Pan african Medical Journal - Volume 31 Pan african Medical Journal. Volume 31 2018-12-11T19:05:07+01:00 pamj logo text/html 2018-12-12T03:05:07+01:00 Frankline Sanyuy Nsai, Samuel Nambile Cumber, Ngwayu Claude Nkfusai, Vecheusi Zennobia Viyoff, Nkemngu Blake Afutendem, Rosaline Yumumkah Cumber, Joyce Mahlako Tsoka-Gwegweni, Jane-Francis Tata Kihla Akoachere [Research] - Knowledge and practices of health practitioners on treatment of Buruli ulcer in the Mbonge, Ekondo Titi and Muyuka Health Districts, South West Region, Cameroon - 10 December 2018. <b>INTRODUCTION: After tuberculosis and leprosy, Buruli ulcer (BU) is the third most common mycobacterial infection. Buruli ulcer begins as a localized skin lesion that progresses to extensive ulceration thus leading to functional disability, loss of economic productivity and social stigma. This study is aimed at assessing the knowledge and practices among health practitioners on the treatment of BU in the Mbonge, Ekondo Titi and Muyuka Health Districts of the South West Region of Cameroon. METHODS: this is a cross sectional study that investigates participants' knowledge and practices on the treatment of BU. The study uses a qualitative method of structured questionnaires in the process of data collection. RESULTS: seventy percent (70%) of the participants acknowledged they encounter cases of BU in their respective Hospitals or Health centers. Among these, 48% agreed they managed BU in their facilities and up to 91.7% noted that their community members are aware that BU is managed in their facility while seventy percent of the medical practitioners indicated they cannot identify the various stages of BU. Eighty-one percent of the practitioners from Muyuka HD indicated they could not identify the various stages of BU. More than 63% of the practitioners regarded BU patients as normal people in their communities however, practitioners that practiced for less than 5 years were likely not to admit BU patients in the same room with other patients. Beliefs such as being cursed (47.06%) and being possessed (29.41%) were reported by practitioners that acknowledged the existence of traditional beliefs in the community. CONCLUSION: despite the fact that a majority of the health practitioners knew what BU is, most of them demonstrated lack of knowledge on the identification of the various stages and management of the illness. Practitioners demonstrated positive attitude towards patients although they would not admit them in the same room with other patients. Considering the poor knowledge on identification and management demonstrated by most of the practitioners, management of the disease would be inadequate and may even aggravate the patient's situation. Training and onsite mentorship on screening, identification and management of BU is therefore highly recommended amongst health personnel practicing in endemic areas.</b><br/> text/html 2018-12-12T03:05:07+01:00 Meryem Belmajdoub, Sofia Jayi, Hikmat Chaara, Abdelilah Melhouf [Case report] - Grossesse sur cicatrice de c&eacute;sarienne: &agrave; propos d’un cas et revue de la litt&eacute;rature - 10 December 2018. <b>La grossesse sur cicatrice de c&eacute;sarienne est une forme rare de la grossesse ectopique qui peut engager le pronostic vital et fonctionnel de la patiente par h&eacute;morragie ou par rupture ut&eacute;rine pr&eacute;coce. Nous rapportons le cas d'une grossesse ectopique sur cicatrice de c&eacute;sarienne diagnostiqu&eacute;e &agrave; 7 semaines d'am&eacute;norrh&eacute;e suite &agrave; des m&eacute;trorragies chez une patiente de 23 ans, 3&eacute;me geste 2&eacute;me pare, porteuse d'un ut&eacute;rus bi-cicatriciel. Gr&acirc;ce &agrave; l'&eacute;chographie endovaginale le diagnostic a &eacute;t&eacute; pr&eacute;coce et le traitement a &eacute;t&eacute; conservateur. A travers cette observation et la lumi&egrave;re d'une revue de la litt&eacute;rature, nous discuterons les caract&eacute;ristiques diagnostiques et th&eacute;rapeutiques de cette rare entit&eacute;, dont la connaissance par les praticiens permet d'am&eacute;liorer le pronostic.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ilyas Derdabi, Hajar El Jouadi, Meryem Edderai [Case report] - Dural ectasia: a manifestation of type 1 neurofibromatosis - 07 December 2018. <b>Dural ectasia denotes circumferential expansion or dilatation of the dural sac, and has been frequently reported in association with type 1 neurofibromatosis (NF1). The pathogenesis has not been defined, but its correlation with NF1 infers a congenital malformative hypothesis. The neural elements in the dilated sleeve typically are not enlarged or abnormal, nevertheless the enlarged area contain an increased amount of cerebrospinal fluid. The dura in the area of ectasia is extremely thin and fragile, and erodes the surrounding bony structures destabilising the spine and permitting spectacular spinal deformities. We present a case: a 40-year-old woman suffering from neurofibromatosis type 1 who developed a thoracic dural ectasia and anterior meningocele.</b><br/> text/html 2018-12-12T03:05:07+01:00 Meriem Benfateh, Souadou Cissoko, Houssine Boufettal, Jean-Jacques Feige, Naima Samouh, Touria Aboussaouira, Mohamed Benharouga, Nadia Alfaidy [Case series] - Risk factors and poor prognostic factors of preeclampsia in Ibn Rochd University Hospital of Casablanca: about 401 preeclamptic cases - 06 December 2018. <b>Preeclampsia is a gestational pathology that complicates 2 to 8% of pregnancies and is one of the major causes of maternal and fetal morbidity and mortality worldwide. The aim of this work was to study the epidemiological profile of preeclampsia in Casablanca and to identify risk factors as well as factors of poor maternal and fetal prognosis. 401 preeclamptic cases were collected in the gynecology-obstetrics "C" Service of Lalla Meryem Maternity of Ibn Rochd University Hospital of Casablanca (2010-2011) were included in this study and a statistical analysis with the SPSS software version (16.0) was performed. We used the Chi-2 test to analyze qualitatives variables and Student's test and ANOVA (analysis of variance) for quantitative variables. The incidence of preeclampsia was (7.1%). The epidemiological profile was that of a primipara (57.6%), average age 30 years and (66.8%) of pregnancies were not followed. Multiparity was a factor of poor maternal prognosis (p = 0.007). The low gestational age and no prenatal care were factors of poor prognosis maternal as well as fetal. Risk factors frequently found in our patients were obesity (15.21%) and chronic hypertension (5.73%) as vascular-renal history; abortion (16.46%) and perinatal death (5.24%) as obstetric history. Pre-eclampsia is a common obstetric pathology in our context. Better prenatal care and early diagnosis could reduce its incidence.</b><br/> text/html 2018-12-12T03:05:07+01:00 Fr&eacute;d&eacute;ric Nogbou Ello, Alain Bawe, Gis&egrave;le Affou&eacute; Kouakou, Chrysostome Melaine Mossou, Doumbia Adama, Alain N’douba Kassi, Dine Mourtada, Eboi Ehui, Aristophane Tanon, Christophe Konin, Fran&ccedil;ois Eba Aoussi, Aka Rigobert Kakou, Serge Paul Eholi&eacute; [Short communication] - Manifestations thromboemboliques chez 36 patients ouest africains infect&eacute;s par le VIH - 06 December 2018. <b>Chez les patients infect&eacute;s par le VIH, la maladie thromboembolique est une complication dont le risque est accru. En C&ocirc;te d'Ivoire, dans le service de r&eacute;f&eacute;rence de prise en charge m&eacute;dicale des personnes atteintes du VIH/SIDA, aucune &eacute;tude n'a &eacute;t&eacute; men&eacute;e sur la question. L'objectif de notre &eacute;tude est de d&eacute;crire les manifestations thromboemboliques collig&eacute;es dans le Service des Maladies Infectieuses et Tropicales (SMIT) chez les patients infect&eacute;s par le VIH, trait&eacute;s ou non par les antir&eacute;troviraux. Il s'est agi d'une &eacute;tude r&eacute;trospective des dossiers de patients infect&eacute;s par le VIH, hospitalis&eacute;s, et pr&eacute;sentant une thrombose veineuse profonde (TVP), art&eacute;rielle et/ou une embolie pulmonaire de la p&eacute;riode de Janvier 2005 &agrave; juillet 2015. Le diagnostic a &eacute;t&eacute; pos&eacute; par l'&eacute;cho-Doppler des vaisseaux et/ou l'angioscanner thoracique. L'analyse a port&eacute; sur les aspects diagnostiques, th&eacute;rapeutiques et &eacute;volutifs. Les dossiers de 36 patients dont 23 femmes (64%), sex-ratio H/F &agrave; 0,57, et &acirc;ge moyen de 43±12 ans ont &eacute;t&eacute; retenus. Les thromboses veineuses profondes (TVP) ont &eacute;t&eacute; retrouv&eacute;es chez 26 (72,2%) patients, des embolies pulmonaires (EP) chez neuf (25%) patients, une thrombose art&eacute;rielle chez un patient (2,8%). La TVP &eacute;tait unilat&eacute;rale dans 81% des cas et plus situ&eacute;e &agrave; gauche (77%). L'EP &eacute;tait unilat&eacute;rale et &agrave; droite dans 100% des cas et la thrombose art&eacute;rielle &eacute;tait bilat&eacute;rale dans 2,7% des cas. Chez les patients atteints de TVP, la veine f&eacute;morale (39%) et la veine poplit&eacute;e (35%) &eacute;taient les si&egrave;ges plus fr&eacute;quents de thrombose. L'EP concernait les art&egrave;res pulmonaires dans 77,8% des cas et la thrombose art&eacute;rielle concernait les carotides internes gauche et droite. La majorit&eacute; des patients &eacute;tait sous traitement antir&eacute;troviral (69%). Les infections opportunistes fr&eacute;quemment associ&eacute;es &eacute;taient les candidoses orales (31%) et la tuberculose (33%). L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par neuf d&eacute;c&egrave;s (25%). Cette &eacute;tude rapporte une fr&eacute;quence &eacute;lev&eacute;e des TVP au cours de l'infection &agrave; VIH. D'autres &eacute;tudes s'av&egrave;rent n&eacute;cessaires pour mieux appr&eacute;hender le r&ocirc;le du VIH dans la survenue de la maladie thromboembolique.</b><br/> text/html 2018-12-12T03:05:07+01:00 Meryem Belmajdoub, Fatima Zohra Fdili Alaoui, Hikmat Chaara, Abdelilah Melhouf [Case report] - Rupture ut&eacute;rine sur ut&eacute;rus sain: complication du misoprostol: &agrave; propos d’un cas et revue de la litt&eacute;rature - 06 December 2018. <b>La rupture ut&eacute;rine sur ut&eacute;rus sain au 2&egrave;me et 3&egrave;me trimestre de grossesse est une complication obst&eacute;tricale rare et grave mettant en jeu les pronostics vitaux maternels et fœtaux et le devenir obst&eacute;trical des patientes en l'absence de diagnostic et de prise en charge imm&eacute;diate. Elle survient majoritairement sur un ut&eacute;rus cicatriciel et reste anecdotique sur un ut&eacute;rus sain. Nous rapportons le cas d'une patiente primigeste ayant pr&eacute;sent&eacute; une rupture ut&eacute;rine sur un ut&eacute;rus non cicatriciel lors d'un d&eacute;clenchement de travail par le misoprostol pour mort fœtale in utero (MFIU) sur retard de croissance intra ut&eacute;rin (RCIU) et oligoamnios s&eacute;v&egrave;re &agrave; 31 semaines d'am&eacute;norrh&eacute;e (SA). Nous discutons &agrave; travers ce cas et la revue de la litt&eacute;rature, l'extr&ecirc;me prudence qu'il faut garder pour utiliser le misoprostol en cas de d&eacute;clenchement du travail ainsi que les signes d'appel cliniques, les facteurs de risque, la m&eacute;thodologie diagnostique et la prise en charge th&eacute;rapeutique de cette entit&eacute; rare mais potentiellement grave.</b><br/> text/html 2018-12-12T03:05:07+01:00 Eleen Korir, Florence Nafula Okwara, Gaudencia Okumbe [Research] - Menstrual hygiene management practices among primary school girls from a pastoralist community in Kenya: a cross sectional survey - 05 December 2018. <b>INTRODUCTION: pubescent girls from developing countries are confronted with diverse menstrual hygiene management (MHM) challenges, especially at school. Girls from rural pastoralist communities experience insurmountable MHM barriers. Inadequate coping strategies adopted result in sub-optimal school performance, absenteeism and physical problems. We conducted a study to assess MHM practices among primary school girls from a pastoralist community in Kenya. METHODS: a cross sectional survey was done among primary school girls in Kajiado County, Kenya. Accent was sought. We administered structured questionnaires which sought information on socio-demographics, knowledge, perceptions and practices. RESULTS: we enrolled 320 girls; with mean age of 14.9 years. Their parents were mostly (69.4%) self-employed pastoralists. Good menstruation knowledge was observed in 51.6%, while 45.5% reported diverse perceptions about menstruation. Majority, (80.9%) used sanitary towels as absorbents, but 40.3% delayed changing by > 6 hours. Poor MHM practices were documented in 28.8% and 32.2% kept the issue secret. Factors associated with poor MHM practices on univariable analysis were age (p=0.016), religion (p=0.037), non-discussions (p=0.001), lack of sanitary pads (p<0.0001), lack of latrine privacy (p=0.031), lack of water (p=0.001) and teasing by boys (p=0.016). On logistic regression, factors that independently influenced MHM practices were inadequate latrine privacy (p=0.031) and fear of teasing by boys (p=0.016). CONCLUSION: a third of pubescent pastoralist girls had poor MHM practices largely determined by inadequate latrine privacy and fear of teasing by boys.</b><br/> text/html 2018-12-12T03:05:07+01:00 Montassar Ghalleb, Hatem Bouzaiene, Sarah Sghaier, Hanen Bouaziz, Monia Hechiche, Jamel Ben Hassouna, Khaled Rahal [Case series] - Fertility sparing surgery for ovarian sex cord stromal tumors: a nine case series - 05 December 2018. <b>Ovarian Sex Cord Stromal Tumors (SCST) are a rare disease carrying a good prognosis. They generally affect young women; therefore fertility preservation is a critical issue. Fertility Sparing Surgery (FSS) showed promising results in both oncologic safety and fertility preservation. A retrospective case series involving 9 patients diagnosed with SCST and treated with fertility sparing surgery at our institution was conducted between January 2000 and May 2015. The median age was 24 years old (10 to 39). The main clinical manifestation was pelvic pain seen in seven patients. Five patients complained about menstrual cycle disorders. The nine patients went through fertility sparing surgery; seven had conservative staging and the other two had a unilateral salpingo-oophorectomy. Three patients out of nine had a pelvic unilateral lymphadenectomy. Two patients received adjuvant chemotherapy. Only two patients presented locoregional recurrence that occurred respectively after 7 and 192 months. The treatment combined chemotherapy and surgery based on mass resection. One patient achieved a natural pregnancy after the treatment. FSS seems to be a suitable approach for SCST. However, more case series and meta-analysis should be conducted.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ahmed Bennis, Idriss Andaloussi Benatiya [Images in medicine] - Une cataracte inhabituelle: r&eacute;gressive &agrave; noyau p&eacute;talo&iuml;de - 04 December 2018. <b>Nous rapportons le cas d'une patiente de 38 ans, sans ant&eacute;c&eacute;dents m&eacute;dico-chirurgicaux, victime d'un traumatisme contusif de l'œil droit par coup de pierre il y a 20 ans, avec baisse de l'acuit&eacute; visuelle progressif depuis 10 ans. L'examen ophtalmologique note au niveau de l'œil droit une acuit&eacute; visuelle &agrave; mouvement des doigts, et un tonus oculaire &agrave; 11mmHg. L'examen du segment ant&eacute;rieur apr&egrave;s dilatation objective une cataracte r&eacute;gressive, dont le noyau pr&eacute;sum&eacute; est de forme p&eacute;talo&iuml;de, les bords et les sutures des p&eacute;tales sont denses. Une &eacute;chographie oculaire est r&eacute;alis&eacute;e vu l'inaccessibilit&eacute; du fond d'œil, ainsi que l'examen de l'œil gauche n'objective aucune anomalie.</b><br/> text/html 2018-12-12T03:05:07+01:00 Abderahim Mahamat Nadjib, Harvey Attoh-Tour&eacute;, Sabine Baron, Adam Abdel-mahamoud, Sol&egrave;ne Brunet-Houdard, Emmanuel Rusch, Leslie Grammatico-Guillon [Research] - Connaissances, attitudes et pratiques des parents face &agrave; la vaccination contre la poliomy&eacute;lite &agrave; Ab&eacute;ch&eacute;-Tchad - 04 December 2018. <b>INTRODUCTION: Au Tchad, la transmission de la poliomy&eacute;lite a &eacute;t&eacute; interrompue en 2000, mais les importations &agrave; partir du Nig&eacute;ria et la faiblesse des couvertures vaccinales constituent un risque majeur de relance de la maladie. L'objectif de ce travail &eacute;tait d'analyser les connaissances, attitudes et pratiques vis-&agrave;-vis de la vaccination contre la poliomy&eacute;lite des parents des enfants &acirc;g&eacute;s de 0 &agrave; 5 ans au Tchad. METHODES: cette &eacute;tude transversale a &eacute;t&eacute; r&eacute;alis&eacute;e dans les six arrondissements d'Ab&eacute;ch&eacute;. Seuls les m&eacute;nages qui avaient des enfants de moins de 5 ans ont &eacute;t&eacute; inclus. Les donn&eacute;es ont &eacute;t&eacute; recueillies par des entretiens avec les parents et tuteurs d'enfants &eacute;ligibles &agrave; l'aide d'un questionnaire test&eacute; et valid&eacute;. RESULTATS: nous avons interrog&eacute; 210 m&eacute;nages. Aucune famille ne poss&eacute;dait de carnet de vaccination de leurs enfants. Cependant, 97% ont d&eacute;clar&eacute; avoir des enfants ayant particip&eacute; aux campagnes de vaccination de masse. Pr&egrave;s de 97% connaissaient la poliomy&eacute;lite et 98% avaient entendu parler des campagnes de vaccination. Les canaux d'information les plus cit&eacute;s &eacute;taient la radio (98%) et les agents vaccinateurs (72%). Seul 3% des parents interrog&eacute;s ont d&eacute;clar&eacute; avoir refus&eacute; la vaccination. Il existait une association entre l'influence n&eacute;gative de l'entourage et la non vaccination des enfants (p = 0,005). CONCLUSION: les connaissances sur la maladie et le vaccin sont bonnes au Tchad malgr&eacute; l'existence de rumeurs concernant notamment les effets des vaccins. L'absence de carnet de vaccination a limit&eacute; l'analyse des r&eacute;sultats de l'enqu&ecirc;te, uniquement d&eacute;clarative avec un taux de vaccination tr&egrave;s &eacute;lev&eacute; d&eacute;clar&eacute;. Dans le cadre de l'&eacute;radication, le carnet est indispensable pour accompagner la politique de pr&eacute;vention.</b><br/> text/html 2018-12-12T03:05:07+01:00 Yemi Raheem Raji, Samuel Oluwole Ajayi, Olusegun Aminu, Busayo Abiola, Oluwafemi Efuntoye, Babatunde Lawal Salako, Ayodeji Arije, Solomon Kadiri [Research] - Outcomes of tunneled internal jugular venous catheters for chronic haemodialysis at the University College Hospital, Ibadan, Nigeria - 03 December 2018. <b>INTRODUCTION: Vascular access is an important aspect of haemodialysis treatments and determinant of patient outcomes. Arteriovenous (AV) fistula has been described as the preferred haemodialysis vascular access for patients on chronic dialysis. There continues to be a challenge with the creation of AV fistula, due to shortage of vascular surgeons skilled in the AV fistula creation particularly in source limited setting. We described the outcomes of the tunneled internal jugular venous catheters amongst our patients at the University College Hospital (UCH) Ibadan. METHODS: a retrospective study of patients on maintenance haemodialysis at the UCH, Ibadan, we reviewed the records of all patients on chronic dialysis over a period of 5 years. Information obtained include demographics, types and aetiology of renal failure, types of vascular access, observed complications and outcomes. RESULTS: a total number of 147 catheters were inserted during the period under review, 94 were in males while 53 were females. The age range was 18-85 years while the mean age was 46.3 ± 17.2 years. The range and mean duration for Tunneled Dialysis Catheter (TDC) carriage were (30 - 1,440) and 220±185 days respectively. The observed immediate complications of TDCs were failed first attempt 7(4.7%), reactionary haemorrhage 5(3.4%), arrhythmia 3(2.0%), haemothorax 2(1.4%) while death during catheter placement was recorded in 2(1.4%) cases. Catheter related infection was the commonest long-term complications and occurred in 15 cases (10.1%), while being diabetic increased the risk of developing catheter related complications. One tenth of our patients with End Stage Renal Disease on TDC had kidney transplantation while catheter related mortality was 16.3%. CONCLUSION: internal jugular tunneled dialysis catheters despite its shortcomings, has been a safe procedure with good outcomes among our patients on maintenance haemodialysis.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mustapha Ahsaini, Mohammed Bounoual, Soufiane Mellas, Jalaleddine El Ammari, Mohammed Fadl Tazi, Mohammed Jamal El Fassi, Moulay Hassan Farih [Case report] - Corps &eacute;tranger intra ur&eacute;tral inhabituel chez un adolescent schizophr&egrave;ne: &agrave; propos d’un cas - 03 December 2018. <b>L'auto insertion d'un corps &eacute;trangers s'observe g&eacute;n&eacute;ralement chez les patients ayant une psychose chronique dans le but d'automutilation ou &eacute;rotique. Le diagnostic est parfois difficile s'il est rapport&eacute; tardivement ou si le patient est non coop&eacute;rant, d'o&ugrave; l'int&eacute;r&ecirc;t d'un bilan d'imagerie compl&eacute;mentaire. Le traitement comporte deux volets: l'extraction de corps &eacute;trangers soit par voie endoscopique ou chirurgie ouverte et la prise en charge psychiatrique de la maladie mentale. Nous rapportons une observation inhabituelle d'un adolescent de 16ans schizophr&egrave;ne qui s'est introduit une aiguille dans son ur&egrave;tre depuis 2ans dont le diagnostic a &eacute;t&eacute; fait &agrave; l'aide l'ur&eacute;trocystographie r&eacute;trograde et mictionnelle, et gr&acirc;ce &agrave; des artifices techniques, l'aiguille a &eacute;t&eacute; enlev&eacute; endoscopiquement sans avoir recours &agrave; la chirurgie ouverte malgr&eacute; l'anciennet&eacute; de l'incident avec bien sur compl&eacute;ment de prise en charge psychiatrique.</b><br/> text/html 2018-12-12T03:05:07+01:00 Abdoulaye Diallo Harouna, Idrissa Salahoudine, Abdelhalim Mahamoudi, Aziz El Madi, Khalid Khattala, Youssef Bouabdallah [Case report] - Perforation c&aelig;cale n&eacute;onatale inaugurale du diagnostic d’un m&eacute;gac&ocirc;lon cong&eacute;nital - 03 December 2018. <b>Les perforations intestinales spontan&eacute;es sont rares chez un nouveau-n&eacute; &agrave; terme. Nous rapportons le cas d'un nouveau-n&eacute; issu d'une grossesse de 41 semaines d'am&eacute;norrh&eacute;e, qui avait pr&eacute;sent&eacute; &agrave; trois jours de vie, un pneumop&eacute;ritoine inaugural d'un m&eacute;gac&ocirc;lon cong&eacute;nital. L'exploration chirurgicale avait mis en &eacute;vidence une perforation c&aelig;cale diastatique associ&eacute;e &agrave; une disparit&eacute; de calibre recto-sigmo&iuml;dienne. La prise en charge avait consist&eacute; &agrave; la r&eacute;alisation d'une c&aelig;costomie d'urgence apr&egrave;s lavage de la cavit&eacute; p&eacute;riton&eacute;ale. L'examen histologique des fragments biopsiques avait permis de confirmer le diagnostic du m&eacute;gac&ocirc;lon cong&eacute;nital. Les suites op&eacute;ratoires &eacute;taient simples et la cure radicale avait eu lieu six mois plus tard.</b><br/> text/html 2018-12-12T03:05:07+01:00 Conar&eacute; Ibrahima, Malle Mahamadou [Images in medicine] - Formes &eacute;volutives post&eacute;rieures de la persistance de la vascularisation fœtale bilat&eacute;rale &agrave; l'h&ocirc;pital r&eacute;gional de Gao - 03 December 2018. <b>La persistance de la vascularisation fœtale (PVF) est une anomalie de la r&eacute;sorption du syst&egrave;me vasculaire hyalo&iuml;dien. Formes &eacute;volutives post&eacute;rieures bilat&eacute;rales de la persistance chez un gar&ccedil;on &acirc;g&eacute; de 2 ans qui a consult&eacute; pour une leucocorie de l'œil droit. L'examen a retrouv&eacute; une leucocorie bilat&eacute;rale, une esotropie de l'œil droit et une exotropie de l'œil gauche. Le fond d'œil droit retrouve une bande fibrovasculaire r&eacute;tinien tendu jusqu’&agrave; l’ora serrata, associ&eacute; &agrave; un d&eacute;collement total de la r&eacute;tine et des remaniements pigmentaires p&eacute;riph&eacute;riques. Le fond d'œil gauche note une bande fibrovasculaire r&eacute;tinien tendu de la papille &agrave; l’ora serrata, associ&eacute;e &agrave; un d&eacute;collement partiel temporal inf&eacute;rieur en ant&eacute;rieur et des remaniements pigmentaires p&eacute;riph&eacute;riques.</b><br/> text/html 2018-12-12T03:05:07+01:00 Sahara Shurie, Edwin Were, Omenge Orang'o, Alfred Keter [Research] - Levonorgestrel only emergency contraceptive use and risk of ectopic pregnancy in Eldoret Kenya: a case-control study - 29 November 2018. <b>INTRODUCTION: Ectopic pregnancy is one of the causes of maternal morbidity and mortality in Sub-Saharan Africa. Levonorgestrel (LNG) only emergency contraceptive pill is a well-established emergency contraceptive pill that is administered within 72 hours after unprotected intercourse. This study aimed at determining whether or not there is a significant association between levonorgestrel emergency contraceptive use and the occurrence of ectopic pregnancy. METHODS: case-control (1:3) study among 79 women with ectopic pregnancy (cases) matched against 237 women without (controls) at Moi Teaching and Referral Hospital in Eldoret, Kenya; Sociodemographic and clinical data were collected using a questionnaire. Association between ectopic pregnancy and LNG-EC was assessed using Pearson chi-square test. The relationship between outcome and exposure (while adjusting for confounders) was assessed using logistic regression model. RESULTS: The mean age was 27.15 years. Both cases and controls were similar by age (p = 0.990), educational level (p = 0.850), marital status (p = 0.559), employment status (p = 0.186) and parity (p = 0.999). Seventy-eight (24.7%) participants had a history of miscarriage. A higher proportion of the cases had history of using LNG-EC compared to the controls (32.9% vs. 7.2%, p < 0.001). The use of LNG-EC portended more than nine times increased odds of ectopic pregnancy compared to other contraceptive methods {OR = 9.34 (95% CI: 3.9 - 16.0)}. CONCLUSION: levonorgestrel only emergency contraceptive use was associated with ectopic pregnancy. One of the limitations of this study is that we could not control for all confounders of ectopic pregnancy.</b><br/> text/html 2018-12-12T03:05:07+01:00 Abdelfattah Latabi, Mohammed Amine Lakmichi, Zakaria Dahami, Mohammed Said Moudouni, Ismail Sarf [Case report] - Giant abdomino scrotal hydrocele: a case report with literature review - 28 November 2018. <b>Abdominoscrotal hydrocele (ASH) is a condition in which the hydrocele sac is extended beyond the scrotum to the abdomen via the inguinal canal. The treatment is ordinarily surgical. Different approaches have been described like paramedian laparotomy, an inguinal or inguino scrotal approach. We report a case of giant unilateral hydrocele in an 18 year old male, occupying a large part of the abdomen with urinary symptoms. Ultrasonography and CT showed typical cystic mass in hourglass shape that we have approached surgically by scrotal incision and we removed all the cyst. Pathological examination found a hydrocele with no signs of malignancy. Urinary symptoms disappeared postoperatively. This is a rare entity that evolves often painless and little reported in the literature. The etiology and pathogenesis of this disease is discussed.</b><br/> text/html 2018-12-12T03:05:07+01:00 Houcine Maghrebi, Amin Makni, Rami Rehaim, Anis Haddad, Wael Rebai, Mouna Ayadi, Amine Daghfous, Fadhel Fteriche, Faouzi Chebbi, Rachid Ksantini, Mohamed Jouini, Montasser Kacem, Zoubeir Ben Safta [Case report] - Tumeur pseudo papillaire et solide du pancr&eacute;as - 28 November 2018. <b>Les tumeurs pseudopapillaires et solides du pancr&eacute;as (TPPS) sont des tumeurs &eacute;pith&eacute;liales rares. Dans la plupart des cas, il s’agit de tumeurs survenant chez la femme jeune dans la deuxi&egrave;me ou la troisi&egrave;me d&eacute;cennie de la vie. La survie apr&egrave;s r&eacute;section primaire approche 90% &agrave; 5 ans. Nous rapportons le cas d’une jeune patiente de la vingtaine qui pr&eacute;sente une tumeur pseudopapillaire et solide du pancr&eacute;as d&eacute;couverte devant des douleurs abdominales sans perturbations des bilans biologiques. La tomodensitom&eacute;trie (TDM), l'imagerie par r&eacute;sonance magn&eacute;tique (IRM) et l'&eacute;chographie endoscopique ont r&eacute;v&eacute;l&eacute; une masse bien limit&eacute;e se d&eacute;veloppant au d&eacute;pend de l'isthme pancr&eacute;atique. L'ex&eacute;r&egrave;se compl&egrave;te de la tumeur a &eacute;t&eacute; r&eacute;alis&eacute;e. L’examen anatomopathologique confirmait le diagnostic de tumeur pseudopapillaire et solide du pancr&eacute;as. En conclusion, les tumeurs pseudopapillaires et solides du pancr&eacute;as doivent &ecirc;tre &eacute;voqu&eacute;es comme un des diagnostics diff&eacute;rentiels de toute masse pancr&eacute;atique en particulier chez les jeunes femmes. L'ex&eacute;r&egrave;se chirurgicale procure un bon pronostic.</b><br/> text/html 2018-12-12T03:05:07+01:00 Siham Alaoui Rachidi, Anas Lahlou Mimi, Amal Akammar, Youssef Lamrani Alaoui, Meriem Boubbou, Mustapha Maaroufi, Badr Alami [Case report] - Syndrome de Sturge Weber Krabb: entit&eacute; exceptionnelle (&agrave; propos d'un cas) - 28 November 2018. <b>Nous rapportons le cas d'un syndrome de Sturge Weber diagnostiqu&eacute; au sein du service de radiologie de CHU Hassan II de F&egrave;s. A partir de cette observation, nous montrons les aspects cliniques, diagnostiques et th&eacute;rapeutiques ainsi qu'&eacute;volutifs de cette entit&eacute; neuro radiologique exceptionnelle.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mohamed Amine Oukhouya, Saad Andaloussi, Hicham Abdellaoui, Mohammed Tazi, Abdelhalim Mahmoudi, Aziz Elmadi, Khalid Khattala, Youssef Bouabdallah [Case report] - Meckel’s diverticulum causing intestinal obstruction in the newborn - 28 November 2018. <b>The causes of neonatal bowel obstruction are variable and dominated by malformations and the Meckel diverticulum must remain exceptional. We report a case of neonatal bowel obstruction in a six day old male neonate admitted on account of inability to pass stool, abdominal distension and bilious vomiting. The radiologic additional examinations are non-specific. Exploratory laparotomy found obstruction at the site of a Meckel's diverticulum.</b><br/> text/html 2018-12-12T03:05:07+01:00 Luchuo Engelbert Bain, Gerald Ngwain Chia, Julius Nwobegahay, Jeffery Sumboh, Nditanchou Rogers, Paschal Kum Awah [Essay] - Research Ethics Committees (RECs) and epidemic response in low and middle income countries - 28 November 2018. <b>The recent Ebola and Zika virus epidemics in some parts of Africa and Asia have showcased the porosity in disaster preparedness and response, not only in the affected countries, but on a global scale. For the Ebola epidemic, scientifically robust research was started late during the course of the epidemic, with waste of resources and lost research opportunities. Research Ethics Committees have a significant role to play with regards to epidemic response for the future. This paper presents key challenges and opportunities for ethics review during emergencies, specifically for low and middle income countries. There is no better moment to test the efficacy and safety of drugs or vaccines for infected, or at risk populations than during the disaster itself. The main mantras that form the back bone of research ethics review (Helsinki Declaration, the CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects, WHO and the ICH guidelines for Good Clinical Practice) are increasingly showing their limitations. Most protocols are generally from developed countries where the funding originates. Not only is the direct transposition to Low and Middle Income Country (LMIC) settings inappropriate on its own, also, using such guidelines in times of public health disasters might be time consuming, and might also lead to wastage of research opportunities, especially when sociocultural peculiarities, and anthropological research arms are completely excluded or avoided within the care and research packages. Governments should include RECs as key members during the elaboration, and daily functioning of their national public emergency response packages. Developing simple research ethics review guidelines, involvement of health care staff in ethics training, community mobilization, and incorporation of anthropological research during the medical response, research and communication phases, are imperatives in epidemic response.</b><br/> text/html 2018-12-12T03:05:07+01:00 Olujide Oladele Soyele, Kehinde Emmanuel Adebiyi, Olufunlola Motunrayo Adesina, Adeola Mofoluwake Ladeji, Adetayo Aborisade, Abiodun Olatunji, Henry Ademola Adeola [Research] - Ameloblastic carcinoma: a clinicopathologic analysis of cases seen in a Nigerian Teaching Hospital and review of literature - 27 November 2018. <b>INTRODUCTION: Ameloblastic carcinoma is a rare malignant odontogenic neoplasm that exhibits histological features of ameloblastoma in combination with cytological atypia. It may arise de novo or secondarily through malignant de-differentiation of pre-existing ameloblastoma or odontogenic cyst. Secondary ameloblastic carcinomas often results from repeated surgical intervention, which is a mainstay of odontogenic tumor management in resource limited settings. To date, relatively few cases of ameloblastic carcinomas have been reported and many cases have been misdiagnosed as ameloblastoma. This is due to its wide range of clinicopathological feature which range from indolent to aggressive. It may present as an aggressive ulcerated mass or as a simple cystic lesion; hence, it often challenging to delineate from its benign counterpart, ameloblastoma. METHODS: This study reviewed the clinicopathological data on 157 cases of odontogenic tumors diagnosed over a 10 years period from the pathology archive of the Oral Pathology Unit of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria. RESULTS: Of all these cases, we identified that 64.9% were Ameloblastomas, while 8.3% were ameloblastic carcinomas. Primary subtypes of ameloblastic carcinoma constituted 23.08%, while 69.23% of the cases were of the secondary subtype. We also found that the secondary subtype of ameloblastic carcinomas showed a higher mean duration value of 7.7 years. Most lesions were found in posterior mandible and presented with ulceration, perforation and ill-defined borders radiographically. CONCLUSION: This study is among the few that have documented higher frequency of secondary ameloblastic carcinoma in the scientific literature.</b><br/> text/html 2018-12-12T03:05:07+01:00 Peter Nsubuga, Ben Masiira, Luka Ibrahim, Nestor Ndakala, Norbert Dongmo [Research] - The contribution of the polio eradication initiative on the operations and outcomes of non-polio public health programs: a survey of programs in the African region - 26 November 2018. <b>INTRODUCTION: The effect of the Global polio eradication initiative (PEI) on public health programs beyond polio is widely debated. PEI contribution to other health programs has been assessed from the perspective of polio-funded personnel, which may introduce bias as PEI staff are probably more likely to show that they have benefited of other programs. We set out to identify and document how public health programs have benefitted from the public health capacity that was provided at the country level as part of the PEI program in a systematic and standardized manner. METHODS: Between July and November 2017, we conducted a mixed-methods cross-sectional study, which combined two methods: a multi-country quantitative survey and a qualitative study. We created a self-administered electronic multi-lingual questionnaire in English, French and Portuguese. The qualitative study, which followed an interim analysis of the quantitative survey, comprised interviews with national and subnational level staff in a few countries. RESULTS: A total of 127 public health workers from 43 of the 47 countries in the African WHO Region responded online. Most of the respondents 56/127 (42.7%) belonged to the immunization sector and 51/127 (38.9%) belonged to the emergencies and outbreaks sector. Respondents who identified themselves with the immunization (50/64 (78%)) and maternal health program (64/82 (78%)) reported the highest level of greatly benefiting from PEI resources. A total of 78/103 (76%) respondents rated PEI’s contribution data management system to their program very high and high. Of the 127 respondents, the majority 91 (71.6%) reported that the withdrawal of PEI resources would result in a weakening of surveillance for other diseases; 88 (62.9%) reported that there would be inadequate resources to carry out planned activities and 80 (62.9%) reported that there would be poor logistics and transport for implementation of activities. Cameroon, DRC, Nigeria and Uganda participated in the qualitative study. Each country had between 7-8 key informants from the national and sub-national level for a total of 31 key informants. Polio funds and other PEI resources have supported various activities in the ministries of health of the four countries especially IDSR, data management, laboratories and development of the public health workforce. Respondents believed that the infrastructure and processes that PEI has created need to be maintained, along with the workforce and they believed that this was an essential role of their governments with support from the partners. CONCLUSION: There is a high awareness of the PEI program in all the countries and at all levels which should be leveraged into improving other child survival activities for example routine immunizations. Future large-scale programs of this nature should be designed to benefit other public health programs beyond the specific program. The public health workforce, surveillance development, data management and laboratory strengthening that have been developed by PEI need to be maintained.</b><br/> text/html 2018-12-12T03:05:07+01:00 Pietro Fransvea, Francesco Cortese [Images in medicine] - A case of idiopathic giant megacolon in an obese patientitle of image - 26 November 2018. <b>A 43-year-old man complaining of abdominal nausea starting 15 days earlier and vomiting was admitted to our emergency department. The patient was affected by a sever obesity with a BMI of 55.5; there was also an history of diabetes and hypertension. The abdomen was distended, diffusely painful, tympanic to percussion and the Blumberg sign was intensely positive; WBC count was 24,000 x10 * 3 with marked neutrophilia, hemoglobin 9.6 g / dl, with haematocrit 30.6%. A distended colon was present at plain RX abdomen while the CT cannot be performed due to the high BMI of the patient. At laparotomy a giant idiopathic megacolon was found and an Hartmann procedure was performed. The patient was discharged 15 postop with no complication. The anatomopathological examination documented a normal colon tissue. Diagnosis in obese patients is often difficult because they are paucisintomatic and the physical examination is difficult to achieve.</b><br/> text/html 2018-12-12T03:05:07+01:00 Soufiane Ennaciri, Moulay Hassan Farih [Images in medicine] - Hydron&eacute;phrose g&eacute;ante sur ur&eacute;t&eacute;roc&egrave;le compliqu&eacute;e de lithiase ur&eacute;t&eacute;rale - 26 November 2018. <b>L'hydron&eacute;phrose g&eacute;ante est d&eacute;finie comme une importante dilatation des cavit&eacute;s py&eacute;lo-calicielles occupant une grande partie de la cavit&eacute; abdominale, ou une dilatation contenant plus d'un litre d'urine d&eacute;bordant la ligne m&eacute;diane. Elle est d&ucirc;e le plus souvent &agrave; un syndrome de la jonction py&eacute;lo-ur&eacute;t&eacute;rale. L'obstruction par ur&eacute;t&eacute;roc&egrave;le compliqu&eacute;e de lithiase est une cause tr&egrave;s rare. Nous rapportons le cas d'un patient de 45 ans, ayant comme ant&eacute;c&eacute;dent des douleurs lombaires droites non explor&eacute;es, qui a consult&eacute; pour une masse abdominale &eacute;voluant depuis quelques ann&eacute;es associ&eacute;e &agrave; une constipation intermittente. L'examen clinique a objectiv&eacute; une distension abdominale asym&eacute;trique avec une matit&eacute; d&eacute;bordant la ligne m&eacute;diane. L'&eacute;chographie a montr&eacute; une formation liquidienne multi-cloisonn&eacute;e occupant toute la r&eacute;gion abdomino-pelvienne droite et refoulant les structures digestives. L'uroscanner a d&eacute;voil&eacute; une &eacute;norme dilatation ur&eacute;t&eacute;ro-py&eacute;lo-calicielle droite (pyelon mesurant 15,2cm) laminant compl&egrave;tement le parenchyme r&eacute;nal avec absence d'excr&eacute;tion du produit de contraste, en amont d'une ur&eacute;t&eacute;roc&egrave;le compliqu&eacute;e d'un calcul de 2cm. Une n&eacute;phro-ur&eacute;t&eacute;rectomie a &eacute;t&eacute; r&eacute;alis&eacute;e par laparotomie et les suites post op&eacute;ratoires ont &eacute;t&eacute; simples.</b><br/> text/html 2018-12-12T03:05:07+01:00 Krishna Mohan Baradhi [Images in medicine] - A challenging case of fungating malignant melanoma - 22 November 2018. <b>We present the case of a 43-yearr-old male present with left arm pain from a football-sized mass over his left shoulder and arm. He had a history of 3cm melanoma on his left back 3 years ago and underwent resection and adjuvant radiation. However, he had recurrence of melanoma a year later with metastases to the left supra clavicular lymph nodes. He underwent further resection followed by multiple regimens of chemotherapy, which included vemurafenib, dabrafenib and trametinib. Unfortunately, his melanoma was aggressive and remained refractory to the currently available standard therapies. Physical examination as visualized in the figure. The patient eventually opted for a palliative total upper extremity amputation including shoulder joint. World Health Organization estimates around 132,000 new cases of melanoma are diagnosed globally every year. Melanoma is the fifth leading cancer in males and seventh leading cancer in females in the United States. Melanoma is deadliest of all skin cancers and its incidence continues to rise. While recent targeted immunotherapies have improved the survival period of melanoma, metastatic melanoma can be fatal even with the currently available therapies. The single most important preventive measure is to avoid excessive ultraviolet radiation and there should be heightened awareness of its risk factors among both clinicians and patients. Patient's education on prevention and early recognition are paramount for battling melanoma and for better outcomes. Novel biological therapies have undoubtedly made substantial progress and will likely change the landscape in the treatment of melanoma in the near future.</b><br/> text/html 2018-12-12T03:05:07+01:00 Jaouad Laoutid, Omar Laghzaoui [Images in medicine] - Unusual hematoma after spinal anesthesia - 22 November 2018. <b>A 45-year-old female, obese with a BMI of 39.5 was scheduled to undergo hysteroscopy for endometrial hyperplasia under spinal anesthesia. She was diagnosed with well controlled diabetes and hypertension. She took neither antiaggregant nor anticoagulants and biological values were normal. In the operating theater, in sitting position, we could not detect the spinous process so we used the line of iliac crests as landmark for the level L4-L5. After several unsuccessful attempts to perform the spinal anesthesia at different levels, a swelling rapidly progressive and extensive appeared at the points of puncture. The intervention was reported and immediate lumbar scan showed a big subcutaneous hematoma in front of the last thoracic vertebras measuring 12x28x20 cm. Hemodynamic values, hemoglobin and the size of the hematoma remained stable and surgical abstention was decided. Hematoma was caused by probable injury of the posterior branch of spinal artery, favored by difficult spinal anesthesia for patient obesity and lumbar hyperlordosis, hence the interest of ultrasound localization both for level L4-L5 and for spinous process in obese patient. Three weeks later, hematoma was completely resolved and hysteroscopy performed under general anesthesia. Biopsy revealed endometrial adenocarcinoma.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mutata Constantine, Tshuma Cremance, Tsitsi Patience Juru, Shambira Gerald, Gombe Tafara Notion, Nsubuga Peter, Tshimanga Mufuta [Research] - Evaluation of the adverse events following immunization surveillance system in Guruve district, Mashonaland Central 2017 - 22 November 2018. <b>INTRODUCTION: An adverse event following immunisation is any untoward medical occurrence which follows vaccination. Frequency of adverse events ranges from 13% to 34% and they should be reported regardless of severity. From the beginning of 2016 to mid-2017, Guruve district in Zimbabwe did not report any AEFIs. This suggests the surveillance system may be failing to detect adverse events. We therefore evaluated the AEFI surveillance system in Guruve district. METHODS: we conducted a surveillance system evaluation using the updated Centers for Disease Control guidelines for evaluating public health surveillance systems. We interviewed health workers and caregivers of babies under 2 years in Guruve district. We also reviewed all records on AEFI surveillance for the period of January 2016 to November 2017. RESULTS: We recruited 31 health workers and 33 caregivers into the study. Between January 2016 and mid-2017, 39% of the caregivers had children who had suffered AEFIs and 45% of the health workers had encountered AEFIs but none had been notified. The main reasons for failure to report AEFIs included health workers' fear of personal consequences and caregivers thinking that an adverse event was not serious enough to report. Knowledge of the surveillance system was good amongst the majority of health workers. All the resources needed by the surveillance system were available. CONCLUSION: We concluded that health workers in Guruve district were afraid to report adverse events following immunization and caregivers were reluctant to report mild adverse events hence the surveillance system was performing poorly and was not useful. However, the stability of the system and the good knowledge gives a good foundation for improving the surveillance system.</b><br/> text/html 2018-12-12T03:05:07+01:00 Soufiane Ennaciri, Jean Paul Omana [Images in medicine] - Tumeur de la voie excr&eacute;trice sup&eacute;rieure et hydron&eacute;phrose due &agrave; un syndrome de la jonction py&eacute;lo-ur&eacute;t&eacute;rale: une association rare - 22 November 2018. <b>L'association tumeur de la voie excr&eacute;trice sup&eacute;rieure et hydron&eacute;phrose due &agrave; un syndrome de la jonction py&eacute;lo-ur&eacute;t&eacute;rale est une entit&eacute; rare. En effet, les tumeurs de la voie excr&eacute;trice sup&eacute;rieure et l'hydron&eacute;phrose ont classiquement une relation de cause &agrave; effet. Cette derni&egrave;re est due le plus souvent &agrave; l'obstruction par une tumeur de l'uret&egrave;re ou de la jonction py&eacute;lo-ur&eacute;t&eacute;rale. Nous rapportons le cas d'un patient de 66 ans, aux ant&eacute;c&eacute;dents de tabagisme et de py&eacute;lon&eacute;phrite droite, pr&eacute;sentant des douleurs lombaires droites &eacute;voluant par intermittence depuis plusieurs mois sans h&eacute;maturie. L'&eacute;chographie a montr&eacute; une dilatation des cavit&eacute;s py&eacute;lo-caliciels avec r&eacute;duction majeur de l'index cortico-m&eacute;dullaire du rein droit. L'uroscanner a dout&eacute; entre une dysplasie kystique du rein droit, et une hydron&eacute;phrose droite sur syndrome de la jonction py&eacute;lo-ur&eacute;t&eacute;rale avec des images bourgeonnantes intra r&eacute;nales faisant suspecter une tumeur py&eacute;lique. Le bilan a &eacute;t&eacute; compl&eacute;t&eacute; par une cytologie urinaire quie est revenue positive. Une n&eacute;phro-ur&eacute;t&eacute;rectomie droite par laparotomie a &eacute;t&eacute; r&eacute;alis&eacute; et l'examen anatomopathologique a confirm&eacute; qu'il s'agit bien d'un carcinome uroth&eacute;lial des voies excr&eacute;trices sup&eacute;rieures.</b><br/> text/html 2018-12-12T03:05:07+01:00 Zvanaka Sithole, Notion Tafara Gombe, Tsitsi Juru, Prosper Chonzi, Gerald Shambira, Peter Nsubuga, Mufuta Tshimanga [Research] - Evaluation of sexual and gender-based violence program in Harare City, Zimbabwe, 2016: a descriptive cross-sectional study - 22 November 2018. <b>INTRODUCTION: In Zimbabwe, there is a gap between sexual violence (SV) survivors' health care needs versus the existing facilities. Harare city started Sexual Gender Based Violence (SGBV) project in 2011, with the aim to reduce SV morbidity.Only 592 (42%) of 1425 SV survivors reported for medical services within 72 hours in 2015. HIV post-exposure prophylaxis (PEP) is effective within 72hours of post exposure. We evaluated the program performance in Harare city. METHODS: We conducted a process-outcome evaluation using a logic model. We purposively recruited all eight SGBV sites and key informants. We randomly selected 27nurses into the study. Interviewer-administered questionnaires and checklists were used to collect data. To generate frequencies, means and proportions we used Epi info 7. RESULTS: The program adequately received inputs except for counselling rooms (1/8). About 4285 survivors were recorded from 2013-2016. Of these, 97% were counselled, 93% received HIV test, 41% reported to the clinic within 72hrs of post-rape, and 12% received PEP. About 16% of the total survivors were followed up. The programme failed to meet its targets on decentralised sites (8/10), awareness campaigns(16/32) and sensitisation activities(16/32). About 500(12.5%) IEC materials were distributed. All 96-targeted supervisory visits were achieved. Two ofeight district supervisors were trained. Majority of health workers(25/35) citedlack of awareness as major reasons for underperformance. CONCLUSION: Availability of resources did not translate to program performance. Most survivors were not reporting to the clinic timeously due to the low level of awareness of the programme to the community, hence were not protected from getting HIV through PEP. The programme was not well disseminated, as most supervisors were not trained. Following this evaluation, we distributed150 IEC materials to each of the eight facilities. A follow-up study on outcomes of clients referred for services and training of district officers were recommended.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ines Kechaou, Im&egrave;ne Boukhris [Images in medicine] - Tumeur b&eacute;nigne de la cavit&eacute; buccale: granulome idiopathique de la langue - 22 November 2018. <b>Le granulome de la cavit&eacute; buccale constitue la circonstance de d&eacute;couverte de plusieurs pathologies comme la sarco&iuml;dose, la maladie de Crohn, la tuberculose, la syphilis et les tumeurs malignes. Son origine idiopathique est classique dans le syndrome de Melkerson Rosenthal. A ce propos, nous rapportons l'observation originale d'un granulome idiopathique de la langue non secondaire &agrave; un syndrome de Melkerson Rosenthal et faisant partie des tumeurs b&eacute;nignes de la cavit&eacute; buccale. Il s'agit d'une patiente &acirc;g&eacute;e de 60 ans sans ant&eacute;c&eacute;dents pathologiques particuliers qui a pr&eacute;sent&eacute; un mois avant son admission une g&ecirc;ne au cours de la mastication secondaire &agrave; une tum&eacute;faction au niveau du bord libre de la langue. A l'examen, elle avait une excroissance au niveau du bord lat&eacute;ral droit de la langue faisant 15mm de grand axe. Sa langue n'&eacute;tait pas plicatur&eacute;e et il n'y avait pas d'ad&eacute;nopathies cervicales. Le reste de l'examen somatique &eacute;tait sans particularit&eacute;s. L'IRM de la cavit&eacute; buccale avait montr&eacute; une l&eacute;sion tissulaire n&eacute;cros&eacute;e du bord libre droit de la langue mobile, d'allure suspecte mesurant 15x12x19mm sans signes d'extension au p&eacute;dicule lingual homolat&eacute;ral ni au plancher buccal et sans ad&eacute;nom&eacute;galies cervicale. La biopsie de la l&eacute;sion de la langue avait montr&eacute; des granulomes &eacute;pith&eacute;lio&iuml;des et giganto-cellulaires sans n&eacute;crose cas&eacute;euse et sans signes histologiques de malignit&eacute;. Sur le plan biologique, il n'y avait pas de syndrome inflammatoire, ni de leucop&eacute;nie ou de lymphop&eacute;nie. Le bilan &eacute;tiologique &agrave; la recherche d'une &eacute;tiologie sous-jacente &eacute;tait n&eacute;gatif: s&eacute;rologie syphilis, bilan phosphocalcique, dosage de l'enzyme de conversion de l'angiotensine, intradermo r&eacute;action &agrave; la tuberculine, radiographie du thorax, scanner thoraco-abdomino pelvien et examen ophtalmologique. Finalement, le diagnostic de granulome idiopathique a &eacute;t&eacute; retenu devant l'absence d'arguments en faveur de son caract&egrave;re secondaire.</b><br/> text/html 2018-12-12T03:05:07+01:00 Elliot Koranteng Tannor, Kwame Yeboah-Mensah [Case report] - Biopsy proven lupus nephritis in a black male patient in West Africa with systemic lupus erythematosus: case report - 22 November 2018. <b><i>Lupus nephritis</i> (LN) is a complication of systematic <i>lupus erythematosus</i> (SLE) with significant impact on morbidity and mortality. It is known commonly to affect females but has worse prognosis when males or blacks are affected. In a setting with deficiency in health care delivery, the diagnosis and adequate management of SLE patients becomes difficult and hence less cases of <i>lupus nephritis</i> in black males have been reported. We present a case of a male black patient with SLE who presented with <i>neurolupus, serositis</i>, skin manifestations and Class IV/V <i>lupus nephritis</i> on histology. Our case highlights the challenges in the management of <i>lupus nephritis</i> and the complications with immunosuppression in an attempt to induce remission. There is the need for high index of suspicion for the diagnosis of <i>lupus nephritis</i> especially in black males for prompt management to get the best outcome.</b><br/> text/html 2018-12-12T03:05:07+01:00 Madeleine Mbuyi Kabongo, Sylvie Linsuke, Sylvain Baloji, Faustin Mukunda, Inoc&ecirc;ncio da Luz R, Christine Stauber, Jean-Pierre Van Geertruyden, Pascal Lutumba [Research] - Schistosoma mansoni infection and its association with nutrition and health outcomes: a household survey in school-aged children living in Kasansa, Democratic Republic of the Congo - 21 November 2018. <b>INTRODUCTION: Schistosomiasis (SCH) is an important public health problem in developing countries and school-aged children are the most affected. This study explored health and nutritional status and their correlation with SCH in children attending primary school (3rd to 6th class) living in the area of Kasansa in the Democratic Republic of Congo. METHODS: A cross-sectional household survey was carried out in Kasansa health area in February 2011. Children whose parents reported to attend primary school (3rd to 6th class) were included. Socio-demographic characteristics, information on morbidity history and risk factor were collected using a semi-structured questionnaire. S. mansoni and malaria infection were assessed using the Kato-Katz technique and Rapid Diagnostic Test, respectively. Haemoglobin concentration was also performed using a portable HemoControl device. Bivariate and multiple logistic regressions were used to assess risk factors for S. mansoni. RESULTS: A total of 197 school aged children participated in the study with a median age of 12 years and 53.8% of them were boys. The overall health status of the children was poor with very high prevalences of S. mansoni infection (89.3%), malaria infection (65.1%), anaemia (61.4%) and stunting (61.0%). Regular contact with river water was the most important risk factor (OR: 11.7; p<0.001) related to SCH infection. A low haemoglobin concentration was significantly associated with a SCH infection (OR: 12.3; p=0.003) and egg load was associated with stunting (OR: 12.4; p=0.04). Children from farmers were more at risk for low school performance (OR: 5.3; p=0.03). CONCLUSION: High prevalence of Schistosoma mansoni and malaria infection was observed in the study population living in Kasansa area. Moreover, they presented a high burden of anaemia, chronic malnutrition and low school performance. An integrated disease control and management of these diseases and their consequences, endorsed by surveillance, is needed.</b><br/> text/html 2018-12-12T03:05:07+01:00 Munekayi Padingani, Ajay Kumar, Jaya Prasad Tripathy, Nyasha Masuka, Sidingiliswe Khumalo [Research] - Does pre-diagnostic loss to follow-up among presumptive TB patients differ by type of health facility? An operational research from Hwange, Zimbabwe in 2017 - 21 November 2018. <b>INTRODUCTION: While there are many studies assessing the pre-treatment loss to follow-up (LFU) among tuberculosis patients in public sector, there is no evidence from private-for-profit health sector and pre-diagnostic LFU from Zimbabwe. We aimed to assess the gaps in the cascade of care of presumptive TB patients registered during January-June 2017 in different types of health facilities in Hwange district, Zimbabwe. METHODS: This was a cohort study involving review of routine programme data. Pre-diagnostic LFU was defined as the proportion of presumptive TB patients not tested using sputum microscopy or Xpert MTB/RIF. A log binomial regression was done to assess factors associated with pre-diagnostic LFU. RESULTS: Of 1,279 presumptive TB patients, 955(75%) were tested for TB and 102(8%) were diagnosed as having TB. All TB patients were started on treatment. Pre-diagnostic LFU (overall 25%) was significantly higher among patients visiting private-for-profit health facilities (36%), local self-government run council health facilities (35%) and church-run mission health facilities (25%) compared to government health facilities (14%). Pre-diagnostic LFU was significantly higher among patients in rural areas (30%) compared to urban areas (18%). Type of health facility was associated with pre-diagnostic LFU after adjusting for HIV status and area of residence. CONCLUSION: While pre-diagnostic LFU was high, there was no pre-treatment LFU. Pre-diagnostic LFU was especially high in private-for-profit-for-profit and council health facilities and rural areas. National TB Programme should take immediate steps to improve access in rural areas and support the private and council health facilities by improving sputum collection and transport.</b><br/> text/html 2018-12-12T03:05:07+01:00 Thomas Obinchemti Egbe, Elvis Songa Tsaku, Robert Tchounzou, Marcelin Ngowe Ngowe [Research] - Prevalence and risk factors of gestational diabetes mellitus in a population of pregnant women attending three health facilities in Limbe, Cameroon: a cross-sectional study - 20 November 2018. <b>INTRODUCTION: There are few studies regarding GDM in the South West Region of Cameroon. We aimed at determining the prevalence and risk factors of GDM in three health facilities in the Limbe health district, Cameroon. METHODS: A cross-sectional study was carried in one secondary and two primary healthcare facilities in Limbe, Cameroon during the period 1st November 2016 to 31st January 2017. We administered a pretested questionnaire on 200 consenting pregnant women at 24 – 28 weeks’ gestation. We carried out a 2-hr oral glucose tolerance test after fasting overnight. GDM was diagnosed when &ge;1 plasma glucose (PG) test result was abnormal according to the IADPSG criteria (FPG&ge;92mg/dL, PG 1-hr 180mg/L, PG 2-hr 153mg/dL). Data analysis was with Epi-Info™ version 3.5.4. Associations were analyzed with the Pearson’s chi squared and Fischer’s exact test where appropriate. Statistical significance was set at p < 0.05. RESULTS: The prevalence of GDM was 20.5% and respondents’ mean age was 27.8 (SD 5.7) years. Majority, 13.5% participants had abnormal FPG alone, while 3.5% had any two abnormal values. GDM was associated with: advanced maternal age (OR 3.4: 95% CI 1.7-7.0; P < 0.001), BMI&ge;30 kg/m2 (OR 6.2: 95% CI 2.9-13.1, P < 0.001), past history of unexplained stillbirth (OR 5.7:95% CI 2.5-12.9, P < 0.001) and history of macrosomia (OR 8.5:95% CI 3.8-19, P < 0.001). CONCLUSION: With the high prevalence of GDM, identification of its associated factors has the potential to be a target of intervention to prevent poor obstetrical outcomes.</b><br/> text/html 2018-12-12T03:05:07+01:00 Kehinde Sharafadeen Okunade, Olayemi Olubunmi Dawodu, Omolola Salako, Gbemisola Eniola Osanyin, Adeyemi Adebola Okunowo, Rose Ihuoma Anorlu [Research] - Comparative analysis of serum trace element levels in women with invasive cervical cancer in Lagos, Nigeria - 20 November 2018. <b>INTRODUCTION: Trace elements although present in minute quantities in human blood, they play a vital role in many biochemical enzymatic reactions and have been examined critically as a potential key factor in various human diseases including cancers. This study was aimed to determine the association between serum levels of trace elements and invasive cancer of the cervix. METHODS: This was an analytical cross-sectional study carried out among women seen at the Lagos University Teaching Hospital (LUTH). Fifty histologically diagnosed patients with squamous cells carcinoma of the cervix, who had not had any treatment and 100 cancer-free volunteers were recruited. A structured interviewer-administered questionnaire was used to collect relevant data following which venous blood sample was obtained from each participant. Serum zinc, copper and selenium concentrations were then measured. The associations of serum trace elements and invasive cervical cancer were tested using the independent sample t-test. All significances were reported at P<0.05. RESULTS: there were significantly low serum levels of zinc and selenium in cervical cancer patients with no significant difference seen in the serum level of copper among cervical cancer patients compared to their cancer-free control counterparts. CONCLUSION: These alterations in trace elements levels may be important in the pathogenesis of cervical cancers; however, future robust prospective studies are needed to determine if routine provision of these supplements will result in improved cervical cancer treatment outcomes in Nigerian women.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ashenafi Tazebew Amare, Zemene Tigabu Kebede, Henry Delois Welch [Research] - Epidemiology of bacterial meningitis in children admitted to Gondar University Hospital in the post pneumococcal vaccine era - 20 November 2018. <b>INTRODUCTION: Community acquired bacterial meningitis (CABM) is responsible for high mortality and disabling sequelae. Introduction of pneumococcal conjugate vaccine (PCV-10) and <i>haemophilus influenzea</i> type b (Hib) has changed the epidemiological and clinical features of patients presenting with CABM as it is shown in different literatures over the last decade. The aim of this study was to assess the clinical and epidemiologic features and outcomes of CABM after the introduction of PCV-10 in Gondar University Hospital (GUH). METHODS: this is a retrospective study among children between 2 months and 14 years of age discharged from Gondar University Hospital. All patient records discharged with a diagnosis of meningitis at GUH were reviewed from September 2011 - September 2013. The data was collected using a structured questionnaire from the patient record charts and analysis was done using SPSS-20. RESULTS: 80 cases (1.6%) of CABM out of 4996 admissions were identified. There were 60 (75%) cases of CABM using WHO criteria of cerebrospinal fluid leukocytosis (CSF) > 100cells/mm<sup>3</sup>, or 10-100cells/mm<sup>3</sup> with either hypoglycorrhea or increased protein; and 20 (25%) with culture confirmation. <i>S. Pneumoniae</i> was the most frequent pathogen identified in 14 (70%) children. The most common age group were infants 2-12 month old (n = 32, 40%). Children with adverse outcomes had shown a higher frequency of being older children (p = 0.045), loss of consciousness (p = 0.046), seizure at admission (p < 0.01), and a positive CSF culture (p = 0.03). CONCLUSION: introduction of PCV-10 has shown a decreased admission rate, mortality, and neurologic sequelae due to CABM.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ilyas Derdabi, Hajar El Jouadi, Leila Jroundi [Case report] - Thrombose bilat&eacute;rale post-traumatique des art&egrave;res r&eacute;nales - 19 November 2018. <b>La thrombose post-traumatique des art&egrave;res r&eacute;nales est une complication rarement vue, secondaire &agrave; des l&eacute;sions vasculaires r&eacute;nales soit par l&eacute;sion intimale ou compression vert&eacute;brale. La conduite diagnostique reste un sujet de discussion compliqu&eacute; n&eacute;cessitant la prise en consid&eacute;ration de plusieurs facteurs de la part du m&eacute;decin et du malade.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mohamed Amine Oukhouya [Images in medicine] - Lymphangiome kystique du cordon spermatique: &agrave; propos d’un cas - 19 November 2018. <b>Nous rapportons le cas d'un nourrisson &acirc;g&eacute; de 1 an, admis &agrave; notre formation pour prise en charge d'une tum&eacute;faction inguino-scrotale gauche &eacute;voluant depuis 4 mois et augmentant progressivement de volume et devenant douloureuse. L'examen clinique a trouv&eacute; un enfant conscient, stable sur le plan h&eacute;modynamique et respiratoire, apyr&eacute;tique; avec une tum&eacute;faction inguino-scrotale gauche molle transilluminable douloureuse &agrave; la palpation. Une &eacute;chodoppler inguinale a objectiv&eacute; une masse multilocul&eacute;e de 30 mm. Une TDM abdomino-pelvienne a &eacute;t&eacute; en faveur d'un lymphangiome kystique (A) objective l'image clinique de la tum&eacute;faction; (B) objective sur une TDM abdomino-pelvienne l'image en faveur d'un lymphangiome kystique; (C) objective l'aspect du lympangiome apr&egrave;s exploration par voie inguinale qui &eacute;tait en contact intime avec le cordon spermatique et arrivant jusqu'au scrotum; on a opt&eacute; pour la r&eacute;section du kyste apr&egrave;s dissection minutieuse tout en pr&eacute;servant les &eacute;l&eacute;ments nobles. (C) montre l'&eacute;tat final apr&egrave;s 3 mois. La nature du kyste a &eacute;t&eacute; confirm&eacute;e par l'&eacute;tude anatomopathologique. Le recul est actuellement de 6 mois; on a remarqu&eacute; l'apparition de la tum&eacute;faction au niveau controlat&eacute;ral.</b><br/> text/html 2018-12-12T03:05:07+01:00 Lina Hmida, Feryel Letaief, Raoudha Doghri, Khedija Meddeb, Khalil Mahjoubi, Amina Mokrani, Yosra Yahiaoui, Azza Gabsi, Nesrine Cheraiet, Henda Rais, Mouna Ayadi, Amel Mezlini [Case report] - Cutaneous leiomyosarcoma on the trunk: an unusual presentation with an aggressive course – case report and review of literature - 19 November 2018. <b>Primary cutaneous leiomyosarcoma (PCL) is the rarest subtype, arising in the dermis, with or without extension into the subcutis. They are thought to have an indolent course compared to their subcutaneous counterparts, they may recur but rarely metastases. We report the case of a patient with a PCL arising in the anterior trunk wall who developed pulmonary, bone and retroperitoneal metastases 6 years after wide surgical excision of the primary tumor.</b><br/> text/html 2018-12-12T03:05:07+01:00 Amira Omrane, Olfa Jlassi, Salma Kammoun, Ines Tka, Awatef Kraiem, Mohamed Adn&egrave;ne Henchi, Taoufik Khalfallah, Lamia Bouzgarrou [Research] - Analyse ergonomique semi-quantitative des contraintes biom&eacute;caniques du rachis cervical parmi les op&eacute;rateurs sur &eacute;cran dans les &eacute;tablissements universitaires tunisiens - 19 November 2018. <b>INTRODUCTION: Cette &eacute;tude &agrave; pour objectif d'&eacute;valuer les contraintes biom&eacute;caniques associ&eacute;es aux cervicalgies parmi les op&eacute;rateurs sur &eacute;cran. METHODES: Etude ergonomique r&eacute;alis&eacute;e au pr&eacute;s de 325 op&eacute;rateurs sur &eacute;cran dans 25 &eacute;tablissements de l’universit&eacute; du centre tunisien, bas&eacute;e sur une &eacute;tude anthropom&eacute;trique du poste du travail sur &eacute;cran et une analyse semi-quantitative sur des enregistrements vid&eacute;o des activit&eacute;s des travailleurs conduits sur une p&eacute;riode repr&eacute;sentative de 30 minutes. RESULTATS: La pr&eacute;valence des cervicalgies &eacute;valu&eacute;e &agrave; 72,3%, a concern&eacute; une population de travailleurs qui exer&ccedil;ait avec un si&egrave;ge et un plan de travail inadapt&eacute;s (84,6%) et un &eacute;cran bas situ&eacute; par rapport au regard horizontal (81,2%). L’analyse semi-quantitative par enregistrement vid&eacute;o du poste de travail a conclu que la nuque &eacute;tait maintenue en flexion franche de plus de 40 degr&eacute;s sur 69% du temps global du travail. La flexion lat&eacute;rale a &eacute;t&eacute; visible sur 50,3% du temps de travail et la rotation droite ou gauche sur 57,4% du temps de travail. Ainsi, Les op&eacute;rations de prise d’information de l’&eacute;cran, de regard du clavier et de consultation des documents se sont d&eacute;gag&eacute;es comme les plus de contraignantes pour la nuque sur le plan gestuel et postural. CONCLUSION: Nos r&eacute;sultats mettent en &eacute;vidence l’importance des contraintes biom&eacute;caniques associ&eacute;es &agrave; la conception du poste de travail sur &eacute;cran non conforme aux dimensions anthropom&eacute;triques ergonomiquement recommand&eacute;es. Ces contraintes sont associ&eacute;es &agrave; une pr&eacute;valence &eacute;lev&eacute;e des cervicalgies traduisant la n&eacute;cessit&eacute; d’am&eacute;nagement ergonomique de ces postes de travail pour pr&eacute;venir ce fl&eacute;au.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mohamed Jira, Taoufik Amezyane [Images in medicine] - Bullous cutaneous reactions - 16 November 2018. <b>Allopurinol (xanthine oxidase inhibitor) is indicated for the treatment of symptomatic hyperuricemia, the treatment of gout and the treatment and prevention of uric and calcium lithiasis. It is one of the leading drugs for severe toxic dermal reactions, such as Lyell Syndrome (NET), Stevens-Johnson Syndrome (SJS) and Dress Syndrome (Drug reaction with eosinophilia and systemic symptoms). We report the case of a 45-year-old woman who was hospitalized for bullous skin rashes, without pathological history, the patient had generalized erythematous and bullous rash (A, B and C) one week after taking allopurinol, prescribed by his rheumatologist for a gout. The diagnosis of bullous Cutaneous reaction due to allopurinol was retained, allopurinol was discontinued and the course was favorable with the disappearance of cutaneous lesions.</b><br/> text/html 2018-12-12T03:05:07+01:00 Fred Bernardes Filho, Loan Towersey [Images in medicine] - Young man with painful black dots on left foot - 16 November 2018. <b>A 30-year-old previously healthy man was admitted to the emergency room due painful black dots on the left foot. On physical examination, multiple erythematous macules with central black dots on left heel (A) were observed. After topical anaesthesia (lidocaine 40mg/g cream), several spines were removed. The patient was seen in a dermatology consultation complaining of local pain 22 days later. Dermatological examination revealed local erythema, and dermoscopy showed several punctiform wounds, some centered by dark brown pinpoint dots or dashes (B). The diagnosis of injuries caused by spicules of cactus in the heel was made. The removal of the fragments from the patient's foot and the follow-up visits to dermatologist led to a successful treatment that allowed the patient to return to work promptly. He was walking on an ecologic trail in Arraial do Cabo, Rio de Janeiro, when the pain started (C). Encounters with cactus spines, needles, prickles and glochids (barbed hairs) are rarely reported. Common signs of a retained cactus spine include: sharp pain as pressure is applied to the site, and discoloration of the skin. Smaller spines of the cactus plant break off easily on contact, and the fragments frequently get embedded in the skin and soft tissues. The lesion is predominantly aseptic. The most frequently affected area by cactus spine-related injuries are extremity and non-fluctuant tender skin papules which is the most frequently presented. Dermoscopy can be useful in helping to promptly detect and remove remaining embedded spines as seen in this cactus injury. Clinicians should consider injuries by cactus's spines in the differential diagnosis of retained foreign material.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mohamed Ali Sbai, Sofien Benzarti, Wafa Gharbi, Wadia Khoffi, Riadh Maalla [Case report] - Glomus tumor of the leg: a case report - 15 November 2018. <b>Glomus tumors are uncommon benign tumors developing from the neuro-myo-arterial glomus body. They are typically located in the fingers. The extra-digital involvement is unusual and makes diagnosis difficult. Only few cases have been reported in literature. We report an exceptional case of a glomus tumor of the lower leg in a 65-year-old male. The diagnosis was clinically suspected and confirmed by a biopsy. Surgical excision gave immediate pain relief. The aim of this report is to make the surgical community more aware of this entity based on the analysis of our own experience and a review of the literature.</b><br/> text/html 2018-12-12T03:05:07+01:00 Maradona Ehikioya Isikhuemen, Monday Osaze Eliboh, Uche Emmanuel Eni, Kenneth Chinedu Ekwedigwe, Ileogben Sunday-Adeoye [Research] - Outcome of open excisional breast biopsies in Abakaliki, South-East Nigeria - 15 November 2018. <b>INTRODUCTION: open excisional breast biopsy is a known modality for treatment of breast lumps especially in developing countries. Other sophisticated methods are available for management of breast lumps in more advanced nations. Our aim in this study was to review the outcome of open excision breast biopsies in our setting with a view to improving patient management. METHODS: This study was conducted at the National Obstetric Fistula Centre, Abakaliki, South East Nigeria among women who had excision breast biopsy between January 2015 and December 2016. Data was analysed using Statistical Package for Social Sciences (SPSS), version 21. RESULTS: A total of 107 case folders were reviewed in this study. The mean age of the women was 27 ± 10 years. Overlying breast incision was the preferred route in 78(72.9%), periareolar incision in 28(26.2%), and Gillard Thomas's method (infero-lateral submammary sulcus incision) used in one patient with bilateral multiple breast lumps (0.9%). The complications recorded in this study were haematoma in 3(2.8%), wound infection in 5(4.7%) and wound breakdown in 1(0.9%). Hypertrophic scar was found in 2(1.8%) patients at follow-up. Overall, most patients were satisfied with the aesthetic outcome of their surgery. CONCLUSION: Open excision breast biopsy is a useful modality for management of breast diseases in our setting. Complication rates are minimal. Both overlying and periareolar breast incisions results in aesthetically satisfactory scar in our practice. Inferior-lateral sub mammary sulcus skin incision is useful when the lumps are multiple and located at different quadrants of the breast. Appropriate use of drain helps to reduce the incidence of haematoma.</b><br/> text/html 2018-12-12T03:05:07+01:00 Esther Kisaakye, Justine Namakula, Christine Kihembo, Angela Kisakye, Peter Nsubuga, Juliet Ndimwibo Babirye [Research] - Level and factors associated with uptake of Human papillomavirus infection vaccine among female adolescents in Lira District, Uganda - 15 November 2018. <b>INTRODUCTION: The principal burden of human papillomavirus (HPV) infections is cervical cancer. Cervical cancer ranks as the fourth most common malignancy in women affecting 500,000 women each year with an estimated 266,000 deaths. Uganda has one of the highest cervical cancer incidence rates globally with an age-standardised incidence rate per 100,000 of 47.5. This study assessed the level and the factors associated with uptake of HPV vaccine by female adolescents in Lira district, Uganda. METHODS: A mixed methods approach was employed using a survey among 460 female adolescents. We collected data using an interviewer-administered questionnaire. We interviewed five key informants and conducted ten in-depth interviews. Uptake was defined as completing three doses of the vaccine as per the recommended schedule. Prevalence risk ratios were used as measures of association and were computed using modified poison regression. Content analysis was used for qualitative data. RESULTS: The mean age of the respondents was 13.97 (SD=1.24). Uptake was at 17.61% (81/460). The factors associated with uptake of HPV vaccine were: attaining ordinary level of education (aPR 1.48, 95%CI 1.11–1.97), positive attitude towards the vaccine (aPR 3.46, 95%CI 1.70–7.02), receiving vaccine doses from different vaccination sites (aPR 1.59, 95% CI 1.10–2.28) and encouragement from a health worker (aPR 1.55, 95%CI 1.15–2.11) or Village Health Team (aPR 3.47, 95%CI 1.50–8.02) to go for the vaccine. Other facors associated with uptake of HPV vaccine included; the existence of community outreaches (aPR 1.47, 95%CI 1.02–2.12), availability of vaccines at vaccination sites (aPR 4.84, 95%CI 2.90–8.08) and receiving full information about the vaccine at the vaccination site (aPR 1.90, 95%CI 1.26–2.85). CONCLUSION: HPV vaccine uptake was low in Lira district. Efforts to improve uptake of HPV vaccine should focus on ensuring a consistent supply of vaccines at the vaccination sites, health education aimed at creating a positive attitude towards the vaccine, sensitisation of the adolescents about the vaccine and conducting community outreaches.</b><br/> text/html 2018-12-12T03:05:07+01:00 Rachid Boufettal, Driss Erguibi, Amal Hajri, Anass Idrissi, Saad Rifki Jai, Farid Chehab [Case report] - Chol&eacute;cystectomie laparoscopique sur situs inversus - 15 November 2018. <b>La coeliochirurgie est la technique de r&eacute;f&eacute;rence pour le traitement de la lithiase v&eacute;siculaire symptomatique. Jusqu’&agrave; ce jour, seuls 42 cas de chol&eacute;cystectomie laparoscopique chez des patients pr&eacute;sentant un situs inversus ont &eacute;t&eacute; publi&eacute;s. Ainsi, nous rapportons un nouveau cas d'un patient, suivi pour cardiopathie cong&eacute;nitale complexe &agrave; type de ventricule unique sur situs inversus et dextrocardie. C’est un patient qui &eacute;tait hospitalis&eacute; pour prise en charge chirurgicale de lithiase v&eacute;siculaire symptomatique. Une chol&eacute;cystectomie laparoscopique &eacute;tait r&eacute;alis&eacute;e. La disposition des trocarts et l’abord chirurgical &eacute;taient compl&egrave;tement inverses et sym&eacute;trique par rapport &agrave; l’abord laparoscopique normal.</b><br/> text/html 2018-12-12T03:05:07+01:00 Zineb Dahbi, Fouad Elmejjatti, Farid Naciri, Amine Guerouaz, Asmae Oabdelmoumen, Ali Sbai, Loubna Mezouar [Case series] - Les traitements du cancer de la vulve: exp&eacute;rience du Centre d’Oncologie d’Oujda - 15 November 2018. <b>Le cancer de la vulve est une affection n&eacute;oplasique rare, repr&eacute;sentant moins de 5% des cancers g&eacute;nitaux de la femme. L'objectif de ce travail est de d&eacute;crire le profil &eacute;pid&eacute;miologique, clinique, paraclinique, th&eacute;rapeutique et &eacute;volutif du cancer de la vulve chez la population de la r&eacute;gion l'oriental du Maroc, ceci &agrave; travers une analyse r&eacute;trospective de toutes les patientes suivies pour un cancer de la vulve, de Juin 2007 &agrave; Janvier 2014, et trait&eacute;es au sein de l'h&ocirc;pital d'oncologie du centre hospitalier universitaire Mohamed VI de Oujda au Maroc. Notre analyse r&eacute;trospective a port&eacute; des 34 patientes, d'une m&eacute;diane d'&acirc;ge de 65,7 ans, dont 52,9% &eacute;taient des multipares. Le motif de consultation dominant &eacute;tait le prurit dans 94.1% des cas. La moyenne du d&eacute;lai de consultation &eacute;tait de 16 mois, allant de 2 mois &agrave; 8 ans. L'ignorance et la pudeur ont &eacute;t&eacute; les causes majeures de ce retard diagnostique, puisque 73.5% des patientes avaient d&eacute;j&agrave; une maladie localement avanc&eacute;e au diagnostic. Le traitement chirurgical a &eacute;t&eacute; propos&eacute; &agrave; 61.4% des cas, il a consist&eacute; en une vulvectomie radicale avec un curage inguinal bilat&eacute;ral dans 68.5% des cas. Le recours &agrave; la radioth&eacute;rapie adjuvante a &eacute;t&eacute; indiqu&eacute; chez 41.2% des cas, 5.9% des patientes ont b&eacute;n&eacute;fici&eacute; d'une radioth&eacute;rapie n&eacute;o adjuvante, et 20,6% d'une radioth&eacute;rapie exclusive associ&eacute;e &agrave; une chimioth&eacute;rapie concomitante. La chimioth&eacute;rapie palliative a &eacute;t&eacute; propos&eacute;e pour 8.8% des patientes. Le taux de survie globale &agrave; 3 ans est &agrave; 65%, le taux de r&eacute;cidives locor&eacute;gionales ou &agrave; distance est de 17.3% des cas. Les particularit&eacute;s culturelles et sociales des patientes de la r&eacute;gion de l'oriental du Maroc, qui sont suivies pour un cancer de la vulve, sont des facteurs influen&ccedil;ant le traitement et ses r&eacute;sultats. Des efforts de pr&eacute;vention et de sensibilisation suppl&eacute;mentaires sont &agrave; mener afin de r&eacute;duire l'incidence des stades localement avanc&eacute;es, et de permettre un traitement curatif &agrave; cette population.</b><br/> text/html 2018-12-12T03:05:07+01:00 Adeseye Michael Akinsete, Chinyere Ezeaka [Research] - Prevalence and risk factors of asymptomatic bacteriuria among children living with HIV in Lagos, Nigeria - 14 November 2018. <b>INTRODUCTION: HIV/AIDS has gradually become a chronic disorder following the success of combination chemotherapy. As a result of the persisting immune deficiency, certain risk factors predispose affected individuals to infections. The aim of the study was to determine the prevalence and identify risk factors of asymptomatic bacteriuria among HIV infected children. METHODS: This was a case control study conducted at the Lagos University Teaching Hospital from July 2010 to June 2011. Eighty-five children living with HIV were consecutively selected from the HIV clinic of the Lagos University Teaching Hospital and compared with 85 age and sex matched HIV negative controls for the occurrence of asymptomatic bacteriuria. Mid-stream urine samples were obtained from the participants and the samples were analyzed for microscopy, culture and sensitivity. Demographic and clinical data was obtained from the caregivers and clinical notes respectively. Data were analyzed utilizing SPSS version 17.</b><br/> text/html 2018-12-12T03:05:07+01:00 Eweka Olutola Mary, Ogbenna Ann Abiola, Gbajabiamila Titilola, Ogundana Oladunni Mojirayo, Akanmu Alani Sulaimon [Research] - Prevalence of HIV related oral lesions in people living with HIV and on combined antiretroviral therapy: a Nigerian experience - 14 November 2018. <b>INTRODUCTION: Oral lesions comprise significant clinical features of HIV infection and are often indicators of immune suppression. However, the advent of antiretroviral therapy has significantly reduced its prevalence. The aim of this study was to relate the prevalence of oral lesions of HIV to treatment outcome of Combined Antiretroviral Therapy (cART) in a Nigerian HIV adult population. METHODS: A cross- sectional study was conducted on 491 People Living with HIV (PLWHIV) on cART from two HIV centres in Lagos state, Nigeria. The EC-clearing house guidelines were employed to categorise oral lesions. Presence or absence of these lesions was reconciled with CD4+ cell count as a measure of efficacy of cART treatment. RESULTS: A total of 491 PLWHIV on cART were enrolled, 366(74.5%) were females and 125(25.5%) were males. Age ranged between 18-80 years, with a mean of 41.2 ± 9.1 years. On examination, 12 (2.4%) patients presented with HIV oral lesions. Oral hyperpigmentation (10, 2.0%) was the most common lesion seen, followed by oral ulcers (2,0.4%). Majority (75%) of the affected patients were on a Lamivudine containing regimen. 7 out of the 12 patients with oral lesions had CD4+ cell count between 200-500 cell/mm<sup>3</sup> prior to cART initiation. Eleven (92%) of the patients with oral lesions had significant improvement of their CD4+ cell count after cART administration. CONCLUSION: The prevalence of oral lesions in HIV patients on cART therapy in Lagos is low. Oral hyperpigmentation and oral ulcers are the most frequent lesions seen. The presence or absence of oral lesions were not associated with CD4+ cell count. Therefore, we conclude that the oral lesions seen in HIV patients on cART may not be a direct manifestation of the disease.</b><br/> text/html 2018-12-12T03:05:07+01:00 Nora Naqos [Images in medicine] - Darier and Ferrand dermatofibrosarcoma of the breast - 14 November 2018. <b>Darier and Ferrand dermatofibrosarcoma (DFS) is a cutaneous mesenchymal tumor, rare, representing 0.1% of malignant skin tumors and less than 5% of adult soft tissue sarcomas. The favorite sites are the trunk, followed by the extremities proximal then the head and neck. It often occurs in patients in their 3rd-4th diecades and presents clinically as plate or nodule lesion. It is a tumor with intermediate malignancy potential, good prognosis after complete resection, slow growth, very high risk of local reccurence, but with low metastatic potential. Due to its rarity, very few studies have been devoted to it. We report an exceptional localization revealed by a mass in the breast. It is a 43-years-old patient who has consulted for an increase in the volume of the right breast, the clinical examination finds a mass ulcero-budding of 12cm/10cm. The biopsy shows the presence of an histiocytofibroma, a mastectomy was performed, and the histopathological examination with immunohistochemistry showed an intense and diffuse CD34 positivity, a focal positivity of AML (smooth muscle actin) and a constant negativity of desmin and PS100 thus confirming that it is a DFS. CT scan does not find any metastasis and a surveillance was adopted. It is a rare tumor and our observation is among of the first cases of mammary siege described in the literature. The main treatment remains a large surgery with margins of resection of at least 4 to 5 cm, postoperative radiotherapy is advocated by second reccurence. Systemic chemotherapy is not recommended, rigorous clinical practice must be maintained, because of slow evolution and high reccurence of this tumor.</b><br/> text/html 2018-12-12T03:05:07+01:00 Babatunde Ajayi Olofinbiyi, Sogo Angel Olofinbiyi, Oladele Simeon Olatunya, Babatunde Olaniyi Rosiji, Rebecca Oluwafunke Olofinbiyi, Olunike Blessing Olofinbiyi, Olabode Oluwadare Akintoye, Oluwole Dominic Olaogun [Research] - Human immunodeficiency virus awareness and condom use among female adolescent prostitutes in Lagos, Nigeria - 14 November 2018. <b>INTRODUCTION: The cornerstone of HIV prevention among female adolescent prostitutes is awareness promotion complemented with advocacy on consistent and correct use of condom. The study aimed at reviewing HIV awareness and condom use among female adolescent prostitutes in Lagos communities, Nigeria. METHODS: it was a mixed-method study realized through a questionnaire-based survey and in-depth interviews of adolescent sex workers in Oyingbo and Yaba communities of Lagos State, Nigeria; conducted between 1<sup>st</sup> of April, 2014 and 30<sup>th</sup> of September, 2014. SPSS version 17.0 and content analysis were used in analyzing quantitative and qualitative data respectively. RESULTS: 97.3% had heard about HIV/AIDS; with 86.9% being tested for HIV in the preceding 6 months. While there was consistent use of male condom in 99.7% of the respondents, 90% had experience with the use of female condom, however, 95.5% would allow non- use of condom for higher financial reward. CONCLUSION: although the level of awareness of HIV/AIDS was high among the respondents, there is need to improve on the level of awareness and preventive strategies for HIV/AIDS, with more emphasis laid on the consistent and correct use of condom in this highly vulnerable class of people.</b><br/> text/html 2018-12-12T03:05:07+01:00 Salomon Bonsi Tchuandom, Thibau Flaurant Tchouangueu, Christophe Antonio-Nkondjio, Abel Lissom, Jean Olivier Ngono Djang, Etienne Philemon Atabonkeng, Assumpta Kechia, Godwin Nchinda, Jules-Roger Kuiate [Research] - Seroprevalence of dengue virus among children presenting with febrile illness in some public health facilities in Cameroon - 13 November 2018. <b>INTRODUCTION: A routine diagnosis of dengue virus (DENV) infection is not usually conducted in hospitals. Because symptoms overlap, many potential febrile illnesses due to DENV may be confused for malaria, typhoid or paratyphoid (enteric) fever. The absence of data on DENV exposure rates among children attending health facilities could undermine management of this disease. This study aimed to investigate the seroprevalence of dengue virus infection in children presenting febrile illness in some public health facilities in Cameroon. METHODS: a cross-sectional study was performed in children &#8804; 15 years attending seven urban and three semi-urban public hospitals of Cameroon. From each volunteer, 2ml of whole blood was collected and tested for dengue virus IgM, malaria (Pf/Pan antigens) and enteric fever (Typhoid IgM) using rapid diagnostic tests (RDT); in order to allow the healthcare workers to quickly put the positive cases under appropriate treatment. Positive cases of dengue virus infection were confirmed by indirect ELISA. Data analysis were performed using the statistical package for social sciences software, version 22.1. RESULTS: a total of 961 children were enrolled in the study and 492 (51.2%) were infected with at least one of the three pathogens. Overall, DENV IgM seroprevalence among febrile children was 14.4% (138/961). About 390 (40.6%) and 22 (2.3%) had malaria (Pf/Pan Ag) and enteric fever (Typhoid IgM) respectively. Co-infection with dengue virus was found in 51 (5.3%) participants. The dengue virus IgM seroprevalence was higher in Bankim (19.3%), Ntui (18.3%) and Douala (18.2%). CONCLUSION: dengue virus infection seroprevalence appears to be low in children presenting with febrile illness in the studied health centres in Cameroon but call for more attention and research to further characterise the circulating strains of the dengue virus.</b><br/> text/html 2018-12-12T03:05:07+01:00 Wadu Wolancho Debancho, Abraham Tamirat Gizaw, Fira Abamecha Ababulgu [Research] - Lactating mothers’ perception toward diarrheal disease in Mizan-Aman District, South-West Ethiopia: mixed study design - 13 November 2018. <b>INTRODUCTION: Acute diarrheal diseases are the leading cause of preventable death, especially among children under-five in developing countries. Worldwide and nationwide diarrheal disease is the second leading cause of death in under-five year children. Therefore, the aim of this study is to assess perception of lactating mothers' toward diarrheal disease in Mizan-Aman District, South-West Ethiopia. METHODS: community based cross-sectional quantitative study supplemented by qualitative study. A total of 383 selected households with the lactating mothers were involved in the study. Data was collected through face-to-face interview technique by trained data collectors. Data was entered and analyzed using SPSS version 20. Multiple logistic regressions analysis was used to identify the independent predictors. Odds ratio, with 95% confidence level and P < 0.05 were used to determine statistically significant association. RESULTS: the majority of the respondents had primary education (44.4%) and from rural area (52.2%). Multiple logistic regression analysis showed that past experience of diarrheal disease at household had association with residence AOR = 4.79(1.33,7.78), educational status AOR = 0.72(0.55,1.29, Wealth index AOR = 8.9(0.99,17.45), knowledge AOR = 2.34(1.2-4.3). Perceived susceptibility AOR = 0.44 (0.33,11.33) and perceived severity of their child to diarrheal disease AOR 0.24CI (1.23,7.99). CONCLUSION: lactating mothers' perceptions toward their child probability of getting diarrheal disease and danger of the disease with primary education and above protected their children against diarrhea better than mothers with no education. Thus, implementing effective educational programs that emphasize on the benefit of complying with nationally recommended practice to prevent diarrheal disease is important to reduce the risk.</b><br/> text/html 2018-12-12T03:05:07+01:00 Djingri Labodi Lompo, Ouss&eacute;ini Diallo, Ben Aziz Dao, Romaric Bassole, Christian Napon, Jean Kabore [Research] - Etiologies of non-genetic epilepsies of child and adolescent, newly diagnosed in Ouagadougou, Burkina Faso - 13 November 2018. <b>INTRODUCTION: In sub-Saharan Africa, epilepsy is common and mainly concerns children before the age of 15 years. The data on childhood epilepsy is parcel, but a high prevalence of non-genetic epilepsy is frequently reported. EEG, TDM and MRI devices are rare. The aim of this work was to study the etiological aspects of non - genetic epilepsy of the child and adolescent, newly diagnosed in Ouagadougou, Burkina Faso. METHODS: this was a cross-sectional, descriptive, multicentric study, from 01/01/2016 to 31/12/2016, involving patients aged 0 to 18 years old, epileptic, newly diagnosed, in the city of Ouagadougou. Each patient included in the study was to have had an EEG and brain CT scan and/or brain MRI and to gather the anamnestic and electro clinical arguments for non-genetic epilepsy. Sociodemographic, clinical, EEG and neuroradiological data were analyzed. An univariate analysis was used to determine the electro-clinical and neuro-radiological characteristics associated with epilepsies of structural causes. RESULTS: in all 115 patients were collected, with an average age of onset of epilepsy of 8.2 years, a male predominance with a sex ratio to 1.67. Risk factors of epilepsy was present in 74.8%; They were dominated by perinatal events in 79.1%. Focal seizures, daily frequency of these seizures and focal epilepsy, were predominant, respectively in 53%, 58% and 60.9% of cases. Brain scan and Brain MRI where performed in 90.4% and 9.6% of patients, respectively. The brain sequelaes of perinatal adverse events, the sequelae of central nervous system infections, and the sequelae of cranial and brain trauma, with 34.8%, 14.8%, and 5.2% respectively, were the main causes of non- genetic epilepsies of the child and adolescent. No cause was identified in 37.4% of cases. CONCLUSION: the improvement of policies in the field of maternal and child health and the generalization of the control of infectious and parasitic diseases, including malaria, may contribute to the reduction of non-genetic epilepsy in sub-Saharan Africa.</b><br/> text/html 2018-12-12T03:05:07+01:00 Christine Princess Cole, Philip Routledge [Research] - An evaluation of rational prescribing in hospital outpatient practice in Sierra Leone and assessment of affordability of a prescription as an outcome - 13 November 2018. <b>INTRODUCTION: Medicines are the most frequently used intervention in healthcare. Rational and cost-effective prescribing is especially important in countries where access to effective medicines may be challenged by affordability issues. This study describes the prescribing patterns of doctors in government hospitals in Freetown, Sierra Leone, considering the scope for rationalising prescribing and reducing cost to the patient. METHODS: A descriptive, retrospective, cross-sectional study was conducted at four hospitals, using selected World Health Organisation (WHO) indicators applied to 600 prescriptions, after systematic random sampling. The data was analysed using SPSS.16 and the Index of Rational Drug Prescrib-ing (IRDP) calculated. The Spearman's rank coefficient was used to examine possible associations between the number of medicines prescribed as generics and from the National Essential Medicines List (NEML) and cost of the prescription respectively. Affordability was determined from the average number of days of work required to purchase a prescription, based on the minimum wage of the lowest paid government worker in Sierra Leone. RESULTS: The mean number of medicines per prescription from the four hospitals was 4.37(range 4.18-4.56) with 57% prescribed generically and 64% from the NEML. An antibiotic and injection were found on 72% and 26% of prescriptions respectively. The overall IRDP was 2.65/5. The aver-age cost per prescription was Le. 29,376.30 ($6.78), equivalent to 43 days of work of the lowest paid government worker. CONCLUSION: In this study, opportunities were identified for significant rationalisation and improvement in cost-effective prescribing.</b><br/> text/html 2018-12-12T03:05:07+01:00 Germaine Tuyisenge, Celestin Hategeka, Ruben Alba Aguilera [Research] - Should condoms be available in secondary schools? Discourse and policy dilemma for safeguarding adolescent reproductive and sexual health in Rwanda - 13 November 2018. <b>INTRODUCTION: As a response to challenges associated with adolescent reproductive and sexual health, policy makers in Rwanda have instituted preventive measures against risky sexual behaviours among adolescents. There is an ongoing debate on whether condoms should be made available in secondary schools to minimise risks related to unprotected sex in the context of a growing number of unplanned pregnancies among school girls. This paper aims to examine the proposal of condom provision in Rwandan secondary schools through the analysis of policy narratives and the claims-making process. METHODS: a narrative policy analysis was used to understand the claims and counter claims surrounding the debate on the provision of condoms in secondary schools. Documents that were consulted include: the national reproductive health policy, the girls' education policy, the national behaviour change and communication policy for the health sector, the Rwanda national policy on condoms, the adolescent sexual reproductive health and rights policy and the Rwanda family planning policy. RESULTS: social and cultural norms in the Rwandan context consider adolescent sexual practices as immoral and thus reject the idea of providing condoms in secondary schools. However, some stakeholders promoting reproductive health suggest that ignoring that some adolescents are sexually active will prevent them from accessing appropriate reproductive and sexual health protective programmes. Consequently, adolescents will be exposed to risky sexual behaviours, a situation which may be counter productive to the overarching goal of safeguarding adolescent sexual health which might impact their long-term education goals. CONCLUSION: making condoms available in secondary schools evokes different meanings among the debaters, underscoring the complex nature of the condom provision debate in Rwanda. This paper calls for a revision of policies related to adolescent reproductive and sexual health in order to answer to the issues of risky sexual behaviours among secondary school students.</b><br/> text/html 2018-12-12T03:05:07+01:00 Rama Djouedjon Dakenyo, Bruno Kenfack, Noel Vogue, Eva Fomo Tsakoue, Maurice Ela Ebode, Samuel Nambile Cumber [Research] - Connaissances, attitudes et pratiques des femmes en &acirc;ge de procr&eacute;er du District de Sant&eacute; de la Mifi sur la pr&eacute;vention du cancer du col de l’ut&eacute;rus, Cameroun - 12 November 2018. <b>INTRODUCTION: D&eacute;crire les connaissances, les attitudes et les pratiques des femmes en &acirc;ge de procr&eacute;er sur la pr&eacute;vention du cancer du col de l’ut&eacute;rus. METHODES: Il s’est agi d’une &eacute;tude transversale descriptive men&eacute;e chez les femmes en &acirc;ges de procr&eacute;er. Les donn&eacute;es ont &eacute;t&eacute; collect&eacute;es face &agrave; face &agrave; l’aide d’un questionnaire. L’analyse a &eacute;t&eacute; faite par &eacute;pi info version avec un intervalle de confiance de 95%. RESULTATS: Il ressort de notre &eacute;tude que 78.11%(464/594) de femmes connaissaient l’existence du cancer du col de l’ut&eacute;rus. Mais 58,59% et 60,27% de femmes ne connaissaient aucun facteur de risque et moyen de pr&eacute;vention respectivement. Seulement 7% connaissent l’existence d’un vaccin. Concernant l’attitude, 31,31% (186/594) avaient d&eacute;j&agrave; d&eacute;sir&eacute; les informations sur la pr&eacute;vention du cancer du col de l’ut&eacute;rus, 26,94% (160/594) ont eu l’initiative de faire le test de d&eacute;pistage et seulement 7,41% (44/594) ont fait le d&eacute;pistage. Les difficult&eacute;s &eacute;voqu&eacute;es &eacute;taient principalement le manque d’information 69,82% et le moyen de sensibilisation le plus fr&eacute;quemment cit&eacute; &eacute;tait les medias 75,9%. CONCLUSION: Malgr&eacute; le bon niveau de connaissance sur l’existence du cancer du col de l’ut&eacute;rus, le niveau d’information sur les facteurs de risque et les moyens de pr&eacute;vention restent faibles. Le programme de sensibilisation devait &ecirc;tre ax&eacute; sur les facteurs de risque, les moyens de pr&eacute;vention et l’organisation des campagnes de d&eacute;pistage. Ces informations peuvent permettre d’am&eacute;liorer la planification des interventions de pr&eacute;vention.</b><br/> text/html 2018-12-12T03:05:07+01:00 Nadia Bouchemla, Abderrahim Nadri, Meriem Chettati, Wafaa Fadili, Inass Laouad [Images in medicine] - Insuffisance r&eacute;nale r&eacute;v&eacute;lant un my&eacute;lome multiple avec des l&eacute;sions radiologiques historiques - 12 November 2018. <b>Il s'agit d'une patiente &acirc;g&eacute;e de 54 ans, admise pour insuffisance r&eacute;nale s&eacute;v&egrave;re. Elle a pr&eacute;sent&eacute; une dyspn&eacute;e stade II &eacute;voluant depuis un mois avec des douleurs thoraciques et douleurs osseuses associ&eacute;es &agrave; une anurie. L'examen clinique a retrouv&eacute; une hypertension &agrave; 160/80mmHg, un syndrome glom&eacute;rulaire avec 2+ de prot&eacute;ine, 2+ de sang et une diur&egrave;se &agrave; 300cc. L'examen pleuro-pulmonaire a montr&eacute; des rales cr&eacute;pitants basithoraciques bilat&eacute;raux. Sur le plan biologique, on a mis en &eacute;vidence une insuffisance r&eacute;nale s&eacute;v&egrave;re &agrave; 107mg de cr&eacute;atinine, ur&eacute;e &agrave; 1.65g/l,une hyperkali&eacute;mie &agrave; 7.8mmol/l, CRP &agrave; 78mg/l, une an&eacute;mie normochrome normocytaire avec une Hb &agrave; 5.7g/dl et une hyperleucocytose &agrave; 13570 sans thrombop&eacute;nie. Elle avait une hyperprotid&eacute;mie &agrave; 144g/l, une normoalbumin&eacute;mie &agrave; 33g/l, une hypercalc&eacute;mie &agrave; 116g/l et une hyperphosphor&eacute;mie &agrave; 120mg/l. L'&eacute;lectrophor&egrave;se des prot&eacute;ines s&eacute;riques a objectiv&eacute; un pic monoclonal de gammaglobulines &agrave; 60g/l avec &agrave; l'immuno-&eacute;lectrophor&egrave;se des prot&eacute;ines plasmatiques une gammapathie de type IgG kappa. La recherche de la prot&eacute;ine de Bence Jones &eacute;tait n&eacute;gative. Le my&eacute;logramme a montr&eacute; une plasmocytose &agrave; 10%. Sur le plan radiologique, de multiples g&eacute;odes &agrave; l'emporte pi&egrave;ce ont &eacute;t&eacute; visualis&eacute; sur la radiographie du crane de profil r&eacute;alisant un aspect historique. La patiente a &eacute;t&eacute; mise sous protocole CDT1 &agrave; base de dexam&eacute;thazone, thalidomide 100mg et endoxan orale.</b><br/> text/html 2018-12-12T03:05:07+01:00 Idris Abiodun Adedeji, Mohammed Faruk Bashir, David Danjuma Shwe, Collins John [Research] - Prevalence and correlates of stunting among the school-age population in North-Central Nigeria - 09 November 2018. <b>INTRODUCTION: Stunting remains a huge public health concern among developing Nations. However, the burden of this problem among the school-age population appears to have been eclipsed by most nutritional surveys that focus more on the under-fives. This study aimed to demonstrate the prevalence, and identify socio-demographic factors that are associated with stunting among the school-age children in North central Nigeria. METHODS: This was a descriptive cross-sectional study that involved 450 pupils, aged 6-12 years from 10 randomly selected primary schools in Jos, Plateau state. Anthropometric indices were measured using standard techniques and the Height-for-age z-scores were generated using the WHO Anthroplus software. Socio-demographic details were obtained using semi-structured questionnaires. Data were analysed using EPI infoTM statistical software RESULTS: The mean age of the subjects was 9.3 ± 1.8 years and the male to female ratio was 1:1.1. The prevalence of stunting was 10.5%. The prevalence of stunting was significantly higher among pupils that attended public schools (p<0.0001), those whose mothers had less than secondary level of education (p=0.0427), those between the ages of 10-12 years (p<0.0001), those from the lower socio-economic class (p=0.0021), and those whose family sizes were larger than six family members (p=0.0063). CONCLUSION: The substantial burden of stunting among the school age population has significant correlation with certain socio-demographic factors. Addressing these factors by alleviating poverty, promoting maternal literacy and encouraging family planning may, perhaps, lessen the burden of stunting among the school-age group in Northern Nigeria.</b><br/> text/html 2018-12-12T03:05:07+01:00 Somnoma Jean-Baptiste Tougouma, Yibar Kambir&eacute;, Jonas Bado, Aim&eacute; Ars&egrave;ne Yam&eacute;ogo, T&eacute;n&eacute; Marceline Yam&eacute;ogo, Samba Sidib&eacute;, Carole Gilberte Kyelem, Alassane Ilboudo, Macaire Ou&eacute;draogo [Case series] - Electrocardiographie coupl&eacute; &agrave; l’&eacute;chocardiographie transthoracique de repos dans le diagnostic des atteintes cardiaques chez le diab&eacute;tique de type 2: les enseignements d’une s&eacute;rie transversale au Burkina Faso - 09 November 2018. <b>Le diab&egrave;te est un puissant facteur de risque cardio-vasculaire ind&eacute;pendant. Les auteurs se proposent de d&eacute;crire les anomalies &eacute;lectrocardiographiques et &eacute;chocardiographiques observ&eacute;es chez les diab&eacute;tiques de type 2 suivis dans le d&eacute;partement de m&eacute;decine du CHUSS. Une &eacute;tude transversale descriptive a &eacute;t&eacute; r&eacute;alis&eacute;e d’avril &agrave; septembre 2014 incluant tous les diab&eacute;tiques de type 2 consentants. Tous ont b&eacute;n&eacute;fici&eacute; d’un recueil de donn&eacute;es cliniques, d’une &eacute;lectrocardiographie et d’une &eacute;chocardiographie doppler. Un total de 155 diab&eacute;tiques a &eacute;t&eacute; enqu&ecirc;t&eacute;. L’&acirc;ge m&eacute;dian de la population &eacute;tait de 55 ans (IIQ: 47-64) &agrave; pr&eacute;dominance f&eacute;minine (Sex ratio 0,5). Les anomalies &eacute;lectrocardiographiques &eacute;taient repr&eacute;sent&eacute;es par les troubles de la repolarisation (31%) et les troubles du rythme auriculaire (16,12%). Sur le plan &eacute;chocardiographique, l’hypertrophie du ventricule gauche (VG) &eacute;tait rapport&eacute;e dans 20,64%. L’oreillette gauche &eacute;tait dilat&eacute;e dans 14,19%, une dilatation VG dans 1,3% des cas. Une alt&eacute;ration de la fraction d’&eacute;jection VG &eacute;tait not&eacute;e dans 3,87% des cas. Les entit&eacute;s nosologiques &eacute;taient repr&eacute;sent&eacute;es par la cardiomyopathie hypertensive dans 27 cas (54%), la cardiopathie isch&eacute;mique dans 19 cas (38%), la cardiomyopathie dilat&eacute;e dans 2 cas (4%) et la cardiomyopathie diab&eacute;tique dans 2 cas (4%). L’insuffisance cardiaque &eacute;tait not&eacute;e dans 22 cas (44%) ind&eacute;pendamment de l’atteinte cardiaque pr&eacute;sent&eacute;e. Les anomalies &eacute;lectrocardiographiques et &eacute;chocardiographiques sont fr&eacute;quentes dans la population de diab&eacute;tique de type 2 au CHUSS de Bobo-Dioulasso. Une meilleure collaboration entre cardiologues et diab&eacute;tologues et la mise en place d’un plateau technique ad&eacute;quat de d&eacute;pistage serait un pr&eacute;alable pour une meilleure stratification du risque cardiaque dans cette population.</b><br/> text/html 2018-12-12T03:05:07+01:00 Samuel Ajayi, Adewole Adebiyi, Solomon Kadiri [Research] - Increased urinary sodium excretion is associated with systolic blood pressure in first degree relatives of hypertensive patients in Ibadan, Southwestern Nigeria - 09 November 2018. <b>INTRODUCTION: Understanding the risk factors of hypertension has led to a better understanding of the pathogenesis, prevention and reduction in morbidity of hypertension. It is well known that offsprings of hypertensive parents have an increased risk of developing hypertension. It is therefore necessary to explore the physiological differences between normotensive patients with and without a positive family history of hypertension with respect to their urinary excretion of sodium. METHODS: This study was carried out at the University College Hospital, Ibadan Nigeria, to determine if normotensive patients with a positive family history of hypertension are different with respect to their urinary excretion of electrolytes and blood pressure. It examined the relationship between 24-hour urinary excretion of sodium, chloride and potassium, urea and creatinine and blood pressure in subjects with and without family history of hypertension. It was a case-control study of sixty-two subjects: normotensive patients first degree relatives of primary hypertensive patients and normotensive patients without positive family history. RESULTS: the mean (SD) systolic blood pressures for subjects with and without family history of hypertension were significantly different: 120.0(22.25) and 105.0(17.50) respectively, (p = 0.001). The mean arterial blood pressures were significantly different: 86.4(10.2) mmHg and 80.1(8.1) mmHg respectively (p=0.010). The mean (SD) 24-hour urinary excretion of sodium for normotensive patients with and without positive family history of hypertension were 180.5 (45.50) mEq/L, and 156.0(36.25) mEq/L respectively. Systolic blood pressure and 24-hour urinary excretion of sodium was also higher in normotensive subjects with a positive family history of hypertension. CONCLUSION: Systolic blood pressure and twenty-four hour urinary excretion of sodium were higher in normotensive subjects with a positive family history of hypertension than in those without a family history of hypertension.</b><br/> text/html 2018-12-12T03:05:07+01:00 Aymar Pierre Gildas Oko,Fay&ccedil;al Khalil Zaharo Ali, Steve Vassili Missambou Mandilou, Judica&euml;l Kambourou, Lombet Letitia, Jesse Pierre Yolaine Poathy,Moyen Engoba, Mamadou Ildevert Cyriaque Ndjobo, Henri Germain Monabeka, Georges Marius Moyen [Research] - Acidoc&eacute;tose diab&eacute;tique chez l’enfant: aspects &eacute;pid&eacute;miologiques et pronostiques - 09 November 2018. <b>INTRODUCTION: Au Congo, les donn&eacute;es concernant l’acidoc&eacute;tose diab&eacute;tique (ACD) chez l’enfant sont anciennes et rares. Notre &eacute;tude avait pour objectifs de d&eacute;crire les caract&eacute;ristiques sociod&eacute;mographiques de l’ACD et d’identifier les facteurs de risque de d&eacute;c&egrave;s. METHODES: De janvier 2013 &agrave; juin 2016, nous avons r&eacute;alis&eacute; une &eacute;tude analytique portant sur l’ACD chez l’enfant au CHU de Brazzaville. Les variables sociod&eacute;mographiques, cliniques, paracliniques et &eacute;volutives ont &eacute;t&eacute; &eacute;tudi&eacute;es. Les tests de Chi-2, de Fischer et l’odds ratios ont servi pour l’analyse univari&eacute;e et le mod&egrave;le de r&eacute;gression logistique pour l’analyse multivari&eacute;e. RESULTATS: Sur 172 enfants hospitalis&eacute;s pour un diab&egrave;te, 55(31%) l’&eacute;taient pour une acidoc&eacute;tose. Il s’agissait de 33(60%) filles, l’&acirc;ge moyen : 11,1± 4,9 ans (extr&ecirc;mes 1 mois et 17 ans), 61,8% des parents avaient un bas niveau socio&eacute;conomique. L’acidoc&eacute;tose &eacute;tait r&eacute;v&eacute;latrice dans 67,2 % de cas. Le diagnostic avant l’hospitalisation &eacute;tait erron&eacute; : 50%. Le facteur d&eacute;clenchant &eacute;tait souvent infectieux (52,7%). La l&eacute;talit&eacute; &eacute;tait de 12,7%. Les facteurs de risque de d&eacute;c&egrave;s en analyse univari&eacute;e &eacute;taient : l’&acirc;ge < 5 ans (p=0,000006), le d&eacute;lai de consultation sup&eacute;rieur &agrave; 7 jours (p= 0,001), la d&eacute;shydratation s&eacute;v&egrave;re (p = 0,0006), les troubles h&eacute;modynamiques (p= 0,0006), la d&eacute;nutrition s&eacute;v&egrave;re (p= 0,02), le Glasgow < 9 (p= 0,007) et la diarrh&eacute;e (p= 0,001). CONCLUSION: L’importance et la gravit&eacute; de l’acidoc&eacute;tose imposent des mesures de pr&eacute;vention ax&eacute;es sur la sensibilisation, l’information, l’&eacute;ducation et la ma&icirc;trise des facteurs de risque de d&eacute;c&egrave;s.</b><br/> text/html 2018-12-12T03:05:07+01:00 Job Kisuya, Alex Chemtai, Evans Raballah, Wilson Okumu, Alfred Keter, Collins Ouma [Research] - The role of mycobacterium tuberculosis antigen specific cytokines in determination of acid fast bacilli culture status in pulmonary tuberculosis patients co-infected with human immunodeficiency virus - 08 November 2018. <b>INTRODUCTION: The interaction between Mycobacterium Tuberculosis and HIV leads to rapid progression of tuberculosis (TB) and human immunodeficiency virus (HIV)-induced immunosuppression. Diagnosis of TB in these patients is more difficult due to its atypical presentations giving contradicting results. The overall aim of this study was to evaluate the ability of pro-inflammatory cytokine (Th1) and anti-inflammatory cytokine (Th2) to discriminate between culture-positive and -negative smear status in HIV-TB co-infected patients. METHODS: in a prospective cohort, a total of 86 study participants were recruited: 46 culture-negative and 40 culture-positive. Blood and sputum samples were collected from all participants. The blood was then analyzed using FACSCalibur flow cytometer to immunophenotype the cells and ELISA performed for cytokine profiles. Sputum samples were analyzed to determine smear status using direct microscopy and Lowenstein Jensen medium. Statistical analyses were performed using R software. Independent samples t-test was used to compare means between the two groups, while the medians were compared using two-sample Wilcoxon rank sum test. Pearson's Chi-square test was used to compare the proportion of male and female participants across the culture and AFB smear status. In order to determine the predictive power of Th1 and Th2 in discriminating Pulmonary Tuberculosis status (PTB) (culture status was used as a confirmatory test), binary logistic regression models were fitted for Th1 covariates [IFN-³, TNF-±, IL-2 and IL-12(p70)] and Receiver Operating Characteristic (ROC) curves plotted. RESULTS: the overall mean age of the participants was 39 years (SD=12), 42% being male. Although, lymphocytes counts were higher in culture-positive relative to culture-negative, the CD8, CD19, and CD16/CD56 were comparable in the two groups. The CD4 counts differed between the two groups (P=0.012). The Th1 showed a better discrimination between culture-positive and -negative PTB individuals; IFN-³ (P=0.001), TNF-± (P=0.001), IL-2 (P=0.001) and IL-12(p70) (P=0.016). The Th2 cytokines (IL-4, IL-6 and IL-10) were comparable between the culture-positive and -negative groups. However, when the combination of Th1 cytokines [IFN-³, TNF-±, IL-2 and IL-12(p70)] was fitted in binary logistic regression models, the predictive power was high with area under curve (AUC) being 89.7% in discriminating PTB. CONCLUSION: this study provides evidence for the ability of a combination of Th1 cytokines in discriminating against culture-positive and culture-negative PTB.</b><br/> text/html 2018-12-12T03:05:07+01:00 Erick Alexander Mboya,Leah Anku Sanga, James Samwel Ngocho [Research] - Irrational use of antibiotics in the Moshi Municipality Northern Tanzania: a cross sectional study - 08 November 2018. <b>INTRODUCTION: Irrational use of antibiotics includes prescription of incorrect doses, self-medication and treatment of non-bacterial illness. As a direct consequence of irrational antibiotic use, resistance to the commonly available antibiotics has been increasing rapidly. This phenomenon is associated with poorer health outcomes, longer hospitalization, increased cost to both the patient and government, and increased mortality. The aim of this study was to determine the prevalence of, and examine factors associated with, irrational use of antibiotics in the Moshi municipality, Northern Tanzania. METHODS: we conducted a cross-sectional descriptive study between April and May 2017 in the Moshi municipality. Twelve drug outlets, of which five were pharmacies and seven accredited drug dispensing outlets (ADDOs), were selected at random. On exiting these outlets, all adults who had purchased antibiotics were interviewed using structured questionnaires. RESULTS: A total of 152 adults were enrolled in this study. The median (QR) age was 31 years (25-42). The majority, 94 (61.8%), of the participants were female. ADDOs contributed 81 (53.3%) and pharmacies contributed 71 (46.7%) of all participants. Overall, 135 (88.8%) of antibiotic purchases were irrational. The most prevalent form of irrational antibiotic use was non-prescription usage; 116 of the 152 (76.3%) purchases fell in this category. Purchases of the incomplete dosage and purchases for non-bacterial illness were also widespread. Poor knowledge about the use of antibiotics had a significant association with irrational use of antibiotics (aOR=5.1, 95% CI: 1.80-15.15). CONCLUSION: Irrational use of antibiotics is highly prevalent in this population. Non-prescription use of antibiotics is the most prevalent form. Poor knowledge about antibiotic use plays a significant role in irrational antibiotic use. There is a need to review the accessibility of antibiotics in drug outlets.</b><br/> text/html 2018-12-12T03:05:07+01:00 St&eacute;phane M&eacute;o Ikama, Bijou Moualengue, Jospin Makani, Solange Flore Mongo-Ngamami, Bertrand Ellenga-Mbolla, Igor Ondze-Kafata, Christian Kouala-Landa, Thierry Raoul Gombet, Gis&egrave;le Kimbally Kaky [Case series] - Profil &eacute;pid&eacute;mio-clinique et &eacute;volutif des cardiomyopathies dilat&eacute;es au Centre Hospitalier Universitaire de Brazzaville, Congo - 07 November 2018. <b>L'objectif de cette &eacute;tude est de contribuer &agrave; l'am&eacute;lioration de la prise en charge des patients porteurs de cardiomyopathies dilat&eacute;es (CMD) &agrave; Brazzaville. Cette &eacute;tude prospective et analytique, a &eacute;t&eacute; r&eacute;alis&eacute;e au CHU de Brazzaville entre le 1er Janvier 2014 et le 30 Juin 2015. Elle a inclus les patients hospitalis&eacute;s dans le service de cardiologie pour une insuffisance cardiaque (IC) en rapport avec une CMD. L'&eacute;tude a port&eacute; sur 100 patients. La fr&eacute;quence hospitali&egrave;re de la CMD &eacute;tait de 32,1%. Il s'agissait de 38 hommes (38%) et 62 femmes (62%), &acirc;g&eacute;s en moyenne de 52,9 ± 17,1 ans. L'IC &eacute;tait globale dans 72 cas (72%). L'ECG s'inscrivait en rythme sinusal (95%), et objectivait une hypertrophie ventriculaire gauche (40%), un bloc de branche gauche (16%), et une fibrillation auriculaire (5%). La fraction d'&eacute;jection du ventricule gauche (VG) &eacute;tait en moyenne de 33,4 ± 6,8%, et le diam&egrave;tre t&eacute;l&eacute;diastolique du VG de 65,5 ± 7,0 mm. Le traitement comportait un diur&eacute;tique de l'anse (100%), un IEC/ARA2 (100%), un b&ecirc;tabloquant (38%), un digitalique (30%), un anti-aldost&eacute;rone (16%), et un anti-vitamine K (11%). Au terme d'un suivi de 12 mois, le taux de l&eacute;talit&eacute; globale &eacute;tait de 9%, le taux de r&eacute;hospitalisation de 12%, et le taux de perdus de vue de 41%. cette &eacute;tude a montr&eacute; que la CMD est une affection fr&eacute;quente, et une des principales causes d'insuffisance cardiaque. La dur&eacute;e de suivi br&egrave;ve et le nombre important de perdus de vue ne permettent pas d'en &eacute;valuer la survie dans notre contexte.</b><br/> text/html 2018-12-12T03:05:07+01:00 Evi Susanti Sinaga, Riris Andono Ahmad, Siddharudha Shivalli, Susanna Hilda Hutajulu [Research] - Age at diagnosis predicted survival outcome of female patients with breast cancer at a tertiary hospital in Yogyakarta, Indonesia - 07 November 2018. <b>INTRODUCTION: Breast cancer is the most common cancer in women in Indonesia. Patients’ survival depends on various factors, namely patient-, tumor-, and treatment-related factors. Survival analysis on Indonesian patients has only been reported in a few studies. This study aimed to identify the factors that are associated with five-year overall survival (OS) among patients with breast cancer at a local tertiary hospital in Indonesia. METHODS: A retrospective cohort study was conducted at Dr Sardjito Hospital, Yogyakarta. Female patients diagnosed with breast cancer between January and December 2009 were studied. Socio-demographic and clinicopathological data were collected from the medical and pathological records. The five-year OS rate was assessed using Kaplan Meier method and prognostic factors were analyzed using Cox regression. RESULTS: A total of 213 eligible patients with breast cancer were recruited. The five-year OS probability of the breast cancer patient was 51.07%. The majority of the patients (151, 70.9%) presented an advanced stage at the time of diagnosis. In the bi-variable analysis, cases who were younger, of a lower educational status, at a more advanced stage, with a bigger tumor size, and a central tumor location showed a worse five-year OS compared to their counterparts (p = 0.005, 0.001, 0.004, 0.011, and 0.023, respectively). In the multivariable analysis, age was an independent predictor for the OS (HR = 3.73; 95% CI = 1.0-13.6, p = 0.046). CONCLUSION: The five-year OS of breast cancer patients in the local tertiary hospital was 51.07%. The patients’ age at diagnosis was the only significant prognostic factor for the patients’ survival.</b><br/> text/html 2018-12-12T03:05:07+01:00 Doumbia Amadou, Kon&eacute; Youssouf, Ma&iuml;ga Oumou, Kon&eacute; Abdoulaye, Diarra Br&eacute;hima, Demb&eacute;l&eacute; Adama, Diallo Mamahadou [Case report] - Cavernomatose c&eacute;r&eacute;brale sporadique r&eacute;v&eacute;l&eacute;e par une crise convulsive: &agrave; propos d’un cas - 02 November 2018. <b>La cavernomatose c&eacute;r&eacute;brale est une pathologie rare pouvant &ecirc;tre sporadique ou familiale autosomique dominante. Elle est caract&eacute;ris&eacute;e par la pr&eacute;sence de cavernomes multiples du syst&egrave;me nerveux central. Souvent asymptomatique, la pathologie peut se r&eacute;v&eacute;ler par des sympt&ocirc;mes vari&eacute;s comme l’h&eacute;morragie c&eacute;r&eacute;bro-m&eacute;ning&eacute;e, les c&eacute;phal&eacute;es ou l’&eacute;pilepsie. Nous rapportons un cas de cavernomatose c&eacute;r&eacute;brale sporadique chez un patient de 55 ans sans ant&eacute;c&eacute;dent pathologique particulier r&eacute;v&eacute;l&eacute; par une crise d’&eacute;pilepsie. A travers cette observation et une revue de la litt&eacute;rature, nous faisons le point sur les aspects cliniques et radiologiques (scanner et IRM) de cette pathologie.</b><br/> text/html 2018-12-12T03:05:07+01:00 Benmoussa Amine, Lasri Najat, Tazi Ilias [Case report] - Epigastralgies r&eacute;v&eacute;lant un lymphome pancr&eacute;atique primitif &agrave; grandes cellule B chez un patient jeune: &agrave; propos d’un cas - 02 November 2018. <b>Le lymphome malin non hodgkinien (LMNH) primitif du pancr&eacute;as est une localisation extr&ecirc;mement rare des LMNH extraganglionnaires repr&eacute;sentant moins de 0,7% de tous les LMNH et moins de 0,5% des tumeurs malignes pancr&eacute;atiques, touchant essentiellement le sujet &acirc;g&eacute; et tr&egrave;s rarement le sujet jeune (l'int&eacute;r&ecirc;t de notre cas). Son diagnostic est difficile simulant cliniquement l'ad&eacute;nocarcinome de pancr&eacute;as et les pancr&eacute;atites chroniques. Nous rapportons le cas d'un patient de 25ans, suivi pour lymphome non hodgkinie (LNH) diffus &agrave; grandes cellules B de localisation pancr&eacute;atique primitive r&eacute;v&eacute;l&eacute; par des &eacute;pigastralgies avec ict&egrave;re foudroyant d'installation brutale dans un contexte d'alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral et diagnostiqu&eacute; sur une biopsie de la loge duod&eacute;no-pancr&eacute;atique. Le diagnostic et la prise en charge pr&eacute;coce de ces tumeurs agressives permettent d'am&eacute;liorer significativement leur pronostic.</b><br/> text/html 2018-12-12T03:05:07+01:00 Paul Kambale Kombi, Salomon Batina Agasa, Jean Paulin Mbo Mukonkole, Lucien Bolukaoto Bome, Camille Atoba Bokele, Charles Kayembe Tshilumba [Research] - Seroprevalence of hepatitis B and C virus infections among diabetic patients in Kisangani (North-eastern Democratic Republic of Congo) - 02 November 2018. <b>INTRODUCTION: The link between diabetes mellitus and hepatitis B and C Virus infections has not yet been studied in the Democratic Republic of Congo, a country where diabetes mellitus is a growing disease and the prevalence of hepatitis B and C viruses infections is high. The aim of this study was to determine the seroprevalence of these viruses in diabetic patients. METHODS: we conducted a descriptive cross-sectional study in diabetic subjects attending Kisangani University Clinics and General Hospitals of Kisangani City as well as the Diabetics Association of Oriental Province. The control group consisted of volunteer blood donors recruited from the Kisangani Provincial Blood Transfusion Center. Blood glucose was measured with the spectrophotometer; for hepatitis B and hepatitis C viruses serology, we used rapid test kits (Determine TM® HBsAg and Hexagon® HCV test) and ELISA if seropositivity by rapid tests. The analysis was done by SPSS software. RESULTS: seroprevalence of hepatitis C virus in diabetics was 24.8% compared to 1.9% in volunteer blood donors (p = 0.0000); that of hepatitis B virus was 3.4% versus 3.5% in volunteer blood donors (p = 0.906). Hepatitis C virus infection was more common in type 2 diabetics (p = 0.006) and significantly associated with age of diabetic patients (p = 0.002). CONCLUSION: the seroprevalence of hepatitis C virus and not hepatitis B virus infection is significantly high in diabetic subjects, particularly type 2 diabetics, in the Democratic Republic of Congo and suggests systematic screening for this infection in any diabetic patient.</b><br/> text/html 2018-12-12T03:05:07+01:00 Simon-Decap Mabakutuvangilanga Ntela, Nathalie Goutte, Jean-Manuel Morvillers, Cyril Crozet, Mathieu Ahouah, Marie-Claire Omanyondo-Ohambe, Bernard Ntoto-Kunzi, Félicien Tshimungu Kandolo, Monique Rothan-Tondeur [Research] - Observance to antiretroviral treatment in the rural region of the Democratic Republic of Congo: a cognitive dissonance - 02 November 2018. <b>INTRODUCTION: This study aimed to understand the influence of local media, religion and cultural beliefs on the therapeutic compliance of patients living with HIV. METHODS: This study was conducted in two rural hospitals in the Central Kongo province of the Democratic Republic of Congo. Semi-directional interviews were conducted with patients on antiretroviral therapy using a phenomenological qualitative method. RESULTS: Our results indicated that patients living with HIV in the rural region of the Democratic Republic of Congo are in a constant state of tension between the messages for compliance to antiretroviral treatment advocated by caregivers, and those broadcasted by audiovisual media, religious leaders and local beliefs. This dissonance constitutes a real barrier to therapeutic compliance. CONCLUSION: Collaborative strategies between healthcare providers, patients, as well as religious, media and traditional organizations are urgently needed.</b><br/> text/html 2018-12-12T03:05:07+01:00 Zakaria Chahbi, Bouchra Lahmar, Sanae El Hadri, Lahoussaine Abainou, Said Kaddouri, Hassan Qacif, Hicham Baizri, Mohamed Zyani [Case study] - The prevalence of painful diabetic neuropathy in 300 Moroccan diabetics - 01 November 2018. <b>Painful diabetic neuropathy is a frequent complication of diabetes. Its diagnosis is clinical. Our goal is to determine the prevalence of painful diabetic neuropathy in this population. We also analyzed the relationship between this neuropathy and certain parameters, concerning the patient and his diabetes. It is a cross sectional study conducted at the department of endocrinology and internal medicine of Avicenne hospital Marrakech-Morocco, among a cohort of 300 diabetic outpatients. We used the DN4 questionnaire (Douleur Neuropathique en 4 questions), for diagnosis. The results showed a prevalence of 15%. In this study: advanced age, female gender, duration of diabetes greater than 10 years, and the lack of medical follow up were found to be statistically significant risk factors for painful diabetic neuropathy, in addition to some diabetes-related comorbidities such as hypertension, dyslipidemia, sedentary life style and diabetic retinopathy. Painful diabetic neuropathy remains undertreated, in fact 74% of our patients did not receive any specific treatment, knowing that the progress in developing effective and well-tolerated therapies has been disappointing.</b><br/> text/html 2018-12-12T03:05:07+01:00 Dimitrios Manatakis, Maria Sioula, Ioannis Passas, Helen Zerbinis, Christos Dervenis [Case report] - Rectal seed bezoar due to sunflower seed: a case report and review of the literature - 31 October 2018. <b>Seed bezoars are a subcategory of phytobezoars, caused by consumption of indigestible vegetable or fruit seeds. We present the case of a 64-year-old male patient, who presented at the Emergency Department, complaining of constipation, tenesmus and rectal pain. History and digital examination revealed a rectal seed bezoar due to sunflower seeds, impacted in the lower rectum. The patient underwent manual disimpaction under general anaesthesia, after conservative measures failed. Seed bezoars represent a different pathophysiological process compared to fibre bezoars. They are usually found in the rectum of patients without predisposing factors, causing constipation and anorectal pain. History taking and digital rectal examination are the cornerstones of diagnosis, with manual disimpaction under general anaesthesia being the procedure of choice.</b><br/> text/html 2018-12-12T03:05:07+01:00 Noufissa Benajiba, Anass Ayyad, Chourouk Aabdi, Rim Amrani, Maria Rkain, Mohammed Benajiba [Case report] - D&eacute;ficit cong&eacute;nital en facteur VII de coagulation: &agrave; propos de deux cas familiaux - 31 October 2018. <b>Le d&eacute;ficit en facteur VII est rare, sa pr&eacute;valence est estim&eacute;e &agrave; 1/1.000.000. Sa transmission est autosomique r&eacute;cessive. L'expression peut aller de la simple &eacute;pistaxis &agrave; l'h&eacute;morragie c&eacute;r&eacute;brale. Le but de notre travail est de mettre l'accent sur les particularit&eacute;s cliniques et l'int&eacute;r&ecirc;t du d&eacute;pistage de ce rare d&eacute;ficit. Nous rapportons deux observations de deux fr&egrave;res porteurs de ce d&eacute;ficit. Il s'agit d'un enfant &acirc;g&eacute; de 8 ans, issu d'un mariage non consanguin, benjamin d'une fratrie de deux, dans ces ant&eacute;c&eacute;dents on note une h&eacute;morragie post circoncisionnelle, admis au service pour prise en charge d'&eacute;pistaxis &agrave; r&eacute;p&eacute;tition depuis l'&acirc;ge de 4ans. Un bilan d'h&eacute;mostase a &eacute;t&eacute; r&eacute;alis&eacute; objectivant un taux de prothrombine (TP) bas, un temps de c&eacute;phaline activ&eacute;e (TCA) normal et le dosage factoriel a r&eacute;v&eacute;l&eacute; un d&eacute;ficit en facteur VII avec un taux &agrave; 26%. L'&eacute;volution est marqu&eacute;e par des transfusions espac&eacute;es du plasma frais congel&eacute; (PFC) suite &agrave; des &eacute;pistaxis et des plaies. Le d&eacute;pistage familial n'a pas &eacute;t&eacute; r&eacute;alis&eacute;. Son fr&egrave;re ain&eacute;, consulte &agrave; l'&acirc;ge de 11 ans pour &eacute;pistaxis de grande abondance, l'examen somatique a &eacute;t&eacute; sans particularit&eacute;. Vu ses ant&eacute;c&eacute;dents le patient a b&eacute;n&eacute;fici&eacute; d'un bilan avec dosage du facteur VII r&eacute;v&eacute;lant un taux &agrave;: 55%, et un d&eacute;pistage chez les parents est pr&eacute;vu. La d&eacute;couverte d'un cas doit motiver &agrave; mener une enqu&ecirc;te familiale afin de d&eacute;pister d'autres porteurs de ce d&eacute;ficit et avoir un conseil g&eacute;n&eacute;tique qui aidera &agrave; &eacute;viter des manifestations graves voir mortelles tout en sachant que les &eacute;tudes n'ont pas montr&eacute; de corr&eacute;lation entre le taux du facteur et la gravit&eacute; du tableau.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ibrahima Sitor Souleymane Sarr, Magatte Faye, Papa Mamadou Faye, Mamadou Seck, Ousmane Ka, Madieng Dieng [Case report] - Occlusion intestinale aigu&euml; r&eacute;v&eacute;lant une grossesse abdominale: &agrave; propos d'un cas - 31 October 2018. <b>La grossesse abdominale (GA) se d&eacute;finit comme la nidation et le d&eacute;veloppement de l'œuf f&eacute;cond&eacute; dans la cavit&eacute; p&eacute;riton&eacute;ale. Elle reste une vari&eacute;t&eacute; rare de grossesse ectopique, dont la d&eacute;couverte peut &ecirc;tre fortuite simulant une urgence chirurgicale. Nous rapportons un cas rare d'une occlusion intestinale aigu&euml; f&eacute;brile r&eacute;v&eacute;lant une grossesse abdominale chez patiente &acirc;g&eacute;e de 27ans sans ant&eacute;c&eacute;dents pathologiques particuliers, re&ccedil;ue pour la prise en charge d'un syndrome occlusif &eacute;voluant depuis une semaine. L'examen physique retrouvait un abdomen distendu luisant, sensible dans son ensemble et m&eacute;t&eacute;oris&eacute;. Le bilan biologique montrait des globules blancs &agrave; 20300, le taux d'h&eacute;moglobine &agrave; 7,2g/dL. L'exploration chirurgicale avait objectiv&eacute; un h&eacute;mop&eacute;ritoine de 2000ml, une masse retro-ut&eacute;rine encapsul&eacute;e, adh&eacute;rent fortement au m&eacute;so-sigmo&iuml;de et au sigmo&iuml;de responsable d'une st&eacute;nose du colon descendant. Il a &eacute;t&eacute; r&eacute;alis&eacute; une ex&eacute;r&egrave;se monobloc dont l'effraction montrait un placenta accol&eacute; au m&eacute;so-sigmo&iuml;de reli&eacute; au fœtus une annexectomie droite, une colostomie.</b><br/> text/html 2018-12-12T03:05:07+01:00 Siham Alaoui Rachidi, Anas Lahlou Mimi, Nizar El Bouardi, Youssef Lamrani Alaoui, Meriem Boubbou, Mustapha Maaroufi, Badr Alami [Case report] - Une localisation rare du lipome au niveau parotidien: &agrave; propos d'un cas - 31 October 2018. <b>La localisation des lipomes au niveau parotidien est tr&egrave;s rare. Nous rapportons un nouveau cas avec une revue de litt&eacute;rature concernant un patient de 55 ans, qui a consult&eacute; pour une masse au niveau de la r&eacute;gion parotidienne &eacute;voluant depuis quatre ans, &agrave; la palpation on a trouv&eacute; une formation de consistance molle, mobile et indolore, le patient a b&eacute;n&eacute;fici&eacute; par la suite d'une imagerie (&eacute;chographie et IRM), d'o&ugrave; le diagnostic final d'un lipome parotidien a &eacute;t&eacute; retenu, le traitement &eacute;tait conservateur sur le choix du patient.</b><br/> text/html 2018-12-12T03:05:07+01:00 Varsha Vekaria-Hirani, Adil Waris [Case report] - Approach to childhood interstitial lung disease in resource limited setting - 31 October 2018. <b>Childhood interstitial lung disease (ChILD) is a rare disease and sensitization is needed in the recognition, diagnosis and treatment approaches. There is no formal approach to diagnosis or therapy in resource limited regions. We present a case of a 4-month infant who presented with all the criteria for diagnosis of ChILD. Lung biopsy being the gold standard is a challenge in our setting and diagnosis was based on clinical signs and imaging after ruling out of other similar respiratory conditions by way of individual trials of therapy. Monotherapy with prednisone showed clinical improvement within days of initiation.</b><br/> text/html 2018-12-12T03:05:07+01:00 David Kitara Lagoro, Denis Arony Anywar, Suzanne Gazda [Letter to the editors] - Could Nodding Syndrome (NS) in Northern Uganda be an environmentally induced alteration of ancestral microbiota? - 30 October 2018. <b>Hippocrates stated in 460-C.370 BC that, "All diseases begin in the Gut." This statement may be beginning to have meanings in the advent of new diseases such as Nodding Syndrome (NS) and Autism Spectrum Disorder (ASD). Interestingly, a recent publication from China in the journal of microbiology in 2017 suggests that high grain diet had dynamically shifted the composition of mucosa-associated microbiota and induced mucosal Injuries in the colon of Sheep. NS is a devastating childhood neurological disorder characterized by atonic seizure, cognitive impairment, head nodding, wasting and stunted growth. In addition, NS in Northern Uganda is clustered in time (those who were in IDPs), in space (discretely observed on either sides of the two rivers of Aswa and Pager) and in person (onset mainly between the ages of 5-15 years) and therefore exhibits spatial temporality. The first case of NS was noticed in Kitgum district in 1997, one year after the reported displacement of that community into IDP. Prior to that internal displacement, there were no reported cases of NS. The same scenario occurred in the IDPs of Odek, Gulu district where the population was displaced into IDPs in 2001 and approximately a year later in 2002, cases of NS began to appear. In the IDPs, children that eventually developed NS fed nearly exclusively on food ration provided by relief agencies and roughly a year later, cases of NS began to appear. In the other East African countries, there were no reported cases of NS prior to internal displacement and dependence on food ration. The observed common factors in the three East African regions where NS occurs at endemic proportion are perhaps: Internal displacement and feeding on relief food. These researchers suggest that NS may have perhaps resulted from dietary and environmental factors during IDPs which may have been foreign to their GIT and links this observation to the concept of microbiota-gut-brain axis.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mohammed Karam Saoud, Imane Benchiba, Nisrine Mamouni, Sanaa Errarhay, Chahrazad Bouchikhi, Abdelaziz Banani [Case report] - Fibrome ut&eacute;rin associ&eacute; &agrave; un STUMP (tumeurs musculaires lisse de malignit&eacute; incertaine): &agrave; propos d'un cas - 30 October 2018. <b>Les tumeurs musculaires lisse de malignit&eacute; incertaine (STUMP) sont des tumeurs musculaires lisses dont les caract&eacute;ristiques morphologiques ne permettent pas de les ranger de fa&ccedil;on formelle en tumeur b&eacute;nigne ou maligne. Nous rapportons ici le cas d'une patiente &acirc;g&eacute;e de 44 ans sans ant&eacute;c&eacute;dents pathologiques notable qui consulte pour une augmentation du volume abdominal. Une &eacute;chographie pelvienne et une TDM TAP ont &eacute;t&eacute; r&eacute;alis&eacute;es objectivant une &eacute;norme masse a double composante tissulaire et liquidienne au d&eacute;pend de l'ut&eacute;rus. La patiente a b&eacute;n&eacute;fici&eacute; d'une laparotomie exploratrice avec d&eacute;couverte de deux masses, une au d&eacute;pend de l'ut&eacute;rus et l'autre en r&eacute;trop&eacute;riton&eacute;al. Le r&eacute;sultat anatomo-pathologique &eacute;tait en faveur d'un myome ut&eacute;rin associ&eacute;e &agrave; un STUMP.</b><br/> text/html 2018-12-12T03:05:07+01:00 Wafaa Arache, Abdelali Bahadi, Driss El kabbaj [Case report] - Thromboses des art&egrave;res r&eacute;nales r&eacute;v&eacute;lant un syndrome des anticorps anti phospholipides - 30 October 2018. <b>Le syndrome des anticorps antiphospholipides est une thrombophilie d&eacute;finie par l'association d'un &eacute;v&eacute;nement clinique thrombotique art&eacute;riel et/ou veineux, ou obst&eacute;trical &agrave; la pr&eacute;sence durable d'anticorps antiphospholipides. Nous rapportons le cas d'une jeune patiente admise pour une insuffisance r&eacute;nale aigue sur thrombose bilat&eacute;rale des art&egrave;res r&eacute;nales et chez qui le bilan immunologique a r&eacute;v&eacute;l&eacute; la pr&eacute;sence d'anticoagulant circulant de type lupique faisant retenir le diagnostic d'anticorps antiphospholipides. La prise en charge rapide de la thrombose des art&egrave;res r&eacute;nales par angioplastie a permis la r&eacute;cup&eacute;ration d'une fonction r&eacute;nale normale.</b><br/> text/html 2018-12-12T03:05:07+01:00 Yassine Otheman, Asmaa Fakir, Mohamed Kadiri, Mohamed Zakariya Bichra [Research] - La fr&eacute;quence des sympt&ocirc;mes physiques dans les troubles anxio-d&eacute;pressifs: &eacute;tude transversale chez une population de 202 consultants psychiatriques - 29 October 2018. <b>INTRODUCTION: Les sympt&ocirc;mes physiques associ&eacute;s aux troubles anxio-d&eacute;pressifs ont fait l'objet de plusieurs &eacute;tudes depuis plusieurs d&eacute;cennies, vu leurs fr&eacute;quences et leurs cons&eacute;quences. Le but de notre &eacute;tude est de pr&eacute;ciser la fr&eacute;quence des principaux sympt&ocirc;mes physiques des troubles anxieux (trouble panique (TP), trouble anxi&eacute;t&eacute; g&eacute;n&eacute;ralis&eacute;e (TAG), troubles phobiques (TPh), et d&eacute;pressifs (&eacute;pisode d&eacute;pressif caract&eacute;ris&eacute; (EDC) dans le cadre d'un trouble d&eacute;pressif). METHODES: nous avons men&eacute; une &eacute;tude transversale &agrave; vis&eacute;e descriptive, r&eacute;alis&eacute;e sur un &eacute;chantillon de 202 consultants dans un Service de Psychiatrie. RESULTATS: l'&acirc;ge moyen des patients est de 42 ans (19 &agrave; 70 ans), avec une l&eacute;g&egrave;re pr&eacute;dominance f&eacute;minine: 118 (58%). Les troubles anxio-d&eacute;pressifs constat&eacute;s sont: l'EDC: 113(56%), le TP: 61 (30.2%), le TAG: 55 (27.2%) et les TPh: 30 (14.9%). La fr&eacute;quence des patients atteints de 2 &agrave; 5, et plus de 5 sympt&ocirc;mes &eacute;tait respectivement de 15.9% et 39.6% dans les troubles d&eacute;pressifs, et de 9.5% et 62.9% dans les troubles anxieux. Les sympt&ocirc;mes les plus rapport&eacute;s sont d'ordre cardiopulmonaire (75%), g&eacute;n&eacute;ral (73.8%) et neurologique (65.8%). CONCLUSION: les sympt&ocirc;mes physiques qui accompagnent les troubles anxio-d&eacute;pressifs, sont variables et surviennent souvent en nombre. Ils peuvent aggraver le pronostic de ces troubles psychiatriques, en rendant difficile leur prise en charge. Un d&eacute;pistage pr&eacute;coce de ces troubles, en portant une attention particuli&egrave;re &agrave; ces sympt&ocirc;mes physiques, permettra de pr&eacute;venir ces complications.</b><br/> text/html 2018-12-12T03:05:07+01:00 Zied Bellaaj, Skander Ben Dhia, Mohamed Allagui, Issam Aloui, Youssef Othmen, Makram Zrig, Mustapha Koubaa, Abderrazek Abid [Case series] - Place des gestes associ&eacute;s &agrave; l’ost&eacute;otomie de Scarf dans le traitement de l’hallux valgus - 29 October 2018. <b>Devant la multiplicit&eacute; des techniques propos&eacute;es pour le traitement de l'hallux valgus, nous proposons d'&eacute;valuer l'ost&eacute;otomie Scarf associ&eacute;e ou non &agrave; une ost&eacute;otomie phalangienne et/ou une ost&eacute;otomie Weil. Il s'agit d'une &eacute;tude r&eacute;trospective de 29 patients, dont un cas bilat&eacute;ral, op&eacute;r&eacute;s entre 2011 et 2016 par une ost&eacute;otomie de Scarf du premier rayon avec un geste associ&eacute; dans 80% des cas. Les r&eacute;sultats ont &eacute;t&eacute; analys&eacute;s selon la satisfaction des patients, l'indice de Groulier et les mesures radiologiques. Le score global de Groulier donnait une bonne &eacute;valuation objective du r&eacute;sultat prenant en compte les donn&eacute;es radiologiques et anatomiques qui influencent le r&eacute;sultat final en cas d'insuffisance de correction. Le recul moyen &eacute;tait de 3 ans et 5 moins. Une diminution significative du valgus phalangien (de 34,17% &agrave; 16,1%), du m&eacute;tatarsus varus (de 15,13% &agrave; 9,93%) et de l'angle articulaire distal m&eacute;tatarsien (de 17,63% &agrave; 12,73%) &eacute;taient retrouv&eacute;s. Les patients sont satisfaits et tr&egrave;s satisfaits dans 83% des cas. Les complications sont domin&eacute;es par l'hypo-correction dans 13,3% des cas et nous n'avons not&eacute; aucun cas de pseudarthrose ou de n&eacute;crose de la t&ecirc;te de M1. Nos r&eacute;sultats sont comparables &agrave; ceux de la litt&eacute;rature. Nous insistons sur le caract&egrave;re surtout fonctionnel de la chirurgie de l'hallux valgus qu'il convient d'int&eacute;grer dans une correction globale de l'avant-pied. L'ost&eacute;otomie de Scarf n&eacute;cessite une technique rigoureuse, elle est fiable par ses r&eacute;sultats et pr&eacute;sente comme limite les grosses d&eacute;formations surtout de l'angle articulaire distal m&eacute;tatarsien.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ahmed Rouihi, Bouchaib Hemmaoui, Noureddine Errami, Fouad Benariba [Case report] - Enorme kyste amygdalo&iuml;de cervical &agrave; propos d'un cas - 26 October 2018. <b>Les kystes amygdaloides sont des tumeurs b&eacute;nignes kystiques dysembryologiques qui se d&eacute;veloppent au niveau de la partie ant&eacute;ro-lat&eacute;rale du cou, ils repr&eacute;sentent 2% des tumeurs lat&eacute;ro-cervicales du cou, ils comptent parmi les plus fr&eacute;quentes des anomalies branchiales, ils repr&eacute;sentent 6,1 &agrave; 85,2% des anomalies de la deuxi&egrave;me fente. Ils sont dus &agrave; la persistance du sinus cervical au cours de la diff&eacute;renciation de l'appareil branchial. Ils se manifestent par une tum&eacute;faction lat&eacute;ro-cervicale situ&eacute;e au bord ant&eacute;rieur du muscle sterno-cl&eacute;ido-masto&iuml;dien. Leur nature kystique est confirm&eacute;e par l'&eacute;chographie et la TDM. Le traitement consiste &agrave; l'ex&eacute;r&egrave;se chirurgicale. Nous rapportons le cas d'une femme de 24 ans qui a consult&eacute; pour une &eacute;norme tum&eacute;faction lat&eacute;ro-cervicale gauche qui &eacute;volue depuis 3 ans sans autres symptomatologies associes. Une cervicotomie exploratrice avec &eacute;tude anatomo-pathologique ont &eacute;t&eacute; r&eacute;alis&eacute;es, le diagnostic histolgique retenu &eacute;tait un kyste amygdalo&iuml;de sans signes de malignit&eacute;. L'objectif de ce travail est d'analyser les caract&eacute;ristiques anatomo-cliniques et discuter des modalit&eacute;s de prise en charge et les indications th&eacute;rapeutiques de cette affection.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ahmed-Salem Kleib, Brahim Hamad Ngaidé, Ahmedou El Mokhtar Eleit, Seck Mame Diack, Sidi Salem-Memmou, Sidi-Mohamed Salihy, Outouma Soumaré [Case series] - Prise en charge chirurgicale des m&eacute;ningiomes intracr&acirc;niens &agrave; Nouakchott, Mauritanie - 26 October 2018. <b>Les m&eacute;ningiomes constituent une pathologie couramment rencontr&eacute;e en neurochirurgie, pourtant les donn&eacute;es sur leur &eacute;pid&eacute;miologie, leurs caract&eacute;ristiques cliniques et leur prise en charge th&eacute;rapeutique restent rares par rapport aux gliomes. Notre but est de d&eacute;gager un profil &eacute;pid&eacute;miologique et d'&eacute;valuer la qualit&eacute; de de la prise en charge des m&eacute;ningiomes intracr&acirc;niens (MIC) au CHN de Nouakchott, Mauritanie. Nous avons revu dans cette &eacute;tude r&eacute;trospective, les observations des patients op&eacute;r&eacute;s d'un MIC, entre septembre 2013 et septembre 2016. Trente-deux patients ont &eacute;t&eacute; op&eacute;r&eacute;s d'un MIC (26,6%). L'&acirc;ge moyen &eacute;tait de 45,12 ans (± 13,8 ans) dont 75% &eacute;taient des femmes. La dur&eacute;e moyenne d'hospitalisation &eacute;tait de 13 jours (± 7jours). Le d&eacute;lai avant le diagnostic &eacute;tait en moyenne de 10 mois (± 5mois). La taille moyenne des MIC &eacute;tait de 5,07 cm (± 2,00cm) avec des extr&ecirc;mes allant de 2,5cm &agrave; 10,5cm. L'IRM a &eacute;t&eacute; r&eacute;alis&eacute;e chez 46,8% en compl&eacute;ment de la TDM c&eacute;r&eacute;brale. Dans notre s&eacute;rie 38% des MIC sont localis&eacute;s sur la convexit&eacute;. Le d&eacute;lai d'attente op&eacute;ratoire &eacute;tait de 23.91 jours (±17jours). La qualit&eacute; d'ex&eacute;r&egrave;se chirurgicale selon le score de Simpson &eacute;tait de Grade I (66%), Grade II: (19%), Grade III: (6%), Grade IV: (9%). Le type histologique de la classification de l'OMS 2007 &eacute;taient de, Garde I (93%), Grade II-III (7%). La mortalit&eacute; op&eacute;ratoire globale &eacute;tait de (n=3, 9,4%). Le perfectionnement du plateau technique dans le service de neurochirurgie, de radiologie et des moyens anesth&eacute;sie-r&eacute;animation prochainement, va contribuer &agrave; l'am&eacute;lioration de nos r&eacute;sultats et &agrave; la diminution de la mortalit&eacute;.</b><br/> text/html 2018-12-12T03:05:07+01:00 Chijioke Elias Ezeudu, John Onuora Chukwuka, Joy Chinelo Ebenebe, Wilson Chukwuneke Igwe, Ifeoma Egbuonu [Research] - Hypertension and prehypertension among adolescents attending secondary schools in urban area of South-East, Nigeria - 25 October 2018. <b>INTRODUCTION: In the past, the need for regular blood pressure screening in children was doubtful, and the main reason against it is that hypertension is an adult illness and there is no evidence that screening healthy children for hypertension was worthwhile. We did this study to determine the prevalence of hypertension and prehypertension as well as some risk factors for hypertension among secondary school adolescents in an urban area of the South-East, Nigeria. METHODS: this was a cross-sectional study of 984 adolescents aged 10-19 years in secondary schools in Awka South Local Government Area of Anambra state, South-East, Nigeria. The multi-stage sampling method was used to select the subjects. Data were collected from all eligible subjects with the aid of a questionnaire administered to them. Weight, height, and blood pressure were measured and recorded. RESULTS: nine hundred and eighty-four adolescents were recruited for this study, and they comprised 470 (47.8%) males and 514 (52.2%) giving a male: female ratio of 1:1.1. Their ages ranged from 10-19 years. The mean systolic blood pressure and mean diastolic BP were 110.5±10.2mmHg 71.5±8.5mmHg respectively. Prevalence of hypertension and pre-hypertension were 6.3% and 5.0% respectively. There were a higher proportion of females (7.3%) than males (5.4%) with hypertension, and more females (5.8%) than males (4.2%) with prehypertension but these were not statistically significant. Overweight and obesity were significantly associated with hypertension. CONCLUSION: hypertension exists among secondary school adolescents in Awka South Local government area of Anambra state, with a prevalence of 6.3%. Early detection and treatment will forestall the early development of complications.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mehdi Borni, Brahim Kammoun, Fatma Kolsi, Mohamed Zaher Boudawara [Case report] - L’esth&eacute;sioneuroblastome p&eacute;diatrique: une l&eacute;sion maligne exceptionnelle (&agrave; propos d’un cas et revue de la litt&eacute;rature) - 25 October 2018. <b>L'esth&eacute;sioneuroblastome (ENB) est une tumeur maligne rare repr&eacute;sentant 3% des cancers des cavit&eacute;s naso-sinusiennes; son origine se situe au niveau de l'&eacute;pith&eacute;lium olfactif. Elle touche g&eacute;n&eacute;ralement des sujets de 30 &agrave; 50 ans. Elle est exceptionnelle chez l'enfant. Le diagnostic est souvent tardif, du fait du caract&egrave;re longtemps confin&eacute; de la tumeur et le pronostic d&eacute;pend des extensions locor&eacute;gionales (notamment c&eacute;r&eacute;brales et orbitaires). Nous rapportons un cas de cette affection &agrave; localisation sph&eacute;no&iuml;dale chez un sujet de 03 ans d&eacute;couverte suite &agrave; une c&eacute;cit&eacute; d'installation rapide dont on discute les particularit&eacute;s cliniques, radiologiques, anatomopathologiques, th&eacute;rapeutiques et pronostique tout en insistant sur la pr&eacute;cocit&eacute; de la prise en charge conditionnant le pronostic qui restait malheureusement toujours p&eacute;joratif du fait du taux de r&eacute;cidives assez &eacute;lev&eacute; ainsi que la survenue de m&eacute;tastases &agrave; distance, notamment pulmonaires et osseuses.</b><br/> text/html 2018-12-12T03:05:07+01:00 Muhumuza Allan, Catherine Atuhaire, Musisi Nathan, Francis Ejobi, Samuel Nambile Cumber [Research] - Bacterial contamination of Ugandan paper currency notes possessed by food vendors around Mulago Hospital complex, Uganda - 25 October 2018. <b>INTRODUCTION: Paper currency notes, exchangeable fomite, that is continuously contaminated because of the poor handling and storage practices. Objective: the general objective of the study was to determine the bacterial contamination of paper currency notes possessed by food vendors around Mulago National Referral Hospital Complex.</b><br/> text/html 2018-12-12T03:05:07+01:00 Imane Sninate, Ahmed Bennana [Review] - Revue de la litt&eacute;rature sur l’impact du vieillissement d&eacute;mographique sur l’&eacute;volution des d&eacute;penses m&eacute;dicales: pays de l’Organisation de coop&eacute;ration et de d&eacute;veloppement &eacute;conomiques et Maroc - 25 October 2018. <b>L'objectif de cette &eacute;tude est de faire un point sur la litt&eacute;rature analysant la relation entre le vieillissement d&eacute;mographique et l'augmentation des d&eacute;penses m&eacute;dicales dans des pays o&ugrave; ce ph&eacute;nom&egrave;ne est d&eacute;j&agrave; pr&eacute;gnant ainsi qu'au Maroc. Les 19 premiers articles les plus cit&eacute;s qui sont produits au cours de la p&eacute;riode: 1995-2014, concernent les pays de l'OCDE et o&ugrave; l'impact du vieillissement sur les d&eacute;penses de sant&eacute; est &eacute;valu&eacute; quantitativement. En ce qui concerne le Maroc, la recherche a port&eacute; sur des publications &eacute;manant des instances gouvernementales nationales qui relatent l'&eacute;volution de la consommation m&eacute;dicale et son lien avec l'&acirc;ge. Pour les pays de l'OCDE, les &eacute;tudes qui incluent la proximit&eacute; du d&eacute;c&egrave;s dans les mod&egrave;les d'explication des d&eacute;penses de sant&eacute;, concluent que cette derni&egrave;re explique mieux que l'&acirc;ge la hausse des d&eacute;penses de sant&eacute;. Quatre auteurs ont mis en &eacute;vidence que les mod&egrave;les d'explication des d&eacute;penses qui ne tiennent pas compte de l'approche du d&eacute;c&egrave;s surestiment les r&eacute;sultats de projection. Dix &eacute;tudes avancent que la hausse des d&eacute;penses de sant&eacute; est imputable &agrave; des facteurs autres que le vieillissement d&eacute;mographique. Pour le Maroc, seul un rapport sur l'Assurance Maladie Obligatoire fait &eacute;merger un lien entre l'&acirc;ge et les d&eacute;penses puisque la pr&eacute;valence des maladies chroniques qui touchent davantage les personnes &acirc;g&eacute;es occasionne des d&eacute;penses importantes &agrave; l'assurance maladie. Compte tenu de la vitesse du vieillissement au Maroc, il est n&eacute;cessaire d'&eacute;laborer des &eacute;tudes permettant la compr&eacute;hension de la dynamique des d&eacute;penses de sant&eacute;.</b><br/> text/html 2018-12-12T03:05:07+01:00 Carlos Eduardo Salazar-Mej&iacute;a, Marusia Gonz&aacute;lez-Villarreal [Images in medicine] - Extra and intracranial metastasis as an initial presentation of testicular cancer - 25 October 2018. <b>A 24-year-old man presented with a 9-month history of a progressively increased painless left testicle. One month before admission, a round tumor appeared on his right forehead; this was associated with a persistent frontal headache of moderate intensity. The tumor progressively increased and was accompanied by altered consciousness characterized by stupor and confusion, which motivated his being taken to the emergency room. On initial evaluation, he had a Glasgow Coma Score of 13 with a proportionate left hemiparesis and a left pyramidal syndrome. The left testicle was increased in size, indurated, painless to palpation, and associated with a large left hydrocele. A brain MRI was performed that showed a heterogeneous lobulated intra and extracranial right frontal lesion. The intracranial component was vascularized and hemorrhagic, 8.2 x 7.1 x 6.8 cm with partially defined borders and vasogenic edema which shifted the midline 30 mm to the left and infiltrated the superior sagittal sinus. This predisposed right subfalcine and uncal herniation as well as left hydrocephalus. Extension studies showed metastatic lung and liver lesions. Laboratory studies revealed an alpha-fetoprotein level of 1210 ng/mL with a normal &#946;-hCG level (1.11 mIU/mL). A diagnosis of poor-risk germ-cell tumor was made and a chemotherapy scheme was planned; however, the patient died due to acute neurological deterioration 48 hours after admission.</b><br/> text/html 2018-12-12T03:05:07+01:00 Yang Wang, Xiangping Wei [Case report] - Acute parenchymal hemorrhage of three cases report after burr hole drainage of chronic subdural hematoma - 25 October 2018. <b>Chronic subdural hematoma (CSDH) is one of the most common neurological diseases, which mainly occurs among elderly people and usually develop after minor head injuries. Over the years, a simple burr hole evacuation of the hematoma has been accepted as the widespread method for most cases of CSDH, but acute parenchymal hemorrhage is a rare and deadly complication after surgery. We report three elderly cases of post-operative parenchymal hemorrhage and analyse the underlying factors and formulate relevant strategies in this article. Three advanced age patients had been admitted to our department with gradually increasing headache and limb activity disorder urgently and underwent an emergency operation of burr hole drainage of CSDH in frontal-temporal region after preoperative evaluations and examinations. Unfortunately, acute post-operative parenchymal hemorrhage occoured in three advanced age patients. Ultimately, the patients achieved satisfying outcome with no significant neurological deficit through conservative treatment. The exact mechanism of such uncommon complications are difficult to explain and remain poorly understood. Advanced age, hypertension, amyloidosis, high perfusion triggered by rapid hematoma release, cerebrospinal fluid (CSF) loss, oral anticoagulant, primary disease aggravation were the main mechanisms which were speculated in our report. Simultaneously, positive measures could be adopt to prevent this rare complication.</b><br/> text/html 2018-12-12T03:05:07+01:00 Safae Elidrissi, Hind Serhane, Salma Aitbatahar, Hafsa Sajiai, Lamyae Amro [Case report] - St&eacute;nose trach&eacute;ale r&eacute;v&eacute;lant un lupus &eacute;ryth&eacute;mateux syst&eacute;mique - 25 October 2018. <b>L’atteinte respiratoire dans le cadre du lupus &eacute;ryth&eacute;mateux syst&eacute;mique (LES) est moins connue que les atteintes cutan&eacute;es, articulaires et r&eacute;nales. Le tableau clinique est assez variable et domin&eacute; par les atteintes pleurales. La st&eacute;nose trach&eacute;ale est inhabituelle voire exceptionnelle au cours de cette pathologie. Nous rapportons un cas assez particulier d’un lupus &eacute;ryth&eacute;mateux syst&eacute;mique r&eacute;v&eacute;l&eacute; par une st&eacute;nose trach&eacute;ale avec un syndrome sec oculo-buccal.</b><br/> text/html 2018-12-12T03:05:07+01:00 Layu Donatus, Dohbit Julius Sama, Joyce Mahlako Tsoka-Gwegweni, Samuel Nambile Cumber [Research] - Factors associated with adolescent school girl’s pregnancy in Kumbo East Health District North West region Cameroon - 25 October 2018. <b>INTRODUCTION: Teenage pregnancy is a social problem in Cameroon in general and in Kumbo East in particular. This results in physical, psychological and socio-economic consequences on the teenage mother, family and the society as a whole. In spite of studies and interventions that have been and are being implemented, the prevalence of unplanned teenage pregnancy in Kumbo East Health District is still high, suggesting that more efforts are required to achieve effective preventive measures. The aim of this study was to determine factors associated with adolescent school girl's pregnancy in Kumbo East health district. METHODS: a cross-sectional descriptive study design was used and a simple random sampling technique was used to select 293 respondents aged 15 to 19year. The district hospital antenatal clinics and the Health Centres were selected. Data was obtained from 292 participants under the age of 20 years who were willing using a questionnaire administered through face-to-face interviews. RESULTS: the study show a high prevalence (60.75%) of teenage pregnancy in the sampled antenatal clinics of Kumbo East Health District attributable to inadequate considerations given to factors associated with school girl's pregnancy. This study has indicated that the age of teenager at first pregnancy, low contraceptive use, socio-economic status and physical violence are factors that are greatly associated with teenage pregnancy. Among the reasons contributing to the low use of contraceptives are: sexually activity, lack of knowledge, fear of side effects, including sterility, condoms disappearing in the womb and inequality of power with sexual partners. This study shows that teenagers obtain information mainly from school (53%) and relatives (20%). CONCLUSION: the use of contraceptive alone may not reduce teenage pregnancy, however double method is very effective but addressing the impact of poverty on teenagers, empowering them on their rights and information in order to make right choices is very important.</b><br/> text/html 2018-12-12T03:05:07+01:00 Supa Pengpid, Karl Peltzer [Research] - The prevalence and social determinants of fruit and vegetable consumption among adults in Kenya: a cross-sectional national population-based survey, 2015 - 24 October 2018. <b>INTRODUCTION: Low fruit and vegetable consumption contributes significantly to the burden of disease. The study aimed to assess the prevalence and correlates of fruit and vegetable (FAV) consumption among adults in a national survey in Kenya. METHODS: a national cross-sectional study based on a stratified cluster random sampling was conducted in 2015. The total sample included 4479 individuals 18-69 years, (females = 60.0%; median age 38.0 years, Inter Quartile Range 23) from Kenya. Sociodemographics, health risk behaviour and anthropometric data were collected using the WHO-STEPS questionnaire. RESULTS: on average, participants had 0.78 servings of fruits a day, 1.31 servings of vegetables a day, and 2.09 servings of FAV. Only 12.4% of respondents had two or more servings of fruit a day, 7.4% had three or more servings of vegetables a day and 94.0% had less than five servings of FAV a day. In adjusted logistic regression analysis, higher education (Odds Ratio=OR: 1.68, Confidence Interval = CI: 1.18, 2.39), greater wealth (OR: 1.61, CI: 1.04, 2.48), and being a Kikuyu (OR: 2.17, CI: 1.46, 3.23) or Luo (OR: 1.58, CI: 1.05, 2.37) were associated with two or more servings of fruits daily. Urban residence (OR: 0.44, CI: 0.23, 0.82) and being male (OR: 0.72, CI: 0.53, 0.98) decreased the odds, and older age (OR: 1.68, CI: 1.05, 2.69) and being Luo (OR: 2.84, CI: 1.53, 5.27) increased the odds of having three or more servings of vegetables daily. Being male (OR: 0.71, CI: 0.52, 0.99) and being Luo (OR: 0.40, CI: 0.23, 0.70) decreased the odds and urban residence (OR: 2.50, CI: 1.27, 4.96) increased the odds of inadequate (< five servings) FAV consumption. CONCLUSION: a high prevalence of inadequate FAV consumption was found, and risk factors identified, such as being female, lower education, urban residence, and not being Luo, that may help in guiding strategies to increase FAV consumption.</b><br/> text/html 2018-12-12T03:05:07+01:00 Craig Vincent-Lambert, Cecile May Smith, Lara Nicole Goldstein [Research] - Hypothermia in trauma patients arriving at an emergency department by ambulance in Johannesburg, South Africa: a prospective study - 23 October 2018. <b>INTRODUCTION: Normal body temperature is considered to be between 36 and 38°C. Temperatures that are too low may negatively affect physiological functions. In trauma cases, factors that promote the development of hypothermia include concomitant hypoxia, hypotension, decreased levels of consciousness, contact with cold surfaces, exposure to low ambient temperatures and the administration of cold fluids. Studies on emergency department related hypothermia in Africa are sparse. This study investigated instances of hypothermia in a sample of trauma cases arriving by ambulance to an emergency department in Johannesburg, South Africa. METHODS: core body temperatures of 140 trauma cases were measured upon arrival and 30 minutes later. Ambient temperatures outside the hospital, inside the ED and in the resuscitation areas were also recorded. Additional information was gathered describing the equipment available to the ambulance crews for temperature, control and rewarming. RESULTS: 72 (51%) of the cases were found to have core body temperatures less than 36°C upon arrival. 29 (21%) the cases were considered clinically hypothermic (core temperatures of less than <35°C). After 30 minutes, 79 (56%) of the participants had core body temperatures of less than 36°C and 39 (28%) remained lower than 35°C. Patients were not warming up in the ED as expected. Rather, some had become colder. The study also found that the ambient temperature in the triage area fluctuated and was recorded as less than the recommended 21°C in 95 (68%) of the cases. In addition, the majority of ambulances that transported these cases lacked appropriate equipment on board to properly facilitate temperature control and rewarming. CONCLUSION: 51% of the trauma cases arriving by ambulance had core temperature <36°C. Many became even colder in the ED. Attention needs to be given to the early identification of hypothermia, the regulation of ambient temperatures inside the ED including the provision of appropriate heating and rewarming devices on ambulances.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ghita Bouayad, Abdelbarre Oubaaz [Images in medicine] - D&eacute;p&ocirc;ts corn&eacute;ens de ciprofloxacine en post chirurgie de cataracte - 23 October 2018. <b>Nous rapportons le cas d’un patient &acirc;g&eacute; de 62 ans, op&eacute;r&eacute; de cataracte de l’œil gauche par phaco&eacute;mulsification avec suites simples; il a re&ccedil;u en post op&eacute;ratoire un traitement comprenant la ciprofloxacine en collyres. Le patient a &eacute;t&eacute; perdu de vue pendant 2 mois sans arr&ecirc;ter le traitement; il se pr&eacute;sente avec une opacit&eacute; para-centrale, blanche, d’allure cristalline, correspondant &agrave; un d&eacute;p&ocirc;t corn&eacute;en de ciprofloxacine. Le collyre antibiotique a &eacute;t&eacute; imm&eacute;diatement suspendu et le patient a b&eacute;n&eacute;fici&eacute; d’un d&eacute;bridement chirurgical tr&egrave;s superficiel, et a &eacute;t&eacute; mis sous agents mouillants &agrave; fortes doses, avec cicatrisation compl&egrave;te de l’ulc&eacute;ration en regard du d&eacute;p&ocirc;t corn&eacute;en, mais il a gard&eacute; une opacit&eacute; &eacute;pith&eacute;liale para-pupillaire inf&eacute;rieure ne g&ecirc;nant toutefois pas la vision.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ach Taieb, Asma Ben Cheikh, Yosra Hasni, Amel Maaroufi, Maha Kacem, Molka Chaieb, Koussay Ach [Case series] - Etude sur le diab&egrave;te aigu c&eacute;tosique inaugural dans un h&ocirc;pital du Centre-Est Tunisien - 23 October 2018. <b>La c&eacute;tose est une complication aigu&euml; du diab&egrave;te qui consiste en une accumulation de corps c&eacute;toniques sanguins. Malgr&eacute; la haute pr&eacute;valence du diab&egrave;te c&eacute;tosique d&eacute;crite, il existe tr&egrave;s peu d’informations concernant l’&eacute;pid&eacute;miologie de cette complication inaugurale du diab&egrave;te en Tunisie. L’objectif &eacute;tait de d&eacute;terminer les caract&eacute;ristiques &eacute;pid&eacute;miologiques et clinico-biologiques des c&eacute;toses inaugurales dans un h&ocirc;pital du Centre-Est tunisien. Il s’agit d’une &eacute;tude r&eacute;trospective, transversale et exhaustive, &agrave; propos de patients admis pour une c&eacute;tose inaugurale sur une p&eacute;riode allant de janvier 2010 &agrave; ao&ucirc;t 2016. La population d’&eacute;tude a &eacute;t&eacute; divis&eacute;e en 2 groupes selon la pr&eacute;sence ou pas d’une auto-immunit&eacute; anti pancr&eacute;atique: groupe DAI (diab&egrave;te de type 1 auto-immun) regroupe tous les patients avec une auto-immunit&eacute;, et le groupe DNAI (diab&egrave;te c&eacute;tosique non auto-immuns) sans auto-immunit&eacute;. Il s’agit de 391 patients, de sex ratio 266 hommes/125 femmes, d’&acirc;ge moyen de 34±14,33 ans. La pr&eacute;dominance masculine &eacute;tait nette: 68% dans la population g&eacute;n&eacute;rale. L’&acirc;ge de la c&eacute;tose &eacute;tait significativement plus pr&eacute;coce dans le groupe DAI. Un facteur pr&eacute;cipitant la c&eacute;tose &eacute;tait retrouv&eacute; chez 77,7% de la population globale d’&eacute;tude, significativement plus fr&eacute;quent dans le groupe DAI que dans le groupe DNAI. Le facteur le plus retrouv&eacute; &eacute;tait les infections virales. Les Anticorps anti thyro&iuml;diens &eacute;taient significativement importants dans le groupe DAI. La c&eacute;tose est un facteur de d&eacute;compensation inaugurale fr&eacute;quent du diab&egrave;te en Tunisie. La population la plus importante a &eacute;t&eacute; d&eacute;crite chez l’adulte jeune masculin, avec l’absence d’une auto-immunit&eacute;, et un profil clinique du diab&egrave;te de type 2.</b><br/> text/html 2018-12-12T03:05:07+01:00 Khadija Karjouh, Fatima-Zahra Azzaoui, Ahmed Ahami, Samira Boulbaroud [Research] - Profile and use of licit psychotropic substances in the former Rabat-Sale-Zemmour-Za&euml;r Region (Morocco): the case of tiflet city - 23 October 2018. <b>INTRODUCTION: Psychopharmacology today faces serious challenges, especially related inappropriate drug choices, abuse and resulting side effects. The aim of this pharmacy based study in the City of Tiflet was to profile the prescription and usage patterns of psychotropic drugs. METHODS: This study was conducted in the pharmacies of the City of Tiflet (Morocco). Descriptive statistics of 5125 prescriptions collected from 21 pharmacies were analysed, and summarized as means, percentages and proportions where appropriate. RESULTS: The patterns of psychotropic drugs use were similar, compared to Western Countries, especially for anxiolytics/hypnotics, neuroleptics and anti-depressants. A poor monitoring of the treatment, and the lack of control of its side effects were major concerns. General practitioners ranked first among doctors who prescribed psychotropic drugs (48.5%), followed by psychiatrists (41.7%), and the rest of the prescriptions come from other specialists (neurologists, cardiologists, gynaecologists...). Among psychotropic drugs, anxiolytics dominated prescriptions (52.0%), followed by neuroleptics (29.0%) and anti-depressants (19.0%). Men consumed more psychotropic drugs than women (51.8% against 48.2% respectively). CONCLUSION: Anxiolytics/hypnotics constitute the main class of psychotropic drugs prescribed in the Tiflet City, followed by neuroleptics and anti-depressants. Nearly half of the population currently receive prescribed psychotropic drugs from general practitioners. Psychiatrists are less involved in the prescription and monitoring of these patients. This could predispose the population to addiction, drug misuse, intoxication, and at times, misdiagnosis of serious psychiatric illnesses. Our study highlights the urgency of reinforcing psychotropic prescription regulation and monitoring in Tiflet city.</b><br/> text/html 2018-12-12T03:05:07+01:00 Robert Nang, Hadiya Hinchi, Taoulouth Lafia, Mohamed Rami, Rachid Belkacem [Case report] - Giant vesical lithiasis, complication of enterocystoplasty: case report - 22 October 2018. <b>Frequent and recurrent pathology, bladder stone is a constant complication in enterocystoplasty enlargement. The occurrence of this lithiasis is due to some factors such as urinary tract infections, mucus secretion by the intestine segment moved, poor urinary emptying and foreign bodies (sutures, staples) intra-vesical. Clinical signs are not specific. However the formation of giant lithiases remains exceptional. Some cases have been documented in the literature. The occurrence of this affection must be prevented by dietary measures and regular follow up. New therapies for the control of mucus in the bladder tank have been emerged. Open surgical remains the most common. Today, One port trocar endoscopy enables to handle and extracted lithiases of every size.</b><br/> text/html 2018-12-12T03:05:07+01:00 Nd&egrave;ye Fatou Sow, Mohamed L&egrave;ye, Idrissa Basse, Yaay Joor Dieng, Mame A&iuml;ta Seck, Dj&eacute;n&eacute;ba Fafa Ciss&eacute;, Amadou Sow, Mohamed Fattah, Awa Kane, Morgiane Houngbadji, Papa Moctar Faye, Amadou Lamine Fall, Nd&egrave;ye Ramatoulaye Diagne Gu&egrave;ye, Ousmane Ndiaye [Case report] - Insuffisance cardiaque sur cœur normal r&eacute;v&eacute;lant une malformation art&eacute;riole-veineuse complexe du membre inferieur chez un enfant: &agrave; propos d'une observation et revue de la litt&eacute;rature - 22 October 2018. <b>Les malformations art&eacute;rioveineuses (MAV) sont des anomalies vasculaires cong&eacute;nitales &agrave; haut d&eacute;bit tr&egrave;s rares chez l'enfant. Leurs localisations atypiques et leurs manifestations cliniques variables rendent leur diagnostic et leur prise en charge souvent tardifs. Nous rapportons le cas d'un enfant pris en charge au Centre Hospitalier National d'Enfants Albert Royer de Dakar. Un gar&ccedil;on &acirc;g&eacute; de 9ans nous a &eacute;t&eacute; r&eacute;f&eacute;r&eacute; par une structure sanitaire en milieu rural pour la prise en charge d'une insuffisance cardiaque. L'examen clinique &agrave; l'admission montrait une alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral, un syndrome d'insuffisance cardiaque globale et une volumineuse masse inguino-crurale droite, chaude, &eacute;tendue &agrave; la paroi abdominale lat&eacute;rale droite (fosse iliaque et flanc droit), &agrave; limites mal d&eacute;finies. L'auscultation de cette masse objectivait un thrill et un souffle diffus. L'&eacute;chographie cardiaque montrait une HTAP s&eacute;v&egrave;re avec retentissement important sur les cavit&eacute;s cardiaques, sans atteinte structurelle du cœur. Le diagnostic de MAV a &eacute;t&egrave; confirm&eacute; par une &eacute;chographie doppler de la masse compl&eacute;t&eacute;e par un angioscanner. Ils mettaient en &eacute;vidence des fistules art&eacute;rioveineuses multiples au sein de la masse. Le diagnostic d'une MAV complexe de la racine de la cuisse droite au stade IV de Sch&ouml;binger a &eacute;t&egrave; retenu. La prise en charge m&eacute;dicale a consist&eacute; au traitement de l'insuffisance cardiaque &agrave; base de furos&eacute;mide, de spironolactone, et de captopril, en vue d'une stabilisation h&eacute;modynamique pour une &eacute;ventuelle cure chirurgicale. Les malformations art&eacute;rioveineuses des membres, en particulier de l'extr&eacute;mit&eacute; proximal du membre inf&eacute;rieur sont encore m&eacute;connues chez l'enfant, d'o&ugrave; les erreurs et retards diagnostiques fr&eacute;quents. Leur &eacute;volution est impr&eacute;visible d'o&ugrave; la n&eacute;cessit&eacute; d'un diagnostic pr&eacute;coce et d'un suivi attentif impliquant une collaboration pluridisciplinaire entre p&eacute;diatres, chirurgiens et radiologues.</b><br/> text/html 2018-12-12T03:05:07+01:00 Riyadh Lafta, Ashraf Hussain [Research] - Trend of vaccine preventable diseases in Iraq in time of conflict - 22 October 2018. <b>INTRODUCTION: Iraq has passed through a series of successive conflicts, economic sanction and violence. The overall health sector in Iraq has been plunged and the services are facing a continuous shortage in vaccines, medicines and other supplies, and access of people to the basic health services being more impaired. The objective of this study was to portray the trend of vaccine preventable diseases in Iraq during the past 17 years to provide baseline information for disease burden estimation.</b><br/> text/html 2018-12-12T03:05:07+01:00 Tej Jitesh Joshi, Gaurang Mistry, Devanand Shetty, Omkar Shetty, Sahil Singh, Shraddha Rumde [Case report] - A novel and easy technique for restoring grossly decayed mandibular molar with a modified cast-post - 22 October 2018. <b>The article addresses the difficulty of restoring a grossly carious molar tooth, where very little tooth structure is left after caries excavation. When enough sound tooth structure is missing for satisfying the ferrule effect, a clinician can follow this technique and easily restore such teeth. A step by step procedure, including instrumentation and materials and a new impression technique, is described in detail, with clinical photographs. This technique results in the fabrication of a robust and extremely retentive post and core on which to place fixed prosthodontic restorations. A 2 and half year study showed that the tooth well in function with no signs of any problem. The author has restored around many decayed molars using this technique. Over a period of three years, no failure was reported. With an increasing demand on the dentist for restoring a structurally compromised teeth, this technique provides the patients with a robust prosthodontic solution.</b><br/> text/html 2018-12-12T03:05:07+01:00 Violet Kayamba, Aaron Shibemba, Kanekwa Zyambo, Douglas Corbett Heimburger, Douglas Morgan, Paul Kelly [Research] - HIV related hypochlorhydria does not appear to respond to anti-retroviral therapy in Zambian adults: a case control study - 22 October 2018. <b>INTRODUCTION: Human Immunodeficiency Virus (HIV) infection is associated with hypochlorhydria but the mechanism is unknown. The objective of this study was to determine effects of anti-retroviral therapy (ART) on gastric physiology as measured by validated markers. METHODS: we studied HIV infected individuals who were either ART-na&iuml;ve or on treatment with undetectable viral loads. We measured H.pylori IgG antibodies, pepsinogen (PG) 1 and 2 levels and fasting gastrin-17 using Biohit GastroPanel®. Gastric antral biopsies and juice were obtained for histology and pH respectively. Also included were historical data from HIV negative participants (n = 72) in a previous study, for reference. RESULTS: we enrolled 84 HIV positive individuals with a median age 42 years (IQR 37-40 years). 55(66%) were female, 32(38%) were ART na&iuml;ve, and 52(62%) were on ART. Hypochlorhydria (pH>4) was present in 48(57%) of the HIV positive and 18(25%) of the HIV negative individuals (OR 4: 95% CI 1.9-8.5, P<0.001) with no significant effect of ART (OR 0.9: 95% CI 0.3-2.3, P = 0.82). Hypochlorhydria was not associated with the serological detection of corpus atrophy using low PG 1:2 ratio (OR 2.1: 95% CI 0.5-10.2, P = 0.37) or GastroPanel® algorithm, (OR 0.7: 95% CI 0.01-60.1, P = 1.0). ART reduced the frequency of low PG 1:2 ratio (P = 0.001), but not the histological detection in the antrum of atrophy or non-atrophic gastritis. CONCLUSION: ART use is associated with reduced serological evidence of corpus atrophy but has no effect on fasting pH, supporting earlier data that suggest that the mechanism of HIV-associated hypochlorhydria is multifactorial.</b><br/> text/html 2018-12-12T03:05:07+01:00 Abderrahim Elktaibi, Amal Damiri, Issam Rharrassi, Mohamed Reda Elochi, Mohamed Oukabli, Ali Akhaddar, Mohamed Boucetta, Abderrahmanne Al Bouzidi [Case report] - A rare tumour in the cerebellopontine angle: endolymphatic sac tumour - 19 October 2018. <b>We present a case of a papillary tumour at the cerebellopontine angle in a 54-year-old man. He presented with right-sided ear pain associated with dizziness and hearing loss. The radiological diagnosis was in favor of acoustic neurinoma. Surgical excision was performed and the diagnosis of the endolymphatic sac tumour was made. Endolymphatic tumour is a low grade adenocarcinoma that originates from the endolymphatic sac. The definitive diagnosis requires a combination of clinical features, radiological finding and pathological correlation.</b><br/> text/html 2018-12-12T03:05:07+01:00 Rita Patricia Frimpong-Mansoh, Benedict Nii Laryea Calys-Tagoe, Esi Forewaa Therson-Coffie, Kwadwo Odei Antwi-Agyei [Research] - Evaluation of the tuberculosis surveillance system in the Ashaiman municipality, in Ghana - 19 October 2018. <b>INTRODUCTION: Tuberculosis (TB) was the leading cause of death from an infectious illness globally with an estimated 10.4 million new cases and 1.4 million deaths in 2015. In Ghana, from the 2013 TB prevalence survey conducted by the National Tuberculosis Control Programme, the incidence is estimated as 165 per 100,000 population and a mortality rate of 7.5 per 1,000 infected people. The Tuberculosis surveillance system is part of the general framework of the Integrated Disease Surveillance and Response. This evaluation was to assess whether the system is meeting its set objectives, assess its usefulness and describe its attributes. METHODS: The TB surveillance system of the Ashaiman Municipality was evaluated using Centre for Disease Control and Prevention Updated Guidelines for Evaluating Public Health Surveillance Systems 2006. Records review from 2014 to 2016 was done to assess objectives of the system and surveillance data source of 2016 was used to assess attributes. Interviews were conducted at the various levels using semi-structured questionnaire and data analysis done with Epi info 7 and Microsoft Excel to run frequencies and percentages. RESULTS: the surveillance system is well structured with standardized data collection tools. The system was found to be useful, though it just partially met its objectives. It was also found to be simple, flexible and fairly stable with average timeliness. It had low acceptability and is not geographically representative. It had low sensitivity of 45/100,000 and a low predictive value positive of 6.6%. CONCLUSION: The surveillance system was found to be useful but partially met its objectives. There is the need to improve the sensitivity, predictive value positive timeliness and acceptability.</b><br/> text/html 2018-12-12T03:05:07+01:00 Abdulkadir Karismaz, Mehmet Hilmi Dogu, G&uuml;lben Huq, Sermin Altindal, Osman Yokus, Elif Suyani [Case report] - A diffuse large B cell lymphoma emerging with breast cancer relapse - 19 October 2018. <b>The prevalence of secondary cancers associated with the breast cancer treatment has increased, which is due to the administration of cytotoxic/hormonal drugs as well as radiotherapy. A 54-year-old female patient with a history of breast cancer for 4 years and receiving tamoxifen the hematology clinic with fatigue and nosebleed. Laboratory parameters were revealed pancytopenia. The bone marrow biopsy finding was compatible with CD20 positive high-grade B cell lymphoma resembling diffuse large B cell lymphoma. The patient started to receive a chemotherapy. Her hemogram values displayed an improvement after the second cycle. However, interim PET-BT, performed after the fourth cycle, showed an incomplete response in cervical lymphatic nodes. Then, a tru-cut biopsy was performed resulting in breast cancer metastasis. This is an unusual case of secondary-DLBCL presenting with pancytopenia and occuring 4 years after the diagnosis of breast cancer. In conclusion, clinicians should carefully set the dosage of chemotherapy drugs to avoid the long-term side effects associated with such drugs.</b><br/> text/html 2018-12-12T03:05:07+01:00 Aaron Alesane, Benjamin Tetteh Anang [Research] - Uptake of health insurance by the rural poor in Ghana: determinants and implications for policy - 19 October 2018. <b>INTRODUCTION: Financing access to healthcare services in developing countries remains a major challenge despite recent advances towards implementation of various health insurance policies in many low and middle-income countries. The use of health insurance is considered an important means to achieve universal health coverage. However, uptake of health insurance in most developing countries remains low as a result of several challenges. Empirical evidence of factors restraining enrolment is rare in many developing countries including Ghana. This paper therefore sought to investigate the factors associated with the uptake of health insurance products and the implications thereof for policy, using Awutu Senya West District of Ghana as case study. METHODS: A logit model was used to analyze data from 178 respondents randomly selected from two microfinance groups operating in the study area. RESULTS: The results indicate that insurance uptake is higher among younger people, but lower among women. Older women are however more likely to take up health insurance compared to older men. In addition, the study reveals that insurance uptake increases with level of education but decreases with household size. CONCLUSION: The study concludes that even though the premium on health insurance coverage in Ghana is arguably low, socio-demographic characteristics such as age, sex, literacy level and household size affect the decision to enroll. Adequate public sensitization on the benefits of the scheme and decreasing the statutory age for exemption from premium payment are some of the measures suggested to enhance health insurance uptake in Ghana and other developing countries.</b><br/> text/html 2018-12-12T03:05:07+01:00 Jean Sehonou, Leoubou Roger Samuel Dodo [Research] - Profil clinique et facteurs associ&eacute;s au syndrome de l’intestin irritable chez les &eacute;tudiants en m&eacute;decine &agrave; Cotonou, B&eacute;nin - 19 October 2018. <b>INTRODUCTION: Le syndrome de l'intestin irritable (SII) est un trouble fr&eacute;quent qui motive souvent une consultation en m&eacute;decine g&eacute;n&eacute;rale et en gastroent&eacute;rologie. L'objectif de l'&eacute;tude &eacute;tait de d&eacute;terminer la pr&eacute;valence du SII, d&eacute;crire ses caract&eacute;ristiques cliniques, d&eacute;terminer ses facteurs associ&eacute;s et la r&eacute;percussion sur la scolarit&eacute; chez les &eacute;tudiants en m&eacute;decine de Cotonou. METHODES: cette &eacute;tude transversale descriptive et analytique &eacute;tait men&eacute;e au cours de la p&eacute;riode du 1er ao&ucirc;t au 29 septembre 2017, chez les &eacute;tudiants en m&eacute;decine. Les crit&egrave;res diagnostiques &eacute;taient ceux de Rome IV, l'&eacute;chelle de Bristol, &eacute;chelle de Cungi et HADS score. L'analyse des donn&eacute;es &eacute;tait effectu&eacute;e gr&acirc;ce au logiciel SPSS 20.0. RESULTATS: sur un total de 315 &eacute;tudiants inclus, 44 (14%) avaient un SII. Les facteurs associ&eacute;s du SII &eacute;taient le sexe f&eacute;minin (OR [IC95%] = 2,4 [1,2-4,7]; p = 0,00), la prise r&eacute;guli&egrave;re d'aliment gras (OR [IC95%] = 2,0 [1,1-3,9]; p = 0,03), un &eacute;tat de stress &eacute;lev&eacute; &agrave; s&eacute;v&egrave;re (OR [IC95%] = 2,2 [1,1-4,7]; p = 0,02) et un &eacute;tat d'anxi&eacute;t&eacute; mod&eacute;r&eacute; &agrave; s&eacute;v&egrave;re (OR [IC95%] = 1,9 [0,9-3,6]; p = 0,04). L'absent&eacute;isme pour SII &eacute;tait rare (1 cas; 2,3%). CONCLUSION: le SII est fr&eacute;quent chez les &eacute;tudiants en m&eacute;decine de Cotonou. Les facteurs associ&eacute;s modifiables identifi&eacute;s &eacute;taient le stress, l'anxi&eacute;t&eacute; et la consommation r&eacute;guli&egrave;re des aliments gras. Aucune r&eacute;percussion notable sur la scolarit&eacute; n'&eacute;tait not&eacute;e.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ach Taieb, Yosra Hasni, Asma Ben Abdelkarim, Amel Maaroufi, Maha Kacem, Molka Chaieb, Koussay Ach [Case report] - Diab&egrave;te de type 1 post-traumatique chez un soldat de l’arm&eacute;e - 18 October 2018. <b>L'influence du stress comme facteur pr&eacute;cipitant l'apparition du diab&egrave;te de type 1 est un sujet largement &eacute;tudi&eacute; dans la litt&eacute;rature. La relation entre les traumatismes physiques et psychologiques et le diab&egrave;te ont &eacute;t&eacute; un sujet rarement &eacute;tudi&eacute; en milieu militaire. Le diab&egrave;te post-traumatique reste toujours un sujet controvers&eacute;. Nous rapportons le cas d'un soldat tunisien, sans ant&eacute;c&eacute;dents personnels ou familiaux d’auto-immunit&eacute;, qui a &eacute;t&eacute; diagnostiqu&eacute; pour un diab&egrave;te de type 1 au d&eacute;cours d’une agression physique lors de conflits sociaux entre les forces de l’ordre et les citoyens.</b><br/> text/html 2018-12-12T03:05:07+01:00 Jean S&eacute;honou, Aboudou Ra&iuml;mi Kpossou, Taofick Oy&eacute;tound&eacute; Amanda, Comlan N’dehougbea Martin Sokpon, Rodolph Koffi Vignon, Jacques Vigan [Research] - H&eacute;patite virale B et insuffisance r&eacute;nale: pr&eacute;valence et facteurs associ&eacute;s au Centre National Hospitalier et Universitaire de Cotonou - 17 October 2018. <b>INTRODUCTION: Les relations entre les reins et l’h&eacute;patite B sont complexes. L’objectif de cette &eacute;tude &eacute;tait de d&eacute;terminer la pr&eacute;valence et les facteurs associ&eacute;s &agrave; l’atteinte r&eacute;nale chez des personnes vivant avec le virus de l’h&eacute;patite B (PVVHB) &agrave; Cotonou. METHODES: Il s’agissait d’une &eacute;tude transversale &agrave; vis&eacute;e descriptive et analytique, men&eacute;e dans le service d’h&eacute;pato-gastroent&eacute;rologie du CNHU-HKM de mai &agrave; ao&ucirc;t 2017. Elle avait inclus les patients porteurs d’Ag HBs re&ccedil;us dans la p&eacute;riode.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mustapha Ben Moussa, Ismail Nouhi, Taib Lachguar, Mohamed El Absi, El Hassan El Faricha El Alami, Mohamed El Ouanani, El Mahjoub Echarrab, Mohamed El Amraoui, Mohamed Rachid Chkof [Case report] - A paraduodenal hernia revealed by bowel obstruction: case report and literature review - 17 October 2018. <b>Internal hernias are defined as the protrusion of abdominal viscera through an aperture in the intraperitoneal recesses, they are considered as a rare cause of intestinal obstruction. The paraduodenal hernias are the most common type of congenital hernia especially the left-sided ones. We report a case of a 46 year-old man presenting a left paraduodenal hernia with acute small bowel obstruction, which was firstly (preoperatively) assigned to a tumoral cause.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ren&eacute; Kwizera, Amani Moib&eacute;ni, Farha Shenawy, Mohamed Youssif [Research] - The prevalence of hepatitis B and C among blood donors at the National Blood Transfusion Center (CNTS) in Burundi - 17 October 2018. <b>INTRODUCTION: In Burundi, blood safety is one of the concerns of the Ministry of Public Health and Fight against AIDS. To this end, all donor blood bags must be screened for hepatitis B and C, that is the reason why the National Blood Transfusion Center (CNTS) has an Enzyme-Linked Immunosorbent Assay (ELISA); better chain to perform these tests properly. This study aimed to highlight the prevalence of hepatitis B and C among blood donors at the National Blood Transfusion Center of Burundi for a period from the January the 1<sup>st</sup> to the 30<sup>th</sup> of June 2016. METHODS: This retrospective study was conducted among blood donors (both sexes) aged between 18 years and 50 years. The objective was to collect from the registration registers and the monthly activity reports, the results of the ELISA test obtained after the diagnosis of hepatitis B and C of the blood donors from 1<sup>st</sup> January to 30<sup>th</sup> June 2016. RESULTS: In our series of 8993 samples tested, the prevalence of HBV was 1.04% and HCV was 1.12%. No association VHB- HCV was recorded. CONCLUSION: This study showed a low prevalence rate which shows a clear improvement in preventative measures for donor selection and screening tests.</b><br/> text/html 2018-12-12T03:05:07+01:00 Daniel Okitundu Luwa E-Andjafono, Marie-Therese Sombo Safi Ayanne, Guy Bumoko Makila-Mabe, Jean-Pierre Banea Mayambu, Dieudonn&eacute; Mumba Ngoyi, Michael Boivin, Jean-Jacques Tamfum-Muyembe, D&eacute;sir&eacute; Tshala-Katumbay [Research] - Troubles socio-&eacute;motionnels de l’enfant en milieu Konzo, un syndrome paralytique de nature &eacute;pid&eacute;mique associ&eacute; &agrave; une intoxication cyanhydrique d’origine alimentaire en Afrique sub-saharienne - 17 October 2018. <b>INTRODUCTION: L’objectif de cette &eacute;tude &eacute;tait d’&eacute;lucider le profil socio-&eacute;motionnel de l’enfant en milieu Konzo, une paralysie toxico-nutritionnelle s&eacute;vissant en Afrique sub-saharienne. METHODES: nous avons &eacute;valu&eacute; le profil socio-&eacute;motionnel de 210 enfants dont 123 avec konzo et 87 pr&eacute;sum&eacute;s contr&ocirc;les sains (4-17 ans d’&acirc;ge) apr&egrave;s interview structur&eacute; avec les parents lors d’une enqu&ecirc;te &eacute;pid&eacute;mio-clinique du konzo en 2011 au Congo-Kinshasa. Le profil neurocognitif &eacute;tait document&eacute; par le KABC-II, le BOT-2 et l’indice global des signes neurologiques du Konzo (IGSNK). Les tests associatifs ont &eacute;t&eacute; r&eacute;alis&eacute;s par le test de Chi-carr&eacute;, la r&eacute;gression logistique, dans le cas &eacute;ch&eacute;ant par mod&egrave;le lin&eacute;aire g&eacute;n&eacute;ralis&eacute;, au seuil de signification de 0,05. RESULTATS: dans l’ensemble, l’irritabilit&eacute;, la violence physique ou l’inhibition avec ou sans tristesse &eacute;taient respectivement retrouv&eacute;s dans 46,0%, 30,2%, 18,7%; avec un risque accru pour le Konzo (OR = 2,6; IC95%: 1,4 - 4,8; p = 0,001). Le trouble socio-&eacute;motionnel &eacute;tait associ&eacute; &agrave; l’insuffisance pond&eacute;rale (OR: 0,49; IC95%: 0,31 - 0,78; p = 0,002) et &agrave; un IGSNK &eacute;lev&eacute; (OR: 1,33; IC 95%: 1,1-1,63; p=0,019); et par ailleurs aggravait les d&eacute;ficits cognitifs dans le Konzo (interaction statut neurologique &Ccedil; troubles socio-&eacute;motionnels, D = 6,297; p = 0,013). Des performances cognitives &eacute;lev&eacute;es &eacute;taient observ&eacute;es chez les enfants non-Konzo mais avec troubles socio-&eacute;motionnels. La concentration moyenne (&eacute;cart-type ± ET) de thiocyanate urinaire &eacute;tait plus &eacute;lev&eacute; (554,8 ± 371,6 µmol/l) chez les enfants Konzo avec troubles socio-&eacute;motionnels. CONCLUSION: l’enfant vivant en milieu Konzo pr&eacute;sente des troubles socio-&eacute;motionnels. Leur nature psychopathologique et l’impact sur la cognition n&eacute;cessitent des &eacute;tudes approfondies.</b><br/> text/html 2018-12-12T03:05:07+01:00 Lamissa Cisse, Yamoussa Karabinta [Images in medicine] - Lupus néonatal chez un enfant dont la mère est suivie pour une dermatomyosite - 17 October 2018. <b>Le lupus n&eacute;onatal est une entit&eacute; rare qui serait due &agrave; la transmission d'auto anticorps maternel &agrave; l'enfant pendant la grossesse. Nous rapportons un cas. Il s'agissait d'un enfant de sexe feminin &acirc;g&eacute; de 2 mois re&ccedil;u en consultation avec des l&eacute;sions &eacute;ryth&eacute;mateuse maculaire du visage et du tronc. La m&egrave;re de l'enfant &eacute;tait suivit pour une dermatomyosite diagnostiqu&eacute; sur la base des l&eacute;sions cliniques de la faiblesse musculaire et d'une &eacute;l&eacute;vation des enzymes musculaires. Toutefois on ne disposait pas d'un bilan d'auto-immunit&eacute; chez cette derni&egrave;re. A l'examen, on notait des l&eacute;sions &eacute;ryth&eacute;mateuses atrophiques en aile de papillon de part et d'autre de la pyramide nasale. Des l&eacute;sions satellites au front, avec des cheveux roux. Le reste de l'examen &eacute;tait sans particularit&eacute;. Le bilan biologique demand&eacute; ne fut pas honor&eacute; par les parents qui ont aussi refus&eacute; la pratique d'une biopsie. Ces l&eacute;sions aurait pu faire &eacute;voquer une dermite s&eacute;borrh&eacute;ique une rosac&eacute;, ou une dermatite atopique. Cependant la rosac&eacute; est tr&egrave;s rare chez l'enfant, c'est une pathologie de la peau blanche. Dans la dermite s&eacute;borrh&eacute;ique, les l&eacute;sions ne sont pas atrophiques. La dermatite atopique d&eacute;bute habituellement &agrave; l'&acirc;ge de 3 mois. Les l&eacute;sions ont r&eacute;gress&eacute; en 15 jours sous dermocortico&iuml;de.</b><br/> text/html 2018-12-12T03:05:07+01:00 Muhammad Omar Bashaeb, Timothy Musila Mutala, Ian Mathenge Muriithi [Research] - Pattern of ultrasonographic findings of disorders of the ankle joint complex in patients presenting with ankle pain at the department of diagnostic imaging, university of Nairobi - 17 October 2018. <b>INTRODUCTION: the ankle joint is a frequently injured joint. It is also affected by inflammatory, infectious and tumoral lesions. Ultrasound is a safe and cost-effective imaging tool when evaluating the ankle joint, as most structures are superficial and accessible. The aim of the study was to determine the pattern of ultrasonographic findings of disorders of the ankle joint complex in patients presenting with ankle pain. METHODS: a total of 43 consecutive patients with ankle pain referred for an ankle radiograph or ankle ultrasound were examined. Statistical analysis was done using SPSS version 20. RESULTS: abnormalities were found in 60% of the examinations performed. The abnormalities were more common in female patients accounting for 61.4% of the abnormalities detected. The most common finding was synovial hypertrophy seen in 26% of the patients. CONCLUSION: ankle ultrasound was able to identify a large number of pathologies. This demonstrates the usefulness of ultrasound in the evaluation of a patient with ankle pain.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ilias Papakonstantinou, Zoi Psaroudaki, Efstathia Perivolioti [Case report] - An unusual case of aggregatibacter aphrophilus liver abscess - 17 October 2018. <b>Liver abscess of oropharyngeal origin in an immunocompetent patient is a rare condition. Furthermore, microbiologic diagnosis of liver abscess can be challenging due to the tremendous diversity of the microorganisms implicated and culture difficulties under laboratory conditions. In this manuscript, we report a case of a previously healthy 23-year-old male, who presented multiple liver abscesses, attributed to aggregatibacter aphrophilus, an obligatory oral gram-negative microorganism, that normally is a component of the commensal oral microbiota and non-virulent. The etiopathogenic microorganism was identified after needle aspiration of a liver abscess cavity. Treatment with broad-spectrum antimicrobials and percutaneous catheter drainage under computed tomography guidance of both abscesses, resulted in full recovery. A. aphrophilus represents a rare entity of liver abscess in healthy individuals and suggests that a pathogen of oropharyngeal origin should be suspected when an overt source of infection cannot be documented.</b><br/> text/html 2018-12-12T03:05:07+01:00 Grace Kaguthi, Videlis Nduba, Martien Wilhelm Borgdorff, Suzanne Verver [Research] - Predictors of post neonatal mortality in Western Kenya: a cohort study - 15 October 2018. <b>INTRODUCTION: To determine the predictors of mortality in infants in Siaya, western Kenya, ahead of novel tuberculosis (TB) vaccine trials in the same population. METHODS: in a study to determine tuberculosis incidence, 2900 infants aged 0-45 days, weighing e" 1700g were enrolled. Four monthly follow up visits were conducted for at least 12 months. HIV testing was done at six weeks of age. Free ancillary care was provided. Deaths were reported by parents, study staff and community workers. Cox proportional Hazard analysis was used to identify risk factors. The period of analysis commenced at six weeks old and was censored at 12 months of age. RESULTS: included in the analysis were 2528 infants with 2020 person years of follow up (pyo). There were 117 deaths (4.6 %). The post-neonatal mortality rate was 58 (95% CI: 48, 69) per 1000 pyo. In multivariate analysis, health facility births were protective against mortality (Hazard Ratio (HR) 0.54; 95% CI: 0.34, 0.84) and infant HIV infection at baseline was associated with increased mortality (HR 10.3; 95% CI: 6.40, 16.7). HIV uninfected infants born to HIV infected mothers had increased hazards of mortality (HR 1.73; 95% CI: 1.03, 2.90). Gender, weight at six weeks, maternal education and occupation were not significant predictors of mortality. CONCLUSION: infant mortality was high and was associated with being born outside a health facility, maternal HIV infection and HIV infection of the infant. Measures to decrease mother to child transmission and other HIV control measures need to be strengthened further to see incremental reductions in infant mortality.</b><br/> text/html 2018-12-12T03:05:07+01:00 Agatha Nkiruka David, Munirah Yewande Jinadu, Agatha Eileen Wapmuk, Titilola Abike Gbajabiamila, Jane Ogoamaka Okwuzu, Ebiere Clara Herbertson, Oliver Chukwujekwu Ezechi [Research] - Prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria - 15 October 2018. <b>INTRODUCTION: Sickle cell disease and HIV infection are prevalent in sub-Saharan Africa. While Haemoglobin S (HbS) contributes to significant morbidity and mortality in the homozygous or double heterozygous states, in the carrier state it confers a survival advantage in disease conditions such as malaria. However the interaction between sickle haemoglobin and HIV infection, especially in children remains largely unknown. This study aimed to assess the prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria. METHODS: a cross-sectional study among HIV infected children in an HIV treatment centre in Lagos, Nigeria. Socio-demographic and clinical characteristics were obtained and blood sample collected for haemoglobin electrophoresis, HIV RNA viral load and haematologic profile. Data was analysed with SPSS version 20. RESULTS: the prevalence of sickle cell trait was 18.8% among the 208 study participants, with none having sickle cell disease (SCD). Participants with SCT were significantly younger (OR = 4.0 95% CI (1.74-9.24)), more likely to be from the Yoruba ethnic group (OR = 3.3 95% CI [1.45-7.52)), had more opportunistic infections (OR = 2.4 95% CI (1.18-5.03), and lower mean HIV RNA viral load (p = 0.05) at baseline. However response to HIV care and treatment was similar in both groups of participants. CONCLUSION: the finding of absence of SCD, low prevalence of SCT, and lower HIV viraemia in HIV infected children with SCT may have implications for childhood survival which requires further clarification in future studies.</b><br/> text/html 2018-12-12T03:05:07+01:00 Saliu Balogun, Hakeem Yusuff, Bilkis Adeleye, Mariam Balogun, Abodunrin Aminu, Kehinde Yusuf, Prudence Tettey [Research] - Determinants of bed net use among older people in Nigeria: results from a nationally representative survey - 15 October 2018. <b>INTRODUCTION: The use of bed nets is a well-recognized and cost-effective preventive measure against malaria. However, little is known about factors associated with the use of bed nets among older people in Nigeria. Therefore, this study aimed to examine the determinants of bed net use among older Nigerian adults. METHODS: data from the first wave of the Nigeria General Household Survey-Panel were used, which included 3,439 participants aged 50 years and above. Log-binomial models were used to model the association between participants' sociodemographic characteristics and the use of bed nets. RESULTS: the frequency of bed net use was 26%. The adjusted prevalence ratio (PR) of bed net use was lower in women (PR = 0.83, 95% CI: 0.73-0.96), older age groups (60-69 years: PR=0.85, 95% CI:0.75-0.97; 70 years and above: PR = 0.80, 95% CI: 0.69-0.94), female-headed households (PR = 0.69, 95% CI: 0.53-0.89) and among those in the highest tertiles of per-capita household expenditure (PR=0.77, 95% CI: 0.66-0.90). However, the frequency of bed net use was higher among older adults residing in the rural areas (PR = 1.84, 95% CI: 1.55-2.18) and those who reported never having attended school (PR=1.15, 95% CI: 1.01-1.30). CONCLUSION: the prevalence of bed net use among older adults is lower compared to previously reported data for younger adults, suggesting an increased risk of the older adults of exposure to malaria. Female sex, age e" 60 years, level of education, economic status, and rural vs urban residence were important determinants of bed net use among older adults.</b><br/> text/html 2018-12-12T03:05:07+01:00 Salah Mhamdi, Mohamed Said Nakhli, Mohamed Kahloul, Nadia Latrech, Mohamed Ben Rejeb, Majdi Khadhraoui, Ajmi Chaouch, Walid Naija [Research] - Pr&eacute;valence du burnout en milieu d'anesth&eacute;sie r&eacute;animation dans le centre tunisien - 12 October 2018. <b>INTRODUCTION: L'&eacute;puisement professionnel serait particuli&egrave;rement pr&eacute;occupant en milieu d'anesth&eacute;sie r&eacute;animation. En plus de ses r&eacute;percussions socio-&eacute;conomiques, il alt&egrave;re la qualit&eacute; des soins prodigu&eacute;s et le pronostic des malades. Notre but est d'&eacute;valuer sa pr&eacute;valence chez le personnel d'anesth&eacute;sie-r&eacute;animation dans le centre tunisien. METHODES: il s'agit d'une enqu&ecirc;te multicentrique transversale r&eacute;alis&eacute;e au sein des services d'anesth&eacute;sie-r&eacute;animation dans les sept centres hospitalo-universitaires du centre tunisien et portant sur tout le personnel m&eacute;dical et param&eacute;dical consentant. L'instrument de mesure utilis&eacute; est le Maslash burnout Inventory. RESULTATS: deux cent quatre-vingt-trois personnes ont particip&eacute; &agrave; l'&eacute;tude (72,19%). L'&acirc;ge moyen &eacute;tait de 40,2 ± 9,38 ans avec une pr&eacute;dominance f&eacute;minine. L'analyse de l'&eacute;chelle de Maslach a r&eacute;v&eacute;l&eacute; que 94,71% des participants &eacute;taient concern&eacute;s par le burnout. Les scores moyens d'&eacute;puisement &eacute;motionnel, de d&eacute;personnalisation et d'accomplissement professionnel &eacute;taient respectivement de 28,65 ± 11,92; 8,62 ± 6.65 et 34,58 ± 8,07. Un niveau &eacute;lev&eacute; &agrave; mod&eacute;r&eacute; de burnout a &eacute;t&eacute; trouv&eacute; respectivement dans 13,3% et 26,2% des cas. Un niveau bas a &eacute;t&eacute; trouv&eacute; dans 55,21% des cas. Les r&eacute;percussions du burnout sont domin&eacute;es par les conduites additives (52,65%) et les id&eacute;es suicidaires (4,59%). CONCLUSION: le burnout appara&icirc;t de plus en plus comme une r&eacute;alit&eacute; palpable chez le personnel d'anesth&eacute;sie r&eacute;animation. Ces cons&eacute;quences sont graves aussi bien sur le plan individuel que social.</b><br/> text/html 2018-12-12T03:05:07+01:00 Vigneswara Srinivasan Sockkalingam, Elankumar Subburayan, Elango Velu, Sujith Tumkur Rajashekar, Anusha Mruthyunjaya Swamy [Research] - Fournier’s gangrene: prospective study of 34 patients in South Indian population and treatment strategies - 12 October 2018. <b>INTRODUCTION: Fournier's gangrene (FG) is a fulminant necrotizing fasciitis of the perineum and genitalia. The objective of this study was to study the etiology and microbiology associated with FG and to study the debridement and reconstructive procedures required in these patients. METHODS: this was a prospective follow up study conducted from September 2011 to November 2012 at Coimbatore medical college hospital, Coimbatore, India. Patients presenting to the outpatient department and emergency department with the clinical diagnosis of FG were included in the study. RESULTS: a total of 34 patients were studied in the study period. The mean age of presentation in years was 50±11.13. The male to female ratio was 33:1. The source of the infection was most commonly anorectal. Diabetes mellitus was the most common co morbid factor associated. Most commonly the disease was polymicrobial with escherichia coli being the commonest grown organism. The average number of wound debridement required was 2.9±1.42. Primary closure of the scrotal skin defect was the most common reconstructive procedure performed. Mortality associated with the disease in our series was 11.8%. CONCLUSION: although FG is a relatively rare disease, it is still prevalent in Indian population. Incidence of FG in HIV patients is high, even though it is not the commonest of the co morbid condition. The mortality can be kept to minimal with aggressive medical and surgical management. Extensive raw area following the infection and wound debridement can be managed by simple reconstructive procedures with good outcome.</b><br/> text/html 2018-12-12T03:05:07+01:00 Nishat Fatema, Houda Nasser Al Yaqoubi [Images in medicine] - Megacystis microcolon intestinal hypoperistalsis syndrome - 12 October 2018. <b>A 34-year old gravida03 para02 woman with fetal bilateral hydronephrosis (A), greatly distended bladder and mild polyhydramnios, detected during a prenatal ultrasound. Based on the ultrasonography findings, megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) was suspected. MMIHS is an unusual disorder with the incidence of 1:1500, characterized by a massively enlarged fetal urinary bladder, microcolon, hypoperistalsis throughout the intestinal tract and incomplete intestinal rotation. A female infant was born at 34 weeks of gestation by an emergency caesarean section because of breech presentation during labor. The neonate weighed 4.2 kg with an Apgar score of 4 in 1 min and 6 in 5 min. Physical examination showed massive distended abdomen (B) and bladder, as well as bilateral palpated enlarged kidneys. Abdominal plain x-ray showed a dilated stomach and minimal gas in the distal bowel segments (C). An abdominal ultrasound imaging showed dilated stomach with distal duodenal atresia. Fluoroscopy gastrografin revealed narrow bowel loops and jejuna malrotation at the right side. Kidney-urinary-bladder ultrasonography showed distended urinary bladder, bilaterally enlarged kidneys, with tortuous and dilated ureter. A vesicostomy was performed to facilitate the drainage of urine (D). Presence of ganglion cells on rectal biopsy excludes Hirschsprung disease. The condition is fatal and surgical correction often remained unsuccessful. MMIH is an autosomal recessive disorder so genetic counseling is suggested for future pregnancies.</b><br/> text/html 2018-12-12T03:05:07+01:00 Che Henry Ngwa, Elvis Akwo Ngoh, Samuel Nambile Cumber [Research] - Assessment of the knowledge, attitude and practice of health care workers in Fako Division on post exposure prophylaxis to blood borne viruses: a hospital based cross-sectional study - 12 October 2018. <b>INTRODUCTION: Accidental exposure to blood and body fluid presents a serious public health concern, especially among healthcare workers (HCW) and constitutes a risk of transmission of blood borne viruses. Infections acquired through occupational exposure are largely preventable through strict control measures such as the use of safe devices, proper waste disposal, immunization and prompt management of exposures including the use of Post Exposure Prophylaxis. This study aimed to assess the knowledge, attitude and practice of healthcare workers on post exposure prophylaxis and also determine the factors influencing reporting of occupational exposures among HCW in Fako Division, Cameroon. METHODS: this was a hospital based cross-sectional study conducted from February 2016 to July 2016 involving the administration of questionnaires to 216 health care workers in Fako division. Data collected was analyzed with SPSS version 22 and results presented as percentages and tables. Pearson chi-square test was used to determine statistically significant relationship between different factors with reporting of occupational exposures among health care workers in Fako division. RESULTS: a high proportion of participants 125(58%) had poor knowledge on Post Exposure Prophylaxis and 131(60.6%) of participants proved to have a positive attitude towards post exposure prophylaxis. 50.9% (110/216) of all participants had at least one occupational exposure with a low uptake 19.1(21/110) of Post Exposure Prophylaxis recorded among participants who were exposed. There was a statistically significant relationship between years of experience (p-value = 0.006, CI= 0.151-0.745) and category of health care worker (p-value= 0.022, CI=0.314-14.215) with reporting of occupational exposure (p-value< 0.05). CONCLUSION: this study recorded among participants a poor knowledge on post exposure prophylaxis and poor practice though a majority of study participants had possitive attitude towards PEP. Therefore, a formal training for all health care workers on post exposure prophylaxis to blood borne viruses, strict monitoring and evaluation of health care worker's adherence to standard precautions, adequate reporting of exposures and uptake of post exposure prophylaxis is recommended.</b><br/> text/html 2018-12-12T03:05:07+01:00 Michael Ogbonnaya Oji, Mesfin Haile, April Baller, Nathalie Tremblay, Nuha Mahmoud, Alex Gasasira, Victor Ladele, Catherine Cooper, Francis Ndivo Kateh, Tolbert Nyenswah, Peter Nsubuga [Research] - Implementing infection prevention and control capacity building strategies within the context of Ebola outbreak in a "Hard-to-Reach" area of Liberia - 12 October 2018. <b>INTRODUCTION: In August 2014, WHO declared that Ebola outbreak ravaging West Africa including Liberia had become a Public Health Emergency of International Concern (PHEIC). Infection prevention and control (IPC) among healthcare workers was pivotal in reducing healthcare worker infection and containing the recent EVD outbreak. Hard to reach areas (HTRA) presents peculiar challenges in public health emergencies. We present the result of IPC capacity building strategies deployed in Gbarpolu County: an HTRA of Liberia. METHODS: Between April to October 2015, we conducted IPC training and mentorship at the county, district and facility levels in a selected HTRA of Liberia using the keep Safe, Keep Serving manual and the WHO core components of infection control. Serial follow-up assessments and mentoring using the Liberian Minimum standard tool for safe care in Liberian health facilities (MST) were done. RESULTS: 180 (100%) facility based healthcare workers were trained: including 59 clinicians (32%) and 121 (67%) non-clinicians. 100% of the healthcare workers in four selected very HTRAs were trained and underwent facility based- mentorship. Compliance with IPC practice increased: the MST score increased from 75% to 90% and for the MST score for waste management and isolation increased 60% to 87%. CONCLUSION: Strengthening the capacity of healthcare workers for IPC was instrumental for containing the EVD epidemic but also critical for routine safe and quality services. A culture of IPC among healthcare workers in HTRA can be implemented through capacity building and training.</b><br/> text/html 2018-12-12T03:05:07+01:00 Abdelouahid Taleuan, Dounia Kamal, Moad Sebti, Moahamed Nourdine Elalami [Case report] - Fasciite nodulaire de la fosse infra-temporale: &agrave; propos d’un cas - 12 October 2018. <b>La fasciite nodulaire est une l&eacute;sion b&eacute;nigne &agrave; prolif&eacute;ration rapide de cellules myofibroblastiques, qui se d&eacute;veloppe aux d&eacute;pens d'un fascia musculaire au sein du tissu sous-cutan&eacute;. Sa croissance rapide et sa richesse cellulaire et mitotique font qu'elle est souvent prise &agrave; tort pour un sarcome. D'o&ugrave; l'importance de poser un diagnostic pr&eacute;cis pour &eacute;viter des chirurgies inutiles et souvent mutilantes.Nous rapportons dans cette observation une localisation exceptionnelle de cette tumeur au niveau de la fosse infra-temporale.</b><br/> text/html 2018-12-12T03:05:07+01:00 Olumide Adeleke Akitoye, Babatunde Oludare Fakuade, Thomas Oseghae Owobu, Akinwale Adeyemi Efunkoya, Adetokunbo Rafel Adebol,Sunday Olusegun Ajike [Research] - Anaesthesia for cleft lip surgeries in a resource poor setting: techniques, outcome and safety - 12 October 2018. <b>INTRODUCTION: Cleft lip and palate is one of the more common congenital malformation and the most common craniofacial anomalies in children. The treatment is expensive and requires specialised care. Access to this care in middle and low income countries is compounded by socioeconomic status of patients and their relation and also the inadequacy of expertise in medical personnel and infrastructure. Objective: the study aimed to review the techniques of anaesthesia used in a low resource setting in terms of the techniques, outcome, and safety. METHODS: this is a retrospective review of 79 cases done in a resource poor setting. Information regarding the patients, surgeries and modes of anaesthesia were retrieved from the case notes. RESULTS: a total of 62 patients were operated with incomplete cleft accounting for 37 (59.7%), complete 23(37.1%), and 2 (3.2%) as bilateral. Forty-six (74.2%) of patients had their surgery done with ketamine anaesthesia without endotracheal intubation, 14 (22.6%) had regional anaesthesia and 2 patients (3.2%) had general anaesthesia with endotracheal intubation. CONCLUSION: this study demonstrates that with careful planning and expertise, cleft lip repair can be done safely in resource poor setting.</b><br/> text/html 2018-12-12T03:05:07+01:00 Amel El Korbi, Rachida Bouatay, Jih&egrave;ne Houas, Karim Ben Ameur, Khaled Harrathi, Jamel Koubaa [Case report] - A rare location of thyroglossal duct cyst in a newborn - 10 October 2018. <b>Thyroglossal duct cyst of the tongue is a rare entity. Occurrence in the anterior part of the tongue is exceptional. We report in this paper a rare case of thyroglossal cyst of the anterior part of the tongue, discovered in a five-days-old newborn at delivery. Images have shown a cystic mass with homogenous liquid content. A transoral complete resection of the lesion was performed, with no postoperative complication. The histological analysis confirm the diagnosis of lingual thyroglossal duct cyst. There were no recurrence with a follow-up of eight months.</b><br/> text/html 2018-12-12T03:05:07+01:00 Brahim El Hasbaoui, Saloua Boujrad, Rachid Abilkacem, Aomar Agadr [Case report] - Vomissements associ&eacute;s &agrave; une stagnation pond&eacute;rale et convulsions : penser &agrave; une anomalie du cycle d’ur&eacute;e - 10 October 2018. <b>Dans certaines maladies m&eacute;taboliques h&eacute;r&eacute;ditaires, les vomissements peuvent appara&icirc;tre comme un sympt&ocirc;me &eacute;tant au premier plan, en particulier les anomalies du cycle de l'ur&eacute;e, qui sont habituellement diagnostiqu&eacute;s en p&eacute;riode n&eacute;onatale ou dans l'enfance. Nous en rapportons un cas de r&eacute;v&eacute;lation tardive par un &eacute;tat de mal convulsif. Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 13 ans, qui a &eacute;t&eacute; hospitalis&eacute; pour prise en charge d'un &eacute;tat de mal convulsif et un retard staturo-pond&eacute;ral. L'interrogatoire a r&eacute;v&eacute;l&eacute; la notion de vomissements chroniques avec des troubles du comportement, ralentissement id&eacute;omoteur et c&eacute;phal&eacute;es. L'examen a trouv&eacute; une ataxie. La ponction lombaire et le scanner c&eacute;r&eacute;bral sont normaux. Une ammoni&eacute;mie nettement augment&eacute;e est mise en &eacute;vidence 75 micromoles/l (11-50). La chromatographie des acides amin&eacute;s dans le sang a montr&eacute; une augmentation de la glutamine et de l'alanine, La chromatographie des acides amin&eacute;s dans les urines a montr&eacute; une augmentation des acides amin&eacute;s basiques &eacute;voquant un d&eacute;ficit du cycle de l'ur&eacute;e par d&eacute;ficit de l'enzyme Argininosuccinate lyase. La patiente a &eacute;t&eacute; trait&eacute; en urgence par une alimentation exclusivement glucidolipidique, et par benzoate de sodium permettant une am&eacute;lioration de l'&eacute;tat clinique, et une reprise de poids. Les crises convulsives ont &eacute;t&eacute; ma&icirc;tris&eacute;es par le ph&eacute;nobarbital. L'enqu&ecirc;te familiale a trouv&eacute; une sœur &acirc;g&eacute;e de 20 ans suivie depuis l'&acirc;ge de 3 ans pour crises convulsives trait&eacute; par le ph&eacute;nobarbital dont le bilan m&eacute;tabolique r&eacute;alis&eacute; dans notre service a objectiv&eacute; la m&ecirc;me anomalie du cycle de l'ur&eacute;e que sa sœur. A tout &acirc;ge, devant une enc&eacute;phalopathie avec &eacute;pilepsie, vomissement, stagnation pond&eacute;rale et hyperammoni&eacute;mie, il faut penser &agrave; un d&eacute;ficit du cycle de l'ur&eacute;e. Le diagnostic est tr&egrave;s souvent pos&eacute; lors d'un acc&egrave;s neuro-digestif aigue associant vomissements, troubles de conscience et/ou crises convulsives.</b><br/> text/html 2018-12-12T03:05:07+01:00 Nery Sabl&oacute;n-Gonz&aacute;lez, Noel Lorenzo Villalba, Yanet Parodis L&oacute;pez, Juan Manuel Fern&aacute;ndez, Silvia Marrero-Robayna, Melek Kechida, Rafael Camacho-Galan, Jose Carlos Rodr&iacute;guez P&eacute;rez [Case report] - Pathological changes of renal biopsy in Sj&ouml;gren Syndrome - 10 October 2018. <b>We are presenting the case of a 53-year-old woman with a history of Sj&ouml;gren syndrome and a secondary antiphospholipid syndrome admitted at the Nephrology department for the evaluation of renal failure. The patient was initially diagnosed with tubulointerstitial nephritis and subsequently a membranoproliferative type I glomerulonephritis, secondary to cryoglobulins during the course of the disease. Repeated renal biopsies were required to confirm the diagnosis.</b><br/> text/html 2018-12-12T03:05:07+01:00 Nabil Tiresse, Ahmed Abid [Images in medicine] - Compression m&eacute;dullaire au cours d’une spondylodiscite tuberculeuse: &agrave; propos d’un cas - 10 October 2018. <b>Patient &acirc;g&eacute; de 76 ans, admis en pneumologie pour prise en charge d'une spondylodiscite tuberculeuse d&eacute;couverte par un tableau clinique associant amaigrissement, fi&egrave;vre prolong&eacute;e et douleur lombaire lancinante qui datent de 2 mois auparavant, confirm&eacute;e par tomodensitom&eacute;trie lombaire. Le diagnostic a &eacute;t&eacute; retenu suite &agrave; l'&eacute;tude Gene Xpert sur liquide de ponction biopsie au niveau de l'anomalie vert&eacute;brale L1 qui a mis en &eacute;vidence le mycobacterium tuberculosis. Trois semaines apr&egrave;s d&eacute;but de traitement le patient a pr&eacute;sent&eacute; un d&eacute;ficit moteur au niveau des 2 membres inf&eacute;rieurs suivi d'un d&eacute;ficit sensitif. Ces anomalies ont &eacute;t&eacute; confirm&eacute;es sur IRM qui a montr&eacute; des anomalies du signal somatique de L1 avec tassement du corps vert&eacute;bral (A), ces l&eacute;sions sont r&eacute;hauss&eacute;es apr&egrave;s injection de gadolinium (B) qui a montr&eacute; &eacute;galement une rupture corticale post&eacute;rieure avec &eacute;pidurite en regard. Cet aspect radiologique a permis de confirmer le diagnostic de compression m&eacute;dullaire sur spondylodiscite tuberculeuse. Quelques jours apr&egrave;s le patient a pr&eacute;sent&eacute; des signes de sepsis s&eacute;v&egrave;re compliqu&eacute; d'un choc septique suite auquel le patient &eacute;tait d&eacute;c&eacute;d&eacute;. La compression m&eacute;dullaire est l'un des aspects rares apparaissant au cours d'une spondylodiscite ayant un potentiel &eacute;lev&eacute; de complications irr&eacute;versibles en absence d'intervention pr&eacute;coce pour d&eacute;compression m&eacute;dullaire. La chirurgie et le traitement antibacillaire d&eacute;marr&eacute; pr&eacute;cocement sont garants d'une &eacute;volution favorable &agrave; moyen et &agrave; long terme.</b><br/> text/html 2018-12-12T03:05:07+01:00 Joseph Archibong, Eshan Henshaw, Adebola Ogunbiyi, Adekunle George [Research] - Occupational skin disorders in a subset of Nigerian hairdressers - 10 October 2018. <b>INTRODUCTION: Hsairdressing is associated with a wide range of disorders. This is particularly true in the African hairdresser, who is saddled with the responsibility of ‘taming’ the rather difficult-to-manage African hair, and is thus exposed to a wide range of chemical, biological and physical materials in the hair grooming process. We therefore sought to determine the prevalence and pattern of occupational skin disorders among hairdressers in Ibadan, one of the oldest and largest cities in Nigeria. METHODS: This was a cross sectional study of hairdressers conducted in 2013 in Ibadan, Nigeria. Hairdressers and their apprentices were interviewed using a structured questionnaire, following which a thorough physical examination was performed to identify any skin disorder. RESULTS: A total of 226 hairstylists were recruited. The prevalence of occupational skin disorders in the study was 68.13%. The prevalence of specific skin disorders was 32.74% for nail disorders; 28.75% for traumatic skin disorders; and 2.64% for hand dermatitis. CONCLUSION: There is a high prevalence of occupational skin disorders among hairdressers, and this may have personal and public health implications.</b><br/> text/html 2018-12-12T03:05:07+01:00 Christian Chukwukere Ogoke, Ifeanyi Innocent Ike, Augustine Emeka Osuji, Kingsley Asinobi, Chukwudi Ernest Okeke [Case report] - Multiple subacute bilateral cerebral infarcts in a 9-year-old Nigerian male: a case of childhood primary angiitis of the central nervous system - 10 October 2018. <b>A Primary Angiitis of the Central Nervous System (PACNS) is ill-defined, complex and rare in children. Clinical presentation is variable, diagnosis is challenging and it is life-threatening but treatable. The index case is a 9-year old male who presented with progressively slurred speech, progressive weakness of the limbs, hemifacial weakness and vomiting. There were no clinical or laboratory features of systemic vasculitis. Neuroimaging showed multiple subacute infarcts in both cerebral hemispheres. He responded well to immunosuppressive therapy. The case report aims to underscore the need for high index of suspicion, early neuroimaging for progressive nonspecific decline in neurologic function and the treatable nature of the condition if diagnosis is made early.</b><br/> text/html 2018-12-12T03:05:07+01:00 Zenab Alami, Touria Bouhafa, Abderrahmane Elmazghi, Khalid Hassouni [Case series] - L’apport de la radio-chimioth&eacute;rapie concomittante dans la prise en charge du carcinome indiff&eacute;renci&eacute; du nasopharynx de l’adulte - 10 October 2018. <b>L'objectif de l'&eacute;tude et d'Analyser les caract&eacute;ristiques &eacute;pid&eacute;miologiques, cliniques, th&eacute;rapeutiques et &eacute;volutives du carcinome indiff&eacute;renci&eacute; du nasopharynx de l'adulte. Il s'agit d'une &eacute;tude cohorte r&eacute;trospective portant sur 163 patients &acirc;g&eacute;s de 17 ans et plus, trait&eacute;s pour un carcinome indiff&eacute;renci&eacute; du nasopharynx non m&eacute;tastatique. L'&acirc;ge moyen des patients &eacute;tait de 46,5ans, avec un sexe-ratio de 1,7. 35,57% des patients &eacute;taient atteints de tumeurs localement &eacute;volu&eacute;es (T3-T4) et 52,27% avec une atteinte ganglionnaire r&eacute;gionale avanc&eacute;e (N2-N3). Sur le plan th&eacute;rapeutique une chimioth&eacute;rapie neoadjuvante a &eacute;t&eacute; r&eacute;alis&eacute;e chez 77% des patients et 93,8% des patients ont b&eacute;n&eacute;fici&eacute; d'une radio-chimioth&eacute;rapie concomitante. Apr&egrave;s un recul moyen de 40,8 mois la survie globale &eacute;tait de 92,9% et la survie sans r&eacute;cidive (SSR) &eacute;tait de 78,9%. L'analyse de la survie sans r&eacute;cidive SSR en fonction des diff&eacute;rents facteurs pronostiques a montr&eacute; une diff&eacute;rence statistiquement significative pour l'atteint ganglionnaire avec des taux de SSR &agrave; trois ans de 88%, 82,6%, 80,8% et 61,5% en cas de tumeur class&eacute;e N0, N1, N2 et N3 respectivement (p = 0,02). Le cancer du nasopharynx est une maladie complexe, mais des progr&egrave;s ont &eacute;t&eacute; accomplis gr&acirc;ce &agrave; des perc&eacute;es en radioth&eacute;rapie et en biologie mol&eacute;culaire. La radio-chimioth&eacute;rapie concomitante repr&eacute;sente le standard th&eacute;rapeutique des stades cliniques sup&eacute;rieur ou &eacute;gal &agrave; T2, ou sup&eacute;rieur ou &eacute;gal &agrave; N1. Les techniques innovantes d'irradiation semblent prometteuses et pourraient pallier aux probl&egrave;mes de toxicit&eacute; tardive tout en assurant un excellent taux de contr&ocirc;le local.</b><br/> text/html 2018-12-12T03:05:07+01:00 Romuald Kouitcheu, Dominique N'Dri Oka, Guy Varlet [Case report] - Hydroc&eacute;phalie sur thrombophl&eacute;bite du sinus sagittal sup&eacute;rieur par ost&eacute;ite de la vo&ucirc;te &agrave; Aspergillus fumigatus sur terrain immunocomp&eacute;tent - 09 October 2018. <b>Les auteurs rapportent dans une observation, une association pathog&eacute;nique inhabituelle de l&eacute;sions cr&acirc;nio-enc&eacute;phaliques. Elle se caract&eacute;rise par l'association d'une ost&eacute;ite de la vo&ucirc;te &agrave; Aspergillus fumigatus, d'une thrombophl&eacute;bite sous-jacente, elle-m&ecirc;me compliqu&eacute;e d'une hypertension intracr&acirc;nienne par hydroc&eacute;phalie. Nous rapportons le cas d'un homme de 43 ans, s&eacute;rologie VIH (virus d'immunod&eacute;ficience humaine) n&eacute;gative avec une notion d'infection multi-r&eacute;cidivante du scalp frontal. Ce patient a &eacute;t&eacute; trait&eacute; avec succ&egrave;s par une d&eacute;rivation du liquide c&eacute;r&eacute;brospinal (LCS), du K&eacute;toconazole et de l'h&eacute;parine de bas poids mol&eacute;culaire. Nous discutons &agrave; la lumi&egrave;re de la litt&eacute;rature les diff&eacute;rents aspects physiopathologiques et de la prise en charge de cette exceptionnelle association pathog&eacute;nique.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ameel Farooq Al Shawi, Abdulrahman Nassir Abdullateef, Mohammad Anmar Khedher, Mohammad Saadon Rejab, Russul Nadhim Khaleel [Research] - Assessing stress among medical students in Anbar governorate, Iraq: a cross-sectional study - 09 October 2018. <b>INTRODUCTION: A high prevalence of stress has been recorded among medical students worldwide. Additionally, high levels of personal distress may have a negative effect on the cognitive functioning and learning abilities of medical students. METHODS: a cross-sectional study was conducted using medical students in the Al-Anbar governorate; data collection was carried out from February to March 2018. The assessment of stress levels among these students was administered using the Kessler10 Psychological Distress instrument (K10). RESULTS: 231 students (77.5%) reported at least some degree of stress, ranging between severe (30.2%), moderate (25.5%) and mild (21.8%). The highest proportion of students with stress (11.5%) was reported by first-year students; this proportion largely fell within the moderate and severe categories. There was a significant statistical association between gender and stress level. CONCLUSION: there is a high level of stress among medical students in Falluja and Anbar Universities; this may require special programmes to identify any predisposing factors.</b><br/> text/html 2018-12-12T03:05:07+01:00 Amira Jamoussi, Takoua Merhabene, Mona Mlika, Henda Neji, Faouzi El Mezni, Jalila Ben Khelil, Mohamed Besbes [Case report] - Interstitial pneumonia in a glassblower: think to chronic beryllium disease! - 09 October 2018. <b>Chronic beryllium disease (CBD) is an occupational illness with varying severity. In this report, we describe a 27 year old man, glassblower, who developed a fatal CBD after six months of unknown Beryllium's exposure. The diagnosis was suspected on histological examination and then consolidated by confirmation of Beryllium's exposure at the working area. Physicians should be aware of the potential risk to develop CBD in glassblowers. These workers should benefit from early medical surveillance using the Beryllium lymphocyte proliferation test (BeLPT) and therefore from suitable management.</b><br/> text/html 2018-12-12T03:05:07+01:00 Nabil Tiresse, Hajar Benataya [Images in medicine] - Subcutaneous nodules revealing systemic sarcoidosis: a case report - 08 October 2018. <b>57-year-old patient, treated for high blood pressure, never treated for tuberculosis and without toxic habits, having presented for one month a cutaneous lesions prevailing on the two upper limbs and on the face, painless, without pruritus, associated to redness eye and dyspnea stage II of the mMRC; the clinical examination revealed papules, subcutaneous nodules of 0.5cm on average and not exceeding 1cm for the most voluminous on the arms and forearms and on the face and the left eyelid, a lupus pernio is also present on the nose. Some lesions have presenting inflammatory signs. The pathological anatomy study of a skin biopsy revealed a granuloma with epithelioid and giant cells without caseous necrosis, suggesting the diagnosis of sarcoidosis first. A chest x-ray showed mediastinal lymphadenopathy and bilateral interstitial syndrome confirmed on thoracic computed tomography. The exploration of respiratory function reveals a restrictive ventilatory disorder supporting pulmonary parenchymal involvement. Ophthalmological examination shows anterior uveitis. The angiotensin converting enzyme assay is high and the tuberculin skin test reveals an anergy. The patient was treated by corticosteroids; synthetic antimalarials will be prescribed when no response or insufficient response happens. Subcutaneous sarcoidosis, also known as Darier-Roussy, and lupus pernio, are uncommon but specific of sarcoidosis. Their presence is often associated with systemic involvement, particularly thoracic.</b><br/> text/html 2018-12-12T03:05:07+01:00 Abdelhakim Elyajouri, Mohammed Benyahia, Rachid Abilkassem, Aomar Agadr [Case report] - Pycnodysostose: &agrave; propos d’un cas - 08 October 2018. <b>La pycnodysostose est une maladie osseuse g&eacute;n&eacute;tique tr&egrave;s rare associant une ost&eacute;ocondensation, un syndrome dysmorphique et un retard de croissance. Rappeler les anomalies ph&eacute;notypiques, les signes radiologiques, la prise en charge th&eacute;rapeutiques et &eacute;volutifs de la Pycnodysostose chez un enfant de 11 ans. Enfant de 11 ans, a &eacute;t&eacute; r&eacute;fer&eacute; par son dentiste pour &eacute;valuation de son &eacute;tat clinique. Il est de parents consanguin de premier degr&eacute;, qui pr&eacute;sentait depuis l'&acirc;ge de 3 ans des fractures spontan&eacute;es &agrave; r&eacute;p&eacute;tition. L'examen trouvait un syndrome dysmorphique fait de bosse frontale, fontanelle ant&eacute;rieure persistante, micrognathie, malformations des doigts, malposition dentaire, ongles incurv&eacute;es, thorax asym&eacute;trique, attitude scoliotique du rachis dorsal, avec retard statural important (-4DS). Les radiographies du squelette montraient une densification des os de la base du cr&acirc;ne, une persistance de la fontanelle ant&eacute;rieure, une malposition dentaire, une densification diaphysaire et m&eacute;taphysaire des os longs pr&eacute;dominants au niveau des membres inf&eacute;rieurs avec pr&eacute;sence des cals vicieux et des phalanges gr&ecirc;les des mains. L'ost&eacute;odensitom&eacute;trie &eacute;tait normale. Devant les signes cliniques et les manifestations radiologiques, le diagnostic retenu est une pycnodysostose. Un conseil g&eacute;n&eacute;tique a &eacute;t&eacute; propos&eacute; pour la famille ainsi qu'une prise en charge dentaire et orthop&eacute;diques. La pycnodysostose est une entit&eacute; rare de diagnostic parfois difficile et tardif, elle pose un probl&egrave;me du diagnostic avec l'ost&eacute;oporose. Le traitement est essentiellement pr&eacute;ventif des fractures et des caries dentaires.</b><br/> text/html 2018-12-12T03:05:07+01:00 Nabil Tiresse, Mohamed Allaoui [Images in medicine] - Tuberculose multifocale r&eacute;v&eacute;l&eacute;e par une pancytop&eacute;nie: &agrave; propos d’un cas - 05 October 2018. <b>Patiente de 58 ans, admise dans un tableau de polypn&eacute;e avec signes de lutte respiratoire et d&eacute;saturant &agrave; 65% &agrave; l’air ambiant et une fi&egrave;vre &agrave; 38,5°C, l’h&eacute;mogramme trouve une pancytop&eacute;nie, l’ionogramme objctive une l&eacute;g&egrave;re cytolyse h&eacute;patique et la radio des poumons objective un aspect de miliaire bilat&eacute;rale. Les recherches de BK dans les expectorations &eacute;taient n&eacute;gatives ainsi que le Gene Xpert. L’&eacute;tude anatomo-pathologique de la biopsie ost&eacute;om&eacute;dullaire montre un granulome &eacute;pith&eacute;lio-giganto-cellulaire sans n&eacute;crose cas&eacute;euse et la PCR met en &eacute;vidence le mycobacterium tuberculosis dans le pr&eacute;l&egrave;vement de biopsie ost&eacute;o-m&eacute;dullaire. Une biopsie h&eacute;patique a mis en &eacute;vidence un granulome &eacute;pith&eacute;lio&iuml;de sans n&eacute;crose cas&eacute;euse. Le diagnostic de tuberculose multifocale avec atteinte pulmonaire, h&eacute;matopo&iuml;&eacute;tique et h&eacute;patique &eacute;tait retenu. La miliaire tuberculeuse est l’une des atteintes s&eacute;v&egrave;res dans le cadre de la tuberculose, les bacilloscopies sont souvent n&eacute;gatives et le diagnostic peut &ecirc;tre retenu par d’autres pr&eacute;l&egrave;vements notamment l’&eacute;tude du liquide c&eacute;phalo-rachidien et la biopsie ost&eacute;om&eacute;dullaire. La biopsie d’autres organes peut apporter le diagnostic dans de rares cas. L’av&egrave;nement de la PCR comme technique de biologie mol&eacute;culaire a permis de raccourcir le d&eacute;lai de diagnostic et donc la mise en route du traitement qui parfois doit &ecirc;tre administr&eacute; avant m&ecirc;me d’obtenir la certitude diagnostique compte tenu de la mise en jeu du pronostic vital au cours de ces atteintes s&eacute;v&egrave;res.</b><br/> text/html 2018-12-12T03:05:07+01:00 Soufiane Aharram, Abdelhafid Derfoufi, Abdessamad Kharraji, Jawad Amghar, Mohammed Benhamou, Abdelkarim Daoudi, Omar Agoumi [Case report] - Un cas rare de luxation astragalo-scapho-calcan&eacute;enne interne - 05 October 2018. <b>Nous rapportons un cas d'un jeune patient ayant pr&eacute;sent&eacute; &agrave; la suite d'un accident de sport une luxation astragalo-scapho-calcan&eacute;enne interne o&ugrave; il a b&eacute;n&eacute;fici&eacute; d'un traitement orthop&eacute;dique avec un bon r&eacute;sultat clinique et radiologique.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mike Wells, Lara Nicole Goldstein [Research] - An algorithm to improve the accuracy of emergency weight estimation in obese children - 05 October 2018. <b>INTRODUCTION: During medical emergencies in children, accurate and appropriate weight estimations may ultimately influence the outcome by facilitating the delivery of safe and effective doses of medications. Children at the extremes of habitus, especially obese children, are more at risk of an inaccurate weight estimation and therefore may be more at risk of medication errors. The objective was therefore to develop an algorithm to guide accurate emergency weight estimation in obese children. METHODS: Relevant medical evidence was reviewed regarding weight estimation and its role and timing in the resuscitation of obese children. This was used as the basis for a weight-estimation algorithm. RESULTS: There was limited evidence regarding the way the weight-estimation systems should be used in obese children other than that the dual length- and habitus-based systems were the most accurate. The methods included in the algorithm were the Broselow tape, the Mercy method, parental estimates, the PAWPER XL tape and the Traub-Johnson formula. The algorithm recognised several ways in which weight estimation could be tailored to the clinical scenario to estimate both ideal and total body weight. CONCLUSION: Weight-estimation in obese children must be conducted appropriately to avoid medication errors. This algorithm provides a framework to achieve this.</b><br/> text/html 2018-12-12T03:05:07+01:00 Yassine Nhamoucha, Mohammed Tazi, Hicham Abdellaoui, Othmane Alaoui, Saad Andaloussi, Mohammed Oukhoya, Lamyae Chater, Karima Atarraf, Mounir Arroud, Abderahman Afifi [Case report] - L’&eacute;piphysiolyse f&eacute;morale sup&eacute;rieure chez un malade en paralysie c&eacute;r&eacute;brale suite &agrave; une crise convulsive - 05 October 2018. <b>L'&eacute;piphysiolyse f&eacute;morale sup&eacute;rieure (EFS) correspond &agrave; un glissement de l'&eacute;piphyse f&eacute;morale sup&eacute;rieure par rapport au col f&eacute;moral qui le plus souvent se fait en arri&egrave;re et en dedans, sous l'effet du poids du corps. Cette affection survient le plus fr&eacute;quemment lors de la pubert&eacute;. Nous rapportons le cas d’un enfant atteint de paralysie c&eacute;r&eacute;brale avec spasticit&eacute; des quatre membres, ce qui repr&eacute;sente une entit&eacute; tr&egrave;s rare.</b><br/> text/html 2018-12-12T03:05:07+01:00 Oliver Waithaka Mbuthia, Scholastica Gatwiri Mathenge, Micah Ongeri Oyaro, Musa Otieno Ng'ayo [Research] - Etiology and pathogenicity of bacterial isolates: a cross sectional study among diarrheal children below five years in central regions of Kenya - 04 October 2018. <b>INTRODUCTION: Bacterial agents are among pathogens implicated to cause diarrhea in children resulting to huge mortality and morbidities. Bacterial etiologies causing diarrhea in children below five years are rarely investigated in Central Kenya, which would otherwise guide prescription and target health education. METHODS: A cross-sectional study approach was applied on 163 randomly selected stool samples from children below five years who presented with diarrhea in Murang`a and Muriranja`s hospitals. The objective was to determine the bacterial agents of diarrhea. Enteric bacterial pathogens were cultured using appropriate media and identified. Statistical analyses were performed using STATA v.13. Chi-square or Fisher exact-test were used to check for evidence of relationship whenever applicable. RESULTS: There were nearly equal distributions in gender 86 (52.8%) female vs. 77 (47.2%) male, majority (35.6%) aged between 0-12 months. Bacterial isolates were highly diverse in female than the male, children aged 49-60 months and least among those aged 0-12 months. A total of 188 bacterial isolates belonging to 11 genera were recovered. The predominant bacteria was nonpathogenic Escherichia coli 85 (45.2%), while 13 (6.9%) Escherichia coli were positive for virulence genes, including 8 (4.3%) positive for LT and STp Shiga-like or Enterotoxigenic Escherichia coli, 3 (1.6%) positive for eae and bfpA Enteropathogenic Escherichia coli and 2 (1.1%) positive for Enteroaggregative Escherichia coli gene. Others included: Salmonella 21 (11.2%), Pseudomonas 14 (7.4%), Shigella 14 (7.4%), Klebsiella 12 (6.4%), Aeromonas 8 (4.3%), Enterobacter 7 (3.7%), Proteus 8 (4.3%), Citrobactor 3 (1.6%), Yersinia 2 (1.1%) and Vibrio 1 (0.5%). CONCLUSION: Salmonella was the major bacterial isolate and majority of the bacteria were statistically significant cause of diarrhea (p=0.001).</b><br/> text/html 2018-12-12T03:05:07+01:00 Siham Alaoui Rachidi [Case report] - Une cause rare et m&eacute;connue de douleur abdominale: l’appendagite &eacute;piplo&iuml;que: &agrave; propos d’un cas - 04 October 2018. <b>Les appendagites &eacute;piplo&iuml;ques primitives sont des causes rares d’abdomen aigu. Elles sont souvent prises pour une appendicite aigu&euml; ou une sigmo&iuml;dite diverticulaire et le diagnostic est pos&eacute; au cours d’une intervention chirurgicale. Nous rapportons un cas o&ugrave; la tomodensitom&eacute;trie a permis de poser le diagnostic et nous insisterons sur l’aspect imagerie qui permet de sursoir ainsi &agrave; une chirurgie inutile.</b><br/> text/html 2018-12-12T03:05:07+01:00 Takura Innocent Kanonge, Felix Chamunyonga, Nellia Zakazaka, Claitos Chidakwa, Mugove Gerald Madziyire [Case series] - Hepatic rupture from haematomas in patients with pre-eclampsia/eclampsia: a case series - 04 October 2018. <b>Hepatic rupture from haematomas is a rare complication of severe preeclampsia/eclampsia especially when complicated with the haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. It is associated with poor maternal and foetal outcomes as demonstrated by three cases we describe. The first case had eclampsia at 31 weeks gestation with features of abruptio placentae and at caesarean section we found haemoperitoneum of 1.5 litres, a 10cm liver rupture and a still birth. She subsequently died in ICU within 24 hours of surgery; the second case had eclampsia at 35 weeks and ended up as a table death during emergency caesarean section. She had 4 litres of haemoperitoneum, hepatic rupture, placental abruption and a stillbirth; the third case had pre-eclampsia at 33 weeks with markedly elevated liver enzymes. She had one litre haemoperitoneum, right lobe hepatic rupture and a stillbirth. She recovered after conservative management. Severe pre-eclampsia/eclampsia associated hepatic rupture calls for rapid and aggressive intervention with prompt multidisciplinary management to avert adverse outcomes.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mohamed Amine Mnaili, Ahmed Bourazza [Images in medicine] - Infarctus m&eacute;dullaire aigu: un diagnostic m&eacute;connu au pronostic s&eacute;v&egrave;re - 04 October 2018. <b>L’infarctus m&eacute;dullaire est un diagnostic relativement m&eacute;connu, qui engage &agrave; court terme le pronostic, aussi bien vital que fonctionnel du patient. La vascularisation m&eacute;dullaire est l’une des plus complexes de l’organisme en raison du nombre important d’art&egrave;res qui y contribuent. La raret&eacute; des accidents vasculaires m&eacute;dullaires et la faible accessibilit&eacute; des vaisseaux m&eacute;dullaires aux investigations expliquent que nos connaissances restent limit&eacute;es. Nous rapportons le cas d’un patient de 62 ans, diab&eacute;tique de type 2 sous antidiab&eacute;tiques oraux depuis 13 ans et suivi pour un psoriasis depuis 4 ans, a &eacute;t&eacute; amen&eacute; &agrave; l’h&ocirc;pital dans la nuit par son fils devant l’installation brutal d’un d&eacute;ficit des 2 membres sup&eacute;rieurs. Ce d&eacute;ficit &eacute;tait pr&eacute;c&eacute;d&eacute; de cervicalgie aigu&euml; lors d’une mont&eacute;e brutale du patient en pratiquant sa pri&egrave;re quotidienne. A son admission, le patient &eacute;tait conscient, tension art&eacute;rielle: 120/86mmhg, fr&eacute;quence cardiaque: 89 battements/min, apyr&eacute;tique. L’examen clinique r&eacute;v&eacute;lait une dipl&eacute;gie brachiale flasque. Il n’y avait pas de troubles sensitifs ni de troubles sphinct&eacute;riens et l’examen des paires cr&acirc;niens &eacute;tait normal. Une IRM (Imagerie par R&eacute;sonnance Magn&eacute;tique) m&eacute;dullaire &eacute;tait r&eacute;alis&eacute;e en urgence, mettant en &eacute;vidence un hyper signal T2 et une diffusion centrale bilat&eacute;rale r&eacute;alisant un aspect de « Snake-eyes » (A et B). Le bilan &eacute;tiologique avait r&eacute;v&eacute;l&eacute; la pr&eacute;sence d’une plaque d’ath&eacute;rome &agrave; l’origine de l’art&egrave;re carotide interne gauche. Le diagnostic d’infarctus m&eacute;dullaire sur embolies fibrocartilagineuses a &eacute;t&eacute; retenu. Une r&eacute;&eacute;ducation fonctionnelle est commenc&eacute;e pr&eacute;cocement ainsi qu’un traitement par antiagr&eacute;gant plaquettaire.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ipek Guney Varal, Pelin Dogan [Images in medicine] - Abdominal eggshell calcifications in the newborn: meconium peritonitis - 04 October 2018. <b>Meconium peritonitis is a sterile chemical peritonitis caused by intestinal perforation in-utero or shortly after birth and perforation usually occurs due to intrauterine obstruction. Its incidence is approximately 1 in 35,000 births and the mortality was reported to be 60-80%. The radiographic findings of meconium peritonitis are pneumoperitoneum, intestinal obstruction and abdominal calcifications. The classic eggshell calcification occurs owing to the defensive mechanism of the body against the inflammation in an effort to surround the meconium in the abdominal cavity. In a newborn with abdominal distension, meconium peritonitis should be kept in mind, especially if calcified foci are seen on plain abdominal radiographs, since timely diagnosis and surgery improves the survival rates. We present the case of a female newborn of 34 weeks' gestational age was admitted to the neonatal intensive care unit (NICU) with marked abdominal distension. The pregnancy was complicated by maternal polyhydramnios and a cesarean section was performed due to fetal distress. The infant was noted to have a grossly distended abdomen; however, the physical examination was otherwise unremarkable. The abdominal radiograph revealed distension of the bowel loops and free air with multiple peritoneal calcifications (Figure 1). Surgery, performed on day 1 of life, demonstrated ileal atresia and perforation in the distal part of the ileum. Solid meconium, which leaked into the abdominal cavity was removed and the atresic bowel was resected and anastomosed. The infant regained bowel function on postoperative day 7 and discharged home on the third week after gradual advancement to full enteral feeding.</b><br/> text/html 2018-12-12T03:05:07+01:00 Carlos Eduardo Salazar-Mej&iacute;a, Enrique Gonz&aacute;lez-Nava [Images in medicine] - Abscessed inguinal metastasis as an initial presentation of testicular cancer - 04 October 2018. <b>A 24-year-old man presented to the emergency service with fever, malaise and a large abscessed tumor located in the left inguinal region.He had a history of hydrocele and varicocele treated surgically in childhood.One year before admission, a small nodule approximately 1 x 2 cm appeared in his left inguinal region; this nodule increased in size and was accompanied by a weight loss of approximately 15 kg. On arrival, a large abscessed and ulcered adenopathy 20 x 18 x 11 cm with purulent secretion was seen in the area associated with a 5 cm left testicular tumor. Imaging studies revealed a 1 cm left subpleural lung nodule on short axis. A radical left orchiectomy and a biopsy of the abscessed adenopathy were performed and the histopathologic report showed a mixed germ cell tumor. Tumor markers after orchiectomy were LDH 1124 IU/L, ²-hCG 197mIU/mL, AFP 172 ng/mL. Wide spectrum antibiotics were started in addition to wide surgical debridement of the abscess with a favorable clincial response. After surveillance, the patient was discharged to receive ambulatory chemotherapy. Inguinal ganglionic metastasis associated with testicle cancer is a rare finding.The history of inguinal and/or scrotal surgery could explain this phenomenon as a result of an alteration of regional lymphatic drainage.When this group of patients develops testicular cancer, involvement of an inguinal node is described in up to 2-10% of cases.Despite this, routine inguinal lymphadenectomy is still controversial in this scenario.</b><br/> text/html 2018-12-12T03:05:07+01:00 Salamata Diallo, Marie Louise Bass&egrave;ne, Mamadou Ngon&eacute; Gueye, Mame Aiss&eacute; Thioubou, Daouda Dia, Mouhamadou Mbengue, Mamadou Lamine Diouf [Case series] - H&eacute;patite virale B: aspects cliniques, paracliniques et &eacute;volutifs dans le service d’H&eacute;pato Gastroent&eacute;rologie de l’H&ocirc;pital Aristide Le Dantec: &agrave; propos de 728 cas - 03 October 2018. <b>L’h&eacute;patite virale B constitue un probl&egrave;me majeur de sant&eacute; publique en Afrique subsaharienne avec environ 65 millions de porteurs chroniques et 56.000 d&eacute;c&egrave;s par an. Notre &eacute;tude avait pour but d’&eacute;tudier les aspects &eacute;pid&eacute;miologiques, paracliniques, th&eacute;rapeutiques, &eacute;volutifs des patients atteints d’h&eacute;patite virale B suivis dans notre service et de d&eacute;crire leurs profils s&eacute;rologiques. Nous avons r&eacute;alis&eacute; une &eacute;tude r&eacute;trospective, longitudinale de 2010 &agrave; 2014 dans le service d’h&eacute;pato gastroent&eacute;rologie de l’h&ocirc;pital Aristide Le Dantec de Dakar. Nous avons inclus tous les patients suivis en ambulatoire ou hospitalis&eacute;s qui avaient une positivit&eacute; de l’AgHBs. Nous avons collig&eacute; 728 cas de patients infect&eacute;s par le virus de l’h&eacute;patite B. Ils &eacute;taient constitu&eacute;s de 7 cas d’h&eacute;patite aigu&euml;, de 442 cas d’infections chroniques, de 161 cirrhotiques et de 118 cas de carcinome h&eacute;patocellulaire. L’&acirc;ge moyen &eacute;tait de 33 ans [14 - 83 ans] avec un sex-ratio de 2,2. Les circonstances de d&eacute;couverte &eacute;taient repr&eacute;sent&eacute;es par le d&eacute;pistage syst&eacute;matique (26,2%), les douleurs de l’hypochondre droit (23%) et le don de sang (18,6%). Il y avait 59 patients monoinfect&eacute;s par le virus de l’h&eacute;patite B qui &eacute;taient au stade d’h&eacute;patite chronique active. Les porteurs inactifs &eacute;taient au nombre de 118. Par insuffisance d’exploration li&eacute;e &agrave; des contraintes &eacute;conomiques, le statut s&eacute;rologique &eacute;tait ind&eacute;termin&eacute; chez 252 patients. Un traitement antiviral B n’a pu &ecirc;tre institu&eacute; que chez 58 patients. Sous T&eacute;nofovir, la r&eacute;ponse virologique et biochimique &eacute;tait respectivement de 85% et 100% apr&egrave;s 120 semaines de traitement. Le virus de l’h&eacute;patite B est une cause majeure d’h&eacute;patopathie au S&eacute;n&eacute;gal.</b><br/> text/html 2018-12-12T03:05:07+01:00 Cyrille Bisseye, Landry-Erik Mombo, St&eacute;phane Meyet Me Bie, Apollinaire Edou, Jean Marie Eko-Mba, Jean-Charles Etho-Mengue, K&eacute;vin Mbacky, Arnaud Mongo-Delis, Bertrand M'batchi, Bolni Marius Nagalo [Research] - Trends of blood-borne infectious diseases in a rural blood donation center of southeast Gabon (Koula-Moutou) - 03 October 2018. <b>INTRODUCTION: Blood-borne pathogens such as human immunodeficiency virus (HIV), hepatitis B and C (HBV and HCV) viruses and <i>Treponema pallidum</i> remain a major public health problem in sub-Saharan Africa. The purpose of this study was to assess the frequency and clinical implications of HIV, HBV, HCV and <i>Treponema pallidum</i> markers in blood donors in a rural area of Southeast Gabon (Koula-Moutou) from 2012 to 2017. METHODS: hepatitis B surface antigen (HBsAg), anti-HIV, anti-HCV and anti-<i>Treponema pallidum</i> antibodies were screened using (RDTs). RESULTS: of a total of 5,706 blood donors, 1,054 (18.5%) were seropositive for at least one infectious marker and 59 (5.6%) had serologic evidence of multiple infections. The overall seroprevalence of HIV, HBsAg, HCV, and syphilis was 3.1%; 5.9%; 6.2% and 3.3%, respectively. HIV, syphilis and HCV distributions were associated with neither the sex nor the age of the donors. Only HBsAg seroprevalence was significantly higher in donors of the age group 26-35 years old compared to donors of the age group 36-45 years (OR = 1.43 (95% CI: 1.01-2.04), P = 0.045). There was a significant increase in the frequencies of HIV and syphilis and a regression of HBsAg and HCV among blood donors. CONCLUSION: this study presents the epidemiology of the main pathogens detected in blood donors in a rural area in Gabon. We found that the overall distribution of transfusion transmitted infectious diseases were lower than those observed in the general population but could be underestimated due to the use of RDTs in the screening process of the blood donations.</b><br/> text/html 2018-12-12T03:05:07+01:00 Pelin Dogan, Ipek G&uuml;ney Varal [Images in medicine] - A stitched jaw in the newborn: subglosso-palatal membrane - 03 October 2018. <b>Subglosso-palatal membrane (SPM) is an extremely rare entity and only a few neonatal cases have been reported in the literature. Anatomically, SPM is a fibrous tissue, extending from the floor of the mouth to the palate. Majority of the cases are recognized during the first feeding with the inability of opening the mouth and latching, thus feeding difficulty is the major sign that prompt the physician to consider the diagnosis. Simple surgical resection of the fibrous band is sufficient for the treatment; however, the practical importance of this entity is that physicians should keep in mind the possible co-occurrence of other congenital anomalies such as cleft lip and palate, micrognathia, microglossia and temporomandibular joint disorders in these infants. We present the case of a 3230g male infant was born at 40 weeks gestation to a 30-year-old gravida 2 para 1 mother via cesarean section. Upon delivery he was noted to have severely restricted oral opening due to a mucous intra-oral band vertically connecting the floor of the mouth to the midline of the hard palate. Tongue movements were intact. The pregnancy history was unremarkable, the mother denied having taken any drugs, there was no family history of congenital anomalies or consanguinity. Immediate surgical resection of the aberrant tissue was performed in the operating room with minimal hemorrhage following excision. The physical examination of the infant was otherwise unremarkable and detailed genetic assessment was also normal. The infant was discharged home on full oral feedings on day 5.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ipek Güney Varal, Pelin Dogan [Images in medicine] - Egg on a string sign - 03 October 2018. <b>A 2850g male infant was born at 36 weeks gestation to a 26-year-old gravida 1 para 1 mother who did not receive routine prenatal care. Upon delivery he was hospitalized to the neonatal intensive care unit for severe respiratory distress. On physical examination, the infant had marked central cyanosis and a soft systolic murmur. Chest X-ray showed "egg on a string" sign raising suspicion for transposition of the great arteries, which was confirmed by urgent echocardiography and cardiac catheterization. Transposition of the great arteries is the most common cyanotic congenital heart lesion that presents in neonates. The hallmark of the condition is ventriculoarterial discordance and the classic "egg on a string" appearance on chest roentgenograms is found in one third of patients. A continuous infusion of prostaglandin E1 is the mainstay of emergent treatment followed by surgical arterial switch procedure.</b><br/> text/html 2018-12-12T03:05:07+01:00 Jawad Lahma, Reda Hejjouji, Imane Azzam, Abdelilah Oujilal, Leila Essakalli [Case report] - Rhinolithiasis: about an observation of a rare condition - 03 October 2018. <b>Rhinolithiasis is a rare condition often neglected or unknown that tends to disappear in developed countries and corresponds to a solid calcification by gradual deposition of calcareous salts around a central resorbable or non-resorbable foundation of varying shape and size. The most common symptom is a long-term unilateral purulent rhinorrhea and unilateral nasal obstruction. Nasal endoscopy and imaging are interesting for the positive diagnosis but especially to highlight the anatomical anomalies or related pathologies. Therapeutic management requires endonasal extraction of the rhinolith under general anesthesia. We report an observation of rhinolithiasis treated in our department associating a significant deformation of the nasal pyramid to osteolysis.</b><br/> text/html 2018-12-12T03:05:07+01:00 Jawad Lahma, Zakaria Arkoubi, Reda Hejjouji, Sophia Nitassi, Ali El Ayoubi, Razika Bencheikh, Mohammed Anas Benbouzid, Abdelilah Oujilal, Leila Essakalli [Case report] - About a rare disease misdiagnosed as malignant lymphoma or tuberculosis: Kikuchi-Fujimoto’s disease - 03 October 2018. <b>Kikuchi-Fujimoto's disease KFD is a rare and benign cause of cervical lymphadenopathy. It is an anatomoclinical entity of unknown etiology. The confirmation of the diagnosis is always provided by histological lymph node study. The clinical picture sometimes evokes lymphoma or tuberculosis. The evolution is generally favorable with spontaneous healing after a few weeks. We report the case of a 26-year-old woman who had consulted for cervical lymphadenopathy associated with fever. The cervical lymph node biopsy concluded to Kikuch-Fujimoto's disease. The evolution was marked by rapid regression of lymphadenopathy under corticosteroid treatment.</b><br/> text/html 2018-12-12T03:05:07+01:00 Anis Haddad, Olfa Zoukar, Sonia Hammami [Case report] - Maladie de Verneuil: un diagnostic &agrave; ne pas m&eacute;connaitre devant une l&eacute;sion tumorale vulvaire et p&eacute;rin&eacute;ale - 03 October 2018. <b>Les auteurs rapportent le cas d'une patiente de 58 ans, nulligeste, aux ant&eacute;c&eacute;dents de maladie de Niemann-Pick qui a consult&eacute; pour une tum&eacute;faction vulvo-p&eacute;rin&eacute;ale de 10 cm, fluctuante et fistulis&eacute; avec une ulc&eacute;ration. La patiente &eacute;tait f&eacute;brile et pr&eacute;sentant un &eacute;tat g&eacute;n&eacute;ral alt&eacute;r&eacute;. Cette masse a fait craindre le d&eacute;veloppement d'une tumeur maligne vulvaire n&eacute;cros&eacute;e et infect&eacute;e sur une dermatose chronique. Elle a eu une incision en vue de drainage des collections purulentes associ&eacute;e &agrave; des biopsies multiples qui ont infirm&eacute; la pr&eacute;sence d'un processus n&eacute;oplasique. L'association l&eacute;sionnelle et leurs distributions ont fait porter alors le diagnostic d'une hidradenite suppurative ou maladie de Verneuil. Ensuite le probl&egrave;me pos&eacute; &eacute;tait celui du choix de la conduite de prise en charge ult&eacute;rieure parmi les traitements m&eacute;dicamenteux et chirurgicaux d&eacute;crits. Les auteurs discuteront &agrave; travers ce cas et une br&egrave;ve revue de la litt&eacute;rature r&eacute;cente les modalit&eacute;s du diagnostic, les complications et la prise en charge th&eacute;rapeutique de cette maladie.</b><br/> text/html 2018-12-12T03:05:07+01:00 Chaanoun Khadija, Zaghba Nahid, Benjelloun Hanane, Yassine Nabiha [Case series] - Pneumom&eacute;diastin spontan&eacute;: &agrave; propos de 18 cas - 02 October 2018. <b>Le pneumom&eacute;diastin spontan&eacute; se d&eacute;finit par la pr&eacute;sence d'air au niveau du m&eacute;diastin en l'absence de cause traumatique ou iatrog&egrave;ne. Son diagnostic repose sur la radiographie thoracique. Le recours &agrave; d'autres examens paracliniques, tels que la tomodensitom&eacute;trie thoracique ou la fibroscopie bronchique ou digestive, s'impose parfois. L'&eacute;volution est le plus souvent favorable. Nous rapportons 18 cas de pneumom&eacute;diastin spontan&eacute;, collig&eacute;s au service des maladies respiratoires du CHU Ibn Rochd de Casablanca entre 2006 et 2017. Il s'agit de 13 hommes et de cinq femmes dont la moyenne d'&acirc;ge &eacute;tait de 24 ans. La symptomatologie clinique &eacute;tait domin&eacute;e par la douleur thoracique r&eacute;trosternale. Les circonstances de survenue du pneumom&eacute;diastin &eacute;taient des quintes de toux dans sept cas, une crise d'asthme dans cinq cas, une consommation de narguil&eacute; et des vomissements It&eacute;ratifs dans deux cas chacun, un accouchement et une exacerbation d'origine bact&eacute;rienne de BPCO dans un cas chacun. L'&eacute;volution &eacute;tait favorable dans tous les cas avec une r&eacute;sorption spontan&eacute;e du pneumom&eacute;diastin. Aucune r&eacute;cidive n'est survenue apr&egrave;s un recul moyen de 3 ans.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mohamed Hbibi, Sara Benmiloud, Safae Rahmouni, Ilhame Tadmouri, Sana Abourazzak, Sana Chaouki, Fatima Zahra Souilmi, Mounia Lakhdar Idrissi, Mostapha Hida [Case report] - Syndrome d’activation macrophagique r&eacute;v&eacute;lant un lymphome T sous-cutan&eacute; chez un adolescent de 16 ans - 02 October 2018. <b>Le syndrome d'activation macrophagique (SAM) est une atteinte multisyst&eacute;mique, li&eacute;e &agrave; une intense activation du syst&egrave;me immunitaire correspondant &agrave; une infiltration plus ou moins diffuse des tissus par des macrophages activ&eacute;s. Il associ&eacute; des signes cliniques (fi&egrave;vre, h&eacute;pato spl&eacute;nom&eacute;galie, ad&eacute;nopathie) et des anomalies biologiques (bi ou pancytop&eacute;nie, cytolyse h&eacute;patique, &eacute;l&eacute;vation des LDH, coagulopathie) &agrave; une h&eacute;mophagocytose .Il peut &ecirc;tre primaire chez l'enfant ou secondaire &agrave; diverses affections. Nous rapportons le cas d'un adolescent de 16 ans admis au service de p&eacute;diatrie pour leucop&eacute;nie f&eacute;brile avec alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral et des l&eacute;sions &eacute;ryth&eacute;mateuses circulaires &eacute;tendues au niveau des membres inf&eacute;rieurs. Le diagnostic de syndrome d'activation macrophagique &eacute;tait retenu devant les signes cliniques, biologiques et cytologiques compatibles. La biopsie cutan&eacute;e de ces l&eacute;sions &eacute;tait en faveur d'un lymphome T sous-cutan&eacute; type panniculite. A travers ce travail nous insistons sur la particularit&eacute; de cette observation clinique vu la raret&eacute; de ce type de lymphome T sous cutan&eacute;e et beaucoup plus au cours de cette tranche d'&acirc;ge, ainsi sur l'int&eacute;r&ecirc;t de penser au lymphome T sous cutan&eacute;e devant un SAM qui pourrait mettre en jeu le pronostic vital, lorsque il est associ&eacute; &agrave; des l&eacute;sions sous cutan&eacute;e &eacute;ryth&eacute;mateuses.</b><br/> text/html 2018-12-12T03:05:07+01:00 Redouane Hani, Mohamed Ben-aissi, Moncef Boufettal, Mohamed Kharmaz, Mohamed Saleh Berrada [Case series] - Int&eacute;r&ecirc;t du clou r&eacute;trograde dans les fractures du f&eacute;mur distal: &agrave; propos de 07 cas - 02 October 2018. <b>Ce travail rapporte une s&eacute;rie de sept cas de fractures de l’extr&eacute;mit&eacute; inf&eacute;rieure du f&eacute;mur trait&eacute;es par enclouage centrom&eacute;dullaire r&eacute;trograde au service de traumatologie orthop&eacute;die au centre hospitalier Ibn Sina durant la p&eacute;riode du 30/05/2010 au 30/04/2015. L’&acirc;ge moyen de nos patients est de 54 ans avec une l&eacute;g&egrave;re pr&eacute;dominance Masculine (57,1%). Les accidents de la voie publique ont repr&eacute;sent&eacute; la principale &eacute;tiologie (71,4%) et le c&ocirc;t&eacute; droit &eacute;tait le plus touch&eacute; (57,1%). Sur le plan op&eacute;ratoire, le d&eacute;lai moyen de l'intervention &eacute;tait de 2 jours. La rachi anesth&eacute;sie a &eacute;t&eacute; r&eacute;alis&eacute; dans cinq cas. La dur&eacute;e moyenne d’hospitalisation &eacute;tait de 5 jours. L’ensemble de nos patients ont consolid&eacute; dans un d&eacute;lai moyen de 4 mois, avec un cas de retard de consolidation &agrave; 6 mois. Nous avons obtenu de bons r&eacute;sultats fonctionnels avec une flexion moyenne du genou &agrave; 120°, avec un seul cas de flexion limit&eacute; &agrave; 90°. Dans notre s&eacute;rie, on avait constat&eacute; un seul cas de retard de consolidation et un seul cas de pseudarthrose. Nous n’avons not&eacute; aucun d&eacute;c&egrave;s ni sepsis superficiel ou profond, ni complication thromboembolique ou embolie graisseuse, nos r&eacute;sultats &eacute;taient en g&eacute;n&eacute;ral satisfaisants, ce qui nous donne le droit de dire que l’enclouage r&eacute;trograde du f&eacute;mur reste une technique d’ost&eacute;osynth&egrave;se qui a toute sa place dans le traitement chirurgical des fractures distales du f&eacute;mur.</b><br/> text/html 2018-12-12T03:05:07+01:00 Salamata Diallo, Boundia Djiba, Marie Louise Bass&egrave;ne, Mamadou Ngon&eacute; Gueye, Mame Aiss&eacute; Thioubou, Mari&eacute;me Pol&eacute;le Fall, Cheikh Ahmadou Bamba Ciss&eacute;, Daouda Dia, Mouhamadou Mbengue, Mamadou Lamine Diouf [Case report] - Une cause inhabituelle d’ict&egrave;re - 02 October 2018. <b>L'atteinte h&eacute;patique est fr&eacute;quente au cours de l'hyperthyro&iuml;die. Elle est le plus souvent asymptomatique. Une hyperthyro&iuml;die r&eacute;v&eacute;l&eacute;e par un ict&egrave;re est rarement d&eacute;crite dans litt&eacute;rature. Nous vous rapportons une observation &agrave; Dakar (S&eacute;n&eacute;gal). Il s'agissait d'un patient de 52 ans qui avait consult&eacute; notre service pour un ict&egrave;re associ&eacute; &agrave; un prurit. Les explorations biologiques montraient une augmentation des alanine aminotranf&eacute;rases (1,1 N), des aspartate aminotranf&eacute;rases (1,5 N), des phosphatases alcalines (3 N), des gamma glutamyl transf&eacute;rases (1,3 N) et de la bilirubin&eacute;mie (22 N). L'&eacute;chographie abdominale &eacute;tait normale. Une cause toxique ou m&eacute;dicamenteuse, un obstacle sur les voies biliaires, une h&eacute;patite virale ou auto immune ainsi qu'une cholangite biliaire primitive ont &eacute;t&eacute; exclu. Le dosage des hormones thyro&iuml;diennes montrait une &eacute;l&eacute;vation de la T4 libre &agrave; 24 ng/dL (9-20 ng/dL) et un taux plasmatique ind&eacute;tectable de TSH inf&eacute;rieure &agrave; 0,01µUI/mL (0,35-4,94 UI/mL). Les anticorps anti r&eacute;cepteurs de la TSH &eacute;taient positifs &agrave; 7,04 UI/L (N < 1,75 UI/L). L'&eacute;chographie thyro&iuml;dienne objectivait un goitre diffus homog&egrave;ne hypervasculaire. Le diagnostic d'une atteinte h&eacute;patique secondaire &agrave; une maladie de Basedow sans dysfonction cardiaque &eacute;tait retenu. L'&eacute;volution clinique et biologique &eacute;tait favorable sous carbimazole. L'ict&egrave;re peut &ecirc;tre r&eacute;v&eacute;latrice d'une hyperthyro&iuml;die. La recherche des signes cliniques et biologiques d'une hyperthyro&iuml;die est obligatoire devant un ict&egrave;re inexpliqu&eacute;.</b><br/> text/html 2018-12-12T03:05:07+01:00 Naima Baddouh, Noureddine Rada, Fatima Ezzahra Elalouani, Ghizlane Draiss, Mohammed Bouskraoui [Letter to the editors] - Acceptabilit&eacute; du vaccin antivirus du papillome humain: enqu&ecirc;te aupr&egrave;s des parents - 02 October 2018. <b>Le but de ce travail est d'&eacute;valuer les connaissances des parents des filles en &acirc;ge de vaccination sur le vaccin anti virus du papillome humain (HPV), leur acceptabilit&eacute; du vaccin et les facteurs associ&eacute;s au refus. Nous avons men&eacute; une enqu&ecirc;te aupr&egrave;s des parents de filles &acirc;g&eacute;es de 8 &agrave; 15 ans, suivies pour diverses pathologies au service de p&eacute;diatrie du CHU Mohamed VI de Marrakech, Maroc, portant sur le profil des parents, leur connaissances sur le cancer du col de l'ut&eacute;rus, l'HPV, et le vaccin anti HPV, l'acceptabilit&eacute; de vacciner leur filles et les arguments li&eacute;s au refus. Quatre vingt seize questionnaires ont &eacute;t&eacute; inclus dans l'analyse. Le cancer du col est consid&eacute;r&eacute; fr&eacute;quent pour 58% des parents. Seuls 5% connaissaient le vaccin anti HPV. Leur source d'information &agrave; tous &eacute;tait les m&eacute;dias. Personne n'avait d'id&eacute;e sur le co&ucirc;t du vaccin et sa tol&eacute;rance. Aucune fille n'&eacute;tait vaccin&eacute;e contre l'HPV. Soixante trois pour cent des parents voudraient bien vacciner leurs filles, ce taux a augment&eacute; &agrave; 82% apr&egrave;s sensibilisation des parents. Treize pour cent des parents &eacute;taient h&eacute;sitants alors que 24% ont refus&eacute; de vacciner pour cause d'effets secondaires majoritairement (51%). Les parents refusant le vaccin &eacute;taient en majorit&eacute; de sexe masculin, de niveau socio-&eacute;conomique et culturel moyen, et ignoraient le virus et le vaccin dans 91% des cas. Cette &eacute;tude a permis de soulever les &eacute;l&eacute;ments de r&eacute;ticences face au vaccin anti HPV afin d'optimiser les strat&eacute;gies de communication aupr&egrave;s des parents.</b><br/> text/html 2018-12-12T03:05:07+01:00 Peter Kiteywo Sisimwo, Geoffrey Mose Onchiri [Research] - Epidemiology of head injuries and helmet use among motorcycle crash injury: a quantitative analysis from a local hospital in Western Kenya - 02 October 2018. <b>INTRODUCTION: Injury from motorcycle is a considerable cause of deaths and disability in the world. It’s becoming one of the most serious public health problems, not only in developed countries but more in low and middle-income countries. METHODS: Descriptive cross sectional study for patients who sustained head injuries related to motorcycle crashes between March 2017 and March 2018. Participant bio data, injury history and neurological examination findings were collected using pretested interviewer administered questionnaires. Frequencies mean (SD) and chi-square was employed in the analysis. Results were considered significant at p<0.05. RESULTS: A total of 341 motorcycle crash injury patients participated in the study. One hundred and forty three (42%), sustained head injuries while 198 (58%) sustained other types of injury. In regard to safety helmets, 94 (28%) wore helmets at the time of crash. One hundred and forty three (42%), of the respondents without helmets at the time of crash sustained head injuries. Riders and passengers who wore helmets at the time of motorcycle crash, suffered less frequent head injuries compared to those who did not wear helmets and this was statistically significant (&#967;2=55.78, P<0.00). Non use of safety helmet during crash was associated with sustaining mild to severe head injury. Most of the crashes 165 (48.3%), occurred as a result of collision between motorcycles versus vehicle. Majority of the crashes occurred in the afternoon hours 174 (51%). The days of the week recording the highest number of injuries were Friday (16.1%) and Monday (15.8%). The day of Involvement in motorcycle crash during the week was not significantly associated with head injury (&#967;2=13.103, p=0.785). CONCLUSION: Majority of motorcycle crash injury victims sustained head injury. Few of the victims used safety helmets at the time of the motorcycle crash. Use of helmets was protective of sustaining mild to severe head injuries among crash injury victims.</b><br/> text/html 2018-12-12T03:05:07+01:00 Fanny Kaj Malonga, Olivier Mukuku, Micrette Tshanda Ngalula, Prosper Kakudji Luhete, Jean-Baptiste Kakoma [Research] - &Eacute;tude anthropom&eacute;trique et pelvim&eacute;trique externe chez les nullipares de Lubumbashi: facteurs de risque et score pr&eacute;dictif de la dystocie m&eacute;canique - 02 October 2018. <b>INTRODUCTION: La morbi-mortalit&eacute; maternelle et p&eacute;rinatale reste &eacute;lev&eacute;e dans la majeure partie de l’Afrique subsaharienne par rapport au reste du monde. D&eacute;pister, avant le travail, les femmes &agrave; risque de dystocies m&eacute;caniques et les r&eacute;f&eacute;rer &agrave; un h&ocirc;pital mieux &eacute;quip&eacute; pour accouchement contribue &agrave; la strat&eacute;gie visant &agrave; r&eacute;duire la morbi-mortalit&eacute;. L’objectif de cette &eacute;tude est de d&eacute;velopper un score pr&eacute;dictif de la dystocie m&eacute;canique lors de l’accouchement chez les nullipares congolaises. METHODES: Il s’agit d’une &eacute;tude transversale analytique sur les nullipares avec des grossesses uniques dans 7 maternit&eacute;s de la ville de Lubumbashi (RDC). La taille, le poids et les mensurations pelvim&eacute;triques externes maternelles ont &eacute;t&eacute; r&eacute;colt&eacute;s et analys&eacute;s. Une analyse univari&eacute;e et une analyse multivari&eacute;e &eacute;taient r&eacute;alis&eacute;es. La discrimination du score &eacute;tait &eacute;valu&eacute;e &agrave; l’aide de la courbe ROC. RESULTATS: Nous avons recrut&eacute; 535 nullipares au cours de la p&eacute;riode d'&eacute;tude, dont 126 (23,55%) avaient accouch&eacute; par c&eacute;sarienne indiqu&eacute;e pour dystocie m&eacute;canique. Apr&egrave;s mod&eacute;lisation logistique, trois crit&egrave;res sont ressortis comme facteurs pr&eacute;dictifs de dystocie m&eacute;canique: la taille maternelle <150cm (ORajust&eacute;=2,96 [1,49-5,87]), le diam&egrave;tre bi-ischiatique <8cm (ORajust&eacute;=15,96 [3,46-73,56]) et le diam&egrave;tre pr&eacute;pubien de Trillat <11cm (ORajust&eacute;=2,34 [1,36-4,01]). L’aire sous la courbe ROC du score est de 0,6549 avec une sensibilit&eacute; de 23,81%, une sp&eacute;cificit&eacute; de 97,80% et une valeur pr&eacute;dictive positive de 76,92%. CONCLUSION: Il a &eacute;t&eacute; observ&eacute; que les valeurs de 10<sup>&egrave;me</sup> percentile des trois mesures anthropom&eacute;triques maternelles &eacute;taient pr&eacute;dictives de la dystocie m&eacute;canique. Lorsqu’elles &eacute;taient utilis&eacute;es ensemble, ces trois valeurs permettaient de d&eacute;velopper un score de d&eacute;pistage &agrave; faible co&ucirc;t pour une utilisation dans les milieux &agrave; faible revenu.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ghita Bouayad, Abdelbarre Oubaaz [Images in medicine] - Une cataracte de dessiccation en "plumes de paon" - 01 October 2018. <b>La cataracte de dessiccation est une complication fr&eacute;quente de la chirurgie du segment post&eacute;rieur par vitrectomie. En effet, le contact entre le gaz utilis&eacute; pour le tamponnement interne et la cristallo&iuml;de post&eacute;rieure peut induire une cataracte pr&eacute;coce sous-capsulaire post&eacute;rieure, survenant dans les vingt-quatre heures, aussi d&eacute;nomm&eacute;e en «feuille de foug&egrave;re». Celle-ci est li&eacute;e &agrave; une d&eacute;shydratation des couches post&eacute;rieures du cristallin ou &agrave; un blocage des &eacute;changes m&eacute;taboliques de part et d'autre de la cristallo&iuml;de post&eacute;rieure. Histologiquement, on retrouve des vacuoles ou des opacit&eacute;s lin&eacute;aires en forme de plume au niveau du cortex sous-capsulaire post&eacute;rieur, le plus souvent r&eacute;gressives. Cependant, les gaz de longue dur&eacute;e d'action favorisent une opacification permanente du cristallin, qui est souvent tr&egrave;s adh&eacute;rente et dont la dissection lors d'une phakoex&eacute;r&egrave;se peut se compliquer d'une rupture capsulaire post&eacute;rieure. Nous rapportons le cas d'un patient &acirc;g&eacute; de 54 ans, op&eacute;r&eacute; de d&eacute;collement de r&eacute;tine de l'œil droit par vitrectomie associ&eacute;e &agrave; une cryopexie de la d&eacute;hiscence r&eacute;tinienne et un tamponnement par hexafluorure de soufre (SF6), et chez qui l'examen &agrave; j1 du post op&eacute;ratoire trouve un aspect de cataracte sous-capsulaire post&eacute;rieure en « plumes de paon ».</b><br/> text/html 2018-12-12T03:05:07+01:00 Anis Haddad, Olfa Zoukar, Amira Daldoul, Hanene Bhiri, Khechine Wiem, Houda Mhabrich, Sonia Zaied, Raja Faleh [Case series] - Breast diseases in women over the age of 65 in Monastir, Tunisia - 01 October 2018. <b>As life expectancy is on the rise, it is predicted that a growing number of people will live beyond the age of 65 and therefore a higher number of elderly women will have breast diseases requiring significant health care and services. This study is aimed at investigating the characteristics, the treatment and outcomes of women older than 65 years old treated for breast diseases at our institution. This was a retrospective study covering the period from January 2003 to December 2011. It involved 92 patients aged over 65 and treated for breast disease in the Maternity Center of Monastir, Tunisia. The data included characteristics of patients and tumors, treatment and outcomes that were obtained through data extraction sheets. We reported a study of 92 women over the age of 65 of whom 77 women had malignant breast disease (83.6%) and 15 benign breast diseases (16.4%). Breast cancer was discovered at a mean age of 72.5 ± 6.6 years. Distant metastases were found in 5.3% of cases and infiltrative ductal carcinoma was detected in 85.7% of patients. Hormonal receptors were positive for estrogens in 64.7% of cases. Surgical treatment was performed in 73 patients and adjuvant treatment was prescribed for 67 women (86%). The complication rate was 16.6% among the 73 patients who underwent surgery. Benign breast diseases represented 16.3% of the mammary pathologies. Abscesses and fibrocystic mastopathy were the most frequent histological diagnoses. Despite great interest in geriatric gynecological pathology worldwide, many questions related to how optimally treat this patient population remain unanswered. In this study, a surgical treatment was performed in 94.8% of breast cancer patients and the complication rate was 16.6%.</b><br/> text/html 2018-12-12T03:05:07+01:00 Eliane Ndounga, Jean Felix Peko, Jean Bernard Nkoua Mbon [Case report] - Double localisation secondaire cutan&eacute;e et sinusienne r&eacute;v&eacute;lant un ad&eacute;nocarcinome &agrave; cellules claires du rein: un cas avec revue de la litt&eacute;rature - 01 October 2018. <b>Situ&eacute; au troisi&egrave;me rang des cancers urologiques, le cancer du rein m&eacute;tastase habituellement au niveau du poumon, des os et du foie. Nous rapportons ici le cas clinique de m&eacute;tastases cutan&eacute;e et sinusienne ayant r&eacute;v&eacute;l&eacute;es un cancer du rein chez un sujet de sexe masculin &acirc;g&eacute; de 70 ans.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ngina Kisangau, Kibet Sergon, Yusuf Ibrahim, Florence Yonga, Daniel Langat, Rosemary Nzunza, Peter Borus, Tura Galgalo, Sara A Lowther [Research] - Progress towards elimination of measles in Kenya, 2003-2016 - 28 September 2018. <b>INTRODUCTION: Measles is targeted for elimination in the World Health Organization African Region by the year 2020. In 2011, Kenya was off track in attaining the 2012 pre-elimination goal. We describe the epidemiology of measles in Kenya and assess progress made towards elimination. METHODS: We reviewed national case-based measles surveillance and immunization data from January 2003 to December 2016. A case was confirmed if serum was positive for anti-measles IgM antibody, was epidemiologically linked to a laboratory-confirmed case or clinically compatible. Data on case-patient demographics, vaccination status, and clinical outcome and measles containing vaccine (MCV) coverage were analyzed. We calculated measles surveillance indicators and incidence, using population estimates for the respective years. RESULTS: The coverage of first dose MCV (MCV1) increased from 65% to 86% from 2003-2012, then declined to 75% in 2016. Coverage of second dose MCV (MCV2) remained <50% since introduction in 2013. During 2003-2016, 26,188 suspected measles cases were reported, with 9043 (35%) confirmed cases, and 165 deaths (case fatality rate, 1.8%). The non-measles febrile rash illness rate was consistently >2/100,000 population, and ?80% of the sub-national level investigated a case in 11 of the 14 years. National incidence ranged from 4-62/million in 2003-2006 and decreased to 3/million in 2016. The age specific incidence ranged from 1-364/million population and was highest among children aged <1 year. CONCLUSION: Kenya has made progress towards measles elimination. However, this progress remains at risk and the recent declines in MCV1 coverage and the low uptake in MCV2 could reverse these gains.</b><br/> text/html 2018-12-12T03:05:07+01:00 Jimoh Adenike Oluwayemisi, Adaji Sunday Enema, Adelaiye Hamdalla, Olorukooba Abiola Aira, Bawa Umma, Ibrahim Ismail Habiba, Garba Comfort, Mfuh Anita Lukong, Idris Suleiman, Shittu Oladapo Sunday [Research] - A cross-sectional study of traditional practices affecting maternal and newborn health in rural Nigeria - 28 September 2018. <b>INTRODUCTION: Certain traditional practices which have negative effects on maternal and child health continue to be practiced in sub-Saharan African countries. A survey was carried out in a rural village in Nigeria to understand the scale and range of these practices. METHODS: This was a cross-sectional study in which trained interviewers administered pre-tested questionnaires on child-bearing women using questionnaires embedded on android devices. RESULTS: The median age of marriage and pregnancy were 15 and 16 years respectively. Home births were high (90.4%) while non-skilled birth attendant was 87.4%. The community had a son preference index ratio of 1:1.4. Up to 81.5% of mothers responded that one form of unhygienic traditional procedure or the other was performed on their children. Time to initiation of breast feeding was in hours in the majority (76.3%) of mothers, with a high rate of use of prelacteal feeds (85.2%). Being an adolescent mother (AOR 0.403, 95%CI 0.203, 0,797) and utilizing a skilled provider at birth (AOR 0.245, 95%CI 0.088, 0.683) were associated with less likelihood of having an unhygienic procedure performed on children. CONCLUSION: The findings of our study suggest that traditional practices which could have negative effects on maternal and child health are still ongoing in the study community. Child protection laws and safeguarding principles could help to reduce these practices and would need to be developed and implemented in these settings where these practices are still prevalent.</b><br/> text/html 2018-12-12T03:05:07+01:00 Aurélia Rakotondrainibe, Harifetra Mamy Richard Randriamizao, Noro Seheno Ratsimbazafy,Yvon Mong-Gine, Catherine Nicole Rakotoarison, Felantsoa Auberlin Rakototiana, Marie Lydia Agnès Ravalisoa [Case series] - Burnout syndrome et ses facteurs chez les m&eacute;decins de deux centres Hospitalo-Universitaires d’Antananarivo - 27 September 2018. <b>La profession m&eacute;dicale est un m&eacute;tier stressant, pouvant engendrer un syndrome d'&eacute;puisement professionnel ou burnout syndrom (BOS). Le but de cette &eacute;tude &eacute;tait de d&eacute;terminer les degr&eacute;s du BOS (faible, moyen, &eacute;lev&eacute;) de par ses dimensions et les facteurs li&eacute;s &agrave; l'activit&eacute; professionnelle du m&eacute;decin qui lui &eacute;taient corr&eacute;l&eacute;s. Il s'agit d'une &eacute;tude transversale, en 2012, par auto-questionnaire, aupr&egrave;s des m&eacute;decins du Centre Hospitalier de Soavinandriana et du Centre Hospitalier Universitaire, Joseph Ravoahangy Andrianavalona. Des tests de corr&eacute;lation et de r&eacute;gression lin&eacute;aire ont &eacute;t&eacute; effectu&eacute;s (SigmaStat® 3.5). Le taux de r&eacute;ponse &agrave; l'enqu&ecirc;te a &eacute;t&eacute; de 47,1% sur 138 m&eacute;decins hospitaliers. Le nombre de dossiers retenus &eacute;tait de 48. La population de l'&eacute;tude &eacute;tait &agrave; pr&eacute;dominance masculine (sex ratio: 1,8) avec un &acirc;ge m&eacute;dian de 37 [25-59] ans. Les internes de sp&eacute;cialit&eacute; et les m&eacute;decins assistants repr&eacute;sentaient 56,3% de la population. Selon l'anciennet&eacute; 16,7% &eacute;taient dans le m&eacute;tier depuis moins d'un an. Le burnout syndrom a &eacute;t&eacute; observ&eacute; dans 51,2 % des cas avec un degr&eacute; &eacute;lev&eacute; pour 4,2% des m&eacute;decins. Le titre avait une corr&eacute;lation significative avec le syndrome d'&eacute;puisement professionnel et son degr&eacute; (p=0,0142 et p=0,0362), notamment l'&eacute;puisement &eacute;motionnel (p=0,0414). L'apparition du BOS n'&eacute;tait ni corr&eacute;l&eacute; avec l'anciennet&eacute; du m&eacute;decin ni avec le secteur d'activit&eacute;. Le BOS existe en milieu hospitalier, surtout li&eacute; au titre du m&eacute;decin. Il est essentiel de le diagnostiquer au plus t&ocirc;t pour en &eacute;viter ses cons&eacute;quences d&eacute;l&eacute;t&egrave;res.</b><br/> text/html 2018-12-12T03:05:07+01:00 Faten Limaiem, Sonia Azzabi, Asma Sassi, Sabeh Mzabi, Saadia Bouraoui [Case series] - Colorectal cancer in young adults: a retrospective study of 32 tunisian patients - 27 September 2018. <b>Young people under the age of 40 with colorectal cancer represent a distinct subgroup with a more aggressive disease behaviour compared to older patients. This study aim to provide an updated overview on clinicopathological features, treatment and outcome of colorectal cancer in young adults under the age of 40. In our retrospective study, we reviewed 32 cases of colorectal cancer in young adults aged less than 40 years that were diagnosed at the pathology department of Mongi Slim hospital over a fifteen-year period (April 2000 - November 2014). Our study group included 13 male and 19 female patients (sex-ratio M/F = 0,68) between 17 and 39 years of age (mean = 31,25 years). The presenting clinical symptoms were dominated by altered bowel habits (n=17), followed by bleeding per rectum (n=16). Histopathological examination of the surgical and biopsy specimens established the diagnosis of mucinous adenocarcinoma in nine cases, well-differentiated adenocarcinoma in 11 cases, moderately differentiated adenocarcinoma in six cases, poorly differentiated adenocarcinoma in four cases and signet ring cell carcinoma in two cases. The tumours were classified after surgery as stage I (n = 2) (6%), stage IIA (n = 7) (22%), stage IIB (n=4) (13%), stage IIC (n=1) (3%), stage IIIB (n=8) (25%), stage IIIC (n= 4) (12%), stage IVA (n=4) (13%) and stage IVB (n=2) (6%). During the follow-up period which ranged between one month and 9 years, local recurrence of the tumour occurred in six cases, seven patients had hepatic metastases and seven patients died after a mean follow-up period of seven months. Molecular genetic studies are increasing the understanding of the pathobiology of colorectal cancer and may ultimately allow at-risk patients to be identified at an earlier stage.</b><br/> text/html 2018-12-12T03:05:07+01:00 Siham Nasri, Asmae Oulad Amer, Narjisse Aichouni, Imane Kamaoui, Imane Skiker [Case report] - Vraie macrodactylie avec orientation nerveuse - 27 September 2018. <b>La vraie macrodactylie repr&eacute;sente une anomalie cong&eacute;nitale rare d'&eacute;tiologie inconnue, caract&eacute;ris&eacute;e par une augmentation de taille de tous les &eacute;l&eacute;ments d'un ou plusieurs rayons de la main. Elle est habituellement isol&eacute;e et comporte une infiltration fibrograisseuse pr&eacute;dominant en palmaire. Elle peut &ecirc;tre expliqu&eacute;e par des anomalies d'ordre embryologique ou neurog&egrave;ne; avec ou sans orientation nerveuse selon que le territoire concern&eacute; par la macrodactylie comporte une augmentation du volume d'un nerf majeur, le plus souvent le m&eacute;dian. Du point de vue &eacute;volutif, il faut distinguer la forme statique (pr&eacute;sente &agrave; la naissance et restant stable avec la croissance) de la forme progressive (ou la croissance est disproportionn&eacute;e). Certains syndromes, tumeurs ou malformations peuvent comporter une augmentation de volume d'un doigt sans qu'on puisse parler de vraie macrodactylie. Cette malformation engendre un handicap fonctionnel mais &eacute;galement un pr&eacute;judice esth&eacute;tique. Le traitement comporte non seulement la chirurgie mais aussi une prise en charge r&eacute;&eacute;ducative.</b><br/> text/html 2018-12-12T03:05:07+01:00 Baha Zantour, Ines Charrada, Zohra Elati, Fatma Larbi Ammari, Fadia Boubaker, Sondes Arfa, Olfa Berriche, Wafa Alaya, Mohamed Habib Sfar [Case report] - Le corticosurr&eacute;nalome: une cause exceptionnelle d’hyperaldost&eacute;ronisme primaire - 27 September 2018. <b>Le corticosurr&eacute;nalome est une tumeur maligne rare de la cortico-surr&eacute;nale. Il secr&egrave;te souvent des corticost&eacute;ro&iuml;des, des st&eacute;ro&iuml;des sexuels et des pr&eacute;curseurs. Le corticosurr&eacute;nalome producteur d'aldost&eacute;rone est tr&egrave;s rare, 1cas/10 millions d'habitants. Nous rapportons l'observation d'un homme de 38 ans se pr&eacute;sentant pour hypertension art&eacute;rielle s&eacute;v&egrave;re associ&eacute;e &agrave; une hypokali&eacute;mie profonde (2.2 mmol/l). L'exploration a conclu &agrave; un hyperaldost&eacute;ronisme primaire (aldost&eacute;rone = 2645pmol/l, rapport aldost&eacute;rone/r&eacute;nine = 327pmol/mUI), avec hypers&eacute;cr&eacute;tion de glucocortico&iuml;des. Le scanner abdomino-pelvien a montr&eacute; une masse surr&eacute;nalienne gauche de 9cm, mal limit&eacute;e et h&eacute;t&eacute;rog&egrave;ne, infiltrant la graisse autour et le diaphragme, envahissant la veine r&eacute;nale gauche, avec ad&eacute;nopathie r&eacute;gionale et nodule h&eacute;patique de 4 cm. Le patient a eu une n&eacute;phrectomie &eacute;largie, suivie d'une h&eacute;patectomie droite deux mois apr&egrave;s entrainant une r&eacute;mission. Un an apr&egrave;s le patient a d&eacute;velopp&eacute; des m&eacute;tastases pulmonaires. Nous concluons que l'hyperaldost&eacute;ronisme primaire peut &ecirc;tre un mode de r&eacute;v&eacute;lation du corticosurr&eacute;nalome, on devra y penser malgr&eacute; son caract&egrave;re exceptionnel.</b><br/> text/html 2018-12-12T03:05:07+01:00 Youssef Zemmez, Naoufal Hjira [Images in medicine] - Giant squamous cell carcinoma of the cheek - 27 September 2018. <b>A 60-year-old woman with a history of non-insulin-dependent diabetes reported a case of cutaneous swelling in her right cheek. The swelling had been evolving for 18 months while gradually increasing in size. The dermatologic examination revealed an ulcero-budding lesion, measuring 5cm at large diameter, rounded, with an ulcerated center and a fibrinous base. It was voluminous, sitting on the level of the right cheek pushing the right wing of the nose and causing an occlusion on right eyelid, but the ganglionic areas were free. A skin biopsy was carried out and histology indicated that a moderately differentiated squamous cell carcinoma was present. The patient was referred to the plastic surgery department for surgical removal of the tumor. The cutaneous squamous cell carcinoma is an invasive tumor that develops at the expense of epidermal keratinocytes or mucous membranes in oral, anal or genitals. The major risk factor is the solar exposure.</b><br/> text/html 2018-12-12T03:05:07+01:00 Piergiorgio Muriana, Giampiero Negri [Images in medicine] - An unusual case of a posterior mediastinal myelolipoma in a patient with mediterranean anemia - 27 September 2018. <b>A 34-year-old male was admitted at our Department for back pain and a right paravertebral mass at the chest x-ray. His medical history was positive for beta-thalassemia major with normal routinely blood tests. A contrast-enhanced chest computed-tomography showed a 26 x 15 mm right solid paravertebral round-shaped lesion at T8-T9 levels, with a small inner component of adipose tissue (Panel A). Contrast-enhanced magnetic resonance-imaging showed irregular low signal intensity in long TR sequences, with mild enhancement after contrast administration (Panel B, Panel C). Surgical excision of the lesion by means of video-assisted thoracic surgery was scheduled for both definitive diagnosis and therapeutic purpose. Histopathologic examination revealed the presence of adipocytes mixed with mature hematopoietic cells (Panel D). Differential diagnosis included mediastinal myelolipoma (MM) and extramedullary hematopoiesis (EH). In fact, both of them are composed of fat and hematopoietic tissue. Mediterranean anemia is a common finding in patients with EH. However, the presence of a single capsulated tumor and the absence of abnormal hematopoietic cells led to a final diagnosis of MM. The patient is currently alive without recurrence 23 months after surgery. Myelolipoma is a benign tumor usually arising in adrenal glands. Less than 50 cases of MM have been described in the literature to date. Many Authors currently support the role of a triggering condition (both metabolic, infectious and neoplastic), which might be responsible for the growth of ectopic adrenal or hematopoietic tissue. Patient's history, radiologic, and pathologic features must all be taken into due consideration in differential diagnosis between MM and EH.</b><br/> text/html 2018-12-12T03:05:07+01:00 Atif Ahmed Mohamed Saad, Tasnim Kkalid, Mohammed Abbas, Karimeldin Mohammed Ali Salih [Case report] - Rare presentation of chronic ileocecal intussusception secondary to Burkitt’s lymphoma in three years Sudanese boy: a case report and literature review - 26 September 2018. <b>A case report of chronic ileocecal intussusceptions in 3-years old Sudanese boy diagnosed as abdominal Burkett's lymphoma as leading point, who presented to his local hospital severely wasted with prolonged abdominal symptoms. Ultra sound and computed tomographic scan of his abdomen and pelvis with oral contrast confirmed intussusception. He was referred to pediatric surgical department and underwent laparotomy confirming ileocecal intussusception with resection of gangrenous part of his large and small bowel with end-to-end anastomosis. Histopathology of resected part showed infiltration of small bowel with cells of Burkett's lymphoma. This case highlights the importance of considering chronic intussusception, though rare, as a cause of faltering growth in young children with prolonged abdominal symptoms. The multidisplinary approach was highly appreciated and the outcome was satisfactory.</b><br/> text/html 2018-12-12T03:05:07+01:00 M&eacute;dard Nyandekwe, Jean Baptiste Kakoma, Manass&eacute; Nzayirambaho [Research] - The health-related Millennium Development Goals (MDGs) 2015: Rwanda performance and contributing factors - 26 September 2018. <b>INTRODUCTION: The Millennium Development Goals (MDGs) 2015 are the eight international development goals adopted by the Millennium Summit of the United Nations in 2000 to which Rwanda is signatory. In 1990, Rwanda was at least one of the Sub-Saharan Africa countries with poor performance on health-related MDGs indicators. To date, despite the setbacks caused by the 1994 genocide, impressive performance is registered. The objective of the study is to document Rwanda gradual progress to achieving the health-related MDGs 2015 targets from 1990 to 2014/2015. METHODS: The study is retrospective and comparative documenting the period of 1990 to 2014/15. RESULTS: The performance of Rwanda on health-related MDGs 2015 targets is impressive despite the negative effects of the 1990-1994 civil wars and the 1994 genocide against Tutsi on 1990’s levels. In effect, out of 17 health-related MDGs indicators, eleven (11) registered “remarkable” performances, i.e. reached global levels or fastened Vision 2020 targets attainment, two (2) registered “good performances”, i.e. reached basic or revised own targets exhibiting overall impressive performance, while four (4) “weaknesses” are observed, i.e. accused gaps until now. . The good governance, Vision 2020 effective implementation, consistent resources invested in health sector and the Rwanda Universal Health Coverage implementation contributed greatly to achieving the above health-related MDGs 2015 performance. CONCLUSION: Rwanda Performance of health-related MDGS 2015 targets is impressive. However, some relative gaps still persist, and hence should be prioritized while implementing the emerging Sustainable Development Goals.</b><br/> text/html 2018-12-12T03:05:07+01:00 Aim&eacute;e Mudekereza Musimwa, Hermann Tamubango Kitoko, Gray Kanteng Wakamb, Stanis Wembonyama Okitotsho, Oscar Luboya Numbi [Research] - Concentration s&eacute;rique en fer au cours de la malnutrition de l’enfant: cas d’une zone urbaine et rurale en R&eacute;publique D&eacute;mocratique Congo - 25 September 2018. <b>INTRODUCTION: La malnutrition (prot&eacute;ine &eacute;nerg&eacute;tique et vitaminique) contribue &agrave; la survenue d’une an&eacute;mie. Parall&egrave;lement, l'an&eacute;mie ferriprive est l'un des troubles nutritionnels les plus r&eacute;pandus au monde et particuli&egrave;rement dans le pays en voie d&eacute;veloppement. Ainsi l’objectif de cette &eacute;tude est de d&eacute;terminer le taux de fer chez l’enfant malnutri de 6 &agrave; 59 mois et les facteurs li&eacute;s &agrave; sa variation. METHODES: Il s’agit d’une &eacute;tude transversale men&eacute;e sur la p&eacute;riode allant du 01 juillet 2013 au 31 juillet 2014. Nous avons collig&eacute; 180 enfants malnutris d&egrave;s leur admission dans centre de prise en charge nutritionnelle. Un autre groupe a &eacute;t&eacute; recrut&eacute; en p&eacute;riph&eacute;rie de la ville, dans le village Kawama. Une ponction veineuse a &eacute;t&eacute; effectu&eacute;e et le sang pr&eacute;lev&eacute; a subi une centrifugation puis une lecture au spectrom&egrave;tre. RESULTATS: Il ressort que 93,4 % de l’&eacute;chantillon soit 170 enfants ont pr&eacute;sent&eacute; une concentration s&eacute;rique inf&eacute;rieure &agrave; la valeur normale. Par contre 6,59% soit 12 enfants ont pr&eacute;sent&eacute; un taux de fer entre 610-1300 µg/L de fer s&eacute;rique avec la m&eacute;diane qui &eacute;tait &agrave; 159,5 µg/L. Parmi les 170 enfants qui avaient un taux de fer s&eacute;rique de <610 µg/L, 79 enfants soit 42,18% &eacute;taient &acirc;g&eacute;s de moins de 24 mois dont 3 (1,78%) &acirc;g&eacute;s de moins de 6 mois. A Kawama, 62 enfants soit 36,47% de l’&eacute;chantillon total avaient un taux de fer < 610. Aucun lien statistiquement significatif entre le fer et les facteurs de risque n’a &eacute;t&eacute; trouv&eacute; sauf pour la variable provenance o&ugrave; le p &eacute;tait significatif (p< 0,05).</b><br/> text/html 2018-12-12T03:05:07+01:00 Hakan Sarbay, Y&#305;lmaz Ay [Research] - Evaluation of children with macrocytosis: clinical study - 25 September 2018. <b>INTRODUCTION: In this study, it is aimed to emphasize the causes and importance of macrocytosis in paediatric practice. METHODS: in the paediatric hematology and oncology clinic, 1752 patients evaluated in 2017, patients with macrocytosis were examined retrospectively with clinical and laboratory findings. Patients with macrocytosis were compared with the frequency of severe hematologic diseases such as acute leukemia and bone marrow failure in patients with normocytic and microcytic mean corpusculer volume. RESULTS: Macrocytosis was detected in 72 out of 1752 patients (4.1%) in the study. Acute lymphoblastic leukemia in 11(15.2%), acute myeloid leukemia in 3(4.1%), Fanconi aplastic anemia in 7(9.7%), Diamond-Blackfan anemia in 2(2.7%), aplastic anemia in 1(1.3%), congenital diseritropoetic anemia in 1(1.3%), deficiency of vitamin B12 in 14(19.4%) were diagnosed. Down syndrome was presented in 33 cases (45.8%). The number of patients with acute leukemia diagnosis was 14(0.8%) in the group in which the mean corpusculer volume was either microcytic or normocytic. The incidence of acute leukemia and bone marrow failure was significantly higher in the group with macrocytosis compared between the two groups. CONCLUSION: Although vitamin B12 deficiency is considered firstly in patients who have undergone cytopenia and macrocytosis in our country, haematological malignancies, bone marrow failures, myelodysplasia and myeloproliferative diseases should be remembered especially in the individuals with Down syndrome at the same time.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ploutarchos Karydakis, Dimitrios Giakoumettis, Ioannis Nikas, Dimitrios Panagopoulos, George Sfakianos, Marios Themistocleous [Case report] - Post-traumatic tremor in child after mild head trauma - 25 September 2018. <b>Despite the fact that movement disorders can be noted after severe traumatic brain injury (TBI), there are very few cases in the literature regarding children with a mild head injury. In addition, their pathophysiological mechanism, radiological features, and treatment options have not been well described yet. Hereby, we report a case of a 3-year-old girl who suffered a head injury after a two-meter fall, resulting in generalized body tremor and dystonia.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mohamed Essarghini, Ahmed Bounaim [Images in medicine] - M&eacute;tastases au niveau des sites d’introduction des trocarts secondaires &agrave; un ad&eacute;nocarcinome de la v&eacute;sicule biliaire - 24 September 2018. <b>La d&eacute;couverte fortuite de l’ad&eacute;nocarcinome de la v&eacute;sicule biliaire apr&egrave;s chol&eacute;cystectomie cœlioscopique pour chol&eacute;cystite aigue &agrave; travers l’examen histologique syst&eacute;matique est rare. Cette situation impose une reprise chirurgicale par voie sous costale pour r&eacute;section du lit v&eacute;siculaire ainsi que des trajets d’introduction des trocarts. Nous pr&eacute;sentons un cas d’une patient de 73 ans qui a &eacute;t&eacute; op&eacute;r&eacute;e il y a trois ans pour chol&eacute;cystite aigue par voie laparoscopique et dont l’examen anatomopathologique a r&eacute;v&eacute;l&eacute; un ad&eacute;nocarcinome tubulo-papillaire de la v&eacute;sicule mais la patiente a refus&eacute; la r&eacute;intervention. Actuellement, elle consulte pour deux masses de la paroi abdominale ant&eacute;rieure dont une ulc&eacute;r&eacute;e. Une tomodensitom&eacute;trie abdominale a objectiv&eacute; deux masses tissulaires p&eacute;riton&eacute;o-parietales et le dosage du CA19-9 est largement positif &agrave; 946 U/ml (soit 30 fois la valeur normale). Une biopsie sous anesth&eacute;sie locale a confirm&eacute; la r&eacute;cidive tumorale et la patiente a &eacute;t&eacute; adress&eacute;e en oncologie pour chimioth&eacute;rapie type GEMOX avant r&eacute;&eacute;valuation pour &eacute;ventuelle chirurgie.</b><br/> text/html 2018-12-12T03:05:07+01:00 Abdelhakim El Yajouri, Chafiq Mahraoui [Case report] - Patient with CHARGE syndrome - 24 September 2018. <b>A two-years-old boy presenting multiple anomaly syndrome (congenital heart disease, Tetralogy of Fallot, bilateral ear anomalies, and micropenis) was consulted in the Pneumo-allergology unit of Rabat children hospital in Morocco. It was ruled out the possibility of multiple deformities caused by genomic imbalances. The patient was then clinically considered to have CHARGE syndrome, an autosomal dominant multi-system disorder involving defects in multiple organs.</b><br/> text/html 2018-12-12T03:05:07+01:00 B&eacute;kaye Traor&eacute;, Lamissa Ciss&eacute; [Images in medicine] - N&aelig;vus verruqueux g&eacute;ant chez une adolescente de 15 ans: &agrave; propos d’un cas - 24 September 2018. <b>Le n&aelig;vus verruqueux est une tumeur b&eacute;nigne &agrave; disposition lin&eacute;aire suivant les lignes de Blaschko. Cette affection est due &agrave; des mutations en mosa&iuml;que du g&egrave;ne du r&eacute;cepteur FGFR3. Elle repr&eacute;sente surtout un pr&eacute;judice esth&eacute;tique, mais aussi fonctionnel en raison des manifestations prurigineuses, les l&eacute;sions peuvent &ecirc;tre localis&eacute;es ou &eacute;tendues (g&eacute;antes). Dans notre contexte, la raret&eacute; des centres sp&eacute;cialis&eacute;s en dermatologie constitue un facteur de retard diagnostique incitant le patient &agrave; entreprendre des th&eacute;rapeutiques peu appropri&eacute;es, responsables de complications infectieuses ou d&eacute;g&eacute;n&eacute;ratives. Nous rapportons le cas d’une adolescente de 15 ans qui pr&eacute;sente depuis l’enfance des l&eacute;sions papuleuses keratosiques dispos&eacute;es en bande de fa&ccedil;on lin&eacute;aire le long du cou, du membre sup&eacute;rieur droit, du flanc. L’examen histologique confirme le diagnostic de n&aelig;vus verruqueux.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ibrahima Diallo, Bineta Ndiaye, Cheikh Abdoukhadre Fall, Mouminatou Mbaye, Imane Korch, Papa Silman Diawara, Ababacar Mbengue, Sara Boury Gning, Papa Saliou Mbaye, Fatou Fall [Case series] - Inactive hepatitis B carriers: outcomes of patients followed at Hôpital Principal de Dakar, Senegal - 21 September 2018. <b>The evolutive profile of inactive HBV carriers is variable. Patients can remain inactive, or may evolve into chronic active hepatitis or hepatocellular carcinoma. Aim: to describe the long-term outcome of chronic hepatitis B inactive carriers followed at Hôpital Principal de Dakar. This is a retrospective study including all inactive HBV carriers, followed since 2001, and with regular monitoring of at least 5 years. Transaminases, viral load and screening for hepatocellular carcinoma were performed every 6 to 12 months. We included 52 patients. The mean follow-up was 76.2 months (60-162), the mean age 36 years (13-62 years) and the sex ratio 0.93 (25 men, 27 women). Four patients (7.7%) had an ALT above the normal. Eleven patients (21.1%) had persistently elevated viral load greater than 2000 IU/ml, while in three cases (5.8%), this increase was transient. Twenty-six patients (50%) had a detectable viral load, but still below 2000 IU/ml. Twelve patients (23.1%) had an undetectable viral load for the duration of monitoring. Eleven patients (21.2%) underwent liver biopsy. The activity or fibrosis were minimal in all cases (A or F = 1) or absent (A or F = 0). Only four patients (7.7%), had HBs seroconversion after a follow-up of six, seven and ten years. There was no focal lesion or cirrhosis detected during the follow-up. After a follow-up of at least 5 years, inactive HBV carriers remain inactive in 92.3% of cases. Their evolutive profile is characterized by an absence of elevated liver enzymes but with fluctuations of the viral load. HBs seroconversion rate is low and the risk of progression to hepatocellular carcinoma almost nil.</b><br/> text/html 2018-12-12T03:05:07+01:00 Assane Ndiaye, David Douglas Banga Nkomo, Souleymane Diatta, Pape Salmane Ba, Magaye Gaye, Modibo Doumbia, Pape Adama Dieng, Amadou Gabriel Ciss, Mouhamadou Ndiaye [Case series] - Indications et r&eacute;sultats de la chirurgie de r&eacute;section des bulles d’emphys&egrave;me pulmonaire - 20 September 2018. <b>La chirurgie d'ex&eacute;r&egrave;se des bulles ou bullectomie, principal moyen th&eacute;rapeutique dans la prise en charge des bulles d'emphys&egrave;me pulmonaire, est g&eacute;n&eacute;ralement r&eacute;serv&eacute;e aux patients dont les bulles sont compliqu&eacute;es ou, sont &agrave; l'origine d'une dyspn&eacute;e invalidante. Le but de notre &eacute;tude &eacute;tait de d&eacute;terminer les indications de la bullectomie et d'&eacute;valuer les r&eacute;sultats de cette chirurgie dans notre service. Nous avons men&eacute; une &eacute;tude r&eacute;trospective descriptive de 24 patients (23 hommes et 1 femme), dont la moyenne d'&acirc;ge &eacute;tait de 49 ans, et qui ont b&eacute;n&eacute;fici&eacute; d'une bullectomie entre 2004 et 2013. Les donn&eacute;es recueillies &eacute;taient les facteurs favorisant la survenue d'un emphys&egrave;me bulleux, les circonstances de d&eacute;couverte de la bulle, les donn&eacute;es des examens radiologiques, les donn&eacute;es de l'&eacute;valuation fonctionnelle respiratoire et cardiovasculaire, les donn&eacute;es de la technique de la bullectomie, les donn&eacute;es de l'&eacute;valuation clinique et fonctionnelle post op&eacute;ratoire. Le taux de morbidit&eacute; &eacute;tait de 37,5%. La principale complication &eacute;tait la fuite a&eacute;rienne prolong&eacute;e (7 cas). Un patient est d&eacute;c&eacute;d&eacute; au 2e jour post op&eacute;ratoire suite &agrave; une insuffisance respiratoire aig&uuml;e. La dur&eacute;e moyenne de suivi &eacute;tait de 26 mois. Durant ce suivi, nous avons observ&eacute; une am&eacute;lioration de la dyspn&eacute;e chez tous les patients et nous n'avons not&eacute; aucune complication. La bullectomie est une technique chirurgicale efficace, fiable et s&ucirc;re qui peut permettre aux patients d'avoir une meilleure qualit&eacute; de vie pendant quelques ann&eacute;es.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mamadou Oury Safiatou Diallo, Ibrahima Bah, Fode Bangaly Sako, Karamba Sylla, Fode Amara Traor&eacute;, Aminata Oumou Sylla, Mamadou Saliou Sow, Moussa Sidib&eacute;, Ali Abdessand Hach&eacute;mi, Fran&ccedil;ois Boiquigny, Mohamed Cisse [Case report] - Tuberculose multifocale associ&eacute;e &agrave; une toxoplasmose c&eacute;r&eacute;brale sur terrain immunod&eacute;prim&eacute; &agrave; VIH chez un patient immigr&eacute; africain au Centre Hospitalier de Soissons, France - 20 September 2018. <b>Dans les pays industrialis&eacute;s et notamment en France, vu les moyens de pr&eacute;vention, d&eacute;pistage pr&eacute;coce et prise en charge imm&eacute;diate de l'infection &agrave; VIH, la survenue d'infections opportunistes ne se voit presque chez les immigr&eacute;s et certaines couches socio-professionnelles d&eacute;favoris&eacute;es. Nous rapportons donc le cas d'un homme de 42 ans, immigr&eacute; africain, hospitalis&eacute; pour syndrome infectieux dans un contexte d'alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral, VIH1 positif sous antir&eacute;troviraux depuis deux ans, arr&ecirc;t&eacute;s depuis quatre mois, une tuberculose pulmonaire trait&eacute;e et d&eacute;clar&eacute;e gu&eacute;rie en novembre 2017 avec, &agrave; l'examen une lenteur a l'id&eacute;ation, une fi&egrave;vre &agrave; 39,6°C et un amaigrissement. Le nadir CD4 &agrave; 12/mm3, une charge virale VIH1 &agrave; 5,80log. Le scanner thoraco-abdominale et l'IRM c&eacute;r&eacute;brale ont permis de visualiser des l&eacute;sions intra-abdomino-thoraciques et c&eacute;r&eacute;brales avant la confirmation diagnostique de la tuberculose et de la toxoplasmose. Le patient fut mis sous trith&eacute;rapie antir&eacute;trovirale &agrave; quinze jours du traitement antituberculeux, puis au traitement antitoxoplasmique avec une &eacute;volution favorable.</b><br/> text/html 2018-12-12T03:05:07+01:00 Yohannes Ghebremedhin Tseghereda, Nyanga Murega Joseph, Nyerere Kimang'a Andrew, Mehari Hagos Tadesse, Gebrekidan Hadgu Yishak [Research] - Glucose-6-phosphate dehydrogenase deficiency allelic variants and their prevalence in malaria patients in Eritrea - 20 September 2018. <b>INTRODUCTION: Glucose 6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymopathy with a relatively high frequency in malaria-endemic regions. In Eritrea, there is scanty knowledge of G6PD deficiency. The aim of the study was to characterize and determine the prevalence of four common G6PD allelic variants.</b><br/> text/html 2018-12-12T03:05:07+01:00 Kays Chaker, Abdelrazek Bouzouita, Marwa Gharbi, Ahlem Blel, Marouene Chakroun, Haroun Ayed, Mohamed Cherif, Mohamed Riadh Ben Slama, Soumaya Rammeh, Amine Derouiche, Mohamed Chebil [Case series] - Diagnostic et prise en charge des cystites &agrave; &eacute;osinophiles - 20 September 2018. <b>La cystite &agrave; &eacute;osinophiles est une pathologie inflammatoire de la paroi v&eacute;sicale. Elle est rare, il n'existe pas des recommandations &eacute;tablies concernant sa prise en charge. Il s'agit d'une &eacute;tude r&eacute;trospective ayant concern&eacute;e dix observations de cystite &agrave; &eacute;osinophiles diagnostiqu&eacute;es et prises en charge dans notre service entre 2006 et 2017. L'&acirc;ge moyen des patients &eacute;tait de 46 ans. On a not&eacute; une pr&eacute;dominance masculine. Un terrain atopique &eacute;tait not&eacute; dans 3 cas. Le mode de pr&eacute;sentation le plus fr&eacute;quent &eacute;tait des signes urinaires irritatifs dans 9 cas, une h&eacute;maturie macroscopique dans 8 cas et des algies pelviennes dans 6 cas. Une hyper-&eacute;osinophilie sanguine &eacute;tait pr&eacute;sente dans 4 cas. La cystoscopie avait montr&eacute; des p&eacute;t&eacute;chies dans 5 cas, un aspect pseudo-tumoral dans 4 cas et &eacute;tait normal dans un cas. Pour les formes pseudo-tumorales une r&eacute;section endoscopique a &eacute;t&eacute; pratiqu&eacute;e. Quatre patients ont &eacute;t&eacute; trait&eacute;s par les anti-inflammatoires non st&eacute;ro&iuml;dien, avec am&eacute;lioration des sympt&ocirc;mes. Six malades ont &eacute;t&eacute; surveill&eacute;s. Apr&egrave;s un recul moyen de 50 mois, aucune r&eacute;cidive n'a &eacute;t&eacute; rapport&eacute;e. La cystite &agrave; &eacute;osinophiles est une pathologie rare. La pr&eacute;sentation clinique est non sp&eacute;cifique. La prise en charge repose sur des moyens m&eacute;dicaux non invasifs dans les formes peu symptomatiques.</b><br/> text/html 2018-12-12T03:05:07+01:00 Saad Alaoui Mhamedi, Hicham Meghraoui, Mohammed Benabdelhak, Yassamine Bentata, Intissar Haddiya [Case series] - La ponction biopsie r&eacute;nale: indications, complications et r&eacute;sultats - 20 September 2018. <b>La ponction biopsie r&eacute;nale (PBR) est une technique indispensable au diagnostic des maladies r&eacute;nales. Ce geste demeure invasif avec diverses complications, essentiellement h&eacute;morragiques. L'objectif de notre travail &eacute;tait d'&eacute;tudier notre pratique de la PBR, mettre le point sur la technique de la biopsie r&eacute;nale transcutan&eacute;e, &eacute;valuer ses complications, et d&eacute;terminer les n&eacute;phropathies diagnostiqu&eacute;es dans notre r&eacute;gion. Il s'agit d'une &eacute;tude r&eacute;trospective, men&eacute;e entre Janvier 2015 et Juin 2017. Nous avons inclus 69 patients du service de N&eacute;phrologie du CHU Mohamed VI, Oujda, Maroc ayant b&eacute;n&eacute;fici&eacute; d'une biopsie de reins natifs. L'&acirc;ge moyen des patients au moment de la PBR &eacute;tait de 38,16 ±13 ans (12-77 ans), le sexe ratio (H/F) &eacute;tait de 0,86. Le syndrome n&eacute;phrotique &eacute;tait l'indication la plus fr&eacute;quente tout &acirc;ge confondu. Les n&eacute;phropathies glom&eacute;rulaires repr&eacute;sentaient 81% des maladies r&eacute;nales, r&eacute;parties comme suit: la glom&eacute;rulon&eacute;phrite extra-membraneuse retrouv&eacute;e chez 19% des patients, la hyalinose segmentaire et focale chez 18%, la glom&eacute;rulon&eacute;phrite lupique chez 11%, les glom&eacute;rulon&eacute;phrites chroniques diagnostiqu&eacute;es dans 11% des cas, la glom&eacute;rulon&eacute;phrite membrano-prolif&eacute;rative chez 7%, la glom&eacute;rulon&eacute;phrite extra-capillaire chez 5% &agrave; part &eacute;gale avec l'amylose r&eacute;nale. Quatre pour cent (4%) des PBR &eacute;taient en faveur d'une n&eacute;phropathie diab&eacute;tique. Avec un taux estim&eacute; &agrave; 2% chacune, l'&eacute;tude histopathologique avait retrouv&eacute; la glom&eacute;rulon&eacute;phrite aigue post-infectieuse, la l&eacute;sion glom&eacute;rulaire minime, la n&eacute;phropathie &agrave; IgA, les vascularites, les n&eacute;phropathies tubulo-interstitielles ainsi que la microangiopathie thrombotique. Cinq pour cent (5%) des PBR &eacute;taient aglom&eacute;rulaires. L'h&eacute;maturie macroscopique &eacute;tait la principale complication observ&eacute;e dans notre s&eacute;rie avec une fr&eacute;quence de 2,8%. La PBR reste le gold standard du diagnostic de la maladie r&eacute;nale, cependant le diagnostic syndromique permet au clinicien d'identifier la maladie r&eacute;nale la plus probable et de guider les th&eacute;rapeutiques urgentes.</b><br/> text/html 2018-12-12T03:05:07+01:00 Youssef Darouassi, Mohamed Amine Hanine, Abdelfettah Aljalil, Amine Ennouali, Brahim Bouaity, Mohamed Mliha Touati, Haddou Ammar [Case series] - Chirurgie des hyperthyro&iuml;dies: &agrave; propos de 60 cas - 20 September 2018. <b>L'hyperthyro&iuml;die englobe plusieurs maladies caract&eacute;ris&eacute;es par un niveau &eacute;lev&eacute; d'hormones thyro&iuml;diennes circulantes. La thyro&iuml;dectomie en est un des principaux traitements. L'objectif de notre &eacute;tude est d'&eacute;valuer, &agrave; travers une &eacute;tude r&eacute;trospective, les particularit&eacute;s &eacute;pid&eacute;miologiques, cliniques, th&eacute;rapeutiques, et &eacute;volutives des patients ayant b&eacute;n&eacute;fici&eacute; d'une prise en charge chirurgicale d'une hyperthyro&iuml;die dans le service d'ORL &agrave; l'h&ocirc;pital militaire Avicenne de Marrakech. Soixante patients ont &eacute;t&eacute; collig&eacute;s avec une pr&eacute;dominance f&eacute;minine et une moyenne d'&acirc;ge de 52 ans. La clinique a &eacute;t&eacute; domin&eacute;e par les signes de thyrotoxicoses qui ont &eacute;t&eacute; retrouv&eacute;s chez tous les patients. L'exploration a permis d'identifier 47 cas de goitre multih&eacute;t&eacute;ronodulaire toxique ou pr&eacute;toxique (soit 78.33% des cas), 5 cas de maladies de Basedow (soit 8.33%) et 8 cas d'ad&eacute;nome toxique (soit 13.33%). Une pr&eacute;paration m&eacute;dicale a &eacute;t&eacute; de mise chez tous nos patients. Une thyro&iuml;dectomie totale a &eacute;t&eacute; r&eacute;alis&eacute;e chez 50 patients (soit 83.33%) et une loboisthmectomie chez 10 patients (soit 16.33%). En post-op&eacute;ratoire, des complications sont &eacute;t&eacute; collig&eacute;s: un cas de paralysie laryng&eacute;e transitoire (1,6% des cas), neuf cas d'hypoparathyro&iuml;die transitoire (15% des cas), un cas d'hypoparathyro&iuml;die d&eacute;finitive (1,6% de cas), et un seul cas d'h&eacute;matome compressif (1,6% de cas). La chirurgie des goitres toxiques r&eacute;put&eacute;s h&eacute;morragiques et adh&eacute;rents, doit &ecirc;tre r&eacute;alis&eacute;e par un chirurgien exp&eacute;riment&eacute; qui doit doubler de vigilance pour minimiser la morbidit&eacute; repr&eacute;sent&eacute;e essentiellement par la paralysie laryng&eacute;e et l'hypoparathyro&iuml;die.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ary&eacute; Weinberg, Andreas Eberhard Albers [Images in medicine] - Klippel-Feil syndrom: a duplicated thumb - 20 September 2018. <b>A 71-year-old woman was admitted to our hospital because of a vertigo. At clinical examination a duplicated right thumb was noticed. The Patient revealed that she was suffering from Klippel-Feil Syndrom (KFS). KFS is a rare skeletal disease where a mutation of the GDF6 and GDF3 genes can be found. It is characterized by congenital fusion of any of the 7 cervical vertebrae. There can be associations with other malformations such as congenital elevation of the scapula (Sprengel’s deformity), spina bifida, scoliosis, cleft palate, malformations of the heart, head, face, arms, legs and fingers. Because of these heterogeneous medical associated conditions treatment for KFS is symptomatic and can include surgery.</b><br/> text/html 2018-12-12T03:05:07+01:00 William Ngatchou, Isabelle Drezen, Felicit&eacute; Kamdem, Gis&egrave;le Imandy, Cecile Okalla, Albert Nkana, Jean Pierre Hacquebard, Pierre Origer, Joseph Sango, Daniel Lemogoum, Sidiki Mouliom, Anastase Dzudie, Henri Ngote, Romuald Hentchoya, Junette Metogo, Olivier Germay, Eug&egrave;ne Belley Priso, Jean Luc Jansens, Henry Luma, Tome Nadjovski [Case report] - Pr&eacute;l&egrave;vement de plaquettes pour la chirurgie cardiaque: premi&egrave;re exp&eacute;rience d'aph&eacute;r&egrave;se &agrave; l'H&ocirc;pital G&eacute;n&eacute;ral de Douala - 20 September 2018. <b>La chirurgie cardiaque sous circulation extracorporelle (CEC) est r&eacute;guli&egrave;rement associ&eacute;e &agrave; la perte d'une quantit&eacute; importante de sang. Une bonne anticipation de ces pertes sanguines et une bonne h&eacute;mostase perop&eacute;ratoire sont reconnues comme moyens permettant de limiter ces saignements post op&eacute;ratoires. Jusqu'&agrave; ce jour, la compensation des besoins en plaquettes des patients op&eacute;r&eacute;s sous CEC dans notre service se faisait par transfusion de sang total ou de concentr&eacute;s plaquettaires pr&eacute;lev&eacute;s &agrave; partir de plusieurs donneurs. Nous rapportons la premi&egrave;re exp&eacute;rience de pr&eacute;l&egrave;vement de concentr&eacute;s plaquettaires par la technique d'aph&eacute;r&egrave;se &agrave; l'h&ocirc;pital G&eacute;n&eacute;ral de Douala.</b><br/> text/html 2018-12-12T03:05:07+01:00 Awatif El Hakkouni, Nabil Mansouri [Case report] - L’aspergillose pulmonaire invasive chez un patient immunod&eacute;prim&eacute; s&eacute;ropositif pour le VIH - 20 September 2018. <b>L'aspergillose pulmonaire invasive est une infection opportuniste parmi les plus rares au cours de l'infection par le VIH. Son pronostic est sombre. Aspergillus fumigatus est l'esp&egrave;ce la plus fr&eacute;quemment incrimin&eacute;e. Le diagnostic doit &ecirc;tre pr&eacute;coce, &eacute;voqu&eacute; sur un faisceau d'arguments cliniques, radiologiques (le scanner thoracique) et mycologiques. L'examen direct du liquide de lavage bronchiolo-alv&eacute;olaire, coupl&eacute; &agrave; la culture permet l'identification de l'Aspergillus sp. L'examen anatomopathologique de biopsies scanno-guid&eacute;es est n&eacute;cessaire en cas de n&eacute;gativit&eacute; du LBA. Le dosage de l'antig&egrave;ne galactomannane est tr&egrave;s utile au diagnostic. Le Voriconazole est la mol&eacute;cule &agrave; prescrire en premi&egrave;re intention avec la n&eacute;cessit&eacute; de v&eacute;rifier l'absence d'interactions m&eacute;dicamenteuses avec les antir&eacute;troviraux hautement actifs.</b><br/> text/html 2018-12-12T03:05:07+01:00 Amine Tahir, Amine Sdoudi, Mohamed Chahed, Aniss Elbaitil, Lkoutbi Fakherdine, Yasser Sbihi, Driss Bennouna, Mustafa Fadili [Case report] - Syndrome du canal carpien secondaire &agrave; une vari&eacute;t&eacute; anatomique rare du nerf m&eacute;dian - 20 September 2018. <b>Le syndrome du canal carpien repr&eacute;sente l'un des motifs de consultation les plus fr&eacute;quents en chirurgie de la main, son incidence annuelle est de 300 par 100.000 habitants et 80.000 interventions chirurgicales pour le syndrome du canal carpien sont faites chaque ann&eacute;e en France. Dans la plupart des cas, le syndrome du canal carpien est idiopathique survenant sans qu'aucune cause puisse &ecirc;tre identifi&eacute;e, cependant en dehors de ces formes l'intrication de plusieurs m&eacute;canismes peuvent expliquer la relation cause &agrave; effet de cette pathologie. A travers cette observation on va essayer de mettre la lumi&egrave;re sur une association exceptionnelle d'un syndrome du canal carpien secondaire &agrave; une vari&eacute;t&eacute; anatomique rare du nerf m&eacute;dian.</b><br/> text/html 2018-12-12T03:05:07+01:00 Katerina Krompa, Ines Barka, St&eacute;phanie Malard, Sopio Tatulashvili, Camille Baudry, H&eacute;l&egrave;ne Bihan, Marinos Fysekidis [Case report] - Ketosis prone diabetes presenting as fulminant type 1 diabetes - 20 September 2018. <b>Patients with ketosis prone diabetes have been reported primarily in Africans and African Americans. At presentation, both insulin secretion and insulin action are impaired in ketosis prone diabetes patients. Fulminant diabetes is a subtype of type 1 diabetes reported mainly in the Asian populations characterized by diabetic ketosis or ketoacidosis occurring soon after the onset of hyperglycemic symptoms with inappropriately low HbA1c (< 8.5%). We report here the first case of a ketosis prone diabetes presenting as fulminant diabetes.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mohamed Moez Kammoun, Rim Karray, Kais Regaieg, Mabrouk Bahloul, Mounir Bouaziz [Case report] - Une cause exceptionnelle des p&eacute;ritonites: une perforation il&eacute;ale par un corps &eacute;tranger lors de la r&eacute;duction d’une hernie inguinale - 18 September 2018. <b>La p&eacute;ritonite secondaire est fr&eacute;quemment rapport&eacute;e dans la litt&eacute;rature. Les causes sont multiples. Nous rapportons un cas d'une perforation il&eacute;ale par une cause exceptionnelle. Il s'agit d'une perforation il&eacute;ale par un corps &eacute;tranger lors de la r&eacute;duction d'une hernie inguinale, responsable d'une p&eacute;ritonite grave avec tableau de d&eacute;faillance multivisc&eacute;rale.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mehdi Hasnaoui, Mohamed Masmoudi, Jamel Chefai, Nouha Ben Hmida, Khalifa Mighri, Nabil Driss [Case series] - Le kyste de la vall&eacute;cule symptomatique chez l’adulte: &agrave; propos de 4 cas - 18 September 2018. <b>Le kyste de la vall&eacute;cule est une l&eacute;sion b&eacute;nigne rare. Ces kystes sont souvent asymptomatiques chez l'adulte. Les auteurs rapportent 4 cas de kystes de la vall&eacute;cule symptomatique de l'adulte. Trois patients ont consult&eacute; pour une dysphagie haute mixte associ&eacute;e &agrave; une dysphonie. Le quatri&egrave;me patient se plaignait d'une sensation de corps &eacute;tranger dans la gorge. La laryngoscopie a montr&eacute; une formation kystique dans la r&eacute;gion vall&eacute;culaire gauche dans tous les cas. La tomodensitom&eacute;trie a confirm&eacute; la pr&eacute;sence d'une formation kystique de la vall&eacute;cule. Le traitement a consist&eacute; en une marsupialisation du kyste dans deux cas et une r&eacute;section endoscopique dans deux cas. &Agrave; partir de ces 4 cas cliniques, nous nous proposons de pr&eacute;ciser les particularit&eacute;s diagnostiques et th&eacute;rapeutiques de cette affection.</b><br/> text/html 2018-12-12T03:05:07+01:00 Molla Temere Mekonen, Hana Abebe Dagnew, Tesfay Ambaye Yimam, Hayat Nuradis Yimam, Melese Abate Reta [Research] - Adolescent-parent communication on sexual and reproductive health issues and associated factors among high school students in Woldia town, Northeastern Ethiopia - 18 September 2018. <b>INTRODUCTION: Sexual and reproductive health (SRH) communication is most likely to promote healthy sexual practices and to reduce risky sexual behavior among adolescents. Communication is the principal means for parents to transmit sexual values and knowledge to their children. This study aimed to assess adolescent-parent communication on SRH issues among high school students in Woldia town. METHODS: A cross-sectional study was conducted from December 15-31, 2016. Systematic random sampling technique was used to select 693 students from Grades 9 and 10. Data were entered into Epi-info version 3.5.1 and analyzed by usingSPSS version 20. Logistic regression with OddsRatios(OR) and 95% Confidence intervals (CI) was used to identify the independent predictors of adolescent-parent communication. RESULTS: 674 students accepted to participate in this study giving a response rate of 97.3%.Only 205(30.4%) had discussed on two or more SRH topics with their parents. In logistic regression analyses, mothers who could read and write [AOR=2.0; 95% CI=1.3-3.1] and had diploma certificate [AOR=2.0; 95% CI=1.4-2.9] were more likely to discuss on SRH issues with their children. Adolescents who agreed on the importance of discussion on SRH issues [AOR=2.5; 95% CI=1.3-4.5], whoever gotSRH information [AOR=2.0; 95% CI=1.4-2.9] and those whoever had sexual intercourse [AOR=1.7; 95% CI=1.1-2.6] were more likely to discuss on different SRH issues with their parents. CONCLUSION: This study revealed that parent-adolescent communication on SRH issues was inadequate.Therefore, there is a need to equip and educate parents on different adolescents' SRH issues.</b><br/> text/html 2018-12-12T03:05:07+01:00 Roger Tshimanga Mukadi, Maurice Sumaili Mwana Ntambwe, Hermann Tamubango Kitoko, Joseph Malashi Mwisi, Fiston Ilunga Mbayo [Research] - Sexualit&eacute; des jeunes en milieu scolaire dans la ville de Likasi en R&eacute;publique D&eacute;mocratique du Congo - 14 September 2018. <b>INTRODUCTION: Des nombreuses &eacute;tudes sur la sexualit&eacute; en Afrique subsaharienne, notent un accroissement de l'activit&eacute; sexuelle des jeunes c&eacute;libataires, cette sexualit&eacute; est pr&eacute;coce, instable, multipartenaire, d&eacute;pendant de l'environnement proche des jeunes et des membres de leurs m&eacute;nages. Cette &eacute;tude vise &agrave; d&eacute;terminer la pr&eacute;valence des jeunes sexuellement actifs et &eacute;valuer les facteurs influant sur le comportement sexuel. METHODES: Il s'agit d'une &eacute;tude d'observation descriptive transversale couvrant la p&eacute;riode allant de Mai &agrave; Juin 2017. L'&eacute;tude a port&eacute; sur 249 &eacute;l&egrave;ves de 5&eacute;me et 6&eacute;me secondaires de 4 &eacute;coles de Likasi (CS Kalunga, CS la Borne, College Tutazamie et Lyc&eacute;e Musofi). Les donn&eacute;es ont &eacute;t&eacute; saisies et encod&eacute;es avec le logiciel excel 2013. RESULTATS: Deux cent quarante neuf jeunes ont r&eacute;pondu &agrave; l'enqu&ecirc;te dont 153 filles et 96 gar&ccedil;ons, parmi lesquels 104 sont sexuellement actifs soit une pr&eacute;valence de 42%. L'&acirc;ge Moyen au premier rapport sexuel chez le gar&ccedil;on est de 16,7 ans et 17,2 ans chez la fille, 38% ont eu leurs premiers rapports sexuels entre 10 et 15 ans, 56% d&eacute;clarent avoir eu plus d'un partenaire sexuel. Le media, l'internet, le niveau et milieu de vie sont identifi&eacute;s comme facteurs qui influencent le comportement sexuel des jeunes. CONCLUSION: selon l'ONUSIDA, le SIDA s'est juvenilis&eacute;, l'&eacute;limination de cette &eacute;pid&eacute;mie passe par la promotion d'une sexualit&eacute; saine et responsable selon la strat&eacute;gie ABC.</b><br/> text/html 2018-12-12T03:05:07+01:00 Abdoulaye Ousmane, Harouna Amadou Mahaman Laouali, Oumarou Amadou, Adakal Ousseini, Harouna Magagi Lawanou, Laouali Boubou, Djimraou Oumarou, Moussa Abdoulaye, Mamadou Saidou [Case series] - Aspects &eacute;pid&eacute;miologiques et bact&eacute;riologiques des infections du site op&eacute;ratoire (ISO) dans les services de chirurgie &agrave; l’H&ocirc;pital National de Niamey (HNN) - 14 September 2018. <b>Ce travail &agrave; consister &agrave; &eacute;tudier les aspects &eacute;pid&eacute;miologiques et bact&eacute;riologiques des souches bact&eacute;riennes isol&eacute;es au cours des infections du site op&eacute;ratoire (ISO) &agrave; l'H&ocirc;pital National de Niamey. Nous avions men&eacute; une &eacute;tude r&eacute;trospective, et descriptive sur une p&eacute;riode de 24 mois. Toutes les souches isol&eacute;es &agrave; partir de pr&eacute;l&egrave;vements bact&eacute;riologiques effectu&eacute;s chez les patients pr&eacute;sentant une infection du site op&eacute;ratoire ont &eacute;t&eacute; identifi&eacute;es et test&eacute;s aux antibiotiques selon les m&eacute;thodes classiques conventionnelles. Les analyses bact&eacute;riologiques ont permis d'isoler 126 souches bact&eacute;riennes avec une pr&eacute;dominance de S.aureus (n=39, 31%) suivi d'Escherichia coli (n = 29, 23%) et de Pseudomonas aeruginosa (n=12, 9,5%). Les souches d'Escherichia coli &eacute;taient sensibles &agrave; 100% &agrave; l'imipen&egrave;me. Elles ont montr&eacute; des r&eacute;sistances marqu&eacute;es &agrave; l'ampicilline, l'amoxicilline, l'acide-clavulanique et la ticarcilline. Elles pr&eacute;sentaient des r&eacute;sistances variables aux aminosides (62% &agrave; la gentamycine, et 78% &agrave; l'amikacine), et aux fluoroquinolones (acide nalidixique 74%, pefloxacine 33%, l'ofloxacine 69%, ciprofloxacine 61%). L'ensemble des isolats d'ent&eacute;robact&eacute;ries &eacute;taient sensibles &agrave; l'imip&eacute;n&egrave;me. Les souches de S.aureus avaient montr&eacute; des r&eacute;sistances &agrave; la P&eacute;nicilline G (88,6%) et &agrave; l'oxacilline (83%). Elles avaient montr&eacute; aussi des r&eacute;sistances de 37% et 57% respectivement &agrave; la vancomycine et teicoplanine. Par contre, elles &eacute;taient sensibles &agrave; la lincomycine et aux aminosides test&eacute;s. Compte tenu de ces r&eacute;sultats, nous pensons qu'il faudra am&eacute;liorer les protocoles d'antibioprophylaxie et d'antibioth&eacute;rapie probabiliste dans les services chirurgicaux. Aussi, mener des &eacute;tudes p&eacute;riodiques de surveillances des ISO.</b><br/> text/html 2018-12-12T03:05:07+01:00 Bounoual Mohammed, Omana Jean paul, Ahsaini Mustapha, Tazi Karim, Mellas Soufiane, EL Ammari Jalaleddine, Tazi Mohammed Fadl, El Fassi Mohammed Jamal, Farih Moulay Hassan [Case report] - Incontinence urinaire r&eacute;v&eacute;lant une fistule v&eacute;sico-ut&eacute;rine: &agrave; propos d’un cas - 14 September 2018. <b>La fistule v&eacute;sico-ut&eacute;rine (FVU) est une l&eacute;sion rare et ne repr&eacute;sente que 4% de toutes les fistules uro-g&eacute;nitales. Elle est le plus souvent cons&eacute;cutive &agrave; une c&eacute;sarienne et r&eacute;alise une communication entre la vessie et l'ut&eacute;rus. Nous rapportons un cas d'une jeune patiente qui pr&eacute;sentait une FVU suite &agrave; une c&eacute;sarienne. Le but de ce travail &eacute;tait d'analyser les aspects cliniques et th&eacute;rapeutiques de cette affection.</b><br/> text/html 2018-12-12T03:05:07+01:00 Aruyaru Stanley Mwenda, Alex Muturi, Fredrick Ouma Oluga [Opinion] - Six stormy years and the audacity to confront a challenging future: taking stock of the Kenyan Doctors’ Union - 13 September 2018. <b>The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) was formed in August 2011. Within the last six years, this union has galvanized the Kenyan doctors together, agitated for healthcare policy reforms and successfully negotiated and registered a Collective Bargaining Agreement (CBA). Though political will and the national citizens' psyche on matters pertaining to public healthcare remains a challenge, this union has made its foot prints on the Kenyan conversation space. KMPDU looks forward to engaging local, regional and international health stake holders to improve the state of the country's health care, key among these being to have a national commission handling all the human resources for health.</b><br/> text/html 2018-12-12T03:05:07+01:00 Anass Ayyad, Maria Rkain, Abdeladim Babakhouya, Noufissa Benajiba [Case report] - La varicelle n’est pas toujours b&eacute;nigne - 13 September 2018. <b>La varicelle est une maladie &eacute;ruptive due au virus varicelle-zona qui touche essentiellement les enfants et dont l'&eacute;volution est habituellement b&eacute;nigne. Cependant des complications de gravit&eacute; variable peuvent &ecirc;tre observ&eacute;es tel que les complications infectieuses bact&eacute;riennes et les complications neurologiques. Nous rapportons deux observations de varicelle compliqu&eacute;e. Comme premi&egrave;re observation, un nourrisson de 5 mois sans ant&eacute;c&eacute;dents qui pr&eacute;sente depuis six jours une &eacute;ruption cutan&eacute;e fait de v&eacute;sicules et pustules, la symptomatologie s'est aggrav&eacute;e la veille de son admission au service par l'installation d'une d&eacute;tresse respiratoire. Comme deuxieme observation, une fillette de 7 ans, admise au service pour prise en charge d'une convulsion simple, et chez qui l'examen clinique a objectiv&eacute; des cicatrices de varicelle g&eacute;n&eacute;ralis&eacute;es et une ataxie c&eacute;r&eacute;belleuse. Bien que la varicelle soit connue comme une affection virale commune, le plus souvent b&eacute;nigne, plusieurs &eacute;tudes ont r&eacute;cemment fait &eacute;tat d'une recrudescence de ses complications, qui semblent responsables de 0,2 &agrave; 1,5% des motifs d'hospitalisation des enfants atteints de varicelle.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ahmed Youssef Kada, Kheireddine Abdelouahed Bouyoucef [Case series] - La mort enc&eacute;phalique post traumatique: &eacute;pid&eacute;miologie et facteurs de risque - 13 September 2018. <b>Il est possible de pr&eacute;voir l'&eacute;volution d'un patient vers l'&eacute;tat de mort enc&eacute;phalique et plusieurs &eacute;quipes se sont int&eacute;ress&eacute;s &agrave; la recherche de facteurs pr&eacute;dictifs de la mort enc&eacute;phalique, cependant la difficult&eacute; de proposer un mod&egrave;le coh&eacute;rent r&eacute;side dans le choix des crit&egrave;res propos&eacute;s, qui, dans la plupart des &eacute;tudes est subjectif. Il conviendrait d'analyser une population uniforme et de d&eacute;finir des crit&egrave;res universels pour pouvoir pr&eacute;dire avec certitude le passage en mort enc&eacute;phalique, un score pr&eacute;dictif &eacute;tant alors parfaitement envisageable.</b><br/> text/html 2018-12-12T03:05:07+01:00 Amine Benmoussa, Khaoula Khalil, Fatimazzahra Boufarissi, Ilias Tazi [Case report] - Leuc&eacute;mie agressive &agrave; cellules NK (Natural Killer): &agrave; propos d'un cas dans la population africaine et revue de la litt&eacute;rature - 13 September 2018. <b>La leuc&eacute;mie agressive &agrave; cellules NK (ANKL) fait partie des syndromes lymphoprolif&eacute;ratifs &agrave; cellules NK. C'est une entit&eacute; rare touchant essentiellement les asiatiques, elle est tr&egrave;s rarement d&eacute;crite dans la population africaine (l'int&eacute;r&ecirc;t de notre cas). Nous rapportons le cas d'une patiente de 19 ans, d'origine marocaine, qui pr&eacute;sente un syndrome d'insuffisance m&eacute;dullaire d'installation brutale avec syndrome tumoral, le diagnostic de la Leuc&eacute;mie &agrave; NK a &eacute;t&eacute; retenu par l'&eacute;tude microscopique et immunoph&eacute;notyique de la moelle osseuse. L'&eacute;volution est fatale avec d&eacute;c&egrave;s de la patiente dans 2 mois apr&egrave;s le diagnostic par un choc septique. Le pronostic d'ANKL est tr&egrave;s mauvais et la survie m&eacute;diane apr&egrave;s le diagnostic est en moyenne de deux mois. En l'absence d'&eacute;tude prospective, aucune attitude th&eacute;rapeutique consensuelle n'est &agrave; ce jour &eacute;tablie.</b><br/> text/html 2018-12-12T03:05:07+01:00 Elsa Ayo Bivigou, Mahutondji Christian Allognon, Francis Ndoume, Jean Bruno Mipinda, Emmanuel Ecke Nzengue [Research] - L&eacute;talit&eacute; de l’insuffisance cardiaque au Centre Hospitalier Universitaire de Libreville (CHUL) et facteurs associ&eacute;s - 13 September 2018. <b>INTRODUCTION: L'insuffisance cardiaque (IC) est une cause fr&eacute;quente de d&eacute;c&egrave;s en Afrique. La pr&eacute;sente &eacute;tude a pour but de d&eacute;terminer le taux de l&eacute;talit&eacute; de l'IC et de rechercher les facteurs associ&eacute;s. METHODES: il s'agissait d'une &eacute;tude r&eacute;trospective transversale r&eacute;alis&eacute;e dans le service de cardiologie du CHUL. Elle portait sur l'analyse de dossiers de patients hospitalis&eacute;s pour IC gauche ou globale collig&eacute;s de Janvier 2014 &agrave; D&eacute;cembre 2016. RESULTATS: la l&eacute;talit&eacute; &eacute;tait de 10,3%. L'&acirc;ge moyen des patients d&eacute;c&eacute;d&eacute;s (n=64) &eacute;tait de 57,4 ± 17 ans. Le d&eacute;lai moyen de prise en charge &eacute;tait de 15± 18 jours et la d&eacute;compensation faisait suite &agrave; un &eacute;cart de traitement chez 51,4% des patients d&eacute;c&eacute;d&eacute;s. L'association hypertension art&eacute;rielle et diab&egrave;te augmentait significativement le risque de d&eacute;c&egrave;s (OR= 2,2 (1,2-6,6)). Les facteurs associ&eacute;s &agrave; la l&eacute;talit&eacute; &eacute;taient essentiellement: l'hypotension art&eacute;rielle (OR=6,8(3,2-14,1)), l'insuffisance r&eacute;nale s&eacute;v&egrave;re (OR=3,5(1,7-7,2)), un index cardio-thoracique sup&eacute;rieur &agrave; 0,7 (OR= 54,4 (15,3-193,1)), une alt&eacute;ration s&eacute;v&egrave;re de la fraction d'&eacute;jection ventriculaire gauche (OR= 3,0(1,5-5,9)) et un taux &eacute;lev&eacute; de NT-proBNP (OR=3,5(1,2-10,5)). La mortalit&eacute; augmentait significativement avec le nombre de comorbidit&eacute;s. Les d&eacute;c&egrave;s &eacute;taient dus dans 28,4% des cas &agrave; une complication extracardiaque. CONCLUSION: la l&eacute;talit&eacute; de l'IC est li&eacute;e &agrave; la s&eacute;v&eacute;rit&eacute; et &agrave; la pr&eacute;cocit&eacute; des l&eacute;sions. Le retard de prise en charge et les comorbidit&eacute;s aggravent cette l&eacute;talit&eacute;. Le d&eacute;pistage des facteurs de risque et l'&eacute;ducation th&eacute;rapeutique pourraient diminuer cette mortalit&eacute; qui concerne des sujets relativement jeunes.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ayesha Ahmed [Case report] - Chondroid and osseous metaplasia in an incidental type II papillary renal cell carcinoma with extensive solid areas: an unraveled molecular character - 13 September 2018. <b>Chondroid and osseous metaplasia in a Type II Papillary renal cell carcinoma (PRCC) with extensive solid areas is a complex histological combination that has not been reported before. A 21 years old male presented with a comminuted fracture of right femur. On hematological investigations he was found to have low RBC count and hemoglobin. Radiological examination revealed an incidental, exophytic complex solid and cystic, mass lesion measuring 7 x 6.5x 4.9 cm with thickened walls, septation and calcification. It was completely replacing upper pole of the left kidney with extension into perinephric fat. Enlarged para aortic and hilar nodes with necrosis were also noted. Radiological diagnosis was infectious processes such as tuberculosis versus malignancy. Surgical intervention comprising left partial nephrectomy was done. Histopathology and immunohistochemical analysis yielded the above diagnosis. Cytogenetic studies did not reveal gain of chromosome 7 and/or 17 or loss of chromosome Y,a characteristic genetic profile of PRCC.This case could be representative of a unique histological variant of PRCC in which the molecular profile yet needs to be unraveled.</b><br/> text/html 2018-12-12T03:05:07+01:00 Olajumoke Ajibola Effiom, Akanbi Clement Olurotimi Olojede, Olakanmi Ralph Akinde, Adetokunbo Babjide Olawuyi, Abiodun Taofeek Amoo, Godwin Toyin Arotiba [Research] - Dermatofibrosarcoma protuberans: clinicopathologic presentation in Nigerians - 12 September 2018. <b>INTRODUCTION: Dermatofibrosarcoma protuberance (DFSP) is in general a rare low grade malignant sarcoma and possesses a tendency for local recurrence. It has a site predilection for the trunk. Occurrence in the facial area is extremely rare. Ample knowledge of its clinical, histological and biologic characteristics is vital for accurate and prompt recognition. METHODS: Over 13 years, clinicohistologic information of cases was retrieved. Histological and immunohistochemical re-evaluation were performed to re-confirm diagnosis. Data collected and analyzed with SPSS Statistics version 20 were presented as frequency tables, charts and proportions as appropriate.</b><br/> text/html 2018-12-12T03:05:07+01:00 Habiba Suleiman Madjapa, Irene Kida Minja [Research] - Root canal morphology of native Tanzanian permanent mandibular molar teeth - 12 September 2018. <b>INTRODUCTION: Research has shown variations in morphology of root canals to differ amongst ethnic groups. We aimed to investigate the root morphology and canal configuration of permanent mandibular molars in a native Tanzanian population. METHODS: The 146 first and 85 second mandibular molars were collected from Tanzanian patients. After removal of the pulp tissues and staining using Methylene blue ink from the canal system, the teeth were decalcified and rendered clear using 98% methyl salicylate. The teeth were then examined under magnification of 10X for: number of roots, tooth length, number of canals, location of apical foramen, presence of an apical delta, and canal configuration using Vertucci’s classification. RESULTS: All mandibular molars had two separate roots. The mean tooth length for mandibular 1<sup>st</sup> and 2<sup>nd</sup> molars were 21.7 mm and 20.5mm, respectively, with no statistically significant difference in mean tooth length between males and females. All the mesial roots 1st and 2<sup>nd</sup> mandibular molars possessed two root canals, while 40.4% and 54.1% of the distal roots of 1st and 2<sup>nd</sup> molars, respectively, had two canals. The majority of the examined teeth had their apical foramen located centrally, with an apical delta present in the distal root of one-second molar. Root canal configuration types commonly reported were Type II in the mesial and Type I in the distal roots of the mandibular 1st molar; while the 2<sup>nd</sup> molar had, respectively, root types II / IV and type I. CONCLUSION: There were observed variations in the morphology of root canals in a Tanzanian population. Caution is advised to clinicians when performing root canal treatment.</b><br/> text/html 2018-12-12T03:05:07+01:00 Alila Mohammed, Hamdane Amine, Sara El Atiq, Bounoual Mohammed, Mouaqit Ouadii, Mazaz Khalid, Ait Taleb Khalid, Ousadden Abdelmalek [Case series] - Applicability and outcome of laparoscopic adrenalectomy for large tumours - 11 September 2018. <b>Laparoscopic adrenalectomy has been shown to be as safe and effective as conventional open surgery for small and benign adrenal lesions. With increasing experience with laparoscopic adrenalectomy, this approach has become the procedure of choice for the majority of patients requiring adrenalectomy. In our department, from 2011 to 2016, a total of 28 patients with 31 adrenal tumours underwent laparoscopic adrenalectomy regardless of tumour size. Our policy in the department is to exclude adrenal tumours that are potentially malignant or metastatic adrenal tumours for laparoscopic resection. In this a retrospective study, we divided patients into two groups according to tumour size: < 5 or &#8805; 5 cm, which was considered as the definition of large adrenal tumours. We compared demographic data and per- and postoperative outcomes. There was no statistical difference between the two groups for per-operative complications (16,6% vs 18,75%, P = 0.71), postoperative complications (16,6% vs 18,75% , P = 0.71), postoperative length of hospital stay (5 vs 8 days P = 0.40), mortality (0% vs 0%) or oncologic outcomes: recurrence and metastasis (8.3% vs 6.25% P = 0.70). The only statistical difference was the operating time, at a mean (SD) 194 (60) vs 237 (71) min (P = 0.039) and the conversion rate (0% vs 12.5% P < 0.01). Laparoscopic adrenalectomy can be done for all patients with adrenal tumours regardless of tumour size, even it needs more time for large tumour but appears to be safe and feasible when performed by experienced surgeons.</b><br/> text/html 2018-12-12T03:05:07+01:00 Olusesan Ayodeji Makinde, Clifford Obby Odimegwu [Research] - A qualitative inquiry on the status and adequacy of legal instruments establishing infectious disease surveillance in Nigeria - 11 September 2018. <b>INTRODUCTION: The threat of devastating disease outbreaks is on the rise with several outbreaks recorded across the world in the last five years. The intractable Ebola Virus Disease outbreak in West Africa which spread to Nigeria was a reawakening point. This study reviews the status and adequacy of the legal framework surveillance for disease in Nigeria. METHODS: a mixed methods approach comprising of document reviews and key informant interviews was used in data collection. RESULTS: fourteen key informants from the federal ministry of health (FMOH) and six States were interviewed. Five legal instruments were identified and reviewed. The Quarantine Act of 1926 remains the active National Law on disease surveillance in Nigeria. An Integrated Disease Surveillance and Response Policy (IDSR) was developed in 2005 as the means for achieving the International Health Regulations (IHR). CONCLUSION: the legal instruments establishing disease surveillance in Nigeria require strengthening and possibly enactment as a National Law in order to address emerging disease threats.</b><br/> text/html 2018-12-12T03:05:07+01:00 Aboyowa Arayuwa Edukugho, Jarlath Udoudo Umoh, Matthew Diem, Oyetunji Ajani, Belinda Uba, Lilian Okeke, Elizabeth Adedire, Adewole Adefisoye, Caroline Edukugho, Patrick Nguku [Research] - Knowledge, attitudes and practices towards rabies prevention among residents of Abuja Municipal Area Council, Federal Capital Territory, Nigeria - 10 September 2018. <b>INTRODUCTION: Rabies is a fatal neglected zoonosis killing 55,000 people worldwide annually. It is endemic in Nigeria with 10,000 people exposed annually through dog-bites. To inform adequate intervention due to the rise in reported dog-bite cases, we assessed knowledge, attitudes and practices (KAP). METHODS: we carried out a cross-sectional study among 224 residents of Abuja Municipal Area Council. We used structured questionnaires to collect data on sociodemographic characteristics, knowledge and attitudes on rabies prevention. Knowledge score of &#8805; 8 points based on ten-point domain questions were regarded as satisfactory. We analyzed data using Epi-Info and Excel for frequencies and proportions and associations were determined at 5% significance level. RESULTS: a total of 123 (55%) respondents owned dogs. One hundred and eighty-four (82%) respondents had satisfactory knowledge on rabies prevention. About 87% knew where to get dogs vaccinated and would seek medical treatment from the hospital when bitten by a dog. Majority (58%) did not know the frequency of anti-rabies administration for dogs and 63.3% did not know the appropriate first aid actions following dog-bites. Of 123 dog owners, 35% would allow their dogs roam without restriction and 94% reported vaccinating their dogs against rabies. Dog owners were more likely to have satisfactory knowledge of rabies compared to non-dog owners (OR 7.8, 95% CI 1.0-62.0, p = 0.02). CONCLUSION: knowledge on rabies is satisfactory but with knowledge gaps in the frequency of dog anti-rabies vaccination, appropriate first-aid following dog bites and non-restriction of dog movement. To prevent rabies, these knowledge gaps need to be addressed through public enlightenment and enforcement of dog movement restrictions laws.</b><br/> text/html 2018-12-12T03:05:07+01:00 Michael Eteng Eyong, Happiness Uko Ntia, Joanah Moses Ikobah, Edu Michael Eyong, Helen Uket, Callistus Enyuma, Kelechi Uheagbu [Research] - Pattern of pubertal changes in Calabar, South South Nigeria - 07 September 2018. <b>INTRODUCTION: Puberty is an essential physiologic process that is characterized by the appearance of secondary sexual features. Secular changes in puberty occur from one generation to another and need to be documented. The assessment of pubertal stages in a child is only useful if recent and reliable reference data from the same population is available for comparison. The study aimed to profile clinical normative sexual maturity characteristics for children in Calabar, South-South Nigeria. METHODS: a cross-section of primary and secondary school pupils aged 6-18 years in the city of Calabar, Nigeria were randomly selected for the study. Sexual maturating rating was assessed using the pubertal staging for breast development and pubic hair as described by Marshall and Tanner (Tanner staging). Testicular volume in boys was measured using the Prader orchidometer. Menarche and "voice break" were established by recall of the event by the girls and boys respectively. RESULTS: a total of 2,830 children were seen, 1542 (54.5%) boys and 1288 (45.5%) girls. The mean age of onset of pubic hair was 11 years in both boys and girls. Pubertal testicular volume of 4 mls was seen in boys at a mean age of 11 years. Breast development in girls occurred at mean age of 11 years and menarche at 13 years. CONCLUSION: in this study, the onset of puberty is occurring at an earlier age than previously reported in Nigeria with a secular trend of a decreasing age at onset of puberty. These sexual characteristics are rather occurring at similar ages reported from western countries.</b><br/> text/html 2018-12-12T03:05:07+01:00 Kola Ademola Jinadu, Akindele Olupelumi Adebiyi, Olubunmi Olutoyin Sekoni, Eniola Adetola Bamgboye [Research] - Integrated disease surveillance and response strategy for epidemic prone diseases at the primary health care (PHC) level in Oyo State, Nigeria: what do health care workers know and feel? - 07 September 2018. <b>INTRODUCTION: Effective diseases surveillance remains an important operational tool in countries with recurrent epidemic prone diseases (EPDs). In Nigeria, insufficient knowledge among Health Care Workers (HCWs) on Integrated Disease Strategy and Response Strategy (IDSR) have been documented. This study assessed knowledge and attitude of HCWs towards IDSR strategy for EPDs at the Primary Health Care (PHC) level in Oyo State, Nigeria. METHODS: a cross-sectional facility based study using an interviewer-administered questionnaire was used to obtain information from 531 HCWs. In addition, 7 Key Informant Interviews was conducted. Discrete data were summarized as proportions while chi-square test was used to assess association between variables. A logistic regression model was used to assess predictors of knowledge of HCWs. All statistical significance was set at 5%. RESULTS: mean age of respondents was 42 ± 8.1 years with female preponderance (86.1%). Community Health Extension Workers (CHEWs) (36.9%) constituted the highest proportion of HCWs. About 70% and 90% of HCWs had good knowledge of EPDs and IDSR surveillance data flow respectively. Majority of HCWs 333(67.3%) knew how to use IDSR form 003 but less than 10% knew how to use other IDSR forms. The majority of HCWs {492(99.4%) and 345(69.7%)} agreed that reporting EPDs is necessary and IDSR tools are simple to use. Number of years post basic qualification was a predictor of HCWs' knowledge (AOR: 1.6; 95% CI: 1.0-2.3). CONCLUSION: this study showed poor knowledge on the use of IDSR forms although majority of HCWs had good knowledge and positive attitude towards IDSR strategy for EPDs. Thus, regular evaluation of health workers' knowledge and attitude towards IDSR strategy as a performance function of the surveillance system is recommended.</b><br/> text/html 2018-12-12T03:05:07+01:00 Luc Pascal Christian Loulouga Badinga, Nour Mekaoui, Lamiae Karboubi, Badr Sououd Benjelloun Dakhala [Case report] - Intoxication au M’khinza: &agrave; propos de deux observations - 06 September 2018. <b>Dysphania ambrosioides ou ans&eacute;rine, appel&eacute;e au Maroc M'Khinza est une plante appartenant &agrave; la famille des Chenopodiaceae. Utilis&eacute;e au Maroc pour ses propri&eacute;t&eacute;s th&eacute;rapeutiques notamment antipyr&eacute;tique, elle peut &ecirc;tre toxique si elle est mal dos&eacute;e. Nous rapportons deux cas d'intoxications collig&eacute;s au service des urgences m&eacute;dicales p&eacute;diatriques de Rabat: un nourrisson de 5 mois et une fille de 10 ans qui, suite &agrave; l'ingestion d'infusion de cette plante &agrave; des doses ind&eacute;termin&eacute;es dans un but antipyr&eacute;tique avaient pr&eacute;sent&eacute; respectivement une enc&eacute;phalopathie toxique et une d&eacute;shydratation s&eacute;v&egrave;re sur gastroent&eacute;rite aigu&euml; aboutissant aux d&eacute;c&egrave;s en moins de 12 heures. Ces nouveaux cas de neurotoxicit&eacute; et d'ent&eacute;rotoxicit&eacute; au M'Khinza doivent interpeler sur la n&eacute;cessit&eacute; de savoir &eacute;voquer le diagnostic, d'informer, de lutter contre la banalisation de sa consommation, d'inciter &agrave; la recherche sur la pharmacop&eacute;e traditionnelle permettant d'identifier leurs propri&eacute;t&eacute;s th&eacute;rapeutiques afin de formaliser, rationaliser et codifier leurs prescriptions.</b><br/> text/html 2018-12-12T03:05:07+01:00 Harriet Aber, Angela Nakanwagi Kisakye, Juliet Ndimwibo Babirye [Research] - Adherence to complementary feeding guidelines among caregivers of children aged 6-23 months in Lamwo district, rural Uganda - 06 September 2018. <b>INTRODUCTION: Malnutrition contributes to half of all deaths among children under-five years in developing countries such as Uganda. Optimal complementary feeding is one of the crucial interventions that could prevent these deaths. This study measured adherence to complementary feeding guidelines and its associated factors among caregivers of children aged 6-23 months in Lamwo district, rural Uganda. METHODS: a household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software. RESULTS: a household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software.nearly all (97.7%, 341/349) children had ever been breastfed. Complementary feeding was initiated at six months for 47.0% (164/349) of the children. The number of complementary meals ranged from 1-4 meals per day with a mean of 3 meals per day (SD = 0.8). About half (55.8%, 195/349) of the children were given less than the recommended amount of food. Overall only 40.1% (140/349) of all study respondents were adherent to complementary feeding guidelines. The odds of adherence to complementary feeding were higher among caregivers with children aged 6-8 months (AOR = 4.68, 95% CI: 1.91-11.48), children whose fathers had attained 8 or more years of formal education (AOR = 2.27, 95% CI: 1.22-4.19), caregivers with two children under five years (AOR = 5.46, 95% CI: 1.46-20.36), those living in the poorest households (AOR = 3.00, 95% CI: 1.37-6.57) and those who showed willingness to recommend initiation of complementary feeding at six months to another mother (AOR = 1.34 95% CI: 1.06-1.70). CONCLUSION: adherence to complementary feeding guidelines was very low in this rural African setting indicating an urgent need for interventions such as health education to improve adherence with consequent reduction in rates of under nutrition. These interventions should target caregivers with older children, fathers with less than 8 years of formal education and those living in the wealthiest households.</b><br/> text/html 2018-12-12T03:05:07+01:00 Michel Kengne, Marlise Beatrice Bidzogo Lebogo, Julius Mbekem Nwobegahay, Bienvenue Etogo Ondigui [Research] - Antibiotics susceptibility pattern of Streptococcus pneumoniae isolated from sputum cultures of human immunodeficiency virus infected patients in Yaound&eacute;, Cameroon - 05 September 2018. <b>INTRODUCTION: The susceptibility of Streptococcus pneumoniae to commonly used antibiotics is threatened by the emergence of resistance of S. pneumonia strains. So, to improve the management of lower respiratory tract infections (LRTIs) in human immunodeficiency virus infected patients, we assessed the antibiotic susceptibility of Streptococcus pneumoniae which is the most common bacterial cause of LRTIs in patients. METHODS: A cross sectional study was carried out from May to October 2014. HIV infected patients suspected of LRTIs attending the Center Medical laboratory and those followed up at the authorized treatment center of Yaounde Military Hospital in Cameroon were enrolled. Sputum was collected from each patient and cultured; identification of microorganisms was performed following standard methods. The disk diffusion method was used for antibacterial susceptibility testing according to the Antibiogram Committee of French Society for Microbiology guidelines. RESULTS: A total of 51 (25.5%) isolates of S. pneumoniae were recovered from sputum samples obtained from 200 HIV infected patients aged 19-66 years old (mean age: 36±10.087 years old); 144 (72%) of them were female (sex ratio M/F: 1/3). S. pneumoniae carriage was not age dependent (P = 0.384) and was significantly higher in male compared to female (P = 0.008). S. pneumoniae isolates were susceptible to amoxicillin-clavulinic acid (100%), pristinamycin (100%), erythromycin (100%) and cefixime (98.04 %). Highest resistance rates were recorded with fusidic acid (100%), fosfomycin (100%) and tetracyclin (100%). CONCLUSION: S. pneumoniae is still susceptible to some agents in our study area however; ongoing surveillance for antimicrobial susceptibility remains essential to identify emerging resistance and attempt to limit its spread.</b><br/> text/html 2018-12-12T03:05:07+01:00 Steven Tandean, Lutfi Hendriansyah, Stanislaus Djokomujianto, Nico Adi Saputra, Andry Juliansen, Silvia Valentina, Monica Ann Mulry, Julius July [Case report] - Neuroendoscopic aspiration and lavage of intraventricular empyema following shunt infection in infants - 05 September 2018. <b>Bacterial ventriculitis is one of the most common and serious complications of shunt placement. Shunt infection has varied management and is difficult to treat neurosurgically. We report a case of intraventricular empyema due to shunt infection. Standard management was failed for this case and reaccumulation of pus in the both ventricles. Neuroendoscopic surgery with intraventricular lavage and aspiration using cannula nasogastric tube (NGT) through a single burr hole, has successfully decreased the accumulation of intraventricular empyema. After lavage and aspiration, antibiotic can be distributed effectively to the affected area. Follow up imaging and cerebrospinal fluid (CSF) culture shown a good result and shorter length of stay in the hospital. Neuroendoscopy appears effective and safe for the management of bacterial ventriculitis due to shunt infection in infant. The strategy described in this report might be useful to treat intraventricular empyema.</b><br/> text/html 2018-12-12T03:05:07+01:00 Houyem Mansouri, Ines Ben Safta, Med Ali Ayadi, Selma Gadria, Tarek Ben Dhiab, Khaled Rahal [Case series] - Cancers primitifs de la verge: &agrave; propos de 11 cas et revue de la litt&eacute;rature - 04 September 2018. <b>Le cancer de la verge est une pathologie rare en Tunisie ou la circoncision est de pratique courante. Il s'agit dans 95% des cas d'un carcinome &eacute;pidermo&iuml;de. Le traitement repose essentiellement sur la chirurgie. Nous rapportons r&eacute;trospectivement les caract&egrave;res &eacute;pid&eacute;miologique, clinique, th&eacute;rapeutique et &eacute;volutif de 11 cas de cancers primitifs de la verge.</b><br/> text/html 2018-12-12T03:05:07+01:00 Fatogoma Issa Kon&eacute;, Kadidiatou Singar&eacute;, Siaka Soumaoro, Naouma Ciss&eacute;, N’Faly Konat&eacute;, Kassim Diarra, Yaya Demb&eacute;l&eacute;, Samba Karim Timbo, Mohamed Amadou Ke&iuml;ta [Case report] - Le traitement conservateur m&eacute;dical de la fistule œsotracheale - 04 September 2018. <b>Les fistules œsotrach&eacute;ales repr&eacute;sentent une entit&eacute; pathologique caract&eacute;ris&eacute;e par la pr&eacute;sence d'une communication anormale entre l'arbre trach&eacute;al et l'œsophage. A travers un cas clinique de fistule œsotrach&eacute;ale suite &agrave; l'ingestion d'un corps &eacute;tranger, nous abordions l'aspect &eacute;tiopathog&eacute;nique, &eacute;valuer notre principe th&eacute;rapeutique et faire une revue de la litt&eacute;rature. Il s'agit d'un patient de 15ans admis pour dysphagie &eacute;voluant depuis deux mois suite &agrave; l'ingestion d'un corps &eacute;tranger &agrave; type de morceau d'os. L'œsophagoscopie sous anesth&eacute;sie g&eacute;n&eacute;rale a permis l'extraction du corps &eacute;tranger. Le Transit Oeso-gastro-duod&eacute;nal (TOGD) en post-op&eacute;ratoire a objectiv&eacute; l'orifice fistulaire si&eacute;geant au niveau de C7. L'absence de l'orifice fistulaire a &eacute;t&eacute; not&eacute;e &agrave; J30 post-endoscopie au TOGD de contr&ocirc;le. Le traitement m&eacute;dical est une alternative th&eacute;rapeutique de la fistule œsotrach&eacute;ale et doit &ecirc;tre bas&eacute; sur des crit&egrave;res bien d&eacute;finis.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mohamed El Amraoui, Badredine Hassam [Images in medicine] - Lichen with triple involvement: cutaneous, mucous and phanerian - 04 September 2018. <b>Lichen is a common chronic inflammatory dermatitis that can affect the skin, mucous membranes and phaneres. The simultaneous involvement of the three compartments is rare and testifies to the severity and activity of the disease. We present a case of this triple involvement. However, the complete muco-cutaneous and phanerienic forms are rare, testify to the severity of the disease and justify a systemic treatment and a regular and long-term monitoring view the risk of degeneration of the mucous lesions. We report the case of this 60-old-man, followed for papular dermatosis, hyperpigmentary, very itchy, generalized, with involvement of the genital mucosa, in the form of erosive balanitis and nails of the hands and feet. The cutaneous histology was in favor of lichen. The biological examinations did not show any dysthyroidism, liver or autoimmune diseases. The patient was placed on systemic and topical corticosteroids. A pigmentogenic evolution of the cutaneous lesions, a beginning of bleaching of the nail lesions and a resistance of the genital lesions were noted.</b><br/> text/html 2018-12-12T03:05:07+01:00 Mohamed El Amraoui, Abdelhafid Achbouk [Images in medicine] - A bleeding tumor of the foot - 04 September 2018. <b>Botriomycoma or pyogenic granuloma is a benign vascular tumor very common in daily practice, which often sits at the extremities and is favored by trauma. The evolution is often favorable enamelled by the frequency of recidivism; however some atypical or massively bleeding forms pose diagnostic and therapeutic difficulties. We present a case illustrating this problematic. Botriomycoma or pyogenic granuloma is a non-rare benign vascular tumor, favored by trauma, mainly at the extremities and characterized by post-traumatic bleeding recurrence. Spectacular and massively bleeding forms are rarely reported. We present a case. A 60-year-old woman, with a history of a recessive infra-centimeter nodule of the second left toe. Has consulted for an increase of this nodule up to three centimeters in diameter. She was lost to follow-up for four months, and then she reconsulted for the same tumefaction which became ulcerated and massively bleeding and having increased in volume to reach five centimeters of large diameter. Ultrasound showed a superficial and much vascularized tumor. In view of the very haemorrhagic character and the repercussions on the general condition of the patient, a total resection of the tumor was done urgently and the histology was in favor of a botriomycoma without signs of malignancy. The evolution was favorable. Most botriomyomas are small and at risk of recurrence, but rapidly progressive and massively bleeding tumor forms, as noted case, requires rapid management and collaboration between dermatologist and plastic surgeon.</b><br/> text/html 2018-12-12T03:05:07+01:00 Desmorys Raoul Moh, Anani Badj&eacute;, Nogbou Frederic Ello, Jean-Baptiste N’takp&eacute;, Jean-Baptiste Anzouan-Kacou, G&eacute;rard Menan Kouam&eacute;, Simplice Ackoundz&eacute;, Franck Boccara, Olivier Ba-Gomis, Serge-Paul Eholi&eacute;, Xavier Anglaret, Christine Danel [Case report] - Dissection aortique an&eacute;vrismale chez un adulte infect&eacute; par le VIH-1 dans le cadre d’un syndrome de reconstitution immune avec tuberculose - 04 September 2018. <b>Un homme de 35 ans, VIH-1, sans antécédents médicaux et chirurgicaux particuliers, a été hospitalisé à Abidjan, Côte d’Ivoire, dans un contexte fébrile, toux, dyspnée, douleurs thoraciques et à la radiographie pulmonaire, un déroulement de la crosse de l’aorte une semaine après avoir débuté les antirétroviraux (ARV). Les scanners angiothoraciques réalisés ont mis en évidence une ectasie aortique globale étendue avec thrombus mural. Une échocardiographie transoesophagienne conclut à une dissection aortique, type A de Stanford. Le diagnostic de tuberculose a été confirmé par l’isolation en culture de Mycobacterium Tuberculosis. Huit ans après, le patient est encore vivant, sans intervention chirurgicale et se plaint de douleurs thoraciques intermittentes. Sa pression artérielle est stable et a une insuffisance rénale modérée. Nous rapportons un cas rare de dissection aortique anévrismale chez un adulte infecté par le VIH-1 dans le cadre d’un syndrome de reconstitution immune avec tuberculose pulmonaire.</b><br/> text/html 2018-12-12T03:05:07+01:00 Amel Harzallah, Hayet Kaaroud, Narjess Laadhari, Rim Goucha, Ezzeddine Abderrahim, Sami Turki, Fethi Ben Hmida, Samia Barbouch, Taieb Ben Abdallah [Report] - Pronostic r&eacute;nal de la n&eacute;phropathie des vascularites &agrave; IgA de l’adulte: &eacute;tude monocentrique, &agrave; propos de 25 cas - 04 September 2018. <b>La n&eacute;phropathie de la vascularite &agrave; IgA conditionne le pronostic de cette affection chez l’adulte. Le but de notre &eacute;tude &eacute;tait d’&eacute;tudier les caract&eacute;ristiques cliniques de cette atteinte r&eacute;nale chez l’adulte et d’identifier les facteurs de pronostic r&eacute;nal. Il s’agit d’une &eacute;tude monocentrique r&eacute;trospective portant sur les patients ayant une vascularite &agrave; IgA (purpura rhumato&iuml;de) (crit&egrave;res de l’EULAR) avec une atteinte r&eacute;nale prouv&eacute;e histologiquement et class&eacute;e selon la classification de Pillebout. Nous avons analys&eacute; la survie r&eacute;nale et identifier les facteurs de pronostic r&eacute;nal. Vingt cinq patients ont &eacute;t&eacute; inclus (genre ratio M/F = 2,57) d’&acirc;ge moyen au diagnostic du purpura rhumato&iuml;de de 35,76 ans. Un purpura &eacute;tait pr&eacute;sent dans 100% des cas avec une atteinte articulaire dans 28%. Une insuffisance r&eacute;nale &eacute;tait pr&eacute;sente dans 44% des cas. La classification histologique la plus fr&eacute;quente &eacute;tait la classe II. Une r&eacute;mission clinique a &eacute;t&eacute; observ&eacute;e dans 44% des cas et une &eacute;volution vers le stade terminal de l’insuffisance r&eacute;nale chronique dans 36% des cas. La survie r&eacute;nale &agrave; 195 mois &eacute;tait de 57%. Les facteurs pronostiques identifi&eacute;s &eacute;taient l’atteinte digestive (p = 0,022), l’insuffisance r&eacute;nale initiale (p = 0,0004), la classification glom&eacute;rulaire (p = 0001) et la s&eacute;v&eacute;rit&eacute; des l&eacute;sions histologiques, le traitement par bloqueurs du syst&egrave;me r&eacute;nine angiotensine (p = 0,01) et les &eacute;changes plasmatiques (p = 0,03). Notre &eacute;tude montre que l’atteinte r&eacute;nale au cours des vascularites &agrave; IgA peut &ecirc;tre relativement s&eacute;v&egrave;re avec un mauvais pronostic r&eacute;nal. L’identification des facteurs pronostiques cliniques et histologiques pourrait guider l’&eacute;laboration d’&eacute;tudes th&eacute;rapeutiques prospectives.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ghizlan EL Amri, Mohamed Zalagh, Fouad Benariba [Case report] - Un lymphome T/NK extra-ganglionnaire de type nasal se pr&eacute;sentant comme une cellulite orbitaire - 04 September 2018. <b>Le lymphome extra-ganglionnaire T/NK de type nasal est une forme rare des lymphomes malins non hodgkinien. Elle pose un probl&egrave;me diagnostique &agrave; cause des sympt&ocirc;mes peu sp&eacute;cifiques. Nous rapportons un cas de lymphome T/NK simulant une cellulite orbitaire. Il s'agit d'une patiente de 46 ans, suivie pour maladie de Beh&ccedil;et. Admise dans un tableau clinique de cellulite orbitaire. Le scanner du massif facial montrait une pansinusite avec infiltration orbitaire. En l'absence d'am&eacute;lioration sous traitement antibiotique. Un traitement chirurgical avec biopsie a &eacute;t&eacute; r&eacute;alis&eacute;. L'examen histologique a mis en &eacute;vidence des signes de vascularite inflammatoire et la patiente a &eacute;t&eacute; mise sous corticoth&eacute;rapie avec am&eacute;lioration clinique. Devant la r&eacute;cidive la patiente a b&eacute;n&eacute;fici&eacute; d'une reprise chirurgicale avec des biopsies de l'ethmo&iuml;de qui ont mis en &eacute;vidence un lymphome T/NK de type nasal. Le traitement a consist&eacute; en une radio-chimioth&eacute;rapie et la patiente est d&eacute;c&eacute;d&eacute;e dans les deux mois. Les lymphomes T/NK sont agressifs, ils touchent essentiellement les cavit&eacute;s naso-sinusiennes. Ils sont responsables d'une angio-destruction et de la n&eacute;crose qui rendent les sympt&ocirc;mes peu sp&eacute;cifiques et les biopsies souvent n&eacute;gatives, posant un probl&egrave;me de diagnostic diff&eacute;rentiel. Le traitement repose sur la radioth&eacute;rapie et la chimioth&eacute;rapie et le pronostic reste r&eacute;serv&eacute;.</b><br/> text/html 2018-12-12T03:05:07+01:00 Asma Korbi, Amel khaskhoussy, Ons Cherif, Ahmed Hajji, Imen Gaddab, Amel Chaabene, Mouna Gara, Fathi Jbeli, Lotfi Grati, Med Salah Rhim, Raja Faleh [Case report] - Anaphylactic shock due to patent blue: case report and review of literature - 04 September 2018. <b>Intraoperative search for the sentinal node using patent blue is considered a non risk procedure. We emphasize the highly exceptional nature of this adverse effect previously observed in other disciplines using this coloring agent. We present a case of allergic reaction to patent blue in a patient who underwent left mastectomy with sentinel lymph node. About 25 min after the dye injection, the patient developed increased heart frequency and allergic skin reaction. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. The patient recovered uneventfully and was discharged from the PACU 3h after the end of surgery without skin changes and was discharged from hospital on the morning after surgery. Allergic reactions with the use of patent blue are far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. Skin tests done later confirmed allergy to patent blue dye; the tests induced a small syndrome reaction. Surgical personnel who use patent blue dye should be made aware of the risk of allergic reactions, sometimes severe, to this dye.</b><br/> text/html 2018-12-12T03:05:07+01:00 Amine Kessab, Safaa Rokhssi, Meriem Rais, Mohamed Anass Benbouzid, Leila Esskalli, Nadia Cherradi [Case report] - Tumeur du sac endolymphatique au niveau du rocher: &agrave; propos d’un cas - 03 September 2018. <b>La tumeur du sac endolymphatique est une tumeur neuroectodermique rare d&eacute;riv&eacute;e de l’oreille interne qui poss&egrave;de un faible potentiel de malignit&eacute; mais avec un pouvoir d’agressivit&eacute; locale tr&egrave;s marqu&eacute; sans notion de m&eacute;tastase. Il s’agit d’un patient de 60 ans qui a pr&eacute;sent&eacute; des signes d’appel en faveur d’une atteinte de l’oreille interne accompagn&eacute; de sympt&ocirc;mes en faveur d’une atteinte de l’angle ponto c&eacute;r&eacute;belleux. L’examen radiologique par IRM a montr&eacute; un processus l&eacute;sionnel envahissant la masto&iuml;de et l’os temporal. L’examen anatomopathologique confirme la nature tumorale en pr&eacute;cisant le type histologique par une &eacute;tude immunohistochimique en retenant le diagnostic de tumeur sporadique du sac endolymphatique. Cette tumeur peut arriver &agrave; n’importe quel &acirc;ge avec une moyenne de 52 ans pour les cas sporadiques. Sur le plan histologique on distingue deux entit&eacute;s: papillaire et folliculaire. Il faut &eacute;liminer les autres diagnostiques diff&eacute;rentiels surtout les m&eacute;tastases du carcinome thyro&iuml;dien. La difficult&eacute; de la r&eacute;section chirurgicale de ces tumeurs est due &agrave; leur vascularisation et &agrave; leur infiltration dans les os et les m&eacute;ninges. L'excision compl&egrave;te est la meilleure garantie contre la r&eacute;cidive tumorale.</b><br/> text/html 2018-12-12T03:05:07+01:00 Aida Ida Tankoano, Judicael Marouane Milcisedek Some, Dominique Bicaba, Gis&egrave;le Marie Ursule Tapsoba, Adama Jean Honor&eacute; Konat&eacute;, D&eacute;nis Kontogom, Zakari Niki&egrave;ma [Case report] - Aspect tdm d’une anomalie de l’arc aortique: variante de Nehausser? - 03 September 2018. <b>Les malformations cong&eacute;nitales par anomalie de position et de d&eacute;veloppement des arcs brachiaux primitifs repr&eacute;sentent 1% des anomalies cong&eacute;nitales cardio-vasculaires. Nous rapportons le cas rare d'un nourrisson de 22 mois, n&eacute; par voie basse d'une grossesse men&eacute;e &agrave; terme qui a pr&eacute;sent&eacute; une dyspn&eacute;e intermittente depuis la naissance associ&eacute;e &agrave; une toux. L'angio-scanner cervico-thoracique a permis d'objectiver un arc aortique droit et une art&egrave;re sub-clavi&egrave;re gauche pr&eacute;-trach&eacute;o-oesophagienne prenant en pince l'œsophage et la trach&eacute;e &agrave; environ 15 mm au-dessus de la car&egrave;ne entrainant une st&eacute;nose d'environ 70% de la trach&eacute;e sur une hauteur de 16 mm. Cette malformation complexe repr&eacute;sente un type rare d'anomalie de l'arc aortique avec une variante inhabituelle du trajet de l'art&egrave;re sub-clavi&egrave;re gauche. Elle pose un probl&egrave;me diagnostique et de traitement dans notre contexte du fait des difficult&eacute;s d'accessibilit&eacute; au scanner et &agrave; la chirurgie.</b><br/> text/html 2018-12-12T03:05:07+01:00 Tariq Bouhout, Badr Serji, Ebo Usman Egyir, Benyounes El Amri, Imad Bouhout, Mehdi Soufi, Mohammed Bouziane, Tijani El Harroudi [Case report] - L’endom&eacute;triose de la paroi abdominale: &agrave; propos d’un cas - 03 September 2018. <b>L'endom&eacute;triose de la paroi abdominale, d&eacute;finie comme l’implantation ectopique du tissu endom&eacute;trial en dehors de la cavit&eacute; ut&eacute;rine, est une affection rare et souvent m&eacute;connue. Elle survient habituellement sur cicatrice d'intervention chirurgicale gyn&eacute;cologique ou obst&eacute;tricale. La pr&eacute;sentation clinique typique est celle d’une masse pari&eacute;tale associ&eacute;e &agrave; des douleurs rythm&eacute;es par les menstruations. Le diagnostic est confirm&eacute; par l’histologie. Le traitement est principalement chirurgical et repose sur l’ex&eacute;r&egrave;se compl&egrave;te de la l&eacute;sion.</b><br/> text/html 2018-12-12T03:05:07+01:00 Ernest Kateule, Ramya Kumar, Modest Mulenga, Victor Daka, Kelvin Banda, Raydel Anderson, Rebecca McNall, Marcia McGrew, Henry Baggett, Webster Kasongo [Research] - Mumps outbreak in an unimmunized population – Luanshya District, Copperbelt Province, Zambia, 2015 - 03 September 2018. <b>INTRODUCTION: Mumps is a vaccine-preventable viral disease that may cause deafness, orchitis, encephalitis or death. However, mumps vaccine is not included in Zambia’s Expanded Program for Immunization. In January 2015, Integrated Disease Surveillance and Response data revealed an increase in reported mumps cases in Luanshya District. We investigated to confirm the etiology and generate epidemiological data on mumps in Zambia. METHODS: We conducted active case finding, examined possible case-patients, and administered a standard questionnaire. A suspected mumps case was defined as acute onset of salivary gland swelling in a Luanshya resident during January - June 2015. Eight case-patients provided serum samples to test for mumps-specific immunoglobulin IgM, and buccal swabs to test for mumps viral RNA by RT-PCR, and genotyping of mumps virus at the Centers for Disease Control and Prevention, Atlanta, Georgia, USA. RESULTS: From January – June 2015, a total of 283 mumps cases were reported in Luanshya, peaking in April (71 cases) and clustering (81%) in two townships. Of 72 suspected case-patients interviewed, 81% were aged < 15 years (29%, 1 - 4 years) and 61% were female. Common clinical characteristics were buccal tenderness (29%) and fever > 37.5ºC (29%). Mumps virus genotype D was confirmed in five case-patients who tested positive by RT-PCR; six case-patients were sero-positive for anti-mumps IgM antibodies (total seven lab-confirmed cases). CONCLUSION: Our findings represent the first reported epidemiologic description of mumps in Zambia. While the epidemiology is consistent with prior descriptions of mumps in unimmunized populations and no serious complications arose, this report provides data to inform policy discussions regarding mumps vaccination in Zambia.</b><br/> text/html 2018-12-12T03:05:07+01:00 Abdelkader Jalil El Hangouche, Oumaima Alaika, Koffi Augustin Assié, Latifa Oukerraj, Nawal Doghmi, Taoufiq Dakka, Mohammed Cherti [Case report] - A complicated steroid resistant nephrotic syndrome: a large intracardiac thrombus with bilateral distal embolization - 03 September 2018. <b>Nephrotic syndrome (NS) is a consequence of the reduced ability of the glomerulus barrier to exclude proteins of intermediate size and other macromolecules from urine. Albumin and proteins that modulate the coagulation cascade are among the substances eliminated in urine. This is responsible of thromboembolic complication. The incidence of this extra renal complication is probably underestimated because of asymptomatic thromboembolic events. We report the case of a 23 years old man followed up for an idiopathic nephrotic syndrome since childhood who presented a large intracardiac thrombus complicated by distal embolisation of his two lower limbs, successfully treated by fogartisation-embolectomy and oral anticoagulation.</b><br/> text/html 2018-12-12T03:05:07+01:00 Frederick Oporia, Angela Nakanwagi Kisakye, Rebecca Nuwematsiko, Abdulgafoor Mahmood Bachani, John Bosco Isunju, Abdullah Ali Halage, Zziwa Swaibu, Lynn Muhimbuura Atuyambe, Olive Kobusingye [Research] - An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study - 02 September 2018. <b>INTRODUCTION: gobally, 1.3 million people die from road traffic injuries every year. Over 90% of these deaths occur in low-and-middle-income countries. In Uganda, between 2012 and 2014, about 53,147 road traffic injuries were reported by the police, out of which 8,906 people died. Temporal and regional distribution of these injuries is not known, hence hindering targeted interventions. We described the trends and distribution of health facility reported road traffic injuries in Uganda from 2011 to 2015.METHODS: we obtained monthly data on road traffic injuries, from 112 districts from the Ministry of Health Uganda. We analyzed the data retrospectively to generate descriptive statistics. RESULTS: a total of 645,805 road traffic injuries were reported from January 2011 through December 2015 and 2,807 deaths reported from 2011 through 2014. Injuries increased from 37,219 in 2011 to 222,267 in 2014 and sharply dropped in December 2015 to 57,149. Kampala region had the highest number of injuries and deaths (18.3% (117,950/645,805) and 22.6% (634/2807)) respectively whereas Karamoja had the lowest injuries and deaths (1.7% (10,823/645,805) and 0.8% (21/2807)) respectively. Children aged 0-4 years accounted for 21.9% (615/2807) deaths; mostly females 81% (498/615) were affected. CONCLUSION: road traffic injuries increased during 2011-2014. Injuries and deaths were highest in Kampala and lowest in Karamoja region. It was noted that health facilities mostly received serious injuries. It is likely that the burden is higher but under reported. Concerted efforts are needed to increase road safety campaigns in Kampala and surrounding regions and to link pre-hospital deaths so as to understand the burden of road traffic crashes and recommend appropriate interventions.</b><br/>