Evaluation de la pertinence des demandes d’angioscanner thoracique pour suspicion d’embolie pulmonaire à Yaoundé

Introduction : L’objectif de la présente étude était d’évaluer la pertinence des demandes d’angioscanner pour suspicion d’embolie pulmonaire (EP) à Yaoundé. Matériel et méthodes : Il s’agissait d’une étude transversale descriptive avec collecte rétrospective et prospective des données. Elle s’est déroulée sur une durée de 7 mois, dans les services de Cardiologie et d’Imagerie médicale de 4 hôpitaux de la ville de Yaoundé. Étaient inclus tous les patients ayant réalisés ou réalisant un angioscanner thoracique pour suspicion d’embolie pulmonaire (EP) durant la période de novembre 2018 à mai 2019. Les variables étudiées étaient les données sociodémographiques, la probabilité clinique de l’EP par le score de Wells, les facteurs prédisposants, ainsi que le recours aux examens paracliniques (D-dimères, échocardiographie, échodoppler des membres). La pertinence de la demande d’angioscanner thoracique a été évaluée selon les recommandations de la Société Européenne de Cardiologie. Le test de Khi carré et le test exact de Fisher ont été utilisés pour rechercher les facteurs associés au diagnostic d’embolie pulmonaire. Une valeur p<0,05 a été considéré comme statistiquement significative. Résultats : Nous avons retenu au total 71 patients dont la moyenne d’âge était de 54 ±15 ans avec des extrêmes de 18 et 89 ans. A l’évaluation du score de Wells, 25 patients (35,2%) avaient une probabilité clinique faible, 40 (56,3%) avaient une probabilité clinique intermédiaire et 6 (8,5%) avaient une probabilité clinique forte. La demande d’angioscanner thoracique était pertinente dans 76% des cas. La proportion d’embolie pulmonaire au scanner était de 39,4% (N=28). Cette fréquence était proportionnelle au degré de suspicion clinique soit 12% en cas de probabilité faible, 47,5% en cas de probabilité intermédiaire, et 100% en cas de probabilité forte. Le facteur le plus associé au diagnostic d’EP était la présence de signes de thrombose veineuse profonde (p=0,012). Conclusion: Les demandes d’angioscanner sont pertinentes dans trois quarts des cas dans notre série. L’utilisation du score de probabilité de Wells est fortement corrélée au diagnostic d’embolie pulmonaire en particulier en présence de signes cliniques de thrombose veineuse profonde. Ces résultats suggèrent de renforcer la sensibilisation des prescripteurs sur l’utilisation courante de ce score afin de limiter le risque d’irradiation et les dépenses financières des patients. English title: Relevance in the request of computed tomography pulmonary angiography for suspected pulmonary embolism in Yaoundé  Introduction: The present study aimed to evaluate the relevance in the prescription of computed tomography pulmonary angiography for pulmonary embolism suspicion in Yaoundé. Materials and methods. We conducted a cross sectional study during a period of 7 months (November 2018 to May 2019) at the cardiology and imaging units of 4 hospitals in Yaoundé. All consenting patients who underwent CTPA were included in the study. The variables studied were socio-demographic data, clinical probability (using Wells score) and paraclinical workups (D-dimers testing, echocardiography, venous ultrasonography). The relevance of prescription was evaluate using the European Society of Cardiology‘s guidelines. Chi square and Fisher tests were used to find association between clinical parameters and diagnostic of pulmonary embolism. A p value<0.05 was considered statistically significant. Results. A total number of 71 patients were recruited; the mean age was 54 ±15.4 years ranging between 18 to 89 years. In assessment of the Wells score, 25 patients (35.2%) had low clinical probability, 40 (56.3%) had intermediate clinical probability and 6 (8.5%) had high clinical probability. We have found that 76% of the request were appropriated according to the current guidelines of the European Society of Cardiology (ESC). The proportion of the pulmonary embolism in our population study was 39.4%. There was a linear relationship between level of clinical suspicion and proportion of pulmonary embolism with 12% in low probability, 47.5% in intermediate probability, and 100% in high Probability. The most associated factor of pulmonary embolism in CTPA was the presence of sign of deep venous thrombosis (p=0,012). Conclusion. The clinical request of computed tomography pulmonary angiography was relevant in three quarter of cases in our population. In case of high clinical suspicion, the diagnostic of pulmonary embolism was always positive. There is an urgent need to reinforce sensibilization of physician about adequate clinical request to reduce the risk of irradiation and high expenditure of the patients

Factors predicting in-hospital all-cause mortality in COVID 19 patients at the Laquintinie Hospital Douala, Cameroon.

Despite being a global pandemic, little is known about the factors influencing in-hospital mortality of COVID-19 patients in sub-Saharan Africa. This study aimed to provide data on in-hospital mortality among COVID-19 patients hospitalized in a single large center in Cameroon. A hospital-based prospective follow-up was conducted from March 18 to June 30, 2020, including patients >18 years with positive PCR for SARS-COV-2 on nasopharyngeal swab admitted to the Laquintinie Douala hospital COVID unit. Predictors of in-hospital mortality were assessed using Kaplan Meir survival curves and Weibull regression for the accelerated time failure model. Statistical significance was considered as p < 0.05. Overall 712 patients (65,7% men) were included, mean age 52,80 ± 14,09 years. There were 580 (67,8% men) in-hospital patients. The median duration of hospital stay was eight days. The in-hospital mortality was 22.2%. Deceased patients compared to survivors were significantly older, had a higher temperature, respiratory rate, and heart rate, and lowest peripheral oxygen saturation at admission. After adjusting for age, sex, and other clinical patient characteristics, increased heart rate, increased temperature, decreased peripheral oxygen saturation. The critical clinical status was significantly associated with increased in-hospital mortality. In contrast, hospitalization duration greater than eight days and the use of hydroxychloroquine (HCQ) + azithromycin (AZM) therapy was associated with decreased risk of in-hospital mortality. One in five hospitalized COVID-19 patients die in a low-middle income setting. Critical clinical status, dyspnea, and increased heart rate were predictors of in-hospital mortality. This study will serve as a prerequisite for more robust subsequent follow-up studies. Also, these results will aid in revising national guidelines for the management of COVID-19 in Cameroon

Late mortality after cardiac interventions over 10-year period in two Cameroonian government-owned hospitals

Background: Cardiac surgery is a growing activity in Sub-Saharan Africa, however, data related to long-term mortality are scarce. We aimed to analyze outcome data of cardiac interventions in two hospitals in Cameroon over 10 years' period. Methods: we conducted a retrospective analytical and descriptive study at the Douala General Hospital and Yaoundé General Hospital. All patients operated between January 2007 and December 2017, or their families were contacted by phone between January and April 2018 for a free of charges medical examination. Results: Of a total of 98 patients operated during the study period, 8 (8.2%) were lost to follow-up. Finally, 90 patients [49 (54.4%) women and 41 (45.6%)] men were included. The mean age was 49±22 years (range, 13-89 years). The surgical indications were valvular heart diseases in 37 (41.1%) cases, congenital heart diseases in 11 (12.2%) cases, chronic constrictive pericarditis in 4 (4.4%) cases, and intra cardiac tumor in 1 (1.1%) case. Valve replacement was the most common type of surgery carried out in 37 (41.1%) cases-mostly with mechanical prosthesis. Pacemaker-mostly dual-chambers were implanted in 36 (40.0%) patients. The median follow-up was 26 months. The overall late mortality was 5.7%, and the overall survival rates at 5 and 10 years were 95.5% and 94.4% respectively. The overall survival rates at 5 and 10 years for mechanical valve prosthesis were 93.3% and 90% respectively. The survival at 10 years was 100% for patients with bioprosthesis. The survival rates at 10 years were 94.1% and 100% respectively for dual and single chamber pacemaker. Conclusions: Long-term outcome of cardiac surgery in hospitals in Cameroon are acceptable with low mortality rate. However, outcome metrics beyond mortality should be implemented for a prospective data collection.SCOPUS: ar.jinfo:eu-repo/semantics/publishe