Pan african Medical Journal - Volume 29 Pan african Medical Journal. Volume 29 2018-02-23T23:59:01+01:00 pamj logo text/html 2018-02-24T07:59:01+01:00 Marcel Mbeko Simaleko, Jean De Dieu Longo, Serge Magloire Camengo Police, G&eacute;rard Gr&eacute;senguet, Ralph Sydney Mboumba Bouassa, Danielle Piette, Beatrice Gulbis, Laurent B&eacute;lec [Research] - Persistent high-risk behavior and escalating HIV, syphilis and hepatitis B incidences among men who have sex with men living in Bangui, Central African Republic - 23 February 2018. <b>INTRODUCTION: HIV in sub-Saharan Africa remains a great concern in men who have sex with men (MSM). Intervention on MSM is a key strategy to control the burden of HIV among this population. Herein we assessed the effect of 2 years of HIV testing and counseling on risk-tacking and HIV and STI incidences among MSM living in Bangui in the Central African Republic. METHODS: the incidences of HIV, syphilis and hepatitis B and the sexual behavior characteristics were assessed at inclusion and after 2 years of follow up in the prospective MSM cohort. RESULTS: 99 MSM were included and followed up during 2 years. The mean age of study MSM was 24 years (range, 14-39); among those, the majority was single (84.8%) and unemployed (33.3%) or students (23.9%). The majority (up to 80%) were living in only 4 (out of 10) neighboring district of Bangui. Insertive anal intercourse showed significant decrease from 54% at inclusion to 46% after 2 years of follow up (P < 0.001). In contrast, we observed slight increase in receptive anal intercourse (60% versus 66%) and oral sex (70% versus 74%), but the difference did not reach statistical significance. Finally, the prevalences of HIV, syphilis and hepatitis B increased significantly from 29% to 41%, 12% to 21% and 14% to 23%, respectively. CONCLUSION: these observations indicate that medical care and counseling on MSM does not provide significant changes in risk-taking, whereas the incidences of HIV, syphilis and hepatitis B remained high. Innovative interventions should be conceived for the MSM population living in Bangui.</b><br/> text/html 2018-02-24T07:59:01+01:00 Idris Abiodun Adedeji, Hamza Mustapha Ahmed, Abdulazeez Olalekan Tella, Mohammad Farouk Bashir, Yusuf Aliyu Saliu [Case report] - Hereditary multiple exostoses and porencephaly in a Nigerian child: a case report - 23 February 2018. <b>Hereditary multiple exostoses (HME) is a rare condition that is characterised by the outgrowth of bony swellings, usually from the growth ends of long bones. It is autosomal dominant, and may result in debilitating deformities. Porencephaly on the other hand is a cystic degeneration of the brain that is associated with the development of encephalomalacia. There is no established link between HME and porencephaly. This case report describes a seven year old female that has features of coexisting HME and porencephaly. She presented with afebrile seizures, learning impairment, stunted growth, macrocephaly and multiple bony swellings. Similar bony swellings were observed in the mother and the sibling of the index case. The coexistence of HME and porencephaly is rarely encountered in clinical practice. This presentation should stimulate the search for a possible link, which may perhaps herald the discovery of a new syndrome.</b><br/> text/html 2018-02-24T07:59:01+01:00 Djidjoho Sonou, L&eacute;opold Codjo, Murielle Hounkponou, Philippe Mahouna Adjagba, Prudence Wachinou, Rosaire Bognon, Corine Hou&eacute;hanou-Sonou, Diane Yam&eacute;ogo, Jeanne Sacca, Martin Hou&eacute;nassi [Research] - D&eacute;terminants de l’insuffisance cardiaque aigu&euml; au cours de l’infarctus du myocarde - 23 February 2018. <b>INTRODUCTION: l’objectif principal &eacute;tait d’&eacute;tudier les facteurs associ&eacute;s &agrave; la survenue de l’insuffisance cardiaque aigu&euml; (ICA) chez les patients hospitalis&eacute;s pour un infarctus du myocarde (IDM) au Centre National Hospitalier Universitaire de Cotonou. METHODES: au cours d’une &eacute;tude r&eacute;trospective descriptive men&eacute;e de janvier 2011 &agrave; d&eacute;cembre 2013, ont &eacute;t&eacute; &eacute;tudi&eacute;s chez ces patients la fr&eacute;quence de l’ICA, les facteurs associ&eacute;s &agrave; sa survenue et la mortalit&eacute; hospitali&egrave;re. RESULTATS: 70 patients ont &eacute;t&eacute; inclus, d’&acirc;ge moyen &eacute;gal &agrave; 58,39 ans, dont 67,14% d’hommes. L’ICA a &eacute;t&eacute; diagnostiqu&eacute;e dans 47,14% des cas. Les facteurs identifi&eacute;s associ&eacute;s &agrave; sa survenue &eacute;taient l’&acirc;ge avanc&eacute;, l’atteinte &eacute;lectrocardiographique &eacute;tendue et les comorbidit&eacute;s telles que les infections, l’an&eacute;mie et l’insuffisance r&eacute;nale. 7,46% des patients &eacute;taient d&eacute;c&eacute;d&eacute;s durant l’hospitalisation soit 12,5% en cas d’ICA et 2,86% en l’absence d’ICA. Des r&eacute;sultats similaires ont &eacute;t&eacute; rapport&eacute;s par de nombreuses publications ant&eacute;rieures. CONCLUSION: l’ICA est un facteur de mauvais pronostic dans l’IDM. Une revascularisation myocardique rapide et le traitement ad&eacute;quat des comorbidit&eacute;s et des complications rythmiques permettront d’am&eacute;liorer le pronostic des patients.</b><br/> text/html 2018-02-24T07:59:01+01:00 Besri Soukaina, Kenouni Houria, Barkat Amina [Case report] - Syndrome de Prune Belly: un cas particulier - 23 February 2018. <b>Le Syndrome de Prune Belly (PBS) est un syndrome anatomo-radiologique extr&ecirc;mement rare qui associe une aplasie des muscles de la paroi ant&eacute;rieure de l'abdomen, des dilatations des voies urinaires et des malformations testiculaires, formant ainsi la triade classique du syndrome. Toutefois, Jusqu'&agrave; 75% des patients pr&eacute;sentant un PBS pr&eacute;sentent des malformations pulmonaires, squelettiques, cardiaques et gastro-intestinales. Nous rapportons le cas d'un nouveau-n&eacute; de sexe f&eacute;minin n&eacute; &agrave; terme, de m&egrave;re diab&eacute;tique, chez qui l'examen clinique &agrave; la naissance retrouve une hypoplasie des muscles de la paroi abdominale gauche ainsi qu'un pied bot et une luxation cong&eacute;nitale de la hanche du m&ecirc;me c&ocirc;t&eacute;. L'hypoplasie des muscles de la paroi abdominale a &eacute;t&eacute; confirm&eacute;e l'&eacute;chographie abdominale et la Tomodensitom&eacute;trie abdominale, des malformations cardiaques ont &eacute;t&eacute; &eacute;galement retrouv&eacute;es &agrave; l'&eacute;chographie Trans thoracique. L'&eacute;volution peut &ecirc;tre tr&egrave;s variable allant du mort-n&eacute; par dysplasie r&eacute;nale et respiratoire majeure &agrave; l'enfant pratiquement normal. Tout cela explique la grande diversit&eacute; d'opinions sur l'attitude &agrave; adopter face &agrave; ce syndrome.</b><br/> text/html 2018-02-24T07:59:01+01:00 Dilek Yilmaz, Asli Akyol Gurses, Koray Akkan, Yusuf Oner, Erhan Ilgit, Baran Onal, Bijen Nazliel [Case report] - Isolated abducens palsy of advanced age: a rare presentation of dural carotid cavernous fistula: a case report - 23 February 2018. <b>Abducens palsy is the most common isolated cranial nerve palsy due to its long peripheral course. Multiple anatomical relationships, particularly within the cavernous sinus and orbita, make the nerve vulnerable. 67 year-old female patient was admitted with worsened headache and lateral gaze restriction of the left eye, which appeared recently. She had no prior history of trauma. Prominent appearance of the left cavernous sinus on cranial magnetic resonance imaging, raised the need of digital substraction angiography which revealed the presence of bilateral type D dural arteriovenous fistula of cavernous sinuses. Cavernous sinus pathologies, which are usually known to manifest with multiple ocular motor palsies because of the close relationship between 3rd, 4th and 6th nerves inside, might rarely present with isolated abducens palsy. The clinician should pay particular attention to headache in such kind of patients and dural carotid-cavernous fistula should be taken into account, even in the absence of previous trauma history.</b><br/> text/html 2018-02-24T07:59:01+01:00 Fred Bernardes Filho, Rodolfo Mendes Queiroz [Images in medicine] - Elderly woman with painless hardened umbilical nodule - 22 February 2018. <b>An 87-year-old woman presented to the emergency room with 3-day history of severe abdominal pain, gross abdominal distention and absolute constipation, in addition to mental confusion and lowering of consciousness level in the last 12 hours. She had past history of appendectomy and left oophorectomy 40 years ago. Patient's daughter reported a painless hardened nodule in the umbilical region for 45 days. The umbilicus nodule had been diagnosed as an umbilical hernia by the general practitioner and the patient was awaiting outpatient evaluation by a general surgeon. Examination revealed a blood pressure of 140/86 mmHg, a heart rate of 108 beats/min, and oxygen saturations of 96% on room air; positive findings included marked abdominal distension, generalized abdominal tenderness without peritonitis, tinkling bowel sounds and a painless erythematous-umbilical nodule measuring 2.2x1.8cm (A). Laboratory testing was remarkable for elevated white blood cells at 15,180/mm3, C-reactive protein of 66.2 mg/dl, and serum CA125 of 139.9 Units/ml. Computed tomography scan of the abdomen and pelvis showed ovarian mass with extrinsic compression of intestinal loops with significant dilatation upstream of the obstruction point; an umbilical nodule was present (B, C). In view of patients with acute abdominal condition exploratory laparotomy was performed and intraoperatively moderate ascites, severe intestinal loops distension and a large and unresectable ovarian mass were observed. Ascitic fluid analysis was positive for atypical cells and histopathology of the umbilical nodule showed solid low-grade carcinoma with numerous atypical mitoses, karyorrhexis and abundant necrosis. After the discussion with patient's caregivers, palliative care was started and unfortunately the patient died 14 days after the surgery. Sister Mary Joseph nodule is an eponym to describe cutaneous metastasis of an underlying abdominal malignancy to the umbilical cicatrix. This ominous finding is uncommon although accurate sign of advanced primary visceral cancer.</b><br/> text/html 2018-02-24T07:59:01+01:00 Mamoudou Sawadogo, Salam Ouedraogo, Alassane Drave, Souleymane Ouedraogo, Hamado Kafando, Sayouba Tinto, Anatole Jean Innocent Ouedraogo, Alexandre Stanislas Korsaga, Mohamed Tall, Songahir Christophe Da [Case report] - Clinical case: giant solitary neurofibroma of the thigh - 22 February 2018. <b>The solitary neurofibroma, a benign ectodermal tumor reaching the nerve sheaths, is very rare both in its frequency and its location. Its diagnosis is histo-immunological and its treatment, surgical, consists of a complete resection of the mass due to a degenerative risk tumor. The authors report the case of a 36-year-old patient, admitted for a large tumor of the anterior aspect of the right thigh. Ultrasound and CT revealed the presence of a soft tissue tumor measuring 28 x 15 cm. The resection was performed without damage to the adjacent noble elements. The tumor weighed 7 kg. The histology found a neurofibroma. Benign tumors of the nerve sheath are rare. The neurofibroma is a benign tumor, which can occur in two forms: solitary in young adults or multiple in the context of a Recklinghausen disease. The majority of cases of giant neurofibromatous tumors reported, were almost always isolated localization. TDM or echo-guided biopsy is the only way to confirm preoperative histological diagnosis. The treatment is surgical. However, the tumor infiltrates the fasciculi of the nerve along its course, which could make its resection difficult and dangerous. Thigh localization of the neurofibroma is rare. Complete excision with negative margins is the treatment of choice. In the case reported, one year after surgery, the patient was in good general condition with normal locomotor function.</b><br/> text/html 2018-02-24T07:59:01+01:00 Lahcen Arjdal, Salek Eddafi,Youssef Rochdi, Hassan Nouri, Lahcen Aderdour, Abdelaziz Raji [Case report] - Abc&egrave;s de la cloison nasale: &agrave; propos de trois cas - 21 February 2018. <b>L'abc&egrave;s de la cloison nasale est une affection rare mais grave du fait des complications qu'il peut engendrer s'il est mal pris en charge. Il correspond &agrave; la pr&eacute;sence de pus entre le cartilage septal et son mucop&eacute;richondre et/ou l'os septal et son mucop&eacute;rioste. Nous rapportons trois cas de patients pris en charge au niveau de notre structure. Nous profitons de ces nouveaux cas pour rappeler les diff&eacute;rentes &eacute;tiologies ainsi que la prise en charge qui doit &ecirc;tre rapide et ad&eacute;quate pour pr&eacute;server le pronostic fonctionnel et esth&eacute;tique engag&eacute; par cette affection.</b><br/> text/html 2018-02-24T07:59:01+01:00 Driss Hanine, Omar Dalero, Hafssa Thaichi, Youness El Azzaoui, Mohamed Rami, Mohamed Amine Bouhafs, Rachid Belkacem [Case report] - Fusion spl&eacute;nogonadique: &agrave; propos d’un cas exceptionnel - 20 February 2018. <b>La fusion spl&eacute;no-gonadique est une anomalie cong&eacute;nitale rare. Le diagnostic pr&eacute;op&eacute;ratoire est difficile et pourrait s'appuyer sur la scintigraphie au techn&eacute;tium 99m. Dans la plupart des cas, le nodule spl&eacute;nique peut &ecirc;tre s&eacute;par&eacute; facilement de la gonade ou des &eacute;l&eacute;ments du cordon spermatique. En cas de doute, un examen histologique extemporan&eacute; peut &ecirc;tre utile pour &eacute;viter une orchidectomie abusive. Il s'agit d'une l&eacute;sion b&eacute;nigne qui reste &agrave; diff&eacute;rencier d'une tumeur testiculaire. Nous rapportons l'observation d'un gar&ccedil;on de 4 ans, chez qui une masse scrotale gauche a conduit &agrave; des examens compl&eacute;mentaires puis une exploration chirurgicale qui a permis de porter le diagnostic histologique de fusion spl&eacute;nogonadique.</b><br/> text/html 2018-02-24T07:59:01+01:00 Fouad Laboudi, Ghizlane Slimani, Mohamed Essaid Gourani, Abderrazzak Ouanass [Case report] - La d&eacute;pression dans le lupus &eacute;ryth&eacute;mateux syst&eacute;mique: &agrave; propos d’un cas clinique - 20 February 2018. <b>Dans le but d’illustrer l’importance des manifestations psychiatriques du lupus &eacute;ryth&eacute;mateux syst&eacute;mique, nous rapportons le cas d’une jeune patiente &acirc;g&eacute;e de 32 ans, n’ayant pas d’ant&eacute;c&eacute;dents psychiatriques. Elle est suivie depuis un an pour lupus &eacute;ryth&eacute;mateux syst&eacute;mique. Elle a pr&eacute;sent&eacute; depuis 2 &agrave; 3 mois des manifestations psychiatriques faisant &eacute;voquer un &eacute;pisode d&eacute;pressif majeur, qui s’est bien am&eacute;lior&eacute; sous traitement. Dans le lupus &eacute;ryth&eacute;mateux syst&eacute;mique, la prise en charge doit &ecirc;tre d'embl&eacute;e multidisciplinaire afin d'assurer une coh&eacute;rence parfaite indispensable &agrave; l'adh&eacute;rence de la patiente au projet de soin.</b><br/> text/html 2018-02-24T07:59:01+01:00 Othmane Yddoussalah, Amine Saouli [Images in medicine] - Diverticule v&eacute;sicale g&eacute;ant - 20 February 2018. <b>Un homme &acirc;g&eacute; de 72 ans hospitalis&eacute; pour prise en charge d'une symptomatologie urinaire obstructive du bas appareil urinaire &eacute;voluant depuis 2 ans, faite de pollakiurie et une dysurie associe a une miction en deux temps. Sur le plan radiologique, une TDM abdominopelvien r&eacute;alis&eacute;e avait montr&eacute; la pr&eacute;sence d un diverticule v&eacute;sicale g&eacute;ant lat&eacute;ralis&eacute; &agrave; droite, mesurant plus de 10cm de grand axe. Contenant une image lithiasique de 1cm. Par ailleurs le patient pr&eacute;sentait une hypertrophie prostatique avec un volume prostatique estime &agrave; 40cc. Les examens biologiques standard &eacute;taient normaux. Le patient a b&eacute;n&eacute;fici&eacute; d'une r&eacute;section transuretrale de la prostate, suivi d'une diverticulectomie par voie transv&eacute;sicale. L'abord v&eacute;sical est r&eacute;alis&eacute; par une petite incision de pfannenstiel de 3cm, apr&egrave;s cath&eacute;t&eacute;risme des deux m&eacute;ats ur&eacute;t&eacute;raux on rep&egrave;re le collet diverticulaire. Ensuite vient l'&eacute;tape de la r&eacute;section du diverticule avec fermeture v&eacute;sicale. Bonne &eacute;volution post-op&eacute;ratoire avec ablation du Redon &agrave; j+2 et ablation de la sonde v&eacute;sicale &agrave; j+5.</b><br/> text/html 2018-02-24T07:59:01+01:00 Richard Kobina Dadzie Ephraim, James Elikem Ahadzie, Patrick Adu, Joseph Boachie, Hope Agbodzakey, Prince Adoba, Obed Cudjoe [Research] - Abnormal coagulation profile in people living with HIV-AIDS on combined Antiretroviral Therapy: findings from a case-control study in the Ho municipality, Ghana - 20 February 2018. <b>INTRODUCTION: Although combined Anti-Retroviral Therapy (cART) has improved the quality of life and survival in people living with HIV-AIDS (PLWHA), there have been reports of increased non-AIDS related co-morbidities such as coagulopathies. The objective of this study was to assess the effect of cART on the coagulation profile of PLWHA. METHODS: this case-control study recruited 110 PLWHA (65 patients on cART, and 45 cART na&iuml;ve patients) from the antiretroviral therapy unit of Volta Regional Hospital, Ho. Blood was collected for prothrombin time (PT), activated partial thromboplastin time (APTT)and platelet count. RESULTS: cART na&iuml;ve individuals had a high PT (p <0.001; 17.2 vs 13.8) and APTT (p = 0.081; 59.7 vs 55.3) compared to their counterparts on cART. Also, INR was significantly lower in cART-treated PLWHA (p<0.001). Platelet count was high in participants on therapy compared to their na&iuml;ve counterparts (204.7 vs 193.6, p = 0.402). Patients on zidovudine + nevirapin + efavirenz therapy had a significantly lower PT compared to those on zidovudine + lamivudine + efavirenz therapy {p = 0.02, 13.23 vs 14.66}. Additionally, PLWHA on zidovudine + nevirapin + efavirenz had reduced APTT compared to those on zidovudine + lamivudine + efavirenz therapy, or zidovudine + lamivudine+ nevirapine therapy (p = 0.058; 47.55 vs 56.81 vs 56.85 respectively). CONCLUSION: HIV infection adversely affects the coagulation profile in PLWHA which improves with cART. Barring the existence of other comorbidities, cART with zidovudine + nevirapin + efavirenz combination could be the treatment of choice as it significantly improves the coagulation profile in PLWHA.</b><br/> text/html 2018-02-24T07:59:01+01:00 Abdelmajid Bouzerda, Nadia Loudiyi [Images in medicine] - Dolichomegacoronary of the anterior interventricular artery - 16 February 2018. <b>He is a 42 years old hypertensive men and smoker, who presented with an acute Anterior ST elevation myocardial infarction 4 hours after chest pain on set. Thrombolysis with tenecteplase was performed. Clinical examination was normal. Coronary angiogram revealed a dolichomegacoronary aspect of the anterior interventricular artery responsible for infarction, a significant stenosis in the proximal segment of an ectasia circumflex artery and normal right mega coronary artery. After collegial discussion, the patient was put on a medical treatment combining anti ischemic, platelet antiaggregant and anticoagulant with favorable evolution. Coronary ectasia is a relatively rare disease. Their etiology in adults is most often atheromatous. With known poor prognosis, these abnormalities would expose the risk of intracoronary thrombosis but not blood stasis, an association with stenosing lesions is most often found, appearing to be the predominant prognostic factor. A strategy for the control and intensive correction of cardiovascular risk factors is the basis of therapy. Some authors have proposed the introduction of an oral anticoagulant treatment based on physiopathological suppositions. The number of patients treated with angioplasty is relatively small outside of acute coronary syndromes, this may be related to the technical complexity associated with this type of lesion. Adaptations of our percutaneous revascularization techniques to these particular anatomical forms with wider use of dedicated stents could help optimize the revascularization of these patients.</b><br/> text/html 2018-02-24T07:59:01+01:00 Obinna Ositadimma Oleribe, Sani Aliyu, Simon David Taylor-Robinson [Research] - Is the prevalence of HIV wrongly estimated in Nigeria? Some insights from a 2017 World AIDS day experience from a Nigerian Non-Governmental Organisation - 16 February 2018. <b>INTRODUCTION: HIV is still a major public health challenge, especially in resource-limited settings. In Nigeria, it is estimated that over 50% of those infected with HIV do not know their status. With the recent Nigerian governmental approval of a "Test and Start Strategy", we embarked on HIV testing and services in four defined locations to mark 2017 World AIDS Day. The aim of this report is to document the process and outcome of the exercise. METHODS: four teams led by senior clinical associates implemented the services and were mandated to test at least 100 persons per location. At each location, we carried out the following activities: (1) short advocacy to community leaders, (2) HIV testing and counselling, (3) disclosure of results, post-test counselling and healthy life-style education and (4) distribution of free male condoms and Information, Education and Communication (IEC) material. RESULTS: a total of 237 people (male 195, female 42) were tested, the majority of whom were between 19 and 49 years (93.7%). Two people were found to be positive, giving a 0.84% positivity rate. Informal interactions between service providers and the people tested revealed that people were aware of HIV as a public health problem, and people positively received HIV services. Although there is a selection bias, as those tested will not be truly representative of the population, the current positively rate of less than 1% is low compared to previous Nigerian estimates, which are based on antenatal testing. However, the exercise showed a willingness to be tested and fair knowledge of HIV as a problem. Population-based data from across Nigeria should be aggregated to determine community prevalence pending the National population-based HIV survey in 2018. Such information will inform evidence-based decisions on the necessity of such large-scale surveys in future years. CONCLUSION: there is an urgent need to define the real prevalence of HIV in Nigeria through a well planned and executed community based survey.</b><br/> text/html 2018-02-24T07:59:01+01:00 Nabil Ali Barrow, Jamilah Atallah Alatawi, Abid Saeed, Tariq Ali Alblowy, Hyder Osman Mirghani, Ayman Fisal Ahmed Foad [Case report] - Tuberculous lymphadenitis associated thrombocytopenic purpura, effectiveness of anti-tuberculous therapy - 15 February 2018. <b>The association of immune thrombocytopenic purpura and tuberculosis is extremely rare. We presented a case with tuberculous lymphadenopathy and immune-mediated thrombocytopenia, the complete remission with anti-tuberculous therapy, and partial response to immunoglobulin and steroid suggested a causal relationship between the two conditions.</b><br/> text/html 2018-02-24T07:59:01+01:00 Youssef Zemmez, Badreddine Hassam [Images in medicine] - Carcinome baso-cellulaire tatou&eacute; - 15 February 2018. <b>Un patient de 25 ans, sans ant&eacute;c&eacute;dent pathologique, a consult&eacute; en dermatologie pour une l&eacute;sion pigment&eacute;e &eacute;voluant depuis 3 ans. L'examen clinique a r&eacute;v&eacute;l&eacute; une l&eacute;sion papuleuse, ovo&iuml;de, pigment&eacute;e de 0,8 millim&egrave;tre au grand diam&egrave;tre, avec un si&egrave;ge r&eacute;tro-auriculaire droit, qui a produit l'aspect classique d'une perle. La biopsie de la l&eacute;sion a mis en &eacute;vidence un foyer tumoral constitu&eacute; de cellules basalo&iuml;des avec des noyaux dispos&eacute;s en palissade &agrave; la p&eacute;riph&eacute;rie et la pr&eacute;sence d'artefacts de r&eacute;traction confirmant le diagnostic de carcinome basocellulaire. Le patient a subi une excision chirurgicale avec des marges de s&eacute;curit&eacute; de 4 millim&egrave;tres. Le carcinome basocellulaire est une tumeur &eacute;pith&eacute;liale d&eacute;velopp&eacute;e aux d&eacute;pens du tissu &eacute;pidermique, principalement de novo, localis&eacute;e uniquement sur la peau et maligne locale. De nombreuses formes cliniques et histologiques sont d&eacute;crites, notamment le carcinome basocellulaire tatou&eacute; ou pigment&eacute; qui pose le probl&egrave;me du diagnostic diff&eacute;rentiel avec m&eacute;lanome.</b><br/> text/html 2018-02-24T07:59:01+01:00 Asmae Lahlou, Sara Elloudi, Salim Gallouj, Fatima-Zohra Mernissi [Case report] - Lichen planus pigmentosus inversus: 3 cases - 14 February 2018. <b>Lichen planus pigmentosus-inversus is a rare variant of lichen planus pigmentosus. The eruption of lichen planus pigmentosus-inversus occurs mainly in the flexural regions and presents with brownish macules and patches. Here we describe three cases of woman who presented with hyperpigmented lesions at the different body folds. Physical examination revealed multiple brownish macules and patches on the intertriginous area without pruritis, and histologic findings showed a regressive pattern of lichen planus. These clinical and histological findings were consistent with a diagnosis of lichen planus pigmentosus-inversus.</b><br/> text/html 2018-02-24T07:59:01+01:00 Michel Kasonga Kasonga, Jean-Claude Otshudi Diumi, Paul Mujangi Beya, Albert Mande Bwabwa, Blaise Kaki Bal’Olam, Roger Munan Muzaz, Ignace Bwana Kangulu [Case report] - Hydrops fetalis associ&eacute; &agrave; la toxoplasmose maternelle: &agrave; propos d’une observation et revue de la litt&eacute;rature - 14 February 2018. <b>Les auteurs rapportent un cas d’hydrops fetalis diagnostiqu&eacute; et pris en charge aux Cliniques Universitaires de Lubumbashi en R&eacute;publique D&eacute;mocratique du Congo. L’&eacute;chographie r&eacute;alis&eacute;e avait diagnostiqu&eacute; une mort fœtale in utero avec anasarque foeto-placentaire et le bilan &eacute;tiologique r&eacute;alis&eacute; avait r&eacute;v&eacute;l&eacute; la toxoplasmose maternelle. Ce cas clinique rappelle l’impact de la morbi-mortalit&eacute; fœtale de la toxoplasmose pendant la grossesse et plaide pour l’int&eacute;gration de son d&eacute;pistage syst&eacute;matique chez les femmes enceintes congolaises.</b><br/> text/html 2018-02-24T07:59:01+01:00 Fai&ccedil;al Choumi, Mohamed Nassih [Images in medicine] - Lambeau fascio-cutan&eacute; de la face interne de la cuisse dans la reconstruction des pertes de substances p&eacute;rin&eacute;o-scrotales - 14 February 2018. <b>La gangr&egrave;ne perin&eacute;o-scrotale est une affection aigue, grave et rapidement extensive. Le traitement de la phase aig&uuml;e laisse souvent une perte de substance &eacute;tendue (A, B) posant souvent des probl&egrave;mes de reconstruction secondaire, ainsi diff&eacute;rents moyens peuvent &ecirc;tre propos&eacute;s: la cicatrisation dirig&eacute;e, la Greffe de peau, l'enfouissement des testicules, et les lambeaux loco-r&eacute;gionaux qui peuvent &ecirc;tre fascio-cutan&eacute; ou musculo-cutan&eacute;. Nous rapportons un cas de perte de substance scrotale dont la couverture a &eacute;t&eacute; r&eacute;alis&eacute;e par un lambeau fascio-cutan&eacute; de la face interne de la cuisse. Patient de 70 ans, sans ant&eacute;c&eacute;dents pathologiques particuliers, qui a &eacute;t&eacute; op&eacute;r&eacute; pour une gangr&egrave;ne de fournier de la r&eacute;gion scrotale, apr&egrave;s le traitement de la phase aig&uuml;e avec orchidectomie gauche, le patient a gard&eacute; une perte de substance du scrotum (A,B) et de la face inferieure de la verge dont la reconstruction a &eacute;t&eacute; r&eacute;alis&eacute;e par un lambeau fascio-cutan&eacute; de la face interne de la cuisse, les suites post op&eacute;ratoires &eacute;taient simples, et le patient &eacute;tait tr&egrave;s satisfait du r&eacute;sultat. Le lambeau fascio-cutan&eacute; de la face interne de la cuisse constitue un lambeau id&eacute;al pour la reconstruction des pertes de substances p&eacute;rin&eacute;o-scrotales, il est vascularis&eacute; par les branches de l'art&egrave;re pudendale, c'est un lambeau simple, facile &agrave; r&eacute;aliser, tr&egrave;s fiable avec des r&eacute;sultats esth&eacute;tiques satisfaisants (C) et permet d'utiliser une palette cutan&eacute;e qui peut atteindre 9 × 20 cm, mais n&eacute;cessite une deuxi&egrave;me intervention de sevrage (D).</b><br/> text/html 2018-02-24T07:59:01+01:00 L&eacute;opold Codjo, Jean Michel Vovor Mawupe, Murielle Hounkponou, Philippe Adjagbe, Arnaud Sonou, Jeanne Vehounkpe-Sacca, Y&eacute;ssoufou Tchabi, Martin Houenassi, Hippolyte Agboton [Case series] - Les thromboses veineuses profondes des membres thoraciques chez le sujet noir africain: &agrave; propos de 5 cas observ&eacute;s &agrave; L'USERC DU CNHU-HKM de Cotonou - 14 February 2018. <b>La thrombose veineuse profonde (TVP) du membre thoracique est rare mais grave du fait de sa complication mortelle qui est l'embolie pulmonaire. Dans ce papier, nous rapportons 5cinq cas afin de contribuer &agrave; une meilleure connaissance de cette affection chez le sujet noir africain. Cinq (5) patients ayant une thrombose veineuse du membre thoracique document&eacute;e par un &eacute;cho-doppler veineux ont &eacute;t&eacute; inclus entre le 01/01/2007 et le 31/12/2012. La pr&eacute;valence a &eacute;t&eacute; de 4,09% sur l'ensemble des thromboses veineuses de membre. L'&acirc;ge moyen &eacute;tait de 48,8 ± 13,8 ans. La sex-ratio a &eacute;t&eacute; de 1,5 pour les femmes. Les causes ont &eacute;t&eacute; le cath&eacute;ter veineux p&eacute;riph&eacute;rique (40%), les cancers (40%), et la phl&eacute;bite d'effort (20%). Les signes cliniques ont &eacute;t&eacute; domin&eacute;s, au niveau du membre atteint, par l'œd&egrave;me (100%), la douleur (80%), l'augmentation de la chaleur (80%). L'atteinte de la veine hum&eacute;rale a &eacute;t&eacute; la plus fr&eacute;quente dans 80% des cas. Les complications ont &eacute;t&eacute; des s&eacute;quelles post phl&eacute;bitiques dans deux (40%), deux cas de d&eacute;c&egrave;s (40%) en rapport avec les comorbidit&eacute;s et un cas d'embolie pulmonaire. L'h&eacute;parinoth&eacute;rapie relay&eacute;e par l'antivitamine K (AVK) a &eacute;t&eacute; le protocole de traitement le plus souvent utilis&eacute;. Le d&eacute;lai moyen de suivi du traitement AVK a &eacute;t&eacute; de 44,7 mois. la thrombose profonde du membre thoracique est une affection rare &agrave; Cotonou dont la cause est domin&eacute;e par le cath&eacute;ter veineux et le cancer. La pr&eacute;vention de ces causes secondaires est le meilleur traitement.</b><br/> text/html 2018-02-24T07:59:01+01:00 Yolande Sissinto Savi de Tové, Aurore Ogouyemi Hounto, Mahublo Vinadou Vodouhe, Arielle d’Oliveira,Dixou Affolabi, Damien Georgia Barikissou, Boris Houessou, Augustin Koupkoliyi, Goudjo Winor, Sévérin Anagonou, Achille Massougbodji, Dorothée Kinde-Gazard [Research] - S&eacute;ropr&eacute;valence et facteurs associ&eacute;s &agrave; la toxoplasmose chez la femme enceinte en milieu rural au B&eacute;nin - 13 February 2018. <b>INTRODUCTION: Le d&eacute;pistage s&eacute;rologique de la toxoplasmose chez la femme enceinte n'est pas syst&eacute;matique en milieu rural au B&eacute;nin o&ugrave; l'hygi&egrave;ne de vie, souvent pr&eacute;caire des populations, constitue un facteur favorable &agrave; la survenue de la maladie. Le but de notre &eacute;tude &eacute;tait de d&eacute;terminer le profil s&eacute;rologique pergravidique de la toxoplasmose et les facteurs de risque associ&eacute;s dans la commune de Kpomass&egrave; en milieu rural au B&eacute;nin. METHODES: une enqu&ecirc;te transversale a &eacute;t&eacute; men&eacute;e de Janvier &agrave; Septembre 2016 dans une population de gestantes de deux centres de sant&eacute; les plus fr&eacute;quent&eacute;s de la commune de Kpomass&egrave; au sud du B&eacute;nin. Les s&eacute;rologies toxoplasmiques ont &eacute;t&eacute; r&eacute;alis&eacute;es &agrave; partir du s&eacute;rum des gestantes par la technique immunologique microparticulaire par chimiluminescence (CIMA). Un questionnaire sur les facteurs de risque et la connaissance de l'affection a &eacute;t&eacute; administr&eacute;e aux participantes. RESULTATS: l'&eacute;tude a port&eacute; sur 399 gestantes &acirc;g&eacute;es de 15 &agrave; 47ans (&acirc;ge moyen de 26,56±10,02 ans). La quasi-totalit&eacute; des enqu&ecirc;t&eacute;es (99,05%) ne connaissaient pas les modes de transmission de la toxoplasmose. Des anticorps IgG anti Toxoplasma gondii ont &eacute;t&eacute; retrouv&eacute;s chez 144 patientes soit une s&eacute;ropr&eacute;valence de 36,1%. Deux cas de s&eacute;roconversion pergravidique ont &eacute;t&eacute; diagnostiqu&eacute;s et trait&eacute;s par de la spiramycine avec une &eacute;volution favorable pour les deux enfants au cours de la premi&egrave;re ann&eacute;e de suivi. La consommation de crudit&eacute;s a &eacute;t&eacute; le facteur de risque identifi&eacute; dans notre population d'&eacute;tude. Dans la commune rurale de Kpomass&eacute;, la majorit&eacute; des gestantes (64,9%) n'est pas immunis&eacute;e contre le toxoplasme. CONCLUSION: une sensibilisation sur les risques de contamination, une surveillance s&eacute;rologique syst&eacute;matique et des mesures d'hygi&egrave;ne devraient &ecirc;tre propos&eacute;es lors des consultations pr&eacute;natales afin de pr&eacute;venir les s&eacute;roconversions toxoplasmiques pergravidiques et prot&eacute;ger l'enfant.</b><br/> text/html 2018-02-24T07:59:01+01:00 Maghrebi Houcine, Makni Amine, Maghraoui Hamida, Bensafta Zoubeir [Letter to the editors] - Int&eacute;r&ecirc;t p&eacute;dagogique des technologies de l’information et de la communication dans l’apprentissage m&eacute;dical - 11 February 2018. <b>Les technologies de l'information et de la communication (TIC) connaissent, depuis plusieurs d&eacute;cennies, un progr&egrave;s tr&egrave;s rapide. En effet, au cours des derni&egrave;res ann&eacute;es, l'&eacute;mergence rapide ses technologies de l'information et de la communication (TIC) a eu des implications importantes sur l'apprentissage des &eacute;tudes m&eacute;dicales et a fait coul&eacute; beaucoup d'encre entre opposants et d&eacute;fenseurs de leur efficacit&eacute; dans l'apprentissage m&eacute;dical. Le but &eacute;tait de rapporter un &eacute;tat des lieux des TIC dans l'environnement m&eacute;dical ainsi que leur impact sur le secteur de l'enseignement m&eacute;dical. Nous avons men&eacute; une enqu&ecirc;te transversale, par auto-questionnaire anonyme envoy&eacute; par voie &eacute;lectronique aupr&egrave;s d'&eacute;tudiants de m&eacute;decine. Les donn&eacute;es ont &eacute;t&eacute; saisies sur tableur Excel® et analys&eacute;es avec le logiciel SPSS®. Sur 80 questionnaires distribu&eacute;s, nous avons recueilli et analys&eacute; 76 questionnaires exploitables. Notre recueil de donn&eacute;es sur l'impact de l'utilisation des TIC, a montr&eacute; que, comme bon nombre de secteurs, l'apprentissage des &eacute;tudes m&eacute;dicales est fortement concern&eacute; par l'essor des technologies de l'information et de la communication (TIC). Tous les participants interrog&eacute;s d&eacute;clarent qu'ils utilisent les TIC pour leur apprentissage, en particulier pour recherche documentaire et d'informations (80%), les r&eacute;seaux sociaux et les messageries &eacute;lectroniques. La grande majorit&eacute; d'entre eux jugent que l'usage des TIC dans l'apprentissage est une source de motivation. Les technologies de l'information et de la communication (TIC) ont connu depuis quelques d&eacute;cennies, un progr&egrave;s tr&egrave;s rapide. Leur int&eacute;gration pour faciliter l'apprentissage des &eacute;tudiants en m&eacute;decine et le travail de leurs enseignants est actuellement indispensable. Ces outils certes fiables et motivants, ne doivent en aucun cas remplacer les m&eacute;thodes d'enseignement classique mais plut&ocirc;t les compl&eacute;ter.</b><br/> text/html 2018-02-24T07:59:01+01:00 Barbara Kabai Burmen, Thadeaus Ochieng Ochieng, Timothy Malika [Research] - Issues to be considered when implementing the standardized tuberculosis contact investigation in a setting with routine tuberculosis contact invitation: an experience from the Kisumu County, Western Kenya, 2014-2015 - 10 February 2018. <b>INTRODUCTION: Persons in close proximity with Tuberculosis (TB) patients are at risk of TB infection. Contact investigation (CI) has not been scaled up to full implementation by the National Tuberculosis Program in Kenya. As part of a TB household CI study, we documented key concerns that the TB program in Kenya need to consider when transitioning from routine contact invitation to standardized contact investigation. METHODS: a mixed methods evaluation, using participant documents, databases and meeting notes, was conducted between 2014 and 2015 in Kisumu County, Kenya. Qualitative data were manually coded as per emerging themes. Quantitative data was summarized into proportions of participants that received specific services. RESULTS: of 554 TB index cases recruited, 95% listed at least one household contact and a total of 1974 contacts; 2,068 contacts were however identified during a home visit (median no. of contacts per index 5 IQR 3-7). Of 98% (1,907/1945) of contacts scheduled for eligibility assessment, 1,855 (99%) were "household contacts" and 1519 (82%) assented enrolment. Of 346 (23%) child contacts (aged <5years), 82% had tuberculin skin test done; only 71% of symptomatic child contacts had Chest x-ray examination. Isoniazid Preventive Therapy initiation and completion rates were 15% and 20% respectively. Study procedures required the use of relational databases and a huge resource investment. CONCLUSION: TB programs should take into account the size of the proposed target population and infrastructure to support screening and treatment of contacts prior to transitioning to standardized contact investigation.</b><br/> text/html 2018-02-24T07:59:01+01:00 Seidu Adebayo Bello, Saliu Adejumobi Balogun, Ifeoluwa Oketade, Nosa Ighile, Ntiense Udoh, Deborah Enebong [Special feature] - Cleft & facial deformity foundation (CFDF) outreach model: 6 year experience of an indigenous Nigerian mission in the surgical correction of facial clefts - 10 February 2018. <b>INTRODUCTION: Orofacial cleft has a worldwide distribution but it is peculiar in the developing countries due to poor healthcare facility with resultant high incidence of un-operated adult cleft. Various model of surgical mission by foreign experts had existed to combat this menace. The indigenous rotatory model by Cleft & facial deformity foundation is hereby presented. METHODS: carrying out an outreach programme in a rural area begins with the identification of a hospital with optimum facility, followed by effective awareness campaign, then a pre- surgical meeting with the hospital management. Personnel, equipment and materials were mobilised to the site while surgery usually lasted one week. RESULTS: seventeen outreach programmes were carried out in 10 different hospitals from March 2011 to June 2017. There were 546 orofacial cleft patients, 280 (51.3%) males and 266 (48.7%) females. The age ranged between 1 week to 70years with a mean age ± (SD) of 9.3±11.5. Four hundred and forty eight (82.1%) of the cleft patients were operated. Three hundred and twenty two (59.0%) patients were treated under general anaesthesia while 126 (23.1%) were treated under local anaesthesia. Eight surgeons and 4 anaesthetics were trained during the study period with several local practitioners benefitting from exposure to standard practice. Standard techniques were employed for cheiloplasty and palatoplasty. Minor complications were recorded with one mortality. CONCLUSION: this model is an effective and efficient way of reaching out to the poor patients with orofacial cleft. Effective mobilization, large volume of safe and quality surgery, easy knowledge transfer and possibility of patient review are some of its advantages. With regular training and funding, it could be an effective way of minimising ignorance and eradicating adult cleft in Nigeria and other developing societies.</b><br/> text/html 2018-02-24T07:59:01+01:00 Hyder Mirghani [Research] - The association of polypharmacy to diabetes distress among patients with type 2 diabetes mellitus attending an outpatient clinic in Omdurman-Sudan - 09 February 2018. <b>INTRODUCTION: Diabetes distress and polypharmacy are causes of concern among diabetic patients. The present study assessed the association of polypharmacy to diabetes distress among patients with type 2 diabetes mellitus. METHODS: a cross-sectional descriptive study conducted among 103 consecutive patients with type 2 diabetes at an outpatient clinic in Omdurman, Sudan during the period from June 2016 to September 2016. Participants signed a written informed consent, then interviewed to collect demographic data, number and type of drugs taken to assess the polypharmacy and the duration of diabetes mellitus. A blood sample was taken for fasting plasma sugar and the HbA1c. The 17-items diabetes distress scale was used to assess diabetes distress. The ethical committee of Omdurman Teaching Hospital approved the research and the Statistical Package for Social Sciences was used for data analysis. RESULTS: they were 103 patients with type 2 diabetes, their age mean± SD (59.64 ± 9.6), the mean HbA1c was 9.91 ± 2.65, the majority (70.9%) had poor glycemic control (HbA1c > 7) and the fasting plasma sugar was above the goal recommended by the American Diabetes Association in 82.4% of the participants. Polypharmacy was observed in 31.1% of patients. No differences were found between patients on polypharmacy and those without regarding age, diabetes duration, the glycated hemoglobin and diabetes distress. COCNCLUSION: no significant statistical difference was found between polypharmacy patients and their counterparts regarding diabetes distress score.</b><br/> text/html 2018-02-24T07:59:01+01:00 Youssef Khaoula, Jawhar Mokni, Gorbel Abir, Aloui Feten, Beizig Ameni, Maksoudi Chedly [Case report] - Hernie discale cervicale post traumatique: &agrave; propos de un cas - 09 February 2018. <b>Le traumatisme du rachis cervical est un accident dramatique survenant souvent dans le cadre de traumatismes violents. La prise en charge et le pronostic diff&egrave;re pleinement selon la pr&eacute;sence ou non de d&eacute;ficit neurologique. Il s'agit d'un homme &acirc;g&eacute; de 73 ans aux ATCDS de HTA sous traitement m&eacute;dical, d'hernie discale lombaire op&eacute;r&eacute;e il y a une dizaine d'ann&eacute;e sans s&eacute;quelles et qui est amen&eacute; par l'&eacute;quipe de protection civile suite &agrave; une chute dans un puit (hauteur estim&eacute; &agrave; 5 m&egrave;tres). Examen: une plaie frontale longiligne peu profonde d&eacute;chiquet&eacute;e, score de GG: 15/15, t&eacute;trapar&eacute;sie des 4 membres grade C de FRANKEL. Niveau sensitif sus mamellonaire. Pas de troubles sphinct&eacute;riens. Le reste de l'examen est sans particularit&eacute;s. Bilan radiologique: une compression m&eacute;dullaire C5-C6 par une &eacute;norme hernie discale r&eacute;duisant le canal m&eacute;dullaire &agrave; 65%, pas de l&eacute;sion traumatique du cadre osseux. L'hernie discale cervicale post traumatique est extr&ecirc;mement rare et si accompagn&eacute;e de d&eacute;ficit neurologique est grave vue un risque vital imm&eacute;diat et diff&eacute;r&eacute; en rapport avec des complications respiratoires et cardiovasculaires n&eacute;cessitant une prise en charge ad&eacute;quate.</b><br/> text/html 2018-02-24T07:59:01+01:00 Faten Limaiem, Asma Sassi [Images in medicine] - A rare lesion of the gallbladder: pyloric gland adenoma - 08 February 2018. <b>Gallbladder adenomas are rare, but well-documented benign epithelial tumors. They are usually found incidentally in cholecystectomy specimens or during preoperative imaging studies. Although they are usually asymptomatic, they may present as a result of associated symptomatic gallstones, or from cystic duct obstruction due to large adenoma. Three subtypes of adenoma are defined: tubular, papillary and tubulopapillary and they are further classified histopathologically as pyloric gland, intestinal and biliary types. Most adenomas found in the gallbladder are pyloric gland type. A 52-year-old woman suffering from aspecific upper abdominal pain was admitted in the surgery department of our hospital. Physical examination did not reveal any abnormalities nor did routine blood testing. Abdominal ultrasonography showed a polypoid lesion in the gallbladder measuring 1.5cm long. Laparoscopy was performed showing normal anatomy of the gallbladder and surroundings. The gallbladder as well as the Mascagni lymph node were removed. Macroscopic examination of the gallbladder revealed a polypoid lesion in the gallbladder body measuring 1.5cm in diameter (A). On microscopy, the polypoid lesion was almost entirely made up of tightly packed pyloric type tubular glands with little intervening stroma (B). In the background gallbladder epithelium there were no abnormalities. Recovery after surgery was uneventful and the symptoms did not recur.</b><br/> text/html 2018-02-24T07:59:01+01:00 Ahmed Bouhamidi, Mohammed Boui [Images in medicine] - Clouston’s hidrotic ectodermal dysplasia - 08 February 2018. <b>A 2-year-old girl, from a consanguineous and phenotypically normal family. Her mother who brought her to our institution reporting that the child had hair loss, scanty eyelashes and eyebrows since she was two months old. Physical examination revealed severely dystrophic nails and thin scalp hair, fine eyebrows and eyelashes and thin body hair. Hyperkeratotic and desquamative plaques on her palms and soles. The patient did not present changes in sudoresis, dentition or hearing. So with the above clinical findings, a diagnosis of hidrotic ectodermal dysplasia was made, and the patient treated with skin emollients and topic keratolytics, she is under regular monitoring. Clouston syndrome is a rare genodermatosis that affects skin and annexes, it's belong to ectodermal dysplasias, which occur approximately one in every 100,000 births, which are caused by primary defects in the development of two or more tissues derived from the embryonic ectoderm.</b><br/> text/html 2018-02-24T07:59:01+01:00 Ahmed Bouhamidi, Mohammed Boui [Images in medicine] - Cutaneous metastases mimicking keratoacanthoma - 07 February 2018. <b>A 60-year-old man, with history of pulmonary tuberculosis treated and chronic obstructive pulmonary disease, presented with multiple, round skin-colored nodules with a central keratin plug were observed in the left parietal area and the left shoulder. In addition, there were palpable enlarged lymph nodes around the inguinal region. A biopsy of one of the lesions showed histological characteristics of a metastatic adenocarcinoma. Computer tomography of thorax showed lesions in the lung. Subsequently, a bronchoscopy revealed a mass in the left lung. Biopsies of the bronchic mass showed an adenocarcinoma resembling the previous skin tumor biopsy. The tumor cells of both lesions expressed cytokeratin 7, but neither expressed cytokeratin 20 nor thyroid transcription factor, so a highly differentiated adenocarcinoma was diagnosed. After diagnosis of a metastatic bronchial adenocarcinoma, the patient was transferred to the department of Oncology, where chemotherapy was started. The patient is under regular monitoring. Metastatic cancer to skin is not a frequent occurrence. It can present with several morphologies including, rarely, keratoacanthoma-like lesions. This included patients with primary tumors of the breast, bronchus, cartilage, esophagus and pleura.</b><br/> text/html 2018-02-24T07:59:01+01:00 Omar Boulahroud, Okacha Naama [Images in medicine] - Giant subdural empyema in adult - 07 February 2018. <b>Subdural empyema (SDE) is a fairly uncommon diagnosis, accounting for only 20% of intracranial infections, the usual source for SDE is direct extension from a contiguous source, such as acute sinusitis or otitis media, although in one-fourth of cases no source of infection is found. An 18-year-old man was admitted to our Institution because of dysarthria, lethargy and fever for 2 days. His medical history was marked by chronic otitis media badly treated by self-medication with several antibiotics. The first clinical examination revealed an increased body temperature of 37.6°C, heart rate of 82 beats per minute, blood pressure 140/74mmHg and respiratory rate of 18 breaths/minute. He was disorientated, his cranial nerves were intact and his pupils were reactive, round and equal. His white cell count was 6,620 per ¼L. His hemoglobin was 11.1g/dL and C-reactive protein was 80mg/L. The levels of his chemistries were normal. A computed tomography (CT) scan with contrast in emergency was performed and showed an extensive subdural fluid collection in the parietal site on the left side with peripheral enhancement, a mass effect was evident with displacement of the middle line structures toward the opposite side (A). An emergent craniotomy was done to evacuate the subdural empyema (B). A cultural examination was attempted with the fluid evacuation and showed no presence of bacteroides. Ceftriaxone and metronidazole were administered for 6 weeks. The patient was improved without neurological sequalae.</b><br/> text/html 2018-02-24T07:59:01+01:00 Ahmed Bouhamidi, Mohammed Boui [Images in medicine] - Tuberous sclerosis: a case report - 07 February 2018. <b>An 11-year-old girl, from a consanguineous family. With history of suspected akinetic seizures and normal intelligence. Physical examination revealed several small-scattered facial angiofibromas that were histologically determined by skin biopsy. Hypomelanotic macules, shagreen patches on her back. Periungual fibromas were not seen. CT brain showed multiple calcified sub ependymal nodules and cortical tubers. Cardiological consult and ECG were normal. Neurological consult shows: normal status of conscience, without meningeal signs of irritation, cranial nerves without deficit, and no ataxia. No hamartomas or retinal achromic patches was noticed by ophthalmologic evaluation. Radiography of the chest, truncal CT was without abnormality. So with the above clinical findings, a diagnosis of Tuberous sclerosis was made, and the patient is under regular monitoring. Tuberous Sclerosis, also known as Bourneville's disease, is an autosomal dominant syndrome with variable clinical expression. The dermatologist plays an essential role in the history of the disease, since skin manifestations represent the most prevalent clinical features, enabling early diagnosis and intervention in its natural course.</b><br/> text/html 2018-02-24T07:59:01+01:00 Hakima Abid, Fatima Babakhouya, Ahmed Zerhouni, Imane Toughrai, Hicham Sbai, Boubou Meryem, Adil Ibrahimi, Ihsane Mellouki [Case report] - Il&eacute;us biliaire: une cause rare d’occlusion intestinale, &agrave; propos d’un cas - 06 February 2018. <b>L’il&eacute;us biliaire est une complication rare de la lithiase v&eacute;siculaire secondaire &agrave; une fistule chol&eacute;cysto-duod&eacute;nale avec passage d’un macrocalcul dans l’intestin gr&ecirc;le. L’occlusion est provoqu&eacute;e par le blocage du calcul au niveau de l’il&eacute;on. Nous rapportons le cas d’une patiente de 75 ans, pr&eacute;sentant des vomissements avec des douleurs abdominales diffuses. L’IRM abdominal a objectiv&eacute; une a&eacute;robilie importante, une v&eacute;sicule biliaire atrophique associ&eacute;e &agrave; une occlusion gr&ecirc;lique terminale sur obstacle intraluminal. La laparotomie a objectiv&eacute; la pr&eacute;sence d’une fistule chol&eacute;cystoduod&eacute;nale, une v&eacute;sicule biliaire scl&eacute;ro-atrophique avec la pr&eacute;sence d’un calcul obstruant la lumi&egrave;re au niveau du gr&ecirc;le distal (&agrave; 1 m&egrave;tre de la valvule de Bauhin); une enterolithotomie a &eacute;t&eacute; r&eacute;alis&eacute; avec une chol&eacute;cystectomie et fermeture du trajet fistuleux en un seul temps op&eacute;ratoire; les suites postop&eacute;ratoires ont &eacute;t&eacute; simples.</b><br/> text/html 2018-02-24T07:59:01+01:00 Fred Kapaya, Francis Dien Mwansa, Patrick Sakubita, Angela Gama, Nelia Langa, Orbrie Chewe, Lwito Mutale, Francis Nanzaluka, Chongwe Gershom, Mumbi Chola, Nathan Kapata, Nyambe Sinyange, Sylvia Chibuye, Ellen Yard [Research] - A foodborne disease outbreak investigation experience in a College in Lusaka, Zambia, 2017 - 05 February 2018. <b>INTRODUCTION: On 19 March 2017, an outbreak of unknown etiology was reported among students at a college in Lusaka, Zambia. We investigated to confirm the outbreak, identify exposures, determine the aetiological agent, and implement preventive measures. METHODS: we conducted an unmatched case-control study. Cases and controls were selected conveniently. A suspected case was diarrhea or abdominal pains in any student at College A and Controls were asymptomatic students at College A during 18-23 March. We interviewed cases and controls about exposures to suspected food and water and collected saved food samples and swabs from food-handlers' hands and kitchen surfaces for culture. We analyzed data using Epi-info v 7.2 (Atlanta, Georgia). RESULTS: we identified 59 suspected case-patients. Predominant symptoms were diarrhea (n = 51.83%) and abdominal pains (n = 44.75%). The outbreak started on 18 March, peaked on 19, and concluded on 20 March. We interviewed 30 case-patients and 71 controls. Exposures associated with increased odds of illness included eating food served at dinner on Saturday (18 March) in school cafeteria (OR = 5.8, 95% CI = 2.0-16.7); specifically, eating beans at Saturday dinner (OR = 21.6, 95% CI = 4.5-104) and drinking water supplied at school (OR = 8.8, 95% CI = 1.45-53.6). Samples from all food-handlers (n = 13) yielded Staphylococcus aureus and all food samples (n = 3) yielded Escherichia coli, Staphylococcus aureus and fecal coliforms. CONCLUSION: the results suggest a foodborne outbreak caused by consumption of contaminated food served at dinner on 18 March at College A. We educated the food handlers and school management about the importance of disinfection of preparation surfaces, supervision of food handling and handwashing practices.</b><br/> text/html 2018-02-24T07:59:01+01:00 Chimae Eddaoudi, Mohammed Achraf Grohs, Abdilhay Filali [Case report] - Inversion ut&eacute;rine: &agrave; propos d’un cas - 05 February 2018. <b>Une inversion ut&eacute;rine est une complication rare de l’accouchement potentiellement grave, dans laquelle le corps ut&eacute;rin se retourne en doigt de gant et fait saillie dans le vagin ou hors de la vulve. Cette pathologie se manifeste en g&eacute;n&eacute;ral juste apr&egrave;s l’accouchement, par une douleur importante dans un tableau de choc h&eacute;morragique. Le diagnostic est essentiellement clinique et impose d’&ecirc;tre imm&eacute;diat afin de permettre une r&eacute;inversion rapide avant la formation d’un anneau de striction. En effet, la mortalit&eacute; est aujourd’hui faible si le diagnostic et la prise en charge sont pr&eacute;coces. L’inversion ut&eacute;rine ne semble pas non plus grever le pronostic obst&eacute;trical. Parmi les facteurs favorisants, on retrouve avant tout une hypotonie ut&eacute;rine associ&eacute;e &agrave; une insertion fundique du placenta, ce qui provoque une d&eacute;pression du fond ut&eacute;rin en cas de manoeuvres intempestives (traction sur le cordon, expression ut&eacute;rine). La r&eacute;inversion doit &ecirc;tre rapide, men&eacute;e de fa&ccedil;on conjointe aux mesures de r&eacute;animation (traitement du choc). Elle fait appel &agrave; plusieurs m&eacute;thodes manuelles consistant &agrave; retourner l’ut&eacute;rus apr&egrave;s &eacute;ventuelle utilisation de proc&eacute;d&eacute;s myorelaxants (d&eacute;riv&eacute;s nitr&eacute;s, b&ecirc;tamim&eacute;tiques, anesth&eacute;sie g&eacute;n&eacute;rale). L’&eacute;chec conduit &agrave; un traitement chirurgical par voie haute ou voie basse. Nous rapportons le cas d’une inversion ut&eacute;rine totale qui s’est produite avant la d&eacute;livrance, lors d’un accouchement par voie haute.</b><br/> text/html 2018-02-24T07:59:01+01:00 Ema Waliyanti, Fatwa Sari Tetra Dewi, Supriyati Supriyati, Renske Fles [Research] - Treatment-seeking behaviour of nasopharyngeal cancer patients in Yogyakarta, Indonesia - 31 January 2018. <b>INTRODUCTION: Nasopharyngeal cancer ranks first among head and neck cancer. About 60-95% of nasopharyngeal cancer patients seek for treatment at advanced stage. Attitudes and behavior of cancer patients in choosing healthcare is affected by the level of socio-economic and cultural backgrounds. Surgery and treatment costs are also the reasons patients to late seek treatment. This study aims to explore what contributes the treatment seeking behavior of nasopharyngeal cancer patients. It conducted in the Yogyakarta, Indonesia. METHODS: Twenty patients were interviewed using indepth interview guide. The data analysis process were done using Opencode software version 3.6. To ensure the data validity, triangulation approach, peer debriefing and thick description were done. RESULTS: it showed that there are five factors that affect the patients in seeking treatment: disease perception, medical services perception, medical expenses, external support and assessment of treatment process. CONCLUSION: this study may help to design health education programs to raise public awareness of nasopharyngeal cancer.</b><br/> text/html 2018-02-24T07:59:01+01:00 Beatrice Ohunene Bello-Ovosi, Sunday Asuke, Shehu Ozovehe Abdulrahman, Muhammed Sani Ibrahim, Joseph Ogirima Ovosi, Modupe Arinola Ogunsina, Felicia Ohunene Anumah [Research] - Prevalence and correlates of hypertension and diabetes mellitus in an urban community in North-Western Nigeria - 31 January 2018. <b>INTRODUCTION: Worldwide, hypertension and diabetes mellitus (DM) are major causes of morbidity and mortality. This study assesses the prevalence and correlates of hypertension and DM in an urban community in northwestern Nigeria. METHODS: this was a cross-sectional descriptive study. Adults aged 18 years and above, who attended a medical outreach program were interviewed and screened for hypertension and DM. Anthropometry, blood glucose and blood pressure were measured with standard instruments and methodology. Primary outcomes were hypertension and DM. Data were analyzed using STATA version 14 and presented as mean ± standard deviation and frequencies. Chi-square and Pearson's correlation co-efficient were used to identify the correlates of hypertension and DM, at 5% level of significance. RESULTS: the mean age of participants was 51.0 ± 14.0 years and 87.8% were females. Prevalence of hypertension and DM were 55.9% and 23.3% respectively. Age greater than 40 years and female gender were associated with risk of hypertension and DM respectively, p < 0.05. There was a weak correlation between systolic hypertension and age (r = 0.18, p = 0.02), diastolic hypertension and body mass index (r = 0.16, p = 0.03) and blood sugar and waist circumference (r = 0.19, p = 0.02). CONCLUSION: the high prevalence of hypertension and DM among the study population highlights the need for the development and implementation of a community-based public health interventions aimed at reducing their risk factors.</b><br/> text/html 2018-02-24T07:59:01+01:00 Hind Cherrabi, Salahoudine Idrissa, Hind Abouljaoud, Abdoulaye Harouna diallo, Karima Atarraf, Aziz El Madi, Khalid Khattala, Youssef Bouabdallah [Case report] - Appendicite aigue sur hernie de Claudius Amyand chez un nouveau-n&eacute; dans un tableau d’occlusion neonatale - 31 January 2018. <b>La hernie de Claudius Amyand est d&eacute;finie par l'incarc&eacute;ration de l'appendice vermiculaire &agrave; travers le sac herniaire. La premi&egrave;re appendicectomie fut r&eacute;alis&eacute;e en 1735. C'est une pathologie tr&egrave;s rare chez l'enfant. De ce fait; la fr&eacute;quence de cette pathologie est non encore &eacute;tablie. Nous rapportons l'observation d'un nouveau-n&eacute; de 22 jours porteur d'une hernie inguino scrotale simple non suivi admis aux urgences dans un tableau de syndrome occlusif fait d'arr&ecirc;t des mati&egrave;res et des gaz avec tum&eacute;faction inguino-scrotale d'allure inflammatoire et des vomissements bilieux install&eacute;s sur 2 jours. La prise en charge a consist&eacute; a une mise en condition et un bilan pr&eacute;-anesth&eacute;sique. L'exploration per op&eacute;ratoire a mis en &eacute;vidence un appendice boudin&eacute; n&eacute;cros&eacute; dans sa moiti&eacute; distale avec pr&eacute;sence de fausses membranes. Le geste a comport&eacute; une appendicectomie et la fermeture du sac herniaire. L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par une reprise de transit 24h de post op&eacute;ratoire.</b><br/> text/html 2018-02-24T07:59:01+01:00 Youssef Zemmez, Mohammed Boui [Images in medicine] - El&eacute;phantiasis du membre inf&eacute;rieur gauche - 31 January 2018. <b>Patiente &acirc;g&eacute;e de 48 ans, ayant comme ant&eacute;c&eacute;dents pathologiques une insuffisance veineuse chronique ayant n&eacute;cessit&eacute; un acte chirurgical depuis 05 ans, qui a consult&eacute; en dermatologie pour augmentation de la taille du membre inf&eacute;rieur gauche &eacute;voluant progressivement depuis 04 ans. L'examen clinique a objectiv&eacute; un membre inf&eacute;rieur augment&eacute; de taille par rapport au membre controlat&eacute;ral, avec une cicatrice chirurgicale au niveau de la face externe de la jambe gauche, des l&eacute;sions papillomateuses int&eacute;ressant la totalit&eacute; du pied gauche et couvrant les cinq orteils gauches. Un lymphœd&egrave;me post-traumatique (post-chirurgical) a &eacute;t&eacute; retenu. Un traitement &agrave; base de bas de contention, drainage lymphatique a &eacute;t&eacute; prescrit ainsi qu'un traitement pr&eacute;ventif a &eacute;t&eacute; pr&eacute;conis&eacute; incluant le benzathine benzyle p&eacute;nicilline : 1,2 MU tous les trois semaines. Le lymphœd&egrave;me est la cons&eacute;quence d'un dysfonctionnement du syst&egrave;me lymphatique responsable d'une stase de la lymphe dans les tissus interstitiels, se traduisant par l'augmentation de volume du membre. Toutes les r&eacute;gions anatomiques pourvues de lymphatiques peuvent &ecirc;tre atteintes de lymphœd&egrave;me, mais l'atteinte des membres est la plus fr&eacute;quente. Au niveau des membres inf&eacute;rieurs, on distingue les lymphœd&egrave;mes primaires et secondaires. L'&eacute;l&eacute;phantiasis correspond au stade ultime de l'&eacute;volution du lymphœd&egrave;me.</b><br/> text/html 2018-02-24T07:59:01+01:00 Placide Kambola Kakoma, Emmanuel Kiyana Muyumba, Clarence Kaut Mukeng, Jaques Mbaz Musung, Christian Ngama Kakisingi, Olivier Mukuku, Dophra Ngoy Nkulu [Research] - Profil pressionnel de l’adolescent en milieu scolaire &agrave; Lubumbashi, R&eacute;publique D&eacute;mocratique du Congo - 31 January 2018. <b>INTRODUCTION: L'objectif de cette &eacute;tude &eacute;tait de donner le profil de la pression art&eacute;rielle (PA) des adolescents &acirc;g&eacute;s de 15 &agrave; 19 ans en milieu scolaire &agrave; Lubumbashi, R&eacute;publique D&eacute;mocratique du Congo.</b><br/> text/html 2018-02-24T07:59:01+01:00 Marie-Pierrette Ntyonga-Pono [Case report] - L’insuffisance surr&eacute;nalienne chronique: une cause sous-estim&eacute;e de fatigue chronique - 30 January 2018. <b>L'insuffisance surr&eacute;nalienne chronique est consid&eacute;r&eacute;e plut&ocirc;t comme une maladie rare dans sa forme primitive. Par contre la forme secondaire, essentiellement &agrave; l'arr&ecirc;t de l'usage des cortico&iuml;des serait plus fr&eacute;quente allant de 4,2% &agrave; 60% selon la pathologie trait&eacute;e, mais souvent m&eacute;connue. Nous rapportons le cas d'une patiente de 66 ans qui se plaignait d'une fatigue chronique depuis plus de deux ans, allant de m&eacute;decin en m&eacute;decin et consid&eacute;r&eacute;e &agrave; tort comme d&eacute;pressive, alors qu'elle pr&eacute;sentait en fait une insuffisance surr&eacute;nalienne corticotrope.</b><br/> text/html 2018-02-24T07:59:01+01:00 Hayat El Maataoui, Amina Fahi, Bouchra Oukkache [Case report] - “Sickle cell trait and haemophilia: a rare association” - 30 January 2018. <b>In this paper we analyze the combination of HbAS disease and haemophilia A must be exceedingly rare. Because of this rarity we report the case of two brothers with sickle cell trait and major haemophilia A. We conclude that it is about a post-circumcision bleeding due to major hemophilia A associated to sickle cell AS, this association was a systematic discovery.</b><br/> text/html 2018-02-24T07:59:01+01:00 Mohamed El Amraoui, Naoufal Hjira [Images in medicine] - Liv&eacute;do atypique et r&eacute;v&eacute;lateur!? - 30 January 2018. <b>L'ath&eacute;roscl&eacute;rose est une fr&eacute;quente et redoutable complication du sujet &acirc;g&eacute; multitar&eacute; et ayant un ou plusieurs facteurs de risque cardiovasculaires. Elle peut toucher tous les troncs art&eacute;riels, au niveau des membres inf&eacute;rieurs (A) elle est pourvoyeuse de l'art&eacute;riopathie oblit&eacute;rante des membres inf&eacute;rieurs. Nous pr&eacute;sentons un cas de liv&eacute;do ecchymotique de la cuisse droite (B) chez un sujet &acirc;g&eacute; ayant r&eacute;v&eacute;l&eacute; un art&eacute;riopathie oblit&eacute;rante du membre inf&eacute;rieur homolat&eacute;ral(C) avec un descellement septique d'une proth&egrave;se totale de la hanche.</b><br/> text/html 2018-02-24T07:59:01+01:00 Catherine Nduku Kiama, Joyce Njeri Wamicwe, Elvis Omondi Oyugi, Mark Odhiambo Obonyo, Jane Githuku Mungai, Zeinab Gura Roka, Ann Mwangi [Research] - Prevalence and factors associated with metabolic syndrome in an urban population of adults living with HIV in Nairobi, Kenya - 30 January 2018. <b>INTRODUCTION: Metabolic syndrome affects 20-25% of the adult population globally. It predisposes to cardiovascular disease and Type 2 diabetes. Studies in other countries suggest a high prevalence of metabolic syndrome among HIV-infected patients but no studies have been reported in Kenya. The objective of this study was to assess the prevalence and factors associated with metabolic syndrome in adult HIV-infected patients in an urban population in Nairobi, Kenya. METHODS: in a cross-sectional study design, conducted at Riruta Health Centre in 2016, 360 adults infected with HIV were recruited. A structured questionnaire was used to collect data on socio-demography. Blood was collected by finger prick for fasting glucose and venous sampling for lipid profile. RESULTS: using the harmonized Joint Scientific Statement criteria, metabolic syndrome was present in 19.2%. The prevalence was higher among females than males (20.7% vs. 16.0%). Obesity (AOR = 5.37, P < 0.001), lack of formal education (AOR = 5.20, P = 0.002) and family history of hypertension (AOR = 2.06, P = 0.029) were associated with increased odds of metabolic syndrome while physical activity (AOR = 0.28, P = 0.001) was associated with decreased odds. CONCLUSION: metabolic syndrome is prevalent in this study population. Obesity, lack of formal education, family history of hypertension, and physical inactivity are associated with metabolic syndrome. Screening for risk factors, promotion of healthy lifestyle, and nutrition counselling should be offered routinely in HIV care and treatment clinics.</b><br/> text/html 2018-02-24T07:59:01+01:00 Ibrahim Elaraoud, Erica Damato [Images in medicine] - Bilateral extensive multiple multi-layered retinal haemorrhage in a patient with alcoholic liver disease - 30 January 2018. <b>We report a rare case of bilateral multiple bilateral vitreous, pre-retinal and intra-retinal haemorrhages after bouts of coughing in a 47 year old female patient with high international normalized ratio (INR) due to alcoholic liver disease. Patient has been complaining of 2 weeks history of reduced vision to her liver physician who referred her to local eye unit. She reported that the vision deteriorated following intense coughing. She was found to have bilateral vitreous, pre-retinal and intra-retinal haemorrhages. liver disease. The patient was kept under ophthalmic observation. The vitreous, preretinal and intraretinal haemorrhages resolved spontaneously and his vision recovered fully Alcoholic liver disease is becoming more common. Clinicians should be aware that the combination of increased intravenous pressure due to persistent coughing and possible early portal hypertension and a pathological increase in INR can lead to severe multiple multi-layered retinal haemorrhage. The haemorrhages, however, will resolve spontaneously in most cases. In foveal involving pre-retinal haemorrhage, YAG- laser membranotomy was shown to speed up visual recovery in previous reports.</b><br/> text/html 2018-02-24T07:59:01+01:00 Pirabu Sakthivel, Chirom Amit Singh [Images in medicine] - Incisional keloid - 30 January 2018. <b>A 24-year-old man underwent left ear tympanoplasty for chronic otitis media and 3 months later started developing asymptomatic, tumor-like, cutaneous lesion over the incision site. There was no pain or itching. The lesion gradually progressed in the subsequent years protruding behind the ear to cause apparent cosmetic deformity. A clinical diagnosis of incisonal keloid was made. Keloids typically occur in response to dermal injuries such as surgical wounds, lacerations, burns, or inflammatory skin conditions. Because recurrence is common, surgical removal is generally not recommended; treatments with glucocorticoid injections, laser therapy, or radiotherapy may be tried but are usually associated with a poor response. Given the large size of the lesion in this patient, a complete surgical excision was performed and a diagnosis of keloid was confirmed histopathologically. The patient also received eight weeks infiltration of glucocorticoids postoperatively. There was no recurrence six months after surgery and the patient was lost to further follow-up.</b><br/> text/html 2018-02-24T07:59:01+01:00 Mohamed El Amraoui, Naoufal Hjira [Images in medicine] - Une cause rare et atypique des ulc&eacute;rations scrotales - 30 January 2018. <b>Les salmonelloses sont des infections bact&eacute;riennes du p&eacute;ril f&eacute;cal, end&eacute;miques dans certaines r&eacute;gions du monde. Elles peuvent coloniser pratiquement tous les organes par voie h&eacute;matog&egrave;ne, ainsi, des formes s&eacute;v&egrave;res peuvent &ecirc;tre observ&eacute;es. Nous rapportons le cas de multiples ulc&eacute;rations scrotales, n&eacute;crotiques, chez un jeune adolescent ayant r&eacute;v&eacute;l&eacute; une fi&egrave;vre typho&iuml;de. Jeune adolescent &acirc;g&eacute; de 16 ans, sans ant&eacute;c&eacute;dents pathologiques notables, notamment sans notion d'IST ou de rapports sexuels. A consult&eacute; pour des ulc&eacute;rations scrotales, n&eacute;crotiques, &eacute;voluant depuis 3 semaines dans un contexte de fi&egrave;vre, de diarrh&eacute;e, d'amaigrissement et d'alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral. Le bilan para clinique montrait une an&eacute;mie microcytaire hypochrome &agrave; 7g/dl avec des globules rouges en cible au frottis et une &eacute;lectrophor&egrave;se de l'h&eacute;moglobine normale, un syndrome inflammatoire biologique, un syndrome de malabsorption, une cytolyse et une chol&eacute;stase h&eacute;patique &agrave; 20 fois la normale, une h&eacute;pato-spl&eacute;nom&eacute;galie, les s&eacute;rologies virales (VHB, VHC, HIV, EBV et CMV) &eacute;taient normales, alors que les s&eacute;rologies des salmonelles &eacute;taient positives. Le patient a &eacute;t&eacute; mis sous Fluor quinolones pendant 3 semaines avec une &eacute;volution favorable. Les manifestations dermatologiques de la fi&egrave;vre typho&iuml;de sont fr&eacute;quentes et polymorphes, cependant les ulc&eacute;rations cutan&eacute;es et particuli&egrave;rement scrotales sont rarement rapport&eacute;es. Le diagnostic diff&eacute;renciel peut se faire avec les IST les MICI ou les h&eacute;mopathies. Le plus souvent la diarrh&eacute;e est fruste ou absente et mise au d&eacute;pend de l'antibioth&eacute;rapie. La confirmation dans les tableaux atypiques, comme chez notre patient, fait appel aux s&eacute;rologies. Le traitement repose sur une antibioth&eacute;rapie adapt&eacute;e et prolong&eacute;e et une prophylaxie pour l'entourage.</b><br/> text/html 2018-02-24T07:59:01+01:00 El Kettani Assiya, Kamal Nabiha [Images in medicine] - Cytost&eacute;aton&eacute;crose n&eacute;onatale compliqu&eacute;e d’hypercalc&eacute;mie majeure - 30 January 2018. <b>Nouveau-n&eacute; de sexe f&eacute;minin, ayant pr&eacute;sent&eacute; une asphyxie p&eacute;rinatale pour laquelle il a &eacute;t&eacute; r&eacute;anim&eacute;. Il a &eacute;t&eacute; r&eacute;f&eacute;r&eacute; ensuite pour scl&eacute;r&egrave;me cutan&eacute;, constat&eacute; par les parents au dixi&egrave;me jour de vie. Les l&eacute;sions &eacute;taient des placards &eacute;ryth&eacute;mateux nodulaires indur&eacute;s, &eacute;voquant une cytost&eacute;aton&eacute;crose n&eacute;onatale au niveau des r&eacute;gions fessi&egrave;res. L’&eacute;volution a &eacute;t&eacute; not&eacute;e par une hypercalc&eacute;mie progressive atteignant 128 mg/L (80-110 mg/L), ce qui a indiqu&eacute; une r&eacute;-hospitalisation &agrave; un mois de vie. L’&eacute;chographie r&eacute;nale a objectiv&eacute; une n&eacute;phrocalcinose m&eacute;dullaire. Le traitement a associ&eacute; une hyperhydratation, des diur&eacute;tiques, des cortico&iuml;des et une abstention d’administration de la vitamine D avec une surveillance clinique et biologique de la calc&eacute;mie. L’&eacute;volution a &eacute;t&eacute; vers la r&eacute;gression des l&eacute;sions cutan&eacute;es et la normalisation de la calc&eacute;mie un mois apr&egrave;s. La surveillance &eacute;chographique de la n&eacute;phrocalcinose est toujours en cours.</b><br/> text/html 2018-02-24T07:59:01+01:00 Mahtat El Mehdi, Ahmed Alayoude, Mohamed Amine Hamzi, Wafe Arache, Kawtar Hassani, Selim Jennane, Hicham Eddou, Kamal Doghmi, Mohamed Mikdame [Case report] - Glom&eacute;rulon&eacute;phrite extra-membraneuse et syndrome my&eacute;lodysplasique: une association rare - 30 January 2018. <b>Les syndromes my&eacute;lodysplasiques peuvent s’accompagner de maladies auto-immunes. L’atteinte r&eacute;nale au cours de ces syndromes est rare. Dans ce cas, les glom&eacute;rulopathies pr&eacute;dominent cette atteinte. La glom&eacute;rulon&eacute;phrite extra-membraneuse est exceptionnellement report&eacute;e en association avec un syndrome my&eacute;lodysplasique. Nous rapportons dans ce papier le cas d’une patiente pr&eacute;sentant une glom&eacute;rulon&eacute;phrite associ&eacute;e &agrave; une an&eacute;mie r&eacute;v&eacute;lant un syndrome my&eacute;lodysplasique de faible risque. Dans la lumi&egrave;re de ce cas, nous faisons une courte revue de la litt&eacute;rature des cas pr&eacute;c&eacute;demment publi&eacute;s et nous discutons le lien pathog&eacute;nique entre ces deux entit&eacute;s.</b><br/> text/html 2018-02-24T07:59:01+01:00 Georges Rosario Christian Millogo, Ragomzingba Frank Edgard Zongo, Anita Benao, Estelle No&euml;la Hoho Youl, Blaise Alexandre Bazona Bassoleth, Moussa Ou&eacute;draogo, Patrice Zabsonr&eacute;, Innocent Pierre Guissou [Case series] - Pr&eacute;valence et caract&eacute;ristiques des effets ind&eacute;sirables des antihypertenseurs chez les patients suivis en ambulatoire au Centre Hospitalier Universitaire Yalgado Ou&eacute;draogo - 29 January 2018. <b>La prise en charge m&eacute;dicamenteuse de l'hypertension art&eacute;rielle (HTA) entraine des effets ind&eacute;sirables qui peuvent &ecirc;tre g&ecirc;nants et ainsi influencer l'observance du patient. Nous avons &eacute;tudi&eacute; ces effets ind&eacute;sirables dans le service de cardiologie du Centre hospitalier universitaire Yalgado Ou&eacute;draogo afin de d&eacute;terminer leurs fr&eacute;quences et leurs caract&eacute;ristiques. Il s'agissait d'une &eacute;tude transversale de juillet &agrave; septembre 2015 chez les patients suivis en ambulatoire pour HTA. Les donn&eacute;es ont &eacute;t&eacute; obtenues &agrave; partir de l'interrogatoire, des carnets de suivi des patients et des fiches de consultations. Au total 278 patients ont &eacute;t&eacute; inclus. La population d'&eacute;tude incluait 69,1% de femmes. L'&acirc;ge moyen &eacute;tait de 52,2 ans avec des extr&ecirc;mes de 23 et 86 ans. Quatre vingt et sept virgule huit pourcent (87,8%) vivaient en milieu urbain. Le tabagisme, la dyslipid&eacute;mie et les ant&eacute;c&eacute;dents familiaux d'HTA repr&eacute;sentaient respectivement 9%, 35,6% et 57,2%. Au plan th&eacute;rapeutique, 43,2% &eacute;taient sous monoth&eacute;rapie, 35,6% sous bith&eacute;rapie &agrave; l'initiation du traitement. Les inhibiteurs calciques (59,7%) &eacute;taient la classe th&eacute;rapeutique la plus utilis&eacute;e. La pr&eacute;valence globale des effets ind&eacute;sirables &eacute;tait de 60,1%. Les inhibiteurs calciques &eacute;taient impliqu&eacute;s dans 53,6% suivis des diur&eacute;tiques (48,6%) dans la survenue de l'effet ind&eacute;sirable. La pr&eacute;valence sp&eacute;cifique par mol&eacute;cule &eacute;tait 28,1% pour l'amlodipine et 24,5% pour l'hydrochlorothiazide. La diur&egrave;se excessive (13,7%), la toux (12,9%) et les vertiges (11,5%) &eacute;taient les effets ind&eacute;sirables les plus fr&eacute;quemment &eacute;voqu&eacute;s par les patients. Le syst&egrave;me nerveux central et p&eacute;riph&eacute;rique et le syst&egrave;me ost&eacute;o-musculaire &eacute;taient les syst&egrave;mes les plus atteints. Les effets ind&eacute;sirables sont un d&eacute;terminant majeur de l'adh&eacute;sion aux traitements antihypertenseur, car leur impact sur la vie quotidienne des patients peut s'av&eacute;rer significatif.</b><br/> text/html 2018-02-24T07:59:01+01:00 Said Benlamkaddem, Imane Iken, Nawfal Houari, Abderrahim Elbouazzaoui, Brahim Boukatta, Hicham Sbai, Sanae Achour, Nabil Kanjaa [Case report] - Paracetamol self-poisoning: when oral N-acetylcysteine saves life? a case report - 29 January 2018. <b>Paracetamol is the most widely drug involved in accidental paediatric exposures and deliberate self-poisoning cases because of its availability. N-acetyl cystein is the main treatment for this poisoning. We report a case of a 24-year-old Arab female who has deliberately ingested 100 tablets of 500 mg paracetamol each (50g). Her first examination was normal. She has received oral N-acetyl cystein (NAC) 6 hours after the ingestion. Serum paracetamol level done 18 hours post ingestion was 900 mg/l. On review the next days, she did not develop any symptoms of liver failure. However, due to the massive paracetamol ingestion associated with high serum paracetamol levels, oral NAC was continued for 3 days. The patient was discharged well on the fifth day of hospitalization. Our patient has ingested one of the highest paracetamol overdose (50g) with the highest paracetamol blood levels ever reported in medical literature. She was treated, six hours after ingestion, with oral NAC for 3 days without any side effects.</b><br/> text/html 2018-02-24T07:59:01+01:00 Gabriel Waari, Joseph Mutai, Joseph Gikunju [Research] - Medication adherence and factors associated with poor adherence among type 2 diabetes mellitus patients on follow-up at Kenyatta National Hospital, Kenya - 29 January 2018. <b>INTRODUCTION: Medication non-adherence is a common problem facing health care providers treating adult type 2 diabetes mellitus patients. Poor glycaemic control associated with increased morbidity and mortality are resulting consequences. The objective of this study was to assess medication adherence among Type 2 diabetes mellitus patients. METHODS: this is a cross-sectional study conducted at Kenyatta National Hospital from November 2015 to January 2016. 290 Type 2 diabetic patients were enrolled. A questionnaire was used for data collection. Adherence levels were determined by patient scores on Morisky Medication Adherence Scale-8 and glycaemic control by blood assay for glycosylated haemoglobin. Ordinal logistic regression modelling was done using STATA software to determine factors associated with poor medication adherence. RESULTS: the prevalence of medication adherence low for 28.3 % [95% CI: 23.1, 33.5], medium for 26.2% (95% CI: 21.1, 31.3) and high for 45.5% (95% CI: 39.6, 51.3) of study participants. Glycaemic control was good (HbA1c < 7%) for 107 (36.9 %) of study participants. Dissatisfaction with family members support (OR = 2.99, CI = 1.12-7.98), patients with 2-10 years duration of disease (OR = 2.07, CI = 1.01-4.22), ever being admitted for diabetes mellitus (OR = 2.94, CI = 1.60-5.41), challenge in drug access (OR = 1.76, CI = 1.01-3.05) and dissatisfaction with attending clinicians (OR = 3.58, CI= 1.36 - 9.43) were factors found associated with poor medication adherence. CONCLUSION: a majority of type 2 diabetes mellitus patients have suboptimal medication adherence. Family support, affordability of medications and good healthcare provider-patient communication are important in ensuring medication adherence.</b><br/> text/html 2018-02-24T07:59:01+01:00 Abib Diop, Ousmane Thiam, Mouhamadou Lamine Gu&egrave;ye, Mamadou Seck, Alpha Oumar Tour&eacute;, Mamadou Ciss&eacute;, Madieng Dieng [Case series] - Diverticules de Meckel compliqu&eacute;s: &agrave; propos de 15 cas - 29 January 2018. <b>Le diverticule de Meckel (DM) est une persistance du canal omphalo-m&eacute;sent&eacute;rique. G&eacute;n&eacute;ralement b&eacute;nin et asymptomatique, il est surtout d&eacute;couvert fortuitement. Sa d&eacute;couverte se fait souvent &agrave; l’occasion de complications. Le but de notre &eacute;tude est de d&eacute;crire les aspects &eacute;pid&eacute;miologiques, cliniques, anatomopathologiques et th&eacute;rapeutiques des complications des DM. Il s’agissait d’une &eacute;tude r&eacute;trospective sur 13 ans (Janvier 2003-Juin 2016) portant sur 15 cas de diverticules de Meckel compliqu&eacute;s pris en charge aux urgences chirurgicales de l’H&ocirc;pital Aristide Le Dantec de Dakar. Il s’agissait de 10 hommes et de 5 femmes dont l’&acirc;ge moyen &eacute;tait de 27,8 ans avec des extr&ecirc;mes de 1 mois et 73 ans. Les 2 principales circonstances de d&eacute;couverte &eacute;taient le syndrome occlusif et l’irritation p&eacute;riton&eacute;ale. La laparotomie en urgence avait permis d’affirmer l’implication d’un DM dans le tableau clinique. Dans les cas d’occlusion, le m&eacute;canisme &eacute;tait toujours une bride. Dix patients pr&eacute;sentaient une n&eacute;crose intestinale avec perforation au moment du diagnostic. Tous les 15 patients avaient eu une r&eacute;section segmentaire du gr&ecirc;le emportant le diverticule. Cette r&eacute;section &eacute;tait suivie d’une anastomose imm&eacute;diate dans 12 cas. La morbidit&eacute; &eacute;tait constitu&eacute;e par 2 cas de fistules et 2 cas de p&eacute;ritonites post op&eacute;ratoires. Un d&eacute;c&egrave;s par choc septique a &eacute;t&eacute; not&eacute;. Trois cas d’h&eacute;t&eacute;rotopie muqueuse ont &eacute;t&eacute; constat&eacute;s dont une h&eacute;t&eacute;rotopie gastrique, une colique et une association d’h&eacute;t&eacute;rotopies colique et gastrique chez le m&ecirc;me patient. Les complications de DM constituent des urgences digestives n&eacute;cessitant une prise en charge chirurgicale pr&eacute;coce et adapt&eacute;e. Cette derni&egrave;re est greff&eacute;e d’une morbidit&eacute; non n&eacute;gligeable.</b><br/> text/html 2018-02-24T07:59:01+01:00 Houssam Laachach, Bachrif Mohamed, Ilham Benahmed, Alaa Fliti, Noha El Ouafi [Case report] - Syndrome coronaire aigu avec sus-d&eacute;calage du segment ST chez un jeune &agrave; coronaires saines r&eacute;v&eacute;lant une myocardite aigue - 26 January 2018. <b>Les syndromes coronariens aigus peuvent parfaitement survenir chez l'adulte jeune, les &eacute;tiologies non-ath&eacute;romateuses peuvent en &ecirc;tre le m&eacute;canisme. Nous rapportons le cas d'un jeune homme admis dans un tableau de coronaropathie aigue avec sus-d&eacute;calage du segment ST syst&eacute;matis&eacute; chez qui la coronarographie &eacute;tait sans anomalies et l'imagerie par r&eacute;sonnance magn&eacute;tique a confirm&eacute; une myocardite aigue ayant bien &eacute;volu&eacute;e sous traitement m&eacute;dical.</b><br/> text/html 2018-02-24T07:59:01+01:00 Abderrahmane Bakkali, Imad Jaabari, Claude Koulekey Dadji, Rochde Sayah, Mohamed Laarroussi [Case series] - R&eacute;sultats du remplacement valvulaire chez les patients porteurs de r&eacute;tr&eacute;cissement valvulaire aortique avec dysfonction ventriculaire gauche s&eacute;v&egrave;re - 26 January 2018. <b>Le risque op&eacute;ratoire du remplacement valvulaire aortique(RVA) pour r&eacute;tr&eacute;cissement aortique (Rao) serr&eacute; avec dysfonction ventriculaire gauche s&eacute;v&egrave;re demeure &eacute;lev&eacute;. Plusieurs facteurs de risques de mortalit&eacute; postop&eacute;ratoire sont d&eacute;crits mais la plupart des s&eacute;ries rapport&eacute;es sont h&eacute;t&eacute;rog&egrave;nes. L'objectif principal de ce travail &eacute;tait d'&eacute;tudier les r&eacute;sultats postop&eacute;ratoires du RVA chez les patients pr&eacute;sentant un Rao serr&eacute; isol&eacute;e avec dysfonction ventriculaire gauche s&eacute;v&egrave;re et d'identifier les facteurs pr&eacute;dictifs de la mortalit&eacute; hospitali&egrave;re. Il s'agit d'une &eacute;tude r&eacute;trospective qui a int&eacute;ress&eacute; 46 patients porteurs de Rao serr&eacute; avec dysfonction s&eacute;v&egrave;re du ventricule gauche et qui ont b&eacute;n&eacute;fici&eacute;s d'un RVA.L'&acirc;ge moyen &eacute;tait de 59±12,70 ans. 69,6% des patients &eacute;taient en classe III ou IV de la NYHA. La FE moyenne &eacute;tait de 32,3 ± 5,3 %, et l'EuroScore moyen &eacute;tait 12,20 ± 8,70. La mortalit&eacute; hospitali&egrave;re &eacute;tait de 15,20 %. La morbidit&eacute; a &eacute;t&eacute; marqu&eacute;e essentiellement par le bas d&eacute;bit dans 35 % des cas. En analyse multivari&eacute;e la r&eacute;gression logistique a identifi&eacute; l'insuffisance r&eacute;nale (OR= 11,94, IC [2,65-72,22], p= 0,03) et l'insuffisance cardiaque congestive (OR= 25,33, IC [3,43-194,74], p= 0,009) comme &eacute;tant li&eacute;es au risque de mortalit&eacute; hospitali&egrave;re. Trente neuf patients survivants ont &eacute;t&eacute; suivis sur une dur&eacute;e moyenne de 59,6± 21mois. La mortalit&eacute; tardive &eacute;tait de 5% .Le statut fonctionnel s'est nettement am&eacute;lior&eacute;. La FE a augment&eacute;, en moyenne, de 5,5 unit&eacute;s en p&eacute;riode postop&eacute;ratoire pr&eacute;coce et de 18 unit&eacute;s en postop&eacute;ratoire tardive. A long terme les diam&egrave;tres t&eacute;l&eacute;diastole et t&eacute;l&eacute;systole ont r&eacute;gress&eacute; en moyenne de 8 et 9mm respectivement. Les r&eacute;sultats du RVA sur RAo serr&eacute; avec dysfonction ventriculaire gauche s&eacute;v&egrave;re sont satisfaisants. L'insuffisance cardiaque congestive et l'insuffisance r&eacute;nale pr&eacute;op&eacute;ratoires constituent les principaux facteurs de risque de mortalit&eacute; hospitali&egrave;re. L'&eacute;volution tardive est marqu&eacute;e par une r&eacute;gression des diam&egrave;tres t&eacute;l&eacute;systolique et t&eacute;l&eacute;diastolique du ventricule gauche avec am&eacute;lioration de la FE et du statut fonctionnel.</b><br/> text/html 2018-02-24T07:59:01+01:00 Hasan Bostanci, Kursat Dikmen, Ozgur Ekinci, Cagr&#953; Buyukkasap, Mustafa Kerem [Case report] - A case of Brunner’s gland adenoma mimicking tumors induced from head of the pancreas - 26 January 2018. <b>Brunner's Gland Adenoma is a very rarely seen benign tumor of duodenum. While it generally leads to obstruction and bleeding complaints, it may very rarely occur by mimicking a pancreatic tumor. A 48 years old male patient admitted to the gastroenterology clinic due to the epigastric pain spreading dorsally. No significant feature is present in his clinical history. A lesion containing cystic solid components in the size of 30x40 mm was detected in the head of pancreas as a result of the abdominal tomography. In the light of these findings, pancreaticoduodenectomy is applied to the patient. It is observed that tumor is in submucosal location and widely invaded the pancreatic head. In the histopathological examination, Brunner's Gland Adenoma is reported in pancreatic head localization. In this manuscript a case of Brunner's gland adenoma diagnosed by performing pancreaticoduodenectomy due to the mass in the head of the pancreas is presented.</b><br/> text/html 2018-02-24T07:59:01+01:00 Obinna Ositadimma Oleribe, Babatunde Lawal Salako, Albert Akpalu, Emmanuel Anteyi, Mamadou Mourtalla Ka, Gibrilla Deen, Temilola Akande, Mei Ran Abellona U, Maud Lemoine, Mairi McConnochie, Matthew Foster, Richard Walker, Simon David Taylor-Robinson, Ali Jawad [Research] - Public private partnership in in-service training of physicians: the millennium development goal 6-partnership for African clinical training (M-PACT) approach - 25 January 2018. <b>INTRODUCTION: In-service training of healthcare workers is essential for improving healthcare services and outcome. METHODS: the Millennium Development Goal (MDG) 6 Partnership for African Clinical Training (M-PACT) program was an innovative in-service training approach designed and implemented by the Royal College of Physicians (RCP) and West African College of Physicians (WACP) with funding from Eco Bank Foundation. The goal was to develop sustainable capacity to tackle MDG 6 targets in West Africa through better postgraduate medical education. Five training centres were establised: Nigeria (Abuja, Ibadan), Ghana (Accra), Senegal (Dakar) and Sierra Leone (Freetown) for training 681 physicians from across West Africa. A curriculum jointly designed by the RCP-WACP team was used to deliver biannual 5-day training courses over a 3-year period. RESULTS: of 602 trained in clinical medicine, 358 (59.5%) were males and 535 (88.9%) were from hosting countries. 472 (78.4%) of participants received travel bursaries to participate, while 318 (52.8%) were residents in Internal Medicine in the respective institutions. Accra had the highest number of participants (29.7%) followed by Ibadan, (28.7%), Dakar, (24.9%), Abuja, (11.0%) and Freetown, (5.6%). Pre-course clinical knowledge scores ranged from 35.1% in the Freetown Course to 63.8% in Accra Course 1; whereas post-course scores ranged from 50.5% in the Freetown course to 73.8% in Accra course 1. CONCLUSION: M-PACT made a positive impact to quality and outcome of healthcare services in the region and is a model for continued improvement for healthcare outcomes, e.g malaria, HIV and TB incidence and mortality in West Africa.</b><br/> text/html 2018-02-24T07:59:01+01:00 Nfally Badji, Chaouch Abdesslem, Niang El Hadji [Case report] - Hernie inguinale &eacute;trangl&eacute;e compliqu&eacute;e d’isch&eacute;mie testiculaire sur perm&eacute;abilit&eacute; du canal periton&eacute;o-vaginal - 25 January 2018. <b>La hernie inguinale de l’enfant est une pathologie fr&eacute;quente. L’&eacute;tranglement herniaire est la principale complication de cette pathologie et constitue une v&eacute;ritable urgence diagnostique et th&eacute;rapeutique. L’imagerie en particulier l’&eacute;chographie joue un r&ocirc;le primordial en cas de doute diagnostic surtout lorsque la hernie survient dans un contexte de testicule oscillant car le tableau peut mimer une torsion du cordon spermatique. La r&eacute;alisation d’une &eacute;chographie doit &ecirc;tre de mise devant un tableau de hernie &eacute;trangl&eacute;e dans un contexte de testicule oscillant pour &eacute;liminer une isch&eacute;mie testiculaire associ&eacute;e.</b><br/> text/html 2018-02-24T07:59:01+01:00 Zakia Sefsafi, Brahim El Hasbaoui, Amina Kili, Aomar Agadr, Mohammed Khattab [Case report] - Macrophage activation syndrome associated with griscelli syndrome type 2: case report and review of literature - 25 January 2018. <b>Macrophage activation syndrome (MAS) is a severe and potentially fatal life-threatening condition associated with excessive activation and expansion of T cells with macrophages and a high expression of cytokines, resulting in an uncontrolled inflammatory response, with high levels of macrophage colony-stimulating factor and causing multiorgan damage. This syndrome is classified into primary (genetic/familial) or secondary forms to several etiologies, such as infections, neoplasias mainly hemopathies or autoimmune diseases. It is characterised clinically by unremitting high fever, pancytopaenia, hepatosplenomegaly, hepatic dysfunction, encephalopathy, coagulation abnormalities and sharply increased levels of ferritin. The pathognomonic feature of the syndrome is seen on bone marrow examination, which frequently, though not always, reveals numerous morphologically benign macrophages exhibiting haemophagocytic activity. Because MAS can follow a rapidly fatal course, prompt recognition of its clinical and laboratory features and immediate therapeutic intervention are essential. However, it is difficult to distinguish underlying disease flare, infectious complications or medication side effects from MAS. Although, the pathogenesis of MAS is unclear, the hallmark of the syndrome is an uncontrolled activation and proliferation of T lymphocytes and macrophages, leading to massive hypersecretion of pro-inflammatory cytokines. Mutations in cytolytic pathway genes are increasingly being recognised in children who develop MAS in his secondary form. We present here a case of Macrophage activation syndrome associated with Griscelli syndrome type 2 in a 3-years-old boy who had been referred due to severe sepsis with non-remitting high fever, generalized lymphoadenopathy and hepato-splenomegaly. Laboratory data revealed pancytopenia with high concentrations of triglycerides, ferritin and lactic dehydrogenase while the bone marrow revealed numerous morphologically benign macrophages with haemophagocytic activity that comforting the diagnosis of a SAM according to Ravelli and HLH-2004 criteria. Griscelli syndrome (GS) was evoked on; consanguineous family, recurrent infection, very light silvery-gray color of the hair and eyebrows, Light microscopy examination of the hair showed large, irregular clumps of pigments characteristic of GS. The molecular biology showed mutation in RAB27A gene confirming the diagnosis of a Griscelli syndrome type 2. The first-line therapy was based on the parenteral administration of high doses of corticosteroids, associated with immunosuppressive drugs, cyclosporine A and etoposide waiting for bone marrow transplantation (BMT).</b><br/> text/html 2018-02-24T07:59:01+01:00 Cinzia Casu, Luca Vigan&ograve; [Images in medicine] - Oral lichen planus and HPV lesions - 25 January 2018. <b>A 42 years old male patient went to our observation for a white lesion in the left cheek presented 5 months ago. He reported general good health, a previous diagnosis of genital lichen planus. During the clinical examination we observed a white not scrapable lesion of 3 cm in the left cheek and 2 small esophitic lesions in the gingival tissue near the retromolar trigone, with cauliflower shape. The lesions is not linked with a traumatic event and we decided to make an incisional biopsy and 2 excisional biopsies for esophitic lesions on the gingiva, with a temporary diagnosis of leukoplakia and HPV squamous papilloma. The histological examination confirms instead the presence of an oral plaque lichen planus, without signs of dysplasia and the presence of 2 squamous papillomas on the tissue removed in the gingival. It is the first documented case in literature of an oral lichen planus which occurs many years after genital lesions, rare in a male subject. In addition, the simultaneous presence of HPV lesions in the same oral anatomic region is particular. Treatment includes topical therapy with podophyllin for HPV lesions or surgical excision and medical treatment of lichen planus with topical cortisones, immunosuppressants or aloe vera-based gels.</b><br/> text/html 2018-02-24T07:59:01+01:00 Tatiana Oystacher, Drew Blasco, Emily He, Debbie Huang, Rebekkah Schear, Devon McGoldrick, Bruce Link, Lawrence Hsin Yang [Research] - Understanding stigma as a barrier to accessing cancer treatment in South Africa: implications for public health campaigns - 25 January 2018. <b>INTRODUCTION: Cancer contributes to significant illness burden in South Africa, with delayed diagnosis resulting from limited knowledge of cancer, lack of biomedical treatment and stigma. This study examines ways in which people are identified as having cancer through perspectives of traditional healing or the biomedical model. Additionally, we sought to understand the stigma associated with cancer, including stereotypes, anticipated discrimination and coping styles. METHODS: Livestrong foundation conducted 11 semi-structured focus groups with key community stakeholders in three South African townships. Interviews examined the negative consequences of being labeled with a cancer diagnosis as well as causes of, possible prevention of and barriers and methods to improve access to cancer treatment. Analyses were completed using directed content analysis. RESULTS: interviews revealed three main labeling mechanisms: physical appearance of perceived signs/symptoms of cancer, diagnosis by a traditional healer, or a biomedical diagnosis by a Western physician. Being labeled led to anticipated discrimination in response to prevalent cancer stereotypes. This contributed to delayed treatment, use of traditional healers instead of biomedical treatment and secrecy of symptoms and/or diagnosis. Further, perceptions of cancer were commonly conflated with HIV/TB owing to prior educational campaigns. CONCLUSION: our study deepens the understanding of the cancer labeling process in South Africa and the resulting negative effects of stigma. Future anti-stigma interventions should partner with traditional healers due to their respected community status and consider how previous health interventions may significantly impact current understandings of illness.</b><br/> text/html 2018-02-24T07:59:01+01:00 Hailemariam Feleke, Girmay Medhin, Almaz Abebe, Birhan Beyene, Helmut Kloos, Daniel Asrat [Research] - Enteric pathogens and associated risk factors among under-five children with and without diarrhea in Wegera District, Northwestern Ethiopia - 24 January 2018. <b>INTRODUCTION: Childhood diarrhea is highly prevalent in slums in developing countries, but it remains understudied. The objectives of this study were to explore the prevalence of Giardia, rotavirus and bacterial enteropathogens among diarrheic and non-diarrheic children and investigate socio-environmental determinants of diarrhea in two Ethiopian towns. METHODS: a cross-sectional study was conducted from June to October 2016. Prevalence of childhood diarrhea was established using information gathered during interviews with mothers/guardians. Saline wet mounts of fresh stool samples were used to test for the presence of Giardia. Stool samples were cultured on MacConkey agar and suspected colonies were characterized using biochemical tests. Susceptibility testing was done by the disk diffusion method. ELISA was used to screen for rotavirus. RESULTS: a total of 225 children were included in this study. Four enteropathogens (Giardia, rotavirus, Shigella and Salmonella) were identified from 31% (35/112) diarrheic and 12% (14/113) from non-diarrheic children (p < 0.001). The prevalence of rotavirus infection was 18.0% among diarrheic children and 3.3% among non-diarrheic children unvaccinated against rotavirus (p < 0.01). The prevalence of Giardia was 21.0% among diarrheic and 8.0% among non-diarrheic children (p < 0.01). Diarrheic children had significantly higher rates of bloody stool (p < 0.02), vomiting, fever and breastfeeding for children beyond 23 months of age (p < 0.001). Giardia and rotavirus were identified in more diarrheic than non-diarrheic children. CONCLUSION: the high prevalence of Giardia and rotavirus in the study area indicates the need for coordinated healthcare activities in the two communities. Vaccination against rotavirus infections and educational interventions are recommended.</b><br/> text/html 2018-02-24T07:59:01+01:00 Audrey Manto, Anastase Dzudie, Marie Patrice Halle, L&eacute;opold Ndemnge Aminde, Martin Hongieh Abanda, Gloria Ashuntantang, Kathleen Ngu Blackett [Research] - Agreement between home and ambulatory blood pressure measurement in non-dialysed chronic kidney disease patients in Cameroon - 24 January 2018. <b>INTRODUCTION: Home blood pressure measurement (HBPM) is not entirely capable of replacing ambulatory blood pressure (BP) measurement (ABPM), but is superior to office blood pressure measurement (OBPM). Although availability, cost, energy and lack of training are potential limitations for a wide use of HBPM in Sub-Saharan Africa (SSA), the method may add value for assessing efficacy and compliance in specific populations. We assessed the agreement between HBPM and ABPM in chronic kidney disease (CKD) patients in Douala, Cameroon. METHODS: from March to August 2014, we conducted a cross sectional study in non-dialyzed CKD patients with hypertension. Using the same devices and methods, the mean of nine office and eighteen home (during three consecutive days) blood pressure readings were recorded. Each patient similarly had a 24-hour ABPM. Kappa statistic was used to assess qualitative agreement between measurement techniques. RESULTS: forty-six patients (mean age: 56.2 ± 11.4 years, 28 men) were included. The prevalence of optimal blood pressure control was 26, 28 and 32% for OBPM, HBPM and ABPM respectively. Compared with ABPM, HBPM was more effective than OBPM, for the detection of non-optimal BP control (Kappa statistic: 0.49 (95% CI: 0.36 - 0.62) vs. 0.22 (95%CI: 0.21 - 0.35); sensitivity: 60 vs 40%; specificity: 87 vs. 81%). CONCLUSION: HBPM potentially averts some proportion of BP misclassification in non-dialyzed hypertensive CKD patients in Cameroon.</b><br/> text/html 2018-02-24T07:59:01+01:00 Oussama Baraket, Wissem Triki, Karim Ayed, Sonia Ben Hmida, Mohamed Amine Lahmidi, Abdelamjid Baccar, Samy Bouchoucha [Case series] - Facteurs th&eacute;rapeutiques affectant la cicatrisation au cours des gangr&egrave;nes du p&eacute;rin&eacute;e - 24 January 2018. <b>Les gangr&egrave;nes du Fournier est une fasc&eacute;ite n&eacute;crosante rare et grave. Elle est grev&eacute;e d'une lourde morbi-mortalit&eacute; n&eacute;cessitant une prise en charge m&eacute;dico-chirurgicale rapide et &eacute;nergique. Le traitement initial repose sur la r&eacute;animation associ&eacute;e au d&eacute;bridement chirurgical. Secondairement le probl&egrave;me majeur reste la cicatrisation et les s&eacute;quelles que gardent les patients. Plusieurs modalit&eacute;s th&eacute;rapeutiques sont actuellement disponibles a fin d'am&eacute;liorer et acc&eacute;l&eacute;rer la cicatrisation. Notre &eacute;tude r&eacute;trospective a collig&eacute; 20 cas. L'&acirc;ge m&eacute;dian dans notre s&eacute;rie &eacute;tait d 56 ans. Il y avait 16 hommes et 7 femmes. Une comorbidit&eacute; &eacute;tait pr&eacute;sente chez 15 patients. L'antibioth&eacute;rapie a &eacute;t&eacute; entreprise dans tous les cas avec une dur&eacute;e m&eacute;diane de 15 jours Le traitement chirurgical &eacute;tait entrepris dans tous les cas. Des r&eacute;visions it&eacute;ratives &eacute;taient n&eacute;cessaires chez tous les patients avec une m&eacute;diane de 3 changements de pansements. Une colostomie &eacute;tait r&eacute;alis&eacute;e dans 6 cas. Une oxyg&eacute;noth&eacute;rapie hyperbare &eacute;tait r&eacute;alis&eacute;e dans 4 cas. Une vaco-th&eacute;rapie dans 1 cas. Un geste de recouvrement cutan&eacute; &eacute;tait n&eacute;cessaire dans 2 cas. La dur&eacute;e m&eacute;diane de cicatrisation &eacute;tait de 15 jours avec l oxyg&eacute;noth&eacute;rapie versus 24 jours en l absence de ce traitement. La dur&eacute;e m&eacute;diane d'hospitalisation &eacute;tait de 20 jours. Quatre d&eacute;c&egrave;s ont &eacute;t&eacute; d&eacute;nombr&eacute;s dans cette s&eacute;rie. L obtention d'une cicatrisation sans s&eacute;quelles est un chalenge dans la prise en charge th&eacute;rapeutique. Malgr&eacute; l'adjonction de nouvelles modalit&eacute;s th&eacute;rapeutique ses r&eacute;sultats restent non satisfaisants. Cependant une approche multidisciplinaire associ&eacute;e &agrave; une oxyg&eacute;noth&eacute;rapie et une vac-th&eacute;rapie pourrait am&eacute;liorer les r&eacute;sultats chez ces patients.</b><br/> text/html 2018-02-24T07:59:01+01:00 Ary&eacute; Weinberg, Andreas Eberhard Albers [Images in medicine] - Facial subcutaneous tumor - 24 January 2018. <b>A 66-year-old woman presented with a group of painless round-shaped solid lesions underneath her right eye measuring 3 x 1 cm (A). The lesions increased in size over the past 2 months. Apart form a curatively treated larynx carcinoma the patient was healthy. Histology form the excised (B) lesion revealed epidermal cysts. Epidermal cysts are benign subcutaneous tumors. They can appear in every part of the body. In the facial region, they are quite common. Never the less differential diagnosis may include cutaneous metastasis, merkel cell carcinoma and cutaneous B-cell lymphoma should be considered among others. Therefore, complete excision and diagnosis based on histology is recommended.</b><br/> text/html 2018-02-24T07:59:01+01:00 Rachidi Alaoui Siham, Zeriouel Asmae [Images in medicine] - Une dyspn&eacute;e r&eacute;v&eacute;lant une laryngopyoc&egrave;le - 24 January 2018. <b>La laryngoc&egrave;le est une pathologie rare. Elle consiste en une dilatation anormale de l'appendice ou saccule ventriculaire de Morgagni. Sa taille est variable. Petite, elle est g&eacute;n&eacute;ralement asymptomatique. Lorsqu'elle est de grande taille, elle peut se manifester sous la forme d'une masse cervicale, ant&eacute;rolat&eacute;rale et paralaryng&eacute;e. L'imagerie reposant sur la tomodensitom&eacute;trie permet de faire le diagnostic. Sa prise en charge est encore discut&eacute;e. En effet, le traitement endoscopique au laser CO2 a gagn&eacute; beaucoup d'int&eacute;r&ecirc;t ces derni&egrave;res ann&eacute;es. Nous rapportons ici l'observation clinique d'une jeune femme de 24 ans, qui pr&eacute;sente depuis quatre ans une dyspn&eacute;e intermittente L'examen endoscopique montre une augmentation du bombement de la bande ventriculaire droite associ&eacute;e &agrave; un œd&egrave;me de l'aryt&eacute;no&iuml;de. Une TDM cervicale avec injection du produit de contraste a &eacute;t&eacute; r&eacute;alis&eacute;e et a objectiv&eacute; une collection hypodense bien limit&eacute;e en regard du cartilage thyro&iuml;de droit prenant le contraste en p&eacute;riph&eacute;rie sans lyse osseuse ni cartilagineuse. Elle refoule la vall&eacute;cule &agrave; gauche avec une discr&egrave;te infiltration de la graisse avoisinante. Le diagnostic laryngopyoc&egrave;le &agrave; d&eacute;veloppement interne est &eacute;voqu&eacute;, confirmant les donn&eacute;es de l'examen clinique. Une antibioth&eacute;rapie et une corticoth&eacute;rapie ont &eacute;t&eacute; initi&eacute;es en attendant la chirurgie par cervicotomie puisque une marsupialisation par voie endoscopique n'est pas possible &agrave; cause de non disponibilit&eacute; du laser.</b><br/> text/html 2018-02-24T07:59:01+01:00 Siham Alaoui Rachidi, Asmae Zeriouel [Images in medicine] - Tumeur r&eacute;nale ou py&eacute;lon&eacute;phrite xanthogranulomateuse pseudotumorale - 24 January 2018. <b>Un homme &acirc;g&eacute; de 55 ans qui consulte pour une colique n&eacute;phr&eacute;tique droite, avec des ant&eacute;c&eacute;dents de lombalgies intermittentes. &Agrave; l'admission, on a trouv&eacute; un contact lombaire positif. L'&eacute;chographie r&eacute;nale a objectiv&eacute; une masse h&eacute;t&eacute;rog&egrave;ne au p&ocirc;le inferieur du rein droit avec une dilatation des groupes caliciels inferieurs. La tomodensitom&eacute;trie abdominale a confirm&eacute; la pr&eacute;sence d'une l&eacute;sion r&eacute;nale droite polaire inferieure h&eacute;t&eacute;rodense associ&eacute;e &agrave; une importante hydron&eacute;phrose laminant le parenchyme r&eacute;nal en amont d'une volumineuse lithiase py&eacute;lique coralliforme. Le patient a b&eacute;n&eacute;fici&eacute; d'une n&eacute;phrectomie dont l'analyse anatomo-pathologique a r&eacute;v&eacute;l&eacute; un envahissement du parenchyme r&eacute;nal par un infiltrat inflammatoire chronique form&eacute; de macrophages associ&eacute;s &agrave; des monocytes, lymphocytes avec des cellules spongieuses et de la fibrose. Cet aspect &eacute;tait compatible avec le diagnostic de py&eacute;lon&eacute;phrite xanthogranulomateuse. La py&eacute;lon&eacute;phrite xanthogranulomateuse est une entit&eacute; de py&eacute;lon&eacute;phrite chronique relativement rare dont la symptomatologie prend souvent une forme pseudotumorale. Le diagnostic est suspect&eacute; sur un faisceau d'arguments cliniques et biologiques et peut &ecirc;tre &eacute;voqu&eacute; presque exclusivement sur l'examen tomodensitom&eacute;trique pr&eacute;op&eacute;ratoire. Le cancer du rein &eacute;tant son principal diagnostic diff&eacute;rentiel.</b><br/> text/html 2018-02-24T07:59:01+01:00 Saoussane Kharmoum, Meryem Soughi [Images in medicine] - Une toxidermie mimant un lupus &eacute;ryth&eacute;mateux aig&uuml;e chimio-induit - 24 January 2018. <b>Le Lupus &eacute;ryth&eacute;mateux aigue(LEA) chimio-induit est une affection rare, quelques cas ont &eacute;t&eacute; rapport&eacute; dans la litt&eacute;rature incriminant la capecitabine, le paclitaxel et le docetaxel. Nous rapportons le cas d’une patiente &acirc;g&eacute;e de 64 ans suivie pour carcinome canalaire invasif du sein droit, d’embl&eacute; m&eacute;tastatique au niveau h&eacute;patique et ganglionnaire, sans ant&eacute;c&eacute;dents de maladies auto-immunes ou d’allergie m&eacute;dicamenteuse. Apr&egrave;s une premi&egrave;re ligne de chimioth&eacute;rapie type AC60 (6 cures au total), elle a re&ccedil;u le docetaxel &agrave; la dose de 100 mg/m2, apr&egrave;s 5 cures elle a pr&eacute;sent&eacute; des l&eacute;sions &eacute;ryth&eacute;mateuses diffuses au niveaux des deux mains, des avants bras, des deux joues et en p&eacute;ribuccale, elle a &eacute;t&eacute; mise sous corticoth&eacute;rapie avec protection solaire, on a pu poursuivre la m&ecirc;me chimioth&eacute;rapie jusqu’&agrave; la huiti&egrave;me cure. L’&eacute;volution a &eacute;t&eacute; marqu&eacute; par la progression de sa maladie elle a &eacute;t&eacute; mise sous capecitabine &agrave; la dose de 1250 mg/m2 deux fois par jours, apr&egrave;s six cures elle a pr&eacute;sent&eacute; des plaques &eacute;ryth&eacute;mateux-squameuse et prurigineuse du visage, dispos&eacute;e en aille de papillon avec ulc&eacute;ration buccale et pulpite des doigts (Panel C) faisant &eacute;voqu&eacute; en premier un lupus &eacute;ryth&eacute;mateux cutan&eacute; aigue chimio-induit. Une biopsie a &eacute;t&eacute; r&eacute;alis&eacute;e qui &eacute;tait en faveur d’une toxidermie lich&eacute;noide. Un bilan immunologique a &eacute;t&eacute; demand&eacute; pour &eacute;liminer un LEA chimio-induit, objectivant des anticorps anti DNA natif et des anticorps anti-histones n&eacute;gatifs, les anticorps anti-nucl&eacute;aires sont positives &agrave; 320, ces derniers peuvent &ecirc;tre positives dans 50 &agrave; 70% des cas de cancer mammaire, ORL ou lymphome. Au vu de ces r&eacute;sultats le diagnostic de toxidermie est le plus probable.</b><br/> text/html 2018-02-24T07:59:01+01:00 Fridah Ntinyari Tait, Charles Mburu, Joseph Gikunju [Research] - Occupational safety and health status of medical laboratories in Kajiado County, Kenya - 23 January 2018. <b>INTRODUCTION: Despite the increasing interest in Occupational Safety and Health (OSH), seldom studies are available on OSH in medical laboratories from developing countries in general although a high number of injuries occur without proper documentation. It is estimated that every day 6,300 people die as a result of occupational accidents or work-related diseases resulting in over 2.3 million deaths per year. Medical laboratories handle a wide range of materials, potentially dangerous pathogenic agents and exposes health workers to numerous potential hazards. This study evaluated the status of OSH in medical laboratories in Kajiado County, Kenya. The objectives included establishment of biological, chemical and physical hazards; reviewing medical laboratories control measures; and enumerating factors hindering implementation of good practices in OSH. METHODS: this was a cross-sectional descriptive study research design. Observation check lists, interview schedules and structured questionnaires were used. The study was carried out in 108 medical laboratories among 204 sampled respondents. Data was analysed using statistical package for social science (SPSS) 20 software. RESULTS: the commonest type of hazards in medical laboratories include; bacteria (80%) for Biological hazards; handling un-labelled and un-marked chemicals (38.2%) for chemical hazards; and laboratory equipment's dangerously placed (49.5%) for Physical hazards. According to Pearson's Product Moment Correlation analysis, not-wearing personal protective equipment's was statistically associated with exposure to hazards. Individual control measures were statistically significant at 0.01 significance level. Only 65.1% of the factors influencing implementation of OSH in medical laboratories were identified. CONCLUSION: training has the highest contribution to good OSH practices.</b><br/> text/html 2018-02-24T07:59:01+01:00 Yosr Chaabouni, Sourour Yaich, Azza Khedhiri, Mohamed Ali Zayen, Mahmoud Kharrat, Khawla Kammoun, Faical Jarraya, Mohamed Ben Hmida, Jamal Damak, Jamil Hachicha [Research] - Profil épidémiologique de l’insuffisance rénale chronique terminale dans la région de Sfax - 22 January 2018. <b>INTRODUCTION: L’insuffisance r&eacute;nale chronique terminaleest un v&eacute;ritable probl&egrave;me mondial de Sant&eacute; publique. En Tunisie, le co&ucirc;t de la prise en charge des patients dialys&eacute;s pour l’ann&eacute;e 2011 a d&eacute;pass&eacute; les 90 millions de dinars (37000 Euro), soit pr&egrave;s de 5% des d&eacute;penses globales de sant&eacute;. Une meilleure connaissance du profil &eacute;pid&eacute;miologique de l’insuffisance r&eacute;nale chronique terminale va contribuer &agrave; l’&eacute;laboration et &agrave; l’&eacute;valuation des strat&eacute;gies sanitaires visant &agrave; am&eacute;liorer la pr&eacute;vention et la prise en charge de cette maladie. L’objectif de notre travail est de d&eacute;crire le profil &eacute;pid&eacute;miologique des cas incidents dans le gouvernorat de Sfax sur une p&eacute;riode de 10 ans. METHODES: Il s’agit d’une &eacute;tude descriptive r&eacute;trospective allant de Janvier 2003 &agrave; D&eacute;cembre 2012. Nous avons inclus les cas incidents d’insuffisance r&eacute;nale chronique terminale dans le gouvernorat de Sfax. RESULTATS: Le diagnostic d’insuffisance r&eacute;nale chronique terminale a &eacute;t&eacute; port&eacute; &agrave; 1708 cas. Il s’agit de 957 hommes et 751 femmes (sex-ratio=1,27). L’&acirc;ge moyen &eacute;tait de 58,4ans [10-100ans]. L’&eacute;tude de l’&eacute;volution de l’&acirc;ge moyen durant la p&eacute;riode &eacute;tudi&eacute;e a montr&eacute; une tendance vers la hausse avec un indice de corr&eacute;lation positive (0,749) et p=0,006. La principale n&eacute;phropathie causale &eacute;tait la n&eacute;phropathie diab&eacute;tique (21,5%), avec une augmentation significative de sa fr&eacute;quence d’une ann&eacute;e &agrave; l’autre (un coefficient de corr&eacute;lation positive (0,770) avec p=0,009). L’h&eacute;modialyse &eacute;tait la technique de dialyse de choix, entreprise chez 96% des patients. CONCLUSION: Un registre national reste indispensable afin de mieux comprendre le profil &eacute;pid&eacute;miologique de l’insuffisance r&eacute;nale chronique terminale en Tunisie et de pouvoir am&eacute;liorer sa prise en charge.</b><br/> text/html 2018-02-24T07:59:01+01:00 Sarafadeen Adeniyi Arisegi, Kehinde Joseph Awosan, Mansur Oche Oche, Anas Ahmad Sabir, Mohammed Taofeek Ibrahim [Research] - Knowledge and practices related to stroke prevention among hypertensive and diabetic patients attending specialist hospital, Sokoto, Nigeria - 22 January 2018. <b>INTRODUCTION: Stroke has become a problem of public health importance worldwide. Knowledge and practices related to stroke prevention among hypertensive and diabetic patients are important in the control of the disease. In Nigeria, recent reports indicate an emerging epidemic of stroke. This study aimed to determine the knowledge and practices related to stroke prevention among hypertensive and diabetic patients in Sokoto, Nigeria.</b><br/> text/html 2018-02-24T07:59:01+01:00 Mahtat El Mehdi, Safae Regragui, Hicham Eddou, Selim Jennane, Hicham El Maaroufi, Kamal Doghmi, Mohamed Mikdame [Case report] - Erdheim-Chester disease: a rare histiocytosis (case report and review of the literature) - 22 January 2018. <b>We report a case of Erdheim-chester disease, a rare non-langerhans histiocytosis revealed by polydipsia-polyuria syndrome in a 26 years old woman, trated by interferon with a good response.</b><br/> text/html 2018-02-24T07:59:01+01:00 Abdou-Rahim Ouro-Koura, Emmanuel Ghislain Sopoh, Jer&ocirc;me Charles Sossa, Yolaine Gl&egrave;l&egrave;-Ahanhanzo, Victoire Agueh, Edgard-Marius Ouendo, Laurent Ouedraogo [Research] - Evaluation de la performance du syst&egrave;me de gestion logistique des intrants de lutte contre le paludisme dans le D&eacute;partement du Littoral, au B&eacute;nin, en 2017 - 22 January 2018. <b>INTRODUCTION: Cette &eacute;tude visait &agrave; &eacute;valuer la performance du syst&egrave;me de gestion logistique (SGL) des intrants de lutte contre le paludisme (ILP) dans le d&eacute;partement du Littoral, au B&eacute;nin, en 2017. METHODES: Il s’agissait d’une &eacute;tude transversale &eacute;valuative qui s’&eacute;tait d&eacute;roul&eacute;e en juin 2017. Elle portait sur les structures de stockage et de cession des ILP ainsi que le personnel impliqu&eacute; dans leur gestion. La performance du SGL &eacute;tait &eacute;valu&eacute;e &agrave; partir de la conformit&eacute; observ&eacute;e pour les composantes et sous-composantes de la « Structure », du « Processus » et des « R&eacute;sultats » par rapport aux normes ou standards d&eacute;finis par le Minist&egrave;re de la Sant&eacute;. RESULTATS: Un total de 36 structures a &eacute;t&eacute; enqu&ecirc;t&eacute; avec leurs cibles secondaires. Il r&eacute;sulte que 52,78% des d&eacute;p&ocirc;ts r&eacute;partiteurs r&eacute;unissaient les conditions optimales de stockage des intrants alors que seulement 33,33% des agents charg&eacute;s de la gestion des ILP &eacute;taient form&eacute;s en gestion logistique. La performance du SGL des ILP &eacute;tait insuffisante (conformit&eacute; de 59,13% par rapport au score attendu). La structure, ainsi que le processus avaient une conformit&eacute; Insuffisante par rapport aux normes (respectivement 60,20% et 73,22% du score attendu), engendrant des r&eacute;sultats jug&eacute;s mauvais (41,53% du score attendu). La sous-composante la plus insuffisante &eacute;tait le syst&egrave;me d’information de la gestion logistique (SIGL). CONCLUSION: Cette &eacute;tude met en &eacute;vidence la place du SIGL pour une meilleure performance de la gestion des ILP. Une attention particuli&egrave;re devra &ecirc;tre accord&eacute;e &agrave; ce volet.</b><br/> text/html 2018-02-24T07:59:01+01:00 Gurmeet Singh, Stephanie Gita Wulansari [Research] - Pattern of bacterial and fungal pathogen in patients with high risk for invasive fungal disease in an indonesian tertiary care hospital: an observational study - 22 January 2018. <b>INTRODUCTION: in critically ill patients, there is a defect in host defense mechanism resulting in increased susceptibility to bacterial and fungal infection. The pattern of organisms causing infections varies between different countries and hospitals; therefore it is important that every hospital generates antibiograms to guide healthcare professionals during treatment with optimal choice of antibiotics. Our study aimed to described the pattern of fungal and bacterial pathogen in patients with high risk for invasive fungal disease [IFD]. METHODS: an observational study was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, within March-September 2015. Specimens were taken from blood, sputum, endotracheal aspiration, bronchoalveolar lavage [BAL], urine, pus and drainage fluid/surgical tissue specimen on 5<sup>th</sup>-7<sup>th</sup> day of hospitalization. Samples were cultured onto suitable culture media and bacterial isolates were identified using standard biochemical methods. RESULTS: bacteria and Candida sp. were isolated from 153 patients. C. tropicalis (44.31%) was the commonest fungal isolated. Incidence of gram-negative bacteria was higher than gram-positive bacteria. Klebsiella pneumonia was the most common gram-negative bacteria isolated, where as Enterococcus faecalis for gram-positive bacteria. CONCLUSION: critically ill patients were vulnerable to contracted fungal and bacterial pathogen. Candida non-albicans and Gram-negative bacteria were the most common pathogen detected among critically ill patients with high risk for IFD.</b><br/> text/html 2018-02-24T07:59:01+01:00 Samia Frioui, Faycel Khachnaoui [Images in medicine] - Posterior epidural migration of a lumbar disk: an entity not to ignore - 22 January 2018. <b>Discal hernia with posterior epidural migration is exceptional. Its diagnosis is difficult and often takes the form of an intraspinal tumor lesion. It has a various clinical manifestations. The association of this entity to a cauda equina syndrome found as isolated cases which were reported in the literature. MRI with injection is the best diagnostic tool. We must always consider this diagnosis in front of a posterior epidural mass with a peripheral enhancement on the contrast-enhanced images. Emergency surgery is needed to prevent serious neurological deficits. We report the case of a 29-year old patient who presented an acute lumbo-sciatica associated with a deficit of both lower limbs and urinary incontinence after lifting a heavy load. Clinical examination revealed a motor deficit of the triceps surae and in the relievers of the foot rated 1 in bilateral sides, hypoesthesia at the anterolateral part of the two legs and the feet, weak or abolished tendon reflexes, anesthesia in the saddle, hypotonic anal sphincter and bladder distension. MRI of the lumbar spine showed a right lumbar discal hernia (L3-L4) excluded with right posterior epidural migration compressing the dural sheath. Surgical treatment was undertaken in emergency: a decompression and herniectomy were performed. A partial sensor-motor recovery was observed. After ten months, the patient still has had a distal deficit of both lower limbs, bladder sphincter disorders for which it is under self-intermittent catheterization.</b><br/> text/html 2018-02-24T07:59:01+01:00 Abdelkader Jalil El Hangouche, Oumaima Alaika [Images in medicine] - "Non parasitic hypereosinophilia revealing biventricular endomyocardial fibrosis" - 22 January 2018. <b>We report a case of a 7-year-old boy, without medical history, who presented a low weight-to-height ratio associated with effort dyspnea class III and hepatalgia. The physical examination objectified signs of right sided heart failure including jugular venous dilatation, congested hepatomegaly, an ascite, without peripheral oedema. At cardiac auscultation, the heartbeats were well perceived, with a breath of tricuspid regurgitation (grade 4/6). The blood pressure was 100/60 mm Hg. The pulmonary auscultation was normal. The electrocardiogram showed a paroxysmal atrial fibrillo-flutter with ventricular rate of 95 beats/min. The chest X-ray showed a cardiomegaly with an important auricles dilatation. The blood analysis objectified iron deficiency anemia and hypereosinophilia of 600/mm3. The liver and renal function tests were normal. The copro-parasitological examination was normal. Given the patient poor echo window, the transthoracic echocardiography hardly objectified, in two-dimension mode, dilated atria and hyperechogenic dense biventricular apical fibrosis. The systolic function of left ventricle and right ventricle was normal. The doppler echocardiography showed tricuspid and mitral restrictive inflow patterns with moderate pulmonary hypertension. The diagnosis of endomyocardial fibrosis was made and consolidated by findings of the cardiovascular magnetic resonance imaging (CMR) that objectified a restrictive cardiomyopathy with dilated atria and biventricular apical obliteration (A). In delayed enhancement sequences, we found apical sub-endocardial late gadolinium enhancement involving both the left ventricle and the right ventricle suggesting fibrosis (B) with left ventricular apical thrombus (C). The patient has received a medical therapy including diuretics and anticoagulant and was referred to undergo endocardiectomy.</b><br/> text/html 2018-02-24T07:59:01+01:00 Nahid Azdaki, Seyedali Moezi, Marjan Farzad [Case report] - Pulmonary tuberculosis: a differential diagnostic priority in unprovoked deep venous thrombosis patients with haemoptysis - 22 January 2018. <b>Deep vein thrombosis (DVT) is a common cause of death worldwide. Several factors are associated with increased risk of DVT. In this report a case of deep venous thrombosis (DVT) of the lower limb and its link with underlying pulmonary tuberculosis is described in a young male patient with haemoptysis.</b><br/> text/html 2018-02-24T07:59:01+01:00 Houcine Maghrebi, Hamida Maghraoui, Amine Makni, Amine Sebei, Sabri Ben Fredj, Ali Mrabet, Kamel Majed, Nabiha Falfoul, Zoubeir Bensafta [Research] - Int&eacute;r&ecirc;t du score d’Alvarado dans le diagnostic des appendicites aig&uuml;es - 22 January 2018. <b>INTRODUCTION: L’appendicite aigue repr&eacute;sente l’urgence chirurgicale la plus fr&eacute;quente aux urgences. Son diagnostic est avant tout clinique. Cependant, sa pr&eacute;sentation clinique parfois trompeuse ainsi que le large &eacute;ventail de diagnostics diff&eacute;rentiels sont fr&eacute;quemment sources d’erreurs diagnostiques et de retard de prise en charge. Afin de pallier &agrave; ces difficult&eacute;s diagnostiques, de r&eacute;duire le nombre d’examens compl&eacute;mentaires et d’actes chirurgicaux abusifs, plusieurs scores cliniques ont &eacute;t&eacute; ainsi d&eacute;velopp&eacute;s, dont le score d’Alvarado. L’objectif de cette &eacute;tude &eacute;tait d’appliquer ce score &agrave; une population de patients adultes venant consulter pour douleurs de la fosse iliaque droite afin d’&eacute;valuer ses performances ainsi que ses limites. METHODES: il s’agissait d’une &eacute;tude prospective qui a inclus tous les malades &acirc;g&eacute;s de plus de 15 ans se pr&eacute;sentant pour douleur de la fosse iliaque droite. Le diagnostic final d'appendicite aigue a &eacute;t&eacute; confirm&eacute; par examen anatomo-pathologique pour les patients op&eacute;r&eacute;s et infirm&eacute; lorsque la symptomatologie des patients avait totalement r&eacute;gress&eacute; en l'absence de tout traitement. RESULTATS: notre &eacute;tude a inclus 106 patients. Chez les patients dont le score d'Alvarado &eacute;tait inf&eacute;rieur &agrave; 4, le diagnostic d'appendicite aig&uuml;e n'a jamais &eacute;t&eacute; retenu. Les meilleures sensibilit&eacute;s et sp&eacute;cificit&eacute;s ont &eacute;t&eacute; retrouv&eacute;es pour une valeur seuil de 8 pour le score d'Alvarado. Ainsi, avec une bonne sensibilit&eacute; (81,25%) et une valeur pr&eacute;dictive positive correcte (74,28%), notre &eacute;tude a d&eacute;montr&eacute; que le score d’Alvarado pouvait apporter un b&eacute;n&eacute;fice dans le diagnostic d'appendicite aig&uuml;e. Le groupe de patient avec un score strictement inf&eacute;rieur &agrave; 4 est consid&eacute;r&eacute; comme &agrave; faible risque. Les patients dont le score d'Alvarado &eacute;tait strictement sup&eacute;rieur &agrave; 6 n&eacute;cessiteraient une hospitalisation afin, soit d'&ecirc;tre op&eacute;rer d'embl&eacute;e, soit de compl&eacute;ter par un examen d'imagerie et une surveillance. Le groupe de patient ayant un score compris entre 4 et 6 (limites incluses), reste un groupe o&ugrave; le doute diagnostic est pr&eacute;sent et o&ugrave; les examens compl&eacute;mentaires d'imagerie ont un apport certain. CONCLUSION: l’utilisation du score d'Alvarado dans nos urgences permet de rationaliser la prise en charge et d’orienter le diagnostic en limitant la prescription d’explorations radiologiques, le co&ucirc;t de la prise en charge et les actes chirurgicaux abusifs.</b><br/> text/html 2018-02-24T07:59:01+01:00 Mohammed Amine Benatta [Images in medicine] - Abouchement s&eacute;par&eacute; du canal pancr&eacute;atique principale et du chol&eacute;doque: est- il synonyme de cholangiographie r&eacute;trograde par voie endoscopique facile? - 21 January 2018. <b>C'est une Papille pro&eacute;minente dont l'examen endoscopique objective deux orifices distincts qui repr&eacute;sente un abouchement s&eacute;par&eacute; du canal pancr&eacute;atique principale et du chol&eacute;doque (A). Il s'agit de la variante anatomoendoscopique la plus rare avec une fr&eacute;quence de seulement 10% au cours des cholangiopancreatographies r&eacute;trogrades par voie endoscopique (CPRE). Pour autant cela allait il faciliter le cath&eacute;t&eacute;risme biliaire s&eacute;lectif (CBS) chez notre patient comme on aurait pu le suppos&eacute;. La papille telle qu'elle se pr&eacute;sente avec cet aspect pseudo polypoide et un orifice biliaire (OB) en position d'angle droit par rapport au mur duod&eacute;nal &eacute;tait plus difficile d'acces au contraire de l'orifice pancr&eacute;atique (OP) qui s'y pr&ecirc;tait plut&ocirc;t facilement mais in&eacute;vitablement a un cath&eacute;t&eacute;risme pancr&eacute;atique non d&eacute;sir&eacute; (B). Le CBS ayant &eacute;t&eacute; notre objectif les techniques sp&eacute;ciales a envisager devant ce cas pr&eacute;cis &eacute;taient: soit la sphinct&eacute;rotomie transpancr&eacute;atique (STP) seule soit la STP apr&egrave;s mise place d'une Proth&egrave;se Pancr&eacute;atique (PP). Ayant opter pour la seconde technique STP + PP nous avons r&eacute;aliser que des la mise en place de la PP cela a permis de mieux exposer l'OB (C). Le CBS a &eacute;t&eacute; finalement obtenu sans recourir a la STP. Dans ce cas pr&eacute;cis comme dans d'autres cas de CBS difficile dans notre pratique, la PP a prouver son int&eacute;r&ecirc;t.</b><br/> text/html 2018-02-24T07:59:01+01:00 Abdullah Ebrahim Laher, Feroza Motara, Mike Wells [Research] - Locating the mental foramen at the bedside with point of care ultrasound imaging - 21 January 2018. <b>INTRODUCTION: Ultrasound guided neuro-anaesthesia is a developing field of interest to clinicians from various disciplines. The objective of this proof of concept study was to explore the ability, ease and rapidity of ultrasonography in locating the mental foramen. METHODS: a convenience sample of 100 patients aged 18 years or older, with no known pathology to the mandibular region, that presented to a single urban ED were enrolled. All patients underwent an ultrasound examination on both sides of the face to locate the mental foramina. RESULTS: a total of 100 patients' mental foramina were studied. Mean age was 35.7 years (SD 9.1 years), 50% were black and 25% each were asian and white. The mental foramina were ultrasonographically identified in all (100%) of the subjects in the study group. Although requiring a larger quantity of ultrasound gel, the mental foramina were also visualized in all twelve subjects with facial hair. Three out of the 100 subjects were noted to have accessory mental foramina. The overall mean time taken to locate the first mental foramen in each patient was 16.1 seconds (SD 12.9 seconds). For the first 25 subjects studied, the mean time taken was 34.7 seconds (SD 13.4 seconds), whereas for the next 75 subjects studied, the mean time taken was 9.9 seconds (SD 3.0 seconds). CONCLUSION: bedside ultrasound imaging is a potentially reliable method to identify and locate the mental foramen. With practice and experience, the mental foramen can be more easily identified.</b><br/> text/html 2018-02-24T07:59:01+01:00 Sara Elloudi, Hanane Baybay, Salim Gallouj, Fatima Zohra Mernissi [Case series] - Scl&eacute;rodermie localis&eacute;e: &agrave; propos de 24 cas - 19 January 2018. <b>La morph&eacute;e ou scl&eacute;rodermie localis&eacute;e est d&eacute;finie par un &eacute;tat scl&eacute;reux de la peau pouvant s’&eacute;tendre aux tissus sous-cutan&eacute;s mais sans ph&eacute;nom&egrave;ne de Raynaud ni atteinte visc&eacute;rale. Certaines formes cliniques peuvent avoir un retentissement fonctionnel et esth&eacute;tique, d’o&ugrave; l’int&eacute;r&ecirc;t d’une prise en charge pr&eacute;coce au stade inflammatoire. Nous d&eacute;crivons les caract&eacute;ristiques &eacute;pid&eacute;mio-cliniques, th&eacute;rapeutiques et &eacute;volutives des diff&eacute;rentes formes de morph&eacute;e &agrave; travers une s&eacute;rie de 24 cas.</b><br/> text/html 2018-02-24T07:59:01+01:00 Attila Frigy [Images in medicine] - Giant left atrium causing severe dysphagia - 19 January 2018. <b>A 65 years old men with mechanical mitral prosthesis (implanted for rheumatic valve disease) was referred to our clinic with signs of advanced heart failure and associated severe dysphagia. This symptom started a couple of years before and became worsened in the last months causing severe difficulties in alimentation, both for solid and liquid foods. Echocardiography revealed a normofunctional mitral prosthesis, a dilated left ventricle with severe systolic dysfunction (EF 15%) and a giant left atrium (A-parasternal long axis view, left atrial postero-anterior diameter = 80mm, B-apical four chamber view, left atrial longitudinal diameter = 105mm). The X-ray examination with barium of the upper gastrointestinal tract demonstrated significant lumen reduction in the middle and lower part of the esophagus (C), corresponding to the external compression caused by the huge left atrium. The explanations for the severely enlarged left atrium would be the late valvular intervention (also suggested by the dilated and dysfunctional left ventricle) and the progression of left atrial remodeling due to chronic inflammation. The patient was referred to esophageal balloon dilation and stent implantation.</b><br/> text/html 2018-02-24T07:59:01+01:00 Petros Ioannou [Images in medicine] - A 29-year old man with abdominal pain - 19 January 2018. <b>A 29-year old man with a history of hypertrophic cardiomyopathy with an implanted cardiac defibrillator due to previous ventricular tachycardia and a family history of sudden cardiac death presented to the Emergency Department because of severe left sided abdominal pain that was non-colicky and was not associated with food. The patient denied urinary frequency, hematuria, vomiting or diarrhea and had normal bowel movements. At clinical examination he was afebrile, with a normal blood pressure, a heart rate of about 100bpm while he had left upper quadrant tenderness at the examination of the abdomen, without rebound tenderness, while the abdominal sounds were normal. Complete blood count revealed leukocytosis with a white blood cell count of 13.800 cells, while transaminases, bilirubin, amylase and urine chemistry were normal. An electrocardiogram showed sinus tachycardia. A computed tomography of the thorax and the abdomen with intravenous contrast was performed and revealed an infarct of the spleen as the cause for the left upper quadrant abdominal pain. A representative image is shown in (A). The patient was admitted and a heart ultrasound revealed the presence of a thrombus in the left ventricle. Splenic infarction is an unusual condition that has been described in almost any age, is mostly associated with hematologic disorders in patients less than 40 years old and with thromboembolic disease in older patients. Other causes are splenic vascular disease, collagen vascular disease, anatomic abnormalities, pancreatic disease and solid tumors.</b><br/> text/html 2018-02-24T07:59:01+01:00 Adelin Nzudjom Foche, Fidele Nyimi Bushabu, Charles Mfutu Mana, Ramazani Haruna, Steve Sekele Masin, Monique Nsudila, Paul Bobe Alifi, Pierre Muyembi Muinamiyi, Jean Paul Sekele Isourady Burley [Research] - Occurrence des traumatismes alv&eacute;olo-dentaires aux cliniques universitaires de Kinshasa: deuxi&egrave;me partie, &eacute;tude pr&eacute;liminaire de 93 cas - 18 January 2018. <b>INTRODUTION: L'objectif de cette &eacute;tude &eacute;tait d'analyser les caract&eacute;ristiques &eacute;pid&eacute;miologiques cliniques des fractures alv&eacute;olo-dentaires aux cliniques universitaires de Kinshasa/RDC. METHODES: &eacute;tude transversale de 7 ans, r&eacute;alis&eacute;e dans le d&eacute;partement d'odontostomatologie, service de stomatologie et de chirurgie maxillo-faciale/cliniques universitaires de Kinshasa de Janvier 2007 &agrave; D&eacute;cembre 2014. RESULTATS: sur les 93 dossiers collig&eacute;s, le sexe masculin &eacute;tait pr&eacute;dominant (66,7%) et l'&acirc;ge le plus pr&eacute;valent se situait entre 20 ans et 29 ans. Les causes les plus fr&eacute;quentes ont &eacute;t&eacute; les agressions/rixes (52,7%) et la luxation dentaire a &eacute;t&eacute; le type des l&eacute;sions la plus fr&eacute;quente avec 52,7%. La RX retro-alv&eacute;olaire &eacute;t&eacute; r&eacute;alis&eacute;e dans 75,7%, et le blocage mono-maxillaire fut le type de traitement le plus r&eacute;alis&eacute; (60,2%). CONCLUSION: l'analyse de profil clinique des traumatismes alv&eacute;olo-dentaires aux cliniques universitaires de Kinshasa est celui d'un adulte jeune de sexe masculin, pr&eacute;sentant des luxations dentaires des maxillaires dont les causes sont les agressions/rixes.</b><br/> text/html 2018-02-24T07:59:01+01:00 Abdurrahman Abdulkadir, Ejikeme Felix Mbajiorgu, Trust Nyirenda [Research] - Effects of concurrent chloroquine and ethanol administration on the rat kidney morphology - 18 January 2018. <b>INTRODUCTION: The use of antimalarial chloroquine in malaria-endemic regions of Africa is rampant and it is not uncommon to find individuals taken the drug concurrent with alcohol. Effects of anti-malarial drug chloroquine (Chq) and ethanol (Et) combination on kidney volume and function using rat model was investigated. METHODS: 32 adult male rats were randomly distributed into four groups of 8 rats each. Group C serve as control and received vehicle only, while Q is Chq treated only, E is Et treated and QE is Et and Chq treated. Chq was administered intraperitoneally at 1mg/100g body weight weekly and 6% Et in drinking water provided ad libitum. Urine volume was collected before the treatment began and after the treatment. After eight weeks, all animals were euthanized; kidneys were harvested and fixed in 10% neutral formalin. The fixed left kidneys were scanned with computed tomography and the scan slices were used to estimate 3-dimensional kidney volume on ImageJ. RESULTS: total kidney volume was none significantly increased in Q, E and QE treated compared to control groups (p = 0.5150). Also, microscopic analysis showed increased proximal tubule diameter (p = 0.1426) and epithelial hypertrophy (p = 0.2530) and significant urinary space shrinkage (p = 0.00001). The initial urine volume was not significantly different between the control and treated groups (p = 0.9864) however, following treatment urine volume was significantly reduced in QE rats group (p = 0.0029). CONCLUSION: the results suggest chloroquine and ethanol combination as potential cause of kidney injury through structural damage and function derangement.</b><br/> text/html 2018-02-24T07:59:01+01:00 Yetunde Ajoke Onimode, David Magbagbeola Dairo, Annare Ellmann [Research] - Pattern of presentation of Graves’ disease and response to radioiodine therapy in South African men - 18 January 2018. <b>INTRODUCTION: typically hyperthyroidism has been more often associated with the female gender. There is a large female predilection (male:female sex ratio up to 1:10), with little documentation in the literature about wholly male hyperthyroid populations. A male incidence of 0.7 per 100, 000 has been reported for South African men while the women have a relatively higher rate of 0.02. There is no documented evidence of differences in response to treatment of PH with radioactive iodine (RAI), although operational evidence suggests that hyperthyroidism in males is less amenable to RAI treatment (RAIT) than females. This study therefore proposed to evaluate male hyperthyroid patients with Graves’ disease (GD) treated at our facility, for factors affecting outcome of RAI. METHODS: this is a retrospective analysis of records of hyperthyroid patients who were treated with RAI over a 19-year period at a university teaching hospital, in the Western Cape of South Africa. RESULTS: the overall cure rate was 76.4% for these male patients. Cure was observed as euthyroidism in 31 patients (15.3%) and hypothyroidism in 129 (63.5%). Age, thyroid uptake, severity of hyperthyroidism, previous antithyroid drug (ATD) usage, administered quantity of RAI, ethnicity and patients’ pulse at presentation were not significant in influencing outcome. CONCLUSION: factors which have been evaluated as affecting outcome of RAIT were unimportant in these patients. Despite the mainly hyperthyroid presentation of the patients, RAIT was so effective that the main type of cure after therapy was hypothyroidism.</b><br/> text/html 2018-02-24T07:59:01+01:00 Abdelmajid Bouzerda [Review] - Risque cardiovasculaire et syndrome d’apn&eacute;es obstructives du sommeil - 18 January 2018. <b>Le syndrome d'apn&eacute;es obstructives du sommeil (SAOS) touche environ 4% des hommes et 2% des femmes d'&acirc;ge moyen mais beaucoup de ces patients ne sont ni diagnostiqu&eacute;s ni trait&eacute;s. Une morbidit&eacute; et une mortalit&eacute; cardio et c&eacute;r&eacute;brovasculaires sont associ&eacute;es aux apn&eacute;es du sommeil. La notion de lien de causalit&eacute; s'est confirm&eacute;e ces derni&egrave;res ann&eacute;es sur des donn&eacute;es &eacute;pid&eacute;miologiques, exp&eacute;rimentales et th&eacute;rapeutiques. La pr&eacute;valence dans la population g&eacute;n&eacute;rale et l'impact sur la gen&egrave;se et l'&eacute;volution de l'hypertension art&eacute;rielle syst&eacute;mique et pulmonaire, des troubles du rythme cardiaque, de la maladie coronarienne, de l'insuffisance cardiaque et des accidents vasculaires c&eacute;r&eacute;braux doivent inciter &agrave; diagnostiquer et &agrave; traiter pr&eacute;cocement les troubles respiratoires du sommeil et si possible &agrave; les pr&eacute;venir.</b><br/> text/html 2018-02-24T07:59:01+01:00 Rodolfo Mendes Queiroz, Fred Bernardes Filho [Images in medicine] - Hand injury from pneumatic needle gun - 18 January 2018. <b>A 37-year-old male complained of pain and swelling of his left hand for 7 days. He was a woodworker and reported that he was using a pneumatic needle gun when the pain began. The patient claimed to have seen a scorpion in the workplace and he believed to have suffered a sting. Initially he sought an emergency room, where hydrocortisone and ketoprofen were administered, and loratadine was prescribed. Because it does not show improvement with seven days of loratadine, he sought the dermatology service. On physical examination, heat, redness and swelling of whole left hand was observed. Dermoscopy with a handheld dermoscope (DermLite II Pro 3Gen) showed a single puncture wound over volar surface of the third left metacarpal. Hand X-ray revealed a foreign body in soft tissue of third left metacarpal. The diagnosis of hand injury from pneumatic needle gun was made. Foreign body was identified and removed. Intravenous antibiotics were administered pre-operatively and oral antibiotics continued post-operatively. Nail gun injuries commonly occur related to improper use by the operator and not following occupational health and safety requirements for operating a nail gun. The amount of energy required to cause serious injury is fairly low: penetration of the skin occurs with projectile velocities of 150 feet per second, whereas bony fractures may occur with projectile velocities of 195 feet per second. Mechanisms of nail gun injury include direct penetration, shrapnel wounds from exploding cartridges and high-pressure injection injuries from the compressed air used to activate the gun. Assessment of a patient with a puncture wound and suspected foreign body begins with a careful history and physical examination.</b><br/> text/html 2018-02-24T07:59:01+01:00 Haddad Souad, Frimeche Zahia, Lakehal Abdelhak, Sifi Karima, Satta Dalila, Abadi Noureddine [Research] - Descriptive study of triple negative breast cancer in Eastern Algeria - 18 January 2018. <b>INTRODUCTION: triple-negative breast cancer (TNBC) is characterized by the lack of estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 (HER-2) expression. It is aggressive and most common in African women. In this study we identified the frequency, clinical an pathological characteristics of this type in a cohort of women in eastern Algeria. METHODS: we conducted a retrospective study between January 2010 and December 2015 at the regional hospital of Constantine in eastern Algeria. Among 472 women with breast cancer, 102 women had a TNBC. Clinical and pathological features and overall survival were analyzed. RESULTS: 21.61% of patients had TNBC with a median age of 52 years. 65.31% of the patients were menopausal. Only 6.82% of women had a family history of breast cancer. The majority of patients had infiltrating ductal carcinoma (96.08%), the proportion of grade III SBR was 53.92%. The average tumor size was 4.4cm and 70.1% of the tumors had a very large size (T2 and T3). 69.07% of patients had positive lymph nodes, vascular invasion was found in 48.57% of cases. Metastatic sites were bone in 16.13% of cases, hepatic in 3.26% and pulmonary in 0.98%. For treatment modalities, 95.24% underwent surgery and adjuvant chemotherapy. 33.33% of patients have received neoadjuvant chemotherapy with 29% of complete pathologic response (pCR) and 96.97% have received radiotherapy. Overall Survival (OS) for all patients at 5 years was 45.2%. CONCLUSION: most of our results are in accordance with literature data, however we noted some discrepancies. In this study, TNBC is more common in menopausal women than non menopausal women and characterized by a low rate of visceral metastases and a lower overall survival at 5 years.</b><br/> text/html 2018-02-24T07:59:01+01:00 Sonia Douamba, Fatimata Diallo, Kisito Nagalo, Laure Tamini, Lassina Dao, Fla Kou&eacute;ta, Diarra Y&eacute; [Research] - Les leuc&eacute;mies aigu&euml;s lymphoblastiques de l’enfant &agrave; Ouagadougou (Burkina Faso): r&eacute;sultats de la prise en charge selon le protocole du Groupe Franco-Africain d’Oncologie P&eacute;diatrique 2005 - 18 January 2018. <b>INTRODUCTION: La leuc&eacute;mie aigu&euml; lymphoblastique (LAL) de l'enfant est une pathologie de plus en plus diagnostiqu&eacute;e dans notre service. Dans les pays d&eacute;velopp&eacute;s, le traitement de cette h&eacute;mopathie maligne permet de gu&eacute;rir pr&egrave;s de 80% des enfants. Dans les pays en d&eacute;veloppement, peu d'&eacute;tudes sont consacr&eacute;es aux leuc&eacute;mies aigu&euml;s chez l'enfant. Les r&eacute;sultats du traitement des cancers de l'enfant sont d&eacute;cevants dans la plupart des pays africains avec un taux de survie de l'ordre de 10 &agrave; 15%. Le but de cette &eacute;tude &eacute;tait d'&eacute;tudier les aspects cliniques, biologiques, th&eacute;rapeutiques et &eacute;volutifs des cas de LAL de l'enfant. METHODES: il s'agissait d'une &eacute;tude r&eacute;trospective sur dossiers des enfants hospitalis&eacute;s pour LAL entre Novembre 2009 et Octobre 2011 dans l'unit&eacute; pilote d'oncologie p&eacute;diatrique du Centre Hospitalier Universitaire P&eacute;diatrique Charles De Gaulle de Ouagadougou (Burkina Faso). Etaient inclus, les enfants pris en charge selon le protocole du Groupe Franco-Africain d'Oncologie P&eacute;diatrique (GFAOP) 2005. RESULTATS: au total, neuf cas de LAL &eacute;taient hospitalis&eacute;s pendant les deux ann&eacute;es &eacute;tudi&eacute;es. L'&acirc;ge moyen des patients &eacute;tait 10,77 ans ± 2,82 ans. On notait une pr&eacute;dominance masculine. Le d&eacute;lai moyen d'hospitalisation &eacute;tait 43,11 jours ± 39,54 jours. Les principaux signes d'appel &eacute;taient l'alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral et la fi&egrave;vre. Le syndrome tumoral et d'insuffisance m&eacute;dullaire &eacute;taient pr&eacute;sents chez la quasi-totalit&eacute; des patients. Six des neuf patients pr&eacute;sentaient une LAL de type 1 au my&eacute;logramme. Huit patients ont b&eacute;n&eacute;fici&eacute; de la chimioth&eacute;rapie selon le protocole du GFAOP 2005. L'&eacute;volution &eacute;tait favorable chez deux patients avec une r&eacute;mission, quatre patients &eacute;taient en &eacute;chec de traitement. Six patients sont d&eacute;c&eacute;d&eacute;s. CONCLUSION: gr&acirc;ce &agrave; des campagnes d'information qui contribueront &agrave; amener la population &agrave; consulter pr&eacute;cocement, au renforcement des capacit&eacute;s du personnel qui permettra un diagnostic pr&eacute;coce des LAL, la construction d'un centre d'oncologie p&eacute;diatrique suffisamment &eacute;quip&eacute; et une subvention par l'Etat burkinab&egrave; des m&eacute;dicaments anticanc&eacute;reux, la prise en charge de la LAL chez l'enfant permettraient d'obtenir de meilleurs r&eacute;sultats.</b><br/> text/html 2018-02-24T07:59:01+01:00 Houcine Maghrebi, Amin Makni, Amin Sebai, Faouzi Chebbi, Wael Rebai, Amin Daghfous, Rachid Ksantini, Mohamed Jouini, Montassar Kacem, Zoubeir Ben Safta [Case series] - R&eacute;sultats de la chirurgie laparoscopique pour la hernie de l’aine: l’exp&eacute;rience Tunisienne - 17 January 2018. <b>La hernie de l'aine de l'adulte reste une affection fr&eacute;quente en chirurgie digestive. De nombreuses techniques de r&eacute;paration ont &eacute;t&eacute; d&eacute;crites &agrave; ce jour dont les proc&eacute;d&eacute;s laparoscopiques. Deux m&eacute;thodes furent rapidement adopt&eacute;es par les diff&eacute;rents praticiens pour le traitement chirurgical des hernies de l'aine par laparoscopie: la m&eacute;thode laparoscopique totalement extra p&eacute;riton&eacute;ale (TEP) et la m&eacute;thode laparoscopique transp&eacute;riton&eacute;ale (TAPP). Le but &eacute;tait d'&eacute;tudier la faisabilit&eacute; de la cure de hernie de l'aine par cœlioscopie et de d&eacute;crire ses r&eacute;sultats du point de vue r&eacute;cidive herniaire et douleur post op&eacute;ratoire. Ce travail &eacute;tait une &eacute;tude r&eacute;trospective, uni centrique, et transversale, portant sur des patients op&eacute;r&eacute;s par des chirurgiens du service de chirurgie A La Rabta pour hernie de l'aine par voie laparoscopique, sur une p&eacute;riode de 8 ans allant de janvier 2006 &agrave; d&eacute;cembre 2013. Le principal crit&egrave;re de jugement &eacute;tait la r&eacute;cidive herniaire. La douleur post op&eacute;ratoire et les complications &eacute;taient les crit&egrave;res de jugement secondaires. Nous avons collig&eacute;s 104 hernies chez 92 patients respectant les crit&egrave;res d'inclusion de notre &eacute;tude. La moyenne d'&acirc;ge de nos patients &eacute;tait de 48 Ans (19-83). L'approche TAPP &eacute;tait la plus utilis&eacute;e: 94 cas (90%) TAPP contre 10 cas TEP. Aucune complication per op&eacute;ratoires n'a &eacute;t&eacute; signal&eacute;e. Le taux de conversion de notre s&eacute;rie &eacute;tait nul. La mortalit&eacute; op&eacute;ratoire &eacute;tait aussi nulle. La morbidit&eacute; postop&eacute;ratoire &eacute;tait de 5% (5 patients). Elle &eacute;tait &agrave; type d'h&eacute;matome dans 3 cas et de s&eacute;rum dans 2 cas. La dur&eacute;e moyenne d'hospitalisation &eacute;tait de 1.2 jours (1-4jours). Le s&eacute;jour post op&eacute;ratoire n'avait pas d&eacute;pass&eacute; 2 jours chez 94% des patients. Seulement 2 patients avaient pr&eacute;sent&eacute; une r&eacute;cidive. Les douleurs chroniques postop&eacute;ratoires &eacute;taient not&eacute;es chez seulement 3 patients. Notre &eacute;tude a montr&eacute; que la cure de hernie de l'aine par laparoscopie a apport&eacute; un confort consid&eacute;rable &agrave; nos patients en ce qui concerne les ph&eacute;nom&egrave;nes douloureux, les dur&eacute;es d'hospitalisation et d'arr&ecirc;t de travail. Les r&eacute;sultats obtenus dans cette s&eacute;rie sont bons et conformes aux r&eacute;sultats d&eacute;j&agrave; publi&eacute;s dans la litt&eacute;rature. Ceci nous encourage &agrave; poursuivre l'utilisation de ces techniques et &agrave; contr&ocirc;ler nos r&eacute;sultats &agrave; plus long terme.</b><br/> text/html 2018-02-24T07:59:01+01:00 Théophile Mitima Kashosi , Archippe Birindwa Muhandule, David Lupande Mwenebitu , Nicolas Mihuhi, John Kivukuto Mutendela, Kanigula Mubagwa [Research] - Antibio-résistance des souches de Salmonella spp isolées des hémocultures à Bukavu en RD Congo - 17 January 2018. <b>INTRODUCTION: La fi&egrave;vre typho&iuml;de est un probl&egrave;me majeur de sant&eacute; publique dans les pays en voie de d&eacute;veloppement jusqu'&agrave; ce jour &agrave; cause de la v&eacute;tust&eacute; des infrastructures sanitaires et des circuits de distribution de l'eau presque inexistant. En RDC en g&eacute;n&eacute;ral et &agrave; Bukavu en particulier, l'h&eacute;moculture est inaccessible &agrave; la majorit&eacute; des patients. L'objectif de cette &eacute;tude &eacute;tait d'&eacute;valuer la sensibilit&eacute; de Salmonella spp aux antibiotiques couramment utilis&eacute;s dans la prise en charge de la Fi&egrave;vre Typho&iuml;de &agrave; Bukavu.</b><br/> text/html 2018-02-24T07:59:01+01:00 Fatima Ihbibane, Ntini Lebi Ars&egrave;ne, Latifa Adarmouch, Mohamed Amine, Noura Tassi [Research] - Evaluation de la prise en charge de l’&eacute;rysip&egrave;le par les m&eacute;decins g&eacute;n&eacute;ralistes de la ville de Marrakech - 17 January 2018. <b>INTRODUCTION: L'&eacute;rysip&egrave;le est la plus fr&eacute;quente des dermohypodermites bact&eacute;riennes non n&eacute;crosantes (DHBNN). L'objectif de notre travail est d'&eacute;valuer l'ad&eacute;quation des connaissances des m&eacute;decins g&eacute;n&eacute;ralistes avec les donn&eacute;es de la litt&eacute;rature sur la prise en charge diagnostique et th&eacute;rapeutique de l'&eacute;rysip&egrave;le.</b><br/> text/html 2018-02-24T07:59:01+01:00 Asmâa Biaz, Mohammed Drissi, Aissam El Maataoui, Samira El Machtani Idrissi, Sanae Bouhsain, Abdellah Dami, Abdellatif Boulahya, Zohra Ouzzif [Research] - Seuil de positivit&eacute; de la troponine i cardiaque dans le diagnostic de l’IDM p&eacute;ri-op&eacute;ratoire apr&egrave;s chirurgie cardiaque sous circulation extra-corporelle chez l’adulte - 17 January 2018. <b>INTRODUCTION: L'objectif de cette &eacute;tude prospective, r&eacute;alis&eacute;e sur une ann&eacute;e au laboratoire de biochimie de l'HMIMV de Rabat, vise &agrave; &eacute;tudier la cin&eacute;tique de la Troponine Ic (TnIc) apr&egrave;s chirurgie cardiaque sous circulation extracorporelle (CEC) en vue d'&eacute;tablir des valeurs seuils pour le diagnostic d'infarctus de myocarde p&eacute;ri-op&eacute;ratoire (IDMPO). METHODES: nous avons inclus 58 patients op&eacute;r&eacute;s pour chirurgie valvulaire ou pontage coronarien sous CEC. Ces patients ont &eacute;t&eacute; s&eacute;par&eacute;s en 3 groupes selon l'&eacute;volution clinique, biologique (TnIc) et &eacute;lectrique durant la p&eacute;riode post op&eacute;ratoire pr&eacute;coce. Nous avons dos&eacute; et suivi la cin&eacute;tique de la TnIc par une technique immuno-enzymatique, au moyen du r&eacute;actif FlexR CTNI avant et apr&egrave;s la CEC, &agrave; H0, H3, H6, H12, H21, H24 et H72 sur l'automate Dimension Xpand plusR de la soci&eacute;t&eacute; Siemens. RESULTATS: les r&eacute;sultats obtenus sont plus &eacute;lev&eacute;s qu'en cardiologie, m&ecirc;me chez le groupe des patients sans complications cardiaques post op&eacute;ratoires, avec un taux moyen de TnIc environ 2,5 fois sup&eacute;rieur &agrave; la valeur seuil en cardiologie. La cin&eacute;tique de lib&eacute;ration est significativement diff&eacute;rente entre les 3 groupes (p‹0,05). CONCLUSION: la valeur seuil que nous proposons pour confirmer le diagnostic de l'IDMPO est de 13ng/ml obtenue entre H12 et H24. Nous recommandons, de ce fait, un &agrave; deux pr&eacute;l&egrave;vements vers H12 puis entre H20 et H24.</b><br/> text/html 2018-02-24T07:59:01+01:00 Houda Ennaifer, Manel Jemel, Hejer Kandar, Wafa Grira, Ines Kammoun, Leila Ben Salem [Case report] - Developed diplopia due to a pituitary macroadenoma during pregnancy - 17 January 2018. <b>Physiologic pituitary enlargement is common during normal pregnancy. However, symptoms such as diplopia, blurred vision and headache resulting from physiologic pituitary enlargement are very rare during pregnancy. A 43-year-old woman complained of sudden headache and left eye ptosis at 36th weeks of gestation. An magnetic resonance imaging (MRI) demonstrated the pituitary enlargement and a macroadenoma without a compressing of the optic chiasm, but with an extension to the left cavernous sinus. 48 hours after the prescription of the bromocriptine, we had a spectacular evolution with disappearance of the headache and a total regression of the ptosis. We report a case of visual loss due to the physiologic pituitary enlargement or to the macroadenoma during pregnancy, which regressed after the prescription of bromocroptine.</b><br/> text/html 2018-02-24T07:59:01+01:00 Anselme Alfred Dabilgou, Julie Marie Adeline Kyelem [Images in medicine] - Rupture h&eacute;morragique d’une malformation arterioveineuse g&eacute;ante chez un sujet jeune &agrave; Ouagadougou - 17 January 2018. <b>Les malformations vasculaires art&eacute;riole-veineuses sont des pathologies vasculaires agressives pr&eacute;sentant un risque h&eacute;morragique lourd de cons&eacute;quence en termes de morbi-mortalit&eacute;. Les MAV sont en majorit&eacute; sporadiques. Le mode de r&eacute;v&eacute;lation de la MAV est une h&eacute;morragie dans 50% des cas. A travers cet article, nous rapportons l'observation clinique d'un patient de 28 ans, hospitalis&eacute; dans le service de neurologie du CHU Yalgado Ou&eacute;draogo pour d&eacute;ficit moteur de l'h&eacute;micorps droit d'installation brutale accompagn&eacute; de trouble de la conscience. Dans les ant&eacute;c&eacute;dents, on notait des c&eacute;phal&eacute;es chroniques trait&eacute;es par autom&eacute;dication et des crises &eacute;pileptiques bravais jacksoniennes droites. L'examen neurologique &agrave; l'entr&eacute;e retrouvait une h&eacute;mipl&eacute;gie droite proportionnelle, une aphasie de Broca, une ophtalmologie gauche douloureuse avec ptosis, un ch&eacute;mosis gauche et un syndrome m&eacute;ning&eacute; f&eacute;brile avec une fi&egrave;vre &agrave; 40°C. Le score NIHSS &eacute;tait &agrave; 21/42 et un score ICH &agrave; 2 &agrave; l'entr&eacute;e. Le scanner c&eacute;r&eacute;bral en urgence montrait une h&eacute;morragie c&eacute;r&eacute;brale des noyaux gris centraux et du tronc c&eacute;r&eacute;bral, une inondation intra-ventriculaire et des citernes de la base. L'h&eacute;mogramme notait une hyperleucocytose &agrave; 13 200/mm3 &agrave; pr&eacute;dominance granulocytaire (72.6%). La radiographie pulmonaire montrait une pneumopathie droite de type alv&eacute;olaire. L'intradermo-reaction (IDR) &agrave; la tuberculine &eacute;tait positive &agrave; 17mm. L'angioscanner c&eacute;r&eacute;brale &agrave; distance (J24) retrouvait une malformation arterio-veineuse des art&egrave;res c&eacute;r&eacute;brales moyennes et vert&eacute;brales post&eacute;rieures et une thrombose du sinus caverneux.</b><br/> text/html 2018-02-24T07:59:01+01:00 Anthony Adeseye Adeniran, Omolade Oluwafadekemi Adegoke, Akinwumi Oluwole Komolafe [Case report] - Cardiac tamponade complicating thoracocentesis: a case for image-guided procedure - 16 January 2018. <b>We present a case of cardiac tamponade that was precipitated by thoracocentesis and discovered at autopsy.</b><br/> text/html 2018-02-24T07:59:01+01:00 Bahia Belatar, Fatna Laidi, Abdelah El Abidi, Rachid Eljaoudi, Fouzia Mamouch, Saad Kabbaj, Wajdi Maazouzi [Research] - Serum levels of Selenium and C-reactive protein in comatose patients with severe traumatic brain injury during the first week of hospitalization: case-control study - 16 January 2018. <b>INTRODUCTION: mortality and morbidity related to traumatic brain injuries still remain high in patients. Many authors reported the importance of Selenium in maintaining the integrity of brain functions. This fact is supported by clinical evidence that therapy with selenium supplementation could help patients suffering from brain disorders like neurodegenerative diseases. The aim of our study was to assess the relationship between Selenium concentration in serum and evolution of comatose patients with severe traumatic brain injury, in the first week of admission, and the correlation between selenium and C-reactive protein. METHODS: this case-control study was conducted with 64 comatose patients with TBI,in the Department of Anesthesiology and Reanimation, IbnSina University Hospital and Hospital of specialties in Rabat-Morocco, and healthy volunteers recruited in Blood transfusion center of Rabat. Blood sampling was collected from TBI patients, in the first week (3h after admission and each 48h during one week), and from healthy volunteers one time. Concentration of Se in serum was determined by electrochemical atomic absorption spectrometry. Statistical analysis was performed using Statistical software (SPSS) and the cases and controls were compared using the Mann–Whitney U test. A P-value <0.05 was considered to be statistically significant. RESULTS: comparison selenium concentration in the first day (D0), third day (D2) and fifth day according to the death and survival statue in patients did not show statistical significance (p>0.05). Selenium concentration of D0 in patients and Selenium concentration in control group also did not show statistical significance (p>0.05). Similarly, we did not report a correlation between selenium and C-reactive protein. CONCLUSION: according to our data selenium and CRP may not play a role in progression of coma state in patients with severe traumatic brain injury.</b><br/> text/html 2018-02-24T07:59:01+01:00 Antoine Lamblin, Marc Bascou, Eve Drouard, Nicolas Alberti, Thierry de Greslan [Case report] - Thrombolyse d’un AVC isch&eacute;mique vert&eacute;bro-basilaire &agrave; N’Djamena, R&eacute;publique du Tchad - 16 January 2018. <b>L’accident vasculaire c&eacute;r&eacute;bral isch&eacute;mique est une pathologie rare chez les militaires fran&ccedil;ais, mais les m&eacute;decins militaires projet&eacute;s en op&eacute;rations ext&eacute;rieures peuvent &ecirc;tre amen&eacute;s &agrave; en prendre en charge, notamment en Afrique Sub-Saharienne. D&egrave;s lors, il s’agit d’une urgence vitale n&eacute;cessitant de r&eacute;agir rapidement avec des moyens limit&eacute;s, de fa&ccedil;on multidisciplinaire avec les m&eacute;decins neurologues de France m&eacute;tropolitaine, afin d’assurer au patient une prise en charge optimale. Nous rapportons le cas d’un patient victime d’un accident vasculaire c&eacute;r&eacute;bral isch&eacute;mique sur le territoire vert&eacute;bro-basilaire, trait&eacute; par thrombolyse intraveineuse.</b><br/> text/html 2018-02-24T07:59:01+01:00 Joseph Bulanda Nsambi, Olivier Mukuku, Jean-de-Dieu Foma Yunga, Xavier Kinenkinda, Prosper Kakudji, Justin Kizonde, Jean-Baptiste Kakoma [Case series] - Fistules obst&eacute;tricales dans la province du Haut-Katanga, R&eacute;publique D&eacute;mocratique du Congo: &agrave; propos de 242 cas - 16 January 2018. <b>Les fistules obst&eacute;tricales constituent un probl&egrave;me majeur de Sant&eacute; Publique dans les pays pauvres. L’objectif de ce travail est de d&eacute;crire les aspects &eacute;pid&eacute;miologiques, cliniques et th&eacute;rapeutiques des fistules obst&eacute;tricales dans la province du Haut-Katanga, R&eacute;publique D&eacute;mocratique du Congo. L’&eacute;tude est transversale descriptive, portant sur 242 patientes souffrant de la fistule obst&eacute;tricale dans la province du Haut-Katanga durant la p&eacute;riode allant de Septembre 2009 &agrave; D&eacute;cembre 2013. Les param&egrave;tres &eacute;tudi&eacute;s &eacute;taient les donn&eacute;es sociod&eacute;mographiques maternelles, les param&egrave;tres obst&eacute;tricaux et n&eacute;onatals, les caract&eacute;ristiques sp&eacute;cifiques de la fistule ainsi que les modalit&eacute;s et l’issue de la prise en charge. Les variables ont &eacute;t&eacute; analys&eacute;es sur logiciel Epi-info version 7.1. Des 242 cas de fistules, 229 patientes ont accouch&eacute; par voie basse soit 95% d’entre elles et 74,6% &agrave; domicile. Le nouveau-n&eacute; &eacute;tait d&eacute;c&eacute;d&eacute; en p&eacute;riode p&eacute;rinatale dans 93,4% des accouchements. L’&acirc;ge moyen des patientes &eacute;tait de 27,9±10,3 ans. Environ une patiente sur six avait moins de 20 ans et dans l’ensemble pr&egrave;s d’une patiente sur 2 avait moins de 25 ans. 7 patientes sur 10 avaient une parit&eacute; inf&eacute;rieure &agrave; 3 et la parit&eacute; moyenne &eacute;tait de 2,5±2,0. Nonante pourcent des cas avaient un niveau d’&eacute;tudes bas et 95% vivaient seules. La fistule avait en moyenne plus de 4,7±4,4 ans d’&acirc;ge, &eacute;tait v&eacute;sico-vaginale (96%), de type 2-3 (37%) et r&eacute;par&eacute;e par voie vaginale (67%). Le taux d’&eacute;checs &eacute;tait de 14%. La fistule obst&eacute;tricale constitue un r&eacute;el probl&egrave;me de Sant&eacute; Publique dans notre milieu et m&eacute;rite une r&eacute;flexion profonde pour son &eacute;radication.</b><br/> text/html 2018-02-24T07:59:01+01:00 Ahmed Daoudi, Najib Abbassi, Mounir Yahyaoui, Omar Agoumi, Abdeljaouad Najib, Abdelkarim Daoudi, Hicham Yacoubi [Case series] - Ost&eacute;otomie de Gauthier et fixation par ost&eacute;o-sutures dans le traitement de la maladie de Freiberg - 16 January 2018. <b>La maladie de Freiberg est une ost&eacute;ochondrose des t&ecirc;tes m&eacute;tatarsiennes, touchant le plus fr&eacute;quemment la deuxi&egrave;me t&ecirc;te. Les auteurs rapportent &agrave; travers une &eacute;tude r&eacute;trospective &eacute;tal&eacute;e sur trois ans, une s&eacute;rie de 06 patientes, dont l’&acirc;ge moyen est de 19,8 ans, op&eacute;r&eacute;es par une ost&eacute;otomie de soustraction dorsale selon Gauthier avec une fixation par des ost&eacute;osutures. Les r&eacute;sultats de cette technique sont satisfaisants vue que la majorit&eacute; de nos patientes ont retrouv&eacute; l’indolence et ont r&eacute;cup&eacute;r&eacute; une activit&eacute; quotidienne habituelle. Les auteurs ont conclu que la fixation par des ost&eacute;osutures est une m&eacute;thode fiable et peu co&ucirc;teuse.</b><br/> text/html 2018-02-24T07:59:01+01:00 Eddie Rekoronirina, Justin Rahariniaina, Fanjandrainy Rasoaherinomenjanahary [Research] - Facteurs associ&eacute;s &agrave; une premi&egrave;re grossesse chez les femmes Malgaches ayant accouch&eacute; dans un h&ocirc;pital de maternit&eacute; d’Antananarivo: une &eacute;tude de cohorte r&eacute;trospective - 16 January 2018. <b>INTRODUCTION: Il y a tr&egrave;s peu de litt&eacute;ratures africaines et Malgaches concernant les d&eacute;tails sur les facteurs de risques qu’encourent les primigestes en g&eacute;n&eacute;ral. Le but de notre &eacute;tude est de d&eacute;terminer les facteurs de risques potentiels associ&eacute;s &agrave; une premi&egrave;re grossesse. METHODES: une &eacute;tude cohorte r&eacute;trospective a &eacute;t&eacute; men&eacute;e aupr&egrave;s des femmes primigestes et multigestes de l’h&ocirc;pital Pavillon sainte Fleur entre Octobre 2014 et D&eacute;cembre 2016. Les risques relatifs &eacute;taient ajust&eacute;s apr&egrave;s contr&ocirc;le avec les caract&eacute;ristiques sociod&eacute;mographiques. RESULTATS: les primigestes &eacute;taient beaucoup plus expos&eacute;es &agrave; un travail prolong&eacute; de plus de 12h (RRa = 2,28; IC 95% 1,74-3,00), &agrave; une c&eacute;sarienne en urgence (RRa = 1,47; IC 95% 1,35-1,60) et &agrave; une &eacute;pisiotomie (RRa = 2,98; IC 95% 2,61-3,40). Leurs enfants &eacute;taient plus susceptibles de pr&eacute;senter des signes de souffrance fœtale avec anomalie du rythme cardiaque fœtale au cours de la phase de travail (RRa = 1,96; IC 95% 1,45-2,65) et un risque accru d’&ecirc;tre admis dans une unit&eacute; de soins intensifs apr&egrave;s l’accouchement (RRa = 2,08; IC 95% 1,25-3,45). CONCLUSION: les complications survenues pendant le travail auraient expos&eacute; les primigestes &agrave; d’autres risques en cascades sur l’issue de leurs accouchements et sur la sant&eacute; de leurs enfants. La prise en charge des primigestes n&eacute;cessiterait, de la part des personnels m&eacute;dicaux, une attention particuli&egrave;re sur la dur&eacute;e de la phase de travail.</b><br/> text/html 2018-02-24T07:59:01+01:00 Amadou Magagi, Harissou Adamou, Ibrahim Amadou Magagi, Maazou Halidou, Oumarou Habou, Hassane Moussa Diongol&eacute;, Maman Sani Rabiou, Mahaman Boukari Baoua [Case report] - Particularit&eacute; de l’anesth&eacute;sie pour cure chirurgicale du ph&eacute;ochromocytome: &agrave; propos d’un cas - 15 January 2018. <b>Nous rapportons la prise en charge d'une patiente de 37 ans, aux ant&eacute;c&eacute;dents d'hypertension art&eacute;rielle (HTA) mal suivie, adress&eacute;e en consultation chirurgicale avec une symptomatologie faite de lombalgies droites, de vertiges, de c&eacute;phal&eacute;es, de sueurs et de palpitations. Durant l'hospitalisation, la tension art&eacute;rielle (TA) oscillait entre 130/80 mm d'Hg et 190/120 mm d'Hg. Le reste de l'examen clinique ne retrouvait aucune autre anomalie. Le scanner thoraco-abdominal avait montr&eacute; une masse surr&eacute;nalienne de 55x45x65 mm comprimant la veine cave inf&eacute;rieure et la veine r&eacute;nale droite. Le dosage de l'acide vanyl-mand&eacute;lique urinaire (VMA) donnait un r&eacute;sultat de 11,8mg/24heures. Le dosage des cat&eacute;cholamines sanguin n'a pas &eacute;t&eacute; r&eacute;alis&eacute;. Le diagnostic d'un ph&eacute;ochromocytome &eacute;tait retenu et l'indication op&eacute;ratoire &eacute;tait pos&eacute;e. En consultation d'anesth&eacute;sie l'examen clinique retrouvait un bon &eacute;tat g&eacute;n&eacute;ral, une tension art&eacute;rielle (TA) &agrave; 190/120 mmHg, une auscultation cardiopulmonaire sans particularit&eacute; et un crit&egrave;re pr&eacute;dictif d'intubation non difficile (Mallampati II). La patiente a b&eacute;n&eacute;fici&eacute;e d'une pr&eacute;paration pr&eacute;op&eacute;ratoire &agrave; base d'alpha-bloquants et b&ecirc;ta-bloquants, et d'un inhibiteur calcique. La surr&eacute;nalectomie a &eacute;t&eacute; r&eacute;alis&eacute;e par laparotomie m&eacute;diane. Il n'y avait pas eu d'instabilit&eacute; h&eacute;modynamique lors de la mobilisation et de la r&eacute;section de la tumeur. Les suites op&eacute;ratoires imm&eacute;diates ont &eacute;t&eacute; simples. Elle a regagn&eacute; son domicile &agrave; J7 postop&eacute;ratoire. Avec un recul de 3 mois, la patiente ne pr&eacute;sentait plus de signes cliniques et ses chiffres tensionnels &eacute;taient normaux. L'anesth&eacute;sie pour la chirurgie du ph&eacute;ochromocytome est faisable m&ecirc;me en situation de ressources limit&eacute;es. Une bonne pr&eacute;paration du patient permet d'&eacute;viter les complications p&eacute;riop&eacute;ratoires.</b><br/> text/html 2018-02-24T07:59:01+01:00 Eugene Sobngwi, Noel D&eacute;sir&eacute;e Mbango, Eric Vounsia Balti, Francoise Ngo Sack, Vicky Ama Moor, Jean-Claude Mbanya [Short communication] - Relative adrenal insufficiency in adults with sickle cell disease - 12 January 2018. <b>Rheological modifications observed in sickle cell anemia are associated with ischemic complications that can cause target organ functional impairment. The objective was to investigate adrenal function of adult patients with sickle cell disease. In this cross-sectional study conducted in a tertiary referral hospital of the capital city of Cameroon, we enrolled ten crisis-free adult patients with sickle cell disease (SCD) and ten age- and sex-matched healthy individuals. We assessed adrenal function by testing basal cortisol levels and 60 min after tetracosactide (Synacthen®) injection using immuno-chemiluminescence method. Post-stimulatory cortisol was defined as primary endpoint and secondary endpoints include basal cortisol levels, post-stimulatory cortisol increments and the fold increase of cortisol one hour after stimulation. Sickle cell patients had an impairment of adrenal function despite no significant difference between patients’ and controls’ for basal or post-stimulatory cortisol levels. In fact, one patient in two failed to achieve a two-fold increase in cortisol levels after stimulation (5/10) as opposed to 1 in 10 in the control population (1/10), P = 0.070. The percent increment of cortisol after stimulation was lower in patients versus controls (133 vs 207, P = 0.047). Relative adrenal insufficiency is frequent in sub-Saharan adult patients with sickle cell disease despite normal basal cortisol levels. Our results suggest that adrenal function require further investigation during SCD crises as these represent an important stress and may worsen the prognosis.</b><br/> text/html 2018-02-24T07:59:01+01:00 Hassane Zejjari [Images in medicine] - Osteitis of the cuboid on unknown foreign body - 12 January 2018. <b>This is a patient aged 35 years old, farmer, who consults for chronic fistula of the soles lasting for three months without any notion of trauma. The review found a swelling of the outer edge of the foot of inflammatory appearance with pus coming through a fistula at the top. Plain radiography shows a well limited round osteolysis recalling the appearance of an abscess of Broca. The scanner confirms the osteolysis and highlights intra-osseous foreign body. The patient underwent surgical treatment by trimming, removal of a piece of wood and curettage of the bone cavity. The outcome was favorable with disappearance of infectious signs and filling the bone cavity.</b><br/> text/html 2018-02-24T07:59:01+01:00 Yaya Ouattara, Joseph Kon&eacute; [Images in medicine] - Lithiase v&eacute;sicale g&eacute;ante - 12 January 2018. <b>Patiente de 67 ans ayant consult&eacute; pour douleur hypogastrique avec une pollakiurie &eacute;voluant depuis plus de 12 mois. L'interrogatoire retrouvait un prolapsus g&eacute;nital, des &eacute;pisodes d'h&eacute;maturies et dysurie. L'&eacute;chographie objectivait une volumineuse formation d'allure lithiasique intra v&eacute;sicale &agrave; bordures irr&eacute;guli&egrave;res. Une cystotomie fut r&eacute;alis&eacute;e sous anesth&eacute;sie p&eacute;rim&eacute;dullaire permettant l'extraction d'un calcul de forme ovo&iuml;de de 7,2 cm de grand axe et 5,5 cm de petit axe.</b><br/> text/html 2018-02-24T07:59:01+01:00 Houssine Boufettal, Na&iuml;ma Samouh [Images in medicine] - Invasive hydatidiform mole in the cervix - 12 January 2018. <b>A patient aged 43-years, multiparous consulted for uterine bleeding of average abundance. The examination revealed a burgeoning lesion of the cervix, which came from the uterine endocervix, measuring two centimeters. The uterus was increased in size measuring 88 mm long and 67 mm in anteroposterior diameter. There were no adnexal mass. Pelvic ultrasound showed a heterogeneous snowflake mass measuring 29 mm in anteroposterior diameter. Beta-h-CG (human chorionic gonadotrophin) quantitative plasma were highly increased to 854212 IU / ml. Histological study of aspirate objectified a complete hydatidiform mole. The staging featuring a thoraco-abdominopelvic CT scan, chest radiography, ultrasound abdomen and pelvis was normal. Pathological examination of the hysterectomy piece objectified an invasive mole to cervical and uterine location. A methotrexate-based agent chemotherapy was introduced. The evolution was marked by the gradual decline of the mass until it disappearance within four months. Plasma beta-h-CG had regressed and were normalized after two months of treatment. The outcome was favorable. With a follow-up of 24 months, no recurrence was noted.</b><br/> text/html 2018-02-24T07:59:01+01:00 Magloire Nkosi Mpembi, Thierry Lukeba, Damien Mayemba, Victoria Kubuta Massamba, Thierry Matonda ma Nzuzi, Symphorien Gokara, Etienne Vermeiren, Gilbert Mananga Lelo, Samuel Mampunza ma Miezi [Research] - &Eacute;tats de stress en consultation externe &agrave; l’h&ocirc;pital g&eacute;n&eacute;ral de Bangui dans un contexte de conflit arme: &eacute;tude transversale descriptive - 12 January 2018. <b>INTRODUCTION: Dans les zones de conflit en Afrique les r&eacute;centes &eacute;tudes rapportent des fr&eacute;quences &eacute;lev&eacute;es des &eacute;tats de stress posttraumatiques (ESPT) notamment en milieu communautaire. L'objectif g&eacute;n&eacute;ral de cette &eacute;tude est de contribuer &agrave; une meilleure prise en charge des patients confront&eacute;s &agrave; la violence subs&eacute;quente au conflit sociopolitique en cours en R&eacute;publique centrafricaine. METHODES: Il s'agit d'une &eacute;tude transversale portant sur les dossiers des patients re&ccedil;us en consultation externe Trauma center de M&eacute;decins sans Fronti&egrave;res/France &agrave; Bangui. RESULTATS: L'ESPT &eacute;tait pr&eacute;sent chez 33.33 % (n = 35) alors que l'&eacute;tat de stress aigu &eacute;tait pr&eacute;sent chez 17.14 % (n = 18) des patients. Les &eacute;tats de stress (ES) &eacute;taient associ&eacute;s au sexe f&eacute;minin, au viol, &agrave; l'anxi&eacute;t&eacute; et &agrave; la d&eacute;pression. Le viol multipliait par 8 le risque de survenue d'un ES. L'&acirc;ge m&eacute;dian observ&eacute; &eacute;tait de 30 ans (P25: 22 ans; P75: 40 ans). La majorit&eacute; des patients pr&eacute;sentait un trouble de l'humeur (63.81 %; n = 67). L'insomnie &eacute;tait pr&eacute;sente chez 62.83 % (n = 66). L'anxi&eacute;t&eacute; (HADS) &eacute;tait pr&eacute;sente chez 44.76 % des patients (n = 47). La d&eacute;pression a &eacute;t&eacute; retrouv&eacute;e chez 40.95 % (n = 43). CONCLUSION: Les r&eacute;sultats obtenus montrent &agrave; quel point, au-del&agrave; des membres de milices, la soci&eacute;t&eacute; est touch&eacute;e par la violence du conflit que traverse le pays. Ces r&eacute;sultats pourraient nourrir la r&eacute;flexion sur l'organisation des soins et la prise en charge de la population centrafricaine consid&eacute;rant l'impact &agrave; court, moyen et long terme des &eacute;tats de stress aigus en situation de conflit.</b><br/> text/html 2018-02-24T07:59:01+01:00 Sara Elloudi, Asmae Lahlou, Mariame Maziane, Salim Gallouj, Fatima Zohra Mernissi, Mouna Rimani [Case report] - Pithyriasis lich&eacute;no&iuml;de: diagnostic pas toujours aussi facile! - 12 January 2018. <b>Le pityriasis lich&eacute;noide est une dermatose inflammatoire rare du sujet jeune &eacute;voluant par pouss&eacute;es spontan&eacute;ment r&eacute;gressives sur le tronc et les membres. Nous rapportons un cas particulier de pityriasis lichenoide, dont le diagnostic &eacute;tait redress&eacute; par l'aspect cicatriciel des l&eacute;sions et dont l'&eacute;volution &eacute;tait favorable sous cycline et phototh&eacute;rapie.</b><br/> text/html 2018-02-24T07:59:01+01:00 Beno&icirc;t Mbiya Mukinayi, Didier Kalombo Kalenda, St&eacute;phanie Mbelu, B&eacute;atrice Gulbis [Research] - Connaissances et comportements de 50 familles congolaises concern&eacute;es par la dr&eacute;panocytose: une enqu&ecirc;te locale - 11 January 2018. <b>INTRODUCTION: La dr&eacute;panocytose est tr&egrave;s fr&eacute;quente en R&eacute;publique D&eacute;mocratique du Congo (RDC). Cette &eacute;tude &eacute;value le niveau de connaissance et les comportements de familles concern&eacute;es ainsi que l’impact de cette maladie dans leur quotidien. METHODES: C’est une &eacute;tude transversale, sur un &eacute;chantillon non al&eacute;atoire, men&eacute;e du 15 juin au 15 ao&ucirc;t 2015 aupr&egrave;s de 50 familles concern&eacute;es par la dr&eacute;panocytose &agrave; Mbujimayi en RDC. RESULTATS: Sur 50 familles &eacute;tudi&eacute;es, 22 familles avaient plus d’un enfant dr&eacute;panocytaire. L’&acirc;ge m&eacute;dian au diagnostic &eacute;tait de 1 an. Le diagnostic &eacute;tait clinique dans 42% (21) des cas. Chaque premier enfant dr&eacute;panocytaire faisait en moyenne annuellement 3 crises douloureuses, 4 &eacute;pisodes de fi&egrave;vre, recevait 2 transfusions sanguines et &eacute;tait hospitalis&eacute; 3 fois. 62% (31) des familles n’avaient pas un revenu mensuel suffisant pour la prise en charge de leur(s) enfant(s), 96% (48) des familles souhaite la cr&eacute;ation d’un centre de r&eacute;f&eacute;rence de prise en charge et 94% (47) acceptent de s’y abonner si le montant annuel est inf&eacute;rieur &agrave; 100$.</b><br/> text/html 2018-02-24T07:59:01+01:00 Othmane Alaoui [Images in medicine] - Rhabdomyosarcome embryonnaire du cuir chevelu: &agrave; propos d’un cas - 11 January 2018. <b>Nous rapportons le cas d’un nouveau n&eacute; de sexe masculin, admis &agrave; J1 de vie, pour une tum&eacute;faction temporo occipitale d&eacute;couverte &agrave; la naissance. L’examen clinique a trouv&eacute; un nouveau n&eacute; tonique et r&eacute;actif, conscient, stable sur le plan h&eacute;modynamique et respiratoire, apyr&eacute;tique; avec &agrave; l’examen cranio facial une masse temporo-occipitale de 10cm de grand axe param&eacute;diane gauche de consistance molle, mobile, recouverte par du cuir chevelu (A). La TDM cranio c&eacute;r&eacute;bral a montr&eacute; une volumineuse formation sous gal&eacute;ale temporo parieto occipitale gauche h&eacute;t&eacute;rog&egrave;ne mesurant 40/80mm faisant &eacute;voquer une pathologie tumorale des parties molles du scalp (B). Le nouveau n&eacute; a &eacute;t&eacute; op&eacute;r&eacute; avec &agrave; l’exploration une tumeur au d&eacute;pend des parties molles temporo occipitale gauche, bilob&eacute;e, sans extension &agrave; la voute cr&acirc;nienne ni en endocr&acirc;nien (C). Une r&eacute;section tumorale compl&egrave;te en deux masses a &eacute;t&eacute; r&eacute;alis&eacute;e (D). L’&eacute;tude anatomopathologique a objectiv&eacute; un aspect histologique et immunohistochimique d’un rhabdomyosarcome embryonnaire. Le bilan d’extension &eacute;tait sans particularit&eacute;s. Aucune chimioth&eacute;rapie ni radioth&eacute;rapie n’a &eacute;t&eacute; propos&eacute; au malade Le recul est actuellement de 1 an; l’enfant est asymptomatique; l’&eacute;chographie du site op&eacute;ratoire est sans particularit&eacute;s.</b><br/> text/html 2018-02-24T07:59:01+01:00 Omar Sow, William Valentin, Diouf Cheikh, Barboza Denis, Faye Samba Thiapato, Diallo Ibrahima, Gueye Serigne Modou Kane [Case report] - Endom&eacute;triome ombilical: &agrave; propos d’un cas et revue de la litt&eacute;rature - 11 January 2018. <b>L’endom&eacute;triose se d&eacute;finit comme l’implantation de tissu endom&eacute;trial en dehors de la cavit&eacute; ut&eacute;rine. Elle touche environ 10% des femmes en &acirc;ge de procr&eacute;er. La localisation ombilicale est rare et la physiopathologie mal connue. Nous rapportons le cas d’une patiente de 42 ans, nulligeste, aux ant&eacute;c&eacute;dents de myomectomie 5 ans auparavant, qui pr&eacute;sentait une douleur cyclique avec une masse ombilicale dont le diagnostic &eacute;tait en faveur d’un endom&eacute;triome ombilical, confirm&eacute;e par l’&eacute;tude histologique de la pi&egrave;ce de biopsie de la masse. Le traitement a consist&eacute; &agrave; une ex&eacute;r&egrave;se large de la masse associ&eacute;e &agrave; une exploration du pelvis et une plastie ombilicale.</b><br/> text/html 2018-02-24T07:59:01+01:00 Tiounkani Th&eacute;ra, Niani Mounkoro, Soumana Omar Traore, Albachar Hamidou, Mamadou Traore, Saleck Doumbia, Saoudatou Tall, Aminata Kouma [Research] - Accouchement g&eacute;mellaire en milieu africain: une analyse de 10 ans dans le district de Bamako au Mali - 10 January 2018. <b>INTRODUCTION: Le but de cette &eacute;tude &eacute;tait de d&eacute;terminer les facteurs influen&ccedil;ant le pronostic de l'accouchement du deuxi&egrave;me jumeau. METHODES: L'&eacute;tude &eacute;tait r&eacute;trospective et a port&eacute; sur tous les cas d'accouchements g&eacute;mellaires enregistr&eacute;s &agrave; la maternit&eacute; du Centre de Sant&eacute; de R&eacute;f&eacute;rence de la commune V du District de Bamako du 1er Janvier 2007 au 31 D&eacute;cembre 2016 soit sur une p&eacute;riode de dix ans. RESULTATS: Nous avons enregistr&eacute; 34.899 accouchements dont 1374 accouchements g&eacute;mellaires soit une fr&eacute;quence de 2,54%; pr&egrave;s de 15% &eacute;taient des primipares; 39,16% &eacute;taient r&eacute;f&eacute;r&eacute;es; 69,10% et 15,5% autres sans aucun suivi pr&eacute;natal. Les facteurs influen&ccedil;ant n&eacute;gativement pronostic du deuxi&egrave;me jumeau &eacute;taient: un d&eacute;lai e" 15 minutes entre les jumeaux, le recours tardif &agrave; la c&eacute;sarienne, la non qualification de l'accoucheur, la grossesse monochor&eacute;ale, le faible poids de naissance. Par contre la parit&eacute;, la r&eacute;alisation de manœuvres obst&eacute;tricales n'avaient aucune influence sur le pronostic du deuxi&egrave;me jumeau. CONCLUSION: Le pronostic du deuxi&egrave;me jumeau est fortement influenc&eacute; par un d&eacute;lai de naissance de plus de 15 minutes entre les jumeaux, les autres facteurs agissant comme des cofacteurs.</b><br/> text/html 2018-02-24T07:59:01+01:00 Paschal Awingura Apanga, John Koku Awoonor-Williams [Research] - Predictors of caesarean section in Northern Ghana: a case-control study - 09 January 2018. <b>INTRODUCTION: caesarean section rates have become a global public health. This study investigated obstetric and socio-demographic factors associated with caesarean section in northern Ghana. METHODS: this was a case-control study comparing 150 women who had caesarean section (cases) and 300 women who had vaginal delivery (controls). Data were collected retrospectively from delivery registers, postpartum and postnatal registers in the Bolgatanga Regional Hospital. Univariate and multivariate analysis of data were done using SPSS 22. RESULTS: the study revealed that women who had higher odds of having a caesarean section were women who; attended Antenatal care (ANC) &#8805; 4 times (Adjusted OR = 2.99, 95% CI1.762-5.065), were referred from other health facilities (Adjusted OR = 1.19, 95% CI 1.108-1.337) and had a foetal weight of &#8805; 4000 grams (Adjusted OR = 1.21, 95% CI 1.064-1.657). There was a slight increase in odds of having a caesarean section among women who had a gestational age > 40 weeks (Adjusted OR = 1.09, 95% CI 1.029-1.281). Women who had secondary/higher education (Adjusted OR = 0.55, 95% CI 0.320-0.941), gestational age < 37 weeks (Adjusted OR = 0.20, 95% CI: 0.100-0.412) and women who had a foetal weight of 1500 grams to 2499 grams (Adjusted OR = 0.17, 95% CI 0.086-0.339) were associated with a lower odds of having a caesarean section. CONCLUSION: there was an increase in odds of having a caesarean section among pregnant women who had a foetal weight of &#8805; 4000 grams and women who attended ANC &#8805; 4 times. Pregnant women who were referred also had increase odds of having a caesarean section.</b><br/> text/html 2018-02-24T07:59:01+01:00 Ad&eacute;bayo cossi Alassani, Adrien Montcho Hodonou, Albert Comlan Dovonou, Gaspard Dansou Gbessi, S&eacute;raphin Ahoui, Francis Mo&iuml;se Dossou, Delphin Kouassi M&ecirc;hinto [Case series] - Fr&eacute;quence et d&eacute;terminants de la d&eacute;nutrition post-op&eacute;ratoire en chirurgie visc&eacute;rale au Centre National Hospitalier et Universitaire Koutoucou Hubert Maga, Cotonou - 09 January 2018. <b>L'objectif de cette &eacute;tude &eacute;tait de d&eacute;terminer la fr&eacute;quence et les facteurs associ&eacute;s &agrave; la d&eacute;nutrition chez les patients op&eacute;r&eacute;s en chirurgie visc&eacute;rale en 2014. Il s'est agi d'une &eacute;tude transversale, descriptive et analytique couvrant la p&eacute;riode du 11septembre 2014 au 11 d&eacute;cembre 2014. La population d'&eacute;tude &eacute;tait constitu&eacute;e des patients op&eacute;r&eacute;s en chirurgie visc&eacute;rale au Centre National Hospitalier Universitaire Hubert Koutoucou MAGA de Cotonou. La d&eacute;nutrition a &eacute;t&eacute; d&eacute;finie pour un indice de masse corporelle inf&eacute;rieur &agrave; 18,5 kg/m2. Au total 90 patients avaient &eacute;t&eacute; inclus dans l'&eacute;tude, 57,78 % (52 patients) &eacute;taient de sexe masculin. La moyenne d'&acirc;ge des patients &eacute;tait 55±6,32 ans. La d&eacute;nutrition &eacute;tait observ&eacute;e chez 42 patients (46,67%). Les facteurs associ&eacute;s &agrave; la d&eacute;nutrition chez les patients en postop&eacute;ratoire &eacute;taient : l'&acirc;ge sup&eacute;rieur ou &eacute;gal &agrave; 50 ans, les apports &eacute;nerg&eacute;tique, prot&eacute;ique et hydrique faibles, la diarrh&eacute;e, la pr&eacute;sence de cancer, la chirurgie sur le tractus digestif, la chirurgie urgente, une perte de poids significative et l'hyperleucocytose. La d&eacute;nutrition est fr&eacute;quente chez les patients en postop&eacute;ratoire. Elle n&eacute;cessite un d&eacute;pistage et une prise en charge pr&eacute;coces.</b><br/> text/html 2018-02-24T07:59:01+01:00 Ditte Thomsen, Cecilie Juul Hviid, Bo Langhoff H&oslash;nge, Candida Medina, David da Silva T&eacute;, Faustino Gomes Correira, Lars &Oslash;stergaard, Christian Erikstrup, Christian Wejse, Alex Lund Laursen, Sanne Jespersen [Short communication] - Increased mortality among HIV infected patients with cryptococcal antigenemia in Guinea-Bissau - 09 January 2018. <b>Cryptococcal antigenemia may precede development of cryptococcal meningitis and death among patients with advanced HIV infection. Among 200 retrospectively and randomly selected ART-na&iuml;ve patients with CD4 counts < 100 cells/µl from Guinea-Bissau, 20 (10%) had a positive cryptococcal antigen test. Self-reported headache and fever were predictors of a positive test, while cryptococcal antigenemia was a strong predictor of death within the first year of follow-up, MRR 2.22 (95% CI: 1.15-4.30). Screening for cryptococcal antigenemia should be implemented for patients with advanced HIV in Guinea-Bissau. Pre-emptive anti-fungal therapy should be initiated prior to ART-initiation if the screening is positive.</b><br/> text/html 2018-02-24T07:59:01+01:00 Chtioui Mamoun, Fellat Nadia [Images in medicine] - Adult aorta coarctation associated with double superior vena cava - 08 January 2018. <b>We report the case of a 45 years old man with no individual's history, suffering from hypertension recently discovered, admitted to our department for hypertensive urgencies. The clinical exam found a significant difference in blood pressure between the upper and lower limbs. The radial and ulnar pulses are present but the pulses of both lower limbs are abolished. The resting electrocardiogram recorded a regular and sinus rhythm and repolarization disorders laterally. The chest x-ray showed a normal heart volume and diffuse ribs erosions. The Transthoracic echodoppler displayed a normal left ventricular size and systolic function and a major LV enlargement. The ascending aorta was at normal size with the presence of a normal tricuspid aortic valve. The thoraco-abdominal CT (A, B) showed a coarctation of the proximal portion of the descending thoracic aorta and a double permeable superior vena cava. The patient underwent successful endovascular treatment of the coarctation with stent placement (C, D). The particularity of this observation is the late announcement of the coarctation at adult age and its association with a double superior vena cava.</b><br/> text/html 2018-02-24T07:59:01+01:00 Fouad Chraibi, Idriss Andaloussi Benatiya [Images in medicine] - Indometacin induced corneal perforation in a patient with rheumatoid arthritis - 08 January 2018. <b>Severe corneal complications associated with the use of anti inflammatory drugs (NSAID) eye drops are known. We report the case of a patient of 57 years treated for rheumatoid arthritis with a central corneal perforation of the right eye following the use of indomethacin eye drops in the postoperative period following cataract surgery. The image shows a paracentral corneal perforation with iris prolaps. The course was favorable with improvement in visual acuity and complete healing of the corneal perforation after stoping indometacin and using of bandage contact lens. The anti inflammatory drugs should be avoided in cases of rheumatoid arthritis because they increase the risk of perforation. Indomethacin, like other molecules in the same therapeutic class should be used with caution in patients with general risk factors of suffering from ocular surface.</b><br/> text/html 2018-02-24T07:59:01+01:00 Touré Fodé Baba, Wade Thomas Marcel Mbar, Diao Mohamed Lamine, Sylla Mohamed Aly, Tendeng Jacques Noel, Cissé Mamadou, Touré Cheikh Tidiane, Konaté Ibrahima [Case series] - Plastron appendiculaire: intervention en urgence ou diff&eacute;r&eacute;e: &agrave; propos d’une s&eacute;rie de 27 cas dans la clinique chirurgicale de l’H&ocirc;pital Aristide Le Dantec - 08 January 2018. <b>Le but de notre &eacute;tude &eacute;tait d’&eacute;valuer les r&eacute;sultats du traitement chirurgicale du plastron appendiculaire apr&egrave;s appendicectomie diff&eacute;r&eacute;e ou imm&eacute;diate. Il s’agit d’une &eacute;tude r&eacute;trospective de type descriptif allant de Janvier 2000 au 31 D&eacute;cembre 2007 portant sur 27 patients re&ccedil;us et trait&eacute;s pour plastron appendiculaire. Le diagnostic &eacute;tait clinique par la pr&eacute;sence d’une masse &agrave; la fosse iliaque droite, &eacute;chographique, ou per op&eacute;ratoire. Tous les patients op&eacute;r&eacute;s en urgence ont &eacute;t&eacute; class&eacute;s dans le groupe I et ceux op&eacute;r&eacute;s &agrave; froid, groupe II. Nous avons not&eacute; 18 hommes et 9 femmes avec un sex-ratio homme /femme = 3. L’&acirc;ge moyen de nos patients &eacute;tait de 33 ans avec des extr&ecirc;mes de 19 et 57 ans. Les signes cliniques &eacute;taient domin&eacute;s par la douleur &agrave; la fosse iliaque droite et la fi&egrave;vre respectivement 25 (92,6%) et 15 (55,6%) des cas. Dans le groupe I, l’appendicectomie n’a pu &ecirc;tre r&eacute;alis&eacute;e pour 7 patients (n = 15) d&ucirc; aux difficult&eacute;s op&eacute;ratoires. Dans les autres cas, l’appendicectomie &eacute;tait possible au prix de l’&eacute;largissement de l’incision de Mac Burney et une dur&eacute;e de s&eacute;jour plus longue. Le groupe II a concern&eacute; 12 patients (n = 12) avec 9 abords laparoscopiques et dans 3 cas, la voie de Mac Burney a &eacute;t&eacute; emprunt&eacute;e. Trois cas d’adh&eacute;rences p&eacute;riton&eacute;ales ont &eacute;t&eacute; not&eacute;s lors de la coelioscopie. L’appendicectomie &agrave; froid du plastron appendiculaire est un proc&eacute;d&eacute; s&ucirc;r et efficace. Elle permet d’&eacute;viter les cicatrices inesth&eacute;tiques et les fistules digestives iatrog&egrave;nes. L’appendicectomie imm&eacute;diate doit &ecirc;tre abandonn&eacute;e chez les patients porteurs de plastron appendiculaire car elle engendre beaucoup de morbidit&eacute;.</b><br/> text/html 2018-02-24T07:59:01+01:00 Amour Espoir Mokoko-Louckou, Badarou Chaibou, Ismail Abdouli, Kevin Parfait Bienvenu Bouhelo-Pam, Mohammed El Idrissi, Mohammed Shimi, Abdelhalim El Ibrahimi, Abdelmajid El Mrini [Case report] - Rupture bilat&eacute;rale spontan&eacute;e et simultan&eacute;e du tendon quadricipital dans l’ad&eacute;nome parathyro&iuml;dien: &agrave; propos d’un cas et revue de la litt&eacute;rature - 04 January 2018. <b>La rupture spontan&eacute;e du tendon quadricipital est rare, ainsi qu'une atteinte bilat&eacute;rale et simultan&eacute;e. Nous rapportons un patient de 53 ans suivi pour ad&eacute;nome parathyro&iuml;dien compliqu&eacute; d'insuffisance r&eacute;nale, admis pour rupture bilat&eacute;rale et spontan&eacute;e des deux tendons quadricipitaux. Il a b&eacute;n&eacute;fici&eacute; d'une r&eacute;paration chirurgicale qui lui a permis une autonomie.</b><br/> text/html 2018-02-24T07:59:01+01:00 Ibrahima Ka, Magatte Faye, Papa Saloum Diop, Amadou Bocar Niang Aliou Coly Faye, Jean Marc Ndoye, Babacar Fall [Case series] - Cancers biliaires: aspects &eacute;pid&eacute;miologiques cliniques et th&eacute;rapeutiques &agrave; propos de 20 cas - 04 January 2018. <b>Les cancers des voies biliaires se r&eacute;partissent en deux localisations principales: les cancers de la v&eacute;sicule biliaire qui sont des ad&eacute;nocarcinomes et les cholangiocarcinomes de localisations intra et extra-h&eacute;patiques. Il s'agit &eacute;tude r&eacute;trospective portant sur 20 cas de cancers biliaires entre Janvier 2006 et Octobre 2014 &agrave; la clinique chirurgicale de l'H&ocirc;pital G&eacute;n&eacute;ral de Grand- Yoff. Il s'agissait de 40% de cancer de la v&eacute;sicule biliaire, 60% de cancer de la voie biliaire principale. Le sex-ratio &eacute;tait de 1. L'&acirc;ge moyen de nos patients &eacute;tait de 58,1 ans. Le d&eacute;lai diagnostique moyen &eacute;tait de 3,77 mois. La symptomatologie &eacute;tait domin&eacute;e par le syndrome ict&eacute;rique et les douleurs de l'hypochondre droit. Tous les patients avaient pr&eacute;sent&eacute; un syndrome de cholestase biologique. L'&eacute;chographie abdominale a &eacute;t&eacute; r&eacute;alis&eacute;e dans 65% des cas, la TDM abdominale dans 85% des cas et L'IRM dans 35% des cas. Les formes avanc&eacute;es &eacute;taient pr&eacute;dominantes dans notre s&eacute;rie (n=19).La majorit&eacute; de nos patients a b&eacute;n&eacute;fici&eacute; d'une chirurgie palliative. Le geste le plus pratiqu&eacute; &eacute;tait la d&eacute;rivation biliaire chez 50% des patients. On notait une pr&eacute;dominance des cholangiocarcinomes. La morbidit&eacute; op&eacute;ratoire globale &eacute;tait de 43,75%. La mortalit&eacute; globale toutes localisations confondues &eacute;tait de 31,25%. La moyenne de survie est de 4 mois et demi. Les cancers des voies biliaires sont d'expression multiforme, se diff&eacute;renciant essentiellement en un cholangiocarcinome intra, extrah&eacute;patique et ad&eacute;nocarcinome de la v&eacute;sicule biliaire dont l'&eacute;volution est globalement diff&eacute;rente mais le pronostic spontan&eacute;ment mauvais.</b><br/> text/html 2018-02-24T07:59:01+01:00 Mohamed Chermiti, Dhia Kaffel [Images in medicine] - Acromegaly and hyperparthyroidism: about a rare association - 04 January 2018. <b>Here we report a case of 49-year-old Tunisian man followed at our consultation for bone pain. He complained of enlargement of the hands and feet since the age of 23. End stage renal failure secondary to hypertension and diabetes was discovered at the age 39. He was also operated at this age for a synchronous GH- and prolactin-secreting pituitary macroadenomas. The examination shows a frontal boss associated with macroglossia. In biology: normocalcemia at 2.16 mmol/l (normal range, 2.1-2.6 mmol/l), normophosphatemia at 1.2 mmol/l (normal range, 0.8-1.5 mmol/l) and increased alkaline phosphatase level of 4647 IU/l (normal range, 42-160 IU/l). Parathyroid hormone was increased (2788 pmol/l (normal range 100-300 ¼g/ml in hemodialysis patients)) as well as growth hormone (122 ng/ml (normal range, < 5 ng/ml)). 25-OH vitamin D was normal (32 ng/ml (normal range, 30-70 ng/ml)). X-rays of the hands (A) and the lateral X-ray of the skull (B) combine images of hyperparathyroidism and acromegaly. An MRI of the brain found after administration of gadolinium a recurrence of the pituitary macroadenoma. Cervical ultrasound showed a single parathyroid adenoma. The patient was referred to neurosurgeons and head and neck surgeons.</b><br/> text/html 2018-02-24T07:59:01+01:00 Redempta Kalekye Mutisya, Kenneth Ngure, Christina Mwachari [Research] - A psychosocial intervention to reduce gender-based violence and antepartum depressive symptoms in pregnant women in Kisumu County, Kenya: a quasi-experimental study - 04 January 2018. <b>INTRODUCTION: Gender-based violence during pregnancy and its associated adverse health effects are disproportionately higher in developing countries like Kenya where screening for and management of gender-based violence is currently not part of routine antenatal care. This study assessed the effect of a psychosocial intervention on gender-based violence and antepartum depressive symptoms in pregnant women. METHODS: this quasi-experimental study compared gender-based violence and antepartum depression scores of 288 pregnant women in the two arms; one exposed to a psychosocial intervention and another receiving usual antenatal care. We used analysis of covariance to estimate the intervention effect and Chi-square to test the equality of proportions. RESULTS: the difference between the psychosocial intervention and the usual antenatal care group in the total intimate partner violence and physical violence scores was a significant, with small effect sizes of partial eta = 0.196 and 0.305 respectively. The two arms did not differ in terms of the proportion of women reporting other acts of gender-based violence by intimate and non-intimate partners post-intervention. The intervention group had significantly lower mean depression scores compared to the usual care group, post-intervention, with a medium effect size of 0.500. CONCLUSION: this intervention aimed at reduction of gender-based violence and improvement of mental health of pregnant women is promising. Primary health care facilities in resource-constrained settings can take advantage of local capacity to deliver focused non-specialized psychosocial support to pregnant women experiencing violence.</b><br/> text/html 2018-02-24T07:59:01+01:00 Fred Bernardes Filho, Andreia de Oliveira Alves [Images in medicine] - Man with a swollen mass on sacrococcygeal region - 04 January 2018. <b>A 43-year-old male patient presented to the emergency department with 8 days of a painful swollen mass on sacrococcygeal region. He had no personal or family medical conditions and was receiving cephalexin 500 mg four times a day two days ago. Examination revealed an erythematous, fluctuant, swollen mass on sacrococcygeal region and an orifice at the buttock cleft (A). He was afebrile and nontoxic. Laboratory study results were unremarkable. Incision, drainage, currettage were made, leaving the surgical wound open for secondary healing. The diagnosis of pilonidal cyst with abscess was performed. Pilonidal sinus probably derives from the perineal pilosebaceous unit and precursor pits associated with trapped hairs. The penetrating hairs may cause a foreign-body giant cell reaction, sometimes with secondary bacterial infection, with can cause a sudden onset of pilonidal abscess. It occurs more commonly in individuals with stiff dark or auburn hair. There are four clinical presentation of the disease: symptomatic, acute pilonidal abscess, chronic fistulizing form or complex pilonidal sinus disease. Chronic fistulizant form is the most common clinical presentation. The sacrococcygeal location is the most common site but it can occur on the p&uacute;bis, anterior perineum and very rarely, the penis. Asymptomatic pits do not require treatment. For acute abscesses, the options available are: aspiration followed by treatment with antibiotics and later curative intent surgery; drainage without curettage; drainage and curettage.</b><br/> text/html 2018-02-24T07:59:01+01:00 Dhia Kaffel, Hela Kchir [Images in medicine ] - About a subcutaneous calcification - 04 January 2018. <b>We report a case of 62-year-old Tunisian woman with a 10-year history of a CREST syndrome (systemic sclerosis meeting the criteria of the CREST syndrome of the 1980 American College of Rheumatology classification for raynaud phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia). Her daughter is treated in neurology for myasthenia gravis. Our patient presents a 5-month history of increasing inflammatory right thumb pain concomitant with the discovery of a subcutaneous hard mass (A). Radiographs of her thumb showed a sub-cutaneous calcification (as another part of the CREST syndrome criteria) (B). X-rays of hands found an acro-osteolysis (C). In the CREST syndrome, the calcific deposits can be subclinical. But, when symptomatic, it becomes painful, tender and an inflammatory reaction can occur facing the calcinosis.</b><br/> text/html 2018-02-24T07:59:01+01:00 Anthonio Oladele Adefuye, Henry Ademola Adeola, Johan Bezuidenhout [Commentary] - The physician-scientists: rare species in Africa - 04 January 2018. <b>There is paucity of physician-scientists in Africa, resulting in overt dependence of clinical practice on research findings from advanced "first world" countries. Physician-scientists include individuals with a medical degree alone or combined with other advanced degrees (e.g. MD/MBChB and PhD) with a career path in biomedical/ translational and patient-oriented/evaluative science research. The paucity of clinically trained research scientists in Africa could result in dire consequences as exemplified in the recent Ebola virus epidemic in West Africa, where shortage of skilled clinical scientists, played a major role in disease progression and mortality. Here we contextualise the role of physician-scientist in health care management, highlight factors limiting the training of physician-scientist in Africa and proffer implementable recommendations to address these factors.</b><br/> text/html 2018-02-24T07:59:01+01:00 Jihad Drissi, Zakaria Idri, Jaouad Kouach, Driss Moussaoui, Mohamed Dehayni [Case report] - Cardiomyopathie du p&eacute;ripartum - 04 January 2018. <b>La cardiomyopathie du p&eacute;ri-partum (CMP-PP) ou syndrome de Meadows, est une cardiomyopathie dilat&eacute;e survenue pendant ou au d&eacute;cours d'une grossesse, d&eacute;finie par une insuffisance cardiaque avec une fraction d'&eacute;jection systolique du ventricule gauche inf&eacute;rieure &agrave; 45%. Il s'agit d'une entit&eacute; pathologique rare dont le m&eacute;canisme physiopathologique en cause reste mal &eacute;lucid&eacute;. Sur le plan clinique il s'agit d'une insuffisance cardiaque inopin&eacute;e d'installation rapide, d'&eacute;volution impr&eacute;visible avec risque de choc cardiog&eacute;nique r&eacute;fractaire justifiant une prise en charge en r&eacute;animation cardiovasculaire. La CMP-PP ne n&eacute;cessite aucun traitement sp&eacute;cifique par rapport aux autres causes d'insuffisance cardiaque. Nous rapportons le cas d'une primigeste de 29 ans qui a consult&eacute; &agrave; 32 semaines d'am&eacute;norrh&eacute;e dans un tableau d'insuffisance cardiaque congestive en rapport avec une cardiomyopathie du p&eacute;ri-partum. L'objectif de ce travail est de pr&eacute;ciser les caract&eacute;ristiques de cette cardiopathie, qui malgr&eacute; son caract&egrave;re exceptionnel ne doit pas &ecirc;tre m&eacute;connu par l'obst&eacute;tricien.</b><br/> text/html 2018-02-24T07:59:01+01:00 Anwar Mechri, Hana Zaafrane, Monia Hadj Khalifa, Samir Toumi, F&eacute;rid Zaafrane, Lotfi Gaha [Case series] - Pratique de l’&eacute;lectroconvulsivoth&eacute;rapie dans un h&ocirc;pital universitaire Tunisien - 04 January 2018. <b>Les objectifs de cette &eacute;tude &eacute;taient de d&eacute;crire les modalit&eacute;s pratiques de l’&eacute;lectroconvulsivoth&eacute;rapie (ECT) &agrave; l’h&ocirc;pital universitaire de Monastir (Tunisie). Il s'agit d'une &eacute;tude r&eacute;trospective portant sur tous les patients trait&eacute;s par ECT &agrave; l’h&ocirc;pital universitaire de Monastir entre 2002 et 2013. Le nombre des patients &eacute;tait de 80 patients (60 hommes et 20 femmes, d’&acirc;ge moyen de 42,1±15,7 ans), repr&eacute;sentant 1,4% de l’ensemble des patients hospitalis&eacute;s en psychiatrie durant la p&eacute;riode d’&eacute;tude. Le nombre total des s&eacute;ances d’ECT &eacute;tait de 784. Le diagnostic principal &eacute;tait le trouble d&eacute;pressif majeur isol&eacute; ou r&eacute;current chez 50% des patients. La majorit&eacute; des patients (78,8%) avait re&ccedil;u une seule cure d’ECT avec un nombre moyen de s&eacute;ances de 8,1 ± 4,9. Le produit anesth&eacute;sique le plus utilis&eacute; &eacute;tait le propofol (97,4%). L’&eacute;nergie d&eacute;livr&eacute;e &eacute;tait comprise entre 40 et 80 joules dans 71% des cas et elle &eacute;tait positivement corr&eacute;l&eacute;e &agrave; l’&acirc;ge des patients. La dur&eacute;e moyenne de la crise motrice &eacute;tait de 22,3 ± 7,2 secondes et elle &eacute;tait n&eacute;gativement corr&eacute;l&eacute;e &agrave; l’&acirc;ge des patients. Le taux de r&eacute;ponse le plus &eacute;lev&eacute; a &eacute;t&eacute; constat&eacute; au niveau des scores de d&eacute;pression (64,3%). Des effets ind&eacute;sirables imm&eacute;diats ont &eacute;t&eacute; mentionn&eacute;s chez 51,2% des patients. Enfin, 20% des patients poursuivaient des s&eacute;ances d’ECT d’entretien avec un rythme uni ou bimensuel. La pratique de l’ECT &agrave; l’h&ocirc;pital universitaire de Monastir reste peu d&eacute;velopp&eacute;e en termes de nombre des patients et des s&eacute;ances d’ECT. Des efforts doivent &ecirc;tre d&eacute;ploy&eacute;s pour promouvoir l’utilisation de cette m&eacute;thode.</b><br/> text/html 2018-02-24T07:59:01+01:00 Nadia El Haddad, Hanan El Ouahabi [Images in medicine] - La n&eacute;crobiose lipo&iuml;dique: &agrave; propos d’un cas - 03 January 2018. <b>La n&eacute;crobiose lipo&iuml;dique est une dermatose granulomateuse rare. Elle est rapport&eacute;e chez 0,3 &agrave; 1,2% des diab&eacute;tiques, localis&eacute;es pr&eacute;f&eacute;rentiellement au niveau de la jambe, les l&eacute;sions apparaissent comme des plaques &eacute;ryth&eacute;mateuses, avec des d&eacute;pressions centrales. Nous rapportons l'observation d'une patiente &acirc;g&eacute;e de 21 ans connue diab&eacute;tique type 1 depuis 6 ans et qui pr&eacute;sente depuis 1 an des plaques &eacute;ryth&eacute;mateuses bien circonscrites avec un centre jaun&acirc;tre atrophique au niveau des faces ant&eacute;rieures des jambes sym&eacute;triques et asymptomatique (A, B). Le diagnostic de n&eacute;crobiose lipo&iuml;dique a &eacute;t&eacute; &eacute;voqu&eacute;, une biopsie a &eacute;t&eacute; r&eacute;alis&eacute;e et l'a confirm&eacute;. Elle a montr&eacute; une r&eacute;action inflammatoire granulomateuse sur toute l'&eacute;paisseur du derme &agrave; bordure palissadique dispos&eacute;e autour de foyers mal limit&eacute;s de stroma conjonctif alt&eacute;r&eacute;. Des cellules g&eacute;antes plurinucl&eacute;&eacute;es et des dendrocytes &eacute;taient pr&eacute;sents, des d&eacute;p&ocirc;ts lipidiques &eacute;taient reconnus. Une corticoth&eacute;rapie locale a &eacute;t&eacute; prescrite chez notre patiente. L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par une persistance des l&eacute;sions.</b><br/> text/html 2018-02-24T07:59:01+01:00 Bounoual Mohammed, Ahsaini Mustapha, Tazi Karim, Azelmad Hamid, Alila Mohammed, Mellas Soufiane, El Ammari Jalal Eddine, Tazi Mohammed Fadl, El Fassi Mohammed Jamal, Farih Moulay Hassan [Case report] - Cause rare d’insuffisance r&eacute;nale aigue: g&eacute;ant calcul de vessie chez une jeune femme - 03 January 2018. <b>G&eacute;ant calcul de vessie se d&eacute;finit par un poids sup&eacute;rieur &agrave; 100 g, c'est une pathologie rare chez la femme, environ 2%. La localisation v&eacute;sicale ne d&eacute;passe pas 5% de l'ensemble des voies urinaires. Chez la femme l'apparition de calcul de vessie est souvent secondaire &agrave; un facteur pr&eacute;disposant notamment un corps &eacute;tranger intra v&eacute;sical, vessie neurogene, les infections urinaires &agrave; r&eacute;p&eacute;tition, ATCDS de chirurgie de l'incontinence urinaire d'effort. Mais on retrouve des calculs de vessie sans causes &eacute;videntes dits calculs primaires idiopathiques. On rapporte un cas d'une jeune patiente de 31 ans avec un g&eacute;ant calcul de vessie qui a retenti sur le haut appareil urinaire entrainant une insuffisance r&eacute;nale aigue. La patiente a b&eacute;n&eacute;fici&eacute; initialement d'un drainage de haut appareil urinaire par des n&eacute;phrostomies bilat&eacute;rales puis elle a b&eacute;n&eacute;fici&eacute; d'une cystolithotomie &agrave; ciel ouvert d'un gros calcul de vessie. Un bilan &eacute;tiologique a &eacute;t&eacute; demand&eacute; pourtant n'a pas identifi&eacute; de cause &eacute;vidente.</b><br/> text/html 2018-02-24T07:59:01+01:00 Youssef Zemmez, Mohammed Boui [Images in medicine] - Maladie de Bowen du pied droit - 02 January 2018. <b>Patiente &acirc;g&eacute;e de 16 ans, sans ant&eacute;c&eacute;dents pathologiques notables, qui a consult&eacute; en dermatologie pour une tum&eacute;faction cutan&eacute;e si&eacute;geant au niveau de l'avant pied droit &eacute;voluant depuis 02 ans. L'examen clinique a objectiv&eacute; une masse cutan&eacute;e bourgeonnante de consistance dure, indolore &agrave; la palpation couvrant les 2&egrave;me, 3&egrave;me et 4&egrave;me orteils droits, mesurant 4 cm de grand diam&egrave;tre. Le reste de l'examen clinique &eacute;tait normal notamment pas d'ad&eacute;nopathies. Une biopsie cutan&eacute;e a &eacute;t&eacute; r&eacute;alis&eacute;e au niveau de la tumeur dont l'histologie &eacute;tait en faveur d'un carcinome in situ. Un traitement chirurgical a &eacute;t&eacute; indiqu&eacute;. La maladie de Bowen est un carcinome in situ malpighien intra&eacute;pith&eacute;lial relativement rare. Elle atteint surtout l'adulte &agrave; tout &acirc;ge avec une pr&eacute;dominance f&eacute;minine. Le diagnostic est suspect&eacute; cliniquement, mais c'est l'examen anatomopathologique qui le confirme.</b><br/> text/html 2018-02-24T07:59:01+01:00 Youssef Zemmez, Mohammed Boui [Images in medicine] - Carcinome épidermoïde sur lichen scléro-atrophique vulvaire - 02 January 2018. <b>Patiente de 58 ans, sans ant&eacute;c&eacute;dent pathologique, consultant en dermatologie pour prurit vulvaire, s&eacute;cheresse et vulvodynie &eacute;voluant depuis 5 ans. L'examen clinique a r&eacute;v&eacute;l&eacute; des l&eacute;sions diffuses porcelain&eacute;es au niveau de la vulve, avec une l&eacute;sion nodulaire h&eacute;misph&eacute;rique jaun&acirc;tre mesurant 1 cm de diam&egrave;tre sur les plaques blanch&acirc;tres, et des l&eacute;sions excori&eacute;es li&eacute;es au grattage. Une biopsie cutan&eacute;e a &eacute;t&eacute; r&eacute;alis&eacute;e au niveau des l&eacute;sions blanch&acirc;tres et au niveau de la l&eacute;sion nodulaire. L'histologie &eacute;tait en faveur du carcinome &eacute;pidermo&iuml;de pour la l&eacute;sion bourgeonnante et en faveur du lichen scl&eacute;ro-atrophique (LSA) vulvaire pour les l&eacute;sions de porcelaine. Un traitement chirurgical a &eacute;t&eacute; recommand&eacute; associ&eacute; &agrave; la radioth&eacute;rapie. L'int&eacute;r&ecirc;t de cette observation est de rappeler le risque de d&eacute;g&eacute;n&eacute;rescence du lichen scl&eacute;ro-atrophique g&eacute;nital.</b><br/> text/html 2018-02-24T07:59:01+01:00 Hasina Andrianarivony Bakohariliva, Imisanavalona Hanitrinihaja Rafehivola, Evah Norotiana Raobelle, Adeline Raharivelo, Bertille Hortense Rajaonarison [Case series] - Etat des lieux des soins de premier recours des malades mentaux &agrave; Antananarivo : &eacute;tude r&eacute;trospective - 01 January 2018. <b>Religion et gu&eacute;risseurs traditionnels occupent encore une place pr&eacute;pond&eacute;rante dans la prise en charge des maladies mentales &agrave; Madagascar. Ainsi, nous nous sommes fix&eacute;s comme objectif d'&eacute;tablir un &eacute;tat des lieux sur les soins de premier recours des malades mentaux. Nous avons men&eacute; une &eacute;tude r&eacute;trospective descriptive s'&eacute;talant sur une p&eacute;riode de 16 mois allant de janvier 2014 en avril 2015 au sein du service de psychiatrie du CHU de Befelatanana &agrave; Antananarivo. La pr&eacute;valence des psychoses &eacute;tait de 25%. Le genre f&eacute;minin (53%), l'ethnie merina (77%), les &eacute;tudiants (45%), le niveau d'&eacute;tude secondaire (40%), les c&eacute;libataires (72%), la religion protestante (45%), ainsi que le niveau socio-&eacute;conomique moyen (57,5%) &eacute;taient pr&eacute;dominants. Dans les param&egrave;tres cliniques, le mode de d&eacute;but brutal (52%), le premier recours &agrave; la religion (40%), la pr&eacute;sence d'ant&eacute;c&eacute;dents des cas similaire (90%), &eacute;taient majoritaires. La schizophr&eacute;nie &eacute;tait la pathologie la plus rencontr&eacute;e dans la moiti&eacute; des cas. Le d&eacute;lai d'am&eacute;lioration en cas de traitement religieux et traditionnels &eacute;tait dans la moiti&eacute; des cas de plus de 10 jours d'hospitalisation. Les patients ayant re&ccedil;u une prise en charge psychiatrique en premier recours, &eacute;taient am&eacute;lior&eacute;s dans 75 % cas en moins de 10jours. Le retard du recours aux soins psychiatriques est une r&eacute;alit&eacute; &agrave; Madagascar qui aggrave le pronostic des psychoses.</b><br/>