Clinical and Demographic Predictors of Acute Pulmonary Embolism in Central Africa Using 64-Rows Multi-Detector Computed Tomography Angiography

Background: Acute pulmonary embolism is a life-threatening entity. Its diagnosis remains a challenge for clinicians and it is important to be aware of factors that increase risks of the disease. In this study, we access the clinical and demographic predictors of pulmonary embolism using 64-rows multi-detector Computed Tomography Angiography in central Africa.Methods: From 01 January to 30 July 2016, the data record of patients who underwent chest 64-rows multi-detector Computed Tomography Angiography indicated for clinical suspicion of acute pulmonary embolism at Biamba Marie Mutombo Dikembe Hospital were retrospectively were revisited and analyzed using logistic regression models.Results: Sixty-five consecutive patients (age range, 24 to 84 years and mean age 56.8 ± 14.9 years) were included with a female predominance. Pulmonary embolism was formerly detected in 17 patients (26.2% of cases). Age ? 65 years (OR = 9.5 CI 95%:14.74, 60.79, p = 0.018) and obesity (OR = 40.8 CI 95%:2.85, 58.44, p = 0.006) were the predictors of pulmonary embolism. Heart disease and pneumonia were the main pathologies associated and the main alternative diagnoses.Conclusion: This study shows that age and obesity were independent predictors of PE. In central Africa where Computed Tomography machine is not widely available, aged and obese patients with a clinical suspicion of pulmonary embolism should be dealt with as a higher suspicion of true pulmonary embolism

Multidetector CT in Quantitative Morphometric Assessment of Post-Menopausal Vertebral Fractures in Black Women of Central Africa

Background: Osteoporosis and major Non-Communicable Diseases (NCDs) are identified by WHO as leading cause of death worldwide. Its economic burden is heavy worldwide and in particularly in low income countries. DXA availability is poorly in our country. Spine CT scanner with sagittal reformation images are known for the ease quotation of vertebral fractures by quantitative morphometric system described by Genant et al. (1996). This study aims to determine the rate and the features of vertebral fractures in postmenopausal black women living in Kinshasa/DRC using CT scanner sagittal reconstructions.Patients and methods: 430 consecutives post-menopausal women referred for Thoraco-lumbar CT scanner from June 2011 to June 2016 were enrolled in this study and theirs CT images used to quote vertebrae.Results: 12.89% of a total of 4730 vertebrae were fractured whose more than half (7.82%) of grade 1. The fracture rate is lower than in Caucasian and ASEAN and increase with ageing and duration of menopausis (24.51% in 70 years of age and over).Conclusion: Vertebral fracture global frequency was 12.89%. Vertebral fractures are present in our population and adverse consequences will arises in terms of morbidity and mortality. Lack of infrastucture, health policy and powerty will contributes to boost for a bader pronostics.The method is reproductible and can be used as routine clinical tools in conditions of poor availability of DXA

Ultrasound Assessment of Bone Mass in Central Africans Population

Background: Osteodensitometry, a procedure increasingly accepted by clinicians to access osteoporosis is not yet fully validated by WHO. It requires the establishment of normal values and references curves for each population, and in our community, this is not yet assessed.The purpose of this study was twofold: to describe the profile of the speed of sound of proximal phalangeal metaphysis and establish references curves in central Africans and to compare them with those of other populations specially Caucasians.Methods: This cross sectional study was carried out at Kinshasa, Democratic Republic of the Congo in Central Africa from January to December 2016.Four hundred twenty four subjects aged from 20 to 87 years old, were explored and the speed of sound in theirs proximal phalanges measured using ultrasound equipment. Age, gender, hormonal status and speed of sound were collected and analyzed.Results: The mean value of the Amplitude Dependent Speed of Sound (AD-SoS) showed a growth feature with age (from 2056 m/sec at second decade of life to 2145.27 m/sec at fourth decade followed by a progressive decrease which was present in both sexes but more marked in postmenopausal women (1927.06 m/sec). This mean value was higher than in Caucasian studies. In this study, age and hormonal status seems to be the bone quality most influencing anthropometric factors as seen in many series.The curve profile with age was also a polynomial curve as seen in others populations of the world.Conclusion: This study provides normal data for phalangeal ultrasound measurements and reference curve of central Africans which were compared to those of Western studies

Osteopenia and Osteoporosis Assessed by Dual X Absorptiometry in Sickle Cell Anemia Adults Subjects

Background: Sickle cell anemia is the most common genetic disease in sub-Saharan Africa. It is an inherited autosomal recessive disorder characterized by chronic hemolysis secondary to falciformation of red blood cells, also responsible of ischemia, bone infarction and accompanied by serious infections and organic lesions.Normal for weight at birth, Sickle cell anemia subjects have low pre puberty growth compared to normal children and also have compromised bone remodeling balance which results in decrease of bone mass and increase of bone fragility. Several studies have established that 37% to 50% of SCA patients were osteopenic or osteoporotic. This study aims to confirm the existence of bone remodeling disorders with osteoporotic translation and to compare the values found in Congolese sickle cell adults subjects to the general population.Methods: Spine and hip DXA were conducted on 270 SS homozygotes aged 18 to 50 years (121 men and 149 women) and 359 AA homozygotes as controls (138 men and 221 women), aged from 18 to 50 years old, who agreed to participate in the study, considered as a control group. AS heterozygotes were not included in the study.Results: AA subjects shows higher density (BMD) and Bone mineral content (BMC) values. Both SCA and AA controls showed the characteristic curve with peak bone mass at the fourth decade of life, followed by a decay with age. The difference in BMD and BMC with the control population ranged from 7.94% to 26.34% (average of 16.02%) which means -0.8 to -2.7 standard deviations, whereas, compared to the T -score in the Congolese population, was 11.6% to 22.15% less (average of -17.5%) equivalent of -0.9 to -2 standard deviations.The overall decrease in bone mass rate for -2.5 DS of the T-score was: -28.4% and 33.2% for -2 DS of T-score.Conclusion: SCA subjects shows high rate of osteopenia and osteoporosis and are more likely at risk for fractures

Human Immunodeficiency Virus Nephropathy in Central Africa: The Value of Renal Ultrasound

Introduction: HIV-Associated Nephropathy may shorten the life expectancy of affected patients. Its early detection is beneficial for the indication of treatment and hence prevention of progression to the end-stage of renal failure. The final diagnosis requires renal biopsy which may be difficult in some African area; clinical and ultrasound criteria may be helpful. The aim of this study was twofold: to characterize renal sonographic changes in HIV-positive patients with HIV associated Nephropathy and to investigate the correlation between renal sonographic changes and histological lesions in central Africa.Methods: A prospective and multi-center study conducted from January 2013 to July 2015 included, for renal ultrasound evaluation of the length, thickness and echogenicity, forty two of the 334 biologically confirmed HIV-positive patients who presented with significant proteinuria suggestive of HIV associated Nephropathy. And transcutaneous renal biopsy with histopathology has been performed in 16 patients of them. Statistical analyzes were used.Results: There were 100 men and 234 women; proteinuria was positive in 42 patients, (12.6%). The average length of the kidneys was 111 ± 8 mm (normal), with 10% of patients with pathological values (5% with kidneys of reduced size and 5%, increased size). The kidneys had an average thickness of 44 ± 5 mm (normal), with 21% of patients presenting an increase in renal thickness. Quantitative echogenicity was calculated at 1.492 ± 0.793 (normal), with 79% of patients with increased quantitative echogenicity. Of the 16 patients biopsied, all had tubulo-interstitial lesions, and 75% of them associated with glomerular lesions. In simple correlation analysis, tubular dilatation was positively and significantly related to quantitative echogenicity (r = 0.67, p < 0.01) and to renal parenchyma thickness (r = 0.67; 0.85, p ? 0.05). The relationship between the other parameters studied did not reach statistical significance. In multiple linear regression, glomerular hyalinosis, glomerular proliferation, tubular dilatation, tubular atrophy, interstitial fibrosis, and interstitial inflammation emerged as the main determinants of quantitative echogenicity; however, the relationship was statistically significant only for tubular dilatation (? = 0.305, p = 0.034).Conclusion: The present study showed the characteristic of renal change and the relation with histology found in central Africans patients