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Background Fluid overload is frequent in haemodialysis (HD) and is one of the major factors of cardiovascular morbidity and mortality for chronic haemodialysis 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 haemodialysed patients. Methods We conducted a cross sectional study including 31 patients undergoing chronic HD treatment for at least 3 months, in Yaounde University Teaching Hospital dialysis unit. Lung ultrasonography and clinical examinations were performed immediately before dialysis, and 30 minutes after dialysis. Differences between variables before and after dialysis were measured to assess dialysis’s effect. Association between categorical variables was assessed with Chi-squared test or Fischer test, and Rho’s Spearman coefficient for quantitative variables. Results There were reduction in 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 frequency of cramps in patients (0% versus 19.4%), all statistically significant (p ≤ 0.031). B-lines score before and after dialysis was associated with dyspnoea and raised jugular venous pressure (p

The main purpose of this study was to determine local diagnostic reference level (LDRL) for routine computed tomography (CT) examination in Bafoussam, western Cameroon. The exposure parameters and dose quantities were collected manually. This retrospective, evaluative and comparative study was conducted to determine LDRLs for routine head CT examination in Bafoussam, to optimize these procedures in the region. The 75th percentile values of the calculated volume CT dose index (CTDIvol) and dose length product (DLP) were proposed as LDRL. The sample was classified in four age groups

Objectives Congenital adrenal hyperplasia (CAH) remains one of the most challenging endocrine disorders to diagnose, manage, and treat, especially in Africa where there is lack of neonatal screening program, and limited access to care. Data on biomolecular anomaly are sparse, therefore type of mutations are unknown, increasing management challenges and genetic counseling. The present study aims to describe clinical, biomolecular aspects of a group of Cameroonian patients. Methods We did an observational retrospective study at the pediatric endocrinology unit of the Mother and Child Centre of the Chantal Biya Foundation in Yaounde from May 2013 to December 2019, including all patients diagnosed with CAH. Results We consecutively included 31 patients aged less than 21 years, diagnosed CAH. Median age at diagnosis was 1.71 years (IQR 0.08–2.57 years). Abnormal genitalia was the main complain in 48.4%(n=15). The most prevalent genetic anomaly found in our study population (n=24) was on CYP11, found in 16 patients (66.6%) followed by CYP21A2 mutation found in 8 patients. Homozygous mutation of p.Q356X was found in half of patients with 11 hydroxylase deficiency. This mutation was mostly found in people from semi-Bantu tribes, declared non consanguineous. Conclusions 11 hydroxylase deficiency is the most prevalent form of CAH found in this group of Cameroonian children.

Background: Cervical cancer is one of the most common cancers, requiring a precise complementary assessment. The aim of this study was to contribute to the improvement of the management of cervical cancer by describing the MRI aspects of cervical cancer according to the IFOG-MRI classification. Material and Methods: This was a cross-sectional study, conducted in patients who came for clinical suspicion, extension assessment of histologically confirmed cervical cancer, from October 2020 to March 2021, in Yaounde (Cameroon). Results: 54 patients were selected, with an average age of 50.4 years. Genital hemorrhage was the most frequent symptom (92%). The mean tumor size was 52.9 mm. According to IFOG staging, stages Ia, Ib, IIa, IIb, IIIa, IIIb, and IV accounted for 9.10%, 10.20%, 12.50%, 29.50%, 5.70%, 12.50%, and 20% respectively. No patient had known metastasis at the time of examination. Conclusion: MRI allows non-invasive, satisfactory tumor staging examination by providing information on tumor size, parametrium invasion, adjacent organ involvement, and the presence of lymph node metastasis.

Computed tomography (CT) scan is currently the most irradiating radio diagnostic procedure for the patients. The effective dose delivered by a CT-scan exploration corresponds to 1–20 years of natural irradiation of an individual. Hence, there is need to evaluate this medical exposure, in order to provide indicators and propose guidelines for its daily practice. The purpose of this work was to assess patient exposure levels due to CT-scan exams and propose a local diagnostic reference levels for the most common CT examinations performed in the radiology units of Douala/Cameroon. Data from 1775 CT scans, amongst which 10 different types of common CT examinations on adults and children, were collected, of which 1378 were adult CT scans and 397 were pediatric CT scans. The dose-length product (DLP) values in the adult population for head, abdomen–pelvic and lumber spine CT scans were high as compared to the Institute for Radiological Protection and Nuclear Safety recommendations and previous local DRL with an increase of 36, 15 and 23%, respectively. A general decrease of the DLP for CT-scans examinations in the pediatric population was observed.

We present a case of pancreatic and splenic tuberculosis (TB) in a 15-year-old human immunodeficiency virus-negative patient who was initially misdiagnosed as suffering from a pancreatic carcinoma with splenic metastases. Pancreatic and splenic TB are extremely rare in young immunocompetent patients, with a nonspecific clinical presentation, making the diagnosis elusive.

Background: Mother and fetal Doppler ultrasound during pregnancy is an established and safe tool for quantitative analysis of the utero-placental and the fetoplacental blood flow and seems to be affected by Ethnic hetérogenicity. Objective. To establish normative data for the resistive index of Uterine arteries, Umbilical artery and middle cerebral artery of Cameroonian pregnant women in the second half of pregnancy using multiples of the median and percentile reference range.Methods. We conducted a cross-sectional study on 93 low risk singleton gestation women aged above 18 years between 28 and 39 weeks of gestation in two hospitals in Cameroon during 7 months. We seek for resistive index (RI) of both left and right uterine arteries (LUt and RUt), Umbilical artery (UmA) and Middle cerebral artery (MCA). We also estimated the gestational age (GA), the mother age, the fetal weight (EFW) and the cerebro – placental ration (CPR).Pearson's correlation analysis of the relationship between these RI and selected maternal parameters was done. Regression modeling across gestational age was performed to obtain the reference values and normogram curve with values ranged at 5 and 95th percentiles. P < 0.05 was considered statistically significant.Results. The mean GA and EFW was 33.5 +/- 2.92 weeks (médian of 34) and 2337.5 +/- 734 g respectively. The means RI value of target vessels were 0.55 +/- 0.077; 0.76 +/- 0.071 ; 0.48 +/- 0.077 and 0.46 +/-0.087 for UmA, McA, RUt and LUt with extremes values of des 0.38 to 0.77 ; 0.49 to 0.87; 0.30 to 0.70 and 0.29 to 0.69 respectively. Only UmA RI and CPR values had shown correlations with GA (r= - 0.338, p≤0.01 and r=0.314; p≤0.001) and EFW (r=-0.445, p≤0.001 and r=0.234; p = 0.02). No difference between LUt and RUt RI values was found. The nomogram curve for UmA, McA, RUt and LUt value revealed a general low RI values of in our sample.Conclusions. Fetal Doppler should carefully interpreted according to general low RI values during low risk singleton pregnancy shown by this study. The generated 5and 95th percentiles RI values curves for each target vessel could be useful in that way.Trial registration:N°431/UY1/FMSB/VDRC/CSD du 24 mai 2017 by the Institutional Review Board at the faculty of Medicine and Biomedical Sciences of University of Yaoundé 1.

Background: In developing sub-Saharan Africa countries such as Cameroon, the head CT-scan, which is more available and accessible than magnetic resonance imaging, gold standard, exposes to a high irradiation dose level and is still expensive. In those countries, head CT-scan has become a routine exploration in patients with headache. In front of this inflation, it is necessary to assess CT-scan requests and their profitability in the patient management. Objective: To assess the relevance and the usefulness of head computerized tomography scanner (CT-scan) requests in the management of adult headache in two referral teaching hospitals of Cameroon, in order to improve their appropriateness. Methods: This was a prospective cross-sectional study conducted in medical imaging units of the Central Hospital of Yaounde and the Laquintinie Hospital of Douala on five months period. We confronted indication mentioned on head CT-scan requests to the recommendation grades and indication’s mentions of the referral imaging guidelines of the French Society of Radiology in order to assess the relevance on the one hand. We also confronted head CT-scan results to the expectations of the requesting physicians in order to assess the usefulness on the other hand. Data analysis: Non-parametric statistical analysis. Results: During the study period, 169 examinations requests for headaches were collected. Symptom was the main clinical data mentioned on CT-scan requests (60.4%), followed by the suspected clinical diagnosis (40.2%). Requesting physicians were general practitioners (50.3%), followed by neurologists in 14.2%. Overall, 92.3% of requests were judged appropriate while 2.4% were non-indicated. The general practitioner’s requests were non-indicated in 75% of the cases. Inappropriate requests multiplied by two the risk of having no significant abnormality on the head CT-scan. Of all the head CT-scan requests, 73.2% were useful and 100% of relevant CT-scans were also useful. 45.5% of useless head CT-scans were requested by a general practitioner. Conclusion: Physicians need to follow the guidelines and justify the use of head CT-scans in patients suffering from headache in order to improve the relevance and usefulness of head CT-scans requests.

Objectives: To assess the patients and health personnel’s level of awareness on risks related to ionizing radiation during CT scan. Materials and methods: Three questionnaires were addressed to patients, prescribing physicians, and the medical imaging staff for three hospitals respectively. This permitted us to assess their knowledge on the benefits and risks of the required medical exam, based on the dangers of being exposed to X-rays, especially induced-radiation cancer following the amount of X-rays received during a CT scan and the possibility of not receiving radiation as tools of diagnosis. Results: 150 patients, 84 referring doctors of CT scan tests and 60 medical imaging personnel were retained. For patients, only 7.1% received information on the benefits and risks of their exams, and 34.4% believed that x-rays were harmful to their health. For the prescribers, 46.7% took into account the benefits/risk ratio before prescribing a test and only 16.7% of the referring doctors have informed the patient of the risks related to X-ray. 90% of the medical imaging staff ensures that the required test is justified, and 50% informed the patient on the risks associated with their radiation exposure, and the increased risk of developing cancer. 65% of the imaging staff could not estimate the dose that the patient will receive during the medical test. 25% mentioned the dose received during the acquisition in the patient’s exam report. Conclusion: This study confirms that the referring doctors, the patients, and the radiologists have a low knowledge concerning the risks associated with radiation exposure during a CT scan assessment. We will therefore say that patients and prescribers are not aware of the doses of radiation on CT and their possible risks, even though there is a risk of developing cancer.

CT-scan is the most irradiating tool in diagnostic radiology. For 5% - 10% of diagnostic X-ray procedures, it is responsible for 34% of irradiation according to UNSCEAR. Patients radiation protection must therefore be increased during CT-scan procedures. This requires the rigorous application of optimization principle which imposes to have “diagnostic reference levels”. Objective: The aim of this study was to determine the diagnostic reference levels (DRLs) of the four most frequent CT-scans examinations of adults in Cameroon. Material and Method: It was a cross-sectional pilot study carried out from April to September 2015 in five health facilities using CT-scan in Cameroon. The studied variables were: patients age and sex, type of CT-scan examination (cerebral, chest, abdomino-pelvic, lumbar spine), Used of IV contrast (IV﹣/ IV+), acquisition length, time of tube rotation, voltage (kV), mAs, pitch, thickness of slices, CTDIvol and DLP. For each type of examination, at least 30 patients were included per center, consecutively on the randomly predetermined days. The DRL for each type of examination was defined as the 75th percentile of its PDL and CTDIvol. Results: Of the 696 examinations, 41.2% were cerebral, 26.9% abdomino-pelvic, 17.7% lumbar spine and 14.2% chest. The mean age of patients was 52 ± 15 years [20 - 90 years], 58.9% were 50 years and older. The sex-ratio was 1.26 (55.9% males). The CT machines were 4, 8 and 16 multidetectors. The 75th percentile of DLP or DRLs [standard deviation] was: [1150 ± 278 mGy·cm], [770 ± 477 mGy·cm], [720 ± 170 mGy·cm] and [715 ± 187 mGy·cm] respectively for cerebral, lumbar spine, abdominopelvic and chest CT-scans. Taking in consideration the number of detectors, the 75th percentile of the Dose-Length product decreased with the increase number of detectors for cerebral examinations but was the highest with 16 MDCT for the abdominopelvic, lumbar spine and chest CT-scans. For the chest and lumbar spine examinations, there was a significant increase in patient-dose with the increase in the number of detectors. Conclusion: Our DRLs values lie between the norms of some European countries and those of some African countries. There is remarquable variation in dose for the commonest CT-scans examinations in Cameroon, requiring then an optimization process from these determined DRLs and establishment of national DRLs. Special attention to optimization should be paid when using 16 MDCT.

Background: Brain malformations (BMs) are congenital abnormalities of the shape or structure of the brain, with corpus callosum agenesis known as the most frequent. Diagnosis of most BMs can be prenatal with ultrasound and fetal magnetic resonance imaging (MRI); post-natal diagnosis is based on transfontanellar ultrasound, CT-scan, and head MRI which is the imaging gold standard technique. MRI has been recently introduced and the CT-scan was previously the reference technique for the diagnosis of BMs in our context. Almost no publication has been made in sub-Saharan Africa on the clinical and CT scan characteristics of Brain malformations in children. Objective: The aim of this study was, in the absence of MRI, to describe the clinical and CT-scan presentations of brain malformations in children at the Yaounde Gynaeco-Obstetric and Pediatric Hospital (YGOPH). Patients and method: This was a cross-sectional descriptive study conducted from February to May 2016 at the YGOPH, including all children of 15-year-old and less with BM diagnosed on CT-scan at YGOPH between April 2006 and March 2016. The studied variables were clinical (age at diagnosis, sex, clinical manifestations) and CT findings (type of cerebral malformation). The data was analyzed using the SPSS 20.0 software with the estimation of hospital prevalence of BMs, frequencies and associations. The chi-square test was used to seek for an association between variables. The threshold of significance was p p = 0.007) with disorders of brain separation (DBS) while the presence of cutaneous lesions was associated (p = 0.013) with anomalies of the cortical development (ACD) especially tuberous sclerosis complex. Conclusion: BMs are infrequent, dominated by tuberous sclerosis complex and agenesis of the corpus callosum. They are mainly revealed by convulsions and psychomotor retardation. Efforts are needed to improve antenatal diagnosis and facilitate access to cerebral MRI.

Introduction Radiological assessments for adult headache disorder show significant intracranial findings in 2.5% to 10% of performed computed tomography scans (CT-scans), leading to an overuse consideration for CT-scan requests by physicians in headache-experiencing patients. Therefore, we undertook this study in order to determine predictors of significant intracranial CT-scan findings in adults experiencing headache disorder; in order to help physicians better select patients who need imaging, which would subsequently decrease the costs of headache disorder management and the useless irradiation rates. Methods We carried out a cross-sectional study in the medical imaging departments of Yaounde Central Hospital and Douala Laquintinie Hospital, which are two teaching hospitals in Cameroon, over a period of five months. We consecutively and non-exhaustively included all consenting patients aged eighteen years and above, referred to the radiology department to perform a head CT-scan as aetiological workup of headache disorder, from either a traumatic or non-traumatic mechanism. Patients having a known brain lesion and those with a Glasgow coma scale less than thirteen were excluded. The clinical history of patients was taken and a complete physical examination was performed. Demographic data, clinical characteristics of the headache, results of neurological and physical examinations were collected and correlated to the results of head CT-scan. Results We enrolled 169 patients in the study, 56.2% were males, with a sex ratio of 1.3; sudden onset of headache increased by two the risk of discovering significant intracranial pathology (p = 0.032). Occipital and cervical location of headache, headache evolving by crisis, and recurrent paroxysmal headache were rather significantly correlated to no structural brain finding. An abnormal neurological examination with specifically abnormal stretch reflexes, aphasia, loss of consciousness, raised intracranial signs, weakness, and meningeal signs were predictive of structural intracranial pathology. Otorrhagia, epistaxis, and periorbital ecchymosis in addition were predictive in post-traumatic headaches. Conclusion Abnormal results from neurological examination are the best clinical parameters to predict structural intracranial pathology on CT-scan in adult patients experiencing headache disorder. In case of post-traumatic headaches, in addition, otorrhagia, epistaxis, and periorbital ecchymosis are too highly predictive.

Background: Anterior cruciate ligament (ACL) tears are common complications of knee trauma. This entity can be reliably diagnosed by Magnetic Resonance Imaging. There is a lack of data on the epidemiology of ACL tears in Sub-Saharan Africa. The aim of this study is to describe the radiological aspects of post traumatic ACL tears in a black African setting (Yaounde Teaching Hospital). Methods: ninety six (96) MR studies of the knee were retrospectively reviewed. They were realized on a low field device (0.2T) from July 2012 to December 2013. All the examinations were indicated for knee trauma. Ligamentous, meniscal, bony and joint lesions were sought on coronal and sagittal sections. Results: the sample consists of 70% (68/96) of men. The mean age is 35.36 ± 11.86 years. The prevalence of ACL tears is 45.8% (44/96) of which 36 (81.81%, 36/44) are total tears. 23 (24%) have associated meniscal lesion and 8 (8.3%) have a simultaneous damage of the collateral ligaments. The most frequently injured part of the meniscus is its posterior horn (12/23 cases). Meniscal and “bi-collateral” ligament injuries are independently associated to ACL tears. Conclusion: The prevalence of ACL tears at the Yaounde Teaching Hospital is 45.8%. It is independently associated to meniscal tears and concomitant injury of the tibial and fibular collateral ligaments.

Purpose: To assess the inter-observer agreement in reading adults chest radiographs (CXR) and determine the effectiveness of observers in radiographic diagnosis of pulmonary tuberculosis (PTB) in a tuberculosis endemic area. Methods: A quasi-observational study was conducted in the Pneumology Department of Yaounde Jamot Hospital (Cameroon) from January to March 2014. This included six observers (two chest physicians, two radiologists, two end-training residents in medical imaging) and 47 frontal CXRs (4 of diffuse interstitial lung disease, 6 normal, 7 of lung cancers, 7 of bacterial pneumonia, 23 of PTB). The sample size was calculated on the basis of an expected 0.47 Kappa with a spread of 0.13 (α = 5%, CI = 95%) for six observers and five diagnostic items. The analysis of concordance was focused on the detection of nodules, cavitary lesions, pleural effusion, adenomegaly and diagnosis of PTB and lung cancer. These intervals of kappa coefficient were considered: discordance ( 0.81). Results: The average score for the detection of caverns was the highest (58.3%) followed by that of the correct diagnosis of tuberculosis (49.3%). Pneumologists had the highest proportions of correct diagnosis of tuberculosis (69.6% and 73.9%) and better inter-observer agreement (k = 0.71) for PTB diagnosis. Observers were more in agreement for the detection of nodules (0.32 - 0.74), adenomegalies (0.43 - 0.69), and for the diagnosis of cancer (0.22 - 1) than for the diagnosis of tuberculosis (0.19 - 0.71). Disagreements were more frequent for the detection of pleural effusions (－0.08 - 0.73). Conclusion: The inter-observer agreement varies with the type of lesions and diagnosis. Pneumologists were most effective for the diagnosis of pulmonary tuberculosis. Observers were more in agreement for the detection of nodules and the diagnosis of cancer than for the diagnosis of pulmonary tuberculosis.

Objective The objective of this study was to investigate the magnitude of chronic venous disease (CVD) in sub-Saharan Africa, specifically the characteristics of the patients, the symptoms, the signs, and the severity. Methods From December 2013 to December 2016, a cross-sectional study was conducted of all consecutive patients with CVD aged ≥18 years and attending the outpatient clinic of the Yaounde General Hospital in Cameroon. We recorded information on demographics, relevant medical history, symptoms, lifestyle, and clinical presentation. A duplex ultrasound examination investigated veins to seek obstruction and reflux (duration ≥0.5 second). The full Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification was used to describe CVD, and severity was assessed by the Venous Clinical Severity Score (VCSS). Statistical significance was at P Results Altogether, 319 patients (503 affected legs) were enrolled; 54.3% of patients were men with a mean age of 44.5 years (18-85 years) and CVD duration of 3 months to 45 years (mean, 2.3 years). Patients had such risk factors as obesity (32.6%), family history of CVD (17.7%), multiparity, and lifestyle requiring long standing periods (64.8%). Only 15% of women older than 49 years were using birth control pills, and none older than 49 years were receiving hormone replacement therapy. Only 42.9% of patients had previously been treated for CVD, mainly with venoactive drugs (34.1%). Of the 503 legs, 366 (72.76%) were symptomatic in the following proportion: leg heaviness, 236 (64.48%); sensation of swelling, 236 (64.48%); pain, 194 (53%); sensation of “pins and needles,” 87 (23.77%); night cramps, 89 (24.39%); and itching, 66 (18.03%). Men had more symptoms ( P = .027). The mean total VCSS was 4.62 ± 4.15 (range, 1-21). The most frequent VCSSs were 0, 2, 3, and 4, and the components of the VCSS most frequently represented were pain, varicose veins, and edema.Patients were assigned to CEAP classes as follows. The C class included C0, 6.1%; C1, 35.4%; C2, 39.6%; C3, 42.7%; C4a, 11.9%; C4b, 4.9%; C5, 1.5%; and C6, 10.13%. The E class designated etiology as primary in 446 (88.66%), secondary in 49 (9.7%), and congenital in 8 (1.59%). The A class identified superficial veins in 365 (72.56%), deep veins in 218 (43.33%), and perforator veins in 22 (4.37%); no venous location was identified in 31 (6.16%). According to the P classification, of the 466 legs of level II and III CEAP, 289 (62%) had reflux, 43 (9.2%) had obstruction, 22 (4.6%) had both reflux and obstruction, and 113 (24.3%) had no venous disease identifiable, with no sex influence on the frequency of reflux ( P = .27) but a higher proportion of obstruction in men ( P = .00029). Conclusions Patients have many risk factors and are young with a male predominance. Most patients are symptomatic with advanced disease. The etiology is primary in most patients, and reflux is more common.

Background Thyroid incidentalomas (TI) are highly prevalent asymptomatic thyroid nodules with ultrasound as the best imaging modality for their detection and characterization. Although they are mostly benign, potential for malignancy is up to 10–15%. In sub-Saharan Africa little data exists on the prevalence and risk categorization of TI. The aim of this study was to determine the prevalence and ultrasound characteristics of non-palpable thyroid incidentalomas among adults in sub-Saharan setting. Methods A cross sectional study was carried out between March and August 2015, at two university teaching hospitals. Sampling was consecutive and included all adults aged ≥ 16 years, presenting for any ultrasound other than for the thyroid, with no history or clinical signs of thyroid disease, and no palpable thyroid lesion. Ultrasound was done using 4 to 11 MHz linear probes. Subjects with diffuse thyroid abnormalities were excluded. Variables studied were age, gender, thyroid volume, ultrasound characteristics of thyroid nodules, TIRADS scores. Differences were considered statistically significant for p-value 10 mm. Solid TI were mainly hyperechoic (42.0%), 3/81 were markedly hypoechoic. Sixty-nine out of 126 persons with TI (54.8%) had at least two nodules. Solitary nodules were predominant in the age group ≤20 years. Of 241 TI, 129 (53.5%) were classified TIRADS 2, 81 (33.6%) TIRADS 3, 25 (10.4%) TIRADS 4A, 6 (2.5%) TIRADS 4B, and none TIRADS 5. Characteristics associated with increased risk of malignancy where mostly founded on solid nodules (p

Background: Justification is the process of weighing the potential benefit of the exposure against potential detriment for that individual. Its role has been largely delegated to imaging professionals. Nevertheless, justification process involves referring physicians, radiographers and radiologists. Objective: To assess the knowledge of referring physicians regarding justification of irradiating examinations in medical imaging at the university-affiliated hospitals in Yaounde Cameroon. Materials and Methods: A questionnaire (18 questions) based on the French guide for the proper use of medical imaging tests in relation to the justification of irradiating examinations, was self-administered to 151 referring physicians in Yaounde (Cameroon) between October 2012 and January 2013. The pre-tested questionnaire was completed in the presence of the investigator. A scoring system was then adopted with a total of 15 points from the level of knowledge on justification which could be classified as satisfactory or not. Results: Referring physicians were 75 (49.7%) GPs, 53 (35.1%) residents and 23 (15.2%) specialists. Knowledge on justification was unsatisfactory for 79.5% of referring physicians with no significant difference in terms of professional experience (p = 0.95) or specialty (p = 0.119). The concepts of “useful exam” and “justified exam” were not known by 113 (74.8%) and 95 (62.9%) practitioners. MRI was selected as irradiating by 62 (41.1%), SPECT and PET-scan as non-radiating examinations by 98 (64.9%) and 115 (76.1%) participants. The main reasons for repeating a giving radiology exam were: unsatisfactory interpretation, unknown of where it was performing and poor quality exam respectively for 23 (15.2%), 37 (24.5%) and 43 (28.5%) referring physicians. Justification was the responsibility of the referring physician alone for 57% of respondent. Only 11 clinicians knew the reference of “Justification-Optimization-Limitation” to radiation protection. Conclusion: The knowledge of physicians on radiating medical procedures and justification of requests for these procedures is inadequate. Training in radiation protection and the introduction of guidelines for the proper use of imaging tests could improve physicians’ justification of radiating examinations.

Purpose: The complexity of chest radiography (CXR) is a source of variability in its interpretation. We assessed the effect of an interpretation grid on the detection of CXR anomalies and radio- graphic diagnosis of tuberculosis in an endemic area for tuberculosis. Methods: The study was conducted in Yaounde (Cameroon). Six observers (2 pulmonologists, 2 radiologists and 2 senior residents in medical imaging) interpreted 47 frontal CXR twice two months apart without (R1) and with (R2) the aid of an interpretation grid. We focused on the detection of micro nodules (n = 16), cavitations (n = 12), pleural effusion (n = 6), adenomegaly (n = 6), and diagnosis of tuberculosis (n = 23) and cancer (n = 7). Results: The average score for accurate detection of elementary lesions was 40.4% [95%CI: 25% - 58.3%] in R1 and 52.1% [36.9% - 65.3%] in R2. The highest im- provement was observed for micro nodules (19.8%). Cavitations had the highest proportions of accurate detections (58.3% in R1 and 65.3% in R2). The average score of accurate diagnosis was 46.1% in R1 and 57.4% in R2. Accurate diagnosis improved by 3.6% for tuberculosis and 19% for cancer between R1 and R2. Intra-observer agreement was higher for the diagnosis of cancers (0.22 ≤ k ≤ 1) than for diagnosing tuberculosis (0.21 ≤ k ≤ 0.68). Inter-observer agreement was highly variable with a modest improvement for the diagnosis of tuberculosis in R2. Conclusion: Standardized interpretation scheme improved the detection of CXR anomalies and diagnosis of tuberculosis. It significantly improved inter-observer’s agreement in diagnosing tuberculosis but not in detecting most lesions.

Purpose: Despite irradiation, CT-scan remains an important diagnostic tool in epilepsy in poor countries where MRI is neither available nor affordable. But many causes of epilepsy are not accessible to CT-scan and this technique remains expensive for many poor families in countries with limited resources. The aim of this study was to determine clinical or electroencephalogram variables which could predict brain CT-scan abnormalities in childhood epilepsy. Methods: It was a cross-sectional study including 151 epileptic children who underwent head CT-scan from October 2011 to march 2012, in one university-affiliated hospital in Cameroon (YGOPH). The data collected were clinical, type of seizure, Electroencephalogram and head CT-scans results. Independent predictive factors for CT abnormalities were sought by logistic regression. A p value : Of the 151 children, 54.3% (82/151) were boys (sex ratio: 1.18 M/1F). The median age was 54 months [2 - 190 months]; 74.8% of children were more than 2 years old but at the onset of epilepsy they were 2 years old or less. Birth asphyxia, mental retardation and neurologic deficit were respectively associated in 62.4%, 54.3% and 51.7% of cases. Eighty-five had focal epilepsy (56.3%), 61.6% had abnormal head CT-scan, 68.9% had abnormal EEG, with no significant gender difference. The factors most significantly associated with abnormal head CT-scan were: child age ≤ 2 years, maternal hypertension/eclampsy, cerebral palsy, and child microcephaly, with 89% to 92% abnormal CT. The two independent predictors of abnormal CT were patients’ age ≤ 2 years and microcephaly. The two main CT-scan lesions were cerebral atrophy (28.5%) and brain infarct (16.6%). None of these abnormalities was correlated to any type of epilepsy. Conclusion: Almost two-thirds of head CT-scan performed in epileptic children are abnormal in our setting. Patients of 2 years old or less and those with microcephaly are very likely to have brain anomalies on CT-scan. The most common brain lesions are atrophy, cerebral infarction and porencephalic cavities. Action to reduce birth asphyxia may lead to the reduction of the incidence of epilepsy in children.

Background: According to the World Health Organization, about 5% of children world-wide of 14-year-old and under have a moderate to severe developmental disability, and up to 15% of children under 5-year-old are developmentally delayed. Purpose: To determine the prevalence, socio-demographic profile, aetiologies, and the clinical presentation of developmental delay in children less than 6-year-old at the child neurology unit in a university-affiliated hospital in Yaounde. Materials and methods: It was a crosssectional descriptive study carried out in Yaounde Gynaeco-Obstetric and Paediatric Hospital (Cameroon) from August to December 2012. Children aged between 5 - 72 months with a developmental quotient less than 70 were enrolled. Developmental delay (DD) was diagnosed and classified using the Denver developmental screening test (DDST). Data concerning the child (age, gender, severity of DD), the mother (age, age at conception, educational level, marital status), history of pregnancy and delivery, perinatal and postnatal events, results of para-clinical explorations (EEG, CT-scan, genetic tests), the severity of DD and the probable or demonstrate cause of DD were recorded on a standardized questionnaire. The chisquare test was used to compare variables. Results: During the study period, 2171 children aged 5 - 72 months consulted the paediatric department of the hospital, 296 were examined at the child neurology unit of which 153 had a developmental quotient less than 70, giving a hospital prevalence of 7.0% and a prevalence of 51.7% at the child neurology unit. The mean age was 26.6 ± 18.0 months and there were 56% males. The main reason for consulting was tonus disorder (43.8%) and the developmental area of parental concern was the motor domain (90.2%). Regarding the clinical presentation, 75.2% of our population were children with cerebral palsy. DD was severe, mild, moderate and profound respectively in 14.2%, 13.5%, 12.2%, and 11.1%. Gross DD represented 90.2% of all DD children. The causes of DD were hypoxic-ischemic encephalopathy (41.8%), epilepsy (13.7%), sequelae of meningitis (6.5%), sequelae of kernicterus (6.5%), and infectious embryofoetopathies (5.2%). Conclusion: Developmental delay is frequent in paediatric neurology, with perinatal disorders being the leading aetiologies in Cameroon. Prevention of perinatal hypoxic-ischemic encephalopathy risk factors needs to be reinforced.

Background: West syndrome (WS) is an epileptic syndrome of the infant occurring between the 3rd and 12th months of life and characterized by the triad: infantile spasms in flexion, extension or mixed; global developmental delay; and hypsarrythmia on the electroencephalogram (EEG). Its incidence varies between 2.9 and 4.5 per 10,000 live births. West syndrome is caused by a brain dysfunction whose origins can be prenatal, neonatal and postnatal. Sometimes the aetiology is genetic or unknown. Purpose: To determine the main clinical, aetiological and major evolutive aspects of West syndrome in child neurology unit in a university-affiliated hospital in Yaounde. Materials and Methods: It was a retrospective descriptive study conducted from September 2011 to January 2012 inthe child neurology unit of the Yaounde gynaeco-obstetric and paediatric hospital. The medical records of 68 children followed for West syndrome (WS) in the service during the period from February 2008 to January 2012 (48 months) were used. All infants of 1- to 16-month-old with the diagnosis of WS were included. The diagnosis of WS was based on clinical evidence of spasm in flexion and/or in extension with global development delay, and EEG evidence of hypsarythmia or focal/multifocal epileptic abnormalities when hypsarythmia is absent. For each included infant, relevant medical history and complete physical examination were performed. The following data were collected and reported on a standardized questionnaire: prenatal, perinatal and postnatal past histories, age at onset of spasms, age at diagnosis, semiology of spasms, psychomotor development, the EEG and CT aspects and the evolutive modes of WS under treatment. Psychomotor development was assessed using theDenverdevelopmental screening test (DDST) which assesses the mental age compared to chronological age. Results: The age of onset of spasms varied between 1 and 16 months with a mean of 4.69 (±1.98) months. Males were highly represented with a sex ratio of 1.72. Flexion spasms were the most common clinical presentation (79.41%). 82.83% of the patients had a global developmental delay on the onset of spasms. Structural causes or symptomatic West syndrome was the most frequent presentation (77.94%). Perinatal aetiologies were highly represented (73.58%) with the main cause being neonatal asphyxia (55.88%). A hypsarrythmic tracing was found on the electroencephalogram (EEG) in 73.53% of cases. The most frequent CT abnormality was cortico-subcortical atrophy (38.24%). At the end of our study, global developmental delay persisted in 89.72%. Conclusion: The main aetiologies of West syndrome in our context are the sequelae of neonatal asphyxia and viral embryofoetopathies. There is a high incidence of associated global developmental delay. More prevention methods on risk factors for foetal distress and proper monitoring of deliveries to minimize severe neonatal asphyxia are indispensable.

Background: Pregnant women are important stakeholders regarding prenatal ultrasound (US) scanning. Their specific needs and preferences have to be ascertained by healthcare providers to ameliorate service delivery. Objective: To assess the pregnant woman’s expectations during routine prenatal US scan and her perspective ofUSsafety during pregnancy in a Central African obstetric population. Methods: A cross-sectional descriptive survey of consenting pregnant women who reported for routine prenatal US scan using an anonymous questionnaire. A convenient sample of 200 participants was adopted. Results: Thirty-three (16.8%) respondents (on a total of 196) declared they had never done anUSscan. One hundred and eleven (58.4%) on a total of 190 stated that they had not received any information on what ultrasonography is all about. Before theUSscan the respondents would like to receive information on the aim or purpose of ultrasonography, possible inconveniences or risks, and on how to prepare before the scan. The most reported expectations were assurance of the wellbeing of the fetus (58%), gender determination (44.5%) and information on fetal position (20.5%). Thirty-four respondents considered ultrasonography as not perfectly safe for the mother or the “baby”, with the relevant reasons being the use or production of some potentially harmful “rays”. Conclusion: Pregnant women would want to be assured of the wellbeing of the fetus, the gender and position during routine prenatal US. They however need to be informed of its purpose and safety.

Background: Ultrasonography (US) is the best diagnostic tool in the initial assessment of thyroid nodule. Giving its appropriateness and accessibility, ultrasound-based thyroid imaging reporting and data systems (TIRADS) classifications have been developed with main goal to standardize reporting and facilitate communication between practitioners, and to indicate when fine-needle aspiration biopsy (FNAB) should be performed. Objective: To determine the reliability of Russ’ modified TIRADS classification in predicting thyroid malignancy. Materials and Methods: It was a cross sectional study carried out at Centre Hospitalier de Lagny, Marne La Vallee (France). Consecutive records of patients with focal thyroid nodules on ultrasound (US) for which US-guided FNAB was performed and pathology results were available, from January 2007 to August 2012, were selected for review. The risk of malignancy of each TIRADS category was determined and correlation with pathology assessed. Statistical performances of some US features were also assessed. The threshold for statistical significance was set at 0.05. Results: A total of 430 records of patients were eligible. Twenty-three out of 430 (5.3%) nodules were malignant. The risk of malignancy of the TIRADS categories were as follows: TIRADS2 0%, TIRADS3 2.2%, TIRADS4A 5.9%, TIRADS4B 57.9%, TIRADS5 100% (Gamma statistic = 0.85; Spearman correlation = 0.30, Pearson’s R = 0.37, p < 0.001). Some US features were associated with a higher risk of malignancy: irregular contours (OR = 22.4), taller-than-wide shape (OR = 19.5), microcalcifications (OR = 15.2), and marked hypoechogenicity (OR = 12.7). Conclusion: Russ’ modified TIRADS classification is reliable in predicting thyroid malignancy. More evidence is nevertheless necessary for widespread adoption and use.

Introduction: Our aim was to identify the risk factors of clinical birth asphyxia and subsequent newborn death in the presence of nuchal cord in a sub-Saharan Africa setting. Methodology: It was a six-months’ case-control study involving 117 parturients whose babies presented with a nuchal cord at delivery. The study was carried out at the Yaounde Gyneco-Obstetric and Pediatric Hospital, Cameroon, from January 1st to June 30th 2013. Results: The risk factors of clinical birth asphyxia identified were: first delivery, absence of obstetrical ultrasound during pregnancy, nuchal cord with more than one loop, duration of second stage of labor more than 30 minutes during vaginal delivery. The risk factors for newborn death from clinical birth asphyxia in the presence of nuchal cord were: maternal age

Les pratiques de radioprotection des patients sont peu documentees en Afrique subsaharienne en raison de l’absence ou de la mise en œuvre approximative des lois et reglements qui y sont relatifs. Ce travail investigue la justification et l’optimisation en scanographie pediatrique dans deux hopitaux universitaires de Yaounde au Cameroun. L’enquete retrospective portait sur 171 examens chez des enfants de 0 a 15 ans pendant un trimestre. Les donnees collectees a l’aide d’une fiche adaptee du modele de l’Institut de radioprotection et de surete nucleaire d’evaluation dosimetrique en scanographie ont ete confrontees aux referentiels de la Societe francaise de radiologie et de la Societe francophone d’imagerie pediatrique et prenatale. La conformite de chaque examen a ete analysee et les valeurs d’index de dose scanographique et de produit dose longueur (PDL) ont ete comparees aux niveaux de reference diagnostiques (NRD) des referentiels ci-dessus. Si tous les examens etaient justifies, les protocoles, non affiches, etaient variables selon les equipes et les services. La tension etait conforme dans 87,7 % des cas et 15,2 % des PDL etaient superieurs aux NRD pour les scanners thoraciques et abdominaux en mode spirale et cerebraux en mode sequentiel. Un affichage des protocoles optimises est necessaire pour ameliorer les pratiques dans ces services avec une rotation importante de techniciens et residents de radiologie.

We evaluated the outcome of treatment of uterine synechiae (or adhesions, also known as Asherman syndrome) by cervical dilatation and sequential estrogen and progestogen administration for three months. This retrospective cohort study examined records of 86 women with infertility or menstrual disorders or both and treated from October 2004 to November 2011 for synechiae diagnosed by hysterosalpingography. The data analyzed included age, presenting complaint, and treatment outcome. During the study period, 86 women were seen for uterine synechiae but only 81 files could be included. The patients' mean age was 25.52 (range: 19-40 years), with 37% in the age group of 25-29 years. Of these 82 women, 71 reported menstrual disorders and 60 infertility. After treatment, 11/60 (18%) became pregnant and 35/71 (49%) recovered normal menstrual profiles. The reference treatment for uterine synechiae is hysteroscopy, which yields good results. In poor settings, however, hysteroscopy remains inaccessible, and the old method of cervical dilation and sequential estrogen and progestogen therapy is an acceptable alternative.

Benign cystic peritoneal mesothelioma is a rare tumor which frequently occurs in women of reproductive age. Abdominal pain associated with pelvic or abdominal mass is the common clinical presentation. We report the case of a 22-year-old woman with a pathological proved benign cystic mesothelioma of the peritoneum revealed by a small bowel obstruction and a painful left-sided pelvic mass with signs of psoitis. Contrast enhanced abdominal CT-scan demonstrated a large pelvic cystic mass with mass effect on rectosigmoid and pelvic organs. The patient underwent surgical removal of the tumor. Pathological examination revealed the diagnosis of benign cystic mesothelioma of the peritoneum. The outcome was excellent with a 12-month recoil.

Carotid artery pseudoaneurysm is a rare condition, particularly in the paediatric population. Only about 30 cases of carotid artery aneurysms in infants have been published until now. This paper reports the case of a giant pseudoaneurysm of the left common carotid artery due to swallowed fish bone by an 8-year-old boy. This pseudoaneurysm was 5.5 cm transverse-diameter and resulted in severe respiratory distress. It was treated by resection and end-to-end anastomosis with satisfactory outcome after one-year follow-up. To the best of our knowledge, this is the largest carotid artery pseudoaneurysm ever described in children.

Oumarou Abdouramani,1 S Nguefack,2,3 VA Dohvoma,3 B Moifo,3,5 André Omgbwa Eballé,1 A Moho,4 E Epee,3 E Mbonda,2,3 AL Bella31Ophthalmology Unit, Yaoundé Gynaeco-obstetric and Paediatric Hospital (YGOPH), 2Neuropaediatric Unit, YGOPH, 3Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, 4Ear, Nose, and Throat Unit, YGOPH, 5Radiology Unit, YGOPH, CameroonBackground: Intraorbital abscess is a very severe infection with ophthalmologic and neurologic complications that are sometimes life-threatening.Objective: To report the etiologic, clinical, radiologic, and prognostic features of one case of bilateral intraorbital abscesses with intracranial complications.Case report: A 15-year-old Cameroonian girl in a comatose state (11/15 on the Glasgow Coma Scale) with meningeal signs, right hemiplegia, right facial palsy, and bilateral exophthalmia was admitted for meningitis and cerebral abscess secondary to orbital cellulitis. A lumbar tap was carried out, no organisms were seen by Gram stain, and culture was negative due to previous antibiotic therapy. A computed tomography scan showed a left internal capsule infarct and a pansinus opacification. Bilateral superior orbitotomies were performed and the abscess evacuated. Microscopy and culture of surgical material were negative. The patient was discharged 4 weeks after hospital admission with a visual acuity of 0.1 in both eyes, aphasia, and right hemiplegia. Nine months later, there was complete visual recovery (visual acuity 1.0 in both eyes). Anterior and posterior segments were normal on slit-lamp examination. There was no aphasia, but right-sided hemiparesis persisted.Conclusion: The authors emphasize the need for prevention, early diagnosis, and adequate treatment of orbital cellulitis in order to avoid complications.Keywords: intraorbital abscess, orbital cellulitis, orbitotomies, hemiparesis, intracranial complications, pansinusitis

Objectifs En l’absence d’IRM, decrire les indications et les resultats des examens scanographiques de la region sellaire et suprasellaire a Yaounde. Materiels et methodes Etude transversale descriptive portant sur l’analyse des dossiers cliniques et des scanners de la region sellaire ou des scanners crânio-encephaliques avec lesions sellaires ou supra-sellaires. Etude portant sur les examens realises a Yaounde de mars 1994 a fevrier 2004. Resultats Les scanners de la region sellaire representaient 150 (1,20 %) des 12502 scanners crânio-encephaliques realises. Cent cinquante patients etaient retenus dont 99 femmes et 51 hommes, âges de 4 a 66 ans un âge moyen de 36 ans pour les adultes et 12 ans pour les enfants. Les troubles visuels et les cephalees chroniques constituaient 54,70 % des indications suivis des troubles endocriniens (29,28 %). 82 (54,67 %) des 150 scanners etaient pathologiques. Les principales lesions decelees au scanner etaient : 34 (41,46%) macro-adenomes hypophysaires ; 20 (24,40 %) micro-adenomes hypophysaires chez les femmes, 14 (17,07 %) craniopharyngiomes chez les enfants et 4 meningiomes sellaires. Une osteolyse de 13 selles turciques et une hydrocephalie (10 cas) etaient associees aux principales lesions. Conclusion Les adenomes hypophysaires et le craniopharyngiome representent les principales pathologies avec pour principal mode de revelation les troubles neuro-ophtalmologiques. Le scanner reste une technique d’exploration de choix dans notre milieu en l’absence de l’IRM.

Background Research activities for medical students and residents (trainees) are expected to serve as a foundation for the acquisition of basic research skills. Some medical schools therefore recommend research work as partial requirement for certification. However medical trainees have many difficulties concerning research, for which reason potential remedial strategies need to be constantly developed and tested. The views of medical trainees are assessed followed by their use and appraisal of a novel “self-help” tool designed for the purposes of this study with potential for improvement and a wider application. Methods This study was a cross-sectional survey of volunteering final-year medical students and residents of a medical school in Cameroon. Results This study surveyed the opinions of a total of 120 volunteers of which 82 (68%) were medical students. Three out of 82 (4%) medical students reported they had participated in research activities with a publication versus 10 out of 38 residents (26%). The reported difficulties in research for these trainees included referencing of material (84%), writing a research proposal (79%), searching for literature (73%) and knowledge of applicable statistical tests (72%) amongst others. All participants declared the “self-help” tool was simple to use, guided them to think and better understand their research focus. Conclusion Medical trainees require much assistance on research and some “self-help” tools such as the template used in this study might be a useful adjunct to didactic lectures.