Chimiotherapie des angiosarcomes de Kaposi au service d'oncologie medicale de L'hopital General de Yaounde, Cameroun

Compte tenu de la séroprévalence de l'infection à VIH/SIDA au Cameroun (5,5%), le service d'oncologie médicale de l'Hôpital Général de Yaoundé, prend en charge par chimiothérapie les patients porteurs d'angiosarcome de Kaposi. Nous avons voulu évaluer la chimiothérapie de l'angiosarcome de Kaposi dans notre service. Une étude descriptive rétrospective a été menée sur une année. Les patients recrutés ont été ceux avec un diagnostic d'angiosarcome de Kaposi. Les données collectées étaient les suivantes : le sexe, l'âge, la localisation, les pathologies associées, la chimiothérapie administrée, les réponses et la tolérance. Les deux dernières données ont été évaluées selon les critères de l'OMS. Au cours de cette année, 57 patients ont été reçus pour un angiosarcome de Kaposi dont 31 (54,4%) hommes et 26 (47,6%) femmes. Les âges extrêmes ont été 14 et 76 ans avec une moyenne de 39,05 ans. La localisation principale était tégumentaire (65,6% des localisations), diffuse pour la plupart des cas. Des 43 patients testés, 38 (88,4%) avaient une sérologie VIH positive et 5 (11,6%) négatifs. Dans notre échantillon, 84,6% ont reçu une polychimiothérapie associant la doxorubucine, la bléomycine et la vincristine. Seuls 20 patients des 38 séropositifs soit 52,6% ont reçu des antiretroviraux. La réponse partielle a été objectivée chez 16 sur 19 (84,2%) de nos patients. La toxicité observée a été hématologique et 13 patients (22,8%) ont été transfusés pour anémie. Nous concluons que la chimiothérapie est bénéfique dans le traitement du sarcome de Kaposi. Des études comparatives ultérieures précisent si le traitement de ces patients améliore la qualité de vie et la survie. Clinics in Mother and Child Health Vol. 3(1) 2006: 469-47

Precision medicine driven by cancer systems biology

Molecular insights from genome and systems biology are influencing how cancer is diagnosed and treated. We critically evaluate big data challenges in precision medicine. The melanoma research community has identified distinct subtypes involving chronic sun-induced damage and the mitogen-activated protein kinase driver pathway. In addition, despite low mutation burden, non-genomic mitogen-activated protein kinase melanoma drivers are found in membrane receptors, metabolism, or epigenetic signaling with the ability to bypass central mitogen-activated protein kinase molecules and activating a similar program of mitogenic effectors. Mutation hotspots, structural modeling, UV signature, and genomic as well as non-genomic mechanisms of disease initiation and progression are taken into consideration to identify resistance mutations and novel drug targets. A comprehensive precision medicine profile of a malignant melanoma patient illustrates future rational drug targeting strategies. Network analysis emphasizes an important role of epigenetic and metabolic master regulators in oncogenesis. Co-occurrence of driver mutations in signaling, metabolic, and epigenetic factors highlights how cumulative alterations of our genomes and epigenomes progressively lead to uncontrolled cell proliferation. Precision insights have the ability to identify independent molecular pathways suitable for drug targeting. Synergistic treatment combinations of orthogonal modalities including immunotherapy, mitogen-activated protein kinase inhibitors, epigenetic inhibitors, and metabolic inhibitors have the potential to overcome immune evasion, side effects, and drug resistance

Expert consensus document:Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA)

Cholangiocarcinoma (CCA) is a heterogeneous group of malignancies with features of biliary tract differentiation. CCA is the second most common primary liver tumour and the incidence is increasing worldwide. CCA has high mortality owing to its aggressiveness, late diagnosis and refractory nature. In May 2015, the "European Network for the Study of Cholangiocarcinoma" (ENS-CCA: www.enscca.org or www.cholangiocarcinoma.eu) was created to promote and boost international research collaboration on the study of CCA at basic, translational and clinical level. In this Consensus Statement, we aim to provide valuable information on classifications, pathological features, risk factors, cells of origin, genetic and epigenetic modifications and current therapies available for this cancer. Moreover, future directions on basic and clinical investigations and plans for the ENS-CCA are highlighted

Posterior urethral valves in children: A review of 28 cases in Yaounde, Cameroon

We reviewed the files of 28 children treated or followed up for posterior urethral valves (PUV) from 1st January 1985 to the 31st of December 1996 in the University Teaching Hospital, Central Hospital and the General Hospital in Yaounde. Our objectives were to review the epidemiological aspects of PUV in Yaounde, assess the clinical presentation, diagnostic procedures and outcome following surgery in terms of renal function and patient growth. The mean age at diagnosis was 2.9 years (range 9days-13 years), mean age at first consultation after onset of symptoms 1.6 years (range 1 day-8 years) and the mean interval between age of first consultation and age at diagnosis was 9.7 months. The most frequent urinary symptoms were dribbling (60.7%) and dysuria (54%), whereas frequent non-urinary symptoms were fever (25%) and failure to thrive (25%). Diagnosis was confirmed on ultrasound in 3 patients and in the remaining 25 both ultrasound and voiding cystourethrograms made the confirmation.There was an overall improvement at follow-up in the glomerular filtration rates (GFR) in 67% of the patients although absolute values remained low in all but 1 patient. Growth was also improved in 56% of the patients. Concerning treatment, 26 patients underwent surgery and 2 were lost to follow-up after diagnosis. 20 patients underwent endoscopic valve ablations, 4 Blocksom vesicostomies, 3 cystostomies and 2 catheter ablations. At final evaluation, we noted 6 deaths (21%), 10 lost to follow-up (36%). Causes of the deaths were septicemia: 3 cases (50%); post-obstructive diuresis: 2 cases (33%) and chronic renal failure: 1 case (17%). We thus conclude that, efforts should be made by clinicians especially (obstetricians, surgeons, radiologists, and pediatricians) to make early diagnosis and management of PUV so that renal impairment should be avoided and optimal growth ensured. Clinics in Mother and Child Health Vol. 1(2) 2004: 89-9

Diagnostic markers of infection in curret pediatric practice

Diagnostic markers are useful biological indicators of infection. Confirmatory diagnostic tests may take time, so biologic markers are necessary to have a rapid indication of the infection status so that antibiotherapy can be rapidly instituted. They are also useful to follow-up the course of the infection with treatment. Some tests as the hematological profile indices (total leukocyte count, total neutrophil count, immature/total neutrophil ratio, platelet count and erythrocyte sedimentation rate) and some acute phase proteins as C-reactive protein are readily available in most clinical settings. Others as procalcitonin chemokines, cytokines, adhesion molecules, cell surface markers and polymerase chain reaction are expensive and available only in specialised research laboratories. Optimal benefit can be obtained from rational use of currently available markers either by multiple marker assays or serial measurements which increase sensitivity and specificity. What ever the clinical setting the decision to institute or stop antimicrobial therapy will depend on the clinical situation of the child, and these markers only confirming the clinical decision. We hope that procalcitonin measurement with a higher sensitivity and specificity than haematological profile indices, C- reactive protein and erythrocyte sedimentation rate, be readily available in low-resource settings at low cost to improve management of sick neonates.Les marqueurs biologiques sont des indicateurs utiles pour le diagnostic de l'infection. Le diagnostic de confirmation de certaines infections étant souvent retardé, les marqueurs biologiques constituent un outil nécessaire non seulement pour le diagnostic de présomption et la prise en charge thérapeutique précoce, mais aussi dans le suivi de l'évolution du traitement. Certains marqueurs comme les tests hématologiques (leucocytes totaux, neutrophiles totaux, rapport neutrophiles immatures/ totaux, taux de plaquettes et la vitesse de sédimentation), et les protéines de la phase aiguë de l'inflammation comme la protéine C-réactive sont souvent disponibles et utilisés dans la plupart des institutions sanitaires. Les autres comme la procalcitonine, les chemokines, les cytokines, les molécules d'adhésion et l'amplification par polymérisation en chaîne sont coûteux et ne sont disponibles que dans certains laboratoires de recherche. Un bénéfice optimal peut être obtenu par une utilisation rationnelle des marqueurs disponibles, soit en utilisant plusieurs marqueurs ou des dosages séquentiels qui augmenteront la sensibilité et la spécificité. Quelque soit le cas, la décision d'instituer ou d'arrêter l'antibiothérapie dépendra de la situation clinique de l'enfant et les marqueurs ne confirmeront que la décision clinique. Nous espérons que le dosage de procalcitonin qui a une sensibilité et une spécificité supérieure aux indices hématologiques, la protéine C- réactive et la vitesse de sédimentation soit disponible à moindre coût dans les pays en voie de développement pour améliorer la prise en charge des nouveaux-nés malades. Keywords: Diagnostic markers-Infection-Children.Clinics in Mother and Child Health Vol. 4 (1) 2007: pp. 671-67

Paludisme grave en milieu rural Camerounais: Problématique d'un cas avec séquelles neurologiques

Le Paludisme grave est souvent cause d'importants déficits moteurs, sensoriels et intellectuels en Afrique. Un enfant de 15 mois a été hospitalisé pour paludisme grave à Plasmodium falciparum avec des convulsions répétées, coma et anémie. Traité en première intention et sans succès avec la quinine, il a présenté des séquelles neurologiques - surdité, cécité, aphasie, dystonie avec des mouvements occulo-gyriques et choréoathétosiques, après traitement avec l'arthéméter. Ces séquelles ont progressivement régressé sous traitement neuroleptique et seule persiste maintenant un retard psychomoteur avec un retard à la marche et au langage. Les séquelles neurologiques après le paludisme sont de plus en plus identifiées et la recherche approfondie sur leur pathogenèse est nécessaire pour développer des traitements appropriés et spécifiques. Mother and Child Health Clinics Vol. 1(3) 2004: 204-20

Standard gestational birth weight ranges and Curve in Yaounde, Cameroon

The aim of this study was to establish standard ranges and curve of mean gestational birth weights validated by ultrasonography for the Cameroonian population in Yaoundé. This cross sectional study was carried out in the Obstetrics & Gynaecology units of 4 major hospitals in the metropolis between March 5 and December 20, 2004, using pre-coded questionnaires. A total of 546 birth weights of neonates delivered to Cameroonian mothers whose duration of pregnancy were validated to be at least 28 weeks were recruited. The data was analysed using the statistical package SPSS 10.0. There was a statistically significant correlation between mean birth weight and mean gestational age (r=0.792,

Blackwater fever: An insight into a controversy

The authors present a comprehensive review of the possible pathogenetic mechanisms, pathophysiology and therapeutic options of blackwater fever. The review points out some salient controversies from several studies concerning this disorder. It is concluded that despite these controversies in literature, blackwater fever should be, as recommended by the World Health Organization, considered as a severe form of malaria and treated accordingly. Mother and Child Health Clinics Vol. 1(3) 2004: 180-18