Boniface Moifo

Acute pulmonary embolism in the era of multi-detector CT: a reality in sub-Saharan Africa

BackgroundThe advantages of multi-detector computed tomography (MDCT) have made it the imaging modality of choice for some patients with suspected cardiothoracic disease, of which pulmonary embolism (PE) is an exponent. The aim of this study was to assess the incidence of PE in patients with clinical suspicion of acute PE using MDCT in a sub-Saharan setting, and to describe the demographic characteristics of these patients.MethodsConsecutive records of patients who underwent MDCT pulmonary angiography for suspected acute PE over a two-year period at the Radiology Department of a university-affiliated hospital were systematically reviewed. All MDCT pulmonary angiograms were performed with a 16-detector computed tomography (CT) scanner using real-time bolus tracking technique. Authorization for the study was obtained from the institutional authorities.ResultsForty-one MDCT pulmonary angiograms were reviewed of which 37 were retained. Of the 4 excluded studies, 3 were repeat angiograms and 1 study was not technically adequate. Twelve of 37 patients (32.4%) had CT angiograms that were positive for PE, of which 7 were males. The mean age of these patients was 47.6±10.5 years (age range from 33 to 65 years). Twenty five patients out of 37 (67.6%) had CT angiograms that were negative for PE. Eleven PE-positive patients (91.7%) had at least 1 identifiable thromboembolic risk factor whilst 5 PE-negative patients (20%) also had at least a thromboembolic risk factor. The relative risk of the occurrence of PE in patients with at least a thromboembolic risk factor was estimated at 14.4.ConclusionAcute PE is a reality in sub-Saharan Africa, with an increased likelihood of MDCT evidence in patients with clinical suspicion of PE who have at least a thromboembolic risk factor. The increasing availability of MDCT will help provide more information on the occurrence of PE in these settings.

Students’ perspectives on research and assessment of a model template designed to guide beginners in research in a medical school in Cameroon

BackgroundResearch 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.MethodsThis study was a cross-sectional survey of volunteering final-year medical students and residents of a medical school in Cameroon.ResultsThis 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.ConclusionMedical 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.

RP20 Echographie des urgences digestives non traumatiques de l’enfant (CD-ROM d’auto enseignement)

Objectifs Realiser un CD-Rom interactif d’auto enseignement sur l’echographie des urgences digestives non traumatiques de l’enfant. Materiels et methodes Revue de la litterature et experience propre des Services d’Imagerie Pediatrique de l’Hopital Robert Debre et de l’Hopital Gyneco Obstetrique et Pediatrique de Yaounde. Resultats Les urgences digestives occupent le 3 e rang des urgences pediatriques. Les signes cliniques d’appel sont domines par les douleurs abdominales et les vomissements. L’echographie est l’examen de premiere intention dans l’exploration des urgences abdominales et digestives de l’enfant. Ce CD-Rom interactif d’auto enseignement passe en revue les principales urgences digestives de l’enfant, rappelle les tableaux cliniques et les indications de l’echographie, precise la place de l’echographie en terme de sensibilite, de specificite, d’efficacite diagnostique et ses limites, presente une iconographie de chaque affection, des images pieges ainsi que des diagnostics differentiels, montre quelques particularites chez l’enfant en milieu tropical. Un algorithme diagnostique est propose pour chacune des principales pathologies, de meme que des astuces techniques permettant d’accroitre l’efficacite de l’examen echographique. 15 cas cliniques et 100 QCM permettent une autoevaluation. Conclusion Ce CD-Rom d’auto enseignement s’adresse principalement aux internes de radiologie et de pediatrie, aux urgentistes et aux praticiens de radiologie generale.

Aspects cliniques et scanographiques des lesions sellaires et suprasellaires a yaounde

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.