No abstract

BackgroundLumbar spinal stenosis (LSS) refers to narrowing of the lumbar central spinal canal, lateral recess, and/or neuro-foramina. Radiographic LSS plays an important role in clinical LSS but is not solely accountable for the presence of symptoms. We sought to characterise clinical LSS and to determine factors associated with presence of symptoms of LSS in patients with radiographic LSS in a sub Saharan Africa setting.MethodsAfter prior ethical clearance, a case control study was done in a tertiary hospital in Douala-Cameroon, including 105 patients with radiographic LSS: 57 with symptoms of LSS (cases) and 58 with no symptoms (controls). Spinal stenosis was assessed using computed tomography (CT) scans. Data were analysed using SPSS version 23.ResultsThe mean age of our study participants was 53.4 ± 13.1 years. The mean age of onset of symptoms of LSS was 50.3 ± 11.6 years and the most common symptoms were Low back pain (100.0%), radicular symptoms (98.2%) and neurogenic claudication (98.2%). Obesity (p < 0.001) and a high waist circumference (p = 0.002) were significantly associated with presence of LSS symptoms in persons with radiographic LSS. After adjusting for body mass index, a positive family history of low back pain (p = 0.004), vertebra lesion at L2 (p = 0.034), L3 (p = 0.002), L4 (p = 0.025) and multiple (p = 0.008) levels, degenerative disc protrusion (p = 0.044), disc lesion at L3-L4 (p = 0.001), L4-L5 (p = 0.011) and multiple (p = 0.046) levels were significantly associated with presence of symptoms of LSS in persons with radiographic LSS.ConclusionCharacteristics of clinical LSS have been described in this sub-Saharan Africa population. Obesity, a high waist circumference and a positive family history of low back pain are significantly associated with presence of symptoms of LSS in persons with radiographic LSS.

Background: Pleuropulmonary manifestations are very common and associated with high mortality in patients with Connective Tissue Disorders (CTDs). Their frequency and patterns are variable depending on the type of CTD. Limited data is available in these patients in Sub-Saharan Africa. Aim:To study the spectrum of pleuropulmonary manifestations of CTDs in a tertiary hospital in Douala, Cameroon.Methods: This was a cross sectional hospital-based study, including CTD patients recruited in the Douala general hospital Rheumatology and Chest Medicine clinics. CTD was defined according to the American College of Rheumatology and European League against Rheumatism (ACR/EULAR) criteria. Between January and August 2016, all consenting adult patients with various CTDs were assessed for pleuropulmonary involvement using a clinical examination, Chest X-Ray (CXR), Pulmonary Function Tests (PFT) and High Resonance Computed Tomography (HRCT). Results:We included 54 CTD patients, 29 had Rheumatoid Arthritis (RA), 16 Systemic Lupus Erythematosus (SLE), 7 scleroderma (SSc) and 2 Mixed Connective Tissue Disease (MCTD). Pulmonary clinical signs and symptoms were present in 18 patients (33.3%) with dyspnea (27.8%) and cough (13.0%) being more predominant. Chest HRCT revealed mostly Interstitial Lung Disease (ILD) patterns in 16 patients (29.6%) with honeycombing lesions occurring in 9.3% of CTD patients, (10.3% of RA patients and 28.6% of SSc patients) and Ground glass lesions occurring in 5.6% of CTD patients [1/29 RA (3.4%) and 2/7 scleroderma patients (28.6%)]. PFTs abnormalities were seen in 51.9% of CTD patients (28/54) and restrictive defect was the most common abnormality as seen in 41.4% of RA patients,71.4% of scleroderma patients, 56.2% of SLE patients and 50.0% of MCTD patients. Pulmonary hypertension was a rare finding as seen only in 1 RA patient (3.4%). Seven out of 16 (43.8%) CTD patients with radiographic lesions and 15 out of 28 (53.6%) CTD patients with abnormal PFTs were asymptomatic. There was a significant association between pleuropulmonary involvement and methotrexate use, (p=0.046), and corticosteroid use (p=0.033). Conclusion:One third of CTDs patients have clinical involvement. Half of the asymptomatic patients have radiographic and/ or PFTs abnormalities. CTDs should be systematically screened for pulmonary involvement.