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Rectal bleeding in adults over 20 years: Endoscopic investigations and results in current hospital practices in Yaoundé, Cameroon  [PDF]
Firmin Ankouane Andoulo, Dominique Noah Noah, Roger Djapa, Michele Tagni Sartre, Elie Claude Ndjitoyap Ndam, Kathleen Ngu Blacket
Open Journal of Gastroenterology (OJGas) , 2013, DOI: 10.4236/ojgas.2013.36051
Abstract: Introduction: In order to identify the modes of investigation and the results of the assessment of rectal bleeding in the Cameroonian adult, we retrospectively analysed the records of 287 patients aged above 20 years diagnosed with rectal bleeding with the aim to know the prescription patterns according to age, the diagnostic performance of tests and the results. Methodology: Between the 1st of January 2009 and the 30th of June 2010, we examined patients at the University Teaching Hospital and the “La Cathédrale” Medical Centre in Yaounde. Age, sex, endoscopic tests and results were evaluated. Results: 287 protocols met our selection criteria, sex ratio (M/F) 2.4/1, median age 46 years interquartile range [36, 55]. Normal tests were 57 (19.2%). Main lesions: haemorrhoids (42.4% CI95 36.7 -48.3), colorectal cancer (10.8% CI95 7.5 -14.9), anal fissure (8.8% CI95 5.8 -12.6) and colorectal polyps (8.4% CI95 5.5 -12.2). The prevalence of significant lesions (polyps and cancer) recorded 7% for those under age 40. 20.5% in those were between 40 -50 years, and 28.9% for those over 50 years. For anoscopies, 44.4% were under 40 years, 39.3% of cases of sigmoidoscopy affected those between 40 -50 years and colonoscopy affected 54% of those over 50 years. For the diagnostic yield, 26.2% had a significant lesion for flexible sigmoidoscopy and only 16.7% and 1.6% for colonoscopy and anoscopy respectively. Conclusion: The study shows that anoscopy and sigmoidoscopy are the main initial tests conducted in Cameroon in the assessment of rectal bleeding in adults of less than 50 years and they are quite sufficient. Haemorrhoids and colorectal cancer are the main pathologies.
Prevalence of the hepatitis B surface antigen in a population of workers in Cameroon  [PDF]
Firmin Ankouane Andoulo, Michèle Tagni-Sartre, Dominique Noah Noah, Roger Djapa, Elie Claude Ndjitoyap Ndam
Open Journal of Gastroenterology (OJGas) , 2013, DOI: 10.4236/ojgas.2013.38057

Hepatitis B surface antigen prevalence in populations of blood donors in Cameroon is estimated at 6%-16%. As such, the Objective of this study was to determine the prevalence of Hepatitis B surface antigen in a population of bank employees, who represent a sample closer to the general population. In tests carried out both Yaounde and Douala in December 2011, we detected the hepatitis B surface antigen among 267 workers, including 151 men and 116 women of a median age of 37 years. The Results obtained revealed that the overall prevalence stood at 7.1%, with a 9.9% prevalence ratio in men, three times higher than that in women (3.4%). Subjects aged 20-29 years and senior staffs were more affected (each of them recording 8.1%). Potential nosocomial risks were detected mostly at the level of dental care (52.8%). Among the other risks of exposure, scarification (53.6%) was more frequent. A univariate analysis revealed an insignificant relationship with tattoos (OR 2.6, 95% CI 0.5-10.8, p = 0.2). These results led to the Conclusion that Hepatitis B surface antigen carrier prevalence in a population of workers in Cameroon is not different from that of blood donors. It is mainly due to early vertical and horizontal contamination.

Intracystic bleeding of a solitary hydatid cyst: A rare complication of a rare disease in central Africa. A case report  [PDF]
Ankouane Andoulo Firmin, Ngo Nonga Bernadette, Monabang Catherine, Djapa Roger, Tchoumi Eric, Njoya Oudou, Ndjitoyap Ndam Elie Claude, D. P. McManus, Malonga Eimo
Case Reports in Clinical Medicine (CRCM) , 2013, DOI: 10.4236/crcm.2013.22044

Splenic cysts are rare lesions and most of them are hydatid in origin. Hydatid disease is very rare in central Africa although it is cosmopolitan in North Africa. We are presenting a case of intracystic bleeding complicated with shock in a rural based Cameroonian and owner of hunting dogs treated in our university teaching hospital.

Prevalence of HBs Antigen, and HCV and HIV Antibodies in a Young Male Population in Cameroon  [PDF]
Dominique Noah Noah, Firmin Ankouane Andoulo, Brice Valery Moussima Essoh, Georges Nko’O Ayissi, Servais Albert Fiacre Eloumou Bagnaka, Magloire Biwole Sida
Open Journal of Gastroenterology (OJGas) , 2015, DOI: 10.4236/ojgas.2015.512028
Abstract: Introduction: According to WHO estimates, 57% of cases of liver cirrhosis and 78% of primary liver carcinoma are caused by a hepatitis B or C virus. This study aimed to assess the prevalence of these diseases and HIV among a young male population, according to region. Methods: This was a descriptive cross-sectional study conducted from 17 February to 31 March 2014 in the ten administrative regions of Cameroon. The study included male subjects of Cameroonian nationality aged at least 18 and at most 23, and living in the regions concerned. It excluded subjects that did not match the age, gender, and nationality criteria. For each subject, 10 ml of blood was collected in a dry tube. After centrifugation at 3000 RPM for 5 minutes, the serum was collected for the detection of viral infections. For subjects that tested positive, a confirmatory test was conducted. Results: In total, 4367 subjects were selected, with an average age of 20.46 (+/- 1.17) years. The prevalence of hepatitis B virus stood at 13.01% (with 95% CI: 12.03% - 14.05%). That of viral hepatitis C was 0.30% (95% CI: 0.17% - 0.52%). Co-infection with hepatitis B and C viruses was 0.05% (95% CI: 0.01% - 0.18%). The prevalence of HIV infection was 1.01% (95% CI: 0.74% - 1.36%). Conclusion: The overall prevalence of HBsAg in the population of young males is high. It tallies with the early vertical and horizontal modes of transmission that prevail in our environment.
Indications, Yield and Outcome of Colonoscopy: A 7-Year Retrospective Study in a Resource-Limited Setting  [PDF]
Gabin Ulrich Kenfack, Servais Albert Fiacre Bagnaka Eloumou, Winnie Tatiana Bekolo Nga, Guy Sadeu Wafeu, Paul Nkemtendong Tolefac, Agnès Malongue, Mathurin Pierre Kowo, Christian Tzeuton, Firmin Ankouane Andoulo, Oudou Njoya, Henry Namme Luma, Dominique Noah Noah
Open Journal of Gastroenterology (OJGas) , 2019, DOI: 10.4236/ojgas.2019.93008
Abstract: Background and Aims: Diagnostic colonoscopy allows exploration of the colonic mucosa. Indications are multiple. The purpose of this work was to describe the indications and to report the lesions observed during colonoscopy at the General Hospital of Douala. Methods: This was a cross-sectional study with retrospective data collection over a period of 7 years (January 1, 2010 to January 31, 2017). The data collected from the reports were socio-demographic characteristics, indications and lesions observed at colonoscopy. Binary logistic regression allowed us to identify the independent risk factors associated with the presence of tumors and polyps. Results: We included 719 exams. The main indications were rectorrhagia (29.5%), abdominal pain (25.9%) and constipation (17.8%). A colonic lesion was found in 60.1% of cases. A colorectal tumor accounted for 10.3% of cases. Factors independently associated with colonic tumor were complete colonoscopy (aOR: 0.167 95% CI [0.096 - 0.289], p < 0.001), presence of abdominal or rectal mass (aOR: 13.390 95% CI) [5.684 - 31.544], p < 0.001) and weight loss (aOR: 5.143, 95% CI [2.450 - 10.797], p < 0.001). Conclusion: The presence of weight loss, abdominal or rectal mass should motivate the realization of a complete colonoscopy in search of a colorectal tumor. The most observed lesions remain hemorrhoids, polyps and diverticulosis of the colon.
Prevalence of Hepatitis C Virus and Associated Risk Factors among Inmates at New Bell Prison, Douala, Cameroon  [PDF]
Mathurin Pierre Kowo, Firmin Ankouane Andoulo, Larry Tangie Ngek, Daniel Tchamdeu Sizimboue, Antonin Ndjitoyap Ndam, Buno Ela Ondo, Servais Eloumou Bagnaka, Rocard Djanteng, Elie-Claude Ndjitoyap Ndam, Oudou Njoya
Open Journal of Epidemiology (OJEpi) , 2019, DOI: 10.4236/ojepi.2019.92011
Abstract: Although a high prevalence of HCV infection in correctional facilities has been well reported in several countries around the world, there has been no such data from Cameroon. The aim of this study was to determine the prevalence and factors associated with viral hepatitis C seropositivity among prisoners incarcerated at the New Bell Central Prison in Douala. From the 2nd to the 27th of July 2018, 940 inmates selected using a systematic random sampling method were interviewed to collect data on sociodemographic status, duration of incarceration, number of incarcerations and risk factors for HCV transmission. Blood samples were collected for screening of anti-HCV antibodies via HEPA-SCAN HCV CARD Test. Positive samples had a confirmatory ELISA test. Data were analysed using EPI DATA software. Statistical significance was set at a p < 0.05. Of the 940 prisoners selected, 94.1% (884) were males. The mean age of the study population was 33.81 ± 10.35 years (extremes: 14 and 74 years). HCV prevalence was 4.4% (40). The use of non-injectable illicit drugs (OR 2.87 95% CI 1.44 - 5.73) (p = 0.002) but not injectable illicit drugs (OR 1.91 95% CI 0.43 - 8.41) (p = 0.42), male homosexuality (OR 17.45 95% CI 7.58 - 40.13) (p < 0.001), sharing of needles (OR 3.45 95% CI 1.59 - 7.83) (p = 0.001), past history of tattooing or piercing (OR 5.94 95% CI 2.80 - 12.16) (p < 0.001) and age ≥ 50 (OR 4.069; 95% CI 1.9 - 8.68) (p = 0.003) were significantly associated with HCV antibodies positivity. Inmates in New Bell Central Prison accumulate risk factors for viral hepatitis C, thus contributing to the high prevalence in this setting. Control strategies and programs that reach this particular population should urgently be implemented.
Clinical Aspects and Precipitating Factors of Hepatic Encephalopathy Associated with Cirrhosis in a Cameroonian Population  [PDF]
Mathurin Pierre Kowo, Edgar Kenne Yimagou, Firmin Ankouane Andoulo, Antonin Wilson Ndjitoyap Ndam, Bonaventure Jemea, Servais Albert Fiacre Eloumou Bagnaka, Patricia Ouamba Guekam, Larissa Pessidjo, Eric Tchoumi Leuwat, Dominique Noah Noah, Oudou Njoya
Open Journal of Gastroenterology (OJGas) , 2019, DOI: 10.4236/ojgas.2019.911026
Abstract: Background: Hepatic Encephalopathy (HE), a common complication of cirrhosis, is associated with a pejorative prognosis. This study aims to describe the clinical presentation, precipitating factors and outcome of HE. Methods: This was a cross-sectional multicenter inpatient study in cirrhotic patients admitted for HE in four tertiary hospitals in Yaoundé (Cameroon) from December 2016 to May 2017. The diagnosis of HE was based on West Haven clinical criteria. The diagnosis of cirrhosis was made using clinical and/or biological, endoscopic and/or ultrasonography signs. Results: A total of 53 patients with HE (mean age: 49.9 ± 18.9 years, 35 Males) were included. The frequency of hospital admission for HE was 4.9%. HE grade III was the most common (37.7%), followed by grades I and II (26.4% and 26.4%, respectively). Grade IV was present in 9.4% of cases. According to the Child-Pugh score, 72.1% of the patients were at stage C and 27.9% at stage B. The main precipitating factors found were: constipation (38.5%), hyponatremia (35.9%), hepatocellular carcinoma (HCC) (31.7%), herbal medicine (28.3%), hypokalemia (25.6%), gastrointestinal bleeding (22.6%) and ascitic fluid infection (spontaneous bacterial peritonitis) (13.8%). In 5.7% of cases, no factor was identified. Mortality rate during hospitalization was 45.3% and was significantly associated with stage III (RR = 11.1; 95% CI: 1.9 - 64.5; p = 0.003) and IV (RR = 24; 95% CI: 1.6 - 40.9; p = 0.01) of HE; Child-Pugh C score (RR = 15.2; 95% CI: 1.7 - 30.1; p = 0.003) and hypokalemia (RR = 12.2; 95% CI: 1.3 - 19; p = 0.01). Conclusion: HE is a common complication during cirrhosis with a poor prognosis. In the majority of cases, a precipitating factor could be determined.
Acute Coronary Syndrome Occurring in a Sub-Saharan Patient Treated with a Reduced Dose of Sorafenib for an Unresectable Hepatocellular Carcinoma: Case Report  [PDF]
Antonin Wilson Ndjitoyap Ndam, Murielle Lema Helles, Pierre Mathurin Kowo, Mazou Temgoua Ngou, Etienne Atenguena, Blaise Mounpou, Aicha Yap, Tangie Ngek Larry, Paul Talla, Jer?me Boombhi, Alain Menanga, Firmin Ankouane Andoulo, Elie Claude Ndjitoyap Ndam
Open Journal of Gastroenterology (OJGas) , 2020, DOI: 10.4236/ojgas.2020.103005
Abstract: Sorafenib is a chemotherapy used as first line treatment in primary liver cancers. It is an oral antiangiogenic treatment which reduces the progression of the tumor. Some mild or severe side effects have been reported among which some uncommon cardiac events: myocardial infarction and cardiogenic stroke. Sorafenib treatment remains expensive and not frequently used in Sub-Saharan countries. Thus, few studies have described its side effects in this milieu. We report a case of acute coronary syndrome occurring in a 75-year-old female patient, without cardiovascular risks factors, after nine months of sorafenib chemotherapy at a reduced dose for an unresectable hepatocellular carcinoma in a Sub-Saharan Africa country. The management was conducted by cardiologists, in collaboration with gastroenterologists and oncologists. We decided to completely stop sorafenib chemotherapy. We observed a reduction of the pain 48 hours after her admission, and a regression of electrocardiographic signs after 8 days. In conclusion, the sorafenib treatment can be associated with cardiac events despite the dose reduction.
High Frequency of HBeAg-Negative Cases in Naive HBsAg-Positive Subjects with Chronic Hepatitis B Virus Infection Managed in the Yaoundé Hepatitis Therapeutic Committee: A Cross Sectional Study  [PDF]
Firmin Ankouane, Mathurin Kowo, Oudou Njoya, Elie Claude Ndjitoyap Ndam
Open Journal of Epidemiology (OJEpi) , 2015, DOI: 10.4236/ojepi.2015.52015
Abstract: The aim was to describe the epidemiology of the chronic hepatitis B virus (HBV) infection within Yaoundé Hepatitis Therapeutic Committee. Methods: This was a cross-sectional study from June 2004 to May 2012. We consecutively collected epidemiological data (gender, age, alanine aminotransferase-ALT, HBe-antigen-HBeAg, hepatitis B viral load-HBV-DNA and cirrhosis evaluation) from naive hepatitis B surface antigen (HBsAg)-positive patients with chronic HBV infection. Chronic HBV infection is defined by the persistence of HBsAg for at least six months. The level of serum HBV-DNA was determined by the COBAS-AmpliPrep Technical/COBAS-TaqMan HBV® 2.0 (Roche). Data were entered and analyzed using SPSS 20.0 software (IBM Corporation, USA). Results: Of the 315 HBsAg-positive patients consulted, 74.6% were male; mean (SD) age 35.04 (10.25) years. Nearly 92% were HBeAg-negative. The serum ALT level was normal in 63.2%; HBV-DNA was detected in 81.0% and was ≤2000 IU/mL in 65.9%. Liver biopsy was performed in 145 (46.03%); 10 (6.9%) had cirrhosis. HBeAg-negative patients were older than HBeAg-positive (35.3 vs. 31.9 years; p = 0.006). The serum ALT level was high in 84.0% HBeAg-positive patients and in 32.8% HBeAg-negative (p < 0.0001). HBV-DNA was detected in 100% of HBeAg-positive patients against 79.7% of HBeAg-negative (p = 0.05). The median HBV-DNA level was 1550 × 103 IU/mL in HBeAg-positive patients and 1140 IU/mL in HBeAg-negative (p < 0.0001). Cirrhosis was diagnosed in 15.4% of HBeAg-positive patients and in 6.1% of HBeAg-negative (p = 0.221). Conclusion: HBeAg-negative cases are predominant among HBsAg-positive patients with chronic HBV infection in Cameroon. With the knowledge of this epidemiology, the care of patients will be improved.
Histological Types of Gastric Cancer and Helicobacter pylori Infection in Yaoundé  [PDF]
Firmin Ankouane, Mathurin Kowo, Bernadette Ngo Nonga, Fidèle Vouffo, Jude-Marcel Nzoumé, Oudou Njoya, Elie Claude Ndjitoyap Ndam
Journal of Cancer Therapy (JCT) , 2015, DOI: 10.4236/jct.2015.68077
Abstract: Introduction: The diffuse type of gastric adenocarcinoma has been found to be more prevalent in low risk countries like Cameroon. The objective of this study was to determine the most frequent histological type of gastric cancer found in Yaoundé and its association to the Helicobacter pylori infection. Materials and Methods: The registries of histopathology laboratories of 4 reference hospitals in Yaoundé, Cameroon have been reviewed for registered primitive gastric malignancies from July 2009 to May 2014. Paraffin blocks mounted on slides and stained with Hematoxylyn and Eosin of gastric cancer cases were re-stained Giemsa to search for Helicobacter pylori and they were classified using the criteria of Lauren in intestinal type or diffuse type. Results: Forty-two cases were reviewed: 25 (59.5%) of them were intestinal type of gastric adenocarcinoma, 11 (26.2%) were diffuse type, 4 (9.5%) were malignant gastric lymphoma, 1 (2.4%) was a stromal tumor, and 1 (2.4%) was a colloid carcinoma. The most common site of location was the proximal gastric portion (52.2%). The overall prevalence of Helicobacter pylori infection was 88.1%, most common with the intestinal type (100%) and malignant lymphoma (100%) than with the diffuse type (72.2%) (p = 0.007). Conclusion: The most common type of gastric adenocarcinoma in Cameroon is the intestinal type and Helicobacter pylori infection is more common in the intestinal type and malignant gastric lymphoma than in the diffuse type. The Helicobacter pylori eradication campaigns are needed.
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