Cout réel de la prise en charge des cancers du col de l'utérus en radiothérapie au Cameroun / The real cost of the management of cervical cancers by radiotherapy in Cameroon

Introduction. Le cancer du col utérin est le deuxième cancer de la femme au Cameroun. La radiothérapie reste une des modalités thérapeutiques phares dans la prise en charge de cette pathologie et l'État participe en y apportant une subvention. Toutefois, plusieurs patientes n'accèdent pas au traitement en raison des difficultés financières. Notre objectif était d'évaluer le coût réel de la prise en charge afin de servir de support aux politiques d'aide aux patientes. Méthodologie. Uneétude descriptive, transversale portant sur les patientes traitées en radiothérapie à l'Hôpital Général de Douala pour cancer du col de l'utérus a été réalisée d'octobre 2020 à janvier 2021.Résultats. Au total 35 dossiers de patientes ont été inclus. Lespatientes avaient de faibles revenus (<108.810 XAF /mois, 51,3%), étaient sans assurance maladie (88,6%), provenant en majorité des villes hors de Douala (54,3%), avec des cancers localement évolués. Le coût global moyen du traitement était de 511 264 XAF+/-103479 XAF (779,42 +/-157,75 euros) pour chaque patiente. La durée moyenne de traitement était de 57,34 jours, avec un nombre médian de 27 séances. Les frais supplémentaires pendant le traitement provenaient de la chimiothérapie, de la gestion des effets secondaires, notamment des transfusions sanguines, et du bilan de suivi. Plus de la moitié des patientes ont eu besoin d'une prise en charge supplémentaire par chimiothérapie ou chirurgie. Conclusion. La prise en charge du cancer du col utérin par radiothérapie est coûteuse et peu accessible à la majorité des patientes Camerounaises.

Introduction.Cervix cancer is the second cancer among women in Cameroon. Radiotherapy is often warranted in its management. Many patients do not access treatment due to financial difficulties. Our objective was to assess the real cost of care in order to support patient assistance policies. Methodology. A descriptive cross over study of women treated by radiotherapy at the Douala General Hospital from October 2020 to January 2021 was conducted. Results. A total number of 35 patient files were included in the study. Patients generally had low income (<108.810 XAF /month), without medical insurance, lived out of Douala, and were diagnosed at locally advanced stages of their disease. Average cost of treatment for radiotherapy alone was 511,264 XAF +/-103,479 XAF. Average duration of treatment was 57.34 days, with a median number of 27 sessions. Extra cost came from chemotherapy, management of side effects especially from blood transfusions, and imaging. More than half of the patients required additional expense for adjunct chemotherapy or surgery. Conclusion. The total cost of treatment for cervix cancer by radiotherapy is quite expensive, and not accessible to the average Cameroonian

Devenir des patientes atteintes de carcinome mammaire invasif apres radiotherapie adjuvante au Cameroun

Le cancer du sein est le premier des cancers tant dans les pays industrialises que dans plusieurs pays africains. Au Cameroun; son incidence est de 29; 7 /100000 personnes-annees et sa mortalite de 16;6 / 100000. Parmi les moyens therapeutiques; la radiotherapie adjuvante a un role non negligeable pour ameliorer la survie. Aussi avons-nous eu le desir de decrire le devenir des patientes atteintes de carcinome mammaire invasif apres radio-therapie adjuvante. Nous avons alors mene une etude retrospective de janvier 2006 a decembre 2010 dans les Services de Radiotherapie des Hopitaux Generaux de Yaounde et de Douala. Afin de determiner le devenir des patientes en termes de survie sans rechute et de survie globale. Nous avons egalement etabli les courbes de survie selon la methode de Kaplan-Meier et analyse les donnees a l'aide du logiciel Epi Info 3.5.3 .Les patientes avaient un age moyen de 46 ans; extremes de 22 a 80 ans. La survie sans rechute etait de 82;5 a 5 ans; les taux de rechute loco-regionale et a distance respectivement de 9;1 et de 18;8. Pour la survie globale; la survenue d'une rechute loco-regionale associee au stade tardif etait un facteur de mauvais pronostic (p = 0;009 et 0;047) tandis que la chirurgie conservatrice l'etait pour la survie sans recidive (p = 0;042). La radiotherapie adjuvante pratiquee au Cameroun pour le traitement des carcinomes mammaires invasifs ameliore le pronostic locoregional et de ce fait la survie globale

[Rare association of a non-functional retroperitoneal paraganglioma and nephrotic syndrome]. / Association rare d'un paragangliome rétropéritonéal non fonctionnel et d'un syndrome néphrotique.

Non functional retroperitoneal paragangliomas are rare: less than 50 cases in literature. They are usually asymptomatic and can attain reasonable dimensions. The association with nephrotic syndrome is exceptional. The authors report a clinical observation of non-functional paraganglioma in a 45 year old woman, with repeated surgical abstention. Literature was reviewed and therapeutic indications discussed.

Une demarche diagnostique des cancers du pancreas exocrine en milieu tropical

Il s'agit d'une etude sur 14 patients et visant a proposer a des malades a faible pouvoir d'achat une demarche diagnostique adaptee a un environnement sous-equipe en materiel et en personnel specialise. Les sequences clinique-echographie-cytoponction percutanee et clinique-echographie-laparotomie ont permis le diagnostic de 13 cancers du pancreas; ce diagnostic etait utilement complete par les donnees d'une laparotomie permettant un traitement palliatif sans aggravation du pronostic

Infections among pygmies in the Eastern Province of Cameroon.

The health requirements of pygmies is poorly understood because of their continued isolation from the other tribes in Central Africa. This study was undertaken among the Baka pygmies of the Eastern Province of Cameroon to generate basic health data among them. A total of 141 adults (18-45 years) were tested for the hepatitis B surface antigen (HBsAg), antibody to the surface antigen (anti-HBs), antibody to the core antigen (anti-HBc) and antibody to the hepatitis C virus (anti-HCV). All HBsAg-positive sera were tested for the hepatitis B e antigen (HBeAg) and antibody (anti-HBe). The presence of antibodies to the hepatitis D virus was determined in most of the anti-Hbs-positive sera, and some of the HBsAg-positive sera. In addition to these, previous infection with syphilis, measles, HIV 1/2 and HTLV were determined by looking for the specific antibodies. We found HBsAg in 14.2% (20/141), anti-HBs in 93.6% (132/141), anti-HBs in 52.2% (73/140), anti-HCV in 7.9% (11/139, measles antibody in 99.3% (139/140), antibody to Treponema pallidum in 13.4% (18/134), antibody to HTLV-1 in 10.9% (15/138) and antibody to HIV-1 in 0.7% (1/140) of the sera tested.

PIP: Pygmies remain isolated from other tribes and urban communities in central Africa. This study was undertaken among the Baka pygmies of the Eastern Province of Cameroon in an effort to redress the lack of published information on the health needs of that population. 141 adults aged 18-45 years were tested for the hepatitis B surface antigen (HBsAg), antibody to the surface antigen (anti-HBs), antibody to the core antigen (anti-HBc), and antibody to the hepatitis C virus (anti-HCV). HBsAg-positive sera were tested for the hepatitis B e antigen and antibody, while the presence of antibodies to the hepatitis D virus was determined in most of the anti-HBs-positive sera and some of the HBsAg-positive sera. Furthermore, previous infection with syphilis, measles, HIV-1 and HIV-2, and HTLV were determined by looking for the specific antibodies. Test results identified HBsAg in 14.2%, anti-HBc in 93.6%, anti-HBs in 52.2%, anti-HCV in 7.9%, hepatitis D in 46%, measles antibody in 99.3%, antibody to Treponema pallidum in 13.4%, antibody to HTLV-1 in 10.9%, and antibody to HIV-1 in 0.7% of sera tested. This prevalence of HIV-1 infection is lower than the estimated 1-1.5% projected for the sexually active general population.

[Ectopic pregnancy in tropical climate. An ultrasonographic study of 93 consecutive cases]. / La grossesse extra-utérine en milieu tropical. Une étude échographique de 93 cas consécutifs.

BACKGROUND AND PURPOSE: Ectopic pregnancy (EP) is common in Cameroon, and incidence is increasing. Ultrasound (US), has been shown to play a key role in its diagnosis, particularly when the transvaginal (TV) route is used. The purpose of our work is to describe sonographic features of EP, and to assess the role of the transvaginal route in the diagnosis of this disease in our environment. PATIENTS AND METHODS: The study was prospectively carried in the US unit of the Yaoundé University teaching Hospital (Cameroon) during a 2 year period. 502 patients aged 14 to 45 were included because of clinical suspicion of EP. The criteria for sonographic diagnosis of EP were the presence of an embryo outside the uterus, a ring-like adnexal structure, or complex adnexal mass separate from the ovaries, in conjunction with free peritoneal fluid. The EP was considered ruptured if significant fluid was found in the upper peritoneal recesses. The diagnosis was confirmed by laparoscopy or laparotomy. RESULTS: Ninety six patients were found to have an EP. 56 patients had only TV pelvic US, 13 had both TV and TA routes, and 24 patients had only TA pelvic US. The mean age was 29 years (interval: 17-42). The main clinical findings included: pain (88%), amenorhea (84%), bleeding (72%), cardio-vascular instability (14%), pelvic mass (9%). The pregnancy was tubal for 93 patients, and abdominal for 3. It was ruptured for 46 (49%). Adnexal abnormalities were present for 86 patients (92%). These were a gestational sac (78%) with a living embryo in 31 patients (33%), or a complex adnexal mass (15%). Uterine findings (40%) included: endometrial thickening (20%), pseudosac (19%), fibroids (6%). An ovarian cysts was present for 10 patients. As a rule, TV route delineated all these findings better than the TA route. CONCLUSION: An exceptionally high proportion of EP was seen after rupture in this study. Our recommendations include: educate patients to seek immediate medical advice for any missed period associated with pain, increase health providers' awareness of EP, and promote availability of TVUS.

[Diagnosis of hepatocellular carcinoma by needle puncture--aspiration and cytological test. The experience in Cameroon]. / Diagnostic du carcinome hépato-cellulaire par ponction-aspiration à l'aiguille et examen cytologique. L'expérience du Cameroun.

The authors report their experience of the diagnosis of hepatocellular carcinoma using needle aspiration cytology over a four year period (1989-1992). In 116 of the 119 patients presenting with histologically proven hepatocellular carcinoma, the diagnosis was previously established by cytology. This method has a 97% sensitivity. Also, in forty patients without hepatocellular carcinoma, previous cytology did not detect any carcinomatous cells and therefore recorded a 100% specificity. Thus, cytologic diagnosis of hepatocellular carcinoma is possible. In countries with limited resources in which this carcinoma is widespread, needle aspiration cytology needs to be well known and used.

Polypes juveniles en milieu camerounais : aspects anatomo-cliniques

Cette etude vise a presenter les aspects anatomo-cliniques du polype juvenile en milieu camerounais. Elle s'etend sur une periode de 8 ans et demi (1er janvier 1984 au 30 juin 1992) et porte sur les polypes juveniles reseques par des gastro-enterologues au cours d'une colonoscopie; puis confirmes par un examen anatomo-pathologique. Au total 55 polypes juveniles sont repertories. Ils proviennent de 46 malades parmi lesquels 26 hommes et 20 femmes. L'age des malades varie de 2 a 37 ans et la moyenne est de 8 ans. Dans l'ensemble; les aspects anatomo-cliniques des polypes juveniles en milieu camerounais ne different pas de ceux observes ailleurs

Gall stone disease in African patients with sickle cell anaemia: a preliminary report from Yaounde, Cameroon.

Cholecystosonography was undertaken in 90 patients with sickle cell disease aged 15 years and over. Gall stones were found in 26 (28.9%) patients. There was no sex difference, but the incidence increased with age from 13.2% at under 20 years to 75% at 30 years and over. The mean serum cholesterol and total and unconjugated bilirubin concentrations were not significantly different between patients with and without gall stones. As most (80.8%) stones were radiolucent they were probably of pigment type, containing little or no calcium, and further investigation into how they are produced is needed. Sickle cell patients with acute abdominal crisis should have gall bladder disease excluded before a diagnosis of vascular crisis is made.