Ultrasound Study of First Trimester Bleeding

Objective: Bleeding during the first trimester of pregnancy is common and can be a sign of complication that often necessitates obstetric ultrasound for the assessment of the haemorrhage, and of fetal well being. The aim of this study was to determine the causes of first trimester bleeding on obstetrical ultrasound in our area. Method: It was a cross-sectional descriptive study during a six-month period from May to October 2017. All women who referred to the Regional center of medical imaging of Ngaoundere who agreed to participate in the study with first trimester bleeding were evaluated with clinical history and ultrasonography (US). Ultrasonographic exam was done via transabdominal or endovaginal approaches using GE LOGIQ 7 scanner brand. Microsoft Office Excel 2010 and SPHINX V 4.0 were used for data analysis. Results: A total of 121 of pregnant women who presented vaginal bleeding during the first trimester were enrolled into the study. These Ultrasound examinations represented 37.93% of all obstetric ultrasounds in the first trimester. The patients in this study ranged in age from 16 to 47 years with an average of 30 years. 50 (41.32%) were pregnant for the first time and 24 (19.83%) were primiparous. Mean gestational age was 9 weeks with the extremes of 5 and 12 weeks. 97 (80.2%) reported spontaneous bleeding while in 24 (18.8%) bleeding was mostly caused by sexual intercourse 11 (45.8%). Pelvic pain 91 (75.2%) was the most associated sign. 36 (29.8%) patients were diagnosed as threatened abortions. 27 (22.3%) were diagnosed with incomplete abortions. 4 (3.3%) cases showed an ectopic gestation. 9 (7.4%) cases showed complete abortions. Concordance between clinical diagnosis and ultrasound results was 84%. Conclusions: Bleeding in the first trimester of pregnancy is common in our area. Ultrasonography occupies a prominent place in the etiological diagnosis of bleeding in the first trimester of pregnancy;it is easy to find in most cases a responsible abnormality of bleeding.

Interest of Systematic Chest Radiography during Periodic Medical Visits in Workers

Background: Systematic chest X-ray is the most prescribed examination by occupational physicians during periodic medical check-ups in our context, unlike in most countries where this practice has been discontinued. Objective: The objective was to determine the diagnostic yield and cost-effectiveness of chest radiography during periodic medical check-ups of workers in Ngaoundere. Materials and Methods: A cross-sectional and descriptive study was carried out in Ngaoundere Regional Hospital from January to December 2018, concerning all persons coming to perform a systematic chest X-ray in the context of the periodic medical check-up having been consented to participate in the study. Posteroanterior (PA) chest radiographs were obtained from all workers during this periodic medical check-up. The variables studied were: age, sex, clinical manifestations, antecedents, job type, cost, and chest X-ray results. Statistical analysis was performed using the Sphinx Plus2-Lexica-V5 Edition software. Results: 753 workers were selected for this study, of whom 88.04% were men and 11.96% were women, a sex ratio H/F is of 7.4, the average age was 39 ± 7.89 years with extremes of 24 and 56 years, the most frequent job type was the administration (38.37%), the storekeepers (17.92) and the drivers (15.27%), most of them were asymptomatic (97.47%), some had cough (2.52%), chest pain (2.12%), dyspnea (0.26%) and fever (0.13%). History was dominated by lung infection (2.39%), pleurisy (1.06%) and tuberculosis (0.79%). 7.43% of workers occasionally smoked tobacco and consumed alcohol. 41 cases of pathologies (5.44%) were found on the chest X-ray, including 1 case (0.13%) of evolutionary pathology, 40 cases (5.31%) of sequelae pathologies. When the results of the chest X-ray are compared with the clinical signs and the pathological history of the workers, it is found that the only case with evolutionary abnormalities on the chest X-ray showed clinical signs and that the other cases with sequelae abnormalities had either clinical signs or antecedents related to these abnormalities. The cost of a chest X-ray at the time of our study was 5,000 FCFA ($8.59), for a total of 3,765,000 FCFA ($6473.74) for all the X-rays performed. Conclusion: In view of the low rate of abnormalities on the chest X-ray and the sequelae nature of the pathologies, it can be said that the routine X-ray of the chest during the periodic medical check-ups has a low diagnostic yield and a low cost-effectiveness ratio and is not profitable. It should be non-systematic and case-by-case based on the clinical context and background of workers.

Exposure of the Population of Ngaoundere-Cameroon to Ionizing Radiation Related to Medical Diagnosis in 2018

Background: Medical applications are the main source of exposure to ionizing radiation of human origin. Our objective was to determine the data on exposure to ionizing radiation of medical origin of the population of Ngaoundéré in 2018. Methodology: It was a cross-sectional descriptive study conducted within a period of one year, in the different hospitals of Ngaoundéré, with a functional medical imaging service. The variables studied were age, sex, type of examination, anatomical region and effective dose. The statistical analysis was performed using the Microsoft Office 2016 software, Sphinx V5;the effective dosage was calculated using the Internet Dose calculation Module. Results: In 2018, 4136 diagnostic acts using ionizing radiation were carried out;it concerned only conventional radiology with an average of 0.02 per capita. The total collective dose received by the population was 8300 mSv, and an average dose of 0.040 mSv per inhabitant. The proportion of the population that has actually benefited from a conventional radiology examination is 2.07%, an individual effective average dose of 2 mSv. The most frequent acts involved the thorax, limbs, spine and pelvis with respectively 53.9%;19.6%;14.3% and 6.7%. Acts involving the spine, pelvis and hip, skull and abdomen contributed to the majority of the collective effective dose respectively with 45.75%, 25.96%, 10.53% and 8.84%. The age group performing most exams in men is 25 to 49 and 25 to 54 in women;the number of acts is higher among men 2457 (59.4%) acts compared to women 1679 (40.6%) acts. The collective dose per sex is higher among women with 4487.22 mSv (54.06%) compared to men with 3812.98 mSv (45.94%). Conclusion: Only 2.07% of population of Ngaoundere benefited from a conventional radiology examination in 2018 with an individual effective average dose of 2 mSv. The annual per capita number of acts is 0.02 and annual per capita effective dose is 0.040 mSv in Ngaoundéré in 2018.

Epidemiologic, Clinical and Radiological Aspects of Male Urethral Strictures at the NgaoundéréRegional Hospital

Background: Urethral stricture is a disabling condition that remains prevalent due to the upsurge of sexually transmitted infections and traumatic lesions of the urethra during trauma of the pelvis in humans. Objective: Describe the epidemiological, clinical and radiological presentations of male urethral strictures. Method: It was a cross-sectional and descriptive study during a one-year period from January to December 2017 including all male patients presenting for a urethrocystography examination, at the Ngaoundere Radiology and Medical Imaging Center who agreed to participate. The urethrocystography technique depended on patient’s condition and was either retrograde, anterograde, or following intravenous urography. The examinations were performed with GE X-ray equipment using Kodak Dry View CRs. The interpretation was performed by a radiologist with at least five years of experience. The variables studied were age, clinic, history, uretrocystography technique and results. The data were collected using a previously established data sheet and processed with Sphinx Plus2 V5 and Microsoft Excel 2010 software. Results: 39 patients were enrolled in this study;the average age of our patients was 43.8 years with extremes of 4 and 76 years. The 50 - 60 age group (30.7%) was the most affected. Infection (53.9%) and trauma (23.1%) were the most common etiologies;dysuria (38.5%) and diminution of urinary flow (30.8%) were the most patient’s complaint. Retrograde urethrocystography (66.7%) was the most performed technic. Minimal bleeding in 46.2% of patients was the most common incident during urethrocystography;76.9% of patients had a difficult urination and 7.7% an impassable urethral meatus. After interpretation, 84.6% of patients had urethral stenosis, which was associated with bladder diverticula (23%) and fistulas (15.3%). The stenosis was seated on membranous urethra (81.8%), tight type (45.4%), short (66.7%) and single (81.8%). The post-void residue was significant in 84.6% of cases and not significant in 15.4% of cases. 15.3% of the urethrocystographies were normal. Conclusion: Urethral stenosis in Ngaoundere mainly affects young adult;the main etiology is infectious, very often unique, short, and tight and the membranous urethra is the seat of predilection. Hence, to reduce the extent of pathology with its functional consequences and its impact on the socio-professional life in our context, the focus should be on sexually transmitted infectious.