Pan african Medical Journal - Volume 26 Pan african Medical Journal. Volume 26 http://www.panafrican-med-journal.com/ 2017-04-27T01:13:44+01:00 pamj logo http://www.panafrican-med-journal.com http://www.panafrican-med-journal.com/img/logo.png text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Aida Daib, Youssef Hellal, Malek Boughdir, Rabiaa Ben Abdallah, Nejib Kaabar [Case report] - La fistule pancr&eacute;atico-pleurale chez l’enfant: &eacute;tiologie rare d’une pleur&eacute;sie de grande abondance - 26 April 2017. http://www.panafrican-med-journal.com/content/article/26/240/abstract/ <b>La fistule pancr&eacute;atico-pleurale est une complication tr&egrave;s rare des faux kystes du pancr&eacute;as. L’objectif de notre article est de d&eacute;crire cette pathologie rare chez l’enfant. On insistera sur l’importance de l’&eacute;voquer devant une pleur&eacute;sie de grande abondance m&ecirc;me en l’absence des signes digestifs. Nous d&eacute;crivons l’observation d’un enfant &acirc;g&eacute; de 2 ans ayant un faux kyste du pancr&eacute;as compliqu&eacute; d’une fistule pleurale d&eacute;couvert suite &agrave; une pleur&eacute;sie de grande abondance sans signes digestifs associ&eacute;s.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khalid Chakour, Mohamed El Faiz Chaoui [Case report] - Kyste &eacute;pidermo&iuml;de du quatri&egrave;me ventricule: &agrave; propos d’un cas - 26 April 2017. http://www.panafrican-med-journal.com/content/article/26/239/abstract/ <b>Les kystes &eacute;pidermo&iuml;des sont des tumeurs b&eacute;nignes rares d&eacute;velopp&eacute;es &agrave; partir d'inclusions ectodermiques. Ils si&egrave;gent habituellement au niveau de l'angle ponto-c&eacute;r&eacute;belleux, la r&eacute;gion para-sellaire et la fosse temporale. Leur si&egrave;ge au niveau du quatri&egrave;me ventricule est exceptionnel. Nous rapportons le cas d'une patiente de 47 ans admise pour un syndrome d'hypertension intracr&acirc;nienne associ&eacute; &agrave; des troubles de la marche. Le diagnostic de kyste &eacute;pidermo&iuml;de du V4 fut &eacute;voqu&eacute; sur les donn&eacute;es de l'IRM en s&eacute;quences de diffusion puis confirm&eacute; en per op&eacute;ratoire et en histologie. L'ex&eacute;r&egrave;se chirurgicale a &eacute;t&eacute; subtotale en raison d'une adh&eacute;rence de la capsule &agrave; la partie sup&eacute;rieure du plancher du V4. Apr&egrave;s un recul de 36 mois, la patiente ne manifeste aucun signe de r&eacute;-&eacute;volution tumorale.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abdelmajid Bouzerda, Issam Serghini, Abdenassar El Kharass [Case report] - Embolie pulmonaire: la thrombolyse pourrait &ecirc;tre &eacute;largie au risque interm&eacute;diaire? - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/238/abstract/ <b>La mortalit&eacute; de l'embolie pulmonaire compliqu&eacute;e d'&eacute;tat de choc varie de 25 &agrave; plus de 50%.Les fibrinolytiques semblent donc justifi&eacute;s dans cette situation, malgr&eacute; la l&eacute;g&egrave;re augmentation du risque h&eacute;morragique. Nous rapportons le cas d'une patiente admise pour une embolie pulmonaire &agrave; risque interm&eacute;diaire fort trait&eacute;e avec succ&egrave;s par tenecteplase. A la lumi&egrave;re de cette observation et une revue de la litt&eacute;rature nous discutons l'indication des thrombolytique dans les embolies pulmonaire de gravit&eacute; interm&eacute;diaire.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ahmed Alami, Mohamed Kriet, Karim Reda, Abelkader Laktaoui, Abdelbaare Oubaaz [Case series] - Beh&ccedil;et oculaire - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/237/abstract/ <b>L'objectif &eacute;tait de d&eacute;terminer les caract&eacute;ristiques cliniques, th&eacute;rapeutiques et pronostiques de l'atteinte oculaire chez les patients atteints de la maladie de Beh&ccedil;et, pris en charge dans notre service d'ophtalmologie. Nous pr&eacute;sentons une &eacute;tude r&eacute;trospective d'une s&eacute;rie de 20 patients collig&eacute;s &agrave; l'h&ocirc;pital militaire de La&acirc;youne. Les patients ont b&eacute;n&eacute;fici&eacute; d'un examen ophtalmologique complet, d'une angiographie &agrave; la fluoresc&eacute;ine si n&eacute;cessaire. Un examen OCT est r&eacute;alis&eacute; chez deux patients. Dix cas d'uv&eacute;ite ant&eacute;rieure dont un cas s'est compliqu&eacute; d'hypertonie oculaire; Deux cas d'uv&eacute;ite interm&eacute;diaire; huit cas d'atteinte du segment post&eacute;rieur dont un cas s'est compliqu&eacute; d'h&eacute;morragie intravitrienne. La maladie de Beh&ccedil;et (MB) est une affection inflammatoire syst&eacute;mique idiopathique actuellement class&eacute;es au sein des vascularites primitives non n&eacute;crosantes. L'atteinte oculaire de la maladie de Beh&ccedil;et est fr&eacute;quente et grave, mettant en jeu le pronostic visuel des patients. La maladie de Beh&ccedil;et est fr&eacute;quente au Maroc, engageant le pronostic visuel, rendant la collaboration entre ophtalmologistes et internistes particuli&egrave;rement importante.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Said Makani, Julia Mitchell, Olivier Metton, Sylvie Di Filippo, Roland Henaine, Jean Ninet [Case report] - Surgical repair of a pseudocoarctation with cervical aortic arch complicated by multiple aneurysms of the aorta: a case report - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/236/abstract/ <b>Aortic pseudocoarctation is a rare congenital anomaly characterized by elongation and deformity of the aortic arch and is known to be associated with aneurysmal formation. Several studies unite to say it leads to a surgical sanction as soon as symptomatic or associated with aneurysms of the aortic arch. Our patient is a 12 years old boy, followed since birth for a little tight pseudocoarctation with a cervical aortic arch and transverse aortic arch hypoplasia. Close clinical and paraclinical monitoring including angioscans, showed the gradual enlargement of the superior mediastinum, in relation with the appearance of three aneurysms of the aortic arch. The intervention, performed by sternotomy, has consisted of the resection of the aneurysmal area and the interposition of a Dacron tube to repair the aortic arch and the reimplantation of the left subclavian artery into the left carotid artery. The postoperative course was uneventful. Management of pseudocoarctation associated with cervical aortic arch and aneurysms remains surgical. Close monitoring of patients with pseudocorctation, seems to be essential to avoid fatal complications such as aneurysmal rupture.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Doudou Diop, Melvin Sanicas [Perspectives] - Innovations en vaccinologie: enjeux et perspectives pour l’Afrique - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/235/abstract/ <b>La vaccination est incontestablement l'une des interventions de sant&eacute; publique les plus efficaces et les plus rentables qui soient. Les vaccins continuent de r&eacute;volutionner notre capacit&eacute; &agrave; pr&eacute;venir les maladies et &agrave; am&eacute;liorer la sant&eacute;. Avec toutes les avanc&eacute;es technologiques, nous sommes en mesure d'&eacute;tendre les avantages des vaccins &agrave; plus de gens et de fournir une meilleure protection contre les maladies infectieuses mortelles. Toutefois, avec le d&eacute;veloppement incessant de nouvelles souches microbiennes &agrave; travers le monde, la recherche en vaccinologie se doit d'innover continuellement. D'&eacute;normes progr&egrave;s ont &eacute;t&eacute; r&eacute;alis&eacute;s pour am&eacute;liorer la couverture vaccinale et introduire de nouveaux vaccins en Afrique. De nouveaux types de vaccins associ&eacute;s &agrave; des outils de vectorisation, d'administration et de d&eacute;livrance sp&eacute;cifiques mais aussi des adjuvants susceptibles de moduler finement la r&eacute;ponse immunitaire sont attendus dans le futur. En Afrique, il est n&eacute;cessaire de d&eacute;velopper une approche r&eacute;gionale afin de r&eacute;pondre efficacement aux nombreux d&eacute;fis. Une meilleure information, la formation des personnels de sant&eacute; en vaccinologie et des recherches bien cibl&eacute;es sont les cl&eacute;s des futurs accomplissements dans le domaine.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Slim Charfi [Images in medicine] - Parapharyngeal space pleomorphic adenoma: a case report - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/234/abstract/ <b>Parapharyngeal space masses account for 0.5% of all head and neck neoplasms. Pleomorphic adenoma arising from the epithelial rests of the salivary tissue in the parapharyngeal space is rare. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) allows a precise topographical localization of the mass and the diagnosis of its nature in the majority of cases. Treatment of parapharyngeal pleomorphic adenoma is primarily surgical excision. Tumor recurrence occur in less than 10% of patients. We report a case of a 37-year-old man presented with dysphagia and disturbed sleep during night since last 6 months. The intraoral examination found a bulging submucosal mass underneath the right oropharynx crossing the midline and pushing the uvula to left side. CT and MRI scan revealed a heterogeneously enhancing tumor in the right parapharyngeal space measuring 4.5×5×6.4 cm and causing luminal narrowing of oropharynx. The patient was operated through a transcervical approach to gain entry into parapharyngeal space without osteotomy of the mandible. The tumor was completely resected without rupture. The postoperative course was uneventful. Histopathological examination confirmed the diagnosis of a pleomorphic adenoma. At the 3 years follow-up the patient was free from disease.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Abdelmonem Ghorbel [Images in medicine] - Unusual presentation of an antrochoanal polyp: a case report - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/233/abstract/ <b>Antrochoanal polyps are benign lesions originating from the mucosa of the maxillary sinus and gradually prolapse through the medial wall of the maxillary sinus into the nasal cavity increasing in size to the choana and nasopharynx. Surgery is the usual treatment for antrochoanal polyps. We present the case of a 41-year-old woman who presented with a history of a progressive right nasal obstruction associated with a five-month history of sensation of a foreign body in the throat. Oral examination revealed a polypoid mass hanging from the nasopharynx into the oropharynx. Nasal endoscopy showed that the mass arose from the right middle meatus and extended into the nasal cavity and then into the nasopharynx. The computed tomography showed a complete opacification of the right maxillary sinus and a soft-tissue mass filling the low part of the right nasal cavity extended posteriorly through the right choana, filling up the nasopharynx and extending to the oropharynx. The polyp was removed under general anesthesia using a functional endoscopic sinus surgery and a large middle meatus antrostomy was performed. The patient made an uneventful post-operative recovery and was discharged home the following day. Histologic analysis confirmed that the mass was an antrochoanal polyp. The patient remained asymptomatic and disease-free at follow-up 12 months later.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Sidi Driss El jaouhari, Mohamed Meziane, Redouane Ahtil, Mustapha Bensghir, Charki Haimeur [Case report] - Int&eacute;r&ecirc;t de l’algorithme rocuronium - sugammadex dans la laryngoscopie directe en suspension - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/232/abstract/ <b>La laryngoscopie directe en suspension est un geste chirurgical diagnostique et/ou th&eacute;rapeutique des l&eacute;sions endo-laryng&eacute;es. Sa gestion anesth&eacute;sique est compliqu&eacute;e. Diff&eacute;rentes techniques anesth&eacute;siques peuvent &ecirc;tre propos&eacute;es. Malgr&eacute; les contraintes, les curares gardent tout leur int&eacute;r&ecirc;t. L’association rocuronium et sugammadex est envisageable, elle permet une inversion rapide du bloc neuromusculaire profond et par cons&eacute;quent une r&eacute;duction de la morbidit&eacute; postop&eacute;ratoire. Nous rapportons un cas d’une laryngoscopie directe en suspension r&eacute;alis&eacute;e sous anesth&eacute;sie g&eacute;n&eacute;rale dont l’utilisation de l’association rocuronium-sugammadex a permis une facilit&eacute; du geste chirurgicale, une s&eacute;curit&eacute; pour le patient et un confort pour l’anesth&eacute;siste.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Achraf El Bakkaly, Fouad Ettayebi, Houda Oubeja, Mounir Erraji, Hicham Zerhouni [Case report] - Closed reduction of a traumatic hip dislocation in children: case report - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/231/abstract/ <b>Traumatic dislocation of the hip in children is a rare disease. It only represents 5% of hip dislocations in all age groups. Before 10 years, the mechanism is often a minimal domestic accident; after 10 years, the dislocation occurs with the waning of an accident of the public highway. It is different from that of the adult by its rarity, its ease of reduction and better prognosis. This is an emergency trauma: risk necrosis of the femoral head (If delayed reduction). We report a rare case of a 3 year old boy, who suffered from bipolar trauma after a fall near his height of his house causing him a detachment of the right humerus and post-traumatic dislocation of the left hip. The diagnosis was clinically confirmed by the results of standard radiographs and CT scans of the pelvis. The consultation period to emergencies was 5 hours after the trauma.We performed an hour after a closed reduction under general anesthesia for hip dislocation with establishment of a splint pelvic-pedal for analgesic keep for three weeks. The radiological outcome was satisfactory. Peeling Salter I humerus was reduced by orthopedic manner and immobilized by thoracoabdominal plaster to keep for a month.The child was discharged the next day. Reviewed in consultation after a month, the clinical examination showed a steady left hip. Traumatic dislocation of the hip in children is a rare diagnosis, the management should as urgent as possible to overcome the different possible subsequent complications dominated by coxa magna.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Wafa Alaya, Haifa Bouchahda, Asma Fradi, Baha Zantour, Mohamed Habib Sfar [Case report] - Macro-ad&eacute;nome surr&eacute;nalien masquant une hyperplasie micronodulaire des surr&eacute;nales au cours d’un syndrome de Cushing ACTH ind&eacute;pendant et hypokali&eacute;mie r&eacute;fractaire - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/230/abstract/ <b>L’association d’une hyperplasie micronodulaire des surr&eacute;nales &agrave; un macro-ad&eacute;nome surr&eacute;nalien au cours d’un syndrome de Cushing (SC) ACTH-ind&eacute;pendant est rare et suscite beaucoup de questions. Nous en rapportons un cas. Patiente &acirc;g&eacute;e de 35 ans nous a &eacute;t&eacute; adress&eacute;e pour suspicion d’un SC devant une ob&eacute;sit&eacute; facio-tronculaire avec hypokali&eacute;mie d’origine r&eacute;nale. Les explorations hormonales ont objectiv&eacute; un SC ACTH-ind&eacute;pendant et le scanner abdominal a montr&eacute; macro-ad&eacute;nome surr&eacute;nalien gauche de 2cm avec une surr&eacute;nale droite normale. La patiente a eu une surr&eacute;nalectomie gauche. Cependant, l’hypercortisolisme et l’hypokali&eacute;mie ont persist&eacute;. L’examen anatomopathologique a permis de conclure &agrave; un ad&eacute;nome corticosurr&eacute;nalien de 2,5cm, avec une hyperplasie micronodulaire non pigment&eacute;e des surr&eacute;nales (i-MAD). La patiente a eu une surr&eacute;nalectomie droite, suivie d’une insuffisance surr&eacute;nalienne. Paradoxalement, l’hypokali&eacute;mie a persist&eacute; sans autres anomalies ni explication &eacute;vidente (magn&eacute;s&eacute;mie, pH sanguin et urinaire, bilan phosphocalcique et &eacute;chographie r&eacute;nale normaux) n&eacute;cessitant une suppl&eacute;mentation parent&eacute;rale puis orale par du KCl.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Cossi Angelo Attinsounon, Cossi Athanase Hounnankan, Comlan Albert Dovonou, Cossi Ad&eacute;bayo Alassani, Sourakatou Salifou [Research] - Connaissances et attitudes des relais communautaires sur les fi&egrave;vres h&eacute;morragiques &agrave; virus Lassa et Ebola dans le d&eacute;partement de la Donga (Nord B&eacute;nin) - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/229/abstract/ <b>INTRODUCTION: l’objectif de cette &eacute;tude &eacute;tait d’&eacute;valuer les connaissances et attitudes des relais communautaires vis-&agrave;-vis des fi&egrave;vres h&eacute;morragiques &agrave; virus Ebola et Lassa et leur implication dans la mise œuvre des activit&eacute;s de pr&eacute;vention de ces maladies.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Olasheni Abdul-afeez Somotun, Kayode Omoniyi Osungbade, Oluwaseun Oladapo Akinyemi, Taiwo Akinyode Obembe, Folashayo Ikenna Adeniji [Research] - What factors influence the average length of stay among stroke patients in a Nigerian tertiary hospital - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/228/abstract/ <b>BACGROUND: increased emphasis is being laid on ensuring that health resources are efficiently utilized, especially in resource-constrained settings such as in Nigeria. One of the main indices of how efficiently a health institution is being run is Length of Stay (LOS), which is likely to be higher in chronic diseases such as stroke and diabetes. Stroke is a chronic disease that is currently on the rise in Low and Middle income countries (LMICs) who are also characterized by constraint of health resources. This study seeks to determine the LOS of stroke patients as well as factors that affect it. METHODS: a retrospective analysis of health records of stroke victims admitted into the medical wards of the University College Hospital, Ibadan between January 2012 and December 2014 was conducted. Data on sociodemographic information, comorbidities and risk factors were extracted while LOS was calculated by counting the number of days the patient was admitted. Analysis was carried out using SPSS. RESULTS: a total of 143 records were used in the final analysis with 53.1% of them being males and having a mean age of 61.5 ± 14.2 years. More than half (53.8%) of the cases were ischemic strokes. The average length of stay was 13.7 ± 8.9 days while bivariate analysis showed that a greater proportion of cases who consumed alcohol, had diabetes and hypertension had LOS of over 7 days than those who did not. However, these differences in proportions were not statistically significant (0.310<p<0.883). CONCLUSION: LOS of stroke patients in Nigeria was shown to be prolonged especially when compared to similar settings in West Africa. The high prevalence of some of the risk factors of stroke such as diabetes mellitus indicates that policy and advocacy to drive changes in lifestyle are necessary to reduce the incidence of stroke and its consequent burden on health systems.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman, Laassad Hassini, Houneida Zaghouani, Nader Naouar, Ely&egrave;s Bouajina [Case report] - Ost&eacute;opo&eacute;cilie associ&eacute;e &agrave; un rhumatisme psoriasique - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/227/abstract/ <b>L'ot&eacute;opo&eacute;cilie est une ost&eacute;opathie condensante b&eacute;nigne et rare. Son association &agrave; un rhumatisme inflammatoire est tr&egrave;s rare. Nous en rapportons un cas. Patiente &acirc;g&eacute;e de 25 ans, atteinte d’un psoriasis cutan&eacute;, a consult&eacute; pour douleur inguinale inflammatoire. L’examen a montr&eacute; une limitation des hanches, une in&eacute;galit&eacute; de longueur des membres inf&eacute;rieurs et une douleur &agrave; la mobilisation de la sacro-iliaque droite. La biologie a montr&eacute; un syndrome inflammatoire et un bilan immunologique n&eacute;gatif. La radiographie du bassin a r&eacute;v&eacute;l&eacute; une ost&eacute;opo&eacute;cilie associ&eacute;e &agrave; une coxite destructrice. La TDM du bassin a montr&eacute; en plus de la coxite et de l'ost&eacute;opo&eacute;cilie une sacro-illite bilat&eacute;rale. Le diagnostic d’un rhumatisme psoriasique associ&eacute; &agrave; une ost&eacute;opo&eacute;cilie a &eacute;t&eacute; retenu. La patiente a &eacute;t&eacute; mise sous m&eacute;thotrexate et AINS. L'ost&eacute;opo&eacute;cilie est souvent de d&eacute;couverte fortuite. Son diagnostic radiologique est imp&eacute;ratif afin d'&eacute;viter des explorations et des traitements inutiles.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Adil Kallat, Ahmed Ibrahimi [Images in medicine] - Kyste para testiculaire associ&eacute; &agrave; un kyste r&eacute;tro v&eacute;sical b&eacute;nin - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/226/abstract/ <b>Il s'agit d'un patient de 34 sans ant&eacute;c&eacute;dents particuliers et qui pr&eacute;sente une augmentation progressive du volume scrotal avec des douleurs scrotales &eacute;voluant depuis 3 mois aggrav&eacute;es 5 jours avant son admission aux urgences. Par ailleurs il n'y avait pas de notion de fi&egrave;vre ou de troubles du bas appareil urinaire ni de traumatisme scrotal. L'examen &agrave; l'admission retrouvait un patient en assez bon &eacute;tat g&eacute;n&eacute;ral. L'examen des bourses trouvait un h&eacute;miscrotum droit une augment&eacute; de volume (A) avec une douleur accentu&eacute;e par la palpation et absence de signes d'inflammation locale. Par ailleurs, l'examen de l'h&eacute;miscrotum gauche &eacute;tait sans particularit&eacute;s. Le dosage des marqueurs tumoraux &eacute;tait normal. L'&eacute;chographie du contenu scrotal associ&eacute;e au doppler a objectiv&eacute; une masse para testiculaire droite remontant le long du cordon spermatique et se terminant en r&eacute;tro v&eacute;sical par une masse kystique arrondie de contours r&eacute;guliers. Nous avons r&eacute;alis&eacute; une orchidectomie par voie inguinale (B) avec ex&eacute;r&egrave;se de la masse r&eacute;tro v&eacute;sicale (C). L'examen anatomopathologique des deux pi&egrave;ces est revenu en faveur de kystes b&eacute;nins.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mustapha Hemama, Nizar El Fatemi, Rachid Gana [Case series] - Percutaneous vertebroplasty in moroccan patients with vertebral compression fractures - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/225/abstract/ <b>Incidence of vertebral compression fractures (VCFs) is increasing due to the increase in human life expectancy and prevalence of osteoporosis. Percutaneous vertebroplasty (PVP) has become a widely used alternative treatment for symptomatic VCFs refractory to medical therapy. It is a minimally invasive technique involving injection most frequently of polymethylmethacrylate (PMMA) directly into the vertebral body through the pedicles. Percutaneous vertebroplasty yields good results in terms of early vertebral stabilization and prompt pain relief. This study describes the experience of the Department of Neurosurgery at Ibn Sina University Hospital (Rabat, Morocco) and assesses short and long term clinical and radiological outcomes and complications of vertebroplasty in a retrospective assessment of 36 vertebral compression fractures in 35 patients (16 men and 19 women subjects) who had been treated with vertebroplasty from November 2006 to December 2014.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mederic Rouault, Marie-Audrey Vonesch, Claude Dussart [Brief] - E-formation &agrave; la st&eacute;rilisation en situation d’isolement: solution retenue par l’arm&eacute;e Fran&ccedil;aise - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/224/abstract/ <b>Le service de Sant&eacute; des Arm&eacute;es assure le soutien sanitaire des forces arm&eacute;es d&eacute;ploy&eacute;es en op&eacute;ration ext&eacute;rieure. Afin d'assurer la m&ecirc;me qualit&eacute; de soin sur le th&eacute;&acirc;tre et en M&eacute;tropole, le Service de Sant&eacute; des Arm&eacute;es r&eacute;alise la st&eacute;rilisation des dispositifs m&eacute;dicaux r&eacute;utilisables par ses propres moyens. Le pharmacien militaire en mission sur place provient de diff&eacute;rents horizons: laboratoire de biologie m&eacute;dicale, recherche, ravitaillement sanitaire, pharmacie hospitali&egrave;re ou encore officine pour certains r&eacute;servistes. Une formation &agrave; la pratique de la st&eacute;rilisation en situation d'isolement est donc n&eacute;cessaire afin d'assurer une uniformit&eacute; des connaissances. Notre travail s'est articul&eacute; en deux temps: d&eacute;termination des besoins et des modalit&eacute;s de formation adapt&eacute;s, puis construction de la formation proprement dite. Cette formation doit &ecirc;tre accessible &agrave; un public dispers&eacute; g&eacute;ographiquement dont les niveaux d'expertise en st&eacute;rilisation sont disparates. Le module « pr&eacute;paration op&eacute;rationnelle &agrave; la st&eacute;rilisation en Op&eacute;ration Ext&eacute;rieure » r&eacute;alis&eacute; permet d'actualiser et d'uniformiser les connaissances des pharmaciens d&eacute;ploy&eacute;s. Il est compos&eacute; de 11 sous-modules couvrant les diff&eacute;rents aspects de la st&eacute;rilisation en Op&eacute;ration Ext&eacute;rieure. Une &eacute;valuation, &agrave; l'aide de questions &agrave; choix multiples (QCM), est n&eacute;cessaire pour v&eacute;rifier le niveau de connaissance et de compr&eacute;hension &agrave; la fin de la formation. Un taux de bonne r&eacute;ponse de 75% est demand&eacute; pour valider la formation. Le contenu de la formation a &eacute;t&eacute; approuv&eacute; par les r&eacute;f&eacute;rents nationaux en st&eacute;rilisation et est d'ores et d&eacute;j&agrave; disponible sur la plateforme de formation e-learning de l'Ecole du Val de Grace.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hanane Raiteb, Hicham El Fazazi, Jaouad Kouach, Driss Moussaoui, Mohamed Dehayni [Case report] - Struma ovarii: un cas rare de kyste ovarien g&eacute;ant - 25 April 2017. http://www.panafrican-med-journal.com/content/article/26/223/abstract/ <b>Le struma ovarii est une tumeur rare qui repr&eacute;sente 2,7% des t&eacute;ratomes ovariens et 0,01% des tumeurs ovariennes. Elle survient souvent chez la femme au cours de la cinqui&egrave;me d&eacute;cennie et constitue le plus souvent une surprise de l'examen &eacute;chographique puis histologique. Sa prise en charge est chirurgicale et son pronostic est excellent. Nous rapportons un cas particulier de struma ovarii, vu sa survenue chez une femme jeune, la taille importante de la tumeur et sa pr&eacute;sentation radiologique inhabituelle. Nous confrontons ce cas aux donn&eacute;es de la litt&eacute;rature.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Eirini Giovannopoulou, Kostas Chondros [Case report] - A technique for non-deflating balloon catheter removal in female patients - 24 April 2017. http://www.panafrican-med-journal.com/content/article/26/222/abstract/ <b>Removing a foley catheter can sometimes be a challenge, especially when it is related to non-deflating balloons which represent most of the cases. In female patients, due to their urethral anatomy, several techniques have been proposed for balloon puncture when other maneuvers have failed. We present a simple technique for non-deflating balloon catheter removal in an old female patient with a permanent indwelling foley catheter which required no anesthesia. The balloon was effectively punctured with minimal patient's discomfort. In addition, this technique was tested in several ex-vivo model catheters and found to be safe and effective. Our technique can be used for non-deflating balloon puncture in female patients in an outpatient setting without anesthesia.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Amah Patricia Victorine Goran-Kouacou, Gonat Serge Dou, Kalou Dibert Zika, Adjoumanvoul&eacute; Honor&eacute; Adou, Oppong Richard Y&eacute;boah, Rita Ahou Aka, Sansan Hien, Kouabla Liliane Siransy, Koffi N’Guessan, Tariam Agn&egrave;s Djibangar, S&eacute;ry Romuald Dass&eacute;, Koffi Daho Adoubryn [Research] - S&eacute;rologie palustre: quel apport dans un pays d’end&eacute;mie palustre comme la C&ocirc;te d’Ivoire? - 24 April 2017. http://www.panafrican-med-journal.com/content/article/26/221/abstract/ <b>INTRODUCTION: la s&eacute;rologie palustre semble avoir peu d'int&eacute;r&ecirc;t dans les pays d'end&eacute;mie comme la C&ocirc;te d'Ivoire. Cependant cet examen a &eacute;t&eacute; r&eacute;guli&egrave;rement r&eacute;alis&eacute; au laboratoire de Parasitologie de l'Unit&eacute; de Formation et de Recherche Sciences M&eacute;dicales d'Abidjan. Le but de notre &eacute;tude &eacute;tait d'appr&eacute;cier l'apport de la s&eacute;rologie palustre dans notre contexte de pays end&eacute;mique. METHODES: nous avons r&eacute;alis&eacute; une &eacute;tude r&eacute;trospective portant sur la s&eacute;rologie palustre qui a utilis&eacute; le kit Falciparum spot-IF de Biom&eacute;rieux &agrave; la recherche d'anticorps antiplasmodiaux d'isotype IgG. Elle a concern&eacute; les s&eacute;rologies r&eacute;alis&eacute;es de janvier 2007 &agrave; f&eacute;vrier 2011 et dont les r&eacute;sultats &eacute;taient disponibles dans le registre. RESULTATS: au total, 136 patients ont &eacute;t&eacute; s&eacute;lectionn&eacute;s. L'&acirc;ge moyen &eacute;tait de 36,3 ans avec des extr&ecirc;mes de 1 an et 81 ans et un sex-ratio de 0,97. Les indications de s&eacute;rologie palustre &eacute;taient vari&eacute;es, domin&eacute;es par la spl&eacute;nom&eacute;galie (49,3%), les cytop&eacute;nies (14,7%), la fi&egrave;vre d'origine ind&eacute;termin&eacute;e (13,2%). La quasi-totalit&eacute; des patients (98,5%) avaient des anticorps antiplasmodiaux avec un titre moyen &eacute;lev&eacute; &agrave; 1057,35UI/ml. Il n'existait pas de lien entre l'&acirc;ge et le titre d'Ac qui &eacute;tait plus &eacute;lev&eacute; pour les cytop&eacute;nies, les fi&egrave;vres prolong&eacute;es et la spl&eacute;nom&eacute;galie. CONCLUSION: la s&eacute;rologie palustre a peu d'int&eacute;r&ecirc;t dans notre pratique courante en zone d'end&eacute;mie car quelque soit le motif de la prescription, les titres &eacute;taient &eacute;lev&eacute;s.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Obinna Oleribe, Vibha Kumar, Adebowale Awosika-Olumo, Simon David Taylor Robinson [Research] - Individual and socioeconomic factors associated with childhood immunization coverage in Nigeria - 24 April 2017. http://www.panafrican-med-journal.com/content/article/26/220/abstract/ <b>Introduction: immunization is the world most successful and cost-effective public health interventions as it prevents over 2 million deaths annually. However, over 2 million deaths still occur yearly from Vaccine preventable diseases, the majority of which occur in sub-Saharan Africa. Nigeria is a major contributor of global childhood deaths from VPDs. Till date, Nigeria still has wild polio virus in circulation. The objective of this study was to identify the individual and socioeconomic factors associated with immunization coverage in Nigeria through a secondary dataset analysis of Nigeria Demographic and Health Survey (NDHS), 2013.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mustafa Nkaoui, Mustapha Mahfoud [Images in medicine] - Une localisation rare du fibrome chondromyxoide: &agrave; propos d’une cas - 24 April 2017. http://www.panafrican-med-journal.com/content/article/26/219/abstract/ <b>Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 65 ans, qui consulte pour douleurs de la cheville droite &eacute;voluant depuis environ 15 ans, sans notion de traumatisme initial. L'examen clinique trouve une cheville droite douloureuse l&eacute;g&egrave;rement tum&eacute;fi&eacute;e avec boiterie &agrave; la marche n&eacute;cessitant l?utilisation d'une canne. L'&eacute;tat g&eacute;n&eacute;ral est conserv&eacute; avec un bilan biologique infectieux normal. Le bilan radiologique standard de la cheville droite montre une l&eacute;sion lytique cloisonn&eacute;e avec ost&eacute;ocondensation p&eacute;riph&eacute;rique du calcan&eacute;um, et &eacute;rosion de la corticale post&eacute;rieure (A). &Agrave; l'IRM, la l&eacute;sion est en hyposignal en T1, Hypersignal h&eacute;t&eacute;rog&egrave;ne en T2 (B). Un curetage-comblement par ciment avec greffe autologue pr&eacute;lev&eacute;e au niveau de la cr&ecirc;te iliaque a &eacute;t&eacute; r&eacute;alis&eacute; (C, D). L'examen anatomopathologique de la pi&egrave;ce a conclu &agrave; un fibrome chondromyxo&iuml;de du calcan&eacute;um. A 6 mois de recul, la patiente est autonome marchant avec l&eacute;g&egrave;re boiterie sans utilisation de cannes et sans douleur.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Obitade Sunday Obimakinde, Kolawole Olubunmi Ogundipe, Taopheeq Bamidele Rabiu, Victoria Nwebuni Okoje [Research] - Maxillofacial fractures in a budding teaching hospital: a study of pattern of presentation and care - 24 April 2017. http://www.panafrican-med-journal.com/content/article/26/218/abstract/ <b>INTRODUCTION: previous reports indicated that there is geographic and sociodemographic variation in the epidemiology of maxillofacial fractures. Audit of maxillofacial injuries managed at any institution is therefore necessary to understand the trends and proffer strategies for prevention. We therefore embarked on this study to determine the pattern of maxillofacial fractures and concomitant injuries in our institution. METHODS: we carried out a retrospective review of information on demography, aetiology and type of maxillofacial fracture, patients' status, type of crash, level of consciousness and concomitant injuries. The data collected was analysed with SPSS Version 20. RESULTS: a total of 233 patients aged 2 to 66 years were reviewed. A higher male preponderance (M:F 3.4:1) was observed. Road traffic crashes (RTC) accounted for 78.5% of injuries. Motorcycle related crashes was responsible for 69.4% of RTC and 54.5% of all fractures. Fracture of the mandible (63.2% n=172) was the most predominant skeletal injury and the body (25% n=43) was the most common site of fracture while the zygoma (29%) was predominantly affected in the midface. Ninety threes patients (40%) suffered loss of consciousness. The relationship between aetiology of injuries and consciousness level of the patients was statistically significant (p=0.001). Of the 43 patients who had concomitant injuries, craniocerebral affectation (60.5%) was the commonest. CONCUSION: RTC remains the major aetiology of maxillofacial fractures. The mandible was mostly affected and nearly half of the patients have associated loss of consciousness. There is need for continual advocacy and enforcement of laws on preventive measures among road users.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Saliu Adejumobi Balogun, Hakeem Abiola Yusuff, Kehinde Quasim Yusuf, Abdullah Mohammed Al-Shenqiti, Mariam Temitope Balogun, Prudence Tettey [Research] - Maternal education and child immunization: the mediating roles of maternal literacy and socioeconomic status - 24 April 2017. http://www.panafrican-med-journal.com/content/article/26/217/abstract/ <b>Introduction: previous studies in Nigeria have documented significant association between maternal education and child immunization. However, little is known about the pathway through which maternal education improves immunization uptake. This study aims to examine whether maternal literacy and socioeconomic status mediates the relationship between maternal education and complete immunization coverage in children. Methods: nationally representative data from the first wave of the Nigeria General Household Survey-Panel were used, which includes 661 children aged one year and below. Regression analyses were used to model the association between maternal education and child's immunization uptake; we then examined whether maternal literacy and household economic status mediates this association. Results: of the 661 children, 40% had complete immunization. The prevalence ratio (PR) of complete immunization in children whose mothers were educated versus those whose mothers were not educated was 1.44 (95% CI: 1.16-1.77). Maternal literacy substantially reduced the estimated association between maternal education and complete immunization by 90%, whereas household economic status reduced the estimates by 27%. Conclusion: these findings suggest that complete immunization was higher in children whose mothers were educated, partly because maternal education leads to acquisition of literacy skills and better health-seeking behavior which then improves immunization uptake for their children. Socioeconomic status is an alternative pathway but with less substantial indirect effect.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Victoria Bolanle Brown, Oyeninhun Abimbola Oluwatosin, Martins Olusola Ogundeji [Research] - Impact of training intervention on immunization providers’ knowledge and practice of routine immunization in Ibadan, south-western Nigeria: a primary health care experience - 24 April 2017. http://www.panafrican-med-journal.com/content/article/26/216/abstract/ <b>INTRODUCTION: immunization coverage rate in Nigeria is low for controlling vaccine-preventable-diseases. To improve immunization service delivery, regular training of health providers is essential. Few studies have evaluated the effect of immunization training on performance of providers in Primary Health Care (PHC) setting. We assessed the impact of immunization training intervention on knowledge and practice of immunization providers in Ibadan, Nigeria. METHODS: a pre-test, post-test experimental design was adopted; four randomly selected Local Government Areas (LGAs) were randomly assigned into two intervention and two control groups. One ward was randomly selected from each LGA. Participants were 70 immunization providers from PHC centers from the four wards. A two-day immunization training was organized for the participants in the intervention groups. Knowledge and practice data were collected from all participants with a questionnaire and an observation checklist pre-intervention, immediately, three months and six months post-intervention. RESULTS: repeated measures ANOVA revealed a statistically significant improvement in the scores of the participants in intervention groups in all the three parameters of questionnaire assessment between time points, general knowledge of immunization and self-reported practice (F= 8.235, P< 0.001), gathering immunization information from community (F=2.919, P< 0.05) and communication with mothers about immunization (F=17.913, P< 0.001). However, the mean scores for observation of participants’ communication practice with mothers on immunization across four points of assessment in all the groups showed no significant improvement (P> 0.05). CONCLUSION: there is a need for effective monitoring and supportive supervision system to ensure standard immunization practice in the context of task-shifting initiatives in PHC.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Houneida Zaghouani, Walid Osman, Lassad Hassini, Nader Naouar, Mohamed Laziz Ben Ay&egrave;che, Ely&egrave;s Bouajina [Case series] - Septic arthritis of the pubis symphysis: clinical and therapeutic features - 24 April 2017. http://www.panafrican-med-journal.com/content/article/26/215/abstract/ <b>Septic arthritis of the pubis symphysis is rare and difficult to diagnose. The objective of our study was to describe the biological, clinical, radiological and therapeutic aspects of this disease. This is a retrospective study of 4 cases of septic arthritis of the pubic symphysis collected in the Department of Rheumatology and Orthopaedics in Sousse in Tunisia over a period of 16 years (2000-2016). Our population consists of 3 women and one men. The mean age was 47 years (18-83). Clinical signs of appeal were inflammatory groin pain, pubic pain and fever. Symptoms appeared after forceps delivery in 2 cases, after surgery on the pelvis in one case and in a context of sepsis in one case. Radiographs showed pubic disjunction with irregular shoreline in all cases. CT performed in all patients and MRI in 2 patients showed erosions of the banks of the pubic symphysis with infiltration of the soft parts in all cases. The causative organisms were isolated in 3 cases by biopsy of soft tissue abscess under CT in 2 cases and vaginal swab in one case. Identified germs were staphylococcus aureus M&eacute;ti-S (n=1), proteus mirabilis (n=1) and varied flora (n=1). The treatment consisted of appropriate antibiotics in all cases and surgical drainage of soft tissue abscess resistant to medical treatment in 2 cases. The outcome was favorable in all cases. Diagnosis of septic arthritis of the pubic symphysis is based on clinic supported by microbiologic culture results, image methods, and proteins augment during acute phase.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Lamyae Amro, Saloua El Fadili, Hind Serhane, Hafsa Sajiai, Salma Ait Batahar [Case report] - Hydatidose multiple &agrave; localisation inhabituelle, pancr&eacute;atique et pelvienne : &agrave; propos d’un cas - 24 April 2017. http://www.panafrican-med-journal.com/content/article/26/214/abstract/ <b>Le kyste hydatique est une pathologie infectieuse assez fr&eacute;quente au Maroc. Les localisations pelvienne et pancr&eacute;atique de cette parasitose sont rares voir exceptionnelles. Nous rapportons l'observation d'une patiente de 66 ans, op&eacute;r&eacute;e il y a 6 ans pour kyste hydatique h&eacute;patique, qui s'est pr&eacute;sent&eacute; pour douleurs thoraciques avec hydatidoptysie. La radiographie thoracique a objectiv&eacute; un hydropneumothorax gauche. La TDM thoraco-abdomino-pelvienne a mis en &eacute;vidence une formation liquidienne m&eacute;diastinale ainsi que des multiples l&eacute;sions kystiques h&eacute;patiques, pancr&eacute;atique (isthme), sous diaphragmatique gauche et pelvienne. La s&eacute;rologie hydatique &eacute;tait positive. Le traitement a consist&eacute; &agrave; une thoracotomie associ&eacute; au traitement m&eacute;dical.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abdelilah Ben El Mekki, Ali Chaib [Images in medicine] - Angioed&egrave;me m&eacute;dicamenteux: un effet secondaire inhabituel de la simvastatine - 19 April 2017. http://www.panafrican-med-journal.com/content/article/26/213/abstract/ <b>L'angioed&egrave;me histaminique m&eacute;dicamenteux, est une urgence diagnostique et th&eacute;rapeutique car le pronostic vital peut &ecirc;tre mis en jeu &agrave; court terme par le risque d’&eacute;volution vers un œd&egrave;me de Quincke. Il se d&eacute;finit par un gonflement soudain localis&eacute; non inflammatoire des tissus sous cutan&eacute;s et/ou sous-muqueux, il se voit surtout avec les p&eacute;nicillines, les produits de contraste iod&eacute;s, les inhibiteurs de l'enzyme de conversion. Il est rarement observ&eacute; avec la simvastatine. Nous rapportons le cas d’une patiente &acirc;g&eacute;e de 43 ans, suivie pour hypercholest&eacute;rol&eacute;mie sous r&eacute;gime depuis deux ans mal &eacute;quilibr&eacute;e, a pr&eacute;sent&eacute; 24h apr&egrave;s la prise de la simvastatine un œd&egrave;me non inflammatoire au niveau des paupi&egrave;res et des joues associ&eacute; &agrave; une macroch&eacute;ilite avec une sensation de tension douloureuse, sans l&eacute;sions urticariennes ni dysphonie ni dyspn&eacute;e, le tout &eacute;voluant dans un contexte de conservation de l’&eacute;tat g&eacute;n&eacute;ral. La patiente a &eacute;t&eacute; hospitalis&eacute;e avec arr&ecirc;t de toute m&eacute;dication, elle a re&ccedil;u une injection d’h&eacute;missuccinate d’hydrocortisone et d’antihistaminique. L’&eacute;volution &eacute;tait favorable, une disparition de l’angioed&egrave;me &eacute;tait observ&eacute;e 48h apr&egrave;s le traitement. Une d&eacute;claration au centre de pharmacovigilance et une interdiction de la r&eacute;introduction des statines &eacute;tait r&eacute;alis&eacute;e.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hind Ouair, Ibtihal Benhsaiene, Leila Jeddane, Jalila El Bakkouri, Naima Elhafidi, Noureddine Rada, Jilali Najib, Fatima Ailal, Hanane Salih Alj, Ahmed Aziz Bousfiha [Case series] - Le profil clinique et immunologique de 15 patients Marocains atteints de syndrome hyper IgM - 19 April 2017. http://www.panafrican-med-journal.com/content/article/26/212/abstract/ <b>Le Syndrome hyper IgM est un d&eacute;ficit immunitaire h&eacute;r&eacute;ditaire bien connu, d&eacute;crit pour la premi&egrave;re fois en 1961. Il est caus&eacute; par un d&eacute;faut au niveau des lymphocytes B, caract&eacute;ris&eacute; par un taux s&eacute;rique normal ou &eacute;lev&eacute; des IgM et un taux bas ou nul des IgG, IgA, IgE r&eacute;sultant d'une d&eacute;ficience de la commutation isotypique. Ses manifestations cliniques sont domin&eacute;es par les infections &agrave; r&eacute;p&eacute;tition, surtout du tube digestif, de la sph&egrave;re ORL et des poumons. Le syndrome est caus&eacute; par un d&eacute;faut de commutation de classe d'immunoglobuline dans les cellules B, et une diminution de la capacit&eacute; des monocytes &agrave; induire la prolif&eacute;ration des lymphocytes T. Le r&eacute;sultat net de tous ces d&eacute;fauts est la susceptibilit&eacute; accrue aux infections opportunistes &agrave; Pneumocystis jiroveci, Cryptosporidium spp et d'autres organismes intracellulaires, ainsi qu'une fr&eacute;quence &eacute;lev&eacute;e d'infections bact&eacute;riennes et virales. L'int&eacute;r&ecirc;t de ce projet est d'illustrer l'importance de la compr&eacute;hension des m&eacute;canismes physiopathologiques associ&eacute;s &agrave; cette susceptibilit&eacute; accrue aux infections, ce qui permettra une meilleure prise en charge diagnostique et th&eacute;rapeutique des patients atteint du Syndrome hyper IgM (SHIM).</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ilias Benchafai, Leila Afani, Noureddine Errami, Bouchaib Hemmaoui, Hassan Errihani, Fouad Benariba [Case report] - Carcinome parathyro&iuml;dien g&eacute;ant: difficult&eacute;s diagnostiques et strat&eacute;gies th&eacute;rapeutiques - 19 April 2017. http://www.panafrican-med-journal.com/content/article/26/211/abstract/ <b>Le carcinome parathyro&iuml;dien est une tumeur maligne tr&egrave;s rare responsable de 0,4 &agrave; 5,2% des hyperparathyro&iuml;dies. Son diagnostic clinique est difficile et son traitement doit &ecirc;tre codifi&eacute;. La chirurgie reste le seul traitement curatif. Nous rapportons le cas d’une patiente suivie pour hypercalc&eacute;mie maligne qui a r&eacute;v&eacute;l&eacute; un carcinome parathyro&iuml;dien, elle a &eacute;t&eacute; op&eacute;r&eacute;e et a pr&eacute;sent&eacute; 3 mois plus tard une r&eacute;cidive ganglionnaire. Vu l’absence d’autres localisations secondaires un curage ganglionnaire bilat&eacute;ral suivi d’une chimioth&eacute;rapieont &eacute;t&eacute; instaur&eacute;s. Le carcinome parathyro&iuml;dien est souvent suspect&eacute; devant des crit&egrave;res biologiques radiologiques et surtout macroscopiques perop&eacute;ratoires mais le diagnostic de certitude reste histopathologique. Le seul traitement curatif repose sur la chirurgie et la place d’un traitement adjuvant reste encore &agrave; &eacute;tablir.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Anis Mzabi [Images in medicine] - A propos d’une l&eacute;sion lytique de la 1&egrave;re phalange: pensez &agrave; la sarco&iuml;dose - 19 April 2017. http://www.panafrican-med-journal.com/content/article/26/210/abstract/ <b>La dactylite sarco&iuml;dosique est rare. Nous rapportons l'observation d'une patiente de 65 ans ayant consult&eacute; pour une tum&eacute;faction indolore du 4&egrave;me doigt de la main gauche &eacute;voluant depuis 6 ans. La radiographie de la main (A) a montr&eacute; une ost&eacute;olyse de la 1&egrave;re phalange du 4&egrave;me doigt avec rupture corticale sans r&eacute;action p&eacute;riost&eacute;e. La radiographie du thorax (B) a r&eacute;v&eacute;l&eacute; des ad&eacute;nopathies hilaires bilat&eacute;rales avec un infiltrat interstitiel. Le bilan tuberculeux &eacute;tait n&eacute;gatif. La biopsie osseuse a montr&eacute; &agrave; l'&eacute;tude anatomopathologique des granulomes &eacute;pith&eacute;lio&iuml;des et giganto-cellulaires sans n&eacute;crose cas&eacute;euse. Le diagnostic de dactylite sarco&iuml;dosique &eacute;tait retenu. Les principaux diagnostics diff&eacute;rentiels regroupent les &eacute;tiologies infectieuses surtout la dactylite tuberculeuse, le chondrome, la dysplasie fibreuse de l'os et le kyste osseux essentiel, la goutte et l'hyperparathyro&iuml;die primitive.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Naourez Kolsi, Ahmed Zrig, Hamdi Chouch&egrave;ne, Rachida Bouatay, Khaled Harrathi, Jamel Koubaa [Case series] - Imaging of complicated frontal sinusitis - 19 April 2017. http://www.panafrican-med-journal.com/content/article/26/209/abstract/ <b>Complications occur in 3% of the cases of frontal sinusitis. These are mainly oculo-orbital, intracranial and osteomyelitis. Our aim is to describe the contribution of different imaging modalities in the diagnosis of these complications and their post-treatment monitoring. within a 15 years period (2000-2014), 10 patients with complicated frontal sinusitis were included into this retrospective study. 10 patients (9 males) aged 9 to 70 year old (mean 28). Two of these patients (20%) had a history of craniofacial trauma. Frontal headache was present in all cases (100%), frontal swelling in 8 cases (80%) and unilateral palpebral edema in 3 cases (30%). A CT scan of the face and brain was performed in all cases and revealed frontal osteomyelitis in 6 cases (60%), extradural empyema in 3 cases (33%), intracranial frontal abscess in 2 cases (20%) and occulo-orbital complications in 3 cases (30%). Magnetic resonance imaging was performed in one patient and demonstrated thrombosis of the upper longitudinal sinus. 40% of our patients associated 2 complications. Cross-sectional imaging is important in early and accurate diagnosis of complicated frontal sinusitis.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Xavier Kinenkinda, Olivier Mukuku, Faustin Chenge, Prosper Kakudji, Peter Banzulu, Jean-Baptiste Kakoma, Justin Kizonde [Research] - C&eacute;sarienne &agrave; Lubumbashi, R&eacute;publique D&eacute;mocratique du Congo II: facteurs de risque de mortalit&eacute; maternelle et p&eacute;rinatale - 17 April 2017. http://www.panafrican-med-journal.com/content/article/26/208/abstract/ <b>INTRODUCTION: l’objectif &eacute;tait d’analyser les facteurs de risque de mortalit&eacute; maternelle et p&eacute;rinatale de la c&eacute;sarienne &agrave; Lubumbashi, R&eacute;publique D&eacute;mocratique du Congo (RDC). METHODES: &eacute;tude multicentrique de 3643 c&eacute;sariennes r&eacute;alis&eacute;es entre le 1<sup>er</sup> janvier 2009 et le 31 d&eacute;cembre 2013 sur un total de 34199 accouchements dans cinq formations hospitali&egrave;res de r&eacute;f&eacute;rence &agrave; Lubumbashi (RDC). Les donn&eacute;es sociod&eacute;mographiques, les indications, l’environnement obst&eacute;trical et la morbi-mortalit&eacute; maternelles et p&eacute;rinatales ont &eacute;t&eacute; analys&eacute;s au logiciel Epi Info 2011. Les fr&eacute;quences calcul&eacute;es sont exprim&eacute;es en pourcentage et les moyennes avec leurs &eacute;cart-types. Le test de Chi-carr&eacute; et le test exact de Fisher lorsque recommand&eacute;s ont &eacute;t&eacute; utilis&eacute;s pour la comparaison des fr&eacute;quences. L’odds ratio a &eacute;t&eacute; calcul&eacute; avec l’intervalle de confiance de 95% de Cornfield gr&acirc;ce &agrave; un mod&egrave;le de r&eacute;gression logistique pour d&eacute;terminer la puissance de facteurs de risque. Le seuil de signification a &eacute;t&eacute; fix&eacute; &agrave; p<0,05. RESULTATS: la fr&eacute;quence de la c&eacute;sarienne &eacute;tait de 10,65%. L'&acirc;ge moyen des c&eacute;saris&eacute;es &eacute;tait de 28,83±6,8 ans (extr&ecirc;mes: 14 et 49 ans). La parit&eacute; variait de 1 &agrave; 16 avec une moyenne de 2,6. De ces op&eacute;r&eacute;es, une sur neuf (10,9%) &eacute;tait porteuse d’un ut&eacute;rus cicatriciel de c&eacute;sarienne ant&eacute;rieure et 22,3% &eacute;taient des &eacute;vacu&eacute;es obst&eacute;tricales. Les taux de l&eacute;talit&eacute; maternelle et p&eacute;rinatale &eacute;taient respectivement de 1,4% et 7,07% lors de la c&eacute;sarienne. L’analyse des facteurs de risque montre que la grande multiparit&eacute; (&#8805;5), l’absence de surveillance de la grossesse, le caract&egrave;re urgent de l’indication op&eacute;ratoire influent significativement sur la mortalit&eacute; maternelle. &Agrave; ces facteurs s’ajoutent pour la mortalit&eacute; p&eacute;rinatale l’&acirc;ge maternel avanc&eacute; (> 35 ans), l’&eacute;vacuation comme mode d’admission et l’immaturit&eacute; fœtale. CONCLUSION: cette &eacute;tude montre que la c&eacute;sarienne dans nos conditions de travail est coupl&eacute;e &agrave; une forte mortalit&eacute; maternelle et p&eacute;rinatale. Les facteurs de risque identifi&eacute;s sont en grande partie &eacute;vitables, surtout &agrave; tort ou &agrave; raison imput&eacute;s &agrave; l’op&eacute;ration masquant ipso facto les circonstances souvent irrationnelles de sa pratique.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Nehal Maja, Ouafa Hocar [Images in medicine] - Papillomatose confluente et r&eacute;ticul&eacute;e de Gougerot-Carteaud: &agrave; propos d’un cas - 17 April 2017. http://www.panafrican-med-journal.com/content/article/26/207/abstract/ <b>La papillomatose confluente r&eacute;ticul&eacute;e est une dermatose rare du sujet jeune, souvent non ou mal diagnostiqu&eacute;e, asymptomatique, d’&eacute;tiopathog&eacute;nie inconnue, caract&eacute;ris&eacute;e par la pr&eacute;sence de papules hyperk&eacute;ratosiques de couleur brun&acirc;tre, de petite taille. Les l&eacute;sions d&eacute;butent et confluent dans les r&eacute;gions intermammaire et interscapulaire, puis &eacute;voluent de fa&ccedil;on centrifuge vers d’autres sites anatomiques o&ugrave; elles prennent un aspect r&eacute;ticul&eacute;. L’histologie cutan&eacute;e montre une hyperk&eacute;ratose, une papillomatose, une acanthose mod&eacute;r&eacute;e, un discret infiltrat dermique superficiel p&eacute;rivasculaire lymphohistiocytaire, ainsi qu’une discr&egrave;te hyperpigmentation de la couche basale. Les colorations PAS et Rouge Congo sont syst&eacute;matiques de m&ecirc;me que le pr&eacute;l&egrave;vement mycologique. Les principaux diagnostics diff&eacute;rentiels sont le pityriasis versicolor, l’acanthosis nigricans, la maladie de Darier, l’amylose maculeuse et pigment&eacute;e et la dermite s&eacute;borrh&eacute;ique. Les traitements propos&eacute;s sont multiples dont le chef de fil est repr&eacute;sent&eacute; par les cyclines. Nous rapportons le cas d'une adolescente de 19 ans, sans ant&eacute;c&eacute;dents particuliers, chez qui l'examen clinique a objectiv&eacute; des papules k&eacute;ratosiques &eacute;voluant depuis 3 ans, de couleur brun jaun&acirc;tre, de taille variable, int&eacute;ressant le cou, le d&eacute;collet&eacute;, les r&eacute;gions intermammaire, l’&eacute;pigastre ainsi que la racine des deux membres sup&eacute;rieurs. A noter que la patiente &eacute;tait trait&eacute;e a tord comme pytiriasis versicolor r&eacute;cidivant mise sous antifongiques sans am&eacute;lioration notable. Le Scotch Test est revenu n&eacute;gatif. La biopsie cutan&eacute;e a confirm&eacute; le diagnostic et un traitement &agrave; base de cyclines &agrave; &eacute;t&eacute; instaur&eacute; &agrave; la posologie de 200mg par jour pendant 3 mois. L’&eacute;volution a &eacute;t&eacute; marqu&eacute;e par une am&eacute;lioration spectaculaire avec disparition totale de toutes les l&eacute;sions cutan&eacute;es.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Azzelarab Bennis, Abdellatif Benabbouha, Mohammed Reda Ouzaa, Adil Lamkhanter, Mohammed Benchakroun, Abdelouahab Jaafar [Case report] - Syndrome naviculo-capital de Fenton (&agrave; propos d’un nouveau cas) - 17 April 2017. http://www.panafrican-med-journal.com/content/article/26/206/abstract/ <b>La fracture scapho-capitale ou syndrome naviculo-capital de Fenton, est une l&eacute;sion tr&egrave;s rare, souvent m&eacute;connue. Elle r&eacute;sulte d'un traumatisme du poignet de haute &eacute;nergie. Son m&eacute;canisme est controvers&eacute;. Les auteurs rapportent l'observation d'un patient,qui a pr&eacute;sent&eacute; dans les suites d’un accident de la voie publique une fracture du scapho&iuml;de associ&eacute;e &agrave; une fracture du capitatum, du triquetrum et de la stylo&iuml;de cubitale. La voie d'abord dorsale, a permis une r&eacute;duction et une contention par embrochage de la premi&egrave;re rang&eacute;e, ind&eacute;pendamment de la deuxi&egrave;me rang&eacute;e. Les ligaments interosseux scapho-lunaire et lunaro-triqu&eacute;tral &eacute;taient intacts. Une immobilisation pl&acirc;tr&eacute;e ant&eacute;brachio-palmaire a &eacute;t&eacute; mise en place pour 12 semaines. La r&eacute;&eacute;ducation a dur&eacute;e six mois. A deux ans de recul, le score fonctionnel de Cooney &eacute;tait bon et l'ensemble des fractures a consolid&eacute; sans aucune d&eacute;saxation intracarpienne. La reprise du travail &eacute;tait au huiti&egrave;me mois apr&egrave;s l’accident.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khalid Chakour, Mohamed El Faiz Chaoui [Case series] - Kystes hydatiques c&eacute;r&eacute;braux de l’enfant: &agrave; propos de 15 cas - 13 April 2017. http://www.panafrican-med-journal.com/content/article/26/205/abstract/ <b>L’objectif de notre &eacute;tude est d’illustrer l’int&eacute;r&ecirc;t de l’imagerie en coupe (TDM, IRM) dans le diagnostic positif et le suivi post-th&eacute;rapeutique du kyste hydatique c&eacute;r&eacute;bral chez l’enfant et de mettre en lumi&egrave;re les particularit&eacute;s et les difficult&eacute;s rencontr&eacute;es dans la prise en charge de la localisation c&eacute;r&eacute;brale de cette affection, par notre exp&eacute;rience bas&eacute;e sur 15 cas de kyste hydatique c&eacute;r&eacute;bral de l’enfant. Il s’agit d’une &eacute;tude r&eacute;trospective de 15 cas d’hydatidose c&eacute;r&eacute;brale de l’enfant collig&eacute;s sur une p&eacute;riode de 10 ans. La TDM c&eacute;r&eacute;brale en coupes axiales de 5 mm d’&eacute;paisseur sans et avec injection de produit de contraste a &eacute;t&eacute; r&eacute;alis&eacute;e chez 15 patients. L’IRM enc&eacute;phalique a &eacute;t&eacute; r&eacute;alis&eacute;e en s&eacute;quences pond&eacute;r&eacute;es en T1 et en T2 chez un patient dans les trois plans de l’espace sans injection de Gadolinium. L’&acirc;ge moyen de nos patients &eacute;tait de 9 ans. La symptomatologie clinique &eacute;tait domin&eacute;e par le syndrome d’hypertension intracr&acirc;nienne. Le kyste hydatique &eacute;tait solitaire et se situait au niveau de l’&eacute;tage sus-tentoriel avec un important effet de masse sur le syst&egrave;me ventriculaire et la ligne m&eacute;diane dans la majorit&eacute; des cas. Tous nos patients ont &eacute;t&eacute; op&eacute;r&eacute;s et l’&eacute;volution &eacute;tait favorable dans tous les cas. La TDM repr&eacute;sente l’examen de choix pour le diagnostic et le suivi postop&eacute;ratoire du kyste hydatique c&eacute;r&eacute;bral. L’IRM trouve son int&eacute;r&ecirc;t essentiellement dans le diagnostic des formes multiples et des formes atypiques permettant une planification th&eacute;rapeutique plus adapt&eacute;e.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hicham El Bote, Sihem Atik, Rami Fares, Ernest Hage [Case report] - Papillome inverse de la vessie: une tumeur b&eacute;nigne rare: &agrave; propos d’un cas - 13 April 2017. http://www.panafrican-med-journal.com/content/article/26/204/abstract/ <b>Le papillome invers&eacute; de la vessie est une tumeur uroth&eacute;liale rare et b&eacute;nigne, qui appara&icirc;t g&eacute;n&eacute;ralement &agrave; l’&acirc;ge adulte avec une nette pr&eacute;dominance masculine. L’h&eacute;maturie macroscopique est le sympt&ocirc;me r&eacute;v&eacute;lateur le plus fr&eacute;quent, les signes radiologiques et cystoscopiques ne sont pas toujours sp&eacute;cifiques. Son diagnostic de certitude repose sur l’examen anatomopathologique. Le traitement est bas&eacute; sur la r&eacute;section endoscopique avec coagulation du lit tumoral. Une surveillance au long cours est n&eacute;cessaire en raison de son association relativement fr&eacute;quente avec le carcinome uroth&eacute;lial.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Rim Limaiem, Faten Limaiem [Images in medicine] - Carcinome in situ conjonctival: une l&eacute;sion rare &agrave; ne pas m&eacute;connaitre - 13 April 2017. http://www.panafrican-med-journal.com/content/article/26/203/abstract/ <b>Un homme &acirc;g&eacute; de 30 ans sans ant&eacute;c&eacute;dents pathologiques notables, avait consult&eacute; pour l'apparition trois mois auparavant d'une l&eacute;sion corn&eacute;enne de l'œil droit. D&egrave;s l'examen par la simple inspection, une l&eacute;sion saillante, accroch&eacute;e au limbe temporal masquait la partie temporale de la corn&eacute;e. Cette image se voyait confirm&eacute;e par l'examen &agrave; la lampe &agrave; fente, la l&eacute;sion &eacute;tait finement polylob&eacute;e et avait un contour irr&eacute;gulier vers la corn&eacute;e. Elle empi&eacute;tait &agrave; la fois sur la corn&eacute;e et sur le versant limbique de la conjonctive (A). L'acuit&eacute; visuelle &eacute;tait &agrave; 10/10. Le reste de l'examen ophtalmologique &eacute;tait normal. Devant cet aspect clinique &eacute;vocateur d'une l&eacute;sion tumorale de la surface oculaire droite, il fut propos&eacute; au patient une ex&eacute;r&egrave;se chirurgicale r&eacute;gl&eacute;e. L'ex&eacute;r&egrave;se fut donc r&eacute;alis&eacute;e sous anesth&eacute;sie locale sous microscope op&eacute;ratoire permettant une excision compl&egrave;te de la l&eacute;sion. L'examen histologique a confirm&eacute; le diagnostic de carcinome in situ (B). Les suites op&eacute;ratoires imm&eacute;diates &eacute;taient simples. Cependant, l'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par la survenue six mois plus tard, d'une r&eacute;cidive locale imposant une r&eacute;intervention chirurgicale.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Abdelmonem Ghorbel [Images in medicine] - Tum&eacute;faction nasog&eacute;nienne: ne pas oublier un kyste nasolabial - 13 April 2017. http://www.panafrican-med-journal.com/content/article/26/202/abstract/ <b>Le kyste nasolabial ou kyste du seuil narinaire est une pathologie rare qui doit &ecirc;tre &eacute;voqu&eacute;e devant toute masse kystique du vestibule nasal. Il s'agit d'une l&eacute;sion kystique d'origine &eacute;pith&eacute;liale, non odontog&egrave;ne &agrave; d&eacute;veloppement maxillaire extraosseux. Le diagnostic est fortement suspect&eacute; cliniquement et la taille du kyste peut atteindre 3 &agrave; 4 cm entrainant ainsi une d&eacute;formation faciale. La tomodensitom&eacute;trie conforte le diagnostic et &eacute;value les rapports avec les structures adjacentes. Le traitement est chirurgical et s'associe un faible taux de r&eacute;cidive. La voie vestibulaire est l'bord privil&eacute;gi&eacute; qui permet l'ex&eacute;r&egrave;se totale du kyste. Nous rapportons le cas d'une femme &acirc;g&eacute;e de 64 ans qui a consult&eacute; pour une tum&eacute;faction nasog&eacute;nienne gauche &eacute;voluant depuis 16 ans. Cette tum&eacute;faction a augment&eacute; progressivement de taille et s'est associ&eacute;e &agrave; une obstruction nasale gauche d'aggravation progressive. L'examen a montr&eacute; une tum&eacute;faction r&eacute;nitente du sillon nasog&eacute;nien gauche &eacute;tendue en infra-orbitaire et au niveau du plancher narinaire gauche faisant 5 cm de grand axe. Une TDM du massif facial a montr&eacute; une formation kystique du vestibule narinaire r&eacute;alisant une large empreinte sur l'os maxillaire avoisinant. La patiente a &eacute;t&eacute; op&eacute;r&eacute;e par voie vestibulaire permettant l'ex&eacute;r&egrave;se d'un gros kyste tr&egrave;s adh&eacute;rant au plancher narinaire gauche et dont la dissection en haut s'est faite au voisinage du foramen infra-orbitaire. Les suites op&eacute;ratoires ont simples L'examen anatomopathologique a confirm&eacute; le diagnostic d'un kyste nasolabial. Aucune r&eacute;cidive n'a &eacute;t&eacute; not&eacute;e apr&egrave;s un recul de 3 ans.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Pratap Kumar Patra [Case report] - Wilson’s disease and diagnostic conundrum in a low income country - 13 April 2017. http://www.panafrican-med-journal.com/content/article/26/201/abstract/ <b>Wilson’s disease is a well-known leading cause of chronic liver disease in children. However it may remain undiagnosed in a resource limited setting for a long period. We describe a six year male child diagnosed Wilson’s disease with extreme elevation of liver enzymes which is not reported earlier. The diagnosis was also baffling because of inconsistency of other laboratory parameters.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Myosite focale de la cuisse - 13 April 2017. http://www.panafrican-med-journal.com/content/article/26/200/abstract/ <b>Madame M.S &acirc;g&eacute;e de 55 ans, a consult&eacute; pour tum&eacute;faction douloureuse de la cuisse droite &eacute;voluant depuis six mois faisant suite &agrave; une chute de sa propre hauteur. L’examen clinique a montr&eacute; une cuisse droite tendue sans signes inflammatoires locaux avec une circonf&eacute;rence augment&eacute;e de 5 cm par rapport au cot&eacute; gauche. Le bilan inflammatoire et les enzymes musculaires &eacute;taient corrects et les AAN &eacute;taient n&eacute;gatifs. La radiographie du f&eacute;mur droit n’a pas montr&eacute; d’anomalies en dehors de l’&eacute;paississement des parties molles. L’&eacute;cho-doppler des membres inf&eacute;rieurs &eacute;tait normal. L’IRM de la cuisse droite a montr&eacute; une discr&egrave;te atrophie musculaire portant sur le muscle quadriceps essentiellement au niveau du 1/3 moyen et inf&eacute;rieur en T1 (A) avec une plage d’hyper signal STIR h&eacute;t&eacute;rog&egrave;ne des vastes m&eacute;dial et lat&eacute;ral qui prend le contraste (B). L’histologie de la biopsie musculaire a confirm&eacute; le diagnostic de myosite focale. La patiente a &eacute;t&eacute; mise sous antalgiques avec une corticoth&eacute;rapie &agrave; faible dose avec am&eacute;lioration des myalgies et de la diff&eacute;rence de circonf&eacute;rence des 2 cuisses de 2 cm &agrave; 3 mois de suivi.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abel Mukengeshayi Ntambue, Rachel Ngalula Tshiala, Fran&ccedil;oise Kaj Malonga, Tabitha Mpoyi Ilunga, Josaphat Mulumba Kamonayi, Simon Tshimankinda Kazadi, Charles Matungu Matungulu, Angel Nkola Musau, Diese Mulamba, Mich&egrave;le Dramaix-Wilmet, Philippe Donnen [Research] - Utilisation des m&eacute;thodes contraceptives modernes en R&eacute;publique D&eacute;mocratique du Congo: pr&eacute;valence et barri&egrave;res dans la zone de sant&eacute; de Dibindi &agrave; Mbuji-Mayi - 13 April 2017. http://www.panafrican-med-journal.com/content/article/26/199/abstract/ <b>INTRODUCTION: l’objectif de cette &eacute;tude &eacute;tait de d&eacute;terminer la pr&eacute;valence contraceptive moderne et les barri&egrave;res &agrave; l’utilisation des m&eacute;thodes contraceptives modernes chez les couples de la Zone de Sant&eacute; Dibindi, &agrave; Mbuji-Mayi en R&eacute;publique D&eacute;mocratique du Congo. METHODES: de Mai &agrave; Juin 2015, nous avons r&eacute;alis&eacute; une &eacute;tude descriptive transversale. Nous avons inclus les femmes &acirc;g&eacute;es de 15 &agrave; 49 ans, en union maritale, non enceinte au moment de l’enqu&ecirc;te, qui habitaient la Zone de sant&eacute; Dibindi depuis deux ans et ayant consenti librement de participer &agrave; l’&eacute;tude. La collecte des donn&eacute;es a &eacute;t&eacute; r&eacute;alis&eacute;e par interview libre des femmes. La pr&eacute;valence contraceptive moderne se r&eacute;f&eacute;rait aux femmes en cours d’utilisation, au moment de l’enqu&ecirc;te, des contraceptifs modernes. La comparaison des proportions a &eacute;t&eacute; r&eacute;alis&eacute;e au seuil de signification de 5%. Le test de Bonferroni a &eacute;t&eacute; utilis&eacute; pour comparer, deux &agrave; deux, les proportions des barri&egrave;res &agrave; l’utilisation des contraceptifs modernes. RESULTATS: la pr&eacute;valence contraceptive moderne &agrave; Dibindi, en 2015, &eacute;tait de 18,4%. Elle &eacute;tait faible eu &eacute;gard aux services de planification familiale disponibles dans cette Zone de sant&eacute;. Plusieurs femmes refusaient d’utiliser les m&eacute;thodes contraceptives modernes malgr&eacute; l’information dont elles disposaient &agrave; cause de leur d&eacute;sir de maternit&eacute;, l’interdiction religieuse, l’opposition du conjoint et la crainte des effets secondaires. CONCLUSION: l’information suffisante et centr&eacute;e sur chaque cliente ou son couple, sur la planification familiale, devrait &ecirc;tre renforc&eacute;e de fa&ccedil;on &agrave; &eacute;liminer les fausses croyances, ce qui accroitrait l’utilisation des m&eacute;thodes contraceptives modernes.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Meriem Elbachiri, Amina Taleb, Nora Derrabi, Zineb Bouchbika, Nadia Benchakroun, Hassan jouhadi, Nezha Tawfiq, Souha Sahraoui, Abdellatif Benider [Case report] - Adult-type granulosa cell tumor of the testis: report of a case and review of literature - 04 April 2017. http://www.panafrican-med-journal.com/content/article/26/198/abstract/ <b>Granulosa cell tumors is classified into juvenile and adult types and comprise less than 5% of ovarian tumors in women and are much rarer in men which only 45 have been previously reported. We report here a 40-year young man with a left testicular adult type granulosa cell tumor. The tumor measured 5.5X5X4cm; Immunohistochemical stains showed the tumor diffusely positive for inhibin and vimentin. Post operative CT scans shows a lomboaortic lymphnodes treated by four cycles of chemotherapy type BEP (bleomycin, etoposide, cisplatin). The thoraco abdominal CT scans post chemotherapy shows the disappearance of the right testicular nodule and the lomboaortic lymphnodes. 2 years after treatment, the patient is alive and well with no signs of recurrence. Our report highlights one more case of this very rare tumor of the testis, which is quite problematic In terms of prognosis and management, and for this reason seems to have attracted the interest of many researchers recently.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mohammed Sbiti, Bahia Bouhamidi, Lhoussaine louzi [Case report] - Arthrite septique &agrave; Proteus mirabilis - 04 April 2017. http://www.panafrican-med-journal.com/content/article/26/197/abstract/ <b>L'arthrite septique aigue est une pathologie peu fr&eacute;quente mais grev&eacute;e d'un pronostic lourd en termes de mortalit&eacute; et morbidit&eacute;. Nous rapportons un cas d'arthrite septique &agrave; Proteus mirabilis survenue de fa&ccedil;on spontan&eacute;e chez un patient de 61 anspr&eacute;sentant un diab&egrave;te compliqu&eacute;,associ&eacute;e &agrave; des h&eacute;moculturespositives et des cultures positives du liquide articulaire. L'&eacute;volution &eacute;tait favorable gr&acirc;ce au diagnostic pr&eacute;coce et &agrave; l'institution d'une antibioth&eacute;rapie ad&eacute;quate. L'arthrite septique &agrave; Proteus Mirabilis est rare, ce qui nous a incit&eacute; &agrave; revoir dans la litt&eacute;rature des s&eacute;ries d'arthrites &agrave; pyog&egrave;nes incluant Proteus mirabilis portant sur les facteurs de risque, la pathog&eacute;nie, le traitement et l'&eacute;volution de ces pathologies. Le diagnostic est avant tout microbiologique, la ponction articulaire pr&eacute;coce est r&eacute;alis&eacute;e avant toute antibioth&eacute;rapie, l'examen direct, la culture et l'antibiogramme qui va guider le choix d'une antibioth&eacute;rapie. L'arthrite septique est une urgence diagnostique et th&eacute;rapeutique, la prise en charge pr&eacute;coce de cette pathologie permet une gu&eacute;rison sans s&eacute;quelles.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hanane Raiteb, Jaouad Kouach [Images in medicine] - L’hidrad&eacute;nome papillif&egrave;re - 04 April 2017. http://www.panafrican-med-journal.com/content/article/26/196/abstract/ <b>Une primipare &acirc;g&eacute;e de 25 ans consultait pour une l&eacute;sion kystique du sillon interlabilial indolore mesurant 1,5 cm de couleur bleut&eacute;e (A). L’ex&eacute;r&egrave;se est faite sous anesth&eacute;sie locale. L’examen histologique montrait des projections papillaires v&ecirc;tues par un rev&ecirc;tement apocrine (B) affirmant le diagnostic d’hidrad&eacute;nome papillif&egrave;re (HP). C’est une tumeur annexielle b&eacute;nigne rare, mais elle reste la plus fr&eacute;quente des tumeurs glandulaires vulvaires (60 %) observ&eacute;e chez les femmes entre 20 et 90 ans, jamais avant la pubert&eacute;. Il s’agit le plus souvent d’une l&eacute;sion unique asymptomatique, de couleur muqueuse normale, bleut&eacute;e ou bien rouge, de localisation vulvaire dans le sillon interlabial ou zones adjacentes au sillon. Sur le plan histologique c'est une tumeur kystique encapsul&eacute;e, situ&eacute;e dans le derme profond, sans connexion avec l'&eacute;piderme. Cette tumeur est remplie de villosit&eacute;s conjonctives, et la lumi&egrave;re est tapiss&eacute;e de deux assises cellulaires, une assise s&eacute;cr&eacute;trice et une assise de petites cellules cubo&iuml;des &agrave; noyaux tr&egrave;s basophiles (cellules myo&eacute;pith&eacute;liales). Il constitue probablement une prolif&eacute;ration ad&eacute;nomateuse des glandes ano-g&eacute;nitales de type mammaire. La simple ex&eacute;r&egrave;se est curative.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ariane Halm,Thomas Seyler, Sainda Mohamed, Saindou Ben Ali Mba&eacute;, Armand Eug&egrave;ne Randrianarivo-Solofoniaina, Maherisoa Ratsitorahina, Ram Nundlall, Shahina Aboobakar, Jastin Bibi, Laurent Filleul, Patrice Piola, Harimahefa Razafimandimby, Harena Rasamoelina, Marta Valenciano, Alain Moren, Eric Cardinale, Richard Lepec, Lo&iuml;c Flachet [Research] - Four years into the Indian ocean field epidemiology training programme - 04 April 2017. http://www.panafrican-med-journal.com/content/article/26/195/abstract/ <b>Introduction: following the 2005-6 chikungunya outbreak, a project to strengthen regional Public Health preparedness in the Indian Ocean was implemented. It includes the Comoros, Madagascar, Mauritius, Reunion (France) and Seychelles. A Field Epidemiology Training Programme (FETP-OI) was started in 2011 to develop a pool of well-trained intervention epidemiologists. Methods: the FETP-OI consists of two years of supervised, learning-by-doing, on-the-job training at national sites involved in disease surveillance and response. It includes work placements at the Madagascar Pasteur Institute and the French regional epidemiology unit in Reunion and up to three training courses per year. Training objectives include epidemiological surveillance, outbreak investigations, research studies, scientific communication and transfer of competencies. Results: in four years, two cohorts of in total 15 fellows originating from four countries followed the FETP-OI. They led 42 surveillance projects (71% routine management, 14% evaluations, 12% setup, 3% other) and investigated 36 outbreak alerts, 58% of them in Madagascar; most investigations (72%) concerned foodborne pathogens, plague or malaria. Fellows performed 18 studies (44% descriptive analyses, 22%disease risk factors, and 34% on other subjects), and presented results during regional and international conferences through 26 oral and 15 poster presentations. Four articles were published in regional Public Health bulletins and several scientific manuscripts are in process. Conclusion: the FETP-OI has created a regional force of intervention consisting of field epidemiologists and trained supervisors using the same technical language and epidemiological methods. The third cohort is now ongoing. Technically and financially sustainable FETP-OI projects help addressing public health priorities of the Indian Ocean. </b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abdelkader Jalil El Hangouche, Latifa Oukerraj [Images in medicine] - Mycobacterium tuberculosis endocarditis in native valves - 04 April 2017. http://www.panafrican-med-journal.com/content/article/26/194/abstract/ <b>A 70 year old female presented with a 4 months history of dyspnea, weight loss and fever. The physical examination revealed icterus, multiple lymphadenopathies, hepatomegaly, jugular venous distension and a 2/6 diastolic heart murmur. Laboratory evaluation showed a moderate inflamatory syndrome, cytolysis and negative hemocultures. CT revealed multiple mediastinal and mesenteric lymphadenopathies, segmental thickening of colic wall and ascites. The PPD skin test was positive at 13 mm. The histopathological study of a lymphadenopathy biopsy was compatible with caseum. Quantiferon-TB test was highly positive. HIV serology was negative. A cardiac echocardiography revealed a 28 x 28 mm masse located at the anterior mitral valve (A, B, C, D) fusing to the mitro-aortic junction and along the proximal aortic wall (E, F). The masse was partially drained at left valsalva sinus (G, H). There was a moderate aortic insufficiency (I). The diagnosis of ganglionar tuberculosis with endocadiac and aortic involvement was highly suggested according to clinical, epidemiologic, biologic arguments. The patient was given antituberculosis drugs for 9 months with a spectacular clinical improvement with no regression of the abcess. She is scheduled for surgical treatment.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ngaroua, Ngah Joseph Eloundou, Yaouba Djibrilla, Ousmane Asmaou, Amvene J&eacute;r&eacute;mie Mbo [Research] - Aspects &eacute;pid&eacute;miologiques, cliniques et prise en charge de st&eacute;nose ur&eacute;trale chez l’adulte dans un H&ocirc;pital de District de Ngaound&eacute;r&eacute;, Cameroun - 04 April 2017. http://www.panafrican-med-journal.com/content/article/26/193/abstract/ <b>INTRODUCTION: l'objectif &eacute;tait de d&eacute;terminer les aspects &eacute;pid&eacute;miologiques, cliniques et prise en charge de la st&eacute;nose de l’ur&egrave;tre &agrave; l’H&ocirc;pital Protestant de Ngaound&eacute;r&eacute; (HPN). METHODES: une &eacute;tude r&eacute;trospective a &eacute;t&eacute; conduite, bas&eacute;e sur la revue des dossiers des patients hospitalis&eacute;s pour st&eacute;nose ur&eacute;trale dans l’unit&eacute; urologique de l’HPN, d’une p&eacute;riode d’un an (janvier 2013 &agrave; janvier 2014). Seuls les dossiers complets &eacute;taient inclus.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mohamed Essarghini, Mohamed Tarchouli, Mohamed Elfahssi, Abdelmounim Aitali, Ahmed Bounaim [Case report] - Un cas rare de pneumop&eacute;ritoine spontan&eacute; massif: &agrave; propos d’une observation - 31 March 2017. http://www.panafrican-med-journal.com/content/article/26/192/abstract/ <b>Le pneumop&eacute;ritoine spontan&eacute; est une affection rare caract&eacute;ris&eacute;e par la pr&eacute;sence d’un &eacute;panchement d’air libre dans la cavit&eacute; p&eacute;riton&eacute;ale en l’absence de toute cause &eacute;vidente, nous rapportons une observation d’un pneumop&eacute;ritoine massif de d&eacute;couverte scanographique dont l’exploration clinique, biologique, radiologique et cœlioscopique n’a aboutie a aucune &eacute;tiologie d&eacute;celable. Cette observation met le jour sur une entit&eacute; clinique rarement vue dans notre pratique constituant un v&eacute;ritable pi&egrave;ge diagnostic, sa connaissance &eacute;viterait des laparotomies blanches inutiles et surtout agressives pour nos patients. La cœlioscopie semble &ecirc;tre un moyen chirurgical peu invasif pour les formes douteuses et permet un diagnostic visuel en &eacute;liminant une perforation d’organe creux.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Samia Belhassen, Braiki Meriem, Laamiri Rachida, Kechiche Nahla, Hidouri Saida, Krichen Imed, Mosbahi Sana, Ksiaa Amine, Sahnoun Lassad, Mekki Mongi, Belguith Mohsen, Nouri Abdellatif [Case series] - Mesenteric cyst in infancy: presentation and management - 31 March 2017. http://www.panafrican-med-journal.com/content/article/26/191/abstract/ <b>Mesenteric cysts are documented as a rare entity in pediatric population. They are considered as benign intra-abdominal tumors with an unknown etiology. Symptoms are not specific and knowledge of such condition is essential in order to establish a proper management. We report three pediatrics cases of mesenteric cysts managed between 2000 and 2009 in the pediatric surgery Department of Monastir College Hospital. We described the clinical, radiological and operative findings. Two males and a female were managed (age range: 10 days-5years, mean age: 6,3years). Two patients were presented with an intestinal obstruction. A preoperative diagnosis was made basing on imaging. Thus, abdominal ultrasonography was performed in all of our reported cases and showed a cystic mass in all cases. The cystic nature of the mass, its margins and its extension were better described on tomographic images. The mesenteric cyst was completely and successfully removed in all cases. The histopathological report confirmed the diagnosis and showed a multiloculated cyst with columnar mesothelial lining, without any defined muscular layer or cellular atypia and without any evidence of malignancy. The children were evaluated post-operatively with a mean follow-up of 2 years and a half. No recurrence was noted in our patients during the follow-up period. It is known that clinical features are not specific of such anomaly but once the diagnosis is made, the complete surgical removal of the cyst remains the treatment of choice with excellent outcomes.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abdelilah El Alaoui, Hicham El Bot&eacute;, Oussama Ziouani, Oussman Dembele, Hachem El Sayegh, Ali Iken, Lounis Benslimane, Yassine Nouini [Case report] - Fistules scrotales r&eacute;v&eacute;lant un ad&eacute;nocarcinome mucineux du scrotum: &agrave; propos d’un cas - 30 March 2017. http://www.panafrican-med-journal.com/content/article/26/190/abstract/ <b>Les fistules scrotales sont rares, et souvent secondaires &agrave; des l&eacute;sions de tuberculose. Les ad&eacute;nocarcinomes mucineux sont des tumeurs qui renferment au moins 50% de mucus extracellulaire, et si&egrave;gent pr&eacute;f&eacute;rentiellement sur le recto sigmo&iuml;de, la localisation scrotale est inhabituelle. Nous rapportons un cas d’ad&eacute;nocarcinome mucineux secondaire du scrotum r&eacute;v&eacute;l&eacute; par des fistules scrotales, chez un patient &acirc;g&eacute; de 54 ans, sans ant&eacute;c&eacute;dents pathologiques notables, qui pr&eacute;sente depuis deux ans des fistules scrotales &agrave; r&eacute;p&eacute;tition, sans autres signes associ&eacute;s. L’examen trouve de multiples fistules scrotales avec issue de pus &eacute;pais, le toucher rectal est normal. Les explorations urologiques (UIV, UCRM, Cystoscopie, …) sont normales, le bilan infectieux ainsi que la recherche de BK dans les urines et le crachat sont n&eacute;gatives. La biopsie de la peau scrotale est revenue en faveur d’un ad&eacute;nocarcinome mucineux moyennement diff&eacute;renci&eacute;, dont l’&eacute;tude immune histochimique est en faveur d’une origine primitive colorectale. L’&eacute;volution a &eacute;t&eacute; marqu&eacute; par l’apparition de fistules anales complexes, ayant a l’IRM une caract&eacute;ristique active, alimentant plusieurs collections pelvi p&eacute;rin&eacute;ales comportant des bourgeons charnus. Sur le plan th&eacute;rapeutique et vu la raret&eacute; de ce cancer, il n’y a pas de consensus. La r&eacute;section chirurgicale reste le traitement de choix pour cette affection. La radio chimioth&eacute;rapie pr&eacute; op&eacute;ratoire est pr&eacute;conis&eacute;e pour ce type de cancer mais son r&ocirc;le n’est pas bien &eacute;tabli. Chez notre patient on a opt&eacute; pour une radio chimioth&eacute;rapie n&eacute;o adjuvante premi&egrave;re, avant la r&eacute;alisation d’une amputation abdomino- p&eacute;rin&eacute;ale.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mohamed Sahli, Bouchaib Hemmaoui, Fouad Benariba [Case report] - Intramedullary spinal cord metastasis from laryngeal carcinoma: case report and review of literature - 30 March 2017. http://www.panafrican-med-journal.com/content/article/26/189/abstract/ <b>Laryngeal cancer metastases are relatively rare and mainly affect the lung. The medullary localization remains exceptional. We report the case of a patient followed for operated laryngeal cancer and whose oncologic control revealed a medullary localization. A patient followed for squamous cell carcinoma of the larynx, treated in 2010 by a partial surgery whose endoscopic control at 5 years revealed the presence of right arytenoid edema without suspicious lesions, multiple biopsies were made and which returned negative. A month later, the patient presented a rebel cervical spine pain and a feeling of heaviness of the upper limbs, for which a radiological assessment was done finally objectifying a right hypopharyngeal process and a suspicious right internal jugular lymphadenopathy (biopsy confirmed the squamous type), as well as an intramedullary metastasis. This case is an illustration of an exceptional evolution of this type of cancer and a are metastatic localization difficult to highlight, which leads us to ask the question on the need of simultaneous and systematic radiological and endoscopic control treatment for operated laryngeal cancer.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Caradee Yael Wright, Patricia Nicole Albers, Anthony Ivor Reeder, Angela Mathee [Research] - Sunbeds and skin cancer risk: quantifying a baseline estimate of sunbed facilities in South Africa prior to implementation of sunbed regulations - 30 March 2017. http://www.panafrican-med-journal.com/content/article/26/188/abstract/ <b>INTRODUCTION: in 2009, ultraviolet-emitting tanning devices, i.e. sunbeds and tanning booths, were officially classified as carcinogenic to human health (Group 1) by the International Agency for Research on Cancer. METHODS: here, we aim to estimate South African-based facilities with indoor tanning services advertised in the printed Yellow Pages and online in two directories. Printed Yellow Pages telephone directory beauty salon facilities listings (2010-14) for all provinces were examined and those mentioning "sunbed" and/or "tanning bed" recorded. Beauty/spa facilities were also identified using two sunbed listing webpages. RESULTS: a total of 40 web-advertised facilities had a sunbed. Beauty facilities in the Yellow Pages specifically mentioning sunbeds declined by 62% between 2010 (n=53) and 2014 (n=20). Gauteng had the highest number of facilities (n=25) with a sunbed. Facilities with sunbeds exist in South Africa, as evidenced by the Yellow Pages and web-advertised data, but their true prevalence remains largely unknown. It is likely that online and walk-by advertising is increasingly more common than print. CONCLUSION: given that sunbeds may likely soon become regulated in South Africa, further research is needed to better quantify sunbed provision, determine advice provided by facility operators to new users, investigate whether age restrictions or limits exist for sunbed use, and describe typical patterns of sunbed use in South Africa.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Oussama Ziouani, Abdelilah Elalaoui, Hicham Elbote, Salwa Belhabib, Hachem El Sayegh, Ali Iken, Lounis Benslimane, Fouad Zouaidia, Yassine Nouini [Case report] - Le carcinome tubulo-mucineux et fusiforme: une tumeur r&eacute;nale rare - 30 March 2017. http://www.panafrican-med-journal.com/content/article/26/187/abstract/ <b>Le carcinome tubulo-mucineux et fusiforme d&eacute;signe une tumeur rare d&eacute;crite dans la classification OMS 2004 comme une nouvelle entit&eacute;. Elle est reconnue de comportement relativement indolent. Nous rapportons l'observation d'une femme &acirc;g&eacute;e de 60 ans qui pr&eacute;sentait des douleurs lombaires, et chez qui la tomodensitom&eacute;trie a r&eacute;v&eacute;l&eacute; la pr&eacute;sence d'une masse r&eacute;nale gauche mesurant 55 x 40 mm. La patiente a &eacute;t&eacute; trait&eacute;e par n&eacute;phrectomie partielle gauche dont l'examen macroscopique a montr&eacute; la pr&eacute;sence d'une tumeur bien limit&eacute;e d'aspect charnu avec des remaniements h&eacute;morragiques et n&eacute;crotiques. L'&eacute;tude histologique a confirm&eacute; le carcinome tubulo-mucineux et &agrave; cellules fusiformes de bas grade. L'immunohistochimie a r&eacute;v&eacute;l&eacute; une positivit&eacute; &agrave; la cytok&eacute;ratine (CK 7 et CK 19) et &agrave; l'antig&egrave;ne des membranes &eacute;pith&eacute;liales (EMA), et une n&eacute;gativit&eacute; au CD10. L'&eacute;volution &eacute;tait favorable avec un recul de 6 mois.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Skeletal fluorosis: a rare cause of diffuse bone condensation - 30 March 2017. http://www.panafrican-med-journal.com/content/article/26/186/abstract/ <b>A 69-year-old man, native of metlaoui in Tunisia, presented to the Department of Rheumatology at our institution with 10 years of non-inflammatory rachialgia with polyarthralgia. On examination, the patient had no fever or joint swelling, his teeth had brown strains and rough, there was diffuse tenderness at the cervical and lumbar spine and neurological examination was normal. Standard radiographs revealed diffuse bone condensation involving all vertebrae of the cervical, dorsal (A) and lumbar (B) spine, the skull (C), the pelvis (D) and the limbs. The origin of the patient, the brownish color of the teeth and the radiological appearance led to suspicion of fluoride poisoning, which was confirmed by the very high blood fluoride and urine dosage. Skeletal fluorosis is a rare toxic osteopathy characterized by massive bone fixation of fluoride. Its origin is dominated in the countries of North Africa by hydro-telluric poisoning. Its severity lies in the development of skeletal deformities and neurological complications. Management of fluorosis generally focuses on symptom treatment.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Joe James, Nallaveettil Kesavan Thulaseedharan [Images in medicine] - Ring enhancing lesions in the brain of an HIV infected patient: a diagnostic challenge - 30 March 2017. http://www.panafrican-med-journal.com/content/article/26/185/abstract/ <b>A 58-year old male presented with headache, unsteadiness of gait and cognitive decline in the form of loss of recent memory of 1-month duration. He also reported significant loss of weight. Neurological examination revealed short term memory loss and gait apraxia. There were no cerebellar signs or sensorimotor deficits. He was tested positive for HIV. MRI showed T2-FLAIR hyperintense lesions with edema in the left centrum semiovale (A), right basal ganglia (B) and right frontal corticomedullary junction (C). The corresponding lesions in T1 after gadolinium showed ring enhancement (D-F). His CD4 count was 70/µL. Serum IgG Toxoplasma was positive. He was started on pyrimethamine with sulfadiazine and anti-retroviral treatment and discharged. Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii. CNS Toxoplasmosis is an important differential diagnosis in HIV patients presenting with neurological symptoms. Common presentations are headache, seizures, focal neurological deficits like hemiparesis or aphasia, and altered sensorium. Toxoplasmosis in AIDS is due to reactivation of previously acquired infection as immunity wanes, almost always when CD4 count is less than 100/µL. Multiple ring enhancing lesions in the corticomedullary junctions of frontal and parietal lobe, centrum semiovale and basal ganglia with edema and mass effect in an HIV patient is virtually diagnostic of toxoplasmosis. Ring enhancing lesions in the brain can also be seen in primary CNS lymphoma which often causes diagnostic confusion. An isolated ring enhancing lesion larger than 4cm in size or a positive serology for Ebstein-Barr virus in CSF favors lymphoma over toxoplasmosis. </b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Lykourgos Christos Alexakis [Images in medicine] - Ascaris lumbricoides roundworms visible on a plain -non-contrast- abdominal x-ray in a patient presenting with gastric outlet obstruction - 29 March 2017. http://www.panafrican-med-journal.com/content/article/26/184/abstract/ <b>A 29 years old male from Bangladesh presented in the emergency department with severe abdominal pain and symptoms of gastric outlet obstruction. Epigastric tenderness, tachycardia, low grade fever, leucocytosis (WBC: 14900/microL) with neutrophilia (Neu:10900/microL) and eosinophilia (Eos:600/microL) were noted, as well as features of obstructive jaundice (increased AST, ALT, and total bilirubin). Stomach dilation was noted on a chest X-ray (A), while in a plain abdominal erect X-ray (C) tubular curvilinear soft tissue densities in a jejunal loop were identified (D). An abdominal CT scan showed stomach dilation and gave the impression of thickening of the pyloric wall and superior part of duodenum (B). In addition, a distended gallbladder, a common bile duct of one cm in diameter and borderline distention of intrahepatic ducts were observed. Subsequently, a nasogastric tube was placed which drained 2 litres of food containing liquid. Antibiotics, opioid analgesics and intravenous fluids were also given. During gastroduodenoscopy a bundle of several entangled Ascaris Lumbricoides roundworms was identified obstructing the duodenum lumen and some of them were removed endoscopically. Following albendazole treatment for three days and passing several dead worms per rectum, the patient recovered and radiological findings resolved completely.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ababacar Abdoulaye Traore, Badreeddine Alami [Images in medicine] - Illustration d’une spondyloptose d&eacute;g&eacute;n&eacute;rative du sujet jeune - 29 March 2017. http://www.panafrican-med-journal.com/content/article/26/183/abstract/ <b>Il s’agit d’un jeune patient de 17 ans, sans facteurs de risques cong&eacute;nitaux ou h&eacute;r&eacute;ditaires ni de notion de traumatisme ayant consult&eacute; pour une douleur lombaire avec troubles importants de la statique. A l’examen physique, les r&eacute;gions glut&eacute;ales &eacute;taient aplaties et le bord sup&eacute;rieur de la premi&egrave;re vert&egrave;bre sacr&eacute;e &eacute;tait palpable dans le creux lombaire. Le patient pr&eacute;sentait par ailleurs une hanche abaiss&eacute;e et des d&eacute;hanchements &agrave; la marche. Une tomodensitom&eacute;trie du rachis dorso-lombo-sacr&eacute;e, demand&eacute;e pour bilan &eacute;tiologique, a mis en &eacute;vidence un glissement complet vers l’avant du corps vert&eacute;bral de L5, dont le plateau vert&eacute;bral inferieur surplombait le bord ant&eacute;ro sup&eacute;rieur de la premi&egrave;re vert&egrave;bre sacr&eacute;e avec un aspect verticalis&eacute; du sacrum. Il s’y associe une lyse isthmique gauche de L5 et des plages ost&eacute;o condensantes r&eacute;actionnelles des berges osseuses. Une spondyloptose d&eacute;g&eacute;n&eacute;rative par lyse isthmique a &eacute;t&eacute; port&eacute; comme diagnostic. En effet, elle constitue le grade V d’&eacute;volution d’une spondylolisth&eacute;sis. En effet, la spondyloptose est une dislocation vert&eacute;brale compl&egrave;te de la cinqui&egrave;me vert&egrave;bre lombaire (L5) venant se placer en avant du sacrum (S1). Elle correspond au dernier stade d’un spondylolisth&eacute;sis. La spondylolisth&eacute;sis serait class&eacute;e en cinq types: dysplasique, isthmique, d&eacute;g&eacute;n&eacute;ratif, traumatique et pathologique. Le traitement d’une spondyloptose efficace est chirurgical chez les adultes, la th&eacute;rapie par r&eacute;duction reste une alternative chez les enfants. Notre patient a &eacute;t&eacute; mis sous traitement conservateur antalgique avec immobilisation simple, vu l’absence d’une issue chirurgicale.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Prosper Kakudji Luhete, Olivier Mukuku, Albert Mwembo Tambwe, Prosper Kalenga Muenze Kayamba [Research] - Etude du pronostic maternel et p&eacute;rinatal au cours de l’accouchement chez l’adolescente &agrave; Lubumbashi, R&eacute;publique D&eacute;mocratique du Congo - 29 March 2017. http://www.panafrican-med-journal.com/content/article/26/182/abstract/ <b>INTRODUCTION: l’objectif de cette &eacute;tude &eacute;tait de d&eacute;terminer la fr&eacute;quence et d’&eacute;valuer le pronostic maternel et p&eacute;rinatal lors de l’accouchement chez les adolescentes dans la ville de Lubumbashi. METHODES: c’&eacute;tait une &eacute;tude cas-t&eacute;moin des accouch&eacute;es d’une grossesse monofoetale de D&eacute;cembre 2013 &agrave; Mai 2014 dans 10 maternit&eacute;s de r&eacute;f&eacute;rence &agrave; Lubumbashi (RD Congo). Les adolescentes (< 20 ans) ont &eacute;t&eacute; compar&eacute;es aux femmes &acirc;g&eacute;es de 20-34 ans. Les param&egrave;tres sociod&eacute;mographiques maternels, la morbi-mortalit&eacute; maternelle et p&eacute;rinatale ont &eacute;t&eacute; analys&eacute;es. Les statistiques usuelles et la r&eacute;gression logistique ont &eacute;t&eacute; utilis&eacute;es pour analyser les r&eacute;sultats. Le seuil de signification a &eacute;t&eacute; fix&eacute; &agrave; une valeur de p<0,05. RESULTATS: la fr&eacute;quence d’accouchement chez les adolescentes &eacute;tait de 7,7%. Nous avons observ&eacute; que la c&eacute;sarienne (ORa=1,9 (1,1-3,1)), l’&eacute;pisiotomie (ORa=4,2 (2,9-5,9)), la d&eacute;livrance pathologique (ORa= 2,7 (1,1-6,5)), l’&eacute;clampsie (ORa= 4,4 (1,3-14,5)) et le faible poids de naissance (ORa=2,0 (1,3-3,0)) ont &eacute;t&eacute; significativement plus &eacute;lev&eacute;s chez les adolescentes que chez les adultes. CONCLUSION: l’accouchement chez les adolescentes, comparativement &agrave; celui de femmes &acirc;g&eacute;es de 20-34 ans, reste associ&eacute; &agrave; un mauvais pronostic. D’o&ugrave; l’organisation des s&eacute;ances de sensibilisation pour une meilleure fr&eacute;quentation des services consultations pr&eacute;natales, une optimisation du d&eacute;pistage, de la surveillance et de la pr&eacute;vention des pathologies de la grossesse chez les adolescentes s’av&egrave;re importante et urgente.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mohammed Amine Benatta, Jean Charles Grimaud [Images in medicine] - Band ligation for a gastroesophageal junction Dieulafoy’s lesion - 29 March 2017. http://www.panafrican-med-journal.com/content/article/26/181/abstract/ <b>In a 24 years old male presented with a first episode of massive hematemesis requiring resuscitation, a first upper endoscopic exam was inconclusive. The second endoscopic exam performed 24 hours later described a lesion as a little vessel with normal surrounding mucosa, without active bleeding (red arrow). This lesion was localized at the gastroesophageal junction (A) see the gastric mucosa (white arrow) and the esophageal mucosa (yellow arrow). This endoscopic finding of an isolated vessel without ulcer are characteristic of a Dieulafoy's lesion (DL). Given its particular localization and to prevent recurrence of bleeding, band ligation of this DL was found to be technically more suitable than haemoclip and/or injection. By Van Stiegmann technique using a Saeed Multi-Band ligator (Cook Medical) (B) the lesion with its surrounding mucosa were aspirated into the overtube (red arrow) and a single elastic band applied around the entire lesion (C) . There were no immediate post procedure complications. Oral feeding was started 24 hours after and Intravenous Proton Pomp Inhibitor (PPI) therapy continued. The patient was discharged 48 h later with oral PPI. The course was uneventful and no recurrence of bleeding was reported after several months follow up. DL is rare and responsible in 0.3-6.7% of upper gastrointestinal bleeding but it is a potentially life-threatening condition. It is usually localized in the proximal stomach up to 6 cm from the gastroesophageal junction Endoscopic management is the gold standard for its diagnosis and treatment. Advances in endoscopy decreased the mortality of DL bleeding from 80% to 8.6%.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Asma Elramalli, Nariman Almshawt, Mohamed Omar Ahmed [Short communication] - Current challenges and emergence of carbapenemase-producing bacteria: a brief report from a libyan hospital - 29 March 2017. http://www.panafrican-med-journal.com/content/article/26/180/abstract/ <b>A collection of 94 Gram-negative bacteria isolates, showing different antimicrobial resistance phenotypes including to the carbapenem classes was investigated. Strains were originated form clinical sources from a single hospital in Tripoli, Libya during 2015 and were identified based on cultural and phenotypic characteristics, and fully characterized by the VITEK automated system. Forty-eight percent (48%) of the collection was identified as Acinetobacter baumannii, 50% Klebsiella pneumoniae and 2% Escherichia coli. Resistance to the carbapenem classes was reported in 96% of the A. baumannii strains and 94% of the K. pneumonia strains. Seventy-eight percent (78%) of the isolates showed different multidrug-resistant (MDR) phenotypes, of which K. pneumoniae expressing the highest rates of MDR (i.e. 91%). Emergence of resistance to carbapenems in the Gram-negative bacteria is a challenging global problem, particularly for Africa. Surveillance of these pathogens and appropriate actions are urgently required in the Libyan healthcare settings. </b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Bah Aliou, Beaudouin Emmanuel [Images in medicine] - Upward closed talocrural dislocation without fracture - 29 March 2017. http://www.panafrican-med-journal.com/content/article/26/179/abstract/ <b>The ankle dislocations are very rare, around 1% of all dislocations. It is usually a fracture-dislocation. The talocrural dislocations are exceptional. We report a case about a 63 years male, carpenter, who fell off the stairs leading to an axial compression trauma of his left ankle. In clinical examination, we found a deformation of his ankle without sensory or vascular deficit. This trauma was closed. The x-rays (A, with arrow) found upward talocrural dislocation without fracture. Immediate reduction was performed. The articulation was still incoercible and unstable. We set up two 3.5 mm tri cortical screws in compression followed by six weeks of cast immobilization (B). After 6 weeks, an X-ray was performed where we noticed a decline off the screws (C, with arrow) without clinical impact. We proposed a removal of materiel, but he refused. After 36 months of follow up, functional results were satisfactory.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Naoual El Omri, Fadwa Mekouar [Images in medicine] - Bourgeon bronchique sarco&iuml;dosique - 29 March 2017. http://www.panafrican-med-journal.com/content/article/26/178/abstract/ <b>Patiente de 53 ans, consulte pour une toux s&egrave;che et une dyspn&eacute;e d’effort. Le scanner thoracique montre des ad&eacute;nopathies m&eacute;diastino-hilaires bilat&eacute;rales et interlobulaires gauches avec des at&eacute;lectasies en bandes et sous segmentaires ventrales bilat&eacute;rales, lingulaire et basales bilat&eacute;rales. La bronchoscopie montre un aspect inflammatoire diffus et un aspect festonn&eacute; de la bronche lobaire moyenne droite qui est incath&eacute;terisable avec des &eacute;perons &eacute;paissies et un bourgeon vascularis&eacute; et lisse saignant au moindre contact au niveau de la bronche segmentaire post&eacute;ro-basale droite. A gauche, on trouve un bourgeon tr&egrave;s vascularis&eacute; au niveau de la bronche postero-basale gauche de taille plus petite que celle du bourgeon droit mais il est plus inflammatoire. La biopsie montre des remaniements granulomateux en rapports avec une sarco&iuml;dose.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Segun Ayodeji Ogunkeyede, Adekunle Daniel, Omowonuola Ogundoyin [Case series] - Paediatric otogenic tetanus: an evidence of poor immunization in Nigeria - 29 March 2017. http://www.panafrican-med-journal.com/content/article/26/177/abstract/ <b>Suppurative otitis media is a common childhood infection that predisposes to otogenic tetanus. Tetanus is a vaccine preventable disease that is associated high cost of care and mortality. This study highlights reasons for otogenic tetanus in Nigerian children and way of reducing the menace. This is a 5-year retrospective reviewof all patients managed for otogenic tetanus between at the Department of Otorhinolaryngology, University College Hospital, Ibadan. The data collected include demographic, clinical presentations, tetanus immunisation history, and duration of hospital admission, and management- outcome. There were 23 patients comprising of 13(56.5 %) males and 10 (43.5%) females, male to female ratio was 1.3:1. The age ranged between 11 months and12 years (mean age 3.4 years ± 2.1). All the patients presented with discharging ear, trismus and spasms. The onset of symptoms prior hospital presentation ranged between 2 - 11 days (mean 3.0 days ± 1.3). Only 12(52.1%) patients had complete childhood tetanus immunisation, 6(26.1) % had no tetanus immunisation and no other childhood immunisation, while 5(21.7%) had partial tetanus immunisation. The discharging ears were managed by self-medication and other harmful health practices. The hospital admission ranged from 20 days - 41days (average of 23days) and there were 3(13.0 %) death. Tetanus immunization was not received because of; non- availability of the vaccine at health centers, lack of health facility in communities, fear of complications from immunization, poor awareness of the immunization programme. Tetanus, an immunisable disease, is still a major problem in Nigeria.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Napo Abdoulaye, Sidibe Mohamed Kol&eacute; [Images in medicine] - Le syndrome du soleil levant - 29 March 2017. http://www.panafrican-med-journal.com/content/article/26/176/abstract/ <b>Le syndrome dit Morning glory ou « belle de jour » est une anomalie cong&eacute;nitale rare de la papille par &eacute;mergence du nerf optique dans l'oeil. Il est parfois associ&eacute; &agrave; des anomalies graves du syst&egrave;me nerveux central. Il atteint pr&eacute;f&eacute;rentiellement les filles et le plus souvent unilat&eacute;rale. Les circonstances de d&eacute;couverte peuvent &ecirc;tre un strabisme, une amblyopie, un nystagmus, une leucocorie ou un trouble r&eacute;fractif. Ce syndrome peut &ecirc;tre &eacute;galement associ&eacute; &agrave; des anomalies du syst&egrave;me nerveux central, endocriniennes, r&eacute;nales, respiratoires, ou dans le cadre d'un syndrome de charge. Nous rapportons le cas d'un adolescent de 12 ans, qui a &eacute;t&eacute; amen&eacute; en consultation par ses parents pour une baisse d'acuit&eacute; visuelle &agrave; l'oeil gauche depuis la naissance qui a &eacute;t&eacute; objectiv&eacute; par une perception lumineuse. La fonction visuelle &eacute;tait conserv&eacute;e &agrave; l'oeil droit. On notait une image de soleil levant autour de la papille &eacute;largit &agrave; l'ophtalmoscopie avec des vaisseaux en rayon de roue et un halo pigment&eacute; au sein d'un territoire atrophique &agrave; l'oeil gauche aspect de fond l'oeil normal &agrave; droite. Il n'y avait pas d'anomalies cong&eacute;nitales associ&eacute;es et une surveillance fut institu&eacute;e.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ismaïl Lawani, Aboudou Raimi Kpossou, Bruno Noukpozounkou, Freddy Houehanou Rodrigue Gnangnon, Yacoubou Imorou Souaibou, Dansou Gaspard Gbessi, Benjamin Hounkpatin, Fancis Moïse Dossou, Jean-Léon Olory-Togbe [Case report] - Pancr&eacute;atite aigu&euml; s&eacute;v&egrave;re sur grossesse chez le noir Africain: &agrave; propos d’un cas - 27 March 2017. http://www.panafrican-med-journal.com/content/article/26/175/abstract/ <b>La pancr&eacute;atite aigu&euml; est un &eacute;v&eacute;nement rare pendant la grossesse. Elle est associ&eacute;e &agrave; une forte mortalit&eacute; maternelle et fœtale. La lithiase biliaire est l’&eacute;tiologie la plus fr&eacute;quente, mais dans beaucoup de cas, la cause reste ind&eacute;termin&eacute;e. Nous rapportons ici le cas d’une patiente de 37 ans qui a pr&eacute;sent&eacute; &agrave; 29 semaines d’am&eacute;norrh&eacute;e une pancr&eacute;atite aigu&euml; r&eacute;v&eacute;l&eacute;e par une occlusion intestinale aigu&euml; f&eacute;brile. Le diagnostic a &eacute;t&eacute; fait en per op&eacute;ratoire. Dans les suites op&eacute;ratoires la patiente a fait une fausse couche, puis est d&eacute;c&eacute;d&eacute;e au 8e jour post op&eacute;ratoire.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Assya Khermach, Hanane Khalki, Lhoussine Louzi, Ali Zinebi, Karim Moudden, Mohamed Elbaaj [Case series] - Perturbations biologiques au cours du paludisme: &agrave; propos de trente cas - 27 March 2017. http://www.panafrican-med-journal.com/content/article/26/174/abstract/ <b>L’infection palustre est une parasitose qui s’accompagne assez fr&eacute;quemment de perturbations h&eacute;matologiques et biochimiques. Quoique non sp&eacute;cifiques, ces signes biologiques peuvent &ecirc;tre &eacute;vocateurs du paludisme chez des patients ayant s&eacute;journ&eacute; en zone d’end&eacute;mie et pr&eacute;sentant des signes cliniques de la maladie. Nous avons essay&eacute; &agrave; travers cette &eacute;tude d’appr&eacute;cier la fr&eacute;quence de ces perturbations chez une s&eacute;rie de cas avec paludisme d’importation. Nous avons analys&eacute; la NFS, le bilan lipidique, la CRP et la LDH chez une s&eacute;rie de 30 cas de paludisme. La thrombop&eacute;nie &eacute;tait pr&eacute;sente chez 90% des cas (n=27) et l’an&eacute;mie chez 23% des cas (n=7). La CRP &eacute;tait augment&eacute;e chez tous les cas. L’hypocholest&eacute;rol&eacute;mie &eacute;tait chez 80% des cas (n=24), l’hypoHDL&eacute;mie chez 93,3% des cas (n=28), l’hypertriglyc&eacute;rid&eacute;mie chez 36,6% (n=11) et la LDH &eacute;tait &eacute;lev&eacute;e chez 53,3% des cas (n=16). Ainsi, devant une suspicion d’infection palustre avec un examen direct n&eacute;gatif, la pr&eacute;sence associ&eacute;e de ces perturbations biologiques augmenterait la probabilit&eacute; diagnostique en faveur du paludisme.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Fadwa Mekouar, Naoual El Omri [Images in medicine] - Pseudotumoral form of granulomatosis with polyangiitis - 27 March 2017. http://www.panafrican-med-journal.com/content/article/26/173/abstract/ <b>A 65-year-old woman, non-smoker presented with a two-month history of cough. She also complained of arthralgia and weight loss. The clinical examination revealed a febrile patient. The chest radiograph and the scanner revealed right upper lobar mass, with spiculated contours (A, B). Biology showed an inflammatory syndrome. Polymerase chain reaction for Mycobacterium tuberculosis and tumor markers was negative. A lung biopsy showed non caseous granulomatous vasculitis. The cytoplasmic antineutrophil cytoplasmic antibody (cANCA/PR3/ANCA) showed a positive result; Wegener's granulomatosis was finally confirmed. The patient was treated with prednisone and cyclophosphamide with favorable outcome. A follow-up chest radiography two weeks after treatment showed resolving pulmonary lesions (C).</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Jihane Smaali, Youssef Sekkach [Images in medicine] - Ad&eacute;nocarcinome ano-r&eacute;ctal apr&egrave;s traitement par Infliximab pour une maladie de Crohn fistulisante - 24 March 2017. http://www.panafrican-med-journal.com/content/article/26/172/abstract/ <b>Patient de 35 ans, suivi pour une maladie de Crohn anop&eacute;rin&eacute;ale trait&eacute;e par corticoides puis, 6-mercaptopurine et azathioprine, avec une r&eacute;mission prolong&eacute;e. Durant l'&eacute;volution, le patient pr&eacute;senta une alt&eacute;ration rapide de l'&eacute;tat g&eacute;n&eacute;ral. Les investigations morphologiques &eacute;taient en faveur d'une pouss&eacute;e grave dans le cadre de sa maladie. Le diagnostic d'une maladie de Crohn ano-p&eacute;rin&eacute;ale dans sa forme fistulisante &eacute;tait pos&eacute; (A), et le patient avait b&eacute;n&eacute;fici&eacute;e d'une antibioth&eacute;rapie &agrave; large spectre, une alimentation parent&eacute;rale, une mise au repos du tube digestif et une colostomie de d&eacute;charge ayant permis une am&eacute;lioration clinique, puis la mise sous anti-TNF alpha type Infliximab &agrave; la dose de 5mg/kg (S0, S2, S4 et S8). L'&eacute;volution s'est compliqu&eacute;e de l'apparition progressive d'une l&eacute;sion anale d'allure tumorale (B) augmentant progressivement de volume avec alt&eacute;ration rapide de l'&eacute;tat g&eacute;n&eacute;ral. Une nouvelle imagerie abdominale (IRM) permettait d'individualiser un processus ano-r&eacute;ctal d'allure tumorale, immunohistochimiquement en faveur d'un ad&eacute;nocarcinome ano-rectal infiltrant. 4,3% de cas d'ad&eacute;nocarcinome ano-rectaux sur maladie de crohn fitulisante ont &eacute;t&eacute; rapport&eacute;s. A la lumi&egrave;re de cette illustration, nous accordons une attention tr&egrave;s particuli&egrave;re sur la possible transformation maligne chez tout patient trait&eacute; par Infliximab pour une maladie de Crohn fistulisante, et nous insistons sur une &eacute;valuation histologique de toute l&eacute;sion anale ou p&eacute;rin&eacute;ale avant traitement par anti-TNF. Le diagnostic reste difficile en raison des ph&eacute;nom&egrave;nes inflammatoires et / ou des st&eacute;noses concomitantes; Les moyens d'imagerie, y compris les examens TDM et l'IRM semblent avoir une faible sensibilit&eacute; dans la d&eacute;tection du cancer.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Lombosciatique r&eacute;v&eacute;lant un &eacute;pendymome intram&eacute;dullaire - 24 March 2017. http://www.panafrican-med-journal.com/content/article/26/171/abstract/ <b>We here report the case of a 68-year old female patient presenting with inflammatory poorly systematized bilateral lumbosciatica, without vesico-sphincteric disorders or associated general symptoms evolving for 4 months. Physical exam showed gait with little steps with trunk anteflexion, disappearance of lumbar lordosis, lumbar spine stiffness, positive bilateral Las&egrave;gue's test and hyperactive osteotendinous reflexes in lower limbs without motor and sensory deficit or saddle block anesthesia. Laboratory tests did not show any inflammatory syndrome. Lumbar spine X-rays were normal. Given the abnormal clinical picture, spinal MRI was performed which showed oval intracanalar mass behind L4 vertebral body, measuring 3 cm height with discrete hypersignal on T1 (A) and with hypersignal on T2 (B), enhanced after gadolinium administration and containing superior polar cystic component. The patient underwent tumor resection in orthopaedics. Histological examination of the surgical specimen revealed myxopapillary ependymomas.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Maguy Ngongo Omoy, Didier Munganga Ngoy, Eric Kasamba Ilunga, DonDieu Bafwafwa Ntumba , Gray Kanteng a Wakamb, Stanis Wembonyama Okitosho, Oscar Luboya Numbi [Case report] - Le diab&egrave;te sucr&eacute; de type I chez l’enfant de moins de 5 ans: &agrave; propos d’une observation aux cliniques universitaires de Lubumbashi et revue de la litt&eacute;rature - 24 March 2017. http://www.panafrican-med-journal.com/content/article/26/170/abstract/ <b>Le diab&egrave;te sucr&eacute; de type I (DT1) est en &eacute;volution dans le monde, affecte de plus en plusles enfants de moins de 5ans. Sa prise en charge est tr&egrave;sd&eacute;licate plus l’enfant est petit. Si non diagnostiqu&eacute; &agrave; temps ou mal prise en charge, le d&eacute;c&egrave;s arrive rapidement de suite des complications aigues s&eacute;v&egrave;res. Il y a lieu d’&ecirc;tre regardant, de sensibiliser la population et d’adapter nos syst&egrave;mes de sant&eacute;, face &agrave; cette nouvelle &eacute;pid&eacute;mie des maladies non transmissibles en Afrique, d’en cr&eacute;er des registres pour en &eacute;tudier les caract&eacute;ristiques&eacute;pid&eacute;miologiques dans nos milieux. L’objectif &eacute;tait de montrer l’&eacute;vidence et la gravit&eacute; de la survenue de plus en plus pr&eacute;coce de l’&acirc;ge de diagnostic du DT1 de l’enfant dans notre milieu.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Asmaa Chehal, Rosabel Lobo, Asmaa Naim, Ignacio Azinovic [Case report] - Am&eacute;loblastome du sinus maxillaire trait&eacute; par radioth&eacute;rapie - 24 March 2017. http://www.panafrican-med-journal.com/content/article/26/169/abstract/ <b>L’am&eacute;loblastome est une tumeur odontog&egrave;ne b&eacute;nigne &agrave; caract&egrave;re agressif qui n&eacute;cessite un diagnostic pr&eacute;coce et un traitement ad&eacute;quat. Son site habituel est la mandibule et la chirurgie radicale demeure le traitement de r&eacute;f&eacute;rence. Nous rapportons le cas d’un am&eacute;loblastome &agrave; localisation sinusienne maxillaire localement tr&egrave;s avanc&eacute; que nous avons trait&eacute; par radioth&eacute;rapie conformationnelle avec modulation d’intensit&eacute;. L’&eacute;volution a &eacute;t&eacute; marqu&eacute;e par une r&eacute;mission de la maladie avec un recul de 24 mois. La localisation maxillaire d’un am&eacute;loblastome est rarement d&eacute;crite, diagnostiqu&eacute;e &agrave; un stade tardif le plus souvent o&ugrave; la chirurgie optimale est impossible. A travers cette observation nous d&eacute;montrons que la radioth&eacute;rapie constitue une v&eacute;ritable alternative th&eacute;rapeutique dans les formes &eacute;volu&eacute;es et inop&eacute;rables des am&eacute;loblastomes.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hicham Bousbaa, Mohammed Ouahidi, Mourad Bennani, Tawfik Cherrad, Hassan Zejjari, El Houssine Kasmaoui, Jamal Louaste, Khalid Rachid, Laarbi Amhajji [Case report] - A propos d’une cause inhabituelle de talalgie - 24 March 2017. http://www.panafrican-med-journal.com/content/article/26/168/abstract/ <b>Une talalgie est l'une des sympt&ocirc;mes les plus courants du pied. LeLipome intra-osseuse est l'un des plus rares tumeurs osseuses trouv&eacute;es dans le calcan&eacute;um. Nous rapportons une observation d’un patient s’est pr&eacute;sent&eacute; &agrave; la consultation avec des douleurs intermittentes chroniques et spontan&eacute;es du talon, chez qui les investigations cliniques et radiologiques ont retenu un diagnostic d’un lipome du calcan&eacute;um.Le but de cet article est de sensibiliser les cliniciens &agrave; l'existence de cette l&eacute;sion inhabituelle.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Alhadji Ahmadou Tounkara, Abdoul Mahama S&eacute;riba Coulibaly, Nouhoun Coulibaly, B&eacute;kaye Traor&eacute;, Mahamane Kalil Ma&iuml;ga [Research] - Gestion de l’anémie des patients hémodialysés chroniques : cas du Service de Néphrologie et d’hémodialyse du CHU du Point G au Mali - 23 March 2017. http://www.panafrican-med-journal.com/content/article/26/167/abstract/ <b>INTRODUCTION: L’an&eacute;mie est une complication fr&eacute;quente de l’IRC couramment retrouv&eacute;e chez les patients h&eacute;modialys&eacute;s chroniques. Chez ces derniers, la prise en charge est principalement bas&eacute;e sur l’administration d’&eacute;rythropo&iuml;&eacute;tine et la suppl&eacute;mentation en fer. Le but de ce travail &eacute;tait d’&eacute;valuer la prise en charge de l’an&eacute;mie des h&eacute;modialys&eacute;s chroniques dans le service de N&eacute;phrologie du CHU du Point G. METHODES: il s’agissait d’une &eacute;tude transversale r&eacute;alis&eacute;e dans ledit service du 1er au 31 Ao&ucirc;t 2016. RESULTATS: au total, 63 patients sur 174 participants avaient &eacute;t&eacute; retenus, 34 hommes et 29 femmes avec un sex-ratio &agrave; 1,17 en faveur des hommes. L’&acirc;ge moyen des patients &eacute;tait de 48,79 ans ±11,59, la dur&eacute;e moyenne en h&eacute;modialyse &eacute;tait de 3,77ans±2,6. La fr&eacute;quence hospitali&egrave;re de l’an&eacute;mie chez nos dialys&eacute;s &eacute;tait de 84,12%. La transfusion sanguine &eacute;tait retrouv&eacute;e chez 92,1%, avec une moyenne annuelle de 5,81poches±5,91. La suppl&eacute;mentation martiale &eacute;tait not&eacute;e dans 87,3% des cas. Les moyennes respectives de ferritine et de CST &eacute;taient de 1245 ng/ml±629,52 et 46,16%±19,12. L’administration occasionnelle d’EPO &agrave; des doses n’exc&eacute;dant pas les 4000UI &eacute;tait rapport&eacute;e par 79,4% des patients. La principale difficult&eacute; pour l’utilisation de l’EPO &eacute;tait le co&ucirc;t (74,6%). L’infection au VHC touchait 60,1% des patients ayant r&eacute;alis&eacute; le dit bilan. CONCLUSION: la gestion de l’an&eacute;mie des dialys&eacute;s chroniques doit &ecirc;tre int&eacute;gr&eacute;e dans un cadre politique nationale de la sant&eacute;.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zafindrasoa Domoina Rakotovao-Ravahatra, Fidiniaina Mamy Randriatsarafara, Sa&iuml;da Rasoanandrasana, L&eacute;a Raverohanta, Andriamiadana Luc Rakotovao [Research] - Ph&eacute;notypes de r&eacute;sistance des souches d’Escherichia coli responsables d’infection urinaire au laboratoire du Centre Hospitalo-Universitaire de Befelatanana Antananarivo - 22 March 2017. http://www.panafrican-med-journal.com/content/article/26/166/abstract/ <b>INTRODUCTION: l’infection urinaire &agrave; Escherichia coli est fr&eacute;quente en milieu hospitalier. Cette &eacute;tude se propose de d&eacute;crire les diff&eacute;rents ph&eacute;notypes de r&eacute;sistance des souches d’Escherichia coli afin de surveiller leur &eacute;mergence. METHODES: il s’agit d’une &eacute;tude r&eacute;trospective de type descriptif de 102 souches d’Escherchia coli responsables d’infection urinaire sur une p&eacute;riode allant du mois de Janvier 2014 au mois d’Octobre 2016 au Laboratoire du Centre Hospitalo-Universitaire Befelatanana Antananarivo. RESULTATS: la r&eacute;sistance aux b&eacute;ta-lactamines a identifi&eacute; des p&eacute;nicillinases de haut niveau 50% (n=51), des Escherichia coli s&eacute;cr&eacute;trices de B&eacute;ta-Lactamase &agrave; Spectre Etendu E-BLSE 22,5% (n=23), des c&eacute;phalosporinases de haut niveau 14,7% (n=15), des p&eacute;nicillinases de bas niveau 5,9% (n=6), des souches sauvages 5,9% (n=6) et une souche d’Escherichia coli hautement r&eacute;sistante &eacute;mergente. La r&eacute;sistance aux aminosides a concern&eacute; 58 (56,9%) ph&eacute;notypes sauvages, 29 (28,4%) souches sensibles &agrave; l’amikacine et 15 (14,7%) r&eacute;sistants &agrave; tous les aminosides. La r&eacute;sistance aux fluoroquinolones a identifi&eacute;e 52 (51%) souches sauvages, 9 (8,8%) souches sensibles &agrave; la ciprofloxacine et 41 (40,2%) r&eacute;sistantes &agrave; tous les fluoroquinolones. Les femmes (25, 7%) (p= 0,25, NS), les sujets de plus de 60 ans (38,7%) (p=0,02), les sujets hospitalis&eacute;s dans le service de n&eacute;phrologie (53,8%) (p=0,04), ayant pr&eacute;sent&eacute; des troubles urinaires et r&eacute;naux (29, 7%) (p= 0,2, NS), ont &eacute;t&eacute; les plus affect&eacute;s par les E-BLSE. CONCLUSION: la multi-r&eacute;sistance &eacute;lev&eacute;e des souches d’Escherichia coli interpelle sur une r&eacute;vision du traitement empirique des infections urinaires.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ahmadou Musa Jingi, Liliane Mfeukeu Kuate, Jean Jacques Noubiap [Case report] - A case management of hypertension in the elderlyin sub-Sahara Africa: lessons from Granny - 22 March 2017. http://www.panafrican-med-journal.com/content/article/26/165/abstract/ <b>Management of chronic disease conditions in the elderly is challenging. They usually have many co-morbidities requiring multiple drug regimens, and memory or cognitive problems that can interfere with management. Also, they sometimes have a degree of social problems as they might often live alone, and thereby cater for their daily activities with minimal assistance. Multiple drug use combined with their fragile health predispose them to adverse drug reactions, drug-drug interactions, and direct drug toxicity from overdosing. We report and discuss the lessons learnt from the case of an elderly woman in an urban setting in sub-Saharan Africa who presented with problems of drug dosing, adverse drug effect, and drug-drug interaction that might prove useful in the future management of hypertension with angiotensin converting enzyme inhibitors.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Amira Omrane, Awatef Kreim, Mohamed Adn&egrave;ne Henchi, Selma Kammoun, Leila Bessadi, Charfeddine Amri, Taoufik Khalfallh, Lamia Bouzgarrou [Research] - Asthme professionnel indemnis&eacute; dans le centre tunisien: &eacute;tude transversale sur huit ans - 21 March 2017. http://www.panafrican-med-journal.com/content/article/26/164/abstract/ <b>INTRODUCTION: les objectifs &eacute;taient de dresser le profil &eacute;pid&eacute;miologique des patients indemnis&eacute;s pour asthme professionnel dans le centre tunisien, identifier leurs caract&eacute;ristiques professionnelles et &eacute;valuer les pratiques d’indemnisation de cette maladie professionnelle. METHODES: &eacute;tude exhaustive r&eacute;trospective, men&eacute;e sur une p&eacute;riode de huit ans, &agrave; propos des cas d'asthme professionnel reconnus et indemnis&eacute;s au centre tunisien par les deux seules commissions m&eacute;dicales habilit&eacute;es &agrave; fixer le taux d’incapacit&eacute; partielle permanente aux victimes des accidents de travail et des maladies professionnelles dans les sept gouvernorats du centre. RESULTATS: au total, 129 travailleurs, d’&acirc;ge moyen &eacute;gal &agrave; 40,6 ± 7,75 ans &eacute;taient indemnis&eacute;s pour asthme professionnel durant la p&eacute;riode d’&eacute;tude. Le sexe ratio &eacute;tait de 0,66. Les agents &eacute;tiologiques les plus incrimin&eacute;s ont &eacute;t&eacute; les poussi&egrave;res v&eacute;g&eacute;tales textiles (75,2%), les poussi&egrave;res de bois, la farine et les isocyanates. Une hyperr&eacute;activit&eacute; bronchique non sp&eacute;cifique a &eacute;t&eacute; retrouv&eacute;e dans 38%, un taux &eacute;lev&eacute; d’IgE dans 14% et des prick tests positifs dans 10,9% des cas. Le taux moyen d’incapacit&eacute; partielle permanente &eacute;tait de 25,6±14,2%. Ce taux &eacute;tait corr&eacute;l&eacute;, selon l’analyse analytique, &agrave; l’&acirc;ge du patient et &agrave; la commission m&eacute;dicale ayant fix&eacute; ce taux. CONCLUSION: l’&eacute;tude des cas d’asthme professionnels indemnis&eacute;s, apportent des donn&eacute;es pertinentes &agrave; propos des caract&eacute;ristiques &eacute;pid&eacute;miologiques et cliniques des patients atteints et des pratiques des comit&eacute;s notamment, en terme d’application du bar&egrave;me indicatif, mais ne permet pas l'appr&eacute;ciation de la pr&eacute;valence, souvent sous-estim&eacute;e, de cette pathologie.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hicham Attifi, Abdelhamid Messary [Images in medicine] - Maladie de Basedow r&eacute;v&eacute;lant une tuberculose thyro&iuml;dienne - 21 March 2017. http://www.panafrican-med-journal.com/content/article/26/163/abstract/ <b>La tuberculose thyro&iuml;dienne est rare m&ecirc;me dans les pays end&eacute;miques tel le Maroc et dont le diagnostic peut poser probl&egrave;me en absence d’&eacute;l&eacute;ments d’orientation cliniques ou biologiques. Elle est exceptionnellement r&eacute;v&eacute;l&eacute;e par une maladie de Basedow. Patiente &acirc;g&eacute;e de 48 ans, suivie au service d’endocrinologie pour maladie de Basedow, ayant re&ccedil;u un traitement &agrave; base d’antithyro&iuml;diens de synth&egrave;se et adress&eacute;e au service d’otorhinolaryngologie pour rechute &agrave; l’arr&ecirc;t du traitement en vue d’une cure chirurgicale. L’examen physique a objectiv&eacute; une thyro&iuml;de augment&eacute;e de taille avec pr&eacute;sence d’un nodule basilobaire gauche ferme, d’un diam&egrave;tre de 2 cm. La naso-fibroscopie a montr&eacute; des cordes vocales mobiles. Les aires ganglionnaires &eacute;taient libres. L'&eacute;chographie cervicale a objectiv&eacute; des nodules hypo&eacute;chog&egrave;nes et hyper&eacute;chog&egrave;nes au d&eacute;pend des 2 lobes. Le bilan hormonal a r&eacute;v&eacute;l&eacute; un profil d'une hyperthyro&iuml;die p&eacute;riph&eacute;rique avec une TSH effondr&eacute;e. La radiographie thoracique ne montrait pas de l&eacute;sions m&eacute;diastino-pulmonaires. Plusieurs pathologies peuvent s'associer exceptionnellement &agrave; une maladie de Basedow tel qu'un lymphome, une tuberculose ou un carcinome. La patiente a b&eacute;n&eacute;fici&eacute; d'une thyro&iuml;dectomie totale. L'examen anatomopathologique a objectiv&eacute; un parenchyme thyro&iuml;dien hyperplasique avec pr&eacute;sence en plusieurs endroits de granulomes &eacute;pith&eacute;lio&iuml;des et giganto-cellulaires avec des foyers de n&eacute;crose cas&eacute;euse. Le diagnostic de tuberculose thyro&iuml;dienne a &eacute;t&eacute; pos&eacute;. Elle n'y avait pas d'autres localisations tuberculeuses. La patiente a re&ccedil;u un traitement antituberculeux pour une dur&eacute;e totale de 12 mois associ&eacute; &agrave; une hormonoth&eacute;rapie substitutive &agrave; vie. L'&eacute;volution &eacute;tait favorable sans notion de r&eacute;cidive. Le recul &eacute;tait de 2 ans.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Asmaa Naim, Nadia Benchekroune, Zineb Bouchbika, Nezha Taoufiq,Hassan Jouhadi, Souha Sahraoui, Abdelatif Benider [Case report] - Liposarcome myxoide sous cutan&eacute; - 21 March 2017. http://www.panafrican-med-journal.com/content/article/26/162/abstract/ <b>Bien que les liposarcomes myxo&iuml;des (LSM) soient la forme la plus fr&eacute;quente des sarcomes des tissus mous chez l’adulte, leur localisation primaire superficielle est rare. Ainsi, on individualise deux formes de sarcomes: superficiel et profond qui sont distincts non seulement par leur si&egrave;ge et leur fr&eacute;quence mais aussi par leur pronostic qui est relativement meilleur dans les sarcomes superficiels. Nous rapportons une observation d’un liposarcome sous cutan&eacute; de la cuisse droite. Le diagnostic a &eacute;t&eacute; confirm&eacute; histologiquement apr&egrave;s une ann&eacute;e d’&eacute;volution de la symptomatologie clinique. La prise en charge a consist&eacute; en une ex&eacute;r&egrave;se large suivie d’une radioth&eacute;rapie locor&eacute;gionale. L’&eacute;volution a &eacute;t&eacute; marqu&eacute;e par une r&eacute;mission compl&egrave;te maintenue apr&egrave;s un recul de 32 mois. Nous soulignons, par la pr&eacute;sente observation que la raret&eacute; des sarcomes superficiels peut &ecirc;tre source de retard diagnostic, ce qui pourrait compromettre leur pronostic.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Younoussa Keita, Ahmed Tall Lemrabott, Assane Sylla, Babacar Niang, El Hadji Fary Ka, Ch&eacute;rif Mohamed Dial, Aliou Abdoulaye Ndongo, Amadou Sow, Claude Moreira, Abdou Niang, Ousmane Ndiaye, Boucar Diouf, Mouhamadou Gu&eacute;laye Sall [Research] - Le syndrome n&eacute;phrotique idiopathique (SNI) de l’enfant &agrave; Dakar: &agrave; propos de 40 cas - 21 March 2017. http://www.panafrican-med-journal.com/content/article/26/161/abstract/ <b>INTRODUCTION: l’objectif de ce travail &eacute;tait d’analyser les caract&eacute;ristiques diagnostiques, th&eacute;rapeutiques et &eacute;volutives de l’enfant atteint de n&eacute;phrose dans un service de p&eacute;diatrie de Dakar. METHODES: l’&eacute;tude &eacute;tait r&eacute;alis&eacute;e au service de p&eacute;diatrie de l’h&ocirc;pital Aristide Le Dantec. Il s’agissait d’une &eacute;tude r&eacute;trospective sur une p&eacute;riode de 03 ans allant du 1<sup>er</sup> janvier 2012 au 31 d&eacute;cembre 2014. Ont &eacute;t&eacute; inclus tous les patients &acirc;g&eacute;s de 02 ans &agrave; 12 ans pr&eacute;sentant un tableau de Syndrome n&eacute;phrotique idiopathique. RESULTATS: quarante cas de n&eacute;phrose &eacute;taient collig&eacute;s soit une pr&eacute;valence de 23% parmi les n&eacute;phropathies prises en charge dans le service. L’&acirc;ge moyen &eacute;tait de 7,11± 3,14 ans. Le syndrome n&eacute;phrotique &eacute;tait pur chez 72,5% (n=29) des patients. Les œd&egrave;mes des membres inf&eacute;rieurs &eacute;taient pr&eacute;sents chez 100% des patients, l’oligurie dans 55% (n=22) et l’HTA dans 5% (n=2) des cas. La prot&eacute;inurie moyenne &eacute;tait de 145,05 ± 85,54 mg/kg/24heures. La protid&eacute;mie moyenne &eacute;tait de 46,42 ±7,88 g/L et l’albumin&eacute;mie moyenne de 17,90 ± 7,15 g/L. Trente-neuf patients avaient re&ccedil;u une corticoth&eacute;rapie &agrave; base de prednisone. La corticosensibilit&eacute; &eacute;tait retenue chez 77% (n=30) des patients et la corticor&eacute;sistance chez 13% (n=5) des cas. Le facteur de mauvaise r&eacute;ponse &agrave; la corticoth&eacute;rapie &eacute;tait un niveau de prot&eacute;inurie initiale sup&eacute;rieure &agrave; 150 mg/kg/jour (p = 0,024). La biopsie r&eacute;nale &eacute;tait r&eacute;alis&eacute;e chez 18% (n=7) des patients et retrouvait dans 57,2% (n=4) des cas une hyalinose segmentaire et focale. Le cyclophosphamide et l’azathioprine &eacute;taient associ&eacute;s aux cortico&iuml;des dans 10% (n=4) des cas chacun. Le taux de r&eacute;mission globale &eacute;tait de 89,8%. L’&eacute;volution vers l’insuffisance r&eacute;nale chronique &eacute;tait not&eacute;e chez trois (03) des patients. CONCLUSION: la n&eacute;phrose repr&eacute;sentait pr&egrave;s du quart des n&eacute;phropathies prises en charge dans notre service. Le taux de r&eacute;mission globale &eacute;tait &eacute;lev&eacute;. Le seul facteur de mauvaise r&eacute;ponse &agrave; la corticoth&eacute;rapie &eacute;tait le niveau de prot&eacute;inurie initiale &eacute;lev&eacute;e. En cas d’indication de la biopsie r&eacute;nale chez nos patients, la HSF &eacute;tait la l&eacute;sion la plus fr&eacute;quemment retrouv&eacute;e.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Allan Mwesiga [Obituary] - Obituary: Dr. Eugene Garfield (1925-2017) - 20 March 2017. http://www.panafrican-med-journal.com/content/article/26/160/abstract/ <b>It is with great sadness that we announce the death of Dr. Eugene Garfield. Dr. Garfield died on Sunday 26 February 2017. He was 91. Dr. Garfield is credited as the inventor of the journal impact factor. He founded the Institute for Scientific Information (ISI) in 1955. The ISI’s Scientific Citation Index (SCI),which was made available electronically as the Web of Science, and other citation index databases have helped link the body of scientific literature and provide an efficient means for scientists to look up search existing scientific literature. In 1982, the Thomson Reuters Corporation acquired the SCI. Clarivate Analytics has owned the division since 2016. Dr. Garfield also founded two publications “Current Contents” and “The Scientist” to compile news and information for scientists and researchers. Dr. Garfield was awarded a PhD in structural linguistics from the University of Pennsylvania in 1961. He is survived by his wife, Meher, three sons, a daughter, a step-daughter, two granddaughters, and two great-grandchildren.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Olugbenga-Bello Adenike, Jimoh Adejumoke, Oke Olufunmi, Oladejo Ridwan [Research] - Maternal characteristics and immunization status of children in North Central of Nigeria - 20 March 2017. http://www.panafrican-med-journal.com/content/article/26/159/abstract/ <b>INTRODUCTION: routine immunization coverage in Nigeria is one of the lowest national coverage rates in the world. The objective of this study was to compare the mother’ characteristics and the child’s Immunization status in some selected rural and urban communities in the North central part of Nigeria. METHODS: a descriptive cross sectional study, using a multistage sampling technique to select 600 respondent women with an index child between 0-12 months. RESULTS: mean age of rural respondents was 31.40±7.21 years and 32.72+6.77 years among urban respondents, though there was no statistically significant difference in age between the 2 locations (p-0.762). One hundred and ninetyseven (65.7%) and 241(80.3%) of rural and urban respondents respectively were aware of immunization, the difference was statistically significant (p-0.016). knowledge in urban areas was better than among rural respondents. There was statistically significant association between respondents age, employment status, mothers’ educational status and the child’s immunization status (P<0.05), while variables like parity, age at marriage, marital status, No of children, household income and place of index were not statistically associated with immunization status as P>0.05. More than half 179(59.7%) of rural and 207(69.0%) of urban had good practice of immunization though the difference was not statistically significant (p-0.165). CONCLUSION: the immunization coverage in urban community was better than that of the rural community. The result of this study has clearly indicated that mothers in Nigeria have improved on taking their children for immunization in both rural and urban area compared to previous reports.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Isolated muscular tuberculosis: unusual location of the Koch bacillus - 16 March 2017. http://www.panafrican-med-journal.com/content/article/26/158/abstract/ <b>A 23-year-old female patient with a family history of pulmonary tuberculosis and tuberculous spondylodiscitis was hospitalized for swelling of the left anterior-external surface of the left thigh, (A) with altered general status. Biology has shown a biological inflammatory syndrome. The ultrasound showed a collection opposite the great trochanter fusing towards the lodge of the gluteus muscle and forward towards the terminal part of the common chief ischio-psoas. MRI of the hips revealed an intra-muscular collection of the antero-lateral side of the thigh root, taking contrast in the periphery, involving the quadriceps muscle and tensor of facia lata, (B and C). The biopsy of the collection under ultrasound guidance brought back 30 cc of casein. The diagnosis of tuberculosis of the quadriceps muscle and tensor of the facia lata was based on the positivity of the tuberculin skin test, (D), the positivity of the PCR for Mycobacterium tuberculosis in the puncture fluid and histology showing multiple epithelioid granulomas centered by caseous necrosis. There were no other tuberculous sites. The patient was treated with antituberculosis drugs for 12 months with good progress. Muscular tuberculosis (MT) is a rare localization of the disease (0.01 to 2%). Its occurrence without associated bone involvement is exceptional. MT often simulates a muscular tumor. MRI contributes to the improvement of the sensitivity of the diagnosis of MT because it allows to specify the extent of the muscular lesions and to orient the site of the muscular biopsy. The diagnosis is essentially based on histology.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hilal Abboud, Ahmed Elhankari [Images in medicine] - A rare case of non-contiguous multifocal spinal tuberculosis - 16 March 2017. http://www.panafrican-med-journal.com/content/article/26/157/abstract/ <b>Spinal tuberculosis is defined as an Infection of the intervertebral disc and the adjacent vertebral bodies, caused by Mycobacterium Tuberculosis (MT). It represents 40% of all osteo-articular spondylitis. It is a common disease in Africa, and recently there has been an upsurge in developed countries in relation to Human Immunodeficiency Virus infection. The early management is associated to a good outcome, and the diagnosis relies on imaging and disco-vertebral biopsy, it is characterized by a low amount MT in lesions and involves the slow multiplication MT. The treatment is based on antibacillary associated to surgical treatment in case of neurological deficit, and presence of vertebral column deformities. We report a rare case of a 46 years old patient, treated 3 years ago for pulmonary tuberculosis, who consults for diffuse back pain, the clinical examination finds a conscious patient, with a diffuse spinal syndrome, without neurological deficit or sphincter disorders. The radiological assessment shows a non contiguous multifocal spinal tuberculosis interesting the cervicodorsal and thoracolumbar junction.The patient underwent a vertebral biopsy, the histological examination confirms the spinal tuberculosis. He was proposed to surgical treatment to prevent the kyphosis progression.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Faten Limaiem, Saadia Bouraoui [Images in medicine] - Cyclopia: the one-eyed fetus - 16 March 2017. http://www.panafrican-med-journal.com/content/article/26/156/abstract/ <b>A 36 year-old female patient gravida 2 para 1, with no particular past medical history consulted her gynecologist at 14 weeks' gestation for pelvic pain. Her first pregnancy was uneventful and she did not take any specific drugs prior or during her pregnancy. Consanguinity and hereditary diseases were denied. Ultrasonography revealed a retention image measuring 67,2 mm with no cardiac pulsations (A). A male cyclopean fetus was delivered by induced labour. The fetus weighed 13,5 g and the placenta 45,4 g. On examination, the fetus was monophtalmic with completely fused eyes (B). In the face was a central proboscis located above the single orbital cavity (B). It had a rhombic form presenting with two lateral commissures and one caruncle at the inferior point of union. There was one lacrimal punctum in the midline and no median cleft. The nasal structures were absent. The upper lip looked normal with both, philtrum and tuberculum labii superioris. The lower lip and the mandible were normal. The brain and the rest of the organs were macerated. The examination of the placenta did not disclose any anomaly. Genetic analysis was not performed.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hicham Bousbaa, Laarbi Amhajji [Images in medicine] - A propos d’une observation de tumeur glomique de l’index - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/155/abstract/ <b>La tumeur glomique (TG) individualis&eacute;e par Masson est une tumeur b&eacute;nigne d&eacute;velopp&eacute;e aux d&eacute;pend du glomus sous cutan&eacute;. La glomus est l'organe de r&eacute;gularisation de la microcirculation capillaire et thermique. Elles repr&eacute;sentent 1 &agrave; 5 % des tumeurs des parties molles de la main. La localisation est surtout sous ungu&eacute;ale (65%) mais aussi pulpaire et p&eacute;ri ungu&eacute;ale. Il s'agit d'une l&eacute;sion d'&eacute;volution lente et de petite taille (en moyenne 3mm). La douleur est fulgurante spontan&eacute;e et/ou provoqu&eacute;e par le simple contact ou effleurement. Elle est exacerb&eacute;e par le froid. Un homme &acirc;g&eacute; de 39 ans, droitier, technicien en r&eacute;paration &eacute;lectronique, sans ant&eacute;c&eacute;dents pathologiques particuliers ; se pr&eacute;sentant avec une douleur paroxystique et exquise de l'index de la main droit, &eacute;voluant depuis deux ans. &Agrave; l'examen on note une zone pulpaire tr&egrave;s sensible &agrave; la pression, avec absence de signes objectifs locaux. La radiographie standard r&eacute;alis&eacute;e n'objective pas de l&eacute;sions osseuses. L'IRM datant de 1 an &eacute;tait normale. Une deuxi&egrave;me IRM dans un intervalle d'un an a &eacute;t&eacute; r&eacute;alis&eacute;e, et a montr&eacute; un aspect &eacute;vocateur d'une tumeur glomique sous forme d'un hyposignal en T1 (A), suivi d'un hypersignal en T2 (B) Une ex&eacute;r&egrave;se chirurgicale par voie pulpaire direct de la tumeur a &eacute;t&eacute; r&eacute;alis&eacute;, l'aspect per op&eacute;ratoire &eacute;tait tr&egrave;s &eacute;vocateur : la tumeur de 3 mm d'aspect bleut&eacute; &eacute;tait bien limit&eacute;e encapsul&eacute;e (C), et l'examen histologique de la pi&egrave;ce a confirm&eacute; le diagnostic. Les suites op&eacute;ratoires ont &eacute;t&eacute; simples, apr&egrave;s 1 an de recul, le patient est asymptomatique. Les tumeurs glomiques sont rares, mais elles peuvent si&eacute;g&eacute;es dans tout le corps. Ce sont des malformations hamartomateuses du glomus normal. Les tumeurs peuvent &ecirc;tre non palpables parce qu'ils sont tr&egrave;s petites et profondes.Cette affection est rare, avec un si&egrave;ge de pr&eacute;dilection sous-ungu&eacute;al. La triade diagnostic classique se compose de douleur spontan&eacute;e, a la pression, et l'hypersensibilit&eacute; au froid. L'&eacute;volution est lente et le retard diagnostique est fr&eacute;quent. Les examens compl&eacute;mentaires qui ont &eacute;t&eacute; utilis&eacute;s avec un succ&egrave;s variable pour le diagnostic des TG sont: la transillumination, l'art&eacute;riographie, la thermographie, l'&eacute;chographie avec s&eacute;quence doppler, et la scintigraphie. l'IRM est consid&eacute;r&eacute; comme le test diagnostique le plus sensible. Le traitement chirurgical est curatif et la r&eacute;cidive est rare.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Diop Moustapha, Diouf Assane, Seck Said Malaob&eacute;, Lo Gora, Ka Daye, Massaly Aminata, Dieye Alassane, Fall Ndeye Maguette, Cisse-Diallo Viviane, Diallo Khardiata, Lakhe Aissatou, Fortes-D&eacute;gu&eacute;nonvo Louise, Ndour Cheikh Tidiane, Soumar&eacute; Maserigne, Seydi Moussa [Research] - Pr&eacute;valence de l’antig&egrave;ne de surface du virus de l’h&eacute;patite B et facteurs associ&eacute;s chez des militaires s&eacute;n&eacute;galais envoy&eacute;s en mission au Darfour - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/154/abstract/ <b>INTRODUCTION: au S&eacute;n&eacute;gal, 85% de la population adulte ont &eacute;t&eacute; en contact avec le virus de l’h&eacute;patite B et environ 11% sont porteurs chroniques de l’antig&egrave;ne de surface de ce virus (AgHBs). Cette infection est peu document&eacute;e dans l’arm&eacute;e s&eacute;n&eacute;galaise. L’objectif de cette &eacute;tude &eacute;tait d’&eacute;valuer la pr&eacute;valence de l’AgHBs chez des militaires s&eacute;n&eacute;galais envoy&eacute;s en mission au Darfour (Soudan) et d’identifier les facteurs associ&eacute;s. METHODES: nous avons men&eacute; une &eacute;tude transversale du 1er juillet 2014 au 31 juillet 2014 chez des militaires s&eacute;n&eacute;galais en mission au Darfour. La recherche de l’AgHBs a &eacute;t&eacute; effectu&eacute;e dans le s&eacute;rum des participants par la m&eacute;thode immunochromatographique. La recherche de facteurs associ&eacute;s a &eacute;t&eacute; r&eacute;alis&eacute;e &agrave; l’aide d’une r&eacute;gression logistique multivari&eacute;e. RESULTATS: notre &eacute;tude a port&eacute; sur 169 militaires de sexe masculin. L’&acirc;ge moyen &eacute;tait de 36,6 ans ± 9,5. Des ant&eacute;c&eacute;dents d’h&eacute;patopathie chronique au niveau familial, d’exposition sanguine et d’exposition sexuelle ont &eacute;t&eacute; retrouv&eacute;s respectivement chez 12,4% ; 24,9% et 45,6% de la population d’&eacute;tude. L’AgHBs a &eacute;t&eacute; retrouv&eacute; chez 24 participants [14,2%(IC95% = 8,9-19,5)]. Apr&egrave;s ajustement sur les facteurs de confusion potentiels, l’&acirc;ge (OR=0,9 IC95% =0,9-1,0), un niveau d’&eacute;tude universitaire (OR= 9,5 IC95% =1,3 – 67,1) et l’exposition sexuelle (OR=3,3; IC95% =1,0 – 10,3) &eacute;taient apparus associ&eacute;s de fa&ccedil;on ind&eacute;pendante &agrave; l’h&eacute;patite B. CONCLUSION: notre &eacute;tude retrouve une pr&eacute;valence &eacute;lev&eacute;e de l’AgHBs et souligne la n&eacute;cessit&eacute; d’une &eacute;valuation plus pouss&eacute;e de l’h&eacute;patite B chez cette population.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khalid Chakour, Mohamed El Faiz Chaoui [Review] - Traitement chirurgical des m&eacute;tastases osseuses rachidiennes - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/153/abstract/ <b>La chirurgie de la m&eacute;tastase est une chirurgie palliative le plus souvent, surtout au niveau du rachis de par sa localisation anatomique. Cette chirurgie doit &ecirc;tre bien pr&eacute;par&eacute;e pour que les suites soient simples et que le traitement adjuvant soit fait dans les meilleurs d&eacute;lais. La strat&eacute;gie th&eacute;rapeutique doit &ecirc;tre syst&eacute;matiquement prise en r&eacute;union de concertation pluridisciplinaire (RCP). Le principal risque de la localisation rachidienne est neurologique, c'est pourquoi cette chirurgie doit &ecirc;tre pr&eacute;ventive le plus souvent. Elle a pour objectif principal d'am&eacute;liorer la qualit&eacute; de vie.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Bouchra Habibi, Leila Achachi, Sohaib Hayoun, Mohammed Raoufi, Laila Herrak, Mustapha El Ftouh [Case series] - La prise en charge du pneumothorax spontan&eacute;: &agrave; propos de 138 cas - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/152/abstract/ <b>Le pneumothorax est d&eacute;finit par la pr&eacute;sence d’air dans la cavit&eacute; pleurale. L’objectif de notre &eacute;tude r&eacute;trospective du pneumothorax spontan&eacute;s au servie de pneumologie &agrave; l’h&ocirc;pital Ibn Sina rabat (2009-2011) est de d&eacute;terminer le profil &eacute;pid&eacute;miologique, clinique, radiologique, th&eacute;rapeutique et &eacute;volutif. Il s’agit de 138 patients: 128 hommes et 10 femmes (17 &agrave; 83 ans), un &acirc;ge moyen de 44,5 +/- 17,4 ans; sexe ratio 12/8. Le tabagisme est not&eacute; chez 81,2%. La symptomatologie clinique est la douleur thoracique (92%), la dyspn&eacute;e (60%). Et sur la radiographie thoracique: on trouve un PNO (pneumothorax) unilat&eacute;ral total (110 cas); partiel (10 cas); localis&eacute; (6 cas); bilat&eacute;ral (4 cas); &agrave; droite dans 51,4% et &agrave; gauche dans 45,7%. On a recens&eacute; 70% de pneumothorax spontan&eacute;s primitifs et 30% de PNO secondaire &agrave; (BPCO 44%, et tuberculose pulmonaire 39%). La prise en charge initiale est l’hospitalisation de tous les patients : le drainage thoracique (95%), l’exsufflation &agrave; l’aiguille (1%). Le repos et l’O2 (4%). Le retour du poumon &agrave; la paroi a &eacute;t&eacute; obtenu avant 10 jours chez 63%. L’&eacute;volution est favorable chez 89%. Et les complications imm&eacute;diates: l’emphys&egrave;me sous cutan&eacute; (5 cas); une infection (6 cas) et 3 d&eacute;c&egrave;s (arr&ecirc;t cardio-respiratoire) ; les complications &agrave; distance sont les r&eacute;cidives dans 11,6% ; une 1&egrave;re r&eacute;cidive chez 13 cas (drainage thoracique chez 11 cas et oxyg&eacute;noth&eacute;rapie chez 2 cas) et une 2&egrave;me r&eacute;cidive chez 3 cas (recours &agrave; la chirurgie). Ce travail montre l’int&eacute;r&ecirc;t du drainage thoracique et la surveillance dans la prise en charge du pneumothorax pour &eacute;viter les complications et surtout pour &eacute;viter les r&eacute;cidives avec un &eacute;ventuel recours &agrave; la chirurgie.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Fouad Nya, Abdessamad Abdou, Mehdi Bamous, Younes Moutakiallah, Noureddine Atmani, Aniss Seghrouchni, Mahdi Ait Houssa, Abdellatif Boulahya [Case report] - Pseudotumeur cardiaque r&eacute;v&eacute;lant une maladie de Beh&ccedil;et - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/151/abstract/ <b>La thrombose intracardiaque est une complication rare de la maladie de Beh&ccedil;et (MB), qui peut se pr&eacute;senter comme une tumeur intracardiaque. Sa d&eacute;couverte pr&eacute;c&egrave;de, dans la moiti&eacute; des cas, le diagnostic de MB. La mortalit&eacute; &eacute;lev&eacute;e peut &ecirc;tre en rapport avec des complications post-chirurgicales et/ou une atteinte associ&eacute;e des art&egrave;res pulmonaires. Nous rapportons l’observation d’un jeune patient de 29 ans, aux ant&eacute;c&eacute;dents d’aphtose bipolaire, qui a b&eacute;n&eacute;ficie d’une intervention chirurgicale apr&egrave;s la d&eacute;couverte d’une tumeur de l’atrium et du ventricule droits. Il s’agissait d’un thrombus &agrave; l’examen anatomopathologique et dans les suites op&eacute;ratoires nous avons diagnostiqu&eacute; une MB. L’&eacute;volution a &eacute;t&eacute; favorable sous traitement m&eacute;dical associant une corticoth&eacute;rapie, de la colchicine et des antivitamines K (AVK). La d&eacute;couverte d’une masse intracardiaque chez un sujet jeune doit faire &eacute;voquer le diagnostic de thrombus cardiaque et de maladie de Beh&ccedil;et, m&ecirc;me en l’absence de facteur ethnique ou g&eacute;ographique pr&eacute;disposant.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Gabriel Ngom, Azhar Salim Mohamed, Pape Allassane Mbaye, Mbaye Fall, Oumar Ndour, Aim&eacute; Lakh Faye, Zakaria El-Hasnaoui [Research] - Wrestling game injuries among children in Dakar: a report on 172 cases - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/150/abstract/ <b>INTRODUCTION: the objective was to report epidemiological and lesional features among children practicing wrestling as a game in Dakar, Senegal. METHODS: it was a retrospective study including all patients under 16, victims of wrestling game injuries. We studied epidemiological and lesional aspects in children: frequency of wrestling game injuries among all games, age, sex, geographic origin, place of injury, parent’s socioeconomic status, nature of the injury and location. RESULTS: wrestling game injuries represented 19.9% injuries in all games. Sex-ratio was 33.4. The most affected age group was the 6-10 years old age group. The majority of children are from suburban Dakar (64%). Injuries occurred most often at home and in the street. Most children are from low socioeconomic status (64%). Fractures predominated and were localized almost exclusively on the elbow. CONCLUSION: wrestling game injuries in Dakar occur among older children from the suburbs, living in the neighborhood of great wrestling champions’ districts of residence. Wrestling game cause injuries, consisting mostly of elbow fractures.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Diogo Carrola Gomes, Lu&iacute;sa Quaresma [Images in medicine] - Plain x-ray films in soft tissue infections - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/149/abstract/ <b>A 39-year-old male with a history of cocaine abuse presents to the emergency room with pain in the right leg and fever (39ºC) 6 days after injecting himself in the thigh with midazolam pills diluted in tap water to control symptoms of withdrawal. Physical examination revealed rubor, swelling and tenderness of the thigh without crepitation, suggestive of cellulitis. Laboratory findings consisted of a WBC of 10.700x106/L (86% Neutrophiles) and CRP of 170 mg/dL. An X-ray of the leg was performed, revealing a feathering pattern of gas within the soft tissue of the thigh indicative of gas gangrene. Intraoperatively, we found wide necrosis of the muscles and fatty tissue of the posterior thigh without substantial quantities pus. An extensive debridement was performed and penicillin and clindamycin were administered for two weeks. Cultural exams revealed the presence of aerobic (Streptococcus mitis and Streptococcus oralis) and anaerobic bacteria (Clostridium clostridioforme and Prevotella oralis). The infection was controlled after further daily debridement and the wound was closed with the assistance of a negative-pressure wound therapy device. The patient was discharged from the hospital to a physical rehabilitation facility and regained most of his functional capacity. Gas gangrene is a life-threatening condition, misdiagnosis and failure of recognition in its early stages can prove fatal. Plain X-ray films are readily available in most hospitals and can provide significant information in patients with soft tissue infections where 'time is tissue.'</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Abdelmonem Ghorbel [Images in medicine] - Traumatic auricular hematoma - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/148/abstract/ <b>Auricular hematoma is a frequent complication of blunt trauma to the auricle. These are usually caused by sports such as boxing and wrestling. Hematoma formation is within the space between perichondrium and cartilage on the anterior ear. Because the blood supply to cartilage is dependent on the perichondrium, infection and cartilaginous necrosis often complicate untreated auricular hematomas. If auricular hematoma is not treated properly, it can progress to abscess formation, chronic scarring and fibrous organization with ear deformity "cauliflower" due to a stimulation of mesenchymal cells in the perichondrion to produce a new cartilage. After incision and evacuation of the fluid, a pressure dressings is traditionally applied to prevent reaccumulation in the resultant dead space. Optimal immobilization of the skin over underlying cartilage for 7-10 days prevent the reaccumulation of fluid with subsequent thickening and fibrosis. We report a case of a 40-year-old football coach presented to the Emergency Department with a painless right ear swelling occurred after auricular trauma during training. The clinical examination showed a right fluctuant non-inflammatory swelling of the lateral face of the pinna. Otoscopy and retroauricular region were normal. The needle puncture brought a serohematic fluid and the diagnosis of auricular hematoma was made. The collection was drained via a double anterior incision under local anesthesia and a tie through dressing was used. After 10 days, the sutures and tie through dressing were removed. One year after the operation, the ear appeared almost normal.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Lykourgos Christos Alexakis [Images in medicine] - Cholera -“Rice water stools” - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/147/abstract/ <b>An adult female presented with acute watery diarrhoea and severe dehydration during a cholera outbreak in Mae La refugee camp, Thailand in 2007. Her stools had the classic appearance of cholera “rice water stools”, which is similar to water where rice was boiled. Stool are watery, greyish in colour, cloudy, with flecks of mucus, with a non offensive fish-like odour (Panels A, B, C and D from this patient). The patient was isolated, treated initially with Ringers’s lactate intravenously and then with oral rehydration solution. Tetracycline per os was given for three days according to local protocol and the patient recovered completely. A culture of stools ob-tained by rectal swab upon admission subsequently tested positive for Vibrio Cholerae, 01 Inaba serotype, which was also the cause of the outbreak. Cholera is transmitted through contami-nated food or water, can cause epidemics and may also infect travellers. Clinical spectrum ranges from asymptomatic to severe disease with massive watery diarrhoea often fatal if untreated. Treatment includes rapid fluid replacement with the WHO’s reduced osmolarity oral rehydration solution or intravenous rehydration (Ringer’s lactate) for severe cases. Antibiotics (azithromycin, erythromycin,tetracycline or ciprofloxacine) decrease disease duration.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Redouane Ahtil, Mustapha bensghir, Mohammed Meziane, Abdelhafid Houba, Abelhamid Jaafari, Salim Jaafar Lalaoui, Charki Haimeur [Case report] - Etiologie rare d’un syndrome subocclusif: polype fibrino&iuml;de inflammatoire de l’il&eacute;on, &agrave; propos d’un cas clinique - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/146/abstract/ <b>Le polype fibro&iuml;de inflammatoire (PFI) est une l&eacute;sion b&eacute;nigne rare, qui d&eacute;coule de la sous-muqueuse du tractus gastro-intestinal, apparait g&eacute;n&eacute;ralement comme une l&eacute;sion b&eacute;nigne solitaire, localis&eacute;e rarement au niveau de l'il&eacute;on. Son origine est controvers&eacute;e. La pr&eacute;sentation clinique varie selon sa localisation, l'invagination et l'obstruction constituent les sympt&ocirc;mes r&eacute;v&eacute;lateurs les plus fr&eacute;quents quand le polype si&egrave;ge au niveau de l'intestin gr&ecirc;le. Nous rapportons le cas d'un patient &acirc;g&eacute; de 22 ans, qui pr&eacute;sentait une douleur abdominale, des naus&eacute;es et des vomissements avec des ant&eacute;c&eacute;dents de constipation intermittente et une perte de poids dans l'ann&eacute;e pr&eacute;c&eacute;dente. La radiologie a objectiv&eacute; une invagination il&eacute;o-il&eacute;ale obstruant compl&egrave;tement la lumi&egrave;re de l'il&eacute;on. La r&eacute;section segmentaire du segment il&eacute;al obstru&eacute; et l'anastomose termino-terminale ont &eacute;t&eacute; effectu&eacute;es. Le diagnostic final de PFI a &eacute;t&eacute; &eacute;tabli par l'examen histologique et immuno-histochimique.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khalid Chakour, Mohamed El Faiz Chaoui [Case report] - Une urgence m&eacute;dico-chirurgicale rare: l’abc&egrave;s &eacute;pidural rachidien (&agrave; propos de 03 cas) - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/145/abstract/ <b>Les infections de l’espace &eacute;pidural sont de mieux en mieux connues gr&acirc;ce au d&eacute;veloppement de la neurochirurgie, notamment l’IRM. Les abc&egrave;s &eacute;piduraux rachidiens repr&eacute;sentent une pathologie rare mais &eacute;minemment grave sur le plan fonctionnel, avec un risque vital potentiel. Nous rapportons trois cas d’abc&egrave;s &eacute;pidural rachidien tous diagnostiqu&eacute;s chez des patients de sexe masculin, le premier &acirc;g&eacute; de 52 ans le deuxi&egrave;me de 57 ans et le troisi&egrave;me de 63ans. Deux patients ont &eacute;t&eacute; admis aux urgences neurochirurgicales pour un tableau de compression m&eacute;dullaire lente &eacute;voluant dans un contexte infectieux, et le dernier se plaignait d’une sciatique S1 droite rebelle au traitement avec des fuites urinaires. Aucune porte d’entr&eacute;e n’a &eacute;t&eacute; identifi&eacute;e dans le bilan initial. Tous les patients ont &eacute;t&eacute; op&eacute;r&eacute;s par voie d’abord post&eacute;rieure avec d&eacute;compression m&eacute;dullaire/radiculaire et &eacute;vacuation de l’abc&egrave;s &eacute;pidural. L’&eacute;tude bact&eacute;riologique a trouv&eacute; un germe pyog&egrave;ne justifiant une antibioth&eacute;rapie adapt&eacute;e dans les trois cas. L’&eacute;volution a &eacute;t&eacute; favorable dans deux cas. Par contre un patient est d&eacute;c&eacute;d&eacute; trois jours en post-op&eacute;ratoire par un sepsis s&eacute;v&egrave;re.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Yosr Chaabouni [Images in medicine] - Multiple brown tumors as a result of hyperparathyroidism in chronic renal disease: a case report - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/144/abstract/ <b>The brown tumor or Osteitis fibrosa cystica is a benign bone lesion that caused by hyperparathyroidism.This complication has been decreased by diagnosis and successful treatment of hyperparathyroidism. The brown tumor of hyperparathyroidism results from a metabolic disorder that affects long bones, ribs, and pelvis. The maxillary involvement is rare. Parathyroidectomy is a good choice for patients with high parathyroid hormone (PTH) levels and diffuse brown Tumor leading to a gradual decrease in the maxillary tumors. We report the case of a 50-year-old woman with Chronic renal failure presented with a one-year history of slowly enlarging mass of the left cheek after 17 years of maintenance hemodialysis. The physical examination revealed a mass of the left jaw and the infraorbital region associated with a left exophthalmia. The mass was soft in consistency and tender on palpation. Her serum PTH Concentration was 4830 pg/ml and her calcemia was normal. The computed tomography (CT) of the facial skeleton showed multiple osteolytic lesions of the maxillary sinuses and mandibular bone suggestive of brown tumors. The expansive lesion of the left maxillary bone had an extensive involvement of the left maxilla and the maxillary sinus. The patient underwent a subtotal parathyroidectomy. The PTH concentration 1 hour after the surgery confirmed a level within the normal range. At 12-month follow-up, there was an improvement of the exophthalmia and partial regression of the tumors.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Malek Mnejja [Images in medicine] - Rhinocerebral mucormycosis: a rare infection - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/143/abstract/ <b>Rhinocerebral mucormycosis, also known as zygomycosis, is an acute opportunistic fungal infection with high associated mortality rates. There are some predisposing factors for mucormycosis such as hematological malignancies, severe burns, neutropenia, diabetes mellitus, and the use of corticosteroids. Treatment of rhinocerebral mucormycosis consists of treating the predisposing disease, aggressive surgical debridement and systemic antifungal therapy. We present the case of a 55-year-old diabetic patient treated with insulin who was admitted to the emergency department for a headache and left purulent rhinorrhea for 3 days. The patient was hospitalized for diabetic ketoacidosis, and intravenous insulin infusion therapy and intravenous antibiotherapy were administered. The day after hospitalization the patient developed a ptosis of the left eye associated with edema of the upper eyelid and the left cheek. The nasal endoscopy showed necrotic tissue in the left middle meatus and the middle turbinate associated with profuse purulent discharge. The culture of the nasal swab identified a Rhizopusoryzae and the diagnosis of rhino-cerebral mucormycosis was retained.The patient was put on amphotericin B (1 mg/kg/daily) under medical care in the hospital. The patient underwent a functional endoscopic sinus surgery with debridement of sinuses, ethmoidectomy and left middle meatal antrostomy. Histopathological findings from the biopsy of the maxillary sinus presented aseptate hyphae in necrotic tissue. The outcome was fatal on the third day of hospitalization, despite appropriate reanimation measures.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hanan El Ouahabi, Nadia Anoun [Images in medicine] - Paragangliome m&eacute;sent&eacute;rique - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/142/abstract/ <b>Les paragangliomes extra-surr&eacute;naliens surviennent rarement de fa&ccedil;on aberrante en dehors de la r&eacute;gion parall&egrave;le au syst&egrave;me nerveux autonome s'&eacute;tendant de la r&eacute;gion cervicale &agrave; la r&eacute;gion pelvienne. Nous rapportons un cas rare de paragangliome localis&eacute; au niveau du m&eacute;sent&egrave;re chez une femme de 58 ans sans ant&eacute;c&eacute;dents pathologiques notables, op&eacute;r&eacute;e quatre mois avant son admission pour une volumineuse masse abdominale mesurant 14 x 12 cm, d&eacute;couverte sur un examen tomodensitom&eacute;trique, r&eacute;alis&eacute; devant des douleurs abdominales diffuses. Le r&eacute;sultat anatomopathologique compl&eacute;t&eacute; d'une &eacute;tude immuno-histochimique a r&eacute;v&eacute;l&eacute; un paragangliome de localisation m&eacute;sent&eacute;rique, pour lequel elle nous a &eacute;t&eacute; adress&eacute;e pour compl&eacute;ment de prise en charge. La patiente &eacute;tait en bon &eacute;tat g&eacute;n&eacute;ral, normo tendue, asymptomatique. L'examen abdominal notait une cicatrice de laparotomie m&eacute;diane &agrave; cheval sur l'ombilic. Elle avait b&eacute;n&eacute;fici&eacute; d'un dosage des d&eacute;riv&eacute;s m&eacute;thoxyl&eacute;s urinaires de 24h revenus normaux. Un bilan d'extension fait d'une TDM thoraco-abdomino-pelvienne avait r&eacute;v&eacute;l&eacute; une thrombose partielle du tronc porte et du tronc spl&eacute;no mesara&iuml;que et de la veine cave inf&eacute;rieure sans autre localisation secondaire. La patiente fut mise sous traitement anticoagulant &agrave; dose curative.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Brian Johnson, William Edward Cayley, Bich-May Nguyen, Paul Larson, Maria del C Colon-Gonzalez, Christine Gibson, Ann Evensen [Commentary] - Faculty development in family medicine education: what is needed? - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/141/abstract/ <b>A growing number of countries are embracing graduate training in the specialty of Family Medicine as a core component of global health systems reform. One significant challenge for new programs is to adequately prepare for educational excellence and leadership. Promising residents are often encouraged to remain in their program as faculty, but may not have had the benefit of specific training in teaching, curriculum development, learner assessment or educational leadership. Faculty Development is a potential avenue to providing these skills to new Family Medicine Faculty and to encourage new graduates to consider teaching. We are currently seeking to further clarify what the current needs and future possibilities are for Family Medicine Faculty Development in Sub-Saharan Africa.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Respicious Boniface,Edwin Rwebugisa Lugazia, Abel Mussa Ntungi, Othman Kiloloma [Research] - Management and outcome of traumatic brain injury patients at Muhimbili Orthopaedic Institute Dar es Salaam, Tanzania - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/140/abstract/ <b>INTRODUCTION: traumatic brain Injuries represents a significant cause of morbidity and mortality worldwide and road traffic crashes accounts for a significant proportion of these injuries. However, access to neurosurgical care is poor in low income countries like Tanzania. The aim of this study was to assess the management and outcome of Traumatic brain injury patients at a tertiary level health facility in Tanzania. METHODS: a retrospective observational study of Traumatic brain injury patients attended at Muhimbili Orthopedic Institute between January 2014 and June 2014. RESULTS: a total of 627 Traumatic brain injury (TBI) patients were seen, 86% were males. Majority (73%) were between 15 – 45 years age group. Road traffic crashes were the leading cause of injury (59.3%). Majority 401/627 (64%) sustained mild TBI, 114/627 (18.2%) moderate TBI and 112/627 (17.8%) severe TBI. All mild TBI patients had good recovery. Among patients with moderate and severe TBI; 19.1% had good recovery, 50.2% recovered with disabilities and 30.7% died. Independent factors associated with mortality were: Severe TBI (Odds Ratio (OR) 3.16. 95%CI 3.42-10.52) and Systolic blood pressure at referring hospital of more than 90mmHg (Odds Ratio (OR) 0.13, 95%CI 0.04-0.49). CONCLUSION: traumatic brain injury is a public health problem in Tanzania, mostly due to road traffic crashes. It is therefore important to reinforce preventive measures for road traffic crashes. There is also a need to develop and implement protocols for pre-hospital as well as in-hospital management of brain trauma in Tanzania.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Jamal Fatihi, Salah Bellasri [Images in medicine] - M&eacute;tastases cutan&eacute;es r&eacute;v&eacute;lant un carcinome indiff&eacute;renci&eacute; du nasopharynx (UCNT) - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/139/abstract/ <b>Les cancers du nasopharynx, domin&eacute;s par les carcinomes &eacute;pidermo&iuml;des surtout de type undifferenciated carcinoma of nasopharyngeal type (UCNT), sont des tumeurs particuli&egrave;res au sein des autres cancers de la sph&egrave;re ORL par leurs &eacute;volutivit&eacute;, le haut potentiel m&eacute;tastatique &agrave; distance et la survenue chez des sujets jeunes sans facteurs de risque classiques alcoolo-tabagiques. Les m&eacute;tastases cutan&eacute;es r&eacute;v&eacute;latrices des carcinomes UCNT sont extr&ecirc;mement rares. Nous rapportons le cas d'un homme de 50 ans, sans pass&eacute; pathologique particulier, hospitalis&eacute; pour des nodules sous cutan&eacute;s (cuir chevelu) (A), r&eacute;gion lombaire (B) et flanc droit (C)) apparus trois mois auparavant dans un contexte d'alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral et de douleurs osseuses. La biopsie ex&eacute;r&egrave;se avec &eacute;tude anatomopathologique d'un des nodules &eacute;tait en faveur d'une localisation secondaire d'un carcinome UCNT. L'endoscopie nasale mettait en &eacute;vidence un processus bourgeonnant endonasal (D) dont la biopsie confirmait le type carcinomateux UCNT. Le bilan d'extension classait la tumeur en stade IV C avec m&eacute;tastases cutan&eacute;es, ganglionnaires, et osseuses. L'&eacute;volution &eacute;tait d&eacute;favorable apr&egrave;s 9 mois malgr&eacute; la radiochimioth&eacute;rapie.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Amina Aounallah, Aicha Arouss, Najet Ghariani, Wafa Saidi, Badreddine Sriha, Mohamed Denguezli, Colandane Belajouza, Rafia Nouira [Case series] - Vascularites cutan&eacute;es leucocytoclasiques: &agrave; propos de 85 cas - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/138/abstract/ <b>La pr&eacute;sentation clinique, les &eacute;tiologies et l'&eacute;volution des Vascularites leucocytoclasiques sont peu &eacute;tudi&eacute;es. L'objectif de notre travail est d'&eacute;tudier les particularit&eacute;s &eacute;pid&eacute;miologiques, cliniques, &eacute;tiologiques et &eacute;volutives de cette entit&eacute;. Nous avons men&eacute; une &eacute;tude transversale portant sur 85 patients ayant une vascularite leucocytoclasique collig&eacute;s dans le service de dermatologie de l'h&ocirc;pital Farhat Hached de Sousse entre Janvier 2000 et D&eacute;cembre 2013. Pour chaque patient, une fiche des donn&eacute;es &eacute;pid&eacute;miologiques, cliniques, paracliniques et &eacute;tiologiques a &eacute;t&eacute; remplie. L'&acirc;ge moyen de nos patients &eacute;tait de 47,65 ans avec des extr&ecirc;mes allant de 10 &agrave; 78 ans. Cinquante trois femmes et 32 hommes &eacute;taient recens&eacute;s (sexe ratio = 0,6). Les manifestations cutan&eacute;es &eacute;taient domin&eacute;es par le purpura vasculaire (88,2%). Les &eacute;tiologies les plus fr&eacute;quentes &eacute;taient les maladies syst&eacute;miques (51%), les infections (20%) et les dermatoses neutrophiliques (14,5%). Les autres &eacute;tiologies retrouv&eacute;es &eacute;taient : les causes m&eacute;dicamenteuses (9,1%) et les h&eacute;mopathies malignes (5,4%). Chez 30 patients (35,3%), l'&eacute;tiologie n'a pas &eacute;t&eacute; retrouv&eacute;e. Deux facteurs pr&eacute;dictifs &agrave; l'&eacute;volution aigue &eacute;taient retenus : la pr&eacute;sence d'une infection r&eacute;cente (p= 0,014) et d'une prise m&eacute;dicamenteuse pr&eacute;c&eacute;dant l'&eacute;ruption cutan&eacute;e (p= 0,013). L'&eacute;volution chronique &eacute;tait corr&eacute;l&eacute;e positivement aux anticorps antinucl&eacute;aires (p= 0,009), et &agrave; la cryoglobulin&eacute;mie (p=0,025). Notre &eacute;tude illustre la multitude des &eacute;tiologies de vascularites leucocytoclasiques. La recherche d'une maladie sous-jacente est imp&eacute;rative afin de garantir une meilleure prise en charge th&eacute;rapeutique.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Badr El Alami, Aimane Naam, Mohamed Admi, Ilyas Rabhi, Mohamed Elbardai, Fawzi Boutayeb [Case series] - Traitement chirurgical des fractures du Calcan&eacute;um: &agrave; propos de 29 cas - 13 March 2017. http://www.panafrican-med-journal.com/content/article/26/137/abstract/ <b>Les fractures du calcan&eacute;um sont peu fr&eacute;quentes mais le plus souvent graves. Nous rapportons une s&eacute;rie de 29 cas de fractures du calcan&eacute;um trait&eacute;s chirurgicalement dans le service de traumatologie orthop&eacute;die du CHU Hassan II de F&egrave;s. L'objectif de ce travail r&eacute;trospectif &eacute;tait de pr&eacute;senter les principes et d'&eacute;valuer les r&eacute;sultats du traitement chirurgical des fractures articulaires du calcan&eacute;um, en comparaison avec le traitement conservateur. Il s'agissait de 21 hommes et de 8 femmes, dont l'&acirc;ge variait entre 21 et 61 ans. L'&eacute;tiologie &eacute;tait domin&eacute;e par les accidents de la voie publique et les chutes d'un lieu &eacute;lev&eacute;. L'&eacute;valuation des l&eacute;sions &eacute;tait bas&eacute;e sur la classification de DUPARC. Le traitement a consist&eacute; &agrave; faire une r&eacute;duction &agrave; foyer ouvert et une ost&eacute;osynth&egrave;se par plaque en Y, ou par une plaque tiers de tube r&eacute;alisant un montage en triangulation. Les r&eacute;sultats cliniques ont &eacute;t&eacute; &eacute;valu&eacute;s en se basant sur le score de kitaoka, avec un recul moyen de 24 mois. 86% de nos patients ont eu un bon &agrave; moyen r&eacute;sultat.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Amina Aounallah, Mariem Jrad, Mehdi Ksiaa, Sana Mokni, Wafa Saidi, Lobna Boussofara, Badreddine Sriha, Mohamed Denguezli, Najet Ghariani, Colandane Belajouza, Rafia Nouira [Short communication] - Forme particuli&egrave;re de Pemphigoide cicatricielle &agrave; d&eacute;p&ocirc;t unique d'IgA - 13 March 2017. http://www.panafrican-med-journal.com/content/article/26/136/abstract/ <b>La Pemphigoide cicatricielle est une dermatose bulleuse sous &eacute;pith&eacute;liale qui atteint essentiellement les muqueuses avec une &eacute;volution cicatricielle. Il s'agit d'un homme de 66 ans hospitalis&eacute; pour gingivite &eacute;rosive avec dysphagie, dyspn&eacute;e et flou visuel. L'examen dermatologique retrouvait des l&eacute;sions &eacute;rosives du palais et du pharynx. L'examen ophtalmologique notait des symbl&eacute;pharons, un ectropion et une cataracte bilat&eacute;rale. La biopsie gingivale avait montr&eacute; un d&eacute;collement n&eacute;crotique de l'&eacute;pith&eacute;lium buccal. L'immunofluorescence directe notait un d&eacute;p&ocirc;t lin&eacute;aire d'Immunoglobuline A &agrave; la jonction dermo-&eacute;pidermique. L'Immunofluorescence indirecte &eacute;tait revenue n&eacute;gative. Le diagnostic de pemphigoide cicatricielle &eacute;tait confirm&eacute;. Le Transit oeso-gastro-duod&eacute;nal a objectiv&eacute; une double st&eacute;nose de l'œsophage. L'endoscopie nasale, pharyng&eacute;e et bronchique retrouvait des ulc&eacute;rations de l'&eacute;piglotte, de l'hypopharynx, du pharynx et de l'arbre bronchique. Le patient a b&eacute;n&eacute;fici&eacute; d'un bolus de Solumedrol relay&eacute; par la Prednisone &agrave; la dose de 0.5mg/Kg/j associ&eacute; &agrave; la Disulone &agrave; la dose de 100mg/j. L'&eacute;volution &eacute;tait favorable au d&eacute;but mais s'est compliqu&eacute;e apr&egrave;s 2 mois d'une aggravation de la dysphagie et de la st&eacute;nose oesophagienne. Notre observation est tr&egrave;s particuli&egrave;re par la survenue d'une Pemphigoide cicatricielle chez un sujet de sexe masculin ayant un tableau grave en rapport avec l'extension des l&eacute;sions &agrave; toutes les muqueuses conjonctivale, buccale, nasale, œsophagienne et m&ecirc;me bronchique associ&eacute;e &agrave; une immunofluorescence directe faite d'un d&eacute;p&ocirc;t d'IgA uniquement.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Tarik Salama, El Mohtadi Aghoutane, Redouane El Fezzazi [Case report] - Forme pseudotumorale de la tuberculose: &agrave; propos d’un cas - 13 March 2017. http://www.panafrican-med-journal.com/content/article/26/135/abstract/ <b>La tuberculose osseuse peut prendre l'aspect d'une tumeur maligne. Nous pr&eacute;sentons le cas d'un enfant de 4 ans porteur d'une tuberculose osseuse ayant simul&eacute; un ost&eacute;osarcome f&eacute;moral. Le diagnostic a &eacute;t&eacute; redress&eacute; par l'&eacute;tude anatomopathologique. Ce cas souligne l'importance de connaitre les des diff&eacute;rents aspects cliniques et radiologiques de la tuberculose osseuse qui peut simuler une tumeur maligne. Afin d'&eacute;viter tout retard diagnostic, chirurgiens p&eacute;diatres et radiologues doivent savoir que la tuberculose peut rev&ecirc;tir les tableaux cliniques et radiologiques de nombreuses pathologies.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Awoke Derbie, Derese Hailu, Daniel Mekonin, Bayeh Abera, Gashaw Yitayew [Research] - Antibiogram profile of uropathogens isolated at Bahir Dar Regional Research Laboratory Centre, Ethiopia - 10 March 2017. http://www.panafrican-med-journal.com/content/article/26/134/abstract/ <b>INTRODUCTION: antimicrobial resistance among bacteria that cause urinary tract infection (UTI) has been increasing since the introduction of chemotherapy. This study was aimed to assess the types of isolates from patients with UTI and to determine their current antimicrobial susceptibility profile.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khaled Chakour, Mohamed El Faizchaoui [Case report] - Kyste hydatique de la fosse c&eacute;r&eacute;brale post&eacute;rieure - 09 March 2017. http://www.panafrican-med-journal.com/content/article/26/133/abstract/ <b>L'hydatidose est une parasitose cosmopolite end&eacute;mique au Maroc. L'&eacute;chinococcose c&eacute;r&eacute;brale est rare repr&eacute;sentant 1 &agrave; 2% de l'ensemble des hydatidoses de l'homme et la localisation auniveau de la fosse post&eacute;rieure est exceptionnelle. Nous rapportons le cas d'un enfant &acirc;g&eacute; de 12 ansadmis pour syndrome d'hypertension intracr&acirc;nienne &eacute;voluant depuis trois mois. La tomodensitom&eacute;trie c&eacute;r&eacute;brale a objectiv&eacute; une formation kystique de la fosse post&eacute;rieurene se rehaussant pas apr&egrave;s injection du produit de contraste. L'intervention chirurgicale r&eacute;v&eacute;lait un kyste hydatique. Ce diagnostic a&eacute;t&eacute; par la suite confirm&eacute;parl'examen anatomo-pathologique. Le patient a re&ccedil;uuntraitement m&eacute;dical &agrave; base d'albendazole en postop&eacute;ratoire. L'&eacute;volution&eacute;tait favorable six mois plus tard.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khalid Chakour, Mohamed El FaizChaoui [Case report] - Une cause rare de compression m&eacute;dullaire: kyste arachno&iuml;dien &eacute;pidural rachidien (&agrave; propos de 03 cas) - 09 March 2017. http://www.panafrican-med-journal.com/content/article/26/132/abstract/ <b>Le kyste arachno&iuml;dien &eacute;pidural rachidien (KAER) est une affection b&eacute;nigne, de physiopathologie encore incertaine. Il est le plus souvent asymptomatique mais peut causer des s&eacute;quelles neurologiques graves surtout quand le traitement n'est pas instaur&eacute; &agrave; temps. Nous rapportons l'exp&eacute;rience du service de Neurochirurgie CHU Hassan II- F&egrave;s concernant la prise en charge du KAER &agrave; travers l'analyse r&eacute;trospective de trois cas. Il s'agit de deux patients de sexe masculin et d'une femme, d'&acirc;ge moyen de 35 ans (Extr&ecirc;mes: 16 et 56 ans), tous admis pour un tableau de compression m&eacute;dullaire lente. Tous nos patients ont b&eacute;n&eacute;fici&eacute; d'une IRM m&eacute;dullaire qui a mis en &eacute;vidence une collection liquidienne de si&egrave;ge &eacute;pidural, ayant le m&ecirc;me signal que le LCR, comprimant la moelle en regard. Le si&egrave;ge de la collection &eacute;tait thoracique dans tous les cas. Tous nos patients ont &eacute;t&eacute; op&eacute;r&eacute;s par voie post&eacute;rieure avec ex&eacute;r&egrave;se du kyste et ligature du collet dans deux cas et une plastie durale dans un seul cas. L'&eacute;tude anatomopathologique a conclu en un kyste arachno&iuml;dien. L'&eacute;volution postop&eacute;ratoire &eacute;tait favorable dans tous les cas. Ce travail a comme objectif de mettre le point sur cette pathologie tout en insistant sur la n&eacute;cessit&eacute; d'une prise en charge pr&eacute;coce, vu la tendance vers l'aggravation progressive en l'absence de th&eacute;rapie adapt&eacute;e et rappeler les particularit&eacute;s cliniques, paracliniques et th&eacute;rapeutiques de cette affection.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khalid Chakour, Mohamed El Faiz Chaoui [Case report] - Une cause rare d’exophtalmie: l’h&eacute;mangiome caverneux intraorbitaire (&agrave; propos d’un cas) - 09 March 2017. http://www.panafrican-med-journal.com/content/article/26/131/abstract/ <b>L'h&eacute;mangiome caverneux est la plus fr&eacute;quente des tumeurs vasculaires b&eacute;nignes primitives de l'orbite chez l'adulte; l'&acirc;ge moyen de d&eacute;couverte est de 42 ans avec une pr&eacute;dilection f&eacute;minine. Cette tumeur est d'&eacute;volution lente et n'a aucune tendance &agrave; la r&eacute;gression spontan&eacute;e; elle se localise &eacute;lectivement au niveau du c&ocirc;ne musculaire en position r&eacute;tro-oculaire mais pouvant se d&eacute;velopper dans l'espace extraconique. Elle se traduit cliniquement par une exophtalmie d'apparition progressive, irr&eacute;ductible, non pulsatile, indolore sauf en cas de complication, associ&eacute;e dans 2/3 des cas &agrave; une baisse de l'acuit&eacute; visuelle. Le diagnostic est facilement confirm&eacute; par l'imagerie qui permet de localiser parfaitement la tumeur par rapport au nerf optique et aux muscles oculomoteurs et de dicter la voie d'abord chirurgicale. L'ex&eacute;r&egrave;se chirurgicale doit &ecirc;tre faite en bloc; elle est habituellement simple car la tumeur est bien limit&eacute;e et parfaitement clivable. Les voies d'abord sont en fonction du volume et surtout du si&egrave;ge de la l&eacute;sion. Le pronostic fonctionnel est bon et les cas de r&eacute;cidives sont rares.Un cas d’angiome caverneux orbitaire r&eacute;v&eacute;l&eacute; par une exophtalmie survenant chez un patient &acirc;g&eacute; de 44 ans est rapport&eacute;.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Youssouf Benmoh, Ahmed Bourazza [Images in medicine] - Mirroring spinal cord lesion secondary to B12 deficiency - 07 March 2017. http://www.panafrican-med-journal.com/content/article/26/130/abstract/ <b>A 26 year-old girl, previously healthy, admitted for progressive weakness of both lower limbs, with permanent paresthaesia evolving for 6 months. Clinical examination found spastic paraparesis with proprioceptive ataxia. The MRI showed bilateral and symmetrical lesions in the cervical spinal cord. Lesions were T1-isointense and T2 hyperintense, located on both lateral and posterior funiculus without enhancement. Investigation revealed deep vitamin B12 deficiency (27pg/ml), macrocytosis, with positive parietal cell-antibody and fundic gastritis. Patient was treated with intra muscular hydorxycobalamin. Evolution was favorable with regression of weakness and parethaesia of both lower limbs, and persistence of discreet ataxia. Cobalamin deficiency is common in the elderly. It causes hematologic, digestive and neurological disorders. Neurological signs are dominated by combined sclerosis of the spinal cord, and peripheral neuropathy. MRI is useful in front of myelopathy, showing an enlargement or T2-hyperintense lesion of the posterior funiculus.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hicham Naji-Amrani, Aziz Ouarssani [Images in medicine] - Chilaiditi syndrome - 07 March 2017. http://www.panafrican-med-journal.com/content/article/26/129/abstract/ <b>Chilaiditi syndrome or subphrenic interposition of the colon, is a rare condition with an incidence of 0.025% - 0.28% in radiographs and mostly diagnosed as an incidental finding. We report the case of a 67-years-old male, heavy smoker, with history of intermittent abdominal pain, who reported cough and muco-purulent sputum without fever or dyspnea. Physical examination showed bilateral bronchial rales and right hypochondrium sensitivity, his vital signs were normal. A posteroanterior chest films (A) reveled an elevated right hemidiaphragm with free gas below. A pneumoperitoneum, subphrenic abscess, and intestinal pneumatosis were suspected, however, a CT scan of the thorax and abdomen (B, C and D) showed the interposition of the right colon angle between the diaphragm and the liver without any perforated viscus. Our patient was treated for chronic bronchitis infection; otherwise his Chilaiditi syndrome required symotomatic treatment with good outcomes.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Walid Osman, Zeineb Alaya, Ali Haggui, Mohamed Ben Rejeb, Sonia Jemni, Nader Naouar, Mohamed Laziz Ben Ayeche [Case series] - Les tumeurs &agrave; cellules g&eacute;antes des gaines synoviales de la main: &agrave; propos de 50 cas - 07 March 2017. http://www.panafrican-med-journal.com/content/article/26/128/abstract/ <b>Les tumeurs &agrave; cellules g&eacute;antes des gaines synoviales (TCGGS) des tendons repr&eacute;sentent la forme localis&eacute;e de la synovite villonodulaire h&eacute;mopigment&eacute;e. Elles s'observent le plus souvent au niveau des mains. Notre but &eacute;tait d'&eacute;tudier les caract&eacute;ristiques &eacute;pid&eacute;mio-cliniques et th&eacute;rapeutiques des TCGGS, &eacute;valuer les r&eacute;sultats du traitement chirurgical et d&eacute;gager les facteurs de r&eacute;cidives. Il s'agit d'une &eacute;tude r&eacute;trospective de 50 cas de TCGGS de la main collig&eacute;s entre 1992 et 2016 au service d'orthop&eacute;die de l'h&ocirc;pital Sahloul de Sousse en Tunisie. Les caract&eacute;ristiques cliniques et &eacute;pid&eacute;miologiques des TCGGS ont &eacute;t&eacute; pr&eacute;cis&eacute;es. L'&acirc;ge moyen des patients &eacute;tait de 33 ans (9-69 ans) avec un sexe-ratio de 0,6. Les motifs de consultation &eacute;taient l'apparition constante d'une tum&eacute;faction (100%), la g&ecirc;ne &agrave; la mobilisation des articulations inter-phalangiennes (6%) et la douleur digitale (18%). Toutes les tumeurs &eacute;taient localis&eacute;es au niveau de la r&eacute;gion digitale, surtout au niveau de l'index (42%). La localisation &eacute;tait palmaire dans 66% des cas. Tous les malades ont &eacute;t&eacute; op&eacute;r&eacute;s, l'aspect macroscopique montrait une tumeur encapsul&eacute;e, polylob&eacute;e et jaune brun&acirc;tre qui se prolongeait dans la gaine des tendons fl&eacute;chisseurs (4 cas) et sous le tendon extenseur (2 cas). Nous avons not&eacute; un seul cas de r&eacute;cidive, soit 2% qui ont &eacute;t&eacute; repris chirurgicalement. Les r&eacute;sultats fonctionnels &eacute;taient bons dans tous les cas. Le diagnostic de TCGGS doit &ecirc;tre &eacute;voqu&eacute; devant une tum&eacute;faction digitale. Leur prise en charge fait appel &agrave; la chirurgie qui reste difficile et doit &ecirc;tre correctement ex&eacute;cut&eacute;e pour &eacute;viter les r&eacute;cidives.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Isolated tuberculous trochanteritis - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/127/abstract/ <b>A 40-year-old patient was hospitalized for inflammatory pain in the superior-external surface of the right thigh evolving since 8 months, with no change in the general condition or fever. The pressure towards the right large trochanter was painful without local inflammatory signs. Biology did not show any inflammatory syndrome. The X-ray of the pelvis revealed an osteolytic lesion of the right great trochanter with thickening of the soft parts (Panel A). Bone scintigraphy showed hyperfixation of the right great trochanter (Panel B). The scanner of the basin revealed an osteolytic lesion of the right great trochanter containing multiple sequesters with cortical irregularity (Panel C). A great-trochanter bone biopsy under scannographic control was made (Panel D). The histological study showed an epithelioid and giganto-cellular granuloma with the presence of BK in the culture of the puncture fluid. The diagnosis of trochanteric tuberculosis was then made. Tuberculin intradermal reaction (IDR) was negative. The search for other tuberculous sites was negative. The patient was treated with anti-tuberculosis drugs during 12 months with good progression. Tuberculosis is a rare cause of trochanteritis. The peculiarity of our observation lies also in the absence of other tuberculous localizations.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Kumeren Govender, Fatima Suleman, Yoshan Moodley [Research] - Clinical risk factors for in-hospital mortality in older adults with HIV infection: findings from a South African hospital administrative dataset - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/126/abstract/ <b>INTRODUCTION: the proportion of older South African adults (aged &ge; 50 years old) with HIV infection requiring hospitalization is likely to increase in the near future. Clinical risk factors for in-hospital mortality (IHM) in these patients are not well described. We aimed to identify clinical risk factors associated with IHM and their overall contribution towards IHM in older South African adults with HIV infection. METHODS: clinical data for 690 older adults with HIV infection was obtained from the hospital administrative database at the Hlabisa Hospital in KwaZulu-Natal, South Africa. Logistic regression was used to determine independent clinical risk factors for IHM. Population-attributable fractions (PAFs) were calculated for all independent clinical risk factors identified. RESULTS: male gender (p=0.005), CD4 count <350 cells/mm<sup>3</sup>(p=0.035), unknown CD4 count (p=0.048), tuberculosis (p=0.033) and renal failure (p=0.013) were independently associated with IHM. Male gender contributed the most to IHM (PAF=0.22), followed by unknown CD4 count (PAF=0.14), tuberculosis (PAF=0.12), renal failure (PAF=0.06) and CD4 count <350 cells/mm<sup>3</sup> (PAF=0.01). CONCLUSION: although further research is required to confirm our findings, there is potential for these clinical risk factors identified in our study to be used to stratify patient risk and reduce IHM in older adults with HIV infection.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Brooke Rosenbaum, Rebecca Klein, Paa Gyasi Hagan, Mark-Young Seadey, Naa Larteley Quarcoo, Rachel Hoffman, Maria Robinson, Margaret Lartey, Marie Leger [Research] - Dermatology in Ghana: a retrospective review of skin disease at the Korle Bu Teaching Hospital Dermatology Clinic - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/125/abstract/ <b>INTRODUCTION: Ghana is currently developing its provision of dermatology services. Epidemiologic studies of the skin diseases seen by Ghanaian dermatologists are needed to guide these efforts. We aimed to describe the skin conditions seen by and management practices of Ghanaian dermatologists in a specialized clinic. METHODS: we conducted a chart review of new patients presenting to the Korle Bu Teaching Hospital dermatology clinic during 2014. RESULTS: among the 529 patients studied, 700 discrete diagnoses were made. The most commonly diagnosed skin conditions were infections (24.6%) and dermatitis (24.6%); atopic dermatitis (8.4%), acne vulgaris (5.3%) and scabies (5.1%) were the most common specific diagnoses. Among infants, children, and adolescents, the most common diagnosis was atopic dermatitis (31.7%, 30.0%, and 14.9%, respectively). Acne vulgaris (12.0%) was the most common skin condition diagnosed in young adults. Irritant contact dermatitis (6.9%) was most common among adults. Lichen planus (9.9%) was the most commonly diagnosed skin condition in the senior population. Diagnoses made by dermatologists differed from the referral diagnosis documented by primary care providers for 65.8% of patients. The most frequently recommended treatments were antihistamines (47.8%) and topical steroids (38.4%). Only 18 diagnostic biopsies were performed. CONCLUSION: our study summarizes the skin diseases seen and management practices of Ghanaian dermatologists in a specialized clinic at a large public teaching hospital. The results of this study can help to guide future dermatology education and development efforts in Ghana.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Alhaji Abubakar Aliyu, Tukur Dahiru [Research] - Predictors of delayed Antenatal Care (ANC) visits in Nigeria: secondary analysis of 2013 Nigeria Demographic and Health Survey (NDHS) - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/124/abstract/ <b>INTRODUCTION: Antenatal Care (ANC) is an important component of maternal health and covers a wide range of activities with huge potential benefits for positive pregnancy out comes. However, large proportions of women do initiate ANC early resulting in adverse consequences. METHODS: the study utilized the nationally-representative sample of women of reproductive age interviewed during the 2013 Nigeria DHS. Analysis was restricted to 20, 467 women aged 15-49 years who had a live birth in the five-year period prior to the survey. Multinomial logistic regression was performed using Stata v13 to determine significant factors related to timing of initiation of ANC. Relative risk ratio (RRR) was used to assess the strength of association between independent and dependent variables. RESULTS: overall, 27%, 62% and 12% of women initiated ANC in the first, second and third trimesters respectively. In both the two model, the findings reveal that maternal education, level of media exposure, region and place of residence are the uniform predictors of initiation of ANC; having health insurance is a significant predictor of third trimester ANC initiation relative to first to first trimester only. Within the categories of household wealth, levels of participation in household decision-making and region some categories are significant predictors while others are not. CONCLUSION: maternal education, level of media exposure, region and place of residence are the uniform and consistent predictors of delay in ANC initiation. This suggests that girl-child education, universal health coverage and universal health insurance could be the interventions required to improve service utilization and maternal health.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Seydou Bakayoko, Nouhoum Guirou, Brainima Coulibaly, Jeannette Traor&eacute; [Case report] - Œd&egrave;me papillaire bilat&eacute;ral secondaire &agrave; une hypertension intracr&acirc;nienne chez une adolescente - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/123/abstract/ <b>L'œd&egrave;me papillaire est un gonflement liquidien et /ou axonal de la t&ecirc;te du nerf optique du &agrave; un blocage du flux axoplasmique au niveau de la lame cribl&eacute;e. Nous rapportons le cas d'une jeune adolescente &acirc;g&eacute;e de 17 ans, qui pr&eacute;senta un œd&egrave;me papillaire bilat&eacute;ral secondaire &agrave; une hypertension intracr&acirc;nienne idiopathique.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com El Mahi Hakima, Mernissi Fatima Zahra [Images in medicine] - Rhinophyma - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/122/abstract/ <b>Rhinophyma (rhis: nose, phyma: growth) is a rare, disfiguring disease characterized by a progressive hypertrophy of the soft-tissues of the nose with its increased volume, mainly in the lower half, and often associated to an end-stage of severe acne rosacea. The cause of rhinophyma is unknown, but it is believed to be the end stage of acne rosacea.The diagnosis is easy to ascertain based on the clinical features of the disease. In advanced cases, medical management is believed to be inferior to the results seen with surgical treatment. Surgical management is divided into 3 approaches: full-thickness excision followed by split-thickness skin graft, full-thickness excision followed by full-thickness skin graft, and decortication or partial excision. Decortication techniques include dermaplaning, dermabrasion, cryosurgery, electrosurgery, laser surgery and sharp blade excision.We reporte a case treated by a decortication technique: a 60-year-old man who presented at the dermatology department with a 20-year history of rhinophyma. He had never undergone any laser or surgical interventions. No other medical problem was reported, and there was no family history of rosacea. In collaboration with the Department of Plastic Surgery, rhinophymectomy using a scalpel and electroscalpel was undertaken. The procedure was performed with the patient under general anesthesia. A scalpel with a no. 15 blade was used. The postoperative period was satisfactory. The first signs of skin reepithelialization appeared 2 weeks after the intervention. At a 2 month-follow-up visit, a scar was present on the nasal tip, but the overall nasal contour was restored.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Felix Uduma Uduma, Anelkan Abaslattai, Dianabasi Udoete Eduwem, Morgan Ekanem, Philip Chinedu Okere [Research] - Utility of first trimester obstetric ultrasonography before 13 weeks of gestation: a retrospective study - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/121/abstract/ <b>INTRODUCTION: first trimester pregnancy is defined as twelve weeks after the last menstrual period. Ultrasonography has revolutionized validation and management of first trimester pregnancies. The aim was to analyze ultrasonographic findings of first trimester pregnancies in University of Uyo teaching hospital (UUTH), Uyo, Nigeria. METHODS: the departmental ultrasonographic records of pregnant women who were referred to Radiology department of UUTH, Uyo, Nigeria. For ultrasound scans were retrospectively reviewed. The period under consideration was from 8th January 2013 to 8th February, 2016. Demographic data and ultrasonographic parameters of first trimester pregnancies like gestational sacs were recorded. Data were statistically analyzed using SPSS Chicago 13. Exclusion criterion included incomplete data and acyesis despite positive ²hCG test. RESULTS: 26.4% (n-645) of the 2438 pregnant women who underwent obstetric ultrasonography had first trimester ultrasonography during the studied period. The peak frequency was seen in the 20-29 age range with 52.2% (n-337) and followed by 30-39 age range with 41.7% (n-269). The commonest first trimester ultrasound findings was viable pregnancy with 42.5% (n-274), followed by incomplete miscarriage with 34.3% (n-221). The least finding was trophoblastic pregnancies 0.3% (n-2). The earliest age at which normal viable pregnancy was diagnosed in this study was 5weeks 5days from the last menstrual period. Only 2.19% (n-6) of the normal viable pregnancies were multiple pregnancies and they were all twins. The highest number of referrals to Radiology Department for first trimester ultrasonography was from accident and emergency unit with 34.42% (n-222) while antenatal clinic referral was only 16.12% (n-104). CONCLUSION: the commonest first trimester’s obstetric ultrasonographic findings in Uyo, Nigeria are viable pregnancies and are predominantly single gestation. The earliest age of ultasonographic pregnancy detection in Uyo is 5week 5days and peak maternal age is second and third decades.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Prastiya Indra Gunawan, Wihasto Suryaningtyas [Images in medicine] - Giant subdural empyema following ventriculo-peritoneal shunt in a child - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/120/abstract/ <b>Subdural empyema is an intracranial focal collection of purulent material located between the dura mater and the arachnoid mater. It developed from varied sources, but the paranasal sinuses, the ears, and the mastoids processes were predominantly affected. Giant subdural empyema secondary to cerebrospinal fluid shunt placement has been extremely unusual. A 9-years-old girl presented with prolonged low-grade fever, vomiting, local wound infection in frontal area and general weakness. She was previously hydrocephalic with large head size since birth. A ventriculo-peritoneal shunt was already inserted for 7 years. Neurological examination showed the patient fully conscious and left hemiparesis. Routine hematological investigation revealed leukocytosis and high C-reactive protein (CRP). A contrast-enhanced CT scan showed an hypodense fluid collection with peripheral ring enhancement on the right of the midline supporting a giant subdural empyema. Emergency surgery was performed to drainage the pus. Pus culture resulted no growth of bacteria. Ceftriaxone and metronidazole were administered for 6 weeks. Follow-up CT Scan showed reduction of mass effect. The patient was improved leaving neurological sequalae.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Yddoussalah Othmane, Jakhlal Nabil, Karmouni Tarik, Elkhader Khalid, Koutani Abdellatif, Ibn Attya Andaloussi Ahmed [Case report] - Paragangliome non s&eacute;cr&eacute;tant r&eacute;trop&eacute;riton&eacute;al: &agrave; propos d'une observation - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/119/abstract/ <b>Les paragangliomes r&eacute;trop&eacute;riton&eacute;aux non fonctionnels sont des tumeurs rares. Ils sont souvent asymptomatiques et peuvent atteindre des dimensions importantes. Les auteurs rapportent le cas d'une tumeur r&eacute;tro p&eacute;riton&eacute;ale, d&eacute;couverte au cours d'un examen tomodensitom&eacute;trique r&eacute;alis&eacute; chez une femme &acirc;g&eacute;e de 49 ans en raison de douleurs abdominales non sp&eacute;cifiques. Les formes malignes, plus fr&eacute;quentes que les formes b&eacute;nignes, pr&eacute;sentent un envahissement locor&eacute;gional et m&eacute;tastasent tardivement. Le traitement de ces tumeurs n&eacute;cessite une ex&eacute;r&egrave;se chirurgicale la plus compl&egrave;te possible puisque le pronostic en d&eacute;pend. Il n'existe par contre pas de consensus sur l'utilit&eacute; des th&eacute;rapeutiques compl&eacute;mentaires qui peuvent n&eacute;anmoins constituer un appoint &agrave; titre symptomatique.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ridha Fatnassi, N&eacute;dia Marouen, Houcem Ragmoun, Latifa Marzougui, Sabra Hammami [Case report] - Le b&eacute;b&eacute; collodion: aspects cliniques et int&eacute;r&ecirc;t du diagnostic ant&eacute;natal - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/118/abstract/ <b>Le b&eacute;b&eacute; collodion est une forme s&eacute;v&egrave;re de l’ichtyose cong&eacute;nitale &agrave; r&eacute;v&eacute;lation n&eacute;onatale. Le tableau clinique est souvent caract&eacute;ristique. L’&eacute;volution, quand elle n’est pas fatale, se fait le plus souvent vers l’ichtyose s&egrave;che. Gr&acirc;ce aux techniques de biologie mol&eacute;culaire, le diagnostic pr&eacute;natal est rendu possible d&egrave;s la 10-12&egrave;me semaine d’am&eacute;norrh&eacute;e, permettant un conseil g&eacute;n&eacute;tique. Quant au pronostic de la maladie, il d&eacute;pend de plusieurs param&egrave;tres, &agrave; savoir le degr&eacute; de l’atteinte initiale, la dur&eacute;e de la desquamation, ainsi que l’ichtyose sous-jacente. A l’occasion d’une nouvelle observation d’un b&eacute;b&eacute; collodion issu &agrave; 34 SA, d’une parturiente ayant un cas index, et a &eacute;volution fatale d&eacute;s le premier jour de vie; nous avons fait une revue de la litt&eacute;rature afin de pr&eacute;ciser les aspects diagnostiques et th&eacute;rapeutiques ainsi que l’utilit&eacute; du diagnostic ant&eacute;natale.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Algodystrophy and pregnancy - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/117/abstract/ <b>The algodystrophy is a regional pain syndrome, characterized by complex neurovascular abnormalities. Pregnancy appears through mechanical factors promote dystrophy of the lower limbs. We report the case of a 31 year old woman, primipara, who presented in the third quarter of pregnancy (35 weeks gestation) mechanical right groin pain with functional impairment. She has consulted in postpartum (4 days after birth). The review noted a limp, functional impairment with a visual analogue scale (VAS) pain 70%. Standard radiographs postpartum showed speckled locoregional demineralization of the right hip. MRI confirmed the diagnosis of right hip algodystrophy (A and B). The patient took analgesic treatment with a discharge and rest for 3 months. She has not received bisphosphonates because she breastfeeding. Disease duration was 24 weeks. The evolution was marked by the persistence of residual pain (VAS 20%) without sequelae. Algodystrophy during pregnancy is rare and is often misunderstood. The analysis of our results compared to literature, allows to identify the main characteristics of this variety of reflex sympathetic dystrophy: gradual onset in the second or third trimester, location in the hip alone or associated with other locations. MRI is currently the modality of choice for the early and differential diagnosis. The course is generally favorable. The safety of bisphosphonates during pregnancy and lactation remains to be demonstrated.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Yassine Ragbaoui, Chafia Chehbouni, Ayoub El Hammiri, Rachida Habbal [Case series] - Epid&eacute;miologie de l’association fibrillation atriale et insuffisance cardiaque - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/116/abstract/ <b>La fibrillation atriale et l’insuffisance cardiaque sont des maladies cardiovasculaires souvent associ&eacute;es, leur coexistence aggrave le pronostic et constitue un probl&egrave;me de sant&eacute; public majeur. L’objectif de cette &eacute;tude est d’&eacute;valuer la pr&eacute;valence de la fibrillation atriale chez les patients en insuffisance cardiaque chronique et d&eacute;terminer le profil clinique de ce groupe de patients. Nous avons conduit une &eacute;tude r&eacute;trospective descriptive bas&eacute;e sur le registre d'insuffisance cardiaque du d&eacute;partement de cardiologie du centre hospitalier universitaire de juin 2006 &agrave; Mars 2015.Nous avons inclus les patients &acirc;g&eacute;s de plus de 18 ans ayant une insuffisance cardiaque chronique avec une fibrillation atriale. Durant cette p&eacute;riode 3048 patients ayant une insuffisance cardiaque chronique avec fibrillation atriale(FA) ont &eacute;t&eacute; inclus. La pr&eacute;valence de la fibrillation atriale &eacute;tait de 10,6%. La fr&eacute;quence des facteurs de risque cardiovasculaires associ&eacute;e &agrave; (FA) &eacute;tait de: (54%) pour l'hypertension art&eacute;rielle, (39%) pour le diab&egrave;te, (8%) pour la dyslipid&eacute;mie, (26%) pour le tabac, (30%) pour la s&eacute;dentarit&eacute; et (17%) pour la m&eacute;nopause. La (FA) &eacute;tait pr&eacute;sente chez (67,4%) des hommes versus (32,6%) des femmes. Les &eacute;tiologies de l'insuffisance cardiaque chronique associ&eacute;es &agrave; la fibrillation atriale &eacute;taient: les valvulopathies (44,1%); les coronaropathies (32%); Hypertensives (11%), primitive (10%), toxiques (2%) et alcoolisme chronique (1%). La fibrillation atriale reste fr&eacute;quente dans la population des patients insuffisants cardiaques au Maroc et la moyenne d’&acirc;ge est inf&eacute;rieure &agrave; celle retrouv&eacute;e dans la litt&eacute;rature.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Yassine Ragbaoui, Imad Nouamou, Ayoub El Hammiri, Rachida Habbal [Case series] - Facteurs pr&eacute;dictifs de l’adh&eacute;sion m&eacute;dicamenteuse chez les patients en insuffisance cardiaque chronique: exp&eacute;rience marocaine - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/115/abstract/ <b>L’adh&eacute;sion m&eacute;dicamenteuse chez les patients ayant une insuffisance cardiaque chronique est reconnue comme l’un des probl&egrave;mes majeurs dans la gestion de cette pathologie. L’&eacute;tat d&eacute;mographique et socio&eacute;conomique des pays africains peut avoir un impact sur l’adh&eacute;sion au traitement de l’insuffisance cardiaque chronique. Nous avons r&eacute;alis&eacute; une &eacute;tude transversale de Septembre 2014 &agrave; Janvier 2015 portant sur les patients en insuffisance cardiaque chronique suivis au centre d’insuffisance cardiaque du d&eacute;partement de cardiologie du centre hospitalier universitaire IBN ROCHD &agrave; Casablanca au Maroc. La mesure de l’adh&eacute;sion m&eacute;dicamenteuse &eacute;tait bas&eacute;e sur un questionnaire: questionnaire CARDIA. Les informations relatifs aux facteurs pr&eacute;dictifs d’adh&eacute;sion m&eacute;dicamenteuse &eacute;tait d&eacute;riv&eacute;s du model d’adh&eacute;sion multidimensionnel. Nous avons inclus dans cette &eacute;tude 147 patients insuffisants cardiaques chroniques. Le pourcentage de l’adh&eacute;sion m&eacute;dicamenteuse &eacute;tait de 83.6% selon CARDIA-Questionary. Les facteurs pr&eacute;dictifs qui influencent significativement l’adh&eacute;sion m&eacute;dicamenteuse &eacute;tait: La d&eacute;pression (p=0.034), le niveau de support social (p=0.03) et la prise de m&eacute;dicaments par le patient lui-m&ecirc;me (p=0.0001). Comme dans plusieurs r&eacute;gions au monde, l’adh&eacute;sion m&eacute;dicamenteuse chez les patients ayant une insuffisance cardiaque chronique reste un probl&egrave;me de sant&eacute; au Maroc. Les diff&eacute;rentes strat&eacute;gies qui agissent sur les facteurs pr&eacute;dictifs pourraient am&eacute;liorer l’adh&eacute;sion m&eacute;dicamenteuse.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mounir Yahyaoui, Abdelhafid Derfoufi, Najib Abbassi, Abdelkarim Daoudi, Omar Agoumi, Hicham Yacoubi, Abdeljaouad Najib [Case report] - Rupture bilat&eacute;rale simultan&eacute;e des deux ligaments crois&eacute;s du genou: &agrave; propos d’un cas - 01 March 2017. http://www.panafrican-med-journal.com/content/article/26/114/abstract/ <b>La rupture bicrois&eacute;e est rare, des deux LCA simultan&eacute;ment est exceptionnelle, alors que la rupture bicrois&eacute;e bilat&eacute;rale simultan&eacute;e et post-traumatique n’a &eacute;t&eacute; jamais d&eacute;crite dans la litt&eacute;rature, ce qui rend notre cas tr&egrave;s int&eacute;ressant pour &eacute;tude, suivi et discussion th&eacute;rapeutique puisqu’on a privil&eacute;gi&eacute; la prise en charge th&eacute;rapeutique en deux temps op&eacute;ratoires espac&eacute;s dans le temps et nos r&eacute;sultats &eacute;taient tr&egrave;s satisfaisantes aussi bien pour nous que pour le malade.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mouna Ayadi, Azza Gabsi, Khdija Meddeb, Amina Mokrani, Yosra Yahiaoui, Feryel Letaief, Nesrine Chraiet, Henda Rais, Amel Mezlini [Case report] - Primary leiomyosarcoma of thyroid gland: the youngest case - 01 March 2017. http://www.panafrican-med-journal.com/content/article/26/113/abstract/ <b>Primary leiomyosarcomas of the thyroid gland are extremely rare. We report a case of a 32 year-old women with a multinodular goiter. She underwent total thyroidectomy. The tumor histology showed spindle-shaped cells that expressed desmine, caldesmone and smooth muscle actine but were negative cytokeratins.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Salma Fares, Mouna Lamchahab, Myriem Aniba, Ghizlane Lembarki, Nadia Mousalli, Meriem Regragui, Mehdi Karkouri, Asmaa Quessar [Case report] - Lymphome T/NK extra-nasal &agrave; localisation colique primitif: &agrave; propos d’un cas - 01 March 2017. http://www.panafrican-med-journal.com/content/article/26/112/abstract/ <b>Le lymphome T/NK intestinal primitif est une entit&eacute; extr&ecirc;mement rare dont le diagnostic pr&eacute;coce est souvent difficile. Pour mieux comprendre cette entit&eacute;, nous rapportons le cas d’un patient de 43 ans diagnostiqu&eacute; avec un lymphome T/NK colique primitif localis&eacute; et isol&eacute; sans ent&eacute;ropathie associ&eacute;e, ayant &eacute;t&eacute; trait&eacute; par 3 cycles (AspaMetDex) avec un &eacute;chec &agrave; l’&eacute;valuation et la survenue du d&eacute;c&egrave;s au cours du traitement dans le tableau d’un abdomen aigu. Le lymphome T/NK intestinal primitif atteint le plus souvent le sujet jeune avec un pronostic p&eacute;joratif. En raison des caract&egrave;res cliniques et endoscopiques non sp&eacute;cifiques, il est difficile de distinguer entre un lymphome T/NK intestinal et les troubles intestinaux inflammatoires ou infectieuses. Les donn&eacute;es histopathologiques et immunohistochimiques ainsi que l’&eacute;tude de l’ADN permettent de redresser le diagnostic et de classer ce lymphome selon l’EuropeanEnteropathy-Type Intestinal T-CellLymphoma (ETL).</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Sinaa Mohamed [Case report] - Lymphome &agrave; cellules de la zone marginale spl&eacute;nique - 01 March 2017. http://www.panafrican-med-journal.com/content/article/26/111/abstract/ <b>Le lymphome &agrave; cellules de la zone marginale spl&eacute;nique (LZMS) est un lymphome B exceptionnel, bien d&eacute;finie dans la classification OMS 2016 des tumeurs h&eacute;matopo&iuml;&eacute;tiques, qui peut &ecirc;tre source de pi&egrave;ges diagnostiques. Patiente &acirc;g&eacute;e de 72 ans, hospitalisait pour l’exploration d’une &eacute;norme spl&eacute;nom&eacute;galie confirm&eacute;e par une tomodensitom&eacute;trie (TDM). Le bilan biologique &eacute;tait normal. Une spl&eacute;nectomie a &eacute;t&eacute; r&eacute;alis&eacute;e. L’&eacute;tude microscopique de la pi&egrave;ce op&eacute;ratoire montrait une prolif&eacute;ration lymphomateuse diffuse &agrave; petites cellules, avec un marquage par le CD20. Le CD 5 et le CD 43 sont n&eacute;gatifs. Le diagnostic d’un LZMS a &eacute;t&eacute; retenu. Le LZMS est repr&eacute;sente moins de 2% de l’ensemble lymphomes non hodgkiniens. Il touche le sujet &acirc;g&eacute; de plus de 50 ans, caract&eacute;ris&eacute; habituellement par la pr&eacute;sence d'une spl&eacute;nom&eacute;galie volumineuse sans ad&eacute;nopathies. L'h&eacute;mogramme montre dans trois quarts des cas la pr&eacute;sence inconstante de lymphocytes villeux. Le diagnostic est essentiellement anatomopathologique, il montre une atteinte constante nodulaire ou parfois diffuse de la pulpe blanche du parenchyme spl&eacute;nique. Les cellules tumorales sont de petite taille exprimant les marqueurs lympho&iuml;des B: CD19, CD20, CD22, CD79. Elles sont n&eacute;gatives pour le CD5, CD10, la cyclinde D1 et le CD43. Aucune anomalie cytog&eacute;n&eacute;tique sp&eacute;cifique du LZMS n'a &eacute;t&eacute; identifi&eacute;e. C’est un lymphome indolent dont le traitement est jusqu’&agrave; ce jour non codifi&eacute;, d&eacute;pend des facteurs pronostiques. Le d&eacute;c&egrave;s est li&eacute; au risque de transformation &agrave; un lymphome &agrave; grandes cellules.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Inimfon Aniema Essiet, Anisah Baharom, Hayati Kadir Shahar, Benjamin Uzochukwu [Research] - Application of the Socio-Ecological Model to predict physical activity behaviour among Nigerian University students - 01 March 2017. http://www.panafrican-med-journal.com/content/article/26/110/abstract/ <b>INTRODUCTION: physical activity among university students is a catalyst for habitual physical activity in adulthood. Physical activity has many health benefits besides the improvement in academic performance. The present study assessed the predictors of physical activity among Nigerian university students using the Social Ecological Model (SEM). METHODS: this cross-sectional study recruited first-year undergraduate students in the University of Uyo, Nigeria by multistage sampling. The International Physical Activity Questionnaire (IPAQ) short-version was used to assess physical activity in the study. Factors were categorised according to the Socio-Ecological Model which consisted of individual, social environment, physical environment and policy level. Data was analysed using the IBM SPSS statistical software, version 22. Simple and multiple logistic regression were used to determine the predictors of sufficient physical activity. RESULTS: a total of 342 respondents completed the study questionnaire. Majority of the respondents (93.6%) reported sufficient physical activity at 7-day recall. Multivariate analysis revealed that respondents belonging to the Ibibio ethnic group were about four times more likely to be sufficiently active compared to those who belonged to the other ethnic groups (AOR = 3.725, 95% CI = 1.383 to 10.032). Also, participants who had a normal weight were about four times more likely to be physically active compared to those who were underweight (AOR = 4.268, 95% CI = 1.323 to 13.772). CONCLUSION: this study concluded that there was sufficient physical activity levels among respondents. It is suggested that emphasis be given to implementing interventions aimed at sustaining sufficient levels of physical activity among students.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri [Images in medicine] - Une cause rare de compression m&eacute;dullaire: l’angiolipome &eacute;pidural rachidien - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/109/abstract/ <b>Une &eacute;tudiante de 19 ans, hospitalis&eacute;e au service de Neurochirurgie pour une lourdeur des deux membres inf&eacute;rieurs &eacute;voluant depuis deux mois chez qui l'examen clinique trouve une parapar&eacute;sie permettant la marche avec aide (Grade D de FRANKEL), un syndrome pyramidal aux deux membres inf&eacute;rieurs avec une douleur provoqu&eacute;e &agrave; la palpation des &eacute;pineuses de la partie moyenne du rachis dorsal. Les explorations paracliniques ont consist&eacute; &agrave; la r&eacute;alisation d'une IRM m&eacute;dullaire en premi&egrave;re intention (A,B) qui a mis en &eacute;vidence un processus l&eacute;sionnel intracanalaire, &eacute;pidural post&eacute;rieur, qui s'&eacute;tend de la premi&egrave;re &agrave; la huiti&egrave;me vert&egrave;bre thoracique et comprime fortement le cordon m&eacute;dullaire. La patiente a &eacute;t&eacute; op&eacute;r&eacute;e en urgence par voie post&eacute;rieure avec r&eacute;section totale d'un processus facilement clivable de la dure-m&egrave;re et saignant au contact. Les suites op&eacute;ratoires imm&eacute;diates &eacute;taient simples et l'&eacute;tude anatomopathologique (C) a mis en &eacute;vidence une prolif&eacute;ration compos&eacute;e par la juxtaposition de lobules d'adipocytes matures et de cavit&eacute;s vasculaires, concluant &agrave; un angiolipome de nature strictement b&eacute;nigne. La patiente a compl&egrave;tement r&eacute;cup&eacute;r&eacute; son autonomie trois mois en postop&eacute;ratoire. Les angiolipomes &eacute;piduraux rachidiens sont des tumeurs b&eacute;nignes rares qui se voient surtout chez l'adulte jeune, qui se manifestent par un tableau de compression m&eacute;dullaire lente. L'imagerie par r&eacute;sonance magn&eacute;tique constitue actuellement l'examen de choix dans l'exploration de cette tumeur. Cependant, le diagnostic de certitude reste histologique.Le traitement est toujours chirurgical, la voie d'abord est habituellement post&eacute;rieure et l'ex&eacute;r&egrave;se est souvent compl&egrave;te.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mulemba Tillika Samutela, Annie Kalonda, James Mwansa, Chileshe Lukwesa-Musyani, John Mwaba, Enoch Mulowa Mumbula, Darlington Mwenya, Edgar Simulundu, Geoffrey Kwenda [Research] - Molecular characterisation of methicillin-resistant Staphylococcus aureus (MRSA) isolated at a large referral hospital in Zambia - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/108/abstract/ <b>INTRODUCTION: methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) is globally recognized as an important public health problem. Whereas comprehensive molecular typing data of MRSA strains is available, particularly in Europe, North America and Australia, similar information is very limited in sub-Saharan Africa including Zambia. METHODS: in this study, thirty two clinical isolates of <i>Staphylococcus aureus</i>, collected at a large referral hospital in Lusaka, Zambia between June 2009 and December 2012 were analysed by Staphylococcal cassette chromosome <i>mec (SCCmec), Staphylococcus</i> protein A gene typing <i>(spa)</i> and detection of the Panton-Valentine Leukocidin genes<i> (pvl)</i>. RESULTS: three SCC<i>mec</i> types were identified namely SCC<i>mec</i> type IV (65.6%), SCCmec type III (21.9%), SCC<i>mec</i> type I (3.1%). Nine point four percent (9.4%) of the isolates were untypable. Five <i>spa</i> types, which included a novel type, were detected and the most prevalent spa type was t064 (40.6%). Other <i>spa</i> types included spa types t2104 (31.3%), t355 (3.1%) and t1257 (21.9%). The <i>pvl </i>genes were detected in 3 out of 32 isolates. CONCLUSION: these molecular typing data indicated that the MRSA strains collected in Lusaka were diverse. Although the source of these MRSA was not established, these results stress the need for assessing infection prevention and control procedures at this health-care facility in order to curtail possible nosocomial infections. Furthermore, country-wide surveillance of MRSA in both the community and health-care facilities is recommended for infection prevention and control. To our knowledge, this represents the first study to characterise MRSA using molecular tools in Zambia.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Karim Nadour, Abdelhamid Messary [Images in medicine] - Dent inclue dans la fosse nasale - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/107/abstract/ <b>Il s'agit d'une patiente &acirc;g&eacute;e de 17 ans, sans ant&eacute;c&eacute;dents pathologiques particuliers qui a consult&eacute; pour des &eacute;pistaxis &agrave; r&eacute;p&eacute;titions de faibles abondances par la fosse nasale gauche associ&eacute;es &agrave; une sensation de nez bouch&eacute; homolat&eacute;rale et des &eacute;pisodes de rinorrh&eacute;es f&eacute;tides, &eacute;voluant depuis 7 mois. L'examen clinique retrouvait une patiente en assez bon &eacute;tat g&eacute;n&eacute;ral. L'examen des fosses nasales a retrouv&eacute; quelques caillots de sang au niveau de la fosse nasale gauche, la canule d'aspiration buttait contre une formation blanch&acirc;tre de consistance osseuse implant&eacute;e dans le plancher de la fosse nasale gauche et faisant saigner la muqueuse nasale en son contact. L'examen buccodentaire notamment celui de l'arcade dentaire sup&eacute;rieure n'a pas objectiv&eacute; d'anomalie morphologique ou en nombre. Un blondeau-scanner r&eacute;alis&eacute; en acquisition spiral&eacute;e en coupes coronales (A) et axiales (B) en fen&ecirc;tre osseuse a objectiv&eacute; la pr&eacute;sence d'un processus l&eacute;sionnel spontan&eacute;ment hyperdense au niveau de la fosse nasale gauche en regard du cornet inf&eacute;rieur en rapport avec une dent incluse (fl&egrave;che). La patiente a b&eacute;n&eacute;fici&eacute; d'une extraction de cette dent par voie endoscopique apr&egrave;s une anesth&eacute;sie locale obtenue par un bon m&eacute;chage &agrave; la xylocaine naphazolin&eacute;e. Les suites op&eacute;ratoires ont &eacute;t&eacute; simples. L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par la disparition des &eacute;pistaxis et de l'obstruction nasale. L'&eacute;ruption dentaire au niveau de la fosse nasale constitue une des formes topographiques de l'ectopie dentaire. Cette situation inhabituelle doit &ecirc;tre &eacute;voqu&eacute;e devant une &eacute;pistaxis et une rhinorrh&eacute;e purulente f&eacute;tide unilat&eacute;rales.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Loyal Poonamjeet Kaur, Nderitu Joseph Munyiri, Wekesa Vincent Dismus [Research] - Clinical analysis of aqueductal stenosis in patients with hydrocephalus in a Kenyan setting - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/106/abstract/ <b>INTRODUCTION: aqueductal stenosis is the commonest cause of congenital hydrocephalus. The scope of this paper is to highlight the disease burden of hydrocephalus attributed to aqueductal stenosis which still remains unknown in our setting. METHODS: in a descriptive cross-sectional study, 258 records of patients diagnosed with hydrocephalus were analyzed after ethical approval from Kenyatta National Hospital- University of Nairobi (KNH-UON) ethics and research committee from January 2010 to May 2016. Patients with a diagnosis of hydrocephalus due to aqueductal stenosis were included in this study. Patients age, sex, mode of delivery, associated comorbidities, presenting complaints, neurosurgical intervention performed, Kafarnosky score were recorded. Data were divided into 2 sets based on the patient’s age i.e. whether < 1 year or > 12 years. Data were recorded on google data collection form and analyzed using Google spreadsheets. RESULTS: out of 258 cases of hydrocephalus, 52 had aqueductal stenosis. Male to female sex ratio for this condition was 3:2. There were 25 cases < 1year and 27 cases > 12 years old who were diagnosed with hydrocephalus due to aqueductal stenosis. Associated conditions were bilateral congenital talipes equinovarus, spina bifida, Arnold Chairi malformations, meningitis and HIV. The presenting complaints differed according to the age groups. Neurosurgical interventions included Endoscopic Third Ventriculostomy (ETV) in 21 cases, insertion of Ventriculoperitoneal (VP) shunt and ETV were done in 3 cases while the rest had only insertion of VP shunt. The Kafanosky score improve from < 50 pre-op to 19 cases achieving a score of 100, six months post-op. CONCLUSION: aqueductal stenosis contributes a significant burden of morbidity in patients with hydrocephalus. Clinical presentation differs according to patients age. Accurate diagnosis and treatment remain a cardinal to improving patient outcome.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Henry Okoli, Taiwo Obembe, Kayode Osungbade, Folashayo Adeniji, David Adewole [Research] - Self-referral patterns among federal civil servants in oyo state, South-Western Nigeria - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/105/abstract/ <b>INTRODUCTION: primary health care is widely accepted as the first point of care seeking; yet, individuals requiring healthcare engage in self-referrals to higher levels of care thereby by-passing primary care. Little is known of the extent to which self-referrals are carried out when care is needed. This study thus sought to determine the prevalence of self-referral, its patterns and factors influencing self-referrals amongst federal civil servants in Southwestern Nigeria. METHODS: a cross-sectional study was carried out among 300 federal civil servants who were interviewed using validated and pre-tested interviewer-administered semi structured questionnaires. Data was analyzed using univariate and Chi-square test at level of significance set at P <0.05. RESULTS: mean age of the respondents was 39.96 ± 9.1 years with majority being married (80.7%); 90.7% completed tertiary education (and 76.7 % were middle grade (7-12) level officers. Most (60.0%) of the respondents had ever engaged in self-referral. Malaria was the commonest health problem (39.7%) for self-referral to secondary or tertiary facilities. Desire for quality service (35.7%) and competent staff (35.2%) were the commonest reasons for self-referral to a higher level of health care. More female respondents (76.0%) compared to male respondents (64.0%) significantly engaged in self-referral (p = 0.02, X2 = 5.14). Respondents having good knowledge of referral practices engaged less in self-referral compared to those with poor knowledge. (p = 0.02, X2 = 5.43). CONCLUSION: having good knowledge of referral practices and being male are positively associated with referral practices. Creating awareness and improving knowledge on referral practices with special emphasis on women population are desirable strategies for encouraging the use of primary health care as first of point of contact with health systems.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Davy Vancampfort, Brendon Stubbs, Marc De Hert, Christy du Plessis, Caleb Ademola Omuwa Gbiri, Jepkemoi Kibet, Nancy Wanyonyi, James Mugisha [Research] - A systematic review of physical activity policy recommendations and interventions for people with mental health problems in Sub-Saharan African countries - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/104/abstract/ <b>INTRODUCTION: there is a need for interventions to address the escalating mental health burden in Sub-Saharan Africa (SSA). Implementation of physical activity (PA) within the rehabilitation of people with mental health problems (PMHP) could reduce the burden and facilitate recovery. The objective of the current review was to explore (1) the role of PA within mental health policies of SSA countries, and (2) the current research evidence for PA to improve mental health in SSA. METHODS: we screened the Mental Health Atlas and MiNDbank for mental health policies in SSA countries and searched PubMed for relevant studies on PA in PMHP in SSA. RESULTS: sixty-nine percent (=33/48) of SSA countries have a dedicated mental health policy. Two of 22 screened mental health policies included broad physical activity recommendations. There is clear evidence for the role of PA in the prevention and rehabilitation of depression in SSA. CONCLUSION: despite the existing evidence, PA is largely a neglected rehabilitation modality in the mental health care systems of SSA. Continued education of existing staff, training of specialized professionals and integration of PA for mental health in public health awareness programs are needed to initiate and improve PA programs within the mental health care systems of SSA.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zainab Datti Ahmed, Baffa Sule Ibrahim, Mohammed Lukman Abolaji, Yahaya Mohammed, Patrick Nguku [Research] - Knowledge and utilization of contraceptive devices among unmarried undergraduate students of a tertiary institution in Kano State, Nigeria 2016 - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/103/abstract/ <b>INTRODUCTION: students in the universities mostly live independently from their parents or guardians, some of them for the first time. This gives them freedom and opportunity for high risk behavior such as unplanned and unprotected sex. The results of such sexual experimentation may include unplanned and or unwanted pregnancies that may lead to unsafe abortions and sexually transmitted infections (STIs) including HIV/AIDS. Contraception has the potential to prevent unwanted pregnancies, abortion, and STIs. This study aimed at assessing the general knowledge on contraceptives, sexual practices, and level of utilization of contraceptives devices among unmarried students of the Bayero University Kano. METHODS: we did an institutional based cross-sectional descriptive study. We administered a pretested, self-administered, structured questionnaire to randomly selected unmarried undergraduate students of the institution. We analyzed data using Microsoft Excel 2016 and Epi-info7. RESULTS: a total of 300 students were interviewed. The median age for respondents was 23years with an age range of 16–25years. Male respondents make up 61.3%(184) while the females made up the remaining 38.7%(116). Also, 158(47.33%) of respondents live outside the school campus, while 158(52.67%) live in the school hostels. Knowledge on contraception was 87.7% among respondents with internet (91%) and media (89.3%) as their commonest sources of knowledge. Proportion of sexually active students was 10.67%, while prevalence of contraceptive utilization among sexually active students was 15.63%. About 8(25%) had their sexual debut at <16years of age, 22(68.75%) at ages between 16-20years, and 4(12.5%) above 20years of age. All sexually active respondents practice vaginal sex. Most sexual debuts are planned (44.75 %) and with friends (86.4%), and they occurred between the ages of 16-20years age group in 70.3% of respondents. CONCLUSION: even though knowledge on contraceptive used was high among the respondents, utilization of contraceptives among sexually active students was low, thus creating a window for possible unintended and unwanted pregnancies among these group of students.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Abdelmone Ghorbel [Images in medicine] - Branchial cleft cyst: a case report - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/102/abstract/ <b>Brachial cleft cysts are rare congenital malformations of the lateral neck and typically present in the second and third decades of life. Many theories have been proposed to explain the aetiology of these cysts including incomplete obliteration of branchial mucosa, persistence of vestiges of the precervical sinus and cystic lymph node origin. Preoperative imaging investigations show a fluid-filled cyst and evaluate anatomic relationships. Differential diagnosis includes metastatic squamous cell carcinoma, lymphadenitis, lymphoma, cervical dermoid cyst, cystic hygroma and parotid pathology. Surgical excision is the treatment of choice and results in a good prognosis. We present the case of a 37-year-old woman referred to our department for assessment of a neck swelling that had gradually increased in size during the previous nine months. The clinical examination found a 6 cm non-tender mass of the upper-left neck. The MRI revealed a cystic lesion measuring 4×5×6 cm, displacing the sternocleidomastoid muscle posterolaterally, and the carotid and internal jugular vein medially. The mass was completely resected through a lateral cervicotomy. The histological examination revealed a cystic wall lined with stratified squamous epithelium consistent with the diagnosis of a branchial cleft cyst. The postoperative course was uneventful. Long-term follow-up has shown no evidence of recurrence.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Youssef Alaoui Lamrani, Mustapha Ma&acirc;roufi [Images in medicine] - Cavernome du quatri&egrave;me ventricule - 26 February 2017. http://www.panafrican-med-journal.com/content/article/26/101/abstract/ <b>Monsieur KR, patient de 58 ans, admis pour trouble de l’&eacute;quilibre avec diplopie horizontale gauche install&eacute;s la veille de son admission. Devant cette atteinte vestibulaire et paralysie du VI gauche, une IRM a &eacute;t&eacute; effectu&eacute;e attestant d’un cavernome intraventriculaire (CIV), rarement d&eacute;crit au V4. Les cavernomes repr&eacute;sentent des hamartomes pouvant atteindre tout le n&eacute;vraxe. IRM c&eacute;r&eacute;brale montrant une l&eacute;sion nodulaire (fl&egrave;che) du plancher du 4&egrave;me ventricule (V4), en hypersignal T1 (a), hyposignal annulaire en T2 (b) et T2* (c). La s&eacute;quence inject&eacute;e T1 montre une anomalie veineuse de d&eacute;veloppement (AVD) paraventriculaire gauche (&eacute;toile). La pr&eacute;valence des CIV varie entre 2,5% et 10%, leurs localisations intraventriculaires int&eacute;ressent le 3&egrave;me ventricule, ventricules lat&eacute;raux, trigone, et V4, dans 44%, 27%, 20% et 9% respectivement. Leurs manifestations cliniques sont asp&eacute;cifiques li&eacute;es essentiellement &agrave; l’hypertension intracr&acirc;nienne. L’imagerie des CIV est similaire aux localisations intraparenchymateuses avec comme particularit&eacute;, une tendance &agrave; des tailles plus volumineuses du fait d’une croissance non contrebalanc&eacute;e par le LCR. La TDM montre une l&eacute;sion ronde hyperdense, avec calcifications annulaires en "popcorn" assez caract&eacute;ristiques. Quant &agrave; l’IRM, le CIV est h&eacute;t&eacute;rog&egrave;ne en T1, en hypersignal central en T2 avec un anneau p&eacute;riph&eacute;rique d’hyposignal relatif au d&eacute;p&ocirc;t d’h&eacute;mosid&eacute;rine. La s&eacute;quence T2* est int&eacute;ressante dans la d&eacute;tection de cavernomes multiples. Les s&eacute;quences inject&eacute;es peuvent montrer des AVD fr&eacute;quemment associ&eacute;es aux cavernomes. Les diagnostics diff&eacute;rentiels (DD) des CIV incluent astrocytomes de bas grade, neurocytomes, et t&eacute;ratomes. L’hypersignal central et l’anneau p&eacute;riph&eacute;rique d’hyposignal T2, rendent le diagnostic de cavernome assez ais&eacute; et &eacute;liminent les DD.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Monoarthritis of the knee revealing tabetic arthropathy - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/100/abstract/ <b>53-year-old man presented with monoarthritis of the knee without fever evolving since 6 months associated with an inflammatory biological syndrome. The articular puncture brought back a sterile inflammatory fluid. The radiographs of the frontal knee (A) and profile knee (B) and CT of the knee (C, D) showed destruction of the internal femoral condyle with osteolysis of the medial border of the internal tibial plateau associated with multiple bone constructions with the presence of intra-articular fragments, intra-articular effusion and thickening of the synovium. The diagnosis of tabetic arthropathy in its hypertrophic form was retained following a 20-year history of syphilitic inoculation chancre, posterior radiculocordonal syndrome, imaging data and positive syphilitic serology (TPHA-VDRL) in the blood and cerebrospinal fluid. The patient was treated with penicillin G (24 million/day) for 15 days. Tabetic arthropathy is a type of neuropathic arthropathy that has become rare and unfamiliarity with the clinical presentation of this disease may lead to considerable delay in diagnosis. This disease means progressive painless joint destruction that is related to neurosensory deficits caused by syphilis. His diagnosis is difficult as its clinical presentation is not specific and differential diagnosis is wide ranging. Hence, his diagnosis requires clinical suspicion and an appropriate serological test.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Salah Bellasri, Hicham Janah [Images in medicine] - Lung hemorrhage and brain stroke following fatal viper (cerastes cerastes) bite - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/99/abstract/ <b>A 46-year-old with a history of mild hypertension was working outside when a viper bit him on his right hand. The patient arrived at the nearest medical facility about 30 minutes after and received polyvalent antivenom serum, bite site care. He was taken to the emergency department (ED) by ambulance. At ED of our center, 2 hours after bite, the patient was unconscious, his blood pressure was initially unobtainable, and his cardiac monitor revealed a rate of 147/min. Breathlessness, hemoptysis and rales were heard in the lung bases. Neurological examination revealed right hemiplegia, a right facial droop, and dysarthria. A Foley catheter was placed and returned a hemorrhagic fluid. A blood samples examinations showed: a hematocrit was 45%, prothrombine (PT) greater than 120 seconds, HGB 8.7 g/dl, platelets 30 x103 /mm3. Blood oxygen saturation after oxygen facemask was low, and the patient was intubated, using in endotracheal tube and was placed on a ventilator. 6 hours following admission, after the patient was somewhat stabilized, a noncontrast computerized tomographic (CT) scan of the head demonstrated multiples stroke with hemorrhagic infarction left middle cerebral artery territory (a, b). A chest CT scan revealed an area of alveolar condensation reaching the superior right lobe and Fowlers segment related to hemorrhagic intra alveolar bleeding (c, d). The morning following admission, the patient was found to be hypoxic. His systolic blood pressure decreased. Later on second day, the patient became flaccid with nonreactive pupils and he was pronounced dead later the same day.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Moulay Omar Moustaine, Foued Dellali, Abbas El Husseini, Anne-Lise Hirsch [Case report] - Le traitement anti-VEGF des n&eacute;ovaisseaux choro&iuml;diens juxta-fov&eacute;olaires du fort myope: &agrave; propos d’une observation - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/98/abstract/ <b>Les n&eacute;ovaisseaux choro&iuml;diens constituent une complication redoutable de la forte myopie rapport&eacute;e dans 5 &agrave; 10% des cas. Ils doivent &ecirc;tre pris en charge rapidement vu leur pronostic sombre. Les IVT des anti-VEGF constituent actuellement la nouvelle alternative th&eacute;rapeutique d&eacute;passant de loin la th&eacute;rapie photo-dynamique (PDT). N&eacute;anmoins l'algorithme th&eacute;rapeutique anti-VEGF devant ce type de n&eacute;ovaisseaux reste un sujet de discussion entre les auteurs. A travers cette observation on essaie d'illustrer la difficult&eacute; de prise en charge de ces n&eacute;ovaisseaux et de discuter le sch&eacute;ma th&eacute;rapeutique Anti-VEGF &agrave; suivre.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hermine Fouda, Gloria Ashuntantang, Fran&ccedil;ois Kaze, Marie-Patrice Halle [Research] - La survie en h&eacute;modialyse chronique au Cameroun - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/97/abstract/ <b>INTRODUCTION: l'h&eacute;modialyse est le seul traitement de substitution r&eacute;nale disponible au Cameroun; elle est subventionn&eacute;e &agrave; 95% par l'Etat depuis 2002 et le nombre de centre de dialyse va croissant. Cependant, depuis l'ouverture du premier centre en 1990, aucune donn&eacute;e n'existe sur la survie des h&eacute;modialys&eacute;s chroniques. METHODES: nous avons conduit une &eacute;tude de cohorte prospective multicentrique de 15 mois dans le but d'&eacute;valuer la mortalit&eacute; et les facteurs qui influencent la survie des h&eacute;modialys&eacute;s chroniques camerounais. RESULTATS: nous avons suivi 197 patients dont 109 incidents. L'&acirc;ge moyen &eacute;tait de 47,97± 13,19 ans et 55% &eacute;taient de sexe masculin. La dur&eacute;e moyenne en dialyse des patients pr&eacute;valent &eacute;tait de 12,5 mois. Le taux de mortalit&eacute; &eacute;tait de 57,58% dont 50% pendant les 3 premiers mois et le taux d'abandon &eacute;tait de 8,6%.. L'ur&eacute;mie et les sepsis sur cath&eacute;ter &eacute;taient les principales causes de d&eacute;c&egrave;s. La survie globale &agrave; 15 mois &eacute;tait de 30,77%, avec une dur&eacute;e moyenne de vie de 8 mois. Les patients pr&eacute;valent, la r&eacute;sidence dans la ville du centre de dialyse, la prise en charge non familiale, le suivi pr&eacute; dialyse > 3 mois, la cholest&eacute;rol&eacute;mie &agrave; l'entr&eacute;e en dialyse> 1,5g/l, un score mental > 25 &eacute;taient associ&eacute;s &agrave; une meilleure survie. CONCLUSION: la mortalit&eacute; en h&eacute;modialyse au Cameroun est &eacute;lev&eacute;e, avec une survie moyenne de 8 mois et la plupart des patients d&eacute;c&egrave;dent au cours des 3 premiers mois.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri [Images in medicine] - Une cause rare de compression m&eacute;dullaire : l'h&eacute;matome &eacute;pidural rachidien spontan&eacute; - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/96/abstract/ <b>Patiente &acirc;g&eacute;e de 26 ans, sans ant&eacute;cedents, admise en urgence pour prise en charge d'une lourdeur des 2 membres inf&eacute;rieurs. La symptomatologie a &eacute;t&eacute; d&eacute;but&eacute; trois jours avant son admission par l'apparition brutale de rachialgies cervico-thoraciques, d'embl&eacute;e intenses r&eacute;sistantes aux antalgiques habituels, suivies d'une lourdeur des deux membres inf&eacute;rieurs associ&eacute;es &agrave; des troubles g&eacute;nito-sphinct&eacute;riens &agrave; type de r&eacute;tention aigue d'urines et une constipation. L'interrogatoire n'a pas trouv&eacute; la notion de traumatisme ni de prise d'anticoagulants ou d'autre ant&eacute;c&eacute;dent m&eacute;dico-chirurgical notable. L'examen clinique a objectiv&eacute; une patiente consciente, apyr&eacute;tique, ayant une parapl&eacute;gie flasque grade A de Frankel avec une anesth&eacute;sie &agrave; niveau sup&eacute;rieur mamelonnaire. Une IRM m&eacute;dullaire urgente a objectiv&eacute; un h&eacute;matome extradural (&eacute;pidural) rachidien post&eacute;rieur &eacute;tendu de la septi&egrave;me vert&egrave;bre cervicale C7 &agrave; la deuxi&egrave;me vert&egrave;bre dorsale D2 . Le Bilan biologique notamment le bilan de la crase sanguine &eacute;tait normal. La patiente fut op&eacute;r&eacute;e en urgence au travers une incision m&eacute;diane post&eacute;rieure avec r&eacute;alisation d'une laminectomie &eacute;tendue de la sixi&egrave;me vert&egrave;bre cervicale jusqu'&agrave; la deuxi&egrave;me vert&egrave;bre dorsale. L'h&eacute;matome &eacute;pidural a &eacute;t&eacute; &eacute;vacu&eacute;, l'h&eacute;mostase faite et des pr&eacute;l&egrave;vements pour &eacute;tude anatomopathologique ont &eacute;t&eacute; faits. L'&eacute;tude histologique n'a pas retrouv&eacute; d'&eacute;tiologie sous-jacente. L'&eacute;volution postop&eacute;ratoire a &eacute;t&eacute; marqu&eacute;e apr&egrave;s un recul de six mois par une r&eacute;cup&eacute;ration compl&egrave;te du d&eacute;ficit moteur . L'h&eacute;matome &eacute;pidural rachidien spontan&eacute; est une affection rare et grave. C'est une urgence neurochirurgicale, diagnostique et th&eacute;rapeutique dont la rapidit&eacute; de la prise en charge conditionne le pronostic. Le diagnostic est devenu ais&eacute; surtout avec l'av&egrave;nement de l'IRM .Les facteurs de gravit&eacute; sont l'installation brutale et rapide du d&eacute;ficit neurologique, la pr&eacute;sence d'un d&eacute;ficit neurologique complet et la localisation thoracique de l'h&eacute;matome. Une r&eacute;cup&eacute;ration neurologique pr&eacute;coce, un d&eacute;ficit incomplet ou essentiellement moteur, une localisation cervicale ou lombo-sacr&eacute;e sont des facteurs d'une meilleure r&eacute;cup&eacute;ration.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri [Images in medicine] - Une &eacute;tiologie rare du syndrome de la queue de cheval : l'h&eacute;mangiome vert&eacute;bral neuro-agressif - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/95/abstract/ <b>Un patient &acirc;g&eacute; de 17 ans, sans ant&eacute;c&eacute;dents pathologiques notables, admis aux urgences neurochirurgicales pour une fatigabilit&eacute; progressive &agrave; la marche et des fuites urinaires. L'examen clinique a trouv&eacute; une discr&egrave;te diminution de la force musculaire des deux membres inf&eacute;rieurs (parapar&eacute;sie grade D de Frankel) associ&eacute;e &agrave; un discret d&eacute;ficit &eacute;picritique sans niveau sensitif. Devant ce tableau de compression de la queue de cheval, une IRM du rachis lombo-sacr&eacute;e a &eacute;t&eacute; r&eacute;alis&eacute;e et a montr&eacute; la pr&eacute;sence d'un processus vert&eacute;bral envahissant la majeure partie du corps vert&eacute;bral de L3 associ&eacute;e &agrave; une &eacute;pidurite ant&eacute;rieure compressive se prolongeant jusqu'en regard du corps vert&eacute;bral de L4 (A, B, C). Le patient a &eacute;t&eacute; op&eacute;r&eacute; par un abord r&eacute;trop&eacute;riton&eacute;al avec une d&eacute;compression du sac dural. Les suites chirurgicales &eacute;taient simples. L'anatomopathologie a confirm&eacute; le diagnostic d'angiome capillaire b&eacute;nin. Apres un recul de 4 ans, le patient a r&eacute;cup&eacute;r&eacute; sa force musculaire des membres inferieur ainsi que ces troubles urinaires. Les h&eacute;mangiomes vert&eacute;braux agressifs repr&eacute;sentent une entit&eacute; tr&egrave;s rare. Il s'agit de l&eacute;sions vasculaires b&eacute;nignes, souvent uniques, qui se manifestent le plus souvent par des signes de compression m&eacute;dullaire. L'IRM occupe une place importante par le fait qu'elle permet une analyse multiplanaire directe et une caract&eacute;risation tissulaire. Elle trouve un int&eacute;r&ecirc;t majeur dans le bilan d'extension au niveau &eacute;pidural et permet une bonne approche du retentissement sur les structures nerveuses.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Osteoid osteoma of the scapula mimicking a pathology of the shoulder - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/94/abstract/ <b>A 14-year-old patient presented with chronic shoulder pain evolving since three years. The pain persisted despite the various medicated and physical treatments followed. The clinical examination noted a normal shoulder examination with pain facing the right scapula without local inflammatory signs. There were no abnormalities in the biological examinations, in particular absence of biological inflammatory syndrome, rheumatoid factor negative and normal calcemia. Radiographs of the shoulder and scapula were normal. Bone scintigraphy showed hyperfixation of the radiotracer regarding the right scapular spine evoking an osteoid osteoma (A). CT scan of the right scapula showed a very limited osteolytic lesion without osteocondensation edges with a non-enhanced hypodense matrix after injection of contrast agent (B). MRI showed lesion of the right scapular spine in hypersignal T1 and T2 without cortical rupture or periosteal reaction suggestive of a benign lesion such as osteoid osteoma (C, D). The patient had a biopsy with surgical resection of the lesion. The diagnosis of osteoid osteoma was confirmed histologically. The peculiarity of this observation lies in the rarity of this localization and the deceptive clinical picture suggesting a shoulder pathology in first intention. In cases of diagnostic doubt and in the presence of normal radiographs, the most specific examination is thin-section CT scans, the sensitivity of which can be improved by association with an MRI.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Yousra El Boussaadni, Noufissa Benajiba, Ahmed Aziz Bousfiha, Fatima Ailal [Case report] - Syndrome d’activation macrophagique compliquant une lymphohistiocytose familiale - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/93/abstract/ <b>Le syndrome d'activation macrophagique (SAM) est une entit&eacute; anatomoclinique due &agrave; une stimulation inappropri&eacute;e des macrophages. Il demeure une pathologie rare, caract&eacute;ris&eacute;e par des signes cliniques peu sp&eacute;cifiques et des &eacute;l&eacute;ments biologiques dont l'association doit faire &eacute;voquer le diagnostic. Il peut &ecirc;tre d'origine primaire ou secondaire, son pronostic reste encore sombre. Nous rapportons une observation d'un nourrisson de 3 ans et 4 mois ayant &eacute;t&eacute; admis dans notre service pour prise en charge d'une SAM primitif afin de rappeler aux praticiens la n&eacute;cessit&eacute; de penser &agrave; une cause primitive devant des situations particuli&egrave;res.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hicham El Bote, Abelilah El Alaoui, Ziouani Oussama, Hachem El Sayegh, Ali Iken, Lounis Benslimane, Yassine Nouini [Case series] - Carcinome neuroendocrine de la vessie: &agrave; propos de 5 cas - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/92/abstract/ <b>Le carcinome neuroendocrine de la vessie est une entit&eacute; histologique rare, caract&eacute;ris&eacute;e par une diss&eacute;mination m&eacute;tastatique rapide et un pronostic d&eacute;favorable. Le but de ce travail &eacute;tait d'analyser les caract&eacute;ristiques cliniques, histologiques, th&eacute;rapeutiques et pronostiques du carcinome neuroendocrine de la vessie. Il s'agissait d'une &eacute;tude r&eacute;trospective portant sur 5 patients collig&eacute;s au service d’Urologie A, CHU Ibn Sina durant la p&eacute;riode entre janvier 2008 et juin 2015. L’&acirc;ge m&eacute;dian &eacute;tait de 63 ans. Quatre patients &eacute;taient de sexe masculin et une patiente de sexe f&eacute;minin. Le carcinome neuroendocrine &eacute;tait pur dans quatre cas et impur ou associ&eacute; &agrave; une composante uroth&eacute;liale dans un cas. Deux cancers &eacute;taient m&eacute;tastatiques d’embl&eacute;e. Une cystectomie a &eacute;t&eacute; r&eacute;alis&eacute;e dans un cas apr&egrave;s chimioth&eacute;rapie n&eacute;oadjuvante, une chimioradioth&eacute;rapie dans deux cas et une chimioth&eacute;rapie palliative dans les deux autres. La dur&eacute;e m&eacute;diane de survie &eacute;tait de 10 mois. Un seul patient &eacute;tait en vie, avec un recul de 20 mois. La prise en charge des carcinomes neuroendocrines de la vessie n’est pas standardis&eacute;e, plusieurs moyens th&eacute;rapeutiques ont &eacute;t&eacute; propos&eacute;s : la chirurgie, la radioth&eacute;rapie et la chimioth&eacute;rapie.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Aggouri Mohamed [Images in medicine] - Glioblastomes intra m&eacute;dullaire chez l'enfant: localisation et type histologique rare - 23 February 2017. http://www.panafrican-med-journal.com/content/article/26/91/abstract/ <b>Un enfant de 4 ans, sans ant&eacute;c&eacute;dents , qui a pr&eacute;sent&eacute;e deux mois avant son admission, des c&eacute;phal&eacute;es associ&eacute;es &agrave; des douleurs cervicales irradiant vers les &eacute;paules et le rachis dorsal, aggrav&eacute;es par l'installation d'une lourdeur des quatres membres, chez qui l'examen a trouv&eacute; un enfant conscient, avec une t&eacute;trapar&eacute;sie lourde . L'IRM m&eacute;dullaire a objectiv&eacute;e un processus tumoral m&eacute;dullaire cervicale &eacute;tendu de la jonction bulbo-m&eacute;dullaire jusqu'&agrave; D1 en hyposignal T1 et en hypersignal T2 avec une composante charnue et kystique rehauss&eacute;e de fa&ccedil;on h&eacute;t&eacute;rog&egrave;ne apr&egrave;s injection de gadolinium (A). La patiente a b&eacute;n&eacute;fici&eacute; d'une laminectomie de 8 niveau, de C1 &agrave; D1, avec craniectomie &agrave; os perdu sous occipitale et ex&eacute;r&egrave;se macroscopiquement totale du processus. Un examen extemporan&eacute; est revenu en faveur de glioblastome, diagnostic qui a &eacute;t&eacute; confirm&eacute; par l'examen anatomo-pathologique de la pi&egrave;ce op&eacute;ratoire (B). La patiente a b&eacute;n&eacute;fici&eacute;e de la radioth&eacute;rapie post op&eacute;ratoire. L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par l'am&eacute;lioration progressive de la t&eacute;trapar&eacute;sie avant son d&eacute;c&egrave;s par des troubles neuro-v&eacute;g&eacute;tatifs 18 mois plus tard. Les glioblastomes de la moelle &eacute;pini&egrave;re sont exceptionnelle, L'IRM apr&egrave;s injection du Gadolinium reste la meilleure modalit&eacute; d'imagerie pour le diagnostic (C). Le traitement de choix est l'ex&eacute;r&egrave;se chirurgicale la plus compl&egrave;te possible suivie d'une radioth&eacute;rapie et &eacute;ventuel chimioth&eacute;rapie , La survie moyenne de ces patients est de 12 mois apr&egrave;s le diagnostic.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com El Mouhtadi Aghoutane, Tarik Salama, Redouane El Fezazi [Case report] - Isolated tuberculosis of metacarpal bone in a 3 year-old child - 23 February 2017. http://www.panafrican-med-journal.com/content/article/26/90/abstract/ <b>Primary tuberculosis osteomyelitis of metacarpal bone is rare. The majority of cases occur in children and young adults and there is difficulty in diagnosis mainly in young children. We report a new case in children aged of 3 years, presenting a swelling on the dorsal side of her right hand since 8 months. X-ray showed an expansile, cystic and lytic lesion involving the little finger metacarpal. Tuberculosis was confirmed on histological examination. No lesions in lung parenchyma or lymphadenopathy were associated. Patient was successfully managed by anti-tubercular drugs.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Sanaa Hammi, Hajar Berrani, Thami Benouchen, Naima Lamlami, Imane Elkhiyat, Jamal Eddine Bourkadi [Case report] - A primary intestinal lymphangiectasia hiding the diagnosis of pleural and pericardial tuberculosis: a clinical observation - 23 February 2017. http://www.panafrican-med-journal.com/content/article/26/89/abstract/ <b>Primary intestinal lymphangiectasia (Waldmann&iuml;¿½s disease) is an exudative enteropathy characterized by lymph leakage into the small bowel lumen leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia (particularly T-cell). The diagnosis is based on viewing the duodenal lymphangiectasia. A 20 years old female patient, treated for a primary intestinal lymphangiectasia, has consulted for anasarca. Etiological work-up reveals pleural and pericardial tuberculosis. The clinical aggravation of an enteropathy, particularly in adulthood, requires a search for a secondary etiology. Tuberculosis should be sought systematically.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hicham Titou, Youssef Jalal, Mohammed Boui [Case report] - Pseudothrombop&eacute;nie non EDTA-d&eacute;pendante: &agrave; propos d’un cas - 22 February 2017. http://www.panafrican-med-journal.com/content/article/26/88/abstract/ <b>La pseudothrombop&eacute;nie est un ph&eacute;nom&egrave;ne rare de laboratoire, expliqu&eacute;e par une agglutination in vitro des plaquettes. L’examen au microscope du frottis du sang p&eacute;riph&eacute;rique est un examen cl&eacute;, pour confirmer le diagnostic et pour &eacute;viter toute d&eacute;cision clinique et th&eacute;rapeutique inadapt&eacute;e voir dangereuse. Sa survenue chez un patient, sous traitement par l’h&eacute;parine, pose le probl&egrave;me de diagnostic diff&eacute;rentiel avec la thrombop&eacute;nie h&eacute;parino-induite. Notre objective, &agrave; travers cette observation, est d’&eacute;viter toute confusion entre ce ph&eacute;nom&egrave;ne purement art&eacute;factuel et la thrombop&eacute;nie h&eacute;parino-induite.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Gideon Chukwudalu Ilechukwu, Chioma Azuka Ilechukwu, Agozie Chukwunedum Ubesie, Ijeoma Okoroafor, Basil Chukwuemeka Ezeanolue, Ngozi Chinyelu Ojinnaka [Research] - Bacterial agents of the discharging middle ear among children seen at the University of Nigeria Teaching Hospital, Enugu - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/87/abstract/ <b>INTRODUCTION: discharging middle ear continues to be one of the commonest problems seen in the developing world. There is an ever growing need to carry out studies periodically to determine the common bacterial agents responsible for discharging otitis media and their antibiotic sensitivity especially in set-ups characterized with minimal laboratory services. The study sought to determine the common bacterial agents causing discharging middle ear among children presenting at the University of Nigeria Teaching Hospital, Enugu and their sensitivity to the commonly available antibiotics. METHODS: middle ear swabs were collected from 100 children aged 1 month to 17 years at the Children Out-Patient and Otorhinolaryngology Clinics of the University of Nigeria Teaching Hospital, Enugu, Nigeria. The specimens were cultured for aerobic bacterial organisms and their sensitivity determined. RESULTS: among those with acute discharge, Staphylococcal aureus was isolated in 31.3% and Proteus species in 25.0%. In chronically discharging ears, Proteus Species dominated (39.1%), followed by Staphylococcal aureus (28.3%).</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Lilia Affes, Mouna Elleuch, Fatma Mnif, Faten Hadj Kacem, Dhouha Ben Salah, Mouna Mnif, Nadia Charfi, Nabila Rekik, Mohamed Abid [Case report] - Syndrome de Guillain Barr&eacute; et d&eacute;compensation acidoc&eacute;tosique du diab&egrave;te au cours de la grossesse: a propos d’un cas et revue de la litt&eacute;rature - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/86/abstract/ <b>Une femme enceinte &acirc;g&eacute;e de 27 ans a &eacute;t&eacute; admise dans le service de r&eacute;animation pour une d&eacute;compensation acidoc&eacute;tosique s&eacute;v&egrave;re spontan&eacute;e inaugurale d'un diab&egrave;te type 1. La patiente a &eacute;t&eacute; r&eacute;anim&eacute;e et insulin&eacute;e avec une bonne &eacute;volution clinique et biologique. Au 4&egrave;me jour, la patiente a pr&eacute;sent&eacute;e un tableau de polyradiculon&eacute;vrite aigue d'installation brutale. Les examens compl&eacute;mentaires faites en urgences &eacute;taient n&eacute;gatives. Une cytoponction lombaire a montr&eacute; une dissociation albuminocytologique. L'&eacute;lectromyogramme a confirm&eacute; le diagnostic de syndrome de Guillain Barr&eacute; (SGB). La patiente a &eacute;t&eacute; mise sous veinoglobuline avec r&eacute;&eacute;ducation physique. Une am&eacute;lioration spectaculaire des signes neurologiques a &eacute;t&eacute; not&eacute;e. Concernant sa grossesse, la patiente a avort&eacute; au bout d'une semaine de diagnostic de SGB. L'association de SGB avec une d&eacute;compensation c&eacute;tosique est rare. En effet, quelques cas ont &eacute;t&eacute; rapport&eacute;s dans la litt&eacute;rature. Cette association au cours d'une grossesse n'est jamais d&eacute;crite d'o&ugrave; l'originalit&eacute; de notre cas.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Trochant&eacute;rite tuberculeuse isol&eacute;e - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/85/abstract/ <b>Un patient &acirc;g&eacute; de 40 ans, &eacute;tait hospitalis&eacute; pour exploration d'une douleur inflammatoire int&eacute;ressant la face sup&eacute;ro-externe de la cuisse droite &eacute;voluant depuis 8 mois, sans alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral ni fi&egrave;vre. La pression en regard du grand trochanter droit &eacute;tait douloureuse sans signes inflammatoires locaux. La biologie n'a pas montr&eacute; de syndrome inflammatoire. La radiographie du bassin a r&eacute;v&eacute;l&eacute; une l&eacute;sion ost&eacute;olytique du grand trochanter droit avec &eacute;paississement des parties molles en regard (A). La scintigraphie osseuse a montr&eacute; une hyperfixation du grand trochanter droit (B). Le scanner du basin a r&eacute;v&eacute;l&eacute; une l&eacute;sion ost&eacute;olytique du grand trochanter droit contenant de multiples s&eacute;questres, avec irr&eacute;gularit&eacute; corticale et collection multicloisonn&eacute;e en regard de la l&eacute;sion (C). Une ponction-biopsie osseuse du grand trochanter, sous contr&ocirc;le scannographique (D), a mis en &eacute;vidence un granulome &eacute;pith&eacute;lio&iuml;de et giganto-cellulaire &agrave; l'histologie, avec pr&eacute;sence de BK &agrave; la culture du liquide de ponction. Le diagnostic de tuberculose trochant&eacute;rienne &eacute;tait alors port&eacute;. L'intradermor&eacute;action &agrave; la tuberculine (IDR) &eacute;tait n&eacute;gative. La recherche d'autres localisations tuberculeuses s'est r&eacute;v&eacute;l&eacute;e n&eacute;gative. Le patient a &eacute;t&eacute; mis sous antituberculeux pendant 12 mois avec bonne &eacute;volution. La tuberculose constitue actuellement une cause rare sinon exceptionnelle de douleur trochant&eacute;rienne. La particularit&eacute; de notre observation r&eacute;side aussi dans l'absence d'autres localisations tuberculeuses.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Taopheeq Bamidele Rabiu [Research] - Clinical outcomes of posterior spinal stabilization with rigid vertical strut and spinal process wires (the Adeolu’s technique) in a developing country - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/84/abstract/ <b>INTRODUCTION: conventional instrumentation for spinal stabilization is beyond the reach of many patients in developing countries. A low-cost and easily-available method of spinal stabilization using vertical struts and spinal process wires (Adeolu’s technique) was recently introduced in Nigeria. We describe the clinical outcomes of a prospective series of patients managed using the technique. METHODS: from 2011 to 2012, we performed posterior spinal stabilization in eighteen patients using the technique. Primary outcomes were radiological evidence of rigid stabilization and mobilization without restrictions referable to the procedure in the immediate post-operative period. Implant rotation, migration, back-out, fracture, wound infection, worsening neurological status and need for implant removal were secondary measures. Overall patient satisfaction was assessed using a five-point Likert scale. The average follow-up period was 11.6 months. RESULTS: the average age of the patients was 45.8 years. Trauma with unstable spinal fractures (11), spondylosis (5), and thoracic extra-dural tumour (2) were the indications for surgery. The average number of spinal levels stabilized was 6. All patients had satisfactory primary outcomes. Implant rotation occurred in 3 patients (16.7%). There was no case of implant migration, back-out or fracture. Superficial surgical site infection occurred in one patient. There was no need to remove the implant in any subject and none had post-operative worsening of neurological status. The overall patient satisfaction was good with 17 patients (94.4%) reporting “highly satisfied” or “satisfied” with the surgical procedure. CONCLUSION: the technique offers utility in a wide range of spinal pathologies and short-term clinical outcomes are good.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Anthony Ademola Olashore, James Ayugi, Philip Opondo [Research] - Prescribing pattern of psychotropic medications in child psychiatric practice in a mental referral hospital in Botswana - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/83/abstract/ <b>INTRODUCTION: there is a growing preference for psycho-pharmacologicaltherapy over non-pharmacological care. The prescription pattern and the choice of psychotropic medications vary in different settings. Whilst newer agents and rational prescribing are favored in the more specialized settings, the pattern remains unclear in less specialized units, largely due to lack of data. The aims were to conduct a treatment audit in the only mental referral hospital in Botswana, which is a non-specialized child and adolescent care setting and see how it conforms to best practice. METHODS: a retrospective audit which involved the extraction of socio-demographic and clinical information from the records of patients who were ? 17 years and seen from January 1, 2012-July 31, 2016. RESULTS: a total of 238 files were used for this report. Mean age (SD) was 12.41 (4.1) years. Of the 120 (50.4%) patients who had pharmacological intervention, only 82(68.6%) had monotherapy. The most commonly prescribed psychotropic was antipsychotic (40%). Off-label use of antipsychotics and polypharmacy were 31.2% and 29.2% respectively. CONCLUSION: the level of conformity to standard practice in terms of psychotropic prescribing in our setting is consistent with the reports from developed countries where more specialized care ostensibly exists. Further studies will be necessary to determinethe scope of psychotropic use.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com B&eacute;kaye Traor&eacute;, Youssouf Fofana [Images in medicine] - Le neurofibrome plexiforme diffus de la cuisse gauche chez une patiente &acirc;g&eacute;e de 78 ans en milieu dermatologique &agrave; Bamako - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/82/abstract/ <b>La neurofibromatose type I (NF) ou maladie de Von Recklinghausen est une g&eacute;nodermatose autosomique dominante se manifestant par des anomalies de la peau, du syst&egrave;me nerveux, des os et des glandes endocrines. Les neurofibromes plexiformes diffus caract&eacute;ristiques de cette maladie sont souvent cong&eacute;nitaux, toujours visibles avant cinq ans et tendent &agrave; se d&eacute;velopper &agrave; partir de l’adolescence. Ils sont retrouv&eacute;s chez 20 &agrave; 25% des malades et sont localis&eacute;s dans 97% des cas &agrave; la paupi&egrave;re sup&eacute;rieure. Nous rapportons le cas d’une patiente &acirc;g&eacute;e de 78 ans, pr&eacute;sentant depuis l’&acirc;ge de 8 ans une tum&eacute;faction indolore, molle, avec comme zone d’insertion la lisi&egrave;re fesse gauche-cuisse gauche et se terminait au tiers inferieur de la cuisse gauche. Elle mesurant 25 cm sur sa longueur, 5 cm &agrave; sa base d’implantation et 10 cm &agrave; son bord libre. Depuis quelques temps, la patiente signalait une sensation de lourdeur de la cuisse gauche. L’examen clinique a objectiv&eacute; 10 taches caf&eacute; au lait sur le tronc, de nombreux neurofibromes cutan&eacute;s sur le tronc et les membres. A noter que son fils pr&eacute;sentait des l&eacute;sions similaires. L’examen ophtalmologique a r&eacute;v&eacute;l&eacute; une cataracte &eacute;volutive li&eacute;e &agrave; l’&acirc;ge. Le reste de l’examen clinique &eacute;tait normal. Nous avions &eacute;voqu&eacute; trois hypoth&egrave;ses diagnostiques : un neurofibrome plexiforme diffus le plus probable, un molluscum pendulum et un liposarcome. Le diagnostic de neurofibrome type I a &eacute;t&eacute; retenu devant le neurofibrome plexiforme diffus, les neurofibromes cutan&eacute;s, les taches caf&eacute; au lait et la pr&eacute;sence des l&eacute;sions similaires chez son fils.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Anis Mzabi [Images in medicine] - An unusual cause of chronic low back pain: ochronosis - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/81/abstract/ <b>A 45-year-old man presented with low back pain evolving since 8 years associated sometimes with a radicular radiation. The clinical examination found a patient in good general condition, a loss of the lumbar lordosis, an exaggeration of the dorsal kyphosis with stiffness of the lumbar spine. The cutaneous-mucosal examination showed a brownish appearance of the ears, conjunctiva, and lower eyelids. In biology there was neither inflammatory syndrome nor perturbation of the phosphocalcic balance. The standard radiographs of the lumbar spine (A) and dorsal spine (B) revealed multiple disc calcifications associated with large staggered disc clumps and discal empty images. Due to mucocutaneous signs, normality of biology and the radiological aspect, the diagnosis of ochronosis was suspected and confirmed by the test of blackening of the urine to the ambient air, the results of the cutaneous biopsy showed pigmented deposits yellow ocher and brownish in the dermis and the dosage of alkaptonuria. Symptomatic treatment resulted in moderate improvement. The family survey did not reveal any similar cases. Ochronosis or alkaptonuria is a rare autosomal recessive disorder of tyrosine metabolism. Deficiency of homogentisate 1,2 dioxygenase results in accumulation of oxidized homogentisic acid in the connective tissues of the skin, eyes and ears, musculoskeletal system, and cardiac valves, and in urolithiasis. Ochronosis is of late onset, responsible for the rachis of extended disc calcifications with maximum spinal fusion. It is the cause of degenerative arthropathy. Early diagnosis and screening of this disease are then of great interest, especially for genetic counseling.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Tarik Boulahri, Abdellah Taous, Maha A&iuml;t Berri, Imane Traibi, Jalal Elbenaye, Abdelhadi Rouimi [Case report] - Association rickettsiose et infarctus c&eacute;r&eacute;bral: une nouvelle observation - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/80/abstract/ <b>La fi&egrave;vre boutonneuse m&eacute;diterran&eacute;enne (FBM) est une rickettsiose du groupe boutonneux due &agrave; rickettsia conorii. Cette zoonose est r&eacute;put&eacute;e d'&eacute;volution b&eacute;nigne mais peut se compliquer dans les formes s&eacute;v&egrave;res d'une atteinte neurologique qui en font parfois toute la gravit&eacute;. Nous rapportons l'observation d'une patiente &acirc;g&eacute;e de 49 ans ayant pr&eacute;sent&eacute; au cours de son hospitalisation en dermatologie pour une rickettsiose, une h&eacute;mipl&eacute;gie droite massive d'installation brutale. L'angio-IRM c&eacute;r&eacute;brale a objectiv&eacute; un accident vasculaire c&eacute;r&eacute;bral isch&eacute;mique sylvien profond gauche. Le diagnostic de rickettsiose de type conorii a &eacute;t&eacute; retenu sur l'aspect des l&eacute;sions dermatologiques et la positivit&eacute; des s&eacute;rologies par immuno-fluorescence indirecte. L'&eacute;volution &eacute;tait favorable sous anti-bioth&eacute;rapie (doxycycline et fluoroquinolone). Exceptionnellement rapport&eacute; dans le cadre des manifestations neurologiques des rickettioses, l'infarctus c&eacute;r&eacute;bral reste une complication &agrave; ne pas m&eacute;connaitre surtout en regard d'un bilan &eacute;tiologique en particulier cardiovasculaire demeur&eacute; n&eacute;gatif.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Redouane Hani, Mustapha Nekkaoui, Mohammed Kharmaz, Mohamed El Ouadghiri, Abdou Lahlou, Mly Omar Lamrani, Ahmed El Bardouni, Mustapha Mahfoud, Mohamed Saleh Berrada [Case series] - Le traitement chirurgical des fractures de la palette hum&eacute;rale chez l’adulte - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/79/abstract/ <b>Le traitement des fractures de la palette hum&eacute;rale repose principalement sur la chirurgie de reconstruction par ost&eacute;osynth&egrave;se. On a collig&eacute; dans nos archives 40 cas de fracture de la palette hum&eacute;rale au service de traumatologie-orthop&eacute;die de CHU IBN SINA de RABAT du mois JANVIER 2012 au mois de DECEMBRE 2014, dont le but est de montrer les particularit&eacute;s cliniques, th&eacute;rapeutiques et &eacute;volutives de ces fractures; ainsi que les difficult&eacute;s de prise en charge de ces fractures complexes et d’&eacute;valuer les r&eacute;sultats. On a not&eacute; une nette pr&eacute;dominance masculine (75 % des cas) avec un &acirc;ge moyen de 35 ans. Les &eacute;tiologies sont domin&eacute;es par accidents de la voie publique (56 %). Tous nos patients ont &eacute;t&eacute; hospitalis&eacute;s par le biais des urgences puis op&eacute;r&eacute;s. Le type C selon la classification de M&Uuml;LLER et ALLGOWER(A.O) est le plus fr&eacute;quent : 62,5% des cas .les l&eacute;sions associ&eacute;es sont assez fr&eacute;quents (52,5%) dans le cadre d’un poly-traumatisme. Tous nos patients ont &eacute;t&eacute; op&eacute;r&eacute;s (100% des cas) via un bord post&eacute;rieur dans 70 % des cas. Ce geste comprenait une r&eacute;duction puis ost&eacute;osynth&egrave;se par plaque de LECESTRE dans 82,5% des cas. Nos r&eacute;sultats sont de 85,5 % de bons et moyens r&eacute;sultats, conform&eacute;ment aux donn&eacute;es de la litt&eacute;rature. La prise en charge de ce type de fracture est bas&eacute;e sur une r&eacute;duction anatomique parfaite, par un montage solide qui doit permettre une r&eacute;&eacute;ducation pr&eacute;coce garante d’un bon r&eacute;sultat fonctionnel.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Youssef Alaoui Lamrani, Mustapha Maaroufi [Images in medicine] - Dissection vertébrale post-traumatique asymptomatique: résultats IRM - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/78/abstract/ <b>IRM cervicale en coupe sagittale T2 montrant une contusion œd&eacute;mateuse m&eacute;dullaire (&eacute;toile), associ&eacute;e &agrave; un h&eacute;matome pr&eacute;vert&eacute;bral (H). Les autres coupes T2 (b, c), et T2* (d) r&eacute;v&egrave;lent une thrombose de l’art&egrave;re vert&eacute;brale (AV) droite (fl&egrave;che). L’occlusion atteint le segment V3 et sans l&eacute;sion isch&eacute;mique intracr&acirc;nienne. Monsieur D.L. &acirc;g&eacute;e de 43 ans, a &eacute;t&eacute; victime d’un traumatisme cervical lors d’un accident de la voie publique. L’examen r&eacute;v&egrave;le une t&eacute;trapar&eacute;sie non expliqu&eacute;e par les donn&eacute;es TDM qui montrent des fractures vert&eacute;brales irradiant vers les trous transverses C5 et C6 droits. Le recours en deuxi&egrave;me intention &agrave; l'IRM cervicale a r&eacute;v&eacute;l&eacute; une contusion m&eacute;dullaire œd&eacute;mateuse, avec occlusion de l’AV droite sur tout son trajet extra-cr&acirc;nien, et qui est le si&egrave;ge d’un h&eacute;matome intramural sugg&eacute;rant une dissection vert&eacute;brale sous-jacente. Son caract&egrave;re asymptomatique est li&eacute;e &agrave; une AV gauche perm&eacute;able avec un polygone de Willis fonctionnel assurant la suppl&eacute;ance du syst&egrave;me vert&eacute;bro-basilaire. Le caract&egrave;re complet de l’occlusion &agrave; &eacute;viter toute complication thrombo-embolique. La dissection des AV extra-cr&acirc;niennes est associ&eacute;e &agrave; des traumatismes de haute &eacute;nergie et corr&eacute;l&eacute;e &agrave; la gravit&eacute; du bilan l&eacute;sionnel ost&eacute;o-m&eacute;dullaire. La clinique est masqu&eacute;e par d’autres l&eacute;sions traumatiques &agrave; la phase aigue, et les sympt&ocirc;mes sont d’apparition retard&eacute;e. Ces derniers sont d’ordre isch&eacute;mique de m&eacute;canisme h&eacute;modynamique ou thrombo-embolique. L’extension de la dissection en intracr&acirc;nien peut causer une h&eacute;morragie m&eacute;ning&eacute;e. Le traitement repose sur des anticoagulants ou antiagr&eacute;gants en absence de l&eacute;sions visc&eacute;rales ou intracr&acirc;niennes s&eacute;v&egrave;res, le recours au traitement endovasculaire s’av&egrave;re n&eacute;cessaire en pr&eacute;sence d’une menace isch&eacute;mique dynamique.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Luc Hervé Samison, Fidiniaina Mamy Randriatsarafara, Stéphane Ralandison [Research] - Joint pain epidemiology and analgesic usage in Madagascar - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/77/abstract/ <b>INTRODUCTION: to describe the epidemiology of joint pains and document analgesics usage in an African context. METHODS: patients suffering from joint pain were recruited from nine sites located in Antananarivo, Madagascar, including 6 hospital services and 3 clinics. Doctors collected information on the etiology and characteristics of the patients’ pain. Analgesics prescribed by these doctors were also documented. RESULTS: in total, 400 patients were enrolled in the study (52.5% women, mean age of 42.34 years ± 17.7 [4-86]). Pain of mechanical type was found in 260 participants, 65%; 95% CI [60.1% to 69.6%] and inflammatory type pains in 128 cases 32%; 95% CI [27.5% to 36.9%]. Mixed pains were found in 12 patients (3%). The median duration of pain prior to the consultation was 6.5 days. The average pain intensity was 57.9 ± 19.9 mm of a total of 100 mm maximum on a visual analogue scale, VAS. The etiologies of mechanical type pains were dominated by fracture, common low back pain and tendonitis. Arthrosis was the dominant cause of inflammatory type pain, followed by rheumatoid arthritis and gout. NSAIDs (74.5%) were the most frequently prescribed analgesics followed by paracetamol (49.5%), weak opioids (23%) and corticosteroids (12.25%). Two-thirds of medical prescriptions (65.3%) were of combined analgesics.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Mohamed Amine Chaabouni [Images in medicine] - Giant laryngeal polyp: an unusual indication of tracheostomy - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/76/abstract/ <b>Benign laryngeal lesions, especially laryngeal polyps are very common and they usually only cause hoarseness andrarely develop into dyspnea.This condition is generally attributed to smoking. Cardiorespiratory failure and sudden death due tolarge laryngeal polypwas reported in the literature. The preferred treatment of large polyps is surgical excision using suspension microlaryngoscopy. We present a case of a 60-year-old man presented to the emergency with stridor and severe dyspnea. He had a 4-month history of a neglected inspiratory dyspnea and dysphonia. Fiberoptic laryngoscopy revealed a large laryngeal mass causing airway obstruction. Administration of oxygen, inhalation and intravenous administrationof corticosteroid did not relieved hissymptoms. As intubation was judged impossible, an emergency tracheostomy was performed to salvage the patient. After tracheostomy, the dyspnea ceased. Computed tomography scan showed a homogeneous regular formation of 2.5×1.5 cm obstructing the glottis and the subglottislumen. Direct laryngoscopy under general anesthesia identified a valve-like large polyp attached to the anterior wall of the subglottic region. The polyp wastotally excised with no complication. Decannulation was carried out on the second postoperative day. The masswas histologically diagnosed as normal vocal cord polyp.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Adil Kallat, Hani Abousaleh [Images in medicine] - H&eacute;matome spontan&eacute; du rein - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/75/abstract/ <b>Il s’agit d’un patient de 54 ayant comme ant&eacute;c&eacute;dents une appendicectomie il y a 6 ans et qui pr&eacute;sente des lombalgies gauches &eacute;voluant depuis 3 mois aggrav&eacute;es 3 jours avant son admission aux urgences. Par ailleurs il n’y avait pas de notion d’h&eacute;maturie ou d’&eacute;mission de calculs ni de traumatisme lombaire ou abdominal. L’examen &agrave; l’admission retrouvait un patient en assez bon &eacute;tat g&eacute;n&eacute;ral, conjonctives l&eacute;g&egrave;rement d&eacute;color&eacute;es, stable sur le plan h&eacute;modynamique. Le bilan biologique retrouvait une h&eacute;moglobine &agrave; 7.7g/dl, le reste du bilan &eacute;tait sans particularit&eacute;. L’uroscanner r&eacute;alis&eacute; mettait en &eacute;vidence la pr&eacute;sence d’une volumineuse collection p&eacute;ri-r&eacute;nale gauche &agrave; pr&eacute;dominance post&eacute;rieure, h&eacute;t&eacute;rog&egrave;ne, renfermant des zones spontan&eacute;ment hyperdenses (A). Le patient a &eacute;t&eacute; transfus&eacute; de deux culots globulaires. Vu la stabilit&eacute; h&eacute;modynamique, on avait d&eacute;cid&eacute; ce faire une simple surveillance avec l’instauration d’un traitement antalgique et antibiotique pour &eacute;viter la surinfection de l’h&eacute;matome. L’uroscanner de contr&ocirc;le a &eacute;t&eacute; r&eacute;alis&eacute; un mois plutard ayant objectiv&eacute; une nette r&eacute;gression de l’h&eacute;matome (B).</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Maryame Ezziti, Fouad Haddad, Mohamed Tahiri, Wafaa Hliwa, Ahmed Bellabah, Wafaa Badre, Rabii Haddouch, Khalid El Hattbi, Mohamed Rachid Elfriyekh, Abdelaziz Fadil [Case report] - Trichob&eacute;zoard gastrique: &agrave; propos d’un cas - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/74/abstract/ <b>Le trichob&eacute;zoard est une affection rare, le plus souvent asymptomatique, mais de diagnostic facile par la fibroscopie œsogastroduod&eacute;nale. Le traitement est le plus souvent chirurgical. On rapporte une observation d’un trichob&eacute;zoard gastrique chez une fillette de 16 ans, qui a &eacute;t&eacute; extrait par gastrotomie, sans complications. Une prise en charge psychiatrique a &eacute;t&eacute; faite.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Adil Kallat, Hicham Ouazize, Otheman Fahsi, Hani Abousaleh, Hachem El Sayegh1, Ali Iken1, Lounis Benslimane, Yassine Nouini [Case report] - Carcinome tubulo-papillaire chez une jeune de 17 ans: &agrave; propos d’un cas et revue de la litt&eacute;rature - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/73/abstract/ <b>Les tumeurs tubulo-papillaires repr&eacute;sentent 10% des carcinomes &agrave; cellules r&eacute;nales. Elles sont plus fr&eacute;quentes chez l’homme que chez la femme (sex ratio: 8/1). L’&acirc;ge moyen se situe dans la sixi&egrave;me d&eacute;cade. Sur le plan anatomopathologique, on distingue deux types: le 1 correspondant &agrave; une prolif&eacute;ration de cellules basophiles et le type 2 qui correspond &agrave; une prolif&eacute;ration de cellules &eacute;osinophiles. Nous rapportant le cas d’une patiente de 17 ans sans ant&eacute;c&eacute;dents pathologiques qui s’est pr&eacute;sent&eacute;e aux urgences pour des douleurs de la fosse lombaire droite et du flanc droit avec h&eacute;maturie &eacute;voluant depuis deux jours avant son admission, le tout &eacute;voluant dans un contexte d’amaigrissement et d’alt&eacute;ration de l’&eacute;tat g&eacute;n&eacute;ral. L’examen clinique &agrave; son admission retrouvait une patiente en mauvais &eacute;tat g&eacute;n&eacute;ral, apyr&eacute;tique avec une tension art&eacute;rielle &agrave; 110mmhg/70mmhg et une fr&eacute;quence cardiaque &agrave; 110 battements par minute. L’examen abdominal objectivait &agrave; l’inspection une voussure du flanc droit avec d&eacute;fense et empattement &agrave; la palpation. La num&eacute;ration formule sanguine retrouvait un taux d’h&eacute;moglobine &agrave; 6 g/dl ayant n&eacute;cessit&eacute; une transfusion. Le scanner abdominal a mis en &eacute;vidence une volumineuse formation tissulaire polaire inf&eacute;rieure r&eacute;nale droite de 10 cm/7.8 cm avec &eacute;panchement liquidien p&eacute;ri-r&eacute;nal de 17 mm d’&eacute;paisseur. Deux jours apr&egrave;s son admission l’&eacute;volution a &eacute;t&eacute; marqu&eacute;e par une d&eacute;globulisation avec accentuation des douleurs abdominales, on d&eacute;cide alors de faire une n&eacute;phrectomie d’h&eacute;mostase. On a r&eacute;alis&eacute; une n&eacute;phrectomie totale &eacute;largie droite par abord sous costal avec &agrave; l’examen anatomopathologique un carcinome tubulo-papillaire de type 2. Le scanner thoracique r&eacute;alis&eacute; ult&eacute;rieurement n’a pas objectiv&eacute; de localisations secondaires.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Anthony Laku Stephen Kirbak, Zipporah Ng’ang’a, Jared Omolo, Hakim Idris, Abdulmumini Usman, William Baguma Mbabazi [Research] - Sero-prevalence for Hepatitis B virus among pregnant women attending antenatal clinic in Juba Teaching Hospital, Republic of South Sudan - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/72/abstract/ <b>INTRODUCTION: hepatitis B virus infection is a major public health problem worldwide and in Africa. This would be the first ever documented study on epidemiology of Hepatitis B infections in the newly formed Republic of South Sudan. This study was designed to estimate the sero-prevalence of Hepatitis B virus infection amongst pregnant women attending antenatal services in Juba. METHODS: a cross-sectional study was conducted among pregnant women attending antenatal clinic services in Juba Teaching Hospital, in the period between December 2012 and March 2013. Any pregnant woman, attending antenatal care services at Juba Teaching Hospital, was included if she was a resident of Juba County for at least 1 year before pregnancy. A Hepatitis B case was defined as any women participating in the study and was found to be positive for HbsAg and confirmed by ELISA. RESULTS: this study documented that the prevalence of Hepatitis B surface antigen (HBsAg) among pregnant women attending ANC in Juba was 11% (31 out of the 280 samples). Other samples tested were indeterminate (36%), naturally immune (27.1%), susceptible (23%) and the remaining 1.8% was immune due to vaccination. Significant risk factors for Hepatitis B infection were loss of partner (OR 4.4 and CI of 1.4-13.9) and history of Jaundice (OR 1.7 and CI of 1.2-2.1). CONCLUSION: these study findings show that only 29% of infants in Juba county are born to immune mothers (naturally or vaccine induced). The remaining 70% of babies would be at risk of infection, if a birth dose of Hepatitis B is not provided. We therefore recommended introduction of Hepatitis B Vaccine birth dose into routine infants’ vaccination series to eliminate this risk.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Therese Ntigwa Ndongmo, Clement Bertin Ndongmo, Charles Michelo [Research] - Sexual and reproductive health knowledge and behavior among adolescents living with HIV in Zambia: a case study - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/71/abstract/ <b>INTRODUCTION: as HIV infected adolescents mature into adulthood, they are confronted with issues related to sexuality and sexual reproductive health (SRH). An estimated 68,000 adolescents aged 10-19 years are living with HIV in Zambia. The current study explores their sexuality and SRH experience and needs. METHODS: this was a mixed method analytical cross-sectional study. Adolescents at a tertiary hospital were surveyed on their sexuality and SRH experiences. Bivariate analyses on SPSS were used to assess factors associated with selected behaviors. Emerging themes from open-ended questions qualitative data were explored using content analysis. RESULTS: a total of 148 adolescents (63.5% females) aged 15-19 years were surveyed. Majority (77.0%) had secondary education; 77.2% currently in school; 40.1 % had a boy or girlfriend; 15.1% have ever had sex, of whom only 61.1 % reported consistent condom use. About 68.9 % expressed intention to have children; 2.1% of girls had been pregnant before. Of 52 respondents, 19.2% had a sexually transmitted infection (STI) before. Not being in school was a significant predictor, for knowing where to access information about sex (OR= 2.53; 95% CI:1.10-5.82; p=0.02), and also for ever gone there (OR=2.61; 95% CI:1.04-6.58; p=0.03). ONCLUSION: the survey of HIV infected adolescents attending a tertiary hospital in Zambia found that their sexuality and SRH needs remain similar to those of the general adolescent population in terms of counseling in sexual matters, family planning and STI services. More efforts are needed to provide for adolescent health care needs, especially those living with HIV.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ababacar Abdoulaye Traore, Alami Badreeddine [Images in medicine] - D&eacute;couverte d’un cas inhabituel de m&eacute;ga chol&eacute;cystite aigue associ&eacute; &agrave; une dilatation kystique de la voie biliaire principale - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/70/abstract/ <b>Il s’agit d’une patiente de 81 ans, admise au service des urgences pour prise en charge d’une colique h&eacute;patique associ&eacute;e &agrave; un ict&egrave;re cutan&eacute;o-muqueux, quelques &eacute;pisodes de vomissement et une hyperthermie. A l’examen physique, la patiente avait une sensibilit&eacute; de l’hypochondre droit avec palpation d’une masse mobile douloureuse du flanc homolat&eacute;ral arrivant jusqu’au niveau de la fosse iliaque droite. Un bilan biologique a montr&eacute; une hyperleucocytose &agrave; polynucl&eacute;aire neutrophile 12000/uL, une C R&eacute;active Prot&eacute;ine &agrave; 144 mg/l avec perturbation du bilan h&eacute;patique de cholestase montre (&eacute;levation de la bilirubine et des transaminases &agrave; X fois la normale (pas besoin des chiffres exacts). Une &eacute;chographie r&eacute;alis&eacute;e en urgence a montr&eacute; une v&eacute;sicule biliaire tr&egrave;s distendue (14x07cm), lithiasiques &agrave; paroi &eacute;paissie, &eacute;tendue en bas jusqu’au niveau du carrefour ilio caecal avec ectasie des voies biliaires (voie biliaire principale = 26mm). Une TDM abdominale a objectiv&eacute; les m&ecirc;mes r&eacute;sultats d&eacute;crits &agrave; l’&eacute;chographie, avec dilatation kystique du chol&eacute;doque, le conduit pancr&eacute;atique principal &eacute;tait de calibre normal. Une CPRE r&eacute;alis&eacute;e avec sphinctorotomie a confirm&eacute; la dilatation kystique de la VBP. Le diagnostic de chol&eacute;cystite aigue associ&eacute; &agrave; une dilatation kystique de la VBP de type I de tadoni est retenu. Apr&egrave;s antibioth&eacute;rapie le patient a b&eacute;n&eacute;fici&eacute; d’un traitement chirurgical qui a consist&eacute; en une chol&eacute;cystectomie avec ex&eacute;r&egrave;se en bloc de la voie biliaire dilat&eacute;e, suivie d’une d&eacute;rivation bilio-digestive sur anse en Y. Les suites op&eacute;ratoires &eacute;taient simples.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Othmane Lahbali, Amine Azami, Mohammed Tbouda, Adil Elyamine, Fouad Zouaidia, Najat Mahassini [Case report] - Un myofibroblastome de type mammaire pas comme les autres: &agrave; propos d’un cas - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/69/abstract/ <b>Le myofibroblastome de type mammaire (MM) est une tumeur m&eacute;senchymateuse b&eacute;nigne rare initialement d&eacute;crit dans le sein. Le diagnostic de cette entit&eacute; repose sur un spectre d’arguments cliniques radiologiques et &eacute;ventuellement histologiques. Nous rapportons un cas rare de myofibroblastome de type mammaire si&eacute;geant au niveau axillaire chez un homme de 50 ans. La particularit&eacute; de notre cas est l’existence de plusieurs figures de mitoses et ceci est rarement d&eacute;crit dans la litt&eacute;rature. A travers ce cas nous soulevons les probl&eacute;matiques du diagnostic diff&eacute;rentiel de cette tumeur rare.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Asmama Yasmina, Amina Barakat [Case study] - Rupture pr&eacute;matur&eacute;e des membranes &agrave; terme: facteurs pronostiques et cons&eacute;quences n&eacute;onatales - 05 February 2017. http://www.panafrican-med-journal.com/content/article/26/68/abstract/ <b>La rupture pr&eacute;matur&eacute;e des membranes (RPM) &agrave; terme survient dans 5 &agrave; 10% des grossesses. Elle rend compte d'une part importante de morbidit&eacute; et de mortalit&eacute; n&eacute;onatales. Le but de cette &eacute;tude est de d&eacute;terminer les facteurs pronostiques maternels et obst&eacute;tricaux ainsi que le devenir des nouveau-n&eacute;s &agrave; terme issus d'une grossesse compliqu&eacute;e de rupture pr&eacute;matur&eacute;e des membranes ayant &eacute;t&eacute; hospitalis&eacute;s au service ou g&eacute;r&eacute;s &agrave; la consultation externe. Etude r&eacute;trospective, analysant toutes les observations de nouveau-n&eacute;s &agrave; terme issus de grossesses compliqu&eacute;es de RPM, enregistr&eacute;es au service de n&eacute;onatologie de l'h&ocirc;pital d'enfants de Rabat entre le 1er janvier et le 31 juillet 2014. Au cours de la p&eacute;riode d'&eacute;tude nous avons collig&eacute; 144 cas de RPM isol&eacute;e sur un total de 2400 naissances vivantes (NV) soit une pr&eacute;valence de 6% NV, r&eacute;partis comme suit : 06 cas de RPM (4%) entre 6 et 12 heures, 14 cas (9,7%) entre 12 et 18 heures, 28 cas (19,4%) entre 18 et 24 heures et 96 cas (66,6%) sup&eacute;rieure &agrave; 24 heures. La majorit&eacute; de nos parturientes &eacute;taient dans la tranche d'&acirc;ge de 25 &agrave; 35ans avec un taux de 52%. Une chorioamniotite associ&eacute;e a &eacute;t&eacute; retenue dans 8,3% des cas. Les parturientes ont &eacute;t&eacute; mises sous antibioth&eacute;rapie prophylactique par voie orale ou parent&eacute;rale dans 28% des cas, avec un liquide amniotique clair dans 81% des cas. Le diagnostic d'IMF probable a &eacute;t&eacute; retenu dans 46 cas dont 65.2 % dans le sous groupesup&eacute;rieur &agrave; 18 h versus respectivement 26% et 8,7% dans les sous groupe 12 &agrave; 18 h et inf&eacute;rieur &agrave; 12 h. A l'admission, on a not&eacute; une pr&eacute;dominance masculine avec 58,3%, les nouveau-n&eacute;s &eacute;taient asymptomatiques dans 76% des cas et ils pr&eacute;sentaient une d&eacute;tresse respiratoire dans 42,8% des cas, un ict&egrave;re dans 31,45% des cas, une fi&egrave;vre dans 14,2% des cas et des signes de souffrance neurologique dans 11,5% des cas. Tous les nouveau-n&eacute;s hospitalis&eacute;s, soit dans 72% des cas, ont &eacute;t&eacute; mis sous antibioth&eacute;rapie pendant une dur&eacute;e allant de 5 &agrave; 10 jours avec une dur&eacute;e d'hospitalisation moyenne de 2,44jours. Ce travail souligne le risque important d'IMF associ&eacute; &agrave; une RPM m&ecirc;me &agrave; terme. Ce risque est d'autant plus important que la rupture est sup&eacute;rieure &agrave; 24 heures de temps. Dans la majorit&eacute; des cas le liquide amniotique est clair et les nouveau-n&eacute;s sont asymptomatiques &agrave; l'admission, ce qui laisse la mise sous antibioth&eacute;rapie automatiquement de ces nouveau-n&eacute;s un sujet encore tr&egrave;s discutable.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Naoual El Omri, Fadwa Mekouar [Images in medicine] - Fistulized multidrug-resistant tuberculosis - 05 February 2017. http://www.panafrican-med-journal.com/content/article/26/67/abstract/ <b>A 21-year-old woman with no history of tuberculosis was admitted to the emergency room with an acute abdominal accompanied by fever. She underwent an emergency abdominal operation surgery and histological studies revealed a peritoneal and appendicular ovarian tuberculosis. The patient received antibacillar (Rifampicine, Isoniazid, Pyrazinamide). Two months later, she was readmitted with fever and a general physical deterioration while being on antituberculosis medications. Chest X-Ray and CT scan revealed a miliary tuberculosis with pleural and peritoneal effusion and lymphadenopathy above and below the diaphragm. HIV serology was negative. This peritoneal collection had caused a fistula on the abdominal wall with two sinus tracts in the midline. The bacteriological examination of the purulent material revealed a Mycobacterium tuberculosis with a high resistance to all anti-bacillar drugs except Etambuthol and Pyrazinamide. The patient was treated by etionamide, pyrazinamide, spiramycin and etambutole, with favorable outcome.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hicham Titou, Christelle Ebongo, Elarbi Bouati, Mohammed Boui [Case series] - Risk factors associated with local complications of erysipelas: a retrospective study of 152 cases - 05 February 2017. http://www.panafrican-med-journal.com/content/article/26/66/abstract/ <b>Erysipelas is a common skin infection. Hemorrhagic, bullous, abcessing and necrotic lesions are the major local complications. However, their occurrence factors are not clearly known. The aim of this study is to identify the risk factors associated with the occurrence of local complications of Erysipelas. Medical records from all patients hospitalized with local complications of erysipelas admitted to the Military Hospital of Rabat between 2005 and 2015, were retrospectively studied. Using an univariate and multivariate statistical study, the main characteristics were compared with those from patients with erysipelas without local complications. In total, 152 patients were analysed, of whom 72 had local disease complications. Using univariate analysis, the factors significantly associated with disease complications were found to be: age d" 50 years, female gender, heart disease, smoking, taking antibiotics or non-steroid anti-inflammatory drug before hospitalization, and accelerated sedimentation rate. However, in multivariate analysis, taking antibiotics before hospitalization (OR 5.15, 95% CI 1.28 to 20.72, P = 0.01) and accelerated sedimentation rate (OR 5, 15, 95% CI 1.00 to 1.06, P = 0.001) were the only independent factors associated with complicated erysipelas. Our study showed that prior antibiotics taking and higher sedimentation rate are independent risk factors for local complications of erysipelas. Patients with these characteristics should be carefully evaluated and monitored.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Saoussane Kharmoum, Rabie Rahhali [Images in medicine] - Maladie du Paget du mamelon - 03 February 2017. http://www.panafrican-med-journal.com/content/article/26/65/abstract/ <b>Nous rapportons le cas d’une patiente &acirc;g&eacute;e de 53 ans, m&eacute;nopaus&eacute;e, sans ant&eacute;c&eacute;dents pathologiques particuliers, qui pr&eacute;sente depuis une ann&eacute;e une l&eacute;sion squameuse et prurigineuse de la plaque ar&eacute;olo-mamelonnaire droite (A), l’examen clinique ne r&eacute;v&egrave;le pas de masses mammaires palpables, les aires ganglionnaires sont libres. La mammographie et l’&eacute;chographie mammaire trouvent un &eacute;paississement du rev&ecirc;tement cutan&eacute; p&eacute;ri-ar&eacute;olaire droit sans l&eacute;sions suspecte sous-jacente. Une biopsie a &eacute;t&eacute; r&eacute;alis&eacute; objectivant un &eacute;piderme papillomateux p&eacute;n&eacute;tr&eacute; par de nombreuses cellules tumorales malignes type Paget (B), l’immunohistochimie a montr&eacute; des cellules tumorales positives pour la cytok&eacute;ratine CK7 et n&eacute;gatives pour la CK20, avec une surexpression de l’HER2. Au vu de ces r&eacute;sultats le diagnostic de maladie de Paget a &eacute;t&eacute; retenu. La maladie de Paget correspond &agrave; l’envahissement de l’&eacute;piderme mamelonnaire par un carcinome canalaire in situ (CIS), il s’agit d’une variante rare du CIS, elle repr&eacute;sente 1 &agrave; 3 % des tumeurs mammaires. Elle peut &ecirc;tre associ&eacute;e &agrave; une n&eacute;oplasie mammaire dans plus de 80% des cas, d’o&ugrave; l’int&eacute;r&ecirc;t de r&eacute;aliser un bilan s&eacute;nologique complet. La maladie de Paget doit &ecirc;tre suspect&eacute;e et recherch&eacute;e devant toute l&eacute;sion unilat&eacute;rale et persistante du mamelon. Le traitement d&eacute;pend essentiellement de la pr&eacute;sence ou non d’un cancer mammaire sous-jacent. Il consiste &agrave; r&eacute;aliser une mastectomie ou une chirurgie conservatrice du sein avec un curage ganglionnaire. Les traitements adjuvants (radioth&eacute;rapie, chimioth&eacute;rapie, immunoth&eacute;rapie et hormonoth&eacute;rapie) doivent &ecirc;tre discut&eacute;s au cas par cas.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Jonathan Peter Nelson [Research] - Indications and appropriateness of caesarean sections performed in a tertiary referral centre in Uganda: a retrospective descriptive study - 03 February 2017. http://www.panafrican-med-journal.com/content/article/26/64/abstract/ <b>INTRODUCTION: the WHO has identified an ideal caesarean section rate for a nation of 10-15%, but much higher rates are seen in tertiary referral centres in resource-poor countries. Interventions by the author to improve care and reduced unnecessary caesareans were undertaken including staff education and production of clinical guidelines. This study aimed to identify indications for caesareans and whether the decision to perform caesareans was appropriate in order to improve care, and whether the above interventions had an impact on this process. METHODS: two groups of 100 consecutive cases from October 2014 and 100 from February 2015 were retrospectively selected that resulted in caesarean. These case notes were analysed for demographic data, caesarean indication and appropriateness. RESULTS: in 46% of cases the decision for caesarean was considered appropriate. No significant difference (p>0.05) was found between the two groups in terms of patient demographics or appropriateness of caesarean (43% in Oct-14 compared to 48% in Feb-15). The most common group of indications for caesarean was dystocia (43.5%) with 28% appropriate; followed by fetal distress (18.5%) with 30% appropriate; previous scar (17%) with 85% appropriate; malpresentation (10.5%) with 48% appropriate; and maternal compromise (10%) with 80% appropriate. CONCLUSION: the high number of unnecessary caesareans appeared to be related to lack of knowledge and inexperience of staff. Despite attempts to address this through teaching the scope of the problem is so large it needs a fundamental change in the healthcare system in terms of resources, education, continuing professional development and clinical governance.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Lamia Kissi, Rajaa El Bouihi, Mouna Lamchahab, Ahmed Alaoui, Ihsane Benyahya [Case report] - Localisation buccale d’un lymphome de Burkitt: &agrave; propos d’un cas - 03 February 2017. http://www.panafrican-med-journal.com/content/article/26/63/abstract/ <b>Le lymphome de Burkitt (LB) est une forme de lymphome malin non-Hodgkinien qui provient de l'&eacute;volution maligne et de la prolif&eacute;ration de cellules lympho&iuml;des de type B. Le diagnostic positif repose sur la biopsie d'une masse tumorale ou la ponction de la moelle osseuse r&eacute;v&eacute;lant la pr&eacute;sence de cellules tumorales. Le cas rapport&eacute; est celui d'un jeune homme d'une vingtaine d'ann&eacute;es qui a &eacute;t&eacute; adress&eacute; pour des tum&eacute;factions gingivales &eacute;voluant depuis 1 mois suite &agrave; des extractions dentaires. L'examen anatomopathologique apr&egrave;s biopsie compl&eacute;t&eacute; par l'immunohistochimie conclut &agrave; un lymphome de Burkitt. La prise en charge a consist&eacute; en une chimioth&eacute;rapie. Bien que rare, le lymphome de Burkitt est une tumeur agressive qui repr&eacute;sente un v&eacute;ritable probl&egrave;me de sant&eacute; publique d'o&ugrave; la place importante qu'occupe le m&eacute;decin dentiste dans le diagnostic pr&eacute;coce afin de permettre une prise en charge rapide et appropri&eacute;e seule garante de la gu&eacute;rison.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Akin Usta, Ceyda Sancakli usta, Ayla Yildiz, Ruhsen Ozcaglayan, Eylem Sen Dalkiran, Aydin Savkli, Meryem Taskiran [Research] - Frequency of fetal macrosomia and the associated risk factors in pregnancies without gestational diabetes mellitus - 02 February 2017. http://www.panafrican-med-journal.com/content/article/26/62/abstract/ <b>BACKGROUND: there has been an increased incidence of macrosomic newborns in the world and most of the macrosomic newborns are born from non-GDM pregnant women. The objective of this study was to determine the frequency and the associated risk factors of fetal macrosomia in non-GDM pregnant women. METHODS: a total 4246 consequtive pregnant women who had no GDM was included the study population. Data was collected from hospital database of Bal?kesir State Hospital between January 2014 and January 2015. Statistical analysis was carried out using the independent samples t-test and chi-squared test. Logistic regression analysis was used to determine the relationships between associated risk factors and the presence of fetal macrosomia. In this analysis, fetal macrosomia was taken as the dependent variable and associated risk factors were taken as independent variables. Results are shown as odds ratios (ORs) (95% CI) in the logistic regression analysis. RESULTS: 366 of the 4246 pregnant women were diagnosed with fetal macrosomia (8.6%). Compared the control women, a statistically significant correlation between fetal macrosomia and pre-pregnancy body mass index (BMI), gestational weight gain (GWG), parity, advanced maternal age, and male fetal sex was found. Maternal BMI, and GWG were the two risk factors most strongly associated with macrosomia. CONCLUSION: the prevalance of fetal macrosomia is rising among Turkish women. High pre-pregnancy BMI and GWG represent main modifiable risk factors for macrosomia and need more attention from health care providers.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Fouad Nya, Abdessamad Abdou, Mehdi Bamous, Younes Moutakiallah, Noureddine Atmani, Aniss Seghrouchni, Mahdi Aithoussa, Abdellatif Boulahya [Case report] - Myxome de la petite valve mitrale: &agrave; propos d’un cas - 02 February 2017. http://www.panafrican-med-journal.com/content/article/26/61/abstract/ <b>Les myxomes cardiaques constituent les formes les plus fr&eacute;quentes des tumeurs primitives du cœur. La localisation la plus fr&eacute;quente est le septum interatrial et exceptionnellement au niveau des valves cardiaques. L’ex&eacute;r&egrave;se chirurgicale est la seule alternative th&eacute;rapeutique. Nous rapportons l’observation clinique d’un patient &acirc;g&eacute; de 69 ans, sans ant&eacute;c&eacute;dents pathologique notables, qui a pr&eacute;sent&eacute; une dyspn&eacute;e stade II &agrave; III de la NYHA associ&eacute;e &agrave; une lipothymie. L’&eacute;chocardiographie transthoracique a objectiv&eacute; un r&eacute;tr&eacute;cissement aortique calcifi&eacute; serr&eacute; avec un gradient moyen VG-aorte &agrave; 58 mmHg. Au niveau de la valve mitrale pr&eacute;sence d’une masse de 15mm de diam&egrave;tre, s’ins&eacute;rant sur la petite valve mitrale sessile, sans effet de st&eacute;nose ni de fuite mitrale &eacute;voquant un myxome de localisation atypique ou un fibro&eacute;lastome. L’examen a &eacute;t&eacute; compl&eacute;t&eacute; par une ETO qui a confirm&eacute; le diagnostic de la masse de la petite valve mitrale. Le patient est op&eacute;r&eacute; avec une st&eacute;rnotomie m&eacute;diane verticale, et sous circulation extracorporelle conventionnelle. Une atriotomie gauche a permis d’objectiver une masse sessile de 15mm de diam&egrave;tre sur la face auriculaire de la petite valve mitrale, friable et facilement clivable. Le geste a &eacute;t&eacute; compl&eacute;t&eacute; par une caut&eacute;risation de la base d’implantation au bistouri &eacute;lectrique sans geste suppl&eacute;mentaire sur la petite valve mitrale. La pi&egrave;ce op&eacute;ratoire est adress&eacute;e en anatomo-pathologie qui a confirm&eacute; le diagnostic de myxome. Le patient a b&eacute;n&eacute;fici&eacute; aussi d’un remplacement valvulaire aortique par proth&egrave;se m&eacute;canique. Les suites op&eacute;ratoires imm&eacute;diates &eacute;taient simples. Le patient a quitt&eacute; le service &agrave; J8 postop&eacute;ratoire. La localisation mitrale du myxome cardiaque est tr&egrave;s rare. Le traitement chirurgical reste la seule option th&eacute;rapeutique avec une r&eacute;section la plus large possible pour &eacute;viter tout risque de r&eacute;cidive.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Eric Sampane-Donkor, Ebenezer Vincent Badoe, Jennifer Adoley Annan, Nicholas Nii-Trebi [Research] - Colonisation of antibiotic resistant bacteria in a cohort of HIV infected children in Ghana - 02 February 2017. http://www.panafrican-med-journal.com/content/article/26/60/abstract/ <b>Antibiotic use not only selects for resistance in pathogenic bacteria, but also in commensal flora of exposed individuals. Little is known epidemiologically about antibiotic resistance in relation to people with HIV infection in sub-Saharan Africa. This study investigated the carriage of antibiotic resistant bacteria among HIV infected children at a tertiary hospital in Ghana. One hundred and eighteen HIV positive children were recruited at the Korle-Bu Teaching Hospital in Ghana and nasopharyngeal specimens were collected from them. The specimens were cultured for bacteria, and the isolates were identified by standard microbiological methods. Antibiotic susceptibility tests were carried out on selected bacterial organisms by the Kirby Bauer method. Bacteria isolated from the study subjects included Moraxella catarrhalis (39.8%), coagulase negative staphylococci (33.1%), Streptococcus pneumoniae (30.5%), diptheroids (29.7%), viridian streptococci (27.1%), Staphylococcus aureus (22.0%), Citrobacter spp. (4.2%) and Neisseria meningitidis (0.9%). Prevalence of antibiotic resistance of S. pneumoniae ranged from 5.6% (ceftriaxone) to 58.3% (cotrimoxazole), M. catarrhalis ranged from 2.1% (gentamicin) to 80.6% (ampicillin), and S. aureus ranged from 7.7% (cefoxitin) to 100% (penicillin). The prevalence of multiple drug resistance was 16.7% for S. pneumoniae, 57.4% for M. catarrhalis and 84.6% for S. aureus. HIV infected children in the study area commonly carry multi-drug resistant isolates of several pathogenic bacteria such as S. aureus and S. pneumoniae. Infections arising in these patients that are caused by S. aureus and S. pneumoniae could be treated with ceftriaxone and cefoxitin respectively.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Irtyah Merchaoui, Lamia Bouzgarrou, Ahlem Mnasri, Mounir Mghanem, Mohamed Akrout, Jacques Malchaire, Neila Chaari [Research] - Influence of shift work on the physical work capacity of Tunisian nurses: a cross-sectional study in two university hospitals - 02 February 2017. http://www.panafrican-med-journal.com/content/article/26/59/abstract/ <b>INTRODUCTION: this study has been performed to determine the influence of rotating shift work on physical working capacity of Tunisian nurses and to design recommendations to managers so that they implement effective preventive measures. METHODS: it is a cross-sectional design using a standardized questionnaire and many physical capacity tests on a representative sample of 1181 nurses and nursing assistants from two university hospital centers of the school of Medicine of Monastir located in the Tunisian Sahel. 293 participants have been recruited by stratified random sampling according to gender and departments. Maximum Grip strength, 30s sit-to-stand test, one leg test, Fingertip-to-Floor test, Saltsa test and peak expiratory flow were used to assess physical capacity. Work ability was assessed through the workability index.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hamza Samlali, Zineb Bouchbika, Zineb Bennani, Amina Taleb, Nadia Benchekroune, Hassan Jouhadi, Nezha Tawfiq, Souha Sahraoui, Abdellatif Benider [Case report] - M&eacute;tastase cr&acirc;nienne d’un ad&eacute;nocarcinome rectal: &agrave; propos d’un cas avec revue de la litt&eacute;rature - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/58/abstract/ <b>Les m&eacute;tastases osseuses sont g&eacute;n&eacute;ralement d'origine pulmonaire, prostatique, r&eacute;nale, v&eacute;sicale ou thyro&iuml;dienne chez les hommes. Une origine colorectale est rare. Peu de publications ont d&eacute;crit ce type de m&eacute;tastases, la localisation la plus fr&eacute;quente est le rachis axial ou le bassin. La localisation cr&acirc;nio-faciale est exceptionnelle. Nous relatons ainsi le cas d'une observation d'un homme suivi pour un cancer du rectum m&eacute;tastatique avec une m&eacute;tastase osseuse temporale. Notre observation se rapportait &agrave; l'histoire d'un homme &acirc;g&eacute; de 38 ans suivi pour un cancer du rectum initialement op&eacute;r&eacute; par r&eacute;section ant&eacute;rieur classant la tumeur pT3N0M0. 24 mois apr&egrave;s, le patient pr&eacute;sentait une exophtalmie gauche r&eacute;v&eacute;lant un processus tumoral temporal. L'&eacute;volution et le contexte &eacute;taient en faveur d'une m&eacute;tastase. En conclusion, nous rapportons dans cette observation, un cas exceptionnel d'une m&eacute;tastase osseuse cr&acirc;nio-faciale d'un cancer colo-rectal multi-m&eacute;tastatique qui pourra enrichir les rares donn&eacute;es rapport&eacute;es dans la litt&eacute;rature se rapportant aux m&eacute;tastases osseuses de primitif colo-rectal.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Alain Farra, Claudine Bekondi, Vianney Tricou, Jean Robert Mbecko, Antoine Talarmin [Short communication] - Free-living amoebae isolated in the Central African Republic: epidemiological and molecular aspects - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/57/abstract/ <b>Among the many species of free-living amoebae infecting humans, only Naegleria fowleri, a few species of Acanthamoeba, Balamuthia mandrillaris recently Sappinia diplo&iuml;dea and Paravahlkampfia Francina are responsible for human diseases especially deadly encephalitis outside of Acanthamoeba keratitis related . In the Central African Republic (CAR), no studies have previously been conducted about free amoebae and no suspicious cases of encephalitis or amoebic keratitis was reported even though the ecosystem supported the proliferation of these microorganisms. The objective of this study was to identify free-living amoebae present in CAR and to define the molecular characteristic. Bathing sites and cerebrospinal fluid from patients died of bacterial meningitis untagged were explored by culture and PCR and the amplicons were sequenced which allowed to characterize the species found. Only species of the genus Tetramitus, namely T. Entericus, T. waccamawensis and T.sp similar to those already described in the world and not pathogenic for humans were found in bathing sites, the cerebrospinal fluid meanwhile remained negative. Although no pathogen species such as Naegleria fowleri or species of Acanthamoeba have been isolated, this study worth pursuing because this investigation was very limited in space because of the insecurity in the country.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Pilakimw&eacute; Egbohou, Tabana Mouzou, Hamza Doles Sama, Pikabalo Tch&eacute;tike, Sarakawabalo Ass&eacute;nouw&eacute;, Gnimdou Akala-Yoba, Kadjika Tomta [Short communication] - Pratique de l’analg&eacute;sie p&eacute;ridurale aupr&egrave;s de 20 parturientes au Centre Hospitalier Universitaire Sylvanus Olympio de Lom&eacute; (Togo) - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/56/abstract/ <b>Etude prospective et descriptive sur la pratique de l’analg&eacute;sie p&eacute;ridurale (APD) obst&eacute;tricale au CHU Sylvanus Olympio (CHU SO) de Lom&eacute;. Etude men&eacute;e de f&eacute;vrier &agrave; juin 2014. Apr&egrave;s accord des gestantes choisies au hasard et en l’absence de contre-indication &agrave; l’issue de la consultation d’anesth&eacute;sie, faite au 8&egrave;me mois de la grossesse, des femmes ont &eacute;t&eacute; retenues pour l’&eacute;tude. Sur 29 gestantes retenues, 20 (69%) ont b&eacute;n&eacute;fici&eacute;es de l’APD. Age moyen 30,6±6,6 ans, primigestes : 35%, multipares 50%, Ob&egrave;ses (BMI>30): 25%. Nombre moyen de ponctions: 1,2±0,5; reflux de sang dans le cath&eacute;ter: 5%, br&egrave;che dure-m&eacute;rienne : 0. D&eacute;lai moyen d’installation: 8,5 ±2,2mn. Quantit&eacute; moyenne de bupivacaine isobare &agrave; 0,125%: 28,8±8ml; Echelle Num&eacute;rique &agrave; T10min < 3 pour toutes les parturientes. Bloc moteur: 0. Hypotension: 1cas (5%). Mode d’accouchement: voie basse: 19 (95%), c&eacute;sarienne: 1 (5%). D&eacute;tresse respiratoire &agrave; la naissance du nouveau n&eacute;: 0. Note de satisfaction: 9,8±0,5 /10. L’APD obst&eacute;tricale est possible au CHU Sylvanus Olympio de Lom&eacute;. En attendant sa vulgarisation &agrave; toutes les parturientes par la disponibilit&eacute; des moyens humains et mat&eacute;riels, la r&eacute;aliser pour ses indications m&eacute;dicales serait un premier pas.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Kaan Sonmez, Ramazan Karabulut, Zafer Turkyilmaz, Canan Turkyilmaz, Berrin Isik, Sibel Eryilmaz, K?vanc Seref, Ebru Ozcan, Gul Meral Hosgoren, Abdullah Can Basaklar [Case report] - Our experience in two cases of type IV laryngotracheoesophageal cleft (LTEC) with a diagnosis of antenatal esophageal atresia - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/55/abstract/ <b>Laryngotracheoesophageal clefts (LTECs) are rare congenital defects that are often accompanied by additional anomalies. The major issues in the treatment of these patients are intraoperative exposure insufficiency, technical difficulty of the operation, and anesthesia problems originating from the respiratory tract. Problems originating from mechanical ventilation and respiratory tract, eating disorders and relapse of fistula are among the problems encountered following surgery. Most of the time, concomitant additional anomalies also worsen the clinical picture. It was our aim with these case reports to report our experience in two cases with Type IV LTEC ranging from the inoperable type IV LTEC due to additional anomalies mounted up to severe respiratory distress to the carina that we operated on with a single stage anterior cervicothoracic approach on its fifth day on life.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Forough Rafii, Seyedeh Fatemeh Vasegh Rahimparvar, Neda Mehrdad, Afsaneh Keramat [Research] - Barriers to postpartum screening for type 2 diabetes: a qualitative study of women with previous gestational diabetes - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/54/abstract/ <b>INTRODUCTION: risk of developing type 2 diabetes is increased in women with previous gestational diabetes mellitus (GDM). Postpartum glycemic screening is recommended in women with recent GDM. But this screening rate is low and the reasons are unclear. The aim of this study was to explore the experiences of Iranian women with recent GDM on barriers of postpartum screening for diabetes. METHODS: this qualitative study was conducted in Tehran, Iran in 2016. Semi-structured interview was used for data collection. 22 women with recent GDM were interviewed. These women gave birth in Tehran hospitals at a minimum of 6 months before interview. The missed screening defined as not attending to laboratory for Fasting Blood Sugar and/or Oral Glucose Tolerance Test, 6 week to 6 month after their child birthing. The data was analyzed by content analysis method. RESULTS: themes and sub-themes that illustrated the barriers to postpartum diabetes screening were: inadequate education (about developing diabetes in the future, implementation of the screening, and glucometer validity in diagnosis of diabetes), perceiving the screening as difficult (feeling comfortable with the glucometer, poor laboratory conditions, issues related to the baby/babies, and financial problems), improper attitudes toward the screening (unwilling to get diagnosed, not giving priority to oneself, having false beliefs) and procrastination (gap to intention and action, self-deception and self-regulation failure). CONCLUSION: women with recent GDM reported several barriers for postpartum diabetes screening. This study help to develop the evidence-based interventions for improving this screening rate.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com El Omri Naoual, El Jaoudi Rachid, Mekouar Fadwa, Jira Mohammed, Sekkach Youssef, Amezyane Taoufik, Ghafir Driss [Case report] - Cannabis arteritis - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/53/abstract/ <b>Cannabis is the most consumed psychoactive substance by young people. Chronic use of cannabis can lead to cannabis arteritis, which is a very rare peripheral vascular disease similar to Buerger's disease. It is affecting young adults, especially men, consuming cannabis. A 27-year old woman, with no particular past medical history except for long-term use of cannabis and tobacco developed a digital necrosis in the left hand. She denied using other illicit drugs. Doppler ultrasound examination of the upper limbs was unremarkable. Toxicological analysis revealed the presence of cannabis in both biological fluid and hair strand. Despite medical treatment, cessation of the cannabis and tobacco consumption and hyperbaric oxygen therapy, an amputation of necrotic parts was then required. This case shows the prolonged use of cannabis could be a risk factor for young adult arteritis. Faced with a rapidly progressive arteritis occurring in young adult, the physician should consider the history of use of cannabis. Hair analysis can be useful for confirmation of the chronic consumption of drugs.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ifeoma Christiana Udenze, Olusola Festus Olowoselu, Ephraim Uchenna Egbuagha, Temitope Adewunmi Oshodi [Research] - Thyroid, cortisol and growth hormone levels in adult nigerians with metabolic syndrome - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/52/abstract/ <b>BACKGROUND: the similarities in presentation of cortisol excess, growth hormone deficiency, hypothyroidism and metabolic syndrome suggest that subtle abnormalities of these endocrine hormones may play a causal role in the development of metabolic syndrome. The aim of this study is to determine the levels of cortisol, thyroid and growth hormones in adult Nigerians with metabolic syndrome and determine the relationship between levels of these hormones and components of the syndrome. METHODS: this was a case control study conducted at the Lagos University Teaching Hospital, Lagos, Nigeria. Participants were fifty adult men and women with the metabolic syndrome, and fifty, age and sex matched males and females without the metabolic syndrome. Metabolic syndrome was defined based on the NCEP-ATPIII criteria. Written Informed consent was obtained from the participants. Socio demographic and clinical data were collected using a structured questionnaire. Venous blood was collected after an over-night fast. The Ethics committee of the Lagos University Teaching Hospital, Lagos, Nigeria, approved the study protocol. Comparison of continuous variables was done using the Student's t test. Correlation analysis was employed to determine the associations between variables. Statistical significance was set at P<0.05. RESULTS: Triiodotyronine (T3) was significantly decreased (p<0.001) and thyroxine (T4 ) significantly increased ( p<0.001) in metabolic syndrome compared to healthy controls. T3 correlated positively and significantly with waist circumference (p=0.004), glucose (p= 0.002), total cholesterol ( p=0.001) and LDL- cholesterol ( p<0.001 ) and negatively with body mass index ( p<0.001 )and triglyceride ( p=0.026). T4 had a negative significant correlation with waist circumference (p=0.004). Cortisol and growth hormone levels were similar in metabolic syndrome and controls. Cortisol however had a positive significant correlation with waist/hip ratio (p<0.001) while growth hormone correlated positively with HDL ( p=0.023)and negatively with diastolic blood pressure (p=0.049). CONCLUSION: Thyroid hormones T3 and T4 were associated with metabolic syndrome. The thyroid hormones, cortisol and growth hormones correlated with components of the syndrome. A therapeutic role may exit for these hormones in the management of metabolic syndrome and related disorders.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Coline Mahende, Billy Ngasala, John Lusingu, Thomas M&aring;rtensson, Paminus Lushino, Martha Lemnge, Bruno Mmbando, Zul Premji [Research] - Profile of C-reactive protein, white cells and neutrophil populations in febrile children from rural north-eastern Tanzania - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/51/abstract/ <b>INTRODUCTION: C-reactive protein (CRP), white blood cell (WBC) and absolute neutrophil counts (ANC) are important inflammatory biomarkers in the early diagnosis of infections. However, little is known on their profile and usefulness in fever case management in children attending outpatient clinic in rural north-eastern Tanzania. METHODS: patients aged between 2 and 59 months presenting with fever at Korogwe District Hospital were enrolled. Venous blood was collected for evaluation of serum CRP, WBC and ANC. Individual patient diagnosis was based on integrated management of childhood illness (IMCI) guidelines and laboratory investigations (blood and urine cultures). RESULTS: a total of 867 patients were enrolled, out of which 691 (79.7%) had complete clinical and laboratory data available for analysis. Acute upper respiratory tract infection 284 (41.1%), acute gastroenteritis 127 (18.4%) and pneumonia 100 (14.5%) were the most frequent diagnoses. The geometric mean levels of serum CRP, WBC and ANC were 10.4 (95% CI: 9.2 - 11.8), 11.5 (95% CI: 11.1 - 11.9) and 5.5 (95% CI: 5.2 - 5.8), respectively. CRPd"20, WBCd"15 (103cells/µL) and ANCd"10 103cells/µL) were observed in the majority of the patients with upper respiratory tract infection, pneumonia, acute gastroenteritis and non-specific febrile illness. Only serum CRP levels were positively correlated with positive blood cultures at a calculated cut-off value of 37.3 mg/L, giving a specificity of 77.8% and sensitivity of 74.2%. CONCLUSION: CRP assessment together with IMCI guidelines may be useful in assisting the diagnosis and management of paediatric febrile infections in Tanzania.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ouchemi Choua, Kimassoum Rimtebaye, Ngueidjo Yamingue, Kalli Moussa, Mignagnal Kaboro [Research] - Aspects des traumatismes ferm&eacute;s de l’abdomen op&eacute;r&eacute;s &agrave; l’H&ocirc;pital G&eacute;n&eacute;ral de R&eacute;f&eacute;rence Nationale de N’Djam&eacute;na (HGRN), Tchad: &agrave; propos de 49 cas - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/50/abstract/ <b>INTRODUCTION: les traumatismes ferm&eacute;s de l’abdomen sont fr&eacute;quents. METHODES: il s’agissait d’une &eacute;tude r&eacute;trospective sur 49 dossiers de patients op&eacute;r&eacute;s pour traumatisme ferm&eacute; de l’abdomen en cinq ans &agrave; l’H&ocirc;pital General de R&eacute;f&eacute;rence Nationale de N’Djam&eacute;na au Tchad. Les param&egrave;tres &eacute;pid&eacute;miologiques, cliniques et th&eacute;rapeutiques &eacute;taient &eacute;tudi&eacute;s. RESULTATS: c’&eacute;taient 42 hommes et 7 femmes d’&acirc;ge moyen de 21,3 ans. Les &eacute;tiologies &eacute;taient: les accidents de la voie publique dans 61,2% des cas; les &eacute;croulements de mur (14,3%); les agressions (8,2%). Les traumatismes ferm&eacute;s de l’abdomen &eacute;taient plus fr&eacute;quents au mois d’Ao&ucirc;t (14,28%) et Octobre (16,32%). Le d&eacute;lai d’admission &agrave; l’h&ocirc;pital &eacute;tait de 6 &agrave; 12h dans 43% des cas. Le moyen d’&eacute;vacuation des bless&eacute;s &eacute;tait une voiture priv&eacute;e dans 85,7% des cas. Cliniquement, l’&eacute;tat h&eacute;modynamique &eacute;tait souvent stable (55,1%). L’imagerie m&eacute;dicale &eacute;tait domin&eacute;e par la radiographie directe de l’abdomen (57,1%). Les l&eacute;sions les plus observ&eacute;es ont &eacute;t&eacute; celles du gr&ecirc;le seul (16,32%) ou associ&eacute;es &agrave; celle de la vessie (8,16%), et de la rate (2,04%). La laparotomie &eacute;tait n&eacute;gative dans 6,12% des cas. La morbidit&eacute; (12,2%) &eacute;tait domin&eacute;e par les abc&egrave;s de paroi. Le taux de d&eacute;c&egrave;s &eacute;tait de 6,1%. CONCLUSION: les accidents de la voie publique sont la premi&egrave;re cause de traumatismes ferm&eacute;s de l’abdomen. Le d&eacute;lai diagnostic et th&eacute;rapeutique est important. Des mesures de s&eacute;curit&eacute; routi&egrave;re devraient pr&eacute;venir les accidents.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Turan Acar1, Erdin&ccedil; Kamer, Nihan Acar, Kemal Atahan, Halis Ba, Mehmet Hac1yanl1, &Ouml;zg&uuml;n Akg&uuml;l [Research] - Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of results between early and late cholecystectomy - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/49/abstract/ <b>INTRODUCTION: laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gallstones. The common opinion about treatment of acute cholecystitis is initially conservative treatment due to preventing complications of inflamation and following laparoscopic cholecystectomy after 6- 8 weeks. However with the increase of laparoscopic experience in recent years, early laparoscopic cholecystectomy has become more common. METHODS: we aimed to compare the outcomes of the patients to whom we applied early or late cholecystectomy after hospitalization from the emergency department with the diagnosis of AC between March 2012-2015. RESULTS: we retrospectively reviewed the files of totally 66 patients in whom we performed early cholecystectomy (within the first 24 hours) (n: 33) and to whom we firstly administered conservative therapy and performed late cholecystectomy (after 6 to 8 weeks) (n: 33) after hospitalization from the emergency department with the diagnosis of acute cholecystitis. The groups were made up of patients who had similar clinical and demographic characteristics. While there were no statistically significant differences between the durations of operation, the durations of hospitalization were longer in those who underwent early cholecystectomy. Moreover, more complications were seen in the patients who underwent early cholecystectomy although the difference was not statistically significant. CONCLUSION: early cholecystectomy is known to significantly reduce the costs in patients with acute cholecystitis. However, switching to open surgery as well as increase of complications in patients who admitted with severe inflammation attack and who have high comorbidity, caution should be exercised when selecting patients for early operation.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Driss Soussi Tanani, Samira Serragui, Sanae Hammi, Latifa Ait Moussa, Abdelmajid Soulaymani, Rachida Soulaymani, Yahia Cherrah [Project evaluation] - National strategy for the integration of pharmacovigilance in the Moroccan TB Control Program - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/48/abstract/ <b>The objective of this work is to demonstrate the interest of integration of pharmacovigilance in Moroccan Tuberculosis Control Program (MTCP). The integration of pharmacovigilance in MTCP was conducted in October 2012with the Global Fund support. We compared the reports notified before and after this integration (period 1: January 2010–October2012; period 2: October 2012–December 2013). The detection of signals was based on the Information Component available inVigiMine. We used the SPSS version 10.0 and Med Calc version 7.3 for data analysis. The average number of spontaneous reports increased from 3.6 to 37.4 cases/month (P< 10-3). The average age was 40.7 ± 17.5 years; the sex ratio was 0.8. Hepatic reactions (32.7%) predominated during the first period, while skin reactions (24.1%) were in the second period (P = 10-4), and40.9% of cases in the first period were serious against 15.8% in second period (P = 0.003). Nine signals were generated (hepaticenzyme increase, cholestasis, jaundice, arthralgia, acne, lower limb edema, pruritus, skin rashes, and vomiting). The integration of pharmacovigilance in Moroccan Tuberculosis Control Program improved the management of ADRs and detected new signals of antituberculosis drugs.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Yogolelo Asani Bienvenu, Musau Nkola Angel, Kabamba Ngombe Leon, Kapalu Mwangala Socrate, Iye Ombamba Kayimba Bruno, Chenge Borasisi Gaby [Case report] - Hyalopathie asteroide: &agrave; propos d’une observation - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/47/abstract/ <b>Nous rapportons un cas d'hyalopathie ast&eacute;ro&iuml;de, rarement d&eacute;crit dans la litt&eacute;rature, chez une personne diab&eacute;tique &acirc;g&eacute;e de 58 ans, de sexe masculin. Cette observation permet d'attirer l'attention des scientifiques sur les pathologies du vitr&eacute; du diab&eacute;tique ainsi que les autres maladies syst&eacute;miques auxquelles la hyalopathie ast&eacute;ro&iuml;de peut &ecirc;tre associ&eacute;e.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Youssef Alaoui Lamrani, Chakib Maaroufi [Images in medicine] - Syndrome d’hypoperfusion distale isch&eacute;mique compliquant une fistule art&eacute;rio-veineuse hum&eacute;ro-c&eacute;phalique - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/46/abstract/ <b>Madame R.G. &acirc;g&eacute;e de 53 ans, h&eacute;modialys&eacute;e pour n&eacute;phropathie ind&eacute;termin&eacute;e a pr&eacute;sent&eacute; 9 ans apr&egrave;s la confection d'une fistule hum&eacute;ro-c&eacute;phalique (FHC) gauche, l'apparition d'une douleur chronique de la main homolat&eacute;rale, associ&eacute;e &agrave; des ulc&eacute;rations n&eacute;crotiques des doigts. Un &eacute;cho-doppler de la FHC a montr&eacute; un hyper-d&eacute;bit &agrave; 1450ml/min, associ&eacute; &agrave; une inversion du flux de l'art&egrave;re hum&eacute;rale en aval de la fistule. Devant les signes montrant un h&eacute;mo-d&eacute;tournement vers le shunt art&eacute;rio-veineux, le diagnostic d'un syndrome de vol vasculaire a &eacute;t&eacute; port&eacute;. La fistule a &eacute;t&eacute; ligatur&eacute;e et un autre shunt art&eacute;rio-veineux a &eacute;t&eacute; r&eacute;alis&eacute; sur le membre controlat&eacute;ral. L'hypo-perfusion isch&eacute;mique distale ou syndrome de vol peut &ecirc;tre le r&eacute;sultat d'une combinaison de l&eacute;sions st&eacute;notiques, d'une art&eacute;riopathie distale, et de l'inversion de flux en aval du shunt. Non pris en charge, ce syndrome peut &eacute;voluer vers la n&eacute;crose digitale, voire la n&eacute;crose de toute la main. Ses principaux facteurs de risque sont les fistules mises au-dessus de la trifurcation brachiale, le sexe f&eacute;minin et le diab&egrave;te. La paresth&eacute;sie, la douleur au repos, la froideur au cours de la dialyse, et l'atrophie musculaire, repr&eacute;sentent des indications formelles pour r&eacute;tablir le flux vers la main souffrante, et &eacute;viter la gangr&egrave;ne digitale. Plusieurs techniques peuvent &ecirc;tre propos&eacute;es pour r&eacute;duire l'hyperd&eacute;bit, entre autres, la technique de DRIL correspondant &agrave; r&eacute;aliser une revascularisation distale par pontage veineux et ligature de l'art&egrave;re en aval de la fistule, une autre technique correspond &agrave; la plicature du segment veineux en aval de la fistule pour r&eacute;duire son d&eacute;bit.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Farid Badri, Hafsa Sajiai, Lamyae Amro [Case series] - Pr&eacute;valence du tabagisme chez le personnel m&eacute;dical et param&eacute;dical du CHU Mohamed VI &agrave; Marrakech - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/45/abstract/ <b>Le tabagisme est un probl&egrave;me majeur de sant&eacute; publique. Le personnel m&eacute;dical et param&eacute;dical n'est pas &eacute;pargn&eacute; par ce fl&eacute;au. L'interdiction de fumer &agrave; l'h&ocirc;pital est n&eacute;e d'une volont&eacute; gouvernementale de r&eacute;duire le tabagisme passif. L'objectif de cette &eacute;tude &eacute;tait d'&eacute;valuer les habitudes tabagiques chez le personnel soignant m&eacute;dical et param&eacute;dical, afin d'&eacute;laborer une strat&eacute;gie de lutte contre le tabagisme au sein de cette population, et de les adresser &eacute;ventuellement &agrave; la consultation d'aide au sevrage tabagique. L'&eacute;tude transversale descriptive concernant l'ensemble du personnel soignant du CHU de Marrakech en se basant sur la distribution des questionnaires anonymes. Nous avons distribu&eacute; 530 questionnaires dont 380 ont &eacute;t&eacute; r&eacute;cup&eacute;r&eacute;s, soit un taux de r&eacute;ponse de 71,7%. La population d'&eacute;tude &eacute;tait constitu&eacute;e de 58,2% de femmes (n= 221) et de 41,8% d'hommes (n=159). Le personnel m&eacute;dical (n=220) &eacute;tait la cat&eacute;gorie professionnelle la plus repr&eacute;sent&eacute;e (57,9%) suivie des infirmiers (31,8%). Les fumeurs (n = 62) repr&eacute;sentaient 16,3% de notre population d'&eacute;tude; les ex-fumeurs (n=31) 8,1% et les non-fumeurs (n= 287) 75,5%. La moyenne d'&acirc;ge des fumeurs &eacute;tait de 31,1 ans avec des extr&ecirc;mes de 22 &agrave; 56 ans. La pr&eacute;valence du tabagisme &eacute;tait de 16,3% (n=62) de la population d'&eacute;tude dont 32,7% (n=52) chez les hommes contre 4,5 % (n=10) chez les femmes. L'&acirc;ge moyen de d&eacute;but du tabagisme &eacute;tait de 19 ans avec des extr&ecirc;mes de 11 &agrave; 29 ans avec une consommation moyenne de 9 cigarettes/jour. 13% (n=50) des personnes fumaient aussi le narguil&eacute;, 9% (n=34) consommaient de l'alcool et 3% (n=21) des personnes consommaient du Cannabis. 67,7% des fumeurs (n=42) se projetaient d'arr&ecirc;ter de fumer, dont 30,9% (n=13) dans les 3 prochains mois, 52,4% (n=22) dans les prochains 6mois et 16,7% (n=16) se projetaient d'arr&ecirc;ter dans l'ann&eacute;e. Plusieurs activit&eacute;s incitaient les fumeurs &agrave; fumer davantage dont la garde, la pause-caf&eacute;, et les repas dans respectivement 90,3% (n=56), 64,3% (n=40) et 61,3% (n=38) des cas. A la suite de cette enqu&ecirc;te, une r&eacute;flexion doit &ecirc;tre men&eacute;e sur la n&eacute;cessit&eacute; de mener des actions de sensibilisation pour renforcer la motivation de ceux qui d&eacute;sirent arr&ecirc;ter et les aider dans leur d&eacute;marche de sevrage.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Farid Badri, Salma Ait Batahar, Safae El Idrissi, Hafsa Sajiai, Hind Serhane, Lamyae Amro [Case series] - M&eacute;tastases pleuro-pulmonaires des n&eacute;oplasies extra-thoraciques - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/44/abstract/ <b>Les poumons re&ccedil;oivent la totalit&eacute; du drainage veineux du corps expliquant la grande fr&eacute;quence des m&eacute;tastases pleuro-pulmonaires de plusieurs cancers. L'objectif &eacute;tait d'&eacute;tudier les manifestations radio-cliniques des m&eacute;tastases pleuro-pulmonaires des cancers extra-thoraciques. Nous rapportons une &eacute;tude r&eacute;trospective de patients porteurs de m&eacute;tastase pleuro-pulmonaire collig&eacute;s dans notre service entre janvier 2006 et d&eacute;cembre 2014. 76 dossiers ont &eacute;t&eacute; &eacute;tudi&eacute;s. La moyenne d'&acirc;ge &eacute;tait de 50 ans (extr&ecirc;mes allant de 21 ans jusqu'&agrave; 89 ans) avec une pr&eacute;dominance masculine dans 57,8% des cas. La symptomatologie clinique &eacute;tait faite principalement de toux (32,8% des cas), de dyspn&eacute;e (23,7% des cas) et d'h&eacute;moptysie (11,2% des cas). Les cancers primitifs &agrave; l'origine des diff&eacute;rentes m&eacute;tastases pleuro-pulmonaires retrouv&eacute;s dans notre s&eacute;rie sont domin&eacute;s respectivement par le cancer du sein dans 27,6% des cas, les cancers digestifs dans 15,8% des cas, les cancers g&eacute;nitaux dans 9,2% des cas, les sarcomes dans 7,8% des cas, le cancer r&eacute;nal dans 5,2% des cas, le cancer de la vessie dans 5,2% des cas, le cancer de la prostate dans 3,9% cas, les cancers ORL dans 3,9% des cas, les cancers thyro&iuml;diens dans 3,9% des cas, le cancer de la peau dans 2,6% des cas et le cancer primitif d'origine ind&eacute;termin&eacute;e dans 14,4% des cas. Plusieurs aspects radiologiques des m&eacute;tastases pleuro-pulmonaires ont &eacute;t&eacute; retrouv&eacute;s dans notre s&eacute;rie, ils peuvent &ecirc;tre isol&eacute;s ou en association. L'aspect radiologique le plus fr&eacute;quent est celui du l&acirc;cher de ballon pr&eacute;sent dans 52,6% des cas, suivi des pleur&eacute;sies pr&eacute;sentes dans 34,2% des cas, des micronodules diffus pr&eacute;sents dans 23,6% des cas et un nodule unique pr&eacute;sent dans 3,94% des cas. Les cancers secondaires pleuro-pulmonaires sont fr&eacute;quents. Ils viennent en 3&egrave;me position apr&egrave;s les m&eacute;tastases ganglionnaires et h&eacute;patiques et ils sont retrouv&eacute;s dans 30% des autopsies de patients porteurs d'une n&eacute;oplasie.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Abdulateef Elbadawi, Hyder Mirghani [Research] - Depression among HIV/AIDS Sudanese patients: a cross-sectional analytic study - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/43/abstract/ <b>INTRODUCTION: depression and HIV/AIDS are common morbid health problems; the relationship is bidirectional exacerbating each other with deleterious consequences. There are limited studies on this topic in Sudan. In this study, we investigated depression among HIV/AIDS in Sudan. METHODS: a cross-sectional analytic study was conducted among 362 HIV/AIDS patients from three centers in Khartoum, Sudan. Data were collected by the Hospital Depression and Anxiety (HADS) questionnaire. Chi-square was used for testing the significance and a P value of &#8804; 0.05 was considered as statistically significant. RESULTS: depression was evident in 332 (63.1%) of patients 68 (19.3%) had mild depression, 114 (32.4%) moderate depression, and 40 (11.4%) severe depression. Depression was commoner among women, illiterate, married/widowed, not receiving counseling, delaying the result of the test, P-value <0.05, no significant differences were found regarding test and treatment type P- Value >0.05. CONCLUSION: depression was prevalent among HIV/AIDS patients, especially females, low level of education, and widowed/married patients, and those not receiving counseling and post diagnosis sessions.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Farouk Hajhouji, Mohammed Lmejjati, Khalid Aniba, Mehdi Laghmari, Houssine Ghannane, Said Ait Benali [Case series] - Foramen magnum meningioma’s management: the experience of the department of neurosurgery in Marrakesh - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/42/abstract/ <b>Our study is a retrospective analysis of the clinical data, surgical outcomes, histological finding and prognosis of foramen magnum meningiomas through a serie of 8 cases operated at the department of neurosurgery at Mohammed VI medical university hospital, Marrakesh. From January 2002 to December 2015. There were 3 male and 5 female patients (mean age, 46.75 years). Cervico-occipital pain (80%) and motor deficit (100%) were the most common presenting symptoms. MRI was the most appropriate diagnostic tool in visualizing tumors of this region. All operations were performed by the posterior approach and gross total resection was achieved in 7 cases. Surgical mortality was 20%. 3 other patients had complications like CSF leak (25%), meningitis (12,5%) and transient worsening of neurological deficit (12.5%) but made neurological recovery later. Foramen magnum meningiomas have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull base exposures, the excision of these lesions is becoming easier and safer.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Adelaide Ogutu Ayoyi, Gideon Kikuvi, Christine Bii, Samuel Kariuki [Research] - Prevalence, aetiology and antibiotic sensitivity profile of asymptomatic bacteriuria isolates from pregnant women in selected antenatal clinic from Nairobi, Kenya - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/41/abstract/ <b>INTRODUCTION: asymptomatic bacteriuria (ASB) is the presence of bacteria in urine without apparent symptoms of urinary tract infections. The importance of asymptomatic bacteriuria lies in the insight it provides into symptomatic infections. To determine prevalence, bacterial isolates and Antibiotic Sensitivity Profile of asymptomatic bacterial urinary tract infection in pregnant women in selected clinics in Nairobi. METHODS: this was a cross-sectional study involving women attending antenatal clinic at selected clinics of Nairobi County. The women who met the inclusion criteria were included in the study. The midstream urine samples of these women were subjected to microscopy, culture and sensitivity. RESULTS: a total of 1020 of women on their first antenatal clinic visit participated in the study; 219 of them had ASB, giving a prevalence of 21.5% at 95% confidence level Escherichia coli were the common organism isolated at 38.8%. The majority of the organisms were sensitive to imipenem and gentamycin. CONCLUSION: there is a high prevalence of ASB among pregnant women included in the study from the Nairobi county clinics. Therefore, routine ASB screening of pregnant women is recommended among the women attending antennal clinics in Nairobi county clinics.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Djibril Marie Ba, Mouhamed Cherif Mboup, Nafissatou Zeba, Khadidiatou Dia, Awa Ndaw Fall, Fatou Fall, Pape Diadie Fall, Sara Boury Gning [Case series] - Infective endocarditis in Principal Hospital of Dakar: a retrospective study of 42 cases over 10 years - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/40/abstract/ <b>Infective Endocarditis (IE) is an endocardial infection usually caused by bacteria that affects not only the native heart valves but also,with increasing frequency intravascular implanted devices and congenital heart diseases. Despite medical advances, IE remains a life-threatening disease with substantial morbidity and mortality. In Africa, its diagnosis and treatment are still a major challenge in clinical practice. The objective of this work was to study the epidemiological, clinical features,diagnostic techniques currently used in medical practice and the range of micro-organisms that are responsible. This was a retrospective study done at Principal Hospital of Dakar. We include all patients who were admitted with clinical manifestations of definite or possible IE according to the extended DUKE criteria between January 1st, 2005 and December 31st, 2014. We collected and analyzed epidemiological, clinical, paraclinical and outcomes data of 42 patients. Hospital prevalence of IE was 0.078% (42/53711). The mean age was 27.5+/- 18 years with a sex ratio (M/F) of 0.55. IE were more common in patients with damaged or abnormal heart valves (78.6%) and in thoses with underlying structural defects (14.3%). The most common presenting symptoms were fever (90%) and cardiac murmurs (81%). Extracardiac clinical manifestations were very rare. The usual laboratory parameters of inflammation were elevated in 90% of patients. Blood cultures were negative in 50% of cases and positive in 21.4%. The main organism found was Staphylococcus aureus. Echocardiography found vegetations in 95.2% of cases, chamber enlargement in 73.8% and mitral regurgiation in 83.3%. Broad-spectrum penicillins including ampicillin and gentamycine were used for all patients. Major complications were heart failure (47.6%). Strokes and cerebral abcess (23.8%) and Vascular emboli 14.3%. Hospital mortality was 31%. IE remains a life-threatening disease with hight mortality despites improved techniques of diagnosis and modern antibiotics.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Monoarthrite du genou r&eacute;v&eacute;latrice d’une arthropathie tab&eacute;tique - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/39/abstract/ <b>Il s’agit d’un patient &acirc;g&eacute; de 53 ans, qui a consult&eacute; pour une monoarthrite du genou droit &eacute;voluant depuis 6 mois sans fi&egrave;vre, associ&eacute; &agrave; un syndrome inflammatoire biologique. La ponction articulaire a ramen&eacute; un liquide inflammatoire st&eacute;rile. Les radiographies du genou de face ( A) et de profil (B) et la TDM du genou (C et D) ont montr&eacute; une destruction du condyle f&eacute;moral interne avec une ost&eacute;olyse du rebord m&eacute;dial du plateau tibial interne associ&eacute; &agrave; de multiples constructions osseuses avec pr&eacute;sence de fragments intra-articulaires, d’un &eacute;panchement intra-articulaire et d’un &eacute;paississement de la synoviale. Le diagnostic d'arthropathie tab&eacute;tique dans sa forme hypertrophique a &eacute;t&eacute; retenu devant un ant&eacute;c&eacute;dent de chancre d’inoculation syphilitique datant de 20 ans, un syndrome radiculocordonal post&eacute;rieur, les donn&eacute;es de l’imagerie et une s&eacute;rologie syphilitique (TPHA-VDRL) positive dans le sang et le LCR. Le patient a &eacute;t&eacute; trait&eacute; par p&eacute;nicilline G (24 millions/j) pendant 15 jours. Plus fr&eacute;quent chez l'homme que chez la femme, le tab&egrave;s, devenu exceptionnel, se d&eacute;couvre tardivement vers 50 ou 60 ans. L'arthropathie tab&eacute;tique est une affection neurog&egrave;ne destructrice secondaire &agrave; l'infection par le tr&eacute;pon&egrave;me. Elle concerne 4 &agrave; 10% des tab&eacute;tiques. Le genou est l'articulation la plus souvent atteinte. Les formes de d&eacute;but souvent m&eacute;connues miment une gonarthrose banale. L'aspect habituel r&eacute;alise une forme hypertrophique. Le traitement de l'arthropathie tab&eacute;tique est essentiellement m&eacute;dical bas&eacute; sur la p&eacute;nicilline G.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mary-Theresa Agutu, Julliette Ongus, Janeth Kombich, Rose Kamenwa, Jim Nyagao, John Kagira, Adelaide Ayoyi Ogutu, Austin Bitek [Research] - Prevalence and genetic diversity of rotavirus infection in children with acute gastroenteritis in a hospital setting, Nairobi Kenya in post vaccination era: a cross-sectional study - 24 January 2017. http://www.panafrican-med-journal.com/content/article/26/38/abstract/ <b>INTRODUCTION: rotavirus is the leading cause of severe diarrhoea among infants and young children. Each year more than 611 000 children die from rotavirus gastroenteritis, and two million are hospitalized, worldwide. In Kenya, the impact of recent rotavirus vaccinations on morbidities has not been estimated. The study aimed at determining the prevalence and identity of rotavirus strains isolated from rotavirus-associated diarrhoea in vaccinated children presenting with acute gastroenteritis. METHODS: two hundred and ninety eight specimen from children presented at Gertrude Childrens’ Hospital from January to June 2012 were tested by EIA (Enzyme-linked Immunosorbent Assay) for rotavirus antigens. Molecular characterization was conducted on rotavirus-positive specimens. Extracted viral RNA was separated by polyacrylamide gel electrophoresis (PAGE) and the specific rotavirus VP4 (P-types) and VP7 (G-types) determined. RESULTS: the prevalence rate of rotavirus was 31.5% (94/298). Of the rotavirus dsRNA, 57 (60.1%) gave visible RNA profiles, 38 (40.4%) assigned long electropherotypes while 19 (20.2%) were short electropherotypes. The strains among the vaccinated were G3P [4], G12P [6], G3P [6], G9P [4], G mixed G9/3P [4] and G1/3P [4]. Specifically, the G genotypes were G9/3 (5.3%), G9 (4.3%), G3 (4.3%), G12 (2.1%) and mixed G1/3 (1.1%). The P genotypes detected were P [4] (5.3%) and P [6] (5.3%). CONCLUSION: the present study demonstrates diversity in circulating genotypes with emergence of genotypes G3, G9, G12 and mixed genotypes G9/3 and recommends that vaccines should be formulated with a broad range of strains to include G9 and G12.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Brandon Talley, Katherine Masyn, Rachna Chandora, Alana Vivolo-Kantor [Research] - Multilevel analysis of school anti-smoking education and current cigarette use among South African students - 24 January 2017. http://www.panafrican-med-journal.com/content/article/26/37/abstract/ <b>INTRODUCTION: South Africa (SA) implemented the Global Youth Tobacco Survey (GYTS) four times between 1999 and 2011. Data from the four surveys indicated that downward trends in cigarette use among students may have stalled. Understanding the effect of school anti-smoking education on current smoking among students within schools and variability across schools may provide important insights into policies aimed at preventing or reducing tobacco use among students. Objective were to assess the student- and school-level effects of students’ exposure to school anti-smoking education on current cigarette use among the study population using the most recent wave of GYTS data in SA (2011). METHODS: an analytic sample of students 13-15 years of age was selected (n=3,068) from the SA GYTS 2011. A taxonomy of two-level logistic regression models was fit to assess the relationship of various tobacco use, control, and exposure predictor variables on current cigarette smoking among the study population. RESULTS: at the student-level in the full model, secondhand smoke (SHS) exposure, peer smoking, and ownership of a promotional item were significantly associated with higher risk of current smoking. At the school-level in the full model, average exposure to peer smoking was associated with significant increases in the prevalence of current cigarette use, while average family anti-smoking education was significantly associated with decreases in the outcome variable. School anti-smoking education was not a statistically significant predictor at the student- or school-levels. CONCLUSION: in this study, exposure to school anti-smoking education had no association with current cigarette smoking among the study population. Consistent with previous studies, having peers that smoked was highly associated with a student being a current smoker. Interestingly, at the school-level in the multilevel analysis, schools with higher rates of average family anti-smoking education had lower prevalence of current smoking. This finding has potential implications for tobacco control in SA, particularly if the school-level, family-centered protective effect can be operationalized as a prevention tool in the country’s tobacco control program.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Guleser Akpinar, Ali Duman, Bedia Gulen, Mucahit Kapci, Ertugrul Altinbilek, Ibrahim Ikizceli [Research] - Role of H-FABP values in determining the etiologic factors of the cardiac injuries - 24 January 2017. http://www.panafrican-med-journal.com/content/article/26/36/abstract/ <b>INTRODUCTION: cardiac injury resulting from blunt thoracic trauma is a frequent clinical occurrence which is difficult to diagnose. Our purpose in this study was to research whether H-FABP, which is a new marker for the diagnosis of cardiac injury, can be used in this patient group. METHODS: 50 patients with blunt thoracic injury who were admitted to our emergency service within a period of 8 months and 50 cases as controls were included in our study.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Nivash Rugbeer, Serela Ramklass, Andrew Mckune, Johan van Heerden [Research] - The effect of group exercise frequency on health related quality of life in institutionalized elderly - 24 January 2017. http://www.panafrican-med-journal.com/content/article/26/35/abstract/ <b>INTRODUCTION: Introduction: the study aimed to determine the effect of group exercise frequency on health related quality of life in institutionalized elderly. METHODS: one hundred participants were recruited for voluntary participation from five aged care facilities, with inclusion being based on the outcome of a medical assessment by a sports physician. RESULTS: a significant difference was noted in social function post training twice (MD = -13.85, 95% CI [-24.66, -3.38], p = 0.017, d = 0.674) and thrice (MD = -13.30, 95% CI [-21.81, -5.59], p = 0.003, d = 0.712) a week. Training thrice a week provided an additional benefit in vitality (MD = -7.55, 95% CI [-13.16, -1.91], p = 0.018,d =0. 379). Improvements in mental component summary scale post training twice (MD = -4.08, 95% CI [-7.67, -0.42], p = 0.033, d = 0.425) and thrice (MD = -6.67, 95% CI [-10.92, -2.33], p = 0.005, d = 0.567) a week was further noted. CONCLUSION: mental health and social health benefits can be obtained irrespective of exercise frequency 2X/week or 3X/week.The exercise intervention at a frequency of thrice a week was more effective in improving mental component summary due to a larger effect size obtained compared to the exercise frequency of twice a week. Additional benefits in vitality wasachieved by exercising 3X/week. This may assist the elderly in preserving their independence. </b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com B&eacute;kaye Traor&eacute;, Youssouf Fofana [Images in medicine] - Pyoderma gangrenosum du cuir chevelu: &agrave; propos d’un cas - 24 January 2017. http://www.panafrican-med-journal.com/content/article/26/34/abstract/ <b>Le pyoderma gangrenosum (PG) est une dermatose inflammatoire chronique rare caractérisé par des ulcérations chroniques stériles et récurrentes. Il reste un diagnostic d’exclusion de toutes les autres affections pustulo-ulcéreuses notamment infectieuses. Il est associé dans deux tiers des cas à des affections morbides variées, qui peuvent révéler la maladie. La localisation au cuir chevelu est exceptionnelle et pose un véritable problème de prise en charge. Nous rapportons un cas qui a bien répondu à l’auto greffe cutanée. Il s’agissait d’une patiente de 49 ans aux antécédent de deux cures de myome (2001), qui présentaient depuis 6 mois une ulcération céphalique de 20/15 cm à bordure régulière, légèrement décollée, la pression était douloureuse et faisait sourdre du pus, le fond était peu creusant rouge et nauséabonde. Ailleurs le reste de l’examen clinique était normal. L’ulcération post fasciite nécrosante, le lupus discoïde dégénéré et le pyoderma gangrenosum furent évoquées comme hypothèses diagnostiques. Les examens complémentaires ont montré une anémie microcytaire hypochrome, une sérologie rétrovirale positive à VIH1, un taux de CD4 à 150/mm3, le prélèvement du pus a retrouvé le Staphylococcus Aureus. Le reste du bilan biologique était normal. La patiente n’était pas consentante pour la biopsie. Un traitement antiseptique, antibiotique conformément à l’antibiogramme et antalgique fut instauré pendant deux semaines sans succès après la trithérapie. Le diagnostic de pyoderma gagrenosum fut évoqué, un traitement à base de thalidomide 200mg (400mg par jour). Après un mois le pus et le suintement ont taris. Nous avons effectué trois séances d’auto greffe en pastille. La cicatrisation était obtenue en deux mois. </b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Abdelmonem Ghorbel [Images in medicine] - Cystic lymphangioma in a 44-year-old woman - 23 January 2017. http://www.panafrican-med-journal.com/content/article/26/33/abstract/ <b>Cystic lymphangioma is a congenital malformation of the lymphatic system. This condition is usually observed among children and very rarely among adults. The aetiology in adults is likely dueto delayed proliferation of cell rests due to physical injury or infection. Clinically, cystic lymphangioma is asymptomatic in adults. Treatment is generally surgical, although other methods, such as aspiration, radiation and sclerotherapy have been used. We report a case of a 44-year-old woman presented with one-year history of slowly enlarging cervical swelling at the right side of the neck. The patient has no medical problems or history of trauma to the neck. Examination showed a 4 cm smooth, soft swelling of right supraclavicular fossa. Moreover, there was no erythema or tenderness on palpation. The general examination revealed normal findings. Computed tomography (CT) showed a supraclavicular cyst-like structure of 5×3×3 cm. The patient was operated through an external approach and a complete cyst excision was achieved without complications. Histopathological examination was consistent with the diagnosis of cystic lymphangioma. The patient made an uneventful recovery with no recurrence noted one year after the surgery. </b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hicham Eddou, Ali Zinebi, Abdelaziz Khalloufi, Mohammed Sina, Mehdi Mahtat, Kamal Doghmi, Mohammed Mikdame, Mohammed Karim Moudden, Mohammed El Baaj [Case report] - Un purpura thrombop&eacute;nique am&eacute;gacaryocytaire acquis qui cache une leuc&eacute;mie aigue my&eacute;loblastique - 23 January 2017. http://www.panafrican-med-journal.com/content/article/26/32/abstract/ <b>Le purpura thrombop&eacute;nique am&eacute;gacaryocytaire acquis est une pathologie tr&egrave;s rare caract&eacute;ris&eacute; par une thrombop&eacute;nie s&eacute;v&egrave;re li&eacute;e une r&eacute;duction ou une disparition des m&eacute;gacaryocytes au niveau de la moelle osseuse. Il peut &ecirc;tre primaire idiopathique ou secondaire &agrave; de nombreux &eacute;tats pathologique dont des h&eacute;mopathies. Nous rapportons le cas d'un patient de 24 ans admis pour prise en charge d'un syndrome h&eacute;morragique mis sur le compte d'un purpura thrombop&eacute;nique immunologique. Le diagnostic a &eacute;t&eacute; redress&eacute; en une am&eacute;gacaryocytose aquise apr&egrave;s un &eacute;chec de la corticoth&eacute;rapie et la r&eacute;alisation d'un my&eacute;logramme. Le patient a &eacute;t&eacute; mis sous traitement par ciclosporine avec une &eacute;volution rapide vers une leuc&eacute;mie aigue my&eacute;loblastique. La progression d'une am&eacute;gacaryocytose acquise vers une leuc&eacute;mie aigue est rapport&eacute; mais g&eacute;n&eacute;ralement pas aussi rapidement et surtout pr&eacute;c&eacute;der par un syndrome my&eacute;lodysplasique ou une aplasie m&eacute;dullaire. Cette observation impose un suivi strict et rapproch&eacute; de ces pathologies d'apparence b&eacute;nigne.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Pauline Diouss&eacute;, Fatimata Ly, Mariama Bammo, Sarah Lizia, Thierno Abdoul Aziz Diallo, Haby Dione, Fatou Sarr, Ramatoulaye Diagne Gueye, Amadou Mactar Gueye, MameThiernoDieng, Bernard Marcel Diop, Mamadou Mourtalla Ka [Case report] - Pityriasis versicolor chez des nourrissons: aspect clinique inhabituel et r&ocirc;le de la d&eacute;pigmentation cosm&eacute;tique par des cortico&iuml;des chez la m&egrave;re - 23 January 2017. http://www.panafrican-med-journal.com/content/article/26/31/abstract/ <b>Nous rapportons deux observations de Pityriasis versicolor (PV) chez des nourrissons &acirc;g&eacute;s de 12 etde 18 mois. Ces derniers &eacute;taient amen&eacute;s en consultation pour des macules hypochromiques et achromiques, rondes, localis&eacute;es aux membres et sur le visage. On retrouvait une notion de d&eacute;pigmentation volontaire &agrave; vis&eacute;e cosm&eacute;tique &agrave; base de cortico&iuml;des et d’hydroquinone chez leur m&egrave;re depuis en moyenne 5 ans. Le scotch test effectu&eacute; chez un des nourrissons et sa m&egrave;re montrait de courts filaments et des grappes de spores. Le traitement &eacute;tait &agrave; base de k&eacute;toconazole. Apr&egrave;s 8 semaines, l’&eacute;volution &eacute;tait favorable chez tous les patients avec cependant une persistance de quelques macules hypochomiques. Les particularit&eacute;s de nos observations sont d’une part la topographie aux membres inf&eacute;rieurs et d’autre part le caract&egrave;re familial du PV dont la survenue est favoris&eacute;e par l’usage de produits d&eacute;pigmentant &agrave; base de cortico&iuml;des. Ces derniers favorisent le caract&egrave;re atrophique et achromique des l&eacute;sions. En effet, les formes achromiques des membres inf&eacute;rieurs &eacute;taient d&eacute;crites chez les adultes s’adonnant &agrave; la d&eacute;pigmentation artificielle.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Lofty-John Anyanwu, Aminu Mohammad, Habeeb Muhammad, Ibrahim Aliyu, Lawal Abdullahi, Aliyu Farinyaro, Abdulkarim Iya [Case report] - Schinzel-Giedion syndrome: a case with sacrococcygeal teratoma and cor-triatriatum dexter - 23 January 2017. http://www.panafrican-med-journal.com/content/article/26/30/abstract/ <b>Schinzel-Giedion syndrome which is associated with midfacial hypoplasia and coarse dysmorphic features is a multiple congenital malformation syndrome. It is believed that risk of malignancy may be a component of the anomaly. We report herein a case of a 16 months old boy with SGS associated with sacrococcygeal teratoma and cor-triatriatum dexter. Histopathology report of the excised sacrococcygeal mass showed no malignant foci. He was however lost to follow up in the second week post-operation.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Said Anajar, Mohammed Moutaa Tatari, Jawad Hassnaoui, Sami Rouadi, Reda Abada, Mohammed Roubal, Mohammed Mahtar [Case report] - Carcinome vesiculaire sur thyro&iuml;de linguale: cas rare - 23 January 2017. http://www.panafrican-med-journal.com/content/article/26/29/abstract/ <b>La thyro&iuml;de linguale est secondaire &agrave; l'absence de migration de l'&eacute;bauche thyro&iuml;dienne. Cette derni&egrave;re se d&eacute;veloppe sur place, c'est-&agrave;-dire au niveau du foramen caecum. Elle peut repr&eacute;senter le seul tissu thyro&iuml;dien retrouv&eacute;, ou &ecirc;tre en association avec une thyro&iuml;de normale. La survenue d'un carcinome sur une thyro&iuml;de linguale constitue une situation exceptionnelle avec seulement une trentaine de cas d&eacute;crits dans la litt&eacute;rature. Nous rapportons a travers notre observation un cas de carcinome v&eacute;siculaire survenu sur thyro&iuml;dien lingual.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Abdelmonem Ghorbel [Images in medicine] - Une polypose naso-sinusienne r&eacute;v&eacute;lant une mucoc&egrave;le du sinus maxillaire - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/28/abstract/ <b>La mucoc&egrave;le est une formation pseudo kystique b&eacute;nigne qui se d&eacute;veloppe rarement au niveau du sinus maxillaire. La mucoc&egrave;le est secondaire &agrave; des situations diverses ayant en commun une inflammation et une obstruction de l’ostium du sinus. Cette derni&egrave;re peut &ecirc;tre primitive mais souvent secondaire &agrave; un (traumatisme, tumeur, inflammation chronique). Le diagnostic repose sur l’imagerie. La tomodensitom&eacute;trie est indispensable pour appr&eacute;cier les modifications osseuses et planifier la chirurgie endonasale sous contr&ocirc;le endoscopique et l’IRM permet de pr&eacute;ciser les rapports de la mucoc&egrave;le. La prise en charge th&eacute;rapeutique de ces mucoc&egrave;les doit dans un m&ecirc;me temps op&eacute;ratoire r&eacute;aliser une marsupialisation de la mucoc&egrave;le et traiter le facteur local en cause. Nous rapportons le cas d’un homme &acirc;g&eacute; de 21 ans, sans ant&eacute;c&eacute;dents pathologiques notables qui consultepour obstruction nasale bilat&eacute;rale associ&eacute;e &agrave; une anosmie. L’examen clinique a trouv&eacute; une douleur exquise de la paroi ant&eacute;rieure du sinus maxillaire, une polypose nasosinusienne bilat&eacute;rale et une voussure au niveau du palais osseux. La tomodensitom&eacute;trie du massif facial a permis de mettre en &eacute;vidence une masse hypodense homog&egrave;ne bien limit&eacute;e ne prenant pas le produit de contraste comblant tout le sinus maxillaire gauche associ&eacute;e &agrave; une lyse osseuse r&eacute;guli&egrave;re de ses parois associ&eacute; &agrave; un comblement &eacute;thmo&iuml;do-nasal bilat&eacute;ral. Le patient a &eacute;t&eacute; op&eacute;r&eacute; par voie endonasale et a eu une &eacute;tho&iuml;dectomie fonctionnelle associ&eacute;e &agrave; un abord du sinus maxillaire par m&eacute;atotomie moyenne permettant la marsupialisation de la mucoc&egrave;le. Les suites op&eacute;ratoires &eacute;taient simples sans r&eacute;cidive.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Yonas Asfaw, Isaac Boateng, Mauricio Calderon, Grazia Caleo, Allan Conteh, Salifu Conteh, Foday Dafae, Achintya Dey, Nadia Duffy, Daffney Davies, Patrick Fatoma, John Fleming, Boima Gogra, Yelena Gorina, Anna Grigoryan, Sara Hersey, Sam Hoare, Sonnia-Magba Bu-Buakei Jabbi, Amara Jambai, Joseph Jasperse, Reinhard Kaiser, Gandi Kallon, Ansumana Kamara, Fatmata Zara Kamara, Isata Pamela Kamara, Wogba Kamara, Joseph Kandeh, Mustapha Kanu, Mabinty Kargbo, Samuel Kargbo, Richard Konie, Simeon Kuyembeh, Patrick Lansana, Fiona Mclysaght, Sheena McCann, Alhaji Samuka Nallo, Stephanie Ngai, Erin Nichols, Charles Njuguna, Shikanga O-Tipo, Sulaiman Parker, Nuzhat Rafique, John Redd, Thomas Samba, Kerry Souza, Alex Tran, Chief Mathew Gibao Younge [Meeting report] - Interagency technical consultation on improving mortality reporting in Sierra Leone: meeting report - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/27/abstract/ <b>By the end of the Ebola epidemic, death reporting in Sierra Leone (SL) became more acceptable amongst local populations, with nearly all deaths being reported to the Ebola hot line alert centers. To continue the positive momentum generated by the epidemic, the Sierra Leone Ministry of Health and Sanitation (MoHS) and the US Centers for Disease Control and Prevention (CDC) organized and conducted the two-day Inter-agency Consultations on Improving Mortality Reporting in Sierra Leone (Consultations). In conjunction with the Consultations, participants were also offered a one-day, in-person training on the major components, characteristics, and uses of a national Civil Registration and Vital Statistics (CRVS) system. To understand processes used by governmental and non-governmental organizations in collection of death data before and during the Ebola epidemic, and to develop recommendations on improving death reporting and CRVS in Sierra Leone. The Inter-agency Consultations were conducted in person over two days in October, 2015. Real-time notes were kept by CDC staff for later abstraction and summarizing. Presenters agreed to share their materials (usually PowerPoint presentations) and approved the summaries. Challenges to implementation and suggestions for improving death reporting were drawn from the presentations and from anonymous suggestions collected at the end of each of three days of the Consultations. The Consultations attracted more than 80 participants from 28 Sierra Leone governmental, business, and other non-governmental organizations. Over the course of 18 presentations, participants presented and discussed the ways deaths were reported before and during the Ebola epidemic and ways in which the CRVS in Sierra Leone might be improved. The presentations made clear the need to improve death reporting in order to improve the health status of Sierra Leone. Many presenters and participants discussed the challenges to improvements, including lack of infrastructure and country diversity. In addition, participants generally agreed upon the need for improving the government’s understanding of the benefits of death reporting at multiple levels: from local chiefdom authorities and councils to the community and individual families. Despite the many challenges identified, all participants stressed the need for modernizing and improving death registration in Sierra Leone. The recommendations from the presentations and notes collected at the end of each day can be categorized within the following five domains: capacity building (organizational, staffing, infrastructure, policies, guidelines and tools), awareness and sensitization (including strategies to use best practices and emerging technologies), political will (governmental support and prioritization), funding (providing resources to achieve sustainability), and monitoring and evaluation (developing charts of existing death reporting pathways and identifying challenges).</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Dimitri Mbethe, Said Moudouni, Zacharia Dahami, Mohamed, Amine Lakmichi, Ismael Sarf [Case report] - L&eacute;iomyosarcome v&eacute;sical trait&eacute; par cystectomie laparoscopique avec ent&eacute;rocystoplastie de remplacement: &agrave; propos d’un cas - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/26/abstract/ <b>Notre travail vise &agrave; rapporter un nouveau cas de l&eacute;iomyosarcome v&eacute;sical qui est une tumeur rare, et proposer une nouvelle approche th&eacute;rapeutique compte tenu du caract&egrave;re non consensuel de son traitement, cela &agrave; travers l'observation d'une patiente &acirc;g&eacute;e de 31 ans, sans ant&eacute;c&eacute;dent particulier, ayant consult&eacute; pour h&eacute;maturie totale caillotante. Le bilan clinique et paraclinique, mettait en &eacute;vidence une volumineuse masse tumorale solide occupant le d&ocirc;me v&eacute;sical et s'&eacute;tendant &agrave; la paroi lat&eacute;rale droite, d'allure infiltrante, sans envahissement ganglionnaire ou organique local ou &agrave; distance. Notre prise en charge chirurgicale a consist&eacute; en une cystectomie totale par voie coelioscopique, avec ent&eacute;rocystoplastie de remplacement. Les suites op&eacute;ratoires ont &eacute;t&eacute; simples. Les contr&ocirc;les radiologiques effectu&eacute;s &agrave; 3, 6, 12 et 24 mois ne montraient aucune r&eacute;cidive. Ainsi, une chirurgie adapt&eacute;e peut &ecirc;tre propos&eacute;e selon les cas de figure, en vue d'am&eacute;liorer la qualit&eacute; de vie des patients pr&eacute;sentant cette affection.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Andriatsihoarana Voahary Nasandratriniavo Ramahandrisoa, Nomeharisoa Rodrigue Emile Hasiniatsy, Val&eacute;ry Refeno, Clairette Raharisolo Vololonantenaina, Andriamihaja Jean Claude Rakotoarisoa, Hanitrala Jean Louis Rakotovao, Florine Rafaramino [Case report] - Carcinome neuroendocrine thymique: &agrave; propos d’un cas et revue de la litt&eacute;rature - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/25/abstract/ <b>Les tumeurs neuroendocrines thymiques (TNET) sont rares, de pronostic mal connu. L'objectif est de rapporter un cas de TNET et discuter la difficult&eacute; diagnostique et th&eacute;rapeutique en milieu &agrave; faibles ressources. Un homme de 60 ans pr&eacute;sentait une douleur thoracique, une toux grasse et un amaigrissement r&eacute;cent. Le scanner thoracique r&eacute;v&eacute;lait une masse tissulaire m&eacute;diastinale ant&eacute;rieure. L'histologie d&eacute;finitive obtenue quatre mois apr&egrave;s la biopsie par m&eacute;diastinotomie ant&eacute;rieure montrait une TNET bien diff&eacute;renci&eacute;e, avec marquage intense &agrave; la chromogranine et &agrave; la synaptophysine. La recherche d'autres tumeurs neuroendocrines et le bilan d'extension &eacute;taient n&eacute;gatifs. La tumeur &eacute;tait inextirpable d'embl&eacute;e et la radioth&eacute;rapie indisponible. Le patient a re&ccedil;u deux lignes de chimioth&eacute;rapie premi&egrave;re. Avec un recul de 16 mois, le patient &eacute;tait asymptomatique, mais en progression tumorale. Le diagnostic de TNET peut &ecirc;tre retard&eacute; quand l'examen immunohistochimique n'est pas r&eacute;alis&eacute; en routine. La chimioth&eacute;rapie apporte une am&eacute;lioration des sympt&ocirc;mes en situation palliative.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hafsae Bounniyt, Badredine Hassam [Images in medicine] - Une tumeur rare de la cuisse - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/24/abstract/ <b>Les synovialosarcomes sont des tumeurs rares, elles repr&eacute;sentent pr&egrave;s de 10% des sarcomes des tissus mous. Nous rapportons le cas d’un synovialosarcome mimant un botriomycome. Une jeune femme de 33 ans, qui s’est pr&eacute;sent&eacute;e avec une tum&eacute;faction l&eacute;g&egrave;rement douloureuse de la racine du membre inf&eacute;rieur gauche augmentant rapidement de volume. L’examen clinique trouvait une tumeur bourgeonnante, saignant au contact, &agrave; contours irr&eacute;guliers, mesurant 6 cm de grand axe. La patiente &eacute;tait en bon &eacute;tat g&eacute;n&eacute;ral et l’examen clinique &eacute;tait normal par ailleurs. Un diagnostic de botriomycome ou de granulome pyog&eacute;nique a &eacute;t&eacute; &eacute;voqu&eacute;, mais la biopsie ex&eacute;r&egrave;se de la tumeur avec &eacute;tude immunohistochimique ont &eacute;t&eacute; en faveur d’un synovialosarcome peu diff&eacute;renci&eacute; de garde 2 FLNCC. Une reprise chirurgicale carcinologique a &eacute;t&eacute; r&eacute;alis&eacute;e dans un service de chirurgie oncologique avec des marges de 2 cm sur tous les plans. Un bilan d’extension fait d’une IRM locale, &eacute;chographie ganglionnaire et une tomodensitom&eacute;trie thoraco-abdomino-pelvienne &eacute;tait n&eacute;gatif. L’&eacute;volution &eacute;tait favorable, sans r&eacute;cidives avec un recul de 2 ans.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mamadou Ngon&eacute; Gueye, Gnagna Diouf, Daouda Dia, Awa Boye, Thierno Fall, Jean Louis Di&eacute;m&eacute;, Oumar Ba, Mouhamadou Mbengue [Case report] - M&eacute;tastase costale r&eacute;v&eacute;lant un carcinome &eacute;pidermo&iuml;de de l’œsophage - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/23/abstract/ <b>Le cancer de l'œsophage est une tumeur de mauvais pronostic. Sa gravit&eacute; est li&eacute;e au retard de diagnostic qui se fait le plus souvent au stade de m&eacute;tastase en Afrique. Les m&eacute;tastases costales de ce cancer sont rares. Nous rapportons un cas de carcinome &eacute;pidermo&iuml;de du bas œsophage avec m&eacute;tastases costales lytiques chez une patiente s&eacute;n&eacute;galaise de 38 ans. Il s’agissait de madame TD, &acirc;g&eacute;e de 38 ans admise pour une tum&eacute;faction douloureuse de l’h&eacute;mithorax droit dans un contexte d’amaigrissement. La patiente signalait par ailleurs une dysphagie d’allure m&eacute;canique &eacute;voluant depuis 4 mois qui n’avait pas motiv&eacute; de consultation. L’examen objectivait un mauvais &eacute;tat g&eacute;n&eacute;ral, une tum&eacute;faction dure, sensible mesurant 3 cm de grand axe, si&eacute;geant sur la face ant&eacute;rolat&eacute;rale de l’h&eacute;mithorax droit en regard de la 5&egrave;me c&ocirc;te. Les examens biologiques mettaient en &eacute;vidence une an&eacute;mie normochrome normocytaire avec un taux d’h&eacute;moglobine &agrave; 9,4 g/dl, un syndrome inflammatoire biologique non sp&eacute;cifique et une hypercalc&eacute;mie (calc&eacute;mie corrig&eacute;e= 107 mg/l). L’endoscopie oeso-gastroduod&eacute;nale objectivait une l&eacute;sion ulc&eacute;ro bourgeonnante st&eacute;nosante &agrave; 32 cm des arcades dentaires. L’examen anatomopathologique des biopsies mettait en &eacute;vidence un carcinome &eacute;pidermo&iuml;de moyennement diff&eacute;renci&eacute;. La tomodensitom&eacute;trie thoraco-abdomino pelvienne montrait en plus de la tumeur œsophagienne, une lyse osseuse de l’arc ant&eacute;rieure de la 5&egrave;me c&ocirc;te, des nodules pulmonaires carcinomateuses et un &eacute;panchement pleural bilat&eacute;ral. La ponction exploratrice du liquide pleural ramenait un liquide s&eacute;roh&eacute;matique et l’examen cytologique de ce liquide objectivait des cellules carcinomateuses. Le diagnostic de carcinome &eacute;pidermo&iuml;de du bas œsophage avec m&eacute;tastases costales, pleurales et pulmonaires &eacute;tait retenu et un traitement palliatif instaur&eacute;. L’&eacute;volution &eacute;tait marqu&eacute;e par le d&eacute;c&egrave;s de la patiente survenu 3 mois apr&egrave;s la r&eacute;alisation de la gastrostomie, dans un tableau de d&eacute;tresse respiratoire. L’originalit&eacute; de cette observation tient au si&egrave;ge atypique des m&eacute;tastases de ce cancer de l’œsophage; mais aussi le terrain de survenue de cette tumeur. Le cancer de l’œsophage du sujet jeune est un probl&egrave;me majeur en Afrique. Le challenge est de d&eacute;terminer ses facteurs de risque afin de pr&eacute;venir sa survenue.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hicham Kechna, Karim Nadour, Omar Ouzzad, Khalid Chkoura, Faical Choumi, Jaouad Loutid, Mohamed Moumine, Moulay Ahmed Hachimi [Research] - Gestion des voies a&eacute;riennes sup&eacute;rieures et cellulite cervico-faciale - 17 January 2017. http://www.panafrican-med-journal.com/content/article/26/22/abstract/ <b>INTRODUCTION: la cellulite maxillo faciale est urgence m&eacute;dico chirurgicale. Ces patients sont le plus souvent pris en charge au bloc op&eacute;ratoire d’une part pour la mise &agrave; plat et le drainage des collections et d’autres parts pour les pr&eacute;l&egrave;vements bact&eacute;riologiques. L’anesth&eacute;sie de ce genre de patient expose &agrave; des difficult&eacute;s potentielles de contr&ocirc;le des voies a&eacute;riennes sup&eacute;rieures. METHODES: il s'agissait d'une &eacute;tude r&eacute;trospective r&eacute;alis&eacute;e sur une dur&eacute;e de 24 mois dans le p&ocirc;le d’anesth&eacute;sie r&eacute;animation et urgence de l’h&ocirc;pital militaire Moulay Ismail de Mekn&egrave;s avec la collaboration des services de stomatologie et d’oto-rhino laryngologie. On &eacute;t&eacute; inclus tous les patients admis au bloc pour cure chirurgicale sous anesth&eacute;sie g&eacute;n&eacute;rale d’une cellulite cervicale et/ou maxillo-faciale. RESULTATS: nous avons collig&eacute; 22 dossiers. Le sexe ratio &eacute;tait &agrave; 4,5 en faveur des hommes. L'&acirc;ge moyen des patients est de 29 ans. Concernant la gestion des voies a&eacute;riennes ; une intubation standard &agrave; l’aide de laryngoscope a &eacute;t&eacute; retenue chez la plupart des patients (17 patients). L’intubation vigile sous fibroscopie a &eacute;t&eacute; r&eacute;alis&eacute;e chez 3 patients, une trach&eacute;otomie premi&egrave;re a &eacute;t&eacute; faite chez une patiente et une intubation r&eacute;trograde salvatrice a &eacute;t&eacute; retenue chez une autre patiente. CONCLUSION: deux d&eacute;fis guettent tout anesth&eacute;siste prenant en charge des patients pr&eacute;sentant une cellulite cervico-faciale, un risque de ventilation difficile et un souci d’intubation laborieuse. Les deux risques sont &agrave; envisager de principe, et o&ugrave; une strat&eacute;gie anticipative devra &ecirc;tre &eacute;labor&eacute;e.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Rasha Farouk Abdellah, Khaled Morsy Salama [Research] - Prevalence and risk factors of workplace violence against health care workers in emergency department in Ismailia, Egypt - 17 January 2017. http://www.panafrican-med-journal.com/content/article/26/21/abstract/ <b>INTRODUCTION: emergency department is one of the high-risk areas, where violence against health care workers (HCWs) is a prevalent and serious problem. Violence has negative effects on HCWs, and therefore on the quality of care provided in emergency department. This study aimed to determine the prevalence, types, sources and risk factors of violence reported by HCWs in emergency department. METHODS: a cross-sectional study was conducted using a standardized questionnaire developed by the WHO. One hundred thirty four questionnaires were included in this study (94.4% response rate). RESULTS: WPV was reported by 59.7% of HCWs. Verbal violence was the most reported (58.2%), compared to physical violence (15.7%). The most reported reasons for violence were waiting time and that patient and family expectations not being met. Only 29.5% of HCWs who experienced verbal violence and 23.8% of who experienced physical violence reported it to hospital authority. About 75% of HCW thought that work place violence could be prevented, and about 60% said that no action was taken against the attacker by hospital authority. CONCLUSION: violence against HCWs in emergency department is a significant issue that cannot be ignored. There are multiple reasons. The key point in dealing with the problem is to treat its specific causes.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Traore Ababacar Abdoulaye, Traore Zakaria, Camara Ousmane, Boubbou Meryem, Maaroufi Moustapha, Tizniti Siham, Kamaoui Imane [Case report] - Ectopie thyro&iuml;dienne: apport du scanner - 17 January 2017. http://www.panafrican-med-journal.com/content/article/26/20/abstract/ <b>L’ectopie thyro&iuml;dienne est une malformation pathologique rare. Nous rapportons un cas suppl&eacute;mentaire d’ectopie du lobe thyro&iuml;dien droit, d&eacute;couvert lors du bilan tomodensitom&eacute;trique d’une masse lat&eacute;ro cervicale gauche.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Said Anajar, Mohammed Tatari, Jawad Hassnaoui, Reda Abada, Sami Rouadi, Mohammed Roubal, Mohammed Mahtar [Case report] - Cas rare de sangsue laryng&eacute;e chez un homme de 70 ans - 16 January 2017. http://www.panafrican-med-journal.com/content/article/26/19/abstract/ <b>La dyspn&eacute;e laryng&eacute;e repr&eacute;sente une urgence extr&ecirc;me en otorhinolaryngologies. Elle r&eacute;pond &agrave; des &eacute;tiologies multiples et reste souvent graves. La dyspn&eacute;e laryng&eacute;e caus&eacute;e par une sangsue est exceptionnellement d&eacute;crite dans la litt&eacute;rature surtout chez l’adulte. Nous rapportons une observation particuli&egrave;re d’infestation de l’arbre respiratoire par une sangsue ayant entra&icirc;n&eacute; une dyspn&eacute;e laryng&eacute;e.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Cheikh Ahm&eacute;dou Lame, Birame Loum, Ibrahima Keita, Thierno Boubacar Diallo, Alamasso Sow [Case report] - Plaie iatrogene de l’artere carotide commune secondaire &agrave; un catheterisme veineux jugulaire interne - 16 January 2017. http://www.panafrican-med-journal.com/content/article/26/18/abstract/ <b>La plaie carotidienne lors du cath&eacute;t&eacute;risme jugulaire veineux est un accident rare mais pouvant &ecirc;tre dramatique. Nous rapportons un cas d'h&eacute;matome cervical compressif avec h&eacute;mothorax survenu &agrave; la suite d'une plaie de l'art&egrave;re carotide commune au d&eacute;cours d'un cath&eacute;t&eacute;risme veineux jugulaire interne. Le diagnostic et la prise en charge de ce type de complication sont discut&eacute;s.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Smitha Reddy, Bhuvan Shome, Jayaprakash Patil, Pradeep Koppolu [Research] - A clinical correlation between stature and posterior tooth length - 16 January 2017. http://www.panafrican-med-journal.com/content/article/26/17/abstract/ <b>INTRODUCTION: exploration and determination of the relationship between stature and length of tooth is essential in Paleontology, Forensic Odontology and Endodontology. This study aimed to determine any association between stature and posterior tooth length in a group of patients who required root canal treatment.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Joseph Syn&egrave;se Bemora, Willy Francis Rakotondraibe, Mijoro Ramarokoto, Willy Ratovondrainy, Cl&eacute;ment Andriamamonjy [Case series] - Aspects épidémiologiques des traumatismes du rachis: à propos de 139 cas - 16 January 2017. http://www.panafrican-med-journal.com/content/article/26/16/abstract/ <b>Les traumatismes du rachis représentent une des lésions les plus fréquemment observées, chez les victimes d’accidents de circulation, d’accident de sportifs, domestique et du travail. Il s’agissait d’une étude rétrospective de 3 ans portant sur 139 cas de traumatismes du rachis hospitalisés et pris en charge dans le service de neurochirurgie du CHUJRA Madagascar. A travers cette étude, 25,17% des traumatisés étaient entre 21 et 30 ans avec une nette prédominance masculine de 69,78% (sexe ratio 2,3). L’étiologie était dominéepar la chute dans 33,09% des cas avec des facteurs de risque dont prise d’alcool (8,63%). Le traumatisme entrait dans le cadre d’un polytraumatisme dont un traumatisme crânien dans 34,63%. Les patients étaient admis dans le service 1 à 5h après le traumatisme dans 31,65% en utilisant comme moyen de transport une voiture personnelle dans 36,69%. Pendant l’hospitalisation 20 patients ont signé une décharge et 6,34% des patients sont décédés. Les traumatismes du rachis posent un problème de santé publique avec une prise en charge lourde surtout pour les patients déficitaires à vie. Devant tout traumatisme du rachis, il faut rechercher systématiquement une lésion crânienne.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Marie-Pierrette Ntyonga-Pono, Daniela Nsame [Case report] - Maltraitance scolaire et maladie de basedow: &agrave; propos d’un cas - 12 January 2017. http://www.panafrican-med-journal.com/content/article/26/15/abstract/ <b>La maladie de basedow, thyr&eacute;opathie auto-immune, est la cause la plus fr&eacute;quente des hyperthyro&iuml;dies aussi bien chez l'adulte que chez l'enfant. Elle rel&egrave;verait d'une pr&eacute;disposition g&eacute;n&eacute;tique sur laquelle vont intervenir des facteurs d&eacute;clenchants environnementaux dont le stress. Le but de cet article est de pr&eacute;senter un cas de maladie de Basedow chez l'enfant dont le facteur d&eacute;clenchant inhabituel serait la maltraitance scolaire, vaste probl&egrave;me aux cons&eacute;quences multiples.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Nyiramana Marie Merci, Uwimana Emerence, Nzitakera Augustin, Michael Habtu, Ingabire Julie, Tuyishime Angelique, Beneyo Jessica, Akimana Cynthia, Augustin Twizerimana Penda [Research] - CD4+ cells recovery in HIV positive patients with severe immunosuppression at HAART initiation at Centre Medico-Social Cor-Unum, Kigali - 12 January 2017. http://www.panafrican-med-journal.com/content/article/26/14/abstract/ <b>INTRODUCTION: up to 30% of HIV infected patients who are receiving HAART do not exhibit a marked increase in the CD4+ T cell count. There is still a concern that immune recovery may not be complete once CD4+ T cells have decreased below 200 cells/µl. The objective is to assess CD4+ cell recovery in HIV+ patients with CD4 count below 200 cells/¼l) at HAART initiation. METHODS: this was a retrospective cohort study among 110 HIV+ patients with initial CD4 count < 200 cells/¼l. Baseline Age, sex, CD4 count and viral load were extracted from the patient’s database. After12 months of HAART; CD4 count was done using flow cytometry and viremia by COBAS AmpliPrep/COBAS TaqMan HIV-1 test v 2.0 technology. RESULTS: the mean age of the respondents was 35 years; males being 57% and females were 43%. The mean CD4 count before HAART was 110.18 cells/µl whereas at 12 months of HAART; this was 305.01 cells/µl. Though some patients did not achieve a CD4 count of more than 200 cells/µl or a drop in viral load; there was a significant recovery of CD4+ cells (P value=0.000) and viremia following HAART (P value=0.001). Participants aged 18-30 years were likely to have less than 200 cells/¼l CD4 count (46.4%) [OR=4.33; 95%CI: 1.29-14.59; P=0.018] than participants aged above 40 years (16.7%). CONCLUSION: HAART was associated with viremia suppression but many patients failed to achieve a CD4 count >200 cells/µl. HAART before severe immunosuppression is a key factor for immune restoration among HIV+ patients.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com El Houcine Haijoubi, Fatiha Benyahya, Abdrezzak Bendahou, Faima Zahra Essadqui, Mohammed El Behhari, Ahmed Fouad El Mamoune, Naima Nourouti Ghailani, Mohcine Bennani Mechita, Amina Barakat [Research] - Etude de la qualit&eacute; bact&eacute;riologique de l’eau utilis&eacute;e dans l’industrie agroalimentaire dans le Nord du Maroc - 05 January 2017. http://www.panafrican-med-journal.com/content/article/26/13/abstract/ <b>INTRODUCTION: l'eau est utilis&eacute;e d'une fa&ccedil;on primordiale dans tout le processus de la fabrication des produits alimentaires. Les industries agroalimentaires du Nord du Maroc utilisent diff&eacute;rentes sources d'eaux mais l'eau de r&eacute;seau public et l'eau de puits sont les principales sources d'eau utilis&eacute;e. Cette eau peut s'av&eacute;rer la source principale des &eacute;ventuelles contaminations et alt&eacute;rations des aliments. Notre but est d'&eacute;valuer la qualit&eacute; bact&eacute;riologique de l'eau utilis&eacute;e par les industries agroalimentaires dans la r&eacute;gion du Nord du Maroc, d'identifier les diff&eacute;rents germes responsables de la pollution de ces eaux et de d&eacute;finir les principales causes de cette pollution. METHODES: des &eacute;chantillons d'eau pr&eacute;lev&eacute;s aux robinets ou des puits ont &eacute;t&eacute; analys&eacute;s pour la recherche des germes indicateurs de la pollution (coliformes totaux (CT), coliformes f&eacute;caux (CF), ent&eacute;rocoques intestinaux (E), microorganismes revivifiables (MOR), ana&eacute;robies sulfitor&eacute;ducteurs) et les germes pathog&egrave;nes (Salmonelles, Staphylocoques, Pseudomonas aeruginosa). Le d&eacute;nombrement des bact&eacute;ries a &eacute;t&eacute; fait par la technique de filtration et par incorporation en milieu solide en surfusion. RESULTATS: les r&eacute;sultats ont montr&eacute; que les eaux du r&eacute;seau public ont &eacute;t&eacute; de qualit&eacute; bact&eacute;riologique satisfaisante tandis que 40% des eaux des puits ont &eacute;t&eacute; non conformes aux normes &agrave; cause de la pr&eacute;sence des indicateurs de pollution CT, CF, E et MOR. En revanche, les germes pathog&egrave;nes, en particulier les Salmonelles, ont &eacute;t&eacute; absents dans les eaux de tous les puits analys&eacute;s. CONCLUSION: la pollution de ces puits a &eacute;t&eacute; g&eacute;n&eacute;ralement li&eacute;e au non-respect des conditions de puisage hygi&eacute;niques. La qualit&eacute; bact&eacute;riologique des eaux de ces puits peut &ecirc;tre am&eacute;lior&eacute;e par une protection ad&eacute;quate.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Meriam Benzalim, Laila Berghalout, Sophia Elfakir, Hicham Jalal [Case report] - Syndrome de poland: &agrave; propos d’un cas et revue de la litterature - 05 January 2017. http://www.panafrican-med-journal.com/content/article/26/12/abstract/ <b>Le syndrome de Poland est une malformation cong&eacute;nitale rare associant &agrave; des degr&eacute;s divers des anomalies thoraciques et du membre sup&eacute;rieur homolat&eacute;ral. Nous rapportons le cas d'une fillette de 7 ans, explor&eacute;e pour d&eacute;pression de l'h&eacute;mithorax gauche avec masse sous claviculaire homolat&eacute;rale. La tomodensitom&eacute;trie a montr&eacute; que la d&eacute;formation de la paroi thoracique &eacute;tait li&eacute;e &agrave; l'absence des chefs &agrave; insertion sterno-costale du muscle pectoralis major gauche avec ag&eacute;n&eacute;sie du pectoralis minor et hypoplasie des arcs ant&eacute;rieurs des six premi&egrave;res c&ocirc;tes correspondantes. Ces anomalies &eacute;taient rapport&eacute;es &agrave; un syndrome de Poland. Un bilan g&eacute;n&eacute;ral fait d'&eacute;chographie abdominale, radiographies des deux mains, a &eacute;t&eacute; r&eacute;alis&eacute; chez la patiente n'ayant r&eacute;v&eacute;l&eacute; aucune malformation associ&eacute;e. Le syndrome de Poland r&eacute;sulte d'un d&eacute;faut d'approvisionnement sanguin des &eacute;l&eacute;ments musculosquelettiques de la paroi thoracique pendant la vie fœtale. Il existe de nombreuses variantes du syndrome de Poland qui peuvent &ecirc;tre mieux d&eacute;tect&eacute;es par la TDM qui doit &ecirc;tre r&eacute;alis&eacute;e chaque fois qu'il est disponible, sans omettre le r&ocirc;le de la radiologie g&eacute;n&eacute;ral dans la d&eacute;tection des malformations associ&eacute;es. La caract&eacute;ristique de ce syndrome est l'ag&eacute;n&eacute;sie des faisceaux sternocostaux du muscle pectoralis major. Son &eacute;tiologie reste inconnue et discut&eacute;e. Une anomalie vasculaire en serait la cause, sans que le primum movens de cette anomalie vasculaire soit connu.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ghada Sahraoui, Fatma Khanchel, Emna Chelbi [Case series] - Profil anatomopathologique du cancer du sein dans le cap bon tunisien - 05 January 2017. http://www.panafrican-med-journal.com/content/article/26/11/abstract/ <b>Le cancer du sein est le cancer le plus fr&eacute;quent de la femme en Tunisie et dans le monde. Dans le Cap Bon tunisien, les particularit&eacute;s anatomopathologiques de ce cancer n'ont pas &eacute;t&eacute; pr&eacute;cis&eacute;es auparavant. Leur connaissance est n&eacute;cessaire pour l'adaptation des syst&egrave;mes de pr&eacute;vention et de soins dans la r&eacute;gion. Le but de notre &eacute;tude &eacute;tait de d&eacute;terminer le profil anatomopathologique des carcinomes mammaires dans l'unique laboratoire d'anatomie pathologique publique de la r&eacute;gion. Il s'agissait d'une &eacute;tude descriptive r&eacute;trospective des carcinomes mammaires diagnostiqu&eacute;s chez 116 malades dans notre laboratoire sur une p&eacute;riode de 5 ans de Juillet 2010 &agrave; Juillet 2015. Notre &eacute;tude a inclus 116 patientes. L'&acirc;ge moyen &eacute;tait de 51 ans. La taille tumorale histologique moyenne &eacute;tait de 31 mm. Le diagnostic initial &eacute;tait pos&eacute; sur pi&egrave;ce de tumorectomie dans 83% des cas. Le carcinome infiltrant de type non sp&eacute;cifique &eacute;tait le type histologique le plus fr&eacute;quent. Le grade SBR III &eacute;tait majoritaire. L'invasion lympho-vasculaire &eacute;tait pr&eacute;sente dans 33% des cas. Le curage axillaire &eacute;tait positif dans 72% des cas. Les r&eacute;cepteurs hormonaux &eacute;taient positifs dans 73% des cas. Les r&eacute;cepteurs de l'Her2-Neu &eacute;taient surexprim&eacute;s dans 19% des cas. Le ki67 &eacute;tait e" 14% dans 38%. Le sous-type mol&eacute;culaire le plus fr&eacute;quent &eacute;tait le luminal A. Le carcinome mammaire dans la r&eacute;gion du Cap Bon se caract&eacute;rise par sa survenue &agrave; un &acirc;ge jeune, son importante taille tumorale et la fr&eacute;quence de facteurs histopronostiques p&eacute;joratifs.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Ali Zinebi, Hicham Eddou, Karim Mohamed Moudden, Mohamed Elbaaj [Case series] - Profil &eacute;tiologique des an&eacute;mies dans un service de m&eacute;decine interne - 05 January 2017. http://www.panafrican-med-journal.com/content/article/26/10/abstract/ <b>L'an&eacute;mie constitue un probl&egrave;me majeur de la sant&eacute; publique &agrave; travers le monde malgr&eacute; l'am&eacute;lioration remarquable des conditions de vie. Elle est class&eacute;e par l'OMS comme l'un des dix probl&egrave;mes les plus s&eacute;rieux du monde. Notre objectif est de d&eacute;crire les profils &eacute;pid&eacute;miologique et &eacute;tiologique des cas d'an&eacute;mies prises en charge dans notre formation. Il s'agit d'une &eacute;tude r&eacute;trospective men&eacute;e durant 5 ans, allant de Janvier 2011 &agrave; d&eacute;cembre 2015 et portant sur 150 patients. L'&acirc;ge moyen de nos patients est de 48,8ans et les femmes sont les plus touch&eacute;es avec un sex-ratio de 1,78. Le taux moyen de l'h&eacute;moglobine est de 8 g/dl avec des extr&ecirc;mes allant de 3,4 &agrave; 11,4 g/dl. L'an&eacute;mie ferriprive est le diagnostic &eacute;tiologique dominant &eacute;tant retrouv&eacute;e dans 60% des cas, suivie par l'an&eacute;mie m&eacute;galoblastique observ&eacute;e chez 21% des patients puis les an&eacute;mies h&eacute;molytiques dans 7,33% des cas. La survenue d'une an&eacute;mie chez l'adulte peut repr&eacute;senter un v&eacute;ritable d&eacute;fit diagnostique pour l'interniste et cela parfois dans un contexte d'urgence. Le recours &agrave; des examens sp&eacute;cialis&eacute;s peut s'imposer.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Garrouche Nada, Jerbi Saida Omezzine, Dhifallah Maher, Dris Nouha, Hamza Hssine [Case report] - Laryngeal lipoma: a rare cause of dysphonia - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/9/abstract/ <b>Lipomas are the most common mesenchymal tumors. Laryngeal lipomas represent 1% of all lipomas but unlike other locations may cause life-threatening symptoms by obstruction of the respiratory tract. In this study, the case of a 32-year old woman with laryngeal lipoma is discussed. The lesion was detected on the left aryepiglottic fold, presented as a stalked and dynamic mass of 2 centimeters diameter. The imaging aspects of laryngeal lipoma cases, clinical evaluation, and approaches to treatment will be discussed.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Boubacar Zan Traor&eacute;, Kamal Serrar, Omar Saoud, Khedid Yahia Zain El Abidine, Rachid Mohammed Chkoff, Rachida M’bida [Case report] - Cause exceptionnelle d'h&eacute;moperitoine spontan&eacute; chez l'adulte: h&eacute;molymphangiome kystique rompu - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/8/abstract/ <b>L'h&eacute;molymphangiome est une tumeur b&eacute;nigne r&eacute;sultant du d&eacute;veloppement anormal des vaisseaux lymphatiques associ&eacute;s &agrave; des malformations vasculaires. 50% &agrave; 60% de ces tumeurs sont pr&eacute;sentes &agrave; la naissance. Les formes cervicales sont les plus fr&eacute;quentes. Les localisations Abdominales sont tr&egrave;s rares. Nous rapportons deux cas d'h&eacute;molymphangiome kystique de la rate r&eacute;v&eacute;l&eacute; par l'h&eacute;moperitoine spontan&eacute; admis en urgence au service des Urgences Chirurgicales Visc&eacute;rales, avec une revue de la litt&eacute;rature. Il s'agit d'une patiente &acirc;g&eacute;e de 50 ans et l'autre un jeune homme de 20 ans admis aux urgences pour respectivement, une sensibilit&eacute; abdominale diffuse avec matit&eacute; d&eacute;clive des flancs et d'une distension abdominale dans un tableau de choc h&eacute;morragique, p&acirc;leur, pouls imprenable, stabilis&eacute; apr&egrave;s une courte r&eacute;animation. La r&eacute;section tumorale &eacute;tait compl&egrave;te chez tous les malades. Le diagnostic d'h&eacute;molymphangiome kystique de la rate &eacute;tait r&eacute;v&eacute;l&eacute; &agrave; l'examen anatomopathologique des pi&egrave;ces op&eacute;ratoires. L'h&eacute;molymphangiome est une tumeur rare &agrave; pronostic favorable. Quelques cas de r&eacute;gression spontan&eacute;e ont &eacute;t&eacute; d&eacute;crits, mais l'&eacute;volution se fait classiquement vers une croissance lente de la tumeur. Il n'y a aucun pouvoir de d&eacute;g&eacute;n&eacute;rescence maligne. Le traitement est chirurgical. Le pronostic est li&eacute; aux complications, &agrave; la qualit&eacute; de l'ex&eacute;r&egrave;se chirurgicale et les r&eacute;cidives qui sont fr&eacute;quents notamment en cas d'ex&eacute;r&egrave;se incompl&egrave;te.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Douamba Sonia, Nagalo Kisito, Tamini Laure, Traor&eacute; Isma&euml;l, Kam Madib&egrave;l&egrave;, Kou&eacute;ta Fla, Y&eacute; Diarra [Research] - Syndromes dr&eacute;panocytaires majeurs et infections associ&eacute;es chez l’enfant au Burkina Faso - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/7/abstract/ <b>INTRODUCTION: le but de cette &eacute;tude &eacute;tait d’&eacute;tudier les infections chez les enfants pr&eacute;sentant un syndrome dr&eacute;panocytaire majeur. METHODES: &eacute;tude hospitali&egrave;re monocentrique, r&eacute;trospective descriptive sur dix ann&eacute;es men&eacute;e &agrave; Ouagadougou, Burkina Faso. &Eacute;taient inclus tous les enfants porteurs d´un syndrome dr&eacute;panocytaire majeur (homozygote SS et double h&eacute;t&eacute;rozygote SC, SD<sub>Punjab</sub>, S&#946; thalass&eacute;mique, SO<sub>Arab</sub> et SE) hospitalis&eacute;s pour une infection bact&eacute;rienne confirm&eacute;e &agrave; la microbiologie. RESULTATS: cent trente trois patients r&eacute;pondaient &agrave; nos crit&egrave;res d’inclusion. Le ph&eacute;notype SS repr&eacute;sentait 63,2 % des cas et le SC 36,8 %. La fr&eacute;quence des infections &eacute;tait de 21,8 %. Celles-ci touchaient dans 45,9 % des cas les enfants &acirc;g&eacute;s de 0 &agrave; 5 ans. Les signes les plus fr&eacute;quents &eacute;taient les douleurs ost&eacute;oarticulaires (42,1 %), la toux (25,7 %), les douleurs abdominales (23,3 %), la p&acirc;leur (43,6 %). Les broncho-pneumopathies (31,6 %), le paludisme (16,5 %), les ost&eacute;omy&eacute;lites (12,8 %) et les septic&eacute;mies (10,5 %) &eacute;taient les principaux diagnostics trouv&eacute;s. Les agents pathog&egrave;nes isol&eacute;s &eacute;taient <i>Streptococcus pneumoniae</i> (35,5 %) et <i>Salmonella sp</i> (33,3 %). Les c&eacute;phalosporines de 3e g&eacute;n&eacute;ration &eacute;taient les antibiotiques les plus fr&eacute;quemment prescrits. Le taux brut de mortalit&eacute; &eacute;tait de 7,5 %. CONCLUSION: les infections bact&eacute;riennes et le paludisme dominent le tableau des infections chez l´enfant dr&eacute;panocytaire majeur au Centre Hospitalier Universitaire P&eacute;diatrique Charles De Gaulle. Les auteurs recommandent la mise en place d’un programme national de prise en charge de la dr&eacute;panocytose, ce qui permettrait de pr&eacute;venir voire r&eacute;duire la survenue des infections chez les enfants dr&eacute;panocytaires.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Sara Elloudi, Fatima Zahra Mernissi [Images in medicine] - Fasciite n&eacute;crosante: une redoutable affection! - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/6/abstract/ <b>La fasciite n&eacute;crosante est une infection bact&eacute;rienne touchant le derme profond, l’hypoderme et l’apon&eacute;vrose superficielle. C’est une infection s&eacute;v&egrave;re mortelle dans 30% des cas. Une association polymicrobienne est fr&eacute;quemment not&eacute;e. Les facteurs associ&eacute;s sont le diab&egrave;te, l’alcoolisme chronique, la toxicomanie intraveineuse, et l’immunosuppression. Nous rapportons le cas clinique d’un patient diab&eacute;tique &acirc;g&eacute; de 65 ans qui &eacute;tait admis aux urgences pour un &eacute;tat de choc septique et dont l’examen dermatologique objectivait des placards œd&eacute;mateux froids et liv&eacute;doides surmont&eacute;es de phlyct&egrave;nes h&eacute;morragiques int&eacute;ressant le membre sup&eacute;rieur et inf&eacute;rieur droits, faisant &eacute;voquer des fasciites n&eacute;crosantes, le patient a install&eacute; rapidement une d&eacute;faillance multi-visc&eacute;rale occasionnant son d&eacute;c&egrave;s. Il est capital de reconna&icirc;tre au plus vite la fasciite n&eacute;crosante. En effet, la pr&eacute;cocit&eacute; de la mise en œuvre du traitement m&eacute;dicochirurgical conditionne le pronostic de cetteinfection redoutable qui peut conduire au d&eacute;c&egrave;s.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Davakis Spyridon, Damaskos Christos [Images in medicine] - A rare complication of catherer insertion pericardiocentesis - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/5/abstract/ <b>Pericardiocentesis with catheter insertion for pericardial drainage is a common procedure used for the treatment of pericardial effusions and of cardiac tamponade as well. The most commonly described complications of an indwelling pericardial catheter system are catheter blockage and infection. We present a rare case of a 63 years old patient with a pericardial catheter for pericardial effusion drainage. He was presented with elevated body temperature and chills, a day after a pericardial catheter insertion. His clinical examination did not reveal any particular findings, while the catheter had stop draining two days earlier. His laboratory examinations revealed slightly increased WBCs' (13.300/ml). Following that, a chest x-ray examination revealed winding of the catheter along the pericardium. Under general anesthesia, the patient underwent left thoracotomy; the pericardial catheter was found tight wreathed and infiltrated to the inner coat of the pericardium. The catheter was carefully removed and a pericardial window was then performed. His post-operative course was uneventful, and he was discharged five days later.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Mehdi Kehila, Manel Seboui [Images in medicine] - Lobe placentaire accessoire: penser aux vaissaux praevia - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/4/abstract/ <b>Il s’agit d’une patiente &acirc;g&eacute;e de 36 ans, deuxi&egrave;me geste, deuxi&egrave;me pare hospitalis&eacute;e &agrave; deux reprises pour des m&eacute;trorragies au troisi&egrave;me trimestre de la grossesse. A chaque hospitalisation, une &eacute;chographie a &eacute;t&eacute; pratiqu&eacute;e par voie sus-pubienne et a conclu &agrave; un placenta ant&eacute;rieur normalement ins&eacute;r&eacute; sans images de d&eacute;collement. A l’occasion de la troisi&egrave;me hospitalisation, &agrave; 36 semaines d’am&eacute;norrh&eacute;e, une &eacute;chographie transvaginale a &eacute;t&eacute; r&eacute;alis&eacute;e. Celle-ci a r&eacute;v&eacute;l&eacute; une structure d’&eacute;chog&eacute;nicit&eacute; similaire &agrave; celle du placenta, situ&eacute;e sur la face post&eacute;rieure de l’ut&eacute;rus, &agrave; 24mm de l’orifice interne du col, &eacute;vocatrice d’un lobe placentaire accessoire. L’application du Doppler couleur a montr&eacute; un vasa pr&aelig;via connect&eacute; &agrave; ce lobe. Une c&eacute;sarienne a alors &eacute;t&eacute; programm&eacute;e &agrave; 37SA donnant naissance &agrave; un b&eacute;b&eacute; de sexe masculin, pesant 3800g en bon &eacute;tat de sant&eacute;. L’&eacute;tude macroscopique du placenta a montr&eacute; le lobe placentaire accessoire s&eacute;par&eacute; du principal disque placentaire par des membranes et reli&eacute; &agrave; celui-ci par de larges vaisseaux.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Imane Khachani, Mohamed Hassan Alami, Rachid Bezad [Case report] - Grossesse cervicale &agrave; 7 semaines d’am&eacute;norrh&eacute;e: d&eacute;fis de la prise en charge - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/3/abstract/ <b>La grossesse cervicale est une forme extr&ecirc;mement rare de grossesse ectopique qui engage le pronostic vital maternel en raison du risque important d'h&eacute;morragie. Nous rapportons l'observation d’une patiente &acirc;g&eacute;e de 35 ans, ayant accouch&eacute; une premi&egrave;re fois par c&eacute;sarienne et qui a pr&eacute;sent&eacute; une grossesse cervicale diagnostiqu&eacute;e &agrave; 7 semaines d'am&eacute;norrh&eacute;e. La prise en charge au sein de notre structure a fait appel au traitement m&eacute;dical puis chirurgical apr&egrave;s &eacute;chec du premier. L'int&eacute;r&ecirc;t de cette observation r&eacute;side dans la d&eacute;marche diagnostique et les diff&eacute;rentes &eacute;tapes de prise en charge th&eacute;rapeutique.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Fatima El Boukhrissi, Ghizlane Zoulati, Issam En-nafaa, Hassan Ouleghzal, Sara Derrou, Soumaya Safi, Youssef Bamou, Lhoussine Balouch [Case report] - Syndrome de Fahr secondaire &agrave; une hypoparathyro&iuml;die primaire: &agrave; propos d’un cas - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/2/abstract/ <b>Le syndrome de Fahr est une entit&eacute; anatomoclinique rare dont la principale &eacute;tiologie est l'hypoparathyro&iuml;die primitive ou postop&eacute;ratoire. Il est caract&eacute;ris&eacute; par des calcifications intrac&eacute;r&eacute;brales bilat&eacute;rales et sym&eacute;triques, localis&eacute;es dans les noyaux gris centraux, le plus souvent associ&eacute;es &agrave; des troubles du m&eacute;tabolisme phosphocalcique. Les auteurs rapportent le cas d’un patient &acirc;g&eacute; de 54 ans suivi depuis 20 ans pour hypoparathyro&iuml;die primaire, qui a pr&eacute;sent&eacute; des troubles amn&eacute;siques r&eacute;v&eacute;lant un syndrome de Fahr secondaire &agrave; l’hypoparathyro&iuml;die.</b><br/> text/html 2017-04-27T08:13:44+01:00 http://www.panafrican-med-journal.com Hajar El Jouadi, Ilyas Derdabi [Images in medicine] - Perforation couverte du duod&eacute;num par ar&ecirc;te de poisson - &agrave; propos d’un cas - 03 January 2017. http://www.panafrican-med-journal.com/content/article/26/1/abstract/ <b>Les perforations de l'estomac et du duod&eacute;num secondaire &agrave; un corps &eacute;tranger ont tendance &agrave; pr&eacute;senter un tableau clinique plus inoffensif que les perforations situ&eacute;es dans le j&eacute;junum ou l'il&eacute;on. Tr&egrave;s rarement ces perforations peuvent &eacute;voluer spontan&eacute;ment vers la gu&eacute;rison. Nous pr&eacute;sentant le cas d'une patiente &acirc;g&eacute;e de 45ans, sans ant&eacute;c&eacute;dents pathologiques notables admise aux urgences dans un tableau d’appendicite: douleur abdominales localis&eacute;es au niveau de la fosse iliaque droite (FID) &eacute;voluant depuis deux jours, accompagn&eacute; de quelques &eacute;pisodes de vomissements, sans autres signes accompagnateurs. L'examen clinique retrouve un patient f&eacute;brile &agrave; 39&deg;C, stable sur le plan h&eacute;modynamique avec &agrave; l'examen abdominal une d&eacute;fense abdominale localis&eacute;e &agrave; la FID. Le reste de l'examen clinique est normal par ailleurs. Le bilan biologique montre une hyperleucocytose &agrave; 22000 &eacute;l&eacute;ment/mm3 et une CRP &agrave; 50. L’&eacute;chographie abdominale est revenue non concluante. On a compl&eacute;t&eacute; par un scanner abdominal qui a objectiv&eacute; un corps &eacute;tranger radio opaque au niveau de la lumi&egrave;re de D2 (probablement ar&ecirc;te de poisson) semblant traverser sa paroi avec micro- bulles de gaz extra luminales et densification de la graisse p&eacute;riton&eacute;ale en regard. Le diagnostic de perforation couverte duod&eacute;nale a &eacute;t&eacute; retenu. La patiente a b&eacute;n&eacute;fici&eacute; d’extraction de corps &eacute;tranger par endoscopie et mise sous antibioth&eacute;rapie avec bonne &eacute;volution clinique.</b><br/>