Pan african Medical Journal - Volume 30 Pan african Medical Journal. Volume 30 2018-07-21T17:12:51+01:00 pamj logo text/html 2018-07-22T00:12:51+01:00 Mohamed Mahmoud El Hacen, Yacoub Mohamed Sghair, Noura Biha, Abdoulay Aw, Moez Trigui, Chekh N&eacute; [Case report] - Pied varus &eacute;quin de l’adulte trait&eacute; par arthrod&egrave;se tibiocalcan&eacute;enne: &agrave; propos de deux cas (3 pieds) - 20 July 2018. <b>Le pied bot varus &eacute;quin (PBVE) inv&eacute;t&eacute;r&eacute; est une attitude vicieuse du pied qui ne repose plus sur le sol par ses points d'appui normaux mais par son bord externe et sa pointe. Lorsque cette attitude vicieuse persiste longtemps, elle &eacute;volue vers des d&eacute;formations ost&eacute;oarticulaires importantes &agrave; l'&acirc;ge adulte. Le PBVE fix&eacute; constitue une bonne indication d'arthrod&egrave;se tibio-calcan&eacute;enne. Celle-ci permet dans la majorit&eacute; des cas d'obtenir un appui plantigrade indolore et stable. Le but de ce travail est d'&eacute;valuer les r&eacute;sultats cliniques et radiologiques de l'astragalectomie avec adh&egrave;se tibiocalcan&eacute;enne. Nous rapportons une s&eacute;rie de 3 cas d'arthrod&egrave;se tibio-calcan&eacute;enne pour d&eacute;formation grave de l'arri&egrave;re-pied associant un varus et un &eacute;quin important et g&ecirc;nant chez l'adulte. Les r&eacute;sultats &eacute;taient jug&eacute;s satisfaisants avec un appui plantigrade indolore et stable. Avec fusion de l'arthrod&egrave;se a 90 jours, sans in&eacute;galit&eacute; pour le cas bilat&eacute;ral et un raccourcissement de 2cm compens&eacute; par une semelle a droite pour le cas unilat&eacute;ral. Dans les d&eacute;formations importantes et fix&eacute;es de la cheville et du PBVE, l'arthrod&egrave;se tibio-calcan&eacute;enne permet dans la majorit&eacute; des cas d'obtenir un appui plantigrade indolore et stable sans risque vasculaire, ni cutan&eacute;.</b><br/> text/html 2018-07-22T00:12:51+01:00 Essohana Padaro, Hezouw&egrave; Magnang, Yao Layibo, Koffi Mawussi, Ir&eacute;n&eacute;e Messanh Ku&eacute;viako&eacute;, Kossi Agb&eacute;tiafa, Anna Vovor [Case series] - Les transcrits bcr-abl et leurs corr&eacute;lations avec l’h&eacute;mogramme au cours de leuc&eacute;mie my&eacute;lo&iuml;de chronique (LMC) au Togo - 20 July 2018. <b>D&eacute;crire les diff&eacute;rents types de transcrits de fusion mol&eacute;culaire bcr-abl afin d'&eacute;valuer leur fr&eacute;quence et &eacute;tudier leurs influence sur les param&egrave;tres de l'h&eacute;mogramme au diagnostic. Il s'agit d'une &eacute;tude prospective de 34 patients porteurs d'une leuc&eacute;mie my&eacute;lo&iuml;de chronique au Togo. La recherche des transcrits de fusion a &eacute;t&eacute; r&eacute;alis&eacute;e au laboratoire d'h&eacute;matologie biologique de l'h&ocirc;pital Henri Mondor &agrave; Cr&eacute;teil (France). L'&acirc;ge moyen des patients &eacute;tait de 42,32±14,87 ans avec des extr&ecirc;mes de 9 et 65ans. On notait une pr&eacute;dominance masculine avec un sex- ratio de 1,61 (21 hommes et 13 femmes). L'&eacute;tude mol&eacute;culaire r&eacute;v&eacute;lait deux types de transcrits b3-a2 et b2-a2. Dix-neuf patients (55,88%) avaient le transcrit b3-a2, 13 (38,24%) le transcrit b2-a2 (32,10 %) et deux patients poss&eacute;daient les deux types de transcrits b3-a2 et b2-a2 (5,88%). Au diagnostic, le taux d'h&eacute;moglobine moyen, le nombre moyen de globules blancs, le chiffre moyen des plaquettes chez les patients porteurs du transcrit b3-a2 &eacute;taient respectivement de 99,2g/l ; 207,63G/l et 451,28G/l. Pour les patients porteurs du transcrit b2-a2 les valeurs sont 104,6g/l, 114,32G/l et 486,11G/l. Les patients ayant les deux types de transcrit de fusion avaient respectivement 67g/l, 867G/l et 780G/l. Les param&egrave;tres de l'h&eacute;mogramme sont significativement plus perturb&eacute;s chez les patients porteurs des deux types de transcrits b3-a2 et b2-a2.</b><br/> text/html 2018-07-22T00:12:51+01:00 Siham Nasri, Zineb Marzouki, Imane Kamaoui, Imane Skiker [Case report] - Le m&eacute;ningiome intra osseux: &agrave; propos de deux cas - 20 July 2018. <b>Les m&eacute;ningiomes intra osseux primitifs sont des m&eacute;ningiomes ectopiques rares, qui constituent 1 &agrave; 2% de tous les m&eacute;ningiomes. Le but de ce travail est d'illustrer les diff&eacute;rents aspects &agrave; l'imagerie contribuant &agrave; une approche diagnostique et de discuter leurs diff&eacute;rents diagnostics diff&eacute;rentiels. Nous rapportons, &agrave; ce propos, deux cas de m&eacute;ningiomes intra osseux &agrave; localisation pt&eacute;rionale, document&eacute;s par TDM et IRM.</b><br/> text/html 2018-07-22T00:12:51+01:00 Charaf Tilfine, Fatima Zahrae Laamrani, Rachida Dafiri [Case report] - Syndrome de r&eacute;gression caudale: &agrave; propos d’un cas - 19 July 2018. <b>Le syndrome de r&eacute;gression caudale est un syndrome malformatif rare associant &agrave; des degr&eacute;s variables une ag&eacute;n&eacute;sie des vert&egrave;bres sacr&eacute;es et coccygiennes, avec raccourcissement des membres inf&eacute;rieurs, et anomalies gastro-intestinales, g&eacute;nito-urinaires et cardiovasculaires. Sa relation avec le diab&egrave;te maternel est bien &eacute;tablie. Mais sa cause exacte reste toujours mal &eacute;tablie. Nous pr&eacute;sentons un cas rare de ce syndrome chez un nourrisson de 8 mois dont la m&egrave;re est connue diab&eacute;tique, et qui pr&eacute;sente en plus du syndrome polymalformatif, une constipation chronique.</b><br/> text/html 2018-07-22T00:12:51+01:00 Bakari Amuri, Mwamba Maseho, Lumbu Simbi, Pierre Duez, Kahumba Byanga [Research] - Ethnobotanical survey of herbs used in the management of diabetes mellitus in Southern Katanga Area/DR Congo - 18 July 2018. <b>INTRODUCTION: Diabetes is becoming a public health burden for sub-Saharan countries due to its prevalence which is growing rapidly. Traditional medicine is more and more used to treat diabetes in RD Congo as well as in other African countries. This study was undertaken in order to list plants used in the management of diabetes by traditional healers in four agglomerations of southern area of Katanga in the Democratic Republic of Congo. METHODS: forty-nine traditional healers were randomly met and interviewed about diabetes treatment in traditional medicine. The survey concerned the plant identification, their part used, method of preparation and the route of administration. The inquest concerned also traditional medicine users. RESULTS: Ninety-five plants from 47 families were indicated as antidiabetic. Fabaceae (24.2%), Euphorbiaceae (7.4%), Apocynaceae and Strychnaceae (4.2 each) are the more representative families. This inventory showed that the root is the most used part of the cited plants, the decoction with water as the main preparation method and the oral administration as the principal way to give antidiabetic traditional formulations.</b><br/> text/html 2018-07-22T00:12:51+01:00 Sankalp Yadav, Gautam Rawal [Short communication] - Ghostwriters in the scientific world - 18 July 2018. <b>The scientific world is facing a constant problem of ghostwriters. These ghostwriters are often attached to the medical publishing houses and are involved in writing an article for a pharmaceutical company which may, in turn, use the name of an established or a famous scientist as an author to the article. Often, such articles are published in well-known journals and are circulated widely. Many a time the adverse effects are overlooked in such papers. This will result in a corrupt practice of prescribing a drug which is not scientifically useful or may have life-threatening side effects. In this present article, the authors discuss this evil practice of ghostwriting in the context of the present day scientific publishing.</b><br/> text/html 2018-07-22T00:12:51+01:00 Jean Damascene Kabakambira, Gladys Uwera, Marthe Hategeka, Marie Louise Kayitesi, Célestin Kaputu Kalala Malu, Celestin Hategeka [Research] - Burden of post-traumatic stress disorder acute exacerbations during the commemorations of the genocide against Tutsis in Rwanda: a cross-sectional study - 17 July 2018. <b>INTRODUCTION: Following the 1994 genocide against Tutsis in Rwanda, the prevalence of post-traumatic stress disorder (PTSD) is high. In a period of seven days every year in April, Rwandans gather to mourn the victims of the genocide. During this commemoration period, survivors living with chronic PTSD experience PTSD acute exacerbations (PAE). We assessed factors associated with severe PAE during the annual commemoration period of the genocide against Tutsis in Rwanda. METHODS: we carried out a retrospective cross-sectional study that included people who had PAE during the commemoration week in April 2011 across Huye District in Rwanda. Our outcome measure was PAE categorized into three levels: < 15 minutes, 15-30 minutes, and > 30 minutes. Ordinal logistic regression analyses were performed to identify factors associated with severe PAE. RESULTS: we enrolled 383 people with PAE, of whom 71.8% were female and 53.5% were aged 20-45 years. All participants reported history of PAE, of which 59.8% had experienced more than two PAE during the previous commemoration periods. 33.2% had PAE that lasted > 30 minutes. History of PAE (> twice) (OR = 1.86; 95% CI = 1.27-2.75) and having lost a partner in genocide (OR=2.19; 95% CI=1.01-4.81) were associated with severe PAE, after adjusting for sex and age. CONCLUSION: our findings suggest that PAE is frequent during the commemoration periods. People who reported having more prior PAE and being widow (er) were more likely to have severe PAE. While history of PAE and bereavement status are non-modifiable factors, our findings could help identify and target these people who are at risk for severe PAE.</b><br/> text/html 2018-07-22T00:12:51+01:00 Jawad El-Azhari, Mohammed Boui [Images in medicine] - M&eacute;lanose de friction et habitudes vestimentaires - 17 July 2018. <b>La m&eacute;lanose de friction est un trouble pigmentaire acquis touchant principalement les sujets jeunes sur les zones situ&eacute;es en regard des saillies osseuses, en particulier la zone claviculaire et le haut du dos. Les traumatismes r&eacute;p&eacute;t&eacute;s de frottement des v&ecirc;tements contre la peau recouvrant les protub&eacute;rances osseuses seraient fondamentaux dans sa pathog&eacute;nie. D'autres facteurs, tels que le phototype fonc&eacute; et la variabilit&eacute; individuelle, peuvent &eacute;galement jouer un r&ocirc;le dans la pathogen&egrave;se. Nous rapportons le cas d’une patiente de 40 ans sans ant&eacute;c&eacute;dents notables, phototype V, qui consulte pour une hyperpigmentation brun&acirc;tre &eacute;voluant depuis plusieurs ann&eacute;es, non prurigineuse et int&eacute;ressant le front, les joues, le menton et le cou. Cette femme est originaire du Sahara marocain, et porte r&eacute;guli&egrave;rement une tenue traditionnelle appel&eacute;e "melhfa"; tissu ample d’environ 4 m&egrave;tres qui est enroul&eacute; autour du corps pour finalement couvrir les cheveux. L’examen du reste du t&eacute;gument et des muqueuses ainsi que le reste de l’examen clinique et le bilan biologiques sont normaux. Les diagnostics &eacute;voqu&eacute;s &eacute;taient un lichen plan pigmentog&egrave;ne, une photodermatose, une amylose maculeuse ou une m&eacute;lanose de friction. Une biopsie cutan&eacute;e a &eacute;t&eacute; effectu&eacute;e objectivant une hyperpigmentation de la couche basale sans d&eacute;p&ocirc;ts amylo&iuml;des dans le derme sup&eacute;rieur, la coloration Rouge Congo &eacute;tait n&eacute;gative. Le diagnostic de m&eacute;lanose de friction a &eacute;t&eacute; retenu, et la patiente a &eacute;t&eacute; mise sous hydroquinone cr&egrave;me topique &agrave; 2% en &eacute;vitant le port fr&eacute;quent de la melhfa.</b><br/> text/html 2018-07-22T00:12:51+01:00 Sourou Bruno Noukpozounkou, Isma&iuml;l Lawani, Ogounrila Thomas Armel Elegbede, Djifid Morel Seto, Beaudelaire Romulus Assan, Amoussou S&egrave;djro Clotaire Rom&eacute;o Houegban, Houenoukpo Koco, Michel Armand Fiogbe [Case report] - Hernie de Littr&eacute; ombilicale &eacute;trangl&eacute;e chez l’enfant: complication rare d’une malformation fr&eacute;quente de l’intestin gr&ecirc;le - 17 July 2018. <b>Le diverticule de Meckel est l'anomalie cong&eacute;nitale la plus fr&eacute;quente de l'intestin gr&ecirc;le. Bien qu'il s'agisse d'une anomalie courante dans la population g&eacute;n&eacute;rale, sa pr&eacute;sence dans un sac herniaire, en particulier au niveau ombilical est une situation peu fr&eacute;quente et constitue la hernie de Littr&eacute;. Nous rapportons le cas d'un nourrisson de 6 mois de sexe f&eacute;minin, admis pour une tum&eacute;faction ombilicale douloureuse et irr&eacute;ductible. Le diagnostic de hernie ombilicale &eacute;trangl&eacute;e a &eacute;t&eacute; pos&eacute;. En per op&eacute;ratoire, il &eacute;tait d&eacute;couvert dans le sac herniaire un diverticule de Meckel inflammatoire. On proc&eacute;da &agrave; une r&eacute;section cun&eacute;iforme du diverticule suivie de la fermeture de la br&egrave;che intestinale par une suture en surjet et de la r&eacute;fection pari&eacute;tale. Le diagnostic clinique de la hernie de Littr&eacute; est difficile et l'attitude th&eacute;rapeutique varie selon les &eacute;quipes.</b><br/> text/html 2018-07-22T00:12:51+01:00 Erdogan Nohuz, Marie-Claire Bui [Images in medicine] - No, it is not a third breast that grows! - 16 July 2018. <b>Dermatofibrosarcoma protuberans (DFSP) is a rare slow growing skin neoplasm which is characterized by a low potential of malignancy. It rarely shows metastasis to local lymph nodes or distant sites. However, it appears locally aggressive with a tendency to peripheral tumor extensions and recurrence. While DFSP can occur in all ages, it affects in the majority of cases the patients between the third and the fifth decades of age. A high index of suspicion should be taken when facing unusual lesion with a history of slow but persistent growth. DFSP involves most commonly the trunk and extremities but can also be located at any site such as scalp, head, neck, breast, pubic area and vulva. Here, we present a case of recurrent DFSP in a 52-year-old woman with a slow enlarging mass in the upper of the thorax, between the two breasts. She was previously managed by surgery several years before for a DFSP developed at the same site. Complete resection including wide surgical margins of at least 3 cm followed by immediate reconstruction is the treatment of choice to minimize recurrence rate. Marked propensity of DFSP to recur necessitates referral to a specialized center to achieve optimal oncological resection and avoid unnecessary re-operation. However, the minimum resection margin required remains undefined. Radiation and chemotherapy have been tried with limited success, although adjuvant radiotherapy may be used in advanced cases where surgery is no longer feasible. Imatinib can contribute to disease control in patients with locally advanced or metastatic DFSP.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mohamed Amine El Ghali, Ons Kaabia, Zaineb Ben Mefteh, Maha Jgham, Amel Tej, Asma Sghayer, Amine Gouidar, Afra Brahim, Rafik Ghrissi, Rached Letaief [Case series] - Acute appendicitis complicating pregnancy: a 33 case series, diagnosis and management features, maternal and neonatal outcomes - 16 July 2018. <b>The occurrence of acute appendicitis during pregnancy may pose diagnostic and therapeutic difficulties. In fact pregnancy can make the clinical diagnosis delicate and the use of morphological examinations is still subject to controversy. The debates concerning the ideal surgical approach during pregnancy continue. On the other hand, in some cases the occurrence of acute appendicitis, especially in its complicated form, which is frequent in pregnant women, exposes to obstetrical complications and an increased risk of premature delivery We aims to describe the clinical and management features of acute appendicitis in pregnant women and the maternal and neonatal outcomes and carry out a review of the literature on this topic. It is a retrospective analysis of a series of 33 cases of appendicitis in pregnant women who were diagnosed and managed, in collaboration between the departments of General and digestive surgery, Gynecology and Obstetrics and Anaesthesia at Farhat Hached Universitary Hospital Sousse Tunisia between January 2005 and December 2015. The average age of the patients was 29 (20-40). Fourteen patients were in the first trimester, twelve in the 2nd and seven in the third trimester. The main symptom was pain in the right iliac fossa. The mean delay between consultation and surgery was 2.7 days. Twenty five patients had a preoperative ultrasound. Eight of the 33 pregnant patients presented complicated appendicitis with localized or generalized peritonitis. Thirty patients underwent laparotomic appendectomy: 28 with a Mc Burney incision and 2 with a midline incision and only three patients underwent laparoscopy. Preventive tocolysis was given to 14 patients, maternal mortality was null. Twenty four pregnancies were followed until delivery: one case of premature birth and one case of preterm labor were observed. Pregnancy makes it difficult to diagnose appendicitis, which explains the high rate of complicated acute appendicitis in our series. An early treatment improves maternal and fetal outcome.</b><br/> text/html 2018-07-22T00:12:51+01:00 Khuram Khan, Ofelia Leroux, Saqib Saeed, Farhana Iqbal, Leaque Ahmed, Brian Davis-Joesph [Case report] - Vanishing spleen syndrome post right partial nehrectomy in a sicklemic patient - 16 July 2018. <b>Splenic infarction after contralateral laparoscopic renal surgery has not, to our knowledge, been reported. The spleen is the most affected organ in sickle cell disease and the mechanism of auto infarction is thought to result from the crystallization of abnormal hemoglobin during periods of hypoxia or acidosis resulting in parenchymal ischemia and ultimately tissue necrosis. We report a case of 45 year old female with sickle cell disease who had an unremarkable spleen at the time of a laparoscopic right partial nephrectomy and was subsequently found to have marked diminution in her splenic volume.</b><br/> text/html 2018-07-22T00:12:51+01:00 Hanane Asri, Adil Zegmout [Images in medicine] - Historic sequelae of lung tuberculosis - 16 July 2018. <b>The patient is a 22-year-old woman who presented for the evaluation of chronic exertional dyspnea. Her past medical history was significant for tuberculosis lung five years ago. Lung auscultation revealed diminished respiratory sounds on the left hemithorax. Chest radiography (A) demonstrated shift of the mediastinal structures to the left with volume loss of the left lung and hyperlucency of the right lung. Pulmonary function tests demonstrated moderate restrictive lung disease. Computed tomography of the chest (B) revealed left bronchial stenosis with passive collapse of the left lung and attraction of the heart and mediastinal elements, compensatory emphysema of the right lung. Bronchoscopy showed obstruction of left main bronchus orifice with normal mucosa. The patient was diagnosed with calcified fibrothorax, believed to be secondary to chronic lung tuberculosis. She was managed conservatively, with no surgical intervention. Fibrothorax can be secondary to empyema or hemothorax, tuberculous pleurisy, asbestos exposure, collagen vascular isease and drug-induced pleuritis. Pleural fibrosis and thickening also may develop as a result of pleurodesis performed to therapeutically obliterate the pleural space treatment should be aimed at the underlying cause, with removal of offending agents if possible. Corticosteroids often are administered and surgical decortication is sometimes attempted; effectiveness of neither approach is established.</b><br/> text/html 2018-07-22T00:12:51+01:00 Marco James, Denis Katundu, Desderius Chussi, Peter Shija [Research] - Prevalence, clinical presentations, associated risk factors and recurrence of laryngeal papillomatosis among inpatients attended at a Tertiary Hospital in Northern zone Tanzania - 16 July 2018. <b>INTRODUCTION: Although Laryngeal papillomatosis is a rare disease and can be conventionally managed through surgical excision as well as adjuvant therapy yet Laryngeal papillomatosis has high tendency to recur raising its prevalence in the community, airway involvement warrants dangerous complications requiring emergency tracheostomy, especially if clinical course is poorly understood and misdiagnosis is common. The study aims to determine the prevalence, clinical features, risk factors and recurrence of Laryngeal Papillomatosis among patients attending ENT department at KCMC from 2005 to 2015. METHODS: this was a 10 year experience/ Descriptive hospital based cross-sectional study conducted based on patients' medical record at KCMC. Information was recorded into data collection sheets, entered and analyzed through SPSS version 20, summarized and presented in tables and charts, proportions and percentage used to compare groups. RESULTS: 51 patients were identified over the 10 years study period corresponding to a prevalence of 0.09%. 26 were males and 25 females, ages ranging from 1 to 67 years. The median age of onset was 6 years. Children less than 5 years accounted for 19 (37.3%) and 58.8% had repeated surgeries. Clinical presentation ranged from hoarseness in 43 (84.3%) patients to weight loss 3 (5.9%) and 96.1% showed complete or partial presence of the clinical triad of risk factors. CONCLUSION: laryngeal papillomatosis is a rare disease that carries severe morbidity due to its highly recurring nature. It is primarily a paediatric disease, generally affecting more males; its clinical features highly resemble other airway obstructive diseases and therefore a careful thorough clinical evaluation is required in order to correctly diagnose Laryngeal papillomatosis.</b><br/> text/html 2018-07-22T00:12:51+01:00 Zenab Alami, Fatima zahraa Farhan, Mohammed Youness Houmada, Abderrahmane Elmazghi, Touria Bouhafa, Khalid Hassouni [Case report] - Sacrococcygeal chondroid chordoma: a case report and literature review - 16 July 2018. <b>Chordomas are low-grade malignant tumours that arise from remnants of the notochord, usually from within the vertebral bodies It accounts for 1%-4% of malignant primary bone tumours, 50% of which are located in the sacrococcygeal region. It's annual incidence is 0.1/100 000 population. The greatest incidence was found between the fifth and the seventh decades with a male predominance. In spite of its slow-growing nature, chondroid chordoma tends to relapse, and it may eventually become malignant, often jeopardising the patient's prognosis. We report the case of sacrococcygeal chondroide chordoma and the treatment performed.</b><br/> text/html 2018-07-22T00:12:51+01:00 Qariani Hajare, Aachak Meriem [Images in medicine] - Exophtalmie unilat&eacute;rale r&eacute;v&eacute;lant un g&eacute;ant an&eacute;vrysme intra caverneux rompu de la carotide interne - 13 July 2018. <b>L'an&eacute;vrysme g&eacute;ant de la carotide intra-cr&acirc;nienne est une pathologie relativement rare et qui peut pr&eacute;senter des complications redoutables. Les l&eacute;sions du sinus caverneux sont habituellement r&eacute;v&eacute;l&eacute;es par une symptomatologie ophtalmologique, principalement, les paralysies oculomotrices. Nous rapportons le cas d'une patiente de 39 ans qui pr&eacute;sente une exophtalmie unilat&eacute;rale d'installation rapidement progressive (A,B) et une diplopie binoculaire associ&eacute;es &agrave; des c&eacute;phal&eacute;es en h&eacute;mi-casque avec un seul &eacute;pisode de vomissements &eacute;voluant dans un contexte d'apyrexie et de conservation d'&eacute;tat g&eacute;n&eacute;ral. L'examen ophtalmologique retrouve une paralysie isol&eacute;e du droit externe droit (d&eacute;ficit d'abduction) avec un examen stato-dynamique des paupi&egrave;res normal .L'acuit&eacute; visuelle corrig&eacute;e est &agrave; 5/10. L'examen &agrave; la lampe &agrave; fente montre une dilatation des vaisseaux conjonctivaux (C) corn&eacute;e claire ne prenant pas la fluoresc&eacute;ine, reflexe photomoteur direct et consensuel conserv&eacute;, une pression intra-oculaire &agrave; 15mmhg, et des tortuosit&eacute;s veineuses au fond d'œil sans anomalies papillaires (D). le bilan neuroradiologique &agrave; savoir l'angio-IRM r&eacute;v&egrave;le un an&eacute;vrysme de la portion intra-caverneuse de la carotide interne droite, compressif, avec une exophtalmie stade 3. L'angiographie c&eacute;r&eacute;brale est en faveur d'un an&eacute;vrysme sacculaire g&eacute;ant carotido-caverneux droit rompu dans le sinus caverneux (E) avec drainage veineux ant&eacute;rieure et post&eacute;rieure associ&eacute; &agrave; un an&eacute;vrisme du syphon carotidien gauche (F).</b><br/> text/html 2018-07-22T00:12:51+01:00 Fatma Dursun, Heves Kirmizibekmez [Research] - A case series of benign transient hyperphosphatasemia from a pediatric endocrinology reference health facility in Turkey - 11 July 2018. <b>INTRODUCTION: Benign transient hyperphosphatasemia (BTH), even a known condition, is not very well managed by primary care physicians. The diagnostic criteria for BTH were alkaline phosphatase (ALP) levels above 3-5 times greater than the age adjusted upper limit of normal among children under 5 years with no evidence of liver or bone disease whose ALP values resolved within 4 months. METHODS: this study involved 15 patients aged 0-5 years, who were referred to the pediatric endocrinology clinic for elevated ALP levels. They were diagnosed with BTH. We examined demographic and biochemical parameters including ALP and ALP isoenzymes, liver enzymes, calcium, phosphate, and parathormone (PTH) levels to rule out liver or bone disease as a cause for hyperphosphatasaemia. RESULTS: of 15 patients 7 were male and 8 were female. Mean age was 2.45 ± 1.09 (range 1.2-4.6) years. Mean serum ALP level was 2315 ± 1028 IU/L (1102-4662), while liver enzymes, calcium, phosphate, PTH and vitamin D3 levels were in normal ranges. The mean normalization period of ALP was 2.4 ± 1.1 (0.5-4) months, and all were normal at the end of 4 months without any treatment. CONCLUSION: this study and literature knowledge related to BTH has shown that being aware of BTH is very important for a primary care physician. Paediatricians can conveniently manage the differential diagnosis and follow up this period of elevated ALP.</b><br/> text/html 2018-07-22T00:12:51+01:00 Narjiss Akerzoul, Saliha Chbicheb [Case report] - Low laser therapy as an effective treatment of recurrent aphtous ulcers: a clinical case reporting two locations - 10 July 2018. <b>Apthous ulcers, commonly referred to as canker sores, are the most common ulcerative lesions of the oral mucosa. These are usually painful and are associated with redness and occasional bleeding from the affected area(s). Low Level Laser Therapy (LLLT) has shown excellent results in relieving the pain and complete remission of the oral ulcers. Through a clinical case, we report two locations of oral ulcers treated successfully with diode laser.</b><br/> text/html 2018-07-22T00:12:51+01:00 Amal Benbella, Siham Aboulmakarim, Houyam Hardizi, Asmaa Zaidouni, Rachid Bezad [Case series] - Infertility in the Moroccan population: an etiological study in the reproductive health centre in Rabat - 10 July 2018. <b>The causes of infertility vary widely and differ between regions and within countries. There is no report on this subject in Morocco. Therefore, the aim of this study was to determine the causes of infertility in Moroccan infertile couples and to compare the findings with data from the various published studies. This retrospective study included 1265 infertile couples who attended the Assisted Reproductive Technology Unit of the Reproductive Health Centre of the University Hospital Ibn Sina in Rabat. All couples had been infertile for at least 1 year and both partners were fully investigated. The median duration of infertility was 5 ± 4 years. Couples had primary and secondary infertility in 77.2% and 22.8% of cases, respectively. Among the 1265 couples, 39.6% had a female factor, 28.2% had a male factor, 17% had both male and female factors and in 15.2% of couples, the cause of infertility was undetermined. The most common causes of male infertility were varicocele (14.3%), obstructive azoospermia (7%), Congenital anomalies (5.5%) and male accessory gland infection (4%). Results showed that 54.8% of men had a normal semen analysis. Among women, infertility factors were ovulatory disorders (27.5%), tubal factor (26.6%), uterine factor (12.6%), endometriosis (4.1%), and 43.4% of women were normal. The causes of infertility in this study are comparable with those reported by the World Health Organization and other studies. However, the substantial delay before attending an infertility clinic highlighted by the study needs additional consideration.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ileogben Sunday-Adeoye, Kenneth Chinedu Ekwedigwe, Maradona Ehikioya Isikhuemen, Monday Osaze Eliboh, Emmanuel Nyan Yakubu, Babafemi Charles Daniyan [Research] - Intravenous urography findings in women with ureteric fistula - 10 July 2018. <b>INTRODUCTION: Ureteric fistula is one of the major morbidities that can arise from pelvic surgeries. It mainly results from gynaecological and obstetric procedures. Intravenous urography is an imaging modality for the upper urinary tract. Its features may be suggestive of ureteric fistula and it is of great value when medicolegal issues arise. It is however expensive and requires expertise. There are other useful and cheap methods for evaluating ureteric fistula including the use of dye test. There is need to determine if IVU (Intravenous urography) should be recommended for women with this disease. The aim of this study was to determine the features of intravenous urography among women with ureteric fistula and therefore determine its relevance in the management of such patients. METHODS: This was a retrospective study conducted at the National Obstetric Fistula Centre, Abakaliki between January 2012 and March 2017. All patients with ureteric fistula during the study period who were assessed with intravenous urography before surgery were included in this study. RESULTS: The mean age was 38 ± 16 years. Twelve (92.3%) were Christians. IVU showed hydroureters in 46.15%, hydronephrosis in 53.85%, non-functioning kidney in 46.15% and ureteric stricture in 7.69%. IVU gave an insight into the side with ureteric fistula except in one who had normal result. CONCLUSION: Hydronephrosis, hydroureters and silent (non-functioning) kidneys are features of IVU in women with ureteric fistulas, however these features are not pathognomonic for the disease.</b><br/> text/html 2018-07-22T00:12:51+01:00 Nneka Chioma Okoronkwo, Chukwuemeka Ngozi Onyearugha, Chioma Akunnaya Ohanenye [Research] - Pattern and outcomes of paediatric medical admissions at the Living Word Mission Hospital, Aba, South East Nigeria - 10 July 2018. <b>INTRODUCTION: There is a decline in child mortality rate globally, courtesy of the erstwhile Millennium Development Goals. However, under-five mortality is still high in the African sub-regions. The need to review the morbidity and mortality pattern among children admitted into private health settings, where 60% of the medical conditions of the masses are being attended to in the sub-regions, cannot be overemphasized. This study aimed at documenting the morbidity pattern and outcomes of admissions among children admitted into the Living Word Mission Hospital (LWMH), Aba, Nigeria. METHODS: this was a retrospective descriptive study over a 3 year period. The study population comprised of all children aged 1 month to 15 years that were admitted into the paediatric wards of the Living Word Mission Hospital, Aba, Nigeria. The age, gender, diagnoses and disease outcome of these patients, were all retrieved from the paediatric ward registers and hospital medical records. The data were analyzed using SPSS, version 20.0. RESULTS: there were 2278 paediatric medical cases admitted over the study period. Males were 1364 and females were 914, giving a male: female ratio of 1.5:1. More than 90% of these patients were aged < less than 5 years. Severe malaria (31.1%), septicaemia (16.6%), bronchopneumonia (15.4%), uncomplicated malaria (11.9%), acute watery diarrhea (10.5%) and meningitis (3.7%) were the leading causes of admission. Mortality rate was 5.7%, with 87.5% of these deaths occurring in under-fives. Septicaemia (34.6%) and Severe malaria (23.2%) were the leading causes of death. CONCLUSION: there is a high rate of paediatric admissions at Living Word Hospital, Aba. The under-five population remains a vulnerable group to both childhood morbidity and mortality. Septicaemia, malaria, bronchopnuemonia and acute watery diarrhoea were the leading causes of morbidity and mortality. Childhood mortality at LWMH is lower than observed in most government hospitals in Nigeria.</b><br/> text/html 2018-07-22T00:12:51+01:00 Roger Sombi&eacute;, Arnaud Jean Florent Tiendr&eacute;b&eacute;ogo, Wendpouir&eacute; Patrice Laurent Guiguimd&eacute;, Alice Guingan&eacute;, Souhouto Tiendr&eacute;b&eacute;ogo, Kampadilemba Ouoba, Alain Bougouma [Research] - Halitose: approches diagnostiques et th&eacute;rapeutiques pluridisciplinaires - 10 July 2018. <b>INTRODUCTION: L’halitose, &eacute;tat morbide caract&eacute;ris&eacute; par une mauvaise haleine, pr&eacute;sente &agrave; la fois un aspect pathologique et social. Dans notre contexte, l’halitose pose de nombreux probl&egrave;mes de prise en charge aux plans diagnostique et th&eacute;rapeutique en pratique clinique. Le but de notre travail &eacute;tait d’&eacute;tudier les aspects diagnostiques et th&eacute;rapeutiques de l’halitose. METHODES: il s’agit d’une &eacute;tude transversale sur une ann&eacute;e. Ont &eacute;t&eacute; inclus, les patients &acirc;g&eacute;s de plus de 15 ans qui ont consult&eacute; pour halitose au centre hospitalier universitaire Yalgado Ou&eacute;draogo. Ont &eacute;t&eacute; exclus les patients avec mauvaise haleine mais consultant pour un autre motif. L’haleine a &eacute;t&eacute; &eacute;valu&eacute;e par un praticien selon le test organoleptique de Rosenberg. RESULTATS: au total 35 patients ont &eacute;t&eacute; inclus pour un sex-ratio de 1,2. L’&acirc;ge moyen &eacute;tait de 31,9 ans. Dans 57,1% des cas, la plainte venait du patient lui-m&ecirc;me. La dur&eacute;e moyenne de l’halitose &eacute;tait de 4,3 ans. Dix-neuf patients avaient un score de Mel Rosenberg &#8805; 2. La carie dentaire (07 cas), la sinusite (07 cas), l’infection &agrave; Helicobacter pylori (09 cas) et l’ulc&egrave;re gastro-intestinal (10 cas) &eacute;taient associ&eacute;s &agrave; l’halitose. Le traitement a &eacute;t&eacute; &eacute;tiologique dans 82.9% des cas avec une am&eacute;lioration satisfaisante &agrave; deux semaines de l’ordre de 71,8%. CONCLUSION: l’halitose reste une pathologie peu &eacute;tudi&eacute;e et pose un probl&egrave;me de diagnostic positif, mais aussi &eacute;tiologique dans notre contexte. Le r&ocirc;le de l’odontologiste est crucial dans la recherche de la cause de l’halitose. Cependant, une prise en soins pluridisciplinaire de l’halitose permettra d’y apporter une r&eacute;ponse plus efficace.</b><br/> text/html 2018-07-22T00:12:51+01:00 Koffi N'guessan, Yekayo Benedicte Kon&eacute;, Oppong Richard Y&eacute;boah, Amah Patricia Goran-Kouacou, S&eacute;ry Romuald Dass&eacute; [Research] - Evaluation externe de la qualit&eacute; de la num&eacute;ration des lymphocytes T-CD4 au laboratoire d’immunologie et h&eacute;matologie du CHU de Cocody - 06 July 2018. <b>INTRODUCTION: Le taux de lymphocytes T-CD4 (LT4) est un param&egrave;tre crucial de suivi et de d&eacute;cision th&eacute;rapeutique au cours de l'infection au Virus de l'Immunod&eacute;ficience Humaine (VIH). Sa d&eacute;termination doit &ecirc;tre fiable et pr&eacute;cise. Pour fournir des r&eacute;sultats de qualit&eacute;, le laboratoire d'immunologie et h&eacute;matologie du Centre Hospitalier et Universitaire (CHU) de Cocody participe &agrave; l'Evaluation Externe de la Qualit&eacute; (EEQ) de la num&eacute;ration des LT4 du QASI (Quality Assessment and Standardization for Immunological Measures relevant to HIV/AIDS). L'objectif de notre travail &eacute;tait d'&eacute;valuer la performance du laboratoire dans la num&eacute;ration des LT4. METHODES: une &eacute;tude r&eacute;trospective a &eacute;t&eacute; men&eacute;e sur les rapports de performance d'EEQ du laboratoire. Les indicateurs de performances SDI (indice de d&eacute;viation standard), CV (coefficient de variation) ont &eacute;t&eacute; &eacute;valu&eacute;s. RESULTATS: le taux de participation au programme &eacute;tait de 83,33%. Les indicateurs de performance &eacute;taient satisfaisants. Les SDI &eacute;taient en majorit&eacute; inclus dans l'intervalle de confiance [-2; +2]. Les CV des &eacute;chantillons de valeurs normales de CD4 &eacute;taient dans les normes. Les taux de conformit&eacute; des r&eacute;sultats CD4 rendus &eacute;taient respectivement de 89,58% et 91,87% pour le compte absolu et le compte relatif. Seuls les CV des &eacute;chantillons de faible taux de CD4 &eacute;taient au-del&agrave; des normes (> 15%). CONCLUSION: l'EEQ &eacute;tait un outil indispensable qui permettait au laboratoire de surveiller la qualit&eacute; de ses analyses. Toutefois des mesures correctives devraient &ecirc;tre renforc&eacute;es dans le suivi-&eacute;valuation pour p&eacute;renniser et am&eacute;liorer la qualit&eacute; des analyses.</b><br/> text/html 2018-07-22T00:12:51+01:00 Nii Lante Heward-Mills, Catherine Atuhaire, Chris Spoors, Ngambouk Vitalis Pemunta, Gunilla Priebe, Samuel Nambile Cumber [Research] - The role of faith leaders in influencing health behaviour: a qualitative exploration on the views of Black African christians in Leeds, United Kingdom - 06 July 2018. <b>INTRODUCTION: Black African communities in the U.K suffer from health disparities compared to the general population. This has been attributed to the lack of culturally sensitive interventions that are meaningful to them. Faith leaders are an integral part of the community and are known to have immense influence on health behaviour of congregants and community members. However, their role in health behaviour change (alcohol and tobacco use) has been largely neglected. The aim of this study is to explore the views of Black African Christians on the role of their faith leaders in their health behaviour, with particular focus on the extent of influence and mechanisms that foster this. METHODS: eight (8) semi-structured interviews were conducted with Black African Christians between the ages of 25-44, from two churches in Leeds, UK. Data were analysed using the principles of thematic analysis. RESULTS: findings revealed that faith leaders could play a very important role in the health behaviour of their congregants. Faith leaders are able to influence health behaviour not only on the individual level but also on a socio-cultural and environmental level. They exert such influence through several mediators including through scriptural influence, social influence and by serving as a role models. However, no single mediator has been found to be exclusively associated to health behaviour change. CONCLUSION: congregants view faith leaders as having an immense influence on their health behaviour. As a community resource, faith leaders could be better positioned to organize and foster community participation in health matters. Health promoters should thus consider collaborations with faith leaders to enhance the health of their community.</b><br/> text/html 2018-07-22T00:12:51+01:00 Faten Limaiem, Saadia Bouraoui [Case series] - Chemotherapy-induced liver injury in metastatic colorectal cancer: about 48 cases - 05 July 2018. <b>Neoadjuvant chemotherapy of colorectal liver metastases can induce hepatotoxicity in noncancerous liver. The aim of the present study was to describe the chemotherapy-induced major changes in the hepatic parenchyma and their prognostic impact. We undertook a retrospective study of 48 cases of colorectal liver metastases treated with neoadjuvant therapy followed by liver resection. These cases were collected at the Pathology Department of Mongi Slim Hospital over a 2-year period (July 2015-February 2018). Our series consisted of 27 men and 21 women with a sex-ratio (M/F = 1.28). The average age of our patients was 57.68 years old with extremes ranging from 30 to 75 years old. All patients received chemotherapy with FOLFOX. From a total of 48 operative specimens examined, we found 24 cases (50%) of non-systematized steatosis, grade 1 sinusoidal obstruction syndrome (n = 12) and grade 2 sinusoidal obstruction syndrome (n = 12), regenerative nodular hyperplasia (n = 3), portal and/or lobular inflammatory infiltrate (n = 6). In three cases, no abnormalities were reported in the liver parenchyma. Surgical margins were < 1 mm in seven cases and were invaded in four cases. Preoperative chemotherapy is associated with regimen-specific liver injury. The presence of such an injury may have a negative impact on the functional reserve of the liver, thereby increasing the risk of surgical morbidity and mortality.</b><br/> text/html 2018-07-22T00:12:51+01:00 Soufiane Ennaciri, Toufik Michel Bitard [Images in medicine] - Collection de la cuisse r&eacute;v&eacute;lant une fistule v&eacute;sicale apr&egrave;s radioth&eacute;rapie pour cancer de la prostate - 05 July 2018. <b>Les fistules urinaires sont une complication tardive rare apr&egrave;s une radioth&eacute;rapie pour le cancer de la prostate. Nous d&eacute;crivons le cas d'un patient &acirc;g&eacute; de 76 ans, ayant eu sept ans auparavant une prostatectomie radicale suivie d'une radioth&eacute;rapie externe pour un cancer de la prostate. Le patient s'est pr&eacute;sent&eacute; pour une tum&eacute;faction de la cuisse r&eacute;cidivante. L'examen clinique a montr&eacute; une masse r&eacute;nitente et indolore au niveau de la partie m&eacute;diale de la cuisse droite. Le bilan radiologique fait d'une &eacute;chographie puis d'un scanner a objectiv&eacute; une grosse collection liquidienne homog&egrave;ne de la face interne de la cuisse exer&ccedil;ant un l&eacute;ger effet de masse sur les vaisseaux f&eacute;moraux. Un drainage chirurgical a &eacute;t&eacute; r&eacute;alis&eacute; ramenant 900ml de liquide louche dont l'examen bact&eacute;riologique &eacute;tait n&eacute;gatif. Les suites post op&eacute;ratoires ont &eacute;t&eacute; marqu&eacute;es par une diminution brutale de la diur&egrave;se, par contre le drain a continu&eacute; &agrave; ramener r&eacute;guli&egrave;rement des quantit&eacute;s importantes de liquide clair. Devant ce tableau, nous avons r&eacute;alis&eacute; un test au bleu de m&eacute;thyl&egrave;ne puis une cystographie r&eacute;trograde qui ont confirm&eacute; qu'il s'agissait d'une fistule provenant de la jonction ur&eacute;tro-v&eacute;sicale. L'ass&egrave;chement de la collection a &eacute;t&eacute; obtenu gr&acirc;ce &agrave; un sondage &agrave; demeure pendant plusieurs semaines.</b><br/> text/html 2018-07-22T00:12:51+01:00 Phatharaporn Kiatpanabhikul, Thiti Snabboon [Images in medicine] - A man with facial disfigurement - 05 July 2018. <b>A 21-year-old man presented with progressive facial disfigurement along with intermittent pain over his prominent mandible and forehead. Examination revealed asymmetrical facial figures especially the forehead and his left side (A). CT skull demonstrated typical features of fibrous dysplasia (FD) including multiple expansile lesions with heterogeneous pattern including radiolucency interspersed with ground glass opacity involving all craniofacial bones (B). No periosteal reaction or soft tissue involvement is noted. Extensive bone survey and hormonal assessments were unremarkable. The patient preferred conservative treatment with pain relief and undergoing regular follow-up. FD is a benign and progressive disorder in which the bone is replaced and expanded by fibro-osseous tissue, leading to fractures and deformities. It may affect a single (monostotic) or multiple (polyostotic) bones. The latter may be associated with endocrine dysfunctions and cafe' au lait spots (McCune-Albright syndrome) or soft tissue myxomas (Mazabraud syndrome). Craniofacial bone involvement has been reported in about one-fourth of the FD case. Its manifestations are varied depending on the involving bones including painless swelling with facial asymmetry, malocclusion, headache, visual or hearing impairment, nasal obstruction or neurological deficit. Diagnosis is based on the clinical ground and typical radiographic findings. Biopsy is reserved for cases suspicious of malignant change or indeterminate diagnosis. Treatment is aimed to alleviate cosmetic or functional problems, ranging from observation, medical treatment with bisphosphonates, to extensive surgery. Regular follow-up is mandatory to detect disease progression or malignant change.</b><br/> text/html 2018-07-22T00:12:51+01:00 Amal Benbella, Siham Aboulmakarim, Houyam Hardizi, Asmaa Zaidouni, Rachid Bezad [Case series] - Infertility in the Moroccan population: major risk factors encountered in the reproductive health centre in Rabat - 05 July 2018. <b>Infertility is responsible for a major cost burden for patients and health care systems. Therefore identifying preventable risk factors for infertility may contribute to the development of more cost-effective approaches to solving the infertility problem. However, such investigations have never been conducted in Morocco. Thereby, the objective of the present study was to determine the occurrence and distribution of these factors among Moroccan infertile couples. This retrospective study included 1265 infertile couples who attended the Assisted Reproductive Technology Unit of the Reproductive Health Centre of the University Hospital Ibn Sina in Rabat. All couples had been infertile for at least 1 year and both partners were fully investigated. Couples had primary and secondary infertility in 77.2% and 22.8% of cases, respectively. Women were overweight in 47.9% of cases and obese in 25.8% of cases while men were overweight in 44.6% of cases and obese in 14.7% of cases. 18.9% of women and 17.5% of men had a previous abdominopelvic or urogenital surgery. A history of sexually transmitted infection was reported by 7% of men and 5.8% of women. A history of tuberculosis was found 9.3% of women and 4.8% of men. In addition, 31.7% of men were cigarette smokers and 8.4% consumed alcohol. The study showed that preventable risk factors of infertility are common among Moroccan infertile couples. However, additional studies are required to investigate each factor and its relation to infertility in the Moroccan population.</b><br/> text/html 2018-07-22T00:12:51+01:00 Daniel Kwame Afriyie, Linda Brakowaah Adu, Marc Dzradosi, Seth Kwabena Amponsah, Prince Ohene-Manu, Francis Manu-Ofei [Research] - Comparative in vitro activity of ciprofloxacin and levofloxacin against isolated uropathogens in Ghana: a pilot study - 05 July 2018. <b>INTRODUCTION: Studies on urinary tract infections (UTIs) in West Africa from 1990 to 2012 have showed moderate to high antimicrobial resistance to commonly prescribed antibiotics. Fluoroquinolones have been the main stay in the management of UTIs, but recent reports show emergence of resistance. Levofloxacin and ciprofloxacin still remain the commonest fluoroquinolones prescribed for UTIs in many settings. objective: this study sought to compare activity of ciprofloxacin and levofloxacin against clinical isolates obtained from patients with suspected UTI at the Ghana Police Hospital.</b><br/> text/html 2018-07-22T00:12:51+01:00 Th&eacute;ophile Mitima Kashosi, John Kivukuto Mutendela, David Lupande Mwenebitu, Jeff Kabinda Maotela, Kanigula Mubagwa [Research] - Contr&ocirc;le de qualit&eacute; virologique du sang transfus&eacute; dans la ville de Bukavu, Sud Kivu, R&eacute;publique D&eacute;mocratique du Congo - 04 July 2018. <b>INTRODUCTION: Le sang transfus&eacute; &agrave; Bukavu est s&eacute;lectionn&eacute; par les tests rapides. Ces tests sont r&eacute;alis&eacute;s facilement sans moyens techniques importants. L'objectif de ce travail &eacute;tait d'&eacute;valu&eacute; la qualit&eacute; virologique du sang qualifi&eacute; par les tests rapides (TDR).</b><br/> text/html 2018-07-22T00:12:51+01:00 Roger Dodo, Alban Zohoun, Tatiana Baglo, Josiane Mehou, Ludovic Anani [Research] - Urgences dr&eacute;panocytaires au Service des Maladies du Sang du Centre National Hospitalier Universitaire-Hubert Koutoukou Maga de Cotonou, Benin - 03 July 2018. <b>INTRODUCTION: L’&eacute;volution de la dr&eacute;panocytose est marqu&eacute;e par la survenue de complications aigues dont certaines constituent de v&eacute;ritables urgences pouvant mettre en jeu le pronostic vital ou fonctionnel. Notre travail avait pour objectif d’&eacute;tudier la fr&eacute;quence et l’&eacute;volution des urgences dr&eacute;panocytaires dans le Service des Maladies du Sang (SMAS) du Centre National Hospitalier Universitaire-Hubert Koutoukou Maga (CNHU-HKM) de Cotonou. METHODES: Nous avons men&eacute; une &eacute;tude r&eacute;trospective et descriptive de janvier 2014 &agrave; d&eacute;cembre 2015 et portant sur l’ensemble des patients hospitalis&eacute;s pour une urgence dr&eacute;panocytaire. Nous avons exclu les patients hospitalis&eacute;s pour des complications dr&eacute;panocytaires chroniques. RESULTATS: Deux cent quatre (204) urgences dr&eacute;panocytaires pour un nombre total de 813 hospitalisations ont &eacute;t&eacute; enregistr&eacute;s (pr&eacute;valence de 25%). L’&acirc;ge moyen des patients &eacute;tait de 24,2 ans. La tranche d’&acirc;ge la plus repr&eacute;sent&eacute;e &eacute;tait celle de 20-30 ans (45,6%). Le sexe masculin pr&eacute;dominait &agrave; 60,8%. Les &eacute;l&egrave;ves/&eacute;tudiants &eacute;taient les plus repr&eacute;sent&eacute;s &agrave; 55,9%. La douleur aigue &eacute;tait le motif principal d’hospitalisation &agrave; 63,7%. L’homozygotie SS &eacute;tait majoritairement repr&eacute;sent&eacute;e &agrave; 72,1%. Les complications vaso-occlusives ost&eacute;o-articulaires pr&eacute;dominaient &agrave; 70,1%. Les complications infectieuses document&eacute;es &eacute;taient domin&eacute;es par le paludisme (27,5%). La d&eacute;compensation an&eacute;mique &eacute;tait not&eacute;e &agrave; 30,4%. Sur le plan th&eacute;rapeutique, l’hydratation a &eacute;t&eacute; utilis&eacute;e &agrave; 85,3%. La dur&eacute;e moyenne de s&eacute;jour &eacute;tait de 5,4 jours. L’&eacute;volution a &eacute;t&eacute; favorable dans 96,5% des cas. La l&eacute;talit&eacute; &eacute;tait de 2,5%. CONCLUSION: Les urgences dr&eacute;panocytaires sont fr&eacute;quentes. Elles n&eacute;cessitent un diagnostic rapide et une prise en charge pr&eacute;coce et efficace. La formation continue du personnel m&eacute;dical &agrave; la prise en charge des urgences dr&eacute;panocytaires s’av&egrave;re n&eacute;cessaire pour r&eacute;duire leur mortalit&eacute;.</b><br/> text/html 2018-07-22T00:12:51+01:00 Hayett Harbi, Latifa Merzougui, Mohamed Hafedh Barhoumi, Hedi Rebai, Sofiene Abdelkefi, Rafik El Kamel, Tarek Barhoumi [Case series] - Evaluation des pratiques d’antibioprophylaxie chirurgicale dans un Hopital Universitaire du Centre Tunisien - 02 July 2018. <b>L'antibioprophylaxie (ATBP) est l'une des mesures sp&eacute;cifiques de pr&eacute;vention des infections du site op&eacute;ratoire dont l'impact a &eacute;t&eacute; quantifi&eacute; dans les interventions chirurgicales propres et propres contamin&eacute;es. L'objectif de notre &eacute;tude est d'&eacute;valuer la conformit&eacute; des pratiques d'ATBP et le respect des prescripteurs des protocoles adopt&eacute;s au sein de notre &eacute;tablissement. Notre travail est une &eacute;tude observationnelle r&eacute;trospective, de type « Audit Clinique », &eacute;valuant les pratiques d'ATBP dans notre &eacute;tablissement durant le mois de mars 2015. Le crit&egrave;re de jugement principal &eacute;tait la conformit&eacute; globale des pratiques observ&eacute;es aux 5 crit&egrave;res majeurs d&eacute;finis par la haute autorit&eacute; fran&ccedil;aise de sant&eacute; (HAS). Nous avons adopt&eacute; le r&eacute;f&eacute;rentiel de la soci&eacute;t&eacute; fran&ccedil;aise d'anesth&eacute;sie r&eacute;animation parue en 2010. Nous avons inclus 150 patients op&eacute;r&eacute;s des services de chirurgie g&eacute;n&eacute;rale, d'orthop&eacute;die et d'urologie. Le taux de conformit&eacute; globale &eacute;tait de 33,3%. La conformit&eacute; de chacun des 5 crit&egrave;res majeurs d&eacute;finis par la HAS &eacute;tait de 74% pour l'indication; 84% pour le d&eacute;lai injection-incision; 60% pour le choix de l'ATB; 89,3% pour la dose de 1&egrave;re injection et 72% pour la dur&eacute;e de l'ATBP. La conformit&eacute; &eacute;tait variable selon le service, meilleure en urologie ; en cas de chirurgie programm&eacute;e et quand le prescripteur est un r&eacute;animateur. Une strat&eacute;gie globale int&eacute;grant organisation, &eacute;ducation et restriction, pourrait permettre une r&eacute;elle am&eacute;lioration des taux de conformit&eacute; des pratiques d'ATBP. La r&eacute;alisation d'audits successifs devrait s'inscrire dans une d&eacute;marche r&eacute;guli&egrave;re, afin d'&eacute;valuer l'impact des actions entreprises.</b><br/> text/html 2018-07-22T00:12:51+01:00 Giovanna Mosaico, Cinzia Casu [Images in medicine] - Particular dental erosion - 02 July 2018. <b>A 30-year-old smoker female patient in good systemic health came to our attention for the professional oral hygiene session. On clinical observation, the patient had a severe erosion of the enamel, dentinal hypersensitivity and excessive pigmentation of eroded areas. These lesions on the enamel, with consequent exposure of the dentin, was caused by exogenous acids: in fact the patient reported having taken lemon juice for about a year during main meals and as a snack. Every morning, for the whole period indicated, she had taken water and lemon juice; at lunch and dinner and during snacks, based exclusively on fruit. She reported having made use of lemon and vinegar juice on salads and fruit, and finally she drank the lemon juice with great frequency after meals. Rubbing the teeth with more force, in the attempt to remove the pigmentations a chain mechanism has been triggered between acidic demineralization and mechanical abrasion of the enamel with increasingly evident dentine exposure. The patient will be subjected to remineralizing agents and to a conservative prosthetic rehabilitation. The differential diagnosis arises with damage from chemical trauma produced by other fruits such as orange juice and lime; alterations of salivary pH, excessive use of bleaching agents. The anamnesis was decisive in this case.</b><br/> text/html 2018-07-22T00:12:51+01:00 David Odoyoh Odatuwa-Omagbemi, Thomas Odafe Adiki, Cornelius Itodo Elachi, Anirejuoritse Bafor [Research] - Complications of traditional bone setters (TBS) treatment of musculoskeletal injuries: experience in a private setting in Warri, South-South Nigeria - 02 July 2018. <b>INTRODUCTION: Complications arising from the practice of traditional bone setting is a major contributor to the challenges the orthodox orthopaedic practitioner in Nigeria faces. We share our experience at a multi-specialist private health facility in Warri, South-south, Nigeria. METHODS: Case notes of patients with musculoskeletal injuries who had prior treatment by traditional bone setters with resulting complications before presenting at our health facility for treatment were reviewed and relevant information extracted and entered in an already prepared proforma. Data were analysed using SPSS version 17 and results presented in form of means, percentages, ratios and tables. RESULTS: 43 cases were reviewed in a period of 8 years. There were 21 males and 22 females. The average age of patients was 44.8 ± 20.3 years. The most frequent age group affected was that of 40-49 years. 45.8% of the initial injuries were due to road traffic accidents while 39.5% resulted from falls. Femoral fractures and humeral fractures formed 20.4% and 14.8% of cases respectively. 40.8% of traditional bone setters complications observed were non-union of fractures of various bones followed by mal-union in 24.5% of cases. CONCLUSION: The observed complications of traditional bone setters practice in this study were similar to those previously reported in the literature. These complications constitute a significant challenge to the orthopaedic practitioner in Africa with associated negative socioeconomic impact on our society. Government and other relevant stakeholders need to unite and take decisive actions to mitigate this problem.</b><br/> text/html 2018-07-22T00:12:51+01:00 Jawad Lahma, Reda Hejjouji, Philippe Gicquel, Leila Essakalli [Case report] - Large cell neuroendocrine carcinoma of the nasal cavity: an extremely rare and new distinct entity - 29 June 2018. <b>Large cell neuroendocrine carcinoma (LCNEC) is a rare but distinct entity of nasal cavity carcinomas. Only a very few cases have been reported in the nasal cavity. Its treatment is not well established. We report the case of a LCNEC in a 70 years old patient who presented with right nasal obstruction and epistaxis since 2 months. Diagnosis was confirmed by histological and immunohistochemical study. The patient underwent complete endoscopic removal of the tumor combined to adjuvant chemoradiotherapy. After 6 month follow-up, the patient was in complete clinical and radiological remission. We will discuss in this paper the various epidemiology, clinical features, pathological findings, differential diagnosis, and evolution of treatment of this uncommon malignancy in the light of current knowledge. Optimal treatment strategies are yet to be determined for this rare malignancy with poor prognosis including surgery and chemoradiotherapy.</b><br/> text/html 2018-07-22T00:12:51+01:00 Kenza Baline, Fouzia Hali [Images in medicine] - Chromomycose cutan&eacute;e &agrave; Fonsecaea Pedrosoi: &agrave; propos d’un cas - 28 June 2018. <b>Nous rapportons le cas d’une patiente de 13 ans d’origine rurale qui pr&eacute;sentait une l&eacute;sion papulo-nodulaire de 4/3cm du tiers inf&eacute;rieur de la jambe droite, &eacute;voluant depuis deux ann&eacute;es. La biopsie cutan&eacute;e montrait une hyperplasie papillomateuse avec des micro-abc&egrave;s &agrave; polynucl&eacute;aires neutrophiles et des spores. L’&eacute;tude mycologique objectivait des corps fumagoides &agrave; l’examen direct et isolait Fonsecaea Pedrosoi &agrave; la culture. La patiente a b&eacute;n&eacute;fici&eacute; d’un traitement m&eacute;dico-chirurgical (terbinafine 250mg/j pendant 6 mois + ex&eacute;r&egrave;se puis greffe cutan&eacute;e) avec une bonne &eacute;volution, le recul actuel &eacute;tant de deux ann&eacute;es sans r&eacute;cidive. La chromomycose est une infection fongique chronique de la peau, fr&eacute;quente en zones tropicales et subtropicales et rare au nord de l’Afrique. Au Maroc, jusqu'&agrave; juin 2014, sept cas seulement ont &eacute;t&eacute; rapport&eacute;s dans la litt&eacute;rature. Elle est contract&eacute;e par inoculation du germe apr&egrave;s contact avec le sol ou les mati&egrave;res organiques. Les agents responsables sont des champignons pigment&eacute;s du groupe des d&eacute;mati&eacute;s. Compte tenu de sa raret&eacute;, elle peut mimer d’autres dermatoses comme la leishmaniose ou la tuberculose. Malgr&eacute; la raret&eacute; de cette infection, il faut y penser devant des l&eacute;sions cutan&eacute;es chroniques (verruqueuses, v&eacute;g&eacute;tantes, nodulaires, en plaque) surtout si elles sont localis&eacute;es au niveau des zones expos&eacute;es &agrave; d’&eacute;ventuels traumatismes v&eacute;g&eacute;taux comme les membres inf&eacute;rieurs. Ceci dit, la place de l’&eacute;tude mycologique parait ind&eacute;niable pour confirmer le diagnostic. Le traitement de choix est la chirurgie ou l’association chirurgie et antifongiques syst&eacute;miques car l’utilisation des antifongiques seuls peut se solder par des r&eacute;sistances ou des r&eacute;cidives.</b><br/> text/html 2018-07-22T00:12:51+01:00 Holaly Gbekley Efui, Damintoti Simplice Karou, Charlemagne Gnoula, Kodjovi Agbodeka, Kokou Anani, Tchadjobo Tchacondo, Amegnona Agbonon, Komlan Batawila, Jacques Simpore [Corrigendum] - Corrigendum: &Eacute;tude ethnobotanique des plantes utilis&eacute;es dans le traitement du diab&egrave;te dans la m&eacute;decine traditionnelle de la r&eacute;gion Maritime du Togo - 28 June 2018. <b>Ce Corrigendum modifie l’article original « &Eacute;tude ethnobotanique des plantes utilis&eacute;es dans le traitement du diab&egrave;te dans la m&eacute;decine traditionnelle de la r&eacute;gion Maritime du Togo ». The Pan African Medical Journal. 2015;20:437. doi:10.11604/pamj.2015.20.437.5660.</b><br/> text/html 2018-07-22T00:12:51+01:00 Pietro Fransvea, Zamira Keyser [Images in medicine] - A double jeopardy: transection of the aero-digestive tract after penetrating neck trauma - 28 June 2018. <b>A 32-year-old male patient presented to emergency department after sustained gunshot injury to the neck. Patient according to the advanced trauma life support (A.T.L.S.®) protocol appeared stable. The patient complained of dysphagia and odynophagia. Local examination revealed a gunshot entrance wound the left posterior neck triangle and no exit wound. A cervical bruising, subcutaneous emphysema was also noted. CT angiography of neck revealed a cut off of the right vertebral artery and extensive surgical emphysema which was suspicious for injury either the pharynx, oesophagus or trachea (A). A contrasted swallow revealed contrast extravasation consistent with hypopharyngeal/oesophageal injury (B). Given these findings, the patient was shifted to the operating room were a primary repair of the oesophagus and trachea was done with sternocleiod and omoiodeus muscle flap (A & B). Gunshot wound are still common worldwide especially in areas with high levels of criminal activities, gangsterism and lawlessness. In the past few years there has been a decline in the number of gunshot wounds seen at most major hospital but penetrating neck injuries are still commonly seen. Although many are minor injuries, they may deceptive in appearance and life threatening and the morbidity and mortality associated with blood loss and aerodigestive injuries remain significant.</b><br/> text/html 2018-07-22T00:12:51+01:00 Chtioui Mamoun, Fagouri Houda [Case report] - Infarctus spl&eacute;nique r&eacute;v&eacute;lant une endocardite infectieuse chez une femme enceinte: &agrave; propos d’un cas et br&egrave;ve revue de litt&eacute;rature - 27 June 2018. <b>Le diagnostic d’infarctus spl&eacute;nique est rarement &eacute;voqu&eacute; chez la femme enceinte. L’incidence actuelle de ces atteintes notamment au cours des endocardites infectieuses ainsi que les moyens diagnostiques utilis&eacute;s sont mal pr&eacute;cis&eacute;s dans la litt&eacute;rature. Une femme de 26 ans, sans ant&eacute;c&eacute;dent particulier ni facteur de risque cardio-vasculaire, au terme de 14 semaines d’am&eacute;norrh&eacute;e, consulte en urgence, pour un syndrome f&eacute;brile &eacute;voluant depuis 10 jours et l’apparition r&eacute;cente de douleur abdominale au niveau de l’hypochondre gauche. L’examen retrouve une fi&egrave;vre &agrave; 39,5°C, une sensibilit&eacute; de l’hypochondre gauche, et des panaris au niveau de la paume de la main gauche et de la plante du pied gauche. L’examen gyn&eacute;cologique &eacute;tait strictement normal. Devant ce tableau, une &eacute;chographie abdominale r&eacute;alis&eacute;e retrouve une image an&eacute;chog&egrave;ne m&eacute;diospl&eacute;nique &agrave; sommet hilaire et &agrave; bords p&eacute;riph&eacute;riques en faveur d’un infarctus spl&eacute;nique. Dans le cadre du bilan &eacute;tiologique, une &eacute;chocardiographie r&eacute;alis&eacute;e r&eacute;v&egrave;le une greffe osl&eacute;rienne sur la valve mitrale qui est &eacute;paissie et remani&eacute;e, avec une v&eacute;g&eacute;tation au niveau de la grande valve et une IM grade II. Des h&eacute;mocultures ont &eacute;t&eacute; r&eacute;alis&eacute;es lors des pics f&eacute;briles qui &eacute;taient revenues positives au staphylocoque dor&eacute;. L’&eacute;volution &eacute;tait marqu&eacute;e par la survenue d’un accident vasculaire c&eacute;r&eacute;bral isch&eacute;mique &eacute;tendu et aggravation de son &eacute;tat neurologique, conduisant au d&eacute;c&egrave;s apr&egrave;s plusieurs embolies syst&eacute;miques. L’atteinte spl&eacute;nique chez une femme enceinte est tr&egrave;s rare. Toutefois, devant une douleur abdominale aigue de l’hypochondre gauche, l’examen clinique et radiologique ne doit pas omettre l’exploration de la rate. Dans le cas pr&eacute;sent, la douleur de l’hypochondre gauche associ&eacute;e &agrave; une fi&egrave;vre et des faux panaris d’Osler s’est r&eacute;v&eacute;l&eacute;e &ecirc;tre un infarctus spl&eacute;nique en rapport avec une endocardite infectieuse. Une antibioth&eacute;rapie probabiliste de premi&egrave;re intention lors de l’endocardite infectieuse est justifi&eacute;e et devra &ecirc;tre secondairement adapt&eacute;e aux r&eacute;sultats bact&eacute;riologiques. Rare, l’infarctus spl&eacute;nique peut avoir des cons&eacute;quences s&eacute;v&egrave;res telles que des abc&egrave;s ou une rupture, ce qui doit appeler &agrave; une certaine vigilance.</b><br/> text/html 2018-07-22T00:12:51+01:00 Nassiba Elouarradi, Ghizlane El Mghari, Nawal El Ansari [Case report] - Difficult&eacute;s de prise en charge de la maladie de Basedow chez l’enfant: &agrave; propos d’un cas - 27 June 2018. <b>La prise en charge ad&eacute;quate de la maladie de Basedow chez l'enfant reste un sujet de controverse en endocrinologie p&eacute;diatrique et la dur&eacute;e optimale du traitement m&eacute;dical pour induire une r&eacute;mission de la maladie ainsi que les indications des th&eacute;rapeutiques alternatives, restent &agrave; d&eacute;finir. Nous rapportons l'observation d'une enfant &acirc;g&eacute;e de 11 ans, sans ant&eacute;c&eacute;dents pathologiques particuliers, qui consulte pour un amaigrissement progressif associ&eacute; &agrave; des diarrh&eacute;es. C'est devant la survenue d'une tum&eacute;faction cervicale ant&eacute;rieure constat&eacute;e par l'entourage que les parents d&eacute;cident de consulter. Les donn&eacute;es cliniques et paracliniques ont permis de retenir le diagnostic de la maladie de Basedow. La patiente a &eacute;t&eacute; mise sous traitement m&eacute;dical : Carbimazole. L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par l'apparition d'une thrombop&eacute;nie sugg&eacute;rant une administration prudente du traitement m&eacute;dical et devant l'absence de r&eacute;mission apr&egrave;s 4 ans de traitement, une irath&eacute;rapie a &eacute;t&eacute; indiqu&eacute;e. Bien que rare, la maladie de Basedow reste la premi&egrave;re cause de l'hyperthyro&iuml;die chez l'enfant. Son diagnostic positif est facile mais sa prise en charge peut poser d'&eacute;normes probl&egrave;mes. Le traitement m&eacute;dical se base sur les antithyro&iuml;diens de synth&egrave;se mais qui n'est pas toujours anodin comme pour le cas de notre patiente .la thyro&iuml;dectomie subtotale ou le traitement par iode radioactif sont les deux alternatives th&eacute;rapeutiques. De diagnostic positif facile, la maladie de Basedow est une maladie rare et s&eacute;v&egrave;re chez l'enfant et qui pose surtout des difficult&eacute;s de prise en charge.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mohamed Ben Jemaa, Wassim Zribi, Emna Elleuch, Wajdi Bouaziz, Ameur Abid, Soumaya Yaich, Mourad Aoui, Kamel Ayedi, Mounir Ben Jemaa, Mohamed Zribi, Hassib Keskes [Case report] - Bursite tuberculeuse de l’&eacute;paule chez une insuffisante r&eacute;nale chronique: &agrave; propos d’un cas - 27 June 2018. <b>La tuberculose de l'&eacute;paule est rare. Elle regroupe toutes les atteintes tuberculeuses des tissus articulaires et p&eacute;ri-articulaires de l'&eacute;paule. Son &eacute;volution insidieuse mimant les pathologies inflammatoires et d&eacute;g&eacute;n&eacute;ratives, explique la fr&eacute;quence de son retard diagnostique. Nous rapportons un cas rare d'une bursite tuberculeuse de l'&eacute;paule chez une femme de milieu rural, insuffisante r&eacute;nale et trait&eacute;e pour une tuberculose p&eacute;riton&eacute;ale et du psoas. Des signes d'impr&eacute;gnation tuberculeuse ont &eacute;t&eacute; not&eacute;s &agrave; l'anamn&egrave;se. L'examen clinique trouvait une tum&eacute;faction douloureuse de l'&eacute;paule avec raideur. L'IRM de l'&eacute;paule &eacute;tait en faveur d'une bursite infectieuse. L'origine tuberculeuse &eacute;tait confirm&eacute;e par l'examen histologique d'une biopsie synoviale &eacute;cho-guid&eacute;e. Un traitement antituberculeux lui a &eacute;t&eacute; instaur&eacute; avec bonne &eacute;volution. Au recul de 9 ans, elle retrouve une fonction articulaire satisfaisante avec absence de r&eacute;cidive infectieuse.</b><br/> text/html 2018-07-22T00:12:51+01:00 Saloua Azennoud, Mohamed Zarrouki [Images in medicine] - Corps &eacute;tranger intra irien - 27 June 2018. <b>Nous rapportons un cas d’un jeune homme &acirc;g&eacute; de 28 ans victime d’un traumatisme oculaire OG, l’examen ophtalmologique objectif au niveau de l’œil atteint une acuit&eacute; visuelle &agrave; 8/10 sans correction, une taie corn&eacute;enne &agrave; 7h (A) avec un corps &eacute;tranger intra irien en regard de la taie (B).</b><br/> text/html 2018-07-22T00:12:51+01:00 Salimanou Ariyoh Amidou, Comlan Albert Dovonou, Corine Houehanou, Ars&egrave;ne Amadohou&eacute; Kpangon, Rhonel Ahanhanzo-Glele, Julie Hounnouga Kpangon, Khadidjatou Sak&eacute; Alassan, Attinsounon Cossi Angelo, Blaise Tchaou, Kabibou Salifou, Thierry Adoukonou, Djimon Marcel Zannou, Dismand Stephan Houinato [Research] - Pr&eacute;valence de l’h&eacute;patite B chronique selon le statut s&eacute;rologique VIH &agrave; Parakou au B&eacute;nin - 27 June 2018. <b>INTRODUCTION: La pr&eacute;valence de l’h&eacute;patite B est tr&egrave;s variable &agrave; travers les espaces g&eacute;ographiques et semble influenc&eacute;e par l’infection &agrave; VIH. La pr&eacute;sente &eacute;tude vise &agrave; comparer la pr&eacute;valence de l’h&eacute;patite B en fonction du statut s&eacute;rologique VIH en milieu hospitalier &agrave; Parakou au B&eacute;nin. METHODES: il s’agissait d’une &eacute;tude transversale incluant les adultes de 18 ans et plus re&ccedil;us au Centre Hospitalier Universitaire et D&eacute;partemental de Parakou entre Mai 2011 et Juin 2012. Le diagnostic de l’h&eacute;patite B a &eacute;t&eacute; fait par la recherche de l’antig&egrave;ne HBs et celui du VIH par des tests rapides sur des pr&eacute;l&egrave;vements de sang veineux. Les donn&eacute;es ont &eacute;t&eacute; analys&eacute;es avec le logiciel EpiInfo. Un mod&egrave;le de r&eacute;gression logistique multivariable a &eacute;t&eacute; d&eacute;velopp&eacute; pour explorer les facteurs associ&eacute;s &agrave; la pr&eacute;sence de l’h&eacute;patite B. RESULTATS: sur un total de 1516 sujets inclus, 744 &eacute;taient s&eacute;ropositifs au VIH. L’&acirc;ge moyen &eacute;tait de 31,3 + 11,1 ans et 65,1% &eacute;taient des femmes. La pr&eacute;valence de l’h&eacute;patite B dans l’ensemble de l’&eacute;chantillon a &eacute;t&eacute; estim&eacute;e &agrave; 13,9% [IC95: 12,2%-15,7%]. Cette pr&eacute;valence &eacute;tait plus &eacute;lev&eacute;e chez les sujets s&eacute;ropositifs au VIH (16,9% vs 10,9%; p < 0,0006), mais la diff&eacute;rence n’est cependant plus significative en analyse multivari&eacute;e, en dehors du groupe des sujets originaires du Borgou/Alibori (p < 0,02). Une association constante a toutefois &eacute;t&eacute; observ&eacute;e entre la tranche d’&acirc;ge de 24 &agrave; 44 ans (p < 0,03), le sexe masculin (p < 0,01), le niveau d’&eacute;tude primaire (p < 0,02) et une pr&eacute;valence &eacute;lev&eacute;e de l’h&eacute;patite B. CONCLUSION: la pr&eacute;valence de l’h&eacute;patite B &eacute;tait plus &eacute;lev&eacute;e chez les sujets s&eacute;ropositifs au VIH. Elle est influenc&eacute;e par l’&acirc;ge, le sexe, le niveau d’instruction et l’origine g&eacute;ographique.</b><br/> text/html 2018-07-22T00:12:51+01:00 Lillian Ojanduru, Dickens Ojamuge, Lauren DuComb, Jeannette Cachan, Esther Spindler [Research] - Testing a proof of concept model for group couples counseling in family planning in Northern Uganda - 27 June 2018. <b>INTRODUCTION: The post-conflict Acholi sub-region of Uganda is undergoing a period of transition that is influencing access, acceptability and use of family planning (FP). Low FP use and high unmet need for FP in Uganda's northern region provides a unique opportunity to test a community-based group counseling approach to reduce unintended pregnancies among young couples. We share findings from a proof of concept testing model in delivering fertility awareness methods (FAM) to groups of couples by trained non-health community youth agents. METHODS: The group counseling model was developed for couples interested in two FAM—standard days method (SDM) and TwoDay Method–within rural communities in Northern Uganda. WALAN was tested in a three-month proof of concept phase, employing 24 direct observations of group counseling sessions; quantitative interviews with 9 couples using either SDM or TwoDay method; 2 focus group discussions with youth facilitators and; 9 key informant interviews with providers and leaders. RESULTS: The proof of concept results suggest model feasibility and acceptability among participating communities. Couples learned how to use FAM correctly. All 9 interviewed female users reported 100% correct knowledge of method use. Couples also reported high levels of satisfaction for both methods. SDM and TwoDay Method participants reported comfort and satisfaction in learning about FAM in small groups with other couples. CONCLUSION: The proof of concept phase confirmed intervention feasibility, albeit with some model adjustments. The results were used to inform the pilot intervention, launched in April 2016 within 15 other villages in the same region.</b><br/> text/html 2018-07-22T00:12:51+01:00 Hudson Taabukk Kigen, Tura Galgalo, Jane Githuku, Jacob Odhiambo, Sara Lowther, Betty Langat, Joyce Wamicwe, Robert Too, Zeinab Gura [Research] - Predictors of loss to follow up among HIV-exposed children within the prevention of mother to child transmission cascade, Kericho County, Kenya, 2016 - 27 June 2018. <b>INTRODUCTION: HIV-exposed infants (HEI) lost-to-follow-up (LTFU) remains a problem in sub Saharan Africa (SSA). In 2015, SSA accounted >90% of the 150,000 new infant HIV infections, with an estimated 13,000 reported in Kenya. Despite proven and effective HIV interventions, many HEI fail to benefit because of LTFU. LTFU leads to delays or no initiation of interventions, thereby contributing to significant child morbidity and mortality. Kenya did not achieve the < 5% mother-to-child HIV transmission target by 2015 because of problems such as LTFU. We sought to investigate factors associated with LTFU of HEI in Kericho County, Kenya. METHODS: A case-control study was conducted in June 2016 employing 1:2 frequency matching by age and hospital of birth. We recruited HEI from HEI birth cohort registers from hospitals for the months of September 2014 through February 2016. Cases were infant-mother pairs that missed their 3-month clinic appointments while controls were those that adhered to their 3-month follow-up visits. Consent was obtained from caregivers and a structured questionnaire was administered. We used chi-square and Fisher’s Exact tests to compare groups, calculated odds ratios (OR) and 95% confidence intervals (CI), and performed logistic regression to identify independent risk factors. RESULTS: We enrolled 44 cases and 88 controls aged &#8805;3 to 18 months: Cases ranged from 7.3–17.8 months old and controls from 6.8–17.2 months old. LTFU cases’ caregivers were more likely than controls’ caregivers to fear knowing HEI status (aOR= 12.71 [CI 3.21–50.23]), lack knowledge that HEI are followed for 18 months (aOR= 12.01 [CI 2.92–48.83]), avoid partners knowing their HEI status(OR= 11.32 [CI 2.92–44.04]), and use traditional medicine (aOR= 6.42 [CI 1.81–22.91]).Factors that were protective of LTFU included mothers knowing their pre-pregnancy HIV status (aOR= 0.23 [CI 0.05–0.71]) and having household health insurance (aOR= 0.11 [CI 0.01–0.76]). CONCLUSION: Caregivers’ intrinsic, interpersonal, community and health system factors remain crucial towards reducing HEI LTFU. Early HIV testing among mothers, disclosure support, health education, and partner involvement is advocated. Encouraging households to enroll in health insurance could be beneficial. Further studies on the magnitude and the reasons for use of home treatments among caregiver are recommended.</b><br/> text/html 2018-07-22T00:12:51+01:00 Lemma Negesa Bulto, Yadeta Dessie, Biftu Geda [Research] - Magnitude, causes and characteristics of trauma victims visiting Emergency and Surgical Units of Dilchora Hospital, Eastern Ethiopia - 27 June 2018. <b>INTRODUCTION: In developing countries, approximately sixteen hundred people die every day from all types of injuries, making injury the third most common cause of all mortalities in the region. The objective of this study was to examine the magnitude, causes and types of traumatic injuries in patients visiting Dilchora Hospital in Dire Dawa Administration of Eastern Ethiopia. METHODS: we conducted a cross-sectional study which was supplemented with qualitative data. Descriptive and thematic analyses were used to characterize the trauma in terms of victims, causes and types. RESULTS: a total of 382 patients were identified within a two-month period of data collection. The most common causes of traumatic injuries identified were conflict (42.67%), road traffic accidents (35.07%), falls (13.35%) and burn injuries (8.90%). Soft tissue injuries (57.6%), abrasion (29.3%) and fractures (22.3%) were the three most common types of injuries experienced. Most of the victims were males, those people in the productive age bracket and those living in urban areas. Poor road structure, poor adherence to traffic rules and the use of old and poorly maintained vehicles were the main reasons for the road traffic accidents. Substance use behaviors in urban areas and farmland boundary issues in rural areas were the common causes of conflicts, and females were the most common victims of burn injuries. CONCLUSION: a high magnitude of injuries was observed such that, on average, six trauma victims visited the hospital each day. Conflict and road traffic accidents were the two most common causes of traumatic injuries. Poor vehicular conditions and poor road design were the main reasons identified for road traffic accident related trauma, which requires multilevel interventions.</b><br/> text/html 2018-07-22T00:12:51+01:00 Julienne Noude Teclessou, Bayaki Saka, S&eacute;fako Abla Akakpo, Houassou Matakloe, Abas Mouhari-Toure, Kousak&eacute; Kombate, Inoussa Oniankitan, Palokinam Pitche [Case study] - Les connectivites en milieu hospitalier &agrave; Lom&eacute;: &eacute;tude r&eacute;trospective de 231 cas - 26 June 2018. <b>Le but de cette &eacute;tude &eacute;tait de documenter le profil &eacute;pid&eacute;miologique, clinique, th&eacute;rapeutique et &eacute;volutif des connectivites en milieu hospitalier &agrave; Lom&eacute;. Il s'agissait d'une &eacute;tude r&eacute;trospective descriptive men&eacute;e du 1er Janvier 1993 au 31 D&eacute;cembre 2012. Elle a port&eacute; sur les dossiers des malades ayant souffert d'une connectivite dans cinq services de dermatologie et de rhumatologie des centres hospitaliers de Lom&eacute;. Au cours de la p&eacute;riode d'&eacute;tude, nous avons recens&eacute; 231 cas de connectivites dans les cinq centres d'&eacute;tude, ce qui correspondait &agrave; une fr&eacute;quence de 0,19% des consultations. L'&acirc;ge moyen des patients &eacute;tait de 36,96±15 ans et la sex-ratio de 0,2. Les principales connectivites &eacute;taient la maladie lupique (50,22%); les scl&eacute;rodermies (21,64%) et la polyarthrite rhumato&iuml;de (20,35%). Sur le plan clinique, les principales manifestations cliniques des connectivites &eacute;taient les l&eacute;sions de lupus disco&iuml;de (87,50%) et la photosensibilit&eacute; (82,50%) chez les patients ayant un lupus &eacute;ryth&eacute;mateux syst&eacute;mique; la scl&eacute;rose cutan&eacute;e (90,48%) chez les patients ayant une scl&eacute;rodermie syst&eacute;mique; et une atteinte articulaire distale (100%) chez les patients ayant une polyarthrite rhumato&iuml;de. La corticoth&eacute;rapie g&eacute;n&eacute;rale &eacute;tait le traitement de base des patients ayant un lupus &eacute;ryth&eacute;mateux syst&eacute;mique (92,5%) et une polyarthrite rhumato&iuml;de (73,47%). Les connectivites sont des affections rares &agrave; Lom&eacute;, avec une pr&eacute;dominance de la maladie lupique. Elles sont plus fr&eacute;quentes chez la femme jeune. La corticoth&eacute;rapie g&eacute;n&eacute;rale reste leur traitement de base.</b><br/> text/html 2018-07-22T00:12:51+01:00 Adewale Luqman Oyeyemi, Adetoyeje Yoonus Oyeyemi, Babatunji Abayomi Omotara, Aliyu Lawan, Kingsley Kolapo Akinroye, Rufus Adesoji Adedoyin, Andrea Ram&iacute;rez [Short communication] - Physical activity profile of Nigeria: implications for research, surveillance and policy - 26 June 2018. <b>Appraising the status of physical activity surveillance, research and policy in Nigeria is relevant to national and regional public health actions on physical activity promotion and non-communicable disease control. This study aimed to 1) evaluate the physical activity profile of Nigeria and 2) propose strategies for improving physical activity in the country. The Global Observatory for Physical Activity-GoPA! with inputs from local experts systematically collected sociodemographic and physical activity surveillance, national policy and research indicators data for Nigeria in 2014. The Nigerian Country Card highlighting the status of these indicators was developed in 2015 and launched in 2016. Prevalence of physical activity among Nigerian adults was 78% (female=76%, male=79%). There was no physical activity surveillance system and national plan, and no empirical data on the proportion of all deaths directly due to physical inactivity in Nigeria. Few (n=7) articles related to physical activity and public health were published in 2013 and the country occupied the 38th position in the global research ranking, contributing about 0.24% to physical activity research worldwide. Implementing national physical activity plans and multi-sectorial collaborations between government and non-governmental partners are needed to improve physical activity surveillance, research and policy in Nigeria and other African countries with similar physical activity gaps.</b><br/> text/html 2018-07-22T00:12:51+01:00 Baccouch Seifeddine, Challakhi Amel, Talbi Ghofrane, Bacha Dhouha, Gharbi Lassaad, Bayar Rached, Khalfallah Mohamed Taher [Case report] - Rupture spontan&eacute;e d’un kyste hydatique du foie dans la cavit&eacute; p&eacute;riton&eacute;ale avec une membrane prolig&egrave;re intacte: &agrave; propos d’un cas et revue de la litt&eacute;rature - 26 June 2018. <b>La rupture intrap&eacute;riton&eacute;ale du kyste hydatique du foie avec une membrane prolig&egrave;re intacte est rare. Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 63 ans qui avait consult&eacute; pour douleur de l'hypochondre droit sans fi&egrave;vre ni ict&egrave;re. L'imagerie trouvait un kyste hydatique du segment IV du foie associ&eacute; &agrave; une l&eacute;sion kystique pelvienne de 12cm x 06cm. L'exploration chirurgicale trouvait un kyste hydatique univ&eacute;siculaire du foie rompu avec une membrane prolig&egrave;re intacte et libre dans la cavit&eacute; p&eacute;riton&eacute;ale. Le but de ce travail est de rapporter un nouveau cas de rupture intrap&eacute;riton&eacute;ale d'un kyste hydatique du foie avec membrane prolig&egrave;re intacte et de pr&eacute;ciser les difficult&eacute;s diagnostiques et th&eacute;rapeutiques rencontr&eacute;es au d&eacute;cours de cette complication.</b><br/> text/html 2018-07-22T00:12:51+01:00 Seth Selorm Klobodu, Sarah Kessner, Levi Johnson [Letter to the editors] - Africa is on the verge of a major health crisis and the need for nutrition and health surveys is imperative - 26 June 2018. <b>The African region may be reaching a tipping point for a major health crisis. Over the last few decades for example, there has been a significant increase in the prevalence of obesity and associated comorbidities. This alarming trend is attributed to the rapid urbanization, increase in income, and unhealthy lifestyles among many others. Most importantly, managing and treating non-communicable diseases (NCDs) is expensive and proving to be beyond the reach of ordinary Africans. Interestingly, Africa has not fully eradicated undernutrition particularly micronutrient malnutrition especially among women and children. Additionally, HIV/AIDs, malaria, diarrheal diseases and other preventable infectious diseases continue to pose serious threat to the health of the populace. The management of NCDs is challenging and costly as most healthcare systems on the continent are largely built for the provision of curative care for communicable diseases. This article proposes the institution of nutrition and health surveys in individual countries to monitor trends. We believe this approach, in addition to addressing lifestyle and behavioral factors, may be effective in curbing the rising phenomenon of obesity and NCDs.</b><br/> text/html 2018-07-22T00:12:51+01:00 Olufunke Bolaji, Olagoke Erinomo, Olufunmilayo Adebara, Julia Okolugbo, Bartholomew Onumajuru, Taiwo Akanni, Olusegun Adebami [Case report] - Autosomal recessive polycystic kidney disease (ARPKD) in a Nigerian newborn: a case report - 25 June 2018. <b>Autosomal recessive polycystic kidney disease (ARPKD) is a rare genetic disorder but even rarer in Africans and it is one of the causes of nephropathies in childhood. Although isolated cases of adult PKD have been reported in Nigerians; to the best of our knowledge, this case is the first to be reported in the paediatric age group in Nigeria. A case of autosomal recessive polycystic kidney disease presenting with severe perinatal asphyxia and severe respiratory distressis hereby presented. Fetal ultrasonography during the pregnancy missed the diagnosis. The difficulty in making diagnosis and management is discussed. Autopsy helped to unravel the diagnosis in this case report.</b><br/> text/html 2018-07-22T00:12:51+01:00 Poobalan Naidoo, Naresh Ranjith, Zuzile Zikalala, Scott Mahoney, Kevin Ho [Case report] - Marfan syndrome: a case report and pictorial essay - 25 June 2018. <b>We report a case of Marfan syndrome (MFS) in a South African patient, which is extraordinary because of the large constellation of clinical, radiological and vascular anomalies in a single patient. A literature search from 1950 to date did not show a similar report of such extensive clinical characteristics of MFS.</b><br/> text/html 2018-07-22T00:12:51+01:00 Catherine Atuhaire, Samuel Nambile Cumber [Short communication] - Factors associated with postpartum depression among adolescents in Uganda - 25 June 2018. <b>Postpartum depression (PPD) is a common and disabling public health complication of the postpartum period in women. It is believed to occur three times more commonly in developing countries than in the developed world and is more prevalent among women in the first six weeks after birth. Research suggests that postpartum depression is more commonly diagnosed among adolescents and may be a risk factor for poor growth and development in children born to these mothers. Therefore, adolescents are a special age group that requires specific health care maternal interventions in order to detect and treat post-partum depression.</b><br/> text/html 2018-07-22T00:12:51+01:00 Gueye Mamadou Ngon&eacute;, Bass&egrave;ne Marie Louise, Bodian Malick, Diallo Salamata, Thioubou Mame A&iuml;ss&eacute;, Halim Ambdil, Fall Mari&egrave;me Pol&egrave;le, Ciss&eacute; Cheikh Ahmadou Bamba, Dia Daouda, Mbengue Mouhamadou, Ba Serigne Abdou, Diouf Mamadou Lamine [Case series] - Anomalies électrocardiographiques et échocardiographiques au cours de la cirrhose virale b: à propos de 60 cas au service d’hepato-gastroenterologie de l’Hopital Aristide Le Dantec de Dakar (HALD) - 25 June 2018. <b>L’objectif de cette &eacute;tude est d’&eacute;valuer les anomalies &eacute;lectrocardiographiques et &eacute;chocardiographiques chez les patients atteints de cirrhose virale B et identifier leurs d&eacute;terminants. Il s’agissait d’une &eacute;tude prospective sur 8 mois aux services de d’H&eacute;pato-Gastroent&eacute;rologie et de Cardiologie de l’h&ocirc;pital Aristide Le Dantec de Dakar. Tous les patients atteints de cirrhose B virale et n’ayant pas de cardiopathie pr&eacute; existante connue ont &eacute;t&eacute; inclus. Nous avons collect&eacute; et analys&eacute; les donn&eacute;es &eacute;pid&eacute;miologiques, cliniques, biologiques, &eacute;chographiques, endoscopiques, &eacute;lectrocardiographiques et &eacute;chocardiographiques (2D et Doppler) de tous les patients. Les donn&eacute;es ont &eacute;t&eacute; saisies sur tableau Excel 2007 et analys&eacute;es &agrave; l’aide du logiciel Sphinx version 5.La comparaison des variables a &eacute;t&eacute; faite par les tests de Chi 2 standard et Fisher.Le seuil de significativit&eacute; a &eacute;t&eacute; arr&ecirc;t&eacute; &agrave; p< 0,05 pour ces 2 tests statistiques. Soixante patients ont &eacute;t&eacute; inclus. La pr&eacute;valence de la cirrhose virale B &eacute;tait de 3,4%. L’&acirc;ge moyen &eacute;tait de 41 ans et le sex ratio de 1,6 (37 hommes). La cirrhose &eacute;tait class&eacute;e Child-Pugh B chez 29 patients (49%), Child-Pugh C et Child Pugh A respectivement chez 20 patients (33%) et 11 patients (18%). Les anomalies &eacute;lectrocardiographiques les plus fr&eacute;quentes &eacute;taient l’hypertrophie ventriculaire gauche et l’allongement de l’intervalle QTc objectiv&eacute;s respectivement chez 27 patients (45%) et 24 patients (40%). L’analyse statistique a montr&eacute; une association entre l’intervalle QTc prolong&eacute; et la gravit&eacute; de la cirrhose (p = 0,01, RR = 2, IC = 0,24 &agrave; 0,341). Les anomalies &eacute;chocardiographiques &eacute;taient domin&eacute;es par la dilatation ventriculaire gauche (58,3%) et l’hyperd&eacute;bit cardiaque (43,3%) avec un d&eacute;bit moyen de 6,05 l / min. L’analyse stastistique mettait en &eacute;vidence une association significative entre la gravit&eacute; de la cirrhose et l’hyperd&eacute;bit cardiaque (p = 0,003; IC: 95% (de 2,883 &agrave; 38,58; RR = 2). Au total, 14 patients (23,3%) avaient une cardiomyopathie cirrhotique latente. La cirrhose virale B peut induire des anomalies cardiaques diverses et vari&eacute;es. Ces anomalies sont morphologiques et/ou &eacute;lectrophysiologiques et leur gravit&eacute; semble corr&eacute;l&eacute;e &agrave; la s&eacute;v&eacute;rit&eacute; de la cirrhose.</b><br/> text/html 2018-07-22T00:12:51+01:00 Raphael Ouede, Blaise Demine Alexandre, Ayegnon Kouakou Gregoire, Landry Kohou-kone, Edouard N’guessan, Maurice Gabin Kouacou, Jean-Marcel Ahui Brou, Flavien Kouassi Kendja, Yves Tanauh [Case series] - Pneumothorax catamenial: resultats de 18 cas op&eacute;r&eacute;s - 25 June 2018. <b>L'objectif de notre &eacute;tude &eacute;tait de proposer une approche th&eacute;rapeutique du pneumothorax catam&eacute;nial &agrave; partir des r&eacute;sultats de nos 18 cas op&eacute;r&eacute;s. Il s'agit d'une &eacute;tude r&eacute;trospective de Janvier 1994 &agrave; D&eacute;cembre 2016 qui a concern&eacute; 18 patientes &acirc;g&eacute;es en moyenne de 32,2 ans op&eacute;r&eacute;es d'un pneumothorax catam&eacute;nial droit (16 cas) et bilat&eacute;ral (2 cas). Les patientes ont &eacute;t&eacute; r&eacute;parties en 3 groupes en fonction de l'&eacute;volution dans le temps de notre attitude chirurgicale: le groupe 1 (G1) de janvier 1994 &agrave; juin 2006, le groupe 2 (G2) de juillet 2006 &agrave; f&eacute;vrier 2008 et le groupe 3(G3) de mars 2008 &agrave; d&eacute;cembre 2016, ces groupes contenaient respectivement 5, 2 et 11 patientes. Ces patientes toutes nullipares avaient une dysm&eacute;norrh&eacute;e depuis la pubert&eacute; associ&eacute;e dans 11 cas &agrave; des douleurs thoraciques catam&eacute;niales. La radiographie standard du thorax a &eacute;t&eacute; syst&eacute;matique et compl&eacute;t&eacute;e dans 8 cas par un scanner thoracique qui a objectiv&eacute; en plus du pneumothorax, des bulles apicales (5 cas). L'exploration par mini thoracotomie post&eacute;ro-lat&eacute;rale (16 cas) et par vid&eacute;othoracoscopie (2 cas de G3) a retrouv&eacute; des fenestrations diaphragmatiques (18 cas) et des bulles (5 cas). La biopsie des l&eacute;sions et la r&eacute;section des bulles a &eacute;t&eacute; syst&eacute;matique. Vis-&agrave;-vis des fenestrations diaphragmatiques, la chirurgie a consist&eacute; dans le groupe 1 en une r&eacute;section-suture avec abrasion pleurale, dans le groupe 2 une couverture par un patch de Gore-tex avec abrasion pleurale et dans le groupe 3 une couverture par un patch avec talcage pleural. Une hormonoth&eacute;rapie (triptoreline) de 6 mois a &eacute;t&eacute; prescrite &agrave; chaque patiente en postop&eacute;ratoire pour suspendre les menstrues. Le r&eacute;sultat de la chirurgie a &eacute;t&eacute; appr&eacute;ci&eacute; sur la base de la survenue ou non d'une r&eacute;cidive du pneumothorax &agrave; la reprise des menstrues. La mortalit&eacute; a &eacute;t&eacute; nulle. Le s&eacute;jour hospitalier post op&eacute;ratoire moyen &eacute;tait de 9,32 jours. Les examens anatomopathologiques ont confirm&eacute; l'endom&eacute;triose thoracique dans 9 cas. Apr&egrave;s un suivi moyen de 5,3 ans, le r&eacute;sultat &eacute;tait bon chez 12 patientes (3/5 de G1, 1/2 de G2 et 8/11 de G3), 3 patientes de G3 ont continu&eacute; de pr&eacute;senter des &eacute;pisodes de dyspn&eacute;e minime au d&eacute;but de quelques menstrues sans r&eacute;cidive radiologique, 3 patientes (2 de G1 et 1 de G2) ont r&eacute;cidiv&eacute; et ont fait l'objet de reprise chirurgicale. En cas de pneumothorax catam&eacute;nial avec fenestrations diaphragmatiques, nous proposons une phr&eacute;noplastie de recouvrement au patch associ&eacute;e &agrave; un talcage pleural et une hormonoth&eacute;rapie compl&eacute;mentaire concomitante de 6 mois.</b><br/> text/html 2018-07-22T00:12:51+01:00 Kome Otokunefor, Paul Agbude, Tosanwumi Vincent Otokunefor [Research] - Non-clinical isolates as potential reservoirs of antibiotic resistance in Port Harcourt, Nigeria - 25 June 2018. <b>INTRODUCTION: Multidrug resistance (MDR) is a growing problem worldwide. This type resistance often arises due to the sequential acquisition of drug resistance determinants and subsequent clonal spread. It is therefore important to determine possible reservoirs of these MDR gene to help set out control strategies. This study was aimed at analysing susceptibility patterns of various non-clinical Gram negative bacterial strains to determine their potential as reservoirs of MDR. METHODS: thirty-five non-clinical Gram negative bacteria were identified and susceptibility profile determined using standard methodologies. RESULTS: findings showed a preponderance of Pseudomonas aeruginosa and Escherichia Coli. Resistance rates of above 80% were noted in 50% of antibiotics, though none of the isolates were resistant to Ofloxacin. Majority of isolates (68.6%) had a multiple antibiotic resistance (MAR) index greater than 0.5, but only 20% of Escherichia Eoli. were found in this category. A high level of MDR was noted in this study (71.4%), but again only 20% of these were Escherichia Coli. CONCLUSION: Gram negative bacteria are the most common group of bacteria frequently encountered in clinical microbiology. In more recent years, infections with these organisms have been further complicated by the phenomenon of drug resistance. Non-clinical isolates have been postulated as possible reservoirs. Findings from this study of widespread multidrug resistance support this idea. This study however highlights the lack of MDR in Escherichia Coli, which is promising. More extensive studies will need to be carried out to properly assess the role of non-clinical isolates as reservoirs of MDR determinants.</b><br/> text/html 2018-07-22T00:12:51+01:00 Peter Magati, Jeffrey Drope, Leopold Mureithi, Raphael Lencucha [Research] - Socio-economic and demographic determinants of tobacco use in Kenya: findings from the Kenya Demographic and Health Survey 2014 - 25 June 2018. <b>INTRODUCTION: Every year, more than 6,000 Kenyans die of tobacco related diseases (79 men and 37 women die per week), while more than 220,000 children and more than 2,737,000 adults continue to use tobacco each day. Some suggest that these numbers will rise without concerted efforts to strengthen the implementation of tobacco control measures. To date, there remains much to be learned about what contributes to tobacco consumption in Kenya. This study analyses the socio-economic and demographic determinants of tobacco use in Kenya. METHODS: to analyze the determinants of tobacco use in Kenya, this study uses the 2014 Kenya Demographic and Health Survey. A logistic regression is used to estimate the probability of an individual smoking, given a set of socio-economic and demographic characteristics. RESULTS: results suggest that the overall smoking and smokeless prevalence rate is 17.3% and 3.10% respectively among men. Women have low rates with smoking and smokeless prevalence standing at 0.18% and 0.93% respectively. However, for both genders, tobacco use is influenced by age, marital status, residence, region, educational status and gender. CONCLUSION: socio-economic, demographic and geographic disparities on tobacco use should be explored in order to ensure prudent allocation of resources used for tobacco control initiatives. Allocation of resources for tobacco control including monitoring advertisements, sales to underage persons and general distribution of human resource for tobacco control should be based on socio-economic and demographic dynamics.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mohammed Chahbouni, Issam Eloukili, Mohamed Ali Berrady, Moulay Omar Lamrani, Mohamed Kharmaz, Farid Ismail, Mustapha Mahfoud, Ahmed El Bardouni, Mohamed Saleh Berrada, Mouradh El Yaacoubi [Corrigendum] - Corrigendum: Schwannome b&eacute;nin du nerf grand sciatique, &agrave; propos de 2 cas - 25 June 2018. <b>This Corrigendum corrects “Schwannome b&eacute;nin du nerf grand sciatique, &agrave; propos de 2 cas” The Pan African Medical Journal. 2014;18:252. doi:10.11604/pamj.2014.18.252.4684.</b><br/> text/html 2018-07-22T00:12:51+01:00 Meriem Rachidi, Fatima Azzahraa Moussair, Naima Daoudi, Nabila Soraa [Case report] - M&eacute;ningite &agrave; Haemophilus influenzae de type non b chez un nourrisson: cause rare &agrave; pronostic r&eacute;serv&eacute; - 22 June 2018. <b>Non-type b Haemophilus influenzae strains are a rare cause of invasive secondary involvement in infants. We here report the case of a 11-month old infant with meningitis caused by non-type b Haemophilus influenzae, a polymorphic gram-negative bacillus exceptionally described in the literature, of unknown origin and with fatal outcome. Clinicians and microbiologists should suspect these uncommon serotypes as a cause of meningitis.</b><br/> text/html 2018-07-22T00:12:51+01:00 Wassim Zribi, Mohamed Zribi, Mohamed Ben Jemaa, Wajdi Bouaziz, Ameur Abid, Abdesslem Naceur, Yosr Hantati, Moez Trigui, Zoubayer Ellouze, Kamel Ayedi, Hassib Keskes [Case report] - Arthrose post-traumatique carpo-m&eacute;tacarpienne du cinqui&egrave;me doigt trait&eacute;e par arthroplastie stabilis&eacute;e: &agrave; propos de deux cas et revue de la litt&eacute;rature - 22 June 2018. <b>Les fractures-luxations anciennes de la base du cinqui&egrave;me m&eacute;tacarpien peuvent se compliquer d'une arthrose post-traumatique g&ecirc;nante sur le plan fonctionnel et de prise en charge difficile. La technique d'arthroplastie stabilis&eacute;e comporte une r&eacute;section arthroplastique de la base du cinqui&egrave;me m&eacute;tacarpien associ&eacute;e &agrave; une arthrod&egrave;se diaphyso-m&eacute;taphysaire lat&eacute;rale entre le quatri&egrave;me et le cinqui&egrave;me m&eacute;tacarpien. A travers deux observations, nous pr&eacute;sentons les objectifs de cette technique d'arthroplastie stabilis&eacute;e et ses particularit&eacute;s par rapport aux autres techniques destin&eacute;es au traitement des s&eacute;quelles des fractures-luxations de la base du M5.</b><br/> text/html 2018-07-22T00:12:51+01:00 Omar Abdulwadud, Fiseha Tadesse, Getachew Yilma, Metti Midekssa, Irina Ibraghimova [Research] - Knowledge and experience with cochrane and evidence based medicine among health professionals in Debreberhan Referral Hospital in Ethiopia: a cross-sectional survey - 22 June 2018. <b>INTRODUCTION: Cochrane generates and disseminates high-quality systematic reviews through the cochrane library. We surveyed Ethiopian health professionals' knowledge and experience with cochrane, the cochrane library and Evidence Based Medicine (EBM). METHODS: a cross-sectional survey was conducted using a convenient sample of health professionals in DebreBerhan Referral hospital in Ethiopia. Participants completed a pre-tested self-administered survey before EBM training. Data were analyzed using Fisher's exact or Chi-Squared test with Yates' correction. The strength of association between variables was quantified using odds ratios with 95% confidence intervals. RESULTS: the response rate was 71.4% (35/49). Over half (54.3%) of the sample were males; 68.6% aged d" 30 years; 54.3% were physicians and 37.1% were nurses. Up to 65.7% had heard about Cochrane and only two knew cochrane South Africa as their reference centre. Nearly 48.6% were aware of the cochrane library, of whom 46% accessed it however; none used it for lacking awareness, search skills, access to internet and time constraints. Majority had a positive attitude towards EBM; 45.7% had heard of EBM; 74.3% rated their EBM knowledge as low; 74.3% lacked EBM training; and 88.6% were keen to attend EBM course. Adequate EBM knowledge was correlated with prior training (OR = 3.7, 95% CI 1.9-6.9, P<0.001], high self-assessment of EBM knowledge (OR = 0.27, 95% CI 0.14-0.51, P<0.001), male gender (P = 0.04), a positive attitude towards EBM (P = 0.001) and awareness of Cochrane (P = 0.004). CONCLUSION: Ethiopian health professionals have unmet training needs and want support through professional development workshops and an improved education system to provide high-quality evidence-based healthcare.</b><br/> text/html 2018-07-22T00:12:51+01:00 Kadir Acar, Burak Uz [Case report] - A chronic myeloid leukemia case with a variant translocation t(11;22)(q23;q11.2): masked Philadelphia or simple variant translocation? - 22 June 2018. <b>Chronic myeloid leukemia (CML) is characterized by the presence of the Philadelphia chromosome (Ph), usually due to a reciprocal translocation, t(9;22)(q34;q11.2). The remaining cases (2-10%) have variant translocation, and more rarely (~1%) a cryptic rearrangement is present which can be detected by fluorescence in situ hybridization analysis in a CML patient with a Ph-negative karyotype (Masked Ph). We present a masked/variant BCL-ABL-positive CML patient showing a t(11;22)(q23;q11.2) which was detected using a combined approach of conventional cytogenetics and reverse transcription polymerase chain reaction. In February 2013, the patient was diagnosed as having CML. Imatinib mesylate (400 mg/day), was then started. Under imatinib therapy a complete hematologic and cytogenetic response was attained. In December 2013, an increment in BCR-ABL/ABL transcript levels according to the International Scale (from 0.0471% to 1.4034%), indicating imatinib failure, was documented. Administration of nilotinib (400 mg twice daily) resulted in durable molecular response after 3 months. The patient is still on nilotinib treatment throughout the observation period with no sign of recurrence and adverse events.</b><br/> text/html 2018-07-22T00:12:51+01:00 Christian Umuhoza, Angelique Charlie Karambizi,Lisine Tuyisenge, Peter Cartledge [Research] - Caregiver delay in seeking healthcare during the acute phase of pediatric illness, Kigali, Rwanda - 22 June 2018. <b>INTRODUCTION: Delay in seeking healthcare contributes significantly to under-five mortality. Multiple socioeconomic and demographic factors have been reported as predictors of such delay. There is no published research in this area in Rwanda. Our aim was to describe the caregivers' delay in seeking healthcare during the acute phase of a childhood illness among under-five children admitted in a tertiary hospital, Rwanda. METHODS: this was an analytical, descriptive cross-sectional study conducted at University Teaching Hospital of Kigali. Bivariate analysis and logistic multivariate regression were used to analyze factors associated with delayed care-seeking behavior, defined as seeking care after the first 48 hours of illness onset. RESULTS: among 275 admitted children under age five, care-seeking delay occurred in 35% (97/275) of cases. The most significant predictors of delay in seeking care were use of traditional healers (AOR = 14.87, 95% CI: 3.94-56.12), the recognition of illness as mild (AOR = 8.20, 95% CI: 4.08-16.47), use of un-prescribed medicine at home (AOR = 2.00, 95% CI: 1.01-3.91), use of special prayers provided by ministers of God before seeking healthcare (AOR = 6.42, 95% CI: 2.50, 16.48), and first consultation at public institutions (AOR = 4.00, 95% CI:1.54-10.39). CONCLUSION: even though Rwanda has made tremendous achievements in strengthening the community-based health systems, delayed care-seeking is a reality. Health education and behavior change communication interventions are needed at the community level to address the factors that lead to delay in seeking healthcare.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mohamed Said Belhamidi, Mohamed Sinaa, Abdessamad Kaoukabi, Hicham Krimou, Mohamed Menfaa, Farid Sakit, Abdelkrim Choho [Case series] - Profil &eacute;pid&eacute;miologique et anatomopathologique du cancer colorectal: &agrave; propos de 36 cas - 22 June 2018. <b>Le cancer colorectal est class&eacute; parmi les cancers les plus fr&eacute;quents au monde (3&egrave;me rang apr&egrave;s le cancer du sein et celui de la prostate), deuxi&egrave;me cancer digestif au Maroc apr&egrave;s celui de l'estomac. Cependant son incidence dans notre pays reste moins &eacute;lev&eacute;e que celle des pays occidentaux (2.5 &agrave; 3.3/100 000 ha) mais rejoint celle des pays du Maghreb dont ce cancer touche les sujets jeunes dans 27% des cas. Le cancer colorectal (CCR) est un des meilleurs exemples du processus multi &eacute;tape de canc&eacute;rogen&egrave;se. La connaissance des caract&eacute;ristiques anatomopathologique du CCR conditionnera certainement nos attitudes th&eacute;rapeutiques. Nous avons men&eacute; une &eacute;tude r&eacute;trospective &eacute;pid&eacute;miologique et anatomopathologique au service de chirurgie visc&eacute;rale de l'h&ocirc;pital militaire Moulay Ismail &agrave; Mekn&egrave;s sur une p&eacute;riode de 5 ans allant du mois de janvier 2012 au mois de D&eacute;cembre 2016 (36 cas: 14 femmes et 22 hommes). &Agrave; la lumi&egrave;re de cette &eacute;tude, l'objectif de ce travail est d'analyser le profil &eacute;pid&eacute;miologique et les aspects anatomopathologiques des cancers colorectaux. L'analyse de nos r&eacute;sultats montre un profil &eacute;pid&eacute;miologique particulier qui se caract&eacute;rise par un &acirc;ge plus jeune, une r&eacute;partition selon le sexe en faveur des hommes, les carcinomes sporadiques sont largement pr&eacute;dominants avec une r&eacute;partition topographique recto sigmo&iuml;dienne fr&eacute;quemment observ&eacute;e. Sur le plan pronostique, le faible degr&eacute; de diff&eacute;renciation des ad&eacute;nocarcinomes et le type mucineux sont corr&eacute;l&eacute;s &agrave; un stade TNM et d'Aster Coller avanc&eacute;s, avec un statut ganglionnaire p&eacute;joratif. Cette approche multidisciplinaire sera une premi&egrave;re nationale, rendant ainsi notre structure de pratique et de recherche m&eacute;dicale l'une des plateformes de prise en charge multidisciplinaire du cancer colorectal au Maroc.</b><br/> text/html 2018-07-22T00:12:51+01:00 Joseph Marie Mendimi Nkodo, Roger Ateba, Christiane Judith Ngo Pambe, Angèle Clarisse Kabeyene Okono, Jean Louis Essamé Oyono [Research] - Pathology of lymph node tuberculosis in Yaounde: diagnostic agreement based on the Kappa coefficient - 22 June 2018. <b>INTRODUCTION: lymph node tuberculosis remains very prevalent in Cameroon. Our goal was to compare the diagnostic agreement between the hematein-eosin coloration technique and the Ziehl-Neelsen technique. METHODS: this study is a retrospective and comparative study realized in the Yaounde University Teaching Hospital over a period of 5 years. We needed to specify the diagnostic agreement for tuberculosis, first inter observer and secondly between the standard and special colorations. The data we collected allowed us to determine the agreement rates observed and the kappa (k) coefficients with linear weighting. RESULTS: the 186 samples of the 1726 cases of tuberculosis of all locations represented a proportion of 10.78%. There were more male patients (65.05%) with a sex ratio (M:F) of 1.30. The average age was 24.21 ± 15.5 with the extremes from 5 to 68 years. The most represented age group was from 10 to 39 years. The two observers agreed in 93 cases using hematein eosin coloration (P0 = 83.87 %; k = 0.8109) and on 73 samples using the Ziehl-Neelsen coloration (P0 = 89.78 %; k = 0.7734). The two coloration techniques presented an agreement on 104 samples (P0 = 88.17 %; k = 0.8783). CONCLUSION: the routine choice of the hematein eosin coloration technique not paired with the coloration technique of Ziehl-Neelsen can effectively alleviate the program for fighting tuberculosis in an environment of limited resources.</b><br/> text/html 2018-07-22T00:12:51+01:00 William Ngatchou, Jeanne Beirnaert, Daniel Lemogoum, Cyril Bouland, Pierre Youatou, Ahmed Sabry Ramadan, Regis Sontou, Maimouna Bol Alima, Alain Plumaker, Virginie Guimfacq, Claude Bika, Pierre Mols [Research] - Application of the Canadian C-Spine rule and nexus low criteria and results of cervical spine radiography in emergency condition - 21 June 2018. <b>INTRODUCTION: The Canadian C Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (Nexus) low criteria are well accepted as guide to help physician in case of cervical blunt trauma. METHODS: we aimed to evaluate retrospectively the application of these recommendations in our emergency department. Secondly we analyzed the quality of cervical spine radiography (CSR) in an emergency setting. RESULTS: 281 patients with cervical blunt trauma were analyzed retrospectively. The CCR and the NEXUS rules were respected in 91.2% and 96.8% of cases respectively. No lesions were found in 96.4% of patient. A lesion was present in 1.1% of patient and suspected in 2.5% of patient. The quality of CSR was adequate in only 37.7% of patient. The poor quality of CSR was due either to the lack of C7 vertebrae visualization in 64.6% or other lower vertebrae in 28%. Other causes included the absence of open mouth view (8%), the absence C1 vertebrae visualization (3.4%), artifact in 2.3% and the absence of lateral view in 0.6% of patient. CONCLUSION: CCR and NEXUS are widely used in our emergency department. The high rate of inadequate CSR reinforces the debate about it’s utility in emergency condition.</b><br/> text/html 2018-07-22T00:12:51+01:00 Sidy Akhmed Dia, Azhar Salim Mohamed, Fatou Sy Gaye, El Hadj Oumar Ndoye, Mame Coumba Gaye Fall, Mouhamed Nanibolio Soumah, Mor Ndiaye [Research] - Caract&eacute;ristiques des accidents du travail et devenir des victimes: &agrave; propos de 133 cas d&eacute;clar&eacute;s aupr&egrave;s de la Caisse de S&eacute;curit&eacute; Sociale de Dakar (S&eacute;n&eacute;gal) - 21 June 2018. <b>INTRODUCTION: Les accidents du travail (AT) ont des r&eacute;percussions sur le syst&egrave;me de s&eacute;curit&eacute; social du pays, sur les victimes elles-m&ecirc;mes ainsi que leurs proches. L’objectif de notre &eacute;tude est de d&eacute;crire les diff&eacute;rentes caract&eacute;ristiques des AT d&eacute;clar&eacute;s aupr&egrave;s de la Caisse de S&eacute;curit&eacute; Sociale (CSS) de Dakar et le devenir socio-professionnel des victimes. METHODES: &eacute;tude r&eacute;trospective et transversale sur une p&eacute;riode de 5 ans, de 2002 &agrave; 2006. Ont &eacute;t&eacute; collig&eacute;s 133 cas sur 9.308 AT d&eacute;clar&eacute;s &agrave; la CSS. Divers param&egrave;tres ont &eacute;t&eacute; &eacute;tudi&eacute;s: caract&eacute;ristiques socio-professionnelles des victimes et aspects l&eacute;sionnels des accidents. Les victimes ont &eacute;t&eacute; interrog&eacute;es pour recueillir leur v&eacute;cu socio-professionnel, la situation professionnelle. RESULTATS: l’&acirc;ge moyen des sujets &eacute;tait de 37,55 ans avec une pr&eacute;dominance masculine (99,22%). Les secteurs du BTP (22,6%) et de la p&ecirc;che (15%) &eacute;taient les plus touch&eacute;s. Pr&egrave;s des deux tiers des accidents survenaient au lieu du travail (77,4%). Ces accidents entrainaient des fractures dans 51,7% des cas et touchaient la main dans 30,1% des cas. Pr&egrave;s de deux tiers des accident&eacute;s (60,9%) avaient repris la m&ecirc;me profession. On notait 31 cas de licenciement et 12 cas de reclassement professionnel. La dur&eacute;e d’incapacit&eacute; temporaire totale moyenne &eacute;tait de 236,7 jours. Le montant annuel moyen de la rente &eacute;tait de 1.640.329 Francs CFA (2 504,31 Euros). CONCLUSION: les AT au S&eacute;n&eacute;gal ne pr&eacute;sentent pas de grandes particularit&eacute;s comme d&eacute;crites partout ailleurs. Les faibles ressources allou&eacute;es aux victimes et l’absence de politique d’accompagnement social expliquent les diff&eacute;rentes souffrances des victimes et leurs familles.</b><br/> text/html 2018-07-22T00:12:51+01:00 Yewande Nejo, Adedayo Faneye, Babatunde Olusola, Solomon Bakarey, Adebowale Olayinka, Babatunde Motayo, PERVI Study Group [Research] - Hepatitis B virus infection among sexually active individuals in Nigeria: a cross-sectional study - 20 June 2018. <b>INTRODUCTION: Hepatitis B virus (HBV) infection is a major health challenge in sub-Saharan African countries. Chronic HBV infection is a risk factor for severe disease progression. Perinatal and sexual transmissions of Hepatitis B virus are the main routes of infection in HBV endemic countries like Nigeria. However, there is paucity of data as regards the major contributory route of transmission to chronic HBV infection in this region. Also, in Nigeria, not everyone at high risk of the infection has been identified. Therefore our study investigated the prevalence of HBV infection among sexually active individuals in Nigeria. METHODS: blood samples collected from 463 participants (360 sexually active individuals and 103 teenagers) recruited from health institutions across the country were tested for the presence of HBsAg, and HBV nucleic acid related antigen (HBVNRAg) by ELISA. Positive samples were further tested for the presence of HBeAg and antiHBe by ELISA. Data were analyzed using Chi-square and binary logistic regression at p = 0.05. RESULTS: HBsAg and HBVNRAg were detected in 10.4% and 7.6% of the participants respectively. STI clinic attendees had the highest prevalence for HBsAg (17%; p = 0.002). Teenagers had the lowest HBsAg (1.9; p = 0.002) and HBVNRAg (2.9%; p = 0.0001) prevalence rates. Male gender (p = 0.01) and reproductive age group (p = 0.009) were the major predictors of chronic HBV infection. CONCLUSION: sexual transmission was identified as the major contributor to chronic HBV infection. Sexually active individuals especially those with STIs are high risk groups for chronic HBV infection. Interventions targeted at this group is therefore recommended.</b><br/> text/html 2018-07-22T00:12:51+01:00 Driss Erguibi, Abdelilah El bakouri, Yassine Fahmi, Bouchaib Kadiri [Case report] - Tumeur stromale &agrave; localisation r&eacute;tro-rectale: entit&eacute; macroscopique et difficult&eacute;s chirurgicales - 20 June 2018. <b>Les tumeurs stromales gastro-intestinales sont des tumeurs m&eacute;senchymateuses peu fr&eacute;quentes dont la localisation rectale est extr&ecirc;mement rare, et posent en pr&eacute;-op&eacute;ratoire un probl&egrave;me de diagnostic et de prise en charge th&eacute;rapeutique. Nous rapportons le cas d’une tumeur stromale &agrave; localisation r&eacute;tro-rectale afin de bien &eacute;tayer les particularit&eacute;s cliniques, radiologiques et th&eacute;rapeutiques de cette entit&eacute; rare.</b><br/> text/html 2018-07-22T00:12:51+01:00 Sanjiv Fitz-Morris Gray, Beatrice Esther Dieudonne [Images in medicine] - Pucker sign in irreducible posterolateral knee dislocation - 20 June 2018. <b>24 years old male seen in the trauma bay involved in a motor vehicle accident with rollover landing on its roof. He was partially ejected with his right leg hyperflexed and entrapped. The patient was stable with complaints of right knee pain. There was dimpling of the right distal medial thigh (A, B). After unsuccessful attempts at closed reduction, the patient was taken for open reduction. There was entrapment of the femoral condyle in the extensor mechanism. The soft tissues were released and the condyle reduced back into its normal position. The extensor mechanism was then repaired. The patient had palpable posterior tibial and dorsalis pedis pulses after completion of the procedure. The mechanism for posterolateral knee dislocation is valgus and rotational stress during knee flexion. The medial cruciate ligament, anterior cruciate ligament, and the posterior cruciate ligament are usually injured in posterolateral knee dislocation with incarceration of the capsule and ligamentous structures in the intercondylar notch. Early open reduction is indicated as it is generally considered irreducible by closed reduction. The "pucker sign" is considered pathognomonic. On Radiographs with attention to the patella shows the patella maintaining its in-line attachments to the tibial tuberosity and is reduced with respect to the proximal tibia but dislocated with respect to the distal femur. At the follow up the patient is ambulatory after rehabilitation.</b><br/> text/html 2018-07-22T00:12:51+01:00 Amal Bousselamti, Brahim El Hasbaoui, Hanae Echahdi, Yamna Krouile [Case report] - Psychomotor regression due to vitamin B12 deficiency - 20 June 2018. <b>A vitamin B12 deficiency in infants is rare, but may sometimes be seen in breastfed babies of strict vegetarian mothers. Vitamin B12, also known as cobalamin, is only found in meat and other animal products. Most babies have a sufficient supply as long as the mother was not deficient herself. Symptoms and signs of vitamin B12 deficiency appear between the ages of 2 to 12 months and include vomiting, lethargy, failure to thrive, hypotonia, and arrest or regression of developmental skills. Urinary concentrations of methylmalonic acid and homocystine are characteristically elevated in vitamin B12 deficiency. Early treatment for a vitamin B12 deficiency in an infant involves immediate administration of vitamin B12 to the baby and the breastfeeding mother. The infant and mother will each receive an injection of vitamin B12 containing 1,000 mcg or more of the vitamin, and the mother will continue to receive injections every month to raise her own stores. After the initial injection, the baby will often receive future vitamin B12 through food sources. We present a case of vitamin B12 deficiency in a 9-month-old girl presented with psychomotor regression, hypotonia and lethargy. The child was exclusively breast-fed from birth by a mother who was on strict vegetarian diet and belong to a low socio-economic status. Laboratory data revealed bicytopenia with macrocytic anemia and methylmalonic acid in the urine, consistent with vitamin B12 deficient anemia. The Brain CT revealed a cerebral atrophy and delayed myelination. Vitamin B12 supply was effective on anaemia and psychomotor delay. This case figures out the importance of an early diagnosis in front of psychomoteur regression and hypotonia, given the risk of incomplete neurologic recovery due to vitamin B12 deficiency mainly in the setting of maternal nutritional deficiency.</b><br/> text/html 2018-07-22T00:12:51+01:00 Carlos Eduardo Salazar-Mej&iacute;a, Luis Alberto P&eacute;rez-Arredondo [Images in medicine] - A giant mass in the neck of a young men: a case of anaplastic thyroid cancer - 20 June 2018. <b>A 29-year-old man presented with a 4-month history of a mass in the left lateral region of the neck that was painful to palpation. Growth of this mass caused a change in his tone of voice, dysphagia to solids that progressed to liquids, and dyspnea. He also referred a weight loss of 3 kg. He had no previous medical history. Physical examination of the neck showed a left ganglionar conglomerate, which covered all areas of the neck and the supraclavicular hollow and that extended to the opposite side with limitation of cervical movement. There was involvement of the left cranial nerves XI and XII. Laboratory tests revealed a TSH serum level of 5.19 uU/ml (0.27-4.2 uU/mL), a free T4 level of 0.80 ng% (0.93-1.7 ng%), and a thyroglobulin of 12.2 ng/ml (1.40-78.0 ng/ml). Histopathological analysis showed an anaplastic carcinoma of the thyroid. Due to the great extension of the disease and metastasis to the lung demonstrated by tomography, it was decided to initiate a chemotherapy regimen based on cisplatin and doxorubicin. Despite this treatment, the patient died three months later. Anaplastic thyroid cancers are extremely aggressive undifferentiated tumors with rapid progression and very poor outcome with a median overall survival of less than six months. For unresectable disease in patients who desire active therapy, radiation and/or chemotherapy is the preferred option for local control of the disease. Palliative care is important in this setting and should be added to any treatment plan.</b><br/> text/html 2018-07-22T00:12:51+01:00 Umar Ibrahim, Sharifa Ezat Wan-Puteh [Research] - An overview of civil society organizations’ roles in health project sustainability in Bauchi State, Nigeria - 20 June 2018. <b>INTRODUCTION: This study sets out to assess the roles of Civil Society Organizations (CSOs) in post donor health project sustainability in Low and Middle Income Countries (LMICs), the case of the Bauchi State, Nigeria. This study equally investigated the CSOs strategies and roles in health project sustainability. METHODS: For quantitative data collection, the random, purposive, and convenient sampling techniques were used and 156 respondents selected from relevant organizations operating in Bauchi state, Nigeria, and 15 respondents for Key Informant Interviews (KIIs). A Semi-structured questionnaire was the study instrument, and consent from the participants as well as ethical clearances were duly obtained. RESULTS: The study revealed that 87.8% of the respondents indicate un-friendly operational policies, while 88.9% of them identified lack of resources (human, money and machineries) as impediments to project sustainability. Also, 74.3% of the respondents said partnership among key stakeholders and 86.6% of them affirmed that community participation and use of available (local) resources ensure health project sustainability. The study further revealed that CSOs fund health projects, support government efforts and encourage development of project sustainability road map in the state. CONCLUSION: Hence, health project sustainability plan should form part of a project right from inception through the donor period and thereafter. In addition to the above, internal income framework, community involvement, enabling policies and partnership among stakeholders, especially with the host government, should always guide project implementation, because without these in place, project sustainability will remain a mirage.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mohamed El Amraoui, Badredine Hassam [Images in medicine] - Une dermatose auto provoqu&eacute;e de l’&eacute;paule - 20 June 2018. <b>Les dermatoses auto provoqu&eacute;es sont de plus en plus fr&eacute;quentes chez les adolescents toxicomanes avec des difficult&eacute;s adaptatives. Nous pr&eacute;sentons un cas de l&eacute;sions bulleuses de l'&eacute;paule auto provoqu&eacute;es chez un adolescent ayant r&eacute;v&eacute;l&eacute; un &eacute;tat d&eacute;pressif majeur avec des id&eacute;es suicidaires. Jeune homme &acirc;g&eacute; de 22 ans, sans ant&eacute;c&eacute;dents pathologiques notables, ayant un tabagisme chronique, un cannabisme et un alcoolisme occasionnels, ses parents sont divorc&eacute;s avec des conflits avec son p&egrave;re. A consult&eacute; pour une &eacute;ruption bulleuse de l’&eacute;paule gauche faite de bulles, d’&eacute;rosions post bulleuses et des croutes, si&eacute;geant sur une peau saine. L’aspect monomorphe des l&eacute;sions, l’accessibilit&eacute; (la localisation sur l’&eacute;paule gauche chez un droitier), les ant&eacute;c&eacute;dents du patient et ses difficult&eacute;s psychiatriques ont rapidement orient&eacute; l’enqu&ecirc;te vers la possibilit&eacute; d’une dermatose auto-provoqu&eacute;e ou une pathomimie. Le patient avouait la prise de psychotropes et que les l&eacute;sions ont &eacute;t&eacute; auto provoqu&eacute;es par des brulures de cigarette. Ce premier abord psychologique a r&eacute;v&eacute;l&eacute; &eacute;galement la pr&eacute;sence d’id&eacute;es suicidaires et un comportement d’auto et d’h&eacute;t&eacute;ro agressivit&eacute;. Le patient a &eacute;t&eacute; mis sous &eacute;mollients et cr&egrave;mes cicatrisantes et adress&eacute; en consultation de psychiatrie de l’h&ocirc;pital pour compl&eacute;ment de prise en charge.</b><br/> text/html 2018-07-22T00:12:51+01:00 Fred Bernardes Filho, Priscila Vinhal Grupioni [Images in medicine] - Advanced squamous-cell carcinoma of the lower lip - 20 June 2018. <b>A 37-year-old male patient was admitted at the emergency room with headache, severe pain and bleeding in the tumor. He had a previous diagnosis of squamous-cell carcinoma of the lower lip two years before, however, despite having been informed of the need to excise the initial lesion, he refused treatment due to religious beliefs. The patient returned to seek treatment after 18 months of diagnosis, however the tumor already had great extent, being unresectable. The lesion did not respond to chemotherapy. On examination, the tumor affected all of the right hemiface, with ocular and nasal destruction; jaw and tongue exposure and severe bleeding were present. Unfortunately the patient died 12 days after the hospital admission. Although informed consent allows patients to make treatment decisions based on the most information possible and patient's right to determine his or her treatment, there are a small number of adherents to religious faiths that proscribe conventional care. Despite the efforts for early diagnosis, patients continue to neglect seeking timely treatment. In our case, this was directly responsible for the patient's poor prognosis.</b><br/> text/html 2018-07-22T00:12:51+01:00 Khaoula Jellali, Ihsane Mellouki, Adil Ibrahimi [Case report] - Macro-ch&eacute;ilite granulomatose r&eacute;v&eacute;lant une maladie de Crohn - 20 June 2018. <b>De nombreuses affections du tube digestif comportent des manifestations cutan&eacute;es qui peuvent &ecirc;tre r&eacute;v&eacute;latrices, ce qui place le dermatologue en premi&egrave;re ligne pour orienter le patient vers la consultation de gastroent&eacute;rologie. A l’inverse, le gastroent&eacute;rologue est souvent confront&eacute; &agrave; des l&eacute;sions cutan&eacute;o-muqueuses pour lesquelles se pose la question d'une &eacute;ventuelle relation avec une maladie digestive d&eacute;j&agrave; connue. Les maladies inflammatoires chroniques de l'intestin repr&eacute;sentent l’exemple type de cette n&eacute;cessaire collaboration entre les deux sp&eacute;cialit&eacute;s. Nous rapportons un cas de maladie de crohn r&eacute;v&eacute;l&eacute;e par une Ch&eacute;ilite granulomateuse. Il s'agit d'une patiente &acirc;g&eacute;e de 30 ans. Suivie en dermatologie pour une ch&eacute;ilite granulomateuse. L’examen somatique &eacute;tait sans particularit&eacute; mise &agrave; part les l&eacute;sions dermatologiques (un œd&egrave;me facio-labiale blanc, indur&eacute; et une gingivite diffuse). La biopsie de la l&eacute;sion labiale a objectiv&eacute; des granulomes &eacute;pith&eacute;lioides et gigantocellulaire &agrave; disposition p&eacute;ri-vasculaire sans n&eacute;crose cas&eacute;euse. Devant la suspicion d’une colite inflammatoire une il&eacute;o-coloscopie a &eacute;t&eacute; r&eacute;alis&eacute;e ayant objectiv&eacute; une valvule de Bauhin b&eacute;ante et ulc&eacute;r&eacute;e avec une muqueuse il&eacute;ale l&eacute;g&egrave;rement &eacute;ryth&eacute;mateuse, dont l’&eacute;tude anatomopathologique avait r&eacute;v&eacute;l&eacute; un aspect histologique en faveur d'une maladie inflammatoire chronique de l’intestin type crohn il&eacute;o-colique. L’&eacute;volution &eacute;tait marqu&eacute;e par l'installation, 6 mois apr&egrave;s, de quelques &eacute;pisodes de r&eacute;ctorragies avec l&eacute;sions ano-p&eacute;rin&eacute;ales: large fissure anale ant&eacute;rieure avec une ulc&eacute;ration aphtoide &agrave; 5 cm de la marge anale, compliqu&eacute;e quelques semaines apr&egrave;s par l'installation d'un abc&egrave;s p&eacute;ri-anale fistulis&eacute; ayant n&eacute;cessit&eacute; un drainage chirurgicale avec mise en place de S&eacute;tons, d’o&ugrave; l’indication de d&eacute;marrer un traitement de fond de sa maladie de crohn apr&egrave;s ass&egrave;chement de l’abc&egrave;s. Les l&eacute;sions dermatologiques observ&eacute;es lors des MICI sont tr&egrave;s vari&eacute;es. Dans certains cas, elles apparaissent au cours d'une MICI connue alors que, dans d'autres, elles pr&eacute;c&eacute;dent ou accompagnent les manifestations digestive, permettant le diagnostic d'une affection intestinale parfois cliniquement latente.</b><br/> text/html 2018-07-22T00:12:51+01:00 Omar Boulahroud, Jalal El Benaye [Images in medicine] - Malformation de la charni&egrave;re cervico-occipitale et vitiligo - 20 June 2018. <b>Le vitiligo est une dermatose relativement fr&eacute;quente (0,5% - 2% de la population g&eacute;n&eacute;rale) d'origine polyg&eacute;n&eacute;tique et de physiopathologie multifactorielle caract&eacute;ris&eacute; par une d&eacute;pigmentation cutan&eacute;e pouvant &ecirc;tres segmentaire ou non segmentaire. La malformation de Chiari est une maladie cong&eacute;nitale de la charni&eacute;re cervico-occipitale qui consiste en une migration d'une partie du cervelet dans le trou occipital. Association de ces deux pathologies est exceptionnelle et pose une probl&eacute;matique de cause &agrave; effet. Notre cas concerne une femme de 45 ans sans ant&eacute;c&eacute;dent particulier qui pr&eacute;sente depuis 2 mois des n&eacute;vralgies cervico-brachiale bilaterale associ&eacute; &agrave; des troubles sensitif de type dissociation thermo-algique. L'examen cutan&eacute; trouve une lesion maculaire hypopigmentaire au niveau du cou et la face post&eacute;rieure de l'avant bras droit r&eacute;sistante au traitement local &agrave; base de corticoides fort (A). L'IRM cer&eacute;brale objective une malformation de chiari type II (B fl&egrave;che rouge) avec cavit&eacute; syringomy&eacute;lique en regard de C6 (B fl&egrave;che blanche). La patiente a b&eacute;n&eacute;fici&eacute; d'une d&eacute;compression ost&eacute;o-durale de la fosse c&eacute;r&eacute;brale post&eacute;rieure avec une bonne am&eacute;lioration neurologique et repigmentation des plaques apr&egrave;s 6 mois. Quelques cas dans la litt&eacute;rature t&eacute;moignent de cette association. Les arguments en faveur sont: la localisation des l&eacute;sions en regard des dermatomes concern&eacute;s par la malformation et la notion de r&eacute;gression apr&egrave;s chirurgie. L'&eacute;tiopathog&eacute;nie du vitiligo n'est pas claire et plusieurs th&eacute;ories ont &eacute;t&eacute; propos&eacute;s pour expliquer son apparition; th&eacute;orie autoimmune, th&eacute;orie d'adh&eacute;sion &eacute;pidermique, th&eacute;orie biochimique et th&eacute;orie neuronale. Cette derni&egrave;re nous parait la plus probable pour expliquer cette association dans notre cas elle suppose que l'apparition des l&eacute;sions cutan&eacute;es est due &agrave; la s&eacute;cr&eacute;tion au niveau des neurones soufrant de substances qui d&eacute;truisent sp&eacute;cifiquement les m&eacute;lanocytes.</b><br/> text/html 2018-07-22T00:12:51+01:00 Fatnassi Ridha, Merzougui Latifa, Rebhi Ines, Hajji Maamar, Braiek Salem [Case series] - Les traumatismes ur&eacute;t&eacute;raux compliquant une chirurgie gyn&eacute;cologique - 20 June 2018. <b>Les l&eacute;sions ur&eacute;t&eacute;rales iatrog&egrave;nes peuvent succ&eacute;der &agrave; toute chirurgie pelvienne. Elles sont graves pouvant mettre en jeu le pronostic fonctionnel du rein et m&ecirc;me le pronostic vital. But du travail: est de pr&eacute;ciser les aspects cliniques et les modalit&eacute;s th&eacute;rapeutiques de cet accident. Il s’agit d’une &eacute;tude r&eacute;trospective sur six observations de l&eacute;sion ur&eacute;t&eacute;rale iatrog&egrave;ne, apr&egrave;s chirurgie gyn&eacute;cologique ou obst&eacute;tricale, collig&eacute;es dans le service d’urologie de Kairouan sur une p&eacute;riode de 4 ans (2012-2016). L’&acirc;ge moyen de nos patientes est de 46 ans. Elles sont toutes des multipares. La symptomatologie clinique est variable selon le type l&eacute;sionnel. L’urographie intraveineuse demeure tr&egrave;s utile au diagnostic, nous l’avons pratiqu&eacute; dans 4 cas revenues toutes anormales. Le traitement a consist&eacute; en une mont&eacute;e de sonde dans un cas et 5 r&eacute;implantations ur&eacute;t&eacute;ro-v&eacute;sicales. Les suites op&eacute;ratoires sont &eacute;maill&eacute;es par une n&eacute;phrectomie. Les l&eacute;sions ur&eacute;t&eacute;rales iatrog&egrave;nes sont devenues rares. Elles sont corr&eacute;l&eacute;es au degr&eacute; de m&eacute;dicalisation du pays. La chirurgie gyn&eacute;cologique ou obst&eacute;tricale est la plus grande pourvoyeuse. Leur pronostic est conditionn&eacute; par la pr&eacute;cocit&eacute; du diagnostic et l’&eacute;tat anatomique de l’uret&egrave;re.</b><br/> text/html 2018-07-22T00:12:51+01:00 Marcos Davi Gomes de Sousa, Fred Bernardes Filho [Images in medicine] - Gamasoidosis (bird mite dermatitis): dermanyssus gallinae in a young boy - 20 June 2018. <b>A 6-year-old boy presented with a 4-day history of a pruritic eruption associated with excoriated erythematous papules over his limbs. He had no known medical conditions and was on summer school vacation 15 days ago. He had a healthy domestic dog without fleas or ticks. On physical examination, multiple erythematous papules and lesions with corkscrew morphology on his legs and feet were observed. In a visit by the first author to the site, many mites on the internal walls and windows, as well as the beds, were observed. Several nests of sparrows (Passer domesticus) were found and removed from the roof. Three representative mites were collected and subsequently were examined precisely; the causative agent of disturbance was recognized as Dermanyssus gallinae. The patient was treated with topical hydrocortisone 1% cream and loratadine (5 mg, once daily) for three days. Avian mites infest humans accidentally, causing a dermatitis characterized by widespread pruritic lesions. It has a worldwide distribution, and is more common in spring and summer. It is haematophagous and feeds at night, leaving its host during the day to hide in close proximity to the bird's nest. Removal of these birds from nesting or roosting sites in the vicinity of afflicted patients, with or without subsequent acaricide treatment of the area, is sufficient to arrest infestations. Cutaneous reactions are nonspecic and difficult to diagnose without a degree of clinical suspicion. Clinically, the condition presents as itching, which intensifies at night, with development of erythematous maculopapules or papulovesicles. When the clinical presentation is nonspecific and the arthropod cannot be found, the only hope for a correct diagnosis lies in a thorough environmental anamnesis.</b><br/> text/html 2018-07-22T00:12:51+01:00 Latifa Merzougui, Tarek Barhoumi, Tayeb Guizani, Hafed Barhoumi, Hajer Hannachi, Elyess Turki, Wael Majdoub [Case series] - Les infections nosocomiales en milieu de r&eacute;animation: incidence annuelle et aspects cliniques au Service de R&eacute;animation Polyvalente, Kairouan, Tunisie, 2014 - 20 June 2018. <b>Bien que les r&eacute;animations ne comprennent en g&eacute;n&eacute;ral qu’une faible proportion des lits hospitaliers; elles constituent la sc&egrave;ne d’une forte proportion des infections nosocomiales La gestion du risque infectieux en r&eacute;animation constitue aujourd’hui une priorit&eacute;; l’un des axes strat&eacute;giques prioritaires est la mise en place d’un syst&egrave;me de surveillance &eacute;pid&eacute;miologique. Nos objectifs &eacute;taient de d&eacute;terminer l’incidence et les Aspects Cliniques afin d’identifier les facteurs de risque. Il s’agit d’une &eacute;tude descriptive longitudinale d’incidence incluant les patients ayant d&eacute;pass&eacute;s 48 heures dans le service de r&eacute;animation polyvalente &agrave; l’h&ocirc;pital Ibn El Jazzar de Kairouan sur une p&eacute;riode d’une ann&eacute;e allant de 01/03/2013 jusqu’au 28/02/2014. L’enqu&ecirc;te a port&eacute; sur 265 patients dont l’&acirc;ge moyen &eacute;tait 39±20 ans (18 &agrave; 93 ans) et le sexe ratio (H/F) a &eacute;t&eacute; de 2,48. Nous avons identifi&eacute; 125 &eacute;pisodes d’infections nosocomiales chez 81 malades soit une incidence de 30,6%. La densit&eacute; d’incidence &eacute;tait de 55 infections pour 1000 jours d’hospitalisation. On a notifi&eacute; une nette pr&eacute;dominance des pneumopathies avec une incidence de 27,73%, suivies des infections urinaires de 9,73%, des infections li&eacute;es au cath&eacute;t&eacute;risme veineux central 6,25% et des infections du site op&eacute;ratoire de 2,34%. Le taux de mortalit&eacute; parmi les enqu&ecirc;t&eacute;s a &eacute;t&eacute; de 28,7% avec une diff&eacute;rence significative entre les patients infect&eacute;s (44,7% des cas) et ceux non infect&eacute;s (29,07%) (p < 10-3). Les microorganismes &eacute;taient des BGN dans 80% des cas. La pr&eacute;vention ne peut se concevoir que sous la forme d’une action globale et multidisciplinaire.</b><br/> text/html 2018-07-22T00:12:51+01:00 Pascale Vandoolaeghe, Lode Schuerman [Review] - Le vaccin antipaludique RTS,S/AS01 chez les enfants &acirc;g&eacute;s de 5 &agrave; 17 mois au moment de la premi&egrave;re vaccination - 19 June 2018. <b>Le vaccin antipaludique RTS,S/AS01 a re&ccedil;u un avis scientifique favorable de l’Agence Europ&eacute;enne des M&eacute;dicaments (EMA) en Juillet 2015. L’Organisation Mondiale de la Sant&eacute; (OMS) a recommand&eacute; l’introduction pilote de ce vaccin chez des enfants &acirc;g&eacute;s d’au moins 5 mois en utilisant un sch&eacute;ma de vaccination comprenant 3 doses initiales espac&eacute;es d’au moins un mois et une 4&egrave;me dose administr&eacute;e 15 &agrave; 18 mois apr&egrave;s la 3&egrave;me dose. Des essais cliniques et des mod&egrave;les math&eacute;matiques ont montr&eacute; que la protection partielle contre le paludisme conf&eacute;r&eacute;e par le vaccin RTS,S/AS01 pourrait avoir un impact substantiel sur la sant&eacute; publique si le vaccin est utilis&eacute; en association avec d’autres mesures de lutte antipaludique, en particulier dans les zones hautement end&eacute;miques. L’impact le plus important a &eacute;t&eacute; observ&eacute; chez les enfants &acirc;g&eacute;s de 5 mois ou plus ayant re&ccedil;u 4 doses de RTS,S/AS01. Le vaccin sera ensuite &eacute;valu&eacute; en situation r&eacute;elle afin de d&eacute;terminer son impact sur la mortalit&eacute;, son innocuit&eacute; dans le cadre d’une vaccination de routine, et la faisabilit&eacute; op&eacute;rationnelle d’administrer 4 doses du vaccin dont certaines n&eacute;cessitant de nouveaux contacts dans le calendrier de vaccination. En cas de succ&egrave;s, cela permettra une mise en œuvre &agrave; plus grande &eacute;chelle.</b><br/> text/html 2018-07-22T00:12:51+01:00 Najoua Bouayad, Naoual Oubelkacem, Wafaa Bono, Ouafae Masbah, Touria Bouhafa, Abderrahman Elmazghi, Hassouni Khalid [Case report] - Lymphome T/NK nasal: à propos de deux cas rares - 19 June 2018. <b>Le lymphome T/NK est une affection grave et rare en Afrique et en Europe. Le traitement repose sur la radioth&eacute;rapie et la chimioth&eacute;rapie. Les auteurs rapportent deux observations de patients &acirc;g&eacute;s respectivement de 55 et 52 ans, qui pr&eacute;sentent une obstruction nasale bilat&eacute;rale avec une rhinorrh&eacute;e purulente, chez eux l'examen clinique a mis en &eacute;vidence la pr&eacute;sence d'une fente palatine. Le diagnostic n'a pu &ecirc;tre pos&eacute; qu'apr&egrave;s une &eacute;tude immuno-histochimique des biopsies. Les 2 patients ont b&eacute;n&eacute;fici&eacute; d'une chimioth&eacute;rapie type CHOEP suivi d'une cure de radioth&eacute;rapie. Le lymphome T/NK nasal est une forme agressive de lymphome non hodgkinien comportant des caract&eacute;ristiques clinicopathologiques qui lui sont sp&eacute;cifiques. L'association de la chimioth&eacute;rapie pour les stades avanc&eacute;s ne semble pas am&eacute;liorer la survie par rapport &agrave; la radioth&eacute;rapie seule qui reste le traitement de choix surtout pour les stades localis&eacute;s. La localisation nasal du lymphome T /NK est rare. Le diagnostic repose sur l'&eacute;tude immunohistochimique. Le traitement comprend chimioth&eacute;rapie et radioth&eacute;rapie. Ce type lymphome est de mauvais pronostic globalement, y compris sous traitement.</b><br/> text/html 2018-07-22T00:12:51+01:00 Jawad El-Azhari, Naoufal Hjira [Images in medicine] - Angiok&eacute;ratome acquis de la face - 19 June 2018. <b>Les angiok&eacute;ratomes sont des dilatations vasculaires (papules t&eacute;langiectasiques) dont la surface est k&eacute;ratosique et qui r&eacute;sultent de la dilatation des capillaires de la papille dermique, due &agrave; une hyperpression veineuse, &agrave; une malformation vasculaire ou &agrave; une fragilit&eacute; capillaire. Le plus souvent b&eacute;nins et seulement inesth&eacute;tiques, ils peuvent parfois r&eacute;v&eacute;ler une redoutable maladie de surcharge comme la maladie de Fabry. Nous rapportons ici le cas d’un patient de 56 ans, sans ant&eacute;c&eacute;dents notables, qui consulte pour des papules &eacute;ryth&eacute;mateuses group&eacute;es en bouquet au niveau de la r&eacute;gion malaire gauche, non prurigineuses, et saignant au contact, apparues depuis 4 mois sans notion de traumatisme ant&eacute;rieur et sans symptomes extra-cutan&eacute;s. A l’examen les papules &eacute;taient partiellement vid&eacute;es &agrave; la vitropression et la surface &eacute;tait k&eacute;ratosique. Les diagnostics &eacute;voqu&eacute;s &eacute;taient un kaposi, un m&eacute;lanome, un carcinome ou un angiokeratome. L’histologie &eacute;tait en faveur d’un angiokeratome, et le traitement propos&eacute; &eacute;tait l’&eacute;lectrocoagulation.</b><br/> text/html 2018-07-22T00:12:51+01:00 Bennis Ahmed, Benatiya Andaloussi Idriss [Images in medicine] - La conjonctive tarsale une localisation exceptionnelle du carcinome &eacute;pidermo&iuml;de conjonctival - 19 June 2018. <b>Patient de 48ans de teint clair, ayant la notion de 5 d&eacute;c&egrave;s dans la famille par des cancers de localisations variables, qui pr&eacute;sente depuis une ann&eacute;e une tum&eacute;faction de la conjonctive palp&eacute;brale inf&eacute;rieur augmentant progressivement de volume, de forme nodulaire ulc&eacute;ro-bourgennante, mesurant 2cm de grand axe, occupant la moiti&eacute; interne de la conjonctive tarsale inf&eacute;rieure pr&eacute;sentant un contact intime avec le point lacrymal inf&eacute;rieur (A). La biopsie de la tumeur est en faveur d’un carcinome &eacute;pidermo&iuml;de de la conjonctive bien diff&eacute;renci&eacute;. Le traitement a consist&eacute; en une ex&eacute;r&egrave;se tumorale (B) avec marges de s&eacute;curit&eacute; larges revenant saines apr&egrave;s &eacute;tude anatomopathologique.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ahmed Bouhamidi, Badreddine Hassam [Images in medicine] - Type B lymphomatoid papulosis - 18 June 2018. <b>A 28-year-old woman with no notable medical history. Who presented with a 3-month history of pruritic erythematous purplish papules at the axilla, elbow folds, flanks, inner thigh and popliteal. On physical examination, there were multiple papular lesions with irregular pigmentation at the axilla (A), associated with maculopapular erythematous plaques on elbow folds, flanks, inner thigh and popliteal (B). There was no lymphadenopathy or mucosal involvement. Skin biopsy was in favor of type B lymphomatoid papulosis with the presence of rare large cells, with CD30 expression confined to the cell membrane and Golgi region (C, D). All the staging investigations were normal. The diagnosis of type B lymphomatoid papulosis was retained and the patient treated with topical corticosteroids with a good improvement, she is under regular monitoring. Lymphomatoid papulosis is characterized by erythematous papulonodular lesions, often evolving into a crust and spontaneously disappear in a few weeks, leaving a depressed and sometimes pigmented scar. Type B lymphomatoid papulosis histology consists of an infiltrate of lymphocytes with cerebriform nuclei, the infiltrate includes large cells that can express the CD30 antigen. lymphomatoid papulosis has a good prognosis but can be associated with or progress to malignancy. Therefore, it is important to monitor these patients.</b><br/> text/html 2018-07-22T00:12:51+01:00 Qariani Hajare, Khmamouche Mehdi [Images in medicine] - L’anneau de Kayser-Fleischer dans la maladie de Wilson - 18 June 2018. <b>La maladie de Wilson est une toxicose cuprique caract&eacute;ris&eacute;e par une surcharge en cuivre tissulaire: essentiellement h&eacute;patique, c&eacute;r&eacute;brale et p&eacute;ricorn&eacute;enne .elle r&eacute;sulte de mutations sur l'ATP7B qui incorpore le cuivre &agrave; la c&eacute;rul&eacute;oplasmine dans le foie et lib&egrave;re le cuivre exc&eacute;dentaire dans la bile. Cette maladie peut &ecirc;tre trait&eacute;e de mani&egrave;re efficace si elle est diagnostiqu&eacute;e pr&eacute;cocement. L'enjeu est d'en faire le diagnostic au stade initial de la maladie h&eacute;patique, avant qu'elle ne devienne multisyst&eacute;mique. Nous rapportons le cas d'une patiente de 19 ans qui pr&eacute;sente une atteinte multisyt&eacute;mique dans le cadre de la maladie de wilson: une p&acirc;leur cutan&eacute;o-muqueuse, tremblement intermittent des mains depuis l'&acirc;ge de 16 ans, une h&eacute;patite compliqu&eacute;e d'ascite, des troubles neurologiques &agrave; type d'un tremblement postural des bras et des jambes. L'examen ophtalmologique &agrave; la lampe &agrave; fente a objectiv&eacute; au niveau des deux yeux l'anneau de Kayser-Fleischer (A,B) qui est un d&eacute;p&ocirc;t de cuivre &agrave; la p&eacute;riph&eacute;rie de l'endoth&eacute;lium corn&eacute;en plus pr&eacute;cis&eacute;ment sur la zone frontali&egrave;re entre la corn&eacute;e et la scl&eacute;rotique(C). le bilan biologique trouve un taux de c&eacute;rul&eacute;oplasmine bas &agrave; 0,03 g/l; La cupr&eacute;mie totale &agrave; 0,4 mg/l. l'excr&eacute;tion urinaire de cuivre &eacute;lev&eacute;e &agrave; 11,6 ¼mol. L'imagerie par r&eacute;sonance magn&eacute;tique c&eacute;r&eacute;brale de la patiente a r&eacute;v&eacute;l&eacute; un changement de signal g&eacute;n&eacute;ralis&eacute;, une gliose et une atrophie des thalamus et du tronc c&eacute;r&eacute;bral.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ahmed Bouhamidi, Mohammed Boui [Images in medicine] - Paederus dermatitis - 18 June 2018. <b>There were two patients, having crushed insects on their bodies, described as a two-colored big ant with three black segments (head, center and end of the abdomen) and two orange segments, which were in their accommodation. They presented with a dermatitis characterized by initial marked erythema and pruritus, with vesicles and blisters in cervical region developing after 48 hours post exposure for the first patient, while the second patient developed similar chest lesions and skin ulceration after 72 hours of exposure. Based on clinical and epidemiological features, the diagnosis of Paederus dermatitis was retained. Treatment is made with topical Trolamine, oral antihistamines, and intensive washing. The lesions improved over several days, with resolution of lesions without sequelaes 10 to 15 days later. Paederus dermatitis is a contact dermatitis that occurs due to physical contact with rove beetles of the genus Paederus. The diagnosis is based on the presence of typical clinical features combined with compatible epidemiological features. This condition is prevalent in some tropical and subtropical regions, such as Guinea-Bissau, and especially in the rainy season.</b><br/> text/html 2018-07-22T00:12:51+01:00 Tunde Nureini Oyebanji, Ismail Mohammed Inuwa, Jameel Ismail Ahmad [Case report] - True superior gluteal artery aneurysm with neurovascular compromise of the lower limb: a case report and review of the therapeutic options - 14 June 2018. <b>Few cases of true superior gluteal artery (SGA) aneurysms have been described in the English-language literature. This is the twenty-second reported case. SGA aneurysms can pose diagnostic problems, specifically when they are non-pulsatile and also therapeutic challenges when they are large. Although more aneurysms are being subjected to endovascular therapies, SGA aneurysmectomy or aneurysmorrhaphy still remain valid therapeutic options, especially in resource-poor settings. Surgery provides quick symptom resolution and still is the only means by which tissue for definitive histological diagnosis can be obtained.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ekrem Akdeniz, Mustafa Bakirtas, Mustafa Suat Bolat, Sevda Akdeniz, Ismail &Ouml;zer [Case report] - Pure large cell neuroendocrine carcinoma of the bladder without urological symptoms - 14 June 2018. <b>Neuroendocrine carcinoma is one of the uncommonly seen pathologies of the urinary bladder. Macroscopic hematuria is frequently encountered symptom in patients with neuroendocrine carcinoma. We report a 45-year-old man with left solitary kidney and oliguria for five days the development of acute renal failure (ARF) with impaired general condition. The underlying cause being identified as pure type large-cell neuroendocrine carcinoma of the bladder. Large-cell neuroendocrine carcinoma of the bladder is an uncommon fatal tumor. No macroscopic hematuria or urological symptom was observed in our case. Advanced ectasia was not observed in the kidney, and the patient's clinical status was complicated with ARF. It must not be forgotten than in some bladder tumors, the patient's general condition may be impaired without urological symptoms.</b><br/> text/html 2018-07-22T00:12:51+01:00 Olorunfemi Akinbode Ogundele [Opinion] - Reducing the risk of nosocomial Hepatitis B virus infections among healthcare workers in Nigeria: a need for policy directive on pre-employment screening and vaccination - 14 June 2018. <b>Healthcare workers (HCWs) are at increased risk of contracting Hepatitis B virus (HBV) infection and other vaccine-preventable diseases especially if they are not protected by immunity derived from previous infection or vaccination. Sub-Sahara Africa countries including Nigeria is reported to have the highest rate of HBV. Vaccination of HCWs is essential in protecting them from acute and chronic sequelae of HBV or any other form of vaccine-preventable diseases; however, HCWs vaccination remains a challenge for many developing countries including Nigeria due to lack of policy directive on pre-employment screening and vaccination. Poor political will and inadequate funding of healthcare in the country also impacts negatively on the implementation of effective pre-employment screening and vaccination programmes needed to protect HCWs. The aim of this opinion paper is to promote policy direction on pre-employment screening and vaccination in other to protect HCWs from nosocomial HBV infection. The most appropriate time perhaps for promoting the importance of employee immunisation is during pre-employment screening. The policy options are either for employers to allocate financial resources towards HCWs pre-employment screening and vaccination or alternatively initiate a programme where new HCWs provide evidence of protection against HBV or other vaccine-preventable diseases specified in the policy directive. Protecting HCWs form nosocomial HBV infection requires well-articulated policy directive, proper implementation, supported by adequate funding and good political will on the part of employers and government.</b><br/> text/html 2018-07-22T00:12:51+01:00 Jawad El-Azhari, Mohammed Boui [Images in medicine] - Hamartome s&eacute;bac&eacute; de la face: &agrave; propos d’un cas - 14 June 2018. <b>Le n&aelig;vus s&eacute;bac&eacute; (ou hamartome s&eacute;bac&eacute;) est une l&eacute;sion cong&eacute;nitale localis&eacute;e principalement au cuir chevelu, dont le diagnostic clinique et histologique est g&eacute;n&eacute;ralement ais&eacute;. Il est diagnostiqu&eacute; d&egrave;s la naissance dans la grande majorit&eacute; des cas, mais peut parfois passer inaper&ccedil;u et donner l'impression d'appara&icirc;tre plus tardivement. Cette l&eacute;sion peut se compliquer de tumeurs b&eacute;nignes ou de fa&ccedil;on plus rare malignes. Nous rapportons le cas d'un patient de 45 ans, suivi depuis 15 ans pour an&eacute;mie de Biermer (trait&eacute;e par injection mensuelle d'HYDROXOCOBALAMINE) et une pelade ophiasique, et qui consulte pour des plaques pigment&eacute;es apparues il y'a plus de 10 ans; bilat&eacute;rales et sym&eacute;triques, augmentant progressivement de taille. A l'examen clinique, il s'agit de plaques temporales et sous-auriculaires, d'aspect verruqueux brun&acirc;tre &agrave; surface lisse (A, B). L'&eacute;tude histologique objectivait une acanthose, une papillomatose, et des glandes s&eacute;bac&eacute;es volumineuses et situ&eacute;es anormalement hauts dans le derme, en faveur d'un hamartome s&eacute;bac&eacute;. Un traitement par laser CO2 a &eacute;t&eacute; propos&eacute; au patient.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ahmed Bouhamidi, Mohammed Boui [Images in medicine] - Madura foot: a case report - 14 June 2018. <b>A 24-year-old girl, without any significant medical history. with seven months' history of a painful tumefaction of his left foot. Physical examination revealed a tumefaction that discharges a purulent exudate containing black granules via skin fistulas. Direct microscopic examination of grains suggests a fungal infection. Standard X-rays of his foot showed no lesion of the bone. So with the combination of the clinical specific lesions and typical grains, a diagnosis of Madura foot was made and the patient treated with surgical debridement, followed by Ketoconazole for 12 months, she is under regular monitoring. Mycetoma is characterized by a clinical triad of chronic induration, draining sinuses and discharge of granules. It is either actinomycotic or eumycotic in etiology. It is endemic in tropical and subtropical countries.</b><br/> text/html 2018-07-22T00:12:51+01:00 Raoul Karfo, Elie Kabr&eacute;, Nadia Safir, Mounya Bouabdellah, Laila Benchekroun, Jean Sakand&eacute;, Layachi Chabraoui [Case series] - Interpr&eacute;tation d&eacute;licate de l'immunofixation des prot&eacute;ines s&eacute;riques - 14 June 2018. <b>L'immunofixation est actuellement tr&egrave;s utilis&eacute;e dans les laboratoires d'analyses m&eacute;dicales. L'interpr&eacute;tation des r&eacute;sultats est en g&eacute;n&eacute;ral facile, mais il existe des cas qui posent des probl&egrave;mes d'interpr&eacute;tation. Nous vous rapportons deux observations d'interpr&eacute;tation d&eacute;licate. Dans la premi&egrave;re observation, nous pr&eacute;sentons un cas de pr&eacute;cipitation non sp&eacute;cifique de la prot&eacute;ine sur toutes les pistes, dans la deuxi&egrave;me observation un cas pr&eacute;sentant une double bande monoclonale &agrave; l'immunofixation. Pour ces deux observations, l'utilisation de la solution r&eacute;ductrice de &#946;2-mercapto&eacute;thanol nous a permis de r&eacute;soudre le probl&egrave;me et de conclure &agrave; un diagnostic. La confrontation des donn&eacute;es cliniques, radiologiques et biologiques est n&eacute;cessaire avant de conclure &agrave; une immunoglobuline monoclonale.</b><br/> text/html 2018-07-22T00:12:51+01:00 Marianneta Chatzopoulou, Maria Tsiakalou [Images in medicine] - Post-operative peritonitis due to a KPC-producing Klebsiella pneumoniae: the canvas of antibiotic resistance - 13 June 2018. <b>Emergence of multidrug-resistant nosocomial pathogens has risen as one of the most critical public health issues globally. The present smear of peritoneal fluid graphically illustrates the dramatic course of an ultimately fatal case of post-operative peritonitis due to a KPC-producing <i>K. pneumoniae</i>. A 60-year-old patient was admitted for a scheduled sigmoidectomy. After a brief stay in the Intensive Care Unit he was transferred to the ward where he showed signs and symptoms of peritonitis. A peritoneal fluid film was stained with May-Grünwald-Giemsa technique and examined microscopically in the laboratory. The intensity of infection is reflected by the abundance of bacilli surrounding and invading neutrophils. The particular <i>K. pneumoniae</i> strain was merely susceptible to tigecycline and colistin. Aggressive antibiotic treatment was not effective in reversing the fulminant clinical course and the patient finally succumbed.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ibrahima Dara Dam&eacute;, Ibrahima Diallo, Modou Ndiaye, Mamadou Beye, Ndiaga Seck Ndour, Tiennou Hafing, Samba Thiapato Faye, Ibrahima Bocar Welle, Yaya Sow, Boubacar Fall [Case report] - Strangulation du p&eacute;nis: &agrave; propos de deux cas en milieu rural - 13 June 2018. <b>La strangulation du p&eacute;nis est une pathologie n&eacute;cessitant une prise en charge en urgence. Plusieurs objets m&eacute;talliques ou non, peuvent &ecirc;tre plac&eacute;s sur le p&eacute;nis pour augmenter les performances sexuelles ou pour des fins auto-&eacute;rotiques. Nous rapportons les observations de deux patients schizophr&egrave;nes de 25 et 33ans re&ccedil;us aux urgences pour une strangulation du p&eacute;nis par anneau m&eacute;tallique. L'anneau &eacute;tait plac&eacute; au niveau du sillon balanop&eacute;nien depuis 3 jours chez l'un et au niveau de la racine de la verge depuis 2 jours chez l'autre. Il n'y avait pas de trouble urinaire chez les deux patients. L'ablation de cet anneau a &eacute;t&eacute; r&eacute;alis&eacute;e par taxis sous anesth&eacute;sie locale chez l'un et sous s&eacute;dation &agrave; la fentanyl suivie d'une double section de l'anneau &agrave; l'aide d'un engin &eacute;lectrique dans le 2&egrave;me cas. A travers cette observation nous rapportons la prise en charge non chirurgicale de ces cas pathologique.</b><br/> text/html 2018-07-22T00:12:51+01:00 Catherine Saleh Ugumba, Marc Kashal Kasong, Cedrick Sangwa Milindi, Gabriel Wakunga Warach, Fran&ccedil;ois Tshilombo Katombe, Etienne Odimba Bfkoshe [Case series] - Etude des relaparotomies pr&eacute;coces aux H&ocirc;pitaux Universitaires de Lubumbashi: aspects &eacute;pid&eacute;miologiques, cliniques et th&eacute;rapeutiques - 13 June 2018. <b>Les relaparotomies pr&eacute;coces pour p&eacute;ritonite post op&eacute;ratoire (PPO) sont des urgences chirurgicales de pronostic grave. L'objectif de la pr&eacute;sente &eacute;tude est de d&eacute;crire le profil &eacute;pid&eacute;miologique, clinique et th&eacute;rapeutique des relaparatomis&eacute;s pr&eacute;coces soign&eacute;s dans les h&ocirc;pitaux universitaires de LUBUMBASHI. Il s'agit d'une &eacute;tude descriptive transversale r&eacute;alis&eacute;e dans deux h&ocirc;pitaux du district sanitaire du haut KATANGA; &agrave; savoir les cliniques Universitaires(CUL) et l'h&ocirc;pital g&eacute;n&eacute;ral de r&eacute;f&eacute;rence JASON SENDWE (HGR JS). Cette &eacute;tude a port&eacute; sur 56 patients r&eacute;op&eacute;r&eacute;s &agrave; l'abdomen 68 fois du 01/Janvier/2012 au 31/D&eacute;cembre/2013. Ont &eacute;t&eacute; inclus, les dossiers des patients r&eacute;op&eacute;r&eacute;s d'abdomen pr&eacute;coce deux fois de suite au moins, de sexe confondu, &acirc;g&eacute;s de 07 jours &agrave; 83 ans qui ont &eacute;t&eacute; r&eacute;op&eacute;r&eacute;s de l'abdomen. Les donn&eacute;es &eacute;pid&eacute;miologiques, cliniques, th&eacute;rapeutiques et les suites op&eacute;ratoires ont &eacute;t&eacute; recueillies puis saisies et analys&eacute;es gr&acirc;ce au logiciel Epi info 2011. Au cours de cette &eacute;tude 304 patients avaient subi une laparotomie dont 248 avaient &eacute;volu&eacute; normalement; 56 patients par contre avaient &eacute;t&eacute; relaparatomis&eacute;s 68 fois (38 hommes et 18 femmes). L'&acirc;ge moyen &eacute;tait de 34,6±19 ans. Le s&eacute;jour moyen d'hospitalisation &eacute;tait de 56,26 ± 51,82 jours. Les comorbidit&eacute;s associ&eacute;es ont &eacute;t&eacute; l'hypertension art&eacute;rielle, le cancer et le mauvais &eacute;tat g&eacute;n&eacute;ral d'avant la laparotomie classifi&eacute; ASA 3 et 4 avec respectivement 34,62% (n = 9); 26,92% (n = 7) et 41,38% (n = 12). Les malaises g&eacute;n&eacute;raux, la circonf&eacute;rence abdominale avec augmentation de plus de 2 cm par jour au niveau de l'ombilic ainsi que la douleur abdominale diffuse et provoqu&eacute;e ont &eacute;t&eacute; retrouv&eacute;es respectivement dans 94,64% (n = 53), 98,21% (n = 55) et 83,93% (n = 47) des cas. Pour laparotomie initiale 51 (91,07%) patients &eacute;taient op&eacute;r&eacute;s en urgences. Les infections associ&eacute;es avaient constitu&eacute; l'indication principale de r&eacute;intervention avec 55,36% des cas (n = 31). La laparotomie initiale &eacute;t&eacute; conduit par un chirurgien non qualifi&eacute; dans 60,71% des cas (n = 34). Douze patients r&eacute;op&eacute;r&eacute;s sont d&eacute;c&eacute;d&eacute;s soit un taux de l&eacute;talit&eacute; de 17,65%. Les relaparotomies pr&eacute;coces pour PPO sont couramment pratiqu&eacute;es dans les h&ocirc;pitaux universitaires du HAUT KATANGA. Le retard dans le diagnostic aggrave le prognostic.</b><br/> text/html 2018-07-22T00:12:51+01:00 Youssef Khaoula, Jawhar Mokni, Aloui Feten, Beizig Ameni, Maksoudi Chedly [Case report] - Traumatisme ferm&eacute; de l’abdomen occasionnant une pancr&eacute;atite aigu&euml;: pr&eacute;sentation de cas - 13 June 2018. <b>La pancr&eacute;atite aigu&euml; est une affection grave de pronostic r&eacute;serv&eacute;, son &eacute;tiologie est soit biliaire ou alcoolique et l'origine traumatique est extr&ecirc;mement rare et souvent associ&eacute;e &agrave; d'autres l&eacute;sions intra abdominale. Nous pr&eacute;sentons le cas d'un homme 56 ans aux atcds psychiatriques sous neuroleptiques et aux ATCDS de n&eacute;phrotomie gauche et qui consulte dans les suites d'une chute d'un escalier 3 jours auparavant pour sd occlusif, &agrave; l'examen &eacute;tat h&eacute;modynamique respiratoire et neurologique correct, sensibilit&eacute; &eacute;pigastrique, une TDM pratiqu&eacute; montre une pancr&eacute;atite stade E traumatique avec au bilan de nombreuses perturbations: &eacute;l&eacute;vation des amylases, de la glyc&eacute;mie, des GB et de la CRP; l'&eacute;volution &eacute;tait d&eacute;favorable avec le d&eacute;c&egrave;s du patient 72 H plupart par une d&eacute;faillance multi visc&eacute;rale suite &agrave; un choc septique malgr&eacute; une r&eacute;animation appropri&eacute;. La pancr&eacute;atite aigu&euml; traumatique &eacute;tant une affection grave, pourvue qu'elle est tr&egrave;s rare et parfois difficile &agrave; diagnostiquer vue la non sp&eacute;cificit&eacute; des signes cliniques, il faut savoir y penser afin la prendre en charge &agrave; temps.</b><br/> text/html 2018-07-22T00:12:51+01:00 Michel Kengne, Dorine Carol Wouado Tsata, Th&eacute;r&egrave;se Ndomgue, Julius Mbekem Nwobegahay [Research] - Prevalence and risk factors of HTLV-1/2 and other blood borne infectious diseases among blood donors in Yaounde Central Hospital, Cameroon - 13 June 2018. <b>INTRODUCTION: Transfusion-transmissible infectious microorganisms including bacteria and viruses are among the greatest threats to blood safety for the recipient. The prevalence and risk factors of HTLV-1/2 and other blood borne infectious diseases were determined among blood donors in Yaounde Central Hospital, Cameroon. METHODS: design: cross sectional study. Setting: The blood bank unit of Yaounde Central Hospital, Cameroon. Subjects: a consecutive sample of 265 apparently healthy adult blood donors. Investigations: Search for the presence of hepatitis B surface antigen (AgHBs) and antibodies to human T-lymphotropic virus type 1 (anti-HTLV-1/2), human immunodeficiency virus (anti-HIV), hepatitis C virus (anti-HCV) and syphilis and to determine the epidemiological correlates, if any, in the occurrence of HTLV infection. RESULTS: 77 (29.05%) of the blood donors had serological evidence of infection with at least one pathogen and 4 (5.2%) had dual infections with HTLV-1/2. The overall prevalence of HTLV-1/2, HIV, HCV, HBV and syphilis were 5.7%, 5.3%, 2.6%, 11.7%, 3.8% respectively. Surgical history (Chi2=4.785; P=0.029), scarification (Chi2=6.359; P = 0.012), piercing (Chi2 = 16.353; P = 0.000) and intravenous drug use (Chi2 = 15.660; P = 0.000) were identified as risk factors for HTLV-1/2 infection. CONCLUSION: a relative high prevalence of viral infections and syphilis was recorded among the study participants especially for HTLV-1/2 for which none blood donation is routine screened in our set up. Therefore, a routine screen of blood prior to transfusion should include anti-HTLV-1/2 tests</b><br/> text/html 2018-07-22T00:12:51+01:00 Youssef Zemmez, Adnane Arrami [Images in medicine] - Synovialosarcome de l’avant-bras droit - 13 June 2018. <b>Patiente &acirc;g&eacute;e de 60 ans, suivis pour cardiomyopathie hypertensive depuis 04 ans, qui a consult&eacute; en dermatologie pour une masse de l’avant-bras droit &eacute;voluant depuis un an et augmentant progressivement de taille. L’examen clinique a objectiv&eacute; une l&eacute;sion tumorale molle, arrondie, volumineuse mesurant 8 centim&egrave;tres au grand diam&egrave;tre, indolore, fixe par rapport aux deux plans, &agrave; surface ulc&eacute;ro-crouteuse et si&eacute;geant au niveau du tiers moyens de la face post&eacute;ro-lat&eacute;rale de l’avant-bras droit (A). La radiographie standard a objectiv&eacute; une masse opaque homog&egrave;ne respectant la corticale en regard (B). L’Imagerie par r&eacute;sonnance magn&eacute;tique &eacute;tait en faveur d’un volumineux processus cutan&eacute;o-sous cutan&eacute; &agrave; double composante tissulaire et kystique multi-cloisonn&eacute;e infiltrant la graisse sous cutan&eacute;e et arrivant en contact intime avec les muscles extenseurs (C). L’histologie a objectiv&eacute; une prolif&eacute;ration sarcomateuse peu diff&eacute;renci&eacute;e &agrave; cellules pl&eacute;omorphes (D) compl&eacute;t&eacute;e par une &eacute;tude Immuno-histochimique qui a confirm&eacute; le diagnostic d’un Synovialo-sarcome. La patiente a &eacute;t&eacute; adress&eacute;e en chirurgie plastique pour b&eacute;n&eacute;ficier d’un traitement chirurgical.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ayesha Aslam Rai, Aisha Nazeer, Nasir Hassan Luck [Research] - Frequency of gallstones and mean BMI in decompensated cirrhosis - 13 June 2018. <b>INTRODUCTION: The aim of the study was to determine the frequency of gallstones in patients with decompensated cirrhosis and to know about mean Body mass index (BMI) in patients of decompensated cirrhosis i.e End stage liver disease (ESLD) with and without gallstones. METHODS: It is a cross sectional descriptive study, conducted at the department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi from 1st August 2014 to 28 February 2015. Two hundred patients were enrolled from outpatient clinics of Hepato-gastroenterology that fulfilled the defined selection criteria. Questionnaire was filled for data collection. SPSS version 20.0 was used to analyze data. Mean value of age and BMI was calculated by mean ± S.D. values. Mean ± SD was also calculated for BMI in patients with and without gallstones. Stratification of the age, gender, and liver disease severity were done and chi-Square test was applied. p-values less than 0.05 considered statistically significant.</b><br/> text/html 2018-07-22T00:12:51+01:00 Oguz Eroglu, Figen Coskun [Research] - Medical students’ knowledge of ultrasonography: effects of a simulation-based ultrasound training program - 13 June 2018. <b>INTRODUCTION: The use of simulation devices in medical education is becoming more prevalent with each passing day. The present study aimed to teach medical students to perform ultrasonography via a simulation-based ultrasound training program. METHODS: the study was prospectively conducted on final year medical students who had not received previous ultrasound training and who came to the Emergency Department of the Kirikkale University Faculty of Medicine between July 2015 and July 2016. Ultrasound training was provided by two emergency department specialists who are qualified in this field. The training time was determined to be 20h (4h for theoretical lessons, 16h for hands-on). The students were evaluated by a theory test and practical application exam both before and after training. RESULTS: obtained were compared using the paired sample t-test, and p < 0.05 was considered to be significant. Results: Ninety-six final year medical students were included. Their mean age was 24.1 ± 2.1 years. The mean test score obtained in the theoretical exam before training was 7.9 ± 2.2, while that after training was 17.1 ± 1.6 (p < 0.0001). The mean score obtained in the practical application exam before training was 1.1 ± 0.9 points and that after training was 10.9 ± 0.2 points (p < 0.0001). CONCLUSION: medical students can learn to use an ultrasound device within a short period of time via simulation-based training programs. New studies must be conducted for the inclusion of ultrasound training programs in the medical education curriculum.</b><br/> text/html 2018-07-22T00:12:51+01:00 Kerclin Danielle de Klerk, Steffen Bau, Gunar G&uuml;nther [Case report] - Diffuse pulmonary small nodular and patchy infiltrates on chest X-ray with hemoptysis: TB or not TB?-a call for scale up of respiratory medicine services in African TB high burden countries: a case of idiopathic pulmonary hemosiderosis - 13 June 2018. <b>Tuberculosis is still one of the most common respiratory diseases in Africa and worldwide and miliary tuberculosis is a regular manifestation of it. Idiopathic pulmonary hemosiderosis is a rare disease entity, presenting in children as well as adults. It is characterized by the triad of recurrent episodes of alveolar hemorrhage, presenting as hemoptysis, iron deficiency anemia and bilateral pulmonary infiltrates seen on chest X-ray. These symptoms and signs can easily be confused for other diseases i.e. miliary tuberculosis, delaying appropriate management. The etiology of idiopathic pulmonary hemosiderosis remains unclear. Diagnosis is established by lung biopsy, revealing hemosiderin laden macrophages in the alveoli. Treatment during an acute episode includes corticosteroids and/or immunosuppressive therapy, as well as supportive measures. Long-term follow-up is essential.</b><br/> text/html 2018-07-22T00:12:51+01:00 Youssef Zemmez, Naoufal Hjira [Images in medicine] - Dress syndrome secondaire &agrave; l’allopurinol - 12 June 2018. <b>Patiente &acirc;g&eacute;e de 60 ans, ayant comme ant&eacute;c&eacute;dents pathologiques une hyper-uric&eacute;mie depuis un mois trait&eacute;e par Allopurinol, qui a consult&eacute; en dermatologie pour &eacute;ruption cutan&eacute;e aigue int&eacute;ressant la face et les membres inf&eacute;rieurs dans un contexte de fi&egrave;vre d’arthralgies et de myalgies. L’examen clinique a objectiv&eacute; un &eacute;ryth&egrave;me maculeux de la face si&eacute;geant au niveau des joues d’une fa&ccedil;on sym&eacute;trique avec un œd&egrave;me discret (A), des placards &eacute;ryth&eacute;mateux au niveau des 2 jambes avec espaces de peau saine s’&eacute;tendant progressivement d’une fa&ccedil;on ascendante, ces l&eacute;sion &eacute;taient tr&egrave;s prurigineuses avec une sensation de cuisson (B). L’examen de la cavit&eacute; buccale a montr&eacute; des l&eacute;sions &eacute;rosives au niveau de la face interne des joues tr&egrave;s douloureuses. Les aires ganglionnaires &eacute;taient libres. Le bilan paraclinique a objectiv&eacute; une hyperleucocytose &agrave; 20000, &eacute;l&eacute;vation des transaminases > 100 UI, &eacute;osinophilie &agrave; 1500, s&eacute;rologie HHV6 &eacute;tait n&eacute;gative. Le diagnostic d’un DRESS Syndrome a &eacute;t&eacute; retenu. Une corticoth&eacute;rapie a &eacute;t&eacute; instaur&eacute;e &agrave; une dose de 1 mg/Kg/jr associ&eacute; &agrave; un traitement symptomatique. L’&eacute;volution &eacute;tait marqu&eacute;e par une am&eacute;lioration spectaculaire apr&egrave;s 06 jours de traitement (C et D) avec r&eacute;gression des l&eacute;sions cutan&eacute;es et normalisation progressive des param&egrave;tres biologiques.</b><br/> text/html 2018-07-22T00:12:51+01:00 Musonda Sharon Machona, Mehak Gupta, Victor Mudenda, Owen Ngalamika [Case report] - Dermatitis herpetiformis in an African woman - 12 June 2018. <b>Dermatitis herpetiformis (DH) is an autoimmune blistering disease of the skin. It is a result of hyper sensitivity to dietary gluten. Diagnosis of DH can be challenging in a low prevalence, resource-limited population. We present the case of an African woman who presented with clinical features of DH.</b><br/> text/html 2018-07-22T00:12:51+01:00 Sanjiv Fitz-Morris Gray, Beatrice Esther Dieudonne [Case report] - Clostridium sordelli causing malignant edema in a trauma patient: a case report and review of literature - 12 June 2018. <b>Clostridium sordelli infection is a rare but potentially lethal infection associated with abortions, injury, contaminated wounds, and illicit drug use. It causes a recognizable syndrome with marked leukocytosis. Rapid diagnosis and aggressive sepsis management is required for optimal outcome. We report a case in a trauma patient with delayed presentation after sustaining facial trauma with soil contamination. The critical care management is summarized and a review of the literature.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ghous Bux Somroo, Ayesha Aslam Rai, Nasir Hassan Luck, Zaigham Abbas [Research] - Clinical presentation of autoimmune hepatitis in Pakistani children - 12 June 2018. <b>INTRODUCTION: Autoimmune hepatitis (AIH) is one of the most common disorder resulting in end stage liver disease (ESLD) among children. Scarce data is available in this regard from Pakistan. In this study we have analyzed clinical and biochemical parameters of children suffering from this disorder. METHODS: It was a cross sectional study conducted in the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT) Karachi from January 2005 to June 2016. Patients aged up-to 18 years were included. AIH was diagnosed by using International Autoimmune hepatitis group (IAIHG) pre-treatment and simplified AIH score. Patients with both probable and definite score were included. Biochemical, serological, sonographic and demographics were recorded at the time of diagnosis, liver biopsy was also performed in most of the cases. Data was analyzed by using SPSS ver.20 and p-value of < 0.05 was considered significant. RESULTS: Total 51 patients were enrolled most of them were females (68.6%). Mean age of presentation was around 10 years. Males had statistically significant earlier age of presentation, p-value = 0.007. The most common presenting complain was jaundice. Hypergammaglobulinemia is seen in almost all patients. Type I AIH was the most common entity while Type II AIH was statistically more significant in males p-value = 0.019. Raised GGT was also seen in male patient specifically in Type II AIH, p-value = 0.001. CONCLUSION: Autoimmune hepatitis predominantly affects female children who have late age of presentation as compare to the males. Type I AIH was the most common while Type II AIH was more common in males and they also had raised GGT.</b><br/> text/html 2018-07-22T00:12:51+01:00 Omar Lassikri, Jalila Benayad, Omar Lachhab, Ali El Ayoubi, Mohamed Anas Benbouzid, Leila Essakalli [Case report] - Rhinoscl&eacute;rome du cavum avec expression ganglionnaire cervicale: &agrave; propos d’un cas - 12 June 2018. <b>Le rhinoscl&eacute;rome est une affection granulomateuse sp&eacute;cifique et chronique d'&eacute;volution insidieuse, dont l'agent pathog&egrave;ne est le Klebsiella rhinoscleromatis. Il touche avec pr&eacute;dilection les fosses nasales, et pose parfois un probl&egrave;me de diagnostic positif. Nous rapportons le cas d'une patiente de 19 ans, qui pr&eacute;sente un rhinoscl&eacute;rome atypique par sa localisation nasopharyng&eacute;e rare, et son association exceptionnelle &agrave; une ad&eacute;nopathie cervicale sous angulo-mandibulaire droite. La mise en &eacute;vidence des cellules de MIKULICZ &agrave; l'examen anatomo-pathologique a permis de poser le diagnostic. La patiente a &eacute;t&eacute; mise sous traitement antibiotique &agrave; base de ciprofloxacine pendant 16 semaines, associ&eacute;e &agrave; un nettoyage des fosses nasales par s&eacute;rum physiologique. L'&eacute;volution &eacute;tait favorable avec un recul de 14 mois.</b><br/> text/html 2018-07-22T00:12:51+01:00 Denis Anywar Arony, Suzanne Gazda, David Lagoro Kitara [Research] - Could nodding syndrome in Northern Uganda be a form of autism spectrum disorder? an observational study design - 12 June 2018. <b>INTRODUCTION: Nodding syndrome (NS) is associated with high anion gap, biotinidase and acetyl carnitine deficiency, vitamin B6 and D deficiency and internal displacement. The objective of this study was to conduct a metabolic analysis on NS children and review literature on its similarities with ASD. METHODS: we conducted biochemical analysis on blood and urine of NS children at Hope for HumaNs (HfH) centre in 2014 and reviewed literature on its similarities with ASD. Ethical approval was obtained from an IRB. Data analysis was conducted using STATA version 12 and a p-value less than 0.05 was considered significant. RESULTS: we found biotinidase deficiency in NS with a mean 1.98 95% CI(1.61, 2.34; p < 0.001); Acetyl carnitine deficiency 16.92 95% CI(16.10,17.75; p<0.001); Low BMI-for-age 16.92 95% CI(16.10,17.75; p = 0.42); Age 14.08 95% CI(0.78,4.660; p = 0.007); IDP duration 4.82 95% CI(4.48, 5.21; p = 0.92); Age at NS onset 8.02 95% CI(7.03, 9.01; p = 0.001); NS associated with multiple nodding episodes (&#967;<sup>2</sup>)=22.15, p=0.005; NS siblings with NS (&#967;<sup>2</sup>) = 9.68, p = 0.004; NS were in IDPs (&#967;<sup>2</sup>) = 22.15, p = 0.005. CONCLUSION: these findings are indicative that NS is associated with biotinidase and acetyl carnitine deficiency, IDPs, and environmental exposures. There are no new cases of NS reported by Ugandan MOH and WHO since 2012 when the IDP camps were disbanded and communities resettled in their own communities and feed on their own grown foods. Perhaps NS may be akin to Autism Spectrum Disorder (ASD). This finding will help support all efforts towards the treatment and rehabilitation of NS children.</b><br/> text/html 2018-07-22T00:12:51+01:00 Abire Allaoui, Khadija Echchilali, Mina Moudatir, Fatim Zohra Alaoui, Hassan Elkabli [Case series] - Etiologies des accidents vasculaires c&eacute;r&eacute;braux isch&eacute;miques chez les jeunes: apport de l’interniste - 12 June 2018. <b>Les isch&eacute;mies c&eacute;r&eacute;brales chez les jeunes sont diff&eacute;rentes par leurs &eacute;tiologies et leur pronostic. Le profil &eacute;tiologique en m&eacute;decine interne est particulier vu le niveau tertiaire de recrutement. L'objet de notre travail est de faire conna&icirc;tre certaines &eacute;tiologies particuli&egrave;res de cette pathologie chez le sujet jeune. Etude r&eacute;trospective des dossiers de jeunes patients au service de m&eacute;decine interne &agrave; Casablanca, sur une p&eacute;riode de 2000-2014. Tous les patients ont b&eacute;n&eacute;fici&eacute; d'une imagerie c&eacute;r&eacute;brale avec des s&eacute;quences angiographiques, pr&eacute;cisant la nature et la topographie de l'AVCI. Un bilan &eacute;tiologique dict&eacute; par la clinique a &eacute;t&eacute; men&eacute;. Vingt et cinq patients ont &eacute;t&eacute; collig&eacute;s, avec un sex-ratio &agrave; 0,73 et un &acirc;ge moyen de 36±7. Le tabagisme &eacute;tait pr&eacute;sent dans 32% des cas, le diab&egrave;te et l'hypertension art&eacute;rielle ont &eacute;t&eacute; not&eacute;s dans 8% des cas. Les &eacute;pisodes d'amn&eacute;sie et de migraine ont &eacute;t&eacute; not&eacute;s dans 24%. La prise d'oestroprogestatifs et l'ant&eacute;c&eacute;dent de fausses couches ont &eacute;t&eacute; not&eacute;s dans 12%. Les &eacute;tiologies &eacute;taient domin&eacute;es par: lupus syst&eacute;mique aigu (32%) associ&eacute; &agrave; un syndrome des antiphospholipides (80%), maladie de Behcet (16%), maladie de Takayasu (12%). En plus de l'antiagr&eacute;gation, 76% de nos patients ont eu un traitement aux cortico&iuml;des et immuno-suppresseurs. La m&eacute;decine interne participe &agrave; la prise en charge des AVCI, notamment dans le volet &eacute;tiologique. Les &eacute;tiologies des isch&eacute;mies c&eacute;r&eacute;brales du sujet jeune sont multiples, la recherche doit &ecirc;tre rigoureuse afin d'identifier des causes particuli&egrave;res, &eacute;valuer le risque de r&eacute;cidive et pr&eacute;ciser la strat&eacute;gie th&eacute;rapeutique.</b><br/> text/html 2018-07-22T00:12:51+01:00 Herve Lawin, Lucie Ayi Fanou, Arsene Amadohoue Kpangon, Antoine Vikkey Hinson, John Balmes, Jacqueline Wanjiku, Boni Maxime Ale, Benjamin Fayomi [Research] - Comparison of motorcycle taxi driver’s respiratory health using an air quality standard for carbon monoxide in ambient air: a pilot survey in Benin - 12 June 2018. <b>INTRODUCTION: Ambient air quality standards are not designed to protect people occupationally exposed to outdoor air pollution on a routine basis. This study aimed to assess the effect of exceeding the US ambient air quality standard for carbon monoxide (CO) on motorcycle taxi drivers respiratory health. METHODS: A cross-sectional study of 85 current motorcycle taxi drivers with at least 5 years of job tenure in Cotonou (Benin) was conducted. Personal CO was measured with a portable CO data logger for 8 hours per day during working hours. A questionnaire on respiratory symptoms was administered to participants and spirometry was performed. Participants were divided into two groups, those with exposure to CO >9 ppm and &#8804;9 ppm, according to the US Environmental Protection Agency (EPA) National Ambient Air Quality Standard which is an 8-hour average of 9ppm. 8 and 10 ppm were also used an exposure limit. Analysis was done using these two groups. RESULTS: Socio-demographic characteristics were well balanced between the two study groups. The drivers with a CO exposure of more than 9ppm had non-significantly more respiratory symptoms (OR=1.67; 95%CI:0.26,10.74), lower FVC and FEV1 compared to the less exposed group but they have a significant lower PEF(-10%, p=0.02). When we used an exposure limit of 8 or 10 ppm the results were not statistically different. CONCLUSION: Drivers with a CO exposure>9 ppm tend to have more respiratory problems. More research is needed to reinforce this result in order to improve air quality standards to protect workers occupationally exposed to outdoor air pollution.</b><br/> text/html 2018-07-22T00:12:51+01:00 Seyitali Gumustas, Haci Bayram Tosun, Mehmet Isyar, Sancar Serbest, Kadir Oznam, G&uuml;ven Bulut [Research] - Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study - 12 June 2018. <b>INTRODUCTION: Femur neck fracture comprises a significant part of intracapsular femur fracture in the intracapsular area of proximal femur and it is mostly seen in elder people. However, these kinds of fractures may be seen in young adults. The present study aims to search factors that affect femoral neck fractures in young adults after surgery carried out by internal determination method. METHODS: Files of patients who were applied internal determination through closed reduction and cannulated screw because of intracapsular femur neck fractures between 2010 and 2015 were analyzed retrospectively. Fractures were evaluated by means of Garden classification, which is based on radiological appearance. The cases were examined in terms of timing of surgery in two groups. Cases operated in the first 24 hours after trauma consisted of group 1 and after 24 hours group 2. Radiological staging in femoral head avascular necrosis was evaluated by Ficat-Arlet classification system whereas acetabular fractures and hip functionality was evaluated by Letournel and Judet system, which is based on direct graph of fracture line. RESULTS: Mean age at the time of surgery for 31 cases included in the study was 40.04±9.63 year. The average duration from injury to surgery was 6.6 (1-20) days. Thirty nine percent of fractures was nondisplaced whereas 61% was displaced. The average follow-up period was 4.9 ± 1.35 years. The rate of nonunion was found 16% and femoral head avascular necrosis 6.4%. According to Judet System, 67.7% of cases showed excellent / good and 32.3% moderate/bad functional results. Six cases had a secondary surgery. Cases who had displaced fractures statistically showed worse functional results and underwent more secondary surgery than patients with nondisplaced fractures (P>0.05). As a result of logistic regression analysis, presence of displacement was a factor negatively affecting the judet score but did not affect the rate of complication. There were no significant differences between the two groups according to the surgical timing in terms of functional outcomes and complications. CONCLUSION: Because of surgical treatment of femoral neck fractures in the first 24 hours does not affect functional outcomes and complication rate, surgery is recommended in optimal conditions. In the case of displacement, care must be taken in terms of poor functional results.</b><br/> text/html 2018-07-22T00:12:51+01:00 Abdelmajid Bouzerda, Laila Bendriss, Ali Khatouri [Case report] - Ath&eacute;rome coronaire &eacute;ctasiant - 12 June 2018. <b>Les ectasies coronaires sont des pathologies relativement rares et mal connues. Leur &eacute;tiologie chez l'adulte est le plus souvent ath&eacute;romateuse. Ces anomalies exposeraient au risque de thrombose intracoronaire par stase sanguine, elles sont le plus souvent associ&eacute;es &agrave; des l&eacute;sions st&eacute;nosantes qui conditionnent le pronostic. Nous rapportons trois observations de patients hospitalis&eacute;s pour un syndrome coronarien aigu ST positif avec un aspect de m&eacute;gacoronaires not&eacute; &agrave; la coronarographie et nous discutons une revue de la litt&eacute;rature concernant ce type de l&eacute;sions.</b><br/> text/html 2018-07-22T00:12:51+01:00 Olusegun Kayode Ajenifuja, Nzechukwu Zimuod Ikeri, Olawale Victor Adeteye, Adekunbiola Aina Banjo [Research] - Comparison between self sampling and provider collected samples for Human Papillomavirus (HPV) Deoxyribonucleic acid (DNA) testing in a Nigerian facility - 12 June 2018. <b>INTRODUCTION: The multiple visits required for an effective Pap smear screening program is difficult to replicate in many developing countries. This precludes early diagnosis and care for patients with cervical cancer and contributes to its high mortality in these countries. HPV screening has higher specificity and high negative predictive value and has the advantage that materials can be self-collected, which permits the screening of women who for various cultural and religious reasons would be reluctant to come to the clinic to expose themselves for screening. The aim of the study was to assess the degree of agreement between self sampling for HPV DNA with samples collected by a health provider. METHODS: each respondent selected from women presenting for cervical cancer screening underwent both self- and provider sampling for HPV DNA testing using Hybribio GenoArray. RESULTATS: of the 194 women screened, 12 (6.2%) and 19 (9.8%) had HPV on self sampling and provider col-lected samples respectively. The commonest HPV type seen using both techniques was HPV 58 (2.6%). Multiple HPV genotypes were seen in 1 (0.5%) and 5 cases (2.6%) of provider and self-collected samples respectively. The high risk-HPV detection rate was 7.2% when self sampled and 6.8% when sampled by the provider. There was moderate correlation between both sampling techniques (K = 0.47, 95% CI: 21.3 - 72.3%, P < 0.05). CONCLUSION: our study shows moderate correlation between both sampling techniques. Larger multicentre studies will be needed to provide results generalisable to the Nigerian population. Keywords: Pap smear, HPV screening, cervical cancer, sample collection, self-sampling, provider collected, PCR, HPV DNA, Ile-Ife Nigeria.</b><br/> text/html 2018-07-22T00:12:51+01:00 Fatma Khalsi, Mohamed Riadh Boukhris, Ines Brini, Jean Pierre Hugot, Patsy Dominique Berrebi, Khedija Boussetta [Case report] - Unusual feature of neonatal hypernatremic dehydration due to microvillus inclusion disease: a case report - 11 June 2018. <b>All over the causes of intractable diarrhea of infancy, microvillous inclusion disease is a rare congenital defect of intestinal brush border of unknown aetiology. An autosomal recessive inheritance is suggested by cases occurring in siblings and high incidence of consanguinity. The prognosis of the disease is extremely poor, as life can be sustained only by total parenteral nutrition. The authors report a preterm male newborn of 35 weeks gestation presenting severe hypernatremic dehydration on day 4 after birth caused by a secretory profuse diarrhea and discuss the tools allowing the light microscopic and genetic diagnosis. The final diagnosis of microvillus intestinal disease (MVID) was made on the third month after extensive investigations using electron microscopic examination of intestinal biopsy and genetic confirmation, finding a mutation at the homozygous status of MYO5B gene. The infant died on the fourth month in spite of optimal electrolytic support and parenteral prolonged nutrition. Although MVID is extremely rare, it remains a possible cause of intractable secretory diarrhea leading to severe hypernatremic dehydration and metabolic acidosis in neonates.</b><br/> text/html 2018-07-22T00:12:51+01:00 John Bosco Tamu Munezero, Catherine Atuhaire, Sara Groves, Samuel Nambile Cumber [Research] - Assessment of nurses knowledge and skills following cardiopulmonary resuscitation training at Mbarara Regional Referral Hospital, Uganda - 11 June 2018. <b>INTRODUCTION: Cardiopulmonary resuscitation (CPR) is considered a core emergency skill in which all health care professionals must be proficient. CPR remains a new procedure in developing compared to develop countries. The objective of this study was to assess Nurses Knowledge and Skills following Cardiopulmonary Resuscitation Training at Mbarara Regional Referral Hospital. METHODS: a prospective pre/post intervention design was adopted. CPR knowledge and skills of 32 nurses from MRRH were assed using two tools. Tool I consisted of 17 item of multiple choice questions that assessed CPR knowledge. Tool II involved an observation checklist of 15-point skills questions. A penalty score of 5 or 10 or 20 was set for each question, based on the guideline. RESULTS: the average score prior to instruction was 53.8 for knowledge and posttest 82.5, and for skills was 46 pre-instruction and 81.5 post instruction. There was a statistically significant (p < 0.001) improvement in the CPR knowledge and (p = 0.02) for CPR skills. The percentage change in respondent's knowledge and skills ranged from 16.8% to137.2% with a mean of 59.9% for knowledge and from 19.18% to 2115.6% with a mean of 159.8% for the skills assessment. CONCLUSION: respondents had inadequate CPR knowledge and skills at pretest. The study revealed statistically significant improvement in both knowledge and skills of CPR for all nurses post training. There was a significant change in nurses' skills than in knowledge post training.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mustapha Ahsaini, Adil Mellouki, Khalid Ouattar, Hamid Azelmad, Soufiane Mellas, Jalaleddine Ammari, Mohammed Fadl Tazi, Mohammed Jamal Fassi, Moulay Hassan Farih [Case report] - Un traumatisme scrotal n&eacute;glig&eacute; r&eacute;v&eacute;lant un rhabdomyosarcome embryonnaire para-testiculaire: &agrave; propos d’un cas - 11 June 2018. <b>Le rhabdomyosarcome paratesticulaire embryonnaire est une tumeur m&eacute;senchymateuse rare qui repr&eacute;sente une urgence diagnostique et th&eacute;rapeutique. Les formes localis&eacute;es sont de pronostic favorable et un traitement multimodal fait appel &agrave; la chirurgie, &agrave; la polychimioth&eacute;rapie et &agrave; la radioth&eacute;rapie permettant d'aboutir &agrave; d'excellents taux de survie globale. Nous rapportons un cas collig&eacute; dans notre service de rhabdomyosarcome embryonnaire para testiculaire &agrave; cellules fusiforme, caract&eacute;ris&eacute; par une confusion clinique, chez un jeune patient de 17ans, et &agrave; l'occasion du quel nous reprendrons l'ensemble des caract&egrave;res sp&eacute;cifiques de cette pathologie.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mohamed Jira, Taoufik Amezyane [Images in medicine] - An&eacute;vrisme de l’art&egrave;re iliaque primitive droite - 11 June 2018. <b>Il s'agissait d'un patient &acirc;g&eacute; de 55 ans, ses ant&eacute;c&eacute;dents &eacute;taient marqu&eacute;s par une aphtose buccale r&eacute;cidivante, il &eacute;tait hospitalis&eacute; pour une douleur pelvienne d'installation brutale et chez qui, l'examen clinique trouvait une masse pelvienne sensible, pulsatile et soufflante &agrave; l'auscultation &eacute;voquant une origine vasculaire, l'examen des organes g&eacute;nitaux externes trouvait une cicatrice d'aphtose scrotale. Le bilan biologique objectivait un syndrome inflammatoire avec CRP &agrave; 80 mg/l, la s&eacute;rologie syphilitique &eacute;tait n&eacute;gative, l'&eacute;cho-doopler pelvienne &eacute;tait faveur d'un an&eacute;vrisme de l'art&egrave;re iliaque primitive droite et l'art&eacute;riographie confirmait le diagnostic Le diagnostic de la maladie de Beh&ccedil;et &eacute;tait retenu devant l'aphtose bipolaire et l'atteinte vasculaire. Le traitement comportait une ex&eacute;r&egrave;se chirurgicale de l'an&eacute;vrisme, corticoth&eacute;rapie en bolus de trois jours puis en relai par voie orale et une perfusion mensuelle de cyclophosphamide. L'&eacute;volution &eacute;tait favorable.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mohamed Said Belhamidi, Abdessamad Kaoukabi, Hicham krimou, Mohamed Menfaa, Fouad Sakit, Karim Choho [Case report] - Lymphome colique r&eacute;v&eacute;l&eacute; par invagination il&eacute;o-caecale chez l’adulte: &agrave; propos d’un cas - 11 June 2018. <b>L'invagination intestinale est une affection tr&egrave;s fr&eacute;quente en p&eacute;diatrie, alors que chez l'adulte, elle reste une entit&eacute; clinique rare et ne repr&eacute;sente que 10% de l'ensemble des invaginations et 4% des occlusions intestinales. Un lymphome colique r&eacute;v&eacute;l&eacute; par invagination intestinale est une entit&eacute; tr&egrave;s rare. Nous rapportons le cas d'une femme de 21 ans, admise aux urgences de l'h&ocirc;pital Militaire Mouly Ismail &agrave; Meknes, Maroc pour une subocclusion intestinale. Le scanner abdominal a montr&eacute; la pr&eacute;sence du boudin d'invagination ainsi que la cause organique au niveau colique. La r&eacute;section chirurgicale &eacute;tait le traitement choisi, avec un examen anatomopathologique de la pi&egrave;ce op&eacute;ratoire qui montre la pr&eacute;sence d'un lymphome B de type diffus &agrave; grandes cellules. Apr&egrave;s la chirurgie, une chimioth&eacute;rapie est indiqu&eacute;e dans le but d'am&eacute;liorer le pronostic et d'&eacute;viter une &eacute;ventuelle rechute.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mohammed Chahbouni, Issam Eloukili, Moulay Omar Lamrani, Mohamed Kharmaz, Farid Ismail, Mustapha Mahfoud, Ahmed El Bardouni, Mohamed Saleh Berrada, Mouradh El Yaacoubi [Corrigendum] - Corrigendum: Abc&egrave;s tuberculeux de la face post&eacute;rieure de la cuisse: &agrave; propos d’un cas - 06 June 2018. <b>This corrigendum corrects article “Abc&egrave;s tuberculeux de la face post&eacute;rieure de la cuisse: &agrave; propos d’un cas. The Pan African Medical Journal. 2014;19:50. doi:10.11604/pamj.2014.19.50.4683.</b><br/> text/html 2018-07-22T00:12:51+01:00 Reginald Mzudumile Ngwanya, Zandile Spengane, Nonhlanhla Khumalo [Case report] - Angioedema, an unusual reaction to hair dye - 06 June 2018. <b>Angioedema is a type-1 hypersensitivity reaction that can be life threatening. It affects the skin airways and the gastrointestinal tract. Henna is a green powder used to dye skin and nails. We report a 29 year old patient who presented with angioedema Her patch test was positive to paraphenynlenediamine. She was discharged after successful treatment with intravenous steroids and later topical steroids.</b><br/> text/html 2018-07-22T00:12:51+01:00 Saida El Khayati, Amal El Yamani [Case report] - La dentisterie holistique au service de la sant&eacute; globale - 06 June 2018. <b>Les amalgames dentaires constituent des mat&eacute;riaux d'obturation utilis&eacute;s pour le traitement des l&eacute;sions carieuses depuis plus de 150 ans. Cependant le mercure servant de base &agrave; la pr&eacute;paration des amalgames est universellement consid&eacute;r&eacute; comme un toxique tr&egrave;s dangereux pour l'&ecirc;tre humain. L'objectif de ce travail est de monter &agrave; travers un cas clinique certains signes locaux et g&eacute;n&eacute;raux d'intoxication au mercure, les pr&eacute;cautions &agrave; prendre lors de la d&eacute;pose des amalgames, ainsi que les solutions de remplacements actuels qu'on doit proposer &agrave; nos patients. En r&eacute;alit&eacute; la toxicit&eacute; des amalgames n'est que la partie &eacute;merg&eacute;e de l'iceberg. Les autres m&eacute;taux employ&eacute;s en dentisterie peuvent &eacute;galement provoquer des probl&egrave;mes importants en induisant des effets galvaniques, des intol&eacute;rances, des allergies, des r&eacute;actions d'intoxication ou de sub-intoxication. En mati&egrave;re de sant&eacute; publique, ces motifs justifient amplement l'int&eacute;r&ecirc;t que tout th&eacute;rapeute doit accorder aux alternatives proth&eacute;tiques n'incluant pas de m&eacute;tal.</b><br/> text/html 2018-07-22T00:12:51+01:00 Bousayna Iraqi, Imane Jroundi, Amina Iraqi, Chafiq Mahraoui [Letter to the editors] - The pharmacist’s role in managing and ameliorating childhood’s asthma care: a descriptive and transversal study about 104 pharmacists in the city of Rabat in Morocco - 06 June 2018. <b>This work aims at enhancing the management of childhood asthma, with a focus on pharmacists in particular, by evaluating their knowledge of childhood asthma and assessing their attitude while they are providing asthma medicines. Consequently, it will look at the necessity of introducing training days about childhood asthma for pharmacists. This is a transversal and descriptive study which lingered from August to October 2015. Data has been collected using a questionnaire that was self-administered to every surveyed pharmacist in the city of Rabat. The 104 pharmacists who replied to the questionnaire have an average general understanding about asthma and its treatment. Only a quarter of them managed an asthma crisis in their pharmacy before directing the child to the emergency. 50% of them do not know the difference between the basic asthma therapy and the asthma attack therapy. However, all of them recommended the parents to see a physician regarding their child’s asthma. 75% advise the systematic use of an asthma spacer with the inhaler. 87.5% of them give advice to parents regarding the good measures for environmental control, and 98% estimate that the therapeutic education is important in childhood asthma management. 88.5% among them are interested in training days about childhood asthma.This study shows the necessity of further pharmacists’ education about asthma and its management.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mohamed Jira, Naoual El Omri, Youssef Sekkach, Fadoua Mekouar, Taoufik Amezyane [Case series] - Oxyg&eacute;noth&eacute;rapie hyperbare dans la prise en charge du pied diab&eacute;tique: exp&eacute;rience d’un service de m&eacute;decine interne &agrave; propos de 80 cas - 05 June 2018. <b>L'oxyg&eacute;noth&eacute;rapie hyperbare (OHB) est un proc&eacute;d&eacute; th&eacute;rapeutique dans la prise en charge des l&eacute;sions chroniques mena&ccedil;ant le pied chez les patients diab&eacute;tiques. Dans le but d'&eacute;valuer ce traitement, les auteurs proposent une analyse r&eacute;trospective des patients diab&eacute;tiques pr&eacute;sentant une ou plusieurs l&eacute;sions chroniques aux niveaux des membres inf&eacute;rieurs et ayant b&eacute;n&eacute;ficier de l'OHB. Il s'agit de 80 patients, hospitalis&eacute;s dans un service de m&eacute;decine interne sur une p&eacute;riode de 10 entre janvier 2006 et d&eacute;cembre 2016. Ces patients ont b&eacute;n&eacute;fici&eacute; de 20 ± 5 s&eacute;ances d'OHB &agrave; raison de 2,5 atmosph&egrave;res absolues sous oxyg&egrave;ne pur pendant 90 minutes par s&eacute;ance et par jour associ&eacute;es &agrave; une insulinoth&eacute;rapie, une antibioth&eacute;rapie adapt&eacute;e, des soins locaux quotidiens. L'&eacute;volution des l&eacute;sions a &eacute;t&eacute; &eacute;valu&eacute;e par l'examen clinique avec des mesures r&eacute;p&eacute;t&eacute;es de la taille des l&eacute;sions &agrave; la cinqui&egrave;me, quinzi&egrave;me et vingti&egrave;me s&eacute;ance d'OHB. Notre &eacute;tude a inclus 80 patients dont 72 hommes et 8 femmes, leur age moyen &eacute;tait de 56,2 ± 4,62 ans, 77,5% pr&eacute;sentaient un diab&egrave;te type 2, &eacute;voluant depuis 13,9±3,3 ans. Ils avaient des l&eacute;sions chroniques du pied (grade 2, 3 ou 4 de Wagner). Une r&eacute;duction significative de la surface de la plaie a &eacute;t&eacute; observ&eacute;e d&eacute;s la dixi&egrave;me s&eacute;ance avec cicatrisation compl&egrave;te et gu&eacute;rison chez 56 (70%) de nos patients au terme de 20 s&eacute;ances d'OHB. L'amputation a &eacute;t&eacute; not&eacute;e chez 20 (25%) patients. L'OHB est reconnue dans le traitement des l&eacute;sions chroniques du pied chez le diab&eacute;tique, elle permet de r&eacute;duire consid&eacute;rablement l'incidence des amputations.</b><br/> text/html 2018-07-22T00:12:51+01:00 Joshua Ondari, James Kinyanjui, Paul Miano, Edward Sang, Ezekiel Oburu, Michael Maru [Case report] - Femoral bifurcation and bilateral tibial hemimelia: case report - 05 June 2018. <b>Femoral bifurcation and tibial hemimelia are rare anomalies described as a variant of Gollop-Wolfgang complex. This article presents a case of Gollop-Wolfgang complex without hand ectrodactyly. A 5-year old patient presented with bilateral tibial hemimelia and left femoral bifurcation. The patient's left limb lacked knee extensor mechanism, disarticulation was done. The right leg which had Jones type 2 tibia hemimelia was treated with tibiofibular synostosis. Currently patient is ambulant with prosthesis on the left limb and ankle foot orthosis on the right. In the absence of proximal tibial anlage, especially in patients with femoral bifurcation, the knee should be disarticulated. Tibiofibular synostosis is a good choice in the presence of a proximal tibial anlage with good quadriceps function.</b><br/> text/html 2018-07-22T00:12:51+01:00 Rafet Eren, Meryem Can, Fatma Alibaz-Öner, Sibel Yilmaz-Oner, Baris Yilmazer, Ayse Cefle, Haner Direskeneli, Pamir Atagündüz [Research] - Prevalence of inflammatory back pain and radiologic sacroiliitis is increased in patients with primary Sj&ouml;gren’s syndrome - 05 June 2018. <b>INTRODUCTION: The prevalence of Sj&ouml;gren's syndrome (SS) in patients with the diagnosis of SpA has been reported to be higher than normal population. Yet, the vice-versa is unclear. In this study, we aimed to investigate the prevalence of IBP, radiologic sacroiliitis and SpA in patients with primary SS. METHODS: 85 patients followed at the rheumatology clinics of the Marmara and Kocaeli Universities with the diagnosis of primary SS between November 2011 and August 2012 were included in this study. The control group consisted of 100 age-and gender-matched patients. Inflammatory back pain and axial SpA were diagnosed according to the assessment of spondylo arthritis International Society (ASAS) criteria. RESULTS: 83 patients were (97%) female and 2 (3%) were male. Mean age of the patients was 49.1 (±11) years. Mean disease duration was 7.3 (±4) years. The patient and control groups were comparable in terms of age and gender (p > 0.05). Inflammatory back pain was observed in 21 (24.7%) of 85 primary SS patients and in 4 (4%) of 100 control subjects (p < 0.001), radiographic sacroiliitis was demonstrated in 9 (10.5%) of primary SS patients and 2 (2%) of the control subjects (p = 0.025). Remaining SpA findings were not encountered in either group. CONCLUSION: inflammatory back pain and radiologic sacroiliitis is increased in patients with primary SS. Whether IBP, SI joint inflammation and radiologic sacroiliitis is due to the co-existence of SpA and primary SS or IBP is an underdiagnosed clinical feature of SS deserves further studies of large patient numbers.</b><br/> text/html 2018-07-22T00:12:51+01:00 Kathy Lynn Rush, Fastone Matthew Goma, Jessica Amelia Barker, Rachel Ann Ollivier, Matthew Scott Ferrier, Douglas Singini [Research] - Hypertension prevalence and risk factors in rural and urban Zambian adults in western province: a cross-sectional study - 05 June 2018. <b>INTRODUCTION: Hypertension is a longstanding problem in Zambia, yet little is known about its prevalence and risk factors, particularly in rural and urban settings. Identifying geographical variations in hypertension is important to enhance the health of adult Zambians regardless of where they live. Therefore, the purpose of this study was to compare the prevalence of hypertension and related risk factors between rural (n = 130) and urban (n = 131) communities in Western Province, Zambia. METHODS: this cross-sectional study included urban and rural adult Zambians attending health checks who completed a modified World Health Organization (WHO) survey, and had blood pressure and anthropometric measurements completed. Descriptive statistics were used to summarize demographic and risk factor variables. Chi-square tests of association were used to analyze relationships between categorical variables, t-tests to analyze relationships between continuous variables and logistic regression to examine associations of hypertension with selected risk factors. RESULTS: the prevalence of hypertension in rural Zambians was double (46.9%) that of urban Zambians (22.9%). Increasing age, not engaging in walking/biking, and alcohol intake within the last 30 days were associated with an increased likelihood of hypertension in rural Zambians while eating vegetables more days during the week was associated with a decreased likelihood of hypertension in rural Zambians. Body Mass Index (BMI) was significantly associated with an increased likelihood of hypertension in urban Zambians. CONCLUSION: modifiable risk factors (such as BMI, dietary intake, and physical activity) are associated with hypertension prevalence in this population, indicating opportunities for screening and other prevention measures.</b><br/> text/html 2018-07-22T00:12:51+01:00 Hassan Bin Usman Shah, Farah Rashid, Iffat Atif, Muhammad Zafar Hydrie, Muhammad Waleed Bin Fawad, Hafiz Zeeshan Muzaffar, Abdul Rehman, Sohail Anjum, Muhammad Bin Mehroz, Ali Haider, Ahmed Hassan, Hassaan Shukar [Research] - Challenges faced by marginalized communities such as transgenders in Pakistan - 05 June 2018. <b>INTRODUCTION: Stigmatization, social exclusion and consequent banishment from the society makes transgender's life even tougher; isolating, pushing and forcing them into inappropriate conducts/habits like selling sex. This study investigates the association of social exclusion/victimization with high-risk behaviors among transgender community of Rawalpindi and Islamabad (Pakistan). METHODS: through a cross-sectional study design, a sample of 189 transgender community living in twin cities of Rawalpindi and Islamabad was selected using snowball sampling technique. A validated close ended questionnaire was used to estimate the high-risk behaviors. Multivariate logistic regression was used to explore the competing outcomes associated with suicidal risk, selling sex and substance abuse. RESULTS: majority study participants 77.8% experienced physical attacks with institutional discrimination even higher (91.5%). Commercial sex work and drug abuse was reported in 39.2% and 37.6% respectively. The prevalence of suicide ideation was high (38.6%) however, suicide attempted rate was less (18.5%). In the multivariate logistic regression, compared to those with no risk, being physically attacked increased the odds of both attempting (OR=2.18) and contemplating suicide and selling sex (OR=4.10). Nevertheless, the relative impact of institutional victimization on suicidal behavior was higher among those who were targeted on the basis of their gender identity or expression (AOR = 6.20, CI = 1.58-24.29, p=0.009). CONCLUSION: the transgender community is socially excluded by the Pakistani society where they experience high levels of physical abuse and face discriminatory behavior in daily life. Such attitudes make them vulnerable for risky behaviors; forcing them to become commercial sex workers, begging, drugs use and even suicidal ideation.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ahlam Abdou, Badredine Hassam [Images in medicine] - Ecthyma gangrenosum - 05 June 2018. <b>Ecthyma gangrenosum (EG) est une infection cutan&eacute;e s&eacute;v&egrave;re, potentiellement mortelle qui &eacute;volue s&eacute;quentiellement d’abord &agrave; type d’&eacute;ruption maculo-papuleuse, puis une bulle h&eacute;morragique, puis vers une ulc&eacute;ration n&eacute;crotique entour&eacute;e d’ un &eacute;ryth&egrave;me EG se produit g&eacute;n&eacute;ralement chez les patients immunod&eacute;prim&eacute;s (aplasie secondaire &agrave; la chimioth&eacute;rapie, infection par le VIH, neutrop&eacute;nie ou d&eacute;ficit fonctionnel des polynucl&eacute;aires neutrophiles, agammaglobulin&eacute;mie). Rarement, il affecte les individus en bonne sant&eacute;. Le diagnostic diff&eacute;rentiel inclut la leishmaniose, le pyoderma gangr&eacute;nosum, les escarres et les tuberculides papulo-n&eacute;crotiques. Les h&eacute;mocultures et/ou le pr&eacute;l&egrave;vement local permettent d’isoler le germe en cause qui est toujours un P. aeruginosa. Le traitement repose en une antibioth&eacute;rapie parent&eacute;rale adapt&eacute;e &agrave; l’antibiogramme (c&eacute;phalosporine de troisi&egrave;me g&eacute;n&eacute;ration, fluoroquinolones). Nous pr&eacute;sentons le cas d’un enfant de 2 ans sans ant&eacute;c&eacute;dent pathologiques notables qui a pr&eacute;sent&eacute; de multiple ulc&eacute;rations n&eacute;crotiques localis&eacute;es au niveau du dos avec une bordure &eacute;ryth&eacute;mateuse le tout &eacute;voluant dans un contexte f&eacute;brile. L’h&eacute;moculture n’a pas mis en &eacute;vidence de germe. Le bilan biologique a objectiv&eacute; une VS &eacute;lev&eacute;e &agrave; 30 mm, une CRP &agrave; 80mg/l. Un pr&eacute;l&egrave;vement bact&eacute;riologique du pus a r&eacute;v&eacute;l&eacute; le pseudomonas aeruginosa. Le diagnostic d’ecthyma gangr&eacute;nosum a &eacute;t&eacute; pos&eacute;. Le patient a &eacute;t&eacute; mis sous c&eacute;phosporine troisi&egrave;me g&eacute;n&eacute;ration par voie parent&eacute;ale. La gu&eacute;rison compl&egrave;te avec cicatrisation a eu lieu apr&egrave;s 4 semaines.</b><br/> text/html 2018-07-22T00:12:51+01:00 Dounia Basraoui, Ayoub Elhajjami, Hicham Jalal [Case series] - Imagerie de la cellulite orbitaire chez l’enfant: &agrave; propos de 56 cas - 31 May 2018. <b>Les cellulites orbitaires de l'enfant sont rares mais potentiellement graves, le diagnostic est principalement bas&eacute; sur l'examen clinique et l'imagerie (tomodensitom&eacute;trie ou IRM). Le but de ce travail est d'illustrer le r&ocirc;le de l'imagerie, essentiellement la TDM, dans le diagnostic et la prise en charge de cette pathologie. Il s'agit d'une &eacute;tude r&eacute;trospective portant sur 56 cas de cellulite orbitaire, collig&eacute;s durant six ann&eacute;es au service de radiologie de l'h&ocirc;pital m&egrave;re-enfant du CHU Mohammed VI de Marrakech (de janvier 2011 &agrave; octobre 2017), explor&eacute;s par TDM cr&acirc;nio-orbitaire. L'&acirc;ge moyen des patients &eacute;tait de 5 ans, avec une l&eacute;g&egrave;re pr&eacute;dominance f&eacute;minine. La porte d'entr&eacute;e &eacute;tait domin&eacute;e par l'atteinte sinusienne retrouv&eacute;e chez 22malades. L'analyse des r&eacute;sultats tomodensitom&eacute;triques a not&eacute; 37 cas de cellulite pr&eacute;septale (66%), 3 cas de cellulite r&eacute;troseptale isol&eacute;e (5%), 16 cas de cellulite mixte (28%), 8 cas d'exophtalmie (14%) et 4 cas d'abc&egrave;s sous-p&eacute;riost&eacute; (7%). Les cellulites orbitaires de l'enfant sont des infections graves, entravant le pronostic vital &agrave; court terme et le pronostic fonctionnel visuel &agrave; moyen et long terme, le diagnostic positif est clinique. L'imagerie joue un r&ocirc;le important dans le diagnostic topographique et &eacute;tiologique, ainsi que pour guider le traitement.</b><br/> text/html 2018-07-22T00:12:51+01:00 Haruna Dika, Elizabeth Masawe, Shabani Iddi, Richard Rumanyika [Research] - Plasma hemoglobin concentration among pregnant and non-pregnant women in Mwanza: are we using correct reference values to diagnose anemia in pregnancy? - 31 May 2018. <b>INTRODUCTION: The definition of anemia has attracted considerable interest because several studies have demonstrated that hematologic profile vary with ethnicity in addition to age, sex and altitude. This has led scholars to recommend the use of population specific hematologic reference values in diagnosing blood disorders. However, there is limited information about Tanzanians population specific hemoglobin (Hb) levels which can be used to set cut-off points to define anemia. This study aimed to determine plasma Hb concentrations among healthy Tanzanian women. METHODS: This cross sectional study was done in Mwanza. Sociodemographic data were collected using questionnaires and plasma Hb concentrations were measured by calorimetric method. Data were analyzed using SPSS. RESULTS: A total of 215 (162 pregnant, 53 non-pregnant) women with a mean age of 28.2 ± 6.54 years participated in the study. The mean plasma Hb concentrations were 12.0 ± 1.43 mg/dl and 11.9 ± 1.15 mg/dl for pregnant and non-pregnant women respectively. The Hb levels did not significantly vary between pregnant and non-pregnant women. Using WHO reference values, 45.3% non-pregnant and 26.5% pregnant women were found to be anemic while using the population specific reference, only 1.9% of pregnant and none of non-pregnant women would be classified as anemic.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ismail Aissa, Aziz Benakrout, Mohamed Meziane, Mustapha Bensghir, Salim Jaafar Lalaoui [Case report] - Asystolie au cours d’une chirurgie pour tumeur de l’intestin gr&ecirc;le: anaphylaxie ou crise carcino&iuml;de - 31 May 2018. <b>L'arr&ecirc;t cardiaque au bloc op&eacute;ratoire est un &eacute;v&eacute;nement redoutable, ces &eacute;tiologies sont multiples. Nous rapportons le cas d'une patiente de 53 ans sans ant&eacute;c&eacute;dents pathologiques particuliers, programm&eacute;e pour cure chirurgicale d'une tumeur de l'intestin gr&ecirc;le. 20 minutes apr&egrave;s l'induction anesth&eacute;sique la patiente a pr&eacute;sent&eacute; une asystolie rapidement r&eacute;versible apr&egrave;s les mesures de r&eacute;animation, l'association d'un rush cutan&eacute; du visage et du thorax a fait suspecter une r&eacute;action anaphylacto&iuml;de tardive. L'am&eacute;lioration rapide de la patiente a permis l'autorisation d'une reprise de l'intervention. Le d&eacute;but de la manipulation tumorale a occasionn&eacute; une deuxi&egrave;me bradycardie extr&ecirc;me rapidement r&eacute;solutive apr&egrave;s 0,5 mg d'atropine, une r&eacute;apparition du rush cutan&eacute; au niveau du visage et du thorax a &eacute;t&eacute; observ&eacute;e, cette deuxi&egrave;me complication a rapidement fait suspecter une crise carcino&iuml;de conduisant &agrave; l'administration du sandostatine. Aucun incident n'a &eacute;t&eacute; signal&eacute; ult&eacute;rieurement, la patiente a pass&eacute;e 24 heures en r&eacute;animation sous une perfusion de sandostatine. Les valeurs du 5-HIAA urinaire &eacute;taient tr&egrave;s &eacute;lev&eacute;es et l'examen histologique de la pi&egrave;ce op&eacute;ratoire a confirm&eacute; la nature carcino&iuml;de de la tumeur. Nous soulignons la raret&eacute; de cette entit&eacute; et l'int&eacute;r&ecirc;t de penser &agrave; une crise carcino&iuml;de devons la survenue de complications perop&eacute;ratoires au cours d'une anesth&eacute;sie pour tumeur de l'intestin gr&ecirc;le.</b><br/> text/html 2018-07-22T00:12:51+01:00 Calixte Ida Penda, Else Carole Eboumbou Moukoko, Nicolas Policarpe Nolla, Nadia Olivia Abomo Evindi, Paul Koki Ndombo [Research] - Malnutrition among HIV infected children under 5 years of age at the Laquintinie hospital Douala, Cameroon - 31 May 2018. <b>INTRODUCTION: The aim of this study was to assess the prevalence of malnutrition among HIV infected children under five years of age followed up at the Laquintinie Hospital Douala (LHD). METHODS: medical records of children aged 13 days-59 months enrolled at initiation of antiretroviral treatment in the Day Care Unit/LHD, were reviewed for a period of 14 years (from 2002 to 2015). We used standard Z-scores, with cut-off point of <-2 SD to define low height-for-age (HAZ), low weight-for-height (WHZ) and low weight-for-age (WAZ). Factors associated with malnutrition were assessed according to World Health Organization (WHO) criteria. RESULTS: overall, 217 medical records were included and 52.5% were records of boys. The median weight, height and age of the children was 9.5 kg (range: 2.5-20), 76 cm (range: 46- 117) and 22 months (range: 0.03-59), respectively. The overall prevalence of malnutrition among HIV-infected children was 68.7%; 63.6% were stunted (HAZ<-2), 37.8% were underweight (WAZ<-2) and 18.4 % were wasted (WHZ<-2). Severe and advanced immunological stages of HIV according to WHO were found in 42.4%, (39/92) and 17.4%, (16/92) of children respectively, and most of them (21.7%) were aged 12-36 months. The overall prevalence of anemia, oropharyngeal candidiasis and pulmonary tuberculosis were 34.6%, 12% and 8.8%, respectively. Oropharyngeal candidiasis was a risk factor independently associated with severe underweight and wasting (OR = 4.9, 95% CI: 1.8-13.5, p = 0.002) and (OR = 5.1, 95% CI: 1.5-17.1, p = 0.007). CONCLUSION: HIV infection negatively affects the nutritional status of children under five years of age. Early detection of malnutrition is necessary and adequate nutrition should be integrated into the management of pediatric HIV.</b><br/> text/html 2018-07-22T00:12:51+01:00 Hafsa Chahdi, Mohamed Oukabli [Images in medicine] - M&eacute;tastases c&eacute;r&eacute;brales d’un l&eacute;iomyosarcome ut&eacute;rin - 31 May 2018. <b>Une patiente de 46 ans, ayant comme ant&eacute;c&eacute;dents une hyst&eacute;rectomie totale en 2011 pour l&eacute;iomyosarcome ut&eacute;rin suivie de s&eacute;ances de radioth&eacute;rapie, a pr&eacute;sent&eacute; brutalement un d&eacute;ficit h&eacute;micorporel droit et chez qui l'examen clinique a trouv&eacute; un syndrome pyramidal droit. L'imagerie par r&eacute;sonance magn&eacute;tique (IRM) c&eacute;r&eacute;brale a montr&eacute; la pr&eacute;sence d'un processus tumoral agressif extra axial fronto-parietal gauche (A). La patiente a b&eacute;n&eacute;fici&eacute; d'une ex&eacute;r&egrave;se chirurgicale de la l&eacute;sion c&eacute;r&eacute;brale. L'examen anatomopathologique a objectiv&eacute; l'existence d'une prolif&eacute;ration tumorale d'architecture fusocellulaire (B). Les cellules tumorales sont d'allures musculaires discr&egrave;tement atypiques, quelques figures de mitose sont not&eacute;es ainsi que des foyers de n&eacute;crose. Cette prolif&eacute;ration tumorale infiltrait l'os, les parties molles et la dure-m&egrave;re. Une &eacute;tude immunohistochimique a &eacute;t&eacute; r&eacute;alis&eacute; et a objectiv&eacute; un marquage positif des cellules tumorales par l'anti H-caldesmone (C) et l'anti Actine muscle lisse. Le diagnostic de m&eacute;tastase c&eacute;r&eacute;brale d'un leiomyosarcome a &eacute;t&eacute; retenu. La patiente a subi des s&eacute;ances de radioth&eacute;rapie avec comme r&eacute;sultat actuel une am&eacute;lioration du d&eacute;ficit moteur.</b><br/> text/html 2018-07-22T00:12:51+01:00 Parisa Parsa, Simin Karimi, Behnaz Basiri, Godratalah Roshanaei [Research] - The effect of kangaroo mother care on physiological parameters of premature infants in Hamadan City, Iran - 31 May 2018. <b>INTRODUCTION: breast-feeding and being with mother have positive effects on the preterm infant's health status. Therefore, this study was conducted to evaluate the effect of Kangaroo Mother Care (KMC) on physiological parameters of premature infants in Fatemiyeh Hospital in Hamadan in 2016. METHODS: this is a quasi-experimental study. One hundred newborns who were admitted to in neonatal intensive care unit of Fatemiyeh Hospital in Hamadan city, Iran were selected by convenience sampling. They were randomly divided into two groups (experimental group, n = 50 and control group, n = 50). In the experimental group, newborns were taken daily KMC for an hour during 7 days. In the control group, routine care was performed in the incubator. The data gathering tool was questionnaire of infants and mother characteristics, checklists of vital signs and oxygen saturation. Data analysis was performed by SPSS 19 software using descriptive and inferential statistics (Independent t -test, Paired t-test, Chi-square, ANOVA). RESULTS: before intervention, there was no significant difference between the physiological parameters of the infants (heart rate, respiratory rate, arterial blood oxygen saturation and temperature) in experimental and control groups. However, after intervention, there was a significant difference between the two groups in terms of physiological indices (p < 0.001). CONCLUSION: the findings of this study indicate the effect of KMC on enhancement of physiological indices. Therefore, it is recommended that KMC is taken as one of the routine care of premature infants.</b><br/> text/html 2018-07-22T00:12:51+01:00 Rodolfo Mendes Queiroz, Fred Bernardes Filho [Images in medicine] - Spontaneous hematoma of the rectus sheath following percutaneous transluminal coronary angioplasty and stent placement - 30 May 2018. <b>A 74-year-old female with hypertension, coronary artery disease, was hospitalized due to an acute myocardial infarction. A percutaneous transluminal coronary angioplasty (PTCA) and stenting were performed successfully. After six hours of PTCA, an intense abdominal pain localized on right iliac fossa started. On physical examination, a palpable, painful, firm, nonpulsatile abdominal mass was observed. Fothergill’s and Carnett’s signs were present; there were not Cullen's and Grey Turner's signs. Abdominal computed tomography (CT) showed oval collection, isodense in relation to the muscular planes, located in almost all the extension of the rectus abdominis muscle on the right, measuring in its greater axial axes 8.6 x 6.0 cm. Patient did not present drop of the hemoglobin levels nor hemodynamic instability. The diagnosis of hematoma of the rectus sheath was performed and conservative management was elected. Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain and can be life threatening if diagnosis and management is delayed. RSH occurs due to the accumulation of blood within the rectus abdominis sheath secondary to bleeding from damaged inferior or superior epigastric arteries, or through direct tears of the rectus abdominis muscle. Abdominal pain and fall in hemoglobin with presence of risk factors (especially systemic anticoagulation drugs like warfarin and intravenous heparin) constitute important clinical clues to the diagnosis. Management is guided by the size of the haematoma and haemodynamic stability of the patient. Clinicians should consider RSH in the differential diagnosis of acute abdominal pain.</b><br/> text/html 2018-07-22T00:12:51+01:00 Sara Hachri, Hind Abouljaoud, Hind Cherrabi, Karima Atarraf, Lamiae Chater, My Abderrahmane Afifi [Case report] - Fracture de l’&eacute;picondyle m&eacute;dial et lat&eacute;ral associ&eacute;e a une luxation du coude chez l’enfant (&agrave; propos d’un cas) - 30 May 2018. <b>La luxation du coude est une l&eacute;sion relativement rare chez l’enfant. Elle repr&eacute;sente 3 a 6% des traumatismes du coude, On constate souvent des fractures associ&eacute;es &agrave; cette luxation, ce sont le plus souvent des fractures de l’&eacute;picondyle m&eacute;dial, l’association d’une fracture de l’&eacute;picondyle lat&eacute;ral et m&eacute;dial &agrave; la fois &agrave; une luxation reste exceptionnelle. Nous rapportons le cas d’un enfant &acirc;g&eacute; de 13 ans victime d’un traumatisme du coude gauche par un m&eacute;canisme indirect. L’examen locomoteur a objectiv&eacute; un coude gauche tum&eacute;fi&eacute;, d&eacute;form&eacute; avec une impotence fonctionnelle totale. La radiographie a mis en &eacute;vidence une luxation posteroexterne du coude associ&eacute;e &agrave; une fracture de l’&eacute;picondyle lat&eacute;ral et de l’&eacute;picondyle m&eacute;dial qui se trouve incarc&eacute;r&eacute; en intra articulaire. La prise en charge a consist&eacute; en une r&eacute;duction de la luxation sous anesth&eacute;sie, avec un contr&ocirc;le scopique objectivant une bonne r&eacute;duction, une fracture de l’&eacute;picondyle lat&eacute;ral jug&eacute;e stade 1 selon la classification de Lagrange et Rigault apr&egrave;s r&eacute;duction et une fracture de l’&eacute;picondyle m&eacute;dial stade 2 selon la classification de Watson-Jones, d’o&ugrave; la d&eacute;cision d’op&eacute;rer cette derni&egrave;re, avec un abord post&eacute;rom&eacute;dial du coude. Le contr&ocirc;le radiologique post op&eacute;ratoire imm&eacute;diat et &agrave; distance jug&eacute; satisfaisant avec une ablation de l’attelle faite &agrave; 3 semaines, et une ablation de mat&eacute;riel d’ost&eacute;osynth&egrave;se faite &agrave; 6 semaines, une r&eacute;&eacute;ducation du coude &eacute;tait prescrite, avec un bon r&eacute;sultat clinique.</b><br/> text/html 2018-07-22T00:12:51+01:00 Angela Owiti, Julius Oyugi, Dirk Essink [Research] - Utilization of Kenya’s free maternal health services among women living in Kibera slums: a cross-sectional study - 30 May 2018. <b>INTRODUCTION: this study was aimed at determining factors affecting utilization of public health facilities by pregnant Kenyan women living in Kibera slums, Nairobi since the implementation of the Free Maternal Service (FMS) Program in 2013.</b><br/> text/html 2018-07-22T00:12:51+01:00 Stephen Ojiambo Wandera, Betty Kwagala, Clifford Odimegwu [Research] - Intimate partner violence and current modern contraceptive use among married women in Uganda: a cross-sectional study - 30 May 2018. <b>INTRODUCTION: This paper examined the relationship between Intimate Partner Violence (IPV) and current modern contraceptive use (MCU) among married women in Uganda. METHODS: we used the 2011 Uganda Demographic and Health Survey (UDHS) data, selecting a weighted sample of 1,307 married women from the domestic violence module. Chi-squared tests and multivariate complementary log-log (clog-log) regressions were used to examine the relationship between IPV and current MCU, controlling for women's socio-demographic factors. RESULTS: significant predictors of current MCU (25.3%) among married women were: women's reported ability to ask a partner to use a condom, number of living children and wealth index. The odds of current MCU were higher among women who could ask their partners to use a condom (aOR = 1.87, 95% CI: 1.26-2.78), had more than one child (aOR = 2.05, 95% CI: 1.07,3.93) and were from better wealth indices for example the richest (aOR = 2.52, 95% CI: 1.25-5.08). IPV was not associated with current MCU independently and after adjusting for women's socio-demographic factors. CONCLUSION: in Uganda's context, IPV was not associated with current MCU. Interventions to promote MCU should enhance women's capacity to negotiate MCU within union and target women of lower socio-economic status.</b><br/> text/html 2018-07-22T00:12:51+01:00 Hafsa Chahdi, Babahabib Abdellah [Images in medicine] - Carcinome &eacute;pidermoide primitif du sein mimant un abc&egrave;s - 29 May 2018. <b>Les cancers du sein de type &eacute;pidermo&iuml;de appartiennent au cancer de type m&eacute;taplasique, avec un pronostic d&eacute;favorable se rapprochant des formes de ph&eacute;notype basal. Son diagnostic est souvent fait au stade de masse palpable volumineuse, &eacute;chappant aux campagnes de d&eacute;pistage. On saura se m&eacute;fier des abc&egrave;s survenant chez certaines patientes comme c'est le cas de notre patiente &acirc;g&eacute;e de 44ans, qui a consult&eacute; pour une masse du sein gauche diagnostiqu&eacute;e &agrave; la mammogr0aphie coupl&eacute;e &agrave; l'&eacute;chographie comme une formation kystique d'allure abc&eacute;d&eacute;e mesurant 5,4cm x 5cm (A). Une biopsie chirurgicale a &eacute;t&eacute; r&eacute;alis&eacute;e et dont l'examen anatomopathologique trouvait une prolif&eacute;ration tumorale faite de larges lobules carcinomateux avec une diff&eacute;renciation malpighienne nette estim&eacute;e &agrave; plus de 90%(B). Les cellules tumorales &eacute;taient tr&egrave;s atypiques et montraient de nombreuses figures mitotiques. A l'&eacute;tude immunohistochimique les cellules tumorales exprimaient les cytok&eacute;ratines 5/6 (C). L'indexe de prolif&eacute;ration &eacute;tait estim&eacute; &agrave; 85% (D). Les r&eacute;cepteurs hormonaux et l'hercept test &eacute;taient n&eacute;gatifs. Le diagnostic retenu &eacute;tait celui d'un carcinome m&eacute;taplasique de type carcinome &eacute;pidermoide. Notre patiente a b&eacute;n&eacute;fici&eacute; d'une mastectomie gauche avec curage axillaire et d'une chimioth&eacute;rapie adjuvante suivie de radioth&eacute;rapie. L'&eacute;volution avec un recul de neuf mois n'a pas r&eacute;v&eacute;l&eacute; de r&eacute;cidive ou de m&eacute;tastase.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ouiam El Anzi, Badreddine Hassam [Images in medicine] - Pustular dermatosis of the scalp due to topical minoxidil 5% - 29 May 2018. <b>Topical minoxidil, the only approved treatment for female pattern hair loss (FPHL), has been associated with scalp allergic contact dermatitis (ACD). We report the case of a female patient who developed ACD from minoxidil solution. A 30-year-old women presented with pruriginous and pustular lesions over an erythematous area on the scalp and forehead. These lesions had appeared after 1 week of treatment with 5% minoxidil solution (Foligan®)[minoxidil 5%, ethanol, propylene glycol and purified water], for androgenetic alopecia. Physical examination revealed multiple millimetric papulovesicles and papulopustules over an erythematous oedematous area on the frontal scalp and forehead. The patient refused to have a biopsy taken. With these clinical lesions a diagnosis of pustular contact dermatitis was made. Minoxidil solution was stopped and topical corticosteroid therapy twice a day was started. A complete clearance of the lesions could be observed after 5 days. Topical 2,6-diamino-4-piperidinopyrimidine 1-oxide (minoxidil) has been shown to be effective in the treatment of androgenetic alopecia for over 15 years. Minoxidil 5% solution has a favorable safety profile, with adverse effects limited to the site of application (5.7% of patients) and signed by pruritus, erythema, scaling and dryness. The most common causes of these symptoms include irritant contact dermatitis, allergic contact dermatitis, or exacerbation of seborrheic dermatitis. Although cases of pustular allergic contact dermatitis have been anecdotally reported. We conclude that our case is interesting in that it represents an uncommon reaction to a drug used very frequently in dermatology.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ines Kechaou, Im&egrave;ne Boukhris [Images in medicine] - Hypoparathyro&iuml;die et d&eacute;mence d’installation rapide: penser au syndrome de Fahr - 29 May 2018. <b>Le syndrome de Fahr est une entit&eacute; rare dont la pr&eacute;valence est inf&eacute;rieure &agrave; 0,5%. Ses manifestations cliniques sont variables allant des simples troubles du comportement aux crises de t&eacute;tanie et aux manifestations neuropsychiatriques s&eacute;v&egrave;res. Il peut &ecirc;tre idiopathique ou secondaire &agrave; de nombreuses &eacute;tiologies domin&eacute;es par les anomalies du m&eacute;tabolisme phosphocalcique dont la principale cause est l'hypoparathyro&iuml;die. Son diagnostic positif est radiologique. Nous rapportons l'observation d'une patiente &acirc;g&eacute;e de 78 ans hypertendue aux ant&eacute;c&eacute;dents d'hypothyro&iuml;die, d'hypoparathyroidie post thyro&iuml;dectomie totale il ya 30ans. Elle est trait&eacute;e par levothyrox®100 µg 2 cp/j, un-alpha®1 µg 3cp/j et calperos® 2cp/j avec euthyroidie clinique et biologique et un bilan phosphocalcique sans anomalie. L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par l'apparition en 2010 de troubles cognitifs d'aggravation rapide avec installation d'une v&eacute;ritable d&eacute;mence en quelques mois. L'examen neurologique avait objectiv&eacute; un syndrome extrapyramidal. Le scanner c&eacute;r&eacute;bral avait mis en &eacute;vidence des calcifications &eacute;tendues des noyaux gris centraux, &agrave; la jonction substance blanche substance grise lin&eacute;aires, du bulbe c&eacute;r&eacute;bral et du cervelet. Le diagnostic d'un syndrome de Fahr, r&eacute;v&eacute;l&eacute; par une d&eacute;mence suite &agrave; une hypoparathyroidie ancienne, a &eacute;t&eacute; alors retenu.</b><br/> text/html 2018-07-22T00:12:51+01:00 Apophia Namageyo-Funa, Anita Samuel, Peter Bloland, Adam Macneil [Commentary] - Considerations for the development and implementation of electronic immunization registries in Africa - 29 May 2018. <b>While paper-based immunization registries are the prevalent form of documenting individual-level immunization service delivery in Africa, some countries are interested in transitioning to electronic immunization registries (EIRs) which have the potential to transform immunization data into useable information for decision making to optimize the performance of immunization programs. This report discusses opportunities and challenges in the adoption of EIRs in the African continent.</b><br/> text/html 2018-07-22T00:12:51+01:00 Fred Bernardes Filho, Breno Nery [Images in medicine] - Elderly woman with purple rash on eyelids - 29 May 2018. <b>A 62-year-old woman presented with purple rash on her eyelids, erythematous and violaceous rash over the lateral thighs, and proximal muscle weakness. On physical examination, she had a pulse rate of 90/min and blood pressure of 138/90 mmHg. Dermatological examination showed reddish-purple rash on the upper eyelids and violaceous erythema on the lateral surface of the thighs. Laboratory testing was remarkable for elevated creatine kinase at 4,460. White blood cells, liver enzymes, electrolytes, antinuclear antibodies, cranial, abdominal and thorax tomography were unremarkable. Serology tests for hepatitis B, and C, HIV, syphilis, spotted fever and Lyme borreliosis were negative. The diagnosis of dermatomyositis was performed and the treatment was started with prednisone 1mg/kg daily. Dermatomyositis is a connective tissue disease that combines myopathy and distinctive skin manifestations. Creatine kinase is the muscle enzyme most widely used to diagnose polymyositis/dermatomyositis and to follow therapeutic response. There are hallmark cutaneous signs described for dermatomyositis that may or may not parallel the inflammatory myopathy. These include: violaceous to dusky erythematous rash with or without edema on periorbital skin (heliotrope rash), scaly erythematous eruption on the dorsum of hands, metacarpophalangeal joints, proximal interphalangeal joints, knees and elbows (Gottron's sign), confluent macular violaceous erythema on the anterior neck and chest ("V" sign) and confluent macular violaceous erythema present on the lateral side of hip and thighs (Holster sign). The cutaneous disease in dermatomyositis is photodistributed and often photoaggravated. The importance of recognizing dermatological signs in dermatomyositis is due to the cutaneous lesions precede muscle disease in one third to one half of patients.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ziba Taghizadeh, Maryam Pourbakhtiar, Sogand Ghasemzadeh, Khadijeh Azimi, Abbas Mehran [Research] - The effect of training problem-solving skills for pregnant women experiencing intimate partner violence: a randomized control trial - 29 May 2018. <b>INTRODUCTION: Intimate partner violence (IPV) in pregnancy is considered as an additional threat to the maternal/fetal health. The present study was aimed to investigate the effectiveness of training problem-solving skills on IPV against pregnant women. METHODS: The present randomized clinical trial was conducted on 125 and 132 women visiting the health centers of Tehran as the intervention and the control groups, respectively; samples were selected using random stratified cluster sampling. The intervention group underwent four problem-solving training sessions. Three months later, both groups completed the revised Conflict Tactics Scale questionnaire. Data were analyzed using SPSS v.16. RESULTS: The mean (SD) ages of the participants were 27.51 (4.26) and 27.02 (4.26) years, respectively, in the control and the intervention groups. The rates of the physical and psychological violence were significantly reduced after the intervention in the intervention group. Risk differences of the physical, psychological and sexual violence before and after the intervention were 3% (95% CI: -8.23 to14.13, P = 0.6), 1.5% (95% CI: -4.93 to 8.03, P = 0.6) and 4.8% (95% CI: -7.11 to 16.52, P = 0.4) in the control group and 8.8% (95% CI: -3.47 to 20.71, P = 0.1), 25.4% (95% CI: 15.77 to 34.66, P < 0.001) and 4.9% (95% CI: -7.38 to16.97, P = 0.4) in the intervention group, respectively. CONCLUSION: It seems that training this skill as a part of the routine prenatal care could be effective in reducing intimate partner violence.</b><br/> text/html 2018-07-22T00:12:51+01:00 Fatima-Zahra Agharbi [Images in medicine] - Epidermodysplasie verruciforme: &agrave; propos d’un cas - 29 May 2018. <b>L'&eacute;pidermodysplasie verruciforme, &eacute;galement appel&eacute;e syndrome de Lutz-Lewandowsky ou la maladie de l'homme-arbre est une affection cutan&eacute;e rare d'origine g&eacute;n&eacute;tique. Elle se caract&eacute;rise par une sensibilit&eacute; anormale du rev&ecirc;tement cutan&eacute; aux papillomavirus. L'affection commence habituellement entre 4 et 8 ans, le plus souvent avant l'&acirc;ge de 20 ans mais peut exceptionnellement apparaitre plus tardivement. Elle se traduit par l'apparition de macules squameuses et de papules d'&eacute;volution parfois exub&eacute;rante, pseudo-tumorale, essentiellement au niveau des mains et des pieds. Dans ces l&eacute;sions, on retrouve des papillomavirus de type 5 et 8, virus que l'on retrouve chez 80% des sujets d'une population normale asymptomatique. D'autres types de papillomavirus peuvent &ecirc;tre parfois identifi&eacute;s. Felix Lewandowsky et Wilhelm Lutz ont fait la premi&egrave;re description clinique de cette affection. La l&eacute;sion cutan&eacute;e la plus fr&eacute;quemment observ&eacute;e est une &eacute;ruption maculaire proche de celle connue dans le pityriasis versicolor; s'y associent des papules d'allure verruqueuses squameuses. Le risque de transformation particuli&egrave;rement en carcinome &eacute;pidermoide est important. Plusieurs traitements ont &eacute;t&eacute; essay&eacute;s (r&eacute;tino&iuml;des, interf&eacute;ron, cim&eacute;tidine) avec des succ&egrave;s peu ou pas reproductibles. Le plus important est la protection solaire, la surveillance clinique assidue et l'excision rapide de toute l&eacute;sion en voie de d&eacute;g&eacute;n&eacute;rescence carcinomateuse. Nous rapportons l'observation d'un homme de 30 ans qui consulte pour des l&eacute;sions verruqueuses multiples des membres et tronc remontant &agrave; l'&acirc;ge de 4 ans associ&eacute;s &agrave; des l&eacute;sions pityriasis versicolor like. L'examen ne trouvait pas de l&eacute;sions suspectes et un traitement &agrave; base de r&eacute;tinoides a &eacute;t&eacute; d&eacute;marr&eacute;.</b><br/> text/html 2018-07-22T00:12:51+01:00 Nassiba Elouarradi, Nawal El Ansari [Images in medicine] - Scleroderma and type 1 diabetes: a rare association - 29 May 2018. <b>The association of type 1 diabetes and systemic scleroderma is rarely reported in the literature, the pathogenesis of this association is unknown, interferon seems to have a major role in being an immunomodulator and inhibitor of collagen production, and it is also involved in autoimmune pathology. Note that this association could be at the origin of a difficulty of passage of the insulin in the sites of injections, responsible for a major glycemic imbalance. We report the case of a 26-year-old patient, who had been diabetic for 6 years on insulin, who was referred for a glycemic imbalance, who had a clinical examination objectifying multiple morphea lesions on the roots of the thighs, arms, abdomen and thorax. A cutaneous biopsy was performed, showing a sclerodermiform appearance with significant fibrosis without sign of malignancy, result rather in favor of a scleroderma.</b><br/> text/html 2018-07-22T00:12:51+01:00 Lantonirina Ravaoarisoa, Hasina Raherimandimby, Julio Rakotonirina, Jean de Dieu Marie Rakotomanga, Mich&egrave;le Wilmet Dramaix, Philippe Donnen [Research] - Mothers’ dietary practices in the Amoron’i Mania region Madagascar - 29 May 2018. <b>INTRODUCTION: Madagascar has one of the highest prevalence's of malnutrition worldwide. Dietary practice is an important element to consider in the fight against malnutrition. This study aims to describe mothers' dietary patterns and dietary diversity and to identify characteristics associated with this dietary diversity. METHODS: A cross sectional study was carried-out among 670 non-pregnant mothers aged 18 to 45, who had delivered more than 6 months earlier and were living in the Amoron'i Mania region of Madagascar. The study was conducted during the post-harvest period. A food frequency questionnaire were used to assess the dietary pattern and the women's dietary diversity score was established from the 24-hour recall data. RESULTS: Almost all (99%) of mothers ate rice every day and 59% ate green leaves. Fifty three percent of mothers had consumed fruit less than once per week, 55% for legumes, 67% for vegetables and 91% for meat. Dietary diversity score ranged from 1 to 7 and 88% of mothers had a low dietary diversity score (<5). On multivariate analysis, factors significantly associated with low dietary diversitywere: low education level (AOR=3.80[1.58–9.02], p=0.003), parity higher than 3 (AOR=2.09[1.22–3.56], p=0.007), birth interval &#8805; 24 months (AOR=4.01[2.08–7.74], p<0.001), rice production availability &#8804; 6 months (AOR=2.33[1.30–4.17], p=0.013), low attendance at market (AOR=4.20[1.63–10.83], p<0.001) and low movable property possession score (AOR=4.87[2.15–11.04], p<0.001). CONCLUSION: Mother's experience poor diet diversity. Unfavorable socioeconomic conditions are associated with this poor food diversification.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ilhame Naciri, Leila Benzekri [Images in medicine] - Association rare: lichen scl&eacute;roatrophique extrag&eacute;nital et vitiligo inflammatoire chez un enfant - 29 May 2018. <b>Le lichen scl&eacute;roatrophique (LSA) et le vitiligo sont deux affections d&eacute;pigmentantes qui peuvent survenir s&eacute;par&eacute;ment, ou bien rarement coexister. Leur association peut sembler logique en raison de la suspicion d'une pathog&eacute;nie auto-immune dans les deux entit&eacute;s. Une fillette &acirc;g&eacute;e de 8 ans, sans ant&eacute;c&eacute;dents pathologiques notables, consultait pour des macules achromiques et des l&eacute;sions papuleuses non prurigineuses &eacute;voluant depuis 6 mois. L'examen clinique objectivait deux types de l&eacute;sions (A). Des macules achromiques, ovalaires, de 1 &agrave; 3 cm de grand axe, situ&eacute;es au niveau du front, du cou, des &eacute;paules, ainsi que la r&eacute;gion p&eacute;ri-mamelonaire et g&eacute;nitale. Ces l&eacute;sions pr&eacute;sentaient par endroits un liser&eacute; inflammatoire p&eacute;riph&eacute;rique l&eacute;g&egrave;rement sur&eacute;lev&eacute;, ainsi qu'une poliose. La patiente avait &eacute;galement des plaques papuleuses atrophiques de teinte blanc nacr&eacute;, localis&eacute;es au niveau des r&eacute;gions inter scapulaire et abdominale ainsi qu'&agrave; la face ant&eacute;rieure des genoux. Deux biopsies ont &eacute;t&eacute; pratiqu&eacute;es. L'examen histologique d'une macule achromique &eacute;tait en faveur d'un vitiligo avec r&eacute;action inflammatoire et celui d'une l&eacute;sion infiltr&eacute;e faisait &eacute;voquer le diagnostic de lichen scl&eacute;roatrophique. Une nette am&eacute;lioration clinique &eacute;tait obtenue gr&acirc;ce &agrave; un traitement local par dermocortico&iuml;des. Ainsi, cette association pathologique LSA et vitiligo chez notre patiente, met en &eacute;vidence le r&ocirc;le d&eacute;terminant du processus inflammatoire lich&eacute;noide &eacute;pidermique, dans la disparition des m&eacute;lanocytes, et &eacute;ventuellement dans l'induction d'un processus auto-immun.</b><br/> text/html 2018-07-22T00:12:51+01:00 Egbe Sarah Balle Tabi, Esum Mathias Eyong, Eric Achidi Akum, Jesper L&ouml;ve, Samuel Nambile Cumber [Research] - Soil-transmitted Helminth infection in the Tiko Health District, South West Region of Cameroon: a post-intervention survey on prevalence and intensity of infection among primary school children - 29 May 2018. <b>INTRODUCTION: Soil-transmitted helminths (STH) infection remains a public health problem in sub-Saharan Africa with children being most vulnerable. STH infection may result in impairment, permanent disability or death. Annual mass deworming has been implemented in the Tiko Health District (THD), however, no study has assessed the current prevalence of STH infection. This study aimed to determine the prevalence, intensity of STH infections and associated risk factors among school children. METHODS: Two months after the school deworming exercise, 400 children were sampled from 10 schools in THD. Stool samples were collected and analyzed using the Kato-katz technique. Data on socio-demographic and behavioral factors were collected using questionnaires. Data were analyzed using SPSS and intensity of infection categorized following WHO recommendations. Descriptive data were calculated with frequencies (n) and proportions (%), prevalence and 95% confidence interval calculated for gender and age respectively. Differences in prevalence for socio-demographic characteristics and behavioral variables were calculated with Chi square (&#967;<sup>2</sup>). Independent sample t-test was used to compare the means in the number of eggs in feces between male and female school children. RESULTS: The prevalence of STH was 1% (95% CI: 0.02–1.98). Ascaris lumbricoides was the only STH species detected and all cases were of low intensities. The arithmetic mean egg intensity was 3.1egg per gram of faeces. Rates of infection were similar between gender and age. Site of defecation showed an association with STH infection (&#967;<sup>2</sup>= 13.63, p=0.03). CONCLUSION: These findings suggested a low prevalence of STH infection which could be explained by the prior deworming of children, modification in environmental and behavioral factors. Questions on effectiveness of annual mass deworming in achieving STH elimination targets need to be investigated further.</b><br/> text/html 2018-07-22T00:12:51+01:00 Belkacem Bendaou, Btissame Zarrouq, Khaoula El kinany, Badiaa Lyoussi, Mohamed Chakib Benjelloun, Chakib Nejjari, Karima El Rhazi [Research] - Risk factors and prevalence of use of different tobacco products among school adolescents in the North Central region of Morocco: a cross-sectional study - 29 May 2018. <b>INTRODUCTION: The rising number of youth smokers is a major concern to public health in Morocco. The implementation of appropriate preventive measures would require information about the prevalence and determinants of tobacco use. Data on tobacco consumption among adolescents in the North Center of Morocco are scarce. Therefore, the current study aims at investigating the risk factors of smoking and the prevalence of the use of different forms of tobacco among school teenagers in the North-Centre region of Morocco. METHODS: A cross-sectional study was conducted in North Central Region of Morocco among students in public secondary schools selected by stratified cluster random sampling. The statistical unit devised was a school class from the seventh to the twelfth grade of the Moroccan educational system. RESULTS: A total of 3020 students (53% were males) and an average age = 16 ± 2.1 years were included in the study. The prevalence of the use of cigarettes was 16.1% (95% CI: 14.8% - 17.4%).For other tobacco types such as hookah, snuff and tobacco chewing, the prevalence was respectively 70.6%, 42.8% and 35.0% for cigarettes smokers. The level of current tobacco use was noticeably higher among boys (15.0% vs. 2.5%, p < 0,001) and high school students in comparison to middle school pupils (21.2% versus 11.9%; p < 0,001). CONCLUSION: Among young people, all types of smoking are growing increasingly in our Moroccan society; this alarming result can contribute to help the decision-makers to make decisions and force us obviously to take preventive measures rapidly.</b><br/> text/html 2018-07-22T00:12:51+01:00 Dimitri Kanyanda Nafatalewa, Jeff Bukasa Misenga, Eric Mbuya Musapudi, Pascal Monga Yebalaya, Didier Tshibangu Mujinga, Guy Nday Ilunga [Case report] - Perforation gastrique n&eacute;onatale spontan&eacute;e: &agrave; propos d’un cas - 29 May 2018. <b>La perforation gastrique n&eacute;onatale spontan&eacute;e est rare. Nous rapportons un cas survenu chez un nouveau-n&eacute; de 4 jours issu d'une grossesse &agrave; terme. L’enfant a n&eacute;cessit&eacute; une r&eacute;animation &agrave; sa naissance. Au deuxi&egrave;me jour de sa vie, une distension abdominale importante &eacute;tait not&eacute;e. La radiographie de l'abdomen sans pr&eacute;paration a montr&eacute; un pneumop&eacute;ritoine. La laparotomie a objectiv&eacute; une perforation au niveau de la petite courbure gastrique de 1,5 cm de diam&egrave;tre qui a b&eacute;n&eacute;fici&eacute; d’une suture simple chirurgicale. L'&eacute;volution &eacute;tait marqu&eacute;e par le d&eacute;c&egrave;s au premier jour post op&eacute;ratoire.</b><br/> text/html 2018-07-22T00:12:51+01:00 Souheil Zayet, Aida Berriche, Lamia Ammari, Mariem Razgallah, Rim Abdelmalek, Mohamed Khrouf, Badreddine Kilani, Hanène Tiouiri Benaissa [Case series] - Caract&eacute;ristiques &eacute;pid&eacute;mio-cliniques de la tuberculose g&eacute;nitale chez la femme tunisienne: une s&eacute;rie de 47 cas - 29 May 2018. <b>L'objet est de relever les caract&eacute;ristiques &eacute;pid&eacute;mio-cliniques, diagnostiques, th&eacute;rapeutiques et &eacute;volutives de la tuberculose g&eacute;nitale (TG) chez la femme en Tunisie. Nous avons men&eacute; une &eacute;tude r&eacute;trospective, descriptive au service des maladies infectieuses de l'h&ocirc;pital la Rabta de Tunis, sur une p&eacute;riode de 15 ans et demi (janvier 2000-juin 2014). Nous avons inclus toutes les patientes hospitalis&eacute;es pour une tuberculose g&eacute;nitale. 47 cas ont &eacute;t&eacute; collig&eacute;s. L'&acirc;ge moyen &eacute;tait de 42,2 ans. Dix-huit femmes &eacute;taient d'origine rurale. Un comptage tuberculeux a &eacute;t&eacute; retrouv&eacute; dans cinq cas. Pour tous les cas, le d&eacute;but &eacute;tait insidieux. Un ou plusieurs signes d'impr&eacute;gnation tuberculeuse ont &eacute;t&eacute; rapport&eacute;s dans 23 cas. L'intradermor&eacute;action (IDR) &agrave; la tuberculine r&eacute;alis&eacute;e chez 35 femmes (74,8%), &eacute;tait positive dans 26 cas (74%). Trente-neuf patientes (83%) avaient eu une exploration radiologique par une &eacute;chographie et / ou une tomodensitom&eacute;trie (TDM) abdomino-pelvienne. Une cœlioscopie diagnostique a &eacute;t&eacute; r&eacute;alis&eacute;e dans 37 cas (75,5%). L'examen Anatomopathologique a permis de confirmer le diagnostic de TG dans 42 cas (89,3%) en retrouvant un granulome &eacute;pith&eacute;lo&iuml;de et giganto-cellulaire. Nous avons relev&eacute; 21 cas de TG isol&eacute;e, alors que les 26 autres avaient une atteinte p&eacute;riton&eacute;ale associ&eacute;e. Toutes les patientes ont re&ccedil;u une antibioth&eacute;rapie sp&eacute;cifique associant l'Isoniazide, la Rifampicine, le Pyrazinamide et l'Ethamubutol pour une dur&eacute;e moyenne de 12 mois. Aucune patiente n'a re&ccedil;u de corticoth&eacute;rapie et aucune chirurgie secondaire n'a &eacute;t&eacute; indiqu&eacute;e. L'&eacute;volution &eacute;tait favorable dans 39 cas, 8 patientes ont &eacute;t&eacute; perdues de vue. La TG est une pathologie rare qui ne repr&eacute;sente que 0,5% de la tuberculose extra-pulmonaire, mais d'un grand polymorphisme clinique. La confirmation diagnostique est difficile et repose sur l'&eacute;tude bact&eacute;riologique et/ou histologique. Le diagnostic doit &ecirc;tre &eacute;voqu&eacute; devant toute symptomatologie abdomino-pelvienne trainante, devant une st&eacute;rilit&eacute; chez la femme, associ&eacute; &agrave; un contexte &eacute;pid&eacute;mio-clinique &eacute;vocateur.</b><br/> text/html 2018-07-22T00:12:51+01:00 Saoussane Kharmoum, Hassan Errihani [Images in medicine] - Docetaxel induced severe palmar plantar erythrodysesthesia - 29 May 2018. <b>Docetaxel is an important chemotherapeutic agent used alone or in combination for the treatment of many solid tumors, it belongs to the taxane family and is known to have some side effects. Although palmar-plantar erythrodysesthesia (PPE) or hand-foot syndrome is a relatively common toxicity of many anticancer drugs (5-fluorouracil, capecitabine and liposomal doxorubicin), it occurs rarely with docetaxel. We report the case of a 43-year-old North African woman diagnosed with locally advanced breast cancer, received neoadjuvant chemotherapy with three cycles of FEC100 regimen: 5-fluorouracil (500 mg/m2), epirubicin (100 mg/m2) and cyclophosphamide (500 mg/m2). This combination was well tolerated. Then, chemotherapy was switched to docetaxel 100mg/m². Three days after the first cycle, the patient developed an important painful erythema in her two feet, followed by a large desquamation and swelling, which interfered with her functional activities. This reaction was classified as grade 3 PPE according to the National Cancer Institute grading system, and was treated conservatively with emollients and analgesics. In agreement with the patient, the docetaxel chemotherapy was continued with dose reduction of 20%. Symptoms disappeared within 2 weeks following dose reduction.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ouiam El Anzi, Badreddine Hassam [Images in medicine] - La miliaire cristalline g&eacute;n&eacute;ralis&eacute;e: &agrave; propos d’un cas - 28 May 2018. <b>La miliaire sudorale est une manifestation cutan&eacute;e b&eacute;nigne li&eacute;e &agrave; l’obstruction sudorale g&eacute;n&eacute;ralement t&eacute;moin d’une exposition excessive &agrave; la chaleur, &agrave; l’humidit&eacute; ambiante ou d’une hyperthermie. Nous rapportons le cas d’une patiente de 70 ans, diab&eacute;tique sous insuline, hospitalis&eacute;e au service de r&eacute;animation pour un coma acidoc&eacute;tosique secondaire &agrave; une py&eacute;lon&eacute;phrite. La patiente a pr&eacute;sent&eacute; des l&eacute;sions v&eacute;siculeuses diffuses au niveau de tout le corps de contenu clair, fermes &agrave; la palpation, reposant sur une peau saine, correspondant &agrave; une miliaire cristalline. La miliaire sudorale est une manifestation cutan&eacute;e b&eacute;nigne li&eacute;e &agrave; une r&eacute;tention sudorale secondaire &agrave; une obstruction des canaux sudoraux. Selon le niveau d'obstruction, on distingue la miliaire cristalline par obstruction dans le stratum corn&eacute;um; la miliaire rouge par obstruction dans le stratum malpighi et la miliaire profonde par obstruction au niveau ou en dessous de la jonction dermo-&eacute;pidermique. La miliaire cristalline gu&eacute;rit spontan&eacute;ment en quelques heures en laissant une desquamation, comme c'&eacute;tait le cas chez notre patiente apr&egrave;s r&eacute;gression du syndrome f&eacute;brile.</b><br/> text/html 2018-07-22T00:12:51+01:00 Brahim El Hasbaoui, Lamia Karboubi, Badr Sououd Benjelloun [Letter to the editors] - The role of abdominal ultrasound in the management of excessive crying in infants - 28 May 2018. <b>Excessive or persistent crying is a common presentation to the pediatric emergency department, and often poses a diagnostic dilemma to emergency physicians. There are several reasons for excessive or persistent crying in children, ranging from benign causes like hunger, to life-threatening causes such as intussusception. The objective of this work is to specify the place of abdominal ultrasound in the diagnosis and management of incessant cries in the infant. A cross sectional investigation for 3 months about cases of infants admitted for excessive or persistent crying to the paediatric emergency medical department of the Rabat Children's Hospital. Thirty-nine cases of excessive crying. The average age of our patients was 5.7 months with a male predominance. The incessant cries constituted the main reason for consultation in all our patients. The abdominal ultrasound performed in all the patients and revealed six cases of "Intestinal intussusception, eight cases of colic with distention gas, one case of uretero-hydronephrosis, one case with lymphadenitis mesenteric whereas it was normal in twenty-three cases. Children presenting with excess or persistent crying with no clear historical and physical examination clues, pose a diagnostic challenge to emergency physicians. This survey illustrates that despite the fact that abdominal ultrasound was normal in 58% of the cases, it made possible to make an early diagnosis of 15% of acute intestinal intussusception and it has become the gold standard in management of excessive crying in infants.</b><br/> text/html 2018-07-22T00:12:51+01:00 Maha Ait Berri, Abdelhadi Rouimi [Images in medicine] - Neurosarcoïdose cérébrale - 28 May 2018. <b>Nous rapportons l&acute;observation d&acute;un patient de 37 ans qui présenta une neuropathie optique droite. L&acute;imagerie par résonnance magnétique (IRM) révéla la présence d&acute;un hypersignal T2 de la ligne médiane rehaussé après injection de gadolinium. L&acute;examen du liquide céphalo-rachidien (LCR) retrouvait une méningite lymphocytaire à 64 éléments blancs avec hyperproteinorachie. Le scanner thoracique était en faveur d’une granulomatose inflammatoire type sarcoïdose stade 2. L&acute;enzyme de conversion de l&acute;angiotensine était élevée. Le patient a été mis sous traitement corticoïdes avec bonne évolution. La sarcoïdose est une granulomatose diffuse, multisystémique, d&acute;étiologie inconnue. Une localisation neurologique est observée dans 5 à 15% des cas et révélatrice dans 10 à 30% des cas. Sa présentation clinique neurologique, très variée, est représentée essentiellement par la méningo-encéphalite et l&acute;atteinte des nerfs crâniens. Le nerf facial est le plus fréquemment touché devant le nerf optique. L&acute;IRM cérébrale permet de mieux visualiser les lésions sous forme de nodules infiltrant en isosignal T1 et en hypersignal T2, avec un rehaussement après injection de produit de contraste. La localisation préférentielle est suprasellaire avec atteinte de l&acute;hypothalamus, du pédoncule hypophysaire et du chiasma optique. D&acute;autres anomalies sont volontiers visualisées par le gadolinium, notamment un épaississement diffus ou nodulaire des leptoméninges avec un aspect de pachyméningite, des lésions du parenchyme cérébral (pariétal, frontal, cérébelleux) ou de la moelle épinière. Le diagnostic repose sur la combinaison de données cliniques, radiologiques, biologiques et histologiques. Le traitement repose sur la corticothérapie en première intention, en association parfois avec des immunosuppresseurs.</b><br/> text/html 2018-07-22T00:12:51+01:00 John Kehinde Amoo, Akeem Abiodun Akindele, Abimbola Oladipupo Joseph Amoo, Akinwale Michael Efunshile, Taiwo Adetola Ojurongbe, Samuel Adetona Fayemiwo, Bolaji Nun Thomas, Olusola Ojurongbe [Research] - Prevalence of enteric parasitic infections among people living with HIV in Abeokuta, Nigeria - 28 May 2018. <b>INTRODUCTION: Enteric parasitic infections have been increasingly recognized as etiology of life-threatening chronic diarrhea in PLWHA in sub-Saharan Africa. This study investigated the prevalence and burden of intestinal parasitic infection among PLWHA in Abeokuta, southwest Nigeria. METHODS: freshly passed stool samples were collected from PLWHA. Detection of Cryptosporidium spp and Microsporidium spp was carried out with Kinyoun's stain and Weber's Chromotrope-based stain respectively. Investigation of other intestinal parasites was done using the direct saline preparation and formol-ether concentration methods. CD4+ T cell count was measured using Partec flow cytometry technique. RESULTS: a total of 231 (males: females 96:135; mean age 31.81±11.40 years) PLWHA were recruited into the study, among whom 84 (36.4%) were infected with at least one intestinal parasites. Fifty two (22.5%) individuals were positive for Cryptosporidium spp and a significant association between Cryptosporidium spp and diarrhea was observed (p=0.006). Seven (3.0%) were positive for Microsporidium spp. Helminths recovered included Ascaris lumbricoides (20.8%), hookworm (6.5%), Strongyloides stercoralis (4.3%), Trichuris trichiura (5.6%) and Taenia spp. (5.6%). Cryptosporidium spp, Microsporidium spp and S. stercoralis were significantly associated with CD4+ count &#8805; 200 cells/mm3 (p<0.05). Cryptosporidium spp and A. lumbricoides were significantly observed among patients that are anti-retroviral therapy (ART) naive. CONCLUSION: high prevalence of opportunistic parasitic infection was significantly correlated with diarrhea, low CD4+ count and ART na&iuml;ve individuals in the study. These findings re-emphasize the need for early diagnosis of opportunistic parasites and appropriate intervention among PLWHA.</b><br/> text/html 2018-07-22T00:12:51+01:00 Adewole Adebola Adefalu, Oladapo Alabi Ladipo, Oluwaseun Oladapo Akinyemi, Oluwafemi Akinyele Popoola, Olajimi Oluwatosin Latunji, Omowunmi Folake Iyanda [Research] - Awareness and opinions regarding contraception by women of reproductive age in North-West Nigeria - 28 May 2018. <b>INTRODUCTION: North-west Nigeria is a traditionally high fertility setting. Increasing attention is being channeled into scaling up the various interventions that can reduce high fertility, including enhancing contraceptive uptake among women of reproductive age. However, in order to improve demand for contraception, understanding the level of awareness, knowledge and perception of WRA to contraceptive use is essential. This study examines the level of knowledge and perception of WRA to contraceptive use. METHODS: a descriptive cross-sectional study was carried out in December 2016 in Kebbi and Sokoto states, North-west Nigeria. Semi-structured questionnaires were administered to 500 women between the ages of 15-49 years in 4 randomly selected local government areas across the states. Data analysis included descriptive and bi-variate statistics. RESULTS: only 43.8% claimed to be currently using a modern form of contraception; 82.4% were aware of at least one form of contraception, while health personnel formed the major source of information. The most popular and least common modern contraceptive methods were the male condom (86.8%) and vasectomy (26.6%) respectively. A higher proportion of married respondents (88.8%) than those presently single (68.8%) had good knowledge of contraceptives. Perception of contraceptives was mixed, with majority believing that contraceptives should be made available to every woman, despite stating that it contradicted their religious beliefs. CONCLUSION: these results underline the need for policy makers to focus on improving the knowledge of younger age groups on contraceptives and include other information channels such as peer-to-peer discussions to increase awareness.</b><br/> text/html 2018-07-22T00:12:51+01:00 Petros Ioannou, Symeon Panagiotakis [Images in medicine] - Chronic tophaceous gout - 28 May 2018. <b>A 98-year old caucasian woman with a history of gout presented to the emergency department due to diarrhea and joint pain. Her chronic medications included allopurinol and colchicine. Physical examination revealed abdominal tenderness without rebound tenderness and normal bowel sounds, as well as enlarged, deformed, painful digits at the upper and lower limbs. The laboratory exams revealed leukocytosis, an elevated Erythrocyte Sedimentation Rate of 82mm at the 1st hour and a serum uric acid of 8.4mg/dl. The patient was admitted due to presumed colchicine toxicity and uric acid arthritis and was treated with intravenous hydration and corticosteroids with improvement of the arthritis and the diarrheas. Uric acid is produced from the purine metabolism after the breakdown of the nucleic acids that are produced after cell destruction and exogenous intake. Since uric acid is the end product of this metabolic pathway, its concentration in the plasma reflects a balance between production and renal excretion; however, about 10% of people are genetically predisposed to have increased uric acid concentration and are predisposed to uric acid nephropathy, nephrolithiasis, gout and development of tophi, like in our patient. Tophi are deposits of monosodium urate in the synovial or soft tissues and in the bones near the joints. Their presence signifies the presence of gout, the commonest inflammatory arthritis in elderly in the Western world. Rarely, tophi may lead to skin ulceration and discharge of chalky uric acid crystals through the skin.</b><br/> text/html 2018-07-22T00:12:51+01:00 Fred Bernardes Filho [Corrigendum] - Corrigendum: Neglected tumor in a female with albinism - 28 May 2018. <b>This corrigendum corrects article “Neglected tumor in a female with albinism” and its publication references ie The Pan African Medical Journal. 2017;28:195. doi:10.11604/pamj.2017.28.195.14122</b><br/> text/html 2018-07-22T00:12:51+01:00 Fred Bernardes Filho [Corrigendum] - Corrigendum: Yellow and black-stained fingers in a patient with headache - 28 May 2018. <b>This corrigendum corrects article “Yellow and black-stained fingers in a patient with headache” and its publication references ie The Pan African Medical Journal. 2017;28:318. doi:10.11604/pamj.2017.28.318.14333.</b><br/> text/html 2018-07-22T00:12:51+01:00 Abdullah Ebrahim Laher, Osman Ebrahim [Review] - HTLV-1, ATLL, severe hypercalcaemia and HIV-1 co-infection: an overview - 28 May 2018. <b>HIV and HTLV (Human T-ymphotropic Virus) are the only known retroviruses responsible for causing infection in humans. HTLV-1 and HIV-1 are frequent co-pathogens, however, despite its potential for accelerated progression of HIV disease and the risk of developing adult T-cell lymphoma/leukemia (ATLL), HTLV-1 is seldom considered for investigation in the HIV-1 positive individual. Severe/refractory hypercalcaemia, unresponsive to conventional calcium lowering therapy may complicate up to 70% of cases of ATLL. In addition, HTLV-1 and ATLL have both been associated with a rise in dysfunctional CD4 lymphocytes, thereby conveying a false sense of immune competence in the HIV-1 infected individual.</b><br/> text/html 2018-07-22T00:12:51+01:00 Fred Bernardes Filho [Corrigendum] - Corrigendum: Man with a swollen mass on sacrococcygeal region - 28 May 2018. <b>This corrigendum corrects article “Man with a swollen mass on sacrococcygeal region” and its publication references ie The Pan African Medical Journal. 2018;29:10. doi:10.11604/pamj.2018.29.10.14447</b><br/> text/html 2018-07-22T00:12:51+01:00 Fred Bernardes Filho [Corrigendum] - Corrigendum: Bilateral plantar deep cleft - 28 May 2018. <b>This corrigendum corrects article “Bilateral plantar deep cleft” and its publication references ie The Pan African Medical Journal. 2017;28:312. doi:10.11604/pamj.2017.28.312.14502.</b><br/> text/html 2018-07-22T00:12:51+01:00 Fred Bernardes Filho [Corrigendum] - Corrigendum: Elderly woman with soft tissue ossification - 28 May 2018. <b>This corrigendum corrects article “Elderly woman with soft tissue ossification” and its publication references ie The Pan African Medical Journal. 2017;28:307. doi:10.11604/pamj.2017.28.307.14507.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mouna Ejjiyar, Saloua Ettalbi [Images in medicine] - Tumeur &eacute;volu&eacute;e du tronc d’origine lymphomateuse - 24 May 2018. <b>Les lymphomes malins constituent un groupe de cancers du tissu lympho&iuml;de, ganglionnaire ou extra ganglionnaire, li&eacute;s &agrave; la transformation n&eacute;oplasique d'une cellule lymphocytaire. On distingue dans cette cat&eacute;gorie les lymphomes malins non hodgkiniens. Nous rapportons le cas d'une localisation cutan&eacute;e &eacute;volu&eacute;e et extr&ecirc;mement agressive d'un lymphome malin non hodgkinien diffus. Il s'agit d'un patient &acirc;g&eacute; de 30 ans, mari&eacute; et p&egrave;re d'un enfant, chauffeur de profession, suivi en h&eacute;mato-oncologie depuis 2 ans pour lymphome malin non hodgkinien diagnostiqu&eacute; devant des poly ad&eacute;nopathies axillaires et inguinales, ayant b&eacute;n&eacute;fici&eacute; de 13 s&eacute;ances de chimioth&eacute;rapie. Le patient a &eacute;t&eacute; admis au service de chirurgie plastique, r&eacute;paratrice, esth&eacute;tique et des br&ucirc;l&eacute;s du CHU Mohammed VI de Marrakech, pour prise en charge d'une localisation cutan&eacute;e de son lymphome sous la forme d'une tumeur &eacute;volu&eacute;e de la r&eacute;gion lat&eacute;ro-thoracique gauche augmentant rapidement de taille. A l'examen, on retrouvait un patient en assez bon &eacute;tat g&eacute;n&eacute;ral, pr&eacute;sentant une volumineuse masse lat&eacute;ro-thoracique gauche, adh&eacute;rente &agrave; son plan profond avec blindage axillaire homolat&eacute;ral. Une biopsie partielle r&eacute;alis&eacute;e a confirm&eacute; &agrave; l'examen anatomo-pathologique le diagnostic de lymphome malin non hodgkinien diffus &agrave; grandes cellules. L'&eacute;tude immunohistochimique et g&eacute;n&eacute;tique n'a pas &eacute;t&eacute; r&eacute;alis&eacute;e. Les s&eacute;rologies &eacute;taient n&eacute;gatives. L'imagerie a permis de r&eacute;v&eacute;ler sur les coupes tomodensitom&eacute;triques la pr&eacute;sence d'une volumineuse masse ganglionnaire &agrave; pr&eacute;dominance axillaire et thoracique ant&eacute;ro-lat&eacute;rale gauche mesurant 30cm de diam&egrave;tre, faite d'une confluence de ganglions avec persistance de ganglions nodulaires en p&eacute;riph&eacute;rie, ulc&eacute;rations cutan&eacute;es et zones de n&eacute;crose. Le patient a b&eacute;n&eacute;fici&eacute; dans notre structure d'une ex&eacute;r&egrave;se tumorale large de propret&eacute; puis d'une couverture par de la peau mince, r&eacute;duisant ainsi le volume tumoral et assurant un meilleur confort pour le patient, qui fut adress&eacute; d&egrave;s cicatrisation en h&eacute;mato-oncologie pour b&eacute;n&eacute;ficier de son traitement compl&eacute;mentaire.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ibidolapo Taiwo Ijarotimi, Olayinka Stephen Ilesanmi, Adeola Aderinwale, Oluwadamilola Abiodun-Adewusi, Ime-Maria Okon [Research] - Knowledge of Lassa fever and use of infection prevention and control facilities among health care workers during Lassa fever outbreak in Ondo State - 24 May 2018. <b>INTRODUCTION: Hospital-acquired infections of Lassa fever (LF) has been described in many West African countries. We assessed the availability of Infection Prevention and Control (IPC) measures and their use in the health centres (HCs) at the affected Local Government Areas (LGAs) during an ongoing LF outbreak in Ondo State, Nigeria. METHODS: We included all primary and secondary HCs and their healthcare workers (HCWs) in the affected Ose and Owo LGAs. We collected data from respondents using self-administered questionnaires and used a checklist to assess the IPC measures at the HCs. We generated frequencies and proportions and tested associations using odds ratios at 95% CI. RESULTS: One hundred and ninety HCWs from 59 HCs were surveyed of which 34 (57.6%) were located in Owo LGA. All HCs had soap for handwashing, 57(96.6%) had wash-hand basins but only 52(88.1%) had water. While 57(96.6%) had gloves and 53(89.8%) had sharps boxes, only 16(27.1%) had an isolation room. Only 44(23.2%) respondents had been trained in IPC. The majority, 144 (91.6%) always had gloves available for their use, 79(41.6%) always had facemask/shield and 71(37.4%) always had full personal protective equipment. At the last patient contact, only 151 (79.8%) washed their hands before the contact, 188(98.9%) washed their hands after and 183 (96.2%) wore gloves. While there was no association between availability of gloves and its use (OR: 0.21, 95%CI 0.04-1.17), there was significant association between having had training in basic universal precautions and having used gloves (OR: 3.64, 95%CI 1.21-19.40) and having washed hands after last patient contact (OR: 2.31, 95%CI 1.67-12.30). CONCLUSION: Among these HCs that serve as point of first contact with possible cases of LF in these endemic LGAs, none met the minimum standard for IPC. We recommend that IPC committee for each LGA and the whole state should be set up and IPC trainings made mandatory.</b><br/> text/html 2018-07-22T00:12:51+01:00 The Pan African Medical Journal [Erratum] - Erratum: Food hygiene assessment in catering establishments in Hay Hassani district-Casablanca - 24 May 2018. <b>This erratum corrects article: “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 2018-07-22T00:12:51+01:00 Sitraka Angelo Raharinavalona, Iandry Michella Razafinjatovo, Rija Eric Raherison, Thierry Razanamparany, Andriamparany Rasata Ravelo, Andrinirina Dave Patrick Rakotomalala [Case report] - Ectopie thyro&iuml;dienne hyo&iuml;dienne: &agrave; propos d’un cas chez une jeune fille malgache - 24 May 2018. <b>L'ectopie thyro&iuml;dienne est une pathologie rare li&eacute;e &agrave; une d&eacute;faillance de migration de la glande thyro&iuml;de lors de son d&eacute;veloppement embryonnaire. Elle est le plus souvent asymptomatique. Nous rapportons un cas d'ectopie thyro&iuml;dienne &agrave; localisation hyo&iuml;dienne chez une jeune fille malgache, r&eacute;v&eacute;l&eacute;e par une g&ecirc;ne esth&eacute;tique, associ&eacute;e &agrave; une hypothyro&iuml;die infraclinique. Le diagnostic &eacute;tait confirm&eacute; par l'&eacute;chographie cervicale et la scintigraphie au techn&eacute;tium 99m. M&ecirc;me si l'hypothyro&iuml;die est infraclinique, une hormonoth&eacute;rapie substitutive est de r&egrave;gle permettant ainsi d'obtenir une euthyro&iuml;die biologique et de maintenir la bonne &eacute;volution clinique.</b><br/> text/html 2018-07-22T00:12:51+01:00 Faten Limaiem, Saadia Bouraoui [Images in medicine] - Metastasis of renal cell carcinoma to the pancreas 11 years postnephrectomy - 23 May 2018. <b>The pancreas is an unusual site for tumor metastasis, accounting for only 2 to 5% of all malignancies affecting the pancreas. A 67-year-old woman with a past medical history of right renal nephrectomy for renal cell carcinoma, eleven years ago, presented with nausea, diarrhea and vertigo. On admission, the patient was pale. Laboratory tests showed a low hemoglobin level (6,4 grams per deciliter). Abdominal ultrasonography revealed a well-defined, hypoechoic, homogeneous, vascular, lobulated mass in the tail of the pancreas. Computed tomography scan demonstrated a hypervascularized tumor of the pancreatic tail. The patient subsequently underwent a distal pancreatectomy with splenectomy. Grossly, the pancreatic mass was well-delineated and encapsulated measuring 9,5 x 6,5 cm and showed extensive hemorrhage (A). Histological examination of the surgical specimen revealed that the pattern of the tumour growth was predominantly solid, with formation of large nests and acini of tumor cells separated by a stroma that was endowed with prominent sinusoid-like vessels (B). The tumour cells were large ranging from optically clear, with sharply outlined boundaries, to eosinophilic tumour cells. The final pathological diagnosis was metastatic clear-cell renal carcinoma to the pancreas. Four peripancreatic lymph nodes were free of the tumor but the pancreatic resection margins were invaded by the tumour. Postoperative course was uneventful. Renal cell carcinoma metastasis should be considered in patients with a pancreatic mass as it gives the past history of renal cell carcinoma. Awareness of this entity and a high index of suspicion would help in proper diagnosis and treatment.</b><br/> text/html 2018-07-22T00:12:51+01:00 Omar Boulahroud, Tarik Ziadi [Images in medicine] - Solitary epidural lipoma - 21 May 2018. <b>Spinal epidural lipomatosis (SEL) is defined as normal adipose tissue that is pathologically overgrown in the epidural space of the spinal canal. It usually occurs in obese people, patients with history of corticosteroid use or endocrinopathy. They usually present with gradually progressing symptoms and are rarely associated with rapidly aggravated neurologic deficits. Radiologic assessments are mostly conducted by using MRI. A 65-year-old woman presented with isolated low back pain. She had no history of corticosteroid use, endocrinopathy or radicular pain. On examination, she was obese (height 155cm, weight 87kg) with a body mass index (BMI) of 56.1 kg/m2. Neurological exam was normal with no motor weakness and sensation was intact. Plain radiographs showed no evidence of abnormality, including instability and other pathologic findings. Magnetic resonance imaging (MRI) revealed an epidural mass posterior to the L5 vertebral body that was isosignal to subcutaneous fat and it compressed asymmetrically on the right side of the cauda equina and the exiting right L5 nerve root on sagittal (A) and axial (B) T2 weighted images. There was no evidence of spinal stenosis. The result of electromyography was normal. We recommended surgical intervention to relieve pain but the patient declined. Opioid analgesia has been prescribed and her symptoms became much improved. Weight reduction by physiotherapy and exercise resulted in complete loss of lumbar pain (the patient lost 30kg in 6 months) and MRI control showed a complete disappearance of the mass.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mohammed Ahmed Ibrhim, Meaza Demissie, Araya Abrha Medhanyie, Alemayehu Worku, Yemane Berhane [Research] - Reasons for low level of skilled birth attendance in Afar pastoralist community, North East Ethiopia: a qualitative exploration - 21 May 2018. <b>INTRODUCTION: Ethiopia has expanded the number of health facilities that offer maternal health services during the last two decades. However, the utilization of skilled birth attendants in health facilities is still very low especially among the pastoralist regions of the country. This study explored why women in the pastoralist region of Afar, Ethiopia still prefer to give birth at home. METHODS: a qualitative study approach was used to collect information from October to December 2015. A total of eighteen focus group discussions and twenty-four key informant interviews were conducted. Focus group discussions were separately conducted with mothers and male tribal or religious leaders. Key informant interviews were conducted with heads of Women's Affairs Bureau, district health office heads and traditional birth attendants. Data were coded and categorized using open code software for qualitative data management and analyzed based on a thematic approach. RESULTS: women preferred to deliver at home due to lack of awareness about the benefits of maternity health facilities, their nomadic lifestyle, lack of confidence and trust in health workers and their close affinity and easy access to traditional birth attendants. Supply-side barriers included distant health facilities, lack of transportation and poor health care. CONCLUSION: demand and supply related factors were identified as barriers to utilization of skilled birth attendants. Increasing awareness, bringing the service closer, arranging maternity waiting area around health facilities, and creating client-friendly service were found critical. Future research to define and improve services and approaches suitable for pastoralist population is warranted.</b><br/> text/html 2018-07-22T00:12:51+01:00 Amenze Oritsemofe Onowhakpor, Vincent Yakubu Adam, Oghenetega Ewomazino Sakpa, Lydia Ukamaka Ozokwelu [Research] - Status of Ebola Virus Disease (EVD) preventive practices among Health care workers (HCWs) in Benin City: a year after disease containment in Nigeria - 21 May 2018. <b>INTRODUCTION: Ebola Virus Disease (EVD) is of great public health importance. Health care workers (HCWs) in various health care facilities especially in developing countries such as Nigeria, are particularly vulnerable to the disease. It is therefore imperative that health care workers adopt the necessary preventive practices to reduce to the barest minimum the risk of infection transmission. The study assessed the factors associated with EVD preventive practices among HCWs in a tertiary institution in Benin City, Nigeria. METHODS: a total of 374 health care workers selected using a two-staged sampling technique participated in this descriptive cross-sectional study. Data were collected using structured, self-administered questionnaires and analyzed with IBM SPSS, version 21.0. Univariate and bivariate analysis were done. Level of significance was set at p < 0.05. RESULTS: the mean age of respondents was 36.3 ± 8.0 years. All, 374 (100.0%) of the respondents were aware of EVD and 347 (92.8%) of respondents had good knowledge of EVD. More than half of the respondents, 228 (61.0%) and 201 (53.7%) had positive attitude towards EVD and good EVD preventive practices respectively. A higher proportion of respondents with positive attitude towards EVD were observed to have good preventive practice (p < 0.05). CONCLUSION: knowledge, attitude and preventive practices towards EVD among HCWs were generally good. Positive attitude towards EVD was significantly associated with good preventive practices.</b><br/> text/html 2018-07-22T00:12:51+01:00 Odette Dorcas Manigoue Tchape, Youth Brittany Tchapoga, Catherine Atuhaire, Gunilla Priebe, Samuel Nambile Cumber [Research] - Physiological and psychosocial stressors among hemodialysis patients in the Buea Regional Hospital, Cameroon - 18 May 2018. <b>INTRODUCTION: End stage renal disease is an irreversible kidney condition and hemodialysis is the most frequent treatment option used for end stage renal disease. Hemodialysis has a detrimental impact on the quality of life and has a negative effect on the individuals' physical and psychosocial wellbeing. The main objective of this study was to identify physiological and psychosocial stressors faced by patients undergoing hemodialysis in the Buea Regional Hospital in Cameroon. METHODS: a cross-sectional study was carried out among patients undergoing hemodialysis at the Buea regional hospital over a period of two months (December 2016 - January 2017). Data were collected with the use of a structured questionnaire and analyzed using SPSS version 21.0. Quantitative variables were expressed as frequencies, percentages and means. RESULTS: among the patients undergoing hemodialysis, 21(52.5%) were male and 19(47.5%) female. Half of the patients were married 20(50%), 13(32.5%) were single, 6(15%) were divorced, and one (2.5%) was a widower. Also, 28 (70.0%) were below 5-year dialysis while 12 (30.0%) had been on dialysis for five years and more. All participants experienced at least one or more physiological and psychosocial stressors. Among physiological stressors, the most frequent were feeling tired (97%), followed by Arterial and venous stick (88%) while itching (49.5%). Among psycho-social stressors, the most recurrent were transportation to and from the hospital (99.5%), cost of treatment (99.5%) and limits on time and place of vacation (99%), limitation in physical activities, frequent hospitalizations, the length of time on dialysis, uncertainty about the future, changes in life style, increased dependence and sleep disturbances. CONCLUSION: the topic of stressors is of importance among patients receiving dialysis, as these affect their psycho-social and physiological wellbeing. Thus, nephrologists, nurses and family members play an important role in providing patients with effective psycho-social and physiological support.</b><br/> text/html 2018-07-22T00:12:51+01:00 Wafa Ben Ameur, Lamia Kallel, Houcine Maghrebi, Slim Haouet, Azza Filali [Case report] - Lymphangiome kystique intra-péritonéal et maladie de Crohn: à propos d’une association exceptionnelle - 18 May 2018. <b>Le lymphangiome kystique est une tumeur b&eacute;gnine malformative rare des vaisseaux lymphatiques &agrave; localisations diverses. La localisation intra-abdominale du lymphangiome kystique est moins fr&eacute;quente compar&eacute;e &agrave; la localisation cervico-axillaire. Sa pr&eacute;sentation clinique est polymorphe. Le diagnostic est &eacute;voqu&eacute; par l'imagerie mais il n&eacute;cessite une confirmation histologique. Le traitement de choix est chirurgical. Nous rapportons ici un cas rare de lymphangiome kystique intrap&eacute;riton&eacute;ale acquis suite &agrave; une colectomie subtotale chez une patiente porteuse de maladie de Crohn &agrave; g&eacute;ni &eacute;volutif s&eacute;v&egrave;re et ayant n&eacute;cessit&eacute; l'introduction des anti TNF alpha. La patiente s'est pr&eacute;sent&eacute;e pour une masse para m&eacute;diane droite douloureuse irr&eacute;ductible et non impulsive &agrave; la toux faisant retenir le diagnostic d'une &eacute;ventration &eacute;trangl&eacute;e sur cicatrice de laparotomie m&eacute;diane et amenant &agrave; op&eacute;rer la patiente en urgence. L'exploration chirurgicale a montr&eacute; une masse multi-kystique intra p&eacute;riton&eacute;ale ext&eacute;rioris&eacute;e en partie &agrave; travers l'&eacute;ventration param&eacute;diane droite. L'examen anatomo-pathologique a permis de confirmer le diagnostic de lymphangiome kystique. Devant une ex&eacute;r&egrave;se chirurgicale incompl&egrave;te, la patiente a eu deux s&eacute;ances de ponction &eacute;vacuatrice en post-op&eacute;ratoire. C'est le premier cas de lymphangiome kystique rapport&eacute; chez un patient sous Anti-TNF alpha. Ceci pourrait &ecirc;tre expliqu&eacute; par la perturbation du syst&egrave;me immunitaire et plus sp&eacute;cifiquement la population lymphocytaire. Cette association n'a pas &eacute;t&eacute; jusque-l&agrave; prouv&eacute;e et des &eacute;tudes exp&eacute;rimentales sont n&eacute;cessaires pour affirmer ou infirmer cette hypoth&egrave;se.</b><br/> text/html 2018-07-22T00:12:51+01:00 Bennis Ahmed, Benatiya Andaloussi Idriss [Images in medicine] - R&eacute;cidive d’une pseudo-exfoliation capsulaire sur implant intraoculaire - 18 May 2018. <b>Patient de 79 ans, op&eacute;r&eacute; de cataracte par phaco-&eacute;mulsification en 2000, avec une pseudo-exfoliation capsulaire ODG pr&eacute;op&eacute;ratoire. Pr&eacute;sente un glaucome pseudo-exfoliatif avec une r&eacute;cidive sur l'implant.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ouiam El Anzi, Badreddine Hassam [Images in medicine] - Tatouage au henn&eacute; noir: attention &agrave; l’ecz&eacute;ma de contact - 18 May 2018. <b>Le henn&eacute; est un produit utilis&eacute; pour colorer les cheveux, mais aussi pour dessiner des tatouages labiles sur la peau. Le henn&eacute; est souvent m&eacute;lang&eacute; avec de la paraph&eacute;nyl&egrave;nediamine (PPD). Nous rapportons l'observation d'une patiente qui a pr&eacute;sent&eacute; un ecz&eacute;ma de contact &agrave; un tatouage labile contenant la PPD. Une jeune femme de 23 ans se fait tatouer sur le dos de la main et sur l'avant-bras des dessins esth&eacute;tiques &agrave; base de henn&eacute; noir. Ce tatouage labile contenait de la PPD. Deux jours plus tard, elle d&eacute;veloppe des l&eacute;sions &eacute;ryth&eacute;matov&eacute;siculeuses et œd&eacute;mateuses tr&egrave;s prurigineuses avec une sensation de cuisson. Les l&eacute;sions si&eacute;geaient au site de tatouage et suivaient exactement le dessin initial. Elles &eacute;taient am&eacute;lior&eacute;es par un traitement &agrave; base de dermocortico&iuml;des de classe 4. La patiente refuse l'exploration allergologique par patch-tests et aucun test allergologique n'est effectu&eacute;. Actuellement, le henn&eacute; est tr&egrave;s en vogue dans les pays occidentaux. La PPD est ajout&eacute;e pour diminuer le temps de fixation ou pour obtenir une coloration plus fonc&eacute;e. Elle peut entrainer de graves r&eacute;actions syst&eacute;miques. La r&eacute;action allergique la plus fr&eacute;quente est la dermatite de contact. Le traitement repose sur la corticoth&eacute;rapie locale. Une meilleure l&eacute;gislation sur la pratique du tatouage temporaire et le contr&ocirc;le des pr&eacute;parations ainsi qu'une Information r&eacute;guli&egrave;re annuelle du grand public sont indispensables. L'int&eacute;r&ecirc;t de notre observation est de montrer l'importance d'informer surtout les jeunes sur les risques d'un tatouage labile.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mouna Ejjiyar, Saloua Ettalbi [Images in medicine] - Complexit&eacute; de prise en charge d’une macrodactylie au niveau de la main: entre pr&eacute;judice esth&eacute;tique et fonctionnel - 18 May 2018. <b>On d&eacute;finit la macrodactylie comme une malformation cong&eacute;nitale d'&eacute;tiologie inconnue et d'incidence rare pouvant int&eacute;resser les doigts ou les orteils, et caract&eacute;ris&eacute;e par l'augmentation, d&egrave;s la naissance ou de fa&ccedil;on progressive, de la taille de tous les &eacute;l&eacute;ments d'un ou plusieurs rayons. Son retentissement social, esth&eacute;tique, et surtout fonctionnel imposent une prise en charge pr&eacute;coce passant par plusieurs interventions chirurgicales voire m&ecirc;me des amputations dans les formes &eacute;volu&eacute;es. Nous rapportons le cas d'un jeune patient &acirc;g&eacute; de 18 ans, c&eacute;libataire, sans profession, gaucher, admis au service de chirurgie plastique, r&eacute;paratrice, esth&eacute;tique et des br&ucirc;l&eacute;s du CHU Mohammed VI de Marrakech, pour prise en charge d'une forme progressive de macrodactylie int&eacute;ressant les premier et deuxi&egrave;me rayons de la main droite. A l'examen, on retrouvait une hypertrophie des deux premiers rayons de la main droite, associ&eacute;e &agrave; une infiltration fibro-graisseuse pr&eacute;dominant en palmaire, ainsi qu'une d&eacute;viation phalangienne en angulation &agrave; 90° au niveau du deuxi&egrave;me doigt. Devant cette forme s&eacute;v&egrave;re de macrodactylie, une amputation du 2&egrave;me rayon associ&eacute;e &agrave; une r&eacute;duction de l'infiltration graisseuse au niveau palmaire a &eacute;t&eacute; propos&eacute;e au patient, lui permettant de conserver une pince pollici-digitale, et de retrouver une vie sociale le plus proche possible de la normale.</b><br/> text/html 2018-07-22T00:12:51+01:00 Emmanuel Edmond Yambasu, Anthony Reid, Philip Owiti, Marcel Manzi, Mariama Jeanne Sia Murray, Ama Kyerewaa Edwin [Research] - Hidden dangers-prevalence of blood borne pathogens, hepatitis B, C, HIV and syphilis, among blood donors in Sierra Leone in 2016: opportunities for improvement: a retrospective, cross-sectional study - 18 May 2018. <b>INTRODUCTION: Transmissible blood-borne infections are a serious threat to blood transfusion safety in West African countries; and yet blood remains a key therapeutic product in the clinical management of patients. Sierra Leone screens blood donors for blood-borne infections but has not implemented prevention of mother-to-child transmission for hepatitis B. This study aimed to describe the overall prevalence of hepatitis B and C, HIV and syphilis among blood donors in Sierra Leone in 2016 and to compare the differences between volunteer versus family replacement donors, as well as urban versus rural donors. METHODS: retrospective, cross-sectional study from January-December 2016 in five blood bank laboratories across the country. Routinely-collected programme data were analyzed; blood donors were tested with rapid diagnostic tests-HBsAg for HBV, anti-HCV antibody for HCV, antibodies HIV1&2 for HIV and TPHA for syphilis. RESULTS: there were 16807 blood samples analysed, with 80% from males; 2285 (13.6%) tested positive for at least one of the four pathogens. Overall prevalence was: 9.7% hepatitis B; 1.0% hepatitis C; 2.8% HIV; 0.8% syphilis. Prevalence was higher among samples from rural blood banks, the difference most marked for hepatitis C. The proportion of voluntary donors was 12%. Family replacement donors had a higher prevalence of hepatitis B, C and HIV than volunteers. CONCLUSION: a high prevalence of blood-borne pathogens, particularly hepatitis B, was revealed in Sierra Leone blood donors. The study suggests the country should implement the prevention of mother-to-child transmission of hepatitis B and push to recruit more volunteer, non-remunerated blood donors.</b><br/> text/html 2018-07-22T00:12:51+01:00 Simant Singh Thapa, Buddha Basnyat [Images in medicine] - Higher ascent, trouble breathing: High altitude pulmonary edema (HAPE) - 18 May 2018. <b>A 40 year old man started his trekking 4 days ago from Lukla (2800m) in the Everest region of Nepal. He reached Tengboche (3860 m) on third day where he was short of breath with moderate exertion and was easily fatigued. He ascended further ignoring his symptoms and reached Dingboche (4410m) on fourth day. He was extremely tired, short of breath at rest and appeared ill so helicopter evacuation was done from Dingboche to Kathmandu (1300m) and he was brought to our clinic. On initial evaluation, his vital signs were temperature 97.8 F, blood pressure 124/66 mmHg, pulse rate 89/min, respiratory rate of 26 breaths/min and saturation (SpO2) of 80% on room air at rest. Auscultation of the lungs revealed bilateral crackles. Finger to nose test and tandem gait was normal. The chest radiograph showed patchy infiltrates bilaterally. He was diagnosed as the case of HAPE. He was treated with bed rest and supplemental oxygen. On evaluation the next day, his pulmonary crackles had resolved and he was no more short of breath. His ambulatory SpO2 was 96% on room air. His dramatic clinical improvement following descent strongly supported our diagnosis. HAPE is a non-cardiogenic form of pulmonary edema. Its notable feature in contrast with other causes of pulmonary edema is fast reversibility following timely descent with or without oxygen.</b><br/> text/html 2018-07-22T00:12:51+01:00 Antoine Lamblin, Cl&eacute;ment Derkenne, Antoine Schwartz, Pierre Pasquier, Romain Gorioux, Pierre-Fran&ccedil;ois Wey [Case series] - Prise en charge des corps &eacute;trangers du tiers sup&eacute;rieur de l’œsophage sans endoscope: un d&eacute;fi pour le m&eacute;decin en situation isol&eacute;e? - 18 May 2018. <b>La prise en charge des corps &eacute;trangers du tiers sup&eacute;rieur de l'œsophage est bien codifi&eacute;e et fait appel le plus souvent &agrave; un traitement endoscopique. Ce mat&eacute;riel sp&eacute;cifique, ainsi que des m&eacute;decins gastro-ent&eacute;rologues entra&icirc;n&eacute;s &agrave; son utilisation fait parfois d&eacute;faut dans les pays d'Afrique. D'autres moyens doivent alors &ecirc;tre envisag&eacute;s pour les m&eacute;decins ayant &agrave; prendre en charge ce type de pathologie. L'objectif de cette &eacute;tude &eacute;tait d'&eacute;valuer la prise en charge des corps &eacute;trangers du tiers sup&eacute;rieur de l'œsophage par des m&eacute;decins anesth&eacute;sistes-r&eacute;animateurs dans un centre m&eacute;dico-chirurgical du Tchad. 37 cas d'extraction chez des enfants de 0 &agrave; 15 ans &eacute;taient analys&eacute;s. Il s'agissait de pi&egrave;ces de monnaie et de piles au lithium dans respectivement 92% et 8% des cas. La m&eacute;thode employ&eacute;e &eacute;tait une sonde de Foley &agrave; ballonnet dans 43,2% et d'une pince &agrave; calcul sous laryngoscopie dans 56,8% des cas. Un cas d'&eacute;chec ayant n&eacute;cessit&eacute; une cervicotomie &eacute;tait not&eacute; dans chaque groupe. Quatre complications mineures &eacute;taient rapport&eacute;es dans le groupe « pince &agrave; calcul », aucune dans le groupe « Foley ». Les indications d'extraction de corps &eacute;trangers du tiers sup&eacute;rieur de l'œsophage doivent &ecirc;tre bien connues des m&eacute;decins amen&eacute;s &agrave; les prendre en charge. En cas d'indisponibilit&eacute; de l'endoscopie, d'autres techniques alternatives peuvent &ecirc;tre utilis&eacute;es avec un taux de succ&egrave;s satisfaisant. En cas d'&eacute;chec un recours &agrave; la chirurgie peut &ecirc;tre n&eacute;cessaire.</b><br/> text/html 2018-07-22T00:12:51+01:00 Lamiae Bouimetarhan, Habib Bellamlih, Issam En-nafaa, Jamal EL Fenni, Touria Amil, Bouchaib Radouane [Case report] - Neurofibfrome plexiforme cervical: &agrave; propos d’un cas - 17 May 2018. <b>Le neurofibrome plexiforme est une tumeur b&eacute;nigne rare des nerfs p&eacute;riph&eacute;riques aux d&eacute;pens des cellules conjonctives du p&eacute;rinevre. Il est pathognomonique de la neurofibromatose de type 1 (NF1 ou maladie de Von Recklinghausen). L'IRM est d'une grande aide au diagnostic de cette pathologie. La confirmation anatomopathologique est parfois n&eacute;cessaire en particulier en dehors d'un contexte &eacute;vocateur d'une NF1. Nousrapportonsl'observation d'une petite fille atteinte de neurofibrome plexiforme cervical r&eacute;v&eacute;lateur d'une neurofibromatose Type 1.</b><br/> text/html 2018-07-22T00:12:51+01:00 Leila Nasiriani, Seyedeh Fatemeh Vasegh Rahimparvar, Tahmine Faraj Khoda, Naser Bahrani [Research] - Compliance to professional codes of ethics and its related factors from midwives’ perspective working in healthcare centers of Tehran-Iran - 17 May 2018. <b>INTRODUCTION: Professional ethics is an important issue in every organization. This study was designed to define compliance level to professional codes of ethics and some of its related factors in midwives working at healthcare centers. METHODS: This cross sectional study was conducted in 2013 Tehran Iran. 125 midwives from the governmental healthcare centers of Tehran were selected through stratified quota sampling method. Data gathering tool was a self-reporting questionnaire which included: demographic characteristics, Iranian version of ethical codes of reproductive health providers, applicability of these ethical codes, and awareness about the professional codes of ethical. Data analysis was conducted using SPSS v.16. p level at 0.05. RESULTS: The level of compliance to the professional ethical codes by midwives was 76.7% as a whole, and between 69 to 85 percent in 10 domains. Compliance to the codes were directly correlated to the income level of the midwives, the applicability of the codes and the midwives' awareness about them. CONCLUSION: It is necessary to pay attention to professional ethics and its teaching as such. It is also important to monitor compliance to the ethical codes. Moreover, living conditions of the midwives should be one of the priorities to enhance their performance.</b><br/> text/html 2018-07-22T00:12:51+01:00 Francine Mwayuma Birungi, Brian van Wyk, Jeannine Uwimana, Joseph Ntaganira, Stephen Michael Graham [Research] - Xpert MTB/RIF assay did not improve diagnosis of pulmonary tuberculosis among child contacts in Rwanda - 17 May 2018. <b>INTRODUCTION: To report on the diagnostic yield using the Xpert MTB/RIF assay on gastric lavage samples from children (<15 years) who were household contacts of tuberculosis (TB) cases in Kigali, Rwanda. METHODS: A cross-sectional study was conducted among 216 child contacts of index cases with sputum smear-positive TB over a 7 month period, from 1<sup>st</sup> August 2015 to 29<sup>th</sup> February 2016. Child contacts with tuberculosis-related symptoms or abnormal chest X-ray had sputum collected by gastric lavage on two consecutive days and samples were examined by smear microscopy, Xpert MTB/RIF assay and solid culture. RESULTS: Of the 216 child contacts, 94 (44%) were less than 5 years of age. Most of them 84 (89%) were receiving isoniazid preventive therapy at the time of screening. Thirty seven out of 216 children had TB-related symptoms. Only 4 (10.8%) were clinically diagnosed with TB; and none had bacteriologically confirmed tuberculosis. CONCLUSION: The use of Xpert MTB/RIF assay did not contribute to bacteriological confirmation of active TB in child contacts in this study. The low prevalence of tuberculosis in child contacts in this study may reflect the high coverage of preventive therapy in young (<5 years) child contacts. The low sensitivity of Xpert MTB/RIF assay in contacts may also suggest likely reflection of paucibacillary disease.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ouahidi Mohamed, Hicham Bousbaa, Mourad Bennani, Toufik Cherrad, Hassan Zejjari, Jamal Louaste, Khalid Rachid, Laarbi Amhajji [Case series] - Traitement des fractures de la diaphyse hum&eacute;rale par l’embrochage centro-m&eacute;dullaire r&eacute;trograde de Hackethal: &agrave; propos de 54 cas - 17 May 2018. <b>Les auteurs rapportent 54 cas de fracture de la diaphyse hum&eacute;rale trait&eacute;s par embrochage de Hackethal. 3 cas avec paralysie du nerf radial ont &eacute;t&eacute; observ&eacute; dont l'abstention th&eacute;rapeutique en urgence a &eacute;t&eacute; l'attitude avec surveillance et qui ont abouti &agrave; une r&eacute;cup&eacute;ration. La technique de l'embrochage est relativement facile mais n&eacute;cessite une technique rigoureuse et une bonne exp&eacute;rience de l'op&eacute;rateur. Un taux de 7,84 % de pseudarthrose &eacute;tait observ&eacute;. L'embrochage d'Hackethal peut &ecirc;tre consid&eacute;rer comme un traitement orthop&eacute;dique am&eacute;lior&eacute; avec un co&ucirc;t modeste et une innocuit&eacute; importante.</b><br/> text/html 2018-07-22T00:12:51+01:00 Noureddine Khiri, Moussa Lazreg, Houssam Bkiyar, Soufiane Diyas, Brahim Housni [Case report] - Le syndrome de Miller Fischer: &agrave; propos d’un cas p&eacute;diatrique - 17 May 2018. <b>Le syndrome de Miller Fisher (MF) repr&eacute;sente une forme rare du syndrome de Guillain-Barr&eacute; qui ne survient que dans 5% des cas chez l'adulte alors que les cas p&eacute;diatriques d&eacute;crits dans la litt&eacute;rature sont encore plus rares. Nous pr&eacute;sentons le cas d'un enfant de 12 ans chez qui on a pos&eacute; le diagnostic de syndrome de Miller Fischer en se basant sur la pr&eacute;sentation clinique avec une atteinte oculaire en premier plan et la positivit&eacute; des anticorps anti-ganglioside. Notre patient est admis dans notre structure dans un tableau de d&eacute;tresse respiratoire n&eacute;cessitant l'intubation orotrach&eacute;ale et le recours aux immunoglobulines intraveineuses avec bonne &eacute;volution clinique.</b><br/> text/html 2018-07-22T00:12:51+01:00 Abdelhafid El Marfi, Badarou Chaibou, Kevin Parfait Bienvenue Bouhelo-Pam, Mohamed El Idrissi, Mohamed Shimi, Abdelhalim El Ibrahimi, Abdelmajid El Mrini [Case report] - L’arthroscopie de la hanche dans le conflit f&eacute;moro-ac&eacute;tabulaire: &agrave; propos de 2 observations - 17 May 2018. <b>Le conflit f&eacute;moro-ac&eacute;tabulaire (CFA) est une des causes de douleur de hanche chez les sujets jeunes et sportifs. Son diagnostic est bas&eacute; sur des arguments cliniques et radiologiques. La prise en charge chirurgicale peut &ecirc;tre conventionnelle ou arthroscopique. L'arthroscopie s'av&egrave;re &ecirc;tre une technique fiable dans les CFA, efficace sur la douleur, permettant d'am&eacute;liorer la fonction de ces patients sportifs afin de reprendre leurs activit&eacute;s pr&eacute;cocement. Nous rapportons l'exp&eacute;rience de notre service dans la prise en charge arthroscopique des CFA &agrave; travers deux observations. Le score de Harris modifi&eacute; &eacute;tait nettement am&eacute;lior&eacute; au dernier recul (24 et 18 mois).</b><br/> text/html 2018-07-22T00:12:51+01:00 Richard-A-Mutshimbe Mukendi, C&eacute;lestin Lubaba Nkulu Banza, Clarence-A-Kaut Mukeng, Jules Thaba Moyambe Ngwe, Albert Ntambwe-A-Nkoy Mwembo, Prosper Muenze Kayamba Kalenga [Research] - Exposition de l’homme aux éléments traces métalliques et altération du sperme: étude menée dans les zones minières du Haut-Katanga en République Démocratique du Congo - 16 May 2018. <b>INTRODUCTION: L’exposition &agrave; l’arsenic et au cadmium entraine des effets n&eacute;fastes importants. L’objectif de cette &eacute;tude est de d&eacute;terminer les concentrations urinaires en arsenic et en cadmium chez les hommes et d’analyser leur profil en rapport avec les &eacute;l&eacute;ments du spermogramme. METHODES: Il s’agit d’une &eacute;tude analytique expos&eacute;s-non expos&eacute;s o&ugrave; les hommes expos&eacute;s ont &eacute;t&eacute; recrut&eacute;s dans une zone mini&egrave;re du Haut-Katanga, en RDC et les hommes non-expos&eacute;s dans une zone loin de toute activit&eacute; mini&egrave;re.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ary&eacute; Weinberg, Ralph Magritz [Images in medicine] - The red ear - 16 May 2018. <b>A 5-year-old boy was presented to our out-patient clinic by his father with a painful swollen red left ear (A). The father stated that his son has been suffering from an upper- respiratory tract infection and that his left ear has been hurting since the other day. Hearing loss was denied. Clinical examination showed a painfull swelling of the left ear causing it to stick out. Behind the ear an insect bite was noticed, probably from a mosquito (B). Otoscopy showed a white transparent ear drum with no signs of infection. Thus an acute mastoiditis based on a middle ear infection was excluded. The patient was treated for a mosquito bite with a topical coricoidsteroid gel and cooling. The boy totally recovered after two days.</b><br/> text/html 2018-07-22T00:12:51+01:00 Mohamed El Amraoui, Mohammed Boui [Images in medicine] - Carcinome basocellulaire: à propos d’un cas historique - 16 May 2018. <b>Un homme &acirc;g&eacute; de 80 ans, villageois, r&eacute;sidant dans l'une des zones les plus enclav&eacute;es de notre royaume, situ&eacute;e &agrave; plus de 2400 m&egrave;tres d'altitude, et ayant un phototype clair (II). A consult&eacute;, lors d'une mission humanitaire, pour une tumeur ulc&eacute;ro-n&eacute;crotique, infiltrant la racine du nez et l'orbite droits avec destruction totale de l''il droit. La l&eacute;sion &eacute;voluait, selon le patient, depuis deux ans et demi, par une petite papule saignante sur la racine du nez avec une extension orbitaire. L'aspect clinique et l'histologie &eacute;taient en faveur d'un carcinome baso-cellulaire infiltrant. Le bilan d'extension montrait un envahissement des plans osseux de la r&eacute;gion naso-orbitaire droite. Une chirurgie carcinologique et mutilante a &eacute;t&eacute; indiqu&eacute;e mais que le patient a refus&eacute;e. Le carcinome baso-cellulaire est r&eacute;put&eacute; par son pronostic relativement bon, vue son &eacute;volution lente et locale, cependant, certaines formes notamment la forme infiltrante, dans certaines zones &agrave; haut risque, notamment dans la zone naso-orbitaire peuvent &ecirc;tre rapidement d&eacute;labrantes, mutilantes et spectaculaires avec des pr&eacute;judices esth&eacute;tiques et fonctionnelles et des difficult&eacute;s de prise en charge.</b><br/> text/html 2018-07-22T00:12:51+01:00 Fitsum Weldegebreal, Habtamu Mitiku, Zelalem Teklemariam [Research] - Treatment outcome of tuberculosis among Human Immunodeficiency Virus positive patients in Eastern Ethiopia: a retrospective study - 16 May 2018. <b>INTRODUCTION: Tuberculosis is the leading cause of morbidity and mortality among people living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome worldwide. Although Human Immunodeficiency Virus related tuberculosis is both treatable and preventable, incidence rates continue to climb in developing countries where both infections are endemic. The aim of this study was to assess the treatment Outcome of Tuberculosis among Human Immunodeficiency Virus positive patients attending in three hospitals of Eastern Ethiopia. METHODS: A retrospective clinical record review was conducted on all 627 Tuberculosis and Human immunodeficiency virus co-infected patients registered from January 2008 to January 2014 cards were reviewed in three hospitals of Tuberculosis Clinics of Eastern Ethiopia from December 2015 to February 2016. The three hospitals were selected based on their high patient load of TB-HIV co infection and the presence of ART and TB units. Data on patient's details and tuberculosis treatment outcome was collected using standardized report format of National Tuberculosis, and Leprosy Control Programme (NTLCP). The collected data were analyzed by Statistical Package for Social Sciences (SPSS) software Version 16. RESULTS: The overall treatment success rate was 78.3%. Of the total TB–HIV co infected study participants, 17.9% cured, 60.4% treatment completed, 8.6% died, 0.6% failure, 1.8% defaulter and 10.7% transferred out. Those participants in the age groups of less than or equal to 18 years old (Adjusted Odds Ratio = 1.990, 95% Confidence Interval: 1.01, 3.350), Extra pulmonary Tuberculosis (Adjusted Odds Ratio =1.51, 95% Confidence Interval =1.12, 3.42), on Antiretro Viral Therapy (Adjusted Odds Ratio= 1.54, 95% Confidence Interval = 1.252, 3.910) were more likely to have higher treatment outcome than each of the above variables counter parts. CONCLUSION: The rate of treatment success in this study was lower than recommended rate by World Health Organization. Thus this study recommends improving counseling during tuberculosis treatment, providing home visits and motivation of patients, improving defaulter tracing and health information dissemination in order to reduce treatment interruption.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ary&eacute; Weinberg, Ralf Siegert [Images in medicine] - A tongue ulcer - 16 May 2018. <b>An 86-year-old man presented with a painful lesion on his left tongue measuring 0.6 x 0.6mm (A). The lesion has been growing over the last 2 weeks. The patient did not remember any trauma except that his teeth did sometimes scratch his tongue. Histology form the excised lesion revealed a pressure ulcer (B). Tongue ulcers can be caused by accidental bites, ill-fitting dentures, braces, citrus or acidic fruits and by a sharp tooth surface. In some other cases nutritional problems such as vitamin B12, iron or folic acid deficiency may cause tongue ulcers. Never the less malignancy needs to be excluded. Therefore, complete excision and diagnosis based on histology is recommended.</b><br/> text/html 2018-07-22T00:12:51+01:00 Skander Zouari, Khaireddine Bouassida, Khaled Ben Ahmed, Ahlem Bdioui Thabet, Mohamed Amine Krichene, Chawki Jebali [Case report] - Acute urinary retention due to benign prostatic hyperplasia associated with cystitis glandularis in a 22-year-old patient - 16 May 2018. <b>A 22-year-old man has consulted in emergency for acute urinary retention and left renal colic. Bladder catheterization was performed. Symptomatic treatment was provided with no improvement. MRI showed a pseudotumoral bladder wall thickening associated with vesical floor budding with prostate median lobe infiltration. The patient got an endoscopy that concluded to an inflammatory aspect of the bladder mycosa and a solid mass in the bladder neck arising. The biopsy during examination concluded to a glandular cystitis. Ultrasonography performed six months later still showed an enlarged prostate of 60g volume, post void residue of 280ml and bilateral hydronephrosis. A second cystoscopy showed an obstructive prostate with a median lobe. A transurethral resection of this lobe was performed. The pathological examination concluded to a benign prostate hyperplasia. This case is likely to be the first reported so far about a BPH in a young male associated with Cystitis Glandularis. Neither etiology nor evidence of the cause behind this case has been identified so far. Although Benign Prostate Hypertrophia is rare among young males, its ethiopathogenesis is not well known, its relation with cystitis glanduralis in young patients has never been described before. Both medical and surgical approaches remain similar to the adults.</b><br/> text/html 2018-07-22T00:12:51+01:00 Nassiba Elouarradi, Nawal El Ansari [Images in medicine] - Familial hypercholesterolemia revealed by multiple xanthomas - 16 May 2018. <b>Familial hypercholesterolemia (HF) is a rare pathology characterized by a major elevation of LDL associated with tendinous and subcutaneous xanthomas. We report the case of a 16-year-old patient, born from a first degree consanguineous marriage, with no particular pathological antecedents, the patient reports appearance for 9 years of cutaneous lesions described as a swellings in the posterior face of the 2 elbows and the anterior surface of the 2 knees, painless, firm, and gradually increasing in volume. The patient consulted only at the age of 16 years in front of the aesthetic discomfort. The biological assessment objectified a hypercholesterolemia: total Cholesterol: 4.44g/l. HDL: 0.64g/l. LDL: 3.71g/l. and Triglycerides: 0.67g/l. The exploration of cardiac repercussion was without particularities.The patient was treated with dietary and lifestyle measures and atorvastatin 80 mg with good clinical and biological evolution.</b><br/> text/html 2018-07-22T00:12:51+01:00 Almeimoune Abdoulhamidou, Mangane Moustapha, Diop Madane Thierno, Beye Seydina Alioune, D&eacute;mbele Seydou Aladji, Diarra Kassim, Diango Djibo Mahamane [Research] - Gestion des secours m&eacute;dicaux aux victimes des attentats terroristes au Mali - 15 May 2018. <b>INTRODUCTION: Les r&eacute;cents attentats suicides ont r&eacute;v&eacute;l&eacute; un nouveau type d’afflux massif de bless&eacute;s, unique en son genre, qui doivent &ecirc;tre pris en charge au sein des formations hospitali&egrave;res. METHODES: Nous rapportons l’exp&eacute;rience du CHU Gabriel Toure de Bamako et de l’h&ocirc;pital N. Fomba de S&eacute;gou dans la gestion des secours m&eacute;dicaux aux victimes des attentats terroristes au Mali. RESULTATS: Soixante-quatre victimes des trois attentats ont &eacute;t&eacute; inclus dans notre &eacute;tude parmi ceci 22 (34,4 %) cas de d&eacute;c&egrave;s constat&eacute; &agrave; l’arriv&eacute;e. Les hommes avaient repr&eacute;sent&eacute; 97% des victimes qui &eacute;taient de nationalit&eacute; malienne dans 71% des cas. Dans 51% des cas il s’agissait de bless&eacute; grave avec des l&eacute;sions pr&eacute;dominantes aux extr&eacute;mit&eacute;s chez 35% d’entre eux. Aucune victime admise vivante n &eacute;tait d&eacute;c&egrave;de au cours de la prise en charge hospitali&egrave;re. CONCLUSION: Pouvoir disposer de donn&eacute;es pr&eacute;cises sur les m&eacute;canismes et la gravit&eacute; des l&eacute;sions, une prise en charge m&eacute;dicale pr&eacute; hospitali&egrave;re permettront de diminuer la morbi-mortalit&eacute; li&eacute;e &agrave; ces catastrophes.</b><br/> text/html 2018-07-22T00:12:51+01:00 Alicia Ehlers, Chandra Rekha Makanjee [Research] - Exploration of gynaecological cancer high dose-rate brachytherapy treatment: a pilot study - 15 May 2018. <b>INTRODUCTION: Performing brachytherapy on female patients with gynaecological cancer is a sensitive procedure, apart from it being an intricate investigation. The aim of this study: establishing gynaecological cancer patients' expectations, experiences and understandings of the high dose-rate brachytherapy treatment procedure. Exploring these patients' life-worlds provides further insights into improving their preparedness and experiences. METHODS: a qualitative research design with a descriptive phenomenological research approach was used. Recruitment entailed using purposive sampling. To obtain rich insights into the lived experiences, data was acquired through semi-structured interviews until data saturation. RESULTS: major challenges were experienced with mixed thoughts and feelings, from negative trauma to desires being fulfilled. These patients should have received more information regarding their upcoming brachytherapy treatment. This would have alleviated some of their fears and anxieties, which would in turn have provided them with a better brachytherapy treatment experience. Envisaged outcomes and desires are used to cope. Patients influence each other negatively, so they rather wanted to "see for themselves". CONCLUSION: despite some disappointments and negative experiences throughout the brachytherapy continuum, the patients were left with a positive outlook, saying that it is an excellent and necessary treatment. Further studies should be done to elaborate on fulfilments of recommendations in the brachytherapy department of radiation oncology.</b><br/> text/html 2018-07-22T00:12:51+01:00 Guglielmo Mantica, Hilgard Ackermann [Images in medicine] - Horseshoe kidney - 15 May 2018. <b>A 21-year-old male presented with a one day history of right flank pain and signs of severe sepsis. The recorded vital signs included a temperature of 39.9° Celsius, blood pressure of 95/65 mmHg and heart rate of 165. The laboratory investigations confirmed a raised C-reactive protein (CRP) of 485 mg/l but it was interesting to note thatthe white cell count and creatinine were respectively normal (5.85 x 109/l; 77 µmol/l). Microbiological investigations confirmed Klebsiella pneumoniae (>106 cfu/mL) on urine culture whilst two blood cultures were negative. Intravenous fluid resuscitation was successful in restoring hemodynamic stability. Amoxicillin/clavulanic acid (1200mg) was administered and continued for seven days after confirmation on antibiotic sensitivity testing. After ultrasonography confirmed severe right hydronephrosis, a contrasted computed tomography (CT) scan confirmed a horseshoe kidney (A, B, C, D) with an obstructed right-sided renalmoiety secondary to right pelvi-ureteric junction (PUJ) obstruction (B) and urothelial enhancement suggestive of an infected collecting system. Horseshoe kidneys are the most common congenital renal abnormality with an incidence of 1:400-600. It is commonly asyptomatic and rarely require interventionunless treating complications such as ureteral obstruction (PUJ), urinary tract infections, urolithiasis andWilms Tumour. It is associated with Trisomy 18 and females with Turner syndrome. Our patient underwent a right percutaneous nephrostomy (PCN) and 500 millilitres of infected urine were aspirated. He made a complete recovery at discharge. An interval MAG3 renogram confirmed that both moeities had good and excretion. A pelvi-ureteric junction repair will be performed after 6 weeks.</b><br/> text/html 2018-07-22T00:12:51+01:00 Khalid Mazine, Pierre Barsotti, Hicham Elbouhaddouti, Ouadii Mouaqit, Elbachir Benjelloun, Khalid Ait Taleb, Abdelmalek Ousadden [Case report] - Trichob&eacute;zoard gastroduod&eacute;nal: &agrave; propos d’un cas - 15 May 2018. <b>Le trichob&eacute;zoard gastroduod&eacute;nal est une affection rare, dont le diagnostic est facile en pr&eacute;sence d'un contexte &eacute;vocateur. Nous rapportons le cas d'une jeune patiente &acirc;g&eacute;e de 21 ans suivie pour une schizophr&eacute;nie, admise pour douleur abdominale aigu&euml;, vomissements et masse &eacute;pigastrique, le scanner abdominal a permis de faire suspecter un b&eacute;zoard en objectivant des l&eacute;sions h&eacute;t&eacute;rog&egrave;nes occupant tout l'estomac, ne prenant pas le contraste et semblant ind&eacute;pendante de la paroi gastrique. Un traitement chirurgical a &eacute;t&eacute; r&eacute;alis&eacute; avec ex&eacute;r&egrave;se du trichob&eacute;zoard par gastrotomie, sans complications et un transfert en service de psychiatrie.</b><br/> text/html 2018-07-22T00:12:51+01:00 Isaac Nkrumah, Catherine Atuhaire, Gunilla Priebe, Samuel Nambile Cumber [Research] - Barriers for nurses’ participation in and utilisation of clinical research in three hospitals within the Kumasi Metropolis, Ghana - 15 May 2018. <b>INTRODUCTION: Scientific research results are a necessary base for high quality nursing practice. The level of implementation of research in the clinical setting, including nurses' participation in and knowledge of research results, have gained considerable attention internationally. However, the remarkable international increase of such studies does not apply to the Ghanaian context. We therefore set out to evaluate the degree of involvement of nurses in research, as well as their utilization patterns of research findings in Ghana. Objectives: the study sought to investigate the proportion of nurses involved in clinical research as well as barriers for nurses' participation and utilization of research findings, within the Kumasi Metropolis area, Ghana. METHODS: a descriptive and analytical cross-sectional study design was used in this study. A 47 item questionnaire elicited data on 158 participants' demographics, the proportion and the barriers to participation, which was then analyzed using SSPS version 17 software. Qualitative interviews with key informants complemented quantitative survey data. In-depth interviews with nurse managers at the hospitals in focus was conducted and analyzed thematically. RESULTS: the study shows that 36.1% of the nurses, included in the study, had participated in research and only 25.3% of these had (knowingly) used specific research results in clinical practice. However, the level of research participation differed greatly between nurses working at different hospitals. Nurses' participation in clinical research was shown to be associated with their perception of benefit of research to practice as well as their understanding of time as a factor for them engaging in reading scientific articles. In addition, barriers associated with nurses' integration of research findings into the daily practice was their perceived lack of support from the collegium and their perception of research as not part of the nursing role. CONCLUSION: findings from the study suggest that there is a need to create institutional support to facilitate and encourage nurses' participation in research, yet also to formalize nurses' continuous professional development. This, could change nurses' attitudes towards research, and contribute to improving health care as it would increase nurses' role as agents for evidence based clinical practice.</b><br/> text/html 2018-07-22T00:12:51+01:00 Andreia de Oliveira Alves, Fred Bernardes Filho [Images in medicine] - Snail track ulcers of the tongue - 15 May 2018. <b>A 36-year-old male, heterosexual, complained of a 4-week history of ulceration in the tongue left margin. He denied previous treatment and any systemic diseases. The patient reported multiple sexual partners and episodes of unprotected sex in the past 12 months. Oral findings showed irregular erythematous patches on the dorsum of the tongue and erosive plaques on the tongue left margin with snail track pattern. On physical examination, cutaneous lesions were absent, and a difuse micropolyadenomegaly was noted. The laboratory tests were positive for TPHA VDRL (1/64), and negative for HIV, hepatitis B and C. The diagnosis of snail track ulcers of secondary syphilis was performed. The patient was treated with two doses of intramuscular benzathine penicillin (total dose of 4,800,000 U IM) with an interval of seven days between each dose. The tongue lesions completely disappeared after the two doses of the penicillin. Although very rarely oral ulceration may be the only manifestation of infection. The two principal oral features of secondary syphilis are mucous patches and maculopapular lesions. The oral features of secondary syphilis can be painless or painful erythematous lesions, grayish-white mucous patches, or irregular linear erosions termed snail track ulcers. The resurgence of syphilis is mainly due to sexual risk behaviors. This cases illustrates the need for include syphilis in the differential diagnosis of oral ulceration and how clinical features should be valued in clinical semiotics.</b><br/> text/html 2018-07-22T00:12:51+01:00 Aziz Bazine, Mohamed Fetohi [Images in medicine] - A giant cutaneous squamous cell carcinoma of the neck - 15 May 2018. <b>A 72-year-old man living in a mountain region presented with a painful giant tumor in the right laterocervical area, which had been observed 2 years previously and had started to grow rapidly over the past 6 months. The patient had a past history of heavy tobacco intake and suffered from arterial hypertension and diabetes mellitus. The physical examination revealed a bulky, exophytic tumor measuring 20 cm in length across the major axis, with a large ulcerated area, which bled easily and multiple fistulae discharged a malodorous secretion. The adjacent dermis was also infiltrated over several centimeters beyond the visible borders of the lesion. A biopsy of the tumor was performed. Histopathological examination revealed a well-differentiated squamous cell carcinoma. The computed tomography (CT) scan showed a heterogeneous mass in the right lateral region of the neck with irregular contours, a necrotic center and an infiltration of the internal jugular vein. The tumor appeared to adhere to the sternocleidomastoid muscle, the paralaryngeal soft tissues, the submandibular region, the parapharyngeal space and the parotid. No local adenopathy or distant metastatic disease was noted. The tumor was considered unresectable. The patient had an ECOG performance status rating of 2 and a normal renal function. Neoadjuvant chemotherapy with cisplatin and 5-fluorouracil was initiated. After the third cycle, the CT scan showed a progression of disease with increased-neck-mass size and appearance of pulmonary metastases. The general condition of the patient did not allow second-line chemotherapy and he died 1 month later.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ulrich Davy Kombila, Yacine Dia Kane, Fatimata Bintou Rassoule Mbaye, Ndeye Fatou Diouf, Waly Ka, Nafissatou Oumar Tour&eacute; [Case series] - Particularit&eacute;s radiologiques de la tuberculose pulmonaire &agrave; microscopie positive au Service de Pneumologie du Centre Hospitalier National Universitaire de FANN (CHNUF), Dakar (S&eacute;n&eacute;gal) - 09 May 2018. <b>L’objectif &eacute;tait de d&eacute;terminer les diff&eacute;rents aspects radiologiques de la tuberculose pulmonaire &agrave; microscopie positive. Il s’agissait d’une &eacute;tude r&eacute;trospective, analysant les clich&eacute;s de radiographies des patients atteints de tuberculose pulmonaire &agrave; microscopie positive entre le 15 Novembre 2015 et le 15 Mars 2016. Soixante-six dossiers r&eacute;pondant aux crit&egrave;res d’inclusion ont &eacute;t&eacute; s&eacute;lectionn&eacute;s, compos&eacute; de 81,8% des hommes. La moyenne d’&acirc;ge &eacute;tait de 37,5 ± 14,9 ans. Les diff&eacute;rentes l&eacute;sions parenchymateuses, &eacute;taient variables et domin&eacute;es par les infiltrats dans 84,8% (IC95%; 73,9 – 92,4%) des cas, suivi du syndrome alv&eacute;olaire dans 68,2% (IC95%; 55,5 – 79,1%) des cas. Elles &eacute;taient extensives dans 71,2% (IC95%; 58,7 – 81,7%) des cas et bilat&eacute;rales dans 45,4% (IC95%; 31,1 – 58,1%) des cas. Ces anomalies radiologiques survenaient dans 52,2% (IC95%; 36,9 – 67,1%) des cas chez les patients d&eacute;nutrie. Dans 22,7% (IC95%; 13,3 – 34,7%) des cas il s’agissait d’un second &eacute;pisode de tuberculose pulmonaire. La consommation r&eacute;guli&egrave;re de tabac a &eacute;t&eacute; retrouv&eacute;e chez 34,8% (IC95; 23,5 – 47,5%) des patients avec une consommation moyenne de 17PA (±11,3). Les rechutes tuberculeuses &eacute;taient plus fr&eacute;quentes chez les patients qui avaient fum&eacute;s versus les non-fumeurs respectivement dans 26,1% et 20,9% (p < 0,42). La s&eacute;rologie r&eacute;trovirale profil 1, &eacute;tait positive dans 7,6% des cas. A travers cette &eacute;tude, nous pr&eacute;conisons en zone d’end&eacute;mie tuberculeuse d’orienter la d&eacute;marche &eacute;tiologique vers la recherche d’une tuberculose pulmonaire devant des images radiologiques infiltratives associ&eacute;es ou non &agrave; des l&eacute;sions cavitaires chez un patient jeune, d&eacute;nutrie et &agrave; fortiori fumeur.</b><br/> text/html 2018-07-22T00:12:51+01:00 Zenab Alami, Touria Bouhafa, Abderrahmane Elmazghi, Khalid Hassouni [Case report] - Le lymphome malin Hodgkinien au cours de la grossesse; quelle modalit&eacute; th&eacute;rapeutique: &agrave; propos d’un cas et une revue de la litt&eacute;rature - 09 May 2018. <b>Bien que le lymphome malin Hodgkinien ou (maladie de Hodgkin) ne repr&eacute;sente que 10% de tous les lymphomes, c'est l'un des sous-types de lymphomes les plus communs diagnostiqu&eacute;s pendant la grossesse, en grande partie &agrave; cause de l'incidence maximale de la maladie qui co&iuml;ncide avec l'&acirc;ge de reproduction. La prise en charge d'une patiente enceinte atteinte d'une maladie de Hodgkin n&eacute;cessite une approche multidisciplinaire, ainsi qu'une communication efficace avec le patient et sa famille. L'objectif est d'optimiser les chances de gu&eacute;rison de la m&egrave;re tout en permettant l'accouchement d'un enfant en bonne sant&eacute;. Nous rapportant un cas rare d'une patiente enceinte diagnostiqu&eacute;e pour une maladie de Hodgkin &agrave; 17 semaines d'am&eacute;norrh&eacute;e.</b><br/> text/html 2018-07-22T00:12:51+01:00 Kadouri Youssef, Ousmane Nago Dembele, Ziani Idriss, Hachem Elsayegh, Ali Iken, Lounis Benslimane, Yassine Nouini [Report] - Le l&eacute;iomyosarcome de la vessie: &agrave; propos de 3 cas - 09 May 2018. <b>Le l&eacute;iomyosarcome de la vessie est une tumeur rare hautement maligne. Il survient aussi bien chez l'enfant que chez l'adulte avec une incidence maximale au-del&agrave; de 60 ans. Il semble atteindre pr&eacute;f&eacute;rentiellement le sexe masculin avec un sexe ratio 3/1. Sa pr&eacute;sentation clinique est non sp&eacute;cifique et domin&eacute;e par l'h&eacute;maturie. La r&eacute;section endoscopique de la vessie avec un examen anathomopathologique permet de poser le diagnostic. Le traitement du l&eacute;iomyosarcome de la vessie reste sujet &agrave; de nombreuses controverses du fait de la raret&eacute; des cas rapport&eacute;s dans la litt&eacute;rature. Cependant le traitement de choix semble &ecirc;tre une cystectomie totale pr&eacute;c&eacute;d&eacute;e d'une chimioth&eacute;rapie n&eacute;o-adjuvante lorsque l'&eacute;tat g&eacute;n&eacute;ral du patient le permet. Nous rapportons une s&eacute;rie de 3 cas de l&eacute;iomyosarcome v&eacute;sical qui ont &eacute;t&eacute; trait&eacute;s tous par une cystectomie totale avec des suites op&eacute;ratoires simple.</b><br/> text/html 2018-07-22T00:12:51+01:00 Abdelhafid El Marfi, Abdelghani Elayoubi, Mohamed El Idrissi, Mohamed Shimi, Abdelhalim El Ibrahimi, Abdelmajid Elmrini, Hassan Fokiladeh [Case report] - Infection et descellement d’une proth&egrave;se totale de la hanche par listeria monocytogenes - 09 May 2018. <b>Le recours aux proth&egrave;ses articulaires est de plus en plus fr&eacute;quent dans notre pratique courante. Une des complications les plus redout&eacute;es est l’infection, le plus souvent due &agrave; des germes de la flore cutan&eacute;e. Listeria monocytogenes &eacute;tant rarement &agrave; l’origine d’une telle infection, nous rapportons le cas d’un patient porteur d’une proth&egrave;se de hanche infect&eacute;e par ce germe: l’&eacute;volution a &eacute;t&eacute; favorable apr&egrave;s antibioth&eacute;rapie et changement de proth&egrave;se en un seul temps.</b><br/> text/html 2018-07-22T00:12:51+01:00 Charlotte Nguefack Tchente, Theophile Njamen Nana, Paul Nkemtendong Tolefac, Martin Hongieh Abanda, Francky Teddy Endomba Angong, Rita Frinue Tamambang, Gabin Ulrich Kenfack, Georges Nkwelle Mangala, Sagir Muhammad, Marie Solange Doualla, Eugene Belley Priso [Research] - Effects of phloroglucinol on the active phase of labour (EPAL trial): a single blinded randomised controlled trial in a tertiary hospital in sub-Sahara Africa - 09 May 2018. <b>INTRODUCTION: One of the most recognized factors of maternal and neonatal outcome pertaining to the peripartum period is the duration of labour. Finding a drug that will decrease the duration of labour with no effects on mother and foetus will be welcomed. Thereby in this study we aimed to evaluate the effects of phloroglucinol on the duration of the active phase of labour. METHODS: we did a single blinded placebo controlled randomised 1:1 parallel designed superiority trial between January and June 2017 in Douala general hospital. Participants greater than 18 years with singleton uncomplicated pregnancy who consented following randomisation, were administered either 80mg/8ml intravenous phloroglucinol or 8ml of sterile water when in active labour. The primary outcome was the duration of labour. Modified intention to treat analysis was done with the level of significance set at a p value of 0.05. RESULTS: 122 participants received the intervention. The mean total duration labour in the treatment and placebo group were 216.8 ± 38.7 and 358.5 ± 65.8 respectively (p value = 0.243). The mean duration of the active phase of labour in the treatment and placebo group were 183.0±35.6 and 316.0±52.2 respectively (p value = 0.046). The mean rate of cervical dilatation in the treatment and placebo group were 2.1 ± 0.4 and 1.3 ± 0.4 respectively (p value = 0.322). There was no difference in maternal and foetal outcomes between the two groups. CONCLUSION: phloroglucinol shortens the duration of active phase of labour by about 2 hours (42%). It is safe to mother and baby and does not cause adverse foetal or maternal outcomes.</b><br/> text/html 2018-07-22T00:12:51+01:00 Andreia de Oliveira Alves, Fred Bernardes Filho [Images in medicine] - Erucism due to cup moth - 08 May 2018. <b>A 12-year-old girl was assessed because of a 1-hour history of severe pruritus after contact with a cup moth (A). She has past history of anaphylactic shock to bee sting two years ago. The patient was sitting next to a mango tree and inadvertently put her left arm over a caterpillar. Physical examination revealed an erythematous infiltrated plaque with moderate swelling and an urticarial eruption with some excoriations on left upper limb (B, C); patient had a pulse rate of 78/min, blood pressure of 108/64 mmHg and respiratory rate of 15/min. The patient received prednisone 40 mg/day and loratadine 10mg/day for 5 and 10 days, respectively. Two weeks after the accident, on the final follow-up visit, the patient showed no late effects. Erucism, also called caterpillar dermatitis, is caused by envenomation by the larval or pupal stages of moths or butterflies. Caterpillars transmit their venom through urticating hairs, spines, or setae distributed over their bodies. Rash is the most common clinical manifestation and can range from a mild itching to a very painful sting. The lesions are provoked by caterpillar bristles filled with toxins that penetrate the skin. The bristles are hollow and when they enter the skin and break, toxins that contain thermolabile proteins, proteolytic enzymes and histamine are released. Treatment is supportive and includes washing the site with soap and water, applying cold water compresses, and administering topical or oral antihistamines or corticosteroids.</b><br/> text/html 2018-07-22T00:12:51+01:00 Chahdi Hafsa, Damiri Amal, Oukabli Mohamed, Abderrahman Al Bouzidi [Case report] - Une tumeur de la valve mitrale - 08 May 2018. <b>Le fibro&eacute;lastome papillaire est une tumeur cardiaque primitive b&eacute;nigne rare pouvant entra&icirc;ner des complications emboliques s&eacute;v&egrave;res. Nous rapportons un cas chez un homme de 69 ans. C’est dans le cadre du bilan &eacute;tiologique d’une dyspn&eacute;e que l’&eacute;chocardiographie transthoracique a montr&eacute; une masse sessile sur la petite valve mitrale. Cette masse a &eacute;t&eacute; excis&eacute;e chirurgicalement et analys&eacute;e histologiquement. Le diagnostic de fibro&eacute;lastome papillaire &eacute;tait alors confirm&eacute;.</b><br/> text/html 2018-07-22T00:12:51+01:00 Antoine Lamblin, Cl&eacute;ment Derkenne [Images in medicine] - A child with fever, cough and Lancisi’s sign - 08 May 2018. <b>An 8-year-old boy from a rural town in Chad was referred to the emergency department following a one-month history of fever, otitis media and left thigh osteoarthritis. Venous jugular examination showed prominent systolic pulsations, also called Lancisi's sign. A chest X-ray (A) showed a right pneumothorax, which was immediately drained, before incision and drainage of the left distal thigh osteoarthritis. A CT-scan showed multiple pulmonary abcesses (B). After transthoracic echocardiography (M-TurboTM, Sonosite® Inc, Bothwell, WA, USA), large vegetations were seen on the tricuspid valve (C) and right ventricular systolic pressure was elevated. There was severe tricuspid regurgitation. Microbiological analysis found methicillin-sensitive Staphylococcus aureus in blood cultures and bacteriological samples from the thigh. This case demonstrates a presentation of right-sided endocarditis with septic pulmonary emboli (SPE) responsible for a right pneumothorax. Prominent systolic pulsations of the jugular veins, or Lancisi's sign, are a manifestation of severe tricuspid regurgitation. They result from a retrograde blood flow in the right atrium due to tricuspid incompetence during systole. Pneumothorax, secondary to SPE, is rare and Staphylococci are the infectious pathogens in all reported cases of secondary pneumothorax due to SPE, characterized by pulmonary inflammation with peripheral necrosis and multiple small cavities which involves the pleura; it may progress into the subpleural tissues or fistulize in situ. In this case, targeted antibacterial therapy was initiated until day 42. A rapid clinical improvement was observed. A follow-up transthoracic echocardiograph was performed at 3 months and revealed a reduction in vegetative growth and mild tricuspid regurgitation sequela.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ihsane Mellouki, Khaoula Jellali, Adil Ibrahimi [Case series] - Les tumeurs du gr&ecirc;le: &agrave; propos de 27 cas - 08 May 2018. <b>Les tumeurs gr&eacute;liques repr&eacute;sentent 5% de l'ensemble des tumeurs du tractus digestif. Leur pronostic reste sombre vu le retard diagnostic d&ucirc; au manque de sp&eacute;cificit&eacute; des manifestations cliniques et &agrave; la difficult&eacute; d'exploration bien que d'important progr&egrave;s ont &eacute;t&eacute; fait sur le plan radiologique et endoscopique. Le but de ce travail est de pr&eacute;ciser les aspects endoscopiques et histologiques des tumeurs gr&eacute;liques. Il s’agit d’une &eacute;tude r&eacute;trospective descriptive men&eacute;e au Service d'H&eacute;pato-gastro-ent&eacute;rologie du CHU Hassan II de F&egrave;s sur une p&eacute;riode de 11 ans (2002-2012). Nous avons analys&eacute; les aspects &eacute;pid&eacute;miologiques, cliniques, endoscopiques et histologiques. 27 cas avaient &eacute;t&eacute; collig&eacute;s. L'&acirc;ge moyen &eacute;tait de 48 ans [21-80ans] avec une pr&eacute;dominance masculine (H/F: 2,4). La tumeur avait &eacute;t&eacute; r&eacute;v&eacute;l&eacute;e par des m&eacute;l&eacute;nas chez 55%, une masse abdominale chez 15% et un syndrome de Koenig ou syndrome occlusif chez 11%. Un ant&eacute;c&eacute;dent de maladie cœliaque avait &eacute;t&eacute; retrouv&eacute; dans un cas. L’ent&eacute;roscanner avait pu pr&eacute;ciser le si&egrave;ge de la tumeur chez 18 cas. L’ent&eacute;roscopie pouss&eacute;e pour les tumeurs proximales et l’ent&eacute;roscopie double ballonnets pour les tumeurs &agrave; localisation distale avaient &eacute;t&eacute; r&eacute;alis&eacute;es chez 8 patients (30%), l'aspect endoscopique avait r&eacute;v&eacute;l&eacute; une l&eacute;sion ulc&eacute;r&eacute;e chez 37,5%, ulc&eacute;r&eacute;e st&eacute;nosante chez 50% et ulc&eacute;ro-bourgeonnante st&eacute;nosante chez 25%. Dans 18 cas, c’est la chirurgie avec &eacute;tude anatomopathologique de la pi&egrave;ce op&eacute;ratoire qui avait permis de poser le diagnostic. Le type histologique &eacute;t&eacute; domin&eacute; par les tumeurs stromales 14 cas (51%), suivi des ad&eacute;nocarcinomes 5 cas (18,5%), 4 cas (15%) de LMNH de type B, un cas de carcinome neuroendocrine j&eacute;junal. Les tumeurs gr&eacute;liques sont rares mais de pronostic sombre, les m&eacute;thodes actuelles d'imageries (Ent&eacute;roscanner et Ent&eacute;ro IRM) coupl&eacute;es aux examens endoscopiques, pr&eacute;cis&eacute;ment l’ent&eacute;roscopie double ballonnet, devraient permettre un diagnostic plus pr&eacute;coce et une diminution de la mortalit&eacute;.</b><br/> text/html 2018-07-22T00:12:51+01:00 Youssef Zemmez, Naoufal Hjira [Images in medicine] - K&eacute;ratoacanthome de l’avant-bras gauche - 08 May 2018. <b>Une femme &acirc;g&eacute;e de 54 ans ayant consult&eacute; pour une tum&eacute;faction de l'avant-bras gauche apparaissant huit semaines auparavant et augmentant rapidement de volume. L'examen clinique retrouvait une l&eacute;sion cutan&eacute;e ulc&eacute;ro-bourgeonnante de 2cm de grand axe, indolore et de couleur violac&eacute;e (A). Une simple biopsie a &eacute;t&eacute; r&eacute;alis&eacute;e. L'examen histologique avait montr&eacute; un &eacute;pith&eacute;lium hyperplasique dysk&eacute;ratosique et d&eacute;sorganis&eacute; avec pr&eacute;sence d'atypies cytonucl&eacute;aires &eacute;voquant un processus tumoral malin mais vu l'absence d'infiltration du chorion et la pr&eacute;sence d'une hyperk&eacute;ratose, le diagnostic d'un k&eacute;ratoacanthome a &eacute;t&eacute; soulev&eacute; et la r&eacute;alisation d'une ex&eacute;r&egrave;se de la tumeur a &eacute;t&eacute; indiqu&eacute;e pour confirmer ou infirmer ce diagnostic. L'&eacute;tude histologique r&eacute;v&eacute;lait une l&eacute;sion tumorale saillante de nature &eacute;pith&eacute;liale circonscrite par deux esp&egrave;ces de becs lat&eacute;raux limitant un crat&egrave;re surmont&eacute; d'importantes strates de k&eacute;ratine. L'&eacute;pith&eacute;lium bordant ce crat&egrave;re est hyperplasique. La base du crat&egrave;re comporte des projections papillomateuse in&eacute;gales ainsi que quelques trav&eacute;es cellulaires qui semblent effilocher dans le derme sous-jacent. Celles-ci sont compos&eacute;es de cellules basophiles montrant un certain degr&eacute; d'anomalies cytonucl&eacute;aires dispos&eacute;es en une ou deux assises p&eacute;riph&eacute;riques et en leur centre de cellules &eacute;osinophiles, k&eacute;ratinis&eacute;es, d'aspect homog&egrave;ne, quelques mitoses ainsi que de nombreux globes corn&eacute;s le plus souvent compl&egrave;tement k&eacute;ratinis&eacute;s (B). Le diagnostic de keratoacanthome a &eacute;t&eacute; retenu. Le k&eacute;ratoacanthome est une entit&eacute; anatomo-clinique bien d&eacute;finie, mais qui peut &ecirc;tre tr&egrave;s difficile &agrave; distinguer du carcinome &eacute;pidermo&iuml;de, dont l'incidence est trois fois sup&eacute;rieure. La distinction entre ces deux l&eacute;sions est n&eacute;cessaire car la prise en charge est diff&eacute;rente.</b><br/> text/html 2018-07-22T00:12:51+01:00 Cinzia Casu, Luca Vigan&ograve; [Images in medicine] - Particular shape of the tongue and benign migratory glossitis - 07 May 2018. <b>A 33-year-old male patient comes to our observation for a slight discomfort in the left side of the tongue. The patient reported good general health and that he have sometimes taken benzodiazepine in periods of stress. The dental abrasion showed the presence of bruxism. On an objective examination we could notice the simultaneous presence of a "toothed tongue" and a slightly area of erosion on the left side of the dorsal tongue, with an irregular white halo around it. This lesion, appeared from some days, is symptomatic. The diagnosis is compatible for benign migratory glossitis. The patient claimed to have never suffered of skin diseases strongly related to migratory glossitis. It is possible that the bruxism may have determined the presence of that lateral tongue shape and that stress may be the main cause of the appearance of migratory glossitis. The simultaneous presence of the two conditions has never been documented in the scientific literature and we do not exclude that there may be a correlation to the genesis of both lesions. Sometimes the presence of a tongue with this morphology could be the result of a trauma or a surgery. The lingual erosion can be placed in differential diagnosis with a heat burn or a chemical burn.</b><br/> text/html 2018-07-22T00:12:51+01:00 Krishna Mohan Baradhi, Thao Tran, Penchala Swamy Mittadodla [Case report] - ’Malignant’ hypertension from hyperaldosteronism: a case report - 04 May 2018. <b>Adrenocortical carcinomas (ACC) are rare with an incidence of 0.7-2 per million population per year and account for only 0.05%-2% of all malignant tumors. While majority of the functional ACC present as Cushing syndrome, recurrent hyperaldosteronism from metastatic ACC is exceedingly rare. We describe a 67-year old female presented with hypertensive urgency & hypokalemia as a result of hyperaldosteronism from an 8-cm right ACC. She underwent a radical right nephrectomy with adrenalectomy that normalized her blood pressure. However, a few years later she presented again with resistant hypertension from hyperaldosteronism, raising the suspicion of recurrence of ACC. A contrast-enhanced CT scan showed a normal left adrenal gland but revealed pulmonary metastases of ACC based on a lung biopsy. Chemotherapy was complicated with side effects leading to refusal of further chemotherapy, henceforth requiring high dose of spironolactone for blood pressure control. Despite curative surgery, metastatic functional ACC should be considered in patients presenting with secondary hypertension from recurrent hyperaldosteronism, due to its high recurrence rate. Besides standard cancer surveillance after a curative surgery, meticulous monitoring of blood pressure is a simple yet crucial way to detect cancer recurrence early.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ahmed Anas Guerboub, Souad Moussaoui, Jad Issouani, Yassine Errahali, Ghizlaine Belmejdoub [Case report] - X-linked vitamin D-resistant rickets: 12 years of follow-up - 04 May 2018. <b>Rickets are abnormalities of mineralization that can lead to bone fractures and deformities. Vitamin-resistant rickets is defined as any rickets not prevented by regular, early and prolonged administration of vitamin D and not cured by a sufficient total dose. The aim of our work is to describe the clinical, paraclinical and therapeutic aspects of X-linked hypophosphatemic rickets (XLHR), which is the most common cause of hereditary rickets and on the other hand to highlight the interest not only of the early care but also the regular long-term monitoring of these children.</b><br/> text/html 2018-07-22T00:12:51+01:00 Fatima Zahra Farhane, Zineb Alami, Touria Bouhafa, Abderrahmane Elmazghi, Khalid Hassouni [Case report] - Primary squamous cell carcinoma of endometrium: case report and literature review - 04 May 2018. <b>In this paper, we report a case of primary squamous cell carcinoma of the endometrium (PSCCE) with a literature review. A 64-year-old woman, was admitted because postmenopausal bleeding. The gynecological exam found bleeding from the endocervix. The pelvic ultrasound objectified uterine regular contours, endometrial thickened was 10 mm, the presence of an intra cavitary lesion mesuring 56/70 mm. The diagnostic hysteroscopy revealed a whitish appearance taking all the uterine cavity making evoke a tumor of the endometrium. Pelvic MRI showed a tumor limited to the uterine corpus endometrium (invasion by more than 50% of the myometrium) without invasion of the cervix. Radical hysterectomy, bilateral salpingo-oophorectomy, and lymph nodes dissection were performed. Grossly, the endometrial carcinoma was polypoid tumor occupying the entire uterine cavity. Histologically, the diagnosis of SCC was retained. No adenocarcinoma element was recognized. Neither squamous metaplasia nor dysplasia was recognized. No ectopic cervical tissue was found. The SCC was found to invade into deeper one half of the myometrium. No tumor cells were seen in other sites including the cervix, ovaries, parametres, and lymph nodes. The patients was FIGO 2009 stage IB (pT1B, N0), and was treated with adjuvant radiation. The patient had a disease progression in the pelvis 3 months after the irradiation. We reported a case of PSCCE which can help to enrich the literature for the treatment and prognosis of this disease.</b><br/> text/html 2018-07-22T00:12:51+01:00 Olfa Zoukar, Anis Haddad, Amira Daldoul, Sonia Zaied, Amina Ben Salem, Ines Zouari, Raja Faleh [Case report] - M&eacute;tastases g&eacute;nitales du cancer du sein: &eacute;tude de 3 cas et revue de la litt&eacute;rature - 04 May 2018. <b>Le cancer du sein est le cancer le plus fr&eacute;quent chez la femme, et son pronostic d&eacute;pend en grande partie de l'existence de m&eacute;tastases. Le foie, le squelette et les poumons en sont les sites les plus fr&eacute;quents, alors que les m&eacute;tastases g&eacute;nitales semblent plus rares et moins connues. La d&eacute;couverte d'une masse ovarienne chez une femme pr&eacute;sentant un ant&eacute;c&eacute;dent de cancer du sein pose le probl&egrave;me de son origine primitive ou secondaire. La fr&eacute;quence rapport&eacute;e dans la litt&eacute;rature des m&eacute;tastases ovariennes est d'environ 20 &agrave; 30 %. Cependant, lorsque l'on d&eacute;couvre une masse ovarienne chez une femme atteinte de cancer du sein, il s'agit trois fois plus souvent d'une tumeur ovarienne primitive que d'une m&eacute;tastase. La localisation ut&eacute;rine cervicale ou corpor&eacute;ale est encore plus rare. Leur diagnostic est souvent tardif, en raison de leur latence clinique; l'&eacute;chographie, notamment par voie endovaginale et coupl&eacute;e au Doppler couleur, et le Frottis cervico-ut&eacute;rin doivent &ecirc;tre r&eacute;alis&eacute;s de premi&egrave;re intention sachant que leur rendement pour leur d&eacute;pistage des masses ovariennes semble tr&egrave;s faible. L'augmentation des marqueurs tumoraux CA 15-3 et ACE doit conduire &agrave; la recherche de m&eacute;tastases, mais ne fournit pas d'orientation diagnostique vers un site m&eacute;tastatique pr&eacute;cis. Enfin, c'est l'examen anatomopathologique qui permettra de poser le diagnostic avec certitude. Les auteurs rapportent 3 observations de m&eacute;tastases g&eacute;nitales de cancer primitif mammaire (deux ovariennes et une cervicale ut&eacute;rine) soulignent l'int&eacute;r&ecirc;t de l'examen g&eacute;nital pr&eacute;cis et r&eacute;gulier dans la surveillance des cancers du sein et discutent les facteurs pr&eacute;dictifs de leur survenue.</b><br/> text/html 2018-07-22T00:12:51+01:00 Matthew Olumuyiwa Bojuwoye, Abdulfatai Bamidele Olokoba, Olumuyiwa Ayotunde Ogunlaja, Sulaiman Olayide Agodirin, Olatunde Kazeem Ibrahim, Kenechukwu Chukwuemeka Okonkwo, Aminu Mansa Aliyu [Case report] - Familial adenomatous polyposis syndrome with colorectal cancer in two Nigerians: a report of two cases and review of literature - 04 May 2018. <b>Familial adenomatous polyposis syndrome is a rare condition characterized by the presence of numerous adenomatous polyps in the gastrointestinal tract and associated with risk for colorectal cancer. The disease is scarcely reported in Nigeria and this is the index report in Ilorin. Two cases were clinically diagnosed in our facility. They both presented with gastrointestinal bleeding and numerous rectal and colonic polyps were identified at colonoscopy. Histological examination of the polyps in the both cases revealed features in keeping with adenomatous polyps. This report highlights the occurrence of this precancerous condition.</b><br/> text/html 2018-07-22T00:12:51+01:00 Saheed Gidado, Emmanuel Awosanya, Suleiman Haladu, Halimatu Bolatito Ayanleke, Suleman Idris, Ismaila Mamuda, Abdulaziz Mohammed, Charles Akataobi Michael, Ndadilnasiya Endie Waziri, Patrick Nguku [Research] - Cholera outbreak in a na&iuml;ve rural community in Northern Nigeria: the importance of hand washing with soap, September 2010 - 04 May 2018. <b>INTRODUCTION: Cholera outbreaks in rural communities are associated with high morbidity and mortality. Effective interventions to control these outbreaks require identification of source and risk factors for infection. In September, 2010 we investigated a cholera outbreak in Bashuri, a cholera na&iuml;ve rural community in northern Nigeria to identify the risk factors and institute control measures. METHODS: We conducted an unmatched case-control study. We defined a case as any resident of Bashuri community two years and above with acute watery diarrhea with or without vomiting and a control as any resident two years and above without acute watery diarrhea and vomiting. We recruited 80 hospital-based cases and 80 neighborhood controls. We collected and analyzed data on demographic characteristics, clinical information and risk factors. Laboratory analysis was performed on 10 stool samples and 14 open-well samples. RESULTS: Mean age was 29 years (± 20 years) for cases and 32 years (± 16 years) for controls; 38 (47.5%) of cases and 60 (75%) of controls were males. Compared to controls, cases were less likely to have washed hands with soap before eating (age-adjusted odds ratio (AAOR) = 0.27, 95% confidence interval (CI): 0.10 - 0.72) and less likely to have washed hands with soap after using the toilet (AAOR = 0.34, 95% CI: 0.15-0.75). Vibrio cholerae O1 was isolated from six stool samples but not from any open-well samples. CONCLUSION: Unhygienic hand washing practices was the key risk factor in this outbreak. We educated the community on personal hygiene focusing on the importance of hand washing with soap.</b><br/> text/html 2018-07-22T00:12:51+01:00 Awalou Mohaman Djibril, Edem Komi Mossi, Agbeko Kodjo Djagadou, Abago Balaka, Toyi Tchamdja, Razak Moukaila [Research] - Pied diab&eacute;tique: aspects &eacute;pid&eacute;miologique, diagnostique, th&eacute;rapeutique et &eacute;volutif &agrave; la Clinique M&eacute;dico-chirurgicale du CHU Sylvanus Olympio de Lom&eacute; - 03 May 2018. <b>INTRODUCTION: Le pied diab&eacute;tique est une complication fr&eacute;quente et grave du diab&egrave;te. Le but de cette &eacute;tude est de d&eacute;terminer le profil &eacute;pid&eacute;miologique, diagnostique, th&eacute;rapeutique et &eacute;volutif du pied diab&eacute;tique en milieu hospitalier &agrave; Lom&eacute; (Togo). METHODS: Etude r&eacute;trospective descriptive r&eacute;alis&eacute;e du 1er janvier 2011 au 31 d&eacute;cembre 2015 (5 ans) &agrave; la clinique m&eacute;dico-chirurgicale du CHU Sylvanus Olympio de Lom&eacute;. Etaient inclus dans l’&eacute;tude tout patiente hospitalis&eacute;e pendant la p&eacute;riode d’&eacute;tude pour pied diab&eacute;tique. RESULTATS: la pr&eacute;valence du pied diab&eacute;tique &eacute;tait de 12,90%. L’&acirc;ge moyen &eacute;tait de 60,74 ans (extr&ecirc;mes: 39 ans et 86 ans). Le sexe masculin pr&eacute;dominait avec un sexe ratio de 1,38. Le diab&egrave;te de type 2 &eacute;tait retrouv&eacute; chez 88,70% des patients. La dur&eacute;e moyenne d’&eacute;volution du diab&egrave;te &eacute;tait de 11,67 ans (extr&ecirc;me : 1 an et 24 ans). Le point de d&eacute;part des l&eacute;sions du pied &eacute;tait un traumatisme g&eacute;n&eacute;rant une plaie surinfect&eacute;e dans 70,97 % des cas. La gangr&egrave;ne (61,29%) et la n&eacute;crose isch&eacute;mique (12,90%) &eacute;taient les principales l&eacute;sions retrouv&eacute;es. Le principal facteur &eacute;tiopathog&eacute;nique retrouv&eacute; &eacute;tait la neuropathie (61,29). La majorit&eacute; des l&eacute;sions (61,29%) &eacute;tait class&eacute;e grade 4 et 5 de Wagner et 51,62% des patients avait b&eacute;n&eacute;fici&eacute; d’une amputation du membre pelvien. CONCLUSION: Les l&eacute;sions du pied sont fr&eacute;quentes chez les patients diab&eacute;tiques &agrave; Lom&eacute;. La lutte contre ce fl&eacute;au passe par l’&eacute;ducation des patients et du personnel soignant et par une prise en charge multidisciplinaire et concert&eacute;e.</b><br/> text/html 2018-07-22T00:12:51+01:00 Adil Arrob, Mohammed Kamal Fiqhi, Abibou N’diaye, Karim El Khatib, Abdeljalil Abouchadi [Case report] - Rhabdomyosarcome cranio-facial de l’adulte: un cas de mouvais pronostic - 03 May 2018. <b>Le rhabdomyosarcome est la tumeur m&eacute;senchymateuse la plus fr&eacute;quente chez l'enfant et l'adolescent. Il repr&eacute;sente 60 &agrave; 70% des tumeurs m&eacute;senchymateuses et environ 5% de l'ensemble des tumeurs solides &agrave; ces &acirc;ges. Pr&egrave;s de la moiti&eacute; des rhabdomyosarcomes surviennent au niveau de la t&ecirc;te et du cou. Nous rapportons le cas d'un rhabdomyosarcome agressif &agrave; localisation temporo-pari&eacute;tale. Chez un jeune adolescent de 20 ans avec une forme histologique nouvelle.</b><br/> text/html 2018-07-22T00:12:51+01:00 Ikenna Desmond Ebuenyi, Soumitra Sudip Bhuyan, Luchuo Engelbert Bain [Commentary] - Zika Virus infection and microcephaly: anxiety burden for women - 03 May 2018. <b>The re-emergence of Zika virus in Brazil and other contiguous countries is a source of anxiety for pregnant women on account of its association with microcephaly. Adverse pregnancy outcome has huge mental health implications. It is essential for health providers to incorporate psychosocial care as part of pre and postnatal care for women in all countries affected by the Zika virus infection.</b><br/> text/html 2018-07-22T00:12:51+01:00 Nouha Zerkaoui [Images in medicine] - Colobome irien bilat&eacute;ral - 02 May 2018. <b>Les colobomes oculaires cong&eacute;nitaux sont dus &agrave; un d&eacute;faut de fermeture de la fissure fœtale lors de l’organog&eacute;n&egrave;se. L’atteinte oculaire pouvant &ecirc;tre variable allant d’une simple fente irienne &agrave; une atteinte plus s&eacute;v&egrave;re du p&ocirc;le post&eacute;rieur (colobome du nerf optique, de la choro&iuml;de, de la r&eacute;tine). Nous allons rapporter le cas d’un colobome typique irien bilat&eacute;ral isol&eacute;. Il s’agit d’une femme de 55 ans qui lors d’un examen ophtalmologique fit la d&eacute;couverte d’un colobome typique irien infero-nasal sans atteinte cristallinienne ni atteinte du p&ocirc;le post&eacute;rieur.</b><br/>