Pan african Medical Journal - Volume 26 Pan african Medical Journal. Volume 26 http://www.panafrican-med-journal.com/ 2017-03-22T22:37:29+01:00 pamj logo http://www.panafrican-med-journal.com http://www.panafrican-med-journal.com/img/logo.png text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Zafindrasoa Domoina Rakotovao-Ravahatra, Fidiniaina Mamy Randriatsarafara, Sa&iuml;da Rasoanandrasana, L&eacute;a Raverohanta, Andriamiadana Luc Rakotovao [Research] - Ph&eacute;notypes de r&eacute;sistance des souches d’Escherichia coli responsables d’infection urinaire au laboratoire du Centre Hospitalo-Universitaire de Befelatanana Antananarivo - 22 March 2017. http://www.panafrican-med-journal.com/content/article/26/166/abstract/ <b>INTRODUCTION: l’infection urinaire &agrave; Escherichia coli est fr&eacute;quente en milieu hospitalier. Cette &eacute;tude se propose de d&eacute;crire les diff&eacute;rents ph&eacute;notypes de r&eacute;sistance des souches d’Escherichia coli afin de surveiller leur &eacute;mergence. METHODES: il s’agit d’une &eacute;tude r&eacute;trospective de type descriptif de 102 souches d’Escherchia coli responsables d’infection urinaire sur une p&eacute;riode allant du mois de Janvier 2014 au mois d’Octobre 2016 au Laboratoire du Centre Hospitalo-Universitaire Befelatanana Antananarivo. RESULTATS: la r&eacute;sistance aux b&eacute;ta-lactamines a identifi&eacute; des p&eacute;nicillinases de haut niveau 50% (n=51), des Escherichia coli s&eacute;cr&eacute;trices de B&eacute;ta-Lactamase &agrave; Spectre Etendu E-BLSE 22,5% (n=23), des c&eacute;phalosporinases de haut niveau 14,7% (n=15), des p&eacute;nicillinases de bas niveau 5,9% (n=6), des souches sauvages 5,9% (n=6) et une souche d’Escherichia coli hautement r&eacute;sistante &eacute;mergente. La r&eacute;sistance aux aminosides a concern&eacute; 58 (56,9%) ph&eacute;notypes sauvages, 29 (28,4%) souches sensibles &agrave; l’amikacine et 15 (14,7%) r&eacute;sistants &agrave; tous les aminosides. La r&eacute;sistance aux fluoroquinolones a identifi&eacute;e 52 (51%) souches sauvages, 9 (8,8%) souches sensibles &agrave; la ciprofloxacine et 41 (40,2%) r&eacute;sistantes &agrave; tous les fluoroquinolones. Les femmes (25, 7%) (p= 0,25, NS), les sujets de plus de 60 ans (38,7%) (p=0,02), les sujets hospitalis&eacute;s dans le service de n&eacute;phrologie (53,8%) (p=0,04), ayant pr&eacute;sent&eacute; des troubles urinaires et r&eacute;naux (29, 7%) (p= 0,2, NS), ont &eacute;t&eacute; les plus affect&eacute;s par les E-BLSE. CONCLUSION: la multi-r&eacute;sistance &eacute;lev&eacute;e des souches d’Escherichia coli interpelle sur une r&eacute;vision du traitement empirique des infections urinaires.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Ahmadou Musa Jingi, Liliane Mfeukeu Kuate, Jean Jacques Noubiap [Case report] - A case management of hypertension in the elderlyin sub-Sahara Africa: lessons from Granny - 22 March 2017. http://www.panafrican-med-journal.com/content/article/26/165/abstract/ <b>Management of chronic disease conditions in the elderly is challenging. They usually have many co-morbidities requiring multiple drug regimens, and memory or cognitive problems that can interfere with management. Also, they sometimes have a degree of social problems as they might often live alone, and thereby cater for their daily activities with minimal assistance. Multiple drug use combined with their fragile health predispose them to adverse drug reactions, drug-drug interactions, and direct drug toxicity from overdosing. We report and discuss the lessons learnt from the case of an elderly woman in an urban setting in sub-Saharan Africa who presented with problems of drug dosing, adverse drug effect, and drug-drug interaction that might prove useful in the future management of hypertension with angiotensin converting enzyme inhibitors.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Amira Omrane, Awatef Kreim, Mohamed Adn&egrave;ne Henchi, Selma Kammoun, Leila Bessadi, Charfeddine Amri, Taoufik Khalfallh, Lamia Bouzgarrou [Research] - Asthme professionnel indemnis&eacute; dans le centre tunisien: &eacute;tude transversale sur huit ans - 21 March 2017. http://www.panafrican-med-journal.com/content/article/26/164/abstract/ <b>INTRODUCTION: les objectifs &eacute;taient de dresser le profil &eacute;pid&eacute;miologique des patients indemnis&eacute;s pour asthme professionnel dans le centre tunisien, identifier leurs caract&eacute;ristiques professionnelles et &eacute;valuer les pratiques d’indemnisation de cette maladie professionnelle. METHODES: &eacute;tude exhaustive r&eacute;trospective, men&eacute;e sur une p&eacute;riode de huit ans, &agrave; propos des cas d'asthme professionnel reconnus et indemnis&eacute;s au centre tunisien par les deux seules commissions m&eacute;dicales habilit&eacute;es &agrave; fixer le taux d’incapacit&eacute; partielle permanente aux victimes des accidents de travail et des maladies professionnelles dans les sept gouvernorats du centre. RESULTATS: au total, 129 travailleurs, d’&acirc;ge moyen &eacute;gal &agrave; 40,6 ± 7,75 ans &eacute;taient indemnis&eacute;s pour asthme professionnel durant la p&eacute;riode d’&eacute;tude. Le sexe ratio &eacute;tait de 0,66. Les agents &eacute;tiologiques les plus incrimin&eacute;s ont &eacute;t&eacute; les poussi&egrave;res v&eacute;g&eacute;tales textiles (75,2%), les poussi&egrave;res de bois, la farine et les isocyanates. Une hyperr&eacute;activit&eacute; bronchique non sp&eacute;cifique a &eacute;t&eacute; retrouv&eacute;e dans 38%, un taux &eacute;lev&eacute; d’IgE dans 14% et des prick tests positifs dans 10,9% des cas. Le taux moyen d’incapacit&eacute; partielle permanente &eacute;tait de 25,6±14,2%. Ce taux &eacute;tait corr&eacute;l&eacute;, selon l’analyse analytique, &agrave; l’&acirc;ge du patient et &agrave; la commission m&eacute;dicale ayant fix&eacute; ce taux. CONCLUSION: l’&eacute;tude des cas d’asthme professionnels indemnis&eacute;s, apportent des donn&eacute;es pertinentes &agrave; propos des caract&eacute;ristiques &eacute;pid&eacute;miologiques et cliniques des patients atteints et des pratiques des comit&eacute;s notamment, en terme d’application du bar&egrave;me indicatif, mais ne permet pas l'appr&eacute;ciation de la pr&eacute;valence, souvent sous-estim&eacute;e, de cette pathologie.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hicham Attifi, Abdelhamid Messary [Images in medicine] - Maladie de Basedow r&eacute;v&eacute;lant une tuberculose thyro&iuml;dienne - 21 March 2017. http://www.panafrican-med-journal.com/content/article/26/163/abstract/ <b>La tuberculose thyro&iuml;dienne est rare m&ecirc;me dans les pays end&eacute;miques tel le Maroc et dont le diagnostic peut poser probl&egrave;me en absence d’&eacute;l&eacute;ments d’orientation cliniques ou biologiques. Elle est exceptionnellement r&eacute;v&eacute;l&eacute;e par une maladie de Basedow. Patiente &acirc;g&eacute;e de 48 ans, suivie au service d’endocrinologie pour maladie de Basedow, ayant re&ccedil;u un traitement &agrave; base d’antithyro&iuml;diens de synth&egrave;se et adress&eacute;e au service d’otorhinolaryngologie pour rechute &agrave; l’arr&ecirc;t du traitement en vue d’une cure chirurgicale. L’examen physique a objectiv&eacute; une thyro&iuml;de augment&eacute;e de taille avec pr&eacute;sence d’un nodule basilobaire gauche ferme, d’un diam&egrave;tre de 2 cm. La naso-fibroscopie a montr&eacute; des cordes vocales mobiles. Les aires ganglionnaires &eacute;taient libres. L'&eacute;chographie cervicale a objectiv&eacute; des nodules hypo&eacute;chog&egrave;nes et hyper&eacute;chog&egrave;nes au d&eacute;pend des 2 lobes. Le bilan hormonal a r&eacute;v&eacute;l&eacute; un profil d'une hyperthyro&iuml;die p&eacute;riph&eacute;rique avec une TSH effondr&eacute;e. La radiographie thoracique ne montrait pas de l&eacute;sions m&eacute;diastino-pulmonaires. Plusieurs pathologies peuvent s'associer exceptionnellement &agrave; une maladie de Basedow tel qu'un lymphome, une tuberculose ou un carcinome. La patiente a b&eacute;n&eacute;fici&eacute; d'une thyro&iuml;dectomie totale. L'examen anatomopathologique a objectiv&eacute; un parenchyme thyro&iuml;dien hyperplasique avec pr&eacute;sence en plusieurs endroits de granulomes &eacute;pith&eacute;lio&iuml;des et giganto-cellulaires avec des foyers de n&eacute;crose cas&eacute;euse. Le diagnostic de tuberculose thyro&iuml;dienne a &eacute;t&eacute; pos&eacute;. Elle n'y avait pas d'autres localisations tuberculeuses. La patiente a re&ccedil;u un traitement antituberculeux pour une dur&eacute;e totale de 12 mois associ&eacute; &agrave; une hormonoth&eacute;rapie substitutive &agrave; vie. L'&eacute;volution &eacute;tait favorable sans notion de r&eacute;cidive. Le recul &eacute;tait de 2 ans.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Asmaa Naim, Nadia Benchekroune, Zineb Bouchbika, Nezha Taoufiq,Hassan Jouhadi, Souha Sahraoui, Abdelatif Benider [Case report] - Liposarcome myxoide sous cutan&eacute; - 21 March 2017. http://www.panafrican-med-journal.com/content/article/26/162/abstract/ <b>Bien que les liposarcomes myxo&iuml;des (LSM) soient la forme la plus fr&eacute;quente des sarcomes des tissus mous chez l’adulte, leur localisation primaire superficielle est rare. Ainsi, on individualise deux formes de sarcomes: superficiel et profond qui sont distincts non seulement par leur si&egrave;ge et leur fr&eacute;quence mais aussi par leur pronostic qui est relativement meilleur dans les sarcomes superficiels. Nous rapportons une observation d’un liposarcome sous cutan&eacute; de la cuisse droite. Le diagnostic a &eacute;t&eacute; confirm&eacute; histologiquement apr&egrave;s une ann&eacute;e d’&eacute;volution de la symptomatologie clinique. La prise en charge a consist&eacute; en une ex&eacute;r&egrave;se large suivie d’une radioth&eacute;rapie locor&eacute;gionale. L’&eacute;volution a &eacute;t&eacute; marqu&eacute;e par une r&eacute;mission compl&egrave;te maintenue apr&egrave;s un recul de 32 mois. Nous soulignons, par la pr&eacute;sente observation que la raret&eacute; des sarcomes superficiels peut &ecirc;tre source de retard diagnostic, ce qui pourrait compromettre leur pronostic.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Younoussa Keita, Ahmed Tall Lemrabott, Assane Sylla, Babacar Niang, El Hadji Fary Ka, Ch&eacute;rif Mohamed Dial, Aliou Abdoulaye Ndongo, Amadou Sow, Claude Moreira, Abdou Niang, Ousmane Ndiaye, Boucar Diouf, Mouhamadou Gu&eacute;laye Sall [Research] - Le syndrome n&eacute;phrotique idiopathique (SNI) de l’enfant &agrave; Dakar: &agrave; propos de 40 cas - 21 March 2017. http://www.panafrican-med-journal.com/content/article/26/161/abstract/ <b>INTRODUCTION: l’objectif de ce travail &eacute;tait d’analyser les caract&eacute;ristiques diagnostiques, th&eacute;rapeutiques et &eacute;volutives de l’enfant atteint de n&eacute;phrose dans un service de p&eacute;diatrie de Dakar. METHODES: l’&eacute;tude &eacute;tait r&eacute;alis&eacute;e au service de p&eacute;diatrie de l’h&ocirc;pital Aristide Le Dantec. Il s’agissait d’une &eacute;tude r&eacute;trospective sur une p&eacute;riode de 03 ans allant du 1<sup>er</sup> janvier 2012 au 31 d&eacute;cembre 2014. Ont &eacute;t&eacute; inclus tous les patients &acirc;g&eacute;s de 02 ans &agrave; 12 ans pr&eacute;sentant un tableau de Syndrome n&eacute;phrotique idiopathique. RESULTATS: quarante cas de n&eacute;phrose &eacute;taient collig&eacute;s soit une pr&eacute;valence de 23% parmi les n&eacute;phropathies prises en charge dans le service. L’&acirc;ge moyen &eacute;tait de 7,11± 3,14 ans. Le syndrome n&eacute;phrotique &eacute;tait pur chez 72,5% (n=29) des patients. Les œd&egrave;mes des membres inf&eacute;rieurs &eacute;taient pr&eacute;sents chez 100% des patients, l’oligurie dans 55% (n=22) et l’HTA dans 5% (n=2) des cas. La prot&eacute;inurie moyenne &eacute;tait de 145,05 ± 85,54 mg/kg/24heures. La protid&eacute;mie moyenne &eacute;tait de 46,42 ±7,88 g/L et l’albumin&eacute;mie moyenne de 17,90 ± 7,15 g/L. Trente-neuf patients avaient re&ccedil;u une corticoth&eacute;rapie &agrave; base de prednisone. La corticosensibilit&eacute; &eacute;tait retenue chez 77% (n=30) des patients et la corticor&eacute;sistance chez 13% (n=5) des cas. Le facteur de mauvaise r&eacute;ponse &agrave; la corticoth&eacute;rapie &eacute;tait un niveau de prot&eacute;inurie initiale sup&eacute;rieure &agrave; 150 mg/kg/jour (p = 0,024). La biopsie r&eacute;nale &eacute;tait r&eacute;alis&eacute;e chez 18% (n=7) des patients et retrouvait dans 57,2% (n=4) des cas une hyalinose segmentaire et focale. Le cyclophosphamide et l’azathioprine &eacute;taient associ&eacute;s aux cortico&iuml;des dans 10% (n=4) des cas chacun. Le taux de r&eacute;mission globale &eacute;tait de 89,8%. L’&eacute;volution vers l’insuffisance r&eacute;nale chronique &eacute;tait not&eacute;e chez trois (03) des patients. CONCLUSION: la n&eacute;phrose repr&eacute;sentait pr&egrave;s du quart des n&eacute;phropathies prises en charge dans notre service. Le taux de r&eacute;mission globale &eacute;tait &eacute;lev&eacute;. Le seul facteur de mauvaise r&eacute;ponse &agrave; la corticoth&eacute;rapie &eacute;tait le niveau de prot&eacute;inurie initiale &eacute;lev&eacute;e. En cas d’indication de la biopsie r&eacute;nale chez nos patients, la HSF &eacute;tait la l&eacute;sion la plus fr&eacute;quemment retrouv&eacute;e.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Allan Mwesiga [Obituary] - Obituary: Dr. Eugene Garfield (1925-2017) - 20 March 2017. http://www.panafrican-med-journal.com/content/article/26/160/abstract/ <b>It is with great sadness that we announce the death of Dr. Eugene Garfield. Dr. Garfield died on Sunday 26 February 2017. He was 91. Dr. Garfield is credited as the inventor of the journal impact factor. He founded the Institute for Scientific Information (ISI) in 1955. The ISI’s Scientific Citation Index (SCI),which was made available electronically as the Web of Science, and other citation index databases have helped link the body of scientific literature and provide an efficient means for scientists to look up search existing scientific literature. In 1982, the Thomson Reuters Corporation acquired the SCI. Clarivate Analytics has owned the division since 2016. Dr. Garfield also founded two publications “Current Contents” and “The Scientist” to compile news and information for scientists and researchers. Dr. Garfield was awarded a PhD in structural linguistics from the University of Pennsylvania in 1961. He is survived by his wife, Meher, three sons, a daughter, a step-daughter, two granddaughters, and two great-grandchildren.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Olugbenga-Bello Adenike, Jimoh Adejumoke, Oke Olufunmi, Oladejo Ridwan [Research] - Maternal characteristics and immunization status of children in North Central of Nigeria - 20 March 2017. http://www.panafrican-med-journal.com/content/article/26/159/abstract/ <b>INTRODUCTION: routine immunization coverage in Nigeria is one of the lowest national coverage rates in the world. The objective of this study was to compare the mother’ characteristics and the child’s Immunization status in some selected rural and urban communities in the North central part of Nigeria. METHODS: a descriptive cross sectional study, using a multistage sampling technique to select 600 respondent women with an index child between 0-12 months. RESULTS: mean age of rural respondents was 31.40±7.21 years and 32.72+6.77 years among urban respondents, though there was no statistically significant difference in age between the 2 locations (p-0.762). One hundred and ninetyseven (65.7%) and 241(80.3%) of rural and urban respondents respectively were aware of immunization, the difference was statistically significant (p-0.016). knowledge in urban areas was better than among rural respondents. There was statistically significant association between respondents age, employment status, mothers’ educational status and the child’s immunization status (P<0.05), while variables like parity, age at marriage, marital status, No of children, household income and place of index were not statistically associated with immunization status as P>0.05. More than half 179(59.7%) of rural and 207(69.0%) of urban had good practice of immunization though the difference was not statistically significant (p-0.165). CONCLUSION: the immunization coverage in urban community was better than that of the rural community. The result of this study has clearly indicated that mothers in Nigeria have improved on taking their children for immunization in both rural and urban area compared to previous reports.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Isolated muscular tuberculosis: unusual location of the Koch bacillus - 16 March 2017. http://www.panafrican-med-journal.com/content/article/26/158/abstract/ <b>A 23-year-old female patient with a family history of pulmonary tuberculosis and tuberculous spondylodiscitis was hospitalized for swelling of the left anterior-external surface of the left thigh, (A) with altered general status. Biology has shown a biological inflammatory syndrome. The ultrasound showed a collection opposite the great trochanter fusing towards the lodge of the gluteus muscle and forward towards the terminal part of the common chief ischio-psoas. MRI of the hips revealed an intra-muscular collection of the antero-lateral side of the thigh root, taking contrast in the periphery, involving the quadriceps muscle and tensor of facia lata, (B and C). The biopsy of the collection under ultrasound guidance brought back 30 cc of casein. The diagnosis of tuberculosis of the quadriceps muscle and tensor of the facia lata was based on the positivity of the tuberculin skin test, (D), the positivity of the PCR for Mycobacterium tuberculosis in the puncture fluid and histology showing multiple epithelioid granulomas centered by caseous necrosis. There were no other tuberculous sites. The patient was treated with antituberculosis drugs for 12 months with good progress. Muscular tuberculosis (MT) is a rare localization of the disease (0.01 to 2%). Its occurrence without associated bone involvement is exceptional. MT often simulates a muscular tumor. MRI contributes to the improvement of the sensitivity of the diagnosis of MT because it allows to specify the extent of the muscular lesions and to orient the site of the muscular biopsy. The diagnosis is essentially based on histology.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hilal Abboud, Ahmed Elhankari [Images in medicine] - A rare case of non-contiguous multifocal spinal tuberculosis - 16 March 2017. http://www.panafrican-med-journal.com/content/article/26/157/abstract/ <b>Spinal tuberculosis is defined as an Infection of the intervertebral disc and the adjacent vertebral bodies, caused by Mycobacterium Tuberculosis (MT). It represents 40% of all osteo-articular spondylitis. It is a common disease in Africa, and recently there has been an upsurge in developed countries in relation to Human Immunodeficiency Virus infection. The early management is associated to a good outcome, and the diagnosis relies on imaging and disco-vertebral biopsy, it is characterized by a low amount MT in lesions and involves the slow multiplication MT. The treatment is based on antibacillary associated to surgical treatment in case of neurological deficit, and presence of vertebral column deformities. We report a rare case of a 46 years old patient, treated 3 years ago for pulmonary tuberculosis, who consults for diffuse back pain, the clinical examination finds a conscious patient, with a diffuse spinal syndrome, without neurological deficit or sphincter disorders. The radiological assessment shows a non contiguous multifocal spinal tuberculosis interesting the cervicodorsal and thoracolumbar junction.The patient underwent a vertebral biopsy, the histological examination confirms the spinal tuberculosis. He was proposed to surgical treatment to prevent the kyphosis progression.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Faten Limaiem, Saadia Bouraoui [Images in medicine] - Cyclopia: the one-eyed fetus - 16 March 2017. http://www.panafrican-med-journal.com/content/article/26/156/abstract/ <b>A 36 year-old female patient gravida 2 para 1, with no particular past medical history consulted her gynecologist at 14 weeks' gestation for pelvic pain. Her first pregnancy was uneventful and she did not take any specific drugs prior or during her pregnancy. Consanguinity and hereditary diseases were denied. Ultrasonography revealed a retention image measuring 67,2 mm with no cardiac pulsations (A). A male cyclopean fetus was delivered by induced labour. The fetus weighed 13,5 g and the placenta 45,4 g. On examination, the fetus was monophtalmic with completely fused eyes (B). In the face was a central proboscis located above the single orbital cavity (B). It had a rhombic form presenting with two lateral commissures and one caruncle at the inferior point of union. There was one lacrimal punctum in the midline and no median cleft. The nasal structures were absent. The upper lip looked normal with both, philtrum and tuberculum labii superioris. The lower lip and the mandible were normal. The brain and the rest of the organs were macerated. The examination of the placenta did not disclose any anomaly. Genetic analysis was not performed.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hicham Bousbaa, Laarbi Amhajji [Images in medicine] - A propos d’une observation de tumeur glomique de l’index - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/155/abstract/ <b>La tumeur glomique (TG) individualis&eacute;e par Masson est une tumeur b&eacute;nigne d&eacute;velopp&eacute;e aux d&eacute;pend du glomus sous cutan&eacute;. La glomus est l'organe de r&eacute;gularisation de la microcirculation capillaire et thermique. Elles repr&eacute;sentent 1 &agrave; 5 % des tumeurs des parties molles de la main. La localisation est surtout sous ungu&eacute;ale (65%) mais aussi pulpaire et p&eacute;ri ungu&eacute;ale. Il s'agit d'une l&eacute;sion d'&eacute;volution lente et de petite taille (en moyenne 3mm). La douleur est fulgurante spontan&eacute;e et/ou provoqu&eacute;e par le simple contact ou effleurement. Elle est exacerb&eacute;e par le froid. Un homme &acirc;g&eacute; de 39 ans, droitier, technicien en r&eacute;paration &eacute;lectronique, sans ant&eacute;c&eacute;dents pathologiques particuliers ; se pr&eacute;sentant avec une douleur paroxystique et exquise de l'index de la main droit, &eacute;voluant depuis deux ans. &Agrave; l'examen on note une zone pulpaire tr&egrave;s sensible &agrave; la pression, avec absence de signes objectifs locaux. La radiographie standard r&eacute;alis&eacute;e n'objective pas de l&eacute;sions osseuses. L'IRM datant de 1 an &eacute;tait normale. Une deuxi&egrave;me IRM dans un intervalle d'un an a &eacute;t&eacute; r&eacute;alis&eacute;e, et a montr&eacute; un aspect &eacute;vocateur d'une tumeur glomique sous forme d'un hyposignal en T1 (A), suivi d'un hypersignal en T2 (B) Une ex&eacute;r&egrave;se chirurgicale par voie pulpaire direct de la tumeur a &eacute;t&eacute; r&eacute;alis&eacute;, l'aspect per op&eacute;ratoire &eacute;tait tr&egrave;s &eacute;vocateur : la tumeur de 3 mm d'aspect bleut&eacute; &eacute;tait bien limit&eacute;e encapsul&eacute;e (C), et l'examen histologique de la pi&egrave;ce a confirm&eacute; le diagnostic. Les suites op&eacute;ratoires ont &eacute;t&eacute; simples, apr&egrave;s 1 an de recul, le patient est asymptomatique. Les tumeurs glomiques sont rares, mais elles peuvent si&eacute;g&eacute;es dans tout le corps. Ce sont des malformations hamartomateuses du glomus normal. Les tumeurs peuvent &ecirc;tre non palpables parce qu'ils sont tr&egrave;s petites et profondes.Cette affection est rare, avec un si&egrave;ge de pr&eacute;dilection sous-ungu&eacute;al. La triade diagnostic classique se compose de douleur spontan&eacute;e, a la pression, et l'hypersensibilit&eacute; au froid. L'&eacute;volution est lente et le retard diagnostique est fr&eacute;quent. Les examens compl&eacute;mentaires qui ont &eacute;t&eacute; utilis&eacute;s avec un succ&egrave;s variable pour le diagnostic des TG sont: la transillumination, l'art&eacute;riographie, la thermographie, l'&eacute;chographie avec s&eacute;quence doppler, et la scintigraphie. l'IRM est consid&eacute;r&eacute; comme le test diagnostique le plus sensible. Le traitement chirurgical est curatif et la r&eacute;cidive est rare.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Diop Moustapha, Diouf Assane, Seck Said Malaob&eacute;, Lo Gora, Ka Daye, Massaly Aminata, Dieye Alassane, Fall Ndeye Maguette, Cisse-Diallo Viviane, Diallo Khardiata, Lakhe Aissatou, Fortes-D&eacute;gu&eacute;nonvo Louise, Ndour Cheikh Tidiane, Soumar&eacute; Maserigne, Seydi Moussa [Research] - Pr&eacute;valence de l’antig&egrave;ne de surface du virus de l’h&eacute;patite B et facteurs associ&eacute;s chez des militaires s&eacute;n&eacute;galais envoy&eacute;s en mission au Darfour - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/154/abstract/ <b>INTRODUCTION: au S&eacute;n&eacute;gal, 85% de la population adulte ont &eacute;t&eacute; en contact avec le virus de l’h&eacute;patite B et environ 11% sont porteurs chroniques de l’antig&egrave;ne de surface de ce virus (AgHBs). Cette infection est peu document&eacute;e dans l’arm&eacute;e s&eacute;n&eacute;galaise. L’objectif de cette &eacute;tude &eacute;tait d’&eacute;valuer la pr&eacute;valence de l’AgHBs chez des militaires s&eacute;n&eacute;galais envoy&eacute;s en mission au Darfour (Soudan) et d’identifier les facteurs associ&eacute;s. METHODES: nous avons men&eacute; une &eacute;tude transversale du 1er juillet 2014 au 31 juillet 2014 chez des militaires s&eacute;n&eacute;galais en mission au Darfour. La recherche de l’AgHBs a &eacute;t&eacute; effectu&eacute;e dans le s&eacute;rum des participants par la m&eacute;thode immunochromatographique. La recherche de facteurs associ&eacute;s a &eacute;t&eacute; r&eacute;alis&eacute;e &agrave; l’aide d’une r&eacute;gression logistique multivari&eacute;e. RESULTATS: notre &eacute;tude a port&eacute; sur 169 militaires de sexe masculin. L’&acirc;ge moyen &eacute;tait de 36,6 ans ± 9,5. Des ant&eacute;c&eacute;dents d’h&eacute;patopathie chronique au niveau familial, d’exposition sanguine et d’exposition sexuelle ont &eacute;t&eacute; retrouv&eacute;s respectivement chez 12,4% ; 24,9% et 45,6% de la population d’&eacute;tude. L’AgHBs a &eacute;t&eacute; retrouv&eacute; chez 24 participants [14,2%(IC95% = 8,9-19,5)]. Apr&egrave;s ajustement sur les facteurs de confusion potentiels, l’&acirc;ge (OR=0,9 IC95% =0,9-1,0), un niveau d’&eacute;tude universitaire (OR= 9,5 IC95% =1,3 – 67,1) et l’exposition sexuelle (OR=3,3; IC95% =1,0 – 10,3) &eacute;taient apparus associ&eacute;s de fa&ccedil;on ind&eacute;pendante &agrave; l’h&eacute;patite B. CONCLUSION: notre &eacute;tude retrouve une pr&eacute;valence &eacute;lev&eacute;e de l’AgHBs et souligne la n&eacute;cessit&eacute; d’une &eacute;valuation plus pouss&eacute;e de l’h&eacute;patite B chez cette population.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khalid Chakour, Mohamed El Faiz Chaoui [Review] - Traitement chirurgical des m&eacute;tastases osseuses rachidiennes - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/153/abstract/ <b>La chirurgie de la m&eacute;tastase est une chirurgie palliative le plus souvent, surtout au niveau du rachis de par sa localisation anatomique. Cette chirurgie doit &ecirc;tre bien pr&eacute;par&eacute;e pour que les suites soient simples et que le traitement adjuvant soit fait dans les meilleurs d&eacute;lais. La strat&eacute;gie th&eacute;rapeutique doit &ecirc;tre syst&eacute;matiquement prise en r&eacute;union de concertation pluridisciplinaire (RCP). Le principal risque de la localisation rachidienne est neurologique, c'est pourquoi cette chirurgie doit &ecirc;tre pr&eacute;ventive le plus souvent. Elle a pour objectif principal d'am&eacute;liorer la qualit&eacute; de vie.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Bouchra Habibi, Leila Achachi, Sohaib Hayoun, Mohammed Raoufi, Laila Herrak, Mustapha El Ftouh [Case series] - La prise en charge du pneumothorax spontan&eacute;: &agrave; propos de 138 cas - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/152/abstract/ <b>Le pneumothorax est d&eacute;finit par la pr&eacute;sence d’air dans la cavit&eacute; pleurale. L’objectif de notre &eacute;tude r&eacute;trospective du pneumothorax spontan&eacute;s au servie de pneumologie &agrave; l’h&ocirc;pital Ibn Sina rabat (2009-2011) est de d&eacute;terminer le profil &eacute;pid&eacute;miologique, clinique, radiologique, th&eacute;rapeutique et &eacute;volutif. Il s’agit de 138 patients: 128 hommes et 10 femmes (17 &agrave; 83 ans), un &acirc;ge moyen de 44,5 +/- 17,4 ans; sexe ratio 12/8. Le tabagisme est not&eacute; chez 81,2%. La symptomatologie clinique est la douleur thoracique (92%), la dyspn&eacute;e (60%). Et sur la radiographie thoracique: on trouve un PNO (pneumothorax) unilat&eacute;ral total (110 cas); partiel (10 cas); localis&eacute; (6 cas); bilat&eacute;ral (4 cas); &agrave; droite dans 51,4% et &agrave; gauche dans 45,7%. On a recens&eacute; 70% de pneumothorax spontan&eacute;s primitifs et 30% de PNO secondaire &agrave; (BPCO 44%, et tuberculose pulmonaire 39%). La prise en charge initiale est l’hospitalisation de tous les patients : le drainage thoracique (95%), l’exsufflation &agrave; l’aiguille (1%). Le repos et l’O2 (4%). Le retour du poumon &agrave; la paroi a &eacute;t&eacute; obtenu avant 10 jours chez 63%. L’&eacute;volution est favorable chez 89%. Et les complications imm&eacute;diates: l’emphys&egrave;me sous cutan&eacute; (5 cas); une infection (6 cas) et 3 d&eacute;c&egrave;s (arr&ecirc;t cardio-respiratoire) ; les complications &agrave; distance sont les r&eacute;cidives dans 11,6% ; une 1&egrave;re r&eacute;cidive chez 13 cas (drainage thoracique chez 11 cas et oxyg&eacute;noth&eacute;rapie chez 2 cas) et une 2&egrave;me r&eacute;cidive chez 3 cas (recours &agrave; la chirurgie). Ce travail montre l’int&eacute;r&ecirc;t du drainage thoracique et la surveillance dans la prise en charge du pneumothorax pour &eacute;viter les complications et surtout pour &eacute;viter les r&eacute;cidives avec un &eacute;ventuel recours &agrave; la chirurgie.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Fouad Nya, Abdessamad Abdou, Mehdi Bamous, Younes Moutakiallah, Noureddine Atmani, Aniss Seghrouchni, Mahdi Ait Houssa, Abdellatif Boulahya [Case report] - Pseudotumeur cardiaque r&eacute;v&eacute;lant une maladie de Beh&ccedil;et - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/151/abstract/ <b>La thrombose intracardiaque est une complication rare de la maladie de Beh&ccedil;et (MB), qui peut se pr&eacute;senter comme une tumeur intracardiaque. Sa d&eacute;couverte pr&eacute;c&egrave;de, dans la moiti&eacute; des cas, le diagnostic de MB. La mortalit&eacute; &eacute;lev&eacute;e peut &ecirc;tre en rapport avec des complications post-chirurgicales et/ou une atteinte associ&eacute;e des art&egrave;res pulmonaires. Nous rapportons l’observation d’un jeune patient de 29 ans, aux ant&eacute;c&eacute;dents d’aphtose bipolaire, qui a b&eacute;n&eacute;ficie d’une intervention chirurgicale apr&egrave;s la d&eacute;couverte d’une tumeur de l’atrium et du ventricule droits. Il s’agissait d’un thrombus &agrave; l’examen anatomopathologique et dans les suites op&eacute;ratoires nous avons diagnostiqu&eacute; une MB. L’&eacute;volution a &eacute;t&eacute; favorable sous traitement m&eacute;dical associant une corticoth&eacute;rapie, de la colchicine et des antivitamines K (AVK). La d&eacute;couverte d’une masse intracardiaque chez un sujet jeune doit faire &eacute;voquer le diagnostic de thrombus cardiaque et de maladie de Beh&ccedil;et, m&ecirc;me en l’absence de facteur ethnique ou g&eacute;ographique pr&eacute;disposant.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Gabriel Ngom, Azhar Salim Mohamed, Pape Allassane Mbaye, Mbaye Fall, Oumar Ndour, Aim&eacute; Lakh Faye, Zakaria El-Hasnaoui [Research] - Wrestling game injuries among children in Dakar: a report on 172 cases - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/150/abstract/ <b>INTRODUCTION: the objective was to report epidemiological and lesional features among children practicing wrestling as a game in Dakar, Senegal. METHODS: it was a retrospective study including all patients under 16, victims of wrestling game injuries. We studied epidemiological and lesional aspects in children: frequency of wrestling game injuries among all games, age, sex, geographic origin, place of injury, parent’s socioeconomic status, nature of the injury and location. RESULTS: wrestling game injuries represented 19.9% injuries in all games. Sex-ratio was 33.4. The most affected age group was the 6-10 years old age group. The majority of children are from suburban Dakar (64%). Injuries occurred most often at home and in the street. Most children are from low socioeconomic status (64%). Fractures predominated and were localized almost exclusively on the elbow. CONCLUSION: wrestling game injuries in Dakar occur among older children from the suburbs, living in the neighborhood of great wrestling champions’ districts of residence. Wrestling game cause injuries, consisting mostly of elbow fractures.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Diogo Carrola Gomes, Lu&iacute;sa Quaresma [Images in medicine] - Plain x-ray films in soft tissue infections - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/149/abstract/ <b>A 39-year-old male with a history of cocaine abuse presents to the emergency room with pain in the right leg and fever (39ºC) 6 days after injecting himself in the thigh with midazolam pills diluted in tap water to control symptoms of withdrawal. Physical examination revealed rubor, swelling and tenderness of the thigh without crepitation, suggestive of cellulitis. Laboratory findings consisted of a WBC of 10.700x106/L (86% Neutrophiles) and CRP of 170 mg/dL. An X-ray of the leg was performed, revealing a feathering pattern of gas within the soft tissue of the thigh indicative of gas gangrene. Intraoperatively, we found wide necrosis of the muscles and fatty tissue of the posterior thigh without substantial quantities pus. An extensive debridement was performed and penicillin and clindamycin were administered for two weeks. Cultural exams revealed the presence of aerobic (Streptococcus mitis and Streptococcus oralis) and anaerobic bacteria (Clostridium clostridioforme and Prevotella oralis). The infection was controlled after further daily debridement and the wound was closed with the assistance of a negative-pressure wound therapy device. The patient was discharged from the hospital to a physical rehabilitation facility and regained most of his functional capacity. Gas gangrene is a life-threatening condition, misdiagnosis and failure of recognition in its early stages can prove fatal. Plain X-ray films are readily available in most hospitals and can provide significant information in patients with soft tissue infections where 'time is tissue.'</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Abdelmonem Ghorbel [Images in medicine] - Traumatic auricular hematoma - 15 March 2017. http://www.panafrican-med-journal.com/content/article/26/148/abstract/ <b>Auricular hematoma is a frequent complication of blunt trauma to the auricle. These are usually caused by sports such as boxing and wrestling. Hematoma formation is within the space between perichondrium and cartilage on the anterior ear. Because the blood supply to cartilage is dependent on the perichondrium, infection and cartilaginous necrosis often complicate untreated auricular hematomas. If auricular hematoma is not treated properly, it can progress to abscess formation, chronic scarring and fibrous organization with ear deformity "cauliflower" due to a stimulation of mesenchymal cells in the perichondrion to produce a new cartilage. After incision and evacuation of the fluid, a pressure dressings is traditionally applied to prevent reaccumulation in the resultant dead space. Optimal immobilization of the skin over underlying cartilage for 7-10 days prevent the reaccumulation of fluid with subsequent thickening and fibrosis. We report a case of a 40-year-old football coach presented to the Emergency Department with a painless right ear swelling occurred after auricular trauma during training. The clinical examination showed a right fluctuant non-inflammatory swelling of the lateral face of the pinna. Otoscopy and retroauricular region were normal. The needle puncture brought a serohematic fluid and the diagnosis auricular hematoma was made. The collection was drained via a double anterior incision under local anesthesia and a tie through dressing was used. After 10 days, the sutures and tie through dressing were removed. One year after the operation, the ear appeared almost normal.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Lykourgos Christos Alexakis [Images in medicine] - Cholera -“Rice water stools” - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/147/abstract/ <b>An adult female presented with acute watery diarrhoea and severe dehydration during a cholera outbreak in Mae La refugee camp, Thailand in 2007. Her stools had the classic appearance of cholera “rice water stools”, which is similar to water where rice was boiled. Stool are watery, greyish in colour, cloudy, with flecks of mucus, with a non offensive fish-like odour (Panels A, B, C and D from this patient). The patient was isolated, treated initially with Ringers’s lactate intravenously and then with oral rehydration solution. Tetracycline per os was given for three days according to local protocol and the patient recovered completely. A culture of stools ob-tained by rectal swab upon admission subsequently tested positive for Vibrio Cholerae, 01 Inaba serotype, which was also the cause of the outbreak. Cholera is transmitted through contami-nated food or water, can cause epidemics and may also infect travellers. Clinical spectrum ranges from asymptomatic to severe disease with massive watery diarrhoea often fatal if untreated. Treatment includes rapid fluid replacement with the WHO’s reduced osmolarity oral rehydration solution or intravenous rehydration (Ringer’s lactate) for severe cases. Antibiotics (azithromycin, erythromycin,tetracycline or ciprofloxacine) decrease disease duration.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Redouane Ahtil, Mustapha bensghir, Mohammed Meziane, Abdelhafid Houba, Abelhamid Jaafari, Salim Jaafar Lalaoui, Charki Haimeur [Case report] - Etiologie rare d’un syndrome subocclusif: polype fibrino&iuml;de inflammatoire de l’il&eacute;on, &agrave; propos d’un cas clinique - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/146/abstract/ <b>Le polype fibro&iuml;de inflammatoire (PFI) est une l&eacute;sion b&eacute;nigne rare, qui d&eacute;coule de la sous-muqueuse du tractus gastro-intestinal, apparait g&eacute;n&eacute;ralement comme une l&eacute;sion b&eacute;nigne solitaire, localis&eacute;e rarement au niveau de l'il&eacute;on. Son origine est controvers&eacute;e. La pr&eacute;sentation clinique varie selon sa localisation, l'invagination et l'obstruction constituent les sympt&ocirc;mes r&eacute;v&eacute;lateurs les plus fr&eacute;quents quand le polype si&egrave;ge au niveau de l'intestin gr&ecirc;le. Nous rapportons le cas d'un patient &acirc;g&eacute; de 22 ans, qui pr&eacute;sentait une douleur abdominale, des naus&eacute;es et des vomissements avec des ant&eacute;c&eacute;dents de constipation intermittente et une perte de poids dans l'ann&eacute;e pr&eacute;c&eacute;dente. La radiologie a objectiv&eacute; une invagination il&eacute;o-il&eacute;ale obstruant compl&egrave;tement la lumi&egrave;re de l'il&eacute;on. La r&eacute;section segmentaire du segment il&eacute;al obstru&eacute; et l'anastomose termino-terminale ont &eacute;t&eacute; effectu&eacute;es. Le diagnostic final de PFI a &eacute;t&eacute; &eacute;tabli par l'examen histologique et immuno-histochimique.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khalid Chakour, Mohamed El Faiz Chaoui [Case report] - Une urgence m&eacute;dico-chirurgicale rare: l’abc&egrave;s &eacute;pidural rachidien (&agrave; propos de 03 cas) - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/145/abstract/ <b>Les infections de l’espace &eacute;pidural sont de mieux en mieux connues gr&acirc;ce au d&eacute;veloppement de la neurochirurgie, notamment l’IRM. Les abc&egrave;s &eacute;piduraux rachidiens repr&eacute;sentent une pathologie rare mais &eacute;minemment grave sur le plan fonctionnel, avec un risque vital potentiel. Nous rapportons trois cas d’abc&egrave;s &eacute;pidural rachidien tous diagnostiqu&eacute;s chez des patients de sexe masculin, le premier &acirc;g&eacute; de 52 ans le deuxi&egrave;me de 57 ans et le troisi&egrave;me de 63ans. Deux patients ont &eacute;t&eacute; admis aux urgences neurochirurgicales pour un tableau de compression m&eacute;dullaire lente &eacute;voluant dans un contexte infectieux, et le dernier se plaignait d’une sciatique S1 droite rebelle au traitement avec des fuites urinaires. Aucune porte d’entr&eacute;e n’a &eacute;t&eacute; identifi&eacute;e dans le bilan initial. Tous les patients ont &eacute;t&eacute; op&eacute;r&eacute;s par voie d’abord post&eacute;rieure avec d&eacute;compression m&eacute;dullaire/radiculaire et &eacute;vacuation de l’abc&egrave;s &eacute;pidural. L’&eacute;tude bact&eacute;riologique a trouv&eacute; un germe pyog&egrave;ne justifiant une antibioth&eacute;rapie adapt&eacute;e dans les trois cas. L’&eacute;volution a &eacute;t&eacute; favorable dans deux cas. Par contre un patient est d&eacute;c&eacute;d&eacute; trois jours en post-op&eacute;ratoire par un sepsis s&eacute;v&egrave;re.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Yosr Chaabouni [Images in medicine] - Multiple brown tumors as a result of hyperparathyroidism in chronic renal disease: a case report - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/144/abstract/ <b>The brown tumor or osteitisfibrosacystica is a benign bone lesion that caused by hyperparathyroidism.This complication has been decreased by diagnosis and successful treatment of hyperparathyroidism. The brown tumor of hyperparathyroidism results from a metabolic disorder that affects long bones, ribs, and pelvis. The maxillary involvement is rare. Parathyroidectomyis a good choice for patients with high parathyroid hormone (PTH) levels and diffuse brown tumorleading to a gradual decrease in the maxillary tumors. We report the case of a 50-year-old woman with chronicrenal failure presented with one-year history of slowly enlarging mass of the left cheek after 17 years of maintenance hemodialysis. The physical examination revealed a mass of the left jaw and the infraorbital region associated with a left exophtalmia. The mass was soft in consistency and tender on palpation. Her serum PTH concentrationwas 4830 pg/ml and her calcemia was normal. The computed tomography (CT) of the facial skeleton showed multiple osteolytic lesions of the maxillary sinuses and mandibular bone suggestive of brown tumors. Theexpansive lesion of the left maxillary bone found an extensive involvement ofthe left maxilla and the maxillary sinus. The patient underwent a subtotal parathyroidectomy. The PTH concentration taken 1 hour after the surgery confirmed a level within the normal range. At 12-month follow-up, there was an improvement of the exophtalmia and partial regression of the tumors.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Malek Mnejja [Images in medicine] - Rhinocerebral mucormycosis: a rare infection - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/143/abstract/ <b>Rhinocerebral mucormycosis, also known as zygomycosis, is an acute opportunistic fungal infection with high associated mortality rates. There are some predisposing factors for mucormycosis such as hematological malignancies, severe burns, neutropenia, diabetes mellitus, and the use of corticosteroids. Treatment of rhinocerebral mucormycosis consists of treating the predisposing disease, aggressive surgical debridement and systemic antifungal therapy. We present the case of a 55-year-old diabetic patient treated with insulin who was admitted to the emergency department for headache and left purulent rhinorrhea for 3 days. The patient was hospitalized for diabetic ketoacidosis, and intravenous insulin infusion therapy and intravenous antibiotherapy were administered. The day after hospitalization the patient developed a ptosis of the left eye associated with edema of the upper eyelid and the left cheek. The nasal endoscopy showed necrotic tissue in the left middle meatus and the middle turbinate associated withprofuse purulent discharge. The culture of the nasal swab identified a Rhizopusoryzae and the diagnosis of rhino-cerebral mucormycosis was retained.The patient was put on amphotericin B (1 mg/kg/daily) under medical care in hospital. The patient underwent a functional endoscopic sinus surgery with debridement of sinuses, ethmoidectomy and bilateral antrotomie. Histopathological findings from biopsy of the maxillary sinus presented aseptate hyphae in necrotic tissue. The outcome was fatal on the third day of hospitalization, despite appropriate reanimation measures.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hanan El Ouahabi, Nadia Anoun [Images in medicine] - Paragangliome m&eacute;sent&eacute;rique - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/142/abstract/ <b>Les paragangliomes extra-surr&eacute;naliens surviennent rarement de fa&ccedil;on aberrante en dehors de la r&eacute;gion parall&egrave;le au syst&egrave;me nerveux autonome s'&eacute;tendant de la r&eacute;gion cervicale &agrave; la r&eacute;gion pelvienne. Nous rapportons un cas rare de paragangliome localis&eacute; au niveau du m&eacute;sent&egrave;re chez une femme de 58 ans sans ant&eacute;c&eacute;dents pathologiques notables, op&eacute;r&eacute;e quatre mois avant son admission pour une volumineuse masse abdominale mesurant 14 x 12 cm, d&eacute;couverte sur un examen tomodensitom&eacute;trique, r&eacute;alis&eacute; devant des douleurs abdominales diffuses. Le r&eacute;sultat anatomopathologique compl&eacute;t&eacute; d'une &eacute;tude immuno-histochimique a r&eacute;v&eacute;l&eacute; un paragangliome de localisation m&eacute;sent&eacute;rique, pour lequel elle nous a &eacute;t&eacute; adress&eacute;e pour compl&eacute;ment de prise en charge. La patiente &eacute;tait en bon &eacute;tat g&eacute;n&eacute;ral, normo tendue, asymptomatique. L'examen abdominal notait une cicatrice de laparotomie m&eacute;diane &agrave; cheval sur l'ombilic. Elle avait b&eacute;n&eacute;fici&eacute; d'un dosage des d&eacute;riv&eacute;s m&eacute;thoxyl&eacute;s urinaires de 24h revenus normaux. Un bilan d'extension fait d'une TDM thoraco-abdomino-pelvienne avait r&eacute;v&eacute;l&eacute; une thrombose partielle du tronc porte et du tronc spl&eacute;no mesara&iuml;que et de la veine cave inf&eacute;rieure sans autre localisation secondaire. La patiente fut mise sous traitement anticoagulant &agrave; dose curative.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Brian Johnson, William Edward Cayley, Bich-May Nguyen, Paul Larson, Maria del C Colon-Gonzalez, Christine Gibson, Ann Evensen [Commentary] - Faculty development in family medicine education: what is needed? - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/141/abstract/ <b>A growing number of countries are embracing graduate training in the specialty of Family Medicine as a core component of global health systems reform. One significant challenge for new programs is to adequately prepare for educational excellence and leadership. Promising residents are often encouraged to remain in their program as faculty, but may not have had the benefit of specific training in teaching, curriculum development, learner assessment or educational leadership. Faculty Development is a potential avenue to providing these skills to new Family Medicine Faculty and to encourage new graduates to consider teaching. We are currently seeking to further clarify what the current needs and future possibilities are for Family Medicine Faculty Development in Sub-Saharan Africa.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Respicious Boniface, Edwin Lugazia, Abel Musa, Othman Kiloloma [Research] - Management and outcome of traumatic brain injury patients at Muhimbili Orthopaedic Institute Dar es Salaam, Tanzania - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/140/abstract/ <b>INTRODUCTION: traumatic brain Injuries represents a significant cause of morbidity and mortality worldwide and road traffic crashes accounts for a significant proportion of these injuries. However, access to neurosurgical care is poor in low income countries like Tanzania. The aim of this study was to assess the management and outcome of Traumatic brain injury patients at a tertiary level health facility in Tanzania. METHODS: a retrospective observational study of Traumatic brain injury patients attended at Muhimbili Orthopedic Institute between January 2014 and June 2014. RESULTS: a total of 627 Traumatic brain injury (TBI) patients were seen, 86% were males. Majority (73%) were between 15 – 45 years age group. Road traffic crashes were the leading cause of injury (59.3%). Majority 401/627 (64%) sustained mild TBI, 114/627 (18.2%) moderate TBI and 112/627 (17.8%) severe TBI. All mild TBI patients had good recovery. Among patients with moderate and severe TBI; 19.1% had good recovery, 50.2% recovered with disabilities and 30.7% died. Independent factors associated with mortality were: Severe TBI (Odds Ratio (OR) 3.16. 95%CI 3.42-10.52) and Systolic blood pressure at referring hospital of more than 90mmHg (Odds Ratio (OR) 0.13, 95%CI 0.04-0.49). CONCLUSION: traumatic brain injury is a public health problem in Tanzania, mostly due to road traffic crashes. It is therefore important to reinforce preventive measures for road traffic crashes. There is also a need to develop and implement protocols for pre-hospital as well as in-hospital management of brain trauma in Tanzania.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Jamal Fatihi, Salah Bellasri [Images in medicine] - M&eacute;tastases cutan&eacute;es r&eacute;v&eacute;lant un carcinome indiff&eacute;renci&eacute; du nasopharynx (UCNT) - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/139/abstract/ <b>Les cancers du nasopharynx, domin&eacute;s par les carcinomes &eacute;pidermo&iuml;des surtout de type undifferenciated carcinoma of nasopharyngeal type (UCNT), sont des tumeurs particuli&egrave;res au sein des autres cancers de la sph&egrave;re ORL par leurs &eacute;volutivit&eacute;, le haut potentiel m&eacute;tastatique &agrave; distance et la survenue chez des sujets jeunes sans facteurs de risque classiques alcoolo-tabagiques. Les m&eacute;tastases cutan&eacute;es r&eacute;v&eacute;latrices des carcinomes UCNT sont extr&ecirc;mement rares. Nous rapportons le cas d'un homme de 50 ans, sans pass&eacute; pathologique particulier, hospitalis&eacute; pour des nodules sous cutan&eacute;s (cuir chevelu) (A), r&eacute;gion lombaire (B) et flanc droit (C)) apparus trois mois auparavant dans un contexte d'alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral et de douleurs osseuses. La biopsie ex&eacute;r&egrave;se avec &eacute;tude anatomopathologique d'un des nodules &eacute;tait en faveur d'une localisation secondaire d'un carcinome UCNT. L'endoscopie nasale mettait en &eacute;vidence un processus bourgeonnant endonasal (D) dont la biopsie confirmait le type carcinomateux UCNT. Le bilan d'extension classait la tumeur en stade IV C avec m&eacute;tastases cutan&eacute;es, ganglionnaires, et osseuses. L'&eacute;volution &eacute;tait d&eacute;favorable apr&egrave;s 9 mois malgr&eacute; la radiochimioth&eacute;rapie.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Amina Aounallah, Aicha Arouss, Najet Ghariani, Wafa Saidi, Badreddine Sriha, Mohamed Denguezli, Colandane Belajouza, Rafia Nouira [Case series] - Vascularites cutan&eacute;es leucocytoclasiques: &agrave; propos de 85 cas - 14 March 2017. http://www.panafrican-med-journal.com/content/article/26/138/abstract/ <b>La pr&eacute;sentation clinique, les &eacute;tiologies et l'&eacute;volution des Vascularites leucocytoclasiques sont peu &eacute;tudi&eacute;es. L'objectif de notre travail est d'&eacute;tudier les particularit&eacute;s &eacute;pid&eacute;miologiques, cliniques, &eacute;tiologiques et &eacute;volutives de cette entit&eacute;. Nous avons men&eacute; une &eacute;tude transversale portant sur 85 patients ayant une vascularite leucocytoclasique collig&eacute;s dans le service de dermatologie de l'h&ocirc;pital Farhat Hached de Sousse entre Janvier 2000 et D&eacute;cembre 2013. Pour chaque patient, une fiche des donn&eacute;es &eacute;pid&eacute;miologiques, cliniques, paracliniques et &eacute;tiologiques a &eacute;t&eacute; remplie. L'&acirc;ge moyen de nos patients &eacute;tait de 47,65 ans avec des extr&ecirc;mes allant de 10 &agrave; 78 ans. Cinquante trois femmes et 32 hommes &eacute;taient recens&eacute;s (sexe ratio = 0,6). Les manifestations cutan&eacute;es &eacute;taient domin&eacute;es par le purpura vasculaire (88,2%). Les &eacute;tiologies les plus fr&eacute;quentes &eacute;taient les maladies syst&eacute;miques (51%), les infections (20%) et les dermatoses neutrophiliques (14,5%). Les autres &eacute;tiologies retrouv&eacute;es &eacute;taient : les causes m&eacute;dicamenteuses (9,1%) et les h&eacute;mopathies malignes (5,4%). Chez 30 patients (35,3%), l'&eacute;tiologie n'a pas &eacute;t&eacute; retrouv&eacute;e. Deux facteurs pr&eacute;dictifs &agrave; l'&eacute;volution aigue &eacute;taient retenus : la pr&eacute;sence d'une infection r&eacute;cente (p= 0,014) et d'une prise m&eacute;dicamenteuse pr&eacute;c&eacute;dant l'&eacute;ruption cutan&eacute;e (p= 0,013). L'&eacute;volution chronique &eacute;tait corr&eacute;l&eacute;e positivement aux anticorps antinucl&eacute;aires (p= 0,009), et &agrave; la cryoglobulin&eacute;mie (p=0,025). Notre &eacute;tude illustre la multitude des &eacute;tiologies de vascularites leucocytoclasiques. La recherche d'une maladie sous-jacente est imp&eacute;rative afin de garantir une meilleure prise en charge th&eacute;rapeutique.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Badr El Alami, Aimane Naam, Mohamed Admi, Ilyas Rabhi, Mohamed Elbardai, Fawzi Boutayeb [Case series] - Traitement chirurgical des fractures du Calcan&eacute;um: &agrave; propos de 29 cas - 13 March 2017. http://www.panafrican-med-journal.com/content/article/26/137/abstract/ <b>Les fractures du calcan&eacute;um sont peu fr&eacute;quentes mais le plus souvent graves. Nous rapportons une s&eacute;rie de 29 cas de fractures du calcan&eacute;um trait&eacute;s chirurgicalement dans le service de traumatologie orthop&eacute;die du CHU Hassan II de F&egrave;s. L'objectif de ce travail r&eacute;trospectif &eacute;tait de pr&eacute;senter les principes et d'&eacute;valuer les r&eacute;sultats du traitement chirurgical des fractures articulaires du calcan&eacute;um, en comparaison avec le traitement conservateur. Il s'agissait de 21 hommes et de 8 femmes, dont l'&acirc;ge variait entre 21 et 61 ans. L'&eacute;tiologie &eacute;tait domin&eacute;e par les accidents de la voie publique et les chutes d'un lieu &eacute;lev&eacute;. L'&eacute;valuation des l&eacute;sions &eacute;tait bas&eacute;e sur la classification de DUPARC. Le traitement a consist&eacute; &agrave; faire une r&eacute;duction &agrave; foyer ouvert et une ost&eacute;osynth&egrave;se par plaque en Y, ou par une plaque tiers de tube r&eacute;alisant un montage en triangulation. Les r&eacute;sultats cliniques ont &eacute;t&eacute; &eacute;valu&eacute;s en se basant sur le score de kitaoka, avec un recul moyen de 24 mois. 86% de nos patients ont eu un bon &agrave; moyen r&eacute;sultat.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Amina Aounallah, Mariem Jrad, Mehdi Ksiaa, Sana Mokni, Wafa Saidi, Lobna Boussofara, Badreddine Sriha, Mohamed Denguezli, Najet Ghariani, Colandane Belajouza, Rafia Nouira [Short communication] - Forme particuli&egrave;re de Pemphigoide cicatricielle &agrave; d&eacute;p&ocirc;t unique d'IgA - 13 March 2017. http://www.panafrican-med-journal.com/content/article/26/136/abstract/ <b>La Pemphigoide cicatricielle est une dermatose bulleuse sous &eacute;pith&eacute;liale qui atteint essentiellement les muqueuses avec une &eacute;volution cicatricielle. Il s'agit d'un homme de 66 ans hospitalis&eacute; pour gingivite &eacute;rosive avec dysphagie, dyspn&eacute;e et flou visuel. L'examen dermatologique retrouvait des l&eacute;sions &eacute;rosives du palais et du pharynx. L'examen ophtalmologique notait des symbl&eacute;pharons, un ectropion et une cataracte bilat&eacute;rale. La biopsie gingivale avait montr&eacute; un d&eacute;collement n&eacute;crotique de l'&eacute;pith&eacute;lium buccal. L'immunofluorescence directe notait un d&eacute;p&ocirc;t lin&eacute;aire d'Immunoglobuline A &agrave; la jonction dermo-&eacute;pidermique. L'Immunofluorescence indirecte &eacute;tait revenue n&eacute;gative. Le diagnostic de pemphigoide cicatricielle &eacute;tait confirm&eacute;. Le Transit oeso-gastro-duod&eacute;nal a objectiv&eacute; une double st&eacute;nose de l'œsophage. L'endoscopie nasale, pharyng&eacute;e et bronchique retrouvait des ulc&eacute;rations de l'&eacute;piglotte, de l'hypopharynx, du pharynx et de l'arbre bronchique. Le patient a b&eacute;n&eacute;fici&eacute; d'un bolus de Solumedrol relay&eacute; par la Prednisone &agrave; la dose de 0.5mg/Kg/j associ&eacute; &agrave; la Disulone &agrave; la dose de 100mg/j. L'&eacute;volution &eacute;tait favorable au d&eacute;but mais s'est compliqu&eacute;e apr&egrave;s 2 mois d'une aggravation de la dysphagie et de la st&eacute;nose oesophagienne. Notre observation est tr&egrave;s particuli&egrave;re par la survenue d'une Pemphigoide cicatricielle chez un sujet de sexe masculin ayant un tableau grave en rapport avec l'extension des l&eacute;sions &agrave; toutes les muqueuses conjonctivale, buccale, nasale, œsophagienne et m&ecirc;me bronchique associ&eacute;e &agrave; une immunofluorescence directe faite d'un d&eacute;p&ocirc;t d'IgA uniquement.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Tarik Salama, El Mohtadi Aghoutane, Redouane El Fezzazi [Case report] - Forme pseudotumorale de la tuberculose: &agrave; propos d’un cas - 13 March 2017. http://www.panafrican-med-journal.com/content/article/26/135/abstract/ <b>La tuberculose osseuse peut prendre l'aspect d'une tumeur maligne. Nous pr&eacute;sentons le cas d'un enfant de 4 ans porteur d'une tuberculose osseuse ayant simul&eacute; un ost&eacute;osarcome f&eacute;moral. Le diagnostic a &eacute;t&eacute; redress&eacute; par l'&eacute;tude anatomopathologique. Ce cas souligne l'importance de connaitre les des diff&eacute;rents aspects cliniques et radiologiques de la tuberculose osseuse qui peut simuler une tumeur maligne. Afin d'&eacute;viter tout retard diagnostic, chirurgiens p&eacute;diatres et radiologues doivent savoir que la tuberculose peut rev&ecirc;tir les tableaux cliniques et radiologiques de nombreuses pathologies.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Awoke Derbie, Derese Hailu, Daniel Mekonin, Bayeh Abera, Gashaw Yitayew [Research] - Antibiogram profile of uropathogens isolated at Bahir Dar Regional Research Laboratory Centre, Ethiopia - 10 March 2017. http://www.panafrican-med-journal.com/content/article/26/134/abstract/ <b>INTRODUCTION: antimicrobial resistance among bacteria that cause urinary tract infection (UTI) has been increasing since the introduction of chemotherapy. This study was aimed to assess the types of isolates from patients with UTI and to determine their current antimicrobial susceptibility profile.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khaled Chakour, Mohamed El Faizchaoui [Case report] - Kyste hydatique de la fosse c&eacute;r&eacute;brale post&eacute;rieure - 09 March 2017. http://www.panafrican-med-journal.com/content/article/26/133/abstract/ <b>L'hydatidose est une parasitose cosmopolite end&eacute;mique au Maroc. L'&eacute;chinococcose c&eacute;r&eacute;brale est rare repr&eacute;sentant 1 &agrave; 2% de l'ensemble des hydatidoses de l'homme et la localisation auniveau de la fosse post&eacute;rieure est exceptionnelle. Nous rapportons le cas d'un enfant &acirc;g&eacute; de 12 ansadmis pour syndrome d'hypertension intracr&acirc;nienne &eacute;voluant depuis trois mois. La tomodensitom&eacute;trie c&eacute;r&eacute;brale a objectiv&eacute; une formation kystique de la fosse post&eacute;rieurene se rehaussant pas apr&egrave;s injection du produit de contraste. L'intervention chirurgicale r&eacute;v&eacute;lait un kyste hydatique. Ce diagnostic a&eacute;t&eacute; par la suite confirm&eacute;parl'examen anatomo-pathologique. Le patient a re&ccedil;uuntraitement m&eacute;dical &agrave; base d'albendazole en postop&eacute;ratoire. L'&eacute;volution&eacute;tait favorable six mois plus tard.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khalid Chakour, Mohamed El FaizChaoui [Case report] - Une cause rare de compression m&eacute;dullaire: kyste arachno&iuml;dien &eacute;pidural rachidien (&agrave; propos de 03 cas) - 09 March 2017. http://www.panafrican-med-journal.com/content/article/26/132/abstract/ <b>Le kyste arachno&iuml;dien &eacute;pidural rachidien (KAER) est une affection b&eacute;nigne, de physiopathologie encore incertaine. Il est le plus souvent asymptomatique mais peut causer des s&eacute;quelles neurologiques graves surtout quand le traitement n'est pas instaur&eacute; &agrave; temps. Nous rapportons l'exp&eacute;rience du service de Neurochirurgie CHU Hassan II- F&egrave;s concernant la prise en charge du KAER &agrave; travers l'analyse r&eacute;trospective de trois cas. Il s'agit de deux patients de sexe masculin et d'une femme, d'&acirc;ge moyen de 35 ans (Extr&ecirc;mes: 16 et 56 ans), tous admis pour un tableau de compression m&eacute;dullaire lente. Tous nos patients ont b&eacute;n&eacute;fici&eacute; d'une IRM m&eacute;dullaire qui a mis en &eacute;vidence une collection liquidienne de si&egrave;ge &eacute;pidural, ayant le m&ecirc;me signal que le LCR, comprimant la moelle en regard. Le si&egrave;ge de la collection &eacute;tait thoracique dans tous les cas. Tous nos patients ont &eacute;t&eacute; op&eacute;r&eacute;s par voie post&eacute;rieure avec ex&eacute;r&egrave;se du kyste et ligature du collet dans deux cas et une plastie durale dans un seul cas. L'&eacute;tude anatomopathologique a conclu en un kyste arachno&iuml;dien. L'&eacute;volution postop&eacute;ratoire &eacute;tait favorable dans tous les cas. Ce travail a comme objectif de mettre le point sur cette pathologie tout en insistant sur la n&eacute;cessit&eacute; d'une prise en charge pr&eacute;coce, vu la tendance vers l'aggravation progressive en l'absence de th&eacute;rapie adapt&eacute;e et rappeler les particularit&eacute;s cliniques, paracliniques et th&eacute;rapeutiques de cette affection.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri, Mohamed Benzagmout, Khalid Chakour, Mohamed El Faiz Chaoui [Case report] - Une cause rare d’exophtalmie: l’h&eacute;mangiome caverneux intraorbitaire (&agrave; propos d’un cas) - 09 March 2017. http://www.panafrican-med-journal.com/content/article/26/131/abstract/ <b>L'h&eacute;mangiome caverneux est la plus fr&eacute;quente des tumeurs vasculaires b&eacute;nignes primitives de l'orbite chez l'adulte; l'&acirc;ge moyen de d&eacute;couverte est de 42 ans avec une pr&eacute;dilection f&eacute;minine. Cette tumeur est d'&eacute;volution lente et n'a aucune tendance &agrave; la r&eacute;gression spontan&eacute;e; elle se localise &eacute;lectivement au niveau du c&ocirc;ne musculaire en position r&eacute;tro-oculaire mais pouvant se d&eacute;velopper dans l'espace extraconique. Elle se traduit cliniquement par une exophtalmie d'apparition progressive, irr&eacute;ductible, non pulsatile, indolore sauf en cas de complication, associ&eacute;e dans 2/3 des cas &agrave; une baisse de l'acuit&eacute; visuelle. Le diagnostic est facilement confirm&eacute; par l'imagerie qui permet de localiser parfaitement la tumeur par rapport au nerf optique et aux muscles oculomoteurs et de dicter la voie d'abord chirurgicale. L'ex&eacute;r&egrave;se chirurgicale doit &ecirc;tre faite en bloc; elle est habituellement simple car la tumeur est bien limit&eacute;e et parfaitement clivable. Les voies d'abord sont en fonction du volume et surtout du si&egrave;ge de la l&eacute;sion. Le pronostic fonctionnel est bon et les cas de r&eacute;cidives sont rares.Un cas d’angiome caverneux orbitaire r&eacute;v&eacute;l&eacute; par une exophtalmie survenant chez un patient &acirc;g&eacute; de 44 ans est rapport&eacute;.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Youssouf Benmoh, Ahmed Bourazza [Images in medicine] - Mirroring spinal cord lesion secondary to B12 deficiency - 07 March 2017. http://www.panafrican-med-journal.com/content/article/26/130/abstract/ <b>A 26 year-old girl, previously healthy, admitted for progressive weakness of both lower limbs, with permanent paresthaesia evolving for 6 months. Clinical examination found spastic paraparesis with proprioceptive ataxia. The MRI showed bilateral and symmetrical lesions in the cervical spinal cord. Lesions were T1-isointense and T2 hyperintense, located on both lateral and posterior funiculus without enhancement. Investigation revealed deep vitamin B12 deficiency (27pg/ml), macrocytosis, with positive parietal cell-antibody and fundic gastritis. Patient was treated with intra muscular hydorxycobalamin. Evolution was favorable with regression of weakness and parethaesia of both lower limbs, and persistence of discreet ataxia. Cobalamin deficiency is common in the elderly. It causes hematologic, digestive and neurological disorders. Neurological signs are dominated by combined sclerosis of the spinal cord, and peripheral neuropathy. MRI is useful in front of myelopathy, showing an enlargement or T2-hyperintense lesion of the posterior funiculus.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hicham Naji-Amrani, Aziz Ouarssani [Images in medicine] - Chilaiditi syndrome - 07 March 2017. http://www.panafrican-med-journal.com/content/article/26/129/abstract/ <b>Chilaiditi syndrome or subphrenic interposition of the colon, is a rare condition with an incidence of 0.025% - 0.28% in radiographs and mostly diagnosed as an incidental finding. We report the case of a 67-years-old male, heavy smoker, with history of intermittent abdominal pain, who reported cough and muco-purulent sputum without fever or dyspnea. Physical examination showed bilateral bronchial rales and right hypochondrium sensitivity, his vital signs were normal. A posteroanterior chest films (A) reveled an elevated right hemidiaphragm with free gas below. A pneumoperitoneum, subphrenic abscess, and intestinal pneumatosis were suspected, however, a CT scan of the thorax and abdomen (B, C and D) showed the interposition of the right colon angle between the diaphragm and the liver without any perforated viscus. Our patient was treated for chronic bronchitis infection; otherwise his Chilaiditi syndrome required symotomatic treatment with good outcomes.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Walid Osman, Zeineb Alaya, Ali Haggui, Mohamed Ben Rejeb, Sonia Jemni, Nader Naouar, Mohamed Laziz Ben Ayeche [Case series] - Les tumeurs &agrave; cellules g&eacute;antes des gaines synoviales de la main: &agrave; propos de 50 cas - 07 March 2017. http://www.panafrican-med-journal.com/content/article/26/128/abstract/ <b>Les tumeurs &agrave; cellules g&eacute;antes des gaines synoviales (TCGGS) des tendons repr&eacute;sentent la forme localis&eacute;e de la synovite villonodulaire h&eacute;mopigment&eacute;e. Elles s'observent le plus souvent au niveau des mains. Notre but &eacute;tait d'&eacute;tudier les caract&eacute;ristiques &eacute;pid&eacute;mio-cliniques et th&eacute;rapeutiques des TCGGS, &eacute;valuer les r&eacute;sultats du traitement chirurgical et d&eacute;gager les facteurs de r&eacute;cidives. Il s'agit d'une &eacute;tude r&eacute;trospective de 50 cas de TCGGS de la main collig&eacute;s entre 1992 et 2016 au service d'orthop&eacute;die de l'h&ocirc;pital Sahloul de Sousse en Tunisie. Les caract&eacute;ristiques cliniques et &eacute;pid&eacute;miologiques des TCGGS ont &eacute;t&eacute; pr&eacute;cis&eacute;es. L'&acirc;ge moyen des patients &eacute;tait de 33 ans (9-69 ans) avec un sexe-ratio de 0,6. Les motifs de consultation &eacute;taient l'apparition constante d'une tum&eacute;faction (100%), la g&ecirc;ne &agrave; la mobilisation des articulations inter-phalangiennes (6%) et la douleur digitale (18%). Toutes les tumeurs &eacute;taient localis&eacute;es au niveau de la r&eacute;gion digitale, surtout au niveau de l'index (42%). La localisation &eacute;tait palmaire dans 66% des cas. Tous les malades ont &eacute;t&eacute; op&eacute;r&eacute;s, l'aspect macroscopique montrait une tumeur encapsul&eacute;e, polylob&eacute;e et jaune brun&acirc;tre qui se prolongeait dans la gaine des tendons fl&eacute;chisseurs (4 cas) et sous le tendon extenseur (2 cas). Nous avons not&eacute; un seul cas de r&eacute;cidive, soit 2% qui ont &eacute;t&eacute; repris chirurgicalement. Les r&eacute;sultats fonctionnels &eacute;taient bons dans tous les cas. Le diagnostic de TCGGS doit &ecirc;tre &eacute;voqu&eacute; devant une tum&eacute;faction digitale. Leur prise en charge fait appel &agrave; la chirurgie qui reste difficile et doit &ecirc;tre correctement ex&eacute;cut&eacute;e pour &eacute;viter les r&eacute;cidives.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Isolated tuberculous trochanteritis - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/127/abstract/ <b>A 40-year-old patient was hospitalized for inflammatory pain in the superior-external surface of the right thigh evolving since 8 months, with no change in the general condition or fever. The pressure towards the right large trochanter was painful without local inflammatory signs. Biology did not show any inflammatory syndrome. The X-ray of the pelvis revealed an osteolytic lesion of the right great trochanter with thickening of the soft parts (Panel A). Bone scintigraphy showed hyperfixation of the right great trochanter (Panel B). The scanner of the basin revealed an osteolytic lesion of the right great trochanter containing multiple sequesters with cortical irregularity (Panel C). A great-trochanter bone biopsy under scannographic control was made (Panel D). The histological study showed an epithelioid and giganto-cellular granuloma with the presence of BK in the culture of the puncture fluid. The diagnosis of trochanteric tuberculosis was then made. Tuberculin intradermal reaction (IDR) was negative. The search for other tuberculous sites was negative. The patient was treated with anti-tuberculosis drugs during 12 months with good progression. Tuberculosis is a rare cause of trochanteritis. The peculiarity of our observation lies also in the absence of other tuberculous localizations.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Kumeren Govender, Fatima Suleman, Yoshan Moodley [Research] - Clinical risk factors for in-hospital mortality in older adults with HIV infection: findings from a South African hospital administrative dataset - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/126/abstract/ <b>INTRODUCTION: the proportion of older South African adults (aged &ge; 50 years old) with HIV infection requiring hospitalization is likely to increase in the near future. Clinical risk factors for in-hospital mortality (IHM) in these patients are not well described. We aimed to identify clinical risk factors associated with IHM and their overall contribution towards IHM in older South African adults with HIV infection. METHODS: clinical data for 690 older adults with HIV infection was obtained from the hospital administrative database at the Hlabisa Hospital in KwaZulu-Natal, South Africa. Logistic regression was used to determine independent clinical risk factors for IHM. Population-attributable fractions (PAFs) were calculated for all independent clinical risk factors identified. RESULTS: male gender (p=0.005), CD4 count <350 cells/mm<sup>3</sup>(p=0.035), unknown CD4 count (p=0.048), tuberculosis (p=0.033) and renal failure (p=0.013) were independently associated with IHM. Male gender contributed the most to IHM (PAF=0.22), followed by unknown CD4 count (PAF=0.14), tuberculosis (PAF=0.12), renal failure (PAF=0.06) and CD4 count <350 cells/mm<sup>3</sup> (PAF=0.01). CONCLUSION: although further research is required to confirm our findings, there is potential for these clinical risk factors identified in our study to be used to stratify patient risk and reduce IHM in older adults with HIV infection.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Brooke Rosenbaum, Rebecca Klein, Paa Gyasi Hagan, Mark-Young Seadey, Naa Larteley Quarcoo, Rachel Hoffman, Maria Robinson, Margaret Lartey, Marie Leger [Research] - Dermatology in Ghana: a retrospective review of skin disease at the Korle Bu Teaching Hospital Dermatology Clinic - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/125/abstract/ <b>INTRODUCTION: Ghana is currently developing its provision of dermatology services. Epidemiologic studies of the skin diseases seen by Ghanaian dermatologists are needed to guide these efforts. We aimed to describe the skin conditions seen by and management practices of Ghanaian dermatologists in a specialized clinic. METHODS: we conducted a chart review of new patients presenting to the Korle Bu Teaching Hospital dermatology clinic during 2014. RESULTS: among the 529 patients studied, 700 discrete diagnoses were made. The most commonly diagnosed skin conditions were infections (24.6%) and dermatitis (24.6%); atopic dermatitis (8.4%), acne vulgaris (5.3%) and scabies (5.1%) were the most common specific diagnoses. Among infants, children, and adolescents, the most common diagnosis was atopic dermatitis (31.7%, 30.0%, and 14.9%, respectively). Acne vulgaris (12.0%) was the most common skin condition diagnosed in young adults. Irritant contact dermatitis (6.9%) was most common among adults. Lichen planus (9.9%) was the most commonly diagnosed skin condition in the senior population. Diagnoses made by dermatologists differed from the referral diagnosis documented by primary care providers for 65.8% of patients. The most frequently recommended treatments were antihistamines (47.8%) and topical steroids (38.4%). Only 18 diagnostic biopsies were performed. CONCLUSION: our study summarizes the skin diseases seen and management practices of Ghanaian dermatologists in a specialized clinic at a large public teaching hospital. The results of this study can help to guide future dermatology education and development efforts in Ghana.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Alhaji Abubakar Aliyu, Tukur Dahiru [Research] - Predictors of delayed Antenatal Care (ANC) visits in Nigeria: secondary analysis of 2013 Nigeria Demographic and Health Survey (NDHS) - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/124/abstract/ <b>INTRODUCTION: Antenatal Care (ANC) is an important component of maternal health and covers a wide range of activities with huge potential benefits for positive pregnancy out comes. However, large proportions of women do initiate ANC early resulting in adverse consequences. METHODS: the study utilized the nationally-representative sample of women of reproductive age interviewed during the 2013 Nigeria DHS. Analysis was restricted to 20, 467 women aged 15-49 years who had a live birth in the five-year period prior to the survey. Multinomial logistic regression was performed using Stata v13 to determine significant factors related to timing of initiation of ANC. Relative risk ratio (RRR) was used to assess the strength of association between independent and dependent variables. RESULTS: overall, 27%, 62% and 12% of women initiated ANC in the first, second and third trimesters respectively. In both the two model, the findings reveal that maternal education, level of media exposure, region and place of residence are the uniform predictors of initiation of ANC; having health insurance is a significant predictor of third trimester ANC initiation relative to first to first trimester only. Within the categories of household wealth, levels of participation in household decision-making and region some categories are significant predictors while others are not. CONCLUSION: maternal education, level of media exposure, region and place of residence are the uniform and consistent predictors of delay in ANC initiation. This suggests that girl-child education, universal health coverage and universal health insurance could be the interventions required to improve service utilization and maternal health.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Seydou Bakayoko, Nouhoum Guirou, Brainima Coulibaly, Jeannette Traor&eacute; [Case report] - Œd&egrave;me papillaire bilat&eacute;ral secondaire &agrave; une hypertension intracr&acirc;nienne chez une adolescente - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/123/abstract/ <b>L'œd&egrave;me papillaire est un gonflement liquidien et /ou axonal de la t&ecirc;te du nerf optique du &agrave; un blocage du flux axoplasmique au niveau de la lame cribl&eacute;e. Nous rapportons le cas d'une jeune adolescente &acirc;g&eacute;e de 17 ans, qui pr&eacute;senta un œd&egrave;me papillaire bilat&eacute;ral secondaire &agrave; une hypertension intracr&acirc;nienne idiopathique.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com El Mahi Hakima, Mernissi Fatima Zahra [Images in medicine] - Rhinophyma - 03 March 2017. http://www.panafrican-med-journal.com/content/article/26/122/abstract/ <b>Rhinophyma (rhis: nose, phyma: growth) is a rare, disfiguring disease characterized by a progressive hypertrophy of the soft-tissues of the nose with its increased volume, mainly in the lower half, and often associated to an end-stage of severe acne rosacea. The cause of rhinophyma is unknown, but it is believed to be the end stage of acne rosacea.The diagnosis is easy to ascertain based on the clinical features of the disease. In advanced cases, medical management is believed to be inferior to the results seen with surgical treatment. Surgical management is divided into 3 approaches: full-thickness excision followed by split-thickness skin graft, full-thickness excision followed by full-thickness skin graft, and decortication or partial excision. Decortication techniques include dermaplaning, dermabrasion, cryosurgery, electrosurgery, laser surgery and sharp blade excision.We reporte a case treated by a decortication technique: a 60-year-old man who presented at the dermatology department with a 20-year history of rhinophyma. He had never undergone any laser or surgical interventions. No other medical problem was reported, and there was no family history of rosacea. In collaboration with the Department of Plastic Surgery, rhinophymectomy using a scalpel and electroscalpel was undertaken. The procedure was performed with the patient under general anesthesia. A scalpel with a no. 15 blade was used. The postoperative period was satisfactory. The first signs of skin reepithelialization appeared 2 weeks after the intervention. At a 2 month-follow-up visit, a scar was present on the nasal tip, but the overall nasal contour was restored.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Felix Uduma Uduma, Anelkan Abaslattai, Dianabasi Udoete Eduwem, Morgan Ekanem, Philip Chinedu Okere [Research] - Utility of first trimester obstetric ultrasonography before 13 weeks of gestation: a retrospective study - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/121/abstract/ <b>INTRODUCTION: first trimester pregnancy is defined as twelve weeks after the last menstrual period. Ultrasonography has revolutionized validation and management of first trimester pregnancies. The aim was to analyze ultrasonographic findings of first trimester pregnancies in University of Uyo teaching hospital (UUTH), Uyo, Nigeria. METHODS: the departmental ultrasonographic records of pregnant women who were referred to Radiology department of UUTH, Uyo, Nigeria. For ultrasound scans were retrospectively reviewed. The period under consideration was from 8th January 2013 to 8th February, 2016. Demographic data and ultrasonographic parameters of first trimester pregnancies like gestational sacs were recorded. Data were statistically analyzed using SPSS Chicago 13. Exclusion criterion included incomplete data and acyesis despite positive ²hCG test. RESULTS: 26.4% (n-645) of the 2438 pregnant women who underwent obstetric ultrasonography had first trimester ultrasonography during the studied period. The peak frequency was seen in the 20-29 age range with 52.2% (n-337) and followed by 30-39 age range with 41.7% (n-269). The commonest first trimester ultrasound findings was viable pregnancy with 42.5% (n-274), followed by incomplete miscarriage with 34.3% (n-221). The least finding was trophoblastic pregnancies 0.3% (n-2). The earliest age at which normal viable pregnancy was diagnosed in this study was 5weeks 5days from the last menstrual period. Only 2.19% (n-6) of the normal viable pregnancies were multiple pregnancies and they were all twins. The highest number of referrals to Radiology Department for first trimester ultrasonography was from accident and emergency unit with 34.42% (n-222) while antenatal clinic referral was only 16.12% (n-104). CONCLUSION: the commonest first trimester’s obstetric ultrasonographic findings in Uyo, Nigeria are viable pregnancies and are predominantly single gestation. The earliest age of ultasonographic pregnancy detection in Uyo is 5week 5days and peak maternal age is second and third decades.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Prastiya Indra Gunawan, Wihasto Suryaningtyas [Images in medicine] - Giant subdural empyema following ventriculo-peritoneal shunt in a child - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/120/abstract/ <b>Subdural empyema is an intracranial focal collection of purulent material located between the dura mater and the arachnoid mater. It developed from varied sources, but the paranasal sinuses, the ears, and the mastoids processes were predominantly affected. Giant subdural empyema secondary to cerebrospinal fluid shunt placement has been extremely unusual. A 9-years-old girl presented with prolonged low-grade fever, vomiting, local wound infection in frontal area and general weakness. She was previously hydrocephalic with large head size since birth. A ventriculo-peritoneal shunt was already inserted for 7 years. Neurological examination showed the patient fully conscious and left hemiparesis. Routine hematological investigation revealed leukocytosis and high C-reactive protein (CRP). A contrast-enhanced CT scan showed an hypodense fluid collection with peripheral ring enhancement on the right of the midline supporting a giant subdural empyema. Emergency surgery was performed to drainage the pus. Pus culture resulted no growth of bacteria. Ceftriaxone and metronidazole were administered for 6 weeks. Follow-up CT Scan showed reduction of mass effect. The patient was improved leaving neurological sequalae.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Yddoussalah Othmane, Jakhlal Nabil, Karmouni Tarik, Elkhader Khalid, Koutani Abdellatif, Ibn Attya Andaloussi Ahmed [Case report] - Paragangliome non s&eacute;cr&eacute;tant r&eacute;trop&eacute;riton&eacute;al: &agrave; propos d'une observation - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/119/abstract/ <b>Les paragangliomes r&eacute;trop&eacute;riton&eacute;aux non fonctionnels sont des tumeurs rares. Ils sont souvent asymptomatiques et peuvent atteindre des dimensions importantes. Les auteurs rapportent le cas d'une tumeur r&eacute;tro p&eacute;riton&eacute;ale, d&eacute;couverte au cours d'un examen tomodensitom&eacute;trique r&eacute;alis&eacute; chez une femme &acirc;g&eacute;e de 49 ans en raison de douleurs abdominales non sp&eacute;cifiques. Les formes malignes, plus fr&eacute;quentes que les formes b&eacute;nignes, pr&eacute;sentent un envahissement locor&eacute;gional et m&eacute;tastasent tardivement. Le traitement de ces tumeurs n&eacute;cessite une ex&eacute;r&egrave;se chirurgicale la plus compl&egrave;te possible puisque le pronostic en d&eacute;pend. Il n'existe par contre pas de consensus sur l'utilit&eacute; des th&eacute;rapeutiques compl&eacute;mentaires qui peuvent n&eacute;anmoins constituer un appoint &agrave; titre symptomatique.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Ridha Fatnassi, N&eacute;dia Marouen, Houcem Ragmoun, Latifa Marzougui, Sabra Hammami [Case report] - Le b&eacute;b&eacute; collodion: aspects cliniques et int&eacute;r&ecirc;t du diagnostic ant&eacute;natal - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/118/abstract/ <b>Le b&eacute;b&eacute; collodion est une forme s&eacute;v&egrave;re de l’ichtyose cong&eacute;nitale &agrave; r&eacute;v&eacute;lation n&eacute;onatale. Le tableau clinique est souvent caract&eacute;ristique. L’&eacute;volution, quand elle n’est pas fatale, se fait le plus souvent vers l’ichtyose s&egrave;che. Gr&acirc;ce aux techniques de biologie mol&eacute;culaire, le diagnostic pr&eacute;natal est rendu possible d&egrave;s la 10-12&egrave;me semaine d’am&eacute;norrh&eacute;e, permettant un conseil g&eacute;n&eacute;tique. Quant au pronostic de la maladie, il d&eacute;pend de plusieurs param&egrave;tres, &agrave; savoir le degr&eacute; de l’atteinte initiale, la dur&eacute;e de la desquamation, ainsi que l’ichtyose sous-jacente. A l’occasion d’une nouvelle observation d’un b&eacute;b&eacute; collodion issu &agrave; 34 SA, d’une parturiente ayant un cas index, et a &eacute;volution fatale d&eacute;s le premier jour de vie; nous avons fait une revue de la litt&eacute;rature afin de pr&eacute;ciser les aspects diagnostiques et th&eacute;rapeutiques ainsi que l’utilit&eacute; du diagnostic ant&eacute;natale.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Algodystrophy and pregnancy - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/117/abstract/ <b>The algodystrophy is a regional pain syndrome, characterized by complex neurovascular abnormalities. Pregnancy appears through mechanical factors promote dystrophy of the lower limbs. We report the case of a 31 year old woman, primipara, who presented in the third quarter of pregnancy (35 weeks gestation) mechanical right groin pain with functional impairment. She has consulted in postpartum (4 days after birth). The review noted a limp, functional impairment with a visual analogue scale (VAS) pain 70%. Standard radiographs postpartum showed speckled locoregional demineralization of the right hip. MRI confirmed the diagnosis of right hip algodystrophy (A and B). The patient took analgesic treatment with a discharge and rest for 3 months. She has not received bisphosphonates because she breastfeeding. Disease duration was 24 weeks. The evolution was marked by the persistence of residual pain (VAS 20%) without sequelae. Algodystrophy during pregnancy is rare and is often misunderstood. The analysis of our results compared to literature, allows to identify the main characteristics of this variety of reflex sympathetic dystrophy: gradual onset in the second or third trimester, location in the hip alone or associated with other locations. MRI is currently the modality of choice for the early and differential diagnosis. The course is generally favorable. The safety of bisphosphonates during pregnancy and lactation remains to be demonstrated.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Yassine Ragbaoui, Chafia Chehbouni, Ayoub El Hammiri, Rachida Habbal [Case series] - Epid&eacute;miologie de l’association fibrillation atriale et insuffisance cardiaque - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/116/abstract/ <b>La fibrillation atriale et l’insuffisance cardiaque sont des maladies cardiovasculaires souvent associ&eacute;es, leur coexistence aggrave le pronostic et constitue un probl&egrave;me de sant&eacute; public majeur. L’objectif de cette &eacute;tude est d’&eacute;valuer la pr&eacute;valence de la fibrillation atriale chez les patients en insuffisance cardiaque chronique et d&eacute;terminer le profil clinique de ce groupe de patients. Nous avons conduit une &eacute;tude r&eacute;trospective descriptive bas&eacute;e sur le registre d'insuffisance cardiaque du d&eacute;partement de cardiologie du centre hospitalier universitaire de juin 2006 &agrave; Mars 2015.Nous avons inclus les patients &acirc;g&eacute;s de plus de 18 ans ayant une insuffisance cardiaque chronique avec une fibrillation atriale. Durant cette p&eacute;riode 3048 patients ayant une insuffisance cardiaque chronique avec fibrillation atriale(FA) ont &eacute;t&eacute; inclus. La pr&eacute;valence de la fibrillation atriale &eacute;tait de 10,6%. La fr&eacute;quence des facteurs de risque cardiovasculaires associ&eacute;e &agrave; (FA) &eacute;tait de: (54%) pour l'hypertension art&eacute;rielle, (39%) pour le diab&egrave;te, (8%) pour la dyslipid&eacute;mie, (26%) pour le tabac, (30%) pour la s&eacute;dentarit&eacute; et (17%) pour la m&eacute;nopause. La (FA) &eacute;tait pr&eacute;sente chez (67,4%) des hommes versus (32,6%) des femmes. Les &eacute;tiologies de l'insuffisance cardiaque chronique associ&eacute;es &agrave; la fibrillation atriale &eacute;taient: les valvulopathies (44,1%); les coronaropathies (32%); Hypertensives (11%), primitive (10%), toxiques (2%) et alcoolisme chronique (1%). La fibrillation atriale reste fr&eacute;quente dans la population des patients insuffisants cardiaques au Maroc et la moyenne d’&acirc;ge est inf&eacute;rieure &agrave; celle retrouv&eacute;e dans la litt&eacute;rature.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Yassine Ragbaoui, Imad Nouamou, Ayoub El Hammiri, Rachida Habbal [Case series] - Facteurs pr&eacute;dictifs de l’adh&eacute;sion m&eacute;dicamenteuse chez les patients en insuffisance cardiaque chronique: exp&eacute;rience marocaine - 02 March 2017. http://www.panafrican-med-journal.com/content/article/26/115/abstract/ <b>L’adh&eacute;sion m&eacute;dicamenteuse chez les patients ayant une insuffisance cardiaque chronique est reconnue comme l’un des probl&egrave;mes majeurs dans la gestion de cette pathologie. L’&eacute;tat d&eacute;mographique et socio&eacute;conomique des pays africains peut avoir un impact sur l’adh&eacute;sion au traitement de l’insuffisance cardiaque chronique. Nous avons r&eacute;alis&eacute; une &eacute;tude transversale de Septembre 2014 &agrave; Janvier 2015 portant sur les patients en insuffisance cardiaque chronique suivis au centre d’insuffisance cardiaque du d&eacute;partement de cardiologie du centre hospitalier universitaire IBN ROCHD &agrave; Casablanca au Maroc. La mesure de l’adh&eacute;sion m&eacute;dicamenteuse &eacute;tait bas&eacute;e sur un questionnaire: questionnaire CARDIA. Les informations relatifs aux facteurs pr&eacute;dictifs d’adh&eacute;sion m&eacute;dicamenteuse &eacute;tait d&eacute;riv&eacute;s du model d’adh&eacute;sion multidimensionnel. Nous avons inclus dans cette &eacute;tude 147 patients insuffisants cardiaques chroniques. Le pourcentage de l’adh&eacute;sion m&eacute;dicamenteuse &eacute;tait de 83.6% selon CARDIA-Questionary. Les facteurs pr&eacute;dictifs qui influencent significativement l’adh&eacute;sion m&eacute;dicamenteuse &eacute;tait: La d&eacute;pression (p=0.034), le niveau de support social (p=0.03) et la prise de m&eacute;dicaments par le patient lui-m&ecirc;me (p=0.0001). Comme dans plusieurs r&eacute;gions au monde, l’adh&eacute;sion m&eacute;dicamenteuse chez les patients ayant une insuffisance cardiaque chronique reste un probl&egrave;me de sant&eacute; au Maroc. Les diff&eacute;rentes strat&eacute;gies qui agissent sur les facteurs pr&eacute;dictifs pourraient am&eacute;liorer l’adh&eacute;sion m&eacute;dicamenteuse.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Mounir Yahyaoui, Abdelhafid Derfoufi, Najib Abbassi, Abdelkarim Daoudi, Omar Agoumi, Hicham Yacoubi, Abdeljaouad Najib [Case report] - Rupture bilat&eacute;rale simultan&eacute;e des deux ligaments crois&eacute;s du genou: &agrave; propos d’un cas - 01 March 2017. http://www.panafrican-med-journal.com/content/article/26/114/abstract/ <b>La rupture bicrois&eacute;e est rare, des deux LCA simultan&eacute;ment est exceptionnelle, alors que la rupture bicrois&eacute;e bilat&eacute;rale simultan&eacute;e et post-traumatique n’a &eacute;t&eacute; jamais d&eacute;crite dans la litt&eacute;rature, ce qui rend notre cas tr&egrave;s int&eacute;ressant pour &eacute;tude, suivi et discussion th&eacute;rapeutique puisqu’on a privil&eacute;gi&eacute; la prise en charge th&eacute;rapeutique en deux temps op&eacute;ratoires espac&eacute;s dans le temps et nos r&eacute;sultats &eacute;taient tr&egrave;s satisfaisantes aussi bien pour nous que pour le malade.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Mouna Ayadi, Azza Gabsi, Khdija Meddeb, Amina Mokrani, Yosra Yahiaoui, Feryel Letaief, Nesrine Chraiet, Henda Rais, Amel Mezlini [Case report] - Primary leiomyosarcoma of thyroid gland: the youngest case - 01 March 2017. http://www.panafrican-med-journal.com/content/article/26/113/abstract/ <b>Primary leiomyosarcomas of the thyroid gland are extremely rare. We report a case of a 32 year-old women with a multinodular goiter. She underwent total thyroidectomy. The tumor histology showed spindle-shaped cells that expressed desmine, caldesmone and smooth muscle actine but were negative cytokeratins.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Salma Fares, Mouna Lamchahab, Myriem Aniba, Ghizlane Lembarki, Nadia Mousalli, Meriem Regragui, Mehdi Karkouri, Asmaa Quessar [Case report] - Lymphome T/NK extra-nasal &agrave; localisation colique primitif: &agrave; propos d’un cas - 01 March 2017. http://www.panafrican-med-journal.com/content/article/26/112/abstract/ <b>Le lymphome T/NK intestinal primitif est une entit&eacute; extr&ecirc;mement rare dont le diagnostic pr&eacute;coce est souvent difficile. Pour mieux comprendre cette entit&eacute;, nous rapportons le cas d’un patient de 43 ans diagnostiqu&eacute; avec un lymphome T/NK colique primitif localis&eacute; et isol&eacute; sans ent&eacute;ropathie associ&eacute;e, ayant &eacute;t&eacute; trait&eacute; par 3 cycles (AspaMetDex) avec un &eacute;chec &agrave; l’&eacute;valuation et la survenue du d&eacute;c&egrave;s au cours du traitement dans le tableau d’un abdomen aigu. Le lymphome T/NK intestinal primitif atteint le plus souvent le sujet jeune avec un pronostic p&eacute;joratif. En raison des caract&egrave;res cliniques et endoscopiques non sp&eacute;cifiques, il est difficile de distinguer entre un lymphome T/NK intestinal et les troubles intestinaux inflammatoires ou infectieuses. Les donn&eacute;es histopathologiques et immunohistochimiques ainsi que l’&eacute;tude de l’ADN permettent de redresser le diagnostic et de classer ce lymphome selon l’EuropeanEnteropathy-Type Intestinal T-CellLymphoma (ETL).</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Sinaa Mohamed [Case report] - Lymphome &agrave; cellules de la zone marginale spl&eacute;nique - 01 March 2017. http://www.panafrican-med-journal.com/content/article/26/111/abstract/ <b>Le lymphome &agrave; cellules de la zone marginale spl&eacute;nique (LZMS) est un lymphome B exceptionnel, bien d&eacute;finie dans la classification OMS 2016 des tumeurs h&eacute;matopo&iuml;&eacute;tiques, qui peut &ecirc;tre source de pi&egrave;ges diagnostiques. Patiente &acirc;g&eacute;e de 72 ans, hospitalisait pour l’exploration d’une &eacute;norme spl&eacute;nom&eacute;galie confirm&eacute;e par une tomodensitom&eacute;trie (TDM). Le bilan biologique &eacute;tait normal. Une spl&eacute;nectomie a &eacute;t&eacute; r&eacute;alis&eacute;e. L’&eacute;tude microscopique de la pi&egrave;ce op&eacute;ratoire montrait une prolif&eacute;ration lymphomateuse diffuse &agrave; petites cellules, avec un marquage par le CD20. Le CD 5 et le CD 43 sont n&eacute;gatifs. Le diagnostic d’un LZMS a &eacute;t&eacute; retenu. Le LZMS est repr&eacute;sente moins de 2% de l’ensemble lymphomes non hodgkiniens. Il touche le sujet &acirc;g&eacute; de plus de 50 ans, caract&eacute;ris&eacute; habituellement par la pr&eacute;sence d'une spl&eacute;nom&eacute;galie volumineuse sans ad&eacute;nopathies. L'h&eacute;mogramme montre dans trois quarts des cas la pr&eacute;sence inconstante de lymphocytes villeux. Le diagnostic est essentiellement anatomopathologique, il montre une atteinte constante nodulaire ou parfois diffuse de la pulpe blanche du parenchyme spl&eacute;nique. Les cellules tumorales sont de petite taille exprimant les marqueurs lympho&iuml;des B: CD19, CD20, CD22, CD79. Elles sont n&eacute;gatives pour le CD5, CD10, la cyclinde D1 et le CD43. Aucune anomalie cytog&eacute;n&eacute;tique sp&eacute;cifique du LZMS n'a &eacute;t&eacute; identifi&eacute;e. C’est un lymphome indolent dont le traitement est jusqu’&agrave; ce jour non codifi&eacute;, d&eacute;pend des facteurs pronostiques. Le d&eacute;c&egrave;s est li&eacute; au risque de transformation &agrave; un lymphome &agrave; grandes cellules.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Inimfon Aniema Essiet, Anisah Baharom, Hayati Kadir Shahar, Benjamin Uzochukwu [Research] - Application of the Socio-Ecological Model to predict physical activity behaviour among Nigerian University students - 01 March 2017. http://www.panafrican-med-journal.com/content/article/26/110/abstract/ <b>INTRODUCTION: physical activity among university students is a catalyst for habitual physical activity in adulthood. Physical activity has many health benefits besides the improvement in academic performance. The present study assessed the predictors of physical activity among Nigerian university students using the Social Ecological Model (SEM). METHODS: this cross-sectional study recruited first-year undergraduate students in the University of Uyo, Nigeria by multistage sampling. The International Physical Activity Questionnaire (IPAQ) short-version was used to assess physical activity in the study. Factors were categorised according to the Socio-Ecological Model which consisted of individual, social environment, physical environment and policy level. Data was analysed using the IBM SPSS statistical software, version 22. Simple and multiple logistic regression were used to determine the predictors of sufficient physical activity. RESULTS: a total of 342 respondents completed the study questionnaire. Majority of the respondents (93.6%) reported sufficient physical activity at 7-day recall. Multivariate analysis revealed that respondents belonging to the Ibibio ethnic group were about four times more likely to be sufficiently active compared to those who belonged to the other ethnic groups (AOR = 3.725, 95% CI = 1.383 to 10.032). Also, participants who had a normal weight were about four times more likely to be physically active compared to those who were underweight (AOR = 4.268, 95% CI = 1.323 to 13.772). CONCLUSION: this study concluded that there was sufficient physical activity levels among respondents. It is suggested that emphasis be given to implementing interventions aimed at sustaining sufficient levels of physical activity among students.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri [Images in medicine] - Une cause rare de compression m&eacute;dullaire: l’angiolipome &eacute;pidural rachidien - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/109/abstract/ <b>Une &eacute;tudiante de 19 ans, hospitalis&eacute;e au service de Neurochirurgie pour une lourdeur des deux membres inf&eacute;rieurs &eacute;voluant depuis deux mois chez qui l'examen clinique trouve une parapar&eacute;sie permettant la marche avec aide (Grade D de FRANKEL), un syndrome pyramidal aux deux membres inf&eacute;rieurs avec une douleur provoqu&eacute;e &agrave; la palpation des &eacute;pineuses de la partie moyenne du rachis dorsal. Les explorations paracliniques ont consist&eacute; &agrave; la r&eacute;alisation d'une IRM m&eacute;dullaire en premi&egrave;re intention (A,B) qui a mis en &eacute;vidence un processus l&eacute;sionnel intracanalaire, &eacute;pidural post&eacute;rieur, qui s'&eacute;tend de la premi&egrave;re &agrave; la huiti&egrave;me vert&egrave;bre thoracique et comprime fortement le cordon m&eacute;dullaire. La patiente a &eacute;t&eacute; op&eacute;r&eacute;e en urgence par voie post&eacute;rieure avec r&eacute;section totale d'un processus facilement clivable de la dure-m&egrave;re et saignant au contact. Les suites op&eacute;ratoires imm&eacute;diates &eacute;taient simples et l'&eacute;tude anatomopathologique (C) a mis en &eacute;vidence une prolif&eacute;ration compos&eacute;e par la juxtaposition de lobules d'adipocytes matures et de cavit&eacute;s vasculaires, concluant &agrave; un angiolipome de nature strictement b&eacute;nigne. La patiente a compl&egrave;tement r&eacute;cup&eacute;r&eacute; son autonomie trois mois en postop&eacute;ratoire. Les angiolipomes &eacute;piduraux rachidiens sont des tumeurs b&eacute;nignes rares qui se voient surtout chez l'adulte jeune, qui se manifestent par un tableau de compression m&eacute;dullaire lente. L'imagerie par r&eacute;sonance magn&eacute;tique constitue actuellement l'examen de choix dans l'exploration de cette tumeur. Cependant, le diagnostic de certitude reste histologique.Le traitement est toujours chirurgical, la voie d'abord est habituellement post&eacute;rieure et l'ex&eacute;r&egrave;se est souvent compl&egrave;te.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Mulemba Tillika Samutela, Annie Kalonda, James Mwansa, Chileshe Lukwesa-Musyani, John Mwaba, Enoch Mulowa Mumbula, Darlington Mwenya, Edgar Simulundu, Geoffrey Kwenda [Research] - Molecular characterisation of methicillin-resistant Staphylococcus aureus (MRSA) isolated at a large referral hospital in Zambia - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/108/abstract/ <b>INTRODUCTION: methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) is globally recognized as an important public health problem. Whereas comprehensive molecular typing data of MRSA strains is available, particularly in Europe, North America and Australia, similar information is very limited in sub-Saharan Africa including Zambia. METHODS: in this study, thirty two clinical isolates of <i>Staphylococcus aureus</i>, collected at a large referral hospital in Lusaka, Zambia between June 2009 and December 2012 were analysed by Staphylococcal cassette chromosome <i>mec (SCCmec), Staphylococcus</i> protein A gene typing <i>(spa)</i> and detection of the Panton-Valentine Leukocidin genes<i> (pvl)</i>. RESULTS: three SCC<i>mec</i> types were identified namely SCC<i>mec</i> type IV (65.6%), SCCmec type III (21.9%), SCC<i>mec</i> type I (3.1%). Nine point four percent (9.4%) of the isolates were untypable. Five <i>spa</i> types, which included a novel type, were detected and the most prevalent spa type was t064 (40.6%). Other <i>spa</i> types included spa types t2104 (31.3%), t355 (3.1%) and t1257 (21.9%). The <i>pvl </i>genes were detected in 3 out of 32 isolates. CONCLUSION: these molecular typing data indicated that the MRSA strains collected in Lusaka were diverse. Although the source of these MRSA was not established, these results stress the need for assessing infection prevention and control procedures at this health-care facility in order to curtail possible nosocomial infections. Furthermore, country-wide surveillance of MRSA in both the community and health-care facilities is recommended for infection prevention and control. To our knowledge, this represents the first study to characterise MRSA using molecular tools in Zambia.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Karim Nadour, Abdelhamid Messary [Images in medicine] - Dent inclue dans la fosse nasale - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/107/abstract/ <b>Il s'agit d'une patiente &acirc;g&eacute;e de 17 ans, sans ant&eacute;c&eacute;dents pathologiques particuliers qui a consult&eacute; pour des &eacute;pistaxis &agrave; r&eacute;p&eacute;titions de faibles abondances par la fosse nasale gauche associ&eacute;es &agrave; une sensation de nez bouch&eacute; homolat&eacute;rale et des &eacute;pisodes de rinorrh&eacute;es f&eacute;tides, &eacute;voluant depuis 7 mois. L'examen clinique retrouvait une patiente en assez bon &eacute;tat g&eacute;n&eacute;ral. L'examen des fosses nasales a retrouv&eacute; quelques caillots de sang au niveau de la fosse nasale gauche, la canule d'aspiration buttait contre une formation blanch&acirc;tre de consistance osseuse implant&eacute;e dans le plancher de la fosse nasale gauche et faisant saigner la muqueuse nasale en son contact. L'examen buccodentaire notamment celui de l'arcade dentaire sup&eacute;rieure n'a pas objectiv&eacute; d'anomalie morphologique ou en nombre. Un blondeau-scanner r&eacute;alis&eacute; en acquisition spiral&eacute;e en coupes coronales (A) et axiales (B) en fen&ecirc;tre osseuse a objectiv&eacute; la pr&eacute;sence d'un processus l&eacute;sionnel spontan&eacute;ment hyperdense au niveau de la fosse nasale gauche en regard du cornet inf&eacute;rieur en rapport avec une dent incluse (fl&egrave;che). La patiente a b&eacute;n&eacute;fici&eacute; d'une extraction de cette dent par voie endoscopique apr&egrave;s une anesth&eacute;sie locale obtenue par un bon m&eacute;chage &agrave; la xylocaine naphazolin&eacute;e. Les suites op&eacute;ratoires ont &eacute;t&eacute; simples. L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par la disparition des &eacute;pistaxis et de l'obstruction nasale. L'&eacute;ruption dentaire au niveau de la fosse nasale constitue une des formes topographiques de l'ectopie dentaire. Cette situation inhabituelle doit &ecirc;tre &eacute;voqu&eacute;e devant une &eacute;pistaxis et une rhinorrh&eacute;e purulente f&eacute;tide unilat&eacute;rales.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Loyal Poonamjeet Kaur, Nderitu Joseph Munyiri, Wekesa Vincent Dismus [Research] - Clinical analysis of aqueductal stenosis in patients with hydrocephalus in a Kenyan setting - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/106/abstract/ <b>INTRODUCTION: aqueductal stenosis is the commonest cause of congenital hydrocephalus. The scope of this paper is to highlight the disease burden of hydrocephalus attributed to aqueductal stenosis which still remains unknown in our setting. METHODS: in a descriptive cross-sectional study, 258 records of patients diagnosed with hydrocephalus were analyzed after ethical approval from Kenyatta National Hospital- University of Nairobi (KNH-UON) ethics and research committee from January 2010 to May 2016. Patients with a diagnosis of hydrocephalus due to aqueductal stenosis were included in this study. Patients age, sex, mode of delivery, associated comorbidities, presenting complaints, neurosurgical intervention performed, Kafarnosky score were recorded. Data were divided into 2 sets based on the patient’s age i.e. whether < 1 year or > 12 years. Data were recorded on google data collection form and analyzed using Google spreadsheets. RESULTS: out of 258 cases of hydrocephalus, 52 had aqueductal stenosis. Male to female sex ratio for this condition was 3:2. There were 25 cases < 1year and 27 cases > 12 years old who were diagnosed with hydrocephalus due to aqueductal stenosis. Associated conditions were bilateral congenital talipes equinovarus, spina bifida, Arnold Chairi malformations, meningitis and HIV. The presenting complaints differed according to the age groups. Neurosurgical interventions included Endoscopic Third Ventriculostomy (ETV) in 21 cases, insertion of Ventriculoperitoneal (VP) shunt and ETV were done in 3 cases while the rest had only insertion of VP shunt. The Kafanosky score improve from < 50 pre-op to 19 cases achieving a score of 100, six months post-op. CONCLUSION: aqueductal stenosis contributes a significant burden of morbidity in patients with hydrocephalus. Clinical presentation differs according to patients age. Accurate diagnosis and treatment remain a cardinal to improving patient outcome.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Henry Okoli, Taiwo Obembe, Kayode Osungbade, Folashayo Adeniji, David Adewole [Research] - Self-referral patterns among federal civil servants in oyo state, South-Western Nigeria - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/105/abstract/ <b>INTRODUCTION: primary health care is widely accepted as the first point of care seeking; yet, individuals requiring healthcare engage in self-referrals to higher levels of care thereby by-passing primary care. Little is known of the extent to which self-referrals are carried out when care is needed. This study thus sought to determine the prevalence of self-referral, its patterns and factors influencing self-referrals amongst federal civil servants in Southwestern Nigeria. METHODS: a cross-sectional study was carried out among 300 federal civil servants who were interviewed using validated and pre-tested interviewer-administered semi structured questionnaires. Data was analyzed using univariate and Chi-square test at level of significance set at P <0.05. RESULTS: mean age of the respondents was 39.96 ± 9.1 years with majority being married (80.7%); 90.7% completed tertiary education (and 76.7 % were middle grade (7-12) level officers. Most (60.0%) of the respondents had ever engaged in self-referral. Malaria was the commonest health problem (39.7%) for self-referral to secondary or tertiary facilities. Desire for quality service (35.7%) and competent staff (35.2%) were the commonest reasons for self-referral to a higher level of health care. More female respondents (76.0%) compared to male respondents (64.0%) significantly engaged in self-referral (p = 0.02, X2 = 5.14). Respondents having good knowledge of referral practices engaged less in self-referral compared to those with poor knowledge. (p = 0.02, X2 = 5.43). CONCLUSION: having good knowledge of referral practices and being male are positively associated with referral practices. Creating awareness and improving knowledge on referral practices with special emphasis on women population are desirable strategies for encouraging the use of primary health care as first of point of contact with health systems.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Davy Vancampfort, Brendon Stubbs, Marc De Hert, Christy du Plessis, Caleb Ademola Omuwa Gbiri, Jepkemoi Kibet, Nancy Wanyonyi, James Mugisha [Research] - A systematic review of physical activity policy recommendations and interventions for people with mental health problems in Sub-Saharan African countries - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/104/abstract/ <b>INTRODUCTION: there is a need for interventions to address the escalating mental health burden in Sub-Saharan Africa (SSA). Implementation of physical activity (PA) within the rehabilitation of people with mental health problems (PMHP) could reduce the burden and facilitate recovery. The objective of the current review was to explore (1) the role of PA within mental health policies of SSA countries, and (2) the current research evidence for PA to improve mental health in SSA. METHODS: we screened the Mental Health Atlas and MiNDbank for mental health policies in SSA countries and searched PubMed for relevant studies on PA in PMHP in SSA. RESULTS: sixty-nine percent (=33/48) of SSA countries have a dedicated mental health policy. Two of 22 screened mental health policies included broad physical activity recommendations. There is clear evidence for the role of PA in the prevention and rehabilitation of depression in SSA. CONCLUSION: despite the existing evidence, PA is largely a neglected rehabilitation modality in the mental health care systems of SSA. Continued education of existing staff, training of specialized professionals and integration of PA for mental health in public health awareness programs are needed to initiate and improve PA programs within the mental health care systems of SSA.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Zainab Datti Ahmed, Baffa Sule Ibrahim, Mohammed Lukman Abolaji, Yahaya Mohammed, Patrick Nguku [Research] - Knowledge and utilization of contraceptive devices among unmarried undergraduate students of a tertiary institution in Kano State, Nigeria 2016 - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/103/abstract/ <b>INTRODUCTION: students in the universities mostly live independently from their parents or guardians, some of them for the first time. This gives them freedom and opportunity for high risk behavior such as unplanned and unprotected sex. The results of such sexual experimentation may include unplanned and or unwanted pregnancies that may lead to unsafe abortions and sexually transmitted infections (STIs) including HIV/AIDS. Contraception has the potential to prevent unwanted pregnancies, abortion, and STIs. This study aimed at assessing the general knowledge on contraceptives, sexual practices, and level of utilization of contraceptives devices among unmarried students of the Bayero University Kano. METHODS: we did an institutional based cross-sectional descriptive study. We administered a pretested, self-administered, structured questionnaire to randomly selected unmarried undergraduate students of the institution. We analyzed data using Microsoft Excel 2016 and Epi-info7. RESULTS: a total of 300 students were interviewed. The median age for respondents was 23years with an age range of 16–25years. Male respondents make up 61.3%(184) while the females made up the remaining 38.7%(116). Also, 158(47.33%) of respondents live outside the school campus, while 158(52.67%) live in the school hostels. Knowledge on contraception was 87.7% among respondents with internet (91%) and media (89.3%) as their commonest sources of knowledge. Proportion of sexually active students was 10.67%, while prevalence of contraceptive utilization among sexually active students was 15.63%. About 8(25%) had their sexual debut at <16years of age, 22(68.75%) at ages between 16-20years, and 4(12.5%) above 20years of age. All sexually active respondents practice vaginal sex. Most sexual debuts are planned (44.75 %) and with friends (86.4%), and they occurred between the ages of 16-20years age group in 70.3% of respondents. CONCLUSION: even though knowledge on contraceptive used was high among the respondents, utilization of contraceptives among sexually active students was low, thus creating a window for possible unintended and unwanted pregnancies among these group of students.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Abdelmone Ghorbel [Images in medicine] - Branchial cleft cyst: a case report - 28 February 2017. http://www.panafrican-med-journal.com/content/article/26/102/abstract/ <b>Brachial cleft cysts are rare congenital malformations of the lateral neck and typically present in the second and third decades of life. Many theories have been proposed to explain the aetiology of these cysts including incomplete obliteration of branchial mucosa, persistence of vestiges of the precervical sinus and cystic lymph node origin. Preoperative imaging investigations show a fluid-filled cyst and evaluate anatomic relationships. Differential diagnosis includes metastatic squamous cell carcinoma, lymphadenitis, lymphoma, cervical dermoid cyst, cystic hygroma and parotid pathology. Surgical excision is the treatment of choice and results in a good prognosis. We present the case of a 37-year-old woman referred to our department for assessment of a neck swelling that had gradually increased in size during the previous nine months. The clinical examination found a 6 cm non-tender mass of the upper-left neck. The MRI revealed a cystic lesion measuring 4×5×6 cm, displacing the sternocleidomastoid muscle posterolaterally, and the carotid and internal jugular vein medially. The mass was completely resected through a lateral cervicotomy. The histological examination revealed a cystic wall lined with stratified squamous epithelium consistent with the diagnosis of a branchial cleft cyst. The postoperative course was uneventful. Long-term follow-up has shown no evidence of recurrence.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Youssef Alaoui Lamrani, Mustapha Ma&acirc;roufi [Images in medicine] - Cavernome du quatri&egrave;me ventricule - 26 February 2017. http://www.panafrican-med-journal.com/content/article/26/101/abstract/ <b>Monsieur KR, patient de 58 ans, admis pour trouble de l’&eacute;quilibre avec diplopie horizontale gauche install&eacute;s la veille de son admission. Devant cette atteinte vestibulaire et paralysie du VI gauche, une IRM a &eacute;t&eacute; effectu&eacute;e attestant d’un cavernome intraventriculaire (CIV), rarement d&eacute;crit au V4. Les cavernomes repr&eacute;sentent des hamartomes pouvant atteindre tout le n&eacute;vraxe. IRM c&eacute;r&eacute;brale montrant une l&eacute;sion nodulaire (fl&egrave;che) du plancher du 4&egrave;me ventricule (V4), en hypersignal T1 (a), hyposignal annulaire en T2 (b) et T2* (c). La s&eacute;quence inject&eacute;e T1 montre une anomalie veineuse de d&eacute;veloppement (AVD) paraventriculaire gauche (&eacute;toile). La pr&eacute;valence des CIV varie entre 2,5% et 10%, leurs localisations intraventriculaires int&eacute;ressent le 3&egrave;me ventricule, ventricules lat&eacute;raux, trigone, et V4, dans 44%, 27%, 20% et 9% respectivement. Leurs manifestations cliniques sont asp&eacute;cifiques li&eacute;es essentiellement &agrave; l’hypertension intracr&acirc;nienne. L’imagerie des CIV est similaire aux localisations intraparenchymateuses avec comme particularit&eacute;, une tendance &agrave; des tailles plus volumineuses du fait d’une croissance non contrebalanc&eacute;e par le LCR. La TDM montre une l&eacute;sion ronde hyperdense, avec calcifications annulaires en "popcorn" assez caract&eacute;ristiques. Quant &agrave; l’IRM, le CIV est h&eacute;t&eacute;rog&egrave;ne en T1, en hypersignal central en T2 avec un anneau p&eacute;riph&eacute;rique d’hyposignal relatif au d&eacute;p&ocirc;t d’h&eacute;mosid&eacute;rine. La s&eacute;quence T2* est int&eacute;ressante dans la d&eacute;tection de cavernomes multiples. Les s&eacute;quences inject&eacute;es peuvent montrer des AVD fr&eacute;quemment associ&eacute;es aux cavernomes. Les diagnostics diff&eacute;rentiels (DD) des CIV incluent astrocytomes de bas grade, neurocytomes, et t&eacute;ratomes. L’hypersignal central et l’anneau p&eacute;riph&eacute;rique d’hyposignal T2, rendent le diagnostic de cavernome assez ais&eacute; et &eacute;liminent les DD.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Monoarthritis of the knee revealing tabetic arthropathy - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/100/abstract/ <b>53-year-old man presented with monoarthritis of the knee without fever evolving since 6 months associated with an inflammatory biological syndrome. The articular puncture brought back a sterile inflammatory fluid. The radiographs of the frontal knee (A) and profile knee (B) and CT of the knee (C, D) showed destruction of the internal femoral condyle with osteolysis of the medial border of the internal tibial plateau associated with multiple bone constructions with the presence of intra-articular fragments, intra-articular effusion and thickening of the synovium. The diagnosis of tabetic arthropathy in its hypertrophic form was retained following a 20-year history of syphilitic inoculation chancre, posterior radiculocordonal syndrome, imaging data and positive syphilitic serology (TPHA-VDRL) in the blood and cerebrospinal fluid. The patient was treated with penicillin G (24 million/day) for 15 days. Tabetic arthropathy is a type of neuropathic arthropathy that has become rare and unfamiliarity with the clinical presentation of this disease may lead to considerable delay in diagnosis. This disease means progressive painless joint destruction that is related to neurosensory deficits caused by syphilis. His diagnosis is difficult as its clinical presentation is not specific and differential diagnosis is wide ranging. Hence, his diagnosis requires clinical suspicion and an appropriate serological test.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Salah Bellasri, Hicham Janah [Images in medicine] - Lung hemorrhage and brain stroke following fatal viper (cerastes cerastes) bite - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/99/abstract/ <b>A 46-year-old with a history of mild hypertension was working outside when a viper bit him on his right hand. The patient arrived at the nearest medical facility about 30 minutes after and received polyvalent antivenom serum, bite site care. He was taken to the emergency department (ED) by ambulance. At ED of our center, 2 hours after bite, the patient was unconscious, his blood pressure was initially unobtainable, and his cardiac monitor revealed a rate of 147/min. Breathlessness, hemoptysis and rales were heard in the lung bases. Neurological examination revealed right hemiplegia, a right facial droop, and dysarthria. A Foley catheter was placed and returned a hemorrhagic fluid. A blood samples examinations showed: a hematocrit was 45%, prothrombine (PT) greater than 120 seconds, HGB 8.7 g/dl, platelets 30 x103 /mm3. Blood oxygen saturation after oxygen facemask was low, and the patient was intubated, using in endotracheal tube and was placed on a ventilator. 6 hours following admission, after the patient was somewhat stabilized, a noncontrast computerized tomographic (CT) scan of the head demonstrated multiples stroke with hemorrhagic infarction left middle cerebral artery territory (a, b). A chest CT scan revealed an area of alveolar condensation reaching the superior right lobe and Fowlers segment related to hemorrhagic intra alveolar bleeding (c, d). The morning following admission, the patient was found to be hypoxic. His systolic blood pressure decreased. Later on second day, the patient became flaccid with nonreactive pupils and he was pronounced dead later the same day.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Moulay Omar Moustaine, Foued Dellali, Abbas El Husseini, Anne-Lise Hirsch [Case report] - Le traitement anti-VEGF des n&eacute;ovaisseaux choro&iuml;diens juxta-fov&eacute;olaires du fort myope: &agrave; propos d’une observation - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/98/abstract/ <b>Les n&eacute;ovaisseaux choro&iuml;diens constituent une complication redoutable de la forte myopie rapport&eacute;e dans 5 &agrave; 10% des cas. Ils doivent &ecirc;tre pris en charge rapidement vu leur pronostic sombre. Les IVT des anti-VEGF constituent actuellement la nouvelle alternative th&eacute;rapeutique d&eacute;passant de loin la th&eacute;rapie photo-dynamique (PDT). N&eacute;anmoins l'algorithme th&eacute;rapeutique anti-VEGF devant ce type de n&eacute;ovaisseaux reste un sujet de discussion entre les auteurs. A travers cette observation on essaie d'illustrer la difficult&eacute; de prise en charge de ces n&eacute;ovaisseaux et de discuter le sch&eacute;ma th&eacute;rapeutique Anti-VEGF &agrave; suivre.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hermine Fouda, Gloria Ashuntantang, Fran&ccedil;ois Kaze, Marie-Patrice Halle [Research] - La survie en h&eacute;modialyse chronique au Cameroun - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/97/abstract/ <b>INTRODUCTION: l'h&eacute;modialyse est le seul traitement de substitution r&eacute;nale disponible au Cameroun; elle est subventionn&eacute;e &agrave; 95% par l'Etat depuis 2002 et le nombre de centre de dialyse va croissant. Cependant, depuis l'ouverture du premier centre en 1990, aucune donn&eacute;e n'existe sur la survie des h&eacute;modialys&eacute;s chroniques. METHODES: nous avons conduit une &eacute;tude de cohorte prospective multicentrique de 15 mois dans le but d'&eacute;valuer la mortalit&eacute; et les facteurs qui influencent la survie des h&eacute;modialys&eacute;s chroniques camerounais. RESULTATS: nous avons suivi 197 patients dont 109 incidents. L'&acirc;ge moyen &eacute;tait de 47,97± 13,19 ans et 55% &eacute;taient de sexe masculin. La dur&eacute;e moyenne en dialyse des patients pr&eacute;valent &eacute;tait de 12,5 mois. Le taux de mortalit&eacute; &eacute;tait de 57,58% dont 50% pendant les 3 premiers mois et le taux d'abandon &eacute;tait de 8,6%.. L'ur&eacute;mie et les sepsis sur cath&eacute;ter &eacute;taient les principales causes de d&eacute;c&egrave;s. La survie globale &agrave; 15 mois &eacute;tait de 30,77%, avec une dur&eacute;e moyenne de vie de 8 mois. Les patients pr&eacute;valent, la r&eacute;sidence dans la ville du centre de dialyse, la prise en charge non familiale, le suivi pr&eacute; dialyse > 3 mois, la cholest&eacute;rol&eacute;mie &agrave; l'entr&eacute;e en dialyse> 1,5g/l, un score mental > 25 &eacute;taient associ&eacute;s &agrave; une meilleure survie. CONCLUSION: la mortalit&eacute; en h&eacute;modialyse au Cameroun est &eacute;lev&eacute;e, avec une survie moyenne de 8 mois et la plupart des patients d&eacute;c&egrave;dent au cours des 3 premiers mois.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri [Images in medicine] - Une cause rare de compression m&eacute;dullaire : l'h&eacute;matome &eacute;pidural rachidien spontan&eacute; - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/96/abstract/ <b>Patiente &acirc;g&eacute;e de 26 ans, sans ant&eacute;cedents, admise en urgence pour prise en charge d'une lourdeur des 2 membres inf&eacute;rieurs. La symptomatologie a &eacute;t&eacute; d&eacute;but&eacute; trois jours avant son admission par l'apparition brutale de rachialgies cervico-thoraciques, d'embl&eacute;e intenses r&eacute;sistantes aux antalgiques habituels, suivies d'une lourdeur des deux membres inf&eacute;rieurs associ&eacute;es &agrave; des troubles g&eacute;nito-sphinct&eacute;riens &agrave; type de r&eacute;tention aigue d'urines et une constipation. L'interrogatoire n'a pas trouv&eacute; la notion de traumatisme ni de prise d'anticoagulants ou d'autre ant&eacute;c&eacute;dent m&eacute;dico-chirurgical notable. L'examen clinique a objectiv&eacute; une patiente consciente, apyr&eacute;tique, ayant une parapl&eacute;gie flasque grade A de Frankel avec une anesth&eacute;sie &agrave; niveau sup&eacute;rieur mamelonnaire. Une IRM m&eacute;dullaire urgente a objectiv&eacute; un h&eacute;matome extradural (&eacute;pidural) rachidien post&eacute;rieur &eacute;tendu de la septi&egrave;me vert&egrave;bre cervicale C7 &agrave; la deuxi&egrave;me vert&egrave;bre dorsale D2 . Le Bilan biologique notamment le bilan de la crase sanguine &eacute;tait normal. La patiente fut op&eacute;r&eacute;e en urgence au travers une incision m&eacute;diane post&eacute;rieure avec r&eacute;alisation d'une laminectomie &eacute;tendue de la sixi&egrave;me vert&egrave;bre cervicale jusqu'&agrave; la deuxi&egrave;me vert&egrave;bre dorsale. L'h&eacute;matome &eacute;pidural a &eacute;t&eacute; &eacute;vacu&eacute;, l'h&eacute;mostase faite et des pr&eacute;l&egrave;vements pour &eacute;tude anatomopathologique ont &eacute;t&eacute; faits. L'&eacute;tude histologique n'a pas retrouv&eacute; d'&eacute;tiologie sous-jacente. L'&eacute;volution postop&eacute;ratoire a &eacute;t&eacute; marqu&eacute;e apr&egrave;s un recul de six mois par une r&eacute;cup&eacute;ration compl&egrave;te du d&eacute;ficit moteur . L'h&eacute;matome &eacute;pidural rachidien spontan&eacute; est une affection rare et grave. C'est une urgence neurochirurgicale, diagnostique et th&eacute;rapeutique dont la rapidit&eacute; de la prise en charge conditionne le pronostic. Le diagnostic est devenu ais&eacute; surtout avec l'av&egrave;nement de l'IRM .Les facteurs de gravit&eacute; sont l'installation brutale et rapide du d&eacute;ficit neurologique, la pr&eacute;sence d'un d&eacute;ficit neurologique complet et la localisation thoracique de l'h&eacute;matome. Une r&eacute;cup&eacute;ration neurologique pr&eacute;coce, un d&eacute;ficit incomplet ou essentiellement moteur, une localisation cervicale ou lombo-sacr&eacute;e sont des facteurs d'une meilleure r&eacute;cup&eacute;ration.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Mohamed Aggouri [Images in medicine] - Une &eacute;tiologie rare du syndrome de la queue de cheval : l'h&eacute;mangiome vert&eacute;bral neuro-agressif - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/95/abstract/ <b>Un patient &acirc;g&eacute; de 17 ans, sans ant&eacute;c&eacute;dents pathologiques notables, admis aux urgences neurochirurgicales pour une fatigabilit&eacute; progressive &agrave; la marche et des fuites urinaires. L'examen clinique a trouv&eacute; une discr&egrave;te diminution de la force musculaire des deux membres inf&eacute;rieurs (parapar&eacute;sie grade D de Frankel) associ&eacute;e &agrave; un discret d&eacute;ficit &eacute;picritique sans niveau sensitif. Devant ce tableau de compression de la queue de cheval, une IRM du rachis lombo-sacr&eacute;e a &eacute;t&eacute; r&eacute;alis&eacute;e et a montr&eacute; la pr&eacute;sence d'un processus vert&eacute;bral envahissant la majeure partie du corps vert&eacute;bral de L3 associ&eacute;e &agrave; une &eacute;pidurite ant&eacute;rieure compressive se prolongeant jusqu'en regard du corps vert&eacute;bral de L4 (A, B, C). Le patient a &eacute;t&eacute; op&eacute;r&eacute; par un abord r&eacute;trop&eacute;riton&eacute;al avec une d&eacute;compression du sac dural. Les suites chirurgicales &eacute;taient simples. L'anatomopathologie a confirm&eacute; le diagnostic d'angiome capillaire b&eacute;nin. Apres un recul de 4 ans, le patient a r&eacute;cup&eacute;r&eacute; sa force musculaire des membres inferieur ainsi que ces troubles urinaires. Les h&eacute;mangiomes vert&eacute;braux agressifs repr&eacute;sentent une entit&eacute; tr&egrave;s rare. Il s'agit de l&eacute;sions vasculaires b&eacute;nignes, souvent uniques, qui se manifestent le plus souvent par des signes de compression m&eacute;dullaire. L'IRM occupe une place importante par le fait qu'elle permet une analyse multiplanaire directe et une caract&eacute;risation tissulaire. Elle trouve un int&eacute;r&ecirc;t majeur dans le bilan d'extension au niveau &eacute;pidural et permet une bonne approche du retentissement sur les structures nerveuses.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Osteoid osteoma of the scapula mimicking a pathology of the shoulder - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/94/abstract/ <b>A 14-year-old patient presented with chronic shoulder pain evolving since three years. The pain persisted despite the various medicated and physical treatments followed. The clinical examination noted a normal shoulder examination with pain facing the right scapula without local inflammatory signs. There were no abnormalities in the biological examinations, in particular absence of biological inflammatory syndrome, rheumatoid factor negative and normal calcemia. Radiographs of the shoulder and scapula were normal. Bone scintigraphy showed hyperfixation of the radiotracer regarding the right scapular spine evoking an osteoid osteoma (A). CT scan of the right scapula showed a very limited osteolytic lesion without osteocondensation edges with a non-enhanced hypodense matrix after injection of contrast agent (B). MRI showed lesion of the right scapular spine in hypersignal T1 and T2 without cortical rupture or periosteal reaction suggestive of a benign lesion such as osteoid osteoma (C, D). The patient had a biopsy with surgical resection of the lesion. The diagnosis of osteoid osteoma was confirmed histologically. The peculiarity of this observation lies in the rarity of this localization and the deceptive clinical picture suggesting a shoulder pathology in first intention. In cases of diagnostic doubt and in the presence of normal radiographs, the most specific examination is thin-section CT scans, the sensitivity of which can be improved by association with an MRI.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Yousra El Boussaadni, Noufissa Benajiba, Ahmed Aziz Bousfiha, Fatima Ailal [Case report] - Syndrome d’activation macrophagique compliquant une lymphohistiocytose familiale - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/93/abstract/ <b>Le syndrome d'activation macrophagique (SAM) est une entit&eacute; anatomoclinique due &agrave; une stimulation inappropri&eacute;e des macrophages. Il demeure une pathologie rare, caract&eacute;ris&eacute;e par des signes cliniques peu sp&eacute;cifiques et des &eacute;l&eacute;ments biologiques dont l'association doit faire &eacute;voquer le diagnostic. Il peut &ecirc;tre d'origine primaire ou secondaire, son pronostic reste encore sombre. Nous rapportons une observation d'un nourrisson de 3 ans et 4 mois ayant &eacute;t&eacute; admis dans notre service pour prise en charge d'une SAM primitif afin de rappeler aux praticiens la n&eacute;cessit&eacute; de penser &agrave; une cause primitive devant des situations particuli&egrave;res.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hicham El Bote, Abelilah El Alaoui, Ziouani Oussama, Hachem El Sayegh, Ali Iken, Lounis Benslimane, Yassine Nouini [Case series] - Carcinome neuroendocrine de la vessie: &agrave; propos de 5 cas - 24 February 2017. http://www.panafrican-med-journal.com/content/article/26/92/abstract/ <b>Le carcinome neuroendocrine de la vessie est une entit&eacute; histologique rare, caract&eacute;ris&eacute;e par une diss&eacute;mination m&eacute;tastatique rapide et un pronostic d&eacute;favorable. Le but de ce travail &eacute;tait d'analyser les caract&eacute;ristiques cliniques, histologiques, th&eacute;rapeutiques et pronostiques du carcinome neuroendocrine de la vessie. Il s'agissait d'une &eacute;tude r&eacute;trospective portant sur 5 patients collig&eacute;s au service d’Urologie A, CHU Ibn Sina durant la p&eacute;riode entre janvier 2008 et juin 2015. L’&acirc;ge m&eacute;dian &eacute;tait de 63 ans. Quatre patients &eacute;taient de sexe masculin et une patiente de sexe f&eacute;minin. Le carcinome neuroendocrine &eacute;tait pur dans quatre cas et impur ou associ&eacute; &agrave; une composante uroth&eacute;liale dans un cas. Deux cancers &eacute;taient m&eacute;tastatiques d’embl&eacute;e. Une cystectomie a &eacute;t&eacute; r&eacute;alis&eacute;e dans un cas apr&egrave;s chimioth&eacute;rapie n&eacute;oadjuvante, une chimioradioth&eacute;rapie dans deux cas et une chimioth&eacute;rapie palliative dans les deux autres. La dur&eacute;e m&eacute;diane de survie &eacute;tait de 10 mois. Un seul patient &eacute;tait en vie, avec un recul de 20 mois. La prise en charge des carcinomes neuroendocrines de la vessie n’est pas standardis&eacute;e, plusieurs moyens th&eacute;rapeutiques ont &eacute;t&eacute; propos&eacute;s : la chirurgie, la radioth&eacute;rapie et la chimioth&eacute;rapie.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Abderrazzak El Saqui, Aggouri Mohamed [Images in medicine] - Glioblastomes intra m&eacute;dullaire chez l'enfant: localisation et type histologique rare - 23 February 2017. http://www.panafrican-med-journal.com/content/article/26/91/abstract/ <b>Un enfant de 4 ans, sans ant&eacute;c&eacute;dents , qui a pr&eacute;sent&eacute;e deux mois avant son admission, des c&eacute;phal&eacute;es associ&eacute;es &agrave; des douleurs cervicales irradiant vers les &eacute;paules et le rachis dorsal, aggrav&eacute;es par l'installation d'une lourdeur des quatres membres, chez qui l'examen a trouv&eacute; un enfant conscient, avec une t&eacute;trapar&eacute;sie lourde . L'IRM m&eacute;dullaire a objectiv&eacute;e un processus tumoral m&eacute;dullaire cervicale &eacute;tendu de la jonction bulbo-m&eacute;dullaire jusqu'&agrave; D1 en hyposignal T1 et en hypersignal T2 avec une composante charnue et kystique rehauss&eacute;e de fa&ccedil;on h&eacute;t&eacute;rog&egrave;ne apr&egrave;s injection de gadolinium (A). La patiente a b&eacute;n&eacute;fici&eacute; d'une laminectomie de 8 niveau, de C1 &agrave; D1, avec craniectomie &agrave; os perdu sous occipitale et ex&eacute;r&egrave;se macroscopiquement totale du processus. Un examen extemporan&eacute; est revenu en faveur de glioblastome, diagnostic qui a &eacute;t&eacute; confirm&eacute; par l'examen anatomo-pathologique de la pi&egrave;ce op&eacute;ratoire (B). La patiente a b&eacute;n&eacute;fici&eacute;e de la radioth&eacute;rapie post op&eacute;ratoire. L'&eacute;volution a &eacute;t&eacute; marqu&eacute;e par l'am&eacute;lioration progressive de la t&eacute;trapar&eacute;sie avant son d&eacute;c&egrave;s par des troubles neuro-v&eacute;g&eacute;tatifs 18 mois plus tard. Les glioblastomes de la moelle &eacute;pini&egrave;re sont exceptionnelle, L'IRM apr&egrave;s injection du Gadolinium reste la meilleure modalit&eacute; d'imagerie pour le diagnostic (C). Le traitement de choix est l'ex&eacute;r&egrave;se chirurgicale la plus compl&egrave;te possible suivie d'une radioth&eacute;rapie et &eacute;ventuel chimioth&eacute;rapie , La survie moyenne de ces patients est de 12 mois apr&egrave;s le diagnostic.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com El Mouhtadi Aghoutane, Tarik Salama, Redouane El Fezazi [Case report] - Isolated tuberculosis of metacarpal bone in a 3 year-old child - 23 February 2017. http://www.panafrican-med-journal.com/content/article/26/90/abstract/ <b>Primary tuberculosis osteomyelitis of metacarpal bone is rare. The majority of cases occur in children and young adults and there is difficulty in diagnosis mainly in young children. We report a new case in children aged of 3 years, presenting a swelling on the dorsal side of her right hand since 8 months. X-ray showed an expansile, cystic and lytic lesion involving the little finger metacarpal. Tuberculosis was confirmed on histological examination. No lesions in lung parenchyma or lymphadenopathy were associated. Patient was successfully managed by anti-tubercular drugs.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Sanaa Hammi, Hajar Berrani, Thami Benouchen, Naima Lamlami, Imane Elkhiyat, Jamal Eddine Bourkadi [Case report] - A primary intestinal lymphangiectasia hiding the diagnosis of pleural and pericardial tuberculosis: a clinical observation - 23 February 2017. http://www.panafrican-med-journal.com/content/article/26/89/abstract/ <b>Primary intestinal lymphangiectasia (Waldmann&iuml;¿½s disease) is an exudative enteropathy characterized by lymph leakage into the small bowel lumen leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia (particularly T-cell). The diagnosis is based on viewing the duodenal lymphangiectasia. A 20 years old female patient, treated for a primary intestinal lymphangiectasia, has consulted for anasarca. Etiological work-up reveals pleural and pericardial tuberculosis. The clinical aggravation of an enteropathy, particularly in adulthood, requires a search for a secondary etiology. Tuberculosis should be sought systematically.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hicham Titou, Youssef Jalal, Mohammed Boui [Case report] - Pseudothrombop&eacute;nie non EDTA-d&eacute;pendante: &agrave; propos d’un cas - 22 February 2017. http://www.panafrican-med-journal.com/content/article/26/88/abstract/ <b>La pseudothrombop&eacute;nie est un ph&eacute;nom&egrave;ne rare de laboratoire, expliqu&eacute;e par une agglutination in vitro des plaquettes. L’examen au microscope du frottis du sang p&eacute;riph&eacute;rique est un examen cl&eacute;, pour confirmer le diagnostic et pour &eacute;viter toute d&eacute;cision clinique et th&eacute;rapeutique inadapt&eacute;e voir dangereuse. Sa survenue chez un patient, sous traitement par l’h&eacute;parine, pose le probl&egrave;me de diagnostic diff&eacute;rentiel avec la thrombop&eacute;nie h&eacute;parino-induite. Notre objective, &agrave; travers cette observation, est d’&eacute;viter toute confusion entre ce ph&eacute;nom&egrave;ne purement art&eacute;factuel et la thrombop&eacute;nie h&eacute;parino-induite.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Gideon Chukwudalu Ilechukwu, Chioma Azuka Ilechukwu, Agozie Chukwunedum Ubesie, Ijeoma Okoroafor, Basil Chukwuemeka Ezeanolue, Ngozi Chinyelu Ojinnaka [Research] - Bacterial agents of the discharging middle ear among children seen at the University of Nigeria Teaching Hospital, Enugu - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/87/abstract/ <b>INTRODUCTION: discharging middle ear continues to be one of the commonest problems seen in the developing world. There is an ever growing need to carry out studies periodically to determine the common bacterial agents responsible for discharging otitis media and their antibiotic sensitivity especially in set-ups characterized with minimal laboratory services. The study sought to determine the common bacterial agents causing discharging middle ear among children presenting at the University of Nigeria Teaching Hospital, Enugu and their sensitivity to the commonly available antibiotics. METHODS: middle ear swabs were collected from 100 children aged 1 month to 17 years at the Children Out-Patient and Otorhinolaryngology Clinics of the University of Nigeria Teaching Hospital, Enugu, Nigeria. The specimens were cultured for aerobic bacterial organisms and their sensitivity determined. RESULTS: among those with acute discharge, Staphylococcal aureus was isolated in 31.3% and Proteus species in 25.0%. In chronically discharging ears, Proteus Species dominated (39.1%), followed by Staphylococcal aureus (28.3%).</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Lilia Affes, Mouna Elleuch, Fatma Mnif, Faten Hadj Kacem, Dhouha Ben Salah, Mouna Mnif, Nadia Charfi, Nabila Rekik, Mohamed Abid [Case report] - Syndrome de Guillain Barr&eacute; et d&eacute;compensation acidoc&eacute;tosique du diab&egrave;te au cours de la grossesse: a propos d’un cas et revue de la litt&eacute;rature - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/86/abstract/ <b>Une femme enceinte &acirc;g&eacute;e de 27 ans a &eacute;t&eacute; admise dans le service de r&eacute;animation pour une d&eacute;compensation acidoc&eacute;tosique s&eacute;v&egrave;re spontan&eacute;e inaugurale d'un diab&egrave;te type 1. La patiente a &eacute;t&eacute; r&eacute;anim&eacute;e et insulin&eacute;e avec une bonne &eacute;volution clinique et biologique. Au 4&egrave;me jour, la patiente a pr&eacute;sent&eacute;e un tableau de polyradiculon&eacute;vrite aigue d'installation brutale. Les examens compl&eacute;mentaires faites en urgences &eacute;taient n&eacute;gatives. Une cytoponction lombaire a montr&eacute; une dissociation albuminocytologique. L'&eacute;lectromyogramme a confirm&eacute; le diagnostic de syndrome de Guillain Barr&eacute; (SGB). La patiente a &eacute;t&eacute; mise sous veinoglobuline avec r&eacute;&eacute;ducation physique. Une am&eacute;lioration spectaculaire des signes neurologiques a &eacute;t&eacute; not&eacute;e. Concernant sa grossesse, la patiente a avort&eacute; au bout d'une semaine de diagnostic de SGB. L'association de SGB avec une d&eacute;compensation c&eacute;tosique est rare. En effet, quelques cas ont &eacute;t&eacute; rapport&eacute;s dans la litt&eacute;rature. Cette association au cours d'une grossesse n'est jamais d&eacute;crite d'o&ugrave; l'originalit&eacute; de notre cas.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Trochant&eacute;rite tuberculeuse isol&eacute;e - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/85/abstract/ <b>Un patient &acirc;g&eacute; de 40 ans, &eacute;tait hospitalis&eacute; pour exploration d'une douleur inflammatoire int&eacute;ressant la face sup&eacute;ro-externe de la cuisse droite &eacute;voluant depuis 8 mois, sans alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral ni fi&egrave;vre. La pression en regard du grand trochanter droit &eacute;tait douloureuse sans signes inflammatoires locaux. La biologie n'a pas montr&eacute; de syndrome inflammatoire. La radiographie du bassin a r&eacute;v&eacute;l&eacute; une l&eacute;sion ost&eacute;olytique du grand trochanter droit avec &eacute;paississement des parties molles en regard (A). La scintigraphie osseuse a montr&eacute; une hyperfixation du grand trochanter droit (B). Le scanner du basin a r&eacute;v&eacute;l&eacute; une l&eacute;sion ost&eacute;olytique du grand trochanter droit contenant de multiples s&eacute;questres, avec irr&eacute;gularit&eacute; corticale et collection multicloisonn&eacute;e en regard de la l&eacute;sion (C). Une ponction-biopsie osseuse du grand trochanter, sous contr&ocirc;le scannographique (D), a mis en &eacute;vidence un granulome &eacute;pith&eacute;lio&iuml;de et giganto-cellulaire &agrave; l'histologie, avec pr&eacute;sence de BK &agrave; la culture du liquide de ponction. Le diagnostic de tuberculose trochant&eacute;rienne &eacute;tait alors port&eacute;. L'intradermor&eacute;action &agrave; la tuberculine (IDR) &eacute;tait n&eacute;gative. La recherche d'autres localisations tuberculeuses s'est r&eacute;v&eacute;l&eacute;e n&eacute;gative. Le patient a &eacute;t&eacute; mis sous antituberculeux pendant 12 mois avec bonne &eacute;volution. La tuberculose constitue actuellement une cause rare sinon exceptionnelle de douleur trochant&eacute;rienne. La particularit&eacute; de notre observation r&eacute;side aussi dans l'absence d'autres localisations tuberculeuses.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Taopheeq Bamidele Rabiu [Research] - Clinical outcomes of posterior spinal stabilization with rigid vertical strut and spinal process wires (the Adeolu’s technique) in a developing country - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/84/abstract/ <b>INTRODUCTION: conventional instrumentation for spinal stabilization is beyond the reach of many patients in developing countries. A low-cost and easily-available method of spinal stabilization using vertical struts and spinal process wires (Adeolu’s technique) was recently introduced in Nigeria. We describe the clinical outcomes of a prospective series of patients managed using the technique. METHODS: from 2011 to 2012, we performed posterior spinal stabilization in eighteen patients using the technique. Primary outcomes were radiological evidence of rigid stabilization and mobilization without restrictions referable to the procedure in the immediate post-operative period. Implant rotation, migration, back-out, fracture, wound infection, worsening neurological status and need for implant removal were secondary measures. Overall patient satisfaction was assessed using a five-point Likert scale. The average follow-up period was 11.6 months. RESULTS: the average age of the patients was 45.8 years. Trauma with unstable spinal fractures (11), spondylosis (5), and thoracic extra-dural tumour (2) were the indications for surgery. The average number of spinal levels stabilized was 6. All patients had satisfactory primary outcomes. Implant rotation occurred in 3 patients (16.7%). There was no case of implant migration, back-out or fracture. Superficial surgical site infection occurred in one patient. There was no need to remove the implant in any subject and none had post-operative worsening of neurological status. The overall patient satisfaction was good with 17 patients (94.4%) reporting “highly satisfied” or “satisfied” with the surgical procedure. CONCLUSION: the technique offers utility in a wide range of spinal pathologies and short-term clinical outcomes are good.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Anthony Ademola Olashore, James Ayugi, Philip Opondo [Research] - Prescribing pattern of psychotropic medications in child psychiatric practice in a mental referral hospital in Botswana - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/83/abstract/ <b>INTRODUCTION: there is a growing preference for psycho-pharmacologicaltherapy over non-pharmacological care. The prescription pattern and the choice of psychotropic medications vary in different settings. Whilst newer agents and rational prescribing are favored in the more specialized settings, the pattern remains unclear in less specialized units, largely due to lack of data. The aims were to conduct a treatment audit in the only mental referral hospital in Botswana, which is a non-specialized child and adolescent care setting and see how it conforms to best practice. METHODS: a retrospective audit which involved the extraction of socio-demographic and clinical information from the records of patients who were ? 17 years and seen from January 1, 2012-July 31, 2016. RESULTS: a total of 238 files were used for this report. Mean age (SD) was 12.41 (4.1) years. Of the 120 (50.4%) patients who had pharmacological intervention, only 82(68.6%) had monotherapy. The most commonly prescribed psychotropic was antipsychotic (40%). Off-label use of antipsychotics and polypharmacy were 31.2% and 29.2% respectively. CONCLUSION: the level of conformity to standard practice in terms of psychotropic prescribing in our setting is consistent with the reports from developed countries where more specialized care ostensibly exists. Further studies will be necessary to determinethe scope of psychotropic use.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com B&eacute;kaye Traor&eacute;, Youssouf Fofana [Images in medicine] - Le neurofibrome plexiforme diffus de la cuisse gauche chez une patiente &acirc;g&eacute;e de 78 ans en milieu dermatologique &agrave; Bamako - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/82/abstract/ <b>La neurofibromatose type I (NF) ou maladie de Von Recklinghausen est une g&eacute;nodermatose autosomique dominante se manifestant par des anomalies de la peau, du syst&egrave;me nerveux, des os et des glandes endocrines. Les neurofibromes plexiformes diffus caract&eacute;ristiques de cette maladie sont souvent cong&eacute;nitaux, toujours visibles avant cinq ans et tendent &agrave; se d&eacute;velopper &agrave; partir de l’adolescence. Ils sont retrouv&eacute;s chez 20 &agrave; 25% des malades et sont localis&eacute;s dans 97% des cas &agrave; la paupi&egrave;re sup&eacute;rieure. Nous rapportons le cas d’une patiente &acirc;g&eacute;e de 78 ans, pr&eacute;sentant depuis l’&acirc;ge de 8 ans une tum&eacute;faction indolore, molle, avec comme zone d’insertion la lisi&egrave;re fesse gauche-cuisse gauche et se terminait au tiers inferieur de la cuisse gauche. Elle mesurant 25 cm sur sa longueur, 5 cm &agrave; sa base d’implantation et 10 cm &agrave; son bord libre. Depuis quelques temps, la patiente signalait une sensation de lourdeur de la cuisse gauche. L’examen clinique a objectiv&eacute; 10 taches caf&eacute; au lait sur le tronc, de nombreux neurofibromes cutan&eacute;s sur le tronc et les membres. A noter que son fils pr&eacute;sentait des l&eacute;sions similaires. L’examen ophtalmologique a r&eacute;v&eacute;l&eacute; une cataracte &eacute;volutive li&eacute;e &agrave; l’&acirc;ge. Le reste de l’examen clinique &eacute;tait normal. Nous avions &eacute;voqu&eacute; trois hypoth&egrave;ses diagnostiques : un neurofibrome plexiforme diffus le plus probable, un molluscum pendulum et un liposarcome. Le diagnostic de neurofibrome type I a &eacute;t&eacute; retenu devant le neurofibrome plexiforme diffus, les neurofibromes cutan&eacute;s, les taches caf&eacute; au lait et la pr&eacute;sence des l&eacute;sions similaires chez son fils.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Anis Mzabi [Images in medicine] - An unusual cause of chronic low back pain: ochronosis - 21 February 2017. http://www.panafrican-med-journal.com/content/article/26/81/abstract/ <b>A 45-year-old man presented with low back pain evolving since 8 years associated sometimes with a radicular radiation. The clinical examination found a patient in good general condition, a loss of the lumbar lordosis, an exaggeration of the dorsal kyphosis with stiffness of the lumbar spine. The cutaneous-mucosal examination showed a brownish appearance of the ears, conjunctiva, and lower eyelids. In biology there was neither inflammatory syndrome nor perturbation of the phosphocalcic balance. The standard radiographs of the lumbar spine (A) and dorsal spine (B) revealed multiple disc calcifications associated with large staggered disc clumps and discal empty images. Due to mucocutaneous signs, normality of biology and the radiological aspect, the diagnosis of ochronosis was suspected and confirmed by the test of blackening of the urine to the ambient air, the results of the cutaneous biopsy showed pigmented deposits yellow ocher and brownish in the dermis and the dosage of alkaptonuria. Symptomatic treatment resulted in moderate improvement. The family survey did not reveal any similar cases. Ochronosis or alkaptonuria is a rare autosomal recessive disorder of tyrosine metabolism. Deficiency of homogentisate 1,2 dioxygenase results in accumulation of oxidized homogentisic acid in the connective tissues of the skin, eyes and ears, musculoskeletal system, and cardiac valves, and in urolithiasis. Ochronosis is of late onset, responsible for the rachis of extended disc calcifications with maximum spinal fusion. It is the cause of degenerative arthropathy. Early diagnosis and screening of this disease are then of great interest, especially for genetic counseling.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Tarik Boulahri, Abdellah Taous, Maha A&iuml;t Berri, Imane Traibi, Jalal Elbenaye, Abdelhadi Rouimi [Case report] - Association rickettsiose et infarctus c&eacute;r&eacute;bral: une nouvelle observation - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/80/abstract/ <b>La fi&egrave;vre boutonneuse m&eacute;diterran&eacute;enne (FBM) est une rickettsiose du groupe boutonneux due &agrave; rickettsia conorii. Cette zoonose est r&eacute;put&eacute;e d'&eacute;volution b&eacute;nigne mais peut se compliquer dans les formes s&eacute;v&egrave;res d'une atteinte neurologique qui en font parfois toute la gravit&eacute;. Nous rapportons l'observation d'une patiente &acirc;g&eacute;e de 49 ans ayant pr&eacute;sent&eacute; au cours de son hospitalisation en dermatologie pour une rickettsiose, une h&eacute;mipl&eacute;gie droite massive d'installation brutale. L'angio-IRM c&eacute;r&eacute;brale a objectiv&eacute; un accident vasculaire c&eacute;r&eacute;bral isch&eacute;mique sylvien profond gauche. Le diagnostic de rickettsiose de type conorii a &eacute;t&eacute; retenu sur l'aspect des l&eacute;sions dermatologiques et la positivit&eacute; des s&eacute;rologies par immuno-fluorescence indirecte. L'&eacute;volution &eacute;tait favorable sous anti-bioth&eacute;rapie (doxycycline et fluoroquinolone). Exceptionnellement rapport&eacute; dans le cadre des manifestations neurologiques des rickettioses, l'infarctus c&eacute;r&eacute;bral reste une complication &agrave; ne pas m&eacute;connaitre surtout en regard d'un bilan &eacute;tiologique en particulier cardiovasculaire demeur&eacute; n&eacute;gatif.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Redouane Hani, Mustapha Nekkaoui, Mohammed Kharmaz, Mohamed El Ouadghiri, Abdou Lahlou, Mly Omar Lamrani, Ahmed El Bardouni, Mustapha Mahfoud, Mohamed Saleh Berrada [Case series] - Le traitement chirurgical des fractures de la palette hum&eacute;rale chez l’adulte - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/79/abstract/ <b>Le traitement des fractures de la palette hum&eacute;rale repose principalement sur la chirurgie de reconstruction par ost&eacute;osynth&egrave;se. On a collig&eacute; dans nos archives 40 cas de fracture de la palette hum&eacute;rale au service de traumatologie-orthop&eacute;die de CHU IBN SINA de RABAT du mois JANVIER 2012 au mois de DECEMBRE 2014, dont le but est de montrer les particularit&eacute;s cliniques, th&eacute;rapeutiques et &eacute;volutives de ces fractures; ainsi que les difficult&eacute;s de prise en charge de ces fractures complexes et d’&eacute;valuer les r&eacute;sultats. On a not&eacute; une nette pr&eacute;dominance masculine (75 % des cas) avec un &acirc;ge moyen de 35 ans. Les &eacute;tiologies sont domin&eacute;es par accidents de la voie publique (56 %). Tous nos patients ont &eacute;t&eacute; hospitalis&eacute;s par le biais des urgences puis op&eacute;r&eacute;s. Le type C selon la classification de M&Uuml;LLER et ALLGOWER(A.O) est le plus fr&eacute;quent : 62,5% des cas .les l&eacute;sions associ&eacute;es sont assez fr&eacute;quents (52,5%) dans le cadre d’un poly-traumatisme. Tous nos patients ont &eacute;t&eacute; op&eacute;r&eacute;s (100% des cas) via un bord post&eacute;rieur dans 70 % des cas. Ce geste comprenait une r&eacute;duction puis ost&eacute;osynth&egrave;se par plaque de LECESTRE dans 82,5% des cas. Nos r&eacute;sultats sont de 85,5 % de bons et moyens r&eacute;sultats, conform&eacute;ment aux donn&eacute;es de la litt&eacute;rature. La prise en charge de ce type de fracture est bas&eacute;e sur une r&eacute;duction anatomique parfaite, par un montage solide qui doit permettre une r&eacute;&eacute;ducation pr&eacute;coce garante d’un bon r&eacute;sultat fonctionnel.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Youssef Alaoui Lamrani, Mustapha Maaroufi [Images in medicine] - Dissection vertébrale post-traumatique asymptomatique: résultats IRM - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/78/abstract/ <b>IRM cervicale en coupe sagittale T2 montrant une contusion œd&eacute;mateuse m&eacute;dullaire (&eacute;toile), associ&eacute;e &agrave; un h&eacute;matome pr&eacute;vert&eacute;bral (H). Les autres coupes T2 (b, c), et T2* (d) r&eacute;v&egrave;lent une thrombose de l’art&egrave;re vert&eacute;brale (AV) droite (fl&egrave;che). L’occlusion atteint le segment V3 et sans l&eacute;sion isch&eacute;mique intracr&acirc;nienne. Monsieur D.L. &acirc;g&eacute;e de 43 ans, a &eacute;t&eacute; victime d’un traumatisme cervical lors d’un accident de la voie publique. L’examen r&eacute;v&egrave;le une t&eacute;trapar&eacute;sie non expliqu&eacute;e par les donn&eacute;es TDM qui montrent des fractures vert&eacute;brales irradiant vers les trous transverses C5 et C6 droits. Le recours en deuxi&egrave;me intention &agrave; l'IRM cervicale a r&eacute;v&eacute;l&eacute; une contusion m&eacute;dullaire œd&eacute;mateuse, avec occlusion de l’AV droite sur tout son trajet extra-cr&acirc;nien, et qui est le si&egrave;ge d’un h&eacute;matome intramural sugg&eacute;rant une dissection vert&eacute;brale sous-jacente. Son caract&egrave;re asymptomatique est li&eacute;e &agrave; une AV gauche perm&eacute;able avec un polygone de Willis fonctionnel assurant la suppl&eacute;ance du syst&egrave;me vert&eacute;bro-basilaire. Le caract&egrave;re complet de l’occlusion &agrave; &eacute;viter toute complication thrombo-embolique. La dissection des AV extra-cr&acirc;niennes est associ&eacute;e &agrave; des traumatismes de haute &eacute;nergie et corr&eacute;l&eacute;e &agrave; la gravit&eacute; du bilan l&eacute;sionnel ost&eacute;o-m&eacute;dullaire. La clinique est masqu&eacute;e par d’autres l&eacute;sions traumatiques &agrave; la phase aigue, et les sympt&ocirc;mes sont d’apparition retard&eacute;e. Ces derniers sont d’ordre isch&eacute;mique de m&eacute;canisme h&eacute;modynamique ou thrombo-embolique. L’extension de la dissection en intracr&acirc;nien peut causer une h&eacute;morragie m&eacute;ning&eacute;e. Le traitement repose sur des anticoagulants ou antiagr&eacute;gants en absence de l&eacute;sions visc&eacute;rales ou intracr&acirc;niennes s&eacute;v&egrave;res, le recours au traitement endovasculaire s’av&egrave;re n&eacute;cessaire en pr&eacute;sence d’une menace isch&eacute;mique dynamique.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Luc Hervé Samison, Fidiniaina Mamy Randriatsarafara, Stéphane Ralandison [Research] - Joint pain epidemiology and analgesic usage in Madagascar - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/77/abstract/ <b>INTRODUCTION: to describe the epidemiology of joint pains and document analgesics usage in an African context. METHODS: patients suffering from joint pain were recruited from nine sites located in Antananarivo, Madagascar, including 6 hospital services and 3 clinics. Doctors collected information on the etiology and characteristics of the patients’ pain. Analgesics prescribed by these doctors were also documented. RESULTS: in total, 400 patients were enrolled in the study (52.5% women, mean age of 42.34 years ± 17.7 [4-86]). Pain of mechanical type was found in 260 participants, 65%; 95% CI [60.1% to 69.6%] and inflammatory type pains in 128 cases 32%; 95% CI [27.5% to 36.9%]. Mixed pains were found in 12 patients (3%). The median duration of pain prior to the consultation was 6.5 days. The average pain intensity was 57.9 ± 19.9 mm of a total of 100 mm maximum on a visual analogue scale, VAS. The etiologies of mechanical type pains were dominated by fracture, common low back pain and tendonitis. Arthrosis was the dominant cause of inflammatory type pain, followed by rheumatoid arthritis and gout. NSAIDs (74.5%) were the most frequently prescribed analgesics followed by paracetamol (49.5%), weak opioids (23%) and corticosteroids (12.25%). Two-thirds of medical prescriptions (65.3%) were of combined analgesics.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Mohamed Amine Chaabouni [Images in medicine] - Giant laryngeal polyp: an unusual indication of tracheostomy - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/76/abstract/ <b>Benign laryngeal lesions, especially laryngeal polyps are very common and they usually only cause hoarseness andrarely develop into dyspnea.This condition is generally attributed to smoking. Cardiorespiratory failure and sudden death due tolarge laryngeal polypwas reported in the literature. The preferred treatment of large polyps is surgical excision using suspension microlaryngoscopy. We present a case of a 60-year-old man presented to the emergency with stridor and severe dyspnea. He had a 4-month history of a neglected inspiratory dyspnea and dysphonia. Fiberoptic laryngoscopy revealed a large laryngeal mass causing airway obstruction. Administration of oxygen, inhalation and intravenous administrationof corticosteroid did not relieved hissymptoms. As intubation was judged impossible, an emergency tracheostomy was performed to salvage the patient. After tracheostomy, the dyspnea ceased. Computed tomography scan showed a homogeneous regular formation of 2.5×1.5 cm obstructing the glottis and the subglottislumen. Direct laryngoscopy under general anesthesia identified a valve-like large polyp attached to the anterior wall of the subglottic region. The polyp wastotally excised with no complication. Decannulation was carried out on the second postoperative day. The masswas histologically diagnosed as normal vocal cord polyp.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Adil Kallat, Hani Abousaleh [Images in medicine] - H&eacute;matome spontan&eacute; du rein - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/75/abstract/ <b>Il s’agit d’un patient de 54 ayant comme ant&eacute;c&eacute;dents une appendicectomie il y a 6 ans et qui pr&eacute;sente des lombalgies gauches &eacute;voluant depuis 3 mois aggrav&eacute;es 3 jours avant son admission aux urgences. Par ailleurs il n’y avait pas de notion d’h&eacute;maturie ou d’&eacute;mission de calculs ni de traumatisme lombaire ou abdominal. L’examen &agrave; l’admission retrouvait un patient en assez bon &eacute;tat g&eacute;n&eacute;ral, conjonctives l&eacute;g&egrave;rement d&eacute;color&eacute;es, stable sur le plan h&eacute;modynamique. Le bilan biologique retrouvait une h&eacute;moglobine &agrave; 7.7g/dl, le reste du bilan &eacute;tait sans particularit&eacute;. L’uroscanner r&eacute;alis&eacute; mettait en &eacute;vidence la pr&eacute;sence d’une volumineuse collection p&eacute;ri-r&eacute;nale gauche &agrave; pr&eacute;dominance post&eacute;rieure, h&eacute;t&eacute;rog&egrave;ne, renfermant des zones spontan&eacute;ment hyperdenses (A). Le patient a &eacute;t&eacute; transfus&eacute; de deux culots globulaires. Vu la stabilit&eacute; h&eacute;modynamique, on avait d&eacute;cid&eacute; ce faire une simple surveillance avec l’instauration d’un traitement antalgique et antibiotique pour &eacute;viter la surinfection de l’h&eacute;matome. L’uroscanner de contr&ocirc;le a &eacute;t&eacute; r&eacute;alis&eacute; un mois plutard ayant objectiv&eacute; une nette r&eacute;gression de l’h&eacute;matome (B).</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Maryame Ezziti, Fouad Haddad, Mohamed Tahiri, Wafaa Hliwa, Ahmed Bellabah, Wafaa Badre, Rabii Haddouch, Khalid El Hattbi, Mohamed Rachid Elfriyekh, Abdelaziz Fadil [Case report] - Trichob&eacute;zoard gastrique: &agrave; propos d’un cas - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/74/abstract/ <b>Le trichob&eacute;zoard est une affection rare, le plus souvent asymptomatique, mais de diagnostic facile par la fibroscopie œsogastroduod&eacute;nale. Le traitement est le plus souvent chirurgical. On rapporte une observation d’un trichob&eacute;zoard gastrique chez une fillette de 16 ans, qui a &eacute;t&eacute; extrait par gastrotomie, sans complications. Une prise en charge psychiatrique a &eacute;t&eacute; faite.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Adil Kallat, Hicham Ouazize, Otheman Fahsi, Hani Abousaleh, Hachem El Sayegh1, Ali Iken1, Lounis Benslimane, Yassine Nouini [Case report] - Carcinome tubulo-papillaire chez une jeune de 17 ans: &agrave; propos d’un cas et revue de la litt&eacute;rature - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/73/abstract/ <b>Les tumeurs tubulo-papillaires repr&eacute;sentent 10% des carcinomes &agrave; cellules r&eacute;nales. Elles sont plus fr&eacute;quentes chez l’homme que chez la femme (sex ratio: 8/1). L’&acirc;ge moyen se situe dans la sixi&egrave;me d&eacute;cade. Sur le plan anatomopathologique, on distingue deux types: le 1 correspondant &agrave; une prolif&eacute;ration de cellules basophiles et le type 2 qui correspond &agrave; une prolif&eacute;ration de cellules &eacute;osinophiles. Nous rapportant le cas d’une patiente de 17 ans sans ant&eacute;c&eacute;dents pathologiques qui s’est pr&eacute;sent&eacute;e aux urgences pour des douleurs de la fosse lombaire droite et du flanc droit avec h&eacute;maturie &eacute;voluant depuis deux jours avant son admission, le tout &eacute;voluant dans un contexte d’amaigrissement et d’alt&eacute;ration de l’&eacute;tat g&eacute;n&eacute;ral. L’examen clinique &agrave; son admission retrouvait une patiente en mauvais &eacute;tat g&eacute;n&eacute;ral, apyr&eacute;tique avec une tension art&eacute;rielle &agrave; 110mmhg/70mmhg et une fr&eacute;quence cardiaque &agrave; 110 battements par minute. L’examen abdominal objectivait &agrave; l’inspection une voussure du flanc droit avec d&eacute;fense et empattement &agrave; la palpation. La num&eacute;ration formule sanguine retrouvait un taux d’h&eacute;moglobine &agrave; 6 g/dl ayant n&eacute;cessit&eacute; une transfusion. Le scanner abdominal a mis en &eacute;vidence une volumineuse formation tissulaire polaire inf&eacute;rieure r&eacute;nale droite de 10 cm/7.8 cm avec &eacute;panchement liquidien p&eacute;ri-r&eacute;nal de 17 mm d’&eacute;paisseur. Deux jours apr&egrave;s son admission l’&eacute;volution a &eacute;t&eacute; marqu&eacute;e par une d&eacute;globulisation avec accentuation des douleurs abdominales, on d&eacute;cide alors de faire une n&eacute;phrectomie d’h&eacute;mostase. On a r&eacute;alis&eacute; une n&eacute;phrectomie totale &eacute;largie droite par abord sous costal avec &agrave; l’examen anatomopathologique un carcinome tubulo-papillaire de type 2. Le scanner thoracique r&eacute;alis&eacute; ult&eacute;rieurement n’a pas objectiv&eacute; de localisations secondaires.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Anthony Laku Stephen Kirbak, Zipporah Ng’ang’a, Jared Omolo, Hakim Idris, Abdulmumini Usman, William Baguma Mbabazi [Research] - Sero-prevalence for Hepatitis B virus among pregnant women attending antenatal clinic in Juba Teaching Hospital, Republic of South Sudan - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/72/abstract/ <b>INTRODUCTION: hepatitis B virus infection is a major public health problem worldwide and in Africa. This would be the first ever documented study on epidemiology of Hepatitis B infections in the newly formed Republic of South Sudan. This study was designed to estimate the sero-prevalence of Hepatitis B virus infection amongst pregnant women attending antenatal services in Juba. METHODS: a cross-sectional study was conducted among pregnant women attending antenatal clinic services in Juba Teaching Hospital, in the period between December 2012 and March 2013. Any pregnant woman, attending antenatal care services at Juba Teaching Hospital, was included if she was a resident of Juba County for at least 1 year before pregnancy. A Hepatitis B case was defined as any women participating in the study and was found to be positive for HbsAg and confirmed by ELISA. RESULTS: this study documented that the prevalence of Hepatitis B surface antigen (HBsAg) among pregnant women attending ANC in Juba was 11% (31 out of the 280 samples). Other samples tested were indeterminate (36%), naturally immune (27.1%), susceptible (23%) and the remaining 1.8% was immune due to vaccination. Significant risk factors for Hepatitis B infection were loss of partner (OR 4.4 and CI of 1.4-13.9) and history of Jaundice (OR 1.7 and CI of 1.2-2.1). CONCLUSION: these study findings show that only 29% of infants in Juba county are born to immune mothers (naturally or vaccine induced). The remaining 70% of babies would be at risk of infection, if a birth dose of Hepatitis B is not provided. We therefore recommended introduction of Hepatitis B Vaccine birth dose into routine infants’ vaccination series to eliminate this risk.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Therese Ntigwa Ndongmo, Clement Bertin Ndongmo, Charles Michelo [Research] - Sexual and reproductive health knowledge and behavior among adolescents living with HIV in Zambia: a case study - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/71/abstract/ <b>INTRODUCTION: as HIV infected adolescents mature into adulthood, they are confronted with issues related to sexuality and sexual reproductive health (SRH). An estimated 68,000 adolescents aged 10-19 years are living with HIV in Zambia. The current study explores their sexuality and SRH experience and needs. METHODS: this was a mixed method analytical cross-sectional study. Adolescents at a tertiary hospital were surveyed on their sexuality and SRH experiences. Bivariate analyses on SPSS were used to assess factors associated with selected behaviors. Emerging themes from open-ended questions qualitative data were explored using content analysis. RESULTS: a total of 148 adolescents (63.5% females) aged 15-19 years were surveyed. Majority (77.0%) had secondary education; 77.2% currently in school; 40.1 % had a boy or girlfriend; 15.1% have ever had sex, of whom only 61.1 % reported consistent condom use. About 68.9 % expressed intention to have children; 2.1% of girls had been pregnant before. Of 52 respondents, 19.2% had a sexually transmitted infection (STI) before. Not being in school was a significant predictor, for knowing where to access information about sex (OR= 2.53; 95% CI:1.10-5.82; p=0.02), and also for ever gone there (OR=2.61; 95% CI:1.04-6.58; p=0.03). ONCLUSION: the survey of HIV infected adolescents attending a tertiary hospital in Zambia found that their sexuality and SRH needs remain similar to those of the general adolescent population in terms of counseling in sexual matters, family planning and STI services. More efforts are needed to provide for adolescent health care needs, especially those living with HIV.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Ababacar Abdoulaye Traore, Alami Badreeddine [Images in medicine] - D&eacute;couverte d’un cas inhabituel de m&eacute;ga chol&eacute;cystite aigue associ&eacute; &agrave; une dilatation kystique de la voie biliaire principale - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/70/abstract/ <b>Il s’agit d’une patiente de 81 ans, admise au service des urgences pour prise en charge d’une colique h&eacute;patique associ&eacute;e &agrave; un ict&egrave;re cutan&eacute;o-muqueux, quelques &eacute;pisodes de vomissement et une hyperthermie. A l’examen physique, la patiente avait une sensibilit&eacute; de l’hypochondre droit avec palpation d’une masse mobile douloureuse du flanc homolat&eacute;ral arrivant jusqu’au niveau de la fosse iliaque droite. Un bilan biologique a montr&eacute; une hyperleucocytose &agrave; polynucl&eacute;aire neutrophile 12000/uL, une C R&eacute;active Prot&eacute;ine &agrave; 144 mg/l avec perturbation du bilan h&eacute;patique de cholestase montre (&eacute;levation de la bilirubine et des transaminases &agrave; X fois la normale (pas besoin des chiffres exacts). Une &eacute;chographie r&eacute;alis&eacute;e en urgence a montr&eacute; une v&eacute;sicule biliaire tr&egrave;s distendue (14x07cm), lithiasiques &agrave; paroi &eacute;paissie, &eacute;tendue en bas jusqu’au niveau du carrefour ilio caecal avec ectasie des voies biliaires (voie biliaire principale = 26mm). Une TDM abdominale a objectiv&eacute; les m&ecirc;mes r&eacute;sultats d&eacute;crits &agrave; l’&eacute;chographie, avec dilatation kystique du chol&eacute;doque, le conduit pancr&eacute;atique principal &eacute;tait de calibre normal. Une CPRE r&eacute;alis&eacute;e avec sphinctorotomie a confirm&eacute; la dilatation kystique de la VBP. Le diagnostic de chol&eacute;cystite aigue associ&eacute; &agrave; une dilatation kystique de la VBP de type I de tadoni est retenu. Apr&egrave;s antibioth&eacute;rapie le patient a b&eacute;n&eacute;fici&eacute; d’un traitement chirurgical qui a consist&eacute; en une chol&eacute;cystectomie avec ex&eacute;r&egrave;se en bloc de la voie biliaire dilat&eacute;e, suivie d’une d&eacute;rivation bilio-digestive sur anse en Y. Les suites op&eacute;ratoires &eacute;taient simples.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Othmane Lahbali, Amine Azami, Mohammed Tbouda, Adil Elyamine, Fouad Zouaidia, Najat Mahassini [Case report] - Un myofibroblastome de type mammaire pas comme les autres: &agrave; propos d’un cas - 20 February 2017. http://www.panafrican-med-journal.com/content/article/26/69/abstract/ <b>Le myofibroblastome de type mammaire (MM) est une tumeur m&eacute;senchymateuse b&eacute;nigne rare initialement d&eacute;crit dans le sein. Le diagnostic de cette entit&eacute; repose sur un spectre d’arguments cliniques radiologiques et &eacute;ventuellement histologiques. Nous rapportons un cas rare de myofibroblastome de type mammaire si&eacute;geant au niveau axillaire chez un homme de 50 ans. La particularit&eacute; de notre cas est l’existence de plusieurs figures de mitoses et ceci est rarement d&eacute;crit dans la litt&eacute;rature. A travers ce cas nous soulevons les probl&eacute;matiques du diagnostic diff&eacute;rentiel de cette tumeur rare.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Asmama Yasmina, Amina Barakat [Case study] - Rupture pr&eacute;matur&eacute;e des membranes &agrave; terme: facteurs pronostiques et cons&eacute;quences n&eacute;onatales - 05 February 2017. http://www.panafrican-med-journal.com/content/article/26/68/abstract/ <b>La rupture pr&eacute;matur&eacute;e des membranes (RPM) &agrave; terme survient dans 5 &agrave; 10% des grossesses. Elle rend compte d'une part importante de morbidit&eacute; et de mortalit&eacute; n&eacute;onatales. Le but de cette &eacute;tude est de d&eacute;terminer les facteurs pronostiques maternels et obst&eacute;tricaux ainsi que le devenir des nouveau-n&eacute;s &agrave; terme issus d'une grossesse compliqu&eacute;e de rupture pr&eacute;matur&eacute;e des membranes ayant &eacute;t&eacute; hospitalis&eacute;s au service ou g&eacute;r&eacute;s &agrave; la consultation externe. Etude r&eacute;trospective, analysant toutes les observations de nouveau-n&eacute;s &agrave; terme issus de grossesses compliqu&eacute;es de RPM, enregistr&eacute;es au service de n&eacute;onatologie de l'h&ocirc;pital d'enfants de Rabat entre le 1er janvier et le 31 juillet 2014. Au cours de la p&eacute;riode d'&eacute;tude nous avons collig&eacute; 144 cas de RPM isol&eacute;e sur un total de 2400 naissances vivantes (NV) soit une pr&eacute;valence de 6% NV, r&eacute;partis comme suit : 06 cas de RPM (4%) entre 6 et 12 heures, 14 cas (9,7%) entre 12 et 18 heures, 28 cas (19,4%) entre 18 et 24 heures et 96 cas (66,6%) sup&eacute;rieure &agrave; 24 heures. La majorit&eacute; de nos parturientes &eacute;taient dans la tranche d'&acirc;ge de 25 &agrave; 35ans avec un taux de 52%. Une chorioamniotite associ&eacute;e a &eacute;t&eacute; retenue dans 8,3% des cas. Les parturientes ont &eacute;t&eacute; mises sous antibioth&eacute;rapie prophylactique par voie orale ou parent&eacute;rale dans 28% des cas, avec un liquide amniotique clair dans 81% des cas. Le diagnostic d'IMF probable a &eacute;t&eacute; retenu dans 46 cas dont 65.2 % dans le sous groupesup&eacute;rieur &agrave; 18 h versus respectivement 26% et 8,7% dans les sous groupe 12 &agrave; 18 h et inf&eacute;rieur &agrave; 12 h. A l'admission, on a not&eacute; une pr&eacute;dominance masculine avec 58,3%, les nouveau-n&eacute;s &eacute;taient asymptomatiques dans 76% des cas et ils pr&eacute;sentaient une d&eacute;tresse respiratoire dans 42,8% des cas, un ict&egrave;re dans 31,45% des cas, une fi&egrave;vre dans 14,2% des cas et des signes de souffrance neurologique dans 11,5% des cas. Tous les nouveau-n&eacute;s hospitalis&eacute;s, soit dans 72% des cas, ont &eacute;t&eacute; mis sous antibioth&eacute;rapie pendant une dur&eacute;e allant de 5 &agrave; 10 jours avec une dur&eacute;e d'hospitalisation moyenne de 2,44jours. Ce travail souligne le risque important d'IMF associ&eacute; &agrave; une RPM m&ecirc;me &agrave; terme. Ce risque est d'autant plus important que la rupture est sup&eacute;rieure &agrave; 24 heures de temps. Dans la majorit&eacute; des cas le liquide amniotique est clair et les nouveau-n&eacute;s sont asymptomatiques &agrave; l'admission, ce qui laisse la mise sous antibioth&eacute;rapie automatiquement de ces nouveau-n&eacute;s un sujet encore tr&egrave;s discutable.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Naoual El Omri, Fadwa Mekouar [Images in medicine] - Fistulized multidrug-resistant tuberculosis - 05 February 2017. http://www.panafrican-med-journal.com/content/article/26/67/abstract/ <b>A 21-year-old woman with no history of tuberculosis was admitted to the emergency room with an acute abdominal accompanied by fever. She underwent an emergency abdominal operation surgery and histological studies revealed a peritoneal and appendicular ovarian tuberculosis. The patient received antibacillar (Rifampicine, Isoniazid, Pyrazinamide). Two months later, she was readmitted with fever and a general physical deterioration while being on antituberculosis medications. Chest X-Ray and CT scan revealed a miliary tuberculosis with pleural and peritoneal effusion and lymphadenopathy above and below the diaphragm. HIV serology was negative. This peritoneal collection had caused a fistula on the abdominal wall with two sinus tracts in the midline. The bacteriological examination of the purulent material revealed a Mycobacterium tuberculosis with a high resistance to all anti-bacillar drugs except Etambuthol and Pyrazinamide. The patient was treated by etionamide, pyrazinamide, spiramycin and etambutole, with favorable outcome.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hicham Titou, Christelle Ebongo, Elarbi Bouati, Mohammed Boui [Case series] - Risk factors associated with local complications of erysipelas: a retrospective study of 152 cases - 05 February 2017. http://www.panafrican-med-journal.com/content/article/26/66/abstract/ <b>Erysipelas is a common skin infection. Hemorrhagic, bullous, abcessing and necrotic lesions are the major local complications. However, their occurrence factors are not clearly known. The aim of this study is to identify the risk factors associated with the occurrence of local complications of Erysipelas. Medical records from all patients hospitalized with local complications of erysipelas admitted to the Military Hospital of Rabat between 2005 and 2015, were retrospectively studied. Using an univariate and multivariate statistical study, the main characteristics were compared with those from patients with erysipelas without local complications. In total, 152 patients were analysed, of whom 72 had local disease complications. Using univariate analysis, the factors significantly associated with disease complications were found to be: age d" 50 years, female gender, heart disease, smoking, taking antibiotics or non-steroid anti-inflammatory drug before hospitalization, and accelerated sedimentation rate. However, in multivariate analysis, taking antibiotics before hospitalization (OR 5.15, 95% CI 1.28 to 20.72, P = 0.01) and accelerated sedimentation rate (OR 5, 15, 95% CI 1.00 to 1.06, P = 0.001) were the only independent factors associated with complicated erysipelas. Our study showed that prior antibiotics taking and higher sedimentation rate are independent risk factors for local complications of erysipelas. Patients with these characteristics should be carefully evaluated and monitored.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Saoussane Kharmoum, Rabie Rahhali [Images in medicine] - Maladie du Paget du mamelon - 03 February 2017. http://www.panafrican-med-journal.com/content/article/26/65/abstract/ <b>Nous rapportons le cas d’une patiente &acirc;g&eacute;e de 53 ans, m&eacute;nopaus&eacute;e, sans ant&eacute;c&eacute;dents pathologiques particuliers, qui pr&eacute;sente depuis une ann&eacute;e une l&eacute;sion squameuse et prurigineuse de la plaque ar&eacute;olo-mamelonnaire droite (A), l’examen clinique ne r&eacute;v&egrave;le pas de masses mammaires palpables, les aires ganglionnaires sont libres. La mammographie et l’&eacute;chographie mammaire trouvent un &eacute;paississement du rev&ecirc;tement cutan&eacute; p&eacute;ri-ar&eacute;olaire droit sans l&eacute;sions suspecte sous-jacente. Une biopsie a &eacute;t&eacute; r&eacute;alis&eacute; objectivant un &eacute;piderme papillomateux p&eacute;n&eacute;tr&eacute; par de nombreuses cellules tumorales malignes type Paget (B), l’immunohistochimie a montr&eacute; des cellules tumorales positives pour la cytok&eacute;ratine CK7 et n&eacute;gatives pour la CK20, avec une surexpression de l’HER2. Au vu de ces r&eacute;sultats le diagnostic de maladie de Paget a &eacute;t&eacute; retenu. La maladie de Paget correspond &agrave; l’envahissement de l’&eacute;piderme mamelonnaire par un carcinome canalaire in situ (CIS), il s’agit d’une variante rare du CIS, elle repr&eacute;sente 1 &agrave; 3 % des tumeurs mammaires. Elle peut &ecirc;tre associ&eacute;e &agrave; une n&eacute;oplasie mammaire dans plus de 80% des cas, d’o&ugrave; l’int&eacute;r&ecirc;t de r&eacute;aliser un bilan s&eacute;nologique complet. La maladie de Paget doit &ecirc;tre suspect&eacute;e et recherch&eacute;e devant toute l&eacute;sion unilat&eacute;rale et persistante du mamelon. Le traitement d&eacute;pend essentiellement de la pr&eacute;sence ou non d’un cancer mammaire sous-jacent. Il consiste &agrave; r&eacute;aliser une mastectomie ou une chirurgie conservatrice du sein avec un curage ganglionnaire. Les traitements adjuvants (radioth&eacute;rapie, chimioth&eacute;rapie, immunoth&eacute;rapie et hormonoth&eacute;rapie) doivent &ecirc;tre discut&eacute;s au cas par cas.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Jonathan Peter Nelson [Research] - Indications and appropriateness of caesarean sections performed in a tertiary referral centre in Uganda: a retrospective descriptive study - 03 February 2017. http://www.panafrican-med-journal.com/content/article/26/64/abstract/ <b>INTRODUCTION: the WHO has identified an ideal caesarean section rate for a nation of 10-15%, but much higher rates are seen in tertiary referral centres in resource-poor countries. Interventions by the author to improve care and reduced unnecessary caesareans were undertaken including staff education and production of clinical guidelines. This study aimed to identify indications for caesareans and whether the decision to perform caesareans was appropriate in order to improve care, and whether the above interventions had an impact on this process. METHODS: two groups of 100 consecutive cases from October 2014 and 100 from February 2015 were retrospectively selected that resulted in caesarean. These case notes were analysed for demographic data, caesarean indication and appropriateness. RESULTS: in 46% of cases the decision for caesarean was considered appropriate. No significant difference (p>0.05) was found between the two groups in terms of patient demographics or appropriateness of caesarean (43% in Oct-14 compared to 48% in Feb-15). The most common group of indications for caesarean was dystocia (43.5%) with 28% appropriate; followed by fetal distress (18.5%) with 30% appropriate; previous scar (17%) with 85% appropriate; malpresentation (10.5%) with 48% appropriate; and maternal compromise (10%) with 80% appropriate. CONCLUSION: the high number of unnecessary caesareans appeared to be related to lack of knowledge and inexperience of staff. Despite attempts to address this through teaching the scope of the problem is so large it needs a fundamental change in the healthcare system in terms of resources, education, continuing professional development and clinical governance.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Lamia Kissi, Rajaa El Bouihi, Mouna Lamchahab, Ahmed Alaoui, Ihsane Benyahya [Case report] - Localisation buccale d’un lymphome de Burkitt: &agrave; propos d’un cas - 03 February 2017. http://www.panafrican-med-journal.com/content/article/26/63/abstract/ <b>Le lymphome de Burkitt (LB) est une forme de lymphome malin non-Hodgkinien qui provient de l'&eacute;volution maligne et de la prolif&eacute;ration de cellules lympho&iuml;des de type B. Le diagnostic positif repose sur la biopsie d'une masse tumorale ou la ponction de la moelle osseuse r&eacute;v&eacute;lant la pr&eacute;sence de cellules tumorales. Le cas rapport&eacute; est celui d'un jeune homme d'une vingtaine d'ann&eacute;es qui a &eacute;t&eacute; adress&eacute; pour des tum&eacute;factions gingivales &eacute;voluant depuis 1 mois suite &agrave; des extractions dentaires. L'examen anatomopathologique apr&egrave;s biopsie compl&eacute;t&eacute; par l'immunohistochimie conclut &agrave; un lymphome de Burkitt. La prise en charge a consist&eacute; en une chimioth&eacute;rapie. Bien que rare, le lymphome de Burkitt est une tumeur agressive qui repr&eacute;sente un v&eacute;ritable probl&egrave;me de sant&eacute; publique d'o&ugrave; la place importante qu'occupe le m&eacute;decin dentiste dans le diagnostic pr&eacute;coce afin de permettre une prise en charge rapide et appropri&eacute;e seule garante de la gu&eacute;rison.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Akin Usta, Ceyda Sancakli usta, Ayla Yildiz, Ruhsen Ozcaglayan, Eylem Sen Dalkiran, Aydin Savkli, Meryem Taskiran [Research] - Frequency of fetal macrosomia and the associated risk factors in pregnancies without gestational diabetes mellitus - 02 February 2017. http://www.panafrican-med-journal.com/content/article/26/62/abstract/ <b>BACKGROUND: there has been an increased incidence of macrosomic newborns in the world and most of the macrosomic newborns are born from non-GDM pregnant women. The objective of this study was to determine the frequency and the associated risk factors of fetal macrosomia in non-GDM pregnant women. METHODS: a total 4246 consequtive pregnant women who had no GDM was included the study population. Data was collected from hospital database of Bal?kesir State Hospital between January 2014 and January 2015. Statistical analysis was carried out using the independent samples t-test and chi-squared test. Logistic regression analysis was used to determine the relationships between associated risk factors and the presence of fetal macrosomia. In this analysis, fetal macrosomia was taken as the dependent variable and associated risk factors were taken as independent variables. Results are shown as odds ratios (ORs) (95% CI) in the logistic regression analysis. RESULTS: 366 of the 4246 pregnant women were diagnosed with fetal macrosomia (8.6%). Compared the control women, a statistically significant correlation between fetal macrosomia and pre-pregnancy body mass index (BMI), gestational weight gain (GWG), parity, advanced maternal age, and male fetal sex was found. Maternal BMI, and GWG were the two risk factors most strongly associated with macrosomia. CONCLUSION: the prevalance of fetal macrosomia is rising among Turkish women. High pre-pregnancy BMI and GWG represent main modifiable risk factors for macrosomia and need more attention from health care providers.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Fouad Nya, Abdessamad Abdou, Mehdi Bamous, Younes Moutakiallah, Noureddine Atmani, Aniss Seghrouchni, Mahdi Aithoussa, Abdellatif Boulahya [Case report] - Myxome de la petite valve mitrale: &agrave; propos d’un cas - 02 February 2017. http://www.panafrican-med-journal.com/content/article/26/61/abstract/ <b>Les myxomes cardiaques constituent les formes les plus fr&eacute;quentes des tumeurs primitives du cœur. La localisation la plus fr&eacute;quente est le septum interatrial et exceptionnellement au niveau des valves cardiaques. L’ex&eacute;r&egrave;se chirurgicale est la seule alternative th&eacute;rapeutique. Nous rapportons l’observation clinique d’un patient &acirc;g&eacute; de 69 ans, sans ant&eacute;c&eacute;dents pathologique notables, qui a pr&eacute;sent&eacute; une dyspn&eacute;e stade II &agrave; III de la NYHA associ&eacute;e &agrave; une lipothymie. L’&eacute;chocardiographie transthoracique a objectiv&eacute; un r&eacute;tr&eacute;cissement aortique calcifi&eacute; serr&eacute; avec un gradient moyen VG-aorte &agrave; 58 mmHg. Au niveau de la valve mitrale pr&eacute;sence d’une masse de 15mm de diam&egrave;tre, s’ins&eacute;rant sur la petite valve mitrale sessile, sans effet de st&eacute;nose ni de fuite mitrale &eacute;voquant un myxome de localisation atypique ou un fibro&eacute;lastome. L’examen a &eacute;t&eacute; compl&eacute;t&eacute; par une ETO qui a confirm&eacute; le diagnostic de la masse de la petite valve mitrale. Le patient est op&eacute;r&eacute; avec une st&eacute;rnotomie m&eacute;diane verticale, et sous circulation extracorporelle conventionnelle. Une atriotomie gauche a permis d’objectiver une masse sessile de 15mm de diam&egrave;tre sur la face auriculaire de la petite valve mitrale, friable et facilement clivable. Le geste a &eacute;t&eacute; compl&eacute;t&eacute; par une caut&eacute;risation de la base d’implantation au bistouri &eacute;lectrique sans geste suppl&eacute;mentaire sur la petite valve mitrale. La pi&egrave;ce op&eacute;ratoire est adress&eacute;e en anatomo-pathologie qui a confirm&eacute; le diagnostic de myxome. Le patient a b&eacute;n&eacute;fici&eacute; aussi d’un remplacement valvulaire aortique par proth&egrave;se m&eacute;canique. Les suites op&eacute;ratoires imm&eacute;diates &eacute;taient simples. Le patient a quitt&eacute; le service &agrave; J8 postop&eacute;ratoire. La localisation mitrale du myxome cardiaque est tr&egrave;s rare. Le traitement chirurgical reste la seule option th&eacute;rapeutique avec une r&eacute;section la plus large possible pour &eacute;viter tout risque de r&eacute;cidive.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Eric Sampane-Donkor, Ebenezer Vincent Badoe, Jennifer Adoley Annan, Nicholas Nii-Trebi [Research] - Colonisation of antibiotic resistant bacteria in a cohort of HIV infected children in Ghana - 02 February 2017. http://www.panafrican-med-journal.com/content/article/26/60/abstract/ <b>Antibiotic use not only selects for resistance in pathogenic bacteria, but also in commensal flora of exposed individuals. Little is known epidemiologically about antibiotic resistance in relation to people with HIV infection in sub-Saharan Africa. This study investigated the carriage of antibiotic resistant bacteria among HIV infected children at a tertiary hospital in Ghana. One hundred and eighteen HIV positive children were recruited at the Korle-Bu Teaching Hospital in Ghana and nasopharyngeal specimens were collected from them. The specimens were cultured for bacteria, and the isolates were identified by standard microbiological methods. Antibiotic susceptibility tests were carried out on selected bacterial organisms by the Kirby Bauer method. Bacteria isolated from the study subjects included Moraxella catarrhalis (39.8%), coagulase negative staphylococci (33.1%), Streptococcus pneumoniae (30.5%), diptheroids (29.7%), viridian streptococci (27.1%), Staphylococcus aureus (22.0%), Citrobacter spp. (4.2%) and Neisseria meningitidis (0.9%). Prevalence of antibiotic resistance of S. pneumoniae ranged from 5.6% (ceftriaxone) to 58.3% (cotrimoxazole), M. catarrhalis ranged from 2.1% (gentamicin) to 80.6% (ampicillin), and S. aureus ranged from 7.7% (cefoxitin) to 100% (penicillin). The prevalence of multiple drug resistance was 16.7% for S. pneumoniae, 57.4% for M. catarrhalis and 84.6% for S. aureus. HIV infected children in the study area commonly carry multi-drug resistant isolates of several pathogenic bacteria such as S. aureus and S. pneumoniae. Infections arising in these patients that are caused by S. aureus and S. pneumoniae could be treated with ceftriaxone and cefoxitin respectively.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Irtyah Merchaoui, Lamia Bouzgarrou, Ahlem Mnasri, Mounir Mghanem, Mohamed Akrout, Jacques Malchaire, Neila Chaari [Research] - Influence of shift work on the physical work capacity of Tunisian nurses: a cross-sectional study in two university hospitals - 02 February 2017. http://www.panafrican-med-journal.com/content/article/26/59/abstract/ <b>INTRODUCTION: this study has been performed to determine the influence of rotating shift work on physical working capacity of Tunisian nurses and to design recommendations to managers so that they implement effective preventive measures. METHODS: it is a cross-sectional design using a standardized questionnaire and many physical capacity tests on a representative sample of 1181 nurses and nursing assistants from two university hospital centers of the school of Medicine of Monastir located in the Tunisian Sahel. 293 participants have been recruited by stratified random sampling according to gender and departments. Maximum Grip strength, 30s sit-to-stand test, one leg test, Fingertip-to-Floor test, Saltsa test and peak expiratory flow were used to assess physical capacity. Work ability was assessed through the workability index.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hamza Samlali, Zineb Bouchbika, Zineb Bennani, Amina Taleb, Nadia Benchekroune, Hassan Jouhadi, Nezha Tawfiq, Souha Sahraoui, Abdellatif Benider [Case report] - M&eacute;tastase cr&acirc;nienne d’un ad&eacute;nocarcinome rectal: &agrave; propos d’un cas avec revue de la litt&eacute;rature - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/58/abstract/ <b>Les m&eacute;tastases osseuses sont g&eacute;n&eacute;ralement d'origine pulmonaire, prostatique, r&eacute;nale, v&eacute;sicale ou thyro&iuml;dienne chez les hommes. Une origine colorectale est rare. Peu de publications ont d&eacute;crit ce type de m&eacute;tastases, la localisation la plus fr&eacute;quente est le rachis axial ou le bassin. La localisation cr&acirc;nio-faciale est exceptionnelle. Nous relatons ainsi le cas d'une observation d'un homme suivi pour un cancer du rectum m&eacute;tastatique avec une m&eacute;tastase osseuse temporale. Notre observation se rapportait &agrave; l'histoire d'un homme &acirc;g&eacute; de 38 ans suivi pour un cancer du rectum initialement op&eacute;r&eacute; par r&eacute;section ant&eacute;rieur classant la tumeur pT3N0M0. 24 mois apr&egrave;s, le patient pr&eacute;sentait une exophtalmie gauche r&eacute;v&eacute;lant un processus tumoral temporal. L'&eacute;volution et le contexte &eacute;taient en faveur d'une m&eacute;tastase. En conclusion, nous rapportons dans cette observation, un cas exceptionnel d'une m&eacute;tastase osseuse cr&acirc;nio-faciale d'un cancer colo-rectal multi-m&eacute;tastatique qui pourra enrichir les rares donn&eacute;es rapport&eacute;es dans la litt&eacute;rature se rapportant aux m&eacute;tastases osseuses de primitif colo-rectal.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Alain Farra, Claudine Bekondi, Vianney Tricou, Jean Robert Mbecko, Antoine Talarmin [Short communication] - Free-living amoebae isolated in the Central African Republic: epidemiological and molecular aspects - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/57/abstract/ <b>Among the many species of free-living amoebae infecting humans, only Naegleria fowleri, a few species of Acanthamoeba, Balamuthia mandrillaris recently Sappinia diplo&iuml;dea and Paravahlkampfia Francina are responsible for human diseases especially deadly encephalitis outside of Acanthamoeba keratitis related . In the Central African Republic (CAR), no studies have previously been conducted about free amoebae and no suspicious cases of encephalitis or amoebic keratitis was reported even though the ecosystem supported the proliferation of these microorganisms. The objective of this study was to identify free-living amoebae present in CAR and to define the molecular characteristic. Bathing sites and cerebrospinal fluid from patients died of bacterial meningitis untagged were explored by culture and PCR and the amplicons were sequenced which allowed to characterize the species found. Only species of the genus Tetramitus, namely T. Entericus, T. waccamawensis and T.sp similar to those already described in the world and not pathogenic for humans were found in bathing sites, the cerebrospinal fluid meanwhile remained negative. Although no pathogen species such as Naegleria fowleri or species of Acanthamoeba have been isolated, this study worth pursuing because this investigation was very limited in space because of the insecurity in the country.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Pilakimw&eacute; Egbohou, Tabana Mouzou, Hamza Doles Sama, Pikabalo Tch&eacute;tike, Sarakawabalo Ass&eacute;nouw&eacute;, Gnimdou Akala-Yoba, Kadjika Tomta [Short communication] - Pratique de l’analg&eacute;sie p&eacute;ridurale aupr&egrave;s de 20 parturientes au Centre Hospitalier Universitaire Sylvanus Olympio de Lom&eacute; (Togo) - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/56/abstract/ <b>Etude prospective et descriptive sur la pratique de l’analg&eacute;sie p&eacute;ridurale (APD) obst&eacute;tricale au CHU Sylvanus Olympio (CHU SO) de Lom&eacute;. Etude men&eacute;e de f&eacute;vrier &agrave; juin 2014. Apr&egrave;s accord des gestantes choisies au hasard et en l’absence de contre-indication &agrave; l’issue de la consultation d’anesth&eacute;sie, faite au 8&egrave;me mois de la grossesse, des femmes ont &eacute;t&eacute; retenues pour l’&eacute;tude. Sur 29 gestantes retenues, 20 (69%) ont b&eacute;n&eacute;fici&eacute;es de l’APD. Age moyen 30,6±6,6 ans, primigestes : 35%, multipares 50%, Ob&egrave;ses (BMI>30): 25%. Nombre moyen de ponctions: 1,2±0,5; reflux de sang dans le cath&eacute;ter: 5%, br&egrave;che dure-m&eacute;rienne : 0. D&eacute;lai moyen d’installation: 8,5 ±2,2mn. Quantit&eacute; moyenne de bupivacaine isobare &agrave; 0,125%: 28,8±8ml; Echelle Num&eacute;rique &agrave; T10min < 3 pour toutes les parturientes. Bloc moteur: 0. Hypotension: 1cas (5%). Mode d’accouchement: voie basse: 19 (95%), c&eacute;sarienne: 1 (5%). D&eacute;tresse respiratoire &agrave; la naissance du nouveau n&eacute;: 0. Note de satisfaction: 9,8±0,5 /10. L’APD obst&eacute;tricale est possible au CHU Sylvanus Olympio de Lom&eacute;. En attendant sa vulgarisation &agrave; toutes les parturientes par la disponibilit&eacute; des moyens humains et mat&eacute;riels, la r&eacute;aliser pour ses indications m&eacute;dicales serait un premier pas.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Kaan Sonmez, Ramazan Karabulut, Zafer Turkyilmaz, Canan Turkyilmaz, Berrin Isik, Sibel Eryilmaz, K?vanc Seref, Ebru Ozcan, Gul Meral Hosgoren, Abdullah Can Basaklar [Case report] - Our experience in two cases of type IV laryngotracheoesophageal cleft (LTEC) with a diagnosis of antenatal esophageal atresia - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/55/abstract/ <b>Laryngotracheoesophageal clefts (LTECs) are rare congenital defects that are often accompanied by additional anomalies. The major issues in the treatment of these patients are intraoperative exposure insufficiency, technical difficulty of the operation, and anesthesia problems originating from the respiratory tract. Problems originating from mechanical ventilation and respiratory tract, eating disorders and relapse of fistula are among the problems encountered following surgery. Most of the time, concomitant additional anomalies also worsen the clinical picture. It was our aim with these case reports to report our experience in two cases with Type IV LTEC ranging from the inoperable type IV LTEC due to additional anomalies mounted up to severe respiratory distress to the carina that we operated on with a single stage anterior cervicothoracic approach on its fifth day on life.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Forough Rafii, Seyedeh Fatemeh Vasegh Rahimparvar, Neda Mehrdad, Afsaneh Keramat [Research] - Barriers to postpartum screening for type 2 diabetes: a qualitative study of women with previous gestational diabetes - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/54/abstract/ <b>INTRODUCTION: risk of developing type 2 diabetes is increased in women with previous gestational diabetes mellitus (GDM). Postpartum glycemic screening is recommended in women with recent GDM. But this screening rate is low and the reasons are unclear. The aim of this study was to explore the experiences of Iranian women with recent GDM on barriers of postpartum screening for diabetes. METHODS: this qualitative study was conducted in Tehran, Iran in 2016. Semi-structured interview was used for data collection. 22 women with recent GDM were interviewed. These women gave birth in Tehran hospitals at a minimum of 6 months before interview. The missed screening defined as not attending to laboratory for Fasting Blood Sugar and/or Oral Glucose Tolerance Test, 6 week to 6 month after their child birthing. The data was analyzed by content analysis method. RESULTS: themes and sub-themes that illustrated the barriers to postpartum diabetes screening were: inadequate education (about developing diabetes in the future, implementation of the screening, and glucometer validity in diagnosis of diabetes), perceiving the screening as difficult (feeling comfortable with the glucometer, poor laboratory conditions, issues related to the baby/babies, and financial problems), improper attitudes toward the screening (unwilling to get diagnosed, not giving priority to oneself, having false beliefs) and procrastination (gap to intention and action, self-deception and self-regulation failure). CONCLUSION: women with recent GDM reported several barriers for postpartum diabetes screening. This study help to develop the evidence-based interventions for improving this screening rate.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com El Omri Naoual, El Jaoudi Rachid, Mekouar Fadwa, Jira Mohammed, Sekkach Youssef, Amezyane Taoufik, Ghafir Driss [Case report] - Cannabis arteritis - 01 February 2017. http://www.panafrican-med-journal.com/content/article/26/53/abstract/ <b>Cannabis is the most consumed psychoactive substance by young people. Chronic use of cannabis can lead to cannabis arteritis, which is a very rare peripheral vascular disease similar to Buerger's disease. It is affecting young adults, especially men, consuming cannabis. A 27-year old woman, with no particular past medical history except for long-term use of cannabis and tobacco developed a digital necrosis in the left hand. She denied using other illicit drugs. Doppler ultrasound examination of the upper limbs was unremarkable. Toxicological analysis revealed the presence of cannabis in both biological fluid and hair strand. Despite medical treatment, cessation of the cannabis and tobacco consumption and hyperbaric oxygen therapy, an amputation of necrotic parts was then required. This case shows the prolonged use of cannabis could be a risk factor for young adult arteritis. Faced with a rapidly progressive arteritis occurring in young adult, the physician should consider the history of use of cannabis. Hair analysis can be useful for confirmation of the chronic consumption of drugs.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Ifeoma Christiana Udenze, Olusola Festus Olowoselu, Ephraim Uchenna Egbuagha, Temitope Adewunmi Oshodi [Research] - Thyroid, cortisol and growth hormone levels in adult nigerians with metabolic syndrome - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/52/abstract/ <b>BACKGROUND: the similarities in presentation of cortisol excess, growth hormone deficiency, hypothyroidism and metabolic syndrome suggest that subtle abnormalities of these endocrine hormones may play a causal role in the development of metabolic syndrome. The aim of this study is to determine the levels of cortisol, thyroid and growth hormones in adult Nigerians with metabolic syndrome and determine the relationship between levels of these hormones and components of the syndrome. METHODS: this was a case control study conducted at the Lagos University Teaching Hospital, Lagos, Nigeria. Participants were fifty adult men and women with the metabolic syndrome, and fifty, age and sex matched males and females without the metabolic syndrome. Metabolic syndrome was defined based on the NCEP-ATPIII criteria. Written Informed consent was obtained from the participants. Socio demographic and clinical data were collected using a structured questionnaire. Venous blood was collected after an over-night fast. The Ethics committee of the Lagos University Teaching Hospital, Lagos, Nigeria, approved the study protocol. Comparison of continuous variables was done using the Student's t test. Correlation analysis was employed to determine the associations between variables. Statistical significance was set at P<0.05. RESULTS: Triiodotyronine (T3) was significantly decreased (p<0.001) and thyroxine (T4 ) significantly increased ( p<0.001) in metabolic syndrome compared to healthy controls. T3 correlated positively and significantly with waist circumference (p=0.004), glucose (p= 0.002), total cholesterol ( p=0.001) and LDL- cholesterol ( p<0.001 ) and negatively with body mass index ( p<0.001 )and triglyceride ( p=0.026). T4 had a negative significant correlation with waist circumference (p=0.004). Cortisol and growth hormone levels were similar in metabolic syndrome and controls. Cortisol however had a positive significant correlation with waist/hip ratio (p<0.001) while growth hormone correlated positively with HDL ( p=0.023)and negatively with diastolic blood pressure (p=0.049). CONCLUSION: Thyroid hormones T3 and T4 were associated with metabolic syndrome. The thyroid hormones, cortisol and growth hormones correlated with components of the syndrome. A therapeutic role may exit for these hormones in the management of metabolic syndrome and related disorders.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Coline Mahende, Billy Ngasala, John Lusingu, Thomas M&aring;rtensson, Paminus Lushino, Martha Lemnge, Bruno Mmbando, Zul Premji [Research] - Profile of C-reactive protein, white cells and neutrophil populations in febrile children from rural north-eastern Tanzania - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/51/abstract/ <b>INTRODUCTION: C-reactive protein (CRP), white blood cell (WBC) and absolute neutrophil counts (ANC) are important inflammatory biomarkers in the early diagnosis of infections. However, little is known on their profile and usefulness in fever case management in children attending outpatient clinic in rural north-eastern Tanzania. METHODS: patients aged between 2 and 59 months presenting with fever at Korogwe District Hospital were enrolled. Venous blood was collected for evaluation of serum CRP, WBC and ANC. Individual patient diagnosis was based on integrated management of childhood illness (IMCI) guidelines and laboratory investigations (blood and urine cultures). RESULTS: a total of 867 patients were enrolled, out of which 691 (79.7%) had complete clinical and laboratory data available for analysis. Acute upper respiratory tract infection 284 (41.1%), acute gastroenteritis 127 (18.4%) and pneumonia 100 (14.5%) were the most frequent diagnoses. The geometric mean levels of serum CRP, WBC and ANC were 10.4 (95% CI: 9.2 - 11.8), 11.5 (95% CI: 11.1 - 11.9) and 5.5 (95% CI: 5.2 - 5.8), respectively. CRPd"20, WBCd"15 (103cells/µL) and ANCd"10 103cells/µL) were observed in the majority of the patients with upper respiratory tract infection, pneumonia, acute gastroenteritis and non-specific febrile illness. Only serum CRP levels were positively correlated with positive blood cultures at a calculated cut-off value of 37.3 mg/L, giving a specificity of 77.8% and sensitivity of 74.2%. CONCLUSION: CRP assessment together with IMCI guidelines may be useful in assisting the diagnosis and management of paediatric febrile infections in Tanzania.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Ouchemi Choua, Kimassoum Rimtebaye, Ngueidjo Yamingue, Kalli Moussa, Mignagnal Kaboro [Research] - Aspects des traumatismes ferm&eacute;s de l’abdomen op&eacute;r&eacute;s &agrave; l’H&ocirc;pital G&eacute;n&eacute;ral de R&eacute;f&eacute;rence Nationale de N’Djam&eacute;na (HGRN), Tchad: &agrave; propos de 49 cas - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/50/abstract/ <b>INTRODUCTION: les traumatismes ferm&eacute;s de l’abdomen sont fr&eacute;quents. METHODES: il s’agissait d’une &eacute;tude r&eacute;trospective sur 49 dossiers de patients op&eacute;r&eacute;s pour traumatisme ferm&eacute; de l’abdomen en cinq ans &agrave; l’H&ocirc;pital General de R&eacute;f&eacute;rence Nationale de N’Djam&eacute;na au Tchad. Les param&egrave;tres &eacute;pid&eacute;miologiques, cliniques et th&eacute;rapeutiques &eacute;taient &eacute;tudi&eacute;s. RESULTATS: c’&eacute;taient 42 hommes et 7 femmes d’&acirc;ge moyen de 21,3 ans. Les &eacute;tiologies &eacute;taient: les accidents de la voie publique dans 61,2% des cas; les &eacute;croulements de mur (14,3%); les agressions (8,2%). Les traumatismes ferm&eacute;s de l’abdomen &eacute;taient plus fr&eacute;quents au mois d’Ao&ucirc;t (14,28%) et Octobre (16,32%). Le d&eacute;lai d’admission &agrave; l’h&ocirc;pital &eacute;tait de 6 &agrave; 12h dans 43% des cas. Le moyen d’&eacute;vacuation des bless&eacute;s &eacute;tait une voiture priv&eacute;e dans 85,7% des cas. Cliniquement, l’&eacute;tat h&eacute;modynamique &eacute;tait souvent stable (55,1%). L’imagerie m&eacute;dicale &eacute;tait domin&eacute;e par la radiographie directe de l’abdomen (57,1%). Les l&eacute;sions les plus observ&eacute;es ont &eacute;t&eacute; celles du gr&ecirc;le seul (16,32%) ou associ&eacute;es &agrave; celle de la vessie (8,16%), et de la rate (2,04%). La laparotomie &eacute;tait n&eacute;gative dans 6,12% des cas. La morbidit&eacute; (12,2%) &eacute;tait domin&eacute;e par les abc&egrave;s de paroi. Le taux de d&eacute;c&egrave;s &eacute;tait de 6,1%. CONCLUSION: les accidents de la voie publique sont la premi&egrave;re cause de traumatismes ferm&eacute;s de l’abdomen. Le d&eacute;lai diagnostic et th&eacute;rapeutique est important. Des mesures de s&eacute;curit&eacute; routi&egrave;re devraient pr&eacute;venir les accidents.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Turan Acar1, Erdin&ccedil; Kamer, Nihan Acar, Kemal Atahan, Halis Ba, Mehmet Hac1yanl1, &Ouml;zg&uuml;n Akg&uuml;l [Research] - Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of results between early and late cholecystectomy - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/49/abstract/ <b>INTRODUCTION: laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gallstones. The common opinion about treatment of acute cholecystitis is initially conservative treatment due to preventing complications of inflamation and following laparoscopic cholecystectomy after 6- 8 weeks. However with the increase of laparoscopic experience in recent years, early laparoscopic cholecystectomy has become more common. METHODS: we aimed to compare the outcomes of the patients to whom we applied early or late cholecystectomy after hospitalization from the emergency department with the diagnosis of AC between March 2012-2015. RESULTS: we retrospectively reviewed the files of totally 66 patients in whom we performed early cholecystectomy (within the first 24 hours) (n: 33) and to whom we firstly administered conservative therapy and performed late cholecystectomy (after 6 to 8 weeks) (n: 33) after hospitalization from the emergency department with the diagnosis of acute cholecystitis. The groups were made up of patients who had similar clinical and demographic characteristics. While there were no statistically significant differences between the durations of operation, the durations of hospitalization were longer in those who underwent early cholecystectomy. Moreover, more complications were seen in the patients who underwent early cholecystectomy although the difference was not statistically significant. CONCLUSION: early cholecystectomy is known to significantly reduce the costs in patients with acute cholecystitis. However, switching to open surgery as well as increase of complications in patients who admitted with severe inflammation attack and who have high comorbidity, caution should be exercised when selecting patients for early operation.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Driss Soussi Tanani, Samira Serragui, Sanae Hammi, Latifa Ait Moussa, Abdelmajid Soulaymani, Rachida Soulaymani, Yahia Cherrah [Project evaluation] - National strategy for the integration of pharmacovigilance in the Moroccan TB Control Program - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/48/abstract/ <b>The objective of this work is to demonstrate the interest of integration of pharmacovigilance in Moroccan Tuberculosis Control Program (MTCP). The integration of pharmacovigilance in MTCP was conducted in October 2012with the Global Fund support. We compared the reports notified before and after this integration (period 1: January 2010–October2012; period 2: October 2012–December 2013). The detection of signals was based on the Information Component available inVigiMine. We used the SPSS version 10.0 and Med Calc version 7.3 for data analysis. The average number of spontaneous reports increased from 3.6 to 37.4 cases/month (P< 10-3). The average age was 40.7 ± 17.5 years; the sex ratio was 0.8. Hepatic reactions (32.7%) predominated during the first period, while skin reactions (24.1%) were in the second period (P = 10-4), and40.9% of cases in the first period were serious against 15.8% in second period (P = 0.003). Nine signals were generated (hepaticenzyme increase, cholestasis, jaundice, arthralgia, acne, lower limb edema, pruritus, skin rashes, and vomiting). The integration of pharmacovigilance in Moroccan Tuberculosis Control Program improved the management of ADRs and detected new signals of antituberculosis drugs.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Yogolelo Asani Bienvenu, Musau Nkola Angel, Kabamba Ngombe Leon, Kapalu Mwangala Socrate, Iye Ombamba Kayimba Bruno, Chenge Borasisi Gaby [Case report] - Hyalopathie asteroide: &agrave; propos d’une observation - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/47/abstract/ <b>Nous rapportons un cas d'hyalopathie ast&eacute;ro&iuml;de, rarement d&eacute;crit dans la litt&eacute;rature, chez une personne diab&eacute;tique &acirc;g&eacute;e de 58 ans, de sexe masculin. Cette observation permet d'attirer l'attention des scientifiques sur les pathologies du vitr&eacute; du diab&eacute;tique ainsi que les autres maladies syst&eacute;miques auxquelles la hyalopathie ast&eacute;ro&iuml;de peut &ecirc;tre associ&eacute;e.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Youssef Alaoui Lamrani, Chakib Maaroufi [Images in medicine] - Syndrome d’hypoperfusion distale isch&eacute;mique compliquant une fistule art&eacute;rio-veineuse hum&eacute;ro-c&eacute;phalique - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/46/abstract/ <b>Madame R.G. &acirc;g&eacute;e de 53 ans, h&eacute;modialys&eacute;e pour n&eacute;phropathie ind&eacute;termin&eacute;e a pr&eacute;sent&eacute; 9 ans apr&egrave;s la confection d'une fistule hum&eacute;ro-c&eacute;phalique (FHC) gauche, l'apparition d'une douleur chronique de la main homolat&eacute;rale, associ&eacute;e &agrave; des ulc&eacute;rations n&eacute;crotiques des doigts. Un &eacute;cho-doppler de la FHC a montr&eacute; un hyper-d&eacute;bit &agrave; 1450ml/min, associ&eacute; &agrave; une inversion du flux de l'art&egrave;re hum&eacute;rale en aval de la fistule. Devant les signes montrant un h&eacute;mo-d&eacute;tournement vers le shunt art&eacute;rio-veineux, le diagnostic d'un syndrome de vol vasculaire a &eacute;t&eacute; port&eacute;. La fistule a &eacute;t&eacute; ligatur&eacute;e et un autre shunt art&eacute;rio-veineux a &eacute;t&eacute; r&eacute;alis&eacute; sur le membre controlat&eacute;ral. L'hypo-perfusion isch&eacute;mique distale ou syndrome de vol peut &ecirc;tre le r&eacute;sultat d'une combinaison de l&eacute;sions st&eacute;notiques, d'une art&eacute;riopathie distale, et de l'inversion de flux en aval du shunt. Non pris en charge, ce syndrome peut &eacute;voluer vers la n&eacute;crose digitale, voire la n&eacute;crose de toute la main. Ses principaux facteurs de risque sont les fistules mises au-dessus de la trifurcation brachiale, le sexe f&eacute;minin et le diab&egrave;te. La paresth&eacute;sie, la douleur au repos, la froideur au cours de la dialyse, et l'atrophie musculaire, repr&eacute;sentent des indications formelles pour r&eacute;tablir le flux vers la main souffrante, et &eacute;viter la gangr&egrave;ne digitale. Plusieurs techniques peuvent &ecirc;tre propos&eacute;es pour r&eacute;duire l'hyperd&eacute;bit, entre autres, la technique de DRIL correspondant &agrave; r&eacute;aliser une revascularisation distale par pontage veineux et ligature de l'art&egrave;re en aval de la fistule, une autre technique correspond &agrave; la plicature du segment veineux en aval de la fistule pour r&eacute;duire son d&eacute;bit.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Farid Badri, Hafsa Sajiai, Lamyae Amro [Case series] - Pr&eacute;valence du tabagisme chez le personnel m&eacute;dical et param&eacute;dical du CHU Mohamed VI &agrave; Marrakech - 31 January 2017. http://www.panafrican-med-journal.com/content/article/26/45/abstract/ <b>Le tabagisme est un probl&egrave;me majeur de sant&eacute; publique. Le personnel m&eacute;dical et param&eacute;dical n'est pas &eacute;pargn&eacute; par ce fl&eacute;au. L'interdiction de fumer &agrave; l'h&ocirc;pital est n&eacute;e d'une volont&eacute; gouvernementale de r&eacute;duire le tabagisme passif. L'objectif de cette &eacute;tude &eacute;tait d'&eacute;valuer les habitudes tabagiques chez le personnel soignant m&eacute;dical et param&eacute;dical, afin d'&eacute;laborer une strat&eacute;gie de lutte contre le tabagisme au sein de cette population, et de les adresser &eacute;ventuellement &agrave; la consultation d'aide au sevrage tabagique. L'&eacute;tude transversale descriptive concernant l'ensemble du personnel soignant du CHU de Marrakech en se basant sur la distribution des questionnaires anonymes. Nous avons distribu&eacute; 530 questionnaires dont 380 ont &eacute;t&eacute; r&eacute;cup&eacute;r&eacute;s, soit un taux de r&eacute;ponse de 71,7%. La population d'&eacute;tude &eacute;tait constitu&eacute;e de 58,2% de femmes (n= 221) et de 41,8% d'hommes (n=159). Le personnel m&eacute;dical (n=220) &eacute;tait la cat&eacute;gorie professionnelle la plus repr&eacute;sent&eacute;e (57,9%) suivie des infirmiers (31,8%). Les fumeurs (n = 62) repr&eacute;sentaient 16,3% de notre population d'&eacute;tude; les ex-fumeurs (n=31) 8,1% et les non-fumeurs (n= 287) 75,5%. La moyenne d'&acirc;ge des fumeurs &eacute;tait de 31,1 ans avec des extr&ecirc;mes de 22 &agrave; 56 ans. La pr&eacute;valence du tabagisme &eacute;tait de 16,3% (n=62) de la population d'&eacute;tude dont 32,7% (n=52) chez les hommes contre 4,5 % (n=10) chez les femmes. L'&acirc;ge moyen de d&eacute;but du tabagisme &eacute;tait de 19 ans avec des extr&ecirc;mes de 11 &agrave; 29 ans avec une consommation moyenne de 9 cigarettes/jour. 13% (n=50) des personnes fumaient aussi le narguil&eacute;, 9% (n=34) consommaient de l'alcool et 3% (n=21) des personnes consommaient du Cannabis. 67,7% des fumeurs (n=42) se projetaient d'arr&ecirc;ter de fumer, dont 30,9% (n=13) dans les 3 prochains mois, 52,4% (n=22) dans les prochains 6mois et 16,7% (n=16) se projetaient d'arr&ecirc;ter dans l'ann&eacute;e. Plusieurs activit&eacute;s incitaient les fumeurs &agrave; fumer davantage dont la garde, la pause-caf&eacute;, et les repas dans respectivement 90,3% (n=56), 64,3% (n=40) et 61,3% (n=38) des cas. A la suite de cette enqu&ecirc;te, une r&eacute;flexion doit &ecirc;tre men&eacute;e sur la n&eacute;cessit&eacute; de mener des actions de sensibilisation pour renforcer la motivation de ceux qui d&eacute;sirent arr&ecirc;ter et les aider dans leur d&eacute;marche de sevrage.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Farid Badri, Salma Ait Batahar, Safae El Idrissi, Hafsa Sajiai, Hind Serhane, Lamyae Amro [Case series] - M&eacute;tastases pleuro-pulmonaires des n&eacute;oplasies extra-thoraciques - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/44/abstract/ <b>Les poumons re&ccedil;oivent la totalit&eacute; du drainage veineux du corps expliquant la grande fr&eacute;quence des m&eacute;tastases pleuro-pulmonaires de plusieurs cancers. L'objectif &eacute;tait d'&eacute;tudier les manifestations radio-cliniques des m&eacute;tastases pleuro-pulmonaires des cancers extra-thoraciques. Nous rapportons une &eacute;tude r&eacute;trospective de patients porteurs de m&eacute;tastase pleuro-pulmonaire collig&eacute;s dans notre service entre janvier 2006 et d&eacute;cembre 2014. 76 dossiers ont &eacute;t&eacute; &eacute;tudi&eacute;s. La moyenne d'&acirc;ge &eacute;tait de 50 ans (extr&ecirc;mes allant de 21 ans jusqu'&agrave; 89 ans) avec une pr&eacute;dominance masculine dans 57,8% des cas. La symptomatologie clinique &eacute;tait faite principalement de toux (32,8% des cas), de dyspn&eacute;e (23,7% des cas) et d'h&eacute;moptysie (11,2% des cas). Les cancers primitifs &agrave; l'origine des diff&eacute;rentes m&eacute;tastases pleuro-pulmonaires retrouv&eacute;s dans notre s&eacute;rie sont domin&eacute;s respectivement par le cancer du sein dans 27,6% des cas, les cancers digestifs dans 15,8% des cas, les cancers g&eacute;nitaux dans 9,2% des cas, les sarcomes dans 7,8% des cas, le cancer r&eacute;nal dans 5,2% des cas, le cancer de la vessie dans 5,2% des cas, le cancer de la prostate dans 3,9% cas, les cancers ORL dans 3,9% des cas, les cancers thyro&iuml;diens dans 3,9% des cas, le cancer de la peau dans 2,6% des cas et le cancer primitif d'origine ind&eacute;termin&eacute;e dans 14,4% des cas. Plusieurs aspects radiologiques des m&eacute;tastases pleuro-pulmonaires ont &eacute;t&eacute; retrouv&eacute;s dans notre s&eacute;rie, ils peuvent &ecirc;tre isol&eacute;s ou en association. L'aspect radiologique le plus fr&eacute;quent est celui du l&acirc;cher de ballon pr&eacute;sent dans 52,6% des cas, suivi des pleur&eacute;sies pr&eacute;sentes dans 34,2% des cas, des micronodules diffus pr&eacute;sents dans 23,6% des cas et un nodule unique pr&eacute;sent dans 3,94% des cas. Les cancers secondaires pleuro-pulmonaires sont fr&eacute;quents. Ils viennent en 3&egrave;me position apr&egrave;s les m&eacute;tastases ganglionnaires et h&eacute;patiques et ils sont retrouv&eacute;s dans 30% des autopsies de patients porteurs d'une n&eacute;oplasie.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Abdulateef Elbadawi, Hyder Mirghani [Research] - Depression among HIV/AIDS Sudanese patients: a cross-sectional analytic study - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/43/abstract/ <b>INTRODUCTION: depression and HIV/AIDS are common morbid health problems; the relationship is bidirectional exacerbating each other with deleterious consequences. There are limited studies on this topic in Sudan. In this study, we investigated depression among HIV/AIDS in Sudan. METHODS: a cross-sectional analytic study was conducted among 362 HIV/AIDS patients from three centers in Khartoum, Sudan. Data were collected by the Hospital Depression and Anxiety (HADS) questionnaire. Chi-square was used for testing the significance and a P. Value of &#8805; 0.05 was considered as statistically significant. RESULTS: depression was evident in 332 (63.1%) of patients 68 (19.3%) had mild depression, 114 (32.4%) moderate depression, and 40 (11.4%) severe depression. Depression was commoner among women, illiterate, married/widowed, not receiving counseling, delaying the result of the test, P-value <0.05, no significant differences were found regarding test and treatment type P- Value >0.05. CONCLUSION: depression was prevalent among HIV/AIDS patients, especially females, low level of education, and widowed/married patients, and those not receiving counseling and post diagnosis sessions.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Farouk Hajhouji, Mohammed Lmejjati, Khalid Aniba, Mehdi Laghmari, Houssine Ghannane, Said Ait Benali [Case series] - Foramen magnum meningioma’s management: the experience of the department of neurosurgery in Marrakesh - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/42/abstract/ <b>Our study is a retrospective analysis of the clinical data, surgical outcomes, histological finding and prognosis of foramen magnum meningiomas through a serie of 8 cases operated at the department of neurosurgery at Mohammed VI medical university hospital, Marrakesh. From January 2002 to December 2015. There were 3 male and 5 female patients (mean age, 46.75 years). Cervico-occipital pain (80%) and motor deficit (100%) were the most common presenting symptoms. MRI was the most appropriate diagnostic tool in visualizing tumors of this region. All operations were performed by the posterior approach and gross total resection was achieved in 7 cases. Surgical mortality was 20%. 3 other patients had complications like CSF leak (25%), meningitis (12,5%) and transient worsening of neurological deficit (12.5%) but made neurological recovery later. Foramen magnum meningiomas have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull base exposures, the excision of these lesions is becoming easier and safer.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Adelaide Ogutu Ayoyi, Gideon Kikuvi, Christine Bii, Samuel Kariuki [Research] - Prevalence, aetiology and antibiotic sensitivity profile of asymptomatic bacteriuria isolates from pregnant women in selected antenatal clinic from Nairobi, Kenya - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/41/abstract/ <b>INTRODUCTION: asymptomatic bacteriuria (ASB) is the presence of bacteria in urine without apparent symptoms of urinary tract infections. The importance of asymptomatic bacteriuria lies in the insight it provides into symptomatic infections. To determine prevalence, bacterial isolates and Antibiotic Sensitivity Profile of asymptomatic bacterial urinary tract infection in pregnant women in selected clinics in Nairobi. METHODS: this was a cross-sectional study involving women attending antenatal clinic at selected clinics of Nairobi County. The women who met the inclusion criteria were included in the study. The midstream urine samples of these women were subjected to microscopy, culture and sensitivity. RESULTS: a total of 1020 of women on their first antenatal clinic visit participated in the study; 219 of them had ASB, giving a prevalence of 21.5% at 95% confidence level Escherichia coli were the common organism isolated at 38.8%. The majority of the organisms were sensitive to imipenem and gentamycin. CONCLUSION: there is a high prevalence of ASB among pregnant women included in the study from the Nairobi county clinics. Therefore, routine ASB screening of pregnant women is recommended among the women attending antennal clinics in Nairobi county clinics.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Djibril Marie Ba, Mouhamed Cherif Mboup, Nafissatou Zeba, Khadidiatou Dia, Awa Ndaw Fall, Fatou Fall, Pape Diadie Fall, Sara Boury Gning [Case series] - Infective endocarditis in Principal Hospital of Dakar: a retrospective study of 42 cases over 10 years - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/40/abstract/ <b>Infective Endocarditis (IE) is an endocardial infection usually caused by bacteria that affects not only the native heart valves but also,with increasing frequency intravascular implanted devices and congenital heart diseases. Despite medical advances, IE remains a life-threatening disease with substantial morbidity and mortality. In Africa, its diagnosis and treatment are still a major challenge in clinical practice. The objective of this work was to study the epidemiological, clinical features,diagnostic techniques currently used in medical practice and the range of micro-organisms that are responsible. This was a retrospective study done at Principal Hospital of Dakar. We include all patients who were admitted with clinical manifestations of definite or possible IE according to the extended DUKE criteria between January 1st, 2005 and December 31st, 2014. We collected and analyzed epidemiological, clinical, paraclinical and outcomes data of 42 patients. Hospital prevalence of IE was 0.078% (42/53711). The mean age was 27.5+/- 18 years with a sex ratio (M/F) of 0.55. IE were more common in patients with damaged or abnormal heart valves (78.6%) and in thoses with underlying structural defects (14.3%). The most common presenting symptoms were fever (90%) and cardiac murmurs (81%). Extracardiac clinical manifestations were very rare. The usual laboratory parameters of inflammation were elevated in 90% of patients. Blood cultures were negative in 50% of cases and positive in 21.4%. The main organism found was Staphylococcus aureus. Echocardiography found vegetations in 95.2% of cases, chamber enlargement in 73.8% and mitral regurgiation in 83.3%. Broad-spectrum penicillins including ampicillin and gentamycine were used for all patients. Major complications were heart failure (47.6%). Strokes and cerebral abcess (23.8%) and Vascular emboli 14.3%. Hospital mortality was 31%. IE remains a life-threatening disease with hight mortality despites improved techniques of diagnosis and modern antibiotics.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Zeineb Alaya, Walid Osman [Images in medicine] - Monoarthrite du genou r&eacute;v&eacute;latrice d’une arthropathie tab&eacute;tique - 30 January 2017. http://www.panafrican-med-journal.com/content/article/26/39/abstract/ <b>Il s’agit d’un patient &acirc;g&eacute; de 53 ans, qui a consult&eacute; pour une monoarthrite du genou droit &eacute;voluant depuis 6 mois sans fi&egrave;vre, associ&eacute; &agrave; un syndrome inflammatoire biologique. La ponction articulaire a ramen&eacute; un liquide inflammatoire st&eacute;rile. Les radiographies du genou de face ( A) et de profil (B) et la TDM du genou (C et D) ont montr&eacute; une destruction du condyle f&eacute;moral interne avec une ost&eacute;olyse du rebord m&eacute;dial du plateau tibial interne associ&eacute; &agrave; de multiples constructions osseuses avec pr&eacute;sence de fragments intra-articulaires, d’un &eacute;panchement intra-articulaire et d’un &eacute;paississement de la synoviale. Le diagnostic d'arthropathie tab&eacute;tique dans sa forme hypertrophique a &eacute;t&eacute; retenu devant un ant&eacute;c&eacute;dent de chancre d’inoculation syphilitique datant de 20 ans, un syndrome radiculocordonal post&eacute;rieur, les donn&eacute;es de l’imagerie et une s&eacute;rologie syphilitique (TPHA-VDRL) positive dans le sang et le LCR. Le patient a &eacute;t&eacute; trait&eacute; par p&eacute;nicilline G (24 millions/j) pendant 15 jours. Plus fr&eacute;quent chez l'homme que chez la femme, le tab&egrave;s, devenu exceptionnel, se d&eacute;couvre tardivement vers 50 ou 60 ans. L'arthropathie tab&eacute;tique est une affection neurog&egrave;ne destructrice secondaire &agrave; l'infection par le tr&eacute;pon&egrave;me. Elle concerne 4 &agrave; 10% des tab&eacute;tiques. Le genou est l'articulation la plus souvent atteinte. Les formes de d&eacute;but souvent m&eacute;connues miment une gonarthrose banale. L'aspect habituel r&eacute;alise une forme hypertrophique. Le traitement de l'arthropathie tab&eacute;tique est essentiellement m&eacute;dical bas&eacute; sur la p&eacute;nicilline G.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Mary-Theresa Agutu, Julliette Ongus, Janeth Kombich, Rose Kamenwa, Jim Nyagao, John Kagira, Adelaide Ayoyi Ogutu, Austin Bitek [Research] - Prevalence and genetic diversity of rotavirus infection in children with acute gastroenteritis in a hospital setting, Nairobi Kenya in post vaccination era: a cross-sectional study - 24 January 2017. http://www.panafrican-med-journal.com/content/article/26/38/abstract/ <b>INTRODUCTION: rotavirus is the leading cause of severe diarrhoea among infants and young children. Each year more than 611 000 children die from rotavirus gastroenteritis, and two million are hospitalized, worldwide. In Kenya, the impact of recent rotavirus vaccinations on morbidities has not been estimated. The study aimed at determining the prevalence and identity of rotavirus strains isolated from rotavirus-associated diarrhoea in vaccinated children presenting with acute gastroenteritis. METHODS: two hundred and ninety eight specimen from children presented at Gertrude Childrens’ Hospital from January to June 2012 were tested by EIA (Enzyme-linked Immunosorbent Assay) for rotavirus antigens. Molecular characterization was conducted on rotavirus-positive specimens. Extracted viral RNA was separated by polyacrylamide gel electrophoresis (PAGE) and the specific rotavirus VP4 (P-types) and VP7 (G-types) determined. RESULTS: the prevalence rate of rotavirus was 31.5% (94/298). Of the rotavirus dsRNA, 57 (60.1%) gave visible RNA profiles, 38 (40.4%) assigned long electropherotypes while 19 (20.2%) were short electropherotypes. The strains among the vaccinated were G3P [4], G12P [6], G3P [6], G9P [4], G mixed G9/3P [4] and G1/3P [4]. Specifically, the G genotypes were G9/3 (5.3%), G9 (4.3%), G3 (4.3%), G12 (2.1%) and mixed G1/3 (1.1%). The P genotypes detected were P [4] (5.3%) and P [6] (5.3%). CONCLUSION: the present study demonstrates diversity in circulating genotypes with emergence of genotypes G3, G9, G12 and mixed genotypes G9/3 and recommends that vaccines should be formulated with a broad range of strains to include G9 and G12.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Brandon Talley, Katherine Masyn, Rachna Chandora, Alana Vivolo-Kantor [Research] - Multilevel analysis of school anti-smoking education and current cigarette use among South African students - 24 January 2017. http://www.panafrican-med-journal.com/content/article/26/37/abstract/ <b>INTRODUCTION: South Africa (SA) implemented the Global Youth Tobacco Survey (GYTS) four times between 1999 and 2011. Data from the four surveys indicated that downward trends in cigarette use among students may have stalled. Understanding the effect of school anti-smoking education on current smoking among students within schools and variability across schools may provide important insights into policies aimed at preventing or reducing tobacco use among students. Objective were to assess the student- and school-level effects of students’ exposure to school anti-smoking education on current cigarette use among the study population using the most recent wave of GYTS data in SA (2011). METHODS: an analytic sample of students 13-15 years of age was selected (n=3,068) from the SA GYTS 2011. A taxonomy of two-level logistic regression models was fit to assess the relationship of various tobacco use, control, and exposure predictor variables on current cigarette smoking among the study population. RESULTS: at the student-level in the full model, secondhand smoke (SHS) exposure, peer smoking, and ownership of a promotional item were significantly associated with higher risk of current smoking. At the school-level in the full model, average exposure to peer smoking was associated with significant increases in the prevalence of current cigarette use, while average family anti-smoking education was significantly associated with decreases in the outcome variable. School anti-smoking education was not a statistically significant predictor at the student- or school-levels. CONCLUSION: in this study, exposure to school anti-smoking education had no association with current cigarette smoking among the study population. Consistent with previous studies, having peers that smoked was highly associated with a student being a current smoker. Interestingly, at the school-level in the multilevel analysis, schools with higher rates of average family anti-smoking education had lower prevalence of current smoking. This finding has potential implications for tobacco control in SA, particularly if the school-level, family-centered protective effect can be operationalized as a prevention tool in the country’s tobacco control program.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Guleser Akpinar, Ali Duman, Bedia Gulen, Mucahit Kapci, Ertugrul Altinbilek, Ibrahim Ikizceli [Research] - Role of H-FABP values in determining the etiologic factors of the cardiac injuries - 24 January 2017. http://www.panafrican-med-journal.com/content/article/26/36/abstract/ <b>INTRODUCTION: cardiac injury resulting from blunt thoracic trauma is a frequent clinical occurrence which is difficult to diagnose. Our purpose in this study was to research whether H-FABP, which is a new marker for the diagnosis of cardiac injury, can be used in this patient group. METHODS: 50 patients with blunt thoracic injury who were admitted to our emergency service within a period of 8 months and 50 cases as controls were included in our study.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Nivash Rugbeer, Serela Ramklass, Andrew Mckune, Johan van Heerden [Research] - The effect of group exercise frequency on health related quality of life in institutionalized elderly - 24 January 2017. http://www.panafrican-med-journal.com/content/article/26/35/abstract/ <b>INTRODUCTION: Introduction: the study aimed to determine the effect of group exercise frequency on health related quality of life in institutionalized elderly. METHODS: one hundred participants were recruited for voluntary participation from five aged care facilities, with inclusion being based on the outcome of a medical assessment by a sports physician. RESULTS: a significant difference was noted in social function post training twice (MD = -13.85, 95% CI [-24.66, -3.38], p = 0.017, d = 0.674) and thrice (MD = -13.30, 95% CI [-21.81, -5.59], p = 0.003, d = 0.712) a week. Training thrice a week provided an additional benefit in vitality (MD = -7.55, 95% CI [-13.16, -1.91], p = 0.018,d =0. 379). Improvements in mental component summary scale post training twice (MD = -4.08, 95% CI [-7.67, -0.42], p = 0.033, d = 0.425) and thrice (MD = -6.67, 95% CI [-10.92, -2.33], p = 0.005, d = 0.567) a week was further noted. CONCLUSION: mental health and social health benefits can be obtained irrespective of exercise frequency 2X/week or 3X/week.The exercise intervention at a frequency of thrice a week was more effective in improving mental component summary due to a larger effect size obtained compared to the exercise frequency of twice a week. Additional benefits in vitality wasachieved by exercising 3X/week. This may assist the elderly in preserving their independence. </b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com B&eacute;kaye Traor&eacute;, Youssouf Fofana [Images in medicine] - Pyoderma gangrenosum du cuir chevelu: &agrave; propos d’un cas - 24 January 2017. http://www.panafrican-med-journal.com/content/article/26/34/abstract/ <b>Le pyoderma gangrenosum (PG) est une dermatose inflammatoire chronique rare caractérisé par des ulcérations chroniques stériles et récurrentes. Il reste un diagnostic d’exclusion de toutes les autres affections pustulo-ulcéreuses notamment infectieuses. Il est associé dans deux tiers des cas à des affections morbides variées, qui peuvent révéler la maladie. La localisation au cuir chevelu est exceptionnelle et pose un véritable problème de prise en charge. Nous rapportons un cas qui a bien répondu à l’auto greffe cutanée. Il s’agissait d’une patiente de 49 ans aux antécédent de deux cures de myome (2001), qui présentaient depuis 6 mois une ulcération céphalique de 20/15 cm à bordure régulière, légèrement décollée, la pression était douloureuse et faisait sourdre du pus, le fond était peu creusant rouge et nauséabonde. Ailleurs le reste de l’examen clinique était normal. L’ulcération post fasciite nécrosante, le lupus discoïde dégénéré et le pyoderma gangrenosum furent évoquées comme hypothèses diagnostiques. Les examens complémentaires ont montré une anémie microcytaire hypochrome, une sérologie rétrovirale positive à VIH1, un taux de CD4 à 150/mm3, le prélèvement du pus a retrouvé le Staphylococcus Aureus. Le reste du bilan biologique était normal. La patiente n’était pas consentante pour la biopsie. Un traitement antiseptique, antibiotique conformément à l’antibiogramme et antalgique fut instauré pendant deux semaines sans succès après la trithérapie. Le diagnostic de pyoderma gagrenosum fut évoqué, un traitement à base de thalidomide 200mg (400mg par jour). Après un mois le pus et le suintement ont taris. Nous avons effectué trois séances d’auto greffe en pastille. La cicatrisation était obtenue en deux mois. </b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Abdelmonem Ghorbel [Images in medicine] - Cystic lymphangioma in a 44-year-old woman - 23 January 2017. http://www.panafrican-med-journal.com/content/article/26/33/abstract/ <b>Cystic lymphangioma is a congenital malformation of the lymphatic system. This condition is usually observed among children and very rarely among adults. The aetiology in adults is likely dueto delayed proliferation of cell rests due to physical injury or infection. Clinically, cystic lymphangioma is asymptomatic in adults. Treatment is generally surgical, although other methods, such as aspiration, radiation and sclerotherapy have been used. We report a case of a 44-year-old woman presented with one-year history of slowly enlarging cervical swelling at the right side of the neck. The patient has no medical problems or history of trauma to the neck. Examination showed a 4 cm smooth, soft swelling of right supraclavicular fossa. Moreover, there was no erythema or tenderness on palpation. The general examination revealed normal findings. Computed tomography (CT) showed a supraclavicular cyst-like structure of 5×3×3 cm. The patient was operated through an external approach and a complete cyst excision was achieved without complications. Histopathological examination was consistent with the diagnosis of cystic lymphangioma. The patient made an uneventful recovery with no recurrence noted one year after the surgery. </b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hicham Eddou, Ali Zinebi, Abdelaziz Khalloufi, Mohammed Sina, Mehdi Mahtat, Kamal Doghmi, Mohammed Mikdame, Mohammed Karim Moudden, Mohammed El Baaj [Case report] - Un purpura thrombop&eacute;nique am&eacute;gacaryocytaire acquis qui cache une leuc&eacute;mie aigue my&eacute;loblastique - 23 January 2017. http://www.panafrican-med-journal.com/content/article/26/32/abstract/ <b>Le purpura thrombop&eacute;nique am&eacute;gacaryocytaire acquis est une pathologie tr&egrave;s rare caract&eacute;ris&eacute; par une thrombop&eacute;nie s&eacute;v&egrave;re li&eacute;e une r&eacute;duction ou une disparition des m&eacute;gacaryocytes au niveau de la moelle osseuse. Il peut &ecirc;tre primaire idiopathique ou secondaire &agrave; de nombreux &eacute;tats pathologique dont des h&eacute;mopathies. Nous rapportons le cas d'un patient de 24 ans admis pour prise en charge d'un syndrome h&eacute;morragique mis sur le compte d'un purpura thrombop&eacute;nique immunologique. Le diagnostic a &eacute;t&eacute; redress&eacute; en une am&eacute;gacaryocytose aquise apr&egrave;s un &eacute;chec de la corticoth&eacute;rapie et la r&eacute;alisation d'un my&eacute;logramme. Le patient a &eacute;t&eacute; mis sous traitement par ciclosporine avec une &eacute;volution rapide vers une leuc&eacute;mie aigue my&eacute;loblastique. La progression d'une am&eacute;gacaryocytose acquise vers une leuc&eacute;mie aigue est rapport&eacute; mais g&eacute;n&eacute;ralement pas aussi rapidement et surtout pr&eacute;c&eacute;der par un syndrome my&eacute;lodysplasique ou une aplasie m&eacute;dullaire. Cette observation impose un suivi strict et rapproch&eacute; de ces pathologies d'apparence b&eacute;nigne.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Pauline Diouss&eacute;, Fatimata Ly, Mariama Bammo, Sarah Lizia, Thierno Abdoul Aziz Diallo, Haby Dione, Fatou Sarr, Ramatoulaye Diagne Gueye, Amadou Mactar Gueye, MameThiernoDieng, Bernard Marcel Diop, Mamadou Mourtalla Ka [Case report] - Pityriasis versicolor chez des nourrissons: aspect clinique inhabituel et r&ocirc;le de la d&eacute;pigmentation cosm&eacute;tique par des cortico&iuml;des chez la m&egrave;re - 23 January 2017. http://www.panafrican-med-journal.com/content/article/26/31/abstract/ <b>Nous rapportons deux observations de Pityriasis versicolor (PV) chez des nourrissons &acirc;g&eacute;s de 12 etde 18 mois. Ces derniers &eacute;taient amen&eacute;s en consultation pour des macules hypochromiques et achromiques, rondes, localis&eacute;es aux membres et sur le visage. On retrouvait une notion de d&eacute;pigmentation volontaire &agrave; vis&eacute;e cosm&eacute;tique &agrave; base de cortico&iuml;des et d’hydroquinone chez leur m&egrave;re depuis en moyenne 5 ans. Le scotch test effectu&eacute; chez un des nourrissons et sa m&egrave;re montrait de courts filaments et des grappes de spores. Le traitement &eacute;tait &agrave; base de k&eacute;toconazole. Apr&egrave;s 8 semaines, l’&eacute;volution &eacute;tait favorable chez tous les patients avec cependant une persistance de quelques macules hypochomiques. Les particularit&eacute;s de nos observations sont d’une part la topographie aux membres inf&eacute;rieurs et d’autre part le caract&egrave;re familial du PV dont la survenue est favoris&eacute;e par l’usage de produits d&eacute;pigmentant &agrave; base de cortico&iuml;des. Ces derniers favorisent le caract&egrave;re atrophique et achromique des l&eacute;sions. En effet, les formes achromiques des membres inf&eacute;rieurs &eacute;taient d&eacute;crites chez les adultes s’adonnant &agrave; la d&eacute;pigmentation artificielle.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Lofty-John Anyanwu, Aminu Mohammad, Habeeb Muhammad, Ibrahim Aliyu, Lawal Abdullahi, Aliyu Farinyaro, Abdulkarim Iya [Case report] - Schinzel-Giedion syndrome: a case with sacrococcygeal teratoma and cor-triatriatum dexter - 23 January 2017. http://www.panafrican-med-journal.com/content/article/26/30/abstract/ <b>Schinzel-Giedion syndrome which is associated with midfacial hypoplasia and coarse dysmorphic features is a multiple congenital malformation syndrome. It is believed that risk of malignancy may be a component of the anomaly. We report herein a case of a 16 months old boy with SGS associated with sacrococcygeal teratoma and cor-triatriatum dexter. Histopathology report of the excised sacrococcygeal mass showed no malignant foci. He was however lost to follow up in the second week post-operation.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Said Anajar, Mohammed Moutaa Tatari, Jawad Hassnaoui, Sami Rouadi, Reda Abada, Mohammed Roubal, Mohammed Mahtar [Case report] - Carcinome vesiculaire sur thyro&iuml;de linguale: cas rare - 23 January 2017. http://www.panafrican-med-journal.com/content/article/26/29/abstract/ <b>La thyro&iuml;de linguale est secondaire &agrave; l'absence de migration de l'&eacute;bauche thyro&iuml;dienne. Cette derni&egrave;re se d&eacute;veloppe sur place, c'est-&agrave;-dire au niveau du foramen caecum. Elle peut repr&eacute;senter le seul tissu thyro&iuml;dien retrouv&eacute;, ou &ecirc;tre en association avec une thyro&iuml;de normale. La survenue d'un carcinome sur une thyro&iuml;de linguale constitue une situation exceptionnelle avec seulement une trentaine de cas d&eacute;crits dans la litt&eacute;rature. Nous rapportons a travers notre observation un cas de carcinome v&eacute;siculaire survenu sur thyro&iuml;dien lingual.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Moncef Sellami, Abdelmonem Ghorbel [Images in medicine] - Une polypose naso-sinusienne r&eacute;v&eacute;lant une mucoc&egrave;le du sinus maxillaire - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/28/abstract/ <b>La mucoc&egrave;le est une formation pseudo kystique b&eacute;nigne qui se d&eacute;veloppe rarement au niveau du sinus maxillaire. La mucoc&egrave;le est secondaire &agrave; des situations diverses ayant en commun une inflammation et une obstruction de l’ostium du sinus. Cette derni&egrave;re peut &ecirc;tre primitive mais souvent secondaire &agrave; un (traumatisme, tumeur, inflammation chronique). Le diagnostic repose sur l’imagerie. La tomodensitom&eacute;trie est indispensable pour appr&eacute;cier les modifications osseuses et planifier la chirurgie endonasale sous contr&ocirc;le endoscopique et l’IRM permet de pr&eacute;ciser les rapports de la mucoc&egrave;le. La prise en charge th&eacute;rapeutique de ces mucoc&egrave;les doit dans un m&ecirc;me temps op&eacute;ratoire r&eacute;aliser une marsupialisation de la mucoc&egrave;le et traiter le facteur local en cause. Nous rapportons le cas d’un homme &acirc;g&eacute; de 21 ans, sans ant&eacute;c&eacute;dents pathologiques notables qui consultepour obstruction nasale bilat&eacute;rale associ&eacute;e &agrave; une anosmie. L’examen clinique a trouv&eacute; une douleur exquise de la paroi ant&eacute;rieure du sinus maxillaire, une polypose nasosinusienne bilat&eacute;rale et une voussure au niveau du palais osseux. La tomodensitom&eacute;trie du massif facial a permis de mettre en &eacute;vidence une masse hypodense homog&egrave;ne bien limit&eacute;e ne prenant pas le produit de contraste comblant tout le sinus maxillaire gauche associ&eacute;e &agrave; une lyse osseuse r&eacute;guli&egrave;re de ses parois associ&eacute; &agrave; un comblement &eacute;thmo&iuml;do-nasal bilat&eacute;ral. Le patient a &eacute;t&eacute; op&eacute;r&eacute; par voie endonasale et a eu une &eacute;tho&iuml;dectomie fonctionnelle associ&eacute;e &agrave; un abord du sinus maxillaire par m&eacute;atotomie moyenne permettant la marsupialisation de la mucoc&egrave;le. Les suites op&eacute;ratoires &eacute;taient simples sans r&eacute;cidive.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Yonas Asfaw, Isaac Boateng, Mauricio Calderon, Grazia Caleo, Allan Conteh, Salifu Conteh, Foday Dafae, Achintya Dey, Nadia Duffy, Daffney Davies, Patrick Fatoma, John Fleming, Boima Gogra, Yelena Gorina, Anna Grigoryan, Sara Hersey, Sam Hoare, Sonnia-Magba Bu-Buakei Jabbi, Amara Jambai, Joseph Jasperse, Reinhard Kaiser, Gandi Kallon, Ansumana Kamara, Fatmata Zara Kamara, Isata Pamela Kamara, Wogba Kamara, Joseph Kandeh, Mustapha Kanu, Mabinty Kargbo, Samuel Kargbo, Richard Konie, Simeon Kuyembeh, Patrick Lansana, Fiona Mclysaght, Sheena McCann, Alhaji Samuka Nallo, Stephanie Ngai, Erin Nichols, Charles Njuguna, Shikanga O-Tipo, Sulaiman Parker, Nuzhat Rafique, John Redd, Thomas Samba, Kerry Souza, Alex Tran, Chief Mathew Gibao Younge [Meeting report] - Interagency technical consultation on improving mortality reporting in Sierra Leone: meeting report - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/27/abstract/ <b>By the end of the Ebola epidemic, death reporting in Sierra Leone (SL) became more acceptable amongst local populations, with nearly all deaths being reported to the Ebola hot line alert centers. To continue the positive momentum generated by the epidemic, the Sierra Leone Ministry of Health and Sanitation (MoHS) and the US Centers for Disease Control and Prevention (CDC) organized and conducted the two-day Inter-agency Consultations on Improving Mortality Reporting in Sierra Leone (Consultations). In conjunction with the Consultations, participants were also offered a one-day, in-person training on the major components, characteristics, and uses of a national Civil Registration and Vital Statistics (CRVS) system. To understand processes used by governmental and non-governmental organizations in collection of death data before and during the Ebola epidemic, and to develop recommendations on improving death reporting and CRVS in Sierra Leone. The Inter-agency Consultations were conducted in person over two days in October, 2015. Real-time notes were kept by CDC staff for later abstraction and summarizing. Presenters agreed to share their materials (usually PowerPoint presentations) and approved the summaries. Challenges to implementation and suggestions for improving death reporting were drawn from the presentations and from anonymous suggestions collected at the end of each of three days of the Consultations. The Consultations attracted more than 80 participants from 28 Sierra Leone governmental, business, and other non-governmental organizations. Over the course of 18 presentations, participants presented and discussed the ways deaths were reported before and during the Ebola epidemic and ways in which the CRVS in Sierra Leone might be improved. The presentations made clear the need to improve death reporting in order to improve the health status of Sierra Leone. Many presenters and participants discussed the challenges to improvements, including lack of infrastructure and country diversity. In addition, participants generally agreed upon the need for improving the government’s understanding of the benefits of death reporting at multiple levels: from local chiefdom authorities and councils to the community and individual families. Despite the many challenges identified, all participants stressed the need for modernizing and improving death registration in Sierra Leone. The recommendations from the presentations and notes collected at the end of each day can be categorized within the following five domains: capacity building (organizational, staffing, infrastructure, policies, guidelines and tools), awareness and sensitization (including strategies to use best practices and emerging technologies), political will (governmental support and prioritization), funding (providing resources to achieve sustainability), and monitoring and evaluation (developing charts of existing death reporting pathways and identifying challenges).</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Dimitri Mbethe, Said Moudouni, Zacharia Dahami, Mohamed, Amine Lakmichi, Ismael Sarf [Case report] - L&eacute;iomyosarcome v&eacute;sical trait&eacute; par cystectomie laparoscopique avec ent&eacute;rocystoplastie de remplacement: &agrave; propos d’un cas - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/26/abstract/ <b>Notre travail vise &agrave; rapporter un nouveau cas de l&eacute;iomyosarcome v&eacute;sical qui est une tumeur rare, et proposer une nouvelle approche th&eacute;rapeutique compte tenu du caract&egrave;re non consensuel de son traitement, cela &agrave; travers l'observation d'une patiente &acirc;g&eacute;e de 31 ans, sans ant&eacute;c&eacute;dent particulier, ayant consult&eacute; pour h&eacute;maturie totale caillotante. Le bilan clinique et paraclinique, mettait en &eacute;vidence une volumineuse masse tumorale solide occupant le d&ocirc;me v&eacute;sical et s'&eacute;tendant &agrave; la paroi lat&eacute;rale droite, d'allure infiltrante, sans envahissement ganglionnaire ou organique local ou &agrave; distance. Notre prise en charge chirurgicale a consist&eacute; en une cystectomie totale par voie coelioscopique, avec ent&eacute;rocystoplastie de remplacement. Les suites op&eacute;ratoires ont &eacute;t&eacute; simples. Les contr&ocirc;les radiologiques effectu&eacute;s &agrave; 3, 6, 12 et 24 mois ne montraient aucune r&eacute;cidive. Ainsi, une chirurgie adapt&eacute;e peut &ecirc;tre propos&eacute;e selon les cas de figure, en vue d'am&eacute;liorer la qualit&eacute; de vie des patients pr&eacute;sentant cette affection.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Andriatsihoarana Voahary Nasandratriniavo Ramahandrisoa, Nomeharisoa Rodrigue Emile Hasiniatsy, Val&eacute;ry Refeno, Clairette Raharisolo Vololonantenaina, Andriamihaja Jean Claude Rakotoarisoa, Hanitrala Jean Louis Rakotovao, Florine Rafaramino [Case report] - Carcinome neuroendocrine thymique: &agrave; propos d’un cas et revue de la litt&eacute;rature - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/25/abstract/ <b>Les tumeurs neuroendocrines thymiques (TNET) sont rares, de pronostic mal connu. L'objectif est de rapporter un cas de TNET et discuter la difficult&eacute; diagnostique et th&eacute;rapeutique en milieu &agrave; faibles ressources. Un homme de 60 ans pr&eacute;sentait une douleur thoracique, une toux grasse et un amaigrissement r&eacute;cent. Le scanner thoracique r&eacute;v&eacute;lait une masse tissulaire m&eacute;diastinale ant&eacute;rieure. L'histologie d&eacute;finitive obtenue quatre mois apr&egrave;s la biopsie par m&eacute;diastinotomie ant&eacute;rieure montrait une TNET bien diff&eacute;renci&eacute;e, avec marquage intense &agrave; la chromogranine et &agrave; la synaptophysine. La recherche d'autres tumeurs neuroendocrines et le bilan d'extension &eacute;taient n&eacute;gatifs. La tumeur &eacute;tait inextirpable d'embl&eacute;e et la radioth&eacute;rapie indisponible. Le patient a re&ccedil;u deux lignes de chimioth&eacute;rapie premi&egrave;re. Avec un recul de 16 mois, le patient &eacute;tait asymptomatique, mais en progression tumorale. Le diagnostic de TNET peut &ecirc;tre retard&eacute; quand l'examen immunohistochimique n'est pas r&eacute;alis&eacute; en routine. La chimioth&eacute;rapie apporte une am&eacute;lioration des sympt&ocirc;mes en situation palliative.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hafsae Bounniyt, Badredine Hassam [Images in medicine] - Une tumeur rare de la cuisse - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/24/abstract/ <b>Les synovialosarcomes sont des tumeurs rares, elles repr&eacute;sentent pr&egrave;s de 10% des sarcomes des tissus mous. Nous rapportons le cas d’un synovialosarcome mimant un botriomycome. Une jeune femme de 33 ans, qui s’est pr&eacute;sent&eacute;e avec une tum&eacute;faction l&eacute;g&egrave;rement douloureuse de la racine du membre inf&eacute;rieur gauche augmentant rapidement de volume. L’examen clinique trouvait une tumeur bourgeonnante, saignant au contact, &agrave; contours irr&eacute;guliers, mesurant 6 cm de grand axe. La patiente &eacute;tait en bon &eacute;tat g&eacute;n&eacute;ral et l’examen clinique &eacute;tait normal par ailleurs. Un diagnostic de botriomycome ou de granulome pyog&eacute;nique a &eacute;t&eacute; &eacute;voqu&eacute;, mais la biopsie ex&eacute;r&egrave;se de la tumeur avec &eacute;tude immunohistochimique ont &eacute;t&eacute; en faveur d’un synovialosarcome peu diff&eacute;renci&eacute; de garde 2 FLNCC. Une reprise chirurgicale carcinologique a &eacute;t&eacute; r&eacute;alis&eacute;e dans un service de chirurgie oncologique avec des marges de 2 cm sur tous les plans. Un bilan d’extension fait d’une IRM locale, &eacute;chographie ganglionnaire et une tomodensitom&eacute;trie thoraco-abdomino-pelvienne &eacute;tait n&eacute;gatif. L’&eacute;volution &eacute;tait favorable, sans r&eacute;cidives avec un recul de 2 ans.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Mamadou Ngon&eacute; Gueye, Gnagna Diouf, Daouda Dia, Awa Boye, Thierno Fall, Jean Louis Di&eacute;m&eacute;, Oumar Ba, Mouhamadou Mbengue [Case report] - M&eacute;tastase costale r&eacute;v&eacute;lant un carcinome &eacute;pidermo&iuml;de de l’œsophage - 18 January 2017. http://www.panafrican-med-journal.com/content/article/26/23/abstract/ <b>Le cancer de l'œsophage est une tumeur de mauvais pronostic. Sa gravit&eacute; est li&eacute;e au retard de diagnostic qui se fait le plus souvent au stade de m&eacute;tastase en Afrique. Les m&eacute;tastases costales de ce cancer sont rares. Nous rapportons un cas de carcinome &eacute;pidermo&iuml;de du bas œsophage avec m&eacute;tastases costales lytiques chez une patiente s&eacute;n&eacute;galaise de 38 ans. Il s’agissait de madame TD, &acirc;g&eacute;e de 38 ans admise pour une tum&eacute;faction douloureuse de l’h&eacute;mithorax droit dans un contexte d’amaigrissement. La patiente signalait par ailleurs une dysphagie d’allure m&eacute;canique &eacute;voluant depuis 4 mois qui n’avait pas motiv&eacute; de consultation. L’examen objectivait un mauvais &eacute;tat g&eacute;n&eacute;ral, une tum&eacute;faction dure, sensible mesurant 3 cm de grand axe, si&eacute;geant sur la face ant&eacute;rolat&eacute;rale de l’h&eacute;mithorax droit en regard de la 5&egrave;me c&ocirc;te. Les examens biologiques mettaient en &eacute;vidence une an&eacute;mie normochrome normocytaire avec un taux d’h&eacute;moglobine &agrave; 9,4 g/dl, un syndrome inflammatoire biologique non sp&eacute;cifique et une hypercalc&eacute;mie (calc&eacute;mie corrig&eacute;e= 107 mg/l). L’endoscopie oeso-gastroduod&eacute;nale objectivait une l&eacute;sion ulc&eacute;ro bourgeonnante st&eacute;nosante &agrave; 32 cm des arcades dentaires. L’examen anatomopathologique des biopsies mettait en &eacute;vidence un carcinome &eacute;pidermo&iuml;de moyennement diff&eacute;renci&eacute;. La tomodensitom&eacute;trie thoraco-abdomino pelvienne montrait en plus de la tumeur œsophagienne, une lyse osseuse de l’arc ant&eacute;rieure de la 5&egrave;me c&ocirc;te, des nodules pulmonaires carcinomateuses et un &eacute;panchement pleural bilat&eacute;ral. La ponction exploratrice du liquide pleural ramenait un liquide s&eacute;roh&eacute;matique et l’examen cytologique de ce liquide objectivait des cellules carcinomateuses. Le diagnostic de carcinome &eacute;pidermo&iuml;de du bas œsophage avec m&eacute;tastases costales, pleurales et pulmonaires &eacute;tait retenu et un traitement palliatif instaur&eacute;. L’&eacute;volution &eacute;tait marqu&eacute;e par le d&eacute;c&egrave;s de la patiente survenu 3 mois apr&egrave;s la r&eacute;alisation de la gastrostomie, dans un tableau de d&eacute;tresse respiratoire. L’originalit&eacute; de cette observation tient au si&egrave;ge atypique des m&eacute;tastases de ce cancer de l’œsophage; mais aussi le terrain de survenue de cette tumeur. Le cancer de l’œsophage du sujet jeune est un probl&egrave;me majeur en Afrique. Le challenge est de d&eacute;terminer ses facteurs de risque afin de pr&eacute;venir sa survenue.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hicham Kechna, Karim Nadour, Omar Ouzzad, Khalid Chkoura, Faical Choumi, Jaouad Loutid, Mohamed Moumine, Moulay Ahmed Hachimi [Research] - Gestion des voies a&eacute;riennes sup&eacute;rieures et cellulite cervico-faciale - 17 January 2017. http://www.panafrican-med-journal.com/content/article/26/22/abstract/ <b>INTRODUCTION: la cellulite maxillo faciale est urgence m&eacute;dico chirurgicale. Ces patients sont le plus souvent pris en charge au bloc op&eacute;ratoire d’une part pour la mise &agrave; plat et le drainage des collections et d’autres parts pour les pr&eacute;l&egrave;vements bact&eacute;riologiques. L’anesth&eacute;sie de ce genre de patient expose &agrave; des difficult&eacute;s potentielles de contr&ocirc;le des voies a&eacute;riennes sup&eacute;rieures. METHODES: il s'agissait d'une &eacute;tude r&eacute;trospective r&eacute;alis&eacute;e sur une dur&eacute;e de 24 mois dans le p&ocirc;le d’anesth&eacute;sie r&eacute;animation et urgence de l’h&ocirc;pital militaire Moulay Ismail de Mekn&egrave;s avec la collaboration des services de stomatologie et d’oto-rhino laryngologie. On &eacute;t&eacute; inclus tous les patients admis au bloc pour cure chirurgicale sous anesth&eacute;sie g&eacute;n&eacute;rale d’une cellulite cervicale et/ou maxillo-faciale. RESULTATS: nous avons collig&eacute; 22 dossiers. Le sexe ratio &eacute;tait &agrave; 4,5 en faveur des hommes. L'&acirc;ge moyen des patients est de 29 ans. Concernant la gestion des voies a&eacute;riennes ; une intubation standard &agrave; l’aide de laryngoscope a &eacute;t&eacute; retenue chez la plupart des patients (17 patients). L’intubation vigile sous fibroscopie a &eacute;t&eacute; r&eacute;alis&eacute;e chez 3 patients, une trach&eacute;otomie premi&egrave;re a &eacute;t&eacute; faite chez une patiente et une intubation r&eacute;trograde salvatrice a &eacute;t&eacute; retenue chez une autre patiente. CONCLUSION: deux d&eacute;fis guettent tout anesth&eacute;siste prenant en charge des patients pr&eacute;sentant une cellulite cervico-faciale, un risque de ventilation difficile et un souci d’intubation laborieuse. Les deux risques sont &agrave; envisager de principe, et o&ugrave; une strat&eacute;gie anticipative devra &ecirc;tre &eacute;labor&eacute;e.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Rasha Farouk Abdellah, Khaled Morsy Salama [Research] - Prevalence and risk factors of workplace violence against health care workers in emergency department in Ismailia, Egypt - 17 January 2017. http://www.panafrican-med-journal.com/content/article/26/21/abstract/ <b>INTRODUCTION: emergency department is one of the high-risk areas, where violence against health care workers (HCWs) is a prevalent and serious problem. Violence has negative effects on HCWs, and therefore on the quality of care provided in emergency department. This study aimed to determine the prevalence, types, sources and risk factors of violence reported by HCWs in emergency department. METHODS: a cross-sectional study was conducted using a standardized questionnaire developed by the WHO. One hundred thirty four questionnaires were included in this study (94.4% response rate). RESULTS: WPV was reported by 59.7% of HCWs. Verbal violence was the most reported (58.2%), compared to physical violence (15.7%). The most reported reasons for violence were waiting time and that patient and family expectations not being met. Only 29.5% of HCWs who experienced verbal violence and 23.8% of who experienced physical violence reported it to hospital authority. About 75% of HCW thought that work place violence could be prevented, and about 60% said that no action was taken against the attacker by hospital authority. CONCLUSION: violence against HCWs in emergency department is a significant issue that cannot be ignored. There are multiple reasons. The key point in dealing with the problem is to treat its specific causes.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Traore Ababacar Abdoulaye, Traore Zakaria, Camara Ousmane, Boubbou Meryem, Maaroufi Moustapha, Tizniti Siham, Kamaoui Imane [Case report] - Ectopie thyro&iuml;dienne: apport du scanner - 17 January 2017. http://www.panafrican-med-journal.com/content/article/26/20/abstract/ <b>L’ectopie thyro&iuml;dienne est une malformation pathologique rare. Nous rapportons un cas suppl&eacute;mentaire d’ectopie du lobe thyro&iuml;dien droit, d&eacute;couvert lors du bilan tomodensitom&eacute;trique d’une masse lat&eacute;ro cervicale gauche.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Said Anajar, Mohammed Tatari, Jawad Hassnaoui, Reda Abada, Sami Rouadi, Mohammed Roubal, Mohammed Mahtar [Case report] - Cas rare de sangsue laryng&eacute;e chez un homme de 70 ans - 16 January 2017. http://www.panafrican-med-journal.com/content/article/26/19/abstract/ <b>La dyspn&eacute;e laryng&eacute;e repr&eacute;sente une urgence extr&ecirc;me en otorhinolaryngologies. Elle r&eacute;pond &agrave; des &eacute;tiologies multiples et reste souvent graves. La dyspn&eacute;e laryng&eacute;e caus&eacute;e par une sangsue est exceptionnellement d&eacute;crite dans la litt&eacute;rature surtout chez l’adulte. Nous rapportons une observation particuli&egrave;re d’infestation de l’arbre respiratoire par une sangsue ayant entra&icirc;n&eacute; une dyspn&eacute;e laryng&eacute;e.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Cheikh Ahm&eacute;dou Lame, Birame Loum, Ibrahima Keita, Thierno Boubacar Diallo, Alamasso Sow [Case report] - Plaie iatrogene de l’artere carotide commune secondaire &agrave; un catheterisme veineux jugulaire interne - 16 January 2017. http://www.panafrican-med-journal.com/content/article/26/18/abstract/ <b>La plaie carotidienne lors du cath&eacute;t&eacute;risme jugulaire veineux est un accident rare mais pouvant &ecirc;tre dramatique. Nous rapportons un cas d'h&eacute;matome cervical compressif avec h&eacute;mothorax survenu &agrave; la suite d'une plaie de l'art&egrave;re carotide commune au d&eacute;cours d'un cath&eacute;t&eacute;risme veineux jugulaire interne. Le diagnostic et la prise en charge de ce type de complication sont discut&eacute;s.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Smitha Reddy, Bhuvan Shome, Jayaprakash Patil, Pradeep Koppolu [Research] - A clinical correlation between stature and posterior tooth length - 16 January 2017. http://www.panafrican-med-journal.com/content/article/26/17/abstract/ <b>INTRODUCTION: exploration and determination of the relationship between stature and length of tooth is essential in Paleontology, Forensic Odontology and Endodontology. This study aimed to determine any association between stature and posterior tooth length in a group of patients who required root canal treatment.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Joseph Syn&egrave;se Bemora, Willy Francis Rakotondraibe, Mijoro Ramarokoto, Willy Ratovondrainy, Cl&eacute;ment Andriamamonjy [Case series] - Aspects épidémiologiques des traumatismes du rachis: à propos de 139 cas - 16 January 2017. http://www.panafrican-med-journal.com/content/article/26/16/abstract/ <b>Les traumatismes du rachis représentent une des lésions les plus fréquemment observées, chez les victimes d’accidents de circulation, d’accident de sportifs, domestique et du travail. Il s’agissait d’une étude rétrospective de 3 ans portant sur 139 cas de traumatismes du rachis hospitalisés et pris en charge dans le service de neurochirurgie du CHUJRA Madagascar. A travers cette étude, 25,17% des traumatisés étaient entre 21 et 30 ans avec une nette prédominance masculine de 69,78% (sexe ratio 2,3). L’étiologie était dominéepar la chute dans 33,09% des cas avec des facteurs de risque dont prise d’alcool (8,63%). Le traumatisme entrait dans le cadre d’un polytraumatisme dont un traumatisme crânien dans 34,63%. Les patients étaient admis dans le service 1 à 5h après le traumatisme dans 31,65% en utilisant comme moyen de transport une voiture personnelle dans 36,69%. Pendant l’hospitalisation 20 patients ont signé une décharge et 6,34% des patients sont décédés. Les traumatismes du rachis posent un problème de santé publique avec une prise en charge lourde surtout pour les patients déficitaires à vie. Devant tout traumatisme du rachis, il faut rechercher systématiquement une lésion crânienne.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Marie-Pierrette Ntyonga-Pono, Daniela Nsame [Case report] - Maltraitance scolaire et maladie de basedow: &agrave; propos d’un cas - 12 January 2017. http://www.panafrican-med-journal.com/content/article/26/15/abstract/ <b>La maladie de basedow, thyr&eacute;opathie auto-immune, est la cause la plus fr&eacute;quente des hyperthyro&iuml;dies aussi bien chez l'adulte que chez l'enfant. Elle rel&egrave;verait d'une pr&eacute;disposition g&eacute;n&eacute;tique sur laquelle vont intervenir des facteurs d&eacute;clenchants environnementaux dont le stress. Le but de cet article est de pr&eacute;senter un cas de maladie de Basedow chez l'enfant dont le facteur d&eacute;clenchant inhabituel serait la maltraitance scolaire, vaste probl&egrave;me aux cons&eacute;quences multiples.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Nyiramana Marie Merci, Uwimana Emerence, Nzitakera Augustin, Michael Habtu, Ingabire Julie, Tuyishime Angelique, Beneyo Jessica, Akimana Cynthia, Augustin Twizerimana Penda [Research] - CD4+ cells recovery in HIV positive patients with severe immunosuppression at HAART initiation at Centre Medico-Social Cor-Unum, Kigali - 12 January 2017. http://www.panafrican-med-journal.com/content/article/26/14/abstract/ <b>INTRODUCTION: up to 30% of HIV infected patients who are receiving HAART do not exhibit a marked increase in the CD4+ T cell count. There is still a concern that immune recovery may not be complete once CD4+ T cells have decreased below 200 cells/µl. The objective is to assess CD4+ cell recovery in HIV+ patients with CD4 count below 200 cells/¼l) at HAART initiation. METHODS: this was a retrospective cohort study among 110 HIV+ patients with initial CD4 count < 200 cells/¼l. Baseline Age, sex, CD4 count and viral load were extracted from the patient’s database. After12 months of HAART; CD4 count was done using flow cytometry and viremia by COBAS AmpliPrep/COBAS TaqMan HIV-1 test v 2.0 technology. RESULTS: the mean age of the respondents was 35 years; males being 57% and females were 43%. The mean CD4 count before HAART was 110.18 cells/µl whereas at 12 months of HAART; this was 305.01 cells/µl. Though some patients did not achieve a CD4 count of more than 200 cells/µl or a drop in viral load; there was a significant recovery of CD4+ cells (P value=0.000) and viremia following HAART (P value=0.001). Participants aged 18-30 years were likely to have less than 200 cells/¼l CD4 count (46.4%) [OR=4.33; 95%CI: 1.29-14.59; P=0.018] than participants aged above 40 years (16.7%). CONCLUSION: HAART was associated with viremia suppression but many patients failed to achieve a CD4 count >200 cells/µl. HAART before severe immunosuppression is a key factor for immune restoration among HIV+ patients.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com El Houcine Haijoubi, Fatiha Benyahya, Abdrezzak Bendahou, Faima Zahra Essadqui, Mohammed El Behhari, Ahmed Fouad El Mamoune, Naima Nourouti Ghailani, Mohcine Bennani Mechita, Amina Barakat [Research] - Etude de la qualit&eacute; bact&eacute;riologique de l’eau utilis&eacute;e dans l’industrie agroalimentaire dans le Nord du Maroc - 05 January 2017. http://www.panafrican-med-journal.com/content/article/26/13/abstract/ <b>INTRODUCTION: l'eau est utilis&eacute;e d'une fa&ccedil;on primordiale dans tout le processus de la fabrication des produits alimentaires. Les industries agroalimentaires du Nord du Maroc utilisent diff&eacute;rentes sources d'eaux mais l'eau de r&eacute;seau public et l'eau de puits sont les principales sources d'eau utilis&eacute;e. Cette eau peut s'av&eacute;rer la source principale des &eacute;ventuelles contaminations et alt&eacute;rations des aliments. Notre but est d'&eacute;valuer la qualit&eacute; bact&eacute;riologique de l'eau utilis&eacute;e par les industries agroalimentaires dans la r&eacute;gion du Nord du Maroc, d'identifier les diff&eacute;rents germes responsables de la pollution de ces eaux et de d&eacute;finir les principales causes de cette pollution. METHODES: des &eacute;chantillons d'eau pr&eacute;lev&eacute;s aux robinets ou des puits ont &eacute;t&eacute; analys&eacute;s pour la recherche des germes indicateurs de la pollution (coliformes totaux (CT), coliformes f&eacute;caux (CF), ent&eacute;rocoques intestinaux (E), microorganismes revivifiables (MOR), ana&eacute;robies sulfitor&eacute;ducteurs) et les germes pathog&egrave;nes (Salmonelles, Staphylocoques, Pseudomonas aeruginosa). Le d&eacute;nombrement des bact&eacute;ries a &eacute;t&eacute; fait par la technique de filtration et par incorporation en milieu solide en surfusion. RESULTATS: les r&eacute;sultats ont montr&eacute; que les eaux du r&eacute;seau public ont &eacute;t&eacute; de qualit&eacute; bact&eacute;riologique satisfaisante tandis que 40% des eaux des puits ont &eacute;t&eacute; non conformes aux normes &agrave; cause de la pr&eacute;sence des indicateurs de pollution CT, CF, E et MOR. En revanche, les germes pathog&egrave;nes, en particulier les Salmonelles, ont &eacute;t&eacute; absents dans les eaux de tous les puits analys&eacute;s. CONCLUSION: la pollution de ces puits a &eacute;t&eacute; g&eacute;n&eacute;ralement li&eacute;e au non-respect des conditions de puisage hygi&eacute;niques. La qualit&eacute; bact&eacute;riologique des eaux de ces puits peut &ecirc;tre am&eacute;lior&eacute;e par une protection ad&eacute;quate.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Meriam Benzalim, Laila Berghalout, Sophia Elfakir, Hicham Jalal [Case report] - Syndrome de poland: &agrave; propos d’un cas et revue de la litterature - 05 January 2017. http://www.panafrican-med-journal.com/content/article/26/12/abstract/ <b>Le syndrome de Poland est une malformation cong&eacute;nitale rare associant &agrave; des degr&eacute;s divers des anomalies thoraciques et du membre sup&eacute;rieur homolat&eacute;ral. Nous rapportons le cas d'une fillette de 7 ans, explor&eacute;e pour d&eacute;pression de l'h&eacute;mithorax gauche avec masse sous claviculaire homolat&eacute;rale. La tomodensitom&eacute;trie a montr&eacute; que la d&eacute;formation de la paroi thoracique &eacute;tait li&eacute;e &agrave; l'absence des chefs &agrave; insertion sterno-costale du muscle pectoralis major gauche avec ag&eacute;n&eacute;sie du pectoralis minor et hypoplasie des arcs ant&eacute;rieurs des six premi&egrave;res c&ocirc;tes correspondantes. Ces anomalies &eacute;taient rapport&eacute;es &agrave; un syndrome de Poland. Un bilan g&eacute;n&eacute;ral fait d'&eacute;chographie abdominale, radiographies des deux mains, a &eacute;t&eacute; r&eacute;alis&eacute; chez la patiente n'ayant r&eacute;v&eacute;l&eacute; aucune malformation associ&eacute;e. Le syndrome de Poland r&eacute;sulte d'un d&eacute;faut d'approvisionnement sanguin des &eacute;l&eacute;ments musculosquelettiques de la paroi thoracique pendant la vie fœtale. Il existe de nombreuses variantes du syndrome de Poland qui peuvent &ecirc;tre mieux d&eacute;tect&eacute;es par la TDM qui doit &ecirc;tre r&eacute;alis&eacute;e chaque fois qu'il est disponible, sans omettre le r&ocirc;le de la radiologie g&eacute;n&eacute;ral dans la d&eacute;tection des malformations associ&eacute;es. La caract&eacute;ristique de ce syndrome est l'ag&eacute;n&eacute;sie des faisceaux sternocostaux du muscle pectoralis major. Son &eacute;tiologie reste inconnue et discut&eacute;e. Une anomalie vasculaire en serait la cause, sans que le primum movens de cette anomalie vasculaire soit connu.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Ghada Sahraoui, Fatma Khanchel, Emna Chelbi [Case series] - Profil anatomopathologique du cancer du sein dans le cap bon tunisien - 05 January 2017. http://www.panafrican-med-journal.com/content/article/26/11/abstract/ <b>Le cancer du sein est le cancer le plus fr&eacute;quent de la femme en Tunisie et dans le monde. Dans le Cap Bon tunisien, les particularit&eacute;s anatomopathologiques de ce cancer n'ont pas &eacute;t&eacute; pr&eacute;cis&eacute;es auparavant. Leur connaissance est n&eacute;cessaire pour l'adaptation des syst&egrave;mes de pr&eacute;vention et de soins dans la r&eacute;gion. Le but de notre &eacute;tude &eacute;tait de d&eacute;terminer le profil anatomopathologique des carcinomes mammaires dans l'unique laboratoire d'anatomie pathologique publique de la r&eacute;gion. Il s'agissait d'une &eacute;tude descriptive r&eacute;trospective des carcinomes mammaires diagnostiqu&eacute;s chez 116 malades dans notre laboratoire sur une p&eacute;riode de 5 ans de Juillet 2010 &agrave; Juillet 2015. Notre &eacute;tude a inclus 116 patientes. L'&acirc;ge moyen &eacute;tait de 51 ans. La taille tumorale histologique moyenne &eacute;tait de 31 mm. Le diagnostic initial &eacute;tait pos&eacute; sur pi&egrave;ce de tumorectomie dans 83% des cas. Le carcinome infiltrant de type non sp&eacute;cifique &eacute;tait le type histologique le plus fr&eacute;quent. Le grade SBR III &eacute;tait majoritaire. L'invasion lympho-vasculaire &eacute;tait pr&eacute;sente dans 33% des cas. Le curage axillaire &eacute;tait positif dans 72% des cas. Les r&eacute;cepteurs hormonaux &eacute;taient positifs dans 73% des cas. Les r&eacute;cepteurs de l'Her2-Neu &eacute;taient surexprim&eacute;s dans 19% des cas. Le ki67 &eacute;tait e" 14% dans 38%. Le sous-type mol&eacute;culaire le plus fr&eacute;quent &eacute;tait le luminal A. Le carcinome mammaire dans la r&eacute;gion du Cap Bon se caract&eacute;rise par sa survenue &agrave; un &acirc;ge jeune, son importante taille tumorale et la fr&eacute;quence de facteurs histopronostiques p&eacute;joratifs.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Ali Zinebi, Hicham Eddou, Karim Mohamed Moudden, Mohamed Elbaaj [Case series] - Profil &eacute;tiologique des an&eacute;mies dans un service de m&eacute;decine interne - 05 January 2017. http://www.panafrican-med-journal.com/content/article/26/10/abstract/ <b>L'an&eacute;mie constitue un probl&egrave;me majeur de la sant&eacute; publique &agrave; travers le monde malgr&eacute; l'am&eacute;lioration remarquable des conditions de vie. Elle est class&eacute;e par l'OMS comme l'un des dix probl&egrave;mes les plus s&eacute;rieux du monde. Notre objectif est de d&eacute;crire les profils &eacute;pid&eacute;miologique et &eacute;tiologique des cas d'an&eacute;mies prises en charge dans notre formation. Il s'agit d'une &eacute;tude r&eacute;trospective men&eacute;e durant 5 ans, allant de Janvier 2011 &agrave; d&eacute;cembre 2015 et portant sur 150 patients. L'&acirc;ge moyen de nos patients est de 48,8ans et les femmes sont les plus touch&eacute;es avec un sex-ratio de 1,78. Le taux moyen de l'h&eacute;moglobine est de 8 g/dl avec des extr&ecirc;mes allant de 3,4 &agrave; 11,4 g/dl. L'an&eacute;mie ferriprive est le diagnostic &eacute;tiologique dominant &eacute;tant retrouv&eacute;e dans 60% des cas, suivie par l'an&eacute;mie m&eacute;galoblastique observ&eacute;e chez 21% des patients puis les an&eacute;mies h&eacute;molytiques dans 7,33% des cas. La survenue d'une an&eacute;mie chez l'adulte peut repr&eacute;senter un v&eacute;ritable d&eacute;fit diagnostique pour l'interniste et cela parfois dans un contexte d'urgence. Le recours &agrave; des examens sp&eacute;cialis&eacute;s peut s'imposer.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Garrouche Nada, Jerbi Saida Omezzine, Dhifallah Maher, Dris Nouha, Hamza Hssine [Case report] - Laryngeal lipoma: a rare cause of dysphonia - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/9/abstract/ <b>Lipomas are the most common mesenchymal tumors. Laryngeal lipomas represent 1% of all lipomas but unlike other locations may cause life-threatening symptoms by obstruction of the respiratory tract. In this study, the case of a 32-year old woman with laryngeal lipoma is discussed. The lesion was detected on the left aryepiglottic fold, presented as a stalked and dynamic mass of 2 centimeters diameter. The imaging aspects of laryngeal lipoma cases, clinical evaluation, and approaches to treatment will be discussed.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Boubacar Zan Traor&eacute;, Kamal Serrar, Omar Saoud, Khedid Yahia Zain El Abidine, Rachid Mohammed Chkoff, Rachida M’bida [Case report] - Cause exceptionnelle d'h&eacute;moperitoine spontan&eacute; chez l'adulte: h&eacute;molymphangiome kystique rompu - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/8/abstract/ <b>L'h&eacute;molymphangiome est une tumeur b&eacute;nigne r&eacute;sultant du d&eacute;veloppement anormal des vaisseaux lymphatiques associ&eacute;s &agrave; des malformations vasculaires. 50% &agrave; 60% de ces tumeurs sont pr&eacute;sentes &agrave; la naissance. Les formes cervicales sont les plus fr&eacute;quentes. Les localisations Abdominales sont tr&egrave;s rares. Nous rapportons deux cas d'h&eacute;molymphangiome kystique de la rate r&eacute;v&eacute;l&eacute; par l'h&eacute;moperitoine spontan&eacute; admis en urgence au service des Urgences Chirurgicales Visc&eacute;rales, avec une revue de la litt&eacute;rature. Il s'agit d'une patiente &acirc;g&eacute;e de 50 ans et l'autre un jeune homme de 20 ans admis aux urgences pour respectivement, une sensibilit&eacute; abdominale diffuse avec matit&eacute; d&eacute;clive des flancs et d'une distension abdominale dans un tableau de choc h&eacute;morragique, p&acirc;leur, pouls imprenable, stabilis&eacute; apr&egrave;s une courte r&eacute;animation. La r&eacute;section tumorale &eacute;tait compl&egrave;te chez tous les malades. Le diagnostic d'h&eacute;molymphangiome kystique de la rate &eacute;tait r&eacute;v&eacute;l&eacute; &agrave; l'examen anatomopathologique des pi&egrave;ces op&eacute;ratoires. L'h&eacute;molymphangiome est une tumeur rare &agrave; pronostic favorable. Quelques cas de r&eacute;gression spontan&eacute;e ont &eacute;t&eacute; d&eacute;crits, mais l'&eacute;volution se fait classiquement vers une croissance lente de la tumeur. Il n'y a aucun pouvoir de d&eacute;g&eacute;n&eacute;rescence maligne. Le traitement est chirurgical. Le pronostic est li&eacute; aux complications, &agrave; la qualit&eacute; de l'ex&eacute;r&egrave;se chirurgicale et les r&eacute;cidives qui sont fr&eacute;quents notamment en cas d'ex&eacute;r&egrave;se incompl&egrave;te.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Douamba Sonia, Nagalo Kisito, Tamini Laure, Traor&eacute; Isma&euml;l, Kam Madib&egrave;l&egrave;, Kou&eacute;ta Fla, Y&eacute; Diarra [Research] - Syndromes dr&eacute;panocytaires majeurs et infections associ&eacute;es chez l’enfant au Burkina Faso - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/7/abstract/ <b>INTRODUCTION: le but de cette &eacute;tude &eacute;tait d’&eacute;tudier les infections chez les enfants pr&eacute;sentant un syndrome dr&eacute;panocytaire majeur. METHODES: &eacute;tude hospitali&egrave;re monocentrique, r&eacute;trospective descriptive sur dix ann&eacute;es men&eacute;e &agrave; Ouagadougou, Burkina Faso. &Eacute;taient inclus tous les enfants porteurs d´un syndrome dr&eacute;panocytaire majeur (homozygote SS et double h&eacute;t&eacute;rozygote SC, SD<sub>Punjab</sub>, S&#946; thalass&eacute;mique, SO<sub>Arab</sub> et SE) hospitalis&eacute;s pour une infection bact&eacute;rienne confirm&eacute;e &agrave; la microbiologie. RESULTATS: cent trente trois patients r&eacute;pondaient &agrave; nos crit&egrave;res d’inclusion. Le ph&eacute;notype SS repr&eacute;sentait 63,2 % des cas et le SC 36,8 %. La fr&eacute;quence des infections &eacute;tait de 21,8 %. Celles-ci touchaient dans 45,9 % des cas les enfants &acirc;g&eacute;s de 0 &agrave; 5 ans. Les signes les plus fr&eacute;quents &eacute;taient les douleurs ost&eacute;oarticulaires (42,1 %), la toux (25,7 %), les douleurs abdominales (23,3 %), la p&acirc;leur (43,6 %). Les broncho-pneumopathies (31,6 %), le paludisme (16,5 %), les ost&eacute;omy&eacute;lites (12,8 %) et les septic&eacute;mies (10,5 %) &eacute;taient les principaux diagnostics trouv&eacute;s. Les agents pathog&egrave;nes isol&eacute;s &eacute;taient <i>Streptococcus pneumoniae</i> (35,5 %) et <i>Salmonella sp</i> (33,3 %). Les c&eacute;phalosporines de 3e g&eacute;n&eacute;ration &eacute;taient les antibiotiques les plus fr&eacute;quemment prescrits. Le taux brut de mortalit&eacute; &eacute;tait de 7,5 %. CONCLUSION: les infections bact&eacute;riennes et le paludisme dominent le tableau des infections chez l´enfant dr&eacute;panocytaire majeur au Centre Hospitalier Universitaire P&eacute;diatrique Charles De Gaulle. Les auteurs recommandent la mise en place d’un programme national de prise en charge de la dr&eacute;panocytose, ce qui permettrait de pr&eacute;venir voire r&eacute;duire la survenue des infections chez les enfants dr&eacute;panocytaires.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Sara Elloudi, Fatima Zahra Mernissi [Images in medicine] - Fasciite n&eacute;crosante: une redoutable affection! - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/6/abstract/ <b>La fasciite n&eacute;crosante est une infection bact&eacute;rienne touchant le derme profond, l’hypoderme et l’apon&eacute;vrose superficielle. C’est une infection s&eacute;v&egrave;re mortelle dans 30% des cas. Une association polymicrobienne est fr&eacute;quemment not&eacute;e. Les facteurs associ&eacute;s sont le diab&egrave;te, l’alcoolisme chronique, la toxicomanie intraveineuse, et l’immunosuppression. Nous rapportons le cas clinique d’un patient diab&eacute;tique &acirc;g&eacute; de 65 ans qui &eacute;tait admis aux urgences pour un &eacute;tat de choc septique et dont l’examen dermatologique objectivait des placards œd&eacute;mateux froids et liv&eacute;doides surmont&eacute;es de phlyct&egrave;nes h&eacute;morragiques int&eacute;ressant le membre sup&eacute;rieur et inf&eacute;rieur droits, faisant &eacute;voquer des fasciites n&eacute;crosantes, le patient a install&eacute; rapidement une d&eacute;faillance multi-visc&eacute;rale occasionnant son d&eacute;c&egrave;s. Il est capital de reconna&icirc;tre au plus vite la fasciite n&eacute;crosante. En effet, la pr&eacute;cocit&eacute; de la mise en œuvre du traitement m&eacute;dicochirurgical conditionne le pronostic de cetteinfection redoutable qui peut conduire au d&eacute;c&egrave;s.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Davakis Spyridon, Damaskos Christos [Images in medicine] - A rare complication of catherer insertion pericardiocentesis - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/5/abstract/ <b>Pericardiocentesis with catheter insertion for pericardial drainage is a common procedure used for the treatment of pericardial effusions and of cardiac tamponade as well. The most commonly described complications of an indwelling pericardial catheter system are catheter blockage and infection. We present a rare case of a 63 years old patient with a pericardial catheter for pericardial effusion drainage. He was presented with elevated body temperature and chills, a day after a pericardial catheter insertion. His clinical examination did not reveal any particular findings, while the catheter had stop draining two days earlier. His laboratory examinations revealed slightly increased WBCs' (13.300/ml). Following that, a chest x-ray examination revealed winding of the catheter along the pericardium. Under general anesthesia, the patient underwent left thoracotomy; the pericardial catheter was found tight wreathed and infiltrated to the inner coat of the pericardium. The catheter was carefully removed and a pericardial window was then performed. His post-operative course was uneventful, and he was discharged five days later.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Mehdi Kehila, Manel Seboui [Images in medicine] - Lobe placentaire accessoire: penser aux vaissaux praevia - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/4/abstract/ <b>Il s’agit d’une patiente &acirc;g&eacute;e de 36 ans, deuxi&egrave;me geste, deuxi&egrave;me pare hospitalis&eacute;e &agrave; deux reprises pour des m&eacute;trorragies au troisi&egrave;me trimestre de la grossesse. A chaque hospitalisation, une &eacute;chographie a &eacute;t&eacute; pratiqu&eacute;e par voie sus-pubienne et a conclu &agrave; un placenta ant&eacute;rieur normalement ins&eacute;r&eacute; sans images de d&eacute;collement. A l’occasion de la troisi&egrave;me hospitalisation, &agrave; 36 semaines d’am&eacute;norrh&eacute;e, une &eacute;chographie transvaginale a &eacute;t&eacute; r&eacute;alis&eacute;e. Celle-ci a r&eacute;v&eacute;l&eacute; une structure d’&eacute;chog&eacute;nicit&eacute; similaire &agrave; celle du placenta, situ&eacute;e sur la face post&eacute;rieure de l’ut&eacute;rus, &agrave; 24mm de l’orifice interne du col, &eacute;vocatrice d’un lobe placentaire accessoire. L’application du Doppler couleur a montr&eacute; un vasa pr&aelig;via connect&eacute; &agrave; ce lobe. Une c&eacute;sarienne a alors &eacute;t&eacute; programm&eacute;e &agrave; 37SA donnant naissance &agrave; un b&eacute;b&eacute; de sexe masculin, pesant 3800g en bon &eacute;tat de sant&eacute;. L’&eacute;tude macroscopique du placenta a montr&eacute; le lobe placentaire accessoire s&eacute;par&eacute; du principal disque placentaire par des membranes et reli&eacute; &agrave; celui-ci par de larges vaisseaux.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Imane Khachani, Mohamed Hassan Alami, Rachid Bezad [Case report] - Grossesse cervicale &agrave; 7 semaines d’am&eacute;norrh&eacute;e: d&eacute;fis de la prise en charge - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/3/abstract/ <b>La grossesse cervicale est une forme extr&ecirc;mement rare de grossesse ectopique qui engage le pronostic vital maternel en raison du risque important d'h&eacute;morragie. Nous rapportons l'observation d’une patiente &acirc;g&eacute;e de 35 ans, ayant accouch&eacute; une premi&egrave;re fois par c&eacute;sarienne et qui a pr&eacute;sent&eacute; une grossesse cervicale diagnostiqu&eacute;e &agrave; 7 semaines d'am&eacute;norrh&eacute;e. La prise en charge au sein de notre structure a fait appel au traitement m&eacute;dical puis chirurgical apr&egrave;s &eacute;chec du premier. L'int&eacute;r&ecirc;t de cette observation r&eacute;side dans la d&eacute;marche diagnostique et les diff&eacute;rentes &eacute;tapes de prise en charge th&eacute;rapeutique.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Fatima El Boukhrissi, Ghizlane Zoulati, Issam En-nafaa, Hassan Ouleghzal, Sara Derrou, Soumaya Safi, Youssef Bamou, Lhoussine Balouch [Case report] - Syndrome de Fahr secondaire &agrave; une hypoparathyro&iuml;die primaire: &agrave; propos d’un cas - 04 January 2017. http://www.panafrican-med-journal.com/content/article/26/2/abstract/ <b>Le syndrome de Fahr est une entit&eacute; anatomoclinique rare dont la principale &eacute;tiologie est l'hypoparathyro&iuml;die primitive ou postop&eacute;ratoire. Il est caract&eacute;ris&eacute; par des calcifications intrac&eacute;r&eacute;brales bilat&eacute;rales et sym&eacute;triques, localis&eacute;es dans les noyaux gris centraux, le plus souvent associ&eacute;es &agrave; des troubles du m&eacute;tabolisme phosphocalcique. Les auteurs rapportent le cas d’un patient &acirc;g&eacute; de 54 ans suivi depuis 20 ans pour hypoparathyro&iuml;die primaire, qui a pr&eacute;sent&eacute; des troubles amn&eacute;siques r&eacute;v&eacute;lant un syndrome de Fahr secondaire &agrave; l’hypoparathyro&iuml;die.</b><br/> text/html 2017-03-23T05:37:29+01:00 http://www.panafrican-med-journal.com Hajar El Jouadi, Ilyas Derdabi [Images in medicine] - Perforation couverte du duod&eacute;num par ar&ecirc;te de poisson - &agrave; propos d’un cas - 03 January 2017. http://www.panafrican-med-journal.com/content/article/26/1/abstract/ <b>Les perforations de l'estomac et du duod&eacute;num secondaire &agrave; un corps &eacute;tranger ont tendance &agrave; pr&eacute;senter un tableau clinique plus inoffensif que les perforations situ&eacute;es dans le j&eacute;junum ou l'il&eacute;on. Tr&egrave;s rarement ces perforations peuvent &eacute;voluer spontan&eacute;ment vers la gu&eacute;rison. Nous pr&eacute;sentant le cas d'une patiente &acirc;g&eacute;e de 45ans, sans ant&eacute;c&eacute;dents pathologiques notables admise aux urgences dans un tableau d’appendicite: douleur abdominales localis&eacute;es au niveau de la fosse iliaque droite (FID) &eacute;voluant depuis deux jours, accompagn&eacute; de quelques &eacute;pisodes de vomissements, sans autres signes accompagnateurs. L'examen clinique retrouve un patient f&eacute;brile &agrave; 39&deg;C, stable sur le plan h&eacute;modynamique avec &agrave; l'examen abdominal une d&eacute;fense abdominale localis&eacute;e &agrave; la FID. Le reste de l'examen clinique est normal par ailleurs. Le bilan biologique montre une hyperleucocytose &agrave; 22000 &eacute;l&eacute;ment/mm3 et une CRP &agrave; 50. L’&eacute;chographie abdominale est revenue non concluante. On a compl&eacute;t&eacute; par un scanner abdominal qui a objectiv&eacute; un corps &eacute;tranger radio opaque au niveau de la lumi&egrave;re de D2 (probablement ar&ecirc;te de poisson) semblant traverser sa paroi avec micro- bulles de gaz extra luminales et densification de la graisse p&eacute;riton&eacute;ale en regard. Le diagnostic de perforation couverte duod&eacute;nale a &eacute;t&eacute; retenu. La patiente a b&eacute;n&eacute;fici&eacute; d’extraction de corps &eacute;tranger par endoscopie et mise sous antibioth&eacute;rapie avec bonne &eacute;volution clinique.</b><br/>