Sonographic Measurement of the Optic Nerve Sheath Diameter (ONSD) and Eyeball Transversal Diameter (ETD) in Benin Healthy African Adults

Background: Measuring optic nerve sheath diameter (ONSD), a relatively re-cent technique, allows an indirect and non-invasive diagnosis of intracranial hypertension. The ONSD ratio to eyeball transverse diameter (ETD) increases this reliability of the technique. The objective of this study was to determine the normal ONSD and its ratio with ETD in black African adults in Benin. Methods: A descriptive cross-sectional study was conducted between May 2019 and August 2019. Ultrasound ONSD and ONSD/ETD ratio were meas-ured in 210 healthy adults received in the medical imaging department of the Borgou and Alibori University Hospital Center in Benin. The ONSD corre-sponded to the average of 12 measurements (03 horizontal and 03 vertical for each eye) taken 3 mm behind the papilla. The transverse ETD corresponded to the average of 03 measurements. Results: The mean ONSD was 4.20 ± 0.28 mm (95% CI = [4.17;4.24] mm and 95th percentile = 4.70 mm). The mean ETD was 24.25 ± 1.10 mm. The ONSD/ETD ratio was 0.17 ± 0.01 (95% CI = [0.17;0.17] and 95th percentile = 0.19). There was no difference between ver-tical and horizontal ONSD and between right and left ONSD. The ONSD and the ONSD/ETD ratio were not correlated with any of the socio-demographic and anthropometric characteristics studied (sex, age, ethnicity, weight, height, body mass index, head circumference and waist circumference). The ONSD was associated with ETD (p < 0.001 and r = 0.55). Conclusion: An ONSD and an ONSD/ETD ratio respectively greater than 4.70 mm and 0.19 should sus-pect intracranial hypertension. The ONSD/ETD ratio may be a better indicator of HICT because of its small variation.

Clinical and Ultrasound Concordance of Joint Damages in Rheumatoid Arthritis in a Resource-Limited Country

Introduction: Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatism. The increasing use of bone and joint ultrasound as a tool to aid in the detection of unrefined synovitis in developed countries, has led us to study the performance of ultrasound in the diagnosis of RA in subjects consulting in rheumatology at Cotonou. Study Method: Descriptive cross-sectional study of patients with RA, selected on the basis of ACR/ EULAR 2010 criteria. A complete clinical examination with imaging including X-rays and ultrasounds of the hands and feet were performed in all patients who have given their consent. The data collected was analyzed using EPI data 3.1 and SPSS 24.0 software. The significance rate was defined with a p-value < 5%. Cohen’s Kappa (k) test was used to assess agreement. Results: All 53 patients included had lesions on ultrasound. Synovitis was found in 98.1% and bone erosions in 88.7%. There was no agreement in the wrists between clinical examination and ultrasound (k = -0.116), MCP (k = -0.097) and MTP (k = -0.031). Agreement was very low at the PPI level (k = 0.03). It was low at the different sites, between ultrasound and radiographic detection of lesions (k between 0.022 - 0.22). Age, positive immunologic RA factor and biological inflammatory syndrome were associated with ultrasound erosions (p = 0.0001) and only age was associated with active synovitis (p = 0.022). Conclusion: Bone and articular ultrasound is a good complementary alternative to clinical examination and radiography diagnostic in early diagnosis of RA in our developing countries, in the absence of MRI which remains a luxury.

Ultrasound Diameter of the Portal Vein to Healthy Adult in Parakou (Benin)

Introduction: The portal vein (PVD) diameter is one of the predictive variables of portal hypertension. This diameter can differ according to the population. The objective of this study was to determine the PVD in a healthy adult population in Parakou using ultrasonography. Methods: A cross-sectional descriptive study was conducted in the medical imaging department of the Borgou and Alibori University-affiliated Hospitals in Parakou from July 1st to October 1st, 2019. The study population consisted of 201 healthy adults. The ultrasound diameter of the portal vein was measured at the level of the hepatic hilum on a cross-sectional epigastric view and on an oblique intercostal view. An association was sought between the PVD and sociodemographic and anthropometric factors. Results: The mean age was 28.97 ± 10.56 years and the sex ratio (M/F) was 0.79. The mean PVD in regular breathing (FB) was 9.83 ± 0.95 mm with a 95% confidence interval of [9.70;9.97], a 95th percentile of 11.49 mm with extremes of 7.50 mm and 12.23 mm. PVD was correlated with age, sex, weight, height and abdominal girth. After multiple linear regressions (r = 0.19), there was correlation between the PVD in normal breathing with age (p = 0.0090), weight (p = 0.0026), body mass index (p = 0.0171) and body surface (p = 0.004). Conclusion: A PVD greater in normal adults is less than 12 mm and seems to be correlated to the subject age, weight, body mass index and body surface. A more than 13 mm PVD should lead to the suspicion of portal vein hypertension in adults in our populations.

Sonographic Measurement of Optic Nerve Sheath Diameter: A Prognostic Tool for Childhood Cerebral Malaria?

Background: Childhood cerebral malaria is one of the most frequent complications of malaria, with high morbidity and mortality. Raised Intracranial Pressure (ICP) is currently recognized as a fundamental element of the severity of that disease. This study aims to look into the prognostic role of the sonographic measurement of optic nerve sheath diameter (ONSD) in the context of that disease. Methods: This study was conducted in the pediatric and imaging departments of the University Hospital Center of Parakou in Republic of Benin in West Africa. This was a descriptive cross-sectional study with a prospective data collection conducted over a period of 6 months, from March 1st to August 31st, 2014. There were two groups of children with severe malaria and conscious impairment: one with unrousable coma or Cerebral Malaria (Group 1) and the other without unrousable coma (Group 2), benefitting from ONSD sonographic measurement. ONSD was measured 3 mm behind the papilla. Correlation between depth of coma, outcome and ONSD measure on ultrasound was investigated. Results: Group 1 consisted of 37 children and Group 2 of 50 children, i.e. a sample of 87 children. The mean age was 27.21 ± 20.11 months and sex ratio (Male/Female) estimated at 0.89. The average ONSD of the sample was 4.39 ± 0.94 mm with a significant difference (p = 0.0001) between Group 1 (5.09 ± 1.09 mm) and Group 2 (3.87 ± 0.17 mm). Raised ICP prevalence was 48.28% with a significant difference between Group 1 (83.78%) and Group 2 (22%) with p Conclusion: Sonographic measurement of ONSD could be a leading prognostic tool in childhood cerebral malaria management.

Anatomic Variants of Sphenoid Sinuses and Adjacent Structures: A Study of 225 Skull CT Scans at CNHU-HKM in Benin, West Africa

Objective: This study aimed to describe anatomic variants of sphenoidal sinuses and adjacent structures. Methods: A retrospective and descriptive study was carried out at The National and University Teaching Hospital Hubert Koutoukou Maga (CNHU-HKM), of Cotonou in Benin from November 1st to December 31st. A review of CT scans skull was done for the subjects aged at least 16 years old. Anatomic variants of the sphenoid sinuses and adjacent structures have been investigated. Results: 225 CT scans of skull were analyzed. The sellar type was the most common type of pneumatization of sphenoid sinuses (74.7%). Pneumatization of anterior clinoid processes of greater and lesser wings of the sphenoid and of pterygoid processes was observed in 7.1%;4.6%;3.3% and 7.3%;respectively. Protrusion of carotid canals and optic canals, maxillary and vidian nerves were observed in 48.3%;13.1%;18% and 9.5%;respectively. Conclusion: Risky anatomic variants of the sphenoid sinuses and adjacent structures are also described by CT-scan among Beninese. Before any surgery and to avoid bad outcome, a precise approach of these risky anatomic variants must be carried out by using CT-scan.