Pan african Medical Journal - Volume 32 Pan african Medical Journal. Volume 32 http://www.panafrican-med-journal.com/ 2019-04-19T05:23:37+01:00 pamj logo http://www.panafrican-med-journal.com http://www.panafrican-med-journal.com/img/logo.png text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Agharbi [Images in medicine] - Les syringomes - 18 April 2019. http://www.panafrican-med-journal.com/content/article/32/194/abstract/ <b>Les syringomes sont des tumeurs b&eacute;nignes des annexes cutan&eacute;es qui tireraient leur origine des canaux exocrines ou apocrines et qui affectent environ 1% de la population. Ils s'observent le plus souvent chez les femmes et prennent g&eacute;n&eacute;ralement la forme de papules molles de couleur chair ou l&eacute;g&egrave;rement jaun&acirc;tres &agrave; la paupi&egrave;re inf&eacute;rieure et &agrave; la partie sup&eacute;rieure des joues. Plus rarement, les syringomes s'observent ailleurs qu'au pourtour des yeux, soit au cou, aux aisselles, aux seins, &agrave; la portion inf&eacute;rieure de l'abdomen, aux cuisses et &agrave; l'aine. Au plan clinique, les syringomes se distinguent des xanth&eacute;lasmas, des verrues ou des cancers par leur caract&egrave;re monomorphe et leur distribution r&eacute;guli&egrave;re; le diagnostic est confirm&eacute; par biopsie dans les cas douteux. &Agrave; l'examen histologique, les syringomes se reconnaissent facilement par la pr&eacute;sence de canaux sudoripares ayant la forme de virgules dans le derme. M&ecirc;me si les syringomes sont b&eacute;nins, leur apparence peut &ecirc;tre g&ecirc;nante pour les patients. Les options th&eacute;rapeutiques, &eacute;tay&eacute;es pour la plupart par de petites s&eacute;ries et rapports de cas, incluent l'excision chirurgicale, l'&eacute;lectrodessication et curetage, l'exfoliation chimique, la cryochirurgie et le traitement au laser. Toutefois, comme ces tumeurs sont profond&eacute;ment ancr&eacute;es dans le derme, tous les traitements sont associ&eacute;s &agrave; un risque substantiel de r&eacute;currence et peuvent entra&icirc;ner des cicatrices et des changements pigmentaires. Nous rapportons l'observation d'une patiente de 40 ans sans ant&eacute;c&eacute;dents qui pr&eacute;sentait des papules couleur chair p&eacute;ri-orbitaires dont l'&eacute;tude histologique &eacute;tait en faveur de syringomes.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Chinawa Josephat Maduabuchi, Awoere Tamunosiki Chinawa, James Akpe, Lovelyn Kelvin-Iloafu, Vivian Onukwuli [Short communication] - What is the cost benefit ratio of sending adeno-tonsillar tissues for histology: does adenoid/tonsillar tissue in children undergo malignant transformation? - 18 April 2019. http://www.panafrican-med-journal.com/content/article/32/193/abstract/ <b>Due to the enormous amount spent on histology of adenoid and tonsillar samples from children with adeno-tonsillectomy with no confirmed result of malignancy, it has become expedient to reconsider sending such tissues for histology. Objectives: this study is aimed at determining the necessity of sending tissues of adenoid and tonsils for histology by means of ascertaining the prevalence of malignancy among children with adeno-tonsillectomy. This was a retrospective study done in three private hospitals that provide care for children in Enugu. Data was obtained from the medical records of 72 patients who had undergone tonsillectomy and/or adenoidectomy from September 2011 to May 2018. All the surgical cases done had their samples sent immediately for histology. A total of 72 adeno-tonsillar tissues were taken for histology of which all showed lymphoid hyperplasia with none showing any form of malignancy. Age group ranged from 6 months-18 years with 57 males and 15 females. Histology of the adeno-tonsillar tissue specimen was done among all the children with each costing 9000 Naira (26 US dollars). There were 3 tonsillectomies, one adenectomy and 68 adeno-tonsillectomies done. Indications for surgery were mainly upper air way obstruction for 69 cases and recurrent tonsillectomy for 3 cases. Histology revealed lymphoid hyperplasia for all cases. None of the patients in our study had histologic evidence of malignancy. Routine histopathologic examination in adeno-tonsillectomy specimens among children may be dispensable as it showed a negative cost-benefit ratio.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Fouad Chraibi, Idriss Andaloussi Benatiya [Images in medicine] - Retinal involvement in an acute lymphoblastic leukemia - 18 April 2019. http://www.panafrican-med-journal.com/content/article/32/192/abstract/ <b>We report a case of a patient who presents for ophthalmic complaints revealing systemic acute lymphoblastic leukemia. The eye fundus examination shows bilateral papilledema, retinal hemorrhages and diffuse white retinal infiltration. After chemotherapy, there was noticeable improvement of visual acuity and important regression of papilledema. Ocular involvement in leukemia is considered as a central nervous system lesion. It requires, therefore, a proper treatment including corticosteroids, chemotherapy and radiation treatment of the central nervous system.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Abderazzak Rafrafi, Talel Znagui, Saber Saadi, Mounira khezami, Mounir Hamdi, Lotfi Nouisri [Case series] - R&eacute;sultats &agrave; moyen terme du traitement des ost&eacute;ochondrites diss&eacute;quantes des condyles f&eacute;moraux par greffe ost&eacute;ochondrale en mosa&iuml;que - 18 April 2019. http://www.panafrican-med-journal.com/content/article/32/191/abstract/ <b>Face &agrave; une perte de substance cartilagineuse des condyles f&eacute;moraux, plusieurs alternatives th&eacute;rapeutiques interventionnelles sont envisageables y compris la mosa&iuml;coplastie. Le but de notre travail &eacute;tait d'&eacute;valuer le r&eacute;sultat clinique et radiologique &agrave; moyen terme ainsi que d'&eacute;valuer les principaux &eacute;l&eacute;ments pronostiques. Notre &eacute;tude &eacute;pid&eacute;miologique r&eacute;trospective &eacute;tal&eacute;e sur 15 ans nous a permis de colliger 35 dossiers exploitables d'ost&eacute;ochondrite diss&eacute;quante des condyles f&eacute;moraux trait&eacute;s par la technique de mosa&iuml;coplastie avec un recul moyen de 24 mois. Le niveau des plaintes ainsi que la fonction du genou en pr&eacute;op&eacute;ratoire ont &eacute;t&eacute; &eacute;tudi&eacute;s et compar&eacute;s par rapport au genou sain selon le Score International Cartilage Repair Society (ICRS), le score International Knee Documentation Committee (IKDC) et l'&eacute;chelle visuelle de la douleur (EVA) et nous avons trouv&eacute; qu'elle &eacute;tait inf&eacute;rieure &agrave; 60% chez 27 malades. L'&eacute;valuation des r&eacute;sultats au recul ont &eacute;t&eacute; analys&eacute;s selon les crit&egrave;res fonctionnels et radiologiques de Hunghston. Apr&egrave;s un recul moyen de 24 mois, l'algoneurodystrophie &eacute;tait observ&eacute;e dans 05 cas avec un seul cas d'h&eacute;marthrose. Une nette am&eacute;lioration du score ICRS &eacute;tait observ&eacute;e avec une moyenne qui a pass&eacute;e du 54% &agrave; 74% au recul. Les patients satisfaits ou tr&egrave;s satisfaits (82,9%) furent largement majoritaires. Les &eacute;l&eacute;ments de bon pronostic constat&eacute;s dans notre &eacute;tude &eacute;taient: un d&eacute;lai op&eacute;ratoire moins de 18 mois de d&eacute;but de la symptomatologie, les l&eacute;sions profondes ayant un diam&egrave;tre inf&eacute;rieur &agrave; 02 cm et les l&eacute;sions si&eacute;geant au niveau du condyle interne. Le traitement des pertes de substances cartilagineuses passe obligatoirement par la correction des causes directes et indirectes &agrave; savoir le morphotype, la laxit&eacute; et le capital m&eacute;niscal. Aucun consensus d&eacute;cisionnel n'a pu &ecirc;tre propos&eacute; et nul ne peut confirmer la sup&eacute;riorit&eacute; d'une technique par rapport &agrave; l'autre mais nous pouvons dire que le d&eacute;fect cartilagineux de 2 &agrave; 4 cm2 peut &ecirc;tre la meilleure indication &agrave; la mosa&iuml;coplastie.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Chimaobi Gideon Ofoha, Venyir Mamhzi Ramyil, Nuhu Kutan Dakum, Samaila Ibrahim Shu’aibu, Idorenyin Cletus Akpayak, Felix Echebiri Magnus, Ushaaka Swem, Ayodele Oshagbemi, Olutayo Osunaiye, Julius Akhaine [Research] - Predictors of urethral stricture recurrence following urethroplasty: a retrospective review at the Jos University Teaching Hospital, Nigeria - 18 April 2019. http://www.panafrican-med-journal.com/content/article/32/190/abstract/ <b>INTRODUCTION: Incidence of urethral stricture recurrence ranges between 2% to 36.4% with 75% occurring within the first 6 months of surgery. Hence, they need to identify the predictors of recurrence following urethroplasty. METHODS: this is a retrospective study involving patients that had urethroplasty from January 2008 to December 2017. Patients' records were reviewed. Analyzed data were for patients with a minimum follow up of one year from the time of urethroplasty and included aetiology of urethral stricture, presence of suprapubic cystostomy, prior urethral dilatation, urine M/C/S, site of urethral stricture, length of urethral stricture, type of urethroplasty, level of training of the surgeon, type of urethral stent used and duration of stenting. Analysis was done using SPSS version 23. P-value of < 0.05 was considered significant. RESULTS: eighty seven urethroplasties were done, from January 2008 to December 2017. However, only records of 44 patients were accessible. Twenty patients completed duration of follow up e" one year. Urethral stricture recurrence was defined as resurgence of Lower Urinary Tract Symptoms (LUTS) within one year. Median age of the patients was 39.5 (± 19) years. Urethral stricture recurrence rate was 25% with mean time to recurrence from urethroplasty of 5.3(±3) months. The use of preoperative suprapubic catheter (SPC) for urinary diversion as well as urethroplasties performed by the consultants had a lower incidence of recurrence. CONCLUSION: this study found urethral stricture recurrence of 25%. The level of training of surgeon vis-&agrave;-vis the expertise and experience seems to be an important factor, though not statistically significant in determining the outcome of urethroplasty.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Monia Ghammam, Jihene Houas, Mouna Bellakhdher, Mohamed Abdelkefi [Case report] - Dysphagia revealing diffuse idiopathic skeletal hyperostosis: report of two cases and literature review - 17 April 2019. http://www.panafrican-med-journal.com/content/article/32/189/abstract/ <b>Diffuse Idiopathic Skeletal Hyperostosis (DISH) also known as Forestier's disease, is a musculo-squelettic disorder characterized by the calcification of ligaments essentially the vertebral longitudinal anterior ligament. Men are generally affected. It is often asymptomatic. The most common extra-spinal clinical manifestation of this disease presents as dysphagia followed by respiratory disturbances such as dyspnea and sleep apnea. In this paper we discuss two cases where the patients have experienced progressive dysphagia. Radiological findings were compatible with DISH. The management was based on diet modification and anti-inflammatory medication.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Lykourgos Christos Alexakis, Maria Athanasiou, Angeliki Konstantinou [Research] - Refugee camp health services utilisation by non-camp residents as an indicator of unaddressed health needs of surrounding populations: a perspective from Mae La refugee camp in Thailand during 2006 and 2007 - 17 April 2019. http://www.panafrican-med-journal.com/content/article/32/188/abstract/ <b>INTRODUCTION: This study explored the differences on the level of medical care required by camp and non-camp resident patients during utilisation of the health services in Mae La refugee camp, Tak province, Thailand during the years 2006 and 2007. METHODS: Data were extracted from camp registers and the Health Information System used during the years 2006 and 2007 and statistical analysis was performed. RESULTS: The analysis showed that during 2006 and 2007 non-camp resident patients, coming from Thailand as well as Myanmar, who sought care in the outpatient depart-ment (OPD) of the camp required at a significantly higher proportion admission to the inpatient department (IPD) or referral to the district hospital compared to camp resi-dent patients. Although there was a statistically significant increased mortality of the non-camp resident patients admitted in the IPD compared to camp resident patients, there was no significant difference in mortality among these two groups when the re-ferrals to the district hospital were analysed. CONCLUSION: Non-camp resident patients tended to need a more advanced level of medical care compared to camp resident patients. Provided that this it is further vali-dated, the above observed pattern might be potentially useful as an indirect indicator of unaddressed health needs of populations surrounding a refugee camp.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Mohamed Maniboliot Soumah, Mariame Koumare, Mor Ndiaye, Mamadou Lamine Sow [Case series] - Causes de d&eacute;c&egrave;s &agrave; Dakar et politique de sant&eacute; - 17 April 2019. http://www.panafrican-med-journal.com/content/article/32/187/abstract/ <b>L'&eacute;tude de la mortalit&eacute; permet d'identifier les principaux probl&egrave;mes de sant&eacute; publique des pays dont ils &eacute;manent. Elle donne une id&eacute;e des mesures pr&eacute;ventives et m&eacute;dico-curatives et des investissements dans la recherche qui pourraient accro&icirc;tre l'esp&eacute;rance de vie de la population. L'objectif g&eacute;n&eacute;ral de ce travail &eacute;tait d'&eacute;valuer les causes de mort dans la population g&eacute;n&eacute;rale &agrave; partir des informations figurant sur les registres de d&eacute;c&egrave;s &agrave; Dakar. Les objectifs sp&eacute;cifiques &eacute;taient de d&eacute;terminer les causes de mort, d'identifier les facteurs sociod&eacute;mographiques influen&ccedil;ant les d&eacute;c&egrave;s et d'identifier les genres de mort et type de mort. Il s'agit d'une &eacute;tude r&eacute;trospective portant sur les cas de d&eacute;c&egrave;s dans la population g&eacute;n&eacute;rale de Dakar, de 2003 &agrave; 2012, ayant b&eacute;n&eacute;fici&eacute; d'une autopsie. Les sources des donn&eacute;es &eacute;taient les registres des autopsies de l'H&ocirc;pital Aristide le Dantec (HALD) et de l'H&ocirc;pital G&eacute;n&eacute;ral de Grand-Yoff (HOGGY), seuls h&ocirc;pitaux de Dakar o&ugrave; sont effectu&eacute;es des autopsies. Les informations contenues dans les diff&eacute;rentes sources de donn&eacute;es ont &eacute;t&eacute; rapport&eacute;es sur une fiche d'enqu&ecirc;te analys&eacute;e par Epi-info version 6.04. Durant la p&eacute;riode d'&eacute;tude, nous trouvions 985 d&eacute;c&egrave;s parmi lesquels, 693 morts violentes (70,3%), 261 morts naturelles (26,5%) et 14 morts ind&eacute;termin&eacute;es (1,4%). Il y avait une pr&eacute;dominance des accidents de la circulation au nombre de 394 (40%). Concernant le genre de mort, plus de la moiti&eacute; des cas de d&eacute;c&egrave;s &eacute;taient accidentels donc des morts violentes. Les d&eacute;c&egrave;s par accident de la circulation se passaient le plus souvent en zone pr&eacute;hospitali&egrave;re ou &agrave; l'arriv&eacute;e &agrave; l'h&ocirc;pital. Le minist&egrave;re de la sant&eacute; devra continuer les efforts sur la pr&eacute;vention et la prise en charge des maladies transmissibles. Les deux priorit&eacute;s devront &ecirc;tre les maladies cardiovasculaires et les traumatismes.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Chukwuma Ekpebegh, Khaled Elmezughi, Lungiswa Mtingi [Case report] - Graves’ disease following hypothyroidism due to Hashimoto’s thyroiditis in a black South African lady: a case report - 17 April 2019. http://www.panafrican-med-journal.com/content/article/32/186/abstract/ <b>Graves' disease and Hashimoto's thyroiditis are autoimmune thyroid disorders with distinct pathological and histopathological features. The conversion from Hashimoto's thyroiditis to Graves' disease has been rarely reported throughout the world with no reports in the African race to our knowledge. We here report an African lady who was initially diagnosed with primary hypothyroidism following Hashimoto's disease but later became thyrotoxic due to Graves' disease.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hailemariam Mekonnen Workie, Teshager Worku Kassie, Tewodros Tesfa Hailegiyorgis [Research] - Knowledge, risk perception, and condom utilization pattern among female sex workers in Dire Dawa, Eastern Ethiopia 2016: a cross-sectional study - 16 April 2019. http://www.panafrican-med-journal.com/content/article/32/185/abstract/ <b>INTRODUCTION: In 2015, in Dire Dawa administration city, adult HIV prevalence was 3.26 with 9,523 HIV positive population, & 251 annual AIDS deaths. Female sex workers are one of the high-risk groups for contracting HIV. Therefore, this study has assessed the level of HIV/AIDS knowledge, risk perception and condom utilization pattern among female sex workers’ in Diredawa city. METHODS: A cross-sectional study was conducted from April 15- June 25, 2016, in Dire Dawa among 156 female sex workers using convenient sampling method. Respondents were interviewed face-to-face using a pretested questionnaire. Training was provided to the data collectors and supervisors. Close supervision was done and double data entry was performed. Then the data were checked for completeness, consistency and entered into Epi Info v3.1 and analyzed using SPSS v20. The descriptive statistical analysis was used to compute frequency, mean, mode and proportion of the findings of this study. The results were presented using tables, charts, graphs, and texts. RESULTS: Among the 156 female sex workers (FSWs), 99 (63.5%) had been working on commercial sex for more than one year, 92 (59%) were usually street-based, and 80 (51.3%) had partners between 2-3 per night. Only, 17 (10.9%) respondents mentioned three and above ways of HIV/AIDS transmission and prevention methods. Less than two-thirds (64.1%) of FSWs used a condom with all partners. One hundred thirty-eight (88.5%) of participants were engaged in unsafe sexual practice at least once since their engagement in sex work. Majority of FSWs (85.3%)) believed that their occupation is hazardous and 145 (92.9%) reported that they were unhappy being a commercial sex worker. Regarding risk perception, 79 (50.64%) and 37 (23.7%) of respondents perceived their chances of contracting HIV/STIs to be high and moderate respectively. CONCLUSIONS: Knowledge about HIV/STIs and magnitude of condom utilization were good. However, a high number of unsafe sex and unsatisfactory risk perception attitudes were observed. Thus, a collaborative effort is needed to create awareness regarding risk perception attitude and increase the level of their practice towards the prevention of unsafe sex.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Charifa Rachidi Alaoui, Mohamed Rami, Khalid khatalla, Aziz Elmadi, Youssef Bouabdellah [Case report] - Rupture spontan&eacute;e de la rate chez un enfant - 16 April 2019. http://www.panafrican-med-journal.com/content/article/32/184/abstract/ <b>Les ruptures non traumatiques ou spontan&eacute;es de la rate (RNTR) sont des entit&eacute;s rares mais potentiellement mortelles. La mortalit&eacute; de cette affection est essentiellement li&eacute;e au retard diagnostique et th&eacute;rapeutique, ainsi qu'aux risques li&eacute;s au terrain et &agrave; la gravit&eacute; de la pathologie sous-jacente. Elles n&eacute;cessitent dans la majorit&eacute; des cas une spl&eacute;nectomie. Elles peuvent survenir soit sur une rate macroscopiquement saine, par exemple au cours d'une mononucl&eacute;ose infectieuse (MNI) ou d'un acc&egrave;s palustre ou sur une rate pathologique par exemple tumorale mai aussi dans certaines coagulopathies. Dans notre cas il s'agit d'un enfant de 6 ans suivi pour une coagulopathie admis pour douleurs abdominales diffuses brutales, une p&acirc;leur cutan&eacute;o-muqueuse avec un &eacute;tat h&eacute;modynamique stable. Le bilan biologique a r&eacute;v&egrave;le une an&eacute;mie normochrome macrocytaire; le diagnostic de confirmation de la rupture &eacute;tait r&eacute;alis&eacute; par l'&eacute;chographie et le scanner abdominal. Vu la stabilit&eacute; de l'&eacute;tat h&eacute;modynamique, la d&eacute;cision d'un traitement conservateur a &eacute;t&eacute; prise avec transfusions de 2 culots globulaires. L'&eacute;volution &eacute;tait favorable.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Pembet Singana Brice, Pembe Issamou Mayengue, Niama Roch Fabien, Ndounga Mathieu [Research] - Genetic diversity of Plasmodium falciparum infection among children with uncomplicated malaria living in Pointe-Noire, Republic of Congo - 12 April 2019. http://www.panafrican-med-journal.com/content/article/32/183/abstract/ <b>INTRODUCTION: Molecular characterization of malaria parasites from different localities is important to improve understanding of acquisition of natural immunity to Plasmodium falciparum, to assist in identifying the most appropriate strategies for control and to evaluate the impact of control interventions. This study aimed to determine the genetic diversity and the multiplicity of infection in Plasmodium falciparum isolates from Pointe-Noire, Republic of Congo. METHODS: Plasmodium falciparum isolates were collected from 71 children with uncomplicated malaria; enrolled into the study for evaluating the therapeutic efficacy of artemether-lumefantrine combination. Both msp-1 and msp-2 genes were genotyped. RESULTS: from 296 distinct fragments detected, 13 msp-1 and 27 msp-2 different alleles were identified. For msp-1, RO33 family was poorly polymorphic. The K1 family has shown the trend of predominance (41%), followed by Mad20 (35%). Comparatively to msp-2, 49.6% and 48.8% fragments belonged to 3D7 and FC27 respectively. Taking together msp-1 and msp-2 genes, the overall multiplicity of infection has been increased to 2.64 and 86% harbored more than one parasite genotype. Parasite density was not influenced by age as well as the multiplicity of infection which was not influenced neither by age nor by parasite density. CONCLUSION: genetic diversity of Plasmodium falciparum in isolates from patients with uncomplicated malaria in Pointe-Noire is high and consisted mainly of multiple clones. The overall multiplicity of infection has been largely increased when considering msp-1 and msp-2 genes together. With the changes in malaria epidemiology, the use of both msp-1 and msp-2 genes in the characterization of Plasmodium falciparum infection is recommended.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Joyce Agyemang, Sam Newton, Isaac Nkrumah, Joyce Mahlako Tsoka-Gwegweni, Samuel Nambile Cumber [Research] - Contraceptive use and associated factors among sexually active female adolescents in Atwima Kwanwoma District, Ashanti region-Ghana - 12 April 2019. http://www.panafrican-med-journal.com/content/article/32/182/abstract/ <b>INTRODUCTION: Unintended pregnancies and adolescent childbearing are on the increase in Sub-Saharan Africa. In Ghana, 14% of adolescents aged 15-19 are already mothers or pregnant with their first child. Most of these pregnancies are associated with poor outcomes such as miscarriages, stillbirths, unsafe abortions and other complications that might result in infant or mortality. In addition, sexually-active adolescents (16-19 years) are at higher risk of contracting STIs. Evidence suggest that contraceptive use help reduce fertility rate and adolescent reproductive health. This study therefore sought to understand the magnitude and associated factors that influence female adolescents' use of contraceptive in the Atwima Kwanwoma District, Ghana. METHODS: a descriptive and analytic cross-sectional study design was used for this study. Using a structured questionnaire, data were collected from randomly sampled 200 sexually active female adolescents; aged 16-19 for a three month period; June to September 2017. The questionnaire elicited data on the socio-demographic characteristics of respondents, their knowledge and perception, use of contraceptives and factors influencing their contraceptive use. Data were analyzed using STATA version 12.1 software. RESULTS: ninety-five percent of the respondents exhibited some knowledge about contraceptives, but this high knowledge did not translate into its use as the prevalence rate was 18%. Condom was the most widely used contraceptive (33%) and perceived side effects of contraceptives was found to be the main reason for not using the contraceptives (53.66%). Marital status and the participants who were staying with both parents were found to be associated with contraceptive use with their p-values of 0.023 and 0.002 respectively. CONCLUSION: considering the fact that contraceptive knowledge does not necessarily translate into use, further studies (qualitative), are needed to understand why high knowledge levels are not associated with high usage patterns.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Erhan Ayg&uuml;n, Fatih Mehmet Kelesoglu, Gafur Dogdu, Aysenur Ersoy, Dilruba Basbug, Dilara Ak&ccedil;a, &Ouml;zge Nur &Ccedil;am, Berat Aky&uuml;z, T&uuml;lay G&uuml;nsay, Ahmet Hakki Kapici, Nur G&ouml;k&ccedil;e Aydin, Edanur Karapinar, Sirin Atay, Nesibe Saglam, Nazli K&uuml;bra Okumus, Melike Zeynep Can, Fatmat&uuml;zzehra Yazici, Rukiye Eker &Ouml;meroglu [Research] - Antinuclear antibody testing in a Turkish pediatrics clinic: is it always necessary? - 11 April 2019. http://www.panafrican-med-journal.com/content/article/32/181/abstract/ <b>INTRODUCTION: The term anti-nuclear antibody (ANA) is used to define a large group of autoantibodies which specifically bind to nuclear elements. Although healthy individuals may also have ANA positivity, the measurement of ANA is generally used in the diagnosis of autoimmune disorders. However, various studies have shown that ANA testing may be overused, especially in pediatrics clinics. Our aim was to investigate the reasons for antinuclear antibody (ANA) testing in the general pediatrics and pediatric rheumatology clinics of our hospital and to determine whether ANA testing was ordered appropriately by evaluating chief complaints and the ultimate diagnoses of these cases. METHODS: the medical records of pediatric patients in whom ANA testing was performed between January 2014 and June 2016 were retrospectively evaluated. Subjects were grouped according to the indication for ANA testing and ANA titers. RESULTS: ANA tests were ordered in a total of 409 patients during the study period, with 113 positive ANA results. The ANA test was ordered mostly due to joint pain (50% of the study population). There was an increased likelihood of autoimmune rheumatic diseases (ARDs) with higher ANA titer. The positive predictive value of an ANA test was 16% for any connective tissue disease and 13% for lupus in the pediatric setting. CONCLUSION: in the current study, more than one-fourth of the subjects were found to have ANA positivity, while only 15% were ultimately diagnosed with ARDs. Our findings underline the importance of an increased awareness of correct indications for ANA testing.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ouissal Aissaoui, Rachid Alharrar [Images in medicine] - Traumatic pulmonary pseudocyst: a rare complication of blunt thoracic injury - 11 April 2019. http://www.panafrican-med-journal.com/content/article/32/180/abstract/ <b>Traumatic pulmonary pseudocyst is a rare and underreported complication of blunt chest trauma. It represents air trapped within a pulmonary laceration. It generally appears on radiographs as a thin-walled, air-filled cavity, with or without air-fluid levels. It is very important for emergency physicians and pediatricians to be familiar with this condition because it generally represents a benign, self-limited condition that only requires observation. We report a case of a young man admitted in our ICU for thoracic injury consecutive to a motor vehicle accident. The chest X-Ray showed multiple large thin-walled cystic lesions. The Chest CT identified several large cavities on the right lung confirming the diagnosis of traumatic pulmonary pseudocysts. He was treated by oxygen therapy and analgesia. His condition was relatively stable and improved after few days. He was discharged 10 days later and a follow-up chest CT showed spontaneous resolution of the pseudocyst.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Sunday Oteikwu Ochigbo, Chimaeze Torty, Maxwell Anah [Research] - Prevalence of HIV infection among siblings of HIV positive children in Calabar, Nigeria - 11 April 2019. http://www.panafrican-med-journal.com/content/article/32/179/abstract/ <b>INTRODUCTION: Early diagnosis and treatment of paediatric HIV is key as mortality of untreated patients is very high in the first two years of life, and reaches 80% by four years. Case finding efforts for children especially outside Prevention of mother-to-child transmission (PMTCT) is inadequate. Targeting siblings of index HIV-exposed and infected children is an important way of improving identification and enrolment into care thereby reducing paediatric mortality. The study therefore aimed to determine the prevalence of HIV infection among siblings of HIV positive children in care in Calabar. METHODS: This descriptive cross-sectional study was conducted among children aged six weeks to 15 years who are siblings of HIV positive children receiving care. Parental consent and child assent were obtained, the children were tested for HIV at their homes irrespective of their prior test results. Ethical clearance certificates were obtained from the health institutions. RESULTS: Siblings of 401 index patients were tested for HIV, four were positive giving a prevalence rate of 1%. Three hundred and sixty-seven 367(91.5%) had been tested previously while 34(8.5%) never had HIV test. Among the siblings who were HIV positive, 1(0.3%) was a male while 3(0.7%) were females. There were more HIV positive siblings in the 11-15 years age group. CONCLUSION: All the four HIV positive siblings were from the lower socioeconomic class (p=0.022). The routine screening of siblings of HIV positive children should be sustained with focus on adolescents from the lower socioeconomic class. This will improve early identification and enrolment into care thereby reducing paediatric mortality.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Loubna Hara, Fatima-Zahra El Hattab, Fatima-Zohra Radi, Jamila Zarzur, Mohamed Cherti [Case report] - Perforation d’an&eacute;vrysme de la valve mitrale post&eacute;rieure: complication rare de l’endocardite infectieuse: &agrave; propos d’un cas - 11 April 2019. http://www.panafrican-med-journal.com/content/article/32/178/abstract/ <b>L'an&eacute;vrysme de la valve mitrale est une anomalie rare dont la physiopathologie est mal &eacute;lucid&eacute;e. Il se d&eacute;finit par une protub&eacute;rance localis&eacute;e au niveau du feuillet valvulaire mitral bombant dans l'oreillette gauche. La localisation sur le feuillet post&eacute;rieur est exceptionnelle. Nous rapportons le cas d'un jeune homme de 26 ans suivi depuis 4 ans pour une insuffisance aortique rhumatismale qui est hospitalis&eacute; pour un syndrome f&eacute;brile avec pouss&eacute;e d'insuffisance cardiaque gauche. L'&eacute;chocardiographique transthoracique (ETT) et transoesophagienne (ETO) ont mis en &eacute;vidence des v&eacute;g&eacute;tations sur la valve aortique avec un large an&eacute;vrysme de la petite valve mitrale associ&eacute; &agrave; une fuite mitrale importante. Le patient a b&eacute;n&eacute;fici&eacute; d'un double remplacement valvulaire mitral et aortique avec des suites op&eacute;ratoires simples. Une suspicion clinique avec une imagerie adapt&eacute;e pr&eacute;op&eacute;ratoire et un traitement chirurgical &agrave; temps sont n&eacute;cessaires pour reconna&icirc;tre et traiter cette complication rare de l'endocardite infectieuse.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Moulay Omar Moustaine, Bouchra Allali, Loubna El Maaloum, Asmaa El Kettani, Khalid Zaghloul [Case report] - Molluscum contagiosum palp&eacute;bral: &agrave; propos d’un cas - 11 April 2019. http://www.panafrican-med-journal.com/content/article/32/177/abstract/ <b>Les Molluscums contagiosum (MC) sont des l&eacute;sions cutan&eacute;es b&eacute;nignes caus&eacute;es par Molluscipoxvirus, ils affectent principalement les enfants et les adultes jeunes et int&eacute;ressent surtout la peau et rarement les muqueuses. Le diagnostic clinique est facile, confirm&eacute; par l'analyse histologique de la l&eacute;sion, cependant il n'existe pas de consensus concernant la prise en charge th&eacute;rapeutique. La localisation palp&eacute;brale de MC est rare, elle pose un probl&egrave;me d'ordre diagnostic diff&eacute;rentiel surtout lorsqu'elle est isol&eacute;e et un probl&egrave;me th&eacute;rapeutique vu la proximit&eacute; du globe oculaire. Nous rapportons le cas d'une fille de 7 ans ayant pr&eacute;sent&eacute; une l&eacute;sion palp&eacute;brale isol&eacute;e dont l'ex&eacute;r&egrave;se avec &eacute;tude anatomopathologique a r&eacute;v&eacute;l&eacute; un MC. A la lumi&egrave;re de cette observation nous d&eacute;crivons les particularit&eacute;s cliniques, th&eacute;rapeutiques, et &eacute;volutives de cette localisation rare du molluscum contagiosum.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Patrice Niamien Koffi, Olivier Ouambi, Nizar El Fatemi, Rachid El Maaquili [Case report] - Tuberculome c&eacute;r&eacute;bral un challenge diagnostic: &agrave; propos d’un cas et mise au point - 10 April 2019. http://www.panafrican-med-journal.com/content/article/32/176/abstract/ <b>La tuberculose du syst&egrave;me nerveux central est le deuxi&egrave;me site le plus fr&eacute;quent apr&egrave;s la m&eacute;ningite tuberculeuse. Elle est une cause majeure de morbidit&eacute; et de mortalit&eacute; dans les pays en d&eacute;veloppement et repr&eacute;sente 10 &agrave; 30% des l&eacute;sions expansives intracr&acirc;niennes dans ces pays contre 0,2% dans certains pays occidentaux. Le but de cet article est de pr&eacute;senter un cas atypique de tuberculome c&eacute;r&eacute;bral dans sa pr&eacute;sentation clinique et radiologique (l'IRM c&eacute;r&eacute;brale et de la spectroscopie), de faire une mise au point &agrave; partir de cette observation sur cette pathologie infectieuse. Il s'agit d'une patiente de 44 ans, sans ant&eacute;c&eacute;dent m&eacute;dico-chirurgical, qui a pr&eacute;sent&eacute; depuis un an des c&eacute;phal&eacute;es, compliqu&eacute;es 08 mois apr&egrave;s de crises de crises d'&eacute;pilepsies partielles &agrave; g&eacute;n&eacute;ralisation secondaire et de lourdeur de l'h&eacute;micorps gauche avec des &eacute;pisodes de vomissements sans trouble visuel ni fi&egrave;vre ni alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral. L'examen clinique trouvait une patiente consciente GCS = 15, pupilles &eacute;gales et r&eacute;actives, station debout et marche possible sans anomalie, avec h&eacute;mipar&eacute;sie gauche 4/5 sans autres signes neurologiques. L'IRM c&eacute;r&eacute;brale objectivait en s&eacute;quence T1 non inject&eacute;e une l&eacute;sion pari&eacute;tale droite sus tentoriel plurilob&eacute;es iso intense mal limite limit&eacute;e, en s&eacute;quence T2 elle est h&eacute;t&eacute;rog&egrave;ne avec un liser&eacute; hyper intense et un fond hypo intense traduisant un processus charnue avec des zones de n&eacute;croses centrales et un œd&egrave;me p&eacute;ri-l&eacute;sionnel en doigt de gans avec une prise de contraste annulaire intense apr&egrave;s injection de gadolinium. L'analyse de la spectroscopie &eacute;tait en faveur d'une tumeur gliale. La patiente fut mise sous anticonvulsivant et a b&eacute;n&eacute;fici&eacute; d'un abord direct avec ex&eacute;r&egrave;se macroscopiquement compl&egrave;te. L'analyse anatomopathologique &eacute;tait en faveur d'un tuberculome c&eacute;r&eacute;bral. Elle a &eacute;t&eacute; mise sous traitement antituberculeux avec arr&ecirc;t des crises et r&eacute;cup&eacute;ration du d&eacute;ficit apr&egrave;s 04 semaines. A travers ce cas nous entrevoyons le polymorphisme clinique et radiologique qu'est le tuberculome c&eacute;r&eacute;bral. Il est &eacute;voqu&eacute; devant un faisceau d'argument clinique, biologique et radiologique mais le diagnostic de certitude reste essentiellement anatomopathologique. La prise en charge ne saurait tarder car les complications sont n&eacute;fastes et de mauvais pronostic lorsqu'il est d&eacute;tect&eacute; tardivement.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hakan Sarbay, Sinan Akbayram [Case report] - Secondary severe thrombocytosis in a patient who underwent splenectomy due to hereditary spherocytosis and its treatment using hydroxyurea - 10 April 2019. http://www.panafrican-med-journal.com/content/article/32/175/abstract/ <b>Thrombocytosis is a frequently seen condition during childhood. While it usually develops secondarily due to reasons such as infection or anemia, it may rarely develop due to clonal causes. Thrombocytosis becomes a life-threatening condition by causing severe complications such as hemorrhage and thrombosis development. Treatment is not recommended in patients who are asymptomatic and with a platelet count below 1,500,000/mm3, however, treatment is required in cases who are symptomatic and with a platelet count above 1,500,000/mm3 in conditions such as primary thrombocytosis. This article present the outcomes of a patient who was treated using low-dose hydroxyurea when he developed severe thrombocytosis after splenectomy.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ngwayu Claude Nkfusai, Tchakounte Minette Mubah, Brenda Mbouamba Yankam, Tabe Armstrong Tambe, Samuel Nambile Cumber [Research] - Prevalence of precancerous cervical lesions in women attending Mezam Polyclinic Bamenda, Cameroon - 10 April 2019. http://www.panafrican-med-journal.com/content/article/32/174/abstract/ <b>INTRODUCTION: Precancerous cervical lesion is significantly a health problem globally. Thus, screening targeting women between the ages of 17-60 is being undertaken in developing countries, including Cameroon. Over 50% (7.8 per 100000) women die of cervical cancer every year. This study was to detertemine the prevalence of precancerous cervical lesion, the age demography and access the risk factor. METHODS: A hospital-based cross-sectional study was conducted from August 09th to October 17th 2017. A total of 60 women participated, and were screened for precancerous cervical lesion. Data were collected by using a questionnaire. Visual inspection with acetic acid and visual inspection with Lugol’s iodine was applied for the screening. SPSS version 16.0 was used for data entry and analysis. Logistic regression analysis was fitted and odds ratios with 95% Confidence intervals and p-values were computed to identify factors associated with precancerous cervical cancer lesion. RESULTS: Out of 60 study participants, 2(3.33%) were found to be positive for precancerous cervical cancer lesion. CONCLUSION: The prevalence of precancerous cervical lesion in women that consulted at the Mezam Polyclinic is high.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Bruce Wembulua Shinga, Alassane Di&egrave;ye, Nd&egrave;ye M&eacute;ry Dia Badiane, Nd&egrave;ye Aissatou Lakhe, Viviane Marie-Pierre Cisse Diallo, Khadiatou Diallo Mbaye, Daye Ka, Aboubakar Sidikh Badiane, Assane Diouf, Louise Fortes D&eacute;gu&eacute;nonvo, Cheikh Tidiane Ndour, Moussa Seydi [Case report] - Tuberculose intestinale r&eacute;v&eacute;l&eacute;e par une occlusion intestinale aig&uuml;e au cours d’une r&eacute;action paradoxale au traitement anti-tuberculeux chez un patient immunocomp&eacute;tent: &agrave; propos d’un cas et revue de la litt&eacute;rature - 10 April 2019. http://www.panafrican-med-journal.com/content/article/32/173/abstract/ <b>La tuberculose intestinale repr&eacute;sente 3 &agrave; 5% de toutes les localisations visc&eacute;rales. Malgr&eacute; l'efficacit&eacute; d&eacute;montr&eacute;e des anti-tuberculeux, des cas d'exacerbation du tableau clinique initial ont &eacute;t&eacute; d&eacute;crits &agrave; l'initiation du traitement. Ces r&eacute;actions dites « paradoxales » sont cependant rarement rapport&eacute;es chez les immunocomp&eacute;tents et beaucoup moins sous forme d'occlusion intestinale. Nous rapportons un cas de tuberculose intestinale r&eacute;v&eacute;l&eacute;e par une occlusion intestinale aig&uuml;e au cours d'une r&eacute;action paradoxale aux anti-tuberculeux. Il s'agit d'un patient de 26 ans, immunocomp&eacute;tent qui a pr&eacute;sent&eacute; un syndrome occlusif &agrave; un mois de traitement d'une tuberculose pleuro-pulmonaire. La tomodensitom&eacute;trie (TDM) abdominale &eacute;tait en faveur d'une occlusion intestinale gr&ecirc;lique. La laparotomie objectivait une masse intra-p&eacute;riton&eacute;ale avec de multiples adh&eacute;rences. L'examen anatomopathologique de la pi&egrave;ce op&eacute;ratoire &eacute;tait en faveur d'une tuberculose intestinale. L'&eacute;volution &eacute;tait favorable apr&egrave;s la poursuite du traitement anti-tuberculeux initial.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Nadia Maguiassu&eacute; T&eacute;fouet, Marius Zambou Vouking, Marie-Jos&eacute; Essi [Research] - Comp&eacute;tences des couples en mati&egrave;re de planification familiale en post-partum imm&eacute;diat dans le District de Sant&eacute; de Biyem-Assi, Cameroun - 09 April 2019. http://www.panafrican-med-journal.com/content/article/32/172/abstract/ <b>INTRODUCTION: La planification familiale en post-partum imm&eacute;diat reste encore peu connue et peu pratiqu&eacute;e par la plupart des couples au Cameroun. Pourtant, juste apr&egrave;s un accouchement, nombreux sont ceux qui d&eacute;sirent diff&eacute;rer la naissance de leur prochain enfant. Cette &eacute;tude avait pour objectif de d&eacute;terminer le niveau de comp&eacute;tences et le besoin &eacute;ducationnel des couples en mati&egrave;re de planification familiale en post-partum imm&eacute;diat dans le District de Sant&eacute; de Biyem-Assi. METHODES: il s'agissait de mener une enqu&ecirc;te CAP (connaissances, attitudes et pratiques), dans le District de Sant&eacute; de Biyem-Assi. La collecte des donn&eacute;es s'est faite &agrave; l'aide de deux questionnaires de 40 questions chacun, r&eacute;dig&eacute;s en fran&ccedil;ais, l'un adress&eacute; aux femmes en couple et en post-partum et l'autre aux hommes en couple et ayant au moins un enfant. Les donn&eacute;es recueillies ont &eacute;t&eacute; saisies dans le logiciel CSPro version 6.2, puis analys&eacute;es &agrave; l'aide du logiciel SPSS version 20.0. RESULTATS: un total de 300 individus a &eacute;t&eacute; interrog&eacute; avec un sex-ratio de 1. Plus de la moiti&eacute; (56,7%) avait une connaissance approximative de la planification familiale en post-partum imm&eacute;diat. Pour 36% des r&eacute;pondants, le post-partum imm&eacute;diat n'&eacute;tait pas un moment appropri&eacute; pour l'utilisation d'une m&eacute;thode contraceptive moderne, l'interaction entre contraceptifs et lait maternel (65,4%) et l'infertilit&eacute; de la femme (26,3%) &eacute;taient les principales raisons &eacute;voqu&eacute;es. Les pratiques contraceptives en post-partum imm&eacute;diat de 60,5% des couples vivant dans le District de Sant&eacute; Biyem-Assi &eacute;taient inad&eacute;quates. Par cons&eacute;quent, la plupart des enqu&ecirc;t&eacute;s avaient un niveau de comp&eacute;tences insuffisant (32,6%) et faible (23,3%) en mati&egrave;re de planification familiale en post-partum imm&eacute;diat. CONCLUSION: certains pr&eacute;jug&eacute;s et de fausses id&eacute;es persistent dans la population du District de Sant&eacute; Biyem-Assi en ce qui concerne les m&eacute;thodes contraceptives modernes, et constituent un frein &agrave; la pratique contraceptive en g&eacute;n&eacute;ral et en post-partum imm&eacute;diat en particulier. Des efforts de sensibilisation et d'&eacute;ducation des couples pour l'am&eacute;lioration de leurs comp&eacute;tences en mati&egrave;re de contraception en post-partum imm&eacute;diat s'av&egrave;rent n&eacute;cessaires.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com H&egrave;zouw&egrave; Magnang, Essohana Padaro, Koffi Mawussi, Tama Ouenangou, Yao Layibo, Messanh D&eacute;lagno Iren&eacute; Ku&eacute;viako&eacute;, Ahoefa Vovor [Research] - Evaluation de la qualit&eacute; des concentr&eacute;s de globules rouges produits au Centre National de Transfusion Sanguine de Lom&eacute; - 09 April 2019. http://www.panafrican-med-journal.com/content/article/32/171/abstract/ <b>INTRODUCTION: Au Centre National de Transfusion Sanguine de Lom&eacute;, le sang total est syst&eacute;matiquement s&eacute;par&eacute; en diff&eacute;rents produits sanguins labiles. L'objectif de cette &eacute;tude &eacute;tait d'&eacute;valuer la qualit&eacute; des concentr&eacute;s de globules rouges (CGR) qui y sont produits. METHODES: Il s'est agi d'une &eacute;tude transversale r&eacute;alis&eacute;e de janvier &agrave; mars 2018 qui a port&eacute; sur 260 CGR (204 unit&eacute;s adultes et 56 unit&eacute;s p&eacute;diatriques). Les poches incluses ont &eacute;t&eacute; pes&eacute;es afin de d&eacute;terminer le volume de leur contenu. Le taux d'h&eacute;moglobine et l'h&eacute;matocrite ont &eacute;t&eacute; d&eacute;termin&eacute;s en utilisant l'automate Pentra XLR de Horiba M&eacute;dical. Nous avons &eacute;valu&eacute; la fid&eacute;lit&eacute; et la justesse de l'automate afin d'assurer la fiabilit&eacute; des mesures des variables analys&eacute;es. Les analyses statistiques ont &eacute;t&eacute; r&eacute;alis&eacute;es &agrave; l'aide du logiciel R. RESULTATS: Concernant les unit&eacute;s adultes, 79,90%; 81,86% et 43,13% des poches &eacute;taient conformes respectivement pour le volume, la teneur en h&eacute;moglobine et l'h&eacute;matocrite. Au niveau des unit&eacute;s p&eacute;diatriques, 98,21%; 69,64% et 37,50% &eacute;taient conformes respectivement pour le volume, la teneur en h&eacute;moglobine et l'h&eacute;matocrite. En consid&eacute;rant les trois param&egrave;tres simultan&eacute;ment, on avait un taux de conformit&eacute; de 42,16% pour les CGR adultes contre 35,71% pour les CGR p&eacute;diatriques. CONCLUSION: Nous recommandons d'&eacute;largir l'intervalle entre deux dons de sang et de mettre en œuvre le contr&ocirc;le d'h&eacute;moglobine avant le don dans les crit&egrave;res d'aptitude au don de sang au CNTS de Lom&eacute;.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Mouhcin Daoudi, Laila Herrak, Mustapha El Ftouh, Leila Achachi [Case report] - Forme pseudo-tumorale d’une tuberculose broncho-pulmonaire chez un immunocomp&eacute;tent mimant un cancer - 09 April 2019. http://www.panafrican-med-journal.com/content/article/32/170/abstract/ <b>La tuberculose est une maladie due &agrave; une infection par le bacille tuberculeux, tous les organes peuvent &ecirc;tre touch&eacute;s, la tuberculose pulmonaire repr&eacute;sente un peu plus de 50% des atteintes, elle constitue un probl&egrave;me de sant&eacute; publique dans le monde entier et particuli&egrave;rement dans les pays en voie de d&eacute;veloppement. La tuberculose broncho-pulmonaire pseudo-tumorale est une forme de pr&eacute;sentation particuli&egrave;re de la tuberculose chez le sujet immunocomp&eacute;tent, elle peut rev&ecirc;tir la forme d'une l&eacute;sion bronchique ou pulmonaire &eacute;vocatrice d'une pathologie n&eacute;oplasique, que ce soit sur une TDM thoracique ou lors d'une endoscopie bronchique. Cette similitude avec la pathologie n&eacute;oplasique est source de confusion pour le clinicien et rend difficile l'&eacute;tablissement du diagnostic positif, elle n&eacute;cessite le recours &agrave; des moyens diagnostiques souvent invasifs, puisque les moyens classiques sont g&eacute;n&eacute;ralement mis &agrave; d&eacute;faut, ce qui alourdit la prise en charge et retarde la mise sous traitement. L'objectif de cet article est de sensibiliser le clinicien vis-&agrave;-vis de cette forme particuli&egrave;re de pr&eacute;sentation de la tuberculose, certes peu fr&eacute;quente, mais &agrave; &eacute;voquer de principe devant un aspect radiologique compatible d'autant plus que le pays de r&eacute;sidence est de forte end&eacute;micit&eacute;. Le traitement de cette forme demeure le m&ecirc;me que celui des pr&eacute;sentations habituelles, que ce soit en mati&egrave;re de m&eacute;dicaments ou de dur&eacute;e.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Vishnu Vardhan Garla, Kanooz Ul Qadir Chaudhary, Abid Yaqub [Case report] - Systemic mastocytosis: a rare cause of osteoporosis - 09 April 2019. http://www.panafrican-med-journal.com/content/article/32/169/abstract/ <b>A 61-year old female patient who was referred to the endocrine clinic for evaluation of an elevated alkaline phosphatase. She was originally referred to gastroenterology (GI), however no GI causes of elevated alkaline phosphatase was found. Upon fractionation, it was noted that she had elevation in bone specific alkaline phosphatase. Past history was significant for hypertension, atrial fibrillation and menopause 6 years ago. She was also noted to have multiple drug allergies manifesting as urticaria and flushing. Review of the past records revealed a persistently elevated alkaline phosphatase over the last two years. She had no history of falls or fractures. Computed tomography (CT) abdomen done to rule out biliary pathology, revealed osteosclerotic and osteolytic lesion in the pelvis concerning for neoplastic disease. Bone marrow biopsy however, was negative for cancer but consistent with systemic mastocytosis (SM). Dual Energy X-ray absorbimetery (DEXA) scan revealed osteoporosis Serum tryptase levels were elevated; further genetic analysis showed a positive CKIT D816 mutation. She was started on bisphosphonates (initially alendronate and then ibandronate).Upon follow up at two years she had not experienced any fractures and her bone mineral density also had improved significantly.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Anelisa Jaca [Meeting report] - Insights from the fifth International One Health Congress, 2018, Saskatoon, Canada - 09 April 2019. http://www.panafrican-med-journal.com/content/article/32/168/abstract/ <b>The recent outbreaks of diseases including Ebola reemergence in the Democratic Republic of Congo (DRC), Nipah virus outbreak in India, Lassa virus in Nigeria and the continued Influenza pandemic shows that we cannot predict outbreaks, however, developing response plans could help alleviate the burden of diseases. Developing response plans involves strategies such as creating a repository of microbial agents as well implementation of the plans. In addition, zoonotic experts and policy makers should work together in order to succeed in fighting against any disease outbreaks. We should also not forget about the importance of vaccination because of the benefits it has brought to humankind preventing disease occurrence. Furthermore, the challenges that come with vaccination including vaccine delivery and vaccine uptake needs to be overcome to make sure that this public health tool continues to be effective. Overcoming these vaccination challenges would play a significant role in decreasing the overuse of antimicrobials, hence avoiding resistance. The One Health Community (OHC) therefore has the responsibility to advocate for the use of vaccines and show that it has costs benefits; this strategy has the potential to fight against antimicrobial resistance.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Badr Slioui, Mohammed Abdellaoui, Soufiane Belabbes, Rachida Dafiri [Case report] - Une association malformative exceptionnelle: situs inversus totalis et hernie r&eacute;tro-costo-xyphoidienne - 09 April 2019. http://www.panafrican-med-journal.com/content/article/32/167/abstract/ <b>La hernie r&eacute;tro-costo-xypho&iuml;dienne est une malformation cong&eacute;nitale rare. Elle repr&eacute;sente 3% de l'ensemble des hernies diaphragmatiques. Elle peut &ecirc;tre isol&eacute;e ou associ&eacute;e &agrave; d'autres malformations. Nous rapportons une observation rarissime d'hernie de Larrey-Morgagni et de situs inversus totalis d&eacute;couverts &agrave; la suite d'une d&eacute;tresse respiratoire n&eacute;onatale.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Alkali Bashir, Iliyasu Garba, Adamu Almustapha Aliero, Abdurrazak Kibiya, Muhammad Hassan Abubakar, Ibrahim Ntulume, Faruku Sarkinfada, Agwu Ezera [Research] - Superbugs-related prolonged admissions in three tertiary hospitals, Kano State, Nigeria - 09 April 2019. http://www.panafrican-med-journal.com/content/article/32/166/abstract/ <b>INTRODUCTION: Superbugs are pathogenic micro-organism and especially a bacterium that has developed resistance to the medications normally used against it. As the superbug family increases, the need for appropriate diagnostic, treatment, prevention and control strategies cannot be over emphasized. Therefore, this work determined the distribution of superbug bacteria among patients on prolonged hospital admissions in three tertiary hospitals of Kano state, Nigeria. METHODS: a descriptive cross sectional study was undertaken among 401 patients from medical, surgery, orthopedic and burn centre wards in a three tertiary hospitals in Kano state. A sample collected comprises wound/pus, urine, urine catheter and nasal intubation and were analysed using standard microbiological methods for <i>Acinetobacter</i> spp and other related nosocomial bacterial pathogens. Antibiotic susceptibility testing was done using Kirby-Bauer disc diffusion method. RESULTS: one hundred and thirty eight (138) isolates were recovered, from the studied participants. More than 80% of the nosocomial infections (NIs) were caused by Gram-negative bacteria, predominantly Escherichia coli, <i>Klebseilla</i> spp, <i>Proteus</i> spp, <i>Pseudomona</i> spp and <i>Acinetobacter</i> spp. In-vitro antibiotic susceptibility test revealed that acinetobacter were 100% resistant to amoxicillin, co-trimoxazole, perfloxacin and imipenem. CONCLUSION: the results of this study reported higher antibiotic resistant among Acinetobacter spp isolated from three studied hospitals. The healthcare manage of the these hospitals and ministry health need to take measures against this resistant bacteria (<i>Acinetobacter</i> spp) especially on prescribing antibiotics that showed 100% resistant from these studied hospitals.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Yacouba Njankouo Mapoure, Chia Mark Ayeah, Hamadou Ba, Hugo Bertrand Mbatchou Ngahane, Romuald Hentchoya, Henry Namme Luma [Research] - The prognostic value of serum uric acid in the acute phase of hemorrhagic stroke patients in black Africans - 09 April 2019. http://www.panafrican-med-journal.com/content/article/32/165/abstract/ <b>INTRODUCTION: Very few studies have been conducted to evaluate the prevalence of hyperuricemia and its impact on the prognosis amongst acute hemorrhagic stroke (AHS) patients. The objectives was to determine the prevalence of hyperuricemia in AHS patients and examined the association between hyperuricemia and stroke outcomes in the Douala General Hospital (DGH). METHODS: this was a hospital based prospective cohort which included AHS patients with baseline SUA levels and 3 months post stroke follow-up data. SUA values were divided into quintiles. Associations between hyperuricemia and stroke outcomes were analyzed using multiple logistic regression and survival analysis (cox regression and Kaplan Meier). RESULTS: a total of 221 AHS patients were reviewed with a mean age of 55.8±11.8 years. The prevalence of hyperuricemia among AHS patients was 34.4% with mean SUA level of 376.8±131.9 µmol/l. On multivariate analysis, hyperuricemia was not independently associated with early death [(OR = 1.072 (CI: 0.370-3.056; p = 0.897)] and poor functional outcome [(OR=2.487 (CI: 0.771-8.699; p = 0.154)] after hemorrhagic stroke. No significant increase in stroke deaths was observed across higher SUA quintiles amongst hemorrhagic stroke patients (p = 0.326). No statistically significant correlation was observed between SUA level and NIHSS (r = 0.063, p = 0.353) and between SUA level and mRS (r = 0.030, p = 0.662) in hemorrhagic stroke.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Christian Nsanzabaganwa, Hubert Habineza, Naphtal Nyirimanzi, Christian Umuhoza, Katie Cartledge, Craig Conard, Peter Cartledge [Research] - Write-up and dissemination of undergraduate and postgraduate research at the University of Rwanda: a cross-sectional study - 09 April 2019. http://www.panafrican-med-journal.com/content/article/32/164/abstract/ <b>INTRODUCTION: Research is essential in all areas of health development. However, medical students and residents frequently lack the time and training on performing research. This is especially prevalent in resource-limited settings. We aimed to compare the word counts of undergraduate and postgraduate dissertations with published projects in Rwanda, and to identify the proportion of postgraduate pediatric research projects that have been published since 2012. METHODS: retrospective, cross-sectional study of undergraduate and postgraduate research dissertations at the University of Rwanda. Dissertations were then compared to randomly selected published papers of Rwandan research. Each IMRaD (Introduction, Methodology, Results and Discussion) section word count was compared using Student's t-test. RESULTS: 19/190 (10%) undergraduate dissertations and 22/41 (54%) postgraduate dissertations, were available in electronic format for word-count analysis. The mean total word count for postgraduate dissertations (5163 words) was significantly longer (p<0.001) than the randomly selected peer-reviewed journal articles (2959 words). Each section of the IMRaD structure of postgraduate dissertations was significantly longer than those of the control group. Undergraduates used a similar number of words to published papers, but used significantly more tables and figures. Of the 41 postgraduate dissertations, only four (10%), were published in peer-reviewed journals. CONCLUSION: this is the first study to assess the writing style of Rwandan medical students and pediatric postgraduate residents. A simple step to increase dissemination of research findings would be for institutions to modify academic regulations so that students write-up in manuscript form rather than dissertation format.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Michel Assane Ndour, Maimouna Sow, Ibou Thiam, Boundia Djiba, Fabrice Senghor, Nafi Diagne, Awa Cheikh Ndao, Abdoulaye Pouye [Case report] - Tuberculose pseudo tumorale du col de l'ut&eacute;rus - 09 April 2019. http://www.panafrican-med-journal.com/content/article/32/163/abstract/ <b>La localisation cervicale de la tuberculose est rare et peut prendre l'apparence d'un cancer du col ut&eacute;rin. La pr&eacute;sentation pauci-symptomatique et l'&eacute;volution insidieuse sont &agrave; l'origine d'un retard diagnostique. Les sympt&ocirc;mes commun&eacute;ment rencontr&eacute;s sont non sp&eacute;cifiques, ce qui contribue au retard th&eacute;rapeutique et majore le risque d'infertilit&eacute; qui reste la s&eacute;quelle quasi in&eacute;luctable. Nous rapportons un cas de tuberculose du col ut&eacute;rin dont le diagnostic de prime abord n'a pas &eacute;t&eacute; &eacute;vident. En effet une patiente a &eacute;t&eacute; adress&eacute;e &agrave; notre d&eacute;partement pour suspicion de cancer du col ut&eacute;rin. Le diagnostic de suspicion de cancer a &eacute;t&eacute; alors retenu devant un col qui saignait au contact avec une tomodensitom&eacute;trie abdomino-pelvienne en faveur d'une tumeur du col ut&eacute;rin. Une biopsie de confirmation histologique a &eacute;t&eacute; indiqu&eacute;e. On a retrouv&eacute; &agrave; l'examen anatomopathologique, un granulome &eacute;pith&eacute;lio-giganto-cellulaire avec n&eacute;crose cas&eacute;euse, compatible avec une tuberculose cervicale. La recherche d'un terrain &eacute;tait n&eacute;gative. Un traitement antituberculeux instaur&eacute; a conduit &agrave; la gu&eacute;rison. Retenue souvent sur la base d'&eacute;l&eacute;ments pr&eacute;somptifs, la d&eacute;cision diagnostique et th&eacute;rapeutique de tuberculose du col cervicale reconnait la place de l'examen anatomopathologique.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Stève Robert Ebana Mvogo, Viola Andin Dohvoma, José Stéphanie Ngassam Fangwa, Caroline Mvilongo Tsimi, Marie Evodie Akono Zoua, Marie Blanche Nguena, Epee Emilienne, Ellong Augustin, Ebana Mvogo Côme [Research] - Age de d&eacute;but de la presbytie chez le sujet noir camerounais - 09 April 2019. http://www.panafrican-med-journal.com/content/article/32/162/abstract/ <b>INTRODUCTION: La prescription d'une addition dans notre pratique n'est pas rare chez les patients de moins de 40 ans. Nous avons recherch&eacute; le besoin d'une addition apr&egrave;s &eacute;tude objective de la r&eacute;fraction et partant d&eacute;terminer l'&acirc;ge moyen de d&eacute;but de la presbytie. METHODES: nous avons men&eacute; une &eacute;tude transversale et descriptive &agrave; l'H&ocirc;pital Central de Yaound&eacute; durant trois mois chez les patients &acirc;g&eacute;s de 35 &agrave; 45 ans. Ils ont tous b&eacute;n&eacute;fici&eacute; d'une &eacute;tude objective de la r&eacute;fraction sous cyclopl&eacute;gie. La correction de la vision de loin &eacute;tait faite sous cyclopl&eacute;gie, alors que l'addition en vison de pr&egrave;s &eacute;tait &eacute;valu&eacute;e deux jours plus tard lorsque la cyclopl&eacute;gie n'&eacute;tait plus effective. La prescription probable d'une addition &agrave; la correction de loin devait &ecirc;tre r&eacute;alis&eacute;e 2 jours apr&egrave;s la cyclopl&eacute;gie. L'analyse statistique a &eacute;t&eacute; faite avec le logiciel IBM SPSS 20.0. RESULTATS: nous avons examin&eacute; 55 patients soit 110 yeux. L'&acirc;ge moyen des patients &eacute;tait de 41,87±2,5 ans, avec un sex-ratio de 0,28 en faveur des femmes. L'astigmatisme hyperm&eacute;tropique &eacute;tait l'am&eacute;tropie la plus fr&eacute;quente avec 58,2% de cas suivi de l'hyperm&eacute;tropie avec 24,6%. Nous n'avons retrouv&eacute; aucun sujet myope. L'&acirc;ge moyen de d&eacute;but de la presbytie dans cette tranche d'&acirc;ge &eacute;tait de 43,2±1,7 ans. Apr&egrave;s correction objective en vision de loin, aucun patient n'avait besoin d'une addition avant 40 ans. Par ailleurs, 4 patients sur 10 avec une am&eacute;tropie hyperm&eacute;tropique n'ont pas besoin d'addition avant 45 ans. La prescription d'une addition &eacute;tait li&eacute;e de fa&ccedil;on significative &agrave; l'&acirc;ge. CONCLUSION: l'&acirc;ge moyen de d&eacute;but de la presbytie est de 43,2±1,7 ans. Avant 45 ans, toute prescription d'une addition doit &ecirc;tre pr&eacute;c&eacute;d&eacute;e d'une &eacute;tude objective de la r&eacute;fraction.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ouardia Bouayadi, Mohammed Bensalah, Nawal Rahmani, Said Assoufi, Mohammed Choukri [Case series] - Electrophor&egrave;se des prot&eacute;ines s&eacute;riques: &eacute;tude de 410 profils &eacute;lectrophor&eacute;tiques - 08 April 2019. http://www.panafrican-med-journal.com/content/article/32/161/abstract/ <b>L'&eacute;lectrophor&egrave;se des prot&eacute;ines s&eacute;riques (EPS) est une analyse de routine dans la pratique quotidienne d'un laboratoire de biologie m&eacute;dicale. Le but de notre &eacute;tude est d’analyser les diff&eacute;rents profils &eacute;lectrophor&eacute;tiques rencontr&eacute;s dans notre pratique courante. Nous avons men&eacute; une &eacute;tude transversale portant sur 410 &eacute;chantillons s&eacute;riques qui ont &eacute;t&eacute; collect&eacute;s dans le cadre de l’analyse de routine au sein du laboratoire de biochimie du Centre Hospitalier Universitaire (CHU) Mohammed VI d’Oujda. L’&eacute;lectrophor&egrave;se des prot&eacute;ines s&eacute;riques a &eacute;t&eacute; r&eacute;alis&eacute;e sur automate Capilarys2 Flex piercing de Sebia. 241 s&eacute;rums de femmes et 169 s&eacute;rums d’hommes ont &eacute;t&eacute; collect&eacute;s. &Acirc;g&eacute;s de 1 &agrave; 91 ans avec une moyenne d’&acirc;ge de 49 ans. 19,5% des EPS &eacute;taient normales, l’hypo-albumin&eacute;mie a &eacute;t&eacute; not&eacute; chez 34% des cas, un syndrome inflammatoire chronique dans 19,5% des cas, un syndrome n&eacute;phrotique chez 2% des cas, 5,8% de nos patients avaient un bloc b&eacute;ta-gamma, une hypogammaglobulin&eacute;mie a &eacute;t&eacute; observ&eacute;e dans 8,5% des cas, et 29 pics monoclonaux ont &eacute;t&eacute; not&eacute;s, une bis-albumin&eacute;mie a &eacute;t&eacute; objectiv&eacute;e chez 2 patients. Sur les 410 pr&eacute;l&egrave;vements: 92 immunofixations ont &eacute;t&eacute; r&eacute;alis&eacute;es dont 23 &eacute;taient positives (objectivant une gammapathie monoclonale). Cette &eacute;tude met en &eacute;vidence la variabilit&eacute; des motifs de prescription d’une &eacute;lectrophor&egrave;se des prot&eacute;ines s&eacute;riques, ainsi que l’importance des donn&eacute;es cliniques pour une interpr&eacute;tation meilleure.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Elise Tourrilhes, Marie Veluire, David Herv&eacute;, Erdogan Nohuz [Research] - Pronostic obst&eacute;trical des femmes atteintes de vaginisme primaire - 08 April 2019. http://www.panafrican-med-journal.com/content/article/32/160/abstract/ <b>INTRODUCTION: Dysfonction importante, le vaginisme est un probl&egrave;me tant individuel que du couple qui peut alt&eacute;rer la relation sexuelle. Il peut influencer le pronostic obst&eacute;trical. Le but de cette &eacute;tude &eacute;tait de d&eacute;terminer si les caract&eacute;ristiques cliniques du vaginisme ont une incidence sur le processus de l’accouchement.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Francis Hamaimbo Nanzaluka, Sylvia Chibuye, Clara Chola Kasapo, Nelia Langa, Sulani Nyimbili , Given Moonga, Nathan Kapata, Ramya Kumar, Gershom Chongwe [Research] - Factors associated with unfavourable tuberculosis treatment outcomes in Lusaka, Zambia, 2015: a secondary analysis of routine surveillance data - 08 April 2019. http://www.panafrican-med-journal.com/content/article/32/159/abstract/ <b>INTRODUCTION: Focus has been put on strengthening surveillance systems in high tuberculosis (TB) burden countries, like Zambia, however inadequate information on factors associated with unfavourable TB treatment outcomes is generated from the system. We determined the proportion of tuberculosis treatment outcomes and their associated factors. METHODS: we defined unfavourable outcome as death, lost-to-follow-up, treatment-failure, or not-evaluated and favourable outcome as a patient cured or completed-treatment. We purposively selected a 1st level hospital, an urban-clinic and a peri-urban clinic. We abstracted data from TB treatment registers at these three health facilities, for all TB cases on treatment from 1st January to 31st December, 2015. We calculated proportions of treatment outcomes and analysed associations between unfavourable outcome and factors such as age, HIV status, health facility, and patient type, using univariate logistics regression. We used multivariable stepwise logistic regression to control for confounding and reported the adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS: we included a total of 1,724 registered TB patients, from one urban clinic 694 (40%), a 1st Level Hospital 654 (38%), and one peri-urban-clinic 276 (22%). Of the total patients, 43% had unfavourable outcomes. Of the total unfavourable outcomes, were recorded as treatment-failure (0.3%), lost-to-follow-up (5%), death (9%) and not evaluated (29%). The odds of unfavourable outcome were higher among patients > 59 years (AOR=2.9, 95%CI: 1.44-5.79), relapses (AOR=1.65, 95%CI: 1.15-2.38), patients who sought treatment at the urban clinic (AOR=1.76, 95%CI:1.27-2.42) and TB/HIV co-infected patients (AOR=1.56, 95%CI:1.11-2.19). CONCLUSION: unfavourable TB treatment outcomes were high in the selected facilities. We recommend special attention to TB patients who are > 59 years old, TB relapses and TB / HIV co-infected. The national TB programme should strengthen close monitoring of health facilities in increasing efforts aimed at evaluating all the outcomes. Studies are required to identify and test interventions aimed at improving treatment outcomes.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Marzouk Sameh, Ben Salah Raida, Cherif Yosra, Jallouli Moez, Garbaa Saida, Kammoun Khawla, Hachicha Jamil, Bahloul Zouhir [Case report] - Amylose r&eacute;nale compliquant une maladie de Still de l’adulte: &agrave; propos de 3 cas - 08 April 2019. http://www.panafrican-med-journal.com/content/article/32/158/abstract/ <b>L’amylose r&eacute;nale est une complication rare au cours de la maladie de Still de l’adulte. Nous rapportons 3 observations d’amylose r&eacute;nale parmi une s&eacute;rie de 33 cas de maladie de Still de l’adulte. Il s’agit de 3 patientes d’&acirc;ge moyen de 43 ans (extr&ecirc;me: 33 et 58 ans). Le diagnostic de maladie de Still a &eacute;t&eacute; retenu devant une polyarthrite f&eacute;brile (3 cas) associ&eacute;e &agrave; une &eacute;ruption cutan&eacute;e fugace (1 cas), un syndrome inflammatoire biologique en l’absence de toute cause infectieuse, inflammatoire ou n&eacute;oplasique. Toutes ont &eacute;t&eacute; trait&eacute;es par une corticoth&eacute;rapie associ&eacute;e secondairement au m&eacute;thotrexate devant une polyarthrite destructrice (2 cas) et devant une r&eacute;cidive (1 cas). Une amylose r&eacute;nale &eacute;tait survenue 4,9 ans apr&egrave;s la maladie de Still (extr&ecirc;me: 33 mois et 7ans). L’amylose &eacute;tait r&eacute;v&eacute;l&eacute;e par un syndrome n&eacute;phrotique (3 cas), associ&eacute; &agrave; une insuffisance r&eacute;nale (1 cas). Le diagnostic a &eacute;t&eacute; pos&eacute; par une ponction biopsie r&eacute;nale (3 cas) concluant &agrave; une amylose AA (2 cas) et non typ&eacute;e (1 cas). Tous les malades ont re&ccedil;u la colchicine. L’&eacute;volution &eacute;tait favorable chez une patiente alors que les deux autres ont &eacute;volu&eacute; vers l’insuffisance r&eacute;nale chronique. L’amylose r&eacute;nale est une atteinte inhabituelle de la maladie de Still de l’adulte. Une fois install&eacute;e, elle peut engager le pronostic vital.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Mohammed Bachrif, Houssam Laachach, Ilham Benahmed, Mehdi Berrajaa, Alaa Fliti, Mustapha Aziouaz, Nabila Ismaili, Noha Elouafi [Case report] - Endocardite infectieuse mitro-aortique compliqu&eacute;e de perforation valvulaire, d’an&eacute;vrisme mycotique et d’infarctus spleno-r&eacute;nal - 08 April 2019. http://www.panafrican-med-journal.com/content/article/32/157/abstract/ <b>L'endocardite infectieuse est consid&eacute;r&eacute;e comme une pathologie potentiellement grave malgr&eacute; tous les progr&egrave;s en diagnostic et traitement. Les valves du cœur gauche sont plus touch&eacute;es et les &eacute;v&egrave;nements emboliques, les an&eacute;vrismes mycotiques, les abc&egrave;s ainsi que les perforations des valves en sont des complications redoutables. Nous rapportons le cas d'une endocardite ayant atteint les valves aortique et mitrale et qui s'est compliqu&eacute;e d'infarctus spl&eacute;nique et r&eacute;nale, d'an&eacute;vrisme mycotique c&eacute;r&eacute;bral et d'une perforation de la grande valve mitrale. L'int&eacute;r&ecirc;t du cas est soulign&eacute; suite &agrave; la bonne &eacute;volution au d&eacute;cours d'un traitement m&eacute;dico-chirurgical en d&eacute;pit de la multitude des complications.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Fahed Hlilan Albangy, Amal Elwan Mohamed, Sabry Mohamed Hammad [Research] - Prevalence of smoking among male secondary school students in Arar City, Saudi Arabia - 08 April 2019. http://www.panafrican-med-journal.com/content/article/32/156/abstract/ <b>INTRODUCTION: Tobacco is one of the leading preventable cause of death worldwide. Tobacco consumption among teenagers is a major public health problem, especially in developing countries. Younger smokers are more liable to smoking complications. The objectives were to evaluate the prevalence of smoking among male secondary school students in the Northern Borders region, KSA. METHODS: a cross-sectional study was conducted in Arar city. Four schools were chosen randomly from 21 secondary schools. A total of 240 students responded to the pre-designed questionnaire. The questionnaire included questions on demographic factors, smoking behavior and knowledge about smoking hazards. RESULTS: prevalence of current smoking among male secondary school students is 40.8%. Cigarette smoking was the most common type (67.3%) followed by Shish smoking(22.4%). Few students (2.1%) reported other forms of smoking, example (Hashish). Of the studied group, 39.8% smoke on a daily basis with 29.6% of them smoke more than five cigarettes per day. CONCLUSION: smoking is a prevalent habit among teenagers. Special concern should be directed to smoking cessation campaigns with behavioral, legal and economic interventions.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Arun Prasad, Amit Kumar Sinha, Bindey Kumar, Abhiranjan Prasad, Manju Kumari [Research] - Individualized dosing of oral propranolol for treatment of infantile hemangioma: a prospective study - 08 April 2019. http://www.panafrican-med-journal.com/content/article/32/155/abstract/ <b>INTRODUCTION: Infantile hemangioma is the most common benign tumor in infancy. Currently, oral propranolol is the treatment of choice for infantile hemangioma, but there is no consensus when it comes to its recommended dosage for this condition. Hence this study was conducted this study to find out the appropriate dosage of oral propranolol for treatment of infantile hemangioma. METHODS: A prospective study was conducted on 25 patients with infantile hemangioma, who were treated with gradually increasing dose of propranolol starting from a lower dose of 1mg/kg/day. RESULTS: 17/22(76%) patients showed regression of the tumor at the dose of 1-1.5 mg/kg/d. 5/22(24%) patients were unresponsive on lower dose and they did not respond even with the gradually escalated dose of 3-4 mg/kg/day. CONCLUSION: Propranolol in a lower dose of 1-1.5 mg/kg/day is safe and efficacious in the treatment of infantile hemangioma and the lesions which do not show initial response to the lower dose are unlikely to respond to the higher dose of 3-4 mg/kg/day.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ceyhun Aksakal, Mehmet &#350;ahin [Research] - Evaluation of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in recurrent epistaxis in childhood: case controlled study - 02 April 2019. http://www.panafrican-med-journal.com/content/article/32/154/abstract/ <b>INTRODUCTION: The aim of this study was to investigate the possible relationship of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) and routine hematological parameters with recurrent epistaxis in children. METHODS: In this retrospective case-controlled study, 294 patients aged between 2 and 18 years who applied to the … … … Ear Nose Throat Clinic due to recurrent epistaxis between January 1st 2013 and December 31st 2017 and 329 sex-and age-matched controls were investigated.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Khalid Mansour Alkhathlan, Mohammad Ghormallah Alzahrani, Khalid Hadi Aldosari, Mohammed Ibrahim Alsheddi, Abdullah abdulrahman Alqeair [Research] - Traumatic spinal injuries in the Kingdom of Saudi Arabia: a study of associated injuries, management and mortality - 01 April 2019. http://www.panafrican-med-journal.com/content/article/32/153/abstract/ <b>INTRODUCTION: Traumatic spinal fracture is a painful and disabling injury associated with poor long-term functional outcome. The objective of the present study was to assess the frequency of spinal fractures in road traffic accident (RTA) victims, their management, mortality rate and associated injuries. This study reveals and adds useful insights to the literature from Kingdom of Saudi Arabia (KSA) in terms of incidence of RTA-related spinal fractures, including their management and mortality rate.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Matthew Ho, Patricia Livingston, Dylan Bould, Jean Damascene Nyandwi, Francoise Nizeyimana, Jean Bonaventure Uwineza, Robin Urquhart [Research] - Barriers and facilitators to implementing a regional anesthesia service in a low-income country: a qualitative study - 01 April 2019. http://www.panafrican-med-journal.com/content/article/32/152/abstract/ <b>INTRODUCTION: Regional anesthesia is a safe alternative to general anesthesia. Despite benefits for perioperative morbidity and mortality, this technique is underutilized in low-resource settings. In response to an identified need, a regional anesthesia service was established at the University Teaching Hospital of Kigali (CHUK), Rwanda. This qualitative study investigates the factors influencing implementation of this service in a low-resource tertiary-level teaching hospital. METHODS: Following service establishment, we recruited 18 local staff at CHUK for in-depth interviews informed by the “Consolidated Framework for Implementation Research” (CFIR). Data were coded using an inductive approach to discover emergent themes. RESULTS: Four themes emerged during data analysis. Patient experience and outcomes: Where equipment failure is frequent and medications unavailable, regional anesthesia offered clear advantages including avoidance of airway intervention, improved analgesia and recovery, and cost-effective care. Professional satisfaction: Morale among healthcare providers suffers when outcomes are poor. Participants were motivated to learn techniques that they believe improve patient care. Human and material shortages: Clinical services are challenged by high workload and human resource shortages. Advocacy is required to solve procurement issues for regional anesthesia equipment. Local engagement for sustainability: Participants emphasized the need for a locally run, sustainable service. This requires broad engagement through education of staff and long-term strategic planning to expand regional anesthesia in Rwanda. CONCLUSION: While the establishment of regional anesthesia in Rwanda is challenged by human and resource shortages, collaboration with local stakeholders in an academic institution is pivotal to sustainability.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Abdelouahid Taleuan, Dounia Kamal, Lotfi Aouinti, Moahamed Nourdine Elalami [Case report] - Ankylose de l'articulation temporo-mandibulaire post-arthrosique - 28 March 2019. http://www.panafrican-med-journal.com/content/article/32/151/abstract/ <b>L'ankylose de l'articulation temporo-mandibulaire (ATM) est d&eacute;finie comme une constriction permanente des m&acirc;choires avec ouverture buccale inf&eacute;rieure &agrave; 30 mm mesur&eacute;e entre les incisives, survenant en raison d'une fusion osseuse, fibreuse ou fibro-osseuse. L'arthrose est une cause rare de l'ankylose de L'ATM. Nous rapportons un cas d'ankylose de l'ATM d'origine arthrosique, afin de pr&eacute;ciser les particularit&eacute;s diagnostiques et th&eacute;rapeutiques de cette entit&eacute; pathologique assez rare.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Obafemi Joseph Babalola, Ismaila Nda Ibrahim, Ibrahim Usman Kusfa, Saheed Gidado, Patrick Nguku, Adebola Olayinka, Aisha Abubakar [Research] - Measles outbreak investigation in an urban slum of Kaduna Metropolis, Kaduna State, Nigeria, March 2015 - 28 March 2019. http://www.panafrican-med-journal.com/content/article/32/150/abstract/ <b>INTRODUCTION: Despite availability of an effective vaccine, the measles epidemic continue to occur in Nigeria. In February 2015, we investigated a suspected measles outbreak in an urban slum in Rigasa, Kaduna State, Nigeria. The study was to confirm the outbreak, determine the risk factors and implement appropriate control measures. METHODS: we identified cases through active search and health record review. We conducted an unmatched case-control (1:1) study involving 75 under-5 cases who were randomly sampled, and 75 neighborhood controls. We interviewed caregivers of these children using structured questionnaire to collect information on sociodemographic characteristics and vaccination status of children. We collected 15 blood samples for measles IgM using Enzyme Linked Immunosorbent Assay. Descriptive, bivariate and logistic regression analyses were performed using Epi-info software. Confidence interval was set at 95%. RESULTS: we recorded 159 cases with two deaths {case fatality rate = 1.3%}. 50.3% (80) of the cases were male. Of the 15 serum samples, 11(73.3%) were confirmed IgM positive for measles. Compared to the controls, the cases were more likely to have had no or incomplete routine immunization (RI) [adjusted odds ratio (AOR) (95% confidence interval (CI)]: 28.3 (2.1, 392.0), contact with measles cases [AOR (95% CI)]: 7.5 (2.9, 19.7), and having a caregiver younger than 20 years [AOR (95% CI)]: 5.2 (1.2, 22.5). Measles serum IgM was positive in 11 samples. CONCLUSION: we identified low RI uptake and contact with measles cases as predictors of measles outbreak in Rigasa, Kaduna State. We recommended strengthening of RI and education of care-givers' on completing RI schedule.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Soufiane Aharram, Yahyaoui Mounir, Abdelhafid Derfoufi, Abdessamad Kharraji, Jawad Amghar, Mohammed benhamou, Lamhaoui Abdessamad, Bouziane Walid, Sadougui Mohammed, Omar Agoumi, Abdelkarim Daoudi [Case report] - Rupture du tendon rotulien avec fracture ferm&eacute;e distale du f&eacute;mur homolat&eacute;ral - 26 March 2019. http://www.panafrican-med-journal.com/content/article/32/149/abstract/ <b>Un patient de 45 ans a subi un traumatisme du genou droit &agrave; la suite d'un accident de la voie publique occasionnant chez lui une fracture distale supra condylienne comminutive du f&eacute;mur droit et une rupture du tendon rotulien ipsilat&eacute;rale. Cette association est exceptionnelle et aucun cas n'a &eacute;t&eacute; retrouv&eacute; dans la litt&eacute;rature. Un diagnostic pr&eacute;cis clinique et radiologique suivi d'une prise en charge pr&eacute;coce et adapt&eacute;e par une ost&eacute;osynth&egrave;se interne et une r&eacute;&eacute;ducation fonctionnelle pr&eacute;coce et adapt&eacute;e ont permis d'obtenir de bons r&eacute;sultats &agrave; long terme.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Daniel David Osiagwu, Alfred Ederialo Azenabor, Abimbola Akinduro Osijirin, Philomina Ikuoyah Awopetu, Folasade Ruth Oyegbami [Research] - Evaluation of interleukin 8 and interleukin 10 cytokines in liquid based cervical cytology samples - 26 March 2019. http://www.panafrican-med-journal.com/content/article/32/148/abstract/ <b>INTRODUCTION: Inflammatory cytokines have been associated with various cancers, including cervical cancers. Interpreting cytokine expression in liquid based cervical samples is quite challenging. This study is aimed at evaluating the levels of interleukin 8 and 10 in liquid based cervical samples. METHODS: This is a descriptive analytical study carried out on eighty five (85) subjects aged between 23 and 68 years. Cervical samples were collected in liquid based medium and smears later examined after staining with Papanicolaou technique. These were categorized into low grade intra–epithelial lesion/malignancy, high grade intraepithelial lesion/malignancy according to the degree of dyskaryosis. Concentrations of interleukin 8 and interleukin 10 in the samples were determined by enzyme linked immunosorbent assay.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Badii Hmida, Walid Mnari, Mezri Maatouk, Ahmed Zrig, Mondher Golli [Case report] - Orbital varix: rare cause of blepharospasm - 26 March 2019. http://www.panafrican-med-journal.com/content/article/32/147/abstract/ <b>Orbital varix (or varicose) is an exceptional pathology with poor clinical sign. The blepharospasm can be a revealing cause. The long-term risk is optic atrophy and blindness. Magnetic resonance imaging is the best diagnostic tools. The rise of lesion dimensions by Valsalva maneuvers and prone position is characteristic. We report the observation of a 42-year-old young man, consulting for a blepharospasm of the left eye evolving for two years. Imaging investigations made the diagnosis of orbital varicose.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Mbuwir Charlotte Bongfen, Essimien Elizabeth Bessem Abanem [Research] - Abortion practices among women in Bu&eacute;a: a socio-legal investigation - 26 March 2019. http://www.panafrican-med-journal.com/content/article/32/146/abstract/ <b>INTRODUCTION: There are controversies surrounding the practice of abortion especially in developing countries of Africa. Cameroon is not an exception to this and hence this study aims at assessing knowledge on the awareness of abortion laws, the factors that determine abortion and people’s perceptions on the legality of abortion in Cameroon. METHODS: The study is cross-sectional in its design. A total of 224 women were randomly sampled. Data for the study were collected through the use of questionnaires from the sampled women of child bearing age. These were used to assess knowledge on the awareness of abortion laws and the determinants of abortion. The data were analysed using STATA 15. RESULTS: The prevalence of induced abortion was 21%. The major determinants of abortion among these women were; desire to stay in school (28%), fear of parents (24%) and shame of being pregnant out of wedlock (26%). Furthermore, many women are not aware of the situations where abortion is allowed and hence some still undertake illegal abortions even when they find themselves in situations deserving a legal abortion. CONCLUSION: Induced abortion is still common in Buea, Cameroon despite the fact that it is illegal. Cameroon’s legal and health system needs to work in harmony in order to lessen the legal processes of having a legal abortion.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hezekiah Kehinde Adesokan, Fiyinfoluwa Adedolapo Adeoye [Research] - Porcine cysticercosis in slaughtered pigs and factors related to Taenia solium transmission amongst abattoir workers in Ibadan, Nigeria - 26 March 2019. http://www.panafrican-med-journal.com/content/article/32/145/abstract/ <b>INTRODUCTION: Porcine cysticercosis is under-reported particularly in Nigeria, despite the reportedly high prevalence of epilepsy and associated life-threatening health implications. This study was aimed at determining the prevalence of porcine cysticercosis and factors related to taenia solium transmission to humans. METHODS: slaughtered pigs at a major abattoir, south-western Nigeria were randomly inspected and questionnaire was administered to pig workers/consumers while the data were analysed using Stata 12.0. RESULTS: a 4.4% (11/250) prevalence of porcine cysticercosis was obtained; the age, breed, sex and body conditions of pigs were not significant for infection (p < 0.05). Further, none (0.0%) of the respondents knew that T. solium could cause epilepsy in man and 39.5% often defaecated on neighbouring open fields and farmlands. Respondents purchasing pork from home slaughter were about four and ten times less likely to demonstrate good knowledge (OR = 0.24; 95% CI: 0.08-0.74) and practice (OR = 0.10; 95% CI: 0.05-0.22) than those purchasing from abattoir. Moreover, those lacking toilet facility were about four and five times less likely to demonstrate good knowledge (OR = 0.24; 95% CI: 0.07-0.86) and practice (OR = 0.19; 95% CI: 0.08-0.45) than those who had it. Other factors associated with practices related to T. solium transmission included age (p = 0.000), sex (p = 0.000) and duration (p = 0.003). CONCLUSION: the increased odds of poor knowledge and practices related to Taenia solium transmission especially among respondents purchasing home slaughter pork and lacking toilet facility provides insights into the parasite epidemiology. Above findings are important in lowering the infection prevalence in pigs and humans in this endemic area.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Walid Mnari, Badii Hmida, Mezri Maatouk, Ahmed Zrig, Mondher Golli [Case report] - Strangulated obturator hernia: a case report with literature review - 26 March 2019. http://www.panafrican-med-journal.com/content/article/32/144/abstract/ <b>Obturator hernia is rare. It occurs when part of the pelvic contents protrude through the obturator foramen. It is a diagnostic challenge in the emergency department since the signs and symptoms are non-specific. It often occurs in elderly, emaciated and chronically ill women. The clinical picture include intestinal obstruction with abdominal pain, nausea and vomiting. The treatment is only surgical. Delayed diagnosis of this condition usually leads to a high mortality rate. We report the case of an 83-year-old woman with a strangulated obturator hernia. The hernia was discovered early by computed tomography and was treated by emergency laparotomy. We emphasize on the rule of CT scan to establishing a prompt preoperative diagnosis of an obturator hernia, appropriate planning of surgical intervention and thus optimizing the outcome.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hafsa Chahdi, Amal Damiri, Mohamed Reda El Ochi, Mohamed Allaoui, Abderrahmane Al Bouzidi, Mohamed Oukabli [Case report] - Chondrosarcome n&eacute; sur un ost&eacute;ochondrome solitaire: &agrave; propos d’un cas - 26 March 2019. http://www.panafrican-med-journal.com/content/article/32/143/abstract/ <b>Le chondrosarcome est une tumeur osseuse maligne rare. Elle peut &ecirc;tre primitive ou secondaire &agrave; une transformation maligne d'une tumeur cartilagineuse b&eacute;nigne sous-jacente. Le chondrosarcome secondaire d&eacute;coulant d'un ost&eacute;ochondrome solitaire b&eacute;nin est extr&ecirc;mement rare et les donn&eacute;es montrent que l'incidence rapport&eacute;e de l'ost&eacute;ochondrome du bassin est tr&egrave;s faible. Nous rapportons le cas d'un patient &acirc;g&eacute; de 20 ans pr&eacute;sentant un chondrosarcome secondaire &agrave; la transformation maligne d'un ost&eacute;ochondrome de l'aile sacro-iliaque droite.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Maurice Omondi Owiny, Mark Odhiambo Obonyo, Peter Maina Gatongi, Eric Maurice F&egrave;vre [Research] - Prevalence and spatial distribution of trematode cercariae in vector snails within different agro-ecological zones in Western Kenya, 2016 - 26 March 2019. http://www.panafrican-med-journal.com/content/article/32/142/abstract/ <b>INTRODUCTION: Freshwater vector snails' distribution, infection with cercariae, preferred habitat and possible trematodiases transmission foci is not well known in Western Kenya. We sought to determine the distribution and prevalence of infection of snails per agro-ecological zone and environmental factors in vector snail habitats. METHODS: we conducted a cross-sectional survey in March-May 2016, harvested and identified snails using shell morphology, determined their infection with trematode cercariae using microscopy, used descriptive statistics to estimate the prevalence of infection and relationship between snail abundance and environmental factors. RESULTS: we sampled a total of 1,678 vector snails from 47 sampling sites of which 42% were Lymnaeid, 23% Biomphalaria, 10% Bulinus, 22% Oncomelaniae and 2% Melanoides. Lower Midland I Ago-Ecological Zones had 44% of the snails and streams from springs had 41% of the snails. Overall, 26.5% (445/1678) (95% CI: 24.4-28.6) of the snails shed cercariae. Cercariae were found in 11 (23%) of the sites and in all zones. F. gigantica cercariae were shed by L. natalensis, B. pfeifferi, B. sudanica. Lakeshore had both F. gigantica and S. mansoni cercariae shed by B. sudanica. A total of 72% (1,202/1,678) of snails were found in water with a pH 6.5-7.5. Grass habitat had 54% (912/1,678) of the snails. CONCLUSION: lymnaeid snails were present in all the zones, while streams from springs and near neutral habitats had most of the snails. Infection with trematode cercariae was noted in all the zones. Trematodiases control should be focused on all zones especially in freshwater streams and lakeshores.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Akinsegun Abduljaleel Akinbami, Ebele Ifeyinwa Uche, Aisha Maude Suleiman, Ann Abiola Ogbena, Festus Olusola Olowoselu, Benjamin Augustine, Mulikat Adesola Badiru, Rafat Abiodun Bamiro, Omolara Risqat Kamson [Research] - On artherogenic index of plasma in sickle cell anaemia patients - 25 March 2019. http://www.panafrican-med-journal.com/content/article/32/141/abstract/ <b>INTRODUCTION: Sickle cell anaemia (SCA) is an inherited abnormality of haemoglobin associated with reduced life expectancy. Patients' complications include dyslipideamia. This study was aimed at determining the artherogenic index of plasma (AIP) in sickle cell anaemia patients and compares the value to HbAA controls value. A high AIP is strongly predictive of elevated cardiovascular risk. METHODS: A comparative study was conducted among SCA patients attending the haematology clinic, Lagos State University Teaching Hospital (LASUTH) and HbAA Phenotype controls. A total of 304 participants were recruited consisting of equal numbers of SCA and HbAA controls. Single lipid profiles were done; logarithms of triglycerides/high density lipoprotein were calculated to obtain AIP and lipid profile ratios established for all participants.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Gora L&ocirc;, Amina Sow-Sall, Halimatou Diop-Ndiaye, Ndiaye Babacar, Niokhar Ndane Diouf, Sokhna Moumi Daff&eacute;, Babacar Ndao, Moussa Thiam, Moustapha Mbow, Mamadou Bayo Soumboundou, Maud Lemoine, Maguette Sylla-Niang, Ousseynou Ndiaye, Cheikh Saad Boye, Souleymane Mboup, Ndeye Coumba Tour&eacute;-Kane [Research] - Hepatitis B virus (HBV) infection amongst children in Senegal: current prevalence and seroprotection level - 25 March 2019. http://www.panafrican-med-journal.com/content/article/32/140/abstract/ <b>INTRODUCTION: Hepatitis B virus (HBV) infection is highly endemic in Senegal. HBV vaccine of all children has been introduced in 1999 and included in the Expanded Programme on Immunization in 2004. The aim of this study was to assess the HBV prevalence and immunity status against HBV amongst children in Senegal. METHODS: between March and August 2016, consecutive children aged from 6 months to 16 years old were recruited in outpatient department of three main children hospitals in Senegal. Serum samples were analyzed for HBV serology (HBsAg, HBcAb, HBsAb) using ARCHITECT analyzer. Children with HBsAb levels &#8805; 10 IU/l) were considered as seroprotected against HBV. RESULTS: during the study period, 295 children fulfilled the criteria for the study and were further analyzed. Three children were HBsAg positive giving a seroprevalence at 1.1% (95% CI: 0.2-3.3), 12/267 (4.5%, 95% CI=2.3-7.7) had positive HBcAb and 226/295 (76.6%, 71.4-81.3) had positive HBsAb including 191 (77.3%, 71.6-82.4) with isolated HBsAb related to previous active immunization. However only 165 children (56%, CI 50-62) had seroprotective HBsAb levels (HBsAb e" 10 UI/L) and 63 (21.4, 16.8-26) had a strong seroprotectiondefined by HBsAb e" 100 IU/L. CONCLUSION: our results suggest that although HBV prevalence has significantly decreased in children in Senegal following a better HBV vaccine coverage, the number of children correctly seroprotected is insufficient (56%). Assessing the levels of HBsAb and providing HBV vaccine boosters should be considered in children in Senegal.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Aymar Pierre Gildas Oko, Patricia Ir&egrave;ne Ondima, Marl&egrave;ne Kibangou Lenvo, Letitia Lombet, Judica&euml;l Kambourou, Nelly Pandzou Guembo, Mamadou Ildevert Cyriaque Ndjobo, Aurore Mbika Cardorelle [Case report] - Perforation gastrique spontan&eacute;e compliquant une bronchiolite aigu&euml; chez un nourrisson - 25 March 2019. http://www.panafrican-med-journal.com/content/article/32/139/abstract/ <b>La perforation gastrique spontan&eacute;e est une affection rare chez le nourrisson et les m&eacute;canismes de survenue demeurent mal compris. Nous rapportons le premier cas congolais. Il s'est agi d'un nourrisson de sexe f&eacute;minin, &acirc;g&eacute;e de 5 mois qui au 4&egrave;me jour d'hospitalisation pour une bronchiolite aigu&euml; s&eacute;v&egrave;re associ&eacute;e &agrave; une diarrh&eacute;e compliqu&eacute;e de d&eacute;shydratation aigu&euml; mod&eacute;r&eacute;e, a pr&eacute;sent&eacute; de fa&ccedil;on brutale une distension importante et douloureuse de l'abdomen associ&eacute;e &agrave; des signes de choc. La radiographie de l'abdomen sans pr&eacute;paration montrait un pneumop&eacute;ritoine massif. La laparotomie avait permis de mettre en &eacute;vidence une perforation arrondie sur la paroi post&eacute;rieure de l'estomac qui a &eacute;t&eacute; sutur&eacute;e. Les suites op&eacute;ratoires &eacute;taient marqu&eacute;es par la survenue d'un choc septique et le d&eacute;c&egrave;s du nourrisson.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Abdelmajid Bouzerda, Zouhair Lakhal, Laila Bendriss, Ali Khatouri [Case report] - Acute coronary syndrome with non ST segment elevation myocardial infarction revealing anomalous connection of the left anterior descending artery - 25 March 2019. http://www.panafrican-med-journal.com/content/article/32/138/abstract/ <b>The occurrence of an acute coronary syndrome (ACS) with an anomalous connection of coronary artery (ANOCOR) identified as a culprit artery is very rare. This association may lead in some anatomical forms to a delay in coronary reperfusion. We report the clinical case of a patient admitted for high-risk Non ST elevation myocardial infarction (NSTEMI) in whom coronary angiography accidentally discovers an anomalous connection of the left coronary network from the right anterior. In light of this case and a review of literature, we discuss the peculiarities of these anomalous connections.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Sqalli Houssaini Asmaa, Badreddine Hassam [Images in medicine] - Kaposi of the penis: about a case - 22 March 2019. http://www.panafrican-med-journal.com/content/article/32/137/abstract/ <b>Kaposi sarcoma (KS) is a multicentric angioproliferative disorder of endothelial origin. It predominantly affects mucocutaneous sites but may also affect visceral organs. We are reporting a case of KS with unusual presentation. A 45-year-old male presented violaceous macules on the glans which appeared 3 weeks ago. Otherwise he reported fever and loss weight. Histological examination detected the presence of spindle cells and the positivity for Kaposi-associated Herpes virus-8 confirmed the lesions as Kaposi's sarcoma. Visceral sarcoma lesions were also present in the oesophagus and gastric fundus. HIV viral serology was positive. Treatment with antiretroviral therapy and bleomycine was initiated. Sarcomas of the penis are very uncommon, representing less than 5% of malignant tumors in this area. KS is the most common sarcoma of the penis and the second most common is leiomyosarcoma. Primary presentation of KS on the penis is not common but more often observed in patients with AIDs, whose lesions are the aggressive form, and only approximately 2-3% cases have shown penile KS lesions as first manifestation of disease as our patient. This case is important as it illustrates that disseminated KS was not to be predicted by the number or the external lesions.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Gaurav Dhansukhlal Gheewala, Ifeoma Oriaku [Images in medicine] - Massive splenic calcification in amyloidosis with normal labs and physical exam - 22 March 2019. http://www.panafrican-med-journal.com/content/article/32/136/abstract/ <b>A 64-years-old male with medical history of hypertension, type II diabetes, coronary artery disease, and AL amyloidosis involving the heart, kidney and liver was admitted for decompensated heart failure, requiring Intra-Aortic Balloon Pump (IABP) and inotropic support. The patient was listed for heart transplant, but later developed cardiac arrest and required Veno-Arterial Extracorporeal Membrane Oxygenation (VAECMO) treatment. Abdominal X-ray was obtained to confirm the position of feeding tube which showed massive intra-peritoneal calcification (A). CT abdomen was obtained, and he was found to have extensive splenic calcification measures 8.9 x 7.1cm in cross-section and it spans 8.9 cm in craniocaudal direction (B). Spleen was impalpable on physical exam. Before the cardiac arrest, patient's renal function was at baseline, with the remaining of the basic metabolic panel normal. Hepatic function panel was significant for mild elevation in alkaline phosphatase and alanine aminotransaminases. All other laboratory work including coagulation and iron studies were normal. Nonetheless, patient's condition deteriorated over the course and he expired. Amyloid fibrils have an affinity to calcium and can result in calcific deposition in organs. Literature review showed that in amyloidosis, splenic calcification occurs in conjunction with other organs calcification especially liver. Thus this patient's case highlights the unique presentation of isolated massive splenic calcification without any other organ calcification with relatively normal laboratory and physical examination except findings consistent with his heart failure diagnosis.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Moses Barasa, Abdulkarim Abdallah [Case series] - Cyto-histologic discordancy in patients undergoing thyroidectomy at Aga Khan University Hospital - 21 March 2019. http://www.panafrican-med-journal.com/content/article/32/135/abstract/ <b>Fine needle aspiration cytology (FNAC) findings are the basis upon which decision and type surgery is made. Therefore the diagnostic accuracy and utility of FNAC being such an integral tool in management of thyroid lesions must be evaluated for cyto-histologic discrepancy from time to time as a quality assurance measure. The objective was to compare thyroid fine-needle aspiration cytology (FNAC) with final histopathological findings at in patients undergoing thyroidectomy. This was a cross-sectional retrospective study at Aga Khan university hospital, Nairobi. Cyto-histologic discrepancy was found in 19(25%) of cases with false positive and negative rates at 9% and 16%. False positive results constituted 7(9%) while 12(16%) were false negative findings. The higher cyto-histological discordancy than seen previous studies could be due to sampling error and cytological mis-interpretation. Our study found higher than expected cyto-histologic discrepancy.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Bousayna Iraqi, Badr Sououd Benjelloun Dakhamaa [Images in medicine] - Eryth&egrave;me margin&eacute; de Besnier: manifestation rare au cours du rhumatisme articulaire aigu - 20 March 2019. http://www.panafrican-med-journal.com/content/article/32/134/abstract/ <b>Il s'agissait d'une fillette &acirc;g&eacute;e de 3 ans accusant depuis un an, une &eacute;ruption cutan&eacute;e se manifestant par des plaques disco&iuml;des faites de macules ros&eacute;es, non prurigineuses arrondies et ovalaires, de 1 &agrave; 3 cm de diam&egrave;tre, polycycliques, confluentes et &agrave; centre clair &eacute;voluant par pouss&eacute;e, avec r&eacute;gression et r&eacute;apparition. L'enfant a &eacute;t&eacute; admise aux urgences dans un tableau de d&eacute;tresse respiratoire et de fi&egrave;vre avec aggravation des l&eacute;sions cutan&eacute;es pr&eacute;existantes devenant diffuses. L'auscultation cardiaque trouvait un souffle holo-systolique mitral d'une intensit&eacute; de 4/6. L'&eacute;chographie cardiaque objectivait une insuffisance mitrale aigue massive avec des v&eacute;g&eacute;tations valvulaires. Sur le plan biologique, on notait la pr&eacute;sence d'un syndrome inflammatoire biologique avec une CRP &agrave; 300mg/l et une vitesse de s&eacute;dimentation &agrave; 60 mm &agrave; la premi&egrave;re heure et les ASLO &eacute;taient tr&egrave;s &eacute;lev&eacute;s (1600 UI/ml). Le diagnostic d'endocardite infectieuse sur valvulopathie rhumatismale &eacute;tait retenu. Apr&egrave;s mise en condition, instauration d'une antibioth&eacute;rapie et d'une cure chirurgicale urgente pour plastie mitrale, il a &eacute;t&eacute; not&eacute; une r&eacute;gression des l&eacute;sions dermatologiques en quelques jours mais l'&eacute;tat h&eacute;modynamique de l'enfant s'&eacute;tait d&eacute;grad&eacute; rapidement avec un d&eacute;c&egrave;s brutal. L'&eacute;ryth&egrave;me de Besnier est une manifestation cutan&eacute;e rare du rhumatisme articulaire aigu. Les m&eacute;decins devraient faire attention &agrave; ne pas n&eacute;gliger ce signe clinique rare mais utile, en particulier chez les patients pr&eacute;sentant une atteinte valvulaire subclinique pour &eacute;viter les complications cardiaques tardives potentielles. Les trois diagnostics diff&eacute;rentiels &eacute;taient l'herp&egrave;s circin&eacute;, l'urticaire et l'&eacute;ryth&egrave;me de l'angioed&egrave;me h&eacute;r&eacute;ditaire.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Dougaz Mohamed Wejih, Gouta Esma Leila, Chaouch Mohamed Ali, Nouira Ramzi, Bouasker Ibtissem, Dziri Chadli [Case report] - Rectal stromal tumor with an exceptional liver and bone metastatic locations - 20 March 2019. http://www.panafrican-med-journal.com/content/article/32/133/abstract/ <b>Gastrointestinal stromal tumours (GIST) are rare mesenchymal tumours which represent 1% to 3% of gastrointestinal neoplasm. Rectal location of GIST is extremely rare reaching 5% of GIST and only 0.1% of rectal tumours. They usually metastases to the liver (65%) and exceptionally to the bone (3%). We reported a case of rectal stromal tumour with an exceptional metastasis located in the rib. A 40-year-old man who presented with pelvic pain, associated with rectal syndrome, rectal bleeding and subocclusive episodes. Physical examination objectified a tough, budding rectal mass, with a smooth wall, localized 3cm above of anal margin. A Thoraco-abdominal computed tomography showed a large heterogeneous tissue mass, taking the whole pelvis, coming from the right-side wall of the rectum of 17.3 x 14cm. It was associated with liver and bone secondary locations. Biopsies confirmed the secondary locations of an intermediate risk GIST. Immunohistochemical study showed an overexpression of c-kit protein (CD117) and Dog1. Imatinib was prescribed to reduce the tumour size. Stromal metastatic rectal tumours in bone level are extremely rare conditions. The diagnosis is confirmed by histological examination with immune histochemical analysis. The prognosis remains poor in metastatic forms but it has been improved since the introduction of Imatinib.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Yasmine Chaoui Roqai, Yousra Ajhoun, Nisrine Laaribi, Soukaina Belfaiza, Yassine Mouzari, Fouad El Asri, Karim Reda, Abdelbarre Oubaaz [Case report] - Œd&egrave;me papillaire isol&eacute; r&eacute;v&eacute;lant une sarco&iuml;dose oculaire - 20 March 2019. http://www.panafrican-med-journal.com/content/article/32/132/abstract/ <b>La sarco&iuml;dose est une granulomatose multisyst&eacute;mique d'&eacute;tiologie inconnue, d&eacute;finit par la pr&eacute;sence de granulomes &eacute;pith&eacute;lio&iuml;des et gigantocellulaires, sans n&eacute;crose cas&eacute;euse. La sarco&iuml;dose oculaire se manifeste essentiellement par une uv&eacute;ite ant&eacute;rieure granulomateuse et bilat&eacute;rale. L'atteinte post&eacute;rieure au cours de la sarco&iuml;dose oculaire est rare et se manifeste par des p&eacute;riphl&eacute;bites ou une atteinte choro&iuml;dienne. L'œd&egrave;me papillaire isol&eacute; au cours est un tableau atypique d'o&ugrave; la particularit&eacute; de notre observation L'atteinte post&eacute;rieure est un &eacute;l&eacute;ment de mauvais pronostic mena&ccedil;ant le pronostic visuel, une prise en charge rapide en collaboration avec les pneumologues par corticoth&eacute;rapie syst&eacute;mique permet d'am&eacute;liorer le pronostic visuel et limiter les complications.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Pranitha Reddy Arrabyru, Ihtesham Aatif Qureshi, Lauren Skalomenos, Gustavo Jose Rodriguez [Case report] - Magnetic resonance imaging changes in a 69-year old man with hypoglycemia induced brain injury: case report and literature review - 20 March 2019. http://www.panafrican-med-journal.com/content/article/32/131/abstract/ <b>We present the case of a 69-year old man who was brought to the hospital after being found unconscious; last seen at baseline 9 hours prior. On admission he was found to be severely hypoglycemic and received prompt glucose administration, with no immediate neurological improvement. Stroke was suspected. A brain MRI revealed abnormal hyperintense signal involving the head and tail of the left hippocampus. After close neurological monitoring and supportive care in the ICU, his condition improved over time, leaving no residual focal deficits. This case highlights the presence of MRI changes in patients with severe hypoglycemia as it happens in hypoglycemic coma.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Tope Olubodun, Oluwakemi Ololade Odukoya, Mobolanle Rasheedat Balogun [Research] - Knowledge, attitude and practice of cervical cancer prevention, among women residing in an urban slum in Lagos, South West, Nigeria - 18 March 2019. http://www.panafrican-med-journal.com/content/article/32/130/abstract/ <b>INTRODUCTION: Cervical cancer is the most common genital tract malignancy among women in Nigeria. Cancer of the cervix is preceded by a curable premalignant stage which can be detected by screening. The disease can also be prevented by Human papillomavirus (HPV) immunization. Women living in slums usually have poor reproductive health knowledge and poor health behaviours. Mostly of low socioeconomic status, these women are at higher risk of cervical cancer. This study assessed the knowledge, attitude and preventive practices towards cervical cancer among women living in an urban slum in Lagos, Nigeria. METHODS: this descriptive cross-sectional study was carried out among 305 women of reproductive age in Idi-Araba, Lagos, Nigeria. Multistage sampling method was used to select respondents. Data were collected using interviewer administered questionnaires. Analysis was done with SPSS 20 software. RESULTS: only 39 (12.8%) had heard about cervical cancer. Knowledge of cervical cancer, screening and Human papilloma virus (HPV) immunization was poor. Most respondents (64.3%) did not consider themselves at risk for cervical cancer. However, majority (88.9%) were willing to undergo screening and 93.8% were willing to take HPV immunization or recommend the vaccine to a friend/relative. Only 2(0.7%) had done a cervical cancer screening test and none had taken HPV vaccine or immunized their eligible daughters. CONCLUSION: there is thus need for increased awareness creation and health education programmes on cervical cancer prevention among such population of women.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com JongChul Baek [Case report] - Paratubal borderline serous tumor in a postmenopausal woman: a case report - 18 March 2019. http://www.panafrican-med-journal.com/content/article/32/129/abstract/ <b>Unlike borderline ovarian tumors, paratubal borderline tumors are extremely rare gynecologic tumors. They occur in reproductive-aged females at an earlier stage of disease and have a good prognosis. A 61-year-old woman, gravida 3 para 3, presented with progression of ovarian cyst. Computed tomography revealed a 6-cm simple cystic lesion without enhancing papillary projections. The patient underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Frozen specimens showed that the tumor was benign, thereby confirming a final diagnosis of paratubal borderline serous tumor. The patient refused comprehensive surgical staging and opted for close follow-up. The patient remains asymptomatic with no evidence of recurrence at the 24-month follow-up. To the best of our knowledge, this is the first reported case of paratubal borderline serous tumor in a postmenopausal patient. The findings of this study and those of other case reports can contribute to the understanding, diagnosis, treatment and prognosis of these rare tumors.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Amour Espoir Mokoko-Louckou, Kevin Parfait Bienvenu Bouhelo-Pam, Badarou Chaibou, Ismail Abdouli, Mohammed Shimi, Abdelhalim El Ibrahimi, Abdelmajid El Mrini [Case report] - La patella cubiti d&eacute;couverte &agrave; la suite d’un traumatisme: &agrave; propos d’un cas et revue de la litt&eacute;rature - 18 March 2019. http://www.panafrican-med-journal.com/content/article/32/128/abstract/ <b>La patella cubiti est une anomalie tr&egrave;s rare qui se caract&eacute;rise par la non union de l'ol&eacute;crane au cubitus proximal. Nous rapportons un patient de 27 ans admis pour traumatisme du coude dont le diagnostic r&eacute;v&eacute;lait une patella cubiti faisant confondre avec une fracture de l'ol&eacute;crane. Le patient a b&eacute;n&eacute;fici&eacute; d'une r&eacute;section du fragment osseux. A 3 mois de l'intervention, le patient s'est senti satisfait car le corps &eacute;tranger qu'il ressentait au niveau du coude a disparu.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Salahiddine Saghir, Toufik Meskini, Said Ettair, Naima Erreimi, Nezha Mouane [Case report] - La maladie de Weber-Christian: s'agit-il d'un &eacute;tat pr&eacute;-leuc&eacute;mique? - 18 March 2019. http://www.panafrican-med-journal.com/content/article/32/127/abstract/ <b>La maladie de Weber-Christian ou panniculite idiopathique est une affection rare, caract&eacute;ris&eacute;e par une inflammation du tissu adipeux sous-cutan&eacute;; il s'agit d'une entit&eacute; pathologique non sp&eacute;cifique qui reste toujours un sujet de d&eacute;bat et dont l'&eacute;volution est impr&eacute;visible. Nous rapportons dans cet article le cas d'un nourrisson de sexe f&eacute;minin de 9 mois, admise dans un tableau de sepsis pr&eacute;c&eacute;d&eacute; d'une symptomatologie respiratoire et suivi de l'apparition de nodosit&eacute;s sous cutan&eacute;es &eacute;ryth&eacute;mateuses, de petite taille, dures, sensibles, asym&eacute;triques et situ&eacute;es au niveau des bras et des membres inf&eacute;rieurs, la biopsie cutan&eacute;e a montr&eacute; une hypodermite lobulaire avec infiltration des polynucl&eacute;aires neutrophiles. La maladie de Weber-Christian a &eacute;t&eacute; retenue apr&egrave;s avoir &eacute;limin&eacute; les autres diagnostics diff&eacute;rentiels. Notre patiente a &eacute;t&eacute; trait&eacute;e par la prednisone avec une bonne &eacute;volution initiale. Durant le suivi et au cours de la d&eacute;gression, le diagnostic d'une leuc&eacute;mie aigue lymphoblastique type B a &eacute;t&eacute; pos&eacute;. Cette &eacute;volution atypique &agrave; notre connaissance n'a jamais &eacute;t&eacute; d&eacute;crite dans la litt&eacute;rature. Nous allons discuter &agrave; travers ce cas les diff&eacute;rentes situations similaires o&ugrave; un autre diagnostic a &eacute;t&eacute; fait apr&egrave;s avoir pris en charge les malades comme ayant une panniculite lobulaire idiopathique, en concluant de la n&eacute;cessit&eacute; d'une enqu&ecirc;te &eacute;tiologique exhaustive et d'une surveillance prolong&eacute;e afin de rechercher une &eacute;ventuelle pathologie associ&eacute;e.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ahmed Nugud, Assmaa Nugud [Images in medicine] - TB or not TB! That’s the question - 15 March 2019. http://www.panafrican-med-journal.com/content/article/32/126/abstract/ <b>Twenty seven years old lady presented to the emergency department accompanied by family members with complaint of fluctuating consciousness and fever for the past three days. Upon further questioning the patient has been complaining of headache for two months, decreased appetite for the past month and had a travel history to Ethiopia five months ago. Family members were not sure about any history of weight loss, the patient took a one week course of antibiotics for tooth infection two weeks ago. Physical examination showed an ill looking, vitally stable lady on chest auscultation diffuse crackles heard bilaterally. Septic work up including CSF sample was ordered to rule-out meningitis chest X-ray was also ordered. Chest X-ray result showed a clinical image specious of miliary TB (A) and results were confirmed by a positive acid fast stain of the CSF. Patient was taken to isolation and proper management was started with a final diagnosis of TB meningitis. A follow-up MRI showed few hyper-intense foci in deep white matter of left frontal lobe (B).</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Catia Aguiar Cabral, Ant&oacute;nio Grilo Novais [Images in medicine] - When do you not listen to your doctor - 15 March 2019. http://www.panafrican-med-journal.com/content/article/32/125/abstract/ <b>Gout is a disease caused by an inflammatory response to crystals of sodium monourate, which occurs in people with elevated uric acid levels. There are acute and chronic forms. Acute forms arise as sudden, self-limiting bouts of arthritis (swelling, flushing, pain and heat of a joint), while chronic forms result in the deposition of crystal aggregates in and around the joints, with progressive joint destruction. In addition to joint manifestations, uric gout has renal manifestations (kidney stones and renal insufficiency) and metabolic manifestations (hypertension, elevated triglycerides). Patients are often obese, have high alcohol consumption and insulin resistance. It is a very painful and disabling illness. Gout is more common in men and usually begins in the 40's and 60's. Analytically the patient had uric acid values of 10.2 mg/dL (2.0-7.0 mg/dL) despite being daily medicated with alopurinol 300mg for more than 5 years. It has an abnormality of fasting glycemia and triglycerides of 305 mg/dl. However it maintains consumptions of alcohol and a diet rich in meat, seafood and fats. He did not diet to lose weight and sometimes he does not take the medication (alopurinol). He already shows involvement and destruction of the joints and deformation on the feet and the hand that currently prevent him from fulfilling the necessary safety norms in his profession.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Muatsim Ahmed Mohammed Adam, Hamdan Mustafa Hamdan Ali, Eltahir Awad Gasim Khalil [Research] - Diagnostic predictive values of the Hain genotype MTBDRsl assay in mycobacterial strains isolated from Sudan - 15 March 2019. http://www.panafrican-med-journal.com/content/article/32/124/abstract/ <b>INTRODUCTION: Hain GenoType MTBDRsl is nucleic acid amplification assay based on reverse hybridization with specific oligonucleotide probes on nitrocellulose strips. MTBDRsl identifies M. tuberculosis complex and detects resistance to fluoroquinolone, second line injectable drugs and ethambutol evident as mutations of gyrA, rrs and embB genes respectively. This study aimed to evaluate the diagnostic performance of the Hain GenoType MTBDRsl Assay using 1% proportion method on LJ medium as gold standard.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Fred Nsubuga, Steven Ndugwa Kabwama, Immaculate Ampeire, Henry Luzze, Pande Gerald, Lilian Bulage, Opar Bernard Toliva [Research] - Comparing static and outreach immunization strategies and associated factors in Uganda, Nov-Dec 2016 - 15 March 2019. http://www.panafrican-med-journal.com/content/article/32/123/abstract/ <b>INTRODUCTION: The government of Uganda aims at reducing childhood morbidity through provision of immunization services. We compared the proportion of children 12-33 months reached using either static or outreach immunization strategies and factors affecting utilization of routine vaccination services in order to inform policy updates. METHODS: We adopted the 2015 vaccination coverage cluster survey technique. The sample selection was based on a stratified three-stage sample design. Using the Fleiss formula, a sample of 50 enumeration areas was sufficient to generate immunization coverages at each region. A total of 200 enumeration areas were selected for the survey. Thirty households were selected per enumeration area. Epi-Info software was used to calculate weighted coverage estimates. RESULTS: Among the 2231 vaccinated children aged 12-23 months who participated in the survey, 68.1% received immunization services from a health unit and 10.6% from outreaches. The factors that affected utilization of routine vaccination services were; accessibility, where 78.2% resided within 5km from a health facility. 29.7% missed vaccination due to lack of vaccines at the health facility. Other reasons were lack of supplies at 39.2% and because the caretaker had other things to do, 26.4%. The survey showed 1.8% (40/2271) respondents had not vaccinated their children. Among these, 70% said they had not vaccinated their child because they were busy doing other things and 27.5% had not done so because of lack of motivation. CONCLUSION: Almost 7 in 10 children aged 12-23 months access vaccination at health facilities. There is evidence of parental apathy as well as misconceptions about vaccination.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Esum Mathias Eyong, Brenda Mbouamba Yankam, Esemu Seraphine, Che Henry Ngwa, Ngwayu Claude Nkfusai, Cho Sabastine Anye, Gilbert Karngong Nfor, Samuel Nambile Cumber [Research] - The prevalence of HBsAg, knowledge and practice of hepatitis B prevention among pregnant women in the Limbe and Muyuka health districts of the South West region of Cameroon: a three-year retrospective study - 15 March 2019. http://www.panafrican-med-journal.com/content/article/32/122/abstract/ <b>INTRODUCTION: Hepatitis B infection is caused by the Hepatitis B virus (HBV). HBV is transmitted through sexual intercourse, by exchange of saliva during kissing and also to newborns of infected mothers. In the Global Burden of Diseases 2010, 786,000 deaths were attributed to HBV. Studies in Cameroon, reported the prevalence of HBV as high as 10.1% and 12% among blood donors in hospital blood banks. This study therefore, aims at determining the prevalence of HBsAg, knowledge and practices of pregnant women on HBV prevention and transmission in the Limbe health district (LHD) and Muyuka health district (MHD). METHODS: ANC registers were exploited from the Health Centers for a period of three years (2014-2016) inorder to determine the prevalence of HBV infection. 270 women attending ANC were selected by exhaustive sampling. Knowledge and practices of participants on HBV prevention and transmission was assessed using a structured questionnaire. RESULTS: the prevalence of HBV in the LHD and MHD were 5.7% and 7.5% respectively. Pregnant women in the LHD demonstrated good knowledge but adopted poor practices whereas in the MHD, pregnant women demonstrated poor knowledge and adopted poor practices regarding the mode of transmission and prevention of HBV infection. There was a significant association between the prevalence of HBsAg and marital status (p = 0.000) in the LHD and age (p = 0.022) in the MHD. CONCLUSION: this study indicated a high prevalence of HBV among pregnant women in the LHD and MHD, knowledge and practices were identified as potential risk factors.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Amel El Korbi, Jih&egrave;ne Houas, Rachida Bouatay, Khaled Harrathi, Jamel Koubaa [Case report] - Primary papillary carcinoma of the thyroglossal duct in a 14-year-old female: case report and review of the literature - 14 March 2019. http://www.panafrican-med-journal.com/content/article/32/121/abstract/ <b>Thyroglossal duct carcinoma is a rare pathologic entity. The surgeon's main concern is whether to perform thyroidectomy or not. In this paper, we report another case of thyroglossal papillary duct carcinoma in a 14-old girl suspected preoperatively and confirmed postoperatively on the histological analysis of resected specimen by a Sistrunk procedure. Therapeutic strategy was completed by a total thyroidectomy with radioactive iodine therapy and suppressive levothyroxine therapy. In the absence of clear guidelines, the management of thyroglossal duct carcinoma is depending on the clinical situation and the experience of the team of surgeons.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Aqeel Abdullah Alaqeel [Case report] - Hyporegenerative anemia and other complications of rhesus hemolytic disease: to treat or not to treat is the question - 14 March 2019. http://www.panafrican-med-journal.com/content/article/32/120/abstract/ <b>Rhesus hemolytic disease of the newborn is rarely found after the implementation of anti-D immunoglobulin prophylaxis. However, it may lead to cholestasis, elevated liver transaminases, iron overload and late hyporegenerative anemia when it occurs. Etiology of this type of anemia is not defined yet and treatment is controversial. It is typically recognized after two weeks of life which is characterized by low hemoglobin and reticulocyte count. We have reported a case of a neonate with Rh hemolytic disease with late hyporegenerative anemia that was noted at day 18 of life. We treated this anemia by erythropoietin (EPO) 250 U/kg three times per week. Two weeks after initiation of erythropoietin treatment, a stable hemoglobin was noted along with an increased reticulocyte count. The patient required one further blood transfusion in the third week of therapy. Other associated findings were self-limited. A year of follow-up showed an appropriate development for age.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Elvis Enowbeyang Tarkang, Luchuo Engelbert Bain [Commentary] - The bane of publishing a research article in international journals by African researchers, the peer-review process and the contentious issue of predatory journals: a commentary - 14 March 2019. http://www.panafrican-med-journal.com/content/article/32/119/abstract/ <b>Scholarly publication in a peer-reviewed journal is the highest form of disseminating research findings. However, the process of publishing in peer-reviewed journals remains a daunting task for researchers and academics in Africa. This commentary will assist authors in Africa to understand the peer-review process, to appreciate the length of time it takes for a manuscript to be published and to encourage them to publish in local peer-review journals. The authors argue that the peer-review process is essential because it acts as a quality control mechanism to ensure that valid and reliable research is published. Although peer review does not guarantee exclusive publication of reliable and valid research, it remains central in the scientific activity. Authors need to take the comments from reviewers and editors, even in cases of rejection seriously and in the positive sense, in order to improve upon the quality of their work. Rejections by some journals happen not to be scientifically grounded. It happens that African authors suffer more from this flaw. This could justify why some naïve authors easily turn to publish in predatory journals. The authors argue that publishing in local journals is imperative for Africans scholars. Therefore, initiatives to encourage publication in these journals are highly needed.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Simeon-Pierre Choukem, Colette Sih, Daniel Nebongo, Philomene Tientcheu, Andr&eacute;-Pascal Kengne [Research] - Accuracy and precision of four main glucometers used in a Sub-Saharan African Country: a cross-sectional study - 14 March 2019. http://www.panafrican-med-journal.com/content/article/32/118/abstract/ <b>INTRODUCTION: Capillary glucose measurement using point-of-care glucometers is an essential part of diabetes care. We determined the technical accuracy, clinical accuracy and precision of commonly available glucometers against standard spectrophotometry in Cameroon. METHODS: a sample of four glucometers was selected. In the 108 diabetic and non-diabetic participants, blood glucose values obtained by glucometers were compared to the reference laboratory method to determine their technical and clinical accuracies. Precision was determined by repeated measurements using standard solutions of different concentrations. RESULTS: accu-Chek® Active, CodeFree™, Mylife™ Pura™ and OneTouch® Ultra® 2 values had correlation coefficients of 0.96, 0.87, 0.97 and 0.94 respectively with reference values, and biases of 18.7%, 29.1%, 16.1% and 13.8% respectively. All glucometers had e" 95% of values located within the confidence limits except OneTouch® Ultra®2. Accu-Chek® Active, CodeFree™, Mylife™ Pura™ and OneTouch® Ultra® 2 had 99%, 93.1%, 100% and 98.0% of values in Parke's zones A and B. The coefficients of variation of the glucometers were all below 5% at all standard concentrations, except for Accu-Chek® Active for glucose concentrations at100 and 200mg/dL. CONCLUSION: no glucometer met all the international recommendations for technical accuracy. Accu-Chek™ Active and Mylife™, Pura™ met the International Organization for Standardization 2013 recommendations for clinical accuracy based on Parke's consensus error grid analysis. All glucometers assessed except Accu-Chek® Active showed a satisfactory level of precision at all concentrations of standard solutions used.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Pius Wonga Omole, Didier Tshibangu Mujinga, Nasser Amisi Lubosha, Igor Mujinga wa Mujinga, Daniel Ilunga Ntanga [Case report] - Occlusion intestinale sur diverticule de Meckel: &agrave; propos d'un cas - 13 March 2019. http://www.panafrican-med-journal.com/content/article/32/117/abstract/ <b>Le diverticule de Meckel est un reliquat du canal omphalom&eacute;senterique. Ce diverticule peut se perforer, s'enflammer aussi cr&eacute;er une occlusion. Les auteurs rapportent le cas d'un homme &acirc;g&eacute; de 30 ans, hospitalis&eacute; et pris en charge aux cliniques universitaires de Lubumbashi pour occlusion intestinale et dont le constat per op&eacute;ratoire &eacute;tait un volvulus du gr&ecirc;le sur diverticule de Meckel avec n&eacute;crose intestinale. Son &eacute;volution &eacute;tait bonne apr&egrave;s l'intervention chirurgicale.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hind Adadi, Hekmat Chaara, Imane Attar, Sofia Jayi, Fatim-Zahra Fdili Alaoui, Moulay Abdelilah Melhouf [Case report] - Maladie des brides amniotiques: diagnostic ant&eacute;natal et difficult&eacute;s de prise en charge (&agrave; propos de 02 cas de malformations l&eacute;tales) - 13 March 2019. http://www.panafrican-med-journal.com/content/article/32/116/abstract/ <b>La maladie des brides amniotiques (MBA) est un ensemble de malformations cong&eacute;nitales complexes, int&eacute;ressant principalement les membres, mais aussi la r&eacute;gion cranio-faciale et l'axe thoraco-abdominal. Deux th&eacute;ories principales physiopathologiques s'opposent: la rupture pr&eacute;coce de l'amnios (th&eacute;orie exog&egrave;ne) conduirait &agrave; la formation de brides fibreuses, qui seraient elles-m&ecirc;mes responsables par strangulation des malformations observ&eacute;es; la th&eacute;orie endog&egrave;ne privil&eacute;gie une origine vasculaire, les brides n'ayant alors aucun r&ocirc;le causal. Le pronostic de la maladie d&eacute;pend de la gravit&eacute; des malformations. Afin de discuter des difficult&eacute;s diagnostiques et th&eacute;rapeutiques de la maladie des brides amniotiques (MBA), nous rapportons deux cas t&eacute;moignant de malformations l&eacute;tales de cette maladie. L'objectif principal de ce travail est d'aborder l'int&eacute;r&ecirc;t du diagnostic ant&eacute;natal concernant son influence sur la prise en charge th&eacute;rapeutique de cette embryo-foetopathie.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Souha Kallel, Abdel Mounem Ghorbel [Images in medicine] - Abc&egrave;s de la face r&eacute;v&eacute;lant une sinusite maxillaire d'origine dentaire - 12 March 2019. http://www.panafrican-med-journal.com/content/article/32/115/abstract/ <b>La sinusite maxillaire s'ext&eacute;riorise exceptionnellement. Nous rapportons une voie inhabituelle d'ext&eacute;riorisation &agrave; travers le m&eacute;at moyen en suivant la cloison intersinuso-nasale vers l'angle ant&eacute;rieur de l'os maxillaire et le sillon naso-g&eacute;nien. Il s'agissait d'un patient &acirc;g&eacute; de 17 ans, sans ant&eacute;c&eacute;dents particuliers, qui a consult&eacute; pour l'apparition depuis deux jours d'une tum&eacute;faction de la face avec une obstruction nasale droite. A l'examen, il &eacute;tait f&eacute;brile avec pr&eacute;sence d'une tum&eacute;faction inflammatoire collect&eacute;e du sillon naso-g&eacute;nien droit (A) avec comblement total de la fosse nasale droite par un bombement sous muqueux r&eacute;nitent. Un scanner inject&eacute; du massif facial a montr&eacute; une sinusite maxillaire droite &eacute;largissant le m&eacute;at moyen (B) avec des collections au niveau de la cloison intersinuso-nasale et du sillon nasog&eacute;nien. Par ailleurs, on visualise une migration de la 17&egrave;me racine dentaire en intra-sinusien (C). D'o&ugrave; le diagnostic d'une sinusite maxillaire d'origine dentaire ext&eacute;rioris&eacute;e &agrave; la face a &eacute;t&eacute; d&eacute;duit. Sous anesth&eacute;sie g&eacute;n&eacute;rale, le patient a eu un drainage des diff&eacute;rentes collections purulentes &agrave; travers une incision du vestibule nasal, une m&eacute;atotomie moyenne pour drainage du sinus maxillaire et une extraction de la 17&egrave;me dent. L'&eacute;volution &eacute;tait favorable avec r&eacute;gression de la fi&egrave;vre et des signes inflammatoires.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Faten Lima&iuml;em [Images in medicine] - Un h&eacute;mangiome intraosseux localement agressif de si&egrave;ge inhabituel - 11 March 2019. http://www.panafrican-med-journal.com/content/article/32/114/abstract/ <b>L'h&eacute;mangiome osseux est une l&eacute;sion primitive b&eacute;nigne de l'os, caract&eacute;ris&eacute;e par la n&eacute;oformation et l'agglom&eacute;ration de vaisseaux sanguins anormaux. L'atteinte des vert&egrave;bres et du squelette cranio-facial est la plus fr&eacute;quente mais, tous les os peuvent &ecirc;tre l&eacute;s&eacute;s. Sa localisation au niveau de l'astragale est rare. Il s'agit d'une patiente &acirc;g&eacute;e de 71 ans sans ant&eacute;c&eacute;dents pathologiques notables, qui avait consult&eacute; pour des douleurs de la cheville &eacute;voluant depuis deux ans. La tomodensitom&eacute;trie du pied a objectiv&eacute; une image lytique et une fracture de l'astragale ainsi qu'une perte de substance interne osseuse. Une biopsie chirurgicale de cette l&eacute;sion a &eacute;t&eacute; pratiqu&eacute;e. Macroscopiquement, nous avons re&ccedil;u un mat&eacute;riel h&eacute;morragique, friable. Histologiquement, il s'agissait d'une prolif&eacute;ration vasculaire b&eacute;nigne, constitu&eacute;e de cavit&eacute;s vasculaires plus ou moins gorg&eacute;es d'h&eacute;maties et rev&ecirc;tues d'une assise de cellules endoth&eacute;liales aplaties. Il n'y avait pas d'atypies cytonucl&eacute;aires ni d'activit&eacute; mitotique anormale au niveau des cellules endoth&eacute;liales. Sur le plan immunohistochimique ces cellules exprimaient le CD34. Le diagnostic retenu &eacute;tait celui d'un h&eacute;mangiome osseux. Les h&eacute;mangiomes localement agressifs peuvent &ecirc;tre confondus, cliniquement et &agrave; l'imagerie, avec un processus malin, vasculaire ou non. L'histologie apporte la confirmation diagnostique. Cette tumeur est g&eacute;n&eacute;ralement stable, parfois spontan&eacute;ment r&eacute;solutive en quelques ann&eacute;es. Elle peut cependant aussi avoir une &eacute;volution agressive localement.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Salma Kamoun, Heifa Azouz, Marwa Zemmali, Slim Haouet, Nidhameddine Kchir [Case report] - Desmoplastic infantile ganglioglioma - 11 March 2019. http://www.panafrican-med-journal.com/content/article/32/113/abstract/ <b>The term desmoplastic infantile ganglioglioma was coined by VandenBerg et al in 1987. In their first report these authors referred to a rare, distinct brain tumor. About 60 cases of desmoplastic infantile ganglioglioma have been described in the literature since its first description. We report a case of a 6-year-old girl who was admitted for seizure without family history. Magnetic resonance imaging scan showed a hypodense area in the right temporal region. A right temporal craniotomy was performed and the tumor was excised. The pathologic examination revealed the diagnosis of desmoplastic infantile ganglioglioma.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Khaled Elmezughi, Chukwuma Ekpebegh [Case report] - Metformin-associated lactic acidosis treated successfully by peritoneal dialysis in a resource limited setting: case report - 11 March 2019. http://www.panafrican-med-journal.com/content/article/32/112/abstract/ <b>Metformin is a commonly used treatment modality in type 2 diabetes mellitus with lactic acidosis as a rare but life-threatening side effect. In this case report we highlight the importance of recognizing this uncommon side effect and the treatment options in a resource limited situation. We present a 14-year-old African girl who ingested an unknown amount of metformin intentionally after an argument with her mother. She was referred late to our institution in severe lactic acidosis. Lactic acidosis resolved with appropriate treatment including peritoneal dialysis. We conclude that in resource constrained settings, peritoneal dialysis may be used for metformin associated lactic acidosis with favourable outcome.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Egbe Sarah Balle Tabi, Samuel Nambile Cumber, Kenneth Okoth Juma, Elvis Akwo Ngoh, Eric Achidi Akum, Esum Mathias Eyong [Research] - A cross-sectional survey on the prevalence of anaemia and malnutrition in primary school children in the Tiko Health District, Cameroon - 11 March 2019. http://www.panafrican-med-journal.com/content/article/32/111/abstract/ <b>INTRODUCTION: Anaemia and malnutrition are common health problems in developing countries with children being the most vulnerable. They have negative impacts on human performance, growth and development, in children, both as cause and consequences of disease. Although annual mass deworming and nutrition supplement strategies have been implemented in the Tiko Health District (THD), no study has been carried out to determine the prevalence of anaemia and malnutrition. The aim of this study was therefore designed to determine the prevalence of anaemia and malnutrition among primary school children aged 5-15 years in the Tiko Health District. METHODS: a cross-sectional study was carried out in 10 randomly selected schools in the THD and a total of 400 school children were enrolled in the study. Body weight and height were measured using an electronic weighing scale and stadiometer respectively. Anthropometric indices: Height-for-Age Z scores (HAZ), Weight-for-Age Z scores (WAZ) and Body Mass Index-for-Age Z scores (BMIAZ) were analyzed and compared with WHO Growth Reference Standards using WHO Anthroplus software. Hemoglobin levels were determined using Urit-12 Haemoglobinometer and anaemia defined as Hemoglobin (Hb) < 11g/dl. Data analysis was done using the SPSS software. RESULTS: the overall prevalence of malnutrition was 9.25%, prevalence of stunting 7.5% with 0.8% being severely stunted. The prevalence of wasting was 1% and underweight 0.7%. The overall prevalence of anaemia was 5%. Parents occupation and the absence of toilet were statistically associated with anaemia (P = 0.04 and P = 0.003). Age, floor type, absence of toilet and BMI were significantly associated with malnutrition (P = 0.00, P = 0.01, P = 0.02 and P = 0.003). CONCLUSION: this study revealed a low prevalence of malnutrition and anaemia which could be attributed to the deworming and nutrition supplement strategies which have been implemented.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Abdelilah El Alaoui, Hicham El Bot&eacute;, Oussama Ziouani, Hachem El Sayegh, Ali Iken, Lounis Benslimane, Yassine Nouini [Case series] - Place de la n&eacute;phrolithotomie &agrave; ciel ouvert dans le traitement du calcul coralliforme: &agrave; propos d'une s&eacute;rie de 53 patients - 08 March 2019. http://www.panafrican-med-journal.com/content/article/32/110/abstract/ <b>Le but de notre &eacute;tude est de discuter la place de la chirurgie ouverte dans le traitement de la lithiase r&eacute;nale, et notamment le coralliforme complexe, devant l'av&egrave;nement de nouvelles techniques moins invasifs. Nous rapportons une s&eacute;rie de 53 calculs coralliformes collig&eacute;s au sein de notre formation durant une p&eacute;riode de 7 ans, de janvier 2011 au janvier 2018, trait&eacute;s par n&eacute;phrolithotomie ouverte par lombotomie. La moyenne d'hospitalisation postop&eacute;ratoire &eacute;tait de 10 jours. Les suites postop&eacute;ratoires imm&eacute;diates et pr&eacute;coces &eacute;taient simples chez 36 patients, 6 patients ont n&eacute;cessit&eacute;s une transfusion sanguin, 2 ont repr&eacute;sent&eacute; un sepsis s&eacute;v&egrave;re en postop&eacute;ratoire, 5 cas une infection de la paroi et 4 cas une fistule urinaire jugul&eacute;e secondairement par un drainage endoscopique. Les calculs r&eacute;siduels sont retrouv&eacute;s dans 9 cas (16,9%). Ces calculs sont trait&eacute;s essentiellement par la lithotripsie extra corporelle. Les suites tardives &eacute;taient marqu&eacute;es par une atrophie r&eacute;nale chez 2 patients, une r&eacute;cidive lithiasique chez 9 patients. Une am&eacute;lioration de la clairance de cr&eacute;atinine chez 9 patients, et une l&eacute;g&egrave;re aggravation chez 5 patients. La chirurgie &agrave; ciel ouvert de la lithiase r&eacute;nale a de nombreuses complications, elle n'est pas recommand&eacute;e en premi&egrave;re ligne, mais il est important de reconna&icirc;tre les patients chez lesquels une n&eacute;phrolithotomie par voie ouverte pourrait repr&eacute;senter un choix valide de traitement.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Kheireddine Mrad Daly, Kays Chaker, Sami Ben Rhouma, Mohamed Ali Ben Chehida, Yassine Ouanes, Ahmed Sellami, Yassine Nouira [Case series] - Evaluation des protocoles analg&eacute;siques pour la prise en charge de la douleur au cours de la lithotripsie extra corporelle - 08 March 2019. http://www.panafrican-med-journal.com/content/article/32/109/abstract/ <b>La douleur ressentie au cours d'une s&eacute;ance de lithotritie extracorporelle (LEC) est le facteur limitant le plus important de cette technique. Le but de notre travail &eacute;tait de comparer l'efficacit&eacute; des diff&eacute;rents types d'analg&eacute;siques utilis&eacute;s pour le contr&ocirc;le de la douleur pendant les s&eacute;ances de LEC. Nous avons men&eacute; une &eacute;tude prospective colligeant 300 patients pr&eacute;sentant une lithiase urinaire justifiant un traitement par LEC. Les patients ont &eacute;t&eacute; r&eacute;partis de fa&ccedil;on randomis&eacute;e en trois groupes: le groupe I, incluant 100 patients ayant re&ccedil;u 2cc de s&eacute;rum physiologique en IM( inta musculaire) (placebo), le groupe II regroupant 100 patients ayant re&ccedil;u 100mg de k&eacute;toprof&egrave;ne en IM tandis que le groupe III colligeant 100 patients ayant eu une application locale d'une cr&egrave;me contenant la lidoca&iuml;ne et la priloca&iuml;ne. L'&eacute;chelle visuelle analogique (EVA) a servi &agrave; &eacute;valuer la douleur &agrave; 10 minutes et &agrave; la fin de la s&eacute;ance. L'EVA moyenne &agrave; 10 minutes et &agrave; la fin de la LEC &eacute;taient respectivement de 3,7 et 4,91. Aucune diff&eacute;rence significative n'a &eacute;t&eacute; trouv&eacute;e entre les trois groupes concernant: les donn&eacute;es &eacute;pid&eacute;miologiques (&acirc;ge, sexe, IMC, ant&eacute;c&eacute;dents pathologies) et les caract&eacute;ristiques du calcul (c&ocirc;t&eacute;, taille, localisation, pr&eacute;sence ou non de sonde double J). L'interruption pr&eacute;coce de la s&eacute;ance de LEC a &eacute;t&eacute; not&eacute;e chez 11 patients du groupe I, avec une diff&eacute;rence significative par rapport aux autres groupes (p=0,003). L'EVA &agrave; 10 minutes et &agrave; la fin de s&eacute;ance de LEC, &eacute;tait statistiquement plus &eacute;lev&eacute;e dans le groupe I par rapport aux groupes II et III (p < 0,001). Aussi, la LEC &eacute;tait nettement plus efficace dans les groupes (II et III) comparativement au groupe I (p<0,001). L'utilisation d'un traitement antalgique est n&eacute;cessaire lors de la s&eacute;ance de lithotritie extracorporelle. Les deux mol&eacute;cules antalgiques &eacute;valu&eacute;es ont montr&eacute; un bon contr&ocirc;le de la douleur ainsi qu'une augmentation de l'efficacit&eacute; du traitement par lithotritie.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Maha Ait Berri, Abdellah Taous, Tarik Boulahri, Imane Traibi, Abdelhadi Rouimi [Case series] - Les troubles neurologiques secondaires &agrave; une carence en vitamine B12: analyse de 29 cas - 08 March 2019. http://www.panafrican-med-journal.com/content/article/32/108/abstract/ <b>Les troubles neurologiques secondaires &agrave; une carence en vitamine B12 sont polymorphes et vari&eacute;s. Peu de travaux se sont int&eacute;ress&eacute;s &agrave; leur analyse aussi bien dans la population marocaine qu'africaine. L'objectif de notre &eacute;tude est donc de d&eacute;crire les aspects cliniques, paracliniques et &eacute;volutifs des manifestations neurologiques des patients atteints d'une carence en vitamine B12, au sein du Service de Neurologie de l'H&ocirc;pital Militaire Moulay Ismail de Mekn&egrave;s sur une dur&eacute;e de 18 ans (1999-2017). Il s'agissait de 06 femmes et 23 hommes &acirc;g&eacute;s en moyenne de 57 ans. Le d&eacute;lai du diagnostic &eacute;tait de 3 mois. L'atteinte neurologique &eacute;tait r&eacute;v&eacute;latrice de la carence en vitamine B12 dans 100% des cas. Le taux moyen de l'h&eacute;moglobine &eacute;tait de 10g/dl, le volume globulaire moyen de 115 fl. Une m&eacute;galoblastose m&eacute;dullaire et une gastrite atrophique &eacute;taient pr&eacute;sentes dans respectivement 95% et 90% des cas. La r&eacute;alisation syst&eacute;matique d'&eacute;lectroenc&eacute;phalographie (EEG), &eacute;lectromyogramme (EMG) et potentiel evoqu&eacute; visuel (PEV), a retrouv&eacute; chez nos patients des neuropathies p&eacute;riph&eacute;riques et optiques infracliniques. Sur le plan &eacute;tiologique, il s'agissait d'une an&eacute;mie de Biermer dans 20 cas. Sous vitamine B12 parent&eacute;rale, l'&eacute;volution &eacute;tait favorable chez tous nos patients. A la lumi&egrave;re de ces r&eacute;sultats, nous insistons sur l'int&eacute;r&ecirc;t du diagnostic pr&eacute;coce en raison de la gravit&eacute; potentielle de certains tableaux neuropsychiatriques et le traitement substitutif qui doit &ecirc;tre rapide car il est le seul garant d'une &eacute;volution favorable de ces atteintes.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Zavier Zomalh&egrave;to, Rose Mikponhoue, Armand Wanvo&egrave;gbe, Ivanovich Adikp&eacute;to, Paul Ay&eacute;lo [Research] - Pr&eacute;valence et facteurs associ&eacute;s &agrave; la lombalgie chez les conducteurs de taxi moto &agrave; Porto-Novo (B&eacute;nin) - 07 March 2019. http://www.panafrican-med-journal.com/content/article/32/107/abstract/ <b>INTRODUCTION: La lombalgie constitue un probl&egrave;me majeur de sant&eacute; au travail. Certaines populations de travailleurs semblent beaucoup plus expos&eacute;es que d’autres. L’objectif de cette &eacute;tude &eacute;tait de d&eacute;terminer la pr&eacute;valence et les facteurs associ&eacute;s &agrave; la survenue de la lombalgie chez les conducteurs de taxi moto &agrave; Porto-Novo. METHODES: &eacute;tude transversale &agrave; vis&eacute;e descriptive et analytique qui avait concern&eacute; 270 conducteurs de taxi-moto ayant au moins un an d’anciennet&eacute; et consentants. Ces derniers &eacute;taient soumis au questionnaire type nordique adapt&eacute; &agrave; notre contexte et un examen physique du rachis. Les donn&eacute;es collect&eacute;es ont &eacute;t&eacute; analys&eacute;es &agrave; l’aide du logiciel Epidata 3.1. et STATA/IC 11.0. Le seuil de significativit&eacute; &eacute;tait de 5% et les intervalles de confiance calcul&eacute;s &agrave; 95%. RESULTATS: la pr&eacute;valence de la lombalgie &eacute;tait de 68,89%. L’&acirc;ge moyen des conducteurs de taxi-moto &eacute;tait de 42,43 ±11,25 [25-64] ans. La majorit&eacute; conduisait depuis plus de 5 ans (93,33%). La dur&eacute;e moyenne de conduite par jour &eacute;tait de plus de 8 heures (93,34%) et 68,52% parcouraient plus de 160km par jour. La lombalgie &eacute;tait d’horaire m&eacute;canique dans 91,39%. Le mode d’installation &eacute;tait brutal dans 81,73%. La douleur &eacute;tait mod&eacute;r&eacute;e chez 55,91% des conducteurs d’&eacute;volution aigue (46,24%) et sans irradiation dans 62,36% des cas. L’&acirc;ge, le niveau d’instruction, le stress, la posture, l’&eacute;tat des amortisseurs de moto &eacute;taient associ&eacute;s &agrave; la lombalgie chez ces conducteurs de taxi-moto (p < 0,001). Par contre la distance parcourue, la dur&eacute;e de travail, l’anciennet&eacute; et l’&eacute;tat des routes n’&eacute;taient pas associ&eacute;s &agrave; la survenue de la lombalgie. CONCLUSION: la lombalgie demeure un s&eacute;rieux probl&egrave;me de sant&eacute; publique notamment chez les conducteurs de taxi-moto dans notre pays o&ugrave; la conduite de moto devient de plus en plus un m&eacute;tier de secours pour la population confront&eacute;e au ch&ocirc;mage grandissant d’o&ugrave; la n&eacute;cessit&eacute; d’agir sur les diff&eacute;rents facteurs pour une pr&eacute;vention efficace.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hind Boukhalit, Ouijdane Zamani, Laila Jroundi [Case report] - Un cas de nœud il&eacute;o-sigmo&iuml;dien chez une femme en post-partum - 07 March 2019. http://www.panafrican-med-journal.com/content/article/32/106/abstract/ <b>Le nœud il&eacute;o-sigmo&iuml;dien est une cause rare d'occlusion intestinale. Nous rapportons un cas de nœud il&eacute;o-sigmo&iuml;dien survenu chez une femme en post-partum. Le diagnostic a &eacute;t&eacute; &eacute;voqu&eacute; sur les donn&eacute;es du scanner et confirm&eacute; en perop&eacute;ratoire.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Farhan Fazal, Nitin Gupta, Shivabalan, Aditya Nayan, Naval Vikram, Animesh Ray [Case report] - Haemophagocytic lymphohistiocytosis in patients with human immunodeficiency virus infection: to treat or not to treat - 06 March 2019. http://www.panafrican-med-journal.com/content/article/32/105/abstract/ <b>Haemophagocytic lymphohistiocytosis (HLH) in Human Immunodeficiency Virus (HIV) infected individuals can either be due to the disease itself or due to associated infections/malignancies. The treatment for HLH requires immunosuppressive therapy but administering immunosuppressive therapy to an already immunosuppressed patient (HIV infection) is complex. We present two such cases of HLH in patients infected with HIV. In the first case, no alternate cause for HLH was found even after extensive investigations and it was attributed to the uncontrolled HIV replication. Patient was started on dexamethasone for the same but succumbed to hospital acquired pneumonia. The second patient was diagnosed with Hodgkin's lymphoma but he succumbed to his illness before initiating immunosuppressive therapy for HLH. We report these cases to highlight the dilemma and a need for further research in this direction.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hermann Yao, Arnaud Ekou, Thierry Joseph Niamkey, Esa&iuml;e Kossa Soya, Emilienne Aboley, Roland N'Guetta [Research] - L&eacute;sions coronaires chez le noir africain dans les syndromes coronariens aigus - 05 March 2019. http://www.panafrican-med-journal.com/content/article/32/104/abstract/ <b>INTRODUCTION: les syndromes coronariens aigus (SCA) sont en progression en Afrique sub-saharienne. Les donn&eacute;es angio-coronarographiques sont rares. L'objectif de cette &eacute;tude &eacute;tait d'analyser les l&eacute;sions coronaires observ&eacute;es dans les syndromes coronariens aigus (SCA) &agrave; Abidjan. METHODES: &eacute;tude transversale, du 1er janvier 2010 au 31 d&eacute;cembre 2014. Tous les patients admis pour SCA et ayant b&eacute;n&eacute;fici&eacute; d'une coronarographie &agrave; l'Institut de cardiologie d'Abidjan pendant la p&eacute;riode d'&eacute;tude ont &eacute;t&eacute; inclus. Deux cent cinquante-six patients ont &eacute;t&eacute; s&eacute;lectionn&eacute;s. Nous avons analys&eacute; et compar&eacute; les l&eacute;sions coronaires chez les patients ayant pr&eacute;sent&eacute; un SCA avec sus d&eacute;calage persistant du segment ST (SCA ST+) et ceux ayant pr&eacute;sent&eacute; SCA sans sus d&eacute;calage du segment ST (SCA ST-). RESULTATS: l'&acirc;ge moyen des patients &eacute;tait de 53,2 ± 10,8 ans. Il existait une pr&eacute;dominance masculine avec un sex-ratio de 6,1. Le taux de coronarographies anormales &eacute;tait significativement plus &eacute;lev&eacute; dans les SCA ST+ (95,4% et 64,2% respectivement, p < 0,001). Trois cent quatre l&eacute;sions coronaires ont &eacute;t&eacute; observ&eacute;es dans les SCA ST+ contre 43 dans les SCA ST-. Les l&eacute;sions st&eacute;nosantes &eacute;taient majoritairement monotronculaires (45,3%) dans les SCA ST+ et bi ou tri tronculaires dans les SCA ST- (68,0%). Les l&eacute;sions de type B1 &eacute;taient plus fr&eacute;quentes dans les SCA ST- (62,8% versus 36,5%, p = 0,002). Les l&eacute;sions les plus complexes de type C &eacute;taient plus fr&eacute;quentes dans les SCA ST+ (17,8%), sans diff&eacute;rence significative. La majorit&eacute; des patients avait un score SYNTAX inf&eacute;rieur &agrave; 22 quel que soit le type de SCA (87,4% dans les SCA ST+ et 90,1% dans les SCA ST-). CONCLUSION: les l&eacute;sions coronaires dans les SCA sont majoritairement monotronculaires dans les SCA ST+ et plus diffuses dans les SCA ST- mais avec une proportion plus importante de coronaires angiographiquement normales. La prise en charge de ces l&eacute;sions rel&egrave;ve dans la majorit&eacute; des cas de l'angioplastie coronaire.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Michel Kengne, Olivier Fotsing, Th&eacute;r&egrave;se Ndomgue, Julius Mbekem Nwobegahay [Research] - Antibiotic susceptibility patterns of Staphylococcus aureus strains isolated at the Yaounde Central Hospital, Cameroon: a retro prospective study - 05 March 2019. http://www.panafrican-med-journal.com/content/article/32/103/abstract/ <b>INTRODUCTION: Staphylococcus aureus is an important pathogen responsible for hospital and community acquired infection(s). Emerging resistance to methicillin in this organism has left physicians with few therapeutic alternatives to treat infections caused by it. This study was aimed at determining the antibiotic susceptibility patterns of Staphylococcus aureus strains isolated at the Yaounde Central Hospital, Cameroon. METHODS: from January 2014 to November 2016, a total of 250 non repeated strains were isolated from various clinical specimens. Isolates and antibiotic susceptibility profiles were identified through standard microbiological techniques. RESULTS: methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) accounted respectively for 80% (201/205) and 20% (49/205) of the total strains isolated. MRSA strains displayed high resistance to cefoxitin (100%), cotrimoxazole (89%), vancomycin (79.7%), lincomycin (70.3%), tobramycin (72.5%), doxycycline (68.0%), kanamycin (69.7%) and erythromycin (55.7%). In contrast, a high susceptibility was observed with rifampicin (82.6%). KTG (42.3%) and constitutive MLSB (17.4%) were the most frequent phenotypes recorded. CONCLUSION: our results show that the carriage of acquired MRSA infections predominates in this population. Despite the noticeable multiresistance of MRSA strains to antibiotics, rifampicin remains the drugs of choice for the therapy of acquired MRSA infections in this setting. In order to slow down antimicrobial resistance, surveillance studies for antimicrobial susceptibility remains essential to identify resistance and inform policy on resistance.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Petros Ioannou [Images in medicine] - An unexpected cause of abdominal pain or maybe more - 04 March 2019. http://www.panafrican-med-journal.com/content/article/32/102/abstract/ <b>A 61-year old Caucasian woman, presented to the Emergency Department due to a four-week history of vomiting, diarrhea and abdominal pain. Physical examination revealed tenderness in the upper abdomen and normal bowel sounds. A CT was performed and the patient was admitted. A CT scan of the chest and the abdomen revealed a chronically dissected Stanford B thoracoabdominal aneurysm with mural thrombus, thrombosis of the celiac, hepatic, splenic and superior mesenteric arteries with collateral circulation, thrombosis of the portal and superior mesenteric veins and a splenic infarct. Dissection of an aneurysm is a catastrophic complication with high mortality and morbidity, thus an invasive treatment is often warranted with either surgery or endovascular repair. On the other hand, portal thrombosis is associated with inherited or acquired procoagulant states (like Factor V Leiden), hematologic diseases (like myeloproliferative diseases), cirrhosis, abdominal surgery or trauma and intra-abdominal inflammatory conditions. Its treatment involves anticoagulation or rarely, thrombolysis or thrombectomy. Both chronic dissection of the abdominal aneurysm and the portal vein thrombosis can cause abdominal pain, nausea, and other gastrointestinal symptoms secondary to bowel hypoperfusion. Diagnosis: chronically dissected Stanford B thoracoabdominal aneurysm and thrombosis of the celiac, hepatic, splenic and superior mesenteric arteries with collateral circulation, thrombosis of the portal and superior mesenteric veins and a splenic infarct.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Younes Barbach, Hanane Baybay, Samia Mrabat, Mohammed Chaouche, Sara Elloudi, Fatima Zahra Mernissi [Case report] - Evolution spectaculaire d’un pemphigus v&eacute;g&eacute;tant r&eacute;fractaire aux th&eacute;rapies conventionnelles sous Rituximab: &agrave; propos d’un cas - 04 March 2019. http://www.panafrican-med-journal.com/content/article/32/101/abstract/ <b>Le pemphigus v&eacute;g&eacute;tant est une vari&eacute;t&eacute; rare de pemphigus. Il n'y repr&eacute;sente que 2%. Plusieurs traitements sont de mise pour traiter cette entit&eacute;, on retrouve les corticost&eacute;ro&iuml;des topiques et/ou oraux en 1&egrave;re intension, les immunosuppresseurs tels que l'Azathioprine, la Cyclosporine, le M&eacute;thotrexate, le Cyclophosphamide et le Mycoph&eacute;nolate mof&eacute;til pour rem&eacute;dier au effet secondaires des st&eacute;roides. Certains cas restent r&eacute;fractaires &agrave; tous ces traitements, l'utilisation du Rituximab a fait r&eacute;volutionner la prise en charge du pemphigus, en particulier sa forme v&eacute;g&eacute;tante. Nous rapportons le cas d'une patiente de 42ans, admise pour prise en charge d'un pemphigus v&eacute;g&eacute;tant confirmer histologiquement mise initialement sous corticoth&eacute;rapie en association avec immunosuppresseur sans am&eacute;lioration, puis fut mise sous Rituximab avec une &eacute;volution spectaculaire.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Yasser El Brahmi, Mbarek Yakka, Abdelkader Ehirchiou, Mountassir Moujahid, Aziz Zentar [Case report] - M&eacute;tastase pari&eacute;tale d’un ad&eacute;nocarcinome bronchique - 04 March 2019. http://www.panafrican-med-journal.com/content/article/32/100/abstract/ <b>Les m&eacute;tastases cutan&eacute;es du carcinome bronchog&eacute;nique sont rares, elles t&eacute;moignent d'un stade tardif de la maladie. Nous rapportons le cas d'une m&eacute;tastase cutan&eacute;e d'un ad&eacute;nocarcinome bronchique trait&eacute;e chirurgicalement en vue d'am&eacute;liorer le confort du malade.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Marius Nsoh, Bassong Olga Yvonne Mankollo, Mbondji Ebongue, Kengne Nde Cyprien, Julienne Louise Ngo Likeng, Sheikh Mohammed Shariful Islam, Andrew Collier, Joyce Mahlako Tsoka-Gwegweni, Samuel Nambile Cumber [Research] - Acute respiratory infection related to air pollution in Bamenda, North West Region of Cameroon - 04 March 2019. http://www.panafrican-med-journal.com/content/article/32/99/abstract/ <b>INTRODUCTION: Air pollution is a global health problem. It's responsible for over 4 million deaths each year and constitutes a risk factor for acute respiratory infections (ARI). The aims of this study was to assess knowledge about air pollution, and to determine environmental risk factors associated with ARIs occurence in the city of Bamenda, Cameroon. METHODS: we conducted a cross sectional study and performed a rectrospective analysis of ARI consultation within the period March 2016 to July 2016 in the Bamenda Health District. We interviewd 201 patients and recorded 1849 cases from hospital registers of patients diagnosed ARI from January 2013 to April 2016. Epi-info 7.2 was used for data entry and analysis. Logistic regression analysis was conducted to determine the importance of the different environmental risk factors. RESULTS: over 70% of the participants used at least a form of solid fuel for cooking. The Odds of developing an ARI was 3.62 greater among those exposed to indoor cooking compared to the unexposed (OR 3.62, CI 1.45-4.90). Participants exposed to open fire burning were 1.91 times more like to develop ARI compared to unexposed (OR: 1.91, CI 1.03-3.55: p : 0.03). Particulate Matter (PM 2.5) levels was 13.2 times higher than the World Health Organization (WHO) recommended levels. Dry and dusty weathers increased the risk of ARIs (OR 3.24; CI 1.47-7.13). The prevalence of ARIs in the Bamenda Health District was 6% of all consultations. CONCLUSION: using solid fuels in poorly ventilated homes increase the total air particle suspension indoor. Inhalling this poor air irritates the repiratory tract, eyes while longterm exposure increases the odds of cancers. Ventilating homes with indoor cooking space reduces exposure while using clean fuels like electricity reduces the odds of ARI associated with pollution.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Markes Wayne Butler, Anthonio Oladele Adefuye [Research] - Assessing the knowledge of emergency medical care personnel in the Free State, South Africa, on aspects of paediatric pre-hospital emergency care - 01 March 2019. http://www.panafrican-med-journal.com/content/article/32/98/abstract/ <b>INTRODUCTION: In South Africa in 2016, injuries accounted for 4 483 deaths of children aged 0-4 years. Prior studies have reported that, in some parts of the country, poor pre-hospital clinical care is a key contributor to the morbidity and mortality of critically ill and injured children. A key component of a coordinated emergency health care system are emergency medical care (EMC) personnel. Here, we assess the knowledge of EMC personnel employed by the Free State Department of Health on aspects of paediatric pre-hospital emergency care. METHODS: This descriptive study used a questionnaire survey to obtain data on the knowledge of Free State EMC personnel on aspects of paediatric pre-hospital emergency care. RESULTS: Only 197 of the initial 250 questionnaires distributed were returned, giving a response rate of 78.8%. More than half (51.2%) of the participants across the five districts had inadequate knowledge of paediatric pre-hospital emergency care. The majority of EMC personnel could not calculate the paediatric blood pressure for age and did not know the paediatric Glasgow Coma Scale (74.0% and 53.4% respectively; P < 0.0001 in both cases). Participants attributed inadequate knowledge to limited exposure to paediatrics cases, insufficient training, limited scope of practice, and lack of equipment. CONCLUSION: Enhancing the knowledge and skills of EMC personnel in paediatrics pre-hospital care through a short learning programme or continuous professional development programme, and providing adequate paediatric emergency equipment, will ensure that comprehensive pre-hospital emergency care is given to paediatric patients in the province.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hajar Ouahbi, Lamiae Amadour, Fatimazahra Elmernissi, Layla Tahiri, Taoufik Harmouch, Zineb Benbrahim, Fatimazahra Elmrabet, Samia Arifi, Ayat Allah Oufkigh, Nawfal Mellas [Case report] - Une r&eacute;ponse compl&egrave;te d'un dermatofibrosarcome de Darrier et Ferrand localement avanc&eacute;: &agrave; propos d'un cas et revue de la litt&eacute;rature - 28 February 2019. http://www.panafrican-med-journal.com/content/article/32/97/abstract/ <b>Le dermatofibrosarcome de Darier et Ferrand (DFS) est une tumeur cutan&eacute;e rare, caract&eacute;ris&eacute; par son agressivit&eacute; locale et son important potentiel aux r&eacute;cidives, dont le pronostic d&eacute;pend essentiellement de la qualit&eacute; de sa prise en charge. Une r&eacute;ponse compl&egrave;te avec des marges saines d'un DFS qui a &eacute;t&eacute; jug&eacute; initialement inop&eacute;rable, apr&egrave;s 1 an d'imatinib en situation n&eacute;oadjuvante est rarement d&eacute;crite dans litt&eacute;rature. Nous rapportons dans notre article, le cas d'une jeune patiente prise en charge au service d'oncologie m&eacute;dicale de F&egrave;s pour une DFS localement avanc&eacute; pr&eacute;sentant une r&eacute;ponse compl&egrave;te, afin d'&eacute;valuer la place de l'imatinib et des th&eacute;rapies cibl&eacute;es dans le traitement de DFS.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Shadrack Oiye, Ngowa Safari, Joseph Anyango, Carolyne Arimi, Benzadze Nyawa, Mbesa Kimeu, Joseph Odinde, Oscar Kambona, Rachel Kahindi, Richard Mutisya [Research] - Programmatic implications of some vitamin A supplementation and deworming determinants among children aged 6-59 months in resource-poor rural Kenya - 28 February 2019. http://www.panafrican-med-journal.com/content/article/32/96/abstract/ <b>INTRODUCTION: Controlling vitamin A deficiency and soil-transmitted helminth infections are public health imperatives. We aimed at revealing some caregiver and child-related determinants of uptake of vitamin A supplementation and deworming, and examine their programmatic implications in Kenyan context. METHODS: a cross-sectional study of randomly selected 1,177 households with infants and young children aged 6-59 months in three of the 47 counties of Kenya. The number of times a child was given vitamin A supplements and dewormed 6 months and one year preceding the study was extracted from mother-child health books. RESULTS: coverage for age-specific deworming was considerably depressed compared to corresponding vitamin A supplementation and for both services, twice-yearly provisions were disproportionately lower than half-yearly. Univariate and multivariate analyses showed relatively younger children, of Islam-affiliated caregivers (vis a vis Christians) and those who took less time to nearest health facilities as more likely to be supplemented with vitamin A. Similar observations were made for deworming where additionally, maternal and child ages were also determinants in favour of older groups. Other studied factors were not significant determinants. Programmatic allusions of the determining factors were discussed. CONCLUSION: key to improving uptake of vitamin A supplementation and deworming among Kenyan 6-59 months olds are: increasing access to functional health facilities, expanding outreaches and campaigns, dispelling faith-related misconceptions and probably modulating caregiver and child age effects by complementing nutrition literacy with robust and innovative caregiver reminders. Given analogous service points and scheduling, relative lower uptake of deworming warrants further investigations.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Amina Alaoui, Badraddine Alami, Hajar Habibi, Meriem Haloua, Youssef Alaoui Lamrani, Meryem Boubbou, Mustapha Maaroufi [Case report] - Apport de l'IRM dans la maladie de Creutzfeldt-Jakob: &agrave; propos d'un cas - 28 February 2019. http://www.panafrican-med-journal.com/content/article/32/95/abstract/ <b>La maladie de Creutzfeld-Jacob (MCJ) est une affection tr&egrave;s rare et fatale qui atteint le syst&egrave;me nerveux central. Elle est caract&eacute;ris&eacute;e par une d&eacute;t&eacute;rioration mentale aboutissant &agrave; une d&eacute;mence progressive, une symptomatologie pyramidale et extra-pyramidale ainsi que des myolclonies. Un diagnostic pr&eacute;coce est essentiel pour pr&eacute;venir la transmission interhumaine. Nous rapportons le cas d'un patient &acirc;g&eacute; de 62 ans chez qui le diagnostic de MCJ sporadique a &eacute;t&eacute; retenu, en se basant sur le tableau clinique fait de syndrome d&eacute;mentiel avec myoclonies pr&eacute;c&eacute;d&eacute;es de troubles du comportement, des hallucinations et de d&eacute;pression, et sur les donn&eacute;es de l'IRM enc&eacute;phalique qui a montr&eacute; des hyper signaux au niveau du striatum et au niveau cortical en s&eacute;quences pond&eacute;r&eacute;es Flair et diffusion.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ahmed Tijani Bawah, Robert Amadu Ngala, Huseini Alidu, Mohammed Mustapha Seini, Joshua Dokurugu Kwame Wumbee, Francis Agyemang Yeboah [Research] - Gestational diabetes mellitus and obstetric outcomes in a Ghanaian community - 27 February 2019. http://www.panafrican-med-journal.com/content/article/32/94/abstract/ <b>INTRODUCTION: This study was aimed at evaluating effect of Gestational diabetes mellitus (GDM) and maternal characteristics on pregnancy outcome. GDM has several risk factors including; advanced maternal age, ethnic background, obesity and family history of diabetes mellitus. These pregnancy complications are associated with fetal morbidity and mortality and may lead to macrosomia and shoulder dystocia. Others are stillbirth, miscarriages, preterm and small for gestational age babies. METHODS: This was a retrospective case-case control study which compared maternal characteristics and pregnancy outcome among pregnant women with and without GDM. Diagnosis of GDM was done in accordance with the American Diabetes Association (ADA) criteria. Weight and height were determined and Body mass index (BMI) calculated. Pregnancy outcome was determined at the end of pregnancy and information on maternal characteristics obtained using questionnaire and patient folders. RESULTS: Those who developed GDM were significantly older (OR= 1.772; 95% CI =1.432-2.192; P<0.0001) and had higher BMI (OR=1.637; 95% CI=1.004-1.289; P=0.044) than those who did not. A significant number of those who developed GDM also had stillbirths OR= 5.188; 95% CI=1.093-24.613; p=0.038) and cesarean deliveries (OR=14.362; 95% CI=3.661-56.335; p= 0.001). CONCLUSION: Women who develop GDM are more likely to deliver stillborn or macrosmic babies and may require surgical intervention in order to have normal deliveries.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Muwada Bashir Awad Bashir, Shahd Mohammed Abdalla, Ngwayu Claude Nkfusai, Frankline Sanyuy Nsai, Rosaline Yumumkah Cumber, Joyce Mahlako Tsoka-Gwegweni, Samuel Nambile Cumber [Research] - Stigma on epileptic patients attending the outpatient clinic of Soba University Hospital and the National Center for Neurological Science (NCNS) Khartoum, Sudan - 27 February 2019. http://www.panafrican-med-journal.com/content/article/32/93/abstract/ <b>INTRODUCTION: Epilepsy is one of the most prevalent neurological conditions for people of different age group, race, gender and socio-economic status in various nations, affecting 50 million people around the world; 80% of them living in developing countries. In Sudan, literature have well documented epilepsy stigma and it related elements of labelling, negative typecasting, isolation, devaluing and discrimination that are significantly affecting patients living standards and social life. This study focuses on understanding the prevailing, different types of stigma among people living with epilepsy (PWE), in Sudan to determine its frequency in connection with demographic factors and patients coping ability of PWE. METHODS: A health facility-based cross-sectional descriptive study was conducted on 270 people between the ages of 16-70years who are affected by epilepsy in an outpatient clinic. Standardized questionnaires were used to interview the patients with assistance gotten from their relative where necessary. The data is analyzed using SPSS version 20. The study was conducted in the outpatient clinic of The National Center for Neurological Sciences (NCNS), Ibrahim-Malik Teaching Hospital Sudan. RESULTS: The study realized that 16.6% of the patient had a positive self-stigma score, half of them having coaching stigma and 25% courtesy stigma. One third of people with epilepsy had poor coping score that was strongly determined by self- stigma and courtesy stigma score. CONCLUSION: Parents and relatives related sigma is a major problem facing people of epilepsy in Sudan; thus, raising such group awareness and education about the disease can markedly improve the quality of life of people with epilepsy in Sudan.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ines Kechaou, Eya Cherif, Ben Salem Sana, Im&egrave;ne Boukhris, Lamia Ben Hassine [Research] - Complications traumatiques et psychosociales des chutes chez le sujet &acirc;g&eacute; tunisien - 26 February 2019. http://www.panafrican-med-journal.com/content/article/32/92/abstract/ <b>INTRODUCTION: Les chutes chez le sujet &acirc;g&eacute; constituent un probl&egrave;me de sant&eacute; majeur de par les complications traumatiques et psychosociales qui peuvent entrainer une perte de l’autonomie et un &eacute;tat de d&eacute;pendance. L’objectif de notre travail est d’&eacute;tudier les circonstances et les cons&eacute;quences traumatiques et psychosociales des chutes chez les sujets &acirc;g&eacute;s. METHODES: Nous avons men&eacute; une &eacute;tude r&eacute;trospective r&eacute;alis&eacute;e entre septembre 2014 et janvier 2016 incluant 40 patients &acirc;g&eacute;s de 65 ans et plus ayant fait au moins une chute l’ann&eacute;e pr&eacute;c&eacute;dente recrut&eacute;s parmi les patients hospitalis&eacute;s ou suivis &agrave; la consultation externe du service de M&eacute;decine Interne B de l’h&ocirc;pital Charles Nicolle. Les circonstances et les cons&eacute;quences des chutes ont &eacute;t&eacute; recueillies par l’interrogatoire r&eacute;trospectif des patients et de leur entourage &agrave; distance de la chute. RESULTATS: L’&acirc;ge moyen des patients chuteurs &eacute;tait de 75,7 ans avec une pr&eacute;dominance f&eacute;minine nette (30F/10H). Des facteurs pr&eacute;cipitants &eacute;taient retrouv&eacute;s chez 38 patients. Ils &eacute;taient de type extrins&egrave;que dans 78,9% des cas et intrins&egrave;ques dans 50% des cas. Un s&eacute;jour prolong&eacute; au sol &eacute;tait not&eacute; dans 10% des cas. Les fractures &eacute;taient plus fr&eacute;quentes chez les femmes (12F/1H) int&eacute;ressant surtout les membres sup&eacute;rieurs (61,5%). Les cons&eacute;quences psychosociales ont &eacute;t&eacute; plus fr&eacute;quentes chez les femmes. Un syndrome post chutes a &eacute;t&eacute; not&eacute; chez 5 patients. CONCLUSION: La correction des facteurs pr&eacute;cipitants intrins&egrave;ques et extrins&egrave;ques des chutes et l’apprentissage du relever du sol en post chutes permettra de pr&eacute;venir le risque de chute ainsi que ses cons&eacute;quences graves.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Mohamed Hedfi, Mehdi Debaibi, Senda Ben Iahouel, Adnen Chouchen [Case report] - Gallbladder schistosomiasis: rare but possible, a case report and review of the literature - 26 February 2019. http://www.panafrican-med-journal.com/content/article/32/91/abstract/ <b>After Malaria, schistosomiasis remains the most important tropical disease in large parts of the world. It affects mainly the colon and the urinary tract. The hepatic involvement is significantly frequent, particularly by the mansoni species. Still one of the extremely rare locations is the gallbladder. Our case is about a 51 year old woman from Tunisia, which is no longer considered an endemic country, with no particular medical history, underwent surgery for symptomatic cholelithiasis. She had a laparoscopic cholecystectomy. Post operative period was uneventful. Histology of the gallbladder showed fibrosis in the mucosa and schistosomal ova in the wall. As a conclusion we can see that due to the lack of specific clinical and radiological signs, the diagnosis of gallbladder schistosomiasis is established only after the histological examination.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ngwayu Claude Nkfusai, Samuel Nambile Cumber, Takang Williams, Judith K Anchang-Kimbi, Brenda Mbouamba Yankam, Cho Sabastine Anye, Joyce Mahlako Tsoka-Gwegweni, Enow-Orock George Enow, Damian Nota Anong [Research] - Cervical cancer in the Bamenda Regional Hospital, North West Region of Cameroon: a retrospective study - 26 February 2019. http://www.panafrican-med-journal.com/content/article/32/90/abstract/ <b>INTRODUCTION: Cervical cancer is ranked the 7th most common cancer in the world. Cancer of the cervix is the second most commonly diagnosed cancer after breast cancer and the third leading cause of cancer deaths among females in less developed countries. Incidence rates are highest in countries with low income. Nearly 90% of cervical cancer deaths occur in developing parts of the world. The study researchers therefore, carried out a retrospective study to determine the proportion of cervical cancer among other types of cancer in the cancer registry of the Bamenda Regional Hospital. METHODS: the objective of this study was to determine the proportion of cervical cancer among other types of cancers in the cancer registry of the Bamenda Regional Hospital, North West Region of Cameroon from past records. We reviewed all records from the registry of patients who attended the Bamenda Regional Hospital to screen and/or be operated upon for cervical cancer and other types of cancer. Socio-demographic and clinical characteristics of cases were captured using a data collection sheet: age, type of cancer, stage of cancer, type of surgery carried out and date of surgery. Data were entered and analysed in Statistical Package for Social Sciences (SPSS) version 25 software. RESULTS: 59 cancer cases were received in the center between 2012 and 2017. Of these, 31 (52%) had cervical cancer. Most patients who screened positive for cancer of the cervix were of the 50-54 age groups. Most of these patients (47.5%), were received at late stages (stages 3 and 4). CONCLUSION: over half (52%) of the patients receiving cancer care in this center have cervical cancer and generally turn up late for management.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Naoual Nchinech, Afaf Elgharbi, Fatima Zahra Aglili, Yamna Kriouile, Yahia Cherrah, Asmaa Aaloui Mdaghri, Samira Serragui [Case report] - M&eacute;susage traditionnel du camphre: un danger oubli&eacute; pour les enfants (&agrave; propos de 2 cas) - 26 February 2019. http://www.panafrican-med-journal.com/content/article/32/89/abstract/ <b>Dans notre pays, le recours aux recettes de m&eacute;decine traditionnelle et aux produits cosm&eacute;tiques artisanaux est tr&egrave;s fr&eacute;quent en raison du taux &eacute;lev&eacute; d'analphab&eacute;tisme, du faible pouvoir d'achat et du grand nombre d'herboristes. Le camphre est un produit peu co&ucirc;teux, facilement accessible et omnipr&eacute;sent dans presque toutes les maisons, le rendant potentiellement toxique en cas de mauvaise utilisation, en particulier chez les enfants. Nous rapportons ici l'histoire de 2 cas d'intoxication cons&eacute;cutifs &agrave; une recette de beaut&eacute; &agrave; base de camphre en poudre. L'anamn&egrave;se donne des informations sur un empoisonnement par une poudre synth&eacute;tique &agrave; base de camphre import&eacute; de Chine chez 2 enfants. Patiente 1: fille &acirc;g&eacute;e de 2 mois, sans ant&eacute;c&eacute;dents, admise aux urgences p&eacute;diatriques dans un &eacute;tat de pleurs incessants avec refus de manger. L'examen clinique est sans caract&eacute;ristique particuli&egrave;re. Le test biologique standard &eacute;tait normal. Le nourrisson &eacute;tait sous surveillance neurologique, digestive et cutan&eacute;e. Patiente 2: jeune fille de 6 ans admise &agrave; la suite d'une crise atonique avec syncope et mousse, suivie d'une douleur abdominale accompagn&eacute;e d'une douleur abdominale accompagn&eacute;e de vomissements alimentaires cons&eacute;cutifs &agrave; l'ingestion de lait. L'&eacute;volution &eacute;tait favorable apr&egrave;s 48 heures de prise en charge symptomatique. L'entretien avec les m&egrave;res a r&eacute;v&eacute;l&eacute; qu'il s'agissait de deux voisins qui avaient re&ccedil;u une recette traditionnelle pour le soin des cheveux d'un troisi&egrave;me voisin, apr&egrave;s quoi ils avaient m&eacute;lang&eacute; du camphre en poudre avec de l'huile d'olive, puis l'avaient appliqu&eacute;e pendant 1 heure sur les cheveux de leurs enfants, provoquant ainsi l'apparition de ces signes.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Zongbing Cao, Dong Zhu, Chen Li, Yan-Hui Li, Lei Tan [Case report] - Traumatic anterior hip dislocation with associated bilateral femoral fractures in a child: a case report and review of the literature - 25 February 2019. http://www.panafrican-med-journal.com/content/article/32/88/abstract/ <b>Traumatic anterior hip dislocation is rare, because the hip joint is a highly stable joint. It is extremely rare for the anterior hip dislocation with combined bilateral femoral fracture in children. We present a case of 7-year-old boy with traumatic anterior hip dislocation with associated bilateral femoral fractures. Radiographic examination showed the right femoral head was dislocated anteroinferiorly. The ipsilateral femoral shaft showed a transverse femoral shaft fracture and proximal and distal femoral bifocal fractures of the contralateral femur. The dislocation of the right hip was reduced 10 hours after the injury in local hospital. One week later, the right femoral shaft fracture and left proximal femoral fracture were open reduced and internally fixed with plate and screws and the distal left femoral fracture was closed reduced and fixed with Kirschner wires. Postoperatively, active hip flexion and extension to recover hip and knee movement were then permitted but without weight bearing for 3 months. Radiographs at 3 months, at 6 months showed the fractures healed well and hardware were removed respectively. However, irregularities of the femoral head meaned avascular necrosis of the femoral head. This case stresses the importance of a rapid evaluation and treatment for the dislocation of the hip, providing a stable reduction and a firm internal fixation of the associated fractures.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Francois-Xavier Mbopi-Keou, Brian Williams, Laurent B&eacute;lec, Ginette Claude Mireille Kalla, Ibra Ndoye, Mamadou Henri Konate, Tina Gifty Mensah [Opinion] - African voices and leadership is imperative for the global AIDS response - 22 February 2019. http://www.panafrican-med-journal.com/content/article/32/87/abstract/ <b>This position paper is written in reference to the recent extensive media coverage of the report of the Independent Panel describing Harassment, Including Sexual Harassment, Bullying and Abuse of Power at UNAIDS Secretariat by several newspapers and authoritative journals such as Science and The Lancet. Unfortunately, none of these publications provide any clear evidence to support the accusations and merely repeat what are, in our view, unsubstantiated statements made in the report. Given the critical role that Africans have played in dealing with one of the most severe epidemics that the world has seen and the gravity of these charges, we believe it is essential to reaffirm that African voices and leadership is imperative for the global AIDS response.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Calypse Asangbe Ngwasiri, Ngo-Mbaki Charmaine Kwangsa, Martin Hongieh Abanda, Leopold Ndemnge Aminde [Case report] - Occurrence and challenges in the management of severe chronic plaque type psoriasis in a limited resourced setting: a case report - 20 February 2019. http://www.panafrican-med-journal.com/content/article/32/86/abstract/ <b>Plaque-type psoriasis is a major dermatosis with significant effects on quality of life. Case complexity is often high in low-resourced settings such as in Africa where the incidence has been on the rise. Despite major advancements and newer therapeutic modalities over the last decade, an insight into the real-life, day to day challenges in low resourced settings reveal an interplay between the difficulty in obtaining these drugs and use of alternative traditional indigenous agents. We report the case of a 50 year old immunocompetent male who presented with chronic and extensive well demarcated plaques covered with silver-white scales occupying about 61% of his body surface area. Patient was however lost to follow up for about 8 months during which time, the lesions responded to some unknown homemade indigenous medications which was preferred to a systemic medication. Paramount importance on proper counselling and the need to retain patients in care is warranted by physicians and allied health personnel. Also, incentives aimed at subsidizing the newer systemic agents for patients in low resourced cohorts will go a long way to combat this multi-faceted disorder which is often unrecognized and under diagnosed.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hamza Belatik, Lotfi Aouinti, Nabil Touiheme, Hicham Attifi, Karim Nadour, Ali El Boukhari [Case report] - Histological surprise of parotid tuberculosis: about two cases - 20 February 2019. http://www.panafrican-med-journal.com/content/article/32/85/abstract/ <b>Parotid tuberculosis remains a very rare localization in the Department of Otolaryngology and Cervico-Facial Surgery (ENT) sphere. It is presented in the form of a deceptive clinical picture causing confusion with other pathologies of the parotid gland, including tumor pathology. In addition, its lack of knowledge by practitioners increases the risk of missing the diagnosis. Often, the diagnosis is a histological surprise on a piece of excision after an exploratory parotidectomy. However, its treatment is primarily medical if the positive diagnosis is well established. We report medical observation of two new cases aged 44 and 45 respectively, who consult our center for parotid swelling. Radiological examinations were in favor of intraparotid cystic lesions. Both patients benefited from an excision whose histopathological study was in favor of primary parotid tuberculosis. The subsequent evolution was favorable under antituberculous treatment.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Lizette Mowatt, Ayodeji Ajanaku, Jennifer Knight-Madden [Research] - Knowledge, beliefs and practices regarding sickle cell eye disease of patients at the sickle cell unit, Jamaica - 19 February 2019. http://www.panafrican-med-journal.com/content/article/32/84/abstract/ <b>INTRODUCTION: Sickle cell disease can result in visually threatening eye disease (proliferative sickle cell retinopathy). This can be prevented with timely eye screening. It is important for patients to understand their role. Our research is to determine the knowledge, beliefs and practices (KBP) regarding eye disease of Sickle Cell patients and the impact of genotype, demographic and socio-economic status. METHODS: Cross-sectional study at the Sickle Cell Unit, Jamaica during May 2016. Consecutive non-pregnant adults (>18 years of age) attendees, who were not acutely unwell, were invited to participate. A 26-item single interviewer administered questionnaire was used to obtain socio-demographic data, highest level of education completed, employment status, sickle cell genotype, if known, frequency of clinic attendance and patients’ knowledge, beliefs and practices. Ten of these were yes/no questions, whereas eight required that they choose correct answers from four choices. RESULTS: One hundred subjects were recruited, 72% had homozygous SS disease. Their ages ranged from 18-63 years (mean 34.1 years, SD11.3). Fifty six percent were female. Most (75%) had achieved at least secondary education. The majority (62%) were unemployed. The mean belief score was 3.6/6 (60%) and the mean knowledge and practice scores were 3.3/7 (47%) and 2.2/5 (44%) respectively. Milder genotypes had higher knowledge scores vs the more severe genotypes (4.0 vs 3.2, P=0.013). Only 28% had regular eye examinations; less than 50% had seen an ophthalmologist in the past year. Practice scores were higher in employed than in unemployed patients (2.6 vs 1.9, (P=0.04)). Employed patients were more likely than the unemployed to see their eye doctor for regular eye ‘examinations’ (42.1% vs 19.4%, &#967;2=6.0, P=0.02). The practice and knowledge scores correlated (r<sup>2</sup>=0.363, P<0.001) and belief score (r<sup>2</sup>=0.304, P =0.002), except where 98% believed they should see an ophthalmologist annually, but only 42% did, and 21% had never. CONCLUSION: Knowledge scores were fair, however, the practice was not always in keeping with knowledge.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com At&iacute;lio Morais, Jotamo Come, Carlos Selemane, Germano Pires, Adriano Tivane, Matchecane Cossa, Satish Tulsid&aacute;s, Lu&iacute;s Antunes, Manuel Jo&atilde;o Costa, Moshin Sidat, Maria do Ros&aacute;rio Martins, Carla Carrilho, L&uacute;cio Lara Santos [Research] - Understanding the bricks to build better surgical oncology unit at Maputo Central Hospital: prevalent surgical cancers and residents knowledge - 18 February 2019. http://www.panafrican-med-journal.com/content/article/32/83/abstract/ <b>INTRODUCTION: cancer is a growing concern in Mozambique. However, the country has limited facilities and few oncologists. Surgical oncologists are an unmet need. The aim of this study was to assess residents' knowledge in prevalent cancer domains and to identify and characterize prevalent cancers treated by surgery at Maputo Central Hospital, the largest hospital in Mozambique. The expectations were that the findings shall inform the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital. METHODS: to identify and characterize prevalent cancers, we performed a retrospective analysis of individual cancer patient registries of Maputo Central Hospital (MCH), Mozambique. Information was recorded into data collection sheets and analyzed with SPSS® 21. To assess MCH residents oncologic knowledge, we invited Twenty-six junior residents (49% of all residents) of different specialties to take a 30 item multiple choice written test used elsewhere in previous studies. The test focused on the domains of Basis of oncology, Radiotherapy, Pathology, Chemotherapy, Pain management, Surgical oncology and Clinical Pathway. The test was administered anonymously and without prior notice. We analyzed the overall test and topic performance of residents. RESULTS: the study covered a period of 3 years and 203 patients. The most prevalent malignant tumors treated by general and thoracic surgery in MCH cancer registry were esophageal (7%), female breast (6.5%) and colorectal cancer (2.8%). Globally these malignancies were diagnosed at an advanced stage of the disease and required a multimodal treatment. The mean percent correct score of residents was 37.3%. The dimension with the highest percent correct score were clinical management (46%) and surgical oncology (28%) showed the lowest correct score. CONCLUSION: in Maputo, Mozambique esophageal, breast and colorectal cancer were the most prevalent malignancies treated, with surgery, by thoracic or general surgery in MCH. The test scores suggest that, among residents, the knowledge in oncology needs to be improved, rendering support to the need of a surgical oncology training tailored to suit the local needs. Specific training should take into account local cancer prevalence, resources, their quality and the support of surgical oncology services with volume and experience.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Adebola Adetiloye, Gregory Erhabor, Olayemi Awopeju, Olufemi Adewole, Ebimobowei Onini, Oladapo Adewuya [Case report] - Challenges of diagnosing and managing bronchiectasis in resource-limited settings: a case study - 18 February 2019. http://www.panafrican-med-journal.com/content/article/32/82/abstract/ <b>Bronchiectasis, once an orphan disease is now gaining renewed attention as a significant cause of morbidity and mortality. It is a morphologic term used to describe abnormal, irreversibly dilated and thick-walled bronchi, with many etiologies. The management of bronchiectasis can be challenging because its pathogenetic mechanisms is still evolving. Its diagnosis and management is particularly more demanding especially in resource-limited settings like Nigeria because of delayed diagnosis and improper management with devastating consequences, hence this case study.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Sqalli Houssaini Asmaa, Badreddine Hassam [Images in medicine] - Cutaneous tuberculosis with an unusual appearance and location - 18 February 2019. http://www.panafrican-med-journal.com/content/article/32/81/abstract/ <b>Tuberculosis is a bacterial disease caused by mycobacterium tuberculosis. It's cutaneous form accounts for 2% of all extrapulmonary tuberculosis. We report a case of 30-year-old woman with nodules evolving for two years. Examination showed gums of genital and inguinocrural location, and scrofulous scars. Several diagnoses were discussed including tuberculosis, syphilis, actinomycosis, or cutaneous lymphoma. Skin biopsy revealed an epithelial giganto-cellular granuloma with caseating necrosis; the culture of a cutaneous fragment was positive for Mycobacterium Tuberculosis. Our case is original and unusual due to the uncommon clinical appearance and location of the nodules grouped in the inguinocrural region. The multiplicity of the clinical forms of cutaneous tuberculosis sometimes makes the diagnosis difficult. Gums and scrofulodermas remain the most frequent forms of cutaneous tuberculosis in Morocco. According to the immuno-anatomo-clinical classification, tuberculous gum is part of the multi-bacillary forms and is seen mostly in immunocompromised patients.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Dhouha Bacha, Asma Sassi, Ghofrane Talbi, Sana Ben Slama, Lassad Gharbi, Saadia Bouraoui, Ahlem Lahmar [Case report] - A disconcerting false gastric diverticulum mimicking malignancy - 14 February 2019. http://www.panafrican-med-journal.com/content/article/32/80/abstract/ <b>Gastric diverticula are the most uncommon form of gastrointestinal diverticula. They can either be of true or false type with different pathogenesis. They may be very challenging to diagnose as symptoms are nonspecific and imaging can simulate a malignant lesion. We report an unusual case of pre-pyloric diverticulum in a 69-year-old man, leading to severe gastric obstruction with a poor general condition. As subsequent endoscopy and imaging were alarming and couldn't exclude malignancy, the patient underwent an antrectomy. The final diagnosis was made on pathological examination. We discuss, through this case, the clinical and pathological features of gastric diverticula with an emphasis on the pathogenesis of this rare entity and the risk of a malignant transformation.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Fidiniaina Mamy Randriatsarafara, Vatsiharizandry Mandrosovololona, Jean Claude Andrianirinarison, Antsa Nomenjanahary Rakotondrandriana, Armand Eugene Randrianarivo-Solofoniaina, Arsène Ratsimbaso, Jean de Dieu Marie Rakotomanga [Research] - Adh&eacute;rence des prestataires du secteur priv&eacute; &agrave; la politique de prise en charge des cas de paludisme simple &agrave; Madagascar - 14 February 2019. http://www.panafrican-med-journal.com/content/article/32/79/abstract/ <b>INTRODUCTION: Cette &eacute;tude se propose d’&eacute;valuer l’adh&eacute;rence des professionnels de sant&eacute; du secteur priv&eacute; &agrave; l'utilisation du TDR-palu (Test de Diagnostic Rapide-palu) et &agrave; la prescription de l’ACT (Artemisinin-based combination therapy) en cas de paludisme simple. METHODES: une approche &eacute;valuative r&eacute;trospective et transversale a &eacute;t&eacute; men&eacute;e en Septembre et Octobre 2015 aupr&egrave;s de 11 districts sanitaires repartis dans les quatre faci&egrave;s &eacute;pid&eacute;miologiques existant &agrave; Madagascar. Au total, 43 prestataires de soins issus de 39 formations sanitaires priv&eacute;es (FSP) ont &eacute;t&eacute; interview&eacute;s et visit&eacute;s. RESULTATS: les prestataires d&eacute;clarent avoir lu le manuel de prise en charge du paludisme dans 16,3% des cas (4/43). Seul le quart (25,6%) des prestataires dispose de TDR dans leur bureau. L’ACT a &eacute;t&eacute; cit&eacute; par 83,7% des prestataires comme m&eacute;dicament de premi&egrave;re intention pour traiter le paludisme simple. Dans la pratique, 55,6% des prestataires &eacute;mettent des doutes sur les r&eacute;sultats des TDR. L’utilisation des antipalud&eacute;ens malgr&eacute; les r&eacute;sultats n&eacute;gatifs des TDR (38,2%) est plus fr&eacute;quente chez ceux ayant &eacute;mis des doutes (p = 0,03). Inversement, malgr&eacute; un TDR positif, la moiti&eacute; des prestataires ne prescrit pas d’ACT (50%). La non-participation aux revues p&eacute;riodiques du District sanitaire (p = 0,05) influence n&eacute;gativement l’adh&eacute;rence aux politiques. CONCLUSION: la faible adh&eacute;rence des prestataires de soin du secteur priv&eacute; aux directives nationales sur la prise en charge des cas de paludisme simple interpelle sur l’int&eacute;r&ecirc;t d’encadrer davantage ce secteur.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Assia Fadili, Nadia Attouche, Boubaker Charra, Khadija Mchichi Alami, Mohamed Agoub [Case report] - Syndrome de s&eacute;cr&eacute;tion inappropri&eacute;e d’hormone antidiur&eacute;tique secondaire &agrave; la risp&eacute;ridone et la carbamaz&eacute;pine: &agrave; propos d’un cas - 13 February 2019. http://www.panafrican-med-journal.com/content/article/32/78/abstract/ <b>Le syndrome de s&eacute;cr&eacute;tion inappropri&eacute;e de l'hormone antidiur&eacute;tique (SIADH) repr&eacute;senterait environ 50% de tous les cas diagnostiqu&eacute;s d'hyponatr&eacute;mie. Seule une faible proportion de SIADH serait d'origine m&eacute;dicamenteuse. Nous rapportons le cas d'une patiente suivie pour un trouble schizo-affectif qui a d&eacute;velopp&eacute; le SIADH apr&egrave;s avoir commenc&eacute; un traitement &agrave; base de la risp&eacute;ridone et la carbamaz&eacute;pine. Les r&eacute;sultats des tests biochimiques sugg&eacute;raient un SIADH secondaire &agrave; l'utilisation de la risp&eacute;ridone et la carbamaz&eacute;pine. La patiente a &eacute;t&eacute; trait&eacute;e avec succ&egrave;s par l'arr&ecirc;t des deux m&eacute;dicaments et une restriction hydrique. Apr&egrave;s correction de la natr&eacute;mie la d&eacute;cision th&eacute;rapeutique &eacute;tait de mettre la patiente sous clozapine. Elle est actuellement sous 400mg avec des taux de natr&eacute;mie stables. Les psychiatres doivent &ecirc;tre conscients du risque d'hyponatr&eacute;mie s&eacute;v&egrave;re associ&eacute; aux m&eacute;dicaments psychotropes. Il est donc primordial de surveiller les &eacute;lectrolytes, en particulier le sodium, chez les patients prenant des antipsychotiques et des anticonvulsivants.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hind Cherrabi, Hind Aboueljaoud, Abdoulaye Diallo Harouna, Aziz El Madi, Khalid Khattala, Youssef Bouabdallah [Case series] - Le pseudokyste du pancr&eacute;as chez l’enfant: &agrave; propos de 7 cas - 12 February 2019. http://www.panafrican-med-journal.com/content/article/32/77/abstract/ <b>Le pseudokyste du pancr&eacute;as est une affection b&eacute;nigne, rare, en particulier chez l'enfant. Ce sont des collections de suc pancr&eacute;atique, d&eacute;pourvues de rev&ecirc;tement &eacute;pith&eacute;lial, et dont la localisation peut &ecirc;tre intra ou extra pancr&eacute;atique. Nous rapportons une &eacute;tude r&eacute;trospective de 7 enfants collig&eacute;s au service de chirurgie p&eacute;diatrique du centre hospitalier universitaire Hassan II de F&egrave;s, durant une p&eacute;riode de 11 ans, allant du 1er janvier 2005 au 31 d&eacute;cembre 2016. Tous les enfants &eacute;taient de sexe masculin, l'&acirc;ge moyen &eacute;tait de 6,6 ans (15 mois-12 ans). Un ant&eacute;c&eacute;dent de traumatisme abdominal &eacute;tait retrouv&eacute; dans 4 cas, le ballonnement abdominal, la douleur, les vomissements et les troubles du transit &eacute;taient les principaux motifs de consultation. L'examen clinique retrouvait chez tous les enfants une sensibilit&eacute; &eacute;pigastrique et une alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral, l'&eacute;chographie abdominale et le scanner abdominal r&eacute;alis&eacute;s respectivement ont permis de poser le diagnostic de pseudo kyste du pancr&eacute;as avant l'intervention chirurgicale. Six malades sur sept ont &eacute;t&eacute; op&eacute;r&eacute;s ; Nous avons opt&eacute; pour la d&eacute;rivation interne (anastomose gastro-kystique) dans 4 cas, une d&eacute;rivation externe dans 2 cas, et l'abstention th&eacute;rapeutique dans le dernier cas. Les Pseudo kystes du pancr&eacute;as sont des affections rares, n&eacute;anmoins, ils de loin les plus fr&eacute;quents (80% des l&eacute;sions kystiques du pancr&eacute;as &eacute;tant des pseudo kystes, et sont la cons&eacute;quence d'une pancr&eacute;atite aig&uuml;e et/ou chronique, d'un traumatisme pancr&eacute;atique, ou d'une obstruction canalaire pancr&eacute;atique.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Fatima Zahra Zaher, Nawal El Ansari [Images in medicine] - Subcutaneous calcinosis: a rare complication of chronic hypercalcemia - 12 February 2019. http://www.panafrican-med-journal.com/content/article/32/76/abstract/ <b>Subcutaneous calcinosis is a rare entity that may be secondary to either tissue damage, phosphocalcic disturbance or idiopathic origin. In the context of hypercalcemia, subcutaneous calcinosis remains a rare complication with few cases reported in the litterature. We report the case of a 27-year-old patient admitted for chronic hypercalcemia with right femur fracture and renal failure. Clinical examination found hard, painless, non-inflammatory subcutaneous nodules at the 2 elbows and at the lower gum (Panel A), the elbow radiography showed radiopaque structures in favor of subcutaneous calcinosis (Panel B). The etiological investigations of hypercalcemia showed a parathyroid hormon at 2200ng/ml (15-65), with cervical ultrasound showing a right inferior parathyroid nodule of 3cm * 1.6cm, in favor of primary hyperparathyroidism. The evolution was marked by the decrease of the size of the lesions in 15 days after normalization of the phosphocalcic balance after a symptomatic treatment based on intravenous rehydration, diuretics, corticosteroid bolus and bisphosphonate. Although hypercalcemia can reach very high serum levels in primary hyperparathyroidism, it is rarely accompanied by subcutaneous calcinosis. Indeed, it is hyperphosphoremia which represents the main factor involved in the development of cutaneous calcinosis in the context of phosphocalcic disturbances, and this independently of the level of hypercalcemia. Lesions tend to resolve spontaneously when calcium and phosphate levels normalize.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Soumaya Nasri, Narjisse Aichouni, Mounir Yahyaoui, Omar Agoumi, Imane Kamaoui, Imane Skiker [Case report] - Extra bone chondroma of the shoulder: a case study and literature review - 12 February 2019. http://www.panafrican-med-journal.com/content/article/32/75/abstract/ <b>Extra-osseous chondroma is a benign and rare tumor. It usually sits at the extremities, we report an exceptional case of a chondroma of the soft parts of the shoulder in a 28 year old woman who manifested by a painless swelling of the left shoulder. The histology confirmed the diagnosis on the excision piece. Clinical and radiological follow-up after a 24-month follow-up did not show a sign of recurrence.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Dhouha Bacha, Asma Sassi, Sana Ben Slama, Mouadh Nefiss, Lassad Gharbi, Saadia Bouraoui, Ahlem Lahmar [Case report] - Ost&eacute;ochondrome solitaire de la symphyse pubienne de d&eacute;couverte fortuite - 12 February 2019. http://www.panafrican-med-journal.com/content/article/32/74/abstract/ <b>L'ost&eacute;ochondrome est la tumeur osseuse b&eacute;nigne la plus fr&eacute;quente. Elle touche habituellement les m&eacute;taphyses des os longs, particuli&egrave;rement autour du genou et de l'hum&eacute;rus proximal. Il touche tr&egrave;s rarement la symphyse pubienne avec fr&eacute;quemment une symptomatologie atypique. Nous rapportons le cas d'un ost&eacute;ochondrome de la symphyse pubienne empi&eacute;tant sur la branche osseuse ilio-pubienne chez un homme de 35 ans, de d&eacute;couverte fortuite. Les explorations radiologiques, l'examen macroscopique et histologique confirment le diagnostic ainsi que l'absence de signe de malignit&eacute;.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Nomeharisoa Rodrigue Emile Hasiniatsy, Elodie Emile Batavisoaniatsy, Val&eacute;ry Refeno, Mamy Andriambololona, Andriatsihoarana Voahary Nasandratriniavo Ramahandrisoa, Florine Rafaramino [Letter to the editors] - ABO blood group in Malagasy patients with cancer: which group predominates? - 12 February 2019. http://www.panafrican-med-journal.com/content/article/32/73/abstract/ <b>The blood group of Malagasy patients with cancer have never been the subject of previous publications. Our objective was to determine the blood group of Malagasy patients with cancer followed in the Medical Oncology Unit of the Soavinandriana Teaching Hospital, Antananarivo. This was a one-year retrospective study (November 2012 to October 2013) in patients over the age of 15 with histological or pathological evidence of their cancer. One hundred and thirty of the 258 patients identified had an ABO blood group determination (50.39%). Among these 130 patients, 114 patients (87.69%) had solid tumors and 16 patients (12.31%) had hematologic malignancies. Thirty seven (28.49%) patients were transfused and 93 (71.54%) not transfused. There were 57 men and 73 women (sex ratio = 0.78), the average age was 55.11 +/- 14.76 years. With regard to their blood group, 52 patients (40%) were blood group B, 44 (33.84%) group O, 27 (20.76%) group A and 7 (5.38%) group AB. The order of blood group frequency of cancer patients in our series differs from other studies. This study has allowed us to know the proportion of each blood group in our Unit and thus help us in the management of stocks of labile blood products in our hospital.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hicham Laraqui, Mohamed Lamgari, Mohamed Essarghini, Aziz Zentar [Case report] - An unusual presentation of appendicitis: a 23 cm long appendix in Morocco - 12 February 2019. http://www.panafrican-med-journal.com/content/article/32/72/abstract/ <b>The appendix is a diverticulum attached to the caecum. It can have variable lengths and locations. Acute inflammation from long appendix is a diagnostic challenge with unusual signs and symptoms. A 35 years old man admitted to the emergency department for an acute abdominal pain with low-grade fever which had been present for 03 days. The abdomen Ultrasound showed minimal effusion in the right iliac fossa. He underwent an appendicectomy which revealed a very long appendix (23 cm in length) with tip reaching the sub hepatic area. The surgeon must kip in mind all anatomical variations of the appendix for making diagnosis and decisison to operate acute appendicitis because the increasing risk of morbidity.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Paa-Kwesi Blankson, Grace Parkins, Matthew Owusu Boamah, Alhassan Emil Abdulai, Abdul-Majeed Ahmed, Sarah Bondorin, Isaac Nuamah [Research] - Severe odontogenic infections: a 5-year review of a major referral hospital in Ghana - 12 February 2019. http://www.panafrican-med-journal.com/content/article/32/71/abstract/ <b>INTRODUCTION: Odontogenic infections are fairly common in healthcare settings. However, late presentations such as Ludwig’s angina, facial cellulitis, necrotizing cervical fasciitis (NCF), among others could lead to mortality. In view of suggestions that the occurrence of severe, near-fatal odontogenic infections is declining, this study set out to determine the incidence of such severe odontogenic infections over the past 5 years at the Korle-Bu Teaching Hospital, a major referral centre in Ghana. METHODS: A retrospective review was done, involving all patients with severe odontogenic infection, thereby requiring admission, per stated criteria at the Department of Oral and Maxillofacial Surgery (Dental clinic), Korle-Bu Teaching Hospital, in the period between July 2012 and July 2017. The cumulative incidence for the respective years were then computed for the years of review. RESULTS: A total of 243 patients were included in the study. This consisted of 121 males and 122 females, with an average age of 42.9 years (SD=16.6), ranging from 18 months to 91 years. Incidence proportions for the years of the review were 8.2, 8.9, 17.7, 17.9 and 27.7 people per 1000 cases of tooth-related infections for the respective years. With a fatality rate of 5.8%, the incidence of odontogenic infections among patients attending the outpatient Dental clinic of the hospital is 40.3%, while that of dentoalveolar abscess is 6.2%. Ludwig’s angina was the commonest (52%) form of presentation of spreading odontogenic infection. CONCLUSION: This study highlights the importance of persisting severe, near-fatal odontogenic infections in Ghana. Not only is there a need to assess the public, professional and institutional strategies to management, but for more evidence-based studies in our local setting to aid in management.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Boubacar Diallo, Mohamed Keita, Hammadoun Dicko, Mamadou Karim Toure, Seydina Alioune Beye, Joseph Kone, Daouda Diallo, Abdoul Hamidou Almeimoune, Moustapha Issa Mangane, Sory Traore, Abdoulaye Traore, Birama Togola, Di&eacute;n&eacute;ba Doumbia, Youssouf Coulibaly [Case report] - H&eacute;matome r&eacute;tro-p&eacute;riton&eacute;al cons&eacute;cutif &agrave; une envenimation vip&eacute;rine: &agrave; propos d’un cas - 08 February 2019. http://www.panafrican-med-journal.com/content/article/32/70/abstract/ <b>Les envenimations ophidiennes constituent un probl&egrave;me de sant&eacute; publique en Afrique, entrainant 20 000 d&eacute;c&egrave;s annuels. Cette mortalit&eacute; traduit les difficult&eacute;s de prise en charge des complications en particuliers h&eacute;morragiques. Nous rapportons le cas de Mr SL 35 ans, agriculteur, victime d'une morsure de vip&egrave;re entrainant un syndrome h&eacute;morragique, suivi d'un abdomen aigu d'installation progressive. L'&eacute;chographie objectivait un &eacute;panchement de grande abondance, dont la ponction ramenait du sang incoagulable. Devant la reconstitution de l'h&eacute;mop&eacute;ritoine apr&egrave;s trois doses de s&eacute;rum antivenimeux et la coagulation des pr&eacute;l&egrave;vements sur tube sec, une laparotomie exploratrice &eacute;tait r&eacute;alis&eacute;e &agrave; J9. Elle a retrouv&eacute; un h&eacute;matome retro p&eacute;riton&eacute;al bombant dans le m&eacute;so-colon et qui s'&eacute;coulait dans la cavit&eacute; p&eacute;riton&eacute;ale. Le geste a consist&eacute; &agrave; une &eacute;vacuation de 1500ml de sang, et un toilettage au s&eacute;rum physiologique. Les suites op&eacute;ratoires ont &eacute;t&eacute; simples. Le patient &eacute;tait transf&eacute;r&eacute; en secteur d'hospitalisation de chirurgie &agrave; J3 post op&eacute;ratoire puis sortie d'h&ocirc;pital &agrave; J19.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Adoukonou Thierry, Accrombessi Donald, Agb&eacute;tou Mendinatou, Houinato Dismand [Research] - Incidence de l'epilepsie apr&egrave;s un accident vasculaire cerebral &agrave; Parakou en 2014 - 07 February 2019. http://www.panafrican-med-journal.com/content/article/32/69/abstract/ <b>INTRODUCTION: les accidents vasculaires c&eacute;r&eacute;braux (AVC) constituent une des principales causes acquises de l'&eacute;pilepsie de l'adulte mais peu de donn&eacute;es sont disponibles sur l'incidence de l'&eacute;pilepsie apr&egrave;s un AVC en Afrique. L'objectif de cette &eacute;tude &eacute;tait d'estimer l'incidence de l'&eacute;pilepsie chez les patients victimes d'AVC &agrave; Parakou. METHODES: il s'est agi d'une &eacute;tude de type cohorte dynamique ayant inclus 203 patients victimes d'AVC et hospitalis&eacute;s dans le service de neurologie du CHU de Parakou. Les patients aux ant&eacute;c&eacute;dents d'&eacute;pilepsie &eacute;taient exclus du suivi. Les patients &eacute;taient suivis sur une p&eacute;riode de 21mois allant du 1er Janvier 2013 au 30 Septembre 2014. L'&eacute;pilepsie &eacute;tait d&eacute;finie selon les crit&egrave;res de la Ligue Internationale contre l'Epilepsie. RESULTATS: ils &eacute;taient &acirc;g&eacute;s de 18 &agrave; 99 ans avec une moyenne de 58,4 ans ± 14,2 ans. Le d&eacute;lai moyen de consultation apr&egrave;s l'installation des sympt&ocirc;mes &eacute;tait de 54,3h (+/-112,9h). Les AVC isch&eacute;miques repr&eacute;sentaient 45,8%, les h&eacute;morragiques 31% et 23,2% d'ind&eacute;termin&eacute;s. L'incidence cumul&eacute;e de l'&eacute;pilepsie &eacute;tait de 17. La densit&eacute; d'incidence de l'&eacute;pilepsie &eacute;tait de 9,8 pour 100 personnes-ann&eacute;es. Les facteurs associ&eacute;s &agrave; la survenue de l'&eacute;pilepsie &eacute;taient le niveau d'instruction, la dur&eacute;e d'hospitalisation et le score de BARTHEL. CONCLUSION: l'incidence de l'&eacute;pilepsie reste tr&egrave;s &eacute;lev&eacute;e et la prise en compte des facteurs associ&eacute;s dans les strat&eacute;gies de prise en charge pourrait permettre de r&eacute;duire sa charge globale.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Muhammad Manzoor Ul Haque, Rajesh Kumar Whadva, Nasir Hassan Luck, Muhammed Mubarak [Case report] - Primary hepaticobiliary tuberculosis mimicking gall bladder carcinoma with liver metastasis: a case report - 07 February 2019. http://www.panafrican-med-journal.com/content/article/32/68/abstract/ <b>Primary hepatic tuberculosis is a rare presentation and sporadically reported in the literature, mostly from our part of the world. Sometimes the presentation can be atypical and mimics hepatic tumor and poses diagnostic challenge. We, herein, present a case of a 58-year-old man who presented to us with abdominal pain and weight loss. Raised serum alkaline phosphatase (ALP) and imaging raised a suspicion of gall bladder carcinoma with hepatic invasion. Peroperative frozen section revealed hepatic chronic granulomatous inflammation with caseous necrosis consistent with the diagnosis of hepatic tuberculosis. Surgery was postponed and he was put on antituberculous treatment. It is important to consider tuberculosis in the differential diagnosis of the space occupying lesion of liver in a patient with vague symptoms and abnormal findings on imaging.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Luchuo Engelbert Bain, Elvis Enowbeyang Tarkang, Ikenna Desmond Ebuenyi, Raoul Kamadjeu [Editorial] - The HIV pandemic will not end by the year 2030 in low and middle income countries - 07 February 2019. http://www.panafrican-med-journal.com/content/article/32/67/abstract/ <b>The recent Lancet Commission-International AIDS Society report: Advancing Global health and strengthening the HIV response in the Era of the Sustainable Development Goals; clearly highlights the fact that the world is NOT on track in ending the HIV pandemic by 2030. Emphasis on massive and early diagnosis and placement on Combined Anti- Retroviral Therapy (cART) remain key cornerstones in reaching these goals. Effective viral load informed care remains very promising in reducing drug resistance, and improving outcomes in infected persons. The authors argue that the current funding trends, management paradigms, research agendas, data collection and information system models, as well as the overall appreciation of the evolution of the pandemic in low and middle- income countries, lead to a logical conclusion that this pandemic will not end, especially in these countries by 2030. Major action areas are proposed for policy makers and researchers for appreciation.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Marc Jamoulle, Daniel Knupp Augusto, Miguel Pizzanelli, Ariana De Oliveira Tavares, Melissa Resnick, Julien Grosjean, Stefan Darmoni [Research] - Une base de connaissance multilingue et dynamique en ligne pour la m&eacute;decine g&eacute;n&eacute;rale et les soins primaires - 05 February 2019. http://www.panafrican-med-journal.com/content/article/32/66/abstract/ <b>INTRODUCTION: La classification internationale des soins primaires, deuxi&egrave;me version (CISP-2) align&eacute;e sur la classification internationale des maladie dixi&egrave;me r&eacute;vision (CIM-10) est un standard pour le recueil &eacute;pid&eacute;miologique en soins primaires. La CISP-2 convient aussi pour identifier les th&egrave;mes cliniques dont discutent les m&eacute;decins de famille. Les domaines contextuels de connaissances sp&eacute;cifiques &agrave; la m&eacute;decine de famille et aux Soins Primaires comme les structures, la gestion, les cat&eacute;gories de patients, les m&eacute;thodes de recherche, les aspects &eacute;thiques ou environnementaux ne sont pas standardis&eacute;s et refl&egrave;tent le plus souvent des vues d'experts. METHODES: une m&eacute;thode de recherche qualitative, appliqu&eacute;e &agrave; l'analyse de plusieurs congr&egrave;s de m&eacute;decine de famille a permis d'identifier, en plus des items cliniques, un ensemble de concepts contextuels abord&eacute;s par les m&eacute;decins de famille lors de leurs &eacute;changes pendant les congr&egrave;s. Assembl&eacute;s sous forme hi&eacute;rarchique, ces concepts ont trouv&eacute; leur place au c&ocirc;t&eacute; de la CISP-2, sous le nom de Q-codes version 2.5, sur le serveur s&eacute;mantique multilingue multi-terminologique du D&eacute;partement d'Information et d'Informatique m&eacute;dicale (D2IM) de l'Universit&eacute; de Rouen, France. Les deux classifications sont &eacute;dit&eacute;es sous le sigle 3CGP pour Core Content Classification of General Practice. Ce serveur d'acc&egrave;s libre permet de consulter la CISP-2 en 22 langues et les Q-codes en dix langues. RESULTATS: le r&eacute;sultat de l'utilisation conjointe de ces deux classifications, comme descripteurs dans des congr&egrave;s, pour identifier des concepts dans des textes, ou indexer la litt&eacute;rature grise en m&eacute;decine de famille et soins primaires est pr&eacute;sent&eacute; ici dans diff&eacute;rentes utilisations pilotes. La validit&eacute; et la g&eacute;n&eacute;ralisabilit&eacute; de 3CGP semble bonne au vu des traductions d&eacute;j&agrave; r&eacute;alis&eacute;es par des coll&egrave;gues du monde entier et de l'applicabilit&eacute; de la m&eacute;thode des deux c&ocirc;t&eacute;s de l'Atlantique. Toute fois la reproductibilit&eacute; et la variation inter-codeurs restent encore &agrave; tester pour les Q-codes. La question de la maintenance reste pos&eacute;e. CONCLUSION: gr&acirc;ce &agrave; cette m&eacute;thode, on peut mettre en &eacute;vidence l'extension conceptuelle, la complexit&eacute; et la dynamique du m&eacute;tier de m&eacute;decin g&eacute;n&eacute;raliste et de famille et de m&eacute;decin de soins primaires.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Malumani Malan, Wu Xuejingzi, Jiang Si, Song Ji Quan [Case report] - Hailey-Hailey disease: the role of azathioprine an immunomodulator - 05 February 2019. http://www.panafrican-med-journal.com/content/article/32/65/abstract/ <b>Hailey-Hailey disease (HHD) is a rare autosomal dominant hereditary blistering and erosions disorder affecting the intertriginous regions of the body. There is still no treatment protocol for this disease thus clinicians are highly advised to draw up individualized treatment plan. In this case report we discuss a case of HHD in a 58-year-old Chinese man who was successfully treated with azathioprine in Hubei province.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Eniola Olubukola Cadmus, Lawrence Adekunle Adebusoye, Olufemi Oluwole Olowookere, Adebowale Taiwo Olusegun, Oluwagbemiga Oyinlola, Raimi Olalekan Adeleke, Olubukola Christianah Omobowale, Temitope Oluwagbenga Alonge [Research] - Older persons’ perceptions about advanced directives and end of life issues in a geriatric care setting in Southwestern Nigeria - 05 February 2019. http://www.panafrican-med-journal.com/content/article/32/64/abstract/ <b>INTRODUCTION: Advanced directives enable the planning of care and support services independent of the older person’s ability to make the decision. There is a paucity of information regarding the views and preferences regarding advanced directives and other end of life issues among older persons in low and middle-income countries such as Nigeria. The study aimed to explore the knowledge, attitude and belief of older persons regarding decision making surrounding end of life and advance directives. METHODS: data were collected through focus group discussions at a monthly social gathering of outpatients in a geriatric center in Oyo State, Nigeria. Discussions were audiotaped, transcribed and analyzed manually using a thematic approach. RESULTS: respondents’ knowledge about the end of life care and advanced directives as prescribed in high income settings were sparse and did not include choices about treatment options or any medical directives. The predominant perceptions among the participants bordered mainly on the arrangements for place of death, burial and property sharing. Participants listed in order of preference the major decision makers in the advanced directive process mainly, the oldest male child, religious leaders and legal practitioners. CONCLUSION: our findings imply the need for improving knowledge and awareness about the benefits of advanced directives among older persons with a focus on opportunities for their active participation.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Gifty Gyamah Nyante, Catherine Oppong, Emmanuel Bonney [Research] - Sex differences in physical activity among Ghanaian patients with sickle cell disease - 05 February 2019. http://www.panafrican-med-journal.com/content/article/32/63/abstract/ <b>INTRODUCTION: Musculoskeletal pain and functional limitations experienced by patients with Sickle Cell Disease (SCD) impact their physical activity and social behaviour. Yet, we know little about physical activity behaviour in patients with SCD. The aim of this study was to investigate gender differences in physical activity, sedentary time and measures of fitness among Ghanaian adults with SCD. The study also determined the association between outcome variables in this population. METHODS: Patients with SCD attending a sickle cell clinic in a tertiary hospital in Accra, Ghana participated in this cross-sectional study. Physical activity, sedentary time, body composition, flexibility and cardiovascular endurance were assessed. Demographic data were also collected by self-report. RESULTS: Fifty three participants enrolled in the study. Of these, more than half were females (60.4%) and the average age of the participants was (M: 26.8, SD: 8.5 years). The total physical activity reported by the participants was different between males and females (t = 2.610, p = 0.012). However, there were no gender differences in sedentary time, body composition, flexibility and cardiovascular endurance. A moderately significant association was found between sedentary time and cardiovascular endurance (r = 0.437, p = 0.001). CONCLUSION: The findings suggest that gender differences in physical activity are apparent in patients with SCD. Investigations into the mechanisms underpinning these differences are warranted. Additionally, longitudinal observations of objectively measured physical activity may be useful to validate these results in a larger sample.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Leila Afani, Hassan Errihani, Ahmad Awada [Case report] - Prise en charge th&eacute;rapeutique des paragangliomes malins: revue de litt&eacute;rature &agrave; travers un cas illustratif - 05 February 2019. http://www.panafrican-med-journal.com/content/article/32/62/abstract/ <b>Les paragangliomes malins pr&eacute;sentent un r&eacute;el challenge pour les praticiens. Il s'agit de tumeurs rares, de caract&eacute;risation complexe et tr&egrave;s h&eacute;t&eacute;rog&egrave;nes dans leur &eacute;volution et pronostic. Devant la raret&eacute; de ce groupe tumoral, il n'existe pas de consensus sur la prise en charge th&eacute;rapeutique. A travers ce cas illustratif, nous rapportons l'observation d'une patiente de 29 ans suivie pour un paragangliome malin trait&eacute;e initialement par chirurgie. Apr&egrave;s six mois d'intervalle, r&eacute;cidive multifocale fixant &agrave; l'Octreo PET-CT (Positron Emission Tomography- Computer Tomography). La patiente a &eacute;t&eacute; mise sous injection mensuelle de Somatuline pendant un an puis arr&ecirc;t&eacute; suite &agrave; une progression. Une 2&egrave;me chirurgie de cytor&eacute;duction a &eacute;t&eacute; r&eacute;alis&eacute;e suivie d'une radioth&eacute;rapie. Apr&egrave;s un an, la patiente a pr&eacute;sent&eacute; une progression massive. Une chimioth&eacute;rapie &agrave; base de Dacarbazine a &eacute;t&eacute; initi&eacute;e et dont l'&eacute;valuation a montr&eacute; une r&eacute;ponse m&eacute;tabolique quasi compl&egrave;te apr&egrave;s huit cures. Le but de ce travail est d'exposer les diff&eacute;rentes options th&eacute;rapeutiques possibles dans la prise en charge des paragangliomes malins.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Christine Aanyu, Daniel Kadobera, Rebecca Racheal Apolot, Angela Nakanwagi Kisakye, Peter Nsubuga, William Bazeyo, John Bosco Ddamulira [Research] - Prevalence, knowledge and practices of shisha smoking among youth in Kampala City, Uganda - 05 February 2019. http://www.panafrican-med-journal.com/content/article/32/61/abstract/ <b>INTRODUCTION: Globally tobacco use kills more than seven million people annually, a figure expected to rise to 8 million deaths every year by 2030. Though perceived as safe, shisha smoking is reported to have the same or worse health effects as cigarette smoking yet, this practice has gained popularity especially among youths globally. We assessed shisha smoking and factors associated with shisha smoking to support public health interventions. METHODS: a cross-sectional study was conducted among 663 systematically selected youths aged between 18-30 years attending bars in two divisions of Kampala city Uganda. Data was analyzed using Stata version 12 and logistic regression model run to establish factors independently associated with shisha smoking. RESULTS: we found that 458 (86.4%) youths had low knowledge of the health effects of shisha and 193 (36.4%) smoked shisha. Majority of the respondents, 184 (97.4%) smoked flavoured and sweetened tobacco, 69 (36.5%) smoked on a weekly basis, 163 (86.2%) smoked in the company of friends, 162 (85.7%) shared shisha pipes. Factors associated with shisha smoking include smoking cigarettes adjusted odds ratio [aOR]: 5.91, 95% Confidence Interval (CI): 3.86-9.05); positive attitude (aOR: 3.89, 95% CI: 2.50-6.05); urban residence (aOR: 3.98, 95% CI: 1.99-8.00) and older age [25-30 years] (aOR: 2.13, 95% CI: 1.37-3.22). CONCLUSION: the prevalence of shisha smoking is high with three in ten youths smoking shisha yet their knowledge about the health effects associated with shisha smoking was low. Shisha smoking ban should be implemented in all bars in Kampala as stated by the newly enacted tobacco law.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Mobolanle Rasheedat Balogun, Adekemi Oluwayemisi Sekoni, Seema Thakore Meloni, Oluwakemi Ololade Odukoya, Adebayo Temitayo Onajole, Olukemi Arinola Longe-Peters, Folasade Tolulope Ogunsola, Phyllis Jean Kanki [Research] - Predictors of tuberculosis knowledge, attitudes and practices in urban slums in Nigeria: a cross-sectional study - 04 February 2019. http://www.panafrican-med-journal.com/content/article/32/60/abstract/ <b>INTRODUCTION: Nigeria is among six countries responsible for the majority of tuberculosis (TB) cases in the world. The Nigerian government has emphasized community-based case finding to increase detection of TB. This process requires efforts to improve knowledge, attitudes and practices (KAP) of TB, particularly in the poorest of communities. This study presents data from a KAP survey administered in two underserved Nigerian communities. METHODS: A structured survey was administered by trained interviewers among adult residents in two slum communities in Lagos, Nigeria. Participants were selected through multistage random sampling. KAP scores were computed and the predictors of higher scores were assessed. RESULTS: A total of 504 respondents were surveyed. The mean KAP scores were relatively low: 9.8 ± 7.1 for knowledge (out of a maximum 34), 5.3 ± 3.4 for attitude (maximum=10) and 5.2 ± 1.5 for practice (maximum=7). The predictors of good knowledge were increasing age, post secondary education and professional occupation. The predictors of positive attitude were post secondary education and good TB knowledge. Good knowledge was a predictor of good practice. CONCLUSION: Our findings underscore the need to improve the education about TB in underserved communities. Improving KAP scores will ultimately lead to higher rates of TB detection and treatment.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ernst Patrick Graamans, Tara Rava Zolnikov, Eefje Smet, Peter Ngatia Nguura, Lepantas Charles Leshore, Steven ten Have [Research] - Lessons learned from implementing alternative rites in the fight against female genital mutilation/cutting - 04 February 2019. http://www.panafrican-med-journal.com/content/article/32/59/abstract/ <b>INTRODUCTION: Historically, programs aimed at making communities abolish female genital mutilation or cutting (FGM/C) consisted mainly of awareness campaigns on sexual reproductive health and rights and the enforcement of newly implemented laws. These types of programs or interventions have proven to be only partially effective and sometimes yield unintended results, such as actually strenghtening commitment to FGM/C or transforming it into a secret practice. A newer approach to change that is intended to account for the cultural meanings ascribed to FGM/C are alternative rites of passage (ARP). Amref Health Africa started adopting this approach in 2007. Since then, by a trial-and-error process lessons have been learned, that will be reflected upon in this paper. METHODS: Desk research was conducted on organizational data regarding all Amref Health Africa's efforts to end FGM/C. Ninety-four in-depth formal interviews were held with members from Maasai and Samburu communities in Kenya targeted through maximum variation sampling. And participant observation of significative events as well as daily pastimes took place during school holiday season at the end of 2016. Furthermore extensive informal talks were held with project donors, activists, journalists, members of other non-governmental organizations, members of community services organizations, local government officials, high-ranking Dutch and US diplomats and senior members of the Anti-Female Genital Mutilation Board, which is part of the Kenyan Ministry of Public Service, Youth and Gender Affairs. On the basis of these data a framework on different positions on FGM/C was developed and published in early 2018. By reviewing the data again from a particular change management and public health perspective, by peer-debriefing within a multi-disciplinary research team and by explicating the lessons learned this paper adds to an overview that is of crucial importance to practitioners working to end FGM/C. RESULTS: Risk of exclusion, perceived loss of cultural identity, changing meanings ascribed to cultural practices, lack of precise knowledge about subjective (sexual) experience and negative stereotyping are reasons not to adhere to anti-FGM/C programs. Areas of concern are the role confusion with following-up on policing, perceived outsider interference and the intended prolonging of the transition phase not being explicated and embedded with ARP. Aspects to enhance to lever change more effectively are education and school curriculum development, male involvement, new stylization of love relationships, monitoring and evaluation and inclusive aspects of religion.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Mouna Ejjiyar, Mehdi Sahibi, Mehdi El Gueouatri, Abdelkoddous Bhihi, Mehdi Mahrouch, Imane Yafi, Moulay Driss El Amrani, Yassine Benchamkha [Case report] - Vitiligo et ph&eacute;nom&egrave;ne de Koebner suite &agrave; des injections de plasma riche en plaquettes - 04 February 2019. http://www.panafrican-med-journal.com/content/article/32/58/abstract/ <b>Le vitiligo est un trouble commun et acquis de la pigmentation cutan&eacute;e caract&eacute;ris&eacute; par une perte s&eacute;lective et souvent continue de m&eacute;lanocytes &eacute;pidermiques. Nous rapportons le cas d'une patiente ayant d&eacute;velopp&eacute; un vitiligo de la face suite &agrave; des injections de plasma riche en plaquettes. Le diagnostic de ph&eacute;nom&egrave;ne de Koebner a &eacute;t&eacute; retenu pour expliquer la survenue de vitiligo sur les zones m&ecirc;mes d'injection de plasma riche en plaquettes.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Kamal Lahrach, Khalid Ibn El Kadi, Amine Marzouki, Fawzi Boutayeb [Case report] - Talar body fracture combined with medial malleolar fracture: a case report and literature review - 31 January 2019. http://www.panafrican-med-journal.com/content/article/32/57/abstract/ <b>Fracture of the talar body is rare, it reaches articular congruence and determines the ankle's functional prognosis. The authors report a case of a combination of a sagittal talar body fracture with fracture of the medial malleolus in a 52-year-old following a road traffic accident. The association talus body fracture with a medial malleolus fracture is exceptional. Stable internal fixation can yield good functional results.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Fatima Ezzahra Imad, Houda Drissi, Nezha Tawfiq, Karima Bendahhou, Nadia Tahiri Jouti, Abdellatif Benider, Driss Radallah [Research] - Aspects &eacute;pid&eacute;miologiques, nutritionnels et anatomopathologiques des cancers colorectaux dans la r&eacute;gion du grand Casablanca - 31 January 2019. http://www.panafrican-med-journal.com/content/article/32/56/abstract/ <b>INTRODUCTION: Le cancer colorectal constitue un probl&egrave;me majeur de sant&eacute; publique. L’objectif de notre &eacute;tude est d’analyser le profil &eacute;pid&eacute;miologique, nutritionnel, clinique et anatomo-pathologique des cancers colorectaux recrut&eacute;s au CHU de Casablanca. METHODES: Notre &eacute;tude cas-t&eacute;moins a port&eacute; sur les patients pris en charge pour un cancer colorectal durant l’ann&eacute;e 2015, compar&eacute;s &agrave; des t&eacute;moins non suivi pour un cancer. RESULTATS: L’&acirc;ge moyen des patients &eacute;tait de 56,65 ans avec un &eacute;cart type de 14,64. Le type histologique le plus fr&eacute;quent chez nos patients &eacute;tait repr&eacute;sent&eacute; par l’ad&eacute;nocarcinome Lieberkh&uuml;nien avec une proportion de 82 %. L’analyse de l’indice de masse corporelle a permis de retrouver une ob&eacute;sit&eacute; chez 50% des patients contre 20% des t&eacute;moins et un diab&egrave;te chez 19% des patients versus 8% des t&eacute;moins (p < 0,019). Par ailleurs, l’&eacute;tude du r&eacute;gime alimentaire des patients compar&eacute; &agrave; celui des t&eacute;moins semble montrer que la moyenne de la fr&eacute;quence de consommation hebdomadaire de viandes rouges est plus &eacute;lev&eacute;e chez les patients que chez les t&eacute;moins (4,24 vs 3,26; p= 0,009) et inversement pour la consommation du poissons (0,97 contre 1,76; p = 0,0001). En revanche, la moyenne de consommation des l&eacute;gumes et des fruits est plus faible chez les patients que chez les t&eacute;moins (5,00 vs 9,50; p = 0,0001). Concernant les habitudes toxiques de nos patients, 32% des patients &eacute;taient fumeurs vs 13 % des t&eacute;moins. CONCLUSION: Nos r&eacute;sultats montrent que la prise de conscience &agrave; propos du r&eacute;gime alimentaire et des changements dans nos habitudes de vie pourrait r&eacute;duire l’incidence du cancer colorectal et par cons&eacute;quent la mortalit&eacute; et la morbidit&eacute;.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Federica Iezzi, Michele di Summa, Paolo Del Sarto, James Munene [Case study] - Fast track extubation in paediatric cardiothoracic surgery in developing countries - 30 January 2019. http://www.panafrican-med-journal.com/content/article/32/55/abstract/ <b>In recent years, low-dose, short-acting anesthetic agents, which replaced the former high-dose opioid regimens, offer a faster postoperative recovery and decrease the need for mechanical ventilatory support. In this study, the aim was to determine the success rate of fast-track approach in surgical procedures for congenital heart disease. There is some evidence, mostly from retrospective analyses, that fast tracking can be beneficial. Ninety-one cases with moderate complex cardiac malformations were operated with fast-track protocol during cardiothoracic charitable missions. The essential aspects of early extubation in our cohort included: selected patients with good preoperative status, good surgical result with hemodynamic stability in low dose of inotropic drugs at the end of bypass, no active bleeding. In this setting a carefull choice and dosing of anesthetic agents, alongside a good postoperative analgesia are mandatory. The authors found that an early extubation (< 4 hours) can be both effective and safe as it reduces intubation and ventilator times without increasing post-operative complications in pediatric congenital heart disease. This study supports a wider use of fast-track extubation protocols in paediatric patients submitted for congenital cardiac surgery in developing countries.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Enesia Mudenha Ziki, Zvavahera Mike Chirenje, Mugove Gerald Madziyire [Case report] - A case of twin reversed arterial perfusion (TRAP) sequence managed conservatively - 30 January 2019. http://www.panafrican-med-journal.com/content/article/32/54/abstract/ <b>The TRAP sequence, also known as acardiac twinning is a rare complication that is unique to monochorioinic multiple pregnancies affecting 1% of monochorioinic pregnancies and about 1 in 35000 of all pregnancies. In TRAP, blood flows from the umbilical artery of the pump twin to the umbilical artery of the perfused twin through artery to artery (AA) anastomosis. The perfused twin has poor development of the upper extremities and the normal or pump twin is at risk of a poor perinatal outcome. This is a report of a patient with TRAP sequence diagnosed in the second trimester who was managed conservatively and had a good outcome for the normal twin.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Palle John Ngunde, Asang Christian Ngwa Akongnwi, Chichom Alain Mefire, Fokam Puis, Eleanor Gounou, Ngwayu Claude Nkfusai, Udoamaka Glory Nwarie, Samuel Nambile Cumber [Research] - Prevalence and pattern of lower extremity injuries due to road traffic crashes in Fako Division, Cameroon - 30 January 2019. http://www.panafrican-med-journal.com/content/article/32/53/abstract/ <b>INTRODUCTION: Low and middle income countries are disproportionately affected with road traffic injuries and the lower extremity is one of the most affected anatomical body parts. There exist very limited data on the pattern of lower extremity injuries in the Cameroon especially in the South West Region. We therefore, hypothesized that lower limb injuries are common in road traffic crashes and motorized two wheelers are the commonest cause. METHODS: this was a hospital based prospective, cross sectional study. It involved four hospitals (Limbe and Buea Regional Hospitals, Baptist hospital Mutengene and Tiko District Hospital) in the Fako Division. It was carried out for three months. Victims of road traffic crashes received at emergency department of these hospitals during this period were assessed. Crash characteristics and injury characteristics were assessed and recorded. RESULTS: we analyzed 411 crash victims, 197(47.93%) had lower extremity injuries. The male to female ratio was 1.4:1. Majority of crash victims were in their 3rd and 4th decades of life. The mean age of patients who had lower limb injuries was 33.30(±16.04). The most vulnerable road users were pedestrians (26.52%) and passengers on motor bikes (38.44%) and the commonest mechanism by which crash victims sustained injuries were: bike-car collisions (22.84%), and bike-pedestrian collisions (19.29%). Commercial motor bikes (62.77%) and taxis (22.38%) were the road users most involved in road traffic collisions. The leg 98(49.75%), thigh 23(11.68%), and knee 20(10.15%) were the most injured anatomical parts of the lower extremity. Fractures 68 (34.52%), lacerations 53(26.90%), and bruises 49(24.87%) were the most recurrent pattern of lower extremity injuries. CONCLUSION: in view of our findings we conclude therefore as follows: The prevalence of lower extremity injuries from Road Traffic Crashes in our study area was 47.93%. Associated risk factors to the road traffic crashes as identified by the victims were bad roads (10.15%) and bad weather (5.05%). The safety gargets were not adequately utilized by our victims, with 87.72% confirming that they did not wear the helmet and 87.50% affirming that they did not wear the seat belt at the time of the crash. The occupations mostly affected in our series were pupils and students (20.3%) and business people (19.2%), then the bike riders (15.23%). We thus recommend that the laws on the use of road safety gargets, especially helmets and seatbelts, be enforced, with riding and driving speeds reduced to below 60km/hour. Road usage should be avoided in bad weather and pedestrians lanes and zebra crossings be provided to minimize pedestrian-car or -bike collision.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Pietro Fransvea, Gianluca Costa, Giulia Massa, Barbara Frezza, Paolo Mercantini, Genoveffa BaIducci [Research] - Non-operative management of blunt splenic injury: is it really so extensively feasible? a critical appraisal of a single-center experience - 30 January 2019. http://www.panafrican-med-journal.com/content/article/32/52/abstract/ <b>INTRODUCTION: The spleen is one of the most commonly injured organ following blunt abdominal trauma. Splenic injuries may occur in isolation or in association with other intra-and extra-abdominal injury. Nonoperative management of blunt injury to the spleen has become routine in children. In adult most minor splenic injuries are readily treated nonoperatively but controversy exists regarding the role of nonoperative management for higher grade injuries above all in multi-trauma patients. The aim of this study is the assessment of splenic trauma treatment, with particular attention to conservative treatment, its limits, its efficiency, and its safety in multi-trauma patient or in a severe trauma patient. METHODS: the present research focused on a retrospective review of patients with splenic injury. The research was performed by analyzing data of the trauma registry of St. Andrea University Hospital in Rome. The St. Andrea University Hospital trauma registry includes 1859. The variables taken into account were spleen injury and general injuries, age, sex, cause and dynamic of trauma, hemoglobin, hematocrit, white blood cells count, INR, number and time blood transfusion, hemodynamic stability, type of treatment provided, hospitalization period, morbidity and mortality. Assessment of splenic injuries was evaluated according to Abbreviated Injury Scale (AIS). RESULTS: the analysis among the general population of spleen trauma patients identified 68 patients with a splenic injury representing the 41.2% of all abdomen injury. The Average age was of 37.01 ± 17.18 years. The Average ISS value was of 22.88 ± 12.85; mediana of 24.50 (range 4-66). The average Spleen AIS value was of 3.13 ± 0.88; mediana 3.00 (range 2-5). The overall mortality ratio was of 19.1% (13 patients). The average ISS value in patients who died was of 41.92 ± 12.48, whereas in patients who survided was of 23.33 ± 10.15. The difference was considered to be statistically significant (p <0.001). The relashionship between the ISS and AIS values in patients who died was considered directly proportional but not statistically significant (Pearson test AIS/ISS = 0.132, p = n.s.). The initial management was a conservative treatment in 27 patients (39.7%) of them 4 patients (15%) failed, in the other 41 cases urgent splenectomies were performed. The average spleen AIS in all the patients who underwent splenectomy was 3.61 ± 0.63 whereas in the patients who were not treated surgically was 2.42 ± 0.69. The difference was deemed statistically significant (p <0.001). CONCLUSION: splenic injury, as reported in our statistic as well as in literature, is the most common injury in closed abdominal trauma. Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The preference of a conservative treatment must be based on the hemodynamic stability indices as well as on the spleen lesion severity and on the general trauma severity. The conservative treatment represent a feasible and safe therapeutic alternative even in case of severe lesions in politrauma patients, but the choice of the treatment form requires an assessment for each singular case.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Karl Peltzer, Li-Wei Chao, Shandir Ramlagan, Helena Szrek [Research] - Daily tobacco use and problem drinking among urban adults in South Africa: a longitudinal study - 29 January 2019. http://www.panafrican-med-journal.com/content/article/32/51/abstract/ <b>INTRODUCTION: There is a lack of longitudinal studies investigating daily tobacco use and problem drinking in Africa. The aim of this study was to explore the prevalence of daily tobacco use and problem drinking and to determine the factors associated with daily tobacco use and problem drinking among urban dwellers in a longitudinal study in South Africa. METHODS: electronic interview data were collected from 2213 adults (mean age 45.7 years, SD=15.1; range 20-97) at time 1 (baseline assessment) and Time 2 (12 months follow-up assessment) from one urban centre in South Africa. RESULTS: daily tobacco use only, was at time 1 24.0% and at time 2 23.4%, a decrease of 0.5%. Problem drinking only was at time 1 19.6% and at time 2 21.1%, an increase of 1.5%. Concurrent daily tobacco use and problem drinking increased from time 1 9.5% to 10.3% at time 2, an increase of 0.8%. In longitudinal regression analyses, being male and being born in current city were significantly associated with all three substance use indicators (daily tobacco use; problem drinking; and concurrent daily tobacco use and problem drinking). In addition, older age, not currently married, lower education, underweight and higher levels of perceived stress were associated with daily tobacco use and younger age was associated with problem drinking.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Adja Coumba Diallo, Mouhamadou Bachir Ba [Images in medicine] - Un cas de gigantomastie gravidique bilat&eacute;rale - 29 January 2019. http://www.panafrican-med-journal.com/content/article/32/50/abstract/ <b>Il s'agissait d'une patiente de 29 ans, sans ant&eacute;c&eacute;dent pathologique, II gestes II pares. La symptomatologie &eacute;voluait depuis 2 mois, marqu&eacute;e par la survenue d'une augmentation mammaire bilat&eacute;rale g&ecirc;nant les activit&eacute;s quotidiennes. L'examen physique montrait des seins hypertrophi&eacute;s, des ulc&eacute;rations mammaires bilat&eacute;rales. Elle pr&eacute;sentait une am&eacute;norrh&eacute;e de 28 semaines. L'examen anatomopathologique des ulc&eacute;rations est revenu en faveur d'un bourgeon charnu. La prolactin&eacute;mie &eacute;tait &eacute;lev&eacute;e (1345 µUI/ml). Les taux de FSH et de LH &eacute;taient normaux. Un traitement &agrave; base de bromocriptine a &eacute;t&eacute; r&eacute;alis&eacute; sans succ&egrave;s. L'&eacute;volution &eacute;tait marqu&eacute;e par une diminution de la taille et la r&eacute;gression des ulc&eacute;rations cutan&eacute;es six mois apr&egrave;s l'accouchement par voie basse. La gigantomastie gravidique est une hypertrophie mammaire dont le volume d&eacute;passe 1500 cm3 durant la grossesse. L'&eacute;tiologie n'est pas connue. Le traitement radical repose sur la mastectomie bilat&eacute;rale.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Jacques Mbaz Musung, Emmanuel Kiyana Muyumba, Dophra Ngoy Nkulu, Placide Kambola Kakoma, Olivier Mukuku, Berthe Kon Mwad Kamalo, Clarence Kaut Mukeng, Christian Ngama Kakisingi, Francoise Kaj Malonga, Faustin Mukalenge Chenge, Oscar Numbi Luboya [Research] - Pr&eacute;valence du surpoids et de l’ob&eacute;sit&eacute; chez l’adolescent en milieu scolaire &agrave; Lubumbashi, R&eacute;publique D&eacute;mocratique du Congo - 28 January 2019. http://www.panafrican-med-journal.com/content/article/32/49/abstract/ <b>INTRODUCTION: Le surpoids et l’ob&eacute;sit&eacute; au cours de l’adolescence constituent un probl&egrave;me pr&eacute;occupant de sant&eacute; publique &agrave; l’&eacute;chelle mondiale en raison de leur retentissement potentiel sur la sant&eacute; et de leur fr&eacute;quence croissante. La pr&eacute;sente &eacute;tude avait pour objectif de d&eacute;terminer la pr&eacute;valence du surpoids et de l’ob&eacute;sit&eacute; chez les adolescents scolaris&eacute;s dans les &eacute;tablissements publics et priv&eacute;s &agrave; Lubumbashi, en R&eacute;publique D&eacute;mocratique du Congo. METHODES: Il s’agissait d’une &eacute;tude transversale men&eacute;e aupr&egrave;s de 5.341 adolescents &acirc;g&eacute;s de 10 &agrave; 19 ans, dont 2.858 (53,5%) filles et 2.483 (46,5%) gar&ccedil;ons ont constitu&eacute; notre &eacute;chantillon. Pour chacun d’eux, nous avons mesur&eacute; le poids et la taille puis calcul&eacute; l’indice de masse corporelle (IMC). RESULTATS: La moyenne du poids &eacute;tait de 43,78 ± 11,62 kg (soit 42,39 ± 12,11 kg pour les gar&ccedil;ons et 44,95 ± 11,04 kg pour les filles), celle de la taille &eacute;tait de 151,30 ± 13,09 cm (soit 151,20 ± 14,64 cm pour les gar&ccedil;ons et 151,38 ± 11,58 cm pour les filles) et celle de l’IMC &eacute;tait de 18,82 ± 3,15 kg/m<sup>2</sup> (soit 19,39 ± 3,39 kg/m<sup>2</sup> pour les gar&ccedil;ons et 18,17 ± 2,71 kg/m<sup>2</sup> pour les filles). La pr&eacute;valence du surpoids &eacute;tait de 8% et celle de l’ob&eacute;sit&eacute; &eacute;tait de 1%. Les filles &eacute;taient significativement plus touch&eacute;es par le surpoids (10,7% filles contre 5% gar&ccedil;ons) et l’ob&eacute;sit&eacute; (1,5 % filles contre 0,4% gar&ccedil;ons) que les gar&ccedil;ons. CONCLUSION: Le surpoids et l’ob&eacute;sit&eacute; chez les adolescents en milieu scolaire s’av&egrave;rent une r&eacute;alit&eacute; &agrave; Lubumbashi. La d&eacute;termination de la pr&eacute;valence du surpoids et de l’ob&eacute;sit&eacute; pour cette cat&eacute;gorie d’&acirc;ge au plan national est recommandable pour leurs pr&eacute;ventions et prises en charges.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hamza Hasnaoui, Ouadii Mouaqit, El Bachir Benjelloun, Abdelmalek ousadden, Khalid Ait Taleb, Hicham El Bouhaddouti [Case report] - Hernie interne du ligament falciforme: une cause rare d'occlusion intestinale - 28 January 2019. http://www.panafrican-med-journal.com/content/article/32/48/abstract/ <b>Les hernies internes sont une cause rare d'occlusion intestinale aigu&euml;. La hernie &agrave; travers le ligament falciforme est une forme exceptionnelle dont le diagnostic est souvent fait en perop&eacute;ratoire. La tomodensitom&eacute;trie abdominale, pratiqu&eacute;e en urgence, peut aider au diagnostic en pr&eacute;op&eacute;ratoire et permet de guider l'attitude th&eacute;rapeutique. Aussi, nous a-t-il paru opportun de rapporter ce cas collig&eacute; dans le service de chirurgie visc&eacute;rale A du CHU Hassan II de F&egrave;s. Nous rapportons l'observation d'un patient &acirc;g&eacute; de 48 ans, sans ant&eacute;c&eacute;dent particulier, admis aux urgences avec un tableau d'occlusion &eacute;voluant depuis 4 jours. La radiographie d'abdomen sans pr&eacute;paration objectivait de multiples niveaux hydro-a&eacute;riques de type gr&ecirc;lique dont certains se projetaient en regard de l'air h&eacute;patique, ainsi que la pr&eacute;sence d'une anse intestinale plate en continuit&eacute; avec un segment intestinal distendu. La tomodensitom&eacute;trie abdominale n'a pas &eacute;t&eacute; r&eacute;alis&eacute;e vu une fonction r&eacute;nale qui &eacute;tait alt&eacute;r&eacute;e. Le patient &eacute;tait alors op&eacute;r&eacute; en urgence apr&egrave;s mise en condition et le diagnostic d'une hernie interne du ligament falciforme &eacute;tait fait en perop&eacute;ratoire. La hernie interne &agrave; travers le ligament falciforme est une cause rare d'occlusion intestinale aigu&euml; de l'adulte dans notre pratique quotidienne. Le diagnostic est le plus souvent fait en perop&eacute;ratoire. Il faut savoir y penser devant le jeune &acirc;ge, l'absence d'ant&eacute;c&eacute;dents de chirurgie abdominale ou de processus infectieux intra p&eacute;riton&eacute;al et la pr&eacute;sence de niveaux hydro-a&eacute;riques dans l'hypocondre droit.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Amine Bout, Nabil Berhili, Hayat Hlal, Rachid Aalouane, Ismail Rammouz [Case report] - Folie &agrave; deux ou le partage de sympt&ocirc;mes comme modalit&eacute; relationnelle: &agrave; propos d’un cas - 28 January 2019. http://www.panafrican-med-journal.com/content/article/32/47/abstract/ <b>Le trouble psychotique partag&eacute; ou Folie &agrave; deux (FD) est une entit&eacute; rare et controvers&eacute;e qui pose des probl&egrave;mes d’ordre ph&eacute;nom&eacute;nologique, nosographique et psychopathologique. Elle interroge la nature du d&eacute;lire et sa survenue en dehors d’une structure psychotique ainsi que la question de la contagion du sympt&ocirc;me en psychiatrie. Nous proposons l’analyse s&eacute;miologique d’un cas intrafamilial de Folie &agrave; deux, cas dont la particularit&eacute; clinique est le partage de sympt&ocirc;mes d&eacute;lirants mais aussi d’&eacute;l&eacute;ments psychotiques non d&eacute;lirant (d&eacute;ficitaires). A travers quoi nous revenons sur les caract&eacute;ristiques &eacute;pid&eacute;miologiques et les facteurs communs avec les autres cas rapport&eacute;s dans la litt&eacute;rature dans diff&eacute;rentes cultures. Nous dressons ensuite l’historique de l’entit&eacute; et son &eacute;volution au fil des classifications depuis sa premi&egrave;re description par Legrand jusqu’au DSM 5. Et de l&agrave;, nous soulignons le caract&egrave;re insuffisant d’une approche purement descriptive et mettons l’accent sur le lien possible avec d’autres situations cliniques plus fr&eacute;quentes avec comme point commun la transmission entre deux ou plusieurs personnes de sympt&ocirc;mes psychiques. Puis, nous proposons une r&eacute;flexion psychopathologique qui s’axe essentiellement sur le partage du sympt&ocirc;me et non sa nature tout en interrogeant la fonction du d&eacute;lire au sein d’un couple d&eacute;lirant.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Mohamed-Lemine Lehreitani, Hatim Abid, Florian Marcaillou, Maanouk Rachid, Abdelhalim El Ibrahimi, Abdelmajid El Mrini, Stephane Blanc [Case report] - Fracture triplane de l’extr&eacute;mit&eacute; sup&eacute;rieure du tibia: une l&eacute;sion rare (&eacute;tude d’un cas et revue de la litt&eacute;rature) - 28 January 2019. http://www.panafrican-med-journal.com/content/article/32/46/abstract/ <b>Nous rapportons le cas d’une fracture triplane de l’extr&eacute;mit&eacute; sup&eacute;rieure du tibia chez un jeune de 16 ans survenue dans les suites d’un accident de sport lors d’une course de v&eacute;lo. La tomodensitom&eacute;trie (TDM) a &eacute;t&eacute; r&eacute;alis&eacute;e pour une meilleure analyse l&eacute;sionnelle. Apr&egrave;s l’identification de tous les fragments n&eacute;cessitant une ost&eacute;osynth&egrave;se, il a &eacute;t&eacute; r&eacute;alis&eacute; &agrave; foyer ferm&eacute; une r&eacute;duction avec fixation des diff&eacute;rents fragments fracturaires par des vis canul&eacute;es. Au dernier recul, les r&eacute;sultats radiologiques et fonctionnels &eacute;taient excellents.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Agharbi [Case report] - Mastocytome solitaire de l'enfant: &agrave; propos d'un cas - 28 January 2019. http://www.panafrican-med-journal.com/content/article/32/45/abstract/ <b>Le mastocytome solitaire est la forme la plus fr&eacute;quente de mastocytose chez l'enfant. Son pronostic est bon comme toutes les autres formes de mastocytoses de l'enfant avec possibilit&eacute; de r&eacute;gression spontan&eacute;e. Les dermocortico&iuml;des peuvent acc&eacute;l&eacute;rer cette r&eacute;gression comme c'est le cas chez notre patient.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ahmed Ghazza, Maha Bakhsh, Ibtissam Hajji, Abdeljalil Moutaouaki [Case series] - Le traitement du d&eacute;collement de r&eacute;tine du pseudophaque: vitrectomie sans indentation &eacute;piscl&eacute;rale VERSUS Chirurgie Ab externo - 24 January 2019. http://www.panafrican-med-journal.com/content/article/32/44/abstract/ <b>Plusieurs facteurs pr&eacute;disposent &agrave; la survenue d'un d&eacute;collement de r&eacute;tine rhegmatog&egrave;ne, notamment la chirurgie de cataracte, la myopie, les l&eacute;sions d&eacute;g&eacute;n&eacute;ratives de la p&eacute;riph&eacute;rie r&eacute;tinienne ainsi que la notion de traumatisme oculaire. L'objectif de notre &eacute;tude est de comparer les r&eacute;sultats anatomiques et fonctionnels des deux techniques chirurgicales (Ab interno Vs Ab externo) au sein de notre structure. Il s'agit d'une &eacute;tude descriptive r&eacute;trospective, r&eacute;alis&eacute;e au sein du service d'ophtalmologie du CHU Mohamed VI de Marrakech, &eacute;tal&eacute;e sur 3 ans, allant de janvier 2013 &agrave; d&eacute;cembre 2015, comparant deux groupes d'&eacute;tude , le premier groupe op&eacute;r&eacute; par voie externe (Cryo application des d&eacute;hiscences avec une indentation &eacute;pi scl&eacute;rale) et le 2&egrave;me op&eacute;r&eacute; par voie endo-oculaire. Le groupe A ou groupe ab externo &eacute;tait constitu&eacute; de 26 yeux (26 patients) contre 22 yeux (22 patients) dans le groupe B ou groupe vitrectomie avec tamponnement interne. Dans le groupe ab externo, l'&acirc;ge moyen &eacute;tait de 54,92 ans contre 51,64 ans dans le groupe ab interno, avec une l&eacute;g&egrave;re pr&eacute;dominance masculine dans les 2 groupes. La r&eacute;application r&eacute;tinienne apr&egrave;s la 1&egrave;re intervention &eacute;tait obtenue chez les deux groupes sans diff&eacute;rence significative, aux alentours de 80,76% chez les patients du groupe A versus 81,82% du deuxi&egrave;me groupe. Les causes d'&eacute;chec dans les deux groupes &eacute;taient dues &agrave; la pr&eacute;sence d'une prolif&eacute;ration vitr&eacute;or&eacute;tinienne avanc&eacute;e (4 cas), d'une d&eacute;chirure de novo (3 cas) et de d&eacute;chirures non vues &agrave; l'examen initial (2 cas). Tous ces cas ont &eacute;t&eacute; repris par un abord ab interno, consistant chez les patients du groupe A en une vitrectomie compl&egrave;te avec r&eacute;vision de l'indentation +/- pelage de membrane limitante interne avec tamponnement interne par gaz et chez les patients du groupe B en un compl&eacute;ment de vitrectomie avec dissection de la PVR et un tamponnement interne par huile de silicone. Apr&egrave;s un recul moyen de 12 mois, l'acuit&eacute; visuelle finale de nos patients &eacute;tait sans diff&eacute;rence significative entre les 2 groupes, avec plus que le tiers des patients avaient retrouv&eacute; une acuit&eacute; visuelle entre 1/10 et 5/10, aux alentours de 34,61% au niveau du groupe ab externo, et 36,36% pour le groupe ab interno. Certes, avec les avanc&eacute;es technologiques en terme de vitrectomie, la tendance actuelle est la chirurgie endo oculaire, cependant la chirurgie ab-externo garde sa place principalement lors des DR avec des d&eacute;chirures visibles, bien accessibles &agrave; l'indentation sans prolif&eacute;ration vitr&eacute;or&eacute;tinienne avanc&eacute;e (PVR A-B&agrave;).</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Nitin Gupta, Kutty Sharada Vinod, Ankit Mittal, Aswin Pius Ajay Kumar, Arvind Kumar, Naveet Wig [Case report] - Histoplasmosis, heart failure, hemolysis and haemophagocytic lymphohistiocytosis - 23 January 2019. http://www.panafrican-med-journal.com/content/article/32/43/abstract/ <b>Histoplasmosis is an endemic mycosis with global distribution, primarily reported in immunocompromised individuals. A 29-year old immunocompetent male presented with fever, hepatosplenomegaly and pancytopenia. His peripheral blood showed features suggestive of intravascular hemolysis and echocardiography showed features suggestive of pulmonary arterial hypertension. Bone marrow showed yeast with morphology suggestive of Histoplasma capsulatum. Further investigations revealed hyperferritinemia, hypofibrinogenemia and increased triglycerides. With a diagnosis of progressive disseminated histoplasmosis with secondary Haemophagocytic lymphohistiocytosis, he was successfully treated with amphotericin B followed by itraconazole. We report this case to highlight the atypical and rare manifestations of histoplasmosis.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ali Sbai, Zineb Dahbi, Farid Naciri, Fouad Elmejjatti, Amine Guerouaz, Kawtar Lakhmis, Mohammed Guezzar, Fadwa Allouch, Loubna Mezouar [Case report] - Six ans de survie sans progression apr&egrave;s chimioth&eacute;rapie pour une tumeur neuro-ectodermique p&eacute;riph&eacute;rique r&eacute;nale m&eacute;tastatique - 23 January 2019. http://www.panafrican-med-journal.com/content/article/32/42/abstract/ <b>Les tumeurs neuro-ectodermiques p&eacute;riph&eacute;riques (PNET) r&eacute;nales sont extr&ecirc;mement rares, souvent diagnostiqu&eacute;es &agrave; un stade tardif compte tenu de leurs pr&eacute;sentations cliniques asp&eacute;cifiques. Le traitement des stades m&eacute;tastatiques repose sur la chimioth&eacute;rapie palliative, nous rapportons un cas de PNET r&eacute;nale m&eacute;tastatique d’embl&eacute;e au niveau ganglionnaire et cutan&eacute;, qui a pr&eacute;sent&eacute; une bonne r&eacute;ponse clinique et radiologique et sans signe de progression depuis 6 ans apr&egrave;s la fin d’une polychimioth&eacute;rapie par vincristine, doxorubicine et cyclophosphamide.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Rajae Azzeddine, Fatimazahra Elyassir, Jamal Eddine Bourkadi [Case report] - Tuberculose multifocale compliqu&eacute;e d’un syndrome d’activation macrophagique: &agrave; propos de deux cas - 22 January 2019. http://www.panafrican-med-journal.com/content/article/32/41/abstract/ <b>Le syndrome d'activation macrophagique (SAM) est une manifestation rare li&eacute;e &agrave; une stimulation inappropri&eacute;e des macrophages dans la moelle osseuse et les organes lympho&iuml;des. Il est d&eacute;fini par des crit&egrave;res cliniques, biologiques et cyto-histologiques. Ce syndrome peut &ecirc;tre primaire essentiellement chez l'enfant, ou secondaire &agrave; diverses affections: h&eacute;matologiques, infectieuses ainsi qu'&agrave; des maladies auto-immunes vari&eacute;es. Le pronostic est sombre, avec une mortalit&eacute; de pr&egrave;s de 50% toutes causes confondues .Le traitement repose sur le traitement sp&eacute;cifique de l'agent causal du SAM et dans certaines indications, sur l'&eacute;toposide, les corticosteroides et les immunogobulines qui doivent alors &ecirc;tre administr&eacute; pr&eacute;cocement. Le SAM est rarement d&eacute;crit en association avec la tuberculose, nous rapportons deux observations de deux patientes, l'une immunod&eacute;prim&eacute;e et l'autre immunocomp&eacute;tente pr&eacute;sentant une tuberculose multifocale compliqu&eacute;e d'un syndrome d'activation macrophagique, Nous insistons &agrave; travers ce travail sur la difficult&eacute; du traitement du syndrome d'activation macrophagique associ&eacute; &agrave; une tuberculose, la n&eacute;cessit&eacute; de l'&eacute;valuation du rapport b&eacute;n&eacute;fice risque, en raison du risque d'immunosuppression li&eacute; &agrave; l'utilisation des cortico&iuml;des ou des immunosuppresseurs, avec possible aggravation de la tuberculose.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Nizar El Bouardi, Amina Alaoui, Meriem Haloua, Youssef Lamrani, Meryem Boubbou, Mustapha Maaroufi, Baderdine Alami [Case report] - Une pneumopathie interstitielle diffuse r&eacute;v&eacute;lant un syndrome des antisynth&eacute;tases: &agrave; propos de 2 cas - 22 January 2019. http://www.panafrican-med-journal.com/content/article/32/40/abstract/ <b>Le syndrome des antisynth&eacute;tases (SAS) est une myopathie inflammatoire fr&eacute;quemment associ&eacute;e &agrave; une atteinte pulmonaire, surtout parenchymateuse (pneumopathie infiltrante diffuse). Les manifestations extrathoraciques associ&eacute;es &agrave; l'atteinte pulmonaire peuvent orienter le diagnostic: myalgies, polyarthralgies, syndrome de Raynaud, hyperk&eacute;ratose &eacute;ryth&eacute;mateuse palmaire fissuraire et fi&egrave;vre. Devant un tableau clinique et radiologique &eacute;vocateur, la pr&eacute;sence d'anticorps anti-ARNt synth&eacute;tases permet de confirmer notamment les anti-Jo1. L'atteinte pulmonaire constitue un facteur pronostic majeur d'o&ugrave; l'indication une th&eacute;rapie immunosuppressive intensive fond&eacute;e sur la corticoth&eacute;rapie, les immunosuppresseurs ou l'association des deux. Une meilleure sensibilisation pour cette affection &agrave; r&eacute;v&eacute;lation pulmonaire permettra d'adopter une prise en charge rapide et ad&eacute;quate, et d'am&eacute;liorer par cons&eacute;quent le pronostic.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Agharbi [Images in medicine ] - Lichen nitidus - 22 January 2019. http://www.panafrican-med-journal.com/content/article/32/39/abstract/ <b>Lichen nitidus(LN) is chronic papulosquamous disorder characterized by multiple, 1-2 mm, flesh-colored, shiny, dome-shaped papules. Its incidence is 0.034% in a study of skin diseases in blacks over a 25-years period.Skin lesions classically involves the genitalia, upper extremities, chest and abdomen. Infrequently, the lower extremities, palms, soles, face, nails, and mucous membranes may be affected. Majority of cases are common in children and young adults. Various clinical variants of lichen nitidus are - linear, confluent, vesicular, haemorrhagic, spinous follicular, perforating, generalised, palmar and plantar. We report the observation of a 6-month-old infant who presented translucent papules of the back of the hands whose hitological study was in favor of a lichen nitidus.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Suzan Salem, Islam Saad, Rana Alamri [Case report] - Thymoma associated myasthenia gravis with atypical presentation of lipomatous tongue atrophy: a case report - 21 January 2019. http://www.panafrican-med-journal.com/content/article/32/38/abstract/ <b>A 28-year-old female patient came to the outpatient dental clinic for multiple teeth extractions and full mouth rehabilitation suffer from myasthenia gravis (MG) primary presentation as tongue atrophy and facial muscles weakness and the symptoms became worries, the patient unable to speak as well and change her voice and complaining of dysphagia and dysarthria. Oral symptoms, treatment schedule and protocol, the selection, prescription and impacts of medications, and prevention of myasthenic crisis are all important aspects should be considered by dentists and oral health care providers. Weakness of facial and oropharyngeal muscle is considered very popular at disease onset and therefore oral health providers are often the first medical professionals to observe these patients. Myasthenic patients seek particular approach and consultation in order to ensure ideal and proper dental management.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Kuhlula Mabunda, Emery Ngasama, Joseph Babalola, Moleen Zunza, Peter Nyasulu [Research] - Determinants of adherence to antiretroviral treatment among human immunodeficiency virus infected young adults attending care at Letaba Hospital HIV Clinic, Limpopo Province, South Africa - 18 January 2019. http://www.panafrican-med-journal.com/content/article/32/37/abstract/ <b>INTRODUCTION: Sustained viral suppression using antiretroviral treatment (ART) occurs with adherence to treatment of at least 95%. Non-adherence promotes the development of drug-resistance and treatment failure in individuals infected with Human Immunodeficiency Virus. In Limpopo Province, the adherence rate is approximately 61%, but the prevalence and the factors associated with adherence at Letaba hospital HIV clinic are not well established. Therefore, the aim of this study was to identify the factors associated with adherence among HIV-infected young adults, aged 18-35 years, attending the clinic. METHODS: A cross-sectional survey was conducted in Letaba HIV clinic among young adults of 18-35 years old. Logistic regression analysis was performed to determine factors associated with ART adherence. We reported odds ratios with the corresponding 95% confidence intervals and p-values. A p-value <0.1 was considered as statistically significant. ART adherence was defined as taking more than 95% of the prescribed treatment 3 days prior to completion of the questionnaire. RESULTS: A total of 281 participants were enrolled with 163 (58.0%) females and more than three quarter, 222 (79.0%) between the ages of 18 and 29 years. The overall ART adherence stood at (87.2%) (95% CI: 63.0%-89.0%) representing 245 participants. Non-adherers to treatment, 36 (12.8%) reported forgetting (3.9%), feeling good (5.0%), fear and running out of treatment (2.5%) as some of the reasons for not taking treatment within the three days prior to data collection. The following factors: tertiary education (p=0.07), age (30-35; p-value: 0.07), drug availability (p-value: 0.07), were only marginally significantly associated with ART adherence. CONCLUSION: The study found unsatisfactory ART adherence among our participants. Our study suggests that factors other than sociodemographic and clinical factors might better explain differences in adherence. This highlights the need for a more complex study that would look at the entire system in which these patients are navigating as well as their mental models.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Nusirat Elelu, Julius Olaniyi Aiyedun, Ibraheem Ghali Mohammed, Oladapo Oyedeji Oludairo, Ismail Ayoade Odetokun, Kaltume Mamman Mohammed, James Olaniyi Bale, Saka Nuru [Review] - Neglected zoonotic diseases in Nigeria: role of the public health veterinarian - 18 January 2019. http://www.panafrican-med-journal.com/content/article/32/36/abstract/ <b>Zoonotic diseases accounts for about 75% of emerging infectious disease and can be devastating to both human and animal health globally. A subset of zoonotic diseases is referred to as "neglected zoonotic diseases - NZDs" as they mainly affect poor populations who live in close proximity to domestic or wild animals often in areas where access to health and adequate sanitary facilities are not available. Furthermore, underestimation of the burden of NZD has continually led to its further neglect in least developed countries such as Nigeria. Controlling zoonotic infections including NZDs in animals is crucial in reducing human infections. Veterinarians provides an understanding of the epidemiology of infectious diseases in animal population and are therefore integral for the overall reduction in global burden of NZDs worldwide. Due to the current lack of and in some cases weak involvement of Veterinarians in policy issues related to zoonotic diseases, there is need to elucidate their importance in NZDs control in Nigeria. This review therefore summarises the neglected zoonotic diseases so far documented in Nigeria and also highlight the important role of the Veterinarian in their prevention and control within both human and animal population. Important recommendations to strengthen the role of the public health Veterinarian for sustainable control of NZDs were made.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Yobi Alexis Sawadogo, Evelyne Komboigo, Sibraogo Kiemtore, Hyacinthe Zamane, Issa Ouedraogo, Dantola Paul Kain, Boubakar Toure, Charlemagne Ouedraogo, Ali Ouedraogo, Blandine Thieba [Case series] - Les suppurations pari&eacute;tales post-cesariennes au Centre Hospitalier Universitaire Yalgado Ouedraogo, Burkina-Faso: aspects epidemiologiques, cliniques, th&eacute;rapeutiques et pronostiques - 18 January 2019. http://www.panafrican-med-journal.com/content/article/32/35/abstract/ <b>Les infections des sites op&eacute;ratoires sont fr&eacute;quemment rencontr&eacute;es dans les pays en d&eacute;veloppement. La c&eacute;sarienne &eacute;tant l'une des interventions chirurgicales la plus pratiqu&eacute;e chez les femmes dans le monde, nous avons initi&eacute; cette &eacute;tude sur les aspects &eacute;pid&eacute;miologiques, cliniques, th&eacute;rapeutiques et pronostiques des suppurations pari&eacute;tales post-c&eacute;sariennes dans le d&eacute;partement de gyn&eacute;cologie-obst&eacute;trique du CHU Yalgado Ou&eacute;draogo en vue de r&eacute;duire leur survenue. Il s'est agi d'une &eacute;tude transversale &agrave; vis&eacute;e descriptive men&eacute;e du 1er Avril 2015 au 30 Septembre 2015 soit une p&eacute;riode de 6 mois. Soixante-dix cas de suppurations pari&eacute;tales ont &eacute;t&eacute; not&eacute;s sur 1998 cas de c&eacute;sariennes soit une incidence de 3,5%. L'&acirc;ge moyen des patientes &eacute;tait de 26,2 ans ± 6,1. Les patientes &eacute;taient majoritairement des femmes au foyer (77%). La c&eacute;sarienne a &eacute;t&eacute; r&eacute;alis&eacute;e en urgence chez toutes les patientes. La suppuration a &eacute;t&eacute; diagnostiqu&eacute;e surtout &agrave; la 1&egrave;re semaine (60%). Le germe identifi&eacute; &eacute;tait le staphylocoque aureus dans 37,8% des cas. Une reprise chirurgicale de la paroi abdominale a &eacute;t&eacute; n&eacute;cessaire dans 34,3% des cas. L'&eacute;volution a &eacute;t&eacute; favorable chez toutes les patientes. La suppuration pari&eacute;tale post c&eacute;sarienne reste fr&eacute;quente. La prise en charge n&eacute;cessite parfois une reprise chirurgicale. Une meilleure identification des facteurs favorisant cette affection par d'&eacute;tude plus pouss&eacute;e pourrait permettre de r&eacute;duire de fa&ccedil;on significative leur incidence et par cons&eacute;quent am&eacute;liorer le pronostic maternel.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Rakotoniaina Masinarivo Daniella, Ramiandrisoa Ritchy, Randriamihangy Avisoa Narindra, Solofonirina Rakotoarimanana, Nirina Rabearivony [Case report] - Une cardiomyopathie dilat&eacute;e r&eacute;versible induite par l’hypocalc&eacute;mie secondaire &agrave; une hypoparathyro&iuml;die post thyro&iuml;dectomie totale: &agrave; propos d’un cas - 17 January 2019. http://www.panafrican-med-journal.com/content/article/32/34/abstract/ <b>Nous rapportons un cas de cardiomyopathie dilat&eacute;e d'origine hypocalc&eacute;mique secondaire &agrave; une hypoparathyro&iuml;die, chez une femme de 38 ans. Sa calc&eacute;mie &eacute;tait &eacute;ffondr&eacute;e &agrave; 30 mg/L et l'&eacute;chocardiographie avait montr&eacute; une cardiomyopathie dilat&eacute;e hypokin&eacute;tique avec baisse de la fraction d'&eacute;jection du ventricule gauche &agrave; 31,4%. Elle a re&ccedil;u une calcith&eacute;rapie avec de la vitamine D3 et l'&eacute;volution &eacute;tait marqu&eacute; par la normalisation de la taille des cavit&eacute;s cardiaques et de la fraction d'&eacute;jection ventriculaire gauche (FEVG) apr&egrave;s normocalc&eacute;mie.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Clifford Mwita, Ruth Negesa, Marissa Boeck, Andrew Wandera [Case report] - Open abdomen management and outcomes: two case reports from western Kenya and a review of literature from Africa - 17 January 2019. http://www.panafrican-med-journal.com/content/article/32/33/abstract/ <b>The open abdomen (OA) is clinically indicated for attenuating the effects of select intra-abdominal insults that may lead to high intra-abdominal pressure with fascial closure. Despite the high incidence of conditions warranting OA in Africa, there are few reports on its use and outcomes. A retrospective chart review was performed for two patients managed with an OA at the Moi Teaching and Referral Hospital. For comparison, a literature review on related studies from Africa was performed. One patient had an anastomotic leak, while the other had a perforated gastric ulcer. A Bogot&aacute; bag was used for temporary abdominal content containment. There was no mortality in our series and fascial closure was achieved in one patient. Upon review of studies from Africa, overall mortality stood at 44%, while 25% of surviving patients underwent fascial closure. The use of OA in Africa is associated with high mortality and low rates of fascial closure. Our limited experience shows this technique is a viable treatment option in an attempt to bridge a patient to abdominal closure during critical illness.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Diekouadio Fabrice, Bellamlih Habib, Laamrani Fatim Zahra [Case report] - Lyse des vert&egrave;bres dorsales r&eacute;v&eacute;lant un an&eacute;vrysme chronique rompu contenu: &agrave; propos d’un cas - 17 January 2019. http://www.panafrican-med-journal.com/content/article/32/32/abstract/ <b>Les an&eacute;vrismes chroniques rompus contenus repr&eacute;sentent une entit&eacute; extr&ecirc;mement rare, qui peut faire suite &agrave; une rupture d'an&eacute;vrisme. En effet, la complication la plus &agrave; craindre de l'an&eacute;vrisme est la rupture, qui est souvent mortelle. Toutefois exceptionnellement, il se formera un h&eacute;matome suite &agrave; la rupture, lequel sera contenu par les structures anatomiques avoisinantes; ce qui permettra en outre d'arr&ecirc;ter la fuite. Contrairement &agrave; la rupture classique, les signes de choc h&eacute;morragique seront absents; remplac&eacute;s par une simple douleur mod&eacute;r&eacute;e, et des signes souvent atypiques tels que la lyse du rachis dorsal par l'h&eacute;matome constitu&eacute;, d&eacute;couverte &agrave; l'imagerie dans notre cas. La connaissance de cette entit&eacute; est importante, car la rupture chronique n&eacute;cessite une prise en charge chirurgicale; du fait du risque de rupture ult&eacute;rieure de l'h&eacute;matome.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Malumani Malan, Zhe Dai, Wu Jianbo, Song Ji Quan [Case report] - Onycholysis an early indicator of thyroid disease - 17 January 2019. http://www.panafrican-med-journal.com/content/article/32/31/abstract/ <b>Onycholysis is also referred to Plummer's nails is a dermatological nail disorder characterized by spontaneous distal separation of the nail plate from the free margin and progressively proximally. We discuss a case of the 38-year-old man with onycholysis associated with hyperthyroidism due to Graves' disease. In this case review, we will discuss an association of onycholysis with thyroid disease and its diagnostic prognosis. Any unexplained onycholysis should prompt the clinician to investigate the client for asymptomatic hyperthyroidism.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Amine Benmoussa, Mostafa Mechtoune, Rajaa Tissir, Ilias Tazi, Lahoussine Mahmal [Case report] - Fistule œsotrach&eacute;ale compliquant un lymphome non hodgkinien B m&eacute;diastinal primitif: &agrave; propos d'un cas - 17 January 2019. http://www.panafrican-med-journal.com/content/article/32/30/abstract/ <b>Le lymphome non hodgkinien m&eacute;diastinal primitif (LNHMP) est un cancer rare, se complique exceptionnellement par des fistules trach&eacute;o-œsophagiennes reliant directement l'œsophage &agrave; la trach&eacute;e, qui sont secondaires &agrave; l'atteinte tumorale œsophagienne ou &agrave; la chimioth&eacute;rapie (l'int&eacute;r&ecirc;t de notre cas). Nous rapportons le cas d'une patiente de 24 ans, d'origine marocaine, suivie pour LNH m&eacute;diatisnal primitif &agrave; grandes cellules B r&eacute;v&eacute;l&eacute; par une dyspn&eacute;e avec dysphagie et alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral. La patiente est mise sous chimioth&eacute;rapie mais le tableau s'aggrave apr&egrave;s la deuxi&egrave;me cure par l'apparition des infections pulmonaires &agrave; r&eacute;p&eacute;tition avec notion de toux lors des repas responsable d'une impossibilit&eacute; d'alimentation, le diagnostic de fistule trach&eacute;o-œsophagienne est retenu par fibroscopie œsogastroduod&eacute;nale, mais l'&eacute;volution est marqu&eacute;e par le d&eacute;c&egrave;s de la patiente malgr&eacute; la mise en place de stent endoscopique et la bonne r&eacute;ponse &agrave; la chimioth&eacute;rapie. La d&eacute;couverte pr&eacute;coce d'une fistule trach&eacute;o-œsophagienne chez le patient atteint de LNHMP est indispensable permettant la mise en route d'un traitement appropri&eacute;.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Saad Benchekroun Belabbes, Kawtar Belkhadir [Images in medicine] - M&eacute;tastase oculaire r&eacute;v&eacute;lant un carcinome canalaire du sein - 16 January 2019. http://www.panafrican-med-journal.com/content/article/32/29/abstract/ <b>Nous rapportons le cas d'une patiente de 56 ans, sans ant&eacute;c&eacute;dents pathologiques notables, ayant consult&eacute; aux urgences pour une baisse de l'acuit&eacute; visuelle de l'œil droit, install&eacute;e depuis 2 semaines. A l'examen ophtalmologique, on trouve une acuit&eacute; visuelle r&eacute;duite au mouvement de doigts, avec au fond d'œil un d&eacute;collement de r&eacute;tine s&eacute;reux associ&eacute; &agrave; une masse sous r&eacute;tinienne comblant une majeure partie de la cavit&eacute; vitr&eacute;enne (A). Une &eacute;chographie oculaire en mode B a &eacute;t&eacute; r&eacute;alis&eacute;e et a mis en &eacute;vidence une masse choro&iuml;dienne iso&eacute;chog&egrave;ne (B) vascularis&eacute;e prenant le doppler (C) sans excavation, mesurant 18 mm de grand axe associ&eacute;e un d&eacute;collement s&eacute;reux de la r&eacute;tine, fortement &eacute;vocatrice d'une m&eacute;tastase oculaire. Un bilan g&eacute;n&eacute;ral a &eacute;t&eacute; r&eacute;alis&eacute; et notamment une mammographie qui a r&eacute;v&eacute;l&eacute; l'existence d'un nodule du sein droit stade 4 selon la classification BI RADS. Une Tomodensitom&eacute;trie thoraco abdomino pelvienne, et c&eacute;r&eacute;brale dans le cadre du bilan d'extension a montr&eacute; la pr&eacute;sence de nombreuses m&eacute;tastases c&eacute;r&eacute;brale, osseuse et h&eacute;patique. Le diagnostic de cancer du sein m&eacute;tastatique a donc &eacute;t&eacute; pos&eacute;, et la patiente a &eacute;t&eacute; r&eacute;f&eacute;r&eacute; en Oncologie pour prise en charge sp&eacute;cialis&eacute;e. Les m&eacute;tastases oculaires sont les tumeurs intraoculaires les plus fr&eacute;quentes. Les carcinomes mammaires repr&eacute;sentent la principale cause des m&eacute;tastases choro&iuml;diennes, justifiant un bilan exhaustif lors de la mise en &eacute;vidence de ces tumeurs intra oculaires.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Olusola Oladeji, Penelope Campbell, Chandrakala Jaiswal, Dick Chamla, Bibilola Oladeji, Christopher Otti Ajumara, Lydie Maoungou Minguiel, Joseph Senesie [Research] - Integrating immunization services into nutrition sites to improve immunization status of internally displaced persons’ children living in Bentiu protection of civilian site, South Sudan - 16 January 2019. http://www.panafrican-med-journal.com/content/article/32/28/abstract/ <b>INTRODUCTION: The protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response. METHODS: a community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations. RESULTS: integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36- 0.55), p<0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p<0.05). CONCLUSION: this study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV).</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ozkan Ozen, Yilmaz Guler, Yavuz Yuksel [Case report] - Giant colonic lipoma causing intussusception: CT scan and clinical findings - 16 January 2019. http://www.panafrican-med-journal.com/content/article/32/27/abstract/ <b>Colonic lipomas are uncommon and usually asymptomatic tumors. A 30-year-old woman with abdominal pain lasting 10 days was admitted to the surgical clinic. Her physical examination revealed sensitivity on the right upper quadrant and her bowel sounds were normal. A lesion and invagination findings in the colon were found in the ultrasound examination and CT was performed. CT scan revealed a lipoma and invagination in the colon and the patient has undergone surgery. Pathological diagnosis of the lesion was reported as submucosallipoma. In this case report, we present clinical and radiological findings of a submucosal colonic lipoma causing intussusception.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Rodolfo Mendes Queiroz, Fred Bernardes Filho [Images in medicine] - Liver abscess due to fish bone ingestion - 16 January 2019. http://www.panafrican-med-journal.com/content/article/32/26/abstract/ <b>A 50-year-old previously healthy male presented with epigastric pain for 10 days and fever in the last three days. Laboratory testing was remarkable for elevated white blood cells at 19,580/mm3 and C-reactive protein of 83.9 mg/dl. Abdomen computed tomography showed a small linear structure with calcium density, transfixing the wall of the gastric antrum and penetrating the left hepatic lobe; an oval massive hypodensity was observed in the surrounding liver parenchyma (A); pneumoperitoneum, free intra-abdominal fluid or vesicular changes were not observed. The hypothesis of gastric perforation due to ingestion of a foreign body with abscess formation was raised. In a new clinical interview, the patient reported a routine habit of fish consumption. Abdominal surgical approach was performed which confirmed the presence of a fish bone and the hepatic collection with purulent fluid (B). After seven days of surgery and treatment with intravenous ceftriaxone and metronidazole, the patient evolved with clinical and laboratory improvement and was discharged. Gastrointestinal perforation by an ingested fish bone resulting in hepatic abscess is very rare. In these cases, the site of perforation is usually in the stomach or duodenum with the abscess most commonly developing in the left hepatic lobe. The classic indicators of hepatic abscess, such as fever with chills, abdominal pain and jaundice are present in only a small number of patients. Among several causative objects that can perforate the gastrointestinal tract are included toothpicks, sewing needles, hairpins, wire, fish bones, chicken bones and dental plates.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Zain Majid, Ghous Bux Somoro, Muhammad Manzoor ul Haque, Raja Taha Yaseen, Shoaib Ahmed Khan, Inamullah Khan Achakzai, Muhammad Ali Khalid, Nasir Hassan Luck [Case report] - Non alcoholic fatty liver disease in a young male with celiac disease - 16 January 2019. http://www.panafrican-med-journal.com/content/article/32/25/abstract/ <b>A young emaciated male, known case of celiac disease came with the complains of diarrhea along with 5kgs of weight loss in 3 months' time. He had severe electrolyte abnormalities along with low albumin, low calcium and a high phosphate with deranged liver function test. Ultrasound abdomen had shown fatty liver. Nutrition consult was sought and he was found to have a BMI of 6.8kg/m2. He was started on nutrition support along with supportive therapy, which resulted in weight gain and improvement in his condition.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Souha Kallel, Moncef Sellami [Images in medicine] - Ost&eacute;oblastome du cornet moyen: tumeur rare du massif facial &agrave; ne pas m&eacute;connaitre - 16 January 2019. http://www.panafrican-med-journal.com/content/article/32/24/abstract/ <b>L'ost&eacute;oblastome est une tumeur osseuse b&eacute;nigne rare, repr&eacute;sentant 1% de toutes les tumeurs de l'os. Elle touche essentiellement les os longs, plus rarement les m&acirc;choires. Les atteintes au niveau des m&acirc;choires sont surtout retrouv&eacute;es &agrave; la mandibule, l'atteinte naso-sinusienne est tr&egrave;s rare. Le diam&egrave;tre de la tumeur peut atteindre 10cm. A la radiographie, la tumeur peut avoir l'aspect d'une l&eacute;sion radio claire bien ou mal d&eacute;finie, g&eacute;n&eacute;ralement parsem&eacute;e de plaques de min&eacute;ralisation. Le taux de r&eacute;cidive est tr&egrave;s faible apr&egrave;s ex&eacute;r&egrave;se chirurgicale et le risque de transformation maligne est tr&egrave;s faible. Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 13 ans qui a consult&eacute; pour une obstruction nasale &eacute;voluant depuis 3 mois avec des &eacute;pisodes d'&eacute;pistaxis et un flou visuel gauche. L'examen a trouv&eacute; un volumineux cornet &agrave; muqueuse polypo&iuml;de comblant toute la fosse nasale gauche avec une exophtalmie gauche axile. Le scanner du massif facial a montr&eacute; un processus expansif fronto-ethmo&iuml;dal gauche de 50 x 47 x 36mm, spontan&eacute;ment hypodense h&eacute;t&eacute;rog&egrave;ne non r&eacute;hauss&eacute; apr&egrave;s injection du produit de contraste (PDC), responsable d'une destruction du labyrinthe ethmo&iuml;dal, d'une souflure des parois osseuses avec effet de masse sur l'orbite homolat&eacute;ral. Le diagnostic &eacute;voqu&eacute; &eacute;tait une mucoc&egrave;le fronto-ethmo&iuml;dale. D'o&ugrave; la d&eacute;cision d'op&eacute;rer par voie endonasale. La section de la t&ecirc;te du cornet moyen a ramen&eacute; du liquide &eacute;pais blanch&acirc;tre rappelant une mucoc&egrave;le infect&eacute;e. Nous avons compl&eacute;t&eacute; par une r&eacute;section du cornet moyen. L'examen histologique a conclu &agrave; un ost&eacute;oblastome du cornet moyen. Les suites &eacute;taient marqu&eacute;es par une r&eacute;gression de l'exophtalmie sans r&eacute;cidive apr&egrave;s un recul de 1 an.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Mahamadou Mall&eacute;, Youssouf Fofana, Mahamadou Diallo, Lassine k&eacute;ita, Sokona Tour&eacute; [Case report] - Grosse lithiase prostatique juv&eacute;nile compliqu&eacute;e de fistule p&eacute;rin&eacute;ale: &agrave; propos d'un cas &agrave; l'H&ocirc;pital R&eacute;gional de Gao - 16 January 2019. http://www.panafrican-med-journal.com/content/article/32/23/abstract/ <b>Les lithiases prostatiques correspondent &agrave; des calculs d&eacute;velopp&eacute;s au sein du tissu prostatique (acini, canaux), elles sont rares chez l'enfant mais fr&eacute;quentes chez l'homme. Nous rapportons le cas d'un patient de 24 ans pr&eacute;sentant depuis quelques mois des troubles de la miction &agrave; type de pollakiurie et dysurie suivie d'une fuite urinaire p&eacute;rin&eacute;ale lors de la miction. L'&eacute;chographie r&eacute;no-v&eacute;sico-prostatique a montr&eacute; une grosse calcification prostatique. La radiographie standard de l'arbre urinaire et une fistulographie de l'orifice p&eacute;rin&eacute;al ont montr&eacute;s une communication avec la vessie et montr&eacute; une grosse calcification se projetant sur le pubis. Le diagnostic de lithiase prostatique a &eacute;t&eacute; retenu. La prise en charge a &eacute;t&eacute; faite par une antibioth&eacute;rapie avant, pendant et apr&egrave;s l'extraction chirurgicale de la grosse lithiase. Les suites op&eacute;ratoires ont &eacute;t&eacute;s favorables.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Naima Baddouh, Safaa Elbakri, Ghizlane Draiss, Youssef Mouaffak, Noureddine Rada, Said Younous, Mohammed Bouskraoui [Case series] - Thrombose veineuse c&eacute;r&eacute;brale de l’enfant: &agrave; propos d’une s&eacute;rie de 12 cas - 15 January 2019. http://www.panafrican-med-journal.com/content/article/32/22/abstract/ <b>La thrombose veineuse c&eacute;r&eacute;brale (TVC) est rare chez l'enfant. Sa pr&eacute;sentation clinique et ses &eacute;tiologies sont variables. Le pronostic des patients reste redoutable devant le risque de d&eacute;c&egrave;s et des s&eacute;quelles neurosensorielles. Objectif: &eacute;tudier le profil clinique, radiologique, et &eacute;tiologique des TVC de l'enfant, et &eacute;valuer l'int&eacute;r&ecirc;t du traitement anti thrombotique. Malades et m&eacute;thodes: &eacute;tude r&eacute;trospective men&eacute;e au service de p&eacute;diatrie et de r&eacute;animation p&eacute;diatrique au CHU Med VI de Marrakech, Maroc, sur une p&eacute;riode de 9 ans 10 mois (janvier 2008 &agrave; octobre 2018), colligeant tous les cas de TVC confirm&eacute;s &agrave; l'imagerie, ayant un &acirc;ge entre 1 mois et 15 ans. Nous avons recens&eacute; 12 cas. L'&acirc;ge moyen &eacute;tait de 6,4 ans. Le sexe ratio &eacute;tait de 1.4. Le mode de d&eacute;but &eacute;tait aigu dans 7 cas. Les principales pr&eacute;sentations cliniques &eacute;taient les convulsions (7 cas), les signes neurologiques focaux (7 cas), et les signes d'hypertension intracr&acirc;nienne (HTIC) (6 cas). La tomodensitom&eacute;trie (TDM) et / ou l'imagerie par r&eacute;sonance magn&eacute;tique (IRM), ont r&eacute;v&eacute;l&eacute; une atteinte du r&eacute;seau veineux superficiel dans 8 cas, &eacute;tendue dans 3 cas. L'&eacute;tiologie &eacute;tait infectieuse chez 6 patients avec un cas de d&eacute;shydratation, deux cas de maladie de syst&egrave;me et une homocystinurie. Cependant, l'&eacute;tiologie restait inconnue chez deux patients. Le traitement anti-thrombotique instaurait chez 7 enfants, avait permis une bonne &eacute;volution clinico-radiologique dans 5 cas. Le d&eacute;c&egrave;s &eacute;tait survenu chez 2 enfants, et 3 autres avaient des s&eacute;quelles neurologiques. Les TVC chez l'enfant sont caract&eacute;ris&eacute;es par la grande diversit&eacute; de leur pr&eacute;sentation clinique et de leurs &eacute;tiologies. L'impact des anticoagulants a &eacute;t&eacute; prouv&eacute; malgr&eacute; l'absence de protocole th&eacute;rapeutique standardis&eacute;.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Lynda Nadine Gui Bil&eacute;, N'Dri Simon D&eacute;d&eacute;, Ra&iuml;ssa Michelle Kabas, Estelle Val&eacute;rie Ohui-Acko, Eric Kouadio, Lolo Marc-Anicet Diambra [Case report] - Tuberculose tibiale chez l'enfant &agrave; l'IRM: &agrave; propos d'un cas - 15 January 2019. http://www.panafrican-med-journal.com/content/article/32/21/abstract/ <b>La localisation osseuse isol&eacute;e de la tuberculose est peu fr&eacute;quente et survient surtout chez les adultes jeunes immunod&eacute;prim&eacute;s. Elle peut simuler une infection &agrave; germe banal au d&eacute;but ou une atteinte tumorale lorsque l'&eacute;volution est chronique. Les auteurs rapportent le cas d'une patiente de 15 ans sans ant&eacute;c&eacute;dent particulier ayant pr&eacute;sent&eacute; une tum&eacute;faction indur&eacute;e et indolore du tiers sup&eacute;rieur de la jambe d'&eacute;volution chronique. Les explorations radiologiques conventionnelles ont permis d'objectiver une l&eacute;sion lytique tibiale m&eacute;taphysaire sup&eacute;rieure avec une r&eacute;action p&eacute;riost&eacute;e. L'IRM a pr&eacute;cis&eacute; une rupture corticale et une extension aux parties molles sous la forme d'une collection liquidienne avec une paroi &eacute;paisse, se rehaussant intens&eacute;ment apr&egrave;s injection de gadolinium. Une biopsie chirurgicale avec analyse histologique a permis de retenir le diagnostic d'ost&eacute;ite tuberculeuse. Ce cas clinique souligne l'int&eacute;r&ecirc;t de l'IRM dans l'exploration des pathologies musculosquelettiques.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Mohammed Tazi Charki, Hicham Abdellaoui, Saad Andaloussi, Mohammed Amine Oukhouya, Abdelhalim Mahmoudi, Aziz El madi, Khalid Khattala, Youssef Bouabdallah [Case report] - Congenital fistulisation of Meckel’s diverticulum in omphalocele sac: case report - 15 January 2019. http://www.panafrican-med-journal.com/content/article/32/20/abstract/ <b>Fistulisation of Meckel's diverticulum in the top of an omphalocele sac is very rare. To our Knowledge, three cases were reported in the literature. We presente in this report a new case of this uncommon presentation.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Fanou Denis, Sehonou Jean, Vinasse Alfred, Agniwo J&eacute;r&ocirc;me, Batcho Jimy, Etekpo Thomas, Tossou-Odjo L&eacute;on [Research] - Evaluation de l’&eacute;tat vaccinal contre l’h&eacute;patite B et portage de l’Ag HBs chez les militaires B&eacute;ninois en mission en C&ocirc;te d’Ivoire - 11 January 2019. http://www.panafrican-med-journal.com/content/article/32/19/abstract/ <b>INTRODUCTION: le but de cet &eacute;tude est de d&eacute;terminer le taux de couverture vaccinale anti-virus de l'h&eacute;patite B (anti-VHB) et la pr&eacute;valence de l'AgHBs chez les soldats b&eacute;ninois en mission ext&eacute;rieure en C&ocirc;te d'Ivoire. METHODES: cette &eacute;tude transversale &eacute;tait r&eacute;alis&eacute;e au sein du bataillon b&eacute;ninois bas&eacute; &agrave; Anankouakout&eacute; en C&ocirc;te d'Ivoire. Les soldats de cette compagnie au d&eacute;cours d'une s&eacute;ance d'&eacute;ducation sanitaire &eacute;taient soumis &agrave; un questionnaire sous forme d'interview. Il portait sur les donn&eacute;es sociod&eacute;mographiques, les facteurs de risques d'infection et les ant&eacute;c&eacute;dents de vaccination contre l'h&eacute;patite B. Des pr&eacute;l&egrave;vements &eacute;taient faits &agrave; la recherche de l'Ag HBs et des anticorps antiHBs. En cas de positivit&eacute; de l'Ag HBs, un compl&eacute;ment de bilan &eacute;tait fait (alanines aminotransf&eacute;rase(ALAT), Ag HBe, AcantiHBe, AcAntiHBcIgM et ADN HBV par PCR). RESULTATS: cent soixante-quinze militaire ont particip&eacute; &agrave; cette &eacute;tude (&acirc;ge m&eacute;dian 31ans avec des extr&ecirc;mes entre 23 et 52 ans; sex-ratio 5,73). Des taux protecteurs d'Ac Anti HBs &eacute;taient not&eacute;s chez 41 militaires (23,4%). Cette immunit&eacute; &eacute;tait post h&eacute;patitique B (25 cas/41) et post vaccinale (16 cas/41). Dix-huit militaires (10,3%) avaient une infection en cours par le VHB (Ag HBs+). L'infection &eacute;tait chronique (IgM anti HBc-et anticorps anti-HBc totaux + dans 18cas/18). Parmi les militaires infect&eacute;s, 4 avaient une &eacute;l&eacute;vation des aminotransferases, 4 un Ag HBe positif et 4 une vir&eacute;mie &eacute;lev&eacute;e (ADN VHB >2000UI/L). CONCLUSION: le portage de l'AgHBs chez les militaires B&eacute;ninois en mission est &eacute;lev&eacute;. La couverture vaccinale est faible. Des strat&eacute;gies d'intervention sont pr&eacute;conis&eacute;es pour traiter ceux qui r&eacute;pondent aux crit&egrave;res et vacciner les non immunis&eacute;s.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Kouhen Fadila, Abbad Faycal, Jabri Lamiaa, Belghiti Mohammed, Ismaili Nabil [Case report] - Lymphoepithelioma-like carcinoma of the breast: a case report and review of the literature - 11 January 2019. http://www.panafrican-med-journal.com/content/article/32/18/abstract/ <b>Lymphoepithelioma-like carcinoma of the breast is uncommon with only 21 patients documented in the literature. It can wrongly be diagnosed as medullary carcinoma and certain types of lymphoma due to undifferentiated proliferation of malignant epithelial cells with prominent lymphoid infiltration. In this paper, we present a case of LELC of the breast in a 64-year-old female with breast LELC and a discussion based on a review of the literature.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Adefisoye Oluwaseun Adewole, Olufemi Ajumobi, Saheed Gidado [Research] - Health care seeking behaviour for visual dysfunction among motor vehicle drivers in Osun State, Southwest Nigeria - 11 January 2019. http://www.panafrican-med-journal.com/content/article/32/17/abstract/ <b>INTRODUCTION: Visual impairment is recognized as a public health problem worldwide. People and generally drivers do not often go for routine medical or eye examination based on varied reasons. This study assessed health care seeking behaviour for visual dysfunction among motor vehicle drivers in Osun state, Southwest Nigeria. METHODS: this was a comparative cross-sectional study among 120 male commercial and 120 government drivers, selected using multi-stage sampling technique in Osogbo, Osun State. Data on knowledge, attitude and health seeking behavior of drivers for visual dysfunction and barriers for not seeking medical treatment was collected using a pre-tested semi-structured questionnaire. Questions on awareness about visual functions and attitude of the respondents concerning visual problems were scored. Two sample independent t-test was used to elicit association between mean age/knowledge of government and commercial drivers and health seeking behavior for visual dysfunction. RESULTS: the mean age of government and commercial drivers was 44.53years ± 8.51 and 38.52years ± 8.60 respectively. The mean knowledge (p<0.001) and attitude (p=0.001) differences of government and commercial drivers were associated with health seeking behavior for visual dysfunction. Of the 120 government drivers, 24 (20.0%) were aware of their current visual problems. Of the 24, government drivers, 10 (47.6%) visited the hospital for treatment. Busy workplace schedule (n = 5, 20.8%) and lack of awareness of visual defects ((n= 3, 12.5%) by commercial drivers were identified barriers for not seeking medical treatment for visual dysfunction. CONCLUSION: knowledge and attitude towards visual dysfunction were higher among the government drivers compared to commercial counterparts. Government drivers had better health seeking behavior for visual dysfunction as compared to their commercial counterparts. We recommended routine eye medical check-up for early detection of visual dysfunction in motor vehicle drivers.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Abdulrahman Al Tamimi, Awad Ali Alawad [Case report] - Large spontaneous subcapsular hematoma of the liver: a rare case report - 10 January 2019. http://www.panafrican-med-journal.com/content/article/32/16/abstract/ <b>Spontaneous subcapsular hematoma of the liver is an extremely rare but potentially life-threatening condition. We report a case of subcapsular hematoma of the liver without any apparent lesion and in the absence of coagulopathy or trauma. A CT scan of the abdomen demonstrated a huge subcapsular hematoma around the liver. The patient was treated conservatively and was discharged home after one week. Up to our knowledge, this is one of the very few reported cases of a spontaneous subcapsular hepatic hematoma.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Abdulkadir Salako, Tajudeen Badmus, Akinwunmi Komolafe, Rotimi David, Martin Igbokwe, Adeyinka Laoye, Ibrahim Akinbola, Rereloluwa Babalola, Chigozie Onyeze [Case series] - Unusual presentation of advanced prostate cancer in a black population of South-Western Nigeria - 10 January 2019. http://www.panafrican-med-journal.com/content/article/32/15/abstract/ <b>There are growing concerns on the varying pattern of advanced prostate cancer (PCa) presentation across the world. We report some of the unusual presentations of PCa at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, South-Western Nigeria.A review of all patients with histologically confirmed PCa who had unusual presentations between January 2014 and December 2015 was done. Unusual presentation was defined as an atypical feature in the absence of lower urinary tract symptoms (LUTS), with the diagnosis of PCa only suspected after abnormal digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA) assay. Thirteen patients had an unusual presentation in OAUTHC during the study period. Five (38.5%) had left supraclavicular swellings while four (30.8%) had haematochyzia and tenesmus. Other unusual presentations include large bowel obstruction requiring emergency colostomy (2;15.4%) and a scalp mass (1;7.7%). All patients had appropriate treatment for stage of CaP and are being followed up in the out-patient clinic. The change in presentations of PCa may suggest the need for DRE and serum PSA assay among all middle-aged and elderly men presenting at health facilities. Large scale studies on PCa across different population groups may also help at identifying related clinical, demographic and epidemiological factors as well as possible validation of some of these unusual presentations.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Marius Zambou Vouking, Christelle Monique Angoula Mengue, Saidu Yauba, Jean Marie Edengue, Modibo Dicko, Hamadou Modibo Dicko, Charles Shey Wiysonge [Review] - Interventions to increase the distribution of vaccines in Sub-Saharan Africa: a scoping review - 09 January 2019. http://www.panafrican-med-journal.com/content/article/32/14/abstract/ <b>Achieving universal access to immunization, as envisioned in the global vaccine action plan continues to be a challenge for many countries in sub-Saharan Africa. Weak immunization supply chain (iSC) has widely been recognized as a key barrier, hindering progress towards vaccination targets in this region. These iSCs, which were designed in the 1980s, have become increasing fragile and are now considered outdated. The objective of this review was to assess the effectiveness of system redesign and outsourcing to improve outdated iSC systems in Sub-Saharan Africa. We searched the following electronic databases from January 2007 to December 2017: Medline, EMBASE (Excerpta Medica Database), the Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. Our search strategy yielded 80 records and after assessment for eligibility, seven papers met the inclusion criteria. Five studies evaluated the experiences of system redesign in three countries (Nigeria, Benin and Mozambique), two assessed outsourcing vaccine logistics to the private sector in Nigeria and South Africa. According to these studies, system redesign improved vaccine availability at service delivery points and reduce the cost of distributing vaccines. Similarly, outsourcing vaccine logistics to the private sector reduced the cost of vaccines distribution and improve vaccine availability at service delivery points.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Vimal Raj Nitish Gunness, David Munoz, Pablo Gonz&aacute;lez-L&oacute;pez, Nabeel Alshafai, Agdaliya Mikhalkova, Julian Spears [Case report] - Ipsilateral brain cavernoma under scleroderma plaque: a case report - 08 January 2019. http://www.panafrican-med-journal.com/content/article/32/13/abstract/ <b>Scleroderma is a rare disease of unknown etiology, which is characterized by thickening and hardening of skin due to an increased collagen production. A 44-year-old female patient with a scleroderma on the scalp known by our department, also presented an ipsilateral brain lesion since 2015, which was showing growth without any clinical symptomatology and the patient wanted the lesion to be removed. This atypical lesion underneath the scleroderma shows that diagnosis can be missed without brain imaging and biopsy.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Thierry Frank, Alain Farra, Pierre-Alain Rubbo, Jean-Robert Mbecko, Hugues Sanke, Anne Le Fl&egrave;che-Mat&eacute;os, Jean-Pierre Lombart, Alain Berlioz-Arthaud [Letter to the editors] - Burkholderia cepacia meningitis in the Central African Republic - 07 January 2019. http://www.panafrican-med-journal.com/content/article/32/12/abstract/ <b>Burkholderia cepacia causes frequent infections in immunocompromised and hospitalized patients, with a significant mortality rate. This bacterial species has also been associated with epidemic outbreaks due to contamination of antiseptic solutions and parenteral and nebulized medications. In 2016, in the town of Bongonon in the north of the Central African Republic (CAR), a three-year-old boy with febrile meningeal syndrome (fever, neck stiffness and altered general condition) was admitted for a medical consultation provided by the nongovernmental organization MSF-Spain. On 20 March 2016, a sample of the boy’s cerebrospinal fluid was sent to the Bacteriology Laboratory of the Pasteur Institute of Bangui for analysis. Conventional bacteriology showed that the isolate was a Gram-negative bacillus, which was identified as B. cepacia by using API 20 NE, with 99.9%confidence. In addition, the strain presented an acquired re¬sistance to ticarcillin-clavulanate, ceftazidime and imipenem but remained susceptible to cotrimoxazole. As B. cepacia had never previously been isolated from cerebrospinal fluid in Africa, we chose to identify the strain by 16S rRNA gene sequencing. The molecular data showed that the isolate belonged to B. cepacia group.This is the first report of a case of meningitis caused by B. cepacia in CAR and developing countries.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Eric Butera, Assumpta Mukabutera, Etienne Nsereko, Cyprien Munyanshongore, Nadine Rujeni, Ivan Emile Mwikarago, Patricia Jean Moreland, Manasse Nzayirambaho Manasse [Research] - Prevalence and risk factors of intestinal parasites among children under two years of age in a rural area of Rutsiro district, Rwanda – a cross-sectional study - 07 January 2019. http://www.panafrican-med-journal.com/content/article/32/11/abstract/ <b>INTRODUCTION: This study aimed to assess the prevalence and associated risk factors of intestinal parasite infections among children less than two years of age in Rutsiro, Rwanda. METHODS: a cross-sectional parasitological survey was conducted in Rutsiro in June 2016. Fresh stool samples were collected from 353 children and examined using microscopy to detect parasite. A questionnaire was administered to collect data on hygiene, sanitation, socio-demographic and economic characteristics. RESULTS: approximately one in two children (44.8%) were found to be infected with at least one intestinal parasite. Ascaris (28.5%) was the most prevalent infection followed by Entamoeba histolytica (25.95%) and Giardia lamblia (19.6%). Infection with more than one pathogen was noted e.g. presence of Ascaris and yeasts (8.9%), and amoeba with Trichocephale (4.4%), respectively. Children from non-farming families were less likely to be at risk of intestinal parasite infections (AOR = 0.41, p = 0.028) compared to children from farming families. Children from households with access to treated drinking water were less likely to contract intestinal parasite infections (AOR = 0.44, p = 0.021) compared with those who used untreated water. Children from families with improved sources of water were twice as likely to be diagnosed with intestinal parasitoses compared to those who did not. We postulate that the majority of families (50.1%) who have access to improved water sources do not treat water before consumption. CONCLUSION: the high prevalence of intestinal parasitoses in children warrants strict control measures for improved sanitation, while treatment of drinking water should be considered.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Chukwuma Anyaike, Oladele Ademola Atoyebi, Omotoso Ibrahim Musa, Oladimeji Akeem Bolarinwa, Kabir Adekunle Durowade, Adeniyi Ogundiran, Oluwole Adeyemi Babatunde [Research] - Adherence to combined Antiretroviral therapy (cART) among people living with HIV/AIDS in a Tertiary Hospital in Ilorin, Nigeria - 07 January 2019. http://www.panafrican-med-journal.com/content/article/32/10/abstract/ <b>INTRODUCTION: This study aims to assess the treatment adherence rate among People Living With HIV/AIDS (PLWHA) receiving treatment in a Nigerian tertiary Hospital. METHODS: This was a cross-sectional study that assessed self-reported treatment adherence among adults aged 18 years and above who were accessing drugs for the treatment of HIV. Systematic random sampling method was used to select 550 participants and data were collected by structured interviewer administered questionnaire. RESULTS: The mean age of respondents was 39.9±10 years. Adherence rate for HIV patients was 92.6%. Factors affecting adherence include lack of money for transportation to the hospital (75%), traveling (68.8%), forgetting (66.7%), avoiding side effects (66.7%) and avoiding being seen (63.6%). CONCLUSION: The adherence rate was less than optimal despite advancements in treatment programmes. Adherence monitoring plans such as home visit and care should be sustained.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Kenneth John, Farba Faye, Rhonda Belue [Research] - A descriptive study of trauma cases encountered in the Grand M’Bour Hospital Emergency Department in Senegal - 07 January 2019. http://www.panafrican-med-journal.com/content/article/32/9/abstract/ <b>INTRODUCTION: This study analyzed the trends of trauma cases that presented to the Emergency Department (ED) in the Grand M'Bour Hospital. We examined demographics of patients, mechanisms of trauma and types of injuries that result and times from injury to arrival. METHODS: this was a descriptive study using prospective ED trauma cases. Patients were selected for the study if their chief complaint was related to a traumatic injury. A trauma flow sheet was developed to obtain information. Data was collected from 6/22/16-7/13/16, with 105 cases recorded. Abstracted data included date, time of arrival, time of injury, age, gender, mechanism of injury, injury sustained and disposition. RESULTS: patients presented to the ED for 13 different trauma-related reasons. 71% of the patients encountered had a mechanism of injury related to falls or motor vehicle accidents. The majority of patients who suffered from a fall-or motor vehicle-related injury were children, with ages 0-10 representing 31% and ages 11-20 representing 14% of the total patients. While 29% of patients were seen within 1 hour of the time of their injury, 10% of the patients were not seen until days after their injury. CONCLUSION: we report that traumatic injuries are most commonly a result of fall-related and vehicle-related accidents. Children under the age of 20 years old are a vulnerable population for traumatic injuries. We observed that many patients were unable to seek care within a day of their injury. This was concerning that proper emergency transportation was not available, leading to potential complications or improper healing of injuries. Knowing these trends, an ED can be better prepared to treat these patients.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Imad Nouamou, Monia El Mourid, Yassine Ragbaoui, Rachida Habbal [Case series] - Adh&eacute;sion m&eacute;dicamenteuse chez les coronariens &acirc;g&eacute;s: exp&eacute;rience marocaine - 04 January 2019. http://www.panafrican-med-journal.com/content/article/32/8/abstract/ <b>La prise en charge des coronaropathies a connu d'importants progr&egrave;s. L’adh&eacute;sion m&eacute;dicamenteuse chez les coronariens, en particulier chez les sujets &acirc;g&eacute;s, demeure un d&eacute;fi majeur pour le contr&ocirc;le de la maladie coronarienne et la pr&eacute;vention de ses complications. L’adh&eacute;sion au traitement pourrait &ecirc;tre influenc&eacute; par la particularit&eacute; d&eacute;mographique et socio&eacute;conomique pr&eacute;caire des pays africains. Nous avons r&eacute;alis&eacute; une &eacute;tude transversale de mars &agrave; octobre 2016 portant sur les patients &acirc;g&eacute;s, suivis pour coronaropathie stable en ambulatoire. L'adh&eacute;rence aux m&eacute;dicaments &eacute;tait &eacute;valu&eacute;e par un questionnaire: Morisky Medication Adherence Scale. Les informations relatifs aux facteurs pr&eacute;dictifs d’adh&eacute;sion m&eacute;dicamenteuse &eacute;tait d&eacute;riv&eacute;s d'un mod&egrave;le d’adh&eacute;sion multidimensionnel. Ont &eacute;t&eacute; inclus dans cette &eacute;tude 115 patients &acirc;g&eacute;s (&acirc;ge > 65 ans). L'adh&eacute;sion m&eacute;dicamenteuse &eacute;tait de 72,2% selon Morisky Medication Adherence Scale. La s&eacute;dentarit&eacute; a &eacute;t&eacute; retrouv&eacute;e dans 59% des patients, l'hypertension art&eacute;rielle et le diab&egrave;te dans 42,6% et 41,7% des patients respectivement. Les facteurs pr&eacute;dictifs de mauvaise observance &eacute;taient: l'absence d'une mutuelle de sant&eacute; (p = 0,02), la s&eacute;v&eacute;rit&eacute; de la symptomatologie (p = 0,001), les patients ayant pr&eacute;sent&eacute; un syndrome coronaire aigue (p = 0,006), le niveau de support social (p = 0,011) et la d&eacute;pression (p = 0,006). L’adh&eacute;sion m&eacute;dicamenteuse reste un probl&egrave;me de sant&eacute; au Maroc notamment chez les personnes &acirc;g&eacute;es. Les fournisseurs de soins de sant&eacute; doivent &ecirc;tre conscients des facteurs associ&eacute;s &agrave; une plus grande probabilit&eacute; d'arr&ecirc;t de traitement, en particulier les facteurs variables afin de mettre en place des strat&eacute;gies adapt&eacute;es pour am&eacute;liorer l'observance du traitement.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Obinna Ositadimma Oleribe, Obehi Hilda Okojie, Nicholas Jonathan Burstow, Simon David Taylor-Robinson [Research] - Premarital sex and condom use among trainee healthcare workers: an exploratory study of selected healthcare training institutions in Enugu State, Nigeria - 04 January 2019. http://www.panafrican-med-journal.com/content/article/32/7/abstract/ <b>INTRODUCTION: To assess the prevalence and causes of premarital sex and condom use among trainee healthcare workers in selected healthcare institutions in Enugu State, Nigeria; and to proffer solution to challenges identified. METHODS: We used a mixed study approach with qualitative and quantitative components. Informed consent was obtained from participants and data collected using self-administered structured questionnaires. Epi info® was used for data analysis. RESULTS: A total of 362 respondents (309 unmarried) from four healthcare training institutions participated in the study. Among unmarried respondents, 141(45.8%) were sexually active. Premarital sex was more common among Pentecostals and sexual activity increased with age (r=0.78; p <0.05). Premarital sexual activity was more common among males and trainee nurses (p <0.005). Although knowledge of condom use was high, actual use was poor (20.1%), with lowest rates among females, Catholics and age-group 30–35 years. Breakages, high failure rates and reduced sexual satisfaction were cited as major factors responsible for poor use. Use of non-specific terms such as "casual sex" and "casual or regular sex partners" hindered consistent, correct condom use. CONCLUSION: There is a significant gap between knowledge of and actual use of condoms, despite high premarital sexual activity amongst healthcare workers. Furthermore, non-specific terminologies hinders appropriate condom usage. We propose the term: Committed Spousal Partner (CSP) defined as "a sexual partner who commits to fidelity (one sexual partner per time) and whose current HIV status is known through medical testing and is properly documented" in place of all non-specific terminology.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Zeleke Mekonnen, Mestawet Getachew, Johannes Bogers, Jozef Vercruysse, Bruno Levecke [Research] - Assessment of seasonality in soil-transmitted helminth infections across 14 schools in Jimma Town, Ethiopia - 04 January 2019. http://www.panafrican-med-journal.com/content/article/32/6/abstract/ <b>INTRODUCTION: Up to date, the frequency of preventive chemotherapy based on the prevalence is the only strategy in the control programmes of soil-transmitted helminths (STHs). However, prevalence of STHs may be affected by climatic and/or seasonal changes, particularly when these are important determinants of transmission of STH infections. Our objective was to describe the prevalence and infection intensity and seasonal variation (mainly dry vs rainy season) of any STHs among school age children. METHODS: assessment of infection intensity and prevalence of STHs was carried out during dry season (February-March, 2012) and end of rainy season (September-October, 2012) across 14 primary schools in Jimma Town, Jimma, Ethiopia. A total of 1,680 school children (840 in each season) were included. All stool samples were processed by the McMaster egg counting method. Odds of infection and intensity was performed to assess any differences in prevalence and infection intensity between the schools and the two seasons. The pooled odd ratio and their 95% confidence interval was also computed and presented using the "metafor" package of the statistical software R. The level of significance was declared at p < 0.05. RESULTS: infections with any STH were observed in 824/1,680 (49.0%) subjects. T. trichiura was the most prevalent (35.5%), followed by A. lumbricoides (23.4%) and hookworm (9.9%). Among the schools there were a huge variation in prevalence, ranging from 16.7% to 68.3% for any STH, 6.7% to 39.2% for A. lumbricoides, 10.8% to 55.0% for T. trichiura and 0 % to 28.3% for hookworms. A significant difference in prevalence (for T. trichiura) and in infection intensity (for A. lumbricoides and T. trichiura) across seasons was observed. Generally, STH infections were more prevalent in the dry season (52.4%) compared to the rainy season (45.7%) and as well intensity of all three STH infections was higher in the dry season. CONCLUSION: our data suggested that there were huge variation in STH prevalence among schools and a significant difference in infection intensity and prevalence across seasons. This in turn might limits how national governments and international organizations define and target resources to combat the disease burden due to STH infection. Long term studies are needed to confirm the influence of seasonal factors and related ecological, environmental and socio-economic factors.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Serena Vita, Miglietta Alessandro, Lopalco Maurizio, Terrazzini Nadia, Sargentini Valeria, Cella Eleonora, Bachetoni Alessandra, Dicuonzo Giordano, Angeletti Silvia, Ciccozzi Massimo, Ceccarelli Giancarlo [Research] - Baseline haematological and biochemical reference values for healthy male adults from Mali - 04 January 2019. http://www.panafrican-med-journal.com/content/article/32/5/abstract/ <b>INTRODUCTION: Haematological reference values are very important for diagnostic orientation and treatment decision. The aim of this study was to establish haematological reference values for Malian healthy adults. METHODS: a cross-sectional study including 161 male Malians aged between 19 and 54 years old was performed. Median and reference ranges were calculated for haematological and biochemical parameters. Parametric student's t-test was used to determine any statistically significant differences by age, smoker status, body mass index (BMI) and occupation. Ranges were further compared with those reported for other African, Afro-American and Caucasian populations. RESULTS: increased levels of MCV, MCH, PLT and EOS were found in younger Malians who had abnormal BMI and altered platelets parameters. Notably, significantly lower eosinophil and monocyte counts were observed in Malians compared to Europeans The smoking status did not seem to directly affect RIs. CONCLUSION: this is the first study to determine normal laboratory parameters in Malian adult males. Our results underscore the necessity of establishing region-specific clinical reference ranges that would allow clinicians and practitioners to manage laboratory tests, diagnosis and therapies. These data are useful not only for the management of patients in Mali, but also to support European and American clinicians in the health management of asylum seekers and migrants from Mali.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ahmed Elhagar, Ibrahim Kamar, Mohamed Faisa Hassan Elsheikh, Anant Mahapatra, Tarig Fadlallah Altahir Ahmed, Yogesh Acharya, Khalid Khan [Case report] - Unusual case of lower back pain-piriformis myositis: a case report and literature review - 03 January 2019. http://www.panafrican-med-journal.com/content/article/32/4/abstract/ <b>We present a case of a 37-year-old male security officer with fever, severe low back pain radiating to left lower leg and diminished mobility for 1 week. His Lumbar spine X-ray was unremarkable, but his inflammatory markers including CRP, ESR and Neutrophils were high. CT scan with contrast showed rim enhancing fluid collection within the left obturator foramen with inflammatory change in the mesorectal fat. Confirmatory MRI scans depicted inflammatory change in the left piriformis muscle and a localized collection without any abnormality in the spine. Urgent CT guided aspiration was performed and the sample sent for microbiological analysis. Intravenous antibiotics commenced and continued for two weeks with complete resolution.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Hicham Abdellaoui, Youssef Bouabdallah [Images in medicine] - Enucl&eacute;ation d’un kyste hydatique du muscle psoas chez un enfant - 03 January 2019. http://www.panafrican-med-journal.com/content/article/32/3/abstract/ <b>Le kyste hydatique (KH) du psoas est exceptionnel et se manifeste par un syndrome de masse sans aucune sp&eacute;cificit&eacute;. La douleur ou les signes compressifs am&egrave;nent le patient &agrave; consulter. L’aspect insidieux du d&eacute;veloppement explique les tailles importantes que peut prendre le kyste. L’&eacute;chographie abdominale est l’examen fondamental. La TDM permet une meilleure &eacute;tude des rapports du kyste avec les structures avoisinantes. La chirurgie reste la m&eacute;thode th&eacute;rapeutique de r&eacute;f&eacute;rence. La voie d’abord extra-p&eacute;riton&eacute;ale est souhaitable afin d’&eacute;viter toute contamination intra-abdominale. L’id&eacute;ale est de r&eacute;aliser une p&eacute;rikystectomie ou mieux encore une &eacute;nucl&eacute;ation. Aussi la ponction, l’&eacute;vacuation et la st&eacute;rilisation du kyste sont d’autant plus efficaces que le kyste se d&eacute;veloppe en pleine &eacute;paisseur du muscle psoas. L’ex&eacute;r&egrave;se trop large peut compromettre les r&eacute;sultats fonctionnels. Le pronostic est g&eacute;n&eacute;ralement bon. Il s’agit d’une fillette de 5 ans, d´origine rural, qui consulte pour une masse douloureuse de la fosse iliaque droite apparue de fa&ccedil;on progressive et insidieuse depuis 3 mois. Une &eacute;chographie avait mis en &eacute;vidence une l&eacute;sion kystique de la FID de 55 x 38 mm &agrave; contenu anechog&egrave;ne &eacute;voquant un kyste hydatique (A). Le scanner (B) avait confirm&eacute; le kyste hydatique du psoas iliaque de 52x42x55 mm avec amincissement de l’os iliaque en regard. La patiente a &eacute;t&eacute; op&eacute;r&eacute;e par une mini laparotomie oblique extra-p&eacute;riton&eacute;ale. Une &eacute;nucl&eacute;ation sans rupture du kyste a &eacute;t&eacute; r&eacute;alis&eacute;e (C et D). Le suivi clinique et &eacute;chographique &eacute;tait satisfaisant.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Ginette Claude Mireille Kalla, Esther Voundi Voundi, Florence Mimo Tanghu, Christiane Medi Sike, Michel Noubom, Joseph Mendimi Nkodo, Justin Amougou, Alexis Ndjolo, Francois-Xavier Mbopi-Keou [Research] - Evaluation des performances du cytom&egrave;tre « MUSE AUTO CD4/CD4% » vs « GUAVA AUTO CD4/CD4% » pour la mesure du taux de lymphocytes CD4 chez des patients infect&eacute;s par le VIH au Cameroun - 03 January 2019. http://www.panafrican-med-journal.com/content/article/32/2/abstract/ <b>INTRODUCTION: Nous avons &eacute;valu&eacute; les performances du cytom&egrave;tre MUSE®, par rapport au cytom&egrave;tre de r&eacute;f&eacute;rence GUAVA®. METHODES: Une &eacute;tude exp&eacute;rimentale a &eacute;t&eacute; r&eacute;alis&eacute;e sur d’&eacute;chantillons de patients s&eacute;ropositifs au VIH. Les &eacute;chantillons de sang veineux recueillis dans un tube K3 EDTA, ont &eacute;t&eacute; analys&eacute;s dans un d&eacute;lai de 24-48h par les cytom&egrave;tres MUSE® et GUAVA®, au Centre International de Diagnostic m&eacute;dical de Yaound&eacute;. RESULTATS: Au total, 227 &eacute;chantillons ont &eacute;t&eacute; analys&eacute;s. Il y avait une forte corr&eacute;lation intraclasse (p<0,0001) entre les cytom&egrave;tres MUSE® et GUAVA® avec un coefficient de 0,998 (95% IC: 0,998-0,999) pour les valeurs absolues et de 0,992 (95% IC: 0,989-0,994) pour les pourcentages. Une forte corr&eacute;lation lin&eacute;aire positive (p=0,000) a &eacute;t&eacute; retrouv&eacute;e entre les cytom&egrave;tres MUSE® et GUAVA® avec des pentes r2=0,98 (95% IC=0,97-0,99) pour les valeurs absolues et r2= 0,98 (95% IC= 0,96-1,00) pour les pourcentages. Les biais &eacute;taient de -4,80 cells/µl (-101,31 – 91,71) pour les valeurs absolues et de -0,89% (IC: -6,08 – 4,3) pour les pourcentages. Le pourcentage des points de donn&eacute;es en dehors des limites d’accord &eacute;tait de 12/227 (5,29%) et de 10/227 (4,41%) respectivement pour les valeurs absolues et les pourcentages. Le coefficient Kappa de Cohen &eacute;tait de 0,92 et l’aire sous la courbe de 0,9975 (IC 95%: 0,99-1). CONCLUSION: Le cytom&egrave;tre MUSE®AUTO CD4/CD4% est un appareil performant car ses r&eacute;sultats concordent avec ceux donn&eacute;s par le cytom&egrave;tre de r&eacute;f&eacute;rence, et peu de fait permettre le suivi des patients infect&eacute;s par le VIH notamment dans les pays en d&eacute;veloppement.</b><br/> text/html 2019-04-19T12:23:37+01:00 http://www.panafrican-med-journal.com Abdoul Aziz Diouf, Djibril Diallo, Papa Youssou Niang, Aminata Niass, Cyr Esp&eacute;rance Koulimaya-Gombet, Moussa Diallo, Jean Charles Moreau, Alassane Diouf [Research] - Sexualit&eacute; des femmes m&eacute;nopaus&eacute;es en Afrique sub-saharienne: exemple du S&eacute;n&eacute;gal - 01 January 2019. http://www.panafrican-med-journal.com/content/article/32/1/abstract/ <b>INTRODUCTION: en Afrique, la vie sexuelle apr&egrave;s la m&eacute;nopause reste un domaine mal explor&eacute; du fait de son caract&egrave;re tabou. L'objectif de cette &eacute;tude &eacute;tait d'appr&eacute;cier la qualit&eacute; de la sexualit&eacute; du couple au cours de la m&eacute;nopause. METHODES: Il s'agissait d'une une enqu&ecirc;te transversale concernant un &eacute;chantillon repr&eacute;sentatif de 320 femmes m&eacute;nopaus&eacute;es. Les crit&egrave;res d'inclusion &eacute;taient la m&eacute;nopause naturelle. N'&eacute;taient pas incluses de l'&eacute;tude les patientes ayant fait l'objet d'une m&eacute;nopause pr&eacute;coce ou iatrog&egrave;ne. La fiche d'enqu&ecirc;te &eacute;tait divis&eacute;e en 4 chapitres : les caract&eacute;ristiques socio-culturelles de la femme, les donn&eacute;es cliniques, les donn&eacute;es psycho-sexuelles et les donn&eacute;es th&eacute;rapeutiques. Nous avons utilis&eacute; la comparaison des proportions et le test du Chi 2 avec un seuil de signification inf&eacute;rieur &agrave; 0,05. RESULTATS: l'&acirc;ge moyen des femmes &eacute;tait de 60 ans. L'&acirc;ge moyen de survenue de la m&eacute;nopause &eacute;tait de 48 ans et l'anciennet&eacute; de la m&eacute;nopause &eacute;tait de 11,3 ans. Aucune femme de notre &eacute;tude n'&eacute;tait &eacute;pargn&eacute;e par les manifestations du syndrome climat&eacute;rique. Les bouff&eacute;es de chaleur &eacute;taient pr&eacute;sentes dans 85,9%, la s&egrave;cheresse vaginale dans 62,8% et les troubles urinaires dans 52,5%. Seules les femmes mari&eacute;es d&eacute;claraient avoir des rapports sexuels avec leurs conjoints (62,1%). Ces rapports sexuels &eacute;taient occasionnels dans 68,9% des cas alors que 18,1% des femmes n'avaient plus d'activit&eacute; sexuelle. La diminution de l'activit&eacute; sexuelle &eacute;tait due aux troubles de l'&eacute;rection du conjoint (62% des couples) et au manque de d&eacute;sir sexuel (83,5% des femmes). Une absence d'excitation sexuelle et d'orgasme &eacute;taient &eacute;galement retrouv&eacute;e respectivement dans 92% et 100%. Cependant, 93,5 % des femmes mari&eacute;es jugeaient supportable leur v&eacute;cu. CONCLUSION: le statut marital, la dyspareunie, la s&egrave;cheresse vaginale et les troubles &eacute;rectiles du conjoint ont un impact r&eacute;el sur la sexualit&eacute; de la femme m&eacute;nopaus&eacute;e au S&eacute;n&eacute;gal.</b><br/>