Pan african Medical Journal - Volume 28 Pan african Medical Journal. Volume 28 2017-11-25T01:37:31+01:00 pamj logo text/html 2017-11-25T09:37:31+01:00 Halima Hadri, Salma Fares, Tarek Moutiqui, Ghizlane Lembarki, Nadia Moussali, Naima El Benna, Meriem Regragui, Nisrine Bennani, Sanaa Naoumi, Mehdi Karkouri, Asmaa Quessar [Case report] - Lymphome de hodgkin primitif de la thyro&iuml;de: &agrave; propos d’un cas - 24 November 2017. <b>Les lymphomes thyro&iuml;diens primitifs sont une entit&eacute; clinique rare, qui ne d&eacute;passent pas 5% des lymphomes diagnostiqu&eacute;s, se produisent plus fr&eacute;quemment chez les femmes que chez les hommes, avec un pic d'incidence &agrave; la sixi&egrave;me d&eacute;cennie de la vie. La relation avec une thyro&iuml;dite chronique est bien connue. Le sous type hodgkinien, encore plus rare, peu d&eacute;crit dans la litt&eacute;rature; posant un probl&egrave;me diagnostique. La confirmation diagnostique est port&eacute;e le plus souvent sur la pi&egrave;ce op&eacute;ratoire. Pour mieux comprendre cette entit&eacute;, nous rapportons le cas d'un patient de 64 ans, sans notion de thyro&iuml;dite chronique, admis pour un lymphome de Hodgkin de la thyro&iuml;de, diagnostiqu&eacute; sur une masse cervicale ant&eacute;rieure. La thyro&iuml;dectomie avec &eacute;tudes histopathologique et d'immunohistochimique avaient confirm&eacute; le diagnostic. Le patient avait re&ccedil;u une chimioth&eacute;rapie de type ABVD (Adriblastine-Bl&eacute;omycine-Vinblastine-Dacarbazine) et programm&eacute; pour une radioth&eacute;rapie.</b><br/> text/html 2017-11-25T09:37:31+01:00 Morris Ndemwa, Sheru Wanyua, Satoshi Kaneko, Mohammed Karama, Makokha Anselimo [Research] - Nutritional status and association of demographic characteristics with malnutrition among children less than 24 months in Kwale County, Kenya - 24 November 2017. <b>INTRODUCTION: Malnutrition is an underlying cause of mortality in about half of the cases that occur among children less than five years in developing countries. In Africa including Kenya, this problem may be exacerbated by socio-demographic and socio-economic factors. This study aimed at determining nutritional status and association of demographic characteristics with malnutrition among children aged 1 day to 24 months in Kwale County, Kenya. METHODS: A cross-sectional study was done in Mwaluphamba Location, Kwale County, Kenya. Data was collected using a semi-structured questionnaire and administered to 380 randomly selected mothers who had children under the age of two years. Nutrition status was determined using anthropometric measurements. Data was analyzed using descriptive statistics and associations were determined by univariate logistic regression. RESULTS: Malnutrition prevalence for children in Kwale was high with 29.2% of the children being stunted and 13.4% being severely stunted. Underweight prevalence was at 20.8% of whom 9.5% were severely underweight. The global acute malnutrition rate was 18.9%. Stunting differed significantly between sex (males 35.1% compared to females 21.7%; p = 0.005). Significant differences were also observed in stunting and underweight due to age (p < 0.005). CONCLUSION: The prevalence of stunting, underweight and global acute malnutrition rates was high among the children. Male children were associated with a significantly higher prevalence of stunting than the females. The prevalence of underweight and stunting significantly increased with increasing age.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mauricio Fernando Villamar [Images in medicine] - Extensive cerebral and extracerebral metastases from a large-cell neuroendocrine cervical carcinoma - 24 November 2017. <b>A 43 year-old woman, gravida 2 para 2 with no regular medical care, presented for 3 months of pelvic pain and vaginal bleeding. Pelvic examination revealed an 8-cm necrotic cervical mass. Biopsy of the lesion demonstrated high-grade large-cell neuroendocrine carcinoma (LCNEC) of the cervix. CT with contrast of chest, abdomen and pelvis showed extensive pulmonary (A), hepatic and renal metastases (Stage IVB). She received palliative radiation, 6 cycles of etoposide and cisplatin and 1 cycle of bevacizumab. Seven months after diagnosis she developed intermittent headaches and expressive aphasia. MRI, pre-gadolinium and post-gadolinium, revealed numerous parenchymal and leptomeningeal contrast-enhancing lesions affecting brain and spinal cord (B). Chest X-ray re-demonstrated innumerable lung metastases (C). The patient decided to pursue hospice care and died 1 month later. Brain metastases from cervical cancer are exceedingly rare. However, brain metastases can occasionally occur from neuroendocrine cervical carcinomas, which account for up to 2% of all cervical cancers. LCNEC is an aggressive, poorly differentiated neoplasm with high mitotic rate, lymphovascular space involvement, and extensive necrosis. It metastasizes early. Due to the rarity of LCNEC, there are no randomized controlled trials evaluating therapies. Clinical guidelines suggest that treatment with surgical resection followed by platinum-and etoposide-based combination chemotherapy can improve survival in early stages. Still, LCNEC has poor prognosis. In a series of 62 patients, median overall survival for stage I, II, III, and IV LCNEC was 19, 17, 3 and 1.5 months, respectively.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohammed Boukhechba, Najat Lamalmi, Abderrahmane Malihy, Lamia Rouas, Zaitouna Al Hamany [Case report] - Fibroblastome &agrave; cellules g&eacute;antes inhabituel: &agrave; propos d’un cas unusuel - 24 November 2017. <b>Le fibroblastome &agrave; cellules g&eacute;antes (FCG) est une tumeur rare de l'enfant de sexe masculin et de localisation superficielle. Nous rapportons un nouveau cas observ&eacute; chez un enfant de 3 mois qui avait consult&eacute; pour une masse du bras droit, une IRM du bras avait montr&eacute; une masse de si&egrave;ge sous cutan&eacute;, cette masse a &eacute;t&eacute; r&eacute;s&eacute;qu&eacute;e de fa&ccedil;on compl&egrave;te. Les &eacute;tudes histologique, immuno-histochimique et g&eacute;n&eacute;tique avaient conclu au diagnostic d'un FCG. Cette tumeur pose des difficult&eacute;s diagnostiques pour le pathologiste avec les tumeurs m&eacute;senchymateuses malignes de pronostic diff&eacute;rent.</b><br/> text/html 2017-11-25T09:37:31+01:00 Gari Hunduma, Mulugeta Girma, Tesfaye Digaffe, Fitsum Weldegebreal, Assefa Tola [Research] - Prevalence and determinants of common mental illness among adult residents of Harari Regional State, Eastern Ethiopia - 24 November 2017. <b>INTRODUCTION: Common mental disorders include depression, anxiety and somatoform disorders are a public health problem in developed as well as developing countries. It represents a psychiatric morbidity with significant prevalence, affecting all stages of life and cause suffering to the individuals, their family and communities. Despite this fact, little information about the prevalence of common mental illness is available from low and middle-income countries including Ethiopia. The aim of this study was to determine the magnitude of common mental disorders and its associated factors among adult residents of Harari Region. METHODS: comparative cross-sectional, quantitative community-based survey was conducted From February 1, 2016 to March 30, 2016 in Harari Regional State using multi-stage sampling technique. A total of 968 residents was selected using two stage sampling technique. Of this 901 were participated in the study. Validated and Pretested Self reported questionnaire (SQR_20) was used to determine the maginitude of common mental disorders. Data was entered and analyzed using Epi-info version 3.5.1 and SPSS-17 for windows statistical packages. Univirate, Bi-variate and multivariate logistic regression analysis with 95% CI was employed in order to infer associations. RESULTS: the prevalence of common mental illnesses among adults in our study area was 14.9%. The most common neurotic symptoms in this study were often head ache (23.2%), sleep badly (16%) and poor appetite (13.8%). Substance use like Khat chewing (48.2%), tobacco use (38.2%) and alcohol use (10.5%) was highly prevalent health problem among study participant. In multivariate logistic regression analysis, respondents age between 25-34 years, 35-44 years, 45-54 years and above 55years were 6.4 times (AOR 6.377; 95% CI: 2.280-17.835), 5.9 times (AOR 5.900; 95% CI: 2.243-14.859), 5.6 times (AOR 5.648; 95% CI: 2.200-14.50) and 4.1 times (AOR 4.110; 95% CI: 1.363-12.393) more likely having common mental illnesses than those age between 15-24 years, respectively. The occurrence of common mental illness was twice (AOR: 2.162; 95% CI 1.254-3.728) higher among respondents earn less than the average monthly income than those earn more than average monthly income. The odds of developing common mental illnesses were 6.6 times (AOR 6.653; 95% CI: 1.640-6.992) higher among adults with medically confirmed physical disability than those without physical disability. Similarly, adults who chewed Khat were 2.3 times (AOR 2.305; 95% CI: 1.484-3.579) more likely having common mental illnesses than those who did not chew Khat. Adults with emotional stress were twice (AOR 2.063; 95% CI: 1.176-3.619) higher chance to have common mental illnesses than adults without emotional stress. CONCLUSION: this study had reveals that common mental disorders are major public health problems. Advancing age, low average family monthly income, Khat chewing and emotional stress were independent predictors of common mental illnesses. Whereas sex, place of residence, educational status, marital status, occupation, family size, financial stress, taking alcohol, tobacco use and family history of mental illnesses were not statistically associated with common mental illnesses.</b><br/> text/html 2017-11-25T09:37:31+01:00 Eliane Rohner, Margaret Kasaro, Susan Citonje Msadabwe-Chikuni, Kathryn Stinson, Zainab Mohamed, Hannock Tweya, Matthias Egger, Julia Bohlius [Short communication] - Treatment and outcome of AIDS-related Kaposi sarcoma in South Africa, Malawi and Zambia: an international comparison - 24 November 2017. <b>HIV-related Kaposi sarcoma (KS) is common in sub-Saharan Africa, but optimal treatment strategies in resource-limited settings remain unclear. We did a retrospective cohort study of adults diagnosed with KS before initiating antiretroviral therapy (ART) at three ART programs in South Africa, Malawi and Zambia. We extracted data from medical charts at HIV clinics and oncological referral centers and used electronic data from the International epidemiology Databases to Evaluate AIDS Southern Africa. We used descriptive statistics to assess tumor (T) and systemic illness (S) stage and treatment of AIDS-KS patients. Kaplan-Meier analyses were used to assess survival after KS diagnosis. We analyzed data from 57 patients in total (20 from South Africa, 20 from Zambia, 17 from Malawi). Median age at KS diagnosis was 35 years and similar across sites. The percentage of patients with poor risk AIDS-KS (T1S1) was similar in South Africa (25%) and Malawi (24%) and higher in Zambia (45%). All AIDS-KS patients initiated ART at the HIV clinic. For KS care, in South Africa 18 patients (90%) were referred to an oncology department; in Malawi and Zambia most patients were managed by the HIV clinics. In Malawi and South Africa, most AIDS-KS patients received systemic chemotherapy, in Zambia one patient received chemotherapy at the HIV clinic. A year after KS diagnosis, 15 patients (75%) in South Africa, 10 patients (50%) in Zambia, and 8 patients (47%) in Malawi were still alive; another 3 patients (15%) in South Africa, 8 patients (40%) in Zambia and 4 patients (24%) in Malawi were lost to follow-up. Management of AIDS-KS patients varied considerably across sites in Malawi, South Africa and Zambia. We need more reliable survival data for AIDS-KS patients in sub-Saharan Africa before we can assess which treatments and clinical pathways should be adopted in a specific setting.</b><br/> text/html 2017-11-25T09:37:31+01:00 Norosoa Julie Zafindraibe, Jeannine Ralalarinivo, Andriamiarimbola Ir&egrave;ne Rakotoniaina, Muriel Nirina Maeder, Mala Rakoto Andrianarivelo, B&eacute;nedicte Contamin, Alain Michault, Andry Rasamindrakotroka [Research] - S&eacute;ropr&eacute;valence de la cysticercose et facteurs de risque associ&eacute;s chez un groupe de patients vus au Centre Hospitalier R&eacute;gional de R&eacute;f&eacute;rence d’Antsirabe, Madagascar - 23 November 2017. <b>INTRODUCTION: A Madagascar, la cysticercose, maladie caus&eacute;e par la forme larvaire de Taenia solium, demeure un probl&egrave;me de sant&eacute; publique. En 2003, la s&eacute;ropr&eacute;valence de la cysticercose variait entre 7% et 21% avec un taux plus &eacute;lev&eacute; dans les r&eacute;gions centrales de l’&icirc;le. Toutefois, depuis une dizaine d’ann&eacute;e, les donn&eacute;es &eacute;pid&eacute;miologiques concernant la cysticercose humaine restent limit&eacute;es. Notre &eacute;tude a pour objectif de d&eacute;terminer, chez les patients issus de la r&eacute;gion de Vakinankaratra et qui sont suspects cliniquement, la s&eacute;ropr&eacute;valence de la cysticercose par Western blot ainsi que les facteurs de risque associ&eacute;s. METHODES: il s’agit d’une &eacute;tude descriptive transversale men&eacute;e sur une p&eacute;riode de 6 mois au sein du Centre Hospitalier R&eacute;gional de R&eacute;f&eacute;rence d’Antsirabe. Tous les patients inclus dans l’&eacute;tude ont r&eacute;pondu &agrave; un questionnaire clinique recueillant leurs caract&eacute;ristiques sociod&eacute;mographiques et culturelles ainsi que leurs habitudes alimentaires et leurs sympt&ocirc;mes cliniques. RESULTATS: la s&eacute;ropr&eacute;valence de la cysticercose retrouv&eacute;e dans la population d’&eacute;tude &eacute;tait de 14,8% (35/237). Ce taux ne diff&egrave;re pas significativement selon le sexe, l’&acirc;ge, la consommation de viande de porc ou le mode de pr&eacute;paration de la viande (p > 0,05). Par contre, une diff&eacute;rence significative (p < 0,05) a &eacute;t&eacute; observ&eacute;e chez les sujets pr&eacute;sentant des nodules sous-cutan&eacute;s ou un r&eacute;sultat de cysticercose ant&eacute;rieur positif. CONCLUSION: l’index &eacute;lev&eacute; d’exposition &agrave; Taenia solium retrouv&eacute; dans notre &eacute;tude justifie le renforcement des mesures de contr&ocirc;le et de pr&eacute;vention d&eacute;j&agrave; implant&eacute;s dans le pays.</b><br/> text/html 2017-11-25T09:37:31+01:00 Adewale Ismahil Badru, Kehinde Kazeem Kanmodi [Research] - Palliative care awareness amongst religious leaders and seminarians: a Nigerian study - 23 November 2017. <b>INTRODUCTION: There exists scanty literature on the awareness of Nigerians towards palliative care. This study was conducted to determine the level of awareness of religious leaders and seminarians in Ibadan, Nigeria, on palliative care. METHODS: Data obtained from a cross-section of 302 religious leaders and seminarians in the metropolitan city of Ibadan, Nigeria, were used in this research. Study tool was a self-administered questionnaire which obtained information from the participants about their bio-data and knowledge of palliative care. Data analysis was done using the SPSS version 16 Software. RESULTS: The mean age of the respondents was 28.99 years, with 55.6% of them being within the age range of 21 to 30 years. The majority (94%) were males, 68.5% were single and 79.8% were seminarians. Only 31.8% have heard of palliative care before, 12.6% knew a health facility where palliative care is rendered in Nigeria, while 21.9% knew that chaplains are members of the palliative care team. CONCLUSION: The level of awareness of palliative care among religious leaders and seminarians in Ibadan, Nigeria, is low. There exists the need to educate Nigerian religious leaders and seminarians on palliative care.</b><br/> text/html 2017-11-25T09:37:31+01:00 Michel Kengne, Amon Todjimbaide Dounia, Julius Mbekem Nwobegahay [Research] - Bacteriological profile and antimicrobial susceptibility patterns of urine culture isolates from patients in Ndjamena, Chad - 23 November 2017. <b>INTRODUCTION: Bacteriological profile and antimicrobial susceptibility patterns of urine culture isolates were determined among patients in the Ndjamena General Hospital, a National Reference centre. METHODS: a cross-sectional study was carried out from July to November 2014. Six hundred and sixty patients were enrolled, to whom a cytobacteriological examination of urine was prescribed. Urine was collected and cultured. Bacterial identification and antimicrobial susceptibility patterns were performed using Vitek 2 compact automated system. RESULTS: 216 isolates were recovered from patients (age range: 10-90 years). E. coli was the pathogen frequently cultured 128 (59.3%) followed by <i>K. pneumonia</i> 28 (13.0%). Bacteriuria was more present in inpatients (70.4%) compared to outpatients (29.6%). High antibiotic-resistance rate (> 60%) of the total isolates was observed with ampicillin, ciprofloxacin and cephalosporins. Imipeneme (94.9%) displayed satisfactory activity against bacteria isolates. ESBLs phenotype was present in 68/105 (64.7%) of betalactamine resistant isolates. AAC(3)-I and AAC(6’)-I enzymes were found respectively in 16/36 (44.4%) and 20/36 (55.6%) of aminoglycosides resistant isolates. Resistance of isolates to quinolones was mainly due to an association of target modification (gyrA and parC), porin reduction and/or efflux mechanisms and was present in 107/213 (49%) of quinolones resistant isolates. CONCLUSION: <i>E. coli</i> is the predominant uropathogen isolated in our setting and there are antibiotic-resistant uropathogens among the studied population. Therefore, routine surveillance of bacterial uropathogens to common used antibiotics must be a continuous process so as to provide physicians with up to date information about the local data of antimicrobial resistance.</b><br/> text/html 2017-11-25T09:37:31+01:00 Lamidhi Salami, Edgard-Marius Ouendo, Benjamin Fayomi [Research] - Qualit&eacute; du syst&egrave;me d’information et de suivi des interventions en sant&eacute; dans les zones expos&eacute;es au financement bas&eacute; sur les r&eacute;sultats en 2014 au B&eacute;nin - 22 November 2017. <b>INTRODUCTION: Le financement bas&eacute; sur les r&eacute;sultats (FBR) est une intervention &agrave; l’&eacute;chelle du syst&egrave;me de sant&eacute; dont les effets sur les piliers de ce syst&egrave;me ne sont pas souvent mesur&eacute;s, surtout au niveau du syst&egrave;me d’information et de suivi des interventions de sant&eacute;. METHODES: l’&eacute;tude transversale faite au B&eacute;nin dans 67 formations sanitaires tir&eacute;es au hasard dans deux zones sanitaires FBR_PRPSS, deux zones FBR_PASS, toutes expos&eacute;es au FBR et deux zones non expos&eacute;es au FBR, a permis d’&eacute;valuer la qualit&eacute; du syst&egrave;me d’information et de suivi. L’indice de qualit&eacute; et les scores de performance des composantes du syst&egrave;me ont &eacute;t&eacute; utilis&eacute;s pour comparer les strates expos&eacute;es au FBR &agrave; la strate non expos&eacute;e. RESULTATS: la qualit&eacute; du syst&egrave;me d’information et de suivi est moyenne dans les trois strates, avec des indices de qualit&eacute; plus &eacute;lev&eacute;s dans les strates FBR_PRPSS (77%) et FBR_PASS (74%) que dans la strate Non_FBR (67%). La distribution de la qualit&eacute; du syst&egrave;me au sein des strates est plus favorable aux strates expos&eacute;es aux FBR. Les composantes ayant une bonne performance sont “Information d&eacute;mographique’’, “R&eacute;sultats et analyses essentiels’’ et “Archivage des supports statistiques’’. Toutefois, des composantes importantes pour le FBR et le syst&egrave;me d’information telles “Supervision’’ et “Rapportage’’ continuaient d’avoir un IQ moyen, deux ans apr&egrave;s le d&eacute;but de l’intervention. CONCLUSION: la performance moyenne du syst&egrave;me d’information et de suivi pourrait davantage s’am&eacute;liorer avec le respect des directives du FBR, surtout si la qualit&eacute; de ce syst&egrave;me devient une priorit&eacute; du FBR.</b><br/> text/html 2017-11-25T09:37:31+01:00 Fortunate Atwine, Katarina Hjelm [Research] - Health professionals’ knowledge and attitudes to healthcare-seeking practices and complementary alternative medicine usage in Ugandans with diabetes: a cross-sectional survey - 22 November 2017. <b>INTRODUCTION: Healthcare-seeking behaviour among persons with diabetes has been investigated to a limited extent, and not from professionals’ perspective. The aim of the study was to describe healthcare professionals’ knowledge, attitudes and practice concerning healthcare-seeking behaviour and the use of complementary and alternative medicine among persons with diabetes. METHODS: a cross-sectional, self-administered questionnaire was conducted in western Uganda. Nurses, midwives or nurse assistants 66.7%, physicians 12% and clinical officers 10% volunteered to participate in the study with a total 108 (93%) response rate. Descriptive statistics were used to analyse data with frequencies, percentages and summarized in tables. RESULTS: most of the healthcare providers perceived more uneducated people to be at risk of developing complications related to diabetes (66.7%) and that most of the patients with diabetes were not knowledgeable about signs and symptoms of diabetes before being diagnosed (75.9%). The main reasons inducing persons with diabetes to seek care outside the health care sector were reported to be seeking a cure for the condition, influence from the popular sector, the accessibility of the place and signs of complications of diabetes related to poor glycaemic control. Healthcare providers had relatively positive attitudes towards using complementary and alternative medicine. CONCLUSION: insufficient knowledge about diabetes, compromised healthcare-seeking practices including drug procurement for diabetes seem to be barriers to diabetes management. Patients were thus reported to be burdened with co-morbidities of complications of diabetes related to poor glycaemic control.</b><br/> text/html 2017-11-25T09:37:31+01:00 Othmane Alaoui, Hicham Abdellaoui [Images in medicine] - Forme rare de malformation anorectale avec une fistule recto urethrobulbaire: &agrave; propos d’un cas - 22 November 2017. <b>Nous rapportons le cas d'un nouveau n&eacute; de sexe masculin admis &agrave; la naissance pour une imperforation anale chez qui l'examen physique a trouv&eacute; &agrave; l'examen de la marge anale une imperforation anale; l'examen des organes g&eacute;nitaux externes a objectiv&eacute; une bifidit&eacute; scrotale avec une fistule au niveau de la racine de la verge ramenant du m&eacute;conium. Le sondage urinaire a not&eacute; l'issue de la sonde &agrave; travers la fistule (A) faisant suspecter une forme rare de malformation anorectale avec fistule recto urethrobulbaire. Un bilan malformatif a &eacute;t&eacute; r&eacute;alis&eacute; revenant sans particularit&eacute;s. Le nouveau n&eacute; a &eacute;t&eacute; admis au bloc op&eacute;ratoire et une opacification a &eacute;t&eacute; r&eacute;alis&eacute; en per op&eacute;ratoire par un cath&eacute;t&eacute;risme de la fistule par deux sondes de Foley charni&egrave;re 6 l'une passant &agrave; travers le rectum et l'autre passant &agrave; travers la vessie; une troisi&egrave;me sonde de Foley a &eacute;t&eacute; mise par le m&eacute;at ur&eacute;tral et objectivant la communication des trois sondes au niveau de la fistule dite recto urethro bulbaire (B). Le diagnostic a &eacute;t&eacute; retenu pour cette forme particuli&egrave;re de malformation anorectale interm&eacute;diaire et une colostomie a &eacute;t&eacute; r&eacute;alis&eacute;e. Le nouveau a b&eacute;n&eacute;fici&eacute; d'une cure de sa malformation ano rectale &agrave; l'&acirc;ge de 3 mois ayant b&eacute;n&eacute;fici&eacute; d'une anorectoplastie avec fermeture de la fistule par voie p&eacute;rin&eacute;ale. Des s&eacute;ances de dilatations anales ont &eacute;t&eacute; r&eacute;alis&eacute;es pendant 6 mois. La fermeture de la colostomie a &eacute;t&eacute; faite &agrave; l'&acirc;ge de 9 mois. L'&eacute;volution a &eacute;t&eacute; favorable avec un recul de 2 ans.</b><br/> text/html 2017-11-25T09:37:31+01:00 Nneka Christina Okafoagu, Oche Mansur Oche Oche, Mansur Olayinka Raji, Ben Onankpa, Ismail Raji [Research] - Factors influencing complementary and weaning practices among women in rural communities of Sokoto state, Nigeria - 22 November 2017. <b>INTRODUCTION: When breast milk alone is no longer sufficient to meet a child's nutritional needs, foods other than breast milk are introduced gradually into the baby's diet, first to complement breast feeding and progressively to replace it and get the child used to adult diet. This study aimed to assess the factors influencing complementary and weaning practices among women in rural communities of Sokoto state, Nigeria. METHODS: it was a cross-sectional study. Using a multi-staged sampling technique, 296 mothers of children 6-24 months were recruited. Data was collected using a pretested structured questionnaire and analyzed using IBM SPSS version 20. Chi square test was used to test associations between categorical variables. Binary logistic and multinomial regression was used to compute the determinants of complementary and weaning practices. The level of significance was set at p < 0.05. Ethical approval was obtained from the State Ethical Committee. RESULTS: timely introduction of complementary feeds was commenced in 54% of the children. Only 6.2% weaned their children at 6 months; 90.5% weaned their children gradually and 63.5% bottle fed. Factors influencing complementary and weaning practices was found to be child's age; maternal age and family setting. CONCLUSION: the respect of World Health Organization (WHO) recommendations on complementary and weaning practices was suboptimal. It was also evident from this study that complementary and weaning practices were influenced by maternal and house-hold factors. It is therefore important to develop interventions aimed at bridging the gap between these practices in rural settings and WHO recommendations</b><br/> text/html 2017-11-25T09:37:31+01:00 Samira Aouadi, Najla Ghrairi, Emna Brahem, Manel Kaabi, Sonia Ma&acirc;lej, Leila Douik Elgharbi [Case report] - Hypogammaglobulin&eacute;mie acquise associ&eacute;e au thymome: le syndrome de Good - 22 November 2017. <b>Le syndrome de Good (SG) est d&eacute;fini par l'association d'un thymome et d'un d&eacute;ficit immunitaire. Il se complique souvent d’infections bact&eacute;riennes broncho-pulmonaires et rhino-sinusiennes. Cette entit&eacute; ne repr&eacute;sente que 5% des syndromes para-thymiques. Ces infections respiratoires r&eacute;currentes peuvent &ecirc;tre &agrave; l’origine de dilatation des bronches associ&eacute;e au syndrome de Good. Nous rapportons l’observation d’une femme &acirc;g&eacute;e de 52 ans, hospitalis&eacute;e pour une pneumopathie infectieuse trainante. La tomodensitom&eacute;trie thoracique a permis de mettre en &eacute;vidence des dilatations des bronches associ&eacute;es &agrave; un thymome confirm&eacute; sur pi&egrave;ce op&eacute;ratoire. La d&eacute;couverte d’une hypogammaglobulin&eacute;mie a permis de porter le diagnostic de syndrome de Good.</b><br/> text/html 2017-11-25T09:37:31+01:00 Glauber Voltan, Fred Bernardes Filho [Images in medicine] - Ecchymosis on the penis, scrotum and pubis - 22 November 2017. <b>A 52-year-old male patient with a mechanical prosthetic valve, in use of the combination of aspirin and warfarin, presented to the emergency department after 12 hours of a blunt injury of erect penis during sexual intercourse. On physical examination there was swelling and subcutaneous hematoma extending over the proximal penile shaft, the scrotum and the pubis with a dorsal-left sided deviation of the penis. The scrotum was swollen and painful on physical examination and the testicles were palpable with difficulty due to the pain. The patient denied any voiding difficulties or haematuria and had neither blood at the meatus nor palpable bladder. On the basis of the history and physical examination, a diagnosis of penile fracture and urethral trauma was made. The patient was brought immediately to the operating room for retrograde urethrography and surgical exploration. Although highly underreported, penile fracture is uncommon urologic injury. These injuries attract a lot of psychological, physical, functional, and emotional distress on the patient. The diagnosis of penile fracture is largely clinical with a definite history of trauma, a "crack" sound and rapid detumescence of the erection. Depending on whether the Buck's fascia has been breached, the hematoma will track to the base of the shaft or spread to the perineum, scrotum (butterfly sign) and lower abdominal wall. If the fracture involves the urethra, blood will extravasate through the urethra. Urethral bleeding or hematuria or voiding symptoms suggest associated trauma to the urethra.</b><br/> text/html 2017-11-25T09:37:31+01:00 Noukhoum Kon&eacute;, Sambou Soumar&eacute; [Images in medicine] - About an observation of cerebral abscess encysted - 21 November 2017. <b>The cerebral abscess represents 2% of the intracranial lesions of the adult, 17% of the child. 35% of abscesses develop before the age of 15 years. It evolves in several phases (pre-suppurative encephalitis, purulent collection without shell, abscess collected with fine capsule, abscess collected with thick shell). We report the case of a 14-year-old girl with no specific pathological history except a neglected oral infection episode; has been present for 4 weeks with headache, vomiting, tonic-clonic convulsive seizures in a febrile context. On examination there is a proportional right hemiparesis with a motor force rated at 3/5 without facial participation, a fever at 39.5°c. The biological examination revealed a leucocytosis (17 000/mm3) predominantly neutrophilic (81%). The brain CT Scan with injection of iodinated contrast medium in axial (A) and coronal (B) sections revealed an isodense occupying process, with a left parietal seat, with annular rehabitation and partitioned, measuring 23.8mm x 20mm and presenting an edema in the satellite. Brain MRI was found 3 weeks later in sequences, T1 (C), T2 Flair (D, E), T1 gado in axial section a volumetric increase of the occupying process with a significant deviation from the line of the median structures. A craniotomy with evacuation of the abscess (F, H) and excision of the cyst wall (G) was performed. The bacteriological examination of the pus was negative. Anatomopathological examination of the cyst wall revealed non-specific inflammatory necrotic tissue. An intravenous antibiotherapy was established in post-operative stages, the clinical course proved to be significantly favorable.</b><br/> text/html 2017-11-25T09:37:31+01:00 Nadia Kabbali, Tarik Sqalli [Images in medicine] - Calcinose pseudo-tumorale chez un h&eacute;modialys&eacute; chronique - 21 November 2017. <b>La calcinose pseudotumorale (CPT) est une affection caract&eacute;ris&eacute;e par le d&eacute;p&ocirc;t de cristaux de phosphate de calcium dans les tissus mous p&eacute;riarticulaires, r&eacute;alisant de volumineuses masses calcifi&eacute;es. Bien que la physiopathog&eacute;nie des CPT ne soit pas totalement &eacute;lucid&eacute;e, l'augmentation du produit phosphocalcique au-del&agrave; du seuil de pr&eacute;cipitation ainsi que l'hyperparathyro&iuml;die s&eacute;v&egrave;re, semble y jouer un r&ocirc;le determinant. Le r&ocirc;le favorisant de microtraumatismes articulaires r&eacute;p&eacute;t&eacute;s est &eacute;galement &eacute;voqu&eacute;. Chez les sujets dialys&eacute;s, la fr&eacute;quence de la CPT est estim&eacute;e entre 0,5 et 7% selon les s&eacute;ries. Son traitement demeure controvers&eacute;. L'ex&eacute;r&egrave;se chirurgicale est souvent recommand&eacute;e. Nous rapportons un cas de CPT survenue chez un patient h&eacute;modialys&eacute;. Il s'agit d'un patient &acirc;g&eacute; de 56 ans, en h&eacute;modialyse chronique depuis 9 ans pour une n&eacute;phropathie ind&eacute;termin&eacute;e. Le patient pr&eacute;sente depuis 6 mois des douleurs d'aggravation progressive au niveau de la hanche droite, avec des difficult&eacute;s de mobilisation de l'articulation en regard. Le scanner alors r&eacute;alis&eacute; montre une masse calcifi&eacute;e, &agrave; contours polylob&eacute;s, mesurant 8,6 x 7,6 x 5,9cm, pr&eacute;sentant des rapports tr&egrave;s &eacute;troits avec le nerf grand sciatique, ce qui explique probablement le tableau clinique tr&egrave;s douloureux. Le bilan biologique montre un produit phosphocalcique &eacute;lev&eacute; et une hyperparathyro&iuml;die. L'ex&eacute;r&egrave;se chirurgicale est jug&eacute;e difficile vu les rapports de la tumeur avec les &eacute;l&eacute;ments vasculo-nerveux. Notre observation illustre les difficult&eacute;s diagnostique et th&eacute;rapeutique de la CPT. L'existence de cette affection peu fr&eacute;quente nous para&icirc;t devoir &ecirc;tre rappel&eacute;e, afin de l'&eacute;voquer rapidement chez un patient h&eacute;modialys&eacute; chronique devant toute masse p&eacute;riarticulaire calcifi&eacute;e d'allure tumorale.</b><br/> text/html 2017-11-25T09:37:31+01:00 Amina Kissou, Badr Eddine Hassam [Images in medicine] - Reticulated aspect! - 21 November 2017. <b>A 25-year-old woman presented with a 5-year history of a reticulated pigmented rash on her upper chest and her back (A). The rash was asymptomatic, squamous and progressively spread to involve her axillae and her neck (B). There were no diabetes, no thyroid disorder. Previous courses of ketoconazole have been tried with no resolution. Scotch test was negative. Histology confirmed a diagnostic of confluent and reticulated papillomatosis of Gougerot and Carteaud (CRPGC). This patient was treated with 100mg a day of doxycycline for 04 months with good improvement. Confluent and reticulated papillomatosis of Gougerot and Carteaud was first described in 1927. With the help of electron microscopy, it has been elucidated that CRPGC arises due to aberrant keratinization. It is an uncommon condition that affects adolescents, especially women with dark skin, often no or misdiagnosed. The etiopathogenesis remains unknown. Clinically, the lesions are asymptomatics. The distrubition of these lesions are: facial, truncal, acral or flexular. This condition may be associated with obesity, diabetes, some endocrine disorders, genodermatosis and some drugs (lithium). Histology shows hyperkeratosis with focal parakeratosis, papillomatosis, moderate acanthosis and hyperpigmentation of the basal layer. Scotch test is negative. Although successful treatment with topical keratolytics, retinoids or antifungals has been reported; antibiotics, such as cyclines, at anti-inflammatory doses; have emerged as a preferred therapeutic option.</b><br/> text/html 2017-11-25T09:37:31+01:00 Obianuju Igbokwe, Gilbert Adimorah, Anthony Ikefuna, Ngozi Ibeziako, Agozie Ubesie, Christopher Ekeh, Kenechukwu Iloh [Research] - Socio-demographic determinants of malnutrition among primary school aged children in Enugu, Nigeria - 21 November 2017. <b>INTRODUCTION: Several factors including the parental literacy, illness, socioeconomic status, poor sanitation and hygienic practices affect the physical growth of children. The aim of this study was to determine the socio-demographic determinants of malnutrition among primary school aged children in Enugu, Nigeria. METHODS: a cross-sectional descriptive study involving primary school children in Enugu was carried out over a 3 month period. Subjects were selected using multistage sampling technique. Weight and height were measured using a digital scale and a wooden stadiometer, respectively. Body Mass Index (BMI), weight-for-age (WAZ), Height-for-age (HAZ) and BMI-for-age z scores were then derived using the new WHO reference standards. RESULTS: 348 children (40.4%) were recruited from 5 public schools while 512 (59.6%) were recruited from 9 private schools. The mean age of the study participants was 9.2 ± 1.8 years. 7 (0.8%) children were stunted, 26 (3.3%) wasted and 28 (3.3%) underweight. Of all the study participants, overweight and obesity were observed in 73 (8.5%) and 35 (4.1%) children, respectively. Children of lower socioeconomic class were more stunted, underweight and wasted, while overweight and obesity were more prevalent among children from the upper socioeconomic class. CONCLUSION: factors such as age and sex, parental education and socioeconomic class had a significant impact on nutritional status. Overweight and obesity were more prevalent among the children from the upper socioeconomic class, attending private schools, while stunting and wasting were more in children of the lower class attending public schools.</b><br/> text/html 2017-11-25T09:37:31+01:00 Samia Frioui, Faycel Khachnaoui [Images in medicine] - La st&eacute;nose trach&eacute;ale s&eacute;v&egrave;re post-intubation prolong&eacute;e - 21 November 2017. <b>La fr&eacute;quence des st&eacute;noses trach&eacute;ales post-intubation (STPI) varie selon les &eacute;tudes de 10 &agrave; 22 %. Seulement 1 &agrave; 2% de ces st&eacute;noses sont s&eacute;v&egrave;res ou symptomatiques et se manifestent par un tableau de dyspn&eacute;e inspiratoire ne c&eacute;dant pas sous traitement cortico&iuml;de. Les STPI surviennent souvent chez des patients &agrave; l'&eacute;tat g&eacute;n&eacute;ral alt&eacute;r&eacute;, ce qui complique leur prise en charge. Nous rapportons le cas d'un patient &acirc;g&eacute; de 43 ans, hypertendu, qui a pr&eacute;sent&eacute; il y a un an un Accident Vasculaire C&eacute;r&eacute;bral h&eacute;morragique suite &agrave; un pic hypertensif avec un coma ayant dur&eacute; 3 mois n&eacute;cessitant une intubation prolong&eacute;e et une trach&eacute;otomie. Une d&eacute;canulation s'est av&eacute;r&eacute;e impossible &agrave; maintes reprises, se soldant &agrave; chaque tentative de d&eacute;canulation par une d&eacute;tresse respiratoire. L'examen ORL sp&eacute;cialis&eacute; avait r&eacute;v&eacute;l&eacute; une st&eacute;nose importante sous glottique au-dessus de l'orifice de trach&eacute;otomie. Le TDM a confirm&eacute; la st&eacute;nose trach&eacute;ale (A, B, C). Une trach&eacute;oscopie sous anesth&eacute;sie g&eacute;n&eacute;rale avait mis en &eacute;vidence une st&eacute;nose sous glottique &agrave; un cm du plan glottique. Le patient a &eacute;t&eacute; op&eacute;r&eacute; et a eu une r&eacute;section trach&eacute;ale proximale de trois cm avec une mucosectomie crico&iuml;dienne post&eacute;rieure et une anastomose crico-trach&eacute;ale. L'&eacute;volution post-op&eacute;ratoire &eacute;tait favorable. Le diagnostic de STPI est parfois difficile mais il doit &ecirc;tre &eacute;voqu&eacute; chez tout patient aux ant&eacute;c&eacute;dents d'intubation et/ou de trach&eacute;otomie pr&eacute;sentant une dyspn&eacute;e d'apparition r&eacute;cente ou inhabituelle. La r&eacute;section-anastomose trach&eacute;ale, telle qu'elle a &eacute;t&eacute; faite pour notre patient, reste le traitement de r&eacute;f&eacute;rence.</b><br/> text/html 2017-11-25T09:37:31+01:00 Sankalp Yadav, Gautam Rawal, Mudit Baxi [Commentary] - Vacuum assisted closure technique: a short review - 21 November 2017. <b>The management of difficult to heal wounds has always been a cause of concern for the treating clinicians. There has been a tremendous increase in the number patients presenting with difficult to heal wounds. The conventional techniques have been in use since the long time for the management of these wounds, yet desired results are not achieved always. Thus a newer novel technique which might be useful in the difficult to heal wounds and delivering at par or better results as compared to the conventional techniques is the need of the hour.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mahdi Aithoussa, Noureddine Atmani, Reda Mounir, Younes Moutakiallah, Mehdi Bamous, Abdessamad Abdou, Fouad Nya, Anis Seghrouchni, Siham Bellouize, Mohamed Drissi, Mostafa Elouennass, Youssef Elbekkali, Abdelatif Boulahya [Research] - Early results for active infective endocarditis - 21 November 2017. <b>INTRODUCTION: cardiac surgery is frequently needed during active phase of infective endocarditis (IE). The purpose of this study was to analyze the immediate and late results and determine the risk factors for death. METHODS: we retrospectively reviewed 101 patients with IE operated in the active phase. The mean age was 40.5 ± 12.5 years. 16 patients (15.8%) were diagnosed with prosthetic valve endocarditis (PVE). 81 (80.9%) were in NYHA functional class III-IV. Blood cultures were positive in only 24 cases (23.9%). RESULTS: in-hospital mortality rate was 17.9% (18 cases). Multivariate analysis indentified five determinant predictor factors: congestive heart failure (CHF), renal insufficiency, high Euroscore, prolonged cardiopulmonary bypass time (> 120 min) and long ICU stay. The median follow-up period was 4.2 (2-6.5) years. Overall survival rate for all patients who survived surgery was 97% at 5 years and 91% at 10 years. CONCLUSION: despite high in-hospital mortality rate, when patients receive operation early in the active phase of their illness, late outcome may be good.</b><br/> text/html 2017-11-25T09:37:31+01:00 Abdoulaye Diallo Harouna, Hind Cherrabi, Karima Atarraf, Lamiae Chater, Abderrahmane My Afifi [Case series] - Fracture des &eacute;pines tibiales chez l’enfant - 17 November 2017. <b>La fracture des &eacute;pines tibiales est une l&eacute;sion rare qui survient g&eacute;n&eacute;ralement chez les adolescents sportifs entre 8 et 17 ans. Le traitement des formes d&eacute;plac&eacute;es n&eacute;cessite une r&eacute;duction chirurgicale et une fixation afin d’offrir au ligament crois&eacute; ant&eacute;rieur une tension ad&eacute;quate et r&eacute;duire le risque de laxit&eacute;. Le but de cette &eacute;tude &eacute;tait de rapporter notre exp&eacute;rience dans la prise en charge des fractures de l’&eacute;pine tibiale chez l’enfant. Il s’agit d’une &eacute;tude r&eacute;trospective collig&eacute;e sur une p&eacute;riode de 7 ans (2009-2016) int&eacute;ressant 11 cas de fractures de l’&eacute;pine tibiale chez l’enfant. L’&acirc;ge moyen de nos malades &eacute;tait de 13 ans et demi. La chute lors du sport &eacute;tait en cause dans 73% des cas. La classification de Meyers et Mac Keever, modifi&eacute;e par Zaricznyja &eacute;t&eacute; adopt&eacute;e, elle a permis de classer les l&eacute;sions en 4 types. Deux cas ont &eacute;t&eacute; trait&eacute;s orthop&eacute;diquement et 9 cas ont b&eacute;n&eacute;fici&eacute; d’une r&eacute;duction chirurgicale par arthrotomie et une fixation par ost&eacute;o-suture. Apr&egrave;s un recul moyen de 3 ans nos r&eacute;sultats sont jug&eacute;s bons dans 91% selon le score fonctionnel de Lysholm. Un seul cas de type II trait&eacute; orthop&eacute;diquement a pr&eacute;sent&eacute; un score fonctionnel de Lysholm jug&eacute; encore moyen. Afin d’assurer un bon tonus du ligament crois&eacute; ant&eacute;rieur, en dehors du type I, il nous semble d&eacute;fendable d’opter de fa&ccedil;on syst&eacute;matique pour un traitement chirurgical pour les types II &agrave; IV. La fracture des &eacute;pines tibiales est de bon pronostic. La r&eacute;duction chirurgicale est la r&egrave;gle &agrave; chaque fois qu’un d&eacute;placement s’y associe afin de mieux v&eacute;rifier l’int&eacute;grit&eacute; du ligament crois&eacute; ant&eacute;rieur et de garantir une bonne stabilit&eacute; genou.</b><br/> text/html 2017-11-25T09:37:31+01:00 Said Benlamkaddem, Nawfal Houari, Brahim Boukatta, Hicham Sbai, Nabil Kanjaa [Case report] - TURP syndrome: &agrave; propos d’un cas - 17 November 2017. <b>Nous rapportons le cas d'un patient de 78 ans, sans ant&eacute;c&eacute;dents pathologiques notables, qui a b&eacute;n&eacute;fici&eacute; d'une r&eacute;section transur&eacute;terale d'une hypertrophie b&eacute;nigne de prostate de 50g sous rachianesth&eacute;sie. Ce patient a pr&eacute;sent&eacute;, 90 minutes apr&egrave;s le d&eacute;but de l'intervention, des naus&eacute;es vomissements, brouillard visuel et bradycardie en rapport avec un TURP syndrome. L'ionogramme a objectiv&eacute; une natr&eacute;mie &agrave; 118meq/l, d'o&ugrave; sa mise sous s&eacute;rum sal&eacute; hypertonique &agrave; 3% avec bonne &eacute;volution. Cette observation d&eacute;crit une forme typique mais mod&eacute;r&eacute;e du TURP syndrome dont la prise en charge &eacute;tait facilit&eacute;e par l'&eacute;tat d'&eacute;veil du patient permis gr&acirc;ce &agrave; la rachianesth&eacute;sie.</b><br/> text/html 2017-11-25T09:37:31+01:00 Tahir Nebhani, Said Jidane, Hicham Bakkali, Lahcen Belyamani [Case report] - Communication interventriculaire post infarctus du myocarde: &agrave; propos d’un cas et revue de la litt&eacute;rature - 17 November 2017. <b>La rupture septale secondaire &agrave; l'infarctus du myocarde est une complication aigu&euml; redoutable dont la mortalit&eacute; est non n&eacute;gligeable &agrave; la phase pr&eacute;coce. Nous rapportons le cas d'une rupture septale apicale chez un patient de 70 ans admis aux urgences pour prise en charge d'un post infarctus de myocarde ant&eacute;ro-septal. C'est une urgence extr&ecirc;me dont la prise en charge doit &ecirc;tre multidisciplinaire. Nous mettons le point sur les facteurs de risque et sur le traitement &agrave; proposer pour ce type de complication.</b><br/> text/html 2017-11-25T09:37:31+01:00 Nahid Zaghba, Kawtar El Hachimi, Hanane Benjelloun, Najiba Yassine [Case report] - La microlithiase alv&eacute;olaire: &agrave; propos d’une nouvelle observation - 17 November 2017. <b>La microlithiase alv&eacute;olaire (MLA) est une affection rare, caract&eacute;ris&eacute;e par l’accumulation de concr&eacute;tions calciques dans la lumi&egrave;re alv&eacute;olaire pulmonaire. Nous rapportons un nouveau cas de MLA, suspect&eacute; &agrave; la radiographie thoracique et confirm&eacute; par le scanner thoracique dont l’aspect est pathognomonique et par la biopsie pulmonaire transbronchique. La MLA est souvent asymptomatique contrastant avec l’importance des l&eacute;sions radiologiques qui sont caract&eacute;ristiques. L’&eacute;tiologie de cette pathologie est inconnue, mais une origine g&eacute;n&eacute;tique avec transmission autosomique r&eacute;cessive est soup&ccedil;onn&eacute;e avec mutation du g&egrave;ne SLC34A2.</b><br/> text/html 2017-11-25T09:37:31+01:00 William Ngatchou, Gildas-paulin Yondou Sadjo, Daniel Lemogoum, Pierre Youatou, Ahmed Sabry Ramadan, Regis Sontou, Maimouna Bol Alima, Alain Plumacker, Virginie Guimfacq, Pierre Mols, Michèle Ngassa [Case report] - Hypoxemia after pneumothorax exsufflation: a case report - 16 November 2017. <b>We describe a 36-year-old patient who was admitted to the emergency ward for acute dyspnea due to a spontaneous pneumothorax. He was successfully drained but shortly after presented a severe hypoxemia due to pulmonary oedema secondary to pulmonary re-expansion. The physiopathology behind this complication is still unknown. We will try to describe this complication and its predictive factors.</b><br/> text/html 2017-11-25T09:37:31+01:00 Abdoulaye Diallo Harouna, Karima Atarraf, Abderrahmane My Afifi [Case report] - Calcinose pseudo-tumorale primitive chez l’enfant - 16 November 2017. <b>La calcinose pseudo-tumorale est une tumeur b&eacute;nigne relativement rare, elle se caract&eacute;rise par un d&eacute;p&ocirc;t de mat&eacute;riel calcique dans les tissus mous p&eacute;ri-articulaires. Nous rapportons un cas de calcinose tumorale primitive de la hanche gauche d&eacute;couvert chez un enfant de 15 ans avec une revue de la litt&eacute;rature. La patiente a &eacute;t&eacute; op&eacute;r&eacute;e avec une ex&eacute;r&egrave;se totale de la masse, les suites postop&eacute;ratoires &eacute;taient simples. 6 mois apr&egrave;s l’intervention il n’y a pas de r&eacute;cidive tumorale.</b><br/> text/html 2017-11-25T09:37:31+01:00 Emmanuel Tettey Sally, Ernest Kenu [Research] - Evaluation of access and utilization of EPI services amongst children 12-23 months in Kwahu Afram Plains, Eastern region, Ghana - 15 November 2017. <b>INTRODUCTION: High vaccination coverage is required to successfully control, eliminate and eradicate vaccine preventable diseases (VPDs). In Ghana, access complete vaccination coverage is 77%. However, sustaining high coverages in island communities such as Kwahu Afram Plains North (KAPN) is still a challenge. METHODS: a descriptive cross-sectional study was conducted in January 2016 at KAPN, an Island district. It targeted children aged 12-23 months. We used a modified WHO EPI 30 by7 cluster sampling approach. Semi-structured questionnaires were employed for data collection. Wincosas and Epi-Info were used for data entry, management and analysis. RESULTS: of the 480 records of children analysed, fully vaccinated accounted 81.3%, partially 16.7% and not vaccinated at all 2.1%. Access was 97.3% and utilization 91.2% with Pentavalent 1-3 dropout rate of 8.8%. Coverage for specific antigens were: BCG (97.1%), OPV 1/Pentavalent 1/PCV 1/Rotarix 1 (97.3%), OPV2/ Pentavalent 2/PCV 2/Rotarix 2 (94.0%), OPV3/ Pentavalent3/PCV 3 (88.8%), MR (87.7%) and YF (87.7%). Vaccination card availability, higher educational level of mothers and lower parity levels were significantly associated (p < 0.05) positively with childhood vaccination status. Invalid doses were 21.6% of childhood total vaccinations. Key reasons accounting for non-vaccination were: distant place of immunization 34.4 % (31/90), mother being busy 14.4% (13/90), vaccine unavailability 10.0% (9/90) and fears of side reactions 8.9% (8/90). CONCLUSION: EPI childhood vaccination coverage for January, 2016 in KAPN District was high. There is the need to focus on counteracting the reasons identified to account for vaccination failure. This would improve and sustain vaccination coverage.</b><br/> text/html 2017-11-25T09:37:31+01:00 Eyerusalem Kassa Mendedo, Yemaneh Berhane, Biniyam Tadesse Haile [Research] - Factors associated with sanitary conditions of food and drinking establishments in Addis Ababa, Ethiopia: cross-sectional study - 15 November 2017. <b>INTRODUCTION: Food borne illness has been a global challenge and it persisted as a major public health problem, which consumes significant amounts of health care resources, particularly in the developing world. Poor sanitary conditions of food and drinking establishments are the major cause for the occurrence of food borne illness. This study mainly assessed sanitary conditions of food and drinking establishments in Arada sub-city, Addis Ababa, Ethiopia. METHODS: a cross-sectional study design with stratified simple random sampling technique was used. Data were collected from 587 licensed food and drinking establishments and their managers, using interviewer administered questionnaire and observation checklist. The data were entered using Epi info version 3.5.3 and analyzed using SPSS version 20. Binary and Multi-variable logistic regression analyses were conducted. RESULTS: the study showed 58.8% of food and drinking establishments were under poor sanitary conditions; only 16.5% of the establishments had a proper liquid waste disposal facility, and only 7.2% had a suitable dish washing facility. Availability of trained managers on hygiene and sanitation (AOR = 2.56, 95% CI: 1.66-3.94); inspection from the respective body (AOR = 4.41, 95% CI: 2.9-6.8) and the distance between kitchen and toilet (AOR = 1.8, 95% CI: 1.1-3.0) were associated factors which affected sanitary conditions. CONCLUSION: a majority of the establishments had poor sanitary conditions; where an absence of sanitary facilities for waste management was major cause. Regulatory bodies should conduct regular inspection on the establishments to promote and ensure proper hygiene and sanitation practices.</b><br/> text/html 2017-11-25T09:37:31+01:00 Said Zizah, Amine Marzouki, Kamal Lahrach, Fawzi Boutayeb [Case report] - Un cas rare de luxation sous-talienne externe - 15 November 2017. <b>La luxation sous-talienne est une l&eacute;sion tr&egrave;s rare. Il s'agit d'une urgence orthop&eacute;dique. La variante externe est exceptionnelle. Elle se voit rarement apr&egrave;s un accident de sport. Les auteurs rapportent le cas d'un footballeur qui a pr&eacute;sent&eacute; une luxation sous-talienne externe ouverte stade II de Couchoix Duparc suite &agrave; un accident de sport lors d'une comp&eacute;tition. Le traitement a &eacute;t&eacute; orthop&eacute;dique. Apr&egrave;s un an de recul, le r&eacute;sultat fonctionnel &eacute;tait satisfaisant.</b><br/> text/html 2017-11-25T09:37:31+01:00 Souha Kallel, Abdel Mounem Ghorbel [Images in medicine] - Kyste arachno&iuml;dien du sinus sph&eacute;no&iuml;dal: diagnostic diff&eacute;rentiel d’une mucoc&egrave;le - 15 November 2017. <b>Il s'agissait d'une patiente &acirc;g&eacute;e de 45 ans, sans ant&eacute;c&eacute;dents de traumatisme cr&acirc;nien, qui a consult&eacute; pour des c&eacute;phal&eacute;es intermittentes isol&eacute;es &eacute;voluant depuis le jeune &acirc;ge. L'examen clinique &eacute;tait strictement normal. Le scanner c&eacute;r&eacute;bral a montr&eacute; une l&eacute;sion hypodense expansive ost&eacute;olytique du sinus sph&eacute;no&iuml;dal s'&eacute;tendant vers la fosse infra-temporale en bas et la fosse temporale en haut (A). Cette masse ne prenait pas le produit de contraste. Une mucoc&egrave;le a &eacute;t&eacute; suspect&eacute;e et un compl&eacute;ment par IRM a &eacute;t&eacute; r&eacute;alis&eacute;. Cette derni&egrave;re a montr&eacute; que la masse avait le m&ecirc;me signale que le LCR et en continuit&eacute; avec la m&eacute;ninge temporale sans modification du parenchyme c&eacute;r&eacute;bral (B, C). Le diagnostic d'un kyste arachno&iuml;dien a &eacute;t&eacute; retenu. Devant l'extension du kyste et l'absence de paralysie nerveuse, la d&eacute;cision &eacute;tait l'abstention th&eacute;rapeutique et la surveillance clinique et radiologique. En conclision, les l&eacute;sions kystiques &eacute;tendues du sph&eacute;no&iuml;de sont relativement rares et peuvent provoquer des sympt&ocirc;mes non sp&eacute;cifiques. Bien que ce soit une l&eacute;sion tr&egrave;s rare, le kyste arachno&iuml;dien doit &ecirc;tre pr&eacute;sent &agrave; l'esprit. Le plus souvent, son diagnostic peut &ecirc;tre d&eacute;termin&eacute; &agrave; partir des donn&eacute;es de la TDM coupl&eacute;e &agrave; l'IRM avec s&eacute;quence de Diffusion, qui permettent le diagnostic diff&eacute;rentiel avec les autres l&eacute;sions, notamment avec une mucoc&egrave;le.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohammed Akibu, Fiseha Gebresillasie, Fitsum Zekarias, Wintana Tsegaye [Research] - Premarital sexual practice and its predictors among university students: institution based cross sectional study - 15 November 2017. <b>INTRODUCTION: Adolescents are susceptible to different social, peer and cultural pressures that Drives them into earlier sexual experimentation. Despite the fact that delaying sexual activity until marriage reduces the spread of HIV/AIDS and various sexually transmitted infections (STI), sexual activities among youths have been reported to be increasing worldwide. METHODS: Institution Based cross-sectional survey was conducted between January 2016 to March 2016. A total of 604 students were included in the study using multi-stage sampling technique. Mixed Quantitative and Qualitative approach was applied. Bivariate and multivariate logistic regression model was fitted to identify factors associated with premarital sexual practice. RESULTS: The proportion of premarital sexual practice in the study area was found to be 54.3%. The mean age of first sexual debut was 18.7±1.96. Half (50.6%) of these sexual activities were performed because of student's interest to meet their sexual desire. Being Male, watching pornography and High academic performance were the factors significantly associated with premarital sexual practice.</b><br/> text/html 2017-11-25T09:37:31+01:00 Jih&egrave;ne Methlouthi, Nabiha Mahdhaoui, Manel Bellalah, Hedia Ayache, Sonia Nouri, Hassen Seboui [Case series] - La varicelle p&eacute;rinatale: risques et prise en charge fœtale et n&eacute;onatale - 15 November 2017. <b>La survenue d'une varicelle clinique en cours de grossesse est rare, pouvant entrainer des risques maternels et fœtaux. La varicelle maternelle p&eacute;rinatale peut entrainer une varicelle n&eacute;onatale potentiellement grave, notamment en cas d'&eacute;ruptions maternelles survenant entre 5 jours avant et 2 jours apr&egrave;s l'accouchement. Nous rapportons huit observations de nouveau-n&eacute;s de m&egrave;res ayant eu une varicelle en p&eacute;ri-partum dans le but de synth&eacute;tiser, l'&eacute;tat actuel des connaissances sur le risque de ce virus et d'essayer d'&eacute;laborer un protocole de prise en charge. Il s'agit d'une &eacute;tude descriptive men&eacute;e au centre de maternit&eacute; et de n&eacute;onatologie de Sousse, sur une p&eacute;riode de 10 ans. Huit nouveau-n&eacute;s ont &eacute;t&eacute; inclus dans l'&eacute;tude. Le diagnostic &eacute;tait fait avant l'accouchement chez 7 m&egrave;res. Une seule femme avait d&eacute;velopp&eacute; sa varicelle 3 jours apr&egrave;s l'accouchement. Cinq nouveau-n&eacute;s &eacute;taient symptomatiques &agrave; l'admission. Ils avaient tous des l&eacute;sions cutan&eacute;es typiques de la varicelle, trois parmi eux avaient une atteinte respiratoire associ&eacute;e. La prise en charge &eacute;tait bas&eacute;e sur l'isolement des nouveau-n&eacute;s, les soins locaux, et le traitement par Acyclovir. L'&eacute;volution &eacute;tait favorable dans tous les cas. La survenue d'une varicelle au cours de la grossesse reste possible dans les pays ou la vaccination n'est pas encore accessible &agrave; tous. Les risques de complications maternelles et fœtales qu'elle occasionne justifient une prise en charge sp&eacute;cifique et bien codifi&eacute;e.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mitchel Otieno Okumu, Francis Okumu Ochola, Allan Odhiambo Onyango, James Mucunu Mbaria, Daniel Waweru Gakuya, Laetitia Wakonyu Kanja, Stephen Gitahi Kiama, Mary Atieno Onyango [Review] - The legislative and regulatory framework governing herbal medicine use and practice in Kenya: a review - 15 November 2017. <b>Complementary and alternative medicine is an integral component of primary healthcare in Kenya. This is because the infrastructural health setup in the country is inadequate in catering for all the medical needs of the population. This particularly holds true in the rural areas where many rural folk rely on products of herbal origin to offset their healthcare needs. More often than not these products are an elaborate cacophony of several different substances of biological origin and thus need personnel adept in their preparation. Sadly, due to loopholes in legislation and regulation, quacks have a field day in the practice. Moreover, the process of planting, harvesting, preparation and storage of herbs and related products dictates that a significant number of people will ultimately be involved in the whole process. This is likely to set the stage for manipulation and compromise of the safety, quality and efficacy of these products. This state of affairs appears unabated especially in the context of the current legal and regulatory framework governing herbal medicine use and practice in Kenya. Not only are these laws inadequate, they are shrouded in ambiguity, open to interpretation and the authorities mandated to implement them often end up performing duplicate roles. The aim of this review is to critique the legal and regulatory provisions governing herbal medicine use and practice in Kenya. In conclusion, laws and regulations meant to control herbal medicine use and practice in Kenya are wanting. Clear and definitive legislation on herbal medicine use and practice coupled with effective implementation by mandated institutions will go a long way in inspiring confidence to all stakeholders of herbal medicine.</b><br/> text/html 2017-11-25T09:37:31+01:00 Fatemeh Oskouie, Farzaneh Kashefi, Forough Rafii, Mohammad Mehdi Gouya [Research] - Barriers to self-care in women of reproductive age with HIV/AIDS in Iran: a qualitative study - 15 November 2017. <b>INTRODUCTION: Although increasing attention is paid to HIV/AIDS, patients with HIV still experience several barriers to self-care. These barriers have been previously identified in small quantitative studies on women with HIV, but qualitative studies are required to clarify barriers to self-care. METHODS: we conducted our study using the grounded theory methodological approach. A total of 28 women with HIV and their family members, were interviewed. The data were analyzed with the Corbin and Strauss method (1998). RESULTS: the key barriers to self-care in women with HIV/AIDS included social stigma, addiction, psychological problems, medication side-effects and financial problems. CONCLUSION: women with HIV/AIDS face several barriers to self-care. Therefore, when designing self-care models for these women, social and financial barriers should be identified. Mental health treatment should also be incorporated into such models and patients' access to health care services should be facilitated.</b><br/> text/html 2017-11-25T09:37:31+01:00 Bankole Peter Kuti, Oluwatoyin Ibukun Oladimeji, Demilade Kehinde Kuti, Adewuyi Temidayo Adeniyi, Emmanuel Oluwatosin Adeniji, Yetunde Justinah Osundare [Research] - Rural-urban disparity in lung function parameters of Nigerian children: effects of socio-economic, nutritional and housing factors - 15 November 2017. <b>INTRODUCTION: The effect of socio-demographic and nutritional factors on lung functions of African children is poorly studied. This study set out to determine the effects of these factors on lung functions of Nigerian school children. METHODS: rural and urban secondary schools students in Ilesa, Nigeria were selected by multistage sampling. The socio-demographic, nutritional status as well as lung function parameters measured using incentive Spirometry (MIR Spirolab III srl, Italy) of the children were obtained and compared among the rural and urban children. RESULTS: a total of 250 children (128 rural and 122 urban) aged 9 to 17 years participated in the study over a 12 month period. Mean (SD) age was 12.6 (1.9) years and Male: Female 1:1.1. The urban children were heavier, taller and have larger lung volumes than their age and sex matched rural counterpart. Stunted rural males [Mean (SD) FVC 1.8 (0.3) L vs. 2.2 (0.6) L t-test = 2.360; p = 0.022], underweight females [Mean (SD) FVC 1.8 (0.4) L vs. 2.2 (0.6) L; t-test = 2.855; p = 0.006] and those exposed to unclean fuel [Mean (SD) FVC 2.1 (0.6) L vs. 2.4 (0.5) L; t-test = 2.079; p = 0.041] had significantly lower lung volumes compared to their counterparts without these conditions. CONCLUSION: undernutrition, low socio-economic class and use of unclean fuels adversely affect the lung functions of Nigerian children. Improved standard of living, use of clean fuel and adequate nutrition may ensure better lung health among these children.</b><br/> text/html 2017-11-25T09:37:31+01:00 Isaac Ogweno Owaka, Margaret Keraka Nyanchoka, Harryson Etemesi Atieli [Research] - Intimate partner violence in pregnancy among antenatal attendees at health facilities in West Pokot county, Kenya - 15 November 2017. <b>INTRODUCTION: The objective of this study was to investigate factors contributing to intimate partner violence in pregnancy among antenatal attendees at the health facilities in West Pokot Sub-County. The study was done in West Pokot Sub-County. METHODS: using cross sectional study design, a total of 238 antenatal attendees were systematically sampled for the study. Four focused group discussions and 20 key informant interviews were conducted for qualitative data collection. Qualitative data was consolidated into various themes while bivariate and logistic regression analysis was done to determine factors associated with experience of IPV in the index of pregnancy with P &#8804; 0.05 being considered significant. RESULTS: the study found prevalence of overall, physical, psychological and sexual IPV in pregnancy to be 66.9%, 29.9%, 55.8% and 39.2% respectively. After adjusting for confounders, Overall IPV in pregnancy was significantly associated with Alcohol intake by partner (OR 2.116, 95% CI 1.950-2.260, P 0.000) and partner's level of education (OR 1.265, 95% CI 1.079-1.487, P 0.031), while psychological and sexual IPV was significantly associated with age of partner (OR 2.292, 95% CI 2.123-2.722, P 0.007) and age of pregnant women (OR 1.174, 95% CI 1.001-1.397 P 0.049) respectively. The care offered to antenatal attendees experiencing IPV was not in line with WHO guidelines and standard on handling gender based violence cases. CONCLUSION: the study finding indicates that IPV in pregnancy among antenatal attendees in West Pokot is very high. This unearths the gaps on gender based violence interventions in the maternal and child health programs.</b><br/> text/html 2017-11-25T09:37:31+01:00 Nisrine Mamouni, Siham Boumhaoued, Sanae Erraghay, Meriem Boubou, Chahrazed Bouchikhi, Abdelaziz Banani [Case report] - Tumeurs trophoblastiques gestationnelles: aspects cliniques et radiologiques - 14 November 2017. <b>La maladie trophoblastique gestationnelle englobe un groupe de maladies qui diff&egrave;rent les unes des autres par leur &eacute;volution vers la r&eacute;gression, aux m&eacute;tastases et &agrave; la r&eacute;currence. C'est une maladie grave qui touche les femmes en &acirc;ge de procr&eacute;er. Les tumeurs trophoblastiques gestationnelles (TTG) repr&eacute;sentent les formes malignes des maladies trophoblastiques gestationnelles. Elles font toujours suite &agrave; une grossesse, le plus souvent m&ocirc;laire (m&ocirc;le hydatiforme). Le type le plus courant de tumeurs trophoblastique gestationnelle (TTG) est la mole invasive, car, dans la plupart des cas, le diagnostic est fait lorsque le cancer est encore confin&eacute; &agrave; l'ut&eacute;rus. Le choriocarcinome est un type plus rare qui g&eacute;n&egrave;re souvent des m&eacute;tastases &agrave; distance. Dans les cas de progression vers une tumeur trophoblastique, la mise en place d'un bilan d'extension locor&eacute;gional et &agrave; distance est essentielle au choix d'un protocole de traitement appropri&eacute;. Les auteurs rapportent trois observations cliniques de TTG en d&eacute;crivant leurs pr&eacute;sentations cliniques et l'utilisation de techniques d'imagerie dans le diagnostic et la prise en charge de ces affections.</b><br/> text/html 2017-11-25T09:37:31+01:00 Kehinde Sharafadeen Okunade, Chidinma Magnus Nwogu, Ayodeji Ayotunde Oluwole, Rose Ihuoma Anorlu [Research] - Prevalence and risk factors for genital high-risk human papillomavirus infection among women attending the out-patient clinics of a university teaching hospital in Lagos, Nigeria - 14 November 2017. <b>INTRODUCTION: Cervical cancer is the second most common cancer among women in the developing countries and the seventh commonest cancer in the developed countries. Human papillomavirus (HPV) is now known to be the main factor in the aetiology of cervical cancer with over 99.7% of cases being associated with previous high risk HPV (hrHPV) infection. This study was aimed to determine the prevalence and risk factors for genital hrHPV infection among women attending the out-patient clinics of the Lagos University Teaching Hospital. METHODS: this was a cross-sectional study involving a total of 200 women. Questionnaires were administered to collect data such as sociodemographic, reproductive and sexual histories. Endocervical swab samples were then taken from each participant. Samples were analyzed by polymerase chain reaction (PCR) using consensus primers targeted against the hrHPV viruses. RESULTS: the prevalence of hrHPV in the study was 36.5%. The most predominant HPV subtypes were 31 (25.0%), 35 (8.0%) and 16 (3.5%) with the largest proportion (76.1%) of the tested samples being positive for only a single hrHPV subtype. The study showed statistically significant associations between early age at coitarche (P = 0.032) and increasing number of lifetime sexual partners (P = 0.001) with genital hrHPV infection. CONCLUSION: the prevalence of hrHPV was high in Lagos with the majority of test positive samples having only a single HPV genotype. We demonstrated early age of sexual debut and increasing number of lifetime sexual partners as the most important factors associated with genital hrHPV infection.</b><br/> text/html 2017-11-25T09:37:31+01:00 Joseph Odirichukwu Ugboaja, Charlotte Blanche Oguejiofor, Anthony Osita Igwegbe [Research] - Clinico-hysteroscopic analysis of severe intrauterine adhesions among nigerian infertile women - 14 November 2017. <b>INTRODUCTION: Severe intrauterine adhesions are difficult to manage and are associated with poor reproductive outcomes following treatment. The objective was to study the clinical presentation and hysteroscopic findings of severe intrauterine adhesions seen at hysteroscopy in two fertility/gynaecological endoscopy units in Nigeria. METHODS: a prospective study of 19 out of 76 women managed for intrauterine adhesions in our units. Data were analyzed with STATA software, version 12.0 SE (Stata Corporation, TX, USA). RESULTS: severe intrauterine adhesion accounted for 19 (25.0%) of 76 cases of intrauterine adhesions managed during the period. This constituted 11.9% of 160 infertile women who had diagnostic hysteroscopies in our units over the study period. The mean duration of symptom was 4.2 years +/-3.2. Amenorrhea in association with infertility (68.4%) was the main presenting complaint. Secondary dysmenorrhea and cyclical abdominal pain were found in 10.8% and 31.6% of the women respectively. The main aetiological events were complicated caesarean section (42.1%) and abdominal myomectomy (26.3%). The adhesions were mainly dense (52.6%) and multiple (94.7%) with complete involvement of the uterine cavity in all the cases. Obliterative lesions were seen in 63.2% of the women. CONCLUSION: the main clinical presentation of severe IUA was amenorrhea and infertility while the major risk factors were complicated caesarean section and myomectomy. The adhesions were mainly multiple, dense, obliterative and complete.</b><br/> text/html 2017-11-25T09:37:31+01:00 Saleh Muhemedi, Yakim Kabangu, Faustin Mpeli, Salomon Salumu, Philippe Kabeya, Emile Okitolonda [Research] - Evolution du système national d’information sanitaire de la République Démocratique du Congo entre 2009 et 2015 - 14 November 2017. <b>INTRODUCTION: Lanc&eacute; en 1987, le Syst&egrave;me national d'information sanitaire (SNIS) de la R&eacute;publique D&eacute;mocratique du Congo (DR Congo) a &eacute;t&eacute; &eacute;valu&eacute; en 2009 et 2015 moyennant l'outil l HMN (Health metrics network). L'objectif de cette &eacute;tude &eacute;tait d'estimer les progr&egrave;s r&eacute;alis&eacute;s entre ces deux &eacute;valuations. METHODES: il s'agissait d'une analyse des donn&eacute;es secondaires d'&eacute;valuations du SNIS, qui a consist&eacute; &agrave; comparer le degr&eacute; de satisfaction par rapport aux six composantes de cet outil entre 2009 et 2015, &agrave; savoir; les ressources, les indicateurs, les sources de donn&eacute;es, la gestion des donn&eacute;es, les produits de l'information, la diffusion et l'utilisation des donn&eacute;es. RESULTATS: entre 2009 et 2015, le degr&eacute; de satisfaction des r&eacute;pondants a &eacute;volu&eacute;s de la mani&egrave;re suivante: 49% contre 61% pour les ressources; 73% vs 88% pour les indicateurs; 52% vs 61% pour les sources de donn&eacute;es; 41% vs 45% pour la gestion des donn&eacute;es; 74% contre 77% pour les produits de l'information et enfin 51% vs 51% pour la diffusion et l'utilisation des donn&eacute;es. Dans l'ensemble, le score moyen est pass&eacute; de 59% &agrave; 64% avec une mention « satisfaisante ». CONCLUSION: notre &eacute;tude a montr&eacute; que le SNIS de la RD Congo n'a pas significativement &eacute;volu&eacute;e entre 2009 et 2015, et n'&eacute;tait pas en mesure de fournir en temps r&eacute;el l'information sanitaire fiable pour la prise de d&eacute;cision et la planification des programmes de sant&eacute;.</b><br/> text/html 2017-11-25T09:37:31+01:00 Eric Yirenkyi Adjei, Keziah Laurencia Malm, Kofi Nyarko Mensah, Samuel Oko Sackey, Donne Ameme, Ernest Kenu, Marijanatu Abdulai, Richael Mills, Edwin Afari [Research] - Evaluation of cholera surveillance system in Osu Klottey District, Accra, Ghana (2011-2013) - 13 November 2017. <b>INTRODUCTION: Cholera is an acute illness characterized by profuse watery diarrhea. It is caused by vibrio cholera subgroup 01 and 0139. Rapid administration of fluid replacement therapy and supportive treatment can reduce mortality to around 1%. By the close of 2011, 10,628 cases and 100 deaths were reported in Ghana with a case fatality rate of 0.99. It is important to evaluate the cholera surveillance system in Ghana to determine if it is meeting its objective. METHODS: the study was conducted in Osu Klottey district in the Accra Metropolitan area in January 2014. We assessed the operations (attributes and performance) of the surveillance system for cholera using CDC guidelines (2001). Surveillance data records at the district level from 2011-2013 were extracted and analyzed for frequency using Microsoft excel. Stakeholders and key informants were interviewed using structured questionnaire. Records were also reviewed at some health facilities and at district levels. RESULTS: in 2011 and 2012, case fatality rates (1.3% and 0.65%) respectively. Males were mostly affected. The most affected age group was 20-29. In 2011, Predictive value positive was 69.2% and 50% in 2012.Cholera peaked in March 2011 and April 2012. The Government of Ghana funded the system. The system is sensitive, simple, stable, flexible, acceptable and representative. It was also useful and data quality was relatively good. Predictive Value Positive was also good.</b><br/> text/html 2017-11-25T09:37:31+01:00 Jide Michael Afolayan, Peter Olufemi Areo, Patrick Temi Adegun, Kolawole Olubunmi Ogundipe, Aderemi Benjamin Filani [Research] - Comparison of ease of induction of spinal anaesthesia in sitting with legs parallel on the table versus traditional sitting position - 13 November 2017. <b>INTRODUCTION: It is sometimes difficult for some patients to optimally flex their hips and knees making traditional position for induction of spinal anaesthesia difficult to achieve. The ease of induction of spinal anaesthesia was compared with patients in sitting position with legs remaining on the table (new sitting method) versus legs placed on the side stool (traditional sitting method). METHODS: one hundred eligible elderly patients, aged between 65 and 80 years, scheduled for open prostactectomy, were prospectively randomized to 2 groups, LS and LT. Patients in (LS group) had their spinal anaesthesia induced in sitting position with their legs placed on the stool while patients in (LT group) had their spinal anaesthesia induced in sitting position with their legs remaning on the operating table. The primary endpoint was correct needle placement. Numbers of attempts, needle redirections and patients' comfort were determined to compare outcome in the two groups. RESULTS: more patients in LS group (78%) than those in the LT group (64%) had successful placement of spinal needle at first attempt (P = 0.12, RR = 1.6, 95% CI = 0.863-3.102). Needle redirections were similar at first attempt (52% versus 40%; P = 0.22). The groups were equivalent with respect to 100% overall success rate (P = 1.000). It took longer time to induce spinal anaesthesia in patients in LS group (240 vs 125s, p < 0.001). Patients in LT were more comfotable. CONCLUSION: the 100% overall success rate was comparable. However, patients were generally more comfortable with their legs placed on the table.</b><br/> text/html 2017-11-25T09:37:31+01:00 Kasiye Shiferaw, Abdulbasit Musa [Research] - Assessment of utilization of long acting reversible contraceptive and associated factors among women of reproductive age in Harar City, Ethiopia - 10 November 2017. <b>INTRODUCTION: world health organization report indicated that, in 2013 alone, over 289,000 maternal death that resulted from pregnancy and delivery related complication were reported worldwide indicating a decline of 45% from 1990. The sub-Saharan Africa region alone accounted for 62% of maternal death followed by southern Asian country (24%). Provision of family planning is one of the effective intervention that prevent unwanted and ill spaced pregnancy there by reducing maternal mortality and morbidity. Given that its effectiveness and, associated fewer visits to health facilities, LARC are very important in tackling maternal mortality and morbidity. However, little is known regarding its prevalence in eastern Ethiopia. Thus, this study aimed to assess utilization of long acting reversible contraceptives and associated factors among women of reproductive age groups. METHODS: a facility based cross-sectional study conducted in Harar city among 402 study participants. The study participants selected by using systematic random sampling method. The quantitative data collected using structured interviewer administered questionnaires. All variables with p-value of d" 0.25 in bivariate logistic regression were taken into multivariable model. Variables having p value d" 0.05 in the multivariate analysis were taken as significant predictors. Crude and adjusted odds ratios with their 95% confidence intervals were calculated. RESULTS: the study identified that the utilization of long acting reversible contraceptive among mother of reproductive age was 38%. Study participants whose occupation was daily laborer were less likely to utilize long acting reversible contraceptive compared to those whose occupation was house wife (adjusted OR = 0.3; 95% CI 0.01 to 0.8). Moreover, those mothers who were unable to read and write utilize long acting reversible contraceptive 5 times more likely compared to those who were above grade 12 (adjusted OR = 4.9; 95% CI 1.2 to 19.6). CONCLUSION: the prevalence of long acting reversible contraceptive was found to be low. Maternal education and occupation were factors found to have a significant association with utilization of long acting reversible contraceptive. Community and facility level awareness creation should be reinforced to improve utilization of long acting reversible contraceptives.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mariam Adeola Toye, Kehinde Sharafadeen Okunade, Alero Ann Roberts, Omolola Salako, Ezekiel Sofela Oridota, Adebayo Temitayo Onajole [Research] - Knowledge, perceptions and practice of cervical cancer prevention among female public secondary school teachers in Mushin local government area of Lagos State, Nigeria - 10 November 2017. <b>INTRODUCTION: cervical cancer is the most common gynecological cancer and a leading cause of cancer death in women in Nigeria. This study was aimed to assess the knowledge, perception, and practice of cervical cancer prevention among female public secondary school teachers in Mushin, Lagos. METHODS: this was a cross-sectional study carried out among female secondary school teachers in Mushin, Lagos. The participants were selected by a two-stage random sampling method and relevant data were collected with the use a self-administered questionnaire. Data entry and analysis were done using Epi-info version 7.2 statistical software and descriptive statistics were computed for all data. RESULTS: the knowledge of cervical cancer and its prevention was 100.0% among the respondents. The most commonly known method of cervical cancer screening identified by the respondents was Papanicolaou smear (91.4%). More than half of the women (67.0%) have had at least one cervical cancer screening done previously. Only 2.2% of the respondents have had HPV vaccine given to their female teenage children in the past despite the acceptance rate for HPV vaccination being 76.2%. CONCLUSION: this study, unlike most previous studies in other regions of Nigeria and most part of sub-Saharan Africa, has demonstrated a relatively high level of awareness about cervical cancer, its cause, risk factors and prevention. However, conversely, the absence of a national health programme means that screening and vaccination centers are not available, accessible or affordable.</b><br/> text/html 2017-11-25T09:37:31+01:00 Youssef Hnach, Mohamed Allaoui, Mohamed Oukabli [Case report] - Tumeur d’Abrikossoff &agrave; localisation gastrique: &agrave; propos d’un nouveau cas - 09 November 2017. <b>Les tumeurs &agrave; cellules granuleuses (TCG) sont des tumeurs peu fr&eacute;quentes. Elles sont localis&eacute;es pr&eacute;f&eacute;rentiellement eu niveau de la peau et des tissus sous-cutan&eacute;s. La localisation gastrique reste rare. A un nouveau cas de tumeur d'Abrikossoff &agrave; localisation gastrique ainsi qu'une br&egrave;ve revue de la litt&eacute;rature, on se propose d'&eacute;tudier les particularit&eacute;s cliniques, endoscopiques et th&eacute;rapeutiques de cette entit&eacute; rare.</b><br/> text/html 2017-11-25T09:37:31+01:00 Nadia Kabbali, Tarik Sqalli [Images in medicine] - Kyste hydatique r&eacute;nal fistulis&eacute; dans les voies urinaires chez un h&eacute;modialys&eacute; chronique - 09 November 2017. <b>L'hydatidose est une parasitose li&eacute;e au d&eacute;veloppement de la forme larvaire d'Echinococcus granulosus. Le kyste hydatique r&eacute;nal constitue une localisation inhabituelle. Il peut se fistuliser dans les voies excr&eacute;trices urinaires et n&eacute;cessiter alors une prise en charge sp&eacute;cifique. Nous pr&eacute;sentons ici un cas t&eacute;moignant de la sp&eacute;cificit&eacute; diagnostique et th&eacute;rapeutique de cette pathologie chez les patients en h&eacute;modialyse chronique, chez qui la diur&egrave;se n’est pas toujours conserv&eacute;e pour t&eacute;moigner de l’hydaturie et orienter le diagnostic. Il s’agit donc d’un patient de 47 ans, en h&eacute;modialyse depuis 4 ans pour une n&eacute;phropathie glom&eacute;rulaire d&eacute;couverte au stade terminal. Le patient pr&eacute;sente depuis 6 mois une alt&eacute;ration de l’&eacute;tat g&eacute;n&eacute;ral avec des lombagies droites, sans fi&egrave;vre. La TDM abdominale montre un rein droit mesurant 13,4cm, si&egrave;ge d’une importante dilatation ur&eacute;t&eacute;ro-py&eacute;lo-calicielle laminant le parenchyme r&eacute;nal, avec un py&eacute;lon mesur&eacute; &agrave; 4,3cm, sans obstacle lithiasique visible. Cependant on individualise au niveau polaire inf&eacute;rieur droit, une formation kystique contenant des membranes, mesurant approximativement 76,5 x 54mm, communiquant avec le py&eacute;lon qui contient &eacute;galement quelques membranes. Un interrogatoire plus laborieux a r&eacute;v&eacute;l&eacute; la pr&eacute;sence d’une hydaturie sur les quelques gouttes de diur&egrave;se r&eacute;siduelle. Vu que le patient est en insuffisance r&eacute;nale chronique terminale en traitement de suppl&eacute;ance, le choix th&eacute;rapeutique s’est port&eacute; sur une n&eacute;phrectomie totale.</b><br/> text/html 2017-11-25T09:37:31+01:00 Burcu Karakayali, Ahmet Sami Yazar, Deniz &Ccedil;akir, Aysen Cetemen, Mandana Kariminikoo, Burak Deliloglu, Sirin Guven, Ismail Islek [Case report] - Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome associated with cefotaxime and clindamycin use in a 6 year-old boy: a case report - 09 November 2017. <b>Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially life-threatening idiosyncratic drug reaction. It presents with extensive rash, fever, lymphadenopathy, hematologic abnormalities (eosinophilia and/or atypical lymphocytosis) and internal organ involvement. It has been described in association with more than 50 drugs. To the best of our knowledge neither cefotaxime nor clindamycin has been previously reported to induce DRESS syndrome in children. Clindamycin was reported only in adults as a cause of DRESS syndrome in the literature. In this report, we aimed to present a child with DRESS syndrome that developed after cefotaxime and clindamycin treatment. A 6-year-old boy was diagnosed with the left lower lobe pneumonia and pleural effusion. Parenteral cefotaxime and clindamycin were then started, after which the patient improved clinically and was discharged 7 days later with oral amoxicillin clavulanate treatment. After four days he was readmitted to the hospital with fever and cough. Chest X-ray revealed left lower lobe pneumonia and pleural effusion. We considered that the pneumonia was unresponsive to oral antibiotic treatment, and thereforeparenteral cefotaxime and clindamycin were re-administered. As a result, his clinical and radiological findings were improved within 10 days. On the 12th of day of hospitalization, the body temperature has risen to 39°C, which we considered to be caused by antibiotics and stopped antibiotic treatment. At the same day he developed generalized maculopapular erythematous rash, which was considered an allergic reaction secondary to antibiotics. Despite the antihistaminic drug administration, the clinical status quickly deteriorated with generalized edema, lymphadenopathies and hepatosplenomegaly. Laboratory tests revealed a white blood cell count of 4300/µl, a lymphocyte count of 1300/µl, a hemoglobin level of 11.2 gr/dl, a platelet count of 120.000/µl, an eosinophilia ratio of 10% on peripheral blood smear, a C-reactive protein level of 20 mg/dl, a procalcitonin level of 23.94 ng/ml and an erythrocyte sedimentation rate of 48 mm/h. Anti nuclear antibody, anti-double strain DNA, the serologic tests for Epstein Bar virus, herpes simplex virus, parvovirus, mycoplasma, toxoplasmosis, rubella, cytomegalovirus were all found negative. Bone marrow aspiration was consistent with an autoimmune reaction. An echocardiographic examination was normal. Thoracic tomography revealed multiple enlarged axillary, supraclavicular and anterior mediastinal lymph nodes. As the patient met 9 out of 10 RegiSCAR criteria for the diagnosis of DRESS, we started pulse methyl prednisolone (30 mg/kg/day) for three days followed by 2 mg/kg/day. On the 2nd day fever resolved and cutaneous rash and edema improved. Ten days after developing eruptions the patient was discharged. To our knowledge, we report the first pediatric case of DRESS syndrome following treatment with cefotaxime and clindamycin. Pediatricians should be aware of this potential complication associated with these commonly prescribed antibiotics.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohamed Rida Ajaja, Amine Cheikh, El Mehdi Moutaouekkil, Mohcine Madani, Moha Arji, Amine El Hassani, Brahim Lakhal, Anas Slaoui [Case report] - Endovascular treatment of acute aortic isthmian ruptures: case study - 09 November 2017. <b>Traumatic rupture of the aortic isthmus is a rare lesion occurring in patients subjected to violent deceleration. Because of the forces involved, it is frequently associated with concomitant life-threatening injuries. The endovascular intervention has been described to be a feasible and efficient technique which may be proposed as a therapeutic option for patients with multiple traumas instead of delayed classical surgical repair after stabilization. We report the case of an adult who has had an accident with a traumatic rupture of the aortic isthmus associated with other lesions, our patient received endovascular treatment. The aortic prosthesis was imported from France and the surgery was done 3 days after the patient's admission. This procedure was performed for the first time in Morocco in our hospital with a multidisciplinary team. The prosthesis was implemented successfully and the result was very satisfactory on the heart level.</b><br/> text/html 2017-11-25T09:37:31+01:00 Jovanny Tsuala Fouogue, Robert Tchounzou, Florent Ymele Fouelifack, Jeanne Hortence Fouedjio, Julius Sama Dohbit, Zacharie Sando, Emile Telesphore Mboudou [Research] - Evaluation of patients’ satisfaction after laparoscopic surgery in a tertiary hospital in Cameroon (Africa) - 08 November 2017. <b>INTRODUCTION: Access to laparoscopy is low in Cameroon where customers' satisfaction has not been reported so far. We assessed patients' satisfaction with the process of care during laparoscopic surgery in a new tertiary hospital. METHODS: A questionnaire was addressed to consenting patients (guardians for patients under 18) with complete medical recordswho underwent laparoscopyat the Douala Gynaeco-Obstetric and Paediatric Hospital (Cameroon) from November 1, 2015 to July 31, 2016. The following modified Likert's scale was used to assess satisfaction: very weak: 0-2.5; weak 2.6-5; good: 5.1-7.5; very good: 7.6-10. Only descriptive statistics were used. RESULTS: Response rate was 90% (45/50). Of the 45 respondents, 39 (86.7%) were female, 14(31.1%) were referred and 39 (86.7%) paid by direct cash deposit. Mean age was 36.8±11.9 years. Laparoscopies were carried out in emergency for 3 (6.7%) patients. Digestive abnormalities indicated 13 (28.9%) laparoscopies while gynaecologic diseases accounted for 32 (71.1%) cases. Perception of the overallcare process was good with a mean satisfaction score of 6.8 ± 1.4. Scores in categories were: 0% (Very weak); 13.3% (weak); 57.8% (Good) and 28.9% (very good). Specifically mean satisfaction scores were: 7.8 ± 1.0 with doctors' care; 7.1 ± 1.3 with hospital administration; 7.0 ± 1.2 with nursing and 4.7 ± 1.4 with the costs. Maincomplaints were: long waiting time (73.3%), constraining geographical access(66.7%) and expensiveness (48.9%). CONCLUSION: Patients were globally satisfied with the process of care but financial and geographical barriers should be addressed.</b><br/> text/html 2017-11-25T09:37:31+01:00 Steven Ndugwa Kabwama, Richardson Mafigiri, Stephen Balinandi, Atek Kagirita, Alex Ario Riolexus, Bao-Ping Zhu [Research] - Risk factors for hematemesis in Hoima and Buliisa Districts, Western Uganda, September-October 2015 - 08 November 2017. <b>INTRODUCTION: on 17 September 2015, Buliisa District Health Office reported multiple deaths due to haemorrhage to the Uganda Ministry of Health. We conducted an investigation to verify the existence of an outbreak and to identify the disease nature, mode of transmission and risk factors. METHODS: we defined a suspected case as onset of hematemesis between 1 June 2015 and 15 October 2015 in a resident of Hoima, Buliisa or neighbouring districts. We identified cases by reviewing medical records and actively searching in the community. We interviewed case-patients and health-care workers and performed descriptive epidemiology to generate hypotheses on possible exposures. In a case-control study we compared exposures between 21 cases and 81 controls, matched by age (± 10 years), sex and village of residence. We collected 22 biological specimens from 19 case-patients to test for Viral Haemorrhagic Fevers (VHF). We analysed the data using the Mantel-Haenszel method to account for the matched study design. RESULTS: We identified 56 cases with onset from June to October (attack rate 15/100,000 in Buliisa District and 5.2/100,000 in Hoima District). The age-specific attack rate was highest in persons aged 31-60 years (15/100,000 in Hoima and 47/100,000 in Buliisa); no persons below 15 years of age had the illness. In the case-control study, 42% (5/12) of cases vs. 0.0% (0/77) of controls had liver disease (ORM-H = "; 95%CI = 3.7-"); 71% (10/14) of cases vs. 35% (28/81) of controls had ulcer disease (ORM-H = 13; 95% CI = 1.6-98); 27% (3/11) of cases vs. 14% (11/81) of controls used indomethacin prior to disease onset (ORM-H = 6.0; 95% CI = 1.0-36). None of the blood samples were positive for any of the VHFs. CONCLUSION: This reported cluster of hematemesis illness was due to predisposing conditions and use of Non-Steroidal Anti-inflammatory Drugs (NSAID). Health education should be conducted on the danger of NSAIDs misuse, especially in persons with pre-disposing conditions.</b><br/> text/html 2017-11-25T09:37:31+01:00 James Prah, Joseph Kizzie-Hayford, Emmanuel Walker, Adelaide Ampofo-Asiama [Research] - Antibiotic prescription pattern in a Ghanaian primary health care facility - 07 November 2017. <b>INTRODUCTION: a major challenge to the provision of health care worldwide is the irrational use of antibiotics. To help promote rational use of drugs, standard treatment guidelines (STG) and essential medicine lists and facility-specific formularies have been developed to be used by clinicians. This study assessed the prescription pattern of antibiotics and explored the use of STG by clinicians. METHODS: a prospective cross sectional study that made use of seven core drug use indicators was conducted from February, 2017 to July, 2017. Prescribing indicators were assessed using 388 prescriptions that were submitted for filling and dispensing at the pharmacy unit of the hospital. Clinicians were interviewed to assess their use of STG. Data were analyzed using SPSS version 20.0 with a p-value of < 0.05 considered as statistically significant. RESULTS: a total of 1351 drugs were prescribed for 388 patients. The average number of medicines per prescription was 3.5. Of the 388 prescriptions, 55.2% bore antibiotics, with amoxicillin (22.5%) and ciprofloxacin (18.4%) being the most prescribed antibiotics. Patients' knowledge about their medications was found to be significantly associated with the number of drugs per prescription (p = 0.001), age (p = 0.015) and educational level (p = 0.001). Only 41.7% of prescribers had copies of STG and used them. CONCLUSION: the prescribing and dispensing practices in the hospital were generally not satisfactory with a low patronage of STG among prescribers. In order to improve the situation, clinicians should practice evidence based medicine rather than empirical treatment of conditions as well as use the STG in practice.</b><br/> text/html 2017-11-25T09:37:31+01:00 Abdellah Taous, Maha A&iuml;t Berri, Mohamed Sinaa, Issam En-nafaa, Karim Nadour, Abdelhadi Rouimi [Case report] - An unusual presentation of neurosarcoidosis with progressive hearing loss - 07 November 2017. <b>Sarcoidosis is a granulomatous disease of unknown etiology that can involve several organ system. Neurological manifestations are not common and mostly include cranial neuropathies. However, auricular disorders are rare and exceptionally inaugural. We describe the case of a 46-year-old lady presented with hearing loss as the initial manifestation of sarcoidosis, and aim to raise awareness of this condition, that is often associated with significant morbidity.</b><br/> text/html 2017-11-25T09:37:31+01:00 Uzenia Ndatelela Mupakeleni, Kofi Mensah Nyarko, Francina Ananias, Peter Nsubuga, Emmy-Else Ndevaetela [Research] - Factors associated with Schistosomiasis outbreak at Omindamba primary school, Omusati region, Namibia: a case-control study, March 2016 - 07 November 2017. <b>INTRODUCTION: On March 2, 2016, the principal of Omindamba primary school in Outapi district notified the Outapi hospital of a cluster of students complaining of dysuria and passing bloody urine. We conducted an investigation to identify the agent, source of infection, and to determine factors associated with the outbreak. METHODS: An unmatched 1:1 case-control study was conducted. A case was defined as any student of Omindamba primary school, who passed bloody urine with or without dysuria or lower abdominal pains from 2nd- 4th March 2016, during the time of the investigation. A control was a classmate of a case. We collected demographic, clinical and environmental data. RESULTS: 125 cases and 125 controls were enrolled into the study. The mean age for cases was 11.3 years and controls was 11.0 years, with standard deviation of 3.2 years in both cases and controls. The most affected age group was 11-15 years with 63 (50.4%) cases, followed by 6-10 years with 51(40.8%) cases. Schistosoma hematobium was isolated in the urine specimens examined. Swimming in the canal (adjusted OR=3.58; 95% CI=1.14-11.2; p-value=0.03), and using Etaka pond as a source of water (adjusted OR=1.95; 95% CI=1.09-3.50, p-value=0.02) were independent factors associated with contracting schistosomiasis. CONCLUSION: The Schistosomiasis outbreak among the school children was caused by Schistosoma hematobium. Swimming in the canal and using Etaka pond as a source of drinking water were the predictive factors for the infection. A community-based health education on the prevention of Schistosomiasis was implemented.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ahmed Bensaad, Roberto Algaba [Images in medicine] - Riedel’s lobe of the liver - 07 November 2017. <b>We report the case of an 80-year-old woman, presented to our department for an Intestinal obstruction due to postoperative adhesions from an anterior exploratory laparotomy. Preoperative imaging showed a downward elongation of the liver, ending at the level of the iliac crest. Originally reported in 1888 by a German Surgeon named Carl Ludwig Riedel in seven female patients who had palpable masses, they were all confirmed by surgical exploration. The potential complications are rare and include torsion, mass effect morbidity and laparoscopic associated difficulty during different surgical procedures. Unnecessary imaging can be avoided with the knowledge of this normal variant of the right lobe of the liver.</b><br/> text/html 2017-11-25T09:37:31+01:00 Aloise Sagna, Ndeye Aby Ndoye, Cheikh Diouf, Papa Alassane Mbaye, Mbaye Fall, Azhar Salim Mohamed, Oumar Ndour, Gabriel Ngom [Case report] - Pyloric atresia: a challenge in an underdeveloped country - 07 November 2017. <b>Pyloric atresia is a rare congenital malformation. We report a case in a 5-day newborn with pyloric atresia type C. Authors emphasize the diagnostic difficulties and therapeutic challenges in a resource-limited country.</b><br/> text/html 2017-11-25T09:37:31+01:00 Dafrossa Lyimo, Christopher Kamugisha, Emmanuel Yohana, Messeret Eshetu Shibehsi, Aaron Wallace, Kirsten Ward, Carsten Mantel, Karen Hennessey [Short communication] - Improving the efficiency and standards of a National Immunization Program Review: lessons learnt from United Republic of Tanzania - 07 November 2017. <b>A National Immunization Program Review (NIP Review) is a comprehensive external assessment of the performance of a country’s immunization programme. The number of recommended special-topic NIP assessments, such as those for vaccine introduction or vaccine management, has increased. These assessments often have substantial overlap with NIP reviews, raising concern about duplication. Innovative technical and management approaches, including integrating several assessments into one, were applied in the United Republic of Tanzania’s 2015 NIP Review. These approaches and processes were documented and a post-Review survey and group discussion. The Tanzania Review found that integrating assessments so they can be conducted at one time was feasible and efficient. There are concrete approaches for successfully managing a Review that can be shared and practiced including having a well-planned desk review and nominating topic-leads. The use of tablets for data entry has the potential to improve Review data quality and timely analysis; however, careful team training is needed. A key area to improve was to better coordinate and link findings from the national-level and field teams.</b><br/> text/html 2017-11-25T09:37:31+01:00 Lamine Thiam, Assane Dram&eacute;, Isabelle Zok&eacute;b&eacute; Coly, Fran&ccedil;ois Niokhor Diouf, Ndiogou Seck, Djibril Boiro, Aliou Abdoulaye Ndongo, Idrissa Basse, Babacar Niang, Indou Deme/Ly, Assane Sylla, Ibrahima Diagne, Ousmane Ndiaye [Case series] - Profils &eacute;pidemiologiques, cliniques et h&eacute;matologiques de la dr&eacute;panocytose homozygote SS en phase inter critique chez l’enfant &agrave; Ziguinchor, S&eacute;n&eacute;gal - 07 November 2017. <b>La dr&eacute;panocytose pose un probl&egrave;me de sant&eacute; publique au S&eacute;n&eacute;gal. Elle concerne principalement les enfants et les adolescents. L'objectif de notre travail &eacute;tait de d&eacute;terminer les profils &eacute;pid&eacute;miologiques, cliniques et h&eacute;matologiques de la dr&eacute;panocytose homozygote SS dans une cohorte d'enfants suivis &agrave; l'h&ocirc;pital de la paix de Ziguinchor. Il s'agit d'une &eacute;tude r&eacute;trospective portant sur des dossiers d'enfants dr&eacute;panocytaires. Etaient inclus, les dr&eacute;panocytaires SS &acirc;g&eacute;s entre 2mois et 21ans, re&ccedil;us en phase inter critique durant la p&eacute;riode d'&eacute;tude allant du 1er Janvier 2015 au 31 Ao&ucirc;t 2017. N'&eacute;taient pas inclus dans l'&eacute;tude les h&eacute;t&eacute;rozygotes composites (SC, S b&eacute;ta thalass&eacute;mie). Nous avons collig&eacute; 46 dossiers de dr&eacute;panocytaires SS (20 filles et 26 gar&ccedil;ons). L'&acirc;ge moyen des enfants &eacute;tait de 8,0ans [11mois-21ans]. Environ 1/3 des enfants (39,1%) avaient un &acirc;ge inf&eacute;rieur ou &eacute;gal &agrave; 5 ans. Il y avait une diversit&eacute; ethnique avec une pr&eacute;dominance de diola (30,2%) suivi de mandingue (27,9%) et de poular (25,6%). L'&acirc;ge moyen des enfants &agrave; la 1&eacute;re crise &eacute;tait de 35,5mois [7-192 mois]. Plus de 1/3 des enfants (41,3%) avaient fait une 1&eacute;re crise avant le deuxi&egrave;me anniversaire. Le type de la 1&eacute;re crise, qu'avait pr&eacute;sent&eacute; l'enfant, &eacute;tait domin&eacute; par la crise vaso-occlusive (32,6%) suivi du syndrome pied-main (30,4%). Les signes cliniques en phase inter critique &eacute;taient la p&acirc;leur 95,6%); l'ict&egrave;re (36,9%) et la spl&eacute;nom&eacute;galie (21,7%). A l'h&eacute;mogramme, le nombre de globules blancs moyen &eacute;tait de 12465 leucocytes/mm3 [5340-26900]. L'hyperleucocytose, sup&eacute;rieure &agrave; 10 000 leucocytes/mm3 &eacute;tait retrouv&eacute;e chez 34 malades (73,9%). La totalit&eacute; des malades pr&eacute;sentait une an&eacute;mie avec une moyenne 08,6 g/dl [05,7-11,8]. Le taux d'h&eacute;moglobine S variait entre 54,6 et 98,4%. Le diagnostic et la prise en charge m&eacute;dicale de la dr&eacute;panocytose SS sont tardifs &agrave; Ziguinchor. Le d&eacute;pistage n&eacute;onatal pourrait favoriser une prise en charge pr&eacute;coce dans la r&eacute;gion.</b><br/> text/html 2017-11-25T09:37:31+01:00 Marius Zambou Vouking, Thierry Binde, Carine Nouboudem Tadenfok, Jean Marie Edengue Ekani, Daniel Ekra [Research] - Contribution of community health workers to surveillance of vaccine-preventable diseases in the Obala health district - 07 November 2017. <b>INTRODUCTION: The establishment of effective community-based surveillance is an essential objective of all disease surveillance systems. Several studies and reports have found that the situation is far from optimal in several developing countries such as Cameroon. METHODS: we conducted a cross-sectional descriptive study to assess the contribution of community health workers to surveillance of vaccine-preventable diseases in Obala health district. The performance of community health workers was measured using: the number of cases referred to the health center, the percentage of accomplished referrals, the percentage of cases referred by community health workers confirmed by the staff of health centers. A questionnaire containing forty-seven questions (open-ended and closed-ended) was used for interviews with community health workers. The data were analyzed using SPSS 21 and Excel 2007. Counts and percentages are reported. RESULTS: the study showed that the age ranged of community health workers was from 24 to 61 years with an average of 37.9 years ± 6.7 years. The most represented age group was between 40 and 50 with a percentage of 38.6%. The male sex was more represented than the female sex (61.4% vs 38.6%) or a sex ratio male man of 1.7. Forty-five percent of community health workers were selected at a village meeting, 93.1% of community health workers were involved in the surveillance of vaccine-preventable diseases and 87% experienced at least one preventable disease. Only 45.8% of them had the case definitions of the four diseases. Analysis of community health workers attendance at organized health committee meetings showed that 79% of community health workers attended at least one health committee meeting in 2015 and only 49% were monitored in 2015. Community health workers reported 42 suspected cases of measles, 37 of which actually went to the nearest Health Center, a baseline rate of 88%. CONCLUSION: community health workers play a key role in the control of vaccine-preventable diseases in the Obala health district. Community-based surveillance is the foundation of surveillance activities. It is a mechanism based on simple case definitions of priority diseases and unexpected events or unusual conditions. Our study also reaffirms the importance of mastering case definitions and home visits and early detection of vaccine-preventable diseases.</b><br/> text/html 2017-11-25T09:37:31+01:00 Idrissa Basse, Nd&eacute;ye Rama Diagne/Gueye, Ndi&eacute;m&eacute; Ndiaye, Marie Mbengue, Dina Cyrienne Obambi, A&iuml;ssatou Ba, Amadou Lamine Fall, Aliou Abdoulaye Ndongo, Djibril Boiro, Abou Ba [Case report] - Difficult&eacute;s de la prise en charge d’une thrombose veineuse c&eacute;r&eacute;brale (TVC) compliqu&eacute;e d’h&eacute;morragie sous arachno&iuml;dienne (HSA) chez le nourrisson: &agrave; propos d’un cas - 07 November 2017. <b>La TVC est rare en g&eacute;n&eacute;ral et particuli&egrave;rement chez l’enfant. La survenue d’une HSA dans ce contexte est une situation tr&egrave;s peu fr&eacute;quente et seuls quelques cas sont rapport&eacute;s dans la litt&eacute;rature. Sa symptomatologie est variable et souvent trompeuse. Non trait&eacute;e ou en cas de traitement tardif l’issue peut &ecirc;tre fatale ou conduire &agrave; des s&eacute;quelles potentiellement graves. Nous rapportons l’observation d’un nourrisson de 22 mois re&ccedil;u pour des convulsions avec coma stade II, syndrome d’hypertension intracr&acirc;nienne et syndrome infectieux. Une septic&eacute;mie &agrave; Pseudomonas spp a &eacute;tait retrouv&eacute;e &agrave; la biologie et le scanner c&eacute;r&eacute;bral a permis de poser le diagnostic. Le traitement a &eacute;t&eacute; bas&eacute; sur l’antibioth&eacute;rapie mais surtout l’anticoagulation. Une nette am&eacute;lioration clinique a &eacute;t&eacute; ainsi not&eacute;e et le scanner c&eacute;r&eacute;bral de contr&ocirc;le montrait une disparition de la thrombose avec images h&eacute;morragiques s&eacute;quellaires droites. La TVC est une pathologie grave d’origine g&eacute;n&eacute;ralement infectieuse. Le traitement anticoagulant est aujourd’hui sujet &agrave; controverse notamment en cas d’h&eacute;morragie associ&eacute;e, mais l’exp&eacute;rience clinique serait en faveur de l’efficacit&eacute; et de l’innocuit&eacute; de ce traitement.</b><br/> text/html 2017-11-25T09:37:31+01:00 Amel Achour Jenayah, Sarah Saoudi, Nour Sferi, Rim Skander, Sofi&egrave;ne Ben Marzouk, Abdallah Cherni, Ezzeddine Sfar, Dalenda Chelli, Fethia Boudaya [Case report] - Spontaneous subserosal venous rupture overlying a uterine leiomyoma in a young woman - 07 November 2017. <b>Uterine leiomyomas are very common tumors found in women. Rupture of veins on the surface of uterine leiomyoma is an unusual source of hemoperitoneum. It is an extremely uncommon gynaecological cause of hemoperitoneum. It is a life threatening emergency. We report a case of massive intraperitoneal hemorrhage due to rupture of vessels on the surface of subserous leiomyoma. A differential diagnosis of rupture of leiomyoma’ssurface vessel should be considered, while dealing with a case of hemoperitoneum with pelvic mass.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ernest Ndukaife Anyabolu [Research] - Dyslipidemia in people living with HIV-AIDS in a tertiary hospital in South-East Nigeria - 06 November 2017. <b>INTRODUCTION: Across the globe, human immunodeficiency virus (HIV) infection is a healthcare problem. Dyslipidemia, a cardiovascular risk factor, is known to occur with the progression of HIV infection. The factors which influence dyslipidemia in HIV subjects have not been completely identified. The aim of this study was to evaluate serum lipids and identify the factors which might influence dyslipidemia in treatment-na&iuml;ve HIV subjects in Owerri, Nigeria. METHODS: this was a cross-sectional study of treatment-na&iuml;ve HIV subjects. Anthropometric and demographic data were collected. Serum LDL serum cholesterol, serum high density lipoprotein cholesterol, serum triglyceride, spot urine creatinine, spot urine osmolality, spot urine protein, serum creatinine, 24-hour urine protein, 24-hour urine osmolality, 24-hour urine creatinine, creatinine clearance and hemoglobin were conducted. The variables were compared between those who have dyslipidemia and those who have no dyslipidemia. RESULTS: the mean age of the subjects was 39 ± 11 years. Females constituted 72.0% and males 28.0%. Elevated serum LDL was present in 17.6%, elevated serum total cholesterol in 11.4%, elevated serum triglyceride in 9.9% and low serum HDL in 34.4% of the subjects. There was significant association between dyslipidemia and CD4 cells count, as well as anemia. There was no significant association between dyslipidemia and urine protein, urine creatinine, urine osmolality, creatinine clearance, as well as 24-hour urine volume. CONCLUSION: the prevalence of dyslipidemia was high in the study subjects. Abnormal CD4 cells count and anemia were common in treatment-na&iuml;ve HIV subjects who have dyslipidemia.</b><br/> text/html 2017-11-25T09:37:31+01:00 Houcine Maghrebi, Amine Makni [Images in medicine] - Cystad&eacute;nome mucineux pancr&eacute;atique doublement compliqu&eacute; de pancr&eacute;atite aig&uuml;e et de rupture dans le r&eacute;tro-p&eacute;ritoine - 06 November 2017. <b>Les cystad&eacute;nomes mucineux sont des tumeurs b&eacute;nignes &agrave; potentiel malin. Ils sont souvent r&eacute;v&eacute;l&eacute;s par des douleurs abdominales non sp&eacute;cifiques, un ict&egrave;re, ou un &eacute;pisode de pancr&eacute;atite aigu&euml;. Nous rapportons l’observation exceptionnelle d’un cystad&eacute;nome mucineux doublement compliqu&eacute; de pancr&eacute;atite aigue et de rupture dans le r&eacute;tro-p&eacute;ritoine. Il s’agit d’une patiente &acirc;g&eacute;e de 30 ans, non tar&eacute;e, qui nous a consult&eacute; pour des douleurs &eacute;pigastriques et de l’hypochondre gauche &eacute;voluant depuis trois mois et qui se sont accentu&eacute;es depuis 3 jours, sans fi&egrave;vre ni ict&egrave;re. L’examen clinique avait not&eacute; un emp&acirc;tement &agrave; la palpation de l’&eacute;pigastre et de l’hypochondre gauche. Il n’y avait pas de masse palpable. Le bilan biologique &eacute;tait sans anomalie en dehors d'une lipas&eacute;mie &agrave; 8 fois la normale. Une TDM abdominale a &eacute;t&eacute; pratiqu&eacute;e montrant une masse kystique de la queue du pancr&eacute;as, bi-locul&eacute;e de 111 mm x 73 mm, &agrave; paroi fine et &agrave; contenu liquidien, associ&eacute; &agrave; une infiltration du fascia para r&eacute;nal gauche. Un compl&eacute;ment d’IRM (A) a &eacute;t&eacute; r&eacute;alis&eacute; montrant un aspect de cystad&eacute;nome mucineux rompu dans r&eacute;tro-p&eacute;ritoine. La portion caudale du canal pancr&eacute;atique principal &eacute;tait l&eacute;g&egrave;rement dilat&eacute;e et communiquait avec le kyste pancr&eacute;atique. La malade a &eacute;t&eacute; op&eacute;r&eacute;e par voie bi sous costale. Il s’agissait d’une formation kystique de la queue du pancr&eacute;as rompue dans le r&eacute;tro-p&eacute;ritoine associ&eacute;e &agrave; une pancr&eacute;atite aigue (coul&eacute;e de n&eacute;crose de l’espace pr&eacute; r&eacute;nal ant&eacute;rieur gauche). Il a alors &eacute;t&eacute; r&eacute;alis&eacute; une spl&eacute;nopancr&eacute;atectomie caudale (B). Les suites op&eacute;ratoires ont &eacute;t&eacute; simples. L’examen anatomo-pathologique de la pi&egrave;ce op&eacute;ratoire avait conclu &agrave; un cystad&eacute;nome mucineux pancr&eacute;atique si&egrave;ge de l&eacute;sions de dysplasie de bas grade.</b><br/> text/html 2017-11-25T09:37:31+01:00 Yddoussalah Othmane, Alae Touzani [Images in medicine] - Epispadias masculin isol&eacute; - 06 November 2017. <b>L’&eacute;pispadias est une malformation urog&eacute;nitale rare se caract&eacute;risant par une aplasie plus ou moins compl&egrave;te de la face sup&eacute;rieure de l’ur&egrave;tre. Fr&eacute;quemment associ&eacute; &agrave; une exstrophie v&eacute;sicale, il est isol&eacute; dans 10% des cas. On distingue donc des &eacute;pispadias continents et incontinents. Nous rapportons le cas d’un patient &acirc;g&eacute; de 29 ans, qui consulte pour prise en charge d’une dysurie et de l’impossibilit&eacute; d’avoir des rapports sexuels. &Agrave; l’examen, des organes g&eacute;nitaux externes notaient une ouverture anormale de l’ur&egrave;tre sous forme de fente sur la moiti&eacute; distale de la face dorsale de la verge. La verge ne pr&eacute;sentait pas de courbure dorsale (chord&eacute;e), les corps caverneux &eacute;taient palp&eacute;s, l&eacute;g&egrave;rement lat&eacute;ralis&eacute;s. La paroi abdominale &eacute;tait sans anomalie. Le reste de l’examen &eacute;tait normal. Devant cette anomalie, le diagnostic d’&eacute;pispadias continent balano-pubien a &eacute;t&eacute; retenu. Une &eacute;chographie de l’arbre urinaire r&eacute;alis&eacute;e est revenue normale et une radiographie sans pr&eacute;paration du bassin montrait un diastasis inter pubien. Le patient a &eacute;t&eacute; op&eacute;r&eacute; en un temps selon la technique de Cantwell-Young, l'&eacute;volution postop&eacute;ratoire imm&eacute;diate &eacute;tait sans anomalie; la sonde ur&eacute;trale a &eacute;t&eacute; enlev&eacute;e 21 jours plutard apr&egrave;s cicatrisation. Le r&eacute;sultat fonctionnel et esth&eacute;tique &eacute;valu&eacute; &agrave; trois et &agrave; six mois ont &eacute;t&eacute; jug&eacute;s satisfaisants sans bri&egrave;vet&eacute; de la verge.</b><br/> text/html 2017-11-25T09:37:31+01:00 Jobert Richie Nansseu, Descartes Maxime Mbogning, Gwladys Chavely Monamele, Stive Fokam Tamoh, Hortense Kamga Gonsu, Charles Kouanfack, Yves Nathan Yanwou, Zacharie Sando [Research] - Sero-epidemiology of human immunodeficiency virus, hepatitis B virus and hepatitis C virus: a cross-sectional survey in a rural setting of the West region of Cameroon - 06 November 2017. <b>INTRODUCTION: human immunodeficiency Virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are the three most common chronic viral infections worldwide, specifically in sub-Saharan Africa (SSA). This study aimed to determine the sero-epidemiology of HIV, HBV and HCV infections in a rural setting of the West region of Cameroon, a SSA country. METHODS: we conducted a cross-sectional study from August 2 to 5, 2014 in the three health districts of the Menoua Division, West region of Cameroon. Sixteen villages were randomly selected. Participants were currently living in the Division at the time of the survey and enrolled after they had provided a signed consent form. HIV screening used the "Determine test" followed by Hexagon HIV for positive cases to the first assay. HBV and HCV were detected using DIASpot HBsAg and DIASpot HCV-Ab, respectively. RESULTS: on the whole, 612 subjects consented to take part in this study, of whom 71.1% were females. Mean age of the study population was 45.3 ± 17.9 years. The seroprevalences of HIV, HBV and HCV infections were 1.0% (6/582), 4.5% (20/443) and 6.3% (23/365), respectively. The 41-50 years age group was the most represented among HIV-positive subjects. HBV prevalence was higher in the 21-30 years age group (13.4%), followed by the 51-60 years age group (7.8%), with a significant difference of prevalences among age groups (p = 0.002). All HCV-positive cases were above 40 years of age with a higher prevalence in the 70 years age group (33.3%) followed by the 61-70 years age group (14.5%); there was a significant difference between the age groups (p = 0.001). CONCLUSION: the seroprevalences of HIV, HBV, and HCV infections in the Menoua Division of the West region of Cameroon were 1.0%, 4.5% and 6.3%, respectively. Preventive measures against these health threats need to be reinforced in this setting.</b><br/> text/html 2017-11-25T09:37:31+01:00 Luchuo Engelbert Bain [Editorial] - Ethics approval: responsibilities of journal editors, authors and research ethics committees - 03 November 2017. <b>Meaningful progress of medicine depends on research that must ultimately involve human subjects. Obtaining ethical approval therefore, especially in medical sciences, should be a moral reflex for researchers. This unfortunately is not the case, with numerous researchers bypassing the ethics approval procedure, or simply unaware of its importance. Good research involves risks taken by research participants and uses tax payers’ money in the process. These mandates the research endeavor to aim at attaining the highest degree of respect for the sacrifices made by others for science. Most researchers mistake scientific clearance or approval, for ethics approval. For a study to be ethical sound, it must be scientifically sound. This is only one of the activities carried out during protocol review. It is not uncommon for sensitive ethical concerns, especially in the social sciences to be overlooked and considered not to be accompanied by any serious risks for the research participants.The researcher has the responsibility of systematically consulting the competent ethics committee for advice and consequent approvals or ethical waivers. Journal editors and reviewers have the duty to systematically evaluate the ethical soundness of manuscripts submitted for review. Capacity building in research ethics and institutional support for Research Ethics Committees to speed up protocol review could reduce the incentive of carrying out research in human subjects without ethics approvals. It is hypocritical and idle to continue to expect optimal reviews on time and of good quality, from ethics committees functioning purely on altruistic grounds. Capacity building for researchers in research ethics, and institutional reforms and support for Research Ethics Committees appear not to have received the attention they truly deserve.</b><br/> text/html 2017-11-25T09:37:31+01:00 Maxwell Ogochukwu Adibe, Patrick Chisom Ewelum, Kosisochi Chinwendu Amorha [Research] - Evaluation of drug-drug interactions among patients with chronic kidney disease in a South-Eastern Nigeria tertiary hospital: a retrospective study - 03 November 2017. <b>INTRODUCTION: The risk of drug-drug interactions (DDIs) is high in patients with chronic kidney disease (CKD) necessitating dose adjustments or the avoidance of drug combinations. This study aimed to evaluate DDIs among patients with CKD in the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. METHODS: this study was a retrospective review of patients with CKD who received treatment at the nephrology unit of UNTH between January 2004 and December 2014. The drug-drug interactions (DDIs) of the prescribed drugs were classified using the RxList interaction checker. The IBM SPSS Version 21.0 was utilized for statistical analysis with P-value d" 0.05, considered statistically significant. RESULTS: a total of 749 DDIs were identified from the folders of the 169 patients with CKD that were eligible. Majority were above 50 years old and in stage 4 or 5 CKD. Furosemide, lisinopril and amlodipine were the most frequently prescribed drugs and had the greatest likelihood for nephrotoxicity. The number of medications and hypertension (as co-morbidity) were significant and independent predictors of DDIs among the patients. About 70% of the drug combinations required monitoring as they fell within the “significant category” of the RxList interaction checker. The most common interactions were between lisinopril and furosemide; furosemide and calcium carbonate; lisinopril and calcium carbonate. CONCLUSION: the prevalence of DDIs was high among the CKD patients. Prescribers and pharmacists in Nigerian hospitals may need to pay close attention to prescriptions of patients with CKD to identify, prevent and resolve undesirable DDIs.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mustapha Azzakhmam, Fouad Zouaidia, Ahmed Jahid, Zakia Bernoussi, Kaoutar Znati, Asmae Lakhdissi, Mohamed Bouchikh, Najat Mahassini [Case report] - Pneumoblastome de l’adulte: rapport d’un nouveau cas et revue de la litterature - 02 November 2017. <b>Le blastome pulmonaire d&eacute;crit surtout chez les enfants, est une tumeur rare. Elle repr&eacute;sente 0.25 &agrave; 0.5% de toutes les tumeurs pulmonaires avec un pronostic tr&egrave;s grave. Sur le plan histologique, il s'agit d'une tumeur &agrave; double composante: une composante &eacute;pith&eacute;liale et une composante m&eacute;senchymateuse. Cliniquement, il s'annonce souvent par des douleurs thoraciques, de la toux, des h&eacute;moptysies et de la dyspn&eacute;e, mais reste asymptomatique dans environ 40% des cas. Nous rapprtons le cas d'une femme de 25 ans, sans ant&eacute;c&eacute;dents particuliers, qui se plaignait de dyspn&eacute;e, de toux et de douleurs basithoraciques gauches. l'exploration radiologique avait montr&eacute; une large masse basithoracique du poumon gauche. La biopsie a &eacute;t&eacute; r&eacute;alis&eacute;e et avait ramen&eacute; uniquement du mat&eacute;riel n&eacute;crotique. La pi&egrave;ce de r&eacute;section &eacute;tait largement n&eacute;cros&eacute;e, le tissu viable examin&eacute; au miroscope avait r&eacute;v&eacute;l&eacute; un pattern biphasique, compos&eacute;e de tissu &eacute;pith&eacute;lial malin, associ&eacute; &agrave; un tissu m&eacute;senchymateux malin, caract&eacute;ristiques du pneumoblastome biphasique. La patiente a b&eacute;n&eacute;fici&eacute; d'une chimioth&eacute;rapie puis radioth&eacute;rapie. Le contr&ocirc;le a montr&eacute; une r&eacute;cidive et la patiente a &eacute;t&eacute; mise sous deuxi&egrave;me ligne de chimioth&eacute;rapie.</b><br/> text/html 2017-11-25T09:37:31+01:00 Marian Khalif Ali, Simon Karanja, Mohammed Karama [Research] - Factors associated with tuberculosis treatment outcomes among tuberculosis patients attending tuberculosis treatment centres in 2016-2017 in Mogadishu, Somalia - 02 November 2017. <b>INTRODUCTION: World Health Organization (WHO) reported that tuberculosis (TB) was a major health problem and the second leading cause of mortality globally. An estimated 1.8 million TB deaths were reported in 2015. In Somalia, the average TB incidence was 274 cases per 100,000 people in 2014; prevalence was 513 per 100,000 population; and mortality rate excluding human immune deficiency virus (HIV)/TB co-infection was 64/100,000. In addition, the prevalence rates of multi-drug resistant (MDR)-TB are still high, 5.2% among new cases and 40.7% for retreatment cases. The objective of this study was to determine individual and institutional level factors associated with TB treatment outcomes (TB-TOs) among patients attending TBTCs in Mogadishu. METHODS: the study design was cross-sectional, using quantitative and qualitative methods. Data was collected using interviewer administered semi-structured questionnaires and key in-depth interviews in 2016/2017. Qualitative data was coded using NVIVO8 and quantitative data analyzed using descriptive and inferential statistics at 95% confidence interval using SPSS20 software.</b><br/> text/html 2017-11-25T09:37:31+01:00 Junhong Li, Chuanfen Lei, Seidu A. Richard, Yanhui Liu [Case report] - Giant solitary primary intracranial lymphoma masquerading as meningioma: a case and review of literature - 01 November 2017. <b>Non-Hodgkin's lymphomas (NHL) with intracranial origin are very rare and constitutes about 1-2% of primary central nervous system lymphomas (PCNSL). Diffuse large B cell lymphoma (DLBCL) is the most common subtype of NHL and mostly seen in immunocompromised patients. Therefore, the occurrence of giant solitary DLBCL in an immunocompetent patient is puzzling. We present a case of 68-year-old man who was admitted at our facility with a history of "hypomnesia of two (2) months" duration. Magnetic resonance imaging (MRI) revealed a space occupying lesion in the bilateral frontal lobe and corpus callosum measuring about 5.4cm * 4.6cm * 3.8cm with mixed signal intensities and vasogenic edema around the mass. Radiological, this mass was mistaken for meningioma until histopathological studies revealed DLBCL. Giant solitary primary intracranial lymphomas are very rare and can be mistake for meningioma even with very experience radiologist or neurosurgeon since the radiological features of PCNSL can be very unspecific. We achieved to total resection because of the giant and solitary nature of our case. The prognosis of PCNSL is general very poor when the patient is immunocompromised. In immunocompetent patients, who are well managed with surgery and chemotherapy, the overall survival and quality of life can very encouraging.</b><br/> text/html 2017-11-25T09:37:31+01:00 Fred Bernardes Filho, Andreia de Oliveira Alves [Images in medicine] - Neglected tumor in a female with albinism - 01 November 2017. <b>A 48-year-old female with albinism presented to emergency department with a complaint of a three-day history of nausea and vomiting, accompanied by fever and general weakness. She had a towel wrapped around her left arm and said it was to cover a wound that was growing in size in the last two years. On physical examination, vegetating and exophytic ulcerous tumor on the lateral side of the left arm was observed; there was granulation tissue on all surfaces, release of fluid with pustules and hemorrhagic points. She had a pulse rate of 125/min, blood pressure of 136/78 mmHg, temperature of 38.5 C, (101.3 F) and respiratory rate of 16/min. Laboratory testing was remarkable for elevated white blood cells at 18,230/mm3 with left shift and C-reactive protein of 85.4 mg/dl; chest radiography and urine analysis were normal. Biopsy was performed, the diagnosis of giant cutaneous basosquamous cell carcinoma was made and she was referred to oncology department, but her follow-up was lost because she was not found.</b><br/> text/html 2017-11-25T09:37:31+01:00 Aziz EL Majdoub, Abdelhak Khallouk, Moulay Hassan Farih [Case series] - La fibrose r&eacute;trop&eacute;riton&eacute;ale: &agrave; propos de 12 cas - 01 November 2017. <b>La fibrose r&eacute;trop&eacute;riton&eacute;ale (FRP) est une maladie rare. Elle se caract&eacute;rise par la transformation progressive du tissu adipeux r&eacute;top&eacute;riton&eacute;al en une masse fibreuse qui enserre l'aorte, la veine cave inf&eacute;rieure et les voies urinaires responsable d'une alt&eacute;ration progressive de la fonction r&eacute;nale. Le mode habituel de pr&eacute;sentation de cette maladie comporte l'association de douleurs lombaires, d'une insuffisance r&eacute;nale, et d'un syndrome inflammatoire biologique. Nous rapportons 12 cas de fibrose r&eacute;trop&eacute;riton&eacute;ale dont nous pr&eacute;cisons les particularit&eacute;s cliniques, radiologiques et th&eacute;rapeutiques. Il s'agit d'une &eacute;tude r&eacute;trospective portant sur douze cas de fibrose r&eacute;trop&eacute;riton&eacute;ale collig&eacute;s au service d'urologie au CHU Hassan II de F&egrave;s durant une p&eacute;riode de 9 ans (2005-2013). Il s'agissait de dix hommes et deux femmes. La symptomatologie clinique &eacute;tait tr&egrave;s variable, domin&eacute;e par la douleur lombaire qui &eacute;tait pr&eacute;sente chez tous les malades et une hydroc&egrave;le chez un patient. Les explorations biologiques avaient montr&eacute; une insuffisance r&eacute;nale chez tous les malades et un syndrome inflammatoire chez dix patients. Le diagnostic de la maladie &eacute;tait suspect&eacute; dans tous les cas sur les donn&eacute;es de l'&eacute;chographie qui a montr&eacute; une obstruction de la voie excr&eacute;trice sup&eacute;rieure sans obstacle visible chez tous les malades, et confirm&eacute; par la TDM abdominale sans injection du produit de contraste qui objectivait une l&eacute;sion tissulaire r&eacute;trop&eacute;riton&eacute;ale engainant les vaisseaux et les voies urinaires. Dans notre s&eacute;rie, la fibrose r&eacute;trop&eacute;riton&eacute;ale &eacute;tait idiopathique dans neuf cas. Elle &eacute;tait p&eacute;ri an&eacute;vrysmale chez deux malades, et post radioth&eacute;rapie chez un malade. Tous nos patients avaient b&eacute;n&eacute;fici&eacute; d'un drainage urinaire par sonde ur&eacute;t&eacute;rale double J. Sept malades avaient re&ccedil;u une corticoth&eacute;rapie. Une am&eacute;lioration clinique et biologique, avec disparition de la douleur et am&eacute;lioration de l'&eacute;tat g&eacute;n&eacute;ral, a &eacute;t&eacute; observ&eacute;e chez 6 patients. A travers cette &eacute;tude nous avons confirm&eacute; la raret&eacute; de la fibrose r&eacute;trop&eacute;riton&eacute;ale, la difficult&eacute; de son diagnostic, la fr&eacute;quence de la douleur, du syndrome inflammatoire et de l'insuffisance r&eacute;nale. La TDM abdominale sans injection du produit de contraste confirme le diagnostic. Le drainage urinaire est indispensable dans la plupart des cas et le suivi r&eacute;gulier des malades est n&eacute;cessaire.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ndiogou Seck, Idrissa Basse, Younoussa Keita, Djiril Boiro, Lamine Thiam, Aliou Adoulaye Ndongo, Ibrahima Diagne [Case report] - Holoprosenc&eacute;phalie alobaire avec diab&egrave;te insipide et hypothyro&iuml;die chez un nourrisson de 10 mois - 01 November 2017. <b>L’holoprosenc&eacute;phalie (HPE) est une malformation c&eacute;r&eacute;brale grave due &agrave; un d&eacute;faut de clivage m&eacute;dian du prosenc&eacute;phale. C’est une anomalie le plus souvent associ&eacute;e &agrave; des malformations cranio-faciales, d’un retard du d&eacute;veloppement psychomoteur, d’un diab&egrave;te insipide et de troubles endocriniens variables. Les &eacute;tiologies sont diverses regroupant les anomalies chromosomiques (trisomie 13, 18), les syndromes polymalformatifs (syndrome de CHARGE). Le diagnostic repose sur l’imagerie c&eacute;r&eacute;brale. Quelques rares cas ont &eacute;t&eacute; d&eacute;crits dans la litt&eacute;rature. Nous rapportons le cas d’une HPE alobaire chez un nourrisson de 10 mois. Le diagnostic a &eacute;t&eacute; pos&eacute; au scanner c&eacute;r&eacute;bral devant la constatation d’un retard du d&eacute;veloppement psychomoteur en l’absence de malformations visibles. Le bilan endocrinien a permis de d&eacute;celer un diab&egrave;te insipide central et une hypothyro&iuml;die centrale probablement d’origine hypothalamique.</b><br/> text/html 2017-11-25T09:37:31+01:00 Radia Chibli, Youssef Omor, Nadir Slimani Sebbouba, Moulay Rachid El Hassani, Mohamed Jiddane, Meriem Fikri [Case report] - Moya moya: &eacute;tiologie rare d’accident vasculaire c&eacute;r&eacute;bral isch&eacute;mique chez l’enfant: &agrave; propos d’un cas - 01 November 2017. <b>La maladie de Moya Moya est une maladie angiog&eacute;nique, caract&eacute;ris&eacute;e par un r&eacute;tr&eacute;cissement de l'art&egrave;re carotide interne distale qui s'&eacute;tend aux segments proximaux des art&egrave;res c&eacute;r&eacute;brales moyennes et ant&eacute;rieures, induisant la formation de vaisseaux de suppl&eacute;ance. Ces derniers proviennent des collat&eacute;rales parenchymateuses, perforantes, leptom&eacute;ning&eacute;es et autres anastomoses transdurales. Ces vaisseaux collat&eacute;raux ont un aspect caract&eacute;ristique &agrave; l'angiographie formant un nuage de fum&eacute;e : r&eacute;seau Moya Moya. Son &eacute;tiologie reste encore mal &eacute;lucid&eacute;e et repr&eacute;sente 10 &agrave; 15% des causes d'accidents vasculaires c&eacute;r&eacute;braux (AVC), avec 2 pics d'&acirc;ge o&ugrave; l'atteinte est plus fr&eacute;quente: les enfants autour de 5 ans et les adultes autour de 40 ans. Son &eacute;volution peut &ecirc;tre lente avec des sympt&ocirc;mes intermittents ou &ecirc;tre fulminante avec un d&eacute;clin neurologique rapide. Les donn&eacute;es actuelles montrent l'importance du traitement chirurgical comme m&eacute;thode de r&eacute;f&eacute;rence pour la prise en charge du syndrome de Moya en particulier chez les patients avec des sympt&ocirc;mes progressifs et r&eacute;cidivants.</b><br/> text/html 2017-11-25T09:37:31+01:00 Julienne Noude Teclessou, Séfako Abla Akakpo, Koumavi Didier Ekouevi, Georges Koumagnanou, Assétina Singo-Tokofai, Palokinam Vincent Pitche [Research] - Evolution of HIV prevalence and behavioral factors among MSM in Togo between 2011 and 2015 - 01 November 2017. <b>INTRODUCTION: the aim of this study was to assess sexual behavior and measure HIV prevalence among MSM in 2015, in Togo. METHODS: we conducted a cross-sectional study from February to March 2015 in nine major cities of Togo. The respondent-driven sampling method was used to recruit MSM. Behavioral data were collected by interviewer-administered questionnaires. The blood tests were then carried out among MSM to assess their HIV status. Data were inputted into an Epidata database and exported to STATA® 9.0 for analysis. Qualitative variables were compared using the chi-2. RESULTS: a total of 496 MSM were involved in this study, with 43.35% in the capital, Lome. Over the past 12 months, 88.9% of MSM had had sexual intercourse with men and 24.1% of them had had sex with women. The last sexual intercourse was with a casual partner among 52.9% of MSM. During the last 30 days preceding the survey, 68.5% of MSM had regularly used a condom during active anal intercourse and 71.9% had used it during passive anal intercourse. The national prevalence rate of HIV among MSM was 13.0%. The factors associated with HIV infection were age of MSM OR = 5.30 [1.85-15.1], HIV testing history OR = 2.63 [1.18-5.87], and the city of residence of MSM OR = 5.56 [2.90-10.64]. CONCLUSION: this study confirms that HIV prevalence among MSM is five times higher than in the general population (13% vs 2.5%). Thus, the need to rethink HIV sensitization and prevention strategies targeting hidden and stigmatized populations such as MSM.</b><br/> text/html 2017-11-25T09:37:31+01:00 Aziz El Majdoub, Abdelhak Khallouk, Moulay Hassan Farih [Case report] - Angiomyolipome r&eacute;nal agressif avec extension &agrave; la veine r&eacute;nale: &agrave; propos d'un cas et une revue de la litt&eacute;rature - 31 October 2017. <b>L'angiomyolipome r&eacute;nal est une tumeur qui est reconnue b&eacute;nigne. Elle pr&eacute;sente trois composantes diff&eacute;rentes: musculaire, vasculaire et graisseuse, dont la distribution est variable. Le diagnostic repose sur la mise en &eacute;vidence de la composante graisseuse intra-tumorale en TDM ou IRM. Exceptionnellement la tumeur peut avoir un caract&egrave;re agressive avec extension locor&eacute;gionale et veineuse (la veine r&eacute;nale et la veine cave inferieure). Nous pr&eacute;sentons une observation d'une patiente &acirc;g&eacute;e de 37 ans pr&eacute;sentant un Angiomyolipome r&eacute;nal volumineux avec extension &agrave; la veine r&eacute;nale.</b><br/> text/html 2017-11-25T09:37:31+01:00 Madib&egrave;l&egrave; Kam, Sonia Douamba, Kisito Nagalo, Lassina Dao, Fla Kou&eacute;ta, Claudine Lougu&eacute;, Diarra Y&eacute; [Case report] - Le syndrome de Pepper: &agrave; propos de deux cas observ&eacute;s au Centre Hospitalier Universitaire P&eacute;diatrique Charles de Gaulle de Ouagadougou (Burkina Faso) - 31 October 2017. <b>Le syndrome de Pepper est une forme m&eacute;tastatique h&eacute;patique du neuroblastome. C’est une entit&eacute; sp&eacute;cifique du nourrisson de moins de six mois qui a la particularit&eacute; de pouvoir r&eacute;gresser de fa&ccedil;on spontan&eacute;e avec un pronostic favorable dans 80% des cas. A cause de sa raret&eacute;, nous rapportons deux cas du syndrome de Pepper observ&eacute;s au Centre Hospitalier Universitaire P&eacute;diatrique Charles de Gaulle de Ouagadougou (Burkina Faso). Il s’agissait de deux nourrissons de sexe f&eacute;minin chez qui la symptomatologie de la maladie se traduisait par une augmentation du volume abdominal, une h&eacute;patom&eacute;galie et des signes de lutte respiratoire. L'&eacute;chographie a permis de poser le diagnostic par l’aspect nodulaire du foie dans les deux cas et la d&eacute;termination de la tumeur primitive dans un cas. Le dosage des cat&eacute;cholamines urinaires a confirm&eacute; un cas. L’&eacute;volution &eacute;tait fatale chez les deux patientes du fait des complications de compression par le foie, des complications de la chimioth&eacute;rapie dans l’un des cas et l’absence de traitement dans l’autre cas.</b><br/> text/html 2017-11-25T09:37:31+01:00 Moez Hamdani, Ali Houidi, Amine Briki, Naoufel Haddad, Abdelmajid Khabir [Case report] - Ost&eacute;omy&eacute;lite chronique compliqu&eacute;e d’un carcinome &eacute;pidermo&iuml;de: &agrave; propos d’une observation - 31 October 2017. <b>La transformation maligne d’une ost&eacute;omy&eacute;lite chronique est une complication rare et tardive qui survient le plus souvent au niveau des berges d’un trajet fistuleux avec extension et infiltration des tissus mous de voisinage et plus rarement une infiltration osseuse. Nous rapportons une observation. Il s’agit de Monsieur N.J. &acirc;g&eacute; de 67 ans, suivi pour une ost&eacute;omy&eacute;lite chronique (OMC) du f&eacute;mur droit fistulis&eacute;e &agrave; la peau et &eacute;voluant depuis l’&acirc;ge de 16 ans. Il s’est pr&eacute;sent&eacute; actuellement pour des fistules productives, avec pr&eacute;sence &agrave; l’imagerie d’une fracture pathologique sur une l&eacute;sion ost&eacute;olytique de l’extr&eacute;mit&eacute; inf&eacute;rieure du f&eacute;mur droit associ&eacute; &agrave; une collection liquidienne mal limit&eacute;e intra-m&eacute;dullaire &eacute;tendue sur 8cm de grand axe. Une excision chirurgicale des fistules avec mise &agrave; plat de la collection et curetage de la cavit&eacute; osseuse ont &eacute;t&eacute; r&eacute;alis&eacute;es. L’examen anatomopathologique a mis en &eacute;vidence une prolif&eacute;ration tumorale maligne &agrave; type de carcinome &eacute;pidermo&iuml;de diff&eacute;renci&eacute; et k&eacute;ratinisant, infiltrant le trajet fistuleux avec extension au niveau des parties molles et infiltration de l’extr&eacute;mit&eacute; inf&eacute;rieure du f&eacute;mur droit. Le bilan d’extension &eacute;tant n&eacute;gatif, une d&eacute;sarticulation de la hanche a &eacute;t&eacute; pratiqu&eacute;e. Au dernier recule de deux ans, le patient va bien et ne pr&eacute;sente pas de r&eacute;cidive locale ni de m&eacute;tastase &agrave; distance. La prise en charge initiale des ost&eacute;omy&eacute;lites chroniques est primordiale pour pr&eacute;venir les complications redoutables. En cas de transformation maligne et particuli&egrave;rement en carcinome &eacute;pidermo&iuml;de comme le cas de notre observation, l’amputation reste le traitement de choix pour pr&eacute;venir les localisations secondaires.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mbaye Thioub, Mzuette Mbaye, Mohamed Elhassimi Ciss&eacute;, Ndaraw Ndoye, Alioune Badara Thiam, Seydou Boubakar Badiane [Case report] - Canal lombaire &eacute;troit par lipomatose &eacute;pidurale: &agrave; propos d’un cas et revue de la litt&eacute;rature - 30 October 2017. <b>La lipomatose &eacute;pidurale est une pathologie caract&eacute;ris&eacute;e par une l'accumulation anormale de graisse non encapsul&eacute;e dans l'espace &eacute;pidural. Bien que rare, elle est une cause possible de lombosciatique ou de canal lombaire &eacute;troit. Elle est souvent associ&eacute;e &agrave; des facteurs favorisants tels qu'une corticoth&eacute;rapie prolong&eacute;e, ou une ob&eacute;sit&eacute;. Nous rapportons une observation d'un patient qui a pr&eacute;sent&eacute; des lombosciatalgies invalidantes et dont l'exploration radiologique a confirm&eacute; une lipomatose &eacute;pidurale compressive. L'&eacute;volution a &eacute;t&eacute; favorable apr&egrave;s d&eacute;compression chirurgicale.</b><br/> text/html 2017-11-25T09:37:31+01:00 Kourosh Kabir, Hassan Hoseini, Mohammad Miri, Fatemeh Amrollahi, Elham Bahraini, Parviz Afrogh, Enayatollah Kalantar [Research] - Prevalence of chronic viral hepatitis infections in Karaj, Iran - 30 October 2017. <b>INTRODUCTION: Viral hepatitis is challenging for health and blood safety. Studies carried out on blood donors can help find the frequency and trending of hepatitis B and C infections in a community and also safety of donation. The study aim is to determine the prevalence of HBV and HCV in Karaj blood donors over a four year period between 2010 to 2013. METHODS: this study reports the results of a cross sectional seroepidemiological study of hepatitis B and C in blood donors. Data on hepatitis infection and demographic characteristics of donors were gathered from blood donor registries. Frequency of hepatitis infections were described with 95% confidence interval. Chi square and logistic regression were used for analysis. RESULTS: the frequency of HBV and HCV infection in Karaj blood donors was 0.40% and 0.18% respectively. In first time donors, HBV and HCV positivity risk was respectively 3.59 and 4.8 fold in people with primary education (OR=3.59; 95% CI between 2.68-4.80) comparing to academic level. Frequency of hepatitis B has decreased significantly (P<0.001) during study period but frequency of Hepatitis C has not changed significantly. CONCLUSION: the frequencies of HBV and HCV infection in Karaj blood donor population is low. There are equal infection rates within both genders. This must be considered in controlling transmission of infection in this area.</b><br/> text/html 2017-11-25T09:37:31+01:00 Fatima-Zohra Madani Benjelloun, Layachi Chabraoui, Yamna Kriouile [Research] - D&eacute;veloppement d’un programme multidisciplinaire de diagnostic de l’adr&eacute;noleucodystrophie li&eacute;e &agrave; l’X au Maroc: r&eacute;sultats de la mise en œuvre du programme de diagnostic clinique et biologique - 30 October 2017. <b>INTRODUCTION: L’adrénoleucodystrophie liée à l’X (X-ALD) est une maladie neurodégénérative sévère, due à des mutations du gène ABCD1. Elle se manifeste par une atteinte du système nerveux centrale et périphérique, une insuffisance surrénalienne et une atteinte des testicules chez le garçon. Son diagnostic repose sur le dosage des Acides Gras à Très Longue Chaine. Le diagnostic précoce est d’une grande importance puisque selon le stade auquel la maladie est diagnostiquée est définie l’accessibilité au traitements ou non. METHODES: nous avons mis en place un programme de diagnostic de l’adrénoleucodystrophie au Maroc au niveau de l’Hôpital d’enfants et du Laboratoire centrale des maladies héréditaires et du métabolisme de rabat. Le programme s’articule sur trois axe: un protocole pour les cas symptomatique, un deuxième pour les cas asymptomatiques et un troisième pour les femmes hétérozygotes. RESULTATS: durant trois ans après la mise en place de notre programme de diagnostic de l’Adrénoleucodystrophie liée à l’X, nous avons diagnostiqué chez sept familles, avec neuf garçons et trois femmes hétérozygotes. Tous les enfants diagnostiqués présentaient la forme cérébrale démyélinisante. Toutes ces femmes étaient asymptomatiques. Une prise une charge thérapeutique a été mise place selon la symptomatologie de chaque cas. CONCLUSION: le programme de diagnostique a permis de diagnostiqué un nombre important de cas de cette maladie reconnue comme une maladie rare et qui se confond avec plusieurs autres maladie. D’où l’importance des compagnes de sensibilisation auprès des professionnels de santé.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ahmed Bensaad, Christophe Fircket [Images in medicine] - Unusual cause of abdominal pain: the disconnected tube after laparoscopic adjustable gastric banding - 30 October 2017. <b>Laparoscopic adjustable gastric banding (LAGB) is a well recognised and valid option in the treatment of morbid obesity. The objective of this procedure is to restrict the overall food intake. The technique has the reputation of being associated with a low morbidity and almost no mortality. We report the case of a 31-year-old woman, with morbid obesity, who complained from a chronic abdominal pain, mostly localized in the hypogastirum and a failure to lose weight, 13 months after a LAGB. An abdominal x-ray was obtained showing the disconnected tubing from the port, with the separated tube slipping in the pelvis. The patient underwent a laparoscopic retrieval of the band at her will, which was uneventful. Tube disconnection must be considered in patient with history of LAGB, presenting with chronic abdominal pain. A reasonable length separating the port from entrance to the peritoneal cavity may diminish the incidence of this rare LAGB complication. Retrieval of the LapBand is not mandatory in all cases, since reconnecting or changing the port can help solve the problem.</b><br/> text/html 2017-11-25T09:37:31+01:00 Tariq Bouhout, Badr Serji, Ebo Usman Egyir, Benyounes El amri, Imad Bouhout, Mehdi Soufi, Mohammed Bouziane, Tijani El Harroudi [Case report] - Tuberculose mammaire: &agrave; propos d’un cas - 27 October 2017. <b>Latuberculose mammaire est une affection rare. Elle pose un probl&egrave;me de diagnostic diff&eacute;rentiel avec le cancer du sein du fait que la clinique et l'imagerie ne sont pas sp&eacute;cifiques. La tuberculose mammaire doit &ecirc;tre &eacute;voqu&eacute;e surtout dans les pays end&eacute;miques ou chez le sujet immunod&eacute;prim&eacute;. Nous rapportons un cas de tuberculose mammaire chez une femme m&eacute;nopaus&eacute;e pour soulever le probl&egrave;me de diagnostic qu'elle suscite.</b><br/> text/html 2017-11-25T09:37:31+01:00 Yassine Abaloun, Abdelhadi Omari [Images in medicine] - Epith&eacute;liopathie r&eacute;tinienne diffuse - 27 October 2017. <b>Nous rapportons le cas d’un homme de 52 ans sans ATCD consultant pour une baisse progressive de l’acuité visuelle de l’œil droit évoluant depuis 10 ans. L’acuité visuelle corrigée est de 2/10 - P6 à l’OD et de 10/10 - P2 à l’OG. L’examen du segment antérieur est sans particularité. Le FO retrouve au niveau de l’OD une altération de l’épithélium pigmentaire (AEP) associée à des migrations pigmentaires d’aspect ostéoblastique intéressant la macula et une zone étendue par coulée gravitationnelle de l’arcade temporale supérieure jusqu’au quadrant temporal inférieur. Au niveau de l’œil gauche on note un aspect similaire surtout dans la région inter papillo-maculaire (A,B). L’angiographie à la fluorescéine montre dans les 2 yeux une hyperfluorescence précoce des zones de dépigmentation de l’EP associé à des migrations pigmentaires donnant un aspect de queue de comète par coulée gravitationnelle (C,D). L’OCT montre un DEP retro-fovéolaire au niveau de l’OD (E). Le patient a été mis sous Diamox avec une surveillance régulière pour prendre en charge l’éventuelle apparition de points de fuite .L’évolution s’est faite vers une régression du DEP et une amélioration de l’AV.</b><br/> text/html 2017-11-25T09:37:31+01:00 Amadou Diop Dia, Samba Niang [Images in medicine] - M&eacute;ga-œsophage r&eacute;v&eacute;l&eacute; par une pleur&eacute;sie - 27 October 2017. <b>Il s'agit d'un homme de 65 ans, non alcoolo-tabagique, aux ant&eacute;c&eacute;dents m&eacute;dicaux de reflux gastro-œsophagien pour lequel il n'a jamais consult&eacute;. Il est admis au service de pneumologie pour l'exploration d'une toux quinteuse s&egrave;che, insomniante, associ&eacute;e &agrave; une douleur thoracique droite diffuse &agrave; type de pesanteur &eacute;voluant depuis 1 mois environ dans un contexte de fi&egrave;vre vesp&eacute;ro-nocturne sans perte de poids. Les examens clinique et radiologique avaient retrouv&eacute; un syndrome d'&eacute;panchement liquidien pleural droit. La radiographie de contr&ocirc;le r&eacute;alis&eacute;e apr&egrave;s la ponction pleurale &eacute;vacuatrice, avait mis en &eacute;vidence une opacit&eacute; inhomog&egrave;ne occupant la quasi-totalit&eacute; du champ pulmonaire droit (A). Le scanner thoracique &eacute;tait en faveur d'un m&eacute;gaœsophage thoracique associ&eacute; &agrave; une pleuro-pneumopathie non sp&eacute;cifique (B). Le patient a b&eacute;n&eacute;fici&eacute; d'une endoscopie digestive haute qui n'avait pas retrouv&eacute; de signe suspect de cancer. L'&eacute;volution de la pleuro-pneumopathie &eacute;tait favorable apr&egrave;s un traitement par amoxicilline.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ilhame Naciri, Karima Senouci [Images in medicine] - Une ulc&eacute;ration atypique de la l&egrave;vre inf&eacute;rieure - 27 October 2017. <b>La pathomimie cutan&eacute;e est une maladie auto-provoqu&eacute;e dans un &eacute;tat de conscience claire par le patient lui-m&ecirc;me, au niveau de son rev&ecirc;tement cutan&eacute;omuqueux ou de ses phan&egrave;res.Nous rapportons le cas d’une jeune femme, &acirc;g&eacute;e de 22 ans, sans ant&eacute;c&eacute;dent notable, consultait pour une ulc&eacute;ration de la l&egrave;vre inf&eacute;rieure, d’installation brutale, &eacute;voluant depuis 3 mois dans un contexte de conservation de l’&eacute;tat g&eacute;n&eacute;ral. La patiente avait consultait auparavant chez plusieurs confr&egrave;res dermatologues, et b&eacute;n&eacute;ficiait de deux biopsies cutan&eacute;es, dont les r&eacute;sultats &eacute;taient non sp&eacute;cifiques. L’examen clinique objectivait une ulc&eacute;ration, douloureuse, bien limit&eacute;e, &agrave; surface propre, et &agrave; base non indur&eacute;e, mesurant 1x3 cm de diam&egrave;tre, et int&eacute;ressant la moiti&eacute; gauche de la l&egrave;vre inf&eacute;rieure (A). Devant l’aspect clinique de la l&eacute;sion, son caract&egrave;re chronique, et la non r&eacute;ponse aux soins locaux, plusieurs diagnostiques ont &eacute;t&eacute; &eacute;voqu&eacute;s: un carcinome &eacute;pidermo&iuml;de, une leishmaniose cutan&eacute;e, un pyodermagangr&eacute;nosum... Une nouvelle biopsie profonde, objectivait une perte de substance mettant &agrave; nu le chorion, sans caract&egrave;res histologiques de malignit&eacute;. Les s&eacute;rologies de la syphilis et du VIH &eacute;taient n&eacute;gatives. 15 jours apr&egrave;s, l’&eacute;volution &eacute;tait marqu&eacute;e par l’apparition d’une nouvelle l&eacute;sion identique sur le c&ocirc;t&eacute; droit de la l&egrave;vre inf&eacute;rieure, avec cicatrisation compl&egrave;te de l’ancienne l&eacute;sion sous pansement occlusif (B). L’interrogatoire r&eacute;p&eacute;t&eacute; retrouvait la notion de manipulation par la main, ainsi que des conflits familiaux. L’examen par un psychiatre, confront&eacute; aux donn&eacute;es cliniques et &eacute;volutives ont conclu &agrave; des l&eacute;sions de pathomimie.</b><br/> text/html 2017-11-25T09:37:31+01:00 Engy Ali, Rafael Van Den Bergh, Rob D’hondt, Donat Kuma-Kuma, Anja De Weggheleire, Yves Baudot, Vincent Lambert, Paul Hunter, Rony Zachariah, Peter Maes [Research] - Localised transmission hotspots of a typhoid fever outbreak in the Democratic Republic of Congo - 27 October 2017. <b>INTRODUCTION: In a semi-urban setting in the Democratic Republic of Congo, this study aims to understand the dynamic of a typhoid fever (TF) outbreak and to assess: a) the existence of hot spots for TF transmission and b) the difference between typhoid cases identified within those hot spots and the general population in relation to socio-demographic characteristics, sanitation practice, and sources of drinking water. METHODS: this was a retrospective analysis of TF outbreaks in 2011 in Kikwit, DRC using microbiological analysis of water sources and a structured interview questionnaire. RESULTS: there were a total of 1430 reported TF cases. The outbreak’s epidemic curve shows earliest and highest peak attack rates (AR) in three military camps located in Kikwit (Ebeya 3.2%; Ngubu 3.0%; and Nsinga 2.2%) compared to an average peak AR of 0.6% in other affected areas. A total 320 cases from the military camps and the high burden health areas were interviewed. Typhoid cases in the military camps shared a latrine with more than one family (P<0.02). All tap water sources in both the military camps and general population were found to be highly contaminated with faecal coliforms. CONCLUSION: the role of military camps in Kikwit as early hotspots of TF transmission was likely associated with lower sanitary and hygiene conditions. The proximity of camps to the general population might have been responsible for disseminating TF to the general population. Mapping of cases during an outbreak could be crucial to identify hot spots for transmission and institute corrective measures.</b><br/> text/html 2017-11-25T09:37:31+01:00 Kishor Parashramji Brahmapurkar [Research] - Gender equality in India hit by illiteracy, child marriages and violence: a hurdle for sustainable development - 26 October 2017. <b>INTRODUCTION: Gender equality is fundamental to accelerate sustainable development. It is necessary to conduct gender analyses to identify sex and gender-based differences in health risks. This study aimed to find the gender equality in terms of illiteracy, child marriages and spousal violence among women based on data from National Family Health Survey 2015-16 (NFHS-4). METHODS: this was a descriptive analysis of secondary data of ever-married women onto reproductive age from 15 states and 3 UTs in India of the first phase of NFHS-4. Gender gap related to literacy and child marriage among urban and rural area was compared. RESULTS: in rural area all states except Meghalaya and Sikkim had the significantly higher percentage of women's illiteracy as compared to male. Bihar and Madhya Pradesh had higher illiterate women, 53.7% and 48.6% as compared to male, 24.7% and 21.5% respectively (P < 0.000). Child marriages were found to be significantly higher in rural areas as compared to urban areas in four most populated states. CONCLUSION: there is a gender gap between illiteracy with women more affected in rural areas with higher prevalence of child marriages and poor utilization of maternal health services. Also, violence against women is showing an upward trend with declining sex-ratio at birth.</b><br/> text/html 2017-11-25T09:37:31+01:00 Pirabu Sakthivel, Chirom Amit Singh [Images in medicine] - Torus mandibularis - 25 October 2017. <b>A 54-year-old man who presented to the clinic for a routine examination was found to have a hard swelling in the floor of mouth. The swelling was noticed at the age of ten years and had been gradually progressing over the years. However, there was no history of chewing difficulty, dysphagia, dysarthria, oral ulcers or sleep disturbances. On examination, a 4x4 cm bony swelling was noted arising from the lingual surface of mandible, with an intact overlying mucosa. The findings were typical of torus mandibularis, a benign bony outgrowth from the mandible which was also confirmed radiologically. About 80 to 90% of the lesions present as small, bilateral bony protrusions near the pre-molars and are incidental findings on routine oral examination. Despite the large size, our patient declined any treatment as the lesion was asymptomatic.</b><br/> text/html 2017-11-25T09:37:31+01:00 Omar Margad, Jalal Boukhris, Hicham Sallahi, Ouahb Azriouil, Mohamed Daoudi, Khalid Koulali [Case series] - Int&eacute;r&ecirc;t de l’enclouage centrom&eacute;dullaire dans les fractures du quart distal de la jambe: &agrave; propos de 30 cas - 25 October 2017. <b>Les fractures du quart distal de la jambe, sont des fractures dont le trait est situ&eacute; au niveau du quart inf&eacute;rieur du tibia. Elles sont r&eacute;put&eacute;es graves et posent &agrave; la fois des probl&egrave;mes de consolidation, de contention et de stabilit&eacute;. Nous pr&eacute;sentons l'exp&eacute;rience du service de traumatologie orthop&eacute;die de l'H&ocirc;pital militaire Avicenne de Marrakech, concernant 30 fractures ferm&eacute;es du quart inf&eacute;rieur de la jambe, sur une p&eacute;riode de 10 ans (de Janvier 2001 &agrave; D&eacute;cembre 2010) ayant re&ccedil;u un enclouage centrom&eacute;dullaire. Le montage &eacute;tait verrouill&eacute; &agrave; 80% des cas et simple dans les autres cas. La moyenne d'&acirc;ge de nos patients &eacute;tait de 36 ans. Il existait une nette pr&eacute;dominance masculine avec 27 hommes pour 3 femmes. La consolidation a &eacute;t&eacute; obtenue dans un d&eacute;lai normal de 17 semaines en moyenne et les r&eacute;sultats fonctionnels &eacute;tait satisfaisants. Un seul cas d'infection est survenu &agrave; 6 mois du geste chirurgical soit 3,3% et aucune autre complication n'a &eacute;t&eacute; mentionn&eacute;e. Un cal vicieux a &eacute;t&eacute; retrouv&eacute; chez 30% de nos patients. Nos donn&eacute;es &eacute;pid&eacute;miologiques et nos r&eacute;sultats sont presque identiques &agrave; ceux de la litt&eacute;rature. Quant aux r&eacute;sultats angulaires, ils sont nettement inf&eacute;rieurs aux s&eacute;ries de plaques, &agrave; l'oppos&eacute;, leurs r&eacute;sultats infectieux portent &agrave; la prudence et certains s&eacute;ries de clous rapportent d'excellents r&eacute;sultats angulaires &agrave; condition d'avoir un montage stable. A la lumi&egrave;re de ces r&eacute;sultats, nous sommes en droit de conclure au grand int&eacute;r&ecirc;t d'&eacute;largir les indications classiques de l'enclouage centrom&eacute;dullaire verrouill&eacute; &agrave; la prise en charge des fractures du quart distal de la jambe, &agrave; condition d'avoir un montage stable par un double verrouillage distal et une ost&eacute;osynth&egrave;se primaire des fractures distales de la fibula.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ahmed Bensaad, Christophe Fircket [Images in medicine] - Perianal abscess following doppler-guided transanal hemorrhoidal dearterialization - 25 October 2017. <b>The doppler-guided transanal hemorrhoidal dearterialization (DG-THD) is a well-established and validated minimally invasive procedure for the treatment of symptomatic hemorrhoids. As compared to the excisional technique, DG-THD has the advantage of being associated with less post-operative pain and do not compromise the anatomy or the physiology of the anal canal. Our objectif is to describe the first case of perianal abscess following DG-THD. We report perianal abscess in a previously healthy 32-year-old male patient, who underwent DG-THD for grade II hemorrhoids, as an outpatient procedure. One week later, the patient complained of persistent pain in the right iliac fossa and hypogastrium. CT-scan showed a peri-rectal fluid collection with gas bubbles and peripheral enhancement. MRI was obtained after first attempt of elective drainage, showing increase of the collection diameter without any fistula, which prompted a surgical exploration and drainage. Multi sensitive E. coli was found on culture. Post-operative recovery was slow but favourable. To the best of our knowledge, no previous report of perianal abscess following DG-THD has been described in the literature, which we believe in our case to be of haematogenous origin.</b><br/> text/html 2017-11-25T09:37:31+01:00 Talla Paul, Tebeu Pierre Marie, Efuetnkeng Bechem [Research] - Knowledge, attitude and practice of staff of 4 hospitals in Yaound&eacute; on the prevention of vertical transmission of hepatitis B - 25 October 2017. <b>INTRODUCTION: Hepatitis B virus infection is a public health concern in Cameroon and worldwide. With hepatitis C virus, it is the first cause of liver cancer in Cameroon. The high prevalence of 11.9% in Cameroon is associated with the premature contamination at the perinatal period, due to vertical transmission, from mother-to-child. To put into practice the preventives measures, actors need a good knowledge on premature contamination of a baby. The general objective of this study was to evaluate the influence of level of knowledge on the attitudes and the professional practices concerning prevention of mother-to-child transmission of hepatitis B (PMTCT/HBV) in Yaound&eacute;hospitals and environs. METHODS: We carried out a cross sectional multicentric, KAP study from 10th March to 15th December 2015 in the obstetrics services of 4 hospitals in Yaound&eacute;and environs. For each health care provider who gave his consent, we used a pretested questionnaire to collect socio-demographics and professional data as well as their knowledges, attitudes and practices on PMTCT/HBV. After given a grade to each item, we proceeded to a quantitative analysis of data using SPSS software and Epi info 7th version. RESULTS: 105 health care provider took part in the study, made up of 82 women (79%) and 22 men (21%). The ages were between 23 and 60 years, with a mean age of 40.9 ± 9.2 years. Only 21% of the participants had good knowledges on HBV/PMCT. This knowledge had a significant link with the profession, the professional experience and the duration in the same service. All the nurseaids had inadequate knowledges as well as the elders in the profession. Most of the participants (64.4%) had favorableattitude on PMTCT/HBV and that was significantly associated to good knowledges.(OR:5.34; CI 95% [1.47-19.47], p = 0.006). The practices on PMTCT/HBV were inappropriate in 57.1% of the participants. There were no significant relation between good knowledge and the practices (OR: 1.818, CI 95% [0.705-4.68]; p = 0.213) as well as between good attitudes and practices on PMTCT/HBV (OR: 0.932; CI 95% [0.423-2.058]; p = 0.862). CONCLUSION: The healthcare provider in hospitals in Yaound&eacute; and its environs are old. Their knowledge on PMTCT/HBV is inadequate and their practices inappropriate. Good knowledge doesn't always lead to good practices of PMTCT/HBV. There exist some obstacles or intermediate variables between good knowledge, good attitudes and appropriate practices of PMTCT/HBV.</b><br/> text/html 2017-11-25T09:37:31+01:00 Lynn Barbara Edwards, Linda Estelle Greeff [Research] - Exploring grassroots feedback about cancer challenges in South Africa: a discussion of themes derived from content thematic analysis of 316 photo-narratives - 25 October 2017. <b>INTRODUCTION: cancer is an important health problem in Africa with projections that incidence could double by 2030. While sparse, the literature on cancer control in African low- and middle-income countries suggests poor cancer planning, overburdened services and poor outcomes. South Africa has established oncology health care services but low cancer awareness, poor cancer surveillance and widespread service challenges. METHODS: data for this study was derived from 316 photovoice interviews with cancer patients, families of cancer patients and oncology workers across South Africa. The objectives of the study were to collect first-hand feedback about cancer challenges and to develop recommendations for the improvement of cancer control strategies. RESULTS: 9 themes of cancer challenges were distinguished via thematic content analysis of the photo-narratives. The identified themes of cancer challenges were physical and treatment challenges, emotional, poor services, transport, finances, information, powerlessness, stigma and schooling challenges. CONCLUSION: the findings of this study offer the patient and family perspective of cancer challenges as a valid contribution to knowledge. The 9 themes of cancer challenges profile the emotional, physical and social impact of cancer on patients and families, and offer detailed subjective information about problem occurrence in the trajectory of care. Recommendations following from the 9 themes of cancer challenges include training for improved patient-centred care standards, the need for cancer surveillance, innovative and locally appropriate cancer awareness campaigns, private and government health care partnerships and the development of psychosocial services. The advocating of findings and recommendations to influence cancer control strategies in South Africa, is indicated.</b><br/> text/html 2017-11-25T09:37:31+01:00 Noureddine Njoumi, Nabil Jakhlal, Mohammed Laaroussi, Faicel Mohafid, Mohammed Najih, Hicham Iraki, Aziz Zentar [Case report] - H&eacute;mangiome surr&eacute;nalien: &agrave; propos d’un cas - 24 October 2017. <b>L’h&eacute;mangiome surr&eacute;nalien est une entit&eacute; histologique tr&egrave;s rare appartenant au groupe des incidentalomes. Il est souvent asymptomatique, de d&eacute;couverte fortuite lors d’un examen d’imagerie sollicit&eacute; par une autre affection abdominale. Nous rapportons dans ce travail un seul cas permettant d’&eacute;toffer la s&eacute;rie internationale qui reste jusqu’&agrave; nos jours tr&egrave;s limit&eacute;e.</b><br/> text/html 2017-11-25T09:37:31+01:00 Maureen Ugonwa Anetoh, Chiamaka Henrietta Jibuaku, Sunday Odunke Nduka, Samuel Uchenna Uzodinma [Research] - Knowledge and implementation of Tertiary Institutions’ Social Health Insurance Programme (TISHIP) in Nigeria: a case study of Nnamdi Azikiwe University, Awka - 24 October 2017. <b>INTRODUCTION: Tertiary Institutions’ Social Health Insurance Programme (TISHIP) is an arm of the National Health Insurance Scheme (NHIS), which provides quality healthcare to students in Nigerian higher institutions. The success of this scheme depends on the students’ knowledge and awareness of its existence as well as the level of its implementation by healthcare providers. This study was therefore designed to assess students’ knowledge and attitude towards TISHIP and its implementation level among health workers in Nnamdi Azikiwe University Medical Centre. METHODS: using a stratified random sampling technique, 420 undergraduate students of Nnamdi Azikiwe University, Awka were assessed on their level of awareness and general assessment of TISHIP through an adapted and validated questionnaire instrument. The level of implementation of the scheme was then assessed among 50 randomly selected staff of the University Medical Center. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 20 software. RESULTS: whereas the students in general, showed a high level of TISHIP awareness, more than half of them (56.3 %) have never benefited from the scheme with 52.8 % showing dissatisfaction with the quality of care offered with the scheme. However, an overwhelming number of the students (87.9 %) opined that the scheme should continue. On the other hand, the University Medical Centre staff responses showed a satisfactory scheme implementation. CONCLUSION: the study found satisfactory TISHIP awareness with poor attitude among Nnamdi Azikiwe University students. Furthermore, the University Medical Centre health workers showed a strong commitment to the objectives of the scheme.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hamid Jiber, Youssef Zrihni, Hamza Naouli, Abdellatif Bouarhroum [Case report] - Fibrodysplasic aneurysms of the extracranial internal carotid artery: a new case report - 23 October 2017. <b>The other reports a case of fibrodysplasic aneurysm of the extracranial internal carotid artery that was successfully treated by resection and direct end-to-end anastomosis of the internal carotid artery.</b><br/> text/html 2017-11-25T09:37:31+01:00 Bouchra Rafiq, Ghizlane El Mghari [Images in medicine] - Paragangliome tympanique simulant un cholestéatome: à propos d’un cas - 20 October 2017. <b>Les paragangliomes tympaniques sont des tumeurs bénignes fréquentes de l’oreille moyenne, faites de cellules neuroendocrines, dispersées le long des axes vasculaires de la tête, du cou et de la colonne vertébrale. Une hypoacousie et un acouphène pulsatile en sont souvent les symptômes révélateurs. L’otoscopie révèle souvent une masse rougeâtre pulsatile rétro-tympanique. L’IRM et la scintigraphie aux analogues de la somatostatine (octréo-scan) sont les examens radiologiques de choix. L’octréo-scan permet de rechercher les autres localisations. Le dosage des dérivés méthoxylés urinaires est nécessaire, complété par le dépistage des autres composantes des néoplasies endocriniennes multiples (NEM). La biopsie est contre-indiquée, vu le risque hémorragique. La chirurgie est le traitement de choix. Nous rapportons le cas du patient FA, 75 ans, admis pour paragangliome tympanique, révélé par une hypoacousie droite installée depuis 4 ans, associée à des acouphènes pulsatiles concomitantes aux battements cardiaques. Otoscopie: masse rétro-tympanique droite rougeâtre battante (A). (B) Comblement totale de l’oreille moyenne et des cellules mastoïdiennes, sans processus tumoral individualisable, avec hypersignal franc en diffusion, qui se rehausse de façon intense après injection de produit de contraste (PDC). Le bilan de NEM s’est révélé sans anomalies, notamment les dérivés méthoxylés de 24h, parathormone et calcitonine. Le diagnostic de paragangliome a été retenu, vu que le rehaussement intense après injection de PDC. Le patient est prévu pour octréo-scan avant la chirurgie.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ndeye Fatou Thiam, Evelyne Siga Diom, Cire Ndiaye, Abdou Sy [Case report] - Plaies trach&eacute;ales post intubations dans la chirurgie cervicale: &agrave; propos de 3 cas - 20 October 2017. <b>Nous rapportons 3 cas rares de plaies trach&eacute;ales post-intubations d&eacute;couvertes au cours de chirurgie cervicale. Il s’agissait de 3 patientes &acirc;g&eacute;es de 27, 30 et 42 ans admises au bloc op&eacute;ratoire pour une thyro&iuml;dectomie totale sous anesth&eacute;sie g&eacute;n&eacute;rale indiqu&eacute;e devant un goitre h&eacute;t&eacute;ro-multi-nodulaire. L’intubation &eacute;tait orotrach&eacute;ale &agrave; l’aide d’un guide rigide avec une sonde N°7,5 munie d’un ballonnet. Nous avons d&eacute;couvert en per op&eacute;ratoire une protrusion du ballonnet dans le champ op&eacute;ratoire &agrave; travers une effraction trach&eacute;ale post&eacute;ro-lat&eacute;rale. Le traitement avait consist&eacute; en une fermeture de la br&egrave;che trach&eacute;ale dans 2 cas et une abstention chirurgicale dans le troisi&egrave;me cas suivi d’un drainage de la loge thyro&iuml;dienne. Les suites op&eacute;ratoires &eacute;taient simples. Les plaies trach&eacute;ales post-intubations sont rares. Leur d&eacute;couverte per op&eacute;ratoire au cours d’une chirurgie cervicale est exceptionnelle. Les causes sont multiples. Il s’agit des difficult&eacute;s d’intubation, d’une d&eacute;chirure de la membraneuse par le bec de la sonde d’intubation, par un guide rigide, un effort de toux avec ballonnet gonfl&eacute; au r&eacute;veil, un sur-gonflage du ballonnet, de la modification structurale et anatomique de la trach&eacute;e dans les goitres anciens. Il n’y a pas de consensus dans le traitement.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hakan Yilmaz, Osman Boyali, Ibrahim Burak Atci, Umit Kocaman [Case report] - Spontaneous resolution of post-traumatic chronic subdural hematoma: a case report - 20 October 2017. <b>Chronic subdural hematomas often occurs in late middle and old age following trivial head trauma. Surgical intervention is the first treatment option in chronic subdural hematomas which compressed the cerebral parenchym. Hematoma may be calcified or ossified in untreated patients. Spontaneous resolution of post-traumatic chronic subdural hematoma is a rare event. Spontaneous resolution is rarer if the subdural hematoma is bilateral. In the literature, this condition is reported mostly in patients with idiopathic thrombocytopenic purpura. Here, we present a case of spontaneously resolved post-traumatic bilateral chronic subdural hematoma within a period of one month in a 55-year-old male and we discuss the probable mechanisms of pathophysiology in the spontaneous resolution of chronic subdural hematoma.</b><br/> text/html 2017-11-25T09:37:31+01:00 Driss Hanine, Achraf El Bakkaly, Mohammed Amine Essaoudi, Aiat Allah Skiredj, Abderahmane Malihy, Abdelouahed El Amrani, Mohammed Anouar Dendane, Sidi Zouhair Fellouss El Alami, Tarik El Madhi [Case report] - Tuberculose de l’omoplate chez l’enfant: &agrave; propos d’une localisation exceptionnelle - 20 October 2017. <b>La tuberculose osseuse est une maladie infectieuse qui constitue un v&eacute;ritable probl&egrave;me de sant&eacute; publique dans les pays en voie de d&eacute;veloppement o&ugrave; elle s&eacute;vit de mani&egrave;re end&eacute;mique. L'atteinte ost&eacute;o-articulaire repr&eacute;sente 1 &agrave; 5% des cas de tuberculose toutes localisations confondues, l'atteinte de l'&eacute;paule reste tr&egrave;s rare et repr&eacute;sente 1 &agrave; 2% des localisations ost&eacute;o-articulaires. Nous pr&eacute;sentons ici un nouveau cas exceptionnel d'une infection tuberculeuse de l'omoplate, atteignant le corps de l'omoplate. La tuberculose est encore un diagnostic diff&eacute;rentiel important des maladies rares ou chroniques des os, notamment tumorales. Le diagnostic a &eacute;t&eacute; redress&eacute; par l'&eacute;tude anatomopathologique.</b><br/> text/html 2017-11-25T09:37:31+01:00 Rajaonarison Lala Andriamasinavalona, Rasaholiarison Nomena Finiavana [Images in medicine] - C&eacute;phal&eacute;es d’allure migraineuse r&eacute;v&eacute;latrice d’un accident vasculaire c&eacute;r&eacute;brale sur dissection carotidienne - 20 October 2017. <b>Les dissections des art&egrave;res cervico-enc&eacute;phaliques repr&eacute;sentent la principale cause d'accident vasculaire c&eacute;r&eacute;bral (AVC) chez l'adulte jeune. Nous rapportons le cas d'un homme de 59 ans qui consultait pour une c&eacute;phal&eacute;e d'allure migraineuse avec des scintillements de l'œil gauche et une paresth&eacute;sie de l'h&eacute;micorps droit paroxystique et d'&eacute;volution r&eacute;gressive. Chez un patient hypertendu et migraineux o&ugrave; l'examen clinique a permis de trouver une paraphasie phon&eacute;mique avec manque de mots. L'imagerie par r&eacute;sonance magn&eacute;tique (IRM) enc&eacute;phalique en s&eacute;quence vasculaire a montr&eacute; en un hypersignal p&eacute;rivasculaire de l'art&egrave;re carotide interne gauche (partie intra p&eacute;treuse) en diffusion et hyposignal en T2*, en faveur d'un h&eacute;matome de la paroi avec occlusion art&eacute;rielle &agrave; ce niveau. Aussi, plusieurs hypersignaux ponctiformes ont &eacute;t&eacute; mis en &eacute;vidence en diffusion et Flair au niveau territoire art&egrave;re c&eacute;r&eacute;brale ant&eacute;rieur gauche et jonctionnel entre l'art&egrave;re c&eacute;r&eacute;brale ant&eacute;rieur et moyenne gauche sans pr&eacute;sence de microbleeds au niveau parenchymateuse, en faveur d'un AVC d'origine embolique suite &agrave; la dissection carotidienne. Une anticoagulation &agrave; dose curative par antagoniste du vitamine K a &eacute;t&eacute; mise en place (INR cible entre 2 &agrave; 3) apr&egrave;s h&eacute;parinoth&eacute;rapie avec une r&eacute;&eacute;ducation orthophonique. Une angio-IRM tronc supra aortique &agrave; 3 mois a montr&eacute; une reperm&eacute;abilisation de La Carotide interne gauche intra p&eacute;treuse. L'imagerie est d'un int&eacute;r&ecirc;t majeur dans la confirmation diagnostique des dissections des art&egrave;res cervico-enc&eacute;phaliques et de l'&eacute;ventualit&eacute; d'un accident c&eacute;r&eacute;bral isch&eacute;mique mais aussi th&eacute;rapeutique tant imm&eacute;diate que pour la suivi de ses patients.</b><br/> text/html 2017-11-25T09:37:31+01:00 Abdelouahab Elkasimi, Ghizlane Elouazzani, Anas Hbali, Nabila Ismaili, Nouha Elouafi [Case report] - La dissection spontan&eacute;e des art&egrave;res coronaires: &agrave; propos de 2 cas - 20 October 2017. <b>La dissection spontan&eacute;e des art&egrave;res coronaires (DSAC) est une cause rare du syndrome coronarien aigu (SAC); sa pr&eacute;valence est de moins de 3%. Elle se d&eacute;finit par une s&eacute;paration au sein de la paroi art&eacute;rielle coronaire secondaire &agrave; une h&eacute;morragie intra murale, avec ou sans d&eacute;chirure de l'intima, cr&eacute;ant un faux chenal. Elle survient essentiellement chez les sujets jeunes, principalement les femmes, sans ath&eacute;roscl&eacute;rose coronarienne ni facteurs de risque d'ath&eacute;roscl&eacute;rose; toutefois la survenue d'une dissection spontan&eacute;e sur une maladie ath&eacute;romateuse est possible. A travers 2 cas de dissection coronaire spontan&eacute;e, nous discutons sa pathog&eacute;nie, les facteurs favorisant sa survenue, sa pr&eacute;sentation clinique et sa gestion th&eacute;rapeutique.</b><br/> text/html 2017-11-25T09:37:31+01:00 Nisrine Mamouni, Hanane Saadi, Hinde belfatemi, Sanaa Erraghay, Chahrazade Bouchikhi, Abdelaziz Banani [Case report] - The primary fallopian tube carcinoma: a rare association with pelvic nodal tuberculosis - 19 October 2017. <b>The primary carcinoma of fallopian tube is a rare entity. It represents 0.14 to 1.81% of genital cancers in women. It is a cancer of older women. Its association with tuberculosis is exceptional. We report a rare case of bilateral serous adenocarcinoma of the fallopian tube in a patient aged 42 years, multiparous, whose characteristic is the unexpected association with peritoneal tuberculosis.</b><br/> text/html 2017-11-25T09:37:31+01:00 Khalid Mazine, Hicham Elbouhaddouti, Imane Toughrai, Ouadie Mouaqit, Elbachir Benjelloun, Abdelmalek Ousadden, Khalid Ait Taleb [Case report] - Volvulus du c&aelig;cum, une cause rare d’occlusion intestinale: &agrave; propos de deux cas - 19 October 2017. <b>Le C&aelig;cum est, en fr&eacute;quence, la deuxi&egrave;me partie du colon concern&eacute;e par le volvulus apr&egrave;s le sigmo&iuml;de et avant l'angle gauche et le c&ocirc;lon transverse. Cette affection survient sur des c&aelig;cums anormalement mobiles. Le m&eacute;canisme du volvulus est la torsion ou la bascule. Le tableau clinique est celui d'une occlusion intestinale aigu&euml; par strangulation. L'abdomen sans pr&eacute;paration (ASP) et la TDM abdominale sont les examens radiologique de premier choix pour le diagnostic. Le traitement consiste en une chirurgie en urgence avec r&eacute;section du c&aelig;cum et de l'il&eacute;on terminal. Nous rapportons deux cas de volvulus du c&aelig;cum admis aux urgences dans un tableau d'occlusion intestinale aigu&euml;, le diagnostic &eacute;tait confirm&eacute; chez les deux patients par un scanner abdomino-pelvien et le traitement consistait en une r&eacute;section il&eacute;o-colique avec r&eacute;tablissement imm&eacute;diate de continuit&eacute;, les suites post op&eacute;ratoires &eacute;taient simples.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mustafa Nkaoui, Youness Sasbou [Images in medicine] - Syndrome canalaire du pied r&eacute;v&eacute;lant un schwannome du nerf fibulaire superficiel: r&eacute;sultat d’un traitement chirurgical conservateur - 19 October 2017. <b>Nous rapportons le cas d'un patient &acirc;g&eacute; de 61 ans sans ant&eacute;c&eacute;dents pathologiques particuliers. Il se plaint depuis 6 mois de douleurs avec paresth&eacute;sies au niveau de la face ant&eacute;rolat&eacute;ralede la jambe gaucheirradiant sur la face dorsale de la cheville et du pied.Ces douleurs sont exacerb&eacute;es par l'effort. L'examen clinique a objectiv&eacute; un d&eacute;ficit partiel de la sensibilit&eacute; et unsigne de Tinel positif dans le territoire du nerf fibulaire superficiel (A). L'EMG a confirm&eacute; l'atteinte de ce nerf avec une diminution d'amplitude des potentiels sensitifs. Une radiographie a &eacute;limin&eacute; une cause ost&eacute;o articulaire sous-jacente (B). L'&eacute;chographie a objectiv&eacute; une formation tissulaire homog&egrave;ne bien limit&eacute;e (C) et l'IRM. Une masse fusiforme centr&eacute;e sur le nerf enhyposignal en T1, et hypersignal en T2 r&eacute;hauss&eacute;e par le produit de contraste (D). L'ex&eacute;r&egrave;se chirurgicale conservatrice respectant les fascicules nerveux (E, F) et l'anatomopathologie ont confirm&eacute; le diagnostic de schwannome (G) et son caract&egrave;re b&eacute;nin. A 1 mois de recul, le patient a vu disparaitre sa symptomatologie avec conservation de la sensibilit&eacute; dans le territoire de ce nerf. En l'absence de tum&eacute;faction, le diagnostic d'unschwannome est difficile et peut mimer un syndrome canalaire comme le cas dans notre observation. Les schwannomes sont des tumeurs nerveuses p&eacute;riph&eacute;riques extirpables. Leur pronostic reste excellent apr&egrave;s un traitementchirurgical adapt&eacute; respectant les fascicules nerveux.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hicham Eddou, Ali Zinebi, Hicham El Maaroufi, Mohammed Karim Moudden, Kamal Doghmi, Mohammed Mikdame, Mohammed El Baaj [Case series] - Traitement des amyloses AL syst&eacute;miques: &agrave; propos de 25 cas - 19 October 2017. <b>L'amylose AL syst&eacute;mique primitive est un d&eacute;sordre h&eacute;matologique rare. La plupart des recommandations th&eacute;rapeutiques sont bas&eacute;es sur des &eacute;tudes de phase II ou des comparaisons r&eacute;trospectives et des s&eacute;ries de cas. Le but de cette &eacute;tude &eacute;tait de d&eacute;crire les cas d'amylose primitive AL et de faire une comparaison entre le protocole standard Melphlan-Dexamethasone et les nouveaux agents dans le traitement de premi&egrave;re ligne de ces patients. Il s'agissait d'une &eacute;tude r&eacute;trospective, descriptive et multicentrique, portant sur l'ensemble des amyloses AL collig&eacute;es durant une p&eacute;riode s'&eacute;talant de juillet 2009 &agrave; juin 2016 au sein de 2 centres hospitaliers militaires. Vingt cinq patients ont &eacute;t&eacute; collig&eacute;s dans notre s&eacute;rie (12 trait&eacute;s par le Melphalan-Dexamethasone et 13 par des protocoles contenant au moins du Bort&eacute;zomib ou du L&eacute;nalidomide). Il n'y avait pas de diff&eacute;rence significative entre les 2 groupes en termes de caract&eacute;ristiques &eacute;pid&eacute;miologiques, cliniques ou pronostiques. Apr&egrave;s un suivi m&eacute;dian de 40 mois, la survie globale m&eacute;diane &eacute;tait de 54 mois dans le groupe melphalan-Dexamethasone et de 60 mois dans le groupe nouvelles th&eacute;rapeutiques (P = 0,98). Concernant la survie sans progression, elle &eacute;tait de 18 mois pour le groupe traitement standard contre 11 mois pour le 2<sup>&egrave;me</sup> groupe (P = 0,08). Dans notre petite s&eacute;rie nous n'avons pas trouv&eacute; une sup&eacute;riorit&eacute; des nouvelles th&eacute;rapeutiques par rapport au protocole classique. Ce r&eacute;sultat doit &ecirc;tre confirm&eacute; par la r&eacute;alisation d'une vraie &eacute;tude prospective surtout en raison du cout de ces nouvelles mol&eacute;cules qui ne sont pas toujours accessibles surtout dans les pays en voie de d&eacute;veloppement.</b><br/> text/html 2017-11-25T09:37:31+01:00 Anouar Jarraya [Reaction] - R&eacute;action &agrave; Mohamed Said Nakhli et al. &agrave; propos de l'article: "Quand le bloc axillaire reste la seule alternative chez un enfant de 5 ans". The Pan African Medical Journal. 2015;21:36 - 19 October 2017. <b>Le bloc axillaire chez l'enfant est une technique facile et recommand&eacute;e chez l'enfant. Sa r&eacute;alisation chez un enfant pr&eacute;sentant une h&eacute;patite A aigue n'est pas d&eacute;munie de risques surtout lorsqu'il est associ&eacute; &agrave; une s&eacute;dation au propofol avec du remifentanil. De m&ecirc;me, la pr&eacute;sence d'un kyste hydatique unique laisse la possibilit&eacute; de l'anesth&eacute;sie g&eacute;n&eacute;rale avec ventilation uni pulmonaire.</b><br/> text/html 2017-11-25T09:37:31+01:00 Dhia Kaffel, Wafa Hamdi [Images in medicine] - Syringomyelia associated to rheumatoid-atlantoaxial subluxation: about a new case - 19 October 2017. <b>We report a case of 64-year-old Tunisian woman with a 12-year history of rheumatoid arthritis, who presented with a 3-month history of increasing inflammatory neck pain. Neurological examination noted a quadripyramidal syndrome without any neurological deficit. Radiographs of her neck showed ananterior atlantoaxial subluxation (A). MRI revealed a pannus around the atlanto axial joint. It also showed a co-existing syringomyelia (B). The cervical spine is frequently involved in patients with rheumatoid arthritis. However, rheumatoid atlantoaxial subluxation with syringomyelia is very rare. Many hypothesised mechanisms were suggested for the syrinx formation. The most commonly admitted, suggested that atlanto axial subluxation may reduce the rate of ascending cerebrospinal fluid, so it would travel through the spinal cord producing syringomyelia.</b><br/> text/html 2017-11-25T09:37:31+01:00 Paul Mawaw, Thierry Yav, Olivier Lukanka, Olivier Mukuku, Christian Kakisingi, Jean-Baptiste Kakoma, Oscar Numbi Luboya [Research] - A cross-sectional study on obesity and related risk factors among women of the central market of Lusonga in Lubumbashi, Democratic Republic of Congo - 19 October 2017. <b>INTRODUCTION: Obesity is known as one of adjuvant factors for increase in non-communiable diseases (NCDs). The aim of this study was to describe the prevalence of obesity and identify its risk factors among women of the central market of Lusonga in Lubumbashi, Democratic Republic of Congo. METHODS: In October 2014, we interviewed a total of 430 women selling in the central market of Lusonga in Lubumbashi. Data on sociodemographic characteristics, health-related habits and behaviors, diet, physical activity, chronic diseases, blood pressure and anthropometric measurements were collected. A multivariate logistic regression model was fitted.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohamed Badri, Dhia Kaffel [Images in medicine] - Idiopathic epidural lipomatosis of the lumbar spine - 19 October 2017. <b>A 50-year-old male without medical history presented with progressive development of motor weakness in his lower extremities and urinary leakage. For one year, he had experienced severe lower back pain associated to bilateral radicular claudication of the lower limbs. Physical examination revealed stepping with bilateral foot dorsiflexor weakness (2/5). Deep-tendon reflexes were abolished in both lower limbs with hypoesthesia of the lower left extremity. Examination of Upper limbs was normal and the body mass index was 37 kg/m2. Magnetic resonance imaging (MRI) of the lumbar spine showed a multilevel high intensity epidural mass lesion compressing the dural sac extending from L1 to L5 level, on T1 and T2 weighted images (WI) (A & B). Axial MRI T2-WI showing a hyperintense anterior epidural mass with deformation of the dural sac at the level of L4 (C). Frontal MRI myelography showed a complete stop of the cerebro-spinal fluid at lumber levels (D). The patient was operated. Laminectomy and epidural decompression at L3, L4 and L5 levels with removal of epidural fat has been performed. Pathologic examination revealed nodular proliferation of mature fat cells, with lipomatosis. Postoperative examination showed improvement of clinical signs.</b><br/> text/html 2017-11-25T09:37:31+01:00 Lassaad Hassini, Thabet Mouelhi, Mohamed Ali Khalifa, Mourad Mtaoumi, Mohamed Laaziz Ben Ayeche [Case report] - Ulnar paddlefish carpometacarpal dislocation of the three lesser fingers: a case report - 18 October 2017. <b>The long fingers' paddlefish carpometacarpal (CMC) dislocation is exceptional. Most dislocations occur after high energy trauma. Untreated, these lesions can result in chronic instability of the CMC joints and early osteoarthritis. We report the case of a 20-year-old patient presenting with an ulnar paddlefish CMC fracture-dislocation of the three lesser fingers resulting from a hand trauma in the context of an occupational accident. Treatment is usually surgical though no strict consensus can be found upon literature review. If diagnosed early and no associated fractures are found, CMC dislocation could benefit from conservative treatment.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ilhame Naciri, Baderddine Hassam [Images in medicine] - Adénocarcinome de l’ampoule de Vater révélé par un prurigo - 18 October 2017. <b>Le prurigo chronique peut être révélateur de plusieurs maladies internes. L’association à une néoplasie solide est rare. Nous rapportons un cas exceptionnel d’un prurigo chronique révélateur d’un adénocarcinome de l’ampoule de Vater, curable chirurgicalement. Il s’agit d’un homme âgé de 70 ans, sans antécédent particulier, qui était hospitalisé pour bilan étiologique de son prurigo évoluant depuis 06 mois dans un contexte d’amaigrissement non chiffré. Les lésions étaient isolées intéressaient le tronc et les membres (A), le bilan initialement réalisé était strictement normal. Devant l’absence d’amélioration sous traitement symptomatique, un complément d’investigations comprenant notamment une tomodensitométrie thoraco-abdominopelvienne objectivait un processus tumoral du confluant bilio pancréatique de 2 cm, évoquant le diagnostic d’ampullome (B). Après un traitement chirurgical de cet adénocarcinome de l’ampoule de Vater, les lésions cutanées régressaient sans aucun traitement complémentaire. Un an plus tard, il n’existait pas de rechute des lésions cutanées et le malade était en rémission complète de son adénocarcinome.</b><br/> text/html 2017-11-25T09:37:31+01:00 Bouchra Rafiq, Ghizlane El Mghari [Images in medicine] - My&eacute;lolipome de la surr&eacute;nale: &agrave; propos d’un cas - 18 October 2017. <b>Le my&eacute;lolipome surr&eacute;nalien est une tumeur rare, b&eacute;nigne, non s&eacute;cr&eacute;tante, souvent de d&eacute;couverte fortuite. Sa physiopathologie serait une m&eacute;taplasie des cellules de la corticosurr&eacute;nale en cellules r&eacute;ticulo-endoth&eacute;liales en r&eacute;ponse &agrave; une infection, &agrave; un stress chronique ou &agrave; une d&eacute;g&eacute;n&eacute;rescence de la surr&eacute;nale. La moyenne d’&acirc;ge de d&eacute;couverte est vers la cinquantaine. Histologiquement, la tumeur est constitu&eacute;e de tissu graisseux m&acirc;ture, associ&eacute; &agrave; du tissu h&eacute;matopo&iuml;&eacute;tique normal. Ainsi l'&eacute;chog&eacute;nicit&eacute; de la tumeur est fonction de la pr&eacute;dominance de la composante graisseuse ou my&eacute;lo&iuml;de. Son diagnostique est port&eacute; par le scanner qui identifie le contingent graisseux. Toutefois, ces aspects radiologiques peuvent pr&ecirc;ter &agrave; confusion avec l'angiomyolipome du rein, le lipome et le liposarcome d'o&ugrave; l’int&eacute;r&ecirc;t de l'IRM. Habituellement respect&eacute;, l'ex&eacute;r&egrave;se du my&eacute;lolipome est indiqu&eacute;e quand il est volumineux, compressif ou pr&eacute;sentant un risque h&eacute;morragique. Nous rapportons le cas du patient AL A, 75 ans, hospitalis&eacute; pour masse surr&eacute;nalienne, r&eacute;v&eacute;l&eacute;e par des lombalgies droites, irradiant vers l'hypocondre droit, sans signes d'hypers&eacute;cr&eacute;tion endocrine. L'examen clinique a r&eacute;v&eacute;l&eacute; une sensibilit&eacute; de la fosse lombaire droite. Le bilan de ph&eacute;ochromocytome et de corticosurr&eacute;nalome s'est r&eacute;v&eacute;l&eacute; sans anomalies, notamment les d&eacute;riv&eacute;s m&eacute;thoxyl&eacute;s urinaires de 24heures et le freinage minute. Le patient a &eacute;t&eacute; op&eacute;r&eacute; par cœlioscopie, avec &agrave; l'examen anatomo-pathologique un aspect de my&eacute;lolipome surr&eacute;nalien.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mustafa Nkaoui, Amine El Yazidi [Images in medicine] - Rupture du long extenseur du pouce secondaire &agrave; une fracture du radius distal r&eacute;par&eacute;e par une greffe tendineuse partielle &agrave; partir du long extenseur radial du carpe avec un bon r&eacute;sultat fonctionnel - 18 October 2017. <b>Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 36 ans, victime d'un accident de sport &agrave; l'occasion d'une chute d'un cheval. Le bilan radiologique objectivait une fracture communitive ferm&eacute;e de l'extr&eacute;mit&eacute; inf&eacute;rieure du radius gauche avec d&eacute;placement important (A et B). La prise en charge initiale a consist&eacute; en une ost&eacute;osynth&egrave;se &agrave; foyer ouvert avec plaque ant&eacute;rieure viss&eacute;e et des broches (C) suivie d'une r&eacute;&eacute;ducation fonctionnelle. L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par la survenue d'une rupture secondaire du long extenseur objectiv&eacute; cliniquement par un d&eacute;ficit d'extension du pouce et confirm&eacute; par une &eacute;chographie dynamique (D); la patiente a &eacute;t&eacute; repris chirurgicalement avec &agrave; l'exploration un tendon effiloch&eacute; coinc&eacute; dans un important cal osseux (E), le traitement conservateur &eacute;tait impossible, la r&eacute;paration a consist&eacute; en une r&eacute;section greffe partielle &agrave; partir du long extenseur radial du carpe apr&egrave;s son dissection par la m&ecirc;me voie d'abord. Le r&eacute;sultat apr&egrave;s r&eacute;&eacute;ducation &eacute;tait excellent (F) avec reprise progressive du travail &agrave; partir du 2&egrave;me mois.</b><br/> text/html 2017-11-25T09:37:31+01:00 Fanna Gebresllasie, Mache Tsadik, Eyoel Berhane [Research] - Potential predictors of risk sexual behavior among private college students in Mekelle City, North Ethiopia - 18 October 2017. <b>INTRODUCTION: Risk sexual practice among students from public universities/colleges is common in Ethiopia. However, little has been known about risk sexual behavior of students in private colleges where more students are potentially enrolled. Therefore, this study aimed to assess the magnitude of risky sexual behaviors and predictors among students of Private Colleges in Mekelle City. METHODS: a mixed design of both quantitative and qualitative methods was used among 627 randomly selected students of private colleges from February to march 2013. Self administered questionnaire and focus group discussion was used to collect data. A thematic content analysis was used for the qualitative part. For the quantitative study, Univariate, Bivariate and multivariable analysis was made using SPSS version 16 statistical package and p value less than 0.05 was used as cut off point for a statistical significance. RESULTS: among the total 590 respondents, 151 (29.1%) have ever had sex. Among the sexually active students, 30.5% reported having had multiple sexual partners and consistent condom use was nearly 39%. In multivariable logistic regression analysis, variables such as sex, age group, sex last twelve months and condom use last twelve months was found significantly associated with risky sexual behavior. The findings of qualitative and quantitative study showed consistency in presence of risk factors. CONCLUSION: finding of this study showed sexual risk behaviors is high among private colleges such as multiple sexual partners and substance use. So that colleges should emphasis on promoting healthy sexual and reproductive health programs.</b><br/> text/html 2017-11-25T09:37:31+01:00 Brahim El Hasbaoui, Lamia Karboubi, Badr Sououd Benjelloun [Case series] - Newborn haemorrhagic disorders: about 30 cases - 18 October 2017. <b>The haemorrhagic disorders are particularly frequent in neonatal period. Their causes are varied and their knowledge is capital for their good management. Our purpose was to describe the epidemiological, diagnostic, and common causes of new-bornhaemorrhagic syndrome in paediatric emergency medical department of the Rabat Children's Hospital. We conducted a descriptive study from December 2015 to April 2016, about new-borns admitted to medical emergencies for haemorrhagic syndrome defined by bleeding, exteriorized or not, whatever its importance, severity, causes and the associated clinical and biological disorders. Between December 2015 and April 2016, we identified 30 cases of newborn haemorrhagic syndromes on 594 hospitalizations (5.05%). The sex-ratio (M/F) was 1.5. None of them received vitamin K after birth and all were breastfed. Preterm infants accounted for 10%.The presentation of haemorrhage encountered was dominated by visceral bleeding especially digestive (80%), followed by epistaxis (10%), Haematuria (7%), and skin haemorrhage (3%). Physical examination was normal in most of cases with exception (nine babies had pallor with hypotonia, three babies suffered from hypovolemic shock, respiratory distress(10%), drowsiness, poor sucking and fever. The most common cause of bleeding disorder was haemorrhagic disease of the new-born (80%), disseminated intravascular coagulation (DIC) (10%), esophagitis (6.67%) and isolated thrombocytopenia (3.33%). At the end of our study, given the high frequency of vitamin k deficiency bleeding disease despite the prophylaxis received, a strengthening of the prevention system is necessary.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mojtaba Ameli, Naser Yousefzadeh [Case report] - Transvesical removal of huge seminal vesicle cystadenoma - 17 October 2017. <b>Benign tumors of the Seminal vesicle that occur more commonly then malignant tumors. Cystadenoma is an extremely rare benign tumor of the seminal vesicle. Management of these tumors remains debatable due to the limited data in the literature. We present a cystadenoma of the seminal vesicle was resected using an open transvesical approach. A Sonography reported enlarged prostate with volume of 560 ml with multiple cystic area inside it. CT scan and abdomen and pelvic MRI with and without Gadolinium also performed and huge (120 * 100 * 100mm) heterogeneous mass in anatomic site of prostate reported. Patient underwent pelvic mass resection by retro vesical abdominal approach. Final pathology report is consistent with cystadenoma/epithelial stromal tumor of the seminal vesicle with no suggestion for malignancy. After recovery from surgery patient was symptom free and totally continent with preserved erectile function. Surgical intervention may be considered when a cystadenoma of the seminal vesicle is diagnosed and symptoms or tumor growth occurs transvesical removal of seminal vesicle mass is an effective surgical procedure for seminal vesicle disease.</b><br/> text/html 2017-11-25T09:37:31+01:00 Meryem Belmajdoub, Sofia Jayi [Images in medicine] - Un ad&eacute;nofibrome kystis&eacute; se r&eacute;v&eacute;lant par un tableau de mastite infectieuse en post partum - 17 October 2017. <b>Nous rapportons le cas de Mme A.A, &acirc;g&eacute;e de 21 ans primigeste, consulte chez nous (&agrave; 4 mois du post-partum de l'accouchement) pour une augmentation du volume du sein Gauche d&eacute;butant une semaine apr&egrave;s l'accouchement dans un contexte f&eacute;brile, suite auquel la patiente a &eacute;t&eacute; mise sous amoxicilline prot&eacute;g&eacute;e pendant plusieurs semaines avec arr&ecirc;t de l'allaitement mais sans am&eacute;lioration. L'examen clinique a trouv&eacute; une patiente f&eacute;brile &agrave; 39°, un sein Gauche augment&eacute; de volume avec des signes inflammatoires surtout au niveau des quadrants internes (A). La palpation a trouv&eacute; une collection de 16 cm, Douloureuse, chaude et adh&eacute;rente &agrave; la peau, si&eacute;geant au niveau des quadrants internes et empi&eacute;tant sur les quadrants externes, sans ad&eacute;nopathies axillaires le tout &eacute;voquant un abc&egrave;s mammaire. L'exploration &eacute;chographique (B) a trouv&eacute; une volumineuse masse solidokystique &agrave; composante liquidienne pr&eacute;dominante finement &eacute;chog&eacute;ne avec des cloisons &eacute;paisse et des bourgeons mesurant jusqu'&agrave; 46mm class&eacute;e ACR4. Une ponction a ramen&eacute; un liquide vert gris&acirc;tre envoy&eacute; pour &eacute;tude bact&eacute;riologique et une antibioth&eacute;rapie &agrave; base de quinolones a &eacute;t&eacute; d&eacute;but&eacute;e. Le contr&ocirc;le au bout de 3 jours a not&eacute; la diminution des signes inflammatoires, et l'&eacute;tude bact&eacute;riologique du liquide n'a trouv&eacute; aucun germe. A 15 jours d'antibioth&eacute;rapie les signes inflammatoires ont disparu et le volume de la masse a discr&egrave;tement diminu&eacute; d'ou la d&eacute;cision de kystectomie. Laquelle a &eacute;t&eacute; r&eacute;alis&eacute;e avec &eacute;nucl&eacute;ation facile (C), et &agrave; notre surprise l'&eacute;tude histologique a conclu &agrave; un ad&eacute;nofibrome kystis&eacute; (D).</b><br/> text/html 2017-11-25T09:37:31+01:00 Othmane Yddoussalah, Harrison Sumba [Images in medicine] - Fistule vesico cutan&eacute;e post traumatique - 16 October 2017. <b>Un homme &acirc;g&eacute; de 43 ans &eacute;tait vu en urgence initialement pour prise en charge d'accident de la voie publique motocycliste heurte par une voiture. Responsable d un traumatisme du bassin avec une disjonction symphysaire importante (A). Trait&eacute;e orthop&eacute;diquement par une d&eacute;charge. L &eacute;volution a &eacute;t&eacute; marque par l apparition d un orifice fistuleux localise au niveau de la face interne de la cuisse droite (B) dans les deux semaines suivant le traumatisme, avec &eacute;coulement urinaire et des stigmate de mac&eacute;ration locale autour de la fistule. Sur le plan radiologique, un TDM abdominopelvien avec temps tardive avait montre une extravasation du produit de contraste en latero et v&eacute;sicale et au niveau de la racine de la cuisse droite en rapport avec une br&egrave;che v&eacute;sicale sous p&eacute;riton&eacute;ale (C). Une ur&eacute;trocystographie r&eacute;alis&eacute;e a objective une disjonction symphysaire manifeste sur le cliche sans pr&eacute;paration. Avec la pr&eacute;sence d un trajet fistuleux apr&egrave;s opacification uretro v&eacute;sicale (D). Les examens biologiques standard &eacute;taient normaux. Devant le caract&egrave;re sous p&eacute;riton&eacute;ale de la br&egrave;che v&eacute;sicale et l absence de l&eacute;sion associes, on a opte pour un traitement conservateur a savoir un drainage v&eacute;sical prolong&eacute; par une sonde ur&eacute;trale. Avec des soin locaux au niveau de l orifice fistuleux. L &eacute;volution a &eacute;t&eacute; marque par l obtention de l'ass&egrave;chement d&eacute;finitif de la fistule.</b><br/> text/html 2017-11-25T09:37:31+01:00 Dhia Kaffel, Hela Kchir [Images in medicine] - A propos d’une tum&eacute;faction sternale - 16 October 2017. <b>Nous rapportons le cas d'une femme &acirc;g&eacute;e de 64 ans suivie pour h&eacute;patite virale C au stade de cirrhose ayant &eacute;chou&eacute; au traitement antiviral. Lors de sa derni&egrave;re consultation, la patiente a signal&eacute; l'apparition d'une voussure douloureuse thoracique ant&eacute;rieure. L'examen physique a r&eacute;v&eacute;l&eacute; une masse dure et immobile en regard de l'articulation manubrio-sternale. Une tomodensitom&eacute;trie (TDM) sterno-claviculaire a &eacute;t&eacute; r&eacute;alis&eacute;e, objectivant une l&eacute;sion expansive ost&eacute;olytique centr&eacute;e au niveau sur le manubrium sternal envahissant les parties molles (A, B) et dont la biopsie a r&eacute;v&eacute;l&eacute; une tumeur maligne d'allure &eacute;pith&eacute;liale d'architecture papillaire exprimant la pancytok&eacute;ratine et la CK7. Ce profil &eacute;tait &eacute;vocateur d'une m&eacute;tastase d'un cholangiocarcinome ou d'un cancer ost&eacute;ophile. Un examen gyn&eacute;cologique sp&eacute;cialis&eacute; avec une mammographie et une &eacute;chographie mammaire ont &eacute;limin&eacute; une origine gyn&eacute;cologique. Une &eacute;chographie cervicale a &eacute;cart&eacute; une tumeur thyro&iuml;dienne. La TDM thoracique a r&eacute;v&eacute;l&eacute; de multiples nodules pulmonaires d'allure secondaire. Un angioscanner abdominal a montr&eacute; la pr&eacute;sence d'une masse tissulaire h&eacute;patique de 6 cm envahissant la bifurcation portale avec thrombose porte &eacute;vocatrice d'un carcinome h&eacute;patocellulaire (CHC) (C). Devant la contradiction discordance entre les donn&eacute;es anatomopathologiques et morphologiques, une &eacute;tude immunohistochimique par l'anti-Hep-Par-1 a &eacute;t&eacute; r&eacute;alis&eacute;e montrant une expression de cet anticorps par les cellules tumorales. Le diagnostic de m&eacute;tastase manubriosternale d'un carcinome h&eacute;patocellulaire peu diff&eacute;renci&eacute; a &eacute;t&eacute; retenu. La patiente a &eacute;t&eacute; propos&eacute;e pour chimioth&eacute;rapie. Les m&eacute;tastases osseuses r&eacute;v&eacute;lant un CHC sont exceptionnelles. Toutefois, il faut les &eacute;voquer devant toute l&eacute;sion osseuse lytique, surtout chez les patients atteints d'h&eacute;patopathie chronique. Vu leur pronostic sombre, leur traitement est palliatif, visant essentiellement &agrave; am&eacute;liorer la qualit&eacute; de vie des patients.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ronald Wanyama, Gerald Obai, Pancras Odongo, Michael Kagawa, Rhona Baingana [Research] - Effect of maternal Helicobacter Pylori infection on gestational weight gain in an urban community of Uganda - 16 October 2017. <b>INTRODUCTION: Maternal Helicobacter Pylori (H. pylori) infection has been associated with undesirable effects during pregnancy such as; hyperemesis gravidarum, anemia, intrauterine fetal growth restriction and miscarriage. Our aim was to document the effect of H. pylori infection on gestational weight gain (GWG) in a low-income urban setting in Uganda. METHODS: This was a prospective cohort study conducted in Kampala between May 2012 and May 2013. The participants were HIV negative, H. pylori positive and H. pylori negative primigravidae and secundigravidae women. Recruitment was at gestation age of eighteen or less weeks and follow up assessments were carried out at 26 and 36 weeks gestation age. H. pylori infection was determined using H. pylori stool antigen test. Maternal weight and height were measured, and body mass index (BMI) and rates of GWG were calculated. RESULTS: The participants’ mean±standard deviation (sd) age was 20.9±2.7 years. Primigravidae were 68.8% (n = 132) and 57.3% (n = 110) of the participants were positive for H. pylori infection. Low pre-pregnancy BMI (< 18.5 kg/m<sup>2</sup>) was recorded in 14.6% (n = 28). The mean±sd rate of GWG during second and third trimesters was 300.5±79.7 grams/week. The mean±sd weight gained by 36 weeks of gestation was 9.6±2.2 kg while gestation age at delivery was 39.4±1.0 weeks. Factors independently associated with the rates of GWG during the second and third trimesters were parity (P=0.023), H. pylori infection (P = 0.006), pre-pregnancy BMI (P = 0.037), height (P = 0.022) and household income (P = 0.003). CONCLUSION: H. pylori infection is associated with low rates of GWG among primigravidae and secundigravidae.</b><br/> text/html 2017-11-25T09:37:31+01:00 Florent Ymele Fouelifack, Filbert Eko Eko, Claude Odile Vanessa Ebode Ko'A, Jeanne Hortence Fouedjio, Robinson Enow Mbu [Research] - Prise en charge des plaies du p&eacute;rin&eacute;e en post partum: faut-il prescrire syst&eacute;matiquement un antibiotique? - 16 October 2017. <b>INTRODUCTION: l'int&eacute;grit&eacute; des voies g&eacute;nitales n'est pas toujours respect&eacute;e au cours de l'accouchement. Aucun protocole de prise en charge des plaies p&eacute;rin&eacute;ales du post-partum (d&eacute;chirures et &eacute;pisiotomies) n'existant dans nos services, la prise en charge reste praticien d&eacute;pendant. Nous avons entrepris cette &eacute;tude dans le but d'&eacute;tablir l'int&eacute;r&ecirc;t de l'antibiotique dans le traitement des plaies p&eacute;rin&eacute;ales du post-partum. Notre objectif &eacute;tait d'&eacute;valuer l'impact de l'antibioprophylaxie sur le processus de cicatrisation et dans la pr&eacute;vention des complications infectieuses apr&egrave;s r&eacute;paration. METHODES: il s'agissait d'une &eacute;tude de cohorte prospective sur une dur&eacute;e de 6 mois, soit du 1er janvier au 31 mai 2016, men&eacute;e dans l'Unit&eacute; de Gyn&eacute;cologie et Obst&eacute;triques de l'H&ocirc;pital Central de Yaound&eacute;. Deux groupes A et B d'accouch&eacute;es avec d&eacute;chirure p&eacute;rin&eacute;ale et/ou &eacute;pisiotomie &eacute;taient suivies. Le groupe A &eacute;tait compos&eacute; de 85 accouch&eacute;es &agrave; qui on avait prescrit le protocole compresse imbib&eacute;e de B&eacute;tadine® (placebo). Le groupe B (ou groupe test) &eacute;tait compos&eacute; d'accouch&eacute;es qui en plus du placebo, avaient la prescription d'un antibiotique (association 1000mg d'amoxicilline et 125mg d'acide clavulanique &agrave; raison de 1000mg 2fois par jour par voie orale). Les 2 groupes &eacute;taient suivis &agrave; J0, J2 et J9. Nos crit&egrave;res d'&eacute;valuation de la prise en charge &eacute;taient: la douleur, l'infection, la tum&eacute;faction, la propret&eacute; de la plaies et le delai de cicatrisation complete. Les donn&eacute;es &eacute;taient saisies et analys&eacute;es &agrave; l'aide des logiciels Epidata analysis version 3.2 et STATA version 12.0 (Texas USA 2001). Les corr&eacute;lations entre les variables &eacute;taient recherch&eacute;es selon le cas par le chi carr&eacute;, l'Odds ratio et avec la valeur de P (significatif pour toute valeur &#8804; 0.05).</b><br/> text/html 2017-11-25T09:37:31+01:00 Sihame Lemouakni, Houria knouni, Amina Barakat [Case report] - Thrombop&eacute;nie s&eacute;v&egrave;re chez un nouveau n&eacute; de m&egrave;re spl&eacute;nectomis&eacute; pour purpura thrombop&eacute;nique idiopathique - 14 October 2017. <b>La thrombop&eacute;nie n&eacute;onatale repr&eacute;sente l’anomalie d’h&eacute;mostase du nouveau-n&eacute; la plus fr&eacute;quente. Elle est d&eacute;finie par un chiffre de plaquettes inf&eacute;rieur &agrave; 150 000/mm3. Le risque de thrombop&eacute;nie n&eacute;onatale concerne 40% des nouveau-n&eacute;s de m&egrave;re ayant des ant&eacute;c&eacute;dents de thrombop&eacute;nie auto-immune et le risque de thrombop&eacute;nie s&eacute;v&egrave;re est &eacute;valu&eacute; &agrave; 10 &agrave; 15%. Nous rapportons &agrave; travers l’observation d’un nouveau n&eacute; &agrave; J20 de vie de m&egrave;re spl&eacute;nectomis&eacute; pour purpura thrombop&eacute;nique idiopathique, la relation entre la gravit&eacute; de la maladie maternelle et la gravit&eacute; de la thrombop&eacute;nie n&eacute;onatale afin d’&eacute;viter le risque de survenue d’une h&eacute;morragie intracr&acirc;nienne &agrave; l’origine de d&eacute;c&egrave;s ou de s&eacute;quelles neurologiques.</b><br/> text/html 2017-11-25T09:37:31+01:00 Khadija Drissi Touzani, Zineb Lamari, Fouad Chraibi, Meryem Abdellaoui, Idriss Benatiya Andaloussi [Case report] - La trichotillomanie des cils: &agrave; propos d’un cas - 14 October 2017. <b>La trichotillomanie est un trouble psychiatrique n&eacute;glig&eacute; qui pousse &agrave; s'arracher les cheveux, mais aussi les sourcils ou tout autre poil dont rarement les cils. Elle est d&eacute;finie dans le Manuel diagnostique et Statistique des Troubles Mentaux en tant que trouble des habitudes et des impulsions. A travers cette observation, nous rapportons le cas d'une fille qui souffre de trichotillomanie des cils de l'œil gauche suite &agrave; une faible estime de soi. La maladie peut &ecirc;tre &eacute;pisodique mais g&eacute;n&eacute;ralement chronique et difficile &agrave; traiter. Sur la base des &eacute;ventuelles complications m&eacute;dicales et psychiatriques, il est important que le diagnostic soit exact et pr&eacute;coce. Le traitement de r&eacute;f&eacute;rence repose sur la th&eacute;rapie cognitive et comportementale.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ilhame Naciri, Baderddine Hassam [Images in medicine] - Ulc&eacute;ration chronique sur la main d’un m&eacute;canicien: penser au carcinome &eacute;pidermo&iuml;de - 14 October 2017. <b>Le carcinome &eacute;pidermo&iuml;de cutan&eacute; est une tumeur maligne d&eacute;velopp&eacute;e &agrave; partir de l’&eacute;piderme ou des muqueuses malpighiennes. Il peut survenir de novo, ou le plus souvent sur des l&eacute;sions pr&eacute;canc&eacute;reuses, notamment les k&eacute;ratoses actiniques. Cette tumeur peut parfois &ecirc;tre secondaire &agrave; des nuisances physiques ou chimiques rencontr&eacute;es lors de l’exercice professionnel. Nous rapportant le cas d’un patient &acirc;g&eacute; de 40 ans, m&eacute;canicien, qui consultait pour une ulc&eacute;ration de la face dorsale du poignet droit, &eacute;voluant depuis 6 mois. La l&eacute;sion avait d&eacute;but&eacute; par une petite l&eacute;sion k&eacute;ratosique, qui s’&eacute;tait transform&eacute;e vers une &eacute;rosion, puis une ulc&eacute;ration rapidement augment&eacute;e de taille. Le patient n’avait pas de notion de traumatisme initial, et il n’avait aucun ant&eacute;c&eacute;dent particulier en dehors de la manipulation de produits chimiques (carburants, huile min&eacute;rale, peinture), sans port de gants depuis environ 30 ans. L’examen physique trouvait une tumeur ulc&eacute;ro-bourgeonnante de grande taille (5 × 6 cm) sur la face dorsale du poignet droit (A), associ&eacute;e &agrave; de multiples l&eacute;sions de k&eacute;ratose actinique diffuses sur les deux avant-bras et le dos des mains (B). Le patient avait &eacute;galement deux ad&eacute;nopathies fermes mobiles et indolores, de 1,5 cm de diam&egrave;tre, si&eacute;geant sur les r&eacute;gions &eacute;pitrochl&eacute;enne et axillaire homolat&eacute;rales. Le reste de l’examen clinique &eacute;tait normal. Les s&eacute;rologies virales h&eacute;patiques, tr&eacute;pon&eacute;miques et r&eacute;trovirale (VIH) &eacute;taient n&eacute;gatives. L’examen histologique d’un fragment biopsique confirmait le diagnostic de carcinome &eacute;pidermo&iuml;de bien diff&eacute;renci&eacute; et infiltrant. La biopsie de l’ad&eacute;nopathie axillaire objectivait une m&eacute;tastase ganglionnaire avec effraction de la capsule et extension au tissu p&eacute;ri-ganglionnaire. Le reste du bilan d’extension &eacute;tait sans anomalie. Une ex&eacute;r&egrave;se large de la l&eacute;sion avec curage ganglionnaire &eacute;taient pratiqu&eacute;s, compl&eacute;ter par une radioth&eacute;rapie. L’&eacute;volution &eacute;tait marqu&eacute;e par une r&eacute;cidive locale pr&eacute;coce (deux mois plus tard) n&eacute;cessitant une reprise chirurgicale. Les suites op&eacute;ratoires &eacute;taient simples.</b><br/> text/html 2017-11-25T09:37:31+01:00 Herv&eacute; Hien, Macaire Ou&eacute;draogo, Abdramane Berth&eacute;, Blahima Konat&eacute;, Nadia To&eacute;, Maxime koin&eacute; Drabo, Adiara Millogo, Fatoumata Badini-Kinda, Nicolas Meda, Jean Macq [Research] - Plaintes des patients: une opportunit&eacute; pour am&eacute;liorer la qualit&eacute; des soins des personnes &acirc;g&eacute;es avec des multimorbidit&eacute;s au Burkina Faso - 14 October 2017. <b>INTRODUCTION: Peu de donn&eacute;es existent sur les plaintes des patients pour identifier des pistes d’am&eacute;lioration de la qualit&eacute; de soins des personnes &acirc;g&eacute;es avec des multimorbidit&eacute;s. L’objectif de cette &eacute;tude &eacute;tait d’analyser les plaintes des personnes &acirc;g&eacute;es qui pr&eacute;sentent des multimorbidit&eacute;s dans les formations sanitaires &agrave; Bobo-Dioulasso, Burkina Faso. METHODES: nous avons r&eacute;alis&eacute; une &eacute;tude transversale dans les formations sanitaires de la ville de Bobo-Dioulasso de novembre 2013 &agrave; f&eacute;vrier 2014. Les personnes &acirc;g&eacute;es de 60 ans ou plus, avec au moins une pathologie chronique vues en ambulatoire ou en hospitalisation pendant la p&eacute;riode d’&eacute;tude ont &eacute;t&eacute; inclues. Des entretiens qualitatifs ont &eacute;t&eacute; r&eacute;alis&eacute;s &agrave; l’aide d’un questionnaire semi-structur&eacute;. Une analyse du contenu a &eacute;t&eacute; r&eacute;alis&eacute;e. RESULTATS: nous avons not&eacute; des plaintes li&eacute;es au long temps d’attente pour les soins, des conditions inadapt&eacute;es de transfert des patients en hospitalisation, un manque d’&eacute;changes d’informations sur les maladies et des conditions d’h&ocirc;tellerie inadapt&eacute;es pour la personnes &acirc;g&eacute;e venue en consultation et en hospitalisation. CONCLUSION: des pistes d’am&eacute;lioration pourraient passer par la r&eacute;novation et l’agrandissement des salles d’attentes des formations sanitaires, la s&eacute;paration des prestations des soins chroniques des soins aigus en ambulatoire et en hospitalisation, l’appui &agrave; l’autonomisation par une meilleure communication avec le patient avec l’appui d’un groupe d’entraide communautaire et l’implication des familles</b><br/> text/html 2017-11-25T09:37:31+01:00 Said Zizah, Richard Dolo, Ossama Elassil, Kamal Lahrach, Amine Marzouki, Fawzi Boutayeb [Case series] - L’enclouage centromedullaire dans les fractures bifocales de la jambe: &agrave; propos de 16 cas - 13 October 2017. <b>Afin d'&eacute;valuer la gravit&eacute; de cette l&eacute;sion inhabituelle, nous avons men&eacute; une &eacute;tude r&eacute;trospective int&eacute;ressant les fractures bifocales ferm&eacute;es du tibia et nous avons &eacute;tudi&eacute; la place de l'enclouage centrom&eacute;dullaire ainsi que les diff&eacute;rents moyens th&eacute;rapeutiques. Seize patients avec fractures bifocales de jambe type 42C2 de l'AO ont &eacute;t&eacute; trait&eacute;s dans notre unit&eacute; de traumatologie Orthop&eacute;die A du CHU Hassan II F&egrave;s. Il s'agissait de sujets jeunes, victimes de traumatisme de moyen &agrave; haute &eacute;nergie. Cinq patients &eacute;taient polytraumatis&eacute;s et deux poly fractur&eacute;s. L'enclouage centrom&eacute;dullaire verrouill&eacute; avec al&eacute;sage &eacute;tait utilis&eacute; dans six cas et sans al&eacute;sage dans dix cas. Nous avons d&eacute;plor&eacute;s apr&egrave;s enclouage deux cas de syndromes de loge. Le d&eacute;lai de consolidation moyen &eacute;tait de douze mois. Deux cas de pseudarthroses ont &eacute;t&eacute; repris avec succ&egrave;s par un enclouage avec sur al&eacute;sage. La fracture bifocale de jambe pose de nombreux d&eacute;fis au chirurgien en raison de l'approvisionnement vasculaire pr&eacute;caire du segment interm&eacute;diaire et de la grave d&eacute;t&eacute;rioration des tissus mous environnants. Elles doivent &ecirc;tre individualis&eacute;es de l'ensemble des fractures de jambe tant par leur contexte de survenue que par les difficult&eacute;s de fixation et la lenteur de leur consolidation.</b><br/> text/html 2017-11-25T09:37:31+01:00 Zidouh Saad, Belkouch Ahmed, Rafai Mostafa, Bakkali Hicham, Belyamani Lahcen [Case report] - Conservative treatment of a psoas hematoma revealed by a lower limb palsy - 13 October 2017. <b>The psoas hematoma is a rare complication of the anticoagulation therapy. It cause abdominal or lumbar pain, muscle dysfunction and sometimes nerve palsy. The optimal treatment is not well established, surgery or conservative treatment? We report here a case of psoas hematoma revealed by a lower limb palsy.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ben Haj Hassine Amine, Siala Haythem, Harzallah Kais, Rachdi Radhouane [Research] - Pregnancy after renal transplantation: a retrospective study at the military hospital of Tunis from 1992 to 2011 - 13 October 2017. <b>INTRODUCTION: our study objective was to analyze the optimum conditions for pregnancy in kidney transplanted women. For that, we conducted a retrospective study was from 1992 to April 2011 about 17 pregnancies in 12 kidney transplanted patients followed in the Department of Obstetrics and Gynecology and Organ Transplant Unit of the Military Hospital of Tunis. METHODS: we studied nephrological parameters and obstetric pathologies encountered during pregnancy and the potential impact of pregnancy on graft. Our main outcome measures were: time between renal transplantation and conception, birth of a living child, renal graft defect. RESULTS: the mean age at the time of renal transplantation was 30.11 years. The average age at the time of conception is 34.23 years. The average time between renal transplantation and the occurrence of pregnancy was 46.94 months. More than 40% of pregnancies were not planned. Of the 17 pregnancies, 12 have advanced beyond the first trimester with 91.6% resulting in the birth of a living child. Toxemia was found in 60% of cases, low birth weight in 50%, preterm in 30% and intrauterine growth retardation in 20% of cases. Cesarean section was indicated in all cases. Graft survival was 90% with a mean of 6 years after delivery. CONCLUSION: pregnancy in kidney transplanted patients is a high-risk pregnancy, but pregnancy does not appear to affect graft function through certain conditions.</b><br/> text/html 2017-11-25T09:37:31+01:00 Souha Kallel, Malek Mnejja [Images in medicine] - Kyste thymique: &eacute;tiologie rare d’un kyste cervical de l’adulte - 11 October 2017. <b>Les kystes thymiques sont des tumeurs cong&eacute;nitales rares, pr&eacute;sentant 1% des masses cervicales kystiques de l'enfant. Ces kystes sont extr&ecirc;mement rares chez l'adulte. Nous rapportons le cas d'une femme &acirc;g&eacute;e de 50 ans, sans ant&eacute;c&eacute;dents particuliers, qui a consult&eacute; pour une tum&eacute;faction basi-cervicale ant&eacute;rieure &eacute;voluant progressivement depuis 2 ans avec une dyspn&eacute;e d'effort. A l'examen, elle pr&eacute;sentait une tum&eacute;faction basi-cervicale ant&eacute;rieure faisant 4 * 4cm de diam&egrave;tre, molle, non mobile &agrave; la d&eacute;glutition. L'&eacute;chographie cervicale a montr&eacute; une formation kystique ovalaire sous cutan&eacute;e du creux sus sternal plongeant au niveau du m&eacute;diastin de 4 * 2.5 * 3cm de dimensions. Le compl&eacute;ment par une TDM cervico-thoracique a montr&eacute; une masse hypodense cervico-m&eacute;diastinale m&eacute;diane venant au contact des troncs supra aortiques, refoulant la thyro&iuml;de en haut et se d&eacute;veloppant en bas vers la loge thymique, mesurant 46 * 64 * 58mm. L'exploration chirurgicale par cervicotomie a trouv&eacute; une masse kystique tendue bien encapsul&eacute;e de la loge thyro&iuml;dienne &eacute;tendue au m&eacute;diastin ant&eacute;rieur, &agrave; contenu jaune citrin. La masse &eacute;tait extirp&eacute;e compl&egrave;tement par voie cervicale. L'&eacute;tude histologique de la pi&egrave;ce op&eacute;ratoire &eacute;tait en faveur d'un kyste thymique. Le recul est de 1 an avec une bonne &eacute;volution sans r&eacute;cidive. Les kystes thymiques, bien que rares, doivent &ecirc;tre &eacute;voqu&eacute;s devant toute masse kystique cervicale ou cervico-m&eacute;diastinale, m&ecirc;me de l'adulte. La TDM, l'IRM et la cytoponction pr&eacute;op&eacute;ratoires sont utiles, mais la confirmation diagnostique n&eacute;cessite l'identification du tissu thymique contenant les corpuscules de Hassall &agrave; l'examen anatomopathologique. Le traitement est chirurgical avec une ex&eacute;r&egrave;se compl&egrave;te de la paroi kystique afin d'&eacute;viter les r&eacute;cidives.</b><br/> text/html 2017-11-25T09:37:31+01:00 Olayemi Atinuke Alagbe, Tinuola Omolade Adeniyi, Olawale Ayobami Abayomi, Emmanuel Olugbenga Onifade [Case report] - Interstitial ectopic pregnancy: a case report - 11 October 2017. <b>Interstitial ectopic pregnancy is a rare type of tubal pregnancy that poses diagnostic challenge. It is associated with the highest risk of massive, uncontrollable bleeding and can result in uterine rupture in the second trimester. This is a rare case of unruptured interstitial ectopic diagnosed in the first trimester by ultrasonography and managed medically with systemic methrotrexate and serial ultrasound monitoring.</b><br/> text/html 2017-11-25T09:37:31+01:00 Taiwo Akinyode Obembe, Kayode Omoniyi Osungbade, Christianah Ibrahim [Research] - Appraisal of primary health care services in Federal Capital Territory, Abuja, Nigeria: how committed are the health workers? - 11 October 2017. <b>INTRODUCTION: The primary health care model was declared as the appropriate strategy for ensuring health-for-all. However up till date, very few studies have assessed the services provided by primary health centres in terms of its basic components. This study aimed to appraise health services provided and to estimate the commitment of the health workers in selected primary health care centres within Abuja Nigeria.</b><br/> text/html 2017-11-25T09:37:31+01:00 Clara Sampaio, Sofia Pina, Sofia Frade, Lu&iacute;s Moniz [Case report] - Surgical treatment for unusual presentations of abdominal actinomycosis: two case reports - 10 October 2017. <b>Actinomycosis is a rare chronic disease caused by anaerobic Gram-positive Actinomyces species. These bacteria normally colonize the mouth, colon and urogenital tract and mucosal disruption is necessary to lead to infection. Due to its propensity to mimic other diseases, it is often misdiagnosed. It can mimic other conditions such as tuberculosis and malignancy and a preoperative diagnosis is rarely considered. An early diagnosis needs a high level of clinical suspicion and bacterial cultures in anaerobic conditions are necessary to identify the bacteria. Of the more than 30 species, Actinomyces Israelii is the most common human pathogen and one of the most involved in abdominal actinomycosis. Treatment includes high doses of antibiotic therapy sometimes combined with surgery in the case of complicated disease such as bowel obstruction. The authors report two cases of abdominal actinomycosis presenting with bowel obstruction and bowel perforation by a strange body.</b><br/> text/html 2017-11-25T09:37:31+01:00 Nassira Aradoini, Sofia Talbi, Hamida Azzouzi, Fatima Zahra Abourazzak, Hajar Khibri, Rhizlane Berrady, Wafaa Bono, Taoufik Harzy [Case report] - Spondylarthrite ankylosante et maladie de Still: un lien physiopathologique ou une simple association? - 10 October 2017. <b>La spondylarthrite ankylosante est un rhumatisme inflammatoire chronique,qui fait partie des groupes de spondyloarthrites, au cours duquel les signes g&eacute;n&eacute;raux comme la fi&egrave;vre et l'amaigrissement sont peu importants. La maladie de Still de l'adulte est une affection syst&eacute;mique rare, qui reste un diagnostic d'&eacute;limination, et qui associe classiquement une fi&egrave;vre &eacute;lev&eacute;e hectique, une &eacute;ruption cutan&eacute;e, des arthrites, et des manifestations syst&eacute;miques diverses. Peu de cas de spondylarthrites ankylosantes pr&eacute;sent&eacute;s avec un tableau de la maladie de Still de l'adulte ont &eacute;t&eacute; d&eacute;crits dans la litt&eacute;rature. Nous rapportons un nouveau cas d'un patient de 31ans suivi pour spondylarthrite ankylosante et qui se pr&eacute;sente avec une fi&egrave;vre au long cours et des signes clinico-biologiques entrant dans le cadre de la maladie de Still de l'adulte. Un &eacute;ventuel lien physiopathologique entre les deux pathologies peut &ecirc;tre &eacute;voqu&eacute;, m&ecirc;me si leur survenue simultan&eacute;e est rarement rapport&eacute;e dans la litt&eacute;rature.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mariam Mwinjuma Mirambo, Ndealilia Senyaeli, Stephen Eliatosha Mshana [Brief] - Low humoral responses to human cytomegalovirus is associated with immunological treatment failure among HIV infected patients on highly active antiretroviral therapy - 10 October 2017. <b>Human cytomegalovirus (HCMV) is one of the opportunistic infections associated with significant morbidity and mortality among HIV/AIDS patients especially before introduction of antiretroviral therapy (ART). Little is known regarding the humoral immune response against HCMV in relation to CD4 counts among HIV infected individuals. A total of 90 achieved sera from HIV infected patients attending Bugando Medical centre care and treatment centre (CTC) aged 18 years and above were retrieved and analyzed. Sociodemographic data were collected using structured data collection tool. Detection of specific HCMV antibodies was done using Indirect Enzyme Linked Immunosorbent Assay (ELISA). Data were analyzed by using STATA version 11. A total of 90 HIV infected patients were enrolled in the study whereby 36(40%) had immunological treatment failure. The mean age of the study participants was 39±12.3 years. The Prevalence of specific HCMV IgG antibodies was 84(93.3%, 95% CI: 88-98.5) while the prevalence of specific HCMV IgM antibodies was 2(2.3% 95% CI: 0.8-5.4). The median CD4 counts at 6 months and 12 months on HAART were significantly high in treatment success group. At 12 months of HAART as CD4 counts increases the HCMV IgG index value was also found to increase significantly, p=0.04. Significant proportion of HIV infected individuals was infected with HCMV. Higher median HCMV IgG titers were observed among patients with immunological treatment success. There is a need to investigate humoral immune responses in HIV infected individuals in relation to CD4 counts against various infectious diseases in developing countries where most of these infections are endemic.</b><br/> text/html 2017-11-25T09:37:31+01:00 Kacou Edele Aka, Gninlgninrin Apollinaire Horo, Minata Fomba, Salif Kouyate, Abdoul Koffi Koffi, Seni Konan, Mohamed Fanny, Benjamin Effi, Mamourou Kone [Case report] - A rare case of important and recurrent abnormal uterine bleeding in a post partum woman caused by cavernous hemangioma: a case report and review of literature - 10 October 2017. <b>The cavernous hemangioma is a rare benign vascular tumor. About 50 cases of this disease were found in the literature over the last century and only 9 cases of cavernous hemangioma on the pregnant uterus were published it comes into cavernous or capillary form. The symptomatology is not unequivocal and when it occurs during pregnancy or postpartum, it causes life-threatening cataclysmic hemorrhage. Antenatal diagnosis is difficult and requires a multidisciplinary approach with pathologists, radiologists and gynecologists to avoid these complications or unnecessary hysterectomies. The diagnosis is histological. Hysterectomy is possible after failure of conservative treatment means. We report a rare case, a novel mixed cavernous hemangioma of the body associated with a capillary hemangioma of the cervix in a patient of 28 years 5th visors with recurrent genital bleeding in the postpartum period leading to a hysterectomy.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ivan Mugisha Taremwa, Lucas Ampaire, Jacob Iramiot, Obed Muhwezi, Aloysius Matte, Herbert Itabangi, Hope Mbabazi, Jeninah Atwebembeire, Monicah Kamwine, Victoria Katawera, Yona Mbalibulha, Patrick Orikiriza , Yap Boum II [Research] - Assessment of three medical and research laboratories using WHO AFRO_SLIPTA Quality Standards in Southwestern Uganda: long way to go - 10 October 2017. <b>INTRODUCTION: While the laboratory represent more than 70% of the clinical diagnosis and patient management, access to reliable and quality laboratory diagnostics in sub-Saharan Africa remains a challenge. To gain knowledge and suggest evidence based interventions towards laboratory improvement in Southwestern Uganda, we assessed the baseline laboratory quality standards in three medical and research laboratories in Southwestern Uganda. METHODS: We conducted a cross sectional survey from October, 2013 to April, 2014. Selected laboratories, including one private research, one private for profit and one public laboratory, were assessed using the WHO AFRO_SLIPTA checklist and baseline scores were determined. RESULTS: The three laboratories assessed met basic facility requirements, had trained personnel, and safety measures in place. Sample reception was properly designed and executed with a well designated chain of custody. All laboratories had sufficient equipment for the nature of work they were involved in. However, we found that standard operating procedures were incomplete in all three laboratories, lack of quality audit schemes by two laboratories and only one laboratory enrolled into external quality assurance schemes. The SLIPTA scores were ONE Star for the research laboratory and NO Star for both the public and private-for-profit laboratories. CONCLUSION: While most of the laboratory systems were in place, the low scores obtained by the assessed laboratories reflect the need for improvement to reach standards of quality assured diagnostics in the region. Therefore routine mentorship and regional supportive supervision are necessary to increase the quality standard.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hind Ramid, Fouzia Hali [Images in medicine] - Malformation lymphatique macrokystique atypique chez un adulte - 10 October 2017. <b>Les malformations lymphatiques macrokystiques (MLMK) constituent une variante circonscrite des lymphangiomes profonds. Elles se caract&eacute;risent par leurs survenue rare chez l’adulte, leurs expansion rapide et leurs fr&eacute;quence au niveau de la r&eacute;gion cervicofaciale (75%) et axillaire (20%), l’atteinte du membre inf&eacute;rieur est exceptionnelle. Le diagnostic des MLMK est essentiellement clinique, l’&eacute;chographie a un int&eacute;r&ecirc;t pour le diagnostic positif et parfois diff&eacute;rentiel. L’IRM a une place dans le diagnostic et l’appr&eacute;ciation des limites de la tumeur apportant ainsi une aide pr&eacute;cieuse &agrave; la chirurgie. Sur le plan th&eacute;rapeutique, les MLMK rel&egrave;vent plut&ocirc;t d’une scl&eacute;roth&eacute;rapie, rarement la chirurgie est indiqu&eacute;e. Nous rapportons le cas d’un homme de 26 ans qui pr&eacute;sentait depuis un an une &eacute;norme tum&eacute;faction sous-cutan&eacute;e de la cuisse droite, indolore et rapidement &eacute;volutif. L’examen clinique trouvait une masse circonf&eacute;rentielle infiltr&eacute;e, compressible et non battante, surmont&eacute;e de l&eacute;sions v&eacute;g&eacute;tantes et ulc&eacute;r&eacute;es. Le reste de l’examen clinique notait la pr&eacute;sence d’ad&eacute;nopathie inguinale homolat&eacute;rale avec limitation de la mobilit&eacute; du genou droit. L’angio IRM objectivait un &eacute;paississement cutan&eacute;o-sous cutan&eacute; diffus de la cuisse droite d’aspect h&eacute;t&eacute;rog&egrave;ne et prenant le contraste avec atteinte apon&eacute;vrotique p&eacute;rimusculaire. La lymphoscintigraphie r&eacute;v&eacute;lait une asym&eacute;trie de la cin&eacute;tique d’accumulation du radiopharmaceutique au d&eacute;triment du membre inf&eacute;rieur droit en faveur d’une surcharge du syst&egrave;me lymphatique au repos. Devant les donn&eacute;es clinico-radiologiques, le diagnostic de MLMK a &eacute;t&eacute; retenu. Apr&egrave;s concertation avec les chirurgiens il n’y avait pas d’indication chirurgicale vue le si&egrave;ge du lymphangiome et son &eacute;tendu; une contention par des bandes amovibles &eacute;tait indiqu&eacute;e chez notre patient.</b><br/> text/html 2017-11-25T09:37:31+01:00 Moustapha Diop, Viviane Marie Pierre Cisse-Diallo, Daye Ka, Nd&egrave;ye Aissatou Lakhe, Khardiata Diallo-Mbaye, Aminata Massaly, Alassane Di&egrave;ye, Nd&egrave;ye Maguette Fall, Aboubacar Sadikh Badiane, Daouda Thioub, Louise Fortes-D&eacute;gu&eacute;nonvo, Gora Lo, Cheikh Tacko Diop, Cheikh Tidiane Ndour, Masserigne Soumar&eacute;, Moussa Seydi [Case report] - R&eacute;activation d’une h&eacute;patite B occulte chez un patient dr&eacute;panocytaire homozygote: cas clinique et revue de la litt&eacute;rature - 10 October 2017. <b>L'h&eacute;patite B occulte correspond &agrave; la pr&eacute;sence de l'ADN du virus de l'h&eacute;patite B dans le s&eacute;rum et/ou dans le foie d'un patient malgr&eacute; la n&eacute;gativit&eacute; de l'AgHBs. C'est une forme clinique habituellement asymptomatique. Sa r&eacute;activation est rare et survient en g&eacute;n&eacute;ral chez le sujet immunod&eacute;prim&eacute;. Nous rapportons un cas d'un patient s&eacute;n&eacute;galais de 21 ans, dr&eacute;panocytaire homozygote, qui pr&eacute;sentait un ict&egrave;re de type cholestatique chez qui l'exploration biologique concluait a une r&eacute;activation d'une h&eacute;patite B occulte. Cette observation souligne la n&eacute;cessit&eacute; de rechercher syst&eacute;matiquement une r&eacute;activation d'une h&eacute;patite B occulte devant toute h&eacute;patopathie aigue chez le dr&eacute;panocytaire.</b><br/> text/html 2017-11-25T09:37:31+01:00 Fatnassi Ridha, Ragmoun houssem, Marzougui Latifa, Mkhinini Ines, Hammami Sabra [Case series] - Facteurs de risque et pronostic materno-fœtal de la macrosomie fœtale: étude comparative à propos de 820 cas - 10 October 2017. <b>L’accouchement d’un fœtus macrosome est une situation relativement fr&eacute;quente. Il s’agit d’un accouchement &agrave; haut risque aussi bien maternel que fœtal. Les principales complications maternelles &eacute;taient repr&eacute;sent&eacute;es par l’augmentation du taux de c&eacute;sarienne, d’h&eacute;morragie de la d&eacute;livrance et des d&eacute;chirures traumatiques cervico-vaginales. La principale complication fœtale &eacute;tait la dystocie des &eacute;paules exposant aux &eacute;longations du plexus brachial. L’objectif &eacute;tait d’identifier les facteurs de risque et les complications materno-fœtales li&eacute;es &agrave; la macrosomie fœtale. Une &eacute;tude r&eacute;trospective comparative effectu&eacute;e au service universitaire de maternit&eacute; de Kairouan durant l’ann&eacute;e 2010. Au cours de cette &eacute;tude, nous comparons un groupe de 820 cas de macrosomes &agrave; un groupe de 800 cas de t&eacute;moins n&eacute;s au cours de la m&ecirc;me p&eacute;riode. Au cours de la p&eacute;riode d’&eacute;tude, nous avons collig&eacute; 820 cas de macrosomies sur un total de 7495 naissances soit une incidence de 10.94%. Plusieurs facteurs favorisants la macrosomie fœtale &eacute;taient mis en &eacute;vidence: Un &acirc;ge maternel >35 ans &eacute;tait pr&eacute;sent dans 28.5% des cas; L’ob&eacute;sit&eacute; maternelle &eacute;tait trouv&eacute;e dans 45% des cas; Les ant&eacute;c&eacute;dents de macrosomie &eacute;taient not&eacute;s dans 28,8% des cas; Le terme prolong&eacute; > 41 semaines d’am&eacute;norrh&eacute;e &eacute;tait not&eacute; dans 35.6% des cas; La multiparit&eacute; &eacute;tait trouv&eacute;e dans 47% des cas. Les complications maternelles &eacute;taient essentiellement l’h&eacute;morragie de la d&eacute;livrance: 71 cas et les traumatismes g&eacute;nitaux: 24 cas. Les complications p&eacute;rinatales &eacute;taient domin&eacute;es par la dystocie des &eacute;paules, 27 cas soit 3.3%. Les complications postnatales traumatiques &eacute;taient retrouv&eacute;es dans 11.6%.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hajar Berrani, Asmae Mdaghri Alaoui, Said Ettair, Nezha Mouane, Amal Thimou Izgua [Research] - Consommation des produits lact&eacute;s chez l’enfant et l’adolescent marocain de 2 &agrave; 16 ans: une &eacute;tude monocentrique - 10 October 2017. <b>INTRODUCTION: Evaluer la consommation quotidienne des produits laitiers dans une population d’enfants marocains et d&eacute;terminer les facteurs associ&eacute;s pouvant influencer cette consommation. METHODES: &eacute;tude prospective du 1<sup>er</sup> octobre 2013 au 31 avril 2014. Les enfants &acirc;g&eacute;s entre 2 et 16 ans ont &eacute;t&eacute; inclus. Le recrutement a eu lieu dans la ville de F&egrave;s. Le recueil des donn&eacute;es s’est fait &agrave; l’aide d’un questionnaire fr&eacute;quentiel. Les parents et les enfants inclus ont &eacute;t&eacute; interrog&eacute;s sur la consommation des produits laitiers et les facteurs socio-d&eacute;mographiques avec une &eacute;valuation anthropom&eacute;trique des enfants. L’association des variables &agrave; la consommation des produits laitiers a &eacute;t&eacute; analys&eacute;e en analyse univari&eacute;e et multivari&eacute;e par un mod&egrave;le de r&eacute;gression logistique. RESULTATS: l’enqu&ecirc;te alimentaire avait int&eacute;ress&eacute; 286 enfants dont 151 filles (52,8 %) et 131 gar&ccedil;ons (45,8%). Les enfants &acirc;g&eacute;s de 2 &agrave; 3 ans repr&eacute;sentaient 26,4 %, ceux &acirc;g&eacute;s de 4 &agrave; 7 ans 28,9 %, ceux &acirc;g&eacute;s de 7 &agrave; 9 ans 18,3 % et les adolescents &acirc;g&eacute;s de 10 &agrave; 16 ans 26,4 %. Les enfants consommaient en moyenne 2.5±1 produits laitiers par jour. Les enfants consommaient au moins 3 produits laitiers par jour dans 57,8% chez les enfants &acirc;g&eacute;s de 2 &agrave; 3 ans, 53,6% chez les enfants &acirc;g&eacute;s de 4 &agrave; 6 ans, 40% chez les enfants &acirc;g&eacute;s de 7 &agrave; 9 ans et 41.2% chez les enfants &acirc;g&eacute;s de 10 &agrave; 16 ans. Les facteurs associ&eacute;s &agrave; la consommation de trois produits laitiers minimum par jour en analyse univari&eacute;e &eacute;taient le niveau d’instruction maternel analphab&egrave;te p < 0.001 OR = 0.1 et primaire p=0.002 OR=0.1, le niveau socio&eacute;conomique familial moyen p < 0.001 OR = 3, l’&acirc;ge p= 0.01 OR = 0.9 et l’indice de masse corporelle normal p = 0.01 OR = 2.5 et > 90° percentiles p < 0.001 OR = 6. Il existe un lien positif entre l’indice de masse corporelle > 90° percentiles p = 0.01 OR=3.9 est et la quantit&eacute; consomm&eacute;e des produits laitiers et n&eacute;gatif avec le faible niveau de scolarit&eacute; maternel analphab&egrave;te p = 0.008 OR = 0.1 et primaire p=0.009 OR= 0.1. CONCLUSION: la consommation du lait et des autres produits laitiers &eacute;tait inappropri&eacute;e en particulier chez l’enfant &acirc;g&eacute; de 7 &agrave; 9 ans et l’adolescent de 10 &agrave; 16 ans. Le faible niveau d’&eacute;ducation maternel et un indice de masse corporelle sup&eacute;rieur au 90° percentiles &eacute;tait des facteurs ind&eacute;pendamment associ&eacute;s &agrave; la consommation de moins de 3 produits laitiers par jour. La sensibilisation des parents et des enfants sur l’int&eacute;r&ecirc;t du lait et de ses d&eacute;riv&eacute;s dans l’alimentation de l’enfant est indispensable.</b><br/> text/html 2017-11-25T09:37:31+01:00 Alsubari Alwan, Riani Mohammed [Images in medicine] - Cataracte morganienne - 10 October 2017. <b>La cataracte est une opacification partielle ou totale du cristallin. Elle peut cong&eacute;nital ou acquise. Celle li&eacute;e au vieillissement (s&eacute;nile) est la plus fr&eacute;quente .sa symptomatologie commune est le g&egrave;ne visuelle qui est variable en fonction de la topographie et de la densit&eacute; des opacitt&eacute;s. Ses &eacute;tiologies sont vari&eacute;es et son traitement es chirurgical. Le cortex de cataracte morganienne se liqu&eacute;fie et le noyau se durci et devient fonc&eacute;. Nous rapportant le cas d'un patient &acirc;g&eacute; de 51 ans sans ant&eacute;c&eacute;dents pathologiques notable qui consulte par une baisse de l'acuit&eacute; visuelle de fa&ccedil;on progressive au niveau de l'oeil gauche sans notion de douleur ou de rougeur oculaire. L'examen ophtalmologique trouve une acuit&eacute; visuelle (voit la main boug&eacute;), une corn&eacute;e claire, une chambre ant&eacute;rieur de profondeur normal, une pression intraoculaire &agrave; 15 mmgh et une cataracte morganienne. Le patient a &eacute;t&eacute; op&eacute;r&eacute; par phaco&eacute;mulsification avec mis en place d'un implant dans le sac capsulaire. Les suites post op&eacute;ratoires &eacute;taient simples.</b><br/> text/html 2017-11-25T09:37:31+01:00 Widad Gueddari, Hayat Sabri, Meryem Chabah [Research] - Infections &agrave; m&eacute;ningocoque lors de purpura f&eacute;brile chez l’enfant dans un h&ocirc;pital marocain: incidence et facteurs cliniques associ&eacute;s - 10 October 2017. <b>INTRODUCTION: Le purpura f&eacute;brile (PF) fait craindre une infection &agrave; m&eacute;ningocoque, et conduit presque toujours &agrave; la r&eacute;alisation d’un bilan et au traitement par une antibioth&eacute;rapie &agrave; large spectre. Notre objectif &eacute;tait de d&eacute;terminer l’incidence des infections &agrave; m&eacute;ningocoque ainsi que les signes cliniques y associ&eacute;s chez les enfants hospitalis&eacute;s aux urgences pour purpura f&eacute;brile.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hajira Ibrahim, Ernest Tei Maya, Kofi Issah, Paschal Awingura Apanga, Emmanuel George Bachan, Charles Lwanga Noora [Research] - Factors influencing uptake of intermittent preventive treatment of malaria in pregnancy using sulphadoxine pyrimethamine in Sunyani Municipality, Ghana - 10 October 2017. <b>INTRODUCTION: Malaria continues to pose a public health challenge in Ghana particularly in pregnant women. Ghana adopted intermittent preventive treatment of malaria in pregnancy policy using Sulphadoxine Pyrimethamine. Despite its implementation, its coverage still remains low. This study sought to investigate factors that influence the uptake of intermittent preventive treatment of malaria in pregnancy in the Sunyani Municipality.</b><br/> text/html 2017-11-25T09:37:31+01:00 Francis Agyemang Yeboah, Joseph Yorke, Christian Obirikorang, Emmanuella Nsenbah Batu, Emmanuel Acheampong, Emmanuel Amankwaa Frempong, Enoch Odame Anto, Bright Amankwaa [Research] - Patterns and presentations of colorectal cancer at Komfo-Anokye teaching hospital Kumasi, Ghana - 06 October 2017. <b>INTRODUCTION: Colorectal cancer is a major cause of morbidity and mortality globally and its incidence is increasing in developing countries. This study determined the incidence, clinical features and the histopathological patterns of colorectal cancer at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana.</b><br/> text/html 2017-11-25T09:37:31+01:00 Aisha Nazeer, Ayesha Aslam Rai, Nasir Hassan Luck [Research] - Factors leading to dyspepsia in renal transplant recipients - 06 October 2017. <b>INTRODUCTION: Renal transplantation is the definitive treatment for end stage renal disease. Patients subjected to transplantation require lifelong immunosuppression and are prone to several gastrointestinal disorders. Dyspepsia is a common disorder in these patients. The objective of this study was to determine factors leading to dyspepsia in renal (kidney) transplant recipients. METHODS: it was a cross sectional study conducted at department of hepatogastroenterology and transplant sciences, SIUT Karachi, from 1-6-15 to 1-12-15 for six months. All renal transplanted patients having dyspeptic symptoms for more than 6 weeks. EGD was performed, biopsy specimens obtained from antrum and duodenum, these were sent for histopathological examination. Frequency and percentages were obtained for categorical variables, mean ± SD was calculated for continuous variables. Chi square test was used for categorical variable and student t-test for continuous variables. RESULTS: ninety patients were included in the study out of which 64 (71.1%) were males, mean age was 35.82 ± 10.04 years (range: 18-65 years). Gastritis (non H.pylori associated) in 78 (78.6%), duodenitis in 35 (38.9%) and H. pylori infection in 29 (32.2%), renal transplant recipients. Most of the patients belonged to Sindhi ethnicity, 27 (30%), followed by Punjabi. Hypertension was the most common co-morbid condition in our patients found in 29 (32.2%), while most of them don't have any co morbid condition. Duodenitis was found to be associated with tacrolimus use (p = 0.037). CONCLUSION: gastritis is the most common factor accountable for this symptoms, followed by duodenitis and H. Pylori. Patients taking tacrolimus as immunosuppressant are more prone to develop duodenitis.</b><br/> text/html 2017-11-25T09:37:31+01:00 Abdoulaye Diallo Harouna, Franck Mvumbi, Karima Atarraf, Lamiae Chater, Meryem Boubbou, Abderrhmane Afifi [Case report] - Lipoblastome d&eacute;couvert chez le grand enfant: description rare et revue de la litt&eacute;rature - 06 October 2017. <b>Le lipoblastome est une tumeur b&eacute;nigne relativement rare. Il est issu de la graisse blanche embryonnaire qui survient presque exclusivement chez le petit enfant, de moins de 3 ans. Nous rapportons un cas de lipoblastome de la cuisse gauche d&eacute;couvert chez un grand enfant (11 ans), avec une revue de la litt&eacute;rature. Le diagnostic &eacute;tait histologique, et le traitement chirurgical consistait &agrave; une ex&eacute;r&egrave;se totale de la masse. Les suites post-op&eacute;ratoires &eacute;taient simples avec un recul de 9 mois.</b><br/> text/html 2017-11-25T09:37:31+01:00 Boushab Mohamed Boushab, Ould Cheikh Melaïnine Mohamed Limame, Fall-Malick Fatim Zahra, Savadogo Mamoudou, Ould, Belizaire Marie Roseline Darnycka, Sow Mamadou Saliou [Research] - Estimation of seroprevalence of HIV, hepatitis B and C virus and syphilis among blood donors in the hospital of A&iuml;oun, Mauritania - 06 October 2017. <b>INTRODUCTION: To estimating the seroprevalence of HIV, hepatitis B, hepatitis C and syphilis among blood donors in the A&iuml;oun hospital. METHODS: This is a retrospective study from 1 January 2010 to 31 December 2015.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ben Salah Imen, Moukit Mounir [Images in medicine] - An unusual localisation of a superficial angiomyxoma - 06 October 2017. <b>A 40-year-old woman, without medical or surgical history, presented in our department for a gradually enlarged mass exteriorized from vagina (figure A). There was no history of vaginal discharge, lower abdominal pain or urinary complaints. On speculum examination, a pedunculated, non-tender, brownish and elastic tumor measuring 8 x 2 cm arising from the anterior cervix labium was noted (figure B), suggestive of a fibroepithelial polyp or a soft tissue tumors. The cervix was macroscopically normal. Under spinal anesthesia, a circular incision was made around the cervix implantation of the lesion with clear margins (about 1cm of the normal tissue) forcing excision of the mass. Histopathological examination revealed a lobulated tumor containing prominent myxoid stroma and thin walled vessels, with spindle to stellate tumor cells in higher power view; there were no atypical or mitotic figures in the tumor cells. The pathologic report was benign superficial angiomyxoma. The postoperative course was smooth and she was discharged 1 day after surgery. No recurrence was noted during a postoperative follow-up period of 2 years. Superficial Angiomyxoma is a benign mesenchymal tumor which rarely occurs in cervix, but it should be considered in differential diagnosis of cervical lesions, especially in women of reproductive age.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohamed Elyadari, Amina Berraho [Images in medicine] - Scl&eacute;romalacie post traumatique - 06 October 2017. <b>Il s’agit d’un jeune de 18 ans qui a &eacute;t&eacute; adress&eacute; en consultation pour une tumeur sous conjonctivale pigment&eacute;e de l'œil gauche mimant un m&eacute;lanome uv&eacute;al. Le patient a indiqu&eacute; que la l&eacute;sion a &eacute;volu&eacute; rapidement au cours des mois pr&eacute;c&eacute;dents. L'examen oculaire a r&eacute;v&eacute;l&eacute; une l&eacute;sion saillante brun fonc&eacute; adjacente au limbe entre 3 et 9 heures, mesurant 10 mm sur 6 mm (A). La biomicroscopie ultrasonographique a r&eacute;v&eacute;l&eacute; une structure kystique avec communication avec la cavit&eacute; vitr&eacute;enne, faisant penser au diagnostic d’une hernie uv&eacute;ale plut&ocirc;t qu’un m&eacute;lanome. Lors d'un interrogatoire plus minutieux, le patient a d&eacute;clar&eacute; avoir b&eacute;n&eacute;fici&eacute; d’une k&eacute;ratoplastie transfixiante pour une taie corn&eacute;enne s&eacute;quellaire survenant &agrave; la suite d’un traumatisme contusif par jet de pierre datant de 10 ans. Nous avons retenu l'hypoth&egrave;se que la paroi scl&eacute;rale avait &eacute;t&eacute; endommag&eacute;e, ce qui avait conduit au d&eacute;veloppement d’une scl&eacute;romalacie avec hernie du tissu uv&eacute;ale. Le patient avait r&eacute;cemment eu un &eacute;pisode grave de vomissements, ce qui aurait pu entra&icirc;ner une augmentation de la taille cette l&eacute;sion. Un suivi a &eacute;t&eacute; assur&eacute; pendant plusieurs semaines, p&eacute;riode au cours de laquelle la l&eacute;sion &eacute;tait stable. Le patient a b&eacute;n&eacute;fici&eacute; d’une chirurgie qui a permis la r&eacute;int&eacute;gration du tissu uv&eacute;al et la fermeture de la scl&egrave;re (B).</b><br/> text/html 2017-11-25T09:37:31+01:00 Kawtar El Hachimi, Hanane Benjelloun, Nahid Zaghba, Najiba Yassine [Case report] - M&eacute;tastase pleurale et pulmonaire d’une polyad&eacute;nofibromatose d&eacute;g&eacute;n&eacute;r&eacute;&eacute;: &agrave; propos d’un cas - 06 October 2017. <b>La polyad&eacute;nofibromatose ou l’ad&eacute;nofibromatose est d&eacute;finie par la pr&eacute;sence d’au moins 3 ad&eacute;nofibromes, uni ou bilat&eacute;raux atteignant une taille importante responsable de troubles trophiques. Nous rapportons une observation collig&eacute;e au service des maladies respiratoires du Centre Hospitalier Universitaire Ibn Rochd de Casablanca. Il s’agit d’une patiente &acirc;g&eacute;e de 46ans, suivie depuis l’&acirc;ge de 30 ans pour une ad&eacute;nofibromatose bilat&eacute;rale op&eacute;r&eacute;e &agrave; 4 reprises. Suite &agrave; un bilan pr&eacute;op&eacute;ratoire d’une mastectomie bilat&eacute;rale, une radio du thorax a &eacute;t&eacute; r&eacute;alis&eacute;e objectivant un h&eacute;mithorax droit opaque avec refoulement des &eacute;l&eacute;ments du m&eacute;diastin. L’examen clinique retrouvait un syndrome d’&eacute;panchement liquidien de l’h&eacute;mithorax droit et une ad&eacute;nopathie cervicale sus claviculaire gauche. La ponction biopsie pleurale confirmait la localisation pleurale d’un carcinome peu diff&eacute;renci&eacute; et invasif compatible avec une origine mammaire. La bronchoscopie apr&egrave;s &eacute;vacuation pleurale objectivait un aspect infiltr&eacute; de tout l’arbre bronchique, dont les biopsies concluaient au m&ecirc;me r&eacute;sultat anatomopathologique. Le traitement pr&eacute;conis&eacute; &eacute;tait une polychimioth&eacute;rapie. L’&eacute;volution &eacute;tait marqu&eacute;e par l’apparition de m&eacute;tastases h&eacute;patiques. A travers cette observation nous concluons que les ad&eacute;nofibromes n&eacute;cessitent une surveillance r&eacute;guli&egrave;re vu le risque de d&eacute;g&eacute;n&eacute;rescence vers le cancer du sein qui est une cause fr&eacute;quente de m&eacute;tastases pleuropulmonaires.</b><br/> text/html 2017-11-25T09:37:31+01:00 Amine Chouchaine, Mahmoud Fodha, Mohamed Taha Abdelkefi, Kamel Helali, Mohamed Fodha [Case report] - Ag&eacute;n&eacute;sie de la v&eacute;sicule biliaire: &agrave; propos de trois cas - 06 October 2017. <b>L’ag&eacute;n&eacute;sie de la v&eacute;sicule biliaire est une anomalie cong&eacute;nitale rare. Le but de ce travail est d’&eacute;tudier, &agrave; travers trois cas que nous rapportons, les aspects &eacute;pid&eacute;miologiques de cette affection ainsi que les particularit&eacute;s de diagnostic et de prise en charge th&eacute;rapeutique. Les 2 adultes ont &eacute;t&eacute; admis pour coliques h&eacute;patiques et troubles dyspeptiques avec &agrave; l’&eacute;chographie une v&eacute;sicule scl&eacute;roatrophique multilithiasique. L’un des deux a eu un scanner qui a objectiv&eacute; l’aspect d’un calcul au niveau d’une v&eacute;sicule scl&eacute;roatrophique. Ces 2 malades ont &eacute;t&eacute; op&eacute;r&eacute;spar voie classique &agrave; tort pour lithiase v&eacute;siculaire. L’absence de v&eacute;sicule biliaire a &eacute;t&eacute; d&eacute;couverte en per op&eacute;ratoire. Afin de confirmer le diagnostic en post op&eacute;ratoire, on a pratiqu&eacute; une bili-IRM pour la 1&egrave;re patiente. L’autre malade a &eacute;t&eacute; perdu de vue. Notre 3&egrave;me cas, une enfant de 13 ans, hospitalis&eacute;e pour pancr&eacute;atite aig&uuml;e et l’ag&eacute;n&eacute;sie v&eacute;siculaire a &eacute;t&eacute; suspect&eacute;e devant l’aspect scannographique, puis confirm&eacute;e par la Bili-IRM et elle n’a pas &eacute;t&eacute; op&eacute;r&eacute;e.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mounira El Euch, Madiha Mahfoudhi, Wafa Skouri, Fethi Ben Hamida, Fatima Jaziri, Khaoula Ben Abdelghani, Sami Turki, Ta&iuml;eb Ben Abdallah [Case report] - Pseudotumeur c&eacute;r&eacute;brale r&eacute;v&eacute;lant une sarco&iuml;dose - 06 October 2017. <b>La sarco&iuml;dose est une granulomatose multi visc&eacute;rale d'&eacute;tiologie inconnue qui peut rev&ecirc;tir des tableaux cliniques et radiologiques diverses. Les localisations c&eacute;r&eacute;brales bien que rares, peuvent se pr&eacute;senter sous forme pseudo-tumorale trompeuse. Nous rapportons l'observation d'un jeune adulte Tunisien hospitalis&eacute; pour hypertension intracr&acirc;nienne en rapport avec une l&eacute;sion pseudotumorale radiologique qui a r&eacute;v&eacute;l&eacute; une sarco&iuml;dose syst&eacute;mique.</b><br/> text/html 2017-11-25T09:37:31+01:00 Isaac Okyere, Anthony Lamina, Benedict Owusu [Case report] - Full median sternotomy approach for treatment of upper thoracic vertebral tuberculosis in a developing country: case report and short literature review - 05 October 2017. <b>Direct anterior approach to the cervicothoracic spine (C7-T4) poses a technical challenge in neurosurgery, due to the presence of important neurovascular structures anterior to the cervicothoracic junction (CTJ). Median Sternotomy approach is a surgical option that allows for direct anterior exposure of the lower cervical and upper thoracic vertebrae. We report the first case from Ghana, West Africa of a young man who developed post-tuberculosis osteomyelitis of upper thoracic (T1-2) vertebrae with cord compression after spinal tuberculosis in childhood. He underwent a full median Sternotomy for Anterior Decompression and Fusion of C7-T2 with autologous iliac crest bone graft. We detail our operative procedure and review the relevant literature.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hasnaa Zaouri, Baderdine Hassam [Images in medicine] - Pemphigo&iuml;de bulleuse et maladie de Parkinson: &agrave; propos d'un cas - 04 October 2017. <b>La pemphigo&iuml;de bulleuse (PB) est une maladie auto-immune sp&eacute;cifique d'organe, qui peut &ecirc;tre associ&eacute;e &agrave; de nombreuses pathologies, notamment &agrave; des maladies neurologiques d&eacute;g&eacute;n&eacute;ratives, comme la maladie de Parkinson et la maladie d'Alzheimer. Des &eacute;tudes ont sugg&eacute;r&eacute; la possibilit&eacute; de r&eacute;actions immunitaires crois&eacute;es selon le ph&eacute;nom&egrave;ne «epitope spreading». La survenue de dermatose bulleuse a toujours suivi l'apparition de la maladie neurologique &agrave; des intervalles allant de quelques mois &agrave; un maximum de quelques ann&eacute;es. Alors s'agitil d'une association occasionnelle ou de causalit&eacute;? Il a &eacute;t&eacute; sugg&eacute;r&eacute; que la consommation de m&eacute;dicaments, les l&eacute;sions de d&eacute;cubitus, les &eacute;v&eacute;nements traumatiques et le vieillissement de l'immunit&eacute; peuvent &ecirc;tre des facteurs d&eacute;clenchants de BP au cours de maladies neurologiques. Nous rapportons le cas d'un patient de 93 ans, ayant comme ant&eacute;c&eacute;dent une maladie de parkinson stade avanc&eacute; depuis 10 ans, qui a &eacute;t&eacute; hospitalis&eacute; pour la prise en charge d'une pemphigo&iuml;de bulleuse typique, confirm&eacute; &agrave; l'histologie et l'immunohistochimie. Le patient a &eacute;t&eacute; trait&eacute; par cortico&iuml;des oraux. Apr&egrave;s une semaine de traitement, le patient est d&eacute;c&eacute;d&eacute; dans un tableau de choc septique. Les pathologies neurologiques constituent un v&eacute;ritable facteur de risque de survenue de PB. Cette derni&egrave;re pourrait &ecirc;tre consid&eacute;r&eacute; comme marqueur de d&eacute;sordre neurologique. Ces associations sont d'un int&eacute;r&ecirc;t majeur, car ils peuvent jouer un r&ocirc;le dans l'&eacute;tiopathog&eacute;nie de la PB et peuvent participer &agrave; la compr&eacute;hension de la base pour ces maladies neurod&eacute;g&eacute;n&eacute;ratives.</b><br/> text/html 2017-11-25T09:37:31+01:00 Janaki Patel, Arina Madan, Amanda Gammon, Michael Sossenheimer, Niloy Jewel Samadder [Case report] - Rare hereditary cause of chronic pancreatitis in a young male: SPINK1 mutation - 04 October 2017. <b>Hereditary chronic pancreatitis associated with a mutation in the serine protease inhibitor, Kazal Type-1 (SPINK-1 gene) is extremely rare. The SPINK1 mutation results in trypsinogen activation which predisposes to chronic pancreatitis predominately when combined with CFTR gene mutations. It presents as either chronic or recurrent acute pancreatitis. Symptom control and management of complications is important. Active surveillance with cross-sectional imaging for pancreatic malignancy in individuals with hereditary pancreatitis is advocated due to individuals being high risk. We present an unusual case of a young male who initially presented with renal colic and was incidentally diagnosed with severe chronic pancreatitis on abdominal imaging, with genetic testing confirming a homozygous SPINK1 mutation.</b><br/> text/html 2017-11-25T09:37:31+01:00 Magbagbeola David Dairo, Tosin Faisal Ibrahim, Adetokunbo Taophic Salawu [Research] - Prevalence and determinants of diarrhoea among infants in selected primary health centres in Kaduna north local government area, Nigeria - 04 October 2017. <b>INTRODUCTION: Despite efforts toward the prevention and management of diarrhoea, associated mortality among infants has remained high in Northern Nigeria. This study was designed to determine the prevalence and identify determinants of diarrhoea among infants in Kaduna North Local Government Area (KNLGA), Nigeria. METHODS: In a cross-sectional survey 630 mothers of infants attending three primary health care centers were interviewed. Data was collected on socio-demo graphic characteristics, infant care practices, infant diarrhoea history and mothers knowledge of causes, symptoms and management of diarrhea. Data were analyzed using descriptive statistics, Chi-square, and logistic regression tests at 5% level of significance. RESULTS: mothers' mean age was 27±5.5 years and 46.1% had secondary education. Infants' mean age was 22.4± 12.8 weeks and 50% were females. Prevalence of diarrhoea in the two weeks preceding the study was 21.1%. Only 11.7% of mothers had poor knowledge of diarrhoea. About 76.3% of mothers always washed their hands with soap after cleaning infants' perineum. Majority of infants (84.6%) completed age appropriate immunization while 31.6% were exclusively breastfed. Infants whose mothers sometimes (OR=2.32; 95% CI: 1.4-3.87) or never washed (OR=2.64; 95% CI: 1.19-5.82) their hands with soap after cleaning the infants perineumand those with incomplete age appropriate immunization (OR=1.87, 95% CI: 1.2-2.896) were more likely to have diarrhoea. CONCLUSION: Promotion of hygiene and nutrition education for mothers particularly on proper infant feeding practices, hand washing practices and complete immunization of infants is needed to address the diarrhea determinants.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohamed Kahloul, Mohamed Said Nakhli, Amine Chouchene, Nidhal Chebbi, Salah Mhamdi, Walid Naija [Research] - Comparison of two doses of hypobaric bupivacaine in unilateral spinal anesthesia for hip fracture surgery: 5 mg versus 7.5 mg - 04 October 2017. <b>INTRODUCTION: hip fracture is a frequent and severe disease. Its prognosis depends on the perioperative hemodynamic stability which can be preserved by the unilateral spinal anesthesia especially with low doses of local anesthetics. This study aims to compare the efficacy and hemodynamic stability of two doses of hypobaric bupivacaine (7.5 mg vs 5 mg) in unilateral spinal anesthesia. METHODS: in this prospective, randomized, double-blind study, 108 patients scheduled for hip fracture surgery under unilateral spinal anesthesia were enrolled to receive either 5 mg (group 1) or 7.5 mg (group 2) of hypobaric bupivacaine. Spinal anesthesia was performed in lateral position. Patients’ socio-demographic characteristics, hemodynamic profile, sensory and motor blocks parameters were recorded. RESULTS: both groups were comparable regarding to demographic data. Two cases of failure occurred in group 1 and one case in group 2 corresponding to a comparable efficiency rates (96.29% and 98.14% respectively; p = 0.5). A higher mean onset and lower mean regression times of sensory block were significantly noted in group 1 (7.79±3.76 min vs 5.75±2.35 min, p < 0.001 and 91.29±31.55 min vs 112.77±18.77 min, p <0.001 respectively). Incidence of bilateralization (29.62% vs 87.03%, p < 0.001), incidence of hypotensive episodes (59.25% vs 92.59%, p < 0.001) and vascular loading (1481.48±411.65 ml vs 2111.11±596.10 ml, p < 0.001) were significantly higher in group 2. CONCLUSION: the dosage of 5mg of hypobaric bupivacaine in unilateral spinal anesthesia is as effective as the dosage of 7.5 mg with lower bilateralization incidence and better hemodynamic stability.</b><br/> text/html 2017-11-25T09:37:31+01:00 Rachid Frikh, Siham Oumakhir, Hafsa Chahdi, Mohammed Oukabli, Abderrahmane Albouzidi, Noureddine Baba, Naoufal Hjira, Mohammed Boui [Case report] - M&eacute;lanome des tissus mous: cas clinique - 04 October 2017. <b>Le m&eacute;lanome des tissus mous a &eacute;t&eacute; d&eacute;crit en 1965 par Enzinger sous le nom de sarcome &agrave; cellules claires. En 1983, Chung et Enzinger le rebaptisent m&eacute;lanome des parties molles en raison de similitudes immunohistochimiques avec le m&eacute;lanome. Nous rapportons un cas de cette forme rare de m&eacute;lanome, chez un jeune homme de 22 ans qui avait une l&eacute;sion mollusco&iuml;de de la cheville sans signes cliniques de malignit&eacute;, et dont l’examen histologique a permis de retenir ce diagnostic.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mpapho Joseph Motsumi, Pako Motlaleselelo, Gezahen Ayane, Sheikh Omar Sesay, Johamel Ramos Valdes [Case report] - A case report of a giant appendiceal mucocele and literature review - 04 October 2017. <b>A 43-year-old female presented at the accident and emergency department of Princess Marina Hospital, Gaborone, Botswana. She reported a deep dull aching pain of two years duration in the right iliac fossa that has been progressively becoming worse. Ultrasound revealed a large sausage like cystic mass extending from the pelvis up to the medial aspect of the ascending colon. CT scan showed a large sausage like cystic mass extending from the pelvis up to the hepatic flexure of the colon with the cecum displaced. No metastatic features were seen. We made an impression of appendiceal mucocele. A semi-elective laparotomy was scheduled. Intraoperative findings: a giant intact cystic distended appendix with involved base, displacing the cecum cranially. A right hemicolectomy was performed. The histopathological results revealed a low-grade appendicular mucinous neoplasm with no lymph node involvement. The surgical margins were free. The patient recovered uneventfully.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mounira El Euch, Souha Haddad, Madiha Mahfoudhi, Fethi Ben Hamida, Fatima Jaziri, Khaoula Ben Abdelghani, Sami Turki, Ta&iuml;eb Ben Abdallah [Case report] - Maladie cœliaque de l’adulte r&eacute;v&eacute;l&eacute;e par une polys&eacute;rite - 04 October 2017. <b>La maladie cœliaque (MC) repr&eacute;sente une maladie auto immune touchant plusieurs organes. Elle est souvent r&eacute;v&eacute;l&eacute;e par des manifestations digestives avec une malabsorption biologique. Cependant, l’atteinte des s&eacute;reuses peut exceptionnellement r&eacute;v&eacute;ler cette ent&eacute;ropathie rendant le diagnostic difficile. Il s’agit du patient JA &acirc;g&eacute; de 63 ans admis pour exploration de syndrome de malabsorption avec des signes de polys&eacute;rite &agrave; type de pleur&eacute;sie, p&eacute;ricardite, ascite et hydroc&eacute;phalie. Le diagnostic de MC a &eacute;t&eacute; port&eacute; devant des signes endoscopiques sans arguments s&eacute;rologiques. L’&eacute;volution &eacute;tait partiellement favorable &agrave; cause de la mauvaise adh&eacute;sion au r&eacute;gime sans gluten. Notre observation est le premier cas rapport&eacute; d’une polys&eacute;rite r&eacute;v&eacute;lant la MC qui devrait &ecirc;tre &eacute;voqu&eacute;e devant tout syndrome de malabsorption en l’absence de signes &eacute;vocateurs.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hind Ramid, Fouzia Hali [Images in medicine] - Mastocytose xanth&eacute;lasmoide: entit&eacute; rare de mastocytose cutan&eacute;e - 04 October 2017. <b>La mastocytose est une maladie rare caract&eacute;ris&eacute;e par l’accumulation anormale de mastocytes dans la peau et &eacute;ventuellement dans d’autres organes. Les formes cliniques sont multiples dont la mastocytose xanth&eacute;lasmoide (MX) qui est une forme tr&egrave;s rare class&eacute;e parmi les formes papulo-nodulaires. Elle se pr&eacute;sente cliniquement par l’apparition de papules ou nodules de couleur jaune chamois, de consistance molle, et de taille variable. Les facteurs d&eacute;clenchant sont ceux d’une mastocytose classique. Le signe de Darier est souvent absent. L’histologie met en &eacute;vidence un infiltrat dense en mastocyte au niveau du derme profond. Cette forme clinique se singularise par la persistance des l&eacute;sions au-del&agrave;s de la pubert&eacute; sans sur- risque d’atteinte syst&eacute;mique. Nous rapportons le cas d’un nourrisson de sexe f&eacute;minin &acirc;g&eacute;e de 18 mois, sans ant&eacute;c&eacute;dents, dont l’histoire remonte &agrave; l’&acirc;ge de 8 mois par l’apparition de l&eacute;sions maculo-papuleuses tr&egrave;s prurigineuses, ovalaires, brun&acirc;tres &agrave; centre jaune-chamois, de consistance &eacute;lastique et de tailles diff&eacute;rentes, l’interrogatoire avait objectiv&eacute; la survenue d’&eacute;pisode de flush surtout &agrave; la chaleur. Le signe de Darrier &eacute;tait n&eacute;gatif. La biopsie cutan&eacute;e montrait un infiltrat dermique de mastocytes, permettant ainsi de retenir le diagnostic de mastocytose cutan&eacute;e dans sa forme Xanth&eacute;lasmoide. Les examens compl&eacute;mentaires ainsi que le dosage de la trypsine &eacute;taient normales. Le traitement &eacute;tait bas&eacute; sur l’&eacute;viction de m&eacute;dicaments et facteurs de d&eacute;granulation mastocytaires et les antihistaminiques de type anti-H1.</b><br/> text/html 2017-11-25T09:37:31+01:00 Amina Atmane, Sanaa Hammi, Asm&acirc;a Regragui, Mohammed Raoufi, Karima Marc, Mouna Soualhi, Rachida Zahraoui, Jouda Benamor, Jamal Eddine Bourkadi [Case report] - Mode r&eacute;v&eacute;lateur original et localisation m&eacute;tastatique particuli&egrave;re d’un synovialo-sarcome chez un adulte immunocomp&eacute;tent: &agrave; propos d’un cas avec revue de la litt&eacute;rature - 04 October 2017. <b>Le synovialo-sarcome (SS) est une tumeur rare, avec atteinte thoracique rare et de localisation vari&eacute;e. Du fait d’une croissance lente, la tumeur peut &ecirc;tre &agrave; tort reconnue comme b&eacute;nigne. Moins de 10% des cas se pr&eacute;sente au stade dem&eacute;tastases. Les m&eacute;tastases endobronchiques sont exceptionnelles. L’&eacute;tude immuno-histochimique et l’analyse cytog&eacute;n&eacute;tique permettent de le distinguer des autres tumeurs m&eacute;senchymateuses. La pr&eacute;sence d’un transcrit de fusion SYT-SSX permet d’affirmer le diagnostic. Le traitement repose sur la chirurgie pour les tumeurs localis&eacute;es qui peut &ecirc;tre associ&eacute;e &agrave; la radioth&eacute;rapie, et sur la chimioth&eacute;rapie pour les formes m&eacute;tastatiques. Le taux moyen de r&eacute;cidive locor&eacute;gionale ou m&eacute;tastatique &agrave; deux ans des SS est de 50%. Nous rapportons le cas de m&eacute;tastase de SS, exceptionnel par son si&egrave;ge, il s’agit de m&eacute;tastase endobronchique ayant pu r&eacute;v&eacute;ler la maladie chez un jeune de 28 ans, une maladie &eacute;voluant depuis plus de 2 ans. Le SS est redoutable par son &eacute;volution lente et insidieuse, son pronostic reste r&eacute;serv&eacute;. A travers cette observation nous soulignons la raret&eacute; de la localisation et nous insistons sur l’int&eacute;r&ecirc;t d’un diagnostic et d’une prise en charge pr&eacute;coces.</b><br/> text/html 2017-11-25T09:37:31+01:00 Achraf El Bakkaly, Fouad Ettayebi, Houda Oubeja, Mounir Erraji, Hicham Zerhouni [Case report] - Syndrome de Bean chez l’enfant: &agrave; propos de deux cas - 04 October 2017. <b>L'angiomatose diffuse ou syndrome de Bean est une entit&eacute; rare caract&eacute;ris&eacute;e par des malformations veineuses essentiellement cutan&eacute;es et digestives pouvant se compliquer d'h&eacute;morragie de gravit&eacute; variable. Notre travail int&eacute;resse l'&eacute;tude de deux enfants, l'un &acirc;g&eacute; de 5ans et l'autre de 9 ans et demi atteints d'angiomatose diffuse suivis au service des urgences chirurgicales p&eacute;diatriques depuis des ann&eacute;es. Le diagnostic a &eacute;t&eacute; &eacute;voqu&eacute; devant des rectorragies et/ou des m&eacute;l&eacute;nas occasionnant une an&eacute;mie s&eacute;v&egrave;re n&eacute;cessitant des transfusions r&eacute;guli&egrave;res chez nos deux patients ainsi que l'apparition des angiomes cutan&eacute;s au niveau des membres. Les explorations radiologiques ont r&eacute;v&eacute;l&eacute; la pr&eacute;sence au niveau du j&eacute;junum et l'il&eacute;on des multiples l&eacute;sions correspondant &agrave; une angiomatose gr&ecirc;lique diffuse pour l'enfant de 9 ans et demi; elles n'ont pas retrouv&eacute; de localisations abdominales pour l'enfant de 5 ans. Les deux malades ont &eacute;t&eacute; admis au bloc op&eacute;ratoire avec individualisation &agrave; l'exploration des angiomes dont certains saignaient activement. Une r&eacute;section par ent&eacute;rotomie a &eacute;t&eacute; r&eacute;alis&eacute;e. Les suites ont &eacute;t&eacute; marqu&eacute;es par l'arr&ecirc;t des saignements. L'int&eacute;r&ecirc;t de notre travail est de mettre le point sur cette entit&eacute; pathologique rare, ainsi que le b&eacute;n&eacute;fice du traitement chirurgical pour le contr&ocirc;le des complications de cette pathologie et pour la diminution de la fr&eacute;quence des transfusions.</b><br/> text/html 2017-11-25T09:37:31+01:00 Gretchen Cowman, Shikanga Otipo, Ian Njeru, Thomas Achia, Harsha Thirumurthy, Jamie Bartram, Jackson Kioko [Research] - Factors associated with cholera in Kenya, 2008-2013 - 03 October 2017. <b>INTRODUCTION: Kenya experienced widespread cholera outbreaks in 1997-1999 and 2007-2010. The re-emergence of cholera in Kenya in 2015 indicates that cholera remains a public health threat. Understanding past outbreaks is important for preventing future outbreaks. This study investigated the relationship between cholera occurrence in Kenya and various environmental and demographic factors related to water, sanitation, socio-economic status, education, urbanization and availability of health facilities during the time period 2008-2013. METHODS: The primary outcome analyzed was the number of cholera cases at the district level, obtained from the Kenya Ministry of Health's national cholera surveillance records. Values of independent variables were obtained from the 2009 Kenya Population and Housing Census and other national surveys. The data were analyzed using a zero-inflated negative binomial regression model. RESULTS: Multivariate analysis indicated that the risk of cholera was associated with open defecation, use of unimproved water sources, poverty headcount ratio and the number of health facilities per 100,000 population (p < 0.05). No statistically significant association was found between cholera occurrence and education, percentage of population living in urban areas or population density.</b><br/> text/html 2017-11-25T09:37:31+01:00 Merriam Bautile Moyimane, Sogo France Matlala, Mokoko Percy Kekana [Research] - Experiences of nurses on the critical shortage of medical equipment at a rural district hospital in South Africa: a qualitative study - 29 September 2017. <b>INTRODUCTION: medical equipment is an essential health intervention tool used by nurses for prevention, diagnosis and treatment of disease and for rehabilitation of patients. However, access to functioning medical equipment is a challenge in low- and middle-income countries. The World Health Organization estimated that 50 to 80 percent of medical equipment in developing countries is not working, creating a barrier to the ability of the health system to deliver health services to patients. This study explored and described the lived experiences of nurses working at a district hospital with a critical shortage of medical equipment.</b><br/> text/html 2017-11-25T09:37:31+01:00 Wiem Ayed, Islem Messaoudi, Zouhour Belghith, Wajih Hammami, Imen Chemkhi, Nabila Abidli, Helmy Guermani, Rim Obay, Ahlem Amouri [Case series] - Chromosomal abnormalities in 163 Tunisian couples with recurrent miscarriages - 29 September 2017. <b>Recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses before 24 weeks of gestation. Parental chromosomal abnormalities represent an important etiology of RM. The aim of the present study was to identify the distribution of chromosome abnormalities among Tunisian couples with RM referred to the Department of Cytogenetic at the Pasteur Institute of Tunis (Tunisia) during the last five years. Standard cytogenetic analysis was carried out in a total of 163 couples presenting with two or more spontaneous abortions. Karyotypes were analyzed by R-banding. We identified 14 chromosomal abnormalities including autosomal reciprocal translocation, Robertsonian translocation, inversion, mosaic aneuploidy and heteromorphysm. The overall prevalence of chromosomal abnormalities was 8.5% in our cohort. This finding underlies the importance of cytogenetic investigations in the routine management of RM.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ilhame Naciri, Baderddine Hassam [Images in medicine] - L&eacute;sions verruqueuses p&eacute;rin&eacute;ales - 29 September 2017. <b>Le lichen plan verruqueux (LPV), est une dermatose inflammatoire chronique, qui si&egrave;ge &eacute;lectivement au niveau desmembres inf&eacute;rieurs. La localisation p&eacute;rin&eacute;ale est rare, souvent associ&eacute;e &agrave; d’autres l&eacute;sions de lichen cutan&eacute;o-muqueux. Nous rapportant un cas &agrave; localisation p&eacute;rin&eacute;ale isol&eacute;e. Il s’agit d’un patient &acirc;g&eacute; de 51 ans, sans ant&eacute;c&eacute;dent pathologique notable, qui consultait pour des l&eacute;sions verruqueuses indolores, l&eacute;g&egrave;rement prurigineuses, au niveau p&eacute;rin&eacute;al, augmentant progressivement de taille depuis 8 ans. L’examen clinique r&eacute;v&eacute;lait la pr&eacute;sence de multiples l&eacute;sions bourgeonnantes, fermes, gris&acirc;tres &agrave; surface rugueuse, de 1 &agrave; 4 cm de diam&egrave;tre, si&eacute;geant au niveau p&eacute;ri anal et scrotal(A). Le reste de l’examen somatique &eacute;tait sans particularit&eacute;. L’&eacute;tude histologique montrait un &eacute;piderme acanthosique d’aspect verruqueux, associ&eacute; &agrave; un infiltrat inflammatoire &agrave; pr&eacute;dominance lymphocytaire grignotant la membrane basale, et une incontinence pigmentaire avec des corps apoptotiques au niveau de l’assise basale &eacute;pidermique, sans objectiver de signes d’infection virale ou de transformation maligne (B). Le diagnostic d’un lichen plan verruqueux &eacute;tait retenu. La s&eacute;rologie de l’h&eacute;patite C, le bilan lipidique, ainsi que l’&eacute;chographie abdominale &eacute;taient sans anomalies. Une corticoth&eacute;rapie locale classe tr&egrave;s forte a &eacute;t&eacute; prescrite. L’&eacute;volution &eacute;tait favorable sans r&eacute;cidive, avec un recul de 18 mois.</b><br/> text/html 2017-11-25T09:37:31+01:00 Lucia Amolo, Grace Irimu, Daniel Njai [Research] - Knowledge of postnatal mothers on essential newborn care practices at the Kenyatta National Hospital: a cross sectional study - 29 September 2017. <b>INTRODUCTION: Of the 130 million babies born yearly, nearly 4 million die in the neonatal period. Kenya Demographic Health Survey (KDHS) 2014 places neonatal mortality rate at 22 deaths per 1,000 live births, well above the Sustainable Development Goal (SDG) 3 that aims to reduce these mortalities to at least 12 deaths per 1000 live births by 2030. The aim of the study was to assess maternal knowledge on selected components of essential newborn care: breastfeeding, cord care, immunisation, eye care and thermoregulation. METHODS: A hospital based cross-sectional study was conducted on 380 postnatal mothers in Kenyatta National Hospital. Interviews were conducted using structured pretested questionnaires. A score of one was given for correct response and zero for incorrect. Data were analysed using SPSS version 18. RESULTS: Modes of thermoregulation identified included kangaroo care (7%), warm room (4%) and warm clothing (93%). Almost all mothers knew of breastfeeding on demand, exclusive breastfeeding and colostrum use. Only 17.8% of mothers identified Bacillus Calmette-Gu&eacute;rin (BCG) and Oral Polio Vaccine (OPV) were birth vaccines. Only 4 mothers knew no substances should be applied to the cord. In logistic regression, factors significantly associated with poor knowledge included lack of education on newborn care during pregnancy, incomplete (less than 3) or no antenatal visits with an odds ratio (OR) of 3.3 (95% confidence interval (CI), 1.5 to 7.4 ), 2.5(1.5 to 4.2), 5.1(1.3 to 19.3) and p values of 0.003, 0.001 and 0.018 respectively. CONCLUSION: Knowledge gaps existed regarding cord care, eye care and immunization. Mothers had good knowledge on breastfeeding practices. Those who fail to fully attend antenatal clinics should be targeted for newborn care education.</b><br/> text/html 2017-11-25T09:37:31+01:00 Moustapha Diedhiou, Philippe Manyacka, Mactar Dieng, Jacques Noel Tendeng, Mohamed Lamine Diao, Ousmane Thiam, Hady Tall, Issa Thiam, Ibrahima Konaté [Research] - Faisabilit&eacute; et pertinence de la check-list de s&eacute;curit&eacute; au bloc op&eacute;ratoire central du Centre Hospitalier R&eacute;gional de Saint Louis du S&eacute;n&eacute;gal - 29 September 2017. <b>INTRODUCTION: La check-list (CL) de sécurité au bloc opératoire est un outil de qualité qui permet de réduire la morbimortalité péri opératoire. C’est une des exigences de la Haute Autorité de Santé (HAS) française dans la procédure de certification des établissements de santé. L’objectif de ce travail est de réaliser une évaluation quantitative et qualitative de l’utilisation de cet outil au sein du bloc opératoire central du centre hospitalier Régional de Saint Louis. METHODES: une évaluation prospective des indicateurs de l’utilisation pratique de la check-list et de son apport dans l’amélioration des pratiques chirurgicales au bloc opératoire du centre hospitalier régional de Saint-Louis a été entamée depuis son lancement en mars 2016. RESULTATS: le taux d’utilisation de la CL était de 75%, le taux de conformité était de 60%; le taux de renseignements était de 99% pour les items pré-induction, 93% pour les items pré-incision et 88% pour les items postopératoires. Seules 73% des CL analysées avaient été remplies avec une communication orale effective aux trois temps. La CL a permis de détecter des dysfonctionnements matériels et/ou des événements indésirables dans 15% des cas. Aucune erreur d’identification de patient ni de coté opéré ne furent objectivées dans notre étude.</b><br/> text/html 2017-11-25T09:37:31+01:00 Wafa Ben Ameur, Safa Belghali, Imen Akkari, Houneida Zaghouani, Elyes Bouajina, Elhem Ben Jazia [Case report] - Bone metastasis as the first sign of gastric cancer - 29 September 2017. <b>The skeleton is a common metastatic site for visceral carcinomas. However, the presentation of gastric cancer as bony metastases without preceding gastrointestinal symptoms is rare which has been infrequently reported in the literature. We report an infrequent case of a 60-year-old patient diagnosed having a gastric carcinoma with bone metastasis as the first evidence. She has consulted with worsening backache which started two months priorly.</b><br/> text/html 2017-11-25T09:37:31+01:00 Stylianos Kapetanakis, Danai Chourmouzi, Grigorios Gkasdaris, Vasileios Katsaridis, Eleftherios Eleftheriadis, Panagiotis Givissis [Case report] - Functional extra-adrenal paraganglioma of the retroperitoneum giving thoracolumbar spine metastases after a five-year disease-free follow-up: a rare malignant condition with challenging management - 29 September 2017. <b>Paragangliomas are benign neoplasms that arise from the autonomic nervous system and the associated paraganglia. Although benign, they have been shown to possess metastatic potential. Extra-adrenal retroperitoneal paraganglioma with vertebral metastasis is considered very uncommon. Here, we present a case of a functional extra-adrenal paraganglioma of the retroperitoneum giving metastasis to T4 vertebra after five years of follow-up in a 48-year-old man who had been initially treated with complete resection of the primary tumor. The condition of the patient improved significantly after radiosurgery and somatostatin analogs treatment, until lumbar spine lesions appeared six months later. Our case demonstrates that retroperitoneal paraganglioma is a rare condition which should be considered in the differential diagnosis of a retroperitoneal mass combined with vertebral lesions. Additionally, increased physician awareness and long-term follow-up is mandatory for all patients with history of retroperitoneal paraganglioma since metastases may occur after long latent intervals from the initial diagnosis.</b><br/> text/html 2017-11-25T09:37:31+01:00 Oluwafunmilayo Funke Adeniyi, Olufunmilayo Adenike Lesi, Foluke Adenike Olatona, Christoper Imokhuede Esezobor, Joanah Moses Ikobah [Research] - Irritable bowel syndrome in adolescents in Lagos - 29 September 2017. <b>INTRODUCTION: Irritable bowel syndrome (IBS) is one of the functional gastrointestinal disorders (FGIDs) which has been well described in western populations especially as the commonest cause of recurrent abdominal pain</b><br/> text/html 2017-11-25T09:37:31+01:00 Prastiya Indra Gunawan, Darto Saharso [Images in medicine] - Unusual location of fibrous plaque in Indonesian child with tuberosclerosis complex - 29 September 2017. <b>Tuberosclerosis complex (TSC) is one of the most frequent genetic causes of epilepsy. A 3-year-old boy was reffered to Soetomo Hospital, Surabaya, Indonesia with chief complain of intractable seizures. The seizures were frequent and various in type. The skin present red dome shaped papules on face and smooth, firm, nodular or fleshy lesions referred to fibrous plaque on gum, right tarsal and right hallux region. Tarsal and hallux region were unusual skin collagenous fibroma area found in TSC. Five white macules with diameter 4-5mm were also found on the trunk. Electroencephalography resulted epileptiform discharges originating from left temporal posterior and right temporal. Head MRI showed multiple tubers at bilateral cortical-subortical fronto-temporo-parieto-occipital. The patient was diagnosed as tuberous sclerosis and received 3 types of anti epileptic seizure drugs (levetiracetam, carbamazepine and vigabatrin). The treatment resulted decrease of seizure frequency.</b><br/> text/html 2017-11-25T09:37:31+01:00 Carlson-Babila Sama, Bonaventure Dzekem, Jules Kehbila, Cyril Jabea Ekabe, Brice Vofo, Naomi Liteba Abua, Therence Nwana Dingana, Fru Angwafo III [Research] - Awareness of breast cancer and breast self-examination among female undergraduate students in a higher teachers training college in Cameroon - 29 September 2017. <b>INTRODUCTION: the incidence of breast cancer (BCa) in Cameroon is on the rise and accounts for a leading cause of mortality. An understanding of the knowledge and practices on breast cancer and breast self-examination (BSE) among teachers are important first steps which will guide the designing of interventions aimed at raising awareness across the general population. METHODS: we conducted a cross-sectional study in April 2016 involving 345 consenting female undergraduate students in the Higher Teachers Training College, Bambili, Cameroon. Data was collected using a pretested self-administered questionnaire and analysed using descriptive methods. RESULTS: the mean age of the respondents was 22.5±3.2years and a vast majority (n = 304, 88.1%) had heard about BCa primarily from the television/radio (n = 196, 64.5%). Overall, less than a quarter (n=65, 21.4%) of respondents who had heard about BCa had sufficient knowledge on its risk factors and signs/symptoms. A plurality (53.3%) thought BCa can be prevented via vaccination while over a third (38.7%) opined that BCa can be treated spiritually. Less than half (47%) of respondents who had heard about BCa had heard about BSE amongst which only 55 (38.5%) had ever practiced it. CONCLUSION: though most students are aware of the existence of breast cancer, their overall knowledge on its risk factors and clinical presentation is insufficient with a concomitant low practice of BSE. These highlighted gaps warrants intensification of sensitization campaigns and educational programmes in order to raise knowledge levels and enhance prevention strategies that would aid in reducing the burden of breast cancer in Cameroon.</b><br/> text/html 2017-11-25T09:37:31+01:00 Marwa Osman, Mazin Shigidi, Haider Ahmed, Ihab Abdelrahman, Wieam Karrar, Elhussein Elhassan, Hussam Shwaib, Rayyan Ibrahim, Marwa Abdalla [Research] - Pattern and outcome of acute kidney injury among Sudanese adults admitted to a tertiary level hospital: a retrospective cohort study - 29 September 2017. <b>INTRODUCTION: Little is known about the pattern and outcome of Acute Kidney injury (AKI) in Sudan. This study aimed to determine the etiology andoutcome of AKI among Sudanese adults. METHODS: a retrospective cohort study was conducted in a tertiary level hospital, Soba University Hospital, Sudan. The medical records of all adults admitted to hospital from the 1<sup>st</sup> of January to 31<sup>st</sup> of December 2014 were reviewed. The diagnosis and severity of AKI was defined as per the Kidney Disease Improving Global Outcomes (KDIGO) recommendations. RESULTS: the medical records of 6769 patients were reviewed. AKI was diagnosed in 384patients (5.7%); being community acquired in 82.6% of cases. Sepsis, volume depletion, obstructive uropathy, heart failure, acute glomerulonephritis and severe malaria were the commonest causes of AKI diagnosed in 44%, 38.5%, 8.9%, 5.7%, 4.7% and 3.1% of patients, respectively. Following treatment complete renal recovery was seen in 35.7% of patients; whereas 31.2% of patients died. Predictors of increased risk of death were old age [OR 1.03, 95% CI (1.01-1.057); P=0.003], presence of chronic liver disease [OR 2.877, 95% CI (1.5-5.5); P=0.001], sepsis [OR 2.51, 95% CI (1.912-4.493);P=0.002] and the severity of AKI [OR 3.873, 95% CI(1.498-10.013);P=0.005]. CONCLUSION: AKI was diagnosed in 5.7% of adults admitted to hospital. Most patients were having community acquired AKI. Old age, the presence of chronic liver disease, sepsis, and the severity of AKI as per KDIQO staging were significant predictors of mortality.</b><br/> text/html 2017-11-25T09:37:31+01:00 Shijun Li, Salim Barywani, Michael Fu [Research] - Impact of heart rate in atrial fibrillation versus sinus rhythm on mortality in octogenarian patients with acute coronary syndrome - 29 September 2017. <b>INTRODUCTION: Association of heart rate (HR) with mortality in patients with acute coronary syndrome (ACS) and aged &#8805; 80 years are underrepresented in clinical trials. We therefore aimed to investigate the association of HR in atrial fibrillation (AF) versus sinus rhythm (SR) with all-cause mortality in octogenarian patients with ACS. METHODS: a total of 336 patients with ACS patients and aged &#8805;80 years were enrolled into the current study. The end point of interest was death from any cause. Association of HR in AF versus SR with mortality was analyzed by Kaplan-Meier curve following log-rank test and multivariable Cox regression analysis. RESULTS: in total, 63 (87.5%) of patients with AF were dead and 147 (59.8%) of patients with SR were dead during the follow-up period. The best cut-off was 80 bpm, with a sensitivity of 62% and specificity of 66%. HR &#8804; 80 bpm in SR but not in AF was associated with better outcome as compared with HR > 80 bpm (Chi-Square = 26.55, Log rank P < 0.001). In SR subgroup, the hazard ratios of HR &#8804; 80 bpm were 0.51(95% CI 0.37-0.70, P < 0.001) adjusted for age, 0.46 (95%CI 0.33-0.63, P < 0.001) adjusted for gender, 0.62 (95%CI 0.42- 0.93, P = 0.020) adjusted for multivariables respectively. In AF subgroup, the hazard ratios of HR &#8804; 80 bpm were 0.83(95% CI 0.49-1.38, P = 0.464) adjusted for age, 0.96 (95%CI 0.59-1.58, P = 0.882) adjusted for gender, 0.72(95% CI 0.41-1.26, P = 0.249) adjusted for multivariables respectively. CONCLUSION: the current study demonstrates that heart rate is an independent prognostic predictor for all-cause mortality, and HR &#8804; 80 bpm is associated with improved outcome in SR but not in AF in octogenarian patients with ACS.</b><br/> text/html 2017-11-25T09:37:31+01:00 Dhia Kaffel, Hend Riahi [Images in medicine] - Primary idiopathic osteoarthropathy - 29 September 2017. <b>A 49-year-old man presented with arthralgias and effusion of the knees. His past medical syndrome revealed digital clubbing for 17 years (A) and an idiopathic Raynaud syndrome. Radiographs of the tibias and fibulas showed bilateral, symmetric, extended and multilayered periosteal thickening (B). Thoracic CT and cardiac ultrasound were normal, as well as inflammatory, hepatic and renal tests. Infectious investigations were negative. The diagnosis of primary idiopathic osteoarthropathy (HOA) was made with 3-year follow-up. HOA is a syndrome characterized by three clinical features: digital clubbing (also termed Hippocratic fingers), periostosis of tubular bones, and synovial effusions. HOA can be a primary entity, or can be secondary to extra skeletal conditions. Primary HOA is a rare disease, with male predilection. Hippocratic fingers show a distinctive bulbous deformity of the fingertips. It can be associated with large joint’s effusions but there is neither synovial membrane hypertrophy nor inflammatory cell exudation. Radiographs may show an acro-osteolysis, periostosis of tubular bones. The tibia, fibula, radius, and ulna are the most commonly affected bones.</b><br/> text/html 2017-11-25T09:37:31+01:00 Magzoub Abbas Magzoub, Naser Eldin Bilal, Jalal Ali Bilal, Mohammad Abdulrahman Alzohairy, Bahaeldin Khalid Elamin, Gasim Ibrahim Gasim [Research] - Detection and sequencing of rotavirus among sudanese children - 27 September 2017. <b>INTRODUCTION: Diarrheal diseases are a big public health problem worldwide, particularly among developing countries. The current study was conducted to detect and characterize group A rotavirus among admitted children with gastroenteritis to the pediatric hospitals, Sudan. METHODS: A total of 755 stool samples were collected from Sudanese children with less than 5 years of age presenting with acute gastroenteritis during the period from April to September 2010. Enzyme-linked immunosorbent assay (ELISA) was used to Detection of Rotavirus antigens. Ribonucleic acid (RNAs) were extracted from rotavirus-positive stool samples using (QIAamp® Viral RNA Mini Kit). (Omniscript® Reverse Transcription kit) was used to convert RNA to complementary Deoxyribonucleic acid (cDNA). The cDNAs were used as template for detection of VP4-P (P for Protease-sensitive) and VP7-G (G for Glycoprotein) genotyping of Rotavirus using nested PCR and sequencing. RESULTS: Out of the 755 stool samples from children with acute gastroenteritis, 121 were positive for rotavirus A. Among 24 samples that were sequenced; the VP7 predominant G type was G1 (83.3%), followed by G9 (16.7%). Out of these samples, only one VP4 P[8] genotype was detected. CONCLUSION: As a conclusion the VP7 predominant G type was G1, followed by G9 whereas only one VP4 genotype was detected and showed similarity to P[8] GenBank strain. It appears that the recently approved rotavirus vaccines in Sudan are well matched to the rotavirus genotypes identified in this study, though more studies are needed.</b><br/> text/html 2017-11-25T09:37:31+01:00 Omar Margad, Jalal Boukhris, Ouahb Azriouil, Mohamed Daoudi, Aziz Mortaji, Khalid Koulali [Case series] - Les synovites villonodulaires du genou: &agrave; propos de 20 cas - 27 September 2017. <b>la synovite villonodulaire pigment&eacute;e (SVNP) est une prolif&eacute;ration b&eacute;nigne rare de la synoviale des articulations, des bourses s&eacute;reuses et des gaines tendineuses, d'&eacute;tiopathog&eacute;nie inconnue. Notre travail porte sur 20 cas de SVN du genou collig&eacute;s &agrave; l'h&ocirc;pital militaire Avicenne de Marrakech sur une p&eacute;riode de 9 ans allant de janvier 2000 au d&eacute;cembre 2009 Il vise &agrave; identifier les sp&eacute;cificit&eacute;s de cette l&eacute;sion, et &agrave; &eacute;tudier ses principaux aspects anatomocliniques et pronostiques. L'incidence annuelle &eacute;tait de 2,2 cas par an, Ils &eacute;taient 15 hommes et 5 femmes, d'&acirc;ge moyen de 32,5 ans, atteints du cot&eacute; droit dans 55%des cas sous un mode mono articulaire chez 18 patients et bi articulaire chez un seul. La douleur et la tum&eacute;faction &eacute;taient pr&eacute;sentes dans 80% des cas, une masse palpable dans un cas, un syndrome m&eacute;niscal a &eacute;t&eacute; retenu dans un cas, une mono arthrite septique dans 3 circonstances de m&ecirc;me qu'un kyste poplit&eacute; dans 2 autres. L'atteinte &eacute;tait diffuse dans 14 cas (70%), localis&eacute;e dans 6 cas. L'imagerie par r&eacute;sonnance magn&eacute;tique(IRM) pratiqu&eacute;e chez 5 patients &eacute;tait &eacute;vocatrice chez 3, l'arthroscopie diagnostique a &eacute;t&eacute; utilis&eacute;e chez 2 malades. La confirmation s'est faite &agrave; chaque fois &agrave; l'examen anatomopathlogique. Le traitement a consist&eacute; en une synovectomie subtotale dans 15 cas et en l'ex&eacute;r&egrave;se de la tumeur dans les autres formes localis&eacute;es, 2 cas pr&eacute;sentant une destruction ost&eacute;ocartilagineuse ont n&eacute;cessit&eacute; une arthroplastie. L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par la survenue de 2 r&eacute;cidives sous la forme diffuse avec un recul de 3, 7 ans. On a not&eacute; une raideur avec atrophie quadricipitale chez 3 patients et une arthrolyse a &eacute;t&eacute; r&eacute;alis&eacute;e. Un cas de SVN confirm&eacute; par l'histologie s'est r&eacute;v&eacute;l&eacute; &ecirc;tre 5 mois apr&egrave;s la synovectomie totale un Synovialosarcome monophasique envahissant l'os d'o&ugrave; l'indication de l'amputation.</b><br/> text/html 2017-11-25T09:37:31+01:00 Soumia Fdil, Saad Bouchikhi, Jamal-Eddine Bourkadi [Case report] - H&eacute;mothorax spontan&eacute;: complication rare de la neurofibromatose type 1 - 27 September 2017. <b>La neurofibromatose de type 1 (NF1) ou maladie de Von Recklinghausen est une maladie h&eacute;r&eacute;ditaire la plus fr&eacute;quente des phacomatoses, de transmission autosomique dominante. Ses complications pulmonaires sont rarement d&eacute;crites dans la litt&eacute;rature. Les complications vasculaires sont retrouv&eacute;es chez 3,6% des patients. Nous rapportant le cas d'une patiente &acirc;g&eacute;e de 38 ans, suivie pour neurofibromatose type 1, admise aux urgences dans un tableau de choc h&eacute;morragique, avec &agrave; l'examen plusieurs taches caf&eacute; au lait, de nombreux neurofibromes plexiformes, un syndrome d'&eacute;panchement liquidien gauche. La ponction pleurale a objectiv&eacute; un liquide h&eacute;morragique coagulable, la patiente a b&eacute;n&eacute;fici&eacute; d'une transfusion et de drainage thoracique en urgence. Le bilan &eacute;tait compl&eacute;t&eacute; par un angioscanner qui n'a pas objectiv&eacute; d'embolie pulmonaire ni d'autres l&eacute;sions associ&eacute;es. L'h&eacute;mothorax spontan&eacute; est une complication rare et grave de la neurofibromatose, il est probablement du &agrave; l'atteinte vasculaire de cette maladie.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohamed Said Belhamidi, Salah Eddine Hammi, Mohamed Bouzroud, Mustapha Benmoussa, Abdelmounaim Ait ali, Ahmed Bounaim [Case series] - Place de la spl&eacute;nectomie dans la prise en charge de l’hypertension portale non cirrhotique: &agrave; propos de 3 cas - 27 September 2017. <b>L’hypertension portale non cirrhotique est une affection d&eacute;crite pour la premi&egrave;re fois par Guido BANTI en 1898 comme une affection associant une hypertension portale avec spl&eacute;nom&eacute;galie et an&eacute;mie sur foie sain. Le diagnostic repose sur l’&eacute;chographie abdominale, la spl&eacute;noportographie et la biopsie h&eacute;patique. Le but de notre travail est d’&eacute;valuer la place de la spl&eacute;nectomie dans l’hypertension portale non cirrhotique &agrave; travers une &eacute;tude r&eacute;trospective portant sur 3 malades dont 2 femmes et un homme pris en charge dans notre formation entre Janvier 2010 et Septembre 2016. Le diagnostic de l’hypertension portale idiopathique a &eacute;t&eacute; bas&eacute; sur les crit&egrave;res suivants: une hypertension portale, la pr&eacute;sence des varices œsophagiennes avec une spl&eacute;nom&eacute;galie, l’absence de cirrhose ou d’autres affections h&eacute;patiques responsables de l’hypertension portale. La spl&eacute;nectomie a &eacute;t&eacute; r&eacute;alis&eacute;e chez les 3 malades. L’&eacute;volution apr&egrave;s la spl&eacute;nectomie &eacute;tait marqu&eacute;e par la normalisation des signes cliniques, radiologiques et biologiques de cette affection, avec absence de r&eacute;cidive des varices œsophagiennes. La spl&eacute;nectomie associ&eacute;e &agrave; la ligature des varices œsophagiennes pourraient &ecirc;tre suffisantes pour traiter ce syndrome et surtout ses cons&eacute;quences sans avoir recours &agrave; une d&eacute;rivation spl&eacute;no-r&eacute;nale.</b><br/> text/html 2017-11-25T09:37:31+01:00 Abdeslam Hiddou, Yassine Zemmrani, Yassine Ahroui, Nabila Soraa [Case report] - Bact&eacute;ri&eacute;mie &agrave; Kingella denitrificans chez un enfant suivi pour un syndrome d’insuffisance m&eacute;dullaire - 27 September 2017. <b>Kingelladenitrificans est un micro-organisme faisant partie de la flore oropharangienne non pathog&egrave;ne. Ce germe est r&eacute;cemment reconnu responsable d'infections invasives opportunistes qui surviennent essentiellement sur des terrains d'immunod&eacute;pression. Ainsi, Il nous a paru int&eacute;ressant de rapporter un cas de bact&eacute;ri&eacute;mie due &agrave; Kingelladenitrificans, bacilles gram n&eacute;gatif de culture difficile encore exceptionnellement d&eacute;crit dans la litt&eacute;rature chez un enfant &acirc;g&eacute; de 3 ans et 7 mois suivi depuis l'&acirc;ge de un an pour un syndrome d'insuffisance m&eacute;dullaire avec pancytop&eacute;nie dont l'origine est rest&eacute;e ind&eacute;termin&eacute;e. Les cliniciens et les microbiologistes doivent penser davantage &agrave; ce germe surtout sur un terrain d&eacute;bilit&eacute;. L'utilisation des flacons d'h&eacute;moculture contribue d'une fa&ccedil;on significative &agrave; la d&eacute;tection de ce germe.</b><br/> text/html 2017-11-25T09:37:31+01:00 Dieudonn&eacute; Tshikwej Ngwej, Olivier Mukuku, Fran&ccedil;oise Kaj Malonga, Oscar Numbi Luboya, Jean-Baptiste Sakatolo Kakoma, Stanis Okitotsho Wembonyama [Research] - S&eacute;ropr&eacute;valence et facteurs associ&eacute;s &agrave; l’acceptation du Conseil et D&eacute;pistage Volontaire du VIH chez l’enfant &agrave; Lubumbashi, R&eacute;publique D&eacute;mocratique du Congo - 27 September 2017. <b>INTRODUCTION: Malgr&eacute; le d&eacute;pistage du VIH propos&eacute; lors de la naissance ou au cours des consultations pr&eacute;scolaires, la proportion des enfants qui croissent ou d&eacute;c&egrave;dent sous statut s&eacute;rologique au VIH inconnu est importante en R&eacute;publique D&eacute;mocratique du Congo (RDC). L’objectif de cette &eacute;tude &eacute;tait de d&eacute;terminer la s&eacute;ropr&eacute;valence au cours d’un d&eacute;pistage volontaire et d’identifier les facteurs associ&eacute;s &agrave; l’acceptation du conseil et d&eacute;pistage du VIH (CDV) en dehors de la maladie ou de toute exposition au VIH dans une population p&eacute;diatrique &agrave; Lubumbashi, RDC. METHODES: il s’agissait d’une &eacute;tude prospective transversale &agrave; vis&eacute;e analytique men&eacute;e du 1er ao&ucirc;t 2006 au 31 septembre 2007. Elle avait &eacute;t&eacute; r&eacute;alis&eacute;e dans 4 centres communautaires de CDV r&eacute;partis dans 4 zones de sant&eacute; de la ville de Lubumbashi en RDC (Lubumbashi, Ruashi, Kampemba et de Kenya). L’&eacute;tude avait consist&eacute; &agrave; faire le d&eacute;pistage volontaire du VIH chez les enfants de moins de 15 ans. Les caract&eacute;ristiques sociod&eacute;mographiques et les param&egrave;tres relatifs au conseil et d&eacute;pistage volontaire ont &eacute;t&eacute; &eacute;tudi&eacute;s. Les analyses statistiques descriptives usuelles et une r&eacute;gression logistique ont &eacute;t&eacute; r&eacute;alis&eacute;es. RESULTATS: sur 463 enfants d&eacute;pist&eacute;s du VIH, 41 (8,9%; IC 95%: 6,5%-11,9%) ont &eacute;t&eacute; test&eacute;s positifs. L’acceptation du conseil et d&eacute;pistage volontaire du VIH en dehors de la maladie ou de l’exposition au VIH &eacute;tait significativement plus &eacute;lev&eacute;e lorsque l’enfant &eacute;tait &acirc;g&eacute; de plus de 2 ans (Odds ratio ajust&eacute; (ORa) = 3,6 [IC 95%: 1,1-12,2]), lorsque le statut s&eacute;rologique du VIH des parents &eacute;tait n&eacute;gatif ou inconnu (ORa = 27,4 [IC 95%: 9,4-80,0]), lorsque l’un ou l’autre ou les deux parents biologiques &eacute;taient en vie (ORa = 24,9 [IC 95%: 2,4-250,8]) et lorsque la connaissance du lieu de d&eacute;pistage &eacute;tait fait par des moyens autres que le professionnel de sant&eacute; (ORa = 2,9 [IC 95%: 1,0-7,9]). CONCLUSION: notre &eacute;tude montre une forte pr&eacute;valence du VIH chez les enfants justifiant la n&eacute;cessit&eacute; de r&eacute;aliser le CDV qui est significativement accept&eacute; par leurs parents et tuteurs dans la ville de Lubumbashi.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hichem Cheikhrouhou, Amine Kharrat, Rahma Derbel, Yesmine Ellouze, Karim Jmal, Hela Ben Jmaa, Mohamed Ali Elkamel, Imed Frikha, Abdelhamid Karoui [Research] - L’effet de l’extubation precoce apres chirurgie cardiaque pour la rehabilitation post op&eacute;ratoire - 27 September 2017. <b>INTRODUCTION: La réhabilitation post opératoire en chirurgie cardiaque est basée sur une prise en charge médico-chirurgicale visant à diminuer la durée de séjour hospitalier et les coûts de soins de cette chirurgie à haut risque. L’extubation trachéale précoce, définie par une extubation avant la sixième heure, constitue la pierre angulaire du Fast-tracking. L’objectif de notre étude est d’évaluer dans notre institution la pratique du fast-track et notamment de l’extubation trachéale précoce en chirurgie cardiaque adulte programmée. METHODES: nous avons conduit une étude descriptive incluant tous les patients âgés de plus 18 ans opérés consécutivement d’une chirurgie cardiaque programmée et qui ont été pris en charge en post-opératoire dans l’unité de réanimation post-opératoire du Service de chirurgie thoracique et cardiovasculaire du CHU HABIB BOURGUIBA de SFAX. Les critères d’inclusion des malades: âgés de 18 ans et plus, opérés d’une chirurgie cardiaque programmée, dont la prise en charge post-opératoire s’est faite dans l’unité de réanimation post-opératoire du service de chirurgie cardio-vasculaire et thoracique. Notre protocole d’anesthésie a été standardisé pour tous les patients: Propofol, Rémifentanil, Cisatracrium. Nous avons noté le délai d’extubation en post opératoire et les facteurs qui allongent ce délai d’extubation.</b><br/> text/html 2017-11-25T09:37:31+01:00 Houcine Maghrebi, Rami Rhaeim, Anis Haddad, Amin Makni, Jouini Mohamed, Kacem Montasser, Ben Safta Zoubeir [Case series] - Pancr&eacute;atite aigu&euml; m&eacute;dicamenteuse: &agrave; propos de 10 cas - 27 September 2017. <b>La pancr&eacute;atite aigu&euml; m&eacute;dicamenteuse repr&eacute;sente environ 2% des pancr&eacute;atites aigu&euml;s. Son incidence est actuellement en augmentation avec plus de 260 m&eacute;dicaments incrimin&eacute;s. Cependant, cette pathologie reste encore peu rapport&eacute;e dans la litt&eacute;rature, car se pose le probl&egrave;me de l'imputabilit&eacute;. Nous rapportons notre exp&eacute;rience &agrave; travers une s&eacute;rie de 10 patients collig&eacute;s sur une p&eacute;riode de 7 ans. La pr&eacute;sentation clinique de la PA &eacute;tait souvent non univoque. Le score de Ranson variait de 0 &agrave; 5. Nous avons recens&eacute; 5 cas de pancr&eacute;atites œd&eacute;mateuses et 5 cas de pancr&eacute;atites n&eacute;crotico-h&eacute;morragiques. Ces pancr&eacute;atites &eacute;taient souvent r&eacute;solutives et sans r&eacute;cidive apr&egrave;s arr&ecirc;t d&eacute;finitif du m&eacute;dicament incrimin&eacute;.</b><br/> text/html 2017-11-25T09:37:31+01:00 Yaw Ampem Amoako, Dennis Odai Laryea, George Bedu-Addo, Bernard Cudjoe Nkum, Jacob Plange-Rhule [Research] - Left ventricular hypertrophy among chronic kidney disease patients in Ghana - 27 September 2017. <b>INTRODUCTION: The presence of left ventricular hypertrophy (LVH) in patients with Chronic Kidney Disease (CKD) is associated with worsening cardiovascular outcomes. There is a dearth of data on LVH in Ghanaian CKD patients. METHODS: this was a cross sectional study carried out at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. A questionnaire was used to obtain information on clinical features of CKD. The MDRD-4 equation was used to calculate eGFR. Information on the prevalence and factors associated with electrocardiographic left ventricular hypertrophy were obtained during the initial assessment. RESULTS: this was a cross sectional study carried out at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. A questionnaire was used to obtain information on clinical features of CKD. The MDRD-4 equation was used to calculate eGFR. Information on the prevalence and factors associated with electrocardiographic left ventricular hypertrophy were obtained during the initial assessment. CONCLUSION: LVH is common in our cohort. High pulse pressure, high DBP, increased BMI and male gender are significant associated factors. Adequate treatment of high blood pressure as well as early detection of LVH and interventions aimed at prevention and/or regression of LVH are to be encouraged.</b><br/> text/html 2017-11-25T09:37:31+01:00 Haithem Zaafouri, Skander Mrad, Nizar Khedhiri, Dhafer Haddad, Ahmed Bouhafa, Anis Ben Maamer [Research] - Chol&eacute;cystectomie laparoscopique ambulatoire: premi&egrave;re exp&eacute;rience en Tunisie - 27 September 2017. <b>INTRODUCTION: La chol&eacute;cystectomie laparoscopique est le gold standard de la prise en charge des calculs v&eacute;siculaires symptomatiques. Il existe une importante controverse quant au fait de savoir si elle devrait &ecirc;tre pratiqu&eacute;e en chirurgie ambulatoire ou dans le cadre d'une chirurgie avec hospitalisation d'une nuit pour ce qui concerne la s&eacute;curit&eacute; des patients. Le but du travail est d’&eacute;valuer l'impact de la chol&eacute;cystectomie laparoscopique en chirurgie ambulatoire versus en chirurgie avec hospitalisation d'une nuit sur les crit&egrave;res de jugement ax&eacute;s sur le patient, tels que la mortalit&eacute;, les graves &eacute;v&eacute;nements ind&eacute;sirables et la qualit&eacute; de vie. METHODES: il s’agit d’une &eacute;tude transversale descriptive r&eacute;alis&eacute;e au sein du service de chirurgie g&eacute;n&eacute;rale de l’h&ocirc;pital Habib Thameur, sur la p&eacute;riode allant de Mai 2009 &agrave; F&eacute;vrier 2010. Cette &eacute;tude porte sur 67 malades porteurs d’une lithiase v&eacute;siculaire symptomatique ayant eu une chol&eacute;cystectomie laparoscopique en ambulatoire (CLA). &Eacute;taient exclus de l’&eacute;tude: les malades ASA III et IV, les diab&eacute;tiques sous sulfamides ou sous insuline, les grands ob&egrave;ses, les malades de plus de 65 ans et moins de 18 ans, ceux avec un ant&eacute;c&eacute;dent de chirurgie abdominale majeure, les malades suspects d’une lithiase de la voie biliaire principale, d’une chol&eacute;cystite aigu&euml; ou d’une pancr&eacute;atite. Pour &ecirc;tre trait&eacute; par CLA, le malade devait r&eacute;sider &agrave; moins de 50 km de l’h&ocirc;pital, et avoir la possibilit&eacute; d’une pr&eacute;sence adulte &agrave; ses c&ocirc;t&eacute;s. RESULTATS: dix-sept patients &eacute;taient inclus puis exclus de notre &eacute;tude devant la d&eacute;couverte per op&eacute;ratoire de signes de chol&eacute;cystite aigue ou devant des difficult&eacute;s de dissection amenant le chirurgien &agrave; mettre un drain de Redon en sous h&eacute;patique en fin d’intervention. Finalement, 50 patients ont &eacute;t&eacute; retenus: 7 hommes et 43 femmes d’&acirc;ge moyen de 48 ans. L’intervention se d&eacute;roulait selon les modalit&eacute;s habituelles. A la sortie de la salle de r&eacute;veil, le patient &eacute;tait dirig&eacute; en secteur ambulatoire o&ugrave; une alimentation liquide &eacute;tait autoris&eacute;e. Le malade &eacute;tait revu avant 19 h et la sortie d&eacute;cid&eacute;e si une analg&eacute;sie orale &eacute;tait possible, si une alimentation liquide &eacute;tait tol&eacute;r&eacute;e, s’il n’existait aucun trouble de la diur&egrave;se, et si le patient acceptait un retour &agrave; domicile avec un traitement antalgique et anti-inflammatoire &agrave; la demande. Trente neuf patients (78%) ont quitt&eacute; l’h&ocirc;pital et 11 ont &eacute;t&eacute; gard&eacute;s. L’&acirc;ge > &agrave; 45 ans, la dur&eacute;e de l’anesth&eacute;sie > &agrave; 70 minutes et la fatigue post op&eacute;ratoire ont &eacute;t&eacute; identifi&eacute; comme facteur de risque de sorties rat&eacute;es. Aucune r&eacute;admission n’a &eacute;t&eacute; observ&eacute;e. Les patients qui ont pu &ecirc;tre mis sortants ont &eacute;t&eacute; satisfaits du protocole de prise en charge avec des r&eacute;ponses majoritairement de type excellent et bon (94%). CONCLUSION: la chirurgie ambulatoire semble tout aussi s&ucirc;re que la chirurgie avec hospitalisation d'une nuit dans la chol&eacute;cystectomie laparoscopique avec un faible taux de complication et de r&eacute;admission chez des malades s&eacute;lectionn&eacute;s, et avec une r&eacute;duction du co&ucirc;t de l’intervention.</b><br/> text/html 2017-11-25T09:37:31+01:00 Roger Munan, Yves Kakudji, Joseph Nsambi, Olivier Mukuku, Amani Maleya, Xavier Kinenkinda, Prosper Kakudji [Research] - Accouchement chez la primipare &agrave; Lubumbashi: pronostic maternel et p&eacute;rinatal - 27 September 2017. <b>INTRODUCTION: La parturition des primipares est associ&eacute;e &agrave; de nombreuses complications et par cons&eacute;quent, elles sont consid&eacute;r&eacute;es comme &eacute;tant &agrave; haut risque en raison des pr&eacute;occupations maternelles et fœtales. La pr&eacute;sente &eacute;tude s’est fix&eacute; comme objectifs de d&eacute;terminer la fr&eacute;quence d’accouchement chez les primipares dans notre milieu, d’identifier les facteurs associ&eacute;s &agrave; l’accouchement par c&eacute;sarienne et d’&eacute;valuer la morbi-mortalit&eacute; maternelle et p&eacute;rinatale lors de l’accouchement chez la primipare dans la ville de Lubumbashi. METHODES: c’&eacute;tait une &eacute;tude transversale analytique des accouch&eacute;es d’une grossesse monofœtale de D&eacute;cembre 2013 &agrave; Mai 2014 dans 10 maternit&eacute;s de r&eacute;f&eacute;rence &agrave; Lubumbashi. Les accouch&eacute;es primipares ont &eacute;t&eacute; compar&eacute;es aux multipares. Les param&egrave;tres sociod&eacute;mographiques maternels, la morbi-mortalit&eacute; maternelle et p&eacute;rinatale ont &eacute;t&eacute; analys&eacute;es. L’odds ratio et son intervalle de confiance ont &eacute;t&eacute; calcul&eacute;s. Le seuil de signification a &eacute;t&eacute; fix&eacute; &agrave; une valeur de p < 0,05. RESULTATS: la fr&eacute;quence de la primiparit&eacute; &eacute;tait de 19,9%. Comparativement aux multipares, les accouch&eacute;es primipares &eacute;taient significativement adolescentes (OR = 11,27 (7,98-15,91)), &eacute;l&egrave;ves/&eacute;tudiantes (OR=5,61 (3,33-9,45)) et vivaient seules (OR = 7,62 (4,36-13,30)). Les facteurs de risque associ&eacute;s &agrave; l’accouchement par c&eacute;sarienne chez les primipares &eacute;taient l’&eacute;vacuation obst&eacute;tricale (OR=9,69 (4,75-19,74)), le manque de suivi de consultations pr&eacute;natales (OR=2,57 (1,32-5,01)), la taille &#8804; 150 cm (OR = 2,42 (1,04-5,65)), la hauteur ut&eacute;rine > 34 cm (OR=2,33 (1,32-4,10)) et la mal pr&eacute;sentation fœtale (OR=6,37 (2,92-13,87)). S’agissant du pronostic maternel, nous avons observ&eacute; que la pression art&eacute;rielle &eacute;lev&eacute;e (OR=1,91 (1,32-2,74)), la mal pr&eacute;sentation fœtale (OR=1,95 (1,16-3,17)), le recours &agrave; l’utilisation d’ocytociques (OR=2,03 (1,64-2,52)), la c&eacute;sarienne (OR=2,04 (1,47-2,83)), l’&eacute;pisiotomie (OR=11,89 (8,61-16,43)) et l’&eacute;clampsie (OR = 4,21 (1,55-11,44)), &eacute;taient significativement associ&eacute;es &agrave; la primiparit&eacute;. Les taux de score d’Apgar d&eacute;prim&eacute; &agrave; la fin de la 5<sup>&egrave;me</sup>minute (OR=1,55 (1,03-2,32)) et de d&eacute;c&egrave;s en p&eacute;riode n&eacute;onatale pr&eacute;coce (OR=1,80 (1,08-2,98)) &eacute;taient significativement plus &eacute;lev&eacute;s chez les primipares que chez les multipares. CONCLUSION: cette &eacute;tude montre que l’accouchement de la primipare reste un probl&egrave;me &agrave; Lubumbashi. D’o&ugrave; l’am&eacute;lioration de la sante du couple m&egrave;re-enfant lors de l’accouchement chez la primipare passe par l’&eacute;laboration des protocoles de prise en charge des accouchements ad&eacute;quats.</b><br/> text/html 2017-11-25T09:37:31+01:00 Nomena Finiavana Rasaholiarison, Rahamefy Odilon Randrianasolo, Lala Andriamasinavalona Rajaonarison, Jenny Larissa Rakotomanana, Julien Razafimahefa, Alain Djacoba Tehindrazanarivelo [Research] - Fr&eacute;quence et caract&eacute;ristiques des AVC impliquant les art&egrave;res perforantes dans le Service de Neurologie de l’Hopital Bafelatanana, Antananarivo - 26 September 2017. <b>INTRODUCTION: Les accidents vasculaires c&eacute;r&eacute;braux des art&egrave;res perforantes sont surtout des art&eacute;riolopathies. Ils &eacute;voluent vers la d&eacute;mence et la r&eacute;currence. Pour mieux pr&eacute;venir ces complications notre &eacute;tude avait pour but d'&eacute;valuer la fr&eacute;quence et les caract&eacute;ristiques de ces AVC. METHODES: c'est une &eacute;tude descriptive r&eacute;trospective du 01 Mars au 25 Septembre 2015 au service de Neurologie CHU-JRB. Ont &eacute;t&eacute; inclus les patients pr&eacute;sentant un d&eacute;ficit neurologique brutal et un scanner c&eacute;r&eacute;bral avec atteinte du territoire profonde. Les caract&eacute;ristiques des AVC des art&egrave;res perforantes ont &eacute;t&eacute; recueillies. Les donn&eacute;es &eacute;taient trait&eacute;es par le logiciel SPSS 20. RESULTATS: quatre-vingt-trois (48,25%) patients avaient des AVC des art&egrave;res perforantes sur 172 AVC. Pour les AVC des art&egrave;res perforantes la population &eacute;tait jeune avec 65,06% moins de 65 ans et &agrave; pr&eacute;dominance masculine avec 61,44%. Les formes h&eacute;morragiques &eacute;taient &agrave; 67,46%. Trente et un patients (37,34%) ont connu des r&eacute;currences et parmi eux presque le quart avait 2 r&eacute;currences avec 38,70% en moins de un an. Tous les patients avec r&eacute;currence avaient un trouble dysex&eacute;cutif (p < 0,0001) et une mauvaise observance th&eacute;rapeutique d'antihypertenseur. La mortalit&eacute; n'&eacute;tait qu'&agrave; 6,02% pour ces types d'AVC pendant l'hospitalisation. CONCLUSION: un suivi sp&eacute;cifique en neurologie est n&eacute;cessaire d&egrave;s le premier accident vasculaire c&eacute;r&eacute;bral d'art&egrave;re perforante pour d&eacute;pister un d&eacute;but de d&eacute;mence et pr&eacute;venir les r&eacute;currences.</b><br/> text/html 2017-11-25T09:37:31+01:00 Asnake Simieneh, Mengistu Hailemariam, Anteneh Amsalu [Research] - HIV screening among TB patients and level of antiretroviral therapy and co-trimoxazole preventive therapy for TB/HIV patients in Hawassa University Referral Hospital: a five year retrospective study - 26 September 2017. <b>INTRODUCTION: Initiation of antiretroviral therapy (ART) and co-trimoxazole preventive therapy (CPT) is recommended for tuberculosis (TB)/human immunodeficiency virus (HIV) co-infected patients to prevent opportunistic infection. The aim of this study was to assess the prevalence of HIV among TB patients and initiation of ART and provision of CPT for TB/HIV co-infected patients in Hawassa university referral hospital.</b><br/> text/html 2017-11-25T09:37:31+01:00 Nidain Maneh, Dani&egrave;le Christelle Tchapbou Moyou, Kassoula Batomaguela Nonon Saa, Messan Kokou Amedome, Kossi Dzidzinyo, B&eacute;n&eacute;dicte Mar&egrave;be Diatewa, Koffi Didier Ayena, M&egrave;ba Banla, Komi Patrice Balo [Research] - Facteurs de risque du d&eacute;collement de r&eacute;tine au Togo - 26 September 2017. <b>INTRODUCTION: Le décollement de rétine pose un problème de prise en charge dans les pays en développement par manque de plateau technique. Sa prévention passe par la connaissance et l’éviction de ses facteurs de risque. Le but de l’étude était d’identifier les facteurs de risque du décollement de rétine chez le Togolais. METHODES: il s’est agi d’une étude rétrospective et descriptive, réalisée dans le service d’ophtalmologie du Chu-Campus et dans un cabinet privé d’ophtalmologie de Lomé du 2 Janvier 2011 à 31 Décembre 2015. Ont été inclus dans l’étude les dossiers des patients portant le diagnostic de décollement de rétine. Le diagnostic de décollement de rétine avait été retenu devant: la présence d’un décollement de rétine à l’examen du fond d’œil ou à l’échographie oculaire. RESULTATS: au total, 116 yeux de 100 patients avaient un décollement de rétine dont 40 à l’OD, 44 à l’OG et 16 bilatéraux (32yeux). L’âge moyen des patients était de 46,65 ± 16,46 ans [07 ans ; 87 ans], une prédominance masculine et avec un sex-ratio = 0,32 (F/H). Les diabétiques représentaient 17% et les patients drépanocytaires 16%. Les patients myopes représentaient 5%, les yeux pseudophaques représentaient 17,2% et les yeux aphaques 3,4%. Quatre déchirures rétiniennes (14,28 % des DR rhegmatogènes) étaient retrouvées dont 2 déchirures en supéro-temporal, une déchirure en inféro-nasal et une déchirure en inféro-temporal. Le décollement était total pour 35 yeux (52,2%) et partiel pour 24 yeux (35,8%). Vingt yeux présentaient des proliférations vitréo-rétiniennes, 5 yeux avaient un vitré hémorragique et 6 yeux une hyalite. Le diabète et la drépanocytose étaient les facteurs de risque du DR tractionnel (p=0,006 et p=0,0003), et la chirurgie de cataracte le facteur de risque du DR rhegmatogène (p=0,0097). CONCLUSION: le diabète, la drépanocytose et la chirurgie oculaire étaient les facteurs de risque les plus importants du DR. Une meilleure prise en charge de ces pathologies et une maîtrise de la chirurgie de la cataracte par l’ophtalmologiste préviendraient le décollement de rétine.</b><br/> text/html 2017-11-25T09:37:31+01:00 Omar Margad, Nabile Bousselmame [Case report] - Tumeur glomique de la cuisse: nouveau cas et revue de la litt&eacute;rature - 26 September 2017. <b>Les tumeurs glomiques sont rares et b&eacute;nignes qui se d&eacute;veloppent au-d&eacute;pends du corps glomique neuromyoart&eacute;riel. Si la localisation digitale est bien connue en chirurgie de la main, les localisations exradigitales souffrent d'une m&eacute;connaissance aboutissant &agrave; des erreurs diagnostiques et th&eacute;rapeutiques. Nous rapportons un nouveau cas de tumeur glomique de la cuisse, et &agrave; travers une revue de la litt&eacute;rature, nous essayerons d'attirer l'attention vers ces localisations atypiques.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ilhame Naciri, Nadia Ismaili [Images in medicine] - K&eacute;ratoses s&eacute;borrh&eacute;iques g&eacute;antes de si&egrave;ge inhabituel - 25 September 2017. <b>Les k&eacute;ratoses s&eacute;borrh&eacute;iques (KS) sont des tumeurs b&eacute;nignes qui si&egrave;gent &eacute;lectivement au niveau de la t&ecirc;te et du tronc. Leur taille varie g&eacute;n&eacute;ralement de quelques millim&egrave;tres &agrave; quelques centim&egrave;tres. Les l&eacute;sions g&eacute;antes sont tr&egrave;s rares, posant un probl&egrave;me de prise en charge et de transformation, et leur emplacement sur la zone g&eacute;nitale est encore plus rare, posant un probl&egrave;me de diagnostic diff&eacute;rentiel avec les condylomes et dont la diff&eacute;renciation est faite uniquement sur l'histopathologie. Nous rapportons le cas d’un homme de 80 ans, sans ant&eacute;c&eacute;dents pathologiques particuliers, qui consultait pour des l&eacute;sions abdominales et g&eacute;nitales asymptomatiques &eacute;voluant depuis vingt ans. L’examen clinique trouvait quatre tumeurs hyperpigment&eacute;es en relief, bien limit&eacute;es, &agrave; surface verruqueuse mesurant entre 2 et 10 cm de grand axe (A). L’examen dermoscopique objectivait un aspect de circonvolutions c&eacute;r&eacute;briformes, &eacute;voquant des k&eacute;ratoses s&eacute;borrh&eacute;iques (B). L’histologie avait confirm&eacute; le diagnostic sans objectiver de signes d’infection virale ni de transformation maligne. Un traitement par ex&eacute;r&egrave;se chirurgicale &eacute;tait entrepris au prix d’une cicatrice ind&eacute;l&eacute;bile.</b><br/> text/html 2017-11-25T09:37:31+01:00 Said Anajar, Mohammed Tatari, Adil Lakhbal, Reda Abada, Sami Rouadi, Mohammed Roubal, Mohammed Mahtar [Case series] - Le cancer diff&eacute;renci&eacute; de la thyro&iuml;de chez l’enfant et l’adolescent: &agrave; propos de 22 cas - 25 September 2017. <b>L’obectif &eacute;tait de mettre en relief les particularit&eacute;s du cancer de la thyro&iuml;de chez l’enfant et l’adolescent, et d’&eacute;valuer nos r&eacute;sultats par rapport &agrave; la litt&eacute;rature internationale a travers une s&eacute;rie de cas la plus repr&eacute;sentatif au Maroc: 22 cas. C'est une &eacute;tude r&eacute;trospective descriptive des patients atteints de cancer diff&eacute;renci&eacute; de la thyro&iuml;de, hospitalis&eacute;s au service d’ORL et de Chirurgie Cervico-faciale de L’hopital 20 Ao&ucirc;t de Casablanca-Maroc, sur la p&eacute;riode qui s’&eacute;tend de Janvier 1995 &agrave; Mars 2015. Nous avons recueilli les donn&eacute;es relatives &agrave; 22 cas, qui r&eacute;pondaient &agrave; nos crit&egrave;res d’inclusion. L’&acirc;ge moyen de nos patients &eacute;tait de 14 ans, avec une sex-ratio 3,4, la plupart de nos patients ont consult&eacute; pour un nodule thyro&iuml;dien, associ&eacute; dans 22,7% des cas &agrave; une ad&eacute;nopathie cervicale, et dans 9,1% &agrave; des signes de compression. L’ensemble des patients ont b&eacute;n&eacute;fici&eacute; d’une thyro&iuml;dectomie totale, suivie d’un curage ganglionnaire dans 31,82%. Le diagnostic de cancer thyro&iuml;dien a repos&eacute; sur l’examen anatomopathologique de la pi&egrave;ce op&eacute;ratoire, qui a objectiv&eacute; un carcinome papillaire dans 95,4% des cas, et un carcinome v&eacute;siculaire dans 4,5%. Le traitement par l’iode radioactif 131 a &eacute;t&eacute; r&eacute;alis&eacute; dans 100% des cas. Par la suite tous nos patients ont &eacute;t&eacute; mis sous hormonoth&eacute;rapie thyro&iuml;dienne. Une surveillance &eacute;troite et r&eacute;guli&egrave;re a permis de d&eacute;tecter des m&eacute;tastases ganglionnaires chez 3 patients, et les m&eacute;tastases &agrave; distance chez 4 patients. Le cancer diff&eacute;renci&eacute; de la thyro&iuml;de de l’enfant et l’adolescent est une entit&eacute; rare mais agressive, son traitement se base sur la chirurgie, associ&eacute;e &agrave; l’irath&eacute;rapie donnant un pronostic excellent.</b><br/> text/html 2017-11-25T09:37:31+01:00 Gezahen Negusse Ayane, Mikel Walsh, Jemal Shifa, Kadimo Khutsafalo [Case report] - Right congenital diaphragmatic hernia associated with abnormality of the liver in adult - 22 September 2017. <b>A Bochdalek hernia (BH) occurs when abdominal contents herniate through the postero-lateral segment of the diaphragm. The right side is affected considerably less commonly than the left. Most BHs present are diagnosed early in life, with some element of cardio-respiratory distress. Rarely, hernias that remain clinically silent until adulthood when they present as life-threatening surgical emergencies. We report a case 35 year old female who emergency exploratory laparotomy for a complete mechanical bowel obstruction. At surgery the redundant transverse colon was twisted and incarcerated within the right hemithorax, creating a closed loop obstruction. The right colon, appendix, terminal ilium, and three accessories right liver lobes were also dragged into the right thoracic cavity. After reducing the hernia, the diaphragmatic defect was primarily repaired with non-absorbable suture. The redundant transvers colon which had been compromised was resected and primary end-to- end anastomosis was carried out. Incidental appendectomy was done. The patient was sent into ICU for post-operative monitoring. She made an uneventful recovery and remains asymptomatic at nine month follow-up. I discuss what i believe to be the first case report of complicated right diaphragmatic hernia in Botswana, associated with another congenital mal-formation (accessories hepatic lobes, partial mal-rotation, and redundant transvers colon) in adult.</b><br/> text/html 2017-11-25T09:37:31+01:00 Lamia Kabbage, Meryem El kouhen, Ahmed Taghy, Kaoutar Znati, Nawal Kabbaj [Case report] - A rare presentation of hepatocellular carcinoma in non-cirrhotic liver - 22 September 2017. <b>Hepatocellular carcinoma is the most frequent type of liver malignancy. Most cases of hepatocellular carcinoma are secondary to either viral hepatitis (hepatitis B, C) or alcoholic cirrhosis. Liver cirrhosis due to any other causes is considered as a risk factor for development of hepatocellular carcinoma; however, hepatocellular carcinoma in non cirrhotic livers remains a rare condition. The present case report describes a 59-year-old woman patient admitted to explore right hypochondriac and epigastric pain, with no evidence of pre-existing liver disease and with a good general condition. The computed tomography was very suggestive of a gastro-intestinal stromal tumor. But, at laparotomy, a huge hepatic tumor was discovered. Histopathological study confirmed the presence of primary hepatocellular carcinoma. Hepatocellular carcinoma occurs more frequently on a cirrhotic liver. However, it can occur on a non cirrhotic liver and remains and extremely rare case.</b><br/> text/html 2017-11-25T09:37:31+01:00 Modupe Comfort Ayoola, Victor Oluwatoyin Akinseye, Eniola Cadmus, Emmanuel Awosanya, Olufemi Akinyele Popoola, Oluwaseun Oladapo Akinyemi, Lorraine Perrett, Andrew Taylor, Judy Stack, Ignacio Moriyon, Simeon Idowu Cadmus [Research] - Prevalence of bovine brucellosis in slaughtered cattle and barriers to better protection of abattoir workers in Ibadan, South-Western Nigeria - 22 September 2017. <b>INTRODUCTION: Brucellosis is a neglected zoonosis of public health importance. This study was conducted to determine the prevalence and risk factors of brucellosis among slaughtered cattle as well as challenges to the protection of abattoir workers in Nigeria. METHODS: a slaughterhouse study was conducted in a major abattoir in Ibadan from March to August, 2013. To diagnose brucellosis, serum samples from 1,241 slaughtered cattle were tested using Rose-Bengal test (RBT) and competitive enzyme-linked immunosorbent assay (cELISA); again, 57 milk samples were tested with milk ring test (MRT) and indirect ELISA (iELISA). Furthermore, a survey on the usage of personal protective equipment (PPE) and challenges to its use by abattoir workers was done. Data were analysed using Stata 12. RESULTS: seroprevalence by RBT was 7.8%; 77.3% (75/97) of these were corroborated by cELISA. Prevalence in milk samples by MRT and indirect ELISA were 33.3% and 3.5%, respectively. Sex (OR: 2.5; 95%CI:1.3-4.5) was the factor significantly associated with Brucella seropositivity. None of the abattoir workers used standard protective overalls; while, 99.6% of the meat handlers and 84.1% of the butchers worked barefoot. Most of the workers (75.7%) wore no protective gloves. The respondents agreed that provision of free PPE and sanctions against non-users would encourage its use. CONCLUSION: our findings indicate moderate prevalence (7.8%) of bovine brucellosis with sex of cattle being a risk factor. A notable barrier to better protection of abattoir workers against brucellosis is perceived inconvenience arising from use of gloves. Therefore, preventive and control measures against brucellosis must include education and use of PPE among abattoir workers.</b><br/> text/html 2017-11-25T09:37:31+01:00 Kunche Nyavor, Margaret Kweku, Isaac Agbemafle, Wisdom Takramah, Ishmael Norman, Elvis Tarkang, Fred Binka [Research] - Assessing the ownership, usage and knowledge of Insecticide Treated Nets (ITNs) in Malaria Prevention in the Hohoe Municipality, Ghana - 22 September 2017. <b>INTRODUCTION: Malaria remains one of the top five killer diseases in sub-Saharan Africa (SSA) and its burden is skewed towards pregnant women and children under five. Insecticide Treated Bed-Net (ITN) usage is considered one of the most cost-effective, preventive interventions against malaria. This study sought to assess ownership, usage, effectiveness, knowledge, access and availability of ITNs among mothers with children under five in the Hohoe municipality. METHODS: in August 2010 a cross-sectional survey was carried out in 30 communities, selected using the WHO 30 cluster sampling technique. In the selected communities, mothers/caregivers with children under five years were selected using the snowball method. Data were collected through questionnaires and direct observation of ITN. Descriptive statistics was used to analyse the data collected. RESULTS: a total of 450 mothers/caregivers were interviewed and their mean age was 30 ± 7 years. ITN ownership was 81.3%, and usage was 66.4%. The majority (97.8%) of the mothers/caregivers said ITNs were effective for malaria prevention. Awareness about ITNs was high (98.7%) and the majority (52.9%) had heard about ITNs from Reproductive and Child Health (RCH) Clinic and antenatal care ANC clinic (33.6%). Over 60% of the ITNs were acquired through free distribution at RCH clinics, clinic and home distribution during mass immunization sessions. The majority of the mothers/caregivers (78.6%) knew the signs and symptoms of malaria, what causes malaria (82.2%) and who is most at risk (90%). CONCLUSION: behaviour change communication strategies on ITN use may need to be further targeted to ensure full use of available ITNs.</b><br/> text/html 2017-11-25T09:37:31+01:00 Jemal Zeberga Shifa, Alemayehu Mekonnen Gezmu [Research] - Presenting signs of retinoblastoma at a tertiary level teaching hospital in Ethiopia - 22 September 2017. <b>INTRODUCTION: Retinoblastoma is a primary malignant intraocular neoplasm that arise from immature retinoblasts with in developing retina. The commonest presenting sign in developing country is proptosis which is the late presenting sign. We report presenting signs of retinoblastoma in Ethiopian children seen at a tertiary level teaching hospitals in Ethiopia. METHODS: prospective case series study wasdone on children who presented with retinoblastoma between May 1, 2005 and September 1, 2006. This study was done as part of requirement for partial fulfilment of certificate of speciality study in ophthalmology during the year 2005 to 2006. SPSS 11 statistical package was used to analyse the data. RESULTS: among 41 patients seen during the study period, 24 (58.5%) were males and 17(41%) were females. Unilateral retinoblastoma wasfound in 32 (78%) patients and bilateral cases were found in 9(22%). Mean age of onset for right eye was 27.5 months and left eye 33.7 months.The mean ages of presentation at time of diagnosis for right and left eye were 34.4 and 40.2 months, respectively .In bilateral retinoblastoma mean age of presentation was 33.3 months.The commonest presenting sign was proptosis 22(53.7%) followed by leucocorea nine (22%),ocular inflammation four (9.0 %), strabismus three (7.3%), glaucoma one (2.4%), loss of vision one (2.4%)and hyphemaone (2.4%). CONCLUSION: the commonest presenting signs of retinoblastoma in our set up were Proptosis followed by leucocorea. This is due to late presentation of patient and late referral by medical professionals. Health education to the public and health professionals will help early detection of retinoblastoma.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ilhame Naciri, Baderddine Hassam [Images in medicine] - Une tumeur historique de l’&eacute;paule - 22 September 2017. <b>Le chondrosarcome est une tumeur osseuse maligne d'origine m&eacute;senchymateuse, qui survient habituellement apr&egrave;s l'&acirc;ge de 40 ans, et qui si&egrave;ge pr&eacute;f&eacute;rentiellement au niveau du pelvis et de l'&eacute;paule. Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 65 ans, sans ant&eacute;c&eacute;dents pathologiques notables, hospitalis&eacute;e pour exploration d'une tumeur volumineuse de l'&eacute;paule droite, &eacute;voluant depuis 3 ans, avec notion d'alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral. L'examen clinique retrouvait une tumeur g&eacute;ante en dos de chameau, faisant 44 × 32 cm de grand axe, dure, adh&eacute;rente, avec des signes inflammatoires en regard et des signes de compression vasculo-nerveuse. La mobilit&eacute; de l'&eacute;paule &eacute;tait limit&eacute;e et douloureuse. Le bilan radiologique objectivait un processus tumoral expansif &eacute;piphyso-m&eacute;taphyso-diaphysaire h&eacute;t&eacute;rog&egrave;ne, multilobul&eacute;, mal limit&eacute;, et calcifi&eacute;, avec une destruction compl&egrave;te de l'articulation gl&eacute;no-hum&eacute;rale et un important envahissement des parties molles et extension locor&eacute;gionale. L'examen histologique d'une biopsie profonde &eacute;tait en faveur d'un chondrosarcome peu diff&eacute;renti&eacute;. Le bilan d'extension r&eacute;v&eacute;lait des ad&eacute;nopathies axillaire bilat&eacute;rales et de multiples nodules sous pleuraux et h&eacute;patique d'allure m&eacute;tastatiques. L'&eacute;volution &eacute;tait fatale au bout de 2 mois. Notre observation souligne l'importance de la sensibilisation de la population pour un diagnostic et une prise en charge pr&eacute;coce.</b><br/> text/html 2017-11-25T09:37:31+01:00 Olufemi Gbenga Omitola, Olujide Oladele Soyele, Opeyemi Sigbeku, Dickson Okoh, Abdulwarith Olaitan Akinshipo, Azeez Butali, Henry Ademola Adeola [Research] - A multi-centre evaluation of oral cancer in Southern and Western Nigeria: an African Oral Pathology Research Consortium initiative - 22 September 2017. <b>INTRODUCTION: Oral cancer is a leading cause of cancer deaths among African populations. Lack of standard cancer registries and under-reporting has inaccurately depicted its magnitude in Nigeria. Development of multi-centre collaborative oral pathology networks such as the African Oral Pathology Research Consortium (AOPRC) facilitates skill and expertise exchange and fosters a robust and systematic investigation of oral diseases across Africa. METHODS: in this descriptive cross-sectional study, we have leveraged the auspices of the AOPRC to examine the burden of oral cancer in Nigeria, using a multi-centre approach. Data from 4 major tertiary health institutions in Western and Southern Nigeria was generated using a standardized data extraction format and analysed using the SPSS data analysis software (version 20.0; SPSS Inc. Chicago, IL). RESULTS: of the 162 cases examined across the 4 centres, we observed that oral squamous cell carcinomas (OSCC) occurred mostly in the 6th and 7th decades of life and maxillary were more frequent than mandibular OSCC lesions. Regional variations were observed both for location, age group and gender distribution. Significant regional differences was found between poorly, moderately and well differentiated OSCC (p value = 0.0071). CONCLUSION: a multi-centre collaborative oral pathology research approach is an effective way to achieve better insight into the patterns and distribution of various oral diseases in men of African descent. The wider outlook for AOPRC is to employ similar approaches to drive intensive oral pathology research targeted at addressing the current morbidity and mortality of various oral diseases across Africa.</b><br/> text/html 2017-11-25T09:37:31+01:00 Nidain Maneh, Kossivi Apetse, B&eacute;n&eacute;dicte Mar&egrave;be Diatewa, Sidik Abdou-Bakr Domingo, Aid&eacute; Isabelle Agba, Koffi Didier Ayena, Koffi Agnon Balogou, Komi Patrice Balo [Case report] - Myasth&eacute;nie juv&eacute;nile oculaire en Afrique Subsaharienne: cas de deux sœurs germaines issues d’un mariage consanguin au Togo - 21 September 2017. <b>La myasth&eacute;nie est une pathologie auto-immune acquise rare &agrave; l'origine de la d&eacute;ficience de la transmission neuro-musculaire dont la forme juv&eacute;nile se manifeste souvent par une atteinte oculaire exclusive. Nous rapportons deux cas de myasth&eacute;nie juv&eacute;nile oculaire (MJO) au sein d'une m&ecirc;me fratrie. il s'agit de deux fillettes XA et XB respectivement &acirc;g&eacute;es de 11 et 9 ans d'origine malienne r&eacute;sidant au Togo, issues d'un mariage consanguin de 1er degr&eacute;, amen&eacute;es en consultation d'ophtalmologie, pour une baisse progressive de l'acuit&eacute; visuelle (AV). XA avait aux deux yeux, une AV &agrave; 8/10 et XB, une AV de 3/10 am&eacute;lior&eacute;e au trou st&eacute;nop&eacute;&iuml;que &agrave; 7/10 en faveur d'une am&eacute;tropie. XA pr&eacute;sentait un ptosis bilat&eacute;ral qui remontait &agrave; l'&acirc;ge de 2 ans avec une action du releveur de la paupi&egrave;re sup&eacute;rieure (RPS) &agrave; 7 mm et XB, un ptosis bilat&eacute;ral remontant &agrave; l'&acirc;ge de 3 ans avec une action du RPS nulle. Pour les deux, le test au gla&ccedil;on &eacute;tait franchement positif, le signe de Cogan pr&eacute;sent avec une par&eacute;sie oculo motrice sans diplopie. Le dosage des auto- anticorps anti r&eacute;cepteurs de l'ac&eacute;thylcholine &eacute;tait normal. Le diagnostic de MJO associ&eacute;e &agrave; une am&eacute;tropie a &eacute;t&eacute; &eacute;voqu&eacute;. Une correction optique de l'am&eacute;tropie par des lunettes et un traitement sp&eacute;cifique par la pyridostigmine avait &eacute;t&eacute; instaur&eacute;e mais les patientes ont &eacute;t&eacute; perdues de vue. la myasth&eacute;nie auto-immune avec des manifestations ophtalmologiques inaugurales est rare mais possible chez l'enfant en Afrique subsaharienne o&ugrave; des &eacute;tudes sont n&eacute;cessaires pour y d&eacute;terminer les &eacute;ventuelles particularit&eacute;s de la maladie.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ogochukwu Chinedum Okoye, Henry Enyinmisan Slater, Nilum Rajora [Research] - Prevalence and risk factors of intra-dialytic hypotension: a 5 year retrospective report from a single Nigerian Centre - 21 September 2017. <b>INTRODUCTION: Intra-dialytic hypotension (IDH) is a common complication of haemodialysis that impacts negatively on the patient's quality of life and can induce serious cardiovascular events. METHODS: ecords of all adults who had haemodialysis treatments from Jan 2012-Jan 2016 were reviewed. Socio-demographic data, health status of patient, aetiology of renal disease, clinical and biochemical parameters such as systolic and diastolic blood pressures (SBP and DBP), packed cell volume, were collated using Microsoft Excel. RESULTS: the overall prevalence of intra-dialytic hypotension was 8.6%. Of all haemodialysis patients, 45.7% experienced a drop in SBP > 20mmHg, 28.5% required nurses' intervention and 8.6% had symptoms. Diagnosis of obstructive nephropathy (OR: 3.1, CI:1.43-6.60, p = < 0.004) and sepsis (OR: 3.57, CI: 1.31- 9.75, P = 0.013) increased the odds of experiencing IDH. Only 5% of patients with predialysis SBP < 100mmHg developed IDH (OR: 0.12, CI: 0.02-0.93, P = 0.04).</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohammed Alae Touzani, Othmane Yddoussalah [Images in medicine] - Sarcome de kaposi penien chez un patient seronegatif - 21 September 2017. <b>Les sarcomes p&eacute;niens repr&eacute;sentent moins de 5% des tumeurs p&eacute;niennes. Elles sont domin&eacute;es par le sarcome de Kaposi que l'on retrouve le plus souvent chez les sujets HIV positifs. Cependant, de r&eacute;centes &eacute;tudes ont montr&eacute;es une association entre le sarcome de Kaposi et l'infection par le HHV-8 (Human Herpes Virus 8), ce qui justifie l'occurrence de ce sarcome chez les patients non immunod&eacute;prim&eacute;s, non s&eacute;ropositifs. Nous rapportons ici le cas d'un patient de 72 ans, sans ant&eacute;c&eacute;dents, qui rapporte depuis 3 ans l'apparition progressive d'un bourgeon charnu d'allure tumorale au niveau du gland, sans autre localisation. Devant le tableau clinique, nous avons suspect&eacute; un carcinome &eacute;pidermo&iuml;de ou un carcinome sarcomatoide de la verge. Une premi&egrave;re biopsie faite est revenue n&eacute;gative, la seconde est revenue en faveur d'un sarcome de Kaposi, confirm&eacute; par l'immunohistochimie. Le patient a b&eacute;n&eacute;fici&eacute; d'une chimioth&eacute;rapie.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohammed Alae Touzani, Othmane Yddoussalah [Images in medicine] - M&eacute;tastase caverneuse d’une tumeur de vessie - 21 September 2017. <b>L'incidence d'apparition de m&eacute;tastases caverneuses apr&egrave;s traitement radical d'une tumeur de vessie est exceptionnelle et est de l'ordre de 1%. Le d&eacute;lai d'apparition est en moyenne de 8 mois apr&egrave;s la chirurgie, avec certains cas ou il arrive &agrave; 10 ans. Le diagnostic est confirm&eacute; par la biopsie qui met en &eacute;vidence l'origine uroth&eacute;liale. Nous rapportons ici le cas d'un patient de 56 ans, tabagique, ayant b&eacute;n&eacute;fici&eacute; en Janvier 2017 d'une cystoprostatectomie totale, qui consulte 2 mois plus tard pour une induration de la verge, sans autre signe associ&eacute;. Le priapisme et la gangr&egrave;ne de la verge d'origine infectieuse ont &eacute;t&eacute; &eacute;voqu&eacute;s mais vu le contexte clinique, le diagnostic de m&eacute;tastase caverneuse &eacute;tait le plus probable. Le patient a refus&eacute; &agrave; deux reprises une biopsie, sur deux consultations &agrave; 15 jours d'intervalle (A, B). Une biopsie a &eacute;t&eacute; accept&eacute;e par le patient &agrave; la 3&egrave;me consultation (C, D), elle a confirm&eacute; le diagnostic de m&eacute;tastase caverneuse.</b><br/> text/html 2017-11-25T09:37:31+01:00 Uvie Ufuoma Onakpoya, Adebisi David Adenle, Anthony Taiwo Adenekan [Research] - Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience - 21 September 2017. <b>INTRODUCTION: More than forty years after the first open heart surgery in Nigeria, all open heart surgeries were carried out in government-owned hospitals before the introduction of such surgeries in 2013 at Biket Medical Centre, a privately owned hospital in Osogbo, South-western Nigeria. The aim of this paper is to review our initial experience with open heart surgery this private hospital. METHODS: All patients who underwent open heart surgery between August 2013 and January 2014 were included in this prospective study. The medical records of the patients were examined and data on age, sex, diagnosis, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted and the data was analysed using SPSS version 16. RESULTS: Eighteen patients comprising of 12 males and 6 females with ages ranging between 8 months and 52 years (mean = of 15.7+/-15 years) were studied. Pericardial patch closure of isolated ventricular septal defect was done in 7 patients (38.9%) while total correction of isolated tetralogy of Fallot was carried out in 5 patients (27.8%). Two patients had mitral valve repair for rheumatic mitral regurgitation. Sixty day mortality was 0%. CONCLUSION: Safe conduct of open heart surgery in the private hospital setting is feasible in Nigeria. It may be our only guarantee of hitch free and sustainable cardiac surgery.</b><br/> text/html 2017-11-25T09:37:31+01:00 Malick Bodian, Awa Thiaw, Simon Antoine Sarr, Kana Babaka, Fatou Aw, Aliou Alassane Ngaïde, Mouhamadou Bamba Ndiaye, Adama Kane, Modou Jobe, Alassane Mbaye, Maboury Diao, Moustapha Sarr, Serigne Abdou Ba [Research] - Syndrome cardio-r&eacute;nal: aspects &eacute;pid&eacute;miologiques, &agrave; propos de 36 cas dans un service de cardiologie de Dakar - 21 September 2017. <b>INTRODUCTION: Le syndrome cardio-r&eacute;nal (SCR) est un trouble physiopathologique du cœur et des reins dans lequel une dysfonction chronique ou aigu&euml; de l’un peut induire une dysfonction chronique ou aigu&euml; de l’autre. En Afrique et au S&eacute;n&eacute;gal en particulier l’incidence du syndrome cardio-r&eacute;nal est mal connue. L’objectif de cette &eacute;tude &eacute;tait d’appr&eacute;cier la pr&eacute;valence du SCR en milieu cardiologique. METHODES: Nous avons men&eacute; une &eacute;tude r&eacute;trospective incluant tous les insuffisants cardiaques ayant une alt&eacute;ration de leur fonction r&eacute;nale et hospitalis&eacute;s entre avril 2010 et avril 2011 au service de cardiologie. Les donn&eacute;es &eacute;taient analys&eacute;es avec le logiciel statistique Epi-info 3.5.3. RESULTATS: Nous avons inclus 36 patients. La pr&eacute;valence &eacute;tait de 3,7% avec une pr&eacute;dominance masculine (sex-ratio &agrave; 1,77) et un &acirc;ge moyen &agrave; 56,9 ans [30-92]. Les ant&eacute;c&eacute;dents &eacute;taient domin&eacute;s par l’hypertension art&eacute;rielle (52,77%) et le diab&egrave;te (19,4%). Les principales &eacute;tiologies &eacute;taient la cardiomyopathie hypertensive (39%) et l’insuffisance coronarienne (19,44%). La symptomatologie &eacute;tait domin&eacute;e par la dyspn&eacute;e (69,4%) et les œd&egrave;mes (50%). On notait une an&eacute;mie (17 patients). La clairance moyenne (MDRD) &agrave; 46 ml/min. L’&eacute;chocardiographie Doppler retrouvait majoritairement des troubles de la cin&eacute;tique (89,3%), une dysfonction systolique VG (71%). Les 3 &eacute;chographies r&eacute;nales &eacute;taient normales. Six d&eacute;c&egrave;s (16,7 %) &eacute;taient not&eacute;s. CONCLUSION: Le syndrome cardio-r&eacute;nal est une r&eacute;alit&eacute; et marque un tournant dans l’&eacute;volution de toute cardiopathie et n&eacute;phropathie. Sa pr&eacute;valence en milieu cardiologique s&eacute;n&eacute;galais est faible. Des &eacute;tudes prospectives et multicentriques sont n&eacute;cessaires pour une meilleure &eacute;valuation au S&eacute;n&eacute;gal.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hendrick Mbutshu Lukuke, Eric Kasamba, Abdulu Mahuridi, Nlandu Roger Ngatu, Suganuma Narufumi, Abel Ntambue Mukengeshayi, Vicky Malou, Michel Makoutode, Françoise Malonga Kaj [Research] - L’incidence des infections nosocomiales urinaires et des sites op&eacute;ratoires dans la maternit&eacute; de l’H&ocirc;pital G&eacute;n&eacute;ral de R&eacute;f&eacute;rence de Katuba &agrave; Lubumbashi en R&eacute;publique D&eacute;mocratique du Congo - 21 September 2017. <b>INTRODUCTION: Les patients hospitalis&eacute;s en Afrique intertropicale sont expos&eacute;s &agrave; un risque des infections nosocomiales. La raret&eacute; des donn&eacute;es publi&eacute;es sur le sujet limite l’analyse descriptive de la situation. L’objectif de ce travail &eacute;tait de d&eacute;terminer l’incidence, les germes en cause et les facteurs de risque des infections nosocomiales urinaires et des sites op&eacute;ratoires &agrave; la maternit&eacute; de l’HGR Katuba de Lubumbashi en R&eacute;publique D&eacute;mocratique du Congo(DRC). METHODES: nous avons r&eacute;alis&eacute; une &eacute;tude descriptive longitudinale de la p&eacute;riode allant du 1<sup>er</sup> octobre 2014 au 1er Janvier 2015. Notre population d’&eacute;tude &eacute;tait constitu&eacute;e de 207 femmes ayant s&eacute;journ&eacute; dans cette maternit&eacute;. La collecte de donn&eacute;es &eacute;tait r&eacute;alis&eacute;e d’une mani&egrave;re exhaustive.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mustafa Nkaoui, El Mehdi El Alouani [Images in medicine] - Osgood-schlatter disease: risk of a disease deemed banal - 21 September 2017. <b>Osgood-schlatter disease, non-articular osteochondrosis, is characterized by pain of anterior tibial tuberosity (TTA), which mainly affects the growing adolescent sportsman. It corresponds to "chronic lesions, due to microtrauma of repeated tractions on the area of insertion of the patellar tendon at the level of the anterior tibial tuberosity". This condition remains benign if the young patient rests well, the only treatment proven effective to avoid complications such as the removal of the anterior tibial tuberosity. The case reported in this article illustrates this complication. He is a 15-year-old boy, followed for Osgood-Schlatter disease, who did not respect the advice given by his attending physician; and who was the victim of an accident during a soccer match: brutal contraction of the quadriceps during an upset extension of the left knee, causing pain and total functional impotence. The examination showed a large oedematous knee with pain on palpation of TTA, with a deficit of active extension of the knee (A). Standard radiographs of the left knee showed avulsion of the anterior tibial tuberosity (B). The treatment was surgical with reduction of the fragment and osteosynthesis by two cortical screws through the median approach (C). With a follow-up of 6 months, the knee mobility was normal and the fracture consolidated. Osgood-Schlatter disease, a pathology of growth, is generally of good prognosis, resolving spontaneously with skeletal maturity. However, if the young athlete does not change his practice, he may seriously aggravate it (removal of the TTA requiring orthopedic or even surgical treatment) and therefore with much more serious consequences for its sporting recovery.</b><br/> text/html 2017-11-25T09:37:31+01:00 Meriem El Bahloul, Fouad Chra&iuml;bi, Marrakchi Mohammed, Meriem Abdellaoui, Idriss Benatiya [Case report] - Colobome maculaire unilat&eacute;rale: &agrave; propos d’un cas - 21 September 2017. <b>Le colobome maculaire est une affection cong&eacute;nitale en rapport avec une anomalie de fermeture de la fissure fœtale, pouvant &ecirc;tre int&eacute;gr&eacute; dans un cadre h&eacute;r&eacute;ditaire. Il se caract&eacute;rise cliniquement par une acuit&eacute; visuelle basse avec une l&eacute;sion excav&eacute;e maculaire o&ugrave; le tissu r&eacute;tinien normal est absent ou rudimentaire et la scl&egrave;re est ectasique. La tomographie en coh&eacute;rence optique maculaire est fortement &eacute;vocatrice du diagnostic et le bilan &eacute;lectrophysiologique s'il est demand&eacute; est alt&eacute;r&eacute;. Le diagnostic diff&eacute;rentiel se pose avec les pathologies entrainant une l&eacute;sion atrophique et excav&eacute;e de la macula, particuli&egrave;rement la toxoplasmose cong&eacute;nitale.</b><br/> text/html 2017-11-25T09:37:31+01:00 Marie-Rosette Nahimana, Candide Tran Ngoc, Olushayo Olu, Jose Nyamusore, Ayodeji Isiaka, Vedaste Ndahindwa, Lakruwan Dassanayake, Andr&eacute; Rusanganwa [Research] - Knowledge, attitude and practice of hygiene and sanitation in a Burundian refugee camp: implications for control of a Salmonella typhi outbreak - 21 September 2017. <b>INTRODUCTION: A <i>Salmonella typhi</i> outbreak was reported in a Burundian refugee camp in Rwanda in October 2015. Transmission persisted despite increased hygiene promotion activities and hand-washing facilities instituted to prevent and control the outbreak. A knowledge, attitude and practice (KAP) study was carried out to assess the effectiveness of ongoing typhoid fever preventive interventions. METHODS: a cross-sectional survey was conducted in Mahama Refugee Camp of Kirehe District, Rwanda from January to February 2016. Data were obtained through administration of a structured KAP questionnaire. Descriptive, bivariate and multivariate analysis was performed using STATA software. RESULTS: a total of 671 respondents comprising 264 (39.3%) males and 407 (60.7%) females were enrolled in the study. A comparison of hand washing practices before and after institution of prevention and control measures showed a 37% increase in the proportion of respondents who washed their hands before eating and after using the toilet (p < 0.001). About 52.8% of participants reported having heard about typhoid fever, however 25.9% had received health education. Only 34.6% and 38.6% of the respondents respectively knew how typhoid fever spreads and is prevented. Most respondents (98.2%) used pit latrines for disposal of feces. Long duration of stay in the camp, age over 35 years and being unemployed were statistically associated with poor hand washing practices. CONCLUSION: the findings of this study underline the need for bolstering up health education and hygiene promotion activities in Mahama and other refugee camp settings.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mousa Victor Al-Madani, Nancy Khalaf Al-Raqqad, Naser Abdallah Al-Fgarra, Amal Mousa Al-Thawaby, Ahmed Abdelra’of Jaafar [Research] - The risk of ischemic optic neuropathy post phacoemulsification cataract surgery - 21 September 2017. <b>INTRODUCTION: The aim was to study the risk of non arteritic ischemic optic neuropathy after phacoemulsification cataract surgery. METHODS: this study was conducted at King Hussein Medical Center during the period between January 2015 and July 2016. Patients attending ophthalmology clinic complaining of decreased vision due to lens opacity were evaluated. Patients were divided into two groups. First group included patients with no medical illness and second group included patients with diabetes mellitus, hypertension or hyperlipidemia. The two groups were further divided into two subgroups. First subgroup included patients who had phacoemulsification surgery and second subgroup did not have surgery. All patients were followed up for 6 months. They were assessed by neuro-ophthalmologist looking for ischemic optic neuropathy. RESULTS: a total number of 568 patients were enrolled. Group 1A included patients with no medical illness who underwent surgery and group 1B did not undergo surgery. The number of patients in these two subgroups was 119 and 103 respectively. Number of patients in group 2A (medical illness and surgery) was 188 and number of patients in group 2B (medical illness and no surgery) was 130. The incidence of ischemic optic neuropathy was 4.3 % in group 2A, 4.2 % in group 1A, 0.8% in group 2B, and 0% in group 1B. CONCLUSION: phacoemulsification is a risk factor for non arteritic ischemic optic neuropathy independent of the presence of medical risk factors. Suggested mechanisms would be local anaesthesia, intraocular pressure fluctuation and local intraocular inflammation.</b><br/> text/html 2017-11-25T09:37:31+01:00 Amina Kissou, Badr Eddine Hassam [Images in medicine] - Cyst of the back of the hand - 20 September 2017. <b>A 70 year-old man, farmer by profession consulted for a firm and painless nodule of the back of his right hand that was evolving since 09 years. The clinical examination revealed a subcutaneous nodular lesion; firm; immobile and painless. The diameter was about 0.8cm. The skin above was normal. Surgical excision was indicated. Intraoperatively the lesion was cystic and surrounded by a whitish membrane. Histological examination confirmed an epidermoid cyst who was abducted in totality. The occurrence of epidermoid cyst in hands can be explained by repeated trauma. It is seen most often in men "a manual worker." Clinically, it is about a firm nodule often sitting at the distal phalanx in size from 0.5 to 2cm. The Pulp location is the common location against in back of the hand which is possible but unusual, as in our patient. The overlying skin is normal or punctuated and the lesion is painless in half of the cases. Treatment is the complete surgical excision of the capsule and the overlying skin to avoid the risk of recurrence.</b><br/> text/html 2017-11-25T09:37:31+01:00 Salah Bellasri, Soufiane Belabbas [Images in medicine] - Lhermitte-Duclos disease: an extremely rare cerebellar tumor - 20 September 2017. <b>A 42-year-old female presented with complaints of mild occipital headaches of severe months duration. There were no cutaneous lesions or significant family history suggesting any genetic disease. On examination, she did not have any papilloedema, dymetria, dysdiadokokinasia or ataxia. Her cranial nerve examination was normal. On non-enhanced computed tomogram (CT) showed a mildly hyperdense well circumscribed lesion, in the left upper cerebellar hemisphere with no bone involvement (not schown). MRI showed an intra-axial lesion measuring 3.7cm × 3.5cm × 2.5cm in relation to the tentorium cerebelli and lateral sinus which was hypointense on T1-weighted image (T1WI) (A), with the characteristic striated appearance or "tiger-striped" appearance on T2-weighted image (T2WI) (B), there was no apparent contrast enhancement (C). This lesion was hyperintense in diffusion (D) and in fluid attenuation inversion recovery (FLAIR) (E). There was no extension into the internal auditory canal. There was no compression of the brainstem and ventricular system. Proton (¹H) MR spectroscopy study (MRS) revealed normal N-acetyl-aspartate (NAA)/Creatine (Cr) ratio (1.48), moderately decreased choline (cho)/Cr (0.76) (F). An abdominal ultrasound was performed in order to evaluate the intraabdominal organs and found to be normal. She has been under routine follow-up for 3 years. On the last control, the brain MRI showed lesion stability. Given the well-tolerated nature of her headaches and the stability of the lesion, the staff of the neurosurgeons indicated a routine control without surgery.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hamza Dergamoun, Zayd El Boukili El Makhoukhi [Images in medicine] - G&eacute;antes lithiases de stase sur vessie il&eacute;o-caecale - 20 September 2017. <b>L'exstrophie v&eacute;sicale est une malformation caract&eacute;ris&eacute;e par la d&eacute;hiscence de la paroi abdominale ant&eacute;rieure sous ombilicale et la paroi ant&eacute;rieure de la vessie. Rencontr&eacute;e environ dans 30000 &agrave; 40000 naissance par an, elle semble plus toucher les gar&ccedil;ons que les filles, la d&eacute;rivation externe continente semble donner de bons r&eacute;sultats &agrave; long terme elle n'est cependant pas d&eacute;nu&eacute;e de complications. Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 30 ans, op&eacute;r&eacute;e il y a 13 ans pour extrophie, ayant b&eacute;n&eacute;ficie d'une cystectomie avec remplacement par vessie il&eacute;o caecal, suivie pendant 5 ans puis perdue de vue. Elle se pr&eacute;sente en mars 2017 dans un tableau de douleurs abdominales &agrave; type de pesanteur ainsi qu'une constipation &eacute;voluant dans un contexte d'apyrexie et de conservation de l'&eacute;tat g&eacute;n&eacute;ral. L'examen retrouve une patiente en bon &eacute;tat g&eacute;n&eacute;ral avec une cicatrice de laparotomie m&eacute;diane, la valve de la poche est continente non invagin&eacute;e avec des touchers pelviens sans particularit&eacute;s. La palpation hypogastrique retrouve une masse dure pierreuse non douloureuse. L'arbre urinaire sans pr&eacute;paration objective une opacit&eacute; de tonalit&eacute; calcique 130*110 mm ainsi qu'une disjonction symphysaire. L'&eacute;chographie r&eacute;nale et pelvienne objective plusieurs images hyper&eacute;chog&egrave;nes avec c&ocirc;ne d'ombre post&eacute;rieur occupant tous le pelvis, deux reins de tailles normales bien diff&eacute;renci&eacute;es sans ur&eacute;t&egrave;ro-hydron&eacute;phrose. L'uroscanner retrouve une n&eacute;o vessie si&egrave;ge de 5 volumineux calculs de densit&eacute; calcique autour de 730 UH dont la plus volumineuses mesures 112*101mm. La fonction r&eacute;nale &eacute;tait normale et l'examen cytobact&eacute;riologique des urines a mis en &eacute;vidence une infection urinaire &agrave; E COLI BLSE sensible aux carbapen&egrave;mes. Le traitement a consist&eacute; en une antibioth&eacute;rapie adapt&eacute;e associ&eacute;e &agrave; une enterocystolithotomie avec extraction laborieuse de 5 gros calculs. A l'&eacute;tude spectrophotom&eacute;trique les calculs sont de nature phospho-ammoniaco-magnesienne. Les suites op&eacute;ratoires &eacute;taient simples, l'arbre urinaire sans pr&eacute;paration post op&eacute;ratoire &eacute;tait stone free.</b><br/> text/html 2017-11-25T09:37:31+01:00 Christine Ngaruiya, Alison Hayward, Lori Post, Hani Mowafi [Essay] - Obesity as a form of malnutrition: over-nutrition on the Uganda “malnutrition” agenda - 20 September 2017. <b>The objectives were to highlight the burden of overweight and obesity as an additional area of importance for the malnutrition agenda in Uganda and to provide evidence-based considerations for stakeholders involved. Introduction: Mirroring other Low- and Middle-Income Countries (LMICs), Uganda is experiencing a "double burden" of over-nutrition related issues - both obesity and overweight, and related non-communicable diseases (NCDs) alongside the under-nutrition that has long plagued the country. Despite the commonplace assumption that under-nutrition is the predominant form of malnutrition in Uganda, we explore recent literature that in fact, challenges this notion. While food insecurity has contributed to the under-nutrition problem, a lack of dietary diversity also has a demonstrated role in increasing over-nutrition. We cannot afford to ignore over-nutrition concomitant with stunting and wasting in the country. Increase in the burden of this less acknowledged form of malnutrition in Uganda is critical to investigate, and yet poorly understood. A move towards increased regionally targeted over-nutrition research, funding, government prioritization and advocacy is needed.</b><br/> text/html 2017-11-25T09:37:31+01:00 Fatima Ezzaitouni, Youssef Thiyfa, Mohamed Tahiri, Fouad Haddad, Wafaa Hliwa, Ahmed Bellabah, Wafaa Badre [Case report] - Le d&eacute;ficit immunitaire commun variable &agrave; r&eacute;v&eacute;lation tardive par des manifestations digestives: &agrave; propos d’un cas - 20 September 2017. <b>Le d&eacute;ficit immunitaire commun variable (DICV) est une pathologie rare, il s’agit d’un d&eacute;ficit constitutionnel de l'immunit&eacute; humorale caract&eacute;ris&eacute; par des infections bact&eacute;riennes &agrave; r&eacute;p&eacute;tition, et par une fr&eacute;quence accrue de tumeurs, de maladies auto-immunes ou granulomateuses. Les manifestations gastro-intestinales sont tr&egrave;s variables et parfois r&eacute;v&eacute;latrices d’un d&eacute;ficit immunitaire commun variable. Nous rapportons le cas d’un patient &acirc;g&eacute; de 31 ans, ayant comme ant&eacute;c&eacute;dent des infections respiratoires &agrave; r&eacute;p&eacute;tition depuis le bas &acirc;ge, compliqu&eacute;es d’une dilatation des bronches, qui pr&eacute;sente depuis 3 ans une diarrh&eacute;e glaireuse r&eacute;currente, chez qui l’ensemble du bilan &eacute;tiologique est en faveur d’un DICV avec une manifestation auto-immune (vitiligo). Le traitement a consist&eacute; en une perfusion mensuelle d’immunoglobulines (Ig) avec une bonne &eacute;volution. Le recul actuel est de deux ans.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hicham Attifi, Mehdi Lagtoubi [Images in medicine] - Lipome du lobe profond de la glande parotide - 20 September 2017. <b>Les lipomes de la parotide sont des tumeurs b&eacute;nignes se d&eacute;veloppant &agrave; partir du tissu graisseux de la glande. Ils sont rares repr&eacute;sentant 0,6 &agrave; 4,4 % de toutes les tumeurs b&eacute;nignes et ceux situ&eacute;s dans le lobe profond de la glande restent exceptionnels. Leur diagnostic clinique est tr&egrave;s difficile &agrave; &eacute;tablir. La tomodensitom&eacute;trie et surtout l'imagerie par r&eacute;sonance magn&eacute;tique peuvent &eacute;tayer le diagnostic. Le traitement est chirurgical mais ses modalit&eacute;s sont tr&egrave;s controvers&eacute;es. Patiente &acirc;g&eacute;e de 52 ans sans ant&eacute;c&eacute;dents pathologiques particuliers a consult&eacute; pour une masse pr&eacute;auriculaire gauche asymptomatique &eacute;voluant depuis un an et augmentant progressivement de volume. L'examen clinique a retrouv&eacute; une tum&eacute;faction &eacute;lastique, indolore, de 2 × 1,5 × 1 cm, s'&eacute;tendant du lobule de l'oreille &agrave; l'angle mandibulaire gauches. Le canal de St&eacute;non &eacute;tait libre et la salive &eacute;tait claire. La patiente ne pr&eacute;sentait aucun signe de paralysie faciale. La tomodensitom&eacute;trie mettait en &eacute;vidence une masse unilobulaire hypodense, homog&egrave;ne, parfaitement cloisonn&eacute;e, situ&eacute;e dans le lobe profond de la glande parotide. Aucune ad&eacute;nopathie cervicale suspecte n'&eacute;tait retrouv&eacute;e. L'imagerie par r&eacute;sonance magn&eacute;tique a confirm&eacute; la pr&eacute;sence d'un processus tissulaire intraparotidien, homog&egrave;ne et de nature lipomateuse. Apr&egrave;s la parotidectomie superficielle et r&eacute;clinaison des branches du nerf facial, une masse jaun&acirc;tre apparaissait sous les rameaux buccal et mandibulaire du nerf facial. Son ex&eacute;r&egrave;se en bloc a &eacute;t&eacute; r&eacute;alis&eacute;e jusqu'&agrave; l'espace parapharyng&eacute; gauche. Les suites op&eacute;ratoires ont &eacute;t&eacute; simples. L'examen anatomopathologique a confirm&eacute; le diagnostic du lipome du lobe profond de la glande parotide.</b><br/> text/html 2017-11-25T09:37:31+01:00 The Pan African Medical Journal [Erratum] - Erratum: Paragangliome m&eacute;sent&eacute;rique - 19 September 2017. <b>This erratum corrects “Paragangliome m&eacute;sent&eacute;rique”. The Pan African Medical Journal. 2017;26:142. doi:10.11604/pamj.2017.26.142.11813.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ilhame Naciri, Baderddine Hassam [Images in medicine] - Une tumeur exophytique du cuir chevelu - 18 September 2017. <b>La tumeur trichilemmale prolif&eacute;rante, encore appel&eacute;e kyste trichilemmal prolif&eacute;rant, est une tumeur annexielle maligne peu fr&eacute;quente, qui se d&eacute;veloppe &agrave; partir des cellules de la gaine folliculaire externe ou le plus souvent &agrave; partir d'un kyste trichilemmal, apr&egrave;s de multiples traumatismes et/ou d'inflammations it&eacute;ratives. Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 64 ans, sans ant&eacute;c&eacute;dent, qui consultait pour une tumeur du cuir chevelu, &eacute;voluant progressivement depuis 18 mois. L'examen clinique montrait une masse tumorale ulc&eacute;ro-bourgeonnante indolore, ferme, adh&eacute;rente, de 12 cm de grand axe si&eacute;geant au niveau du vertex. Les aires ganglionnaires &eacute;taient libres. L'examen histologique montrait une prolif&eacute;ration cellulaire malpighienne agenc&eacute;e en massifs et en lobules coalescents centr&eacute;s par une k&eacute;ratinisation abrupte selon un mode trichilemmal, avec des atypies cyto-nucl&eacute;aires tr&egrave;s marqu&eacute;es et un stroma infiltr&eacute; fibreux, faisant &eacute;voquer une tumeur trichilemmale prolif&eacute;rante. Le bilan d'extension n'a pas objectiv&eacute; de m&eacute;tastase. La patiente a b&eacute;n&eacute;fici&eacute; d'une ex&eacute;r&egrave;se chirurgicale large suivie d'une recoupe en profondeur, sans r&eacute;cidive avec un recul de 3 ans.</b><br/> text/html 2017-11-25T09:37:31+01:00 Rachid Lefryekh, Ahmed Bensaad, Fatimazahra Bensardi,Khalid Elhattabi,Mounir Bouali, Bessam Daif, Abdelaziz Fadil, Zakaria Jouahari, Tazi Hicham, Aziz Hamdani, Maha Soussi Abdalaoui [Case report] - Hepatic fascioliasis presenting with bile duct obstruction: a case report - 18 September 2017. <b>Fascioliasis is a zoonotic infection caused by a liver trematode: fasciola hepatica; which commonly affects cattle and sheep, humans are accidental hosts. Several cases have been reported in the literature worldwide with a large geographical distribution. We present a case of bile duct obstruction due to a hepatic fascioliasis, successfully treated with both a combined surgical and medical approaches. A high index of suspicion should be kept in mind for all cases of obstructive jaundice, especially in areas in which human fascioliasis infection is repeatedly reported.</b><br/> text/html 2017-11-25T09:37:31+01:00 Viviane Marie Pierre Cisse Diallo, Louise Fortes Deguenonvo, Khardiata Diallo Mbaye, Daye Ka, Ndeye Aissatou Lakhe, Ibrahima Ndiaye, Daouda Thioub, Sylvie Audrey Diop Nyafouna, Aminata Massaly, Alassane Di&egrave;ye, Moustapha Diop, Cheikh Tidiane Ndour, Moussa Seydi [Case report] - Co-infection tuberculose/VIH et Maladie de kaposi sous traitement de substitution par la m&eacute;thadone: &agrave; propos d’un cas - 15 September 2017. <b>Le diagnostic tardif de l’infection &agrave; VIH peut &ecirc;tre fatal car favorisant l’apparition d’infections opportunistes dont la prise en charge n&eacute;cessite l’utilisation de plusieurs mol&eacute;cules pouvant provoquer des interactions m&eacute;dicamenteuses. Nous rapportons le cas d’une patiente de 45 ans, sous traitement de substitution &agrave; l’h&eacute;ro&iuml;ne par la m&eacute;thadone, VIH1 sous traitement antir&eacute;troviral. Cette patiente pr&eacute;sentait un tableau pulmonaire non sp&eacute;cifique associant une toux quinteuse s&egrave;che avec une dyspn&eacute;e d’apparition progressive &eacute;voluant dans un contexte f&eacute;brile. Par ailleurs l’examen notait un lymphœd&egrave;me du membre inferieur gauche surmont&eacute;e de nodules angiomateux indolores &eacute;voluant depuis trois ans associ&eacute; &agrave; des plaques, des nodules angiomateux d’apparition plus r&eacute;cente au niveau de la face ant&eacute;rieure du thorax. Le GeneXpert sur les crachats avait permis d’isoler Mycobacterium tuberculosis. Le diagnostic retenu &eacute;tait celui d’une tuberculose pulmonaire associ&eacute;e &agrave; une maladie de kaposi cutan&eacute; sur un terrain d’immunod&eacute;pression au VIH.</b><br/> text/html 2017-11-25T09:37:31+01:00 Pilakimw&eacute; Egbohou, Tabana Mouzou, Kadanga Beketi, Essossinam Kpelao, Abdel Kader Moumouni, Hamza Doles Sama, Sarakawabalo Ass&eacute;nouw&eacute;, Gnimdou Akala-Yoba, Kadjika Tomta [Case series] - Les méningiomes intracrâniens opérés au CHU Sylvanus Olympio de Lomé: aspects anesthésiologiques et complications, à propos de 21 cas - 15 September 2017. <b>L’objectif &eacute;tait de relever les aspects anesth&eacute;siologiques et les complications p&eacute;riop&eacute;ratoires des m&eacute;ningiomes intracr&acirc;niens op&eacute;r&eacute;s au CHU Sylvanus Olympio de Lom&eacute; (CHU SO).</b><br/> text/html 2017-11-25T09:37:31+01:00 Ngoie Muleka Serge, Cilundika Mulenga Philippe, Mukuku Kabiriko Olivier, Kakisingi Ngama Christian, Sangwa Milindi C&eacute;drick, Nawej Tshimwang Pascal, Mwamba Mulumba Claude, Ngoy Nkulu Dophra, Muteta Wa Pa Manda Faustin [Research] - Maladie r&eacute;nale chronique: facteurs associes, &eacute;tiologies, caract&eacute;ristiques clinique et biologique &agrave; Lubumbashi en R&eacute;publique D&eacute;mocratique du Congo - 15 September 2017. <b>INTRODUCTION: La maladie r&eacute;nale chronique constitue un v&eacute;ritable probl&egrave;me mondial de sant&eacute; publique du fait de l’augmentation de ses principaux facteurs de risque &agrave; savoir l’hypertension art&eacute;rielle et le diab&egrave;te sucr&eacute;. Dans nos milieux &agrave; faible revenu et sp&eacute;cialement dans notre pays, peu d’&eacute;tudes sont connues sur cette pathologie diagnostiqu&eacute;e &agrave; un stade tr&egrave;s avanc&eacute;e et posant un probl&egrave;me de prise en charge.</b><br/> text/html 2017-11-25T09:37:31+01:00 Olushayo Olu, Amos Petu, Martin Ovberedjo, Diane Muhongerwa [Case series] - South-South cooperation as a mechanism to strengthen public health services in Africa: experiences, challenges and a call for concerted action - 15 September 2017. <b>Calls for implementing new models of development cooperation have been on the increase including a call for increased use of horizontal development cooperation mechanisms such as South-South Cooperation (SSC) as a way to enhance aid effectiveness in the health sector of developing countries. In this policy and practice paper, we review recent experiences in application of SSC initiatives to two public health situations in Africa to demonstrate the veracity of this new paradigm. Our review highlight the immense benefits associated with the use of SSC for health and provide evidence for increasing use of horizontal development coordination mechanisms to strengthen public health services delivery and socioeconomic development among African countries. Opportunities for SSC among African countries include in the areas of disease prevention and control, production of medical products and essential medicines, harmonization of regulatory processes, and health workforce development among others. However, pitfalls such as poor coordination, inadequate political commitment, lack of conducive policy environments, language barrier and inadequate financing opportunities for SSC initiatives present major dilemma for the use of SSC mechanisms. We conclude that the need for a paradigm shift from vertical to horizontal development cooperation needs no further proof but a call to action. We call on the concerned stakeholders to support the establishment of a systematic approach for use of SSC mechanisms in the health sector of Africa, designation of an African Centre of Excellence for SSC in public health and development of a regional mechanism for monitoring and evaluation of SSC initiatives in Africa.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ghizlane El Mghari, Bouchra Rafiq, Nawal El Ansari [Case report] - Kyste &eacute;pidermoide de la selle turcique: &agrave; propos d’un cas - 15 September 2017. <b>Le kyste &eacute;pidermo&iuml;de (KE) ou cholest&eacute;atome est une tumeur b&eacute;nigne d'origine souvent cong&eacute;nitale, survenant dans les espaces sous-arachno&iuml;diens, son traitement est principalement chirurgical. Nous rapportons le cas d'un patient, &acirc;g&eacute; de 38 ans, qui a pr&eacute;sent&eacute; d'une fa&ccedil;on progressive, un syndrome d'hypertension intracr&acirc;nienne, associ&eacute; &agrave; des signes d'insuffisance ant&eacute;hypophysaire des axe corticotrope, thyr&eacute;otrope et gonadotrope install&eacute;s depuis 1an et chez qui l'IRM c&eacute;r&eacute;brale a &eacute;t&eacute; en faveur d'un craniopharyngiome, avec r&eacute;v&eacute;lation de kyste &eacute;pidermoide sur pi&egrave;ce anatomo-pathologique.</b><br/> text/html 2017-11-25T09:37:31+01:00 Hanane Oummad, Maryama Elkaddoumi, Josiane Mar&eacute;, Mounir Lezrek, Ouafae Cherkaoui [Case report] - R&eacute;tinoschisis maculaire bilat&eacute;ral associ&eacute; &agrave; un r&eacute;tinoschisis p&eacute;riph&eacute;rique unilat&eacute;ral - 14 September 2017. <b>Le retinoschisis juv&eacute;nile li&eacute; au chromosome X est une affection h&eacute;r&eacute;ditaire qui affecte habituellement les gar&ccedil;ons avec de rare cas d’atteinte du sexe f&eacute;minin. Les premi&egrave;res manifestations cliniques apparaissent g&eacute;n&eacute;ralement au cours de la premi&egrave;re d&eacute;cennie. Il est responsable d’une baisse d’acuit&eacute; visuelle d’importance variable et lentement progressive. Cette &eacute;volution peut &ecirc;tre &eacute;maill&eacute;e d’h&eacute;morragies dans le vitr&eacute; et de d&eacute;collements de r&eacute;tine volontiers r&eacute;cidivants. Nous pr&eacute;sentons le cas d’un patient &acirc;g&eacute; de 17ans. Au fond d'œil on retrouve remaniement maculaire microkystique stellaire bilat&eacute;ral, centr&eacute; sur la fov&eacute;ola, associ&eacute; &agrave; des schisis p&eacute;riph&eacute;riques avec d&eacute;collement de r&eacute;tine et d&eacute;chirure des feuillets interne et externe unilat&eacute;ral.</b><br/> text/html 2017-11-25T09:37:31+01:00 Chigozie Jesse Uneke, Issiaka Sombie, Henry Chukwuemeka Uro-Chukwu, Ermel Johnson, Friday Okonofua [Workshop report] - Using equitable impact sensitive tool (EQUIST) and knowledge translation to promote evidence to policy link in maternal and child health: report of first EQUIST training workshop in Nigeria - 14 September 2017. <b>The Equitable Impact Sensitive Tool (EQUIST) designed by UNICEF and knowledge translation (KT) are important strategies that can help policymakers to improve equity and evidence-informed policy making in MNCH. The purpose of this study was to improve the knowledge and capacity of an MNCH implementation research team (IRT) and policy makers to use EQUIST and KT. A modified "before and after" intervention study design was used in which outcomes were measured on the target participants both before the intervention (workshop) is implemented and after. A 5-point likert scale according to the degree of adequacy was employed. A three -day intensive EQUIST and KT training workshop was organized in Edo State, Nigeria with 45 participants in attendance. Some of the topics covered included: (i) Knowledge translation models, measures & tools; (ii) Policy review, analysis and contextualization; (iii) Policy formulation and legislation process; (iv) EQUIST Overview & Theory of change; (v) EQUIST's situation analysis, scenario analysis and scenario comparison. The pre-workshop mean of understanding of use of KT ranged from 2.02-3.41, while the post-workshop mean ranged from 3.24-4.30. Pre-workshop mean of understanding of use of EQUIST ranged from 1.66-2.41, while the post-workshop mean ranged from 3.56-4.54 on the 5point scale. The percentage increase in mean of KT and EQUIST at the end of the workshop ranged from 8.0%-88.1% and 65.6%-158.4% respectively. Findings of this study suggest that policymakers' and researchers KT and EQUSIT use competence relevant to evidence-informed policymaking can be enhanced through training workshop.</b><br/> text/html 2017-11-25T09:37:31+01:00 The Pan African Medical Journal [Erratum] - Erratum: Food hygiene assessment in catering establishments in Hay Hassani district-Casablanca - 14 September 2017. <b>This erratum corrects "Food hygiene assessment in catering establishments in Hay Hassani district-Casablanca." The Pan African Medical Journal. 2016;24:335. doi:10.11604/pamj.2016.24.335.9171</b><br/> text/html 2017-11-25T09:37:31+01:00 Hasan Hamze, Asrat Mengiste, Jane Carter [Research] - The impact and cost-effectiveness of the Amref Health Africa-Smile Train Cleft Lip and Palate Surgical Repair Programme in Eastern and Central Africa - 14 September 2017. <b>INTRODUCTION: Cleft lip with or without cleft palate (CLP) is a congenital malformation that causes significant morbidity in low and middle income countries. Amref Health Africa has partnered with Smile Train to provide CLP surgeries since 2006. METHODS: we analyzed anonymised data of 37,274 CLP patients from the Smile Train database operated on in eastern and central Africa between 2006 and 2014. Cases were analyzed by age, gender, country and surgery type. The impact of cleft surgery was determined by measuring averted Disability-Adjusted Life Years (DALYs) and delayed averted DALYs. We used mean Smile Train costs to calculate cost-effectiveness. We calculated economic benefit using the human capital approach and Value of Statistical Life (VSL) methods. RESULTS: the median age at time of primary surgery was 5.4 years. A total of 207,879 DALYs were averted at a total estimated cost of US$13 million. Mean averted DALYs per patient were 5.6, and mean cost per averted DALY was $62.8. Total delayed burden of disease from late age at surgery was 36,352 DALYs. Surgical correction resulted in $292 million in economic gain using the human capital approach and $2.4 billion using VSL methods. CONCLUSION: cleft surgery is a cost-effective intervention to reduce disability and increase economic productivity in eastern and central Africa. Dedicated programs that provide essential CLP surgery can produce substantial clinical and economic benefits.</b><br/> text/html 2017-11-25T09:37:31+01:00 Basma Karrakchou, Youssef Yaikoubi, Mohamed Said Chairi, Abdelouahed Jalil [Case report] - Elastofibroma dorsi: case report and review of the literature - 14 September 2017. <b>Elastofibroma dorsi (ED) is an uncommon benign soft tissue tumor with an uncertain pathogenesis. It mostly occurs in the infrascapular region of elderly people with a female predominance. Typically bilateral, ED can also be unilateral. While many patients remain asymptomatic, ED can be responsible of a periscapular arch source of ache. The diagnosis of ED is set on magnetic resonance imaging, and the pathological study ensures the diagnosis after surgical excision and establishes the differential diagnosis with malignant neoplasic process. The prognosis is excellent with extremely rare recurrence cases. Herein we report a case of a 54-years-old woman with a bilateral painful ED. The diagnosis was based on clinical and MRI findings that revealed bilateral tumors. Surgery was decided due to the symptomatic nature of the tumors. Pathological study confirmed the diagnosis. The post operative course was uncomplicated. We update through a review of the literature aspects of the diagnostic and therapeutic care of Elastofibroma dorsi.</b><br/> text/html 2017-11-25T09:37:31+01:00 Oyebimpe Jumoke Adenlewo, Peter Olalekan Adeosun, Olawunmi Adedoyin Fatusi [Research] - Medical and dental students’ attitude and practice of prevention strategies against hepatitis B virus infection in a Nigerian university - 14 September 2017. <b>Introduction: Medical and dental students are a high-risk group for hepatitis B virus (HBV) infection which is an occupational hazard for them and a leading cause of death globally. Prevention strategies include vaccination and observance of standard precaution. However, available reports claim utilization of the prevention strategies is low. This study evaluated the attitude of the students towards HBV vaccine and cross-infection practices.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohammed Alila, Abdelouahab Marouni, Imane Toughrai [Case report] - Hernie paraduod&eacute;nale gauche: une cause rare d'occlusion intestinale - 14 September 2017. <b>Nous rapportons l'observation de deux cas pr&eacute;sentant une occlusion intestinale aigu&euml;. L'intervention en urgence a trouv&eacute; une hernie para-duod&eacute;nale gauche obstructive &agrave; l'origine d'un volvulus, avec n&eacute;crose des anses gr&ecirc;les incarc&eacute;r&eacute;es pour un patient, trait&eacute; par r&eacute;section anastomose en un temps et un gr&ecirc;le souffrant mais viable pour le deuxi&egrave;me malade, trait&eacute; par la r&eacute;duction du gr&ecirc;le incarc&eacute;r&eacute; et l'obturation de l'orifice herniaire. Nous discutons &agrave; l'occasion de ces observations les particularit&eacute;s diagnostiques et th&eacute;rapeutiques de cette affection rare.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohamed Elyadari, Amina Berraho [Images in medicine] - Plaques scl&eacute;rales s&eacute;niles - 14 September 2017. <b>Nous rapportons le cas d'une femme &acirc;g&eacute;e de 75 ans, hypertendue sous traitement, pseudophake au niveau de l'œil droit, cataracte de l'œil gauche et chez qui l'examen ophtalmologique d&eacute;c&egrave;le de fa&ccedil;on bilat&eacute;rale et sym&eacute;trique des zones de d&eacute;pression scl&eacute;rale de couleur gris&acirc;tre situ&eacute;e en avant de l'insertion des deux muscles droits internes. La plaque scl&eacute;rale est le r&eacute;sultat d'une d&eacute;g&eacute;n&eacute;rescence de la scl&egrave;re li&eacute;e &agrave; l'&acirc;ge et est habituellement asymptomatique. La zone scl&eacute;rale touch&eacute;e devient mince et l&eacute;g&egrave;rement d&eacute;prim&eacute;e. Les l&eacute;sions sont d&eacute;crites comme &eacute;tant bilat&eacute;rales, sym&eacute;triques, bien d&eacute;finies et de forme ovo&iuml;de. Elles sont habituellement situ&eacute;es en avant de l'insertion des muscles droits internes.</b><br/> text/html 2017-11-25T09:37:31+01:00 Chong Yau Ong, Jin Lee Lim, Lourdes Ducusin Galang [Case report] - Extensive pyomyositis of vastus muscles - 14 September 2017. <b>We report a case study on a patient who presented with low back and thigh pain of one month duration. He was eventually diagnosed with left thigh pyomyositis. Tissue from thigh grew Staphylococcus aureus. With commencement of antibiotics and surgical drainage, patient made recovery despite prolonged hospital stay. The underlying mechanism of the extensive abscess accompanied by lack of systemic symptoms; is related to relative immunocompromised state of having underlying diabetes mellitus.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohammed Sbiti, khalid Lahmadi, Lhoussaine louzi [Case series] - Profil &eacute;pid&eacute;miologique des ent&eacute;robact&eacute;ries uropathog&egrave;nes productrices de b&ecirc;ta-lactamases &agrave; spectre &eacute;largi - 13 September 2017. <b>Les infections urinaires &agrave; ent&eacute;robact&eacute;ries productrices de b&ecirc;talactamases &agrave; spectre &eacute;largi (E-BLSE) constituent un risque infectieux, un enjeu th&eacute;rapeutique de taille et peuvent m&ecirc;me conduire dans certains cas &agrave; des impasses du fait de leur multi-r&eacute;sistance aux antibiotiques. Le but de ce travail est de pr&eacute;ciser le profil &eacute;pid&eacute;miologique des (E-BLSE) uropathog&egrave;nes et d&eacute;crire leur niveau actuel de r&eacute;sistance aux antibiotiques pour une meilleure prise en charge des patients selon les donn&eacute;es locales. Il s'agit d'une &eacute;tude r&eacute;trospective sur une p&eacute;riode de trois ans (du 1er janvier 2013 au 31 d&eacute;cembre 2015) concernant toutes les souches d' E-BLSE isol&eacute;es de tous les ECBU trait&eacute;s au laboratoire de microbiologie de &agrave; l'H&ocirc;pital Militaire Moulay Ismail de Mekn&egrave;s. La culture a &eacute;t&eacute; faite selon les techniques usuelles, et l'antibiogramme a &eacute;t&eacute; r&eacute;alis&eacute; par m&eacute;thode de disque diffusion sous g&eacute;lose Muller-Hinton selon les recommandations du Comit&eacute; de l'antibiogramme de la Soci&eacute;t&eacute; fran&ccedil;aise de microbiologie CA-SFM 2013/2014. Cette &eacute;tude a permis de noter une importante pr&eacute;valence globale d'isolement des E-BLSE (12.2 %), particuli&egrave;rement chez les patients hospitalis&eacute;s (54.8 %) dont la plus grande pr&eacute;valence (72 %) a &eacute;t&eacute; enregistr&eacute;e dans le service d'urologie. Parmi ces E-BLSE Escherichia coli constitue la majorit&eacute; (61 %) des isolats, cependant au sein de la m&ecirc;me esp&egrave;ce Klebsiella pneumoniae est le plus producteur de BLSE (25.8%). L'&eacute;tude de l'antibioresistance des E-BLSE durant ces trois ans a mis en &eacute;vidence des co-r&eacute;sistances &agrave; la ciprofloxacine (92.5 %), au sulfametoxazole-trimethoprime (88,4 %), &agrave; la gentamycine (67,2 %). Globalement nos r&eacute;sultats sont en accord avec les donn&eacute;es des autres pays m&eacute;diterran&eacute;ens exception faite pour l'amikacine dont la r&eacute;sistance est tr&egrave;s basse (6.1%) dans notre &eacute;tude. Cette &eacute;tude a montr&eacute; que la pr&eacute;valence des E-BLSE en milieu hospitalier est importante et que sa diffusion en milieu communautaire est un fait pr&eacute;occupant. Ces E-BLSE sont g&eacute;n&eacute;ralement r&eacute;sistantes aux antibiotiques, notamment des aux mol&eacute;cules utiles en urologie.</b><br/> text/html 2017-11-25T09:37:31+01:00 Adil Zegmout, Hicham Souhi [Images in medicine] - Tuberculosis of the scalp: the tubercle bacilli has not ceased to surprise us - 13 September 2017. <b>A 52-year-old men was referred with a 6-months history of a 3cm single skin lesion, erythematous, not pruriginous, with a verrucous surface, surmounted by scales, with circinated border. His history included weight loss of 8kg, but no other associated symptoms or contact with tuberculosis patients. Erythrocyte sedimentation rate (ESR) was slightly elevated at 82mm in the first hour. Mycological sampling was negative. Tuberculin skin test was positive (15mm) and anti-human immunodeficiency virus serology was negative. A skin biopsy was performed and sent for histopathology and culture. The skin biopsy showed inflammatory granuloma composed mostly of epithelioid cells and giant cells, consistent with tubercular granuloma. Mycobacteria were absent on Ziehl-Neelsen staining, tubercle bacilli were isolated and grown in culture from the lesion and confirmed a scalp localisation of tuberculosis. The scalp localization of tuberculosis very rare and not sufficiently described in the literature and demonstrates the multifaceted aspect of tuberculosis, which continues to yield surprises with its unusual clinical manifestations. Antitubercular chemotherapy consisting of isoniazid, rifampicin, ethambutol and pyrazinamide was started. Follow-up at the end of treatment at 6 months showed a clinical remission.</b><br/> text/html 2017-11-25T09:37:31+01:00 Rupali Awale, Ratnaprabha Maji, Parag Patil, Raghavendra Lingiah, Ashok Kumar Mukhopadhyay, Subhadra Sharma [Short communication] - Toluidine blue: rapid and simple malaria parasite screening and species identification - 13 September 2017. <b>Malaria, a febrile illness mostly confined to the tropical countries is transmitted by bite of infected female Anopheles mosquito. In 2015 alone, 88% of the malaria burden and 90% deaths due to malaria were confined to the African and Asian countries. Although number of tests are available for rapid diagnosis and screening for malaria, peripheral blood smear examination remains the gold standard. Leishman stain is recommended by WHO however herein we evaluate one of the alternative methods of staining which is simple and rapid. Fifty patients attending the various outpatient departments of the tertiary care hospital with fever and suspected to have malaria were selected. Two thin air dried smears prepared from the peripheral venous blood from these subjects were stained by Leishman and Toluidine blue method. The findings of the slides by two independent qualified professionals were noted and the results were analyzed. A total of 14% (7/50) cases were diagnosed to have malaria. All the malaria cases which were positive in Leishman stain were also detected in Toluidine blue stain. Malarial parasites were clearly visible against the homogenously light green background in Toluidine blue. The detection of malarial parasite by Toluidine blue was quick, easy and confirmative. Toluidine blue stained peripheral blood smear allows for easy identification and speciation of malarial parasite at low magnification and in shorter period of time.</b><br/> text/html 2017-11-25T09:37:31+01:00 Amine Ghalem, Hanane Boussir, Kamal Ahsayan, Nabila Ismaili, Noha El Ouafi [Case report] - ST-segment elevation after blunt chest trauma: myocardial contusion with normal coronary arteries or myocardial infarction following coronary lesions - 13 September 2017. <b>Cardiac lesions secondary to blunt chest trauma vary from insignificant arrhythmias to fatal cardiac rupture. Of these, a distinction remains difficult; face to ST-segment elevation on ECG with positive cardiac biomarkers, is it a myocardial contusion or a genuine myocardial infarction (MI) secondary to coronary lesions? We report the case of a patient admitted for multiple trauma. Initial assessment showed an ST segment elevation on ECG, along with multiple fractures and abdominal injuries. We would like to discuss, through this case, the similarities and the differences between myocardial infarction due to coronary lesions and myocardial contusion in a traumatic context, but also emphasize the difficulty of striking the right balance between thrombotic and bleeding risks in this situation, and insist on the importance of a multidisciplinary and collegial reflexion so we can offer these patients the best care there is.</b><br/> text/html 2017-11-25T09:37:31+01:00 Aymen Saidi, Lassaad Hassini, Aymen Fekih, Monia Ben Othmen, Mohamed Allagui, Abderrazek Abid, Issam Aloui [Case report] - Intra-articular knee arborescent lipoma: a case treated with arthroscopic synoviectomy - 13 September 2017. <b>Arborescent lipoma is an unusual intra-articular lesion that typically develops in the knee and has to be evoked before chronic effusion. It corresponds to hyperplasia of mature fatty tissue and hypertrophy of synovial villi, developing within a joint. The reference treatment is synovectomy by arthrotomy. The rare forms localized to the anterior compartment of the knee can benefit from an arthroscopic synovectomy. The authors report a case of arborescent knee lipoma in a 47-year-old patient who received arthroscopic synoviectomy. To our knowledge, only a few cases of arborescent lipoma treated by arthroscopic synoviectomy have been reported in the literature.</b><br/> text/html 2017-11-25T09:37:31+01:00 Evans Mokaya, Isaac Mugoya, Jane Raburu, Lora Shimp [Research] - Use of cellular phone contacts to increase return rates for immunization services in Kenya - 13 September 2017. <b>INTRODUCTION: In Kenya, failure to complete immunization schedules by children who previously accessed immunization services is an obstacle to ensuring that children are fully immunized. Home visit approaches used to track defaulting children have not been successful in reducing the drop-out rate. METHODS: This study tested the use of phone contacts as an approach for tracking immunization defaulters in twelve purposively-selected facilities in three districts of western Kenya. For nine months, children accessing immunization services in the facilities were tracked and caregivers were asked their reasons for defaulting. RESULTS: In all of the facilities, caregiver phone ownership was above 80%. In 11 of the 12 facilities, defaulter rates between pentavalent1 and pentavalent3 vaccination doses reduced significantly to within the acceptable level of < 10%. Caregivers provided reliable contact information and health workers positively perceived phone-based defaulter communications. Tracking a defaulter required on average 2 minutes by voice and Ksh 6 ($ 0.07). Competing tasks and concerns about vaccinating sick children and side-effects were the most cited reasons for caregivers defaulting. Notably, a significant number of children categorised as defaulters had been vaccinated in a different facility (and were therefore "false defaulters"). CONCLUSION: Use of phone contacts for follow-up is a feasible and cost-effective method for tracking defaulters. This approach should complement traditional home visits, especially for caregivers without phones. Given communication-related reasons for defaulting, it is important that immunization programs scale-up community education activities. A system for health facilities to share details of defaulting children should be established to reduce "false defaulters".</b><br/> text/html 2017-11-25T09:37:31+01:00 Eric Mbuya Musapudi, Aim&eacute; Lukoba Bwalya, Igor Mujinga wa Mujinga, Didier Tshibangu Mujinga, Julien Ilunga Nikulu, Guy Nday Ilunga [Case report] - Lymphangiome du sein: &agrave; propos d’un cas - 13 September 2017. <b>Le lymphangiome est une l&eacute;sion b&eacute;nigne de vaisseaux lymphatiques. C'est une affection p&eacute;diatrique rare et exceptionnelle chez l'adulte. Le site habituel est le cou, l'aisselle et l'abdomen. La localisation mammaire est exceptionnelle. Nous rapportons l'observation d'une patiente &acirc;g&eacute;e de 18 ans re&ccedil;ue en consultation pour une masse du sein gauche &eacute;voluant depuis 23 mois. La prise en charge &eacute;tait chirurgicale par une ex&eacute;r&egrave;se compl&egrave;te. L'examen anatomo-pathologique a conclu &agrave; un lymphangiome du sein. Son &eacute;volution a &eacute;t&eacute; bonne et sans r&eacute;cidive apr&egrave;s 10 mois de suivi.</b><br/> text/html 2017-11-25T09:37:31+01:00 Asma Ben Cheikh, Mahmoud Ben Maitigue, Karim Masmoudi, Thabet Mouelhi, Nader Naouar, Yamen Grissa, Karim Bouattour, Walid Osman, Mohamed Laziz Ben Ayeche [Case series] - L'ost&eacute;otomie f&eacute;morale de varisation par ouverture externe pour les gonarthroses f&eacute;moro-tibiales lat&eacute;rales sur genuvalgum idiopathique: &eacute;tude r&eacute;trospective de 10 cas - 13 September 2017. <b>L'ost&eacute;otomie f&eacute;morale de varisation est un traitement conservateur des gonarthroses uni-compartimentales externes qui reste de pratique peu courante et dont les r&eacute;sultats sont peu &eacute;tudi&eacute;s. L'objectif de ce travail &eacute;tait d'&eacute;valuer les r&eacute;sultats cliniques et radiologiques de l'ost&eacute;otomie f&eacute;morale de varisation chez les sujets pr&eacute;sentant une gonarthrose f&eacute;moro-tibiale externe sur genou valgum idiopathique r&eacute;pertori&eacute;s sur une p&eacute;riode de 21 ans(de 1992 &agrave; 2013) au service d'Orthop&eacute;die du CHU Sahloul &agrave; Sousse. L'&eacute;valuation clinique des patients a &eacute;t&eacute; faite &agrave; partir du score IKS (International Knee Society). L'&eacute;valuation radiologique a &eacute;t&eacute; bas&eacute;e sur un bilan pr&eacute; op&eacute;ratoire et un bilan au dernier recul. L'&eacute;tude portait sur une s&eacute;rie de 9 patients (et 10 genoux) dont l'&acirc;ge moyen &eacute;tait de 45,2 ans avec un sex ratio de 0,5. Le recul moyen &eacute;tait de 99 mois. Le score genou moyen est pass&eacute; de 48,4 points en pr&eacute;op&eacute;ratoire &agrave; 73,5 points au dernier recul avec une am&eacute;lioration statistiquement significative (p<10-3). Le score fonctionnel moyen s'est am&eacute;lior&eacute; d'une fa&ccedil;on significative avec une valeur pr&eacute;op&eacute;ratoire de 49,5 points et une valeur 72 pointsau dernier recul. La correction finale a permis de r&eacute;duire le valgus &agrave; une moyenne de 3,7° pour une valeur pr&eacute;-op&eacute;ratoire de 14°. Cette &eacute;tude, ainsi que l'analyse de la litt&eacute;rature, nous ont permis de d&eacute;duire que l'ost&eacute;otomie f&eacute;morale de varisation est l'indication de choix dans les genuvalgum invalidant d'origine f&eacute;morale, en l'absence d'arthrite rhumatismale, de surcharge pond&eacute;rale, d'arthrose f&eacute;moro-tibiale interne ou f&eacute;moro-patellaire s&eacute;v&egrave;re.</b><br/> text/html 2017-11-25T09:37:31+01:00 Japheth Mativo Nzioki, James Ouma, James Hebert Ombaka, Rosebella Ongutu Onyango [Research] - Community health worker interventions are key to optimal infant immunization coverage, evidence from a pretest-posttest experiment in Mwingi, Kenya - 13 September 2017. <b>INTRODUCTION: Immunization is a powerful and cost-effective health intervention which averts an estimated 2 to 3 million deaths every year. Kenya has a high infant and under five mortality and morbidity rates. Increasing routine child immunization coverage is one way of reducing child morbidity and mortality rates in Kenya. Community Health Workers (CHWs) have emerged as critical human resources for health in developing countries. The Community Strategy (CS) is one of the CHW led interventions promoting Maternal and Child Health (MCH) in Kenya. This study sought to establish the effect of CS on Infant Vaccination Coverage (IVC) in Mwingi west sub-county; Kenya. METHODS: this was a pretest -posttest experimental study design with 1 pretest and 2 post-test surveys conducted in intervention and control sites. Mwingi west and Mwingi north sub-counties where intervention and control sites respectively. Sample size in each survey was 422 households. Women with a child aged 9-12 months were main respondents. RESULTS: intervention site end-term evaluation indicated that; the CS increased IVC by 10.1% (Z =6.0241, P <0.0001), from a suboptimal level of 88.7% at baseline survey to optimal level of 98.8% at end term survey. Infants in intervention site were 2.5 times more likely to receive all recommended immunizations within their first year of life [(crude OR= 2.475, P<0.0001; 95%CI: 1.794-3.414) (adj. OR=2.516, P<0.0001; 95%CI: 1.796-3.5240)]. CONCLUSION: CS increased IVC in intervention site to optimal level (98.8%). To improve child health outcomes through immunization coverage, Kenya needs to fast-track nationwide implementation of the CS intervention.</b><br/> text/html 2017-11-25T09:37:31+01:00 Rajae Borki, Sihame Lkhoyaali, Karima Laadam, Sophia Nitassi, Fouad Zouaidia, Basma Elkhannoussi, Hassan Errihani, Anass Benbouzid, Leila Essakalli [Case report] - Lymphadenopathic kaposi sarcoma in an immunocompetent young patient: a case report - 12 September 2017. <b>Kaposi's sarcoma (KS) is a vascular lesion that usually originates from several sites in the mid-dermis extending into the dermis. Infection from human herpes virus type 8 (HHV-8) is the mostly associated cause. Several articles reported cases of KS, first in Africa, then worldwide because of its close association with HIV / AIDS. KS may also be due to iatrogenic immunosuppression of chronic steroid use, high level of expression of many cytokines and angiogenic growth factors. It can involve skin, mucous membranes, lymph nodes and viscera. We report a case of a 24-year-old immunocompetent, HIV negative male who presented with indolent lymphadenopathy, after adenectomy and histological and immunohistochemical examination revealed a KS. The patient did not have skin lesions. Refusing any other therapy, our patient still lives healthy.This very rare case shows that KS does not always equal immunodeficiency.</b><br/> text/html 2017-11-25T09:37:31+01:00 Sabrina Amiri, Samia Hammami, Kamel Amoura, Mazouz Dekhil, Ilhem Boutiba-Ben Boubaker [Research] - Characterization of carbapenem resistant acinetobacter baumannii isolated from intensive care units in two teaching hospitals from Algeria and Tunisia - 12 September 2017. <b>INTRODUCTION: This study was conducted to identify the enzymatic mechanism of carbapenem resistance in <i>A. baumannii</i> isolated from intensive care units of 2 teaching hospitals (Charles Nicolle hospital of Tunis and University hospital of Annaba). METHODS: Twenty seven non repetitive carbapenem-resistant <i>A. baumannii</i> were collected (7 strains in Algeria and 20 in Tunisia). Antibiotic susceptibility was performed by disk diffusion method. MICs were determined by agar dilution method. EDTA-disk synergy test was performed for metallo-B-lactamases (MBL) phenotypic detection. Detection of bla<sup>OXA-23-like</sup>, bla<sup>OXA-24-like</sup>, bla<sup>OXA-51-like</sup> and bla<sup>OXA-58-like</sup> families was performed by PCR followed by sequencing. Genetic relatedness between strains was investigated by pulsed-field gel electrophoresis (PFGE). RESULTS: Strains were recovered especially from respiratory tract specimens (n=12) and blood (n=11). All strains were co-resistant to all ?-lactams, gentamicin, amikacin and ciprofloxacin, but remainded susceptible to colistin. MBL production was negative for all isolates. bla<sup>OXA-51-like</sup> was detected in all strains and bla<sup>OXA-23-like</sup> in 23 strains. However, bla<sup>OXA-58-like</sup> and bla<sup>OXA-24-like</sup> were not found in any isolate. Six major PFGE patterns were found in the Tunisian isolates. However, the Algerian strains were clustered in one clone. CONCLUSION: This study shows a high distribution of blaOXA-23 in imipenem-resistant <i>A. baumannii</i> isolated in Tunisia and Algeria. It demonstrated the epidemic diffusion of this multidrug resistant pathogen. Thus, strengthening of prevention measures are required to control further spread of carbapenemases in the two countries.</b><br/> text/html 2017-11-25T09:37:31+01:00 Timothy Abiola Oluwasola, Rukiyat Adeola Abdus-Salam, Clement Abu Okolo, Akin-Tunde Ademola Odukogbe [Case report] - Bilateral ovarian serous cystadenocarcinoma in a teenager: a case report - 12 September 2017. <b>Epithelial ovarian cancers are uncommon among young girls and teenagers compared to germ cell tumors. We report a case of bilateral ovarian serous cystadenocarcinoma in a teenage girl with the attendant challenges of diagnosis, management and follow up. HT, 19 year old had presented at a secondary care level with features suggestive of benign ovarian tumor and had ovariectomy done. However, histology report revealed a malignant epithelial cancer, necessitating a repeat exploration. She was found to have surgical stage 3c disease and subsequently has total abdominal hysterectomy with bilateral salpingectomies, right oophorectomy and omentectomy. She was further managed with paclitaxel-carboplatin combination chemotherapy but defaulted after the 3rd cycle on account of financial constraints. She succumbed to the disease 11 months post diagnosis. Though uncommon, detailed evaluation of teenage patients for malignant ovarian cancer is expedient. The financial burden of cancer care in our environment is also highlighted.</b><br/> text/html 2017-11-25T09:37:31+01:00 Houcine Maghrebi, Zoubeir Bensafta [Images in medicine] - Expulsion trans abdominale spontan&eacute;e d’un corps &eacute;tranger - 11 September 2017. <b>L'ingestion d'un corps &eacute;tranger (CE) est une urgence m&eacute;dicale courante. Chez l'adulte, cet accident est beaucoup plus rare que chez l'enfant et survient le plus souvent sur des terrains pr&eacute;dispos&eacute;s. Nous rapportons le cas d’un patient &acirc;g&eacute; de 36 ans, suivi en psychiatrie, admis en urgence pour l’ingestion d’un fil de fer faisant 15 cm de long et qui a &eacute;t&eacute; spontan&eacute;ment expuls&eacute; &agrave; travers la paroi abdominale au niveau de l’&eacute;pigastre.L’examen clinique &eacute;tait sans anomalie notamment pas de signe p&eacute;riton&eacute;aux (A). La tomodensitom&eacute;trie abdominale (B) avait mis en &eacute;vidence un corps &eacute;tranger lin&eacute;aire ext&eacute;rioris&eacute; depuis l’antre gastrique &agrave; travers un trajet fistuleux gastro cutan&eacute;. Le fil de fer a &eacute;t&eacute; retir&eacute; sous anesth&eacute;sie g&eacute;n&eacute;rale par une traction douce ext&eacute;riorisant le bout restant dans l’antre laissant une fistule gastro cutan&eacute; qui n’a rien ramen&eacute;.Les suites op&eacute;ratoires &eacute;taient simples. L’ingestion de CE est un probl&egrave;me fr&eacute;quent en pratique courante. Pr&egrave;s de 80% des CE ing&eacute;r&eacute;s traversent spontan&eacute;ment la fili&egrave;re digestive sans aucune complication. Dix &agrave; 20% n&eacute;cessitent la r&eacute;alisation d’une extraction endoscopique et moins de 1% une intervention chirurgicale. L’expulsion spontan&eacute;e &agrave; traves la paroi abdominale reste un &eacute;v&eacute;nement exceptionnel.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohammed Amine Mahdi, Maryam Erraoui, Ange Ngeuleu, Latifa Tahiri, Hanan Rkain, Fadoua Allali [Research] - Falls, fear of falling and risk of falls in patients with rheumatoid arthritis: prevalence and associated factors - 11 September 2017. <b>INTRODUCTION: We aimed to analyze the prevalence of fall, fear of falling and risk of falls in the patients with rheumatoid arthritis and the associated factors. METHODS: one hundred and twenty-three participants with rheumatoid arthritis (RA) aged over 18 years were enrolled based on the 1987 ACR/EULAR classification criteria. Patients were asked to complete an interviewer-assisted questionnaire about the number of falls and fear of falling during the last 12 months. Comorbidities and complications related to the disease were also obtained. The disease activity was evaluated by the patient and evaluator global assessment (PGA, EGA), the tender and swollen joint counts (TJC28, SJC28), the disease activity Score 28 ESR (DAS28 ESR) and the clinical and simple disease activity indexes (CDAI, SDAI). The functional disability was measured by the health assessment questionnaire (HAQ). The risk of falls was estimated by five standardized performance tests: the Tinetti test (TIT), the timed get up and go test (TUG), the chair-rising test (CRT), the tandem and the tandem stand tests. The relation between disease parameters and the test of fall were analyzed by the r of Pearson, Spearman and Chi-square. The factors associated with falls and fear of falls were evaluated using multiple linear regression analysis and t independent test. RESULTS: twenty-three (18.7%) participants reported a fall and forty-five (36.6%) of them the fear of falls. Risk of falls was strongly correlated with age (CRT: r = 0.345, TIT: r = -0.314), TJC 28 (TIT: r = -0.482, TUG: r = 0.260), PGA (TIT: r = -0.481, TUG: r = 0.375) EGA (CRT: r = 0.27, TIT: r = -0.48), DAS28 ESR (CRT: r = 0.32, TUG: r= 0.25, TIT: r = -0.51), CDAI (TIT: r= -0.421, TUG: r= 0.292), HAQ (CRT: r= 0.411, TIT: r= -0.648, TUG: r= 0.537) and disease duration (CRT: r= 0.343, TIT: r= -0.400, TUG: r= 0.363). No relation was found between corticosteroid use and the risk of falls. Fear of falls was related in simple analysis to the presence of a comorbidity (p = 0.002 OR: 0.252 CI [0.104-0.611]), the walk with aid (p = 0.010 OR: 0.1225 CI[0.025-0.602]), the body mass index (BMI) (p < 0,001 OR:1.143 CI[1.064-1.228]), the disease duration (p < 0.001 OR:3.69 CI[1.97-6.92]), the VAS pain (p = 0.001 OR:1.03 CI[1.011.05]) and the HAQ (p < 0.001 OR: 3.69 CI[3.69-6.92]). In multiple regression analysis, fear of falls remained related to BMI, HAQ and disease duration. CONCLUSION: the falls in RA seems to be frequent. Several factors were associated to a high risk of falls and fear of falling: disease duration, HAQ, and especially the high disease activity, which is the case of many patients in African countries. These results suggest that the physician has to be aware of the high risk of falling in RA patients and the importance of identifying them with a simple interrogation and physical examination.</b><br/> text/html 2017-11-25T09:37:31+01:00 The Pan African Medical Journal [Erratum] - Erratum: Ownership and utilization of insecticide-treated nets (ITNs) for malaria control in Harari National Regional State, Eastern Ethiopia - 08 September 2017. <b>This erratum corrects "Ownership and utilization of insecticide-treated nets (ITNs) for malaria control in Harari National Regional State, Eastern Ethiopia." The Pan African Medical Journal. 2015; 21: 52. doi:10.11604/pamj.2015.21.52.5380.</b><br/> text/html 2017-11-25T09:37:31+01:00 Ghizlane El Mghari, Bouchra Rafiq, Nawal El Ansari, Nissrine Aboussair [Case report] - Retard de croissance staturo-pond&eacute;ral r&eacute;v&eacute;lant un syndrome de Silver Russell associ&eacute; &agrave; une composante in&eacute;dite - 08 September 2017. <b>Le syndrome de Silver-Russell (SSR) associe un retard de croissance intra-ut&eacute;rin, sans rattrapage, &agrave; une dysmorphie faciale et une asym&eacute;trie des membres. L'incidence est &eacute;valu&eacute;e &agrave; 1-30/100 000 cas et environ 500 cas sont rapport&eacute;s dans la litt&eacute;rature. Le d&eacute;ficit pond&eacute;ral est souvent plus marqu&eacute; que celui de la taille, avec un retard de maturation osseuse. Le volume normal du cr&acirc;ne contraste avec la petite taille et peut donner un aspect de pseudohydroc&eacute;phalie, dans de rares cas, une l&eacute;g&egrave;re d&eacute;ficience mentale est d&eacute;crite. La plupart des cas sont sporadiques. Une disomie uniparentale maternelle du chromosome 7 est retrouv&eacute;e chez 10% des patients. Environ 35 &agrave; 50% des cas ont une hypom&eacute;thylation du g&egrave;ne H19 dans la r&eacute;gion 11p15 soumise &agrave; empreinte parentale. Celle-ci r&eacute;sulte le plus souvent d'un m&eacute;canisme &eacute;pig&eacute;n&eacute;tique ou d'un micror&eacute;arrangement g&eacute;nomique, notamment une microduplication maternelle de la r&eacute;gion. Le diagnostic est avant tout clinique, mais il peut &ecirc;tre confirm&eacute; par la mise en &eacute;vidence de l'anomalie mol&eacute;culaire sous-jacente. Le conseil g&eacute;n&eacute;tique d&eacute;pend du m&eacute;canisme mol&eacute;culaire sous-jacent. Le risque de r&eacute;currence est extr&ecirc;mement faible en cas de disomie uniparentale du chromosome 7 ou d'anomalies &eacute;pig&eacute;n&eacute;tiques de la r&eacute;gion 11p15. Le diagnostic pr&eacute;natal n'est habituellement pas possible, puisque la majorit&eacute; des cas sont sporadiques. Le traitement est symptomatique. L'administration d'hormone de croissance acc&eacute;l&egrave;re la croissance et augmente la taille d&eacute;finitive, mais ne permet pas d'atteindre la taille cible. En dehors de la persistance d'une petite taille et d'une faible corpulence, le pronostic &agrave; long terme est bon. L'h&eacute;mihypotrophie ne semble pas &ecirc;tre associ&eacute;e &agrave; un risque tumoral accru.</b><br/> text/html 2017-11-25T09:37:31+01:00 Belarj Badia, Zegmout Adil, Biaz Asmae, El Machtani Samira, Bouhsain Sanae, Dami Abdallah, Aissam El Maataoui, Abid Ahmed, Ouzzif Zohra [Case report] - Un taux de procalcitonine s&eacute;rique d&eacute;routant! - 08 September 2017. <b>La procalcitonine (PCT) est un marqueur de gravit&eacute; du sepsis, dont la valeur absolue et la cin&eacute;tique sont corr&eacute;l&eacute;es &agrave; la s&eacute;v&eacute;rit&eacute; de l'infection. On rapporte le cas d'un patient qui pr&eacute;sente une PCT tr&egrave;s &eacute;lev&eacute;e sans relation avec un sepsis. Il s'agit d'un homme &acirc;g&eacute; de 55 ans, admis en rhumatologie pour des lombosciatalgies hyperalgiques f&eacute;briles. Le bilan biologique a montr&eacute; une hyperleucocytose &agrave; 15000 &eacute;l&eacute;ment/mm3 &agrave; pr&eacute;dominance neutrophile, associ&eacute;e &agrave; une CRP et une PCT s&eacute;riques, respectivement &agrave; 305 mg/l et 2,5ng/ml. Devant ce tableau &eacute;vocateur de sepsis, des h&eacute;mocultures &eacute;taient r&eacute;alis&eacute;es et un traitement antibiotique probabiliste &eacute;tait instaur&eacute;. L'absence d'&eacute;volution favorable du malade ainsi que la discordance entre les chiffres de la PCT demeurant tr&egrave;s &eacute;lev&eacute;s et les h&eacute;mocultures n&eacute;gatives, une IRM dorso-lombaire &eacute;tait r&eacute;alis&eacute;e. Elle a objectiv&eacute; une arthrite de la hanche droite, associ&eacute;e &agrave; des l&eacute;sions osseuses multiples secondaires du squelette axial &eacute;voquant une origine n&eacute;oplasique. Une TDM thoraco-abdomino-pelvienne a montr&eacute; la pr&eacute;sence d'une masse pulmonaire gauche. La biopsie pulmonaire a r&eacute;v&eacute;l&eacute; un ad&eacute;nocarcinome infiltrant.</b><br/> text/html 2017-11-25T09:37:31+01:00 Mohammed Abdi Hassan, Wanja Mwaura-Tenambergen, Muthoni Mwangi Eunice [Research] - Uptake of health insurance among Muslims in Nairobi county, Kenya - 08 September 2017. <b>INTRODUCTION: In Kenya and the world across, health insurance has been reckoned as an important health policy that serves to protect households from the direct financial consequences of health care and meet the Sustainable Development Goal of Universal Health Coverage and Poverty Eradication. However, health insurance uptake has remained to be a major challenge for universal health care coverage especially among Kenyan Muslims who have conflicting religious faith towards conventional health insurance. This study had two main objectives: (1) to determine level of uptake of health insurance among Muslims and (2) to examine the role of religion in health insurance uptake among Muslims.</b><br/> text/html 2017-11-25T09:37:31+01:00 Alpha Oumar Toure, Ibrahima Konate, Mamadou Seck, Abdelouahad Faouzi, Ousmane Thiam, Mohamadou Lamine Gueye, Mamadou Cisse, Ousmane Ka, Madieng Dieng, Cheikh Tidiane Tour&eacute; [Case series] - Les fistules anastomotiques (FA) post-colectomie au Service de Chirurgie G&eacute;n&eacute;rale de l’H&ocirc;pital Aristide Le Dantec - 07 September 2017. <b>La fistule anastomotique reste la complication la plus redout&eacute;e apr&egrave;s chirurgie colorectale et continue &agrave; poser un probl&egrave;me diagnostique et th&eacute;rapeutique. Le but de cette &eacute;tude est de d&eacute;terminer &agrave; la fois la pr&eacute;valence et les &eacute;l&eacute;ments de prises en charge diagnostiques et th&eacute;rapeutiques de la fistule colique apr&egrave;s colectomie. Nous avons men&eacute; une &eacute;tude r&eacute;trospective descriptive des cas de fistule colique apr&egrave;s colectomie sur une p&eacute;riode de 7 ans allant de janvier 2007 au d&eacute;cembre 2013. Il y avait 17 patients qui ont pr&eacute;sent&eacute; une fistule colique parmi les 170 patients ayant b&eacute;n&eacute;fici&eacute; de colectomie dans notre service soit un taux de 10%. L'&acirc;ge moyen au moment de l'intervention initiale &eacute;tait de 45,1 ans (extr&ecirc;mes de 20 et 78 ans). Il y avait une pr&eacute;dominance des patients de sexe masculin (n=13) avec un sex ratio de 3,3. Les pathologies tumorales colorectales (n=9) et le volvulus de colon pelvien (n=7) &eacute;tait les principales indications de colectomie L'intervention initiale a &eacute;t&eacute; r&eacute;alis&eacute;e en urgence chez 13 patients. Le d&eacute;lai moyen d'apparition de la fistule &eacute;tait de 10,8 jours. Il y avait 10 patients ayant pr&eacute;sent&eacute; une fistule colo-cutan&eacute;e et 7 cas de p&eacute;ritonites postop&eacute;ratoires stercorales. Onze de nos patients pr&eacute;sentaient une an&eacute;mie (taux moyen d'h&eacute;moglobine de 9,1 g/dl) et 8 patients, une hyperleucocytose (taux moyen de 15100 leucocytes/mm3). Une &eacute;chographie, r&eacute;alis&eacute;e chez 6 patients, &eacute;tait revenue normale chez 1 patient et avait mis en &eacute;vidence un &eacute;panchement intra p&eacute;riton&eacute;al chez 5 patients tandis que La tomodensitom&eacute;trie (TDM) sans opacification digestive, r&eacute;alis&eacute;e chez 2 patients, n'&eacute;tait contributive au diagnostic que chez 1 seul patient. Neuf patients avaient b&eacute;n&eacute;fici&eacute; de traitement m&eacute;dical seul. Ce dernier consistait en une couverture antibiotique, un r&eacute;gime hyperprot&eacute;ique, et un appareillage de la fistule par une poche de colostomie. La fistule s'est ferm&eacute;e spontan&eacute;ment, dans un d&eacute;lai moyen de 15 jours. La reprise chirurgicale a &eacute;t&eacute; r&eacute;alis&eacute;e chez 8 patients dans un d&eacute;lai moyen de 4,8 jours. Elle a &eacute;t&eacute; indiqu&eacute;e pour une p&eacute;ritonite par fistule anastomotique chez 7 patients et pour persistance de la fistule colo-cutan&eacute;e malgr&eacute; traitement m&eacute;dical chez 1 patient. Le geste chirurgical consistait en une stomie digestive dans 6 cas. Sept patients ont pr&eacute;sent&eacute; au moins une complication li&eacute;e &agrave; la fistule colique (2 r&eacute;cidives de la fistule, 3 suppurations et 2 &eacute;visc&eacute;rations). La dur&eacute;e moyenne d'hospitalisation &eacute;tait de 55,2 jours (extr&ecirc;mes de 15 et 168 jours). Deux d&eacute;c&egrave;s &eacute;taient enregistr&eacute;s cons&eacute;cutif &agrave; un choc septique. Une accessibilit&eacute; des moyens th&eacute;rapeutiques telles que la nutrition parent&eacute;rale et le drainage percutan&eacute; nous permettrait de r&eacute;duire une dur&eacute;e d'hospitalisation prolong&eacute;e et &eacute;galement des co&ucirc;ts de prise en charge &eacute;lev&eacute;s.</b><br/> text/html 2017-11-25T09:37:31+01:00 Djibril Boiro, Demba Di&eacute;dhiou, Babacar Niang, Djiby Sow, Mandiaye Mbodj, Anna Sarr, Aliou Abdoulaye Ndongo, Aliou Thiongane, Modou Gu&egrave;ye, Lamine Thiam, Ndiogou Seck, Yaay Joor Dieng, Abou Ba, Idrissa Demba Ba, Ibrahima Man&eacute; Diallo, Ousmane Ndiaye, Said Nourou Diop [Research] - L’hyperthyro&iuml;die de l’enfant au centre hospitalier universitaire de Dakar (S&eacute;n&eacute;gal) - 07 September 2017. <b>INTRODUCTION: l'hyperthyro&iuml;die de l'enfant semble rare et constitue un probl&egrave;me de par son retentissement psychosomatique. L'objectif &eacute;tait de faire le point sur ces aspects chez l'enfant &agrave; Dakar. METHODES: il s'agissait d'une &eacute;tude multicentrique, descriptive sur 15 ans. Etaient analys&eacute;s les aspects &eacute;pid&eacute;miologiques, cliniques et &eacute;tiologiques. RESULTATS: 239 patients s&eacute;lectionn&eacute;s avec une pr&eacute;valence de 2.4%, un sex ratio (H/F) de 0.36, un &acirc;ge moyen de 10.8 ans. &Agrave; l'inclusion, il s'agissait d'un ain&eacute; de famille (26.3%), d'une croissance avanc&eacute;e (36.9%), retard&eacute;e (12.5%), d'une corpulence insuffisante (40.1%). L'&eacute;tiologie &eacute;tait la maladie de Basedow dans 90.3% avec un facteur psychoaffectif dans 22.1%. Sur le plan clinique, pr&eacute;dominaient la tachycardie (92.4%), le goitre (91.1%), l'exophtalmie (81.8%), l'amaigrissement (69.8%) avec cependant une &eacute;nur&eacute;sie (30.2%) et des manifestations psychiques (3.1%). Les manifestations cardiovasculaires et cutan&eacute;es &eacute;taient positivement associ&eacute;es avec l'&acirc;ge (p < 0.05). Le goitre &eacute;tait associ&eacute; au sexe f&eacute;minin (p = 0.005), aux signes cardiovasculaires (p = 0.02), neuropsychiques (p = 0.03), cutan&eacute;es (p = 0.03) et &agrave; la diarrh&eacute;e (p = 0.03). La T4 libre &eacute;tait corr&eacute;l&eacute;e &agrave; l'&acirc;ge (p = 0.007), la diarrh&eacute;e (p = 0.021), l'anxi&eacute;t&eacute; (p = 0.024), la fr&eacute;quence cardiaque (p = 0.00) et la maladie de Basedow (p = 0.04). Plus le goitre &eacute;tait volumineux, plus &eacute;tait augment&eacute;e la T4 libre (p = 0.007). CONCLUSION: l'hyperthyro&iuml;die de l'enfant se diff&eacute;rencie de celle de l'adulte par les facteurs d'induction, les perturbations sur la croissance et l'&eacute;nur&eacute;sie. L'&acirc;ge et le sexe semble favoriser le tableau clinique de thyrotoxicose et les signes associ&eacute;s.</b><br/> text/html 2017-11-25T09:37:31+01:00 Lamyae Amro, Siham Jridi, Hafsa Sajiai, Hind Serhane, Salma A&iuml;t batahar [Case report] - Endobronchial localization of Hodgkin’s disease - 07 September 2017. <b>The endobronchial localization of Hodgkin's disease is a rare entity which is often confused with endobronchial tuberculosis in our setting. We report the case of a 16 years old female who presented with 6 months history of dry cough, hemoptysis, dyspnea, dysphagia and dysphonia. The chest radiography showed a mediastinal and pulmonary opacity. The chest CT scan found enlarged mediastinal lymph nodes. The bronchial biopsy and peripheral lymph node biopsy confirmed Hodgkin's disease with endobronchial localization. The patient received chemotherapy (ABVD protocol) and radiotherapy with a favorable follow up.</b><br/> text/html 2017-11-25T09:37:31+01:00 Roch Fabien Niama, Nadia Claricelle Loukabou Bongolo, Edith Sophie Bayonne Kombo, Ruth Yengo, Pembe Issamou Mayengue, Etoka-Beka Mandingha Kosso, Igor Louzolo, Lucette Macosso, Ghislain Dzeret, Angélie Serge Patrick Dzabatou Babeaux, Marie-Francke Puruehnce, Henri Joseph Parra [Research] - Syphilis and HIV infections among pregnant women attending antenatal clinics in Republic of Congo - 07 September 2017. <b>INTRODUCTION: HIV and syphilis during pregnancy remain a public health concern especially in developing countries. Pregnant women attending antenatal clinics sites for the first time between September and December 2011 and who accepted to participate in the study were enrolled. The objective was to estimate the syphilis and HIV infection rate in this population. METHODS: a study was conducted in 44 selected ANCs from 12 departments (5 urban and 7 rural). Pregnant women who accepted to participate in the study, attending selected sentinel ANCs sites for the first time between September and December 2011 were enrolled. To detect HIV antibodies, two consecutive ELISA assays were used (Genscreen Ultra HIV Ag/Ac, (BioRad, France) and Enzygnostic Intergral II (Siemens, GMBH, Marbug-Germany). In case of discordant results, the Western blot test II, HIV1 and 2 (Bio-Rad, Marne la Coquette, France) was used as the reference method. The RPR (Bio-Scan, Karnataka, India) test was performed to detect syphilis infection. The RPR positive results were confirmed using the TPHA test (Biotech, Cambridge, UK). Data were analyzed using SPSS 17.0 software. RESULTS: a total of 2979 pregnant women attending ANCs were enrolled. The global HIV infection rate was estimated to be 3.6% (CI: 95%; 3.0-4.4). As expected, HIV prevalence was significantly higher in women aged above 25 years (4.4% [3.4-5.6], p = 0.026) and those attending urban ANCs (5.04%, p < 0.01). Also, women living in the urban area are more at risk to be infected (5.04 VS 2.38, p < 0.01). The RPR test was positive in 117 pregnant women (3.92%). The risk for syphilis occurrence was significantly higher among the single women compared to the married ones (4.4% VS 2.7%; p < 0.01). It was also estimated that the HIV and syphilis coinfection occurred in 22 cases (0.73%). CONCLUSION: the prevalence's of syphilis and HIV were relatively low. Marital status and sentinel site location were a risk factor associated with HIV and syphilis infections respectively. Therefore, substantial effort is needed to reinforce prevention strategies in this population to prevent mother-to-child and further horizontal transmissions of these infections.</b><br/> text/html 2017-11-25T09:37:31+01:00 Frank Ndaks Ndakala, Julius Otieno Oyugi, Margaret Ng’wono Oluka, Joshua Kimani, Georg Martin Norbert Behrens [Research] - The incidence of first-line antiretroviral treatment changes and related factors among HIV-infected sex workers in Nairobi, Kenya - 05 September 2017. <b>INTRODUCTION: In many settings, several factors including adverse drug reactions and clinical failure can limit treatment choices for combined antiretroviral therapy (cART). The aim of the study was to describe the incidence of first-line cART changes and associated factors in a cohort of Kenyan sex workers. METHODS: this was a retrospective review of medical records collected from 2009 to 2013. The review included records of HIV-infected patients aged e" 18 years, who received either stavudine or zidovudine or tenofovir disoproxil fumarate-based regimens. Using systematic random sampling, the study selected 1 500 records and censoring targeted the first incident of a drug change from the first-line cART. RESULTS: the overall incidence rate of cART changes was 11.1 per 100 person-years within a total follow-up period of 3 427.9 person-years. Out of 380 patients who changed cART, 370 (97%) had a drug substitution and 10 (3%) switched regimens. The most commonly cited reasons for changing cART were adverse drug reactions (76%). Tenofovir disoproxil fumarate had a lower drug change rate (1.9 per 100 person years) compared to stavudine (27 per 100 person years). Using zidovudine as the reference group, stavudine-based regimens were significantly associated with an increased hazard of drug changes (adjusted hazards ratio 10.2; 95% CI: 6.02-17.2). CONCLUSION: these findings suggest a moderate incidence of cART changes among sex workers in Nairobi, Kenya. Individuals using stavudine were at a higher risk of experiencing a change in their cART, mostly presenting within 20 months, and primarily due to adverse drug reactions.</b><br/> text/html 2017-11-25T09:37:31+01:00 Onyeanunam Ngozi Ekeke, Kelechi Emmanuel Okonta [Research] - Trauma: a major cause of death among surgical inpatients of a Nigerian tertiary hospital - 05 September 2017. <b>INTRODUCTION: Trauma presents a significant global health burden. Death resulting from trauma remains high in low income countries despite a steady decrease in developed countries. Analysis of the pattern of death will enable intervention to reduce these deaths from trauma in developing countries. This study aims to present the pattern of trauma-related deaths in the surgical wards of University of Port Harcourt Teaching Hospital (UPTH). METHODS: this was a retrospective study of all patients who died from trauma during admission into the surgical wards of UPTH from 2007 to 2012. Data on demography and traumatic events leading to death were collected from surgical wards, the emergency unit, and theatre records and analyzed using SPSS version 16.0. RESULTS: trauma accounted for 219 (42.4%) of the 527 mortalities recorded. Most of the deaths (62.6 %) occurred between 20 and 59 years. There were 148 males</b><br/> text/html 2017-11-25T09:37:31+01:00 Babatunde Oludare Fakuade, Joshua Biodun Adeoye [Case report] - Melanotic neuroectodermal tumor of infancy: a rare presentation of an extremely rare neoplasm and diagnostic implications in Gombe, Nigeria - 04 September 2017. <b>Melanotic neuro-ectodermal tumor of infancy is very rare. A unique neoplasm of the formative years, it typically involves the face or cranium; possesses rapid, expansile growth; presents as a firm swelling and displays a high rate of recurrence. Its rarity and unique features make diagnosis and management quite challenging. This challenge is increased in resource-limited settings like ours and with atypical presentation, such as was seen at our center, where patient presented with a bony hard swelling.</b><br/> text/html 2017-11-25T09:37:31+01:00 Kenny Moise, Joseph Junior Bernard, Jean Hugues Henrys [Short communication] - Evaluation of antibiotic self-medication among outpatients of the state university hospital of Port-Au-Prince, Haiti: a cross-sectional study - 04 September 2017. <b>In Haiti, where all drugs are available over the counter, self-medication with antibiotics appears as a common practice. Inappropriate use of beta-lactams and macrolides is likely to contribute to the development of antimicrobial resistance. This study aimed to (i) assess the extent of self-medication with antibiotics, (ii) explore the contributing factors (age, gender and educational background) and (iii) identify specific antibiotic drug classes used among patients attending the outpatient clinic of the State University Hospital of Port-au-Prince. A cross-sectional survey among 200 outpatients of the State University Hospital of Port-au-Prince was conducted in December 2014. Face-to-face interviews were conducted using a standardized questionnaire. Parents of pediatric patients were allowed to answer to questions on their behalf. Among the study sample, 45.5% practiced self-medication with antibiotics. It was less prevalent among patients with the highest education level (23.1%; OR: 0.89 (0.5-1.75), p = 0.001). Mild symptoms (28.6%) and vaginal itching (44.4%) were the main reasons for self-medication with antibiotics. Self-medication using amoxicillin was reported by 67.0%. Self-medication with antibiotics is a common practice among Haitian patients and is more common among the less educated. Amoxicillin for urinary tract infections is the most commonly used medication. It is crucial to raise awareness on the dangers of the practice in the population and inforce the current law regarding the use of over the counter antibiotics.</b><br/> text/html 2017-11-25T09:37:31+01:00 Daniella Rakotoniaina Masinarivo, Jenny Larissa Rakotomanana [Images in medicine] - Aspect clinico-&eacute;lectrocardiographique d'embolie pulmonaire masquant une dissection aortique r&eacute;v&eacute;l&eacute; par l'angioscanner thoracique - 04 September 2017. <b>Il s'agit d'une femme de 52 ans, hypertendue, tabagique et ob&egrave;se (IMC &agrave; 32,46 kg/m2), sans facteurs de risques thromboembolique &eacute;vident, hospitalis&eacute;e pour une douleur thoracique gauche &agrave; irradiation dorso-lombaire associ&eacute;e &agrave; une dyspn&eacute;e. L'examen clinique &agrave; l'entr&eacute; objectivait une pression art&eacute;rielle gauche &agrave; 100/60 mmHg, une tachycardie &agrave; 100/min, une d&eacute;saturation en oxyg&egrave;ne &agrave; 88% &agrave; l'air ambiant, avec auscultation cardio-pulmonaire sans particularit&eacute;, pouls p&eacute;riph&eacute;riques per&ccedil;us et absence de signes de phl&eacute;bite des membres inf&eacute;rieurs. L'ECG montrait un axe droit, un aspect S1Q3, une hypertrophie ventriculaire droite et un bloc de branche complet droit (A, B, C). L'angioscanner thoracique effectu&eacute; en urgence objectivait une dissection aortique allant de l'origine de l'aorte jusqu'&agrave; la bifurcation iliaque soit de type Stanford A. Notre patiente a &eacute;t&eacute; trait&eacute; m&eacute;dicalement par contr&ocirc;le de la pression art&eacute;rielle et de la fr&eacute;quence cardiaque ainsi que des antalgiques, avec une bonne &eacute;volution devant l'absence de moyen chirurgical.</b><br/> text/html 2017-11-25T09:37:31+01:00 Sylvie Ndongo Amougou, Dieudonn&eacute; Danwe, Hamadou Ba, Bonaventure Jemea, Liliane Kuate Mfeukeu, Christian Ngongang Ouankou, Jingi Musa Ahmadou, Samuel Kingue [Research] - Vascular hyperreactivity in black Cameroonian hypertensive and normotensive patients: a comparative study - 04 September 2017. <b>INTRODUCTION: Vascular hyperreactivity is a risk factor and a factor predicting hypertension (high blood pressure). Unlike other continents where several studies were carried out, it has rarely been studied in black Africa in general and in Cameroon in particular. METHODS: vascular reactivity was measured by the cold test. Vascular hyperreactivity was defined as an increase in blood pressure > 20 mmHg for systolic and/or > 15 mmHg for diastolic. Khi2, Man-Withney, Wilcoxon's signed ranks and logistic regression tests were used for statistical analysis. RESULTS: a total of 31 hypertensive and 31 normotensive patients matched by age and sex participated in this study. Vascular hyperreactivity was present in 77.4% hypertensive patients and 51.6% normotensive patients. There was a significant association between vascular hyperreactivity and hypertension [OR = 3.2 (1.07 - 9.63), p = 0.034]. The median arterial pressure was higher in responders compared to non-responders in the normotensive group. Age > 45 years, female sex, obesity and family history of hypertension appeared to be associated with vascular hyperreactivity, but only in normotensive patients. CONCLUSION: vascular hyperreactivity appears to be a risk factor for high blood pressure in black Cameroonians. It appeared to be associated with low blood pressure, age, sex, obesity and family history of hypertension but this was only in the normotensive.</b><br/> text/html 2017-11-25T09:37:31+01:00 David Kitara Lagoro, Denis Anywar Arony [Letter to the editors] - Nodding syndrome (NS) and Onchocerca Volvulus (OV) in Northern Uganda - 04 September 2017. <b>Nodding Syndrome (NS) is a childhood neurological disorder characterized by atonic seizures, cognitive decline, school dropout, muscle weakness, thermal dysfunction, wasting and stunted growth. There are recent published information suggesting associations between Nodding Syndrome (NS) with cerebrospinal fluid (CSF) VGKC antibodies and serum leiomidin-1 antibody cross reacting with Onchocerca Volvulus (OV). These findings suggest a neuro-inflammatory cause of NS and they are important findings in the search for the cause of Nodding Syndrome. These observations perhaps provide further, the unique explanation for the association between Nodding Syndrome and Onchocerca Volvulus. Many clinical and epidemiological studies had shown a significant correlation between NS and infestation with a nematode, Onchocerca volvulus which causes a disease, Onchocerciasis, some of which when left untreated can develop visual defect ("River Blindness"). While these studies conducted in Northern Uganda and Southern Sudan indicate a statistically significant association with (OV infection (using positive skin snips), we observe that (OV is generally endemic in many parts of Sub Saharan Africa and Latin America and that to date, no NS cases have been recorded in those regions. This letter to the Editor is to provide additional information on the current view about the relationship between Nodding Syndrome and Onchocerca Volvulus as seen in Northern Uganda.</b><br/>