Rhumatologie en Afrique noire francophone et à Madagascar : état des lieux sur les rhumatologues, les pathologies rhumatologiques, les moyens diagnostiques et thérapeutiques en 2015

Objectif : Dresser l'état des lieux de la rhumatologie en Afrique Noire Francophone (ANF) sur le nombre de rhumatologues, les pathologies rhumatologiques, les moyens diagnostiques et thérapeutiques.Patients et méthodes : Etude transversale par interview auprès de rhumatologues africains pour connaître le nombre de rhumatologues, les moyens diagnostiques et thérapeutiques dans chaque pays entre juin 2014 et juin 2015. Revue de la littérature par recherche avec les mots "rheumatic diseases ; africa" sur Medline, "Médecine d'Afrique noire" électronique, "Médecine et santé tropicale" et "Société des pathologies exotiques". Les données concernaient les pays d'ANF jusqu'en juin 2015 hormis le Burundi, la République Démocratique du Congo et le Rwanda. Celles du Gabon concernaient 6050 rhumatisants vus entre janvier 2009 et décembre 2014 dans le service de médecine interne du centre hospitalier et universitaire de Libreville.Résultats : Pour une population totale de 182,14 millions d'habitants, il y avait 50 rhumatologues soit une densité de 0,03 rhumatologue pour 100.000 habitants. La pathologie la plus fréquente était l'arthrose. La goutte et les infections étaient les premières causes d'arthrites respectivement au Burkina Faso, au Congo Brazzaville, au Gabon et au Bénin, au Cameroun, en Côte d'Ivoire, au Togo. Les rhumatismes inflammatoires chroniques les plus fréquents étaient la polyarthrite rhumatoïde au Burkina Faso, au Cameroun, au Congo Brazzaville et les spondylarthrites par arthrites réactionnelles en Côte d'Ivoire, au Gabon, au Togo. La radiographie et le MTX étaient disponibles dans chaque pays. Il y avait 21 IRM, soit un appareil pour 8,673 millions d'habitants. Les biothérapies type Adalimumab et Etanercept respectivement à 1.710,36 et 1.733,23 € par mois au Gabon, restaient exceptionnellement utilisées.Conclusion : L'état des lieux de la rhumatologie en ANF en 2015 révèle surtout l'extrême carence en rhumatologues dans ces pays, principalement du fait de l'absence de formations locales dans cette spécialité

[Pathology of the processus vaginalis in urological practice]. / La pathologie du canal péritonéo-vaginal en pratique urologique.

PURPOSE: To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams. PATIENTS AND METHODS: We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment. RESULTS: A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences. CONCLUSION: Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams. LEVEL OF EVIDENCE: 5.

[Bone mineral density in Cameroon women in Yaounde: an echographic study]. / Densité minérale osseuse de la femme camerounaise à Yaoundé: une étude échographique.

AIM: To determine the bone mineral density (BMD) of Cameroonian woman and the importance of primary osteoporosis of the menopausal women. METHOD: It was a 10 months cross sectional and observational study carried out on voluntary clinically healthy women aged at least 20 years. A complete clinical examination and measurement of the BMD by quantitative ultrasound measurement of the calcaneus was carried out. The BMD was calculated automatically by the apparatus with values in g/cm2 and in T-score. RESULTS: 367 women, mean age 52 year (range 20 and 89) were included in the study. 218 (59.4%) were menopausal. The average bone mineral density was 0.513 g/cm2 (+/- 0.141). The bone minera density reduction was progressive with age with a sharp slope after 70 years. The statistically significant reduction of BMD was associated with: menopause, lower or moderate physical activity, weekly consumption of milk product evaluated at less than the equivalent of a cup of yoghurt, cigarette smoking. Alcohol consumption and obesity had no significant influence on the distribution of BMD. Considering the T-score, 13.6% had osteoporosis, 46.6% osteopenia and 53.4% were normal. In the women of 50 years and above, 17.9% had osteoporosis against 0.6% in women below 50 years while above 70 years, 55.8% had osteoporosis. CONCLUSION: The BMD of urban Cameroonian women is comparable with that of other women in the world. Osteoporosis is seemingly also present as in the western world, but with relatively less fractures. These results need to be confirmed by studies with larger population size.

Rheumatic diseases in patients attending a clinic at a referral hospital in Yaounde, Cameroon.

BACKGROUND: The spectrum of rheumatic diseases in sub-Saharan Africa remains poorly defined. OBJECTIVES: To determine the spectrum of rheumatic diseases in Yaounde. DESIGN: Descriptive cross-sectional study. SETTING: Rheumatology clinic at the Yaounde General Hospital, Cameroon. SUBJECTS: Twelve thousand four hundred and ninety four patients were referred to the outpatient department of the Internal Medicine service of the General Hospital of Yaounde over a 12-month period. Of these cases, 536 (9.4%) were diagnosed as belonging to the general class of rheumatic conditions. There were 334 (62.31%) females and 202 (37.69%) males. The mean age was 52.72 +/- 5.3 years. RESULTS: The 536 cases were further classified as follows: degenerative disease of the spine 196 (36.5%), osteoarthritis of the limbs 110 (20.5%), regional musculo-skeletal disorders 83 (15.5%), arthritis associated with infections 50 (9.3%), chronic inflammatory and connective tissue diseases 44 (8.2%), crystalline arthropathies 32 (5.9%) and miscellaneous (unclassified) rheumatic conditions 21 (4.1%). CONCLUSION: From these results, we concluded that degenerative disease of the spine and limbs are the most common forms of rheumatic disease in this region. Gout is the most commnon acute inflammatory arthropathy and rheumatoid arthritis the most prevalent arthropathy due to chronic inflammation.

Waldenström's disease complicated by recurrent meningococcal arthritis.

Meningococcal arthritis is rare. We report a patient in whom a first episode of meningococcal arthritis revealed Waldenström's disease and who experienced a second episode of meningococcal arthritis 8 years later. We suggest that an impaired immune response secondary to Waldenström's disease favored the recurrence of meningococcal arthritis.