Predictive values of ultrasound characters associated with malignant thyroid nodules in Yaoundé: a cross-sectional study.

Introduction: most ultrasound criteria are defined in developed countries and commonly used in practice to assess the malignancy risk of thyroid nodules. This practice does not take into consideration some aspects of our context as delay of consultation and insufficient iodine intake. The objective of this study was to determine the predictive values of ultrasound characters associated with malignant thyroid nodules in our environment. Methods: we conducted a cross-sectional, prospective, and analytical study in three hospitals in Yaoundé over a six-month period in 2022. Our sample consisted of thyroid nodules with ultrasound, cytopathological, and histopathological data. The ultrasound characters and histology status of category III thyroid nodules and higher in Bethesda score were analysed in univariate and multivariate statistics to determine their predictive values. Results: eighty-nine nodules were obtained according to our inclusion criteria. The sex ratio was 0.46 and the average age of the patients was 46 years (IQR=42-59). The cancer prevalence in our sample was 22.47%. On ultrasound assessment, the characters associated to malignant histology (p<0.05) were nodules count, echogenicity, echostructure, presence or absence of microcalcifications, margins, and type of vascularization. Positive predictive values ranged from 26.15 to 57.14%, while negative predictive values ranged from 12.5 to 33.3%. Conclusion: taken alone, the ultrasound characters of suspected thyroid nodules have poor predictive values. There was a high variability in sensitivity but that was generally good (60-95%) while specificity was low. The prediction of malignant thyroid nodules is correlated with the association of at least two ultrasound criteria supported by clinical arguments.

Thyroid heterotopia revealed by a cervical subcutaneous nodule: a clinical case report.

Thyroid heterotopia is an abnormal localization of normal thyroid tissue coexisting with a normal organ on a normal localization. It is a rare condition with a frequency that is not well known in the literature. We report a case of thyroid heterotopia in a 30 month-old girl referred for a painless lower antero-cervical nodule that has been developing for one year with past history no contributory. The clinical examination found a subcutaneous formation mobile in relation to the different deep and superficial planes with bilateral angulomandibular micro-lymphadenopathy. Ultrasounds of the soft parts of the neck showed hypoechogenic tissue reminiscent of thyroid tissue, the thyroid was in place. The thyroid hormone profile was normal. In the absence of a functional scintigraphy device, the diagnosis was confirmed with a pathology exam after surgery. We discuss the diagnostic relevance of thyroid heterotopia in front of any anterior nodular formation of the neck.

Bilateral sphenoid sinus mucocele observed in Yaoundé-Cameroon: a case report.

A mucocele is a cystic and expansive lesion of the sinus cavities. It is uncommon in the sphenoid sinus and its management is quite challenging especially in low to middle income countries like Cameroon. A 43-years-old female was referred to us by a neurologist for chronic headache and visual disturbances. The pain was unresponsive to analgesics. Physical examination was non-remarkable and a head CT scan realized showed a cyst-like lesion in the sphenoid sinus cavity. Surgical endoscopic treatment was proposed and realized with basic endoscopic instruments, consisting of opening the cavity with drainage of the mucocele. A large opening was made on the anterior wall of the sphenoid sinus, in order to ensure continuous drainage and prevent a recurrence. Sphenoid sinus mucocele is a rare condition, and its diagnosis can be difficult. Confirmation requires specific imaging and treatment is presently well established, but it can be managed with basic tools.

[An unusual case of condylomata acuminata identified in the nasal cavity of a patient living in Yaoundé, Cameroon: a clinical report and literature review]. / Localisation exceptionnelle de condylomes acuminés dans les fosses nasales d'une patiente vivant à Yaoundé, Cameroun: cas clinique et revue de la littérature.

Condylomata acuminata are sexually transmitted lesions caused by human papillomavirus. They mainly occur in the anogenital area and exceptionally in the nasal cavity. We here report a new case of uncommon detection. The study involved a HIV-positive female patient with recurrence of vulvar condylomata acuminata treated in the department of gynecology. She was referred to our department with pink masses in the nasal cavity preventing nasal breathing and evolving over several weeks. Clinical examination and computerized tomography (CT) scan suggested condylomata. Surgical treatment was performed under general anesthesia and endoscopic control; the histological examination showed condylomata acuminata. The postoperative course was simple, with no recurrence after 6 months of follow-up. Condylomata acuminata in the nasal cavity are rare or even exceptional; only very few cases have been described in the literature. They commonly affect young subjects with or without HIV infection, having sexual risk behavior and can occur in several areas, in particular in the genital area. In this case, nasal lesions could result from hand-mediated transfer. Surgical treatment is effective and long-term follow-up is essential to treat possible recurrences.

Effectiveness of amoxicillin alone in the treatment of uncomplicated acute otitis media: a systematic review protocol.

INTRODUCTION: Amoxicillin is the first-line antibiotic recommended by most scientific societies for the treatment of uncomplicated acute otitis media (AOM) in children and adults. In low-income and middle-income countries however, absence of setting-specific recommendations and antibiotic resistance, promoted by higher population density and over-the-counter antibiotic availability, could hamper the effectiveness of amoxicillin. We aim to provide updated information to enable evidence-based decisions for first-line therapy of uncomplicated AOM in our setting. METHODS AND ANALYSIS: We will conduct a systematic review of all randomised controlled trials on the clinical effectiveness of amoxicillin for the treatment of uncomplicated AOM in children above 6 months and adults. The search will include studies published from the generation of the included databases to 31 December 2017. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and study quality will be assessed by the Risk of Bias Assessment Tool from the Cochrane Handbook for randomised trials. A meta-analysis will be conducted for homogeneous studies, eventually, using the fixed-effect model. Subgroup analysis will include age groups, amoxicillin dosage, treatment duration, effectiveness criteria, time of trial realisation, study quality and region of the world involved. ETHICS AND DISSEMINATION: Formal ethical approval is not required, as primary data will not be collected. The results will be disseminated through a peer-reviewed publication and presented at scientific meetings. PROSPERO REGISTRATION NUMBER: CRD42017080029.

Ultrasonographic prevalence and characteristics of non-palpable thyroid incidentalomas in a hospital-based population in a sub-Saharan country.

BACKGROUND: Thyroid incidentalomas (TI) are highly prevalent asymptomatic thyroid nodules with ultrasound as the best imaging modality for their detection and characterization. Although they are mostly benign, potential for malignancy is up to 10-15%. In sub-Saharan Africa little data exists on the prevalence and risk categorization of TI. The aim of this study was to determine the prevalence and ultrasound characteristics of non-palpable thyroid incidentalomas among adults in sub-Saharan setting. METHODS: A cross sectional study was carried out between March and August 2015, at two university teaching hospitals. Sampling was consecutive and included all adults aged ≥ 16 years, presenting for any ultrasound other than for the thyroid, with no history or clinical signs of thyroid disease, and no palpable thyroid lesion. Ultrasound was done using 4 to 11 MHz linear probes. Subjects with diffuse thyroid abnormalities were excluded. Variables studied were age, gender, thyroid volume, ultrasound characteristics of thyroid nodules, TIRADS scores. Differences were considered statistically significant for p-value < 0.05. RESULTS: The prevalence of TI was 28.3% (126 persons with TI /446 examined). This prevalence was 46.2% in population ≥ 61-year-old; 6.3% in population ≤ 20-year-old; 33.3% for females and 18.4% for males (p < 0.001). Of the 241 TI found, 49.4% were cysts, 33.6% solid, 17.0% mixed; 37.8% <5 mm and 22% >10 mm. Solid TI were mainly hyperechoic (42.0%), 3/81 were markedly hypoechoic. Sixty-nine out of 126 persons with TI (54.8%) had at least two nodules. Solitary nodules were predominant in the age group ≤20 years. Of 241 TI, 129 (53.5%) were classified TIRADS 2, 81 (33.6%) TIRADS 3, 25 (10.4%) TIRADS 4A, 6 (2.5%) TIRADS 4B, and none TIRADS 5. Characteristics associated with increased risk of malignancy where mostly founded on solid nodules (p < 0.000) and nodules larger than 15 mm (p < 0.001). CONCLUSION: Thyroid incidentalomas were very frequent with a prevalence of 28.3% and potential risk of malignancy in 12.9%. Prevalence had a tendency to increase with age and in female. Cystic nodules were the most prevalent. Potential for malignancy would be increased for larger and solid nodules.

Epidemiological and clinical aspects of ear nose and throat sensorineural emergencies in the Yaoundé reference hospital.

INTRODUCTION: Sensorineural emergencies (SNE) are rare clinical situations. Few patients consult early explaining subsequent difficulty in having accurate data and management. Three clinical conditions are considered SNE in otolaryngology; they include sudden sensorineural hearing loss (SSHL), Bell's palsy and acute vertigo. There is very little data available on sensorineural emergencies in our setting. The aim of this study was to provide preliminary data on the management of Ear Nose and Throat (ENT) sensorineural emergency cases in Yaoundé Reference Hospital. METHODS: A descriptive retrospective study was carried out based on data collected over a period of 5 years, January 2010 to July 2014 at the Yaoundé Reference Hospital. Information was obtained from patients' files collected from the archives of the institution. Patients presenting with SSHL, Bell's palsy, acute vertigo who consulted during the study period were included in the study. RESULTS: A total of 22 patients were included in the study out of 6406 patients who consulted at the ENT Unit. The prevalence of SNE in ENT consultations was 0.003, distributed as follows; 13 patients (59.1%) of SNE had Bell's palsy, seven (31.8%) had vestibular neuritis and two (9.1%) had SSHL. CONCLUSION: The prevalence of SNE was low with idiopathic Bell's palsy being the most frequent. There was a general delay in arrival of patients hence delay in diagnosis. This delay could equally be a factor for treatment failure and poor prognosis. More effort should be made in terms of population sensitization about the necessity of getting early medical attention.

Epidemiological and histopathological patterns of salivary gland tumors in Cameroon.

INTRODUCTION: Tumors of salivary glands are rare. According to Johns and Goldsmith in 1989, their annual incidence is less than 1/100000 without noteworthy geographical gap. But other authors suggest that their distribution may vary according to the race and geographical location. In Cameroon, existing studies give incomplete data. Hence, we underwent this study in order to draw the general profile of salivary gland tumors in Cameroon. METHODS: A retrospective study was carried out on the period spanning from January 2000 to December 2010 (11 years). It was done in nine Pathology services of different hospitals in Yaoundé, Douala and Bamenda. We consulted the archive registers of those services, retaining any patient with salivary gland tumor, whatever the histological type or location. Information gathered was the year of diagnosis, the service, the age and sex, the site of the tumor (gland) the histological type and the benign/ malignant character. RESULTS: We recruited a total of 275 files. Women were 56% (154/275) and men 44% (121/275) of the sample. Fifty eight tumors were malignant (21.9%) while 217 were benign (78.1%). The overall mean age was 37.44 years, with extremes between 1 and 84 years. Pleomorphic adenoma (60.36%) was the most common benign tumor. Adenoid cystic carcinoma (31%), mucoepidermoid carcinoma (22.4%) and adenocarcinoma (19%) were the most common malignant tumors. Palate (66.7%), cheek (30%) and lips (3.3%) were the sites were the minor salivary glands were mostly involved. CONCLUSION: The differences with western world authors suggest a geographical variability of salivary gland tumors.

Trois cas de paragangliome tympanojugulaire observés au Cameroun

Trois cas de paragangliome tympanojugulaire ont ete observes dans nos services de 2008 a 2013. Le diagnostic de ces tumeurs benignes s'est appuye en grande partie sur l'imagerie medicale disponible dans nos hopitaux. Les auteurs rapportent les limites rencontrees quant a l'aspect therapeutique de ces tumeurs rares

A comparative study of the diagnostic methods for Group A streptococcal sore throat in two reference hospitals in Yaounde, Cameroon.

INTRODUCTION: Sore throat is a common complaint in general practice which is more frequent in children. The most frequent pathogenic bacteria associated with this infection is Streptococcus pyogenes. Rapid Antigen Diagnostic Test (RADT) facilitates the rapid identification and consequently prompt treatment of patients, prevents complications, and also reduces the risk of spread of Group A Streptococcus (GAS). The main objective of this study was to assess the diagnostic value of a rapid streptococcal antigen detection test in patients with sore throat. METHODS: A cross-sectional descriptive study was carried out from January to April 2011 on patients aged 3 to 72 years consulting for pharyngitis or sore throat at the paediatric and Ear, Nose and Throat units of the University Teaching Hospital Yaounde and the Central Hospital Yaounde. Two throat swabs were collected per patient. One was used for the rapid test and the other for standard bacteriological analysis. RESULTS: The prevalence of GAS in the study population was 22.5%. Out of the 71 samples collected, the RADT detected group A streptococcal antigens in 12 of 16 positive cultures giving a sensitivity of 75%. The specificity of the rapid test was 96%, with positive predictive value of 85.7%, and negative predictive value of 93% respectively. CONCLUSION: Rapid test may have an additional value in the management of patients with high risk of having GAS infection. However, tests with a higher sensitivity are needed for accurate and reliable results for early diagnosis of patients with sore throat caused by GAS.

Indications actuelles de l'adenoidectomie; de l'amygdalectomie et de l'adenoamygdalectomie a l'Hopital General de Douala

"Sur une serie de patients operes dans le service ORL de l'Hopital General de Douala; evaluer les indications de la chirurgie des vegetations adenoidiennes et de l'amygdale en fonction des criteres de l' "" Evidence Based Medecine "". MATeRIELS ET MeTHODES etude retrospective colligeant les cas d'amygdalectomie; d'adenoidectomie et d'adenoamygdalectomie sur une periode de six ans a ete entreprise. Ont ete inclus les enfants de 0 a 15 ans. Les indications operatoires ont ete repertoriees. Pour l'analyse l'utilisation de la grille standardisee d'evaluation selon les criteres de l' "" Evidence Based Medecine "" en quatre niveaux de preuve suivant le type d'etude effectue pour la pertinence des indications. ReSULTATS 100 dossiers ont ete colliges repartis en 43 adenoidectomies; 40 adenoamygdalectomies et 17 amygdalectomies. L'age moyen des adenoidectomies etait de 3;5 ans ; 5;4 ans pour l'adenoamygdalectomie et 9 ans pour l'amygdalectomie. Pour l'adenoidectomie 3 indications ont ete relevees; le syndrome d'apnee du sommeil (SAS) dans 48;8 des cas; les rhinopharyngites a repetition dans 34;8 des cas et l'otite des cas. L'adenoamygdalectomie a concerne dans 80 seromuqueuse dans 16;2 des cas le SAS et dans 20 une notion d'angine a repetition. L'amygdalectomie isolee etait plus rare que les deux autres interventions et a ete principalement realisee pour les angines a repetition. CONCLUSION Suivant les criteres de l'EBM le SAS; les rhinopharyngites a repetition et l'otite seromuqueuse sont des indications majeures des adenoamygdalectomies. Les angines a repetition sont en regression."

Waardenburg Syndrome in Childhood Deafness in Cameroon

Background. Waardenburg syndrome (WS) is a rare hereditary disorder essentially characterised by deafness and pigment disorders of the eyes; hair and skin.Methods. Between October 2010 and December 2011; we identified six patients with WS during an aetiological survey of 582 deaf participants recruited in schools for the deaf and ear; nose and throat outpatient clinics in seven of the ten regions of Cameroon. Two classic characteristics of WS were used as diagnostic criteria: deafness and pigmentation abnormalities (heterochromia iridis; white forelock and depigmented skin patches). In addition; to identify dystopia canthorum; a sign of WS type I; we calculated the W-index. Results. WS comprised 1 of the whole sample; 7 of the genetic cases; and 50 of the genetic syndromic cases. All patients with WS had severe to profound congenital sensorineural and symmetrical hearing loss with flat audiograms. They also had pigment disorders of the eyes and the skin. In the absence of dystopia canthorum; they were all classified as having WS type II. The pedigree was suggestive of autosomal dominant inheritance in two cases; and the four others seemed to be de novo cases. Conclusion. The results suggest that WS type II is the most common syndromic form of hearing loss among Cameroonians. This has implications for retrospective genetic counselling and hearing tests for earlier management in affected families

Aetiology of childhood hearing loss in Cameroon (sub-Saharan Africa).

BACKGROUND: Severe hearing loss is a global problem affecting particularly developing countries. There is scarcity of recent published data on the epidemiology of childhood deafness in sub-Saharan Africa. OBJECTIVE: To determine the etiological profile of severe childhood deafness in Cameroon. METHODS: Prospective cross-sectional study of patients with a severe hearing loss that started before the age of 15 years. Detailed family and medical history was obtained; careful clinical, otological and audiological examinations were performed. RESULTS: A total of 582 patients with a severe hearing loss were examined. Prelingual deafness accounted for 75.1% (n = 437), with a mean age at medical diagnosis of 3.3 ± 1.2 years. This late presentation may be explained by limited parental awareness of signs raising suspicion of hearing loss, poor access to health care and the absence of neonatal screening for hearing loss in Cameroon. Identified genetic causes accounted for 14.8% (n = 86), putative environmental causes for 52.6% (n = 306) and unknown causes for 32.6% (n = 190). Amongst Genetic causes, the syndromic hearing loss accounted for 13.1% (n = 12) of cases, the rest being non syndromic (n = 74). Consanguineous families accounted for 5.7% (n = 33) of the whole sample, and 15.1% (n = 13) of genetic cases. No union between deaf parents was observed. CONCLUSION: These data highlight the possible predominance of putative environmental causes of childhood deafness in Cameroon, and emphasize the need for improved policies for prevention of infectious diseases and for neonatal hearing screening. However, further molecular analyses and targeted CT scan investigations are required to more accurately gauge the contribution of genetics etiologies.