Yaounde University Teaching Hospital Research Articles

Evaluation of the management of infectious risk at the laboratories of the Yaounde University Teaching Hospital

Evaluation of the management of infectious risk at the laboratories of the Yaounde University Teaching Hospital

Seroprevalence of Cytomegalovirus, Epstein-barr Virus and Herpes Simplex Viruses in Children Born HIV Positive at the Yaounde University Teaching Hospital, Cameroon

Background: Cameroon is a country located in sub-Saharan Africa, which is an area endemic to herpesviridae family, there is very little data on the herpes virus infections epidemiology, especially associated with HIV infection. Aims: The aim of our study was to determine the seroprevalence of four herpes viruses that are cytomegalovirus (CMV), Epstein-Barr virus (EBV), Herpes Simplex virus 1 (HSV-1) and 2 (HSV-2) in HIV-positive patients in Yaoundé University Teaching Hospital. Methodology: the study was prospective cross-sectional and took place at Yaounde University Teaching Hospital and Department of Microbiology, Faculty of Sciences, University of Yaounde I, between November 2020 and April 2021. We included consecutively 74 on children living with HIV born HIV positive, on antiretroviral treatment (23 men, 51 women; age range 3-19 years), and whose medical file was complete and available within the ATC. IgG/IgM antibodies against HSV-1, HSV-2, CMV, and IgM against EBV were qualitatively determined by Rapid Diagnostic Tests, for the detection of these pathogens. The statistical analysis was done using IBM SPSS version 22.0, the Fisher exact and the Khi-sqaure tests to compare qualitative variables between groups, while on the other hand, we used the Mann-Whitney test to compare quantitative variables. All P values below 0.05 were considered significant. Results: A total of 74 participants were enrolled in the study with a female predominance of 68.92% (n=51/74). The average age of our serie was 9.05±5.09 years, and a majority of participants was under 10 years old (56.76%, n=42/74). HSV-1, HSV-2, EBV and CMV Seroprevalences were 93.24%, 93.24%, 22.97% and 12.2% respectively. Other parameters such as sex, age, stage of disease, smoking and alcohol consumption were significantly associated with the seropositivity of these herpesviridae. Conclusion: Despite the absence for most of the clinical manifestations related to HSV-1 and HSV-2, it was strong to note a high circulation of those virus in HIV infected patients, mainly in bi and tri co-infections.

"Seroprevalence of Cytomegalovirus, Epstein-Barr Virus, and Herpes Simplex Viruses in Children Born HIV Positive at the Yaounde University Teaching Hospital, Cameroon After 12 Months of Follow-Up: A Cross Sectional Study"

"Seroprevalence of Cytomegalovirus, Epstein-Barr Virus, and Herpes Simplex Viruses in Children Born HIV Positive at the Yaounde University Teaching Hospital, Cameroon After 12 Months of Follow-Up: A Cross Sectional Study"

Evaluation of the Oral Health of Hemophiliac Patients in Cameroon

Introduction: The aim of our study was to identify oral pathologies, determine their frequencies and assess the oral care needs of hemophilia patients in Cameroon. Method: A descriptive cross-sectional study was conducted from January 2021 to June 2021 in the approved Hemophilia Treatment Centres in Cameroon, one in the Yaounde University Teaching Hospital and the other one in the Gynaeco-obstetric and Paediatric Hospital of Douala. A survey form was used to collect data for the description of our sample. The patients’s files were useful for additional information. Mucosal, dental and periodontal conditions were described using the hygiene indices of Silness and Loë, DMFT and CPITN. The data were entered into the Google forms mask and analysed using SPSS 20. Results: A total of 52 hemophiliac patients were included in our study, all of them males aged between 15 months and 42 years. The mean age of our sample was 14.6 years old ± 10.7. The CAO index was 1.71. 88.46% had episodes of gingivorrhagia caused by brushing. Only 21.15% had a history of dental consultations. Only 7.69% had good hygiene. The oral pathologies encountered were gingivitis 78.85% and periodontitis 1.92%. Conclusion: In view of these results, it would be necessary to integrate regular oral care into the follow-up of haemophilia patients in order to improve their quality of life.

SUPER HYPERTENSION OR VERY SEVERE HYPERTENSION IN A SUB-SAHARAN COUNTRY: EPIDEMIOLOGICAL, CLINICAL, THERAPEUTICAL AND EVOLUTIVE OF THESE PARTICULAR PATTERNS

Objective: To describe the epidemiological, clinical, therapeutical and evolutive patterns of super hypertension in Yaounde University Teaching Hospital. Design and method: This study is an observation cohort over a period of 9 months (January 2016 to September 2016). We recruited from members of the public who accepted voluntary blood pressure screening offered in various localities in Yaounde, and were aged 18 years or over. Results: Of a total of 6.519 people, 1.875 (28.8%) presented a high blood presure. Amongst them, 37 presented a super hypertension (a systolic blood pressure 250 mmHg and/or diastolic blood pressure 150 mmHg in presence or not of complications), corresponding to a prevalence of 2% of all hypertensive patients. Our cohort comprised 33 of these individuals who accepted the invitation to participate in the study. The mean age was 49.3 years, with a sex- ratio of 0.7. Twenty-three (70%) of the patients were known hypertensive for a mean time of 10 years, out of 9% were regularly rewieved, but none on medications. The mean of cardiovascular risk factors was 7, with 91% who had an excess salt intake. Dyspnea and headache were the main symptoms. The means systolic blood pressure and diastolic blood pressure were respectively 244.9 mmHg and 144.8 mmHg. Twenty-six (78.8) patients were either overweight or obese. We noticed a fundoscopy stage II or III in 21.1% of the cases. Seventy percent of the cases had left ventricular hypertrophy on electrocardiogram and 18.2 on echography. Complications were noticed on admission in 60.6% of all cases, it's was mainly signs of renal failure. Acute kidney injury occurred in 15.15% of the cases during follow-up. The average rate of blood pressure control over 6 months was 3%. The main cause of poor blood pressure control was lack of therapeutic compliance. We noticed refractory high blood pressure in 4 (12.1%) cases and registered one death at the 3rd month of follow up due to acute kidney injury. Conclusions: Super hypertension is a youth's pathology. Its early detection reduces significantly the high morbi-mortality. However, its efficient management needs minimal additional resources.

Antibiotic Susceptibility Patterns of Bacteria Associated with Sepsis among Hospitalized Patients in the Yaoundé University Teaching Hospital—Cameroon

Background and Objective: In developing countries, the steep increase in septicaemia cases is a major health problem that creates the biggest challenge for clinicians in the selection of appropriate antimicrobial agents. This is further complicated by the development of resistance in organisms to antimicrobial agents, which is the mainstay of treatment. The aim of this study was to determine the antimicrobial resistance patterns of bacterial isolates associated with sepsis among hospitalized patients including the detection of Methicillin Resistance Staphylococcus aureus (MRSA) and Extended Spectrum Beta lactamases (ESBLs). Methods: A cross-sectional study was carried out for 5 months at the Yaounde University Teaching Hospital. Bacterial species were isolated from 150 blood samples collected from hospitalized patients. Antimicrobial susceptibility testing was carried out using the Kirby-Bauer disc diffusion method. The isolates were tested for methicillin resistance and ESBLs. Results: The prevalence of septicaemia was 16% (24/150) among hospitalized patients. In our study, 75% (18/24) of infections were caused by Gram- negative and 25% (6/24) by Gram-positive bacteria. Klebsiella spp., Escherichia coli, and Staphylococcus aureus were the most common isolates. The antibiotic susceptibility patterns of the isolates showed that Gram-negative bacteria were highly resistant to Amoxicillin clavulanic acid and ceftriaxone while the Gram- positive bacteria were highly resistant to minocycline. Fifty percent (3/6) of the isolated S. aureus were methicillin-resistant and 27.8% (5/18) of the isolated Enterobacteriaceae were ESBLs producers. In multivariable logistic regression analysis, temperature above 37.9℃ (AOR = 4.455; 95% Cl = 1.458 - 15.693; p = 0.033) and being under respiratory assistance (AOR = 4.311; 95% Cl = 1.458 - 12.749; p = 0.008) were significantly associated with septicaemia. Conclusion: The Occurrence of multidrug-resistant strains in this study emphasizes the need for continuous surveillance in hospitals to detect resistant strains. Strict guidelines for antibiotic therapy and the implementation of infection control measures to reduce the increasing burden of antibiotic resistance are advocated.

PS-C15-8: SUPER HYPERTENSION OR VERY SEVERE HYPERTENSION IN A SUB-SAHARAN COUNTRY: EPIDEMIOLOGICAL, CLINICAL, THERAPEUTICAL AND EVOLUTIVE PATTERNS

Backgroung: To describe the epidemiological, clinical, therapeutical and evolutive patterns of super hypertension in Yaounde University Teaching Hospital. Methodology: This study is an observation cohort over a period of 9 months (January 2016 to September 2016). We recruited from members of the public who accepted voluntary blood pressure screening offered in various localities in Yaounde, and were aged 18 years or over. Results: Of a total of 6.519 people, 1.875 (28.8%) presented a high blood presure. Amongst them, 37 presented a super hypertension (a systolic blood pressure 250 mmHg and/or diastolic blood pressure 150 mmHg in presence or not of complications), corresponding to a prevalence of 2% of all hypertensive patients. Our cohort comprised 33 of these individuals who accepted the invitation to participate in the study. The mean age was 49.3 years, with a sex- ratio of 0.7. Twenty-three (70%) of the patients were known hypertensive for a mean time of 10 years, out of 9% were regularly rewieved, but none on medications. The mean of cardiovascular risk factors was 7, with 91% who had an excess salt intake. Dyspnea and headache were the main symptoms. The means systolic blood pressure and diastolic blood pressure were respectively 244.9 mmHg and 144.8 mmHg. Twenty-six (78.8) patients were either overweight or obese. We noticed a fundoscopy stage II or III in 21.1% of the cases. Seventy percent of the cases had left ventricular hypertrophy on electrocardiogram and 18.2 on echography. Complications were noticed on admission in 60.6% of all cases, mainly signs of renal failure. Acute kidney injury occurred in 15.15% of the cases during follow-up. The average rate of blood pressure control over 6 months was 3%. The main cause of poor blood pressure control was lack of therapeutic compliance. We noticed refractory high blood pressure in 4 (12.1%) cases and registered one death at the 3rd month of follow up due to acute kidney injury. Conclusion: Super hypertension is a yout s pathology. The early detection reduces significantly the high morbi-mortality. However, its efficient management needs minimal additional resources.

Role of Lung Ultrasound in the Assessment of Hydration Status of Chronic Haemodialysis Patients

Background: Fluid overload is frequent in Haemodialysis (HD) and is one of the major factors of cardiovascular morbidity and mortality for chronic HD patients. The main challenge with chronic haemodialysis patients is indeed the maintenance of a normal extracellular volume through dry weight determination. Our study aimed at assessing the role of lung ultrasound in the detection of B-lines for the determination of hydration status in chronic HD patients. Methods: We conducted a cross-sectional study including 31 patients undergoing chronic HD treatment for at least 3 months, in the Yaounde University Teaching Hospital dialysis unit. Lung ultrasonography and clinical examinations were performed immediately before dialysis, and 30 minutes after dialysis. Differences between clinical and ultrasound variables before and after dialysis were measured to assess the effects of dialysis. Association between categorical variables was assessed with the Chi-squared test or Fischer test, and Rho’s Spearman coefficient for quantitative variables. Results: There was a reduction in the median of B-lines score after dialysis [12 (7 - 26) versus 8 (5 - 13)], clinical score [2 (1 - 3) versus 0 (-1 - 2)], mean of systolic blood pressure (164.74 ± 26.50 versus 158.48 ± 27.89), frequency of dyspnoea in patients (32.3% versus 6.5%); and raising of the frequency of cramps in patients (0% versus 19.4%) and all statistically significant (p ≤ 0.031). B-lines score before and after dialysis was associated with dyspnoea and raised jugular venous pressure (p < 0.05). B-lines score before dialysis was correlated with B-lines score after dialysis (r = 0.805; p < 0.001), B-lines reduction (r = 0.862; p < 0.001), and clinical score (r = 0.49; p = 0.005). Reduction of B-lines score was not correlated with weight loss. Conclusion: Lung ultrasound for the detection of B-lines reflects the variation of extracellular volume during dialysis and can even capture pulmonary oedema at a pre-clinical stage. It is then a reliable and sensible method for assessing extravascular lung water and thus hydration status of haemodialysis patients. It could constitute a better alternative for an objective and accurate definition of dry weight, specifically in the African and Cameroonian context, with its assets being low cost, availability, and easiness to perform in a large population of HD patients. We, therefore, recommend further multicentric studies in order to design a standardized protocol of ultrasound follow-up for all chronic HD patients’ hydration status assessments.

Intravaginal Practices and Genital Infections: Case of Women from the Yaounde University Teaching Hospital

Intravaginal Practices and Genital Infections: Case of Women from the Yaounde University Teaching Hospital

Epidemiological, Clinical, and Therapeutic Aspects of Congenital Heart Disease in Two Teaching Hospitals in Yaounde-A Cross-sectional Study

The in-hospital prevalence, type, treatment, and outcome of Congenital Heart Disease (CHD) has not been described in our setting. We carried out a cross-sectional study in two teaching hospitals in Yaounde-The Yaounde University Teaching Hospital and the Chantal Biya Foundation (Mother-Child center). We retrospectively reviewed the records of all echocardiography confirmed cases of CHD seen between 2012 and 2018. A total of 105 patients (53 males and 52 females) were included in this study. The most frequent age groups were 1 to 6 months. The in-hospital prevalence of CHD was 8.7%. A heart murmur was the most frequent index sign in 97.1% followed by pneumonia in 41% of patients. Trisomia 21 was associated with 6.7% of cases. Non-cyanotic CHD was the most frequent in (74.4%), and these were mainly ventricular septal defect (42.9%) and atrial septal defect (25.7%) of all CHD. Tetralogy of Fallot was the most frequent cyanotic CHD in 13.3% of all cases. Complications due to CHD was seen in 38.1% of cases, and this mainly pulmonary hypertension in 22 (53.7%) cases. Surgical treatment was performed in 41.9% (all abroad) with a favorable outcome in all cases. CHD represents 8.7% of in-hospital pediatric admissions, and these were mainly acyanotic. Few patients had surgical correction abroad with a good outcome in all cases.

Pitfalls in Diagnosing Heterotopic Pregnancy in Sub-Saharan Africa: A Case Report at the Yaounde University Teaching Hospital (Cameroon)

Heterotopic pregnancy (HP) is a dizygotic twin pregnancy in which one gestational sac is intrauterine and the other is extrauterine. The prevalence of HP is unknown in Cameroon where the diagnosis is difficult and usually fortuitous like in other resource-poor settings. We herein depict pitfalls and delays in the diagnosis and management of a ruptured heterotopic pregnancy at the Yaounde University Teaching Hospital. After a wrong diagnosis and inadequate treatment, our patient presented at our emergency unit with severe pelvic pain and clinical signs of hemoperitoneum with shock. She underwent a total left salpingectomy through laparotomy. She had a complete spontaneous abortion five days after the surgery. Given that sonography is not routinely available in emergency departments in resource-poor settings, it may be relevant for practitioners to always bear HP in mind when facing ruptured ectopic pregnancies.

Bacteriological Profile and Antibiotic Resistance Pattern at the Yaounde University Teaching Hospital: A Retrospective Study

Aims: Over the decades, antibiotic resistance has become a cross-border public health problem. This calls for the profiling of microorganisms, particularly bacteria implicated in antibiotic resistance, in order to improve clinical practice and reduce the incidence of therapeutic failure in the treatment of infectious diseases.&#x0D; Study Design: We conducted a retrospective cross-sectional study.&#x0D; Place and Duration of the Study: The study was made at the bacteriology laboratory at the Yaounde University Teaching Hospital, Cameroon during the period between January 2016 and June 2021.&#x0D; Methodology: All bacterial strains from the following biological fluids were included: blood, stool, urine, suppurations, probe tip and catheter tip. The antibiotic susceptibility of isolates was collected from the registers of the said laboratory. The data were encoded in Censuses and Survey Procession Software (CSPro) version 7.3 and analysed using the Statistical Package for Social Science (SPSS) version 25. Graphs and figures were made using Excel 2016 spreadsheet software.&#x0D; Results: A total of 1071 bacteria were enrolled in 955 patients. The age group most represented was 0-5 years (34.6%). Most of the isolates came from a blood sample. Among the isolates, Coagulase-negative Staphylococci (18.5%), Escherichia coli (17.7%), Staphylococcus aureus (14%) and Klebsiella pneumoniae (11.2%) were the most common. A total of 1071 bacteria were enrolled in 955 patients. The age group most represented was 0-5 years (34.6%). Most of the isolates came from a blood sample. Among the isolates, Coagulase-negative Staphylococci (18.5%), Escherichia coli (17.7%), Staphylococcus aureus (14%) and Klebsiella pneumoniae (11.2%) were the most represented. Between 2016 and 2020, almost remarkable resistance was observed to the class of penicillins (78% to 83%), cephalosporins (44% to 61%) and quinolones (43% to 100%) for Escherichia coli. For Staphylococcus aureus, resistance changes range from 68% to 77% for the penicillin class. Klebsiella pneumoniae showed an evolution ranging from 11% to 19% for aminosides.&#x0D; Conclusion: Although not all isolates showed a change in the level of resistance to all antibiotics that are frequently used in our study population, Nevertheless, it is important for national public health actors to establish active surveillance of antibiotic and even antimicrobial resistance and to implement a guide to the proper use of antibiotics for health professionals, and the community.

POS-057 IMPACT OF SEVERITY AND AETIOLOGY OF ACUTE KIDNEY INJURY ON RENAL PROGNOSIS IN TWO REFERRAL HOSPITALS IN CAMEROON

Acute kidney injury (AKI) is associated with a high morbi-mortality worldwide and an increase in health costs. It increases the risk of developing chronic kidney disease (CKD). Various factors associated with poor renal prognosis have been described. These include advanced age, severity, duration and frequency of AKI, the existence of an underlying CKD or oliguria. To our knowledge, there are still several limitations to the current studies, such as studies provided by single institutions and more often on Caucasian population. Furthermore, no study has been carried out in our setting to assess the impact of the severity of AKI and its aetiology on renal prognosis. The aim was to evaluate the impact of severity and aetiology of AKI on renal prognosis in two referral hospitals in Cameroon. We conducted a retrospective cohort study for a period from January 1, 2015 to April 30, 2017. Patients older than 18 years with AKI admitted and followed-up for at least 3 months at the nephrology unit of either the Yaounde General Hospital or the Yaounde University Teaching Hospital during the study period were included. Incomplete records, AKI of non-organic mechanism were excluded. Sociodemographic and clinical data were collected on technical data sheets from patient’s records and medical registries. Staging of AKI was assessed by using the 2012 KDIGO classification. Data analysis was done using SPSS software version 20. The significance threshold was set at p <0.05. The study was approved by the Faculty of Medicine and Biomedical Sciences ethics committee. We included a total of 83 patients (36 with non-complete recovery of the renal function and 47 with complete recovery) with an average age of 46.6 ± 13.8 years and 60.2% of males. Patients with non-complete recovery of the renal function (non CR group) were similar to those with complete recovery (CR group) in terms of age (p=0.25) and sex (p=0.051). The reference period was greater than 72 hours in 88.9% and 29.8% respectively of the patients of the non CR group and the CR group (p<0.001). The other clinical features were similar for both groups. Stage 3 of AKI increased the risk of lack of complete recovery of renal function by 56-fold (OR: 56.1, 95% CI = 5.6-561.5 and p=0.001). Malignant hypertension was associated with a 22-fold risk of non-recovery of renal function (OR: 22.5, 95% CI = 2.5-204.4, p = 0.006). The severity and aetiology of AKI influence the renal prognosis. Stage 3 of AKI and malignant hypertension are associated with an increased risk of lack of complete recovery of renal function within 3 months after AKI.

Coagulation Tests’ Normal Values in a Cameroonian Adult Population

Coagulation tests are routine analyses most prescribed in routine medical practices. Africans tend to use the thresholds of other races since they don’t have their own normal values. This was a prospective descriptive study carried out at the Yaounde University Teaching Hospital to determine normal values for coagulation’s tests. We included 160 venous samples from healthy blood donors, aged 18 to 56 years. Standard techniques were used for the measurement of prothrombin time, activated partial thromboplastin time and fibrinogen levels in all samples. The median prothrombin time was 13.01 s (10.2.-15.2) with a significant difference between males (PT=13,2s(11,1-15,5)) and females (PT=13,0s(10,1-15,2)), p=0,02 but not significant between the age groups (p=0,31).The median of APTT and fibrinogen were 32.4 s(22.2.-40.5), 2.8 g/L (1.5-4.2) and not significant between sex and age groups, p=0,34 and 0,14 respectively. Although the sample size does not allow for generalized conclusions, nevertheless, these findings provide indications to normal ranges for these coagulation tests among healthy adult Cameroonians. Furthermore, it may be relevant to consider the gender when interpreting coagulation tests in Cameroonian settings.

Prevalence, clinical characteristics and related mortality of cirrhosis in a tertiary hospital setting in Sub Saharan Africa

Background: Published data on the prevalence and mortality associated to cirrhosis is rare in Cameroon. The aim of this study was to determine the prevalence, clinical and para clinical characteristics and associated mortality of cirrhosis at the Yaounde University Teaching Hospital (YUTH), Cameroon. Methods: Files of patient’s followed up or admitted for cirrhosis at the YUTH between June 1st 2016 and June 30th 2018 were reviewed. The diagnosis of cirrhosis was made based on clinical, biological, ultrasonographic and/or endoscopic signs of portal hypertension and chronic liver failure. In other to establish the cause of cirrhosis, markers of documented chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) was sought in the file of the patients and if not present, hepatitis C antibody and hepatitis B surface antigen testing were requested. In patients negative for HBV and HCV markers, alcohol intake was considered as a cause of cirrhosis in someone who have been consuming more than 30 g/day (for males) or more than 20 g/day (for females) of alcohol. Data analyses were performed using Epi info V 3.5.4. Results: During the period of study, 1748 patients were admitted in the internal medicine unit among which 117 had cirrhosis giving a prevalence of 6.7%. There were 67 males (57.3%) and 50 females (42.7%). The mean age of patients was 51 +/- 19.862 years. Patients with HCV related cirrhosis were older (mean age: 68years) than those with HBV induced cirrhosis (mean age: 38years). The most frequent signs were ascites 104 patients (88.9%), asthenia 92(78.6%), hepatomegaly 68(58.1%), jaundice 61(52.1%), abdominal distension 54(46.2%) and gastrointestinal bleeding 29(24.8%). Anaemia was present in 58 patients (49.6%), thrombocytopenia in 56 patients (47.9%), low prothrombine time in 64 patients (54.7%). Mean serum albumine was 27.59 g/l (6-70), mean total bilirubine 49.41mg/l (3-275mg/l), mean AFP 75693 mg/ml (0.8-1578022). Spontaneous bacterial peritonitis was found in 21 patients (17.9%) Performed in 30 patients (25.6%), upper digestive endoscopy showed oesophageal varices in 27 patients (90%), hypertensive gastropathy in 17 patients (56.7%) and an ulcer in 3 patients (10%). Found in 47 patients (40.2%), HBV infection was the most frequent cause of cirrhosis followed by chronic HCV infection in 43 cases (36.8%) and alcohol intake in 26 patients (22.2%). The most frequent Child-Pugh class was C in 32 patients (48.5%) followed by Child-Pugh B and A in 26 patients (39.4%) and 8 patients (12.1%) respectively. Mortality rate was estimated at 20.5% (24 patients) and death was attributed to hepatic encephalopathy in 19 patients, gastrointestinal bleeding in 3 patients and spontaneous bacterial peritonitis in 2 patients. Conclusion: Liver cirrhosis is frequent in our setting, mostly diagnosed on advanced stages with complications. The most common causes are viral hepatitis B and C. The mortality rate is high.

Epidemiology, Diagnosis and Management of Pancreatic Cancer in 4 Hospitals in Yaoundé And Douala (Cameroon)

Introduction: Pancreatic cancer is a public health problem because of its poor prognosis. Most of the factors related to the prognosis of this cancer are negative and pessimistic. Therefore, our work is to estimate the overall survival of our patients and to establish the prognostic factors associated to survival. Materials and Methods: This was a cohort study with retrospective data collection method, carried out from January 1, 2010 to December 31, 2019 i.e. a period of 10 years. The research took place in General hospitals of Yaounde and Douala; at Yaounde University Teaching Hospital and at Laquintinie. We obtained ethical clearance from the Institutional Review Board of the University of Douala. We included records of patients with pancreatic cancer of at least 12 months follow-up after diagnosis. Results: We had a total of 94 cases of pancreatic cancer during our study. Mean age at diagnosis was 56.5 ±12.3 years, the most represented age group was 50-59 years (48.9%), with sex ratio of 1.6 in favor of men. Median consultation time was 6 months. The most common stage of diagnosis was stage IV of the TNM classification. Conclusion: At the end of our study, it appeared that survival associated to pancreatic cancer remains low, in fact the median overall survival was 25 months. All prognostic factors found in our study were factors of poor prognosis which were: consultation time >3 months; high serum creatinine level and the occurrence of metastases.

Imaging of Degenerative Pathologies of the Lumbar Spine: Professional Habits in Some Hospitals in Cameroon

Background: The lumbar spine is the portion most frequently involved in degenerative pathologies. Everyone will suffer one day from “low back pain”. These pathologies are very frequent: epidemiological studies have shown that 65% to 90% of the general population could be affected by low back pain (lumbago) which could become chronic at acertain stage or could be complicated (2% to 4%) of cases could end up affecting nerve roots. Chronic low back pain causes a major public health problem in terms of morbidity and socioeconomic repercussions. Purpose: The overall purpose of this study is to evaluate the professional habits of exam applicants in case of degenerative pathologies of the lumbar spine, to Appreciate the knowledge of clinicians on the usefulness of medical imaging techniques in the event of suspicion of a degenerative pathology of the lumbar spine and finally to evaluate if the professional habits of requesting examinations in Cameroon comply with the Recommendations for Clinical Practice. Methods: A cross-sectional and descriptive study was used and was based on questionnaires distributed to those practitioners who requested for these diagnostic medical imaging studies and procedures at Yaounde General Hospital (HGY), Yaounde Central Hospital, La Cathedrale Medical Center, Yaounde University Teaching Hospital, the Douala General Hospital, the Laquintinie Hospital of Douala, the Military Hospital of Douala, the Daniel Muna Memorial Clinic of Douala, the International Center for Clinical and Medicine Imaging, the Ngaoundere Regional Hospital and the Protestant Hospital of Ngaoundere (HPN), from April 2020 to March 2021. Data collected was processed and analyzed via Epi Info version 12.0 and the statistical test used for correlation was Chi2. Results: 137 practitioners were retained among whom, 90 were male and 47 females, their average age being 46 years with working experience less than 5 years (35.8%). The results obtained show that parameters such as availability and accessibility of the required diagnostic medical imaging modalities could greatly influence the examination prescription. On the contrary, few prescribers were less interested in the costs and secondary effects due to irradiation and the invasiveness of these examinations. Professional habits of those who requested these examinations were in majority closer in line with the recommended clinical practices. However, an average of 43.78% of prescribers never followed recommendations nor applied them. On the other hand, knowledge and the application of these recommendations increased as the prescriber’s working experience too increased. Up to 54.47% of prescribers were not aware of those recommendations about requesting these examinations. Conclusion: Our results indicate that Medical Diagnostic Imaging techniques are not judiciously and optimally exploited in the diagnosis of degenerative pathologies of the lumbar spine and it would be necessary to establish recommendations for clinical practice adapted to Cameroonian realities.

High Prevalence of Multidrug Resistant &amp;lt;i&amp;gt;Klebsiella&amp;lt;/i&amp;gt; Species Isolated from the Yaounde University Teaching Hospital, Cameroon

Background and Purpose: Klebsiella species are amongst the most common causes of a variety of community-acquired and hospital-acquired infections (HAI), characterized by high morbidity and mortality rates. Most infections caused by Klebsiella species are usually treated using antibiotics. The aim of this study was to determine the antimicrobial resistance profile of Klebsiella species isolated from in-patients and out-patients at the Yaounde University Teaching Hospital. The data generated will go a long way to improve on the choice of an adequate empiric antibiotic treatment for infections caused by Klebsiella species. Methodology: A cross-sectional descriptive study was carried out over a period of 6 months, spanning from February 2019 to July 2019 with a sample size of 37 isolates, obtained from 6 different clinical specimens. Identification of isolates was done using API 20E identification system (Biomerieux SA, Lyon, France). Susceptibility to antibiotics was tested as described by Kirby-Bauer in 1956. Inhibition diameters were interpreted according to recommendations from the European Committee on Antimicrobial Susceptibility Testing (EUCAST, 2019). Results and Conclusion: Among the 37 Klebsiella isolates identified, Klebsiella pneumoniae was the most prevalent species isolated with a percentage of 54.1%, followed by Klebsiella rhinoscleromatis 18.9%, Klebsiella ozaenae 16.2% and Klebsiella oxytoca, 10.8%. The resistance pattern of Klebsiella to amoxicillin, amoxicillin/clavulanate, tircacillin, tircacillin + clavulanic acid, piperacillin, piperacillin + tazobactam, cefalotin, cefuroxim, ceftazidime, cefotaxime, ceftriaxone, cefepime, imipenem, meropenem, aztreonam, amikacin, gentamicin, tobramycin, trimethoprim/ sulfamethoxazole, nalidixic acid, pipemidic acid, norfloxacin, ciprofloxacin, levofloxacin, ofloxacin, and moxifoxacin was as follows; 100%, 86.5%, 97.3%, 83.6%, 86.5%, 16.2%, 86.5%, 83.8%, 78.4%, 32.4%, 78.4%, 76.7%, 2.7%, 2.7%, 76.7%, 13.5%, 75.7%, 73.0%, 91.9%, 51.4%, 48.6%, 64.9%, 48.6%, 48.6%, 73.0% and 62.2% respectively. Multidrug resistance was observed in 94.6% of the Klebsiella isolates. Conclusion: This study shows that the level of multidrug resistance is high. The isolates expressed good sensitivity to carbapenems, piperacillin + tazobactam, amikacin and high resistance to all other antimicrobials tested. Therefore, antimicrobial susceptibility testing prior to prescriptions should be encouraged and sensitization of the population about consequences of inappropriate antibiotic treatment and auto medication should be enforced as a means to curb antimicrobial resistance.

Evolution of Antibiotic Resistance in Enterobacter Spp Isolated at the Yaounde University Teaching Hospital from January 2008 to November 2019

Purpose: A study was conducted to evaluate the evolution of the resistance of Enterobacter spp to antibiotics during twelve years and to update the data. Method: A retro-prospective study was carried from January 2008 to November 2019. Data was extracted from the registers of the bacteriology laboratory and the strains from samples received from the different units of the YUTH. The study of the antibiotic resistance profile of these species and phenotypic analysis was carried out by the method of discs diffusion in Mueller-Hinton agar. Phenotypic characterization was carried out by synergy test and modified Hodge test. Findings: A total of 109 strains were isolated in our study. Enterobacter species showed high resistance with a peak in 2012 for cephalosporins, in 2011 for aminoglycosides, in 2018 for quinolones, in 2019 for carbapenems with the frequencies of 80%, 45%, 37% and 36,1% respectively. These species exhibited 30% resistance to colistin. The resistance peak to the majority of antibiotics between 2018 and 2019 reflects an increase of resistance. The Extended Spectrum  - Lactamases (ESBL) phenotype was the most represented with frequency of 32.4%. Unique contri bution to theory, practice and policy: To Update the data on the evolution of Enterobacter spp, which will help to establish a surveillance strategy in Cameroonand adapt an adequate treatment regimen.

Factors influencing the return of inactive blood donors in a Cameroonian blood bank.

Identify factors that influence the return of donors to increase their loyalty while improving blood safety is crucial in our context. Between October 2017 and April 2018, we conducted a descriptive cross-sectional study at the Blood Bank of the Yaoundé University Teaching Hospital. The study included all former donors who had not donated blood voluntarily for over a year. Quantitative variables were described using means and standard deviations. Fisher's exact test and Chi2 test were used for association measures between qualitative variables. Statistical test results were considered significant for a P<0.05 value. We interviewed a total of 101 inactive donors. The study population was 74.3% male, donors average 30±7 years. Female gender and good staff hospitality were the factors most associated with the intention to return. The barriers to donor return were mainly lack of information on blood needs (35.60%) and time constraint for blood donation (26.73%). Pro-social motivations such as altruism (30.70%) were the main possible sources of motivation cited. To reduce blood deficiency and mortality due to lack of blood products, non-financial material compensation, good outreach and communication strategy can increase inactive donors' loyalty and consequently in improving blood safety in our context.