Pan african Medical Journal - Volume 30 Pan african Medical Journal. Volume 30 2018-05-26T02:22:33+01:00 pamj logo text/html 2018-05-26T09:22:33+01:00 Mouna Ejjiyar, Saloua Ettalbi [Images in medicine] - Tumeur &eacute;volu&eacute;e du tronc d’origine lymphomateuse - 24 May 2018. <b>Les lymphomes malins constituent un groupe de cancers du tissu lympho&iuml;de, ganglionnaire ou extra ganglionnaire, li&eacute;s &agrave; la transformation n&eacute;oplasique d'une cellule lymphocytaire. On distingue dans cette cat&eacute;gorie les lymphomes malins non hodgkiniens. Nous rapportons le cas d'une localisation cutan&eacute;e &eacute;volu&eacute;e et extr&ecirc;mement agressive d'un lymphome malin non hodgkinien diffus. Il s'agit d'un patient &acirc;g&eacute; de 30 ans, mari&eacute; et p&egrave;re d'un enfant, chauffeur de profession, suivi en h&eacute;mato-oncologie depuis 2 ans pour lymphome malin non hodgkinien diagnostiqu&eacute; devant des poly ad&eacute;nopathies axillaires et inguinales, ayant b&eacute;n&eacute;fici&eacute; de 13 s&eacute;ances de chimioth&eacute;rapie. Le patient a &eacute;t&eacute; admis au service de chirurgie plastique, r&eacute;paratrice, esth&eacute;tique et des br&ucirc;l&eacute;s du CHU Mohammed VI de Marrakech, pour prise en charge d'une localisation cutan&eacute;e de son lymphome sous la forme d'une tumeur &eacute;volu&eacute;e de la r&eacute;gion lat&eacute;ro-thoracique gauche augmentant rapidement de taille. A l'examen, on retrouvait un patient en assez bon &eacute;tat g&eacute;n&eacute;ral, pr&eacute;sentant une volumineuse masse lat&eacute;ro-thoracique gauche, adh&eacute;rente &agrave; son plan profond avec blindage axillaire homolat&eacute;ral. Une biopsie partielle r&eacute;alis&eacute;e a confirm&eacute; &agrave; l'examen anatomo-pathologique le diagnostic de lymphome malin non hodgkinien diffus &agrave; grandes cellules. L'&eacute;tude immunohistochimique et g&eacute;n&eacute;tique n'a pas &eacute;t&eacute; r&eacute;alis&eacute;e. Les s&eacute;rologies &eacute;taient n&eacute;gatives. L'imagerie a permis de r&eacute;v&eacute;ler sur les coupes tomodensitom&eacute;triques la pr&eacute;sence d'une volumineuse masse ganglionnaire &agrave; pr&eacute;dominance axillaire et thoracique ant&eacute;ro-lat&eacute;rale gauche mesurant 30cm de diam&egrave;tre, faite d'une confluence de ganglions avec persistance de ganglions nodulaires en p&eacute;riph&eacute;rie, ulc&eacute;rations cutan&eacute;es et zones de n&eacute;crose. Le patient a b&eacute;n&eacute;fici&eacute; dans notre structure d'une ex&eacute;r&egrave;se tumorale large de propret&eacute; puis d'une couverture par de la peau mince, r&eacute;duisant ainsi le volume tumoral et assurant un meilleur confort pour le patient, qui fut adress&eacute; d&egrave;s cicatrisation en h&eacute;mato-oncologie pour b&eacute;n&eacute;ficier de son traitement compl&eacute;mentaire.</b><br/> text/html 2018-05-26T09:22:33+01:00 Ibidolapo Taiwo Ijarotimi, Olayinka Stephen Ilesanmi, Adeola Aderinwale, Oluwadamilola Abiodun-Adewusi, Ime-Maria Okon [Research] - Knowledge of Lassa fever and use of infection prevention and control facilities among health care workers during Lassa fever outbreak in Ondo State - 24 May 2018. <b>INTRODUCTION: Hospital-acquired infections of Lassa fever (LF) has been described in many West African countries. We assessed the availability of Infection Prevention and Control (IPC) measures and their use in the health centres (HCs) at the affected Local Government Areas (LGAs) during an ongoing LF outbreak in Ondo State, Nigeria. METHODS: We included all primary and secondary HCs and their healthcare workers (HCWs) in the affected Ose and Owo LGAs. We collected data from respondents using self-administered questionnaires and used a checklist to assess the IPC measures at the HCs. We generated frequencies and proportions and tested associations using odds ratios at 95% CI. RESULTS: One hundred and ninety HCWs from 59 HCs were surveyed of which 34 (57.6%) were located in Owo LGA. All HCs had soap for handwashing, 57(96.6%) had wash-hand basins but only 52(88.1%) had water. While 57(96.6%) had gloves and 53(89.8%) had sharps boxes, only 16(27.1%) had an isolation room. Only 44(23.2%) respondents had been trained in IPC. The majority, 144 (91.6%), always had gloves available for their use, 79(41.6%) always had facemask/shield and 71(37.4%) always had full personal protective equipment. At the last patient contact, only 151 (79.8%) washed their hands before the contact, 188(98.9%) washed their hands after and 183 (96.2%) wore gloves. While there was no association between availability of gloves and its use (OR: 0.21, 95%CI 0.04-1.17), there was significant association between having had training in basic universal precautions and having used gloves (OR: 3.64, 95%CI 1.21-19.40) and having washed hands after last patient contact (OR: 2.31, 95%CI 1.67-12.30). CONCLUSION: Among these HCs that serve as point of first contact with possible cases of LF in these endemic LGAs, none met the minimum standard for IPC. We recommend that IPC committee for each LGA and the whole state should be set up and IPC trainings made mandatory.</b><br/> text/html 2018-05-26T09:22:33+01:00 The Pan African Medical Journal [Erratum] - Erratum: Food hygiene assessment in catering establishments in Hay Hassani district-Casablanca - 24 May 2018. <b>This erratum corrects article: “Food hygiene assessment in catering establishments in Hay Hassani district-Casablanca”. The Pan African Medical Journal. 2016;24:335. doi:10.11604/pamj.2016.24.335.9171.</b><br/> text/html 2018-05-26T09:22:33+01:00 Sitraka Angelo Raharinavalona, Iandry Michella Razafinjatovo, Rija Eric Raherison, Thierry Razanamparany, Andriamparany Rasata Ravelo, Andrinirina Dave Patrick Rakotomalala [Case report] - Ectopie thyro&iuml;dienne hyo&iuml;dienne: &agrave; propos d’un cas chez une jeune fille malgache - 24 May 2018. <b>L'ectopie thyro&iuml;dienne est une pathologie rare li&eacute;e &agrave; une d&eacute;faillance de migration de la glande thyro&iuml;de lors de son d&eacute;veloppement embryonnaire. Elle est le plus souvent asymptomatique. Nous rapportons un cas d'ectopie thyro&iuml;dienne &agrave; localisation hyo&iuml;dienne chez une jeune fille malgache, r&eacute;v&eacute;l&eacute;e par une g&ecirc;ne esth&eacute;tique, associ&eacute;e &agrave; une hypothyro&iuml;die infraclinique. Le diagnostic &eacute;tait confirm&eacute; par l'&eacute;chographie cervicale et la scintigraphie au techn&eacute;tium 99m. M&ecirc;me si l'hypothyro&iuml;die est infraclinique, une hormonoth&eacute;rapie substitutive est de r&egrave;gle permettant ainsi d'obtenir une euthyro&iuml;die biologique et de maintenir la bonne &eacute;volution clinique.</b><br/> text/html 2018-05-26T09:22:33+01:00 Faten Limaiem, Saadia Bouraoui [Images in medicine] - Metastasis of renal cell carcinoma to the pancreas 11 years postnephrectomy - 23 May 2018. <b>The pancreas is an unusual site for tumor metastasis, accounting for only 2 to 5% of all malignancies affecting the pancreas. A 67-year-old woman with a past medical history of right renal nephrectomy for renal cell carcinoma, eleven years ago, presented with nausea, diarrhea and vertigo. On admission, the patient was pale. Laboratory tests showed a low hemoglobin level (6,4 grams per deciliter). Abdominal ultrasonography revealed a well-defined, hypoechoic, homogeneous, vascular, lobulated mass in the tail of the pancreas. Computed tomography scan demonstrated a hypervascularized tumor of the pancreatic tail. The patient subsequently underwent a distal pancreatectomy with splenectomy. Grossly, the pancreatic mass was well-delineated and encapsulated measuring 9,5 x 6,5 cm and showed extensive hemorrhage (A). Histological examination of the surgical specimen revealed that the pattern of the tumour growth was predominantly solid, with formation of large nests and acini of tumor cells separated by a stroma that was endowed with prominent sinusoid-like vessels (B). The tumour cells were large ranging from optically clear, with sharply outlined boundaries, to eosinophilic tumour cells. The final pathological diagnosis was metastatic clear-cell renal carcinoma to the pancreas. Four peripancreatic lymph nodes were free of the tumor but the pancreatic resection margins were invaded by the tumour. Postoperative course was uneventful. Renal cell carcinoma metastasis should be considered in patients with a pancreatic mass as it gives the past history of renal cell carcinoma. Awareness of this entity and a high index of suspicion would help in proper diagnosis and treatment.</b><br/> text/html 2018-05-26T09:22:33+01:00 Omar Boulahroud, Tarik Ziadi [Images in medicine] - Solitary epidural lipoma - 21 May 2018. <b>Spinal epidural lipomatosis (SEL) is defined as normal adipose tissue that is pathologically overgrown in the epidural space of the spinal canal. It usually occurs in obese people, patients with history of corticosteroid use or endocrinopathy. They usually present with gradually progressing symptoms and are rarely associated with rapidly aggravated neurologic deficits. Radiologic assessments are mostly conducted by using MRI. A 65-year-old woman presented with isolated low back pain. She had no history of corticosteroid use, endocrinopathy or radicular pain. On examination, she was obese (height 155cm, weight 87kg) with a body mass index (BMI) of 56.1 kg/m2. Neurological exam was normal with no motor weakness and sensation was intact. Plain radiographs showed no evidence of abnormality, including instability and other pathologic findings. Magnetic resonance imaging (MRI) revealed an epidural mass posterior to the L5 vertebral body that was isosignal to subcutaneous fat and it compressed asymmetrically on the right side of the cauda equina and the exiting right L5 nerve root on sagittal (A) and axial (B) T2 weighted images. There was no evidence of spinal stenosis. The result of electromyography was normal. We recommended surgical intervention to relieve pain but the patient declined. Opioid analgesia has been prescribed and her symptoms became much improved. Weight reduction by physiotherapy and exercise resulted in complete loss of lumbar pain (the patient lost 30kg in 6 months) and MRI control showed a complete disappearance of the mass.</b><br/> text/html 2018-05-26T09:22:33+01:00 Mohammed Ahmed Ibrhim, Meaza Demissie, Araya Abrha Medhanyie, Alemayehu Worku, Yemane Berhane [Research] - Reasons for low level of skilled birth attendance in Afar pastoralist community, North East Ethiopia: a qualitative exploration - 21 May 2018. <b>INTRODUCTION: Ethiopia has expanded the number of health facilities that offer maternal health services during the last two decades. However, the utilization of skilled birth attendants in health facilities is still very low especially among the pastoralist regions of the country. This study explored why women in the pastoralist region of Afar, Ethiopia still prefer to give birth at home. METHODS: a qualitative study approach was used to collect information from October to December 2015. A total of eighteen focus group discussions and twenty-four key informant interviews were conducted. Focus group discussions were separately conducted with mothers and male tribal or religious leaders. Key informant interviews were conducted with heads of Women's Affairs Bureau, district health office heads and traditional birth attendants. Data were coded and categorized using open code software for qualitative data management and analyzed based on a thematic approach. RESULTS: women preferred to deliver at home due to lack of awareness about the benefits of maternity health facilities, their nomadic lifestyle, lack of confidence and trust in health workers and their close affinity and easy access to traditional birth attendants. Supply-side barriers included distant health facilities, lack of transportation and poor health care. CONCLUSION: demand and supply related factors were identified as barriers to utilization of skilled birth attendants. Increasing awareness, bringing the service closer, arranging maternity waiting area around health facilities, and creating client-friendly service were found critical. Future research to define and improve services and approaches suitable for pastoralist population is warranted.</b><br/> text/html 2018-05-26T09:22:33+01:00 Amenze Oritsemofe Onowhakpor, Vincent Yakubu Adam, Oghenetega Ewomazino Sakpa, Lydia Ukamaka Ozokwelu [Research] - Status of Ebola Virus Disease (EVD) preventive practices among Health care workers (HCWs) in Benin City: a year after disease containment in Nigeria - 21 May 2018. <b>INTRODUCTION: Ebola Virus Disease (EVD) is of great public health importance. Health care workers (HCWs) in various health care facilities especially in developing countries such as Nigeria, are particularly vulnerable to the disease. It is therefore imperative that health care workers adopt the necessary preventive practices to reduce to the barest minimum the risk of infection transmission. The study assessed the factors associated with EVD preventive practices among HCWs in a tertiary institution in Benin City, Nigeria. METHODS: a total of 374 health care workers selected using a two-staged sampling technique participated in this descriptive cross-sectional study. Data were collected using structured, self-administered questionnaires and analyzed with IBM SPSS, version 21.0. Univariate and bivariate analysis were done. Level of significance was set at p < 0.05. RESULTS: the mean age of respondents was 36.3 ± 8.0 years. All, 374 (100.0%) of the respondents were aware of EVD and 347 (92.8%) of respondents had good knowledge of EVD. More than half of the respondents, 228 (61.0%) and 201 (53.7%) had positive attitude towards EVD and good EVD preventive practices respectively. A higher proportion of respondents with positive attitude towards EVD were observed to have good preventive practice (p < 0.05). CONCLUSION: knowledge, attitude and preventive practices towards EVD among HCWs were generally good. Positive attitude towards EVD was significantly associated with good preventive practices.</b><br/> text/html 2018-05-26T09:22:33+01:00 Odette Dorcas Manigoue Tchape, Youth Brittany Tchapoga, Catherine Atuhaire, Gunilla Priebe, Samuel Nambile Cumber [Research] - Physiological and psychosocial stressors among hemodialysis patients in the Buea Regional Hospital, Cameroon - 18 May 2018. <b>INTRODUCTION: End stage renal disease is an irreversible kidney condition and hemodialysis is the most frequent treatment option used for end stage renal disease. Hemodialysis has a detrimental impact on the quality of life and has a negative effect on the individuals' physical and psychosocial wellbeing. The main objective of this study was to identify physiological and psychosocial stressors faced by patients undergoing hemodialysis in the Buea Regional Hospital in Cameroon. METHODS: a cross-sectional study was carried out among patients undergoing hemodialysis at the Buea regional hospital over a period of two months (December 2016 - January 2017). Data were collected with the use of a structured questionnaire and analyzed using SPSS version 21.0. Quantitative variables were expressed as frequencies, percentages and means. RESULTS: among the patients undergoing hemodialysis, 21(52.5%) were male and 19(47.5%) female. Half of the patients were married 20(50%), 13(32.5%) were single, 6(15%) were divorced, and one (2.5%) was a widower. Also, 28 (70.0%) were below 5-year dialysis while 12 (30.0%) had been on dialysis for five years and more. All participants experienced at least one or more physiological and psychosocial stressors. Among physiological stressors, the most frequent were feeling tired (97%), followed by Arterial and venous stick (88%) while itching (49.5%). Among psycho-social stressors, the most recurrent were transportation to and from the hospital (99.5%), cost of treatment (99.5%) and limits on time and place of vacation (99%), limitation in physical activities, frequent hospitalizations, the length of time on dialysis, uncertainty about the future, changes in life style, increased dependence and sleep disturbances. CONCLUSION: the topic of stressors is of importance among patients receiving dialysis, as these affect their psycho-social and physiological wellbeing. Thus, nephrologists, nurses and family members play an important role in providing patients with effective psycho-social and physiological support.</b><br/> text/html 2018-05-26T09:22:33+01:00 Wafa Ben Ameur, Lamia Kallel, Houcine Maghrebi, Slim Haouet, Azza Filali [Case report] - Kystique intra-p&eacute;riton&eacute;al et maladie de Crohn: &agrave; propos d’une association exceptionnelle - 18 May 2018. <b>Le lymphangiome kystique est une tumeur b&eacute;gnine malformative rare des vaisseaux lymphatiques &agrave; localisations diverses. La localisation intra-abdominale du lymphangiome kystique est moins fr&eacute;quente compar&eacute;e &agrave; la localisation cervico-axillaire. Sa pr&eacute;sentation clinique est polymorphe. Le diagnostic est &eacute;voqu&eacute; par l'imagerie mais il n&eacute;cessite une confirmation histologique. Le traitement de choix est chirurgical. Nous rapportons ici un cas rare de lymphangiome kystique intrap&eacute;riton&eacute;ale acquis suite &agrave; une colectomie subtotale chez une patiente porteuse de maladie de Crohn &agrave; g&eacute;ni &eacute;volutif s&eacute;v&egrave;re et ayant n&eacute;cessit&eacute; l'introduction des anti TNF alpha. La patiente s'est pr&eacute;sent&eacute;e pour une masse para m&eacute;diane droite douloureuse irr&eacute;ductible et non impulsive &agrave; la toux faisant retenir le diagnostic d'une &eacute;ventration &eacute;trangl&eacute;e sur cicatrice de laparotomie m&eacute;diane et amenant &agrave; op&eacute;rer la patiente en urgence. L'exploration chirurgicale a montr&eacute; une masse multi-kystique intra p&eacute;riton&eacute;ale ext&eacute;rioris&eacute;e en partie &agrave; travers l'&eacute;ventration param&eacute;diane droite. L'examen anatomo-pathologique a permis de confirmer le diagnostic de lymphangiome kystique. Devant une ex&eacute;r&egrave;se chirurgicale incompl&egrave;te, la patiente a eu deux s&eacute;ances de ponction &eacute;vacuatrice en post-op&eacute;ratoire. C'est le premier cas de lymphangiome kystique rapport&eacute; chez un patient sous Anti-TNF alpha. Ceci pourrait &ecirc;tre expliqu&eacute; par la perturbation du syst&egrave;me immunitaire et plus sp&eacute;cifiquement la population lymphocytaire. Cette association n'a pas &eacute;t&eacute; jusque-l&agrave; prouv&eacute;e et des &eacute;tudes exp&eacute;rimentales sont n&eacute;cessaires pour affirmer ou infirmer cette hypoth&egrave;se.</b><br/> text/html 2018-05-26T09:22:33+01:00 Bennis Ahmed, Benatiya Andaloussi Idriss [Images in medicine] - R&eacute;cidive d’une pseudo-exfoliation capsulaire sur implant intraoculaire - 18 May 2018. <b>Patient de 79 ans, op&eacute;r&eacute; de cataracte par phaco-&eacute;mulsification en 2000, avec une pseudo-exfoliation capsulaire ODG pr&eacute;op&eacute;ratoire. Pr&eacute;sente un glaucome pseudo-exfoliatif avec une r&eacute;cidive sur l'implant.</b><br/> text/html 2018-05-26T09:22:33+01:00 Ouiam El Anzi, Badreddine Hassam [Images in medicine] - Tatouage au henn&eacute; noir: attention &agrave; l’ecz&eacute;ma de contact - 18 May 2018. <b>Le henn&eacute; est un produit utilis&eacute; pour colorer les cheveux, mais aussi pour dessiner des tatouages labiles sur la peau. Le henn&eacute; est souvent m&eacute;lang&eacute; avec de la paraph&eacute;nyl&egrave;nediamine (PPD). Nous rapportons l'observation d'une patiente qui a pr&eacute;sent&eacute; un ecz&eacute;ma de contact &agrave; un tatouage labile contenant la PPD. Une jeune femme de 23 ans se fait tatouer sur le dos de la main et sur l'avant-bras des dessins esth&eacute;tiques &agrave; base de henn&eacute; noir. Ce tatouage labile contenait de la PPD. Deux jours plus tard, elle d&eacute;veloppe des l&eacute;sions &eacute;ryth&eacute;matov&eacute;siculeuses et œd&eacute;mateuses tr&egrave;s prurigineuses avec une sensation de cuisson. Les l&eacute;sions si&eacute;geaient au site de tatouage et suivaient exactement le dessin initial. Elles &eacute;taient am&eacute;lior&eacute;es par un traitement &agrave; base de dermocortico&iuml;des de classe 4. La patiente refuse l'exploration allergologique par patch-tests et aucun test allergologique n'est effectu&eacute;. Actuellement, le henn&eacute; est tr&egrave;s en vogue dans les pays occidentaux. La PPD est ajout&eacute;e pour diminuer le temps de fixation ou pour obtenir une coloration plus fonc&eacute;e. Elle peut entrainer de graves r&eacute;actions syst&eacute;miques. La r&eacute;action allergique la plus fr&eacute;quente est la dermatite de contact. Le traitement repose sur la corticoth&eacute;rapie locale. Une meilleure l&eacute;gislation sur la pratique du tatouage temporaire et le contr&ocirc;le des pr&eacute;parations ainsi qu'une Information r&eacute;guli&egrave;re annuelle du grand public sont indispensables. L'int&eacute;r&ecirc;t de notre observation est de montrer l'importance d'informer surtout les jeunes sur les risques d'un tatouage labile.</b><br/> text/html 2018-05-26T09:22:33+01:00 Mouna Ejjiyar, Saloua Ettalbi [Images in medicine] - Complexit&eacute; de prise en charge d’une macrodactylie au niveau de la main: entre pr&eacute;judice esth&eacute;tique et fonctionnel - 18 May 2018. <b>On d&eacute;finit la macrodactylie comme une malformation cong&eacute;nitale d'&eacute;tiologie inconnue et d'incidence rare pouvant int&eacute;resser les doigts ou les orteils, et caract&eacute;ris&eacute;e par l'augmentation, d&egrave;s la naissance ou de fa&ccedil;on progressive, de la taille de tous les &eacute;l&eacute;ments d'un ou plusieurs rayons. Son retentissement social, esth&eacute;tique, et surtout fonctionnel imposent une prise en charge pr&eacute;coce passant par plusieurs interventions chirurgicales voire m&ecirc;me des amputations dans les formes &eacute;volu&eacute;es. Nous rapportons le cas d'un jeune patient &acirc;g&eacute; de 18 ans, c&eacute;libataire, sans profession, gaucher, admis au service de chirurgie plastique, r&eacute;paratrice, esth&eacute;tique et des br&ucirc;l&eacute;s du CHU Mohammed VI de Marrakech, pour prise en charge d'une forme progressive de macrodactylie int&eacute;ressant les premier et deuxi&egrave;me rayons de la main droite. A l'examen, on retrouvait une hypertrophie des deux premiers rayons de la main droite, associ&eacute;e &agrave; une infiltration fibro-graisseuse pr&eacute;dominant en palmaire, ainsi qu'une d&eacute;viation phalangienne en angulation &agrave; 90° au niveau du deuxi&egrave;me doigt. Devant cette forme s&eacute;v&egrave;re de macrodactylie, une amputation du 2&egrave;me rayon associ&eacute;e &agrave; une r&eacute;duction de l'infiltration graisseuse au niveau palmaire a &eacute;t&eacute; propos&eacute;e au patient, lui permettant de conserver une pince pollici-digitale, et de retrouver une vie sociale le plus proche possible de la normale.</b><br/> text/html 2018-05-26T09:22:33+01:00 Emmanuel Edmond Yambasu, Anthony Reid, Philip Owiti, Marcel Manzi, Mariama Jeanne Sia Murray, Ama Kyerewaa Edwin [Research] - Hidden dangers-prevalence of blood borne pathogens, hepatitis B, C, HIV and syphilis, among blood donors in Sierra Leone in 2016: opportunities for improvement: a retrospective, cross-sectional study - 18 May 2018. <b>INTRODUCTION: Transmissible blood-borne infections are a serious threat to blood transfusion safety in West African countries; and yet blood remains a key therapeutic product in the clinical management of patients. Sierra Leone screens blood donors for blood-borne infections but has not implemented prevention of mother-to-child transmission for hepatitis B. This study aimed to describe the overall prevalence of hepatitis B and C, HIV and syphilis among blood donors in Sierra Leone in 2016 and to compare the differences between volunteer versus family replacement donors, as well as urban versus rural donors. METHODS: retrospective, cross-sectional study from January-December 2016 in five blood bank laboratories across the country. Routinely-collected programme data were analyzed; blood donors were tested with rapid diagnostic tests-HBsAg for HBV, anti-HCV antibody for HCV, antibodies HIV1&2 for HIV and TPHA for syphilis. RESULTS: there were 16807 blood samples analysed, with 80% from males; 2285 (13.6%) tested positive for at least one of the four pathogens. Overall prevalence was: 9.7% hepatitis B; 1.0% hepatitis C; 2.8% HIV; 0.8% syphilis. Prevalence was higher among samples from rural blood banks, the difference most marked for hepatitis C. The proportion of voluntary donors was 12%. Family replacement donors had a higher prevalence of hepatitis B, C and HIV than volunteers. CONCLUSION: a high prevalence of blood-borne pathogens, particularly hepatitis B, was revealed in Sierra Leone blood donors. The study suggests the country should implement the prevention of mother-to-child transmission of hepatitis B and push to recruit more volunteer, non-remunerated blood donors.</b><br/> text/html 2018-05-26T09:22:33+01:00 Simant Singh Thapa, Buddha Basnyat [Images in medicine] - Higher ascent, trouble breathing: high altitude pulmonary edema (HAPE) - 18 May 2018. <b>A 40 year old man started his trekking 4 days ago from Lukla (2800m) in the Everest region of Nepal. He reached Tengboche (3860 m) on third day where he was short of breath with moderate exertion and was easily fatigued. He ascended further ignoring his symptoms and reached Dingboche (4410m) on fourth day. He was extremely tired, short of breath at rest and appeared ill so helicopter evacuation was done from Dingboche to Kathmandu (1300m) and he was brought to our clinic. On initial evaluation, his vital signs were temperature 97.8 F, blood pressure 124/66 mmHg, pulse rate 89/min, respiratory rate of 26 breaths/min and saturation (SpO2) of 80% on room air at rest. Auscultation of the lungs revealed bilateral crackles. Finger to nose test and tandem gait was normal. The chest radiograph showed patchy infiltrates bilaterally. He was diagnosed as the case of HAPE. He was treated with bed rest and supplemental oxygen. On evaluation the next day, his pulmonary crackles had resolved and he was no more short of breath. His ambulatory SpO2 was 96% on room air. His dramatic clinical improvement following descent strongly supported our diagnosis. HAPE is a non-cardiogenic form of pulmonary edema. Its notable feature in contrast with other causes of pulmonary edema is fast reversibility following timely descent with or without oxygen.</b><br/> text/html 2018-05-26T09:22:33+01:00 Antoine Lamblin, Cl&eacute;ment Derkenne, Antoine Schwartz, Pierre Pasquier, Romain Gorioux, Pierre-Fran&ccedil;ois Wey [Case series] - Prise en charge des corps &eacute;trangers du tiers sup&eacute;rieur de l’œsophage sans endoscope: un d&eacute;fi pour le m&eacute;decin en situation isol&eacute;e? - 18 May 2018. <b>La prise en charge des corps &eacute;trangers du tiers sup&eacute;rieur de l'œsophage est bien codifi&eacute;e et fait appel le plus souvent &agrave; un traitement endoscopique. Ce mat&eacute;riel sp&eacute;cifique, ainsi que des m&eacute;decins gastro-ent&eacute;rologues entra&icirc;n&eacute;s &agrave; son utilisation fait parfois d&eacute;faut dans les pays d'Afrique. D'autres moyens doivent alors &ecirc;tre envisag&eacute;s pour les m&eacute;decins ayant &agrave; prendre en charge ce type de pathologie. L'objectif de cette &eacute;tude &eacute;tait d'&eacute;valuer la prise en charge des corps &eacute;trangers du tiers sup&eacute;rieur de l'œsophage par des m&eacute;decins anesth&eacute;sistes-r&eacute;animateurs dans un centre m&eacute;dico-chirurgical du Tchad. 37 cas d'extraction chez des enfants de 0 &agrave; 15 ans &eacute;taient analys&eacute;s. Il s'agissait de pi&egrave;ces de monnaie et de piles au lithium dans respectivement 92% et 8% des cas. La m&eacute;thode employ&eacute;e &eacute;tait une sonde de Foley &agrave; ballonnet dans 43,2% et d'une pince &agrave; calcul sous laryngoscopie dans 56,8% des cas. Un cas d'&eacute;chec ayant n&eacute;cessit&eacute; une cervicotomie &eacute;tait not&eacute; dans chaque groupe. Quatre complications mineures &eacute;taient rapport&eacute;es dans le groupe « pince &agrave; calcul », aucune dans le groupe « Foley ». Les indications d'extraction de corps &eacute;trangers du tiers sup&eacute;rieur de l'œsophage doivent &ecirc;tre bien connues des m&eacute;decins amen&eacute;s &agrave; les prendre en charge. En cas d'indisponibilit&eacute; de l'endoscopie, d'autres techniques alternatives peuvent &ecirc;tre utilis&eacute;es avec un taux de succ&egrave;s satisfaisant. En cas d'&eacute;chec un recours &agrave; la chirurgie peut &ecirc;tre n&eacute;cessaire.</b><br/> text/html 2018-05-26T09:22:33+01:00 Lamiae Bouimetarhan, Habib Bellamlih, Issam En-nafaa, Jamal EL Fenni, Touria Amil, Bouchaib Radouane [Case report] - Neurofibfrome plexiforme cervical: &agrave; propos d’un cas - 17 May 2018. <b>Le neurofibrome plexiforme est une tumeur b&eacute;nigne rare des nerfs p&eacute;riph&eacute;riques aux d&eacute;pens des cellules conjonctives du p&eacute;rinevre. Il est pathognomonique de la neurofibromatose de type 1 (NF1 ou maladie de Von Recklinghausen). L'IRM est d'une grande aide au diagnostic de cette pathologie. La confirmation anatomopathologique est parfois n&eacute;cessaire en particulier en dehors d'un contexte &eacute;vocateur d'une NF1. Nousrapportonsl'observation d'une petite fille atteinte de neurofibrome plexiforme cervical r&eacute;v&eacute;lateur d'une neurofibromatose Type 1.</b><br/> text/html 2018-05-26T09:22:33+01:00 Leila Nasiriani, Seyedeh Fatemeh Vasegh Rahimparvar, Tahmine Faraj Khoda, Naser Bahrani [Research] - Compliance to professional codes of ethics and its related factors from midwives’ perspective working in healthcare centers of Tehran-Iran - 17 May 2018. <b>INTRODUCTION: Professional ethics is an important issue in every organization. This study was designed to define compliance level to professional codes of ethics and some of its related factors in midwives working at healthcare centers. METHODS: This cross sectional study was conducted in 2013 Tehran Iran. 125 midwives from the governmental healthcare centers of Tehran were selected through stratified quota sampling method. Data gathering tool was a self-reporting questionnaire which included: demographic characteristics, Iranian version of ethical codes of reproductive health providers, applicability of these ethical codes, and awareness about the professional codes of ethical. Data analysis was conducted using SPSS v.16. p level at 0.05. RESULTS: The level of compliance to the professional ethical codes by midwives was 76.7% as a whole, and between 69 to 85 percent in 10 domains. Compliance to the codes were directly correlated to the income level of the midwives, the applicability of the codes and the midwives' awareness about them. CONCLUSION: It is necessary to pay attention to professional ethics and its teaching as such. It is also important to monitor compliance to the ethical codes. Moreover, living conditions of the midwives should be one of the priorities to enhance their performance.</b><br/> text/html 2018-05-26T09:22:33+01:00 Francine Mwayuma Birungi, Brian van Wyk, Jeannine Uwimana, Joseph Ntaganira, Stephen Michael Graham [Research] - Xpert MTB/RIF assay did not improve diagnosis of pulmonary tuberculosis among child contacts in Rwanda - 17 May 2018. <b>INTRODUCTION: To report on the diagnostic yield using the Xpert MTB/RIF assay on gastric lavage samples from children (<15 years) who were household contacts of tuberculosis (TB) cases in Kigali, Rwanda. METHODS: A cross-sectional study was conducted among 216 child contacts of index cases with sputum smear-positive TB over a 7 month period, from 1<sup>st</sup> August 2015 to 29<sup>th</sup> February 2016. Child contacts with tuberculosis-related symptoms or abnormal chest X-ray had sputum collected by gastric lavage on two consecutive days and samples were examined by smear microscopy, Xpert MTB/RIF assay and solid culture. RESULTS: Of the 216 child contacts, 94 (44%) were less than 5 years of age. Most of them 84 (89%) were receiving isoniazid preventive therapy at the time of screening. Thirty seven out of 216 children had TB-related symptoms. Only 4 (10.8%) were clinically diagnosed with TB; and none had bacteriologically confirmed tuberculosis. CONCLUSION: The use of Xpert MTB/RIF assay did not contribute to bacteriological confirmation of active TB in child contacts in this study. The low prevalence of tuberculosis in child contacts in this study may reflect the high coverage of preventive therapy in young (<5 years) child contacts. The low sensitivity of Xpert MTB/RIF assay in contacts may also suggest likely reflection of paucibacillary disease.</b><br/> text/html 2018-05-26T09:22:33+01:00 Ouahidi Mohamed, Hicham Bousbaa, Mourad Bennani, Toufik Cherrad, Hassan Zejjari, Jamal Louaste, Khalid Rachid, Laarbi Amhajji [Case series] - Traitement des fractures de la diaphyse hum&eacute;rale par l’embrochage centro-m&eacute;dullaire r&eacute;trograde de Hackethal: &agrave; propos de 54 cas - 17 May 2018. <b>Les auteurs rapportent 54 cas de fracture de la diaphyse hum&eacute;rale trait&eacute;s par embrochage de Hackethal. 3 cas avec paralysie du nerf radial ont &eacute;t&eacute; observ&eacute; dont l'abstention th&eacute;rapeutique en urgence a &eacute;t&eacute; l'attitude avec surveillance et qui ont abouti &agrave; une r&eacute;cup&eacute;ration. La technique de l'embrochage est relativement facile mais n&eacute;cessite une technique rigoureuse et une bonne exp&eacute;rience de l'op&eacute;rateur. Un taux de 7,84 % de pseudarthrose &eacute;tait observ&eacute;. L'embrochage d'Hackethal peut &ecirc;tre consid&eacute;rer comme un traitement orthop&eacute;dique am&eacute;lior&eacute; avec un co&ucirc;t modeste et une innocuit&eacute; importante.</b><br/> text/html 2018-05-26T09:22:33+01:00 Noureddine Khiri, Moussa Lazreg, Houssam Bkiyar, Soufiane Diyas, Brahim Housni [Case report] - Le syndrome de Miller Fischer: &agrave; propos d’un cas p&eacute;diatrique - 17 May 2018. <b>Le syndrome de Miller Fisher (MF) repr&eacute;sente une forme rare du syndrome de Guillain-Barr&eacute; qui ne survient que dans 5% des cas chez l'adulte alors que les cas p&eacute;diatriques d&eacute;crits dans la litt&eacute;rature sont encore plus rares. Nous pr&eacute;sentons le cas d'un enfant de 12 ans chez qui on a pos&eacute; le diagnostic de syndrome de Miller Fischer en se basant sur la pr&eacute;sentation clinique avec une atteinte oculaire en premier plan et la positivit&eacute; des anticorps anti-ganglioside. Notre patient est admis dans notre structure dans un tableau de d&eacute;tresse respiratoire n&eacute;cessitant l'intubation orotrach&eacute;ale et le recours aux immunoglobulines intraveineuses avec bonne &eacute;volution clinique.</b><br/> text/html 2018-05-26T09:22:33+01:00 Abdelhafid El Marfi, Badarou Chaibou, Kevin Parfait Bienvenue Bouhelo-Pam, Mohamed El Idrissi, Mohamed Shimi, Abdelhalim El Ibrahimi, Abdelmajid El Mrini [Case report] - L’arthroscopie de la hanche dans le conflit f&eacute;moro-ac&eacute;tabulaire: &agrave; propos de 2 observations - 17 May 2018. <b>Le conflit f&eacute;moro-ac&eacute;tabulaire (CFA) est une des causes de douleur de hanche chez les sujets jeunes et sportifs. Son diagnostic est bas&eacute; sur des arguments cliniques et radiologiques. La prise en charge chirurgicale peut &ecirc;tre conventionnelle ou arthroscopique. L'arthroscopie s'av&egrave;re &ecirc;tre une technique fiable dans les CFA, efficace sur la douleur, permettant d'am&eacute;liorer la fonction de ces patients sportifs afin de reprendre leurs activit&eacute;s pr&eacute;cocement. Nous rapportons l'exp&eacute;rience de notre service dans la prise en charge arthroscopique des CFA &agrave; travers deux observations. Le score de Harris modifi&eacute; &eacute;tait nettement am&eacute;lior&eacute; au dernier recul (24 et 18 mois).</b><br/> text/html 2018-05-26T09:22:33+01:00 Richard-A-Mutshimbe Mukendi, C&eacute;lestin Lubaba Nkulu Banza, Clarence-A-Kaut Mukeng, Jules Thaba Moyambe Ngwe, Albert Ntambwe-A-Nkoy Mwembo, Prosper Muenze Kayamba Kalenga [Research] - Exposition de l’homme aux éléments traces métalliques et altération du sperme: étude menée dans les zones minières du Haut-Katanga en République Démocratique du Congo - 16 May 2018. <b>INTRODUCTION: L’exposition &agrave; l’arsenic et au cadmium entraine des effets n&eacute;fastes importants. L’objectif de cette &eacute;tude est de d&eacute;terminer les concentrations urinaires en arsenic et en cadmium chez les hommes et d’analyser leur profil en rapport avec les &eacute;l&eacute;ments du spermogramme. METHODES: Il s’agit d’une &eacute;tude analytique expos&eacute;s-non expos&eacute;s o&ugrave; les hommes expos&eacute;s ont &eacute;t&eacute; recrut&eacute;s dans une zone mini&egrave;re du Haut-Katanga, en RDC et les hommes non-expos&eacute;s dans une zone loin de toute activit&eacute; mini&egrave;re.</b><br/> text/html 2018-05-26T09:22:33+01:00 Ary&eacute; Weinberg, Ralph Magritz [Images in medicine] - The red ear - 16 May 2018. <b>A 5-year-old boy was presented to our out-patient clinic by his father with a painful swollen red left ear (A). The father stated that his son has been suffering from an upper- respiratory tract infection and that his left ear has been hurting since the other day. Hearing loss was denied. Clinical examination showed a painfull swelling of the left ear causing it to stick out. Behind the ear an insect bite was noticed, probably from a mosquito (B). Otoscopy showed a white transparent ear drum with no signs of infection. Thus an acute mastoiditis based on a middle ear infection was excluded. The patient was treated for a mosquito bite with a topical coricoidsteroid gel and cooling. The boy totally recovered after two days.</b><br/> text/html 2018-05-26T09:22:33+01:00 Mohamed El Amraoui, Mohammed Boui [Images in medicine] - Carcinome basocellulaire: à propos d’un cas historique - 16 May 2018. <b>Un homme &acirc;g&eacute; de 80 ans, villageois, r&eacute;sidant dans l'une des zones les plus enclav&eacute;es de notre royaume, situ&eacute;e &agrave; plus de 2400 m&egrave;tres d'altitude, et ayant un phototype clair (II). A consult&eacute;, lors d'une mission humanitaire, pour une tumeur ulc&eacute;ro-n&eacute;crotique, infiltrant la racine du nez et l'orbite droits avec destruction totale de l''il droit. La l&eacute;sion &eacute;voluait, selon le patient, depuis deux ans et demi, par une petite papule saignante sur la racine du nez avec une extension orbitaire. L'aspect clinique et l'histologie &eacute;taient en faveur d'un carcinome baso-cellulaire infiltrant. Le bilan d'extension montrait un envahissement des plans osseux de la r&eacute;gion naso-orbitaire droite. Une chirurgie carcinologique et mutilante a &eacute;t&eacute; indiqu&eacute;e mais que le patient a refus&eacute;e. Le carcinome baso-cellulaire est r&eacute;put&eacute; par son pronostic relativement bon, vue son &eacute;volution lente et locale, cependant, certaines formes notamment la forme infiltrante, dans certaines zones &agrave; haut risque, notamment dans la zone naso-orbitaire peuvent &ecirc;tre rapidement d&eacute;labrantes, mutilantes et spectaculaires avec des pr&eacute;judices esth&eacute;tiques et fonctionnelles et des difficult&eacute;s de prise en charge.</b><br/> text/html 2018-05-26T09:22:33+01:00 Fitsum Weldegebreal, Habtamu Mitiku, Zelalem Teklemariam [Research] - Treatment outcome of tuberculosis among Human Immunodeficiency Virus positive patients in Eastern Ethiopia: a retrospective study - 16 May 2018. <b>INTRODUCTION: Tuberculosis is the leading cause of morbidity and mortality among people living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome worldwide. Although Human Immunodeficiency Virus related tuberculosis is both treatable and preventable, incidence rates continue to climb in developing countries where both infections are endemic. The aim of this study was to assess the treatment Outcome of Tuberculosis among Human Immunodeficiency Virus positive patients attending in three hospitals of Eastern Ethiopia. METHODS: A retrospective clinical record review was conducted on all 627 Tuberculosis and Human immunodeficiency virus co-infected patients registered from January 2008 to January 2014 cards were reviewed in three hospitals of Tuberculosis Clinics of Eastern Ethiopia from December 2015 to February 2016. The three hospitals were selected based on their high patient load of TB-HIV co infection and the presence of ART and TB units. Data on patient's details and tuberculosis treatment outcome was collected using standardized report format of National Tuberculosis, and Leprosy Control Programme (NTLCP). The collected data were analyzed by Statistical Package for Social Sciences (SPSS) software Version 16. RESULTS: The overall treatment success rate was 78.3%. Of the total TB–HIV co infected study participants, 17.9% cured, 60.4% treatment completed, 8.6% died, 0.6% failure, 1.8% defaulter and 10.7% transferred out. Those participants in the age groups of less than or equal to 18 years old (Adjusted Odds Ratio = 1.990, 95% Confidence Interval: 1.01, 3.350), Extra pulmonary Tuberculosis (Adjusted Odds Ratio =1.51, 95% Confidence Interval =1.12, 3.42), on Antiretro Viral Therapy (Adjusted Odds Ratio= 1.54, 95% Confidence Interval = 1.252, 3.910) were more likely to have higher treatment outcome than each of the above variables counter parts. CONCLUSION: The rate of treatment success in this study was lower than recommended rate by World Health Organization. Thus this study recommends improving counseling during tuberculosis treatment, providing home visits and motivation of patients, improving defaulter tracing and health information dissemination in order to reduce treatment interruption.</b><br/> text/html 2018-05-26T09:22:33+01:00 Ary&eacute; Weinberg, Ralf Siegert [Images in medicine] - A tongue ulcer - 16 May 2018. <b>An 86-year-old man presented with a painful lesion on his left tongue measuring 0.6 x 0.6mm (A). The lesion has been growing over the last 2 weeks. The patient did not remember any trauma except that his teeth did sometimes scratch his tongue. Histology form the excised lesion revealed a pressure ulcer (B). Tongue ulcers can be caused by accidental bites, ill-fitting dentures, braces, citrus or acidic fruits and by a sharp tooth surface. In some other cases nutritional problems such as vitamin B12, iron or folic acid deficiency may cause tongue ulcers. Never the less malignancy needs to be excluded. Therefore, complete excision and diagnosis based on histology is recommended.</b><br/> text/html 2018-05-26T09:22:33+01:00 Skander Zouari, Khaireddine Bouassida, Khaled Ben Ahmed, Ahlem Bdioui Thabet, Mohamed Amine Krichene, Chawki Jebali [Case report] - Acute urinary retention due to benign prostatic hyperplasia associated with cystitis glandularis in a 22-year-old patient - 16 May 2018. <b>A 22-year-old man has consulted in emergency for acute urinary retention and left renal colic. Bladder catheterization was performed. Symptomatic treatment was provided with no improvement. MRI showed a pseudotumoral bladder wall thickening associated with vesical floor budding with prostate median lobe infiltration. The patient got an endoscopy that concluded to an inflammatory aspect of the bladder mycosa and a solid mass in the bladder neck arising. The biopsy during examination concluded to a glandular cystitis. Ultrasonography performed six months later still showed an enlarged prostate of 60g volume, post void residue of 280ml and bilateral hydronephrosis. A second cystoscopy showed an obstructive prostate with a median lobe. A transurethral resection of this lobe was performed. The pathological examination concluded to a benign prostate hyperplasia. This case is likely to be the first reported so far about a BPH in a young male associated with Cystitis Glandularis. Neither etiology nor evidence of the cause behind this case has been identified so far. Although Benign Prostate Hypertrophia is rare among young males, its ethiopathogenesis is not well known, its relation with cystitis glanduralis in young patients has never been described before. Both medical and surgical approaches remain similar to the adults.</b><br/> text/html 2018-05-26T09:22:33+01:00 Nassiba Elouarradi, Nawal El Ansari [Images in medicine] - Familial hypercholesterolemia revealed by multiple xanthomas - 16 May 2018. <b>Familial hypercholesterolemia (HF) is a rare pathology characterized by a major elevation of LDL associated with tendinous and subcutaneous xanthomas. We report the case of a 16-year-old patient, born from a first degree consanguineous marriage, with no particular pathological antecedents, the patient reports appearance for 9 years of cutaneous lesions described as a swellings in the posterior face of the 2 elbows and the anterior surface of the 2 knees, painless, firm, and gradually increasing in volume. The patient consulted only at the age of 16 years in front of the aesthetic discomfort. The biological assessment objectified a hypercholesterolemia: total Cholesterol: 4.44g/l. HDL: 0.64g/l. LDL: 3.71g/l. and Triglycerides: 0.67g/l. The exploration of cardiac repercussion was without particularities.The patient was treated with dietary and lifestyle measures and atorvastatin 80 mg with good clinical and biological evolution.</b><br/> text/html 2018-05-26T09:22:33+01:00 Almeimoune Abdoulhamidou, Mangane Moustapha, Diop Madane Thierno, Beye Seydina Alioune, D&eacute;mbele Seydou Aladji, Diarra Kassim, Diango Djibo Mahamane [Research] - Gestion des secours m&eacute;dicaux aux victimes des attentats terroristes au Mali - 15 May 2018. <b>INTRODUCTION: Les r&eacute;cents attentats suicides ont r&eacute;v&eacute;l&eacute; un nouveau type d’afflux massif de bless&eacute;s, unique en son genre, qui doivent &ecirc;tre pris en charge au sein des formations hospitali&egrave;res. METHODES: Nous rapportons l’exp&eacute;rience du CHU Gabriel Toure de Bamako et de l’h&ocirc;pital N. Fomba de S&eacute;gou dans la gestion des secours m&eacute;dicaux aux victimes des attentats terroristes au Mali. RESULTATS: Soixante-quatre victimes des trois attentats ont &eacute;t&eacute; inclus dans notre &eacute;tude parmi ceci 22 (34,4 %) cas de d&eacute;c&egrave;s constat&eacute; &agrave; l’arriv&eacute;e. Les hommes avaient repr&eacute;sent&eacute; 97% des victimes qui &eacute;taient de nationalit&eacute; malienne dans 71% des cas. Dans 51% des cas il s’agissait de bless&eacute; grave avec des l&eacute;sions pr&eacute;dominantes aux extr&eacute;mit&eacute;s chez 35% d’entre eux. Aucune victime admise vivante n &eacute;tait d&eacute;c&egrave;de au cours de la prise en charge hospitali&egrave;re. CONCLUSION: Pouvoir disposer de donn&eacute;es pr&eacute;cises sur les m&eacute;canismes et la gravit&eacute; des l&eacute;sions, une prise en charge m&eacute;dicale pr&eacute; hospitali&egrave;re permettront de diminuer la morbi-mortalit&eacute; li&eacute;e &agrave; ces catastrophes.</b><br/> text/html 2018-05-26T09:22:33+01:00 Alicia Ehlers, Chandra Rekha Makanjee [Research] - Exploration of gynaecological cancer high dose-rate brachytherapy treatment: a pilot study - 15 May 2018. <b>INTRODUCTION: Performing brachytherapy on female patients with gynaecological cancer is a sensitive procedure, apart from it being an intricate investigation. The aim of this study: establishing gynaecological cancer patients' expectations, experiences and understandings of the high dose-rate brachytherapy treatment procedure. Exploring these patients' life-worlds provides further insights into improving their preparedness and experiences. METHODS: a qualitative research design with a descriptive phenomenological research approach was used. Recruitment entailed using purposive sampling. To obtain rich insights into the lived experiences, data was acquired through semi-structured interviews until data saturation. RESULTS: major challenges were experienced with mixed thoughts and feelings, from negative trauma to desires being fulfilled. These patients should have received more information regarding their upcoming brachytherapy treatment. This would have alleviated some of their fears and anxieties, which would in turn have provided them with a better brachytherapy treatment experience. Envisaged outcomes and desires are used to cope. Patients influence each other negatively, so they rather wanted to "see for themselves". CONCLUSION: despite some disappointments and negative experiences throughout the brachytherapy continuum, the patients were left with a positive outlook, saying that it is an excellent and necessary treatment. Further studies should be done to elaborate on fulfilments of recommendations in the brachytherapy department of radiation oncology.</b><br/> text/html 2018-05-26T09:22:33+01:00 Guglielmo Mantica, Hilgard Ackermann [Images in medicine] - Horseshoe kidney - 15 May 2018. <b>A 21-year-old male presented with a one day history of right flank pain and signs of severe sepsis. The recorded vital signs included a temperature of 39.9° Celsius, blood pressure of 95/65 mmHg and heart rate of 165. The laboratory investigations confirmed a raised C-reactive protein (CRP) of 485 mg/l but it was interesting to note thatthe white cell count and creatinine were respectively normal (5.85 x 109/l; 77 µmol/l). Microbiological investigations confirmed Klebsiella pneumoniae (>106 cfu/mL) on urine culture whilst two blood cultures were negative. Intravenous fluid resuscitation was successful in restoring hemodynamic stability. Amoxicillin/clavulanic acid (1200mg) was administered and continued for seven days after confirmation on antibiotic sensitivity testing. After ultrasonography confirmed severe right hydronephrosis, a contrasted computed tomography (CT) scan confirmed a horseshoe kidney (A, B, C, D) with an obstructed right-sided renalmoiety secondary to right pelvi-ureteric junction (PUJ) obstruction (B) and urothelial enhancement suggestive of an infected collecting system. Horseshoe kidneys are the most common congenital renal abnormality with an incidence of 1:400-600. It is commonly asyptomatic and rarely require interventionunless treating complications such as ureteral obstruction (PUJ), urinary tract infections, urolithiasis andWilms Tumour. It is associated with Trisomy 18 and females with Turner syndrome. Our patient underwent a right percutaneous nephrostomy (PCN) and 500 millilitres of infected urine were aspirated. He made a complete recovery at discharge. An interval MAG3 renogram confirmed that both moeities had good and excretion. A pelvi-ureteric junction repair will be performed after 6 weeks.</b><br/> text/html 2018-05-26T09:22:33+01:00 Khalid Mazine, Pierre Barsotti, Hicham Elbouhaddouti, Ouadii Mouaqit, Elbachir Benjelloun, Khalid Ait Taleb, Abdelmalek Ousadden [Case report] - Trichob&eacute;zoard gastroduod&eacute;nal: &agrave; propos d’un cas - 15 May 2018. <b>Le trichob&eacute;zoard gastroduod&eacute;nal est une affection rare, dont le diagnostic est facile en pr&eacute;sence d'un contexte &eacute;vocateur. Nous rapportons le cas d'une jeune patiente &acirc;g&eacute;e de 21 ans suivie pour une schizophr&eacute;nie, admise pour douleur abdominale aigu&euml;, vomissements et masse &eacute;pigastrique, le scanner abdominal a permis de faire suspecter un b&eacute;zoard en objectivant des l&eacute;sions h&eacute;t&eacute;rog&egrave;nes occupant tout l'estomac, ne prenant pas le contraste et semblant ind&eacute;pendante de la paroi gastrique. Un traitement chirurgical a &eacute;t&eacute; r&eacute;alis&eacute; avec ex&eacute;r&egrave;se du trichob&eacute;zoard par gastrotomie, sans complications et un transfert en service de psychiatrie.</b><br/> text/html 2018-05-26T09:22:33+01:00 Isaac Nkrumah, Catherine Atuhaire, Gunilla Priebe, Samuel Nambile Cumber [Research] - Barriers for nurses’ participation in and utilisation of clinical research in three hospitals within the Kumasi Metropolis, Ghana - 15 May 2018. <b>INTRODUCTION: Scientific research results are a necessary base for high quality nursing practice. The level of implementation of research in the clinical setting, including nurses' participation in and knowledge of research results, have gained considerable attention internationally. However, the remarkable international increase of such studies does not apply to the Ghanaian context. We therefore set out to evaluate the degree of involvement of nurses in research, as well as their utilization patterns of research findings in Ghana. Objectives: the study sought to investigate the proportion of nurses involved in clinical research as well as barriers for nurses' participation and utilization of research findings, within the Kumasi Metropolis area, Ghana. METHODS: a descriptive and analytical cross-sectional study design was used in this study. A 47 item questionnaire elicited data on 158 participants' demographics, the proportion and the barriers to participation, which was then analyzed using SSPS version 17 software. Qualitative interviews with key informants complemented quantitative survey data. In-depth interviews with nurse managers at the hospitals in focus was conducted and analyzed thematically. RESULTS: the study shows that 36.1% of the nurses, included in the study, had participated in research and only 25.3% of these had (knowingly) used specific research results in clinical practice. However, the level of research participation differed greatly between nurses working at different hospitals. Nurses' participation in clinical research was shown to be associated with their perception of benefit of research to practice as well as their understanding of time as a factor for them engaging in reading scientific articles. In addition, barriers associated with nurses' integration of research findings into the daily practice was their perceived lack of support from the collegium and their perception of research as not part of the nursing role. CONCLUSION: findings from the study suggest that there is a need to create institutional support to facilitate and encourage nurses' participation in research, yet also to formalize nurses' continuous professional development. This, could change nurses' attitudes towards research, and contribute to improving health care as it would increase nurses' role as agents for evidence based clinical practice.</b><br/> text/html 2018-05-26T09:22:33+01:00 Andreia de Oliveira Alves, Fred Bernardes Filho [Images in medicine] - Snail track ulcers of the tongue - 15 May 2018. <b>A 36-year-old male, heterosexual, complained of a 4-week history of ulceration in the tongue left margin. He denied previous treatment and any systemic diseases. The patient reported multiple sexual partners and episodes of unprotected sex in the past 12 months. Oral findings showed irregular erythematous patches on the dorsum of the tongue and erosive plaques on the tongue left margin with snail track pattern. On physical examination, cutaneous lesions were absent, and a difuse micropolyadenomegaly was noted. The laboratory tests were positive for TPHA VDRL (1/64), and negative for HIV, hepatitis B and C. The diagnosis of snail track ulcers of secondary syphilis was performed. The patient was treated with two doses of intramuscular benzathine penicillin (total dose of 4,800,000 U IM) with an interval of seven days between each dose. The tongue lesions completely disappeared after the two doses of the penicillin. Although very rarely oral ulceration may be the only manifestation of infection. The two principal oral features of secondary syphilis are mucous patches and maculopapular lesions. The oral features of secondary syphilis can be painless or painful erythematous lesions, grayish-white mucous patches, or irregular linear erosions termed snail track ulcers. The resurgence of syphilis is mainly due to sexual risk behaviors. This cases illustrates the need for include syphilis in the differential diagnosis of oral ulceration and how clinical features should be valued in clinical semiotics.</b><br/> text/html 2018-05-26T09:22:33+01:00 Aziz Bazine, Mohamed Fetohi [Images in medicine] - A giant cutaneous squamous cell carcinoma of the neck - 15 May 2018. <b>A 72-year-old man living in a mountain region presented with a painful giant tumor in the right laterocervical area, which had been observed 2 years previously and had started to grow rapidly over the past 6 months. The patient had a past history of heavy tobacco intake and suffered from arterial hypertension and diabetes mellitus. The physical examination revealed a bulky, exophytic tumor measuring 20 cm in length across the major axis, with a large ulcerated area, which bled easily and multiple fistulae discharged a malodorous secretion. The adjacent dermis was also infiltrated over several centimeters beyond the visible borders of the lesion. A biopsy of the tumor was performed. Histopathological examination revealed a well-differentiated squamous cell carcinoma. The computed tomography (CT) scan showed a heterogeneous mass in the right lateral region of the neck with irregular contours, a necrotic center and an infiltration of the internal jugular vein. The tumor appeared to adhere to the sternocleidomastoid muscle, the paralaryngeal soft tissues, the submandibular region, the parapharyngeal space and the parotid. No local adenopathy or distant metastatic disease was noted. The tumor was considered unresectable. The patient had an ECOG performance status rating of 2 and a normal renal function. Neoadjuvant chemotherapy with cisplatin and 5-fluorouracil was initiated. After the third cycle, the CT scan showed a progression of disease with increased-neck-mass size and appearance of pulmonary metastases. The general condition of the patient did not allow second-line chemotherapy and he died 1 month later.</b><br/> text/html 2018-05-26T09:22:33+01:00 Ulrich Davy Kombila, Yacine Dia Kane, Fatimata Bintou Rassoule Mbaye, Ndeye Fatou Diouf, Waly Ka, Nafissatou Oumar Tour&eacute; [Case series] - Particularit&eacute;s radiologiques de la tuberculose pulmonaire &agrave; microscopie positive au Service de Pneumologie du Centre Hospitalier National Universitaire de FANN (CHNUF), Dakar (S&eacute;n&eacute;gal) - 09 May 2018. <b>L’objectif &eacute;tait de d&eacute;terminer les diff&eacute;rents aspects radiologiques de la tuberculose pulmonaire &agrave; microscopie positive. Il s’agissait d’une &eacute;tude r&eacute;trospective, analysant les clich&eacute;s de radiographies des patients atteints de tuberculose pulmonaire &agrave; microscopie positive entre le 15 Novembre 2015 et le 15 Mars 2016. Soixante-six dossiers r&eacute;pondant aux crit&egrave;res d’inclusion ont &eacute;t&eacute; s&eacute;lectionn&eacute;s, compos&eacute; de 81,8% des hommes. La moyenne d’&acirc;ge &eacute;tait de 37,5 ± 14,9 ans. Les diff&eacute;rentes l&eacute;sions parenchymateuses, &eacute;taient variables et domin&eacute;es par les infiltrats dans 84,8% (IC95%; 73,9 – 92,4%) des cas, suivi du syndrome alv&eacute;olaire dans 68,2% (IC95%; 55,5 – 79,1%) des cas. Elles &eacute;taient extensives dans 71,2% (IC95%; 58,7 – 81,7%) des cas et bilat&eacute;rales dans 45,4% (IC95%; 31,1 – 58,1%) des cas. Ces anomalies radiologiques survenaient dans 52,2% (IC95%; 36,9 – 67,1%) des cas chez les patients d&eacute;nutrie. Dans 22,7% (IC95%; 13,3 – 34,7%) des cas il s’agissait d’un second &eacute;pisode de tuberculose pulmonaire. La consommation r&eacute;guli&egrave;re de tabac a &eacute;t&eacute; retrouv&eacute;e chez 34,8% (IC95; 23,5 – 47,5%) des patients avec une consommation moyenne de 17PA (±11,3). Les rechutes tuberculeuses &eacute;taient plus fr&eacute;quentes chez les patients qui avaient fum&eacute;s versus les non-fumeurs respectivement dans 26,1% et 20,9% (p < 0,42). La s&eacute;rologie r&eacute;trovirale profil 1, &eacute;tait positive dans 7,6% des cas. A travers cette &eacute;tude, nous pr&eacute;conisons en zone d’end&eacute;mie tuberculeuse d’orienter la d&eacute;marche &eacute;tiologique vers la recherche d’une tuberculose pulmonaire devant des images radiologiques infiltratives associ&eacute;es ou non &agrave; des l&eacute;sions cavitaires chez un patient jeune, d&eacute;nutrie et &agrave; fortiori fumeur.</b><br/> text/html 2018-05-26T09:22:33+01:00 Zenab Alami, Touria Bouhafa, Abderrahmane Elmazghi, Khalid Hassouni [Case report] - Le lymphome malin Hodgkinien au cours de la grossesse; quelle modalit&eacute; th&eacute;rapeutique: &agrave; propos d’un cas et une revue de la litt&eacute;rature - 09 May 2018. <b>Bien que le lymphome malin Hodgkinien ou (maladie de Hodgkin) ne repr&eacute;sente que 10% de tous les lymphomes, c'est l'un des sous-types de lymphomes les plus communs diagnostiqu&eacute;s pendant la grossesse, en grande partie &agrave; cause de l'incidence maximale de la maladie qui co&iuml;ncide avec l'&acirc;ge de reproduction. La prise en charge d'une patiente enceinte atteinte d'une maladie de Hodgkin n&eacute;cessite une approche multidisciplinaire, ainsi qu'une communication efficace avec le patient et sa famille. L'objectif est d'optimiser les chances de gu&eacute;rison de la m&egrave;re tout en permettant l'accouchement d'un enfant en bonne sant&eacute;. Nous rapportant un cas rare d'une patiente enceinte diagnostiqu&eacute;e pour une maladie de Hodgkin &agrave; 17 semaines d'am&eacute;norrh&eacute;e.</b><br/> text/html 2018-05-26T09:22:33+01:00 Kadouri Youssef, Ousmane Nago Dembele, Ziani Idriss, Hachem Elsayegh, Ali Iken, Lounis Benslimane, Yassine Nouini [Report] - Le l&eacute;iomyosarcome de la vessie: &agrave; propos de 3 cas - 09 May 2018. <b>Le l&eacute;iomyosarcome de la vessie est une tumeur rare hautement maligne. Il survient aussi bien chez l'enfant que chez l'adulte avec une incidence maximale au-del&agrave; de 60 ans. Il semble atteindre pr&eacute;f&eacute;rentiellement le sexe masculin avec un sexe ratio 3/1. Sa pr&eacute;sentation clinique est non sp&eacute;cifique et domin&eacute;e par l'h&eacute;maturie. La r&eacute;section endoscopique de la vessie avec un examen anathomopathologique permet de poser le diagnostic. Le traitement du l&eacute;iomyosarcome de la vessie reste sujet &agrave; de nombreuses controverses du fait de la raret&eacute; des cas rapport&eacute;s dans la litt&eacute;rature. Cependant le traitement de choix semble &ecirc;tre une cystectomie totale pr&eacute;c&eacute;d&eacute;e d'une chimioth&eacute;rapie n&eacute;o-adjuvante lorsque l'&eacute;tat g&eacute;n&eacute;ral du patient le permet. Nous rapportons une s&eacute;rie de 3 cas de l&eacute;iomyosarcome v&eacute;sical qui ont &eacute;t&eacute; trait&eacute;s tous par une cystectomie totale avec des suites op&eacute;ratoires simple.</b><br/> text/html 2018-05-26T09:22:33+01:00 Abdelhafid El Marfi, Abdelghani Elayoubi, Mohamed El Idrissi, Mohamed Shimi, Abdelhalim El Ibrahimi, Abdelmajid Elmrini, Hassan Fokiladeh [Case report] - Infection et descellement d’une proth&egrave;se totale de la hanche par listeria monocytogenes - 09 May 2018. <b>Le recours aux proth&egrave;ses articulaires est de plus en plus fr&eacute;quent dans notre pratique courante. Une des complications les plus redout&eacute;es est l’infection, le plus souvent due &agrave; des germes de la flore cutan&eacute;e. Listeria monocytogenes &eacute;tant rarement &agrave; l’origine d’une telle infection, nous rapportons le cas d’un patient porteur d’une proth&egrave;se de hanche infect&eacute;e par ce germe: l’&eacute;volution a &eacute;t&eacute; favorable apr&egrave;s antibioth&eacute;rapie et changement de proth&egrave;se en un seul temps.</b><br/> text/html 2018-05-26T09:22:33+01:00 Charlotte Nguefack Tchente, Theophile Njamen Nana, Paul Nkemtendong Tolefac, Martin Hongieh Abanda, Francky Teddy Endomba Angong, Rita Frinue Tamambang, Gabin Ulrich Kenfack, Georges Nkwelle Mangala, Sagir Muhammad, Marie Solange Doualla, Eugene Belley Priso [Research] - Effects of phloroglucinol on the active phase of labour (EPAL trial): a single blinded randomised controlled trial in a tertiary hospital in sub-Sahara Africa - 09 May 2018. <b>INTRODUCTION: One of the most recognized factors of maternal and neonatal outcome pertaining to the peripartum period is the duration of labour. Finding a drug that will decrease the duration of labour with no effects on mother and foetus will be welcomed. Thereby in this study we aimed to evaluate the effects of phloroglucinol on the duration of the active phase of labour. METHODS: we did a single blinded placebo controlled randomised 1:1 parallel designed superiority trial between January and June 2017 in Douala general hospital. Participants greater than 18 years with singleton uncomplicated pregnancy who consented following randomisation, were administered either 80mg/8ml intravenous phloroglucinol or 8ml of sterile water when in active labour. The primary outcome was the duration of labour. Modified intention to treat analysis was done with the level of significance set at a p value of 0.05. RESULTS: 122 participants received the intervention. The mean total duration labour in the treatment and placebo group were 216.8 ± 38.7 and 358.5 ± 65.8 respectively (p value = 0.243). The mean duration of the active phase of labour in the treatment and placebo group were 183.0±35.6 and 316.0±52.2 respectively (p value = 0.046). The mean rate of cervical dilatation in the treatment and placebo group were 2.1 ± 0.4 and 1.3 ± 0.4 respectively (p value = 0.322). There was no difference in maternal and foetal outcomes between the two groups. CONCLUSION: phloroglucinol shortens the duration of active phase of labour by about 2 hours (42%). It is safe to mother and baby and does not cause adverse foetal or maternal outcomes.</b><br/> text/html 2018-05-26T09:22:33+01:00 Andreia de Oliveira Alves, Fred Bernardes Filho [Images in medicine] - Erucism due to cup moth - 08 May 2018. <b>A 12-year-old girl was assessed because of a 1-hour history of severe pruritus after contact with a cup moth (A). She has past history of anaphylactic shock to bee sting two years ago. The patient was sitting next to a mango tree and inadvertently put her left arm over a caterpillar. Physical examination revealed an erythematous infiltrated plaque with moderate swelling and an urticarial eruption with some excoriations on left upper limb (B, C); patient had a pulse rate of 78/min, blood pressure of 108/64 mmHg and respiratory rate of 15/min. The patient received prednisone 40 mg/day and loratadine 10mg/day for 5 and 10 days, respectively. Two weeks after the accident, on the final follow-up visit, the patient showed no late effects. Erucism, also called caterpillar dermatitis, is caused by envenomation by the larval or pupal stages of moths or butterflies. Caterpillars transmit their venom through urticating hairs, spines, or setae distributed over their bodies. Rash is the most common clinical manifestation and can range from a mild itching to a very painful sting. The lesions are provoked by caterpillar bristles filled with toxins that penetrate the skin. The bristles are hollow and when they enter the skin and break, toxins that contain thermolabile proteins, proteolytic enzymes and histamine are released. Treatment is supportive and includes washing the site with soap and water, applying cold water compresses, and administering topical or oral antihistamines or corticosteroids.</b><br/> text/html 2018-05-26T09:22:33+01:00 Chahdi Hafsa, Damiri Amal, Oukabli Mohamed, Abderrahman Al Bouzidi [Case report] - Une tumeur de la valve mitrale - 08 May 2018. <b>Le fibro&eacute;lastome papillaire est une tumeur cardiaque primitive b&eacute;nigne rare pouvant entra&icirc;ner des complications emboliques s&eacute;v&egrave;res. Nous rapportons un cas chez un homme de 69 ans. C’est dans le cadre du bilan &eacute;tiologique d’une dyspn&eacute;e que l’&eacute;chocardiographie transthoracique a montr&eacute; une masse sessile sur la petite valve mitrale. Cette masse a &eacute;t&eacute; excis&eacute;e chirurgicalement et analys&eacute;e histologiquement. Le diagnostic de fibro&eacute;lastome papillaire &eacute;tait alors confirm&eacute;.</b><br/> text/html 2018-05-26T09:22:33+01:00 Antoine Lamblin, Cl&eacute;ment Derkenne [Images in medicine] - A child with fever, cough and Lancisi’s sign - 08 May 2018. <b>An 8-year-old boy from a rural town in Chad was referred to the emergency department following a one-month history of fever, otitis media and left thigh osteoarthritis. Venous jugular examination showed prominent systolic pulsations, also called Lancisi's sign. A chest X-ray (A) showed a right pneumothorax, which was immediately drained, before incision and drainage of the left distal thigh osteoarthritis. A CT-scan showed multiple pulmonary abcesses (B). After transthoracic echocardiography (M-TurboTM, Sonosite® Inc, Bothwell, WA, USA), large vegetations were seen on the tricuspid valve (C) and right ventricular systolic pressure was elevated. There was severe tricuspid regurgitation. Microbiological analysis found methicillin-sensitive Staphylococcus aureus in blood cultures and bacteriological samples from the thigh. This case demonstrates a presentation of right-sided endocarditis with septic pulmonary emboli (SPE) responsible for a right pneumothorax. Prominent systolic pulsations of the jugular veins, or Lancisi's sign, are a manifestation of severe tricuspid regurgitation. They result from a retrograde blood flow in the right atrium due to tricuspid incompetence during systole. Pneumothorax, secondary to SPE, is rare and Staphylococci are the infectious pathogens in all reported cases of secondary pneumothorax due to SPE, characterized by pulmonary inflammation with peripheral necrosis and multiple small cavities which involves the pleura; it may progress into the subpleural tissues or fistulize in situ. In this case, targeted antibacterial therapy was initiated until day 42. A rapid clinical improvement was observed. A follow-up transthoracic echocardiograph was performed at 3 months and revealed a reduction in vegetative growth and mild tricuspid regurgitation sequela.</b><br/> text/html 2018-05-26T09:22:33+01:00 Ihsane Mellouki, Khaoula Jellali, Adil Ibrahimi [Case series] - Les tumeurs du gr&ecirc;le: &agrave; propos de 27 cas - 08 May 2018. <b>Les tumeurs gr&eacute;liques repr&eacute;sentent 5% de l'ensemble des tumeurs du tractus digestif. Leur pronostic reste sombre vu le retard diagnostic d&ucirc; au manque de sp&eacute;cificit&eacute; des manifestations cliniques et &agrave; la difficult&eacute; d'exploration bien que d'important progr&egrave;s ont &eacute;t&eacute; fait sur le plan radiologique et endoscopique. Le but de ce travail est de pr&eacute;ciser les aspects endoscopiques et histologiques des tumeurs gr&eacute;liques. Il s’agit d’une &eacute;tude r&eacute;trospective descriptive men&eacute;e au Service d'H&eacute;pato-gastro-ent&eacute;rologie du CHU Hassan II de F&egrave;s sur une p&eacute;riode de 11 ans (2002-2012). Nous avons analys&eacute; les aspects &eacute;pid&eacute;miologiques, cliniques, endoscopiques et histologiques. 27 cas avaient &eacute;t&eacute; collig&eacute;s. L'&acirc;ge moyen &eacute;tait de 48 ans [21-80ans] avec une pr&eacute;dominance masculine (H/F: 2,4). La tumeur avait &eacute;t&eacute; r&eacute;v&eacute;l&eacute;e par des m&eacute;l&eacute;nas chez 55%, une masse abdominale chez 15% et un syndrome de Koenig ou syndrome occlusif chez 11%. Un ant&eacute;c&eacute;dent de maladie cœliaque avait &eacute;t&eacute; retrouv&eacute; dans un cas. L’ent&eacute;roscanner avait pu pr&eacute;ciser le si&egrave;ge de la tumeur chez 18 cas. L’ent&eacute;roscopie pouss&eacute;e pour les tumeurs proximales et l’ent&eacute;roscopie double ballonnets pour les tumeurs &agrave; localisation distale avaient &eacute;t&eacute; r&eacute;alis&eacute;es chez 8 patients (30%), l'aspect endoscopique avait r&eacute;v&eacute;l&eacute; une l&eacute;sion ulc&eacute;r&eacute;e chez 37,5%, ulc&eacute;r&eacute;e st&eacute;nosante chez 50% et ulc&eacute;ro-bourgeonnante st&eacute;nosante chez 25%. Dans 18 cas, c’est la chirurgie avec &eacute;tude anatomopathologique de la pi&egrave;ce op&eacute;ratoire qui avait permis de poser le diagnostic. Le type histologique &eacute;t&eacute; domin&eacute; par les tumeurs stromales 14 cas (51%), suivi des ad&eacute;nocarcinomes 5 cas (18,5%), 4 cas (15%) de LMNH de type B, un cas de carcinome neuroendocrine j&eacute;junal. Les tumeurs gr&eacute;liques sont rares mais de pronostic sombre, les m&eacute;thodes actuelles d'imageries (Ent&eacute;roscanner et Ent&eacute;ro IRM) coupl&eacute;es aux examens endoscopiques, pr&eacute;cis&eacute;ment l’ent&eacute;roscopie double ballonnet, devraient permettre un diagnostic plus pr&eacute;coce et une diminution de la mortalit&eacute;.</b><br/> text/html 2018-05-26T09:22:33+01:00 Youssef Zemmez, Naoufal Hjira [Images in medicine] - K&eacute;ratoacanthome de l’avant-bras gauche - 08 May 2018. <b>Une femme &acirc;g&eacute;e de 54 ans ayant consult&eacute; pour une tum&eacute;faction de l'avant-bras gauche apparaissant huit semaines auparavant et augmentant rapidement de volume. L'examen clinique retrouvait une l&eacute;sion cutan&eacute;e ulc&eacute;ro-bourgeonnante de 2cm de grand axe, indolore et de couleur violac&eacute;e (A). Une simple biopsie a &eacute;t&eacute; r&eacute;alis&eacute;e. L'examen histologique avait montr&eacute; un &eacute;pith&eacute;lium hyperplasique dysk&eacute;ratosique et d&eacute;sorganis&eacute; avec pr&eacute;sence d'atypies cytonucl&eacute;aires &eacute;voquant un processus tumoral malin mais vu l'absence d'infiltration du chorion et la pr&eacute;sence d'une hyperk&eacute;ratose, le diagnostic d'un k&eacute;ratoacanthome a &eacute;t&eacute; soulev&eacute; et la r&eacute;alisation d'une ex&eacute;r&egrave;se de la tumeur a &eacute;t&eacute; indiqu&eacute;e pour confirmer ou infirmer ce diagnostic. L'&eacute;tude histologique r&eacute;v&eacute;lait une l&eacute;sion tumorale saillante de nature &eacute;pith&eacute;liale circonscrite par deux esp&egrave;ces de becs lat&eacute;raux limitant un crat&egrave;re surmont&eacute; d'importantes strates de k&eacute;ratine. L'&eacute;pith&eacute;lium bordant ce crat&egrave;re est hyperplasique. La base du crat&egrave;re comporte des projections papillomateuse in&eacute;gales ainsi que quelques trav&eacute;es cellulaires qui semblent effilocher dans le derme sous-jacent. Celles-ci sont compos&eacute;es de cellules basophiles montrant un certain degr&eacute; d'anomalies cytonucl&eacute;aires dispos&eacute;es en une ou deux assises p&eacute;riph&eacute;riques et en leur centre de cellules &eacute;osinophiles, k&eacute;ratinis&eacute;es, d'aspect homog&egrave;ne, quelques mitoses ainsi que de nombreux globes corn&eacute;s le plus souvent compl&egrave;tement k&eacute;ratinis&eacute;s (B). Le diagnostic de keratoacanthome a &eacute;t&eacute; retenu. Le k&eacute;ratoacanthome est une entit&eacute; anatomo-clinique bien d&eacute;finie, mais qui peut &ecirc;tre tr&egrave;s difficile &agrave; distinguer du carcinome &eacute;pidermo&iuml;de, dont l'incidence est trois fois sup&eacute;rieure. La distinction entre ces deux l&eacute;sions est n&eacute;cessaire car la prise en charge est diff&eacute;rente.</b><br/> text/html 2018-05-26T09:22:33+01:00 Cinzia Casu, Luca Vigan&ograve; [Images in medicine] - Particular shape of the tongue and benign migratory glossitis - 07 May 2018. <b>A 33-year-old male patient comes to our observation for a slight discomfort in the left side of the tongue. The patient reported good general health and that he have sometimes taken benzodiazepine in periods of stress. The dental abrasion showed the presence of bruxism. On an objective examination we could notice the simultaneous presence of a "toothed tongue" and a slightly area of erosion on the left side of the dorsal tongue, with an irregular white halo around it. This lesion, appeared from some days, is symptomatic. The diagnosis is compatible for benign migratory glossitis. The patient claimed to have never suffered of skin diseases strongly related to migratory glossitis. It is possible that the bruxism may have determined the presence of that lateral tongue shape and that stress may be the main cause of the appearance of migratory glossitis. The simultaneous presence of the two conditions has never been documented in the scientific literature and we do not exclude that there may be a correlation to the genesis of both lesions. Sometimes the presence of a tongue with this morphology could be the result of a trauma or a surgery. The lingual erosion can be placed in differential diagnosis with a heat burn or a chemical burn.</b><br/> text/html 2018-05-26T09:22:33+01:00 Krishna Mohan Baradhi, Thao Tran, Penchala Swamy Mittadodla [Case report] - ’Malignant’ hypertension from hyperaldosteronism: a case report - 04 May 2018. <b>Adrenocortical carcinomas (ACC) are rare with an incidence of 0.7-2 per million population per year and account for only 0.05%-2% of all malignant tumors. While majority of the functional ACC present as Cushing syndrome, recurrent hyperaldosteronism from metastatic ACC is exceedingly rare. We describe a 67-year old female presented with hypertensive urgency & hypokalemia as a result of hyperaldosteronism from an 8-cm right ACC. She underwent a radical right nephrectomy with adrenalectomy that normalized her blood pressure. However, a few years later she presented again with resistant hypertension from hyperaldosteronism, raising the suspicion of recurrence of ACC. A contrast-enhanced CT scan showed a normal left adrenal gland but revealed pulmonary metastases of ACC based on a lung biopsy. Chemotherapy was complicated with side effects leading to refusal of further chemotherapy, henceforth requiring high dose of spironolactone for blood pressure control. Despite curative surgery, metastatic functional ACC should be considered in patients presenting with secondary hypertension from recurrent hyperaldosteronism, due to its high recurrence rate. Besides standard cancer surveillance after a curative surgery, meticulous monitoring of blood pressure is a simple yet crucial way to detect cancer recurrence early.</b><br/> text/html 2018-05-26T09:22:33+01:00 Ahmed Anas Guerboub, Souad Moussaoui, Jad Issouani, Yassine Errahali, Ghizlaine Belmejdoub [Case report] - X-linked vitamin D-resistant rickets: 12 years of follow-up - 04 May 2018. <b>Rickets are abnormalities of mineralization that can lead to bone fractures and deformities. Vitamin-resistant rickets is defined as any rickets not prevented by regular, early and prolonged administration of vitamin D and not cured by a sufficient total dose. The aim of our work is to describe the clinical, paraclinical and therapeutic aspects of X-linked hypophosphatemic rickets (XLHR), which is the most common cause of hereditary rickets and on the other hand to highlight the interest not only of the early care but also the regular long-term monitoring of these children.</b><br/> text/html 2018-05-26T09:22:33+01:00 Fatima Zahra Farhane, Zineb Alami, Touria Bouhafa, Abderrahmane Elmazghi, Khalid Hassouni [Case report] - Primary squamous cell carcinoma of endometrium: case report and literature review - 04 May 2018. <b>In this paper, we report a case of primary squamous cell carcinoma of the endometrium (PSCCE) with a literature review. A 64-year-old woman, was admitted because postmenopausal bleeding. The gynecological exam found bleeding from the endocervix. The pelvic ultrasound objectified uterine regular contours, endometrial thickened was 10 mm, the presence of an intra cavitary lesion mesuring 56/70 mm. The diagnostic hysteroscopy revealed a whitish appearance taking all the uterine cavity making evoke a tumor of the endometrium. Pelvic MRI showed a tumor limited to the uterine corpus endometrium (invasion by more than 50% of the myometrium) without invasion of the cervix. Radical hysterectomy, bilateral salpingo-oophorectomy, and lymph nodes dissection were performed. Grossly, the endometrial carcinoma was polypoid tumor occupying the entire uterine cavity. Histologically, the diagnosis of SCC was retained. No adenocarcinoma element was recognized. Neither squamous metaplasia nor dysplasia was recognized. No ectopic cervical tissue was found. The SCC was found to invade into deeper one half of the myometrium. No tumor cells were seen in other sites including the cervix, ovaries, parametres, and lymph nodes. The patients was FIGO 2009 stage IB (pT1B, N0), and was treated with adjuvant radiation. The patient had a disease progression in the pelvis 3 months after the irradiation. We reported a case of PSCCE which can help to enrich the literature for the treatment and prognosis of this disease.</b><br/> text/html 2018-05-26T09:22:33+01:00 Olfa Zoukar, Anis Haddad, Amira Daldoul, Sonia Zaied, Amina Ben Salem, Ines Zouari, Raja Faleh [Case report] - M&eacute;tastases g&eacute;nitales du cancer du sein: &eacute;tude de 3 cas et revue de la litt&eacute;rature - 04 May 2018. <b>Le cancer du sein est le cancer le plus fr&eacute;quent chez la femme, et son pronostic d&eacute;pend en grande partie de l'existence de m&eacute;tastases. Le foie, le squelette et les poumons en sont les sites les plus fr&eacute;quents, alors que les m&eacute;tastases g&eacute;nitales semblent plus rares et moins connues. La d&eacute;couverte d'une masse ovarienne chez une femme pr&eacute;sentant un ant&eacute;c&eacute;dent de cancer du sein pose le probl&egrave;me de son origine primitive ou secondaire. La fr&eacute;quence rapport&eacute;e dans la litt&eacute;rature des m&eacute;tastases ovariennes est d'environ 20 &agrave; 30 %. Cependant, lorsque l'on d&eacute;couvre une masse ovarienne chez une femme atteinte de cancer du sein, il s'agit trois fois plus souvent d'une tumeur ovarienne primitive que d'une m&eacute;tastase. La localisation ut&eacute;rine cervicale ou corpor&eacute;ale est encore plus rare. Leur diagnostic est souvent tardif, en raison de leur latence clinique; l'&eacute;chographie, notamment par voie endovaginale et coupl&eacute;e au Doppler couleur, et le Frottis cervico-ut&eacute;rin doivent &ecirc;tre r&eacute;alis&eacute;s de premi&egrave;re intention sachant que leur rendement pour leur d&eacute;pistage des masses ovariennes semble tr&egrave;s faible. L'augmentation des marqueurs tumoraux CA 15-3 et ACE doit conduire &agrave; la recherche de m&eacute;tastases, mais ne fournit pas d'orientation diagnostique vers un site m&eacute;tastatique pr&eacute;cis. Enfin, c'est l'examen anatomopathologique qui permettra de poser le diagnostic avec certitude. Les auteurs rapportent 3 observations de m&eacute;tastases g&eacute;nitales de cancer primitif mammaire (deux ovariennes et une cervicale ut&eacute;rine) soulignent l'int&eacute;r&ecirc;t de l'examen g&eacute;nital pr&eacute;cis et r&eacute;gulier dans la surveillance des cancers du sein et discutent les facteurs pr&eacute;dictifs de leur survenue.</b><br/> text/html 2018-05-26T09:22:33+01:00 Matthew Olumuyiwa Bojuwoye, Abdulfatai Bamidele Olokoba, Olumuyiwa Ayotunde Ogunlaja, Sulaiman Olayide Agodirin, Olatunde Kazeem Ibrahim, Kenechukwu Chukwuemeka Okonkwo, Aminu Mansa Aliyu [Case report] - Familial adenomatous polyposis syndrome with colorectal cancer in two Nigerians: a report of two cases and review of literature - 04 May 2018. <b>Familial adenomatous polyposis syndrome is a rare condition characterized by the presence of numerous adenomatous polyps in the gastrointestinal tract and associated with risk for colorectal cancer. The disease is scarcely reported in Nigeria and this is the index report in Ilorin. Two cases were clinically diagnosed in our facility. They both presented with gastrointestinal bleeding and numerous rectal and colonic polyps were identified at colonoscopy. Histological examination of the polyps in the both cases revealed features in keeping with adenomatous polyps. This report highlights the occurrence of this precancerous condition.</b><br/> text/html 2018-05-26T09:22:33+01:00 Saheed Gidado, Emmanuel Awosanya, Suleiman Haladu, Halimatu Bolatito Ayanleke, Suleman Idris, Ismaila Mamuda, Abdulaziz Mohammed, Charles Akataobi Michael, Ndadilnasiya Endie Waziri, Patrick Nguku [Research] - Cholera outbreak in a na&iuml;ve rural community in Northern Nigeria: the importance of hand washing with soap, September 2010 - 04 May 2018. <b>INTRODUCTION: Cholera outbreaks in rural communities are associated with high morbidity and mortality. Effective interventions to control these outbreaks require identification of source and risk factors for infection. In September, 2010 we investigated a cholera outbreak in Bashuri, a cholera na&iuml;ve rural community in northern Nigeria to identify the risk factors and institute control measures. METHODS: We conducted an unmatched case-control study. We defined a case as any resident of Bashuri community two years and above with acute watery diarrhea with or without vomiting and a control as any resident two years and above without acute watery diarrhea and vomiting. We recruited 80 hospital-based cases and 80 neighborhood controls. We collected and analyzed data on demographic characteristics, clinical information and risk factors. Laboratory analysis was performed on 10 stool samples and 14 open-well samples. RESULTS: Mean age was 29 years (± 20 years) for cases and 32 years (± 16 years) for controls; 38 (47.5%) of cases and 60 (75%) of controls were males. Compared to controls, cases were less likely to have washed hands with soap before eating (age-adjusted odds ratio (AAOR) = 0.27, 95% confidence interval (CI): 0.10 - 0.72) and less likely to have washed hands with soap after using the toilet (AAOR = 0.34, 95% CI: 0.15-0.75). Vibrio cholerae O1 was isolated from six stool samples but not from any open-well samples. CONCLUSION: Unhygienic hand washing practices was the key risk factor in this outbreak. We educated the community on personal hygiene focusing on the importance of hand washing with soap.</b><br/> text/html 2018-05-26T09:22:33+01:00 Awalou Mohaman Djibril, Edem Komi Mossi, Agbeko Kodjo Djagadou, Abago Balaka, Toyi Tchamdja, Razak Moukaila [Research] - Pied diab&eacute;tique: aspects &eacute;pid&eacute;miologique, diagnostique, th&eacute;rapeutique et &eacute;volutif &agrave; la Clinique M&eacute;dico-chirurgicale du CHU Sylvanus Olympio de Lom&eacute; - 03 May 2018. <b>INTRODUCTION: Le pied diab&eacute;tique est une complication fr&eacute;quente et grave du diab&egrave;te. Le but de cette &eacute;tude est de d&eacute;terminer le profil &eacute;pid&eacute;miologique, diagnostique, th&eacute;rapeutique et &eacute;volutif du pied diab&eacute;tique en milieu hospitalier &agrave; Lom&eacute; (Togo). METHODS: Etude r&eacute;trospective descriptive r&eacute;alis&eacute;e du 1er janvier 2011 au 31 d&eacute;cembre 2015 (5 ans) &agrave; la clinique m&eacute;dico-chirurgicale du CHU Sylvanus Olympio de Lom&eacute;. Etaient inclus dans l’&eacute;tude tout patiente hospitalis&eacute;e pendant la p&eacute;riode d’&eacute;tude pour pied diab&eacute;tique. RESULTATS: la pr&eacute;valence du pied diab&eacute;tique &eacute;tait de 12,90%. L’&acirc;ge moyen &eacute;tait de 60,74 ans (extr&ecirc;mes: 39 ans et 86 ans). Le sexe masculin pr&eacute;dominait avec un sexe ratio de 1,38. Le diab&egrave;te de type 2 &eacute;tait retrouv&eacute; chez 88,70% des patients. La dur&eacute;e moyenne d’&eacute;volution du diab&egrave;te &eacute;tait de 11,67 ans (extr&ecirc;me : 1 an et 24 ans). Le point de d&eacute;part des l&eacute;sions du pied &eacute;tait un traumatisme g&eacute;n&eacute;rant une plaie surinfect&eacute;e dans 70,97 % des cas. La gangr&egrave;ne (61,29%) et la n&eacute;crose isch&eacute;mique (12,90%) &eacute;taient les principales l&eacute;sions retrouv&eacute;es. Le principal facteur &eacute;tiopathog&eacute;nique retrouv&eacute; &eacute;tait la neuropathie (61,29). La majorit&eacute; des l&eacute;sions (61,29%) &eacute;tait class&eacute;e grade 4 et 5 de Wagner et 51,62% des patients avait b&eacute;n&eacute;fici&eacute; d’une amputation du membre pelvien. CONCLUSION: Les l&eacute;sions du pied sont fr&eacute;quentes chez les patients diab&eacute;tiques &agrave; Lom&eacute;. La lutte contre ce fl&eacute;au passe par l’&eacute;ducation des patients et du personnel soignant et par une prise en charge multidisciplinaire et concert&eacute;e.</b><br/> text/html 2018-05-26T09:22:33+01:00 Adil Arrob, Mohammed Kamal Fiqhi, Abibou N’diaye, Karim El Khatib, Abdeljalil Abouchadi [Case report] - Rhabdomyosarcome cranio-facial de l’adulte: un cas de mouvais pronostic - 03 May 2018. <b>Le rhabdomyosarcome est la tumeur m&eacute;senchymateuse la plus fr&eacute;quente chez l'enfant et l'adolescent. Il repr&eacute;sente 60 &agrave; 70% des tumeurs m&eacute;senchymateuses et environ 5% de l'ensemble des tumeurs solides &agrave; ces &acirc;ges. Pr&egrave;s de la moiti&eacute; des rhabdomyosarcomes surviennent au niveau de la t&ecirc;te et du cou. Nous rapportons le cas d'un rhabdomyosarcome agressif &agrave; localisation temporo-pari&eacute;tale. Chez un jeune adolescent de 20 ans avec une forme histologique nouvelle.</b><br/> text/html 2018-05-26T09:22:33+01:00 Ikenna Desmond Ebuenyi, Soumitra Sudip Bhuyan, Luchuo Engelbert Bain [Commentary] - Zika Virus infection and microcephaly: anxiety burden for women - 03 May 2018. <b>The re-emergence of Zika virus in Brazil and other contiguous countries is a source of anxiety for pregnant women on account of its association with microcephaly. Adverse pregnancy outcome has huge mental health implications. It is essential for health providers to incorporate psychosocial care as part of pre and postnatal care for women in all countries affected by the Zika virus infection.</b><br/> text/html 2018-05-26T09:22:33+01:00 Nouha Zerkaoui [Images in medicine] - Colobome irien bilat&eacute;ral - 02 May 2018. <b>Les colobomes oculaires cong&eacute;nitaux sont dus &agrave; un d&eacute;faut de fermeture de la fissure fœtale lors de l’organog&eacute;n&egrave;se. L’atteinte oculaire pouvant &ecirc;tre variable allant d’une simple fente irienne &agrave; une atteinte plus s&eacute;v&egrave;re du p&ocirc;le post&eacute;rieur (colobome du nerf optique, de la choro&iuml;de, de la r&eacute;tine). Nous allons rapporter le cas d’un colobome typique irien bilat&eacute;ral isol&eacute;. Il s’agit d’une femme de 55 ans qui lors d’un examen ophtalmologique fit la d&eacute;couverte d’un colobome typique irien infero-nasal sans atteinte cristallinienne ni atteinte du p&ocirc;le post&eacute;rieur.</b><br/>