Aspects scanographiques de la pneumopathie à COVID-19 à Ouagadougou: Étude multicentrique à propos de 1017 cas.

OBJECTIVE: To study the chest CT profile of SARS-CoV-2 pneumonia in patients in the city of Ouagadougou. PATIENTS AND METHODS: descriptive cross-sectional study with retrospective collection of 1017 patients of both sexes. Included were patients aged 15 and over who had performed a chest CT scan without or with injection of contrast product, suspected or positive for COVID -19. The variables analyzed were: the history, the nature of the examination, the socio-demographic, clinical, CT data including the description of the tomodensitometric lesions and their characteristics, the extent of the parenchymal lesions according to the visual estimate of the French thoracic Imaging Society, complications, other lesions on the chest CT scan and CORADS classification. All parameters (age, sex on the one hand and clinical and CT findings on the other) were subjected to statistical analysis. RESULTS: The mean age of the patients was 56.95 years, predominantly male (1.47). Dyspnea was the most frequent symptomatology, at 46.26% (n = 506). Diabetes was the most common comorbidity with 29.37% (n = 94). Frosted glass opacity accounted for 90.95% of elementary lesions which were predominantly in plaque in 44.35% (n = 451), bilateral in (82.79%) and peripheral subpleural in (81.51%). The lower lobes were the most affected and postero-basal involvement predominant with greater involvement in the right lung. The extent was severe in 28.42% (n = 289). Thirty-nine point twenty-three (39.23)% or 399 of cases presented with complications dominated by pleural effusion at 56.39% (n = 225) and pulmonary embolism at 34.08% (n = 136 ). The lesions were classified as CORADS type in 815 CT reports. CORADS 5 type lesions were found in 47% of patients. Five hundred and ninety-two (592) PCRs of our patients were undetermined, in 58.21%. The PCR was positive in 342 cases or 33.63%. The bi- and multivariate analysis noted: a statistically significant link between the age and the extent of the lesions, between the extent of the lesions and the clinical context, between the extent of the lesions and comorbidities such as diabetes, Hypertension and renal failure. There was also a link between the PCR result and basic lesions such as ground glass and crazy paving and between the occurrence of pulmonary embolism and the presence of hypertension. DISCUSSION: The scanographic profile corresponded to that described in the literature. Frosted glass was the most common elementary lesion. The impairment was severe to critical in patients over 65 with comorbidity. CT angiography was the most requested in front of signs such as dyspnea and desaturation CONCLUSION: A study on CT specificities with precision on the onset of symptoms and the notion of vaccination would complement these results.

Aortic dissection-Pulmonary embolism association: A therapeutic dilemma.

Aortic dissection is a rare but serious condition. Its association with pulmonary embolism is exceptional and produces a real therapeutic dilemma. We are discussing the case of a 67-year-old male patient who presented with paraplegia with infectious syndrome. The chest X-ray performed to screen for an infectious site led to the suspicion of an aortic aneurysm and the CT angiography showed Stanford type B aortic dissection associated with bilateral proximal pulmonary embolism. The treatment was symptomatic and resulted in the patient's death 48 hours after diagnosis. Management of this pathological association is not standardized between establishing anticoagulant therapy and therapeutic abstention. This management depends on the teams and has a very cautious prognosis.

[Myoma, fortuitous discovery or metrorrhagia: Which is more revealing?] / Myome, découverte fortuite ou métrorragie: qui dit mieux?

INTRODUCTION: myoma is commonly diagnosed in our hospital. It can be accidentally discovered or discovered due to metrorrhagia. The purpose of this study is to evaluate the association between the size of myomas and the circumstances under which they are detected and between the location of myomas and the occurrence of bleeding. METHODS: we conducted a cross-sectional study including women aged 18 or older undergoing ultrasound at the University Teaching Hospital Bogodogo and who were diagnosed with at least one uterine myoma over a period of 6 years from January 2012 to December 2018. Binary logistic regression was used to assess metrorrhagia while multinomial logistic regression was used to assess circumstances under which they were detected and size. RESULTS: we assessed 1049 women, among whom 2294 had myomas diagnosed on ultrasound. Each woman had two myomas. The average age of patients was 37 years. Women with myomas larger than 50 mm accounted for 29.7% (n=311). There was a strong association between interstitial, subserosal and submucosal myomas and the occurrence of metrorrhagias (p<0.001). A size less than 50 mm was significantly associated with fortuitous discovery (p=0.016) but not with revealing metrorrhagia (p=0.084). Women who had submucosal myomas (OR=3.13; CI95%= [1.45-6.76]), interstitial and submucosal myomas (OR=2.24; CI95%= [1.05-4.78] as well as interstitial, subserosal and submucosal myomas (OR=3.57; CI95%= [1.88-6.76]) were at higher risk of developing metrorrhagia. Myomas measuring less than 50 mm had twice the odds of revealing fortuitously (RRR=1.80; CI95%= [1.25-2.62]) or by metrorrhagia (RRR=1.75; CI95%= [1.04-2.95]. CONCLUSION: metrorrhagia is more common in women with myomas in specific locations.

[Status of obstetrical echography at the imaging service of the University Hospital Center of Bogodogo from January 1st, 2016 to December 31st, 2018]. / État des lieux des échographies obstétricales au service d'imagerie du Centre Hospitalier Universitaire Bogodogo du 1er janvier 2016 au 31 décembre 2018.

Obstetric ultrasound performed according to standards from its prescription to the report is a guarantee of quality. The aim of our study was to take stock of obstetrical ultrasounds in order to make rational the ultrasound follow-ups of pregnancy. This was a descriptive cross-sectional study with retrospective data collection through the reports of obstetrical ultrasounds performed from the 1st January 2016 to 31st December 2018. Of the 13,487 ultrasounds in the study period, 2,355 were obstetric ultrasounds, constituting 1746% of the ultrasound activity. The mean gestational age was 27.54 years (± 6.19). The CHU Bogodogo was the requesting structure for 86.88%. Paramedics were prescribers in 66.47%. Third trimester ultrasounds made up 57.06%. Gestational age in 12.99% was greater than 37 weeks while in 66.37% gestational age was greater than 24 weeks. Prenatal follow-up was indicated in 54.48%. Pregnancies were progressive in 97.49%. Twin pregnancies represent 2.72% and ultrasound pathological pregnancies 11.80%. Obstetric Doppler was performed in 2.12% with pre-eclampsia as the main indication (52%). There was 1.18% malformation with nervous system involvement in 60.71%. Through this inventory, the training of prescribers of obstetric ultrasound appears essential. The establishment of an observatory of obstetric ultrasound practices would be an asset for the quality of these medical examinations.

[Clinical and paraclinical profile of autoimmune myasthenia gravis in Ouagadougou, Burkina Faso]. / Profil clinique et paraclinique de la myasthénie auto-immune à Ouagadougou au Burkina Faso.

Introduction: Certain differences in the epidemiological, clinical, paraclinical and evolution profiles of autoimmune myasthenia gravis (AIMG) are increasingly described in patients according to geographic origins. The present study was carried out in order to help characterize the socio-demographic, clinical and paraclinical profile of AIMG in Ouagadougou, Burkina Faso. Patients and methods: This was a cross-sectional, descriptive, multicenter, hospital study carried out in Ouagadougou (Burkina Faso), over a period of 5 years 6 months, from March 2015 to September 2019. The study concerned all patients who had a clinical symptomatology suggestive of myasthenia gravis, associated with the presence in the serum of anti-AChR Ab and / or anti-MuSK Ab and / or the presence of a >10% decrement in electroneuromyography and / or a positive therapeutic test for oral anticholinestherasics. Sociodemographic, clinical and paraclinical variables, were analyzed. Results: A total of 25 patients (15 women and 10 men), were included. The young adult form was predominant (20 cases). The median time between the first symptoms and the diagnosis was 28.4 months +/- 44.8 (2 - 217 months). Diplopia and/or ptosis (80%) and dysphonia (72%) were the most frequent revealing clinical presentations. On admission, 7 patients (28%) had a moderate generalized form (MGFA class III) and 9 patients (36%) had a severe to very severe generalized form (MGFA class IV to V). Plasma Ab assays were performed in 17 patients (68%): anti-RACh Ab were positive in 11 patients (64.7%) and anti-MuSK Ab in 3 patients (14.3%). Thoracic CT revealed thymus hyperplasia in 12 patients (48%), thymoma in 5 patients (20%). Hyperthyroidism was associated in 2 patients (8%). Conclusion: AIMG in Ouagadougou, Burkina Faso is marked by delayed diagnosis, a predominance in young women, severe generalized forms and a high frequency of plasma anti-MuSK Ab. This profile appears to be different from that of Caucasian patients. Collaborative studies in the sub-Saharan region on AIMG in general populations are needed.

Anomalies associées aux holoprosencéphalies à l'échographie anténatale: à propos d'une série de 11 cas à Ouagadougou (Burkina Faso)

Objectifs : décrire les anomalies associées aux holoprosencéphalies suspectées lors de l'échographie anténatale. Patients et méthodes. Il s'est agi d'une étude transversale descriptive. Nous avons inclus de façon consécutive, les cas suspects d'holoprosencéphalies diagnostiqués au cours d'échographies anténatales évolutives réalisées dans notre centre d'imagerie, entre janvier 2016 et décembre 2018, quel que soit l'âge gestationnel. Résultats : 11 cas suspects d'holoprosencéphalies ont été identifiés. Il s'agissait de formes alobaires dans huit cas et de forme semi lobaire dans trois cas. L'âge gestationnel médian lors du diagnostic était de 31 semaines d'aménorrhée [13 et 38 ans]. L'âge maternel médian était de 32 ans [23-41ans]. Il n'y avait pas de diabète maternel ou d'antécédent familial noté chez ces patientes. Les anomalies encéphaliques à type d'absence de la ligne médiane, de ventricules unique et de fusions des thalami étaient notées chez tous les foetus. Les anomalies nasales étaient présentes dans 8 cas /11, labiales dans 2 cas/11 et oculaires dans 5 cas/11. Les foetus étaient majoritairement de type féminin. On notait la présence d'autres anomalies dans 5 cas/11. Il s'agissait de néphropathie, d'anomalie fémorale et d'une communication interventriculaire. Conclusion : Malformation rare, l'holoprosencéphalie est diagnostiquée tardivement dans notre contexte. Il n'y avait pas de facteur étiopathogénique retrouvé. Les tests génétiques et l'étude du caryotype n'étaient pas disponibles dans notre contexte au cours de l'étude

Profil mammo-échographique et histopathologique des cancers du sein de la femme à Ouagadougou (Burkina Faso)

Objectif : Décrire les aspects radiologiques et histopathologiques des tumeurs malignes mammaires chez la femme au Burkina Faso. Matériels et méthodes : étude transversale analytique à collecte rétrospective réalisée de janvier 2014 à octobre 2017. Les patientes incluses ont eu une microbiopsie mammaire sous guidage échographique après une exploration mammographique et échographique, avec un résultat histopathologique de malignité. Les variables recueillies étaient l'âge, les antécédents, la taille des nodules, la classification ACR et le diagnostic anatomopathologique. Résultats : l'échantillon de lésions malignes étaient constitué de 173 nodules. L'âge moyen était de 49.15 ± 11.55 ans et la taille moyenne des lésions de 31.57 ± 18.21mm. Les femmes de moins de 40 ans représentaient 16,8% de l'échantillon. Les antécédents familiaux étaient connus dans 7% des cas. A l'imagerie, on notait 4,05% de lésions classées ACR3, 68,79% de lésions ACR4 et 27,17% de nodules ACR5. Les tumeurs malignes étaient constituées essentiellement de carcinomes canalaires infiltrants dans 98,26 %. Conclusion. Le cancer du sein est mis en évidence chez la femme de la cinquantaine. Les nodules ont une tendance à la bénignité chez les femmes jeunes. La taille moyenne de la lésion est importante au moment du diagnostic

CT Features of Saba Senegalensis (a Tropical Fruit) in Patients with Abdominal Pain.

Saba senegalensis (SS) is a well-known and commonly eaten fruit in Western Africa, especially in the rainy season when it is abundant. The ingestion of its seeds may cause abdominal pain and bowel obstruction. This cause might not be recognized by radiologists who are not aware of SS CT features. We thus present the characteristic CT features of SS as found in patients presenting with abdominal pain and incidentally in others. We also discuss the differential diagnosis with the cowries (ornament) and other similar fruits as imaged on CT.

Right upper pulmonary vein metastasis from hepatocarcinoma.

Metastatic tumor involvement of the heart is uncommon but may occur with all types of primary neoplasms. We report the case of a 51-year-old male who developed a massive mass involving the upper right pulmonary vein. The tumor was removed and the final pathology report disclosed metastatic hepatocellular carcinoma. Hepatocellular carcinoma affecting the pulmonary veins is a very rare condition.

Etiologies of non-genetic epilepsies of child and adolescent, newly diagnosed in Ouagadougou, Burkina Faso.

INTRODUCTION: in sub-Saharan Africa, epilepsy is common and mainly concerns children before the age of 15 years. The data on childhood epilepsy is parcel, but a high prevalence of non-genetic epilepsy is frequently reported. EEG, TDM and MRI devices are rare. The aim of this work was to study the etiological aspects of non - genetic epilepsy of the child and adolescent, newly diagnosed in Ouagadougou, Burkina Faso. METHODS: This was a cross-sectional, descriptive, multicentric study, from 01/01/2016 to 31/12/2016, involving patients aged 0 to 18 years old, epileptic, newly diagnosed, in the city of Ouagadougou. Each patient included in the study was to have had an EEG and brain CT scan and/or brain MRI and to gather the anamnestic and electro clinical arguments for non-genetic epilepsy. Sociodemographic, clinical, EEG and neuroradiological data were analyzed. An univariate analysis was used to determine the electro-clinical and neuro-radiological characteristics associated with epilepsies of structural causes. RESULTS: In all 115 patients were collected, with an average age of onset of epilepsy of 8.2 years, a male predominance with a sex ratio to 1.67. Risk factors of epilepsy was present in 74.8%; They were dominated by perinatal events in 79.1%. Focal seizures, daily frequency of these seizures and focal epilepsy, were predominant, respectively in 53%, 58% and 60.9% of cases. Brain scan and Brain MRI where performed in 90.4% and 9.6% of patients, respectively. The brain sequelaes of perinatal adverse events, the sequelae of central nervous system infections, and the sequelae of cranial and brain trauma, with 34.8%, 14.8%, and 5.2% respectively, were the main causes of non- genetic epilepsies of the child and adolescent. No cause was identified in 37.4% of cases. CONCLUSION: The improvement of policies in the field of maternal and child health and the generalization of the control of infectious and parasitic diseases, including malaria, may contribute to the reduction of non-genetic epilepsy in sub-Saharan Africa.

Head Computed Tomography Scan in Isolated Traumatic Brain Injury in a Low-Income Country.

BACKGROUND: Head computed tomography scan (HCTS) is the cornerstone of the management of traumatic brain injury (TBI). The impact of performing a HCTS in TBI has been scarcely investigated in low-income countries (LICs). Furthermore, the cost of a HCTS is a burden for family finances. METHODS: A prospective observational study was conducted in Burkina Faso. All consecutive patients with isolated TBI needing a HCTS were included. Result and impact of HCTS were evaluated. RESULTS: There were 183 patients prescribed a HCTS for an isolated TBI. Mild, moderate, and severe TBIs represented 55%, 31%, and 14% of the cases, respectively. In 72 patients, HCTS was not performed because of economic barrier. Among the 110 HCTSs performed, there were intracranial lesions in 81 (74%) patients. Among the 110 performed HCTS, 34 (31% [22.3%-39.5%]) HCTSs altered the management of TBI, with 16 (15%) cases of surgical indications, and 20 (18%) cases of modification of the medical treatment. In patients without neurologic signs, the rate of alteration of management was 28%. The realization of the HCTSs was associated with the presence of neurologic signs and income level. In-hospital mortality was 11% (n = 21). Among the 162 patients discharged alive from the hospital, 27 (20%) were discharged with a severe disability state (Glasgow Outcome Scale score ≤3). The rate of return to work was 77%. CONCLUSIONS: No modification of guidelines can be advocated from this study. However, given the financial burden on family of performing HCTS, research may identify criteria allowing for avoiding HCTS. Guidelines specific to LICs are needed to get closer to the best interest of patients.

La ponction biopsie hépatique écho-guidée en ambulatoire à Ouagadougou : indications, apport diagnostique et complications

Objectif : Déterminer l'apport diagnostique de la ponction biopsie hépatique par voie per cutanée sous guidage échographique.Matériel et méthodes : étude rétrospective descriptive réalisée de mars 2013 à mars 2017. Ont été inclus tous les patients ayant bénéficié d'une biopsie hépatique sous guidage échographique. Les variables recueillies ont été le sexe, l'âge, l'indication, le nombre de carottes biopsiques, les complications et le diagnostic anatomopathologique.Résultats. 53 patients ont été colligés. Il y avait 37 hommes (69,81%) et 16 femmes (30,18 %) soit un sex ratio de 2,31. L'âge moyen était de 45,79 ans avec des extrêmes de 15 et de 82 ans. Les indications étaient principalement représentées par l'exploration des nodules dans 49 cas (92,24%) et des hépatopathies chroniques dans 4 cas (7,76%). Le diagnostic anatomopathologique était essentiellement dominé par le CHC dans 33 cas (63,46%). Une douleur modérée passagère, était notée chez 37,73% des patients au passage de la capsule. Aucune complication majeure n'était retrouvée.Conclusion. La réalisation des PBH sous guidage échographique était fiable et réalisable en ambulatoire, pour peu que le bilan d'hémostase, l'utilisation d'une prémédication et d'une aiguille fine avec un système coaxial soit respecté

Rheumatoid arthritis in Burkina Faso: clinical and serological profiles.

The objective of this work was to study the clinical and serological profiles of rheumatoid arthritis in Burkina Faso (West Africa). It is a cross-sectional study conducted from March 2006 to February 2009 in the Internal Medicine Department of the University Hospital Yalgado Ouedraogo. All patients seen in the rheumatologic consultation unit during this period, with rheumatoid arthritis fulfilling the ACR criteria, were routinely selected. The determination of anticyclic citrullinated peptide antibodies (ACPA) was carried out with a computerized method (Elia CCP, Phadia AB, Uppsala, Sweden). Values higher than 10 IU/l were considered positive. Forty-eight cases of rheumatoid arthritis (RA) were recruited throughout the study period among 2,194 (2.2 %) patients. Forty-two files were subjected to the study. There were 34 women and 8 men. The average age was 41.70 ± 13 years with extremes of 22 and 71 years. The average duration of the disease was 86.17 ± 82.01 months with extremes of 8 and 360 months. Rheumatoid factors (RF) were positive in 21 out of 30 patients (70.0%). The determination of ACPA carried out in all the patients was positive in 34 (81%) patients; their average value was 217 IU/l with extremes of 38 and 1,170. RF and ACPA were associated to bones erosions (p = 0.0001). Twenty-two patients were placed on methotrexate, eight on hydroxychloroquine, and three on salazopyrine. Nine were given only NSAIDs or prednisolone. No patients had had a biotherapy agent. The frequency of RA was low in our study compared to other African studies published so far. The particularity of RA cases reported in African series, including ours, is the rarity of extra-articular manifestations of the disease. The severity of the disease at presentation in the rheumatology clinic may be due to their late consultation among other causes.

Type 1 primary hyperoxaluria in pediatric patients: renal sonographic patterns.

OBJECTIVE: Our aim was to review the sonographic features of type I primary hyperoxaluria in children and to correlate the sonographic patterns with the clinical development of end-stage renal disease (ESRD). MATERIALS AND METHODS: We performed a retrospective analysis of the clinical and imaging files of 13 patients with type I primary hyperoxaluria who were treated in one institution and of the sonographic patterns and the clinical follow-up reports. RESULTS: We encountered the following two sonographic patterns: medullary nephrocalcinosis in eight patients and cortical nephrocalcinosis in five patients. The sonographic appearance of cortical nephrocalcinosis is quite specific: a hyperechoic peripheral renal cortex with acoustic shadowing behind it. Medullary nephrocalcinosis is less specific because there are many other causes of hyperechoic pyramids. All patients with medullary nephrocalcinosis developed lithiasis during the course of the disease. All patients with cortical nephrocalcinosis but only two of eight with medullary nephrocalcinosis developed ESRD. CONCLUSION: Sonography can be used differentiate the two patterns of type 1 primary hyperoxaluria. The cortical nephrocalcinosis type carries a higher risk of developing ESRD.