Pan african Medical Journal - Volume 27 Pan african Medical Journal. Volume 27 http://www.panafrican-med-journal.com/ 2017-05-29T01:29:19+01:00 pamj logo http://www.panafrican-med-journal.com http://www.panafrican-med-journal.com/img/logo.png text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Negussie Alula Bekele, Worknehe Agegnehu Abebe, Jemal Zeberga Shifa [Case report] - Misplaced subclavian central venous catheter - 26 May 2017. http://www.panafrican-med-journal.com/content/article/27/59/abstract/ <b>Percutaneous Central Venous Catheter (CVC) insertion using internal jugular and Subclavian veins routes is common procedure for all intensive care admitted patients and some patients in the ward as demand arises in central and referral hospitals of Botswana. This is a case report of a patient on whom a third attempt of re-inserting a CVC for fluid and total parenteral nutrition (TPN) was made. X-ray showed that left Subclavian inserted catheter was mis-directed to internal jugular vein of the same side creating discomfort to the patient. Ultra sound is recommended for routine investigation to confirm proper Central venous catheter placement as it can reduce failure, minimize complication and reduce cost of treatment.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Hicham El Bote, Ernest Hage, Rami Fares [Case report] - Corps &eacute;tranger inhabituel intra-ur&eacute;tral : &agrave; propos d’un cas - 26 May 2017. http://www.panafrican-med-journal.com/content/article/27/58/abstract/ <b>De nombreux articles de la litt&eacute;rature m&eacute;dicale rapportent des cas rares d'introduction de corps &eacute;trangers dans l'ur&egrave;tre. Ils sont souvent secondaires, soit &agrave; une curiosit&eacute; &eacute;rotique, soit &agrave; des troubles psychiatriques, ou rarement lors d'une tentative d'&eacute;vacuation des urines. Le diagnostic reste clinique aid&eacute; par l'imagerie. Le traitement est le plus souvent endoscopique, mais dans certains cas le recours &agrave; la chirurgie ouverte est n&eacute;cessaire. L'approche th&eacute;rapeutique doit &ecirc;tre syst&eacute;matiquement compl&eacute;t&eacute;e par une &eacute;valuation psychiatrique du malade. Nous rapportons le cas un homme de 64 ans aux ant&eacute;c&eacute;dents de troubles du comportement, il s'est introduit un fil &eacute;lectrique dans l'ur&egrave;tre. La prise en charge constituait en une extraction endoscopique sous anesth&eacute;sie locor&eacute;gionale. A sa sortie le patient a &eacute;t&eacute; r&eacute;f&eacute;r&eacute; en consultation psychiatrique.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Chigozie Jesse Uneke, Issiaka Sombie, Namoudou Keita, Virgil Lokossou , Ermel Johnson, Pierre Ongolo-Zogo [Review] - An assessment of policymaker’s engagement initiatives to promote evidence informed health policy making in Nigeria - 24 May 2017. http://www.panafrican-med-journal.com/content/article/27/57/abstract/ <b>In most developing countries including Nigeria, one of the most challenging issues associated with evidence-to-policy link is the capacity constraints of policymakers to access, synthesize, adapt and utilize available research evidence. The purpose of this review is to assess the efforts and various initiatives that have been undertaken to deliberately engage policymakers and other stakeholders in the health sector in Nigeria for the promotion of evidence informed policymaking. A MEDLINE Entrez Pubmed search was performed and studies that investigated policy making process, evidence to policy link, research to policy mechanism, and researchers/policymakers interaction in Nigeria in relation to health policy were sought. Of the 132 publications found, 14(10.6%) fulfilled the study inclusion criteria and were selected and included in the review. Of the fourteen scientific publications identified, 11 of the studies targeted both researchers and policymakers and the principal tool of intervention was training workshops which focused on various aspects of evidence informed policymaking. All the studies indicated positive outcomes and impacts in relation to quantifiable improvement in policymakers' knowledge and competence in evidence to policy process. Capacity strengthening engagement mechanism is needed for both researchers to generate better evidence and for policymakers and health-care professionals to better use available evidence.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, B&eacute;chir Achour [Images in medicine] - Sarcome granulocytique du rachis dorsal: une cause inhabituelle de compression médullaire - 24 May 2017. http://www.panafrican-med-journal.com/content/article/27/56/abstract/ <b>Le sarcome granulocytique ou chlorome est une tumeur maligne extra-m&eacute;dullaire rare, compos&eacute;e de cellules my&eacute;lo&iuml;des immatures. La localisation rachidienne &eacute;pidurale est exceptionnelle. Nous rapportons le cas d'un patient de 21 ans pr&eacute;sentant une parapl&eacute;gie compl&egrave;te avec un syndrome h&eacute;morragique (h&eacute;maturie et ecchymoses diffuses). L'IRM rachidienne en s&eacute;quence sagittale T2 (A) et axiale T1 apr&egrave;s injection du gadolinium centr&eacute;e sur D4 (B) a montr&eacute; un processus expansif &eacute;pidural post&eacute;rieur &eacute;tendu de D4 &agrave; D7 de signal h&eacute;t&eacute;rog&egrave;ne T2 rehauss&eacute; intens&eacute;ment apr&egrave;s injection qui comble largement le canal m&eacute;dullaire et exerce un effet de masse sur la moelle dorsale en regard sans signe d'atteinte osseuse. L'h&eacute;mogramme a montr&eacute; une pancytop&eacute;nie. Le frottis sanguin a objectiv&eacute; 55% de blastes. Le my&eacute;logramme a r&eacute;v&eacute;l&eacute; une leuc&eacute;mie aigu&euml; my&eacute;loblastique (LAM). La cytologie du liquide c&eacute;phalo-rachidien n'a pas montr&eacute; de cellules malignes. Le patient a subi une laminectomie de D4 &agrave; D7 et une r&eacute;section compl&egrave;te de la masse tumorale dont l'examen anatomopathologique a conclu &agrave; un sarcome granulocytique du rachis. Le patient a re&ccedil;u une cure de chimioth&eacute;rapie syst&eacute;mique selon le protocole des LAM de l'adulte. L'&eacute;volution &eacute;tait marqu&eacute;e par l'obtention d'une r&eacute;mission h&eacute;matologique et m&eacute;dullaire avec persistance d'un fauchage s&eacute;quellaire avec un recul de 7 ans.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Caroline Muringazuva, Daniel Chirundu, More Mungati, Gerald Shambira, Notion Gombe, Donewell Bangure, Tsitsi Juru, Mufuta Tshimanga [Research] - Evaluation of the adverse drug reaction surveillance system Kadoma City, Zimbabwe 2015 - 24 May 2017. http://www.panafrican-med-journal.com/content/article/27/55/abstract/ <b>INTRODUCTION: medicines have the potential to cause adverse drug reactions and because of this Zimbabwe monitor reactions to medicines through the Adverse Drug Reaction Surveillance System. The Medicines Control Authority of Zimbabwe monitors reactions to medicines through the Adverse Drugs Reactions Surveillance System. The system relies on health professionals to report adverse drug reactions to maximize patient safety. We report results of an evaluation of the Adverse Drugs Reactions Surveillance System in Kadoma District. METHODS: a descriptive cross-sectional study was conducted using the updated CDC guidelines in six health facilities in Kadoma City. Data were collected using a pretested interviewer administered questionnaire, checklists and records review. Data was analyzed using Epi InfoTM to calculate frequencies and means. Qualitative data were analyzed manually. Written informed consent was obtained from all study participants.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Taher Ismail Boudhaye, Mohamed Sidimalek, Cheikhani Jdoud [Case report] - L’hydronephrose g&eacute;ante idiopathique: vers une approche th&eacute;rapeutique en 2 temps - 24 May 2017. http://www.panafrican-med-journal.com/content/article/27/54/abstract/ <b>L’hydron&eacute;phrose g&eacute;ante est rare. Le syndrome de jonction py&eacute;lour&eacute;t&eacute;rale repr&eacute;sente l’&eacute;tiologie la plus fr&eacute;quente. Nous rapportons un cas inhabituel d’un patient hospitalis&eacute; pour hydron&eacute;phrose g&eacute;ante avec alt&eacute;ration de l’&eacute;tat g&eacute;n&eacute;ral. Le diagnostic a &eacute;t&eacute; fait par le scanner. Le traitement avait consist&eacute; en une n&eacute;phrectomie diff&eacute;r&eacute;e apr&egrave;s drainage percutan&eacute;.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Hasnaa Zaouri, Baderddine Hassam [Images in medicine] - K&eacute;ratoses s&eacute;borrh&eacute;iques: une localisation inhabituelle - 24 May 2017. http://www.panafrican-med-journal.com/content/article/27/53/abstract/ <b>Les k&eacute;ratoses s&eacute;borrh&eacute;iques (KS) sont des tumeurs &eacute;pith&eacute;liales b&eacute;nignes fr&eacute;quentes. Elles se d&eacute;veloppent pr&eacute;f&eacute;rentiellement dans les zones s&eacute;borrh&eacute;iques,notamment le visage et le tronc, rarement au niveau g&eacute;nital.Nous rapportons le cas d’un patient &acirc;g&eacute; de 41 ans, sans ant&eacute;c&eacute;dents pathologiques notables, consultait pour des l&eacute;sions pubiennes &eacute;voluant depuis trois ans. L'examen clinique retrouvait des l&eacute;sions noir&acirc;tres &agrave; surface k&eacute;ratosique, c&eacute;r&eacute;briformes au niveau de la verge. La biopsie cutan&eacute;e &eacute;tait en faveur d’une k&eacute;ratose s&eacute;borrh&eacute;ique. Un traitement par &eacute;lectrocoagulation-curetage a &eacute;t&eacute; r&eacute;alis&eacute;.Il existe deux th&eacute;ories expliquant le m&eacute;canisme de formation des KS. La premi&egrave;re, &eacute;met l’hypoth&egrave;se que les KS sont la r&eacute;sultante d’une prolif&eacute;ration de k&eacute;ratinocytes aboutissant &agrave; une inhibition de l’apoptose et l’expression de la survivine. D'apr&egrave;s la seconde, les KS seraient le r&eacute;sultat d’une accumulation de k&eacute;ratinocytes s&eacute;nescents avec une surexpression de la prot&eacute;ine p16. Dans le cas des KS g&eacute;nitales, le r&ocirc;le du frottement chronique et de l’HPV a &eacute;t&eacute; suspect&eacute;. Le traitement repose sur l'ex&eacute;r&egrave;se chirurgicale, le curetage, la cryoth&eacute;rapie par azote liquide, l'application d'acide trichloroac&eacute;tique, l'&eacute;lectrosection ou l’ablation par laser CO2. Si les KS ne posent pas a prioride probl&egrave;mes de sant&eacute; majeurs, leur localisation au niveau de la r&eacute;gion g&eacute;nitale peut influencer n&eacute;gativement la vie sexuelle du patient, d’o&ugrave; l’int&eacute;r&ecirc;t d’une prise en charge pr&eacute;coce.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com David Ayobami Adewole, Saidat Abisola Akanbi, Kayode Omoniyi Osungbade, Segun Bello [Research] - Expanding health insurance scheme in the informal sector in Nigeria: awareness as a potential demand-side tool - 19 May 2017. http://www.panafrican-med-journal.com/content/article/27/52/abstract/ <b>INTRODUCTION: the implementation and expansion of a health insurance scheme in the informal sector, particularly in developing countries, is a challenge. With the aid of an innovative Information-Education and Communication model, titled ‘Understanding the concept of health insurance: An innovative social marketing tool’, an assessment of the awareness and perception of the scheme among market women was carried out. METHODS:</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Sakher Tahaineh, Rawan Abu Mughli, Moayid Fallatah [Case report] - Giant mixed Sertoli-Leydig-Granulosa sex cord tumor of the testis; clinical, histopathological, and radiological features: a case report - 19 May 2017. http://www.panafrican-med-journal.com/content/article/27/51/abstract/ <b>Sex cord tumors of the testis in post pubertal men are rare. Mixed leydig-Sertoli-Granulosa sex cord tumors are exceptionally rare. To the best of our knowledge there is only three reported similar cases in the literature. We reported a case of a 27-year-old male who presented with huge left scrotal mass of 6-years duration. The gross tumor specimen after resection measured 11 cm in diameter. Histological examination revealed mixed sex cord stromal tumor. This case demonstrates the limited ability of accurate diagnostic determination preoperatively, with pathologic examination and immune-histochemical staining post-orchiectomy representing the only definitive means of diagnosis. It also highlights the unique radiological appearances of this tumor, which are not previously reported in literature.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Irtyah Merchaoui, Asma Chouch&egrave;ne, Ines Bouan&egrave;ne, N&eacute;ilaChaari, Wassim Zrafi, Adn&egrave;ne Henchi, Mohamed Akrout, Charfeddine Amri [Research] - Pr&eacute;occupations de carri&egrave;re chez les m&eacute;decins de travail des groupements de M&eacute;decine de travail en Tunisie - 19 May 2017. http://www.panafrican-med-journal.com/content/article/27/50/abstract/ <b>INTRODUCTION: l'insatisfaction de carri&egrave;re des m&eacute;decins de travail (MT) peut influencer leur performance et la qualit&eacute; des prestations fournies. L'objectif de notre &eacute;tude est d'&eacute;valuer la satisfaction au travail des MT du terrain de l'ensemble des Groupements de m&eacute;decine de travail (GMT) de la Tunisie et pr&eacute;ciser les facteurs d&eacute;terminants. METHODES: il s'agit d'une &eacute;tude nationale transversale portant sur les MT de 22 GMT, bas&eacute;e sur le questionnaire, valid&eacute; SAPHORA JOB. RESULTATS: 58% des MT des GMT &eacute;taient insatisfaits de leur carri&egrave;re. La satisfaction de carri&egrave;re &eacute;tait statistiquement influenc&eacute;e par le nombre d'entreprises en charge (p=0,016), l'organisation du travail (p=0,010),le ressenti du m&eacute;tier (p=0,011),le salaire (p‹10-3) et l'information sur la r&eacute;glementation en vigueur (p=0,047).</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Abdoulaye Napo, Youssouf Fofana [Images in medicine] - Lipome g&eacute;ant palp&eacute;bral droit - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/49/abstract/ <b>Les lipomes sont des tumeurs sous-cutan&eacute;es uniques ou multiples, de consistance molle, compressibles, arrondies ou lobul&eacute;es, mobiles sous la peau. Ils peuvent se localiser n'importe o&ugrave;, mais plus particuli&egrave;rement sur le cou, le tronc et les membres. Il survient surtout &agrave; l'&acirc;ge adulte, sans pr&eacute;dilection de race, ni de sexe, avec dans certaines &eacute;tudes, une l&eacute;g&egrave;re pr&eacute;dominance f&eacute;minine. Le lipome est dit g&eacute;ant lorsque la pi&egrave;ce d'ex&eacute;r&egrave;se est sup&eacute;rieure &agrave; cinq centim&egrave;tres. Nous rapportons le cas de Mr BK &acirc;g&eacute; de 35 ans qui a consult&eacute; pour une tum&eacute;faction de la paupi&egrave;re sup&eacute;rieure droite &eacute;voluant depuis 2008. Depuis quelques temps le patient ressent une g&egrave;ne fonctionnelle de l'œil droit. A la palpation, c'est une masse indolore, mobile et mole et le reste de l'examen &eacute;tait normal. Nous avions &eacute;voqu&eacute; trois hypoth&egrave;ses diagnostiques: un lipome le plus probable, un kyste et une tumeur royale. La tomodensitom&eacute;trie et l'&eacute;chographie mettaient en &eacute;vidence des images de lipome. L'excision chirurgicale de la tumeur a permis d'extraire la graisse bien encapsul&eacute;e et elle mesurait 5,5x4 cm. L'histologie de la pi&egrave;ce op&eacute;ratoire a confirm&eacute; la nature graisseuse de la tumeur. Les suites op&eacute;ratoires &eacute;taient simples avec correction des troubles visuels.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Adriana Saavedra, Nia Campinha-Bacote, Maurice Hajjar, Ernest Kenu, Fizza Syeda, Gillani, Adjoa Obo-Akwa, Margaret Lartey, Awewura Kwara [Research] - Causes of death and factors associated with early mortality of HIV-infected adults admitted to Korle-Bu Teaching Hospital - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/48/abstract/ <b>Introduction: this study sought to identify common causes of death as well as the factors associated with the high inpatient mortality rate of HIV-infected patients at the Korle-Bu Teaching Hospital (KBTH). Methods: the retrospective study reviewed the medical records of 547 HIV-infected adults aged 18 years or older admitted to the KBTH between the months of January 2012 and October 2013. Using standardized abstraction forms, clinical and demographic data of eligible patients was collected. Data was summarized using descriptive statistics. Demographic and clinical characteristics of patients who died within 7 days (early) and after (late) admission were compared using Rank Sum tests or Chi-square tests. Results: of 547 eligible patients during the period, 222 (40.6%) died during hospitalization, with 109 (49.1%) of them dying within a week of admission. Of the 222 patients who died, 190 (85.6%) were previously known HIV-positive. Yet, 141 (63.5%) of the 222 patients who died had no prior highly active antiretroviral therapy (HAART). The most common admitting diagnoses were anemia (34.2%), cerebral toxoplasmosis (29.3%), and pneumonia (25.7%); the most common causes of death were tuberculosis (34.7%), anemia (30.2%) and cerebral toxoplasmosis (27.5%). Tuberculosis was the only factor significantly associated with early death (P<0.05). Conclusion: the inpatient mortality rate among HIV-infected adults admitted to the KBTH is high. A majority of the patients were not receiving HAART despite known HIV diagnosis. Earlier initiation of HAART may lower the risk of opportunistic infections and HIV mortality rates. Additionally, a high index of suspicion and initiation of empiric treatment for TB may reduce early deaths.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Keerthi Krishnankutty Nair, Kanad Chaudhuri, Ashok Lingappa, Ranjani Shetty, Pramod Gujjar Vittobarao [Case report] - Aggressive fibromatosis of the oral cavity in a 5 year old boy: a rare case report - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/47/abstract/ <b>Fibrous tissue proliferations express a wide spectrum of histologic and morphologic variations in both infants and adults. This ranges from hypertrophic scar formation at one end to malignant fibrosarcoma at the other end of the spectrum. Aggressive fibromatosis is an intermediate tumour which is in proximity to fibro sarcomas. These are locally invasive and often recur after excision, but do not metastasize. Histologically, they are characterized by proliferating fibroblasts with little mitotic activity. Aggressive fibromatosis in the head and neck region is not common, and very sporadically occurs in the oral cavity or jaw bones. Here we report a rare case of aggressive fibromatosis occurring in a 5 year old boy.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Marc Leroy Guifo, Joel Noutakdie Tochie, Blondel Nana Oumarou, Jean Roger Moulion Tapouh, Aristide Guy bang, Aurelien Ndoumbe, Bonaventure Jemea, Maurice Aurelien Sosso [Research] - Paediatric fractures in a sub-saharan tertiary care center: a cohort analysis of demographic characteristics, clinical presentation, therapeutic patterns and outcomes - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/46/abstract/ <b>Introduction: paediatric fractures are often of good prognosis due to auto-correction of insufficient fracture reduction by bone remodeling. In sub-Saharan Africa, traditional healers are renowned for managing fractures and there is a neglect for specialized pediatric fracture care. We aimed to determine the demographic characteristics, clinical presentation, treatment patterns and outcomes of paediatric fractures in a tertiary health care centre in Yaound&eacute;. Methods: we conducted a prospective cohort study of all consenting consecutive cases of fractures in patients younger than 16 years managed between January 2011 and June 2015 at the University Teaching Hospital, Cameroon. We analysed demographic data, injury characteristics, fracture patterns, treatment details, therapeutic challenges and outcome of treatment at 12 months of follow-up. Results: we enrolled 147 fractures from 145 children with a mean age of 7 years and male-to-female sex ratio of 2.5:1. The main mechanisms of injury were games (53%) and accidental falls (20.7%). Forearm fractures were the most common fractures (38%). The mainstay of management was non-operative in 130 (88.5%) fractures, with 29.3% manipulations under anesthesia and 17 (11.5%) open reductions with internal fixation. The most surgically reduced fractures were supracondylar humeral fractures. Major difficulties were long therapeutic delay, lack of diligent anaesthesia and the lack of fluoroscopy. The outcome of treatment was favorable in 146 (99.3%) paediatric fractures. Conclusion: with the growing population of sub-Saharan Africa and the objective of becoming an emergent region, public policies should match the technical realities.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Habib Bellamlih, Soukaina Zaimi, Mohamed Mahi, Touria Amil, Naoufal Chouaib, Ahmed Belkouch, Mostafa Rafai, Lahcen Belyamani [Case report] - Le syndrome de Mirizzi: une cause rare de l’obstruction des voies biliaires: &agrave; propos d’un cas et revue de litt&eacute;rature - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/45/abstract/ <b>Le syndrome de Mirizzi est une complication rare de la lithiase v&eacute;siculaire chronique, avec une incidence de 0,7% &agrave; 1,4% chez les malades chol&eacute;cyst&eacute;ctomis&eacute;s. Il est caract&eacute;ris&eacute; par un ict&egrave;re cholestatique en rapport avec une compression de la voie biliaire principale par un calcul enclav&eacute; dans le collet v&eacute;siculaire ou le canal cystique. La maladie peut &eacute;voluer vers l’&eacute;rosion de la paroi du canal h&eacute;patique commun et par cons&eacute;quent, provoquer la formation d’une fistule chol&eacute;cysto-bilaire. Nous pr&eacute;sentons ici un syndrome de Mirizzi type I en soulignant l’importance du diagnostic pr&eacute;op&eacute;ratoire, celui-ci &eacute;tant rendu plus ais&eacute; par la cholangiographie r&eacute;trograde endoscopique ou par la cholangio-IRM, qui permet d’&eacute;viter des l&eacute;sions iatrog&egrave;nes de la voie biliaire principale. Le pr&eacute;sent article passe en revue la litt&eacute;rature disponible sur les divers aspects de ce syndrome, y compris sa pathogen&egrave;se, son diagnostic et sa prise en charge.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Sohaib Hayoun, Hanane El Ouazzani, Bouchra Habibi, Salwa Belhabib, Hicham Souhi, Ismail Abderahmane Rhorfi, Ahmed Abid [Case report] - Tum&eacute;faction du muscle pectoral r&eacute;v&eacute;lant une tuberculose musculaire isol&eacute;e - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/44/abstract/ <b>La tuberculose des parties molles repr&eacute;sente l'une des formes rares de la tuberculose extra pulmonaire, la localisation musculaire isol&eacute;e est par-ailleurs exceptionnelle. Nous rapportant une observation m&eacute;dicale originale, une tuberculose musculaire isol&eacute;e int&eacute;ressant le muscle grand pectoral chez un jeune patient immunocomp&eacute;tent. Le diagnostic a repos&eacute; essentiellement sur l'histologie. L'&eacute;volution &eacute;t&eacute; favorable sous traitement anti bacillaire seul. Ce cas rare est pr&eacute;sent&eacute; avec revue de litt&eacute;rature.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Houda Chahed, Ghada Kharrat, Rim Bechraoui, Jihene Marrakchi, Azza Mediouni, Mohamed Ben Amor, Rim Zainine, Nejeh Beltaief, Ghazi Besbes [Case report] - Ectopic thyroid tissue: unusual differential diagnosis of cervical paraganglioma - 16 May 2017. http://www.panafrican-med-journal.com/content/article/27/43/abstract/ <b>Ectopic thyroid tissue (ETT) lateral to the midline is rare. Its occurrence in the carotid bifurcation is exceptional. We present a 45 years woman who consulted with a slow growing right cervical swelling. Clinical examination Ultrasonography, contrast enhanced CT and cervical MRI concluded to a paraganglioma. Intra-operatively, the tumor didn't have the characteristic aspect of a paraganglioma. Complete excision was performed. Histology concluded to an ectopic micro-vesicular thyroid adenoma.Previous literature was reviewed to summarize clinical and radiologic characteristics of such rare entity. Despite its rarity, ETT must be included in the differential diagnosis of cervical paraganglioma.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Drosos Evangelos, Giakoumettis Dimitrios, Sfakianos Georgios, Eleftherakis Nikolaos, Papadopoulos Filippos, Themistocleous Marios [Case report] - Percutaneous placement of the peripheral catheter to the subclavian vein for a VA shunt - 16 May 2017. http://www.panafrican-med-journal.com/content/article/27/42/abstract/ <b>Hydrocephalus is a common neurosurgical pathology that affects people of all ages and especially the pediatric population. It can be very often a life threatening condition that pediatric neurosurgeons must deal with. Therefore a number of CSF diversion techniques have been established. The gold standard treatment currently is the placement of a ventriculo-peritoneal shunt. Because of hydrocephalus being a lifelong condition, it is almost in daily practice dealing with cases of shunt failures for a number of reasons. Herewith we present a 4 year old child with multiple ventriculo-peritoneal shunt revision surgeries and ventriculo-atrial failure due to distal catheter malfunction that was treated with percutaneous placement of the peripheral catheter in the subclavian vein.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Faten Limaiem, Marwa Bouhamed, Ghada Sahraoui, Sabeh Mzabi [Case series] - Hepatocellular carcinoma: a clinicopathological study of 64 cases - 16 May 2017. http://www.panafrican-med-journal.com/content/article/27/41/abstract/ <b>Hepatocellular carcinoma (HCC) is the most common of all liver cancers and is a major worldwide public health problem. The aim of this study was to provide an updated overview on clinicopathological features, treatment and outcome of HCC. In our retrospective study, we reviewed 64 cases of HCC that were diagnosed at the pathology department of Mongi Slim hospital over a fifteen-year period (2000- 2014). Relevant clinical information and microscopic slides were retrospectively reviewed. Our study group included 38 men and 26 women (sex ratio M/F = 1,26) aged between 8 and 83 years (mean = 56,64 years). The presenting clinical symptoms were dominated by abdominal pain (n=34), followed by altered general health (n=25) and jaundice (n=4). Fifty-five patients underwent surgical treatment. Liver transplantation was performed in two cases and transarterial chemoembolization was achieved in seven cases. Histopathological examination of the surgical or biopsy specimen established the diagnosis of conventional HCC in 55 cases, fibrolamellar carcinoma in 6 cases and clear cell HCC in 3 cases. Seven patients with HCC died postoperatively. Local recurrence of the tumour occurred in three cases and two patients had distant metastases postoperatively. The other patients are still being followed-up. Hepatocellular carcinoma is associated with a high rate of mortality because of early invasion, widespread metastasis and lack of effective therapeutic modalities. Accurate diagnosis and staging of these tumours is critical for optimal treatment planning and for determining prognosis.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Patrick Kazooba, Ivan Kasamba, Billy Nsubuga Mayanja, Joseph Lutaakome, Ivan Namakoola, Tino Salome, Pontiano Kaleebu, Paula Munderi [Research] - Cardiometabolic risk among HIV Positive Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy - 15 May 2017. http://www.panafrican-med-journal.com/content/article/27/40/abstract/ <b>BACKGROUND: we investigated the prevalence, predictors of and effect of Antiretroviral Therapy (ART) regimen on cardiometabolic risk among HIV-positive Ugandan adults at enrolment into a prospective cohort to study the Complications of Long-Term ART (CoLTART). METHODS: we collected data on cardiometabolic risk factors including dyslipidemia, hypertension, hyperglycemia, obesity and calculated the mean atherogenic index for Plasma (AIP) and 10 year Framingham risk score (FHS). Exposures were: ART regimen, duration on ART, demographic, socio-economic, behavioral, and life-style factors including smoking, physical activity and diet (including fruit and vegetables consumption). RESULTS: we enrolled 1024 participants, 65% female, mean age was 44.8 years (SD 8.0) and median duration on ART was 9.4 years (IQR 6.1-9.8). The prevalence of abdominal obesity was 52.6%, BMI&#8805;25 kg/m2-26.1%, hypertension-22.6%, high AIP-31.3% and FHS above 10% was 16.6%. The prevalence of low High Density Lipoprotein (HDL) was 37.5%, high Total cholesterol (Tc)-30.2%, high Low Density Lipoprotein (LDL) -23.6%, high Triglycerides (TG)-21.2%, low physical activity-46.4% and alcohol consumption-26.4%. In multivariate linear regression analyses, increasing age was associated with higher mean Tc, HDL, LDL, FHS (P<0.001) and hyperglycemia (p<0.005). In multivariate logistic regression analyses, Protease Inhibitor (PI) containing regimens were significantly associated with higher risks of abnormal: Tc, LDL, TG, AIP, abdominal obesity, hypertension, low HDL and lower risk of a FHS >10% compared to the non PI regimen. CONCLUSION: ART increases cardiometabolic risk. Integration of routine assessment for cardiometabolic risk factors and preventive interventions into HIV care programs in resource-limited settings is recommended.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Hasnaa Zaouri, Baderdine Hassam [Images in medicine] - Une tumeur historique de la fesse: &agrave; propos d’un cas - 15 May 2017. http://www.panafrican-med-journal.com/content/article/27/39/abstract/ <b>Le lymphome anaplasique &agrave; grandes cellules (LAGC) est un type rare de lymphome T. Il repr&eacute;sente environ 1 &agrave; 2 % de tous les cas de lymphome non hodgkinien (LNH) chez l'adulte. Nous rapportons le cas d'une tumeur historique de la fesse Nous rapportons le cas d'un patient &acirc;g&eacute; de 48 ans, sans ant&eacute;c&eacute;dents pathologiques notables, qui s'est pr&eacute;sent&eacute; pour un placard tumoral de la fesse droite, &eacute;voluant depuis 12 ans. L'examen dermatologique retrouvait un placard tumoral de 15 cm de diam&egrave;tre fait de nodules tumoraux &eacute;ryth&eacute;mato-violac&eacute;s, dont certains sont ulc&eacute;r&eacute;s, si&egrave;ge au niveau de la fesse droite. Avec un nodule controlat&eacute;ral .le reste de l'examen clinique &eacute;tait sans particularit&eacute;s. L'&eacute;tude immuno-histologique &eacute;tait en faveur d'un lymphome T anaplasique CD30 +.Le bilan d'extension a objectiv&eacute; des ad&eacute;nopathies inguinales et iliaque externe d'allure lymphomateuse. Une ex&eacute;r&egrave;se chirugicale apr&egrave;s une chimioth&eacute;rapie CHOP &eacute;tait indiqu&eacute;e. Notre observation souligne l'importance de la sensibilisation de la population pour un diagnostic et prise en charge pr&eacute;coce.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Dadja Essoya Landoh, Anna-L&eacute;aKahn, Anani Lacle, Kodjovi Adjeoda, Bayaki Saka, Issifou Yaya, Danladi Ibrahim Nassoury, Assima Kalao, Makawa-Sy Makawa, Nsiari-Mueyi Joseph Biey, Andre Bita, Yaovi Temfa Toke, Petit D&ouml;rte, Lucile Imboua, Olivier Ronveaux [Research] - L’utilisation de l’approche CTC: quel impact sur la couverture vaccinale lors de la campagne pr&eacute;ventive de vaccination contre la m&eacute;ningite A avec le MenAfriVac au Togo en 2014 ? - 12 May 2017. http://www.panafrican-med-journal.com/content/article/27/38/abstract/ <b>INTRODUCTION: une campagne de vaccination contre la m&eacute;ningite A avec le vaccin MenAfriVac a &eacute;t&eacute; organis&eacute;e dans les quatre r&eacute;gions septentrionales du Togo du 28 novembre au 07 d&eacute;cembre 2014. L’approche CTC a &eacute;t&eacute; utilis&eacute;e pour la premi&egrave;re fois &agrave; une grande &eacute;chelle pour la campagne de vaccination dans dix districts sanitaires du Togo. L’objectif de cette &eacute;tude &eacute;tait d’estimer la couverture vaccinale et, de d&eacute;terminer l’effet de l’utilisation de la Cha&icirc;ne &agrave; Temp&eacute;rature Contr&ocirc;l&eacute;e (CTC) sur ces couvertures vaccinales. METHODES: l’enqu&ecirc;te s’est d&eacute;roul&eacute;e du 9 au 14 mars 2015, soit environ 3 mois apr&egrave;s la fin de la campagne de vaccination dans ces quatre r&eacute;gions. Le sondage en grappe &agrave; deux degr&eacute;s stratifi&eacute;s selon les r&eacute;gions a &eacute;t&eacute; utilis&eacute;. Dans 10 districts, le Togo a fait le choix d’utiliser le vaccin MenAfriVac en CTC. R&eacute;sultats: au total, 2707 m&eacute;nages ont &eacute;t&eacute; enqu&ecirc;t&eacute;s et 9082 personnes &acirc;g&eacute;es de 1 &agrave; 29 ans ont &eacute;t&eacute; interview&eacute;es. L’&acirc;ge moyen des personnes enqu&ecirc;t&eacute;es &eacute;tait de 11,8±7,7 ans et le sex-ratio (H/F) de 1,01. Le nombre moyen de personnes par m&eacute;nage &eacute;tait de 5,7 et celui des personnes de 1 &agrave; 29 ans cibl&eacute;es par la campagne &eacute;tait de 3,4.Sur les 9082 personnes enqu&ecirc;t&eacute;es, 8889 (98%) &eacute;taient vaccin&eacute;es. En analyse multivari&eacute;e, les facteurs associ&eacute;s &agrave; la couverture vaccinale avec le MenAfrivac &eacute;taient la r&eacute;sidence dans la zone au moment de la campagne (aOR = 4,52 ; 95%IC = [4.07 - 4.97]) et le fait d’&ecirc;tre inform&eacute; de la campagne avant son d&eacute;marrage (aOR=2,42 ; 95%IC = [2.05 - 2.80]). Par contre, la couverture vaccinale n’&eacute;tait pas diff&eacute;rente selon la zone ayant utilis&eacute; l’approche CTC ou non (aOR=0,09 ; 95%IC = [-0,27 – 0,45]). Deux cent sept personnes interrog&eacute;es (2,3%) ont d&eacute;clar&eacute; avoir eu une Manifestation Adverse Post Immunisation (MAPI) apr&egrave;s l’administration du vaccin. Il s’agissait surtout de MAPI mineures &agrave; type de fi&egrave;vre, d’abc&egrave;s et de gonflement au point d’injection. CONCLUSION: les r&eacute;sultats de cette enqu&ecirc;te montrent que l’utilisation de la CTC dans un pays &agrave; ressources limit&eacute;es comme le Togo n’a pas eu un effet n&eacute;gatif sur les couvertures vaccinales. En effet, il n’y avait pas de diff&eacute;rence entre la couverture vaccinale dans les zones CTC et celles non CTC. Il importe de capitaliser l’exp&eacute;rience acquise pour l’utilisation des vaccins du Programme Elargi de Vaccination avec l’approche CTC surtout dans les pays &agrave; ressources limit&eacute;es confront&eacute;s &agrave; la disponibilit&eacute; de la cha&icirc;ne de froid.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Siham Jridi, Rajae Azzedine, Jamal Eddine Bourkadi [Case report] - Le DRESS syndrome secondaire aux antituberculeux: &agrave; propos d’un cas - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/37/abstract/ <b>Le syndrome d'hypersensibilit&eacute; m&eacute;dicamenteuse ou Drug Rash with Eosinophilia and Systemic Symptoms ou DRESS syndrome est une toxidermie grave qui peut mettre en jeu le pronostic vital. Il faut y penser devant toute r&eacute;action cutan&eacute;e apr&egrave;s la prise des m&eacute;dicaments. Nous rapportons un cas clinique d'un patient &acirc;g&eacute; de 45 ans trait&eacute; pour tuberculose pulmonaire TPM+ pr&eacute;sentant un DRESS syndrome induit par les anti-bacillaires.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Sami Aziz Brahmi, Fatima Zahra Ziani, Youssef Seddik, Said Afqir [Letter to the editors] - L’oncologie m&eacute;dicale; nouvelle sp&eacute;cialit&eacute; en Afrique ? - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/36/abstract/ <b>Le cancer est un probl&egrave;me majeur de sant&eacute; public en Afrique. Les progr&egrave;s r&eacute;alis&eacute; dans le traitement des cancers ces dix derni&egrave;res ann&eacute;es est ind&eacute;niable. L'approche multidisciplinaire est primordiale pour une meilleure prise en charge des patients. La sp&eacute;cialit&eacute; d'oncologie m&eacute;dicale est r&eacute;cente en Afrique. En effet la plusieurs pays Africains ne dispose pas de m&eacute;decins qualifi&eacute;s dans cette sp&eacute;cialit&eacute; ou en nombre insuffisant. La lutte contre le cancer en Afrique passe par la formation de comp&eacute;tences dans ce domaine et l'&eacute;laboration de cursus afin de garantir une prise en charge optimale.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Edith Nkwembe-Ngabana, Steve Ahuka-Mundeke, Benoit Kebela-Ilunga, Emile Okitolonda Londa, Jean-Jacques Muyembe-Tamfum [Review] - Revue d’&eacute;pid&eacute;mies de grippe humaine avant la mise en place de la surveillance sentinelle en R&eacute;publique D&eacute;mocratique du Congo - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/35/abstract/ <b>En R&eacute;publique D&eacute;mocratique du Congo (RDC), plusieurs &eacute;pid&eacute;mies de la grippe restent m&eacute;connues car confondues &agrave; d’autres pathologies infectieuses avec lesquelles elle partage la m&ecirc;me symptomatologie. L’objet de cette &eacute;tude &eacute;tait de faire l’&eacute;tat de lieu des &eacute;pid&eacute;mies de grippe rapport&eacute;e en RDC avant 2008, l’ann&eacute;e de la mise en place de la surveillance de la grippe en RDC. Nous avons recherch&eacute; tous les documents (articles, rapport,…) ayant rapport&eacute; une &eacute;pid&eacute;mie de grippe ou d’infection respiratoires aigues (IRA) en RDC avant 2008 en utilisant des mots cl&eacute;s choisis. Pour chaque rapport retrouv&eacute;, les &eacute;l&eacute;ments de description d’&eacute;pid&eacute;mie ont &eacute;t&eacute; recherch&eacute;s et analys&eacute;s. Quatre documents ont &eacute;t&eacute; retrouv&eacute;s dont aucun article publi&eacute;. Les sites des &eacute;pid&eacute;mies rapport&eacute;es &eacute;taient les Zones de sant&eacute; rurales de Koshibanda et Kahemba dans le Bandundu (1995 et 2007), de Bosobolo &agrave; l’Equateur (2002) et de Kinshasa (2002-2003). Les taux d’attaque et de l&eacute;talit&eacute; &eacute;taient respectivement de 3.9% et 16% &agrave; Koshibanda ; de 0.1% et 2% &agrave; Kinshasa ; de 47.5 % et 1.5% &agrave; Bosobolo et de 14.6 % et 2.9% &agrave; Kahemba. Les enfants de moins de 5 ans &eacute;taient les plus touch&eacute;s. Leurs taux d’attaque variaient entre 22.6 et 57.7% et les taux de l&eacute;talit&eacute; entre 3.2 et 3.7%. Les deux &eacute;pid&eacute;mies de Bosobolo et de Kinshasa &eacute;taient associ&eacute;es au virus influenza H3N2.Cette revue montre une grande morbi-mortalit&eacute; des rares &eacute;pid&eacute;mies de grippe rapport&eacute;es en RDC.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Esohe Olivia Ogboghodo, Vivian Ossaidiom Omuemu, Oisedebame Odijie, Ofure Jennifer Odaman [Research] - Cold chain management practices of health care workers in primary health care facilities in Southern Nigeria - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/34/abstract/ <b>Introduction: vaccination has caused a dramatic reduction in the threat of diseasesthat were once widespread and often times fatal. The efficient practice of cold chain management is therefore key to ensuring that the benefits of vaccination are sustained. The objective of this study is to assess the practice of cold chain management among health workers in primary health care facilities in Benin City, Edo State. Methods: a descriptive cross-sectional study design was employed in this study. The study population consisted of registered nurses, auxiliary nurses and community health extension workers in primary health care facilities in Benin City, Edo State. The tool for data collection was pre-tested, structured self-administered questionnaire. Bivariate analysis between socio-demographic variables and practice of cold chain management was done. Binary logistic regression was also done to determine significant predictors of practice of cold chain management. The level of significance was set at p < 0.05 for all associations. Results: a total of 425 respondents participated in this study. Over two-thirds of respondents 314 (73.9%) had good practice of cold chain management. Significant determinants of practice of cold chain management were cold chain management training (p = 0.004), presence of functional refrigerators (p = 0.016), NPI supervision (p < 0.001) and higher level of education (p < 0.001).</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Bargley Makumbe, Cremence Tshuma, Gerald Shambira, More Mungati, Notion Tafara Gombe, Donewell Bangure, Tsitsi Patience Juru, Mufuta Tshimanga [Research] - Evaluation of severe malaria case management in Mazowe District, Zimbabwe, 2014 - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/33/abstract/ <b>INTRODUCTION: malaria is a preventable and curable disease. Mazowe district had been experiencing a lower malaria transmission rate in comparison to other districts in the Mashonaland Central province but it experienced a huge outbreak in the 2013-2014 rainy seasons with a case fatality rate (CFR) of 0.21%. This CFR was the highest in the province and it was twice as much as the national CFR (0.12%) for the same period. We evaluated severe malaria case management in Mazowe district to determine if practice is as per standard treatment guidelines.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Fikreselassie Getachew, Getachew Mullu Kassa, Mulatu Ayana, Endawoke Amsalu [Research] - Knowledge of direct obstetric causes of maternal mortality and associated factors among reproductive age women in Aneded woreda, Northwest Ethiopia; a cross-sectional study - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/32/abstract/ <b>INTRODUCTION: in Ethiopia, 20,000 women die each year from complications related to pregnancy and childbirth with much more maternal morbidity occurring for each maternal death. Good knowledge of women related with direct causes of maternal mortality is important in reducing maternal morbidity and mortality. Therefore, the aim of this study was to assess knowledge of direct obstetric causes of maternal mortality and associated factors among reproductive age of women in Aneded woreda, Northwest Ethiopia. METHODS: a community-based cross-sectional study was conducted using multi-stage sampling followed by simple random sampling technique. The study was conducted in Aneded woreda, Northwest Ethiopia. A total of 844 reproductive age women were included in the study. Pre-tested semi-structured questionnaire was used to collect the data. Data was collected through face-to-face interviews by 12 data collectors. Data was cleaned, coded and entered into Epi-data, then exported and analyzed using SPSS software. Bivariate and multivariable logistic regression analysis were computed to identify factors related to knowledge of obstetric causes of maternal mortality. The crude and adjusted odds ratios together with their corresponding 95% confidence intervals (CI) were computed. A P-value less than 0.05 was used to declare statistical significance. RESULTS: this study found that almost half (49.6%) of respondents have good knowledge level towards obstetric causes of maternal mortality. Significant variables associated with knowledge towards obstetric causes of maternal mortality were; being government employee (AOR=3.6, 95% CI=1.4-8.9), respondents who had additional monthly income from family members (AOR=1.54, 95% CI=1.04-2.27), respondents who attended primary school and above (AOR=1.6, 95% CI=1.13-2.25), distance of health facility in which the time it took less than 20 minutes (AOR=2.25, 95% CI(1.24-4.09), 20-39minutes (AOR=3.06, 95% CI=1.66-5.64), 40-60 minutes (AOR=2.38, 95% CI=1.52-5.26), and previous history of prolonged labor (AOR=1.4, 95% CI=1.04 -2.03) were the significant variables. CONCLUSION: this study indicated that the reproductive age women in the study area had poor knowledge towards about obstetric causes of maternal mortality. Therefore, to improve maternal knowledge and thereby reduce maternal death, the identified significant factors should be addressed through maternal and child health services. Designing appropriate strategies including the provision of targeted information, education, and communication is important.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com St&eacute;phane M&eacute;o Ikama, Jospin Makani, Bertrand Ellenga-Mbolla, Louis Igor Ondze-Kafata, Thierry Raoul Gombet, Gis&egrave;le Kimbally-Kaky [Case report] - Orage rythmique chez un patient porteur d’une cardiomyopathie dilat&eacute;e et un d&eacute;fibrillateur automatique implantable (DAI) - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/31/abstract/ <b>Les arythmies ventriculaires graves sont fr&eacute;quentes au cours de l’insuffisance cardiaque, mettant en jeu le pronostic vital du fait du risque accru de mort subite. Leur prise en charge efficace reste limit&eacute;e en Afrique Subsaharienne, du fait des moyens limit&eacute;s ou non disponibles comme le d&eacute;fibrillateur automatique implantable (DAI). Nous rapportons l’observation d’un patient de 56 ans, porteur d’une cardiomyopathie dilat&eacute;e non isch&eacute;mique &agrave; fraction d’&eacute;jection du ventricule gauche (FEVG) tr&egrave;s abaiss&eacute;e, et qui a b&eacute;n&eacute;fici&eacute; en 2012 de l’implantation d’un DAI en pr&eacute;vention primaire de mort subite pour des arythmies ventriculaires. Le traitement d’entretien associait un diur&eacute;tique, un IEC, et un anti-vitamine K. Le patient a pr&eacute;sent&eacute; au mois de novembre 2014 des &eacute;pisodes it&eacute;ratifs de d&eacute;charges &eacute;lectriques d&eacute;livr&eacute;es par le DAI, sans sensation de palpitations suggestives d’&eacute;pisodes d’arythmies. L’examen clinique est pauvre, en particulier pas de signes d’insuffisance cardiaque. L’interrogation du DAI a objectiv&eacute; de nombreux &eacute;pisodes de tachycardie et fibrillation ventriculaires ayant justifi&eacute; le traitement par ATP ou par chocs de 15 joules. Le patient est mis sous amiodarone et b&ecirc;tabloquant. L’&eacute;volution a &eacute;t&eacute; favorable avec un recul de trois mois, marqu&eacute;e par la reprise d’une vie normale, sans nouvel &eacute;pisode de choc. Les anti-arythmiques gardent une importance capitale en cas d’arythmies ventriculaires graves, m&ecirc;me en pr&eacute;sence d’un DAI.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Faith Mutsigiri, Patron Trish Mafaune, More Mungati, Gerald Shambira, Donewell Bangure, Tsitsi Juru, Notion Tafara Gombe, Mufuta Tshimanga [Research] - Malaria morbidity and mortality trends in Manicaland province, Zimbabwe, 2005-2014 - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/30/abstract/ <b>INTRODUCTION: Zimbabwe targets reducing malaria incidence from 22/1000 in 2012 to 10/1000 by 2017, and malaria deaths to near zero by 2017. As the country moves forward with the malaria elimination efforts, it is crucial to monitor trends in malaria morbidity and mortality in the affected areas. In 2013, Manicaland Province contributed 51% of all malaria cases and 35% of all malaria deaths in Zimbabwe. This analysis describes the trends in malaria incidence, case fatality and malaria outpatient workload compared to the general outpatient workload. METHODS: we analyzed routinely captured malaria data in Manicaland Province for the period 2005 to 2014. Epi Info version 7 was used to calculate chi-square trends for significance and Microsoft Excel was used to generate graphs. Permission to analyze the data was sought and granted by the Provincial Medical Directorate Institutional Review Board of Manicaland and the Health Studies office. RESULTS: malaria morbidity data for the period 2005-2014 was reviewed and a total of 947,462 cases were confirmed during this period. However, malaria mortality data was only available for the period 2011-2014 and cumulatively 696 deaths were reported. Malaria incidence increased from 4.4/1,000 persons in 2005 to 116.3/1,000 persons in 2014 (p<0.001). The incidence was higher among females compared to males (p-trend<0.001) and among the above five years age group compared to the under-fives (p-trend<0.001). The proportion of all Outpatient Department attendances that were malaria cases increased 30 fold from 0.3% in 2005 to 9.1% in 2014 (p-trend<0.001). The Case Fatality Rate also increased 2-fold from 0.05 in 2011 to 0.1 in 2014 (p-trend<0.001).</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Burcu Karakayali, Sila Yilmaz, Deniz &Ccedil;akir, Pembe G&uuml;l G&uuml;nes, Sirin G&uuml;ven, Ismail Islek [Case report] - Henoch-schonlein purpura associated with primary active epstein barr virus infection: a case report - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/29/abstract/ <b>Henoch-Sch&ouml;nlein purpura (HSP) is the most common form of childhood vasculitis. Various viral and bacterial infections, drugs, vaccines, food allergy and even insect bites have been considered as triggering factors in pathogenesis of HSP. Epstein-Barr virus (EBV) infection, which is associated with HSP, have been rarely reported. Herein we present HSP patient possibly caused by EBV infection. A 8-year old boy was admitted to our department with fever, rashes on legs and arms and intermittant mild abdominal pain. Multiple purpuric rashes were on his extremities, abdomen and buttock. Laboratory investigations revealed that monospot test was positive, EBV seriology tests; Anti-EA-D Ig G: 3+, Anti-VCA gp125 Ig G: 3+, Anti-VCA p19 Ig M: 2+, Anti EBNA-1 Ig M: negative, Anti EBNA-1 Ig M: negative, Anti EBNA-1 Ig G: negative. The patient was interpreted as the primary active acute EBV infection. A skin biopsy showed leucocytoclastic vasculitis. The other viral and bacterial investigations were negative. The patient was diagnosed as HSP vasculitis according to EULAR criteria and treated with intravenous hydration and ibuprofen. He was discharged after 15 days with normal laboratory findings and physical examination. We think that EBV infection may be stimulant factor for autoimmune reactions and may cause HSP vasculitis. Hence, it may be usefull to investigate the EBV infection in etiology of HSP cases.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Asma Sassi, Dhouha Bacha, Ghofrane Talbi, Sana Ben Slama, Rahma Boughriba, Zeineb Mzoughi, Saadia Bouraoui, Ahlem Lahmar [Case report] - Ad&eacute;nocarcinome colique et carcinome &agrave; cellules r&eacute;nales papillaire de type 1 synchrones: une association exceptionnelle - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/28/abstract/ <b>La d&eacute;couverte de tumeurs primitives synchrones &agrave; un cancer colorectal a fait l’objet de plusieurs publications. Cette association peut survenir de mani&egrave;re sporadique ou rentrer dans le cadre de syndromes cliniques bien d&eacute;finis tel que le syndrome de Lynch. L’association synchrone d’un cancer colorectal (CCR) et d’un carcinome &agrave; cellules r&eacute;nales est rare. Elle est encore plus rare lorsque le carcinome &agrave; cellules r&eacute;nales est de sous-type papillaire avec seulement 2 cas rapport&eacute;s dans la litt&eacute;rature. L’association CRC et r&eacute;naux ne semble pas &ecirc;tre li&eacute;e &agrave; une anomalie des prot&eacute;ines du syst&egrave;me MMR (MisMatch Repair) et n’int&egrave;gre &agrave; ce jour aucun syndrome clinique. Nous rapportons le cas d’une femme &acirc;g&eacute;e de 69 ans qui a simultan&eacute;ment pr&eacute;sent&eacute; un ad&eacute;nocarcinome colique et un carcinome papillaire du rein de type 1, de d&eacute;couverte fortuite au cours du bilan d’extension du CCR. Nous discuterons la pathog&eacute;nie ainsi que le pronostic de cette entit&eacute; rarement d&eacute;crite.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Ahmed Meklaa, Abdennasser El Kharass [Case report] - Lymphome malin non hodgkinien du sein et VIH: &agrave; propos d’un cas - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/27/abstract/ <b>Le lymphome malin non-hodgkinien (LNH) repr&eacute;sente 0,5% de tous les cancers du sein. Son diagnostic est essentiellement histologique. Nous rapportons un cas de LMNH du sein chez une patiente de 42 ans et chez qui la s&eacute;rologie VIH est positive. L’objectif de cet article est de discuter les aspects cliniques, radiologiques et th&eacute;rapeutiques de cette affection et de souligner l’importance du d&eacute;pistage du VIH en cas de localisation extraganglionnaire des LMNH.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Hasnaa Zaouri, Baderddine Hassam [Images in medicine] - Papules du dos des mains: penser au granulome annulaire - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/26/abstract/ <b>Le granulome annulaire est une dermatose inflammatoire chronique. Les th&eacute;ories physiopathologiques actuelles incluent une r&eacute;action inflammatoire de type Th1 et une alt&eacute;ration du tissu &eacute;lastique. Cliniquement, ce sont des papules asymptomatiques, de couleur chaire ou ros&eacute;e, avec une bordure papuleuse annulaire. IL si&egrave;ge en regard des saillies articulaires des mains ou pieds. Sur le plan histologique, on note la pr&eacute;sence d'une n&eacute;crobiose centrale, entour&eacute;e d'un infiltrat histiocytaire palissadique. L'&eacute;tiologie de cette dermatose est inconnue. Certains facteurs ont &eacute;t&eacute; incrimin&eacute;s tels que les piq&ucirc;res d'insectes, les traumatismes, les infections virales, ainsi que la prise m&eacute;dicamenteuse. L'association aux n&eacute;oplasies et au diab&egrave;te a &eacute;t&eacute; rapport&eacute;e. Le traitement repose sur la cryoth&eacute;rapie ou la corticoth&eacute;rapie locale pour les formes localis&eacute;es; la corticoth&eacute;rapie syst&eacute;mique, les antipalud&eacute;ens de synth&egrave;se sont discut&eacute;s pour les formes diss&eacute;min&eacute;es. Nous rapportons le cas d'une patiente de 29 ans, qui consulte pour des papules asymptomatiques du dos des mains &eacute;voluant depuis 3 mois. L'examen clinique trouve des papules arrondies de couleur chaire, de 4 mm de diam&egrave;tre au niveau de la face dorsale des mains (A&B). Les diagnostics &eacute;voqu&eacute;s sont le lichen plan, les nodules de Darier Roussy, l'&eacute;ryth&eacute;ma &eacute;l&eacute;vatumdiutinum et le granulome annulaire. L'examen histologique a objectiv&eacute; une dermite granulomateuse de disposition interstitielle en faveur d'un granulome annulaire (C). Le bilan &eacute;tiologique demand&eacute; est normal. La patiente a &eacute;t&eacute; mise sous dermocortico&iuml;de classe forte &agrave; raison d'une fois par jour. L'&eacute;volution &eacute;tait marqu&eacute;e par la disparition compl&egrave;te des l&eacute;sions apr&egrave;s 4 semaines (D).</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Zemene Tigabu Kebede, Belaynew Wasie Taye, Yohannes Hailu Matebe [Research] - Childhood tuberculosis: management and treatment outcomes among children in Northwest Ethiopia: a cross-sectional study - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/25/abstract/ <b>Introduction: childhood tuberculosis (TB) treatment is becoming a major challenge in the TB control efforts of the Ethiopian health system. This study assessed childhood tuberculosis management, and treatment outcomes among children who completed anti-TB treatment in Northwest Ethiopia. Methods: a cross-sectional study was conducted among children who completed their anti-TB treatment in Gondar University Referral Hospital and 6 satellite health centers. Data from each child with tuberculosis were obtained from review of medical records. P-values < 0.05 were considered statistically significant. Results: the commonest method of childhood TB diagnosis was clinical assessment combined with chest x-ray (48.5%). Absence of compliance with TB treatment guideline (98.7%), providing inadequate anti-TB regimen (1.8%), and poor adherence to treatment (22.5%) were challenges in management of childhood tuberculosis. Treatment success rate was 78.9%. In the bivariate regression, factors associated with TB treatment outcomes were permanent residence (OR=8.3, 95%CI: 4.1, 16.7), antiretroviral therapy (OR=4.5, 95%CI: 1.2, 16), and adherence to treatment (p < 0.001). After controlling for confounders, adherence to anti-TB treatment (OR=0.003, 95% CI: 0.001, 0.02) was independent predictor of treatment success. Conclusion: anti-tuberculosis treatment success rate was still low among children in Northwest Ethiopia. The health centers and hospital shall enhance strong follow-up of children on anti-tuberculosis treatment to improve treatment success with focus on rural children.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Mindekem Rolande, Monique Lechenne, Idriss Oumar Alfaroukh, Daugla Doumagoum Moto, Jakob Zinsstag, Laurent Tinoaga Ouedraogo, Sahidou Salifou [Research] - Evaluation des Connaissances-Attitudes-Pratiques des populations des districts sanitaires de Benoye, Laoukassy, Moundou et N’Djam&eacute;na Sud sur la rage canine au Tchad - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/24/abstract/ <b>INTRODUCTION: la rage canine demeure une pr&eacute;occupation en Afrique comme au Tchad. La pr&eacute;sente &eacute;tude vise &agrave; &eacute;valuer les Connaissances-Attitudes-Pratiques des populations pour la prise en charge appropri&eacute;e des personnes expos&eacute;es et une lutte efficace. METHODES: c’&eacute;tait une &eacute;tude transversale descriptive r&eacute;alis&eacute;e en juillet et septembre dans quatre districts sanitaires au Tchad en 2015. Les donn&eacute;es ont &eacute;t&eacute; collect&eacute;es &agrave; l’aide d’un questionnaire aupr&egrave;s des m&eacute;nages recrut&eacute;s suivant un sondage al&eacute;atoire &agrave; 3 degr&eacute;s. RESULTATS: c’&eacute;tait 2428 personnes enqu&ecirc;t&eacute;es avec un niveau maximum primaire (54,12%). L’&acirc;ge moyen &eacute;tait de 36 ± 13,50 ans. Ils &eacute;taient cultivateurs (35,17%), commer&ccedil;ants (18,04%), m&eacute;nag&egrave;res (12,81%). La rage &eacute;tait d&eacute;finie comme une maladie transmise du chien &agrave; l’homme (41,43%), une alt&eacute;ration du cerveau (41,27%), une sous-alimentation (10,26%). Le chat &eacute;tait faiblement connu r&eacute;servoir (13,84%) et vecteur (19,77%) ainsi que la griffure comme moyen de transmission (4,61%) et la vaccination du chat comme mesure pr&eacute;ventive (0,49%). Les premiers soins en cas de morsure &agrave; domicile &eacute;taient les pratiques traditionnelles (47,69%), le lavage des plaies (19,48%) ou aucune action entreprise (20,43%). Les m&eacute;nages consultaient la sant&eacute; humaine (78,50%), la sant&eacute; animale (5,35%) et les gu&eacute;risseurs traditionnels (27%). CONCLUSION: la communication en rapport avec des premiers soins &agrave; la maison en cas de morsure, la connaissance du chat comme r&eacute;servoir et vecteur, celle de la griffure comme moyen de transmission et la promotion de la consultation des services v&eacute;t&eacute;rinaires en cas de morsure sont n&eacute;cessaires.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Faith Mutsigiri-Murewanhema, Patron Trish Mafaune, Gerald Shambira, Tsitsi Juru, Donewell Bangure, More Mungati, Notion Tafara Gombe, Mufuta Tshimanga [Research] - Factors associated with severe malaria among children below ten years in Mutasa and Nyanga districts, Zimbabwe, 2014-2015 - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/23/abstract/ <b>BACKGROUND: severe malaria is a rare life threatening illness. Only a small proportion of patients with clinical malaria progress to this medical emergency. On reviewing 61 malaria death investigation forms submitted to the provincial office in 2014, 22(36%) were children below ten years who succumbed to severe malaria. Mutasa and Nyanga Districts reported 73% of these deaths. This study was conducted to determine factors associated with severe malaria so as to come up with evidence based interventions to prevent severe malaria and associated mortality. METHODS: a 1:2 unmatched case control study was conducted. A case was defined as a child 10 years and below, who was admitted at Hauna (Mutasa) or Nyanga District Hospitals between September 2014 and May 2015 with a primary diagnosis of severe malaria. Controls were children of similar age with uncomplicated malaria. Permission to conduct the study was sought and granted by the Medical Research Council of Zimbabwe (Approval number B/874), Joint Research Ethics Committee, Health Studies Office and the Manicaland Directorate Institutional Review Board. Written informed consent was sought from all caregivers of enrolled children. Interviewer administered questionnaires were used to ascertain exposures. RESULTS: a total of 52 cases and 104 controls were enrolled into the study. The median age of cases was 4 years (Q1=3, Q3=9) and 6 years for controls (Q1=3, Q3=8). The Case Fatality Rate among cases was 28.8%. The independent risk factors for severe malaria were; distance >10 km to the nearest health facility [Adjusted Odds Ratio (aOR)=14.35, 95% CI=1.30, 158.81], duration of symptoms before seeking medical care >2 days [aOR=9.03, 95% CI=2.21, 36.93], having comorbidities [aOR=5.38, 95% CI=1.90, 15.19], staying in a house under construction [aOR=4.51, 95%CI=1.80, 11.32] and duration of illness before receiving antimalarial medicines >24 hours [aOR=3.82, 95% CI=1.44, 10.12]. Owning at least one ITN in the household [aOR=0.32, 95% CI=0.11, 0.95] and having a mother as a caregiver [aOR=0.23, 95% CI=0.09, 0.76] were independently protective of severe malaria. Being undernourished [Odds Ratio (OR)=10.13, 95% CI=1.04, 98.49] and being female [OR=0.27, 95% CI=0.08, 0.96] were associated with mortality owing to severe malaria. CONCLUSION: factors associated with severe malaria and mortality owing to severe malaria identified in this study are consistent with other studies. Caregiver healthcare seeking behaviours, patient related factors and health system related factors are important determinants of severe malaria among children. There is need for regular health education campaigns emphasizing on malaria prevention, signs and symptoms and benefits of seeking medical care immediately for sick children.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Ayorinde Oluwatobiloba Afolayan, Funmilola Abidemi Ayeni, Werner Ruppitsch [Research] - Antagonistic and Quantitative Assessment of Indigenous Lactic Acid Bacteria in Different Varieties of Ogi against Gastrointestinal Pathogens - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/22/abstract/ <b>BACKGROUND: ogi is a popular fermented cereal gruel consumed mainly in the western part of Nigeria. Traditionally, uncooked ogi is normally administered to diarrhoea patients to reduce the frequency of stooling. This study was therefore undertaken to identify, quantify and determine the antimicrobial properties of lactic acid bacteria (LAB) isolated from Ogi. METHODS: the ogi samples (Yellow, white, sorghum) were obtained from different market in Ibadan, Nigeria and Ogi control (cooked, uncooked and Omidun) were prepared with the viable counts of bacteria monitored over 5 days period. LAB were isolated from the varieties and identified by partial sequencing of 16S rRNA gene. The antimicrobial activities of the cell free supernatant (CFS) and the viable cells of the isolated LAB against Escherichia coli EC004, Salmonella sp. SS11, Shigella sp. SS10 were investigated by agar diffusion assay, agar overlay method, and coculture growth studies. RESULTS: omidun had the highest LAB count while cooked ogi has the lowest LAB count. Weissella paramesenteroides , L. brevis, L. rossiae, L. fermentum, L. plantarum, Acetobacter pasteurianus, Paenibacillus sp. and Bacillus sp. were isolated from Ogi in this study. Large zone of inhibition (11?x?20) was observed with CFS against Salmonella sp. SS11 and Shigella sp. SS10 and also the overlay method. Coculture studies of Weissella paramesenteroides, Lactobacillus fermentum, and L. plantarum with Salmonella sp. SS11 showed a 5-8 log reduction of the pathogens’ growth after 24 hours as compared with the control. CONCLUSION: ogi and its contents have antimicrobial properties against pathogenic organisms.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Chantal Zoungrana Ouattara, Ang&egrave;le Kalmogho, Caroline Yonaba, Chantal Gabrielle Bouda, Ghislaine Yam&eacute;ogo, Ludovic Kam [Case report] - Le lymphœd&egrave;me cong&eacute;nital primaire: la maladie de Milroy: &agrave; propos du premier cas observ&eacute; dans le D&eacute;partement de P&eacute;diatrie du Centre Hospitalier Universitaire Yalgado Ou&eacute;draogo, Ouagadougou - 09 May 2017. http://www.panafrican-med-journal.com/content/article/27/21/abstract/ <b>Le lymphœd&egrave;me est l'accumulation de liquide lymphatique dans les espaces interstitiels, celui de l’enfant, la maladie de Milroy, est rare, h&eacute;r&eacute;ditaire, autosomique dominante &agrave; p&eacute;n&eacute;trance partielle. Nous rapportons un cas de maladie de Milroy chez une fillette de 7 ans vue, pour &eacute;rysip&egrave;le sur grosse jambe droite cong&eacute;nitale. Des ant&eacute;c&eacute;dents de gros membre cong&eacute;nital existent dans la famille maternelle. L’examen retrouvait une grosse jambe droite oed&eacute;mati&eacute;e et douloureuse &agrave; la palpation, avec une lichenification de la peau en regard et un &eacute;rysip&egrave;le cutan&eacute;. Le bilan paraclinique objectivait un lymphœd&egrave;me cutan&eacute; avec atteinte vasculaire &agrave; type d’ectasie de la saph&egrave;ne droite. Le caryotype de type f&eacute;minin, &eacute;tait sans anomalie, n’excluant pas des remaniements chromosomiques de petite taille. Le traitement a constitu&eacute; en une kin&eacute;sith&eacute;rapie, des bandages, le port de bas de compression et une psychoth&eacute;rapie. Ce premier cas d&eacute;crit au Burkina Faso t&eacute;moigne de la raret&eacute; de la pathologie mais surtout des difficult&eacute;s diagnostiques li&eacute;es &agrave; l’insuffisance des investigations paracliniques.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Caroline Muringazuva, Daniel Chirundu, Shepherd Shamu, Gerald Shambira, Notion Gombe, Tsitsi Juru, Donewell Bangure, Mufuta Tshimanga [Research] - An evaluation of the proposed organisation restructuring at Kadoma city 2015 - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/20/abstract/ <b>Introduction: restructuring is the corporate management term for the act of reorganizing the legal, operational, or other structures of a company for the purpose of making it more profitable or better organized for its present needs. However, preparing an organization to accept and welcome any change is crucial.There is concern though over poor service delivery ,untimely payment of workers , top management structure which is thought to be top heavy and employee costs taking (58%) of total expenditure. Methods: a descriptive cross sectional study was carried out. A cost benefit analysis was used to assess the cost and benefits of the proposed retrenchment exercise. A descriptive cross sectional study survey was conducted to assess the workers’ perceptions towards the proposed restructuring exercise. A pretested self-administered questionnaire was used for data collection and data were analysed using EpiInfoTM (CDC 2012).Written informed consent was obtained from all study participants. Results: sixty nine percent of the respondents were males. The median years working for the organisation was 8 years (Q1=1; Q3=17). The total income was surpassed by expenditure with USD$11 000 and 52% of expenditures was going towards employment costs. A midyear financial review showed that 1% was channeled towards capital expenditure 2% on repairs and maintenance and employee costs accounting to 58% of all incurred expenditure. Current departmental salary budget amounted to USD 3,3million dollars. Estimated salary costs for the proposed departmental structures amount to USD 3,8 million dollars. Comparison of the current and proposed structure showed that the proposed structure costs USD$486 000 more. Projected benefits of the proposed structure aims to improve service delivery from 60%-85% . Unlike managers, lower levels workers did not want the exercise to be carried out. Conclusion: the proposed structure has higher costs than the current structure but with more benefits in terms of service delivery. Generally workers perceived restructuring negatively and did not want it done.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Erden Erol &Uuml;nl&uuml;er, Eylem Kuday Kaykisiz [Case report] - An unanticipated diagnosis with bedside ultrasonography in patients with acute abdominal pain: rectus hematoma - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/19/abstract/ <b>Although abdominal pain is a common presentation in emergency departments, rectus sheath hematoma (RSH) is among the rarest diagnosis. Here we present 2 cases of RSH likely caused by coughing due to upper respiratory tract infection. The two described cases were diagnosed by bedside ultrasonography and confirmed as RSH by computed tomography. Review of patient history and use of ultrasonography are important to avoid misdiagnosisof RSH.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Majda Askour, Christelle Ebongo, Hafsae Bounniyt, Karima Senouci, Badredine Hassam [Case report] - Erythrodermie desquamative - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/18/abstract/ <b>Les dermatoses paran&eacute;oplasiques sont un ensemble de signes cutan&eacute;s qui peuvent pr&eacute;c&eacute;der, co&iuml;ncider ou suivre le diagnostic du cancer. Notre observation rappelle que l’&eacute;rythrodermie desquamative fait partie des dermatoses paran&eacute;oplasiques facultatives au cours des h&eacute;mopathies, d’o&ugrave; l’importance de faire un bilan complet devant ce signe clinique &agrave; la recherche d’un processus n&eacute;oplasique interne, surtout quand la clinique est suspecte.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Anass Ayad, Badr Ettouhami, Benouachane Thami, Abdelali Bentahila [Case report] - Masse abdominale chez un nourrisson r&eacute;v&eacute;lant une py&eacute;lon&eacute;phrite xanthogranulomateuse - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/17/abstract/ <b>La py&eacute;lon&eacute;phrite xanthogranulomateuse (PXG) est une forme de py&eacute;lon&eacute;phrite chronique observ&eacute;e chez l'enfant et exceptionnellement chez le nourrisson, la symptomatologie est fruste et peut retarder le diagnostic et la prise en charge. Le traitement est m&eacute;dical mais le plus souvent chirurgical avec un pronostic r&eacute;nal qui est mis en jeu. Nous rapportons l'observation d'un jeune nourrisson de 15 mois qui pr&eacute;sente une masse isol&eacute;e du flanc gauche. N'avait pas de fi&egrave;vre ou d'alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral et les urines &eacute;taient st&eacute;riles. Le bilan radiologique (&eacute;chographie r&eacute;nale, uro-scanner et scintigraphie r&eacute;nale) mettait en &eacute;vidence un aspect d'« hydropyon&eacute;phrose » sur un rein gauche non fonctionnel, &eacute;voquant le diagnostic de PXG. L'indication d'une n&eacute;phrectomie totale par lombotomie a &eacute;t&eacute; pos&eacute;e et l'examen anatomopathologique d&eacute;finitif a confirm&eacute; le diagnostic de PXG diffuse. Cette observation souligne l'importance de penser au diagnostic de PXG devant toute masse r&eacute;nale ou de contexte d'uropathie malformative avec infection urinaire &agrave; r&eacute;p&eacute;tition dont le traitement doit &ecirc;tre rigoureux et codifi&eacute;.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com K&agrave; Daye, Manga No&euml;l Magloire, Ngom-Gu&eacute;ye Nd&eacute;ye Fatou, Diop Ndiaga, Diop Moustapha, Cisse-Diallo Viviane Marie Pierre, Diallo-Mbaye Khardiata, Lakhe Nd&egrave;ye Aissatou, Fort&egrave;s-D&eacute;guenonvo Louise, Ndour Cheikh Tidiane, Diop-Nyafouna Sylvie Audrey, Seydi Moussa [Research] - Facteurs associ&eacute;s &agrave; la dissociation immunovirologique chez les patients infect&eacute;s par le VIH-1 sous traitement antir&eacute;troviral hautement actif au Centre de Traitement Ambulatoire (CTA) de Dakar - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/16/abstract/ <b>INTRODUCTION: l'objection de ce travail est d'&eacute;valuer les diff&eacute;rents facteurs associ&eacute;s &agrave; la dissociation immunovirologique malgr&eacute; un traitement antir&eacute;troviral hautement actif et efficace. METHODES: il s'agissait d'une &eacute;tude de cohorte historique, descriptive et analytique faite &agrave; partir de dossiers de patients infect&eacute;s par le VIH-1; sous traitement antir&eacute;troviral depuis au moins 12 mois, suivis dans la cohorte du CTA de 2001 &agrave; 2011 et ayant une charge virale ind&eacute;tectable depuis 6 mois. RESULTATS: durant cette p&eacute;riode d'&eacute;tude de 10 ans, la pr&eacute;valence de la DIV &eacute;tait de 19,3%. Le sexe f&eacute;minin &eacute;tait pr&eacute;dominant avec un sexe ratio de 1,9. La dissociation immunovirologique a &eacute;t&eacute; plus fr&eacute;quemment rencontr&eacute;e chez les patients de sexe masculin (29,7% vs 14,1%) avec une diff&eacute;rence statistiquement significative (p = 0,00006). L'&acirc;ge m&eacute;dian &eacute;tait de 44 ans ± 10 ans. Un ant&eacute;c&eacute;dent de tuberculose a &eacute;t&eacute; retrouv&eacute; dans environ un tiers des cas (31,4%). La dissociation immunovirologique &eacute;tait significativement plus fr&eacute;quente chez les patients ayant un ant&eacute;c&eacute;dent de tuberculose (p = 0,00005). La plupart des patients (68%) &eacute;tait au stade SIDA 3 ou 4 de l'OMS. Les patients ayant une dissociation immunovirologique &eacute;taient plus souvent aux stades 3 et 4 de l'OMS (p = 0,0001). La d&eacute;nutrition a &eacute;t&eacute; not&eacute;e dans plus de la moiti&eacute; des cas (56,2%) et la dissociation immunovirologique pr&eacute;dominait chez les patients d&eacute;nutris (p=0,005). Le taux moyen de lymphocytes TCD4+ &eacute;tait de 86,7± 83 cellules/mm3. La dissociation immunovirologique &eacute;tait plus fr&eacute;quente chez les patients ayant un taux de lymphocytes TCD4 bas &agrave; l'initiation avec une diff&eacute;rence statistiquement significative (p = 0,00000). En analyse multivari&eacute;e ; Seuls l'&acirc;ge sup&eacute;rieur ou &eacute;gal &agrave; 43 ans, le taux de CD4 initial < 100 c/mm3 et le sexe masculin &eacute;taient significativement associ&eacute;s &agrave; cette dissociation immunovirologique. CONCLUSION: les principaux facteurs associ&eacute;s &agrave; la dissociation immunovirologique &eacute;tant &eacute;valu&eacute;s, d'autres &eacute;tudes portant sur ce groupe m&eacute;riteraient d'&ecirc;tre envisag&eacute;es afin de connaitre l'impact de cette r&eacute;ponse immunologique partielle sur la survenue d'infections opportunistes ou bien la mise en place d'une trith&eacute;rapie sp&eacute;cifique uniquement dans le but d'avoir une restauration immunologique optimale.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Hanae Harchaoui, Boussayna Iraqi, Houria knouni, Youness Taboz, Hasnae Benkirane, Hassan Aguenaou, Amina Barakat [Case report] - H&eacute;matome h&eacute;patique n&eacute;onatal: &agrave; propos d’un cas - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/15/abstract/ <b>L'h&eacute;matome h&eacute;patique est une affection m&eacute;connue, peut &ecirc;tre gravissime et son diagnostic se fait souvent lors de l'autopsie p&eacute;rinatale. Devant une symptomatologie clinique souvent non sp&eacute;cifique et un tableau biologique retard&eacute;. Le diagnostic est bas&eacute; essentiellement sur l'&eacute;chographie et son traitement est souvent conservatif. Nous rapportons un cas d'h&eacute;matomes h&eacute;patiques chez un nouveau-n&eacute; &agrave; terme, asymptomatique dans un contexte de traumatisme obst&eacute;trical.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Mohamed Amine Azami, Iliass El Alami, Imane Bourhafour, Salwa Belhabib, Mohamed Oukabli, Abderrahmane Albouzidi [Case report] - Gliosarcome c&eacute;r&eacute;bral primitif: &agrave; propos de deux cas et revue de la litt&eacute;rature - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/14/abstract/ <b>Le gliosarcome est une tumeur c&eacute;r&eacute;brale tr&egrave;s rare repr&eacute;sentant 1,8 &agrave; 8% de l’ensemble des tumeurs gliales. Il est consid&eacute;r&eacute; par l’organisation mondiale de la sant&eacute; comme une variante de glioblastome. C’est une tumeur &agrave; double composante gliale et sarcomateuse. Le tableau clinique est polymorphe, les donn&eacute;es de l’imagerie sont &eacute;vocatrices, la confirmation est histologique. Le traitement est essentiellement chirurgical. Le pronostic est li&eacute; &eacute;troitement &agrave; la qualit&eacute; d’ex&eacute;r&egrave;se. Dans notre travail Nous rapportons deux observations cliniques dont l’objectif est de faire le point sur les particularit&eacute;s, essentiellement diagnostiques, th&eacute;rapeutiques ainsi que pronostiques de cette entit&eacute; rare.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Stephane Tshitenge Tshitenge, Chiratidzo Ellen Ndhlovu, Radiance Ogundipe [Research] - Evaluation of problem-based learning curriculum implementation in a clerkship rotation of a newly established African medical training institution: lessons from the University of Botswana - 05 May 2017. http://www.panafrican-med-journal.com/content/article/27/13/abstract/ <b>BACKGROUND: problem-based Learning (PBL) curricula, like all curricula, require systematic evaluation as there is a risk of implementing a dysfunctional PBL curriculum. The study intended to evaluate the PBL curriculum delivery from the perspective of the clerkship students at the University of Botswana-Faculty of Medicine. METHODS: a cross-sectional study was conducted among clerkship students in Family Medicine, Paediatrics, Internal Medicine and Surgery. During a 4-week period, each respondent completed weekly a questionnaire based survey tool. The three part questionnaire consisted of demographic data, ‘seven-jumps’ adapted from a ‘typical’ PBL tool to evaluate PBL process and 11 items ‘adopted ‘from the Short-Questionnaire-to-Evaluate-the-Effectiveness-of-Tutors in the PBL tool to evaluate the PBL facilitation with open ended questions at the end. RESULTS: Of the 81 eligible participants, 89% (n=72) responded. We collected back 141 (49%) forms out of the 288 expected (72 X 4 weeks). PBL first sessions took place all the time only in Family Medicine and in about 75% of the time in Pediatrics but none were conducted in the other disciplines. Overall, they evaluated the PBL process as ‘good’ (median= 8 /10) and the PBL facilitation as ‘very good’ (median=9 /10). Students appeared to have differing opinions on the preferred approach to the nature of patient problems that the PBL sessions should be structured around. CONCLUSION: despite students rating PBL process as ‘good’ and facilitation as ‘very good’, PBL first sessions were not consistently undertaken.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Marcellin Bugeme, Papa Alioune Seck, Paul Makinko Ilunga, Olivier Mukuku [Case report] - Trouble psychotique partag&eacute; atypique: &agrave; propos d’une observation - 05 May 2017. http://www.panafrican-med-journal.com/content/article/27/12/abstract/ <b>Le trouble psychotique partag&eacute; est une entit&eacute; psychiatrique consid&eacute;r&eacute;e comme rare et caract&eacute;ris&eacute;e par la transmission des id&eacute;es d&eacute;lirantes d'un patient dit "inducteur", &agrave; un autre dit "induit". Nous rapportons une observation clinique de trouble psychotique partag&eacute; atypique mettant en jeu un d&eacute;lire de pers&eacute;cution et un autre de grandeur induits chez un adolescent par deux sujets (grand-p&egrave;re et oncle paternel) ayant pr&eacute;sent&eacute; deux entit&eacute;s psychiatriques diff&eacute;rentes, mais tous les partagent &agrave; un m&ecirc;me sujet (le troisi&egrave;me). La nature du contenu transmis au troisi&egrave;me sujet &eacute;tait la somme des id&eacute;es des deux premiers. Ces trois sujets vivaient en association proche, dans un milieu clos et coup&eacute; de l'ext&eacute;rieur.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Aymen Ben Fredj, Lassaad Hassini, Aymen Fekih, Mohamed Allagui, Issam Aloui, Abderrazek Abid [Case report] - Chondroblastic osteosarcoma of the distal tibia: a rare case report - 05 May 2017. http://www.panafrican-med-journal.com/content/article/27/11/abstract/ <b>Chondroblastic osteosarcoma, representing about 25% of osteosarcoma, is a fatal primary malignancy of the skeleton if not diagnosed and treated appropriately. It most commonly occurs in the long bones of the extremities near the metaphyseal growth plates. In this report, we describe the occurrence of chondroblastic osteosarcoma involving the left distal tibia in a 14-year-old male. The diagnosis was confirmed by the histological examination of a surgical biopsy. The patient was treated by both surgery and neoadjuvant chemotherapy. No recurrence was noted at 3 years of follow-up. To our knowledge, only two cases describing chondroblastic osteosarcoma of the distal tibia had been reported through English medical literature. Therefore, the aim of our article is to make the clinician aware of this rare clinical presentation and also to provide a comprehensive review of the literature related to this uncommon malignant tumour.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Meryam Rchachi, Maazou Larwanou, Hanan El Ouahabi, Farida Ajdi [Case report] - Association syndrome de Williams et insuffisance surr&eacute;nalienne - 05 May 2017. http://www.panafrican-med-journal.com/content/article/27/10/abstract/ <b>Les anomalies du d&eacute;veloppement d&eacute;crites dans le syndrome de Williams, associent classiquement une dysmorphie, des malformations cardiovasculaires et un profil neuropsychologique particulier et d'autres troubles associ&eacute;s. Nous rapportons le cas d'une jeune fille &acirc;g&eacute;e de 17 ans, issu d'un mariage non consanguin, chez qui le syndrome de Williams a &eacute;t&eacute; d&eacute;couvert suite &agrave; une exploration dans le cadre du bilan d'un retard staturo-pond&eacute;ral. L'association a une insuffisance surr&eacute;nalienne primitive en fait la singularit&eacute;. La confirmation diagnostique avait n&eacute;cessit&eacute; une analyse cytog&eacute;n&eacute;tique et mol&eacute;culaire. La prise en charge consistait &agrave; la mise en route de traitement pour l'insuffisance surr&eacute;nalienne associ&eacute; &agrave; une surveillance clinico-biologique.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Harifetra Mamy Richard Randriamizao, Aur&eacute;lia Rakotondrainibe, Nadia Marie Philibertine Rahanitriniaina, Andriambelo Tovohery Rajaonera, Mamy Lalatiana Andriamanarivo [Case series] - Prise en charge p&eacute;ri-op&eacute;ratoire de l’atr&eacute;sie de l’œsophage: petits pas non n&eacute;gligeables &agrave; Madagascar - 05 May 2017. http://www.panafrican-med-journal.com/content/article/27/9/abstract/ <b>La prise en charge de l'atr&eacute;sie de l'œsophage est encore limit&eacute;e par la pr&eacute;carit&eacute; des plateaux techniques &agrave; Madagascar. Les cas d&eacute;crits dans ce travail ont pour objectif de relater nos possibilit&eacute;s th&eacute;rapeutiques et de d&eacute;crire les progr&egrave;s &agrave; r&eacute;aliser pour optimiser le traitement de cette pathologie cong&eacute;nitale. Nous avons recueilli tous les dossiers ayant pour motif d’entr&eacute;e au service de R&eacute;animation Chirurgicale du CHU JRA, Antananarivo, une atr&eacute;sie de l’œsophage. Nous en avons retenu les tous premiers cas qui ont surv&eacute;cu sur une p&eacute;riode de 42 mois entre janvier 2011 et juin 2014. Parmi 17 admissions pour atr&eacute;sie de l’œsophage, trois nouveau-n&eacute;s &agrave; terme, admis successivement en R&eacute;animation Chirurgicale, pr&eacute;sentant un type III d'atr&eacute;sie; premiers patients, &agrave; Madagascar, ayant surv&eacute;cu au d&eacute;cours de leur intervention. Une seule patiente avait pr&eacute;sent&eacute; des malformations associ&eacute;es. Ces trois b&eacute;b&eacute;s ont &eacute;t&eacute; extub&eacute;s pr&eacute;cocement au bloc op&eacute;ratoire, sous oxyg&eacute;noth&eacute;rapie jusqu'&agrave; une ventilation spontan&eacute;e efficace. Des s&eacute;ances de kin&eacute;sith&eacute;rapie postop&eacute;ratoire permettaient d'am&eacute;liorer l'&eacute;tat respiratoire des nouveau-n&eacute;s. La mortalit&eacute; globale de cette pathologie en 42 mois a &eacute;t&eacute; de 76,5%. Malgr&eacute; ces premiers succ&egrave;s, des progr&egrave;s restent &agrave; entreprendre dans le traitement de cette anomalie cong&eacute;nitale ; de son diagnostic jusqu'&agrave; la p&eacute;riode postop&eacute;ratoire. L'am&eacute;lioration du plateau technique, surtout ventilatoire et du support nutritionnel permettrait d'avoir des r&eacute;sultats plus probants, tout comme dans les pays o&ugrave; des progr&egrave;s ont &eacute;t&eacute; r&eacute;alis&eacute;s sur le plan de la r&eacute;animation.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Hichem Cheikhrouhou, Karim Jmal, Amine Kharrat, Meriem Keskes, Abdelhamid Karoui [Case report] - Chol&eacute;cystite aigue gangr&eacute;neuse alithiasique en postop&eacute;ratoire d’une chirurgie orthop&eacute;dique: &agrave; propos d’un cas - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/8/abstract/ <b>La chol&eacute;cystite gangreneuse alithiasique postop&eacute;ratoire est une complication grave et s&eacute;v&egrave;re, surtout chez les malades hospitalis&eacute;s en r&eacute;animation. Elle survient le plus souvent au d&eacute;cours d'une chirurgie vasculaire ou digestive majeure, d'un polytraumatisme, dans un contexte septique ou dans un contexte de choc. Nous rapportons l'observation d'un homme &acirc;g&eacute; de 74 ans op&eacute;r&eacute; d'une fracture du col du f&eacute;mur, au sixi&egrave;me jour postop&eacute;ratoire il a d&eacute;velopp&eacute; un tableau clinique d'une chol&eacute;cystite aigue dont les explorations radiologiques ont confirm&eacute; son caract&egrave;re alithiasique. Apr&egrave;s une chol&eacute;cystectomie en urgence, l'&eacute;tude anatomopathologique a conclu &agrave; une chol&eacute;cystite gangreneuse alithiasique.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Philippe Mahouna Adjagba, Arnaud Sonou, L&eacute;hila Bagnan Tossa, L&eacute;opold Codjo, Murielle Hounkponou, Salimatou Assani Mouta&iuml;rou, Yasmine Eyiss&egrave; Kpossou, Latif Mouss&eacute;, Yessoufou Tchabi, Jeanne Vehounkp&eacute; Sacca, Martin D&egrave;donougbo Hou&eacute;nassi [Case report] - Ventricule droit &agrave; double chambre (VDDC) isol&eacute;: &agrave; propos d'un cas au CNHU, Cotonou, B&eacute;nin - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/7/abstract/ <b>Le ventricule droit &agrave; double chambre (VDDC) est une malformation cardiaque rare dans laquelle le ventricule droit est divis&eacute; en deux chambres par une bande musculaire anormale. Il est associ&eacute; dans 80 &agrave; 90% &agrave; d'autres malformations. L'expression clinique est vari&eacute;e et d&eacute;pend de l'importance de l'obstruction intraventriculaire. Nous rapportons l'observation d'une adolescente de 16 ans, pr&eacute;sentant une forme isol&eacute;e de VDDC r&eacute;v&eacute;l&eacute;e par des syncopes &agrave; r&eacute;p&eacute;tition. Le diagnostic est fait par l'&eacute;chocardiographie D&ouml;ppler. La r&eacute;section chirurgicale de la bande musculaire anormale a &eacute;t&eacute; faite avec succ&egrave;s.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Ayad Anass, Amina Kili [Images in medicine] - Pubert&eacute; pr&eacute;coce chez une fillette r&eacute;v&eacute;lant un corticosurr&eacute;nalome malin - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/6/abstract/ <b>Il s'agit d'une fillette de 5ans, hospitalis&eacute;e pour pubert&eacute; pr&eacute;coce h&eacute;t&eacute;rosexuelle. Elle est n&eacute;e par c&eacute;sarienne, le premier cri &eacute;tait imm&eacute;diat avec un poids de 4 kg, le d&eacute;veloppement psychomoteur &eacute;tait normal et pas d'histoire de malignit&eacute; dans la famille. Le d&eacute;but de sa maladie remontait &agrave; l'&acirc;ge de 4 ans par l'apparition d'une pilosit&eacute; pubienne progressive, d'une acn&eacute;, de s&eacute;borrh&eacute;e et d'une hypertrophie clitoridienne, une voix grave et d&eacute;veloppement d'une masse musculaire de type masculin. Ainsi que l'apparition de duvet au niveau de la l&egrave;vre sup&eacute;rieure et sur le visage. Le tout &eacute;voluant dans un contexte d'agitation et d'agressivit&eacute;. La palpation abdominale, a trouv&eacute; une &eacute;norme masse difficile &agrave; d&eacute;limiter, allant de l'hypochondre jusqu'au flanc droit et arrivant jusqu'&agrave; l'ombilic. L'examen des organes g&eacute;nitaux externes a not&eacute; la pr&eacute;sence des grandes l&egrave;vres. Absence des petites l&egrave;vres et hypertrophie clitoridienne (clitoris p&eacute;nien) et une pilosit&eacute; pubienne stade 4 selon la classification de Tanner. Le reste de l'examen somatique &eacute;tait normal. Le bilan hormonal a objectiv&eacute; une &eacute;l&eacute;vation de l'aldost&eacute;rone, &#916; Androstendione, 17 hydroxyprog&eacute;st&eacute;rone, SDHA, et la testosterone ainsi qu'une cortisol&eacute;mie de 8 h &agrave; 778,5 nmol/l (VN= 280-876nmol/l). La TDM abdominale a montr&eacute; une masse d'origine surr&eacute;nalienne, h&eacute;t&eacute;rog&egrave;ne, polylob&eacute; avec des zones de n&eacute;crose, hyper vasculaires, d'allure maligne corticosurr&eacute;nalome tr&egrave;s probable. Une ex&eacute;r&egrave;se tumorale totale a &eacute;t&eacute; r&eacute;alis&eacute;e avec confirmation anatomopathologique, Les suites op&eacute;ratoires &eacute;taient simples. La petite a &eacute;t&eacute; mise sous hydrocortisone &agrave; la dose 15 mg/m<sup>2</sup>/j associ&eacute;s &agrave; un min&eacute;ralocortico&iuml;de. Aucune chimioth&eacute;rapie n'a &eacute;t&eacute; donn&eacute;e.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Berthier Nsadi, Olivier Detry, Willy Arung [Letter to the editors] - Inguinal hernia surgery in developing countries: should laparoscopic repairs be performed ? - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/5/abstract/ <b>Laparoscopy is a clear revolution in abdominal surgery and should be developed in dedicated experienced facilities in developing countries. However, compared to the Lichtenstein procedure, laparoscopic techniques of inguinal hernia repair have clear disadvantages, as the necessity of a general anaesthesia, of availability of CO2 and electricity, a higher cost and a risk of more life-threatening complications. The Lichtenstein technique is a much easier procedure can be easily performed under spinal or even local anaesthesia. The Lichtenstein technique should be considered as the standard of care of inguinal hernias not only in the developing countries, but in the whole world, as until now, no clear differences in term of recurrence and pain could be demonstrated between both techniques. The availability of a cheap mesh is still a challenge, and the use of mosquito nets should be further investigated.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Matthieu Betofe Labama, Eug&egrave;ne Basandja Longembe, Joris Losimba Likwela [Research] - Efficacit&eacute; de la gestion de vaccins et qualit&eacute; de vaccination &agrave; l'antenne PEV Kisangani en R&eacute;publique D&eacute;mocratique du Congo - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/4/abstract/ <b>INTRODUCTION: la qualit&eacute; des vaccins conditionne les r&eacute;sultats attendus de la vaccination. Elle est tributaire de l'efficacit&eacute; de syst&egrave;me de gestion technique et logistique mis en place. Cette &eacute;tude est men&eacute;e pour &eacute;valuer l'efficacit&eacute; de la gestion des vaccins et d'en tirer des le&ccedil;ons. METHODES: une &eacute;tude r&eacute;trospective est men&eacute;e pendant la p&eacute;riode de 2010 &agrave; 2014 sur la gestion logistique de vaccins au niveau de l'antenne PEV Kisangani. La revue documentaire compl&eacute;t&eacute;e par les entretiens semi-dirig&eacute;s des gestionnaires et prestataires de services de vaccination ont permis d'&eacute;valuer la gestion de vaccins en se servant des mod&egrave;le GEV de l'OMS, en vue de d&eacute;gager les &eacute;carts. RESULTATS: il est observ&eacute; une faible connaissance des prestataires sur les vaccins qui ne peuvent pas &ecirc;tre congel&eacute;s, sur les tests de cong&eacute;lation et d'autres dommages de vaccins. La gestion informatis&eacute;e des donn&eacute;es au niveau de l'antenne est correctement assur&eacute;e. Aucun crit&egrave;re &eacute;valu&eacute; n'a atteint l'objectif de 80%. Le respect de la temp&eacute;rature de stockage est de 70% au niveau de l'antenne ; le crit&egrave;re relatif &agrave; la gestion de vaccins est respectivement de 65% et 67% au niveau du BCZ et CS. Le crit&egrave;re relatif &agrave; la maintenance est nul &agrave; tous les niveaux. CONCLUSION: le dysfonctionnement de syst&egrave;me logistique est remarquable &agrave; tous les niveaux de la pyramide sanitaire, ceci pourrait interf&eacute;rer avec la qualit&eacute; et l'impact attendu de la vaccination. Une attention particuli&egrave;re doit &ecirc;tre accord&eacute;e &agrave; la maintenance des &eacute;quipements.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Traore Abdoulaye Ababacar, Mvumbi Kutubisa Franck, Ly Seydou, Alaoui Lamrany Youssef, Boubbou Meryem, Maaroufi Maaroufi, Alami Badreeddine [Case report] - D&eacute;couverte tomodensitom&eacute;trique d’un m&eacute;sent&egrave;re commun complet par perforation d’une appendicite aigu&euml; - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/3/abstract/ <b>Le m&eacute;sent&egrave;re commun complet est une anomalie rare de rotation du tube digestif. Sa d&eacute;couverte est exceptionnelle &agrave; &acirc;g&eacute; adulte; &agrave; cette p&eacute;riode, il demeure tr&egrave;s souvent asymptomatique et donc non diagnostiqu&eacute;e. Le m&eacute;sent&egrave;re commun complet peut &ecirc;tre d&eacute;couvert de fa&ccedil;on fortuite, lors d’un syndrome appendiculaire ectopique, comme ce fut le cas de notre observation. Il s’agissait d’un patient &acirc;g&eacute; de 42 ans, qui &agrave; pr&eacute;sent&eacute; un tableau inflammatoire clinico-biologique aigu&euml; pelvien. La TDM a permis de poser le diagnostic d’une appendicite aigue sur un m&eacute;sent&egrave;re commun complet. Le traitement par laparotomie a confirm&eacute; le diagnostic d’une appendicite aigu&euml; perfor&eacute;e sur la malrotation intestinale. Les suites post appendicectomies &eacute;taient favorables.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Jean Eric Kouassi Kouam&eacute;, Blaise Yao Loukou, Justin Leopold Niaore Sery Bada, Innocent Kouam&eacute; M’bra, L&eacute;opold Krah Koffi, Franck Lohourou Grah, Michel Kodo [Case report] - Abc&egrave;s froid dorsolombaire r&eacute;v&eacute;lant un mal de Pott - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/2/abstract/ <b>Les abc&egrave;s froids tuberculeux repr&eacute;sentent une forme rare et inhabituelle de tuberculose extra pulmonaire. Nous rapportons un cas d’abc&egrave;s froid dorsolombaire r&eacute;v&eacute;lant un mal de Pott sans complications neurologiques chez un patient de 27 ans, pr&eacute;sentant depuis 05 mois une tum&eacute;faction dorsolombaire gauche. L’examen du pr&eacute;l&egrave;vement &agrave; l’issu d’une incision et drainage de l’abc&egrave;s a permis de confirmer l’origine tuberculeuse. Un traitement antituberculeux de 12 mois permettait une gu&eacute;rison avec une s&eacute;quelle &agrave; type de gibbosit&eacute; mod&eacute;r&eacute;e.</b><br/> text/html 2017-05-29T08:29:19+01:00 http://www.panafrican-med-journal.com Sempeera Hassard, Anguzu Ronald, Kawooya Angella [Research] - Patient attitudes towards community-based tuberculosis DOT and adherence to treatment in an urban setting; Kampala, Uganda - 01 May 2017. http://www.panafrican-med-journal.com/content/article/27/1/abstract/ <b>BACKGROUND: High Tuberculosis treatment default rate (17%) and sub-optimal treatment completion rates (45%) has burdened Kampala. Nevertheless, there are observable increase in the number of patients on TB DOT; from 6% to 29% in two consecutive annual reports. The main objective was to determine the association of TB patient attitudes towards community-based observers on the TB drug adherence on directly observed treatment for TB in Kampala. METHODS: A cross-sectional study was carried out in Lubaga division, Kampala. A total of 201 patients in continuation phase of treatment for Pulmonary TB (i.e. 8 to 20 weeks of TB treatment) were included in the study. Patient attitudes were measured using a 4-point Likert scale aggregated into a binary outcome with “agree” and “disagree” responses. Poisson regression model using a forward fitting approach in STATA v12 was used to determine the association between patient attitude towards CB-DOTs observers and adherence to TB treatment. RESULTS: Among the 201 patients, 66% reported their treatment was being observed by someone. Relatives were the commonest (82%) treatment observers, 26% were non adherent to their TB treatment. Perceiving “no need for a treatment observer” and “people rejecting TB patients” were predictors of non-adherence to TB treatment (IRR=1.6,95%CI 1.00-2.57;p=0.048) and (IRR=0.6, 95%CI 0.35-0.95; p=0.019) respectively. CONCLUSION: Patient’s perceived attitude and stigma towards treatment observers contribute to non-adherence on TB treatment. For improved local TB control, more emphasis is needed to build a friendly environment between treatment supporters and patients during the course of TB treatment.</b><br/>