Publications by authors named "Djientcheu Vincent de Paul"

11 Publications

  • Page 1 of 1

Use of Dental Bisphenol A-Glycidyl Methacrylate Composite to Repair Refractory Cerebrospinal Fluid Leaks Associated With Large-Scale Anterior Skull Base Defects.

J Craniofac Surg 2021 Jul-Aug 01;32(5):1805-1809

Department of Surgery, Faculty of Medicine and Biomedical Sciences, Yaounde Central Hospital, Yaounde, Cameroon.

Abstract: Treatment of refractory cerebrospinal fluid (CSF) leaks, particularly those associated with large skull base defects, is challenging. A variety of synthetic biomaterial-based systems have been investigated in experimental models and/or humans for reconstructing cranial base defects. A widely used dental composite (bisphenol A-glycidyl methacrylate [bis-GMA]) has been shown to be effective for reconstruction of anterior skull base defects in animal models. Here, we report 4 patients who underwent reconstruction of large anterior skull base defects (1405.8 ± 511 mm2) secondary to tumor resection and traumatic injury using the dental bis-GMA resin-based composite. A vascularized pericranial flap with fibrin glue was initially performed in all patients with concurrent use of dental bis-GMA during the primary surgery in 2 patients, and later use (in a repeat surgery) in other 2 cases. In these latter 2, CSF rhinorrhea persisted after the initial surgery (in the absence of bis-GMA use) despite external CSF drainage with lumbar drain. Following treatment with bis-GMA, rigid structural support and watertight closure of the defect were successfully achieved. At the follow-up, CSF leak did not recur and none of the patients had any complications related to the surgery or the composite. The results obtained from this series are promising, and dental bis-GMA resin seems to provide an effective and feasible material for the treatment and prevention of CSF leaks related to large-scale anterior skull base defects. However, further studies with longer clinical follow-up and larger number of patients are required to prove the safety and efficacy of this matrix in the long run.
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July 2021

[Burnout among caregivers in the Yaounde Central Hospital, Cameroon].

Pan Afr Med J 2019 21;34:126. Epub 2019 Jun 21.

Department of Public Health, School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon.

Introduction: Burnout or burnout syndrome is a public health problem in Cameroon. It manifests itself by emotional exhaustion, depersonalization, and diminished personal accomplishment of the subject. It affects most healthcare workers (HCW) and the consequences are numerous. In Cameroon in general, and Yaounde Central Hospital (HCY) in particular, in recent years, healthcare workers have continued to express dissatisfaction with their working conditions through strikes and threats of various kinds. The care of patients is suboptimal with sometimes dramatic consequences and ethical concerns.

Methods: Our cross-sectional study aimed to determine the factors that are associated with burnout among healthcare personnel (HCW) of HCY. To do this, for one month, we administered to these HCWs our questionnaire designed according to the theoretical models of MASLACH and SIEGRIST. We were able to obtain information from 104 caregivers; data entry and analysis was done with SPSS 20.

Results: The results show that HCWs of four departments of HCY have similar manifestations to those found in the literature and the prevalence of burnout syndrome amon HCWs of HCY was 63%. Seven factors were statistically significantly associated with burnout syndrome among HCWs in HCY: the department (care unit) the HCW was assigned to (OR = 3.93, 1.16-13.24, p-value = 0.027); marital status (OR: 2.56, 1.22 - 5.39, p-value = 0.049); the effort-reward imbalance (OR: 2.31, 1.10 - 4.84, p-value = 0.026); having received been threatened physically or verbally (OR: 3.75, 1.49 - 9.41, 0.005); maintaining the balance between private and professional life (OR: 3.41, 1.19- 10.7, p-value = 0.038); frequency of forgetfulness (OR: 4.25 -1.33, 7.91, p-value = 0.002) and attribution of errors to working conditions (OR: 2.05, 1.52 - 24.0; -value = 0.011).

Conclusion: Burnout is common among HCWs of HCY and is likely to keep increasing if nothing is done. Prevention and promotion strategies for occupational health are strongly needed in aspects of improving working conditions; making good political and managerial decisions; improving relationships between caregivers and caregivers-hierarchy and constant research, monitoring and control of risk factors.
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June 2019

Management of tethered cord syndrome in adults: a case report in Cameroon.

Pan Afr Med J 2014 19;17:217. Epub 2014 Mar 19.

Neurosurgical Unit, of Surgery, University of Yaoundé 1, Yaoundé. Cameroon.

Tethered cord syndrome (TCS) is spinal cord fixation from multiple pathological entities. No case of TCShas been reported in our region. The goal of this case report was to describe a TCS managed at the Douala General hospital. Mrs. EEL, 23 year old consulted in 2012 for urinary and fecal incontinence. She had a past history of a spina bifida at birth operated on day two of life. On admission, lumbar MRI showed an abnormally low lying conus medullaris ending at S. Microsurgery permitted to gradually detach the spinal cord from subcutaneous tissue and carefully free the spinal nerves. A 12 months post-surgery, the patient could control defecation, and achieve proper micturition. TCS should also be ruled out in patients who present with urinary and ano-rectal symptoms especially of childhood onset; more so with present day availability of modern radiological tools like MRI.
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May 2015

Multiple myeloma revealed by spinal cord compression and herpes zoster in a 36-year-old Cameroonian.

Pan Afr Med J 2013 18;16:21. Epub 2013 Sep 18.

Department of neurosurgery, Central Hospital of Yaoundé, Cameroon.

Multiple myeloma is a malignant plasma cell disorder occurring mostly in people above 60 years old. The authors describe a case of multiple myeloma in a 36-year-old patient revealed by spinal cord compression and Herpes zoster with a rapidly unfavourable outcome.
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November 2014

HIV-Associated Central Nervous System Disease in Patients Admitted at the Douala General Hospital between 2004 and 2009: A Retrospective Study.

AIDS Res Treat 2013 26;2013:709810. Epub 2013 Feb 26.

Department of Internal Medicine, Douala General Hospital, P.O. Box 4856, Douala, Cameroon ; Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.

Background. Studies on HIV-associated central nervous system (CNS) diseases in Cameroon are rare. The aim of this study was to describe the clinical presentation, identify aetiological factors, and determine predictors of mortality in HIV patients with CNS disease. Methods. From January 1, 2004 and December 31, 2009, we did at the Douala General Hospital a clinical case note review of 672 admitted adult (age ≥ 18 years) HIV-1 patients, and 44.6% (300/672) of whom were diagnosed and treated for HIV-associated CNS disease. Results. The mean age of the study population was 38.1 ± 13.5 years, and median CD4 count was 49 cells/mm(3) (interquartile range (QR): 17-90). The most common clinical presentations were headache (83%), focal signs (40.6%), and fever (37.7%). Toxoplasma encephalitis and cryptococcal meningitis were the leading aetiologies of HIV-associated CNS disease in 32.3% and 25% of patients, respectively. Overall mortality was 49%. Primary central nervous system lymphoma (PCNSL) and bacterial meningitis had the highest case fatality rates of 100% followed by tuberculous meningitis (79.8%). Low CD4 count was an independent predictor of fatality (AOR: 3.2, 95%CI: 2.0-5.2). Conclusions. HIV-associated CNS disease is common in Douala. CNS symptoms in HIV patients need urgent investigation because of their association with diseases of high case fatality.
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March 2013

HIV-associated sensory neuropathy in HIV-1 infected patients at the Douala General Hospital in Cameroon: a cross-sectional study.

AIDS Res Ther 2012 Nov 26;9(1):35. Epub 2012 Nov 26.

Department of internal Medicine, Douala General Hospital, Douala, Cameroon.


Background: Peripheral neuropathy (PN) which is the most common neurological complication of HIV infection is under recognised and undertreated especially in resource limited settings. This ailment which has a negative impact on the quality of life of HIV/AIDS patients exists in different clinical patterns of which HIV-associated Sensory neuropathy (HIV-SN) is the most common affecting up to two thirds of patients with advanced disease in some settings. In Cameroon where HIV is a major public health problem, the burden of HIV-SN has not yet been well defined.

Methods: Using the Brief Peripheral Neuropathy Screening (BPNS) tool validated by the AIDS Clinical Trial Group (ACTG) we carried out a cross sectional study to determine the prevalence of HIV-SN and its associated factors among HIV-1 patients at the Douala General Hospital between 1st July and 31st October 2011. HIV-SN was defined as the presence of neuropathic symptoms and at least an abnormal perception of vibrations of a 128Hz tuning fork on the great toe or abnormal ankle reflexes or both and expressed as a percentage of the study population.

Results: Out of 295 patients studied, 21% had HIV-SN. In HIV-SN patients the median duration of HIV infection was 79.8 months (IQR 46 - 107.5) and their median CD4 count 153cells/μL (IQR 80 - 280). Patient recall and clinical chart review showed that, 83.9% had neuropathic symptoms prior to HAART initiation and 16.1% after HAART initiation. Low CD4 count, history of alcohol intake and history of anti-tuberculosis treatment were strongly associated with HIV-SN (AOR 2.5, 2.8 and 2.9 respectively).

Conclusions: HIV-SN is common among patients with advanced HIV infection in Cameroon. This simple diagnostic tool (BPNS) should therefore be routinely used to detect those with HIV-SN or at risk so as to minimise the negative impact it has on their quality of life.
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November 2012

Hydrocephalus in toddlers: the place of shunts in sub-Sahara African countries.

Childs Nerv Syst 2011 Dec 7;27(12):2097-100. Epub 2011 Aug 7.

Neurosurgery Unit, Yaounde Central Hospital, Yaounde, Cameroon.

Purpose: This study describes the epidemiological patterns of hydrocephalus in toddlers in our setting in order to determine the proportion of those who could benefit from endoscopic third ventriculostomy (ETV).

Methods: This prospective and descriptive study included all toddlers operated on for hydrocephalus from 1 March 2008 to 31 March 2010 at the Yaounde Central Hospital.

Results: Forty-six toddlers were included representing 72% of all hydrocephalus cases managed at the Neurosurgery Unit during the study period. The mean age was 6.9 ± 1.6 months. The delay before treatment varied from 5 days to 15.8 months (mean = 3.7 ± 0.5 months). The commonest clinical presentation was macrocrania (78.3%). Of the toddlers, 58.7% presented with a probable blindness (loss of ocular pursuit); dilated and non-reactive pupils were found in nine patients (19.6%). The diagnosis was based on transfontanellar echography (TFE), CT scan or combined TFE and CT scan. Identified aetiologies were aqueduct stenosis (28.7%), haemorrhage (18%), Dandy-Walker's syndrome (14.3%), meningitis (10.8%), myelomeningocele (10.8%), agenesis of Monro's foramen (3.6%), brain abscess (3.2%) and posterior fossa tumour (3.6%). No specific cause was found in 7% of cases. The treatment was ventriculoperitoneal shunting in 42 cases (91.3%) and ETV in two cases (4.3%). Infections (11.1%) and shunts' obstruction (5.4%) were the main complications.

Conclusion: Cases of hydrocephalus in toddlers are frequent in our setting. Regardless of the patient's age, the most prevailing aetiologies (infections, haemorrhage, myelomeningocele) and technological conditions (neuroendoscope) are less favourable for ETV. The use of ETV in the treatment of hydrocephalus in sub-Saharan Africa is still marginal and needs to be encouraged in selected cases. The prevention of non-tumoral hydrocephalus is of critical importance.
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December 2011

Patterns of non-traumatic myelopathies in Yaounde (Cameroon): a hospital based study.

J Neurol Neurosurg Psychiatry 2010 Jul;81(7):768-70

Faculty of Medicine and Biomedical Sciences, Yaounde I, Hôpital Neurologique, 59 Bd Pinel, Lyon 69500, France.

Background: The relative frequency of compressive and non-compressive myelopathies and their aetiologies have not been evaluated extensively in most sub-Saharan African countries. The case of Cameroon is studied.

Methods: Admission registers and case records of patients in the neurology and neurosurgery departments of the study hospital were reviewed from January 1999 to December 2006.

Results: 224 (9.7% of all admissions) cases were non-traumatic paraplegia/paraparesis or tetraplegia/tetraparesis and 147 were due to myelopathies, representing 6.3% of all cases admitted during the study period and 65.6% of cases of paraplegia or tetraplegia; 88% were compressive myelopathies. Aetiologies were dominated by primary and secondary spinal tumours (mainly prostate carcinoma, lymphoma and liver carcinoma) that each accounted for 24.5% of cases. Other causes included spinal tuberculosis (12.9%), tropical spastic paraparesis (five positive for human T cell lymphotrophic virus (HTLV)-I and one for HTLV-II) (4.8%), spinal degenerative disease (4.1%), acute transverse myelitis (4.1%), HIV myelopathy (1.4%), vitamin B12 deficiency myelopathy and multiple sclerosis (0.7%). No aetiology was found in 21.1% of participants.

Conclusions: Myelopathies in our setting are dominated by spinal compressions. Metastasis is a leading cause of spinal cord compression with liver carcinoma being more frequent than reported elsewhere. Infections nevertheless remain a major cause of spinal cord disease and both cancers and infections constitute public health targets for reducing the incidence of myelopathies.
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July 2010

The International HIV Dementia Scale is a useful screening tool for HIV-associated dementia/cognitive impairment in HIV-infected adults in Yaoundé-Cameroon.

J Acquir Immune Defic Syndr 2008 Dec;49(4):393-7

Neurology Unit, Department of Internal Medicine and Specialties, FMBS, University of Yaoundé I, Yaoundé, Cameroon.

Objective: As a baseline for a series of studies on HIV-associated dementia (HAD), we sought to assess the usefulness of the recently developed International HIV Dementia Scale (IHDS) as a screening tool for HAD or HIV-associated cognitive impairment (HACI) in HIV-positive adults in Yaoundé-Cameroon.

Design: The frequency of HAD/HACI is largely unknown in resource-limited countries. In Cameroon, few studies suggest that HAD may be frequent but no specific study had so far investigated the problem. We therefore used a case-control study design involving HIV-positive adults as cases and HIV-negative individuals as controls to determine the usefulness of the IHDS as a screening instrument.

Methods: HIV-positive adults followed up in an HIV outpatient clinic were matched to HIV-negative subjects for age and sex and screened using IHDS.

Results: Overall, 204 HIV-positive individuals and 204 HIV-negative subjects were screened. The HIV-positive subjects had a significantly lower IHDS mean total score of 10.87 compared with the HIV-negative subjects with a score of 11.28 (P = 0.00). Abnormal scores (< or = 10) on the IHDS were found in 21.1% of the HIV-positive subjects and in 2.5% of the HIV-negative subjects (P = 5.0 x 10(-10)).

Conclusions: These results suggest that the prevalence of possible HAD/HACI may be higher in Cameroon than the previous estimates and demonstrate that the IHDS can be used as a screening tool for HAD in Cameroon. We therefore suggest that all studies on HAD in Cameroon should strategically start with the IHDS as a screening tool.
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December 2008

Salmonella epidural abscess in sickle cell disease: failure of the nonsurgical treatment.

J Natl Med Assoc 2003 Nov;95(11):1095-8

Service de Pédiatrie, Hôpital du Chablais, CH 1860 Aigle, Switzerland.

In patients suffering from sickle cell disease (SCD), bone is a preferred site of infection. We report the case of a five-year-and-eight-month-old black African boy with homozygous-SS disease who developed a cranial epidural abscess. This intracranial infectious complication originated from a Salmonella enteritidis osteitis of the frontal bone. Antibiotic treatment alone did not control the disease, so surgery was necessary to remove the necrotic bone and to evacuate the epidural pus. The numerous factors interfering with normal healing of a septic focus in sickle cell anemia, particularly in this previously undescribed intracranial complication, emphasize the need for a primary and early surgical treatment in similar situations.
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November 2003