Pan african Medical Journal - Volume 27 Pan african Medical Journal. Volume 27 http://www.panafrican-med-journal.com/ 2017-07-25T21:47:35+01:00 pamj logo http://www.panafrican-med-journal.com http://www.panafrican-med-journal.com/img/logo.png text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Chantal Ngoune Nanfack, Yannick Bilong, Giles Kagmeni, Ngoulou Ngoulou Nathan, Lucienne Assumpta Bella [Case report] - Malarial retinopathy in adult: a case report - 25 July 2017. http://www.panafrican-med-journal.com/content/article/27/224/abstract/ <b>Although widely reported in children, the malarial retinopathy has rarely been described in adults. We observed a case in the department of ophthalmology at the pediatric and gynecology-obstetrics Yaound&eacute; Hospital. The diagnosis revealing a decrease in visual acuity was confirmed by thorough ophthalmological and biological assessments. The basic treatment by quinine therapy was conclusive. The authors point out the need to consider this diagnosis in case of any decrease in visual acuity in febrile context for any adult living or recently having stayed in endemic areas.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Meriem Menany, Safae khnaba, Bouchaib Radouane, Mohamed Jidal, Touriya Amil, Rachida Saouab [Case report] - Giant bilateral angiomyolipomas with spontaneous hemorrhage and inferior vena cava thrombosis in a patient with tuberous sclerosis - 25 July 2017. http://www.panafrican-med-journal.com/content/article/27/223/abstract/ <b>Renal angiomyolipomas are rare type of benign renal neoplasm. They are composed of vascular, smooth and fat elements and can be associated to phacomatosis as Tuberous Sclerosis disease. Symptomatic presentation is most frequently spontaneous retroperitoneal hemorrhage, which can be fatal. The risk of bleeding is proportional to the size of the lesion (>4 cm of diameter). Typical angiomyolipomas are benign but may have alarming properties: nuclear pleomorphism and mitotic activity, extension into the vena cava, and spread to regional lymph nodes without malignant progression. We report a Computed Tomography finding of a rare giant bilateral angiomyolipomas with spontaneous hemorrhage and inferior vena cava thrombus in a patient with tuberous sclerosis, emphasizing the importance of imagery in the positive and etiologic diagnosis.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Fay&ccedil;al Abbad, Souad Sellami, Fe Hazmiri, Najat El Idriss Ganouni, Said Ait Benali, Mouna Khouchani, Hanane Rais [Case series] - Neurocytomes centraux: corr&eacute;lations cliniques et radiopathologiques &agrave; propos de 12 observations - 25 July 2017. http://www.panafrican-med-journal.com/content/article/27/222/abstract/ <b>Les neurocytomes centraux sont d&eacute;finis comme &eacute;tant des n&eacute;oplasmes compos&eacute;s de cellules rondes, uniformes, ayant un profil immunoph&eacute;notypique neuronal et un index de prolif&eacute;ration bas. Elles repr&eacute;sentent 0,5% des tumeurs intracr&acirc;niennes. Elles sont habituellement situ&eacute;es &agrave; proximit&eacute; du foramen de Monro et peuvent &ecirc;tre &agrave; l’origine d’une hydroc&eacute;phalie obstructive. Nous rapportons 12 observations de neurocytomes centraux collig&eacute;s au laboratoire d’anatomie pathologique du CHU Mohammed VI de Marrakech entre janvier 2006 et juin 2015. Le but de ce travail est de rapporter et d&eacute;crire les aspects radio-pathologiques de ce type histologique rare. Le sex-ratio homme/femme &eacute;tait de 1,4. L’&acirc;ge moyen au diagnostic &eacute;tait de 22,3 ans. La symptomatologie r&eacute;v&eacute;latrice &eacute;tait domin&eacute;e par l’hypertension intracr&acirc;nienne chez tous nos patients, associ&eacute;e &agrave; une baisse de l’acuit&eacute; visuelle et une diplopie. Notre mat&eacute;riel d’&eacute;tude a concern&eacute; une biopsie simple dans un cas, une ex&eacute;r&egrave;se subtotale dans sept cas et une ex&eacute;r&egrave;se totale dans quatre cas. L’&eacute;tude histopathologique a montr&eacute; une prolif&eacute;ration tumorale d’architecture endocrine. Les cellules tumorales sont uniformes de petite taille le plus souvent. L’index mitotique &eacute;tait bas. Cette prolif&eacute;ration tumorale s’accompagnait d’un fond fibrillaire et d’un r&eacute;seau vasculaire d&eacute;velopp&eacute; de type arborescent. L’&eacute;tude immunohistochimique &eacute;tait identique chez tout les patients. Elle a montr&eacute; une positivit&eacute; des cellules tumorales &agrave; l’anticorps anti synaptophysine, &agrave; chromogranine et NSE. Chez tous nos patients la corr&eacute;lation radiopathologique &eacute;tait en faveur d’un neurocytome central (Grade II – OMS 2016). A travers cette s&eacute;rie, nous rapportons les particularit&eacute;s anatomo-cliniques, radiologiques et &eacute;volutives de ces tumeurs rares.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Fatima Zahra Debbarh, Fatima Zahra Mernissi [Images in medicine] - Piebaldisme: une g&eacute;nodermatose rare - 24 July 2017. http://www.panafrican-med-journal.com/content/article/27/221/abstract/ <b>Le piebaldisme est une g&eacute;nodermatose rare de transmission autosomique dominante. Il est du &agrave; l'absence cong&eacute;nitale des m&eacute;lanocytes aux zones touch&eacute;es. Nous en rapportant un cas. Une fille de 5 ans; avec notion de consanguinit&eacute; et cas similaire chez la m&egrave;re; a pr&eacute;sent&eacute; d&egrave;s la naissance des l&eacute;sions achromiques des jambes d'&eacute;volution stable. L'examen a objectiv&eacute; des nappes achromiques des jambes avec ilots de pigmentation et poliose (A); sans accentuation du contraste &agrave; la lumi&egrave;re de Wood et multiples t&acirc;ches caf&eacute; au lait au niveau du tronc et cuisses (B). Le diagnostic de piebaldisme a &eacute;t&eacute; pos&eacute;. Le piebaldisme est une g&eacute;nodermatose rare. Son incidence est estim&eacute;e &agrave; moins de 1/20000 naissance. Il est caract&eacute;ris&eacute; par l'absence cong&eacute;nitale de m&eacute;lanocytes aux zones touch&eacute;es par mutation du g&egrave;ne c-kit et se manifeste par des macules achromiques sym&eacute;triques d&egrave;s la naissance d'&eacute;volution stable et persistante. Une m&egrave;che de cheveux blanche au niveau frontal pourrait se voire dans 80% des cas. Le diagnostic diff&eacute;rentiel se fait avec le vitiligo; l'albinisme et le syndrome de Waardenburg. Des associations ont &eacute;t&eacute; d&eacute;crites avec la neurofibromatose de type I. Cependant; des t&acirc;ches caf&eacute; au lait isol&eacute;es peuvent &ecirc;tre observ&eacute;; comme le cas de notre patiente. Le traitement est bas&eacute; sur la greffe de peau mince. Le piebaldisme est une g&eacute;nodermatose rare. A travers cette observation; on discute ses aspects cliniques et ses diagnostics diff&eacute;rentiels.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mohamed El amraoui, Youssef Zemmez, Ahmed Bouhamidi, Rachid Frikh, Naoufal Hjira, Mohammed Boui [Case report] - Vitiligo r&eacute;v&eacute;lant une maladie de Vogt-Koyanagi-Harada - 24 July 2017. http://www.panafrican-med-journal.com/content/article/27/220/abstract/ <b>Le vitiligo est une dermatose chronique auto-immune, souvent associ&eacute; ou fait d&eacute;couvrir d’autres pathologies auto-immunes. Son association &agrave; une atteinte ophtalmologique &agrave; type de pan uv&eacute;ite et /ou une atteinte neurologique &agrave; type de m&eacute;ningite et/ou de l’oreille interne &agrave; type de surdit&eacute; d&eacute;termine la maladie ou le syndrome de Vogt-Koyanagi-Harada (VKH). Nous rapportons le cas d’une jeune femme qui consultait pour des uv&eacute;ites r&eacute;cidivantes depuis un an, Et ce n’&eacute;tait qu’avec l’apparition des l&eacute;sions de vitiligo que le diagnostic de maladie de VKH a &eacute;t&eacute; &eacute;voqu&eacute; et confirm&eacute;.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Emmanuel Wekesa Wamalwa [Case report] - Recurrent impetigo herpetiformis: case report - 24 July 2017. http://www.panafrican-med-journal.com/content/article/27/219/abstract/ <b>Impetigo herpetiformis (pustular psoriasis of pregnancy) is a rare dermatosis of pregnancy that typically starts in the 2nd half of pregnancy and resolves postpartum. It may recur in subsequent pregnancies. I present a case of 23 year old female gravida 4 para 3 with recurrent impetigo herpetiformis at 26 weeks gestation. She presented with a one month history of pustular lesions which responded to treatment with prednisone. She delivered at term with a favourable outcome. The disease resolved one month postpartum. This was the second recurrence of the disease. She had her first episode of impetigo herpetiformis during the second pregnancy. The disease recurred in the 3rd pregnancy and resulted in a still birth.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Yassine Abaloun, Yousra Ajhoun [Images in medicine] - Nodules de lisch dans la neurofibromatose type 1 - 21 July 2017. http://www.panafrican-med-journal.com/content/article/27/218/abstract/ <b>La neurofibromatose 1 (NF1) ou maladie de Von Recklinghausen est une maladie qui se manifeste par des taches caf&eacute; au lait cutan&eacute;es et des neurofi bromes. C'est une des maladies g&eacute;n&eacute;tiques les plus fr&eacute;quentes &agrave; transmission autosomique dominant. Ses manifestations sont extr&ecirc;mement variables d'un malade &agrave; l'autre. Les manifestations les plus souvent rencontr&eacute;es sont cutan&eacute;es et neurologiques mais d'autres organes peuvent &ecirc;tre touch&eacute;s comme l'œil, les os...Les nodules de Lisch constituent la manifestation oculaire la plus fr&eacute;quente de la NF1 et correspondent &agrave; des petites tumeurs pigment&eacute;es de l'iris (hamartomes iriens) qui n'entra&icirc;nent aucun sympt&ocirc;me mais sont une aide au diagnostic car ils sont caract&eacute;ristiques de la maladie et pr&eacute;sents chez la plupart des malades adultes. Nous rapportons le cas d'une patiente de 45 ans suivie pour une neurofibromatose type 1 retenue sur la pr&eacute;sence de multiples taches cutan&eacute;es caf&eacute; au lait et des neurofibormes. L'examen ophtalmologiques trouve une acuit&eacute; visuelle &agrave; 10/10 P3 en ODG avec &agrave; l'examen bio-microscopique des nodules de lisch iriens au niveau des deux yeux (A,B).</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Chama Daoudi, Noureddine boutimzine, Samia El Haouzi, Omar Lezrek, Samira Tachfouti, Mounir Lezrek, Mina Laghmari, Rajae Daoudi [Case report] - Le syndrome d’Usher: &agrave; propos d’une observation - 21 July 2017. http://www.panafrican-med-journal.com/content/article/27/217/abstract/ <b>Le syndrome d'Usher est une maladie g&eacute;n&eacute;tique comportant une double atteinte sensorielle (auditive et visuelle) appel&eacute;e surdic&eacute;cit&eacute;. Nous rapportons l'observation d'un patient de 50 ans, issue d'un mariage consanguin pr&eacute;sentant une surdit&eacute; cong&eacute;nitale avec une fonction vestibulaire normale et une r&eacute;tinopathie pigmentaire responsable d'une baisse bilat&eacute;rale de l'acuit&eacute; visuelle apparue vers l'&acirc;ge de 16 ans. Cette association compose le type 2 du syndrome d'Usher, affection rare de transmission autosomique r&eacute;cessive. La chirurgie de la cataracte a permis une am&eacute;lioration de l'acuit&eacute; visuelle chez ce patient.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Th&eacute;ophile Mitima Kashosi, Department of Biomedical Sciences, School of Medicine, Universit&eacute; Evang&eacute;lique en Afrique, BP 3323 Bukavu, DR Congo [Research] - Performance of SD Bioline Malaria Ag Pf/Pan rapid test in the diagnosis of malaria in South-Kivu, DR Congo - 21 July 2017. http://www.panafrican-med-journal.com/content/article/27/216/abstract/ <b>INTRODUCTION: use of malaria rapid diagnostic tests (RDTs) has improved the management of this disease. We evaluated the validity of the SD-Bioline Malaria-Ag-Pf/Pan™ (Batch 60952) RDT supplied by the Malaria Control Program of the DRCongo. METHODS: children (n=460) aged below 5 years seen in curative care (CC) for suspected malaria and in pre-school consultation (PSC) in two rural centers underwent clinical evaluation and capillary blood collection for microscopic reading of thick smear (TS) and thin film (BF), and for RDT. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values of the RDT, and the corresponding accuracy and Youden indices were determined using microscopic data as reference. Results were compared using the Chi-square test. RESULTS: microscopy showed malaria infection in 53.8% of CC and in 10.8% of PSC children. Similar results were obtained using the RDT (CC: 47.1%; PSC: 18.3%; P > 0.05 vs. microscopy). Se of the RDT was 82.1%, Sp 92.0%, PPV 88.5% and NPV 87.4%. RDT positivity was significantly (p<0.01) associated with some symptoms (chills, profuse sweating) and with a recent history of malaria attack. In addition, Se of the RDT depended on parasitemia and decreased at low parasite denstity. CONCLUSION: SD-Bioline Malaria-Ag-Pf/Pan™ RDT has a relatively good sensitivity and specificity but seems useful only for high parasitemia. Negative SD Bioline Malaria Ag Pf/Pan™ RDT should be complemented with microscopy when clinical signs suggest malaria.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Oppah Kuguyo, Alice Matimba, Nomsa Tsikai, Thulani Magwali, Mugove Madziyire, Muchabayiwa Gidiri, Collet Dandara, Charles Nhachi [Research] - Cervical cancer in Zimbabwe: a situation analysis - 21 July 2017. http://www.panafrican-med-journal.com/content/article/27/215/abstract/ <b>INTRODUCTION: Despite the wide-spread availability of cervical cancer prevention and screening programs in developed countries, the morbidity and mortality rates of cervical cancer in Zimbabwe are still very high. Limited resources as well as the high HIV prevalence are contributors to the high burden of cervical cancer. This paper aims to analyse the policies, frameworks and current practices in the management of cervical cancer in Zimbabwe.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Khadija Sarghini, Sofia Oubaha, Zouhour Samlani, Khadija Krati [Case report] - Association maladie cœliaque et tuberculose multifocale: &agrave; propos d’un cas avec revue de la litt&eacute;rature - 20 July 2017. http://www.panafrican-med-journal.com/content/article/27/214/abstract/ <b>La maladie cœliaque est une ent&eacute;ropathie auto-immune li&eacute;e &agrave; l'intol&eacute;rance au Gluten qui survient sur un terrain g&eacute;n&eacute;tiquement pr&eacute;dispos&eacute;. Le diagnostic repose sur la combinaison d'arguments cliniques, biologiques et histologiques. Elle est associ&eacute;e &agrave; de nombreuses complications, notamment le lymphome. Le risque de tuberculose chez les patients cœliaques est augment&eacute;. Plusieurs hypoth&egrave;ses expliquant cette association ont &eacute;t&eacute; discut&eacute;es. Nous rapportons un cas de maladie cœliaque associ&eacute;e &agrave; la tuberculose multifocale chez une patiente &acirc;g&eacute;e de 17 ans.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Sitraka Angelo Raharinavalona, Haritsiky Robertini Ramalanjaona, Nalisoa Andrianera, Andrinirina Dave Patrick Rakotomalala, George Ramahandridona [Case series] - D&eacute;pistage du risque podologique chez les diab&eacute;tiques de type 2 &agrave; Antananarivo - 20 July 2017. http://www.panafrican-med-journal.com/content/article/27/213/abstract/ <b>Le pied diab&eacute;tique p&egrave;se lourdement sur la sant&eacute; des diab&eacute;tiques, &eacute;tant responsable d’une grande morbidit&eacute; et de graves incapacit&eacute;s. Leur pr&eacute;vention reste incontournable. Notre &eacute;tude vise &agrave; r&eacute;duire le taux d’amputation chez les diab&eacute;tiques. Nous avons fait une &eacute;tude r&eacute;trospective descriptive, transversale et multicentrique du d&eacute;pistage du risque podologique chez les diab&eacute;tiques de type 2, au service d’Endocrinologie de l’H&ocirc;pital Universitaire de Befelatanana et &agrave; la Clinique AMADIA, Faravohitra, sur une p&eacute;riode de 6 mois. L’&acirc;ge moyen de nos patients &eacute;tait de 54,43 ans. Le genre masculin pr&eacute;dominait (60%). Leur diab&egrave;te &eacute;voluait, en moyenne, depuis 7,35 ans. Les ant&eacute;c&eacute;dents les plus observ&eacute;s &eacute;taient le tabagisme et les ulc&eacute;rations chroniques du pied. Plus de la moiti&eacute; de nos patients avaient un diab&egrave;te d&eacute;s&eacute;quilibr&eacute;, une microalbuminurie et une r&eacute;tinopathie. Nous avons enregistr&eacute; 56,50% de patients conscients du risque mais moins de 46% donnant des exemples pr&eacute;cis sur les conduites adapt&eacute;es. Seulement 13,33% de nos patients b&eacute;n&eacute;ficiaient d’un examen des pieds avant la pr&eacute;sente &eacute;tude. Leur risque podologique &eacute;tait tr&egrave;s &eacute;lev&eacute;. Les facteurs pr&eacute;dictifs d’ulc&eacute;ration identifi&eacute;e &eacute;taient le tabagisme, l’ant&eacute;c&eacute;dent d’ulc&eacute;ration chronique des membres inf&eacute;rieurs, le mauvais &eacute;quilibre du diab&egrave;te et l’existence d’une d&eacute;formation du pied. La strat&eacute;gie de pr&eacute;vention efficace des amputations doit comporter le d&eacute;pistage et l’identification de la population &agrave; risque d’ulc&eacute;ration.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Siham Bouchal, Ouarda Ouali, Mouhamed Faouzi Belahsen [Case report] - R&eacute;ponse spectaculaire au valproate de sodium d’une chor&eacute;e de Sydenham r&eacute;currente - 20 July 2017. http://www.panafrican-med-journal.com/content/article/27/212/abstract/ <b>La chor&eacute;e du Sydenham est la premi&egrave;re cause de chor&eacute;e acquise dans le tiers monde. Nous rapportons le cas d'une Chor&eacute;e r&eacute;currente trait&eacute;e avec succ&egrave;s par le valproate du sodium. Mlle A.C &acirc;g&eacute;e de 16 ans ayant comme ant&eacute;c&eacute;dents des angines &agrave; r&eacute;p&eacute;tition et un &eacute;pisode de mouvement chor&eacute;ique il y a 2 ans, pour lequel elle a &eacute;t&eacute; mise sous Halop&eacute;ridol et sous pr&eacute;vention du rhumatisme articulaire aigu. La patiente a interrompue le traitement et quelques mois plus tard elle a pr&eacute;sent&eacute; le m&ecirc;me tableau neurologique. L'IRM c&eacute;r&eacute;brale et l'&eacute;chographie transthoracique &eacute;taient normales. La pr&eacute;vention par Extencilline a &eacute;t&eacute; r&eacute;instaur&eacute;e ainsi que l'halop&eacute;ridol sans aucune am&eacute;lioration, d'o&ugrave; la mise en route sous valproate de sodium. La r&eacute;ponse &eacute;tait spectaculaire apr&egrave;s 2 mois de traitement sans r&eacute;cidive apr&egrave;s 3ans de recul. Le traitement de la chor&eacute;e du Sydenham &eacute;tait les neuroleptiques. Des &eacute;tudes r&eacute;centes pr&eacute;conisent d'autres mol&eacute;cules efficaces et mieux tol&eacute;r&eacute;es.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Georges Antoine Bazolo Ba Ngouala, Loubna Bourgi, Joao Arm Indo Da Veiga, Arona Sakho [Research] - Endoscopie digestive haute &agrave; Louga (S&eacute;n&eacute;gal): profil des patients et difficult&eacute;s rencontr&eacute;es - 20 July 2017. http://www.panafrican-med-journal.com/content/article/27/211/abstract/ <b>INTRODUCTION: les objectifs de cette étude étaient de déterminer le profil épidémiologique, clinique et endoscopique des patients adressés pour endoscopie digestive haute à la clinique Magou de Louga et d’analyser les difficultés rencontrées. METHODES: il s’agit d’une étude rétrospective et descriptive qui analyse les comptes rendus de 248 gastroscopies réalisées entre le 1er janvier et le 31 decembre 2014. RESULTATS: l’âge moyen était de 39,9 ans, le sex ratio était de 2,3 en faveur des femmes. La majorité des patients (56,5%) provenait d’une zone rurale. Les patients étaient surtout des femmes au foyer (55,2%). Les principaux prescripteurs étaient les médecins (77,8%). L’épi gastralgie était la principale indication. La hernie hiatale domine avec 33,1% suivi d’examen normaux 22,5% et le reflux gastrooesophagien isolé 12,5% des cas. Seulement 2 résultats anatomopathologiques sur 13 ont été reçus. Aucun contrôle endoscopique demandé n’a été fait. CONCLUSION: peu d’endoscopie digestive haute sont réalisées à Louga. Le profil type du patient est une femme au foyer jeune vivant en zone rurale se plaignant d’épi gastralgies dont l’examen endoscopique à défaut d’être normal retrouve une hernie hiatale ou reflux gastrooesophagien. Les difficultés sont liées aux résultats d’analyses anatomopathologiques non reçus et à l’absence de contrôle endoscopique après traitement.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hamza Dergamoun, Zayd El Boukili El Makhoukhi [Images in medicine] - Rupture de l’albugin&eacute;e du corps caverneux - 20 July 2017. http://www.panafrican-med-journal.com/content/article/27/210/abstract/ <b>Les fractures de la verge sont peu fr&eacute;quentes dans notre contexte, et font le plus souvent suite &agrave; un faux pas du co&iuml;t. Une cause plus fr&eacute;quente a &eacute;t&eacute; d&eacute;crite dans les pays du moyen orient qui vise &agrave; interrompre l'&eacute;rection par une flexion brutale de la verge, appel&eacute;e « Taqaandan ». Nous rapportons ici le cas d'un patient de 21 ans, sans ant&eacute;c&eacute;dent particulier, qui se pr&eacute;sente aux urgences du centre hospitalier Avicenne pour une douleur et d&eacute;formation de la verge suite &agrave; une manœuvre de « Taqaandan ». Apr&egrave;s avoir entendu un claquement, le patient a not&eacute; une douleur et une d&eacute;tumescence brutale, sans signes urinaires associ&eacute;s excluant alors une atteinte ur&eacute;trale. Nous remarquons sur l'image l'aspect classique en aubergine (A). Apr&egrave;s r&eacute;alisation d'une &eacute;chographie confortant de diagnostic de rupture de l'albugin&eacute;e du corps caverneux, le patient a &eacute;t&eacute; admis au bloc op&eacute;ratoire ou il a b&eacute;n&eacute;fici&eacute; d'une intervention chirurgicale. Nous avons alors choisis un abord s&eacute;lectif controlat&eacute;ral &agrave; la d&eacute;viation, afin d'&eacute;viter toute dissection inutile. Apr&egrave;s &eacute;vacuation de l'h&eacute;matome, le trait de fracture a &eacute;t&eacute; visualis&eacute; (B) puis sutur&eacute; par des points invers&eacute;s. Le patient a &eacute;t&eacute; d&eacute;clar&eacute; sortant le lendemain de l'intervention sous traitement antalgique et traitement anti hormonal. Notre jeune patient a &eacute;t&eacute; revu &agrave; 2, 4 et 6 mois en ayant r&eacute;cup&eacute;r&eacute; une fonction &eacute;rectile normale sans coudure ni plaque de fibrose.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Abderrahim Doudouh, Abdelhamid Biyi [Images in medicine] - Des m&eacute;tastases osseuses d’un m&eacute;lanome malin d&eacute;tect&eacute;es sur une TEP au 18F-FDG avec scintigraphie du squelette normale - 20 July 2017. http://www.panafrican-med-journal.com/content/article/27/209/abstract/ <b>Nous rapportons le cas d’une patiente &acirc;g&eacute;e de 30 ans, op&eacute;r&eacute;e deux ans plus t&ocirc;t pour un m&eacute;lanome de la fesse droite et qui a consult&eacute; pour les douleurs rachidiennes persistantes. La scintigraphie osseuse (SO) &eacute;tait tout &agrave; fait normale (A). Compte tenu de l’histoire m&eacute;dicale de la patiente, une tomographie par &eacute;mission de positons (TEP) au 18-FDG a &eacute;t&eacute; pratiqu&eacute;e dans les 30 jours qui ont suivi et a montr&eacute; de multiples foyers d’hyperm&eacute;tabolisme aux niveaux de la fesse droite, d’ad&eacute;nopathies inguinales du m&ecirc;me cot&eacute;, du poumon gauche et de l’ensemble du squelette (B). La patiente est malheureusement d&eacute;c&eacute;d&eacute;e dans les jours qui ont suivi avant toute tentative de traitement. Les m&eacute;tastases osseuses des m&eacute;lanomes malins sont rares. Quand elles surviennent, elles sont typiquement ost&eacute;olytiques dans 87,5% des cas avec une infiltration m&eacute;dullaire dans 91,6% des cas. Pour cette derni&egrave;re raison, la pratique d’une TEP au 18-FDG s’av&egrave;re tr&egrave;s contributive. Notre cas illustre clairement sa sup&eacute;riorit&eacute; de la TEP au 18-FDG par rapport &agrave; la SO dans cette indication. Actuellement et selon les donn&eacute;es de la litt&eacute;rature, l’inscription d’une TEP au 18-FDG dans le cadre du bilan d’extension ou bien de surveillance d’un m&eacute;lanome malin s’av&egrave;re largement justifi&eacute;e.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mohamed Amine Oukhouya, Hind Abou El Jaoud, Saad Andaloussi, Hicham Abdellaoui, Karima Atarraf, Lamia Chater, My Abderrahman Afifi [Case report] - L&eacute;sion Monteggia du groupe III association rare, &agrave; propos d’un cas - 20 July 2017. http://www.panafrican-med-journal.com/content/article/27/208/abstract/ <b>La lesion Monteggia du groupe III est une l&eacute;sion tr&egrave;s rare, elle survient g&eacute;n&eacute;ralement dans un contexte de traumatisme violent et passe souvent inaper&ccedil;ue. Nous rapportons le cas d’un gar&ccedil;on de 11 ans qui s’est pr&eacute;sent&eacute; aux urgences pour un traumatisme ferm&eacute; du membre sup&eacute;rieur, et chez qui le bilan radiologique a objectiv&eacute; une fracture de l’ol&eacute;cr&acirc;ne et d&eacute;collement &eacute;piphysaire du radius avec luxation de la t&ecirc;te radiale, le patient a b&eacute;n&eacute;fici&eacute; d’un traitement orthop&eacute;dique avec une bonne &eacute;volution apr&egrave;s 3 mois de recul.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Seydou Togo, Moussa Abdoulaye Ouattara, Xing Li, Shang Wen Yang, S&eacute;kou Koumar&eacute; [Case series] - Prise en charge des corps &eacute;trangers enclaves de l’œsophage: &agrave; propos de 36 cas - 20 July 2017. http://www.panafrican-med-journal.com/content/article/27/207/abstract/ <b>L'ingestion de corps &eacute;tranger de l'œsophage est un motif fr&eacute;quent de consultation aux urgences p&eacute;diatriques. Cependant le ph&eacute;nom&egrave;ne peut se retrouver &agrave; tous les &acirc;ges. Les auteurs d&eacute;crivent les caract&eacute;ristiques cliniques, paracliniques et th&eacute;rapeutiques des corps &eacute;trangers enclav&eacute;s dans l'œsophage pris en charge &agrave; l'h&ocirc;pital du Mali. Il s'agit d'une &eacute;tude prospective, men&eacute;e entre janvier 2011 et d&eacute;cembre 2014 incluant tous les cas d'ingestion de corps &eacute;trangers enclav&eacute;s dans l'œsophage. Au total 36 patients ont &eacute;t&eacute; pris en charge par des moyens endoscopiques ou chirurgicaux. L'&acirc;ge moyen &eacute;tait de 6 ans (extr&ecirc;mes: 14 mois- 62 ans). Le sexe masculin &eacute;tait dominant avec un sexe ratio de 1,75. Les corps &eacute;trangers &eacute;taient bloqu&eacute;s dans le r&eacute;tr&eacute;cissement crico-pharyngien dans 69,45% des cas suivi du r&eacute;tr&eacute;cissement aortique dans 22,22% des cas. Le d&eacute;lai d'extraction du corps &eacute;tranger en moyenne &eacute;tait de 7 heures 30. La fibroscopie rigide a permis l'extraction du corps &eacute;tranger dans 88,89% des cas. Une chirurgie par thoracotomie a permis d'extraire le corps &eacute;tranger dans 5,55%. Les corps &eacute;trangers de l'œsophage peuvent se retrouver &agrave; tout &acirc;ge mais restent plus fr&eacute;quent chez l'enfant. L'extraction endoscopique est la man'uvre la plus r&eacute;alis&eacute;e mais la chirurgie pour extraction d'un corps &eacute;tranger bloqu&eacute; dans l'œsophage bien que rare reste le dernier recours &agrave; cause souvent de leur nature et de la survenue des complications. Le meilleur moyen pour lutter contre ces accidents reste la pr&eacute;vention.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Khalid Mouhadi Tarik Boulahri, Abdelhadi Rouimi [Case report] - M&eacute;ningo-enc&eacute;phalite tuberculeuse r&eacute;v&eacute;l&eacute;e par des troubles psychiatriques: &agrave; propos d’un cas - 20 July 2017. http://www.panafrican-med-journal.com/content/article/27/206/abstract/ <b>La m&eacute;ningo-enc&eacute;phalite tuberculeuse est une pathologie assez fr&eacute;quente dans les pays end&eacute;miques, et repr&eacute;sente la forme la plus s&eacute;v&egrave;re de la tuberculose. L’&eacute;chec th&eacute;rapeutique est fr&eacute;quent &agrave; cause du retard diagnostique. Ce retard est essentiellement d&ucirc; au grand polymorphisme clinique et notamment en raison des formes trompeuses. Ce travail expose le cas clinique rare d’une m&eacute;ningite tuberculeuse se pr&eacute;sentant sous forme d’un tableau psychiatrique typique au cours de sa phase prodromique</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Amina Kissou, Badredine Hassam [Images in medicine] - Un nodule rose du visage - 18 July 2017. http://www.panafrican-med-journal.com/content/article/27/205/abstract/ <b>Une jeune patiente &acirc;g&eacute;e de 32 ans, sans ant&eacute;c&eacute;dents pathologiques notables, s'est pr&eacute;sent&eacute;e en consultation de dermatologie pour un nodule de la joue droite qui &eacute;voluait depuis 10 ans. L'examen clinique trouvait un nodule rouge&acirc;tre &agrave; surface lisse avec une base ench&acirc;ss&eacute;e dans le derme. La l&eacute;sion mesurait 1cm de diam&egrave;tre et si&eacute;geait au niveau de la joue droite (A). Il n'y avait pas d'ad&eacute;nopathie et le reste de l'examen clinique &eacute;tait normal. Une biopsie cutan&eacute;e a &eacute;t&eacute; r&eacute;alis&eacute;e et avait montr&eacute; au niveau du derme, une prolif&eacute;ration tumorale faite de cellules fusiformes &agrave; cytoplasme &eacute;osinophile mal limit&eacute; et aux noyaux allong&eacute;s peu atypiques sans mitose avec un infiltrat inflammatoire mononucl&eacute;es. L'&eacute;piderme &eacute;tait aminci. Les anti-corps anti CD68 &eacute;tait positif, par contre, les anti-corps anti CD34, PS100 et anti AML &eacute;taient n&eacute;gatifs. Le diagnostic d'histiocytofibrome b&eacute;nin cellulaire a &eacute;t&eacute; retenu. La patiente a b&eacute;n&eacute;fici&eacute; d'une ex&eacute;r&egrave;se totale avec une marge de 5mm qui &eacute;taient saines. Il n y avait pas de r&eacute;cidive avec un recul de 2 ans. L'histiocytofibrome b&eacute;nin est une tumeur qui se voit fr&eacute;quemment chez la femme d'&acirc;ge moyen. Elle se pr&eacute;sente le plus souvent sous forme nodulaire &eacute;ryth&eacute;mateuse, bleut&eacute;e, brun&acirc;tre ou achromique, caract&eacute;ris&eacute;e par sa consistance ferme, ench&acirc;ss&eacute;e dans le derme, peu douloureuse mais parfois g&ecirc;nante avec une localisation typique au niveau des membres inf&eacute;rieurs. La localisation au niveau du visage comme notre patiente est rarement rapport&eacute;. Le diagnostic diff&eacute;rentiel se pose avec un dermatofibrosarcome de Darier et Ferrand, un l&eacute;iomyosarcome, un l&eacute;iomyome, un nodule de Kaposi et avec la tumeur fibreuse solitaire dans sa localisation cutan&eacute;e. Histologiquement, l'histiocytofibrome b&eacute;nin dans sa forme cellulaire est form&eacute; d'une prolif&eacute;ration intradermique pure, d&eacute;sordonn&eacute;e, faite de cellules fusiformes dispos&eacute;es en faisceaux ou en tourbillons et circonscrites par une r&eacute;action inflammatoire lymphocytaire avec pr&eacute;sence d'histiocytes spumeux. La l&eacute;sion est souvent richement vascularis&eacute;e avec possibilit&eacute; de foyers h&eacute;morragiques et surtout images d'angiog&eacute;n&egrave;se. Dans une minorit&eacute; de cas, concernant surtout les histiocytofibromes de grande taille, l'&eacute;piderme est aminci et peut m&ecirc;me s'ulc&eacute;rer. L'immunohistochimie montre un marquage positif du CD68 et F XIIIa+, par contre, le CD34, PS100 et Anti-AML sont n&eacute;gatifs. L'&eacute;volution est chronique, b&eacute;nigne avec possibilit&eacute; de r&eacute;gression spontan&eacute;e. Le traitement repose sur l'ex&eacute;r&egrave;se chirurgicale.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Faith Mutsigiri-Murewanhema, Patron Trish Mafaune, Tsitsi Juru, Notion Tafara Gombe, Donewell Bangure, More Mungati, Mufuta Tshimanga [Research] - Evaluation of the maternal mortality surveillance system in Mutare district, Zimbabwe, 2014-2015: a cross sectional study - 18 July 2017. http://www.panafrican-med-journal.com/content/article/27/204/abstract/ <b>INTRODUCTION: In Zimbabwe the integrated disease surveillance and response guidelines include maternal mortality as a notifiable event reported through the Maternal Mortality Surveillance System (MMSS). A preliminary review of the MMSS data for Mutare district for the period January to June 2014 revealed that there were some discrepancies in cases notified and those captured on the T5 monthly return form. There were also delays in reporting of some maternal deaths. Poor reporting indicated shortcomings in the MMSS in Mutare district and we therefore sought to assess the performance of the maternal mortality surveillance system in Mutare district. METHODS: a descriptive cross sectional study was conducted using Centers for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems. A total of 64 health workers were enrolled into the study from 19 selected health facilities in Mutare district and 32 maternal death notification forms submitted in 2014 to the provincial office were reviewed to assess the quality of information on the forms. Interviewer administered questionnaires were used to collect information from enrolled health workers, the system's attributes namely usefulness, acceptability, simplicity, stability, data quality, timeliness and completeness were assessed and a checklist was used to assess availability of resources for the implementation of the maternal mortality surveillance. We also determined the cost of reporting each maternal death in Mutare district. RESULTS: half of the study participants gave the correct definition of a maternal death. All health workers participated and were willing to continue participating in the maternal mortality surveillance. Majority of health workers, 79.7% used data generated from the surveillance system and 59.5% found it easy to implement the system. A total of 32 death notification forms were reviewed and of these, 31 forms were forwarded to the national office and all did not reach the national office on time. Average completeness of notification forms was 76.0% and 53.1% of the forms had all the necessary accompanying documents. Reporting each maternal death was estimated to cost $28.65 in Mutare district. CONCLUSION: the strongest components of the maternal mortality surveillance system in Mutare district were usefulness and acceptability. Timeliness and completeness were the weaker components of the system. The system was found to be simple; however, resources were not adequately available in all health facilities.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Annamercy Makoni, Milton Chemhuru, Notion Gombe, Gerald Shambira, Tsitsi Juru , Donewell Bangure, Mufuta Tshimanga [Research] - Evaluation of the acute flaccid paralysis (AFP) surveillance system, Gokwe North district, Zimbabwe, 2015: a descriptive cross sectional study - 18 July 2017. http://www.panafrican-med-journal.com/content/article/27/203/abstract/ <b>INTRODUCTION: AFP surveillance was adopted globally as a key strategy for monitoring the progress of the polio eradication initiative. Gokwe North district with an estimated 119 655 children <15 years detected 2 cases, 4 cases and 1 case of AFP in 2012, 2013 and 2014 respectively against a target of 5 cases per year. We therefore set out to evaluate the system and find out why it was failing to detect at least 5 cases per year.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Daniel Massi Gams, Mohamed Lelouma Mansare, Mari&eacute;tou Traor&eacute;, Moustapha Ndiaye, Amadou Gallo Diop, Mouhamadou Mansour Ndiaye [Case report] - Post-ivermectin encephalopathy in Senegal: a case report - 18 July 2017. http://www.panafrican-med-journal.com/content/article/27/202/abstract/ <b>Ivermectin is an ant parasitic drug used for combating onchocerciasis and lymphatic filariasis. It works by inhibiting the function of neurons and muscles, thus causing paralysis of microfilariae. Side effects of this drug have been reported including post-ivermectin encephalopathy requiring emergency care in hospital. We report the case of a 35 years old patient living in rural areas of Senegal who presented two days after a mistake in administration of a second dose of ivermectin, headaches, altered consciousness and bilateral blindness. The workup revealed brain white matter lesions, abnormal liver function tests and biological inflammation without evidence of Loa loa microfilariae in blood and cerebrospinal fluid. Corticosteroid treatment was administered in emergency and patient recovered despite the persistence of bilateral blindness. Inflammatory process seems to have an important role in the pathophysiology of this encephalopathy. We should therefore carefully control the administration of this drugs.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Edmund Kwadwo Kwakye Brakohiapa, Benard Ohene Botwe, Benjamin Dabo Sarkodie, Eric Kwesi Ofori, Jerry Coleman [Research] - Radiographic determination of cardiomegaly using cardiothoracic ratio and transverse cardiac diameter: can one size fit all? Part one - 14 July 2017. http://www.panafrican-med-journal.com/content/article/27/201/abstract/ <b>INTRODUCTION:the cardio-thoracic ratio and the transverse cardiac diameter on Plain chest radiography are the two parameters commonly used to diagnose cardiomegaly and heart disease. A CTR of greater than 50% on a PA film is abnormal and normally indicates cardiac dilatation or pericardial effusion, whiles an increase of 1.5 to 2cm on two consecutive radiographs, taken at short interval, suggests possible cardiac pathology. The aim was to determine the suitability of using the same TCD and CTR to detect cardiomegaly for all age groups and genders respectively. METHODS: a retrospective study involved the review of 1047 radiological images of adults aged 20 to 80 years, who had plain frontal chest radiographs between January 2012 and November 2013 by 3 radiologists. Data recorded included the transverse cardiac and thoracic diameter and the cardiothoracic ratios. Descriptive and inferential analyses were carried out using the SPSS V17. RESULTS: the mean age and standard deviation for the study population was 35.1 ± 12.7. The mean and standard deviations for the transverse cardiac diameter, thoracic diameter, and the cardiothoracic ratios for male participants were 13.08cm ± 1.2, 29.7cm ± 2.7 and 46.6% ± 3.9, and 12.9 cm ± 1.3, 27.1 cm ± 2.6, and 47.8% ± 4.8 for females. An increase in TCD of 1cm resulted in a CTR of greater than 50.0% in all but the males aged 21-40 years. CONCLUSION: the study found that the same TCD and CTR values are not suitable in detecting cardiomegaly for all age groups and genders.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mouna Bouaddi, Badredine Hassam [Images in medicine] - Hidradenite suppurative et psoriasis: anguille sous roche - 14 July 2017. http://www.panafrican-med-journal.com/content/article/27/200/abstract/ <b>L'hidrad&eacute;nite suppurative et le psoriasis sont des maladies inflammatoires chroniques. La premi&egrave;re si&egrave;ge pr&eacute;f&eacute;rentiellement au niveau des zones riches en glande apocrine, la deuxi&egrave;me est ubiquitaire. L'association des deux pathologies n'a jamais &eacute;t&eacute; d&eacute;crite dans la litt&eacute;rature. Cette association cachait une infection &agrave; HIV &eacute;volutive. Mr MB, &acirc;g&eacute; de 45 ans, tabagique chronique depuis 10ans, &eacute;tait hospitalis&eacute; pour la prise en charge de nodules durs douloureux &eacute;ryth&eacute;mateux fistulis&eacute;s des r&eacute;gions axillaires et inguinales apparus 6 mois avant avec des l&eacute;sions &eacute;ryth&eacute;mato-squameuses des plantes (A). Les nodules ont augment&eacute; de taille et ont conflu&eacute; en placard avec apparition secondaire de fistules laissant sourdre de pus jaune naus&eacute;abond en grande abondance (B). L'&eacute;tat g&eacute;n&eacute;ral &eacute;tait conserv&eacute; et l'examen somatique ne relevait pas d'anomalie. Le patient a b&eacute;n&eacute;fici&eacute; de deux biopsies une au niveau axillaire et l'autre au niveau de la plante confirmant les diagnostics de maladie de Verneuil sur la premi&egrave;re et de psoriasis sur la deuxi&egrave;me. Une s&eacute;rologie HIV a &eacute;t&eacute; demand&eacute;e, fortement positive ce qui a &eacute;t&eacute; confirm&eacute; par le western blot avec taux CD4>500/mm3. Les pr&eacute;sentations atypiques des dermatoses et les associations inhabituelles des dermatoses ayant des m&eacute;canismes physiopathologiques tr&egrave;s diff&eacute;rents doivent faire suspecter une infection r&eacute;trovirale. L'association de psoriasis et de l'hidradenite suppurative n'a jamais &eacute;t&eacute; d&eacute;crite m&ecirc;me au cours de l'infection HIV. L'infection VIH peut occasionner une multitude de dermatoses de pr&eacute;sentation atypique. Le dermatologue doit &ecirc;tre vigilant pour permettre d'&eacute;tablir un diagnostic pr&eacute;coce de l'infection.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Walid Osman, Zeineb Alaya, Hamdi Kaziz, Lassad Hassini, Meriem Braiki, Nader Naouar, Mohamed Laaziz Ben Ayeche [Case series] - Treatment of high-energy pilon fractures using the ILIZAROV treatment - 14 July 2017. http://www.panafrican-med-journal.com/content/article/27/199/abstract/ <b>The management of high-energy pilon fractures is still controversial. Open reduction and internal fixation are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. The aim of this retrospective study was to analyze the clinical and radiographic outcome of the ILIZAROV technique in patients with high-energy pilon fractures. Thirty cases of distal tibia epiphysis fractures (pilon fractures) were managed from 1999 to 2012. The study group included 5 cases of open fractures. The mean age was 47 years. According to R&uuml;edi and Algower classification; 11 fractures were type II, and 19 type III. All fractures were a consequence of high-energy trauma. Fractures of the lower fibula were present in 28 of the patients. An external Fixator was applied for open fractures. Closed injuries were operated on 3 to 13 days after injury, with an average of 8 days. The mean follow-up was 48 months. All fractures united. The external fixator was removed after a mean of 22 weeks (10 - 28 weeks). Two patients with a type III fracture had a delayed union and were treated with corticotomy and dynamisation of the ILIZAROV fixator. Only one secondary displacement of a type III fracture was noted after two months and was treated by adjuction of 2 olive wires. There were no cases of osteomyelitis or deep infections. Pin-tract infections occurred in ten patients. We had not any case of nervous injury due to introduction of the pins. Using radiological criteria for assessement of reduction of the articular fragments, there was excellent and good restoration of articular structure in 24 cases. The average American Orthopeadic Foot and Ankle Society ankle-hind foot score was excellent in 16, good in 6, fair in 6 and poor in 2. Soft tissue healing occurred without need for plastic surgery in all cases. The movements of the ankle ranged from 0 to 20° of dorsiflexion and 5° to 40° of plantar flexion. Twenty patients had gone back to their preinjury profession. The ILIZAROV technique is a safe and a very effective treatment for severe pilon fractures with minimum complications and good healing results.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Akin Usta, Dilay Karademir, Eylem Sen, Selcuk Yazici, Ertan Adali, Erkan Erdem, Meric Karacan [Case report] - Osteogenesis imperfecta Type IV: a newly identified variant at position c.560 (G > T; p.Gly187Val) in the COL1A2 gene - 14 July 2017. http://www.panafrican-med-journal.com/content/article/27/198/abstract/ <b>Osteogenesis imperfecta is a clinically heterogenous disease caused by defective collagen syntesis associated with a mutation in the COL1A1 or COL1A2 genes. In this report, we present a case of osteogenesis imperfecta (OI) type IV, seen in a female fetus with incurved femurs at 18 weeks of gestation. Molecular analysis of the newborn revealed a novel mutation at position c.560 (c.560 G > T) of the exon 12 in the COL1A2 gene; which lead to the glycine modification with valine (p.Gly187Val) at codon 187. The pregnancy follow-up was uneventful. After delivery, the newborn underwent biphosponat therapy and no fracture was detected until 1 year old.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Ahmed Guennoun, Yousra Krimou, Nisrine Mamouni, Sanaa Errarhay, Chahrazed Bouchikhi, Abdelaziz Banani [Case report] - Torsion d’annexe saine et grossesse: &agrave; propos d’un cas - 14 July 2017. http://www.panafrican-med-journal.com/content/article/27/197/abstract/ <b>La torsion d'annexe saine lors d’une grossesse est une entit&eacute; rare. Nous pr&eacute;sentons le cas d'une patiente de 22 ans, ayant consult&eacute; pour des algies lat&eacute;ro-pelvienne aigu&euml;s sur am&eacute;norrh&eacute;e de 2 mois et qui a b&eacute;n&eacute;fici&eacute; d'une laparotomie exploratrice revenue en faveur d'une torsion sur un ovaire sain en isch&eacute;mie s&eacute;v&egrave;re. Nous avons r&eacute;alis&eacute; une d&eacute;torsion de l'annexe sans pexie ovarienne. Les suites post-op&eacute;ratoires &eacute;taient sans particularit&eacute;. Un control &eacute;chographique apr&egrave;s 3 semaines en faveur d'une grossesse toujours &eacute;volutive. La torsion d'annexe est une urgence &agrave; ne pas m&eacute;conna&icirc;tre devant toute douleur pelvienne aigu&euml; chez la femme enceinte. Le traitement conservateur est actuellement le gold standard et une prise en charge appropri&eacute;e est n&eacute;cessaire pour &eacute;viter d'&eacute;ventuelles complications maternelles et fœtales.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Yibar Kambir&eacute;, Georges Rosario Christian Millogo, Claire Dauphin, Jean-Ren&eacute; Lusson [Case series] - Septal alcoholization in hypertrophic cardiomyopathy: about 11 cases - 13 July 2017. http://www.panafrican-med-journal.com/content/article/27/196/abstract/ <b>Outcomes of septal alcoholization in hypertrophic obstructive cardiomyopathy are not enough studied in all centers. The purpose of this study was to determine the outcomes of septal alcoholization in hypertrophic obstructive cardiomyopathy in our hospital. A retrospective and prospective descriptive study focused on all patients aged at least 18 years treated by alcohol septal ablation between July 2005 and June 2010 in the cardiology unit of Clermont-Ferrand teaching Hospital. The inclusion criteria were, hypertrophic obstructive cardiomyopathy with left ventricular outflow tract obstruction e" 50 mmHg, symptomatic despite optimal medical therapy. The clinical, paraclinical data and the results of alcohol ablation were collected from medical records of patients and a telephone conversation with the patients or their physicians. These data were analyzed by EPI info 6.04. Eleven patients with average age of 56.27 ± 15, 83 were included of which 81.8% of men. The main indications of alcohol septal were dyspnea stage NYHA II-IV (45.5%), lipothymia (18.2%) and invalidating angina (18.2%). Main electrocardiographic abnormalities were left ventricular hypertrophy and disorders of repolarization with 72.7% each. Minor conductive disorders were found in 45.5% of the cases. The left ventricular outflow tract obstruction was 98.18 ± 25.93 mmHg before alcohol septal ablation and 18.91 ± 31.97 mmHg after a follow-up of 25.64 ± 21.97 months. The success rate was 81.8%. Conductive disorders (45.5%) required the establishment of a definitive pacemaker in 36.4% of the patients. A cardiac defibrillator was implanted at 27.3%. Septal alcoholization was succesful.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Lara Nicole Goldstein, Sameer Carim [Images in medicine] - Lodox reveals the ideal body - 13 July 2017. http://www.panafrican-med-journal.com/content/article/27/195/abstract/ <b>A 110 kg patient presented to the hospital emergency department after being involved in a motor vehicle collision. A full body LODOX® (low-dose digital x-ray) was performed as part of the primary survey. The patient was subsequently intubated for airway protection. The utilisation of lower tidal volumes for ventilation of patients came to the fore with the ARDSNET publication. Despite the now well-known risks of ventilator-associated lung injury, patients with higher body mass indices who require ventilation in the emergency department are at increased risk of receiving inappropriately high tidal volumes. This Lodox image highlights that even though the patient's actual body weight was 110 kg and body mass index greater than 40, the lung size was equivalent to that of a 65 kg person. In addition, obesity can result in reduced lung volumes as well as reduced lung and chest wall compliance. This is exacerbated by the weight of the adipose leading to an increase in the work of breathing. It is a good reminder that in order to avoid deleterious, iatrogenic lung injury, we need to ventilate obese patients with tidal volumes scaled to their ideal body weight and mitigate the decreased chest wall compliance by considering starting with higher PEEP levels.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Dhia Kaffel, Wafa Hamdi [Images in medicine] - About a rare complication of spondyloarthritis - 13 July 2017. http://www.panafrican-med-journal.com/content/article/27/194/abstract/ <b>A 60-year-old Tunisian male, treated for an axial spondyloarthritis with indometacin (100 mg per day), consulted for a new 4-month history of inflammatory neck pain. The neurologic exam was normal. Radiographs of his neck showed a vertical atlantoaxial subluxation. MRI did not find any neurological suffering. Atlantoaxial subluxation is an uncommon and potentially fatal complication of spondyloarthritis. Vertical subluxation is a rare variant and is also the most severe. Vertical subluxation is measured using the Clark and Ranawat's method. It includes determination of the vertical distance between the center of the axis pedicle and the transverse axis of the atlas. If the distance is less than 14mm in males and 13mm in females, vertical subluxation is diagnosed. For some authors, to obtain the diagnosis of vertical subluxation, a combination of the Clark and Ranawat's method, the Redlund-Johnell methods has been recommended. The distance between "McGregor's line" and "the midpoint of the inferior margin of the body of axis" is used to evaluate vertical subluxation according to Redlund-Johnell method (less than 34 mm in men and 29 mm in women indicates vertical subluxation).</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Adil Kallat, Ahmed Ibrahimi, Otheman Fahsi, Hachem El Sayegh, Ali Iken, Lounis Benslimane, Yassine Nouini [Case report] - Le dispositif intra-ut&eacute;rin: &agrave; propos d’une complication rare et revue de la litt&eacute;rature - 13 July 2017. http://www.panafrican-med-journal.com/content/article/27/193/abstract/ <b>Le dispositif intra-ut&eacute;rin (DIU) constitue la m&eacute;thode contraceptive la plus utilis&eacute;e dans le monde. Sa migration trans-ut&eacute;rine est une complication rare et son incidence est estim&eacute;e dans la litt&eacute;rature de 1/350 insertions &agrave; 1/10000 insertions. Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 40 ans, chez qui un DIU a &eacute;t&eacute; pos&eacute; il y a 12 ans environ, ayant consult&eacute; pour des douleurs pelviennes et des lombalgies droites associ&eacute;es &agrave; une h&eacute;maturie intermittente et des br&ucirc;lures mictionnelles. Le bilan radiologique a mis en &eacute;vidence un dispositif intra ut&eacute;rin calcifi&eacute; en intra v&eacute;sicale. Une cystotithotomie a &eacute;t&eacute; r&eacute;alis&eacute;e sans difficult&eacute; particuli&egrave;re permettant l'extraction du calcul et du DIU. Une sonde urinaire a &eacute;t&eacute; laiss&eacute;e en place pendant 5 jours puis retir&eacute;e. Les suites op&eacute;ratoires ont &eacute;t&eacute; simples.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Nawfal Doghmi, Amine Meskine, Aziz Benakroute, Mustapha Bensghir, Abdelouahed Baite, Charki Haimeur [Case report] - Aseptic meningitis following a bupivacaine spinal anesthesia - 13 July 2017. http://www.panafrican-med-journal.com/content/article/27/192/abstract/ <b>Spinal anesthesia complicated by meningitis is rare. The diagnosis is difficult and the clinical signs are unspecific. There is a subgroup called aseptic meningitis of a different mechanism (hypersensitive reaction and irritation of the meninges), which must be identified for appropriate care. We report the case of aseptic meningitis resulting from bupivacaine use complicating spinal anesthesia. She is 31 years old and was admitted to the intensive care unit for meningitis following a Caesarean delivery. 10 hours after the procedure, she was found to have severe headache, neck stiffness and was found restless. She lost consciousness; she was treated by attending physicians. A CT scan have been performed and was found normal. 24 hours after intubation, the patient woke up. The clinical and biological valuations were normal, allowing for the elimination of the other causes of meningitis.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Bouchaib Hemmaoui, Mohamed Sahli, Noureddine Errami, Ahmed Rouihi, Mohamed Habib Bahalou, Ilias Benchaifai, Amine Ennouali, Sara Britel, Ismail Nakkabi, Ali Jahidi, Mohamed Zalagh, Saloua Ouaraini, Fouad Benariba [Case series] - Laryngectomies partielles supra-crico&iuml;diennes avec reconstruction par CHEP: notre exp&eacute;rience sur 16 cas - 13 July 2017. http://www.panafrican-med-journal.com/content/article/27/191/abstract/ <b>La chirurgie partielle du larynx avec reconstruction par crico-hyo&iuml;do-&eacute;piglottopexie (CHEP) s’adresse essentiellement aux cancers du plan glottique permettant une pr&eacute;servation satisfaisante des r&ocirc;les physiologiques et un contr&ocirc;le carcinologique local &eacute;galement satisfaisant. L’objectif de notre &eacute;tude est d’analyser les r&eacute;sultats fonctionnels et carcinologiques de cette chirurgie. Il s’agit d’une &eacute;tude r&eacute;trospective incluant l’ensemble des patients ayant b&eacute;n&eacute;fici&eacute; d’une chirurgie partielle du larynx avec reconstruction CHEP entre 2011 et 2014 dans notre institution. Nous avons analys&eacute; les donn&eacute;es &eacute;pid&eacute;miologiques, les particularit&eacute;s chirurgicales, les suites fonctionnels et le contr&ocirc;le carcinologique de la maladie. Au total, 16 patients ont &eacute;t&eacute; inclus dans cette &eacute;tude. Tous nos patients avaient un carcinome &eacute;pidermo&iuml;de du plan glottique class&eacute; T1 ou T2. Les suites fonctionnels &eacute;taient g&eacute;n&eacute;ralement simples surtout dans les cas o&ugrave; La conservation des 2 unit&eacute;s cricoaryt&eacute;no&iuml;diennes &eacute;tait possible (75% des cas) mais avec toutefois des complications post-op&eacute;ratoires not&eacute;es dans 31,25%. Le contr&ocirc;le carcinologique &eacute;tait satisfaisant, une seule r&eacute;cidive locale a &eacute;t&eacute; objectiv&eacute;e dans notre &eacute;tude. La chirurgie partielle du larynx avec reconstruction par crico-hyo&iuml;do-&eacute;piglottopexie (CHEP) est une chirurgie sure avec une pr&eacute;servation des r&ocirc;les physiologiques et une qualit&eacute; de vie satisfaisante, elle permet &eacute;galement un bon contr&ocirc;le carcinologique sous r&eacute;serve de bien cerner les indications.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Raji Yemi Raheem, Abiona Taiwo, Gureje Oye [Research] - Awareness of hypertension and its impact on blood pressure control among elderly nigerians: report from the Ibadan study of aging - 13 July 2017. http://www.panafrican-med-journal.com/content/article/27/190/abstract/ <b>INTRODUCTION: hypertension is highly prevalent among the elderly. Its awareness has a direct influence on control through drug adherence. Earlier studies have shown that awareness of hypertension is low among sub-Saharan African populations but only a few studies have looked at the prevalence and awareness of hypertension among the elderly. METHODS: the Ibadan Study of Ageing is a longitudinal cohort study of the mental and physical health status as well the functioning of elderly persons residing in the Yoruba-speaking areas of Nigeria. Study was conducted in multiple waves from 2003/2004 to 2009. This report is based on the sample studied in 2007 (N = 1469). Respondents, aged &#8805;65 years, were assessed for the presence of hypertension, its awareness, receipt of and adherence to medication for the condition, and effectiveness of treatment on the control of blood pressure. Blood pressure was measured with the use of digital monitors (Omron MS – 2 Basic Model). Awareness of the diagnosis of hypertension was ascertained by self-reports. We explored social, economic, demographic and clinical correlates of the presence of hypertension, its awareness and control using multiple logistic regression analyses. RESULTS: the sample was composed of 809 (55.1%) females and 666 (44.9%) males. The mean age of the participants was 76.9±8.4 years. Hypertension (defined as previous diagnosis by a health provider or a measured blood pressure higher than 140/90 mm Hg) was recorded in 973 (62.2%) participants, with females having a prevalence of 61.4% and males that of 70.1%. Other than female gender, residing in urban/semi urban areas and being overweight or obesity were associated with the occurrence of hypertension. Among those assessed to have hypertension, 78% were not previously aware of its presence. Factors independently associated with lack of awareness of hypertension included low socioeconomic class (OR 8.21, 95% CI 3.72–18.11, P < 0.001), and BMI >25kg/m<sup>2</sup> (OR 3.11, 95% CI 1.36–7.09, P < 0.009). Among those who were aware of the presence of hypertension and were on treatment, 77.3% still had uncontrolled hypertension. Only obesity or overweight (OR 5.56, 95% CI 1.35 – 22.83, P < 0.016) was independently associated with poor blood pressure control. CONCLUSION: the prevalence of hypertension among elderly Nigerians is high and those affected are often not aware of having the condition. Only a minority of those who receive treatment for the condition have adequate blood pressure control. The findings highlight the need for improved healthcare for the growing population of elderly persons, with particular attention to early detection and effective control of the condition.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Lotfi Zeghari, Youssef Aboussaleh, Rachid Sbaibi, Imane Achouri, Rachid Benguedour [Research] - Le surpoids, l’ob&eacute;sit&eacute; et le contr&ocirc;le glyc&eacute;mique chez les diab&eacute;tiques du centre de r&eacute;f&eacute;rence provincial de diab&egrave;te (CRD), K&eacute;nitra, Maroc - 11 July 2017. http://www.panafrican-med-journal.com/content/article/27/189/abstract/ <b>INTRODUCTION: Le diab&egrave;te est d&eacute;finit comme un trouble de l'assimilation, de l'utilisation et du stockage des sucres apport&eacute;s par l'alimentation, sa prise en charge est assur&eacute;e par le suivi du surpoids et l'ob&eacute;sit&eacute; et le contr&ocirc;le glyc&eacute;mique r&eacute;gulier. L'objectif de ce travail &eacute;tait l'&eacute;tude du surpoids, l'ob&eacute;sit&eacute; et le contr&ocirc;le glyc&eacute;mique chez 2227 diab&eacute;tiques de diff&eacute;rent type (type 1, 2 et gestationnel), consultants le centre de r&eacute;f&eacute;rence provincial de diab&egrave;te (CRD), K&eacute;nitra-Maroc. METHODES: l'&eacute;tude s'est d&eacute;roul&eacute;e sur une p&eacute;riode d'une ann&eacute;e du mois janvier au mois d&eacute;cembre 2015, L'&eacute;valuation du surpoids et l'ob&eacute;sit&eacute; a &eacute;t&eacute; effectu&eacute;e par le calcul de l'Indice de Masse Corporelle (IMC=Poids/Taille<sup>2</sup> (Kg/m<sup>2</sup>)), elles sont d&eacute;finit respectivement par IMC > 25 Kg/m<sup>2</sup>, et IMC > 30 Kg/m<sup>2</sup>, le poids et la taille ont &eacute;t&eacute; mesur&eacute;s selon les recommandations de l'organisation mondiale de sant&eacute; (OMS), Le contr&ocirc;le glyc&eacute;mique a &eacute;t&eacute; effectu&eacute; par l'analyse sanguine de l'H&eacute;moglobine glycosyl&eacute;e et de la Glyc&eacute;mie &agrave; jeun. Les normes sont 7% pour l'H&eacute;moglobine glycosyl&eacute;e et 0,70g/l &agrave; 1,10g/l pour la Glyc&eacute;mie &agrave; jeun. RESULTATS: l'intervalle d'&acirc;ges des patients est compris entre 8 mois et 80 ans, avec une dominance des diab&eacute;tiques provenant du milieu urbain (74%) par rapport &agrave; ceux provenant du milieu rural (26%). Le surpoids touche l'ensemble de cette population. L'IMC moyen des femmes tends vers l'ob&eacute;sit&eacute; (IMCH &#8776; 30): (29,21 Kg/m<sup>2</sup> ± 3,1) pour le diab&egrave;te gestationnel et (29,15 Kg/m<sup>2</sup> ± 3,2) pour le diab&egrave;te de type 2. Les valeurs du contr&ocirc;le glyc&eacute;mique sont sup&eacute;rieures aux normes: avec 8,5% ± 2,6 > 7% pour l'h&eacute;moglobine glycosyl&eacute;e et 1,5 g/l ± 1,3 > 1,10g/l pour la glyc&eacute;mie &agrave; jeun. La diff&eacute;rence entre les valeurs de l'h&eacute;moglobine glycosyl&eacute;e entre les hommes (8,5 7% ± 2,6) et les femmes (8,1% ± 2,3) n'est pas significative (P > 0,05), m&ecirc;me chose pour la Glyc&eacute;mie capillaire &agrave; jeun: pour les hommes (1,44 g/l ± 1,1) et les femmes (1,43 g/l ± 1,2). Les coefficients de corr&eacute;lation de Pearson sont hautement significatifs (P < 0,005); d'une part entre IMC et la Glyc&eacute;mie &agrave; jeun(r = 0,5) et d'autre part entre IMC et les valeurs de l'H&eacute;moglobine glycosyl&eacute;e (r = 0,4). CONCLUSION: l'ensemble des diab&eacute;tiques pr&eacute;sente des valeurs de l'IMC et du contr&ocirc;le glyc&eacute;mique, sup&eacute;rieures aux normes. Des recherches approfondies sont n&eacute;cessaires sur ces diab&eacute;tiques afin de dresser un programme urgent de rem&eacute;diation.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Tarik Madani, Mohamed Amine Karabila, Younes Mhammdi, Mohammed Kharmaz, Mohamed El Ouadghiri, Abdou Lahlou, Ahmed El Bardouni, Mustapha Mahfoud, Mohamed Saleh Berrada [Case report] - L’amputation de Chase dans un m&eacute;lanome de l’index: &agrave; propos d’un cas - 11 July 2017. http://www.panafrican-med-journal.com/content/article/27/188/abstract/ <b>Nous rapportons le cas d'une patiente de 40 ans, adress&eacute;e par le service de dermatologie de l'h&ocirc;pital ibn-sina de rabat pour amputation de l'index suite &agrave; un m&eacute;lanome diagnostiqu&eacute; sur une biopsie. L'amputation a &eacute;t&eacute; r&eacute;alis&eacute;e selon la technique de Chase. Le r&eacute;sultat esth&eacute;tique et fonctionnel &eacute;tait tr&egrave;s satisfaisant apr&egrave;s six mois de l'intervention.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Khalid Mazine, Pierre Barsotti, Hicham Elbouhaddouti, Khalid Ait Taleb [Case report] - Il&eacute;us biliaire colique: une cause rare d’occlusion colique - 11 July 2017. http://www.panafrican-med-journal.com/content/article/27/187/abstract/ <b>L'il&eacute;us biliaire avec migration du calcul dans le c&ocirc;lon &agrave; travers une fistule chol&eacute;cystocolique est rare. Le diagnostic est difficile et souvent tardif. Nous rapportons ici le cas d'une patiente de 89 ans aux ant&eacute;c&eacute;dents d'une diverticulose du sigmo&iuml;de, qui a pr&eacute;sent&eacute; une occlusion colique en rapport avec un il&eacute;us biliaire par migration d'un gros calcul &agrave; travers une fistule chol&eacute;cysto-colique. La TDM abdominale a permis de poser le diagnostic. La chirurgie a permis d'extraire du calcul par sigmo&iuml;dotomie transform&eacute;e par la suite en une sigmo&iuml;dostomie avec r&eacute;tablissement ult&eacute;rieur de la continuit&eacute; digestive, la fistule chol&eacute;cysto-duod&eacute;nale n'a pas &eacute;t&eacute; objectiv&eacute;e.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Lydia Taiwo, Suleiman Idris, Aisha Abubakar, Patrick Nguku, Peter Nsubuga, Saheed Gidado, Lilian Okeke, Samuel Emiasegen, Endie Waziri [Research] - Factors affecting access to information on routine immunization among mothers of under 5 children in Kaduna State Nigeria, 2015 - 10 July 2017. http://www.panafrican-med-journal.com/content/article/27/186/abstract/ <b>INTRODUCTION: immunization is one of the most effective interventions to prevent disease and early child death. A substantial number of children worldwide do not complete immunization schedules because neither health services nor conventional communication mechanisms regularly reach their communities. Knowledge and perception of mothers/caregivers regarding VPDs influence demand and utilization of immunization services. We examined the associations between knowledge, perception and information on routine immunization received by mothers/caregivers in Kaduna State. METHODS: we enrolled 379 eligible caregivers in a community-based cross-sectional study. We sampled respondents using multistage sampling technique. We collected data on socio-demographic characteristics; knowledge and perception on routine immunization using semi-structured interviewer-administered questionnaire. We conducted bivariate analysis and logistic regression using Epi-InfoTM version 7 at 5% level of significance. RESULTS: mean age of respondents was 28.6 years (standard deviation=±6.6 years), 34% completed secondary school, 65% were unemployed, 49% lived in rural settlements. Among respondents' children 53.3% were females and 62.8% fell within 2nd-5th birth order. Only 15.6% of these children were fully immunized. Seventy-five percent of respondent did not obtain information on routine immunization within 12 months prior to the study. About 64% had unsatisfactory knowledge while 55.4% exhibited poor perceptions regarding routine immunization. Commonest source of information was radio (61.61%). On logistic regression educated participants (Adjusted odds ratio (AOR)=1.9, 95% CI: 1.1-3.3), mothers' perception (AOR=2.6, 95% CI: 1.5-4.5) and monogamous family setting (AOR=2.4, 95% CI: 0.2-0.6) were likely to have obtained information on routine immunization. CONCLUSION: there is low access to information, poor maternal knowledge on routine immunization with low vaccination coverage in this community. Efforts should be made by the Governments to scale up sensitization of mothers/caregivers to improve their knowledge on routine immunization through radio jingles.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Abdul Habeeb Bin Mohsin, Varalakshmi Reddy, Praveen Kumar, Jeevan Raj, Siva Santosh Babu [Research] - Evaluation of wetting ability of five new saliva substitutes on heat-polymerized acrylic resin for retention of complete dentures in dry mouth patients: a comparative study - 10 July 2017. http://www.panafrican-med-journal.com/content/article/27/185/abstract/ <b>INTRODUCTION: the aim of this study was to evaluate & compare the wetting ability of five saliva substitutes & distilled water on heat-polymerized acrylic resin. Contact angle of the saliva substitute on denture base can be taken as an indicator of wettability. Good wetting of heat-polymerized acrylic resin is critical for optimum retention of complete dentures. METHODS: two hundred & forty samples of heat-polymerized acrylic resin were fabricated using conventional method. 240 samples divided into 6 groups with 40 samples in each group. Advancing & Receding contact angles were measured using Contact Angle Goniometer & DSA4 software analysis. RESULTS: Anova test was carried out to test the significance in difference of contact angle values in the six groups. The mean of advancing angle values & mean of receding angle values of all the six groups has shown statistically significant difference between the groups. The mean of angle of hysteresis values of all the six groups are statistically not significant between the groups. A multiple comparison using Bonferroni’s test was carried out to verify the significance of difference between the contact angles in a pair of groups. Statistically significant difference was seen when Aqwet (Group II) was compared to Distilled water (Group I), Wet Mouth (Group III), E-Saliva (Group IV), Biotene (Group V), and Moi-Stir (Group VI). CONCLUSION: the contact angles of five saliva substitutes and distilled water were measured and compared. Group II (AQWET) has the lowest advancing and receding contact angle values and the highest angle of hysteresis on heat-polymerized acrylic resin. Based on contact angle values, Group II (AQWET) has the best wetting ability on heat-cured acrylic resins. The ability of saliva to wet the denture surface is one of the most important properties for complete denture retention in dry mouth cases</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Eyasu Ejeta, Regea Dabsu, Olifan Zewdie, Elias Merdassa [Research] - Factors determining late antenatal care booking and the content of care among pregnant mother attending antenatal care services in East Wollega administrative zone, West Ethiopia - 07 July 2017. http://www.panafrican-med-journal.com/content/article/27/184/abstract/ <b>INTRODUCTION: Antenatal care (ANC) is important for both maternal and fetal health. However, the existing evidence from developing countries indicates that most pregnant women attending ANC in their late pregnancy. Little is known about the factors determining ANC booking and the content of care among pregnant women in West part of Ethiopia. Therefore, the present study was conducted to identify factors determining late ANC booking and the content of care among pregnant mother attending antenatal care services in East Wollega administrative zone, West Ethiopia.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hossein Ebrahimi, Giti Atashsokhan, Farzaneh Amanpour, Azam Hamidzadeh [Research] - Self-medication and its risk factors among women before and during pregnancy - 07 July 2017. http://www.panafrican-med-journal.com/content/article/27/183/abstract/ <b>INTRODUCTION: Self-medication can cause significant challenges for the individuals and community, especially in women during pregnancy. This study was aimed to compare the prevalence of self-medication before and during pregnancy among women in Iran.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Saloua Boujrad, Brahim El Hasbaoui, Hanae Echahdi, Mohamed Malih, Aomar Agadr [Case report] - D&eacute;ficit cong&eacute;nital en facteur V: &agrave; propos d’un cas - 06 July 2017. http://www.panafrican-med-journal.com/content/article/27/182/abstract/ <b>Le d&eacute;ficit cong&eacute;nital en facteur V est une anomalie rare de la coagulation, initialement d&eacute;crite par Owren en 1947 et connue sous le nom de para h&eacute;mophilie. Elle est transmise selon un mode autosomique r&eacute;cessif, et est g&eacute;n&eacute;ralement symptomatique &agrave; l'&eacute;tat homozygote. Le facteur V est un cofacteur essentiel dans la conversion de la prothrombine en thrombine par le facteur X activ&eacute;. En l'absence du facteur V, la g&eacute;n&eacute;ration de thrombine est ralentie et la formation de fibrine retard&eacute;e. Il en r&eacute;sulte une tendance aux saignements. Nous rapportons un cas de d&eacute;ficit cong&eacute;nital en facteur V chez un nourrisson pr&eacute;sentant des &eacute;pistaxis &agrave; r&eacute;p&eacute;tition.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Karim Bourra, Samir El Mazouz [Case report] - Lambeau grand dorsal dans la reconstruction d’une tumeur g&eacute;ante de la paroi abdominale: &agrave; propos d’un cas rare - 06 July 2017. http://www.panafrican-med-journal.com/content/article/27/181/abstract/ <b>Nous nous permettons de vous pr&eacute;senter le cas d’un jeune patient, &acirc;g&eacute; de 16 ans, qui pr&eacute;sente une grosse tumeur de la paroi abdominale, multinodulaire de nature m&eacute;senchymateuse occupant la moiti&eacute; abdominale gauche et mesurant dans les 25 cm d’axe vertical / 20 cm d’axe transversal, mobile par rapport aux plans profonds, et augmentant progressivement de volume depuis l’enfance et n&eacute;glig&eacute;e. Nous avons dans le but du traitement chirurgical, apr&egrave;s petite ex&eacute;r&egrave;se biopsique qui a r&eacute;v&eacute;l&eacute; la nature «desmoide » de la tumeur, r&eacute;alis&eacute; une ex&eacute;r&egrave;se chirurgicale total de la tumeur avec reconstruction imm&eacute;diate par un lambeau musulo-cutan&eacute; de grand dorsal libre, branch&eacute; sur les gros vaisseaux du pli de l’aine (art&egrave;re iliaque et veine iliaque externes gauches), branch&eacute;s en anastomose termino-lat&eacute;rale. La survie du lambeau s’est faite correctement et la reconstruction a ainsi &eacute;t&eacute; r&eacute;ussie.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Otieno Careena Flora, Kaseje Margaret, Kaseje Dan [Research] - Perspectives on utilization of community based health information systems in Western Kenya - 06 July 2017. http://www.panafrican-med-journal.com/content/article/27/180/abstract/ <b>INTRODUCTION: Health Information Systems (HIS) are considered fundamental for the efficient delivery of high quality health care. However, a large number of legal and practical constraints influence the design and introduction of such systems. The inability to quantify and analyse situations with credible data and to use data in planning and managing service delivery plagues Africa. Establishing effective information systems and using this data for planning efficient health service delivery is essential to district health systems' performance improvement. Community Health Units in Kenya are central points for community data collection, analysis, dissemination and use. In Kenya, data tend to be collected for reporting purposes and not for decision-making at the point of collection. This paper describes the perspectives of local users on information use in various socio-economic contexts in Kenya. METHODS: information for this study was gathered through semi-structured interviews. The interviewees were purposefully selected from various community health units and public health facilities in the study area. The data were organized and analysed manually, grouping them into themes and categories. RESULTS: information needs of the community included service utilization and health status information. Dialogue was the main way of information utilization in the community. However, health systems and personal challenges impeded proper collection and use of information. CONCLUSION: the challenges experienced in health information utilization may be overcome by linkages and coordination between the community and the health facilities. The personal challenges can be remedied using a motivational package that includes training of the Community Health Workers.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Nouzha Sadak, Laila Herrak, Leila Achachi, Mustapha El Ftouh [Case report] - Quand le dentier devient danger! - 05 July 2017. http://www.panafrican-med-journal.com/content/article/27/179/abstract/ <b>Bien que rare chez l'adulte, l'inhalation de corps &eacute;tranger (CE) est un accident grave pouvant mettre en jeu le pronostic vital ou entrainer des s&eacute;quelles importantes. Nous rapportons l'observation d'un patient de 50 ans, sans ant&eacute;c&eacute;dents pathologiques particuliers, qui s'est pr&eacute;sent&eacute;e aux urgences pour douleur thoracique, toux intermittente et dyspn&eacute;e d'effort, six jours apr&egrave;s avoir inhal&eacute;, accidentellement, sa proth&egrave;se dentaire en plastique lors d'un repas. L'examen clinique &eacute;tait sans particularit&eacute;s. La radiographie thoracique ainsi que l'ASP ne montraient pas d'anomalie. Une bronchoscopie souple sous anesth&eacute;sie g&eacute;n&eacute;rale a permis de visualiser le CE au niveau du tronc interm&eacute;diaire et l'extraction a &eacute;t&eacute; r&eacute;alis&eacute;e avec succ&egrave;s &eacute;vitant ainsi le recours &agrave; un geste beaucoup plus invasif. La radiographie standard peut s'av&eacute;rer utile en visualisant les CE radio-opaque ou par des signes indirects &eacute;voquant la pr&eacute;sence d'un CE, mais le recours &agrave; la bronchoscopie &agrave; vis&eacute;e diagnostique et th&eacute;rapeutique est primordial.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mwagi Joseph Onyango, Iyeri Kombe, Daniel Sagwe Nyamongo, Moses Mwangi [Research] - A study to determine the prevalence and factors associated with hypertension among employees working at a call centre Nairobi Kenya - 05 July 2017. http://www.panafrican-med-journal.com/content/article/27/178/abstract/ <b>INTRODUCTION: Hypertension often referred to as Non Communicable Diseases (NCDs). Causes of hypertension are classified into modifiable and non-modifiable factors. The objective of the study was to determine the prevalence and other associated factors leading to the onset of hypertension among employees working at the call center. METHODS: this was a descriptive cross sectional study design. Data collection was done in two parts; part one comprised of clinical health assessments; weight and height to aid determine Body Mass Index and blood pressure measurement. Part two was by self-administered questionnaires to participants to aid identify behavioral risk factors and further elicit lifestyle practices. Data was collected from a sample population of 370 respondents. Descriptive statistical analysis was applied in univariate analysis. Further analysis included bivariate and multiple regression analysis; Odds Ratio with 95% confidence interval was used to determine the strength of association. RESULTS: the proportion of hypertension was significantly higher among overweight respondents (32.7%) (OR= 11.55; 95% CI= 4.44-30.07; P < 0.001) and obese respondents (60.2%) (OR= 36.02; 95% CI= 13.43-96.60; P < 0.001) compared to those respondents who were within normal range of weight (4.0%). Nine (9) factors that were associated with hypertension at bivariate analysis (P < 0.05) were all subjected to a multiple regression analysis or reduced model where four factors remained in the final analysis. Respondents who were classified as overweight had 10.6 times likelihood developing hypertension compared to those respondents with normal weight (AOR= 10.61; 95%CI= 3.98-28.32; P < 0.001). Likewise, obese respondents were 43.6 fold more likely to develop hypertension compared to those respondents within normal range of weight [OR=43.68; 95%CI=15.24-125.16; P<0.001]. Respondents not trying to reduce fat in their diet were highly predisposed having hypertension at (AOR=2.44; 95% CI=1.20-4.96; P= 0.014) than respondents who always tried to reduce fat in their diet. Respondents who sometimes engage on more physical exercises were 2.2 times likely to develop hypertension (AOR=2.22; 95%CI= 1.20-4.10; P= 0.011) compared to those who always engaged in more physical exercises. Respondents with parenting issues were about twice as likely to have hypertension (AOR= 2.15; 95% CI: 1.23-3.74; P= 0.007) than parents who did not have parenting issues. CONCLUSION: this study depicts rising cases of hypertension and an alarming rate of pre-hypertension among the working population. This vary based on the age, obesity, parental responsibility, unhealthy diet and lack of or reduced physical activity. These call for strategic interventions and greater emphasis on health promotion programs at the workplace alongside staff empowerment towards health seeking behaviors.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Ines Barka, Emna Dendana, Nesrine Chikhrouhou, Amel Maroufi, Maha Kacem, Molka Chadli, Koussay Ach [Case report] - Micro ad&eacute;nome &agrave; prolactine &agrave; l’&acirc;ge de la m&eacute;nopause - 05 July 2017. http://www.panafrican-med-journal.com/content/article/27/177/abstract/ <b>L'ad&eacute;nome &agrave; prolactine est rare chez la femme &acirc;g&eacute;e. Le tableau clinique peut &ecirc;tre confondu avec les manifestations de la m&eacute;nopause, rendant son diagnostic parfois difficile. Nous rapportons une observation sur les particularit&eacute;s d'un micro ad&eacute;nome &agrave; prolactine survenant chez une femme &acirc;g&eacute;e de 57 ans, qui a pr&eacute;sent&eacute; une am&eacute;norrh&eacute;e secondaire sans bouff&eacute;es de chaleur associ&eacute;e &agrave; une galactorrh&eacute;e &eacute;voluant depuis 2 ans. L’examen physique confirme la galactorrh&eacute;e et la biologie montre une hyperprolactin&eacute;mie &agrave; 2735 mUI /L, FSH = 15,1 UI/L et LH = 4,1UI/L. L’IRM hypophysaire montre un ad&eacute;nome gauche de 8mm. L'&eacute;volution sous traitement dopaminergique &eacute;tait marqu&eacute; par la reprise transitoire des cycles et apparition de bouff&eacute;es de chaleur, normalisation de la prolactin&eacute;mie et diminution de la taille de l'ad&eacute;nome.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Endale Gebreegziabher Gebremedhn, Girmay Fitiwi Lemma [Research] - Patient satisfaction with the perioperative surgical services and associated factors at a University Referral and Teaching Hospital, 2014: a cross-sectional study - 05 July 2017. http://www.panafrican-med-journal.com/content/article/27/176/abstract/ <b>INTRODUCTION: globally, increasing consideration has been given to the assessment of patient satisfaction as a method of monitor of the quality of health care provision in the health institutions. Perioperative patient satisfaction has been contemplated to be related with the level of postoperative pain intensity, patients’ expectation of the outcome, patient health provider relationship, inpatient services, hospital facilities, access to care, waiting time, cost and helpfulness of treatments received. The study aimed to assess the level of patient satisfaction with perioperative surgical services and associated factors. METHODS: hospital based quantitative cross-sectional study was conducted in University of Gondar teaching hospital from April1-30, 2014. Structured Amharic version questionnaire and checklist used for data collection. All patients who operated upon during the study period were included. Both bivariate and multivariate logistic regression model used to identify the variables which had association with the dependent variable. P-values < 0.05 were considered statistically significant. RESULTS: two hundred and seventy eight patients underwent surgery during the study period. Nine patients were excluded due to refusal to participate in the study. A total of 269 out of 278 patients were included in the study with a response rate of 96.8%. The overall level of patient satisfaction with perioperative surgical services was 98.1%. The variables that had association with the outcome variable from the multivariate analysis were patient admission status (AOR=0.073, CI=0.007-0.765, P=0.029), information about the disease and operation (AOR=0.010, CI=0.001-0.140, P=0.001) and operation theatre staff attention to the patients complains (AOR=0.028, CI=0.002-0.390, P=0.008) respectively. CONCLUSION: the level of patient satisfaction with perioperative surgical services was high compared with previous studies conducted in the country and other countries in the world. Health professionals need to give emphasis for information on care provision processes, patients' health progress and patients' complaints.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Appolonia Budzee, Jean Claude Ambassa, Charles Mve Mvondo, Marcel Fanka, Jacques Cabral Tantchou Tchoumi [Meeting report] - Sixth scientific and international meeting in Shisong captures new healthcare challenges - 05 July 2017. http://www.panafrican-med-journal.com/content/article/27/175/abstract/ <b>The rapid-changing scientific and technological landscape is triggered and in turn, warrants continuous scientific research. The Shisong Cardiac Center, instead of being contented with just repeating theses that have been proven elsewhere, is determined to contribute to the scientific community worldwide its experiences and findings which are both universal and unique. The Cardiac Center of St. Elizabeth Catholic General Hospital, Shisong, in the North West Region of Cameroon, was inaugurated in 2009 by Health Minister, Mr. Andre MAMA FOUDA. Its capacity is able to serve all of Central Africa, where such services are rare.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Pauline Diouss&eacute;, Haby Dione, Mariama Bammo, Ndiaga Gueye, Thierno Abdoul Aziz Diallo, Fatou Seck, Ramatoulaye Diagne Gueye, Mame Thierno Dieng, Fatma Sarr Fall, Moustapha Diop, Bernard Marcel Diop, Mamadou Mourtalla Ka [Case series] - La l&egrave;pre de l’enfant &agrave; Thi&egrave;s/S&eacute;n&eacute;gal: signal d’une recrudescence? - 05 July 2017. http://www.panafrican-med-journal.com/content/article/27/174/abstract/ <b>La l&egrave;pre est une maladie infectieuse, transmissible. Le nombre de nouveaux cas de l&egrave;pre chez l’enfant au S&eacute;n&eacute;gal connait une l&eacute;g&egrave;re hausse depuis 2013 selon l’OMS. Les objectifs du travail &eacute;taient d’&eacute;tudier les aspects &eacute;pid&eacute;miologiques, cliniques, th&eacute;rapeutiques et &eacute;volutifs de la l&egrave;pre de l’enfant dans les zones g&eacute;ographiques de deux villages de reclassement de la r&eacute;gion de Thi&egrave;s. Il s’agit d’une &eacute;tude r&eacute;trospective men&eacute;e sur une p&eacute;riode de 3 ans (2013-2015). Etaient inclus tous les nouveaux cas de maladie de Hansen &acirc;g&eacute;s de 0 &agrave; 15 ans. En trois ans, 39 enfants &eacute;taient inclus, avec une pr&eacute;dominance de gar&ccedil;ons (n=23, 59%). Parmi ces enfants, 27 (66,7%) provenaient d’un village de reclassement social des l&eacute;preux. Il existait une atteinte d’un membre de la famille dans 27 cas (69,2%). Plus de la moiti&eacute; des enfants, soit 23 cas (58,9%) avaient une l&egrave;pre multi bacillaire (L&eacute;promateuse-L&eacute;promateuse). Tous les enfants &eacute;taient mis sous traitement durant 12 mois, au terme desquels trente-six (92,3%) enfants &eacute;taient gu&eacute;ris. La l&egrave;pre est encore pr&eacute;sente au S&eacute;n&eacute;gal malgr&eacute; les efforts du programme national de lutte. Au regard de ces r&eacute;sultats, il est important de souligner l'importance de la strat&eacute;gie de d&eacute;pistage actif cibl&eacute; sur les enfants, qui semble avoir montr&eacute; son efficacit&eacute; dans la r&eacute;gion. La d&eacute;tection pr&eacute;coce, la recherche des contacts et le traitement pr&eacute;coce sont autant de facteurs importants dans la r&eacute;duction de la contagiosit&eacute; de la l&egrave;pre.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Anastasiadis Kleanthis, Vasilis Mouravas, Vasilis Lampropoulos, Evgenia Babatseva, Ioannis Spyridakis [Case report] - Laparoscopic evaluation and management of isolated gastric rupture in a boy after blunt abdominal injury - 05 July 2017. http://www.panafrican-med-journal.com/content/article/27/173/abstract/ <b>Blunt abdominal injury in children can be a significant diagnostic and therapeutic challenge. The extent and localization of organ damage cannot be always thoroughly investigated noninvasively and in spite of modern imaging techniques and a laparotomy may be necessary for diagnosis, even though it carries a significant morbidity. We present a rare case of isolated gastric rupture after blunt abdominal injury in a 12 year old boy that sustained a bicycle accident. He was hemodynamically stable, had signs of acute abdomen and axial tomography was inconclusive as of the site of visceral perforation. Definitive diagnosis and treatment were carried out laparoscopically with excellent results. Laparoscopic surgery in cases of blunt abdominal injury with gastric rupture can serve both as a diagnostic and therapeutic modality with the additional advantage of being less traumatic. The accumulation of relevant experience is mandatory in order to establish this modality in the diagnostic and therapeutic protocols.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Ibrahim Baffa Sule, Mohammed Yahaya, Abubakar Ahmed Aisha, Ahmed Datti Zainab, Bajoga Ummulkhulthum, Patrick Nguku [Research] - Descriptive epidemiology of a cholera outbreak in Kaduna State, Northwest Nigeria, 2014 - 04 July 2017. http://www.panafrican-med-journal.com/content/article/27/172/abstract/ <b>INTRODUCTION: Cholera is an acute gastrointestinal infection caused by Vibrio cholerae, which may lead to severe dehydration and death if not treated. This analysis is aimed at highlighting the magnitude, pattern and trend of cholera outbreak that occurred in Kaduna State in 2014. METHODS: we obtained the 2014 cholera line-list from the Kaduna State Disease Surveillance and Notification officer (DSNO). We described the outbreaks in time, place and person using Epi-info 7 and Health Mapper. RESULTS: a total of 1468 case-patients and 54 deaths were recorded, giving a case fatality rate (CFR) of 3.68%. Female case-patients were 809(55.08%). The median age for case-patients was 15 years, with an age range of 0.04-90 years. Age specific case fatality rate (ASCFR) is highest among the > 60 years. Seven (30%) out of the 23 local government areas (LGAs) in Kaduna State were affected by the cholera outbreak in 2014. Igabi LGA has the highest attack rate (150.46 per 100,000 population) while Chikun LGA has the lowest attack rate (12.22 per 100,000 population). Chikun LGA records the highest CFR (17.54%). Cholera infection spread across LGAs sharing the same borders. The outbreak started from the first epidemic week of 2014 and lasted over 33 weeks. CONCLUSION: our analysis revealed a protracted cholera outbreak that gradually increases in magnitude throughout the first half of 2014 and spread within contiguous LGAs. We recommended the strengthening of the state's diseases surveillance system towards timely detection and early response to disease outbreaks in the future.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, B&eacute;chir Achour [Images in medicine] - Primary spinal marginal zone lymphoma: an unusual cause of spinal cord compression - 04 July 2017. http://www.panafrican-med-journal.com/content/article/27/171/abstract/ <b>Marginal zone lymphoma (MZL) describes a heterogeneous group of B-cell lymphomas derived from marginal zone cells found in the spleen's white pulp and surrounding germinal centers. To date, only one case of spinal primary MZL has been reported. We report a second case. A 67-year-old man without special medical history was referred to our clinic because of progressive paralysis first noticed 2 months before hospitalization. On examination, his paralysis concerned the lower limbs. No reflex deficits were identified. No further neurological deficits were found. Spinal MRI in sagittal sequence in weighting T2 (A) and sagittal sequence (B); coronal (C) and axial (D) T1-weighted after gadolinium injection showed dorsal compression by an extensive posterior epidural tissue process from T6 to T8 in continuity with left pleural neoplastic thickening through the inter-vertebral homolateral foramens. A laminectomy with resection of the intra-ductal lesion was performed, the examination of which found a MZL. In an extension study, thoraco-abdomino-pelvic CT showed medial and celiac lymphadenopathy, a tissue sleeve of the left costo-vertebral gutter extended to a height of 9 cm. An osteo-medullary biopsy revealed a marrow of normal wealth without sign of malignancy. The lymphoma was classified in bone IV stage. The patient was treated according to the 2013 National Adult Non-Hodgkin's Lymphoma protocol. He received 8 RCHOP cures. The evolution was marked by the improvement of neurological signs with no lesion of evolutive suspicious nature at the thoracic and abdominopelvic stages at the end-of-treatment scan.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Uchenna Okonkwo, Soter Ameh, Akaninyene Out, Henry Okpara [Research] - HIV-related knowledge, attitude and practices of healthy adults in Cross River State Nigeria: a population based-survey - 04 July 2017. http://www.panafrican-med-journal.com/content/article/27/170/abstract/ <b>INTRODUCTION: Human Immunodeficiency Virus (HIV) remains a global health problem disproportionately distributed across Nigeria. Cross river state (CRS), a tourist state, located in the Niger delta, has one of the highest prevalence rates. There is evidence that poor knowledge and stigmatization are obstacles to achieving universal access to HIV prevention programs. The objective of this study was to determine the Knowledge, Attitude and Practice (KAP) of HIV among adults resident in CRS, Nigeria. METHODS: a cross sectional descriptive survey design was employed. A total of 1,620 healthy adults were recruited. KAP towards HIV was assessed using a structured pre-tested questionnaire. Categorical variables were described as frequencies and continuous variables as median and interquartile range. Kruskal-Wallis test was used to determine relationship between variables and median KAP scores. P value < 0.05 was considered significant. All analyses were performed using Stata 12 statistical package. RESULTS: a total of 1,465 respondents completed the questionnaire correctly giving a response rate of 91%. The M: F ratio was 1:1.8. The median age was 38 years. Majority was married and had formal education. Knowledge of HIV and common routes of transmission was high (>80%). However, misconception that HIV can be transmitted through hugging, hand shake, mosquito bites and witch craft was also common (> 60%). The overall attitude and practice towards persons living with HIV infection was poor. CONCLUSION: this study showed misconceptions in the knowledge and consequences of HIV infection which is associated with negative attitude towards persons living with HIV.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Nadia Anoun, Hanan El Ouahabi [Case report] - L’acrom&eacute;galie du sujet &acirc;g&eacute;: quelles particularit&eacute;s? - 04 July 2017. http://www.panafrican-med-journal.com/content/article/27/169/abstract/ <b>Les ad&eacute;nomes somatotropes de la personne &acirc;g&eacute;e sont rares, et caract&eacute;ris&eacute;s par un retard diagnostique, un tableau clinique peu bruyant. Leurs crit&egrave;res diagnostiques rejoignent ceux des patients plus jeunes. La chirurgie, si possible, reste le traitement de choix de l’acrom&eacute;galie du sujet &acirc;g&eacute;. Les analogues de la somatostatine ont montr&eacute; leur efficacit&eacute; dans le traitement de ces patients. Le pronostic des patients acrom&eacute;gales est inversement corr&eacute;l&eacute; &agrave; l’&acirc;ge du patient, &agrave; la dur&eacute;e de la maladie, au dernier taux de GH sous traitement. L’&acirc;ge est un d&eacute;terminant majeur de la mortalit&eacute; en dehors de l’&eacute;volutivit&eacute; de l’acrom&eacute;galie. Nous rapportons trois observations de patientes acrom&eacute;gales &acirc;g&eacute;es respectivement de 75, 70 et 66 ans avec une revue de la litt&eacute;rature.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Jackline Odhiambo, Felix Cyamatare Rwabukwisi, Christian Rusangwa, Vincent Rusanganwa, Lisa Ruth Hirschhorn, Evrard Nahimana, Patient Ngamije, Bethany Lynn Hedt-Gauthier [Research] - Health worker attrition at a rural district hospital in Rwanda: a need for improved placement and retention strategies - 04 July 2017. http://www.panafrican-med-journal.com/content/article/27/168/abstract/ <b>INTRODUCTION: the shortage and maldistribution of health care workers in sub-Saharan Africa is a major concern for rural health facilities. Rural areas have 63% of sub-Saharan Africa population but only 37% of its doctors. Although attrition of health care workers is implicated in the human resources for health crisis in the rural settings, few studies report attrition rates and risk factors for attrition in rural district hospitals in sub-Saharan Africa. METHODS: we assessed attrition of health care workers at a Kirehe District Hospital in rural Rwanda. We included all hospital staff employed as of January 1, 2013 in this retrospective cohort study. We report the proportion of staff that left during 2013, and used logistic regression to assess individual characteristics associated with attrition.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Nicola Zingaretti, Fabrizio De Biasio, Michele Riccio, Nastassia Nardini, Laura Mariuzzi, Pier Camillo Parodi [Case report] - A case of gestational gigantomastia in a 37-years-old woman associated with elevated ANA: a casual linkage? - 04 July 2017. http://www.panafrican-med-journal.com/content/article/27/167/abstract/ <b>Hypertrophy of the breast (macromastia and gigantomastia) is a rare medical condition of the breast connective tissues. The etiology of this condition is still not clear; rarely, gigantomastia has been reported to develop in the setting of an autoimmune illness. We reported a case of a 37-years-old woman with undifferentiated connective tissue disease of 2-years duration presented with enlargement of breasts. The breast enlargment started at5 months of gestation. She successfully underwent reduction mammoplasty with free nipple graft. In the succeeding monthsthe level of antinuclear ANA remained stable. It is uncertain whether a positive antinuclear antibodies in gigantomastia is a casuative agent or an effect.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Abdessamad El Bahri, Jaouad Chafiki, Nabil Louardi, Omar Jendouzi, Abdellatif Janane,Ahmed Ameur, Mohammed Abbar [Case report] - Carcinome du tube collecteur de Bellini: une nouvelle observation avec revue de la litt&eacute;rature - 04 July 2017. http://www.panafrican-med-journal.com/content/article/27/166/abstract/ <b>Le carcinome du tube collecteur de Bellini est un type tr&egrave;s rare des carcinomes &agrave; cellules r&eacute;nales (CCR), sa fr&eacute;quence est inf&eacute;rieure &agrave; 1%. Il d&eacute;rive de la partie distale du n&eacute;phron, plus pr&eacute;cis&eacute;ment du tube collecteur. Ses aspects morphologiques sont extr&ecirc;mement variables, rendant son diagnostic difficile. Nous rapportons le cas d'un patient &acirc;g&eacute; de 62 ans admis pour une tum&eacute;faction non douloureuse du flanc gauche, d’apparition progressive. La tomodensitom&eacute;trie a objectiv&eacute; une &eacute;norme masse, occupant la partie sup&eacute;rieure du rein gauche. Le malade avait b&eacute;n&eacute;fici&eacute; d’une n&eacute;phrectomie &eacute;largie. L’examen anatomo-pathologique avait objectiv&eacute; un carcinome des tubes collecteurs du rein. L’&eacute;volution est exceptionnellement favorable: pas de r&eacute;cidives, pas de m&eacute;tastases locor&eacute;gionales et pas de m&eacute;tastases &agrave; distance.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Nezha Taoufiq, Asmaa Naim, Zineb Bouchbika, Nadia Benchekroune, Hassan Jouhadi, Souha Sahraoui, Abdelatif Benider [Case series] - Tumeurs Stromales Gastro-Intestinales «GIST»: &eacute;tat des lieux et actualit&eacute;s &agrave; travers notre exp&eacute;rience portant sur 54 cas et une Revue de litt&eacute;rature - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/165/abstract/ <b>Les Tumeurs Stromales Gastro-intestinales « GIST » sont une forme tr&egrave;s rare de cancers du tube digestif appartenant &agrave; la famille des sarcomes. Le but de ce travail est d'&eacute;tablir le profil &eacute;pid&eacute;miologique et &eacute;volutif ainsi que les difficult&eacute;s diagnostique et th&eacute;rapeutique de cette pathologie maligne prise en charge dans un pays en d&eacute;veloppement. Une Etude r&eacute;trospective &eacute;tal&eacute;e sur 8 ans de Janvier 2002 &agrave; Mars 2010, a &eacute;t&eacute; men&eacute; au Service de Radioth&eacute;rapie et d'Oncologie du CHU de Casablanca (Maroc) ayant collig&eacute;e 54 cas de tumeurs stromales gastro-intestinales. L'&acirc;ge moyen de nos patients &eacute;tait de 55 ans. Le d&eacute;lai moyen d'&eacute;volution &eacute;tait de 11 mois (0-72 mois). La biopsie a permis de confirmer le diagnostic dans 14 cas et la chirurgie dans 40 cas. La principale forme histologique &eacute;tait fusiforme (92,6%). Les GIST dans notre s&eacute;rie avaient une taille tumorale moyenne de 12,5 cm avec un C-Kit positif dans 52 cas. Le risque &eacute;volutif a pu &ecirc;tre &eacute;tabli dans 47 cas dont 39 avaient un risque &eacute;lev&eacute;. La chirurgie &eacute;tait le principal traitement des patients de notre s&eacute;rieApr&egrave;s un recul moyen de 31 mois, la moiti&eacute; des patients &eacute;valuables de notre s&eacute;rie (n=19) est en r&eacute;mission compl&egrave;te maintenue, le tiers (n=13) est d&eacute;c&eacute;d&eacute; alors que le quart (n=8) pr&eacute;sente une r&eacute;cidive locale et /ou m&eacute;tastatique. Quoique les recommandations soient &eacute;dit&eacute;es pour la prise en charge de ces tumeurs, ces derni&egrave;res soul&egrave;vent encore de nombreux probl&egrave;mes aussi bien diagnostiques que th&eacute;rapeutiques dans notre contexte.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Basil Benduri Kaburi, Chrysantus Kubio, Ernest Kenu, Donne Kofi Ameme, Jacob Yakubu Mahama, Samuel Oko Sackey, Edwin Andrew Afari [Research] - Evaluation of bacterial meningitis surveillance data of the northern region, Ghana, 2010-2015 - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/164/abstract/ <b>INTRODUCTION: bacterial meningitis is a disease of major public health importance especially for countries such as Ghana; whose northern part lie within the meningitis belt. The Northern region of Ghana has been recording cases with outbreaks over the years. In order to generate evidence to improve surveillance, we described the epidemiology of bacterial meningitis using surveillance data of the region. METHODS: bacterial meningitis datasets from January 2010 to December 2015 for all the 26 districts of the Northern region were retrieved from line lists. Data were analyzed in terms of person, place, time, and identity of causative organisms using descriptive statistics.The results were presented as proportions, rates, tables and graphs. RESULTS: a total of 1,176 cases were reported. Of these, 53.5% (629/1,176) were males. The proportion of cases aged 0 to 29 years was 77.4%; Overall Case Fatality Rate (CFR) was 9.7% (114/1,176). About 65% of all cases were recorded from January to April. Only 23.7% (279/1,176) of cases were laboratory-confirmed. <i>Neisseria meningitides</i> and <i>Streptococcus pneumonia</i> accounted for 91.4% of confirmed cases.Over the period, the incidence reduced from 9.0/100,000 population to 3.8/100,000 population and CFR reduced from 16.6% to 5.7%. CONCLUSION: most cases were recorded in the dry season and in persons younger than 30 years. Less than a quarter of cases were laboratory confirmed, and no new bacteria species were identified. Both morbidity and mortality rates were on the decline. There is the need to consolidate these gains by intensifying meningitis surveillance and improving onthe rate of laboratory case confirmation.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Victor Tunje Jeza, Xiaoyi Li, Jun Chen, Zhihui Liang, Adem Onago Aggrey, Xiongwen Wu [Research] - IL-21 augments rapamycin in expansion of alpha fetoprotein antigen specific stem-cell-like memory T cells in vitro - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/163/abstract/ <b>INTRODUCTION: Alloreactive tumor specific T cells are important arsenals of the adaptive immune system in the fight against tumors. However, stem cell-like memory T cells (Tscm) provide the key to effective elimination of tumor cells. Methods for generating these T cell subsets already exist. However, they could be made more efficient. Further, they are expensive and unattainable to the resource poor laboratories. In this regard, we are hereby describing a novel in vitro allogeneic co-culture method for raising allo-restricted tumor specific Tscm cells that we developed. METHODS: we started by obtaining PBLs that screened negative for HLA-A2 molecules from healthy donors followed by co-culture with T2/AFP cells to generate AFP peptide specific tumor-reactive T cells. Controls, IL-21 and/or rapamycin were applied to samples in 24 well plates. Samples were harvested and stained with anti-human CD3, CD8, CD44, CD62L, and HLA-A2/AFP dimer followed by flow cytometry analysis. Cell viability was measured by Trypan blue exclusion assay. One Way ANOVA and independent t test were used to compare the mean differences among and between groups where P values less than 0.05 were considered significant. RESULTS: our results show that rapamycin arrests the differentiation of, and expands AFP specific Tscm cells. Further, the expansion of Tscm cells is augmented in the presence of IL-21. CONCLUSION: IL-21 and Rapamycin can be used concurrently to raise and maintain antigen specific Tscm cells in vitro for purposes of augmenting immunotherapy strategies against cancers.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Landry Missounga, Josaphat Iba ba, Ingrid Rosalie Nseng Nseng Ondo, Maria Ines Carine Nziengui Madjinou, Doris Malekou, Emeline Gracia Mouendou Mouloungui, Emmanuel Ecke Nzengue, Jean Bruno Boguikouma, Moussavou Kombila [Case series] - La connectivite mixte: pr&eacute;valence et caract&eacute;ristiques cliniques chez le noir africain, &eacute;tude de 7 cas au Gabon et revue de la litt&eacute;ratuire - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/162/abstract/ <b>La litt&eacute;rature rapporte que la connectivit&eacute; mixte semble plus fr&eacute;quente dans la population noire et chez les asiatiques. Le but de l'&eacute;tude &eacute;tait de d&eacute;terminer la pr&eacute;valence de la connectivit&eacute; mixte (CM) parmi les connectivites et l'ensemble des pathologies rhumatologiques dans une population hospitali&egrave;re au Gabon ; de d&eacute;crire ensuite les caract&eacute;ristiques cliniques de la maladie. Il s'agissait d'une &eacute;tude r&eacute;trospective des dossiers de patients suivis pour connectivite mixte (crit&egrave;res de Kasukawa) et les autres entit&eacute;s de connectivites (crit&egrave;res ACR) en rhumatologie au CHU de Libreville entre janvier 2010 et d&eacute;cembre 2015. Pour chaque cas de CM, les manifestations articulaires et extra-articulaires, le taux d'anticorps anti-U1RNP, l'&eacute;volution, &eacute;taient les param&egrave;tres &eacute;tudi&eacute;s. Sept cas ont &eacute;t&eacute; collig&eacute;s en 6 ans parmi 6050 patients et 67 cas de connectivites soit une pr&eacute;valence de 0,11% et de 10,44% respectivement. Il s'agissait de 7 femmes (100%), d'&acirc;ge moyen de 39,5 ans. Les signes articulaires comprenaient : polyarthrite, myalgies, doits boudin&eacute;s et ph&eacute;nom&egrave;ne de Raynaud dans 87,5 %, 87,5 %, 28,6 % et 14 % respectivement. Les 7 patients avaient un taux d'anti-U1RNP &eacute;lev&eacute; entre 5 et 35N (Nd"7 UI). Un cas de d&eacute;c&egrave;s par HTAP &eacute;tait constat&eacute;. Il s'agit de la s&eacute;rie de CM la plus importante rapport&eacute;e en Afrique noire. La maladie semble rare chez le noir africain, la raison pourrait &ecirc;tre g&eacute;n&eacute;tique. Les aspects d&eacute;mographiques et cliniques paraissent similaires chez les caucasiens, les asiatiques et les noirs hormis une faible fr&eacute;quence du ph&eacute;nom&egrave;ne de Raynaud chez les noirs.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Brahim El Hasbaoui, Amal Bousselamti, Mohammed Amine Redouani, Amina Barkat [Case report] - Severe neonatal cytomegalovirus infection: about a case - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/161/abstract/ <b>Maternofoetal infection with Cytomegalovirus (CMV) is the most common congenital infection and a leading cause of mental retardation and sensori-neural hearing loss. Population-based studies indicate that at least 0.5% of all infants born alive have CMV of whom approximately 10% have clinically evident symptomsat birth. The Justification of systematic screening for foetal CMV infection is still controversial and is not recommended in most developed countries. This is mainly justified by the paucity of antenatal prognostic factors and the lack of established intrauterine treatment when foetal infection has been diagnosed. In case of congenital CMV infection, infants can be symptomatic or asymptomatic at birth. Mortality for such infants can reach 30%, and survivors can have mental retardation, sensorineural hearing loss, chorioretinitis, and other significant medical problems. A newborn symptomatic is defined by the existence of clinical and / or biological signs and / or neonatal imaging, the most frequent clinical signs are: hepatosplenomegaly (60%), microcephaly (53%), jaundice (67%), petechiae (76%), at least one neurological abnormality (68%). The frequency of biological abnormalities is as follows: increase in transaminases (83%), thrombocytopenia (77%), hyperbilirubinemia (69%), haemolysis (51%), hyperproteinorrachy (46%). The abnormalities of neonatal imaging are present in 70% of symptomatic newborns; intracerebral calcifications are the most frequent abnormalities. We report a case of newborn who presented a congenital infection by CMV, evoked on the intrauterine growth retardation, organs of the reticulo endothelial and haematological system were reached while nervous system was spared, and CMV PCR was very positive. indicating an antiviral treatment for 6weeks based on ganciclovir.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Anis Mzabi, Wafa Marrakchi, Zeineb Alaya, Fatma Ben Fredj, Amel Rezgui, Ely&egrave;s Bouajina, Chedia Laouani Kechrid [Case series] - Cellulitis in aged persons: a neglected infection in the literature - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/160/abstract/ <b>Cellulitis is a frequent soft tissue and skin infection. The lower limbs are affected in 70 to 80% of cases. Cellulitis in aged persons is not yet well described in literature. A retrospective descriptive study conducted in the Internal Medicine Department of Sahloul hospital in Sousse in Tunisia. It included patients whose age was up to 65 years old admitted into hospital for cellulitis of the legs, the arms or the face. One hundred fifty eight patients with a mean age of 73 years old (range: 65 to 94 years old) were included. Female to male sex ratio was 0.68. Among them, we noted diabetes mellitus in 81 cases (50.6%). The infection was located in the lower limbs in 155 cases (98%), in the face in two cases (1.3%) and in the upper limb in one case (0.7%). Twenty one patients (13.3%) presented with severe cellulitis and one presented with necrotizing fasciitis. All patients received intra venous antibiotic therapy. Surgical treatment was indicated in 14 cases. Cefazolin was prescribed in 77 cases (48%). Favorable evolution was noted in 144 patients (91.1%). Forty four patients (27.8%) received prophylactic antibiotics. Prevention of skin and soft tissue infection is a crucial step to preserve health in aged persons.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Fabrice Akpadjan, Hugues Ad&eacute;gbidi, Cossi Angelo Attinsounon, Christiane Koudoukpo, B&eacute;r&eacute;nice D&eacute;gbo&eacute;, Nad&egrave;ge Agbessi, F&eacute;lix Atadokp&egrave;d&eacute; [Case report] - A case of reccuring giant condyloma of vulva in infant without sexual abuse successfully treated with electrocoagulation in Benin - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/159/abstract/ <b>We report here a case of giant vulval condyloma in a two-year-old infant infected by her "baby sitter" without sexual abuse. Treated by surgical excision coupled with electrocoagulation, it was noted a rapid recurrence two weeks after treatment requiring a second electrocoagulation session. More than a year later, no lesion was noted, thus demonstrating therapeutic success. The unavailability of imiquimod in our context requires a systematic use of invasive treatment regardless of the age of the patient.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Naoufal Chouaib, Said Jidane, Mostafa Rafai, Ahmed Belkouch, Saad Zidouh, Lahcen Belyamani [Case report] - Complication rare et grave de la rachianesth&eacute;sie: la m&eacute;ningite bact&eacute;rienne (&agrave; propos d’un cas et revue de la litt&eacute;rature) - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/158/abstract/ <b>La rachianesth&eacute;sie (RA) est la premi&egrave;re anesth&eacute;sie locor&eacute;gionale. Elle comporte des effets secondaires et des risques qu'il faut pouvoir &eacute;viter, pr&eacute;venir ou traiter pr&eacute;cocement. C'est le cas d'une patiente op&eacute;r&eacute;e sous rachianesth&eacute;sie qui a pr&eacute;sent&eacute; quelques jours apr&egrave;s l'interventionde c&eacute;phal&eacute;es intenses associ&eacute;es &agrave; des naus&eacute;es et des vomissements &eacute;voluant dans un contexte de fi&egrave;vre. La ponction lombaire mettait en &eacute;vidence un liquide trouble avec la pr&eacute;sence de cocci gram + &agrave; l'examen direct, ce qui a permis de poser le diagnostic d'une m&eacute;ningite bact&eacute;rienne et dont l'&eacute;volution a &eacute;t&eacute; favorable apr&egrave;s antibioth&eacute;rapie.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com D&eacute;sir&eacute; Alain Affangla, Mohamed Leye, Ang&egrave;le Wabo Simo, Franck D’Almeida, Th&eacute;r&egrave;se Yand&eacute; Sarr, Adamson Phiri, Adama Kane [Case report] - Une tachycardie à QRS large mal tolérée chez un nourrisson - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/157/abstract/ <b>Les tachycardies &agrave; QRS large mal tol&eacute;r&eacute;es du nourrisson posent le probl&egrave;me de leur diagnostic et de la prise en charge en urgence. Nous rapportons un cas de tachycardie &agrave; QRS large chez un nourrisson de 35 jours re&ccedil;u pour d&eacute;tresse cardio-circulatoire. Le cœur &eacute;tait morphologiquement normal &agrave; l’&eacute;chographie cardiaque Doppler. Un traitement par une dose charge d’Amiodarone n’a pas permis de r&eacute;duire cette tachycardie. Un retour en rythme sinusal a &eacute;t&eacute; obtenu apr&egrave;s cardioversion par un d&eacute;fibrillateur externe semi-automatique type Lifeline. Un traitement d’entretien par Amiodarone per os est institu&eacute; et le patient est en rythme sinusal &agrave; 03 mois.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mohammed Meziane, Abdelghafour Elkoundi, Redouane Ahtil, Miloudi Guazaz, Bensghir Mustapha, Charki Haimeur [Case report] - Anaesthetic management for awake craniotomy in brain glioma resection: initial experience in Military Hospital Mohamed V of Rabat - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/156/abstract/ <b>The awake brain surgery is an innovative approach in the treatment of tumors in the functional areas of the brain. There are various anesthetic techniques for awake craniotomy (AC), including asleep-awake-asleep technique, monitored anesthesia care, and the recent introduced awake-awake-awake method. We describe our first experience with anesthetic management for awake craniotomy, which was a combination of these techniques with scalp nerve block, and propofol/r&eacute;mifentanil target controlled infusion. A 28-year-oldmale underwent an awake craniotomy for brain glioma resection. The scalp nerve block was performed and a low sedative state was maintained until removal of bone flap. During brain glioma resection, the patient awake state was maintained without any complications. Once, the tumorectomy was completed, the level of anesthesia was deepened and a laryngeal mask airway was inserted. A well psychological preparation, a reasonable choice of anesthetic techniques and agents, and continuous team communication were some of the key challenges for successful outcome in our patient.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hicham Bousbaa, Mourad Bennani, Naoufal Elghoul, Mohammed Ouahidi, Jamal Louaste, Laarbi Amhaji [Case report] - Une fracture pertrochanterienne r&eacute;v&eacute;lant un my&eacute;lome multiple: quelle prise en charge? - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/155/abstract/ <b>L’atteinte squelettique est la complication clinique majeure au cours des my&eacute;lomes multiples avec une part non n&eacute;gligeable pour les fractures pathologiques. Les fractures du f&eacute;mur proximal sont tr&egrave;s fr&eacute;quentes au cours de l’&eacute;volution du my&eacute;lome multiple et elles compromettent s&eacute;rieusement la survie ainsi que la qualit&eacute; de vie du patient canc&eacute;reux. Un traitement chirurgical pr&eacute;coce permet l’am&eacute;lioration de la mortalit&eacute; et la morbidit&eacute;. L’ost&eacute;osynth&egrave;se par clou cervicom&eacute;dullaire verrouill&eacute; de type clou gamma constitue un moyen stable, efficace et durable qui permet la lev&eacute;e pr&eacute;coce et une am&eacute;lioration de la survie du malade. Cependant, une survie prolong&eacute;e impose une surveillance r&eacute;guli&egrave;re de l’ost&eacute;osynth&egrave;se pour d&eacute;pister et traiter une faillite de mat&eacute;riel.Il faut en dernier lieu ne pas perdre de vue que le regain de l’autonomie apr&egrave;s une fracture pertrochant&eacute;rienne hypoth&egrave;que m&ecirc;me le contr&ocirc;le du my&eacute;lome par la possibilit&eacute; ou non de r&eacute;aliser l’autogreffe de la moelle osseuse.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Christian Chukwukere Ogoke, Sylvester Onabeke Iloeje [Research] - Severity of motor dysfunction in children with cerebral palsy seen in Enugu, Nigeria - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/154/abstract/ <b>INTRODUCTION: children with cerebral palsy (CP) have gross motor dysfunction (GMD) of varying degrees of severity. The Gross Motor Function Classification System (GMFCS) is widely used internationally to classify children with CP into functional severity levels. There are few reports on the use of GMFCS in Nigeria to determine the severity of motor dysfunction in children with CP. This study aims to classify children with CP in Enugu on the basis of severity of their GMD in order to ascertain their management needs. METHODS: the study was a cross sectional observational study and sample selection was by consecutive recruitment. One hundred (100) children with CP aged 9 – 96 months, attending two Pediatric Neurology Clinics in Enugu, were consecutively recruited. Relevant history was taken including modalities of treatment received. Neurological examination was done and the GMFCS manual was used to classify the children into levels of severity. RESULTS: GMD varied in severity in the patients from mild (47%) (GMFCS levels I & II) to moderate (7%) (GMFCS levels III) and to severe (46%) (GMFCS levels IV & V). Those in levels I – III (54%) were ambulatory while those in levels IV & V (46%) were non-ambulatory. Of the 53 that required mobility assistive device, only 6 (11.3%) were using one. CONCLUSION: more than half of CP patients seen in Enugu were ambulatory with mild to moderate motor dysfunction based on the GMFCS. Only a few of our patients are appropriately rehabilitated with augmentative interventions.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hela Jebali, Meriam Hajji, Lamia Rais, Fethi Ben Hamida, Soumaya Beji, Mohammed Karim Zouaghi [Case series] - Clinicopathological findings and outcome of lupus nephritis in Tunisian children: a review of 43 patients - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/153/abstract/ <b>We report clinical and renal histological data, treatment modalities and outcome of 43 Tunisian children with biopsy-proven lupus nephritis seen over a 23-year period. There were 39 girls and 4 boys with a mean age of 12.5 years at diagnosis of lupus nephritis and followed for a mean period of 77 months. Renal symptoms included urinary abnormalities in all patients, hypertension in 40% of cases, nephrotic syndrome in 60% of cases and renal failure in 25% of cases. Class IV and class III nephritis were observed in 48.8 % and 30.2 % respectively. Corticosteroids were used in all cases, associated to immunosuppressive therapy in 23%. Overall survival was 86% at 5 years and 74% at 10 and 15 years. Renal survival was 83% at 5 and 10 years and 63% at 15 years. Initial renal failure and tubulointerstitial fibrosis were significantly increased risk for the development of end-stage renal disease in our study group. Renal histological findings provide the basis for treatment recommendations. Timely performed renal biopsy is greatly needed to accurately determine the prognosis and to guide treatment in children lupus nephritis.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Amina Kissou, Badr Eddine Hassam [Images in medicine] - Un nodule plantaire - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/152/abstract/ <b>Un patient &acirc;g&eacute; de 30 ans, sans ant&eacute;c&eacute;dents notables, s'est pr&eacute;sent&eacute; en consultation de dermatologie pour l'apparition d'une nodule plantaire qui &eacute;voluait depuis 2 ans. L'examen clinique trouvait un nodule douloureux au niveau de la plante du pied droit. La l&eacute;sion mesurait 2.5cm de grand axe, bien ench&acirc;ss&eacute;e dans le derme, &agrave; surface k&eacute;ratosique et de consistance dure (A). Il n'y avait pas d'ad&eacute;nopathies. Une biopsie cutan&eacute;e a &eacute;t&eacute; faite. L'histologie avait objectiv&eacute; une prolif&eacute;ration tumorale fuso-cellulaire, sous &eacute;pidermiques, faites de faisceaux entrecrois&eacute;s storiformes. Les cellules tumorales &eacute;taient allong&eacute;es au cytoplasme r&eacute;duit &eacute;osinophile, munies de noyaux allong&eacute;s &agrave; chromatine fine avec des figures de mitoses estim&eacute;e &agrave; 6 mitoses/10 champs faisant &eacute;voquer un sarcome de Darier et Ferrand (B). L'immuno-histochimie avait objectiv&eacute; un marquage CD68 positif, par contre le CD34 &eacute;tait n&eacute;gatif (C,D). Le diagnostic d'une histiocytofibrome cellulaire b&eacute;nin a &eacute;t&eacute; retenu. Le patient a b&eacute;n&eacute;fici&eacute; d'une ex&eacute;r&egrave;se totale sans r&eacute;cidive avec un recul de 3 ans. Dans notre cas, l'immuno-histochimie a permis de redresser le diagnostic d'une histioctofibrome b&eacute;nin, dans sa forme atypique, pris initialement pour une tumeur maligne.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Rufus Wale Ojewola, Ezekiel Sofela Oridota, Olanrewaju Samuel Balogun, Ezra Olatunde Ogundare, Taiwo Opeyemi Alabi, Oluseyi Omotola Banjo, Adeyinka Laoye, Babatunde Adetunmbi, Bamidele Oludele Adebayo, Rotimi Oluyombo [Research] - Knowledge, attitudes and screening practices regarding prostatic diseases among men older than 40 years: a population-based study in Southwest Nigeria - 30 June 2017. http://www.panafrican-med-journal.com/content/article/27/151/abstract/ <b>INTRODUCTION: Despite the global increase in awareness of prostatic diseases resulting from widespread availability of screening tools, there is no evidence that the knowledge, attitudes and screening practices of Nigerian men have improved regarding prostatic diseases. METHODS: a descriptive cross-sectional study amongst 305 community-dwelling men. Respondents were selected using multi-staged sampling techniques. Knowledge, attitudes and screening practices were determined based on responses to a semi-structured KAP questionnaire. Data were analyzed using SPSS version 18. Pearson's chi-square and Fisher's exact test (two-tail) with level of significance set at 0.05 were used to determine the level of statistical significance. Pearson's correlation coefficient was used to establish correlation between variables. RESULTS: mean age of respondents was 63.4±11.8 years. Slightly less than half, 145(47.5%) were aware of prostate cancer (PCa) while only 99(32.5%) and 91(29.8%) were aware of BPH and prostatitis respectively. About a quarter (25.1%) had heard of PSA. The main sources of information were radio and television. Overall, 143(46.9%) respondents had good knowledge while 162(53.1%) had poor knowledge. Sexually transmitted disease was the commonest misconception as the cause of prostatic diseases. Overall, 44.3% had good attitudes. Only 31(10.2%) respondents had ever carried out screening for PCa. Only educational and occupational status had significant associations with level of knowledge and attitudes of participants. The only factor that influenced screening practices was educational status.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Fatima Dahmani, Souad Benkirane, Jaafar Kouzih, Aziz Woumki, Hassan Mamad, Azlarab Masrar [Case series] - Profil épidémiologique des hémoglobinopathies: étude transversale descriptive autour du cas index - 29 June 2017. http://www.panafrican-med-journal.com/content/article/27/150/abstract/ <b>Les h&eacute;moglobinopathies sont des affections constitutionnelles cons&eacute;quentes &agrave; des anomalies des h&eacute;moglobines. Elles sont souvent graves dans leurs formes majeures, leur prise en charge est lourde avec un grand impact psycho-social sur les patients et leur famille. Class&eacute;es parmi les maladies rares, elles sont encore insuffisamment connues des professionnels de sant&eacute;. Cette m&eacute;connaissance est &agrave; l'origine d'une errance diagnostique, d'un retard dans leur prise en charge et par cons&eacute;quent une morbidit&eacute; et une mortalit&eacute; &eacute;lev&eacute;e chez ces patients. L'Organisation Mondiale de la Sant&eacute; (OMS) a publi&eacute; en 2008 des donn&eacute;es concernant l'&eacute;pid&eacute;miologie des h&eacute;moglobinopathies: plus de 330000 cas naissent chaque ann&eacute;e avec une h&eacute;moglobinopathie (83% des cas de dr&eacute;panocytose, 17% des cas de thalass&eacute;mie). Les troubles de l'h&eacute;moglobine sont responsables d'environ 3,4% des d&eacute;c&egrave;s chez les moins de 5 ans. A l'&eacute;chelle mondiale, 7% environ des femmes enceintes seraient porteuses d'une forme de la thalass&eacute;mie et 1% des couples sont &agrave; risque. Toutefois, elles sont relativement fr&eacute;quentes dans certaines r&eacute;gions du globe o&ugrave; les mariages consanguins sont communs. Afin de d&eacute;crire les caract&eacute;ristiques &eacute;pid&eacute;miologiques des familles &agrave; risque d'h&eacute;moglobinopathies (&eacute;tude autour du cas) dont les cas index sont suivis au service de p&eacute;diatrie &agrave; l'H&ocirc;pital Provincial El Idrisi de Kenitra au Maroc, une &eacute;tude transversale descriptive a &eacute;t&eacute; r&eacute;alis&eacute;e durant deux enqu&ecirc;tes la premi&egrave;re en mai 2015 et la deuxi&egrave;me en juin de la m&ecirc;me ann&eacute;e lors des journ&eacute;es de vaccination des cas index contre le pneumocoque. Apr&egrave;s avoir recueilli les donn&eacute;es &eacute;pid&eacute;miologiques de nos patients, nous avons r&eacute;alis&eacute; une &eacute;tude biologique comportant: l'h&eacute;mogramme avec &eacute;tude morphologique des globules rouges en coloration MGG et num&eacute;ration automatique des r&eacute;ticulocytes; les &eacute;lectrophor&egrave;ses de l'h&eacute;moglobine &agrave; pH alcalin (8.8) et secondairement &agrave; pH acide (5.4) sur gel d'agarose avec int&eacute;gration densitom&eacute;trique. 275 patients ont pr&eacute;sent&eacute; des profils compatibles &agrave; une h&eacute;moglobinopathie. La majorit&eacute; de ces malades &eacute;taient issus de mariages consanguins (83.1%) et originaires de r&eacute;gions situ&eacute;es dans le nord du Maroc. L'enqu&ecirc;te familiale a permis de retrouver les familles &agrave; risque, chez lesquelles on note une fr&eacute;quence &eacute;lev&eacute;e de dr&eacute;panocytose. Nos r&eacute;sultats confirment l'existence de diff&eacute;rents types d'h&eacute;moglobinopathies dans la population marocaine.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Yasmina Rhofir, Rachida Zahraoui, Nabil Tiress, Hicham Naji-Amrani, Mouna Soualhi, Jamal Eddine Bourkadi [Case report] - Nocardiose pulmonaire sur un terrain immunocomp&eacute;tent: &agrave; propos de 2 cas - 29 June 2017. http://www.panafrican-med-journal.com/content/article/27/149/abstract/ <b>La nocardiose est une infection rare, mais s&eacute;v&egrave;re, caus&eacute;e par des bact&eacute;ries du genre nocardia, qui appartiennent &agrave; l'ordre des actinomyc&eacute;tales. Si elles peuvent toucher l'adulte immunocomp&eacute;tent, les nocardioses restent des pathologies de l'individu fragilis&eacute; sur le plan immunitaire. L'atteinte pulmonaire reste la plus fr&eacute;quente, sa prise en charge correcte est li&eacute;e au diagnostic qui est souvent retard&eacute; par des pr&eacute;sentations non sp&eacute;cifiques et des pr&eacute;l&egrave;vements non concluants. Nous rapportons ici deux cas de nocardiose chez des patients immunocomp&eacute;tents. Le premier cas est celui d'un homme de 24 ans, avec notion de tabagisme et d'ethylisme, hospitalis&eacute; pour des douleurs thoraciques et des h&eacute;moptysies de faible abondance, &eacute;voluant depuis deux mois, avec apparition d'abc&egrave;s sous cutan&eacute;s dorsales fistulis&eacute;s. L'exploration radiologique d&eacute;couvre une masse tissulaire m&eacute;diastino-pulmonaire droite avec lyse costale adjacente et diffusion aux tissus para vert&eacute;braux droits. Les pr&eacute;l&egrave;vements bact&eacute;riologiques restent n&eacute;gatifs motivant une biopsie scannoguid&eacute;e de la l&eacute;sion qui est revenue en faveur d'infection &agrave; nocardiose. Le second cas concerne un homme de 22 ans, aux ant&eacute;c&eacute;dents de tuberculose pleurale trait&eacute;e il y a 8 ans puis une rechute de tuberculose en 2011 (abc&egrave;s m&eacute;diastinale). Admis pour suspicion de rechute de tuberculose devant une toux chronique avec alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral et une h&eacute;patospl&eacute;nom&eacute;galie. Le scanner thoracique montre des condensations alv&eacute;olaires avec pleur&eacute;sie. Au cours de son hospitalisation, apparition de tum&eacute;factions sous cutan&eacute;es purulentes dont l'&eacute;tude bact&eacute;riologique du pus est revenue en faveur de nocardiose avec une souche r&eacute;sistante &agrave; tous les antibiotiques sauf la colistine et bactrim. Les auteurs illustrent &agrave; travers ces deux observations, les aspects cliniques et radiologiques de nocardiose pulmonaire en mettant le point sur les difficult&eacute;s diagnostiques et th&eacute;rapeutiques surtout dans un pays &agrave; forte pr&eacute;valence de tuberculose et tr&egrave;s faible incidence de nocardiose.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Serge Irie Bi Gohi, Pete Yaich, Koffi N'guessan, Bernard Ogondon, Yapo Brouh [Case report] - Diab&egrave;te gestationnel r&eacute;v&eacute;l&eacute; par une acidoc&eacute;tose diab&eacute;tique inaugural: &agrave; propos de un cas - 29 June 2017. http://www.panafrican-med-journal.com/content/article/27/148/abstract/ <b>L'acidoc&eacute;tose compliquant un diab&egrave;te gestationnel est une affection rare, responsable d'une mortalit&eacute; materno-f'tale importante. C'est une urgence m&eacute;tabolique aigue dont la prise en charge est multidisciplinaire. La pr&eacute;cocit&eacute; du diagnostic et du traitement conditionnent le pronostic vital de la m&egrave;re et du fœtus. Nous rapportons l'observation d'une gestante de 27 ans &agrave; terme, avec un ant&eacute;c&eacute;dent familial de diab&egrave;te, qui a &eacute;t&eacute; admise aux urgences obst&eacute;tricales pour un trouble de la vigilance associ&eacute; &agrave; une dyspn&eacute;e. Le diagnostic d'acidoc&eacute;tose inaugural d&eacute;compens&eacute;e par un paludisme grave sur un diab&egrave;te gestationnel a &eacute;t&eacute; retenu sur la base de l'anamn&egrave;se, de l'examen clinique et du bilan paraclinique. Elle a b&eacute;n&eacute;fici&eacute; d'une insulinoth&eacute;rapie, d'une r&eacute;hydratation, d'une correction des troubles ioniques et d'une traitement antipaludique. Une c&eacute;sarienne a &eacute;t&eacute; r&eacute;alis&eacute;e en urgence sous anesth&eacute;sie g&eacute;n&eacute;rale et a permis d'extraire un macrosome de sexe masculin mort-n&eacute; mac&eacute;r&eacute;. L'&eacute;volution a &eacute;t&eacute; favorable avec une reprise de la conscience et une normalisation des param&egrave;tres biologiques.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hanae Echahdi, Brahim El Hasbaoui, Mohamed El Khorassani, Aomar Agadr, Mohamed Khattab [Case report] - Von Willebrand's disease: case report and review of literature - 29 June 2017. http://www.panafrican-med-journal.com/content/article/27/147/abstract/ <b>Von Willebrand Disease (VWD) is the most common human inherited bleeding disorder due to a defect of Von Willebrand Factor (VWF), which a glycoprotein crucial for platelet adhesion to the subendothelium after vascular injury. VWD include quantitative defects of VWF, either partial (type 1 with VWF levels < 50 IU/dL) or virtually total (type 3 with undetectable VWF levels) and also qualitative defects of VWF (type 2 variants with discrepant antigenic and functional VWF levels). The most bleeding forms of VWD usually do not concern type 1 patients with the mildest VWF defects (VWF levels between 30 and 50IU/dL). Von willebrand factor is a complex multimeric protein with two functions: it forms a bridge between the platelets and areas of vascular damage and it binds to and stabilizes factor VIII, which is necessary for the clotting cascade. By taking a clinical history of bleeding (mucocutaneous bleeding symptoms suggestive of a primary haemostatic disorder, a quantitative or qualitative abnormality of VWF is possible) it is important to think about VWD and to make the appropriate diagnosis. If the VWD is suspected diagnostic tests should include an activated partial thromboplastin time, bleeding time, factor VIII: C Ristocetin cofactor and vWF antigen. Additional testing of ristocetin induced plattlet adhesion (RIPA) the multimeric structure and collagen binding test and genanalysis allow diagnosing the different types of von. Willebrand Disease. The treatment of choice in mild forms is the synthetic agent desmopressin. In patients with severe type 1, type 2B, 2N and type 3 or in people who do not response to desmopressin, the appropriate treatment is a factor VIII concentrate that is rich of VWF. We report a case of infant in 27-month-old boy who had been referred due to haemorrhagic shock. His birth histories, his familie's social history and developmental milestones were unremarkable. He was born at full term with no antenatal or perinatal complications. Prior to the symptoms, the child was on a normal diet and was thriving appropriately. The child presented one days before his admission trauma to the inner face of the lower lip that caused an external acute bleeding loss. The laboratory data showed unfortunately, the most severe form of Von Willebrand's Disease; Type 3. The management was based on erythrocyte and fresh-frozen plasma (FFP) transfusions with administration of factor VII with good evolution.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Azzeddine Laaraje, Naima El Hafidi, Chafik Mahraoui [Case report] - Cause rare d'une toux s&egrave;che &agrave; l'effort: ag&eacute;n&eacute;sie de l'art&egrave;re pulmonaire gauche avec hypoplasie pulmonaire - 29 June 2017. http://www.panafrican-med-journal.com/content/article/27/146/abstract/ <b>L'ag&eacute;n&eacute;sie de l'art&egrave;re pulmonaire gauche associ&eacute;e &agrave; l'hypoplasie du poumon homolat&eacute;ral, est une malformation cong&eacute;nitale rare qui peut &ecirc;tre d&eacute;couverte chez l'enfant de fa&ccedil;on fortuite ou par des infections respiratoires r&eacute;cidivantes. Son diagnostic est &eacute;tabli par l'angioscanner thoracique. Le traitement est essentiellement conservateur. Nous rapportons un cas survenant chez un enfant de 6 ans et r&eacute;v&eacute;l&eacute; par une toux d'effort.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Faustinos Tatenda Takawira, Racheal Shamiso Dube Mandishora, Zephaniah Dhlamini, Ellen Munemo, Babill Stray-Pedersen [Research] - Mutations in rpoB and katG genes of multidrug resistant mycobacterium tuberculosis undetectable using genotyping diagnostic methods - 28 June 2017. http://www.panafrican-med-journal.com/content/article/27/145/abstract/ <b>INTRODUCTION: Tuberculosis remains the leading causes of death worldwide with frequencies of mutations in rifampicin and isoniazid resistant Mycobacterium tuberculosis isolates varying according to geographical location. There is limited information in Zimbabwe on specific antibiotic resistance gene mutation patterns in MTB and hence, increased rate of discordant results and mortality due to inappropriate antibiotic prescriptions. The rpoB and katG genes molecular markers are used for detecting rifampicin and isoniazid resistance respectively. Some mutations within these gene sequences are associated with drug resistance as they directly alter gene function. The objectives of this research was to determine the drug resistance profiles in M. tuberculosis isolates that are phenotypically resistant but not detected by the GeneXpert and MTBDRplus kit and also to detect mutations in the rpoB and katG genes which are not detected by the Hain Genotype MTBDRplus kit and GeneXpert diagnosis. METHODS: PCR was used for the amplification of the rpoB and katG genes from MTB isolates collected from human clinical samples between 2008 and 2015. The genes were sequenced and compared to the wild type MTB H37Rv rpoB (accession number L27989) and kat G genes (KP46920), respectively. Sequence analysis results were compared to genotyping results obtained from molecular assays and culture results of all isolates. RESULTS: the most frequent mutation responsible for rifampicin resistance was (25/92) S531L that was detected by using all molecular assays. Some inconsistencies were observed between phenotypic and genotypic assay results for both katG and rpoB genes in 30 strains. For these, eight codons; G507S, T508A, L511V, del513-526, P520P, L524L, R528H, R529Q and S531F were novel mutations. In addition, the I572P/F, E562Q, P564S, and Q490Y mutations were identified as novel mutations outside the rifampicin resistance determining region. In katG gene, amino acid changes to threonine, asparagine and isoleucine exhibited high degrees of polymorphism such as V473N, D311N, and L427I. The R463L (20/92) amino acid substitution was most common but was not associated with isoniazid resistance. CONCLUSION: these finding indicate that molecular assay kit diagnosis that is based on the rpoB and katG genes should be improved to cater for the genetic variations associated with the geographic specificity of the target genes and be able to detect most prevalent mutations in different areas.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Sanaa Elfihri, Mustapha Laine, Fouad Kettani, Jaouda Ben amor, Jamel Eddine Bourkadi [Case report] - Maladie de Kikuchi-Fujimoto: &agrave; propos d’un cas - 28 June 2017. http://www.panafrican-med-journal.com/content/article/27/144/abstract/ <b>La maladie de Kikuchi-Fujimoto ou lymphad&eacute;nite histyocytaire n&eacute;crosante constitue une cause rare et b&eacute;nigne d’ad&eacute;nopathies cervicales. C’est une entit&eacute; anatomoclinique d’&eacute;tiologie inconnue. La confirmation du diagnostic est toujours apport&eacute;e par l’&eacute;tude histologique ganglionnaire. L’&eacute;volution est g&eacute;n&eacute;ralement favorable avec gu&eacute;rison spontan&eacute;e au bout de quelques semaines. Nous rapportons l’observation d’une fille de 9ans ayant consult&eacute;e pour des ad&eacute;nopathies cervicales associ&eacute;es &agrave; une fi&egrave;vre. La biopsie ganglionnaire cervicale a conclu &agrave; une maladie de Kikuchi. L’&eacute;volution &eacute;tait marqu&eacute;e par la r&eacute;gression des ad&eacute;nopathies sans aucun traitement.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Jihad Drissi, Ayman Hachi, Laila Adlani, Jaouad Kouach, Driss Moussaoui, Mohamed Dehayni [Case report] - Hypertension intracr&acirc;nienne idiopathique: &agrave; propos d’un cas rare associ&eacute; &agrave; la grossesse - 28 June 2017. http://www.panafrican-med-journal.com/content/article/27/143/abstract/ <b>Nous rapportons le cas d’une primigeste de 25ans dont la grossesse a &eacute;t&eacute; compliqu&eacute;e, d&egrave;s le premier trimestre, d’une hypertension intracr&acirc;nienne (HTIC) idiopathique avec retentissement visuel, ayant b&eacute;n&eacute;fici&eacute;e d’un shunt lombo-p&eacute;riton&eacute;al sans cons&eacute;quences obst&eacute;tricales. L’objectif de ce travail est de pr&eacute;ciser les caract&eacute;ristiques de cette entit&eacute; pathologique rare dont le m&eacute;canisme physiopathologique est mal &eacute;lucid&eacute;. Elle serait li&eacute;e &agrave; un d&eacute;faut de r&eacute;absorption du liquide c&eacute;phalorachidien (LCR) au niveau des granulations arachno&iuml;diennes. Les principaux facteurs de risque &eacute;voqu&eacute;s sont : l’ob&eacute;sit&eacute;, le syndrome des ovaires polykystiques, la thrombophilie et l’hyperfibrinolyse. Le diagnostic repose sur les crit&egrave;res modifi&eacute;s de Dandy apr&egrave;s enqu&ecirc;te clinico-biologique et radiologique n&eacute;gative. Comme pour l’HTIC « classique », le pronostic visuel est compromis. Cependant, il n’y a pas de risque d’engagement qui mettrait en jeu le pronostic vital. Par ailleurs, cette maladie n’influence pas l’&eacute;volution de la grossesse. Ceci dit, un traitement rapide et efficace devra &ecirc;tre instaur&eacute; afin de pr&eacute;server la fonction visuelle de ces patientes.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Seth Kwabena Amponsah, George Obeng Adjei, Abdul Malik Sulley, Joan Woode, Jorgen Anders Lindholm Kurtzhals, Christabel Enweronu-Laryea [Research] - Diagnostic utility of procalcitonin versus C-reactive protein as markers for early-onset neonatal sepsis at Korle-Bu Teaching Hospital - 28 June 2017. http://www.panafrican-med-journal.com/content/article/27/142/abstract/ <b>INTRODUCTION: symptoms of sepsis are non-specific among neonates and diagnosis requires a high index of suspicion. The study sought to evaluate the utility of procalcitonin (PCT) versus C-reactive protein (CRP) in diagnosing early-onset neonatal sepsis. METHODS: this was a cross-sectional study in which neonates admitted to the neonatal intensive care unit, with signs suggesting sepsis were categorized according to an adapted criteria from Tollner's sepsis score and case definition of bloodstream infection as: ''highly probable'', ''probable'' and ''less probable''. Laboratory investigations including blood culture, complete blood count, PCT and CRP levels were done before first antimicrobial drug administration. RESULTS: a total of 62 neonates less than 12 hours postnatal age (0.16-9.82 hours) were recruited. Proportion of neonates with PCT>2 ng/mL was 91% (20/22) in the ''highly probable'' group compared to 31.6% (6/19) in the ''probable group'' (p<0.001). Neonates with CRP>5 mg/L was 54.4% (12/22) in the ''highly probable'' group compared to 26.3% (5/19) in the ''probable group'' (p = 0.07). The receiver operator characteristics for PCT and CRP were; sensitivity (87.5% vrs 50%), specificity (63.0% vrs 72.2%), positive predictive value (44.1% vrs 37.5%) and negative predictive value (93.8% vrs 81.3%), respectively. CONCLUSION: PCT was a better predictive marker for neonatal sepsis within the first 12 hours of life than CRP in this setting, however, its low specificity relative to CRP suggests that neonates without patent infection are more likely to be incorrectly diagnosed with sepsis using this test.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Saqib Saeed, Sanjiv Gray [Images in medicine] - Vanishing lung syndrome in a patient with HIV infection and recurrent pneumothorax - 28 June 2017. http://www.panafrican-med-journal.com/content/article/27/141/abstract/ <b>Vanishing lung syndrome (VLS) is a rare chronic, progressive clinical entity seen in smokers characterized by giant emphysematous bullae mainly in the upper lobes. Extensive paraseptal emphysema coalesces to form giant bullae, compressing the normal lung parenchyma. The criteria for diagnosis based on radiography was defined by Roberts et al in 1987 and includes the presence of giant bulla in one or both upper lobes, occupying at least one third of the hemithorax and compressing the surrounding normal lung parenchyma. HIV infection can worsen the disease process. We report a 56 year-old HIV positive male with a smoking history of 30 pack-years smoking history who presented to the Emergency room with chronic chest pain, dyspnea, and cough for 2-3 weeks duration. He had a history of COPD and had multiple prior admissions for recurrent pneumothoraces. Chest radiography (A) showed hyperlucent and hyperinflated lung with bilateral pleural thickening and bilateral severe bullous emphysematous changes which was suggestive of vanishing lung syndrome. Computed tomography of the chest confirmed these findings (B). Chest tube was placed on the left side for treatment of the pneumothorax. The patient had refused lung reduction surgery in the past. He was counseled on smoking cessation and was discharged home with a Heimlich valve catheter. The main complication of VLS is pneumothorax. Lung reduction surgery such as bullectomy results in improvements in dyspnea, gas exchange, and exercise tolerance. Clinical should be aware of the condition and early referral for lung reduction surgery is required. Smoking cessation is essential.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Amina Kissou, Badr Eddine Hassam [Images in medicine] - An unexpected guest - 28 June 2017. http://www.panafrican-med-journal.com/content/article/27/140/abstract/ <b>A 60-year-old woman, diabetic with amlodipine, consulted for a rapidly progressive lesion in the back of the hand. The examination found a hard, sessile, painful lesion with purple-colored and keratosic surface. It was 1cm in diameter. Total removal of the lesion with 2mm margin was indicated. The histological examination showed the presence of papillomatosis and acanthosis with koilocytes and the diagnosis of wart was retained. The clinical presentation of this lesion is a typical; it is a lesion on the dorsal margin of the hand, painful, purple-colored, with a rapid evolution in 01mois. A keratoacanthoma or epidermoid carcinomas were both suspected firstly. After resection there was no recurrence with a follow-up of 4 years.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Sanaa Lemtibbet, Badreddine Hassam [Images in medicine] - Carcinome &eacute;pidermo&iuml;de compliquant la maladie de Verneuil - 28 June 2017. http://www.panafrican-med-journal.com/content/article/27/139/abstract/ <b>La maladie de Verneuil (MV) est une affection chronique suppurative fistulisante et d'&eacute;volution cicatricielle des follicules pilo-s&eacute;bac&eacute;s des r&eacute;gions cutan&eacute;es o&ugrave; sont pr&eacute;sentes des glandes apocrines. La d&eacute;g&eacute;n&eacute;rescence maligne ou la survenue de carcinome &eacute;pidermo&iuml;de au cours de la Maladie de Verneuil est une complication rare &agrave; long terme. La fr&eacute;quence est estim&eacute;e &agrave; 1,5-3%. Une pr&eacute;dominance masculine est not&eacute;e. La r&eacute;gion p&eacute;rin&eacute;o-fessi&egrave;re est le plus &agrave; risque. Un d&eacute;lai de 23 ans en moyenne est n&eacute;cessaire entre le d&eacute;but de la Maladie de Verneuil et la d&eacute;g&eacute;n&eacute;rescence. L'histologie montre le plus souvent un carcinome &eacute;pidermoide bien diff&eacute;renti&eacute;. C'est une tumeur de croissance habituellement rapide, souvent invasive, &agrave; risque m&eacute;tastatique non n&eacute;gligeable (40% cas), avec risque de d&eacute;c&egrave;s en quelques mois. Nous rapportons le cas d'un patient &acirc;g&eacute; de 42 ans pr&eacute;sentant une maladie de Verneuil de localisation p&eacute;rin&eacute;o-fessi&egrave;re &eacute;voluant depuis 20 ans et trait&eacute;e irr&eacute;guli&egrave;rement par des antiseptiques et des cyclines per os. Le patient rapportait l'apparition il y a un an sur un tissu cicatriciel inter-fessier d'une l&eacute;sion verruqueuse d'&eacute;volution progressivement v&eacute;g&eacute;tante. La biopsie cutan&eacute;e a r&eacute;v&eacute;l&eacute; un carcinome &eacute;pidermoide bien diff&eacute;renci&eacute; et infiltrant. Le bilan d'extension &eacute;tait n&eacute;gatif. Le traitement consistait en l'ex&eacute;r&egrave;se de la l&eacute;sion. L'&eacute;volution &eacute;tait favorable avec un recul de 3 mois.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mohamad Syafeeq Faeez Md Noh, Siti Jusna @ Siti Sharifah Muhammad [Images in medicine] - Beaver in the liver - 23 June 2017. http://www.panafrican-med-journal.com/content/article/27/138/abstract/ <b>A 60-year-old woman with a congenital solitary right kidney presented with 1 month history of right flank pain associated with hematuria and urinary tract infection (UTI) symptoms. A Computed tomography (CT) was done in view of the precious kidney, and revealed features suggestive of right obstructive uropathy with pyelonephritis; for which appropriate treatment was subsequently instituted. Incidentally, an elongated left liver lobe was discovered. This anatomical variant, also known as 'Beaver tail liver' is seen to be extending beyond the spleen, almost encasing it entirely (A). The term was coined due to its resemblance to the tail of a beaver (B). Although not widely reported in the medical literature, the presence of this variant has a few clinical implications. When present, lesions occurring in the elongated left lobe may be missed on ultrasonography (USG). In cases of trauma, injury to the left side of the abdomen which classically affects the spleen, may affect the elongated left liver lobe. It may also be mistaken for a splenic hematoma. Operative intervention, when pursued without prior knowledge of its presence, may result in unwanted complications. In essence, clinicians should be aware of its occurrence and clinical significance; as this may influence patient management and treatment outcome.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Rabecca Tembo, Trevor Kaile, Doris Kafita, Chrispin Chisanga, Annie Kalonda, Annie Kalonda, Ephraim Zulu, Mulemba Samutela, Pascal Polepole, Geoffrey Kwenda [Research] - Detection of Human Herpes Virus 8 in Kaposi’s sarcoma tissues at the University Teaching Hospital, Lusaka, Zambia - 22 June 2017. http://www.panafrican-med-journal.com/content/article/27/137/abstract/ <b>BACKGROUND: human herpes virus-8, a ?2-herpes virus, is the aetiological agent of Kaposi sarcoma. Recently, Kaposi’s sarcoma cases have increased in Zambia. However, the diagnosis of this disease is based on morphological appearance of affected tissues using histological techniques, and the association with its causative agent, Human Herpes virus 8 is not sought. This means poor prognosis for affected patients since the causative agent is not targeted during diagnosis and KS lesions may be mistaken for other reactive and neoplastic vascular proliferations when only histological techniques are used. Therefore, this study was aimed at providing evidence of Human Herpes virus 8 infection in Kaposi’s sarcoma tissues at the University Teaching Hospital in Lusaka, Zambia. METHODS: one hundred and twenty suspected Kaposi’s sarcoma archival formalin-fixed paraffin-wax embedded tissues stored from January 2013 to December 2014 in the Histopathology Laboratory at the University Teaching Hospital, Lusaka, Zambia were analysed using histology and Polymerase Chain Reaction targeting the ORF26 gene of Human Herpes virus 8. RESULTS: the predominant histological type of Kaposi’s sarcoma detected was the Nodular type (60.7%) followed by the plaque type (22.6%) and patch type (16.7%). The nodular lesion was identified mostly in males (40.5%, 34/84) than females (20.2%, 17/84) (p=0.041). Human Herpes virus 8 DNA was detected in 53.6% (45/84) and mostly in the nodular KS lesions (60%, 27/84) (p=0.035). CONCLUSION: the findings in this study show that the Human Herpes virus-8 is detectable in Kaposi’s sarcoma tissues, and, as previously reported in other settings, is closely associated with Kaposi’s sarcoma. The study has provided important baseline data for use in the diagnosis of this disease and the identification of the virus in the tissues will aid in targeted therapy.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Fatima Zahra Aglili, Maha Oudrhiri, Houria Knouni, Younes Taboz, Hasna Benkiran, Hassan Aguenaou, Fouad Ettaybi, Amina Barkat [Case report] - Perforation gastrique idiopathique du nouveau-n&eacute;: &agrave; propos d’un cas - 22 June 2017. http://www.panafrican-med-journal.com/content/article/27/136/abstract/ <b>La perforation gastrique n&eacute;onatale spontan&eacute;e est rare. Nous rapportons un cas survenu chez un nouveau-n&eacute; issu d'une grossesse et une naissance sans anomalies, et qui a pr&eacute;sent&eacute; au troisi&egrave;me jour de sa vie brutalement une distension abdominale importante, suivie des vomissements bilieux. La radiographie de l'abdomen sans pr&eacute;paration montrait un pneumop&eacute;ritoine massif, la laparotomie trouvait une perforation au niveau de la paroi gastrique ant&eacute;rieure, qui &eacute;tait sutur&eacute;e en un plan. Les suites op&eacute;ratoires &eacute;taient simples. L'&eacute;volution des perforations gastriques spontan&eacute;es survenant chez le nouveau-n&eacute; est habituellement favorable. Sous r&eacute;serve d'un diagnostic et prise en charge pr&eacute;coce.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Cyr Esp&eacute;rance Koulimaya-Gombet, Abdoul Aziz Diouf, Moussa Diallo, Anna Dia, Codou S&egrave;ne, Jean Charles Moreau, Alassane Diouf [Case series] - Grossesse et accouchement des patientes ayant un ant&eacute;c&eacute;dent de c&eacute;sarienne &agrave; Dakar: aspects &eacute;pid&eacute;mio-cliniques th&eacute;rapeutiques et pronostiques - 22 June 2017. http://www.panafrican-med-journal.com/content/article/27/135/abstract/ <b>Il s’agissait de d&eacute;terminer la fr&eacute;quence hospitali&egrave;re de l’accouchement sur ut&eacute;rus cicatriciel &agrave; Pikine, d’&eacute;valuer la qualit&eacute; de la prise en charge ant&eacute;natale des grossesses sur ut&eacute;rus cicatriciel et de rechercher les facteurs pronostiques de l’issue d’une &eacute;preuve ut&eacute;rine. Nous avons proc&eacute;d&eacute; &agrave; une &eacute;tude r&eacute;trospective &agrave; partir de dossiers m&eacute;dicaux et des protocoles op&eacute;ratoires des patientes ayant accouch&eacute; sur ut&eacute;rus cicatriciel durant la p&eacute;riode du 1er Janvier 2010 au 31 D&eacute;cembre 2011. Ont &eacute;t&eacute; analys&eacute;s les donn&eacute;es socio-d&eacute;mographiques, le suivi de la grossesse, les modalit&eacute;s th&eacute;rapeutiques et le pronostic. Les donn&eacute;es &eacute;taient saisies et analys&eacute;es &agrave; l’aide du logiciel Microsoft Office Excel 2007 et du logiciel SPSS version 17.0. La fr&eacute;quence des accouchements sur ut&eacute;rus cicatriciel &eacute;tait de 9,6%. L’&acirc;ge moyen des patientes &eacute;tait de 29,4 ans. Les primipares repr&eacute;sentaient 54%. Un espace inter-g&eacute;n&eacute;sique court &eacute;tait retrouv&eacute; dans 52,6% des cas. En fonction du nombre de c&eacute;sarienne, la r&eacute;partition &eacute;tait la suivante: 79,8% des cas d’ut&eacute;rus unicicatriciels, 17,9% pour les bicicatriciels et 2,3% pour les tricicatriciels. Le nombre de consultations pr&eacute;natales effectu&eacute;es &eacute;tait sup&eacute;rieur ou &eacute;gal &agrave; 3 dans 79,8% des cas. Les patientes &eacute;vacu&eacute;es repr&eacute;sentaient 54,2% et elles &eacute;taient d&eacute;j&agrave; en travail &agrave; l’admission dans 81,7% des cas. Une &eacute;preuve ut&eacute;rine &eacute;tait autoris&eacute;e chez 177 patientes (34,3%), et &agrave; l’issue de cette &eacute;preuve, 147 patientes avaient accouch&eacute; par voie basse, soit 83% dont 21,7% par ventouse obst&eacute;tricale. L’accouchement par c&eacute;sarienne &eacute;tait r&eacute;alis&eacute; dans 71,4% des cas avec 245 c&eacute;sariennes en urgence et 93 c&eacute;sariennes programm&eacute;es. Un ant&eacute;c&eacute;dent d’accouchement par voie basse &eacute;tait un facteur d&eacute;terminant d’un accouchement normal (p = 0,0001). Il existait &eacute;galement un lien significatif entre le mode d’admission et la d&eacute;cision de c&eacute;sarienne (p = 0,0001). La mortalit&eacute; maternelle &eacute;tait de 0,4%. La mortalit&eacute; p&eacute;rinatale &eacute;tait de 28,2‰ naissances vivantes. Nous assistons &agrave; une augmentation fulgurante des accouchements sur ut&eacute;rus cicatriciel dans nos centres de SONUC. La qualit&eacute; de la prise en charge doit &ecirc;tre rehauss&eacute;e par une meilleure strat&eacute;gie de pr&eacute;paration &agrave; l’accouchement. L’&eacute;preuve ut&eacute;rine est une proc&eacute;dure &agrave; encourager pour r&eacute;duire le taux de c&eacute;sarienne it&eacute;rative.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com The Pan African Medical Journal [Erratum] - Erratum: Profil &eacute;pid&eacute;mio-clinique des chez le noir africain en h&eacute;modialyse chronique - 21 June 2017. http://www.panafrican-med-journal.com/content/article/27/134/abstract/ <b>This erratum corrects “Profil &eacute;pid&eacute;mio-clinique des atteintes dermatologiques chez le noir africain en h&eacute;modialyse chronique”. The Pan African Medical Journal. 2017;25:142. doi:10.11604/pamj.2016.25.142.7193.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Abdelghani El Ayoubi, Kevin Parfait Bienvenu Bouhelo, Hachem Chafik, Mohammed Nasri, Mohammed El idrissi, Mohammed Shimi, Abdelhalim El ibrahimi, Abdelmajid Elmrini [Case series] - Le co&ucirc;t m&eacute;dical direct de la prise en charge hospitali&egrave;re des fractures de l’extr&eacute;mit&eacute; sup&eacute;rieure du f&eacute;mur - 20 June 2017. http://www.panafrican-med-journal.com/content/article/27/133/abstract/ <b>Les fractures de l'extr&eacute;mit&eacute; sup&eacute;rieure du f&eacute;mur sont des fractures graves du fait de leur morbidit&eacute; et de leurs cons&eacute;quences sociales et/ou &eacute;conomiques. Elles font l'objet de plusieurs &eacute;tudes &agrave; l'&eacute;chelle mondiale concernant leurs prises en charge th&eacute;rapeutique, leurs &eacute;volutions et leurs pr&eacute;ventions. En raison du vieillissement de la population et de l'allongement de l'esp&eacute;rance de vie, l'augmentation de l'incidence de cette pathologie para&icirc;t in&eacute;luctable et posera &agrave; terme un v&eacute;ritable probl&egrave;me de sant&eacute; publique dont l'importance sera encore major&eacute;e par la n&eacute;cessit&eacute; d'une ma&icirc;trise des d&eacute;penses de sant&eacute;. Les r&eacute;sultats de ce travail montrent que l'&acirc;ge moyen de survenue d'une fracture de l'extr&eacute;mit&eacute; proximale du f&eacute;mur est de 68,13 ± 16,9 ans, et que la pr&eacute;dominance a &eacute;t&eacute; masculine avec un sex-ratio de 1,14. Les fractures per trochant&eacute;riennes ont repr&eacute;sent&eacute; 69,4% des cas. Le co&ucirc;t m&eacute;dical direct hospitalier des fractures de l'extr&eacute;mit&eacute; sup&eacute;rieure du f&eacute;mur au CHU Hassan II est de 387 714,38 £ chez 222 cas, avec un co&ucirc;t moyen de 1757,4 £, dont les frais li&eacute;s au s&eacute;jour ont repr&eacute;sent&eacute; la majorit&eacute; des d&eacute;penses avec 77% du co&ucirc;t total. Pour diminuer le co&ucirc;t de la prise en charge de cette pathologie, il est souhaitable de sensibiliser le personnel sur le co&ucirc;t des consommables &agrave; fin d'adapter le comportement le plus &eacute;conomique. Et aussi il faudrait limiter au maximum la dur&eacute;e de s&eacute;jour car elle seule permet de r&eacute;duire les d&eacute;penses li&eacute;es au frais du personnel et l'h&ocirc;tellerie.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Ilker Murat Arer, Hakan Yabanoglu, Huseyin Ozgur Aytac, Ali Ezer, Kenan Caliskan [Research] - Long-term results of retromuscular hernia repair: a single center experience - 20 June 2017. http://www.panafrican-med-journal.com/content/article/27/132/abstract/ <b>BACKGROUND: incisional hernia (IH) is one of the most frequent postoperative complications after abdominal surgery. There are multiple surgical techniques described for IH repair. The aim of the study is to evaluate the effect of primary fascial closure on long-term results in retromuscular hernia repair (RHR) for incisional hernias. METHODS: a total of 132 patients underwent RHR for IH were included in our study. 109 patients were evaluated in 2009 and 55 patients in 2015 for short and long-term results. RESULTS: among 132 patients perfromed RHR, fascia was closed in 107 (81%) and left open in 25 (19%) patients. The mean age of patients was 57.9 ± 11.8 years. Average mesh area was 439.8 ± 194.6 cm<sup>2</sup>, hernia area was 112 ± 77.5 cm<sup>2</sup> and open area after repair was 40.8 ± 43.3 cm<sup>2</sup>. Mean follow-up of 104 patients regarding postoperative complications evaluated in 2009 was 30.7 ± 14.1 months. Recurrent IH was observed in 6 (4.5%) patients according to data collected in 2009. Long-term results were; mean follow-up period was 91 ± 20.2 months (20-112 months) and recurrent IH was observed in 4 (7.3%) patients. CONCLUSION: retromuscular repair for incisional hernia regardless of the fascial closure gives high patient satisfaction, less recurrence rates and complications in long-term follow-up.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Souleymane Ouedraogo, Salam Ouedraogo, Jean Luc Kambire, Maurice Zida, Adama Sanou [Case report] - Occlusion par hernie interne transmesenterique cong&eacute;nitale: &agrave; propos de deux cas - 20 June 2017. http://www.panafrican-med-journal.com/content/article/27/131/abstract/ <b>La hernie interne &agrave; travers un d&eacute;fect du m&eacute;sent&egrave;re ou hernie transm&eacute;sent&eacute;rique est une cause rare d'occlusion intestinale aigu&euml;. Son diagnostic est le plus souvent r&eacute;alis&eacute; en per op&eacute;ratoire. La connaissance de ses particularit&eacute;s cliniques permet d'envisager le diagnostic pr&eacute;op&eacute;ratoire. Nous pr&eacute;sentons 2 cas d'occlusion intestinale aigu&euml; caus&eacute;e par une hernie transm&eacute;sent&eacute;rique cong&eacute;nitale chez 2 adultes. Nous discutons des particularit&eacute;s cliniques de cette forme rare de hernie interne.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Amel Achour Jenayah, Abdallah Cherni [Images in medicine] - Forme ulc&eacute;ro-n&eacute;crotique d’un cancer de la vulve - 19 June 2017. http://www.panafrican-med-journal.com/content/article/27/130/abstract/ <b>Le cancer de la vulve est une affection n&eacute;oplasique peu fr&eacute;quente repr&eacute;sentant moins de 5% des cancers gyn&eacute;cologiques, il survient le plus souvent chez des femmes &acirc;g&eacute;es. Notre patiente est &acirc;g&eacute;e de 70 ans. La symptomatologie clinique &eacute;tait domin&eacute;e par un prurit vulvaire &eacute;voluant depuis 6 ans, n&eacute;glig&eacute; par la patiente. La l&eacute;sion touche de mani&egrave;re pr&eacute;f&eacute;rentielle les grandes l&egrave;vres, c'est le cas de notre patiente qui pr&eacute;sentait une forme ulc&eacute;ro-n&eacute;crotique qui a touch&eacute; la grande l&egrave;vre droite puis s'est &eacute;tendu &agrave; la petite l&egrave;vre homolat&eacute;rale. Le diagnostic &eacute;tait pos&eacute; apr&egrave;s la r&eacute;alisation d'une biopsie vulvaire qui avait conclu &agrave; un carcinome &eacute;pidermo&iuml;de, type histologique le plus fr&eacute;quent. L'IRM abdomino-pelvienne avait class&eacute; la tumeur selon la classification FIGO 2009 en stade III A. La patiente avait b&eacute;n&eacute;fici&eacute; d'une vulvectomie &eacute;largie associ&eacute;e &agrave; une lymphad&eacute;nectomie inguinale bilat&eacute;rale suivie d'une radioth&eacute;rapie externe.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Soulemane Pessinaba, Yaovi Dodzi Molba Atti, Soodougoua Baragou, Machihude Pio, Yaovi Afassinou, Mohamed Kp&eacute;lafia, Edem Goeh-Aku&eacute;, Findib&eacute; Damorou [Research] - L’embolie pulmonaire au centre hospitalier universitaire Campus de Lom&eacute; (Togo): &eacute;tude r&eacute;trospective &agrave; propos de 51 cas - 18 June 2017. http://www.panafrican-med-journal.com/content/article/27/129/abstract/ <b>INTRODUCTION: L’objectif &eacute;tait d’&eacute;tudier les aspects &eacute;pid&eacute;miologiques, cliniques et &eacute;volutifs de l’embolie pulmonaire au CHU Campus de Lom&eacute;. METHODES: c’est une &eacute;tude r&eacute;trospective, analytique et descriptive sur une p&eacute;riode de 39 mois (1er Novembre 2011- 31 Janvier 2015). Etaient inclus, tous les dossiers des patients hospitalis&eacute;s dans le service de cardiologie du CHU Campus pour une EP. RESULTATS: la pr&eacute;valence de l’EP &eacute;tait de 3,1%. Le sex ratio femme/homme &eacute;tait de 2,2. L’&acirc;ge moyen des patients &eacute;tait de 52,7 ± 14,4 ans. Les facteurs de risque de MTEV &eacute;taient domin&eacute;s par: l’ob&eacute;sit&eacute; (54,9%), l’alitement (25,5%) et le long voyage (17,6%). Les principaux sympt&ocirc;mes &eacute;taient: dyspn&eacute;e (98,0%), douleur thoracique (78,4%) et toux (60,8%). Le score de Wells &eacute;tait &eacute;lev&eacute; dans 29,4%. L’ECG notait: tachycardie (78,4%), HVD (49,0%), aspect S1Q3T3 (47,1%) et bloc droit (39,2%). L’&eacute;chodoppler cardiaque transthoracique montrait une dilatation cavitaire droite et thrombus intra ventriculaire droit dans 5,6%. L’angioscanner thoracique &eacute;tait normal dans 9,8% et objectivait un embole dans 82,4%. Le traitement &eacute;tait fait d’HBPM &agrave; dose curative avec relais par un AVK. Une thrombolyse &eacute;tait effectu&eacute;e chez 8 malades. L’&eacute;volution &eacute;tait favorable dans 86,3%. Le taux de l&eacute;talit&eacute; &eacute;tait de 13,7%.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Haifa Bouchahda, Houda El Mhabrech, Hechmi Ben Hamouda, Sobhi Ghanmi, Rim Bouchahda, Habib Soua [Case report] - Prenatal diagnosis of caudal regression syndrome and omphalocele in a fetus of a diabetic mother - 16 June 2017. http://www.panafrican-med-journal.com/content/article/27/128/abstract/ <b>The caudal regression syndrome is defined as total or partial agenesis of the sacrum and lumbar spine, frequently associated with other developmental malformations (orthopedic, neurological, genito-urinary, gastrointestinal...). Prenatal diagnosis is possible through fetal ultrasound (US) and magnetic resonance imaging (MRI). A case of fetal caudal regression syndrome with omphalocele from a diabetic mother is presented, demonstrating the sonographic, MRI, CT and X-Ray features diagnostic. We will also discuss neonatal findings, risk factors and prognosis of this condition.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Biruk Melkamu Gemechu, Endale Gebreegziabher Gebremedhn, Tadesse Belayneh Melkie [Research] - Risk factors for postoperative throat pain after general anaesthesia with endotracheal intubation at the University of Gondar Teaching Hospital, Northwest Ethiopia, 2014 - 16 June 2017. http://www.panafrican-med-journal.com/content/article/27/127/abstract/ <b>INTRODUCTION: Postoperative sore throat is listed from the top as patients’ most undesirable outcome in the postoperative period. It is believed to originate from mucosal dehydration or edema, tracheal ischemia secondary to the pressure of endotracheal tube cuffs, aggressive oropharyngeal suctioning, and mucosal erosion from friction between delicate tissues and the endotracheal tube. Even if the problem was indicated in many literatures, it has never been studied in our country. The study aimed to assess prevalence and factors associated with postoperative sore throat among patients who were operated under general anesthesia with endotracheal intubation. METHODS: hospital based cross sectional study was conducted from February 25 - April 10, 2014 in Gondar University hospital. Patient interview and chart review were employed for data collection. Bivariate and multivariate logistic regressions were used to determine the association.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Fatuma Some, Mathew Koech, Emily Chesire, Gabriel Kigen [Case report] - Reversal of tenofovir induced nephrotoxicity: case reports of two patients - 16 June 2017. http://www.panafrican-med-journal.com/content/article/27/126/abstract/ <b>The use of the antiretroviral drug tenofovir has been associated with nephrotoxicity. However, the overall impact of this adverse effect has not been comprehensively evaluated. Some researchers have reported that it is quite severe to warrant monitoring for renal toxicity, while others have concluded that the magnitude may not be that significant. We report two clinical cases seen in our renal clinic with high creatinine levels suggestive of nephrotoxicity, who reverted back to normality upon withdrawal of tenofovir.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Abdoul Aziz Ndiaye, Mouhameth Bakhoum, Alioune Badara Tall, Ndeye Fatou Ngom-Gueye, Mohamed Sidy Seck, Boubacar Gueye, Awa Diop-BA, Awa Gaye, Gallo Papa Sow, Lamine Gueye, Anta Tal-Dia [Research] - Assessment of potentially preventable hospitalizations in the regional hospital of Saint-Louis, Senegal - 16 June 2017. http://www.panafrican-med-journal.com/content/article/27/125/abstract/ <b>INTRODUCTION: The "potentially preventable hospitalizations (PPH)" are hospital admissions that could have been avoided through effective primary care given at the appropriate time. Non-communicable diseases (NCDs), causes of PPH, are the leading cause of death worldwide with significant socioeconomic consequences especially in developing countries. This study aimed to assess the burden of potentially preventable hospitalizations in the St. Louis regional hospital. METHODS: this was a descriptive cross-sectional study. The surveyed population consisted of all patients older than one year, admitted to St. Louis hospital for more than four (04) hours time between January 20 and April 30, 2015. Patients hospitalized in surgery (general surgery, ENT, ophthalmology), maternity and neonatology, as well as those who refused or were unable to participate in the study were excluded.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Sinaa Mohamed [Case report] - Carcinome &eacute;pidermo&iuml;de primitif du colon: &agrave; propos d’un cas - 15 June 2017. http://www.panafrican-med-journal.com/content/article/27/124/abstract/ <b>Le carcinome &eacute;pidermo&iuml;de (CE) primitif du c&ocirc;lon est une tumeur exceptionnelle. Moins de 150 cas ont &eacute;t&eacute; publi&eacute;s dans la litt&eacute;rature jusqu'&agrave; l'ann&eacute;e 2014. Outre sa raret&eacute;, il se distingue par son association fr&eacute;quente avec d'autres n&eacute;oplasies digestifs. Nous rapportons l'observation d'un patient de 54 ans ayant une CE primitive du c&ocirc;lon. &Agrave; la lumi&egrave;re de cette observation, on discutera les particularit&eacute;s anatomo-cliniques et th&eacute;rapeutiques ainsi que les hypoth&egrave;ses &eacute;tiopathog&eacute;niques de cette entit&eacute; peu commune.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mustafa Nkaoui, Moncef Boufettal, Youness sasbou, Mohammed Kharmaz, Mohamed EL Ouadaghiri, Moulay Omar Lamrani, Ahmed El Bardouni, Mustapha Mahfoud, Mohamed Saleh Berrada [Case report] - Luxation sous-talienne interne pure: &agrave; propos d’un cas - 15 June 2017. http://www.panafrican-med-journal.com/content/article/27/123/abstract/ <b>La luxation sous talienne pure est une affection rare, les auteurs rapportent le cas d'un jeune patient ayant pr&eacute;sent&eacute; suite &agrave; un accident de sport une luxation sous talienne interne pure, trait&eacute; orthop&eacute;diquement avec un bon r&eacute;sultat fonctionnel.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Tarik Madani,Younes Mhammdi, El Mehdi El alouani, Mohammed Kharmaz, Mohamed El Ouadghiri, Abdou Lahlou, Lamrani Moulay Omar, Ahmed El Bardouni, Mustapha Mahfoud, Mohamed Saleh Berrada [Case report] - L’int&eacute;r&ecirc;t du trauma damage control orthop&eacute;dique dans les polytraumatismes : un cas de disjonction du bassin associ&eacute;e &agrave; une luxation de la hanche avec atteinte vasculaire - 15 June 2017. http://www.panafrican-med-journal.com/content/article/27/122/abstract/ <b>La connaissance de la physiopathologie du traumatis&eacute; grave et les cons&eacute;quences h&eacute;modynamiques et inflammatoires de la prise en charge chirurgicale initiale a amen&eacute; de nombreux chirurgiens &agrave; modifier leur approche du traitement des polytraumatis&eacute; graves avec l&eacute;sions du bassin ou des membres en int&eacute;grant les principes d'un traitement s&eacute;quentiel ou Trauma Damage Control Orthop&eacute;dique (TDCO).Nous rapportons le cas d'une patiente victime d'un accident de la voie publique, admise dans un tableau d'&eacute;tat de choc avec un disjonction du bassin associ&eacute;e &agrave; une luxation de la hanche compliqu&eacute;e d'une l&eacute;sion vasculaire du m&ecirc;me membre. Nous avons agit selon les concepts du TDCO en privil&eacute;giant une fixation externe du bassin apr&egrave;s r&eacute;duction de la luxation. La rapidit&eacute; de notre conduite a permis une revascularisation pr&eacute;coce du membre tout en &eacute;vitant les complications h&eacute;modynamiques et inflammatoires de la chirurgie &agrave; ciel ouvert.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Bonface Ombaba Osano, Fred Were, Shanaaz Mathews [Research] - Mortality among 5-17 year old children in Kenya - 15 June 2017. http://www.panafrican-med-journal.com/content/article/27/121/abstract/ <b>INTRODUCTION: Global mortality trends have changed over time and are expected to continue changing with a reduction in communicable diseases and an increase of non-communicable disease. Increased survival of children beyond five years may change mortality patterns for these children. There are few studies in Africa that explore the causes of mortality in children over five years. The objective of this study was to determine the mortality rate and clinical profiles of children aged 5-17 years who died in six Kenyan hospitals in 2013. METHODS: retrospective review of patients’ medical records to abstract data on diagnosis for those who died in year 2013. Data was analysed to provide descriptive statistics and explored differences in mortality rates between age groups and gender. RESULTS: we retrieved 4,520 patient records. The in-hospital mortality rate was 3.5% (95%CI 3.0-4.1) with variations in deaths between the ages and gender. Among the deaths, 60% suffered from communicable diseases, maternal and nutritional causes; 41.3% suffered from non-communicable diseases. A further 11.9% succumbed to traumatic injuries. The predominant clinical diagnoses among patients who died were HIV/AIDS, respiratory tract infections and malaria. CONCLUSION: infectious causes had the highest proportion of diagnoses among children aged 5-17 years who died.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Adaeze Chikaodinaka Ayuk, Agozie Ubesie, Chioma Laura Odimegwu, Kenechukwu Iloh [Research] - Use of Global initiative for asthma (GINA) guidelines in asthma management among paediatric residents in a Sub Saharan African country: a cross-sectional descriptive study - 15 June 2017. http://www.panafrican-med-journal.com/content/article/27/120/abstract/ <b>INTRODUCTION: clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Despite abundance of asthma guidelines, prevalence has continued to increase globally. There is need to assess how the contents of asthma guidelines are put to clinical use by doctors in the management of children with asthma. This study aims at evaluating the clinical practice of paediatric residents in applying GINA guidelines. METHODS: cross-sectional descriptive study of paediatric residents from 23 university teaching hospitals in Nigeria using structured questionnaire. Data analyses were with Statistical Package for Social Sciences (SPSS) version 19 (Chicago IL). Chi square was used to assess for any significant associations between categorical variables. A p < 0.05 was regarded to be statistically significant. RESULTS: sixty-six paediatric residents aged 27- 40 years were enrolled into the study (37 females and 29 males). One-third had spent more than three years in residency training. Fifty-eight residents (87.9%) were aware of the GINA guidelines while 46 (69.7%) were familiar with its contents. Only 39 (59.1%) residents adhered to the GINA guidelines. Twenty of the 35 junior residents (57.1%) compared to 26 of 31 (83.9%) senior residents were familiar with the GINA guidelines (p=0.031) while 15 of 35 junior residents (42.9%) compared to 24 of 31 senior residents (77.4%) consistently follow the GINA guidelines (p=0.006). Adherence to GINA guidelines was not influenced significantly by years of graduation or training (p>0.05). CONCLUSION: the use of the GINA guidelines was poor among paediatric residents. Application of contents rather than just availability of asthma guidelines may partly account for increasing asthma prevalence globally.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Salma Charfeddine, Rania Hammami, Faten Triki, Leila Abid, Mourad Hentati, Imed Frikha, Samir Kammoun [Case series] - La plastie tricuspide: annuloplastie de Carpentier versus technique de De VEGA - 15 June 2017. http://www.panafrican-med-journal.com/content/article/27/119/abstract/ <b>L'atteinte de la valve tricuspide a &eacute;t&eacute; longtemps n&eacute;glig&eacute;e aussi bien par cardiologue que par le chirurgien, mais depuis quelques ann&eacute;es, la fuite tricuspidienne a &eacute;t&eacute; d&eacute;montr&eacute;e comme un facteur pronostic dans l'&eacute;volution des patients op&eacute;r&eacute;s d'une valvulopathie du c'ur gauche. Plusieurs techniques de plastie tricuspide ont &eacute;t&eacute; d&eacute;velopp&eacute;es et les &eacute;tudes publi&eacute;es divergent sur les r&eacute;sultats de ces techniques; Nous avons men&eacute; ce travail afin d'&eacute;valuer les r&eacute;sultats de plastie tricuspide dans une population caract&eacute;ris&eacute;e par une forte pr&eacute;valence de la maladie rhumatismale et de comparer les techniques d'annuloplastie de carpentier versus la plastie de DeVEGA. Etude r&eacute;trospective men&eacute;e sur une p&eacute;riode de 25 ans ayant inclus les patients trait&eacute;s par plastie tricuspide dans le service de cardiologie de SFAX. Nous avons compar&eacute; les r&eacute;sultats de groupe 1 (annuloplastie de Carpentier) vs groupe 2 (plastie de DeVEGA) 91 patients &eacute;taient inclus dans notre &eacute;tude, avec 45 patients dans le groupe 1et 46 patients dans le groupe 2. La plupart des patients avaient une IT moyenne ou importante (83%) avant la chirurgie, une dilatation de l'anneau a &eacute;t&eacute; observ&eacute;e chez 90% des patients sans qu'il y ait une diff&eacute;rence significatives entre le groupe 1 et 2. Les r&eacute;sultats imm&eacute;diats &eacute;taient comparables entre les deux techniques mais au cours de suivi une insuffisance r&eacute;currente au moins moyenne a &eacute;t&eacute; plus significativement fr&eacute;quente dans le groupe de plastie de DeVEGA. Les facteurs pr&eacute;dictifs d'IT r&eacute;currente significative au long cours &eacute;taient en &eacute;tude multivari&eacute;e la technique de DeVEGA (OR=3.26 (1.12-9.28)) et la pression art&eacute;rielle pulmonaire systolique pr&eacute;operatoire (OR=1.06 (1.01-1.12)). La plastie tricuspide avec anneau de Carpentier semble garantir de meilleurs r&eacute;sultats que la plastie de DeVEGA, par contre une PAPS pr&eacute;op&eacute;ratoire &eacute;lev&eacute;e est pr&eacute;dictive de r&eacute;currence de la fuite tricuspidienne m&ecirc;me apr&egrave;s plastie d'o&ugrave; l'int&eacute;r&ecirc;t d'op&eacute;rer les malades &agrave; un stade pr&eacute;coce.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Fatima Zahra El M’rabet, Hajar Ouahbi [Images in medicine] - Une ost&eacute;o-arthropathie hypertrophiante (OAH) secondaire ou syndrome de Pierre-Marie Bamberger r&eacute;v&eacute;lant un ad&eacute;nocarcinome bronchique - 15 June 2017. http://www.panafrican-med-journal.com/content/article/27/118/abstract/ <b>Nous rapportons le cas d’une patiente jeune &acirc;g&eacute;e de 33 ans qui pr&eacute;sente depuis 2 ans des arthralgies avec des œd&egrave;mes des quatre membres aggrav&eacute;s par la survenue d’un hippocratisme digital et une ost&eacute;o-arthropathie hypertrophiante (OAH) secondaire ou syndrome de Pierre-Marie Bamberger. Dans le cadre du bilan &eacute;tiologique, un scanner thoraco abdominal a objectiv&eacute; la pr&eacute;sence d’une volumineuse masse tissulaire d'allure tumorale de 11.5 cm massivement excav&eacute;e pulmonaire au niveau du lobe sup&eacute;rieur droit avec large extension locor&eacute;gionale et &agrave; distance. L’aspect histologique et immuno histochimique a &eacute;t&eacute; compatible avec un ad&eacute;nocarcinome pulmonaire primitif. La patiente a &eacute;t&eacute; mise sous chimioth&eacute;rapie palliative avec d&eacute;but de r&eacute;gression des œd&egrave;mes. L’ost&eacute;o-arthropathie hypertrophiante ou syndrome de Pierre-Marie Bamberger est un syndrome paran&eacute;oplasique qui peut pr&eacute;c&eacute;der un carcinome brochique dans 25% des cas. Il associe un hippocratisme digital (d&eacute;formation des doigts en baguette de tambour, ramollissement de la matrice ungu&eacute;ale, et l’ongle, avec bombement et une d&eacute;formation en verre de montre) et une augmentation de volume des articulations des os des mains et des pieds. Sur le plan radiologique, il se manifeste par un d&eacute;veloppement accru du p&eacute;rioste au niveau des diaphyses distales des os longs et au niveau des phalanges. Ces d&eacute;formations ost&eacute;o-articulaires sont douloureuses, associ&eacute;es &agrave; des d&eacute;sordres neuro-vasculaires avec œd&egrave;me important pouvant &ecirc;tre responsable d’une impotence fonctionnelle. Le traitement &eacute;tiologique suffit &agrave; faire r&eacute;gresser les d&eacute;formations et les œd&egrave;mes comme le cas de cette patiente.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Bahija Lemrhari, Soumyia Chiheb [Images in medicine] - L’ulc&egrave;re de Marjolin: complication rare et tardive des escarres chez un patient parapl&eacute;gique - 15 June 2017. http://www.panafrican-med-journal.com/content/article/27/117/abstract/ <b>L’ulc&egrave;re de Marjolin d&eacute;signe la transformation maligne d’une cicatrice de br&ucirc;lure ou de toute autre plaie ou ulc&eacute;ration chronique. Il est rare, son incidence est estim&eacute;e &agrave; 2% des cas. Le type histologique pr&eacute;dominant reste le carcinome &eacute;pidermo&iuml;de (75%). La survenue d’un carcinome &eacute;pidermo&iuml;de sur une escarre sacr&eacute;e est une complication exceptionnelle moins de 0,5%; touchant quasi exclusivement les patients parapl&eacute;giques et survenant apr&egrave;s un d&eacute;lai sup&eacute;rieur &agrave; trois d&eacute;cennies (entre blessure et d&eacute;g&eacute;n&eacute;rescence). L’&eacute;tiologie de cette transformation maligne reste jusqu’&agrave; pr&eacute;sent inconnue. Le diagnostic est fait souvent tardivement &agrave; cause de la chronicit&eacute; des l&eacute;sions comme le cas de notre malade. Nous rapportons un cas d’un patient &acirc;g&eacute; de 64ans, connu parapl&eacute;gique depuis plusieurs ann&eacute;es, suite &agrave; un traumatisme du rachis. qui pr&eacute;sentait une escarre sacr&eacute;e sans tendance &agrave; la cicatrisation, compliqu&eacute;e d’une l&eacute;sion ulc&eacute;ro-bourgennante, mac&eacute;r&eacute;e, naus&eacute;abonde. Une biopsie de la l&eacute;sion montrait une transformation maligne en faveur d’un carcinome &eacute;pidermo&iuml;de bien diff&eacute;renci&eacute; infiltrant. Les TDM thoraco-abdomino-pelvienne ne montraient pas d’atteinte osseuse ni d’autres localisations secondaires. Une ex&eacute;r&egrave;se large suivie d’une greffe &eacute;tait r&eacute;alis&eacute;e. A la lumi&egrave;re de cette observation, la prise en charge correcte des escarres, chez les parapl&eacute;giques, est indispensable permettant de pr&eacute;venir la transformation maligne de ces l&eacute;sions chroniques.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mouna Tamzaourte, Ikram Errabih, Hayat Krami, Fadlouallah Maha, Lahmiri Maria, Nadia Benzzoubeir, Laaziza Ouazzani, Ahmed Sefiani, Houria Ouazzani [Case series] - Mutation du g&egrave;ne NOD2 chez les patients marocains atteints de la maladie de Crohn: pr&eacute;valence, &eacute;tude g&eacute;notypique et corr&eacute;lation au ph&eacute;notype de la maladie - 14 June 2017. http://www.panafrican-med-journal.com/content/article/27/116/abstract/ <b>L'objectif &eacute;tait de d&eacute;terminer la pr&eacute;valence des mutations du g&egrave;ne NOD2/CARD15 dans un groupe de patients Marocains atteint de Maladie de Crohn et &eacute;tudier sa corr&eacute;lation g&eacute;notype-expression ph&eacute;notypique. Etude transversale cas t&eacute;moin men&eacute;e sur une dur&eacute;e de 16 mois. Ont &eacute;t&eacute; inclus 101 patients atteints de la maladie de Crohn, entre Janvier 2012 et Avril 2013 ainsi qu'un groupe contr&ocirc;le de 107 patients. L'analyse g&eacute;n&eacute;tique a consist&eacute; &agrave; rechercher 3 variants du g&egrave;ne NOD2: p.Arg702Trp, p.Gly908Arg et p.Leu1007fsins. Puis une &eacute;tude de corr&eacute;lation g&eacute;notype-expression ph&eacute;notypique a &eacute;t&eacute; men&eacute;e. L'analyse g&eacute;n&eacute;tique des patients atteint de maladie de crohn a mis en &eacute;vidence la pr&eacute;sence de la mutation NOD2 chez 14 patients (13,77%) contre 7 patients (6,53%) du groupe t&eacute;moin. L'&eacute;tude de la fr&eacute;quence des diff&eacute;rents all&egrave;les a retrouv&eacute; la mutation de p.Gly908Arg dans 6,43%, p.Leu1007fsins dans 0,99% et p.Arg702Trp dans 0,49% contre respectivement 2,80%, 0% et 0,46% dans le groupe t&eacute;moin. L'&eacute;tude de la corr&eacute;lation g&eacute;notype, expression ph&eacute;notypique a d&eacute;montr&eacute; que la mutation CARD15 est corr&eacute;l&eacute;e &agrave; une localisation il&eacute;o-caecale de la maladie, &agrave; une pr&eacute;sentation fistulisante et st&eacute;nosante ainsi qu'&agrave; une &eacute;volution s&eacute;v&egrave;re avec recours fr&eacute;quent &agrave; la chirurgie et aux immunosuppresseurs. La pr&eacute;valence de la mutation NOD2/ CARD15 dans notre s&eacute;rie est faible. Cette mutation est corr&eacute;l&eacute;e &agrave; une forme grave de la maladie.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Achraf El Bakkaly, Moulay Dris Hanine, Abdelouahed Amrani, Anouar Dendane, Sidi Zouhair Fellouss El Alami, Tarik El Madhi [Case report] - Kyste an&eacute;vrismal osseux de la clavicule: &agrave; propos d’un cas - 14 June 2017. http://www.panafrican-med-journal.com/content/article/27/115/abstract/ <b>Le kyste osseux an&eacute;vrismal est une l&eacute;sion agressive et destructrice, mais b&eacute;nigne, des os longs, de la colonne vert&eacute;brale ou du bassin, touchant principalement les enfants et les jeunes adultes. Il s’agit cependant d’une v&eacute;ritable tumeur rare. Nous rapportons un cas d’un gar&ccedil;on de 8 ans,pr&eacute;sentant une localisation tr&egrave;s rare de kyste an&eacute;vrismal, claviculaire, qui s'est initialement pr&eacute;sent&eacute; pour une fracture sur os pathologique soit une l&eacute;sion kystique b&eacute;nigne. L'enfant a b&eacute;n&eacute;fici&eacute; d'un traitement radical avec r&eacute;section compl&egrave;te du kyste situ&eacute; au niveau de la clavicule droite avec envoi de la pi&egrave;ce op&eacute;ratoire pour &eacute;tude anatomo-pathologique, confirmant notre diagnostic. L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par l'absence de r&eacute;cidive et un bon remodelage osseux sur le plan radiologique. Le traitement radical par r&eacute;section semble permettre d'&eacute;viter la r&eacute;cidive. A travers notre travail, nous voulons mettre le point sur cette affection orthop&eacute;dique rare en comparant nos r&eacute;sultats avec ceux de la litt&eacute;rature mondiale.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Nashwa Ahmed, Mazin Shigidi, Al Nour Al Agib, Hassan Abdelrahman, Elshafie Taha [Research] - Clinical features and antinuclear antibodies profile among adults with systemic lupus erythematosus and lupus nephritis: a cross-sectional study - 14 June 2017. http://www.panafrican-med-journal.com/content/article/27/114/abstract/ <b>INTRODUCTION: Limited data is available regarding the clinical manifestations and pattern of Systemic Lupus Erythematosus (SLE) in Sudan. This study aimed to determine the clinical manifestations and Antinuclear Antibodies (ANA) profile among Sudanese adults with SLE and lupus nephritis (LN). METHODS: a descriptive study was conducted in Omdurman Military Hospital, Sudan. It included all adults with SLE and on regular follow-up during the study period (December 2012 to May 2013). These were investigated regarding their demographic details, clinical features, and immunological profile (ANA, anti-double stranded DNA, and ANA profile 3 levels). Patients with LN had their pattern of renal involvement described; furthermore, associations between the various SLE reactive antibodies and the histological diagnosis of lupus were studied.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mustafa Nkaoui, Amine El Yazidi [Images in medicine] - Kyste osseux essentiel du calcan&eacute;um d&eacute;couvert &agrave; l'occasion d’une entorse de la cheville: risque et prise en charge - 14 June 2017. http://www.panafrican-med-journal.com/content/article/27/113/abstract/ <b>Nous rapportons le cas d'une jeune fille &acirc;g&eacute;e de 16 ans, re&ccedil;ue aux urgences pour un traumatisme de sa cheville gauche lors d'un accident de sport. Le diagnostic d'une entorse simple a &eacute;t&eacute; &eacute;voqu&eacute; cliniquement. La radiologie standard a objectiv&eacute; une l&eacute;sion ost&eacute;olytique lacunaire au niveau du calcan&eacute;um sans visualisation de trait de fracture (Panel A). L'IRM du pied a confirm&eacute; le caract&egrave;re kystique de la l&eacute;sion avec une composante h&eacute;morragique (Panel B). La prise en charge en diff&eacute;r&eacute; a consist&eacute; en un curetage comblement &agrave; l'aide de substitut osseux de synth&egrave;se (Panel C, D, E, F) avec pose d'un pl&acirc;tre pendant 3 semaines sans appui suivie d'une r&eacute;&eacute;ducation fonctionnelle de la cheville. L'&eacute;tude histologique &eacute;tait caract&eacute;ristique de kyste essentiel du calcan&eacute;um. Le r&eacute;sultat &eacute;tait satisfaisant avec une bonne consolidation sans r&eacute;cidive et sans complications et reprise du sport au 3<sup>&egrave;me</sup> mois. Le kyste osseux essentiel du calcan&eacute;um est une l&eacute;sion rare et b&eacute;nigne, souvent asymptomatique et de d&eacute;couverte fortuite. Le principal risque &eacute;volutif &eacute;tant la fracture pathologique justifiant un traitement chirurgical pr&eacute;ventif.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Sana Aissa, Wafa Benzarti, Faouzi Alimi, Imen Gargouri, Halima Ben Salem, Am&egrave;ne Aissa, Khadija Fathallah, Atef Ben Abdelkade, Rafika Alouini, Abdelhamid Garrouche, Abdelaziz Hayoun, Ahmed Abdelghani, Mohamed Benzarti [Case report] - Catamenial pneumothorax revealing diaphragmatic endometriosis: a case report and revue of literature - 14 June 2017. http://www.panafrican-med-journal.com/content/article/27/112/abstract/ <b>Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in women. We aim to discuss the etiology, clinical course, and surgical treatment of a 42-year-old woman with CP. This patient had a right-sided spontaneous pneumothoraces occurred one week after menses. She had under-gone video-assisted thoracoscopic surgery (VATS) because of a persistent air leak under chest tube. VATS revealed multiple diaphragmatic fenestrations with an upper right nodule. Defects were removed and a large part of the diaphragm was resected. Pleural abrasion was then performed over the diaphragm. Diaphragmatic endometriosis was confirmed by microscopic examination. Medical treatment with GnRH agonists was prescribed, and after recovery, the patient has been symptoms free for 20 months.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Georgios Karamitros, Nikolaos Kitsos, Fotios Athanasopoulos [Case report] - A case of enterobiasis presenting as post-traumatic-stress-disorder (PTSD): a curious case of the infection with predominant mental health symptoms, presenting for the first time in the settings of a refugee camp - 13 June 2017. http://www.panafrican-med-journal.com/content/article/27/111/abstract/ <b>Enterobiasis (oxyuriasis) is a common infection in human caused by Enterobius vermicularis (E vermicularis), a human intestinal helminth. Because of the easy way of its transmission among people, it has an extremely high prevalence in overcrowded conditions, such as nurseries and primary schools. Oxyuriasis's symptoms are extremely diverse in children, ranging from nausea, diarrhea, insomnia, irritability, recurrent cellulitis, loss of appetite, nightmares and endometritis. Here we report a curious case of oxyuriasis in the settings of a refugee camp in Greece. The patient was a 10-year old Syrian female, who presented with unusual and vague symptoms like insomnia and irritability. Given the violent background of the Syrian warzone that the patient had escaped, she was firstly diagnosed with post traumatic stress disorder (PTSD) before eventually getting correctly diagnosed with enterobiasis. This infection is the first documented case of enterobiasis in the settings of a refugee camp and can highlight the unsanitary living conditions that refugees have to endure in those camps.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Amina Kissou, Badr Eddine Hassam [Images in medicine] - Dermoscopy of pyogenic granuloma - 13 June 2017. http://www.panafrican-med-journal.com/content/article/27/110/abstract/ <b>A patient aged 58 years, presented with 2 months history of an erythematous, painful and bleeding nodule, after labial herpes (A). The dermoscopic examination confirms the diagnosis of a pyogenic granuloma (B). The dermoscopic criteria are: the reddish homogeneous area (green line) whose color varied from completely red to red with whitish zones which is corresponded to proliferating vessels. A white collarette (yellow line) corresponds to the hyperplastic adnexal epithelium that embraces the lesion at the periphery. The white lines (blue line) like a double rail which is corresponded to a fibrous septa that criss-cross the lobules. And finally ulceration or hemorrhagic crusts (black line) which are frequently observed in pyogenic granuloma.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Figen Tunali Turkdogan, Kenan Ahmet Turkdogan, Murat Dogan, Mehmet Haydar Atalar [Case series] - Assessment of sphenoid sinus related anatomic variations with computed tomography - 13 June 2017. http://www.panafrican-med-journal.com/content/article/27/109/abstract/ <b>INTRODUCTION: frequent and broad application of endoscopic sinus surgery (ESS) in parallel with experience makes it imperative to know the anatomy and the existing pathology very well before surgery. This study examines the association between anomalies in the sphenoid sinus area in paranasal sinuses computed tomography (PNS-CT) and pathological findings and determines variations of sphenoid sinus. METHODS: a total of 200 cases (100 women, 100 men) who had PNS-CT in the emergency and radiology polyclinics within the period of one year were included in this study. Bone tissue anomalies and soft tissue pathologies were assessed in the CT.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Saad Benkirane, Hanane Saadi, Ahmed Mimouni [Case series] - Le profil &eacute;pid&eacute;miologique des complications maternelles de la c&eacute;sarienne au CHR EL Farabi Oujda - 12 June 2017. http://www.panafrican-med-journal.com/content/article/27/108/abstract/ <b>Au Maroc le taux de c&eacute;sariennes est pass&eacute; de 2% en 1992 &agrave; 16% en 2011, cette augmentation est corr&eacute;l&eacute;e &agrave; une augmentation de la mortalit&eacute; et de la morbidit&eacute; per et post op&eacute;ratoire qui est de 19% dans notre s&eacute;rie. Ce travail est le premier du genre &agrave; &ecirc;tre effectu&eacute; dans la r&eacute;gion de l'oriental du Maroc dont l'objectif est d'analyser le profil &eacute;pid&eacute;miologique d&eacute;taill&eacute; des complications maternelles de la c&eacute;sarienne &agrave; partir de 2417 cas, &agrave; la maternit&eacute; El farabi de Oujda, cette &eacute;tude est une &eacute;tude observationnelle descriptive r&eacute;trospective d'une s&eacute;rie de 2416 patientes, ayant b&eacute;n&eacute;fici&eacute; d'une c&eacute;sarienne &agrave; la maternit&eacute; de l'h&ocirc;pital EL FARABI d'Oujda sur une p&eacute;riode &eacute;tal&eacute;e entre le 1er janvier 2011 et le 31 d&eacute;cembre 2013. 24464 accouchements &eacute;taient r&eacute;alis&eacute;s, dont 2416 cas par c&eacute;sarienne, soit un taux de 9.87%. La fr&eacute;quence des complications li&eacute;es &agrave; la c&eacute;sarienne &eacute;tait de 19.45%. Les complications postop&eacute;ratoires repr&eacute;sentaient 63.6% des complications domin&eacute;es par l'infection. Les complications h&eacute;morragiques repr&eacute;sentaient 25.53% de toutes les complications. On a enregistr&eacute; 4 cas de d&eacute;c&egrave;s maternels. Si l'augmentation du taux de c&eacute;sariennes a contribu&eacute; &agrave; l'am&eacute;lioration du pronostic materno-fœtal, l'acte chirurgical en lui m&ecirc;me n'est pas d&eacute;nu&eacute; de complications, ce qui nous incite &agrave; revoir ses indications pour une meilleure prise en charge de nos patientes.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Regis Gothard Bopaka, Presley Lee Esthel Bemba, Hind Janah, Franck Hardain Okemba Okombi, Hasna Jabri, Wiam El Khattabi, Hicham Afif [Case report] - Tuberculose pari&eacute;tale compliqu&eacute;e d’embolie pulmonaire - 12 June 2017. http://www.panafrican-med-journal.com/content/article/27/107/abstract/ <b>La tuberculose est une maladie infectieuse qui reste fr&eacute;quente dans les pays en d&eacute;veloppement. La localisation peut &ecirc;tre pulmonaire ou extra-pulmonaire. Cette forme extra-pulmonaire pose un grand probl&egrave;me diagnostique. Nous rapportons le cas d'un patient pr&eacute;sentant une embolie pulmonaire r&eacute;v&eacute;lant une tuberculose pari&eacute;tale. A travers cette observation, nous soulignons la n&eacute;cessit&eacute; de rechercher l'&eacute;tiologie devant une embolie pulmonaire.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Latifa Merzougui, Nedia Marwen, Tarek Barhoumi, Afef Ben Ltaeifa, Hajer Hannachi, Roukaya Jaballah, Ridha Fatnassi [Case series] - &Eacute;valuation de la conformit&eacute; de la tenue du Partogramme dans une maternit&eacute; Tunisienne: audit clinique cibl&eacute; - 12 June 2017. http://www.panafrican-med-journal.com/content/article/27/106/abstract/ <b>Le partogramme est un outil incontournable dans la pratique quotidienne en salle de naissance. C'est le reflet &eacute;crit de la qualit&eacute; de la prise en charge materno-fœtale pendant l'accouchement et le post-partum imm&eacute;diat. Le but de notre travail est d'&eacute;valuer la conformit&eacute; de la tenue du partogramme au sein de notre maternit&eacute; et de proposer des axes d'am&eacute;lioration de la qualit&eacute; de sa tenue. il s'agit d'une &eacute;tude r&eacute;trospective par audit clinique, effectu&eacute;e sur 400 dossiers des patientes ayant accouch&eacute; dans la maternit&eacute; universitaire de Kairouan du 1er Janvier au 31 d&eacute;cembre 2014. Le r&eacute;f&eacute;rentiel utilis&eacute; est celui de la Haute Autorit&eacute; de Sant&eacute; (2006) comportant 29 crit&egrave;res divis&eacute;s en 3 domaines (PARTOten, PARTOobs, PARTOeve). le Taux de Conformit&eacute; Globale (TCG) de la tenue du partogramme dans notre audit &eacute;tait de 55,9%. Pour le domaine I « La tenue du partogramme » (PARTOten), le TCG &eacute;tait de 88,9%. Pour le domaine II « la tra&ccedil;abilit&eacute; du d&eacute;roulement du travail » (PARTOobs), le TCG &eacute;tait de 51,4%. Pour le domaine III « la tra&ccedil;abilit&eacute; des actes, des &eacute;v&egrave;nements et des traitements au cours du travail » (PARTOeve), le TCG &eacute;tait de 27,4%. Notre &eacute;tude a permis de d&eacute;gager plusieurs points &agrave; am&eacute;liorer. Le but ultime de l'Audit Clinique est l'am&eacute;lioration des pratiques professionnelles, de ce fait nous allons mettre en place un plan d'action (formation, sensibilisation...) qui sera suivi par une r&eacute;&eacute;valuation afin de v&eacute;rifier la p&eacute;rennit&eacute; des actions correctives.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Noukhoum Kon&eacute;, Outouma Soumar&eacute; [Images in medicine] - Triple spondylolyse bilat&eacute;rale lombaire &eacute;tag&eacute;e - 12 June 2017. http://www.panafrican-med-journal.com/content/article/27/105/abstract/ <b>Nous rapportons le cas d'une patiente de 30 ans, sans ant&eacute;c&eacute;dents pathologiques particuliers, qui pr&eacute;sente depuis 6 mois des lombalgies sans notion de radiculalgie aux membres inf&eacute;rieurs. L'examen neurologique retrouve un syndrome rachidien lombaire sans d&eacute;ficit neurologique associ&eacute;. Le scanner du rachis lombaire en coupes sagittales param&eacute;dianes droite (A) et gauche (B) montre une triple spondylolyse bilat&eacute;rale L2, L3, L4 associ&eacute;e &agrave; un spondylolisth&eacute;sis L3-L4 de grade I de Meyerding. L'&eacute;volution clinique est marqu&eacute;e par une disparition de la symptomatologie par le traitement m&eacute;dical &agrave; base d'antalgique, d'anti-inflammatoire non st&eacute;ro&iuml;dien et de ceinture de stabilisation lombaire au bout de deux semaines de traitement. L'incidence des spondylolyses lombaires dans la population adulte est d'environ 6% et concernent dans plus de 90% des cas la vert&egrave;bre L5. Les spondylolyses lombaires &eacute;tag&eacute;es sont inhabituelles, elles repr&eacute;sentent 1.2% &agrave; 5.6% des spondylolyses lombaires et il s'agit dans plus de 60% des cas d'une atteinte de 2 niveaux, L4 et L5. Le traitement conservateur avec un suivi r&eacute;gulier est indiqu&eacute; en cas d'absence de sympt&ocirc;mes neurologiques avec ou sans spondylolisth&eacute;sis inf&eacute;rieur &agrave; 25%.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Laura Gallo Padilla, Raquel R&iacute;os Fern&aacute;ndez [Images in medicine] - Digital ischemia and tobacco - 12 June 2017. http://www.panafrican-med-journal.com/content/article/27/104/abstract/ <b>An active smoker 50-year-old male with precedents of arterial hypertension, consulted for a month history of pain and severe vasomotor disorder in the right hand. Physical exam revealed preserved radial pulse and severe cyanosis in all fingers, especially evolved in the fourth and fifth ones (A). Autoimmunity and hypercoagulability studies were requested and normal. An arteriogram of the right arm showed a corkscrew morphology of radial and ulnar arteries, without a complete refill of the palmar arches and with collateral circulation, typical findings of thromboangiitis obliterans (TAO), also known as Buerger's disease. In spite of smoking cessation and an initial improvement with intravenous iloprost and sildenafil infusions, the injuries kept on deteriorating. A thoracic sympathectomy was perform, which allowed to reduce the doses of opiate for pain control, but did not manage to avoid the amputation. TAO is a rare vascular, inflammatory and occlusive disease that affects the small to medium sized arteries, the distal veins and nerves of extremities. The etiology still remains unclear and it affects typically young smoking men. The only therapy that has demonstrated a constant benefit is smoking cessation. Other therapies frequently used are anticoagulants, vasodilators, antiplatelets and/or anti-inflammatories, although in most cases with a more palliative than curative purpose. Prognosis is favourable if patient quits smoking for good and the vessels damage is not too much evolved.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Yaa Karikari, Oyinade Akinyede, Vanessa Davis, Kenneth Soyemi [Brief] - Impact of vaccine mandate on Tdap vaccination coverage among Illinois students 2014-15 - 09 June 2017. http://www.panafrican-med-journal.com/content/article/27/103/abstract/ <b>In response to recent pertussis resurgence, a multi-agency recommendation that students receive a one-time Tdap vaccine was introduced. Post mandate there was sequential increase in the Tdap vaccine uptake in the targeted population.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Adama Dicko, Ousmane Faye, Youssouf Fofana, Moussa Soumoutera, Siritio Berth&eacute;, Saidou Tour&eacute;, Bekaye Traor&eacute;, Binta Guindo, Koureissi Tall, Alimata Keita, Lassine K&eacute;ita, Karim Coulibaly, Somita Keita [Research] - Tuberculose cutan&eacute;e &agrave; Bamako, Mali - 08 June 2017. http://www.panafrican-med-journal.com/content/article/27/102/abstract/ <b>INTRODUCTION: La tuberculose est la mycobactériose la plus fréquente en Afrique subsaharienne. La localisation cutanée est rare et sous diagnostiquée à cause de son polymorphisme clinique et la faiblesse du plateau technique. Le but de cette étude était de décrire les aspects épidémiologiques, cliniques, histopathologiques de la tuberculose cutanée à Bamako (Mali).</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Otheman Fahsi, Adil Kallat, Hicham Ouazize, Hamza Dergamoun, Hachem El Sayegh, Ali Iken, Lounis Benslimane, Yassine Nouini [Case report] - Liposarcome paratesticulaire m&eacute;tastatique - 08 June 2017. http://www.panafrican-med-journal.com/content/article/27/101/abstract/ <b>Nous rapportons le cas dramatique d'un liposarcome &agrave; cellules rondes paratesticulaire d'embl&eacute;e m&eacute;tastatique chez un jeune homme de 18 ans. Il s'agit d'une tumeur rare qui se d&eacute;veloppe &agrave; partir du tissu graisseux entourant le testicule et le cordon spermatique. Les signes cliniques et radiologiques sont peu sp&eacute;cifiques, le diagnostic n'est en g&eacute;n&eacute;ral fait que sur la pi&egrave;ce op&eacute;ratoire. Le traitement consiste en une orchid&eacute;ctomie radicale par voie inguinale, parfois &eacute;largie aux structures adjacentes. La radioth&eacute;rapie adjuvante pourrait avoir une place en cas de masse localement avanc&eacute;e ou en cas de r&eacute;section incompl&egrave;te. Malgr&eacute; une &eacute;volutivit&eacute; lente, une surveillance prolong&eacute;e s'impose du fait du risque &eacute;lev&eacute; de r&eacute;cidive tardive.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Lam Nguyen Ho, Hang Le Van [Images in medicine] - Boerhaave’s syndrome: food particles in chest tube - 08 June 2017. http://www.panafrican-med-journal.com/content/article/27/100/abstract/ <b>A 61-year-old alcoholic man presented to the emergency department because of vomiting and dyspnea after discharged from hospital due to appendectomy two days ago. He smoked heavily and his past medical history revealed gastritis. On the examination, he was hypotension (50/00 mmHg) and lethargy. Cardiopulmonary resuscitation was initiated aggressively. His chest x-ray showed right-sided tension pneumothorax (A). Chest drainage tube was inserted immediately and his clinical status improved spectacularly. On the fifth hospital day, the presence of food particles (rice, green onions) (red arrows) in the chest tube was found accidentally (B). Suspecting for esophageal perforation, the oral methylene blue test showed that the fluid in the chest tube turned bluish (C). Boerhaave's syndrome was established. An operation undertaken revealed a perforation of lower esophagus which was marked with nasogastric tube (yellow arrow) (D). However, his condition became worsen with nosocomial infection and died after that. The contents in the chest tube which can be an important diagnostic clue should be checked closely in the clinical practice.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Georgios Karamitros, Nikolaos Kitsos, Ioanna Karamitrou [Opinion] - The ban on blood donation on men who have sex with men: time to rethink and reassess an outdated policy - 08 June 2017. http://www.panafrican-med-journal.com/content/article/27/99/abstract/ <b>During the 1980s the HIV/AIDS epidemic outbreak occurred. Due to the high prevalence of the disease on men who had sex with men (MSM) a lifetime ban on blood donations on men who had sex with men (MSM) was implemented. In the recent years, organizations like the European Union (EU) and the World Health Organization (WHO) have established new guidelines introducing the term of "risky sexual behavior" without any reference to the sex orientation of the potential donor, however many countries are hesitant to review the ban on men who had sex with men (MSM). Given the lack of screening methods for HIV back in the '80s the ban on men who had sex with men seemed like the only choice in order to limit the disease. However, nowadays the screening methods have advanced and the possibility of a transfusion related HIV infection is extremely low. Many countries, considering the new data available, have reformed their policies and moved from the lifetime ban to 5-year and 1-year deferrals but only a fraction of countries have adopted the guidelines for the "risky sexual behavior" assessment.The ban that forbid men who have sex with men from donating blood was implemented more than 30 years ago. During the '80s, the epidemiology was different and it seems not only hypocritical but also na&iuml;ve to rely on guidelines that are far outdated and old-fashioned. The medical community has a duty to secure safe blood for every person who might need it, let us not waste safe potential donors and stigmatize them by focusing on outdated policies.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Khalid Ibn El Kadi, Mounir Benabid , Sarr Saliou, Oussama El assil, Amine Marzouki, Kamal Lahrach, Fawzi Boutayeb [Case report] - Simultaneous ipsilateral fractures of distal and proximal ends of the radius - 08 June 2017. http://www.panafrican-med-journal.com/content/article/27/98/abstract/ <b>We treated a patient with a rare combination of ipsilateral fractures of the distal and proximal ends of the radius. A man aged 42 years had simultaneous fractures of the distal and proximal ends of the radius (radial neck) following a roadside accident. The distal end fracture of the radius was treated with surgical reduction and T-plate volar fixation, and the undisplaced radial neck fracture was treated by an above elbow splintage for 2 weeks. The elbow mobilization was started at 2 weeks. The distal radius was protected for another 4 weeks in a below elbow functional brace. Ipsilateral proximal and distal radial fracture is an uncommon injury pattern. The series illustrates a number of problems associated with this combination. Firstly, one should be aware of this rare injury pattern and there should be greater emphasis on clinical examination of elbow in cases of wrist injuries and vice versa. Once diagnosed, one faces the dilemma of appropriate management in these cases. The appropriate management will depend on the injury characteristics including the age of the patient and the fracture pattern. One should try to preserve the radial head to prevent a possible proximal radial migration especially in younger patients.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mariam Tayae, Jihad Jamor [Case report] - Un cas rare de galactoc&egrave;le g&eacute;ant associ&eacute; &agrave; un prolactinome - 08 June 2017. http://www.panafrican-med-journal.com/content/article/27/97/abstract/ <b>Le galactoc&egrave;le est une forme kystique rare, c'est une l&eacute;sion b&eacute;nigne du sein, apparaissant quand un canal mammaire est obstru&eacute; et tr&egrave;s rempli de lait. On le rencontre g&eacute;n&eacute;ralement chez les femmes en post-partum, soit allaitant ou non. Il n'y a que quelques cas signal&eacute;s qui ne sont pas li&eacute;es &agrave; la lactation, comme on le voit chez les femmes m&eacute;nopaus&eacute;es ou chez les hommes; tant plus, que la relation &agrave; la surproduction de prolactine, un facteur de croissance de l'&eacute;pith&eacute;lium mammaire n'est pas tr&egrave;s bien d&eacute;fini &agrave; ce moment. Nous pr&eacute;sentons un tel cas inhabituel d'une patiente &acirc;g&eacute;e de 30 ans qui n'a pas d'ant&eacute;c&eacute;dents d'accouchement ou l'avortement. Elle est suivie en endocrinologie pour micro ad&eacute;nome hypophysaire mise sous Cabergoline* qu'elle a arr&ecirc;t&eacute; d'elle-m&ecirc;me pendant un an. M&ecirc;me compte tenu de la raret&eacute; de l'association, il est important de souligner le r&ocirc;le hormonal dans l'&eacute;volution de l'anatomie du sein.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Kumar Nilesh, Shivsagar Tewary, Sameer Zope, Jinesh Patel, Aaditee Vande [Case report] - Dental, dermatological and radiographic findings in a case of Gorlin-Goltz Syndrome: report and review - 07 June 2017. http://www.panafrican-med-journal.com/content/article/27/96/abstract/ <b>Gorlin-Goltz syndrome (GGS) is a rare autosomal dominant disorder. The disease shows multiple organ involvement with variable clinical presentation. Thus a multidisciplinary approach is required for its prompt clinical diagnosis and management of this condition. This paper highlights a case of GGS presenting in a young male patient with cranial, facial, dermatological, dental and skeletal involvement. The diagnosis of the syndrome was based on its clinical presentation, radiological features and histopathological findings. A review of the diagnostic criteria is also presented.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Madeeha Dean, Nicole Stamatopoulos, Thierry Vancaillie [Case report] - A severed IP ligament as a cause for trans-vaginal uterine bleeding post termination of pregnancy: a case report - 07 June 2017. http://www.panafrican-med-journal.com/content/article/27/95/abstract/ <b>Uterine perforation is an uncommon yet serious complication of surgical management of first and second trimester termination of pregnancies. The rate of uterine perforation is under reported, as patients are usually asymptomatic. Although uncommon, uterine perforation can cause life-threatening complications for some patients. This case report discusses a second trimester surgical termination resulting in uterine perforation and haemorrhage secondary to an avulsion of the infundibulopelvic ligament and prolapse of the left fallopian tube and ovary into the uterine cavity. A literature search was undertaken to compare this case report to those previously published. To the best of our knowledge, this is the first case report in Australia that discusses a unique case of a severed infundibulo-pelvic ligament as a cause for trans-vaginal uterine bleeding post second trimester termination of pregnancy.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Amina Kissou, Badr Eddine Hassam [Images in medicine] - Localized po&iuml;kiloderma - 07 June 2017. http://www.panafrican-med-journal.com/content/article/27/94/abstract/ <b>A patient aged 58 years, diabetic, consulted for the appearance of a lesion on the left thigh that evolved for 2 years. The clinical examination found a plaque, with digital edges, hyper-pigmented center dotted with a few areas of skin atrophy and a hypochromic periphery. The lesion was not infiltrated, mildly pruriginous and measured 10 cm of major axis (A). There were no adenopathies. Histology demonstrated an orthokeratosic hyperkeratosis. The dermis was the site of an inflammatory infiltrate of increased lymphocytes of incised size. This infiltrate was arranged in a linear manner, producing the appearance in "Indian file" (B). The cells were CD3+, CD4+ and CD8- (Panel C and D). The diagnosis of mycosis fungoides in its po&iuml;kilodermic form was retained. An extension report was without anomaly. The lymphoma was classified T1N0M0. Treatment with dermocorticoid associated with phototherapy "UVB-type" allowed complete remission with a follow-up of 2 years.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Asmâa Biaz, Maroua Neji, Yousra Ajhoun, Samira EL Machtani Idrissi, Abdellah Dami, Karim Reda, Zohra Ouzzif, Sanae Bouhsain [Case report] - D&eacute;couverte fortuite d'une dr&eacute;panocytose h&eacute;t&eacute;rozygote composite S/C - 07 June 2017. http://www.panafrican-med-journal.com/content/article/27/93/abstract/ <b>Le syndrome dr&eacute;panocytaire composite SC repr&eacute;sente 20% &agrave; 30% des syndromes dr&eacute;panocytaires majeurs. Nous rapportons le cas d'une d&eacute;couverte fortuite d'une dr&eacute;panocytose h&eacute;t&eacute;rozygote composite SC dans un contexte de d&eacute;collement r&eacute;tinien. Il s'agit d'une patiente hospitalis&eacute;e au service d'ophtalmologie pour une baisse de l'acuit&eacute; visuelle d&eacute;tect&eacute;e depuis 06 mois et rebelle au traitement. Les ant&eacute;c&eacute;dents cliniques sont domin&eacute;s par la mise en place d'une proth&egrave;se totale de la hanche (PTH) douze ans auparavant. Notre observation rappelle la grande variabilit&eacute; clinique de la maladie dr&eacute;panocytaire imposant un d&eacute;pistage pr&eacute;coce des patients &agrave; risque avec une surveillance clinique adapt&eacute;e afin d'&eacute;viter l'&eacute;volution vers des s&eacute;quelles organiques irr&eacute;versibles telles que la r&eacute;tinopathie dr&eacute;panocytaire.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Charles Michelo, Joseph Mumba Zulu, Moses Simuyemba, Benjamin Andrews, Max Katubulushi, Benjamin Chi, Evariste Njelesani, Bellington Vwalika, Kasonde Bowa, Margaret Maimbolwa, James Chipeta, Fastone Goma, Selestine Nzala, Sekelani Banda, John Mudenda, Yusuf Ahmed, Lotti Hachambwa, Craig Wilson, Sten Vermund, Yakub Mulla [Research] - Strengthening and expanding the capacity of health worker education in Zambia - 07 June 2017. http://www.panafrican-med-journal.com/content/article/27/92/abstract/ <b>INTRODUCTION: Zambia is facing a chronic shortage of health care workers. The paper aimed at understanding how the Medical Education Partnership Initiative (MEPI) program facilitated strengthening and expanding of the national capacity and quality of medical education as well as processes for retaining faculty in Zambia. METHODS: data generated through documentary review, key informant interviews and observations were analyzed using a thematic approach. RESULTS: the MEPI program triggered the development of new postgraduate programs thereby increasing student enrollment. This was achieved by leveraging of existing and new partnerships with other universities and differentiating the old Master in Public Health into specialized curriculum. Furthermore, the MEPI program improved the capacity and quality of training by facilitating installation and integration of new technology such as the eGranary digital library, E-learning methods and clinical skills laboratory into the Schools. This technology enabled easy access to relevant data or information, quicker turnaround of experiments and enhanced data recording, display and analysis features for experiments. The program also facilitated transforming of the academic environment into a more conducive work place through strengthening the Staff Development program and support towards research activities. These activities stimulated work motivation and interest in research by faculty. Meanwhile, these processes were inhibited by the inability to upload all courses on to Moodle as well as inadequate operating procedures and feedback mechanisms for the Moodle.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Adil Belhachmi [Case report] - Fistules carotido-caverneuses bilat&eacute;rales spontan&eacute;es: &agrave; propos d’un cas et revue de la litt&eacute;rature - 06 June 2017. http://www.panafrican-med-journal.com/content/article/27/91/abstract/ <b>Nous rapportons une observation clinique d'une fistule carotidocaverneuse survenue spontan&eacute;e avec Une exophtalmie biilat&eacute;rale pulsatile et sym&eacute;trie des 2 sinus caverneux au scanner ont permis de suspecter le diagnostic. Une art&eacute;riographie a permis de confirmer ce diagnostic, avec embolisation couronn&eacute;e de succ&egrave;s chez cette malade, avec une &eacute;volution est favorable sur le plan neurologique et ophtalmique. La fistule carotido-caverneuse est une complication rare mais grave pouvant engager le pronostic fonctionnel (c&eacute;cit&eacute;) et vital (h&eacute;morragie m&eacute;ning&eacute;e et intrac&eacute;r&eacute;brale). L'art&eacute;riographie et l'embolisation en un seul temps ont consid&eacute;rablement am&eacute;lior&eacute; le pronostic.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Munda Elias, Elia John Mmbaga, Ahmed Abade Mohammed, Rogath Saika Kishimba [Research] - Male partner involvement in the prevention of mother to child transmission of HIV infection in Mwanza Region, Tanzania - 06 June 2017. http://www.panafrican-med-journal.com/content/article/27/90/abstract/ <b>INTRODUCTION: Globally, there are 3.3 million children &lt; 15 years of age living with HIV infection. About 95% of HIV infected children have acquired infection from their mothers. Although new pediatric HIV infection in Tanzania has declined by 48% and Prevention of Mother to Child Transmission (PMTCT) coverage of highly active anti-retroviral therapy (HAART) has increased to 77%, the MTCT rate remains high (15%). Poor male partner involvement in PMTCT services is one of the factors contributing to reduced effectiveness of the PMTCT and hence failure to achieve the elimination of maternal to child transmission of HIV. This study examined the predictors of male involvement in PMTCT services in Mwanza Region, Tanzania from perspectives of the mother. METHODS: a cross sectional study involving selected health facilities was conducted in Mwanza urban from October 2013 through January 2014. HIV positive pregnant women attending ante-natal clinic (ANC) were interviewed using a semi structured questionnaire. Univariate analysis was used to describe the study respondents where bivariate and logistic regression was used to determine predictors of male involvement. RESULTS: a total of 300 HIV positive mothers attending ANC with the mean age of 27.5 + 5.6 were interviewed. Few mothers (24.7%) had their male partners involved in PMTCT. Predictors of male partner involvement in PMTCT were mothers being proactive (Adjusted Odds Ratio (AOR) 28.6; Confidence Interval (CI) 7-116), perceived partners knowledge on PMTCT (AOR 24.6, CI 5.9-102.8), exposure to TV/Radio announcements on PMTCT (AOR 4.6, CI 1.5-14) and married status of the mother (AOR 3.7, CI 1.5-9). Mothers who never wanted to be escorted by their male partners and busy partners were associated with reduced odds of male involvement into PMTCT (AOR 0.07, CI 0.007-0.68) and (AOR 0.46 CI 0.21-0.99) respectively. Male partner involvement was associated with 98% reduced odds of violence (Crude Odds Ratio 0.018 CI 0.002-0.14). CONCLUSION: male partner involvement in PMTCT is still low in Mwanza Region. Proactive mothers, partner’s knowledge on PMTCT and announcements from television or radio were the major facilitating factors for male involvement in PMTCT as perceived by mothers. Busy male partners and mothers who did not want to be escorted by their partners were a hindrance to male involvement in PMTCT services. These factors highlight the importance of women role in promotion of PMTCT male involvement.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hafsae Bounniyt, Badredine Hassam [Images in medicine] - Leucocytoclastic vasculitis due to Oxicam - 06 June 2017. http://www.panafrican-med-journal.com/content/article/27/89/abstract/ <b>Vasculitis is an inflammatory disease of blood vessels characterized by the alteration or destruction of the vessel wall. A 55 year’s old woman, followed for diabetes and hypertension, presented to our consultation complaining of generalized pruritic lesions, without fever arthritis or any other systemic manifestations. The patient reported the concept of taking Oxicam; Brexin® for pain of the right wrist and denies any food, drug or environnement allergies. The physical examination showed violaceous petechial purpuric patches, coalescing by area, ulcerated nodular lesions extended to both lower limbs, with presence of necrosis in center of lesions (Figure 1A). Histological examination found a perivascular inflammatory cell, and necrosis of the vessels wall. The diagnostic of Leukocytoclastic vasculitis was made. A treatment with colchicine was introduced, with good improvement after two months (Figure 1B). Dermatological side effects of Brexin, are fortunately very rare but they should be constantly kept in mind; and the clinician should be aware of uncommon but not rare possibility that a cutaneous eruption could evolve into a significantly more serious reaction.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Ephrem Tefera, Tariku Belay, Seleshi Kebede Mekonnen, Ahmed Zeynudin, Tefera Belachew [Research] - Prevalence and intensity of soil transmitted helminths among school children of Mendera Elementary School, Jimma, Southwest Ethiopia - 06 June 2017. http://www.panafrican-med-journal.com/content/article/27/88/abstract/ <b>INTRODUCTION: soil transmitted helminths are wide spread in developing countries and in Ethiopia the prevalence of STHs varies in different parts of the country. The aim of this study was to determine the prevalence and intensity of soil transmitted helminths among school children of Mendera Elementary School Jimma town, Western Ethiopia. METHODS: a cross-sectional study was conducted between March 29 and April 9, 2010 to determine the prevalence and intensity of soil transmitted helminths among elementary school children. The study participants were randomly selected from class enrollment list after proportional allocation of the total sample size to each grade. Data about the background characteristics were collected using structured questionnaire. The stool samples were examined by McMaster method for the egg count which was used to determine intensity of infection. Data were analyzed using SPSS for windows version 16 and p-value less than 5% was considered as statistically significant. RESULTS: of the total 715 stool specimens examined, 346 were positive for at least one intestinal parasite making the prevalence 48.4%. The most prevalent parasites were Ascaris lumbricoides 169 (23.6%) and Trichuris trichiura 165 (23.1%). The prevalence of soil transmitted helminth in this study was 45.6% (326/715). There was statistically significant difference in the prevalence of Trichuriasis between those who use latrine always and who use sometimes (p = 0.010). Females are two times more likely to be positive for Ascaris than males (p = 0.039). Majority of the students had light infection of soil transmitted helminths and none of them had heavy intensity of infection of Trichuriasis and hookworms. CONCLUSION: nearly half of the school children were infected with at least one STHs and majority of the students had light infection of soil transmitted helminths. Students who did not wash their hands after defecation were three times more likely to be positive for Ascaris infection than those who washed their hands after defecation. Therefore, measures like health information dissemination on the advantage of washing hands after defecation and on proper use of latrine should be taken into account to alleviate the problem.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mache Tsadik, Yemane Berhane, Alemayehu Worku, Wondwossen Terefe [Research] - Perceived risk of reinfection among individuals treated for sexually transmitted infections in Northern Ethiopia: implication for use in clinical practice - 05 June 2017. http://www.panafrican-med-journal.com/content/article/27/87/abstract/ <b>Introduction: the prevention of reinfection of sexually transmitted infections (STIs) is highly dependent on the level of risk perception and the subsequent adoption of preventive behaviors. While perceived risk is assumed to be key to adoption of preventive measures, the evidence regarding the predictors of perceived risk to STI reinfection are limited. Methods: this paper is based on a cross sectional facility based survey conducted in North Ethiopia from January to June; 2015. Patients attending public health facilities for STI care responded to a structured questionnaire at clinic exist. Ordinal logistic regression was employed to identify factors associated with risk perception. Results: of the 1082 STI patients who participated in the study, 843(77.91%) indicated a high perceived risk of STI reinfection. The major factor associated with high perceived risk of reinfection was willingness to notify partner; the odds of being willing to notify partner was greater among those with perceived high risk (AOR=3.01, 95% CI: 2.13-4.25). In addition, high perceived risk was associated with female index cases (AOR=1.49, 95% CI: 1.07-2.08), those who had high school education and above (AOR=1.68, 95% CI: 1.07-2.65), those aged 25 years and above (AOR=1.52, 95% CI: 1.09-2.12), those who had a single partner (AOR=1.82, 95% CI: 1.20-2.74), and those who had low perceived stigma (AOR=1.42, 95% CI: 1.04-1.95).</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hanane Oummad, Lalla Ouafae Cherkaoui [Images in medicine] - Parry-romberg syndrome: about a case - 05 June 2017. http://www.panafrican-med-journal.com/content/article/27/86/abstract/ <b>A six-year-old girl presented with skin lesions on the left cheek at 5 years of age. On examination diffuse sclerosis on the left cheek was noted, hypoplasia of left half of the face and deviation of mouth and lips to left side were noted. Investigations show normal blood counts and rheumatoid factor and antinuclear antibody were negative. CT scan of brain was normal. Fundus examination revealed a grade 2 hyalitis. Parry-romberg syndrome (PRS), also known as "progressive facial hemiatrophy" is a rare degenerative condition of the face. It is characterized by progressive but self-limiting unilateral wasting of facial skin, subcutaneous fat, muscle and occasionally bone. It can be associated with various ophthalmic and neurologic complications.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Naourez kolsi, Sondos Jellali, Jamel Koubaa [Case report] - Le carcinome parathyro&iuml;dien: &agrave; propos d’un cas et revue de la litt&eacute;rature - 05 June 2017. http://www.panafrican-med-journal.com/content/article/27/85/abstract/ <b>Le carcinome parathyro&iuml;dien est une tumeur maligne, tr&egrave;s rare, de la glande parathyro&iuml;de. Cliniquement, ce cancer se pr&eacute;sente souvent par un tableau d'hyperparathyro&iuml;die primaire s&eacute;v&egrave;re. Le diagnostic est histologique mais n'est pas toujours ais&eacute;. Le traitement est bas&eacute; sur la chirurgie. Femme &acirc;g&eacute;e de 59 ans, aux ant&eacute;c&eacute;dents d'hypertension art&eacute;rielle, et de lithiases r&eacute;nales r&eacute;cidivantes, consultait pour des douleurs osseuses diffuses avec asth&eacute;nie. L'examen du cou a trouv&eacute; une tum&eacute;faction basi-cervicale dure et &agrave; bord inf&eacute;rieur non palpable. A la biologie: hypercalc&eacute;mie &agrave; 4,1 mmol/l, une hyperparathyro&iuml;die avec valeur de parathormone (PTH) tr&egrave;s &eacute;lev&eacute;e &agrave; 1088 pg/ml soit 13 fois la normale. La scintigraphie au Techn&eacute;tium-99m-sestamibi a montr&eacute; une plage de fixation anormale de MIBI en projection de la parathyro&iuml;de inf&eacute;rieure gauche. Une parathyro&iuml;dectomie inf&eacute;rieure gauche, avec &eacute;videment m&eacute;diastino-r&eacute;currentiel homolat&eacute;ral ont &eacute;t&eacute; r&eacute;alis&eacute;s. Les suites op&eacute;ratoires &eacute;taient marqu&eacute;es par la normalisation de la calc&eacute;mie et de la PTH. L'anatomopathologie &eacute;tait en faveur d'un carcinome parathyro&iuml;dien. Le diagnostic de carcinome parathyro&iuml;dien est g&eacute;n&eacute;ralement &eacute;tabli sur la conjonction de signes radiologiques biologiques et histologiques. La gravit&eacute; de cette pathologie est due &agrave; l'hypercalc&eacute;mie s&eacute;v&egrave;re et au risque de r&eacute;cidive et de m&eacute;tastases &agrave; distance justifiant la surveillance prolong&eacute;e.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Jefitha Karimurio, Hillary Rono, Doris Njomo, John Sironka, Catherine Kareko, Michael Gichangi, Ernest Barasa, Alice Mwangi, Kefa Ronald, Francis Kiio [Research] - Use of validated community-based trachoma trichiasis (TT) case finders to measure the total backlog and detect when elimination threshold is achieved: a TT methodology paper - 05 June 2017. http://www.panafrican-med-journal.com/content/article/27/84/abstract/ <b>Introduction: the World Health Organization recommends TT surveys to be conducted in adults aged 15+ years (TT 15 survey) and certifies elimination of TT as a public health problem when there is less than 1 unknown case per 1,000 people of all ages. There is no standard survey method to accurately confirm this elimination prevalence threshold of 0.1% because rare conditions require large and expensive prevalence survey samples. The aim of this study was to develop an accurate operational research method to measure the total backlog of TT in people of all ages and detect when the elimination threshold is achieved. Methods: between July to October 2016, an innovative Community-based, Mapping, Mop-up and Follow-up (CMMF) approach to elimination of TT as a public health problem was developed and tested in Esoit, Siana, Megwara and Naikara sub-locations in Narok County namely in Kenya. The County had ongoing community-based TT surgical camps and case finders. TT case finders were recruited from existing pool of Community health volunteers (CHV) in the Community Health Strategy Initiative Programme of the Ministry of Health. They were trained, validated and supervised by experienced TT surgeons. A case finder was allocated a population unit with 2 to 3 villages to conduct a de jure pre-survey census, examine all people in the unit and register those with TT (TT all survey). Identified cases were confirmed by TT surgeons prior to surgery. Operated patients were reviewed at 1 day, 2 weeks and 3-6 months. The case finders will also be used to identify and refer new and recurrent cases. People with other eye and medical conditions were treated and referred accordingly. Standardised data collection and computer based data capture tools were used. Case finders kept registers with details of all persons with TT, those operated and those who refused to be operated (refusals). These details informed decision and actions on follow-up and counselling. Progress towards achievement of elimination threshold was assessed by dividing the number of TT cases diagnosed by total population in the population unit multiplied by 1,000. Results: Narok County Government adopted both the CMMF approach and TT all survey method. All persons in 4,784 households in the four sub-locations were enumerated and examined. The total population projection was 29,548 and pre-survey census 22,912 people. Fifty-three cases of TT were diagnosed. The prevalence of was 0.23% and this is equivalent to 2.3 cases per thousand population of all ages. Prior to this study, the project required to operate on at least 30 cases (excess cases) to achieve the elimination threshold of 1 case per 1000 population. Conclusions: the total backlog of TT was confirmed and the project is now justified to lay claim of having eliminated TT as a public health problem in the study area. Limitation: TTall method may not be appropriate in settings with high burden of TT. Nomadic migrations affect estimation of population size. Non-trachomatous TT could not be ruled-out.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hasnaa Zaouri, Baderdine Hassam [Images in medicine] - Une papule rose de la tempe - 02 June 2017. http://www.panafrican-med-journal.com/content/article/27/83/abstract/ <b>La maladie de Bowen (MB) est un carcinome &eacute;pidermo&iuml;de in situ relativement rare. Les facteurs favorisant sont l’exposition solaire, les rayonnements ionisants, l’arsenic, l’infection par le virus du papillome humain HPV, certaines g&eacute;nodermatoses, elle peut survenir sur des l&eacute;sions cutan&eacute;es chroniques notamment des k&eacute;ratoses actiniques ou de lupus disco&iuml;de. Aucun cas de maladie de Bowen au niveau du site de biopsie temporale n’a &eacute;t&eacute; rapport&eacute; dans la litt&eacute;rature. Nous rapportons le cas d’un patient &acirc;g&eacute; de 72 ans, de phototype IIIa, suivi depuis une ann&eacute;e pour art&eacute;rite de Horton, sous corticoth&eacute;rapie par voie orale et antiagr&eacute;gants plaquettaires, qui rapporte depuis six mois, l’apparition d’une papule asymptomatique au niveau du site de la biopsie temporale, augmentant progressivement de taille. L'examen dermatologique trouve une papule de 0,5 cm de taille, de couleur rose-jaune, &agrave; surface l&eacute;g&egrave;rement k&eacute;ratosique, non infiltr&eacute;e, si&eacute;geant au niveau de la tempe droite, au site de la biopsie temporale. Une biopsie ex&eacute;r&egrave;se compl&egrave;te r&eacute;alis&eacute;e, a montr&eacute; un rev&ecirc;tement &eacute;pidermique, acanthosique et parak&eacute;ratosique pr&eacute;sentant une d&eacute;sorganisation architecturale sur toute la hauteur avec pr&eacute;sence d’atypies cytonucl&eacute;aires marqu&eacute;es et mitoses, le derme sous jacent comporte un infiltrat inflammatoire mod&eacute;r&eacute; p&eacute;ri vasculaire, en faveur de la MB. Le patient a b&eacute;n&eacute;fici&eacute; d’une s&eacute;ance de cryoth&eacute;rapie &agrave; l’azote liquide et il a &eacute;tait mis sous cr&egrave;me &agrave; base de 5 fluoro-uracile pendant un mois avec photo protection. Le pronostic de la MB est en g&eacute;n&eacute;ral favorable. En revanche, en l'absence d'un diagnostic et d'un traitement appropri&eacute;, l’&eacute;volution se fait vers un v&eacute;ritable carcinome &eacute;pidermo&iuml;de invasif.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Soufiane Baggar, Hajar Ouahbi, Meryem Azegrar, Fatima Zahra El M’rabet, Samia Arifi, Nawfel Mellas [Case report] - Carcinome neuroendocrine du col ut&eacute;rin: &agrave; propos d’un cas avec revue de la litt&eacute;rature - 02 June 2017. http://www.panafrican-med-journal.com/content/article/27/82/abstract/ <b>Les carcinomes neuroendocrines &agrave; petites cellules gyn&eacute;cologiques sont inhabituels, et ils ne repr&eacute;sentent que 2% des tumeurs du col ut&eacute;rin. Compte tenu de leur raret&eacute; et de l’absence d’essais randomis&eacute;s, la prise en charge diagnostique et th&eacute;rapeutique de ces tumeurs est difficile et est essentiellement calqu&eacute;e sur celle des tumeurs neuroendocrines pulmonaires. A l’instar de ces derni&egrave;res, et malgr&eacute; un traitement multimodal, leur pronostic reste d&eacute;favorable. Nous rapportons un nouveau cas de carcinome neuroendocrine du col &agrave; petites cellules et &agrave; travers les donn&eacute;es de la litt&eacute;rature nous mettons le point sur les diff&eacute;rents aspects de cette entit&eacute; rare.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Ezra Olatunde Ogundare, Oladele Simeon Olatunya, Isaac Oluwadare Oluwayemi, Adekoya Joshua Inubile, Adekunle Bamidele Taiwo, Oyinkansola Tolulope Agaja, Alfred Airemionkhale, Adewale Fabunmi [Research] - Pattern and outcome of dog bite injuries among children in Ado-Ekiti, Southwest Nigeria - 02 June 2017. http://www.panafrican-med-journal.com/content/article/27/81/abstract/ <b>Introduction: dog bites in humans are a major public health problem. Globally, millions of people are bitten by dogs but most of the fatal cases occur in children. There is paucity of data on dog bite related diseases among Nigerian children. Objectives: to determine the pattern of dog bite injuries and associated health problems among children seen at Ekiti State University Teaching Hospital. Methods: this is a retrospective study on the clinical data of patients managed for dog bite related injuries between January 2010 and June 2014. Results: in all, 84 cases of dog bite injuries were managed constituting 0.89% of the total consultations; six (7.1%) had rabies. Most of the victims were aged 6-12 years (60.7%) and majority (71.4%) was boys. Eighty two percent of the victims presented within 24hrs of the injury. Thirty-six (43%) had WHO grade 3 dog bite injury at presentation and the lower limb was the commonest (57.1%) bite site. Use of herbal preparation was the most common pre-hospital treatment 60%. Although 92.9% received anti-rabies vaccine, only 64.3% of them completed the vaccination schedule. The case fatality rate for dog bite was 7.14%. The six that died all presented late, had no post exposure prophylaxis and died within 24 hours of admission. Conclusion: there is need for public enlightenment on dangers associated with dog bites and also for the government to defray the high cost of post exposure prophylaxis treatment for children.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Naod Firdu, Fikre Enquoselassie, Degu Jerene [Research] - HIV infected adolescents have low adherence to antiretroviral therapy: a cross sectional study in Addis Ababa, Ethiopia - 02 June 2017. http://www.panafrican-med-journal.com/content/article/27/80/abstract/ <b>Introduction: for antiretroviral therapy (ART) to work effectively, adherence is very crucial. However, most studies done on ART adherence are either on children or on adults. There is limited information on the level of adherence among adolescents.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Fatimazahra El M’rabet, Rajae Kanab, Taoufiq Ameuraoui, Fatoumata Sidibe, Meryem Azegrare, Samia Arifi, Moustapha El Maaroufi, Afaf Amarti, Nawfal Mellas [Case report] - M&eacute;tastase parotidienne d’un cancer du sein: &agrave; propos d’un cas et revue de la litt&eacute;rature - 02 June 2017. http://www.panafrican-med-journal.com/content/article/27/79/abstract/ <b>La localisation au niveau de la parotide des m&eacute;tastases du cancer du sein est tr&egrave;s rare, quelques cas ont &eacute;t&eacute; rapport&eacute;s dans la litt&eacute;rature. On rapporte le cas d'une patiente de 43 ans, qui a &eacute;t&eacute; trait&eacute;e pour un cancer du sein droit, et qui a pr&eacute;sent&eacute; deux ans apr&egrave;s la fin du traitement une m&eacute;tastase au niveau de la parotide gauche, confirm&eacute;e histologiquement.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Anthony Lyonga Ngonge, Domin Sone Majunda Ekaney, Carlson-Babila Sama, Joffi Musonge-Effoe, Valery Sammah Effoe, Gerald Ekwen [Case report] - Multiple jejunal perforation secondary to intestinal tuberculosis infection: a case report - 02 June 2017. http://www.panafrican-med-journal.com/content/article/27/78/abstract/ <b>Abdominal tuberculosis (TB) may affect any part of the gastrointestinal tract resulting in significant morbidity and mortality. There is an increase in the incidence of abdominal TB favored by the emergence of multi-drug resistant Mycobacterium tuberculosis and immunosuppression especially from HIV co-infection. Our case is that of a 31 year old HIV-positive woman, adherent to antiretroviral therapy, who presented with a 2 month history of progressive abdominal distention, drenching night sweat and fatigue, but without fever. She was admitted on a presumptive diagnosis of peritoneal TB, and suddenly developed signs and symptoms of an acute abdomen. Laboratory investigations showed a CD4+ count of 155 cells/µL, white blood cell count of 15,700 cells/mm3 and haemoglobin of 8.0g/dl. An emergency laparotomy revealed small bowel caseous necrosis with multiple jejunal perforations. Ziehl-Nelsen staining of operative specimen was positive for acid fast bacilli. Given her immunodeficiency status, clinical signs and symptoms, CD4 cell count > 50 cells/µL, and intestinal sample showing caseous necrosis and perforations, a final diagnosis of intestinal TB was made. In conclusion, abdominal tuberculosis may mimic a number of intra-abdominal pathologies; thus should always be considered as a differential diagnosis in patients presenting with acute abdomen in TB-endemic areas especially in an HIV-positive individual.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Pakoyo Fadhiru Kamba, Bruhan Kaggwa, Edson Ireeta Munanura, Tom Okurut, Freddy Eric Kitutu [Commentary] - Why regulatory indifference towards pharmaceutical pollution of the environment could be a missed opportunity in public health protection. a holistic view - 01 June 2017. http://www.panafrican-med-journal.com/content/article/27/77/abstract/ <b>The last generation has witnessed bludgeoning of the world's population, a spike in disease burden, and unprecedented levels of pharmaceutical consumption and production. Unfortunately, pharmaceuticals have left their industrial and household confines and leaked into the environment. Pharmaceuticals are now major environmental pollutants, and are ubiquitous in waters and soils. Unlike other environmental contaminants, pharmaceutical pollutants are not yet regulated globally, simply because acute risk assessments show insignificant human health hazard. But the pitfalls of pharmaceutical pollutants extend beyond acute effects to delayed effects from bioaccumulation, amplified effects from drug-drug interactions, exacerbation of drug resistance, and reduction in aquatic and terrestrial food production. Therefore, ignoring pharmaceutical pollutants deprives society of holistic public health protection.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Papa Alassane Mbaye, Aime Lakh Faye, Aloise Sagna, Ndeye Aby Ndoye, Ndeye Fatou Seck, Omar Ndour, Gabrie Ngom [Case report] - Volvulus du gr&ecirc;le sur lipome du m&eacute;sent&egrave;re - 01 June 2017. http://www.panafrican-med-journal.com/content/article/27/76/abstract/ <b>Nous rapportons l'observation d'une fillette &acirc;g&eacute;e de 7ans qui re&ccedil;ue dans un tableau de syndrome sub-occlusif avec une douleur abdominale aigue paroxystique si&eacute;geant au niveau de l'&eacute;pigastre associ&eacute;e &agrave; des vomissements et un arr&ecirc;t des mati&egrave;res. L'examen physique mettait en &eacute;vidence une sensibilit&eacute; &agrave; la palpation de l'&eacute;pigastre. L'&eacute;chographie abdominale a montr&eacute; une formation tissulaire intra p&eacute;riton&eacute;ale mal limit&eacute;e sans caract&egrave;re vasculaire au doppler, exer&ccedil;ant un effet de masse sur les structures de voisinage ; les vaisseaux m&eacute;sent&eacute;riques &eacute;taient en position normale. A la tomodensitom&eacute;trie cette masse correspondait &agrave; une formation lipomateuse bien limit&eacute;e exer&ccedil;ant un effet de masse sur le caecum avec un volvulus du gr&ecirc;le. Le diagnostic de volvulus du gr&ecirc;le sur lipome m&eacute;sent&eacute;rique a &eacute;t&eacute; retenu. L'exploration chirurgicale confirmait ce diagnostic. Une d&eacute;torsion gr&eacute;lique et une &eacute;nucl&eacute;ation lipomateuse &eacute;taient r&eacute;alis&eacute;es. Les suites op&eacute;ratoires &eacute;taient simples apr&egrave;s un recul de 6 mois. L'examen anatomopathologique confirmait la nature lipomateuse de la masse.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Amina Kissou, Badr Eddine Hassam [Images in medicine] - Docteur! regardez ma langue! - 01 June 2017. http://www.panafrican-med-journal.com/content/article/27/75/abstract/ <b>La langue noire villeuse est une condition b&eacute;nigne. C'est une modification de la couleur de l'aspect de la langue qui devient noire, sale, avec des papilles filiformes allong&eacute;es. Plusieurs facteurs sont impliqu&eacute;s: tabagisme, consommation excessive de caf&eacute; / th&eacute;, mauvaise hygi&egrave;ne bucco-dentaire, n&eacute;vralgie du trijumeau et certains m&eacute;dicaments. Nous rapportons un nouveau cas.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Adedayo Olukemi Sabageh, Oluwatosin Adediran Adeoye, Adeleye Abiodun Adeomi, Donatus Sabageh, Adebola Afolake Adejimi [Research] - Birth preparedness and complication readiness among pregnant women in Osogbo Metropolis, Southwest Nigeria - 01 June 2017. http://www.panafrican-med-journal.com/content/article/27/74/abstract/ <b>Introduction: high maternal mortality is a major problem in Nigeria. Birth Preparedness and Complication Readiness will ensure that women can have professional delivery thus reducing obstetric complications. This study assessed the birth preparedness and complication readiness among pregnant women in Osogbo metropolis, a south western community in Nigeria. Methods: a community based descriptive cross sectional survey was used. A total of 180 women were selected using multistage sampling technique. Pretested semi-structured interviewer administered questionnaires were used to elicit information about previous obstetric history, knowledge of the danger signs of pregnancy and level of birth preparedness. Composite score and mean were computed. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 17. P-value was set at < 0.05.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Minal Ray, Lorena Wallace, Lawrence Mbuagbaw, Lynn Cockburn [Research] - Functioning and disability in recent research from Cameroon: a narrative synthesis - 01 June 2017. http://www.panafrican-med-journal.com/content/article/27/73/abstract/ <b>Introduction: people living with disabilities in Cameroon face many barriers to daily functioning and social participation. However, there is limited research on disabilities and their impact. We sought to examine the research related to disability from Cameroon. Methods: we conducted a systematic review, bibliometric analysis, and narrative synthesis of research related to disability, functioning, and social participation from Cameroon published during 2005-2014. The articles were screened in duplicate to identify articles addressing impacts of disability on functioning. Disability was contextualized using the International Classification of Functioning, Disability and Health (ICF) framework. Data were analyzed narratively per identified themes using an inductive data-driven approach. Results: a total of 46 studies were included following full-text review of which 36 addressed non-communicable diseases and conditions, 7 addressed infectious diseases and 3 addressed neglected tropical diseases. Among ICF Activity and Participation Restrictions, work and employment was the highest reported category (19 studies), followed by intimate relationships (14 studies), and looking after one's health (8 studies). Among ICF Environmental Factors, societal attitudes were the highest reported category (21 studies), followed by health services, systems and policies (14 studies) and support and relationships (11 studies). Among other common themes, knowledge and awareness was the highest reported category (22 studies), closely followed by traditional beliefs (20 studies) and financial barriers (9 studies). Conclusion: there is a small body of primary research from Cameroon on disability. The main themes related to disability are stigma, limited knowledge and awareness, poor quality of care and hindered employment opportunities. Further efforts are required to investigate the complexities of living with a disability in Cameroon and strategies to enhance adequate participation in activities of daily life.</b><br/> text/html 2017-07-26T04:47:35+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 I: fr&eacute;quence, indications et mortalit&eacute; maternelle et p&eacute;rinatale - 01 June 2017. http://www.panafrican-med-journal.com/content/article/27/72/abstract/ <b>INTRODUCTION: la fr&eacute;quence de la c&eacute;sarienne (CS) ne cesse d'augmenter ces derni&egrave;res d&eacute;cennies mais cette augmentation diff&egrave;re &eacute;norm&eacute;ment d'un pays &agrave; un autre et dans un m&ecirc;me milieu, d'une institution m&eacute;dicale &agrave; une autre. L'objectif de cette &eacute;tude est d'&eacute;tudier la fr&eacute;quence, les indications et la morbi-mortalit&eacute; maternelle et p&eacute;rinatale de la c&eacute;sarienne (CS) &agrave; Lubumbashi, R&eacute;publique D&eacute;mocratique du Congo (RDC). METHODES: &eacute;tude multicentrique, r&eacute;trospective, descriptive et analytique de 3643 CS cons&eacute;cutives sur un total de 34199 accouchements dans cinq formations hospitali&egrave;res de r&eacute;f&eacute;rence &agrave; Lubumbashi (RDC) entre le 1er janvier 2009 et le 31 d&eacute;cembre 2013. Les donn&eacute;es sociod&eacute;mographiques, les indications, l'environnement obst&eacute;trical et la morbi-mortalit&eacute; maternelle et p&eacute;rinatale ont &eacute;t&eacute; analys&eacute;s au logiciel Epi Info 2011. Les fr&eacute;quences exprim&eacute;es en pourcentage et les moyennes avec leurs &eacute;cart-types ont &eacute;t&eacute; calcul&eacute;s. 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 au seuil de signification de p<0,05. RESULTATS: la fr&eacute;quence moyenne de c&eacute;sarienne &eacute;tait de 10,65%. Elle est pass&eacute;e de 10,24% en 2009 &agrave; 11,38% en 2013 soit une croissance de 11,13% (p=0,03). Cinquante-un virgule quatre pourcent de CS &eacute;taient effectu&eacute;es apr&egrave;s tentative de la voie basse et 48,6% dans un contexte d'urgence obst&eacute;tricale. Les indications sont rest&eacute;es constantes et domin&eacute;es par la disproportion fœto-pelvienne (18,6%), la souffrance fœtale aigu&euml; (11,9%), la mal pr&eacute;sentation fœtale (10,1%), le placenta pr&aelig;via (9,2%) et le bassin r&eacute;tr&eacute;ci (8,4%). La morbidit&eacute; maternelle s'&eacute;l&egrave;ve &agrave; 11,6% mat&eacute;rialis&eacute;e par les complications h&eacute;morragiques dans 6,1%. La mortalit&eacute; maternelle globale est pass&eacute;e de 2,3‰ en 2009 &agrave; 6,4‰ en 2013 soit une inflation de 178,26%. Pour la voie haute, elle est pass&eacute;e de 4‰ &agrave; 16,7‰ pour les 4 derni&egrave;res ann&eacute;es prises ensemble &eacute;quivalant &agrave; une inflation de 317,5% (p=0,005) contre 2,1‰&agrave; 2,8‰ (33,33% d'inflation ; p=0,296) pour la voie basse au cours de la m&ecirc;me p&eacute;riode. La mortalit&eacute; p&eacute;rinatale globale a connu une augmentation de 56,04% l'ann&eacute;e 2010 (p=0,0000) et 43,36% en 2013 (p=0,0000). Concernant la CS, l'on notera une am&eacute;lioration de la mortalit&eacute; p&eacute;rinatale de 48,64% les trois premi&egrave;res ann&eacute;es suivant 2009 (59,4‰contre 70,5‰; p=0,3278), am&eacute;lioration &agrave; laquelle succ&eacute;dera une hausse de 46,52% (p=0,026). Globalement, la mortalit&eacute; p&eacute;rinatale n'aura pas &eacute;t&eacute; significativement modifi&eacute;e par la dynamique &eacute;volutive de la CS durant ces 5 ann&eacute;es. CONCLUSION: les cinq derni&egrave;res ann&eacute;es, la pratique de la CS &agrave; Lubumbashi (RDC) a connu une croissance de plus de 11% sans &eacute;volution de ses indications ni dividendes maternelles et p&eacute;rinatales.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com F&eacute;lix Kitenge wa Momat, Pierre Akilimali Zalagile, Faustin Chenge Mukalenge, Oscar Numbi Luboya, Cl&eacute;ophas Tshibangu Kalala, D&eacute;sir&eacute; Mashinda, Gilles Grang&eacute;, Olivier Mukuku, Fanny Malonga Kaj, Chamy Cham Lubamba, Joseph Bagambe Bwama, C&eacute;lestin Kayembe Mukoko, Jean Baptiste Kakoma, Justin Kizonde Kalungwe [Research] - Accouchements sur ut&eacute;rus cicatriciel en R&eacute;publique D&eacute;mocratique du Congo: &eacute;preuve ut&eacute;rine et facteurs d&eacute;terminants de l’issue - 01 June 2017. http://www.panafrican-med-journal.com/content/article/27/71/abstract/ <b>INTRODUCTION: l'objectif &eacute;tait d'identifier les principaux facteurs de risque associ&eacute;s &agrave; un &eacute;chec d'&eacute;preuve ut&eacute;rine et d&eacute;finir un score pr&eacute;dictif d'accouchement sur ut&eacute;rus cicatriciel en R&eacute;publique D&eacute;mocratique du Congo. METHODES: &eacute;tude multicentrique, transversale et analytique des patientes porteuses d'un ut&eacute;rus cicatriciel sur la p&eacute;riode du 1er janvier au 31 d&eacute;cembre 2013 dans quatre maternit&eacute;s de la R&eacute;publique D&eacute;mocratique du Congo (RDC). Un mod&egrave;le de r&eacute;gression logistique a &eacute;t&eacute; construit pour identifier les facteurs associ&eacute;s &agrave; l'&eacute;chec de l'&eacute;preuve ut&eacute;rine. De ce mod&egrave;le, un score pr&eacute;dictif a &eacute;t&eacute; construit pour pr&eacute;dire l'&eacute;chec de l'&eacute;preuve ut&eacute;rine dans les maternit&eacute;s de la RDC. La courbe ROC a &eacute;t&eacute; utilis&eacute;e pour &eacute;valuer la capacit&eacute; du score construit &agrave; identifier les patientes &agrave; risque de connaitre un &eacute;chec de l'&eacute;preuve ut&eacute;rine. Le cut off point du score pr&eacute;dictif a &eacute;t&eacute; d&eacute;termin&eacute; en fonction de la sensibilit&eacute; et sp&eacute;cificit&eacute; optimale via l'index de Youden. Tous les tests ont &eacute;t&eacute; r&eacute;alis&eacute;s au seuil de signification ±=0,05. RESULTATS: deux types de facteurs explicatifs de l'&eacute;chec de l'&eacute;preuve ut&eacute;rine ont &eacute;t&eacute; retenus. Il s'agit d'un facteur sociod&eacute;mographique (&acirc;ge maternel) et de trois facteurs obst&eacute;tricaux (hauteur ut&eacute;rine, pr&eacute;sentation du fœtus et rupture pr&eacute;matur&eacute;e des membranes). Le score de pr&eacute;diction a &eacute;t&eacute; d&eacute;fini pour pr&eacute;dire l'&eacute;chec de l'&eacute;preuve ut&eacute;rine. La construction de ce score s'est bas&eacute;e sur quatre &eacute;l&eacute;ments : l'&acirc;ge maternel, l'&eacute;tat de la poche des eaux &agrave; l'admission, la hauteur ut&eacute;rine et la pr&eacute;sentation fœtale. Le score minimal est de 4 et le score maximal est de 16. Le seuil est de 7. Un Score total sup&eacute;rieur ou &eacute;gal &agrave; 7 traduit un risque d'&eacute;chec de l'&eacute;preuve ut&eacute;rine. CONCLUSION: l'utilisation de ce score pr&eacute;dictif chez les patientes pourra am&eacute;liorer la qualit&eacute; dans les indications de la voie haute, l'augmentation des taux de c&eacute;sariennes prophylactiques ainsi que la meilleure s&eacute;lection des patientes soumises &agrave; l'&eacute;preuve ut&eacute;rine. Ceci pourra &eacute;galement contribuer &agrave; la r&eacute;duction de la morbi-mortalit&eacute; fœto-maternelle li&eacute;e &agrave; la gestion de l'accouchement sur ut&eacute;rus cicatriciels.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Ghizlane Slimani, Hicham Lakbiri, Fatima Zahra Sekkat [Case report] - Evaluation psychiatrique et psychologique du syndrome de Tako-Tsubo: &agrave; propos d’un cas - 30 May 2017. http://www.panafrican-med-journal.com/content/article/27/70/abstract/ <b>La cardiopathie de stress ou Tako Tsubo est une pathologie cardiaque &eacute;voquant un syndrome coronarien aigu, avec signes &eacute;lectrocardiographiques, augmentation des enzymes cardiaques, mais o&ugrave; la coronarographie ne retrouve pas d'anomalie. Elle touche g&eacute;n&eacute;ralement des femmes m&eacute;nopaus&eacute;es, dans les suites d'un stress intense. Le mode de d&eacute;but est variable, depuis la douleur angineuse le plus souvent jusqu'au tableau de choc cardiog&eacute;nique. Le m&eacute;canisme physiopathologique exact de l'affection reste d&eacute;battu. Plusieurs hypoth&egrave;ses sont invoqu&eacute;es, dont la plus cr&eacute;dible semble &ecirc;tre un hyperadr&eacute;nergisme brutal, li&eacute; au stress. Notamment il n'existe pas de consensus sur le traitement et la pr&eacute;vention. On peut alors s'interroger sur l'existence d'une pathologie psychiatrique sous-jacente ou une personnalit&eacute; pr&eacute;dispos&eacute;e et donc sur la place du psychiatre dans cette prise en charge.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Kenneth Ebele Izuchukwu, Emmanuel Okwudili Oranu, Goddy Bassey, Ngozi Clare Orazulike [Research] - Maternofetal outcome of asymptomatic bacteriuria among pregnant women in a Nigerian Teaching Hospital - 30 May 2017. http://www.panafrican-med-journal.com/content/article/27/69/abstract/ <b>INTRODUCTION: asymptomatic bacteriuria has been reported to be associated with adverse pregnancy outcome. This study sought to determine the prevalence and complications of asymptomatic bacteriuria amongst parturient in the University of Port Harcourt Teaching Hospital (UPTH). METHODS: the study was a prospective cohort study involving 220 eligible antenatal attendees. Urine culture and sensitivity was conducted for each participant and the fetomaternal outcome between affected and unaffected women were compared and p value <0.05 was considered significant. RESULTS: sixty-five of the participants had asymptomatic bacteriuria giving a prevalence of 29.5%. Twenty-three (35.4%) cultures yielded <i>Klebsiella spp</i> while Fifty-eight (89%) of the cultured organisms were sensitive to Nitrofurantoin. There was no statistical difference in the rate of prelabour rupture of membranes, preeclampsia, preterm delivery, birth asphyxia and low birth weight between affected and unaffected women. CONCLUSION: contrary to widely held view, there was no significant increase in adverse pregnancy outcome amongst affected women.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Saad Andaloussi, Mohamed Amine Oukhouya, Othmane Alaoui, Karima Atarraf, Lamiae Chater, My Abderrahmane Afifi [Case series] - Les complications de l’ECMES dans le traitement des fractures des 2 os de l’avant-bras chez l’enfant (&agrave; propos de 87 cas) - 30 May 2017. http://www.panafrican-med-journal.com/content/article/27/68/abstract/ <b>Le but de notre &eacute;tude est de d&eacute;crire les complications de l'embrochage centrom&eacute;dullaire &eacute;lastique stable (ECMES) dans le traitement des fractures diaphysaires des deux os de l'avant-bras chez l'enfant. Entre Janvier 2009 et D&eacute;cembre 2013, 87 enfants pr&eacute;sentant des fractures diaphysaires des os de l'avant-bras ont &eacute;t&eacute; trait&eacute;s par embrochage centro-m&eacute;dullaire &eacute;lastique stable par des broches de M&eacute;taizeau. Il s'agissait de 76 gar&ccedil;ons et 11 filles d'&acirc;ge moyen 12 ans. L'embrochage a &eacute;t&eacute; r&eacute;alis&eacute; d'embl&eacute;e dans 50 cas et suite &agrave; un d&eacute;placement secondaire sous pl&acirc;tre dans les autres. Les deux os ont &eacute;t&eacute; embroch&eacute;s dans tous les cas. L'immobilisation pl&acirc;tr&eacute;e &eacute;tait syst&eacute;matique pour tous les malades pendant une dur&eacute;e moyenne d'un mois. Les broches ont &eacute;t&eacute; enlev&eacute;es au bout d'environ 6 mois en moyenne. Les r&eacute;sultats fonctionnels ont &eacute;t&eacute; &eacute;tudi&eacute;s avec un recul moyen de 10 mois. Les complications ont &eacute;t&eacute; marqu&eacute;es par 14 infections superficielles, 2 cas d'ost&eacute;ites sur mat&eacute;riel, 3 cas de refracture, 3 cas de pseudarthrose, 2 cas de retard de consolidation et une synostose radio-cubitale proximale. Bien que l'embrochage centro-m&eacute;dullaire soit une m&eacute;thode d'ost&eacute;osynth&egrave;se id&eacute;alement adapt&eacute;e aux enfants, il reste plus invasif que le traitement orthop&eacute;dique. Ses indications doivent rester dans les limites de celui ci.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mustafa Nkaoui, Ahmed EL Bardouni, Omar Lazrek, Nasser Ibo, Fouad Zouaidia, Mohamed Kharmaz, Mohamed Elouadghiri, Omar Lamrani, Mustapha Mahfoud, Mohamed Saleh Berrada [Case report] - Abc&egrave;s du coude r&eacute;v&eacute;lant la maladie des griffes du chat: &agrave; propos d’un cas - 30 May 2017. http://www.panafrican-med-journal.com/content/article/27/67/abstract/ <b>La maladie des griffes du chat (MGC) appara&icirc;t comme une cause fr&eacute;quente de lymphad&eacute;nopathie chronique b&eacute;nigne chez l'enfant et l'adulte jeune. L'agent responsable de la maladie est Bartonella henselae. Les sympt&ocirc;mes habituels sont une lymphad&eacute;nopathie r&eacute;gionale associ&eacute;e &agrave; une fi&egrave;vre. Nous rapportons une observation cliniquement atypique et potentiellement trompeuse de MGC, r&eacute;v&eacute;l&eacute;e par un abc&egrave;s du coude chez une fille de 18 ans.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Angus Nnamdi Oli, Dennis Emeka Eze, Thaddeus Harrison Gugu, Ifeanyi Ezeobi, Ukamaka Nwakaku Maduagwu, Chibueze Peter Ihekwereme [Research] - Multi-antibiotic resistant extended-spectrum beta-lactamase producing bacteria pose a challenge to the effective treatment of wound and skin infections - 30 May 2017. http://www.panafrican-med-journal.com/content/article/27/66/abstract/ <b>INTRODCUTION: the increasing incidence of antibiotic resistant bacteria is a concern both to the clinicians and the patients due to obvious consequences such as treatment failures, prolonged patients’ stay in hospital and nosocomial infections. The choice of the first antibiotic therapy in emergency wards in hospitals is usually not based on patient-specific microbial culture and susceptibility test result.This study is aimed at profiling extended-spectrum beta-lactamase (ESBL) producing bacteria associated with wound injuries and highlighting their multi-antibiotic resistance character. METHODS: sixty-three wound swab samples were collected and cultured on nutrient agar and on selective media. Evaluation for ESBL production was by phenotypic method while the antibiogram screening was by disc-diffusion. RESULTS: the wounds evaluated were diabetic sore (14), cancer wounds (12), surgical wounds (17), wounds due to road traffic accidents (10) and wounds from fire burn (10). The result showed that 61 wounds were infected and the prevalence of the infecting pathogens was Escherichia coli 17.46%, Klebsiella Pneumonia 14.28%, Salmonella typhi 12.79%, Pseudomonas Aeruginosa 34.92% and Staphylococcus aureus 17.46%. Thirty four (55.74 %) isolates were ESBL producers, greater than 50% of which being Pseudomonas Aeruginosa. The antibiogram study of theESBL producers showed multi-drug resistance with resistance highest against ampicillin (100%), followed by cephalosporins: cefuroxime (94.12%) and ceftriaxone (61.76%). No resistance was recorded against the ²-lactamase inhibitors: amoxicillin/clavulanate and ceftriaxone/sulbactam. There was a high incidence (55.74 %) of ESBL-producing microbes in the wounds. The isolates were mostly multi-antibiotic resistant. CONCLUSION: multi-drug resistant ESBL-producing bacteria are common in wound infections in the community. However, amoxicillin/clavulanate or ceftriaxone/sulbactam is may be used to treat most patients with such infections in the hospital. This may guide antibiotic selection and use in trauma, most especially in resource limited countries where laboratory test is unaffordable for a majority of patients.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Dziedzom Komi de Souza, Irene Offei Owusu, Joseph Otchere, Michelle Adimazoya, Kwadwo Frempong, Collins Stephen Ahorlu, Daniel Adjei Boakye, Michael David Wilson [Short communication] - An evaluation of Wb123 antibody elisa in individuals treated with ivermectin and albendazole, and implementation challenges in Africa - 29 May 2017. http://www.panafrican-med-journal.com/content/article/27/65/abstract/ <b>The development of antibody testing for the diagnosis of lymphatic filariasis (LF) is intended to enhance the monitoring and evaluation activities of the Global Program for the Elimination of LF. This is due to the fact that antibody tests are expected to be the most sensitive at detecting exposure to LF compared to antigen that takes longer to develop. To this end a new antibody-based enzyme linked immunosorbent assay (ELISA) to Wuchereria bancrofti antigen Wb123 has been developed and further designed into a point of care rapid diagnostic test, under evaluation. In pre-treatment surveys, individuals were tested for antigen using the immuno-chromatographic test (ICT) card, and night blood microfilariae, after which all positives were treated using Ivermectin and Albendazole. The Wb123 ELISA was tested in antigen positive individuals, three months after they were treated. Samples were also tested for ICT and night blood microfilariae. The results revealed a reduction in microfilariae and ICT prevalence after treatment. Antigen and antibody prevalence increased with age. However, there was no correlation with the antibody responses observed. The mean WB123 antibody titers were higher among ICT positives, but not significantly different from ICT negative persons. While the Wb123 is targeted for use in untreated populations, further evaluations and guidelines will be required to define its use in populations that have undergone treatment for the control of LF.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Amina Kissou, Badr Edine Hassam [Images in medicine] - L&eacute;sion &eacute;rosive du mamelon - 29 May 2017. http://www.panafrican-med-journal.com/content/article/27/64/abstract/ <b>La maladie de Paget du sein a &eacute;t&eacute; d&eacute;crite la premi&egrave;re fois par Sir James Paget en 1874. Il s'agit d'une pathologie qui, bien que rare, est souvent associ&eacute;e &agrave; un carcinome in situ ou invasif sous-jacent. Elle repr&eacute;sente 1 &agrave; 3 % des tumeurs mammaires et moins de 5 % des cancers du sein chez l'homme. Nous rapportons le cas d'un patient &acirc;g&eacute; de 50 ans qui a consult&eacute; pour une l&eacute;sion &eacute;rosive du mamelon gauche &eacute;voluant depuis plus d'un an. L'examen clinique trouvait une l&eacute;sion &eacute;rosive de 1,5cm de diam&egrave;tre qui si&eacute;geait au niveau de l'ar&eacute;ole du sein gauche, suintante, surmont&eacute;e de cro&ucirc;tes en p&eacute;riph&eacute;rie, avec disparition du relief du mamelon (A). Il n'y avait pas d'ad&eacute;nopathies ni masse palpable. Plusieurs diagnostics ont &eacute;t&eacute; &eacute;voqu&eacute;s: un ecz&eacute;ma chronique, une maladie de Paget ou encore une ad&eacute;nomatose &eacute;rosive du mamelon. Une biopsie cutan&eacute;e a &eacute;t&eacute; faite et avait objectivait une maladie de Paget associ&eacute;e &agrave; un carcinome canalaire infiltrant. Les seins &eacute;taient class&eacute;es BIRADS 1 en &eacute;cho-mammographie. La tomodensitom&eacute;trie thoraco-abdomino-pelvienne et la scintigraphie osseuse &eacute;taient normales. Le patient a b&eacute;n&eacute;fici&eacute; d'une mastectomie avec curage ganglionnaire. L'histologie a objectiv&eacute; une maladie de Paget avec un carcinome canalaire infiltrant et les ganglions &eacute;taient indemnes. Il a b&eacute;n&eacute;fici&eacute; d'une chimioth&eacute;rapie et d'une radioth&eacute;rapie avec bonne &eacute;volution et un recul de deux ans.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hasnaa Zaouri, Baderdine Hassam [Images in medicine] - Une &eacute;ruption pustuleuse - 29 May 2017. http://www.panafrican-med-journal.com/content/article/27/63/abstract/ <b>Les pustuloses amicrobiennes (PA) correspondent &agrave; un groupe de maladies &agrave; expression cutan&eacute;e dont la l&eacute;sion &eacute;l&eacute;mentaire est une pustule. Elles sont actuellement consid&eacute;r&eacute;es comme une maladie rare associ&eacute;e &agrave; un large spectre de troubles immunitaires. Cliniquement,ellessont caract&eacute;ris&eacute;es par des r&eacute;currences d’&eacute;ruptions pustuleuses aseptiques, si&eacute;geant principalement au niveau du cuir chevelu, les grands plis et le tronc. L’histologie permetde diff&eacute;rencier entre les pustules uniloculaires (non spongiforme) et les pustules multiloculaires (spongiformes). Les PA ont &eacute;t&eacute; d&eacute;crite en association avec le lupus &eacute;ryth&eacute;mateux syst&eacute;mique, la myasth&eacute;nie, le syndrome de Sj&ouml;gren, la maladie coeliaque, l’imp&eacute;tigo herp&eacute;tiforme, le psoriasis ou une pustulose exanth&eacute;matique aigue g&eacute;n&eacute;ralis&eacute;e. Mais avant de r&eacute;aliser un bilan &eacute;tiologique, il faut &eacute;liminer une hypocalc&eacute;mie. Toutes les causes d’hypocalc&eacute;mie peuvent provoquer une PA: hypoparathyro&iuml;die, malabsorption, insuffisance r&eacute;nale chronique, dans ce cas, la correction de l'hypocalc&eacute;mie entra&icirc;ne la gu&eacute;rison.Nous rapportons le cas d’un patient &acirc;g&eacute; de 33 ans, suivi pour une n&eacute;phropathie glom&eacute;rulaire primitive stade d’insuffisance r&eacute;nale chronique, qui pr&eacute;sente depuis une semaine une &eacute;ruption g&eacute;n&eacute;ralis&eacute;e, faite de l&eacute;sions pustuleuses &agrave; contenus blanch&acirc;tres, de taille variable, &eacute;voluant dans un contexte d’apyrexie (A). Le pr&eacute;l&egrave;vement bact&eacute;riologique d’une pustule &eacute;tait st&eacute;rile. L'examen histopathologique a montr&eacute; des pustules spongiformes multiloculaires, avec infiltrat inflammatoire neutrophilique interstitiel. Le bilan biologique a r&eacute;v&eacute;l&eacute; une hypocalc&eacute;mie. La correction de l'hypocalc&eacute;mie a permis la r&eacute;gression des l&eacute;sions au bout d'une semaine (B).</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Safae El Abbadi, Fatima Zahra Rhouni, Laila Jroundi [Case report] - Rupture spontan&eacute; de la rate: &agrave; propos d’un cas et revue de la litt&eacute;rature - 29 May 2017. http://www.panafrican-med-journal.com/content/article/27/62/abstract/ <b>Ce travail rapporte le cas d’un h&eacute;matome sous capsulaire spontan&eacute; rompu de la rate (avec h&eacute;mop&eacute;ritoine) et fait le point sur cette pathologie rare. Les ruptures non traumatiques peuvent &ecirc;tre mortelles, le diagnostic est parfois difficile. Elles r&eacute;v&egrave;lent souvent une pathologie sous-jacente, notamment infectieuse, tumorale ou h&eacute;matologique. La symptomatologie est habituellement aigu&euml;, mais des formes progressives sont possibles. La majorit&eacute; des patientssont spl&eacute;nectomis&eacute;s.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Abdi Ahmed Bonahy, Houssam Sabbah, Ahmed Haiba Med Vadell, Nacer Eddine Med Baba [Case report] - T&eacute;ratome canc&eacute;ris&eacute;: &agrave; propos d’un cas avec revue de la litt&eacute;rature - 29 May 2017. http://www.panafrican-med-journal.com/content/article/27/61/abstract/ <b>Parmi les tumeurs germinales de l’ovaire, on retrouve les kystes dermo&iuml;de dans 10 &agrave; 20% des cas. Dans 1 &agrave; 2 % des cas, une transformation maligne en kyste dermo&iuml;de canc&eacute;ris&eacute; a &eacute;t&eacute; d&eacute;crite(KDC). Le traitement, est un v&eacute;ritable sujet &agrave; controverse, Chez la femme en &acirc;ge de procr&eacute;er et pour les stades d&eacute;butants, une annexectomie unilat&eacute;rale sans traitement adjuvant est pr&eacute;conis&eacute;e. Quant aux cas o&ugrave; il s’agit d’une femme m&eacute;nopaus&eacute;e, certaines &eacute;quipes r&eacute;alisent une chirurgie &eacute;largie et ceci quelques soit le stade. Nous rapportons le cas KDC chez une patiente m&eacute;nopaus&eacute;e trait&eacute;e chirurgicalement et dont l’&eacute;volution a &eacute;t&eacute; favorable.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Rabie Karrouri [Case report] - Mariage non consomm&eacute; et vaginisme: &agrave; propos de trois cas clinique - 29 May 2017. http://www.panafrican-med-journal.com/content/article/27/60/abstract/ <b>Le vaginisme est un probl&egrave;me de couple. Il est source de mariages non consomm&eacute;s, d’infertilit&eacute; et d’alt&eacute;ration de la qualit&eacute; de la relation sexuelle du couple. Par trois cas cliniques illustratifs rapport&eacute;s de notre pratique clinique quotidienne et suivis sur deux ann&eacute;es en consultation du service de psychiatrie de l’H&ocirc;pital Militaire Moulay Ismail de Mekn&egrave;s, nous essayons de clarifier les motifs de rencontre pour vaginisme, ses aspects cliniques et relationnels et ses particularit&eacute;s culturelles.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Negussie Alula Bekele, Worknehe Agegnehu Abebe, Jemal Zeberga Shifa [Case report] - Misplaced subclavian central venous catheter - 26 May 2017. http://www.panafrican-med-journal.com/content/article/27/59/abstract/ <b>Percutaneous Central Venous Catheter (CVC) insertion using internal jugular and Subclavian veins routes is common procedure for all intensive care admitted patients and some patients in the ward as demand arises in central and referral hospitals of Botswana. This is a case report of a patient on whom a third attempt of re-inserting a CVC for fluid and total parenteral nutrition (TPN) was made. X-ray showed that left Subclavian inserted catheter was mis-directed to internal jugular vein of the same side creating discomfort to the patient. Ultra sound is recommended for routine investigation to confirm proper Central venous catheter placement as it can reduce failure, minimize complication and reduce cost of treatment.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hicham El Bote, Ernest Hage, Rami Fares [Case report] - Corps &eacute;tranger inhabituel intra-ur&eacute;tral : &agrave; propos d’un cas - 26 May 2017. http://www.panafrican-med-journal.com/content/article/27/58/abstract/ <b>De nombreux articles de la litt&eacute;rature m&eacute;dicale rapportent des cas rares d'introduction de corps &eacute;trangers dans l'ur&egrave;tre. Ils sont souvent secondaires, soit &agrave; une curiosit&eacute; &eacute;rotique, soit &agrave; des troubles psychiatriques, ou rarement lors d'une tentative d'&eacute;vacuation des urines. Le diagnostic reste clinique aid&eacute; par l'imagerie. Le traitement est le plus souvent endoscopique, mais dans certains cas le recours &agrave; la chirurgie ouverte est n&eacute;cessaire. L'approche th&eacute;rapeutique doit &ecirc;tre syst&eacute;matiquement compl&eacute;t&eacute;e par une &eacute;valuation psychiatrique du malade. Nous rapportons le cas un homme de 64 ans aux ant&eacute;c&eacute;dents de troubles du comportement, il s'est introduit un fil &eacute;lectrique dans l'ur&egrave;tre. La prise en charge constituait en une extraction endoscopique sous anesth&eacute;sie locor&eacute;gionale. A sa sortie le patient a &eacute;t&eacute; r&eacute;f&eacute;r&eacute; en consultation psychiatrique.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Chigozie Jesse Uneke, Issiaka Sombie, Namoudou Keita, Virgil Lokossou , Ermel Johnson, Pierre Ongolo-Zogo [Review] - An assessment of policymaker’s engagement initiatives to promote evidence informed health policy making in Nigeria - 24 May 2017. http://www.panafrican-med-journal.com/content/article/27/57/abstract/ <b>In most developing countries including Nigeria, one of the most challenging issues associated with evidence-to-policy link is the capacity constraints of policymakers to access, synthesize, adapt and utilize available research evidence. The purpose of this review is to assess the efforts and various initiatives that have been undertaken to deliberately engage policymakers and other stakeholders in the health sector in Nigeria for the promotion of evidence informed policymaking. A MEDLINE Entrez Pubmed search was performed and studies that investigated policy making process, evidence to policy link, research to policy mechanism, and researchers/policymakers interaction in Nigeria in relation to health policy were sought. Of the 132 publications found, 14(10.6%) fulfilled the study inclusion criteria and were selected and included in the review. Of the fourteen scientific publications identified, 11 of the studies targeted both researchers and policymakers and the principal tool of intervention was training workshops which focused on various aspects of evidence informed policymaking. All the studies indicated positive outcomes and impacts in relation to quantifiable improvement in policymakers' knowledge and competence in evidence to policy process. Capacity strengthening engagement mechanism is needed for both researchers to generate better evidence and for policymakers and health-care professionals to better use available evidence.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, B&eacute;chir Achour [Images in medicine] - Sarcome granulocytique du rachis dorsal: une cause inhabituelle de compression médullaire - 24 May 2017. http://www.panafrican-med-journal.com/content/article/27/56/abstract/ <b>Le sarcome granulocytique ou chlorome est une tumeur maligne extra-m&eacute;dullaire rare, compos&eacute;e de cellules my&eacute;lo&iuml;des immatures. La localisation rachidienne &eacute;pidurale est exceptionnelle. Nous rapportons le cas d'un patient de 21 ans pr&eacute;sentant une parapl&eacute;gie compl&egrave;te avec un syndrome h&eacute;morragique (h&eacute;maturie et ecchymoses diffuses). L'IRM rachidienne en s&eacute;quence sagittale T2 (A) et axiale T1 apr&egrave;s injection du gadolinium centr&eacute;e sur D4 (B) a montr&eacute; un processus expansif &eacute;pidural post&eacute;rieur &eacute;tendu de D4 &agrave; D7 de signal h&eacute;t&eacute;rog&egrave;ne T2 rehauss&eacute; intens&eacute;ment apr&egrave;s injection qui comble largement le canal m&eacute;dullaire et exerce un effet de masse sur la moelle dorsale en regard sans signe d'atteinte osseuse. L'h&eacute;mogramme a montr&eacute; une pancytop&eacute;nie. Le frottis sanguin a objectiv&eacute; 55% de blastes. Le my&eacute;logramme a r&eacute;v&eacute;l&eacute; une leuc&eacute;mie aigu&euml; my&eacute;loblastique (LAM). La cytologie du liquide c&eacute;phalo-rachidien n'a pas montr&eacute; de cellules malignes. Le patient a subi une laminectomie de D4 &agrave; D7 et une r&eacute;section compl&egrave;te de la masse tumorale dont l'examen anatomopathologique a conclu &agrave; un sarcome granulocytique du rachis. Le patient a re&ccedil;u une cure de chimioth&eacute;rapie syst&eacute;mique selon le protocole des LAM de l'adulte. L'&eacute;volution &eacute;tait marqu&eacute;e par l'obtention d'une r&eacute;mission h&eacute;matologique et m&eacute;dullaire avec persistance d'un fauchage s&eacute;quellaire avec un recul de 7 ans.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Caroline Muringazuva, Daniel Chirundu, More Mungati, Gerald Shambira, Notion Gombe, Donewell Bangure, Tsitsi Juru, Mufuta Tshimanga [Research] - Evaluation of the adverse drug reaction surveillance system Kadoma City, Zimbabwe 2015 - 24 May 2017. http://www.panafrican-med-journal.com/content/article/27/55/abstract/ <b>INTRODUCTION: medicines have the potential to cause adverse drug reactions and because of this Zimbabwe monitor reactions to medicines through the Adverse Drug Reaction Surveillance System. The Medicines Control Authority of Zimbabwe monitors reactions to medicines through the Adverse Drugs Reactions Surveillance System. The system relies on health professionals to report adverse drug reactions to maximize patient safety. We report results of an evaluation of the Adverse Drugs Reactions Surveillance System in Kadoma District. METHODS: a descriptive cross-sectional study was conducted using the updated CDC guidelines in six health facilities in Kadoma City. Data were collected using a pretested interviewer administered questionnaire, checklists and records review. Data was analyzed using Epi InfoTM to calculate frequencies and means. Qualitative data were analyzed manually. Written informed consent was obtained from all study participants.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Taher Ismail Boudhaye, Mohamed Sidimalek, Cheikhani Jdoud [Case report] - L’hydronephrose g&eacute;ante idiopathique: vers une approche th&eacute;rapeutique en 2 temps - 24 May 2017. http://www.panafrican-med-journal.com/content/article/27/54/abstract/ <b>L’hydron&eacute;phrose g&eacute;ante est rare. Le syndrome de jonction py&eacute;lour&eacute;t&eacute;rale repr&eacute;sente l’&eacute;tiologie la plus fr&eacute;quente. Nous rapportons un cas inhabituel d’un patient hospitalis&eacute; pour hydron&eacute;phrose g&eacute;ante avec alt&eacute;ration de l’&eacute;tat g&eacute;n&eacute;ral. Le diagnostic a &eacute;t&eacute; fait par le scanner. Le traitement avait consist&eacute; en une n&eacute;phrectomie diff&eacute;r&eacute;e apr&egrave;s drainage percutan&eacute;.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hasnaa Zaouri, Baderddine Hassam [Images in medicine] - K&eacute;ratoses s&eacute;borrh&eacute;iques: une localisation inhabituelle - 24 May 2017. http://www.panafrican-med-journal.com/content/article/27/53/abstract/ <b>Les k&eacute;ratoses s&eacute;borrh&eacute;iques (KS) sont des tumeurs &eacute;pith&eacute;liales b&eacute;nignes fr&eacute;quentes. Elles se d&eacute;veloppent pr&eacute;f&eacute;rentiellement dans les zones s&eacute;borrh&eacute;iques,notamment le visage et le tronc, rarement au niveau g&eacute;nital.Nous rapportons le cas d’un patient &acirc;g&eacute; de 41 ans, sans ant&eacute;c&eacute;dents pathologiques notables, consultait pour des l&eacute;sions pubiennes &eacute;voluant depuis trois ans. L'examen clinique retrouvait des l&eacute;sions noir&acirc;tres &agrave; surface k&eacute;ratosique, c&eacute;r&eacute;briformes au niveau de la verge. La biopsie cutan&eacute;e &eacute;tait en faveur d’une k&eacute;ratose s&eacute;borrh&eacute;ique. Un traitement par &eacute;lectrocoagulation-curetage a &eacute;t&eacute; r&eacute;alis&eacute;.Il existe deux th&eacute;ories expliquant le m&eacute;canisme de formation des KS. La premi&egrave;re, &eacute;met l’hypoth&egrave;se que les KS sont la r&eacute;sultante d’une prolif&eacute;ration de k&eacute;ratinocytes aboutissant &agrave; une inhibition de l’apoptose et l’expression de la survivine. D'apr&egrave;s la seconde, les KS seraient le r&eacute;sultat d’une accumulation de k&eacute;ratinocytes s&eacute;nescents avec une surexpression de la prot&eacute;ine p16. Dans le cas des KS g&eacute;nitales, le r&ocirc;le du frottement chronique et de l’HPV a &eacute;t&eacute; suspect&eacute;. Le traitement repose sur l'ex&eacute;r&egrave;se chirurgicale, le curetage, la cryoth&eacute;rapie par azote liquide, l'application d'acide trichloroac&eacute;tique, l'&eacute;lectrosection ou l’ablation par laser CO2. Si les KS ne posent pas a prioride probl&egrave;mes de sant&eacute; majeurs, leur localisation au niveau de la r&eacute;gion g&eacute;nitale peut influencer n&eacute;gativement la vie sexuelle du patient, d’o&ugrave; l’int&eacute;r&ecirc;t d’une prise en charge pr&eacute;coce.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com David Ayobami Adewole, Saidat Abisola Akanbi, Kayode Omoniyi Osungbade, Segun Bello [Research] - Expanding health insurance scheme in the informal sector in Nigeria: awareness as a potential demand-side tool - 19 May 2017. http://www.panafrican-med-journal.com/content/article/27/52/abstract/ <b>INTRODUCTION: the implementation and expansion of a health insurance scheme in the informal sector, particularly in developing countries, is a challenge. With the aid of an innovative Information-Education and Communication model, titled ‘Understanding the concept of health insurance: An innovative social marketing tool’, an assessment of the awareness and perception of the scheme among market women was carried out. METHODS:</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Sakher Tahaineh, Rawan Abu Mughli, Moayid Fallatah [Case report] - Giant mixed Sertoli-Leydig-Granulosa sex cord tumor of the testis; clinical, histopathological, and radiological features: a case report - 19 May 2017. http://www.panafrican-med-journal.com/content/article/27/51/abstract/ <b>Sex cord tumors of the testis in post pubertal men are rare. Mixed leydig-Sertoli-Granulosa sex cord tumors are exceptionally rare. To the best of our knowledge there is only three reported similar cases in the literature. We reported a case of a 27-year-old male who presented with huge left scrotal mass of 6-years duration. The gross tumor specimen after resection measured 11 cm in diameter. Histological examination revealed mixed sex cord stromal tumor. This case demonstrates the limited ability of accurate diagnostic determination preoperatively, with pathologic examination and immune-histochemical staining post-orchiectomy representing the only definitive means of diagnosis. It also highlights the unique radiological appearances of this tumor, which are not previously reported in literature.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Irtyah Merchaoui, Asma Chouch&egrave;ne, Ines Bouan&egrave;ne, N&eacute;ilaChaari, Wassim Zrafi, Adn&egrave;ne Henchi, Mohamed Akrout, Charfeddine Amri [Research] - Pr&eacute;occupations de carri&egrave;re chez les m&eacute;decins de travail des groupements de M&eacute;decine de travail en Tunisie - 19 May 2017. http://www.panafrican-med-journal.com/content/article/27/50/abstract/ <b>INTRODUCTION: l'insatisfaction de carri&egrave;re des m&eacute;decins de travail (MT) peut influencer leur performance et la qualit&eacute; des prestations fournies. L'objectif de notre &eacute;tude est d'&eacute;valuer la satisfaction au travail des MT du terrain de l'ensemble des Groupements de m&eacute;decine de travail (GMT) de la Tunisie et pr&eacute;ciser les facteurs d&eacute;terminants. METHODES: il s'agit d'une &eacute;tude nationale transversale portant sur les MT de 22 GMT, bas&eacute;e sur le questionnaire, valid&eacute; SAPHORA JOB. RESULTATS: 58% des MT des GMT &eacute;taient insatisfaits de leur carri&egrave;re. La satisfaction de carri&egrave;re &eacute;tait statistiquement influenc&eacute;e par le nombre d'entreprises en charge (p=0,016), l'organisation du travail (p=0,010),le ressenti du m&eacute;tier (p=0,011),le salaire (p‹10-3) et l'information sur la r&eacute;glementation en vigueur (p=0,047).</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Abdoulaye Napo, Youssouf Fofana [Images in medicine] - Lipome g&eacute;ant palp&eacute;bral droit - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/49/abstract/ <b>Les lipomes sont des tumeurs sous-cutan&eacute;es uniques ou multiples, de consistance molle, compressibles, arrondies ou lobul&eacute;es, mobiles sous la peau. Ils peuvent se localiser n'importe o&ugrave;, mais plus particuli&egrave;rement sur le cou, le tronc et les membres. Il survient surtout &agrave; l'&acirc;ge adulte, sans pr&eacute;dilection de race, ni de sexe, avec dans certaines &eacute;tudes, une l&eacute;g&egrave;re pr&eacute;dominance f&eacute;minine. Le lipome est dit g&eacute;ant lorsque la pi&egrave;ce d'ex&eacute;r&egrave;se est sup&eacute;rieure &agrave; cinq centim&egrave;tres. Nous rapportons le cas de Mr BK &acirc;g&eacute; de 35 ans qui a consult&eacute; pour une tum&eacute;faction de la paupi&egrave;re sup&eacute;rieure droite &eacute;voluant depuis 2008. Depuis quelques temps le patient ressent une g&egrave;ne fonctionnelle de l'œil droit. A la palpation, c'est une masse indolore, mobile et mole et le reste de l'examen &eacute;tait normal. Nous avions &eacute;voqu&eacute; trois hypoth&egrave;ses diagnostiques: un lipome le plus probable, un kyste et une tumeur royale. La tomodensitom&eacute;trie et l'&eacute;chographie mettaient en &eacute;vidence des images de lipome. L'excision chirurgicale de la tumeur a permis d'extraire la graisse bien encapsul&eacute;e et elle mesurait 5,5x4 cm. L'histologie de la pi&egrave;ce op&eacute;ratoire a confirm&eacute; la nature graisseuse de la tumeur. Les suites op&eacute;ratoires &eacute;taient simples avec correction des troubles visuels.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Adriana Saavedra, Nia Campinha-Bacote, Maurice Hajjar, Ernest Kenu, Fizza Syeda, Gillani, Adjoa Obo-Akwa, Margaret Lartey, Awewura Kwara [Research] - Causes of death and factors associated with early mortality of HIV-infected adults admitted to Korle-Bu Teaching Hospital - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/48/abstract/ <b>Introduction: this study sought to identify common causes of death as well as the factors associated with the high inpatient mortality rate of HIV-infected patients at the Korle-Bu Teaching Hospital (KBTH). Methods: the retrospective study reviewed the medical records of 547 HIV-infected adults aged 18 years or older admitted to the KBTH between the months of January 2012 and October 2013. Using standardized abstraction forms, clinical and demographic data of eligible patients was collected. Data was summarized using descriptive statistics. Demographic and clinical characteristics of patients who died within 7 days (early) and after (late) admission were compared using Rank Sum tests or Chi-square tests. Results: of 547 eligible patients during the period, 222 (40.6%) died during hospitalization, with 109 (49.1%) of them dying within a week of admission. Of the 222 patients who died, 190 (85.6%) were previously known HIV-positive. Yet, 141 (63.5%) of the 222 patients who died had no prior highly active antiretroviral therapy (HAART). The most common admitting diagnoses were anemia (34.2%), cerebral toxoplasmosis (29.3%), and pneumonia (25.7%); the most common causes of death were tuberculosis (34.7%), anemia (30.2%) and cerebral toxoplasmosis (27.5%). Tuberculosis was the only factor significantly associated with early death (P<0.05). Conclusion: the inpatient mortality rate among HIV-infected adults admitted to the KBTH is high. A majority of the patients were not receiving HAART despite known HIV diagnosis. Earlier initiation of HAART may lower the risk of opportunistic infections and HIV mortality rates. Additionally, a high index of suspicion and initiation of empiric treatment for TB may reduce early deaths.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Keerthi Krishnankutty Nair, Kanad Chaudhuri, Ashok Lingappa, Ranjani Shetty, Pramod Gujjar Vittobarao [Case report] - Aggressive fibromatosis of the oral cavity in a 5 year old boy: a rare case report - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/47/abstract/ <b>Fibrous tissue proliferations express a wide spectrum of histologic and morphologic variations in both infants and adults. This ranges from hypertrophic scar formation at one end to malignant fibrosarcoma at the other end of the spectrum. Aggressive fibromatosis is an intermediate tumour which is in proximity to fibro sarcomas. These are locally invasive and often recur after excision, but do not metastasize. Histologically, they are characterized by proliferating fibroblasts with little mitotic activity. Aggressive fibromatosis in the head and neck region is not common, and very sporadically occurs in the oral cavity or jaw bones. Here we report a rare case of aggressive fibromatosis occurring in a 5 year old boy.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Marc Leroy Guifo, Joel Noutakdie Tochie, Blondel Nana Oumarou, Jean Roger Moulion Tapouh, Aristide Guy bang, Aurelien Ndoumbe, Bonaventure Jemea, Maurice Aurelien Sosso [Research] - Paediatric fractures in a sub-saharan tertiary care center: a cohort analysis of demographic characteristics, clinical presentation, therapeutic patterns and outcomes - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/46/abstract/ <b>Introduction: paediatric fractures are often of good prognosis due to auto-correction of insufficient fracture reduction by bone remodeling. In sub-Saharan Africa, traditional healers are renowned for managing fractures and there is a neglect for specialized pediatric fracture care. We aimed to determine the demographic characteristics, clinical presentation, treatment patterns and outcomes of paediatric fractures in a tertiary health care centre in Yaound&eacute;. Methods: we conducted a prospective cohort study of all consenting consecutive cases of fractures in patients younger than 16 years managed between January 2011 and June 2015 at the University Teaching Hospital, Cameroon. We analysed demographic data, injury characteristics, fracture patterns, treatment details, therapeutic challenges and outcome of treatment at 12 months of follow-up. Results: we enrolled 147 fractures from 145 children with a mean age of 7 years and male-to-female sex ratio of 2.5:1. The main mechanisms of injury were games (53%) and accidental falls (20.7%). Forearm fractures were the most common fractures (38%). The mainstay of management was non-operative in 130 (88.5%) fractures, with 29.3% manipulations under anesthesia and 17 (11.5%) open reductions with internal fixation. The most surgically reduced fractures were supracondylar humeral fractures. Major difficulties were long therapeutic delay, lack of diligent anaesthesia and the lack of fluoroscopy. The outcome of treatment was favorable in 146 (99.3%) paediatric fractures. Conclusion: with the growing population of sub-Saharan Africa and the objective of becoming an emergent region, public policies should match the technical realities.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Habib Bellamlih, Lamiae Bouimetarhan, Hassan En-nouali, Touria Amil, Naoufal Chouaib, Said Jidane, Mostafa Rafai, Ahmed Belkouch, Lahcen Belyamani [Case report] - Le syndrome de Mirizzi: une cause rare de l’obstruction des voies biliaires: &agrave; propos d’un cas et revue de litt&eacute;rature - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/45/abstract/ <b>Le syndrome de Mirizzi est une complication rare de la lithiase v&eacute;siculaire chronique, avec une incidence de 0,7% &agrave; 1,4% chez les malades chol&eacute;cyst&eacute;ctomis&eacute;s. Il est caract&eacute;ris&eacute; par un ict&egrave;re cholestatique en rapport avec une compression de la voie biliaire principale par un calcul enclav&eacute; dans le collet v&eacute;siculaire ou le canal cystique. La maladie peut &eacute;voluer vers l’&eacute;rosion de la paroi du canal h&eacute;patique commun et par cons&eacute;quent, provoquer la formation d’une fistule chol&eacute;cysto-bilaire. Nous pr&eacute;sentons ici un syndrome de Mirizzi type I en soulignant l’importance du diagnostic pr&eacute;op&eacute;ratoire, celui-ci &eacute;tant rendu plus ais&eacute; par la cholangiographie r&eacute;trograde endoscopique ou par la cholangio-IRM, qui permet d’&eacute;viter des l&eacute;sions iatrog&egrave;nes de la voie biliaire principale. Le pr&eacute;sent article passe en revue la litt&eacute;rature disponible sur les divers aspects de ce syndrome, y compris sa pathogen&egrave;se, son diagnostic et sa prise en charge.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Sohaib Hayoun, Hanane El Ouazzani, Bouchra Habibi, Salwa Belhabib, Hicham Souhi, Ismail Abderahmane Rhorfi, Ahmed Abid [Case report] - Tum&eacute;faction du muscle pectoral r&eacute;v&eacute;lant une tuberculose musculaire isol&eacute;e - 18 May 2017. http://www.panafrican-med-journal.com/content/article/27/44/abstract/ <b>La tuberculose des parties molles repr&eacute;sente l'une des formes rares de la tuberculose extra pulmonaire, la localisation musculaire isol&eacute;e est par-ailleurs exceptionnelle. Nous rapportant une observation m&eacute;dicale originale, une tuberculose musculaire isol&eacute;e int&eacute;ressant le muscle grand pectoral chez un jeune patient immunocomp&eacute;tent. Le diagnostic a repos&eacute; essentiellement sur l'histologie. L'&eacute;volution &eacute;t&eacute; favorable sous traitement anti bacillaire seul. Ce cas rare est pr&eacute;sent&eacute; avec revue de litt&eacute;rature.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Houda Chahed, Ghada Kharrat, Rim Bechraoui, Jihene Marrakchi, Azza Mediouni, Mohamed Ben Amor, Rim Zainine, Nejeh Beltaief, Ghazi Besbes [Case report] - Ectopic thyroid tissue: unusual differential diagnosis of cervical paraganglioma - 16 May 2017. http://www.panafrican-med-journal.com/content/article/27/43/abstract/ <b>Ectopic thyroid tissue (ETT) lateral to the midline is rare. Its occurrence in the carotid bifurcation is exceptional. We present a 45 years woman who consulted with a slow growing right cervical swelling. Clinical examination Ultrasonography, contrast enhanced CT and cervical MRI concluded to a paraganglioma. Intra-operatively, the tumor didn't have the characteristic aspect of a paraganglioma. Complete excision was performed. Histology concluded to an ectopic micro-vesicular thyroid adenoma.Previous literature was reviewed to summarize clinical and radiologic characteristics of such rare entity. Despite its rarity, ETT must be included in the differential diagnosis of cervical paraganglioma.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Drosos Evangelos, Giakoumettis Dimitrios, Sfakianos Georgios, Eleftherakis Nikolaos, Papadopoulos Filippos, Themistocleous Marios [Case report] - Percutaneous placement of the peripheral catheter to the subclavian vein for a VA shunt - 16 May 2017. http://www.panafrican-med-journal.com/content/article/27/42/abstract/ <b>Hydrocephalus is a common neurosurgical pathology that affects people of all ages and especially the pediatric population. It can be very often a life threatening condition that pediatric neurosurgeons must deal with. Therefore a number of CSF diversion techniques have been established. The gold standard treatment currently is the placement of a ventriculo-peritoneal shunt. Because of hydrocephalus being a lifelong condition, it is almost in daily practice dealing with cases of shunt failures for a number of reasons. Herewith we present a 4 year old child with multiple ventriculo-peritoneal shunt revision surgeries and ventriculo-atrial failure due to distal catheter malfunction that was treated with percutaneous placement of the peripheral catheter in the subclavian vein.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Faten Limaiem, Marwa Bouhamed, Ghada Sahraoui, Sabeh Mzabi [Case series] - Hepatocellular carcinoma: a clinicopathological study of 64 cases - 16 May 2017. http://www.panafrican-med-journal.com/content/article/27/41/abstract/ <b>Hepatocellular carcinoma (HCC) is the most common of all liver cancers and is a major worldwide public health problem. The aim of this study was to provide an updated overview on clinicopathological features, treatment and outcome of HCC. In our retrospective study, we reviewed 64 cases of HCC that were diagnosed at the pathology department of Mongi Slim hospital over a fifteen-year period (2000- 2014). Relevant clinical information and microscopic slides were retrospectively reviewed. Our study group included 38 men and 26 women (sex ratio M/F = 1,26) aged between 8 and 83 years (mean = 56,64 years). The presenting clinical symptoms were dominated by abdominal pain (n=34), followed by altered general health (n=25) and jaundice (n=4). Fifty-five patients underwent surgical treatment. Liver transplantation was performed in two cases and transarterial chemoembolization was achieved in seven cases. Histopathological examination of the surgical or biopsy specimen established the diagnosis of conventional HCC in 55 cases, fibrolamellar carcinoma in 6 cases and clear cell HCC in 3 cases. Seven patients with HCC died postoperatively. Local recurrence of the tumour occurred in three cases and two patients had distant metastases postoperatively. The other patients are still being followed-up. Hepatocellular carcinoma is associated with a high rate of mortality because of early invasion, widespread metastasis and lack of effective therapeutic modalities. Accurate diagnosis and staging of these tumours is critical for optimal treatment planning and for determining prognosis.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Patrick Kazooba, Ivan Kasamba, Billy Nsubuga Mayanja, Joseph Lutaakome, Ivan Namakoola, Tino Salome, Pontiano Kaleebu, Paula Munderi [Research] - Cardiometabolic risk among HIV Positive Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy - 15 May 2017. http://www.panafrican-med-journal.com/content/article/27/40/abstract/ <b>BACKGROUND: we investigated the prevalence, predictors of and effect of Antiretroviral Therapy (ART) regimen on cardiometabolic risk among HIV-positive Ugandan adults at enrolment into a prospective cohort to study the Complications of Long-Term ART (CoLTART). METHODS: we collected data on cardiometabolic risk factors including dyslipidemia, hypertension, hyperglycemia, obesity and calculated the mean atherogenic index for Plasma (AIP) and 10 year Framingham risk score (FHS). Exposures were: ART regimen, duration on ART, demographic, socio-economic, behavioral, and life-style factors including smoking, physical activity and diet (including fruit and vegetables consumption). RESULTS: we enrolled 1024 participants, 65% female, mean age was 44.8 years (SD 8.0) and median duration on ART was 9.4 years (IQR 6.1-9.8). The prevalence of abdominal obesity was 52.6%, BMI&#8805;25 kg/m2-26.1%, hypertension-22.6%, high AIP-31.3% and FHS above 10% was 16.6%. The prevalence of low High Density Lipoprotein (HDL) was 37.5%, high Total cholesterol (Tc)-30.2%, high Low Density Lipoprotein (LDL) -23.6%, high Triglycerides (TG)-21.2%, low physical activity-46.4% and alcohol consumption-26.4%. In multivariate linear regression analyses, increasing age was associated with higher mean Tc, HDL, LDL, FHS (P<0.001) and hyperglycemia (p<0.005). In multivariate logistic regression analyses, Protease Inhibitor (PI) containing regimens were significantly associated with higher risks of abnormal: Tc, LDL, TG, AIP, abdominal obesity, hypertension, low HDL and lower risk of a FHS >10% compared to the non PI regimen. CONCLUSION: ART increases cardiometabolic risk. Integration of routine assessment for cardiometabolic risk factors and preventive interventions into HIV care programs in resource-limited settings is recommended.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hasnaa Zaouri, Baderdine Hassam [Images in medicine] - Une tumeur historique de la fesse: &agrave; propos d’un cas - 15 May 2017. http://www.panafrican-med-journal.com/content/article/27/39/abstract/ <b>Le lymphome anaplasique &agrave; grandes cellules (LAGC) est un type rare de lymphome T. Il repr&eacute;sente environ 1 &agrave; 2 % de tous les cas de lymphome non hodgkinien (LNH) chez l'adulte. Nous rapportons le cas d'une tumeur historique de la fesse Nous rapportons le cas d'un patient &acirc;g&eacute; de 48 ans, sans ant&eacute;c&eacute;dents pathologiques notables, qui s'est pr&eacute;sent&eacute; pour un placard tumoral de la fesse droite, &eacute;voluant depuis 12 ans. L'examen dermatologique retrouvait un placard tumoral de 15 cm de diam&egrave;tre fait de nodules tumoraux &eacute;ryth&eacute;mato-violac&eacute;s, dont certains sont ulc&eacute;r&eacute;s, si&egrave;ge au niveau de la fesse droite. Avec un nodule controlat&eacute;ral .le reste de l'examen clinique &eacute;tait sans particularit&eacute;s. L'&eacute;tude immuno-histologique &eacute;tait en faveur d'un lymphome T anaplasique CD30 +.Le bilan d'extension a objectiv&eacute; des ad&eacute;nopathies inguinales et iliaque externe d'allure lymphomateuse. Une ex&eacute;r&egrave;se chirugicale apr&egrave;s une chimioth&eacute;rapie CHOP &eacute;tait indiqu&eacute;e. Notre observation souligne l'importance de la sensibilisation de la population pour un diagnostic et prise en charge pr&eacute;coce.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Dadja Essoya Landoh, Anna-L&eacute;aKahn, Anani Lacle, Kodjovi Adjeoda, Bayaki Saka, Issifou Yaya, Danladi Ibrahim Nassoury, Assima Kalao, Makawa-Sy Makawa, Nsiari-Mueyi Joseph Biey, Andre Bita, Yaovi Temfa Toke, Petit D&ouml;rte, Lucile Imboua, Olivier Ronveaux [Research] - L’utilisation de l’approche CTC: quel impact sur la couverture vaccinale lors de la campagne pr&eacute;ventive de vaccination contre la m&eacute;ningite A avec le MenAfriVac au Togo en 2014 ? - 12 May 2017. http://www.panafrican-med-journal.com/content/article/27/38/abstract/ <b>INTRODUCTION: une campagne de vaccination contre la m&eacute;ningite A avec le vaccin MenAfriVac a &eacute;t&eacute; organis&eacute;e dans les quatre r&eacute;gions septentrionales du Togo du 28 novembre au 07 d&eacute;cembre 2014. L’approche CTC a &eacute;t&eacute; utilis&eacute;e pour la premi&egrave;re fois &agrave; une grande &eacute;chelle pour la campagne de vaccination dans dix districts sanitaires du Togo. L’objectif de cette &eacute;tude &eacute;tait d’estimer la couverture vaccinale et, de d&eacute;terminer l’effet de l’utilisation de la Cha&icirc;ne &agrave; Temp&eacute;rature Contr&ocirc;l&eacute;e (CTC) sur ces couvertures vaccinales. METHODES: l’enqu&ecirc;te s’est d&eacute;roul&eacute;e du 9 au 14 mars 2015, soit environ 3 mois apr&egrave;s la fin de la campagne de vaccination dans ces quatre r&eacute;gions. Le sondage en grappe &agrave; deux degr&eacute;s stratifi&eacute;s selon les r&eacute;gions a &eacute;t&eacute; utilis&eacute;. Dans 10 districts, le Togo a fait le choix d’utiliser le vaccin MenAfriVac en CTC. R&eacute;sultats: au total, 2707 m&eacute;nages ont &eacute;t&eacute; enqu&ecirc;t&eacute;s et 9082 personnes &acirc;g&eacute;es de 1 &agrave; 29 ans ont &eacute;t&eacute; interview&eacute;es. L’&acirc;ge moyen des personnes enqu&ecirc;t&eacute;es &eacute;tait de 11,8±7,7 ans et le sex-ratio (H/F) de 1,01. Le nombre moyen de personnes par m&eacute;nage &eacute;tait de 5,7 et celui des personnes de 1 &agrave; 29 ans cibl&eacute;es par la campagne &eacute;tait de 3,4.Sur les 9082 personnes enqu&ecirc;t&eacute;es, 8889 (98%) &eacute;taient vaccin&eacute;es. En analyse multivari&eacute;e, les facteurs associ&eacute;s &agrave; la couverture vaccinale avec le MenAfrivac &eacute;taient la r&eacute;sidence dans la zone au moment de la campagne (aOR = 4,52 ; 95%IC = [4.07 - 4.97]) et le fait d’&ecirc;tre inform&eacute; de la campagne avant son d&eacute;marrage (aOR=2,42 ; 95%IC = [2.05 - 2.80]). Par contre, la couverture vaccinale n’&eacute;tait pas diff&eacute;rente selon la zone ayant utilis&eacute; l’approche CTC ou non (aOR=0,09 ; 95%IC = [-0,27 – 0,45]). Deux cent sept personnes interrog&eacute;es (2,3%) ont d&eacute;clar&eacute; avoir eu une Manifestation Adverse Post Immunisation (MAPI) apr&egrave;s l’administration du vaccin. Il s’agissait surtout de MAPI mineures &agrave; type de fi&egrave;vre, d’abc&egrave;s et de gonflement au point d’injection. CONCLUSION: les r&eacute;sultats de cette enqu&ecirc;te montrent que l’utilisation de la CTC dans un pays &agrave; ressources limit&eacute;es comme le Togo n’a pas eu un effet n&eacute;gatif sur les couvertures vaccinales. En effet, il n’y avait pas de diff&eacute;rence entre la couverture vaccinale dans les zones CTC et celles non CTC. Il importe de capitaliser l’exp&eacute;rience acquise pour l’utilisation des vaccins du Programme Elargi de Vaccination avec l’approche CTC surtout dans les pays &agrave; ressources limit&eacute;es confront&eacute;s &agrave; la disponibilit&eacute; de la cha&icirc;ne de froid.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Siham Jridi, Rajae Azzedine, Jamal Eddine Bourkadi [Case report] - Le DRESS syndrome secondaire aux antituberculeux: &agrave; propos d’un cas - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/37/abstract/ <b>Le syndrome d'hypersensibilit&eacute; m&eacute;dicamenteuse ou Drug Rash with Eosinophilia and Systemic Symptoms ou DRESS syndrome est une toxidermie grave qui peut mettre en jeu le pronostic vital. Il faut y penser devant toute r&eacute;action cutan&eacute;e apr&egrave;s la prise des m&eacute;dicaments. Nous rapportons un cas clinique d'un patient &acirc;g&eacute; de 45 ans trait&eacute; pour tuberculose pulmonaire TPM+ pr&eacute;sentant un DRESS syndrome induit par les anti-bacillaires.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Sami Aziz Brahmi, Fatima Zahra Ziani, Youssef Seddik, Said Afqir [Letter to the editors] - L’oncologie m&eacute;dicale; nouvelle sp&eacute;cialit&eacute; en Afrique ? - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/36/abstract/ <b>Le cancer est un probl&egrave;me majeur de sant&eacute; public en Afrique. Les progr&egrave;s r&eacute;alis&eacute; dans le traitement des cancers ces dix derni&egrave;res ann&eacute;es est ind&eacute;niable. L'approche multidisciplinaire est primordiale pour une meilleure prise en charge des patients. La sp&eacute;cialit&eacute; d'oncologie m&eacute;dicale est r&eacute;cente en Afrique. En effet la plusieurs pays Africains ne dispose pas de m&eacute;decins qualifi&eacute;s dans cette sp&eacute;cialit&eacute; ou en nombre insuffisant. La lutte contre le cancer en Afrique passe par la formation de comp&eacute;tences dans ce domaine et l'&eacute;laboration de cursus afin de garantir une prise en charge optimale.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Edith Nkwembe-Ngabana, Steve Ahuka-Mundeke, Benoit Kebela-Ilunga, Emile Okitolonda Londa, Jean-Jacques Muyembe-Tamfum [Review] - Revue d’&eacute;pid&eacute;mies de grippe humaine avant la mise en place de la surveillance sentinelle en R&eacute;publique D&eacute;mocratique du Congo - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/35/abstract/ <b>En R&eacute;publique D&eacute;mocratique du Congo (RDC), plusieurs &eacute;pid&eacute;mies de la grippe restent m&eacute;connues car confondues &agrave; d’autres pathologies infectieuses avec lesquelles elle partage la m&ecirc;me symptomatologie. L’objet de cette &eacute;tude &eacute;tait de faire l’&eacute;tat de lieu des &eacute;pid&eacute;mies de grippe rapport&eacute;e en RDC avant 2008, l’ann&eacute;e de la mise en place de la surveillance de la grippe en RDC. Nous avons recherch&eacute; tous les documents (articles, rapport,…) ayant rapport&eacute; une &eacute;pid&eacute;mie de grippe ou d’infection respiratoires aigues (IRA) en RDC avant 2008 en utilisant des mots cl&eacute;s choisis. Pour chaque rapport retrouv&eacute;, les &eacute;l&eacute;ments de description d’&eacute;pid&eacute;mie ont &eacute;t&eacute; recherch&eacute;s et analys&eacute;s. Quatre documents ont &eacute;t&eacute; retrouv&eacute;s dont aucun article publi&eacute;. Les sites des &eacute;pid&eacute;mies rapport&eacute;es &eacute;taient les Zones de sant&eacute; rurales de Koshibanda et Kahemba dans le Bandundu (1995 et 2007), de Bosobolo &agrave; l’Equateur (2002) et de Kinshasa (2002-2003). Les taux d’attaque et de l&eacute;talit&eacute; &eacute;taient respectivement de 3.9% et 16% &agrave; Koshibanda ; de 0.1% et 2% &agrave; Kinshasa ; de 47.5 % et 1.5% &agrave; Bosobolo et de 14.6 % et 2.9% &agrave; Kahemba. Les enfants de moins de 5 ans &eacute;taient les plus touch&eacute;s. Leurs taux d’attaque variaient entre 22.6 et 57.7% et les taux de l&eacute;talit&eacute; entre 3.2 et 3.7%. Les deux &eacute;pid&eacute;mies de Bosobolo et de Kinshasa &eacute;taient associ&eacute;es au virus influenza H3N2.Cette revue montre une grande morbi-mortalit&eacute; des rares &eacute;pid&eacute;mies de grippe rapport&eacute;es en RDC.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Esohe Olivia Ogboghodo, Vivian Ossaidiom Omuemu, Oisedebame Odijie, Ofure Jennifer Odaman [Research] - Cold chain management practices of health care workers in primary health care facilities in Southern Nigeria - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/34/abstract/ <b>Introduction: vaccination has caused a dramatic reduction in the threat of diseasesthat were once widespread and often times fatal. The efficient practice of cold chain management is therefore key to ensuring that the benefits of vaccination are sustained. The objective of this study is to assess the practice of cold chain management among health workers in primary health care facilities in Benin City, Edo State. Methods: a descriptive cross-sectional study design was employed in this study. The study population consisted of registered nurses, auxiliary nurses and community health extension workers in primary health care facilities in Benin City, Edo State. The tool for data collection was pre-tested, structured self-administered questionnaire. Bivariate analysis between socio-demographic variables and practice of cold chain management was done. Binary logistic regression was also done to determine significant predictors of practice of cold chain management. The level of significance was set at p < 0.05 for all associations. Results: a total of 425 respondents participated in this study. Over two-thirds of respondents 314 (73.9%) had good practice of cold chain management. Significant determinants of practice of cold chain management were cold chain management training (p = 0.004), presence of functional refrigerators (p = 0.016), NPI supervision (p < 0.001) and higher level of education (p < 0.001).</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Bargley Makumbe, Cremence Tshuma, Gerald Shambira, More Mungati, Notion Tafara Gombe, Donewell Bangure, Tsitsi Patience Juru, Mufuta Tshimanga [Research] - Evaluation of severe malaria case management in Mazowe District, Zimbabwe, 2014 - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/33/abstract/ <b>INTRODUCTION: malaria is a preventable and curable disease. Mazowe district had been experiencing a lower malaria transmission rate in comparison to other districts in the Mashonaland Central province but it experienced a huge outbreak in the 2013-2014 rainy seasons with a case fatality rate (CFR) of 0.21%. This CFR was the highest in the province and it was twice as much as the national CFR (0.12%) for the same period. We evaluated severe malaria case management in Mazowe district to determine if practice is as per standard treatment guidelines.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Fikreselassie Getachew, Getachew Mullu Kassa, Mulatu Ayana, Endawoke Amsalu [Research] - Knowledge of direct obstetric causes of maternal mortality and associated factors among reproductive age women in Aneded woreda, Northwest Ethiopia; a cross-sectional study - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/32/abstract/ <b>INTRODUCTION: in Ethiopia, 20,000 women die each year from complications related to pregnancy and childbirth with much more maternal morbidity occurring for each maternal death. Good knowledge of women related with direct causes of maternal mortality is important in reducing maternal morbidity and mortality. Therefore, the aim of this study was to assess knowledge of direct obstetric causes of maternal mortality and associated factors among reproductive age of women in Aneded woreda, Northwest Ethiopia. METHODS: a community-based cross-sectional study was conducted using multi-stage sampling followed by simple random sampling technique. The study was conducted in Aneded woreda, Northwest Ethiopia. A total of 844 reproductive age women were included in the study. Pre-tested semi-structured questionnaire was used to collect the data. Data was collected through face-to-face interviews by 12 data collectors. Data was cleaned, coded and entered into Epi-data, then exported and analyzed using SPSS software. Bivariate and multivariable logistic regression analysis were computed to identify factors related to knowledge of obstetric causes of maternal mortality. The crude and adjusted odds ratios together with their corresponding 95% confidence intervals (CI) were computed. A P-value less than 0.05 was used to declare statistical significance. RESULTS: this study found that almost half (49.6%) of respondents have good knowledge level towards obstetric causes of maternal mortality. Significant variables associated with knowledge towards obstetric causes of maternal mortality were; being government employee (AOR=3.6, 95% CI=1.4-8.9), respondents who had additional monthly income from family members (AOR=1.54, 95% CI=1.04-2.27), respondents who attended primary school and above (AOR=1.6, 95% CI=1.13-2.25), distance of health facility in which the time it took less than 20 minutes (AOR=2.25, 95% CI(1.24-4.09), 20-39minutes (AOR=3.06, 95% CI=1.66-5.64), 40-60 minutes (AOR=2.38, 95% CI=1.52-5.26), and previous history of prolonged labor (AOR=1.4, 95% CI=1.04 -2.03) were the significant variables. CONCLUSION: this study indicated that the reproductive age women in the study area had poor knowledge towards about obstetric causes of maternal mortality. Therefore, to improve maternal knowledge and thereby reduce maternal death, the identified significant factors should be addressed through maternal and child health services. Designing appropriate strategies including the provision of targeted information, education, and communication is important.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com St&eacute;phane M&eacute;o Ikama, Jospin Makani, Bertrand Ellenga-Mbolla, Louis Igor Ondze-Kafata, Thierry Raoul Gombet, Gis&egrave;le Kimbally-Kaky [Case report] - Orage rythmique chez un patient porteur d’une cardiomyopathie dilat&eacute;e et un d&eacute;fibrillateur automatique implantable (DAI) - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/31/abstract/ <b>Les arythmies ventriculaires graves sont fr&eacute;quentes au cours de l’insuffisance cardiaque, mettant en jeu le pronostic vital du fait du risque accru de mort subite. Leur prise en charge efficace reste limit&eacute;e en Afrique Subsaharienne, du fait des moyens limit&eacute;s ou non disponibles comme le d&eacute;fibrillateur automatique implantable (DAI). Nous rapportons l’observation d’un patient de 56 ans, porteur d’une cardiomyopathie dilat&eacute;e non isch&eacute;mique &agrave; fraction d’&eacute;jection du ventricule gauche (FEVG) tr&egrave;s abaiss&eacute;e, et qui a b&eacute;n&eacute;fici&eacute; en 2012 de l’implantation d’un DAI en pr&eacute;vention primaire de mort subite pour des arythmies ventriculaires. Le traitement d’entretien associait un diur&eacute;tique, un IEC, et un anti-vitamine K. Le patient a pr&eacute;sent&eacute; au mois de novembre 2014 des &eacute;pisodes it&eacute;ratifs de d&eacute;charges &eacute;lectriques d&eacute;livr&eacute;es par le DAI, sans sensation de palpitations suggestives d’&eacute;pisodes d’arythmies. L’examen clinique est pauvre, en particulier pas de signes d’insuffisance cardiaque. L’interrogation du DAI a objectiv&eacute; de nombreux &eacute;pisodes de tachycardie et fibrillation ventriculaires ayant justifi&eacute; le traitement par ATP ou par chocs de 15 joules. Le patient est mis sous amiodarone et b&ecirc;tabloquant. L’&eacute;volution a &eacute;t&eacute; favorable avec un recul de trois mois, marqu&eacute;e par la reprise d’une vie normale, sans nouvel &eacute;pisode de choc. Les anti-arythmiques gardent une importance capitale en cas d’arythmies ventriculaires graves, m&ecirc;me en pr&eacute;sence d’un DAI.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Faith Mutsigiri, Patron Trish Mafaune, More Mungati, Gerald Shambira, Donewell Bangure, Tsitsi Juru, Notion Tafara Gombe, Mufuta Tshimanga [Research] - Malaria morbidity and mortality trends in Manicaland province, Zimbabwe, 2005-2014 - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/30/abstract/ <b>INTRODUCTION: Zimbabwe targets reducing malaria incidence from 22/1000 in 2012 to 10/1000 by 2017, and malaria deaths to near zero by 2017. As the country moves forward with the malaria elimination efforts, it is crucial to monitor trends in malaria morbidity and mortality in the affected areas. In 2013, Manicaland Province contributed 51% of all malaria cases and 35% of all malaria deaths in Zimbabwe. This analysis describes the trends in malaria incidence, case fatality and malaria outpatient workload compared to the general outpatient workload. METHODS: we analyzed routinely captured malaria data in Manicaland Province for the period 2005 to 2014. Epi Info version 7 was used to calculate chi-square trends for significance and Microsoft Excel was used to generate graphs. Permission to analyze the data was sought and granted by the Provincial Medical Directorate Institutional Review Board of Manicaland and the Health Studies office. RESULTS: malaria morbidity data for the period 2005-2014 was reviewed and a total of 947,462 cases were confirmed during this period. However, malaria mortality data was only available for the period 2011-2014 and cumulatively 696 deaths were reported. Malaria incidence increased from 4.4/1,000 persons in 2005 to 116.3/1,000 persons in 2014 (p<0.001). The incidence was higher among females compared to males (p-trend<0.001) and among the above five years age group compared to the under-fives (p-trend<0.001). The proportion of all Outpatient Department attendances that were malaria cases increased 30 fold from 0.3% in 2005 to 9.1% in 2014 (p-trend<0.001). The Case Fatality Rate also increased 2-fold from 0.05 in 2011 to 0.1 in 2014 (p-trend<0.001).</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Burcu Karakayali, Sila Yilmaz, Deniz &Ccedil;akir, Pembe G&uuml;l G&uuml;nes, Sirin G&uuml;ven, Ismail Islek [Case report] - Henoch-schonlein purpura associated with primary active epstein barr virus infection: a case report - 11 May 2017. http://www.panafrican-med-journal.com/content/article/27/29/abstract/ <b>Henoch-Sch&ouml;nlein purpura (HSP) is the most common form of childhood vasculitis. Various viral and bacterial infections, drugs, vaccines, food allergy and even insect bites have been considered as triggering factors in pathogenesis of HSP. Epstein-Barr virus (EBV) infection, which is associated with HSP, have been rarely reported. Herein we present HSP patient possibly caused by EBV infection. A 8-year old boy was admitted to our department with fever, rashes on legs and arms and intermittant mild abdominal pain. Multiple purpuric rashes were on his extremities, abdomen and buttock. Laboratory investigations revealed that monospot test was positive, EBV seriology tests; Anti-EA-D Ig G: 3+, Anti-VCA gp125 Ig G: 3+, Anti-VCA p19 Ig M: 2+, Anti EBNA-1 Ig M: negative, Anti EBNA-1 Ig M: negative, Anti EBNA-1 Ig G: negative. The patient was interpreted as the primary active acute EBV infection. A skin biopsy showed leucocytoclastic vasculitis. The other viral and bacterial investigations were negative. The patient was diagnosed as HSP vasculitis according to EULAR criteria and treated with intravenous hydration and ibuprofen. He was discharged after 15 days with normal laboratory findings and physical examination. We think that EBV infection may be stimulant factor for autoimmune reactions and may cause HSP vasculitis. Hence, it may be usefull to investigate the EBV infection in etiology of HSP cases.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Asma Sassi, Dhouha Bacha, Ghofrane Talbi, Sana Ben Slama, Rahma Boughriba, Zeineb Mzoughi, Saadia Bouraoui, Ahlem Lahmar [Case report] - Ad&eacute;nocarcinome colique et carcinome &agrave; cellules r&eacute;nales papillaire de type 1 synchrones: une association exceptionnelle - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/28/abstract/ <b>La d&eacute;couverte de tumeurs primitives synchrones &agrave; un cancer colorectal a fait l’objet de plusieurs publications. Cette association peut survenir de mani&egrave;re sporadique ou rentrer dans le cadre de syndromes cliniques bien d&eacute;finis tel que le syndrome de Lynch. L’association synchrone d’un cancer colorectal (CCR) et d’un carcinome &agrave; cellules r&eacute;nales est rare. Elle est encore plus rare lorsque le carcinome &agrave; cellules r&eacute;nales est de sous-type papillaire avec seulement 2 cas rapport&eacute;s dans la litt&eacute;rature. L’association CRC et r&eacute;naux ne semble pas &ecirc;tre li&eacute;e &agrave; une anomalie des prot&eacute;ines du syst&egrave;me MMR (MisMatch Repair) et n’int&egrave;gre &agrave; ce jour aucun syndrome clinique. Nous rapportons le cas d’une femme &acirc;g&eacute;e de 69 ans qui a simultan&eacute;ment pr&eacute;sent&eacute; un ad&eacute;nocarcinome colique et un carcinome papillaire du rein de type 1, de d&eacute;couverte fortuite au cours du bilan d’extension du CCR. Nous discuterons la pathog&eacute;nie ainsi que le pronostic de cette entit&eacute; rarement d&eacute;crite.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Ahmed Meklaa, Abdennasser El Kharass [Case report] - Lymphome malin non hodgkinien du sein et VIH: &agrave; propos d’un cas - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/27/abstract/ <b>Le lymphome malin non-hodgkinien (LNH) repr&eacute;sente 0,5% de tous les cancers du sein. Son diagnostic est essentiellement histologique. Nous rapportons un cas de LMNH du sein chez une patiente de 42 ans et chez qui la s&eacute;rologie VIH est positive. L’objectif de cet article est de discuter les aspects cliniques, radiologiques et th&eacute;rapeutiques de cette affection et de souligner l’importance du d&eacute;pistage du VIH en cas de localisation extraganglionnaire des LMNH.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hasnaa Zaouri, Baderddine Hassam [Images in medicine] - Papules du dos des mains: penser au granulome annulaire - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/26/abstract/ <b>Le granulome annulaire est une dermatose inflammatoire chronique. Les th&eacute;ories physiopathologiques actuelles incluent une r&eacute;action inflammatoire de type Th1 et une alt&eacute;ration du tissu &eacute;lastique. Cliniquement, ce sont des papules asymptomatiques, de couleur chaire ou ros&eacute;e, avec une bordure papuleuse annulaire. IL si&egrave;ge en regard des saillies articulaires des mains ou pieds. Sur le plan histologique, on note la pr&eacute;sence d'une n&eacute;crobiose centrale, entour&eacute;e d'un infiltrat histiocytaire palissadique. L'&eacute;tiologie de cette dermatose est inconnue. Certains facteurs ont &eacute;t&eacute; incrimin&eacute;s tels que les piq&ucirc;res d'insectes, les traumatismes, les infections virales, ainsi que la prise m&eacute;dicamenteuse. L'association aux n&eacute;oplasies et au diab&egrave;te a &eacute;t&eacute; rapport&eacute;e. Le traitement repose sur la cryoth&eacute;rapie ou la corticoth&eacute;rapie locale pour les formes localis&eacute;es; la corticoth&eacute;rapie syst&eacute;mique, les antipalud&eacute;ens de synth&egrave;se sont discut&eacute;s pour les formes diss&eacute;min&eacute;es. Nous rapportons le cas d'une patiente de 29 ans, qui consulte pour des papules asymptomatiques du dos des mains &eacute;voluant depuis 3 mois. L'examen clinique trouve des papules arrondies de couleur chaire, de 4 mm de diam&egrave;tre au niveau de la face dorsale des mains (A&B). Les diagnostics &eacute;voqu&eacute;s sont le lichen plan, les nodules de Darier Roussy, l'&eacute;ryth&eacute;ma &eacute;l&eacute;vatumdiutinum et le granulome annulaire. L'examen histologique a objectiv&eacute; une dermite granulomateuse de disposition interstitielle en faveur d'un granulome annulaire (C). Le bilan &eacute;tiologique demand&eacute; est normal. La patiente a &eacute;t&eacute; mise sous dermocortico&iuml;de classe forte &agrave; raison d'une fois par jour. L'&eacute;volution &eacute;tait marqu&eacute;e par la disparition compl&egrave;te des l&eacute;sions apr&egrave;s 4 semaines (D).</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Zemene Tigabu Kebede, Belaynew Wasie Taye, Yohannes Hailu Matebe [Research] - Childhood tuberculosis: management and treatment outcomes among children in Northwest Ethiopia: a cross-sectional study - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/25/abstract/ <b>Introduction: childhood tuberculosis (TB) treatment is becoming a major challenge in the TB control efforts of the Ethiopian health system. This study assessed childhood tuberculosis management, and treatment outcomes among children who completed anti-TB treatment in Northwest Ethiopia. Methods: a cross-sectional study was conducted among children who completed their anti-TB treatment in Gondar University Referral Hospital and 6 satellite health centers. Data from each child with tuberculosis were obtained from review of medical records. P-values < 0.05 were considered statistically significant. Results: the commonest method of childhood TB diagnosis was clinical assessment combined with chest x-ray (48.5%). Absence of compliance with TB treatment guideline (98.7%), providing inadequate anti-TB regimen (1.8%), and poor adherence to treatment (22.5%) were challenges in management of childhood tuberculosis. Treatment success rate was 78.9%. In the bivariate regression, factors associated with TB treatment outcomes were permanent residence (OR=8.3, 95%CI: 4.1, 16.7), antiretroviral therapy (OR=4.5, 95%CI: 1.2, 16), and adherence to treatment (p < 0.001). After controlling for confounders, adherence to anti-TB treatment (OR=0.003, 95% CI: 0.001, 0.02) was independent predictor of treatment success. Conclusion: anti-tuberculosis treatment success rate was still low among children in Northwest Ethiopia. The health centers and hospital shall enhance strong follow-up of children on anti-tuberculosis treatment to improve treatment success with focus on rural children.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mindekem Rolande, Monique Lechenne, Idriss Oumar Alfaroukh, Daugla Doumagoum Moto, Jakob Zinsstag, Laurent Tinoaga Ouedraogo, Sahidou Salifou [Research] - Evaluation des Connaissances-Attitudes-Pratiques des populations des districts sanitaires de Benoye, Laoukassy, Moundou et N’Djam&eacute;na Sud sur la rage canine au Tchad - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/24/abstract/ <b>INTRODUCTION: la rage canine demeure une pr&eacute;occupation en Afrique comme au Tchad. La pr&eacute;sente &eacute;tude vise &agrave; &eacute;valuer les Connaissances-Attitudes-Pratiques des populations pour la prise en charge appropri&eacute;e des personnes expos&eacute;es et une lutte efficace. METHODES: c’&eacute;tait une &eacute;tude transversale descriptive r&eacute;alis&eacute;e en juillet et septembre dans quatre districts sanitaires au Tchad en 2015. Les donn&eacute;es ont &eacute;t&eacute; collect&eacute;es &agrave; l’aide d’un questionnaire aupr&egrave;s des m&eacute;nages recrut&eacute;s suivant un sondage al&eacute;atoire &agrave; 3 degr&eacute;s. RESULTATS: c’&eacute;tait 2428 personnes enqu&ecirc;t&eacute;es avec un niveau maximum primaire (54,12%). L’&acirc;ge moyen &eacute;tait de 36 ± 13,50 ans. Ils &eacute;taient cultivateurs (35,17%), commer&ccedil;ants (18,04%), m&eacute;nag&egrave;res (12,81%). La rage &eacute;tait d&eacute;finie comme une maladie transmise du chien &agrave; l’homme (41,43%), une alt&eacute;ration du cerveau (41,27%), une sous-alimentation (10,26%). Le chat &eacute;tait faiblement connu r&eacute;servoir (13,84%) et vecteur (19,77%) ainsi que la griffure comme moyen de transmission (4,61%) et la vaccination du chat comme mesure pr&eacute;ventive (0,49%). Les premiers soins en cas de morsure &agrave; domicile &eacute;taient les pratiques traditionnelles (47,69%), le lavage des plaies (19,48%) ou aucune action entreprise (20,43%). Les m&eacute;nages consultaient la sant&eacute; humaine (78,50%), la sant&eacute; animale (5,35%) et les gu&eacute;risseurs traditionnels (27%). CONCLUSION: la communication en rapport avec des premiers soins &agrave; la maison en cas de morsure, la connaissance du chat comme r&eacute;servoir et vecteur, celle de la griffure comme moyen de transmission et la promotion de la consultation des services v&eacute;t&eacute;rinaires en cas de morsure sont n&eacute;cessaires.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Faith Mutsigiri-Murewanhema, Patron Trish Mafaune, Gerald Shambira, Tsitsi Juru, Donewell Bangure, More Mungati, Notion Tafara Gombe, Mufuta Tshimanga [Research] - Factors associated with severe malaria among children below ten years in Mutasa and Nyanga districts, Zimbabwe, 2014-2015 - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/23/abstract/ <b>BACKGROUND: severe malaria is a rare life threatening illness. Only a small proportion of patients with clinical malaria progress to this medical emergency. On reviewing 61 malaria death investigation forms submitted to the provincial office in 2014, 22(36%) were children below ten years who succumbed to severe malaria. Mutasa and Nyanga Districts reported 73% of these deaths. This study was conducted to determine factors associated with severe malaria so as to come up with evidence based interventions to prevent severe malaria and associated mortality. METHODS: a 1:2 unmatched case control study was conducted. A case was defined as a child 10 years and below, who was admitted at Hauna (Mutasa) or Nyanga District Hospitals between September 2014 and May 2015 with a primary diagnosis of severe malaria. Controls were children of similar age with uncomplicated malaria. Permission to conduct the study was sought and granted by the Medical Research Council of Zimbabwe (Approval number B/874), Joint Research Ethics Committee, Health Studies Office and the Manicaland Directorate Institutional Review Board. Written informed consent was sought from all caregivers of enrolled children. Interviewer administered questionnaires were used to ascertain exposures. RESULTS: a total of 52 cases and 104 controls were enrolled into the study. The median age of cases was 4 years (Q1=3, Q3=9) and 6 years for controls (Q1=3, Q3=8). The Case Fatality Rate among cases was 28.8%. The independent risk factors for severe malaria were; distance >10 km to the nearest health facility [Adjusted Odds Ratio (aOR)=14.35, 95% CI=1.30, 158.81], duration of symptoms before seeking medical care >2 days [aOR=9.03, 95% CI=2.21, 36.93], having comorbidities [aOR=5.38, 95% CI=1.90, 15.19], staying in a house under construction [aOR=4.51, 95%CI=1.80, 11.32] and duration of illness before receiving antimalarial medicines >24 hours [aOR=3.82, 95% CI=1.44, 10.12]. Owning at least one ITN in the household [aOR=0.32, 95% CI=0.11, 0.95] and having a mother as a caregiver [aOR=0.23, 95% CI=0.09, 0.76] were independently protective of severe malaria. Being undernourished [Odds Ratio (OR)=10.13, 95% CI=1.04, 98.49] and being female [OR=0.27, 95% CI=0.08, 0.96] were associated with mortality owing to severe malaria. CONCLUSION: factors associated with severe malaria and mortality owing to severe malaria identified in this study are consistent with other studies. Caregiver healthcare seeking behaviours, patient related factors and health system related factors are important determinants of severe malaria among children. There is need for regular health education campaigns emphasizing on malaria prevention, signs and symptoms and benefits of seeking medical care immediately for sick children.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Ayorinde Oluwatobiloba Afolayan, Funmilola Abidemi Ayeni, Werner Ruppitsch [Research] - Antagonistic and Quantitative Assessment of Indigenous Lactic Acid Bacteria in Different Varieties of Ogi against Gastrointestinal Pathogens - 10 May 2017. http://www.panafrican-med-journal.com/content/article/27/22/abstract/ <b>BACKGROUND: ogi is a popular fermented cereal gruel consumed mainly in the western part of Nigeria. Traditionally, uncooked ogi is normally administered to diarrhoea patients to reduce the frequency of stooling. This study was therefore undertaken to identify, quantify and determine the antimicrobial properties of lactic acid bacteria (LAB) isolated from Ogi. METHODS: the ogi samples (Yellow, white, sorghum) were obtained from different market in Ibadan, Nigeria and Ogi control (cooked, uncooked and Omidun) were prepared with the viable counts of bacteria monitored over 5 days period. LAB were isolated from the varieties and identified by partial sequencing of 16S rRNA gene. The antimicrobial activities of the cell free supernatant (CFS) and the viable cells of the isolated LAB against Escherichia coli EC004, Salmonella sp. SS11, Shigella sp. SS10 were investigated by agar diffusion assay, agar overlay method, and coculture growth studies. RESULTS: omidun had the highest LAB count while cooked ogi has the lowest LAB count. Weissella paramesenteroides , L. brevis, L. rossiae, L. fermentum, L. plantarum, Acetobacter pasteurianus, Paenibacillus sp. and Bacillus sp. were isolated from Ogi in this study. Large zone of inhibition (11?x?20) was observed with CFS against Salmonella sp. SS11 and Shigella sp. SS10 and also the overlay method. Coculture studies of Weissella paramesenteroides, Lactobacillus fermentum, and L. plantarum with Salmonella sp. SS11 showed a 5-8 log reduction of the pathogens’ growth after 24 hours as compared with the control. CONCLUSION: ogi and its contents have antimicrobial properties against pathogenic organisms.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Chantal Zoungrana Ouattara, Ang&egrave;le Kalmogho, Caroline Yonaba, Chantal Gabrielle Bouda, Ghislaine Yam&eacute;ogo, Ludovic Kam [Case report] - Le lymphœd&egrave;me cong&eacute;nital primaire: la maladie de Milroy: &agrave; propos du premier cas observ&eacute; dans le D&eacute;partement de P&eacute;diatrie du Centre Hospitalier Universitaire Yalgado Ou&eacute;draogo, Ouagadougou - 09 May 2017. http://www.panafrican-med-journal.com/content/article/27/21/abstract/ <b>Le lymphœd&egrave;me est l'accumulation de liquide lymphatique dans les espaces interstitiels, celui de l’enfant, la maladie de Milroy, est rare, h&eacute;r&eacute;ditaire, autosomique dominante &agrave; p&eacute;n&eacute;trance partielle. Nous rapportons un cas de maladie de Milroy chez une fillette de 7 ans vue, pour &eacute;rysip&egrave;le sur grosse jambe droite cong&eacute;nitale. Des ant&eacute;c&eacute;dents de gros membre cong&eacute;nital existent dans la famille maternelle. L’examen retrouvait une grosse jambe droite oed&eacute;mati&eacute;e et douloureuse &agrave; la palpation, avec une lichenification de la peau en regard et un &eacute;rysip&egrave;le cutan&eacute;. Le bilan paraclinique objectivait un lymphœd&egrave;me cutan&eacute; avec atteinte vasculaire &agrave; type d’ectasie de la saph&egrave;ne droite. Le caryotype de type f&eacute;minin, &eacute;tait sans anomalie, n’excluant pas des remaniements chromosomiques de petite taille. Le traitement a constitu&eacute; en une kin&eacute;sith&eacute;rapie, des bandages, le port de bas de compression et une psychoth&eacute;rapie. Ce premier cas d&eacute;crit au Burkina Faso t&eacute;moigne de la raret&eacute; de la pathologie mais surtout des difficult&eacute;s diagnostiques li&eacute;es &agrave; l’insuffisance des investigations paracliniques.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Caroline Muringazuva, Daniel Chirundu, Shepherd Shamu, Gerald Shambira, Notion Gombe, Tsitsi Juru, Donewell Bangure, Mufuta Tshimanga [Research] - An evaluation of the proposed organisation restructuring at Kadoma city 2015 - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/20/abstract/ <b>Introduction: restructuring is the corporate management term for the act of reorganizing the legal, operational, or other structures of a company for the purpose of making it more profitable or better organized for its present needs. However, preparing an organization to accept and welcome any change is crucial.There is concern though over poor service delivery ,untimely payment of workers , top management structure which is thought to be top heavy and employee costs taking (58%) of total expenditure. Methods: a descriptive cross sectional study was carried out. A cost benefit analysis was used to assess the cost and benefits of the proposed retrenchment exercise. A descriptive cross sectional study survey was conducted to assess the workers’ perceptions towards the proposed restructuring exercise. A pretested self-administered questionnaire was used for data collection and data were analysed using EpiInfoTM (CDC 2012).Written informed consent was obtained from all study participants. Results: sixty nine percent of the respondents were males. The median years working for the organisation was 8 years (Q1=1; Q3=17). The total income was surpassed by expenditure with USD$11 000 and 52% of expenditures was going towards employment costs. A midyear financial review showed that 1% was channeled towards capital expenditure 2% on repairs and maintenance and employee costs accounting to 58% of all incurred expenditure. Current departmental salary budget amounted to USD 3,3million dollars. Estimated salary costs for the proposed departmental structures amount to USD 3,8 million dollars. Comparison of the current and proposed structure showed that the proposed structure costs USD$486 000 more. Projected benefits of the proposed structure aims to improve service delivery from 60%-85% . Unlike managers, lower levels workers did not want the exercise to be carried out. Conclusion: the proposed structure has higher costs than the current structure but with more benefits in terms of service delivery. Generally workers perceived restructuring negatively and did not want it done.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Erden Erol &Uuml;nl&uuml;er, Eylem Kuday Kaykisiz [Case report] - An unanticipated diagnosis with bedside ultrasonography in patients with acute abdominal pain: rectus hematoma - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/19/abstract/ <b>Although abdominal pain is a common presentation in emergency departments, rectus sheath hematoma (RSH) is among the rarest diagnosis. Here we present 2 cases of RSH likely caused by coughing due to upper respiratory tract infection. The two described cases were diagnosed by bedside ultrasonography and confirmed as RSH by computed tomography. Review of patient history and use of ultrasonography are important to avoid misdiagnosisof RSH.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Majda Askour, Christelle Ebongo, Hafsae Bounniyt, Karima Senouci, Badredine Hassam [Case report] - Erythrodermie desquamative - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/18/abstract/ <b>Les dermatoses paran&eacute;oplasiques sont un ensemble de signes cutan&eacute;s qui peuvent pr&eacute;c&eacute;der, co&iuml;ncider ou suivre le diagnostic du cancer. Notre observation rappelle que l’&eacute;rythrodermie desquamative fait partie des dermatoses paran&eacute;oplasiques facultatives au cours des h&eacute;mopathies, d’o&ugrave; l’importance de faire un bilan complet devant ce signe clinique &agrave; la recherche d’un processus n&eacute;oplasique interne, surtout quand la clinique est suspecte.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Anass Ayad, Badr Ettouhami, Benouachane Thami, Abdelali Bentahila [Case report] - Masse abdominale chez un nourrisson r&eacute;v&eacute;lant une py&eacute;lon&eacute;phrite xanthogranulomateuse - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/17/abstract/ <b>La py&eacute;lon&eacute;phrite xanthogranulomateuse (PXG) est une forme de py&eacute;lon&eacute;phrite chronique observ&eacute;e chez l'enfant et exceptionnellement chez le nourrisson, la symptomatologie est fruste et peut retarder le diagnostic et la prise en charge. Le traitement est m&eacute;dical mais le plus souvent chirurgical avec un pronostic r&eacute;nal qui est mis en jeu. Nous rapportons l'observation d'un jeune nourrisson de 15 mois qui pr&eacute;sente une masse isol&eacute;e du flanc gauche. N'avait pas de fi&egrave;vre ou d'alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral et les urines &eacute;taient st&eacute;riles. Le bilan radiologique (&eacute;chographie r&eacute;nale, uro-scanner et scintigraphie r&eacute;nale) mettait en &eacute;vidence un aspect d'« hydropyon&eacute;phrose » sur un rein gauche non fonctionnel, &eacute;voquant le diagnostic de PXG. L'indication d'une n&eacute;phrectomie totale par lombotomie a &eacute;t&eacute; pos&eacute;e et l'examen anatomopathologique d&eacute;finitif a confirm&eacute; le diagnostic de PXG diffuse. Cette observation souligne l'importance de penser au diagnostic de PXG devant toute masse r&eacute;nale ou de contexte d'uropathie malformative avec infection urinaire &agrave; r&eacute;p&eacute;tition dont le traitement doit &ecirc;tre rigoureux et codifi&eacute;.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Kà Daye, Manga Noël Magloire, Ngom-Guéye Ndéye Fatou, Diop Ndiaga, Diop Moustapha, Cisse-Diallo Viviane Marie Pierre, Diallo-Mbaye Khardiata, Lakhe Ndèye Aissatou, Louise fortès-Déguenonvo, Ndour Cheikh Tidiane, Diop-Nyafouna Sylvie Audrey, Seydi Moussa [Research] - Facteurs associ&eacute;s &agrave; la dissociation immunovirologique chez les patients infect&eacute;s par le VIH-1 sous traitement antir&eacute;troviral hautement actif au Centre de Traitement Ambulatoire (CTA) de Dakar - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/16/abstract/ <b>INTRODUCTION: l'objection de ce travail est d'&eacute;valuer les diff&eacute;rents facteurs associ&eacute;s &agrave; la dissociation immunovirologique malgr&eacute; un traitement antir&eacute;troviral hautement actif et efficace. METHODES: il s'agissait d'une &eacute;tude de cohorte historique, descriptive et analytique faite &agrave; partir de dossiers de patients infect&eacute;s par le VIH-1; sous traitement antir&eacute;troviral depuis au moins 12 mois, suivis dans la cohorte du CTA de 2001 &agrave; 2011 et ayant une charge virale ind&eacute;tectable depuis 6 mois. RESULTATS: durant cette p&eacute;riode d'&eacute;tude de 10 ans, la pr&eacute;valence de la DIV &eacute;tait de 19,3%. Le sexe f&eacute;minin &eacute;tait pr&eacute;dominant avec un sexe ratio de 1,9. La dissociation immunovirologique a &eacute;t&eacute; plus fr&eacute;quemment rencontr&eacute;e chez les patients de sexe masculin (29,7% vs 14,1%) avec une diff&eacute;rence statistiquement significative (p = 0,00006). L'&acirc;ge m&eacute;dian &eacute;tait de 44 ans ± 10 ans. Un ant&eacute;c&eacute;dent de tuberculose a &eacute;t&eacute; retrouv&eacute; dans environ un tiers des cas (31,4%). La dissociation immunovirologique &eacute;tait significativement plus fr&eacute;quente chez les patients ayant un ant&eacute;c&eacute;dent de tuberculose (p = 0,00005). La plupart des patients (68%) &eacute;tait au stade SIDA 3 ou 4 de l'OMS. Les patients ayant une dissociation immunovirologique &eacute;taient plus souvent aux stades 3 et 4 de l'OMS (p = 0,0001). La d&eacute;nutrition a &eacute;t&eacute; not&eacute;e dans plus de la moiti&eacute; des cas (56,2%) et la dissociation immunovirologique pr&eacute;dominait chez les patients d&eacute;nutris (p=0,005). Le taux moyen de lymphocytes TCD4+ &eacute;tait de 86,7± 83 cellules/mm3. La dissociation immunovirologique &eacute;tait plus fr&eacute;quente chez les patients ayant un taux de lymphocytes TCD4 bas &agrave; l'initiation avec une diff&eacute;rence statistiquement significative (p = 0,00000). En analyse multivari&eacute;e ; Seuls l'&acirc;ge sup&eacute;rieur ou &eacute;gal &agrave; 43 ans, le taux de CD4 initial < 100 c/mm3 et le sexe masculin &eacute;taient significativement associ&eacute;s &agrave; cette dissociation immunovirologique. CONCLUSION: les principaux facteurs associ&eacute;s &agrave; la dissociation immunovirologique &eacute;tant &eacute;valu&eacute;s, d'autres &eacute;tudes portant sur ce groupe m&eacute;riteraient d'&ecirc;tre envisag&eacute;es afin de connaitre l'impact de cette r&eacute;ponse immunologique partielle sur la survenue d'infections opportunistes ou bien la mise en place d'une trith&eacute;rapie sp&eacute;cifique uniquement dans le but d'avoir une restauration immunologique optimale.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hanae Harchaoui, Boussayna Iraqi, Houria knouni, Youness Taboz, Hasnae Benkirane, Hassan Aguenaou, Amina Barakat [Case report] - H&eacute;matome h&eacute;patique n&eacute;onatal: &agrave; propos d’un cas - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/15/abstract/ <b>L'h&eacute;matome h&eacute;patique est une affection m&eacute;connue, peut &ecirc;tre gravissime et son diagnostic se fait souvent lors de l'autopsie p&eacute;rinatale. Devant une symptomatologie clinique souvent non sp&eacute;cifique et un tableau biologique retard&eacute;. Le diagnostic est bas&eacute; essentiellement sur l'&eacute;chographie et son traitement est souvent conservatif. Nous rapportons un cas d'h&eacute;matomes h&eacute;patiques chez un nouveau-n&eacute; &agrave; terme, asymptomatique dans un contexte de traumatisme obst&eacute;trical.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Mohamed Amine Azami, Iliass El Alami, Imane Bourhafour, Salwa Belhabib, Mohamed Oukabli, Abderrahmane Albouzidi [Case report] - Gliosarcome c&eacute;r&eacute;bral primitif: &agrave; propos de deux cas et revue de la litt&eacute;rature - 08 May 2017. http://www.panafrican-med-journal.com/content/article/27/14/abstract/ <b>Le gliosarcome est une tumeur c&eacute;r&eacute;brale tr&egrave;s rare repr&eacute;sentant 1,8 &agrave; 8% de l’ensemble des tumeurs gliales. Il est consid&eacute;r&eacute; par l’organisation mondiale de la sant&eacute; comme une variante de glioblastome. C’est une tumeur &agrave; double composante gliale et sarcomateuse. Le tableau clinique est polymorphe, les donn&eacute;es de l’imagerie sont &eacute;vocatrices, la confirmation est histologique. Le traitement est essentiellement chirurgical. Le pronostic est li&eacute; &eacute;troitement &agrave; la qualit&eacute; d’ex&eacute;r&egrave;se. Dans notre travail Nous rapportons deux observations cliniques dont l’objectif est de faire le point sur les particularit&eacute;s, essentiellement diagnostiques, th&eacute;rapeutiques ainsi que pronostiques de cette entit&eacute; rare.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Stephane Tshitenge Tshitenge, Chiratidzo Ellen Ndhlovu, Radiance Ogundipe [Research] - Evaluation of problem-based learning curriculum implementation in a clerkship rotation of a newly established African medical training institution: lessons from the University of Botswana - 05 May 2017. http://www.panafrican-med-journal.com/content/article/27/13/abstract/ <b>BACKGROUND: problem-based Learning (PBL) curricula, like all curricula, require systematic evaluation as there is a risk of implementing a dysfunctional PBL curriculum. The study intended to evaluate the PBL curriculum delivery from the perspective of the clerkship students at the University of Botswana-Faculty of Medicine. METHODS: a cross-sectional study was conducted among clerkship students in Family Medicine, Paediatrics, Internal Medicine and Surgery. During a 4-week period, each respondent completed weekly a questionnaire based survey tool. The three part questionnaire consisted of demographic data, ‘seven-jumps’ adapted from a ‘typical’ PBL tool to evaluate PBL process and 11 items ‘adopted ‘from the Short-Questionnaire-to-Evaluate-the-Effectiveness-of-Tutors in the PBL tool to evaluate the PBL facilitation with open ended questions at the end. RESULTS: Of the 81 eligible participants, 89% (n=72) responded. We collected back 141 (49%) forms out of the 288 expected (72 X 4 weeks). PBL first sessions took place all the time only in Family Medicine and in about 75% of the time in Pediatrics but none were conducted in the other disciplines. Overall, they evaluated the PBL process as ‘good’ (median= 8 /10) and the PBL facilitation as ‘very good’ (median=9 /10). Students appeared to have differing opinions on the preferred approach to the nature of patient problems that the PBL sessions should be structured around. CONCLUSION: despite students rating PBL process as ‘good’ and facilitation as ‘very good’, PBL first sessions were not consistently undertaken.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Marcellin Bugeme, Papa Alioune Seck, Paul Makinko Ilunga, Olivier Mukuku [Case report] - Trouble psychotique partag&eacute; atypique: &agrave; propos d’une observation - 05 May 2017. http://www.panafrican-med-journal.com/content/article/27/12/abstract/ <b>Le trouble psychotique partag&eacute; est une entit&eacute; psychiatrique consid&eacute;r&eacute;e comme rare et caract&eacute;ris&eacute;e par la transmission des id&eacute;es d&eacute;lirantes d'un patient dit "inducteur", &agrave; un autre dit "induit". Nous rapportons une observation clinique de trouble psychotique partag&eacute; atypique mettant en jeu un d&eacute;lire de pers&eacute;cution et un autre de grandeur induits chez un adolescent par deux sujets (grand-p&egrave;re et oncle paternel) ayant pr&eacute;sent&eacute; deux entit&eacute;s psychiatriques diff&eacute;rentes, mais tous les partagent &agrave; un m&ecirc;me sujet (le troisi&egrave;me). La nature du contenu transmis au troisi&egrave;me sujet &eacute;tait la somme des id&eacute;es des deux premiers. Ces trois sujets vivaient en association proche, dans un milieu clos et coup&eacute; de l'ext&eacute;rieur.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Aymen Ben Fredj, Lassaad Hassini, Aymen Fekih, Mohamed Allagui, Issam Aloui, Abderrazek Abid [Case report] - Chondroblastic osteosarcoma of the distal tibia: a rare case report - 05 May 2017. http://www.panafrican-med-journal.com/content/article/27/11/abstract/ <b>Chondroblastic osteosarcoma, representing about 25% of osteosarcoma, is a fatal primary malignancy of the skeleton if not diagnosed and treated appropriately. It most commonly occurs in the long bones of the extremities near the metaphyseal growth plates. In this report, we describe the occurrence of chondroblastic osteosarcoma involving the left distal tibia in a 14-year-old male. The diagnosis was confirmed by the histological examination of a surgical biopsy. The patient was treated by both surgery and neoadjuvant chemotherapy. No recurrence was noted at 3 years of follow-up. To our knowledge, only two cases describing chondroblastic osteosarcoma of the distal tibia had been reported through English medical literature. Therefore, the aim of our article is to make the clinician aware of this rare clinical presentation and also to provide a comprehensive review of the literature related to this uncommon malignant tumour.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Meryam Rchachi, Maazou Larwanou, Hanan El Ouahabi, Farida Ajdi [Case report] - Association syndrome de Williams et insuffisance surr&eacute;nalienne - 05 May 2017. http://www.panafrican-med-journal.com/content/article/27/10/abstract/ <b>Les anomalies du d&eacute;veloppement d&eacute;crites dans le syndrome de Williams, associent classiquement une dysmorphie, des malformations cardiovasculaires et un profil neuropsychologique particulier et d'autres troubles associ&eacute;s. Nous rapportons le cas d'une jeune fille &acirc;g&eacute;e de 17 ans, issu d'un mariage non consanguin, chez qui le syndrome de Williams a &eacute;t&eacute; d&eacute;couvert suite &agrave; une exploration dans le cadre du bilan d'un retard staturo-pond&eacute;ral. L'association a une insuffisance surr&eacute;nalienne primitive en fait la singularit&eacute;. La confirmation diagnostique avait n&eacute;cessit&eacute; une analyse cytog&eacute;n&eacute;tique et mol&eacute;culaire. La prise en charge consistait &agrave; la mise en route de traitement pour l'insuffisance surr&eacute;nalienne associ&eacute; &agrave; une surveillance clinico-biologique.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Harifetra Mamy Richard Randriamizao, Aur&eacute;lia Rakotondrainibe, Nadia Marie Philibertine Rahanitriniaina, Andriambelo Tovohery Rajaonera, Mamy Lalatiana Andriamanarivo [Case series] - Prise en charge p&eacute;ri-op&eacute;ratoire de l’atr&eacute;sie de l’œsophage: petits pas non n&eacute;gligeables &agrave; Madagascar - 05 May 2017. http://www.panafrican-med-journal.com/content/article/27/9/abstract/ <b>La prise en charge de l'atr&eacute;sie de l'œsophage est encore limit&eacute;e par la pr&eacute;carit&eacute; des plateaux techniques &agrave; Madagascar. Les cas d&eacute;crits dans ce travail ont pour objectif de relater nos possibilit&eacute;s th&eacute;rapeutiques et de d&eacute;crire les progr&egrave;s &agrave; r&eacute;aliser pour optimiser le traitement de cette pathologie cong&eacute;nitale. Nous avons recueilli tous les dossiers ayant pour motif d’entr&eacute;e au service de R&eacute;animation Chirurgicale du CHU JRA, Antananarivo, une atr&eacute;sie de l’œsophage. Nous en avons retenu les tous premiers cas qui ont surv&eacute;cu sur une p&eacute;riode de 42 mois entre janvier 2011 et juin 2014. Parmi 17 admissions pour atr&eacute;sie de l’œsophage, trois nouveau-n&eacute;s &agrave; terme, admis successivement en R&eacute;animation Chirurgicale, pr&eacute;sentant un type III d'atr&eacute;sie; premiers patients, &agrave; Madagascar, ayant surv&eacute;cu au d&eacute;cours de leur intervention. Une seule patiente avait pr&eacute;sent&eacute; des malformations associ&eacute;es. Ces trois b&eacute;b&eacute;s ont &eacute;t&eacute; extub&eacute;s pr&eacute;cocement au bloc op&eacute;ratoire, sous oxyg&eacute;noth&eacute;rapie jusqu'&agrave; une ventilation spontan&eacute;e efficace. Des s&eacute;ances de kin&eacute;sith&eacute;rapie postop&eacute;ratoire permettaient d'am&eacute;liorer l'&eacute;tat respiratoire des nouveau-n&eacute;s. La mortalit&eacute; globale de cette pathologie en 42 mois a &eacute;t&eacute; de 76,5%. Malgr&eacute; ces premiers succ&egrave;s, des progr&egrave;s restent &agrave; entreprendre dans le traitement de cette anomalie cong&eacute;nitale ; de son diagnostic jusqu'&agrave; la p&eacute;riode postop&eacute;ratoire. L'am&eacute;lioration du plateau technique, surtout ventilatoire et du support nutritionnel permettrait d'avoir des r&eacute;sultats plus probants, tout comme dans les pays o&ugrave; des progr&egrave;s ont &eacute;t&eacute; r&eacute;alis&eacute;s sur le plan de la r&eacute;animation.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Hichem Cheikhrouhou, Karim Jmal, Amine Kharrat, Meriem Keskes, Abdelhamid Karoui [Case report] - Chol&eacute;cystite aigue gangr&eacute;neuse alithiasique en postop&eacute;ratoire d’une chirurgie orthop&eacute;dique: &agrave; propos d’un cas - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/8/abstract/ <b>La chol&eacute;cystite gangreneuse alithiasique postop&eacute;ratoire est une complication grave et s&eacute;v&egrave;re, surtout chez les malades hospitalis&eacute;s en r&eacute;animation. Elle survient le plus souvent au d&eacute;cours d'une chirurgie vasculaire ou digestive majeure, d'un polytraumatisme, dans un contexte septique ou dans un contexte de choc. Nous rapportons l'observation d'un homme &acirc;g&eacute; de 74 ans op&eacute;r&eacute; d'une fracture du col du f&eacute;mur, au sixi&egrave;me jour postop&eacute;ratoire il a d&eacute;velopp&eacute; un tableau clinique d'une chol&eacute;cystite aigue dont les explorations radiologiques ont confirm&eacute; son caract&egrave;re alithiasique. Apr&egrave;s une chol&eacute;cystectomie en urgence, l'&eacute;tude anatomopathologique a conclu &agrave; une chol&eacute;cystite gangreneuse alithiasique.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Philippe Mahouna Adjagba, Arnaud Sonou, L&eacute;hila Bagnan Tossa, L&eacute;opold Codjo, Murielle Hounkponou, Salimatou Assani Mouta&iuml;rou, Yasmine Eyiss&egrave; Kpossou, Latif Mouss&eacute;, Yessoufou Tchabi, Jeanne Vehounkp&eacute; Sacca, Martin D&egrave;donougbo Hou&eacute;nassi [Case report] - Ventricule droit &agrave; double chambre (VDDC) isol&eacute;: &agrave; propos d'un cas au CNHU, Cotonou, B&eacute;nin - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/7/abstract/ <b>Le ventricule droit &agrave; double chambre (VDDC) est une malformation cardiaque rare dans laquelle le ventricule droit est divis&eacute; en deux chambres par une bande musculaire anormale. Il est associ&eacute; dans 80 &agrave; 90% &agrave; d'autres malformations. L'expression clinique est vari&eacute;e et d&eacute;pend de l'importance de l'obstruction intraventriculaire. Nous rapportons l'observation d'une adolescente de 16 ans, pr&eacute;sentant une forme isol&eacute;e de VDDC r&eacute;v&eacute;l&eacute;e par des syncopes &agrave; r&eacute;p&eacute;tition. Le diagnostic est fait par l'&eacute;chocardiographie D&ouml;ppler. La r&eacute;section chirurgicale de la bande musculaire anormale a &eacute;t&eacute; faite avec succ&egrave;s.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Ayad Anass, Amina Kili [Images in medicine] - Pubert&eacute; pr&eacute;coce chez une fillette r&eacute;v&eacute;lant un corticosurr&eacute;nalome malin - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/6/abstract/ <b>Il s'agit d'une fillette de 5ans, hospitalis&eacute;e pour pubert&eacute; pr&eacute;coce h&eacute;t&eacute;rosexuelle. Elle est n&eacute;e par c&eacute;sarienne, le premier cri &eacute;tait imm&eacute;diat avec un poids de 4 kg, le d&eacute;veloppement psychomoteur &eacute;tait normal et pas d'histoire de malignit&eacute; dans la famille. Le d&eacute;but de sa maladie remontait &agrave; l'&acirc;ge de 4 ans par l'apparition d'une pilosit&eacute; pubienne progressive, d'une acn&eacute;, de s&eacute;borrh&eacute;e et d'une hypertrophie clitoridienne, une voix grave et d&eacute;veloppement d'une masse musculaire de type masculin. Ainsi que l'apparition de duvet au niveau de la l&egrave;vre sup&eacute;rieure et sur le visage. Le tout &eacute;voluant dans un contexte d'agitation et d'agressivit&eacute;. La palpation abdominale, a trouv&eacute; une &eacute;norme masse difficile &agrave; d&eacute;limiter, allant de l'hypochondre jusqu'au flanc droit et arrivant jusqu'&agrave; l'ombilic. L'examen des organes g&eacute;nitaux externes a not&eacute; la pr&eacute;sence des grandes l&egrave;vres. Absence des petites l&egrave;vres et hypertrophie clitoridienne (clitoris p&eacute;nien) et une pilosit&eacute; pubienne stade 4 selon la classification de Tanner. Le reste de l'examen somatique &eacute;tait normal. Le bilan hormonal a objectiv&eacute; une &eacute;l&eacute;vation de l'aldost&eacute;rone, &#916; Androstendione, 17 hydroxyprog&eacute;st&eacute;rone, SDHA, et la testosterone ainsi qu'une cortisol&eacute;mie de 8 h &agrave; 778,5 nmol/l (VN= 280-876nmol/l). La TDM abdominale a montr&eacute; une masse d'origine surr&eacute;nalienne, h&eacute;t&eacute;rog&egrave;ne, polylob&eacute; avec des zones de n&eacute;crose, hyper vasculaires, d'allure maligne corticosurr&eacute;nalome tr&egrave;s probable. Une ex&eacute;r&egrave;se tumorale totale a &eacute;t&eacute; r&eacute;alis&eacute;e avec confirmation anatomopathologique, Les suites op&eacute;ratoires &eacute;taient simples. La petite a &eacute;t&eacute; mise sous hydrocortisone &agrave; la dose 15 mg/m<sup>2</sup>/j associ&eacute;s &agrave; un min&eacute;ralocortico&iuml;de. Aucune chimioth&eacute;rapie n'a &eacute;t&eacute; donn&eacute;e.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Berthier Nsadi, Olivier Detry, Willy Arung [Letter to the editors] - Inguinal hernia surgery in developing countries: should laparoscopic repairs be performed ? - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/5/abstract/ <b>Laparoscopy is a clear revolution in abdominal surgery and should be developed in dedicated experienced facilities in developing countries. However, compared to the Lichtenstein procedure, laparoscopic techniques of inguinal hernia repair have clear disadvantages, as the necessity of a general anaesthesia, of availability of CO2 and electricity, a higher cost and a risk of more life-threatening complications. The Lichtenstein technique is a much easier procedure can be easily performed under spinal or even local anaesthesia. The Lichtenstein technique should be considered as the standard of care of inguinal hernias not only in the developing countries, but in the whole world, as until now, no clear differences in term of recurrence and pain could be demonstrated between both techniques. The availability of a cheap mesh is still a challenge, and the use of mosquito nets should be further investigated.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Matthieu Betofe Labama, Eug&egrave;ne Basandja Longembe, Joris Losimba Likwela [Research] - Efficacit&eacute; de la gestion de vaccins et qualit&eacute; de vaccination &agrave; l'antenne PEV Kisangani en R&eacute;publique D&eacute;mocratique du Congo - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/4/abstract/ <b>INTRODUCTION: la qualit&eacute; des vaccins conditionne les r&eacute;sultats attendus de la vaccination. Elle est tributaire de l'efficacit&eacute; de syst&egrave;me de gestion technique et logistique mis en place. Cette &eacute;tude est men&eacute;e pour &eacute;valuer l'efficacit&eacute; de la gestion des vaccins et d'en tirer des le&ccedil;ons. METHODES: une &eacute;tude r&eacute;trospective est men&eacute;e pendant la p&eacute;riode de 2010 &agrave; 2014 sur la gestion logistique de vaccins au niveau de l'antenne PEV Kisangani. La revue documentaire compl&eacute;t&eacute;e par les entretiens semi-dirig&eacute;s des gestionnaires et prestataires de services de vaccination ont permis d'&eacute;valuer la gestion de vaccins en se servant des mod&egrave;le GEV de l'OMS, en vue de d&eacute;gager les &eacute;carts. RESULTATS: il est observ&eacute; une faible connaissance des prestataires sur les vaccins qui ne peuvent pas &ecirc;tre congel&eacute;s, sur les tests de cong&eacute;lation et d'autres dommages de vaccins. La gestion informatis&eacute;e des donn&eacute;es au niveau de l'antenne est correctement assur&eacute;e. Aucun crit&egrave;re &eacute;valu&eacute; n'a atteint l'objectif de 80%. Le respect de la temp&eacute;rature de stockage est de 70% au niveau de l'antenne ; le crit&egrave;re relatif &agrave; la gestion de vaccins est respectivement de 65% et 67% au niveau du BCZ et CS. Le crit&egrave;re relatif &agrave; la maintenance est nul &agrave; tous les niveaux. CONCLUSION: le dysfonctionnement de syst&egrave;me logistique est remarquable &agrave; tous les niveaux de la pyramide sanitaire, ceci pourrait interf&eacute;rer avec la qualit&eacute; et l'impact attendu de la vaccination. Une attention particuli&egrave;re doit &ecirc;tre accord&eacute;e &agrave; la maintenance des &eacute;quipements.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Traore Abdoulaye Ababacar, Mvumbi Kutubisa Franck, Ly Seydou, Alaoui Lamrany Youssef, Boubbou Meryem, Maaroufi Maaroufi, Alami Badreeddine [Case report] - D&eacute;couverte tomodensitom&eacute;trique d’un m&eacute;sent&egrave;re commun complet par perforation d’une appendicite aigu&euml; - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/3/abstract/ <b>Le m&eacute;sent&egrave;re commun complet est une anomalie rare de rotation du tube digestif. Sa d&eacute;couverte est exceptionnelle &agrave; &acirc;g&eacute; adulte; &agrave; cette p&eacute;riode, il demeure tr&egrave;s souvent asymptomatique et donc non diagnostiqu&eacute;e. Le m&eacute;sent&egrave;re commun complet peut &ecirc;tre d&eacute;couvert de fa&ccedil;on fortuite, lors d’un syndrome appendiculaire ectopique, comme ce fut le cas de notre observation. Il s’agissait d’un patient &acirc;g&eacute; de 42 ans, qui &agrave; pr&eacute;sent&eacute; un tableau inflammatoire clinico-biologique aigu&euml; pelvien. La TDM a permis de poser le diagnostic d’une appendicite aigue sur un m&eacute;sent&egrave;re commun complet. Le traitement par laparotomie a confirm&eacute; le diagnostic d’une appendicite aigu&euml; perfor&eacute;e sur la malrotation intestinale. Les suites post appendicectomies &eacute;taient favorables.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Jean Eric Kouassi Kouam&eacute;, Blaise Yao Loukou, Justin Leopold Niaore Sery Bada, Innocent Kouam&eacute; M’bra, L&eacute;opold Krah Koffi, Franck Lohourou Grah, Michel Kodo [Case report] - Abc&egrave;s froid dorsolombaire r&eacute;v&eacute;lant un mal de Pott - 02 May 2017. http://www.panafrican-med-journal.com/content/article/27/2/abstract/ <b>Les abc&egrave;s froids tuberculeux repr&eacute;sentent une forme rare et inhabituelle de tuberculose extra pulmonaire. Nous rapportons un cas d’abc&egrave;s froid dorsolombaire r&eacute;v&eacute;lant un mal de Pott sans complications neurologiques chez un patient de 27 ans, pr&eacute;sentant depuis 05 mois une tum&eacute;faction dorsolombaire gauche. L’examen du pr&eacute;l&egrave;vement &agrave; l’issu d’une incision et drainage de l’abc&egrave;s a permis de confirmer l’origine tuberculeuse. Un traitement antituberculeux de 12 mois permettait une gu&eacute;rison avec une s&eacute;quelle &agrave; type de gibbosit&eacute; mod&eacute;r&eacute;e.</b><br/> text/html 2017-07-26T04:47:35+01:00 http://www.panafrican-med-journal.com Sempeera Hassard, Anguzu Ronald, Kawooya Angella [Research] - Patient attitudes towards community-based tuberculosis DOT and adherence to treatment in an urban setting; Kampala, Uganda - 01 May 2017. http://www.panafrican-med-journal.com/content/article/27/1/abstract/ <b>BACKGROUND: High Tuberculosis treatment default rate (17%) and sub-optimal treatment completion rates (45%) has burdened Kampala. Nevertheless, there are observable increase in the number of patients on TB DOT; from 6% to 29% in two consecutive annual reports. The main objective was to determine the association of TB patient attitudes towards community-based observers on the TB drug adherence on directly observed treatment for TB in Kampala. METHODS: A cross-sectional study was carried out in Lubaga division, Kampala. A total of 201 patients in continuation phase of treatment for Pulmonary TB (i.e. 8 to 20 weeks of TB treatment) were included in the study. Patient attitudes were measured using a 4-point Likert scale aggregated into a binary outcome with “agree” and “disagree” responses. Poisson regression model using a forward fitting approach in STATA v12 was used to determine the association between patient attitude towards CB-DOTs observers and adherence to TB treatment. RESULTS: Among the 201 patients, 66% reported their treatment was being observed by someone. Relatives were the commonest (82%) treatment observers, 26% were non adherent to their TB treatment. Perceiving “no need for a treatment observer” and “people rejecting TB patients” were predictors of non-adherence to TB treatment (IRR=1.6,95%CI 1.00-2.57;p=0.048) and (IRR=0.6, 95%CI 0.35-0.95; p=0.019) respectively. CONCLUSION: Patient’s perceived attitude and stigma towards treatment observers contribute to non-adherence on TB treatment. For improved local TB control, more emphasis is needed to build a friendly environment between treatment supporters and patients during the course of TB treatment.</b><br/>