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Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon)
Mve Koh Valere,
Essiben Felix,
Essome Henri,
Dang Atanga Danielle,
Mbu Enow Robinson
Issue:
Volume 7, Issue 3, May 2019
Pages:
60-67
Received:
17 March 2019
Accepted:
25 April 2019
Published:
23 May 2019
Abstract: Ectopic pregnancy is the leading cause of maternal mortality in the first trimester. When a patient is admitted before rupture, organ-preserving management which keeps a higher fertility rate than ablative surgery can be done. The incidence of Unruptured Ectopic Pregnancy (UTP) on admission is unknown. In the study facilities, methotrexate treatment was given to most of UTP regardless of Fernandez score. The aim of this study was therefore to assess the lessons learnt from that experience. Methods: It was a cross sectional study over a 10 years period, conducted in four university teaching hospitals affiliated to the University of Yaoundé I, Cameroon. Included patients were managed either by therapeutic abstention, single or multidose intra muscular MTX. Onset of clinical acute abdomen was the only indication of failure of conservative management and prompted emergency laparotomy. Results: We included 153 UTP cases. The incidence of UTP on admission was 0.46%, the mean age 28.4 ± 4.9, 88.2% were admitted at a gestational age <9 weeks, 19% had no pelvic pain. Medical treatment by MTX success rate was 81.7% but was not related to mono or multiple-dose (p=0.87), the success rate when β-hCG value was ≥ 10000 mIU/ml was 63.3% (p=0.004). When Fernandez score was ≥ 13, 21/25 (84%) were still successful including 3/7 with cardiac activity. (p=0.007). Conclusions: The incidence of UTP on admission is approximately 1/10th of all EP. Some UTP patients should be given MTX treatment opportunity even when Fernandez score recommends surgical management.
Abstract: Ectopic pregnancy is the leading cause of maternal mortality in the first trimester. When a patient is admitted before rupture, organ-preserving management which keeps a higher fertility rate than ablative surgery can be done. The incidence of Unruptured Ectopic Pregnancy (UTP) on admission is unknown. In the study facilities, methotrexate treatmen...
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Breast Plasty by Selective Mastectomy on Thoracic Supernumerary Breast: A Case Report
Noa Ndoua Claude Cyrille,
Belinga Etienne,
Ofakem Ilick Ingrid Doriane,
Metogo Junie,
Kasia Onana Yves Bertrand,
Mendibi Sandrine,
Kemfang Ngowa Jean-Dupont,
Kasia Jean Marie
Issue:
Volume 7, Issue 3, May 2019
Pages:
68-71
Received:
21 October 2018
Accepted:
3 December 2018
Published:
27 May 2019
Abstract: Background: Supernumerary breasts result from the persistence of ectopic mammary buds on the path of the primary mammary crest. The thoracic location with presence of glandular tissue remains exceptional. In its management, the surgeon is confronted not only with the aesthetic concern but also with the problem of surveillance given the risk of neoplastic degeneration due to the persistence of the supernumerary breast. It is then a question of determining the moment of the surgery and especially the appropriate operative technique. Presentation of the case: A 14-year-old girl was received for aesthetic gene linked to the presence of two nipples on her left breast. The physical examination revealed an asymmetry of left and right breasts volume. The left breast was classified as class I mammary glands according to KAJAVA classification. The mammogram described two mammary glands juxtaposed 180 and 80cm³ respectively. After performing the preoperative schema, the surgical procedure consisted of a selective mastectomy by complete excision of the lower mammary gland of 80 cm³ with remodeling by sub-mammary detachment over 2 cm of the remaining gland. The postoperative course was simple. Conclusion: Selective mastectomy for thoracic supernumerary breast is a technique of easy realization. The surgeon must find his anatomy to properly choose the preoperative schema. The postoperative result in our case was satisfactory.
Abstract: Background: Supernumerary breasts result from the persistence of ectopic mammary buds on the path of the primary mammary crest. The thoracic location with presence of glandular tissue remains exceptional. In its management, the surgeon is confronted not only with the aesthetic concern but also with the problem of surveillance given the risk of neop...
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HPV Viral Test for Primary Cervical Cancer Screening at the Nabil Choucair Health Center in Senegalese Women 30 to 65 Years Old
Omar Gassama,
Babacar Faye,
Mor Cisse,
Mamadou Seye,
Lamine Gueye,
Babacar Biaye,
Mamadou Lamine Cisse,
Philippe Marc Moreira,
Alassane Diouf,
Moussa Moro Guindo,
Alioune Dieye,
Jean Charles Moreau
Issue:
Volume 7, Issue 3, May 2019
Pages:
72-75
Received:
28 March 2019
Accepted:
15 May 2019
Published:
4 June 2019
Abstract: The objective of this study was to describe demographics of patients who had benefited from a cervical cancer screening by an HPV viral test; to specify the protocol used to establish diagnosis using the test results; and to describe treatment and follow-up methods on positively tested patients. This was an descriptive prospective cohort study conducted at the Nabil Choucair health center and the Military Hospital of Ouakam from May 1st 2017 to January 30th 2018. The study involved 144 patients who had benefited from an HPV ABBOOT m2000 viral test. The studied parameters included socio-demographic characteristics, clinical aspects, test results, diagnosis, treatment and follow-up. The data was collected on a form and the statistical analysis was performed using Epi-info 7. In this study we collected 144 women. The mean age of the patients was 39.9 years. Patients were predominantly married (84%) and mostly housewives (48.1%), with slightly more than half (55.6%) of them who attended school. More than half of the patients 61.8% were under contraception. Almost all patients (92.4%) were of child bearing age. The average gravidity was 3.4 with an average parity of 2.7. The average age at marriage was 22.6 years mostly in a monogamous household (56.8%). The average age at first intercourse was 22.1. The average age at first pregnancy was 23.9. More than ¾ of women (78.3%) had one partner; however, note that 21.7% of the patients had 2 or more partners. The viral test was positive in 17 patients (11.8%). Papillomaviruses 16 and 18 were the most encountered (56%). Colposcopy was normal and satisfactory in 9 patients (53%), 2 patients had abnormal minor changes (11.7%) and 2 cases had major changes (11.7%). Cervical biopsy was performed in 2 patients (11.7%), histology showed CIN3 and micro invasive carcinoma. For those patients a conization was performed. The postoperative course was simple. The HPV viral test for primary cervical cancer screening offers opportunities and is possible in developing countries such as Senegal despite its limited means.
Abstract: The objective of this study was to describe demographics of patients who had benefited from a cervical cancer screening by an HPV viral test; to specify the protocol used to establish diagnosis using the test results; and to describe treatment and follow-up methods on positively tested patients. This was an descriptive prospective cohort study cond...
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Hyperthyroid Fetal Goiter: A Case Report
Vedi Loue,
Mamadou Traore,
Charles Kacou,
Arthur Kouame,
Eleonore Gbary-Lagaud,
Julie Grevoul-Fesquet
Issue:
Volume 7, Issue 3, May 2019
Pages:
76-80
Received:
5 December 2018
Accepted:
1 February 2019
Published:
11 June 2019
Abstract: The persistent presence of maternal thyroid-stimulating hormone receptor antibody in patients with Graves’disease could cause fetal hyperthyroid goiter during pregnancy. The recognition and treatment of hyperthyroid fetal goiter are believed to be very important to optimize growth and intellectual development in affected fetuses. We report here, a case of a hyperthyroid fetal goiter identified by ultrasound exam at 27 weeks 5 days of gestation in a women having Graves’ disease and on antithyroid drugs therapy. This observation shows the fetal risk associated with the persistence of anti-TSH receptor antibodies in mothers with Graves' disease and the possibility of fetal approach.
Abstract: The persistent presence of maternal thyroid-stimulating hormone receptor antibody in patients with Graves’disease could cause fetal hyperthyroid goiter during pregnancy. The recognition and treatment of hyperthyroid fetal goiter are believed to be very important to optimize growth and intellectual development in affected fetuses. We report here, a ...
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Challenge in the Management of Twin Pregnancy with Anencephaly of One Fetus in a Low- Income Country: A Case Presentation
Romaric Joel Momo,
Julius Dohbit Sama,
Esther Meka,
Mazou Ngou Temgoua,
Pascal Foumane
Issue:
Volume 7, Issue 3, May 2019
Pages:
81-84
Received:
11 March 2019
Accepted:
23 April 2019
Published:
11 June 2019
Abstract: Anencephaly of one twin is a frequent congenital abnormality in a twin pregnancy and it’s associated with a poor prognosis of this pregnancy. In developed countries, the goal standard management calls for an interventional fetal medicine either by injection of a cardiotoxic or by intervention on the umbilical cord. Another option is an expectative management with strict follow-up of pregnant women and delivery organized in a level 3 maternity. There is still a challenge in the management of such high risk pregnancy in low income countries. A 37 years-old female, G3P2002, referred from a clinic for the better management of a 28 weeks and 4 days twin pregnancy in labor. Obstetrical ultrasonography realized in the second trimester revealed dichorionic-diamniotic pregnancy and the presence of anencephaly with hydramnios of one twin. The expectative approach was adopted for the management of this high risk pregnancy, unfortunately the death of the fetus occurred despite all the care provided. This case brings to lamp light the difficulties encountered in providing standard obstetrical care for high risk pregnancies in resource limited settings.
Abstract: Anencephaly of one twin is a frequent congenital abnormality in a twin pregnancy and it’s associated with a poor prognosis of this pregnancy. In developed countries, the goal standard management calls for an interventional fetal medicine either by injection of a cardiotoxic or by intervention on the umbilical cord. Another option is an expectative ...
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Women’s Preference of Home Delivery in Wonago District, Gedeo Zone, Southern Ethiopia 2018
Abebe Alemu,
Gedefa Amenu,
Muhammed Feyiso
Issue:
Volume 7, Issue 3, May 2019
Pages:
85-91
Received:
3 February 2019
Accepted:
31 May 2019
Published:
12 June 2019
Abstract: Introduction: Maternal mortality and morbidity associated with pregnancy related obstetric complications is imposing substantial burden for developing countries. Maternal place of deliver and lack of skilled birth attendant during delivery period is the main determinant indicator for the maternal death. Majority of women of developing country do not decide or make choice on place of delivery before onset of labor. Thus, this study was aimed to assess maternal preference of place of delivery and associated factors among postnatal women in Wonaggo district, Gedeo Zone, Southern Ethiopia, 2018. Methods: Mixed study design; employing community-based cross-sectional study combined with in-depth interviews and focus group discussions was used. Multi-stage sampling technique was used to enroll 772 study participants. A pre-tested structured questionnaire was used to collect data. Data was entered to EpiInfo7 and exported to SPSS 20.0 for analysis. Descriptive and summary statistics were done. Logistic regression analysis was used to identify the association of different variables. Odds ratios and 95% Confidence interval were computed to determine the presence and strength of association. Results: according to this study finding, 25.6% of participants were preferred to deliver at their home. Maternal educational status (AOR=2.1, 95%CI: 1.27 -3.6), parity (AOR=1.5, 95%CI: 1.08, 1.6), antenatal care follow up during pregnancy (1.575, 95%CI: 1.203, 5.12), place of last delivery (9.93, 95%CI: 2.355, 4.192) and knowledge towards danger sign of obstetric complications were variables found to be significantly associated with maternal preference of place of delivery. In Conclusion, a significant proportion of respondents were preferred to deliver at home. Thus, improving women education status in the community, accessing quality antenatal care, providing quality obstetric care service and avoiding disrespect and abuse during child birth are toughly suggested directions in order to assure institutional delivery in Wonag Distric, Southern Ethiopia.
Abstract: Introduction: Maternal mortality and morbidity associated with pregnancy related obstetric complications is imposing substantial burden for developing countries. Maternal place of deliver and lack of skilled birth attendant during delivery period is the main determinant indicator for the maternal death. Majority of women of developing country do no...
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A New Function of Granulocyte Colony-stimulating Factor (G-CSF): Suppression of Cell Proliferation in Uterine Endometrial Carcinoma
Yayoi Fukuda,
Hitomi Nakamura,
Keiichi Kumasawa,
Tadashi Kimura
Issue:
Volume 7, Issue 3, May 2019
Pages:
92-99
Received:
27 March 2019
Accepted:
11 May 2019
Published:
12 June 2019
Abstract: Granulocyte colony-stimulating factor (G-CSF) is cytokine which belongs to the family of colony-stimulating factors and recombinant human G-CSF has been widely used in clinical practice for treating patients with neutropenia for over 20 years. Recently, it has also seen use in assisted reproductive technology (ART) treatment based on the hypothesis that G-CSF might help the uterine endometrium proliferate and prepare for implantation. However, the risk of this treatment has not been fully assessed yet and there is a potential complication with its usage. It has been reported that G-CSF stimulates cell proliferation in hematopoietic cells and various other cell types, including cancer cells, suggesting that repeated local G-CSF administration into the uterine cavity might raises the risk of contracting uterine endometrial carcinoma. Based on this hypothesis, we assessed the effect of G-CSF on human uterine carcinoma cell proliferation, using cell lines. Our study showed that G-CSF administration produced dose-dependent suppression of proliferation of human uterine endometrial carcinoma cells through a G-CSF receptor-independent mechanism via a part of mitogen-activated protein kinase (MAPK) signaling pathway. While further studies will be needed to confirm G-CSFs efficacy in improving the outcomes of ART treatment, our data at least suggests that repeated G-CSF administration does not increase the risk of uterine endometrial carcinoma and may even lower it.
Abstract: Granulocyte colony-stimulating factor (G-CSF) is cytokine which belongs to the family of colony-stimulating factors and recombinant human G-CSF has been widely used in clinical practice for treating patients with neutropenia for over 20 years. Recently, it has also seen use in assisted reproductive technology (ART) treatment based on the hypothesis...
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