Pan african Medical Journal - Volume 32 Pan african Medical Journal. Volume 32 2019-02-19T00:44:14+01:00 pamj logo text/html 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 Sqalli Houssaini Asmaa, Badreddine Hassam [Images in medicine] - Cutaneous tuberculosis with an unusual appearance and location - 18 February 2019. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 Fatima Zahra Zaher, Nawal El Ansari [Images in medicine] - Subcutaneous calcinosis: a rare complication of chronic hypercalcemia - 12 February 2019. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 Malumani Malan, Wu Xuejingzi, Jiang Si, Song Ji Quan [Case report] - Hailey-Hailey disease: the role of azathioprine an immunomodulator - 05 February 2019. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 Gifty Gyamah Nyante, Catherine Oppong, Emmanuel Bonney [Research] - Sex differences in physical activity among Ghanaian patients with sickle cell disease - 05 February 2019. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 Adja Coumba Diallo, Mouhamadou Bachir Ba [Images in medicine] - Un cas de gigantomastie gravidique bilat&eacute;rale - 29 January 2019. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 Fatima-Zahra Agharbi [Case report] - Mastocytome solitaire de l'enfant: &agrave; propos d'un cas - 28 January 2019. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 Fatima-Zahra Agharbi [Images in medicine ] - Lichen nitidus - 22 January 2019. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 Malumani Malan, Zhe Dai, Wu Jianbo, Song Ji Quan [Case report] - Onycholysis an early indicator of thyroid disease - 17 January 2019. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 Ozkan Ozen, Yilmaz Guler, Yavuz Yuksel [Case report] - Giant colonic lipoma causing intussusception: CT scan and clinical findings - 16 January 2019. <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 2019-02-19T08:44:14+01:00 Rodolfo Mendes Queiroz, Fred Bernardes Filho [Images in medicine] - Liver abscess due to fish bone ingestion - 16 January 2019. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 Abdulrahman Al Tamimi, Awad Ali Alawad [Case report] - Large spontaneous subcapsular hematoma of the liver: a rare case report - 10 January 2019. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 Hicham Abdellaoui, Youssef Bouabdallah [Images in medicine] - Enucl&eacute;ation d’un kyste hydatique du muscle psoas chez un enfant - 03 January 2019. <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 2019-02-19T08:44:14+01:00 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. <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 2019-02-19T08:44:14+01:00 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. <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/>