite the quasi-availability of operating kits and the operating theatre. The state of the premises reveals a sub-workforce creating work overload and therefore a demotivation of the staff leading to insufficient communication between the operator and operated, a lack of postoperative follow-up and significant neonatal morbidity and mortality. Hence the need to initiate a staff satisfaction survey.

Hematological Profile and Risk Factors of Anemia in Pregnant Women: A Cross Sectional Descriptive and Analytical Study in Douala Cameroon

During pregnancy, the hematological system undergoes numerous changes so as to meet up with the demands of the developing fetus and placenta, with major alterations in blood volume and this differs with women from different regions. The aim of this study was therefore to assess the hematological parameters and risk factors for anemia among pregnant women according to different trimesters of pregnancy in Douala, Cameroon. Methods: A cross-sectional study was conducted from February to May 2017, and all pregnant women who attended antenatal visits during our study period and who suited our inclusion criteria were recruited. The study was carried out in the antenatal care Unit of the Douala Laquintinie Hospital (DLH). A pretested questionnaire was used for the necessary data collection. Venous blood was collected from each of these women to perform a Complete Blood Count (CBC) test using an automated hematological analyzer (URIT 3010). Data were analyzed using XLSTAT 2007 and Stata version 11 software. Results: The mean age of the participants was 28 (SD = 5 years). The prevalence of anemia among pregnant women was 22% with a majority (18.4%) of these women being mildly anemic. Mean Hemoglobin values were significantly higher among women in first trimester compared to the third (12.1 ± 0.9 g/dl vs 11.8 ± 1.3 g/dl;p = 0.043). There was also a significant change in mean hematocrit (HCT) values between the first and second trimester (32.8% ± 2.5% vs 31.4% ± 2.9%, p = 0.004) and between the first and third trimester (32.8% ± 2.5% vs 30.8% ± 3.5%, p -4). RBC count value was higher in the first trimester than in the second trimester (3.7 ± 0.3 × 1012/L vs 3.5 ± 0.4 × 1012/L, p -4) and in the third trimester (3.7 ± 0.3 × 1012/L vs 3.5 ± 0.4 × 1012/L, p = 0.001). After a multivariate analysis, the following categories of women had more odds of developing anemia;women between the age range of 30 - 35 (OR = 2.81, 95%CI: 1.16 - 6.81, p = 0.023), women in the second trimester of pregnancy (OR = 2.20, 95%CI: 0.88 - 5.48, p = 0.024), women with blood group O (OR = 3.57, 95%CI: 1.41 - 16.66, p = 0.012). Conclusion: This study confirms significant variations in hematological parameters. The findings reinforce the need for supplementation and provide additional information on hematological reference values in pregnancy in Cameroon. It also helps us understand that, third trimester, age range 30 - 35, and blood group may be potential risk factors associated with anemia in pregnancy though a cohort study would be necessary to ascertain this hypothesis.

Risk Factors for Breast Cancer in the City of Douala: A Case Control Study

Background: The breast cancer is an abnormal proliferation of mammary gland cells. This condition as well as other cancers is globally increasing in the world. It is the most frequent malignancy of women in the world and is a public health problem. Generally in Africa and central Africa in particular, few studies have been realized in search of risk factors of breast cancer. It’s all in this optical we began the study to determine the risk factors of this disease in the city of Douala. Patients and Methods: We conducted a case-control study, gave retrospectives collect on five years and prospectives collect on seven months. The studied population was all women aged 18 years and above with breast cancer diagnostic on histological plan for cases;and women from 18 years or more with normal physical examination and mammography. We have done our research in three reference hospitals of the city of Douala and two laboratories of pathological anatomy. The data were collected at the search files and the patients where interviewed. The parameters studied were: socio-demographic profile, clinic and Para clinic parameters, and the histological type. Results: At the end of this study, breast cancer is predominantly on young women in the city of Douala with a middle age of 44.08 ± 2.6 years. The most significant risk factors were age, age of the first birth ≥ 30 years, age of the first sexual act ≤ 18 years, low economic level, tobacco, hormonal contraceptive, parity. Conclusion: Finally, the malignancy of the breast takes a primordial place within the feminine population of Douala with many risk factors likes causes.

Epidemiological, Clinical and Management of Benign Prostatic Hypertrophia in Urologie Department in N’Djamena, Chad

Aim: To determine the epidemiological, clinical, paraclinical characteristics and assess the result of surgical treatment of benign prostatic hyperplasia (BPH) in the urological department. Patients and Method: It is a retrospective descriptive study of 757 patient samples whose BPH diagnosis was pronounced and have benefited of the open surgery in urology department from January 2006 to December 2010. The variables studied were sociodemographical, clinical, paraclinical, therapeutical and the follow up. Those variables were: arterial tension, sonography, consultation reasons and hospitalization, the data provided rectal touch, the comorbidity, the prostatic specific antigen (PSA), other blood tests, urinary tests, medical management surgical treatment, the causes of death and the complications. Results: during the study period, 2406 patients were hospitalized, from them 1472 (61.18%) for low urinary tract diseases where 757 for BPH. The mean age was 64.18 years. The acute urine retention was the main cause of hospitalizations and consultations (51.51%). The rectal touch Helped in diagnosing 96.43% of cases. PSA in 74.10%, the sonography evaluated the volume of the prostate and the complications on the upper urinary tract, kidney dilatation and stones. An urgent evacuation of acute retention of urine in the bladder was done in 74.10%, a medical treatment was done in 33.47%. The open surgery was done in 66.47%. The evolution was good for 703 (92.86%), 54 died (7.14%) and the causes were various (anemia, hyperglycemia, HIV…). Conclusion: The BHP was the first reason of consultation and hospitalization in urology department in N’Djamena. Its diagnosis was done after the analysis of a beam clinical and paraclinical arguments. In the absence of an endoscopic resection column, open surgery was the only surgical treatment.

Etiology and Management of Complete Acute Urinary Retention in Urology Department in N’Djamena, Chad

Goal: To study the epidemiological, clinical, etiological, characteristics and ensure earlier management of complete acute urine retention (CAUR) in the urology department of N’Djamena in Chad. Patient and Method: It was a retrospective descriptive study of a sample of 606 patients during the period ranging from November 2008 to December 2010. The patients were consulted first in urology or referred by a colleague for a CAUR. The diagnosis was confirmed by an earlier clinical examination. The patients have benefited from a urine evacuation before looking for the etiologies. Results: We managed a sample of 606 patients suffering from CAUR. Average age was 60 years old with extremes of 1 month and 100 years. There were more patients in the ranks of 60 years and more (n = 436;71.94%). Men were more than women in the proportion of 583/25, and 63.20% of the patients lived In N’Djamena. The benign prostatic hypertrophia was the first cause of CAUR, followed by urethral stricture, urinary infection, lithiasis of the lower urinary tract, adenocarcinoma of the bladder, hymen imperforation in young girls, bilharzias, paraphimosis and ovenbird necrosis. The bladder catheterization was the most urgent gesture done in 61.71%, followed by open cystostomy. In the second case, etiological treatment was done as: open prostatic surgery (n = 306), urethral reconstitution (n = 58), cystololithotomia (n = 54), dilatation of urethral conduct (n = 54), hymenostomia (n = 6). Conclusion: CAUR was the first symptom which motivated the consultation in the department of urology in N’Djamena the main problem of public health in Chad.

Diagnostic Approach and Management of a Unilateral Total Ectopy of the Scrotum

Introduction: Total unilateral ectopy of the scrotum can be defined by the abnormal congenital anatomical position of the scrotum and its contents. The aim of the study is to describe the diagnostic and therapeutic approach of a total unilateral ectopy of the right scrotum. Methods: This is a clinical observation of a 46-year-old patient with a right abdominal mass evolving from birth. Analyzing the cluster of arguments clinically, operatively and anatomopathologically, allowed us to retain the diagnosis of a total unilateral ectopy of the right scrotum. The informed consent of the patient was obtained before the use of the images for scientific purposes. Conclusion: the unilateral total ectopy of the right scrotum is a rare congenital malformation of the external genitalia, which clinical diagnosis is difficult. Its management is surgical.

Symptomatic Pelvic Kidney in Women at Childbearing Potential: Diagnostic Difficulties and Management in Urology Department of N’Djamena in Chad

Introduction: We aim to report, from three observations, the diagnostic difficulties and complications, and ensure the management of pelvic kidney in women at childbearing age in the Urology Department of the National General Referral Hospital of N’Djamena. Pelvic kidney is due to an abnormality of the migration that can be associated or not with a malrotation. Its symptomatology is not specific, causing diagnostic difficulties and therapeutic errors. Observation: There were three observations of female patients aged respectively 26, 29 and 32 years who were taken care of for years in the gynecology department for pelvic inflammatory disease before being routed in urology. The diagnosis of pelvic kidney was retained on the basis of morphological examination (ultrasound, intravenous urography, CT urography). The patients have undergone nephrectomy;the postoperative aftermath was simple. Conclusion: Pelvic kidney is a rare disease. It is often discovered during autopsy. Symptoms are non-specific;nephrectomy is the treatment of choice in symptomatic cases.

Clinical, Paraclinical and Therapeutic Aspects of Chronic Prostatitis

Aim: Present the clinical and paraclinical aspects of chronic prostatitis and report the management in urology. Methods: We conducted a retrospective descriptive study of 47 patients referred to the urology department from January 2011 to December 2013. Analysed variables were epidemiological (age, marital status, place of residence, occupation, education level, taking stimulants), clinical, paraclinical (CBU, chlamydia, syphilis and HIV serologies, urine culture susceptibility testing, semen analysis, ultrasound of urinary tree, radiographs, RCU, IVU), treatment and results. Results: The mean age was 44.6 years. The main reasons for consultation were dysuria (55.3%), prostatorrhea (29.8%) and sexual asthenia (12.8%). The general condition was satisfactory (80.9%). Purulent drop was objectified in the urethral meatus in 10.6% of cases, and the DRE was painful at 44.68%. Escherichia coli was the main isolated germ (23.4%). In 55.3%, calcification of the prostatic area was objectified to ultrasound of the urinary tract. The RCU had objectified bilharzia in 8.5% of calcifications of the bladder area and 19.14% of urethral stricture. The medical treatment was completed in all patients according to the etiology and complications by an instrumental or surgical treatment, offline or emergency. The outcome was favorable in 25 patients. Symptoms were improved in 12 others and a failure for the ten remaining. Conclusion: Chronic prostatitis is relatively frequent in urology. Clinical manifestations are diverse and varied. Treatment is difficult with a significant failure rate.

Epidemiological and Histological Profile of Cervical Cancer in Cameroon: About 2078 Cases

Objective: To describe the epidemiological and histological aspects of cervical cancer in Cameroon. Materials and Methods: It was a descriptive retrospective study carried out over a period of 10 years (2005-2014), on malignant tumors of the cervix observed at the laboratory of Anatomic Pathology in four regions (Center, Littoral, West, South-west). The studied parameters were frequency, age, sex, localization, histological type and the immuno-histochemical aspects. Results: A total of 2078 cases with an annual frequency of 20.78 cases were registered;the peak was reached in 2010 with 304 cases (14.62%). Cervical cancer was the main genital cancer affecting women with a percentage of 82.26%. The average age of the patients was 52.33 ± 12. 80 years old, with extremes from 22 to 93 years old. The age group from 40 to 59 had more than half of the cases, with 1094 cases (52.65%). The major histological types recorded were squamous cell cancer with 1687 cases (81.51%) and adenocarcinoma with 269 cases (12.95%). Conclusion: Cervical cancer is the chief genital cancer affecting female genital organs. The predominant histological types are squamous cell cancers.

Diagnosing and Managing Androgen Insensitivity Syndrome

Introduction: Androgen insensitivity syndrome is a rare congenital abnormality of genital organs revealing a female phenotype in a person with XY chromosomes. The aim of our work is to describe the clinical aspects, to determine the chromosomal sex and to report our therapeutic management. Observation: A 28-year-old woman with female phenotype, feminine voice, normal breast development, normal underarms and pubic hair, absence of menstruation, fusion of small and large vaginal lips leaving a small pertuis to serve as urethral meatus. On the dorsal surface of the large, left lip was a mass the size of a date. Hormonal balance was normal. A feminizing genitoplasty was performed as well as excision of the mass. Histological analysis of the mass concluded that it was a feminizing testicular. Conclusion: Androgen insensitivity syndrome is a rare abnormality of the genitals. Multidisciplinary management is essential both for the designation of the breeding sex and feminizing genitoplasty.